The feasibility of falciformopexy in the repair of peptic ulcer perforation.

BACKGROUND: Modified Graham omentopexy is the most commonly used operative technique in the repair of peptic ulcer perfo-ration (PUP); however, there is little data on falciformopexy in the literature. The aim is to investigate the feasibility of falciformopexy in the repair of PUP, comparing with modified Graham omentopexy. METHODS: Data of 471 patients who were operated for PUP were retrospectively analyzed. Patients' demographics, pre-operative basic laboratory findings, American Society of Anesthesiologists (ASA) status, operative findings, and post-operative complications were recorded. The patients were classified into two groups modified Graham omentopexy and falciformopexy, and then compared with each other in terms of clinical characteristics, operative findings, and post-operative complications. RESULTS: Modified Graham omentopexy and falciformopexy were performed in 425 (90.2%) and 46 (9.8%) patients, respectively. The two groups were similar in terms of basic patient characteristics and pre-operative laboratory findings (P>0.05). ASA physical status was significantly different between the groups (P=0.001). No statistically significant difference was found between the groups in terms of complications, except for an anastomotic leak. Anastomotic leak was observed more frequently in patients who underwent falciformopexy than in patients with modified Graham omentopexy (P=0.017). CONCLUSION: Although falciformopexy technique has a higher rate of leak compared to the modified Graham omentopexy method, it should be kept in mind as an alternative method for repair of PUP, especially in cases where omentopexy cannot be applied for various reasons such as the presence of unavailable or unsuitable omentum.

Research of Importance of Thiol, CRP and Lactate in Diagnosing Mesenteric Ischemia At An Early Stage: Animal Model.

INTRODUCTION AND PURPOSE: Acute mesenteric ischemia is especially seen in the elderly population. It has an increasing incidence in today's world where the average life expectancy is increasing. Early diagnosis is the most important factor reducing morbidity and mortality, and there is still no marker with high sensitivity and specificity for early diagnosis.In this study, we aimed to find a more sensitive and specific serum marker in the early diagnosis of mesenteric ischemia by comparing thiol with the currently used markers C-reactive protein and lactate. MATERIALS AND METHODS: In our study, 32 Wistar Albino male rats, 10-12 weeks old, weighing 250-300 g, were used. 32 rats were divided into 4 groups, one of which was the control group. The superior mesenteric artery of the other 3 groups was ligated. Blood samples were taken after 2 hours from the first group, 4 hours from the second group, and 6 hours from the third group. Then the rats were sacrificed. Mesenteric ischemia and its level were observed in sacrificed subjects. The samples were separated under appropriate conditions and analyzed biochemically. RESULTS: As the ischemia time increased, CRP increased and this increase was found to be statistically insignificant (p>0.05). The changes in lactate were found to be statistically significant (p<0.05). The difference between the changes of total and native thiol values was found to be statistically significant (p<0.05). CONCLUSION: Although CRP is a non-specific parameter in the early diagnosis of acute mesenteric ischemia, lactate maintains its importance as seen in our study. Differences in total thiol and native thiol changes were statistically significant. The fact that this significant difference is observed at the 4th hour values, reveals the importance of these parameters in early diagnosis. Thanks to the economic and fast results of thiol parameters, it is thought that new studies to be added to the literature can lead to the diagnosis of mesenteric ischemia.

What is the effectiveness of the Tzanakis scoring system modified by the Delta Neutrophil Index in the diagnosis of acute appendicitis in pregnant women?

INTRODUCTION: Acute appendicitis is the most common cause of abdominal pain that is unrelated to pregnancy in pregnant women. The aim of this study was to evaluate the performance of the Alvarado, Ohmann, and Tzanakis scores in the prediction of acute appendicitis in pregnant women and compare the hematological parameters. PATIENTS AND METHODS: Herein, 1542 patients, aged 18-49 years, who were admitted to the emergency department with abdominal pain and underwent appendectomy were evaluated retrospectively. Of these, 140 female patients, including 35 who were pregnant and had been diagnosed with acute appendicitis, were included in the study. The obtained data were used to calculate the Alvarado, Tzanakis, and Ohmann scores. Histopathological evaluation reports were examined, and the diagnosis of acute appendicitis was confirmed. Those with different histopathological diagnoses were recorded as negative appendectomy. RESULTS: In the pregnant and non-pregnant women, the Tzanakis scoring system showed the best predictive performance in terms of the sensitivity and accuracy percentage from the Alvarado and Ohmann scoring systems (84.85%, 85.71% vs. 92.93%, and 92.38%, respectively). When the parameters showing infection were compared, the Delta Neutrophil Index (DNI) was significantly higher in the pregnant appendicitis patients (P = 0.012). When the Tzanakis scoring system was modified with the DNI, the sensitivity, accuracy, and negative predictive values were significantly increased (93.94%, 94.29%, 50% vs. 94.95%, 94.29%, and 50%, respectively). CONCLUSION: The Tzanakis scoring system appeared to be more effective than the other scoring systems in the diagnosis of acute appendicitis. Modification of the Tzanakis scoring system with the DNI was more successful in predicting appendicitis in pregnant women.