Matriptase as a potential biomarker and therapeutic target in newly diagnosed type 2 diabetes mellitus.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder that affects the processing of carbohydrates, proteins, and lipids. In T2DM, metabolic dysregulation occurs through various pathways caused by increased levels of many adipokines and inflammatory chemokines. Impaired insulin-glucose metabolism occurs in tissues. The proteolytic enzyme matriptase is thought to be closely related to glucose metabolism due to its glycolization sites. AIM: Our study aimed to evaluate the correlation between matriptase, a proteolytic enzyme, and metabolic parameters in individuals recently diagnosed with T2DM. We also sought to investigate the potential involvement of matriptase in the development of diabetes. METHODS: We measured all participants' metabolic laboratory parameters, including basic biochemical tests, hemograms, high-sensitivity C-reactive protein (hsCRP), and matriptase levels. RESULTS: Our results showed a significant increase in circulating matriptase levels in individuals with T2DM compared to the control group. Furthermore, individuals with metabolic syndrome had significantly higher matriptase levels than those without in the T2DM and control groups. We also observed that T2DM patients had elevated levels of Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), hsCRP, and matriptase, which displayed a positive correlation. CONCLUSION: Our study is the first to report elevated levels of matriptase in individuals with newly diagnosed T2DM and/or metabolic syndrome. Additionally, we found a significant positive correlation between matriptase levels and metabolic and inflammatory parameters, indicating a potential role for matriptase in the pathogenesis of T2DM and glucose metabolism. Further research on matriptase could lead to its recognition as a novel target for investigation.

Risks of Polymyxin B Nephrotoxicity and Its Precursors in the Intensive Care Unit: A Retrospective Cohort Study.

BACKGROUND AND AIM: Polymyxin group antibiotics constitute a part of our limited arsenal in the treatment of multidrug-resistant gram-negative bacteria. However, their use is limited especially due to nephrotoxicity and other side effects. In this study, we primarily aimed to determine the effect of polymyxin B on the rate of nephrotoxicity in critically ill patients, and secondly to identify the factors that facilitate nephrotoxicity caused by polymyxin B. MATERIALS AND METHODS: The study was designed as a retrospective cohort study and conducted by scanning patients aged 18 years or older who had been admitted to our intensive care unit (ICU) in 2022 and treated with polymyxin B for at least 72 hours. Patients without chronic renal failure and acute kidney injury (AKI) before starting polymyxin B therapy were included and AKI was examined after the use of polymyxin B. The patients were then divided into two groups, those with AKI and those without AKI. We tried to find factors that may facilitate AKI by comparing the two groups. RESULTS: Of the patients, 26 were female and 34 were male. In 21 of the patients (35%), renal damage of varying degrees developed; these patients belonged to the nephrotoxicity (NT) group, while the rest belonged to the non-nephrotoxicity (non-NT) group. We found that advanced age (p=0.008), low baseline GFR (p=0.01), baseline creatinine (p=0.006), BMI (p=0.011), concomitant diseases (p<0.001), and days of use of polymyxin B (p=0.006) were statistically different between the two groups. In multivariate analysis of univariate analysis, we found that duration of polymyxin B use, BMI, and advanced age were independent risk factors for AKI development. CONCLUSION: We found that 21 (35%) of 60 intensive care unit patients who had no previous history of kidney injury developed kidney injury after being treated with polymyxin B. We identified advanced age, high BMI, and duration of polymyxin B use as independent risk factors. Therefore, we recommend close monitoring of renal function and prompt intervention, particularly in patients with risk factors, during polymyxin B use.

Does Maintaining a Targeted Abdominal Perfusion Pressure Reduce Renal Damage in Patients with Septic Shock?: A Randomized, Controlled, and Open-label Study

Background: Increased intra-abdominal pressure (IAP) in patients admitted to the intensive care unit leads to reduced abdominal perfusion pressure (APP), causing circulatory insufficiency and organ failure. Aims: To investigate the effect of maintaining a targeted APP on renal injury and the effect of increased IAP on the mortality rate in patients with septic shock. Study Design: Randomized, controlled, open-label study. Methods: A total of 72 patients were randomly divided into two groups (MAP65 or APP60). The MAP target for patients in the MAP65 group (n = 36) was 65 mmHg according to the Surviving Sepsis Guidelines. In the APP60 group (n = 36), the target APP was set to > 60 mmHg. The glomerular filtration rate (GFR), inotrope consumption, and IAP were recorded daily. The need for renal replacement therapy, decrease in GFR, and 30- and 90-day mortality rates were compared between the two groups. Results: In both the groups, the IAP was statistically similar (p = 0.458). The decreased in GFR was similar in both groups during the first 2 days. From day 3, there was a more statistically significant rapid decline in GFR in the MAP65 group than in the APP60 group. The GFR p-values on the 3rd, 4th, and 5th days were 0.040, 0.043, and 0.032, respectively. Eight patients (22.2%) in the MAP65 group and three patients (8.3%) in the APP group required renal replacement therapy (p = 0.101). The 30-day mortality rates in the MAP65 and APP60 groups were 61.1%, and 47.7%, respectively (p = 0.237). The 90-day mortality rates in the MAP65 and APP60 groups were 66.7% and 66.7%, respectively (p = 1). Conclusion: Setting an APP target limited the reduction in GFR. The mortality rates were similar in the two groups and there was no difference in the rate of end-stage renal failure between the groups.

Factors affecting the recurrence of acute cholecystitis after treatment with percutaneous cholecystostomy.

BACKGROUND: The aim of this study was to determine the recurrence rate of patients who did not have interval cholecystectomy after treatment with percutaneous cholecystostomy and to investigate the factors that may affect the recurrence. METHODS: Patients who did not undergo interval cholecystectomy after percutaneous cholecystostomy treatment between 2015 and 2021 were retrospectively screened for recurrence. RESULTS: 36.3% of the patients had recurrence. Recurrence was found more frequently in patients with fever symptoms at the time of admission to the emergency department (p = 0.003). Recurrence was found to be more frequent in those who had a previous cholecystitis attack (p = 0.016). It was determined that patients with high lipase and procalcitonin levels had statistically more frequent attacks (p = 0.043, p = 0.003). It was observed that the duration of catheter insertion was longer in patients who had relapses (p = 0.019). The cut-off value for lipase was calculated as 15.5, and the cut-off value for procalcitonin as 0.955, in order to identify patients at high risk for recurrence. In the multivariate analysis for the development of recurrence, presence of fever, a history of previous cholecystitis attack, lipase value higher than 15.5 and procalcitonin value higher than 0.955 were found to be risk factors. CONCLUSIONS: Percutaneous cholecystostomy is an effective treatment method in acute cholecystitis. Insertion of the catheter within the first 24 h may reduce the recurrence rate. Recurrence is more common in the first 3 months following removal of the cholecystostomy catheter. Having a previous history of cholecystitis attack, fever symptom at the time of admission, elevated lipase and procalcitonin are risk factors for recurrence.

A new prognostic marker in patients undergoing Hartmann's procedure for acute tumoral obstruction of the left colon.

BACKGROUND: In acute obstructive left-sided colorectal cancers (AOLCRC), damage to the colon wall may occur as a result of distension of the colon segments proximal to the tumor. In this study, we aimed to evaluate the relationship between the ratio of dilated colon diameter (CD) to lumbar vertebral corpus diameter on preoperative abdominal computed tomography (CT) scan in patients undergoing Hartmann's Procedure (HP) and post-operative complications. METHODS: The tumor group consisted of 49 patients who underwent HP for AOLCRC under emergency conditions. The control group consisted of 49 age-and gender-matched individuals (compatible with tumor group) that had an abdominal CT due to pathologies outside the gastrointestinal tract and without a history of abdominal surgery. In both group, the ratios of the CD to the diameter of the first lumbar vertebra corpus (L1-VD) measured on axial CT images of each patient. These ratios were compared between groups. In the tumor group, the relationship between post-operative complications (Clavien-Dindo classification-major (grade ≥III), minor (grade

Histopathological examination of the impact of sodium hypochlorite on the hepatobiliary system. An experimental study.

BACKGROUND: The liver is the most common organ for settlement of hydatic cyst disease. All acknowledged protoscolicidals that are used for echinococcus degeneration have a risk of caustic secondary sclerosing cholangitis. The sodium hypochlorite is an effective protoscolicidal agent for treatment of hydatid liver cysts in vitro. OBJECTIVE: This study aimed to investigate the safe usability of sodium hypochlorite for the treatment of hydatid cyst in the hepatobiliary system in an experimental rat model. METHODS: This experimental study designed as one side blinded animal study. Study was carried out between October 2017 and August 2018. Rats were randomly allocated to the study (n=7), control (n=7), and sham (n=7) groups. A duodenotomy was performed, and a catheter was inserted through the ampulla. The tip of the catheter was placed to instill 0.15 ml sodium hypochlorite (0,25%) solution, and 0.15 ml isotonic saline solution were into the common bile duct in the study and control groups, respectively. After three months, all rats were sacrificed. Livers, biliary tracts, pancreas, and duodenum were investigated for histopathological changes by blinded two pathologists. RESULTS: No significant difference was found between groups for periductal portal inflammation (p=0.077), parenchymal inflammation, and focal necrosis (p=0.119). There was not any histopathological change in 71.4 % of the subjects in control and experimental groups. CONCLUSION: Sodium hypochlorite (0,25%) did not cause any unfavorable changes in the hepatobiliary system, and this reminds that sodium hypochlorite can be a safe alternative in percutaneous drainage, laparoscopic, and open surgery in the treatment of hydatid cyst. KEY WORDS: Hepatobiliary system, Hydatid disease, Sodium hypochlorite, Treatment.

Evaluation of Antibiotic Prophylaxis and Discharge Prescriptions in the General Surgery Department.

Introduction Although there are international guidelines for surgical antibiotic prophylaxis (SP), the use of inappropriate SP is still a common problem. Most studies investigated SP applications in clean and clean-contaminated cases. However, antibiotics in the discharge prescriptions of these cases have not been adequately investigated. In this study, we aimed to examine the antibiotics in SP applications and discharged prescriptions together and to find out the causes of inappropriate use. Materials and methods We retrospectively evaluated the data of patients admitted to our general surgery wards between 2014 and 2015. Patients with clean or clean-contaminated wound category operations were included. The patients were evaluated in terms of convenience of SP (choice of antibiotics, compliance with an indication for SP, timing of the first dose, SP>24 hours, and discharge prescription). In addition, to interpret the results, a questionnaire has been performed for the surgeons in the same clinics. Results A total of 1205 patients with clean and clean-contaminated wound class operation were enrolled in this study. The total accuracy rate of SP was 7.1%. SP application with the correct indication and timing of the first dose was compatible with guidelines: 55.6% and 81.9%, respectively. SP was applied >24 hours at 60.2% and antibiotic prescribing carried out after discharge at 80.6% of patients. According to questionnaire results, the use of SP over 24 hours and the prescription of antibiotics during discharge were: drain usage, hyperthermia, leukocytosis, surgeons feeling of comfort, avoidance of patients, and their relatives' reactions. Conclusion The total accuracy rate of SP rate was low in the present study and in surgeons prescribing the SP after discharge. In light of the present study, we suggest that discharge prescriptions should also be reviewed in clinics who have a high inappropriate surgical antibiotic prophylaxis rate.

Correction: Evaluation of Antibiotic Prophylaxis and Discharge Prescriptions in the General Surgery Department.

[This corrects the article DOI: 10.7759/cureus.4793.].

Intussusception Can Be the First Sign of Post-transplant Lymphoproliferative Disease.

Intussusception is usually seen in the pediatric age group and rarely seen in adults. It results in the progression of the proximal segment of the intestine into the distal intestine. A 50-year-old immunosuppressive male patient presented with the complaints of abdominal pain, nausea, vomiting, and no gas or stool discharge for 2 days. He was hospitalized with the presumptive diagnosis of acute abdomen. He has a history of renal transplantation due to chronic renal insufficiency. An explorative laparotomy was performed. The operative findings were compatible with jejunojejunal intussusception, and a segmental small bowel resection and end-to-end anastomosis were performed. The patient was uncomplicated postoperatively and discharged on the fifth postoperative day. The pathology was reported as Epstein-Barr virus negative with diffuse large-cell B lymphoma. In this case report, we aim to report on a jejunojejunal intussusception that was presented as the first sign of post-transplant lymphoproliferative disease.

Robotic-Assisted Transthoracic Esophageal Diverticulectomy.

INTRODUCTION: Esophageal diverticulum is a rare entity with symptoms that include dysphagia, halitosis, chest pain, and regurgitation. Indications for surgery include the presence of any of these symptoms and a diverticulum larger than 3 cm because of the increased risk of malignancy and aspiration. Treatment is open or minimally invasive surgery performed from the transhiatal or transthoracic approach. CASE DESCRIPTION: Three patients were investigated by esophagogastroduodenoscopy, esophageal manometry, and computed tomography and were given the diagnosis of epiphrenic diverticulum of the esophagus. MANAGEMENT AND OUTCOME: The patients underwent robot-assisted surgery by a transthoracic approach for esophageal diverticulectomy. The mean operative time was 211 min, with no significant blood loss or intraoperative complications. DISCUSSION: This report of robot-assisted surgery for esophageal diverticulectomy from a transthoracic approach adds to the literature regarding surgical treatment of epiphrenic esophageal diverticulum. It is a feasible method that can be used in selected patients with esophageal diverticulum.

Visceral organ resection during femoral hernia surgery is a predictor of morbidity.

Reports on the outcomes of emergency and elective femoral hernia surgery are scarce. Most studies do not distinguish femoral hernia from other types of groin hernia; studies of femoral hernia alone are few in number. The main objective of the present study was to identify factors affecting morbidity of femoral hernia patients. We retrospectively analyzed data on 80 patients who underwent femoral hernia surgery between June 2009 and June 2013. Patients who did and did not experience morbidity were compared in terms of age, sex, hernia location, the presence of any comorbid disease, the type of anesthesia employed, the operative technique used, the type of surgical intervention, and performance of small bowel resection. Forty-three patients (53.8%) underwent emergency surgery because of incarceration. Of these, 18 (41.9%) experienced strangulation and underwent resection. Postoperative complications developed in 11 patients (13.8%). Upon multiple logistic regression analysis, visceral organ resection (of the small bowel and/or omentum) was the only independent predictor of significant morbidity (P < 0.05; odds ratio [OR]: 14.010, 95% confidence interval [CI]: 1.001-196.143). When diagnosed, femoral hernias should be electively repaired as soon as possible. The cumulative probability of strangulation rises over time. A requirement for bowel resection seems to significantly increase morbidity.

Gynecologic pathologies in our appendectomy series and literature review.

PURPOSE: Appendectomy applied from the diagnosis of acute appendicitis is one the most common operations in surgery. The rates of negative appendectomy are still high. The rates of negative appendectomy in males and females differ and are higher in females. In our study, these differences, particularly in females, were studied and possible solutions were discussed. METHODS: Between October 2002 and October 2009, among women receiving urgent appendectomies, those whose primary cause was gynecological pathology were studied retrospectively. All our women subjects were examined by preoperative gynecologists. After gynecological consultation, the patients were evaluated by a general surgeon due to lack of urgent ultrasonography, computed tomography (CT) and diagnostic laparoscopy and the patient received appendectomy due to acute appendicitis. RESULTS: In our series of 1,969 appendectomies, the rate of female/male is 811/1,158. It was determined that the primary cause in 47 (47/811; 5.8%) women with applied appendectomy was gynecological pathology. As a gynecological pathology, it was observed that the most common cause was ovarian cyst ruptures at a rate of 72.3%. The negative appendectomy rate in males was found to be 14.94% (173/1,158), and in females it was 22.56% (183/811). The difference between them is significant (P < 0.01). Of these women, 5.8% were gynecologically-induced and 16.76% were unrelated to gynecological causes. CONCLUSION: We believe that gynecological consultation before appendectomy in women is necessary, but not sufficient. It is also important that at least one of the facilities, such as us, CT, magnetic resonance imaging, and diagnostic laparoscopy should be available in surgical use for the diagnosis of negative appendicitis.

Gallstone ileus as an unexpected complication of cholelithiasis: diagnostic difficulties and treatment.

BACKGROUND: Gallstone ileus is a rare complication of cholelithiasis, mostly in the elderly. The aim of this study was to evaluate our experience with 12 gallstone ileus cases and discuss current opinion as reported in the literature. METHODS: Data of 12 patients operated between January 1998 and January 2008 with gallstone ileus were retrospectively studied. RESULTS: There were 12 cases (9 F, 75%; 3 M, 25%) with a mean age of 63.6 (50-80) years. Median duration of symptoms before admission to the hospital was 4.1 (1-15) days. Preoperative diagnosis was made in only five cases (41.6%). Enterolithotomy was done in nine cases (75%). Enterolithotomy and resection of the small intestine--required for decubital necrosis from the gallstone--was performed in one case (8.3%). In one case (8.3%), enterolithotomy was completed in one stage with cholecystectomy and closure of the fistula during acute surgery, and in another case (8.3%), enterolithotomy + primary suturing of the jejunal perforation was performed. There were two (16.6%) perioperative mortalities. CONCLUSION: Gallstone ileus remains a diagnostic challenge despite advances in imaging techniques, and pre-operative diagnosis is often delayed. Gallstone ileus should be suspected in all cases admitted to the emergency service with acute intestinal obstruction with a history of cholelithiasis, especially in the elderly and females.

Cirugía conservadora en hidatidosis: problemas / Surgical treatment of hydatid cyst

Background: Hydatid Cyst is an infectious disease observed in many parts of the world, more often in endemic parts. While it can show symptoms related to the organ where it is localized, it can be also diagnosed incidentally. Aim: To report the experience in surgical treatment of hydatid cysts. Material and Methods: Retrospective review of 62 patients aged 17 to 75 years old (45 females), operated for hydatid cysts between 2002 and 2006. Results: The most common presenting complaint was right upper quadrant abdominal pain. The cyst was primary in 56 patients (90 percent) and a relapse in six (10 percent). Liver cysts were located in the right lobe in 41cases (66 percent) and left lobe in 11 (18 percent). Nine patients (15 percent) had bilateral lobe involvement. One patient (2 percent) had primary spleen hydatid cyst. Conservative surgery was used in all cases. A biliary fistula was found in 6 cases (10 percent) during the operation. In two patients, cysts were found in the choledochus and a choledochotomy was performed. Five patients had extrahepatic organ involvement of lung, omentum, colon meso and right ovary. Conclusions: To reduce the rate of relapse, operation technique must be carried out properly and carefully. Primary prophylaxis should be the first line of treatment of hydatid diseases.

Introducción: La Hidatidosis quística es una enfermedad infecciosa que se observa en muchas partes del mundo, más aún en zonas endémicas. En la mayoría, los síntomas son propios del órgano que afectan, pero a veces puede descubrirse de forma incidental. Objetivos: Describir e informar nuestra experiencia en el manejo quirúrgico de la hidatidosis quística. Material y Método: Quistes hidatídicos operados durante los últimos 7 años analizados de forma retrospectiva. Resultados y Discusión: Hubo 62 casos en nuestra serie, razón mujer hombre 45/17 y edad promedio de 41,6 años. Presentación más frecuente fue el dolor en cuadrante superior derecho. Cincuenta y seis (90,3 por ciento) casos fueron primarios y 6 (9,7 por ciento) recidivas. Compromiso de lóbulo hepático derecho en 41 casos (66 por ciento), izquierdo en 11 (17,7 por ciento) y bilateral en 9 (14,5 por ciento). Un caso fue (1,8 por ciento) primario esplénico. Se realizó cirugía conservadora en todos los pacientes. Se encontraron fístulas biliares en 6 casos (9,8 por ciento). En estos últimos el tamaño de los quistes fue de 14 cm. En 2 casos se observó compromiso del colédoco por lo que se realizó coledocostomía. En 5 casos (8 por ciento), se observó compromiso extrahepático los cuales fueron pulmón, omento, mesocolon y ovario derecho. Considerando que los quistes hidatídicos se pueden encontrar en todos los órganos, se debe realizar estudio imagenológico toracoabdominal. Para disminuir la tasa de recidiva, la técnica quirúrgica debe ser realizada de manera adecuada y cuidadosa. Debe realizarse profilaxis primaria como principal factor del tratamiento.

Is repair of incisional hernias by polypropylene mesh a safe procedure?

OBJECTIVE: The aim of our study was to evaluate the safety of the intraperitoneal mesh repair procedure and to assess the complications that develop after the procedure. SUBJECTS AND METHODS: We reviewed the records of 25 patients who underwent intraperitoneal mesh repair procedures. Data on age, sex, size and cause of the hernia, postoperative mortality, and morbidity with special attention to complications were obtained from the medical records. RESULTS: Of the 25 patients (7 males, 18 females), the original operation was cholecystectomy in 15 cases (60%), gynaecological surgery in 2, gastric surgery in 2, and umbilical hernia in 2. Incisions were midline in 20 cases (80%), transverse in 2 and laparoscopic port sites in 3 patients. The average size of the hernia was 150 cm(2). Local complications occurred in 4 (16%) patients. Postoperative complications included wound infection in 3 patients and haematoma in 1 patient. Postoperative hospital stay ranged from 3 to 25 days with a mean of 6 days. No recurrence developed during 28-month follow-up. CONCLUSION: The tension-free repair of incisional hernia with polypropylene mesh in intraperitoneal position is a safe and easy procedure with acceptable morbidity and no recurrence.

Phrenic-recurrent nerve anastomosis in animal models with unilateral cutting of the recurrent nerve.

In our experimental study, the aim was to recover vocal cord physiology in cutting of recurrent laryngeal nerve, thus phrenic-recurrent nerve transposition was planned in rabbits. Experiments were performed on 10 experimental and 10 control rabbits. The right recurrent nerve was cut in the control group, while in the experiment group, the right recurrent nerve was cut. Then, a right phrenic-recurrent nerve end-to-end anastomosis was performed and the results were evaluated. After the 3rd postoperative week, videolaryngoscopy (VLS) and intramuscular electromyography (EMG) could not be evaluated in 1 rabbit from the experimental group which had died during anesthesia. In eight of the nine rabbits in the experiment which underwent VLS and EMG, activity was recorded in the right vocal cords. On light microscopic examination, atrophy was not detected in the vocal cord muscles of 9 rabbits among the 10 in the experiment group, while all rabbits in the control group and 1 rabbit in the experiment group were diagnosed with vocal cord atrophy. A success rate of approximately 90% was obtained based on the pathologic examination. We believe that the method can be used in patients without any contraindications, considering the complications of tracheostomy and the quality of life.

[Acute necrotizing pancreatitis: the results of the management of 38 patients]. / Akut nekrotizan pankreatit: Otuz sekiz hastanin tedavi sonuçlari

BACKGROUND: We evaluated the patients who underwent surgical or nonoperative treatment for acute necrotizing pancreatitis. METHODS: The study included 38 patients (22 males, 16 females; mean age 51.3 years; range 16 to 79 years) with acute necrotizing pancreatitis. Surgical treatment was performed in 23 patients, while 15 patients were treated conservatively. RESULTS: Gallstone (in 17 patients) was the most common cause of pancreatitis. Twenty-five patients had sterile necrotizing pancreatitis, while 13 patients had infected necrotizing pancreatitis. Fifteen of the 25 cases with sterile necrosis were treated conservatively. The other 10 patients were initially treated by conservative methods, and were later treated surgically (due to six incorrect diagnosis, three organ failures, and one symptomatic pseudocyst). We applied continuous lavage to six of those patients and conventional drainage to four of them. Mortality rate was 23.7% globally; 24.0% in the sterile necrosis group and 23.1% in the infected necrosis group. Mortality rate was 21.7% in the surgical treatment group, and 26.7% in the conservative treatment group. There were no statistically significant differences between those groups (p>0.05). Eleven of the 29 patients who survived had some complications. CONCLUSION: The management of sterile pancreatic necrosis is still a matter of debate. Most patients with sterile necrosis can be treated with conservative methods. Indication for surgery in sterile necrosis should be based on persisting or advancing organ complications and sepsis signs despite intensive care therapy. The patients with infected necrosis should be treated surgically. Surgical intervention is best deferred until the demarcation of necrosis is complete.