Comparison of 'primary repair' and 'placing a drain without repair' methods in duodenum perforations.

BACKGROUND: Duodenal ulcer perforation is a serious condition. A number of methods have been defined and used in surgical treatment. In this study, it was aimed to compare the effectiveness of 'primary repair' and 'drain placement without repair' methods in duodenal perforations using an animal model. METHODS: Three equivalent groups of ten rats each were formed. Perforation was created in the duodenum in the first (primary repair/sutured group) and the second group (drain placement without repair/sutureless drainage group). In the first group, the per-foration was repaired with sutures. In the second group, only a drain was placed in the abdomen without sutures. In the third group (control group), only laparotomy was performed. Neutrophil count, sedimentation, serum C-reactive protein (CRP), serum total an-tioxidant capacity (TAC), serum total thiol, serum native thiol, and serum myeloperoxidase (MPO) analyses were performed on animal subjects in the pre-operative period and on the post-operative 1st and 7th days. Histological and immunohistochemical (transforming growth factor-beta 1 [TGF-ß1]) analyzes were performed. Blood analysis, histological, and immunohistochemical findings obtained from the groups were compared statistically. RESULTS: There was no significant difference between the first and second groups, except for the TAC on the post-operative 7th day and MPO values on the post-operative 1st day (P>0.05). Although tissue healing was more pronounced in the second group than in the first group, there was no significant difference between the groups (P>0.05). TGF-ß1 immunoreactivity observed in the second group was found to be significantly higher than in the first group (P<0.05). CONCLUSION: We think that the sutureless drainage method is as effective as the primary repair method in the treatment of duo-denal ulcer perforation and can be safely applied as an alternative to the primary repair method. However, further studies are needed to fully determine the efficacy of the sutureless drainage method.

Evaluation of risk factors for necrotic tissue resections in elderly patients with groin hernia.

AIM: To reveal the relationships between patient findings and tissue resection in elderly patients. MATERIALS AND METHODS: Between September 2020 and September 2022 three hundred eighty four patients over the age of 60 who were operated with the diagnosis of groin hernia were retrospectively analyzed. Gender, age, height, weight and body mass index value, groin and inguinal hernia types, hernia sides, primary or recurrent cases, hernia sac content, incarceration, tissue necrosis and resection presence, and accompanying pathologies were recorded. These findings were compared and evaluated in order to determine the relationships between patient findings and tissue resection, and the findings at risk for tissue resection. RESULTS: Of the patients in the study, 352 (91.7%) were male and 32 (8.3%) were female. The mean age, height, weight and BMI were 67.48±5.893 years, 169.27±6.113 cm, 73.28±7.878 kg and 25,566±2.3518 kg/m2, respectively. There were 369 inguinal, 15 femoral, 285 indirect, 84 direct, 312 primary, and 72 recurrent hernias. Incarceration was present in 65 (16.9%) patients, 19 (4.9%) of these patients underwent resection due to tissue necrosis (twelve omentum and seven small intestine). Tissue resection was 3.1% in male, 25% in female, 4.3% in inguinal, 20% in femoral, 5.6% in indirect, 0% in direct, 3.5% in primary and 11.1% in recurrent hernias. Tissue resections were significantly higher in females, femoral hernias, indirect inguinal hernias and recurrent cases (p<0.05). CONCLUSIONS: We can say that female gender, femoral, indirect and recurrent hernias are important risk factors for tissue resection in elderly patients. KEY WORDS: Elderly Patients, Emergency Surgery, Groin Hernia, Incarceration, Tissue Resection.

Evaluation of psychiatrist's communication with psychosis patients / Evaluación de la comunicación de psiquiatras con pacientes psicóticos / Avaliação da comunicação de psiquiatras com pacientes psicóticos

Abstract: Evaluation of the physician-patient relationship is very important in determining priorities in medical practice and medicine. For this purpose, in this study the psychiatrist's communication with psychotic patients as a sensitive group was evaluated. A questionnaire was administered to 210 patients in a psychiatric clinic of Inonu University Hospital in Turkey to determine how the examination is performed in the facility for outpatients in the psychosis unit. According to the study conducted, it was observed that the evaluation score of the psychiatrist's communication with psychotic patients increased positively with increasing consultation duration. Our work is particularly noteworthy because it deals with a sensitive area, such as a group of psychiatric patients. The scores were obtained based on data from the evaluation of the questionnaires, which showed that the communication between the psychiatrist and the psychotic patient was conducted in a sensitive and careful manner, and without ethical problems.

Resumen: La evaluación de la relación médico-paciente es muy importante para determinar las prioridades en la práctica médica y la medicina. Para este propósito, en este estudio se evaluó la comunicación del médico psiquiatra con los pacientes psicóticos como grupo sensible. Se administró un cuestionario a 210 pacientes de una clínica psiquiátrica del Hospital de la Universidad de Inonu en Turquía, para determinar cómo se realiza el examen en el establecimiento para los pacientes externos de la unidad de psicosis. De acuerdo con el estudio realizado, se observó que el puntaje de evaluación de la comunicación del psiquiatra con los pacientes psicóticos se incrementó positivamente al aumentar la duración de la consulta. Nuestro trabajo se destaca particularmente por tratarse de un área sensible, como es un grupo de pacientes psiquiátricos. Los puntajes se obtuvieron basándose en datos de la evaluación de los cuestionarios, que mostraron que la comunicación entre el psiquiatra y el paciente psicótico se realizó de una forma sensible y cuidadosa, y sin problemas éticos.

Resumo: A avaliação da relação médico-paciente é muito importante para determinar as prioridades na prática médica e na medicina. Para este fim, neste estudo foi avaliada a comunicação do psiquiatra com pacientes psicóticos como um grupo sensível. Um questionário foi aplicado a 210 pacientes em uma clínica psiquiátrica do Hospital Universitário Inonu na Turquia para determinar como o exame é conduzido nas instalações para pacientes ambulatoriais da unidade de psicose. De acordo com o estudo realizado, observou-se que a pontuação da avaliação da comunicação do psiquiatra com pacientes psicóticos aumentou positivamente à medida que a duração da consulta aumentava. Nosso trabalho é particularmente notável porque trata de uma área sensível, tal como um grupo de pacientes psiquiátricos. Os resultados foram obtidos com base nos dados da avaliação dos questionários, que mostraram que a comunicação entre psiquiatra e paciente psicótico foi realizada de forma sensível e cuidadosa, e sem problemas éticos.

Comparison of the effects of conventional physiotherapy and proprioception exercises on pain and ankle proprioception in patients with lumbar radiculopathy.

BACKGROUND: Lumbar radiculopathy is characterized by a significant amount of backache causing loss of workforce and is a significant health problem frequently seen in the general population. OBJECTIVE: The purpose of this study was to compare the effects of conventional physiotherapy (CT) and proprioception exercises (PE) on ankle proprioception and lumbar pain between patients with lumbar radiculopathy and a healthy control group. METHODS: In this randomized clinical trial, 89 patients referred to the Physical Medicine and Rehabilitation outpatient clinic were selected through convenience sampling. They were randomly assigned to three groups: CT (n= 27), PE (n= 31), CT&PE (n= 31). Thirty healthy volunteers were included in the study as the control group. Proprioception measurements were made with an isokinetic dynamometer at 10∘ dorsiflexion (DF), 11∘, and 25∘ plantarflexion (PF) angles. Lumbar pain was assessed by using the Numerical Pain Rating Scale (NPRS). The data were analyzed by IBM SPSS Statistics version 22.0 via the Kruskal-Wallis and Mann-Whitney U tests. RESULTS: There was a statistically significant difference between the groups in terms of ankle proprioception and NPRS measurements in post-treatment evaluations (p< 0.05). Statistically significant differences were found between CT and PE groups and CT&PE and control groups. There was no statistically significant difference in comparing CT and PE groups and CT&PE and control groups within themselves (p> 0.05). CONCLUSION: The combined use of CT and PE is an effective method that can be used in the clinic to reduce angular differences in ankle proprioception which is one of the primary factors of balance and coordination and lumbar pain.

A comparison of crystal phenol treatment, midline primary closure and Limberg flap reconstruction methods in female patients with primary pilonidal sinus disease.

Pilonidal sinus disease (PSD) is a chronic problem often occurs in healthy hirsute men, however, women may also be affected. A range of conservative techniques to surgical flaps have been used to treat this condition. Currently, midline primary closure (MPC) is considered the standard of therapy; however, no statistically significant difference has been noted between primary versus secondary (Karydakis flap or Limberg flap) closure. Recently, flap reconstruction methods have been applied and superiority of these methods have been shown. Treatment methods should be employed to the individual, taking into account recurrence and complication rates of the method, recovery time, patients' preference and surgeon's skill. KEY WORDS: Crystal Phenol Treatment, Female Patient, Pilonidal Sinus, Limberg Flap Reconstruction, Primary Midline Closure.

Pilonidal Sinus Disease: An Analysis of the Factors Affecting Recurrence.

OBJECTIVE: To assess the success of treatment methods at reducing recurrence, the most important problem in pilonidal sinus disease (PSD), along with factors affecting the occurrence of PSD and posttreatment recurrence. METHODS: The researchers retrospectively analyzed files of patients treated for PSD between 2003 and 2018. Three study groups were created: G1, G2, and G3. G1 included all PSDs with recurrence, and a comparable number of cases without recurrence were selected randomly for the G2 group. The control group, G3, included healthy individuals without PSD. In all groups, the following were recorded: body mass index, skin color and oiliness, family history of PSD, hair overgrowth, smoking habit, time spent sitting per day, and number of baths per week. The following were additionally recorded for G1 and G2: treatment methods, follow-up periods, pretreatment abscess(es), and time of onset of complaints before treatment. The number of recurrences and the period between last treatment and recurrence were also recorded for G1. RESULTS: G1 comprised 234 patients; G2, 247 patients; and G3, 128 healthy individuals. The significant factors causing recurrence included body mass index, family history, bathing habits, hair overgrowth, skin color and oiliness, time spent sitting per day, smoking habit, abscess(es), and duration of symptom(s) (P < .05). Limberg flap repair was the most successful treatment method. Sixty-three (27%), 135 (58%), and 185 (79%) recurrences occurred in the first 6 months, in the first year, and in the first 2 years, respectively. CONCLUSIONS: The researchers recommend Limberg flap repair for treatment. It is possible to reduce recurrence by taking preventable factors into consideration.

Efficacy of Intragastric Balloon Placement and Botulinum Toxin Injection in Bariatric Endoscopy.

BACKGROUND: To evaluate the results obtained from the combination of intragastric botulinum toxin A (IGBTA), intragastric balloon (IGB), and IGBTA(+)IGB in the treatment of obesity. MATERIALS AND METHODS: Three separate treatment groups were set up. IGBTA, IGB, and IGBTA(+)IGB were administered to Group 1, 2, and 3, respectively. The body mass indexes (BMI) of patients were measured before and 6 months after the treatment. The intragroup and intergroup treatment results have been evaluated. P<0.05 was considered significant. RESULTS: The mean BMI decreased by 1.6 kg/m in 40 patients who received IGBTA in group 1 (P<0.001), 3.95 kg/m in 42 patients who received IGB in group 2 (P<0.001), and 4.9 kg/m in 39 patients who received IGBTA and IGB in group 3 (P<0.001) after 6 months of treatment. The intolerance because of the application was the highest in group 3, followed by group 2. CONCLUSION: The treatment was most successful in group 3 followed by group 2 and group 1, respectively. The authors recommend the group 3 treatment, provided that nausea, vomiting, and flatulence have a high index of probability in such a treatment. However, when deciding between group 1 and group 2 treatments, the authors recommend opting for group 2 treatment that shows to be more efficient.

The Relationship of Perforated Appendicitis with Total and Direct Bilirubin.

Introduction Very different results have been reported regarding the relationship between bilirubin and perforated appendicitis. We observed this relationship with our own studies. Methods The patients, who underwent appendectomy, were retrospectively categorized as perforated and non-perforated based on their files. Those with a total bilirubin (TB) 1.20 mg/dL or less were considered normal whereas those with a 1.21 mg/dL or higher were considered having a high. Those with a direct bilirubin (DB) 0.50 mg/dL or less were considered normal whereas those with a 0.51 mg/dL or higher were considered having a high. The patients were assessed under two groups. Perforated appendicitis (PA) and non-perforated appendicitis (NPA) were analyzed according to the TB in Group 1 and the DB in Group 2. Results Group 1 included 269 patients whose TB were measured. Of those, 218 had NPA and 51 had PA. The rate of patients with high TB among the patients with PA was 1.37 times higher than those with NPA (p ˂ 0.01). Group 2 included 258 patients whose DB values were measured. Of those, 208 had NPA and 50 had PA. The rate of patients with high TB among the patients with PA was 1.71 times higher than those with NPA (p ˂ 0.001). Conclusion In the diagnosis of PA, both TB and DB show low diagnostic values. In the diagnosis, they can only be considered as a supportive factor to other parameters. However, in the case of a differential diagnosis, we recommend using DB since it has a higher sensitivity and specificity.

The Correlation Between Delayed Surgical Therapy After the Diagnosis of Pilonidal Sinus Disease and Relapse, Labor Loss, and Costs.

Introduction There has been no detailed study of the relationship between recurrence and symptom duration in pilonidal sinus disease. The aim of this study was to explore the correlation between delayed surgical therapy after symptoms appear in sacrococcygeal pilonidal sinus disease (SPSD) and relapse, labor loss and costs. Methods Patients diagnosed with SPSD were split into two groups according to symptom duration before surgery: 30 days or less (G1) and more than 30 days (G2). Patients included those who underwent Limberg flap reconstruction (LFR) for primary SPSD. The length of hospitalization during surgery, postoperative follow-up period, and, if any, relapse periods were obtained from patients' files. Of the patients with incomplete information, only those whose information was confirmed by phone were also covered by the study. Results G1 included 153 patients, including 37 (24.18%) females and 116 (75.82%) males. The median age in G1 was 22 years and the mean age was 23.08±8.72 years. G2 included 214 patients, including 51 (23.83%) females and 163 (76.17%) males. The median age in G2 was 22 years and the mean age was 22.64±9.06 years. The mean lengths of hospitalization in G1 and G2 were 2.14±0.86 and 2.98±1.04 days, respectively, and the difference between them was significant (p<0.03). The follow-up periods in G1 and G2 were 61.52±29.84 (12-108) and 64.0±31.24 (12-113) months, respectively. Relapse occurred in nine patients (5.8%) in G1 and 19 patients (8.8%) in G2, and the difference between them was significant (p<0.02). The mean relapse period was 3.44±6.01 and 11.23±7.62 months in G1 and G2, respectively, and the difference between them was significant (p<0.04). Conclusion Delayed surgery should be avoided to minimize the costs and the probability of relapse in SPSD.

[Comparison of lateral deltoid splitting and deltopectoral approaches in the treatment of proximal humerus fractures]. / Proksimal humerus kiriklarinin tedavisinde lateral deltoid split girisim ile deltopektoral girisimin karsilastirilmasi.

BACKGROUND: Fractures of the proximal humerus that limit function are quite common. The objective of this retrospective study was to compare deltoid splitting and deltopectoral approaches by using the same fixation method. METHODS: Eighty-six patients who underwent surgical treatment between September 2005 and July 2011 were included into the study group. Deltoid splitting approach was used by exploring the axillary nerve on Group A patients as described by Codman, and deltopectoral approach was used on Group B patients. Group A consisted of a total of fifty-six patients of whom twenty-two were male and thirty-four were female patients, with a mean age of 62.5 years (range, 26 to 90 years). Group B consisted of a total of thirty patients of whom fourteen were male and sixteen were female patients, with a mean age of 54.8 years (range, 24 to 84 years). PHILOS plate system was utilized as an internal fixation tool in all patients. Functional results and complications of the two groups were compared using Constant scores. RESULTS: It was observed that humeral head and tubercular fragment reduction were better with lateral deltoid splitting approach, and Constant shoulder scores were higher in the early stages (66.8-57.4 consecutively; p>0.05). DISCUSSION: Deltoid splitting approach, especially with AO/ASIF B and C type fractures, enables reduction and plate fixing under 270 degree control of the proximal humerus without forceful retraction and soft tissue damage, providing easy access to posterior tubercular fragment. Compared to deltopectoral approach, patients treated with deltoid splitting approach achieved higher Constant scores at an earlier stage. Lateral deltoid splitting approach, by exploring the axillary nerve, is a useful surgical technique which provides an expansive and multi-dimensional control without risking the deltoid muscle function and the axillary nerve.

Comparison of femur intertrochanteric fracture fixation with hemiarthroplasty and proximal femoral nail systems.

BACKGROUND: The aim of this study was to compare the outcomes of intertrochanteric femur fractures treated with proximal femoral nail (PFN) and bipolar hemiarthroplasty (BPH) in elderly patients. METHODS: A total of one hundred and forty-three patients with intertrochanteric femur fractures treated surgically between January 2008 and January 2012 were included into the study. Patient demographics, type of fracture according to Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF) classification, and the American Society of Anesthesiologists (ASA) classification system scores; type of surgical procedure (BPH or PFN), operative details, complications and follow-up scores (Harris Hip Score [HHS]; Mean Mobility Score [MMS]) were recorded. RESULTS: The preoperative characteristics of the patients in both PFN and BPH groups were similar. BPH had higher operation times, blood loss in operation and mortality rates (p<0.005). Reoperation times were higher in PFN group (p<0.005). There were no differences with regard to the HHS and the reduction in MMS at the last follow-up with a 30.4 (10.9) months follow-up (p>0.05). CONCLUSION: Although both PFN and BPH had satisfactory outcomes in surgically treated patients with intertrochanteric femur fractures, we recommend intertrochanteric femur fractures in the elderly tobe treated with PFN; which is an effective and appropriate treatment modality with less surgery related trauma and lower mortality rates.

Giant bladder stone: A case report and review of the literature.

Bladder stones comprise 5% of urinary tract stones. Generally, they occur in the presence of bladder neck obstruction, urinary tract infections associated with neurogenic bladder and foreign objects. They are more common among men than women. Infection stones comprise approximately 15% of urinary tract stones. A giant bladder stone is a rare finding in contemporary urological practice. The general clinical setting is recurrent urinary tract infections, hematuria and urinary retention. We performed an open cystolithotomy on a mentally impaired patient who had a giant bladder stone. The stone removed weighed 465 grams. There was no evidence of any infravesical obstruction on the cystoscopy performed before the operation or during the operation. The stone consisted of 75% carbonate apatite and 25% struvite. Given that such a stone was found in a mentally impaired patient indicates that infection stones can form without infravesical obstruction.

Breast hydatid cyst mimicking fibroadenoma and malignancy: A case report.

Echinococcus granulosis is known as the cause of hydatid cyst disease. It is often seen in many regions of the world, and can cause serious health problems. This parasite can invade tissues in all parts of the body and produce hydatid cysts, although it has been mainly observed in the liver and the lungs. Breast hydatid cysts are encountered rarely. After physical examination, radiological and serological tests are performed on patients with breast hydatid disease. These examinations are helpful for an early diagnosis, but they are insufficient to make a definitive diagnosis, which can only be made according to the results of histopathological examinations. We had a primary diagnosis of either fibroadenoma or malignancy in the breast during the preoperative period of the present case. A precise diagnosis could only be made by histopathological examinations in the postoperative period.