A rare cause of acute abdomen in adults: Parasitic infection-related acute appendicitis.

Ascaris lumbricoides is a common parasitic disease all over the world, especially in less developed countries. Acute appendicitis related to parasitic infection is a rare condition. Parasitic infections should be kept in mind in patients who are admitted to the emergency department with acute abdomen, especially in endemic areas.

Bedside decompression of abdominal compartment syndrome caused by spontaneous pneumoperitoneum: A case report.

Pneumoperitoneum is the presence of free air within the peritoneal cavity and indicates perforation of a hollow viscus. However, it may also occur in the absence of perforation and in this case, it is called spontaneous pneumoperitoneum (SP). A 57-year-old female patient who was intubated and mechanically ventilated due to respiratory failure developed abdominal compartment syndrome (ACS) secondary to massive SP. Peritoneal lavage was performed for the patient both to achieve decompression and to support the diagnosis. Many surgeons proceed with laparotomy as a reflex response for SP due to lack of awareness of the condition. However, laparotomy has no place in this setting. SP coexisting with ACS is extremely rare. With this case report, we aimed to raise awareness of SP among physicians and help avoid unnecessary laparotomies.

Immature Granulocyte Count and Delta Neutrophil Index as New Predictive Factors for Axillary Metastasis of Breast Cancer.

OBJECTIVE: To determine the diagnostic value of preoperative immature granulocyte (IG) count and delta neutrophil index (DNI) level before clinical detection of axillary lymph node metastasis. STUDY DESIGN: Cohort study. PLACE AND DURATION OF STUDY: Department of General Surgery, Kahramanmaras Sutcu Imam University, Onikisubat, Turkey from February 2015 to February 2020. METHODOLOGY: Patients older than 18 years and operated for breast pathologies in the study period were evaluated retrospectively. Patients without axillary or distant organ metastasis, and who did not receive neoadjuvant chemotherapy were examined by dividing them into two groups as pathologically non-metastatic axilla (Group NM) and metastatic axilla (Group M). They were retrospectively evaluated for DNI, IG, white blood cell count (WBC), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and mean platelet volumes (MPV). RESULTS: All of the 83 patients, who met the inclusion criteria, were females (100%). Forty-six patients (55.42%) were in the Group-NM and 37 (44.58%) were in Group-M. Statistically significant difference was observed between the groups in terms of WBC, NLR, PLR, MPV, DNI and IG count (p<0.05), while there was no difference in age (p = 0.862). As a result of the univariate and multivariate analysis, WBC, NLR, PLR, MPV, DNI and IG count were determined as predictive factors. The discriminatory power of the DNI for diagnosing clinically negative pathologically positive axillary metastasis of breast cancer at the cut-off value ≥0.35% (ARUC:0.903; 95% confidence interval [CI]: 0.84-0.967) showed 86.5% sensitivity, 80.4% specificity, positive predictive value (PPV) 86.5%, negative predictive value (NPV) 80.4%. The discriminatory power of the IG count for diagnosing clinically negative pathologically positive axillary metastasis of breast cancer, at the cut-off value ≥25/mm3 (ARUC:0.976; 95% CI:0.953-1.000) showed 100% sensitivity, 82.6% specificity, 100% PPV, and 82.6% NPV. CONCLUSION: DNI and IG count may be new predictive factors with high sensitivity and specificity in detecting axillary metastasis of breast cancer. Key Words: Delta neutrophil index, Immature granulocyte count, Neutrophil lymphocyte ratio, Breast cancer, Axillary metastasis.

Treatment of Hepatic Hydatid Disease: Role of Surgery, ERCP, and Percutaneous Drainage: A Retrospective Study.

INTRODUCTION: Failure to follow the World Health Organization's Informal Working Group on Echinococcosis guidance or having limited experience in the management of cystic echinococcosis (CE) in endemic or nonendemic areas of the world may lead to risky unnecessary procedures. MATERIALS AND METHODS: Medical records of all patients undergoing surgery for hepatic hydatid disease at the gastroenterologic surgery and general surgery departments of our hospital between December 2014 and October 2019 were collected and reviewed retrospectively. Demographic characteristics, the size and number of the cysts preoperative liver function tests, surgical treatment, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage (PD), morbidity, and treatment outcomes were reviewed. RESULTS: Of 122 patients included in the study, 77 (63, 1%) were female and 45 (36, 9%) were male individuals and their mean age was 44.95 years. CE1 was identified in 13 patients (10.6%) CE2 in 66 patients (54.1%), CE3a in 7 patients (5.8%), CE3b in 28 patients (22.9%), and CE4 in 8 patients (6.6%). Twenty patients (16.4%) with a cystobiliary fistula in the liver, obstructive jaundice, and postoperative bile leak underwent ERCP. PD was performed in patients with fluid in the hepatic hydatid cyst pouch, increased pouch size because of bile collection, and clinical symptoms postoperatively. Patients presenting with persistent bile leak despite PD underwent ERCP and were treated with endoscopic sphincterotomy and stent placement. Patients with PD were followed by keeping the percutaneous drain open and closed for a while to create pressure difference in the cyst pouch after ERCP. The percutaneous drain was removed in the next 14 to 21 days after checking the pouch size, whereas the common bile duct stents were removed 2 months later after performing a follow-up cholangiography. CONCLUSIONS: ERCP should be the primary method for the diagnosis and treatment for hepatic hydatid cysts ruptured into the ducts. In some cases, high-flow hydatid cysts with rupture into the bile ducts or persistent biliary fistulas can be treated with ERCP and endoscopic sphincterotomy, biliary stent, PD, and nasobiliary drainage without the need for surgical intervention.

Crystallized phenol treatment of pilonidal disease improves quality of life.

The effects of crystallized phenol treatment of pilonidal sinus on quality of life has not been investigated before. This study aimed to compare the phenol treatment with surgical excision plus primary closure technique in terms of life quality by means of a life quality questionnaire. This is a prospective randomized clinical study. The study was conducted at Training and Teaching Hospital, Kayseri, Turkey. In total, 40 patients with pilonidal disease were randomly assigned into 2 clinically comparable groups between September 2010 and June 2011. Cristallyzed phenol application was done to 20 patients and surgical excision plus primary closure was done to 20 patients for the treatment of pilonidal disease. Data regarding demographic variables were recorded. To evaluate quality of life and patient comfort all patients asked to fill the questionnaire after complete healing occurred. There was no difference between the groups in age, sex and occupation. Two of the 20 patients in the excision and primary closure group had complication of wound dehiscience and needed prolonged wound care. There was significant differences in favor of the phenol group in all terms of life quality except for complete healing time. As a first degree treatment, phenol treatment is better than the other treatment choices of pilonidal disease in terms of time off work perioperative pain, being away from school and social life. Also phenol treatment can be done without any pretreatment laboratory examination. Further studies will be needed about cost-effectivity of phenol treatment.