Mortality Factors in Crush Syndrome.

BACKGROUND: Crush Syndrome is a major cause of morbidity and mortality following large-scale catastrophic earthquakes. Since there are no randomized controlled studies on Crush Syndrome, knowledge on this subject is limited to expert experience. The primary objective is to analyze the epidemiological and demographic characteristics, clinical outcomes, and mortality factors of earthquake victims after the Pazarcik and Elbistan earthquakes on February 6, 2023. METHODS: This cross-sectional and observational retrospective study evaluated 610 earthquake victims who presented to our center between February 6 and April 30, 2023. Among these patients, 128 with Crush Syndrome were included in the study. Patient information was gathered from hospital records during their stay and from national registries upon referral. The primary outcome was to identify risk factors for mortality. Demographic and laboratory data were analyzed by acute kidney injury (AKI) stages; mortality-affecting factors were identified through regression analysis. RESULTS: Of the 128 Crush Syndrome patients (100 adults, 28 children), 64 were female. The AKI rate was 32.8%. Among patients with AKI, the frequency of hemodialysis requirement was 69%, and the mortality rate was 14.2%. The overall mortality rate for patients with Crush Syndrome was 4.6%, compared to 3.9% (19/482) in earthquake victims without Crush Syndrome (p=0.705). Notably, low systolic blood pressure at admission was the only factor significantly affecting mortality in Crush Syndrome patients (Hazard Ratio [HR]: 1.088, p=0.021, 95% Confidence Interval [CI]). CONCLUSION: Our study highlights low systolic blood pressure upon admission as a significant risk factor for increased mortality in Crush Syndrome patients. This finding may contribute to the literature by emphasizing the importance of monitoring blood pressure under rubble and administering more aggressive fluid therapy to patients with low systolic blood pressure.

Comparison of Mortality Rates in Patients Waiting for Liver Transplant and Patients With Colorectal Metastatic Tumors.

OBJECTIVES: We aimed to identify outcomes of liver surgery in patients with hepatocellular carcinoma and colorectal cancer, which result in primary and secondary liver tumors. MATERIALS AND METHODS: Our study included 51 patients with colorectal cancer and liver metastases and 63 patients with hepatocellular carcinoma who were prepared for liver transplant due to cirrhosis who underwent hepatic resection or local ablation treatments; patients were seen between January 2011 and December 2021. RESULTS: Most patients with colorectal cancer were men (58.8%). Mean age was 65.76 ± 13.818 years (range, 27-88 y). Most patients had planned, elective surgery (86.3%). Neoadjuvant chemotherapy was administered to 58.8% of patients. The most common location of metastasis in the liver was in the right lobe (43.1%), and the most common surgery was low anterior resection (17 patients). During simultaneous liver surgery, 31 patients required metastasectomy and 7 patients required radiofrequency ablation plus metastasectomy. No deaths occurred in the early posttransplant period, and cumulative survival was 82.624 ± 7.962 months. Disease-free survival was 45.2 ± 7.495 months. Most patients with hepatocellular carcinoma were men (82.5%). Mean age was 58.73 ± 17.428 years. Hepatocellular carcinoma lesions were mostly located in both the right and left lobes (23.8%). In the hepatocellular cancer group, 60.3% had transarterial chemoembolization and 42.9% had radiofrequency ablation. The primary surgical resection was metastasectomy (17.9%) because of multiple localized lesions. Median follow-up was 22 months (range, 1-126 mo). Overall survival was 101.898 ± 7.169 months, with 10-year overall survival of 38%. Disease-free survival was 74.081 ± 8.732 months, with 1-year and 5-year disease-free survival of 90.5% and 54%. CONCLUSIONS: Better survival was shown in patients with hepatocellular carcinoma than in patients with colorectal cancer.Therefore, more aggressive treatment options, as used in hepatocellular carcinoma, including liver transplant, may be options for patients with colorectal cancer.

Effect of Ozone Added to University of Wisconsin Solution on Preservation Damage in Perfused Liver.

OBJECTIVES: Ischemia is defined as the inability of the tissue to provide oxygen and other metabolites by the circulation and the removal of residual products. The University of Wisconsin solution is widely used to preserve ischemia and to preserve organs for transplant. Ozone is used in various areas of ischemia damage due to its antioxidant properties. The aim of our study was to investigate the effects of ozone added to University of Wisconsin solution on perfused liver preservation injury. MATERIALS AND METHODS: Our study included 24 Sprague Dawley rats with an average weight of 300 to 350 g. Animals were divided into 4 groups: group 1 (Ringer lactate), group 2 (Ringer lactate + ozone), group 3 (University of Wisconsin solution), and group 4 (University of Wisconsin + ozone). Solutions were perfused from the liver portal vein and aorta. After perfusion, rats were killed and liver biopsies were taken at 0, 6, and 12 hours of storage for pathological examination. For biochemical analysis, samples were collected from liver specimen storage solutions at 0, 6, and 12 hours. RESULTS: Mean alanine aminotransferase/aspartate aminotransferase levels in group 3 were 77/82 U/L at hour 0, 680/461 U/L at hour 6, and 1027/682 U/L at hour 12. In group 4, these levels were 35/31 U/L at hour 0, 415/295 U/L at hour 6, and 546/372 U/L at hour 12. CONCLUSIONS: In terms of liver function values, we observed favorable result with University of Wisconsin solution with added ozone. Therefore, we suggest that the addition of ozone to the University of Wisconsin solution may be effective in preventing liver preservation damage.

Hand-made Extracorporeal Knotting versus Hem-o-Lok Clip for Stump Closure in Laparoscopic Appendectomy.

OBJECTIVE: To compare hand-made extracorporeal knotting and hem-o-lok clip for the closure of appendix stump regarding safety, complications and cost-effectiveness. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Baskent University Adana Teaching and Research Center, between January 2010 and December 2016. METHODOLOGY: A total of 287 patients, who underwent laparoscopic appendectomy, were enrolled in this study. Patients were divided into hand-made extracorporeal knotting and hem-o-lok clip groups. Patients were compared according to age, gender, duration of symptoms, serum leukocyte count, American Society of Anesthesiologists (ASA) score, intraoperative findings, operation time, hospital stay, pathology report and complications. RESULTS: Of 287 patients, 149 (51.9%) were female and 138 (48.1%) were male. The mean age was found 34.9 years. No statistical difference was observed between groups according to age, gender, duration of symptoms, serum leukocyte count, ASA score, operation time and hospital stay. Intraoperative findings were different between groups (p<0.05). Overall postoperative complication rate was 6.6%. No statistical difference was observed regarding complications Conclusion: Both hand-made extracorporeal knotting and hem-o-lok clips can be used for stump closure in laparoscopic appendectomy. Hand-made extracorporeal knotting is an effective, safe and costeffective method alternative to hem-o-lok clips.

Role of preoperative C-reactive protein value and neutrophil ratio in the determination of conversion from laparoscopic appendectomy to open appendectomy.

BACKGROUND: In this study, we aimed to investigate the factors causing conversion from laparoscopic appendectomy (LA) to open appendectomy (OA) in patients with acute appendicitis and to investigate the role of preoperative C reactive protein (CRP) and neutrophil ratio in this conversion and determine a cut-off point for these parameters. METHODS: Records of patients who underwent LA due to acute appendicitis at our general surgery department between January 2011 and January 2017 were retrospectively evaluated. The preoperative American Society of Anesthesiology (ASA) scores, Alvarado scores, white blood cell count, C-reactive protein level, and neutrophil ratio were evaluated. RESULTS: LA was performed in 394 patients with an initial diagnosis of acute appendicitis. A conversion to OA (cOA) was performed in 17 patients (4.31%). A CRP value of ≥108.5 mg/L and a neutrophil ratio of ≥81.5% were found to be statistically significant for the cOA (p<0.001). CONCLUSION: Our study results showed that male gender, age, elevated neutrophil ratio, and CRP value were the main risk factors for cOA in patients who were scheduled for LA due to acute appendicitis.

Partial Splenic Torsion in situ: Revealed by Ultrasound and Computed Tomography.

We present a case of acute abdominal pain due to partial torsion of spleen located in its own normal anatomical position in a 20-year-old woman, diagnosed by ultrasound and confirmed on computed tomography and treated laparoscopically.

Comparison of the Early-Term Complications and Patency Rates of the Standard (Parachute) and Diamond-Shaped End-To-Side Anastomosis Techniques in Arteriovenous Fistulas Created for Hemodialysis.

OBJECTIVE: To compare the early-term patency and complication rates of the end-to-side anastomosis techniques parachute and diamond-shaped techniques in arteriovenous fistulas. STUDY DESIGN: Prospective randomised study. PLACE AND DURATION OF STUDY: Department of General Surgery, Adana Baskent University Application and Research Hospital, Adana, Turkey, between October 2014 and January 2015. METHODOLOGY: Patients with end stage renal disease who underwent arteriovenous fistula creation for hemodialysis were grouped into two according to the anastomosis technique performed. Group 1 was composed of the patients undergoing the standard parachute technique and Group 2 consisted of the patients operated with the diamond-shaped anastomosis technique. The two groups were compared with each other with respect to clinical and demographic data, operative and postoperative variables, and complication and patency rates. RESULTS: A total of 56 patients underwent arteriovenous fistula creation. The overall complication rate was 12.5%. The early-term patency rate was higher in the diamond-shaped anastomosis technique than the standard parachute end- to-side anastomosis technique. Effective dialysis was established after 4 weeks in 48 (85.7%) patients in the overall study group, 23 (82.1%) in Group 1, and 25 (89.2%) in Group 2. However, there was no significant difference between both the techniques with respect to effectiveness of dialysis. CONCLUSION: Both end-to-side anastomosis techniques have their own advantages and disadvantages. Using a patient- specific suitable technique rather than a standard technique would be more appropriate in arteriovenous fistulas formation.

Retrospective Analysis of Patients with Synchronous Primary Breast and Thyroid Carcinoma.

OBJECTIVE: Breast and thyroid cancers are commonly encountered malignancies. Increased risk of breast cancer in follow-up period of thyroid cancer or vice versa has been reported. However, they have some associations, synchronous presentation of these tumors is rare. We presented 12 patients diagnosed as breast and thyroid cancer and treated at the same time. MATERIALS AND METHODS: Mastectomy and thyroidectomy were performed in 19 patients at the same time. 7 patients were excluded because of benign thyroid pathology. Therefore 12 patients who had diagnosis of synchronous breast and thyroid cancer were included. Data regarding clinical, pathological, treatment and prognostic factors was retrospectively analyzed. RESULTS: Total thyroidectomy was performed in all patients. The mean age of patients was 54 years (min. 44-max. 70). Only one patient was male. Thyroid pathology was detected preoperatively by FDG PET-CT scan in 11 patients. Breast reconstruction was performed in three patients. The most commonly seen thyroid malignancy was papillary thyroid carcinoma. Postoperative complication rate was 33.3%. Adjuvant chemotherapy was given in 11 patients whereas one patient received adjuvant radiotherapy. CONCLUSION: Although synchronous presentation of breast and thyroid cancer is rare, surgical treatment of both of these tumors can be safely performed at the same time. Association of these tumors should be evaluated by large scaled studies.

Primary small intestinal non-Hodgkin lymphoma diagnosed after emergency surgery.

BACKGROUND: The aim of this study was to investigate clinical manifestation, diagnosis, treatment, and prognosis of patients with primary gastrointestinal non-Hodgkin lymphoma (PGI NHL), whose initial presentation was bowel obstruction or perforation. METHODS: Data of patients who underwent surgical intervention due to radiological evidence of perforation or intestinal obstruction and were subsequently diagnosed with intestinal lymphoma at Baskent University hospitals between January 2007 and November 2014 were examined retrospectively. Medical records, clinical history, symptoms, pathological reports, and treatment modalities were analyzed. RESULTS: Study population comprised 17 patients (8 male, 9 female) with PGI NHL and mean age of 52±20.2 years. Symptoms reported by the patients were abdominal pain, nausea, vomiting, weight loss, and loss of appetite. All 17 patients underwent surgical treatment; 12 also received postoperative chemotherapy. Most common pathological subtype was diffuse large B-cell lymphoma (70.5%). Mean follow-up time was 26 months (range: 1-69 months) and 5-year survival rate was 64.3%. CONCLUSION: Initial presentation of PGI NHL may be obstruction with or without perforation; clinicians and surgeons should keep this in mind while assessing patient with bowel obstruction, and particularly patient in fifth decade of life.

One of the Rare Causes of Acute Abdomen Leading to Subileus: Jejunal Diverticulitis.

BACKGROUND: Jejunal diverticulitis is one of the rare causes of acute abdomen generally seen in the elderly. Jejunal diverticulosis was defined as the herniation of the mucosa and the submucosa from the inside of the muscular layer of the bowel wall on the mesenteric side of the intestine. CASE REPORT: We presented the intraoperative and pathological findings of a 69-year-old male patient who had presented with complaints about abdominal pain, nausea, and vomiting and been operated upon due to subileus and peritonitis induced by large-sized jejunal diverticulitis, along with his computed tomography (CT) findings. CONCLUSION: Jejunal diverticulitis is uncommon and may be a disease which might be difficult to diagnose when it develops on the basis of the large-sized diverticula resembling intestinal ansae. To the best of our knowledge, the computed tomography and intraoperative findings of a case in which partial resection is applied to the jejunum due to subileus have not been previously presented in the literature.