Prognostic significance of serum galectin-3 in hospitalized patients with COVID-19.

BACKGROUND: There are no major tools that could predict disease severity in COVID-19. The aim of this study is to evaluate if serum galectin-3 levels can identify disease progression in COVID-19. METHODS: Patients that were hospitalized due to COVID-19 between March and June 2020 were included in this cross-sectional prospective study. Baseline demographic and clinical data in addition to levels of serum parameters including galectin-3 were measured at the time of hospital admission. Patients with COVID-19 were categorized into two groups (non-severe and severe illness). The need for ICU during hospital stay, duration from hospital admission to the transfer to the ICU, and the total length of hospital stay were recorded. RESULTS: A total of 175 patients were included in the study and among these, 64 patients formed the severe illness group whereas 111 comprised the non-severe illness group. There was statistically significant difference in terms of galectin-3 levels between groups (1.07 ± 0.75 vs 0.484 ± 0.317, p < 0.0001, respectively). Our results showed that galectin-3, IL-6 and CRP levels at admission were independent risk factors associated with transfer to the ICU whereas only galectin-3 was an independent factor for the need for advanced ventilatory support. Also, galectin-3 and IL-6 were independent risk factors related to in-hospital mortality. CONCLUSION: In conclusion, our results indicated that galectin-3 had moderate power in outlining disease severity and the need for ICU transfer throughout the clinical course in COVID-19.

Chronic inflammation in adult familial Mediterranean fever patients: underlying causes and association with amyloidosis.

Background: Chronic inflammation, as determined by persistently elevated acute-phase reactants in attack-free periods, can occasionally be observed in patients with familial Mediterranean fever (FMF) and is suggested to be a risk factor for the development of amyloidosis. We aimed to investigate the underlying causes of chronic inflammation in FMF patients and its association with amyloidosis in long-term follow-up. Method: Electronic medical records of FMF patients who had regular follow-up for ≥ 5 years in our cohort were utilized. As part of routine evaluation, detailed history, physical examination, and pertinent laboratory and radiographic investigations were performed in all patients to determine potential causes of elevated C-reactive protein (CRP) levels. Results: The study included 146 FMF patients who had no evidence of amyloidosis at baseline and had regular follow-up for ≥ 5 years. Thirty-seven patients (25.3%) were found to have chronic inflammation in the disease course. Twenty-five (67.5%) of them had either very frequent attacks or chronic manifestations of disease. In the entire study group, amyloidosis developed in five patients (3.42%) during the 5 year follow-up, four in the FMF with chronic inflammation group (10.8%), and only one of the 109 patients without chronic inflammation (odds ratio 13.09, 95% confidence interval 1.41-121.2). Conclusions: The results suggest that persistently high CRP levels during the attack-free periods may be a strong risk factor for the development of amyloidosis in patients with FMF. The vast majority of FMF patients with chronic inflammation had active FMF.

Lateral sided trocar site hernia following laparoscopic hernia repair: results of a long-term follow-up.

PURPOSE: Trocar site hernias (TSH) at the umbilical site following laparoscopic cholecystectomy forms the majority of the studies about TSH and there is a missing data in literature about lateral sided TSH. We aimed to evaluate the incidence and factors affecting lateral sided TSH occurrence following laparoscopic abdominal wall hernia repair (LAHR). METHODS: Patients who underwent LAHR between March 2013 and 2015 were included in the study. Open approach with blunt dissection for optical trocar insertion and z-shaped suture for closure were used in 22 cases initially (Group 1). Sharp dissection and continuous suture for closure were used for the rest of the patients (Group 2). RESULTS: 285 patients-237 females (83.2%) and 48 males (16.8%)-with a mean age of 50.14 ± 12.03 were included in the study. Most of the patients were overweight or obese and mean BMI was 29.25 ± 5.04 kg/m2. BMI was significantly higher in patients with TSH (p:0.025) and TSH occurrence is significantly higher in Group 1 patients (p < 0.001). CONCLUSIONS: Trocar insertion and closure technique have a major role in lateral sided TSH occurrence. Trying to avoid blunt dissection during trocar insertion, closure of trocar site with continuous suture and enlargement of skin incision to provide good view decreases lateral sided TSH occurrence. In addition, increase at the level of BMI has increased the probability of TSH occurrence and further studies are needed to evaluate efficiency of prophylactic prosthetic closure for obese patients.

Anal melanoma: Outcomes of current surgical approaches.

AIM: In this study, we aimed to evaluate the clinical characteristics and outcomes of the patients with anal melanoma (AM), who underwent surgical treatment. MATERIALS AND METHODS: This study was conducted in Kartal Training and Research Hospital between January 2010 and December 2017. All patients, who underwent surgical resection with a diagnosis of AM, were enrolled. RESULTS: A total of 10 patients were examined, 8 of them were females, and their average age was 69.2 years (range, 47-85 years). Abdominoperineal resection (APR) was performed in five (50%) patients, and local excision (LE) was performed in other five (50%) patients. Three patients (30%) had stage I disease, two (20%) had stage II disease, and five (50%) had stage III disease. All five patients in APR group had stage III disease. In the comparison of the survival period after surgery, the mean survival period of the APR group was 6.2 months (range, 1-16 months) while that of the LE group was 19.6 months (range, 7-43 months). CONCLUSION: LE with adjuvant radiation seems to offer good locoregional control without reducing the survival and may be an option of treatment for patients with small, superficial AM. However, APR should be offered for patients with locally advanced disease or as a salvage following recurrence.

Early Allograft Function in Renal Transplant Recipients: Is it Affected by Volatile Anesthetics?

BACKGROUND: Different inhalational anesthetics have various hemodynamic effects, either on the global circulation or on renal perfusion. The purpose of the current retrospective, single-center study was to evaluate allograft function of renal transplant recipients after transplantation surgery under either sevoflurane or isoflurane anesthesia. METHODS: From January 2004 through February 2014, a total of 240 patients undergoing renal transplantation were retrospectively enrolled in this study. The recipients were categorized into a sevoflurane or isoflurane group based on the type of volatile anesthetic used. The evaluated outcomes were serum urea and creatinine values and volume of diuresis at day 14 after transplantation. RESULTS: There were no differences between the 2 anesthesia groups regarding age, gender, duration and etiology of end-stage renal disease, duration and type of dialysis regimen, and source of transplantation (living or cadaveric). Length of hospitalization was higher in the sevoflurane group when compared with the isoflurane group (21.64 ± 11.55 days vs 17.35 ± 8.06 days; P = .033). Similarly, the sevoflurane group had more postoperative complications then the isoflurane group. Although serum creatinine levels were similar between the 2 groups, the serum level of urea was higher (89.56 ± 47.60 mg/dL vs 76.85 ± 65.42 mg/dL; P = .038) and the volume of diuresis was lower (3718.00 ± 2558.94 mL/24 hours vs 4991.25 ± 2861.90 mL/24 hours; P = .042) in the sevoflurane group when compared with the isoflurane group. CONCLUSION: Our data seem to suggest a potential role of isoflurane for improving allograft function and reducing complications more safely than sevoflurane as a volatile anesthetic in patients undergoing renal transplantation.

Lichtenstein or darn procedure in inguinal hernia repair: a prospective randomized comparative study.

BACKGROUND: The aim of this study was to assess the outcome of patients with inguinal hernia where the Moloney darn or Lichtenstein procedure was used as the surgical choice. METHOD: A herniorrhaphy procedure was performed in a total of 306 patients at our clinic between January 2003 and December 2008. The duration of operations and complication and recurrent rates were compared between the two groups. Hematoma formation, seroma collection, and wound infection were accepted as early complications, whereas chronic pain, loss of sensation at the operation site, and the rejection of mesh were accepted as late complications. RESULTS: Considering early complications as hematoma formation, the accumulation of seroma and wound infection ratios were similar in the two groups. Loss of sensation at the operation site and chronic pain, which were classified as late complications, were similar in the groups. However, in considering rejection, there were three rejections in the group where mesh was used. CONCLUSION: The darn repair method is simple, safe, and has similar recurrence rates when compared to the Lichtenstein method in inguinal hernia patients.

Effects of seprafilm and heparin in combination on intra-abdominal adhesions.

AIM: Postoperative intra-abdominal adhesion formation is a significant cause of morbidity. The aim of this study was to assess the effects of heparin and Seprafilm, which is considered the gold standard, on the prevention of intra-abdominal adhesions. METHOD: Four groups consisting of 25 rats each were formed. Cecal abrasion was performed in all animals. Group 1 was the control group with no treatment; in group 2, heparin was applied intraperitoneally; in group 3, Seprafilm was used underneath the abdominal wall, and group 4 animals were treated with both heparin and Seprafilm. Two weeks after the surgical procedure, animals were sacrificed and specimens were removed for the measurement of the grade of adhesions, according to the Mazuji classification. RESULTS: Formation of adhesions was prevented in the three study groups treated with heparin only, Seprafilm only and both heparin and Seprafilm (p < 0.001) compared with the control group. There was no statistical difference between the treatment groups. Autopsy results of the animals that died within the first week after the surgical procedure revealed intra-abdominal abscess formation and infections, which were considered as possible causes of death. CONCLUSION: Seprafilm seems to be more effective in the prevention of adhesions. In the combined application of Seprafilm and heparin, heparin showed no additive impact. Future studies are needed to detect the suitable dose and side effects of heparin for humans.

Liver failure in transplanted liver due to Amanita falloides.

Two patients underwent liver transplantation due to Amanita falloides poisoning. In one of them the clinical symptoms, signs, and laboratory findings related to liver failure were similar to the findings before the transplantation. The patient died and the pathological examination of the liver was similar to the patient's earlier explanted liver.

[Evaluation of patients wounded in the 17 August 1999 Marmara earthquake]. / Depremde yaralanan hastalara yaklasim: 17 Agustos 1999 Marmara depremi deneyimimiz.

This study describes the experience of Kartal Research and Training Hospital in the Marmara Earthquake. We reviewed medical records of 698 patients admitted to our hospital in a 30 days' period after the earthquake and analysed the types of injuries, treatment, morbidity and mortality rates. The hospitalized 273 patients were grouped according to the major injury; patients with crush syndrome were analysed separately. The most frequent injuries were crush injury (23.1%), extremity fractures (16.8%) and pelvis and spine injuries (16.1%). More than two system injuries were seen most frequently in the abdominal injury (45.5%), crush injury (24.4%), and pelvis and spine injury (27.3%) groups (p < 0.05). Overall mortality rate was 7.3%. The highest mortality rates were seen in the abdominal injury (27.3%) and crush injury (20%) groups (p < 0.05). 61.9% of the patients with crush syndrome underwent fasciotomy due to the compartment syndrome; hemodialysis was performed in 31 patients. The most serious problem with earthquake is organization in the earthquake area, between hospitals and in hospitals. Crush injury is the major injury seen earthquakes. Early diagnosis and proper treatment should be done to improve survival.

Renal hydatid cyst and situs inversus totalis (a case report).

Although echinococcal disease is common in some parts of the world isolated renal involvement is rare. We present a single case of a renal hydatid cyst in a patient with situs inversus totalis.

Bullet embolism of the right external iliac artery following cardiac gunshot wound (a case report).

Penetrating cardiac injury (PCI) frequently cause hemorrhage and cardiac tamponade. However peripheral embolization is very rare. In this manuscript one of the rare case of bullet embolism in the right external iliac artery, which occurred after cardiac gunshot wound is reported under the light of literature.

[Evaluation of 572 cases of blunt and penetrating thoracic trauma]. / Künt ve penetre toraks travmali 572 olgunun degerlendirilmesi.

We retrospectively evaluated 572 patients with thoracic trauma from total of 2163 trauma patients who admitted to 2nd General Surgery Emergency Service of Kartal Education and Research Hospital from January 1997 to February 2000. 501 of the patients (87.5%) were male and 71 (12.5%) were female. The range of ages 2-84 and mean age was 32.2. 337 (59%) patients had blunt and 235 (41%) had penetrating thoracic trauma. While traffic accidents (72%) were determined as the most common ethiological factor for blunt thoracic trauma, penetrating and cutting instruments injuries (82%) were the most common factor for penetrating thoracic trauma. Accompanying trauma were observed in 37.5% of cases. 332 (58%) tube thoracostomy, 185 (32.5%) conservative treatment, 41 (7.1%) thoracotomy 14 (2.4%) mechanical ventilation were carried out. The rates of mortality were 6.8% and of morbidity 3.3%. Early diagnosis and immediate appropriate treatment in thoracic trauma increases the survival.