[Intussusception in adults]. / Eriskinlerde invajinasyon.

BACKGROUND: Adult intussusception is an unusual entity, and its etiology differs from that in pediatric patients. The purpose of this study was to determine the causes and management of intussusception in adults. METHODS: A retrospective review of patients with a diagnosis of gastrointestinal intussusception between 1986 and 2006 was conducted. All patients under the age of 18 and cases with rectal, ostomy, or gastroenterostomy prolapse were excluded. RESULTS: There were 28 cases of adult intussusception. Mean age was 38.6+/-16.7 years. A preoperative diagnosis of intussusception was made in 53.5% of the cases. There were 23 enteric, three colonic and two ileocolic intussusceptions. A lead point was identified in 25 patients (89.3%). Invagination was due to benign causes in 19 patients, malignant causes in six patients and idiopathic in three patients. Complication was seen in three (10.3%) cases. CONCLUSION: In this series, the mean age of the patients was younger than in the literature. Since intussusception was due to small bowel pathologies, the proportion of benign/malignant lesions favored benign lesions. Although it is encountered rarely in adults, physicians should be aware of invagination and consider it in each case of acute abdomen because of the wide spectrum of the clinical settings.

Factors affecting mortality of Fournier's gangrene: review of 70 patients.

BACKGROUND: Fournier's disease is a potentially fatal, acute, gangrenous infection of the scrotum, penis or perineum associated with a synergistic bacterial infection of the subcutaneous fat and superficial fascia. METHODS: The clinical records of 70 patients treated for Fournier's gangrene were evaluated retrospectively to determine prognostic indices and to stress Fournier's Severity Index (FSI), influencing outcome. RESULTS: The mortality rate in this study was 22.8%. Length of the hospitalization time and FSI were detected as effective factors on mortality of Fournier's gangrene (P < 0.05) by Binary Logistic Regression analysis and the area under the receiver operating characteristic curve of these variables was also found to be significant (P < 0.001). The average FSI was determined as 4.66 +/- 2.31 in survivors and 11.56 +/- 2.68 in non-survivors and 5.11 +/- 2.83 in patients with primary genito-urinary infection but 7.56 +/- 4.35 in primary anorectal infection. The FSI was also found predictive of hospitalization time and number of debridements among survivors. CONCLUSION: Fournier's Severity Index is a simplified way of comparing patients with this disease and may also have some significance in predicting outcome. The FSI is a more significant and predictive tool that should be popularized to predict the prognosis in Fournier's gangrene.

L-carnitine has a protective effect on the colonic mucosa during abdominopelvic radiotherapy in rats.

PURPOSE:: To evaluate histopathologically the radioprotective effect of L-carnitine on the colonic mucosa in rats undergoing abdominopelvic irradiation. METHODS:: Thirty-two rats were randomly assigned to four experimental groups: intraperitoneal administration of normal saline (group 1) or L-carnitine (300 mL/kg; group 2), followed in groups 3 and 4, respectively, by one dose of abdominopelvic radiation (20 Gy) 30 min later. Rats were sacrificed 5 days after radiation, and their descending colons were resected for histopathological evaluation of the presence and severity of damage. RESULTS:: Average damage scores did not differ significantly between groups 1 and 2 (0.13 ± 0.35 and 0.25 ± 0.46, respectively); the group 3 score was highest (10.25 ± 0.71), and the group 4 score (3.63 ± 1.41) was significantly lower than that of group 3 (both p = 0.0001). Pre-radiation L-carnitine administration significantly reduced mucosal thinning, crypt distortion, reactive atypia, inflammation, cryptitis, and reactive lymph-node hyperplasia (all p < 0.01). CONCLUSIONS:: L-carnitine had a radioprotective effect on rat colonic mucosa. L-carnitine use should be explored for patients with gastrointestinal cancer, who have reduced serum L-carnitine levels.

[Factors affecting mortality in Fournier's gangrene]. / Fournier kangreninde mortaliteye etkili faktörler.

BACKGROUND: Fournier's gangrene is the most serious and life threatening infection. The aim of this retrospective study is to describe effective factors on mortality in Fournier's gangrene. METHODS: Thirty three patients with Fournier's gangrene were investigated retrospectively. The variables such as age, gender, etiological and predisposing factors, symptoms, physical signs, intervals between symptoms and hospital admission, laboratory findings, types of microorganisms isolated from the wound scrapings, the number of surgical debridements, the length of hospitalisations were evaluated and their effects on mortality were analysed. The diagnosis of Fournier's gangrene was established with a detailed anamnesis nad physical examination. Ultrasonographic (US) and computerized tomographic examinations were performed in case of suspected involvement of adjacent tissues. RESULTS: The overall mortality rate was 33.3% in this series. The median duration of symptoms was 6.5 days in patients who survived and 10 days in patients who died (p<0.05). Only the increase in mortality in the presence of tachycardia and anaemia were was statistically significant. CONCLUSION: It was concluded that early diagnosis, stabilization of hemodynamic status, repeated debridements of whole necrotic tissue combined with antibiotherapy, before establishment of anemia and tachicardia due to multiple organ failure, might decrease mortality in patients with Fournier's gangrene.

Efficiency of obliteration procedures in the surgical treatment of hydatid cyst of the liver.

BACKGROUND: Hydatid cyst of the liver (HCL) is a parasitic infestation caused by several species of Echinococcus and is endemic in many sheep-raising areas. The aim of the present study is to evaluate the value of clinical, physical and laboratory findings and to discuss the diagnostic and therapeutic options in 250 patients with HCL. METHODS: Between January 1980 and December 1989, 148 patients with HCL were treated surgically, and surgical procedures performed were evaluated retrospectively. On the basis of these findings, a prospective study of 102 patients was initiated between January 1990 and December 1999. RESULTS: External drainage was performed in retrospective and prospective groups, respectively, in 110 and five patients, obliteration procedures in 31 and 82 and resectional procedures in seven and 15. While mean hospitalization time morbidity, mortality and recurrence rates were 16.2 +/- 6.9 days, 37.8%, 2.0% and 6.7% in the retrospective group, these rates were decreased to 7.8 +/- 3.5 days, 10.7%, 0.9% and 1.9%, respectively, in the prospective group. Overall morbidity, mortality and recurrence rates and median hospitalization time were 49.5%, 2.6%, 9.5% and 18.0 +/- 7.4 days in external drainage group, 7.0%, 0% 0.8% and 8.5 +/- 4.5 in obliteration procedures and 9.0%, 4.5%, 0% and 7.3 +/- 1.9 resectional procedures, respectively. CONCLUSIONS: External drainage should be performed only in infected HCL. Resection procedures are too radical and extensive for benign lesions. Obliteration procedures are simple and safe methods for the treatment of HCL, and they have low morbidity, mortality and recurrence rates.

Involution of multicystic dysplastic kidney: is it predictable?

OBJECTIVE: To evaluate the clinical course of multicystic dysplastic kidney (MCDK) and to reveal any criteria indicating spontaneous involution. MATERIAL METHODS: Hospital records of patients with MCDK followed in two different institutions in 1994-2009 were reviewed and data were analyzed regarding involution. RESULTS: Records of 96 patients were reviewed, of whom 46 were diagnosed antenatally and followed for more than 1 year. Fourteen patients had undergone nephrectomy. There was one case of hypertension which resided with nephrectomy. There was no malignancy. Involution rate was 53.6% (15/28) for right-sided and only 16.7% (3/18) for left-sided kidneys. The initial size of the kidney was found to be another predictive parameter for involution. Initial sizes of 43 (15 involuted and 28 non-involuted) kidneys were documented. Mean standard deviation score for involuting and non-involuting kidneys was -3.19 and 3.12, respectively. The chance of involution for a large kidney on the left was zero; however, involution risk for a small right-sided kidney was 67%. CONCLUSION: Reviewing a 15-year period of our patient records conveyed data supporting current literature mainly encouraging non-operative management of MCDK. Further studies are required; however, our two objective indicators, the initial size and side of dysplastic kidney, may contribute to the management.

Perianal giant condyloma acuminatum-buschke-löwenstein tumor: a case report.

Condyloma acuminatum caused by Human Papillomavirus is the most commonly occurring sexually transmitted infection in the anogenital region. Buschke-Löwenstein tumor (BLT) known also as giant condyloma acuminatum is a rare disease. The disease, for which the most important treatment method is the surgical excision, differs from normal condyloma acuminatum cases with its high degree of malignancy. The purpose of this paper is to present the case that reached huge dimensions in the perianal region and that was treated with wide resection in the literature.

L-carnitine has a protective effect on the colonic mucosa during abdominopelvic radiotherapy in rats

ABSTRACT PURPOSE: To evaluate histopathologically the radioprotective effect of L-carnitine on the colonic mucosa in rats undergoing abdominopelvic irradiation. METHODS: Thirty-two rats were randomly assigned to four experimental groups: intraperitoneal administration of normal saline (group 1) or L-carnitine (300 mL/kg; group 2), followed in groups 3 and 4, respectively, by one dose of abdominopelvic radiation (20 Gy) 30 min later. Rats were sacrificed 5 days after radiation, and their descending colons were resected for histopathological evaluation of the presence and severity of damage. RESULTS: Average damage scores did not differ significantly between groups 1 and 2 (0.13 ± 0.35 and 0.25 ± 0.46, respectively); the group 3 score was highest (10.25 ± 0.71), and the group 4 score (3.63 ± 1.41) was significantly lower than that of group 3 (both p = 0.0001). Pre-radiation L-carnitine administration significantly reduced mucosal thinning, crypt distortion, reactive atypia, inflammation, cryptitis, and reactive lymph-node hyperplasia (all p < 0.01). CONCLUSIONS: L-carnitine had a radioprotective effect on rat colonic mucosa. L-carnitine use should be explored for patients with gastrointestinal cancer, who have reduced serum L-carnitine levels.

Acute appendicitis in pregnancy--risk factors associated with principal outcomes: a case control study.

BACKGROUND: The aim of this study was to determine the risk factors associated with the principal outcomes in acute appendicitis during pregnancy: appendix-perforation, and maternal and fetal mortality and maternal morbidity. METHODS: Fifty-two pregnant women who were diagnosed and operated upon acute appendicitis in Dicle University Hospital, Diyarbakir, Turkey were presented. RESULTS: The frequency of appendicitis was higher in second trimester. On laparotomy 21 patients had perforated, 29 patients had non-perforated and 2 patients had normal appendix. Interval between symptom onset and operation was found as the only predictive variable, which was independently associated with the presence of appendiceal perforation. There was a significant difference between perforated and non-perforated patients about the rate of complications (52% vs. 17%). Gestational age (p=0.036), interval between symptom onset and operation (p=0.018) and white blood cell count (p=0.025) were the variables related with preterm labor. Tocolytic treatment after the onset of contractions could not prevent preterm labor. The rate of fetal mortality was 8%. CONCLUSIONS: Presence of perforation is the only predictive factor for maternal morbidity. The aim of the surgeon should be operating the patient before perforation. An observation period may be essential in equivocal patients, but should be individualized according to duration of symptoms and findings of physical examination. The interval between the symptom onset and operation should never exceed 20 hours. Tocolytics should be ordered for the patients with delayed presentation and advanced gestational age in order to prevent preterm labor and fetal loss.

Intestinal and peritoneal tuberculosis: changing trends over 10 years and a review of 80 patients.

BACKGROUND: To establish the efficiency of minimally invasive procedures in the diagnosis and management of abdominal (intestinal and peritoneal) tuberculosis (AT), I retrospectively and then prospectively evaluated clinical, physical and laboratory findings in patients with AT at a university general-surgery clinic. Diagnostic and therapeutic options were also considered. METHODS: Data from the case records of 43 patients diagnosed with AT via laparotomy were collected and analyzed. On the basis of findings from that early analysis, a further 37 patients were studied prospectively. In the latter group, percutaneous aspiration, endoscopy and laparoscopy were used for diagnosis, except in cases with acute abdominal findings or failure of these diagnostic procedures. Morbidity and mortality rates and mean hospitalization time were evaluated for both groups. RESULTS: In the early group of 43 patients, the morbidity rate was 30%; mortality, 12%; and median hospital stay, 18.3 days (standard deviation [SD] 6.2 d). The diagnosis was confirmed by laparotomy in 18 patients in the prospective group: laparoscopy or endoscopy in 10 and percutaneous drainage of an intra-abdominal abscess in 9. Changes in our approach to diagnostic procedures in the prospective group led to decreased morbidity (11%), mortality (0) and median hospital stay (9.3 [SD 4.7] d). CONCLUSIONS: Minimally invasive procedures such as laparoscopic, endoscopic and percutaneous biopsy should be used for diagnosis of IPTB as a first step in diagnosis. Laparotomy should be performed only when complications develop or diagnosis remains unclear in spite of these diagnostic modalities.

[The factors affecting mortality in complicated emergency cases who were transferred to our center after being operated on]. / KLINIGIMIZE SEVK EDILEN POSTOPERATIF KOMPLIKE ACIL OLGULARDA MORTALITEYE ETKILI FAKTORLER.

BACKGROUND: To find out the deficiencies related to education and experience of surgeons about the surgical treatment of emergency patients, and to investigate their effects on mortality. METHODS: The records of 214 patients, who were transferred to our department after being operated with the diagnosis of abdominal trauma or acute abdomen in last 7 years, were reviewed. RESULTS: Total mortality rate was 34.1%.1t was seen that 14.5% in patients who underwent efficient surgical treatment and 42.1 % in patients whose treatment was inefficient. CONCLUSION: In centre when intensive care unit does not exist, immediately transportation of emergency operated patients with high risk will decrease morbidity and mortality rates. Participation of the surgeons who deal with emergency surgery to the post graduating courses adapting their experiences to the current improvements has also importance. Key words: Abdominal trauma, acute abdomen, postoperatively transported patients, mortality, surgery training.

[Intestinal and peritoneal tuberculosis].

BACKGROUND: Abdominal tuberculosis (tbc) is still a medical problem in developing countries. Since it imitates many abdominal diseases, diagnosis can be easily missed unless the disease is suspected. METHODS: The aim of this study to evaluate the value of clinical, physical and laboratory findings and to discuss the diagnostic and therapeutic options in 121 patients with intestinal and peritoneal tbc. The diagnosis was made by histopathological examination of biopsy material and isolation of mycobacterium bacillus in cultures or smears of ascites fluid. RESULTS: The diagnosis was confirmed with laparotomy in 102, laparoscopy in 4, colonoscopy in 6, and percutaneous aspiration in 9 patients. There were intestinal tbc in 67 (55.3%) patients and peritoneal tbc in 54 (44.6%). Intestinal involvement was commonly located at ileocecal area. Anti tuberculous chemotherapy was started and avoided from extensive resection in surgical treatment. There were a total of 87 complications in 52 patients (42.9%) at the postoperative period. Wound infection was the most frequent complication. Overall mortality rate was 13.2%. The mortality rate in emergency operation was 20.5% while 3.4% in elective conditions. There were no morbidity and mortality in patients whose diagnosis were made by conservative procedures. CONCLUSIONS: Laparoscopic endoscopic and percutaneous aspiration procedures are useful for diagnosis in the selected cases of intestinal and peritoneal tbc. Laparotomy should be performed only when complication develops or diagnosis is uncertain. Extensive resection should be avoided in surgical treatment of intestinal tbc. Early diagnosis and treatment will decrease the complications that can be develop during the progress of the disease and consequently the mortality rates.