Emergency/Elective Surgery and Emergency Percutaneous Interventions in Liver Hydatid Cysts and Their Results.

BACKGROUND: Hydatid cyst may remain asymptomatic for several years or may become complicated. The aim of this study is to evaluate the patients who were operated on for liver hydatid cyst in our clinic and the results of preoperative or postoperative complications. METHODS: The data of 836 patients who underwent surgery (n = 750) or Puncture, Aspiration, Injection, and Re-aspiration (n = 86) for hydatid cyst disease in our clinic between January 2006 and January 2021 were evaluated retrospectively. RESULTS: Surgical operation was performed in 750 of the patients and Puncture, Aspiration, Injection, and Re-aspiration procedure was performed in 89 of the patients. In the surgery and Puncture, Aspiration, Injection, and Re-aspiration group, respiratory distress, anaphylaxis, allergic rash, and urticaria were observed in 11 patients (8 in Puncture, Aspiration, Injection, and Re-aspiration group and 3 in open surgery group). All patients recovered with emergency medical interventions. Recurrence was observed after the percutaneous procedure in 11 cases and after surgery in 36 cases. There was no statistically significant difference between the surgical and Puncture, Aspiration, Injection, and Re-aspiration groups in terms of recurrence and cyst infection (P = .253 and P = .547, respectively). The incidence of the development of intrabiliary rupture, allergic reaction, and intraperitoneal rupture was found 135 (16.14%), 12 (1.43%), and 2 (0.23%) in our study, respectively. CONCLUSIONS: Intraperitoneal or intrabiliary rupture is a rare but fatal complication of hydatid cyst. The presence of fever, jaundice, abdominal pain, urticaria, and anaphylactic reactions in endemic areas should take the suspicion of hydatid cyst rupture. The timing of surgery is an important factor affecting morbidity and mortality. Detailed exploration of the abdomen in emergency surgery for rupture hydatid cyst is essential for recurrence.

Early post-operative morbidity and mortality predictors in peptic ulcer perforation.

BACKGROUND: Peptic ulcer perforation (PUP) is one of the cause of acute abdomen, incidence of this entity is 5% of all abdominal emergencies. Numerous prognostic factors have been reported for morbidity and mortality after PUP, this study attempts to analyze the factors affecting mortality and morbidity in patients with PUP. METHODS: The medical record of patients who were operated for PUP in our clinic was retrospectively evaluated between January 2008 to January 2018. A total of 318 patients were included in this study. Patients were retrospectively analyzed in terms of age, gender, comorbidity, ASA score, biochemical, hematological parameters, complications, and mortality. The risk factors affected to morbidity and mortality were also evaluated. RESULTS: The study population consisted of 318 patients and the mean age of the patients was 41.30±19.37 (min-max: 16-89). In the study, 271 (85.22%) patients were male and 47 (14.78%) were female and male to female ratio was 5.76. In the analysis of the predictors of morbidity, age ≥60 years, (p<0.001); perforation-surgery interval >24 h (p<0.001); purulent intraperitoneal contamination (p<0.001); pre-operative renal failure (p<0.001); duodenal perforation (p<0.001); pre-operative shock (p<0.001); and ASA score > III (p<0.0001) were found statistically significant. Gender was not found statistically significant (p=0.672). Mortality developed in 15 (4.71%) of 318 patients in the post-operative period. In the multivariate analysis, age ≥60 years, (p<0.001); perforation-surgery interval >24 h (p<0.001); purulent intraperitoneal contamination (p<0.001); pre-operative renal failure (p<0.001); duodenal perforation (p<0.001); and pre-operative shock (p<0.001) were found to be independent predictors of post-operative mortality. CONCLUSION: In our study, age ≥60 years, perforation-surgery interval >24 h, purulent intraperitoneal contamination, pre-oper-ative renal failure, duodenal perforation, pre-operative shock, and intensive care unit in the post-operative period were found to be independent predictors of post-operative morbidity and mortality. A comprehensive clinical evaluation, adequate fluid resuscitation, initiation of appropriate antibiotic therapy, and early access to surgery can minimize the risk of morbidity and mortality in PUP.

The Utility of Immature Granulocyte Count and Percentage on the Prediction of Acute Appendicitis in the Suspected Acute Appendicitis According to the Alvarado Scoring System: A Retrospective Cohort Study.

BACKGROUND: This study aimed to investigate the utility of immature granulocyte count and percentage on the prediction of suspected acute appendicitis according to the Alvarado scoring system and its effect on the need for computed tomography scanning. METHODS: Adult patients who had an Alvarado scoring system between 4 and 7 with the first imaging technique computed tomography were included and retrospectively analyzed. The immature granulocyte count and granulocyte percentage were obtained from the blood samples taken at the time of the patient's first admission to the hospital. RESULTS: A total of 652 patients were evaluated and 186 patients were included in the study. Acute appendicitis was not detected in computed tomography imaging of 121 (65%) patients (group N) and detected in 65 (35%) patients (group P). The mean immature granulocyte percentage in group N and group P were 0.314 ± 0.188 (0.00-1.40) and 0.364 ± 0.205 (0.05-1.00), respectively. The mean immature granulocyte percentage was similar between groups (P = .095). The mean immature granulocyte count was 33 ± 46/µL (0-50) in group N and 60 ± 85/µL (10-690) in group P. Immature granulocyte count was significantly higher in group P (P = .005). Univariate analysis results revealed that age and immature granulocyte percentage were not predictive factors for the presence of acute appen- dicitis in suspected cases (P > .05). On the other hand white blood cell, neutrophil-lymphocyte ratio, C-reactive protein, and immature granulocyte count were determined as predictive factors in univariate analysis and multivariate analysis. Receiver operating character- istic curve analysis of preoperative immature granulocyte percentage and immature granulocyte count values in the diagnosis of acute appendicitis: the cut-off value of immature granulocyte percentage was ≥0.35 and its sensitivity, specificity, positive predictive value, and negative predictive value were 44.1%, 72.1%, 71.1%, and 41.5%, respectively (area under the curve: 0.588; CI: 0.484-0.682). The cut-off value of immature granulocyte count was ≥35/µL and its sensitivity, specificity, positive predictive value, and negative predictive value were 66.1%, 73.6%, 71.9%, and 67.7%, respectively (area under the curve: 0.743; CI: 0.659-0.827) Conclusion: Immature granulocyte count is a predictive factor for acute appendicitis in patients with the middle-risk group according to the Alvarado score and may be useful for the selective use of tomography.

The effects of carnosine in an experimental rat model of septic shock.

BACKGROUND: To examine the effect of carnosine on liver function and histological findings in experimental septic shock model, 24 Sprague-Dawley rats were used. MATERIAL/METHODS: Rats were divided into control, septic shock, and carnosine-treated septic shock groups. Femoral vein and artery catheterization were performed on all rats. Rats in the control group underwent laparotomy and catheterization; in the test groups, cecal ligation-perforation and bladder cannulation were added. Rats in the treatment group received a single intraperitoneal (IP) injection of 250 mg/kg carnosine 60 minutes after cecal ligation-perforation. Rats were monitored for blood pressure, heart rate, and body temperature to assess the postoperative septic response, and body fluids were replaced as necessary. At the end of 24 hours, rats were sacrificed and liver samples were collected. RESULTS: Statistically significant improvements were observed in liver function, tissue and serum MDA levels, and histological findings in rats treated with carnosine, compared to rats with untreated sepsis. HB and HCT values did not change significantly during the course of the experiment. Rats exposed to septic shock and treated with carnosine exhibited decreased sinusoidal dilatation and cellular inflammation into the portal region, compared to the sepsis group; the livers of rats in this group had near-normal histological structure. CONCLUSIONS: We conclude that carnosine may be an effective treatment for oxidative damage due to liver tissue perfusion defects in cases of septic shock.