How to reduce conjunctival cyst formation after strabismus surgery?

PURPOSE: To determine our rate of conjunctival cyst developing after strabismus surgery and to minimize its formation. MATERIALS AND METHODS: The data of 4026 eyes of 2662 patients were included in our retrospective analysis of, those that underwent strabismus surgery at the Beyoglu Eye Training and Research Hospital Strabismus Unit between 2015 and 2021. Clinical characteristics and follow-up data of patients were recorded together with age, sex, and operation type. All patients were examined postoperatively on 1st day, 1st month and 6th month. RESULTS: The mean age of the patients was 15.66 ± 11.81 (1-59 years). While two eyes were operated on in 1494 patients, one eye was operated on in 1168 patients. The surgeries performed were recession and/or resection of the horizontal and vertical rectus muscles and inferior and superior oblique procedures. The conjunctival cyst was detected in 11 patients postoperatively between 20 days and 8 months. The cyst was detected on the nasal side in 7 cases and temporal in 4. CONCLUSION: Conjunctival cyst is a rare complication after strabismus surgery and it is thought to be caused by a proliferation of the conjunctival epithelium. In addition to proper closure of the conjunctiva, attention to personal hygiene, avoidance of contacts that may increase suture contamination, and attention to the fact that the operation period is not long are actions that can help prevent conjunctival cyst formation.

Influence of colonic mesenteric area on the number of lymph node retrieval for colon cancer: a prospective cohort study.

PURPOSE: The minimum harvested 12 lymph nodes (LNs) is regarded as the limit for accurate staging of nodal status in colorectal cancer patients. Besides the association of the lengths of resected intestinal segments and vascular pedicles, the mesocolic mesenteric area's impact on LN count has not been studied. We aimed to evaluate the associations between metric variables, including the mesocolic mesentery area on the nodal harvest. METHODS: All consecutive patients who underwent elective colectomy with a curative intention for colon adenocarcinoma were prospectively included. The metric variables included the lengths of resected intestinal segments, vascular pedicle, and colonic mesenteric area. The variables influencing the LN count and the correlation between the total LN count and the specimens' relevant metric measurements were analyzed. RESULTS: There were 46 patients with a median age of 64 years. The median count for total LNs was 22, and the LN positivity was 59.2%. There was an inadequate LN yield (<12) in 3 patients (6.1%). No significant associations were found between the adequacy of nodal harvest and the demographic, clinical, and tumoral features (P>0.05). There were significant positive correlations between total LN number and length of vascular pedicle and mesenteric area (r=0.576, P<0.001 and r=0.566, P<0.001). CONCLUSION: The length of the vascular pedicle and mesenteric area were significantly correlated with total LN counts. Although there was no significant impact on the length of resected segments, the colonic mesenteric area can be used alone as a measure for the assessment of the nodal yield in colon cancer.

Effect of glutamine use on the formation of intestinal neomucosa on peritoneal surface in rats.

BACKGROUND: Short bowel syndrome (SBS) is a clinical condition with high mortality and morbidity, which leads to the lack of absorption of fluids or nutrients necessary for the body due to the decrease in the length of the small bowel (SB). Glutamine is an amino acid essential for the nutrition and proliferation of intestinal mucosa cells. The main aim of the present study was to investigate the effect of glutamine on intestinal neomucosa formation in rats which developed SBS. METHODS: Sixteen Wistar Hannover rats were randomly divided into two groups of eight rats. Saline was applied to the rats in Group 1 (control) following the enteroperitoneal anastomosis between mucosal surface of the ileum and the parietal peritoneum surface (adherent to abdominal wall) while glutamine was applied to the rats in Group 2 following the same anastomosis. Fourteen days later, the rats were euthanatized and blood samples were taken. Simultaneously, en bloc resection of the anastomosis part was performed and histopathological examination was carried out to observe neomucosa formation. The effects of glutamine on anastomosis were determined by microscopic and biochemical evaluations. RESULTS: Biochemical analyses were performed by measuring serum oxidant (malondialdehyde [MDA] and 8-hydroxy-2'-deoxyguanosine [8-OHdG]) and antioxidant (superoxide dismutase [SOD] and glutathione peroxidase [GPx]) parameters. Based on the biochemical evaluation results of the antioxidant values of the control and glutamine groups, it was found that while the serum antioxidant level (SOD and GPx activity) was significantly higher (p<0.05) in the glutamine-administered rats compared to the control group, the oxidative damage (MDA and 8-OHdG) was lower (p<0.05). In terms of the histological evaluations made for the neomucosa formation, the number of neomucosa formation was higher in the glutamine group, but the difference was not significant (p=0.315). CONCLUSION: The use of glutamine in patients with SBS may increase surface absorption by increasing neomucosa formation. However, additional studies of large statistical power are needed.

90-day readmission rates after cholecystectomy: A retrospective cohort study.

OBJECTIVE: Although readmission after surgical procedures has been recognized as a new problem, its association with cholecystectomy has not been solved. We aimed to investigate the rate of unplanned readmission after cholecystectomy and to evaluate the reasons and outcomes in these patients. METHODS: All consecutive patients who underwent open and laparoscopic cholecystectomy were retrospectively evaluated. Hospital readmission within the post-operative first 90 days after the procedure was searched. The rate and reasons for hospital readmission were the primary outcomes. RESULTS: There were 601 patients with a mean age of 53.2 ± 12.4 years. The rate of readmission was 6.16%. Obesity (p = 0.001), number of coexisting disease (p = 0.039), conversion to open surgery (p = 0.002), development of intraoperative complications (p < 0.001), use of drain (p = 0.001), and length of hospital stay > 1 day (p = 0.024) were significantly associated with higher readmission rates. Biliary surgical causes were detected in five patients (12.8%). Non-biliary surgical causes were seen in 34 patients (87.2%). Among these, post-operative pain, nausea, and vomiting were the most common diagnoses in 25 (67.6%) and 5 patients (12.8%). CONCLUSION: The readmission rate after cholecystectomy is low. Significant predictive factors may help physicians to be alerted during the discharge of the patients. Post-operative pain, nausea, and vomiting were the most common diagnoses.

OBJETIVO: Aunque el reingreso hospitalario posterior a la cirugía se reconoció como un problema nuevo, su asociación con la colecistectomía no ha sido resuelta. Nuestro objetivo fue investigar la tasa de reingreso al hospital no planificado después de la colecistectomía y evaluar las razones y los resultados en estos pacientes. MÉTODOS: Todos los pacientes consecutivos que se sometieron a colecistectomía abierta y laparoscópica fueron evaluados retrospectivamente. Se investigó el reingreso al hospital dentro de los primeros 90 días postoperatorios. La tasa y las razones de la readmisión hospitalaria fueron los resultados primarios. RESULTADOS: Se examinaron 601 pacientes con una edad media de 53.2 ± 12.4 años. La tasa de reingreso fue del 6.16%. Obesidad (p = 0.001), número de enfermedades coexistentes (p = 0.039), conversión a cirugía abierta (p = 0.002), desarrollo de complicaciones intraoperatorias (p < 0.001), uso de drenaje (p = 0.001) y longitud de estancia hospitalaria > 1 día (p = 0.024) se asociaron significativamente con tasas más altas de reingreso. Se detectaron causas quirúrgicas biliares en cinco pacientes (12.8%). Se observaron causas quirúrgicas no biliares en 34 pacientes (87.2%). Entre estos, el dolor postoperatorio, las náuseas y los vómitos fueron los diagnósticos más comunes en 25 (67.6%) y 5 pacientes (12.8%). CONCLUSIÓN: La tasa de reingreso después de la colecistectomía es baja. Factores predictivos significativos pueden ayudar a los médicos a estar alertas durante el alta de los pacientes. El dolor postoperatorio, las náuseas y los vómitos fueron los diagnósticos más frecuentes.

Curcumin Enhanced the Neomucosa Formation by Mediating the Antioxidation Mechanism in Rats.

Objectives: The purpose of the study was to examine the possible effects of curcumin on the formation of neomucosa in parietal peritoneum which was applied as a patch for terminal ileal defect in rats. Methods: Sixteen male Wistar Hannover rats were split into two groups. The control group was injected with saline and curcumin (2 mL/kg/day, by gavage) was given to the experimental group. In both groups, amounts of 8-hydroxy-2'-deoxyguanosine (8-OHdG) and malondialdehyde (MDA), the activities of glutathione peroxidase and superoxide dismutase were determined in serum. The development of neomucosa formation was examined morphologically. Results: Serum antioxidant levels and glutathione peroxidase activity in rats given curcumin were significantly higher than those of the control group (p<0.05). The levels of oxidative markers (MDA and 8-OHdG) in rats given curcumin were significantly lower than those of the control group (p<0.05). In the histopathological examination, 62.5% of rats in the curcumin group showed formation of neomucosa while 37.5% of control rats showed neomucosa. Conclusion: The use of curcumin in rats with terminal ileal defect enhanced the formation of neomucosa by decreasing the oxidation level and increasing the antioxidation level. Curcumin may be used in the patients with short bowel syndrome to increase the absorption surface area.

Infantil Acute Hemorrhagic Edema in a Neonate: A Case Report.

Acute infantile hemorrhagic edema is a rare leukocytoclastic vasculitis with symptom triad of fever, large purpuric skin lesions, and edema. The major features are an ecchymotic purpura, an inflammatory edema of the limbs and face. It is a benign condition with a dramatic onset, resolves spontaneously and completely within 1-3 weeks, and is seen in children younger than 3 years of age. We would like to detail a newborn with acute infantile hemorrhagic edema, as it is a rare disease in childhood, especially in the neonatal period.

Association of Preoperative Risk Factors and Mortality in Older Patients following Emergency Abdominal Surgery: A Retrospective Cohort Study.

BACKGROUND: Older patients undergoing emergency laparotomy have high morbidity and mortality rates. Preoperative risk assessment with good predictors is an appropriate measure in this population. Frailty status is significantly associated with postoperative outcomes in older adults. This study aimed to investigate the effect of preoperative risk factors and frailty on short-term outcomes following emergency surgery for acute abdomen in older patients. METHODS: This study included older patients (≥65 years of age) who underwent emergency abdominal surgery. We retrospectively analyzed their demographic and clinical variables and used the modified Frailty Index-11 to evaluate their frailty status. The primary outcome was the 30-day mortality rate. We also analyzed risk factors of mortality in these patients. RESULTS: The study included 150 patients with a median age of 74 years. The mortality rate was 17.3% (n=26). We observed significantly higher mortality rates in patients who were obese and who had higher American Society of Anesthesiology (ASA grades) (p<0.05). Frailty status was worse in deceased group (p<0.001), when compared to individuals who survived. Septic shock was associated with the development of mortality (p<0.001). Multivariate regression analysis revealed that ASA grade was the only independent risk factor for mortality (odds ratio=19.642; 95% confidence interval, 3.886-99.274; p<0.001). CONCLUSION: Older patients with obesity and frailty presenting with higher ASA grades and septic shock had the worst survival following emergency abdominal surgery. The ASA grade was an independent risk factor for mortality.

Impact of Ultrasonographic Features for Thyroid Malignancy in Patients With Bethesda Categories III, IV, and V: A Retrospective Observational Study in a Tertiary Center.

INTRODUCTION: Although fine-needle aspiration biopsy (FNAB) with cytologic interpretation using the Bethesda System for Reporting Thyroid Cytopathology has been widely used for thyroid nodules, its efficiency in Bethesda categories of III, IV, and V has been questioned due to variable risk of malignancy. We aimed to evaluate the impact of radiological parameters in Bethesda category III, IV, and V for thyroid malignancy. METHODS: We performed a retrospective review of patients with Bethesda category III, IV, and V, and subsequent thyroidectomy. Demographic, ultrasonographic, and clinical variables were recorded. Independent variables for thyroid malignancy and the predictive power of imaging findings were analyzed. RESULTS: There were 159 patients with a mean age of 48.1±13.4 years. Hypoechogenicity of the index nodule was the most common finding in 87 patients (54.7%). There were 74 (46.5%), 34 (21.4%), and 51 patients (32.1%) with Bethesda III, IV, and V categories, respectively. There were 91 patients (57.2%) with a diagnosis of thyroid malignancy. Overall malignant pathology was detected in 18 (24.3%), 25 (73.5%), and 48 patients (94.1%) in Bethesda III, IV, and V categories, respectively (p=0.001). The presence of solitary nodule, hypoechogenicity, and solid structure of index nodule and Bethesda category IV and V were significant variables for final malignant pathology (p<0.05 for all). CONCLUSION: Hypoechogenicity and solid structure in a solitary index nodule should be regarded as significant ultrasonographic findings for thyroid malignancy. Bethesda category IV and V were also significantly associated with malignancy.

Predictive value of ultrasonography and magnetic resonance cholangiopancreatography in the diagnosis of biliary obstruction.

OBJECTIVE: Use of diagnostic tools with high predictive value for common biliary duct (CBD) obstruction has the potential to provide valuable information. This study aimed to examine the respective diagnostic values of biochemistry, abdominal ultrasonography (US), and magnetic resonance cholangiopancreatography (MRCP) in patients with suspected biliary obstruction. MATERIALS AND METHODS: A total of 119 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) based on a suspicion of CBD obstruction were included. Patients also had data for biochemical and hematologic tests, abdominal US and MRCP. The respective sensitivity, specificity, negative predictive value, and positive predictive value of US, MRCP, and the laboratory parameters in the diagnosis of ERCP-confirmed CBD obstruction were estimated. RESULTS: ERCP did not show obstruction in 15.1% of the cases. Based on 95% confidence intervals, MRCP had greater sensitivity than ultrasound in predicting obstruction (95% vs. 62%). In addition, ultrasound had a very high 31.9% false negative rate when compared to MR (4.2%). On the other hand, a combined approach had better diagnostic value. None of the laboratory parameters exhibited a predictive value. However, old age was significantly associated with biliary obstruction. CONCLUSION: MRCP, particularly when combined with ultrasound, is a useful diagnostic tool for the diagnosis of common biliary duct obstruction and may have the potential to eliminate the need for further ERCP in some patients. On the other hand, US alone does not seem to have acceptable diagnostic value. Further large and prospective studies are warranted to draw firm conclusions. KEY WORDS: Biliary Obstruction, Endoscopic Retrograde Cholangiopancreatography (ERCP), Magnetic Resonance Cholangiopancreatography (MRCP), Ultrasonography.

The appearance of free-air in the abdomen with related pneumatosis cystoides intestinalis: Three case reports and review of the literature.

INTRODUCTION: Pneumatosis sistoides intestinalis (PSI) is a rare condition with unknown origin, defined as the appearance of gas-filled cysts in the intestinal wall. It usually occurs due to respiratory infections, tumor or collagen disease, traumas, immunosuppression. PRESENTATION OF CASE: Three patients with PSI were examined that followed up and treated in our clinic. The first patient was hospitalized for emergency treatment of previously diagnosed free-air under the diaphragm. He had a defense on physical examination and free-air was detected in X-ray and abdomen CT. We decided to laparatomy and peroperatively, stenotic pylorus with an abnormally increased stomach and gas-filled cysts were seen in the terminal ileum. Antrectomy and gastrojejunostomy with partial ileum and cecum resection and end ileostomy were performed. The second patient underwent laparatomy because of intraperitoneal free-air and acute abdomen. Partial ileum and cecum resection and ileotransversostomy were performed. The third patient with intraperitoneal free-air was treated with antibiotics, oxygen treatment and bowel rest. DISCUSSION: PSI is usually asymptomatic. Plain radiographs, USG, CT, upper gastrointestinal endoscopy, colonoscopy can use for diagnosis. Treatment of PSI depends on the underlying cause; include elemental diet, antibiotics, steroids, hyperbaric oxygen therapy and surgery. CONCLUSION: In patients with asymptomatic and symptomatic PSI are different treat. Symptomatic PSI can be safely treated antrectomy and gastrojejunostomy with partial ileum and cecum resection.