RESIDUAL GASTRIC VOLUME IN MORBIDLY OBESE DIABETICS AFTER AN OVERNIGHT FASTING OR 3 HOURS OF A CARBOHYDRATE-ENRICHED SUPPLEMENT: A RANDOMIZED CROSSOVER PILOT STUDY.

BACKGROUND: To reduce the risk of regurgitation during anesthesia for elective procedures, residual gastric volumes (RGV) have traditionally been minimized by overnight fasting. Prolonged preoperative fasting presents some adverse consequences and has been abandoned for most surgical procedures, except for obese and/or diabetic patients. AIMS: The aim of this study was to assess the RGV in morbidly obese diabetic patients after traditional or abbreviated fasting. METHODS: This study was approved by the Ethics Committee for Research with Human Beings from the Federal University of Mato Grosso, under number 179.017/2012. This is a prospective, randomized, and crossover design study in eight morbidly obese type II diabetic patients. RGV was measured endoscopically after either traditional overnight fasting of at least 8 hours, or after abbreviated fasting of 6 hours for solids and 3 hours for a drink containing water plus 25 g (12.5%) of maltodextrin. Data were expressed as mean and range and differences were compared with paired t-tests at p<0.05. RESULTS: The study population had a mean age of 41.5 years (28-53), weight of 135 kg (113-196), body mass index of 48.2 kg/m2 (40-62.4), and type II diabetes for 4.5 years (1-10). The RGV after abbreviated fasting was 21.5 ml (5-40) vs 26.3 ml (7-65) after traditional fasting. This difference was not significant (p=0.82). CONCLUSIONS: Gastric emptying in morbidly obese diabetic patients is similar after either traditional or abbreviated fasting with a carbohydrate drink.

Residual gastric volume in morbidly obese diabetics after an overnight fasting or 3 hours of a carbohydrate-enriched supplement: a randomized crossover pilot study. / Volume gástrico residual em diabéticos obesos mórbidos após jejum noturno ou 3 horas de suplemento enriquecido com carboidratos: um estudo piloto cruzado randomizado.

RACIONAL: Para reduzir o risco de regurgitação durante a anestesia para procedimentos eletivos, os volumes gástricos residuais (VRG) têm sido tradicionalmente minimizados com jejum noturno. O jejum pré-operatório prolongado tem algumas consequências adversas e tem sido abandonado para a maioria dos procedimentos cirúrgicos, com exceção de pacientes obesos e/ou diabéticos. OBJETIVOS: O objetivo deste estudo foi avaliar o VRG em pacientes diabéticos obesos mórbidos após jejum tradicional ou abreviado. MÉTODOS Este estudo foi aprovado pelo Comitê de Ética em Pesquisa em Seres Humanos da Universidade Federal de Mato Grosso, sob o número 179.017/2012. Este é um projeto prospectivo, randomizado e cruzado em 8 pacientes diabéticos tipo II com obesidade mórbida. O VRG foi medido endoscopicamente após jejum noturno tradicional (pelo menos 8 horas) ou após jejum abreviado (6 horas para sólidos e 3 horas para uma bebida contendo água mais 25 g (12,5%) de maltodextrina). Os dados são expressos como média e variação e as diferenças foram comparadas com testes t pareados em p<0,05. RESULTADOS: A população estudada tinha 41,5 (28-53) anos de idade, peso médio de 135 (113-196) kg, índice de massa corporal (IMC) de 48,2 (40-62,4) kg/m2 e diabetes tipo II de 4,5 (1-10) anos. O VRG após o jejum abreviado foi de 21,5 (5-40) ml versus 26,3 (7-65) ml após o jejum tradicional. Essa diferença não foi significativa (p=0,82). CONCLUSÕES:  O esvaziamento gástrico em pacientes diabéticos obesos mórbidos é semelhante após jejum tradicional ou abreviado com uma bebida com carboidrato.

BACKGROUND: To reduce the risk of regurgitation during anesthesia for elective procedures, residual gastric volumes (RGV) have traditionally been minimized with overnight fasting. Prolonged preoperative fasting have some adverse consequences and has been abandoned for most surgical procedures, with the exception of obese and/or diabetic patients.  AIMS: The aim of this study was to assess the RGV in  morbidly obese diabetics patients after traditional or abbreviated fasting. METHODS: This study was approved by the Committee of Ethics in Research in Human Beings from the Federal University of Mato Grosso, number 179.017/2012. This is a prospective, randomized, and cross-over design in 8 morbidly obese type II diabetic patients. RGV was measured endoscopically after either traditional overnight fasting (at least 8 hours) or after abbreviated fasting (6 h for solids and 3 hours for a drink containing water plus 25 g (12.5%) of maltodextrin). Data are expressed as mean and range and differences were compared with paired t tests at p<0.05.  RESULTS: The study population was 41.5 (28-53) years old, with a mean weight of 135 (113-196) kg, body mass index (BMI) 48.2 (40-62.4) kg/m2, and having type II diabetes for 4.5 (1-10) years. The RGV after abbreviated fasting was 21.5 (5-40) ml vs 26.3 (7-65) ml after traditional fasting. This difference was not significant (p=0.82). CONCLUSIONS: Gastric emptying in morbidly obese diabetics patients is similar after either traditional or abbreviated fasting with a carbohydrate drink.

Predictive Factors of BK Virus Development in Kidney Transplant Recipients and the Effect of Low-Dose Tacrolimus Plus Everolimus on Clinical Outcomes.

OBJECTIVES: This study aimed to determine the predictive factors of BK virus viremia/nephropathy in kidney transplant recipients and to evaluate the effects of low-dose tacrolimus plus everolimus. MATERIALS AND METHODS: This study included 3654 kidney transplant recipients. The patients were divided into 2 groups: group 1 were BK virus negative (n = 3525, 96.5%) and group 2 were BK virus positive (n = 129, viremia 3.5%, nephropathy 1%). Predictive factors were determined by receiver operating characteristic curve analysis and logistic regression models.We also divided and analyzed patients with BK virus viremia/nephropathy into 2 groups according to immunosuppressive changes. Group 2a had been switched to low-dose tacrolimus plus everolimus (n = 54, 41.9%), and group 2b had been switched to other immunosuppressive protocols (n = 75, 58.1%). RESULTS: We found that use of anti-T-cell lymphocyte globulin and tacrolimus, deceased donor transplant, and rejection were predictive factors for BK virus viremia/nephropathy. In addition, patients who had low-dose calcineurin inhibitor plus mammalian target of rapamycin inhibitor regimens showed a low rate of BK virus development(only 6.2% of all cases). In Group 2a, both the BK polyomavirus-associated nephropathy rate (n = 23 [42.6%] vs n = 12 [16%] in group 2b; P = .001) and viral load (DNA > 104 copies/mL) (n = 49 [90.7%] vs n = 27 [36%] in group 2b; P = .001) were increased versus group 2b. Graft function, graft survival, viral clearance, and rejection rate were similar between the groups after protocol change. CONCLUSIONS: BK virus viremia/nephropathy rate was lower in patients who received low-dose calcineurin inhibitor plus mammalian target of rapamycin inhibitor protocols; the low-dose tacrolimus plus everolimus switch protocol after BK virus was more effective and safe than other protocols.

Residual gastric volume in morbidly obese diabetics after an overnight fasting or 3 hours of a carbohydrate-enriched supplement: a randomized crossover pilot study / Volume gástrico residual em diabéticos obesos mórbidos após jejum noturno ou 3 horas de suplemento enriquecido com carboidratos: um estudo piloto cruzado randomizado

ABSTRACT BACKGROUND: To reduce the risk of regurgitation during anesthesia for elective procedures, residual gastric volumes (RGV) have traditionally been minimized by overnight fasting. Prolonged preoperative fasting presents some adverse consequences and has been abandoned for most surgical procedures, except for obese and/or diabetic patients. AIMS: The aim of this study was to assess the RGV in morbidly obese diabetic patients after traditional or abbreviated fasting. METHODS: This study was approved by the Ethics Committee for Research with Human Beings from the Federal University of Mato Grosso, under number 179.017/2012. This is a prospective, randomized, and crossover design study in eight morbidly obese type II diabetic patients. RGV was measured endoscopically after either traditional overnight fasting of at least 8 hours, or after abbreviated fasting of 6 hours for solids and 3 hours for a drink containing water plus 25 g (12.5%) of maltodextrin. Data were expressed as mean and range and differences were compared with paired t-tests at p<0.05. RESULTS: The study population had a mean age of 41.5 years (28-53), weight of 135 kg (113-196), body mass index of 48.2 kg/m2 (40-62.4), and type II diabetes for 4.5 years (1-10). The RGV after abbreviated fasting was 21.5 ml (5-40) vs 26.3 ml (7-65) after traditional fasting. This difference was not significant (p=0.82). CONCLUSIONS: Gastric emptying in morbidly obese diabetic patients is similar after either traditional or abbreviated fasting with a carbohydrate drink.

RESUMO RACIONAL: Para reduzir o risco de regurgitação durante a anestesia para procedimentos eletivos, os volumes gástricos residuais (VRG) têm sido tradicionalmente minimizados com jejum noturno. O jejum pré-operatório prolongado tem algumas consequências adversas e tem sido abandonado para a maioria dos procedimentos cirúrgicos, com exceção de pacientes obesos e/ou diabéticos. OBJETIVOS: O objetivo deste estudo foi avaliar o VRG em pacientes diabéticos obesos mórbidos após jejum tradicional ou abreviado. MÉTODOS: Este estudo foi aprovado pelo Comitê de Ética em Pesquisa com Seres Humanos da Universidade Federal de Mato Grosso, sob o número 179.017/2012. Este é um projeto prospectivo, randomizado e cruzado em 8 pacientes diabéticos tipo II com obesidade mórbida. O VRG foi medido endoscopicamente após jejum noturno tradicional (pelo menos 8 horas) ou após jejum abreviado (6 horas para sólidos e 3 horas para uma bebida contendo água mais 25 g (12,5%) de maltodextrina). Os dados são expressos como média e variação e as diferenças foram comparadas com testes t pareados em p<0,05. RESULTADOS: A população estudada tinha 41,5 (28-53) anos de idade, peso médio de 135 (113-196) kg, índice de massa corporal (IMC) de 48,2 (40-62,4) kg/m2 e diabetes tipo II de 4,5 (1-10) anos. O VRG após o jejum abreviado foi de 21,5 (5-40) ml versus 26,3 (7-65) ml após o jejum tradicional. Essa diferença não foi significativa (p=0,82). CONCLUSÕES: O esvaziamento gástrico em pacientes diabéticos obesos mórbidos é semelhante após jejum tradicional ou abreviado com uma bebida com carboidrato.

Prognosis and Treatment for Active and Chronic Antibody-Mediated Rejection in Renal Transplant Recipients; Single Center Experience.

BACKGROUND: The aim of the study was to evaluate the prognostic factors and treatment alternatives of antibody-mediated rejection (ABMR) in renal transplant patients. METHODS: Three thousand renal transplant patients were included in the study. The patients were first divided into 2 groups. Group 1: ABMR [-] recipients (n = 2871), Group 2: ABMR (+) recipients (n = 129). ABMR patients were compared among themselves by dividing them into 3 subgroups (early-active, late-active, chronic-active). The study was performed retrospectively. Different combinations of methylprednisolone, intravenous immunoglobulin (IVIG), rituximab, plasmapheresis (PP), anti-thymocyte globulin (ATG) were used in the treatment and the results were compared. RESULTS: Graft survival and functions were worse and the rates of CAD, delayed graft function, BK virus, and cytomegalovirus higher in patients with ABMR. Also, graft survival was lower in patients with serum creatinine ≥3 (P = 0.001), GFR <30 (P <0.001), and spot urine protein to creatinine ratio ≥1 (P = 0.042) at the time of diagnosis. High interstitial fibrosis and tubular atrophy scores in chronic ABMR cases and high intimal arteritis scores in active ABMR cases were poor prognostic factors. CONCLUSIONS: The study showed that ABMR has a poor prognosis in terms of clinical parameters, and treatment should be individualized according to pathologic findings and graft functions at the time of diagnosis. Pulse methylprednisolone and IVIG should be used in the treatment of all ABMR patients, but PP, rituximab, and ATG should be used in selected cases. ABMR has a poor prognosis and treatment should be individualized.

Comparison of tomographic kidney volumes measured by semiautomatic segmentation method with scintigraphic split renal function in predicting posttransplant kidney functions.

INTRODUCTION: In this study, it was aimed to compare scintigraphic split renal function (SRF) and computed tomographic (CT) kidney volumes by semiautomatic segmentation method in predicting graft functions after kidney transplantation. METHODS: One hundred and twelve patients (77 males, 35 females) who had a living-donor kidney transplant between 2015 and 2017 in our centre were included in the study. While SRF was calculated with technetium-99m-diethylenetriaminepentaacetic acid (99m Tc-DTPA) scintigraphy, CT angiography was used for volumetric calculations. RESULTS: CT-volumetric measurements, especially renal cortical volume (RCV: 103.8 ± 20 ml) and ratio to body mass index (RCV/BMI: 4.45 ± 1.3) were found to be more significant than 99m Tc-DTPA-SRF in predicting graft functions. The correlations between SRF and RCV with 6th-month estimated glomerular filtration rate (eGFR) (rSRF: 0.052, rRCV: 0.317, p = 0.041) and 1st-year eGFR (rSRF: 0.104, rRCV: 0.374, p = 0.033) were found to be more significant in favour of RCV. The correlation between SRF/BMI and RCV/BMI with 1st-, 6th- and 12th-month eGFR (respectively, p = 0.02/0.048/0.024) were found to be more significant in favour of RCV/BMI. Although univariate analysis showed a significant relationship between most volumetric measurements and 1st-year graft functions, in multivariate analysis only RCV [odds ratio (OR): 1.04 (1.01-1.07), p = 0.023] and RCV/BMI [OR: 2.5 (1.27-5.39), p = 0.013] showed a significant relationship between graft functions. CONCLUSION: In our study, it was shown that CT-based renal volumetric measurements, especially RCV and RCV/BMI, predicted graft functions more strongly than scintigraphic 99m Tc-DTPA-SRF.

The use of anti-interleukin-1 agents and tumor necrosis factor-alpha inhibitors in renal transplant recipients.

OBJECTIVES: The aim of this study was to investigate the efficacy and safety of anti-interleukin-1 (anti-IL-1) agents and tumor necrosis factor-alpha (TNF-α) inhibitors in renal transplant patients. PATIENTS AND METHODS: Between February 2014 and February 2020, data of 12 renal transplant recipients (9 males, 3 females; median age: 51 years; range, 19 to 70 years) who received anti-IL-1 agents or TNF-α inhibitors for inflammatory diseases in the post-transplant time period and were followed in a single transplant center (n=12) were retrospectively analyzed. A total of 46 cases were reported in the literature, before the data were collected. The overall outcomes of all cases were analyzed in this study. RESULTS: Thirty-seven patients received anti-IL-1 agents in the post-transplant period. The main indications for anti-IL-1 agents were familial Mediterranean fever (FMF) and amyloidosis (75.7%). The continuation rate of colchicine treatment in patients with FMF was 85.7%. Anti-IL-1 agents prevented attacks completely in 89.3% of FMF patients. The number of cases used TNF-α inhibitors among renal transplant patients was lower (n=21). The TNF-α inhibitors were used mainly for inflammatory bowel diseases (57.1%) and ankylosing spondylitis (33.3%) and suppressed the disease activity in most of the patients with inflammatory diseases (72.7%). Death (n=3) and malignancies (n=3) were reported in patients who received TNF-α inhibitors, but not in patients who received anti-IL-1. The renal outcomes and graft survival rates were satisfactory in patients who received both anti-IL-1 agents and TNF-α inhibitors. CONCLUSION: Our results support that anti-IL-1 agents can be used effectively and safely in renal transplant patients.

Effect of platelet-rich plasma on postoperative peritoneal inflammation and adhesions.

INTRODUCTION: Postoperative peritoneal adhesion is an important complication of abdominopelvic surgery. The aim of this study is to reveal the effect of platelet-rich plasma (PRP) on postoperative intraperitoneal inflammation and adhesions. MATERIAL AND METHODS: Twenty-four Wistar albino rats were divided into three groups. Cecal incision and suturation was carried out for the experimental model. Intraperitoneally, 3 ml of 0.9% NaCl, 3 ml of PRP, and nothing were applied, and called as saline, PRP, and control groups, respectively. Four subjects in each group were sacrificed at the 3rd and 7th days postoperatively. Adhesion formations and giant cell, lymphocyte/plasmocyte, neutrophil, and histiocyte counts were assessed and hydroxyproline levels were measured in all groups and statistical comparisons were performed. RESULTS: Except giant cell 3rd day scores, PRP had the lowest adhesion, neutrophil, lymphocyte, plasmocyte, histiocyte and fibrosis scores. Both 3rd and 7th days scores of giant cell, neutrophil, lymphocyte, plasmocyte, but only 7th days scores of histiocyte reaction and fibrosis were statistically significant (p < 0.05). Hydroxyproline levels were lower in the saline group at the 3rd day. However, at the 7th day, the levels were lower in the PRP group and no statistically significant difference was found compared to the saline group 3rd day levels (p > 0.05). CONCLUSIONS: Platelet-rich plasma has a reducing effect on the postoperative peritoneal adhesions with separation of the damaged tissues, affecting the inflammation, matrix metalloproteinase, plasminogen activation or the other stages of adhesion formation.

Serum Levels of S100ß, Neuron-Specific Enolase, Glial Fibrillary Acidic Protein in Kidney Transplant Recipients and Donors: A Prospective Cohort Study.

BACKGROUND: The aim of this study was to evaluate changes in serum levels of S100ß, neuron-specific enolase, glial fibrillary acidic protein in living donors and recipients after kidney transplantation. METHODS: We enrolled 56 patients into the study. Of these, 27 underwent donor nephrectomy (group D), and the remaining 29 underwent kidney transplantation (recipient, group R). Neuromarkers were measured in samples obtained before the procedure, on postoperative day 7, and at 1 month postoperatively. RESULTS: Postoperative kidney functions were impaired in patients who underwent living donor nephrectomy compared with their preoperative levels (P < .001), although no significant difference was observed in their neuromarkers. The postoperative delirium rating scale was also impaired after living donor nephrectomy compared with preoperative levels (P < .05). Postoperative kidney functions were improved (P < .001), and a progressive decrease in neuromarker levels (P < .05) was observed in kidney transplant recipients compared with their preoperative levels. Linear regression analysis showed a significant correlation between neuron-specific enolase, glial fibrillary acidic protein levels and kidney functions in recipients. CONCLUSION: The present study demonstrated that neuron-specific enolase and glial fibrillary acidic protein levels decrease in kidney transplant recipients and do not change in donors. This result indicated that there is no evidence of neurotoxicity in either recipients and donors in kidney transplantation.

Effect of post-perfusion hyperoxemia on early graft function in renal transplant recipients: a retrospective observational cohort study.

BACKGROUND: The effects of hyperoxemia on the transplanted grafts arouse interest nowadays, particularly intraoperative hyperoxemia, on transplant kidney function and survival in the 1-year post-operative period. AIMS: We aimed to investigate the effect of post-perfusion (5 min after perfusion) hyperoxemia on early graft function and survival in renal transplant recipients. METHODS: Two hundred forty-seven living donor kidney transplant recipients were included in the study. Patients were divided into the three groups according to their partial arterial oxygen pressure in post-perfusion blood gas samples: group 1: normoxia (n = 52, PaO2 pressure: < 120 mmHg, 103 ± 13); group 2: moderate hyperoxemia (n = 121, PaO2: 120-200 mmHg, 169 ± 21); group 3: severe hyperoxemia (n = 74, PaO2: > 200 mmHg, 233 ± 25). Graft functions (serum creatinine levels, estimated-glomerular filtration rate values, spot urine protein/creatinine ratio), survival rates, and groups' clinical outcomes were compared in the first year after transplantation. RESULTS: Graft survival rates were similar in the groups and the rate of BK virus viremia was the lowest in the group 3 (groups 1, 2, and 3: 15.4% (n = 8), 6.6% (n = 8), 1.4% (n = 1), respectively, P: 0.009). Serum creatinine and proteinuria levels were lower, and estimated-glomerular filtration rate values were higher in group 3. A negative correlation between partial arterial oxygen pressure and serum creatinine levels and a positive correlation with estimated-glomerular filtration rate value were noted. These results were confirmed by univariate and multivariate analyses. CONCLUSIONS: We demonstrated that the kidney transplant recipients with post-perfusion hyperoxemia have better early graft functions and lower BK virus viremia rates. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04420897.

A Single-Center Experience in Portal Flow Augmentation in Liver Transplantation With Prior Large Spontaneous Splenorenal Shunt.

Large portosystemic shunts may cause portal steal syndrome in liver transplantation (LT). Because of the possible devastating consequences of the syndrome, the authors recommend perioperative management of these large shunts. Fourteen adult recipients who underwent portal flow augmentation, including left renal vein ligation (LRVL), renoportal anastomosis (RPA), shunt ligation (SL), and splenic vein ligation (SVL) for large spontaneous splenorenal shunt (SSRS), are included in this study, and the results were analyzed. A total of 13 patients had a large SSRS, and in 1 patient, the large shunt was placed between the superior mesenteric vein and the right renal vein. LDLT was performed in 13 patients. LRVL (n = 5), SVL (n = 6), RPA (n = 2), SL (n = 1) were performed to the patients as graft inflow augmentation. The graft-recipient weight ratios (GRWR) were less than 0.8% in 5 patients (35.7%): 2 had LRVL, and 3 had SVL. Small-for-size syndrome (SFSS) occurred only in these 2 patients with LRVL (GRWR ≤0.8%) and, splenic artery ligation was performed for graft inflow modulation. No mortality or serious complications were reported during follow-up. We consider that in patients with large SSRS and small-for-size grafts, SVL can be performed safely and with satisfactory outcomes.

A New Practical Intracerebral Hematoma Volume Calculation Method and Comparison to simple ABC/2.

AIM: To find a more practical and effective formula than simple ABC/2 (sABC/2) to calculate the hematoma volume in patients with subdural and parenchymal haemorrhage. MATERIAL AND METHODS: We reviewed the records of 157 patients who underwent brain computed tomography examinations for stroke from January to October 2017. Our method, sABC/2 formula, and the planimetric method (the gold standard) were used for measuring the volumes of hematoma. RESULTS: The concordance in brain hematoma volumes calculated by sABC/2 and the proposed method as compared to planimetry were 0.92 and 0.93, respectively (p < 0.05). The proposed method calculates the subdural hematoma volumes much better than the conventional one, and the root mean square error (RMSE) values were 32.17 and 20.62 ml for sABC/2 and our new method, respectively, whereas the RMSE values for parenchymal hematomas were 25.01 and 20.46 ml for sABC/2 and our new method, respectively. CONCLUSION: Our new formula for calculating the volume of subdural and parenchymal hematomas is as practical as sABC/2 and allows the clinician to apply the method bedside.

Automated segmentation of the injured kidney due to abdominal trauma.

The objective of this study is to propose and validate a computer-aided segmentation system which performs the automated segmentation of injured kidney in the presence of contusion, peri-, intra-, sub-capsular hematoma, laceration, active extravasation and urine leak due to abdominal trauma. In the present study, total multi-phase CT scans of thirty-seven cases were used; seventeen of them for the development of the method and twenty of them for the validation of the method. The proposed algorithm contains three steps: determination of the kidney mask using Circular Hough Transform, segmentation of the renal parenchyma of the kidney applying the symmetry property to the histogram, and estimation of the kidney volume. The results of the proposed method were compared using various metrics. The kidney quantification led to 92.3 ± 4.2% Dice coefficient, 92.8 ± 7.4%/92.3 ± 5.1% precision/sensitivity, 1.4 ± 0.6 mm/2.0 ± 1.0 mm average surface distance/root-mean-squared error for intact and 87.3 ± 8.4% Dice coefficient, 84.3 ± 13.8%/92.2 ± 3.8% precision/sensitivity and 2.4 ± 2.2 mm/4.0 ± 4.2 mm average surface distance/root-mean-squared error for injured kidneys. The segmentation of the injured kidney was satisfactorily performed in all cases. This method may lead to the automated detection of renal lesions due to abdominal trauma and estimate the intraperitoneal blood amount, which is vital for trauma patients.

A new surgical approach for pilonidal sinus disease: "de-epithelialization technique''.

OBJECTIVE: In the treatment of pilonidal sinus disease different approaches are used such as conservative treatment and fasciocutaneous rotation flap. The aim of this study was to evaluate the efficacy of "de-epithelialization technique" as a new approach in pilonidal sinus disease treatment. MATERIAL AND METHODS: Forty pilonidal sinus disease patients treated with de-epithelialization method were evaluated retrospectively. Patient age, gender, body mass index, wound healing time, visual analog scale scores, operation times, hospital stay duration, drain removal time, cosmetic satisfaction rates, complications, and recurrence rates were evaluated. RESULTS: The numbers of male and female patients in this study were 39 and 1, respectively. The median age of the patients was 25 years and the mean BMI was 26.6. The mean operating time was 43 min, and all patients were discharged 5 h after the operation. Wound healing time varied from 10 to 20 days. Median follow-up period was 9 months (4-17 months). One patient with high body mass index suffered from partial wound separation. No other complications such as infections and fluid collections (hematoma and seromas) were observed. Maximum cosmetic satisfaction rate was 90% (n=36), and no patient had a recurrence during the follow-up period. CONCLUSION: "De-epithelialization" may be considered as a complementary and/or alternative approach to other surgical techniques such as primary closure, rhomboid excision, and Limberg flap in the treatment of pilonidal sinus disease, with acceptable cosmesis and recurrence rates.

Incidental gastrointestinal stromal tumor at a gastroscopic polypectomy specimen: A case report and review of literature.

Although gastrointestinal stromal tumors (GISTs) comprise less than 1% of all gastrointestinal (GI) tract tumors, they are the most common mesenchymal tumors of the GI tract. Gastrointestinal stromal tumors can occur anywhere along the GI tract, but the stomach and small intestine are the most frequently involved sites. Gastrointestinal stromal tumors are frequently asymptomatic, and one-third of all cases are found incidentally. Endoscopy, endoscopic ultrasonography, and computed tomography are useful tools in the diagnosis. Endoscopic mucosal resection, endoscopic submucosal dissection, laparoscopic endoscopic cooperative surgery, and surgery with either laparoscopic or open approaches are treatment modalities for GISTs. An R0 resection is the principle surgery. Imatinib is the main medical agent used in the adjuvant or neoadjuvant treatment of GIST. We present a 65-year-old woman with an asymptomatic GIST that arose from a gastric polyp treated via endoscopic polypectomy.

Can balneotherapy improve the bowel motility in chronically constipated middle-aged and elderly patients?

Balneotherapy or spa therapy is usually known for different application forms of medicinal waters and its effects on the human body. Our purpose is to demonstrate the effect of balneotherapy on gastrointestinal motility. A total of 35 patients who were treated for osteoarthritis with balneotherapy from November 2013 through March 2015 at our hospital had a consultation at the general surgery for constipation and defecation disorders. Patients followed by constipation scores, short-form health survey (SF-12), and a colonic transit time (CTT) study before and after balneotherapy were included in this study, and the data of the patients were analyzed retrospectively. The constipation score, SF-12 score, and CTT were found statistically significant after balneotherapy (p < 0.05). The results of our study confirm the clinical finding that a 15-day course of balneotherapy with mineral water from a thermal spring (Bursa, Turkey) improves gastrointestinal motility and reduces laxative consumption in the management of constipation in middle-aged and elderly patients, and it is our belief that treatment with thermal mineral water could considerably improve the quality of life of these patients.

Computer-Aided Detection (CADx) for Plastic Deformation Fractures in Pediatric Forearm.

Bowing fractures are incomplete fractures of tubular long bones, often observed in pediatric patients, where plain radiographic film is the non-invasive imaging modality of choice in routine radiological workflow. Due to weak association between bent bone and distinct cortex disruption, bowing fractures may not be diagnosed properly while reading plain radiography. Missed fractures and dislocations are common in accidents and emergency practice, particularly in children. These missed injuries can result in more complicated treatment or even long-term disability. The most common reason for missed fractures is that junior radiologists or physicians lack expertise in pediatric skeletal injury diagnosis. Not only is additional radiation exposure inevitable in the case of misdiagnosis, but other consequences include the patient's prolonged uncomfortableness and possible unnecessary surgical procedures. Therefore, a computerized image analysis system, which would be secondary to the radiologists' interpretations, may reduce adverse effects and improve the diagnostic rates of bowing fracture (detection and quantification). This system would be highly desirable and particularly useful in emergency rooms. To address this need, we investigated and developed a new Computer Aided Detection (CADx) system for pediatric bowing fractures. The proposed system has been tested on 226 cases of pediatric forearms with bowing fractures with respect to normal controls. Receiver operation characteristic (ROC) curves show that the sensitivity and selectivity of the developed CADx system are satisfactory and promising. A clinically feasible graphical user interface (GUI) was developed to serve the practical needs in the emergency room as a diagnostic reference. The developed CADx system also has strong potential to train radiology residents for diagnosing pediatric forearm bowing fractures.