The role of immature granulocyte count and delta neutrophil index in the early prediction of mesenteric ischemia.

OBJECTIVE: Mesenteric ischemia is a fatal condition leading to ischemia and necrosis of the intestines following the interruption of blood flow in the vessels feeding the intestines. The present study investigated the significance of immature granulocyte count and delta neutrophil index in the early prediction of mesenteric ischemia. PATIENTS AND METHODS: The study included 248 patients who applied to the hospital between 01.01.2020 and 01.04.2022 and underwent emergency and elective bowel resection in the general surgery clinic. The study population was divided into two groups as patients who underwent surgery for causes non-related to mesenteric ischemia (Group 1) and patients with findings of mesenteric ischemia who underwent laparotomy (Group 2). Preoperative immature granulocyte counts, and delta neutrophil index levels were compared between the groups with and without perioperative mesenteric ischemia. RESULTS: No statistical difference was observed between the groups in terms of age or sex. Comparing the two groups regarding immature granulocyte count and delta neutrophil index revealed a statistically significant difference (p<0.001). The median immature granulocyte count was 0.04 (0.02-0.06) in Group 1 and 1.83 (0.18-2.5) in Group 2, with a statistically significant difference (p<0.001). Also, the comparison of delta neutrophil index levels revealed a median value of 0.4 (0.2-0.6) in Group 1 and 5.6 (0.7-8.1) in Group 2, with a statistically significant difference. CONCLUSIONS: The results of this study have demonstrated that immature granulocyte counts, and delta neutrophil index levels are reliable markers that do not require any additional time or expense, can be easily measured in a complete blood count, and can be used for evaluating intestinal necrosis in mesenteric ischemia.

Blast injury: lessons learned from an autopsy.

Blast injury is becoming more common in the non-military population but it is still rare to see such injuries and deaths unrelated to terrorist acts. The exact mechanisms involved in blast injuries are unclear. Civilian physicians and surgeons need to have a basic understanding of the patho-mechanics and physiological effects of blast injuries. We report a case where a 31-year-old male accidentally detonated a diesel storage tank. His autopsy findings provide useful information for those who investigate explosive-related deaths.

Sudden death related to anomalous origin of coronary artery and coexisting fenestrated membrane of the sinus coronarius.

Coronary artery anomalies that may be an isolated defect or part of complex congenital malformations of the heart are also often associated with a high risk of sudden death. A 19-year-old woman lost consciousness in the night. She was taken to hospital where she was treated. However, she died on the same day. The prosecutor considered the death suspicious, and the victim was taken to the morgue department for further examination and autopsy. On macroscopical examination, both coronary arteries originated from the left aortic sinus with the left one being dominant. The orifice of the sinus coronarius in the right atria was covered with a fenestrated membrane. Demonstration of coronary artery pathologies and associated anomalies in autopsies is vital for the elucidation of sudden death cases related to these lesions and for the development of new treatment approaches. The purposes of this case report are to characterise and identify markers of the coronary artery anomalies and to highlight their medicolegal importance in sudden death cases.

Cardiac rupture following blunt trauma.

A case of cardiac rupture following blunt trauma with no additional injuries is described. This can be a difficult diagnosis because of the presence of additional injuries and the lack of clinical symptoms. Here, there was a rupture of the pericardium, all chambers of the heart and the thoracic aorta.