Utility of immature granulocyte in severity of helicobacter pylori infection.

Introduction: Helicobacter pylori infection is a chronic bacterial infection associated with some extragastric diseases as well as gastric involvements that occur most commonly worldwide. In our study, we aimed to investigate the usability of immature granulocytes as a basic indicator that can reflect the severity of helicobacter pylori inflammation, to the best of our knowledge, for the first time. Materials and Methods: Patients who underwent upper gastrointestinal endoscopy between April 2019 and April 2020 and were diagnosed with antral gastritis were included in this study. The relationship between helicobacter infection and its severity detected in gastric biopsies of patients and immature granulocyte count (IGC), immature granulocyte percentage (IG%), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume (MPV) were investigated. Results: Of the 868 patients, 210 were HP negative, 658 were HP positive (218 mild HP positive, 293 moderate HP positive, and 147 severe HP positive). There were statistically significant differences between the HP negative and HP positive groups in terms of IGC, IG%, NLR, and PLR. However, IG% and IGC were not clinically useful because the median IG% (0.3 vs 0.3) and IGC (0.02 vs 0.02) were the same in the HP negative and total HP positive groups. Conclusion: In our study, IGC and IG% were not found useful to detect H. pylori intensity and severity of inflammation.

Idiopathic granulomatous mastitis and steroid use during the pandemic of COVID-19.

BACKGROUND: Steroid therapy is an immunosuppressive treatment and may have possible side effects in a pandemic period. However, the number of studies on the use corticosteroids for the treatment of idiopathic Granulomatous Mastitis (IGM) especially during the pandemic is almost negligible. METHODS: The data of patients with the diagnosis of IGM between January-December 2020 in the General Surgery Clinic were retrospectively analyzed. The patients were explained in detail that steroid therapy is an immunosuppressive treatment and it may have possible side effects. Prednisolone 0.5-1 mg/kg/day was given as steroid therapy. The treatment was planned for 4-6 months according to the severity of the symptoms and was completed by reducing it to a total dose of 10 mg/month. RESULTS: Eleven patients were included in the study. Five patients had completed steroid treatment and continued their follow-up. In our study, a total of six patients were receiving steroid therapy. CONCLUSIONS: There is no consensus yet on the use of the steroid in the COVID-19 pandemic. Low doses Corticosteroids (<1 mg/kg/day) don't have an effect on increase mortality in patients with severe COVID-19. We can think that low-dose corticosteroids used by many centers in IGM treatment do not have a negative effect on mortality.

Crystallized phenol treatment vs excision and primary closure in pilonidal sinus disease: A randomized clinical trial in adolescent patients.

INTRODUCTION: Pilonidal sinus is a chronic inflammatory disease seen in the intergluteal sulcus. A wide variety of treatment modalities have been described for the management of this disease, however optimal therapy remains controversial. The study aims to compare phenol treatment, a minimally invasive method used in the treatment of pilonidal sinus disease, with the commonly practiced surgical methods of excision and primary closure in the adolescent age group. PATIENTS AND METHODS: Adolescent patients who presented with pilonidal sinus disease between January 2018 and December 2018 were randomized into 2 groups as phenol treatment and surgical treatment (after obtaining consent for the study). Early complications and recurrence rates after 24 months of follow-up were the two main endpoints of the study. RESULTS: A total of 100 patients (phenol group n = 50, surgery group n = 50) were included in the study. Both groups were similar in terms of age, gender, and BMI. The mean duration of the procedure was 12.4 ± 2.84 min in the phenol group and 42.3 ± 7.22 min in the surgery group (p = 0.00). There was no difference in postoperative complications between the groups (p = 0.22). After 24 months of follow-up, recurrence was found in 8% (n = 4) of the cases in the phenol group and 10% (n = 5) of the cases in the surgery group (p = 0.5). CONCLUSION: In our study, phenol treatment and excision/primary closure methods for pilonidal sinus disease have similar complication and recurrence rates. However, phenol treatment seems to be the method of choice in the adolescent age group as it has the advantage of being a minimally invasive method and it does not affect subsequent surgical treatments. LEVEL OF EVIDENCE: Level II treatment study.

Effect of propolis on wound healing in sacrococcygeal pilonidal disease: A randomized controlled clinical trial.

Wound healing and recurrence are the leading problems encountered in sacrococcygeal pilonidal sinus disease. Propolis has a place in both traditional and complementary medicine, and in vitro and in vivo studies have reported its anti-inflammatory, anti-oxidant, anti-bacterial, anti-fungal and immunostimulant properties. In the present study, we discuss the effect of propolis on wound healing in sacrococcygeal pilonidal diseases treated with marsupialization. Patients who were admitted to our clinic with sacrococcygeal pilonidal disease were analyzed prospectively, with a total of 33 patients divided into study and control groups. All patients underwent marsupialization surgery, and the wound areas were analyzed post-operatively, on the 0, 7th, 14th, 28th days and on the day of complete recovery. An acceleration of wound healing was observed from the first week that was found to be even faster between days 14 and 28. The complete recovery score in the study group was significantly lower. Propolis can be used to accelerate wound healing when the marsupialization method is preferred in patients diagnosed with uncomplicated sacrococcygeal pilonidal cyst due to its low cost, good patient compliance, low side effect profile, lack of toxicity and high efficacy.

A Novel Transabdominal Preperitoneal Hernioplasty Technique in the Repair of Large Inguinal Hernias: The use of Polypropylene Mesh in the form of Plug-patch.

OBJECTIVE: To describe the outcome of modified transabdominal laparoscopic preperitoneal (TAPP) hernioplasty repair with plug-patch of polypropylene mesh. STUDY DESIGN:  A descriptive study. PLACE AND DURATION OF STUDY: Alanya Alaaddin Keykubat University Training and Research Hospital, Alanya, Turkey from December 2017 to December 2019. METHODOLOGY: Patients aged 18-70 years, who underwent TAPP hernioplasty at this clinic between December 2017 and 2019 were evaluated retrospectively. Those with a defect diameter of 3 cm and above, which were measured intraoperatively, were considered as large inguinal hernias. A modified TAPP procedure that includes the plug-patch technique, using polyester mesh, similar to that of open inguinal hernia repair, was performed on these patients. Complications and recurrences frequency was noted. RESULTS: This modified TAPP procedure was applied to 35 patients (24 men, 11 women). The defect size was 3-4 cm in 24 patients, and 4 cm in 11 patients. None of the patients developed chronic pain. Five patients had a feeling of fullness in the inguinal region where the repair was performed, and their complaints subsided at the first month of follow-up. Seroma developed in 2 patients, but resolved spontaneously. During the follow-up period, no chronic complications or recurrences were observed. CONCLUSION: This technique is simple and does not create a serious cost burden on TAPP technique. Furthermore, it can be applied routinely with the advantages of low pain, rapid recovery and acceptable complication rates as well as the reduction of pseudo-recurrence rates. Key Words: Hernia, Laparoscopic repair, Plug-patch technique, Modified TAPP, Mesh.

Hypovolemic shock due to giant ovarian tumor rupture after minor trauma: A case report.

Rupture of gynecologic tumors secondary to trauma rarely occurs. Rupture can lead to acute abdominal pain due to hemorrhage from the ruptured area and organs; rupture can also lead to peritonitis, depending on the size of the tumor. We describe the case of giant epithelial ovarian tumor rupture exhibiting due to minor trauma and the development of hypovolemic shock. A 69-year-old female patient was admitted to the emergency room with complaints of acute abdominal pain and subsequent clouding of consciousness after falling down while walking. Emergency abdominal computed tomography scan revealed widespread hemorrhagic free fluid in the abdominal cavity and a mass measuring 27.5 cm × 21 cm × 15 cm, extending from the right quadrant of the abdomen to the left. The patient underwent an emergency operation due to hypovolemic shock. During surgery, a totally ruptured mass lesion arising from the right ovary was seen; the mass contained cystic components and measured approximately 30 cm × 20 cm × 15 cm. Hemostasis was achieved in the bleeding areas, and the right ovarian mass was totally resected. The patient was discharged as cured on the 6th post-operative day. Gynecologic tumor rupture due to trauma is a rare event. However, it is a clinical condition that should be kept in mind regardless of the type of trauma. This is especially true in patients who experienced trauma and were radiologically found to have intra-abdominal hemorrhage with normal-appearing solid organs, such as liver and spleen, that frequently cause bleeding.

What Should be Done for Perforation of the Gallbladder During Laparoscopic Cholecystectomy: Prophylaxis or Treatment?

Background: Iatrogenic perforation of the gallbladder during laparoscopic cholecystectomy (LC) is one of the most common intraoperative complications, and there is no clear consensus among surgeons on this issue and there are studies reporting the antibiotic treatment. The aim of this study is to determine the effect of type and duration of antibiotic use on infective complications between iatrogenic perforations of the gallbladder during LC patients. Methods: Patients who developed iatrogenic perforation of gallbladder during LC were subdivided into three groups according to antibiotic treatment; single dose intravenous (i.v.) antibiotic group, prophylactic antibiotic + additional dose i.v. antibiotic group, and prophylaxis + additional dose i.v. antibiotic + oral antibiotic group. Results: A total of 577 patients who underwent LC were included in the study, and 114 patients (19.8%) had iatrogenic perforation of gallbladder. No statistically significant difference was found in wound infection and surgical site infection in all three groups (P > .05). Conclusions: We suggest that single dose antibiotic use is sufficient to prevent infectious complications in patients who had iatrogenic perforation of the gallbladder during LC. Adding intravenous and/or oral antibiotics does not contribute to prevention of infective complications in these patients.

Comparison of Tumor Volume Dependent Mean Diameter with the Longest Diameter and Tumor Volume in Assessing Axillary Lymph Nodes in Breast Cancer.

OBJECTIVE: To investigate the effectiveness of tumor volume dependent mean diameter (Rmax) in determining axillary lymph node metastasis positivity instead of the largest diameter (Dmax) in breast cancer. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of General Surgery, Ankara Training and Reseach Hospital, Turkey, from January 2009 to December 2018. METHODOLOGY: Patients with breast cancer, who underwent modified radical mastectomy and lumpectomy and axillary lymph node dissection due to invasive carcinoma, included in this study. Approximate vTm was calculated from the obtained tumor specimen dimensions using ellipsoid volume formula. From the sphere volume formula, Rmax, which gives the same vTm value, was reversely calculated. Efficacy and usability of Rmax value were evaluated on nomograms that are available online; and are used most frequently owing to its ease of use. RESULTS: In 305 patients, mean Dmax was 3.4 ±1.8 cm, mean vTm was 17.9 ±35.9 cm3, and mean Rmax was 2.6 ±1.4 cm. For the distinction of ALNM positive and negative patients, Dmax significant [Area Under Curve (AUC) 0.709], Rmax significant [AUC 0.748] and vTm significant [AUC 0.748] efficacy was considered. CONCLUSION: When the relationships of Dmax and vTm with ALNM were compared in breast cancer cases, the efficacy of vTm is higher. It was found that vTm and Rmax can be used instead of Dmax. The relation of Rmax parameter with ALNM was found to be higher. When Rmax was used in nomogram samples, which are currently used in predicting ALNM positivity, it increased nomogram efficacy. Key Words: Breast neoplasm, Tumor burden, Tumor volume, Tumor diameter, Lymphatic metastasis.

The Role of Serum Laboratory Biomarkers for Complicated and Uncomplicated Appendicitis in Adolescents.

OBJECTIVE: To investigate if serum biomarkers could differentiate complicated and uncomplicated appendicitis in adolescents. STUDY DESIGN: An cross sectional study. PLACE AND DURATION OF STUDY: Department of General Surgery, Faculty of Medicine, Alanya Alaaddin Keykubat University, Alanya, Turkey, between January 2016 and December 2018. METHODOLOGY: Patients operated for acute appendicitis, aged between 10 and 19 years, were retrospectively evaluated. Patients were divided according to the negative appendectomy (group 1), uncomplicated appendicitis (group 2A) and complicated appendicitis (group 2B). White blood cell count (WBC), neutrophil count (NEU), lymphocyte count (LC), neutrophil/lymphocyte ratio (NLR), mean platelet volume (MPV), red cell distributions width (RDW), C-reactive protein (CRP), and length of hospital stay (LoHS) were analysed by ROC curve, one-way and Mann-Whitney U-tests. RESULTS: There were 277 adolescents (group 1=30, group 2A=205 and group 2B=42). There were statistically significant differences between the groups in WBC, NEU, LYM, NLR, CRP, LoHS. The cut-off values of NLR, WBC, and NEU were 4.1, 10.6x109/L, and 8.17x109/L, respectively for uncomplicated appendicitis, and 7.32, 11.5x109/L, and 10.3x109/L, respectively for complicated appendicitis. The cut off value of CRP was 1.3 mg/dl for complicated appendicitis. CONCLUSIONS: Elevated WBC, NEU, CRP and NLR may be considered useful biomarkers in assisting physical examination and other diagnostic methods in distinguishing severity of acute appendicitis. Key Words: Adolescent, Appendicitis, Neutrophil-to-lymphocyte ratio, C-reactive protein, Length of hospital stay.

Comparison of laparoscopic and open appendectomy on wound infection and healing in complicated appendicitis.

The aim of this study was to investigate the effects of laparoscopic and open surgery on the development of postoperative surgical wound infection and wound healing between complicated appendicitis patients. Patients with complicated appendicitis were divided into those underwent laparoscopic and open surgical procedures according to the surgical method. Patients were followed up with regard to development of any postoperative wound infection, and medical, radiological, and surgical treatment methods and results were recorded. A total of 363 patients who underwent appendectomy were examined, of which 103 (28.4%) had complicated appendicitis. Postoperative wound infection rate in patients who underwent open surgery was 15.9%, while it was 6.8% in the laparoscopic surgery group. There was no statistically significant difference between the two groups in terms of infection development rates (P > .05). The rate of surgical drainage use and rehospitalisation was significantly higher in the group with wound infection than in the group without wound infection. (P < .05). We suggest that in terms of wound infection and wound healing, laparoscopic surgery should be the method of choice for patients with complicated appendicitis. In order to reduce the frequency of wound infection, drains should not be kept for a long time in patients undergoing appendectomy.

Non-healing wounds: Can it take different diagnosis?

Wound healing is a complex cellular and biochemical process and can be affected by several systemic and local factors. In this study, we aimed to discuss the aetiologic factors of non-healing wounds and the management of this complicated process with current information. The medical data of the patients who were admitted to our clinic due to non-healing or chronic wounds were analysed retrospectively. A total of 27 patients were evaluated retrospectively during the 14 months of the study. The data of 6 patients who were followed up for chronic wound that developed after abdominal incisional hernia repair and pilonidal sinus surgery were not included in the study as their data could not be reached. A total of 21 patients were included in the study. Malignancy was diagnosed in two patients and granulomatous disease was found in four patients. The aetiology of the other cases included foreign body reaction, infection, and mechanical causes. Non-healing wounds are a serious social and economic problem for patients. Further studies on the pathophysiology of various aetiologies in non-healing wounds in both clinical settings and experimental animal models would be a useful step in treatment.

Burnout syndrome should not be underestimated.

OBJECTIVES: Burnout syndrome can be seen among health professionals at every stage of their careers. The incidence of burnout syndrome among health care professionals has increased in recent years and varies between countries and depending on different areas of specialization and work units. It is known that burnout syndrome significantly affects the work and social life of individuals. We aimed to investigate the effect of burnout syndrome on trauma and infection. METHODS: The study was conducted in the Alanya Alaaddin Keykubat University, Faculty of Medicine, Training and Research Hospital. All health professionals working at the hospital were included in the study. The Maslach Burnout Inventory was applied to the participants, who were asked about infective disease and trauma history over the past year. RESULTS: The total burnout rate was 77.8% among participants. We found that the rate of trauma and infective disease history was significantly high in employees who had burnout syndrome (p<0.05). CONCLUSION: Burnout syndrome is a common and important problem among health professionals that also has adverse effects on people's daily life, especially increasing the incidence of infection and trauma.

The effect of antibiotic prophylaxis on wound infections after laparoscopic cholecystectomy: A randomised clinical trial.

The aim of this study was to determine whether the use of prophylactic antibiotics had any effects on the development of postoperative surgical wound infections between laparoscopic cholecystectomy patients. Patients who received a single dose of prophylactic antibiotics prior to surgery were included in the prophylaxis group, and those who did not receive preoperative and postoperative intravenous and/or oral antibiotics were included in the no prophylaxis group. A total of 206 patients who underwent laparoscopic cholecystectomy were examined; the infection rate in patients who received prophylaxis was 4.5%, while it was 4.2% in the non-prophylactic group. There was no statistically significant difference between the groups in terms of infection development rates (P > .05). We suggest that antibiotics should not be given for prophylaxis before low-risk laparoscopic cholecystectomy as there is no statistically significant difference in the rate of postoperative wound infection among patients who were either given or not given prophylaxis.

The effects of perioperative antibiotherapy on surgical site infections in sacrococcygeal pilonidal sinus treated with rhomboid excision and Limberg transposition procedure.

Pilonidal sinus disease is a common disorder. We aimed to evaluate the effects of perioperative antibiotherapy on surgical site infections in pilonidal sinus patients who were treated with rhomboid excision with Limberg transposition procedure. A total of 104 patients between 18 and 40 years of age (52 males, 52 females) were included in the study. The patients were divided into two groups and evaluated because of the administration of perioperative antibiotherapy. On the 10th-day, first-month, and third-month follow ups, the status of the wound was recorded. No significant difference was found between the ages, gender distribution, and smoking. Wound dehiscence rate was higher in the non-antibiotic group on the 10th-day, first-month, and third-month follow up, whereas the rate of superficial infection was higher in the antibiotic group. None of the patients had any signs of recurrence. Antibiotic administration did not provide a significant advantage in terms of wound healing, surgical site infection, and recurrence. We think that perioperative antibiotherapy, except for patients with immunosuppression, diffuse cellulitis, or a major coexisting disease who were treated with rhomboid excision with Limberg transposition procedure, does not have any effect on healing surgical site infections and delaying early recurrence.

Metachronous Occurrence of Granular Cell Tumor in Breast Skin and Scalp: Diagnostic Challenging Differentiating Benign from Malignant and a Literature Review.

Granular cell tumor (GCT) is a Schwann cell related benign neoplasm of soft tissue. GCT is an uncommon entity that occurs in a wide variety of body sites, but it is generally presented in the skin, oral cavity, superficial soft tissue, and respiratory and digestive tracts. Most of the GCTs are benign but clinically and radiologically these may mimic malignancy. Histopathological diagnosis is gold standard for establishing the true nature of the lesion. GCT is most commonly solitary but in about 10% of cases can be multifocal, usually involving various skin and soft tissue sites versus involving various internal sites. Therefore, these can involve skin and soft tissue or submucosa and viscera. GCT is usually benign; however, local recurrence is common due to incomplete removal. Malignant cases are rarely reported in 1-2% of cases. In this study, we report clinical and histopathological findings of a 36-year-old woman with metachronous GCT in breast and scalp. The clinical features raise the question of whether these are metachronous benign GCTs or whether this is establishment of malignant behavior. The aim of this report is to present the histopathological and clinical features of GCT and the diagnostic challenge of differentiating benign from malignant GCT.

Primary leiomyosarcoma of the breast: a case report.

Primary leiomyosarcoma of the breast is an extremely rare tumor, accounting for less than 1% of all breast tumors and only 24 cases have been reported in the English medical journals. It is quite difficult to diagnose leiomyosarcoma preoperatively. Establishing an accurate diagnosis is very important in planning treatment. When preoperative diagnosis can be achieved before or during the operation, wide resection should be performed. There is no need for axillary lymph node dissection. In this case report, we present a case involving primary leiomysarcoma of the breast in a 48-year-old woman and we discuss optimal treatment options.

Ileovesical fistula secondary to chemotherapy for follicular non-Hodgkin lymphoma: a case report and review of the literature.

Enterovesical fistulas are rare complications of malignancies, diverticulitis, inflammatory bowel diseases, radiotherapy, and traumas involving the colorectal and pelvic region. In this study, an ileovesical fistula that occurred during chemotherapy for non-Hodgkin lymphoma is presented. The patient had acute abdomen and multiple comorbidities, and ileovesical fistula was diagnosed during the operation. The affected intestinal segment was resected, and an end-to-end anastomosis was performed with a primary bladder repair. This is a reliable treatment method for such cases.

Effectiveness of multiple neurectomies to prevent chronic groin pain after tension-free hernia repair.

The question of which nerve--the ilioinguinal or the iliohypogastric--most often causes chronic groin pain after hernia repair remains to be answered. We sought to evaluate the effects of prophylactic neurectomies on the incidence of persistent groin pain after Lichtenstein repair. Two hundred forty patients were randomized to 1 of 4 groups: the all-nerve preservation group, the ilioinguinal neurectomy group, the iliohypogastric neurectomy group, and the neurectomies group. During follow-up visits, pain was characterized through use of the McGill Pain Questionnaire and the visual analog scale, and quality of life was assessed with the Short Form 6 Dimension. Significant differences regarding chronic groin pain at 1 year were found between the preservation group and both neurectomies groups, in favor of the latter. No statistically significant differences in quality of life were noted in any of the groups. In conclusion, both nerves seem to be responsible for neuropathic postherniorrhaphy pain. Elective excision of the nerves can be done safely during tension-free hernia repair.