Comparison of the Efficiency of Epidermal Growth Factor and Negative Pressure Wound Therapy in Diabetic Foot Patients.

Advanced modalities are used for wounds where conventional treatment is insufficient in diabetic foot patients. In this study, we investigated the effects of using Epidermal growth factor (EGF) and NPWTmodalities alone or in combination on the frequency and level of amputation. In the retrospective study, which included 286 patients in total, 76 patients were referred with the decision of amputation or amputation was planned during hospitalization. After the treatments, amputation and distalization of amputation were found 73.3% and 33.3% in the conventional treatment patients. While 86.4% amp and 18.2% amp distalization were found in negative pressure wound therapy (NPWT) only patients, this rate was 52.4% and 90.5% in EGF + NPWT patients, 50% and 83.3% in EGF only patients. While amp and distalization rates were found to be significantly better in those receiving only EGF or EGF + NPWT (P = .015, P = .017 respectively for amputation and P = .000 for distalization), no difference was found in those receiving EGF and EGF + NPWT. As a result of our study, although npwt contributed positively to the number and level of amputations compared to conventional treatment, a significant improvement was found in the number and level of amps when EGF was used alone or combined with NPWT. With this result, EGF was thought to be an important treatment modality that should be evaluated in diabetic foot ulcers (DFUs) without amputation decision.

Effects of the COVID-19 pandemic on the management of diabetic foot ulcers: experiences from a dedicated diabetic foot care center.

INTRODUCTION: As did many other nations, the Turkish government implemented precautions and lockdown measures in response to the rapid spread of the COVID-19 viral infection. The pandemic has caused millions of deaths globally, resulted in the development of comorbidities, and negatively affected national health care systems. The increased workload at hospitals and spread of the virus among health care professionals have resulted in delays in health care services delivery. The fear of COVID-19 transmission has resulted in people mostly staying at home. OBJECTIVE: The aim of this study is to present the effects of the pandemic on the behavior of patients with diabetic foot ulcers (DFUs). MATERIALS AND METHODS: Patients with DFU were categorized into 2 groups: patients hospitalized during the COVID-19 pandemic and patients hospitalized during the same period in 2019 (prepandemic). Demographic data, length of hospital stay, place of residence, Wagner grade of DFU, comorbidities, laboratory parameters, wound duration, duration of diabetes, and treatments applied were recorded. RESULTS: During the pandemic, the length of hospital stay decreased, and patient referrals from other cities significantly decreased (P <.001). Hemoglobin A1c level was higher and Wagner grade was more advanced during the pandemic period (P =.014 and P =.033, respectively). The number of patients undergoing debridement alone decreased during the pandemic period, while those requiring amputation increased (P =.008 and P =.005, respectively). CONCLUSIONS: Patients with DFU delayed seeking timely proper medical advice during the pandemic. This resulted in a significantly higher amputation rate, with physical, psychosocial, and economic consequences. Virtual techniques (eg, video consultation) can be used to identify patients who require hospitalization. Close follow-up can be provided via home nursing care and by supplying advanced wound care products for in-home use. Patients with DFU should be encouraged to seek proper medical advice and take recommended precautions.

Comparison of Short-Term Results of Laparoscopic and Open Surgeries for Colorectal Cancer: A Single-Center Experience.

OBJECTIVE: Although laparoscopic colon cancer surgeries have increased in recent years, their oncological competence is questioned. In our study, we aimed to evaluate oncological competence by comparing laparoscopic and open surgery. METHOD: The study was planned retrospectively. A total of 94 patients were included in the study, 42 of whom underwent laparoscopy, and 52 patients underwent open surgery. Both groups were compared in terms of demographic characteristics, staging, number of benign/malignant lymph nodes, histological findings, and complications. RESULT: The final pathology report of all patients was adenocarcinoma. The median number of dissected lymph nodes was 20.9 in the open group (8-34) and 19.46 in the laparoscopy group (7-31) (p = 0.639). The median number of dissected malignant lymph nodes was 1 (0-13) in the open surgery group and 3.1 (0-8) in the laparoscopy group (p = 0.216). The laparoscopy group exhibited a longer operation time (281.2 ± 54.2 and 221.0 ± 51.5 min, respectively; p = 0.036) than the open surgery group, but a shorter intensive care unit (ICU) discharge, quicker initiation oral feeding, and shorter length of hospital stay (4.0 ± 0.9 vs 5.7 ± 2.0 days, respectively; p < 0.001). DISCUSSION: Laparoscopic surgery elicits many benefits such as less wound infection, lower requirement for blood transfusion, shorter hospitalization, quicker initiation of oral feeding, and mobilization. Our study has shown that laparoscopic surgery provides quite adequate lymph node dissection when compared to oncological surgery, which is viewed with suspicion in the light of these benefits of laparoscopy.

Applying a Silver-containing Dressing to the Incision Site and Its Effect on the Development of Surgical Site Infection After Ostomy Closure: A Prospective Randomized Clinical Pilot Study.

BACKGROUND: Surgical site infections (SSIs) can occur after colorectal surgery. Ionic silver has been used to prevent the development of SSIs. New-generation dressings, defined as total occlusive ionic silver-containing dressings, have been shown to reduce bacterial colonization in SSIs. PURPOSE: To evalute the effect of a silver hydrofiber dressing on the development of SSIs at the abdominal incision after ostomy closure. METHODS: There was a total of 37 eligible patients who underwent temporary ostomy closure. Five patients required an associated intervention during ostomy closure and were excluded. One patient was lost to follow-up. Hence, 32 patients were included in the study. Silver-containing occlusive dressings and conventional dressings were used in patients who underwent ostomy closure. In the control group (n = 16), the wound area was covered with a standard sterile gauze dressing for 24 to 48 hours, and then wound cleansing was performed with 10% povidone iodine, followed by daily dressing replacement with sterile gauze for 5 days. The patients in the study group (n = 16) were treated with a silver-containing hydrofiber dressing, which was not changed for 5 days following application in the operating room. RESULTS: At the end of the 30-day follow-up period, no SSIs were observed in the study group. When the dressing methods applied to the patient groups with and without SSIs were compared, SSIs developed at a higher rate in the control group (n = 4; 26.7%) compared with the study group (n = 0); this result was statistically significant (P = .043). CONCLUSIONS: In this study, the use of a wound care product containing ionic silver reduced the rate of SSIs related to ostomy closure. Multicenter, randomized, clinical studies involving a larger number of patients are needed. In addition, occlusive wound dressings with and without silver should be investigated in further studies.

Does lymph node ratio (metastasis/total lymph node count) affect survival and prognosis in gastric cancer?

OBJECTIVES: To investigate the influence of the metastatic lymph node/total lymph node ratio (N-ratio) on survival and prognosis in surgically treated gastric carcinomas. METHODS: A retrospective review of 73 patients who underwent curative resection at the Department of General Surgery, Hitit University Faculty of Medicine, Turkey. Receiver operating characteristic analysis was used to calculate the cut-off value for the N-ratio of the patients. The N-ratio cut-off value was determined to be 0.32. Patients were divided into 2 groups: below 0.32 (Group 1) and 0.32 and above 0.32 (Group 2). RESULTS: Group 2 patients had a total lymph node mean of 25.10±13.64 while Group 1 patients had a total lymph node mean of 18.77±9.36 (p=0.04). In Group 2, the mean of metastatic lymph node was 15.97±10.30 (p<0.001). The mortality rate of Group 1 was 18% while Group 2 was 51.7%, and were statistically significant (p=0.0039). The estimated survival duration of Group 2 was 24.22 months, and Group 1 was 48.01 months (p=0.001). The mean estimated survival time for the entire group was 40.92 months. We differentiated patients from the development of mortality cut-off value in ROC analysis with 65.2% sensitivity and 72% specificity. This ratio was found to be 0.32, which was statistically significant (p=0.003). Ratios greater than 0.32 raised the risk of mortality by 4.8 times, which was statistically significant (p=0.003). CONCLUSION: The N-ratio could be a new metric to evaluate prognosis following curative gastrectomy and improve the existing tumor lymph node metastasis staging system.

Arsenic and selenium measurements in nail and hair show important relationships to Alzheimer's disease in the elderly.

BACKGROUND AND RESEARCH QUESTION: The relationships of Arsenic (As) and selenium (Se) to Alzheimer's Disease (AD) are not clearly known. This case-control observational study aims to investigate the possible relationship of these elements to the diagnosis and pathophysiology of the disease. METHODS: This case-control observational study was performed using 40 AD patients in different clinical stages and 40 healthy control subjects, living in a similar environment with low As exposure. The levels of As and Se in nail and hair were measured with Inductively Coupled Plasma Mass Spectrometry. The results were analysed with regards to clinical condition, age, disease duration, sex, education, living environment, and the relationship of the two elements using Mann Whitney U test and Spearman Rho or Pearson correlation tests as appropriate. RESULTS: The levels of As and Se were not related to age, disease duration, sex, education, or living environment in the study groups (p > 0.05). The levels of As and Se in hair and nail samples of all patients and patient subgroups were higher than those in the healthy subjects (p < 0.001). A positive correlation was found between the levels of As and Se in both hair and nail samples only in the patient group (p < 0.01). CONCLUSION: According to the results, As and Se levels probably increase due to some metabolic or genetic factors affecting both of them together. There may be an increase in the unregulated pool (selenomethionine) and a decrease in the regulated pool of Se (selenosycteine) in AD. Our findings need verification and the subject seems to deserve more elaborate evaluations including genetic analyses and analysis of different chemical forms of these elements.

General surgery specialism in Turkey: work power currently, continuity at quality and quantity.

OBJECTIVES: As one of the oldest and main branches of medicine, process of General Surgery speciality training is long, expensive and difficult. Along with the principle of using limited sources wisely, there is a need for national forward planning in order to keep the number of General Surgery specialists in the proper level and in the proper quality. This study is made for the assurement of training quality specialists and for the sustainability in the best conditions after determining of the number of general surgeons, work force, and working conditions. MATERIAL AND METHODS: The number of General Surgery specialists (professors, associate professors, specialists or General Surgery subspecialists) and assistants who actively work in our country from the end of 2017 in the public sector, private sector, and university hospitals, is examined. These numbers were subjected to cross evaluation according to the provinces, academic titles and number of assistants. The estimated ratio of the existing number of General Surgery specialists to upcoming five and ten years were calculated according to the data of Turkish Statistical Institute. RESULTS: From the end of 2017, 3957 General Surgery specialists are actively working in 1031 of 1499 health facilities. Four hundred and forty of them are titled as professors, 324 of them are titled as associate professors. For every 25 thousand people, there exist 1.22 surgeons. Ten years ago, this ratio was calculated as 1.27. The number of assistans, which was 1005 ten years ago, is decreased to 768 today, but the increase of the number of specialists is 409. CONCLUSION: The number of General Surgeons in our country is above the ideal ratio, which is one for 25 thousand people. In case rate of increase of the number of General Surgeons for the last 10 years continues, when the decrease of population growth rate is considered, there will be an uncontrolled increase in the number of surgeon per 25 thousand people. Just as the distribution of General Surgery specialists -whether or not having an academic title- is not balanced, the number of instructor per assistant is also excessive.

Analysis of factors associated with mortality in major burn patients.

OBJECTIVES: Major burn injury is a type of trauma with high morbidity and mortality rates at all age groups. There is no consensus on the provided guidelines regarding the prediction of severity of the victims. Not being accessible to sophisticated clinical and blood monitoring in developing countries, it remains a challenge for them. The aim of the present study was to analyze the factors that have an effect on mortality and serve as a guide for burn treatment. Factors affecting mortality in major burn patients treated in a burn treatment center of a third step hospital with over 30% of burns of the total body surface area were evaluated, and parameters indicating severity were specifically determined. MATERIAL AND METHODS: Medical records and follow-up notes of patients hospitalized in Ankara Numune Education and Research Hospital Burn Center between 2008 and 2014 were evaluated retrospectively. Data on age, gender, comorbidities, burn percentage, locality, type of burn, process of the burn (suicide or accident), presence of inhalation injury, results of blood hemogram and biochemical tests, length of hospitalization, type of surgical procedures performed, presence of multitrauma, and ventilatory support requirement were analyzed to determine the factors affecting mortality. White blood cell count, hemoglobin count, platelet count, and lactate dehydrogenase level were examined at admission, at the middle of the clinical course, and at the end of treatment (at both exitus date or discharge date). RESULTS: A total of 224 patients were hospitalized with burns ≥ 30% total body surface area. Of the 224 patients, 81.7% were males, and 18.4% were females. In the mortality group, 41.3% were males, and 58.5% were females. Gender (female, p <0.041), age (p <0.001), age group (0-14/15-59/> 60 years, p <0.001), total body surface area (p <0.001), type of burn (flame, p <0.002), presence of inhalation injury (p <0.001), process of the burn (p <0.002), time spent between the event and admission to the hospital (p <0.001), length of hospitalization (p <0.001), presence of comorbidity (p <0.038), diabetes mellitus (p <0.05), ventilation support (p <0.001), lactate dehydrogenase values (lactate dehydrogenaseadmission, p <0.001; lactate dehydrogenasemiddle, p <0.015; lactate dehydrogenaselast, p <0.001), white blood cell count (p <0.001), and platelet count (p <0.043) were found to be significant for univariate analyses. These parameters were further evaluated using multivariate analyses. Lactate dehydrogenaselast level (p <0.001), age (p <0.001), length of hospitalization (negative odds ratio), p <0.001), presence of inhalation injury (p <0.029), total body surface area burned (p <0.029), and leukocytosis (p <0.006) were found to be significantly associated with mortality; however, leukocytosis and length of hospitalization did not pose risk for mortality with regard to odds ratios. CONCLUSION: Early recognition of the factors affecting morbidity and mortality in patients and taking preventive measures, in addition to earlier detection and prevention of complications in long-time intensive care unit patients, could reduce complication and mortality rates in major burn trauma patients. Parameters for the indication of severity and mortality are important; however, lactate dehydrogenase is an easily studied parameter and is found to have a predictive value on prognosis.

Comparison of Primary Midline Closure, Limberg Flap, and Karydakis Flap Techniques in Pilonidal Sinus Surgery.

BACKGROUND Pilonidal sinus (PS) is a common disease of the sacrococcygeal-natal region. There are many treatment options, but there is still no consensus on the ideal treatment. We compared the results of our PS patients who were treated with primary midline closure (PMC), Limberg flap repair (LFR), and Karydakis flap (KF). MATERIAL AND METHODS The data for 924 PS patients from 2013 to 2017 were retrospectively examined. Demographic data, surgical procedures, schedules, and recurrence rates were examined. RESULTS The mean age was 28.4 years (14-77 years), 82.5% were male (n=762), and 17.5% were female (n=162). PMC was performed on 53.7% (n=496) of the patients, 32.5% (n=300) received LFR, and 13.9% (n=128) underwent KF. PMC was the first choice among females but LFR was the first choice in recurrent patients. The recurrence rate was 10.8% in the PMC group, 8% in the LFR group, and 3.1% in the KF group. In Short Form Survey-36 (SF-36) scores, the best cosmetic outcomes were observed in cases of PMC (p<0.05). Overall, wound dehiscence (WD) was observed in 7.5%, surgical site infection (SSI) in 2.4%, and seroma in 8.5% of all patients. The KF group had the lowest complication rates (p<0.01). CONCLUSIONS According to the results of this study, the reason for preferring PMC among women is cosmetic concerns. PMC still remains important for treatment, but it should be noted that the recurrence rates due to inadequate excision are mostly observed in cases of PMC. Considering their low recurrence rates, LFR or KF should be considered first. When low recurrence rates, patient comfort, and cosmetic results are evaluated together, KF in particular emerges as a method preferred by physicians and patients.

Analysis of factors associated with mortality in major burn patients.

OBJECTIVE: Major burn injury is a type of trauma that still has high morbidity and mortality rates at all age groups. There is no consensus on the provided guidelines regarding the prediction of the severity of the victims. It is sometimes not easy to have sophisticated clinical and blood monitoring for developing countries. It is still a challenge for them. The aim of the present study was to analyze the factors that have an effect on mortality and serve as a guide for burn treatment. Factors affecting mortality in major burn patients with over 30% of burns of the total body surface area who were treated in a burn treatment center of a third step hospital were evaluated, and parameters indicating severity were specifically determined. MATERIAL AND METHODS: Medical records and follow-up notes of patients hospitalized in in Ankara Numune Education and Research Hospital Burn Center between 2008 and 2014 were evaluated retrospectively. Data on age, gender, comorbidities, burn percentage, locality, type of burn, process of the burn (suicide or accident), presence of inhalation injury, results of blood hemogram and biochemical tests, length of hospitalization, type of surgical procedures performed, presence of multitrauma, and ventilatory support requirement were analyzed to determine the factors affecting mortality. White blood cell count, hemoglobin count, platelet count, and lactate dehydrogenase level were examined at admission, at the middle of the clinical course, and at the end of treatment (at both exitus date or discharge date). RESULTS: A total of 224 patients were hospitalized with burns ≥30% total body surface area. Of the 224 patients, 81.7% were males, and 18.4% were females. In the mortality group, 41.3% were males, and 58.5% were females. Gender (female, p<0.041), age (p<0.001), age group (0-14/15-59/>60 years, p<0.001), total body surface area (p<0.001), type of burn (flame, p<0.002), presence of inhalation injury (p<0.001), process of the burn (p<0.002), time spent between the event and admission to the hospital (p<0.001), length of hospitalization (p<0.001), presence of comorbidity (p<0.038), diabetes mellitus (p<0.05), ventilation support (p<0.001), lactate dehydrogenase values (lactate dehydrogenaseadmission, p<0.001; lactate dehydrogenasemiddle, p<0.015; lactate dehydrogenaselast, p<0.001), white blood cell count (p<0.001), and platelet count (p<0.043) were found to be significant for univariate analyses. These parameters were further evaluated using multivariate analyses. lactate dehydrogenaselast level (p<0.001), age (p<0.001), length of hospitalization (negative odds ratio), p<0.001), presence of inhalation injury (p<0.029), total body surface area burned (p<0.029), and leukocytosis (p<0.006) were found to be significantly associated with mortality; however, leukocytosis and length of hospitalization did not pose risk for mortality with regard to odds ratios. CONCLUSION: Early realization of the factors affecting morbidity and mortality in patients and taking preventive measures, in addition to earlier detection and prevention of complications in long-time intensive care unit patients, could reduce complication and mortality rates in major burn trauma patients. Parameters for the indication of severity and mortality are important; however, lactate dehydrogenase is an easily studied parameter and is found to have a predictive value on prognosis.

Comparison of Effects of Vessel-Sealing Devices and Conventional Hemorrhoidectomy on Postoperative Pain and Quality of Life.

BACKGROUND The aim of this study was to investigate the early and late results of use of LigaSure, Harmonic Scalpel, and conventional hemorrhoidectomy in hemorrhoidectomy, to determine the least painful method, and to investigate the relationship between pain perception and personal differences in hemorrhoid bundles. MATERIAL AND METHODS Ninety patients undergoing hemorrhoidectomy between 2014 and 2017 were retrospectively evaluated. We investigated the duration of hospitalization and the presence of bleeding, incontinence, perianal wetness, urinary retention, stenosis, and recurrence during follow-up after surgery. Analgesic requirement was determined by Patient-Controlled Analgesia, as well as pain score by use of the Visual Analog Score and patient satisfaction by Short Form-36. We also assessed the relationship between pain and lateral thermal damage, the number of peripheral nerves, number of excised bundles, and the number of thrombosed vessels, as determined by histopathological examination. RESULTS No differences were found among the 3 methods in the duration of hospitalization, the presence of bleeding, fecal incontinence, perianal wetness, urinal retention, anal stenosis, recurrence rate, VAS, analgesic consumption, or results of the SF-36. There was no difference in the number of bundles, thrombosed vessels, or number of nerve fibers in a bundle, but the LigaSure Hemorrhoidectomy had more lateral thermal damage (p<0.001). While there was a difference between VAS of day 1 and 7 according to the hemorrhoid bundles, there was no difference in the other parameters. CONCLUSIONS There was no difference among the 3 methods in terms of complications, postoperative pain, or patient satisfaction, and pain intensity was positively correlated with the number of excised bundles.

Clinical infection in burn patients and its consequences.

BACKGROUND: Burn injuries facilitate invasive infections and sepsis not only by destroying the continuity of the protective skin barrier but also through systemic effects. The burn wound, blood, and urine samples are frequently cultured to determine the pathogen agent. The aim of this study was to analyze pathogen growth in patients' cultures confirmed as "infection positive" by the hospital Infection Control Committee and to assess the clinical implications of these growths. METHODS: Hospitalized patients included in the study were those with a total burned body surface area of >10% and "presence of infection" confirmed by the Infection Control Committee. The patients were evaluated with respect to age, gender, burn etiology, the total body surface area burned (TBSA), the presence of inhalation injury, sepsis, positive cultures, the microorganisms cultured in wound-blood-urine samples, and septic focus. RESULTS: Of the total 36 (10.3%) "infection-positive" patients, 26 (72.2%) were male; the mean age of patients was 44±21 years. The mean burned TBSA of the whole group was 45.58%±23.1%. Acinetobacter baumannii was the most isolated organism in the wound cultures. In patients with confirmed infection, there was a correlation between the pathogen isolated in urine cultures and mortality rates (p=0.023). Sepsis was diagnosed in 23 (63.9%) patients, of whom 21 had inhalation injuries. There was a significant correlation between inhalation injury and sepsis (p=0.015), and both the presence of sepsis or inhalation injury increased mortality (p=0.027 and p=0.009, respectively). CONCLUSION: According to the study data, the TBSA burned demonstrated a greater significance for mortality, although the presence of sepsis and/or urinary tract infection should also be noted as a cause of mortality in burned patients.

Retrospective Clinical Study of the Effects of T-Tube Placement for Bile Duct Stricture.

BACKGROUND T-tube placement in the common bile duct (CBD) is a surgical alternative to bile duct reconstruction in cholecystectomy for cholecysto-choledocholithiasis, or gallstones. The aim of this retrospective clinical study was to investigate the incidence of late complications of T-tube placement. MATERIAL AND METHODS Retrospective review identified 35 patients who had T-tube placement during cholecystectomy. Clinical data were collected on surgical indications, patient demographics, and clinical symptoms. Ultrasound (US) was used measure the diameter of the common bile duct (CBD), intrahepatic ducts, and presence or absence of stones in the CBD. Data from laboratory investigations included the aspartate aminotransferase-to-platelet ratio index (APRI), which was used as a non-invasive method to evaluate both cholestasis and liver fibrosis. RESULTS Of the 35 patients included in the study, 33 (94.3%) underwent open cholecystectomy, CBD exploration, and T-tube placement due to cholecysto-choledocholithiasis. The remaining two patients (5.7%) underwent primary CBD repair and T-tube placement secondary to CBD injury. The mean follow-up period after T-tube placement was 69 months. In patients with T-tube placement, the CBD diameters ranged from 4-21 mm, were normal in 20 patients (57.1%), dilated in 15 patients (42.9%), with the mean CBD diameter being 8.91±4.82 mm. No residual or recurrent CBD calculus and no clinical or laboratory evidence of cholangitis or cholestasis were found. CONCLUSIONS A retrospective clinical study at a single surgical center, showed that T-tube placement during open cholecystectomy and CBD exploration was a safe procedure that did not result in late complications.

Trace metal concentrations in hair and nails from Alzheimer's disease patients: Relations with clinical severity.

BACKGROUND AND OBJECTIVES: Metals, especially transition metals, seem to be important in the pathogenesis of Alzheimer disease. This study aims to determine the relationship of trace metal elements to the pathogenesis and/or course of Alzheimer Disease in terms of clinical severity. METHODS: The hair and nail trace metal levels of 62 Alzheimer Disease patients at different clinical stages (21 mild, 20 moderate, 21 severe) and 60 healthy control subjects were measured by using inductively coupled plasma-mass spectrometry. The statistical comparisons were performed with regards to the study groups, clinical stages, disease duration and age. RESULTS: The patient and control groups were significantly different from each other in regards to Mn, Fe, Cu, Cd, Hg (p<0.001), Zn (p<0.01) in nail concentrations and, Na, Al, Pb, Co (p<0.001), Fe, Mn (p=0.001), Hg, Cu, Cd, K in hair concentrations (p<0.01). No difference was detected in the levels of Mg and Ca. Nail Na level showed differences among different clinical stages of the disease (p<0.01). In comparing the mild degree Alzheimer patients to the control group; significant differences were detected in nail Mn, Fe, Cu, Co (p<0.001), Hg, Zn (p<0.01) and, hair Pb, Al (p<0.001), Na, K levels (p<0.01). CONCLUSIONS: Our results have shown that transition and posttransition metals are especially important metals for the disease process. The relation of nail Na level with clinical stages of AD is an interesting new finding, making someone to think that alkali metals may be important in the progression of the disease.

The rising trend of papillary carcinoma in thyroidectomies: 14-years of experience in a referral center of Turkey.

BACKGROUND: During the past 25 years, the incidence of thyroid papillary carcinoma (TPC), especially the micropapillary subtype, has been increasing in different countries worldwide. The rise in the rate of thyroid malignancies were also determined in Turkey in the last two decades. This fact was attributed to the Chernobyl accident because Turkey is one of the affected countries by the radioactive fallout. The aim of this study was to assess the changes in the parameters of the thyroid and put forth the reasons in a 14-year period. METHODS: The patient records, demographic and malignancy characteristics, and operations of 1,585 patients who had a thyroidectomy from 1996 to 2009 were reviewed retrospectively. The study was divided in two equal time periods for comparison of data. RESULTS: A total of 216 thyroid carcinomas (13.6%) were diagnosed in the study period. There was a significant increase in the frequency of papillary (P <0.023) and micropapillary (P <0.001) carcinomas when the two different time periods were compared. The rate of follicular, medullary and other types of malignancies did not change. In the second period (2003 to 2009) of analysis, the rate of micropapillary carcinoma (P = 0.001) and within male (P = 0.031) and female (P <0.001) genders, application of total thyroidectomy (p = 0.029), and multicentric disease (P = 0.015) increased significantly. A slight decrease in the mean age of the whole number of patients and patients with papillary and micropapillary carcinomas (P >0.05) was observed. The increased number of TPC >10 mm was insignificant. Geographic region and age specific malignancy increase was not determined. CONCLUSIONS: Micropapillary carcinoma has become a dominant type of thyroid malignancy in Turkey. The main reasons of this transition were mandatory iodization and much higher application of total thyroidectomy in surgery. Improvement in healthcare and diagnostic techniques are the complementary factors. Due to its lack of molecular and genetic basis from the perspective of thyroid cancer, the Chernobyl disaster has lost its importance in Turkey.

Colorectal emergencies associated with penetrating or retained foreign bodies.

BACKGROUND: Foreign bodies in rectum and colon is an uncommon problem in surgical practice. Anal eroticism leads amongst etiologic factors. In some patients accidents or forceful application of foreign bodies are causative factors. This study was designed to describe our experience in diagnosis and treatment of this exciting clinical problem. METHODS: Data were collected prospectively from 1998 to 2013 in 30 patients. Patient demographics, diagnostic findings, location, type, extraction method, and postextraction period were reviewed. RESULTS: All the 30 patients were their first admission in emergency service of a hospital. On admission high alcohol intake was determined in 15(50%) patients. All the patients were hospitalized. Most of the rectal foreign bodies (23 of 25) was located distal 2/3 of the rectum. Colorectal perforation was diagnosed in 5 patients who had not any retained foreign body. Under adequate anesthesia transanal extraction was implemented in 23 (92%) patients in the operating room. In the patients with proximal located rectal foreign bodies (2/25), grade III and IV rectal injury or colonic perforation (7/30) laparotomy was carried out. CONCLUSION: A careful physical and rectal examination is essential for correct diagnosis and localization of retained foreign bodies. Forceful and repeated efforts without sphincter relaxation is gives rise to proximal migration of objects and unwanted complications such as rectal perforation. The operating room provides adequate anaesthesia for muscle relaxation and technical advantages in transanal extraction of rectal foreign bodies. Therefore, nonoperative success rate improves. If the objects are large and proximally migrated and if the patients suffer from peritonitis due to rectal or colon perforation or pelvic sepsis, laparatomy is performed witout much delay.