Risk of burns in pressure cooker usage: a comprehensive analysis of explosive injuries.

BACKGROUND: Despite the widespread use of pressure cookers for quick and efficient cooking, literature has insufficiently highlighted the potential dangers resulting from inappropriate handling. This study aims to provide a comprehensive overview of 32 patients who presented with pressure cooker burns, emphasizing the serious risks associated with their misuse. METHODS: Retrospective data were collected from patients admitted to Bagcilar Training and Research Hospital Burn Center between 2017 and 2020 with pressure cooker burns in Türkiye. Data encompassed patient characteristics, burn causes, locations, severities, treatments, and clinical outcomes. RESULTS: The study included 32 patients (29 female/3 male) with a mean age of 42.3 (8-83). Patients were categorized based on burn areas, revealing associated injuries such as ocular (34.3%) and ear injuries (6.25%). The average hospital stay was 10.5 days [2-37]. While five pressure cookers exploded due to product-related issues, 26 explosions resulted from user errors (15.6%/81.2%). Importantly, no mortality was observed among the patients. CONCLUSION: While pressure cookers facilitate rapid food preparation, this study underscores the severe risks arising from product or usage errors. This study emphasizes the need for more effective usage instructions and increased awareness about pressure cookers to prevent burn risks. We anticipate that educational programs focused on safe pressure cooker use could significantly reduce the incidence of serious injuries.

Impact of body weight-based dosing of palonosetron and ondansetron on postoperative nausea and vomiting following laparoscopic sleeve gastrectomy: a randomized, double-blind study.

BACKGROUND: Postoperative nausea and vomiting (PONV) is a frequent adverse effect following laparoscopic sleeve gastrectomy. Palonosetron with a standard dosing (75 µg) schedule has been questioned due to its low efficiency in obese patients. This study aimed to investigate the effectiveness and safety of the body weight-based dosing of palonosetron in managing PONV following laparoscopic sleeve gastrectomy. METHODS: A single-center, prospective, double-blinded randomized study was conducted between August 2021 and December 2021. Patients who underwent laparoscopic sleeve gastrectomy were prospectively recruited in the study. One hundred patients were randomly divided into palonosetron (Group P) and ondansetron (Group O). The demographic and clinical variables were recorded. The primary outcome of the study was the incidence of PONV between the two groups during the hospitalization. The secondary outcomes were the number of rescue anti-emetic and analgesic medications and the Functional Living Index-Emesis scores. RESULTS: There were 50 patients in each group (Group P and Group O). There were significant differences in the scores of POVN, nausea, and vomiting favoring Group P. In Group P, the rate of patients using rescue anti-emetics was significantly lower. The incidence of complete response and proportion of patients with higher Functional Living Index-Emesis scores were significantly higher in patients using palonosetron. CONCLUSIONS: The use of palonosetron significantly reduced the incidence of PONV following laparoscopic sleeve gastrectomy. There was a significant improvement in the scores of Functional Living Index-Emesis in patients using palonosetron.

The effect of fundectomy on histopathological findings and metabolic hormones in rats.

AIM: Fundectomy, shown as an alternative to restrictive techniques, causes absorption restriction and metabolic changes. This study aimed to examine the histopathological changes caused by the fundectomy as a technique applied to rats by hormones that affect stomach and obesity metabolism and its effect on weight loss. MATERIAL AND METHODS: 2randomly selected Winstar-Hannover rat groups were evaluated by measuring their pre-and postoperative weights and biochemically measuring Gastrin, Ghrelin, and Leptin levels on day 30. After sacrification, the stomachs were taken for histopathological examination. RESULTS: Significant weight loss was observed in the fundectomy group in the 1stmonth postoperatively. Biochemically, Gastrin means in the fundectomy group were statistically significantly higher than in the control group. The mean Ghrelin and Leptin levels of the Fundectomy Group were statistically significantly lower (p=0.005). Immunohistochemically, Gastrin means ™at the antrum and proximal stomach parts of the Fundectomy Group were significantly higher than in the control group. As Ghrelin, a significant decrease was observed in all 3regions of the Fundectomy Group compared to the control group. Leptin results were significantly lower at the antrum and proximal stomach parts of the Fundectomy Group. Histopathologically, in the Fundectomy Group, cystic glandular hyperplasia was moderate at the proximal stomach, foveolar hyperplasia was mild at the antrum, fibrosis was moderate at the antrum and corpus, and high at the proximal stomach. CONCLUSION: Fundectomy is an effective method in terms of weight loss. This animal experiment, conducted as a pilot study, will be an essential step in elucidating metabolic and histopathological changes. KEY WORDS: Bariatric surgery, Fundectomy, Obesity.

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

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

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

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

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

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

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

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

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

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

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

Cordycepin prevents the esophageal stricture formation in the alkali-burn rat model by exerting anti-inflammatory and antifibrotic effects.

PURPOSE: To investigate the efficacy of cordycepin, an adenosine analogue, on prevention of esophageal damage and stricture formation due to esophageal caustic burns in rat model comparing with prednisolone. METHODS: Caustic esophageal burn was introduced by 37.5% of NaOH to distal esophagus. Thirty-two Wistar albino rats were divided in four groups: sham rats undergone laparotomy, treated with 0.9% NaCl; control rats injured with NaOH without cordycepin treatment; cordycepin group injured with NaOH, treated with 20 mg/kg cordycepin; prednisolone group injured with NaOH, treated with 1 mg/kg prednisolone for 28 days. Efficacy was assessed by histopathological and immunohistochemical analysis of esophageal tissues. RESULTS: Cordycepin treatment significantly decreased inflammation, granulation tissue and fibrous tissue formation and prevented formation of esophageal strictures shown by histopathological damage score and stenosis indexes compared to control group (p < 0.01). These effects are relatively more substantial than prednisolone, probably based on attenuation of elevation of proinflammatory cytokines hypoxia-inducible factor 1-alpha (HIF-1?), tumor necrosis factor alpha (TNF-?), proliferative and fibrotic factor fibroblast growth factor 2 (FGF2) and angiogenic factor vascular endothelial growth factor A (VEGFA) (p < 0.05). CONCLUSIONS: The findings suggest that cordycepin has a complex multifactorial healing process in alkali-burned tissue, more successful than prednisolone in preventing the formation of esophageal strictures and may be used as a therapeutic agent in the acute phase of esophageal alkali-burn.

Comparative analysis of the management of acute appendicitis between the normal period and COVID-19 pandemic.

BACKGROUND: Acute appendicitis is the most common abdominal surgical emergency. There is no adequate information to evaluate the effects of the COVID-19 pandemic on acute appendicitis and its surgical management. The present comparative study reports successful appendectomy and infection control in patients with appendicitis during the COVID-19 pandemic and last year covering the same period. METHODS: This retrospective observational study was conducted in acute appendicitis-treated patients from 13.03.19 to 13.05.19 and from 13.03.20 to 13.05.20, respectively. RESULTS: This study included 150 patients (110 patients in 2019; 40 patients in 2020 (during COVID-19 pandemic)). The patients were named as Group A (Normal period) and Group B (Pandemic period), respectively. The groups were comparable as there was no significant difference between the mean age, mean BMI, and mean length of stay. There is a significant difference between the comorbidities of Group A and Group B (p=0.033). There was no significant difference between the laboratory and radiological findings of Group A and Group B. There was a significant difference between the perforation number of Group A and Group B (p=0.029). There was no significant difference between the needs of ICU and conversion from laparoscopic to conventional appendectomy of Group A and Group B. CONCLUSION: The findings obtained in this study suggest that late admission to the hospital caused complicated cases and made acute appendicitis management more difficult during the pandemic period, which was already a troubling period. During the COVID-19 pandemic, the principles applied to emergency surgery for infected patients should be applied to both suspected and confirmed cases.

Is Mesenteric Ischemia In COVID-19 Patients A Surprise?

Aim. The disease caused by the 2019 novel coronavirus is known predominantly for its respiratory outcomes; a subset of critically ill patients demonstrates clinically remarkable hypercoagulability in which thrombotic events range from acute pulmonary embolism in patients with COVID-19 pneumonia to extremity ischemia. Our observational study aimed to describe the incidence and characteristics, as well as clinical outcomes, of patients presenting and treated for mesenteric ischemia during the COVID-19 pandemic. Material and Methods. Between March 13 and May 13, 2020, 60 patients operated for emergency reasons were analyzed, and it was noticed that 5 of the 6 COVID-positive patients were operated due to mesenteric ischemia. Results. Five of sixty patients (83.3%) applied to our emergency clinic with COVID-19 positive and acute abdomen. Two of them (40%) did not have any comorbidities. All of them (%100) were male. There were no complications and only 1 death (20%). Mean leukocyte, neutrophil, and platelet levels were within the normal range, while the lymphocyte level was near the lower limit. C-Reactive Protein was above the limit in all patients. The mean levels of International Normalized Ratio, Platelet, and Activated Partial Thromboplastin Time were above the limits. While D-dimer levels were close to the upper limit; fibrinogen levels were above the normal limit for each patient. Conclusion. The presence of hypercoagulation status in critical COVID-19 patients should be observed closely, and anticoagulation therapy can be considered in selected patients. More clinical data are needed to examine the role of anticoagulation in COVID-19 treatment.

COVID-19 and acute biliary pancreatitis: comparative analysis between the normal period and COVID-19 pandemic.

BACKGROUND: The development of acute pancreatitis is multifactorial requiring predisposition and relevant injury.Viral acute pancreatitis has been described in other viral infections.However, pancreatic involvement in SARS-CoV-2 infection is still poorly defined.The present comparative study reports the patients with acute pancreatitis during the COVID-19 pandemic and last year covering the same period to appraise the link between COVID-19 and acute biliary pancreatitis. METHODS: The retrospective observational study was conducted in acute biliary pancreatitis patients from 13.03.19to13.09.19 and from 13.03.20to13.09.20 respectively. RESULTS: The study included 181patients(105patients in 2019;76 patients in 2020(during COVID-19 pandemic)).The patients were named as Group A(Normal period)and GroupB(Pandemic period),respectively.The groups were found to be comparable as there was no significant difference between the mean age, sex, comorbidities, cholecystectomized, and recurrency. There is no significant difference in the laboratory and radiological findings of GroupA and GroupB. However, there is a significant difference between the COVID-19 positive and negative patients in GroupB in terms of Glucose levels(p=0,025)and the presence of edema or necrosis in radiological images(p=0,046).There is a significant difference between the patients' number with abdominal pain of acute biliary pancreatitis in 2019and2020.(p=0)The length of stay was statistically significant in COVID-19 positive patients.(p= 0,013) CONCLUSIONS: Clinicians involved in the management of acute pancreatitis should be aware of its existence in the context of COVID-19.Understanding of the disease process and clinical manifestations of COVID-19 is still developing.Awareness of these issues and addressing them adequately will be crucial for the management. KEY WORDS: Acute Biliary Pancreatitis, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Cordycepin prevents the esophageal stricture formation in the alkali-burn rat model by exerting anti-inflammatory and antifibrotic effects

ABSTRACT Purpose To investigate the efficacy of cordycepin, an adenosine analogue, on prevention of esophageal damage and stricture formation due to esophageal caustic burns in rat model comparing with prednisolone. Methods Caustic esophageal burn was introduced by 37.5% of NaOH to distal esophagus. Thirty-two Wistar albino rats were divided in four groups: sham rats undergone laparotomy, treated with 0.9% NaCl; control rats injured with NaOH without cordycepin treatment; cordycepin group injured with NaOH, treated with 20 mg/kg cordycepin; prednisolone group injured with NaOH, treated with 1 mg/kg prednisolone for 28 days. Efficacy was assessed by histopathological and immunohistochemical analysis of esophageal tissues. Results Cordycepin treatment significantly decreased inflammation, granulation tissue and fibrous tissue formation and prevented formation of esophageal strictures shown by histopathological damage score and stenosis indexes compared to control group (p < 0.01). These effects are relatively more substantial than prednisolone, probably based on attenuation of elevation of proinflammatory cytokines hypoxia-inducible factor 1-alpha (HIF-1?), tumor necrosis factor alpha (TNF-?), proliferative and fibrotic factor fibroblast growth factor 2 (FGF2) and angiogenic factor vascular endothelial growth factor A (VEGFA) (p < 0.05). Conclusions The findings suggest that cordycepin has a complex multifactorial healing process in alkali-burned tissue, more successful than prednisolone in preventing the formation of esophageal strictures and may be used as a therapeutic agent in the acute phase of esophageal alkali-burn.

The value of inflammatory markers in diagnosing acute appendicitis in pregnant patients.

BACKGROUND: Acute appendicitis (AA) is the most common extra-obstetric condition requiring surgery during pregnancy. AA diagnosis is made by laboratory tests along with anamnesis and physical examination findings. Due to the physiological and anatomical changes during the pregnancy, AA diagnosis is more challenging in pregnant women compared to non-pregnant patients. The present study evaluated the significance of white blood cell counts (WBC), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR) and lymphocyte-to-C-reactive protein ratio (LCR) to diagnose acute appendicitis during pregnancy. METHODS: Pregnant patients admitted to General Surgery Inpatient Clinic with AA pre-diagnosis in September 2015-December 2019 period were screened using International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10) diagnosis code (K35= acute appendicitis, Z33= pregnancy), and AA patients were identified retrospectively. The patients were divided into two groups. The Group I included the patients who had appendectomy due to AA and had a suppurative appendicitis diagnosis based on the pathological evaluation. On the other hand, Group II had the patients admitted as an inpatient with AA pre-diagnosis, but discharged from the hospital with full recovery without operation. Group III, i.e., the control group, on the other hand, was constituted by 32 randomly and prospectively recruited healthy pregnant women who were willing to participate in the study and who had matching study criteria among the patients followed in Obstetrics and Gynecology outpatient clinic of our hospital. RESULTS: This study included 96 pregnant women with an average age of 29.20±4.47 years (32 healthy pregnant women, 32 pregnant women followed for acute abdominal observation and 32 pregnant women who underwent appendectomy). Of these patients, three cases who turned out not to have suppurative appendicitis (negative appendectomy) and two cases found to have perforated appendicitis based on intraoperative and histopathological evaluations were excluded from this study. The results showed that Group I patients had significantly higher WBC (p=0.001), CAR (p=0.001) and NLR (p=0.001), but significantly lower LCR values (p=0.001) compared to the Groups II and III. Besides, based on logistic regression analysis, it was revealed that higher WBC, CAR and NLR values and lower LCR values were independent variables that could be used for the diagnosis of AA in pregnant women. CONCLUSION: Considering WBC, NLR, CAR and LCR parameters in addition to medical history, physical examination and imaging techniques could help clinicians diagnose acute appendicitis in pregnant women.

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

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

A comparison of the quantitative evaluation of in situ parathyroid gland perfusion by indocyanine green fluorescence angiography and by visual examination in thyroid surgery

ABSTRACT Objective The most vital complications of thyroidectomy are recurrent nerve damage and hypocalcaemia. We aimed to compare the tissue perfusion scores (PS) of IG fluorescence angiography (IGFA) and visual examination by the surgeon after total thyroidectomy. Subjects and methods Forty-three patients were accepted into the study. Localisation of the parathyroid gland (PG) was determined by the naked eye and scored in terms of tissue perfusion. The averages of fluorescent light intensities for each IGFA were calculated, the perfusions were scored and compared with the PS given by the surgeon. Biochemical parameters were noted. Results 37.2% of patients had autotransplanted PGs, according to their visual scores. The means of IGFA-PS for PGs scored as 0, 1 or 2 on visual inspection were 48.58 ± 4.49 [30-70], 89.65 ± 8.93 [36-144] and 158.76 ± 8.93 [70-253], respectively, which correlated with the visual PSs in a statistically significant manner (P < 0.0001). The predictive cut-off value for IGFA-PS was determined to be 70, given a visual PS of 0 (95% CI [0.72-0.85]), and this was interpreted to be a candidate cut-off point for the autotransplantation of PGs. Conclusion IGFA scoring may be considered as an operative predictor, providing objective criteria to evaluate the tissue and blood perfusion of PGs after thyroidectomy. IGFA scoring may be considered to have value in minimising postoperative permanent hypoparathyroidism in patients.

A comparison of the quantitative evaluation of in situ parathyroid gland perfusion by indocyanine green fluorescence angiography and by visual examination in thyroid surgery.

Objective The most vital complications of thyroidectomy are recurrent nerve damage and hypocalcaemia. We aimed to compare the tissue perfusion scores (PS) of IG fluorescence angiography (IGFA) and visual examination by the surgeon after total thyroidectomy. Subjects and methods Forty-three patients were accepted into the study. Localisation of the parathyroid gland (PG) was determined by the naked eye and scored in terms of tissue perfusion. The averages of fluorescent light intensities for each IGFA were calculated, the perfusions were scored and compared with the PS given by the surgeon. Biochemical parameters were noted. Results 37.2% of patients had autotransplanted PGs, according to their visual scores. The means of IGFA-PS for PGs scored as 0, 1 or 2 on visual inspection were 48.58 ± 4.49 [30-70], 89.65 ± 8.93 [36-144] and 158.76 ± 8.93 [70-253], respectively, which correlated with the visual PSs in a statistically significant manner (P < 0.0001). The predictive cut-off value for IGFA-PS was determined to be 70, given a visual PS of 0 (95% CI [0.72-0.85]), and this was interpreted to be a candidate cut-off point for the autotransplantation of PGs. Conclusion IGFA scoring may be considered as an operative predictor, providing objective criteria to evaluate the tissue and blood perfusion of PGs after thyroidectomy. IGFA scoring may be considered to have value in minimising postoperative permanent hypoparathyroidism in patients.

Diverting Ileostomy Duration Is the Main Determinant of Ileostomy-Related Complications after Surgical Treatment of Rectum Cancer.

BACKGROUND: This study aimed to investigate factors associated with the development of ileostomy complications in rectal cancer patients, including those who received neoadjuvant treatment. METHODS: This retrospective trial included 133 consecutive patients who underwent surgery for rectal cancer with temporary diverting ileostomy. Patients' demographic characteristics as well as the pre- and postclosure outcomes and complications were analyzed. RESULTS: In logistic regression analysis, longer duration of ileostomy emerged as a significant independent predictor of any complication during ileostomy. The respective odds ratios for 3-6 months and >6 months vs. <3 months of ileostomy duration were as follows: OR, 4.5 (95% CI, 1.2-16.7), p=0.023; and OR, 15.2 (95% CI, 3.1-75.2), p=0.001. An additional stepwise model also identified hypertension as a significant predictor. In stepwise logistic regression model, adjuvant chemoradiotherapy emerged as significant independent predictor of "any ileostomy-related complication after ileostomy closure": OR, 4.5 (2.0-10.2), p < 0.001. CONCLUSION: Duration of ileostomy appears to be the main determinant of ileostomy-related complications. Patients who had received neoadjuvant or adjuvant therapy had longer ileostomy duration, which may be attributed to the concerns of the surgeon or to the complications themselves.

Two Different Clinical Approaches with Mortality Assessment of Four Cases: Complete and Incomplete Type of Abdominal Cocoon Syndrome.

Abdominal cocoon syndrome (ACS), also called sclerosing encapsulated peritonitis, is a condition characterized by encapsulation of all or some of small bowel loops by a thick fibrous membrane. Etiologic cause is not fully known. It is among the rare causes of intestinal obstruction in adults. Preoperative diagnosis is difficult, and high suspicion is required. Diagnosis is generally made during laparotomy performed due to mechanical obstruction. In treatment of the condition, large scale surgical resections should be avoided. In the present study, we aimed to evaluate all clinical and radiological characteristics and surgical treatment of ACS in light of the literature through four patients operated in our clinic.

Potent therapeutic effects of ruscogenin on gastric ulcer established by acetic acid.

BACKGROUND/OBJECTIVE: The present study investigated the potent therapeutic effects of Ruscogenin, main steroid sapogenin of traditional Chinese plant called 'Ophiopogon japonicas', on chronic ulcer model established with acetic acid in rats. METHODS: 24 rats were attenuated to the sham (2 ml/kg/day isotonic solution), control (untreated ulcer) and treatment (3 ml/kg/day ruscogenin) groups. After treatment for 2 weeks, gastric tissues were collected and prepared for light microscopic (H&E), immunohistochemical (Collagen I, III and IV) and biochemical analysis [Epidermal growth factor (EGF), Prostaglandin E2 (PGE2), Tumor Necrosis Factor alpha (TNF-α), Interleukin 6 and 8 (IL-6 and IL-8), Lipid Peroxidase (LPO), Myeloperoxidase (MPO), Glutathione (GSH) and Glutathione Peroxidase (GSH-Px)] and transmission electron microscopy (TEM). RESULTS: Macroscopic scoring showed that the ulceration area of ruscogenin-treated group decreased compared with control group. Immunohistochemical analysis revealed ruscogenin ameliorated and restored the levels of Collagen I and IV to the levels of sham group. Tissue levels of EGF and PGE2 enhanced significantly in untreated ulcer group while were higher in treated ulcer group than the control group. TNF-α, IL-6, IL-8, LPO, MPO levels increased significantly in control group whereas decreased in treated rats after ruscogenin treatment. However, levels of GSH and GSH-Px increased significantly in treatment group. TEM showed chief cells and parietal cells of ulcer group having degenerated organelles while ruscogenin group had normal ultrastructure of cells. CONCLUSION: There are potent anti-inflammatory and anti-oxidant effects of ruscogenin on gastric ulcer and may be successfully used as a safe and therapeutic agent in treatment of peptic ulcer.