Identifying Factors Associated with Non-mesenterovascular Pathology in Patients Undergoing Surgical Treatment for Acute Mesenteric Ischemia.

AIM: To identify factors that can help us to avoid a preoperative incorrect diagnosis of vascular occlusion by evaluating patients who underwent laparotomy with a probable preoperative diagnosis of acute mesenteric ischemia (AMI), but later at laparotomy, were diagnosed to have a different pathology than AMI. MATERIAL AND METHODS: A total of 213 patients who were operated with the diagnosis of AMI were enrolled in this study. Based on their operational, clinical, and pathological findings, they were divided into two groups. Patient demographic data, along with the American Society of Anesthesiology (ASA) score, Charlson comorbidity index, history of previous abdominal surgery, and computed tomography (CT) findings were compared between groups. RESULTS: There were 37 patients in Group 1 (non-mesenterovascular pathology) and 176 patients in Group 2 (mesenterovascular pathology). The percentage of ASA 4 patients was higher in Group 2, with 48.3%, compared to 35.1% in Group 1 (p-value: 0.028). Upon admission, Group 2 had a higher rate of pathologic findings on CT examinations. 21.8% of the patients with non-mesenterovascular pathology had normal intra-abdominal findings. In univariate and multivariate analysis for no-nmesenterovascular pathology, patient age less than 65, Charlson comorbidity index 1-2, INR level >1.2, history of previous abdominal operation, and pneumatosis intestinalis were identified as independent risk factors. DISCUSSION: The possibility of non-mesenterovascular pathology in presumed AMI patients should be kept in mind, especially if the patients have a history of abdominal surgery, a low comorbidity index, an elevated international normalised ratio (INR), and are younger than 65 years of age. CONCLUSION: Evaluating the significant parameters identified in this study among patients with a preliminary diagnosis of AMI may prove useful in avoiding misdiagnosis and unnecessary surgeries.

Effect of Prophylactic Negative-Pressure Wound Therapy for High-Risk Wounds in Colorectal Cancer Surgery: A Randomized Controlled Trial.

OBJECTIVE: To determine the effect of prophylactic negative-pressure wound therapy (pNPWT) in patients at high risk of surgical wound complications (SWCs) who underwent colorectal cancer (CRC) surgery. METHODS: In an open-label randomized controlled trial, 50 patients who underwent open CRC surgery between November 2018 and February 2020 were included. Participants were randomly assigned to the pNPWT group (n = 24) or control group (n = 26). For patients in the pNPWT group, the pNPWT device was placed on the wound for 7 days, whereas for patients in the control group, the wound was covered with a sterile gauze dressing. The primary outcome measured was 30-day SWCs: surgical site infection, hematoma, seroma, and wound dehiscence/evisceration. Secondary outcomes included postoperative wound infection assessment score and length of postoperative hospital stay. RESULTS: The incidence of 30-day SWCs differed significantly between the pNPWT and control groups (16.7% vs 53.8% respectively, P = .006). Patients in the pNPWT group had a significantly lower incidence of seroma than did those in the control group (8.3% vs 34.6%, P = .025). Surgical site infection occurred in 10 of 50 patients (20%) in the study: two (8.3%) in the pNPWT group and eight (30.8%) in the control group (P = .048). No hematomas or wound dehiscence/evisceration were noted in the study. There was no difference in median length of stay between groups (P = .153). CONCLUSIONS: This study confirmed that pNPWT effectively helps prevent SWCs in high-risk wounds after open CRC surgery.

Does ß-Glucan can have protective role against oxidative stress in experimental sepsis model in rats?

BACKGROUND: Very high mortality rate in sepsis may be related to oxidative stress. This study was conducted on the rats to investigate the presence of oxidative stress and also the potential protective effects of the ß-glucan in the intra-abdominal sepsis model formed by cecal ligation-perforation (CLP). METHODS: In this study, 30 Male rats were equally divided into three groups as 'Sham', 'Sepsis' and 'ß-Glucan'. Only laparotomy was performed in the Sham group, and sepsis was induced by CLP in Sepsis and ß-Glucan groups. Following CLP, a single dose of 4 mg ß-glucan/kg was also intraperitoneally administered to the ß-Glucan group. Blood and tissue (liver, lung and kidney) samples were taken from Sepsis and ß-Glucan groups after sepsis development determined at the end of the 48th hour, also from the Sham group. The levels of myeloperoxidase (MPO) and advanced oxidation protein products (AOPP) were determined in plasma samples, and the malondialdehyde (MDA) was measured in plasma and tissues. RESULTS: MPO and AOPP were higher in both the Sepsis and ß-Glucan groups; however, plasma and tissue MDA levels were higher only in the Sepsis group than the Sham group (p<0.05). However, when compared to the Sepsis group, all parameters measured, except kidney MDA, were significantly lower in the ß-Glucan group (p<0.05). CONCLUSION: To our knowledge, this is the first study to investigate the AOPP levels in the CLP sepsis model, ROS produced by the reaction of MPO derived from neutrophils may form oxidative damage to the proteins, compared to the lipids, and ß-glucan may be used as an alternative agent for sepsis treatment.

Application of crystal-line phenol in pilonidal sinus disease A single-center and single-surgeon experience.

AIM: Various surgical and minimally invasive treatment options are available in the treatment of pilonidal sinus. In our study, we aimed to retrospectively analyze the results of crystalline phenol application in patients who applied to our clinic with pilonidal sinus. MATERIAL AND METHOD: Patients who were applied crystalline phenol due to pilonidal sinus disease between 2018- 2019 were included in the study. The patients were evaluated in terms of demographic characteristics, pit count, surgical treatment history, abscess drainage history, number of repeated applications, complication status, recovery rate in the first month, success rate in the first year, and recurrence. RESULTS: 209 patients participated in our study. The average age of patients was 25.5, and the number of male patients was 4 times that of women. The patients had an average of 2.13 pits. Twenty-two patients had a history of abscess drainage. Thirteen patients had a history of surgical treatment. The recovery rate was 89.3% in the 1-month controls and 93.7% in the 1-year controls. Repeated application was performed to 11% of the patients. Seventeen patients had recurrence after wound healing. The most common complications were skin burn (1.4%) and wound infection (1.4%). CONCLUSION: In the treatment of pilonidal sinus disease, crystalline phenol can be safely applied with a high success rate, low recurrence rate and an acceptable percentage of complications. KEY WORDS: Crystalline phenol application recurrence, Pilonidal sinus, Minimally invasive.

Ectopic adrenal tissue in a hernia sac in an adult. A case report.

The discovery of ectopic adrenal tissue in the hernial sac is very rare, and in the majority of reported cases it is in children, while it is never described in adult subjects. This could be due to a progressive previous atrophy of the ectopic tissue or to an insufficient examination of the sac removed surgically. The most frequent site of these ectopias is the kidney, adjacent to the adrenal glands. The presence of ectopic adrenal tissue is important because of its neoplastic and hyperplastic potential. We report a case of a 69-year-old male patient who underwent a surgical operation of a left inguinal hernia and that the presence of ectopic adrenal tissue was reported in the pathologist's report. Preoperative abdominal ultrasound should therefore be performed in patients destined for an inguinal hernia surgery, because also the rare existence of ectopic adrenal tissue in the hernial sac should be kept in mind. KEY WORDS: Adrenal, Adult, Ectopia, Herni sac.

Comparison of Clinical Features and Treatment Results of Mix Mucinous Carcinomas and Other Atypical Carcinomas of the Breast.

OBJECTIVE: There are multiple subtypes of breast cancer with different biological and pathological features and accordingly exhibit different clinical behaviors. The aim of this study was to compare the treatment modalities, clinical features and prognostic characteristics of Mix Mucinous Carcinomas (MMBC) and other rare tumors of the breast. MATERIALS AND METHOD: A total of 2152 patients who were operated on for breast cancer in our clinic between 2010-2019, with pathological diagnoses of tubular, pure mucinous, mix mucinous or papillary carcinoma were enrolled in the study. Patients were divided into two groups as mix mucinous patients (Group1) and other rare tumors (Group2). The demographic, clinical and prognostic characteristics and treatment approaches were compared between Groups, and additionally between the subtypes of Group 2. RESULTS: 42 patients participated in our study. Group 1 consisted of 7 patients, and Group2 consisted of 35 patients. The subtypes in Group2 were papillary (n=21), pure mucinous (n=10) and tubular (n=4). Progesterone Receptor Positivity was found to be significantly higher in Group 2 patients than in Group1 patients (p=0.005, p<0.05). Multicentricity rates in the tumors of the patients in Group1 were found to be statistically significantly higher than the patients in Group 2 (p=0.024, p<0.05). In subtype analysis in Group2, there were no statistically significant differences parameters in the subgroups (p>0.05). Mean survival was 19.5+5.6 (8.5-30.5) months in Group 1 and 46.3+5.2 (36.1-56.6) months, in Group2 when evaluated separately (p:0.002). CONCLUSION: The prognosis of pure mucinosis (PMBC) and other atypical cancers of the breast compared to the (MMBC) is quite good. Rare pathological types of breast cancer can have favorable outcomes when treated with necessary oncological principles.

Determination of risk factors causing hypocalcaemia after thyroid surgery.

OBJECTIVE: The most common complication after thyroid surgery is hypocalcaemia and it sometimes leads to problems that are difficult to correct in patients. The present study was aimed to determine the risk factors causing the development of hypocalcaemia after thyroid surgery. METHODS: 818 adult patients were included in the study. The data were recorded by examining the hospital automation system and patient files retrospectively. Patients' demographic characteristics, radiological imaging findings, serum biochemical parameters, extent of the performed surgery, histopathological diagnoses were recorded. RESULTS: The rate of hypocalcaemia was 28.4% (1.7% permanent). In multivariate analysis: the female gender (p = 0.002), heavier thyroid gland (p = 0.084), substernal location (p = 0.004) and cervical lymph nodes dissection (CLND) (p < 0.001) were found to be significantly. Malignant thyroid pathology (p = 0.006) and total thyroidectomy (p = 0.025) increased the risk of hypocalcaemia significantly in univariate analysis. However, this increase in risk was not found to be statistically significant in regression analysis. Significant statistical result was not found on postoperative hypocalcaemia in terms of advanced age, hyperthyroidism and re-operation. The duration of hospitalization was higher in patients with postoperative hypocalcaemia (m = 2 days) (p < 0.001). CONCLUSION: In our analyses CLND, female gender, substernal location and heavier thyroid gland was found to be the independent risk factors in the development of postoperative hypocalcaemia. The development of postoperative hypocalcaemia may be predicted and measures may be taken to prevent clinical findings.

Value of the serum I-FABP level for diagnosing acute mesenteric ischemia.

PURPOSE: This study examined the feasibility of using the serum intestinal fatty acid binding protein (I-FABP) level for the early diagnosis of acute mesenteric ischemia, and investigated whether it contributes to the clinical decision-making process. METHOD: Thirty patients diagnosed with acute mesenteric ischemia, 27 patients with other types of acute abdomen who presented with acute abdomen symptoms but were not diagnosed with acute mesenteric ischemia, and 20 healthy people were included in the study. Mesenteric ischemia was confirmed by a pathological evaluation in patients who underwent intestinal resection due to detection of mesenteric ischemia during surgery. RESULTS: There was no significant difference in the leukocyte counts and D-dimer levels between subjects with mesenteric ischemia and acute abdomen due to other causes (p > 0.05). There was a significant difference in the serum I-FABP level between these groups (p < 0.001). CONCLUSION: The I-FABP level is a more reliable parameter for diagnosing acute mesenteric ischemia compared to leukocytosis and D-dimer elevation.

The effect of piracetam on brain damage and serum nitric oxide levels in dogs submitted to hemorrhagic shock.

BACKGROUND: To demonstrate the effect of piracetam on changes in brain tissue and serum nitric oxide levels in dogs submitted to hemorrhagic shock. METHODS: The subjects were randomized into four subgroups each consisting of 10 dogs. Hemorrhagic shock was induced in Group I for 1 hour and no treatment was given to this group. Blood and saline solutions were administered to Group II following 1 hour hemorrhagic shock. Blood and piracetam were given to Group III following 1 hour shock. No shock was induced and no treatment was applied to Group IV. Blood samples were obtained at the onset of the experiment and at 60, 120 and 180 minutes for nitric oxide analysis. For histopathological examination, brain tissue samples were obtained at the end of the experiment. RESULTS: The observed improvement in blood pressure and pulse rates in Group III was more than in Group II. Nitric oxide levels were increased in Group I; however, no correlation between piracetam and nitric oxide levels was determined. It was seen that recovery in brain damage in Group III was greater than in the control group. CONCLUSION: Piracetam, added to the treatment, may ecrease ischemic damage in hemorrhagic shock.

[Injuries due to parachute jumping]. / Parasütle atlama sonucu olusan yaralanmalar.

BACKGROUND: Parachuting is performed for sportive and occupational purposes and demands a high level of controlled physical performance. In conjunction with the growing interest in parachuting, injury rates in the emergency departments are also increasing. We thus aimed to evaluate the mechanism and characteristics of injuries due to parachuting. METHODS: Parameters of the patients injured and presenting to the emergency department, including mean age, body area exposed to injury, definite diagnosis, applied treatment modalities, and admission to/discharge from the hospital, were all recorded in a previously prepared form and analyzed. Degree of injury was detected by calculating the Injury Severity Score (ISS) using the Abbreviated Injury Scale (AIS). RESULTS: Mean ISS of the patients was 8.15+/-4.29. The most commonly affected body sites were the extremities. Of the extremity injuries, 13 (81%) involved lower extremities and 3 (19%) involved upper extremities. The most commonly affected site in the lower extremities was the ankle (47%). Head injuries followed extremity injuries as the second most affected site. CONCLUSION: Injuries from parachute jumping mostly occur during landing due to loss of balance. Loss of balance was seen to result from change in wind direction and personal factors. When jumpers acquire adequate knowledge about phases of parachute jumping and landing, probability of injury will decrease.

Effect of interleukin-10 on tissue damage caused by organophosphate poisoning.

Organophosphate poisoning is a common cause of severe morbidity and mortality among patients admitted to emergency departments. Tissue damages as a consequence of organophosphate poisoning are frequently reported, but preventing this potentially severe complication has not been the subject of much research. We tested whether interleukin-10, a cytoprotective agent, could prevent or diminish pathological signs of tissue damages caused by organophosphate poisoning. Thirty rats were divided into three equal groups (n = 10). Group 1 (sham) did not receive any agent during the experiment. Group 2 (control) received 0.8 g/kg of fenthion intraperitoneally, followed by 6 ml/kg of intraperitoneal normal saline 30 min and 3 hr later. Group 3 (treatment) received 0.8 g/kg of fenthion intraperitoneally, followed by 2 microg/kg of interleukin-10 intraperitoneally 30 min and 3 hr later. All rats were killed under anaesthesia after 6 hr and tissue samples were obtained from liver, kidneys and lungs. Even organophosphate poisonings do not cause significant clinical problems; several degrees of damages could be observed in liver, kidneys and lungs. These damages could be reduced by interleukin-10 treatment.

[Juguler vein gunshot injury from blank cartridges]. / Kurusiki tabanca atisi sonucu gelisen juguler ven yaralanmasi.

Blank cartridge guns, which are produced for self-defence needs and considered harmless, can be easily purchased by adults due to lack of legal regulations. We present this case because injuries caused by gunshot from blank cartridges may be fatal and are rarely encountered in emergency departments. A 3-year-old boy was brought to the emergency department since he had a wound on his neck caused accidentally by gunshot from blank cartridges. He had a moderate general condition and pale appearance. There was an irregular-edged, defective wound 2 cm above the sternal notch in midline localization with a dimension of 3 x 4 cm. Computed tomography of the thorax revealed contusion in the apex of the left lung. A 2-mm plastic piece embedded in the left internal jugular vein was removed during the operation. A mass education on danger and harm of these guns as well as legal regulations for restricted use seem to be necessary. Also, physicians should keep in mind that blank cartridge guns can cause fatal injuries.