Comparison of Unilateral Fasciocutaneous V-Y Flap Technique with Cleft Lift Procedure in the Treatment of Recurrent Pilonidal Sinus Disease: A Retrospective Clinical Study.

BACKGROUND This study aimed to assess treatment outcomes of the cleft lift procedure and V-Y flap technique in the treatment of recurrent pilonidal sinus disease (PSD). MATERIAL AND METHODS A total of 51 patients who underwent cleft lift procedure and 43 patients who underwent fasciocutaneous V-Y flap technique were evaluated. The demographic characteristics, previous operations, duration of symptoms, perioperative complications, duration of operation and hospital stay, duration of draining of all patients, and recurrence of PSD were recorded. RESULTS The mean operation time was 35.61±5.254 min in the cleft lift group (CLG) and 57.42±7.327 min in the V-Y flap group (VYFG) (p=0.001). No wound dehiscence was found in the VYFG and 5 patients (9.8%) had wound dehiscence in the CLG (p=0.035). Draining time was 1.39±0.603 days in the CLG and 2.79±0.638 days in VYFG (p=0.001). The mean hospital stay was 1.75±0.523 days in the CLG and 3.77±1.02 days in the VYFG (p=0.001). Two patients (3.9%) in the CLG had recurrence and no recurrence was reported in the VYFG (p=0.189) in the given time interval. CONCLUSIONS Both methods in treatment of recurrent PSD can be preferred because of low complication and recurrence rates. Because no recurrence was found after the V-Y flap technique, it appears to be a preferable method despite some disadvantages.

Effect of strontium ranelate on serum leptin and bone turnover markers in women with established postmenopausal osteoporosis.

OBJECTIVE: To assess the association between leptin levels and bone mineral density (BMD) and bone metabolism markers in postmenopausal women taking strontium ranelate. STUDY DESIGN: In this longitudinal uncontrolled study, postmenopausal osteoporotic women were administered strontium ranelate and categorized into 1 of 2 groups: overweight and lean. BMD, serum leptin, bone-specific alkaline phosphatase (ALP) and urinary deoxypyridinoline (Dpd) were assessed at baseline, 6 and 12 months of the therapy. RESULTS: For all 47 women, leptin levels increased at the sixth month (p = 0.001) and 1 year after treatment (p = 0.001), Dpd levels decreased at the sixth month (p = 0.001) and 1 year after treatment (p = 0.003), but ALP levels did not change with respect to basal levels. Spine and hip BMD also increased at the end of 1 year (p = 0.01 and p = 0.001, respectively). For overweight women leptin levels increased 6 months and 1 year after treatment (p = 0.003 and p = 0.001, respectively). Dpd levels decreased significantly at the sixth month and at 1 year (p = 0.001 and p = 0.041), but ALP levels did not change. Hip and spine BMD also increased (p = 0.036 and p = 0.002). The lean group had similar serum results and BMD scores after treatment. CONCLUSION: Our data supports a positive effect of leptin on bone metabolism in favor of bone resorption inhibition in postmenopausal osteoporotic women on strontium treatment.

The relation of pelvic pain and dense adhesions to Doppler ultrasound findings in patients with ovarian endometriomas.

PURPOSE: To study the relation of pelvic pain symptoms and pelvic adhesions to Doppler ultrasound findings in patients with ovarian endometriomas. METHODS: 62 patients who underwent laparoscopic surgery for endometrioma were divided into two groups according to their pelvic pain symptoms. Group 1 (n = 27) included patients with pelvic pain, group 2 (n = 35) asymptomatic patients. Patients were evaluated for the vascularization of endometrioma by transvaginal color and power Doppler ultrasonography before the surgery. The presence and amount of blood flow reported in terms of a color scale, pulsed Doppler indices, and dense pelvic adhesions were compared between the groups. The relation of Doppler ultrasound findings to the dense pelvic adhesions was also analyzed. RESULTS: Blood flow was present in 74.1 % (n = 20) of patients in group 1 and 68.6 % (n = 24) in group 2 (p = 0.63). The volume and vascularization of the endometriomas, pulsed Doppler indices, stage of endometriosis, and the presence of dense pelvic adhesions were also similar. Patients with dense pelvic adhesions had significantly higher amount of blood flow compared to patients without adhesions (p = 0.006), but the mean pulsatility index and resistance index were not different between the groups (p = 0.55 and 0.59, respectively). CONCLUSIONS: Pelvic pain symptoms were not found to be related to endometrioma vascularization. On the other hand, we observed an association between higher vascularized endometrioma and the presence of dense pelvic adhesions.

Comparison of ethanol and hypertonic saline as a single intracystic agent in the percutaneous treatment of liver hydatid cysts.

PURPOSE: In this study, the effects of hypertonic saline and ethanol as a single intracystic agents in the percutaneous treatment of liver hydatid cysts were compared. METHODS: The 50 patients were separated into two groups as those administered 30% hypertonic saline alone as the intracystic agent in percutaneous treatment (33 patients, 52 cysts), and those administered 96% ethanol alone (17 patients, 26 cysts). Both groups were compared in terms of percentage of cyst volume reduction, complications, and treatment success. RESULTS: The follow-up period was median 17.0 months (11.0-20.0) in the ethanol group and 17.0 (14.0-22.0) in the hypertonic saline group (p = 0.269). Complications were observed in 5 (19.2%) cysts applied with ethanol as the intracystic agent and in 7 (13.5%) of the cysts where hypertonic saline was used (p = 0.521). Clinical success was evaluated as 100% in both groups. The percentage of cyst volume reduction according to the initial volume was determined as mean 75.6 ± 20.43 (28.19-98.13) in the ethanol group cysts and as 68.2 ± 16.45 (26.39-97.48) in the hypertonic saline group (p = 0.427). CONCLUSION: The results of this study demonstrated similar efficacy of hypertonic saline and ethanol in the percutaneous treatment of CE1 and CE3A liver hydatid cysts. These results suggest that the use of hypertonic saline as a single intracystic agent in the percutaneous treatment of CE1 and CE3A liver hydatid cysts provides sufficient efficacy of treatment and cyst volume reduction. Nevertheless, there is a need for further prospective, randomized studies to support these findings.

Control and study of bio-inspired quadrupedal gaits on an underactuated miniature robot.

This paper presents a linear quadratic Gaussian (LQG) controller for controlling the gait of a miniature, foldable quadruped robot with individually actuated and controlled legs (MinIAQ-III). The controller is implemented on a palm-size robot made by folding an acetate sheet. MinIAQ-III has four DC motors for actuation and four rotary sensors for feedback. It is one of the few untethered robots on a miniature scale capable of working with different gaits with the help of its individually-actuated legs and the developed controller. The presented LQG controller controls each leg's positions and rotational speeds by measuring the positions and estimating the rotational speeds, respectively. With the precise gait control on the robot, we demonstrate different gaits inspired by quadrupeds in nature and compare the simulation and experiment results for some of the gaits. An extensive simulation environment developed for robot dynamics helps us to predict the locomotion behavior of the robot in various environments. The match between the simulation and the experiment results shows that the proposed LQG controller can successfully control the miniature robot's gaits. We also conduct a case study that shows the potential to use the simulation to achieve different robot behavior. In a case study, we present our robot performing a prancing similar to horses. We use the simulation environment to find the required motor configuration phases and physical parameters, which can make our robot prance. After finding the parameters in simulation, we replicate the configuration in our robot and observe the robot making the same moves as the simulation.

Prognostic value of Prognostic Nutritional Index (PNI) for 5-year recurrence-free survival in surgically resected gastrointestinal stromal tumors.

BACKGROUND: Recent studies have investigated the role of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammation index (SII), and prognostic nutritional index (PNI) on prognosis for various malignancies. However, the value of these markers in determining the prognosis for gastrointestinal stromal tumors (GIST) remains controversial. We investigated the effect of NLR, PLR, SII, and PNI on 5-year recurrence-free survival (RFS) in patients with surgically resected GIST. MATERIALS AND METHODS: We retrospectively analyzed patients (n=47) who had undergone surgical resection for primary, localized GIST at a single institution between 2010 and 2021. The patients were divided into two groups according to the recurrence status in the 5-year period as 5-year RFS(+) (patients with no recurrence (n=25) and 5-year RFS(-) (patients with recurrence (n=22) groups. RESULTS: In univariate analyses, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), tumor localization, tumor size, PNI, and risk category were significantly different between the RFS(+) and RFS(-) groups while NLR, PLR, SII were not. Multivariate analyses revealed that only the tumor size (HR =5.485, 95% CI: 0.210-143.266, p=0.016), and PNI (HR= 112.020, 95% CI: 8.755-1433.278, p<0.001) were independent prognostic factors for RFS. The patients with a high PNI (≥46.25) had a higher 5-year RFS rate than the patients with low PNI (<46.25) (95.2% to 19.2%, p<0.001). CONCLUSION: A higher preoperative PNI is an independent positive predictor for 5-year RFS for patients with surgically resected GIST. However, NLR, PLR, and SII have no significant effect. KEY WORDS: GIST, Prognostic Nutritional Index, Prognostic Marker.

Hemostatic effects of traditional Inula viscosa and Capsella bursa-pastoris plant mixture extract on rat liver parenchymal bleeding model.

BACKGROUND: Failure to achieve effective bleeding control and problems related to transfusion in liver surgery are the most common causes of post-operative mortality and morbidity. Various methods/drugs including topical hemostatic agents have been em-ployed for bleeding control in liver surgery. This study was aimed to investigate the hemostatic properties of the herb mixture extract of Inula viscosa and Capsella bursa-pastoris (IvCbp) in rat liver laceration model, which have been traditionally used as antiseptic and hemostatic agents public in Hatay/Tukey. METHODS: Thirty rats were divided into three groups equally and blood samples were taken from all rats for preoperative hemoglobin (Hb) measurements. Then, the standard liver resection model was applied to all rats. Sponge for the first rat group, Ankaferd Blood Stopper® Trend-Tech for the second rat group and IvCbp plant extract mixture for the third group were applied to resection areas for 3 minutes. Liver samples of all rats were evaluated in terms of inflammation and necrosis intensity on the 5th post-operative day. RESULTS: Post-operative Hb values were found as 11.0±1.1 g/dL in the sponge group, 11.9±2.0 g/dL in the Ankaferd group, and 14.1±1.2 g/dL in the IvCbp herb mixture group (p<0.001). In the histopathological examination, less necrosis was observed in the herb mixture group compared to the sponge and Ankaferd groups (p=0.001). In addition, no statistically significant necrosis difference was observed between sponge and Ankaferd groups. While less inflammation was observed in the herb mixture group compared to the other groups, Ankaferd group had the highest inflammation score (p<0.001). CONCLUSION: IvCbp herb mixture extract group provide effective hemostatic control, caused less Hb decrease and resulted in less inflammation and necrosis compared to Ankaferd and sponge groups in a rat liver resection model.

Continuous versus interrupted episiotomy repair with monofilament or multifilament absorbed suture materials: a randomised controlled trial.

PURPOSE: To compare different repair techniques and different suture materials for episiotomy. METHODS: 160 women having vertex delivery with right-mediolateral episiotomy were randomly allocated to four groups. In the groups where continuos technique was performed, vaginal mucosa, perineal muscles and the skin were sutured continuously. In the groups of interrupted technique, vaginal mucosa was sutured with continuous sutures, then muscle layers and skin were closed by interrupted sutures. Two different types of synthetic absorbed suture material were used: monofilament type is in form of polyglycolide-co-caprolactone and multifilament one is polyglactin 910-Rapide. Perineal pain during different activities on the first and tenth day postpartum and also during sexual intercourse 6 weeks after the delivery was questioned by visual analogous scale (VAS). Furthermore, repair time, amount of suture and episiotomy complications were investigated in each groups. RESULTS: On the first day after delivery, the perineal pain scores, the repair time, the amount of suture were statistically less in the continuous technique groups. The differences between the pain at tenth day and during sexual intercourse 6 weeks after the delivery were statistically same. CONCLUSIONS: The continuous suturing techniques for episiotomy closure, compared to interrupted methods, are associated with less short-term pain, are quicker and also need less suture material.

The value of urocortin and Ca-125 in the diagnosis of endometrioma.

PURPOSES: In this study, we sought to establish the value of a new molecule, urocortin (Ucn), in the diagnosis of endometrioma and compare with Ca-125 to identify superiority of urocortin. METHODS: Of the patients operated on at our hospital with the initial diagnosis of adnexal mass, 88 patients whose pathology results were endometrioma and benign ovarian cyst were included in the study. As a result of the pathological examination, the patients were assessed in two groups. Group 1 consisted of 42 cases of endometrioma and Group 2 included 46 cases of benign ovarian cyst (control group). The serum Ucn and CA 125 levels of patients were measured from the blood samples drawn prior to the operation. RESULTS: While the serum Ucn level was 4.8 ± 1.00 ng/ml in the endometrioma group, it was 4.5 ± 1.03 ng/ml in the control group (P = 0.21). The difference was statistically not meaningful. On the other hand, mean serum Ca-125 level was 43.8 U/l (11.7-251) in the endometrioma group, it was 16.5 U/l (4.3-121.1) in the control group. The difference was statistically meaningful (P = 0.001). When the cut-off point for Serum Ca-125 level was taken as 21.38, sensitivity and specificity levels were found to be 88.1 and 63%. When the cut-off point for Ucn was taken as 4.16, sensitivity was 76.2%, and specificity 45.7%. CONCLUSION: Ucn was not found to be efficient in distinguishing endometrioma from other benign ovarian cysts or to be superior to CA125 in the diagnosis of endometrioma.

Vascular endothelial growth factor +405 C/G polymorphism is highly associated with an increased risk of endometriosis in Turkish women.

OBJECTIVE: Endometriosis is a chronic gynecological disease characterized by the growth of hormonally responsive, endometrial tissue outside the uterine cavity. The present study aims to analyze two vascular endothelial growth factor (VEGF) polymorphisms (-460 C/T and +405 C/G) in Turkish women with and without endometriosis. STUDY DESIGN: A case-control study was undertaken at the Infertility Department of Zekai Tahir Burak Women's Health Care Education and Research Hospital. The single nucleotide polymorphisms, -460 C/T and +405 C/G, in the 5'-untranslated region of the VEGF gene were tested in 98 affected women and 94 women with no laparoscopic evidence of disease. Endometriosis was also confirmed histologically. Following genomic extraction of genomic DNA, genotyping of the -460 C/T and +405 C/G polymorphisms of the VEGF gene were performed by polymerase chain reaction and restriction fragment length polymorphism assay. Nominal data were evaluated by Pearson Chi-square or Fisher's Exact test, where applicable. Odds ratios and 95% confidence intervals were also calculated. A P value less than 0.05 was considered statistically significant. RESULTS: Demographic data were similar among groups. The genotype and allele frequencies of the -460 C/T polymorphism did not differ significantly between cases and controls. In contrast, the genotype (P < 0.001) and allele frequencies (P < 0.001) of +405 C/G polymorphism showed a significant difference between cases and controls. Regardless of the early or advanced stage, women with endometriosis showed a higher incidence of the +405 GC genotype and +405G allele when compared with the controls. CONCLUSIONS: These data suggest that VEGF +405 GC genotype and +405G allele may be associated with the risk of developing early and advanced stage endometriosis in the Turkish population.

Bariatric surgery has positive effects on patients' and their partners' sexual function: A prospective study.

BACKGROUND: Obesity has been associated with severe conditions and sexual dysfunction. Bariatric surgery has effects positively patients' sexual function. OBJECTIVES: To assess the effect of bariatric surgery on sexual functions of couples. MATERIALS AND METHODS: The study included 57 obese patients and their sexually active partners. Male participations were assessed with the International Index of Erectile Function (IIEF) and Male Sexual Health Questionaries (MSHQ-4), and female participations were assessed with the Female Sexual Function Index (FSFI). RESULTS: There were 31 (54.4%) male patients and 26 (45.6%) female patients in the study. The median IIEF score of the male patients statistically increased postoperatively (p < 0.001). The IIEF subgroup areas were found to have increased after surgery. The median FSFI score of the female patients statistically increased postoperatively (p < 0.001). The median FSFI of male patients' partners significantly increased postoperatively (p < 0.001). All FSFI domains were statistically significantly increased (p < 0.001, all areas). The median IIEF value of the postoperative partners of the female patients also increased statistically significant (p < 0.001). In addition, the increases in the IIEF's subdomains in terms of sexual desire (p < 0.001), intercourse satisfaction (p < 0.001), and general satisfaction (p < 0.001) were statistically significant. CONCLUSION: The sexual functions of both males and females and also their' partners were improved after bariatric surgery. Patients with preoperative poor sexual function achieve significant benefits over patients without sexual dysfunction.

Immunohistochemical expression of estrogen and progesterone receptors in endometrial polyps and its relationship to clinical parameters.

OBJECTIVE: To investigate the differences in steroid receptor expression patterns between glandular and stromal portions in endometrial polyps among premenopausal and postmenopausal patients and the relationship between the receptor expression in endometrial polyps and clinical parameters. MATERIALS AND METHODS: A total of 25 postmenopausal and 25 premenopausal patients with solitary endometrial polyp detected by office hysteroscopy were involved in the study. All patients underwent hysteroscopic polypectomy under general anesthesia or spinal anesthesia. Estrogen and progesterone expression patterns were investigated in the polyps using immunohistochemistry. The mean age was 57.6 years in postmenopausal patients and 36.9 in premenopausal patients. Average gravida, body mass index (BMI), and frequency of smokers did not differ between groups. However, the patient's age and their concomitant diseases were significantly different between premenopausal and postmenopausal patients (P = 0.01). RESULTS: Comparison in postmenopausal patients showed that glandular estrogen and progesterone receptor expression were both significantly greater than stromal estrogen and progesterone receptor expression (P = 0.037 and <0.001, respectively). Proliferative phase endometrial polyps also demonstrated significantly greater expression of progesterone receptors in glandular epithelium compared with stroma (P = 0.019). However, stromal and glandular estrogen receptor expression did not differ among premenopausal patients. There was a statistically significant correlation among stromal progesterone receptor expression, plasma estrogen and FSH level (P = 0.01). A negative correlation was found between stromal progesterone receptor expression and patient's age (P = 0. 01). CONCLUSION: Estrogen and progesterone receptor expression were lower in the stromal portion of the endometrial polyp than in the glandular portion in postmenopausal patients. Stromal progesterone receptor expression was lower in older patients and there was a relation between low estrogen hormone levels and lower stromal progesterone receptor expression.

Comparison of GnRH agonists and antagonists in normoresponder IVF/ICSI in Turkish female patients.

PURPOSE: To evaluate the results of gonadotropin-releasing hormone agonist (GnRHa) and gonadotropin-releasing hormone antagonist (GnRHant) use in two demographically matched groups of normoresponder in-vitro fertilisation or intracytoplasmic sperm injection (IVF/ICSI) patients in a prospective study. METHODS: We randomised 93 patients undergoing IVF/ICSI between May 2005 and August 2006. Patients with IVF indications were included except for those with polycystic ovary syndrome or azoospermia, women older than 38 years and those with follicle-stimulating hormone (FSH) > or =10 IU/ml. Patients were stimulated with standard 225 IU recombinant FSH. In Group I (n=45) a daily dose of GnRHant cetrorelix acetate 0.25 mg was administered when follicles reached a diameter of > or =14 mm. Group II (n=48) patients were desensitised with the GnRHa, leuprolide acetate, in a long protocol. Human chorionic gonadotropin (hCG) was administered when at least three follicles of 18 mm in diameter were observed. Oocyte retrieval was scheduled 36 hours following hCG administration and embryos were transferred on day 3 after oocyte retrieval. RESULTS: The two groups were homogenous for age, infertility duration, basal FSH and serum oestradiol (E2) (P=0.537, P=0.911, P=0.103 and P=0.733, respectively). In Group II (the GnRHa group) more antral follicles (P<0.001), a longer induction duration (P=0.017) and higher peak E2 levels (P<0.001) were observed. No differences were observed in the number of oocytes retrieved (P=0.749), embryos achieved and transferred (P=0.677), or fertilisation rates (P=0.839) between the two groups. There was no statistically significant difference between groups in clinical pregnancy rates, cycle cancellation and ovarian hyperstimulation (P=0.437, P=0.109 and P=0.415, respectively). CONCLUSION: GnRHant and GnRHa provide comparable results in normoresponder patients, while GnRHant allows a greater flexibility in their treatment.

Effect of therapeutic hypothermia on superficial surgical site infection and postoperative pain in urgent abdominal surgery.

BACKGROUND: Although therapeutic hypothermia has been shown to be effective on surgical site infection and postoperative pain in patients undergoing elective surgery, its exact effect on emergency laparotomy remains unclear. In this study, we aimed to investigate the effect of therapeutic hypothermia on superficial surgical site infection and postoperative pain in patients undergoing urgent open abdominal surgery. METHODS: The study included 100 patients who underwent emergency open abdominal surgery from 01/01/2016 to 01/01/2017. The patients were randomly divided into two groups: therapeutic hypothermia, group I underwent cold therapy with local sterile frozen ice compress; and control group II, underwent conventional sterile compress. Age, gender, primary pathology diagnosis, size of incision, wound type and size, and duration of surgery were compared between the groups. Visual analog scale scores were determined every 3 hours, and the requirement for analgesics was assessed for each patient within 48 hours postoperatively. Both before and after 5 days of laparotomy, c-reactive protein (CRP), white blood cell count (WBC), albumin, serum total antioxidant status, and total oxidant status levels were measured, and oxidative stress index was calculated for each patient. The rates of superficial surgical site infection were compared between both groups. RESULTS: The two groups were similar in terms of age, gender, primary pathology diagnosis, size of incision, wound type and size, and duration of surgery (p>0.05). Although no significant difference was found between the groups with regards to visual analog scale scores (p>0.05), requirement for analgesics was lower in the group I compared to that in the control group (p<0.05). No significant difference was found between the groups in terms of preoperative WBC, albumin, CRP, serum total antioxidant status, total oxidant status, and oxidative stress index (OSI) levels (p>0.05). At postoperative day 5, serum total antioxidant status level was significantly higher, and OSI level was significantly lower in the group I compared to the respective levels in the control group (p<0.05). Moreover, the superficial surgical site infection rate was significantly lower in the group I (p<0.05). CONCLUSION: In patients undergoing urgent open abdominal surgery, therapeutic hypothermia led to lower requirement for analgesics and lower superficial surgical site infection rates in the early postoperative period. We consider that therapeutic hypothermia exerts this effect by elevating the serum total antioxidant status level, and decreasing the effects of inflammatory mediators and OSI.

The V-Y flap technique in complicated and recurrent pilonidal sinus disease.

OBJECT VES: This study presents early and long term (5 years) outcome of 61 complicated pilonidal sinus disease cases undergoing V-Y advancement flap method together with the literature data. METHOD: Data of 336 patients undergoing surgery for pilonidal sinus disease between 2008 and 2012 were retrospectively analyzed. Patients with defect size ≥ 10 cm, and more than one subcutaneous sinus tunnels were assumed to have complicated pilonidal sinus disease. A total of 61 patients were included in the study. Age, gender, type of surgery, duration of hospitalization, time of drain removal, pre-operative complications, and relapse rates at post-operative 5th year were analyzed. RESULTS: Of the 66 patients, 51 underwent unilateral V-Y advancement and 10 patients had bilateral V-Y plasty. Mean duration of operations was 66.87±18.37 minutes for total, 61.02±12.30 minutes for unilateral V-Y plasty, and 96.70±15.04 minutes for bilateral V-Y plasty. Hemovac drains were removed at 5.59±1.91 days averagely, 5.16±1.37 in unilateral group, and 7.80±2.74 in bilateral V-Y plasty group. Of the 4 patients who developed wound site infection, 2 had unilateral and 2 had bilateral V-Y flap advancement. Postoperative hematomas developed in 2 patients with unilateral flap and one patient with bilateral flapss. Seroma occurred in 2 patients with unilateral flap and one patient with bilateral flaps. Dehiscence developed two patients, one patient from each group. The mean duration of hosptalization was 5.98±2.21 days; 5.49±1.52 in unilateral group, and 8.50±3.34 in bilateral group. Early or late relapse was not seen in any groups. CONCLUS ON: V-Y advancement flap technique can be applied as an efficient method in the treatment of complicated pilonidal sinus disease due to low relapse and complication rates. KEY WORDS: Advancement flap, Complicated pilonidal sinus, Pilonidal sinus, V-Y flap.

Effects of temporary abdominal closure methods on mortality and morbidity in patients with open abdomen.

BACKGROUND: Open abdomen (OA) in which the abdomen is closed with temporary abdominal closure methods is the most effective in patients who develop severe abdominal sepsis or abdominal compartment syndrome. Major techniques used are Vacuum-Assisted Closure Method (VACM) and non-vacuum assisted closure method (NVACM). In the present study, the effects of different abdominal closure methods on morbidity and mortality were evaluated. METHODS: In the study, the temporary abdominal closure methods of the patients with OA during 2013-2016 were studied retrospectively. OA etiopathologies, mortality prediction scores, final abdominal closure periods and methods, hospitalization periods, complications (enteroatmospheric fistula, mesh infection, and incisional hernia), and mortality rates of patients who underwent VACM and NVACM were determined and compared. RESULTS: The present study included 123 patients who underwent VACM (n=65) and NVACM (n=58). There was no difference between the groups in terms of age, gender, and etiopathogenesis (p>0.05). The mean APACHE 4 and Multiple Organ Dysfunction Score (MODS) scores in the VACM/NVACM groups in treatment period were 47/63 and 11/14, respectively (p<0.05). The mean intensive care and hospitalization periods in the VACM/NVACM groups were 11/16 (days) and 22/28 (days), respectively (p<0.05). The collection and abscess development rates in the VACM and NVACM groups were 46.2% and 77.6%, respectively (p<0.05). The rate of enteroatmospheric fistula (EAF) development in the VACM and NVACM groups were 15.4% and 56.9%, respectively (p<0.05). The mean abdominal closure times in the VACM and NVACM groups were 13 and 17 days, respectively (p<0.05). Mortality rate in the VACM and NVACM groups were 18% (n=18) and 55% (n=32), respectively (p<0.05). CONCLUSION: In patients with OA, the temporary abdominal closure technique VACM has lower complication and mortality rates and shorter hospitalization period than other methods. Therefore, it is an effective and safe method for the treatment of OA.

The role of co-administration of damage control surgery and vacuum-assisted closure in the treatment of perineal wounds.

Perineal wounds caused by high-kinetic-energy shotgun blasts have a high mortality risk because they are often accompanied by injuries of the anus, rectum, genitourinary system, and extremities. Mortality often results from hemorrhage in the early stage and from multiple organ failure caused by sepsis in the late stage. The primary step in the treatment of patients presenting with perineal wound and hemodynamic instability caused by severe hemorrhage is to control hemorrhage and contamination using damage control surgery. After achieving hemodynamic stability, vacuum-assisted closure can be used to reduce the risks of infection and sepsis. In this report, we present a case who had a perineal wound caused by a mine blast and was successfully treated by damage control surgery and vacuum-assisted closure.

Treatment of colorectal injuries in the civil war and the factors affecting mortality.

AIM: Colorectal injuries are one of the most common causes of mortality in war. Mainstay treatment of these injuries include primary repair or stoma creation. METHODS: Clinical data of the patients were evaluated retrospectively. Time from injury to hospital admission, method of treatment, the colorectal area affected, injury severity score ISS, hemodynamic instability, and mortality rate were determined. RESULTS: Of the 61 patients included in the study. Mean time from injury to hospital admission was 160±19 minutes. The injury was in the right colon in 24 patients 39.3%, in the left colon in 18 29.5%, and in the rectum in 19 31.2% patients. Median ISS value of 61 patients was 16, IQR 5. Mortality and complication rates were higher in patients with hemodynamic instability and stoma requirement was also higher in this group p<0.05. Total mortality occurred in 15 24.5% patients. Of these, 10 66.6% patients had hemodynamic instability. DISCUSSION: Hemodynamic instability is the most important factor affecting the mortality and the treatment method in wartime colorectal injuries. CONCLUSION: We believe that in victims of war with colorectal injuries, surgical intervention before the development of hemodynamic instability may reduce the rate of mortality and stoma requirement. KEY WORDS: Colorectal injury, Firearm injury, Hemodynamic instability, Stoma.

Acetaminophen Reduces acute and persistent incisional pain after hysterectomy.

OBJECTIVE: Acetaminophen is effective for acute surgical pain, but whether it reduces persistent incision pain remains unknown. We tested the primary hypothesis that patients given perioperative acetaminophen have less incisional pain three months after surgery. Our secondary hypotheses were that patients randomized to acetaminophen have less postoperative pain and analgesic consumption, and better functional recovery at three months. METHODS: 140 patients having abdominal hysterectomy were randomly assigned to: 1)intravenous acetaminophen (4 g/day for 72 postoperative hours); or, 2) saline placebo. The primary outcome was incisional pain visual analog scale (VAS) at three months after surgery. The secondary outcomes were (1, 2) postoperative VAS scores while laying and sitting and (3) total patient-controlled intravenous tramadol consumption during the initial 24 hours, (4) DN4 questionnaires and (5) SF-12 at three months after surgery. RESULTS: The persistent incisional pain scores at three months were significantly lower in acetaminophen (median [Q1, Q3]: 0 [0, 0]) as compared with saline group (0 [0, 1]) (P = 0.002). Specifically, 89%, 9%, and 2% of acetaminophen patients with VAS pain score at three months of 0, 1, and 2 or more, as compared with 66%, 23%, and 10% in the saline group (odds ratio: 2.19 (95% CI: 1.33, 3.59), P = 0.002). Secondly, postoperative pain scores both laying and sitting were significantly lower in the acetaminophen group. Acetaminophen group had significantly better DN4 score and mental health related but not physical health related quality of life. CONCLUSIONS: Our results suggest that acetaminophen reduces the risk and intensity of persistent incisional pain. However, there are other mechanisms by which acetaminophen might reduce persistent pain. KEY WORDS: Anesthesia, acetaminophen, Persistent surgical pain, Postoperative acute pain.