Non-invasive detection of infection in acute pancreatic and acute necrotic collections with diffusion-weighted magnetic resonance imaging: preliminary findings.

PURPOSE: The purpose of this study was to evaluate the contribution of diffusion-weighted magnetic resonance imaging (DW-MRI) to the detection of infection in acute pancreatitis-related collections. METHODS: A total of 21 DW-MRI, and computed tomography (CT) were performed on 20 patients diagnosed as acute pancreatitis with acute peri-pancreatic fluid or necrotic collections. Collections were classified as infected or sterile according to the culture and follow-up results. Collections with gas bubbles on CT images were considered to be infected. Collections with peripheral bright signals on DW-MRI images were considered to be positive, whereas those without signals were considered to be negative. Apparent diffusion coefficient (ADC) values of the peripheral and central parts of the collections were measured. Student's t test was used to compare the means of ADC values of independent groups. RESULTS: Apart from one false positive result, the presence of infection was detected by DW-MRI with 95.2% accuracy. The sensitivity and accuracy of DW-MRI were higher than CT for the detection of infection. The ADC values in the central parts of the collections were significantly different between the infected and sterile groups. CONCLUSION: DW-MRI can be used as a non-invasive technique for the detection of infection in acute pancreatitis-associated collections.

Acute biliary pancreatitis related with pregnancy: a 5-year single center experience.

BACKGROUND: Pregnancy-associated acute biliary pancreatitis is a rare but challenging clinical entity in terms of diagnosis and management. We report our institutional medical data of pregnancy-associated acute biliary pancreatitis. METHODS: Medical records of 27 patients admitted to our clinics for pregnancy-associated acute biliary pancreatitis between January 2005 and January 2010 were reviewed. RESULTS: Of the 27 patients, 25 (93%) were in the post-partum period, and 2 (7%) were pregnant. Seventeen patients (63%) were managed with conservative treatment, and were scheduled for interval cholecystectomy, while 10 patients (37%) had early cholecystectomy prior to discharge. The mortality rate was 3% (n=1). CONCLUSION: Pregnancy-associated acute biliary pancreatitis usually has a mild-to-moderate clinical course with a favorable outcome, and can be managed successfully with conservative treatment. Early cholecystectomy done prior to discharge in the initial admission should be considered in mild-to-moderate pregnancy-associated acute biliary pancreatitis, except in patients within the first trimester.

Comparison of operative and non operative management of acute appendicitis.

BACKGROUND: In this prospective study, operative and nonoperative management of acute appendicitis were evaluated regarding their safety and cost effectiveness. METHODS: Two hundred ninety patients presenting to our Emergency Department between March 2005 and March 2006 with acute appendicitis were included in this prospective study. Nonoperative medical therapy was performed in 107 patients (Group 1), and 183 patients were treated surgically (Group 2). Routine follow-up controls were done on the 10th day, at the 3rd and 6th months and at the first year after discharge in Group 1. Both groups were compared regarding age, gender, mean hospital stay, modified Alvarado score, morbidity, mortality, and cost effectiveness. RESULTS: The male/female ratio of Groups 1 and 2 were 65/42 (mean age: 30.98+/-1.30) and 125/58 (mean age: 26.25+/-0.79), respectively. In Group 1, 19 patients were operated. Operation indications were resistance to therapy, patient's request, and operation in another hospital. Although the mean hospital stay of Group 1 was statistically significantly longer than Group 2, the mean cost of the therapy was $559 in Group 2 and $433 in Group 1. Morbidity rates were similar, with no mortality in either group. CONCLUSION: With its high success rate and cost effectiveness, medical treatment seems to be a good alternative to the gold standard therapy of surgery in management of acute appendicitis.

Albendazole is not effective for primary treatment of hepatic hydatid cysts.

INTRODUCTION: In current practice, minimal invazive interventions such as percutaneous drainage and laparoscopic surgery in adjunct treatment with benzimidazoles have been gaining acceptance in treatment of hydatid cystic disease with minimal morbidity and mortality. In this prospective study, the efficacy and validity of primary medical therapy in the treatment of hydatid cystic disease has been investigated. PATIENTS AND METHODS: Sixty-five patients with hepatic cystic disease were treated with albendazole alone between January 2004 and June 2007. All of the patients were administrated albendazole as 10 mg kg(-1) day(-1) divided into two equal doses for 6 months with ultrasonography (USG), serological tests, full-blood cell count and hepatic function tests performed in 2 months intervals in the course of treatment. RESULTS: Fifty of the patients were female and 15 were male with a mean age of 47.0+/-16.9 (17-80). A total number of 106 cysts were present in 65 patients. Mean cystic diameter was 5.5+/-3.6 (1-16). In 41 of the patients, cysts were solitary and in remaining 24 patients cysts were multiple. Mean follow-up period was 28.3+/-8.6 (12-42) months. The overall success rate of albendazole therapy was 18% (12/65) in the study. CONCLUSION: Albendazole therapy for hepatic hydatidosis is not effective in the vast majority of patients and, therefore, should not be used as the primary therapy for patients who are surgical candidates.

Spontaneous regeneration capacity of controlled small bowel perforations: an experimental study in rats.

BACKGROUND: Selective observation method has started to replace routine laparotomy application for abdominal penetrating trauma patients after Shaftan's selective observation method applied in the 1960s. In this respect, there is a possibility of bowel perforations healing without operations. An experimental model was established in this study in order to clarify this possibility. METHODS: Fifty Wistar-Albino rats were divided into five groups, ten in each. While one group served as the control, distal part of the small bowel of the rats in the other four groups was perforated 1, 2, 3, and 4 mm in diameter with appropriate cutters. After a week of observation, test rats were sacrificed and relaparotomy was applied. The test material consisting of the perforated bowel, covering 1 cm of proximal and distal margins, and some peritoneal tissue was taken for histopathological examination. RESULTS: Small bowel perforations with a diameter of 2 mm or below healed spontaneously without any operation. Peritonitis intensity increased in direct ratio with perforation diameters. Wall repair capacity of the bowel diminished with increasing perforation diameters. CONCLUSION: It was observed that small perforations in the small bowel of rats could be limited by the organism itself without a necessity of any surgical intervention.

Management of acute appendicitis in pregnancy.

BACKGROUND: Acute appendicitis is the most common surgical non-obstetric pathology during pregnancy. In this report, pregnant patients operated with a diagnosis of acute appendicitis in the last three years are evaluated retrospectively. METHODS: Between January 2009 and January 2011, 20 pregnant patients were operated for acute appendicitis. Patients were evaluated regarding age, gestational age, clinical and laboratory examinations, imaging studies, operative findings, mean hospital stay, mean operative time, and outcome. RESULTS: In 17 of 20 patients, acute appendicitis was confirmed and appendectomy was performed. Ten of the patients were operated with laparoscopic technique and the remaining 10 had open appendectomy. There was no fetal or maternal morbidity or mortality in any patient. All 20 patients delivered healthy babies during the postoperative course. CONCLUSION: Acute appendicitis is a challenging diagnosis in the pregnant patient; however, early surgical intervention should be performed with any suspicion. The type of surgery depends on the surgeon's preference and experience.

Intracorporeal knotting versus metal endoclip application for the closure of the appendiceal stump during laparoscopic appendectomy in uncomplicated appendicitis.

PURPOSE: The goal of the study was to compare the efficacy of two methods--intracorporeal knotting and metal endoclip application--for closure of the appendiceal stump during laparoscopic appendectomy in a specific group of patients with uncomplicated appendicitis. METHODS: The patients were randomized into two groups who had their appendiceal stump secured by intracorporeal knotting (Group 1) and metal endoclipping (Group 2). Primary outcome measure was postoperative complications, whereas secondary outcome measures were intraoperative complications, operative time, length of hospital stay, and re-admissions (including rehospitalizations and reoperations). RESULTS: One hundred seven patients were prospectively recruited in a randomized study between December 2010 and May 2011. Group 1 and Group 2 included 46 and 61 patients, respectively. The rate of postoperative complications in Group 1 and Group 2 was 8.7% (4/46) and 4.9% (3/61) (P>.05). There were no significant differences between the groups in secondary outcome measures except the mean operative time (61.9 minutes versus 46.3 minutes, P=.0008). CONCLUSIONS: The closure of the appendiceal stump by either intracorporeal knotting or metal endoclipping during laparoscopic appendectomy in uncomplicated appendicitis is safe with comparable morbidity and mortality rates.

Efficiency of unenhanced MRI in the diagnosis of acute appendicitis: comparison with Alvarado scoring system and histopathological results.

PURPOSE: The purpose of this study was to assess the diagnostic value of unenhanced magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis and compare with Alvarado scores and histopathological results. MATERIALS AND METHODS: The study included 85 consecutive patients (mean age, 26.5±11.3 years) who were clinically suspected of having acute appendicitis. Each patients Alvarado scores were recorded and unenhanced MRI was performed, consisting of T1-weighted, T2-weighted and fat-suppressed T2-weighted fast spin-echo sequences. The MR images were prospectively reviewed in consensus for the presence of acute appendicitis by two radiologists who were blinded to the results of the Alvarado scores. The study population were divided into three subgroups based on the MRI findings: Group I: definitely not appendicitis, Group II: probably appendicitis, Group III: definitely appendicitis. All patients were divided into two subgroups according to Alvarado scores as Group A (low: 1-6), and Group B (high: 7-10). MR findings were compared with Alvarado scores and histopathological findings. RESULTS: Sixty-six (77.6%) of the 85 patients with clinically suspected acute appendicitis, had undergone surgery. The diagnosis of appendicitis could be correctly achieved with MRI in 55 (83.3%) of 57 (86.4%) patients with histopathologically proven acute appendicitis. The sensitivity, specificity, positive predictive value and negative predictive value of MRI examination and Alvarado scoring system in the diagnosis of acute appendicitis were 96.49%, 66.67%, 94.83%, 75.0% and 84.21%, 66.67%, 94.12%, 40.0%, respectively. CONCLUSIONS: MRI is a valuable technique for detecting acute appendicitis even in the cases with low Alvarado scores. To increase the diagnostic accuracy and preventing unnecessary laparotomies for suspected appendicitis, shorter and cheaper unenhanced basic MRI may be performed.