The length of necrosis and renal insufficiency predict the outcome of acute mesenteric ischemia

Background: Acute mesenteric ischemia (AMI) is a potentially life-threatening condition because of its diagnostic difficulty, operative challenges, and comorbidities a patient may have. The aim of this study was to identify factors associated with adverse outcomes in patients with AMI. Methods: The hospital records and clinical data of all patients with AMI were reviewed for a recent 4-year period. Clinical outcomes and factors influencing mortality were analyzed. Results: Included in the study were 104 patients (46 females and 58 males) with an overall mean age of 66 ± 13.4 years. The cause of AMI was arterial pathology in 74 (71%) patients, venous thrombosis in 15 (14%) patients, and nonocclusive ischemia in 12 (12%) patients. Abdominal pain was the most common presenting symptom (97% of patients). The 30-day mortality rate was 66%. Univariate analysis showed that mortality was associated with renal insufficiency (p = 0.004), an age greater than 70 years (p = 0.02), the presence of comorbidities (p = 0.001), a leukocyte count greater than 18,000/mL (p = 0.04), and small bowel necrosis of more than 100 cm (p < 0.0001). Logistic regression analysis showed that independent predictors of mortality were small bowel necrosis of more than 100 cm (p = 0.002) and a serum creatinine level greater than 2 mg/dL (p = 0.04). Conclusion: The length of the necrosis and renal insufficiency are the primary factors that result in a poor outcome in AMI patients. Prompt diagnostic evaluation and early therapeutic interventions may help to prevent the development of these fatal predictors

The Effects of Melatonin and N-Acetylcysteine on Obstructive Jaundiced Rats Sıçanlarda Tıkanma Sarılığında Melatonin ve N-Asetilsisteinin Etkileri̇

© 2022, Hacettepe University, Faculty of Pharmacy. All rights reserved.Aim: The aim of this experimental study is to investigate the effects of N-ace-tylcysteine and melatonin on cholestasis and their protective effects on liver and renal injury. Materials and Methods: Forty-eight rats were used in the study. Rats were divided into three main groups as sham, main control, and study groups. The main control group is further divided into early sacrification group and control group. The study group is divided into melatonin, N-acetylcysteine, and me-latonin & N-acetylcysteine groups. A laparotomy was performed in study and control groups,and the common bile duct was ligated and divided. Five days after the first operation, blood samples liver and renal tissues were collected from early sacrification group. Between postoperative days five and ten, melatonin, N-acetylcysteine, melatonin & N-acetylcysteine solutions were applied to the rats in the study group subcutaneously and saline to the sham and control group. Blood samples, and liver tissues, and renal tissues of the rest of the rats were collected. Results: AST, ALT, BUN, creatinine, total bilirubin levels were significantly higher in rats with jaundice than in sham group. AST, ALT, total bilirubin, BUN, creatinine levels were significantly higher in the control group at the end of day ten. Among the melatonin group, N-acetylcysteine group, and melatonin & N-acetylcysteine group, all biochemical parameters were not different. Also, the MDA and NO levels were higher in control group in comparison with the study groups. On the other hand, there was no significant difference between the me-latonin group, N-acetylcysteine group, and melatonin & N-acetylcysteine group on behalf of MDA and NO levels, and histopathologic findings. Conclusion: Use of melatonin and N-acetylcysteine in rats with obstructive jaundice prevents damages to free oxygen radicals on the liver and renal tissue

Evaluation of the Factors Related to Strangulation and Mortality in Patients with Incarcerated Abdominal Wall Hernias

AbstractBackground: Patients with incarcerated abdominal wall hernias (AWHs) are often encountered in emergency care units. Despite advances in anesthesia, antisepsis, antibiotic therapy, and fluid therapy, the morbidity and mortality rates for these patients remain high.Objectives: In this five-year study, the authors aimed at investigating the factors related to strangulation and mortality in patients who underwent urgent surgery for incarcerated abdominal wall hernias.Methods: Participants of this study included patients referring to the emergency department with an incarcerated abdominal wall hernia(incisional, umbilical, femoral, or inguinal) between October 2015 and October 2019. The presence of intraoperative ischemia and necrosis was defined as “strangulation”. Based on the presence or absence of strangulation in the incarcerated segment, patients were divided into two groups: Group 1 (non-strangulated) and Group 2 (strangulated). The following factors were determined with univariate and multivariate analyses between the two groups: length of time between incarceration and hospital admission, demographic characteristics and clinical data, physical examination findings, and risk factors for strangulation and mortality.Results: A total of 161 patients were selected for this study. Group 1 consisted of 119 patients and Group 2 consisted of 42 patients. In multivariate analysis, the prominent risk factors for strangulation were: high American Society of Anesthesiologists score (P=0.008), acute abdomen findings with distension and elevated body temperature (P&lt;0.001), delayed hospital admission (P&lt;0.001), procalcitonin level of &gt;0.5 ng/mL (P&lt;0.001), D-Dimer level of &gt;500 µg/L (P&lt;0.001), lactate level of &gt;2 mmol/L (P&lt;0.001), and creatinine level of &gt;2 mg/dl (P&lt;0.001). The leading risk factors for mortality were the presence of strangulation (P&lt;0.001), lactate level of &gt;2 mg/dL (P=0.004), and ASA scores of &gt;3 (P=0.035).Conclusion: The most significant risk factors for strangulation were delay of more than 48 h in hospital admission, as well as high levels of procalcitonin, creatinine, lactate, and D-Dimer. On the other hand, significant risk factors for mortality were strangulation, as well as high lactate levels and ASA scores. Mortality rates may be lowered with an earlier diagnosis, more specifically, one made before the development of metabolic and radiologic impairment.Keywords: Hernia, Incarceration, Morbidity, Mortality, Strangulation</p

The Effects of Melatonin and N-Acetylcysteine on Obstructive Jaundiced Rats

ABSTRACTAim: The aim of this experimental study is to investigate the effects of N-ace- tylcysteine and melatonin on cholestasis and their protective effects on liver and renal injury.Materials and Methods: Forty-eight rats were used in the study. Rats were divided into three main groups as sham, main control, and study groups. The main control group is further divided into early sacrification group and con- trol group. The study group is divided into melatonin, N-acetylcysteine, and me- latonin &amp; N- acetylcysteine groups. A laparotomy was performed in study and control groups,and the common bile duct was ligated and divided. Five days after the first operation, blood samples liver and renal tissues were collected from early sacrification group. Between postoperative days five and ten, melatonin, N-acetylcysteine, melatonin &amp; N-acetylcysteine solutions were applied to the rats in the study group subcutaneously and saline to the sham and control group. Blood samples, and liver tissues, and renal tissues of the rest of the rats were collected. Results: AST, ALT, BUN, creatinine, total bilirubin levels were signifi- cantly higher in rats with jaundice than in sham group . AST, ALT, total bilirubin, BUN, creatinine levels were significantly higher in the control group at the end of day ten. Among the melatonin group, N- acetylcysteine group, and melatonin &amp; N-acetylcysteine group, all biochemical parameters were not different. Also, the MDA and NO levels were higher in control group in comparison with the study groups. On the other hand, there was no significant difference between the me- latonin group, N-acetylcysteine group, and melatonin &amp; N- acetylcysteine group on behalf of MDA and NO levels, and histopathologic findings.Conclusion: Use of melatonin and N-acetylcysteine in rats with obstructive jaun- dice prevents damages to free oxygen radicals on the liver and renal tissue.Keywords:&nbsp;Melatonin, N-acetylcysteine obstructive jaundice, free oxygen radicals</div

Laparoscopic surgery in functional and nonfunctional adrenal tumors: A single-center experience

Laparoscopic adrenalectomy (LA) is a safe and minimally invasive operation for benign adrenal tumours. The purpose of this study was a retrospective analysis of outcomes following laparoscopic lateral transabdominal adrenalectomy performed for benign adrenal tumours responsible for various endocrinological disorders and non-functioning tumours. A total of 100 laparoscopic adrenalectomy were carried out between January 2007 and March 2013 via the lateral transabdominal approach. The analysed factors included demographic data of patients, indication for surgery, tumour size and side, intraoperative and postoperative outcome of laparoscopic lateral transabdominal adrenalectomy including duration of surgery, length of hospital stay, the complication rate, as well as the conversion rate to open adrenalectomy. There were 34 patients with non-functioning tumours (Group 1) and 66 with functioning tumours (Group 2). The intraoperative and postoperative outcomes were not significantly different in the cases among the analysed groups of patients. The median operative time was 101 ± 4.3 (range, 30–210) minute in group 1 and 95 ± 5.9 (range, 30–190) minute in group 2, there was not statistically significant (p = 0.56). The median duration of the postoperative hospital stay in the group 1 was bigger than group 2, this did not differ significantly (p = 0.08). Peroperative complications were occured in 9 (9%) patients, observing 6 (9%) patients in Group 1 and 3 (8.8%) patients in Group 2. There was not statistically significant (p = 0.96). In the postoperative period, three patients in group I, 1 patient in group II developed complications, this difference was not statistically significant (p = 0.69). The conversion to open surgery was found in 9 (9%) patients. This study shows that laparoscopic lateral transabdominal adrenalectomy is a safe, effective, and technically feasible procedure in the treatment of both functioning and nonfunctioning benign tumours of the adrenal gland