A study to use hematological and biochemical parameters as a key in the diagnosis of acute mesenteric ischemia

Aim: Acute mesenteric ischemia is still fatal in 59-92% of cases. Delay in diagnosis of acute mesenteric ischemia can cause dramatic increase in morbidity and mortality rates.  However several diagnostic and disease related factors have been widely studied. Controversy still remains. In this study, we evaluated hematological and biochemical parameters in patients with acute mesenteric ischemia.Methods: 46 patients (study group) who underwent emergent surgery for acute mesenteric ischemia and 46 patients (control group) operated for acute abdomen with another etiology other than acute mesenteric ischemia and internalized to intensive care unit were included in this study. Medical records and clinical data of acute mesenteric ischemia patients between January 2008 and December 2014 were evaluated with regard to 8 parameters; age, amylase, white blood cell count, mean platelet volume, creatine kinase, lactate dehydrogenase, lactate and D-dimer. These parameters were selected for their increased levels in acute mesenteric ischemia patients according to many published medical studies. Control group was formed randomly from patients followed in intensive care unit for their co-morbidities after acute abdomen operation in the same period. Gender was included in the table but was not taken into account as a parameter for the study. Results: Mean values of age, white blood cell count, creatine kinase, lactate dehydrogenase, lactate and D-dimer were significantly higher in acute mesenteric ischemia group than the control group. Mean platelet volume was significantly lower in acute mesenteric ischemia group. The p values were for age (p=0.009), for amylase (0.475), for white blood cell (p=0.001) for mean platelet volume (0=0.001), for creatinine kinase (p=0.017), for lactate dehydrogenase (p=0.001), for lactate (p=0.001), for D-dimer (p=0.001) respectively. Conclusion: White blood cell count, creatine kinase, lactate dehydrogenase, lactate and D-dimer levels increase; mean platelet volume decrease in acute mesenteric ischemia patients significantly

Is there any benefit of harmonic scalpel for hemorrhoidectomy versus conventional diathermy?

Aim: Symptomatic hemorrhoidal disease is among the most common surgical diseases and it may necessitate surgical intervention. The most common and effective approaches used for surgical treatment are harmonic scalpel hemorrhoidectomy and conventional diathermy excision. The aim of the study was to compare the outcomes of hemorrhoidectomy using harmonic scalpel and the conventional diathermy excision techniques. Methods: The files of 113 consecutively operated patients (26 females 23%, 87 males 77%), who were operated on for symptomatic Grade III–IV hemorrhoids, were retrospectively reviewed for length of operation and hospitalization, early and delayed bleeding, urinary retention, postoperative abscess and anal stenosis. Exclusion criteria were additional operations, recurrent cases and inflammatory bowel disease. Results: Conventional diathermy hemorrhoidectomy in 60 (53%) and harmonic scalpel hemorrhoidectomy were used in 53 patients (47%). There were significant differences between the operation and hospitalization times in favor of harmonic scalpel group (p<0.05 for both). The other parameters did not show any significant differences (p>0.05 for all). Conclusion: Harmonic scalpel hemorrhoidectomy is advantageous and superior to conventional diathermy hemorrhoidectomy in regard to shorter operation time and earlier discharge from the hospital with no additonal complications

Is the use of intraoperative nerve monitoring an effective method to reduce the rate of permanent recurrent laryngeal nerve paralysis?

Aim: Recurrent laryngeal nerve (RLN) paralysis is a common complication of thyroid surgery. In recent years, intraoperative nerve monitoring (IONM) has been used to reduce the risk of RLN paralysis. The purpose of this study was to assess the role of IONM in reducing RLN paralysis.Methods: A retrospective clinical study was conducted between January 2015 and January 2017 in a two-center-clinical trial at Lutfiye Nuri Burat State and Haseki Teaching and Research Hospitals. Patients who underwent thyroidectomy using IONM (Group A, n=100) or direct visual technique (Group B, n=232) were included. Patients' files were reviewed for age, body mass index, gender, American Society of Anesthesiologists score, calcium levels, complications, duration of operation and follow-up. Postoperative complications were regarded as the main outcomes.Results: A total of 332 patients (52 male, 280 female) with a mean age of 46.4±12.9 years were enrolled. 30.1% of the patients were in Group A (IONM). Bilateral and unilateral thyroidectomies were performed in 70.8% and 29.2% of the operations, respectively. Operative time was shorter in Group A (76.9±12.0 minutes vs 97.7±27.6 minutes, p <0.001). There was no significant difference between the two groups in terms of preoperative and postoperative calcium levels (p=0.407).There was no statistically significant difference in early RLN paralysis rates between the two groups (for Group A and Group B, 10 (10%) and 34 (14%), respectively) (p=0.251) While it was not present in Group A, permanent RLN paralysis was found in 10 patients in Group B (4.3%) (p = 0.035).Conclusion: The use of IONM may be useful in reducing the rate of permanent RLN paralysis