Fournier's gangrene: etiology, treatment outcomes and factors affecting mortality in 38 patients

Aim: Fournier's gangrene (FG) is a rare, rapidly progressing and life-threatening disease of the genital, perianal and perineal regions. We aimed to evaluate etiological parameters, accompanying diseases, current treatment methods and factors affecting mortality in patients with FG. Method: The medical records of 38 patients who were operated by the same team with a diagnosis of FG from December 2015 to January 2021 were retrospectively reviewed. Those patients were divided into two groups: survivors (Group 1), and non-survivors (Group 2). Comparisons were made regarding clinical and demographic features; comorbid diseases; leukocyte count at first presentation; etiological factors; treatment outcomes; and mortality rates. Results: Thirty-eight patients (24 males, 14 females) were evaluated; mean age was 60.2 ± 13.2 years. While 76.3% (n = 29) of these patients recovered with treatment, the total mortality rate was 23.7% (n = 9). The most common cause of the FG and comorbidity were anorectal diseases (n = 22; 57.9%) and type 2 diabetes mellitus (n = 21; 55.3%), respectively. Female gender, septic shock, necrosis, abdominal wall and lumbar region involvement, chronic renal failure, FG development secondary to postoperative complications and ostomy rates were higher in non-survivors. There were no significant differences between the two groups regarding leukocyte count at first presentation, number of debridement, dressing methods, reconstruction methods, and length of hospital stay. Conclusions: Female gender, presence of septic shock and necrosis on physical examination, involvement of the abdominal wall and lumbar region in addition to the perianal region, chronic renal failure, disease secondary to postoperative complications and the necessity of ostomy play an important role in mortality

Thyroid fine needle aspiration reporting rates and outcomes before and after Bethesda implementation: A single-center experience over 8 years

Aimː To evaluate data from our hospital system before and after the implementation of the Bethesda System for Reporting Thyroid Cytology (TBSRTC) and comparison of our data with the previously published studies. Methods: Seven hundred seventy-one patients with thyroid nodules who underwent fine needle aspiration biopsy (FNAB) and surgery at our institution were analyzed retrospectively. FNAB results were divided into two parts in terms of the period they related to: pre-TBSRTC (between 2005 and 2010) and TBSRTC (between 2011 and 2013). Results: 341 FNAB were applied in the period of TBSRTC. Of the 341 FNAB, 53(16%) were non diagnostic, 82(24%) were benign, 62(18%) were atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 28(8%) were follicular neoplasms and/or suspicion of follicular neoplasms (FN/SFN), 95(28%) were suspicion for malignancy (SuspM), and 21(6%) were malignant. Rates of malignancy reported on follow-up histopathological examination were non diagnostic in 11%, benign in 4.9%, AUS/FLUS in 23%, FN/SFN in 32%, SuspM in 44%, and malignant in 95.3%. Conclusions: In this study, the distribution of cases in TBSRTC categories and malignancy rates, differed from, recommended by TBSRTC and some studies. Implementation of TBSRTC did significantly affect our institution’s reporting rates

Effects of evening primrose oil and 5-fluorouracil on the healing of colonic anastomoses in rats

Aim: This study was designed to evaluate the efficacy of evening primrose oil (EPO) on colonic anastomosis. Methods: Sixty rats with colonic anastomosis were randomly divided into six groups. EPO and 5-Fluorouracil (5-FU) were administered at doses of 5 g/kg/day and 20 mg/kg/day, respectively.  Group 1 served as sham control. The rats in Group 2 (EPO) received EPO (14 days preoperatively), in Group 3 (Extended EPO) received EPO (14 days preoperatively and 7 days postoperatively), in Group 4 (5-FU) received intraperitoneally 5-FU (5 days preoperatively), in Group 5 (5-FU+EPO) received EPO (14 days preoperatively), and 5-FU (5 days preoperatively), in Group 6 (5-FU+ extended EPO) received EPO (14 days preoperatively and 7 days postoperatively)  and 5-FU (5 days preoperatively). Histopathological examination, bursting pressure, and hydroxyproline content were used for evaluation. Results: Significant differences were found between the Groups 1, 2, and 3 and Groups 4, 5, and 6 in bursting pressures. Polymorphonuclear leukocyte (PMNL) and lymphocyte infiltration was significantly less in group 3, compared to the control and group 2. The least PMNL infiltration was in group 6 compared to groups 4 and 5.  The hydroxyproline level was different in group 3 compared to the control and group 2. Furthermore, groups 5 and 6 were different compared to group 4. Conclusion: EPO had favorable effects on colonic anastomosis even in groups where 5-FU was used

The value of inflammatory indexes in colorectal cancers

In recent years, a relationship has been established between inflammatory indexes and the prognosis of many cancers. Although there are many studies investigating their relationship with colorectal cancers (CRC), there is a serious difference between the results in the related literature. The present study aimed to share our own experience with inflammatory indexes in CRC patients. Patients with a diagnosis of CRC who underwent surgery between January 2019 and June 2022 were retrospectively scanned. Exclusion criteria were as follows; being in a septic state before surgery, accompanying hematological disease, receiving neoadjuvant chemotherapy/radiotherapy, being diagnosed with recurrent CRC, undergoing emergency surgery, receiving immunosuppressive or anti-inflammatory treatment. Therefore, the study was conducted with 52 patients. Demographic information, tumor localization, stages and pathology data of the patients were examined. The relationship between these variables and the systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) was investigated. A significant correlation was found between pathological T stages and SII (p=0.008), NLR (p [Med-Science 2023; 12(2.000): 453-07

Acute appendicitis during coronavirus disease 2019 in Turkiye: Changes in clinical approach, treatment, and diagnosis modalities: A retrospective and cohort study

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) has resulted in major changes in health-care systems and emergency surgical interventions. Here, we examined patients with acute appendicitis who presented to emergency departments and compared diagnosis, treatment, and post-treatment processes before and during the pandemic period and investigated how the pandemic affected management of acute appendicitis. METHODS: A national, multicenter, and cohort study model was designed that included patients older than 18 years of age diagnosed with acute appendicitis clinically and/or radiologically, with patients compared before (pre-pandemic period: January 1-April 30, 2019) and after (pandemic period: January 1-April 30, 2020) the pandemic. Our investigation included comparisons of pre-operative imaging methods, presence of plastron appendicitis/abscess, conservative/surgical approach, type of anesthesia given, laparoscopic/ open surgical approach, bowel resection rates, drain insertion rates, and presence of post-operative complications RESULTS: For the two study groups, 8972 patients from 69 centers were examined, with 4582 patients operated in the pre-pandemic period and 4234 patients operated in the pandemic period. During the pandemic period, 63.6% of patients underwent open surgery, whereas 34.4% had laparoscopic surgery. Although 60 patients (1.3%) requested non-operative follow-up in the pre-pandemic period, 94 patients (2.2%) requested this in the pandemic period. When conditions of patients were evaluated regardless of their own wishes, 114 patients (2.4%) before and 163 patients (3.8%) during the pandemic received non-operative follow-up. CONCLUSION: Our study did not show the direct correlation between the application of COVID-19-related restrictions and the severity of acute appendicitis. Although non-operative management rates have been increased during the COVID-19 period, the incidences of both complicated and the uncomplicated appendicitis were similar during the COVID-19 crisis period. Given this information non-operative management can be employed for patients diagnosed with appendicitis

Early results of single-incision laparoscopic cholecystectomy in comparison with the conventional: Does it have any impact on quality of life?

Tarim, ismail Alper/0000-0002-6203-2644WOS: 000438981600001PubMed: 29928499Background: Laparoscopic cholecystectomy is the standard treatment for gallbladder diseases. In recent times, single-incision laparoscopic cholecystectomy(SILC) has developed as a less invasive alternative technique to conventional laparoscopy. In the literature, many studies have compared SILC and conventional laparoscopic cholecystectomy (CLC) procedures but a limited number of studies have compared the two techniques with regard to quality of life (QOL). The choice of surgical procedure was effected by QOL of the patients. The effects of SILC on QOL remain unclear. In this study, we aimed to compare the effects of conventional laparoscopic cholecystectomy (CLC) and single-incision laparoscopic cholecystectomy (SILC) procedures on the clinical outcomes and quality of life of patients by short-term follow-up evaluation. Material and methods: In this study, 142 patients who underwent cholecystectomy operations with either technique underwent SILC and CLC were evaluated. The quality of life index in the patients was measured with short form 36 (SF 36) test. Results: The results of mean operative time, length of stay and complication rate for SILC and CLC were similar. The postoperative health-related quality of life (HRQOL) scores were not significantly different between the SILC and CLC patients but only physical functioning score were higher in SILC patients. Conclusions: SILC is a safe and effective alternative to CLC. To detect the effects of SILC on HRQOL, we need long-term prospective comparative studies