The Role of Doctors and Patients in Appendicitis Perforation.

In this study, we aimed to determine factors that cause appendix perforations and to identify the role of physicians and patients in contributing to the cause of these perforations. This study was conducted between April 2010 and May 2015 and included 64 patients with perforated appendicitis. Patients' medical records were examined for factors that might have contributed to perforation, and the roles of patients and physicians in perforation appendicitis were evaluated. The perforation rate of patients with appendicitis was 16.0 per cent. The average duration from symptom onset to hospital admission was 4.4 days (29 patients were admitted to hospital within two days, 35 were admitted later). In total, 38 patients had visited a different hospital before admission. Furthermore, six out of 26 patients who had not visited any other hospital had consumed analgesics. Factors contributing to appendix perforation included misdiagnosis at the patient's initial visit (56.0%), delayed admission to hospital (11.0%), and use of analgesics (9.0%). The cause of perforation was mostly physician-related in children and adults, and patient-related in older adults.

The comparison of the effectiveness of tomography and Alvarado scoring system in patients who underwent surgery with the diagnosis of appendicitis.

OBJECTIVE: The aim of this study is to compare the effectiveness of computed tomography and Alvarado scoring system in the diagnosis of acute appendicitis in patients who underwent appendectomy with the preliminary diagnosis of acute appendicitis. MATERIAL AND METHODS: One hundred and one patients who underwent appendectomy with the diagnosis of acute appendicitis between January and December 2011 were included in the study. Alvarado scores were calculated, and abdominal tomography scans were obtained for each patient before surgery. Patients with Alvarado score ≥7 were considered to have appendicitis while patients with a score <7 were considered not to have appendicitis. Patients were classified into two groups based on the presence of appendicitis findings on abdominal tomography. Histopathological examination of the appendices was performed following appendectomy. All patients were classified into groups according to pathology results, Alvarado score and tomography findings. The effectiveness of Alvarado score and tomography were compared using the McNemar test. RESULTS: Sixty patients (59.4%) were male and 41 (40.6%) were female, with a mean age of 32 years (5-85 years). The rate of negative appendectomy was 3.9%. In 78 patients (77.3%) the Alvarado score was ≥7, while 23 patients (22.7%) had Alvarado scores <7. The presence of appendicitis was determined by histopathology in 22 out of 23 patients whose Alvarado score was <7. Tomography indicated appendicitis in 97 patients (95.9%) whereas four patients (4.1%) exhibited no signs of appendicitis by tomography. However, histopathological evaluation indicated the presence of appendicitis in those four patients as well. CONCLUSION: The study results imply that tomography is a more effective means of diagnosing acute appendicitis as compared to the Alvarado scoring system.

A prolapsed intraductal papilloma: a case report.

Intraductal papillomas (IP) are benign papillary lesions caused by proliferation of mammary ductal epithelium. IP occurs in the breast tissue. Prolapse of IP from nipple can be rarely seen. IPs are generally treated with total excision. A 31-year-old female patient was admitted to our clinic because of a protruded lesion from the nipple of her right breast. On her breast examination, an 8 mm- prolapsed mass was seen on the areola of her right breast. Breast ultrasonography showed no other lesions in the breast. The patient was operated with initial diagnosis of IP. The prolapsed mass, the overlying nipple skin and related ductus were totally excised under local anesthesia. Histopathological examination of the specimen revealed intraductal papilloma without atypical dysplasia. Herein, we are presenting a rarely encountered case of IP prolapsed from the nipple of a female patient.

Active gas aspiration to reduce pain after laparoscopic cholecystectomy.

OBJECTIVE: To investigate to what effect active subdiaphragmatic gas aspiration reduces pain after a laparoscopic cholecystectomy. MATERIALS AND METHODS: A total of 104 patients undergoing laparoscopic cholecystectomy were randomly placed into 2 groups. Group I included active subdiaphragmatic gas aspiration (n=52) while group II included simple evacuation (n=52) without any additional procedures. Postoperative analgesic requirements were recorded and the level of postoperative abdominal and shoulder pain was assessed using a numeric scale after 24 postoperative hours. Data were analyzed using the χ test for nonparametric data and Student t test for parametric data. RESULTS: Age, volume of CO2 used during surgery, and operation duration were similar in the 2 groups. The simple evacuation group (group II) experienced more shoulder and abdominal pain postoperatively when compared with the active subdiaphragmatic aspiration group (group I) and had a higher use of analgesics during the postoperative period. CONCLUSIONS: Active subdiaphragmatic gas aspiration after a laparoscopic cholecystectomy is a simple procedure that can effectively reduce postoperative abdominal and shoulder pain and as a result the need for analgesics.

Natal cleft deeper in patients with pilonidal sinus: implications for choice of surgical procedure.

PURPOSE: The study was planned to evaluate the depth of natal cleft in patients with pilonidal sinus disease and in healthy persons. METHODS: The study included 50 patients with pilonidal sinus disease and 51 volunteers. Data including body mass index and natal cleft depth were recorded. Natal cleft depth was measured in millimeters by using a caliper instrument. Data were evaluated with the use of the statistical package program (SPSS) with a chi-squared test analysis. P < 0.01 was evaluated as significant. RESULTS: There was no discernable difference in age, occupation, and sex between the groups. The mean natal cleft depth was 27.06 mm in the pilonidal sinus group and 21.07 in the nonpilonidal sinus group. The differences between the two groups were statistically significant (P < 0.01) for natal cleft depth. The mean body mass index was 25.71 in the pilonidal sinus group and 25.28 in the nonpilonidal sinus group. The difference between groups was statistically insignificant for body mass index. CONCLUSIONS: The natal cleft of patients with pilonidal sinus disease is deeper than the natal cleft of members of the volunteer group.

Effect of different pharmacologic and chemical agents on the integrity of hydatid cyst membranes.

OBJECTIVE: We performed an in vitro investigation of the effects of widely used scolicidal and sclerosing agents, as well as some pharmacologic products, on the integrity of the membrane of hydatid cysts. MATERIALS AND METHODS: Two milliliters each of 22 agents, 2 mL of clear fluid, and one piece of hydatid cyst membrane were put into bottles. The hydatid cyst membranes were evaluated by visual observation and manual palpation. Visual examination of the bottles was performed daily for 7 days, and observations of membrane changes, including translucency, destruction, swelling, and melting, were recorded. Manual evaluation was done on the seventh day by finger examination, and membrane fragility was scored. RESULTS: The hydatid cyst membrane was completely melted in a few minutes in a 2.5% solution of sodium hypochlorite and in 1 hr by a 0.1% sodium hypochlorite solution. The integrity of the hydatid cyst membrane was preserved in alcohol, acetone, glutaraldehyde, albendazole, acetylsalicylic acid, formaldehyde, lidocaine, hydrochloric acid, ammonia, pancreatin, Betadine, methylene blue, and isotonic saline samples. The membranes in the metronidazole and hypertonic saline solutions were not damaged but showed significantly increased fragility. The membranes in levamisole and piperazine hexahydrate became translucent and showed moderate fragility. CONCLUSION: None of the agents that are used in clinical practice had important effects on the dissolution of hydatid cyst membranes. However, sodium hypochlorite solutions completely melted the hydatid cyst membranes. Because the use of this agent on living tissue is limited, further study is needed to investigate its clinical use.

A simplified laparoscopic technique for enteral access in cancer patients.

BACKGROUND/AIMS: A feeding jejunostomy may be required for cancer patients who have obstructed upper gastrointestinal tract. Numerous minimally invasive techniques have been described for laparoscopic enteral access. We presented here a simple technique for laparoscopic jejunostomy that requires only two ports and no specialized tools. METHODOLOGY: Seven patients with laryngeal and foregut tumors underwent laparoscopic feeding jejunostomy. Briefly, umbilical port houses the camera and a second port placed at the proposed jejunostomy site are used to identify the appropriate segment of jejunum and exteriorize through the port opening. After jejunostomy a catheter is placed in the usual fashion, intestine segment is returned to the abdomen, then the jejunostomy site is secured to fascia edges by several non-absorbable sutures. Operative time and postoperative complications were evaluated. RESULTS: All patients tolerated the procedure well. Average operative time was 35 min. The only complication seen after the procedure was minor skin extrusion in two patients. CONCLUSIONS: This technique appears as a minimally invasive, safe, quick and easily applicable method for enteral access in selected patients.