The Karaman score: A new diagnostic score for acute appendicitis.

BACKGROUND: The Karaman score is a novel diagnostic scoring system consisting of 6 parameters. The aim of the present study was to assess the diagnostic performance of the Karaman score in comparison with the Alvarado score. METHODS: A total of 200 patients who underwent an appendectomy were enrolled in the study (research registry number: 2290). RESULTS: The cutoff threshold of the Karaman score in distinguishing acute appendicitis from negative appendectomy was ≥9 with 84.3% sensitivity, 64.7% specificity, 92.1% positive predictive value (PPV), and 45.8% negative predictive value (NPV). The cutoff threshold of the Alvarado score in distinguishing acute appendicitis from negative appendectomy was ≥8 with 72.9% sensitivity, 70.6% specificity, 92.4% PPV, and 34.8% NPV. In multivariate logistic regression analysis, an Alvarado ≥8 score (Odds ratio [OR]:6.644, 95% confidence interval [CI]: 2.854-15.466; p<0.001) and a Karaman ≥9 score (OR:10.374, 95% CI: 4.383-24.558; p<0.001) were each individually predictive in distinguishing acute appendicitis from negative appendectomy when correction was made according to age and gender. However, when both scores were evaluated together, the Alvarado score ≥8 lost its efficacy (OR:1.838, 95% CI: 0.517-6.530; p=0.347), whereas the Karaman score ≥9 retained its predictive power (OR:6.586, 95% CI: 1.893-22.917; p=0.003). CONCLUSION: The Karaman score was more predictive than the Alvarado score in distinguishing acute appendicitis from a negative appendectomy.

Stump appendicitis: a retrospective review of 3130 consecutive appendectomy cases.

Background: Stump appendicitis is inflammation of remnant appendix tissue due to incomplete removal of the appendix. Due to appendectomy history, stump appendicitis diagnosis is usually delay and that can cause increase morbidity. Methods: Medical records of patients who had surgery for acute appendicitis at a single center from 2008 to 2017 were retrospectively reviewed. During the evaluation of medical records, patients that had a previous operation for acute appendicitis or had "stump appendicitis" as an exploratory finding in operation notes were included. Results: Appendectomy was performed in 3130 patients (2630 open surgeries and 380 laparoscopic surgeries). Stump appendicitis was diagnosed in five patients (0.15%). The appendectomies had been performed 4, 5, 7, 7, and 11 years previously. Mean time taken for surgery was 36 h after symptoms began. Open surgery was performed in three patients, laparoscopic procedures in others. Conclusion: Awareness of stump appendicitis before radiological examinations may facilitate accurate diagnosis and decrease the duration of the decision-making process, leading to decreased morbidity.

An Endoscopic Nasomediastinal Approach to a Mediastinal Abscess Developing after Zenker's Diverticulectomy.

Zenker's diverticulum is the most frequent symptomatic diverticulum of the esophagus, but the prevalence is <0.1%. The optimal treatment is surgery. Here, we present a nasomediastinal drainage approach to treatment of a mediastinal abscess, developing in the late postoperative period and attributable to leakage from the staple line.

Coexisting Situs Inversus Totalis and Immune Thrombocytopenic Purpura.

Situs inversus totalis is a rare congenital abnormality with mirror symmetry of mediastinal and abdominal organs. Immune thrombocytopenic purpura is an autoimmune disease with destruction of thrombocytes. This paper is presentation of surgical approach to a case with coexistence of these two conditions.

Retrospective review of pilonidal sinus patients with early discharge after Limberg flap procedure.

The aim of this study was to evaluate the results of cases with pilonidal sinus (PS) disease that underwent Limberg flap (LF) transposition and to compare the short and long-term results of early discharge cases with those in the literature. A total of 345 patients who underwent rhomboid excision and LF transposition for PS were evaluated retrospectively. No major anesthetic or surgical complications occurred. Partial wound dehiscence, localized flap necrosis, hematoma, wound infection, and seroma rates were determined as 4.0, 2.1, 1.5, 3.3, and 3.7% respectively. All patients other than those with a hematoma or localized necrosis were discharged with a drain in place 24 hours after the operation. The recurrence rate was 3.9% after a mean 33.1-month follow-up (range, 6-72 months). As a result, we found that short and long-term results of patients who underwent LF and were discharged 24 hours after the operation were similar to those in the literature. We suggest that patients without postoperative complications, such as hematoma or flap necrosis, can be discharged early.

Effects of irrigation system management turnover on water table depth and salinity of groundwater.

In recent years, management of large, state owned irrigation projects in Turkey have been transferred to water users such as farmers cooperatives or associations in order to reduce the financial burden on the government and to increase irrigation efficiency and farmer participation. Water table depth and groundwater salinity are important factors in irrigation systems, not only for plant growth but for human health as well. The objective of this study was to determine the impact on water table depth and groundwater salinity for transferring management of the Mustafakemalpasa irrigation project (19,370 ha) in north-western Turkey to local, farmer controlled irrigation districts. Maps of water table depth and groundwater salinity were created for the month of July (averaged over several years), the month with the highest amount of applied irrigation water, based on measurements made in 200 wells in the project area before and after transfer of managerial control. Both depth of the water table and salinity decreased after transfer The area with average water table depth of 100-200 cm was 25.41% of total area before turnover and 79.45% after, and the area with water table depth 200-300 cm was 73.84% before turnover and 20.50% after Before turnover; the area with average groundwater salinity 1.5-2.0 dS/m was 26.16% of total area, and that with average salinity 2.0-2.5 dS/m was 61.73% of total area; after turnover, average groundwater salinity was 1.5-2.0 dS/m in over all areas. Both changes were the consequence of an increased amount of applied water after transfer of the control of irrigation management from the state to local irrigation districts controlled by farmers. In the short run, the farmers will get benefit from increased irrigation. However over the long term, if water table depth continues to decrease then secondary salinization could become a major hindrance to irrigation sustainability