A Retrospective Study of the Presentation and Management of Perianal Disease in HIV-Positive Patients Referred to a Surgical Outpatient Unit in Turkey.

BACKGROUND The incidence of human immunodeficiency virus (HIV) infection is on the rise, and perianal region diseases in HIV-infected patients have become increasingly prevalent. This study aimed to analyze the surgical treatment outcomes of HIV-infected patients presenting with perianal concerns. MATERIAL AND METHODS We included 311 HIV-positive patients admitted to the Infectious Diseases Clinic of Samsun Training and Research Hospital between January 2014 and December 2022. From this group, we selected those who sought care at the general surgery outpatient clinic for perianal and anal concerns, retrospectively reviewing their medical records. RESULTS Out of 311 patients, 54 (17.3%) were referred to the general surgery outpatient clinic with anal and/or perianal region complaints. Of these cases, 38 (70.3%) had a single disease, while 16 (29.6%) had combined diseases. There were 20 males (95%) and 1 female (5%). Among these 54 patients, 33 (61.1%) received medical treatment from the outpatient clinic, while 21 (38.9%) underwent surgical intervention. The diagnoses included 22 hemorrhoidal diseases, 24 anal condylomas, 15 anal fissures, 11 anal abscesses, and 4 anal fistulas. We evaluated the postoperative results and recurrence status of these patients. CONCLUSIONS Perianal diseases in HIV-positive patients can be categorized as isolated or combined. The management of patients with postoperative follow-up compliance problems and combined diseases with low CD4 counts may pose treatment challenges.

Comparison of Presentation Types and Clinical Findings of Rural and Urban Patients with Mastalgia: A Retrospective Analysis of 730 Patients from Turkey.

BACKGROUND Breast pain, prevalent among women of reproductive age, varies during menstrual cycles and is influenced by sociodemographic and clinical factors. This study aimed to assess these demographic and clinical variables in women with breast pain, considering the spatial distinctions between urban and rural locations. MATERIAL AND METHODS This retrospective study included 730 women presenting with mastalgia between 2010 and 2023. The study evaluated patient demographics, pain characteristics (eg, breast pain duration, site, quadrant-based localization, and radiation of breast pain), radiologic findings, and the presence of comorbid medical conditions. RESULTS There were 498 patients in the urban group and 232 patients in the rural group. Among the radiologic findings, the rate of mastitis was higher in the rural group (P<0.05). Regarding the localization of breast pain within the quadrants, left breast upper-inner (LUI) quadrant pain was more common in the rural group (P=0.014). Regarding comorbid medical conditions, the prevalence of gastrointestinal system disease was higher in the rural group (P=0.009). Using logistic regression analysis, gastrointestinal disease was determined to be a significant independent risk factor for increased LUI quadrant pain in the rural group (odds ratio [OR]: 3.132, P=0.014), while pre-existing thyroid disease (OR: 2.482, P=0.004), hypertension (OR: 2.534, P=0.006), and radiologic evidence of ductal ectasia (OR: 2.878, P=0.03) were independent risk factors in the urban group. CONCLUSIONS Patient outcomes may be improved by a tailored, population-based approach to mastalgia patients in rural and urban locations focused on their radiologic findings and comorbid medical conditions.

Can whole blood viscosity predict the development of acute mesenteric arterial thrombosis?

BACKGROUND: Acute mesenteric ischemia is a serious condition with high mortality rate, resulting internal organ damage and intestinal necrosis due to sudden occlusion in the arteries feeding the abdominal solid organs and intestines. The most common causes of acute mesenteric artery ischemia are embolic processes and thrombosis that develops on the basis of primary mesenteric artery atherosclerosis. Whole blood viscosity (WBV) was defined by De Simon and could be calculated with a formula that consists of total plasma protein and hematocrit (HCT). In our study, we aimed to investigate the predictive value of WBV for acute mesenteric ischemia caused by primary mesenteric artery occlusion. METHODS: Between January 2015 and February 2021, a total of 55 patients with a retrospective diagnosis of acute mesenteric ischemia (AMI) and 50 healthy volunteers as a control group were included in the study. WBV was calculated with the De Simon for-mula using the HCT and plasma protein levels from the blood tests of healthy volunteers and patients at the time of admission with acute abdomen. RESULTS: No significant differences between the two groups in terms of baseline demographic characteristics except the preva-lence of age (72.1±12.4 vs. 65.7±6.4; p<0.001) and hypertension (40% vs. 23% p=0.002). AMI patients had significantly higher WBV values both at low shear rate (LSR) ([46.3±21.7 vs. 33.4±±13.1, p<0.001] and high shear rate [HSR] [16.5±11 vs. 15.8±0.7, p<0.001]). The univariate analysis identified several variables for predicting AMI including age (odds ratio [OR]: 1.066 confidence interval [CI]: 1.023-1.111, p=0.003), hypertension (OR: 3.612 CI: 1.564-8.343, p=0.003), WBV at HSR (OR: 2.074 CI: 1.193-3.278, p=0.002), and WBV at LSR (OR: 2.156 CI: 1.331-3.492, p=0.002). However, after multivariate analysis, only hypertension (OR: 3.537 CI: 1.298-9.639, p=0.014) and age (OR: 1.085 CI: 1.026-1.147, p=0.004) showed significance. In receiver operating characteristic analysis, a cut-off value of 43.5 WBV for LSR had a 72% sensitivity and a 70% specificity for prediction of mesenteric ischemia patients (area under curve [AUC]: 0.743, p<0.001) and a cut-off value of 16.29 WBV for HSR had a 78% sensitivity and 76% specificity for prediction of mesen-teric ischemia patients (AUC: 0.773, p<0.001). CONCLUSION: In our study, we determined that the WBV value obtained with the De Simon formula is a valuable parameter in predicting the development of acute mesenteric artery ischemia caused by primary mesenteric artery occlusion.

Causative Pathogens in Surgical Drain Infections and Antibiotic Resistance Profiles of These Pathogens: Growing Frequency of Resistance Among the Enterobacteriaceae Family.

Introduction Surgical drain infections (SDIs) and antibiotic resistance profiles of these infectious pathogens are the issues that need to be emphasized. This study aimed to identify microorganisms isolated from drain cultures and determine antibiotic resistance rates among these microorganisms. Materials and methods The drain culture results of patients analyzed between January 2008 and January 2020 were included in the study. Data such as microorganisms grown in drain cultures, antibiotic resistance rates, and demographic information of patients were evaluated. Results Three hundred forty-six isolates were analyzed from the drain cultures of 279 patients. The mean age of the patients was 62.82 ± 17.77 years. Polymicrobial growth was detected in samples from 49 (18%) patients. The most frequently isolated microorganisms were pathogens belonging to the Enterobacteriaceae family (44%) and to Staphylococcus species (spp.) (20%). As shown by our results, the frequency of Staphylococcus spp. decreased in the last four years, whereas the frequency of Enterococcus increased. In terms of drug resistance, the highest rate of resistance among the isolates was to ampicillin (Enterobacteriaceae family), followed by gentamicin (Acinetobacter species.), cefepime (Pseudomonas spp.), penicillin (Staphylococcus spp.), and ciprofloxacin (Enterococcus spp.). In the Enterobacteriaceae family, 49% of the isolates were resistant to extended-spectrum beta-lactamases, and 17% were resistant to carbapenems. Methicillin resistance was detected in 55% of Staphylococcus aureus, and vancomycin resistance was found in 11% of Enterococcus. Conclusions In drain cultures for SDIs, information on the causative pathogens, in addition to the antibiotic resistance rates of these pathogens, is needed to initiate appropriate empirical treatment.

Brucellosis Mimicking COVID-19: A Point of View on Differential Diagnosis in Patients With Fever, Dry Cough, Arthralgia, and Hepatosplenomegaly.

The novel Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome Coronavirus-2, emerged in China in late 2019, and a variety of clinical symptoms and signs were reported following patients' clinical presentation. By contrast, human Brucellosis is a worldwide zoonosis that may present with general symptoms including fever, dry cough, malaise, and arthralgia, making it indistinguishable from other causes of respiratory infection. Here, an 18-year-old man who was hospitalized with a suspected COVID-19 infection, but finally confirmed as having Brucellosis with positive blood culture for Brucella melitensis is presented. This case is a reminder for healthcare workers to consider the diagnosis of Brucellosis in patients exhibiting febrile syndromes in endemic regions during the COVID-19 pandemic.

Giant fibroepithelial polyp of the perineum: Giant fibroepithelial polyp.

INTRODUCTION: Fibroepitheial polyps (FEP) are among the most common benign skin lesions and definitive histology is often needed to exclude malignancy. These polyps are usually less than 5cm in size and are often seen in genito-urinary sites including the perineum. A small number can reach a significant size. PRESENTATION OF CASE: A 46-year-old female patient presented with a pedunculated mass measuring 18cm in diameter, localized to the left perineum. The lesion was excised and the histopathological diagnosis was fibroepithelial polyp. CONCLUSION: We present this case as the third largest FEP recorded in the available literature.

Technical and social challenges of laparoscopic appendectomy performed in a rural setting.

AIM: The current study reports technical and social details aiming to evaluate difficulties faced while performing laparoscopic appendectomy (LA) in a rural hospital as well as providing solutions. METHODS: Patients who underwent LA with a diagnosis of acute appendicitis between April 2009 and December 2010 were included in this study. Demographic details, operative findings and postoperative outcomes were analyzed. RESULTS: Fifty-one consecutive patients (28 male and 23 female) underwent LA. The median age was 23 years (range, 13-74); the median operative time was 45 minutes (range, 20-75). Appendiceal base securing was performed either endoloops in 4 (7.8%), or via intracorporeal knot tying in 46 (90.2%) patients and 1 was sutured. Complicated/technically difficult appendicitis was faced in 20 (39.2%) patients. One patient underwent conversion to open procedure (2%). Mean postoperative hospital stay was 2.4 ± 0.8 days. Postoperative intra-abdominal abscess occurred in 1 (2%) patient. CONCLUSION: LA can be performed safely in a rural hospital, even for complicated cases. In this study, we have discussed some technical and social difficulties encountered and the solution methods adopted when performing LA in rural settings.

Association between colchicine resistance and vitamin D in familial Mediterranean fever.

Although colchicines are the only effective treatment of familial Mediterranean fever (FMF), resistance to colchicines (CR) which is observed in up to 30% of the patients is still a problem. Clinically, resistance to colchicine is defined as three or more attacks within the last 6 months period while using ≥2 mg/day colchicine. Previous studies have shown decreased vitamin D levels in FMF patients compared with healthy controls. The aim of this study is to evaluate whether vitamin D levels differ between CR and non-CR FMF patients. This study included 64 FMF patients who were being followed in Nephrology Clinic of Samsun Research and Education Hospital for at least 1 year. FMF was diagnosed according to the criteria defined by Livneh et al. Serum 25-hydroxy vitamin D (25-OHD) concentration (ng/mL) was detected in all FMF patients who were not in an acute attack period. From 64 patients 29 were accepted as CR. Mean 25-OHD level was 9.39 ± 1.00 ng/mL in CR patients and 18.48 ± 1.09 ng/mL in colchicine responsive patients (p < 0.001). Plasma vitamin D levels were significantly lower in colchicine resistant patients. Vitamin D deficiency may be a factor in etiopathogenesis of CR. Studies in larger patient samples that particularly evaluate the response to vitamin D replacement in CR FMF patients are needed.

Histopathological Response and Adhesion Formation After Omentectomy with Ultrasonic Energy, Bipolar Sealing, and Suture Ligation.

This study was designed to evaluate the histopathological response and intra-abdominal adhesion formation after an omentectomy in rats using the bipolar vessel-sealing device, ultrasonic coagulator, and suture ligation techniques. Forty Wistar albino rats were used, divided into four random groups. The rats underwent a midline laparotomy, and a partial omentectomy was performed using a 3-0 silk suture with suture ligation in group 1, bipolar device in group 2, and ultrasonic coagulator in group 3; only a laparotomy was performed on the control group. Lateral thermal damage was examined the same day, and a piece of the omentum was left in the animals to be examined on postoperative day 15. A relaparotomy was performed to assess adhesion formation and histopathological response. In pairwise comparisons, there was no statistically significant difference among the ultrasonic device, bipolar device, and suture ligation groups in terms of microscopic adhesion scoring; however, the scores of the bipolar device and suture ligation groups were significantly higher compared with those of the control group (p < 0.01). Furthermore, the macroscopic adhesion scores were significantly lower for the ultrasonic device group when compared with those of the bipolar device and suture ligation groups (p < 0.05 and p < 0.01). The ultrasonic device seems to be superior to the bipolar device and suture ligation in terms of macroscopic adhesion formation, but no significant difference was found in terms of the histopathological response in rats following an omentectomy. Further research may be required.

Prospective randomized trial of mesh fixation with absorbable versus nonabsorbable tacker in laparoscopic ventral incisional hernia repair.

The aim of this prospective randomized trial was to compare 2 main fixation devices in regard to pain and recurrence in laparoscopic ventral incisional hernia repair (LVIHR). A total of 51 patients were evaluated in this study (n = 25, nonabsorbable tack (NAT) and n = 26, absorbable tack (AT) groups). A visual analogue scale (VAS) was performed on both groups preoperatively and on the postoperative (PO) first day, second week, and sixth month. All patients were followed for recurrence by clinical examination, ultrasonography, and/or abdominal computed tomography. The median follow-up time was 31 months (15-45). The mean age and the mean body mass index (BMI) of the patients were 53.1 ± 11 years and 34 ± 5 kg/m(2), respectively. The median defect size was 60 cm(2) (35-150) and median operation time was 110 minutes (40-360). In 2 patients from AT group and 2 from NAT group (7.8%), recurrence occurred. The 2 groups had similar features regarding demographics, operation time, postoperative hospital stay, morbidity, and VAS scores. The 2 fixation methods were found similar for PO pain and recurrence. In our opinion, the choice of either of these fixation methods during surgery should not be based on the concerns of pain or recurrence. AT may be the preferable option in LVIHR due to the lower cost.

A Case of Primary Hyperparathyroidism due to Intrathyroidal Parathyroid Cyst.

Parathyroid cysts constitute 0.08-3.41% of all parathyroid masses. Intrathyroidal parathyroid cysts, however, are rare conditions with only a few cases being reported. Most of the parathyroid cysts are found to be nonfunctional and functional cysts are generally thought to be due to cystic degeneration of parathyroid adenomas. A cystic, smooth contoured lesion of 24 × 19 × 16 mm was observed in left thyroid lobe of a 76-year-old woman during ultrasonography which was performed as routine workup for primary hyperparathyroidism. It was defined as a cystic thyroid nodule at first. Tc(99m) sestamibi scintigraphy was performed to see any parathyroid lesions, but no radioactive uptake was observed. Intact parathormone (iPTH) level was found to be >600 pg/mL in cyst aspiration fluid. Left lobectomy was performed, with a diagnosis of primary hyperparathyroidism due to functional parathyroid cyst. Serum iPTH level was decreased >50% postoperatively and histopathological evaluation was consistent with an encapsulated parathyroid adenoma with a cystic center. Parathyroid cysts are among rare causes of primary hyperparathyroidism. Diagnosis is made by markedly increased iPTH level in cyst fluid and observation of parathyroid epithelium lining the cyst wall.

Laboratory Risk Indicators for Necrotizing Fasciitis and Associations with Mortality.

OBJECTIVES: Necrotizing fasciitis (NF) is rare but life threatening soft tissue infection characterized by a necrotizing process of the subcutaneous tissues and fascial planes. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score has been verified as a useful diagnostic tool for detecting necrotizing fasciitis. A certain LRINEC score might also be associated with mortality. The aims of this study are to determine risk factors affecting the prognosis and to evaluate the prognostic value of the LRINEC score in NF. METHODS: Twenty-five patients with necrotizing fasciitis treated in Samsun Education and Research Hospital between January 2008 and April 2013 were enrolled in the study. Surviving and non-surviving patient groups were compared regarding demographic data, co-morbidity, predisposing factors, causative agents, number of debridements and LRINEC score. RESULTS: Mean age was 55.6±16.79 years (min: 17-max: 84), and the female/male ratio was 16/9. Mortality was observed in 6 (24%) patients. The most frequent comorbid diseases were diabetes mellitus (52) and peripheral circulatory disorders (24%), and the most frequent etiologies were cutaneous (32%) and perianal abscess (20%). Pseudomonas aeruginosa infection was higher in the non-surviving group (p=0.006). The mean number of debridements and LRINEC score were higher in the non-surviving group than in the surviving group (p=0.003 and p=0.003, respectively). CONCLUSIONS: Pseudomans aeruginosa infection and multiple debridements are related with mortality. The LRINEC score might help predict mortality in NF.