[Prognostic factors for hospital mortality in patients with acute mesenteric ischemia who undergo intestinal resection due to necrosis]. / Nekroz nedeniyle bagirsak rezeksiyonu uygulanan akut mezenterik iskemili olgularda hastane mortalitesi için prognostik faktörler.

BACKGROUND: The purpose of this study was to review our experience in patients with acute mesenteric ischemia (AMI) and to identify prognostic factors associated with hospital mortality. METHODS: Clinical data of patients with AMI were reviewed and analyzed retrospectively. A total of 67 patients (34 female, overall mean age 66 years) were evaluated in the study. RESULTS: Small bowel necrosis was detected in all patients, while colonic involvement was present in 21 (31.3%). Necrosed small bowels were resected in 59 (88%) in the first intervention. Embolectomy was also performed in 2 (3%) of these cases. Anastomosis was established in 22 (32.8%). Second-look operation was performed in 31 (46.3%) and primary resection and re-resection were performed in 8 (11.9%) and 11 (16.4%) patients, respectively. Hospital mortality rate was 56.7% (n=38). Logistic regression analysis showed prolonged symptom duration (>24h) (p=0.000), sepsis (p=0.022) and colonic necrosis accompanied with small bowel necrosis (p=0.002) as the independent prognostic factors in hospital mortality. CONCLUSION: AMI has a high hospital mortality rate due to late diagnosis and sepsis. Another risk factor is colonic involvement. Early evaluation in high-risk patients and resection for necrosed intestinal segments as soon as possible prior to sepsis may reduce the hospital mortality rate.

[Outcomes of surgical therapy and prognostic factors in spontaneous gastric tumor perforation]. / Mide tümör perforasyonlarinda cerrahi tedavi sonuçlari ve prognostik faktörler.

BACKGROUND: The aim of the present study was to evaluate the clinicopathological features in patients with perforated gastric cancer, to point out the surgical approaches, and to analyze the factors that affect morbidity and mortality. METHODS: The data of 24 patients with perforated gastric cancer who underwent emergency intervention between 1996 and 2006 were retrospectively analyzed. The overall age was 60.6 years, and 62.5% of the patients were male. RESULTS: The tumor was localized at the antrum most frequently (66.7%), and stage IV disease was present in 66.7% of the patients (n = 16). Concomitant disease was present in 58.3% of the patients (n = 14). In 54.2% of patients (n = 13) primary repair and omentopexy, in 20.8% (n = 5) D0 or D1 total gastrectomy, in 8.3% (n = 2) D0 subtotal gastrectomy, in 8.3% (n = 2) D0 wedge resection, and in 8.3% (n = 2) staged D2 total gastrectomy were performed. The morbidity rate was 29.2% (n = 7) and the mortality rate was 25% (n = 6). Multivariant analysis showed that diffuse peritonitis and the period between perforation and operation (longer than 24 hours) were effective on prognosis, either on morbidity (p = 0.002 and p = 0.002, respectively) or on mortality (p = 0.009 and p = 0.000, respectively). CONCLUSION: Postoperative morbidity and mortality rates are high in patients with perforated gastric cancer. In resectable cases, one-stage radical gastrectomy should be encouraged if conditions allow. In patients with diffuse peritonitis and poor general condition, palliative surgery or staged radical gastrectomy should be considered. High rates of mortality and morbidity can be reduced with early diagnosis and with the surgical control of gastric perforation before peritonitis.

Analysis of early relaparotomy after lower gastrointestinal system surgery.

PURPOSE: To evaluate the complications after lower gastrointestinal system (GIS) operations, and to investigate the reasons for and outcomes of relaparotomy (RL), and the factors influencing its mortality rate. METHODS: The subjects of this retrospective study were 38 patients who underwent early RL for complications of lower GIS surgery. We analyzed the demographic features and initial diagnoses of the patients, the reasons for their initial surgery and their postoperative complications, and the number, duration, and outcome of early RLs. RESULTS: The average patient age was 54.8 +/- 16.2 years and the male:female ratio was 30:8. Early RL was performed for the following complications: leakage of an intestinal repair or anastomosis (n = 17, 44.7%); intraabdominal infection or abscess (n = 8, 21%); stomal complications (n = 5, 13.2%); necrosis caused by mesenteric arterial thrombosis (n = 4, 10.5%); hemorrhage (n = 2, 5.3%); and intestinal rupture (n = 2, 5.3%). A mortality rate of 36.8% (n = 14) was attributed mainly to infections (n = 27, 71.4%). The average interval between the first laparotomy and RL was 5.5 +/- 3.5 days, and the average hospital stay was 27.1 +/- 19.4 days. CONCLUSIONS: Relaparotomy performed soon after major lower GIS surgery is associated with a high mortality rate. Thus, to decrease both the RL and mortality rates, complicated surgery should ideally be performed by experienced surgeons in fully equipped facilities.

Effect of Hyaluronic Acid-carboxymethylcellulose Adhesion Barrier on Wound Healing: An Experimental Study.

 The aim of this study was to investigate the effects of hyaluronic acid-carboxymethylcellulose (HA-CMC) membrane on the healing process of wounds in rats. One hundred animals were assigned randomly into two equal groups. Midline laparotomies were performed. In group 1, a 5-cm x 3-cm piece of HA-CMC membrane was placed under the laparotomy incision. The same procedure was performed in group 2, but without the HA-CMC membrane. Ten animals from each group were euthanized on postoperative days (POD) 4, 7, 14, 21, and 35 after wounding. Breaking strength, histologic examination, and tissue hydroxyproline levels were analyzed. The tensiometric test showed that there was no significant difference in the breaking strengths between the two groups (P > 0.05). Statistical difference was found to be significant on POD 4, 14, 21, and 35 when the groups were compared with regard to average hydroxyproline levels (P < 0.05). Significant differences were found in the results of histologic examination of the tissue specimens between the two groups in terms of acute inflammation on POD 14, chronic inflammation, and granulation tissue fibroblast maturation on POD 35, collagen deposition on POD 21, and neovascularization on POD 7, 14, 21, and 35 (P < 0.05). The results show that the HA-CMC membrane did not negatively affect the mechanical strength and healing process of the laparotomy incisions.

Early diagnosis and prediction of severity in acute pancreatitis using the urine trypsinogen-2 dipstick test: a prospective study.

AIM: To evaluate the use of the trypsinogen-2 dipstick (Actim Pancreatitis) test for early diagnosis and prediction of severity in acute pancreatitis (AP). METHODS: Ninety-two patients with AP were included in this study. The control group was 25 patients who had acute abdominal pain from non-pancreatic causes. Urine trypsinogen-2 dipstick test (UTDT) and conventional diagnostic tests were performed in all patients. Patients were divided by the Atlanta classification into two groups as having mild or severe pancreatitis. RESULTS: UTDT was positive in 87 (94.6%) of the AP patients and in two (8%) controls (P < 0.05). Positive UTDT was found in 61 (92.4%) of 66 (71.7%) patients with mild pancreatitis and in all (100%) of the 26 (28.3%) with severe pancreatitis (P > 0.05). UTDT positivity lasted longer in severe pancreatitis compared with that in mild pancreatitis (6.2 +/- 2.5 d vs 2.0 +/- 1.43 d, P < 0.05). The sensitivity, specificity, positive predictive value, negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of UTDT were 91%, 72%, 96.6%, 70.4%, 3.4 and 0.1, respectively. CONCLUSION: UTDT is a simple, rapid and reliable method for use on admission. It has high specificity and low NLR for early diagnosis and prediction of severity in AP. However, its relatively low NPV does not allow trypsinogen-2 dipstick test to be a stand-alone tool for diagnosis of acute pancreatitis; the use of other conventional diagnostic tools remains a requirement.

Analysis of risk factors affecting the development of seromas following breast cancer surgeries: seromas following breast cancer surgeries.

This study aimed to determine the effects of demographic, clinical, and therapeutic variables in development of seromas. The relation between development of seromas and age, preference for surgery, tumor size, existence of axillary lymph nodes and lymph nodal metastases, number of lymph nodes removed, type of surgical equipments used, drainage duration, drainage flow rate, and whether or not neoadjuvant chemotherapy was received; dead volume was reduced; or pressure garment was used in patients who received surgery due to breast cancer between 2000 and 2005 years. Mean age of 119 patients included in the study was 53.13+/-13.26 (range 26-79). Seromas were observed in 17 (14.28%) patients. In multivariate logistic regression analysis an association of postoperative seroma formation was noted with a drainage flow rate greater than 50 mL/day after 48th hours following breast surgery (p=0.007), while other variables investigated herein are not associated with development of seromas. We conclude that a drainage flow rate greater than 50 mL/day after 48th hours is a predicting factor for seroma formation in breast cancer patients. Thus, we do not recommend terminating the drainage before flow rate at 48 hours is seen and daily drainage is lower than acceptable limit.

Lower recurrence rate for Limberg vs. V-Y flap for pilonidal sinus.

PURPOSE: Pilonidal sinus is a disease that does not have a standardized surgical treatment method. This study was designed to compare the outcomes of Limberg fasciocutaneous transposition and V-Y fasciocutaneous advancement flaps in the treatment of patients with pilonidal sinus. METHODS: A total of 111 patients (98 males; 88.3 percent; mean age, 27.1 years) who received reconstruction after pilonidal sinus excision in our clinics with Limberg flap (Group 1, n = 66, 59.5 percent) or V-Y flaps (Group 2, n = 45, 40.5 percent) between 1997 and 2004 were investigated retrospectively. RESULTS: No significant difference was detected between Groups 1 and 2 in terms of gender, history of infection or abscess, mean duration of operation, requirement for analgesics, wound-related complications, such as necrosis, seroma, and infection, and average time off work. Mean follow-up periods were 45.4 vs. 48.8 months in Group 1 and Group 2, respectively (P = 0.337). On the other hand, rate of recurrence was significantly lower in Group 1 (n = 1, 1.5 percent) compared with Group 2 (n = 5, 11.1 percent; P = 0.039). CONCLUSIONS: We conclude that, if the defect is to be reconstructed with a flap in pilonidal sinus cases, reconstruction with Limberg flap should be preferred over reconstruction with V-Y flap because of its lower rate of recurrence.

[Thick-needle vacuum-assisted biopsy technique for inflammatory breast carcinoma diagnosis]. / Técnica de biópsia aspirativa por agulha de grosso calibre para o diagnóstico do carcinoma inflamatório da mama.

PURPOSE: Inflammatory breast carcinoma (IBC) is a rare clinicopathological cancer type with unique clinical features and a poor prognosis. In this disease, there is generally no palpable mass in the breast. IBC can be mistakenly diagnosed as mastitis and patients may receive a delayed diagnosis and treatment, since these two disorders cause similar pathological appearences on the breast. Clinical suspicion of the disease followed by histopathological observation of occluded dermal lympthatics by tumor emboli leads to definitive diagnosis of IBC. METHODS: Here, we report our experiences in diagnosing IBC using Thick-Needle Aspiration Biopsy (TNAB). RESULTS: Eight patients having clinically suspected IBC, received TNAB. IBC was definitively diagnosed upon observation in histopathological examination of occluded dermal lymphatics by tumor emboli since TNAB allowed adequate tissue sampling. CONCLUSION: In this study, we showed that IBC can be reliably diagnosed using TNAB.

Thick-needle vacuum-assisted biopsy technique for inflammatory breast carcinoma diagnosis

PURPOSE: Inflammatory breast carcinoma (IBC) is a rare clinicopathological cancer type with unique clinical features and a poor prognosis. In this disease, there is generally no palpable mass in the breast. IBC can be mistakenly diagnosed as mastitis and patients may receive a delayed diagnosis and treatment, since these two disorders cause similar pathological appearences on the breast. Clinical suspicion of the disease followed by histopathological observation of occluded dermal lympthatics by tumor emboli leads to definitive diagnosis of IBC. METHODS: Here, we report our experiences in diagnosing IBC using Thick-Needle Aspiration Biopsy (TNAB). RESULTS: Eight patients having clinically suspected IBC, received TNAB. IBC was definitively diagnosed upon observation in histopathological examination of occluded dermal lymphatics by tumor emboli since TNAB allowed adequate tissue sampling. CONCLUSION: In this study, we showed that IBC can be reliably diagnosed using TNAB.

OBJETIVO: O carcinoma inflamatório da mama (CIM) é um raro tipo histopatológico do câncer mamário, com características clínicas especiais e prognóstico reservado. Nesta doença, geralmente não se palpa nódulos mamários. O CIM pode equivocadamente ser diagnosticado como mastite e gerando um retardo no diagnóstico e tratamento, visto que ambas as doenças tem apresentação semelhante. A suspeita clínica da doença seguida da observação histopatológica de embolia tumoral com oclusão dos linfáticos da derme conduz ao diagnóstico definitivo de CIM. MÉTODOS: Relata-se o procedimento no diagnóstico de CIM utilizando a biópsia de aspiração por agulha de grosso calibre (BAAGC). RESULTADOS: Oito pacientes com suspeita clínica CIM foram submetidos a BAAGC. Todos os casos receberam diagnóstico definitivo de CIM após caracterização histopatológica da biópsia. BAAGC permitiu a amostragem adequada do tecido. CONCLUSÃO: O CIM pode ser diagnosticado utilizando BAAGC.

Total gastrectomy for gastric carcinoma.

BACKGROUND/AIMS: Gastric cancer is one of the most common organ cancers all around the world and surgical resection is essential for treatment. Total gastrectomy is the procedure of choice for treatment of proximal gastric cancer. Mortality and morbidity risks of this procedure are high, especially among the elderly. METHODOLOGY: Thirty-eight gastric cancer patients underwent total gastrectomy in the Third Surgical Clinic of Izmir Ataturk Training and Research Hospital between 1996 and 2001. Age, gender, location of the tumor, histopathological findings, TNM stage, type of anastomosis, operation time, blood transfusions, oral food intake, postoperative hospital stay, morbidity, mortality both early and late, and survival rate were evaluated. RESULTS: Mean age of the patients was 59.5 years (22-85 years). Sites of the tumors were: cardia 28.9%, cardia and corpus 15.8%, corpus 34.3%, corpus and antrum 18.4%, linitis plastica 2.6%. Histological types were adenocarcinoma (97.4%), and squamous cell carcinoma (2.6%). TNM stages were: stage la 2.6%, stage II 7.9%, stage IIIa 39.5%, stage IIIb 42.1%, and stage IV 7.9%. Esophagojejunostomies were performed manually (34.3%) or by circular staplers (65.7%). Operation time ranged between 3 and 6.5 hours. Gastric tubes were removed on the fourth postoperative day. Average postoperative hospital stay was 12.9 days. Postoperative morbidity was 21%. Wound infection occurred in three patients (7.9%), pulmonary infection occurred in two patients (5.2%) and anastomotic stricture developed in three patients (7.9%). Hospital mortality was 20%. Anastomotic leak occurred in five cases (13.2%) and all died on days 8, 13, 14, 26, and 30. Three patients (7.9%) died of cardiac complications on days 1, 5, and 29. Twelve patients survived for less than one year and eight patients survived for one to two years. Average survival was 10.5 months for 20 out of 30 patients (median 8 months). Ten patients are still alive after 14.3 months. Four patients have been living for less than one year, another four patients for one to two years, and two patients for more than two years. CONCLUSIONS: Total gastrectomy, either performed with a curative or palliative aim, is a safe procedure with acceptable mortality rates. 89.5% of our cases were stage III or IV resulting in a low survival rate. Longer survival rates can be achieved in patients with comparatively earlier stages.

[Retrospective analysis of the patients with penetrating cardiac trauma]. / Penetran kardiyak travmali hastalarin retrospektif analizi.

BACKGROUND: Penetrating cardiac stab wounds are among rarely seen traumas, associated with high mortality. We aimed to present and investigate our experience in such cases. METHODS: Eighteen cases with penetrating cardiac stab wounds, between 1993-2001, were investigated retrospectively. Gender, age, conditions at application, injured areas, extent of cardiac damage, accompanying organ damages and outcomes of these patients were studied. RESULTS: All patients were male with a mean age of 25.38 years (between 16-42 years). Heart was the only affected organ in nine 9 patients, whereas there were additional organ injuries in the remaining patients. The injuries were at left ventricle in 11, right ventricle in 4 and right atrium in three patients. Only two patients survived among 14 patients who developed cardiac arrest. There was additional organ damage in three of the six survivors. CONCLUSION: The overall mortality was 66%. Suspect of cardiac injury should be considered in patients who are injured close around cardiac area and one should intervene quickly both in diagnosis and treatment.