Assessment of the water quality of Bartin Kisla (Kozcagiz) Dam by using geographical information system (GIS) and water quality indices (WQI).

This study was conducted to evaluate the water quality of the Kisla (Kozcagiz) Dam located in the province of Bartin in the Western Black Sea Region of Turkey. Water samples were collected monthly from 5 stations for a year and analyses were conducted using 27 water quality parameters. The quality of the dam and the water quality parameters were evaluated using different indices in comparison to the limits determined according to the standards set by the World Health Organization (WHO) and Turkey Surface Water Quality Regulation (SWQR). Water quality index (WQI), organic pollution index (OPI), sodium adsorption ratio (SAR), magnesium adsorption ratio (MAR), permeability index (PI), and metal pollution index (MPI) were calculated and spatial assessment of pollution was made seasonally by making use of the geographic information system (GIS). A piper diagram was used in determining the facies of the water. The types of Ca2+-Mg2+-HCO3- predominated in the dam water. Moreover, statistical analyses were used in order to determine if there was a significant difference between the parameters. WQI results generally indicate that the water quality was good in all seasons; however, only in the autumn, sampling points S1 (101.58), S2 (100.59), S4 (102.31), and S5 (102.12) showed poor water characteristics. According to the OPI results, while winter and spring yielded good water quality, summer samples were lightly polluted and autumn samples were moderately polluted. Given SAR results, it can be stated that the water of Kisla Dam could be used as irrigation water. Considering the standards specified by WHO and SWQR, the parameters generally exceeded the threshold values, but the water hardness value was much higher than 100 mg L-1 specified in SWQR as very hard water. The principal component analysis (PCA) results showed that the pollution sources were anthropogenic. Thus, for the dam water to not be affected by the increasing pollutant factors, it should be continuously monitored, and attention should be paid to the irrigation methods used in agricultural activities.

Spatial-temporal distribution and pollution indices of heavy metals in the Turnasuyu Stream sediment, Turkey.

The potential contamination levels and human health risk of heavy metals in sediment of the Turnasuyu Stream in Ordu, Turkey, were evaluated comprehensively by taking seasonal samples from three different locations. The order of the mean heavy metals (HMs) concentrations (mg/kg) were as follows: Fe > Al > Mn > Pb > Zn > Cu > Co > Cr > Ni > Cd > As. All HM levels, except Cd and Pb, were in the minimum enrichment range as assessed by the sediment enrichment factor (EF). Similar low contamination levels for all HM, except Pb and Cd, were also observed when the contamination factor (CF) and geo-accumulation index (Igeo) were taken into account. The low risk of the study area has also been confirmed by the ecological risk index (Eri) values. The probable human health risk assessment has been performed, and the lifetime cancer risk (LCR) values for adults were found as negligible with values below 10-6. In addition, the hazard index (HI) and total hazard index (THI) results were both higher in children than in adults. The Pearson correlation coefficient (PCC) revealed the highest correlation between Cd and Pb (0.85). When the ecological indexes and statistical results are evaluated together, it is thought that the presence of HMs in the sediment may be due to lithological reasons as well as anthropogenic activities such as quarrying, municipal, agricultural, and domestic discharges in the region. Mitigation measures should be taken in accordance with the standards within the river basin to prevent the potential risks of pollution.

Distribution of peripheral blood cells after splenectomy in immune thrombocytopenia patients.

BACKGROUND: There are some difficulties regarding the evaluation of the post-splenectomy state. OBJECTIVE: The objective of the study is to compare the post-splenectomy blood changes of immune thrombocytopenia (ITP) patients with those of trauma patients, 1 month and ≥ 6 months after surgery. METHODS: Medical records of patients, who had undergone total splenectomy for ITP and trauma at a tertiary center between January 2009 and December 2019, were retrospectively reviewed. RESULTS: The current study included 52 patients, who had undergone splenectomy for ITP (57.7%), and trauma (42.3%). Splenectomy, irrespective of the indications, resulted in an increase in hemoglobin concentration, hematocrit, and platelet levels. Neutrophils were responsible for the preoperative leukocytosis in ITP patients, and neutrophilia was ameliorated by splenectomy and also withdrawal of the steroid therapy in some patients. Decreased neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio supported the finding that splenectomy ameliorated inflammation in ITP patients. Splenectomy resulted in a change in percentages of leukocytes in favor of basophils in ITP patients. CONCLUSIONS: Splenectomy, irrespective of the indications, resulted in an increase in hemoglobin concentration, hematocrit and platelet levels, lymphocyte, monocyte, and eosinophil counts. Splenectomy ameliorated inflammation in ITP patients and resulted in a change in percentages of leukocytes in favor of basophils.

ANTECEDENTES: Existen algunas dificultades con respecto a la evaluación del estado post-esplenectomía. OBJETIVO: Comparar los cambios sanguíneos post-esplenectomía de pacientes con PTI con los de pacientes traumatizados, 1 mes y ≥ 6 meses después de la cirugía. MÉTODOS: Se revisaron retrospectivamente las historias clínicas de los pacientes que habían sido sometidos a esplenectomía total por PTI y trauma en un centro terciario entre enero de 2009 y diciembre de 2019. RESULTADOS: El presente estudio incluyó a 52 pacientes, que habían sido sometidos a esplenectomía por PTI (57.7%) y traumatismo (42.3%). La esplenectomía, independientemente de las indicaciones, resultó en un aumento de la concentración de hemoglobina, hematocrito y niveles de plaquetas. Los neutrófilos fueron responsables de la leucocitosis preoperatoria en pacientes con PTI, y la neutrofilia mejoró mediante esplenectomía y también la suspensión de la terapia con esteroides en algunos pacientes. La disminución de NLR y PLR apoyó el hallazgo de una disminución de la inflamación en la esplenectomía en pacientes con PTI. La esplenectomía resultó en un cambio en los porcentajes de leucocitos a favor de los basófilos en pacientes con PTI. CONCLUSIONES: La esplenectomía, independientemente de las indicaciones, resultó en un aumento de la concentración de hemoglobina, niveles de hematocrito y plaquetas, recuentos de linfocitos, monocitos y eosinófilos. Una disminución de la inflamación en la esplenectomía en pacientes con PTI resultó en un cambio en los porcentajes de leucocitos a favor de los basófilos.

Mortality after kidney transplantation: 10-year outcomes.

OBJECTIVES: In the past decade, advances in immunological therapy have increased the survival of kidney recipients and their grafts. However, it has not achieved the desired level of improvement. This study aims to reveal the mortality among kidney recipients. METHODS: Medical data of the patients, who had undergone kidney transplantation (KT) between November 2010 and December 2020, were retrospectively reviewed. Inclusion criteria were adult kidney recipients, who had died. Exclusion criteria were pediatric recipients, recipients of en bloc and dual KT, recipients with missing data, and recipients with a primary non-functioning graft. The recipients were grouped according to their donor type; Group 1 (from a living donor) and Group 2 (from a deceased donor). Subgroup analyses were done for mortality by time-period post-transplant and for infectious causes of mortality. RESULTS: Of 314 recipients, 35 (11.14%) died. Twenty-nine recipients were included in the study (Group 1: 17 and Group 2: 12). The most common cause of mortality was infection (58.6%), and the second was cardiovascular disease (CVD) (24.1%). Sepsis developed in 29.4% of infection-related deaths, while COVID-19 constituted 23.5% of infection-related deaths. CONCLUSION: Early diagnosis and treatment of infectious and CVD are important to improve survival in kidney recipients.

OBJETIVOS: En la última década, los avances en la terapia inmunológica han aumentado la supervivencia de los receptores de riñón y sus injertos. Sin embargo, no se pudo lograr el nivel de mejora deseado. Este estudio tiene como objetivo revelar la mortalidad entre los receptores de riñón. MATERIALES Y MÉTODOS: Se revisaron retrospectivamente los datos médicos de los pacientes, que se habían sometido a un trasplante de riñón entre Noviembre de 2010 y Diciembre de 2020. Los criterios de inclusión fueron los receptores de riñón adultos, que habían fallecido. Los criterios de exclusión fueron los receptores pediátricos, los receptores de trasplantes de riñón dual y en bloque, los receptores con datos faltantes y los receptores con un injerto primario no funcionante. Los receptores se agruparon según su tipo de donante; Grupo 1 (de un donante vivo) y Grupo 2 (de un donante fallecido). Se realizaron análisis de subgrupos para la mortalidad por período de tiempo posterior al trasplante y para las causas infecciosas de mortalidad. RESULTADOS: De 314 beneficiarios, 35 (11,14%) fallecieron. Se incluyeron 29 receptores en el estudio (Grupo 1:17; Grupo 2:12). La causa más común de mortalidad fue la infección (58,6%) y la segunda fue la enfermedad cardiovascular (24,1%). La sepsis se desarrolló en el 29,4% de las muertes relacionadas con la infección, mientras que el COVID-19 constituyó el 23,5% de las muertes relacionadas con la infección. CONCLUSIÓN: El diagnóstico y tratamiento tempranos de enfermedades infecciosas y cardiovasculares es importante para mejorar la supervivencia de los receptores de riñón.

Environmental, ecological and human health risk assessment of heavy metals in sediments at Samsun-Tekkeköy, North of Turkey.

A detailed study was conducted in order to evaluate the effects of heavy metal pollution in the sediments in terms of environmental, ecological, and human health. Sediment samples were collected from 5 different points in two seasons, namely summer (August 2017) and winter (December 2017), to determine the distribution of heavy metals, potential pollutants, and toxic and ecological risks in the river sediments in Samsun-Tekkeköy district located in the Mid-Black Sea Region of Turkey and to evaluate the human health risk. The distribution of heavy metals at the sampling points was Fe>Al>Mn>Zn>Cu>Cr>Ni>Pb>Cd based on their averages. According to the toxic risk index (TRI) results, sampling point OIZ (Organized Industrial Zone) Channel (T3) was also found to have a moderate risk, and it was determined that the highest contribution was from Cu>Ni>Cd>Cr, respectively. Potential ecological risk index (PERI) results revealed a low risk except for Cd metal at all sampling points. While the sediment enrichment factor (EF) did not show much metallization at many points, the highest enrichment was observed in Cd, Cu, and Zn metals at sampling point T3. According to the geoaccumulation index (Igeo) and contamination factor (CF), sampling point T3 showed contamination with Cd, Cu, Cr, and Zn. Evaluation of human health risk showed that the hazard index (HI) results of carcinogenic and non-carcinogenic risks were higher among children than adults. The total lifetime cancer risks (TLCR) of heavy metals were within the limits determined by USEPA. However, the risk was ranked as Cr>Cd>Pb. Sediment quality guidelines (SQGs) and pollution index results showed that heavy metal contamination was due to anthropogenic and industrial activities since the region was an industrial zone. It was determined that heavy metals posed ecological risks and that the Samsun-Tekkeköy region was moderately and significantly contaminated.

Perianal Infections in Patients With Hematologic Malignancy: The Risk of Fournier's Gangrene Leading to Mortality and Irreversible Organ Damage.

INTRODUCTION: The efficacy of surgical intervention for perianal infection in patients with hematologic malignancy is not well-established. OBJECTIVE: This article presents a case series of perianal infection progressing to Fournier's gangrene (FG) in patients with hematologic malignancy to guide physicians, because to the author's knowledge, there were no randomized or prospective studies presenting the management strategies reported herein. It was hypothesized that surgery might reduce mortality and morbidity in patients with inflammation spreading beyond the perianal region, in patients with abscess formation, and in those who show no improvement with medical therapy. MATERIALS AND METHODS: The data of 4 adults with hematologic malignancy who developed perianal infection progressing to FG between January 2010 and December 2018 were reviewed retrospectively. Patients younger than 18 years and patients without hematologic malignancies or FG were excluded. The primary outcome was mortality. The secondary outcome was irreversible organ damage. RESULTS: Four male patients with a mean age of 36.75 years ± 13.1 standard deviation (range, 23-52 years) reported fever and dull anal pain during treatment for hematologic malignancy. A broad-spectrum antibiotic regimen was administered as initial empiric therapy at onset of fever and was de-escalated based on the culture results and clinical response. However, FG arose in all cases approximately 8.75 days ± 6.94 (range, 3-17 days) after onset of anal pain. All patients underwent surgical debridement, and diverting ostomy was performed in 3 cases. One patient died of overwhelming sepsis (25%), and 1 patient required orchiectomy (25%). CONCLUSIONS: Clinical suspicion of FG may be effective in reducing mortality in patients with hematologic malignancy, especially in cases with fever accompanied by anal pain. Surgical intervention may improve the prognosis for patients with inflammation spreading beyond the perianal region, patients with abscess formation, those who show no improvement in medical therapy, and those who develop FG. Diverting ostomy may improve survival in patients with FG.

Thigh Abscess Secondary to Intra-abdominal Pathologic Conditions: Three Cases Progressing to Necrotizing Fasciitis.

INTRODUCTION: Necrotizing fasciitis results in progressive destruction of the fascia and overlying tissue. Mortality primarily depends upon the timing of medical care and the extent of infection. OBJECTIVE: This article presents a case series of thigh abscesses originating from intra-abdominal pathologic conditions and progressing to necrotizing fasciitis due to delayed diagnosis. MATERIALS AND METHODS: The data concerning 3 patients with thigh abscess originating from an intra-abdominal pathologic condition and progressing to necrotizing fasciitis are presented. RESULTS: All patients had undergone previous colorectal surgery for malignancy and were admitted to the hospital with pain concentrated in the lower back and spreading down to the buttock, sacrum and coccyx, and leg. Patients had received symptomatic therapy, including nonsteroidal anti-inflammatory drugs, and 1 patient had undergone diskectomy for a herniated disk in the lumbar region. All 3 patients subsequently developed thigh abscesses (initially treated by percutaneous and/or surgical drainage) and received antibiotic therapy. One patient underwent percutaneous drainage, and 2 patients underwent abdominal surgery to address the abdominal abscess. During the course of treatment, thigh abscesses progressed to necrotizing fasciitis, which was treated by surgical debridement with or without negative pressure wound therapy. All patients died of overwhelming sepsis. CONCLUSIONS: Thigh abscess may spontaneously arise from surrounding soft tissues, or it may be a sign of intraperitoneal, retroperitoneal, or pelvic pathologic conditions. Deep, vague pain in the back or hip area that spreads downward to the buttock and leg may be an early symptom of these pathologic conditions. Clinical suspicion may be effective in reducing mortality by enabling early surgical intervention, especially in the patient with a previous history of abdominal surgery, radiotherapy, or inflammatory or malignant disease.

Management of thoracoepigastric flap necrosis in patients with breast cancer.

Thoracoepigastric flap is rarely used for reconstruction of the large chest wall defects due to potential for necrosis and delayed wound healing. This article presents three patients with breast cancer, who underwent mastectomy and chest wall reconstruction with thoracoepigastric flap and subsequently developed distal flap necrosis. The negative pressure wound therapy may eliminate the need for additional graft and/or flap surgery in patients with large necrosis size.

El colgajo toracoepigástrico rara vez se utiliza para la reconstrucción de grandes defectos de la pared torácica debido al potencial de necrosis y al retraso en la cicatrización de la herida. En este artículo se presentan tres pacientes con cáncer de mama, que fueron sometidas a mastectomía y reconstrucción de la pared torácica con colgajo toracoepigástrico y posteriormente desarrollaron necrosis del colgajo distal. La terapia de presión negativa para heridas puede eliminar la necesidad de cirugía adicional de injerto y/o colgajo en pacientes con necrosis de gran tamaño.

Transplantation Using Renal Grafts With Multiple Renal Arteries: A Putative Study on the Impact of Arterial Reconstruction Technique and Site of Implantation on Outcomes.

BACKGROUND: In the present retrospective study, we analyzed the outcomes of patients transplanted with grafts with multiple renal arteries (MRAs). PATIENTS AND METHODS: In total, 89 patients were transplanted with renal grafts with MRAs from 2003 to 2018. Demographic characteristics; type of donor; warm and cold ischemia times; arterial anastomosis technique; complications; graft function at first month, first year, and last outpatient clinic visit; and patient and graft survival were all retrospectively evaluated. RESULTS: The mean age of the patients was 40.4 ± 13.3 years. Fifty-six patients (62.9%) were male. In total, 42 patients (47.2%) received renal grafts from living related donors. In group A (n = 24; 27%), anastomosis was performed separately to the recipient external or internal iliac arteries; in group B (n = 38; 42.7%), the secondary artery was anastomosed to the main artery in a side-to-side fashion to form a single common orifice; in group C (n = 27; 30.3%), secondary arteries were anastomosed to the main renal artery in an end-to-side fashion. Creatinine clearance at the first month was significantly lower for deceased-donor grafts compared to living-donor renal grafts (P < .05). Creatinine clearance in the first postoperative month was significantly lower in group A and creatinine clearance in the first year was significantly lower in group C (P < .05). The best survival was found for anastomosis to the internal iliac artery (P < .05). CONCLUSION: MRAs can be safely used and the reconstruction technique does not matter if the graft kidney's arterial supply is preserved and the internal iliac artery is chosen for anastomosis.

THE PREDICTORS OF MORTALITY IN NON-TRAUMATIC SPLENECTOMIES.

BACKGROUND: There are quite a few studies examining prognostic factors in non-traumatic splenectomies compared to traumatic ones. OBJECTIVE: This study aimed to evaluate the predictors of mortality in patients who underwent splenectomy for non-traumatic spleen diseases. METHODS: Medical records of the patients, who had undergone total splenectomy for non-traumatic spleen diseases at a tertiary center between January 2009 and December 2019, were retrospectively reviewed. Exclusion criteria included patients younger than 18 years of age, partial splenectomies, splenectomies applied to facilitate surgery for malignancy on contiguous organs, and splenectomies performed during liver transplantation. Iatrogenic splenic injuries were regarded as trauma and these cases were also excluded. RESULTS: The current study included 98 patients. Nine (9.2%) patients died. In univariate analysis, age, the presence of hematological neoplasia, hematocrit, hemoglobin, white blood cell counts, neutrophil-to-lymphocyte ratio, indications for splenectomy, application of emergency surgery, surgical technique, and transfusion of blood components were all significantly associated with mortality. In multivariate analysis, the presence of hematological malignancy [P=0.072; OR=7.17; (CI: 0.386-61.56)], the application of emergency surgery [P=0.035; OR=8.33; (CI: 1.165-59.595)] and leukocytosis [P=0.057; OR=1.136; (CI: 0.996-1.296)] were found to be positively associated with mortality. CONCLUSION: Hematologic neoplasia, emergency surgery, and leukocytosis were the independent predictors of mortality in patients, who were operated on for non-traumatic spleen diseases. A thorough preoperative evaluation, early therapeutic intervention, and advanced surgical techniques are important and can serve to minimize complications and mortality in case of inevitable splenectomy. Immunological research can provide new therapeutic opportunities that may impact positively on patients by minimizing morbidity and mortality.

Why potential donors and recipients not proceed to live kidney transplantation, malatya algorithm / Por qué los donantes y receptores potenciales no proceden al trasplante de riñón vivo, algoritmo de malatya

ABSTRACT Introduction: In some countries, organ donation is not widespread enough due to medical, cultural, ethical and socioeconomic factors. Living-donor kidney transplant constitutes the main source of kidney donation. Aim: To evaluate the causes of cancellation of living-donor kidney transplant and improve the effectiveness of transplant programs. Methods: Medical records of possible donors and recipients who were evaluated for living-donor kidney transplant at a tertiary medical center between November 2010 and September 2019 were reviewed retrospectively. Results: Evaluations were performed on 364 potential donors and 338 living-donor kidney transplant recipients; 207 of the latter (61.24%) underwent living-donor kidney transplant. Immune disorders represented the majority of cancellations (38.84%). Fifty-six donors (15.38%) were rejected mainly due to renal disorders (39%). Conclusion: Timely referral of patients to transplant centers must be guaranteed in order to overcome immune problems. Transplant centers should invest in programs adequate both for their resources and for their patients: paired kidney exchange, desensitization protocols, future research, etc.

RESUMEN Introducción: En algunos países la donación de órganos no es suficiente debido a factores médicos, culturales, éticos y socioeconómicos. El donante vivo de riñón constituye la principal fuente de donación de riñones. Objetivo: Evaluar las causas de cancelación de los donantes vivos de riñón y mejorar la eficacia de los programas de trasplante. Material y métodos: Se evaluaron retrospectivamente los registros médicos de posibles donantes y receptores para trasplante de riñón con donante vivo en un centro terciario, entre noviembre de 2010 y septiembre de 2019​​. Resultados: Se evaluaron 364 donantes potenciales y 338 receptores de trasplante de riñón con donante vivo; 207 receptores (61,24%) se sometieron a trasplante de riñón con donante vivo. Los problemas inmunológicos ocasionaron la mayoría de las cancelaciones (38,84%). A cincuenta y seis donantes (15,38%) se les negó la donación, principalmente debido a problemas renales (39%). Conclusión: La derivación oportuna de los pacientes a los centros de trasplante debe garantizarse para superar las barreras inmunológicas. Los centros de trasplante deberían invertir en programas adecuados, tanto por sus recursos como por los pacientes: protocolos de desensibilización, trasplante renal cruzado, investigación futura, etc.

Os preditores da mortalidade em esplenectomias não traumáticas / The predictors of mortality in non-traumatic splenectomies

ABSTRACT BACKGROUND: There are quite a few studies examining prognostic factors in non-traumatic splenectomies compared to traumatic ones. OBJECTIVE: This study aimed to evaluate the predictors of mortality in patients who underwent splenectomy for non-traumatic spleen diseases. METHODS: Medical records of the patients, who had undergone total splenectomy for non-traumatic spleen diseases at a tertiary center between January 2009 and December 2019, were retrospectively reviewed. Exclusion criteria included patients younger than 18 years of age, partial splenectomies, splenectomies applied to facilitate surgery for malignancy on contiguous organs, and splenectomies performed during liver transplantation. Iatrogenic splenic injuries were regarded as trauma and these cases were also excluded. RESULTS: The current study included 98 patients. Nine (9.2%) patients died. In univariate analysis, age, the presence of hematological neoplasia, hematocrit, hemoglobin, white blood cell counts, neutrophil-to-lymphocyte ratio, indications for splenectomy, application of emergency surgery, surgical technique, and transfusion of blood components were all significantly associated with mortality. In multivariate analysis, the presence of hematological malignancy [P=0.072; OR=7.17; (CI: 0.386-61.56)], the application of emergency surgery [P=0.035; OR=8.33; (CI: 1.165-59.595)] and leukocytosis [P=0.057; OR=1.136; (CI: 0.996-1.296)] were found to be positively associated with mortality. CONCLUSION: Hematologic neoplasia, emergency surgery, and leukocytosis were the independent predictors of mortality in patients, who were operated on for non-traumatic spleen diseases. A thorough preoperative evaluation, early therapeutic intervention, and advanced surgical techniques are important and can serve to minimize complications and mortality in case of inevitable splenectomy. Immunological research can provide new therapeutic opportunities that may impact positively on patients by minimizing morbidity and mortality.

RESUMO CONTEXTO: Há alguns estudos que examinam fatores prognósticos em esplenectomias não traumáticas em comparação com os traumáticos. OBJETIVO: Este estudo teve como objetivo avaliar os preditores de mortalidade em pacientes submetidos à esplenectomia para doenças do baço não traumático. MÉTODOS: Os prontuários dos pacientes, submetidos à esplenectomia total não traumática para doenças do baço em um centro terciário entre janeiro de 2009 e dezembro de 2019, foram revisados retrospectivamente. Os critérios de exclusão incluíram pacientes menores de 18 anos, esplenectomias parciais, esplenectomias aplicadas para facilitar a cirurgia para a malignidade em órgãos contíguos e esplenectomias realizadas durante o transplante hepático. As lesões esplênicas iatrogênicas foram consideradas trauma e esses casos também foram excluídos. RESULTADOS: O presente estudo incluiu 98 pacientes. Nove (9,2%) pacientes morreram. Na análise univariada, idade, presença de neoplasia hematológica, hematócrito, hemoglobina, contagem de glóbulos brancos, razão entre neutrófilos-linfócitos, indicações de esplenectomia, aplicação de cirurgia de emergência, técnica cirúrgica e transfusão de componentes sanguíneos foram significativamente associadas à mortalidade. Na análise multivariada, a presença de malignidade hematológica [P=0,072; OR=7,17; (IC: 0,386-61,56)], aplicação de cirurgia de emergência [P=0,035; OR=8,33; (IC: 1,165-59,595)] e leucocitose [P=0,057; OR=1,136; (IC: 0,996-1,296)] verificou-se que estão positivamente associados à mortalidade. CONCLUSÃO: Neoplasia hematológica, cirurgia de emergência e leucocitose foram os preditores independentes da mortalidade em pacientes, operados por doenças não traumáticas do baço. Uma avaliação pré-operatória minuciosa, intervenção terapêutica precoce e técnicas cirúrgicas avançadas são importantes e podem servir para minimizar complicações e mortalidade em caso de inevitável esplenectomia. Pesquisas imunológicas podem fornecer novas oportunidades terapêuticas que podem impactar positivamente nos pacientes, minimizando a morbidade e a mortalidade.

The evaluation of the effect of vaginal delivery and aging on anal sphincter anatomy and function.

OBJECTIVE: This study was conducted to evaluate the effect of vaginal delivery and aging on anal sphincter anatomy and function. METHOD: Asymptomatic thirty women were included in this prospective study. Group 1 included 10 women (age range: 18-50) who had never been pregnant. Group 2 included 10 women (age range: 18-50) who had vaginal delivery. Group 3 included 10 women over 50 who had vaginal delivery. RESULTS: There was no statistically significant difference between the three groups in terms of resting and squeeze pressures. It was found that sphincter thickness showed statistically significant difference between the group 1 and group 3, and also group 2 and group 3. There was not statistically significant difference between the group 1 and group 2 in terms of sphincter thickness. There was a positive correlation between the age and sphincter thickness in all groups. In terms of sphincter thickness and pressure findings there was a positive correlation between the squeeze pressure and external anal sphincter thickness only in group 3. CONCLUSION: The vaginal delivery did not have a negative influence on the structure and function of the anal sphincter in asymptomatic women. However, it was found that anal sphincter thickness changed strongly in a positive manner with aging.

A surgical technique for secondary repair of obstetric anal sphincter injuries; sphinctero-vagino-perineoplasty.

OBJECTIVE: This study was conducted to present the preliminary results of seven patients treated with sphinctero-vagino-perineoplasty for secondary repair of obstetric anal sphincter injuries. MATERIALS AND METHODS: This retrospective study was conducted on the records of seven patients who underwent secondary repair of obstetric anal sphincter injuries at the colorectal surgery unit of a tertiary care center between February 2015 and December 2017. RESULTS: All patients with solid stool incontinence were fully recovered at postoperative month 3. The Wexner incontinence score was significantly improved (decreased from 14.12 [range: 8-20] to 2.28 [range: 1-4]). The complication rate was 85.7% (wound infection, abscess, hematoma, detachment). CONCLUSION: Combined repair of anal sphinchters, perineal body, superficial transverse perineal muscles, and bulbospongious muscles, which contribute to anal continence, may improve surgical outcomes in patients with obstetric anal sphincter injuries.

Managing endoscopic retrograde cholangiopancreatography-related complications in patients referred to the surgical emergency unit.

BACKGROUND: The goal of this study was to present our experience in the management of endoscopic retrograde cholangiopancreatography-related complications in patients referred to our surgical emergency unit by various endoscopy centers. METHODS: A retrospective investigation was conducted on the records of the 54 patients who were referred to our surgical emergency unit between October 2005 and January 2014 due to endoscopic retrograde cholangiopancreatography-related complications. RESULTS: There were 25 and 29 female and male patients, respectively. Pancreatitis was the most common complication (38.8%). Perforation (27.7%), infection (20.3%), and bleeding (12.9%) were the other complications. In 22.2% of cases, patients were died. The mortality rate was the highest in patients with perforation (40%). The mean age of the patients who were died due to complications was 75.9 years (range, 47-94 years). In total, 41.6% of the patients were died within the first week and 33.3% were died within the second week following ERCP. Nearly half of these patients had a cancerous disease (one had metastatic breast cancer, one had a gallbladder cancer, one had a duodenal cancer, and the other three had periampullary cancers) and 50% of the patients who died also had cardiopulmonary and/or cerebrovascular disorders. CONCLUSION: Comprehending and managing the main risk factors can minimize complications; however, they would not be eliminated. Moderate and severe complications may increase the mortality rates, particularly in high-risk patients.

Evaluation of maternal serum progranulin levels in normotensive pregnancies, and pregnancies with early- and late-onset preeclampsia.

AIMS: To investigate the possible pathophysiological associations between progranulin (PGRN) and preeclampsia (PE), early-onset PE (EOPE) and late-onset PE (LOPE). STUDY DESIGN: A cross-sectional study was designed to include consecutive patients with uncomplicated pregnancy (n = 28), EOPE (n = 30) and LOPE (n = 22). Maternal levels of serum PGRN were measured with the use of an enzyme-linked immunosorbent assay kit. RESULTS: The mean serum PGRN level was significantly higher in women with PE compared to the control group (54.17 ± 4.20 pg/ml versus 42.37 ± 5.64 pg/ml, p < 0.001), in the LOPE group compared to the control group (51.63 ± 4.61 pg/ml versus 42.37 ± 5.64 pg/ml, p < 0.001) and also in women with EOPE compared to women with LOPE (56.03 ± 2.68 pg/ml versus 51.63 ± 4.61 pg/ml, p < 0.001). Serum PGRN was negatively correlated with gestational age at birth (r = -0.669, p = 0.001) and birth weight (r = -0.653, p = 0.001); and positively correlated with systolic (r = 0.653, p = 0.001) and diastolic blood pressure (r = 0.601, p = 0.001), C-reactive protein (r = 0.519, p = 0.001), uterine artery pulsatility (r = 0.441, p = 0.001) and resistance indices (r = 0.441, p = 0.001). CONCLUSIONS: Serum PGRN levels increase significantly in women with PE as an indirect sign of placental dysfunction. This increase is even more prominent in women with EOPE. The serum PGRN in the third trimester is positively correlated with gestational age at birth and birth weight.

A rare complication of jejunostomy tube: Enteral migration.

Feeding jejunal tubes provide an excellent method for enteral nutritional support in cases where the oral route is impossible or insufficient for use. However, several complications may result from the placement of the tube. Detachment of the tube and migration through the intestine is a very rare complication. We report herein a 65-year-old male patient in whom a jejunal feeding tube (28-F Pezzer catheter) was placed two months before due to unresectable gastric cancer. He presented with disappearance of the tube and abdominal pain. Radiological investigations showed the tube localized in the lumen of the small intestine and its advancement through the gut. Conservative measures were taken as there was neither intestinal obstruction nor peritonitis. The tube passed spontaneously through the rectum 18 days later. One should be careful during the placement of jejunostomy tubes, and health care providers and patients should be instructed well in the care of feeding enterostomy tubes in order to prevent this complication.

Pelvic actinomycosis presenting as a malignant pelvic mass: a case report.

INTRODUCTION: Pelvic actinomycosis constitutes 3% of all human actinomycosis infections. It is usually insidious, and is often mistaken for other conditions such as diverticulitis, abscesses, inflammatory bowel disease and malignant tumors, presenting a diagnostic challenge pre-operatively; it is identified post-operatively in most cases. Here we present a case that presented as pelvic malignancy and was diagnosed as pelvic actinomycosis post-operatively. CASE PRESENTATION: A 48-year-old Caucasian Turkish woman presented to our clinic with a three-month history of abdominal pain, weight loss and difficulty in defecation. She had used an intra-uterine device for 16 years, however it had recently been removed. The rectosigmoidoscopy revealed narrowing of the lumen at 12 cm due to a mass lesion either in the wall or due to an extrinsic lesion that prevented the passage of the endoscope. On examination, there was no gynecological pathology. Magnetic resonance imaging showed a mass, measuring 5.5 × 4 cm attached to the rectum posterior to the uterus. The ureter on that side was dilated. Surgically there was a pelvic mass adhered to the rectum and uterine adnexes, measuring 10 × 12 cm. It originated from uterine adnexes, particularly ones from the left side and formed a conglomerated mass with the uterus and nearby organs; the left ureter was also dilated due to the pelvic mass. Because of concomitant tubal abscess formation and difficulty in dissection planes, total abdominal hysterectomy and bilateral salphingo-oophorectomy was performed (our patient was 48 years old and had completed her childbearing period). The cytology revealed inflammatory cells with aggregates of Actinomyces. Penicillin therapy was given for six months without any complication. CONCLUSIONS: Pelvic actinomycosis should always be considered in patients with a pelvic mass especially in ones using intra-uterine devices, and who have a history of appendectomy, tonsillectomy or dental infection. Surgeons should be aware of this infection in order to avoid excessive surgical procedures.