Seasonal effects on the mechanisms of burn injuries.

Objectives: This study aimed to evaluate seasonal effects on the mechanisms of burn injuries in patients requiring hospitalization. Material and Methods: A retrospective evaluation was made using the information of 419 hospitalized burns patients, including demographic data, degree and percentage of burn injury, cause and mechanism of burn injury, morbidity and mortality. Burn mechanisms were grouped as thermal burns (flame, boiling liquid, contact), chemical burns and electrical burns. When calculating the percentage of body surface area burned, the rule of nines was applied. Seasonal classification was made appropriate to the northern hemisphere. Results: According to the seasons, the most burns were seen in spring months (n= 130, 31.0%). In the examination of the mechanism of burn injury, the most common type of injury was boiling liquid in 159 patients followed by flame injury in 146 patients. There was an increase in electrical and chemical burns in spring and summer. A statistically significant difference was determined between the types of burns according to the seasons (p= 0.024). The burn injury occurred as a result of a workplace accident in 82 cases, the majority of which were in autumn, and summer, and the difference in the seasons was determined to be statistically significant (p= 0.045). There was a statistically significant increase in the exposure of individuals aged >65 years to boiling liquid burns in winter and summer months (p= 0.014). Conclusion: The results of this study showed a seasonal effect on the types of burn injuries. A higher rate of thermal burns was expected to be found in winter, but this was not the case in patients with indications for hospitalization, as chemical and electrical burns in workplace accidents were seen more frequently in warmer seasons of spring and summer. In this context, burns units should be prepared for patient profiles to vary according to the season.

Comparison of the newly developed Fournier's gangrene mortality prediction model with existing models.

BACKGROUND: Many predictive factors and scoring systems associated with Fournier's gangrene have been proposed, including comorbidities, vital signs, biochemical and hematological parameters, and demographic characteristics of the patient. The aim of this study was to determine the strengths of the scoring systems that have been formed by revealing these factors from a wider perspective and in a larger patient population. METHODS: The patient population included 144 patients, 21 of whom died. Age, biochemical and hematological parameters, Uludag Fournier's Gangrene Severity Index (UFGSI), Fournier's Gangrene Severity Index (FGSI), and Age-Adjusted Charlson Comorbidity Index (ACCI) scores were analyzed using the Mann Whitney U-test due to their non-parametric distribution. Categorical data such as comorbidities, gender, need for positive inotropes, diversion ostomy status, and UFGSI grading status was analyzed with the Chi-square test, and independent risk factors were determined from the significant data emerging from univariate and multivariate logistic regression analysis. Their strengths were compared using the logistic regression model (Fournier's Gangrene Mortality Prediction Model: FGMPM) created through ROC analysis of the FGSI, UFGSI, and ACCI scores. RESULTS: The results of the statistical analyses showed that albumin (p<0.001) and need for positive inotropic support (p<0.001) were independent risk factors for mortality and ROC analysis revealed that the created FGMPM regression model (AUC: 0.995) was a stronger model than the FGSI (AUC: 0.874), UFGSI (0.893), and ACCI (0.788) scoring systems. CONCLUSION: The results of this study revealed that albumin and the need for positive inotropic support are independent risk factors for mortality. It is thought that the determination of these two parameters can be used to predict mortality more practically than the parameters used in the UFGSI and FGSI.

The effect of intraoperative neuromonitoring on the number of lymph nodes excised and recurrence when applied during neck dissection in cases of papillary thyroid cancer.

PURPOSE: The aim of this study was to evaluate the effect of neuromonitoring on the number of lymph nodes (LNs) removed when applied during neck dissection. METHODS: A total of 166 patients receiving neck dissection due to papillary thyroid cancer were separated into 2 groups (monitoring group, n = 76; non-monitoring group, n = 90). RESULTS: The number of LNs dissected was observed to be statistically significantly higher in the monitoring group (P = 0.001), and the difference between the groups in the number of positive LNs was significant (P = 0.031). There was seen to be a negative relationship between the number of positive LNs dissected and recurrence (r = -0.404, P = 0.005). CONCLUSION: Intraoperative neuromonitoring during neck dissection makes a positive contribution to the prevention of the development of recurrence by increasing the number of LNs excised and the number of metastatic LNs.

An Evaluation of the Factors Affecting Failure of the Procedure in Reoperated Thyroidectomies: A Retrospective Analysis.

BACKGROUND: The aim of this study was to determine the factors affecting procedure failure in revision thyroidectomy surgery. METHODS: A total of 148 patients applied with revision surgery were separated into 2 groups according to the surgical success status. Comparisons were made of the 2 groups of patients where residual tissue was totally excised (Group 1, n:132) and patients where residual tissue could not be completely excised (Group 2, n:16). The patients were examined in respect of factors affecting the success of the procedure. RESULTS: The patients comprised 133 (89.9%) females and 15 (10.1%) males with a mean age of 49.68±12.02 years. Surgical failure was observed in 7 patients as the lesion could not be determined despite the use of intraoperative USG, and in 9 patients because of weak signal or signal loss. The determination of residual tissue ≤25mm on preoperative USG examination was seen to have a significant negative effect on surgical success (r=-0.329, p0.001). The patient having undergone ≥3 previous operations was determined to have a negative effect on surgical success (r=-0.229, p=0.005), and nerve damage on the opposite side to the lesion in a previous surgical procedure was determined to be the most important factor with a negative effect on surgical success (r=-0.571, p<0.001). In multinomial logistic regression analysis of the factors affecting success, the preoperative presence of nerve damage in the contralateral lobe to the lesion (OR: 33.11, 95% CI: 4.22-192.28, p<0.001) and lesion size ≤25 mm (OR: 10.10, 95% CI: 3.54-75.01, p=0.001) were determined to contribute significantly to surgical failure. CONCLUSION: The results of this study clearly showed that as residual tissue size ≤25mm and contralateral nerve damage in the preoperative ultrasonographic evaluation are associated with surgical failure, alternative treatment methods such as radioactive iodine ablation may be preferred in these patients.

Comparison of the impact of open and laparoscopic inguinal hernia operations on male sexual function and pain during sexual activity.

In the current study, we aimed to compare sexual function and pain during the sexual activity of men who underwent surgery with the open or laparoscopic total extraperitoneal hernia repair techniques. Patients were randomised into two groups according to the technique used during the operation: the Lichtenstein hernia repair open technique (n = 63) and the laparoscopic total extraperitoneal repair technique (n = 57). In both groups, postoperative sexual function score was significantly improved compared with the preoperative period (p < .001 for both), but the change was higher in the laparoscopy group (6.8 ± 3.7) compared with the open group (4.3 ± 4.4) (p < .001). In both groups, postoperative pain during sexual activity score was significantly decreased compared with the preoperative period (p = .001 for the open group and p < .001 for the laparoscopy group), with the amount of decrease being higher in the laparoscopy group (1.8 ± 0.9) compared with the other (1.1 ± 1.4) (p = .002). This study showed that both hernia repair techniques had a positive impact on sexual function and pain during sexual activity. The improvement in sexual parameters and pain during sexual intercourse was better in the laparoscopy group.

What is the effectiveness of the Tzanakis scoring system modified by the Delta Neutrophil Index in the diagnosis of acute appendicitis in pregnant women?

INTRODUCTION: Acute appendicitis is the most common cause of abdominal pain that is unrelated to pregnancy in pregnant women. The aim of this study was to evaluate the performance of the Alvarado, Ohmann, and Tzanakis scores in the prediction of acute appendicitis in pregnant women and compare the hematological parameters. PATIENTS AND METHODS: Herein, 1542 patients, aged 18-49 years, who were admitted to the emergency department with abdominal pain and underwent appendectomy were evaluated retrospectively. Of these, 140 female patients, including 35 who were pregnant and had been diagnosed with acute appendicitis, were included in the study. The obtained data were used to calculate the Alvarado, Tzanakis, and Ohmann scores. Histopathological evaluation reports were examined, and the diagnosis of acute appendicitis was confirmed. Those with different histopathological diagnoses were recorded as negative appendectomy. RESULTS: In the pregnant and non-pregnant women, the Tzanakis scoring system showed the best predictive performance in terms of the sensitivity and accuracy percentage from the Alvarado and Ohmann scoring systems (84.85%, 85.71% vs. 92.93%, and 92.38%, respectively). When the parameters showing infection were compared, the Delta Neutrophil Index (DNI) was significantly higher in the pregnant appendicitis patients (P = 0.012). When the Tzanakis scoring system was modified with the DNI, the sensitivity, accuracy, and negative predictive values were significantly increased (93.94%, 94.29%, 50% vs. 94.95%, 94.29%, and 50%, respectively). CONCLUSION: The Tzanakis scoring system appeared to be more effective than the other scoring systems in the diagnosis of acute appendicitis. Modification of the Tzanakis scoring system with the DNI was more successful in predicting appendicitis in pregnant women.

Identification of the recurrent laryngeal nerve during thyroidectomy can affect the complication rate.

AIM: Identification of recurrent laryngeal nerve (RLN), performed via different techniques, decreases nerve injury during thyroidectomy. We aimed to evaluate the effect of different anatomic levels at which RLN was identified on postoperative complications. MATERIAL AND METHODS: The patients underwent total thyroidectomy or lobectomy without lymph node dissection were included. Two different surgical methods were performed: thyroidectomy identifying RLN at level of inferior thyroid artery (ITA) (Group 1); at level of Berry's ligament (Group 2). Patients were evaluated with indirect laryngoscopy on 3rd postoperative day, if nerve damage was determined, at each six months. Nerve damage and postop hypocalcemia were accepted transient up to 6th month, permanent after 6th month. Total serum calcium levels were postoperatively measured on 24th and 48th hours, and then monthly. RESULTS: Unilateral and bilateral RLN damage were detected as 4.4% and 2.2% in Group 1; and 8% and 2.67% in Group 2, respectively. The frequency of RLN damage was similar (p=0.62). Postoperative hypocalcemia was significantly higher in Group 1 (p=0.04); hypocalcemia was similar (p=0.149). One patient in Group 1, and 2 patients in Group 2 had f superior laryngeal nerve (SLN) injury. Three patients from each group showed permanent hypocalcemia. One patient in Group 1, and two in Group 2 developed permanent hoarseness. DISCUSSION: RLN injury was similar in both groups, however, temporary hypocalcemia was more frequent in patients undergone thyroidectomy with RLN identification at ITA level. CONCLUSIONS: Devascularization of parathyroid glands may be accused. Future studies are needed. KEY WORDS: Recurrent laryngeal nerve, Thyroidectomy.

Can preoperative modified systemic inflammation score (mSIS) be used to predict malignancy in persistent nondiagnostic thyroid nodules?

Background/aim: Despite the use of ultrasound guidance, a significant part of thyroid biopsies are nondiagnostic (ND). We aimed to investigate the utility of the preoperative modified systemic inflammation score (mSIS) to predict malignancies in patients with persistent ND thyroid nodules (TNs). Materials and methods: Records of 924 patients underwent thyroidectomy between September 2016 and May 2019 were retrospectively reviewed. The calculation of mSIS was as follows: mSIS 0 [patients with albumin (ALB) ≥ 4.0 g/dL and lymphocyte to monocyte ratio (LMR) ≥ 3.4], mSIS 1 [ALB < 4.0 g/dL or LMR < 3.4], and mSIS 2 [ALB < 4.0 g/dL and LMR < 3.4]. Results: One hundred and thirty-six patients were included in the study. Of the patients with a median age of 49 (21­81) years, 26 (19.1%) were male, and 110 (80.9%) were female. Besides low lymphocyte count (P = 0.03), and ALB levels (P < 0.01), higher BMI (P = 0.02) were also associated with malignancy. In patients classified as mSIS 2, 1 and 0; malignancy rates were 100%, 25.8%, and 16.1%, respectively. The association between preoperative mSIS and thyroid malignancies was statistically significant (P < 0.01). Conclusion: We recommend that when patients with persistent ND TNs are assigned to mSIS 2 or 1, surgery should not be delayed due to the risk of malignancy.

Effects of sagging breasts and other risk factors associated with mastalgia: a case-control study.

The aim of this study is to compare patients with and without mastalgia and to analyze the factors affecting mastalgia and its severity. The patient's age, height, weight, educational status, marital status, and occupation were recorded in all subjects. In addition, the women were asked about the presence of any risk factors for mastalgia, such as tea and coffee consumption, smoking, alcohol consumption, and weight gain. The sternal notch to nipple distance (SNND) was measured to determine whether there was breast sagging. Mastalgia was significantly more common in women with BMIs of > 30 kg/m2 (OR: 2.94, CI 1.65-5.24), those who were primary school graduates or illiterate (OR: 2.96, CI 1.6-5.46), and those with SNND values of 22-25 cm (OR: 2.94, CI 1.79-4.82). In these women, drinking more than 6 cups of tea a day (OR: 2.15, CI 1.32-3.5), smoking at least 10 cigarettes a day (OR: 2.94, CI 1.78-4.83), and drinking alcohol at least once a week (OR: 2.1, CI 1.12-3.91) were found to be important factors that increased the risk of mastalgia. As a result, it has been found that severe mastalgia complaints cause by obesity, sagging breasts, never giving birth, unemployment anxiety, regular smoking, alcohol use, and excessive tea consumption.

A Diagnostic Dilemma: Skip Metastasis in Papillary Thyroid Cancer.

The frequency, pattern, and predictive factors for skip LN metastasis in patients with papillary thyroid carcinoma (PTC) remain controversial. In this study, we evaluated predictive factors of skip LN metastasis in these patients. We reviewed the medical records of 68 PTC patients who underwent total thyroidectomy, central neck dissection, and lateral neck dissection at the initial operation. The relationships between skip LN metastasis and clinicopathologic factors were analyzed. After careful examination of electronic medical records of patients, 19 patients were excluded from the study. Of the remaining 49 patients, 9 (18.4%) had skip LN metastasis. Multivariate analysis showed that tumor size <1 cm was an independent risk factor for the presence of skip metastasis (P = 0.035, odds ratio: 3.78, 95% confidence interval: 1.09-13.15). The rate of positive LN was relatively higher in micro-PTC patients than PTC patients. This finding is clinically significant and should be considered in routine clinical practice.

Diagnosis of Appendicitis in Patients with a Normal White Blood Cell Count; A Cross-Sectional Study.

OBJECTIVE: To investigate the clinical, imaging and laboratory findings for diagnosis of acute appendicitis (AA) in patients with a normal white blood cell count (WBCC). METHODS: This retrospective cross-sectional study was conducted in Ankara Numune Training and Research Hospital, Ankara, Turkey, during a 1-year period. To determine diagnostic factors in AA in patients with normal WBCC, medical records of eligible patients were reviewed for demographic and clinical variables, as well as patient outcome. RESULTS: A total of 105 patients that had undergone appendectomy and were found to have a normal WBCC were included in the study. Of these patients, 53 (50.5%) were men and 52 (49.5%) were women. The mean age of the patients was 34.2±12.3 (min 14, max 78). The negative exploration rate was identified as 19%. In the multivariate analysis, only the diameter of appendix was statistically significant (p=0.002). ROC analysis revealed the cut off appendiceal diameter as 8 mm. CONCLUSION: In patients suspected of AA due to ≥8 mm appendiceal diameter determined by imaging, we recommend surgical treatment even if WBCC and neutrophil count are normal.

Validation of COLA score for predicting wound infection in patients undergoing surgery for rectal cancer.

AIM: The purpose of our study was to estimate the incidence of SSI (Surgical site infection) and the effect of COLA (contamination, obesity, laparotomy and ASA grade) score on SSI in patients undergoing rectal surgical procedures for rectal cancer. MATERIAL OF STUDY: A total of 92 patients who underwent operation for rectum cancer were enrolled in this study. Wound surveillance was performed in all patients by a staff surgeon identified infected wounds during the hospital stay, and collected information for up to 30 days after operation. RESULTS: The overall rate of incisional SSI and organ/space SSI was 22.8% and 7.6% respectively. Surgical site infection rates were 14.2%, 20.58%, 40.7%, 57.1% for COLA 1,2,3 and 4 scores respectively. The area under the receiver/ operator characteristic curve for the score was 0,660. CONCLUSION: COLA scoring systems predict, with reasonable accuracy, the risk of SSI in rectal cancer patients undergoing elective rectal surgery. KEY WORDS: COLA score Rectal surgery, Surgical site infection, Risk prediction, Wound infection.

Cysts of the round ligament simulating inguinal hernia: report of a case.

We report on a 49-year-old woman with cysts of the round ligament causing a nonreducible mass of the groin. Cysts of the round ligament are rare. Physical findings were similar to those of an inguinal hernia. Such cysts are usually not considered in the differential diagnosis of groin hernias and might be identified only at the time of herniorraphy.

A new and simple score for predicting cystobiliary fistula in patients with hepatic hydatid cysts.

BACKGROUND: Hepatic hydatid cysts are common disorders in Turkey. Although most patients are treated by percutaneous drainage, some cases require operative intervention. Biliary fistula is a major complication of hydatid cyst operations. The purpose of this study is to identify preoperative predictors of cystobiliary fistula (CBF) and to develop a scoring system for this disorder. METHODS: Overall, 135 patients with hepatic hydatid cysts were included in this study. The following variables were analyzed as potential predictors of CBF: Age, gender, findings on physical examination, complete blood cell count, liver function tests, and ultrasonographic features of the cysts (type, diameter, number, and localization). RESULTS: CBF was detected in 33 of 135 patients. Univariate analyses showed significant differences in cyst diameter, levels of alkaline phosphatase (ALP) and direct bilirubin, platelet count, and white blood cell (WBC) count between patients with and without CBF. On multivariate analyses, WBC count > 9,000/mm(3) (odds ratio [OR], 4.5), direct bilirubin level > 0.7 mg/dL (OR, 2.76), cyst diameter > 8.2 cm (OR, 5.48), and ALP level > 120 U/L (OR, 3.82) were significant and independent predictors of CBG. One point was given for the presence of each of these factors to develop a new score. The resulting area under the receiver operator characteristic curve was 0.803 (95% confidence interval, 0.726-0.866). CONCLUSION: Preoperative detection and management of CBF are important issues in the treatment of hydatid cysts of the liver. Developing a scoring system based on routinely measured laboratory and radiologic factors will help the clinician to manage patients with hepatic hydatid cysts. External studies are needed to validate this new scoring system in routine clinical practice.

D1 versus D2 dissection in gastric carcinoma: Evaluation of postoperative mortality and complications.

OBJECTIVE: Surgery is the only curative treatment for patients with gastric cancer. However, the extent of lymph node dissection is still debated. The aim of the study was to evaluate complications, postoperative length of hospital stay and postoperative mortality after D1 or D2 lymph node dissection for gastric cancer in a non-specialized hospital. MATERIAL AND METHODS: All patients who underwent surgery for pathologically confirmed gastric cancer at our 3rd General Surgery Department, Ankara Numune Training Hospital between January 1999 and 2007 were retrospectively reviewed. A consecutive series of 71 gastric cancer patients was identified. D1 resection (level 1 lymphadenectomy) was compared with D2 resection (levels 1 and 2 lymphadenectomy). RESULTS: The D2 group had higher postoperative mortality (16% vs. 8%; p<0.005) and morbidity (54% vs. 34%; p<0.005), and their postoperative length of stay was longer. Splenectomy did not have an effect on postoperative morbidity and mortality in either the D1 or the D2 group. CONCLUSION: The D2 procedure was associated with significantly higher postoperative mortality, morbidity, and postoperative length of hospital stay.

Thyroid gland hematoma after blunt neck trauma.

Hemorrhage of a previously normal thyroid gland as a result of blunt trauma is a very rare condition. We report a case of blunt trauma that caused acute hemorrhage into the thyroid gland and presented with hoarseness. The diagnosis of thyroid gland hematoma was made with a combination of fiberoptic laryngoscopy, cervical computed tomography, and carotid angiography. The patient was treated conservatively, had a favorable course without further complications, and was discharged four days after admission.