The factors affecting mortality in intensive care unit of a burns center.

OBJECTIVE: To determine the characteristics of patients, mortality-affecting factors and mortality rate in follow-up burn-injured patients in an intensive care setting at a burns treatment centre. Methods: The retrospective study was conducted between May and November 2014 at Kocaeli Derince Training and Research Hospital Burn Treatment Centre, Kocaeli, Turkey, and comprised data from January 2008 to January 2013 of in-patients who had been treated at the intensive care unit. The therapy outcomes and the follow-up processes were evaluated. Data was analysed using SPSS 17. RESULTS: Of the 381 patients, 105(27.6%) were females and 276(72.4%) were males. The overall mean age was 28.4±21.1 years. There were 52(13.6%) mortalities, while 329(86.4%) survived. The mean total body surface area was 18.3±12.9% in those who survived compared to 52±24.3% in those who died (p<0.000). The highest rate of death was observed in those aged >66 years (p<0.000). The impact of flame burns on mortality was statistically significant (p<0.05). The impact of inhalation burns, suicide, abuse, operational requirements and systemic disease on mortality was statistically significant (p<0.05). CONCLUSIONS: Older age, higher total body surface area, flame burns, presence of inhalation burn, third degree burn, suicide attempt, presence of systemic disease, duration of prolonged mechanical ventilation and operation requirements were found to be poor prognostic factors for survival in burn patients.

Evaluation of vitamin D receptor gene polymorphisms in patients with differentiated thyroid carcinomas and nodular goiter.

BACKGROUND: The role of vitamin D has previously been determined in autoimmune and malignant thyroid diseases. We aimed to identify the haplotype distribution of single nucleotide polymorphisms (SNPs) in the vitamin D receptor (VDR) gene, which has been suggested to play a role in the pathogenesis of differentiated thyroid cancers and benign thyroid diseases. METHODS: Two hundred and sixteen patients, 113 with benign and 103 with differentiated thyroid cancers, together with the same number of healthy controls, were included in the study. FokI, BsmI, ApaI, and TaqI SNPs in VDR were analyzed in all participants using the PCR-RFLP method. RESULTS: When the patients with differentiated thyroid cancers or the patients with nodular goiter and control cases were compared for BsmI, ApaI or TaqI polymorphisms, three genotype distributions (BB, Bb, bb; AA, Aa, aa; TT, Tt, tt) were found to not differ significantly. When the patients with differentiated thyroid cancers and control cases were compared for the FokI polymorphism in the VDR gene, the three genotype distributions (FF, Ff, ff) did not differ. However, in patients with nodular goiter, the FF genotype in the FokI polymorphism of the VDR gene was found to be statistically significantly higher (P=0.033). CONCLUSIONS: This is the first study in the literature evaluating the role of VDR gene SNPs in nodular goiter. We can suggest that SNP distribution in the VDR gene is not associated with malignancy but may cause some alterations in thyrocyte morphology and functions.

Comparison of the reliability and efficacy of LigaSure hemorrhoidectomy and a conventional Milligan-Morgan hemorrhoidectomy in the surgical treatment of grade 3 and 4 hemorrhoids.

OBJECTIVE: The aim of this study was to compare the clinical results of LigaSure-assisted hemorrhoidectomy and Milligan-Morgan hemorrhoidectomy as a conventional method in our clinic. MATERIALS AND METHODS: Patients who underwent LigaSure-assisted hemorrhoidectomy or conventional hemorrhoidectomy for grade 3 and 4 hemorrhoids in our clinic between 2009 and 2014 were included in this study. The patient data were reviewed by screening records. Gender, age, preoperative hemoglobin and hematocrit levels, operation time, presence of thrombosis, number of packages, hospitalization time, early and late postoperative complications, prolonged pain presence, and follow-up period were recorded. RESULTS: In this period, surgical interventions were performed on 365 patients diagnosed with hemorrhoids. Among these, 159 underwent LigaSure-assisted operations, while 206 were operated on by conventional methods. One hundred forty-four (39.5%) cases were female, while 221 (60.5%) cases were male. The median age of the patients was 40 (19-82) years in the LigaSure group and 41 (16-78) years in the conventional method group. The operation time was 15 (4-60) min in the LigaSure group and 20 (6-40) min in the conventional method group. Postoperative analgesics were given to the 182 (88.3%) cases in the conventional group and 107 (67.3%) cases in the LigaSure group. The time required for returning to normal daily activity was 6 (1-15) days in the LigaSure group and 7 (1-30) days in the conventional method group. CONCLUSION: In this study, LigaSure was determined to be superior to a conventional method in terms of operation time, hospitalization period, postoperative analgesic requirements, time required for returning to normal daily activity, and postoperative bleeding.

Factors affecting mortality among victims of electrical burns.

BACKGROUND: The aim of this study was to determine the factors affecting mortality rate among patients with an electrical burn. METHODS: A total of 115 patients admitted to the emergency department and hospitalized in the Burn Treatment Center or Intensive Care Unit (ICU) due to the electrical burn, were included in the study. RESULTS: A total of 115 patients (4 female and 111 male) with a mean age of 32.88±12.87 years were included in the study. The mean hospitalization period was 25.03±20.50 days, and the mean total body surface area burned (% TBSA) was 22.83±15.54%. Among those patients, 9 (8.5%) expired, and the remaining 106 were discharged after treatment. In a logistic regression analysis, TBSA >20% (p=0.02, OR: 11.7, CI: 1.38-99.16); ICU requirement (p=0.005, OR: 1.28, CI: 1.08-1.58); erythrocyte transfusion requirement (p=0.02, OR: 12.48, CI: 1.44-107.83); fresh frozen plasma (FFP) requirement (p=0.03, OR: 10.23, CI: 1.18-88.17); albumin requirement (p=0.02, OR: 12.60, CI: 1.44-109.85); admission serum albumin level <3.5 mg/dl (p=0.04, OR: 7.25, CI: 0.82-63.64); and admission hemoglobin level <12 mg/dl (p=0.01, OR: 8.29, CI: 1.57-43.61) were determined as risk factors for mortality in patients with electrical burns. CONCLUSION: In clinical practice, defining a mortality risk analyzer using these factors may be helpful in the management of patients with electrical burns. Additional, more comprehensive studies are required to define the risk factors for mortality and long-term morbidities in patients with electrical burns.

General characteristics of paint thinner burns: Single center experience.

BACKGROUND: The aim of the present study was to present characteristic features and risk factors of paint thinner burns in order to raise awareness and help prevent these injuries. METHODS: Records of patients admitted to the burn unit due to paint thinner burns were retrospectively reviewed, and patients with comprehensive data available were included in the study. Total of 48 patients (3 female and 45 male) with mean age of 27.79±11.49 years (range: 4-58 years) were included in the study. RESULTS: Mean total hospitalization period was 30.25±27.11 days (range: 3-110 days), and mean total burn surface area was 32.53±24.06% (range: 3.0-90.0%). In 31 cases (64.6%), intensive care unit admission was required. Among all 48 patients, 9 (18.8%) died in hospital and remaining 38 were discharged after treatment. Primary cause of death was septicemia (n=7) or respiratory failure (n=6). Inhalation injury was present in 12 of the patients, 6 of whom died (50%). Statistically significant differences were found between expired and discharged patients when compared for presence of inhalation injury (p=0.01) and septicemia (p=0.031). CONCLUSION: Ignition of paint thinner is an important cause of burn injuries that may result in very severe clinical picture. Patients require prompt and careful treatment. Clinicians should be aware that inhalation injury and sepsis are the 2 main factors affecting mortality rate in this group of patients. With increased awareness, preventive measures may be defined. Further studies are warranted to decrease mortality rate in this subgroup of burn patients.

The effect of enteral immunonutrition in upper gastrointestinalsurgery for cancer: a prospective study.

BACKGROUND/AIM: Enteral feeding and immunonutrition (ImN) have been shown to be associated with a number of favorable effects in patients undergoing cancer surgery. In this prospective study, we aimed to assess the perioperative use of enteral immunonutrition in patients undergoing radical gastrointestinal surgery for malignancy. MATERIALS AND METHODS: Forty-one patients with malignancy were included in this study and were randomized into one of the two following nutritional strategies: enteral only (EN) or enteral with enteral immunonutrition (ENIN). These regimens were followed for 7 days perioperatively by all patients. Nutritional parameters and postoperative morbidity, mortality, and length of hospital stay (LHS) were assessed. RESULTS: Serum prealbumin levels increased significantly in the ENIN group (P = 0.033). Moreover, patients in the ENIN group showed a more marked decrease in the rate of postoperative infections (P = 0.021) and anastomotic leakage (P = 0.018) than patients fed with EN. In the EN group, LHS was significantly longer than that in the ENIN group (18 vs. 12 days) (P = 0.032). Rates of overall morbidity and mortality were similar in the two groups (P > 0.05). CONCLUSION: ENIN was found to have a favorable effect on the outcome of radical gastrointestinal surgery for malignancy. Meticulous preoperative assessment of malnutrition and at least a 7-day perioperative enteral use can increase the effectiveness of immunonutrition.

IS SAME-DAY INGUINAL HERNIA SURGERY POSSIBLE?

1-INTRODUCTION: The Lichtenstein hernia repair is associated with low recurrence rates and short operation times, and can be performed under local anaesthesia. Thus, this is among the most-preferred methods used in recent years. Our objective was to explore the same-day discharge rates, and the causes of delayed discharge and re-admission to hospital, of patients treated using the Lichtenstein repair method, to evaluate the feasibility of performing same-day hernia surgery in clinical practice. 2. MATERIALS AND METHODS: . One hundredof a total of 236 patients diagnosed with unilateral inguinal or femoral hernias, who required surgical treatment, and who agreed with the conditions of the study, were prospectively included. All patients were treated using the Lichtenstein mesh repair method, under local anaesthesia between June 2006 and January 2008. We investigated the types and locations of hernias, duration of surgery, seniority of the surgeon, the feasibility of same-day surgery in subgroups stratified by ASA risk scores, and postoperative complication rates, in patients who underwent inguinal surgery under local anaesthesia 3. RESULTS , DISCUSSION AND CONCLUSIONS:. The rates of pain and post-operative complications were very low in hernia patients who underwent same-day surgery under local anaesthesia. The operation reduces the length of hospital stay and helps patients mobilise earlier. Both the literature, and our data, indicate that inguinal hernia repair under local anaesthesia is safe and effective, reducing anaesthesia-related complications and the length of hospital stay; is cost-effective; and is applicable in all patients.

Antiadhesive and anti-inflammatory effects of pirfenidone in postoperative intra-abdominal adhesion in an experimental rat model.

BACKGROUND: Pirfenidone (PF) is a potent antifibrotic and anti-inflammatory agent. We investigated the protective effect of PF against postoperative intra-abdominal adhesions. MATERIAL AND METHODS: Thirty male Sprague-Dawley rats were divided into three groups (n = 10 in each group). In group 1 (control), adhesion induction was performed by cecal abrasion, and no treatment was administered. In group 2 (vehicle), for 2 wk after adhesion induction, 0.4%-carboxymethylcellulose was administered by gavage. In group 3 (PF treatment), for 2 wk after adhesion induction, 500-mg/kg/d PF was administered by gavage. On the 15th postoperative day, the animals were killed, and cecal and peritoneal tissues were excised. The adhesions were graded macroscopically. The protein concentrations and mRNA expression levels of the following genes were measured in the tissues: matrix metallopeptidase-9 (MMP-9); tissue inhibitor of metalloproteinase-1 (TIMP-1); tumor necrosis factor-alpha (TNF-α); and transforming growth factor-beta 1 (TGF-ß1). The tissue samples were also evaluated histopathologically. RESULTS: Macroscopic and histopathologic evaluation showed that PF-reduced adhesion and inflammation (P < 0.001, P = 0.004, respectively). Pretreatment with PF-reduced TIMP-1, TNF-α, and TGF-ß1 protein concentrations (P < 0.001, P < 0.001, and P < 0.001, respectively) and mRNA expression levels (P = 0.030, P = 0.005, and P = 0.016, respectively) and increased MMP-9 protein concentrations (P < 0.001) and mRNA expression (P = 0.021). CONCLUSIONS: The findings of this study suggest that PF can be used as a protective agent to prevent the development of peritoneal adhesions and inflammation during the postoperative period.

Ambulatory laparoscopic cholecystectomy: A single center experience.

AIM: To evaluate the demographic and clinical parameters affecting the outcomes of ambulatory laparoscopic cholecystectomy (ALC) in terms of pain, nausea, anxiety level, and satisfaction of patients in a tertiary health center. MATERIALS AND METHODS: ALC was offered to 60 patients who met the inclusion criteria. Follow-up (questioning for postoperative pain or discomfort, nausea or vomiting, overall satisfaction) was done by telephone contact on the same day at 22:00 p.m. and the first day after surgery at 8: 00 a.m. and by clinical examination one week after operation. STAI I and II data were used for proceeding to the level of anxiety of patients before and/or after the operation. RESULTS: Sixty consecutive patients, with a mean age of 40.6 ± 8.1 years underwent ALC. Fifty-five (92%) patients could be sent to their homes on the same day but five patients could not be sent due to anxiety, pain, or social indications. Nausea was reported in four (6.7%) cases and not associated with any demographic or clinical features of patients. On the other hand, pain has been reported in 28 (46.7%) cases, and obesity and shorter duration of gallbladder disease were associated with the increased pain perception (P = 0.009 and 0.004, respectively). Preopereative anxiety level was significantly higher among patients who could not complete the ALC procedure (P = 0.018). CONCLUSION: Correct management of these possible adverse effects results in the increased satisfaction of patients and may encourage this more cost-effective and safe method of laparoscopic cholecystectomy.

The Relationship between Adiponectin and Breast Cancer.

OBJECTIVE: Breast cancer is the most common type of cancer in women worldwide. It is indicated that increased body mass index elevates the risk of developing breast cancer, worsens prognosis, and decreases survival. Several polymorphisms of adiponectin have been shown to affect serum levels of adiponectin and their association with breast cancer. The aim of this study was to investigate the relationship between the adiponectin 45T/G and 276 G/T gene polymorphism and breast cancer in the East Marmara region. MATERIALS AND METHODS: A case-control study was performed in 97 patients with breast cancer and 101 controls in East Marmara in order to evaluate the prevalence of adiponectin gene polymorphism at positions 45 and 276. Patients with familial breast cancer and those who had received chemotherapy or radiotherapy were excluded from the study. Adiponectin gene polymorphisms were investigated using polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP). RESULTS: Adiponectin 45T/G gene genotype frequencies of TT, TG, and GG were 61.9%, 37.1%, and 1% in patients with breast cancer, and 67.3%, 30.7%, and 2% in the control group, respectively. Adiponectin 276G/T gene genotype frequencies of GG, GT, and TT were 45.4%, 45.4%, and 9.3% in patients with breast cancer and 55.4%, 39.6%, and 5.0% in the control group, respectively. CONCLUSION: Our study showed that adiponectin 45T/G and 276 G/T gene polymorphism is not associated with breast cancer risk in patients from the East Marmara region.

Mean Platelet Volume as a Biomarker for Thyroid Carcinoma.

AbstractObjective: This study aimed to determine the relationship between MPV and thyroid malignancy by comparing patients who underwent surgery for benign or malignant thyroid diseases. BACKGROUND: Mean platelet volume (MPV) is a useful early indicator of platelet activation. Platelets differ in terms of functional activity and size. Large platelets are relatively new, more reactive and produce more thrombogenic factors. Therefore, in conditions that involve increased platelet activation, an increase in the proportion of young platelets and MPV is expected. PATIENTS AND METHODS: This study involved 146 patients who underwent total thyroidectomy because of benign (99 patients) or malignant (47 patients) diseases of the thyroid. Data on age, sex, MPV, white blood cell (WBC) count, hemoglobin level and platelet count were collected retrospectively. RESULTS: MPV was significantly higher in patients with malignant thyroid diseases than in those with benign thyroid diseases. Age, sex, hemoglobin level, WBC count and platelet count did not significantly differ between the two groups. CONCLUSION: MPV was significantly higher in patients with thyroid malignancies than in patients with benign thyroid diseases. We propose that MPV might be an important predictive factor for thyroid malignancies. Further prospective studies with a larger number of patients in high-volume endocrine surgery centers are required to confirm our findings.