Bulent Dinc

New parameter in diagnosis of acute appendicitis: platelet distribution width.

AIM To investigate the diagnostic accuracy of the mean platelet volume and platelet distribution width in acute appendicitis. METHODS This retrospective, case-controlled study compared 295 patients with acute appendicitis (Group I, 100 patients with other intra-abdominal infections (Group II), and 100 healthy individuals (Group III) between January 2012 and January 2013. The age, gender, and white blood cell count, neutrophil percentage, mean platelet volume, and platelet distribution width values from blood samples were compared among the groups. Statistical analyses were performed using SPSS for Windows 21.0 software. In addition, the sensitivity, specificity, positive and negative predictive values and likelihood ratios, and diagnostic accuracy were calculated. RESULTS The mean ages of patients were 29.9 ± 12.0 years for Group I, 31.5 ± 14.0 years for Group II, and 30.4 ± 13.0 years for Group III. Demographic features such as age and gender were not significantly different among the groups. White blood cell count, neutrophil percentage and platelet distribution width were significantly higher in Group I compared to groups II and III (P < 0.05). Diagnostically, the sensitivity, specificity and diagnostic accuracy were 73.1%, 94.0%, and 78% for white blood cell count, 70.0%, 96.0%, and 76.0% for neutrophil percentage, 29.5%, 49.0%, and 34.0% for mean platelet volume, and 97.1%, 93.0%, and 96.0% for platelet distribution width, respectively. The highest diagnostic accuracy detected was for platelet distribution width between Group I and Group III (P < 0.01). CONCLUSION Platelet distribution width analysis can be used for diagnosis of acute appendicitis without requiring additional tests, thus reducing the cost and loss of time.

Alvarado skoru akut apandisitte ne kadar güvenilir

BACKGROUND We aimed to investigate the reliability of the Alvarado score (AS) in determining acute appendicitis and the different parameters that affect the AS. METHODS Three hundred and thirteen patients suspected of acute appendicitis (AA) aged 18-70 years were included in this study. Patient data including AS calculated from emergency services and at discharge, follow-up, and operations were recorded. Patients were divided into three groups according to the AS, as AS <4, AS 5-7 and AS 8-10. AA and appendicitis perforation rates were compared according to the different parameters. RESULTS The mean age of patients (55% females, 45% males) was 30.8±10.8 years. The AA (appendix perforation) rates of 211 patients who underwent operation were found as: AS ≤4: 56.5% (7.7%), AS 5-7: 75.9% (10%), and AS 8-10: 89% (27.8%). The percentage of negative appendectomy was 19.4%. The scoring was more reliable in males with AS 5-7, and the reliability weakened as body mass index (BMI) increased in all groups. CONCLUSION Patients with AS ≤4 must be followed up and should be informed at the time of their discharge about the slight possibility of appendicitis. The effect of AS in determining the diagnosis of appendicitis is not influenced by age or symptom duration.

Comparison of outcomes of laparoscopic intracorporeal knotting technique in patients with complicated and noncomplicated acute appendicitis.

Background and aim In our study we aimed to compare laparoscopic intracorporeal knotting technique (base of the appendix was ligated with 20 cm of 2.0 silk) in patients with complicated acute appendicitis (CAA) and noncomplicated acute appendicitis. Patients and methods Ninety patients (female/male: 40/50, age ranging from 16 to 60 years, median age and interquartile range [IQR]: 25 [20; 32] years) who underwent laparoscopic appendectomy were included in the study. The patients were evaluated for the type of acute appendicitis, duration of operation, duration of hospital stay, and postoperative complications. Results The number of cases diagnosed as CAA was 28 (31.1%), and the number of noncomplicated cases was 62 (68.9%). We found that there was no significant difference in postoperative complication rates between complicated and noncomplicated appendicitis cases. Incision site infection was seen in seven cases (7.8%) and ileus was seen in two cases (2.2%). Bleeding, intra-abdominal abscess, and appendix stump leakage were not observed in any of the cases. Median and IQR duration of operation were 42 (35; 52) minutes and median and IQR duration of hospital stay were detected as 2 (1; 2) (range 1–10) days. Conclusion Laparoscopic intracorporeal knotting technique may be a safe, effective, and reliable technique as the materials needed for closing the appendix stumps are easily available for both CAA cases and noncomplicated cases.

Concurrent unilateral or bilateral native nephrectomy in kidney transplant recipients

BACKGROUND The aim of this study is to present results of patients who have undergone renal transplantation concurrent with bilateral or unilateral native nephrectomy, with a special focus on polycystic kidney disease (PKD). MATERIAL AND METHODS We presented the outcome of renal transplantation patients who have undergone native nephrectomy unilaterally (n=38) and bilaterally (n=125) and compared the results of patients with PKD and other nephrectomy indications. RESULTS Overall graft survival in the 1st, 3rd, and 5th years were 93%, 90%, and 89%, respectively, in transplantation with concomitant nephrectomy patients. Overall patient survival in the 1st, 3rd, and 5th years were 97%, 94%, and 94%, respectively. Overall surgical complications rate was 17.7% and medical complication rate was 19%. Patients with PKD had more frequent complications. CONCLUSIONS Despite additional surgery, the long-term results of patients with complications were not affected negatively by early diagnosis and treatment. We believe that native nephrectomy concurrent with transplantation can be successfully performed when indicated in selected patients at experienced centers.

Chyluria and Delayed Graft Function in Early Posttransplant Period in a Renal Transplant Patient

Chyluria mostly occurs because of the leakage of lymphatic fluid into the urinary system from the lymphatic system. The patient reported here with end-stage renal disease caused by the nephrotic syndrome underwent renal transplantation from a living donor. During the early posttransplant period, her daily urine output was 300 to 400 mL, and it was chylous. The only abnormality on physical examination was pretibial edema. On renal biopsy, there was no sign of glomerular disease, acute tubular necrosis, or rejection that could have caused delayed graft function. All factors except surgery were excluded, and a lymphourinary fistula was demonstrated with lymphoscintigraphy. After 15 days, chyluria resolved and she recovered spontaneously. Normal diuresis began, and her creatinine level decreased to less than 1 mg/dL in 3 days. According to our knowledge, this is the first chyluria case secondary to surgery in the posttransplant setting.

Comparing methods of ileostomy closure constructed in colorectal surgery in Turkey

Introduction Stoma construction is a life saver method for emergent and elective operations in colorectal surgery. However, they are associated with high rates of morbidity and mortality. Aim To compare the operative findings, early postoperative complications, and costs of stapled and hand-sewn closures in loop ileostomies that are constructed in emergent and elective colorectal surgery. Material and methods The data of 68 patients requiring loop ileostomies during colorectal surgery were retrospectively evaluated. SPSS (version 20) was used for data analysis. Results The study group consisted of 44 men and 24 women with a mean age of 55.5 years. The ileostomy closures were performed with hand-sewn method in 36 patients (group 1) and stapled method in 32 patients (group 2). The mean operation time was 75.4 min in group 1 and 46.7 min in group 2 (p < 0.001). Early postoperative complications were wound infection (8.8%), small bowel obstruction (6.06%), and anastomotic leakage (2.9%). Total costs, flatulence and faeces outlet time, oral feeding starting time, time of hospital stay, and early postoperative complications were lower in the stapled group. Conclusions Morbidity and mortality rates of stoma construction and its closure are still considerable. Lower anastomotic leakage rate, complication rate, and costs and shorter operative times in the stapled group make this method preferable.

A Giant Simple Liver Cyst That Caused Increases in Serum CA 19-9 and CA 15-3 Levels.

Simple cysts (SCs) of the liver are not associated with the biliary malformations in intrahepatic bile duct biliary. Seen in 0.1% to 7% of adult population, biliary malformations are more common in women. The levels of glycoprotein-like tumor markers (carbohydrate antigen (CA) 19-9) in the cysts and serum could be high. Although studies regarding CA 19-9 exist, sufficient data on cancer antigen (CA) 15-3 are not available. This case is about a 76-year-old woman who complained of painless intra-abdominal mass. The patient with a giant simple cyst extending from the gallbladder to the pelvis had preoparative CA 19-9 and CA 15-3 serum levels of 87.3 IU/L and 37 IU/L respectively. It was observed that CA 19-9 levels had decreased to 36 IU/L and CA 15-3 to 28.1 IU/L in blood samples taken in the third month after the surgery. There is a need for comprehensive studies to investigate the relationship between the size of the cyst and biomarkers (including markers such as CA 15-3) in the assesment of liver SC.

Comparison of Open and Retroperitonoscopic Donor Nephrectomy in Terms of Lipid and Protein Peroxidation Responses

BACKGROUND This study was designed to compare donors who underwent open (ODN) versus retroperitonoscopic nephrectomy (RDN) in terms of intra-operative oxidative stress and recipients graft function in the early postoperative period. METHODS Among 40 patients who underwent donor nephrectomy, 23 were operated via an open method and 17 via retroperitonoscopic method. To analyze oxidative stress, we measured plasma levels of malondialdehyde (MDA), protein carbonyl, and protein sulfhydryl moieties in donor venous blood before induction of anesthesia and postoperatively at 0, 6, and 24 hours. The influence of oxidative stress on graft function was evaluated by means of the postoperative 5th day recipient creatinine and estimated glomerular filtration rate (eGFR) Modification of Diet in Renal Disease Formula (MDRD) to evaluate delayed graft function (DGF) status. RESULTS ODN patients showed significantly higher 24-hour mean levels of MDA, (6,139 ± 1,854 vs 4,813 ± 1,771 nmol/L; P = .01), protein carbonyl (366 ± 64 vs 311 ± 62 μmol/L; P = .01) and protein sulfhydryl (468 ± 110 vs 386 ± 75 μmol/L; P = .01) moieties compared with those RDN patients. However, ODN and RDN recipients were similar in terms of 5th day mean creatinine and eGFR (1.1 ± 0.3 vs 1.4 ± 0.8 mg/dL and 69.15 ± 12.24 vs 56.31 ± 25.2, respectively) and DGF status (4.4% [1/23] vs 5.9% [1/17], respectively). CONCLUSIONS Although ODN donors were more prone to intra-operative oxidative stress than RDN donors, based on significantly higher levels of oxidative stress markers, this difference seems to not significantly influence recipients early graft function.

Hepatic artery reconstruction with gonodal vein interposition: First case in patients receiving liver from the living donor

Summary Background: Technical problems such as graft and vascular size are more common in living donor liver transplantation (LDLT) than in deceased donor liver transplantation. It is usually possible to get enough length of vessels on the graft, but the opposite situation is devastating. Finding the suitable vessel graft is life-saving in those situations. In this paper we present a case of gonodal vein interpositioning for hepatic artery reconstruction in an LDLT recipient. To the best of our knowledge, this is the first such case to be reported in the literature. Case Report: A 36-year-old man with cirrhosis secondary to hepatitis B underwent LDLT. Within minutes after completing the anastomosis, the artery was thrombosed. Disrupting the anastomosis showed subintimal dissection of the recipient right hepatic artery extending to the gastro-duodenal junction. A 4 cm segment of gonodal vein, which matched the diameter of the recipient hepatic artery, was used as a bridge. The patient’s postoperative recovery was excellent and Doppler ultrasonography demonstrated sufficient hepatic arterial blood flow. At long-term follow-up (18th months), the patient’s graft is still functioning. Conclusions: Gonodal vein interposition for hepatic artery reconstruction in living donor liver transplantation has not been previously reported. In light of the urgency of this situation, we believe it can be a life-saving reconstruction.