Doğan Albayrak

The Amount of Comorbidities as a Single Parameter Has No Effect in Predicting the Outcome in Appendicitis Patients Older than 60 Years

Background: Retrospective analysis of acute appendicitis patients older than 60 and statistical evaluation of the association between the accompanying illnesses, severity of peritonitis, morbidity, and mortality rates. Introduction: Although acute appendicitis is not frequent among aged populations, accompanying comorbidities of the geriatric patients are always fear factors before an emergency abdominal surgery even for acute appendicitis. Methods: The data of the 27 patients older than 60 years who underwent appendectomy were retrospectively analyzed. The patients were grouped according to the total number of their comorbidities, Mannheim peritonitis index scores, and the period between the onset of abdominal pain and the admission to the hospital. Results: The mean age of the patients was 73 years. The morbidity and mortality rates were statistically significantly higher in perforated cases. The comparison of patients with ≤1 comorbidity with patients with ≥2 comorbidities did not show any statistical difference in morbidity and mortality. The sensitivity, specificity, positive predictive value, and negative predictive values for mortality in geriatric acute appendicitis patients with Mannheim peritonitis index scores greater than 26 were found to be 75%, 86%, 50%, and 95%, respectively. Discussion: Retrospective evaluation of geriatric patients with acute appendicitis, according to the total number of their comorbidities, surprisingly revealed no statistical difference between groups. We thought that a high Mannheim peritonitis index score is a more reliable criteria than the total number of comorbidities in predicting the prognosis of patients with acute appendicitis in the geriatric population.

Primary hydatid disease of pancreas mimicking cystic neoplasm.

Primary hydatid disease of the pancreas is very rare. We report a 33-year-old female who was admitted to the hospital with abdominal discomfort due to the pancreatic mass. A diagnosis of a pancreatic cystic mass was established through abdominal ultrasonography and computed tomography scan. Hydatid disease as well as a cystic neoplasm of the pancreas were both thought in the differential diagnosis. Distal pancreatectomy with splenectomy was performed. The histopathologic evaluation of the specimen revealed a hydatid cyst affecting the tail of the pancreas. Hydatid disease should be considered in the differential diagnosis of all cystic masses of the pancreas, especially in endemic regions.

Combined effects of tauroursodeoxycholic Acid and glutamine on bacterial translocation in obstructive jaundiced rats

BACKGROUND Bacterial Translocation is believed to be an important factor on mortality and morbidity in Obstructive Jaundiced. AIMS We investigated the probable or estimated positive effects of tauroursodeoxycholic acid, which has antibacterial and regulatory effects on intestinal flora, together with glutamine on BT in an experimental obstructive jaundiced rat model. STUDY DESIGN Animal experimentation. METHODS Forty adult, male, Sprague Dawley rats were used in this study. Animals were randomised and divided into five groups of eight each: sham (Sh); control (common bile duct ligation, CBDL); and supplementation groups administered tauroursodeoxycholic acid (CBDL+T), glutamine (CBDL+G), or tauroursodeoxycholic acid plus glutamine (CBDL+TG). Blood and liver, spleen, MLN, and ileal samples were taken via laparotomy under sterile conditions for investigation of bacterial translocation and intestinal mucosal integrity and hepatic function tests on the tenth postoperative day. RESULTS There were statistically significant differences in BT rates in all samples except the spleen of the CBDL+TG group compared with the CBDL group (p=0.041, p=0.026, and p=0.041, respectively). CONCLUSION It is essential to protect hepatic functions besides maintaining intestinal mucosal integrity in the active struggle against BT occurring in obstructive jaundice. The positive effect on intestinal mucosal integrity can be increased if glutamine is used with tauroursodeoxycholic acid, which also has hepatoprotective and immunomodulatory features.

Bilateral brucellar breast abscess in a 48-year-old woman.

To the Editor: Brucellosis is a zoonotic infection transmitted from animals to humans by ingestion of infected food products, direct cont tact with an infected animal, or int halation of aerosols.1 The disease remains endemic in many countries, mainly in the Mediterranean basin, the Middle East, India, Mexico, Central and South America and, currently, central and southwest Asia. Soft tissue involvement is an uncommon occurrence of the dist ease. Breast involvement in animals is common, whereas in humans it is an extremely rare manifestation.2t5 We report a case of bilateral brucelt lar breast abscess, which was succest fully treated through abscess draint age and antibiotic therapy. A 48tyeartold woman was adt mitted to our department with pain, swelling, erythema, and an odorless nipple discharge in both breasts for 10 days. She was involved in stockt breeding on a farm and was suspectt ed of having a history of consumpt tion of unpasteurized cheese. She had also been suffering from night sweats for the previous 2 years. Physical examination revealed a 5×3 cm, indurated, erythematous, and painful mass in the upper left quadrant of the breast on the left side and 3×3 cm periareolar paint ful mass in the right breast. Bilateral abscess formation with cystic and solid components were detected through ultrasonographic examinat tion of both breasts. Needle punct ture of the lesions revealed an obt vious purulent material. Bilateral surgical drainage was performed. Oral antibiotic therapy with cefut roxime axetil was began immedit ately due to a suspected pyogenic abscess. Despite daily wound dresst ing changes of the abscess cavities and scheduled antibiotic therapy, the patient did not improve. Approximately 2 weeks after primary abscess drainage, bactet rial culture of the purulent material revealed Brucella species. Following the positive culture for Brucella, the Wright and RosetBengal tests were also found to be positive, which confirmed the diagnosis of human brucellosis and bilateral brucellar breast abscess. After replacing the ongoing antibiotic therapy with combined regimen of oral doxycyt cline (200 mg/day) and rifampin (600 mg/day), dramatic regression of both of the abscesses and rapid improvement in clinical symptoms were observed, which also cont firmed the diagnosis of human brut cellosis. The 6 month followtup was uneventful. Brucellar infection of the human breast is extremely rare. Clinical symptoms of brucellosis are nont spesifics and include fever, malt aise, sweats, arthralgias, lower back pain, and headache. Based on the series of Andriopoulos et al, the prevalence of human brucellosis as a breast abscess is only 0.7%.6 Our case presented with bilateral breast abscesses first though to be pyogenic. Unfortunately, bilateral surgical abscess drainage followed by broadtspectrum oral antibiotic therapy did not heal the abscesses. The delay in the definitive diagnosis of the causative agent of the breast abscess was the most likely reason for failure of treatment. The clinit cal management of brucellosis is of particular concern because of high initial treatment failure and relapse rates.7 Two weeks after initial treatt ment we were able to replace our initial treatment regimen with apt propriate combined antibiotic thert apy based on the definitive isolation and positive culture for Brucella spet cies as the causative agent in our pat tient. Although the breast abscess is a very rare complication of systemic brucellosis, the physician should be aware of this unusual manifestat tion of human brucellosis. We cont cluded that repeated cultures from purulent material in an unhealing breast abscess, despite the broadt spectrum antibiotic therapy and surgical drainage, may eventually show underlying systemic brucelt losis, especially in endemic areas of the world.

Value of Preoperative Indocyanine Green Clearance Test for Predicting Post-Hepatectomy Liver Failure in Noncirrhotic Patients

Background Liver failure is the most feared complication following hepatectomy. Post-hepatectomy liver failure (PHLF) is closely related to the remnant liver volume, and functional reserve. There are several methods for predicting PHLF prior to liver resection. The indocyanine green (ICG) clearance test was popularized in patients with hepatocellular cancer (HCC). We aim to demonstrate the value of preoperative ICG clearance measurement via pulse spectrophotometer (LIMON®) in prediction of PHLF in noncirrhotic patients prior to liver resection. Material/Methods Fifty-three noncirrhotic patients who underwent liver resection due to different pathologies were included. Retrospectively collected clinical data, including the preoperative ICG clearance measurements and remnant liver volumes of the patients, were statistically evaluated according to the PHLF criteria of the International Study Group of Liver Surgery. Results Four (7.5%) patients with PHLF were observed. There was no significant difference between PHLF and non-PHLF groups regarding ICG clearance measurements with cut-off values of 5% and 9.5%. Conclusions The ICG clearance test does not satisfy our expectations in noncirrhotic patients in predicting PHLF. We believe that the ICG clearance test should be reserved for patients with cirrhosis and/or HCC. This test could be an option for noncirrhotic patients with chronic active hepatitis, advanced-grade fatty livers, or for patients who received long-term preoperative chemotherapy, and also for patients who underwent single or multiple sessions of TACE or TARE prior to liver resection. If the routine selection criteria have been fulfilled, there is no further need to perform the ICG clearance test for living liver donors.

Abdominal Tuberculosis Mimicking Peritoneal Carcinomatosis

Abdominal tuberkuloz nadir bir durumdur ve bulgulari cogu zaman nonspesifiktir. Bircok degisik patolojik durumu taklit edebilir. Abdominal tuberkuloz tum gastrointestinal sistemi, mezenteri ve peritonu tutmasinin yani sira, solid organlar olan dalak, karaciger ve pankreasida tutabilmektedir. Karin icinde kitle nedeniyle ameliyat edilen ve ameliyat sirasinda makroskopik olarak peritonitis karsinomatoza tanisi dusunulen 42 yasindaki kadin hastaya iliskin olgu literatur bilgileri esliginde sunuldu.