Erdal Karagulle

Retained surgical sponge (gossypiboma) after intraabdominal or retroperitoneal surgery: 14 cases treated at a single center

Background and aimsThe objective of this study was to present the etiology, clinical presentation, diagnosis, and management for 14 cases of gossypiboma [retained surgical sponge (RSS)] treated at a single center and to emphasize the importance of this potential complication.MethodsData for 14 cases of RSS treated between January 1999 and December 2004 were retrospectively assessed. The details of preoperative evaluation, demographic features, and operative findings were recorded. Use of, and findings from, abdominal x-ray, ultrasonography, computed tomography, magnetic resonance imaging, and upper-gastrointestinal endoscopy were also noted.ResultsIn all cases, the RSS was surgically removed. Thirteen of the 14 patients were symptomatic, and the most frequent finding was nonspecific abdominal pain and intestinal obstruction. Four patients required urgent surgery because the sponges were causing intestinal obstruction or intraabdominal sepsis. Based on history, physical examination findings, and diagnostic imaging, RSS was diagnosed preoperatively in five of the patients. Postoperative complications, including surgical site infection and evisceration, occurred in five cases.ConclusionRSS can lead to significant medical and legal problems between the patient and the doctor. RSS may be incorrectly diagnosed preoperatively, which can lead to unnecessary invasive diagnostic procedures and operations. Strict measures must be taken to prevent this complication.

Use of telemedicine and telephone consultation in decision-making and follow-up of burn patients: Initial experience from two burn units

OBJECTIVE This study investigated the use of telemedicine in decision-making and follow-up of burn patients. METHODS The Konya Burn Unit was established in July 2003, and up to December 2009, 187 patients were admitted to this unit, all of them were consulted-via audiovisual transmission of data (telemedicine)-to the same burn surgeon at the Ankara Burn Referral Center of our hospital network. Three basic systems are currently used: live interactive video, store-and-forward images, and telephone. The demographic data and burn criteria of the patients were investigated. Changes in the number of televisits and patient management were analyzed. RESULTS During the 66-month timeframe, 525 televisits were performed on 187 patients. There were 126 males (67.4%) and 61 females (32.6%). The mean total burn surface area (percentage of total burn surface area burned) was 23.3 ± 17.8% (range, 3-95%). Nine of the 187 patients (4.8%) died owing to multiorgan failure and sepsis. As a result of these televisits, 21 patients (11.2%) were transferred to our referral center. The number of dead and transferred patients decreased during the study. CONCLUSIONS Telemedicine is appropriate and cost-effective for treatment and follow-up of patients in burn units with personnel with limited experience.

The Role of Mean Platelet Volume in the Diagnosis of Acute Appendicitis: A Retrospective Case-Controlled Study

Background: The level of platelet volume (MPV) has been reported to be a laboratory marker in inflammatory cases. Objectives: The aim of this study was to seek whether MPV has a role in the diagnosis of acute appendicitis. It was also aimed to show the relationship of MPV with leukocyte count and C-reactive protein (CRP) level. Materials and Methods: This study was conducted via retrospective assessment of the hospital records of the adult patients who were operated for acute appendicitis between January 2010 and December 2012 and had a pathology report that confirmed the diagnosis of acute appendicitis. The patients in the control group were selected from healthy adults of similar age who applied to check-up clinic. The number of essential cases was defined by performing power analysis. Age, gender, leukocyte count, CRP, and MPV values were recorded. This study is a case controlled retrospective clinical study. Results: A total of 503 patients in the acute appendicitis group and 121 patients in the control group were included, making up a total of 624 subjects. The median MPV levels were 7.92 ± 1.68 fL in the acute appendicitis group, while 7.43 ± 1.34 fL in the control group. CRP, leukocyte count, and MPV level were significantly higher in the acute appendicitis group (P < 0.001). MPV, leukocyte count, and CRP had a sensitivity and specificity of 66% and 51%; 91% and 74%; and 97% and 41%, respectively. No correlation was found between MPV, CRP, and leukocyte count. Conclusions: MPV level was higher in patients with acute appendicitis. MPV may guide the diagnostic process of acute appendicitis. However, we detected that the sensitivity and specificity of leukocyte count and CRP were superior to those of MPV in the diagnosis of acute appendicitis.

The role of red cell distribution width in the diagnosis of acute appendicitis: a retrospective case-controlled study

PurposeThe aim of this study was to seek whether red cell distribution width (RDW) has a role in the diagnosis of acute appendicitis. It was also aimed to show the relationship of RDW with leukocyte count and C-reactive protein (CRP) level.MethodsThis study was conducted via retrospective assessment of the hospital records of the adult patients who were operated for acute appendicitis between January 2010 and February 2013 and had a pathology report that confirmed the diagnosis of acute appendicitis. The patients in the control group were selected from healthy adults of similar age who applied to check-up clinic. Age, gender, leukocyte count, CRP, and RDW values were recorded. This study is a case controlled retrospective clinical study.ResultsA total of 590 patients in the acute appendicitis group and 121 patients in the control group were included, making up a total of 711 subjects. The mean RDW levels were 15.4 ± 1.5% in the acute appendicitis group, while 15.9 ± 1.4% in the control group. CRP, leukocyte count were significantly higher in the acute appendicitis group, and RDW level were significantly lower in the acute appendicitis group (p < 0.001, p < 0.001, p = 0.001, respectively). RDW, leukocyte count, and CRP had a sensitivity and specificity of 47% and 67%; 91% and 74%; and 97% and 41%, respectively in acute appendicitis. RDW was not correlated with CRP and leukocyte levels. However, we found a correlation between CRP and leukocyte levels.ConclusionRDW level was lower in patients with acute appendicitis. The magnitude of difference in RDW seen between acute appendicitis and controls was so slight as to be of no utility in diagnostic testing.

UNUSUAL FINDINGS IN APPENDECTOMY SPECIMENS OF ADULTS: RETROSPECTIVE ANALYSES OF 1466 PATIENTS AND A REVIEW OF LITERATURE

Background: Diseases and tumors of the appendix vermiformis are very rare, except acute appendicitis. Objectives: This retrospective study was conducted to document the unusual findings in appendectomy specimens. Patients and Methods: Data of 1466 adult patients were gathered retrospectively. Appendectomy was performed in 1169 and in 297 patients following a diagnosis of acute appendicitis and during other abdominal operations, respectively. The data of 57 (3.88 %) patients who were pathologically reported to have unusual appendix findings were retrospectively collected. The records were analyzed according to patients’ age, gender, clinical presentations, operative reports, pathological reports and follow up. Results: Unusual pathologic examination findings were detected in the appendectomy specimens of 57 patients with a mean age of 48.34 ± 19. Twenty-nine patients (50.8 %) were male and 28 (49.2 %) were female. Normal appendix tissues were observed in specimens of 26 (45.6 %) patients and inflamed appendix in 31 (54.3 %). The most common unusual finding was parasitic diseases of the intestine. Pathological diagnosis of malignancy and benign features were reported in specimens of 14 and 43 patients, respectively. Macroscopic evaluation of appendectomy specimens during surgery might result in negligence of the presence of unusual pathology. Conclusions: Even if the macroscopic appearance of the specimen is normal or acute appendicitis, we suggest routine histopathological examination.

Effect of cefazolin prophylaxis on postoperative infectious complications in elective laparoscopic cholecystectomy: a prospective randomized study.

Background In patients with symptomatic cholelithiasis, laparoscopic cholecystectomy (LC) is the standard method of treatment. Laparoscopic cholecystectomy has a low rate of postoperative infections probably owing to smaller wounds and minimal tissue damage compared with the open procedure. Objectives This study assessed the effect of cefazolin prophylaxis on postoperative infection in patients undergoing elective laparoscopic cholecystectomy. Additionally, we determined the risk factors of cases with postoperative infection. Patients and Methods A total of 753 patients were enrolled in the study. Among these, 206 were excluded from the study. As a result, 547 patients with symptomatic cholelithiasis who underwent elective laparoscopic cholecystectomy were selected for this prospective study. Patients were randomized consecutively and divided into 2 groups: patients in the cefazolin (CEF) group (n = 278) received 1 g of cefazolin and those in the control group (n = 269) received 10 mL of isotonic sodium chloride solution. Patient characteristics and overall surgical outcomes were compared between the groups. All patients were followed for development of postoperative infections. Results Postoperative infections occurred in 4 patients in the CEF group and in 2 patients in the control group; no significant difference existed in this regard(P = .44). Risk of infection increased in patients with previous cholecystitis and/or endoscopic retrograde cholangiopancreatography (P < 0.001), patients with ruptured gallbladders, and patients for whom a suction drain was used (respectively, P < 0.001 and P < 0.001). Conclusions No correlation existed between cefazolin prophylaxis and postoperative infections in elective laparoscopic cholecystectomy patients. There may be an increased risk of infection in patients with previous cholecystitis or endoscopic retrograde cholangiopancreatography. In addition, there was an increased risk of postoperative infection in patients with gallbladder rupture and suction drain use.

Successful skin homografting from an identical twin in a severely burned patient.

Flame burns are a serious condition and usually have high morbidity and mortality because they affect large areas of the body surface as well as the lungs. In these patients, it is especially difficult to find healthy skin for grafting if they have more than 70% third-degree burns. Repeated autografting or synthetic wound care materials are the only treatment options to cover burned areas. Partial-thickness skin grafting from the patients identical twin sibling may be an alternative treatment option, if possible. Here, we report a patient with severe flame injury treated with skin from his identical twin. The patient had third-degree burns covering 70% of his body surface. Initial treatment consisted of fluid and electrolyte replacement, daily wound care, and surgical debridements, as well as nutritional support. After initial treatment, we performed a successful skin grafting from his identical twin. Skin grafting between identical twins might be an alternate method for severely burned patients.

Parasitic Infections of the Appendix as a Cause of Appendectomy in Adult Patients

OBJECTIVE Assessment of frequency and clinical findings of parasitic infections for etiology of acute appendicitis. METHODS Data of 1452 patients who were carried out appendectomy between January 1999 and December 2012 were analyzed retrospectively. Appendectomy was performed in 1159 of the patients with a pre diagnosis of acute appendicitis. Demographics, physical findings, radiologic and laboratory studies, operative findings, pathological results, presence and type of parasitosis were investigated. RESULTS Among the 1159 patients done appendectomy with a pre diagnosis of acute appendicitis, 719 (62%) were males and 440 (38%) were females. Parasitic infection was demonstrated in 17 (1.4%) of them. Mean average age of these patients was 36.6 ± 20.1 years. Enterobius vermicularis was present in 15 (88.2%) and Entamoeba histolytica in 2 (11.8%) of the patients. Of the pathology specimens of appendix consisting Enterobius vermicularis, 12 (80%) were normal appendix tissues, 1 (6.6%) was acute uncomplicated appendicitis and 2 (13.3%) were perforated appendicitis. One (50%) of the two specimens consisting Entamoeba histolytica was normal appendix and the other (50%) was acute appendicitis. CONCLUSION Differential diagnosis of parasitic infections in etiology of acute appendicitis should be made properly. It must be remembered that this attention can save patients from a negative laparotomy and morbidity and mortality of it.

Results of modified Dufourmentel rhomboid flap in patients with extensive Sacrococcygeal pilonidal disease.

Abstract Purpose: The aim of our study was to assess our modified Dufourmentel flap outcomes in a standardized patient group (a symptom duration of equal to or greater than 60 months, presence of equal to or more than 3 sinus ostia or presence of sinus ostia fistulized equal to or greater than 2 cm laterally, and a normal body mass index) with extensive pilonidal sinus. Methods: Patients who were diagnosed with chronic pilonidal sinus disease and gave consent to surgical repair with modified Dufourmentel flap were enrolled. Patients were assessed with respect to age, sex, body mass index, presenting symptom, symptom duration, number of previous operations, number of sinus ostia, length of flap rims, depth of inter-gluteal sulcus, distance of sinus from anus, duration of operation, time of drain removal, length of hospital stay, early postoperative complications, postoperative pain, loss of labor, length of follow-up, and recurrences. Results: A total of 42 patients were enrolled. Average duration of presenting symptoms was 64.4 ± 4.7 months and average length of follow-up was 29.4 ± 3.6 months. Average length of hospital stay was 4.2 ± 0.8 days, and time to return to work was 16.3 ± 2.1 days. Two patients (4.7%) developed postoperative wound infection, one patient (2.4%) developed seroma, and three patients (7.1%) had wound dehiscence. There was no recurrence. Conclusion: Modified Dufourmentel flap application can be safely used in the treatment of extensive pilonidal sinus disease.

Prothrombin 20210 G/A defect as a cause of mesenteric venous infarction: report of a case.

A 50-year-old man with abdominal pain, nausea, and vomiting presented at our emergency department. Physical examination revealed diffuse abdominal tenderness and absent bowel sounds. Computed tomography showed partial portal vein thrombosis extending to the right portal vein and the superior mesenteric vein, perfusion defects in the liver, and nonopacified intestinal segment after contrast injection. An emergency laparotomy was performed. The wall of the distal jejunum was edematous, congested, and a 10-cm jejunal segment was necrotic. A partial intestinal resection and a primary anastomosis were performed. Screening for thrombophilia revealed a heterozygote 20210 G/A mutation of the prothrombin gene. Anticoagulation was initiated. Computed tomography 45 days after surgery showed a complete dissolution of the thrombi and cavernous transformation in the main portal vein. His subsequent clinical course was uneventful. Mesenteric venous thrombosis which causes an intestinal infarction is rare, and also difficult to diagnose. However, a prothrombin 20210 defect should be considered in the differential diagnosis of patients with unexplained thrombosis.