Ozgur Ekinci

Hyperbilirubinemia as a predictive factor in acute appendicitis

PurposeOur aim was to establish the role of hyperbilirubinemia as a predictive parameter for the prediction of either acute, or gangrenous/perforated appendicitis as well as to compare other parameters in a similar role.MethodsMedical files of the patients who underwent appendectomies between September 2013 and September 2014 were evaluated. Age, gender, preoperative white blood cell count (WBC), neutrophil count (NEU), neutrophil percentage (NEU%), C-reactive protein (CRP), total/direct/indirect bilirubin levels, and the postoperative histopathological findings were recorded. The Fisher’s exact, Pearson’s χ2, ANOVA, and Kruskal–Wallis tests while logistic regression for multivariate analysis was performed. pxa0<xa00.05 was accepted as statistically significant.ResultsThe study group of 162 patients consisted of 97 (60xa0%) men and 65 (40xa0%) women with a median age of 36 (18–90). Histopathological examinations revealed normal appendix in 21 (13xa0%) patients, non-complicated acute appendicitis in 100 (62xa0%), and appendiceal gangrene/perforation in 41 (25xa0%) patients. WBC, NEU, NEU%, and CRP levels were significantly higher in cases of acute and gangrenous/perforated appendicitis (pxa0<xa00.01). Total and direct bilirubin levels were also significantly elevated in patients with acute and gangrenous/perforated appendicitis (pxa0<xa00.01). According to multivariate analysis, elevated CRP levels were associated with 14 times, elevated total bilirubin levels were associated with five times, and elevated direct bilirubin levels were associated with 36 times greater risk for appendiceal gangrene/perforation (pxa0<xa00.01, pxa0<xa00.05, pxa0<xa00.01, respectively).ConclusionsHyperbilirubinemia, especially with elevated direct bilirubin levels, may be considered as an important marker for the prediction of appendiceal gangrene/perforation.

Factors Effecting Mastalgia

Background: Breast pain is one of the leading complaints that ends up with referral to breast surgery clinics. The purpose of the present study was to investigate the factors that cause mastalgia, and its relation with benign or malignant breast disease. Methods: The study was performed in 700 patients. Data obtained from surveys, and imaging findings were prospectively recorded, and analyzed. Results: The mean age was 45.20 ± 10.78 years. The mastalgia group included 500 cases; the asymptomatic group comprised 200 individuals. Stressful lifestyle, caffeine consumption, and smoking were associated with mastalgia (p < 0.05). Rates of women who had breast fed 3 times or more were higher in the mastalgia group (p < 0.05). Increased breast density, and breast imaging-reporting and data system (BI-RADS) 2 mammography findings were related with mastalgia (p < 0.05). Cysts and fibroadenomas were more common in the mastalgia group (p < 0.05). The incidence of a past history of malignant breast disease was significantly higher in the mastalgia group (p < 0.05). Conclusions: Stress, caffeine, smoking, lactation frequency, and benign disorders were factors detected to be related with mastalgia. Although a significant relation between mastalgia and malignant breast disease was detected in our study, more controlled studies are still required to investigate this issue further.

Protective effects of thymoquinone on the healing process of experimental left colonic anastomosis

PURPOSEnColorectal cancer is globally the third most common cancer. Anastomotic complications remain to be an important issue for colorectal surgery. The aim of this study was to investigate the protective effects of thymoquinone (TQ) on the healing process of left colonic anastomosis in an experimental model.nnnMETHODSnThirty-two male rats were divided into two groups, as the TQ group and the control group. TQ was administered to the TQ group, whereas the control group was given a standard feed and water for 2xa0wk. Following the creation of a left colonic anastomosis, subjects in both groups were sacrificed on the postoperative (PO) third and seventh days. Anastomotic burst pressures were measured mechanically. Immunohistochemical stainings for proliferating cell nuclear antigen, cluster of differentiation (CD) 31, CD45 were performed, and the matrix metalloproteinase-2 levels were measured. Histologic total scores were calculated according to Ehrlich-Hunt model. A value of Pxa0<xa00.05 was considered as statistically significant.nnnRESULTSnOne rat in the control group that died on the PO fourth day was excluded. Anastomotic burst pressures on the PO seventh day were higher in the TQ group than the control group (Pxa0<xa00.01). Histopathological total scores on the PO third and seventh days were higher in the TQ group (Pxa0<xa00.01). In addition, the TQ group revealed lower matrix metalloproteinase-2 scores on the PO third day and higher hydroxyproline levels on the PO seventh day (Pxa0<xa00.05 and Pxa0<xa00.01, respectively).nnnCONCLUSIONSnThe use of TQ in colorectal surgery cases with left-sided colonic anastomosis resulted with increased anastomotic burst pressures and increased tissue hydroxyproline levels.

Torsion of a preperitoneal pedunculated lipoma of anterior abdominal wall mimicking acute appendicitis

Lipoma is the most common benign tumor of adipose tissue. Lipomas can occur almost anywhere in the body, but are rarely found in parietal peritoneum of abdominal wall. Occasionally lipomas are detected incidentally during abdominal surgery for other organ pathologies. Presently described is rare case of torsion of pedunculated lipoma originating in parietal peritoneum of anterior abdominal wall causing abdominal pain that mimicked acute appendicitis in 35-year-old woman.

Difficult cases of inguinal hernia repair: 12 cases aged 65 years and over

Two hundred and forty-nine cases of inguinal hernia operated on at Medeniyet University Goztepe Training and Research Hospital from 2010 to 2012 were reviewed retrospectively. Malignancy was present as a comorbid disease in twelve patients, ten of whom were male and two female. Eleven cases were operated on electively and one case was operated on in an emergency setting. The average duration of hospital stay was 2.7 days. No mortality was recorded. Nowadays, notwithstanding the increased risk due to comorbid diseases, consensus advocates routine surgery for inguinal hernia repair in patients aged 65 years and over.

Partial caecal necrosis

Non-occlusive caecal infarction is a rare condition that has been described in association with a variety of clinical entities, generally due to a low-flow state, and has been reported to occur in association with chronic heart disease, open-heart surgery, certain drugs, and haemodialysis.We report on an 80-year-old female with known chronic heart disease and chronic renal failure presenting with right lower abdominal quadrant pain, tenderness and leukocytosis. Intraoperatively, caecal necrosis was confirmed, while the appendix and the remainder of the intestine appeared normal. Ileocaecal resection and anastomosis was performed. Histopathologic analysis demonstrated isolated transmural caecal necrosis as a consequence of nonocclusive ischaemic colitis. The patient made a complete recovery and was discharged from the hospital on the fifth postoperative day without any surgical complications.

Acute appendicitis in pregnancy: case series and review

OBJECTIVE: Acute appendicitis is one of the most common acute surgical pathology we encountered. In this study we investigated our pregnant cases of appendicitis, and reviewed literature. METHODS: A total of 21 pregnant women who underwent appendectomy with the initial diagnosis of acute appendicitis in Istanbul Medeniyet University Clinics of General Surgery between January 2012, and December 2014 were retrospectively analyzed. The patients’s ages, trimesters, complaints, abdominal examination, laboratory, and ultrasonographic findings, surgical techniques, complications and hospital stay were noted. RESULTS: The patients were in their first (n=12; 57.1%), second (n=5; 23.8%), and third trimesters (n=4; 19.0%) of their pregnancies Median age was 23.9 years. All of the patients had abdominal pain. Median value of WBC count was 13.297/mm³. Ultrasound was positive in 12 patients (57.1%). In 14 (66.6%) patients McBurney incision, and in 6 (28.6%) cases right paramedian incision were used. One patient (4.8%) underwent laparoscopic appendectomy. Nineteen cases were acute appendicitis (90.5%), and two cases were perforated appendicitis (9.5%). Average hospital stay was 3.8 days. Two cases with perforated acute appendicitis developed wound infection and treated conservatively. There were no fetomaternal mortality. CONCLUSION: Physiologically anatomic and biochemical changes occurring during pregnancy can delay the diagnosis of acute appendicitis threaten the lives of both the mother and the fetus Therefore, rapid diagnosis and appropriate treatment convey importance.