Suat Can Ulukent

The clinical value of leucocyte count and neutrophil percentage in diagnosing uncomplicated (simple) appendicitis and predicting complicated appendicitis.

BACKGROUND The aim of this study was to establish the diagnostic value of leucocyte count and neutrophil percentage in both diagnosing simple appendicitis and predicting complicated appendicitis. METHODS The patients who underwent appendectomy with a clinical diagnosis of acute appendicitis (AA) between January 2011 and December 2012 were studied retrospectively. The data of total WBC count, neutrophil ratio, and physical findings were analyzed. Sensitivities and specificities of leucocyte count and neutrophil ratio were calculated. RESULTS One hundred and fifty-nine patients, diagnosed with acute appendicitis, were operated. Simple appendicitis was detected in 82.4% of the patients and complicated appendicitis in 17.6%. Leucocyte count had low sensitivity and specificity for diagnosing acute appendicitis (67.5% and 36.3%, respectively). Neutrophil ratio had a sensitivity rate of 60.1% and specificity rate of 90.9%. Complicated appendicitis was more common in male patients. Leucocyte count was statistically higher in patients with complicated appendicitis. CONCLUSION Two inflammatory markers, leucocyte count and neutrophil ratio, were evaluated for diagnosing acute appendicitis. Neutrophil ratio had higher sensitivity and specificity for acute appendicitis. On the other hand, increased leucocyte count and male gender was found to be a risk factor for complicated appendicitis.

Is It Necessary to Specifically Define the Cause of Surgically Treated Biliary Tract Infections? A Rare Case of Raoultella planticola Cholecystitis and Literature Review

Raoultella planticola is an aquatic and soil organism that does not notoriously cause invasive infections in humans. Infections in the literature are limited only in case reports. We present a very rare case of R. planticola cholecystitis. A 71-year-old female patient with abdominal pain was diagnosed with acute cholecystitis. Patient received intravenous antibiotic treatment, but the treatment failed and the patient underwent an open cholecystectomy. The final pathological result was gangrenous cholecystitis complicated with R. planticola. Eventually, the patient recovered with appropriate antimicrobial therapy. Patients with acute cholecystitis are usually treated without any microbiological sampling and antibiotic treatment is started empirically. To date, there have only been 5 reported biliary system related R. planticola infections in humans. We believe that Raoultella species might be a more frequent agent than usually thought, especially in resistant cholecystitis cases. Resistant strains should be considered as a possible causative organism when the patient’s condition worsened despite proper antimicrobial therapy. It should be considered safe to send microbiological samples for culture and specifically define the causative microorganisms even in the setting of a cholecystectomized patient.

Prolene mesh migration into the rectum after sacral colpopexy presented with frozen pelvis

INTRODUCTION Pelvic organ prolapse (POP) is a common gynecological problem. Repair with synthetic materials such as prolene mesh has become a popular approach in prolapsus surgery. Migration of synthetic materials can cause serious complications. PRESENTATION OF CASE A 69-year-old woman was admitted to the hospital with a complaint of sensation of fullness and a feeling of a foreign material protruding during defecation. The patient underwent exploratory laparotomy. Prolene mesh was detected in sacral region but resection of the mesh could not be conducted because of dense adhesions causing frozen pelvis. The migrated prolene mesh was resected transanally. DISCUSSION Genital prolapse or genital hernia is described as the protrusion of pelvic organs along the vagina. It is one of the common gynecological conditions that affect the quality of life in women. Mesh migration is a well-known clinical pathology. CONCLUSION Mesh migration is a serious complication after sacral colpopexy. Surgical resection of migrated mesh can be difficult due to dense adhesions.

Evaluation of laboratory parameters in the diagnosis of acute appendicitis

Abstract Introduction: The aim of this prospective study was to investigate the diagnostic value of the fibrinogen level, platelet (PLT) count, mean platelet volume (MPV), lymphocyte count, neutrophil/lymphocyte ratio (NLR) and C-reactive protein (CRP) level with white blood cell (WBC) and neutrophil count in acute appendicitis (AA). Methods: One hundred and ninety-seven patients who were admitted with the findings of acute abdomen and operated on with a preoperative diagnosis of AA were included in this prospective observational study. After surgery, according to the histopathological results of the appendix, patients were classified as Group 1; with normal histology of appendix vermicularis, Group 2; patients with positive histology for appendicitis with or without perforation, periappendiceal abscess, suppurative, gangrenous or ulcerophlegmonous appendicitis. Results: In the comparison of the two groups, the difference between CRP and MPV were insignificant (p=0.12 and p=0.09, respectively). WBC, neutrophil count, NLR were significantly higher in Group 2 (p<0.001 for each), whereas fibrinogen levels, lymphocyte count and the PLT counts were significantly higher in Group 1 (p=0.03, 0.002 and 0.003, respectively). Discussion and conclusion: WBC, neutrophil and NLR are predictive for the diagnosis of AA, whereas elevated levels of fibrinogen, high lymphocyte and PLT count are predictive for non-appendicial pathology with low diagnostic accuracies.

Evaluation of Factors Affecting Lymph Node Metastasis in Clinical Stage I-II Epithelial Ovarian Cancer

Background: Systematic lymphadenectomy is useful for accurate staging of early-stage ovarian cancer and has obvious prognostic value. Accurate staging may prevent unnecessary postoperative chemotherapy. The aim of this study was to evaluate the rate of lymph node involvement and factors affecting it in clinically early-stage epithelial ovarian cancer (EOC; stages I, II). Patients and Methods: The study included 163 patients who underwent surgery at our hospital between January 2004 and April 2017 and who were diagnosed with early-stage EOC based on preoperative and intraoperative examination. Patient data were retrospectively analyzed. The rate of lymph node involvement and factors affecting it were analyzed. Results: Of 163 patients, 21 (12.9%) had lymph node metastasis, whereas 16 (16.3%) of 98 patients who underwent comprehensive lymphadenectomy had lymph node metastasis. According to the univariate results for patients undergoing any type of lymphadenectomy, the rate of positive lymph nodes was significantly higher (37.1%) in those with bilateral ovarian involvement (p < 0.001). The rate was significantly higher in patients with positive intraabdominal fluid cytology (25.9%; p < 0.001), serous histology (20.5%; p = 0.02), and grade 3 disease (33.3%; p < 0.001). In multivariate logistic regression analysis, the rate was significantly higher in patients with bilateral adnexal involvement (p = 0.012). The risk of positive lymph nodes was significantly higher in patients with grade 3 disease (p = 0.016). Conclusion: Comprehensive lymphadenectomy increases the detection rate for metastatic lymph nodes in patients with clinically early-stage EOC. The rate of lymph node involvement is significantly higher in grade 3 tumors, serous cytology, bilateral adnexal involvement, and positive intraabdominal fluid cytology.

Yirmi Dokuz Haftalık Gebelikte Preterm Eylem ve Eşlik Eden Krukenberg Tümörü

168 ebelikte saptanan adneksiyal kitleler, literatür serilerinde %0,2-2 arasında görülmektedir.1 Bunların ancak %1-6’sı malign özellik göstermektedir. Krukenberg tümörleri ise tüm over tümörlerinin %12’si olup, gebelikte çok nadir görülmekle birlikte, genellikle ileri evrelerde saptanmaları nedeni ile prognozları kötüdür.2 Geç tanı almalarının en önemli nedeni de gastrointestinal yakınmalara gebelikte çok sık rastlanmasıdır.

Pelvic tuberculosis mimicking ovarian cancer: a series of 13 cases

Introduction: In this study, we aimed to investigate the incidence of pelvic tuberculosis mimicking ovarian cancer. Material and methods: The data of a total of 13 patients diagnosed with peritoneal or genital tuberculosis in the gynecologic oncology unit between January 1, 2004 and January 1, 2016 were retrospectively analyzed. Results: The mean age of the patients was 39.4 ±14.1 (range: 22–67) years. The mean parity number was 1.69 ±1.1 (range: 0–5) and mean body mass index was 23.3 ±4.1 (range: 18–43) kg/m2. The mean cancer antigen 125 (CA125) level was 473 ±394 (range: 22–1153) U/ml. The most common complaints were abdominal pain (n = 3) and bloating (n = 9). The most common ultrasonographic findings were diffuse ascites and adnexal mass. No signs of malignancy were found in 6 patients who underwent paracentesis and in 5 patients who underwent endoscopy preoperatively. Six patients underwent laparoscopic surgery, whereas 7 patients underwent laparotomy by subumbilical medial incision. Findings in abdominal examination included diffuse adhesions (13/13), diffuse ascites (11/13), pelvic mass (10/13), and diffuse nodular formations (11/13). Conclusions: In tuberculosis-endemic regions, peritoneal tuberculosis should be considered in the differential diagnosis of malignant adnexal masses. Although various tests are helpful, histopathological and bacterial examination of tissue samples is of utmost importance for establishing a definitive diagnosis.

A modified technique for the laparoscopic management of large gastric bezoars

Bezoar is an intraluminal mass formed by the accumulation of undigested material anywhere in the gastrointestinal system. Most of small bezoars are removed by gastrointestinal endoscopy, while the best approach for the larger ones is surgical removal. Currently, laparoscopic technique is successfully used in the treatment of bezoars, which are used to be managed by open surgery. In the laparoscopic treatment of bezoars, contamination of peritoneal cavity is a major problem. We describe a modified laparoscopic technique in which an endobag is placed in the stomach instead of the peritoneal cavity in order to avoid spillage of the bezoar during laparoscopic removal.