IntroductionAcute appendicitis is the most frequently observed disease requiring emergency surgery. The role of parasites in its pathogenesis has long been discussed. The signs of the parasitic infestations can mimic the signs of acute appendicitis. Therefore, it can cause a negative laparotomy.AimTo evaluate the parasitic infestations of the appendix vermiformis whether increas the rate of negative laparotomy.Material and methodsThe histopathology results of a total of 3863 patients who underwent appendectomy with clinically acute appendicitis were evaluated retrospectively. All appendectomy materials in which parasites were observed were evaluated with respect to the nature of the parasites and the findings of inflammation. Cases in which parasite tissue fragments and/or eggs as well as findings of inflammation were histopathologically observed in the appendix lumen were diagnosed with parasitic appendicitis.ResultsEvidence of parasites was observed in 19 (0.49%) of the evaluated appendectomy materials. In 9 (47.3%) of these specimens that had evidence for parasites, findings for acute appendicitis and localized peritonitis were identified. Findings of acute appendicitis had not been identified in the other ten (52.7%) of the specimens. Enterobius vermicularis was the most frequently identified parasite.ConclusionsIn parasitic acute appendicitis, appendectomy in itself is not sufficient for treatment. Pharmacological treatment should also be administered after surgery. Patients should be evaluated prior to surgery for parasites, and diagnosis of acute appendicitis should be considered more cautiously in order to avoid negative laparotomies.

There is still an ongoing debate, especially regarding early diagnosis of acute appendicitis. Early surgery leads to inadequate evaluation of acute abdominal pain and negative appendectomy, whereas delayed surgery leads to appendicitis perforation complications. The diagnosis of this condition is considerably difficult, especially due to subtle early symptoms and clinical condition. The aim of the present study was to identify whether the Alvarado scoring system could reduce the incidence of negative appendectomy in patients who will undergo surgery for acute appendicitis. Patients who underwent surgery with acute appendicitis prediagnosis were retrospectively classified as negative appendectomies (group A) and positive appendectomies (group B) according to histological diagnosis. All groups were evaluated for age, gender, Alvarado scores, and parameters. Two hundred eighty-one patients were included in the study. Group A contained 71 (25.3 %) patients, and group B contained 210 (74.7 %) patients. There was a significant difference in WBC, left shift, rebound, and change of pain localization between the groups ( = 0.002, < 0.001, < 0.001, and = 0.023, respectively). Alvarado scores were significantly different between the groups ( < 0.001). In logistic model examination, the major factor was the Alvarado score (7 or above) and the minor factor was spreading pain. The Alvarado scoring system can be used to reduce negative appendectomy in patients who will undergo surgery with acute appendicitis.

Objective: Penetrating stab wounds (PSW) are among the most frequent causes of admissions to the emergency services. The current study attempted to answer the question of whether unnecessary laparotomies could be reduced by preoperative tests and physical examinations. Methods: The electronic records of patients admitted to the Emergency Service of the Ministry of İzmir Bozyaka Education and Research Hospital between 2008 and 2013 with penetrating stab wounds were retrospectively examined. Results: 29367 (96,7%) of total 30.356 patients were ambulatory patients. Of these patients, 274 (27.7%) were hospitalized in general surgery clinics. 131 (47.8%) of these patients had abdominal injuries. Hundred and twenty patients who were operated on were divided into two groups as Group A (necessary laparotomy: therapeutic group) which consisted of 30 patients (25%) and Group B (unnecessary laparotomy: nontherapeutic+ negative laparotomy group) consisted of 90 patients (75%).Chest tubes were inserted to eight patients (26.7%) in Group A, and five (5.6%) patients in Group B. Accidental mesenteric ischemia was observed in two patients in which negative laparotomy was conducted, and while in one of them segmental small intestinal resection and terminal ileostomy were performed, and an inflamed appendix was observed and appendectomy was performed. The histopathology of appendix was consistent with carcinoid tumor. Conclusion: Conservative treatment should be a strong option in young patients who have stable hemodynamic conditions whose US and CT was unremarkable without alcohol abuse, anemia and thoracic trauma.

Acute pancreatitis is a common disease that can be fatal at advanced stages. Therefore, early evaluation of the prognosis of acute pancreatitis is important. The aim of this study was to evaluate the importance of monocyte distribution width in defining the prognosis of acute pancreatitis. Material and Method:The study included patients hospitalized with the diagnosis of acute biliary pancreatitis between December 2019 and October 2020. The cases were evaluated in 2 groups as mild pancreatitis and non-mild pancreatitis. The groups were compared in terms of age, white blood cell, neutrophil count, C-reactive protein, length of hospital stay, neutrophil to lymphocyte ratio, Monocyte Distribution Width, amylase, Aspartate Aminotransferase, albumin, and lactate dehydrogenase.Results: A statistically significant difference was determined between the mild pancreatitis group (n:59) and non-mild pancreatitis group (n:48) in terms of white blood cell, neutrophil count, C-reactive protein, Monocyte Distribution Width and length of hospital stay (p<0.05). When the cut-off value for Monocyte Distribution Width was taken as 703.00, sensitivity was 50.94% and specificity was 61.11%. Conclusion:The Monocyte Distribution Width is a parameter that can be used to differentiate mild pancreatitis from non-mild pancreatitis. More extensive studies are needed for a clearer evaluation.

Aim: Peptic ulcer perforation (PUP) is currently the most common complication of peptic ulcer disease (PUD), which requires surgery. Mortality and morbidity rates are high after surgical treatment. The aim of this study was to determine the predictive factors affecting postoperative mortality in patients undergoing surgery due to peptic ulcer perforation. Material and Method:The study included 135 patients diagnosed and operated on because of PUP in the general surgery clinic between February 2015 and January 2020. Evaluations were made of the relationships between mortality and age, gender, ASA scores, season of surgery, preoperative leukocyte, preoperative neutrophil to lymphocyte ratio (NLR), preoperative creatinine and amylase values, location and diameter of the perforation, comorbid diseases, onset of pain and time of surgery.Results: Advanced age, male gender, high ASA score, >12 hours between the onset of the symptoms and the time of surgery, and high creatinine, NLR and amylase values before surgery, ulcer diameter >1 cm and comorbid diseases were associated with mortality. No relationship was found between the location of the ulcer and leukocyte values at the time of admission and mortality. Conclusion:Advanced age, male gender, high ASA score, >12 hours between the onset of symptoms and the time of surgery, and high preoperative creatinine, NLR and amylase values, ulcer diameter >1 cm and comorbid diseases are risk factors for mortality in peptic ulcer perforation. Understanding these factors, identifying patients at risk, and early intervention can help reduce mortality in PUP.

Aim: This experimental study aimed to evaluate the hepatoprotective effect on obstructive jaundice (OJ) of oral Red Ginseng (RG) extract, which is known to have anti-inflammatory and antioxidant properties. Material and Method: The rats were randomly separated into 3 groups of 10 rats: The sham group, the control group, and the treatment group. In Group 1 (sham), the common bile duct (CBD) was identified but no ligation or transection was performed. In Group 2 (control), the CBD was identified and ligation and transection were performed, but no treatment was given. In Group 3 (RG group), CBD ligation and transection were performed, then RG extract was administered via an orogastric tube at a dose of 100 mg/ kg/day for 10 days. After 10 days, blood samples were taken for biochemical analysis, and liver tissue samples for biochemical and histopathological analysis. Results: Significantly higher serum albumin levels and lower serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were determined in the RG group than in the control group (p=0.028, p=0.001 and p=0.034, respectively). In the oxidative stress parameters, malondialdehyde (MDA) levels and catalase (CAT) levels were significantly different between the RG group and control group (p≤0.001 for each). Total sulfhydryl (T-SH) was not at a statistically significant level, although it was high and approached the value of the sham group (p=0.076). In the histopathological evaluation, the RG group had statistically significantly lower scores in all parameters compared to the control group (p<0.05). Conclusion:The results of this study showed that RG has a strong hepatoprotective effect as a result of its anti-inflammatory and antioxidant properties.

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