Education, monitoring, improved availability of resources, and disciplinary measures in cases of poor compliance are necessary to improve TDI management in hospitals, especially among physicians.

BACKGROUND:The aim of the present study was to examine the efficacy of simple laboratory parameters including neutrophilto-lymphocyte ratio (NLR), platelet count (PLT), mean platelet volume (MPV), and serum bilirubin level in the diagnosis of acute appendicitis and recognition of perforated appendicitis. METHODS:Records of 3392 patients who underwent appendectomy in a 10-year period were reviewed retrospectively. Patients were divided into 2 groups according to histopathological examination results: Group 1 had normal appendix, Group 2 had acute appendicitis. Patients with acute appendicitis were divided into subgroups: Group 2A had simple acute appendicitis, while Group 2B had perforated appendicitis. Efficacy of the aforementioned laboratory parameters was evaluated in the diagnosis of acute appendicitis and recognition of perforated appendicitis. Independent variables were determined by univariate analysis and multivariate analysis was performed. Receiver operating characteristic (ROC) curve analysis was used to identify significant parameters in multivariate analysis. Cut-off values, sensitivity, specificity, and accuracy calculations performed for parameters with area under curve (AUC) >0.600 were accepted as "significant parameters."

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Increased MMP-1, MMP-2, MMP-9 values play a role in the etiology of inguinal hernia. Since weakening may also occur in other tissues in addition to the floor of inguinal canal in inguinal hernia patients, the association of arterial aneurisms and connective tissue diseases should also be investigated in these patients.

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IntroductionBreast cancers, particularly those that are locally advanced, may rarely present with acute severe bleeding. They usually appear in the form of fungating and/or ulcerating tumors. This condition can be difficult to manage through a surgical procedure. Interventional radiology has gained an increased role in coping with this problem. The most frequently used method to achieve safe and efficacious hemostasis is transcatheter arterial embolization (TAE). This method was also reported to ensure a reduction in tumor size. Case PresentationA woman aged 47 years who had recently undergone a toilet mastectomy plus axillary dissection for locally-advanced breast cancer, presented with sudden severe bleeding from a loco-regionally recurrent tumor that had developed rapidly. She had been diagnosed as having locally-advanced left breast cancer with axillary metastasis at the age of 46 years, which was histopathologically determined as a triplenegative breast cancer. The tumor had remained unresponsive to the neoadjuvant of chemotherapy (NACT), therefore she underwent toilet mastectomy plus axillary dissection to prevent further complications. However, in the very early postoperative period, a locoregional recurrent tumor began to develop on the chest wall and in the axillary region. Recurrent masses, especially the ones in the axilla, tended to ulcerate over the course of time. Owing to ulceration, radiotherapy (RT) was not considered as an option in the treatment. Finally, approximately three months after the operation, the patient presented with sudden severe bleeding from the recurrent breast tumor. She was admitted to our general surgery clinic for treatment of this acute bleeding. On physical examination, the patient was alert, conscious, and cooperative. She had moderate pallor. Her initial blood pressure was 100/60 mmHg, and heart rate of 90 bpm. Inspection of the chest wall showed that there was a very large loco-regionally recurrent breast tumor on the left side along the incision line; the bleeding originated from the deep part of the left axilla where many large ulcerated recurrent tumors were located. She also had an apparent upper limb edema. The results of the lab tests on admission showed a low hemoglobin level of 6 mg/dL and hematocrit of 20.9%. The platelet count was found 241 x 10 3 /microliter. INR and aPTT were within normal ranges. First, a temporary control of bleeding was performed by dressing the wound with sterile gauze pads and compressing them with an elastic bandage around the chest wall. Soon after, an intravenous access was established and replacement of isotonic fluid was initiated. Three units of red cell suspension were transfused consecutively as quickly as possible. Following these resuscitative measures, her vital signs improved with a blood pressure of 120/90 mmHg, and heart rate of 76 bpm. Hemoglobin and hematocrit increased to 11.1 mg/dL and 33.7%, respectively.An interventional radiologist's opinion was requested to aid in providing safer hemostasis and the patient was tra...

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Peutz-Jeghers' syndrome (PJS) is an autosomal dominant inherited disease, which is characterized by mucocutaneus pigmentation and hamartomatous gastro-intestinal polyps. Intussusceptions can easily occur in patients with PJS. Repeated laparotomy with resections and eventual short bowel syndrome is a major problem in these patients. We present a 20-year-old woman with multiple intestinal intussusceptions. Multiple enterotomies and intestinal resections were performed to achieve a longer symptom-free period.