Acute mesenteric ischemia (AMI) is a life threatening cause of acute abdomen. The purpose of this study is to define risk factors that predict the adverse outcome of AMI and to present our experience in the last 30 years. Hospital records and clinical data of 107 patients undergoing surgical intervention for AMI during the last 30 year period were reviewed and clinical outcomes as well as factors influencing mortality were analyzed. Mesenteric arterial thrombosis, arterial embolism and nonocclusive mesenteric ischemia (NOMI) were the cause of AMI in 68 (63.6%), 28 (26%), and 11 patients (10.2%), respectively. Abdominal pain was the most common presenting symptom (90.6%). Peritonitis was observed in 96 patients (89.7%) and 24 patients (22.4%) were in shock. Abdominal ultrasonography was performed in 46 patients (42%), abdominal CT angiography in 36 patients (33%) and mesenteric angiography in 12 patients (10.5%). All patients were operated and 11 (10%) patients underwent a second-look operation. Bowel resection was necessary in 101 patients (93.4%) during the initial operation and in seven patients (6.5%) during the second-look operation. The hospital mortality was 55.1%. Mortality was mainly due to multiorgan failure (43%). Diabetes mellitus, use of digoxine and antiplatelet drugs, duration of the symptoms until before surgery, existence of shock, low levels of the pH and bicarbonate and re-laparotomy were found to be negative predictors of the perioperative mortality. The use of total parenteral nutrition and CT angiography was found to be a protective factor against mortality. A high index of suspicion with prompt diagnostic evaluation with CT angiography may reduce time prior to surgical intervention which may lead to improved patient survival.
BackgroundAlthough there are many therapeutic options to manage patients with sacrococcygeal pilonidal sinus disease, there remains controversy over a gold standard method for treating such patients. Most studies regarding sacrococcygeal pilonidal sinus, collected patients in a single pool, and single modality was performed to all patients so far. Staging according to the progressive nature of disease and comparisons of stage-based treatment approaches are yet to be conducted. This study aimed to define a staging system and to evaluate outcomes with the use of stage-based treatment approach.MethodsThe collected data of patients who underwent surgery for the treatment of pilonidal sinus disease prior to June 2011 were analyzed. Following this analysis, a staging system was defined based on morphological extent of disease (stage I to stage IV for primary disease, and stage R for recurrent disease). Specific surgical technique was used for each stage. Between June 2011 and December 2014, 367 patients were operated based on proposed staging system and treatment algorithm. Demographics, perioperative data, short-term and long-term outcomes were evaluated according to the disease stage.ResultsFor all patients, the median length of hospital stay was 1 (range, 0–4) day. Primary healing without any wound complications was achieved in 320 (87.2 %) patients. The median time to functional recovery was 10 (range, 2–35) days and for wound healing was 12 (range, 10–55) days. Disease recurrence was identified in six (1.6 %) patients within the median follow-up period of 29 (range, 5–47) months. The outcomes of each stage were evaluated separately.ConclusionsWe believe that the proposed staging system and stage-based treatment approach, which need further validation, will have an efficacy in the treatment of chronic pilonidal sinus disease and will contribute to the development of more appropriate individualized management approaches. Moreover, the use of this staging system will likely facilitate sharing and comparing more specific clinical data from future studies.Trial registrationNCT02712970 (ClinicalTrials.gov/09.03.2016)
The overall malignancy rate for nodules diagnosed as AUS/FLUS and the malignancy rate for nodules that underwent repeated FNA after AUS/FLUS were higher than the expected malignancy rates of the National Cancer Institute. It is, therefore, suggested that the current recommendations should be reconsidered.
The aim of this study was to evaluate demographic and clinical findings in Fournier's gangrene and to assess feasibility of several scoring indexes for predicting morbidity and mortality. Patients who underwent surgery for Fournier's gangrene between 2006 and 2020 were analyzed. Scores of Fournier Gangrene Severity Index, Uludag Fournier Gangrene Severity Index, Age-adjusted Charlson Comorbidity Index, and Sequential Organ Failure System for each patient were calculated. Mortality rate was regarded as the primary outcome. There were 60 patients with a mean age of 61.4 SD 16.0 years. There were 10 deaths with a mortality rate of 16.7%. There were significant differences between non-survivor (n = 10) and survivor patients (n = 50) with regard to hemoglobin, serum total protein, and serum bicarbonate levels (p < 0.05). In all patients who survived, the scores of all indexes were significantly higher than that of the patients who were non-survivors (p < 0.05). Although the diagnostic accuracy of Fournier Gangrene Severity Index and Uludag Fournier Gangrene Severity Index for mortality was moderate, diagnostic accuracies of Age-adjusted Charlson Comorbidity Index and Sequential Organ Failure System score for prediction of mortality were regarded as good. Fournier Gangrene Severity Index, Uludag Fournier Gangrene Severity Index, Age-adjusted Charlson Comorbidity Index, and Sequential Organ Failure System score were shown to be associated with mortality in Fournier's gangrene. Diagnostic accuracies of Uludag Fournier Gangrene Severity Index, Age-adjusted Charlson Comorbidity Index, and Sequential Organ Failure System score for prediction of mortality were higher than that of Fournier Gangrene Severity Index.
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