BACKGROUND: Acute mesenteric ischemia (AMI) is a disease that causes an ischemia in the intestines due to the obstruction of the mesenteric vessels feeding the intestines, with a mortality rate reaching up to 80%. The overall incidence of AMI is 0.63 per 100,000 people. Early diagnosis and treatment are very important for survival. There is no ideal biomarker that can reflect different types and stages of AMI. This study investigated the predictive and prognostic value of L-lactate, D-dimer, leukocyte, C reactive protein (CRP) and neutrophil/lymphocyte ratio (NLR) in the preoperative period were investigated in patients operated for AMI. METHODS: A total of 44 patients operated for AMI between 2015 and 2019 were evaluated in this study. Demographic, clinical, radiological, laboratory and surgical findings of the patients included in this study were recorded. The patients were divided into groups according to the etiological type of AMI. L-lactate, D-dimer, CRP, leukocyte, and NLR levels of these patients were determined. Statistical analysis was performed according to AMI groups. RESULTS: The mean age of the 44 patients included in this study was 67.7 years and the female to male ratio was 0.76. According to tomography results, 31.8% (n=14) of the patients had mesenteric artery embolism, 29.5% (n=13) had mesenteric artery thrombus, 25% (n=11) had mesenteric vein thrombus and 13.6% (n=6) had non-occlusive mesenteric ischemia. When AMI types were compared, D-dimer and CRP levels were found to be significantly different from other markers. The total length of stay in the hospital was found to be significantly correlated with the L-lactate (p=0.047) and CRP (p=0.045) levels. In the analyses, CRP was determined to be the common biomarker that could be used in the diagnosis of mesenteric ischemia in all AMI types. CONCLUSION: Particularly, the CRP level can be used effectively in the preoperative period to diagnose AMI and to determine its subtype and clinical course. However, L-lactate, D-dimer, leukocyte and NLR are markers that have no predictive value in the diagnosis of all AMI subtypes.
BACKGROUND: Approximately 10%-25% of patients with colon diverticular disease experience colonic diverticulitis during their lives. Right-sided diverticulosis is a rare condition in Western countries, but it is common among Asian countries. The aim of this study was to evaluate the clinical and treatment outcomes in our patients with right colon diverticulitis. METHODS: Demographic and clinical data of 22 patients with a diagnosis of cecum and right-sided colon diverticulitis between 2014 and 2017 were analyzed. The Hinchey staging was applied according to the radiological evaluation and clinical findings. Then, the proportions of demographic and clinical features of the patients according to the Hinchey staging and its statistical significance were evaluated. RESULTS: Our study included 22 patients who suffered from right colon diverticulitis. The female-to-male ratio was 0.69. A total of 68.1% of the patients were the Hinchey Stage I, and 31.8% were the Hinchey Stage II, all of which were evaluated by tomography. The Hinchey Stage I diverticulitis was mostly found in the right colon (66.7%) and the Hinchey Stage II diverticulitis in the cecum (57.1%). The mean age of the Hinchey Stage II patients was higher (63.6 years) and statistically significant (p<0.05). Two patients had appendectomy, and one had right hemicolectomy. Conservative treatment was applied to other 19 patients. The mean hospitalization time was 3.4 days. Four patients who received conservative treatment at the 2-year follow-up had recurrence. No recurrence was observed in patients receiving surgical treatment. CONCLUSION: Right colon diverticulitis is usually seen in solitary men aged <50 years from Eastern societies. As a treatment option, conservative methods should be preferred, especially in uncomplicated cases. Surgical treatment is usually used in the treatment of recurrent and complicated cases.
Esophageal melanosis which is characterized by melanocytic proliferation in the squamous epithelium of the esophagus and melanin accumulatin of esophageal mucosa (EM) is a rare disease of the digestive system. Although esophageal melanosis is considered to be a benign disease, its etiology is not cleared and has been reported to be the precursor lesion of esophageal primary melanomas. In this report, we aimed to note esophageal melanosis in a 55-year-old female case who applied to our clinic with difficulty in swallowing, burning behind the breastbone in the stomach, heartburn, indigestion, and pain in the upper abdomen after endoscopic and pathologic evaluation. Complaints dropped with anti-acid therapy and case was followed by intermittent endoscopic procedures because of precursor melanocytic lesions.
Background: Elastofibroma dorsi (ED) is a benign soft tissue tumour of the subscapular region of the chest wall. It is a frequent lesion, especially seen in females and in the elderly. It remains unclear whether the size or symptomatology of the tumour is important to make a resection decision. Our aim in this study is to reveal the results between asymptomatic or symptomatic ED cases, and to reveal which factors are important for making a resection decision. Methods: Patients operated between January 2010 and December 2019 were included in the study, and divided into two groups as patients who were asymptomatic or with various symptoms. Patients were evaluated in terms of demographic and operational factors. Results: The study included 57 patients with the average age of 56.1 AE 11.5 years. Whilst 31 (54.4%) of these patients were asymptomatic, 26 (45.6%) were symptomatic. There was a statistical significance between groups in terms of occupation (P < 0.001), comorbidity (P = 0.042) and the duration of complaints (P = 0.001). A statistically significant difference was analysed between comorbidity versus early and late complications (P = 0.011 and P = 0.002, respectively). Conclusion: ED probably occurs as a result of repeated trauma in the subcapular region in people who use their arms extensively. Regardless of the size of the lesion, surgery should be avoided as much as possible, especially in asymptomatic patients. However, in patients who are symptomatic, a precise surgical procedure can give satisfactory results. In these patients, who are generally elderly, early and late complications can be seen more, if they have comorbidity.
Background/Aims: Acute appendicitis is the most frequent cause of acute abdomen emergency surgery. It continues to be a problem today due to delayed diagnosis and its high perforation rate. For this reason, diagnostic tests continue to be developed. In this experimental study, the diagnostic significance of blood procalcitonin (PCT), interleukin (IL)-6, IL-2, and D-dimer levels in an acute appendicitis model in rabbits was investigated. Materials and Methods: A total of five groups were included: control group, sham group, and three different acute appendicitis groups. In the appendicitis groups, the appendix was ligated by laparotomy, and the blood PCT, IL-6, IL-2, and D-dimer levels were measured at 12 (group 3), 24 (group 4), and 48 h (group 5). Then, an appendectomy was performed. Results: In the present study, PCT and IL-6 levels increased in parallel with the inflammation of the appendix in all groups and were found to be statistically significant. IL-2 and D-dimer values were higher in the groups diagnosed with appendicitis but were not statistically significant. Conclusion: In our experimental study, PCT and IL-6 levels were determined to be important in the early diagnosis of acute appendicitis, especially IL-6, and that these two parameters are more important markers than IL-2 and D-dimer.
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