BACKGROUND: Anastomotic leakages and adhesions after gastrointestinal tract surgery are still a significant cause of morbidity and mortality. The rate of anastomotic leakage is 3%–8%, whereas the mortality from leakage is over 30%. Intra-abdominal sepsis is a well-known cause of anastomotic leakage. In addition, intra-abdominal adhesion is a major cause of hospital admissions and reoperations and is associated with morbidity and mortality. In this study, we aimed to investigate the effects of a polyurethane membrane on anastomotic healing and intra-abdominal adhesions.
METHODS: This study used 32 Wistar albino rats divided into four groups. Standard resection of left colon 2 cm above the peritoneal reflection and colonic anastomosis were performed after causing abdominal sepsis through caecal ligation and perforation. The control groups (1 and 3) received no further treatment. The experimental groups (2 and 4) received the polyurethane membrane around the colonic anastomosis. Burst pressure, hydroxyproline, interleukin-6 (IL-6), nitric oxide (NO), tissue plasminogen activator (tPA), and tumor necrosis factor-alpha (TNF-α) levels were measured, and histopathological characteristics of the anastomosis were analyzed after re-laparotomy. Moreover, adhesion scores were measured.
RESULTS: No statistically significant differences were found in the mean burst pressure levels between sacrificed animals on days three and five (p=0.259, p=0.177). When all the groups were compared, no significant difference was observed in the hydroxyproline, NO, and IL-6 levels (p=0.916, p=0.429, p=0.793, p=0.332, p=0.400, p=0.317). However, in groups 2 and 4, the tPA levels were significantly increased by Opsite therapy (p=0.001, p=0.003), and a statistically significant difference was observed in the adhesion scores (p<0.035). Groups 2 and 4 had significantly lower adhesion scores than groups 1 and 3.
CONCLUSION: We found that Opsite therapy had no positive or negative effects on histopathological and biochemical healing in the experimental septic colon anastomosis model. However, the perianastomotic application of polyurethane membrane effectively decreased the intra-abdominal adhesions.

BACKGROUND: In burn wound healing, zones of burn, namely zone of hyperemia, the zone of stasis, and zone of coagulation, have crucial importance. These zones have been identified based on the pathophysiology of the burn, and treatment of burn has been improved. The zone of necrosis is treated by excision and repair through grafting. Zone of stasis fully recovers in 24–48 h if the burn treatment is managed well. Otherwise, it may convert to a zone of coagulation. Hyperemia zone is a zone that recovers itself. Recovery of the zone of stasis is very critical in burn treatment. Active oxygen radicals produced due to the hypermetabolism due to burn wounds are known to speed to the process of the zone of stasis converting into the zone of coagulation. The present experimental study aims to evaluate the effects of sildenafil and N-acetylcysteine on the zone of stasis and to establish whether they had any contribution to wound healing in burns.
METHODS: In the present study, 32 four months old female Wistar Albino rats with 200±20 gr body weights were used. The rats were divided into four groups as the sham group (Group 1), the intraperitoneal group (Group 2), Sildenafil group (Group 3, intraperitoneal 10 mg/kg for 10 days), N-acetylcysteine (Group 4, intraperitoneal 100 mg/kg for 10 days). Tissue samples were collected for serum and cytopathology studies of the Malondialdehyde level, glutathione peroxidase, superoxide dismutase, and catalyze enzyme activity. All the rats were sacrificed on the 10th day of the tests edema, hyperemia, epithelial degeneration, necrosis, inflammatory infiltration and fibrosis measurements were made.
RESULTS: When compared with the controls, both of the treatment groups had lower tissue damage scores. MDA level was lower in Group 3 and 4 compared to Group 2 and lower in Group 3 compared to Group 4. SOD, catalase and GPH-Px levels were higher in Group 3 and Group 4 compared to Group 2 and higher in Group 3 compared to Group 4.
CONCLUSION: The results of our study conducted on an experimental burn model created by rats support that Sildenafil and N-acetylcysteine have positive effects, such as decreasing oxidative stress level and increasing wound healing in burns. Further experimental studies are required on this subject.

BACKGROUND: This study aims to evaluate the prevalence of abdominal aortic aneurysm (AAA) in Turkish men aged 60 years and older and the factors associated with AAA.
METHODS: Through sixty-two family health centers located in the Kecioren district of Ankara, 239 male volunteers of the target age were recruited for this pilot study. The volunteers were scanned using B-mode ultrasonography. An aorta of 3 cm or larger in outer to outer diameter was accepted as having AAA. The participants were screened for age, height, weight, known diseases and risk factors.
RESULTS: AAA was detected in 11 volunteers (4.6%). A history of smoking increased the risk of AAA (Odds ratio: 12.75; CI 95%, 1.2–134.3). The presence of an aneurysm with a history of myocardial infarction (MI) was statistically significant when compared to volunteers without a history of MI (p=0.007). Similarly, volunteers with a history of coronary angiography had a greater risk of an aneurysm than volunteers without (9.5% and 1.9%, respectively). Also, there was a negative correlation between diabetes, peripheral arterial disease, and aortic diameters.
CONCLUSION: Although AAA has high mortality rates when ruptured, it is a preventable disease. Therefore, it is necessary to know the prevalence of AAA in Turkey. Our findings were compatible with the literature. However, our study was performed as a pilot study, and there is a need for larger studies in our country.

BACKGROUND: Acute appendicitis is the most common abdominal surgical emergency. There is no adequate information to evaluate the effects of the COVID-19 pandemic on acute appendicitis and its surgical management. The present comparative study reports successful appendectomy and infection control in patients with appendicitis during the COVID-19 pandemic and last year covering the same period.
METHODS: This retrospective observational study was conducted in acute appendicitis-treated patients from 13.03.19 to 13.05.19 and from 13.03.20 to 13.05.20, respectively.
RESULTS: This study included 150 patients (110 patients in 2019; 40 patients in 2020 (during COVID-19 pandemic)). The patients were named as Group A (Normal period) and Group B (Pandemic period), respectively. The groups were comparable as there was no significant difference between the mean age, mean BMI, and mean length of stay. There is a significant difference between the comorbidities of Group A and Group B (p=0.033). There was no significant difference between the laboratory and radiological findings of Group A and Group B. There was a significant difference between the perforation number of Group A and Group B (p=0.029). There was no significant difference between the needs of ICU and conversion from laparoscopic to conventional appendectomy of Group A and Group B.
CONCLUSION: The findings obtained in this study suggest that late admission to the hospital caused complicated cases and made acute appendicitis management more difficult during the pandemic period, which was already a troubling period. During the COVID-19 pandemic, the principles applied to emergency surgery for infected patients should be applied to both suspected and confirmed cases.

BACKGROUND: To investigate the efficacy of WBC, PLR and NLR for use in the differential diagnosis of acute appendicitis and renal colic in the emergency department.
METHODS: This study was conducted after consent was received from the Cukurova University Medicine Faculty Noninvasive Clinical Research Ethics Committee. In this study, 440 patients for whom file data could be accessed in the hospital automation and archive system who were admitted to the hospital with abdominal pain were included.
RESULTS: Of the 440 patients included in this study, 59.5% were male and 40.5% were female. The average age of the patients was 37.74±13.39 years. According to the pathological diagnosis, 207 patients were diagnosed with acute appendicitis. When the efficacy of differential diagnosis using hematological parameters was examined with ROC analysis, the neutrophil/lymphocyte ratio (NLR) value had the strongest predictive ability (AUC, 0.716, SS=0.024, 95% GA 0.668–0.764). After NLR, the platelet/lymphocyte ratio (PLR) value was the second-best concerning predictive ability for differential diagnosis (AUC, 0.608 SS=0.027, 95%, GA 0.555–0.661).
CONCLUSION: Patients with acute appendicitis and renal colic often present to the emergency department with abdominal pain. While patients with acute appendicitis are usually treated with surgical methods, medical treatment is used for renal colic in the acute period. The differential diagnosis of these two patient groups is important. We believe that the PLR and NLR values can be used when an exact differential diagnosis cannot be made.

BACKGROUND: Acute cholecystitis (AC), a common complication of gallstones, is responsible for a significant part of emergency applications, and cholecystectomy is the only definitive treatment method for AC. Early cholecystectomy has many reported advantages. Operation-related morbidity and mortality have increased during the COVID-19 pandemic. In this study, our aim is to present our general clinical approach to patients who were diagnosed with AC during the pandemic and our percutaneous cholecystostomy experience during this period.
METHODS: This study included 72 patients who were presented to our hospital’s emergency room between March 11 and May 31, 2020, with AC. Patients were divided into three groups based on their treatment: outpatients (Group 1), inpatients (Group 2) and patients undergoing percutaneous cholecystostomy (Group 3). These three groups were compared by their demographic and clinical characteristics.
RESULTS: There were 36 (50%) patients in Group 1, 25 (34.7%) patients in Group 2, and 11 (15.3%) patients in Group 3. The demographic characteristics of the patients were similar. The CRP and WBC levels of the patients in Group 3 were significantly higher compared to the other groups. Moreover, the wall of the gallbladder was thicker and the size of the gallbladder was larger in Group 3. Patients had percutaneous cholecystostomy at the median of 3.5 days and the length of hospital stay was longer compared to Group 2 (3.9 days versus 9.2 days, p=0.00). The rate of re-hospitalization after discharge was similar in Group 2 and Group 3, but none of the patients in Group 1 required hospitalization. None of 72 patients developed an emergency condition requiring surgery, and there was no death.
CONCLUSION: Although many publications emphasize that laparoscopic cholecystectomy (LC) can be performed with low morbidity at the first admission in acute cholecystitis, it is a clinical condition that can be delayed in the COVID-19 pandemic and other similar emergencies. Thus, percutaneous cholecystostomy should be effectively employed, and its indications should be extended if necessary (e.g., younger patients, patients with lower CCI or ASA). This approach may enable us to protect both patients and healthcare professionals that perform the operation from the risk of COVID-19.

BACKGROUND: Acute appendicitis (AA) still maintains its prominence among general surgical emergencies, and the risk of developing AA is 8.6% for men and 6.7% for women. The clinical diagnosis of acute appendicitis has a rate of approximately 20% false positive and false-negative. Ultrasound (US) and Computed Tomography (CT) are the imaging methods most utilized in this field. The present study aims to determine the relationship between the evaluation results of the clinician who examined the patient and the radiologist’s evaluation in the evaluation of cross-sectional imaging tests for the diagnosis of acute appendicitis.
METHODS: In this study, the records of 1891 patients who underwent an appendectomy in the General Surgery Clinic of Fatih Sultan Mehmet Training and Research Hospital between January 2010 and 2017 were reviewed retrospectively. From the file of the patients who underwent appendectomy with acute appendicitis and whose appendix was reported as normal in CT results, clinical examination findings of the patient in the emergency department and CT evaluation results of the relevant surgeon (Compatible with acute appendicitis, normal appendix or appendix could not be visualised) were recorded.
RESULTS: Of the 1891 patients, who underwent appendectomy on suspicion of acute appendicitis, 1478 had CT scans for diagnosis and 145 were reported as normal by radiologists. In the evaluations by surgeons of these CT results all reported as normal by radiologists, 105 (%) 72,4) were compatible with acute appendicitis, while 18 (12.4%) were considered normal. In 22 (15.2%) patients, appendix could not be the visualized by surgeons. 70.0% of the cases with Lymphoid hyperplasia - fibrous obliteration pathology result; 73.8% of the cases with acute appendicitis; 75.6% of those with phlegmonousappendicitis and 64.0% of those with gangrenous/perforated appendicitis were diagnosed as appendicitis by CT evaluation performed by a general surgeon.
CONCLUSION: Diagnostic accuracy rates increase significantly when the CT results are interpreted by the physician performing the clinical evaluation of the patient. The chance of reaching the correct diagnosis will increase with gaining the ability to interpret abdominal cross-sectional imaging techniques during general surgery specialty training.

BACKGROUND: Laboratory parameters have important diagnostic value in the evaluation of acute appendicitis. This study aimed to evaluate the efficacy of bilirubin values in predicting acute and complicated appendicitis in patients with leukocyte values in the normal reference range.
METHODS: This study included 200 patients aged 18 and over who underwent appendectomy with leukocyte values within the normal reference range. The demographic characteristics, total and direct bilirubin and C-reactive protein values of the patients were examined. According to the pathology results, the patients were divided into two groups as a normal appendix and acute appendicitis. Acute appendicitis was further classified as simple and complicated.
RESULTS: Of the 200 patients included in this study, 110 (55%) were female and 90 (45%) were male, and the mean age was 37±16 years. The pathology results were reported as normal in 45 (22.5%) and acute appendicitis in the remainder of the sample. Of those diagnosed with acute appendicitis, 141 (91%) had simple appendicitis and 14 (9%) had complicated appendicitis. When the normal appendix and acute appendicitis groups were compared, the total and direct bilirubin levels were higher in the patients diagnosed with acute appendicitis. According to the receiver operator characteristic curve analysis, the area under the curve values of total bilirubin and direct bilirubin for the prediction of acute appendicitis were 0.597 and 0.625, respectively.
CONCLUSION: In patients with normal leukocyte values, high bilirubin levels may be useful in predicting the diagnosis of acute appendicitis.

BACKGROUND: The present study aims to assess whether there are any differences in the management and outcome of polytrauma patients with thoracic trauma in trauma units of two different hospitals in the same country; one hospital is near the Syrian border.
METHODS: A retrospective analysis (January 2012 to January 2014) of 348 polytrauma casualties with thoracic trauma from Manisa Celal Bayar University Hospital (MH) were compared according to age, gender, mechanism of injury, associated injuries, abbreviated injury scale (AIS), injury severity score (ISS), treatment modalities, and mortality with 917 patients of Þanlýurfa Training and Research Hospital (SH) registry (near the Syrian border).
RESULTS: Of the 348 patients in the MH, 230 (66%) and of the 917 patients in the SH, 697 (76%) were males (p<0.001). Mean age was 45.6±18.3 yrs in the MH group and 26.4±22.4 yrs in the SH group (p<0.001). The SH patients had a larger proportion of stab wounds (MH; 9% vs. SH; 17%, p<0.05), gunshot injuries (MH; 5% vs. SH; 18%, p<0.05), higher mean ISS (MH; 30.2±8.4 vs. SH; 42.8±10.2, p<0.001), and increased mortality (MH; 2.6% vs. SH; 11.1%, p<0.001). AISabdomen was the highest component in the SH registry (AISabdomen = 4.8±0.7), whereas AIS extremities were the highest component in the MH registry (AISextremities = 3.6±0.2).
CONCLUSION: Significantly different demographic features, mechanisms of injury, worse outcomes and higher mortality rates in SH demonstrate and reflect the surgical challenges depending on the combat environment. Two hospitals in Turkey, one seemingly adjacent to a war zone and another with the more standard civilian experience highlight the impact of the Syrian conflict on the Turkish healthcare system.

BACKGROUND: Soft tissue trauma of the face is considered a leading cause of presentation and referral to the pediatric emergency department. The present study aims to evaluate the demographics properties of facial injuries presenting to the pediatric emergency.
METHODS: In this study, 1160 patients presented with a simple facial laceration to the pediatric emergency department of Baþkent University were reviewed from 2011 to 2017. Patients up to 18 years of age were included. We evaluated demographics about patients’ age, sex, the cause of injury, the location of laceration and timing of the injury. Age was categorized according to the National Institute of Child Health and Human Development (NICHD) pediatric terminology into five groups as follows: 0–12 months, 12 months-2 years, 2–5 year, 6–11 year, and 12–18 years. The following analyses were performed to each age group: a number of cases, male to female predominance, timing of injury (e.g., early morning, afternoon, evening, late evening and at night), the place that the injury has occurred (e.g., at home, at school, in sport hall), the cause of injury (fall, hitting a hard subject, sports-related), the location of laceration (forehead, periorbital area, cheek, perioral area, nose, submental area) and the incidence according to the season.
RESULTS: Number and relative percentages of cases were as follows: 0–12 months (n=127, 10.9%), 12–24 months (n=113, 9.7%), 3–5 years (n=385, 33.1%), 6–11 years (n=403, 34.7%) and 12–17 years (n=132, 11.3%). The average age of children was 6.5 year (range, 5 month - 17.9 year). The age group 6–11 showed a higher incidence compared to other age groups (n=403, 34.7%). Fifty-three percent of the population was younger than six years and there was a male predominance in all age groups.
CONCLUSION: The demographic data provided in this study can be useful in trauma prevention programs which are effective in reducing the incidence, nature and severity of facial lacerations. Parents should be reminded of age-specific preventive measures in injury avoidance.

BACKGROUND: Diagnosis and treatment of emergency surgical pathologies should be addressed within hours, and the prognosis of the patient may deteriorate further in cases of delay. Easy and effective markers are needed in this regard. Our aim in this study is to evaluate the CRP/albumin ratio and the usability of hematological parameters in predicting prognosis in emergency surgical patients in intensive care.
METHODS: This study was performed by retrospectively scanning the files of the patients who were followed up in the intensive care unit. Patients hospitalized after emergency surgery were taken as ‘emergency group’ and patients hospitalized after elective major surgery were taken as ‘control group’. In addition to the demographic characteristics of the patients, the length of hospitalization in the intensive care unit, whether there was a need for mechanical ventilation, platelet/lymphocyte (P/L), neutrophil/lymphocyte (N/L), C-reactive protein (CRP)/albumin values were recorded and the values of both groups were compared statistically.
RESULTS: In this study, 341 patients were included, of which 111 were emergency (32.6%) (Group 1), 230 were elective (67.4%) (Group 2) cases. When the emergency and elective cases were compared, the average CRP/albumin value was 49.05 in Group 1 and 32.8 in Group 2 (p=0.001). N/L values were 11.9 in Group 1 and 9.87 in Group 2 (p=0.04). When looking at another hematological parameter, P/L, it was found 272.62 in Group 1 and 229.17 in Group 2 (p=0.03). Hospitalization days were 13.61 days in Group 1, while 12.43 days in Group 2. When CRP/albumin >40, its sensitivity was determined as 80.49% and its selectivity as 67.22% (p<0.001).
CONCLUSION: The CRP/albumin ratio can be used as an effective marker in determining the urgency of surgical cases and predicting mortality.

BACKGROUND: This study aimed to show whether it is necessary to hospitalize pregnant women who have been involved in traffic accidents.
METHODS: Patients at a hospital in Istanbul, Turkey, who underwent traffic accidents between 2012 and 2018 were studied, and pregnant patients’ files were evaluated. Demographic and obstetric features of patients, type of accident, type of trauma, Glasgow Coma Score, whether or not hospitalization were examined, the response of patients to hospitalization, and the obstetric and maternal results of accidents were assessed.
RESULTS: In the present study, 95 patients were included. Overall, hospitalization was recommended for 50 patients, but of these, 58% refused to be admitted. No patients who refused hospitalization had complications. Preterm labor was seen in 3.2% of patients, while 3.2% had a fetal loss and 5.3% had a placental abruption. Only one mother was lost (1.1%) due to sustaining multiple traumas in a traffic accident. Hospitalization was increasingly indicated with increasing gestational age, but other parameters had no effect on hospitalization.
CONCLUSION: The likelihood that hospitalization was recommended for pregnant women involved in traffic accidents increased with gestational age. Patients with minor trauma who refused hospitalization had no complications.

BACKGROUND: Blast-induced hearing loss is an acoustic trauma commonly caused by high-energy explosions of improvised explosive devices, and the auditory system may be affected by blast damage. This study aims to evaluate the protective effect of tympanic membrane perforation (TMP) on the inner ear against blast injury.
METHODS: In this study, 43 adult patients who had suffered blast injury were divided into three subgroups: intact tympanic membranes in both ears, unilateral TMP, and bilateral TMP. Each patient underwent a comprehensive audiogram, including bone conduction, in the audiology department.
RESULTS: Evaluation was performed on 43 (100%) males with a mean age of 31.44±8.01 years (range, 18–52 years). When the type of hearing loss was evaluated separately for each ear, sensorineural hearing loss (SNHL) was observed in 31 (36%), high-frequency SNHL in 26 (30.2%), conductive hearing loss in eight (9.3%), and mixed type hearing loss in 21 (24.4%) ears. TMP was detected in 21 (48.8%) of 43 blast-injured patients, on the right side in four (9.3%) patients, on the left side in seven (16.3%), and bilateral in 10 (23.3%). When the type of acoustic trauma was evaluated, 15 (34.9%) patients were observed to have suffered from the explosion of an IED, 12 (30.2%) from weapon explosion, six (14%) were a vehicle bomb explosion, three (7%) were projectile missile explosion, three (7%) were mortar explosion, two (4.7%) were mine explosion, and two (4.7%) were exposed to the explosion in an armored vehicle (Table 1).
CONCLUSION: No significant difference was observed in the majority of the frequencies whether the tympanic membrane was perforated or not in the blast-injured patients and it was concluded that tympanic membrane perforation caused by blast injury had no protective effect on the inner ear.

BACKGROUND: Acute appendicitis is the most common cause of non-obstetric acute abdomen in pregnant women. We examined the patients who were admitted to our emergency department with abdominal pain and diagnosed with acute appendicitis in the light of the literature.
METHODS: Seventeen pregnant patients with acute appendicitis who were admitted to the emergency department of Sanliurfa Training and Research Hospital between the years of 2016–2019 were retrospectively analyzed using an electronic recording system. Our patients were evaluated concerning age, gestational week, clinical status, the operation performed, ultrasonography results, pathology results, presence of additional diseases, laboratory results and hospital stay length.
RESULTS: The mean age of our patients was 25.5 (18–41) years. Three patients were in the first trimester (17.6%), 11 patients were in the second trimester (64.8%), and three patients were in the third trimester (17.6%) at the time of admission. All of our patients had abdominal pain. Acute appendicitis was detected in 11 patients, while it was not detected in six patients on the USG examination. Two patients having term delivery underwent caesarean section with concurrent appendectomy. The mean hospital stay length was 2.9 (2–5) days. Histopathologically, 13 (86.7%) of our operated patients were diagnosed with appendicitis. No additional problems were observed in the mothers and infants in the postoperative period.
CONCLUSION: Acute appendicitis should be considered as a non-obstetric pathology in pregnant patients admitted to the emergency department with abdominal pain. We think that it is important for both maternal and infant health to examine this condition, which shows differences concerning clinical course and physical examination, with a meticulous and multidisciplinary approach.

BACKGROUND: Laparoscopic cholecystectomy (LC) is the accepted standard treatment for acute cholecystitis (AC) in patients eligible for surgery. Percutaneous cholecystostomy (PC) can provide a permanent treatment for high-risk patients for surgery or act as a bridge for later surgical treatment. This study is an evaluation of the use of PC during the current coronavirus 2019 (COVID-19) pandemic at a single hospital.
METHODS: Fifty patients with AC were admitted as of the start of the COVID-19 pandemic in Turkey through June 2020. Patients with pancreatitis, cholangitis, and/or incomplete data were excluded from the study. Data of the remaining 36 patients included in the study were recorded and a descriptive statistical analysis was performed. The patients were divided into three groups: PC (n=14), only conservative treatment with antibiotherapy (OC) (n=14), and LC (n=8). The findings were compared with a group of 70 similar patients from the pre-pandemic period.
RESULTS: The mean age of the pandemic period patients was 53 years (range: 26–78 years). The female/male ratio was 1.11. PC was preferred in eight (11%) patients in the same period of the previous year, whereas 14 (39%) patients underwent PC in the pandemic period. Four of the 36 pandemic patients were positive for COVID-19, including one member of the PC group. There was one (7.1%) mortality in the pandemic-period PC group due to cardiac arrest. The length of hospital stay between the groups based on the type of treatment was not statistically significant.
CONCLUSION: LC is not recommended during the pandemic period; PC can be an effective and safe alternative for the treatment of AC.

BACKGROUND: Thoracic complications from retained abdominal gallstones are quite rare and the incidence rate ranges between 0.08% and 0.3%. Diagnosis and treatment of these complications are challenging due to the uncommon presentations and the debated role of the thoracic approach. This review of all cases reported in literature aims to discuss the best practice of this rare condition.
METHODS: A comprehensive literature search was performed for articles from January 1993 to May 2019 using PubMed, MEDLINE, Embase, ScienceDirect. The following mesh-words were used: “cholelithopthysis”, “thoracic”, “gallstones” “retained”, and “spilled”. All cases of thoracic complications from retained gallstones after laparoscopic cholecystectomy were extrapolated.
RESULTS: Twenty-four patients were included in this study. The most common symptoms were fever, hemoptysis and lithoptysis. Symptoms after laparoscopic cholecystectomy were presented after a mean time of 9.8±14.2 months (range from one week to 60 months). Delayed diagnosis was found in fourteen patients (58.4.%). Only four subjects were treated successfully with antibiotic therapy alone (16.7%), whereas 20 patients needed surgery or interventional radiology (83.3%). Seven patients (29.2%) were successfully managed with an abdominal approach. Three patients were managed using thoracentesis, thoracoscopic-thoracotomic drainage (12.5%). Right lung decortication and pulmonary wedge resections were necessary for ten patients (41.6%).
CONCLUSION: Clinicians always must inquire about the previous cholecystectomy for cholelithiasis related diseases in all patients suffering from recurrent right-sided pleural/lung affections, to improve diagnostic delay. The escalated approach must be performed: empirical antimicrobial therapy followed by targeted therapy as soon as microbiological data are available; afterwards, abdominal surgery is effective in approximately 30% of patients while the remaining patients have to be submitted to a thoracic approach.

BACKGROUND: Various surgical techniques have been defined for hip hemiarthroplasty (HA), including metaphyseal vs. diaphyseal and short stem vs. long stem. The present study aims to compare outcomes of metaphyseal fixed short-stem vs. diaphyseal fixed long-stem HA in treating unstable intertrochanteric fractures in elderly patients.
METHODS: This study was conducted retrospectively and included 129 patients ≥65 years of age, having unstable intertrochanteric fractures and undergoing HA. Outcome measures were the 2-year Harris hip score and the mobility score of Parker and Palmer; comorbidities as well as mortality rates of the groups were compared.
RESULTS: Mean operation time and median full weight-bearing time were significantly shorter in group B (p<0.05 for both). As for the Harris hip scores, group B showed better outcomes for the third-month evaluation (p=0.006). However, 2-year assessments were similar (p=0.067). In addition, higher Parker and Palmer mobility scores were obtained in group B at the 2-year assessment (p<0.001). The frequencies of prosthetic dislocation, cortical porosis and subsidence were higher in group A (p<0.05 for all).
CONCLUSION: The findings obtained in this study suggest that diaphyseal fixed long-stem HA seems to be superior to the metaphyseal fixed short-stem HA because the former is related to better functional scores, earlier mobilization, and lower complication rates.

BACKGROUND: There is no consensus on the optimal treatment of Tillaux-Chaput fractures. The results of our cases treated with mini-open surgery (open reduction and internal fixation) concerning efficacy and complications, we aim to compare other procedures (open, percutaneous, and arthroscopy-assisted) with the literature data and to look for an answer to the question of whether the primary treatment can be mini-open surgery.
METHODS: Between the years 2014 and 2017, 22 of 30 patients with Tillaux-Chaput fractures were treated using mini-open surgery, open reduction and internal fixation with one cannulated screw. These cases were retrospectively examined concerning age, sex, side, surgery duration, complications, and American Orthopedic Foot and Ankle Score (AOFAS). Functional results were statistically evaluated 12 months after the injury. Follow-up included a clinical examination, imaging and AOFAS.
RESULTS: Of the patients, 14 were male (63.6%) and eight were female (36.4%). The mean age of the patients was 13.8 years. The mean surgery duration was 21 minutes. All fractures healed after an average of 14 weeks. No complications were observed in any of the cases. The mean follow-up time was 24.7 months. The mean preoperative AOFAS score was 53.3 and the mean postoperative AOFAS score was 93.6, which was a statistically significant difference. At the last follow-up, the AOFAS score was perfect for all cases.
CONCLUSION: Contrary to what is stated in the literature, the mini-open surgical procedure has many advantages. The operation is very short and the risk of nerve injury is very low. This study showed that Tillaux-Chaput fractures could be safely and efficiently treated with mini-open surgery. We recommend mini-open surgery, complete anatomical reduction, and internal fixation for successful results.

BACKGROUND: Anterior shoulder dislocation is the most common shoulder injury in patients presenting to the emergency department (ED). Up to 25% of these injuries are fracture-dislocations. In general, the standard approach is to obtain plain radiographs before and after reduction. Fresno-Quebec Rules (FQR) are described to identify the patients who require an x-ray before reduction to reduce radiation exposure and delays in treatment. We aimed to evaluate the efficacy of clinical predictors used in the Fresno-Quebec algorithm for detecting a shoulder fracture-dislocation.
METHODS: Records of patients who presented to the Emergency Department with presumed shoulder dislocation were retrieved and retrospectively analyzed according to “Fresno-Quebec Rule (FQR)”. Sensitivity, specificity, and predictive values of FQR for detecting associated injuries were calculated.
RESULTS: Eighty-nine (65.9%) men and 46 (34.1%) women were included. The mean age of patients was 46 years (16–89). Ninety-nine (73.3%) of the cases had their shoulder dislocated for the first time, whereas 36 (26.7%) patients had a recurrent dislocation. Fifty percent of the patients (18 cases) with recurrent dislocation presented with an atraumatic episode. The remaining 18 patients with a history of recurrent dislocations had their shoulder dislocated as a result of trauma, and four (22%) of them had fracture-dislocation. Using the Fresno-Quebec rules yielded 100% specificity for the diagnosis of fracture-dislocation. The severity of the injury mechanism was not predictive in traumatic but recurrent dislocations. Only one of four patients with a fracture-dislocation in the traumatic recurrent dislocation group had high energy trauma.
CONCLUSION: FQR has 100% sensitivity in detecting fracture-dislocations in patients admitted to ED with anterior shoulder dislocation. It utilizes simple parameters that are easy to use and recall. Using these rules, 30% of unnecessary radiographs can be avoided, saving time and money and reducing radiation exposure in anterior dislocations.

BACKGROUND: We aimed to evaluate the effects of two different burn dressings, hydrofiber with a silver (HFAg) and polylactic membrane (PLM), on altering the levels of important biomarkers Interleukin-6 (IL-6), Tumor necrosis factor-α (TNF-α), Transforming growth factor-β3 (TGF-β3) in blood and burnt tissue in children with second-degree burns.
METHODS: Children between the ages of one to 16 years, with 25–50% second-degree partial-thickness burns of the total body surface area were included in this study. Patients in the PLM group were dressed with PLM in a typical way according to the manual. The HFAg group was dressed with HFAg and a sterile cover. During and at the end of the 21-day treatment, blood and skin tissue samples were taken from the two burn and control groups. IL-6, TNF-α, and TGF-β β3 levels were evaluated in blood and tissue samples from all groups, and the results were analyzed statistically.
RESULTS: In the PLM group, IL-6 and TNF-α levels decreased early days in both serum and tissue samples to reach normal ranges compared with the HFAg group. In the PLM group, TGF-β3 levels were elevated than in other groups for two weeks.
CONCLUSION: In this study, we found that PLM controls inflammation earlier in both systemic and burn tissue. We also found that PLM increased the level of TGF-β3, which may be associated with the prevention of the development of hypertrophic scar in the burn wound, in the blood and burn tissue during this study.

BACKGROUND: Acute left colonic diverticulitis (ALCD) ranges from localized diverticulitis to perforation and fecal peritonitis, and treatment varies from conservative management to emergency surgery. The risk factors for recurrence following nonoperative management of ALCD is still controversial. We aimed to define the factors predicting severity level, progression and recurrence risk of ALCD to timely select patients requiring surgery.
METHODS: This is a multicenter study where patients were included on accrual. Patients in our clinic between December 2017 and June 2019 with ALCD above 18 years of age were included (n=144) in this study, while 18 years and younger, pregnant or nursing mothers, those with Crohn’s disease, ulcerative colitis, colorectal and/or anal cancer were excluded from this study. Laboratory parameters, Modified Hinchey Scores, clinical features, demographics, diet, smoking, alcohol consumption, body mass index, previous diverticulitis episodes, chronic diseases of patients with ALCD, as well as recurrences within 18 months after discharge were evaluated.
RESULTS: The findings showed that smoking was more common in patients with previous episodes (p=0.04) and patients who underwent emergency surgery (p=0.04). Recurrence was higher in Modified Hinchey 1b and 2 (p=0.03) than 0 and 1a. Patients who were older than 50y had a higher propensity to undergo emergency surgery than the patients younger than 50y (p=0.049). Nausea, fever, respiratory rate, procalcitonin, total bilirubin and direct bilirubin levels were higher in patients with Modified Hinchey 4 (p=0.03, 0.049, 0.02, 0.001, 0.002, 0.001, respectively). Recurrence was higher in patients with a smoking history, previous ALCD episodes, lower body mass index and pandiverticulitis.
CONCLUSION: Laboratory parameters, body mass index, age, clinical features, previous episodes of diverticulitis and smoking may predict the severity and progression of ALCD. Smoking and having low BMI seem to be precursors of ALCD recurrence, especially when the patient with MHS 1b or 2 had at least one previous episode of ALCD. Control colonoscopy results are predictive of recurrence.

BACKGROUND: To compare the effectiveness of spinal anesthesia (SA) and the combination of intraurethral topical instillation of 2% lidocaine + intraurethral local visual injection anesthesia (T + LIA) for visual internal urethrotomy (VIU) in the treatment of traumatic posterior urethral strictures and prostatic urethral stenoses.
METHODS: In this study, the results of 178 patients who underwent visual internal urethrotomy for posterior urethral strictures and prostatic urethral stenoses secondary to trauma in our clinic between October 2018 and January 2020 were analyzed retrospectively. Patients were divided into two groups as combined T + LIA (n=146, 82.08%) group and SA (n=32, 17.97%) group according to the type of anesthesia used. The preoperative clinical data and postoperative results of the patients were analyzed and compared between the groups.
RESULTS: The mean age of the patients was 67.99±10.87 years and the mean follow-up was 5.32±3.27 months. The median age of the patients in the T + LIA group was significantly higher than that of the patients in the SA group (p=0.033). There was no statistically significant difference between the groups regarding preoperative Q-max value (p=0.931). Similarly, the rate of postoperative improvement in the Q-max values of the patients was similar between the groups (p=0.572). The presence of postoperative complications and recurrence rates were similar between the groups (p=0.879 and p=0.904, respectively).
CONCLUSION: Compared to spinal anesthesia, T + LIA anesthesia is a safe and effective technique for visual internal urethrotomy in treating traumatic posterior urethral strictures and prostatic urethral stenoses, with a high rate of success and acceptable rate of complications.

BACKGROUND: Over-the-scope clip (OTSC) devices are now widely used by endoscopists for gastrointestinal bleeding, perforation, or leakage. The present study aims to examine the therapeutic success rate of this technique.
METHODS: This was a single-center, retrospective study. In this study, 23 patients with gastrointestinal bleeding, leakage, or perforation were included. The procedure was performed by an experienced endoscopist.
RESULTS: Of the patients with an upper gastrointestinal tract defect, six had a perforation and there was one case of anastomosis leakage. Eight patients had a perforation in the lower gastrointestinal tract, and there were two cases of anastomosis leakage. Bleeding was detected in only six patients and all of them were upper gastrointestinal bleeding. Anastomosis leaks, perforations, and bleeding were treated with OTSC and additional procedures. The success rate of OTSC clipping alone was 56.5%. However, the success rate was 86.9% with additional therapeutic procedures (clamp, stent, sclerotherapy). Analysis according to categories of bleeding, perforation, and anastomosis leak revealed that the success rate of the clip application in bleeding was significantly higher than that of perforation or anastomosis leak (p=0.002). The median length of stay in the hospital was five days (min-max: 2–30 days). There were no complications associated with the OTSC procedure.
CONCLUSION: OTSC is a safe and effective method for the management of gastrointestinal bleeding, perforation, or anastomosis leak.

Decompression illness (DCI) is a rare condition caused by air bubbles that arise because of a rapid decrease in ambient pressure. These air bubbles exert both physical and chemical effects associated with a range of findings from asymptomatic clinical presentation to death. In the literature, changes in consciousness, severe musculoskeletal and abdominal pain, respiratory distress, and skin changes have been described. The diagnosis of DCI is difficult, but anamnesis and physical examination are helpful. Radiologic evaluation is useful for determining possible complications in patients with severe disease and excluding other acute pathologies. In computed tomography (CT) images of patients diagnosed with DCI, air bubbles in the portal venous system, iliac and mesenteric veins, the vena cava inferior (VCI), and the cerebral and spinal arteries have been described before. Herein, we present the clinical and CT findings of two cases of DCI with extensive intra-abdominal free bubbles evident on abdominal CT.

Wandering spleen is defined as the spleen that is not in its normal anatomic position due to the absence or laxity of suspensory ligaments. Congenital and acquired factors play a role in its etiology. It is a rare condition and may cause life-threatening complications as torsion or infarction. Rarely, patients may present to the emergency department with an acute abdomen. They may also present with chronic abdominal pain or intraabdominal mass. Given that its clinical diagnosis is difficult to make, radiological studies have an important role for an accurate diagnosis. In this paper, we presented a 24-year-old patient with torsion of a wandering spleen who presented with an acute abdomen and underwent laparoscopic splenectomy under urgent conditions.

A 20-year-old man suffered from a swelling with a painless but cosmetic problem in the right temporal region. Pseudoaneurysm of the superficial temporal artery is rare. It typically occurs after blunt trauma to the temporal region and presents as a painless, preauricular and pulsatile mass during the following 2–6 weeks. The diagnosis is made simply by physical examination and ultrasound. Surgery under local anesthesia is a very effective treatment.