BACKGROUND: The purpose of this study was to present a systematic review and meta-analysis of the diagnostic accuracy of magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis in pregnant women.
METHODS: A literature search was conducted using the databases of PubMed, Ovid MEDLINE, EMBASE, and the Cochrane Library. The inclusion criteria were the use of MRI, as a diagnostic protocol for acute appendicitis in pregnant women, and the availability of diagnostic parameters, such as sensitivity and specificity. For each selected study, the basic demographic information and measures of diagnostic accuracy, such as sensitivity, specificity, and positive and negative predictive values, were extracted. Forest plots and summary receiver operating characteristic curves (SROC) were also obtained for diagnostic accuracy of MRI for acute appendicitis during pregnancy.
RESULTS: A total of 22 studies and the data of 2392 patients were analyzed. Most studies had high sensitivity, with the exception of a few that had sensitivities of 0.18, 0.5, and 0.6. With respect to specificity, most results were close to 1.0, and the lowest result was 0.92. The SROC curves showed high levels of accuracy, as evidenced by an area under the curve value of 0.9922.
CONCLUSION: MRI showed overall high accuracy for diagnosing acute appendicitis in pregnant women. Therefore, it is a good diagnostic tool as a first-line imaging method for suspected appendicitis in pregnant women.

BACKGROUND: Acute mesenteric ischemia (AMI), although relatively rare, is an emergency condition with high mortality rates (60–80%) attributed to lack of early diagnosis. The aim of this experimental study was to observe the changes in serum intestinal fatty acid-binding protein (I-FABP) levels over time in the AMI model by ligating superior mesenteric artery (SMA) in rats and to compare with the serum I-FABP levels of the rats in the control group.
METHODS: Twenty rats were randomly allocated into two groups as control and ischemia group. The basal serum I-FABP levels were determined. SMA was isolated by laparotomy in all animals. In the ischemia group, SMA was ligated and intestinal ischemia was formed. Blood was taken from each rat in both groups at 30th, 60th, and 90th min to determine the serum I-FABP levels. The blood results were compared between two groups and were also compared by time in each group.
RESULTS: In the ischemia group, serum I-FABP levels were significantly higher than the control group at post-operative 30th, 60th, and 90th min (p<0.01). In comparison with pre-operative serum I-FABP levels, remarkable increases were observed statistically at post-operative 30th, 60th, and 90th min in the ischemia group (p<0.01). In contrast, there was no statistically significant difference within the serum I-FABP levels over time in the control group. The increases of serum I-FABP levels in the ischemia group were directly correlated with the time of ischemia.
CONCLUSION: Serum I-FABP levels have increased significantly in the intestinal ischemia and these values have risen progressively over time. Serum I-FABP may be a useful and promising biomarker for the early diagnosis of AMI.

BACKGROUND: In this experimental rat model, we aimed to investigate boric acid’s possible protective effect against the formation of post-operative abdominal adhesions through its anti-inflammatory and antioxidant properties.
METHODS: Forty healthy male albino rats were randomly and evenly allocated to vehicle, hyaluronic acid-based (HA-b) material, boric acid 50 (BA50), boric acid 100 (BA100), and sham groups. Intra-abdominal adhesions were induced by mechanical cecal abrasion. Macroscopic and pathologic assessments of the adhesions were done and tissue tumor necrosis factor-α (TNF-α) and transforming growth factor-β1 (TGF-β1) levels were measured.
RESULTS: Total abdominal adhesion scores were 129.7, 91.07, 53.77, 90.07, and 140.5 for the vehicle, HA-b, BA50, BA100, and sham groups, respectively, with the highest score indicating more severe adhesions. A significant difference in fibrosis scores was noted between both BA50 and BA100, and the sham group (p=0.018). When objective parameters were analyzed, TNF-α levels were significantly lower in the BA50 group than the sham, BA100, and vehicle groups (p=0.01, 0.019, and 0.03, respectively). TGF-β1 levels were also significantly lower in BA50 group than the sham, BA100, and the vehicle groups (p=0.013, 0.016, and 0.05, respectively). No difference was observed for any parameter between BA50 group and HA-b group.
CONCLUSION: Topical boric acid at a dose of 50 mg/kg is found safe and as effective as the hyaluronic acid-based agent in preventing postoperative abdominal adhesions in our rat model.

BACKGROUND: This study aimed to examine the relationship between the immediate and early complete blood count-based scores and prognosis in trauma patients.
METHODS: This retrospective observational study included adult patients admitted for severe trauma between January 2014 and December 2018. Multivariate logistic regression analysis was conducted to assess the association between the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR), and in-hospital mortality.
RESULTS: Among the 288 patients included in the study, in-hospital mortality was 26.4% (n=76). Immediately after emergency department (ED) arrival, non-survivors had lower NLR (3.28 vs. 4.73) and PLR (55.73 vs. 87.21) and higher LMR (4.91 vs. 3.91) than survivors. At 6 h after ED arrival, non-survivors had lower NLR (4.98 vs. 8.37) and PLR (58.23 vs. 123.74) and higher LMR (2.88 vs. 1.69) than survivors. Results of multivariate regression analysis revealed that NLR (odds ratio [OR], 0.926; 95% confidence interval [CI], 0.881–0.973) and PLR (OR, 0.994; 95% CI, 0.990–0.998) at 6 h after ED arrival were independently associated with in-hospital mortality.
CONCLUSION: Lower NLR and PLR at 6 h after ED arrival were associated with in-hospital mortality in cases of severe trauma.

BACKGROUND: The purpose of the study was to review the efficacy, safety, and outcomes of percutaneous cholecystostomy (PC) in elderly patients with acute calculous cholecystitis (ACC), high comorbidity, and COVID-19.
METHODS: The hospital registry data were examined of patients aged >65 years who were diagnosed with ACC and COVID-19 between March 2020 and June 2020 and who underwent PC treatment in the interventional radiology unit.
RESULTS: A total of 18 patients were diagnosed with ACC and COVID-19, then underwent PC. The patients comprised 14 (78%) males and 4 (22%) females with an average age of 73.4 years (range, 67–81 years). In 17 (94%) patients, symptoms associated with acute cholecystitis decreased within 48–72 h of the PC treatment and a clinical improvement was determined. The success rate of PC was 100% and no complications. In 3 (16.6%) patients followed up with intubation in intensive care after the procedure, mortality developed due to COVID-19-associated pneumonia and subsequent acute respiratory distress syndrome, and 15 (83.4%) patients were discharged with an elective cholecystectomy plan.
CONCLUSION: COVID-19 infection can be fatal especially in patients over 65 years of age due to additional comorbidities. PC treatment, which can be performed under local anesthesia as a minimally invasive procedure, is an alternative treatment option in this patient group. PC can also act as a bridge in transition to elective surgery in this process management.

BACKGROUND: The present study aims to investigate the efficacy of ultrasound simulators in the training of the health staff working in the emergency department of a university hospital on Focused Assessment with Sonography for Trauma (FAST).
METHODS: This study was conducted on emergency medicine residents, medical interns and paramedics of the emergency department of Selçuk University Medical Faculty, prospectively. The participants were given theoretical and practical training on FAST using the SonoSim® USG simulator. At the end of the training, all participants were requested to perform FAST for the pre-selected scenarios for five patients to find the ideal diagnostic window for each patient and declare the diagnosis.
RESULTS: This study included 60 participants, including emergency medicine residents, medical interns and paramedics, each having 20 members. The rate of obtaining the correct image was 99.5%, and the rate of diagnosing correctly was 94% among resident physicians. For interns, these rates were 98.5% and 88%, respectively. For paramedics, the rates were 98% and 81.5%, respectively.
CONCLUSION: It was observed that the theoretical knowledge level of the trainees did not affect the ability to obtain a correct image in the simulator. However, the skills of the trainees for correctly diagnosing via FAST were directly proportional to their theoretical knowledge levels. Our findings suggest that a short theoretical training followed by a simulator-guided practice would easily provide a sufficiency for FAST for the health workers.

BACKGROUND: There is still no consensus about whether laparoscopic appendectomy should be performed in selected cases or routinely in all cases for treatment of acute appendicitis. Especially for rural hospitals with laparoscopic equipment shortages, it is critical to develop surgical methods alternative to LA. This prospective study aimed to compare mini-incision open appendectomy (MOA) and laparoscopic appendectomy (LA) procedures.
METHODS: A total of 102 patients who had been operated on by a single surgeon for acute appendicitis between July 2018 and February 2020 and whose body mass index (BMI) was <30 were included in this study. Fifty-one patients were operated on with MOA and 51 with LA technique. The patients were evaluated concerning operation time, postoperative pain, hospital stay, postoperative infectious complications and cost-effectiveness.
RESULTS: Operation time was shorter in the MOA group than LA group (p<0.001). VAS scores at postoperative 12th and 24th hours were significantly lower in the MOA group than those in the LA group (p<0.001). Total hospitalization costs were lower in the MOA group than those in the LA group (p<0.001). No significant difference was found between the two groups concerning length of hospital stay and postoperative infectious complications (p=0.061 and p>0.999, respectively).
CONCLUSION: Mini-incision open appendectomy is a reliable method in patients with acute appendicitis who have a BMI of <30 and it is superior to laparoscopic appendectomy concerning the operation time, postoperative pain and cost.

BACKGROUND: To compare the clinical, biochemical, and histopathological features of patients who underwent appendectomy due to a presumed diagnosis of acute appendicitis (AAp).
METHODS: The demographic, biochemical and histopathological data of 8206 patients who underwent appendectomy for AAp between January 2006 and March 2014 were retrospectively analyzed in this study. Patients were compared regarding the following characteristics: disruption by season (autumn vs. winter vs. spring vs. summer), working days (weekdays vs. weekends), histopathological findings (AAp vs. normal appendix [NAp]) and histopathological subgroup (non-perforated AAp vs. perforated AAp vs. NAp).
RESULTS: Of the 8206 patients aged between 16 and 89 years, 4763 (58.0%) were male. Appendectomy distribution by season was as follows: autumn (n=1959; 23.9%), winter (n=2062; 25.1%), spring (n=2061; 25.1%) and summer (n=2124, 25.9%). NAp rates were higher in summer than those in other seasons. White blood cell (WBC) and neutrophil levels were significantly higher in autumn and winter compared with those in other seasons. In total, 6120 (74.6%) appendectomies occurred on weekdays and 2086 (25.4%) on weekends. WBC and neutrophil levels were significantly higher on weekends than those on weekdays. Appendectomy distribution by histopathological groups as follows: AAp (n=7414; 90.3%) and NAp (n=792; 9.7%). Appendectomy distribution by histopathological subgroups was as follows: non-perforated AAp (n=6966; 84.9%), perforated AAp (n=448; 5.5%), and NAp (n=792; 9.7%). WBC, neutrophil, and TBil levels in the non-perforated and perforated AAp groups were significantly higher than in the NAp group. While most of the patients with perforated AAp (62.1%) and non-perforated AAp (59.6%) were males, most of the patients with NAp (58.1%) were females.
CONCLUSION: This study suggests that a relationship exists between demographic features, histopathological findings of appendectomy specimens, seasons, days of the week, and working days in patients undergoing appendectomy.

BACKGROUND: The optimum biochemical or hematological marker to determine diagnosis and severity of acute diverticulitis has not been established. We aimed to compare the utility of hematological parameters in the diagnosis and severity of acute diverticulitis.
METHODS: Sixty-nine patients in diverticular disease (acute diverticulitis and diverticulosis subgroups) and 36 patients in control group were included in the study. The biochemical analysis performed at the time of diagnosis included white blood cell, mean platelet volume, neutrophil count, platelet count (PLT), C-reactive protein, and calculation of neutrophil count/lymphocyte and PLT/lymphocyte ratios. Patients in the diverticulitis group were divided into four stages according to the Hinchey classification based on abdominal CT findings.
RESULTS: The mean platelet-lymphocyte ratio in the diverticulitis and diverticulosis groups was significantly lower than that in the control group (p<0.05). The best sensitivity and specificity values to distinguish acute diverticulitis and diverticulosis were 63.64% and 72.22% for the neutrophil-lymphocyte ratio (NLR) at a cutoff value of 2.78 and above and 30.30% and 86.11% for the platelet-lymphocyte ratio at a cutoff value of 87.46 and above. The diagnostic accuracy rates to distinguish between the diverticulitis and the control groups that the best sensitivity and specificity values were found to be NLR at a cutoff value of 11.55 and above and 100% and 100% for the platelet-lymphocyte ratio at a cutoff value of 12.28 and above. The NLR values were significantly lower in patients with Hinchey Stage 1 disease than those in patients with Stages 2 and 3 disease (respectively, p=0.003 and p=0.006).
CONCLUSION: NLR and platelet-lymphocyte ratio can serve as useful biomarkers for the differential diagnosis and severity in acute diverticulitis.

BACKGROUND: The primitive cable car is the generic name given to the cable transportation settings driven between one or more steel cables is known as “varangel.” In this retrospective autopsy study, it was aimed to discuss the common injury patterns of the fatalities associated with the use of these primitive cable car systems.
METHODS: It is a retrospective archive-based study. The analysis of autopsy records of 10-year period between 2007 and 2016 revealed eight death cases resulting from the primitive cable car accident.
RESULTS: It was revealed that the primitive cable car-related deaths mainly occur because of blunt traumas (crash of cage, chit by the broken cables, and failing from height) and electric shock. The blunt traumas and failings from height occur because of contact with the cage of primitive cable car, whereas the electric shocks occur because of contact with cables, on which the cage is hung.
CONCLUSION: Primitive cable cars may be fatal and must be under official control.

BACKGROUND: Burn contractures that cause a restriction in extremity movements have to be reconstructed. Free microvascular flaps are generally needed in cases of severe contractures. The ideal free flap for severe contracture defects has to have a large skin island without bulk and a long pedicle for preventing recurrence and tension-free adaptation. Anterolateral thigh flap (ALT flap) that meets these features has widely been used for several indications in reconstructive surgery. Usage of ALT flap in burn contracture was described for burn and axillary contractures in literature. In this study, the usage of free ALT flaps in various anatomic contracture sites was reported.
METHODS: Fifteen free ALT flaps were performed in 14 (12 male, two female) patients with a mean age of 36.6. Burn contracture defects in neck, axilla, popliteal, cubital region, plantar foot and hand were reconstructed with ALT flap.
RESULTS: No total flap loss was encountered. Distal flap necrosis was seen in one case. All patients had significant improvement in a range of motions. Recurrence in contracture was seen in one patient with hand flexor contracture due to lack of physical treatment.
CONCLUSION: ALT flap can safely be used in various anatomic contracture sites. Suprafascial elevation of the flap can be preferred for better adaptation in the neck, hand and foot and prevention of bulky appearance.

BACKGROUND: The aim of this study was to compare two different nail types (i.e., Intertan (IT) and Talon Distal Fix Nail / Lag Screw (TDFN)) used in the treatment of unstable intertrochanteric fractures in mobile patients over 65 years of age in terms of radiological parameters.
METHODS: Between June 2013 and August 2018, 106 patients over 65 years old who were operated with closed reduction and internal fixation for intertrochanteric fractures were included in this single-center study. Patients were divided into two groups based on the proximal femoral nail used: IT group and TDFN group. These two groups were compared in terms of age, sex, complication rates and radiological parameters (i.e., reduction quality, tip apex distance (TAD), Parker index, union time, cut-out rate, and varus collapse).
RESULTS: There were no differences between the groups in terms of age, sex, fracture union time as well as reduction quality measured on the first postoperative radiograph, Parker index, and collodiaphysial angle. In the first postoperative radiographs, TAD was higher than 25 mm in 12 patients in the IT group and in 5 patients in the TDFN group. Although the number of patients with high TAD was more than that of the IT group, varus collapse and the cut-out complications were higher in TDFN nail. In the IT group, nail-dependent complications emerged in 4 patients (trochanter major fracture in 3 cases, femoral fracture in distal screw in 1 case) while there was no complication in the TDFN group.
CONCLUSION: Intertan nail is superior to TDFN in preventing varus collapse and the cut-out complications as well as in maintaining of radiological parameters until fracture union. On the other hand, the higher complication rate is a disadvantage of this nail.

BACKGROUND: To describe gender-related differences in the length of the left chord and pedicle at the level of 12th thoracic vertebrae and appropriate length of the screw to be applied so as to decrease the perforation risk of anterior cortex of the corpus and preventable injury of major vascular vessels.
METHODS: Axial bone window computed tomography images of T12 vertebral pedicles of 60 patients (30 males and 30 females, age >25 years) without any sign of spinal trauma were obtained and morphometric data were analyzed.
RESULTS: Mean ages of the female (n=30) and male (n=30) patients were 32.17±4.24 and 31.70±3.60 years, respectively. The left chord lengths of T12 of the male (38.17±2.54 mm) and female (36.62±2.27 mm) patients were compared and a statistically significant difference was found between these two measurements (p=0.016). A statistically significant difference between the length of the left chord (37.40±2.51) (range, 32–44 mm) and age (31.93±3.91) (range, 25–40 years) and also a moderate degree of correlation were observed (p=0.002), (r=0.401). A statistically significant difference and a moderate degree of correlation were found between the lengths of the left chords (37.40±2.51; range, 32–44 mm) and the left pedicles (12.12±1.34; range, 10.0–15.80 mm) (p=0.001), (r=0.577).
CONCLUSION: Significant differences and correlations exist between the left pedicle and the left chord in male and female patients and patients with different ages. The data obtained can be used as a guide to determine the implant size and intraoperative management of T12 vertebral pedicle.

BACKGROUND: Although there is consensus that closed tendinous mallet finger injuries should be treated conservatively, the best method of immobilization to be used is not clear and the existing data in the literature are not conclusive. The aim of this study is to compare the results of four different immobilization methods used in the conservative treatment of tendinous mallet finger injury.
METHODS: Ninety-six patients with tendinous mallet finger injury were treated with four different immobilization methods (stack orthosis, thermoplastic orthosis, aluminum orthosis, and Kirschner wire [K-wire] immobilization). The patients then were assessed with distal interphalangeal joint extensor lag, total active motion (TAM), grip strength, and Abouna and Brown Criteria.
RESULTS: No significant difference was found between four immobilization methods in extensor lag and TAM at the 8th and 12th weeks. According to grip strength assessment, stack orthosis group was found to have significantly better results than the K-wire and aluminum orthosis groups at 12 weeks, while the difference was not significant versus the thermoplastic orthosis group.
CONCLUSION: In this first study making multiple comparisons between four immobilization methods used in the treatment of tendinous mallet finger injury, the only significant difference detected between the groups was the superior grip strength with stack orthosis compared with K-wire immobilization and aluminum orthosis.

BACKGROUND: Hepaticojejunostomy is a challenging and complex procedure to be administered with the confidence, in conditions which contain a large number of bile duct damaged by benign pathologies or major bile duct trauma.
METHODS: Here, our clinical series of portoenterostomy (PE), in which we applied in patients who had aggressive hilar dissection for hilar benign biliary pathologies and major bile duct traumas during laparoscopic cholecystectomies were discussed in the light of the literature. The PE procedure was performed in the presence of three or more bile ducts that could not be merged. The classic Roux-en-Y style hepaticojejunostomy was performed to prevent postoperative ascending cholangitis. The ropeway system was used when sewing. 6-8 stitches were laid on the back or anterior wall and the sutures were tied on the outside. Thin-long silicone stents placed in the small diameter (2 mm) bile ducts coinciding with the anastomosis line were extended into the jejunum.
RESULTS: This study included six patients who underwent PE between 2015–2019. Five of the cases were male and one was female and the mean age was 70.33 years. Hepaticojejunostomy was performed in two of the four cases with biliary trauma, but the endoscopic and surgical revision was performed due to developing strictures and bile flow was corrected with stents. In these two cases coming from the external center, PE was applied to multiple bile ducts resulting from aggressive hilar dissection. In two patients who developed major biliary tract trauma (Strasberg-Bismuth-E4) at our hospital underwent PE in the same session. In the other two cases, PE was performed due to a large number of bile ducts caused by benign pathology-related complications (Mirizzi syndrome, Type 4). The mean follow-up period for six patients was 20.1 months (range 11 to 37 months).
CONCLUSION: Portoenterostomy can be performed as a salvage procedure in cases where multiple biliary tracts occur and hepaticojejunostomy is inadequate. PE can be safely used in selected cases that had benign pathologies, major bile duct trauma, in the presence of intense fibrosis, inflammation, very thin bile ducts and more fragile tissues in the liver hilum. PE should be performed in centers with surgeons experienced in hepatobiliary surgery. However, to better understand the efficacy of PE, large multicentric clinical series and patient follow-up are required.

The frequency of osteochondral fractures in the knee joint in the pediatric population is not clearly known. Although fragment fixation is generally considered to be the ideal treatment method in acute injuries, the data of the results of late fixation in neglected and/or late-diagnosed cases are very limited. In this paper, we report our findings regarding the fixation of a delayed large osteochondral fracture in lateral femoral condyle in a pediatric patient.

Subcutaneous facial emphysema is a well-known consequence of oral and maxillofacial traumatic injury. In some rare cases, the subcutaneous air collection could spread through the retropharyngeal and paralatero-cervical spaces, reaching the mediastinum. A 55-year-old man was presented to the emergency room after a blast injury caused by a blown truck tire while trying to change tires. The chest radiograph demonstrated suspected pneumomediastinum or pneumothorax. A computed tomography scan of the neck and thorax revealed widespread surgical emphysema along the thoracic wall, extending through the mediastinum. The patient was monitored in the Thoracic Surgery Department after surgery and managed with conservative methods. He had no complications on clinical follow-up following hospital discharge. The development of pneumomediastinum after oral or maxillofacial trauma is rare. Nevertheless, given the mortal complications that may develop, clinicians should keep pneumomediastinum in mind in the differential diagnosis.

Although corrosive injury of the digestive tract is a well-known clinical entity, damages of the airway and a critically life-threatening condition, have not been clearly documented. Tracheal stenosis is very rare associated with corrosive acid ingestion. We report the case of a 4-year-old girl child who presented to the emergency department three weeks after accidentally drinking an acidic cleaning agent stored in an unlabeled bottle. Rigid bronchoscopy was administered to observe the stenosis. She was treated by serial dilation, repair of tracheal laceration, and placement of a temporary polyurethane-coated nitinol stent. Careful and accurate stent placement may provide significant and life-saving airway improvement as observed in the presenting pediatric case.