Turkish Journal of Surgery最新文献

Everolimus is one of the immunosuppressive drugs used in solid organ transplantation. Many side effects have been described for these immunosuppressive drugs, similar to other drugs in this category. The purpose of this case presentation is to draw attention to drug-induced pneumonitis, which is a rare and life-threatening side effect of everolimus. A nineteen-year-old female patient who received liver transplantation for toxic hepatitis was admitted to our institute with cough and dyspnea. Everolimus had been started in conjunction with tacrolimus therapy 6 months prior to admission. Her chest imaging were consistent with pneumonitis. Markers of infection and cultures were all negative. After discontinuation of everolimus, symptoms and radiological findings resolved. The adverse effects of the drug should be kept in mind while investigating possible infectious agents in liver transplant recipients who are prone to opportunistic infections.

Objective: The aim of this study is to compare the results of repeat colonoscopies performed on the same day and by appointment in patients with inadequate bowel cleansing.

Material and methods: The study was designed as a prospective randomized controlled study. Eighty patients with inadequate bowel cleansing detected in elective colonoscopies were included in the study. Patients were randomly divided into 2 groups: Group I: Same day group and Group II: Appointment day group. Same day colonoscopy group was given day hospitalization, sennoside A+B calcium was given and colonoscopy procedure was repeated. Patients in Group II were rescheduled and standard colonoscopy preparation protocol was applied. Boston bowel preparation scale (BBPS) was used for bowel preparation quality. Cecal intubation time, cecal intubation rate, procedure time, BBPS score and polyp detection rate were compared between the groups.

Results: In the same-day group, 52.5% of the patients were female while 45.9% were female in the appointment group. There was no significant difference between the two groups in terms of age or gender (p>0.05). The rate of cecum intubation was higher in the same-day group than it was in the appointment group (p=0.022). The total BBPS score was 7.9±1.79 in the same-day group and 6.89±2.23 in the appointment group, and the difference was statistically significant (p=0.03). When the two groups were compared in terms of tolerability of the procedure, no difference was detected (p>0.05).

Conclusion: Same-day colonoscopy is an effective method and can be performed safely in patients with inadequate bowel cleansing.

Acute mesenteric ischemia represents a group of diseases, which lead to an abrupt interruption of blood flow to the small intestine resulting in intestinal necrosis. Its first symptoms are vague and in the majority of cases nonspecific, so the diagnostic suspicion is of the utmost importance to establish the correct diagnostic and prompt treatment. It is a complex and difficult event, that needs a multidisciplinary approach involving different specialties such as gastrointestinal and vascular surgeons, interventional radiologists, and expertise from the acute care unit team. The fundamental aspect is the precocity of diagnostic based on abdominal computed angio-tomography and the immediate re-establishment of blood supply to the affected areas. In this report, we introduce a case of a patient with mesenteric venous thrombosis, who has beenundergone a percutaneous endovascular treatment (portal-mesenteric mechanical thrombectomy, besides an intravenous thrombolytic infusion), due to poor clinical response after anticoagulation approach that needed mechanical ventilation.

The case involves a one-year-old male with a mesenchymal hamartoma involving the right hepatic lobe. The tumor-free segments comprised 17% of the liver volume, which placed the patient at risk for post-resection liver failure. A staged approach, the associating liver partition with portal vein ligation for staged hepatectomy, was employed. This allowed the interval growth of the liver remnant and thereafter enabled right lobectomy with adequate liver function.

Objective: The acquisition of communication skills, which form the basis of solution-focused thinking, also develops self-confidence in organ transplantation coordinators, enabling them to plan appropriate care in the organ donation process. The aim of this study was to determine the levels of self-confidence, communication skills, and solution-focused approaches in organ transplantation coordinators.

Material and methods: A descriptive and correlational study. The study was conducted with 203 organ transplantation coordinators in Türkiye between August and September 2023. The data were collected using a personal information form, the self-confidence scale, the communication skills scale, and the solution-focused inventory.

Results: A positive, weak correlation was determined between the solution-focused inventory and communication skills (r=0.261, p<0.001) and self-confidence (r=0.269, p<0.001), and a positive high-level correlation was determined between communication skills and self-confidence (r=0.811, p<0.001). Self-confidence (β=0.614) and the solution-focused approach inventory (β=0.076) explained 65.6% of the communication skills (corrected R²=0.656).

Conclusion: The solution-focused approach and self-confidence were found to increase the communication skills of the organ transplantation coordinator.

Objective: Malignant ascites is suggestive of peritoneal carcinomatosis. The distinction between malignant and non-malignant ascites in a patient with malignancy is important, as it alters the management and prognosis. Current diagnostic methods are imaging, cytology, and diagnostic laparoscopy, all of which have low sensitivities. The vascular endothelial growth factor (VEGF) is essential for tumour growth and, hence, ascitic VEGF levels can be a diagnostic method for malignant ascites.

Material and methods: This cross-sectional study was conducted in patients with gastrointestinal malignancies and ascites. The calculated sample size was 68 patients, who were divided into those who were truly positive or negative for malignant ascites based on a composite gold standard, comprising cytology, contrast enhanced computed tomography, and laparoscopy. The ascitic VEGF levels in these patients were compared.

Results: A total of 84 patients were enrolled, of whom 60.71% were found to have malignant ascites. It was found that the greater the volume of ascites, the greater the statistical likelihood of finding truly malignant ascites. The ascitic VEGF levels had a non-normal distribution, with median values of 783.64 and 41.12 pg/mL for malignant and non-malignant ascites (p<0.001). Using a receiver operating characteristics curve, a cut-off of 83.68 pg/mL was obtained, with a sensitivity of 100% and a specificity of 93.94%.

Conclusion: This study demonstrates that ascitic VEGF levels are significantly elevated in patients with gastrointestinal malignancies and malignant ascites and hence can reliably be used for diagnosing malignant ascites. This study also shows that massive ascites and well-differentiated tumours have a higher rate of peritoneal carcinomatosis.

Objective: The complication rates after parotidectomy were reported to be 13-29% and many techniques were implemented to decrease these post-parotidectomy complications.

Material and methods: Between August 2016 and June 2022, one hundred and twenty-five patients with parotid tumors had parotidectomy and ligation of the main parotid duct in the Department of Surgical Oncology, Oncology Center, Mansoura University with the observation of its effect on the postoperative outcomes.

Results: Superficial parotidectomy was performed in 87 (69.6%) patients, total parotidectomy in 31 (24.8%) patients, and quadrantectomy in 7 (5.6%) patients. The operative time was 130.76±51.5 min, and the blood loss was 81.32±45.02 mL. A suction drain was placed in 106 patients and a non-suction drain was used in 19 patients. Postoperative complications included facial nerve morbidity in 12% of the patients, bleeding in 1 patient, seroma in 5 patients, edema in 1 patient, wound gap in 1 patient, wound infection in 1 patient, and keloid in 1 patient.

Conclusion: The identification and ligation of the main parotid duct during parotidectomy has favorable impacts on the incidence of post-parotidectomy complications such as salivary fistula, seroma, sialocele, and wound infections.

Objective: The aim of this study was to investigate the frequency of incidental pathologies detected in the surgical specimens of patients who underwent laparoscopic cholecystectomy in high-volume referral center, which accepts patients from different regions of our country, and to contribute to epidemiological studies.

Material and methods: Male and female patients over 18 years of age who underwent laparoscopic cholecystectomy between July 2010 and May 2019 were included in the study. All surgical specimens were taken for pathologic examination. The pathology results were classified into three categories: Benign pathologies (including cholecystitis, non-neoplastic lesions and benign tumors), premalignant pathologies and malignant pathologies.

Results: The study included a total of 8148 patients. The mean age was 49.74±14.51 years (minimum 18, maximum 94) and 72.2% of the patients were female. Benign pathologies included cholecystitis in 1742 (21.4%), non-neoplastic lesions in 6203 (76.1%) and benign tumors in 12 (0.1%), premalignant pathologies in 173 (2.1%) and malignant pathologies in 18 (0.2%). Although no statistically significant gender difference was observed between benign, premalignant and malignant pathologies, the incidence of premalignant and malignant pathologies increased with age (p=0.273, p<0.001, respectively).

Conclusion: In this study of 8148 patients, incidental premalignant and malignant pathologies were identified in 2.1% and 0.2% of cases, respectively, which is consistent with the findings of literature. These results may be instructive for epidemiologic studies.

Objective: Concurrent traumatic diaphragmatic hernia (TDH) and blunt thoracic aortic injury (BTAI) are rare but critical injury complexes that result from high-energy trauma mechanisms. This study analyzed the epidemiology, diagnostic approaches, risk factors, and outcomes of concurrent TDH and BTAI and proposed a structured treatment algorithm.

Material and methods: A retrospective analysis was performed using trauma records from a level 1 trauma center (2004-2024). Four male patients with confirmed concurrent TDH and BTAI were included in the study. Data on demographics, injury characteristics, diagnostic methods, treatment, and outcomes were collected. Statistical analyses were conducted using appropriate tests.

Results: All injuries were caused by high-energy traumas. Mean injury severity score was 38 and the revised trauma score was 6.58. A massive transfusion protocol was activated in 75.0% of cases. Diagnostic imaging showed varying accuracies, with computed tomography demonstrating superior sensitivity for both injuries. All TDH were left-sided posterolateral and BTAI predominantly involved the isthmus. Management followed a sequential approach, with 75.0% of diaphragmatic repairs preceding the aortic intervention. Mean hospital stay was 33 days, with complications including infections, deep vein thrombosis, and atelectasis. Despite the high severity of the injury, all patients survived.

Conclusion: Concurrent TDH and BTAI are rare, but critical injury complexes. Early recognition through structured diagnostic protocols and sequential management guided by institutional capabilities can achieve favorable outcomes despite high injury severity.