F. Şahin, Ramazan Adan, Neslihan Bademler, Elif Akkoç Demirel, Murat İbrahim Toplu, V. Mihmanlı
Background/Aim: Recognition and assessment of apical vaginal support defects remains a significant challenge in the evaluation and management of prolapse because there are no consensus or guidelines address the degree of apical support loss at which an apical support procedure should routinely be performed. The aim of this study was to evaluate whether preoperative genital hiatus (GH), perineal body (PB), and total vaginal length (TVL) are associated with prolapse recurrence after apical prolapse surgery. Methods: Our cohort study included 98 patients who underwent vaginal hysterectomy apical suspension due to uterovaginal prolapse of grade 2 or higher according to Pelvic Organ Prolapse Quantification (POP-Q) staging between 2020 and 2021. Patients with a history of gynecologic malignancy, those who could not tolerate surgery or anesthesia, those who had previously undergone pelvic organ prolapse surgery, those with concomitant stress urinary incontinence, and those with abnormal cervical smear results were excluded. Patients were followed for 2 years at intervals of 3 months in the first year after the surgery. The last POP-Q was performed 24 months after surgical intervention. Surgical failure or recurrence was defined as apical descent greater than one third of the total vaginal length, anterior or posterior vaginal wall past the hymen, subsequent surgery, or bothersome vaginal bulge. Patients were given the Pelvic Organ Prolapse Symptom Score (POP-SS) questionnaire before surgery and 6 months postoperatively, and the severity of symptoms was compared between the groups with and without postoperative recurrence. Logistic regression (LR) analysis was performed to determine the factors affecting recurrence. Areas under the ROC curve were calculated as a differential diagnosis for the presence of recurrence, and the predictive value (cut-off) of variables was determined using sensitivity, specificity, positive predictive value, negative predictive value, and LR (+) values. Results: While surgery was successful in 80 patients, genital relapse was seen in 18 patients. The mean preoperative perineal body was 3.05 (0.28) cm, mean preoperative GH was 3.9 (0.39) cm, and mean preoperative TVL was 8.54 (1.33) cm. The mean GH of the group with recurrence was significantly higher than the group without recurrence (P=0.004). The mean preoperative POP-SS score was 15.14 (1.86), and the postoperative POP-SS score was 4.01 (3.74). The postoperative POP-SS score mean of the recurrence (+) group was significantly higher than the group without recurrence (P<0.001). For the genital hiatus, the cut-off >4 cm had a sensitivity of 61.11%, specificity of 76.25%, positive predictive value of 36.70%, negative predictive value of 89.70%, and LR (+) value of 2.57. For POP-SS Preop-Postop Change %, the cut-off <60 had a sensitivity of 94.44%, specificity of 98.75%, positive predictive value of 94.40%, negative predictive value of 98.80%, and LR (+) value of 75.56. Conclusi
{"title":"Genital hiatus measurements predict cuff prolapse risk in prolapse surgery","authors":"F. Şahin, Ramazan Adan, Neslihan Bademler, Elif Akkoç Demirel, Murat İbrahim Toplu, V. Mihmanlı","doi":"10.28982/josam.7776","DOIUrl":"https://doi.org/10.28982/josam.7776","url":null,"abstract":"Background/Aim: Recognition and assessment of apical vaginal support defects remains a significant challenge in the evaluation and management of prolapse because there are no consensus or guidelines address the degree of apical support loss at which an apical support procedure should routinely be performed. The aim of this study was to evaluate whether preoperative genital hiatus (GH), perineal body (PB), and total vaginal length (TVL) are associated with prolapse recurrence after apical prolapse surgery.\u0000Methods: Our cohort study included 98 patients who underwent vaginal hysterectomy apical suspension due to uterovaginal prolapse of grade 2 or higher according to Pelvic Organ Prolapse Quantification (POP-Q) staging between 2020 and 2021. Patients with a history of gynecologic malignancy, those who could not tolerate surgery or anesthesia, those who had previously undergone pelvic organ prolapse surgery, those with concomitant stress urinary incontinence, and those with abnormal cervical smear results were excluded. Patients were followed for 2 years at intervals of 3 months in the first year after the surgery. The last POP-Q was performed 24 months after surgical intervention. Surgical failure or recurrence was defined as apical descent greater than one third of the total vaginal length, anterior or posterior vaginal wall past the hymen, subsequent surgery, or bothersome vaginal bulge. Patients were given the Pelvic Organ Prolapse Symptom Score (POP-SS) questionnaire before surgery and 6 months postoperatively, and the severity of symptoms was compared between the groups with and without postoperative recurrence. Logistic regression (LR) analysis was performed to determine the factors affecting recurrence. Areas under the ROC curve were calculated as a differential diagnosis for the presence of recurrence, and the predictive value (cut-off) of variables was determined using sensitivity, specificity, positive predictive value, negative predictive value, and LR (+) values.\u0000Results: While surgery was successful in 80 patients, genital relapse was seen in 18 patients. The mean preoperative perineal body was 3.05 (0.28) cm, mean preoperative GH was 3.9 (0.39) cm, and mean preoperative TVL was 8.54 (1.33) cm. The mean GH of the group with recurrence was significantly higher than the group without recurrence (P=0.004). The mean preoperative POP-SS score was 15.14 (1.86), and the postoperative POP-SS score was 4.01 (3.74). The postoperative POP-SS score mean of the recurrence (+) group was significantly higher than the group without recurrence (P<0.001). For the genital hiatus, the cut-off >4 cm had a sensitivity of 61.11%, specificity of 76.25%, positive predictive value of 36.70%, negative predictive value of 89.70%, and LR (+) value of 2.57. For POP-SS Preop-Postop Change %, the cut-off <60 had a sensitivity of 94.44%, specificity of 98.75%, positive predictive value of 94.40%, negative predictive value of 98.80%, and LR (+) value of 75.56.\u0000Conclusi","PeriodicalId":30878,"journal":{"name":"International Journal of Surgery and Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86500874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Multinodular and vacuolating neuronal tumors (MVNT) are indolent, low-grade, superficial neuronal tumors of the cerebrum that consist only of neuronal cells in adults. They were first reported in 2013 by Huse et al. and defined by the World Health Organization in 2016. MVNT is characterized by vacuolated tumor nodules with glial and/or neuronal differentiation histopathologically. MVNT is most commonly located in the temporal lobe. Radiologically, it has a subcortical, soap-bubble morphology, sometimes extending to the cortex, and is almost as hyperintense as cerebrospinal fluid on T2-weighted images. Its signal is not suppressed on the FLAIR sequence, and there is no diffusion restriction on diffusion-weighted images. Usually, there is no enhancement after gadolinium injections, but a few reports show weak enhancement in the literature. In the first case, we present a 22-year-old female with MVNT who underwent MRI for a complaint of dizziness which was detected incidentally. MRI showed a clustered multinodular lesion in the left superior frontal gyrus that was hyperintense on T2-weighted/FLAIR series and isointense with gray matter on T1-weighted images. There was no diffusion restriction or contrast enhancement on MRI. In the second case, a 51-year-old female with complaints of numbness and pain in her left arm had an MRI that showed a lesion in the right cerebral hemisphere at the temporoparietal junction. The lesion did not cause edema or mass effect and was distributed in the cortical-subcortical area. The lesion was hyperintense in T2-weighted and FLAIR series and consisted of many millimetric nodular components in close intensity with gray matter in the T1-weighted series. No contrast enhancement was detected. Knowing the characteristic imaging findings of MVNT is important in avoiding aggressive diagnosis and treatment approaches in asymptomatic cases. In conclusion, MVNT is a newly identified tumor that appears hyperintense on the FLAIR sequence and should not be operated on.
{"title":"Radiological approach to multinodular and vacuolating neuronal tumor: Two case report","authors":"S. O. Ocak Karatas, M. Beyhan, E. Gökçe","doi":"10.28982/josam.7344","DOIUrl":"https://doi.org/10.28982/josam.7344","url":null,"abstract":"Multinodular and vacuolating neuronal tumors (MVNT) are indolent, low-grade, superficial neuronal tumors of the cerebrum that consist only of neuronal cells in adults. They were first reported in 2013 by Huse et al. and defined by the World Health Organization in 2016. MVNT is characterized by vacuolated tumor nodules with glial and/or neuronal differentiation histopathologically. MVNT is most commonly located in the temporal lobe. Radiologically, it has a subcortical, soap-bubble morphology, sometimes extending to the cortex, and is almost as hyperintense as cerebrospinal fluid on T2-weighted images. Its signal is not suppressed on the FLAIR sequence, and there is no diffusion restriction on diffusion-weighted images. Usually, there is no enhancement after gadolinium injections, but a few reports show weak enhancement in the literature. In the first case, we present a 22-year-old female with MVNT who underwent MRI for a complaint of dizziness which was detected incidentally. MRI showed a clustered multinodular lesion in the left superior frontal gyrus that was hyperintense on T2-weighted/FLAIR series and isointense with gray matter on T1-weighted images. There was no diffusion restriction or contrast enhancement on MRI. In the second case, a 51-year-old female with complaints of numbness and pain in her left arm had an MRI that showed a lesion in the right cerebral hemisphere at the temporoparietal junction. The lesion did not cause edema or mass effect and was distributed in the cortical-subcortical area. The lesion was hyperintense in T2-weighted and FLAIR series and consisted of many millimetric nodular components in close intensity with gray matter in the T1-weighted series. No contrast enhancement was detected. Knowing the characteristic imaging findings of MVNT is important in avoiding aggressive diagnosis and treatment approaches in asymptomatic cases. In conclusion, MVNT is a newly identified tumor that appears hyperintense on the FLAIR sequence and should not be operated on.","PeriodicalId":30878,"journal":{"name":"International Journal of Surgery and Medicine","volume":"127 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90571442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Necrotizing fasciitis (NF) is a rare condition that is observed in obstetric and gynecological practices. It is a rapidly progressive and often fatal complication. Failure to obtain an early diagnosis and delay in initiating appropriate treatment can lead to significant morbidity and mortality. Our case was 25 years old, and she was in her first pregnancy. The patient had no systemic disease or history of previous surgery. Our patient’s baby was delivered by cesarean section with an indication of emergency fetal distress. During the cesarean section, it was observed that the amniotic fluid contained very dark meconium. No complications occurred during the cesarean section. Our patient presented with complaints of severe pain, bullae, and hyperemia at the level of the incision line one week later. In her vital findings, fever was 39.3 ºC, blood pressure was 90/60 mmHg, and heart rate was 110 /min. In laboratory tests, white blood cell count was 25,280 /mm3, C-reactive protein (CRP) was 431 mg/dL, and sedimentation was 100 mm/hour. On the ultrasonographic examination, air, significant edema, and thickening were observed in the incision line, skin, and subcutaneous tissues. On the computed tomography scan, thickening of the skin and subcutaneous tissues, fluid locations, and areas of air densities were observed over a wide area extending to the level of the thoracic 10th and 11th vertebrae superiorly and to the mons pubis inferiorly. Based on these findings, the patient was diagnosed with NF. After broad-spectrum antibiotic therapy and fluid-electrolyte support, extensive surgical debridement was performed under emergency conditions. Before applying the skin graft, vacuum-assisted wound closure was performed, and a very good response was obtained. The patient, whose pathology result was compatible with necrotizing fasciitis, was discharged on the 20th post-operative day. In this case, we aimed to present a case of NF after cesarean section.
{"title":"A case of necrotizing fasciitis developing after cesarean section","authors":"İsa Kaplan","doi":"10.28982/josam.1060759","DOIUrl":"https://doi.org/10.28982/josam.1060759","url":null,"abstract":"Necrotizing fasciitis (NF) is a rare condition that is observed in obstetric and gynecological practices. It is a rapidly progressive and often fatal complication. Failure to obtain an early diagnosis and delay in initiating appropriate treatment can lead to significant morbidity and mortality. Our case was 25 years old, and she was in her first pregnancy. The patient had no systemic disease or history of previous surgery. Our patient’s baby was delivered by cesarean section with an indication of emergency fetal distress. During the cesarean section, it was observed that the amniotic fluid contained very dark meconium. No complications occurred during the cesarean section. Our patient presented with complaints of severe pain, bullae, and hyperemia at the level of the incision line one week later. In her vital findings, fever was 39.3 ºC, blood pressure was 90/60 mmHg, and heart rate was 110 /min. In laboratory tests, white blood cell count was 25,280 /mm3, C-reactive protein (CRP) was 431 mg/dL, and sedimentation was 100 mm/hour. On the ultrasonographic examination, air, significant edema, and thickening were observed in the incision line, skin, and subcutaneous tissues. On the computed tomography scan, thickening of the skin and subcutaneous tissues, fluid locations, and areas of air densities were observed over a wide area extending to the level of the thoracic 10th and 11th vertebrae superiorly and to the mons pubis inferiorly. Based on these findings, the patient was diagnosed with NF. After broad-spectrum antibiotic therapy and fluid-electrolyte support, extensive surgical debridement was performed under emergency conditions. Before applying the skin graft, vacuum-assisted wound closure was performed, and a very good response was obtained. The patient, whose pathology result was compatible with necrotizing fasciitis, was discharged on the 20th post-operative day. In this case, we aimed to present a case of NF after cesarean section.","PeriodicalId":30878,"journal":{"name":"International Journal of Surgery and Medicine","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86651321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mahli Batuhan Özdoğar, M. Ayar, Şerif Hamitoğlu, Ö. Olukman
Background/Aim: Transient tachypnea of the newborn (TTN) is mostly a benign and self-limiting common physiological disorder. Certain factors, such as elective cesarean section (CS) not preceded by spontaneous labor, delivery before 39 gestational weeks, and perinatal asphyxia, interfere with the fetal–neonatal transition. In our study, we aimed to review the results of hospitalized newborns who receive a diagnosis of TTN and investigate the possible relationship between the implementation of labor induction and the occurrence of this disorder. Methods: This study used a case-control study design. We scanned the hospital records of 156 term newborns hospitalized between January 2017 and January 2018 who received a diagnosis of TTN and who did not have any additional fetal and/or maternal risk factors. Demographic features, mode of delivery, and implementation of labor induction in vaginal deliveries were recorded and compared to the data from 150 healthy term infants. Infants were then split into two groups according to their type of labor induction, and a separate subgroup analysis was performed in terms of the risk of TTN development. Results: The incidence of TTN was 2.9% in vaginal deliveries and 8.5% in CSs. Differences between groups regarding gestational age, birth weights, gender, elective induction in vaginal deliveries, interventions in the delivery room, and types of intervention were found (P<0.05). The risk of developing TTN was 2.5 times higher in the induction group compared to those who did not receive induction but still developed TTN (P<0.001). Also, the risk was significantly higher in the induction group compared to those who did not receive induction and did not develop TTN (P<0.001). After applying a logistic regression analysis, labor induction (odds ratio: 1.005; 95% confidence interval: 1.003–1.008, P<0.001) was found to be an independent significant risk factor for developing TTN. Conclusions: This study indicates that infants born via electively induced vaginal delivery had significantly higher rates of TTN. Therefore, elective labor induction can be added as a new risk factor for TTN development. In our opinion, labor induction without valid medical and obstetric indications should be avoided due to maternal and fetal complications.
{"title":"Elective cesarean section versus induced vaginal delivery: Do any differences in terms of neonatal respiratory morbidities exist?","authors":"Mahli Batuhan Özdoğar, M. Ayar, Şerif Hamitoğlu, Ö. Olukman","doi":"10.28982/josam.7747","DOIUrl":"https://doi.org/10.28982/josam.7747","url":null,"abstract":"Background/Aim: Transient tachypnea of the newborn (TTN) is mostly a benign and self-limiting common physiological disorder. Certain factors, such as elective cesarean section (CS) not preceded by spontaneous labor, delivery before 39 gestational weeks, and perinatal asphyxia, interfere with the fetal–neonatal transition. In our study, we aimed to review the results of hospitalized newborns who receive a diagnosis of TTN and investigate the possible relationship between the implementation of labor induction and the occurrence of this disorder. \u0000Methods: This study used a case-control study design. We scanned the hospital records of 156 term newborns hospitalized between January 2017 and January 2018 who received a diagnosis of TTN and who did not have any additional fetal and/or maternal risk factors. Demographic features, mode of delivery, and implementation of labor induction in vaginal deliveries were recorded and compared to the data from 150 healthy term infants. Infants were then split into two groups according to their type of labor induction, and a separate subgroup analysis was performed in terms of the risk of TTN development.\u0000Results: The incidence of TTN was 2.9% in vaginal deliveries and 8.5% in CSs. Differences between groups regarding gestational age, birth weights, gender, elective induction in vaginal deliveries, interventions in the delivery room, and types of intervention were found (P<0.05). The risk of developing TTN was 2.5 times higher in the induction group compared to those who did not receive induction but still developed TTN (P<0.001). Also, the risk was significantly higher in the induction group compared to those who did not receive induction and did not develop TTN (P<0.001). After applying a logistic regression analysis, labor induction (odds ratio: 1.005; 95% confidence interval: 1.003–1.008, P<0.001) was found to be an independent significant risk factor for developing TTN.\u0000Conclusions: This study indicates that infants born via electively induced vaginal delivery had significantly higher rates of TTN. Therefore, elective labor induction can be added as a new risk factor for TTN development. In our opinion, labor induction without valid medical and obstetric indications should be avoided due to maternal and fetal complications.","PeriodicalId":30878,"journal":{"name":"International Journal of Surgery and Medicine","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86702362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ülkü Sabuncu, Hatice Selçuk Kuşderci, Mesut Öterkuş, R. Abdullayev, Ö. Uludağ, S. Özdaş
Background/Aim: A recently introduced drug, sugammadex, can be a good alternative to conventional neuromuscular blockade reversal agents, such as neostigmine. This choice is of great importance, especially in the patients in whom it would be wise to avoid cholinergic side effects. The aim of this study was to compare the effects of sugammadex and the combination of neostigmine/atropine on post-operative cognitive dysfunction in bariatric surgery patients. Methods: This randomized controlled trial included a total of 90 patients with American Society of Anesthesiologists (ASA) I–III physical status and body mass index >30 who were scheduled for elective sleeve gastrectomy were recruited for the study after obtaining ethics committee approval. Written consent was obtained from each patient. The exclusion criteria consisted of several parameters: lack of consent, co-existing muscular diseases, and severe cardiovascular diseases (New York Heart Association [NYHA]). The patients were randomly divided into two groups, and the randomization was performed by the investigator using previously prepared envelopes. In both groups, Mini Mental State Examination (MMSE) was performed before the operation. The patients’ memory, attentive executive functions, and motor skills were evaluated as part of a control cognitive evaluation. After the operation while in the post-anesthesia care unit and when the Modified Aldrete Recovery Score was ≥9, the MMSE evaluation was repeated one and six hours later. Results: The pre-operative MMSE results were similar in both groups. In the post-operative period, MMSEpo, MMSEpo1, and MMSEpo6 values were not significantly different between the groups. When a detailed examination of MMSEpo data was performed, it was determined that the MMSE scores were 20–25 in 14 patients (32.6%) in Group N/A and six patients (14.6%) in Group S. In Group N/A, the percentage of patients with MMSE 20–25 was significantly higher than that of Group S (X2=3.807; P=0.046). Conclusion: In this study, sugammadex produced less effects on cognitive functions when compared with neostigmine/atropine combination. The neostigmine/atropine combination produced mild effects on cognitive functions in the first hour of recovery.
{"title":"Comparison the effects of sugammadex and neostigmine/atropine on cognitive functions in bariatric surgery patents: Randomized controlled trial","authors":"Ülkü Sabuncu, Hatice Selçuk Kuşderci, Mesut Öterkuş, R. Abdullayev, Ö. Uludağ, S. Özdaş","doi":"10.28982/josam.7605","DOIUrl":"https://doi.org/10.28982/josam.7605","url":null,"abstract":"Background/Aim: A recently introduced drug, sugammadex, can be a good alternative to conventional neuromuscular blockade reversal agents, such as neostigmine. This choice is of great importance, especially in the patients in whom it would be wise to avoid cholinergic side effects. The aim of this study was to compare the effects of sugammadex and the combination of neostigmine/atropine on post-operative cognitive dysfunction in bariatric surgery patients.\u0000Methods: This randomized controlled trial included a total of 90 patients with American Society of Anesthesiologists (ASA) I–III physical status and body mass index >30 who were scheduled for elective sleeve gastrectomy were recruited for the study after obtaining ethics committee approval. Written consent was obtained from each patient. The exclusion criteria consisted of several parameters: lack of consent, co-existing muscular diseases, and severe cardiovascular diseases (New York Heart Association [NYHA]). The patients were randomly divided into two groups, and the randomization was performed by the investigator using previously prepared envelopes. In both groups, Mini Mental State Examination (MMSE) was performed before the operation. The patients’ memory, attentive executive functions, and motor skills were evaluated as part of a control cognitive evaluation. After the operation while in the post-anesthesia care unit and when the Modified Aldrete Recovery Score was ≥9, the MMSE evaluation was repeated one and six hours later.\u0000Results: The pre-operative MMSE results were similar in both groups. In the post-operative period, MMSEpo, MMSEpo1, and MMSEpo6 values were not significantly different between the groups. When a detailed examination of MMSEpo data was performed, it was determined that the MMSE scores were 20–25 in 14 patients (32.6%) in Group N/A and six patients (14.6%) in Group S. In Group N/A, the percentage of patients with MMSE 20–25 was significantly higher than that of Group S (X2=3.807; P=0.046).\u0000Conclusion: In this study, sugammadex produced less effects on cognitive functions when compared with neostigmine/atropine combination. The neostigmine/atropine combination produced mild effects on cognitive functions in the first hour of recovery.","PeriodicalId":30878,"journal":{"name":"International Journal of Surgery and Medicine","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84699460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background/Aim: The PRE-DELIRIC score is a test to detect delirium in the intensive care unit (ICU). Delirium has been studied as a factor associated with the clinical course of patients in COVID-19 intensive care. Our study aimed to investigate the relationship between the PRE-DELIRIC score and prognosis in patients followed in the COVID-19 ICU. Methods: Patients hospitalized in the COVID-19 ICU between March 2020 and May 2021 were retrospectively analyzed, and 461 patients were included in the study. The PRE-DELIRIC scores of the patients were calculated using data obtained from the hospital information system. Patients with a PRE-DELIRIC score ≥50 were considered Group 1, and those with a score <50 were considered Group 2. The groups were compared in terms of gender, Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation (APACHE II) score, Sequential Organ Failure Evaluation Score (SOFA), length of hospital stay, and mortality rates. Results: Of the 461 patients included in the study, 153 were female, and 308 were male. A high PRE-DELIRIC score was determined in 157 (34.1%) patients (Group 1), while 304 patients (65.9%) had lower scores (Group 2). The hospitalization duration was 9.6 (6.7) days, and the mortality rate was 87.2% in Group 1, compared to 8.2 (6.03) days and 38.1% in Group 2, respectively. A significant difference was observed in the length of hospital stay and mortality between the groups (P<0.001). The rate of patients who were intubated and followed up on an invasive mechanical ventilator (MV) was 81.5% in Group 1, whereas it was 16.4% in Group 2 (P<0.001). Conclusion: Our study found that patients with a high PRE-DELIRIC score indicating delirium had higher mortality rates and longer hospital and MV stays. Delirium is one of the factors affecting mortality in COVID-19 disease. We believe that the PRE-DELIRIC score, as one of these factors, can serve as an important prognostic test in COVID-19 ICU patients.
{"title":"The relationship between the PRE-DELIRIC score and the prognosis in COVID-19 ICU patients","authors":"Bilge Banu Taşdemir Mecit","doi":"10.28982/josam.7794","DOIUrl":"https://doi.org/10.28982/josam.7794","url":null,"abstract":"Background/Aim: The PRE-DELIRIC score is a test to detect delirium in the intensive care unit (ICU). Delirium has been studied as a factor associated with the clinical course of patients in COVID-19 intensive care. Our study aimed to investigate the relationship between the PRE-DELIRIC score and prognosis in patients followed in the COVID-19 ICU.\u0000Methods: Patients hospitalized in the COVID-19 ICU between March 2020 and May 2021 were retrospectively analyzed, and 461 patients were included in the study. The PRE-DELIRIC scores of the patients were calculated using data obtained from the hospital information system. Patients with a PRE-DELIRIC score ≥50 were considered Group 1, and those with a score <50 were considered Group 2. The groups were compared in terms of gender, Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation (APACHE II) score, Sequential Organ Failure Evaluation Score (SOFA), length of hospital stay, and mortality rates.\u0000Results: Of the 461 patients included in the study, 153 were female, and 308 were male. A high PRE-DELIRIC score was determined in 157 (34.1%) patients (Group 1), while 304 patients (65.9%) had lower scores (Group 2). The hospitalization duration was 9.6 (6.7) days, and the mortality rate was 87.2% in Group 1, compared to 8.2 (6.03) days and 38.1% in Group 2, respectively. A significant difference was observed in the length of hospital stay and mortality between the groups (P<0.001). The rate of patients who were intubated and followed up on an invasive mechanical ventilator (MV) was 81.5% in Group 1, whereas it was 16.4% in Group 2 (P<0.001).\u0000Conclusion: Our study found that patients with a high PRE-DELIRIC score indicating delirium had higher mortality rates and longer hospital and MV stays. Delirium is one of the factors affecting mortality in COVID-19 disease. We believe that the PRE-DELIRIC score, as one of these factors, can serve as an important prognostic test in COVID-19 ICU patients.","PeriodicalId":30878,"journal":{"name":"International Journal of Surgery and Medicine","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85546672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emre Oteyaka, O. Kuguoglu, Gizem Sari, Mehmet Turan Basunlu, Y. Yozgat, M. Uğurlucan, H. Turkoglu
Truncus arteriosus is a rare, cyanotic, and congenital heart defect occurring due to failure in the differentiation of the aorta and the pulmonary artery during fetal development. The disease is categorized into four sub-categories in the Van Praagh and Collett & Edwards classification systems according to the origin of the pulmonary arteries. Surgical correction of the pulmonary arteries and repair of the ventricular septal defect is the preferred treatment strategy of choice; this intervention is required early in life. Here, we report a four-month-old baby with truncus arteriosus consisting of atypical pulmonary anatomy undefined by either the Van Praagh or the Collett & Edwards classification systems who underwent successful corrective surgery.
{"title":"Truncus arteriosus with meandering pulmonary arteries","authors":"Emre Oteyaka, O. Kuguoglu, Gizem Sari, Mehmet Turan Basunlu, Y. Yozgat, M. Uğurlucan, H. Turkoglu","doi":"10.28982/josam.1104984","DOIUrl":"https://doi.org/10.28982/josam.1104984","url":null,"abstract":"Truncus arteriosus is a rare, cyanotic, and congenital heart defect occurring due to failure in the differentiation of the aorta and the pulmonary artery during fetal development. The disease is categorized into four sub-categories in the Van Praagh and Collett & Edwards classification systems according to the origin of the pulmonary arteries. Surgical correction of the pulmonary arteries and repair of the ventricular septal defect is the preferred treatment strategy of choice; this intervention is required early in life. Here, we report a four-month-old baby with truncus arteriosus consisting of atypical pulmonary anatomy undefined by either the Van Praagh or the Collett & Edwards classification systems who underwent successful corrective surgery.","PeriodicalId":30878,"journal":{"name":"International Journal of Surgery and Medicine","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88518116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arachnoid cysts are primarily developmental in origin and constitute rare, benign lesions. Sylvian arachnoid cysts may infrequently present with subdural and/or intracystic hemorrhage. Hemorrhage is typically of venous origin and occurs due to stretching and tearing of bridging veins, depending on minor traumas. The annual risk of bleeding associated with Sylvian arachnoid cysts, with no additional complaints other than headache and an asymptomatic course, has been reported to be 0.04%. Symptoms can range from headache to coma, depending on the mass effect after hemorrhage. If there is no clinical evidence linking the arachnoid cyst, it is sufficient to perform surgery only for the hematoma without resecting it. In this case report, we present a rare instance of hemorrhage due to a Sylvian arachnoid cyst that developed after trauma and was observed in a patient who came to our clinic with a headache. In our patient, the cyst-dependent left parietal subdural hemorrhage was evacuated through a burr-hole craniotomy, and a closed-system drainage with a Hemovac drain was applied for 48 hours. During post-operative follow-up, complete resorption of subdural and intracystic hemorrhages was observed. A case-based surgical approach is necessary for bleeding due to arachnoid cysts in the Sylvian region.
{"title":"A rare case of bleeding into the Sylvian arachnoid cyst: A case report","authors":"İlyas Tadayyon Einaddin Karakoc, F. Sarica","doi":"10.28982/josam.7349","DOIUrl":"https://doi.org/10.28982/josam.7349","url":null,"abstract":"Arachnoid cysts are primarily developmental in origin and constitute rare, benign lesions. Sylvian arachnoid cysts may infrequently present with subdural and/or intracystic hemorrhage. Hemorrhage is typically of venous origin and occurs due to stretching and tearing of bridging veins, depending on minor traumas. The annual risk of bleeding associated with Sylvian arachnoid cysts, with no additional complaints other than headache and an asymptomatic course, has been reported to be 0.04%. Symptoms can range from headache to coma, depending on the mass effect after hemorrhage. If there is no clinical evidence linking the arachnoid cyst, it is sufficient to perform surgery only for the hematoma without resecting it. In this case report, we present a rare instance of hemorrhage due to a Sylvian arachnoid cyst that developed after trauma and was observed in a patient who came to our clinic with a headache. In our patient, the cyst-dependent left parietal subdural hemorrhage was evacuated through a burr-hole craniotomy, and a closed-system drainage with a Hemovac drain was applied for 48 hours. During post-operative follow-up, complete resorption of subdural and intracystic hemorrhages was observed. A case-based surgical approach is necessary for bleeding due to arachnoid cysts in the Sylvian region.","PeriodicalId":30878,"journal":{"name":"International Journal of Surgery and Medicine","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78443442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Yucel, Erhan Disci, Zeynep Gural, Sedenay Kaptan, H. Kadioglu, F. Agaoglu
Background/Aim: Significantly lower heart doses can be achieved by breath-hold technique at left-sided breast cancer radiotherapy (RT). We see high doses at organs at risk such as lung, heart, and contralateral breast during right-sided breast cancer RT planning especially in the presence of RT indication for mammaria interna (MI) lymph nodes. This study compared RT-planning methods that are conformal with intensity-modulated RT (IMRT) with breath holding and free breathing for right-sided breast cancer RT including full axillary and MI lymph node fields. Methods: Computed tomography (CT) simulations were performed using free-breath (FB) and breath-hold (BH) methods in 10 patients with right-sided breast cancer. A total of 40 RT treatment plans were calculated. Right-sided breast, level 1-2-3 axillary regions, and MI regions served for the target-planning volume. Left-sided breast, heart, as well as right-sided and left lungs were contoured as critical organs according to the atlas of the "Radiation Therapy Oncology Group." We used a Varian Eclipse v.13 for treatment planning. Conformal “FieldinField” RT (FinFRT) and dynamic IMRT (dIMRT) planning were performed separately for each patient over breath-hold and free-breath images. For PTV, 50 Gy was prescribed in 25 fractions and optimized such that the planned target volume (PTV) remained between 95% and 110% of the dose. The mean and maximum doses of the heart, V5 and V20 of the lungs, as well as V95 doses for MI were recorded. Statistical analyses were performed with SPSS version 22, and a paired t-test was used for comparison. Results: Four treatment plans (FB FinFRT, BH FinFRT, FB dIMRT, BH dIMRT) were made separately for 10 patients. For comparison, common FB FinFRT plans were accepted as the baseline plan. As expected, there were no significant differences in PTV coverage. The mean dose received by 95% of the MI volume was between 42.27 Gy and 42.4 Gy. For the maximum heart dose, the breath hold technique had no significant effect on plans. The lowest average maximum heart dose was seen in the BH FinFRT group. Mean heart doses are between 1.28 Gy – 4.85 Gy. There was no significance between BH FinFRT and FB FinFRT plan (P=0.504), and there was a significant difference for heart mean dose versus dIMRT plans (P=0.001). The mean V20 of the lungs ranged from 11.9 to 17.8. There was a significant decrease in V20 with BH or FB dIMRT plans (P=0.001). There was no difference between BH FinFRT (P=0.138). On the contrary, lung V5 values were significantly higher in dIMRT plans, and the lowest mean V5 value was seen in BH FinFRT plan. Conclusion: With the BH method, lower doses (but not significantly lower doses) were obtained in critical organ doses. There was a significant decrease with FinFRT plans in terms of heart mean and maximum dose and lung V5 percentages. The dIMRT plans were significant only in lung V20 percentages. When planning RT, we recommend evaluating all treatment techniques individua
{"title":"The effect of breath-hold technique on conformal and intensity modulated radiotherapy techniques at right breast cancer radiotherapy including internal mammarian field","authors":"S. Yucel, Erhan Disci, Zeynep Gural, Sedenay Kaptan, H. Kadioglu, F. Agaoglu","doi":"10.28982/josam.7695","DOIUrl":"https://doi.org/10.28982/josam.7695","url":null,"abstract":"Background/Aim: Significantly lower heart doses can be achieved by breath-hold technique at left-sided breast cancer radiotherapy (RT). We see high doses at organs at risk such as lung, heart, and contralateral breast during right-sided breast cancer RT planning especially in the presence of RT indication for mammaria interna (MI) lymph nodes. This study compared RT-planning methods that are conformal with intensity-modulated RT (IMRT) with breath holding and free breathing for right-sided breast cancer RT including full axillary and MI lymph node fields.\u0000Methods: Computed tomography (CT) simulations were performed using free-breath (FB) and breath-hold (BH) methods in 10 patients with right-sided breast cancer. A total of 40 RT treatment plans were calculated. Right-sided breast, level 1-2-3 axillary regions, and MI regions served for the target-planning volume. Left-sided breast, heart, as well as right-sided and left lungs were contoured as critical organs according to the atlas of the \"Radiation Therapy Oncology Group.\" We used a Varian Eclipse v.13 for treatment planning. Conformal “FieldinField” RT (FinFRT) and dynamic IMRT (dIMRT) planning were performed separately for each patient over breath-hold and free-breath images. For PTV, 50 Gy was prescribed in 25 fractions and optimized such that the planned target volume (PTV) remained between 95% and 110% of the dose. The mean and maximum doses of the heart, V5 and V20 of the lungs, as well as V95 doses for MI were recorded. Statistical analyses were performed with SPSS version 22, and a paired t-test was used for comparison.\u0000Results: Four treatment plans (FB FinFRT, BH FinFRT, FB dIMRT, BH dIMRT) were made separately for 10 patients. For comparison, common FB FinFRT plans were accepted as the baseline plan. As expected, there were no significant differences in PTV coverage. The mean dose received by 95% of the MI volume was between 42.27 Gy and 42.4 Gy. For the maximum heart dose, the breath hold technique had no significant effect on plans. The lowest average maximum heart dose was seen in the BH FinFRT group. Mean heart doses are between 1.28 Gy – 4.85 Gy. There was no significance between BH FinFRT and FB FinFRT plan (P=0.504), and there was a significant difference for heart mean dose versus dIMRT plans (P=0.001). The mean V20 of the lungs ranged from 11.9 to 17.8. There was a significant decrease in V20 with BH or FB dIMRT plans (P=0.001). There was no difference between BH FinFRT (P=0.138). On the contrary, lung V5 values were significantly higher in dIMRT plans, and the lowest mean V5 value was seen in BH FinFRT plan.\u0000Conclusion: With the BH method, lower doses (but not significantly lower doses) were obtained in critical organ doses. There was a significant decrease with FinFRT plans in terms of heart mean and maximum dose and lung V5 percentages. The dIMRT plans were significant only in lung V20 percentages. When planning RT, we recommend evaluating all treatment techniques individua","PeriodicalId":30878,"journal":{"name":"International Journal of Surgery and Medicine","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84831518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background/Aim: Lateral epicondylitis (LE), commonly known as “tennis elbow”, is a painful inflammatory condition affecting wrist extensor tendons. Various treatments, such as extracorporeal shockwave therapy (ESWT) and neural therapy injections, have been used to alleviate symptoms of LE. However, there is a limited number of comparative studies available. This study aims to compare the effectiveness of sequential neural therapy injections and ESWT in reducing pain and improving functionality in patients with LE. Methods: A retrospective cohort study analyzed data from 128 LE patients. Among them, 30 patients underwent neural therapy, while 30 underwent ESWT, following the exclusion criteria. Pain levels were measured using the visual analog scale (VAS), and functionality was assessed using the Duruöz hand index (DHI) before and after treatment. Results: Both neural therapy injections and ESWT led to substantial reductions in pain and improvements in functionality, with no notable differences observed between the two treatment methods. Additionally, no significant variations were found based on age, body mass index, gender, or the side of the elbow treated. Conclusion: The findings suggest that both neural therapy injections and ESWT are equally effective in managing symptoms of LE. Treatment choice may depend on patient preference, cost, availability, or other factors. Further research is necessary to examine long-term outcomes, potential side effects, and factors predicting a better response to one treatment.
{"title":"Comparison of the effects of neural therapy injection and extracorporeal shock wave therapy on pain and hand functions in the treatment of lateral epicondylitis","authors":"Ülkü Dönmez, O. Aygün","doi":"10.28982/josam.7789","DOIUrl":"https://doi.org/10.28982/josam.7789","url":null,"abstract":"Background/Aim: Lateral epicondylitis (LE), commonly known as “tennis elbow”, is a painful inflammatory condition affecting wrist extensor tendons. Various treatments, such as extracorporeal shockwave therapy (ESWT) and neural therapy injections, have been used to alleviate symptoms of LE. However, there is a limited number of comparative studies available. This study aims to compare the effectiveness of sequential neural therapy injections and ESWT in reducing pain and improving functionality in patients with LE.\u0000Methods: A retrospective cohort study analyzed data from 128 LE patients. Among them, 30 patients underwent neural therapy, while 30 underwent ESWT, following the exclusion criteria. Pain levels were measured using the visual analog scale (VAS), and functionality was assessed using the Duruöz hand index (DHI) before and after treatment.\u0000Results: Both neural therapy injections and ESWT led to substantial reductions in pain and improvements in functionality, with no notable differences observed between the two treatment methods. Additionally, no significant variations were found based on age, body mass index, gender, or the side of the elbow treated.\u0000Conclusion: The findings suggest that both neural therapy injections and ESWT are equally effective in managing symptoms of LE. Treatment choice may depend on patient preference, cost, availability, or other factors. Further research is necessary to examine long-term outcomes, potential side effects, and factors predicting a better response to one treatment.","PeriodicalId":30878,"journal":{"name":"International Journal of Surgery and Medicine","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90414044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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