No abstract

BACKGROUND: Clinical scoring systems have been used to reduce negative appendectomy rate for several decades. However, the use of these systems has been questioned due to differences in their diagnostic accuracies. The aim of this prospective study was to develop a new clinical scoring system using a combination of all previously described variables for the diagnosis of acute appendicitis (AA). METHODS:Consecutive patients who underwent emergency appendectomy for AA between December 2016 and April 2017 were prospectively included in the study. During admission, a prepared questionnaire including variables obtained from the previously used clinical scoring systems was administered. Histopathological analysis was regarded as the main outcome. Patients with no histopathological evidence of AA were defined as negative appendectomy. All variables were analyzed separately to assess their association with AA. A receiver operating characteristic curve with area under curve analysis was performed to obtain the cut-off values for numerical variables. RESULTS:There were 200 patients with a mean age of 30.8±12.8 years with a negative appendectomy rate of 5.5%. There was no significant association between the variables and the detection of histologically proven AA except increased white blood cell count >11.05/mm 3 and proportion of the polymorphonuclear leukocytes >71.2% (p=0.003 and p=0.015, respectively). CONCLUSION:The present study shows that the development and/or use of scoring systems does not significantly improve the diagnostic accuracy of AA.

Video-assisted thoracoscopic and laparoscopic esophagectomy combined with a cervical single-port assist is a safe and minimally invasive technique for whole esophagus and mediastinal lymph node dissection. This technique allows for the clear visualization of the mediastinum, reducing the risk of surgery-related trauma.

Aim: Hepatic hydatidosis is common parasitosis in Turkey and caused by Echinococcus granulosus. Biliary fistula is the most common complication after liver hydatid cyst surgery. The aim of this study was to investigate an appropriate treatment strategy for patients whose biliary fistula might develop, by revealing variables that affect biliary fistula. Methods: A total of 118 patients who underwent liver hydatid cyst surgery were included in this study. The following variables were analyzed between patients with biliary fistula (group 2) and without fistula (group 1): Age, gender, hematologic and liver function tests, and features of the cysts (type, cyst size, number, and localization). Results: Cystobiliary fistula was detected in 19 (16%) of 118 patients. In-group 2, cyst size, white blood cell, alkaline phosphatase and g-Glutamyl transpeptidase levels were higher than group 1 on univariate analysis (p=0.03, p=0.008, p=0.04 and p=0.001, respectively). In the multivariate model, only cyst diameter remained as an independent predictor (odds ratio 0.03, 95% confidence interval 0.002 to 0.06; p=0.03) On the receiver operating characteristic curve, the 100% sensitive, 100% specific, and optimal cutoffs of the cyst diameter were 7.5 cm, 4.0 cm and14.6 cm, respectively (The area under the receiver operator characteristic curve was 0.67). Conclusion: Preoperative cyst size is a valuable parameter for predicting biliary fistula. Our study suggests that cyst size greater than 7.5 cm is a risk factor for biliary fistula. ÖzAma : arac ğer h dat k k st hastalığı Ech nococcus granulosus un neden olduğu Türk ye de yaygın görülen b r parazitozdur. araciğer kist hidatik cerrahisi sonrası en sık gelişen komplikasyon safra fistülüdür. Bu alışmadaki amacımız safra fistülü gelişimini etkileyen değişkenleri ortaya koymak ve uygun tedavi se eneklerini incelemektir. öntemler: Bu alışmaya karac ğer k st h dat k cerrah s uygulanmış olan 118 hasta dah l ed ld . Hastalar safra fistülü gelişen (grup2) ve gelişmeyen (grup1) olarak iki gruba ayrıldı ve değişkenler analiz edildi: yaş hematolojik ve karaciğer fonksiyon testleri ve kistin özellikleri (tip kist boyutu sayısı ve yerleşim yeri). Bulgular: 118 hastanın 19 (%16) unda safra fistülü saptandı. Grup 2 de kist boyutu lökosit alkalin fosfataz ve g-Glutamin transpeptidaz değerleri tek değişkenli analiz sonucuna göre grup 1 den daha yüksekti (p=0 03 p=0 008 p=0 04 p=0 001). Çok değişkenli analiz sonucuna göre; safra fistülü gelişimine etki eden tek bağımsız değişken yalnızca kist boyutu olarak saptandı (olasılık oranı 0.03 95% güven aralığı 0 002-0 06; p=0 03). İşlem karakteristik eğrisine göre kist boyutlarının 100% duyarlılık 100% özgüllük ve eşik değeri sırasıyla 7 5 cm 4 0 cm ve 14 6 cm olarak bulundu. (Eğrinin altındaki alan 0,67).onu : afra f stülünün tahm n nde preoperat f k st boyutu öneml b r parametred r. B z m alışmamıza göre; kist boyutunun 7 5 cm den büyük olması safra fistülü gelişimi i in bir risk faktörüdür.Anahtar el meler: arac ğer k st h dat k hastalığı safra f stülü Ech...

ÖzetSığırlarda abomasumun sola deplasmanı vakalarının cerrahi tedavisinde laparoskopik esaslı tekniklere başvurulması, belirgin üstünlükleri nedeniyle giderek yaygınlaşmaktadır. Gerek iki gerekse tek aşamalı laparoskopik abomasopeksi uygulayabilmenin ön koşulu, desüfle edilen abomasumun kendiliğinden replase olmasıdır. Desüfle edilen abomasumun replase olup olmayacağının ya da ne kadar sürede replase olacağının önceden bilinmesi, sola deplasmanlı bir sığırın cerrahi tedavisi planlanırken, laparoskopik veya laparotomik tekniklerden hangisinin tercih edileceği yönünden önemli bir bilgi olabilir. Bu araştırmada; 20 ineğe uygulanan tek aşamalı laparoskopik abomasopeksi işlemi sırasında kayıt edilen desüflatif replasman süresi ile preoperatif dönemde toplanan klinik ve biyokimyasal bulgular arasındaki olası korelasyon analiz edilerek replasman süresini önceden tahmin etmeye yönelik parametrelerin bulunup bulunmadığı araştırıldı. Replasman süresinin vücut kondisyon skoru (r = -0.465) ve su tüketimi (r = -0.466) verileri ile negatif bir korelasyon gösterdiği tespit edildi (P<0.05). Vücut ısısı, rasyonda silaj varlığı, dışkılama varlığı, dışkı kıvamı ve ping sesinin yeri gibi veriler ile replasman süresi arasında ise zayıf ve istatistiksel yönden anlamlı olmayan (P>0.05) bir korelasyon bulunduğu belirlendi. Serum kalsiyum, potasyum, klor, sodyum ve glikoz seviyeleri ile abomasal replasman süresi arasında bir ilişki bulunmadı. Anahtar sözcükler: Sığır, Abomasumun sola deplasmanı, Tek aşamalı laparoskopik abomasopeksi, Replasman süresi, Preoperatif bulgular Is It Possible to Estimate Deflative Replacement Time from Preoperative Examination Data in Left-Sided Abomasal Displacement Cases? A Retrospective Study in Cows Treated with One-Step Laparoscopic Abomasopexy SummaryLaparoscopic techniques in surgical treatment of abomasal displacement in cattle are common nowadays by their certain advantages. Self replacement of abomasum following laparoscopic deflation is a precondition for both one-and two-step laparoscopic abomasopexy. To know whether abomasum will replace or in how many minutes the replacement will continue are probably critical knowledge for selection of laparoscopic or laparotomic techniques during planning the surgical therapy of a cow with left-sided abomasal displacement. In this study, the presence of parameters which can help to estimate the replacement time beforehand by analyzing possible correlation between laparoscopically recorded replacement time and clinic-biochemical parameters collected during preoperative examination period was investigated in 20 cows. The recorded replacement times were found statistically (P<0.05) correlated with both body condition score (r = -0.465) and water intake (r = -0.466). A weak correlation was found for body temperature, silage presence in diet, feces production, feces consistence and localization of pings, but they were all not significant (P>0.05). It was revealed that serum levels of calcium, potassium, chlor, sodium and glucose were not correlated with abomasal re...