BACKGROUND: Accurately diagnosing appendicitis can be difficult. This retrospective study aimed to evaluate the ability of the neutrophil-to-lymphocyte ratio (NLR) to predict acute appendicitis pre-operatively and to differentiate between simple and complicated appendicitis.
Objective: Oral amino-acid-combination supplements have become a common intervention to maintain or potentially increase the lean body mass (LBM) in the elderly. Our aim was to determine the tolerance and efficacy of the 8-week beta-hydroxy beta-methylbutyrate/arginine/glutamine (HMB/Arg/Gln) supplementation on anthropometrics, LBM, muscle strength, and gait speed in elderly patients. Methods: In this longitudinal observational study, a total of 131 elderly patients were evaluated at two consecutive visits, including baseline (Week 0) and single follow-up (Week 8). The use of HMB/Arg/Gln was evaluated in terms of patient compliance, the efficacy on anthropometrics, LBM (kg, measured with bioelectrical impedance analysis-BIA), muscle strength (kg), gait speed, and safety. Results: The mean (standard deviation, SD) age was 74.7 (6.8) years (57.3% of participants were males). Of the patients were diagnosed with malnutrition (according to the Subjective Global Assessment test). The main indications for the HMB/Arg/Gln supplementation were sarcopenia (45.8%) and cancer cachexia (42.0%). Only two patients stopped supplementation because of taste problem (1.5%). Overall, 79.4% of patients were still on HMB/Arg/Gln at the follow-up. The mid-upper-arm circumference (MUAC, 25.3–27.0 cm, p=0.017), mid-upper-arm muscle circumference (MUAMC, 21.7–22.2 cm, p=0.006), hand grip strength (16.0–19.0 kg, p=0.0001), and gait speed (0.5–0.7 m/sec, p=0.008) were increased after the HMB/Arg/Gln supplementation. The adverse events were reported in 14 (10.7%) patients. No serious adverse events were reported in association with HMB/Arg/Gln. Conclusion: Our findings showed that 8 weeks of the HMB/Arg/Gln supplementation applied twice daily were well tolerated and safe in the elderly. The supplementation seems to improve the MUAC, MUAMC, muscle strength, and gait speed.
Background/Aims: The incidence and prevalence of peptic ulcer disease has decreased in recent years, but it is not so easy to make the same conclusion when complications of peptic ulcer are taken into consideration. The aim of this study is to determine the time trends in complicated peptic ulcer disease and to state the effects of H2 receptor blockers, proton pump inhibitors (PPI), and H. pylori eradication therapies on these complications. Materials and Methods: This study retrospectively evaluated the patients who were operated on for complications (perforation, bleeding, and obstruction) of peptic ulcer for the last 50 years. Patients were grouped into four groups (G1-G4) according to the dates in which H2 receptor blockers, PPIs, and eradication regimens for H. pylori were introduced The time periods that were studied were: (G1) 1962-1980, (G2) 1981-1990, (G3) 1991-1997, and (G4) 1998-2012. Results: In total, 2953 patients were operated on for complications of peptic ulcer disease, of which 86% of the patients were male. In G1, perforation and obstruction were significantly the most frequent complications (p<0.001), followed by bleeding. In groups G2 and G3, obstruction was still the most frequent complication requiring surgery (p<0.001). In G2 and G3, obstruction was followed by perforation and bleeding, respectively. In G4, perforation was significantly the most frequent complication (p<0.001). Conclusion: From 1962 to 1990 obstruction was the most common complication requiring surgery. In the last decade, perforation became the most common complication. In contrast to reports in the literature, bleeding was the least common complication requiring surgery in Turkey.
Background. The local anaesthetics used in day-case spinal anaesthesia should provide short recovery times. We aimed to compare hyperbaric prilocaine and bupivacaine in terms of sensory block resolution and time to home readiness in day-case spinal anaesthesia. Methods. Fifty patients undergoing perianal surgery were randomized into two groups. The bupivacaine-fentanyl group (Group B) received 7.5 mg, 0.5% hyperbaric bupivacaine + 20 μg fentanyl in total 1.9 mL. The prilocaine-fentanyl group (Group P) received 30 mg, 0.5% hyperbaric prilocaine + 20 μg fentanyl in the same volume. Results. Time to L1 block and maximum block was shorter in Group P than in Group B (Group P 4.6 ± 1.3 min versus Group B 5.9 ± 01.9 min, P = 0.017, and Group P 13.2 ± 7.5 min versus Group B 15.3 ± 6.6 min, P = 0.04). The time to L1 regression and S3 regression of the sensorial block was significantly shorter in Group P than in Group B (45.7 ± 21.9 min versus 59.7 ± 20.9 min, P = 0.024, and 133.8 ± 41.4 min versus 200.4 ± 64.8 min, P < 0.001). The mean time to home readiness was shorter for Group P than for Group B (155 ± 100.2 min versus 207.2 ± 62.7 min (P < 0.001)). Conclusion. Day-case spinal anaesthesia with hyperbaric prilocaine + fentanyl is superior to hyperbaric bupivacaine in terms of earlier sensory block resolution and home readiness and the surgical conditions are comparable for perianal surgery.
Abdominal wall hernias are a common problem in the general population. A Western estimate reveals that the lifetime risk of developing a hernia is about 2%.1–3 As a result, hernia repairs likely comprise the most frequent general surgery operations. More than 20 million hernias are estimated to be repaired every year around the world.4 Numerous repair techniques have been described to date however tension-free mesh repairs are widely used today because of their low hernia recurrence rates. Nevertheless, there are some ongoing debates regarding the ideal approach (open or laparoscopic),5,6 the ideal anesthesia (general, local, or regional),7,8 and the ideal mesh (standard polypropylene or newer meshes).9,10
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