Makale Arama

Aim: Gastric cancer is one of the leading causes of cancer-related deaths. Tumor budding has been
shown to be a prognostic factor in many cancers. In this study, we aimed to evaluate the prognostic
significance of tumor budding in intestinal-type gastric adenoc arcinoma.
Patients and Methods: A total of 152 cases diagnosed as intestinal type gastric adenocarcinoma in
the Pathology Clinic between 2015 and 2021 were included in the study. Tumor budding was grouped
as low, medium and high. Hematoxylin and eosin-stained slides were re-evaluated in terms of tumor
differentiation, lymphovascular invasion (LVI), perineural invasion (PNI), lymph node involvement, depth
of invasion (pT) and tumor budding.
Results: Tumor budding was low in 30.9% (n=47) of the subjects included in the study, moderate in 37.5%
(n=57) and high in 31.4% (n=48). Statistically, as tumor budding increased, tumor size increased (p<0,05),
follow-up times were shortened, survival time (p<0,05), and tumor differentiation (p<0,05) decreased. A
statistically significant correlation was observed between tumor budding and LVI (p<0,05), PNI (p<0,05),
pT(p<0,05), lymph node involvement(p<0,05), and mortality of the cases (p<0,05). No statistically
significant correlation was observed between tumor budding and gender, age, tumor localization and
operation type (p>0.05).
Conclusions: Tumor budding is associated with poor prognostic factors. As it may be important to guide
the treatment modality and follow-up, tumor budding status may be mentioned in routine pathology reports.

Objective: Feeding gastrostomy is generally needed in the cases of oropharnyngeal dysphagia. The objective of this study is to analyze the use of surgical gastrostomy with mini laparatomy under local anaesthesia in situations where endoscopic procedure is not possible.

Methods: Stamm gastrostomy was performed in 62 patients in whom oral and nasogastric tube feeding could not be given and percutaneous endoscopic gastrostomy could not be performed.

Results: A mean age of 63.7 years and 83.9% of them were ASA IV. The indications for gastrostomy were tumour obstruction, neuromuscular diseases, paralysis and cerebrovascular bleeding, oesophageal injury, metastatic tumours and hypoxic encephalopathy in 51.6, 17.7, and 16.6, 1.6 and 12.9% respectively. The mean operation duration was 34 ± 12.8 minutes. Procedure-dependent hospital morbidity and mortality were low (% 16.2- % 14.5, respectively).

Conclusion: Stamm gastrostomy with mini laparatomy under local anaesthesia is an effective alternative in situations where percutaneous or endoscopic procedures cannot be done. It can be performed in high-risk patients safely due to its short operation time, low morbidity and mortality.

Aim: The aim of this study was to evaluate the demographic characteristics, emergency care needs and prognosis of patients aged 65 years and older who presented to our Emergency Medicine Clinic with abdominal pain for a period of one year.

Patients and Methods: In this single-center, retrospective, observational study included patients aged 65 years and older who presented to the emergency department with abdominal pain between June 15, 2015 and June 14, 2016. The related variables were recorded from the patients' electronic and written files. The general patient population and the differences of variables in the 65-74 age group, 75-84 age group and ≥85 age group were investigated.

Results: A total of 1330 patients were included in the study. The mean age of the patients was 75.2 ± 7.2 years and 582 (43.8%) were male. While 58.8% of the patients were discharged from the emergency department, the most common hospitalization wards were General Surgery (14.1%) and Gastroenterology (11.4%). The ICU admission rate increased with age (p<0.001; 3.3% - 5.8% - 11.6%). The mean length of stay in hospital was 5.9 ± 7.1 days and the in-hospital mortality rate was 3.4%. While 50.1% of the patients in the 65-74 age group were discharged from the emergency department without consultation, this rate decreased to 36.6% in the ≥85 age group and the difference was statistically significant (p<0.001). Abdominal ultrasound was performed in 34.1%, abdominal tomography in 20.0% and both of them in 7.5% of the patients.

Conclusion: The patients aged 85 years and older with abdominal pain are more likely to be characterized by more examination needs, more consultation needs, more hospitalization rates and higher mortality rates. Taking these differences into consideration during the management of the elderly patients with abdominal pain in emergency department will help to reduce morbidity and mortality rates while improving patient care quality.

The presence of cardiac disease in pregnancy is still one of the most important reason of maternal mortality. The possibility of acute coronary syndrome increases in pregnancy. Birth with caesarean section provides proper hemodynamic monitoring and management in parturients with cardiac disease. However the ideal anesthetic to be applied to parturient with cardiac disease is controversial. Although regional anesthesia is usually preferred method, general anesthesia may be applied in some special cases. Invasive monitoring reduces mortality and morbidity in cardiac patients undergoing general anesthesia. Opioid use reduces the stress response to surgery and intubation. If the use of opioid is required before birth, remifentanil is the ideal agent because of its rapid onset of action and metabolism. In this case, we aimed to present our general anesthesia experience on a parturient with high cardiac risk where regional anesthesia is contraindicated because of the use of anticoagulation.

Aim: In this study, we aimed to present our 10-year experience regarding clinicopathology characteristics and
overall survival of 69 patients with adenocarcinomas of esophag ogastric junction (AEJs).
Patients and Methods: A total of 69 consecutive patients diagnosed with AEJ and operated in our clinics
were included in the study. Patients’ demographic characteristics; laboratory parameters, surgical resection
approach; TNM stages; resection extent; total number of removed lymph nodes; tumor localization; presence
of lymphatic, vascular and perineural invasion and overall survival (OS) status were recorded. The patients
were divided into two groups as Siewert Type II and Siewert Type III.
Results: There was no statistically significant difference between the groups in terms of age (p=0.696)
and gender (p=0.140). Distribution of T stage was statistically significantly different between the groups
(p=0.026). OS was found to be significantly higher in patients at R0 level compared to those at R1 level. OS
was statistically significantly higher in patients without lymphatic, vascular and perineural invasion. 1-year OS
was determined as 83.50%, 3-year OS as 49.10% and 5-year OS as 43.60%. The risk of mortality increased
by 8.63 folds in the presence of perigastric fat infiltration, 12.60 folds in the case of vascular invasion and
13.45 folds in the case of perineural invasion. The survival rate was found as 51% and 41% in the Siewert
Type II and Type 3 patients at median 10-year follow-up.
Conclusion: This study had successfully evaluated the clinicopathological characteristics and overall
survival, and demonstrated that Siewert II tumors and Siewert III tumors had similar survival outcomes.
Further comprehensive multicenter studies with larger series and long-term studies are needed to provide
contribution to the existing evidence on outcomes of patients w ith AEJs.

ABSTRACT

Aim: Sternal dehiscence is one of the most troublesome complications following cardiac surgery. Although it can be corrected by simple methods if detected earlier, treatment failure or delay in sternal dehiscence may result in mediastinitis, which is highly lethal.  In this study, we aimed to investigate alternative sternal closure systems, mainly sternal talon (STalon) and titanium sternal plates (SPlate). Patients and Methods: In between April 2015 and January 2018, patients with sternal dehiscence after any kind of open cardiac surgery were included in this study. These patients were retrospectively evaluated according to the their demographic data, risk factors for sternal dehiscence, type of operations, techniques used for fixation of the sternum, mainly focusing on the STalon and titanium SPlate fixation. Results: A total of 45 patients were taken into surgical correction because of sternal dehiscence.  Thirty-four (75.6%) of the patients male, whereas 11 (24.4%) were female. Mean time interval after the first operation to sternal dehiscence was 68.5 days (1-780 days). Mean body-mass-index (BMI) was 31.52 kg/m² (22.03-43.69 kg/m²). Before the sternal fixation, mean CRP value was 68.34, whereas it was 75.55 before discharge. Confounding risk factors were internal mammarian artery (IMA) harvesting for coronary artery disease, diabetes mellitus, bronchial asthma, chronic pulmonary artery disease and advanced age. Mean post-operative intensive care unit (ICU) length-of-stay (LOS) was 5.02 days (1-29 days), whereas hospital LOS was 17.18 days (2-74 days). Early mortality was observed in 3 patients (6.67%). The first choice of operation was simple closure and/or Robicsek closure. Apart from simple and Robicsek closure techniques, sternal talon and/or titanium plates were used in 24 patients (53.3%). DM was found to be related to extanded total hospital LOS, ICU LOS, and postoperative time to discharge. DM also increased the risk of both superficial and deep sternal infection rates (p<0.05).  Conclusion: Ideal sternal closure should stabilize the sternum, be cost-effective and provide shortest hospital LOS with minimal post-operative complications. In patients with intact intercostal spaces, sternal talon may eliminate serious complications, such as cardiac rupture mainly caused by dense adhesions. Sternal plates are mainly effective in fragmented fractures without stable intercostal spaces. All patients should be individualized according to type of lesions and sternal fractures.

Backround: Myocardial infarction with coronary artery disease (MICAD) is the leading cause of myocardial injury. Myocardial injury non-related to atherosclerotic plaque disruption (non-MICAD) is a rare and heterogeneous diagnosis. Although MICAD is well studied, non-MICAD was not thoroughly identified in young patient population. We aimed to investigate the frequency, main etiologies, and five-year mortality of patients with non-MICAD younger than 40 years.

Methods: We retrospectively enrolled 292 patients with acute myocardial injury younger than 40 years between January 2010 and December 2014. Clinical, demographic, laboratory, angiographic features, and five-year all-cause mortality were compared between patients with non-MICAD (n=78) and MICAD (n=214).

Results: Median age of patients was 36. Non-MICAD group was younger than MICAD group [32 (28-37) vs 37 (34-39)]. The frequency of female patients with non-MICAD was higher than those with MICAD (24.4% vs 10.3%). Most of the patients with MICAD presented with STEMI (77.1%), while most of the patients with non-MICAD presented with non-STEMI (89.7%). Most common etiologies of non-MICAD in were myocarditis (32%) and vasospasm (9%). Age, female sex, no smoking and, absence of dyslipidemia were independent predictors for non-MICAD. Five-year all-cause mortality in non-MICAD group was significantly lower than MICAD group (2.6% vs 10.3%) (log-rank test p=0.04).

Conclusion: Non-MICAD represents a heterogeneous group of patients who had varying etiologies at different ages. Despite the lower mortality rate of non-MICAD group, different diagnostic and treatment strategies are required for management of patients with non-MICAD.

 Postpartum haemorrhage (PPH) which is the first cause of maternal mortality in our country is responsible for about 25% of maternal deaths in the world . While PPH is defined as loss of 500 ml or more of blood from the genital tract within 24 hours of thebirth of a baby, severe PPH is blood loss exceeding 1,000 mL. The most common causes are uterine atony, genital tract injuries and placental retention. Many methods are used such as effective implementation of the uterine fundus massage, the use of agents which myometrium contact, hypogastric and/or uterine artery ligation or embolization in its treatment. Despite this, PPH is the primer cause of maternal death in our country. To reduce maternal mortality rates caused by dependence of PPH,  evidence-based approaches are important in treatment and care. Pharmacological, surgical approaches and various applications for the third stage of labour in the prevention and treatment of PPH are used. But there are no evidence-based studies at adequate levels for all treatment. The clinical data in a large part of the PPH/therapeutic approach are limited. Therefore, it is intended in this article to determine the current approaches related to the prevention of postpartum haemorrhage and to inform health professionals about the adequacy of the initiatives implemented.

Aim: The aim of this study is to examine whether the timing of surgery in our elderly patients with a
diagnosis of hip fracture changed before and after the pandemic, and whether this situation caused an
increase in mortality .
Patients and Methods: The patients who were operated with the diagnosis of hip fracture between March
2019 and March 2020 in our hospital database were accepted as in the pre-pandemic period, and the
patients who were operated with the diagnosis of hip fracture between April 2020 and April 2021 were
considered as in pandemic period. Both groups were statistically compared in terms of age, gender,
waiting time for surgery , length of hospital stay and one year mortality .
Results: When the factors af fecting mortality were examined, the time elapsed until surgery significantly
increased mortality. While the mean waiting time for surgery was 27.6±19.4 hours in all patients, it was
25.7±19.1 hours in Group 1 and 29.6±19.6 hours in Group 2 and there was a significant difference between
the two groups (p=0.043). The cut-off value of the waiting time for surgery, which caused mortality, was
determined as “23.35” hours. While no significant increase in mortality was found in Group 1 (p=0.340),
the increased delay for surgery in Group 2 affected mortality significantly (p=0.027).
Conclusion: In this study, it was found that the increase in the delay of admission for surgery over 23.35
hours in the elderly population after hip fractures was directly associated with one year of mortality
and also we think that the waiting time for surgery in the pandemic conditions is one of the factors that
negatively af fect mortality in these patients.

Since the identification of SARS-CoV-2, a multisystem inflammatory syndrome (MIS-C) that appears in
children after COVID-19 disease and mimics Kawasaki disease was reported in the UK in April 2020,
while it is associated with Covid-19 in adults. Multisystem inflammatory syndrome (MIS-A) was reported
in June 2020. MIS-A patients have been reported to be up to 50 years of age in the literature and are more
likely to have some underlying health condition and have recently had an identifiable respiratory disease
compared to MIS-C. On the other hand, MIS-A patients and MIS-C patients have many overlapping clinical
features, but the severity of cardiac dysfunction, incidence of thrombosis, and MIS-A mortality may be
higher in MIS-A. While it is clear that neutrophilia, lymphopenia, and thrombocytopenia are common in
MIS-C/A, these features, together with elevations in troponin and BNP/NT-proBNP, have been considered
measures of disease activity .

\r\n Prognostic importance of thrombocyte indices in children with carbon monoxide poisoning

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\r\n Abstract

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\r\n Objective: Carbon monoxide (CO) poisoning is still being a major cause of morbidity and mortality all over the world. Although the role of platelet functions in CO poisoning is not clear, increased platelet activation and aggregation had been reported previously. Increased thrombotic tendency due to endothelial damage, increased platelet stickiness, and alterations in the fibrinolytic pathway occurs in CO poisoning. The aim of our study was to determine whether platelet indices provide clinical benefit or not in children with CO poisoning.

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\r\n Materials and Methods: We retrospectively reviwed the records of children with the diagnosis of CO poisoning who admitted to the pediatric emergency departments of Konya Beyhekim State Hospital and Necmettin Erbakan University Meram Medical Faculty. A total of 92 children with CO poisoning and 62 age- and gender-matched healthy controls were included in the study.

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\r\n Results: While mean platelet volume (MPV) and platelet distribution width (PDW) levels were significantly higher (9,34±0,55 vs 9,78±0,97fL, p=0.001 ; 11,46±2,64 vs 10,57±1,41, retrospectively, p=0.007), platelet count and plateletcrit (PCT) (324,05±82,07 vs 357,27±89,70 x10⁹ p=0.015 ; 0,31±0,06 vs 0,33±0,07, retrospectively, p=0.039) were significantly lower in patients with CO poisoning. MPV levels were also significantly higher in patients with a carboxy hemoglobin (COHb) level higher than 20, when compared with COHb levels between 10-20 (9,40±0,84 vs 10,08±1,22 fL, p=0.003).

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\r\n Conclusion: Our results showed that platelet indices MPV and PDW are markedly elevated in patients with CO poisoning while platelet count and PCT were decreased. MPV and PDW levels, which reflect the changes in platelet activation and function, may predict the development of especially thromboembolic complications in the course of CO poisoning.  MPV and PDW levels may be useful in prognostic estimation of CO poisoning.

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\r\n Keywords: carbon monoxide; children; platelet indices; poisoning

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Aim: Convalescent plasma (CP) therapy has been used for treatment, although it has not been Corona
Virus 2019 Disease (COVID-19) specific antiviral agent so far. However, the effectiveness of CP treatment
on prognosis and mortality is still a matter of debate. In this study, we aimed to share our experiences
about the ef fectiveness of CP treatment in COVID-19.
Materials and Methods: The study was conducted in 126 patients diagnosed with COVID-19 who received
CP treatment in addition to standard treatment between May 2020 and February 2021. 126 patients were
divided into two groups as those who underwent SP within the first five days (Group A) and after five days
(Group B). The patients in these two groups were evaluated in terms of laboratory parameters, clinical
and mortality.
Results: A total of 126 patients were identified (86 patients in Group A and 40 patients in Group B). 119
(94.4%) patients were discharged with recovery, 7 (5.5%) patients died. The mean days of hospitalization
were found to be 11.4±0.7 in Group A and 18.4±1.7 in Group B (p<0.001). Treatment-related lymphocyte,
PLT, fibrinogen and CRP main effect of change was significant (p<0.001). However, the results were
marginally significant when the two groups were compared in terms of D-dimer. When the simple effect is
evaluated; Group A as not significant, while group B was significant. Starting CP treatment 5 days before
or 5 days later did not change the laboratory parameters. However, D-dimer was marginally significant
(p=0.058).
Conclusion: In our study, it was shown that early initiation of CP treatment reduced the hospitalization,
but had no ef fect on mortality and laboratory parameters.

Abstract

INTRODUCTION

Acute mesenteric ischemia (AMI) is an acute abdominal disease which is age-related with possible bad prognosis; and while its morbidity and mortality rate is 10% in early diagnosis and treatment it may progress with 100% mortality when diagnosis and treatment are delayed.The aim of this study was to unearth the efficiency of neutrophil-to-lymphocyte ratio (NLR) which has recently been started to be utilized in the prediction of AMI prognosis and used as a prognostic factor in many diseases.

MATERIALS and METHODS:

The data of a total of 111 patients, who had undergone surgical procedures and diagnosed with mesenteric ischemia intraoperatively at Necmettin Erbakan University Meram Medical School’s General Surgery Clinic between 2005 and 2013 and whose diagnoses had later on been confirmed pathologically, were retrospectively evaluated within the scope of the study.

The demographic data of all patients (age, sex) were recorded. The hemogram results of the patients, analyzed with peripheral blood, were reviewed for preoperative evaluation. The surgical procedure performed, the part and length of the resected bowel based on pathology results, the duration of hospitalization, survey, presence of comorbidity, white blood cell count, creatinine values, and NLR of the patients were determined. The data were statistically analyzed.

RESULTS:

The patients who did not survive had a mean NLR of 24.77 ±10.38, while the same ratio was found to be 17.6±10.65 for survivors. The NLO value was found to be high in cases with mortality.

CONCLUSION:

AMI still proves to have high mortality in spite of the developments in imaging techniques and laboratory analyses. There is no specific laboratory analysis for early diagnosis. High preoperative NLR in patients suspected to have AMI may indicate bad prognosis.

Aim: Venous thromboembolism (VTE) events covering deep vein thrombosis (DVT) and pulmonary
embolism (PE) constitute the most important morbidity-mortality cause in obesity surgery. The objective
of this study was to assessment of thromboembolism results in patients who underwent bariatric surgery
with standard dose prophylaxis.
Patients and Methods: The patients who were operated for morbid obesity in our clinic between 2015 and
2019 were retrospectively examined. Cases that had laparoscopic sleeve gastrectomy and were applied
standard dose Enoxaparin prophylaxis were included in the study. Demographic data, preoperative
preparation and postoperative antiembolic treatment conditions of the patients were registered.
Results: Eighty-seven patients who had laparoscopic sleeve gastrectomy were included in the study. 66
(%75,8) of the patients were female and 21 (%24,1) were male. The mean age was 38.7 (18-55). Mean
hospitalization duration was 6.6 (3-69) days. Four patients (% 4,5) had postoperative complication. PE
developed in two patients while leak-related mediastinitis and incisional hernia (%1,1) developed in one
case each.
Conclusion: Despite available prophylaxis methods, VTE constitutes an important morbidity and mortality
cause in patients who had bariatric surgery. While high-dose low-molecular weight heparin (LMWH) use
may cause bleeding, the possibility of VTE increases with using low-dose LMWH. This situation appears
as a limitation of LMWHs. New studies are needed for increased dose at early period and standard dose
application after discharge.

Although foreign body embolization is a rare complication of percutaneous coronary intervention, the increase in the number of procedures results in this problem being more frequently encountered by interventional cardiologists. Contemporary case studies have reported the rate of stent stripping to be below 1%. Interventional cardiologists attend to a considerable number of cases in everyday practice and witness a diverse spectrum of complications. Stent stripping can result in severe complications such as emergency coronary bypass surgery, coronary thrombosis, myocardial infarction, cerebrovascular event and death. Thus, the proper management of stent stripping is important for reducing the risk of mortality and morbidity. In this article, we present a case of left main coronary artery stent stripping; we discuss the removal procedure and the complications that arose.

Amaç: Bu çalışmada, kritik bakım hastalarında yoğun bakım ünitesi (YBÜ) yatışında ölçülen kan üre
azotu (BUN)/albümin oranının hastane içi mortaliteyi tahmin etme açısından prognostik değerinin
değerlendirilmesi amaçlandı.
Hastalar ve Yöntem: Bu retrospektif gözlemsel çalışma, bir üniversite hastanesinin acil servisinde (AS)
gerçekleştirildi. Altı ay (1 Temmuz 2019 - 31 Aralık 2019) boyunca acil AS-YBÜ’ye yatırılan hastalar
çalışmaya dahil edildi. BUN/albümin oranının hesaplanmasında YBÜ’ye kabul öncesi ölçülmüş olan BUN
ve albümin değerleri esas alındı. Çalışmanın birincil sonucu ha stane içi mortaliteydi.
Bulgular: Çalışmaya toplam 572 hasta dahil edildi. Dahil edilen hastaların ortanca yaşı 66 (54–77) yıldı
ve bunların 362'si (%63,3) erkekti. Genel hastane içi mortalite oranı 29.0% (166 hasta) idi. Vefat edenlerin
ortanca BUN seviyesi hayatta kalanlardan daha yüksekti (38,2 (21,4-59,7) ve 21,9 (14,9-36,9) mg/dL,
p<0,001). Vefat edenlerin ortanca albümin seviyesi hayatta kalanlardan daha düşüktü (2,9 (2,3-3,5) ve 3,7
(3,2-4,0) g/dL, p<0,001). Vefat edenlerin ortanca BUN/albümin oranı hayatta kalanlardan daha yüksekti
(13.33 (6.69–22.99) ve 6.21 (3.83–11.21), p<0.001). Eğri altında kalan alanların sıralaması albümin
(0,742), BUN/albümin oranı (0,720) ve BUN (0,678) idi. Hastane içi mortaliteyi tahmin etme açısından
hesaplanan kesim değerleri, albümin için 3,2 g/dL, BUN/albümin oranı için 10 ve BUN için 32 mg/dL idi.
Sonuç: Sonuç olarak, YBÜ’ye yatış sırasında saptanan hipoalbüminemi, kritik hastalarda hastane içi
mortalite ile ilişkilidir. Yüksek BUN ve BUN/albümin oranı da bu hastalarda hastane içi mortalitenin
öngörücüleridir; ancak BUN ve BUN/albümin oranı hipoalbüminemid en daha üstün değildir .

Aim: Post-myocardial infarction ventricular septal defects (PMIVSD) are rare but have extremely high
mortality and morbidity. Mortality rates and risk factors vary in many studies. We aimed to evaluate
the mortality rates and risk factors of ventricular septal defects (PMIVSD) after myocardial infarction
performed in our center .
Patients and Methods: We retrospectively enrolled the patients who underwent surgery for PMIVSD in
our clinic from January 2006 to April 2020 with the age ≥ 18.
Results: A total of 9451 patients admitted to our center with acute myocardial infarction between 2006
and 2020 were examined. Twenty-eight patients operated for PMIVSD were included in the study. Our
PMIVSD rate was 0.296%. When we compare those survivors and non-survivors the only thing which
statistically significant was length of stay in hospital. In survivors it was 13 days when it 2 days in nonsurvivors
group (p<0.001). One patient in survivor group was st ayed in hospital for 107 days.
Conclusion: Timing of the surgery for PMIVSD patients is still challenging. Further strategies like
implanting LVAD or percutaneous devices and waiting for a while before the surgery will be the better
approach for PMIVSD patients.