Journal of Surgery and Medicine

Journal Information
EISSN : 2602-2079
Published by: Fatih Basak (10.28982)
Total articles ≅ 910
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DOAJ
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SHERPA/ROMEO
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Latest articles in this journal

Suphi Aydin, Gürhan Öz, , Adem Gencer, Aydın BALCI, Funda Demirağ
Published: 1 November 2021
Journal of Surgery and Medicine, Volume 5, pp 1-1; https://doi.org/10.28982/josam.909324

Abstract:
Benign metastasizing leiomyoma is exceedingly rare. Pulmonary benign metastasizing leiomyoma is defined as the metastasis of leiomyoma to the lung tissue. It has a benign histological character, but the presence of metastasis is contradictory. First reported in 1937, it is generally seen among women of young reproductive age and premenopausal women who have undergone uterine leiomyoma or hysterectomy, and the most common site of metastasis is the lung. The prognosis is generally very favorable, and it rarely undergoes a malignant transformation. However, various studies suggest that pulmonary and pleural leiomyoma may cause acute respiratory failure. Radiological findings have a wide spectrum ranging from primary malignant neoplasms to metastatic diseases. Benign metastasizing leiomyoma is usually incidentally found on chest x-rays, and it appears as nodules arising from the benign proliferation of smooth muscles. Here, we present a 46-year-old patient who had a hysterectomy 15 years ago due to uterine leiomyoma and was recently diagnosed with benign leiomyoma which metastasized to the lung. It should be kept in mind that benign leiomyomas with pulmonary metastasis may rarely undergo malignant transformation.
Shilpi Karmakar, Arun Singh, Saurabh Karmakar
Published: 1 November 2021
Journal of Surgery and Medicine, Volume 5, pp 1-1; https://doi.org/10.28982/josam.857493

Abstract:
Osteomyelitis (OM) of zygomatic bone (zyb) is a rare disease, characterized by relapses. We present two patients presenting with chronic discharging sinus over zyb, who had been treated in previous centers, with multiple culture–directed antibiotics, over many months, without cure. We administered intramuscular Benzathine Penicillin 1.2 million IU with oral Vitamin C 1000 mg/day, for a total of six months and achieved successful healing. In chronic OM (cOM), most bacteria are sessile, embedded in biofilm. Sessile bacteria are not picked by a swab; therefore, the bone must be biopsied. Sessile bacteria also do not grow well in culture media. Thus, the conventional cultures do not reflect the true organisms causing cOM. The Minimum Biofilm Eradication Concentration of antibiotics cause toxicity. To eradicate the biofilm bacteria in patients whose computed tomography showed absence of a sequestrum, we administer this regimen. Judicious case selection is necessary. This regimen adds to the clinician’s armamentarium.
Ahmet Yabalak, Murat Yilmaz
Published: 1 November 2021
Journal of Surgery and Medicine, Volume 5, pp 1-1; https://doi.org/10.28982/josam.1000878

Abstract:
There are difficulties in the use of embolic protection devices (EPD) for carotid artery stenting (CAS), and various side effects can be observed. We presented a patient who underwent CAS with a distal filter-type (DF) EPD for symptomatic right internal carotid artery (ICA) stenosis and showed advanced vasospasm. A 68-year-old male patient was hospitalized with a pre-diagnosis of transient ischemic attack (TIA) in the form of left-sided weakness. Computed tomography angiography revealed 90% stenosis in the right ICA. On the 5th day, he underwent an angiography, which showed a plaque causing 90% stenosis. A 5F Spider FX (Medtronic Corp.; Minneapolis, MN, USA) was placed in the cervical ICA. At this time, mild vasospasm was observed in the cervical ICA, but the flow was normal. After pre-dilatation, a Protégé 8-6x40 stent was placed in the stenotic segment. Due to the 50% residual stenosis, a post-dilatation was performed. After post-dilatation, advanced vasospasm developed distal to the stent and the flow was completely obstructed. Vasospasm significantly regressed within a few minutes with intra-arterial nitrate administration. There was no change in the neurological examination of the patient during and after the procedure. Although vasospasm is usually a self-limiting complication that resolves without clinical symptoms, it may cause a TIA or an infarct. In CAS procedures, the possibility of a vasospasm should be kept in mind and if it occurs, the irritant should be removed. If there is no improvement, an intra-arterial vasodilator should be administered.
Helin Şahintürk, Emre Kandemir, Mesher Ensarioglu, , Ender Gedik, Pınar Zeyneloglu
Published: 1 November 2021
Journal of Surgery and Medicine, Volume 5, pp 1107-1112; https://doi.org/10.28982/josam.993577

Abstract:
Background/Aim: Acute kidney injury (AKI) is a common serious complication associated with morbidity and mortality in critically ill COVID-19 patients. Although there is very limited data on the incidence of AKI in this cohort, conflicting results were recently reported. The incidence of AKI in critically ill COVID-19 patients ranged between 0.5-50% in the early studies. This study aimed to evaluate the incidence and determine the demographic parameters, clinical courses, and outcomes of AKI in critically ill COVID-19 patients admitted to the intensive care unit (ICU). Methods: After ethics committee approval was obtained, critically ill COVID-19 patients admitted to our ICU between June 1- December 30, 2020, were analyzed in this retrospective cohort study. Patients over the age of 18 years who were admitted to the intensive care unit with the diagnosis of COVID-19 or whose real-time polymerase chain reactions (RT-PCR) test were positive were included in the study. Incidence and stages of AKI among the included critically ill COVID-19 patients were evaluated. The patients were divided into two groups according to the presence of AKI to define the risk factors and clinical outcomes. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines based on serum creatinine and urine output. Results: We analyzed seventy-four critically ill confirmed COVID-19 patients. The mean age was 70.7 (14.8) years and 63.5% were male. Thirty-four patients (45.9%) had AKI, 12 patients in stage I (16.2%), 13 patients in stage II (17.6%), and 9 patients in stage III (12.1%). Renal replacement therapy (RRT) was initiated in 28.4% of patients with AKI; 16.2% received intermittent hemodialysis and 12.2%, continuous renal replacement therapy. APACHE II score and GCS at ICU admission were similar in patients with or without AKI (P>0.05), but the SOFA score was significantly higher in patients with AKI (P=0.03). ARDS and shock were significantly higher in patients with AKI than without (P=0.01 and P=0.039, respectively). Compared to the patients without AKI, those with AKI required higher amounts of oxygen therapy (high-flow oxygen therapy, non-invasive mechanical ventilation) and invasive mechanical ventilation (P=0.01 and P<0.001). The ICU mortality was 61.8% for the AKI group compared to 20% among those without (P<0.001). Conclusions: Our study showed that AKI and renal replacement therapy are common in critically ill COVID-19 patients. SOFA score, ARDS, and shock rates were significantly higher among patients who developed AKI. The presence of AKI was associated with higher amounts of oxygen therapy and increased invasive mechanical ventilation. The severity of illness at ICU admission and ICU mortality were higher among those with AKI. Since AKI is seen in almost one in two patients and its development is associated with higher mortality, urine output, and creatinine values should be closely monitored in critically ill COVID-19 patients. It is recommended not to delay RRT therapy as soon as stage 2 AKI develops to preserve kidney function. In addition, optimal hemodynamic monitoring with appropriate fluid management and vasopressor drugs is required to ensure adequate renal perfusion.
Feyza Bayram, Canan Urun, Jale Karakaya, Süleyman Serkan Karaşin
Published: 1 November 2021
Journal of Surgery and Medicine, Volume 5, pp 1086-1089; https://doi.org/10.28982/josam.987243

Abstract:
Background/Aim: Postpartum hemorrhage (PPH) is an important cause of maternal death and morbidity worldwide. Its incidence is still increasing in some countries. This study aimed to evaluate the incidence, indications, risk factors, complications, maternal and fetal outcomes, mortality rates and management strategies of emergency peripartum hysterectomy (EPH) in women with life-threatening postpartum hemorrhage. Methods: This retrospective cohort study included 94 cases of EPH performed at tertiary obstetric center between January 2016-January 2021. The demographic data, current pregnancy and delivery mode, hysterectomy indications, operative complications, postoperative conditions, and maternal and fetal outcomes were analyzed. EPH was performed for hemorrhage which cannot be controlled with other conventional treatments within 24 hours of delivery. Results: The incidence of EPH was 1.71 per 1000 deliveries. In our study, the indications of hysterectomy were placenta previa in 47 cases (50%), placental insertion anomalies in 23 cases (24.5%), uterine atony in 22 cases (23.4%), and uterine rupture in 2 cases (2.1%). Hysterectomy was performed after vaginal delivery in 7 patients (7.4%) and during cesarean section in 87 cases (92.6%). Total and subtotal hysterectomy were performed in 88 (93.6%) and 6 cases (6.4%), respectively. Major complications occurred in 40 patients (42.6%). In total, 97.9% of the patients required a transfusion of blood and blood products. The mean postoperative hospital stay was 8.1 (6.1) days. There were two (2.2 %) maternal deaths due to pulmonary embolism and coagulopathy. Conclusion: EPH operation has high maternal morbidity and mortality but is lifesaving when performed at the appropriate time. The most common indication for EPH was placental abnormality (74.5%), followed by uterine atony (23.4%). Together with a significant increase in cesarean rates, significant increases in the frequency of placental abnormalities are remarkable. Limiting the number of cesarean deliveries will have a significant impact on reducing the risk of EPH.
Aysun Tekeli Taşkömür, Özlem Erten, Berna Dilbaz
Published: 1 November 2021
Journal of Surgery and Medicine, Volume 5, pp 1099-1103; https://doi.org/10.28982/josam.1002126

Abstract:
Background/Aim: Serious side effects, depending on the length of the hormone-free interval and the estrogen dose, cause the discontinuation of combined oral contraceptives (COCs). Therefore, it is important to identify COCs with minimal side effects which provide effective contraception. This study aimed to compare the effects of two different drospirenone-containing oral contraceptives (COCs) on ovarian suppression, cycle control, premenstrual symptoms, pain, acne, and the incidence of side-effects. Methods: This prospective randomized controlled study was conducted with eighty women aged between 17-40 years. Patients were randomized to either 3mg drospirenone/30mcg ethinylestradiol (21/7 tablets) (Group 1) or 3mg drospirenone/20mcg ethinylestradiol (24/4 tablets) (Group 2) COCs. On Day-3 of the pre-treatment cycle, menstrual cycle patterns, serum hormone and lipid levels, menstrual complaints were recorded, followed by an evaluation of Day-21 progesterone levels, sonographic evaluation of endometrial thickness and the ovaries. Same assessment was repeated after pill use and the findings of the two cycles were compared. Results: Both COC formulations suppressed serum hormone levels, decreased endometrial thickness and reduced incidence of dysmenorrhea-dyspareunia, and acne while serum HDL-cholesterol level was increased. Progesterone, FSH and endometrial thickness were lower, and serum cholesterol level was higher in Group 2 (P=0.007, P=0.044, P<0.001, P=0.035; respectively). Breast tenderness was significantly less in Group 2 (P=0.02). The incidence of follicular development, menstrual irregularity, and a headache was higher in Group 1, but the difference was not significant except for headaches (P=0.027). Conclusion: 24/4 tablets might be a better alternative to 21/7 tablets with the advantage of tolerability as well as providing effective contraception.
Altay Atalay, Ayşe Nedret KOÇ, Nuri Çakir, Fatma Mutlu Sariguzel, Pınar Sağiroğlu
Published: 1 November 2021
Journal of Surgery and Medicine, Volume 5, pp 1104-1106; https://doi.org/10.28982/josam.892965

Abstract:
Background/Aim: C. albicans remains the most common pathogen responsible for invasive candidiasis. On the other hand, increased rates of candidiasis have been reported worldwide, caused by other Candida species (such as K. marxianus and C. lusitaniae). Considering these uncommon yeasts may be crucial pathogens in the future, it is preferable to describe the in-vitro activities of antifungal agents as potential options for their treatments. This study aimed to evaluate the in-vitro activity of nine different antifungal agents that are routinely used to contribute to the treatment of the infections caused by K. marxianus and C. lusitaniae. Methods: The study included 21 K. marxianus and eight C.lusitaniae strains isolated from various clinical specimens of patients with suspected invasive fungal infection. Conventional identification was confirmed using the molecular methodology of DNA sequencing analysis. Antifungal susceptibilities of the isolates were tested using the Sensititer Yeast One Test Panel Y06 kit, a colorimetric microdilution test. Results: For K. marxianus, amphotericin B had the highest geometric mean MIC (1 μg/mL) and voriconazole had the lowest geometric mean MIC (0.010 μg/mL). For C. lusitaniae, flucytosine had the highest geometric mean MIC (8 μg/mL) and voriconazole had the lowest geometric mean MIC (0.011 μg/mL). Conclusion: Considering that these two species, rare causes of invasive candidiasis nowadays, may become important pathogens in the future, it is reasonable to investigate the in-vitro activities of antifungal agents that can be used in their treatment.
Gökhan Evcili, Ahmet Yabalak
Published: 1 November 2021
Journal of Surgery and Medicine, Volume 5, pp 1131-1134; https://doi.org/10.28982/josam.1000962

Abstract:
Background/Aim: Migraine is a common, disabling neurological disorder and cranial nerve blocks (CNB) are used in the treatment of headaches. This study aimed to compare the effectiveness of a CNB with conventional medical treatment in patients with chronic migraine resistant to first-line treatment. Methods: This retrospective cohort study included 102 patients with chronic migraine resistant to first-line treatment who were treated in our outpatient clinic. The patients were divided into two groups as those who underwent CNB (n=67) and the control group, who were only treated with conventional drugs (n=35). Bilateral CNB was performed on the patients at baseline and in the second week. The patients’ Visual Analogue Scale (VAS) scores, number of days in pain, and the number of analgesics taken were recorded at baseline and the second month. Results: The second-month VAS scores and the number of days in pain were significantly lower than baseline in both the CNB and control groups (P<0.01, and P<0.05, respectively). However, while the number of analgesics taken in the 2nd month was lower in the CNB group, it was similar in the control group. (P<0.01, P=0.33). No significant difference was found between the groups in terms of the number of days in pain in the second month (P=0.09). The second month's VAS scores and the number of analgesics taken were significantly lower in the CNB group compared to the control group (P=0.01, P<0.01). Conclusion: Our findings indicated that the CNB was more effective than conventional treatment in patients with chronic migraine resistant to first-line treatment.
Funda Pepedil Tanrikulu, , Bilal Aygun, Mehmet Bankir, Mikail Özdemir
Published: 1 November 2021
Journal of Surgery and Medicine, Volume 5, pp 1095-1098; https://doi.org/10.28982/josam.981625

Abstract:
Background/Aim: The reactivation of Hepatitis B virus (HBV) among cancer patients is a critical issue which is preventable by precise detection of risky cases prior to the administration of chemotherapy drugs. This study aimed to investigate whether the evaluated serological tests for HBV screening before chemotherapy in adults with newly diagnosed hematological malignancies follow the guidelines. Methods: In this retrospective cohort study, all patients with hematological malignancies who visited our hematology clinic between January 01, 2018-January 01, 2020, were examined and adult patients referred to the outpatient clinic for combined chemotherapy were included. All clinical data and laboratory results were obtained from the electronic hospital information system. Serological tests performed for HBV screening and their results were noted. The compliance of our clinical practice with the current guidelines was analyzed assuming that there are three mandatory serological tests for screening, HBsAg, anti-HBs and anti-HBc, recommended in the guidelines. Results: A total of 91 newly diagnosed cases were included for analysis. HBV screening completely lacked in 10% of the patients and it did not follow the current guidelines in 30%. The most neglected serological test was anti-HBc. Regarding different hematological malignancies, the results were best in lymphoma patients (76% compliance with guidelines) and worst in MM (only 40% compliance with guidelines). The serological test results of eighty-two cases were also examined and the seropositivity rates for HBsAg and anti-HBc were 2%, and 41%, respectively. Conclusion: We observed that the risk of reactivation was not adequately evaluated by serological screenings for HBV in adult patients receiving chemotherapy for hematological malignancy. To protect patients from this mostly preventable complication, it is necessary to increase the awareness on the subject and encourage more compliance with the related guidelines.
Murathan Erkent, Güneş Dinç Akbulut, Utku Horzum, Çisel Aydin Meriçöz, Güneş Esendağli
Published: 1 November 2021
Journal of Surgery and Medicine, Volume 5, pp 1079-1085; https://doi.org/10.28982/josam.1003837

Abstract:
Background/Aim: Ischemia/reperfusion (I/R) injury occurs during breast cancer surgery, especially those involving a modified radical mastectomy, lumpectomy, and axillary lymph node dissection. Tissue damage and stress due to I/R alter immune system functions, especially those of the myeloid cells. The immunologic impact of this I/R injury on myeloid-derived cancerous cells remains unknown. We sought to investigate the effect of I/R injury in the extremity close the breast tumor location on myeloid cell population in the liver and liver metastasis. Methods: 4T1 breast tumors were created in the left inguinal breast region of the experimental animals. When the tumor reached 0.5 cm in diameter, ischemia was produced on the left down-extremity for 90 min and reperfusion was induced for short (3 days), middle (7 days), and long terms (14 days). At the end of the reperfusion period, proximal limbs and livers were harvested. The limb and liver samples were histopathologically examined with H&E staining. Immune cell percentages were determined in the liver by flow cytometry. Results: There was an increase in muscle fiber degeneration and disorganization in the I/R induced proximal legs on days 3 and 7 of I/R in both tumor free and tumor bearing animals with a further impact in tumor bearing mice. Even though I/R injury did not affect tumor metastasis to the liver, it had an impact on liver myeloid cell percentages in both tumor free and tumor bearing animals. Additionally, tumor bearing mice demonstrated higher myeloid cell percentages in both the pre-I/R and post-I/R experimental groups. There was a remarkable change in the levels of granulocytic, and monocytic myeloid cells and macrophages due to the I/R injury. Conclusion: With the formation of short-term I/R injury in a distant site, tumor development and/or seeding to metastasis sites after surgery could be prevented. This study contributes to the understanding of the inflammatory process after I/R injury occurring during interventions.
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