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Background: This study retrospectively analyzed the clinical data, laboratory results, imaging findings, and histopathological features of 28 patients who underwent ultrasound-guided core-needle biopsy from a hepatic lesion and were diagnosed with alveolar echinococcosis. Results: Among 28 patients included in the study, 16 were females and 12 were males. The mean age of the studied population was 53 ± 16 years, and the age range was 18–79 years. The most common presenting symptom was abdominal pain, which was observed in 14 patients. A total of 36 lesions were detected in the patients’ livers, out of which 7 had a cystic appearance. Hepatic vascular involvement, bile duct involvement, and other organ involvement were depicted in 14, 5, and 7 patients, respectively. The average number of cores taken from the lesions was 2.7, ranging between 2 and 5. In histopathological evaluation, PAS+ parasitic membrane structures were visualized on a necrotic background in all cases. Regarding seven patients, who were operated, the pathological findings of preoperative percutaneous biopsies were in perfect agreement with the pathological examinations after surgical resections. None of the patients developed major complications after biopsy. Conclusion: Ultrasound-guided core-needle biopsy is a minimally invasive, reliable, and effective diagnostic tool for the definitive diagnosis of hepatic alveolar echinococcosis.

Introduction: This study describes the terrorist attacks on two synagogues (Beth Israel and Neve Shalom) in Istanbul, Turkey on November 15, 2003 and the terrorist attacks on the Hong Kong‐Shanghai Banking Corporation (HSBC) and British Consulate on November 20, 2003. Method: A retrospective descriptive study was performed using hospital records and open sources reports. Results: On November 15, the emergency services of 24 hospitals were incorporated in the action and 330 patients were treated. Eighty‐five (26%) patients were hospitalized for prolonged medical care, 10 of whom required intensive care unit (ICU) support. These 85 patients needed a total of 348 days of hospitalization and the mean hospitalization time was 4 days. One hundred and forty‐two (43%) patients were transported to the hospitals via ambulances and 188 (57%) patients were taken to the hospitals in various other vehicles. Twenty‐six patients died. On November 20, 34 hospitals were involved in the operation, and a total of 495 patients were admitted. Fifty‐nine patients were hospitalized, 10 of whom needed ICU support. These 59 patients were hospitalized for 370 days with a mean of 6.2 days. In all, 164 (33%) patients were transported to the hospitals via ambulances. Thirty‐four people died. Discussion: Mortality, injury and hospitalization rates were consistent with previous reports of terrorist bombings. Head and neck injuries were the most common injuries among the victims in both events. Trauma center and trauma physicians play a principal role in the management of disaster victims. All hospitals should have a disaster plan. It must always be remembered that the devastating impact and consequences of these episodes may be diminished with global collaboration. [ABSTRACT FROM AUTHOR]

Background: Gastroduodenal ulcers are still a common cause of severe upper gastrointestinal bleeding. Endoscopy has gained popularity worldwide over conventional open surgery for the treatment of upper gastrointestinal bleeding. This study aims to assess the efficacy of endoscopic injection of epinephrine in the treatment of gastroduodenal ulcer bleeding. Methods: This study was conducted between March 2000 and March 2003. We analyzed 107 consecutive patients admitted to our department of trauma and emergency surgery with upper gastrointestinal bleeding. Endoscopy was performed on all 107 patients and bleeding ulcers were treated with injection of diluted epinephrine. Results: Recurrent bleeding was seen in 21 patients (19.6%), all of whom underwent a second endoscopy. Four patients (3.7%) required a third endoscopy session and nine patients (8.5%) needed surgery after endoscopy failed. There were two mortalities (1.9%). The nine patients who required surgery and the two patients who died were all in the Forrest Ia and Ib groups of acute UGI hemorrhage. Discussion: Endoscopic injection therapy with epinephrine reduces operation rates and can be used safely in adequate hemostasis of gastroduodenal ulcers. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this randomized controlled experimental study was to evaluate the efficacy of potassium, pH and D-dimer levels in blood, as well as potassium and pH levels in peritoneal lavage fluid, in the early diagnosis of acute mesenteric ischemia., Material and Methods: This study was conducted at the Istanbul University Center of Experimental Medicine after having received approval from the Istanbul University animal testing ethics committee. Male albino Wistar rats ( n = 24; 250 to 350 g) were divided into two control groups and two ischemic groups. Levels of potassium, pH, and D-dimer in blood and levels of potassium and pH in peritoneal lavage fluid were analyzed for 1 h and 2 h after the induced acute mesenteric ischemia procedure. The degree of ischemic injury was determined using the histopathological damage score in tissue samples taken from the terminal ileum., Results: Ischemic groups had statistically significant differences in potassium and pH in blood and peritoneal lavage fluid compared to non-ischemic groups ( p < 0.05). There was no significant difference between control and ischemic groups in terms of D-dimer and histologic grading results after 1 h ( p = 0.132, p = 0.475 respectively), while there was a significant difference between control and ischemic groups after 2 h ( p < 0.05)., Conclusions: The levels of potassium, pH, and D-dimer could be useful in daily practice for the early diagnosis of acute mesenteric ischemia., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2019 Termedia & Banach.)

Background: Sleeve gastrectomy(SG) is a popular bariatric surgery procedure with rare but dreaded complications. Although drain amylase levels are a reliable early predictor of anastomosis leakage in oesophagectomy and pancreaticoduodenectomy, for SG have not yet been studied. We aimed to monitor drain amylase levels to ascertain their applicability for early diagnosis of gastric leakage in SG., Methods: Twenty-four rats were randomly divided into three groups: Group A: only laparotomy and abdominal drain; Group B: laparotomy, SG, and drain; Group C: laparotomy, SG with fistula,and drain. On postoperative days 0,1,2,3, and 4, drain lavage samples were collected to measure amylase., Results: Groups were compared in pairs. Preoperative weights were not significantly different in any comparison. On postoperative days 0,1,2,3, and 4, drain amylase levels were found to be significantly lower in Group A than in Group B as well as in Group A than in Group C but were significantly higher in Group C than in Group B. For postoperative day 1, a receiver operating characteristic curve was done. Drain amylase levels over 1514 IU were statistically significant for leakage., Conclusions: Drain amylase levels were significantly high in sleeve gastrectomy with fistula. This indicates that drain amylase level monitoring might be an easy and cheap alternative for determining staple-line leakage for high risk patients with Body Mass Index(BMI)>50kg/m2 in whom we cannot use radiological imaging., Key Words: Animal Experimental Study, Bariatric Surgery, Drain amylase, Sleeve gastrectomy, Staple-line leakage.

Aim: To investigate the role of second-look laparoscopy in patients with acute mesenteric ischemia (AMI)., Methods: Between January 2000 and November 2005, 71 patients were operated for the treatment of AMI. The indications for a second-look were low flow state, bowel resection and anastomosis or mesenteric thromboembolectomy performed during the first operation. Regardless of the clinical course of patients, the second-look laparoscopic examination was performed 72 h post-operatively at the bed side in the ICU or operating room., Results: The average time of admission to the hospital after the initiation of symptoms was 3 d (range, 5 h-9 d). In 14 patients, laparotomy was performed. In 11 patients, small and/or large bowel necrosis was detected and initial resection and anastomosis were conducted. A low flow state was observed in two patients and superior mesenteric artery thromboembolectomy with small bowel resection was performed in one patient. In 13 patients, a second-look laparoscopic examination revealed normal bowel viability, but in one patient, intestinal necrosis was detected. In two of the patients, a third operation was necessary to correct anastomotic leakage. The overall complication rate was 42.8%, and in-hospital mortality rate was 57.1% (n = 6)., Conclusion: Second-look laparoscopy is a minimally invasive, technically simple procedure that is performed for diagnostic as well as therapeutic purposes. The simplicity and ease of this method may encourage wider application to benefit more patients. However, the timing of a second-look procedure is unclear particularly in a patient with anastomosis.

Background/aims: Dieulafoy's lesions are uncommon sources of upper gastrointestinal tract bleeding. Endoscopists must be aware of these lesions when evaluating patients with upper gastrointestinal tract bleeding., Methodology: The aim of this study is to analyze the results of active bleeding or recurrently bleeding Dieulafoy's lesions treated either by endoscopic injection therapy (EIT) or endoscopic band ligation (EBL). Fifteen patients who had active bleeding due to Dieulafoy's lesions were evaluated retrospectively with respect to demographic properties, comorbidities, endoscopic therapy procedures, and the success rate of the procedure., Results: The incidence of Dieulafoy's lesions was 4.5% in all cases of upper gastrointestinal tract bleeding. Among the 15 patients there were nine men and six women with a median age of 52 years (25-84 years). Eleven of these lesions were located in the stomach, two were in the duodenum, and two were in the distal esophagus. Eight patients were initially treated by EIT and seven patients had EBL therapy. There was no recurrent bleeding in any of the patients treated with EBL, but five patients (62.5%) treated with EIT bled again and were treated secondarily with EBL. Two of these patients required surgical intervention and one died on the 15th day of surgery due to myocardial infarction. No endoscopy-related complications were detected., Conclusions: Endoscopic methods should be the first choice in treating bleeding Dieulafoy's lesions. Both EIT and EBL are successful methods for achieving initial hemostasis. However, EIT therapy has a higher re-bleeding rate. EBL is a safe and effective method for the treatment of bleeding Dieulafoy's lesions.

Primary aorto-colic fistula is rarely reported in the literature. Although infrequently encountered, it is an important complication since it is usually fatal unless detected. Primary aorto-colic fistula is a spontaneous rupture of abdominal aortic aneurysm into the lumen of the adjacent colon loop. Here we report a case of primary aorto-colic fistula in a 54-year old male. The fistulated sigmoid colon was repaired by end-to-end anastomosis. Despite inotropic support, the patient died of sepsis and multiorgan failure on the first postoperative day.

Aim: To assess the efficacy and safety of ultrasound guided percutaneous cholecystostomy (PC) in the treatment of acute cholecystitis in a well-defined high risk patients under general anesthesia., Methods: The data of 27 consecutive patients who underwent percutaneous transhepatic cholecystostomy for the management of acute cholecystitis from January 1999 to June 2003 was retrospectively evaluated. All of the patients had both clinical and sonographic signs of acute cholecystitis and had comorbid diseases., Results: Ultrasound revealed gallbladder stones in 25 patients and acalculous cholecystitis in two patients. Cholecystostomy catheters were removed 14-32 d (mean 23 d) after the procedure in cases where complete regression of all symptoms was achieved. There were statistically significant reductions in leukocytosis, (13.7 x 10(3)+/-1.3 x 10(3) microg/L vs 13 x 10(3)+/-1 x 10(3) microg/L, P < 0.05 for 24 h after PC; 13.7 x 10(3)+/-1.3 x 10(3) microg/L vs 8.3 x 10(3)+/-1.2 x 10(3) microg/L, P < 0.0001 for 72 h after PC), C -reactive protein (51.2+/-18.5 mg/L vs 27.3+/-10.4 mg/L, P < 0.05 for 24 h after PC; 51.2+/-18.5 mg/L vs 5.4+/-1.5 mg/L, P < 0.0001 for 72 h after PC), and fever (38+/-0.35 centigrade vs 37.3+/-0.32 centigrade, P < 0.05 for 24 h after PC; 38+/-0.35 centigrade vs 36.9+/-0.15 centigrade, P < 0.0001 for 72 h after PC). Sphincterotomy and stone extraction was performed successfully with endoscopic retrograde cholangio-pancreatography (ERCP) in three patients. After cholecystostomy, 5 (18%) patients underwent delayed cholecystectomy without any complications. Three out of 22 patients were admitted with recurrent acute cholecystitis during the follow-up and recovered with medical treatment. Catheter dislodgement occurred in three patients spontaneously, and two of them were managed by reinsertion of the catheter., Conclusion: As an alternative to surgery, percutaneous cholecystostomy seems to be a safe method in critically ill patients with acute cholecystitis and can be performed with low mortality and morbidity. Delayed cholecystectomy and ERCP, if needed, can be performed after the acute period has been resolved by percutaneous cholecystostomy.

Background/aims: The ingestion of caustic substances is a common condition, which may result in serious injuries of the upper gastrointestinal system. The purpose of this study is to assess the outcomes of patients who had a history of the ingestion of caustic substances., Methodology: Between January 1995 and May 2002, 53 patients with clinical and/or endoscopic signs of caustic agents injury admitted to the Emergency Surgery Service of University of Istanbul, Istanbul Medical School, were retrospectively evaluated., Results: The group consisted of 29 females and 24 males with a mean age of 33 years (range 15 to 77). Caustic ingestion was accidental in 31 (59%) and suicidal in 22 (41%). Twenty-five (47%) patients had history of acid ingestions, 21 (40%) alkaline and 7 (12%) unknown agents. The findings of upper gastrointestinal tract endoscopy in 37 patients were as follows: i) fourteen patients had Grade I esophagitis, ii) fourteen patients had Grade II esophagitis; four with gastric mucosal burn, three with gastric and duodenal mucosal burn, five with pharyngeal mucosal burns, iii) two patients had gastric and duodenal mucosal burns, iv) four patients had gastric mucosal burn, vi) three patients had esophageal, gastric and duodenal mucosal burn. Eight patients (15%) with signs of acute abdomen underwent urgent surgery (six of these cases were acid ingestions and seven were suicidal ingestions); four of these patients with esophageal necrosis and gastric perforation, two with esophageal, gastric, duodenal and jejunal necrosis, one with local necrosis in the gastric fundus, and one had normal findings at laparotomy. The mean follow-up period was 11.6 months (range 1 to 42 months). During the follow-up one patient presented with pyloric stenosis, which required surgery. The mortality rate was 11%., Conclusions: Suicidal caustic ingestion and acid ingestion seem to cause more severe injuries. Early admission to the hospital with clinical and endoscopic evaluation and early surgery when required may reduce morbidity and mortality.

Background: This study was performed to evaluate the results of massive lower gastrointestinal bleeding in the elderly patients., Methods: The data of patients older than 60 years with massive lower gastrointestinal bleeding were retrospectively analyzed between January 1999 and March 2002., Results: There were 14 (52%) males and 13 (48%), females with mean age of 70.2 years (range 60 to 88). Twenty patients were diagnosed with colonoscopy. Angiography was employed in six, scintigraphy in three and r- enteroclysis in two patients. Colonic diverticulosis was the leading etiologic factor (48%). Mean comorbidity and hospital stay were 1.59 and 6.7 days, respectively. Conservative treatment were performed in eighteen, band JCC, ligation in three, surgery in five and embolization in two patients. Mortality rate was 26%. Mortality was high it in patients who had a lower initial diastolic pressure and required more transfusions (p:0.006 and p:0.025, respectively ), Conclusion: Massive lower gastrointestinal system bleeding in the elderly with comorbidities is associated with higher rate of mortality. Surgery in these patients has high mortality rates. Endoscopic and conservative diagnosis and treatment methods should be the first choice in the elderly. Key words: Bleeding, lower gastrointestinal system, elderly.

Objective: To invstigte the physiologic effects and therapeutic management ofthe abdominal kompartm sendrome (ACS) METHODS: A review ofthe recent Iiterature, experiences and opinions ofthe author are expressed in the papei:, Results and Conclusions: Intraabdominal bleeding, peritonitis, ileus, shock-reperfusion syndrome, intestinal edema, Iaparoscopic procedures with gas, ciosure ofthe abdomen in spite ofincreased pressure and burns are some ofthefactors that take place in etiology. The critical intrabdominal pressure value that requires decompression is debatable. In patients with high abdominal pressures, the pressure should be decreased with Iaparotomy immediately and the abdomen should not be ciosed primarily. These measures will help us to Iower the rates of mortality and morbidity and improve the quality ofhealth services.

Background: In this review we wanted to explane of opinions of The Turkish Association for Trauma and Emergency Surgery monthly inter-hospital meetings results., Methods: Opinions of meetings participants about blunt abdominal trauma were reviewed., Results: Haemodynamic stability and conscience situation are the main factors to determine the approach to blunt abdominal trauma patients. We generally prefer ultrasonography (USG) to first step diagnostic technique for haemodynamica/ly stable patients. IfUSG is not possible, diagnostic peritoneallavage (DPL) could be perform. We propose that DPL or USGcould be perform when the focus isnot known in the haemodynamica/ly unstable, multi-traumatised patients. But we don 't agree to perform any diagnostic techniques if we know that haemodynamic unstability is caused from intraperitoneal injury., Conclution: We prefer and propose resuscitation and emergency laparotomy for a/l patients of whom focus of the haemodynamica/ly un-stability is i1itra-abdominal damage. But ifthe haemodynamica/ly un-stable patients have pelvic bone fractures we don't propose the emergency laparotomy, because the probablefocus ofthe serious bleeding is pelvic vessels. In our opinion that patients must be resuscitated aggressively and evaluated with C1; because in this situations false positivity of the DPL is often. Surgeons must not take shelter the laparotomy for the name of life rescue, because negative and non- therapeutic laparotomy has high morbidity.