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Background: Pilonidal sinus (PS) is a benign disease for which different treatment modalities are used, varying from non‐surgical treatments to surgical treatments with flap use for big defects. High recurrence is the main problem in complicated cases. We presented complete natal cleft excision with kite incision and fasciocutaneous flap (CNCEF with kite incision) in extensive sacrococcygeal PS. Methods: Seventy‐six patients who underwent CNCEF with kite incision because of extensive PS extending through intergluteal sulcus to the anus, with multiple sinus tracts and recurrent PS were retrospectively analysed. A special incision involving natal cleft and all sinus tracts completely and fasciocutaneous flap, lateralizing median line, was used in all cases. Post‐operative complications and recurrence was recorded. Results: Sixteen (21.1%) patients were operated because of recurrence. The mean age and body mass index were 33.04 ± 6.78 and 29.86 ± 5.46, respectively. The mean hospital stay period and mean operation time was 2.95 ± 0.76 days and 64.33 ± 8.64 min, respectively. The mean drain removal time was 2.78 ± 0.7 days and mean follow‐up was 13.46 ± 4.31 months. There were flap oedema and seroma in one (1.3%) and four (5.3%) of the patients, respectively. Surgical site infection necessitating antibiotic treatment developed in three (3.9%) patients. The overall post‐operative complication rate was 10.5% and there was recurrence in one patient on follow‐up period (1.3%). Conclusion: CNCEF with kite incision method, which shifts midline, is a safe and reliable method with acceptable post‐operative complication and recurrence rates in extensive sacrococcygeal PS patients. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is a very common surgical emergency. Early and correct diagnosis and early intervention are necessary to prevent complications. It is often diagnosed on clinical signs and a certain ratio of negative appendectomy is acceptable. For early and accurate diagnosis, various scoring systems such as Alvarado, Ohmann, Eskelinen and more recently Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) have been developed. Objective: In this study, we aimed to compare the effectiveness and accuracy of scoring systems. Materials and methods: The patients who attended emergency department and operated with acute appendicitis pre-diagnosis were evaluated retrospectively. Alvarado, Ohmann, Eskelinen, and RIPASA scores were calculated and compared with histopathologic results by reviewing the patient files. Results: A total of 76 patients (44 males and 32 females) were included in the study. The mean age was 33.8 ± 13.2 years. Of which, 59 patients (77.6%) were diagnosed to have acute appendicitis on histopathological examination. The mean leukocyte count was 13.9 ± 3.7 × 103 μL. Sensitivity and specificity of Alvarado, Ohmann, Eskelinen, and RIPASA were 36%–82%; 58%–71%; 36%–8%, and 68%–71%, respectively. Cut-off values were 8, 14, 55.63, and 10, respectively. RIPASA had the highest accuracy. The cut-off value of leukocyte counts was 13,900 × 103/μL. Sensitivity and specificity were 64% and 88%, respectively; positive predictive value was 95%. In the receiver operating curve analysis, the area under the curve was found to be 74%. Conclusion: The RIPASA scoring system is a more reliable scoring system than Ohmann, Eskelinen, and Alvarado scoring systems. In cases of suspected acute appendicitis, it may be useful to evaluate patients with RIPASA score in emergency departments by general practitioners, where there is no general surgeon. Thus, patients can be guided in a timely manner to reduce the complications that may arise from delays. The cut-off value of 13,900 × 103/μL is an important marker for the presence of acute appendicitis. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the effects of melatonin on the healing of colon anastomosis following chemotherapy.Methods: 32 rats were randomised into four groups: (a) control group, which underwent sigmoid colon transection and primary anastomosis; (b) melatonin group, which received melatonin daily following anastomosis; (c) 5-fluorouracil (5-FU) group, which received 5-FU for five days prior to anastomosis; and (d) 5-FU+melatonin group, which received 5-FU for five days prior to anastomosis and melatonin daily following anastomosis. The rats were sacrificed on Postoperative Day 7 and anastomotic bursting pressures were measured. The anastomotic segment was extracted for hydroxyproline, luminol and lucigenin measurement and histopathological examination. Blood samples were obtained from the vena cava for measurement of tumour necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β) plasma levels.Results: Compared to the 5-FU group, bursting pressures of anastomosis and hydroxyproline levels were significantly higher, while luminol and lucigenin levels were significantly lower, in the control and 5-FU+melatonin groups. In addition, TNF-α and IL-1β plasma levels were significantly lower in the control and 5-FU+melatonin groups than in the 5-FU group. Histopathological examination showed a significant decrease in inflammation and necrosis formation in the melatonin group when compared to the control group. The positive effect of melatonin was also seen in the rats that received 5-FU.Conclusion: Our study results showed that the adverse effects of chemotherapy on the mechanical, biochemical and histopathological parameters of anastomosis healing were attenuated through melatonin treatment. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the possible protective effect of spironolactone (SPL) and role of the Na-K ATPase pump on intestinal ischemia/reperfusion injury. In our study, the period of ischemia was established by clamping the mesenteric artery for 45 minunder anesthesia in Wistar albino rats and the animals left for reperfusion at the end of this period were decapitated after one hour. Spironolactone (20 mg kg-1) was administered orally for three days before ischemia, 30 minbefore ischemia. The control group rats were subjected to the Sham operation and administered saline solution. TNF-α and IL-1β levels were measured in the serum samples. Ileal Na+/K+-ATPase, myeloperoxidase (MPO) analysis were performed. Structural injury was assessed histopathologically. Ischemia/reperfusion increased serum TNF-α and IL-1β levels together with MPO activity, whereas these values were maintained at the control group levels through SPL activation. However, ischemia/reperfusion decreased Na+/K+-ATPase activity in ileal tissues; however, these parameters were found to be significantly increased with SPL activation. The protective effect of SPL against ischemia/reperfusion injury by different mechanisms, mainly the activity of the Na+/K+-ATPase pump, suggests that this nontoxic agent may constitute a new clinical therapeutic principle. [ABSTRACT FROM AUTHOR]

Introduction: Pneumoperitoneum (PP) is known to cause ischemia in kidneys and other intra-abdominal organs because of decreased splanchnic blood flow. Aim: We aimed to determine the degree of renal injury that occurs due to a PP and prolonged PP. We measured renal injury biomarkers and made a histopathological evaluation to estimate the degree of injury and assessed the correlation of biomarkers with histopathological findings. Material and methods: Twenty-one female Sprague Dawley rats were separated randomly into three groups. Group 1 was the control group and was given anesthesia for 3 h. In group 2, a PP was administered under anesthesia for 1 h. A pneumoperitoneum was administered under anesthesia to animals in group 3 for 3 h. Results: Pathological analysis showed a significant statistical difference between the 3 groups. In particular, neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (Cys C) levels at the 24th h and preoperative mean urea levels showed a significant difference between the groups. The 24th-hour NGAL level in group 3 was significantly higher than that of group 1. The preoperative Cys C level was higher in group 1 than in either group 2 or 3. Cys C was decreased significantly in group 1 and increased significantly in both groups 2 and 3. Conclusions: The increase in NGAL and Cys C levels directly correlated with the duration of PP and intra-abdominal pressure, and they are therefore good biomarkers in diagnosing acute renal injury in the early phase. Serum creatinine level is not a good biomarker in the early phase of renal injury. [ABSTRACT FROM AUTHOR]