Gultekin Ozan Kucuk

BACKGROUND The incidence of human immunodeficiency virus (HIV) infection is on the rise, and perianal region diseases in HIV-infected patients have become increasingly prevalent. This study aimed to analyze the surgical treatment outcomes of HIV-infected patients presenting with perianal concerns. MATERIAL AND METHODS We included 311 HIV-positive patients admitted to the Infectious Diseases Clinic of Samsun Training and Research Hospital between January 2014 and December 2022. From this group, we selected those who sought care at the general surgery outpatient clinic for perianal and anal concerns, retrospectively reviewing their medical records. RESULTS Out of 311 patients, 54 (17.3%) were referred to the general surgery outpatient clinic with anal and/or perianal region complaints. Of these cases, 38 (70.3%) had a single disease, while 16 (29.6%) had combined diseases. There were 20 males (95%) and 1 female (5%). Among these 54 patients, 33 (61.1%) received medical treatment from the outpatient clinic, while 21 (38.9%) underwent surgical intervention. The diagnoses included 22 hemorrhoidal diseases, 24 anal condylomas, 15 anal fissures, 11 anal abscesses, and 4 anal fistulas. We evaluated the postoperative results and recurrence status of these patients. CONCLUSIONS Perianal diseases in HIV-positive patients can be categorized as isolated or combined. The management of patients with postoperative follow-up compliance problems and combined diseases with low CD4 counts may pose treatment challenges.

BACKGROUND:Breast pain, prevalent among women of reproductive age, varies during menstrual cycles and is influenced by sociodemographic and clinical factors. This study aimed to assess these demographic and clinical variables in women with breast pain, considering the spatial distinctions between urban and rural locations. MATERIAL AND METHODS:This retrospective study included 730 women presenting with mastalgia between 2010 and 2023. The study evaluated patient demographics, pain characteristics (eg, breast pain duration, site, quadrant-based localization, and radiation of breast pain), radiologic findings, and the presence of comorbid medical conditions. RESULTS:There were 498 patients in the urban group and 232 patients in the rural group. Among the radiologic findings, the rate of mastitis was higher in the rural group (P<0.05). Regarding the localization of breast pain within the quadrants, left breast upper-inner (LUI) quadrant pain was more common in the rural group (P=0.014). Regarding comorbid medical conditions, the prevalence of gastrointestinal system disease was higher in the rural group (P=0.009). Using logistic regression analysis, gastrointestinal disease was determined to be a significant independent risk factor for increased LUI quadrant pain in the rural group (odds ratio [OR]: 3.132, P=0.014), while pre-existing thyroid disease (OR: 2.482, P=0.004), hypertension (OR: 2.534, P=0.006), and radiologic evidence of ductal ectasia (OR: 2.878, P=0.03) were independent risk factors in the urban group. CONCLUSIONS:Patient outcomes may be improved by a tailored, population-based approach to mastalgia patients in rural and urban locations focused on their radiologic findings and comorbid medical conditions.

Introduction Surgical drain infections (SDIs) and antibiotic resistance profiles of these infectious pathogens are the issues that need to be emphasized. This study aimed to identify microorganisms isolated from drain cultures and determine antibiotic resistance rates among these microorganisms. Materials and methods The drain culture results of patients analyzed between January 2008 and January 2020 were included in the study. Data such as microorganisms grown in drain cultures, antibiotic resistance rates, and demographic information of patients were evaluated. Results Three hundred forty-six isolates were analyzed from the drain cultures of 279 patients. The mean age of the patients was 62.82 ± 17.77 years. Polymicrobial growth was detected in samples from 49 (18%) patients. The most frequently isolated microorganisms were pathogens belonging to the Enterobacteriaceae family (44%) and to Staphylococcus species (spp.) (20%). As shown by our results, the frequency of Staphylococcus spp. decreased in the last four years, whereas the frequency of Enterococcus increased. In terms of drug resistance, the highest rate of resistance among the isolates was to ampicillin (Enterobacteriaceae family), followed by gentamicin (Acinetobacter species.), cefepime (Pseudomonas spp.), penicillin (Staphylococcus spp.), and ciprofloxacin (Enterococcus spp.). In the Enterobacteriaceae family, 49% of the isolates were resistant to extended-spectrum beta-lactamases, and 17% were resistant to carbapenems. Methicillin resistance was detected in 55% of Staphylococcus aureus, and vancomycin resistance was found in 11% of Enterococcus. Conclusions In drain cultures for SDIs, information on the causative pathogens, in addition to the antibiotic resistance rates of these pathogens, is needed to initiate appropriate empirical treatment.

The novel Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome Coronavirus-2, emerged in China in late 2019, and a variety of clinical symptoms and signs were reported following patients’ clinical presentation. By contrast, human Brucellosis is a worldwide zoonosis that may present with general symptoms including fever, dry cough, malaise, and arthralgia, making it indistinguishable from other causes of respiratory infection. Here, an 18-year-old man who was hospitalized with a suspected COVID-19 infection, but finally confirmed as having Brucellosis with positive blood culture for Brucella melitensis is presented. This case is a reminder for healthcare workers to consider the diagnosis of Brucellosis in patients exhibiting febrile syndromes in endemic regions during the COVID-19 pandemic.

The aim of this prospective randomized trial was to compare 2 main fixation devices in regard to pain and recurrence in laparoscopic ventral incisional hernia repair (LVIHR). A total of 51 patients were evaluated in this study (n = 25, nonabsorbable tack (NAT) and n = 26, absorbable tack (AT) groups). A visual analogue scale (VAS) was performed on both groups preoperatively and on the postoperative (PO) first day, second week, and sixth month. All patients were followed for recurrence by clinical examination, ultrasonography, and/or abdominal computed tomography. The median follow-up time was 31 months (15-45). The mean age and the mean body mass index (BMI) of the patients were 53.1 ± 11 years and 34 ± 5 kg/m(2), respectively. The median defect size was 60 cm(2) (35-150) and median operation time was 110 minutes (40-360). In 2 patients from AT group and 2 from NAT group (7.8%), recurrence occurred. The 2 groups had similar features regarding demographics, operation time, postoperative hospital stay, morbidity, and VAS scores. The 2 fixation methods were found similar for PO pain and recurrence. In our opinion, the choice of either of these fixation methods during surgery should not be based on the concerns of pain or recurrence. AT may be the preferable option in LVIHR due to the lower cost.

This study was designed to evaluate the value of resection and to analyze clinicopathologic data on gastric cancer patients who were evaluated as curable preoperatively but diagnosed as advanced intraoperatively. A retrospective analysis was performed on clinical, surgical, and pathological data of 264 patients who had undergone surgery for gastric cancer between January 2008 and October 2012. The patients who were diagnosed in advanced stages during surgical exploration were accepted into the study group. Patients were categorized into the following two groups: non-resection group (NRG) and resection group (RG). We compared the clinicopathologic features of the two groups and investigated the prognostic factors by performing univariate and multivariate analyses. A total of 79 patients diagnosed with advanced disease in surgical exploration were evaluated. There were 40 patients (50.6%) in the NRG and 39 patients (49.4%) in the RG. The difference in median overall survival between the NRG and the RG was statistically significant (1.7 vs 5 months; p=0.001). In multivariate analysis, age less than 70 years, gastric resection, adjuvant chemotherapy, and male gender were found to be favorable significant independent prognostic factors for overall survival. Resection seems to be associated with improved overall survival in patients who were diagnosed as advanced intraoperatively. Therefore, patient and tumor-related factors should be taken into consideration before planning resection. Randomized controlled studies are required.

The current study reports technical and social details aiming to evaluate difficulties faced while performing laparoscopic appendectomy (LA) in a rural hospital as well as providing solutions. Patients who underwent LA with a diagnosis of acute appendicitis between April 2009 and December 2010 were included in this study. Demographic details, operative findings and postoperative outcomes were analyzed. Fifty-one consecutive patients (28 male and 23 female) underwent LA. The median age was 23 years (range, 13-74); the median operative time was 45 minutes (range, 20-75). Appendiceal base securing was performed either endoloops in 4 (7.8%), or via intracorporeal knot tying in 46 (90.2%) patients and 1 was sutured. Complicated/technically difficult appendicitis was faced in 20 (39.2%) patients. One patient underwent conversion to open procedure (2%). Mean postoperative hospital stay was 2.4 ± 0.8 days. Postoperative intra-abdominal abscess occurred in 1 (2%) patient. LA can be performed safely in a rural hospital, even for complicated cases. In this study, we have discussed some technical and social difficulties encountered and the solution methods adopted when performing LA in rural settings.