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Hospitalizations in emergency general surgery (EGS) cases in the USA have increased by 28% since 2001. The costs of these cases are estimated to increase by 45% annually until 2060, reaching 41.20 billion dollars. According to the literature, the general surgery clinic team allocates an average of 5.5 hours a day for emergency room consultations. The aim of this study is to determine the effects of consultations from the emergency room in our country on the EGS approach and to create appropriate solution proposals with the data obtained from the regional hospitals.The source of the data in our study is the number of EGS cases presented by 10 regional hospitals at the Central Anatolia regional meetings of The Turkish Association of Trauma and Emergency Surgery between 2017 and 2020. MATLAB R2021b (The MathWorks, Inc., Natick, Massachusetts, USA) and SPSS (IBM SPSS Statistics for Windows, version 22.0, IBM Corp., Armonk, NY, USA) programs were used for data analysis and graphics creation.The hospitalization/consultation rate was evaluated as the success of the doctors working at the emergency department in recognizing EGS cases; the average value was 20.15% across all hospitals. The surgery/emergency hospitalization rate, which shows rate of the hospitalized patients underwent surgery, is 59.17% when all centers are taken into account. The rate of surgery/admission in acute cholecystitis cases is 31.49% for all centers. It is seen that the hospitalization/consultation rate decreases with the increase in hospital workload. The rate of laparoscopic/total appendectomy is 22.78% across all centers. There is a correlation between acute appendicitis cases and EGS consultation numbers, but there is no correlation between laparoscopic appendectomy and consultation numbers. In addition, it is seen that medical follow-up is preferred in acute cholecystitis cases in centers where the consultation burden is increased; cholecystectomy is preferred at a higher rate in centers where the consultation burden is less. National EGS systems are needed and tried to be developed in order to improve the approach and outcomes of EGS patients worldwide. It is considered essential to establish a national EGS maintenance system that coordinates country resources and optimizes outcomes.

Background In the presence of advanced age and comorbidities, patients with gallstones may face gangrenous and perforated cholecystitis during their follow-up. In the literature, dynamic thiol/disulfide homeostasis has been shown to play an important role in detoxification, antioxidant protection, regulation of enzymatic reactions, and apoptosis and cellular signaling mechanisms. In this study, we aimed to evaluate the efficacy of IMA and thiol/disulfide homeostasis in the preoperative diagnosis of patients with cholelithiasis, acute/chronic cholecystitis, and perforated gallbladder. Methods Sixty-six patients that presented to the General Surgery Clinic of Ankara City Hospital for a cholecystectomy operation between February 2019 and May 2020 were included in this study. The patients were divided into three groups depending on the condition for which they were scheduled for surgery: cholelithiasis, cholecystitis, and perforated gallbladder. The demographic data, history of cholecystitis, chronic disease, white blood cell (WBC), amylase, lipase and liver function tests (AST and ALT) were recorded before the operation. Gallbladder appearance was evaluated using hepatobiliary ultrasonography. The duration of surgery, pericholecystic adhesions, hospital stay, body mass index (BMI), postoperative complications, and pathology results of specimens were recorded. In addition, thiol/disulfide and IMA values were analyzed in the blood samples taken from the patients preoperatively. Results The mean native thiol and total thiol values of the patients with an adhesion score of 0 were significantly higher than those with an adhesion score value of 1, 2 or 3. In addition, the disulfide, disulfide/native thiol, native thiol/total thiol and IMA values of the cases with an adhesion score of 2 or 3 were significantly higher than those with an adhesion score of 0. The native thiol and total thiol averages of the patients with normal cholecystectomy were higher than the others. The disulfide, native thiol/total thiol and IMA averages of those who underwent cholecystectomy due to a perforated gallbladder were also higher than the other groups. The mean preoperative WBC of the patients who underwent cholecystectomy due to a perforated gallbladder was also significantly higher than the other groups. Lastly, the native thiol and total thiol values had a statistically significant negative correlation with age, operation time, and hospital stay, and a statistically significant positive relationship with BMI. Conclusion We consider that in the preoperative diagnosis of the perforated gallbladder, the evaluation of thiol/disulfide hemostasis and IMA parameters can be used as an effective and reliable method to predict intraoperative difficulties.

Background We aimed to compare the cytology and histopathology results of hot, cold, and warm nodules in patients who had thyroidectomy due to toxic multinodular goiter (TMNG). Methods Five hundred and nine thyroid nodules from 413 patients who had operation with TMNG were included in this retrospective study. The nodules were categorized as hot, cold, and warm groups. The cytology and histopathology results were compared. Results The 509 thyroid nodules were grouped as hot (n = 364 [71.5%]), cold (n = 122 [24.0%]), and warm (n = 23 [4.5%]) according to scintigraphy. Cytological evaluations of 364 hot nodules were as follows: 80 (22%) nondiagnostic (ND), 259 (71.2%) benign, 17 (3.6%) atypia of undetermined significance/follicular lesion of undetermined significance (AUS/ FLUS), 2 (0.5%) follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 2 (0.5%) suspicious for malignancy (SM), and 4 (1.1%) malignant. The cytology of 122 cold nodules were ND in 25 (20.5%), benign in 86 (70.5%), AUS/FLUS in 8 (6.6%), FN/SFN in 1 (0.8%), and finally SM in 2 (1.6%). The 23 warm nodules were determined as ND, benign, and FN/SFN in 7 (30.4%), 15 (65.2%) and 1 (4.3%), respectively. There were no differences according to cytological results between groups (P = .616). However, malignancy rate was 3.8% in hot nodules, it was found as 6.6% in cold nodules. The malignancy was detected in 4.3% of warm nodules. There were no differences in malignancy rates between groups (P = .459). Conclusion We demonstrated similar malignancy rates in hot nodules when compared with cold and warm nodules.

WOS: 000483427400017 PubMed: 31233903 Background Atypia of undetermined significance (AUS) is an indeterminate category in the Bethesda system for reporting thyroid cytopathology. Cytological features described as atypia are not always observed in every case, and it is difficult to determine how the small population of cells with enlarged nuclei, a few grooves, and rare elongated nuclei should be classified. Therefore, there is inter-intra observer variability considering these cell types, even though the cytological criteria are well defined. Therefore, this study aimed to establish a nuclear scoring system to help in the differential diagnosis of AUS. Methods: Fine needle aspiration (FNA) samples that showed AUS and had surgical follow-up were included in this study. The aspirate was scored for the presence of intanuclear cytoplasmic inclusions, nuclear grooves, overlapping, enlargement, and elongation individually. The total nuclear score for each case was calculated. Statistical analysis of the association between each nuclear feature and the presence of papillary thyroid cancer (PTC) in the surgical specimens was performed. Cut-off points from the total score of these nuclear features were also calculated. Results: Nuclear grooves and overlapping were more common in malignant cases (p < 0.001 and p = 0.048, respectively). A cut-off point of >= 5.5 for the total score was sensitive and specific for defining malignancy. Conclusion: The risk of PTC was higher in nodules with more prominent nuclear overlapping or nuclear groove in their FNA samples. In order to achieve a more confident AUS diagnosis, our scoring system can be helpful for thyroid FNA samples.

We aimed to investigate the relation between preoperative serum thyrotrophin (TSH) and clinicopathological features in patients with papillary thyroid carcinoma (PTC) and microcarcinoma (PTMC). Patients who underwent thyroidectomy and diagnosed to have benign nodular disease or PTC/PTMC in our clinic were evaluated retrospectively. Patients with a previous history of thyroid surgery, patients using antithyroid medications or thyroid hormone and patients with tumors known to be unresponsive to TSH were excluded. Data of 1632 patients were analyzed. Histopathological diagnosis was benign in 969 (59.4%) and malignant in 663 (40.6%) patients. Preoperative median serum TSH was significantly higher in malignant compared to benign group (1.41 IU/dL vs. 0.98 IU/dL, p