Can fruit seeds and undigested plant residuals cause acute appendicitis

Objective:To investigate the relation between fruit seeds,plants residuals and appendicitis. Methods:Among cases that underwent appendectomy,the appendicitis cases having fruit seeds and undigested plant residuals in their etiology were examined retrospectively.Also, histopathological features,age,sex,and parameters of morbidity and mortality were used. Results:Fruit seed was found in one case(0.05%) with presence of pus in appendix lumen, undigested plant residuals in 7 cases(0.35%).It was determined that there were appendix inflammation in 2 of the plant residuals cases,while there were obstruction and lymphoid hyperplasia in the appendix lumen of 5 cases.No mortality was observed.Conclusions:The ratio of acute appendicitis caused by plants is minimal among all appendectomised patients, but avoidence of eating undigested fruit seeds and chewing plants well may help to prevent appendicitis.

Comparison of visual and topographic outcomes of deep-anterior lamellar keratoplasty and penetrating keratoplasty in keratoconus

AIM：To compare visual,surgical and topographic outcomes of deep anterior lamellar keratoplasty（DALK）and penetrating keratoplasty（PK）for keratoconus（KC）.METHODS：In this multicenter,prospective,randomized clinical trial 76 eyes of 71 KC patients operated between January 2011 and July 2014 in 2 tertiary referral hospitals were included. Consecutive patients were alternately selected to receive one of the two surgical methods. Thirty eight eyes underwent DALK with the big-bubble technique and 38 eyes underwent PK.RESULTS：Mean best spectacle corrected visual acuity（BSCVA）at the first postoperative week（P=0.012）and the first postoperative month（P〈0.001）was statistically significantly higher in DALK group. The mean BSCVA at12 mo was not significantly different for DALK（0.30±1.99 log MAR）versus PK（0.40±0.33 log MAR）（P=0.104）. The76.3% of the eyes had a BSCVA over 0.5 in DALK and 47.4%in PK group（P=0.009）. The 7.9% of the eyes had a BSCVA of 1.0 in DALK and 5.3% in PK group（P=0.644）. Mean spherical equivalent was-2.94 D in DALK and-3.09 D in PK group.Mean topographic astigmatism was 4.62 D and 4.18 D respectively. Regular topographic patterns were observed in 31（81.6%）of DALK and 29（76.3%）of PK（P=0.574）. The most frequent topographic pattern was oblate asymmetric bow tie,seen in 39.5% in DALK and 23.7% in PK. CONCLUSION：Big bubble DALK provides an earlier visual improvement compare to PK. However,visual and topographic outcomes are similar to those in PK at 1y. Postoperative complications including rejection and intraocular pressure elevation are more frequent in PK. DALK is a safer alternative to PK for KC. However,intraoperativeperforation of the Descemet＇s membrane is a significant complication.

Esophagogastric malignancies detected in a tertiary surgical center endoscopy unit from Turkey: a descriptive study

Background:The most common symptoms of upper gastrointestinal(UGI)diseases are epigastric pain and heartburn,nausea and vomiting,regurgitation and dysphagia.Endoscopic examination is the most reliable method for assessing UGI evaluation.Methods:Malignant tumors detected in UGI endoscopies performed between Dec 31,2015 and Jan 1,2011were included in our study.Age,gender,indication for endoscopy,tumor site,tumor type,stage of disease and type of treatment data were recorded.Results:According to the analysis of five-year patient data;39(1.17%)of 3,309 cases had malignancy in the UGI endoscopy.The average age of malignancy detected cases were 63.4 years(range,33–88 years).In the malignancy positive group;35(1%)cases had gastric and 4(0.12%)cases had esophagus tumors.According to the gastric localization of tumors,12 of cases were distal,10 were proximal,7 were middle and 4 were linitis plastica.Two of the cases had previous gastric surgery and the gastric malignancy of these cases was localized at the gastrojejunostomy site.The most frequent symptoms were abdominal pain,anemia,dyspepsia,bleeding,weight loss,obstruction and dysphagia in patients with gastric cancer.Two(5.7%)of the cases had previous gastrectomies because of benign causes.Malignant tumors were detected in the remnant tissue of these cases.The percentage of over 50-year-old patients was 89.7%in UGI malignancy detected patients.Three percent of gastric cancers were stage I,18%of them were stage II,25%of them were stage III and 53%of the cases were stage IV.Seventy-five percent of esophageal cancer cases had systemic metastases.Conclusions:Malignity is rarely detected among the patients from general surgery outpatient clinic,on whom UGI endoscopy is performed.But it is not different from the literature.Most of the malignancies are at advanced stage.In older age patients,endoscopy should be recommended even there are nonspecific symptoms.In the presence of alarm symptoms,UGI endoscopy should be recommended without considering the age.