BACKGROUNDIn this prospective study, operative and nonoperative management of acute appendicitis were evaluated regarding their safety and cost effectiveness.METHODSTwo hundred ninety patients presenting to our Emergency Department between March 2005 and March 2006 with acute appendicitis were included in this prospective study. Nonoperative medical therapy was performed in 107 patients (Group 1), and 183 patients were treated surgically (Group 2). Routine follow-up controls were done on the 10th day, at the 3rd and 6th months and at the first year after discharge in Group 1. Both groups were compared regarding age, gender, mean hospital stay, modified Alvarado score, morbidity, mortality, and cost effectiveness.RESULTSThe male/female ratio of Groups 1 and 2 were 65/42 (mean age: 30.98+/-1.30) and 125/58 (mean age: 26.25+/-0.79), respectively. In Group 1, 19 patients were operated. Operation indications were resistance to therapy, patient's request, and operation in another hospital. Although the mean hospital stay of Group 1 was statistically significantly longer than Group 2, the mean cost of the therapy was $559 in Group 2 and $433 in Group 1. Morbidity rates were similar, with no mortality in either group.CONCLUSIONWith its high success rate and cost effectiveness, medical treatment seems to be a good alternative to the gold standard therapy of surgery in management of acute appendicitis.

Objective: In this prospective study nonoperative management of acute appendicitis is evaluated regarding safety and cost effectivity. Material and Methods: Between March 2005-March 2006, 107 patients hospitalized for medical treatment among a total number of 380 patients with acute appendicitis were included in this study. Informed consents of the patients were obtained. Intravenous suid + antibiotherapy with ampicillin 1 g 4x1 daily + gentamicin 160 mg/day + metronidazole 500 mg 3x1 daily and analgesic with diclophenac sodium 50-75 mg 3x1 im daily were administered to the patients after cessation of oral feeding. Patients resistant to medical therapy confirmed by radiologic and physical examination were operated. Patients with clinical improvement were discharged on the 3rd day of treatment with oral antibiotherapy completed to 10 days. Routine follow up controls were done on the 10rd day, 3th month and 6th months after dischargewith hemograms and ultrasonography. Results: Male to female ratio was 65/42 with a mean age of 38 (16-65). 19 (17.8%) of these patients were operated. Mean follow up period was 136 days (21-360). Operation indication was resistance to therapy in 11, patients’ choice in 5, operation inanother hospital in 3 patients. During the follow up period recurrence occurred in 9 patients and 7 of them were treated surgically whereas 2 were retreated medically. Mean hospital stay in the nonoperative therapy group was 3 days (2-5). Mean cost of the therapy was 585 YTL in the nonoperative group and 755 YTL in the operated ones. Conclusion: With high success rate and cost effectivity, medical treatment seems to be a good alternative to the gold standard therapy of surgery in the management of acute appendicitis.

Hydatid disease is still an important problem in endemic area like South America, Middle Asia and South Europe as well as Turkey. Although the disease occurs more frequently in liver and lungs, it can be seen in any part of the body including pancreas. The incidence of isolated pancreatic hydatid disease is reported as 1-2%. In this report we presented an isolated pancreatic hydatid cyst which is a rare entity in the literature.

Hepatic hydatid disease is a frequently seen disease in endemic regions like Turkey. It has a wide spectrum of treatment modalities ranging from medical therapy to radical hepatic resections depending on the cyst size, location, and choice and experience of the physician. Currently, with the advances in laparoscopy, laparoscopic interventions are gaining acceptance in the surgical treatment of hepatic hydatid disease. In this report laparoscopic pericystectomy for a peripherally located hepatic hydatid cyst has been presented.

Objective: Thyroidectomy is one of the commonly performed operations with low mortality rates; however it has complications such as bleeding, injury of recurrent nerve and parathyroid gland causing serious morbidity. It is still controversial whether the recurrent nerve should be identified and preserved during thyroidectomy.Material and Methods: In this study 244 cases performed thyroidectomy with routine recurrent nerve dissection in Bakirkoy Dr. Sadi Konuk Training and Research Hospital between January 2001 and February 2004 were evaluated regarding temporary and permanent recurrent nerve injury in the light of the literature.Results: Of these 244 cases 209 were female and 35 were male with a mean age of 43.36 years. Mean follow up was 15 months and mean hospital stay was 2.5 days. Preoperative diagnosis was multinodular goiter in 222 cases, thyroid carcinoma in 11 cases, diffuse toxic goiter in 6 cases and follicular neoplasia in 5 cases. Choice of operation was bilateral subtotal thyroidectomy in 114 cases, unilateral total thyroidectomy in 49 cases, unilateral total and unilateral subtotal thyroidectomy in 48 cases and bilateral total thyroidectomy in 33 cases. Mean operation time was 73 minutes. In early postoperative period symptoms suggesting recurrent nerve injury developed in 10 cases as hoarseness in 8 cases and hoarseness accompanied with respiratory distress in 2 cases. Control laryngoscopies performed at the end of the first postoperative month revealed recurrent nerve paralysis in 3 of the cases but at the control by the end of the sixth postoperative month 2 of these cases were improved.Conclusion: We suggest that routine nerve dissection may decrease recurrent nerve injury during performing thyroidectomy.