Nutcracker syndrome with different clinical presentations in a young male population

The nutcracker syndrome [NCS] depends on mesoaortic compression of the left renal vein. It has different clinical entities. This study aimed to examine different clinical aspects of NCS. This was a retrospective and descriptively designed study. The patients with abdominal pain, flank pain, or scrotal pain admitted to the Urology and General Surgery outpatient clinic between January 2014 and May 2016 were reviewed. All data were examined descriptively. Urologic and general surgical examinations were performed individually by a urologist and a general surgeon. The abdominal ultrasonography and computed tomography findings, blood pressure, white blood cell count, bilirubin tests, and urine tests were recorded. Patients with inconsistent diagnostic data or missing outcomes were excluded. Five patients were diagnosed with NCS on scanning 134 patients. The mean age was 24 years [20-33 years]. The first patient had left lower quadrant pain. The second patient also had left lower quadrant pain with microscopic hematuria and a mild increase in the total bilirubin level [1.84 mg/dL]. The third patient presented left testicular pain and hypertension [160/100 mm Hg]. Consequently, left side varicocele was found on physical examination and Doppler ultrasound. The fourth patient had leukocytosis [11,900], a mild increase in total bilirubin level [1.73 mg/dL], and left and right lower quadrant pain. The radiological and laboratory entities must be taken into consideration with clinical findings for correct diagnosis because NCS may have different symptoms

Upper Gastrointestinal Endoscopy performed before sleeve gastrectomy in patients with morbid obesity: retrospective analysis of 460 patients

Objective: We aim to retrospectively evaluate results of preoperative upper gastrointestinal endoscopy[UGE] performed in our endoscopy unit on morbid obese patients who underwent Laparoscopic Sleeve Gastrectomy [LSG].

Material and Method: The study was carried out on 460 morbid obese patients who underwent UGE before LSG at the General Surgery Endoscopy Unit of Keçi?ren Training and Research Hospital and their age, body mass index, additional diseases and endoscopy findings were evaluated..From endoscopy findings, antral gastritis, LES laxity, pyloric dysfunction, esophagitis, hiatal hernia, pancreatitis, body mass index were evaluated with univariate analysis and comparative logistic method

Findings: UGE was performed in 460 patients who were scheduled for LSG. Patients had antral gastritis, 46 [10 percent] patients had pangastritis, 30 [6.6 percent] patients had esophagitis, 163 [35.6] patients had LES laxity, 58 [12.7 percent] patients had Hiatal Hernia, 25 [5.5 percent] patients had pylor dysfunction and additional comorbidities were detected in 18 [3.9; percent] patients.Patients with antral gastritis had statistical significance with LES laxity and age [p 0,002, p 0,003], patients with pancreatitis had statistical significance with Hiatal Hernia, pyloric dysfunction and LES laxity[p 0.007, p 0.004, p 0.002]. There is also significant statistical relationship between esophagitis and hiatal hernia [p 0.001].In multivariant analysis; Hiatal Hernia increased the risk of pancreatitis by 2.5 times, while LES laxity increased risk of pangastritis by 0.42 times. Pyloric dysfunction has been shown to increase pangastritis risk by 5.6 fold.Age increased risk of antral gastritis by 1.04 fold, and LES laxity increased risk of antral gastritis by 2.07 fold

Discussion and Conclusion: We believe that an upper GIS endoscopy that will be performed before obesity surgery will play a very important role in surgical method selection

Comparison of the accuracy of isosulfan blue and technetium-99m lymphoscintigraphy to determine axillary lymph node metastasis in breast cancer

This study aimed to compare the efficiency of isosulfan blue [ISB] and colloid methods in determining metastatic conditions of axillary lymph node in sentinel lymph node biopsy [SLNB]. This prospective study was performed between April 2005 and July 2009 at Gulhane Medical Faculty, Department of General Surgery. A total of 102 female patients diagnosed with breast cancer were enrolled in the clinic of Gulhane School of Medicine. According to the diagnostic protocols of SLN, the patients were divided into three groups as follows: ISB [group I], colloid [group II], and ISB and colloid [group III]. SLN was identified in 49 of 52 patients [94.2%] in the ISB group; the sensitivity, specificity, negative predictive value [NPV], positive predictive value [PPV], and false negativity [FN] ratio were found to be 90.9%, 75.8%, 96.1%, 55.5%, and 9.1%, respectively. On the contrary, the sentinel lymph node was identified in 38 of 38 [100%] patients in the colloid group; the sensitivity, specificity, PPV, NPV, and FN were found to be 88.2%, 100%, 100%, 91.3%, and 11.8%, respectively. In ISB and colloid groups; SLN was identified in 12 of 12 [100%] patients in the ISB and colloid groups; the sensitivity, specificity, PPV, NPV, and FN were found to be 100%, 100%, 100%, and 0%, respectively. This study showed that the combined methods applied to heterogeneous groups of patients for SLNB in breast cancer cases were minimally invasive and effective and hence could be used for evaluating nodal metastases