Cyst of the canal of nuck: A rare cause of inguinal swelling in women.

Among various reasons of swellings in the female inguinal region nuck canal cysts are rare entities. Abnormal persistence of procesus vaginalis opening cause this formation. Presentation at adults can lead misdiagnosis. Inguinal hernia, tumors (benign or malign), cysts, lymphadenopathies and endometriosis are other common reason for female groin swelling. Once diagnosed surgical excision is definitive treatment.

Abdominal tuberculosis leading to portal vein thrombosis, mimicking peritoneal carcinomatosis and liver cirrhosis.

Abdominal tuberculosis is a rare infectious disease that can involve the peritoneum and lead to portal vein thrombosis and mimic peritoneal carcinomatosis. We report on a 43-year-old male patient with fatigue and progressive weight loss for two years. Ascites was the only pathologic finding in his physical examination and laboratory findings revealed only a mild anaemia with Ca-125 elevation. The ascitic fluid Adenosine deaminase (ADA) level was also elevated. Computed tomography revealed splenomegaly, a mesenteric mass measuring 3.5 cm and intra-abdominal lymphadenopathies at the hepatic hilum. Oesophagogastroduodenoscopy (EGD) revealed oesophageal varices which was also consistent with portal hypertension. Diagnostic laparotomy and biopsies obtained from the omentum and the lymph nodes revealed acid-fast staining tuberculosis bacilli.

Nine years' experience of needle localized breast biopsy in a university hospital: results and evaluation of the role of the surgeon in decision making.

BACKGROUND: Needle localized breast biopsy is an effective means of detecting breast cancer in its early stages. We analysed the indications for needle localized biopsies, evaluated the results, and determined the surgeon's role in the decision-making process. METHODS: The needle localized open biopsy results of 350 patients were assessed. RESULTS: Malignancy was encountered in 7 of 56 patients in whom the radiologist suggested follow-up due to mammographical images, although a surgeon performed a biopsy with the assessment of the patient's historical and clinical findings (12.5%). Biopsy failure rates were higher for office-based ambulatory patients (9.1%) than for those patients who underwent biopsies in an operating theatre (1.9%; P < .05). Patients undergoing operating theatre biopsies under local anaesthesia showed statistically significant failure rates compared with those under general anaesthesia (p = .04). The rate of malignancy of micro-calcification was highest in patients younger than 40 years of age (64.3%), while spicular lesions were commonly malignant in patients over 50 years of age. CONCLUSIONS: From our experience, we suggest that needle localized biopsies should be performed in the operating theatre with the patient under general anaesthesia. Although both micro-calcifications and spicular lesions have a high rate of malignancy in all decades, micro-calcifications are more prevalent in younger patients while spicular lesions prevail in older patients. The final decision, to follow-up or biopsy, should be based on a patient's clinical and historical perspective and not only on the guidance of the mammography report.

Insulinoma: an evaluation by a single institution.

INTRODUCTION: Insulinoma is a rare pancreatic islet cell tumour that is associated with hypoglycaemia. Diagnosis of the disease, localisation of the tumour and surgical therapy may be challenging and the aim of this study is to evaluate the problems concerning insulinoma. MATERIALS AND METHODS: The surgical records of patients who were operated on for insulinoma at Hacettepe University Department of General Surgery between January 1980 and December 2006 were evaluated retrospectively. The evaluated parameters were the gender and ages of the patients with symptoms, signs, diagnostic tools and surgical methods. RESULTS: Twenty-six patients were included in the study. There were 17 male and nine female patients. The median age was 34. The median diagnostic period was 285 days. Abdominal computer tomography was the most frequently used diagnostic method. A total of 15 enucleations, nine distal pancreatectomies and three pancreaticoduodenectomies were performed. Histopathologically most of the tumours were benign islet cell tumours. CONCLUSIONS: There are still difficulties in the diagnosis, localisation and histopathologic evaluation of insulinoma. Appropriate pre-operative evaluation, through exploration and palpation of the pancreas during the surgery, as well as experienced centres are important to increase the success of the surgery of insulinoma.

Laparoscopic splenectomy for haematological diseases.

PURPOSE: To show the utility of laparoscopic splenectomy for hematologic diseases. PATIENTS AND METHODS: Ten patients with hematologic diseases who were operated between February 1997 and October 1998 were analysed retrospectively. TECHNIQUE: The operations were performed by four trocars, hilar vessels were divided by clips and bag was used for splenic retrival. RESULTS: All operations were completed successfully. No accessory spleens were found. Intraoperative complication, other than a bag tear in one operation did not occur. Postoperative complications occurred in two patients. The first one was a portal vein thrombosis and the second one was a peritonitis. All patients responded hematologically to the operation. CONCLUSION: With appropriate surgical technique and patient follow up, laparoscopic splenectomy is a safe, adventageous and efficaceus operation for hematologic diseases.