Vascular variations of the kidney, retrospective analysis of computed tomography images of ninety-one laparoscopic donor nephrectomies, and comparison of computed tomography images with perioperative findings.

BACKGROUND: In this retrospective study, we aimed to determine the variations of kidney arteries and veins in kidney donor patients who underwent preoperative, computed tomography angiography (CTA). MATERIALS AND METHODS: We analysed kidney CTA findings of 91 donor nephrectomy patients operated from July 2016 through December 2017. Demographics, vascular diameters, abnormalities, numbers, branching variations, routing variations of arteries, and veins were assessed according to CTA images. We also compared the radiological findings with perioperative findings. Two radiologists evaluated CTA images, and the same surgical team performed all donor nephrectomies by laparoscopic approach. RESULTS: Ninety-one of the 96 patients involved to study. Forty-six (50.5%) patients were female. Thirty-five (38.4%) of 91 cases had accessory arteries. Seven (7.6%) right, 1 (1.1%) left and 8 (8.7%) bilateral double hilar artery was observed on CTA. No statistically significant difference was observed in the evaluation of the side of accessory/polar arteries (p > 0.05), and in the evaluation of the distribution of arterial/venous variations according to perioperative findings (p > 0.05). However, in the evaluation of CTA images, we found that the diameter of the kidney artery and vein differed according to gender and side. CONCLUSIONS: The knowledge of the vascular variations of the kidney is essential for surgeons performing kidney transplantation. It is also essential for urologist and vascular surgeons. Incompatible with the literature, the right kidney has more vascular variations and, one kidney artery is found in the majority of Turkish kidney donor patients.

Is hemithyroidectomy a rational management for benign nodular goitre? A Multicentre Retrospective Single Group Study.

BACKGROUND: The incidence and potential risk factors for the recurrence of benign nodular goitre after unilateral thyroidectomy are not clearly defined. The aim of this study was to assess the rate of progression of nodular goitre in the contralateral thyroid lobe and of hypothyroidism requiring replacement therapy after unilateral thyroid lobectomy for benign nodular goitre. PATIENTS AND METHODS: Patients who underwent hemithyroidectomy for benign nodular goitre between 2000 and 2009 were included in the study. The primary outcome of this study was the reoperation rate for recurrent goitre, the rate of progression of nodular goitre and the rate of hypothyroidism requiring L-T4 replacement therapy. Clinical factors that have an effect on progression were further analysed. RESULTS: 259 patients were included for study. Progression of the nodular goitre in the remnant lobe was observed in 32% (n = 83) of the patients. However, over time, only 2% of these 83 patients underwent contralateral hemithyroidectomy due to this progression. Fifty-six (22%) patients required L-thyroxin replacement due to persistent hypothyroidism after hemithyroidectomy. The factors shown to affect progression of nodular goitre were advanced age, preoperative hyperthyroidism, preoperative diagnosis of toxic nodular goitre and the presence of surgical indication for a toxic goitre causing hyperthyroidism and a definitive pathological diagnosis of nodular hyperplasia. CONCLUSION: There was a progression of the nodular goitre in the remnant lobe in about one-third of the patients who underwent hemithyroidectomy. However, only 2% of these patients underwent complementary contralateral hemithyroidectomy due to clinical progression in 31 months of follow-up.

Mesenteric Meckel's diverticulum: a case report.

Meckel's diverticulum, an omphalomesenteric remnant caused by the failure of the vitelline duct to involute by the seventh or eight week of gestation, was first described in 1809 by Johann Friederick Meckel. It is the most common congenital abnormality of the small intestine. It is usually located in the last 90 cm of the terminal ileum and is formed by all layers of the small intestine. It frequently contains heterotopic tissue, usually gastric mucosa. Here we report a 15-year-old white female who presented to the emergency ward with abdominal pain. Laparatomy was performed with the diagnosis of acute abdomen. A Meckel's diverticulum was found in the mesenteric aspect of the ileum. Histologic examination of the specimen revealed the presence of pancreatic tissue and oxyntic and antral type gastric mucosa showing chronic peptic ulceration apart from intestinal mucosa. This case report underlines the need for a revision in our understanding and classification of Meckel's diverticulum.

A rare cause of intestinal obstruction: incarcerated femoral hernia, strangulated obturator hernia.

Obturator hernia may occur bilaterally in association with another hernia, which is usually of the femoral type. We present a 77-year-old-woman who had abdominal pain with nausea and vomiting together with swelling of the right groin for 3 days. Incarcerated right femoral hernia and consequent mechanical small-bowel obstruction was diagnosed, and urgent operation was undertaken. As the incarcerated femoral hernia reduced spontaneously during the induction of anesthesia, a lower median incision was performed. During exploration, the real cause of mechanical intestinal obstruction was found to be a small intestinal loop strangulated in the left obturator hernia. Right femoral and left obturator hernia were repaired with preperitoneal polypropylene mesh. If there is enough time and general condition of the older patient is suitable, further diagnostic techniques for concomitant obturator hernias may be useful in patients who present with signs of incarcerated inguinal hernia and intestinal obstruction.

The role of pre-operative B mode ultrasound in the evaluation of the axillary lymph node metastases in the initial staging of breast carcinoma.

The lymph node status of a breast cancer is one of the main prognostic criterias. This status is very important to determine the therapeutic approach. Physical examination alone is not sufficient to assess axillary metastases. Mammographic examination can give us an idea about breast cancer and axillary involvement. Ultrasonographic evaluation can improve the sensitivity of clinical and mammographic examination in assessing axillary lymph node status. 42 patients operated on for breast cancer between January 2000-January 2003 were included in this prospective study. In the study, we used axillary B mode ultrasound to evaluate the axillary lymph nodes. There are several sonographic features to categorize them. Axillary B mode ultrasound was performed to evaluate the axillary lymph nodes for metastatic involvement. In the evaluation of lymph nodes, the sonographic criteria were centric echogenity, thickening of cortex, length/width ratio (L/W) and the diameter of lymph nodes. Hyperechogenic hilus was accepted as a benign finding. The thickening of the cortex less than 50% of the thickening of the centric echogenic hilus was also accepted as a benign finding. L/W ratio below 2 and parameters above 2 cm were accepted as malignant findings. 168 lymph nodes in 42 patients were evaluated pre-operatively with axillary B mode ultrasound. As a result, these lymph nodes were defined as benign in 19 patients (45.2%) and malignant in 23 patients (54.8%). Axillary lymph node status was found as benign in 18 patients (42.9%) and malignant in 24 patients (57.1%) pathologically . Comparative results of ultrasound and axillary lymph node status can be seen on Table III. As a result, the sensitivity of axillary B mode ultrasound to show the metastases was found as 79.1%, specificity was 77.7%, positive predictive value 82.6% and negative predictive value 73.6%. We think some better results may be obtained in the future and these developments may affect the surgeon's decisions concerning axillary dissection for breast cancer operations.

Primary T-lymphoma of the breast with bilateral involvement, unusual presentation.

Primary or secondary involvement of the breast is a rare form of extranodal lymphoma. Most reported primary non-Hodgkin lymphomas of the breast have a B-cell phenotype, those of T-cell phenotype are even more rare. Bilateral breast involvement at diagnosis also is very rare. We herein report a young female patient with bilateral breast involvement by low-grade T-cell malignant lymphoma.

Abdominal actinomycosis: a case report.

Actinomycosis is an anaerobic infection caused by actinomycetes, which are part of the normal flora in the intestinal, anal and genital tracts. Although the infection is often cured medically with appropriate antimicrobial therapy, diagnosis is usually made surgically. We report the case of a 41 year-old woman with intra-abdominal mass secondary to extensive actinomycosis involving the hepatic flexura. She required emergency surgery during which the mass was excised. A review of the literature on abdominal actinomycosis during the last 20 years is reported. Emergency surgery has been rarely described in this condition. Although the incidence of actinomycosis has decreased, the abdominal form has been observed with increasing frequency: it could be the result of prolonged use of intra-uterine device. Abdominal actinomycosis is an extremely rare infection that can mimic multiple disease processes and requires accurate diagnosis for successful therapy.

Can negative appendectomy rate be decreased by using spiral computed tomography without contrast material?

Approximately 15-20% of error in the diagnosis of acute appendicitis argues for new diagnostic methods. In recent years it has been proposed that Computed Tomography be used in the diagnosis of acute appendicitis with high sensitivity and specificity. In our study, the effect of Computed Tomography on the diagnosis of acute appendicitis and on negative appendectomy was investigated on patients with suspected acute appendicitis. In the last 18 months, spiral Computed Tomography without contrast material has been used for 65 patients. The history, physical findings, laboratory results and Computed Tomography images of patients were compared and the final decision to operate was always made by an attending surgeon. The results of Computed Tomography have been correlated with the reports of pathology and operation findings. Other patients who have not been operated on have been followed up clinically. Correlating Computed Tomography results with operation findings revealed; 42 true positive, 3 false positive, 17 true negative and 3 false negative results. The sensitivity and specificity of CT have been found to be 93.3% and 85% respectively. Forty-eight out of 65 patients have been operated on for acute appendicitis and the negative appendectomy rate has been calculated as 6.25%. As a consequence, it was thought that in the diagnosis of acute appendicitis the use of Computed Tomography could decrease the negative appendectomy rate when used together with clinical follow-up.

Bilateral nipple necrosis in a breastfeeding woman with Behçet's disease.

Behçet's disease is a chronic, multisystem disorder. A 23-year-old female patient diagnosed with Behçet's disease 3 years earlier was admitted with deep ulcers on both areolae caused by detachment of the nipples following breastfeeding since spontaneous delivery of her baby. Physical examination revealed a necrotic ulcer crater 2 cm in diameter on each breast, with the lactiferous ducts draining into these. Incisional biopsy sample from the areola ulcer border on the left breast showed leukocytoclastic vasculitis. Breastfeeding was stopped, and local wound care and systemic corticosteroid therapy were started. After 4 weeks, epithelialization tissue filled the ulcers, leveling the crater base with the areola. Bilateral nipple necrosis in a breastfeeding woman is a rare entity. It is thought that in the present case minor trauma caused by breastfeeding accompanied by neutrophilic infiltration resulting from amplified inflammatory response and leukocytoclastic vasculitis attributable to Behçet's disease was responsible for the necrosis.

Surgical treatment of hepatic hydatid disease.

The results of surgery in 38 patients with hepatic hydatid disease are described. Cystectomy was done in four patients with small peripheral cysts. For them the mean postoperative stay was 8.2 days. Partial cystectomy, introflexion and omentoplasty were performed in 28 patients with uncomplicated large cysts. The mean postoperative stay for these patients was 8.6 days. One patient in this group died of massive hemorrhage and disseminated intravascular coagulation. Exploration of the common bile duct and choledochoduodenostomy were required in three patients who had large cysts complicated by rupture into the biliary tree. This complication resulted in a mean postoperative stay of 11.5 days. Three patients who had cysts complicated by pyogenic infection were treated with tube drainage. They were discharged with their tubes in place after a mean hospital stay of 26.5 days. Hydrogen peroxide 10% was used as a scolicidal agent and was successful in preventing dissemination. All patients underwent ultrasonography 3 months after surgery, and 28 (74%) were followed up by annual examination. There was no recurrence after a mean follow-up of 2.7 years. The results suggest that surgical treatment of hepatic hydatid disease should be governed by the size, location and complications of the cyst. The combination of partial cystectomy, introflexion and omentoplasty was safe and effective therapy for patients with large hepatic cysts uncomplicated by pyogenic infection.