Diagnostic value of elastosonographically determined strain index in the differential diagnosis of benign and malignant thyroid nodules.

Elastosonography (ES) is a newly developed method that is used for the differential diagnosis of benign and malignant thyroid nodules. In different studies, ES scoring has been compared with histopathological findings, and sensitivity and specificity of the scoring were calculated. In this study, it determines the strain index (SI) as well as the ES to score thyroid nodules, and establishes the role for these parameters in the differential diagnosis of thyroid nodules using histopathological analysis as a reference standard. Real-time ES in transverse axis (TA) and longitudinal axis (LA) was performed in 391 nodules of 292 patients. ES scoring was made for all the nodules. SI in TA and LA was calculated for four times in each nodule and mean values were determined. The results were compared with final histopathological diagnoses. In histopathological examinations, 125 (31.97%) of 391 nodules were malignant and 266 (68.03%) were benign. Of these histopathologically benign nodules, 189 (%71.05) were also probably benign according to elastosonographic scoring (scores of 1, 2, or 3), while 77 (28.95%) were probably malignant (scores of 4 or 5). Among 125 histopathologically malignant nodules, 52 (41.60%) were probably benign and 73 (58.40%) were probably malignant according to elastosonographic scoring. There was a significant relation between scoring and histopathological findings (χ(2) = 36.513; P < 0.001). Accordingly, sensitivity and specificity of ES scoring were 58.4 and 71.0%, respectively. ROC analysis value obtained for strain ratios in LA (AUC: 75.5%; P < 0.001) had a higher significance compared to ROC analysis value obtained for strain ratios in TA (AUC: 66.0%). Thus, ROC analysis evaluation was applied only for SI in LA. The optimal SI cut-off value in LA for all the nodules was found to be 16.709 (sensitivity: 73.4%, specificity: 70.0%) (AUC: 75.4 ± 0.03%; 70.2-80.5%). SI cut-off value corresponding to 90% sensitivity in this axis was 4.516 (specificity: 35.7%). Sensitivity and specificity of SI values that were determined according to morphological features of nodules in gray-scale ultrasonography were higher. For hypoechoic nodules with microcalcifications and without a halo, SI cut-off value, sensitivity, and specificity were 17.020, 84.3, and 81.1%, respectively. Our study is the first clinical-wide series study that measured, used, and compared the ES scoring and SI cut-off values for the differential diagnosis of benign and malignant thyroid nodules. This study indicates that measurement of SI with ES as a noninvasive procedure may be used as an adjunctive method to the conventional methods for the differential diagnosis of thyroid nodules.

A very rare localisation of pilomatrixoma.

Pilomatrixoma is a rare skin neoplasm which is usually localized on face, neck and lower extremites and its etiology is still unknown. We report a case of a 32-year-old male patient with a rare localisation of pilomatrixoma on the right shoulder. The presumed diagnosis was sebaceous cyst. Excision biopsy was performed (Fig. 1, Ref. 8). Full Text (Free, PDF) www.bmj.sk.

The short term effects of infected gallstones lost intraperitoneally.

In this experimental study, an animal model was set up to evaluate what sort of complications may cause intraperitoneal retained bile stones. Forty rats were divided into 4 groups. The first group was assigned as the control group and the subjects had only laparatomy. In the 2nd group, during laparotomy, sterile bile and bile stones were placed within the peritoneal cavity. In the 3rd group, contaminated bile and bile stones were placed within the peritoneal cavity. In the 4th group, again contaminated bile and bile stones were placed and prophylactic antibiotic (Ceftriaxon) was used for 7 days. After a 4 week interval, survivors were subjected to laparatomy and necropsy. As a conclusion, the peritoneal adhesion difference between the infected bile and stone inooculation group without antibiotic and the other group with antibiotic usage may show that antibiotics might prevent further complications in case of abdominal contamination. Available clinical and experimental data is not enough to recommend laparatomy to collect stones. We conclude that more detailed studies with larger series are necessary to clarify the issue (Tab. 1, Fig. 1, Ref. 26).

Gastric adenocarcinoma and GIST (collision tumors) of the stomach presenting with perforation; first report.

Gastrointestinal stromal tumors are very rare tumors of stomach. To our knowledge there are a few reported cases of synchronous occurrence of epithelial and gastrointestinal stromal tumors of stomach. Also, tumor perforation is very rare. This is the first case of gastrointestinal stromal tumor synchronous with primary gastric adenocarcinoma presented with perforation (Fig. 1, Ref. 6).

Giant primary synchronously bilateral mesenteric dedifferentiated liposarcoma with hyperparathyroidism, hyperthyroidism, type-2 diabetes mellitus and hypertension.

Liposarcomas represent the single most common type of soft tissue sarcoma, occurring most commonly in the extremities and retroperitoneum. There is no relation between liposarcomas and multiple endocrine syndromes. We presented a 61-year old woman with giant primary synchronously bilateral mesenteric dedifferentiated liposarcoma with hyperparathyroidism, hyperthyroidism, Type-2 diabetes mellitus (T2DM) and hypertension. The mesenteric liposarcoma was reported neither synchronously bilateral nor with endocrine disorders. We must note if the patients' presentation was a co-incidence or an undescribed syndrome, waiting to be discovered.

Axial torsion and gangrene of a giant Meckel's diverticulum mimicking acute appendicitis.

Meckel's diverticulum is the most common congenital anomaly of gastrointestinal tract, occurring in 2% of the population. More than 80% of patients are asymptomatic. Complications like intestinal obstruction, bleeding and inflammation of Meckel's diverticulum occur in 4% of patients. The case of a 42-year-old male patient with axial torsion and gangrene of giant Meckel's diverticulum is presented.

The PlasmaKinetic tissue management system in thyroid surgery.

BACKGROUND: Thyroid surgery involves meticulous devascularization of the gland. Although conventional technique being a highly efficient technique for vessel bleeding control, it takes long time. The aim of this study was evaluate the efficacy of PlasmaKinetic to the conventional technique. METHODS: We reviewed the medical records of 86 patients who underwent primary thyroid surgery by the same surgeon at our clinic between June 2006 and January 2008. Total thyroidectomy was performed at all of the patients in the study group. RESULTS: When the incidence of postoperative cord palsy was 2.32%, transient hypoparathyroidism was 4.6%. There was no significant difference in consideration of age, gender, thyroid gland weight, and complication rates between the PlasmaKinetic group and conventional group (p>0.05). Operation time, mean drainage from the suction drain and duration of hospital stay of the patients in PlasmaKinetic group were significantly lower than those in conventional group (p<0.05). CONCLUSION: PlasmaKinetic technique decreases the operation time to a level of less than 50 minutes with no increase at complication rate (Tab. 3, Fig. 3, Ref. 14). Full Text (Free, PDF) www.bmj.sk.

Amebic perforation of small bowel: an unexpected localization of a fatal complication.

The intestinal protozoan parasite E. histolytica is the causative organism responsible for human amebiasis and amebic dysentery. Although it is primarily an infection of the colon, it may also be spread by hematogenous path to other organs, especially the liver. In general, the clinical spectrum of colorectal amebiasis ranges from the state of asymptomatic carrier to severe fulminant necrotizing colitis with bleeding and perforation. Here we present an extremely rare case of necrotizing amebiasis of small bowel with a fatal outcome (Fig. 1, Ref. 4). Full Text (Free, PDF) www.bmj.sk.

Results of lateral internal sphincterotomy with open technique for chronic anal fissure: evaluation of complications, symptom relief, and incontinence with long-term follow-up.

The aim of this study is to investigate the results of open lateral internal sphincterotomy (LIS) and the recurrence and incontinence rate, to perform a long-term assessment of incontinence and to assess complications and relief of symptoms. This clinical prospective study was undertaken in patients undergoing open LIS. One hundred and twenty-nine patients entered the study. Mean duration of pain relief was 1.2 +/- 0.4 days and mean time before defecation without pain was 1.9 +/- 1.0 days. Complication rate was 41.8%. We found that urine retention was seen frequently in males. We demonstrated that open LIS up to the dentate line does not have a higher rate of incontinence. Incontinence after LIS was only to flatus and two-thirds of these resolved in 6 weeks. No patient showed improvement of incontinence after 6 weeks.

[Evaluation of Ohmann and Eskelinen scores, leukocyte count and ultrasonography findings for diagnosis of appendicitis]. / Apandisit tanisinda Ohmann ve Eskelinen skorlari ile lökosit sayisi ve ultrasonografi bulgularinin degerlendirilmesi.

BACKGROUND: The purpose of this study was to demonstrate the diagnostic value of Ohmann and Eskelinen scores, leukocyte count and ultrasonographic (USG) evaluations in acute appendicitis. METHODS: This is a retrospective presentation of 186 patients (105 males, 81 females; mean age 29.94+/-12.70; range 6 to 70 years) operated with the diagnosis of acute appendicitis between May 1, 2004 and January 1, 2005. The diagnostic value of Ohmann and Eskelinen scores, leukocyte counts, and USG evaluations and the differences between the sexes were studied. RESULTS: According to the evaluation of Ohmann and Eskelinen scores, there were significant differences in positive and negative appendectomy between the total patient population and female patients (p=0.01), but no significant difference was found for men (p=0.341 and p=0.217, respectively). The leukocyte count increase and USG evaluations also demonstrated significant differences between negative and positive appendectomy in female patients (p=0.001 and p=0.001, respectively). However, no significant differences in the leukocyte count increase and USG evaluations between positive and negative appendectomy were determined in male patients (p=0.480 and p=0.732, respectively). CONCLUSION: Ohmann and Eskelinen scores could be useful in definitive diagnosis of appendicitis especially in primary care units. The leukocyte count increase alone or with the help of USG evaluation could be helpful in the diagnosis of appendicitis especially in females during the reproductive period.

Does low molecular weight heparin impair anastomotic wound healing?

BACKGROUND: Enoxaparin is an important molecule which had been using in prophylaxis and treatment of deep venous thrombosis. Also, it is showed that it prevents postsurgical peritoneal adhesions in rats. It is aimed to evaluate its effects on gastrointestinal wound healing. METHODS: Thirty Wistar albino rats were divided into three groups as control, subcutan, and intraperitoneal enoxaparin groups. Left colon anastomoses were performed. On postoperative seventh day, anastomotic healing was evaluated by measuring anastomotic bursting pressure, tissue hydroxyproline levels, and histopathological examination. RESULTS: The anastomotic bursting pressure was highest in subcutan enoxaparin group (p < 0.001), intraperitoneal enoxaparin group (p < 0.01) came the second, and the control group has the worst value. The hydroxyproline results were found nearly similar to the bursting pressure values (subcutan (p < 0.001) > intraperitoneal (p < 0.05) > control). Neovascularization in subcutan group (p < 0.001) has a statistically significant difference to other groups. CONCLUSION: Enoxaparin did not interfere with colonic anastomotic resistance but improved the intestinal wound healing.

An unusual and difficult diagnosis of intestinal obstruction: The abdominal cocoon. Case report and review of the literature.

Since publication of our article, "An unusual and difficult diagnosis of intestinal obstruction: The abdominal cocoon. Case report and review of the literature." World J Emerg Surg. 2006, 1: 8 we believe that the case mentioned should have been described as a 'peritoneal encapsulation' rather than 'abdominal cocoon' as concluded in the original publication.

Family history of acute appendicitis.

OBJECTIVES: To evaluate the association of acute appendicitis with age, sex, Alvarado score (AS) and family history. METHODS: Medical records of 2670 patients, who were admitted to our hospital's emergency department between January 2005 and June 2007, were reviewed. These patients were referred as acute abdominal pain by general practitioners. The data of patients were devided into sub-groups according to their age, sex, operative status, AS status and having a pathologically confirmed postoperative diagnose of acute appendicitis or not. Logistic regression analysis was performed to find out relationships among the sub-groups. RESULTS: Male gender (1.37), age < 50 (2.4), positive family history (3.16), AS 5-6 (13) and AS 7 (31) increased the risk of acute appendicitis. The sensitivity and specificity of AS was 91.5% and 60.5% respectively. The sensitivity and specificity of family history was 68.9% and 75.4% respectively. CONCLUSION: Family history is an important parameter while predicting acute appendicitis.

Bilateral Paget disease of the male nipple: first report.

Bilateral breast carcinoma is reported to occur in 5-10% of all patients with breast cancer. Paget disease of the breast represents 1-3% of all breast malignancies [Ashikari R, Park K, Huvos AG, Urban JA. Paget's disease of the breast. Cancer 1970;26:680-5; Marshall JK, Griffith KA, Haffty BG, Solin LJ, Vicini FA, McCormick B, et al. Conservative management of Paget disease of the breast with radiotherapy. Cancer 2003;97:2142-9]. However, synchronous bilateral Paget disease of the nipple is extremely rare. We report synchronous bilateral Paget disease with infiltrative ductal carcinoma in a 74-year-old man who underwent bilateral mastectomy.

Castleman's disease of the duodenum.

Castleman's disease is a rare lymphoproliferative disorder of uncertain origin. Just two cases of Castleman's disease of the gastrointestinal tract have been reported. These were found in the stomach. However, as far as we know, Castleman's disease of the duodenum has not been reported. This is the first report of hyaline vascular subtype of Castleman's disease at the duodenum.

An unusual and difficult diagnosis of intestinal obstruction: The abdominal cocoon. Case report and review of the literature.

Abdominal cocoon is a rare cause of intestinal obstruction. The abdominal cocoon is probably a developmental abnormality, largely asymptomatic, and is found incidentally at laparotomy or autopsy. Pre-operative diagnosis cannot be often made correctly. This rare entity of intestinal obstruction has been described in the whole literature as a thick fibrotic sac covering the small bowel partially or completely. The etiology of abdominal cocoon is unknown and most often it is found in adolescent girls from tropical or subtropical countries. Complete recovery is generally expected after the removal of the membrane surgically. This paper reports a male patient who has had intestinal obstruction symptoms and has per-operatively been diagnosed as abdominal cocoon.