A new prognostic marker in patients undergoing Hartmann's procedure for acute tumoral obstruction of the left colon.

BACKGROUND: In acute obstructive left-sided colorectal cancers (AOLCRC), damage to the colon wall may occur as a result of distension of the colon segments proximal to the tumor. In this study, we aimed to evaluate the relationship between the ratio of dilated colon diameter (CD) to lumbar vertebral corpus diameter on preoperative abdominal computed tomography (CT) scan in patients undergoing Hartmann's Procedure (HP) and post-operative complications. METHODS: The tumor group consisted of 49 patients who underwent HP for AOLCRC under emergency conditions. The control group consisted of 49 age-and gender-matched individuals (compatible with tumor group) that had an abdominal CT due to pathologies outside the gastrointestinal tract and without a history of abdominal surgery. In both group, the ratios of the CD to the diameter of the first lumbar vertebra corpus (L1-VD) measured on axial CT images of each patient. These ratios were compared between groups. In the tumor group, the relationship between post-operative complications (Clavien-Dindo classification-major (grade ≥III), minor (grade

Corticosteroid associated lupus pancreatitis.

The relationship between acute pancreatitis and the administration of glucocorticoids is unclear because most reported cases have been diagnosed with systemic vascular diseases, such as systemic lupus erythematosus, which may be responsible for pancreatitis. A 22-year-old woman with eye involvement of a newly diagnosed systemic lupus erythematosus was admitted to our hospital. Pulse intravenous methylprednisolone therapy was given at 1mg/kg day for 3 days, and oral prednisolone at 40 mg/day thereafter. During pulse steroid therapy, she had abdominal pain, back pain, distention, nausea, and vomiting. Her physical examination was compatible with acute abdomen and peritonitis. Abdomen Computerized Tomography scan revealed diffuse liquid perihepatic and perisplenic area with heterogeneity around the mesentery. Due to the symptoms of acute abdomen, explorative laparotomy was performed. There was diffuse free fluid in the abdomen and edematous changes were observed around the pancreas. Amylase and lipase from intraabdominal fluid were studied and found to be high. The postoperative prednol dose was reduced carefully. On the sixth postoperative day, the drain was removed, and the patient was discharged without any problem. Physicians should keep in mind that acute pancreatitis may also be a cause of differential diagnosis of newly developed abdominal pain in patients receiving pulse steroid therapy with a normal level of serum amylase and lipase.

Corticosteroid associated lupus pancreatitis

SUMMARY The relationship between acute pancreatitis and the administration of glucocorticoids is unclear because most reported cases have been diagnosed with systemic vascular diseases, such as systemic lupus erythematosus, which may be responsible for pancreatitis. A 22-year-old woman with eye involvement of a newly diagnosed systemic lupus erythematosus was admitted to our hospital. Pulse intravenous methylprednisolone therapy was given at 1mg/kg day for 3 days, and oral prednisolone at 40 mg/day thereafter. During pulse steroid therapy, she had abdominal pain, back pain, distention, nausea, and vomiting. Her physical examination was compatible with acute abdomen and peritonitis. Abdomen Computerized Tomography scan revealed diffuse liquid perihepatic and perisplenic area with heterogeneity around the mesentery. Due to the symptoms of acute abdomen, explorative laparotomy was performed. There was diffuse free fluid in the abdomen and edematous changes were observed around the pancreas. Amylase and lipase from intraabdominal fluid were studied and found to be high. The postoperative prednol dose was reduced carefully. On the sixth postoperative day, the drain was removed, and the patient was discharged without any problem. Physicians should keep in mind that acute pancreatitis may also be a cause of differential diagnosis of newly developed abdominal pain in patients receiving pulse steroid therapy with a normal level of serum amylase and lipase.

RESUMO A relação entre pancreatite aguda e a administração de glicocorticoides é incerta pois a maioria dos casos relatados foram diagnosticados com doenças vasculares sistêmicas, como lúpus eritematoso sistêmico, que pode causar pancreatite. Uma paciente de 22 anos com envolvimento ocular e lúpus eritematoso sistêmico recém-diagnosticado foi admitida em nosso hospital. Pulsoterapia intravenosa com metilprednisolona 1mg/kg foi administrada por 3 dias. Depois disso, a paciente foi tratada com prednisolona oral 40 mg/dia. Durante a pulsoterapia com corticoides, a paciente apresentava dor abdominal, dor nas costas, distensão, náusea e vômitos. O exame físico era compatível com quadro de abdome agudo e peritonite. Tomografia computadorizada do abdome revelou líquido difuso na região perihepática e periesplênica, com heterogeneidade ao redor do mesentério. Devido aos sintomas de abdome agudo, foi realizada laparotomia exploradora. Havia líquido livre difuso no abdome e alterações edematosas foram observadas em torno do pâncreas. A amilase e lipase do líquido intra-abdominal foram analisadas e consideradas elevadas. A dose pós-operatória de prednol foi reduzida com cuidado. No sexto dia de pós-operatório, o dreno foi retirado, e a paciente recebeu alta sem qualquer problema. Médicos devem lembrar que a pancreatite aguda também pode ser uma causa de diagnóstico diferencial para dor abdominal recém-desenvolvida em pacientes recebendo pulsoterapia com corticoides e com níveis normais de amilase e lipase séricas.

Outcomes of early cholecystectomy (within 7 days of admission) for acute cholecystitis according to diagnosis and severity grading by Tokyo 2013 Guideline.

OBJECTIVE: The timing of early cholecystectomy in acute cholecystitis is still controversial, and data regarding the use of Tokyo 2013 guideline for diagnosis and severity grading in Acute Cholecystitis is limited. The aim of this study was to evaluate the clinical and pathologic outcomes of early cholecystectomy after 72 hr and within seven days of index admission according to Tokyo 2013 guideline for diagnosis and severity grading of Acute cholecystitis (in patients with Acute cholecystitis. MATERIAL AND METHODS: Medical charts of 172 patients who underwent early cholecystectomy after 72 hr and within 7 days of index admission with a diagnosis of Acute cholecystitis between Aug 2009 and Apr 2014 were retrospectively analyzed. Patients were classified according Tokyo 2013 guideline criteria. RESULTS: The median age of the study group was 52 yr. The rates of open and laparoscopic cholecystectomies was 53.5% and 33.1%, respectively. Conversion to open cholecystectomy was performed in 19 patients (13.4 %). The median length of hospital stay was 7 days. Eighty-four patients (59.2%) met the criteria for a definite diagnosis of Acute cholecystitis according to Tokyo 2013 guideline. Longer postoperative and total length of hospital stay was determined in patients with a definite diagnosis. CONCLUSION: Increased severity grading is correlated with longer pre- and post-operative hospital stay. Early cholecystectomy in Acute cholecystitis performed by experienced surgeons after 72 hr of admission and within 7 days maybe a feasible and safe procedure.

The free neural grafting for recurrent nerve laceration Experimental study in rabbit.

AIM: The most dreaded complication of thyroidectomy is recurrent laryngeal nerve damage, which is most of the time hardly irreversible. In our experimental study we researched the use of free nerve grafts in the treatment of laryngeal nerve damage in rabbit. MATERIAL AND METHODS: There were three groups in our study. In the first group, the recurrent laryngeal nerve was severed and then a free nerve graft was interposed between the phrenic nerve and distal end of recurrent laryngeal nerve. In the second group, a defect in the continuity of the laryngeal nerve was created. The two ends of the nerve were joined together later by an interposed free nerve graft. In the third group, only a defect in the recurrent nerve was created without any attempt at uniting the ends together so that these latter subjects could be assigned as control group. In the evaluation process we performed laryngeal endoscopy, laryngeal EMG and histopathologic examination. RESULTS: On the 21. day of trial, in the first and second group vocal cord movements were detected on the laryngoscopy along with regeneration waves on EMG. In the third group there was no vocal cord movements on the side where a neural damage was created intentionally. On EMG there was degeneration waves as opposed to regeneration waves seen in the first and second groups. Histopathologic findings were similar. CONCLUSIONS: Recurrrent laryngeal nerve paralysis is an unwanted complication because it causes permenant sequela. Studies which intend to find a cure for this complication are increasing in number. We aim to find new approaches to cure patients suffering from this devastating complication as well. In our exprerimental study, vocal cord movements were reproduced without causing diaphragmatic paralysis. We believe the results of our study promise to relieve the suffering of patients. The results are encouraging. KEY WORDS: Muscle, Rat model, Reinnervation, Surgery.

A rare cause of gastrointestinal bleeding, "GANT".

Acute gastrointestinal hemorrhage is frequently seen in emergency surgical conditions. Benign pathologies are generally responsible in etiologic factors. Our case is a GANT. GANT is a mesenchymal tumor originated from Cajal cells or precursors of them. Cajal cells are pacemaker cells in the intestinal wall. Because GANT is a very rare tumor, we would like to report our case to the medical literature. We think very rare cases and treatments of its as like our case create view point states in etiology of acute gastrointestinal hemorrhage.

Gynecologic pathologies in our appendectomy series and literature review.

PURPOSE: Appendectomy applied from the diagnosis of acute appendicitis is one the most common operations in surgery. The rates of negative appendectomy are still high. The rates of negative appendectomy in males and females differ and are higher in females. In our study, these differences, particularly in females, were studied and possible solutions were discussed. METHODS: Between October 2002 and October 2009, among women receiving urgent appendectomies, those whose primary cause was gynecological pathology were studied retrospectively. All our women subjects were examined by preoperative gynecologists. After gynecological consultation, the patients were evaluated by a general surgeon due to lack of urgent ultrasonography, computed tomography (CT) and diagnostic laparoscopy and the patient received appendectomy due to acute appendicitis. RESULTS: In our series of 1,969 appendectomies, the rate of female/male is 811/1,158. It was determined that the primary cause in 47 (47/811; 5.8%) women with applied appendectomy was gynecological pathology. As a gynecological pathology, it was observed that the most common cause was ovarian cyst ruptures at a rate of 72.3%. The negative appendectomy rate in males was found to be 14.94% (173/1,158), and in females it was 22.56% (183/811). The difference between them is significant (P < 0.01). Of these women, 5.8% were gynecologically-induced and 16.76% were unrelated to gynecological causes. CONCLUSION: We believe that gynecological consultation before appendectomy in women is necessary, but not sufficient. It is also important that at least one of the facilities, such as us, CT, magnetic resonance imaging, and diagnostic laparoscopy should be available in surgical use for the diagnosis of negative appendicitis.

Incarcerated femoral hernia containing the right uterine tube. A pre-operative diagnosis is possible.

The incarcerated femoral hernia containing the right uterine tube is very rare to see. The case report is important to accumulate knowledge of very rare cases. The diagnosis of the case was established pre-operatively with abdominal computerized tomography (CT) On CT examination, the mass in the hernia sac was not connected with the intestines and a tubal structure on the right side of the uterus was shown to extend out of the abdomen. In the operation, the right uterine tube(RUT) was reduced into the abdomen after its blood supply was shown to be normal. A hernia repair was performed. Sometimes in obese patients, incarcerated femoral or inguinal hernias may not been noted. Ultrasonography, CT and magnetic resonance imaging (MRI) is used frequently to diagnose abdominal wall hernias. The organs in the incarcerated sac must be examined carefully and the viability must be checked. The surgeon must decide whether or not to resect the organs. In our case, strangulation was not found and polypropylene mesh was not used for hernia repair due to a fear of infection of the prosthesis. Incarceration of the uterine tube in the sac is traumatic and this condition may lead to infection. Such conditions may lead to ectopic pregnancy. The patient must be informed about ectopic pregnancy due to a previous incarceration of the tube because ectopic pregnancy may be fatal.

Can fruit seeds and undigested plant residuals cause acute appendicitis.

OBJECTIVE: To investigate the relation between fruit seeds, plants residuals and appendicitis. METHODS: Among cases that underwent appendectomy, the appendicitis cases having fruit seeds and undigested plant residuals in their etiology were examined retrospectively. Also, histopathological features, age, sex, and parameters of morbidity and mortality were used. RESULTS: Fruit seed was found in one case (0.05%) with presence of pus in appendix lumen, undigested plant residuals in 7 cases (0.35%). It was determined that there were appendix inflammation in 2 of the plant residuals cases, while there were obstruction and lymphoid hyperplasia in the appendix lumen of 5 cases. No mortality was observed. CONCLUSIONS: The ratio of acute appendicitis caused by plants is minimal among all appendectomised patients, but avoidence of eating undigested fruit seeds and chewing plants well may help to prevent appendicitis.

Can fruit seeds and undigested plant residuals cause acute appendicitis

Objective:To investigate the relation between fruit seeds, plants residuals and appendicitis. Methods: Among cases that underwent appendectomy, the appendicitis cases having fruit seeds and undigested plant residuals in their etiology were examined retrospectively. Also, histopathological features, age, sex, and parameters of morbidity and mortality were used. Results: Fruit seed was found in one case(0.05%) with presence of pus in appendix lumen, undigested plant residuals in 7 cases(0.35%). It was determined that there were appendix inflammation in 2 of the plant residuals cases, while there were obstruction and lymphoid hyperplasia in the appendix lumen of5 cases. No mortality was observed.Conclusions: The ratio of acute appendicitis caused by plants is minimal among all appendectomised patients, but avoidence of eating undigested fruit seeds and chewing plants well may help to prevent appendicitis.

Gallstone ileus as an unexpected complication of cholelithiasis: diagnostic difficulties and treatment.

BACKGROUND: Gallstone ileus is a rare complication of cholelithiasis, mostly in the elderly. The aim of this study was to evaluate our experience with 12 gallstone ileus cases and discuss current opinion as reported in the literature. METHODS: Data of 12 patients operated between January 1998 and January 2008 with gallstone ileus were retrospectively studied. RESULTS: There were 12 cases (9 F, 75%; 3 M, 25%) with a mean age of 63.6 (50-80) years. Median duration of symptoms before admission to the hospital was 4.1 (1-15) days. Preoperative diagnosis was made in only five cases (41.6%). Enterolithotomy was done in nine cases (75%). Enterolithotomy and resection of the small intestine--required for decubital necrosis from the gallstone--was performed in one case (8.3%). In one case (8.3%), enterolithotomy was completed in one stage with cholecystectomy and closure of the fistula during acute surgery, and in another case (8.3%), enterolithotomy + primary suturing of the jejunal perforation was performed. There were two (16.6%) perioperative mortalities. CONCLUSION: Gallstone ileus remains a diagnostic challenge despite advances in imaging techniques, and pre-operative diagnosis is often delayed. Gallstone ileus should be suspected in all cases admitted to the emergency service with acute intestinal obstruction with a history of cholelithiasis, especially in the elderly and females.

Cirugía conservadora en hidatidosis: problemas / Surgical treatment of hydatid cyst

Background: Hydatid Cyst is an infectious disease observed in many parts of the world, more often in endemic parts. While it can show symptoms related to the organ where it is localized, it can be also diagnosed incidentally. Aim: To report the experience in surgical treatment of hydatid cysts. Material and Methods: Retrospective review of 62 patients aged 17 to 75 years old (45 females), operated for hydatid cysts between 2002 and 2006. Results: The most common presenting complaint was right upper quadrant abdominal pain. The cyst was primary in 56 patients (90 percent) and a relapse in six (10 percent). Liver cysts were located in the right lobe in 41cases (66 percent) and left lobe in 11 (18 percent). Nine patients (15 percent) had bilateral lobe involvement. One patient (2 percent) had primary spleen hydatid cyst. Conservative surgery was used in all cases. A biliary fistula was found in 6 cases (10 percent) during the operation. In two patients, cysts were found in the choledochus and a choledochotomy was performed. Five patients had extrahepatic organ involvement of lung, omentum, colon meso and right ovary. Conclusions: To reduce the rate of relapse, operation technique must be carried out properly and carefully. Primary prophylaxis should be the first line of treatment of hydatid diseases.

Introducción: La Hidatidosis quística es una enfermedad infecciosa que se observa en muchas partes del mundo, más aún en zonas endémicas. En la mayoría, los síntomas son propios del órgano que afectan, pero a veces puede descubrirse de forma incidental. Objetivos: Describir e informar nuestra experiencia en el manejo quirúrgico de la hidatidosis quística. Material y Método: Quistes hidatídicos operados durante los últimos 7 años analizados de forma retrospectiva. Resultados y Discusión: Hubo 62 casos en nuestra serie, razón mujer hombre 45/17 y edad promedio de 41,6 años. Presentación más frecuente fue el dolor en cuadrante superior derecho. Cincuenta y seis (90,3 por ciento) casos fueron primarios y 6 (9,7 por ciento) recidivas. Compromiso de lóbulo hepático derecho en 41 casos (66 por ciento), izquierdo en 11 (17,7 por ciento) y bilateral en 9 (14,5 por ciento). Un caso fue (1,8 por ciento) primario esplénico. Se realizó cirugía conservadora en todos los pacientes. Se encontraron fístulas biliares en 6 casos (9,8 por ciento). En estos últimos el tamaño de los quistes fue de 14 cm. En 2 casos se observó compromiso del colédoco por lo que se realizó coledocostomía. En 5 casos (8 por ciento), se observó compromiso extrahepático los cuales fueron pulmón, omento, mesocolon y ovario derecho. Considerando que los quistes hidatídicos se pueden encontrar en todos los órganos, se debe realizar estudio imagenológico toracoabdominal. Para disminuir la tasa de recidiva, la técnica quirúrgica debe ser realizada de manera adecuada y cuidadosa. Debe realizarse profilaxis primaria como principal factor del tratamiento.

Is repair of incisional hernias by polypropylene mesh a safe procedure?

OBJECTIVE: The aim of our study was to evaluate the safety of the intraperitoneal mesh repair procedure and to assess the complications that develop after the procedure. SUBJECTS AND METHODS: We reviewed the records of 25 patients who underwent intraperitoneal mesh repair procedures. Data on age, sex, size and cause of the hernia, postoperative mortality, and morbidity with special attention to complications were obtained from the medical records. RESULTS: Of the 25 patients (7 males, 18 females), the original operation was cholecystectomy in 15 cases (60%), gynaecological surgery in 2, gastric surgery in 2, and umbilical hernia in 2. Incisions were midline in 20 cases (80%), transverse in 2 and laparoscopic port sites in 3 patients. The average size of the hernia was 150 cm(2). Local complications occurred in 4 (16%) patients. Postoperative complications included wound infection in 3 patients and haematoma in 1 patient. Postoperative hospital stay ranged from 3 to 25 days with a mean of 6 days. No recurrence developed during 28-month follow-up. CONCLUSION: The tension-free repair of incisional hernia with polypropylene mesh in intraperitoneal position is a safe and easy procedure with acceptable morbidity and no recurrence.

Phrenic-recurrent nerve anastomosis in animal models with unilateral cutting of the recurrent nerve.

In our experimental study, the aim was to recover vocal cord physiology in cutting of recurrent laryngeal nerve, thus phrenic-recurrent nerve transposition was planned in rabbits. Experiments were performed on 10 experimental and 10 control rabbits. The right recurrent nerve was cut in the control group, while in the experiment group, the right recurrent nerve was cut. Then, a right phrenic-recurrent nerve end-to-end anastomosis was performed and the results were evaluated. After the 3rd postoperative week, videolaryngoscopy (VLS) and intramuscular electromyography (EMG) could not be evaluated in 1 rabbit from the experimental group which had died during anesthesia. In eight of the nine rabbits in the experiment which underwent VLS and EMG, activity was recorded in the right vocal cords. On light microscopic examination, atrophy was not detected in the vocal cord muscles of 9 rabbits among the 10 in the experiment group, while all rabbits in the control group and 1 rabbit in the experiment group were diagnosed with vocal cord atrophy. A success rate of approximately 90% was obtained based on the pathologic examination. We believe that the method can be used in patients without any contraindications, considering the complications of tracheostomy and the quality of life.

A Clinicopathological Evaluation of Male Patients with Breast Cancer.

BACKGROUND: Although male breast cancer constitutes only 1% of all breast cancers, its incidence is increasing and it is becoming an important public health issue. The present study aims to present the clinicopathological characteristics of surgically treated male breast cancer patients from multiple centers. PATIENTS AND METHODS: Twenty-one male patients operated on for breast cancer were retrospectively examined in terms of clinical presentation, pathological characteristics, TNM staging status, and type of surgical treatment. RESULTS: The mean age of the 21 patients was 62.3 years (range 38-94), with the majority being in the range of 50-69 years (61.9%). The most frequent finding was breast mass (85.7%). Most patients underwent modified radical mastectomy (76.1%), and the most prevalent histological type was invasive ductal carcinoma (85.7%). The majority of patients had stage II or III disease, and estrogen receptors were positive in 18 (85.7%) of the patients. CONCLUSION: Since male breast cancer is a rare condition, it is challenging to conduct prospective randomized trials. Currently, there is a lack of comprehensive data on the diagnosis and management of this condition. Thus, further studies and the implementation of specific guidelines or protocols for this subgroup of patients will aid better management.

HINTERGRUND: Obwohl der Brustkrebs des Mannes nur 1% aller Mammakarzinome ausmacht, ist die Inzidenz doch steigend, und die Erkrankung entwickelt sich zu einem für das Gesundheitswesen bedeutenden Problem. Ziel der vorliegenden Studie ist es, die klinisch-pathologischen Charakteristika chirurgisch behandelter männlicher Brustkrebspatienten verschiedener Zentren darzustellen. PATIENTEN UND METHODEN: Insgesamt wurden 21 chirurgisch behandelte Brustkrebspatienten retrospektiv bezüglich ihrer klinischen Präsentation, pathologischen Charakteristika, TNM-Status und Art der chirurgischen Behandlung ausgewertet. ERGEBNISSE: Das mittlere Alter der 21 Patienten war 62,3 Jahre (Spanne 38­94); die Mehrzahl der Patienten war 50­69 Jahre alt (61,9%). Der häufigste Befund war Brusttumor (85,7%). Bei den meisten Patienten wurde eine modifizierte, radikale Mastektomie durchgeführt (76,1%), und der häufigste histologische Befund war invasives duktales Karzinom (85,7%). Die Mehrzahl der Patienten war im Stadium II oder III. 18 (85,7%) Patienten waren östrogenrezeptorpositiv. SCHLUSSFOLGERUNG: Da der Brustkrebs des Mannes eine seltene Erkrankung ist, ist es schwierig, prospektive randomisierte Studien durchzuführen, und im Moment mangelt es an umfassenden Daten zu Diagnose und Management. Weitere Studien sowie die Implementierung spezifischer Richtlinien oder Protokolle für diese Patientenuntergruppe würden deshalb das Management dieser Erkrankung erleichtern.

Laparoscopic anterograde cholecystectomy in acute cholecystitis.

UNLABELLED: In the laparoscopic surgery of acute cholecystitis, no identification of anatomic structures in Calot triangle prevents the retrograde disection. Therefore, the anterograde disection of gall bladder, which we often use in open cholecystectomy, was applied as an alternative method in laparoscopic cholecystectomy in our 2 cases. Through this method, the safety of the attempt was increased and the patients were not deprived of the comfort of laparoscopic cholecystectomy. KEYWORDS: Laparoscopic anterograde cholecystectomy; Acute cholecystitis; Gall bladder.