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Introduction: The aim of this study was to investigate the incidence of general psychiatric symptoms, aggression levels, and sexual dysfunction in patients with benign anorectal diseases and compare the results with those of healthy control subjects. Methods: We prospectively enrolled consecutive adult patients who presented for treatment of benign perianal diseases and healthy control subjects between June 2017 and December 2018. All patients had either grade 3 or 4 hemorrhoidal disease or perianal fistula with active discharge who had not undergone previous anorectal surgery. We also included a control group with benign subcutaneous lumps presenting for minor surgery. We used the Symptom Checklist-90-Revised Form to evaluate general psychiatric symptoms, the Buss-Perry Aggression Questionnaire (BPAQ) to evaluate aggression levels, and the Arizona Sexual Experiences Scale to evaluate sexual dysfunction. Results: A total of 563 patients were assessed for eligibility; after exclusions, 94 with anal fistula, 89 with hemorrhoids, and 59 healthy control subjects were enrolled. The groups were similar with regard to age, gender, and educational level. Physical and verbal aggression, anger, and total BPAQ score were significantly higher in patients with perianal fistula than in those with hemorrhoidal disease and healthy control subjects (P <.001). Conclusion: This study suggests that patients with perianal fistula have higher levels of aggression than healthy control subjects and those with hemorrhoidal disease. One must bear this in mind during preoperative patient evaluations and obtaining informed consent. Further studies are needed to investigate the reason for this association and potential causality. [ABSTRACT FROM AUTHOR]

Objective: The aim of this long-term follow-up study was to investigate the association of local and systemic cardiovascular complications with endothelium-dependent and-independent microvascular relaxations and blood biomarkers and biochemicals in patients with peripheral arterial disease (PAD) caused by atherosclerosis. Methods: This prospective study included 67 patients with PAD who had not undergone any endovascular intervention, peripheral arterial surgery, or major amputation. Changes in the microvascular blood flow were measured using laser Doppler imaging after iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP). The biochemical markers of high sensitivity C reactive protein (hs-CRP), nitric oxide (NO), total antioxidant capacity (TAC), asymmetric dimethyl arginine (ADMA), and hydrogen sulfide (H2S) levels were measured from blood samples. All the patients were followed up for 5 years to determine the development of cardiovascular adverse events (CVAEs) and major amputation. At the end of the follow-up period, the patients were classified into two groups: those who had a CVAE [CVAE (+)] and those who did not experience CVAE [CVAE (-)]. Parameters such as demographic features, atherosclerotic risk factors, chronic ischemia category, microvascular endothelial functions, and plasma biomarkers were compared between the groups. Results: A total of 67 patients comprising 61 (91%) males and 6 (9%) females with a mean age of 62.3±9.7 years were included. During the follow-up period, 29 patients had CVAE (43.3%) and 38 patients did not have CVAE (56.7%). There was no difference between the groups in terms of ACh and SNP-induced vasodilation responses. Plasma high density lipoprotein (HDL) cholesterol values were lower in the CVAE (+) group [(CVAE+HDL: 38.4±9.1), (CVAE-HDL: 44.7±11.1), p=0.02]. Plasma hs-CRP values were significantly higher in the CVAE (+) group [(CVAE+ hs-CRP: 14.3±20.6), (CVAE-hs-CRP: 5.9±10.9), p=0.004]. No significant difference was observed between the groups in terms of plasma biomarkers and other biochemical levels. Conclusion: Based on the study findings, it was concluded that only low plasma HDL and high hs-CRP levels were risk factors for the development of CVAEs during follow-up of patients with PAD. [ABSTRACT FROM AUTHOR]

Objective: The aim of this long-term follow-up study was to investigate the association of local and systemic cardiovascular complications with endothelium-dependent and-independent microvascular relaxations and blood biomarkers and biochemicals in patients with peripheral arterial disease (PAD) caused by atherosclerosis. Methods: This prospective study included 67 patients with PAD who had not undergone any endovascular intervention, peripheral arterial surgery, or major amputation. Changes in the microvascular blood flow were measured using laser Doppler imaging after iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP). The biochemical markers of high sensitivity C reactive protein (hs-CRP), nitric oxide (NO), total antioxidant capacity (TAC), asymmetric dimethyl arginine (ADMA), and hydrogen sulfide (H2S) levels were measured from blood samples. All the patients were followed up for 5 years to determine the development of cardiovascular adverse events (CVAEs) and major amputation. At the end of the follow-up period, the patients were classified into two groups: those who had a CVAE [CVAE (+)] and those who did not experience CVAE [CVAE (-)]. Parameters such as demographic features, atherosclerotic risk factors, chronic ischemia category, microvascular endothelial functions, and plasma biomarkers were compared between the groups. Results: A total of 67 patients comprising 61 (91%) males and 6 (9%) females with a mean age of 62.3±9.7 years were included. During the follow-up period, 29 patients had CVAE (43.3%) and 38 patients did not have CVAE (56.7%). There was no difference between the groups in terms of ACh and SNP-induced vasodilation responses. Plasma high density lipoprotein (HDL) cholesterol values were lower in the CVAE (+) group [(CVAE+HDL: 38.4±9.1), (CVAE- HDL: 44.7±11.1), p=0.02]. Plasma hs-CRP values were significantly higher in the CVAE (+) group [(CVAE+ hs-CRP: 14.3±20.6), (CVAE- hs-CRP: 5.9±10.9), p=0.004]. No significant difference was observed between the groups in terms of plasma biomarkers and other biochemical levels. Conclusion: Based on the study findings, it was concluded that only low plasma HDL and high hs-CRP levels were risk factors for the development of CVAEs during follow-up of patients with PAD. [ABSTRACT FROM AUTHOR]

BACKGROUND: Intermittent ischemia in remote tissues can be applied before ischemic injury, during ischemic injury or at the beginning of reperfusion of an index organ ischemia. The aim of this study was to investigate the effect of Remote Ischemic Conditioning (RIC) of the leg on changes in ischemia-induced the microvascular functions of the arm. MATERIAL AND METHODS: Ischemic microvascular injury was induced by arm ischemia (20 min) and reperfusion in healthy, nonsmoker, male volunteers (ischemia group-ISC, n: 9). In another group of volunteers, to investigate the effects of remote organ ischemic conditioning 5 cycles of reperfusion followed by leg ischemia (each lasting 60 seconds) were applied either before (preRIC, n:11), or during (perRIC, n:12) or immediately after (postRIC, n:9) 20 minutes of arm ischemia. The microvascular flow of arm was assessed before and after ischemia using iontophoresis of the endothelium-derived nitric oxide (NO) releaser acetylcholine (ACh) and the endothelium-independent NO donor sodium nitroprusside (SNP). Changes in microvascular blood flow were measured using Laser Doppler imaging. The plasma level of biomarkers related to endothelial function such as nitric oxide (NO), asymmetric dimethylarginine (ADMA), total antioxidant capacity (TAC) and hydrogen sulphide (H2S) were measured. RESULTS: No difference was determined between the groups in terms of age, BMI or blood biochemicals reflecting cardiovascular status. ACh caused a rise in microvascular blood flow in a charge dependent manner. The ACh-induced flow increase was not significantly depressed by ischemia and not affected by any of the types of RIC in the study subjects. The increase in SNP-induced microvascular flow was significantly decreased in the ISC, perRIC and postRIC groups, but not in the preRIC group. Plasma levels of NO, ADMA, TAC and H2S were not changed by ischemia and RIC. CONCLUSION: These results suggested that microvascular perfusion of human forearm skin was elevated by either endothelium or drug-derived NO. The effect of ischemia and RIC on NO-induced flow increase was affected differently by different applications in the healthy young individuals. These complicated results are taken into consideration in experimental and therapeutic interventions. [ABSTRACT FROM AUTHOR]

At present there is no widely accepted biomarker for monitoring of vascular functions. The purpose of this prospective study was to investigate the association of some blood biomarkers with vascular reactivity in patients with peripheral arterial diseases (PAD). A prospective evaluation was made of 3 groups comprising a control group of healthy individuals, and patients with PAD caused by either atherosclerosis or Buerger's disease. Microvascular perfusion was examined using laser Doppler imaging of cutaneous erythrocyte flux after iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP). The correlation of microvascular reactivity with endothelium-related biomarkers was assessed. AChinduced and SNP-induced vasodilations were significantly diminished in the PAD groups. The plasma nitric oxide (NO) levels of PAD patients were significantly higher than those of the control group, but asymmetric dimethylarginine, total antioxidant capacity and hydrogen sulphide levels were similar. Plasma NO level was negatively correlated with ACh and SNP-stimulated microvascular flow increase, whereas a positive correlation was detected with blood glucose and glycated hemoglobin (HbA1c) levels in all groups. These results indicate that a high plasma level of NO in PAD patients is associated with diminished endothelium-dependent and independent flow increase in the microvascular bed. An excessive amount of NO-induced nitrosative stress in an inflammatory condition that might be a reason for vascular dysfunction should be taken into consideration in the diagnostic and therapeutic approaches to PAD. [ABSTRACT FROM AUTHOR]

Aim: Evaluation of histopathological results after wire guidance and BI-RADS (breast imaging and reporting data system) scores of cases with nonpalpable mammary lesions like mass in breast, microcalcification and structural distortion diagnosed via screening techniques. Materials and Methods: The wire guided biopsy results of cases who were diagnosed as nonpalpable mammary lesion and had BI-RADS scores of 3,4,5 between March 2007 and March 2012 were evaluated. 107 cases were included to the study.Patients admitted to our general surgery clinic were assesed with physical examination, mammography (older than 35 years) and mammary ultrasound . BI-RADS categories were determined according to the results of mammography and mammary ultrasound. The lesions of the cases having mammary cancer risk were excised after wire guidance at the same day. Status of having mammary cancer in first degree relatives, radiomorphologic diagnosis before wire guidance, BI-RADS scores and histopathologic results of the lesions were noted. Results: The mean age of the patients were 51.4 (36-72) years. In 24 (22.4%) of the cases a mammary cancer history in first degree relatives was present. The radiologic diagnosis of the mammary lesions before wire guidance was 65 (60.7%) microcalcification, 26 (24.2%) mass lesion with irregular borders, 9 (8.4%) asymmetric density area, 6 (6%) specular lesions. 58 (54.2%) of the lesions were localized in left breast and 49 (45.8%) were localized in right breast. Of the 107 cases wire guidance was performed with the aid of ultrasound in 62 (57.9%) and with the aid of mammography number and percentage missing. Of the 107 lesions excised under guidance 24 (22.4%) took malign diagnosis, where 83 (77.6%) took benign diagnosis. 32 (29.9%) lesions were categorized as BI-RADS III, 71 (66.4%) as BI-RADS IV and 4 (3.7%) as BI-RADS V. Conclusion: In conclusion, to diagnose the mammary cancer in early stages, the results gathered from the technique of wire guided biopsy of the nonpalpable masses detected as suspicious in ultrasound and mammography support that this technique should be efficiently used. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study is to evaluate demograhic characteristics, indications and complications of patients who were performed percutaneous endoscopic gastroenterostomy in our endoscopy unit. Material And Method: 36 patients with different indications were performed percutaneous endoscopic gastroenterostomy between January 2007 and March 2012 in our endoscopy unit. PEG were placed in all of the patients by Pull method. demographic characters, indications, major and minor complications were determined retrospectively. Results:Patients who were enrolled in the study were consisted of 22 (%61.2) male and 14 (% 38.8) female patients. Patients with norologic disease comes first with the rate of % 77 between the indications of PEG. There was one major complication. One patient was died because of major complication and septic shock that was occured during and after the procedure. Furthermore systemic candidiasis because of gastroenterostomy tube was seen in one patient. Different minor complications including the superficial infections (% 22.2, 8 patients) which was the most common were occured. Discussion:Percutaneous endoscopic gastroenterostomy is the longstanding enteral nutrition tecnique that is cheap, is performed easily and does not need operation room. Although low rates of complications, it must not be forgetted that this is an invasive procedure and can cause fatal complications. [ABSTRACT FROM AUTHOR]

Hilar cholangiocarcinoma, is a relatively rare tumor arising from the bile ducts, was first described by Klatskin in 1965. It usually ocurs in adults in their sixth decade of life and there is slight male predominance. It is most frequently located in the confluence of the hepatic ducts, where it is called hilar cholangiocarcinoma or Klatskin tumor. The etiology of hilar cholangiocarcinoma remains unknown but there are predisposing conditions and environmental risk factors such as primary sclerosing cholangitis, Caroli disease, bile duct malformations, industrial toxins and parasitic infections. If 30% of the liver is drained jaundice can be relieved, but the presence of undrained bile ducts may result in pruritus and a continued risk of cholangitis and hepatic abscess. This study aimed to emphasize the current treatment approaches for hilar cholangiocarcinoma in the light of literature. [ABSTRACT FROM AUTHOR]

Although pancreatic cystic lesions are monitored frequently, there still occure diffuculties in the diagnosis and treatment. Most of the cystic lesions are pseudocysts and retention cysts. Basically, pancreatic cystic neoplasms can be divided into four groups: serous cystic neoplasm (SCN), mucinous cystic neoplasms (MCN), intaduktal papillary mucinous neoplasm (IPMN) and solid pseudopapiller neoplasy (SPN). The diagnosis of the pancreatic cystic neoplasms is challenging, since clinical signs and symptoms are not typical. The treatment varies across types or even sub-type of the disease. For this reason, making the differential diagnosis of pancreatic cysts is crucially important. [ABSTRACT FROM AUTHOR]

Introduction: The goal of surgical treatment of thyroid diseases is to provide the most effective treatment with low complication and recurrence rates. Total thyroidectomy was prefered only in patients with cancer, due to high complication rates. The surgical aim can be reached in the total thyroidectomi operations with capsular dissection. Material and Methods: We evaluated patients, who underwent totally thyroidectomy for benign or malignant thyroid disease between August 2006 and August 2010 in our Department of General Surgery. The age, sex, indication of operation, postoperative complication ratas were recorded for each patient. Results: The median age of patients was 50.34+12.24 years (range 19-78) and 202 (77%) patients were female. Indications of operations were 216 ( 81.8%) multinoduler goitre, 34 (12.9%) diffuse goitre, 14 (5.3%) malignant condition. Postoperative complications were presented in postoperative period in 18(6.8%) patients; corresponding to recurrent laryngeal nerve injuries 5 (2 permanent) and hypoparathyroidisms 6 ( 1 permanent). Conclusion: Total thyroidectomy operation can be performed confidentally in appopriate patients with low complication rates. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with the case of a 70 year old woman who was diagnosed with a benign ovarian cyst which presented as an intraabdominal mass.

The aim of this study was to examine the relationship between eating behavior, eating awareness, and depression in young adults. Young adults aged between 18 and 25 years were included in the study. Questionnaires and body composition measurements were made face‐to‐face by the researcher in the interview room. The demographic characteristics were questioned through the questionnaire form. Three Factor Eating Questionnaire (TFEQ), Mindful Eating Questionnaire (MEQ), and Beck Depression Inventory (BDI) were used. It was determined that the Mindful Eating Questionnaire total score and Beck Depression Inventory total score affected emotional eating. A statistically significant positive correlation was found between the Beck Depression Inventory total score and the Three Factor Eating Questionnaire sub‐scores. There was a statistically significant negative correlation Beck Depression Inventory total score and the Mindful Eating Questionnaire total score and sub‐scores of mindless eating and emotional eating. In summary, depression seems to be a factor that triggers emotional eating, and emotional eating is a factor that negatively affects mindful eating. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to compare acute effects of consuming extra virgin coconut oil (EVCO) as a source of medium chain fatty acids and extra virgin olive oil (EVOO) as a source of long chain fatty acids in normal weight and obese subjects. Design: Randomised, crossover design. Participants: Metabolically healthy twenty male subjects (10 normal weight; 10 obese) aged 19–40 years. Intervention: Subjects consumed breakfast meals containing skimmed milk, fat-free white cheese, bread and EVCO (25 g) or EVOO (25 g). Outcome measures: Visual analog scale evaluations, resting metabolic rate measurements and selected blood parameters analysis (glucose, triglyceride, insulin and plasma peptide YY) were performed before and after the test breakfast meals. In addition, energy intakes were evaluated by ad libitum lunch meal at 180 min. Results: Visual analogue scale values of hunger and desire to eat decreased significantly after EVCO consumption than EVOO consumption in normal weight subjects at 180 min. There was an increase trend in plasma PYY at 30 and 180 min after EVCO breakfast compared to EVOO breakfast. Ad libitum energy intakes after EVCO and EVOO consumption in normal weight subjects were 924 ± 302; 845 ± 158 kcal (p = 0.272), respectively whereas in obese subjects were 859 ± 238; 994 ± 265 kcal (p = 0.069) respectively. Conclusion: The results of this study shows that consumption of EVCO compared to EVOO may have suppressive effect on hunger and desire to eat, may affect postprandial PYY levels differently and have no effect on postprandial energy expenditure. Trial registration: Clinical Trials NCT04738929. [ABSTRACT FROM AUTHOR]

Necrotizing fasciitis (NF) is an aggressive, necrotic, life-threatening infection of the soft tissues. The delay on treatment is generally accompanied by almost 90 % lethality according to the development of septic shock and its associated complications. Primary Necrotizing Fasciitis of the Breast (PNFB) is seen extremely rare. To date, breast necrotizing fasciitis have been reported only as a limited number of case reports in the literature. PNFB is commonly misdiagnosed as cellulitis, mastitis, abscess or inflammatory breast cancer. Although PNFB is a very rapid and aggressive disease, which can be fatal. Delayed cases were unfortunately resulted in mortality due to several consequential reasons. Therefore, careful and detailed evaluation of all cases irrespective of age, especially those with risk factors and comorbidities, could be life saving in respect of early diagnosis and timely treatment. Our aim is to to present the analysis and treatment modalities of five primarily seen PFNB, in this case series. [ABSTRACT FROM AUTHOR]

This study aimed to postoperatively evaluate the effects of intraoperative neural monitoring (IONM) on muscles and nerves in patients who underwent modified radical mastectomy (MRM). In the 11 patients included in the study, nerves were determined and protected by nerve monitoring during the axillary dissection (IONM group). In another 11 patients, nerve monitoring was not performed; however, protection of the same nerves was attempted through careful nerve dissection (cautious nerve dissection [CND] group). The control group consisted of 22 healthy subjects. Muscle and nerve functions were blindly evaluated by an experienced physical therapy and rehabilitation specialist using electromyography (EMG) and ultrasonography (US) methods. The EMG values of the pectoralis major muscle were similar in the IONM and control groups (1.97 mV/1.98 mV, p = 0.97) but significantly lower in the CND group (1.57 mV, p < 0.05). Significant differences were found in the US values of the pectoralis major and minor muscles between the IONM and CND groups. No significant difference was found between the IONM and control groups in terms of EMG values of the serratus anterior muscle. This is the first prospective randomized study to objectively evaluate preservation of the nerve through nerve monitoring and its functional results. Monitoring of nerves during MRM is of great importance in terms of demonstrating the positive effects on muscle and nerve functions. [ABSTRACT FROM AUTHOR]

Aim: Splenic infarction is a rare condition successfully treated with medical methods in general. The aim of this study was to evaluate the invasive treatment options in patients with splenic infarction-associated abscess. Methods: Files of thirteen patients, who underwent percutaneous drainage or a surgical procedure due to abscess as a result of splenic infarction, were retrospectively reviewed. Age symptoms, results of physical and radiological examinations and therapeutic methods were analyzed. Results: A total of 13 patients with the mean age of 56±18 years were included in the study. Seven (54%) patients were female and six (46%) were male. Acute abdomen was observed in 11 patients (85%), and acute abdomen as well as high white blood cell (WBC) count (>15000/mL) in nine patients (70%). Percutaneous drainage was performed in five patients (39%) and splenectomy in eight patients (62%), all of whom were diagnosed with splenic abscess by means of computed tomography. There was no difference in age, gender, acute abdomen, WBC count, platelet count and mortality between patients who underwent splenectomy and percutaneous drainage group, whereas in the splenectomy group, the number of associated diseases was higher and the length of hospital stay was longer (p=0.017 and p=0.011, respectively). Conclusion: Percutaneous drainage and, when necessary, splenectomy should be performed in patients who develop abscess as a result of splenic infarct, whose general health conditions deteriorates and whose symptoms do not improve and who have high WBC count despite medical treatment. [ABSTRACT FROM AUTHOR]

The article discusses a novel monitorization technique for nerve protection during axillary surgery of the breast cancer patients. Topics include the surgical option has evolved toward breast preservation and oncoplastic breast surgery techniques; and median intraparticular LPN and lateral localized MPN in the interpectoral dissection area are found via placing the needle electrodes in the pectoral major muscle.

Appendiceal mucocele is a rare entity which is characterised by cystic dilatation due to abnormal accumulation of mucus in the lumen of the appendix. Patients are often diagnosed incidentally by abdominal screening or abdominal surgery for other causes. Pain in the right lower quadrant of the abdomen, which may present as acute or chronic appendicitis, is the most common symptom of appendix mucocele, when the patient is symptomatic. This study describes the case of a 26 year old female for whom surgical intervention for a complex ovarian cyst was planned, but who instead underwent laparoscopic appendectomy because appendiceal mucocele was determined during laparoscopic exploration. [ABSTRACT FROM AUTHOR]

Appendiceal mucocele is a rare entity which is characterised by cystic dilatation due to abnormal accumulation of mucus in the lumen of the appendix. Patients are often diagnosed incidentally by abdominal screening or abdominal surgery for other causes. Pain in the right lower quadrant of the abdomen, which may present as acute or chronic appendicitis, is the most common symptom of appendix mucocele, when the patient is symptomatic. This study describes the case of a 26 year old female for whom surgical intervention for a complex ovarian cyst was planned, but who instead underwent laparoscopic appendectomy because appendiceal mucocele was determined during laparoscopic exploration. [ABSTRACT FROM AUTHOR]

Acute appendicitis is a common surgical emergency requiring intervention. Stump appendicitis is an acute inflammation of the residual part of the appendix and a rare complication of incomplete appendectomy. This case report describes a patient admitted to the emergency department for abdominal pain with rebound tenderness and an appendectomy scar on lower right quadrant. He was diagnosed with stump appendicitis. Upon laparotomy, an inflamed residual appendix was seen. Appendectomy was performed. We present a case of stump appendicitis 16 years after the primary operation. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented related to a case study of 47-year-old female patient suffering from intestinal perforation, an initial presentation of Wegener's granulomatosis in the previous issue.

The article describes the case of a 24-year-old woman who was diagnosed with appendicocutaneous fistula due to appendicitis. Her symptoms included nausea, vomiting and abdominal pain. Information on the results of her physical and laboratory examinations is provided. Plastron appendicitis was detected via abdominal computerized tomography (CT). She also developed an increase in leukocyte count and abdominal mass during her hospital stay. She underwent appendectomy and resection of the fistula.