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Oral anticoagulants and anti-platelet therapies are used for treatment and especially prophylaxis in clinical situations where there is a risk of thromboembolism or when thromboembolic events occur. The presented case was a patient who was hospitalized due to cellulitis in the leg, and was diagnosed with heart failure, obesity and chronic obstructive pulmonary disease. She was started on prophylactic oral anticoagulants for deep vein thrombosis and pulmonary emboli and subsequently developed spontaneous breast hematoma. The usual sites of such bleeding are the skin, gastrointestinal tract, genitourinary tract, central nervous system, retroperitoneum, muscle, and the site of recent surgical procedures or trauma while breast hematomas are usually of traumatic origin. Spontaneous bleeding into the breast after anticoagulant use is rare. While using anticoagulants, it should be kept in mind that, rarely, bleeding may occur in the breast. We advise that intervention in such cases is unnecessary, no matter how large the breast hematoma is, and that new anti-coagulant drugs may be safer.

Objective: The aim of this observational retrospective cohort study was to define the effect of the embryo transfer (ET) technique on pregnancy and live birth rates. Material and Methods: Infertile women with good prognostic factors undergoing in vitro fertilization treatment with freezing all the 5th day good quality embryos and consecutive frozen ET in 468 infertile good responders with first quality 5th day embryos were chosen for this study. Logistic regression analysis was performed to determine the effect of ET on the live birth rates. Results: Of the six predictive values, four were statistically significant: The easy passage of the external catheter, ultrasonographic visualization of the bubble, leaving the embryo at the desired location, and bleeding found in the external catheter after the catheter were excluded from the cervical ostium. While the probability of pregnancy decreased by 98.1% in cases where the embryo could not be left at the expected location, it was observed that the probability of pregnancy decrease was 96.4% in cases where no bubble could be seen, and 59.2% in cases with bleeding in the external catheter. Similarly, a 74.4% decrease in the probability of pregnancy was observed in patients in whom the passage of the catheter was difficult. Even though the tip of the transfer catheter during the ET is easily seen, the blood in the external catheter decreases pregnancy chance. Conclusion: Visualizing the internal catheter and the air bubble under the ultrasound guidance with the atraumatic placing of the embryo 1–1.5 cm away from the uterine fundus is crucial for the success of ET.

COVID-19 crisis affects ovarium cancer patients seriously. Thus, it is vital to diagnose ovarium cancer, one of the most common types of cancer diagnosed and the causes of death of women around the world, at early stages. Herein, 5-(2-phenylbenzo[b]thiophen-3-yl) thiophene-2-carbaldehyde (PTTC)-based sensor is designed to detect CA-125 more precisely and rapidly via electrochemical methods. PTTC, novel benzothiophene derivative, is synthesized by electrophilic cyclization reactions and Pd-catalyst coupling reactions. Then, PTTC is dispersed homogeneously in Nafion solution, and an ink is obtained. This ink is transferred onto the glassy carbon electrode and CA-125 is incubated on this electrode. Cyclic voltammetry (CV), differential pulse voltammetry (DPV), and electrochemical impedance spectroscopy measurements are employed to determine sensitivity and reliability of CA-125 on PTTC based GCE electrode. The effect of CA 125 concentration, incubation time, scan rate studies are performed by CV to determine the optimum conditions. Optimum conditions are found as 3 μL PTTC loading, 5000 ng/mL CA125 antigen concentration and 30 min incubation time. Linear range of the PTTC based GCE electrode prepared at optimum conditions are obtained by DPV as 1–100 ng/ml.Limit of detection and limit of quantification values were obtained as 0.0096 ng/mL and 0.0288 ng/mL, respectively. Interference and artificial serum results reveal that this electrode is a promising electrode for CA125 antigen determination for the ovarium cancer. PTTC is a novel and unique material for the detection of ovarium cancer antigen CA-125 and promising for CA-125 antigen detection.

Aim: In the study, it was aimed to investigate the relationship between inflammatory markers and radiology in COVID-19 patients. Material and Method: The study was conducted in the quarantine wards of a tertiary hospital between March and June 2020. Patients with a definite diagnosis of COVID-19 were included in the study. The lung damage of the patients caused by COVID-19 was determined by computed tomography and the relationship between lung damage and inflammatory markers was examined. Results: The mean age of 259 COVID-19 patients included in the study was 61.96 ± 14.076. Except for thrombocytopenia, all variables such as ferritin, D-dimer, thoracic computerized tomography (CT) involvement rates were significantly poorer in the patients requiring the care in ICU than the patients in wards (p

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy which is frequently associated with metabolic syndrome. The aim of this study is to compare the clinical, biochemical and hormonal characteristics of healthy women and women with PCOS in Black Sea Region. 91 healthy women (Group 1) and 109 PCOS (Group 2) patients were included in this retrospective study. This study was conducted in Samsun Women and Children’s Health Research and Training Hospital between October 2019-May 2020.The anthropometric, clinical and laboratory characteristics of the women were recorded. The Institutional Review Board of the hospital approved the study. IBM SPSS Statistics 22 program was used for statistical analysis. Variables were expressed as mean ± standard deviation or as a number (percentage), and statistical significance was defined as a p value of less than 0.05. In this study, no statistically significant difference was found between patients with PCOS and control subjects in age, height, BMI, waist circumference and waist-to-hip ratio. Weight, BP systolic, BP diastolic and FG scores, were significantly higher in patients with PCOS compared to control subjects. In this study, no statistically significant difference was found between patients with PCOS and control subjects in FSH, estradiol prolactin, TSH, fT3, fT4 and DHEASO4 levels. But, LH, cortisol, total and free testosterone and 17-OH progesteron levels were significantly higher in patients with PCOS compared to control subjects. Also in this study, vitamin B12 and the 25-OH-D levels were significantly lower in patients with PCOS compared to control subjects. HbA1C, fasting blood glucose levels, fasting insulin levels and HOMA-IR were significantly higher in patients with PCOS compared to control subjects . Total-C, LDL-C and TG levels were significantly higher in women with PCOS compared to control subjects. Also, HDL-C levels were significantly lower in women with PCOS compared to control subjects. As a result, the risk of metabolic syndrome is increased in PCOS patients because of high androgen levels, obesity and insulin resistance.

Cystic echinococcosis (CE) is a zoonotic infection and could lead to significant public health problems. The genetic diversity of CE includes five species: E. granulosus sensu stricto (s.s.) (G1–G3), Echinococcus equinus (G4), Echinococcus ortleppi (G5), Echinococcus canadensis genotypic cluster (G6, G7, G8 and G10, with the doubtful G9) and the Echinococcus felidis (lion strain). The species are important in epidemiology, pathology, control, prevention measures and vaccine/drug designs. The aim of the present study was to determine the E. granulosus genotypes in humans in the Van province in east of Turkey. In total, 102 echinococcal cysts were collected from operated patients. Genomic analyses were conducted with PCR-RFLP of the rDNA internal transcribed spacer 1 (ITS1) fragment and partial PCR sequencing of the cytochrome c oxidase subunit 1 (cox1) mitochondrial DNA gene region. In total, DNAs of 96 isolates could be extracted, unfortunately six extractions failed. The PCR-RFLP analysis findings were identical in all isolates. Two bands were observed at approximately 300 bp and 600 bp. All profiles corresponded to the G1-G3 strain. Also, 446 bp amplified gene regions were observed for cox1. Out of 20 samples, alignment of 16 sequences exhibited a total identification (100%) of granulosus sensu stricto (G1/G3). Of 16 samples, 8 were obtained in the lung and 12 were obtained in the liver; 8 belonged to male and 12 belonged to female patients. Other four samples exhibited one nucleotide substitution at different positions. Four samples had one nucleotide substitution at different positions. We detected single nucleotide variations in TRH1, TRH67, TRH85 and TRH89 isolates at the positions C240T; G330T; G211A and T157C, respectively. In conclusion, the present study was the first comprehensive molecular investigation on genetic characterization of human CE isolates in Van region. The findings demonstrated that E. granulosus s.s. was the dominant species, which indicated that the sheep-dog cycle was the source in human infections. And, probably, it would be possible to describe these mutations as “Turkey” or “lung” variants. In addition to contributing molecular epidemiological data, the present results should be considered when designing and implementing E. granulosus control programs.

Intraoperative testing (IT) is used to confirm the integrity of gastrointestinal anastomosis. Clinical trials are available in the literature to support the fact that methylene blue can identify the leaks, and can thus help in minimizing the postoperative ratio of clinical leaks after total gastrectomy. In the recent literature, machine learning tools have been used very successfully to investigate the hypothesis of such complex clinical trials, where incomplete data is available. In this article, data obtained from a clinical study, is analyzed using machine learning, to verify whether or not the methylene blue test can accurately identify the leaks and to predict future outcomes. Furthermore, a comparative study based on most robust machine learning solvers is presented in this article to identify the most appropriate machine learning technique(s) for future applications. We have considered the data (over a period starting from Jan 2007 till Dec 2014) based on the total gastrostomies (TG), where methylene blue test was applied. Data was obtained from 198 patients having gastric cancer. Out of 198, 108 cases went through methylene blue test done by a nasojejunal tube while no test was carried out for rest of 90 cases. Intraoperative leakage rate, mortality rate, length of hospitalization and postoperative clinical leakage rate were the measured outcomes. To analyze the data and to predict whether there will be a leak or not, machine learning techniques were applied and the accuracy was compared. The main objective of this research is to predict the clinical leakage after applying methylene blue test on gastric cancer patients. This objective is successfully achieved by implementing six machine learning approaches. Case specific machine learning approaches are discussed to evaluate post clinical leakage rate and radio leakage rate. From our analysis, we have concluded that the prediction of intraoperative leak, post clinical leak and radio leak is possible with the aid of different machine learning techniques. An important conclusion drawn from this study is that a single machine learning technique can not accurately predict different stages of leak, since the accuracy of the technique depends on the specification of clinical data that varies from stage to stage.

Objectives To compare the efficacy, safety and cost of combinations of perineal pudendal nerve block + periprostatic nerve block and intrarectal local anesthesia + periprostatic nerve block with the standard technique (periprostatic nerve block). Methods The study was designed as a randomized prospective controlled trial. Patients with elevated serum prostate-specific antigen values (prostate-specific antigen >= 4 ng/mL) and/or abnormal digital rectal examination findings were included in the study. Patients with anorectal diseases, chronic prostatitis, previous history of prostate biopsy and anorectal surgery were excluded from the study. A total of 148 patients (group 1 [periprostatic nerve block], n = 48; group 2 [intrarectal local anesthesia + periprostatic nerve block], n = 51; group 3 [perineal pudendal nerve block + periprostatic nerve block], n = 49) were included in the final analysis. Pain during insertion and manipulation of the transrectal ultrasound probe was recorded as visual analog scale 1, pain during penetration of the biopsy needle into the prostate and sampling was recorded as visual analog scale 2, and pain during the entire procedure recorded as visual analog scale 3. Results The mean visual analog scale 1 score was significantly lower in group 3, when compared with group 1 and group 2 (P < 0.001). There was no significant difference between the groups in terms of the mean visual analog scale 2 score. The mean visual analog scale 3 score was significantly lower in group 3 when compared with other groups (P < 0.001). The total cost for transrectal ultrasound-guided biopsy in the intrarectal local anesthesia + periprostatic nerve block group was significantly higher than the other two groups. Conclusions The combination of perineal pudendal nerve block and periprostatic nerve block provides more effective pain control than intrarectal local anesthesia plus periprostatic nerve block and periprostatic nerve block alone, with similar complication rates and without increasing cost.

Introduction The effective control of malignant pleural effusion (MPE) is of paramount importance in the treatment of patients with disseminated cancer. In this study, we compared two different approaches (early pleurodesis versus late pleurodesis) to MPE. Material and methods Patients (188 cases) whose primary tumor type was known and who were confirmed to have MPE, were included in the study and were separated into two groups. One group consisted of patients who were asymptomatic and who underwent early phase pleurodesis (group I, n = 79). The other group (group II, n = 109) was composed of patients who were symptomatic and whose pleurodesis was performed later. In all cases, pleural effusion was evaluated by means of direct radiography. Computed tomography was performed with the goal of confirming the parenchymal or mediastinal lesions accompanying the pleural fluid. Results The rate of complete success in group I cases was observed to be higher, while the rate of recurrence was lower (p = 0.001 and p = 0.002, respectively) than group II. In multiple logistic regression analysis, co-morbidities and the group that patient belong were found to be significant in terms of pleurodesis success (p = 0.02 and p = 0.03). There was a significant difference in survival time between group I and group II, with group I exhibiting longer average survival time (log rank test p < 0.001). Conclusions We observed that the success rate was lower and the rate of recurrence higher in the late pleurodesis group, whose members already had greater volumes of pleural effusion.

Background/Aim. Although rare, parasitic infection can cause acute appendicitis and result in contamination of the peritonea during appendectomy. The goal of this study was to summarize our experiences with parasitic appendicitis and describe a novel laparoscopic technique to prevent contamination.Method. All patients diagnosed with acute appendicitis who underwent appendectomy between January 2016 and January 2017 were included in the study. All appendectomies were performed using the standard three-port laparoscopic method, and a video recording was made of each procedure. Following separation of the mesoappendix, a single endoloop was placed in the base of the appendix, and the appendix was then transected 3-4 mm above the clamp with the aid of a thermal cauterizing/sealing device. The appendix was extracted from the 10 mm trocar hole below the umbilicus and placed inside a bag prepared from a glove. After pathological confirmation of parasitic appendicitis, medical records were retrospectively analyzed in each case for whether peritoneal contamination had occurred or not.Results. Out of 97 appendectomies, parasitic infection was observed in 4 cases, as confirmed by pathological examination. In two of these patients,E. vermiculariswas detected, while the other two were infected withBalantidium coli. Intraoperative contamination did not occur in any of the cases, and retrospective review of the video recordings indicated no peritoneal contamination.Conclusion. As a result of the coagulation and sealing effects of thermal devices, airtight seals were created on the residual appendiceal stumps, and consequently, no contamination was observed in any of the cases.

Background and Objective Spinal bone metastases are common. They are mostly localized to the lumbar, thoracic, and cervical spine. The most common primaries to result in spinal metastases include lung, breast, and prostate carcinomas in adults as opposed to leukemia, Ewing sarcoma, rhabdomyosarcoma, and neuroblastoma in children. In patients diagnosed with cancer, bone metastases are found in 40% and spinal metastases in 10%. In this study, we reviewed 25 patients diagnosed with a spinal metastasis of unknown primary who presented with low back pain or acute-onset neurologic deficits and underwent operative treatment. Methods The retrospective study included 25 patients with a spinal metastasis of unknown primary who presented to our clinic with acute-onset vertebral fracture or neurologic deficit. Statistical descriptions were obtained for each patient. Survival analysis was performed using the Kaplan-Meier method. Results The 25 patients included 17 men (68%) and 8 women (32%), with a mean age of 55 years (range, 14–81 years). Eleven patients (44%) presented with varying degrees of motor deficits ranging from flaccid paralysis to paraplegia. Motor deficits were completely reversed in 4 patients postoperatively. The tumors were localized to the upper thoracic spine (T1-4) in 2 patients, in the midthoracic spine (T5-8) in 2 patients, in the lower thoracic spine (T9-12) in 8 patients, in the cervical 7 in 1 patient, and in the lumbar spine in 12 patients. In 10 patients, the tumor affected multiple spinal regions. Nonosseous tumors were not present in 10 patients. Ten patients had an extradural tumor. Costal involvement was detected in 2 patients. The tumors were pathologically identified as lung cancer (n = 3), lymphoma (n = 5), breast cancer (n = 3), gastric cancer (n = 2), liver cancer (n = 2), prostate cancer (n = 2), renal cell carcinoma (n = 2), malignant melanoma (n = 1), plasmacytoma (n = 1), bladder cancer (n = 1), paraganglioma (n = 1), Ewing sarcoma (n = 1), and yolk sac carcinoma (n = 1). Posterior instrumentation was performed in patients with instability. In addition, decompression was performed in patients with neurologic deficit. Conclusions Considering that 10% of patients with cancer are diagnosed by vertebral metastasis, presence of malignancy should be suspected and a detailed examination should be performed in patients presenting with vertebral fractures caused by no or minor trauma. Moreover, in patients presenting with neurologic deficit, soft tissue metastases leading to spinal cord compression should be kept in mind and further examinations should be promptly administered.

Objective. Elevated serum Mac 2-binding protein (M2BP) levels have been observed in some cancers. As far as we know, its importance has not been investigated in esophageal squamous cell carcinoma (ESCC). The investigated problem of this study was to evaluate whether there was a difference between ESCC patients and the control group in terms of M2BP. Also, we evaluated the diagnostic performance of serum M2BP alone or in combination with the CEA for patients with ESCC.Material and Methods. Blood serum samples were collected from 50 healthy donors and 150 patients with ESCC. M2BP levels of all 200 samples were quantified by ELISA (enzyme-linked immunosorbent assay). Patients who had been diagnosed with ESCC and did not have any other malignancies were enrolled to study.Results. The two groups did not significantly differ in terms of age (p>0.05). In the control group, the mean serum M2BP level was 14.97 ± 3.46 ng/mL. The mean serum M2BP level of the ESCC patients was 176.65 ± 22.14 ng/mL. The serum M2BP level was significantly higher in patients with ESCC than in the control group (p<0.001). Gender was also comparable in both groups (p=0.695).Conclusions. Our analysis demonstrated that this marker may be associated with the mechanism of the disease. Despite that serum M2BP is not a specific marker for ESCC, it can be used as an adjuvant biomarker for the diagnosis of ESCC.

Objective Prehospital and hospital care during incidents of mass violence and civil conflict involve a number of aspects that distinguish it from care during times of peace. We aimed to analyze the dynamics and outcomes of prehospital and hospital care during ongoing conflicts. Study design Multicentric prospective observational study. Method Patients enrolled in the study, which was conducted in Turkey, were all injured in armed conflict and taken to level 1 trauma centers. On admittance, patients were requested to complete a semistructured questionnaire containing questions on patient demographics, transport type, weapons used, injury severity score (ISS), and other incident-related factors. We analyzed patient outcomes (mortality, morbidity, complications, and length of hospital stay) and transfers of patients between hospitals. The present study evaluated the cases of 390 victims enrolled over a 9-month period and followed up for 6 months. Results The majority of patients were transported by ambulances (n = 334, 85.6%); other transport modes were helicopters (n = 32, 8.2%) and private vehicles (n = 24, 6.2%). Nearly half of patients (48.7%) did not benefit by changing hospitals. During transport to hospitals, 4.1% of the vehicles in the study were involved in accidents. Using multiple regression analysis, only ISS (odds ratio [OR]: 1.098, 95% confidence interval [CI]: 1.044–1.156) and the Glasgow Coma Scale (OR: 0.744, 95% CI: 0.639–0.866) were found to affect mortality. In Receiver-operator characteristic analysis, a cutoff value of 22.5 for ISS had a sensitivity of 100% and a specificity of 89.6% for mortality. Conclusions Despite lower ISS values, patient outcomes were worse in terror incidents/civil conflicts. Transport modes did not significantly affect outcomes, whereas hospital transport was found to be inefficiently used.

Objective: The purpose of this study was to compare the effects of thymoquinone and icodextrin in rats within the framework of an experimental adhesion model.Materials and Methods: Rats were separated into three groups: (1) a control group consisting of rats that had 2 ml of isotonic solution administered intraperitoneally, (2) an ICO group administered with 2 ml of 4% icodextrin, and (3) a TQ group administered thymoquinone (10 mg/kg), all following cecal abrasion. The three groups underwent a reoperation on the 7th postoperative day. Hydroxyproline levels were analyzed in the resected adhesive tissues, and histopathological investigations were conducted. Blood samples were collected for biochemical analyses.Results: Fewer postoperative adhesions were observed in the ICO and TQ groups compared with the control group. A comparison of the TQ and ICO groups revealed lowers levels of postoperative adhesions in the TQ group. Compared with the control group, malondialdehyde, 8‑OH‑deoxyguanosine/ deoxyguanosine (8‑OHdG/10dG), Coenzyme Q10 (CoQ10), and CoenzymeQ10/ reduced CoenzymeQ10 (CoQ10/CoQ10H) values were found to be lower in the TQ and ICO groups. When the TQ and ICO groups were compared with respect to their biochemical parameters, the results for all of the four parameters were found to be statistically significantly lower in the TQ group (P < 0.000). The levels of hydroxyproline in the control, ICO, and TQ groups were found to be (mean ± standard deviation) 502.25 ± 90.39 μg/g, 342.13 ± 66.61 μg/g, and 287.88 ± 49.59 μg/g, respectively.Conclusions: A comparison of the antiadhesive effects of thymoquinone and icodextrin revealed thymoquinone to be more effective. These results indicate that thymoquinone is an efficient and strong antiadhesive molecule.Keywords: Icodextrin, postoperative adhesions, rat, thymoquinone

ÖZETÖzofagus kanser cerrahisinde tek üniversite hastanesi deneyimleri ve değişentrendler; sonuçlar değişti mi?Amaç: Özofagus kanserinin temel tedavi yöntemi cerrahi olarak devam etmektedir. Son dekatlarda cerrahiyöntemlerde ciddi ilerlemeler olmuştur. Neoadjuvan kemoradioterapinin stantdart hale gelmesi ile beraber,cerrahinin tedavideki yeri, cerrahi yöntemin tipi ve zamanlaması tartışılmaya başlanmıştır. Bu çalışmada,farklı cerrahi yöntemler ile tedavi edilen vakalarımızın sonuçları paylaşıldı.Yöntem: Özofagus kanserli 51 vakanın verileri retrospektif olarak değerlendirildi. Bu 51 vakanın 31 tanesioperable idi. Ameliyat edilen 31 vaka, ayrıca cerrahi yönteme ve neoadjuvant kemoradioterapiye göre altgruplara ayrıldı. Ay olarak median sağ-kalım süreleri, komplikasyonlar, hastane mortaliteleri, yatış sürelerive patoloji sonuçları (toplam çıkarılan lenf nodu sayısı, TNM sınıflaması) farklı cerrahi tekniklere göre yorumlandı.Bulgular: Açık cerrahi teknikler ile 21 vaka ameliyat edilirken, 10 vaka minimal invazif yöntemler (MİY) ileameliyat edildi. Açık cerrahi yöntemlere göre MİY ile ameliyat olanlar daha sıklıkla neoadjuvant tedavi almışidi (p=0.013). MİY ile ameliyat olan grupta daha fazla komplikasyon gözlendi ancak açık teknikleregöre bu fark istatiksel olarak anlamalı değildi. Aynı şekilde, hastanede yatış süresi açık tekniklere göre MİYile ameliyat olanlarda daha fazla idi ancak istatiksel anlamlılık yoktu. Neoadjuvant tedavi alan 11 vakanın 8tanesinde patolojik tam yanıt (%72.7) gözlenmesine rağmen, cerrahi sonuçlar neoadjuvant tedavi alanlardaistatiksel olarak anlamlı olmasa da, daha kötüydü.Sonuç: Özofagus kanseri cerrahisinde, değişen trendlere ve tedavi seçeneklerine rağmen, istenilen iyisonuçlara ulaşılamamıştır.Anahtar kelimeler: özofagus kanseri, minimal invazif cerrahi, neoadjuvant tedavi ABSTRACTObjective: The main treatment modality for esophageal cancer remains to be surgery. Over the lastdecades, surgical strategies have evolved remarkably. When neoadjuvant chemoradiotherapy becamestandard, discussions about the role, type, and timing of surgery began. In this study, we share results weobtained after operating our patients using various surgical techniques.Material and Methods: Reliable data from 51 esophageal cancer patients were evaluated retrospectively.Of the 51 cases, 31 were operable. These operable cases were further classified according to surgicalmethod and neoadjuvant therapy status. Median survival time in months, complications, hospital mortality,length of hospital stay, and pathology results (total lymph nodes harvested and pathologic tumor nodemetastasis stage [p_TNM]) were documented for the different surgical approaches.Results: Open surgical methods were performed in 21 cases, while in 10 cases the Minimally InvasiveSurgery (MIS) method was used. The MIS group received neoadjuvant therapy more frequently than theopen surgical methods group (p=0.013). Although more complications were observed in the MIS group, thedifference to the open esophagectomy methods group was not significant. Patients in the MIS group alsohad longer hospital stays, but again the difference was not significant. Although a pathologic completeresponse was seen in 8 of the 11 (72.7%) patients in our study who received chemoradiotherapy asneoadjuvant treatment, the surgical results of patients who received chemoradiotherapy were worse,although not to a statistically significant extent.Conclusion: Despite changing trends and treatment options in esophageal cancer surgery, we have yet tosee the expected improved results.Keywords: esophagus cancer, minimally invasive surgery, neoadjuvant therapy

BACKGROUND: Acute appendicitis is one of the most common causes of abdominal pain seen in surgical clinics. Although it can be easily diagnosed, the picture may be confusing, particularly in premenopausal women and the elderly. The present study is an evaluation of 2 of the current scoring systems with respect to accurate diagnosis of the disease and indication of inflammation severity.

Subcutaneous (incisional) endometriosis is a well described but extremely unusual entity. Patients who remain undiagnosed despite suffering associated symptoms are not infrequently encountered. This case report presents a patient who had an incisional endometriosis that developed on scar tissue following cesarean section. The patient was suffering from an atypical pain on the incision line which was associated with menstrual cycles. A palpable mass that resolved during the luteal phase was detected. An ultrasound imaging and a computed tomography scanning were carried out to delineate the size and relations of the mass. After total excision of the lesion, a histological diagnosis of endometriosis was achieved. During two months of follow-up, there has been no recurrence of symptoms. Scar endometriosis is such a diagnosis that should be kept in mind in patients having a pain associated with incision after any abdominal surgery.

Diverticulum of the cecum is a rarely seen reason of acute abdomen and it is difficult to be distinguished from appendicitis. The diagnosis is generally made during operation. We have presented this case in order to remember that it is a disease which should be kept in mind in cases of right lower quadrant pain.

An association of pancreatic cancer and median arcuate ligament syndrome (MALS) is a rare and challenging situation in terms of treatment. A 60-year-old man diagnosed with pancreatic cancer underwent laparotomy. A pancreaticoduodenectomy was planned, but during the resection part of the operation, a celiac artery stenosis was noticed. The patient was diagnosed with MALS causing almost total celiac artery occlusion, with no radiological solution. The patient was re-operated the next day, and an iliac artery allograft was used for aorta-proper hepatic artery reconstruction, concomitant with the total pancreaticoduodenectomy. Preoperative meticulous evaluation of vascular structures of the celiac trunk and its branches is important, especially in pancreatic surgery. A vascular allograft may be a lifesaving alternative when vascular reconstruction is necessary.