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Background: The use of positron emission tomography-computed tomography (PET/CT) for the preoperative staging of patients with colon and rectal cancer has increased steadily over the last decade. The aim of this study was to evaluate the effect of PET/CT on the preoperative staging and clinical management of patients with colorectal cancer. Methods: Between December 2010 and February 2012, 64 consecutive patients with colorectal cancer were evaluated with both PET/CT scans and conventional preoperative imaging studies. We prospectively recorded the medical reports of these patients. The PET/CT findings were compared with conventional imaging studies and the rate of over-staging or down-staging and changes in clinical management were evaluated. The correlation of the PET/CT with the conventional imaging was compared by a kappa agreement coefficient. Differences in the accuracy for N and T staging were assessed by ?2 and related-samples marginal homogeneity tests. Results: Thirty-nine (60.9%) patients had rectal cancer and 25 (39.1%) had colon cancer. Based on PET/CT, additional lesions were found in 6 (9.4%) of the patients: hilar and paratracheal lesions in 4 patients, hepatic in 1 and supraclavicular in 1 patient. In four of six patients, detailed imaging studies or biopsies revealed chronic inflammatory changes. Hepatic and supraclavicular involvement was confirmed in two patients. Therefore, the false positivity rate of PET/CT was 6.25%. Based on the additional PET/CT, 2 (3.2%) patients had a change in surgical management. A chemotherapy regimen was administered to the patient with a 1.5 cm hepatic metastasis near the right hepatic vein; for another patient with an identified supraclavicular lymph node metastasis, a simultaneous excision was performed. Conclusions: Routine use of PET/CT for preoperative staging did not impact disease management for 96.8% of our patients. The results of our study conclude that PET/CT should not be routinely used for primary staging of colorectal cancer. More studies are required for identifying the subgroup of patients who might benefit from a PET/ CT in their initial staging. [ABSTRACT FROM AUTHOR]

A 32-year-old woman with type 2 diabetes mellitus suffering from morbid obesity with BMI 45,14 kg/m² was operated on. Not only the type 2DMbut also one of its complication known as necrobiosis lipoidica diabeticorum remitted postoperatively. Obesity should no longer be regarded simply as a cosmetic problem affecting certain individuals but an epidemic that threatens global well-being. It causes or exacerbates many health problems, and in particular, it is associated with the type 2 diabetes. Necrobiosis lipoidica is a granulomatous skin disease of unknown etiology, associated mainly with diabetes mellitus.We presented in this paper a morbid obese case of necrobiosis lipoidica diabeticorum with dramatic good response to bariatric surgery. [ABSTRACT FROM AUTHOR]

In the treatment of distal rectal cancer, abdominoperineal resection is traditionally performed. However, the recognition of shorter safe distal resection line, intersphincteric resection technique has given a chance of sphincter-saving surgery for patients with distal rectal cancer during last two decades and still is being performed as an alternative choice of abdominoperineal resection. The first aim of this study is to assess the morbidity, mortality, oncological, and functional outcomes of intersphincteric resection. The second aim is to compare outcomes of patients who underwent intersphincteric resection with the outcomes of patients who underwent abdominoperineal resection. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the accuracy of diffusion weighted magnetic resonance imaging (MRI) in preoperative assessment of metastatic lymph nodes of gastric cancer., Methods: A total of 23 gastric cancer patients with a mean age of 59.4±10.9 years were analyzed. Lymph nodes were grouped as perigastric lesser curvature (Group Ia), perigastric greater curvature (Group Ib), D1+/D2 lymph nodes (Group II). Identification of histologically metastatic lymph nodes by diffusion weighted MRI was regarded as the main outcome., Results: A total of 1,056 lymph nodes including 180 histologically proven metastatic lymph nodes were dissected. Although diffusion weighted MRI could identify the metastatic lymph nodes in 18 out of 23 patients (77.8%), only 69 of total 1,056 nodes (6.53%), either metastatic or non-metastatic, could be detected. There was no correlation between histopathology and diffusion weighted MRI with regard to lymph node groups (P>0.05 for all). Overall accuracy was calculated as 69.56, 65.21 and 52.17 for Groups II, Ib and Ia lymph nodes, respectively. Apparent diffusion coefficient (ADC) values could not be helpful to differentiate metastatic lymph nodes (P=0.673)., Conclusions: Diffusion weighted MRI has low accuracy to detect or to differentiate metastatic and non-metastatic lymph nodes based on their ADC values in gastric cancer.

Background/aims: To study the effect of selective concomitant cholecystectomy (SCC) on laparoscopic sleeve gastrectomy (LSG)., Materials and Methods: A retrospective case-control study of 16 morbidly obese patients treated with concomitant LSG as the primary bariatric surgery and SCC for proven gallbladder (GB) pathology (Group A) between November 2010 and February 2013 was performed. Randomly selected 32 patients who underwent laparoscopic sleeve gastrectomy was the control group (Group B)., Results: A total of 48 patients with a mean age of 35.5±10.7 years were included. Demographic data of groups were similar except that there were more female patients in the Group A (p=0.036). Mean body mass index (kg/m2) was 51.1±5.6 and 50.9±5.4 in Groups A and B, respectively (p=0.894). The mean operative time for patients with and without cholecystectomy was 157.2±40 and 95.72±6.2 min, respectively (p=0.001). Cholecystectomy resulted in an additional mean operative time of 49.1±27.9 min without any specific complication. There was no statistical difference with regard to overall morbidity (p=0.316) and the length of hospital stay (p=0.528) between groups., Conclusion: Although an increase in operative time may be an important issue, SCC can be performed on all patients with proven GB pathology during LSG without an increase in morbidity or length of hospital stay.

Background: Means to prevent and control intra- or postoperative bleeding remain a topic of utmost importance in thyroidectomy. In this randomised clinical trial, we used adrenaline spraying to see if it helps bleeding control and reduces drainage and hematoma formation after thyroidectomy., Methods: After total thyroidectomy, 1 mg/ml adrenaline solution in 10 ml saline was sprayed all over the operation area by a syringe in 40 patients of "Adrenaline (+) Group". In the other 40 patients in "Adrenaline (-) Group", only standart total thyroidectomy was performed. Drainage amounts of 24 hours were recorded., Results: Among 80 patients, 66 (82.5%) were female and 14 (17.5%) were male. The daily drainage amounts of the Adrenaline (+) Group were found statistically significantly lower than the Adrenaline (-) Group (p<0.05). In both of the groups, thyroid volumes were significantly correlated with the drainage amounts. "p" values were 0.008 and <0.001 in Adrenaline (+) and Adrenaline (-) Groups, respectively., Conclusions: Preliminary experience using adrenaline has been encouraging and it is useful as an adjunct to thyroid surgery in order to prevent hemorrhagia and give up drain placement. But prospective randomized trials using adequate patient numbers are still needed to validate efficacy and safety.

Gastrointestinal stromal tumors (GIST) are highly frequent mesenchymal tumors of the digestive tract, which mainly affect the stomach and small intestine. GISTs frequently exist with unclear symptoms. Their initial clinical presentation as acute abdomen due to their perforation is particularly rare. In the present study we report a case of a 59-year-old male presenting with acute abdomen. The final diagnosis revealed a small bowel perforation due to GIST. In this paper, we report the clinical manifestation as well as computed tomography and histopathological findings helpful for the accurate diagnosis of this rare complication of GIST. Emergency laparotomy and complete resection of tumor are essential. Following surgical resection, adjuvant tyrosine kinase inhibitor therapy should be considered for prevention of early recurrence.

Background and Purpose: Intra-abdominal pressure created during laparoscopic cholecystectomy is accepted as a factor for postoperative pain. In this prospective, randomized, clinical study, the goal is to determine the effects of different intra-abdominal pressure values on visceral type pain., Materials and Methods: Sixty women who underwent laparoscopic cholecystectomy were included in this study. Low-pressure (8 mm Hg), standard-pressure (SP: 12 mm Hg), and high-pressure (HP: 14 mm Hg) groups were designed for the study. The statistical analysis included mean age, weight, analgesic consumption, postoperative pain assessed by the Numeric Scale, duration of anesthesia, and operation., Results: No statistically significant difference was found between the groups comparing age, weight, analgesic consumption, and Numeric Scale values. In terms of duration of anesthesia, statistically significant difference was found between the groups low-pressure and HP and SP and HP, and statistically significant difference was found regarding operative duration between the groups SP and HP. There was no difference between the others groups., Conclusions: We think that intra-abdominal pressure has no effect on postoperative visceral pain, but has effect on duration of anesthesia and operation.

Background: The aim of this study is evaluate the percutaneous endoscopic gastrostomy (PEG) and its complications in order to provide enteral nutrition support for a long time period., Methods: PEG tube was applied to 15 patients aged between 18-95 years, who could not feed orally prophylactic antibiotic didn't use to any patient. After 8 hours hungry PEG was applied by using pull technique and the results were evaluated prospectively., Results: PEG was successfully done in 14 patients. Gastric juice drainage at the sides of the tube were seen in two patients, and PEG was pulled out in one of them., Conclusions: PEG is the route of choice for a long lived enteral nutrition, because, it can be applied without general anesthesia, easy to apply, patients can start feeding in a short time period, need shorter hospital stay, can be changed easily, cost effective and has a low rate of mortality and morbidity.