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Microvillus inclusion disease is a cause of congenital intestinal intractable diarrhea. Total parenteral nutrition is required throughout life and the patients need intestinal transplantation for survival. The new Coronavirus Disease 2019 (COVID-19) caused a worldwide pandemic in January 2020. Emergency surgical interventions are suggested to carrying out by taking appropriate measures during the pandemic period. In this case report, we aimed to discuss the small bowel transplantation management during the COVID-19 pandemic by presenting a child with microvillus inclusion disease who was underwent emergency small bowel transplantation due to the appropriate cadaveric organ donation.

Objectives: The aim of this study is to evaluate the results of advanced stage (stage IIIB-IVB) ovarian cancer (OC) patients with intestinal metastasis, and to investigate the factors that affect survival. Material and methods: Patients who underwent cytoreductive surgery (CS) for FIGO stage IIIB-IVB OC with metastasis in the intestinal system, at Tepecik Research and Treatment Hospital between 2008–2014, were analyzed retrospectively. Patients with borderline ovarian tumor; those who had previously undergone radiation therapy and/or hysterectomy and patients having secondary or tertiary cytoreduction were excluded and 49 patients were included and analyzed in this study. Hysterectomy, bilateral salpingo-oopherectomy, pelvic and para-aortic lymph node sampling, resection of bulky lymph nodes and omentectomy were performed. Optimal cytoreduction was accepted as that which left residual tumor ≤ one cm maximum size. Results: The risk factors affecting OS interval were investigated according to Cox’ regression analysis. Optimality of the primary CS (P = 0.008 and HR = 5.202) and cancer stage (P = 0.016 and HR = 6.083) were found to be statistically significant factors. Conclusions: Achieving optimal CS is the most important aim for the general surgeon carrying out an intestinal resection procedure. Although resection procedures are superior in providing the desired optimal results when compared to excision surgery, their higher complication rates and subsequent lower quality of life must be taken into consideration when choosing either resection or excision methods; surgical intervention should always be kept to the minimum possible.

Background In kidney transplant recipients with borderline infiltration, protocol biopsy results demonstrated the relationship with chronic injury. The purpose of this study was to evaluate the effect of subclinical rejection (SCR) on 6-month protocol biopsy results in long-term renal function in renal transplant recipients with stable graft function. Material and Methods Transplant protocol biopsies performed in 45 patients with stable renal function were included in this study at 6 months. Biopsy specimens were evaluated for SCR. Study groups were divided into patients with and without SCR. Renal functions were compared with pathologic evaluation. The effect of immunosuppressive regimens on renal function were evaluated in patients with SCR Result The median age of patients was 32 years (range, 18-64 years). The median follow-up was 56 months (range, 24-84 months). According to the 6-month protocol biopsy results, 20 of 45 patients (44.4%) met SCR criteria based on Banff 07 parameters. There was not a statistically significant difference in renal function with SCR. Conclusion The presence of SCR on the 6-month protocol biopsy results in renal transplant recipients with a stable graft function does not cause deterioration in the long-term graft function.

Hydatid disease is a parasitic infection caused by Echinococcus granulosus. Although the liver and lung are the most common sites of hydatid disease, it can also be seen in other organs due to migration via systemic circulation, Paraspinal lumbar hydatid disease without the involvement of other organs is extremely rare, We aimed to present the imaging and histopathological findings of a case with painful lumbar swelling that was later diagnosed as primary lumbar paraspinal hydatid disease. Hydatid disease should be considered as the differential diagnosis in patients with a lumbar paraspinal mass, particularly that containing multiple well-defined, round, small cysts, and in patients living in or traveling to endemic regions.

Introduction: We wanted to evaluate the comparison of clinical and demographic structures of patients admitted to the intensive care unit according to whether they have chest pain or not. Materials and Methods: Clinical records of 134 patients who were hospitalized in the tertiary ICUs of Our Hospital due to COVID-19 between October 1 and November 30, 2020 were reviewed retrospectively. Results: Mortality occurred in 56.7% of the patients. All of these patients were aged over 65 years and hypertension was the most common comorbidity. Mean length of ICU stay was 8 (range, 2-49) days. Eighty-two (61.2%) patients were oxygenated with noninvasive, high-flow nasal oxygen and facemask oxygenation. The remaining 52 (38.8%) patients were ventilated invasively. All patients received antibiotic treatment and 47.8% of them received antiviral (favipiravir) treatment. Conclusion: Mortality occurred in 56.7% of the patients admitted to ICU with the complaint of chest pain. Further studies are needed to substantiate our findings.

BACKGROUND Renal tubular acidosis (RTA) is a non-anion gap metabolic acidosis and is generally mild and asymptomatic in kidney recipients. Calcineurine inhibitors (CNIs) increase the frequency of RTA but the frequency of RTA development in kidney transplant recipients receiving mammalian target of rapamycin inhibitors (mTORi) treatment remains unclear. In this study, we aimed to investigate the frequency of RTA in kidney transplant recipients on mTORi and CNI treatment and to compare both groups. MATERIAL AND METHODS We enrolled 137 adult renal transplant patients - 82 patients on mTORi and 55 patients on CNI who had similar age, sex, posttransplant follow-up period, and graft functions. We recorded the parameters of venous blood gas analysis, including serum pH value, serum bicarbonate (HCO3) concentration, presence of metabolic acidosis defined as low HCO3 (

Intestinal transplantation is the most effective treatment for patients with short bowel syndrome and small bowel insufficiencies. We evaluated epithelial chimerism after infusion of autologous bone marrow mesenchymal stromal cells (BMSCs) in patients undergoing cadaveric donor isolated intestinal transplantation (I-ITx). BMSCs were isolated from patients' bone marrow via iliac puncture and expanded in vitro prior to infusion. Two out of the 3 patients were infused with autologous BMSCs, and small intestine tissue biopsies collected post-operatively were analyzed for epithelial chimerism using XY fluorescent in situ hybridization and short tandem repeat polymerase chain reaction. We observed epithelial chimeric effect in conditions both with and without BMSC infusion. Although our results suggest a higher epithelial chimerism effect with autologous BMSC infusion in I-ITx, the measurements in multiple biopsies at different time points that demonstrate the reproducibility of this finding and its stability or changes in the level over time would be beneficial. BMSC infusion may have potential implications for improved graft survival, lower immunosuppressant doses, superior engraftment of the transplanted tissue, and higher success rates in I-ITx.

Background/aims Small bowel transplantation (SBTx) is a treatment option for patients with serious parenteral nutrition-related problems in intestinal failure. Izmir Tepecik Training Research Hospital Organ Transplantation Center is still the only pediatric intestinal transplant center in Turkey. Material and methods This study was approved by the local ethics committee. Patients' data were analyzed from the medical charts and the hospital digital database. Seven isolated SBTxs were performed in six children between 2010 and 2016. Results One jejunal segment and six partial jejuno-ileal segments were used for seven transplants. All grafts were retrieved from deceased donors (one child and six adult donors). The six recipients had a mean age of 8.8±6.9 years (9 months to 17 years; M: 4, F: 2). The mean follow-up period of patients was 727±848 (34 to 1950) days. Acute cellular rejection (ACR) rates were 57% (n: 4) in the first 2 months. Graft loss due to severe ACR was seen in one patient. Central line-associated fungal (n: 3, 42%) and bacterial infections (n: 3, 42%) were seen in the first 2 months. Two Epstein-Barr virus (EBV) infections were recorded between 3 and 8 months in two patients. Our 1-year patient and graft survival rates were 71% and 71%, respectively. Conclusion SBTx has become a treatment modality for patients with intestinal failures. Management of ACR and infections are still challenging problems in SBTx. Appropriate-sized cadaveric donors are very limited in Turkey for pediatric intestinal transplantation candidates. Although the number of SBTxs performed was small, this study shows promising results.

Introduction The aim of this study was to examine the effect of lornoxicam used in preemptive analgesia on the intensity of pain and requirement for analgesics in the perioperative period for major abdominal surgery. Methods Sixty patients scheduled for elective major abdominal surgery were randomly assigned to three groups after ethics committee approval. Patients in Group PRE ( n =20) received lornoxicam i.v. 8mg 20min before incision and saline i.v. after skin closure; patients in Group POST ( n =20) received saline i.v. 20mins before incision and lornoxicam i.v. 8mg after skin closure; patients in Group C ( n =20) received saline i.v. 5min before incision and after skin closure. A standardized general anesthetic was used. All patients were started on i.v. tramadol patient-controlled analgesia during the postoperative period. Pain intensity was measured using the visual analog scale (VAS), and tramadol consumption. In addition, the incidences of side effects were recorded at the end of the study period. Results There were no significant differences among the three groups of the demographic data. Groups PRE and POST demonstrated significantly reduced pain scores compared to Group C at various points in time. Group PRE also demonstrated a weakly significant reduction in analgesic consumption of tramadol postoperatively compared to Groups POST and C. Conclusion Lornoxicam administered preemptively appears to improve the quality of postoperative analgesia and leads to reduced consumption of tramadol postoperatively in patients undergoing major abdominal operations.

Highlights • Retroperitoneal paragangliomas are mostly benign with good prognosis. • Complete surgical excision is the treatment of choice for extra-adrenal paragangliomas. • Reactive thrombocytosis is a common cause of thrombocytosis after splenectomy., Introduction Paragangliomas are tumors that arise from extraadrenal chromaffin cells and most of them are asymptomatic presenting with painless mass. Retroperitoneal paragangliomas are mostly benign with good prognosis; however, they can present with abdominal pain, palpable mass, or hypertensive episodes. Surgical resection is still the main treatment and necessary for histological assessment. Case report A 41 year old female patient presented with 6 months of loss of appetite, weight loss, weakness and breathlessness on exertion.. The patient’s initial blood examination showed marked anemia, reduced leukocyte count with neutropenia and lymphopenia and a marked reduction in the platelet count. The patient was admitted for evaluation of her pancytopenia. Magnetic resonance imaging revealed a 8 × 7 × 8 cm sized mass closed to the pancreatic tail invading splenic hilum. A large mass was identified retroperitoneally, closed to the tail of pancreas with a splenic hilum invasion. Total mass resection and splenectomy was performed. Discussion Complete surgical excision is the treatment of choice for extra-adrenal paragangliomas as well as for recurrent or metastatic neoplasms. Reactive thrombocytosis is a common cause of thrombocytosis. Splenectomy was found to be one of the main causes of extreme reactive thrombocytosis. Reactive thrombocytosis is a predictable finding after splenectomy and management of the thrombocytosis and prevention of complications should be initiated.

WOS: 000353480500017, Lymphedema is a rare complication of sirolimus treatment in transplantation patients. We present a case of a 14-year-old female patient who developed lymphedema in three extremities. The patient had undergone ileal and colon resections after sustaining a gunshot to her abdomen. Four months after the injury, she had developed a short bowel syndrome and underwent small intestine transplantation from a cadaver and mesenchymal stem cell transplantation to prevent rejection. Because kidney failure developed at postoperative month 3, mycophenolate mofetil therapy was discontinued and sirolimus therapy was initiated. The patient was monitored under this therapy until postoperative month 11 when she had swelling in both the legs and left arm. Her condition significantly improved with complex decongestive therapy. This is the first case in the literature involving mesenchymal stem cell transplantation together with ileum transplantation. This case is also noteworthy in terms of lymphedema treatment administered and the involvement of three extremities.

In our study, we aimed to evaluate and discuss the recurrence rate and the causes for recurrences in splenectomy due to immune thrombocytopenic purpura. Thirty-six patients who had splenectomy due to immune thrombocytopenic purpura, enrolled in the study. Patients were evaluated for age and gender. Twenty-five patients were followed at a mean of 24 months. Recurrence rate and causes for recurrences; laparoscopic or open surgery, gender, age, preoperative and postoperative 2nd day platelet count were evaluated and discussed with the data in the literature. Thirteen patients (36.1%) were male and 23 patients (63.9%) patients were female. Mean age was 37,7. Accessory spleen was found in 4 patients (11.1%). In the follow-up of 25 patients, 5 patients (20%) had recurrence, 1 patient (4%) had partial recurrence. Although the recurrence rate was higher in woman and over 40 year old group, this was not statistically significant. The recurrence rate of patients, whose platelet count below 156.000/ml in postoperatively 2nd day, was significantly more than the patients whose platelet count above this value (p=0,024). Even under the best conditions, it is not possible to completely avoid the recurrences in surgical treatment of immune thrombocytopenic purpura. Therefore, we think it would be helpful to identify the patients with postoperatively 2nd day platelet count who have possibility for recurrence and keep those under control more often., Çalışmamızda, immun trombositopenik purpura nedeniyle splenektomi yapılan hastalarda, yineleme oranı ve buna etki eden nedenleri değerlendirip sonuçları literatür eşliğinde tartışmayı amaçladık. İmmun trombositopenik purpura nedeni ile splenektomi yapılan 36 hasta çalışma kapsamına alındı. Hastalar yaş ve cinsiyet yönünden değerlendirildi. Takipli olan 25 hasta ortalama 24 ay izlendi. Yineleme oranı ve buna etki edebilecek nedenler olarak ameliyatın açık veya kapalı olması, cinsiyet, yaş, ameliyat öncesi ve sonrası 2. gün trombosit değerleri değerlendirilerek literatür eşliğinde tartışıldı. On üç hasta (%36,1) erkek, 23 hasta (% 63,9) hasta kadın idi. Ortalama yaş 37,7 idi. Aksesuar dalak 4 hastada (%11,1) bulundu. İzlenen 25 hastanın, 5’inde (%20) yineleme, 1’inde (%4) ise parsiyel yineleme saptandı. Kadınlarda ve 40 yaş üzerindekilerde yineleme oranı fazla olsa da istatistiksel olarak anlamlı değildi. Ameliyat sonrası 2. gün alınan trombosit değeri 156000/ml altında olanlarda, bu değerin üstünde olanlara göre yineleme oranı fazla ve istatistiksel olarak anlamlı idi (p=0,024). İmmun trombositopenik purpura cerrahi tedavisinde yinelemeyi tamamen önlemek en iyi şartlarda dahi mümkün olamamaktadır. Bu nedenle ameliyat sonrası 2. gün alınan trombosit değerleri ile yineleme olabilecek hastaları saptayıp daha sık kontrol altında tutmanın yerinde olacağını düşünmekteyiz.

Introduction. Hydatid disease (HD) is an infestation that is caused by the larval stage ofEchinococcus granulosus. The liver is affected in approximately two-thirds of patients, the lungs in 25%, and other organs in a small proportion. Primary retroperitoneal hydatid cyst is extremely rare. The most common complaint is abdominal pain; however, the clinical features of HD may be generally dependent on the location of the cyst.Case Presentation. A 43-year-old female was admitted with the complaint of abdominal pain. Her physical examination was normal. Computed tomography (CT) revealed a17×11 cm cystic lesion, with a thick and smooth wall that is located among the left liver lobe, diaphragm, spleen, tail of the pancreas, and transverse colon and invading the splenic hilum. Total cystectomy and splenectomy were performed. Pathological examination was reported as cyst hydatid.Discussion. Cysts in the peritoneal cavity are mainly the result of the spontaneous or traumatic rupture of concomitant hepatic cysts or surgical inoculation of a hepatic cyst. Serological tests contribute to diagnosis. In symptomatic and large hydatid peritoneal cysts, surgical resection is the only curative treatment. Total cystectomy is the gold standard. Albendazole or praziquantel is indicated for inoperable and disseminated cases. Percutaneous aspiration, injection, and reaspiration (PAIR) technique is another nonsurgical option.

Background. The management of complex pilonidal sinus disease (PSD) with multiple pits on and beside the natal cleft is variable, contentious, and problematic. Wide excision of the sinus and reconstruction of the defect using different flap techniques have become more popular in recent years.Case Report. We report a case with a complex chronic PSD to which we applied primary closure after S-shaped wide excision. The patient’s postoperative course was uneventful, and at the end of one-year followup he is now disease-free and comes for routine checkups.Conclusion. The simplicity of the technique and the promising results support the applicability of the S-shaped wide excision in chronic bilaterally extended large PSDs. Further studies entailing large patient populations are needed to reach a definite conclusion.

The aim of this study was to compare the postoperative analgesic efficacy of preincisional and intraperitoneal levobupivacaine or normal saline in patients undergoing laparoscopic cholecystectomy.Sixty patients who participated in the study were randomly divided into 3 groups. Group 1 received intraperitoneal levobupivacaine (0.25% 40 mL) immediately after the pneumoperitoneum. Group 2 received periportal levobupivacaine (0.25% 5 mL in each trochar incision area) before incision and intraperitoneal levobupivacaine (0.25% 40 mL) immediately after the pneumoperitoneum. Group 3 received for periportal and intraperitoneal instillation of normal saline. The visual analog scale (VAS) at 0, 1, 2, 4, 8, 12 and 24 hours for both shoulder and abdominal pain were recorded. Analgesia requirements and incidence of nausea and vomiting were also recorded.There were no difference between the groups for demographic data. The pain scores were lower in Groups 1 and 2 than Group 3 (control) during rest, cough and movement (p0.05). Rescue analgesic treatment was significantly lower in patients of Group 2 (15%) as compared with that of Groups 1 (35%) and 3 (90%) (p0.05). The incidence of shoulder pain was significantly lower in Group 2 (25%) and Group 1 (20%) than in any of the control group patients (p0.05).The results indicated that 0.25% levobupivacaine was effective in preventing pain and the need for postoperative analgesic when intraperitoneal instillation or preincisional local infiltration in combination with intraperitoneal instillation. However, levobupivacaine for preincisional local infiltration in combination with intraperitoneal instillation is the better choice because of its higher efficacy.

BACKGROUND/AIMS Obesity is one of the most serious public health problems. Laparoscopic sleeve gastrectomy (LSG), a type of bariatric surgery, is emerging as the new promising therapy for the treatment of morbid obesity. METHODOLOGY In the present study we aimed to assess the effects of LSG on body weight and other obesity related pathological conditions. RESULTS A total of 19 obese subjects underwent LSG surgery. All patients underwent complete evaluation including anthropometric/clinical parameters and laboratory tests. Hypertension (HT), diabetes mellitus (DM), body mass index (BMI), and hyperlipidemia were significantly reduced after LSG. CONCLUSIONS Results of this study demonstrate that LSG induces stable weight loss and resolution of obesity-associated comorbidities.

There is a continuing debate about the techniques of kidney transplantation from small donors because of the high vascular thromboses and ureteric leak rates. Transplantation of en-bloc pediatric kidneys with a partial bladder segment has potential benefits over established techniques. We transplanted cadaveric en-bloc kidneys together with a partial bladder segment from a 1.5-year-old donor to a 12-year-old boy with end-stage renal disease due to vesicoureteral reflux (VUR) of a solitary kidney. En-bloc kidneys were transplanted together with both ureters and a partial bladder segment. Using donor bladder segment augmented the recipient bladder. Thereby, potential complications of bilateral ureteroneocystostomies of small ureters were avoided. During the following 12 months, the clinical course was normal and there was no evidence of VUR. In conclusion, the technique of using en-bloc pediatric kidneys together with a partial bladder segment is feasible and safe as well as an efficient procedure to preserve the natural anti-reflux mechanism in childhood.

Background: Nutcracker Syndrome (NCS) is a rarely encountered clinical condition. In NCS, due to the compression of the left renal vein between aorta and superior mesenteric artery, outflow of the left renal vein is impaired. It may occur with the symptoms like hematuria, proteinuria, pain on the left lumber, lower abdomen, varicocele and pelvic congestion or asymptomatic. In suspected cases, the diagnosis can be established by the radiological imaging. Case Presentation: In this case report, a 31 year old female who was referred to a live kidney donor diagnosed with NCS during preoperative evaluation is described. Transplantation process and post-transplantation course have been discussed according to literature. This case report is unique due to being the first report describing allogeneic kidney transplantation performed from a donor with NCS. Conclusion: In nutcracker syndrome, surgical treatment is recommended for the patients with serious symptoms. Surgical interventions and stenting are treatment modalities and this article suggests a new approach. It may be meaningful in terms of reporting the first successful allogeneic transplantation performed from a donor with NCS.

To study the effects of mesenchymal stem cell (MSC) therapy on the prevention of acute rejection and graft vs host disease following small bowel transplantation.In our transplantation center, 6 isolated intestinal transplants have been performed with MSC therapy since 2009. The primary reasons for transplants were short gut syndrome caused by surgical intestine resection for superior mesenteric artery thrombosis (n = 4), Crohn's disease (n = 1) and intestinal aganglionosis (n = 1). Two of the patients were children. At the time of reperfusion, the first dose of MSCs cultured from the patient's bone marrow was passed into the transplanted intestinal artery at a dose of 1000000 cells/kg. The second and third doses of MSCs were given directly into the mesenteric artery through the arterial anastomosis using an angiography catheter on day 15 and 30 post-transplant.The median follow-up for these patients was 10.6 mo (min: 2 mo-max: 30 mo). Three of the patients developed severe acute rejection. One of these patients did not respond to bolus steroid therapy. Although the other two patients did respond to anti-rejection treatment, they developed severe fungal and bacterial infections. All of these patients died in the 2(nd) and 3(rd) months post-transplant due to sepsis. The remaining patients who did not have acute rejection had good quality of life with no complications observed during the follow-up period. In addition, their intestinal grafts were functioning properly in the 13(th), 25(th) and 30(th) month post-transplant. The patients who survived did not encounter any problems related to MSC transplantation.Although this is a small case series and not a randomized study, it is our opinion that small bowel transplantation is an effective treatment for intestinal failure, and MSC therapy may help to prevent acute rejection and graft vs host disease following intestinal transplantation.