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Coronavirus disease 2019 (COVID-19) has a wide clinical spectrum from asymptomatic to mild, moderate, and severe cases. There are still many unknowns about the role of immunoregulatory mechanisms in COVID-19. We aimed to study regulatory T cells (Tregs) and B cell subsets and evaluate their correlations with severity of COVID-19.In total, 50 patients with COVID-19 confirmed by PCR (mean age = 49.9 ± 12.8 years) and 40 healthy control (mean age = 47.9 ± 14.7 years) were included in this study. The patients were classified as 14 mild (median age = 35.5 [24-73] years), 22 moderate (median age = 51.5 [28-67] years) and 14 severe (median age = 55.5 [42-67] years). Within 24 h of admission, flow cytometry was used to assess the lymphocyte subsets, Tregs and Bregs without receiving any relevant medication.In all patients with COVID-19, the proportion of CD3+CD8+ T cells was reduced (p = 0.004) and the CD8+ Tregs were increased compared with control (p = 0.001). While the levels of regulatory B cells, plasmablasts, and mature naive B cells were found to be significantly high, primarily memory B-cell levels were low in all patients compared with controls (p0.05). Total CD3+ T cells were negatively correlated with the length of stay in the hospital (r = -0.286, p = 0.044).The changes in T and B cell subsets may show the dysregulation in the immunity of patients with COVID-19. In this context, the association between CD8+ Tregs and COVID-19 severity may help clinicians to predict severe and fatal COVID-19 in hospitalized patients.

Amaç: Hasta konforu inguinal herni cerrahisinde başarıyı belirleyen temel unsurlardandır. Mesh kullanımı nüks sorununu ciddi şekilde çözmüş olsa da yeni bir sorun olarak kronik ağrı problemini doğurmuştur. Desarda tekniği eksternal oblik kas aponevrozunu kullanan bir yöntemdir ve fizyolojiye uyguluğun yanında düşük nüks oranları ile popülerlik kazanmıştır. Çalışmanın amacı Desarda ve Lichtenstein tekniklerinin nüks, kronik ağrı ve hasta konforu açısından karşılaştırılmasıdır. Gereç ve Yöntem Ekim 2010 ve Şubat 2014 tarihleri arasında Konya Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği’ne kasık fıtığı şikayeti ile müracaat eden hastalar çalışmaya dahil edildi. Hastalar kapalı zarf usulü ile randomize edilerek 2 gruba ayrıldı. İlk gruba Desarda prosedürü(D),ikinci gruba Lichtenstein prosedürü(L)uygulandı. Her 2 teknik de orijinal tarif edildiği şekli ile uygulandı. Kronik ağrının değerlendirmesinde kullanılan anketler hastalara ameliyat öncesi, ameliyat sonrası 1. ve 3. yılda uygulandı. Bulgular Desarda grubunda 80,Lichtenstein grubunda 82 olmak üzere toplamda 162 hasta değerlendirmeye alındı. Ortalama takip süresi 122 (96-145)ay’dı.Her 2 gruptan da 2 ‘şer hastada nüks gözlendi.Ameliyat öncesi ağrı değerlendirmesinde gruplar arasında fark yoktu.Yine ameliyat sonrası 1. ve 3. yılda ağrı şiddet,sıklık ve hareket kısıtlılığında gruplar arasında anlamlı fark yoktu.Ortalama ameliyat süreleri sırasıyla 44.5±3.7 dk. ve 56.7±2.97 dk. olmak üzere D grubunda daha kısaydı. Fark istatistiksel olarak anlamlıydı(p

Aims: Human asparaginase-like protein 1 (ASRGL1) is closely related to tumor growth. ASRGL1 can significantly promote cell proliferation and suppress apoptosis. To date, high levels of expression of ASRGL1 have been reported in various tumors, but the function of ASRGL1 in carcinogenesis is still not well understood. In this study, we aimed to immunohistochemically investigate the expression of ASRGL1 in non-neoplastic breast tissue and invasive ductal carcinoma. Methods and results: ASRGL1 was evaluated immunohistochemically in 148 invasive ductal carcinomas and 105 nonneoplastic breast tissue samples to assess the impact on breast cancer development and its association with clinicopathologic features. ASRGL1 was observed positive in 63 (42.6%) and negative in 85 (57.4%) invasive ductal carcinoma. In nonneoplastic breast tissue, 24 (22.9%) cases were ASRGL1 positive and 81 (77.1%) were negative. A significant difference was observed between invasive ductal carcinoma and nonneoplastic breast tissue in terms of ASRGL1 expression, and ASRGL1 expression was increased in invasive ductal carcinoma (P = .001). Most estrogen receptor-negative tumors and progesterone receptor-negative tumors were also negative with ASRGL1 and the difference was significant (P = .006 and P = .001, respectively). The correlation between the ASRGL1 expression of the tumors and event-free survival or overall survival was not significant (P>.05). Conclusions: ASRGL1 may play a role in increasing cell proliferation and breast cancer development. ASRGL-1 expression in breast cancer closely correlates with the hormone receptor status of the tumor. In breast cancer, ASRGL-1 expression does not contribute to predicting tumor behavior.

Objective:Gastrointestinal stromal tumors are the most common primary mesenchymal tumors of the gastrointestinal tract and show Cajal cell differentiation. Fibulin-5 is a multifunctional extracellular matrix protein that inhibits epithelial and endothelial cell proliferation. Expression of fibulin-5 is down-regulated in various carcinomas. In contrast, fibulin-5 stimulates fibroblast and fibrosarcoma cells. In this study we aimed to investigate the expression of fibulin-5 in Cajal cells and gastrointestinal stromal tumors.Materials and Methods: Immunohistochemical fibulin-5 staining is performed on 34 (22 gastric and 12 small intestinal) gastrointestinal stromal tumors. Fibulin-5 staining intensity was scored in 4 quantitative categories and compared with clinicopathological features of the patients.Results: There was no staining in 4 of the gastrointestinal stromal tumors; weak staining in 20 cases, moderate staining in 6 cases, and strong staining in 4 cases were observed. In 3 cases Cajal cells were detected with fibulin-5 by moderately staining. The relationship between fibulin-5 staining intensity and age and gender of the cases, localization, size, grade, and the risk groups of the tumors wasn’t statistically significant.Conclusion: A great proportion of gastrointestinal stromal tumors show fibulin-5 expression, even if weak, in contrast to the infrequent fibulin-5 expression in Cajal cells. Based on these findings, it can be speculated that the expression of fibulin-5 in Cajal cells can be increase cell proliferation, but it would be useful to conduct new studies with larger series to clarify this issue. There is no correlation between fibulin-5 expression intensity and clinicopathological and prognostic data of gastrointestinal stromal tumors.

Background Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign breast lesion that is is extremely rare in children and adolescents. Case A 13-year-old girl was admitted to our clinic with a giant mass in the left breast for 3 months. Physical examination findings of the patient were normal except for the mass in the breast. The mass was removed totally, and its pathological diagnosis was pseudoangiomatous stromal hyperplasia. The patient has been followed up for 6 months without disease.

The aim of this study was to evaluate the clinical importance of fibulin-5, which has been shown to display tumour-promoting and tumour-protective functions in breast lesions. Sixty-two breast cancer patients, 19 patients with fibroadenoma, and 15 healthy breast tissues were enrolled. Forty-seven patients had invasive ductal carcinoma (IDC) (12 of them also had in situ carcinoma DCIS), and 15 had invasive lobular carcinoma (ILC). A scoring system from 0 to 4 was used to evaluate the fibulin-5 staining according to the percentage of stained cells. The median values of fibulin-5 staining scores of the breast cancer, fibroadenoma, and healthy breast tissues were 2 (range: 0-4), 3 (range: 3-4), and 4 (range: 1-4), respectively, and the difference is statistically significant (p = 0.0001). There was no significant difference between the fibulin-5 scores of IDC, ILC, and DCIS. Fifteen patients with triple-negative breast cancer (TNBC) had the lowest fibulin-5 score (p < 0.0001). The median fibulin-5 scores of the patients according to Ki-67 index ≥ 14% and < 14% were 2 (range: 1-5) and 4 (range: 1-5), respectively, and the difference is statistically significant (p = 0.001). These data can be explained by the inhibitory effect of fibulin-5 on epithelial cell proliferation, which is closely related to differentiation and prognosis.

Summary: Background: Harmonic focus (HF) was introduced in thyroid surgery in an effort to reduce operation time and complications. Objective: The present study aimed to compare function of superior laryngeal nerve and incidence of other postoperative complications in total thyroidectomies using HF and conventional ligation (CL). Methods: The trial is a randomized single-center, single-blinded study. Patients aged ≥ 18 years scheduled for total thyroidectomy were considered for participation. An ultrasonic dissector was used for coagulation and cutting in the HF group, while the standard technique was used in the CL group. Demographic, surgical data, and complications were recorded. Data were analyzed using SPSS for Windows. Results: Of 244 eligible patients, data of 206 patients who completed the study were analyzed. The groups were similar in terms of age, sex, and indication for operation. The mean operative time in the HF group was significantly shorter than that in CL group (p = 0.01). Drain necessity, duration of drainage, duration of postoperative hospitalization, and the incidence of postoperative complications was similar in the groups (p > 0.05). The external branch of the superior laryngeal nerve and recurrent laryngeal nerve palsy were noted in three and two patients in the HF group and in two and one patients in the CL group at 6 months. Conclusion: To the best of our knowledge, this is the first study comparing conventional technique with HF in total thyroidectomy, focusing on the function of the external branch of the superior laryngeal nerve using laryngostroboscopy; results showed that HF is as safe as the conventional technique. Keywords: harmonic focus, superior laryngeal nerve, thyroidectomy

INTRODUCTION The American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS) was developed to guide imaging-based surgical treatment in patients with breast cancer. Studies confirming the BI-RADS did not include adolescents. To evaluate the validity of this classification system in adolescents, we aim to investigate the relationship between the BI-RADS and pathology findings in adolescents. METHODS The medical data of 67 female adolescent patients, aged 12 to 18, referred to our clinic for breast-related complaints between 2013 and 2016 were reviewed retrospectively for demographic data and the results of radiologic and surgical pathologies. RESULTS The main underlying reasons for the visit at the clinic were fullness, tenderness, pain, and palpable masses. Of the 67 patients, 46 were enrolled in the study. After breast ultrasonography, patients whose complaints had diminished were subtracted from the follow-up. The mean age of the patients was 16 years (12 to 18 y). The mean mass diameter size was 3.69 cm (0.9 to 15 cm), and the mean clinical follow-up was 65.3 days (11 to 1095 d). All the patients who were surgically intervened had benign pathology. Of the 21 surgically intervened patients with BI-RADS levels of ≥3, most had fibroadenomas. CONCLUSIONS The BI-RADS classification-based treatment algorithm may not be valid in adolescents. In the present study, all patients with lesions with BI-RADS ≥3 levels had revealed benign pathologies. The BI-RADS classification may show an increased risk. However, to determine the need for a biopsy in adolescents, there is a need for larger-scale pediatric and adolescent studies using the BI-RADS classification.

Amaç: Cerrahi acillerin sayısının sürekli artmasına rağmen acil cerrahi yatışları hakkında kısıtlı veri bulunmaktadır. Bu çok merkezli çalışmanın amacı, Konya şehrinde acil genel cerrahi sonuçlarını değerlendirmektir.Gereç ve Yöntemler: Konya'da tüm genel cerrahi acil başvurularının dokuz yıllık sonuçları incelendi (Ocak 2003Ocak 2012). Tüm demografik veriler istatistiksel olarak değerlendirildi.Bulgular: Konya'da yer alan 4 hastaneden 21954 hasta çalışmaya alınmıştır. Konya Numune Hastanesi (7154), Konya Eğitim ve Araştırma Hastanesi (6654), Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi (6400) ve Başkent Üniversitesi Konya Eğitim ve Araştırma Hastanesi (1390) verileri toplandı. Hastaların yaş ortalaması 59,6 ve ortalama hastanede kalış süresi 3,3 gündü. Hastaneye kabul edilen hastaların tanıları; akut apandisit (%59,57), bağırsak tıkanıklığı (%11,12), travma (%7,97), boğulmuş kasık fıtığı (%5,46), akut kolesistit (%4,87), peptik ülser perforasyonu (%4,09), mezenterik iskemi (%2,73), nekrotizan fasiit (%2,73), gastrointestinal sistem kanaması (%1,79) ve diğerleriydi (%1,1).Sonuç: Bu çalışma ile cerrahi kabullerin sürekli arttığı görülmüştür. Non-travmatik akut karın, genel cerrahi acillerinin en sık nedeniydi. Yaşlı hastaların sayısında artış olmasına rağmen, hastanede kalış süresi ve mortalite oranları azalmıştır., Objective: Although the number of surgical emergencies continues to increase, comprehensive data on emergency surgical admissions are scarce. The aim of this multicenter study was to evaluate the causes, management, and outcomes of the general surgical emergencies in the city of Konya, Turkey.Material and Methods: The relevant details of the cases admitted and considered to be general surgical emergencies in Konya over a nine-year period (January 2003-January 2012) were analyzed. All demographic data were analyzed statistically.Results: The study group comprised 21954 cases from 4 hospitals in Konya: 7154 from Konya Numune Hospital, 6,654 from Konya Education and Research Hospital, 6,400 from Necmettin Erbakan University Meram Medical Faculty, and 1,390 from Başkent University Konya Education and Research Hospital. Their mean age was 59.6 years, and the average hospitalization time was 3.3 days. The diagnoses of the admitted patients were as follows: acute appendicitis (59.57%), bowel obstruction (11.12%), trauma (7.97%), strangulated inguinal hernia (5.46%), acute cholecystitis (4.87%), peptic ulcer perforation (4.09%), mesenteric ischemia (2.73%), necrotizing fasciitis (2.73%), gastrointestinal system bleeding (1.79%), and others (1.1%).Conclusion: The findings of the study indicate a steady increase in surgical admissions to emergency units. Nontraumatic acute abdomen was the most common reason for general surgical emergencies. Although the number of elderly patients increased, the hospital stay and mortality rates decreased over the study period.

Aim: Along with the increased availability of radiologic imaging methods, early identification of tumor tissue, and patient surveillance programs; ductal carcinoma in situ (DCIS) and microinvasive DCIS became more commonly identified in the tru-cut biopsy specimens and resected samples of patients. Pathological examinations of the excision materials from these patients reveal invasive tumors, microinvasions or DCIS alone. Recently, it has become debatable whether to perform a sentinel lymph node biopsy (SLNB) in patients diagnosed with DCIS or microinvasive DCIS. In this present study, we evaluated the diagnosis made by examining the excision material, any presence of lymph node metastases, and the relationship of hormone profile to the presence of metastases in the patients diagnosed with DCIS or microinvasive DCIS by the examination of tru-cut biopsy specimens. Based on our study results, we discussed the requirement for SLNB in patients with a tru-cut diagnosis of DCIS or microinvasive DCIS.Materials and Methods: The study included 172 patients, who underwent surgical excision and SLNB after receiving a tru-cut biopsy diagnosis of DCIS and microinvasive DCIS in our hospital from the year 2010 to 2018.Results: Tru-cut biopsy diagnoses were DCIS and microinvasive DCIS in 69.8% (120 patients) and 30.2% (52 patients) respectively. SLNB metastases were identified in 35.8% (n=43) of the DCIS positive patients and 44.2% (n=23) in the microinvasive DCIS positive patients. The diagnosis of invasive ductal carcinoma after mastectomy was made at a rate of 90.0% (n=108) among the DCIS positive patients and 92.3% (n=48) among the microinvasive DCIS positive patients. Conclusion: SLNB metastases were found in 35.8% (n=43) and 44.2% (n=23) of the DCIS positive patients and microinvasive DCIS positive patients, respectively. We conclude that SLNB should be favorably proper to perform in the patients with tru-cut diagnoses of DCIS and microinvasive DCIS because a high rate of SLNB metastases was detected in our DCIS and microinvasive DCIS patients and a high rate of invasive ductal carcinoma diagnosis was made after examining the excision material of these patients.

Idiopathic granulomatous mastitis is a rare, chronic inflammatory breast disease. Surgical excision with or without steroids is an acceptable and effective therapy in carefully selected patients. Herein an alternative treatment strategy is reported to discuss if it is beneficial or not.

Aim: Breast hamartomas are uncommon benign lesions that constitute 4.8% of benign breast tumors; they consist of mammary ducts and lobules, fatty tissue, and fibrous tissue. The aim of this study was to determine the clinical and pathological characteristics of breast hamartomas diagnosed by surgical resection and to examine the accompanying lesions. Material and Methods: Patients who underwent breast surgery between January 2013 and January 2018 at Konya Education and Research Hospital and who were diagnosed as having breast hamartomas were reviewed retrospectively. Results: Seven breast hamartomas were identified. All of them were female. The mean age was 45 years. The mean tumor size was 3.9 cm. Most of the lesions were located in the right breast (57.1%). All the hamartomas appeared in the upper part of the breast. Five of the seven cases were admitted with a painless palpable mass in the breast (71.4%). Three of the seven cases were myoid hamartomas. The type of lesion most commonly associated with breast hamartomas is cyst formation. Pseudoangiomatous stromal hyperplasia, columnar cell hyperplasia, and ductal epithelial hyperplasia are also common. Ductal epithelial hyperplasia and columnar cell hyperplasia were observed in all the myoid hamartomas. Ductal carcinoma in situ was detected in one case; it was also a myoid hamartoma. Conclusions: Breast hamartomas are accompanied by many types of lesions such as fibrocystic changes, adenosis, ductal epithelial hyperplasia, and pseudoangiomatous stromal hyperplasia. In addition to these lesions, columnar cell hyperplasia was also identified. Malignancies are rarely detected in breast hamartomas; however, one case of ductal carcinoma in situ in a myoid hamartoma was detected.

To compare a minimally invasive preperitoneal (MIP) single-layer mesh repair with the standard Lichtenstein hernia repair (LHR) for inguinal hernia in terms of operative characteristics, recovery, complications, recurrence and chronic pain.Two hundred and twenty male patients diagnosed with primary inguinal hernia were randomized to either MIP or LHR methods. MIP repair consisted of a single-layer polypropylene mesh developed by our group placed preperitoneally using the Kugel technique. Patients were followed for a minimum of 2 years. Chronic pain was assessed by Sheffield's pain score.One hundred and one patients in MIP group and 105 patients in LHR group were included in the analysis. Most patients were diagnosed with indirect hernia (n = 79 for MIP, n = 81 for LHR). Surgery was slightly but significantly shorter for MIP (38.2 ± 7.4 vs. 40.3 ± 6.6, p = 0.031). Early complications such as cord edema, hematoma, scrotal edema, and wound infection were infrequent in both groups. Recurrence was detected in three patients in MIP and one patient in LHR. Chronic pain score was similar with both methods within the first year, but significantly lower for MIP at 24 months (0.66 ± 0.06 vs. 0.87 ± 0.07, p = 0.03).MIP single-layer mesh repair is as effective and safe as LHR, with the additional benefits of minimally invasive nature, less chronic pain at 2 years and low polypropylene load when compared with the original Kugel patch.

Although many methods, either surgical or non-surgical, are being used for the treatment of pilonidal sinus disease (PSD), there is still no consensus as to what constitutes the most appropriate method of treatment. The aim of this study was to compare the outcomes of the Limberg flap (LF), modified Limberg flap (MLF), and Karydakis flap (KF) procedures.A prospective, randomized study was conducted on 295 patients scheduled for surgical treatment for PSD at the General Surgery Clinic of the Konya Training and Research Hospital in January 2009-May 2010. Patients with recurrent disease, an ASA score higher than III, obesity (BMI35 kg/m(2)), insulin-dependent diabetes, or a drug or alcohol addiction were excluded. The procedures performed were as follows: LF (n = 96), MLF (n = 108), and KF (n = 91).The patients were followed up for a median of 33 months (range 24-41 months). There were more female patients in the LF group. The rate of seroma formation was higher in the KF group (19.8 %) compared to the LF and MLF groups (5.2 and 7.4 %, respectively; p = 0.027). The rate of wound dehiscence was higher in the KF group (15.4 %) compared to the LF and MLF groups (2.1 and 3.7 %, respectively; p0.001) as was the incidence of flap maceration (11 % in the KF vs. 1 % in the LF and 3.7 % in the MLF; p = 0.004). The incidence of PSD recurrence was also higher in the KF group (11 %) compared to the LF and MLF groups (6.3 and 1.9 % respectively; p = 0.027). In a multivariate analysis, the presence of seroma, hematoma, and wound infection were independent predictors of recurrence.In our study, LF and MLF procedures were associated with a lower recurrence and complication rate compared to KF. However, more randomized studies comparing different reconstruction methods after PSD excision are needed.

Objective: The treatment of trans-sphincteric fistulas is a surgical challenge since eradicating the fistula tract while maintaining the anal continence is vitally important. In this study we documented the outcomes of the patients with one or more fistulas treated at the same operation with a new type of seton. Patients and Methods: The study included 78 patients with 107 high anal fistulas who were treated with seton between 2007 and 2011. Fifty seven patients had only one fistula, 13 patients had two isolated fistulas and 8 patients had three isolated fistulas. Group I was the patients with one fistula and Group II was the patients having more than one fistula. Postoperative complications, hospital stay, cutting through the sphincter and healing times and Wexner’s scores were compared between the two groups. Results: In Group I, there were 57 patients and in Group II, 21 patients were operated for 50 fistulas. No postoperative complications were observed except urinary retentions (4 patients in Group I, 3 patients in Group II). No infection on the operation site was documented in both groups, in Group I none of the patients needed extra dose of narcotic analgesic but in Group II two of the patients who had 3 fistulas were discharged on the second postoperative day because of pain on the operation site. The median for the cutting seton to cut through the sphincter was 31 days and complete healing was achieved with a median of 40 days in Group I, whereas it was 56 and 65 days respectively for Group II. There were no recurrences in our patients in both groups. Although the Wexner scores of the both groups were low, the difference between the groups was statistically significant. Conclusion: It seems to be feasible to perform seton by using a cheap, effective, easily inserted material, also in treatment of patients with more than one fistula while preserving anal continence.

The extrahepatic vascular and biliary anatomy of Calot\'s triangle is well known to be highly variable and this provides a surgical challenge. The liver has a dual blood supply consisting of the portal vein and the hepatic artery. The hepatic artery which delivers 25% of the blood supply, arises from the celiac trunk. The celiac trunk gives off the left gastric, splenic and common hepatic arteries. The common hepatic artery then divides into gastroduodenal artery and hepatic artery proper which diverts in right and left hepatic arteries. The systic artery usually originates from the right hepatic artery. The “classic” arterial anatomy is present in approximately 75% of cases. The remaining 25% of the cases have many anatomical variants. Here in we present a patient with multiple anatomic variants in celiac trunk which were determined incidentally during laparoscopic cholecystectomy. Being aware of the arterial variations in the liver is really important in surgical procedures in order to avoid bleeding and ischemia., Ekstrahepatik vasküler ve Calot’s üçgeninin biliyer anatomisi oldukça değişken olduğu bilinmektedir ve bu cerrahi bir endişe oluşturur. Karaciğer portal ven ve hepatik arterin oluşturduğu ikili bir kan kaynağına sahiptir. Çölyak trunkusdan kaynak alan hepatik arter kan akımının % 25’ini sağlar. Çölyak trunkus, sol gastrik arter, splenik arter ve ortak hepatik arter dallarını verir. Daha sonra ortak hepatik arter; gastroduodenal arter ve hepatik arteri verir, hepatik arter de sağ ve sol hepatik dallara ayrılır. Sistik arter genellikle sağ hepatik arterden kaynaklanmaktadır. "Klasik" arteriyel anatomi vakaların yaklaşık% 75'inde mevcuttur. Olguların% 25'inde pek çok anatomik varyantlar vardır. Biz laparoskopik kolesistektomi sırasında tesadüfen tespit edilen Çölyak trunkusunda birden anatomik varyantları olan bir hastayı sunduk. Cerrahi işlemler sırasında kanama ve iskemiyi önlemek için karaciğer içinde arteriyel varyasyonları bilmek çok önemlidir

Extrahepatic bile duct tumors are uncommon, with the majority being adenocarcinomas. Primary neuroendocrine tumors of the extrahepatic bile ducts are extremely rare. Herein, we report a case of the extrahepatic biliary duct primary well-differentiated neuroendocrine carcinoma in a 45-year-old woman.

Background This study was designed in order to compare the effectiveness of subtotal-total colectomy with other surgical methods in the treatment of malignant obstructive lesions of the left colon. Methods Patients admitting with symptoms of colonic obstruction and treated by emergency surgery in Konya Education and Research Hospital between 2004 and 2007 were enrolled. Patients were divided into three groups according to the surgical procedures (Group I: Hartmann procedure; Group II: resection + diverting ileostomy; Group III: total-subtotal colectomy). Related patient data were evaluated retrospectively. Results The mean age of 62 patients was 64 (38-89) years. There were no significant differences between the groups with respect to gender, age, American Society of Anesthesiology scores, and tumor stages. There were no significant differences between the study groups in terms of operative duration, postoperative mortality, and five-year survival; however, the length of hospital stay and hospitalization costs were lower in Group III compared to the other groups. Conclusion We suggest that subtotal-total colectomy performed by experienced surgeons may be a good alternative to the other procedures.

Intestinal anastomotic healing is a complex procedure in which several mediators and cytokines play roles. Calcitonin gene-related peptide is an important neuropeptide in inflammation. In this study we aimed to investigate the effect of calcitonin gene-related peptide on healing of intestinal anastomosis in rats with obstructive jaundice.Obstructive jaundice was induced in rats by the ligation and division of the common bile duct. Four days after the operation, intestinal anastomosis was performed, and either calcitonin gene-related peptide or 0.9% NaCl was administered intraperitoneally to these jaundiced rats and controls. The concentrations of serum tumor necrosis factor-alpha (TNF-alpha) and triglyceride levels of all rats were measured, and healing of the anastomosis was evaluated by measuring the bursting pressure and hydroxyproline content on the 7th postoperative day.Calcitonin gene-related peptide was found to have positive effects on healing of the anastomosis by inhibiting the effects of TNF-alpha and increasing the bursting pressure and hydroxyproline content of the anastomosis.Calcitonin gene-related peptide increases anastomotic wound healing in experimental anastomosis in the presence of obstructive jaundice in rats.

Neurofibromatosis (NF) type 1, also known as von Recklinghausen’s disease, is an autosomal-dominant inherited disorder. Some tumors may develop in these patients, including optic pathway gliomas, astrocytomas, brainstem gliomas, chronic myeloid leukemia, and rhabdomyosarcoma. Patients with neurofibromatosis type 1 show also an increased risk of endocrine tumors, especially pheochromocytomas, whereas thyroid carcinoma is very rare. It is also rare for a neurofibroma to arise in the tissue neighboring the thyroid gland, and mimicking a nonfunctional thyroid nodule. This report presents a case of a neurofibroma adherent to the thyroid gland with thyroid papillary carcinoma in a 26-year-old woman with NF type 1.

Accurate identification of lymph nodes involved in metastases is vitally important for predicting survival, and it facilitates decision making with regard to adjuvant therapy. The study described here, which was undertaken to evaluate the role of sentinel lymph node mapping in refining the staging of colorectal cancer, was performed prospectively in 19 patients with colorectal cancer who underwent surgery from January to July 2005. Sentinel lymph node sampling was performed during each operation with isosulfan blue dye. Additional immunohistochemical staining was performed only if the sentinel nodes were negative for metastasis. In 18 of 19 patients, at least I sentinel node was identified. In 5 of 18 patients, sentinel nodes were positive for metastasis, and in 3 of 5, the sentinel node was the only node containing metastasis that was detected by immuncihistochemical staining. In 3 patients, metastases in nonsentinel lymph nodes were detected by hernatoxylin and eosin staining; these were determined to be false-negative results. Upstaging associated with sentinel lymph node mapping may reveal disease that might otherwise remain undetected by conventional methods. Patients who are upstaged may benefit from adjuvant therapies that have been shown to improve survival.

GIRIS Pilonidal sinus, gobek basta olmak uzere degisik yerlesimlerde gorulmekle birlikte en sik yerlesim yeri sakrokoksigiyal bolgedir. Daha cok 15–30 yas arasindaki aktif genclerde ve erkeklerde gorulur. Hastaligin etyopatogenezi ve tedavisi en cok tartisilan konulardir. Gunumuzde pilonidal sinusun edinsel hastalik oldugu genel kabul gormektedir. Akdeniz ulkelerinde yuksek siklik gosterir (2). Turk askerleri arasinda %8,8 oraninda pilonidal sinus bulunmustur (3). Insan sagligi ve ulkemizde cok uzerinde durulmayan ekonomik yuk ve isgucu kaybi bakimindan %8,8 onemli bir orandir.

Bu çalışmanın amacı, LK sırasında CO2 pnömoperitoneumun BNP ve cTnI içeren kardiyak belirteçler üzerine etkisini araştırmaktır.Amaç: Bu çalışmanın amacı laparoskopik kolesistektomi sırasında karbondioksit pnömoperitoneumun beyin natriüretik peptid (BNP) ve troponin I'yı (cTnI) içeren kardiyak belirteçler üzerine etkisini araştırmaktır. Gereç ve yöntem: Hastalar; laparoskopik kolesistektomi uygulanan hastalar (Grup I) ve genel anestezi altında diğer cerrahi işlem uygulanan hastalar (Grup II) olarak iki gruba ayrıldı. Kan örnekleri preoperatif, peroperatif dönemde ve ameliyatın 24. saatinde alındı. Troponin I ve BNP düzeyleri ölçüldü. Bulgular: Hiçbir hastada ameliyat sırasında elektrokardiyografide akut ST değişikliği saptanmadı. Grup I'de ameliyattın 24. saatindeki BNP düzeyleri hem preoperatif hem de peroperatif dönem BNP düzeylerinden anlamlı yüksek bulundu. Grup II'nin BNP düzeyleri değerlendirildiğinde aralarında anlamlı fark saptanmadı. Grup I ve II'de cTnI düzeyleri arasında anlamlı fark saptanmadı. Sonuç: Laparoskopik kolesistektomiye bağlı pnömoperitoneum kardiyak iskemik olaya yol açmadan hemodinamik değişlikliğe yol açmaktadır., The purpose of this study is to investigate the effects of carbondioxide pneumoperitoneum on brain natriuretic peptide (BNP) and cardiac markers including troponin I (TnI) during laparoscopic cholecystectomy (LC). Material and methods: Patients performed LC were grouped as Group I and patients performed different surgical procedures under general anesthesia were grouped as Group II. Blood samples were obtained in preoperative and peroperative periods and 24 hours after the surgery, Troponin I and BNP levels were measured. Results: Acute ST segment changes in the electrocardiography were not determined in any patient during the operation. For Group I, the BNP levels at the 24th hour of the operation was significantly higher than both preoperative and peroperative periods whereas there were no significant differences in BNP levels in Group II. Between Group I and II no significant differences in cTnI levels were determined. Conclusion: Pneumoperitoneum due to LC causes hemodynamic changes without lead- ing to any cardiac ischemic conditions.