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Fournier gangrene is an infectious disease originates from perineal and gluteal region spreading throughout the fascia. Life threatining results can be seen due to insufficient debridation or delay in treatment. A 23-year-old male patient admitted to hospital with an effusive lesion around gluteal and scrotal area which has a bad smelling. There was a color change at the left leg. He was in septic shock status. General condition of patient didn't change after debridation of gluteal and scrotal region. Consideration of the lesion as Fournier gangrene, wide debridation from scrotum to toe secondary was performed and improvement was observed. Afterwards reconstructive approach was applied. Debridement of all lesions even if they are apart from Fournier gangrene area is essential and these patients should be treated with multidisciplinary approach including general surgery, anesthesiology and reanimation, urology, gynecology, plastic and reconstructive surgery specialists., Fournier gangreni perineal ve genital bölgelerden başlayarak fasya boyunca yayılan enfeksiyöz bir hastalıktır. Tedavide gecikme ve yetersiz debridmanlar hastalığın ölümcül seyretmesine sebep olabilir. 23 yaşında erkek hasta, gluteal ve skrotal bölgeyi tutan kötü kokulu, akıntılı lezyon nedeniyle başvurdu. Sol bacağında renk değişikliği vardı. Hasta başvuru anında septik şokta idi. Gluteal ve skrotal bölgeyi içeren debridman sonrası hastanın genel durumu düzelmedi. Bacaktaki lezyonun Fournier gangrenine bağlı olduğu düşünülmesinin ardından, skrotumdan ayakucuna kadar yapılan çok geniş bir debridman sonrası iyileşme gözlendi. Daha sonra rekonstrüktif girişim uygulandı. Fournier gangreninde ana lezyondan uzakta bile olsa tüm lezyonların debridmanı ve bu hastaların, anesteziyoloji ve reanimasyon, üroloji, kadın hastalıkları, plastik ve rekonstrüktif cerrahi uzmanları ile birlikte multidisipliner bir yaklaşımla tedavisi gerekir.

Amaç: Kolorektal hastalıklarının tanı ve tedavisi için kolonoskopi işlemi öncesi barsak hazırlığının yeterli olması çok önemlidir. Biz bu çalışmada; kolonoskopi işlemi öncesinde oral ve lavman yoluyla sağlanan kolon temizliğinin etkinliğini ve hastaların uyumunu değerlendirilmeyi amaçladık. Yöntemler: Çalışmaya kolonoskopi planlanan ve 250 ml Sennozit A-B ve kalsiyum tuzunu içeren solüsyon ve 210 ml sodyum hidrojen fosfat içerikli lavman ile barsak hazırlığı yapılan 400 hasta çalışmaya alındı. Kolonoskopi öncesinde kolonoskopi işlemine hazırlık ve işlem esnasında yaşamış olabilecekleri soruları içeren anket uygulandı. Kolonoskopi işlemi öncesinde hastaların kendilerinden demografik, klinik ve barsak hazırlığına yönelik 14 sorudan oluşan anketin doldurulması istendi. Anketin sonuçları değerlendirildi. Bulgular: 213 erkek 187 bayan toplam 400 hastanın ortalama yaşı 48.6±12.3 (18-80) idi. Hastaların Boy, kilo ve Vücut Kitle İndeksleri sırasıyla; 158.6±27.5cm (142-197), 76.8±9.7kg (47-152), 27.9±4.2 kg/m² (22-41) olarak bulundu. Kolon Anketi soruları ve sonuçlarından hastaların oral, rektal temizliğe ve diyete uyumlulukları sırasıyla %93.2, %90.5, ve %88.0 olarak bulundu. İşlemden bir gün öncesinde günlük alınan sıvı miktarı ise büyük bir çoğunlukta 3litre ve üzeri olarak bulundu (%71.8). Hastaların kolon temizliği sırasında karşılaştıkları şikayet ve bulguların başında bulantı (%30.3), karın ağrısı ya da kramp (%15.5) ve şişkinlik (%12.8) gelmekteydi. Hastaların yaklaşık %45.5’i işlemin başarısız olması durumunda kolon temizliğinin zor olmasından ve de işlemin kendi zorluğu nedeniyle tekrar yaptırmayacağını bildirdi. Hastaların çoğunluğunun anestezi Skoru ASA I ve kolon temizliği iyi olarak değerlendirildi. Sonuç: Kolon temizliği için, Sennozit A-B ve kalsiyum tuzunu içeren oral solüsyon ve 210 ml sodyum dihidrojen fosfat ve disodyum hidrojen fosfat içerikli rektal lavman güvenle kullanılabilir. Objective: Enough bowel preparation prior to colonoscopy for the diagnosis and treatment of colorectal is very important. In this study; we aimed to assess the effectiveness of cleansing the colon provided through oral and enema prior to colonoscopy and the compliance of the patients. Material and Methods: 400 patients were enrolled to this study scheduled for a colonoscopy and bowel preparation made with 250 ml Sennozit A-B and calcium salt solution containing 210 ml of sodium hydrogen phosphate containing enema. A questionnaire containing questions will be administered during colonoscopy preparation and processing before the colonoscopy. Before the colonoscopy from patients themselves were asked to fill in the questionnaire consisting of 14 questions related to demographic, clinical data and bowel preparation. The results of the survey were evaluated. Results: A total of 400; 213 male and 187 female patients has a mean age of 48.6±12.3(18-80) years. Patients height, weight and body mass index were; 158.6±27.5cm(142- 197), 76.8±9.7kg(47-152), 27.9±4.2kg/m²(22-41), respectively. From questions from the survey patients compliance to oral, rectal cleansing and diet was found to be 93.2%, 90.5%, and 88.0%, respectively. The amount of fluid taken daily on the day before the procedure was found to be 3litre and over at a large majority (71.8%). Complaints of patients encountered while cleansing the colon were; nausea (30.3%), abdominal pain or cramps (15.5%) and distention (12.8%). Approximately 45.5% of the patients were in the process of colon cleansing in case of failure is also announced that it would not make the process again because of their difficulties. The majority of patients have Anesthesia score as ASA I and Cleansing Score was evaluated as well. Conclusion: For colon cleansing, oral solution containing the 210 ml Sennozit A-B and calcium salt rectal enema consisting of sodium dihydrogen phosphate and disodium hydrogen phosphate can be used safely.

As the rise on the prevalence of obesity, it is related with physical impairment of joints, especially in the lumbar spine and knee joints. Losing body weight can reduce or eliminate pain of head, neck, shoulder, lumbar spine and knees. By performing a laparoscopic bariatric surgery we demonstrated a significant improvement on the pain by body weight reduction. In this study we aimed to explore the efficacy and safety of Laparoscopic Sleeve Gastrectomy (LSG) on the relief of pain on head and neck, shoulder, low back and knee among the severely morbid obese female patients. A total of 39 morbidly obese female patients who underwent LSG for morbid obesity were included in this study. Body weight, height, body mass index (BMI), head and neck, shoulder, low back and knee pain intensity were measured with Visual Analog Scale (VAS) before and after LSG at the 6(th) month. 39 morbidly obese female patients were enrolled to this study. The mean age of the patients was 37.69 ± 11.33 years. Preoperative and postoperative body weights were 127.3 kg and 91.21 kg, respectively. Mean height was 165.23 ± 5.78 cm. Preoperative and postoperative BMIs were 46.49 kg/m(2) and 32.33 kg/m(2), respectively. A significant correlation between preoperative and postoperative parameters was found according to BMI. Our data showed that LSG is an efficient and safe procedure on severely obese patients and showed a predictive remission of head and neck, shoulder, low back and knee pain intensity of female patients by analyzing with VAS during the first 6 months.

Acute primary hyperparathyroidism and parathyroid crisis are characterized by life-threatening hypercalcemia, a rare disorder. A 69-year-old female patient presented at our hospital’s neurology clinic with weakness, nausea, vomiting, depression, and hypercalcemia. Treatment of hypercalcemia resulted in no improvement in neurological symptoms, indicating resistance to treatment. Thyroid ultrasonography and parathyroid scintigraphy revealed hypoechoic nodules in the right lobe, pieces of nodules in the left lobe, and high serum calcium and parathyroid hormone levels. After provision of intensive medical treatment including hydration, diuresis, and bisphosphonate infusion resulted in only minimal decrease in the calcium level, urgent surgical treatment was performed. Frozen biopsy of the right intrathyroidal giant parathyroid adenoma in the right lobe confirmed initial diagnosis of primary hyperparathyroidism. Based on the biopsy findings, right parathyroidectomy and right total and left subtotal thyroidectomy were performed. Histopathologic examination revealed a parathyroid adenoma localized inside large thyroid nodules. Review of the findings resulted in diagnosis of intrathyroidal parathyroid adenoma. Symptoms of hypercalcemia improved rapidly during the postoperative period.

Most commonly performed laparoscopic surgery is laparoscopic cholecystectomy. Although cholecystectomy through three port is not commonly preferred, researches have shown that it is a safe and feasible way of surgery. Material and Methods. We evaluate 100 patient that have undergone elective laparoscopic cholecystectomy through three port (group one). These patients were compared with 50 patients that have undergone laparoscopic cholecystectomy through four port (group two). Complications, lenght of stay in hospital, operation time, conversion to open surgery rate were compared in two group. Results: In group one, fourth port was necessary for nine (9%) patients. Duration of operation in group one was in average 31 min and in group two, 31, 3 min. Operation time, lenght of stay in hospital, complication rate, conversion to open surgery rate was similar in both groups. Conclusion: Three port laparoscopic cholecystectomy is a safer method when performed by experienced surgeons. Laparoscopic cholecyctectomy can be tried through three ports firstly and can be continued with addition of fourth port if necessary.

Single-incision laparoscopic surgery (SILS) is being used with increasing frequency in the treatment of many conditions requiring surgery. Experience with SILS for hepatectomy is limited. This is one of the first reports of SILS hepatectomy in the treatment of hepatic hydatid disease. A 17-years-old female who has 89 × 59-mm cystic mass in the left lobe of the liver was admitted with abdominal pain persisting for several months. For treatment of the mass, SILS hepatectomy performed. Although complexity of the liver structure and the technical difficulties of SILS restrict its applications in hepatic surgery, the treatment of liver hydatid disease with SILS in selected patients is safe and efficient. Moreover, it allows a better cosmetic result and rapid recovery.

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