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The aim of the present study was to evaluate thyroid nodules using virtual touch quantification (VTQ) of force impulse acoustic radiation (ARFI) imaging and to investigate a cutoff value for the differentiation of malignant thyroid nodules. Ninety-five patients with quantitatively-assessed (VTQ) thyroid nodules were evaluated with ARFI imaging in this prospective study. ARFI imaging with VTQ was performed only on the nodules which were expected to undergo fine-needle aspiration biopsy (FNAB). All of the thyroid lesions were examined histopathologically. The mean shear wave velocity (SWV) value of the malignant nodules (3.18 ± 0.39 m/s) was higher than that of the benign nodules (2.11 ± 0.53 m/s). There was a statistically significant difference between the mean SWV values of benign and malignant nodules (p

Introduction: We aimed to analyze the approaches to the diagnosis and treatment of patients with fascioliasis in light of current literature. Methodology: Thirty-nine patients with fascioliasis admitted to the Surgery Clinic of Dicle Medical Faculty (Turkey) were included in this study. The demographic, clinical, diagnostic, treatment and outcome data were analyzed retrospectively. Results: Abdominal pain (n = 37; 95%) and eosinophilia (n = 31; 79%) were the most common findings. Twenty-seven patients were diagnosed by clinical and radiological findings. Patients were treated with triclabendazole. Thirty-six (92.4%) of the patients improved after medical treatment. Conclusions: The presence of typical clinical, laboratory and radiological findings is sufficient for diagnosis. Triclabendazole administration is often an effective treatment, with improvements occurring over the course of a few months.

Wandering spleen (WS) is a rare clinical condition resulting from an abnormally long splenic pedicle and the absence or weakening of the supporting splenic ligaments that help to hold the spleen stationary. WS is more commonly seen in females aged between 20 and 40 years. Congenital and acquired factors are reported as the predisposing factors for WS. Patients with WS may be asymptomatic, or may be evident with a painful abdominal mass or an acute abdomen due to gastrointestinal symptoms and torsion of the WS. The diagnosis of WS can be established incidentally or during the Ultrasonography (USG) or Computed Tomography (CT) explorations performed for other pathologies. A high index of suspicion aids in the diagnosis of WS. WS is mostly treated by surgery and splenopexy remains the method of choice. In the cases with persistent ischemia following detorsion, splenectomy should be performed either via laparoscopy or laparotomy. In the present report, we present a 37-year-old woman who presented with a wandering spleen causing ileus. The patient underwent laparoscopic splenectomy. Wandering spleen is a rare condition which should be suspected as a potential cause of ileus and acute abdomen.

Objective: Lymphadenopathy may be the first symptom of many diseases. Enlarged lymph nodes may show significant regional differences in the etiologic profile. In this study we investigated patients with peripheral lymphadenopathy diagnosed by excisional biopsy. Methods: A retrospective study was done of 67 lymph node biopsy specimens obtained from adult patients and submitted for histopathological examination over a 5-year period. Results: The average age of the patients was 37.9±15 years, 29 (43.3%) were male. The regions of the lymphadenopathy excised were axillary (n = 36, 53.7%), inguinal (n = 22, 32.8%), and cervical area (n = 9, 13.4%) respectively. About one-third (n=23; %34.3) of the patients had malignancies. Malignancies were non-Hodgkin's lymphoma (n=11, 16.4%), Hodgkin lymphoma (n= 7, 10.4%) and metastases (n = 5, 7.5%), respectively. Tuberculosis lymphadenitis (n=20; %29.9) and non-specific lymphadenitis (n=19; %28.4) were the other common causes. Non-specific lymphadenitis included reactive hyperplasia, benign follicular hyperplasia, and mixed follicular hyperplasia. Lymphadenopathy diameter and the presence of generalized lymphadenopathy were significantly higher in malignant tumors. Conclusion: Although fine-needle aspiration biopsy may be useful in the differentiation of benign and malignant lymphadenopathies, inability of the diagnosis is often encountered. In addition, an excisional biopsy is needed for the diagnosis of lymphoma. Excisional biopsy is a diagnostic procedure that can be applied safely with minimal morbidity and mortality. On the other hand, especially in patients with tuberculosis lymphadenopathy incisional biopsy is contraindicated as it can lead to sinus and fistula formation., Amaç: Lenfadenopati pek çok hastalığın ilk bulgusu olabilir. Büyümüş lenf nodlarının etyolojik profili önemli ölçüde bölgesel farklılıklar gösterebilmektedir. Bu çalışmada kliniğimizde eksizyonel biyopsiyle tanı konmuş periferik lenfadenopatili hastalar incelendi. Yöntemler: Dicle Üniversitesi Tıp Fakültesi Genel Cerrahi Kliniği\'nde 5 yıllık dönemde periferik lenfadenopati nedeniyle eksizyonel biyopsi yapılan 67 hastaya ait veriler geriye dönük olarak incelendi. Sonuçlar: Hastaların yaş ortalaması 37,9±15 olup, 29\'u (%43,3) erkekti. Eksizyonel biyopsi uygulanan lenfadenopati bölgeleri sıklık sırasına göre aksiller (n=36; %53,7), inguinal (n=22; %32,8) ve servikal bölgeydi (n=9; %13,4). Patolojik incelemede, en sık maligniteler (n=23; %34,3) gözlendi. Maligniteler sıklık sırasına göre non-hodgkin lenfoma (n=11; %16,4), hodgkin lenfoma (n=7; %10,4) ve metastaz (n=5; %7,5) idi. İkinci sıklıkta tüberküloz lenfadenopati (n=20; %29,9) görüldü. Non-spesifik lenfadenit üçüncü sırada (n=19; %28,4) görülmüş olup; reaktif hiperplazi, benign foliküler hiperplazi, ve miksed foliküler hiperplaziyi içermekteydi. Granulomatöz lenfadenit (n=4; %5,9) ve sistemik lupus eritomatozis (n=1; %1,5) en az sayıda görüldü. Malign olgularda lenfadenopati çapı ve generalize lenfadenopati varlığı anlamlı olarak daha fazlaydı. Sonuç: Lenfadenopati tanısı için ince-iğne aspirasyon biyopsisi benign-malign ayrımında yararlı olabilir ancak tanı için yetersizlik durumuyla sık karşılaşılmaktadır. Ayrıca lenfoma tanısı için eksizyonel biyopsi gerekir. Eksizyonel biyopsi, minimal morbidite ve mortalite ile güvenli bir şekilde uygulanabilen bir tanı yöntemidir. Öte yandan, özellikle tüberküloz lenfadenopati olgularında insizyonel biyopsi sinüs ve fistül oluşumuna yol açabildiğinden dolayı kontrendikedir.

Aim: To determine the usefulness of the neutrophil to lymphocyte ratio (NLR) as a diagnostic tool for the early detection and prediction of acute pancreatitis (AP) severity compared with that of C-reactive protein (CRP). Material and Methods: The medical records of 464 patients hospitalized with AP between 2006 and 2014 were reviewed. The patients were classified into two groups: severe AP (SAP) and mild/moderate AP groups. Lymphocyte and neutrophil counts and CRP levels at the time of admission were noted. Results: Out of the total number of patients (n = 464), 67 had severe AP. The median NLR was significantly higher in the SAP group (median of 11.1) than in the mild/moderate AP group (median of 6.9) (p < 0.0001). The sensitivity and specificity of NLR were 83.6% and 49.4%, respectively, with a cut-off value of 6.8 and an AUC of 0.68. CRP levels were also significantly higher in the SAP group (median of 189 mg/L) than in the mild/moderate AP group (median of 53.5 mg/L) (p < 0.0001). The sensitivity and specificity of the CRP values were 83.6 % and 74.9 %, respectively, with a cut-off value of 113 mg/L and an AUC of 0.83. Conclusion: The NLR was significantly higher in patients with severe AP. However, CRP measurement was superior to NLR as an early predictor of severe disease.

Objectives: Acute necrotizing pancreatitis is a condition still with high morbidity and mortality which is associated with severe acute pancreatitis because parenchyma necrosis occurs during illness. Our aim in this study is to examine the factors affecting mortality in patients undergoing surgery because of acute necrotizing pancreatitis and present our surgical outcomes. Materials and methods: The clinical features, Ranson and APACHE II scores of 38 patients operated in clinic (2006-2012) for acute necrotizing pancreatitis were recorded retrospectively. Results: From the patients included in the study, 11 (28.9%) were male and 27 (71.1%) were female with an age average of 55.1±16.0 years. No relationship was found between age, C-reactive proteins, amylase and liver enzymes, pancreatitis etiology, complications seen after surgery and mortality (p>0.05). The effects of white blood cell values, width of necrosis area and the APACHE II and Ranson values upon admission on mortality were significant (p, Amaç: Akut nekrotizan pankreatit, seyri sırasında parankim nekrozu geliştiği için şiddetli akut pankreatit ile özdeşleşmiş, morbidite ve mortalitesi hala yüksek olan bir durumdur. Bu çalışmadaki amacımız akut nekrotizan pankreatit nedeniyle cerrahi uygulanan hastalarda mortaliteyi etkileyen faktörleri incelemek ve cerrahi tedavi sonuçlarımızı sunmaktır. Gereç ve yöntem: Kliniğimizde 2006-2012 yılları arasında akut nekrotizan pankreatit nedeniyle ameliyat edilen 38 hastanın özellikleri, Ranson ve APACHE II skorları retrospektif olarak kaydedildi. Bulgular: Çalışmaya dahil edilen hastaların 11\'i (%28.9) erkek, 27\'si (%71.1) kadın ve yaş ortalamaları 55.1±16.0 idi. Yaş, C-reaktif protein, amilaz ve karaciğer enzimleri, pankreatit etiyolojisi, ameliyat sonrası görülen komplikasyonlar ile mortalite arasında ilişki saptanamadı (p>0.05). Beyaz küre değerleri, nekroz alanının genişliği, başvuru anındaki APACHE II ve Ranson değerlerinin mortalite üzerindeki ilişkisi anlamlı idi (p

Aims: Minimally invasive parathyroidectomy (MIP) has become the first line of treatment for primary hyperparathy- roidism caused by solitary parathyroid adenoma. In order to increase the sensitivity of high-resolution ultrasonography (hUS), surgeon performed ultrasonography (SUS) has been increasingly used preoperatively. However, a radiologist and surgeon performing ultrasonography (RSUS) has not been a usual practice. In this study, we aimed to evaluate the clinical contribution of RSUS on MIP. Material and methods: From 2012 to 2014, a total of 30 consecutive patients (4 male, 26 female, mean age 48.87±14.52 years) with solitary parathyroid adenoma, were included in the study. All patients underwent preoperative hUS and Technetium-99m sestamibi scintigraphy. In patients, demographic characteristics, diagnostic tools used, levels of bio- chemical parameters, duration of operation, and length of hospital stay were recorded. Results: Adenomas were successfully localized by US in all patients and the surgical approach was determined according to this localization. Parathyroidectomy with MIP was successfully performed under local anesthesia in all patients. Mean operation time was 19.87±3.35 min. Post- operative PTH and calcium values were significantly decreased. All patients were discharged from the hospital in the same day. None of the patients had complications such as recurrent laryngeal nerve injury, hematoma, or injury to nearby organs. None of the patients had drains placed. Conclusions: Adenoma is well localized by US and thus, MIP can be completed under local anesthesia. US provides a very important clinical contribution to the success of MIP. In addition to these, RSUS helps in determining the location of the incision and the shortest way to achieve the lesion; therefore, it provides a small incision and shortens duration of the operation with a minimal dissection.