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Giriş Amaç: Kanser hastalarının preoperatif en sık görülen klinik problemlerinden biri preoperatif anemidir. Preoperatif aneminin en sık görüldüğü kanser türlerinden biri mide kanseridir. Fakat, mide kanserinin anemi ile ilişkisi net değildir. Bu çalışmanın amacı mide kanserli hastaların bağımsız prognostik risk faktör olan patolojik evrelerinin ve tümör boyutlarının ameliyat öncesi hemoglobin değerleriyle karşılaştırarak preoperatif anemi ile tümör boyutu ve tümör evresi arasındaki ilişkiyi incelemek ve prognostik belirteçleri zayıf olan mide kanseri için preoperatif aneminin prognostik değerini araştırmaktır. Materyal ve Metod : XX üniversitesi XX bölümünde 1 ocak 2017 ile 1 aralık 2019 yılları arasında mide kanseri dolayısıyla küratif D2 gastrektomi ve Ro rezeksiyon uygulanmış hastaların klinikopatolojik ve demografik özellikleri retrospektif olarak incelendi. Bulgular : Toplam 85 hasta incelendi. Hastaların 66 (%77,6)’sı erkek 19 (%22,4)’u kadındı. Hastaların yaş ortalaması 68,1(41-87) idi. 55(%64,7) hastaya total gastrektomi 30 (%35,2) hastaya subtotal gastrektomi uygulandı. Hastaların tümü adenokarsinom tanılı idi. Hastaların 48(%56,5)’i evre 3, 29(%34,1)’u evre 2, 8(%9,4)’i evre 1 idi. 51(%60) hastanın tümör boyutu büyük 34(%40) hastanın küçüktü.51(%60) hastanın anemisi vardı. Sonuç : Preoperatif anemisi bulunan mide kanserli hastaların tümör boyutları daha büyük ve ileri evre tümörlerdir. Mide kanserli hastaların tedavisi planlanırken preoperatif anemisi bulunan hastaların tümör özelliklerinin daha agresif olabileceği gözardı edilmememidir.

OBJECTIVE To investigate the association between the ratio of negative/positive lymph nodes (RNP) and other clinic pathological parameters. STUDY DESIGN Descriptive study. PLACE AND DURATION OF STUDY Faculty of Medicine, Cumhuriyet University, Sivas, Turkey, from February 2008 to December 2019. METHODOLOGY Consecutive 119 patients with gastric adenocarcinoma, who underwent gastrectomy and D2 lymph node dissection, were included. RNP, other clinicopathological parameters such as tumour grade, type and lymphovascular invasion (LVI) were analysed, as their prognostic impact was investigated. RESULTS RNP was an independent prognostic factor for overall survival (p = 0.003) and was significantly associated with poor survival (p

Objective: Gastric cancer is among the most common human cancers with high mortality rates. ADAM10, a member of the ADAM (a disintegrin and metalloproteinase) family has also been found to be associated with gastric carcinoma and has been suggested as a potential therapeutic target. Here, we investigated the association of ADAM10 expression with prognosis in gastric adenocarcinoma patients that underwent gastric resection with D2 lymph node dissection. Methods: Total 86 consecutive patients that underwent resection for gastric adenocarcinoma were included. Immunohistochemical ADAM10 expression and its association with clinicopathological parameters were analyzed. Univariate and multivariate analyses and survival analyses were performed using SPSS ver.22. Results: High grade tumors, advanced stage tumors and diffuse type tumors showed significantly worse prognosis. A statistically significant association between ADAM10 expression and overall survival (OS) was observed in the univariate analysis, however, this association did not maintain its significance in the multivariate analysis. No statistically significant association was found ADAM-10 expression and clinicopathological parameters. Conclusion: Immunohistochemical ADAM10 expression may be used as a prognostic marker in gastric adenocarcinoma, however, introduction of a standardized immunohistochemical scoring system seems to be necessary for evaluation of ADAM10 staining. doi: https://doi.org/10.12669/pjms.37.2.3613 How to cite this:Alakus H, Kaya M, Ozer H, Egilmez HR, Karadayi K. ADAM10 expression in gastric adenocarcinoma: Results of a curative gastrectomy cohort. Pak J Med Sci. 2021;37(2):543-549. doi: https://doi.org/10.12669/pjms.37.2.3613 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: Covid-19 disease has increased rapidly since the day it appeared (December 2019), and has turned into an unpreventable pandemic all over the world, especially in Europe. As it spreads rapidly and started to show its effects in a short time, there was not enough time to conduct and implement effective studies on the subject. After the first case coronavirus was detected at 10 March 2020 in Turkey, various guidelines were published. Surgeons, especially regarding the safe treatment of patients in cancer surgery, have tried to find the way in which they can be the most beneficial for the patients in their clinics. In this study, we aimed to share the approach and results of our own clinic to the cancer patients during Covid-19 pandemics.Method: Between March 10 - July 15 2020, 52 patients who were operated in Sivas Cumhuriyet University Faculty of Medicine Surgical Oncology Department for oncological reasons were analyzed retrospectively. The analyzed patient data included tumor location, patient age, gender, surgery technique, histopathological of specimen, stage and whether neoadjuvant therapy treatment was applied.Results: 52 patients were operated with a diagnosis of cancer in our clinic during the pandemic. 25 patients were female and 27 were male, and their mean age was 60.45 years. None of the patients showed signs and symptoms of Covid-19 infection before, during and after the operation.Conclusions: In hospitals not used as a pandemic hospital, Covid-19 negative oncological patients can be operated safely without affecting the pandemic by providing suitable conditions.

Introduction Cytoreductive surgery (CRS) and intraperitoneal chemotherapy are effective in the treatment of ovarian peritoneal carcinomatosis (OPC). Colon resection is often required to achieve maximal cytoreduction during CRS. The success of complete mesocolic excision (CME) and total mesorectal excision (TME) in the surgical treatment of primary colorectal tumors is well-known. Our study aimed to investigate the factors affecting mesocolic lymph node metastasis (MLNM) and the contribution of CME/TME techniques to maximal cytoreduction in patients diagnosed with ovarian peritoneal carcinomatosis (OPC) with colon metastasis. Patients and methods Between 2004-2020, 30 patients who underwent colorectal resection with CME/TME techniques due to OPC-related colon metastasis were retrospectively analyzed. Results The median age of patients was 61 (33-86). Six (20%) patients underwent total colectomy, 7 (23%) subtotal colectomy, 6 (20%) right hemicolectomy, 4 (13%) left hemicolectomy, and 7 (23%) rectosigmoid resection. Histopathological diagnosis was high-grade serous carcinoma in 29 (97%) patients, and malignant mixed Mullerian tumor in 1 (3%) patient. MLNM was detected in 17 (56%) of 30 patients. There was a significant relationship between MLNM and pelvic and para-aortic lymph node metastasis (PALNM) (p = 0.009) and lymphovascular invasion in primary ovarian tumors (p = 0.017). There was no significant relationship between MLNM and depth of colonic invasion (p = 0.463), histological grade (p = 0.711), and primary/secondary surgery (p = 0.638). MLNM was seen in 8 (47%) of 17 patients with only serosal invasion. Conclusion A high rate of MLNM can be seen in OPC-induced colon metastasis regardless of the degree of colon wall invasion. In patients with PALNM, the frequency of MLNM increases. We believe that if colon resection is to be performed in OPC, a colectomy should be performed by CME/TME principles to achieve maximal cytoreduction.

Primaryanal malignant melanoma is a rare tumor of the anal region. Usually it wasmisdiagnosed as hemorrhoids or anal polyp so delayed diagnosis can leadcomplicated status of the disease.Clinical and histopathological diagnosis maybe difficult due to uncommon presentation and smilar morphological findingswhen compared with other malignant anal tumors. Effectiveness of thechemotherapy and radiotheraphy are limited. Surgical resection is still seen asstandart treatment option and abdominoperineal resection (APR) and wide localexcision are the most preferred methods. In this paper we presented 55 year-oldmale patient with recurrent anal malignant melanoma treated withabdominoperineal resection., Primer anal malign melanom, anal bölgenin nadir görülen birpatolojisidir. Genellikle anal melanomaya hemoroid ya da anal polip olarakyanlış tanı konulmakta, bununla birlikte tanı ve tedavideki bu gecikmehastalığın komplike bir tablo ile karşımıza çıkmasına neden olmaktadır.Kemoterapi ve radyoterapinin yararlılığı sınırlıdır. Cerrahi standart tedaviyöntemi olup abdominoperineal rezeksiyon (APR) veya genişletilmiş lokaleksizyon en sık tercih edilen yöntemlerdir. Biz bu yazıda 55 yaşında APR ameliyatı yapılan nüks anorektal malignmelanomu olan erkek hastayı sunmayı amaçladık.

Background: Gastric cancer (GC) is one of the most common cancers worldwide. Despite the declining prevalence in Western countries, it is still a major health problem in Turkey and Asian countries. In the current study, we investigated the hypermethylation status of 25 TSGs in GC. Furthermore, the association between hypermethylation status of these TSGs and some demographic and clinicopathological characteristics were investigated. Methods: Formalin-fixed paraffin-embedded tissue samples obtained from 27 patients with GC and genomic DNA isolated from these tissues. To compare the methylation status of 25 TSGs, methylation-specific multiplex ligation-dependent probe amplification (MS–MLPA) technique was used. Results were evaluated in terms of age, gender, positive lymph node status, lymphovascular invasion, perineural invasion, mortality and five-years of survival, retrospectively. Results: Tumor suppressor gene hypermethylation was detected 16 (59.3%) of 27 GC tissues. Patients with hypermethylation-detected and patients with no hypermethylation-detected in their TSGs were classified as group 1 and group 2, respectively. The mean age of group 1 was 66.38±7.43 and the mean age of group 2 was found as 58.18±11.12 (p= 0.03). Hypermethylation was detected in 12 of 25 TSGs in patients with GC. Hypermethylation was detected as 51.8% for WT1, 40.7% for ESR1, 18.5% for CDH13, 14.8% for MSH6 and CD44, 7.4% for TP73 and PAX5 genes in the tumor tissues of patients with GC. Mean positive lymph node number was 8.81±5.38 in group 1 and 4.81±3.21 in group 2 (p= 0.037). Lymphovascular invasion, perineural invasion, mortality and five-years of mean survival were not statistically different between group 1 and group 2 (p>0.05 for all comparisons). Conclusions: Hypermethylation frequency of certain tumor suppressor genes may increase with advancing age and with positive lymph nodes in gastric cancer patients.

Aim: Breast cancer is the most common type of cancer in women. The presence and number of metastatic lymph nodes in the axilla are the most significant prognostic factors in breast cancer. In addition, tumor size, lymphovascular invasion, perineural invasion, histopathological type and grade of the tumor are among the best-known prognostic factors. Ki-67 is expressed in G1, S, G2 and M phases of the cell cycle but not in the G0 phase, which allows it to be used as a marker for proliferating cells. The purpose of this study is to determine the relationship between Ki-67 Index and classical prognostic factors in breast cancer patients and to investigate its effect on axillary lymph node metastasis.Material and Methods: 46 patients, who were diagnosed as breast carcinoma in Sivas Cumhuriyet University Medical Faculty Surgical Oncology Department and who underwent a modified radical mastectomy and axillary lymph node dissection between 2017 and 2019 were included in this study. Histological tumor type, stage, status of axillary lymph nodes and Ki-67 Index were evaluated retrospectively from the pathology reports of the patients. The patients were grouped under three categories according to Ki-67 Index. Results: Regarding the grouping of the patients according to Ki-67 Index, the ones below 15% formed the first group, between 15-29% the second group, and above 30% the third group. The distribution of the patients according to negativity-positivity of axillary lymph node metastasis in the groups was as fallow: First group, 7 (41.2%) negative - 10 (58.8%) positive; Second group 4 (33.3%) negative - 8 (66.7%) positive; Third Group 3 (17.6%) negative - 14 (82.4%) positive. Of the 46 patients included in the study, 14 (30.4%) were negative for axillary lymph node metastasis and 32 (69.9%) were positive. In our study, the relationship between the increase of Ki-67 Index and axillary lymph node positivity was found to be statistically significant.Conclusion: In this study, we investigated the relationship between Ki-67 Index and classical prognostic markers, especially lymph node metastasis. Proliferation is an important indicator used to predict prognosis and treatment response in breast cancer. In our study, Ki-67 Index, one of the cell proliferation markers, was found to be positively correlated with axillary lymph node metastasis and other prognostic factors. Therefore, Ki-67 Index was shown to be a significant prognostic indicator in breast cancer.

Aim: The purpose of this study is to investigate the changes in renal function of the patients having primary hyperparathyroidism with GFR 60 ml/min/1.73 m2 and GFR>60 ml/ min/1.73 m2 before and after PTX. A. Prolonged hypercalcemia leads to impaired renal function and the associated glomerular filtration rate (GFR) decrease. One of the indications of surgery in primary hyperparathyroidism is decreased renal function (GFR 60 ml/min). Discussions about the effect of parathyroidectomy (PTX) on renal function still continue.Materials and Methods: The archive files of 59 patients diagnosed with primary hyperparathyroidism (PHPT), to whom PTX have been performed between January 2008 and October 2019 at Cumhuriyet University Surgical Oncology Clinic, were reviewed retrospectively. GFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Patients were divided into two groups according to their GFR values, as GFR60 ml/min/1.73 m2 and GFR>60 ml/min/1.73 m2. Laboratory outcomes of the patients one week before and after PTX were compared. The data of the study were analyzed in SPSS (ver. 23.0) program.Results: Regarding the patients to whom PTX have been performed, 12 patients (20.3%) were male and 47 (79.7%) were female. The mean age was 54.7 years. In patients with GFR60 ml/min/1.73 m2, pre-op mean Parathormone (PTH) value was 1227.36 pg/ml, Calcium (Ca) 10.60 mg/dl, Creatine (Cr) 5.12 mg/dl: while mean PTH value in post-op period was found to be 131.69 (SS: 2.99), Ca: 8.29, Cr: 3.57. In the patient group with GFR>60 ml/min/1.73 m2, pre-op mean PTH was 309.34, Ca: 11.05, Cr: 0.73 (SD: 0.15); whereas post-op PTH was 48.51, Ca: 8.88, Cr: 0.68. In addition, GFR increased in patients in both groups and statistically significant results were obtained between pre and post PTX values.Conclusion: In this study, an improvement was observed after PTX in the renal function of the patients with impaired renal function, whereas GFR values of the patients with normal renal function were increased.

Aim: Breast cancer is the most frequent cancer among women. Cerb B2 is an oncogene that encodes a transmembrane glycoprotein known as HER-2 protein or receptor. Ki-67 is nuclear protein associated with cellular proliferation. In this study, we investigated the relationships between the histopathologic parameters in the “Modified Scarff-Bloom-Richardson” microscopic grading and expression of Cerb B2 and Ki-67 index gene in cases with invasive ductal carcinoma. Breast cancer is the most common type of cancer in women, but also the second most common cause of death after lung cancer.Material and Methods: In this study examined 45 patients who were diagnosed with invasive ductal carcinoma between January 2017 and January 2019 in Sivas Cumhuriyet University, department of surgical oncology. Cases, Cerb B2 expression and Ki-67 index were retrospectively screened from pathology recordsResults: Increased expression of Cerb B2 was statistically significant related with increased tubule formation, pleomorfism, mitosis rate, and histological grade (p=0.006, p=0.027, p0.001, p=0.001, respectively). Increased Ki-67 index was statistically significant related with increased tubule formation, pleomorphism, mitosis rate, and histological grade (p=0.031, p0.001, p=0.048, p=0.010, respectively).Conclusion: As a result, it was observed that there was a positive correlation between parameters included in Modified Scarff-Bloom-Richardson grading system with Cerb B2 expression and Ki-67 index. Cerb B2 and Ki-67 index are important prognostic biomarkers in human breast cancer.

Objective: The preoperative and postoperative calcium, parathormone levels, platelet counts, mean platelet volume values of the patients were compared in order to investigate the changes in the risk of atherosclerosis and coronary artery disease in parathyroidectomy. Method: Twelve male and 43 female patients who underwent parathyroidectomy between 01.01.2008 and 01.01.2018 at the Cumhuriyet University Surgical Oncology Clinic were included in the study. On the tenth preoperative and postoperative day, blood was drawn for the platelet, mean platelet volume, calcium and parathyroid hormone levels after a fasting period of twelve hours. The preoperative and postoperative calcium, parathormone levels, platelet counts, mean platelet volume values of the patients were compared in order to investigate the changes in the risk of atherosclerosis and coronary artery disease in parathyroidectomy. Results: The mean pre-operative blood calcium levels of the patients included in the study were 10.75 ± 1.49 mg / dl, . Mean postoperative blood calcium level was 8.59 ± 1.14 mg / dl. The mean preoperative mean platelet volume of the patients was 26.1 ± 121.55 fL, Postoperative mean platelet volume was 9.36 ± 1.26 fL. The mean preoperative parathormone level was 535,08 ± 711,08, The mean postoperative parathyroid hormone level was 74.47 ± 128.02 pg / ml. The mean preoperative blood platelet count of the patients included in the study was 418000 ± 8000 / mm³, The mean postoperative blood platelet count was 252000 ± 7000 / mm³. Conclusions: In our study, we found that the decrease in serum parathormone level, serum platelet level, mean platelet volume, after parathyroidectomy was statistically significant. Mean platelet volume and platelet count were decreased after parathyroidectomy, which are indicators of atherosclerosis and coronary artery disease; Parathyroidectomy reduces the risk of atherosclerosis and coronary artery disease. Additional clinical and laboratory studies are needed to support the risk of atherosclerosis and coronary artery disease after parathyroidectomy.

Peritoneal loose body (PLB) alsoknown as peritoneal mouse is a rare phenomen. A 74 year old man presented with abdominalpain and an intraabdominal 6x5x4 cm well shaped mass detected on abdominaltomography images. The pathology report of the excised lesion was fibroma. Thepatient was discharged on fourth day without any problem. PLBs are mostly foundincidentally. Surgery is the optimal treatment for these undiagnosed masses., Peritoneal serbestcisim; peritoneal fare olarak da bilinen nadir bir fenomendir. Karın ağrısışikayeti ile başvuran 74 yaşında erkek hastanın abdominal tomografisindeintraabdominal 6x5x4 cm’ lik düzgün sınırlı kitle saptandı. Çıkarılan kitleninpatolojik inceleme sonucu fibrom olarak raporlandı. Hasta postoperatif dördüncügün sorunsuz taburcu edildi. Peritoneal serbest cisim çoğunlukla rastlantısalolarak tespit edilir. Kesin tanı konulamayan bu kitleler için uygun tedaviyaklaşımı cerrahidir.

WOS: 000322392300004, PubMed ID: 23645038, We hypothesized that solid tumors rarely occur in patients with hydatid disease. We obtained the serum of 14 patients diagnosed with hydatid disease, the serum of 10 patients who did not have a history of hydatid disease, and the hydatid cyst fluid from six patients. These sera and fluid samples were added at different concentrations to NCI-H209/An1 human lung small cell carcinoma cells and L929 mouse fibroblasts as a control group. Sera of patients with hydatid diseases had cytotoxic effects on NCI-H209/An1 cells, but they did not have cytotoxic effects on fibroblast cells. Sera from healthy subjects did not have a cytotoxic effect on the tumor cell line or control fibroblasts. Cyst fluid, also, did not have toxic effects on the NCI-H209/An1 cell line, but was toxic to fibroblasts up to a 1:32 dilution. Sera from patients with hydatid disease had cytotoxic effects on human small cell lung cancer cells in vitro.

WOS: 000296562600034, PubMed ID: 22002274, The advantage of partial splenectomy is the preservation of its immunologic function. In this series, 8 patients underwent a spleen preservation procedure with radiofrequency. Four of the partial splenectomy procedures were performed in elective situations, whereas the other 4 cases were performed to control traumatic bleeding in emergency situations. A harrow-like radiofrequency probe with 6 needles was applied to the spleen, and the division of the splenic parenchyma was completed using a surgical scalpel through the midline of the ablated tissue. This safe, fast, and simple technique allows for preservation of splenic function with minimum blood loss.

WOS: 000333499600011, PubMed ID: 24720141, Background : Whether to perform colorectal cancer and liver metastasis resections simultaneously or in separate procedures is controversial. The aim of the present study was to investigate the effect of the Pringle manoeuvre on the healing of left-sided colonic anastomoses in rats. Methods : Sixteen rats were randomly separated into two groups. In Groups 1 and 2, 1 cm of descending colon was resected and a primary anastomosis was performed. In Group 2, an intermittent pedicle clamp (the Pringle manoeuvre) was performed. On postoperative day 5, laparotomy was performed and the bursting pressures of all colon anastomoses were determined. Tissues were sampled for assay of hydroxyproline levels. Cultures of intraperitoneal swabs were also performed. Results : Clostridium was twice as abundant in the Pringle manoeuvre group as in the control group (p

Dear Editor,A 68 years old female patient applied to the General Surgery clinic with complaints of pain in the right lower quadrant and abdominal distention. Her vitals and blood tests revealed no abnormality. The contrasted abdominal tomography was interpreted as a soft tissue mass containing fat density with smooth margins, adjacent to the ileocecal valve and having a diameter of approximately3 cm. In her surgery, the mass was excised by a5 cmincision5 cmdistal to the cecal region on the wall adjacent to the mass. The incision was closed using a linear stapler.

WOS: 000354077600001, PubMed ID: 25927975, Background: We presented abdominal liposarcoma cases diagnosed and managed in a tertiary care center and also conducted a literature review on main features of this tumor. Methods: Chart reviews of eight cases were conducted, and clinical, surgical, histopathological, and follow-up data were recorded. Results: Overall, complete surgical resection was performed with adjacent organ resection in 25% of cases, and radiotherapy was not administered. Recurrence was developed in only one case and died after 2 years and 3 months, and other cases are under follow-up without recurrence. Histopatological examinations revealed findings of well-differentiated liposarcoma. Conclusions: According to our surgical experience, the surgical margin positivity may not be a determining factor for the survival of patients with well-differentiated liposarcoma, and in the absence of macroscopic invasion, adjacent organ resection may not be required. Radiotherapy may not be preferred when complete resection of abdominal mass was achieved.

Inflammatory myofibroblastic tumours are benign lesions most commonly located in the lungs, abdominal origin is rare. As differentiation from malignant conditions can be difficult on clinical grounds alone, pathological examination is essential. We report a patient with an abdominal inflammatory myofibroblastic tumour in whom the diagnosis could be made by laparotomy and pathological examination.

Amyand hernia is determined as the presence of normal or inflamed appendix in the hernia sac. Amyand’s hernia is seen in approximately 1% of inguinal hernia cases. Incidance of Amyand’s hernia is reported 0.1% in a case with acute appendisitis. Signs and symptoms of acute appendicitis are overshadowed by clinical findings related to incarcerated inguinal hernia and thus preoperative diagnosis of Amyand’s hernia may be difficult. The aim of this report is to describe and review the litreture in a case 81 years old male patient operated for incarcerated inguinal hernia and diagnosed as Amyand hernia in peroperative period, Özetİnguinal herni kesesi içerisinde inflamasyon olsun yada olmasın apendiks vermiformis bulunması, Amyand herni olarak isimlendirilir. Amyand hernisi, inguinal herni olgularının yaklaşık %1’i kadar görülür. Akut apendisitli olgularda ise Amyand herni sıklığı %0,1 olarak bildirilmiştir. İnkarsere inguinal herni kliniği, çoğunlukla akut apandisitin belirti ve bulgularını maskeler ve bu nedenle preoperatif tanı koymak zor olabilir. Bu yazımızda, inkarsere inguinal herni nedeniyle acil opere edilen ve peroperatuvar herni kesesi içinde perfore apandisit saptanarak Amyand hernisi tanısı konan 81 yaşında erkek hasta olgusu sunulmuş ve ilgili literatürler eşliğinde tartışılmıştır.Anahtar sözcükler: İngıinal herni, amyand hernisi, akut apandisit AbstractAmyand hernia is determined as the presence of normal or inflamed appendix in the hernia sac. Amyand’s hernia is seen in approximately 1% of inguinal hernia cases. Incidance of Amyand’s hernia is reported 0.1% in a case with acute appendisitis. Signs and symptoms of acute appendicitis are overshadowed by clinical findings related to incarcerated inguinal hernia and thus preoperative diagnosis of Amyand’s hernia may be difficult. The aim of this report is to describe and review the litreture in a case 81 years old male patient operated for incarcerated inguinal hernia and diagnosed as Amyand hernia in peroperative period.Keywords: Inguinal hernia, amyand’s hernia, acute appendisitis

The present case is of a patient undergoing radiofrequency-assisted partial splenectomy. A 48-year-old man was found to have a hydatic cyst in the superior pole of the spleen. A six in-line needle radiofrequency probe was applied to the spleen. The division of the splenic parenchyma was completed with a surgical scalpel through the midline of the ablated tissue. There was no bleeding. This procedure may reduce the number of splenectomies and the amount of blood transfusion required.

WOS: 000225102400024, PubMed ID: 15571035, A 10 x 9 mm metastasis-like lesion in segment V of the liver was detected, when a 70-year-old man was operated on for adenocarcinoma of the stomach. Since exact diagnosis of the hepatic lesion could not be made by frozen sections, the lesion was excised, considering it to be a metastasis of gastric adenocarcinoma. Bacteriologic and pathologic studies established a diagnosis of isolated tuberculosis of the liver. A good response to antituberculous drug therapy was noted.

Horner's syndrome (HS) is a disorder of oculosympathetic pathway. Signs of this syndrome are ipsilateral ptosis, pupillary miosis, and anhidrosis. Cerebrovascular diseases, malignant tumors and iatrogenic injuries after neck and thoracic surgical procedures are the most common reasons. It is a rare complication of thyroid cancer surgery. In this case report, a patient with HS after total thyroidectomy and central neck dissection due to medullary thyroid carcinoma with multiple endocrine neoplasia type 2A had presented.

Myeloid sarcoma (MS) is an extramedullary tumor of the myeloid cells and usually develops in lymphoid organs, bones, skin, adipose tissue, and the central nervous system. Gastrointestinal or isolated mesenteric involvement is an extremely rare without bone marrow (BM) involvement. Only a few cases had reported before. In this paper, we report a case of a 37-year-old male who presented with small bowel intussusception due to mesenteric MS. Abdominal computed tomography findings revealed intussusception of the small bowel in the left lower quadrant of the abdomen and mesenteric masses. The patient underwent operation, and masses were excised with segmental small bowel and segmental colon resection because the masses were adjacent to the bowel wall. Histopathology and immunohistochemistry showed MS in mesentery. Patient received 2 cycles of cytosine arabinoside combined with idarubicin chemotherapy in the postoperative period and was doing well at 6 months of follow-up. MS in mesentery presenting as intussusception of small bowel without BM involvement is very rare and it should be considered in the differential diagnosis of intestinal obstruction.

WOS: 000184227300013, Transmural migration of a sponge without symptoms of peritonitis is very rare. We report a case of a retained surgical sponge in the abdominal cavity, which caused intestinal obstruction 1 month after right nephrectomy and appendectomy due to completely intraluminal migration with spontaneous closure of intestinal wall where the foreign body penetrated.

A 64-year-old woman presented with right upper abdominal pain, nausea, and vomiting. Physical examination revealed tenderness at palpation of the right upper quadrant. Laboratory results demonstrated

WOS: 000187887200015, Pneumatosis cystoides intestinalis (PCI) is a rare benign condition affecting portions of the intestinal tract and is characterized by multiple subserosal and submucosal gas cysts of unknown etiology and nonspecific clinical presentation. Its diagnosis is often coincidental. We here present two cases of small intestinal PCI associated with duodenal ulcer and pyloric stenosis.

WOS: 000302272100023, Objective: The purpose of this study was to analyze the morbidity and mortality of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC) with closed abdomen technique in the treatment of peritoneal surface malignancies. Material and Methods: Twenty-six patients (8 with ovarian cancer, 7 peritoneal mesothelioma, 6 colorectal cancer, 3 uterine sarcoma, 1 peritoneal carcinoma and 1 with gastric cancer) underwent 27 procedures. Peritonectomy was performed with complete removal of all the involved visceral and parietal peritoneum. HIPEC was performed with the closed abdominal technique using preheated (42.5 degrees C) perfusate for 60 minutes. EPIC was continued for postoperative 5 days. Results: All patients underwent resection of the lesions. Total pentonectomy was performed in 12 patients, while subtotal or partial peritonectomy was carried out in 14 according to the spread of carcinomatosis. Completeness of cytoreduction score of our patients was 0 in 18 patients, 1 in 6 patients and 2 in 2 patients. Major morbidity developed in 7 patients (27%). CRS+HIPEC+EPIC yielded acceptable morbidity and mortality rates. Of the 26 patients, 20 (77%) were alive without evidence of disease with a mean follow-up period of 13 6 months. Overall 1 year survival was 60%. Conclusion: Cytoreductive approach combined with intraperitoneal chemotherapy prolongs survival in selected patients with peritoneal carcinomatosis (PC) with acceptable morbidity and mortality.

WOS: 000293484400023, Neuroendocrine (NE) carcinoma of the breast is extremely rare and constitutes less than 0.1% of all breast tumors. Only a few studies are currently available in the literature and a standard approach to treating this tumor has yet to be established. The aim of this study was to apply pathological treatment modalities in clinical practice and to select the most appropriate treatment accordingly. Six female patients were diagnosed with primary NE carcinoma of the breast. The patients underwent modified radical mastectomy with axillary dissection. Pathological specimens were stained with hematoxylin and eosin and an immunohistochemical panel of antibodies [neuron-specific enolase (NSE), chromogranin, synoptophysin, estrogen and progesterone receptor, c-erbB2 and Ki-67]. The results showed that tumor size ranged from 2 to 4.5 cm in diameter. Lymph node metastasis was detected in 4 (67%) patients. Estrogen and progesterone receptor expression was found in 5 (83%) patients. None of the patients expressed c-erbB2. Chromogranin was found to be positive in 5 (83%) patients. Synoptophysin expression was detected in 5 (83%) patients. NSE was stained in 4 (67%) patients. An intraductal component was found in 5 (83%) patients. Lymphovascular invasion was found in 5 (83%) patients. Adjuvant chemotherapy was administered to patients with a Ki-67 index of >= 10%. Radiotherapy was administered to 4 (67%) patients, and 4 (67%) patients received hormonal therapy. The mean follow-up time was 31.1 months (range 12-52). All 6 patients survived, although following chemotherapy and tamoxifen, the disease progressed in 1 patient who received second-line hormonal therapy. In conclusion, NE carcinoma of the breast is a distinct entity. Management of this rare tumor may include surgery and radiotherapy depending on the size of the tumor and lymph node status. However, the exact role of chemotherapy and hormonal therapy has yet to be established. Adjuvant chemotherapy is recommended for patients with a Ki-67 index of >= 10%, and hormonal treatment appears to be feasible in patients who are positive for estrogen and/or progesterone receptor.

WOS: 000293434100019, PubMed ID: 21805429, Lymphangiomas are rare benign congenital malformations of the lymphatic system. Clinical presentation varies from asymptomatic masses to acute abdominal pain. A 25-year-old female who presented with acute onset of abdominal distension and severe pelvic pain is presented. As a palpable mass was found on the pelvic examination and ultrasonography demonstrated a hypoechoic cystic mass, an ovarian malignancy was suspected. Exploratory laparotomy was performed and revealed cystic lymphangioma of the sigmoid colon. The clinical, radiological and pathological findings of the patient are discussed with a brief review of the literature.

WOS: 000227179000020, PubMed ID: 15650798, Hydatid disease is a parasitic disease that is treated primarily by surgery. The most important complication of surgical treatment is spillage of the contents of the cyst, leading to secondary dissemination. In this study, the effect of chlorhexidine gluconate (Chx-Glu) was investigated in the treatment of experimental intraperitoneal hydatidosis (IPH). IPH was reproduced in 100 Wistar albino rats by inoculation with 1 ml of a suspension contained approximately 1500 viable protoscolices of Echinococcus granulostis following determination of scolicidal activity of chlorhexidine gluconate in vitro. Five minutes after protoscolex inoculation, 5 ml of the scolicidal solution was instilled into the peritoneal cavity: 0.9% NaCl (control group), 4.0% Chx-Glu, 0.4% Chx-Glu, and 0.04% Chx-Glu. After 6 months of follow-up, the rats were sacrificed, and the number of isolated cysts, peroperative and postoperative deaths, and toxicity were evaluated. Cyst formation did not occur in any of the Chx-Glu groups compared to the control group (p < 0.05), whereas it was detected in all of the control rats. In addition, to 4.0% Chx-Glu was found to be more toxic and to cause a high mortality rate compared to the 0.4% and 0.04% Chx-Glu groups and the control group (p < 0.05). Chx-Glu 0.04% was found to be the most potent, nontoxic agent; it is easily available, inexpensive, and highly potent in a short period of time at the low concentration. Chx-Glu 0.04% can be used safely in the treatment of intraperitoneal hydatidosis and hydatid cyst.

WOS: 000222592300021, PubMed ID: 15285551, Peripancreatic tuberculous lymphadenitis is a rare clinical entity and it usually raises serious diagnostic problems. We report a case of a solitary abdominal tuberculoma. A 45-year old woman was admitted to hospital with obstructive jaundice. An exploratory laparotomy was performed. A conglomerated mass, penetrating into the pancreas was found. Since exact diagnosis could not be obtained by peroperative frozen sections, standard Whipple procedure, segmental portal vein resection and reconstruction with autogenous saphenous vein were performed. Histopathological examination of the resected specimen revealed tuberculous lymphadenitis. The patient was given an anti-tuberculous treatment and a good response was noted. Abdominal tuberculoma is often mistaken for a malignant neoplasm and a high grade of suspicion is neccessary in order to make the exact diagnosis and optimal medical treatment of this entity.

WOS: 000224169200005, PubMed ID: 15458527, BACKGROUND. This study was designed to determine the possible correlation between phenytoin and vascular endothelial growth factor and basic fibroblast growth factor in the wound healing process. METHODS. Sixty Wistar albino rats were divided into four groups, each containing 15 animals. The experimental groups received a daily phenytoin treatment (10 mg) for 3 or 7 days following 3-cm dorsal skin incisions on the midline; the control group incisions were treated with 0.5 mL of saline solution during the same time periods. After completion of treatments, all animals were killed, and skin tissue samples were obtained. RESULTS. Histopathologic examination of all groups revealed that there were significantly increased (p

Background/aims: the sigmoid colon is the most frequent site for a volvulus. In this report, we review our experience with sigmoid colon volvulus. Methodology: we present our experience of 81 cases of sigmoid volvulus admitted to our department. Results: preoperative endoscopic volvulus detortion was attempted in all patients, and in 39 of them the procedure was successful. The success rate of endoscopic detortion for sigmoid colon volvulus with a flexible colonoscope (60%) was higher than with a rigid rectosigmoidoscope (42%). In 19 of these 39 non-operatively devolvulated patients, sigmoid resection with primary anastomosis was performed within 7-10 days after reduction, but 20 patients did not accept the elective operation after a non-operative treatment. Among the 61 patients undergoing urgent or elective operation for sigmoid volvulus, there were 17 laparotomies laparatomies with only detortion, 19 resections with elective anastomosis, 6 resections with primary anastomosis, and 19 resections with a Hartmann’s pouch. There were 9 deaths (21%) among 42 patients who underwent an emergency operation, and one (5.2%) among the 19 patients who had elective surgery died because of a cerebral embolus. Conclusions: initial therapy with endoscopy affords decompression and an adequate preparation of patients for surgical resection, and a flexible colonoscope has notable advantages over rigid instruments for the detortion process.

WOS: 000220562000013, PubMed ID: 14508600, Background and aims. Anastomotic dehiscence following colorectal surgery is a significant cause of morbidity and mortality. Phenytoin has wound-healing promoting and collagenase inhibitory effects. This study assessed these effects on healing of experimental colonic anastomoses in a rat model. Materials and methods. Ninety Wistar rats weighing 240-290 g were divided into six groups: 3rd-day control group (n=15), 3rd-day oral administration of phenytoin (n=15), 3rd-day rectal administration of phenytoin (n=15), 7th-day control group (n=15), 7th-day oral administration of phenytoin (n=15), and 7th-day rectal administration of phenytoin (n=15). In oral phenytoin groups the agent was given at 10 mg/kg daily per orogastric route by 4-F fine feeding catheter; in rectal phenytoin RAP groups the agent was administered at 10 mg/0.5 cc daily to the anastomoses transrectally via a fine anal catheter. Results. There were significantly higher anastomosis bursting pressure values and hydroxyproline contents in phenytoin groups than in controls. In histopathological examination it was seen that phenytoin treatment caused greater collagen deposition, fibroblast, and blood vessel ingrowth than in controls. Immunohistochemical analysis showed the stimulatory effect of phenytoin in expression of vascular endothelial growth factor and basic fibroblast growth factor. Anastomosis bursting pressure, histopathological analysis, hydroxyproline content, and immunohistochemical results were better in the groups with rectal administration than in those with oral administration. Conclusion. These results had showed us that phenytoin administration resulted in enhanced stability of colonic anastomoses during the first postoperative week and rectal administration showed better results than oral administration.

WOS: 000223021400016, PubMed ID: 15290406, Paragangliomas are uncommon tumors arising from the neuroendocrine elements of the paraganglia. Their successful management is associated with many problems. We herein present the findings of a 22-year-old man in whom a paraganglioma was incidentally found and in which the clinical and previous operative behavior was functioning desensitization. As a result, preoperative medication was not performed; however, during the tumor resection the patient demonstrated hemodynamic instability.

WOS: 000187973400011, PubMed ID: 14709843, Extent of thyroidectomy in the management of benign thyroid disease remains controversial. In this clinical study, three different thyroidectomy techniques were compared by means of the complication, short period recurrence and L-thyroxin requirement rates. Two hundred consecutive patients who had bilateral subtotal thyroidectomy (BST) (n = 71), unilateral total lobectomy + contralateral subtotal lobectomy (Dunhill Procedure (DP)) (n = 71), or total thyroidectomy (TT) (n = 58) for benign thyroid disorders were included in this study. One patient was re-operated due to bleeding in BST group. Wound infection was observed in 1 patient both in BST and DP group and 2 patients in TT group. Temporary hypocalcaemia was seen in 14 (19.7%) of BST group, in 19 (26.7%) of DP group, and in 14 (24.1%) patients of TT group (p>0.05). Transient recurrent laryngeal nerve palsy developed in I patient both in DP and TT group. One patient of DP group had secondary thyroidectomy due to postoperative diagnosis of papillary carcinoma. There was no significant difference in the mean durations of hospitalization between the groups. Mean postoperative follow-up periods were 27.7 months (6-56), 34.8 months (8-55), 26.5 months (6-54) in BST, DP and TT groups, respectively. While all patients were administered L-thyroxin in TT group, 26 (36.6%) patients in DP group and 34 (47.8%) patients in BST group needed no L-thyroxin supplementation and L-thyroxin requirement rates were not different in either group. We think that total thyroidectomy should be adopted for benign thyroidal diseases, because its complications are no different than those for BST and DP. If individual factors and patient's preference are not in favor of lifelong L-thyroxin supplementation, however, DP may be carried out for benign thyroidal diseases instead of BST.

WOS: 000182780100014, PubMed ID: 12707829, We report the case of an 18-year-old, mentally retarded boy who suffered acute abdominal symptoms and signs after eating a heavy meal. Laparotomy showed massive gastric dilatation with near-total infarction and perforation. Total gastrectomy and esophagojejunostomy were performed, but the patient died a few hours after the operation.

Background and aims: This study assessed the effect of short-chain fatty acids (SCFAs) on the healing of ischemic colonic anastomosis and compared the enteral and intraluminal (transrectal) forms of SCFAs in the same study. Material and methods: Left colonic ischemia was induced and a 1-cm left colon resection 2–4 cm above the peritoneal reflection was performed through a midline incision. In all, 160 rats were divided into eight groups: a control group, an ischemia group, a transrectal SCFAs group, an ischemia + transrectal SCFAs group, an enteral guar gum group, an ischemia + enteral guar gum group, an ischemia + enteral sham group, and a control + enteral sham group. The animals in each group were anesthetized again on day 4 or 7 after the operation for in vivo analytic procedures. Wound complications, intestinal obstructions, and anastomotic complications were recorded. Periperitoneal adhesions were graded. The strength of each anastomosis was assessed by measuring its bursting pressure. Results: There were significantly more dense intra-abdominal adhesions in the ischemic group and ischemia + enteral sham group. Five animals in the ischemia group, six in the ischemia + enteral sham group, and one in each of the control and ischemia + transrectal SCFA groups developed anastomotic dehiscence. The median bursting pressures were significantly lower in the ischemic group and in the ischemia + enteral sham group on the 4 day and 7 days. Conclusion: Deleterious effects of ischemia on left colonic anastomotic healing were significantly prevented by the administration of either 7 days' pretreatment with enteral guar gum or the intraluminal instillation of SCFAs. There were no significant differences between enteral and intraluminal SCFA groups.

WOS: 000393519300013, PubMed ID: 27857996, Detorsion, cecopexy, cecostomy and tube cecostomy are the treatment options for acute cecal volvulus if there is no intestinal ischemia. Resection required if intestinal viability, necrosis, gangrene or perforation exists. After resection, primary anastomosis or ileostomy can be performed. First colonoscopic decompression testing may be appropriate in terms of saving time for elective surgery. The co-existance of situs inversus totalis with cecal volvulus may cause uncertainty of the definite diagnosis and delay of surgical procedure. This is a case report about cecal volvulus together with situs inversus totalis. Copyright (C) 2016 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).