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Introduction: The aim of this study was to investigate the incidence of general psychiatric symptoms, aggression levels, and sexual dysfunction in patients with benign anorectal diseases and compare the results with those of healthy control subjects. Methods: We prospectively enrolled consecutive adult patients who presented for treatment of benign perianal diseases and healthy control subjects between June 2017 and December 2018. All patients had either grade 3 or 4 hemorrhoidal disease or perianal fistula with active discharge who had not undergone previous anorectal surgery. We also included a control group with benign subcutaneous lumps presenting for minor surgery. We used the Symptom Checklist-90-Revised Form to evaluate general psychiatric symptoms, the Buss-Perry Aggression Questionnaire (BPAQ) to evaluate aggression levels, and the Arizona Sexual Experiences Scale to evaluate sexual dysfunction. Results: A total of 563 patients were assessed for eligibility; after exclusions, 94 with anal fistula, 89 with hemorrhoids, and 59 healthy control subjects were enrolled. The groups were similar with regard to age, gender, and educational level. Physical and verbal aggression, anger, and total BPAQ score were significantly higher in patients with perianal fistula than in those with hemorrhoidal disease and healthy control subjects (P <.001). Conclusion: This study suggests that patients with perianal fistula have higher levels of aggression than healthy control subjects and those with hemorrhoidal disease. One must bear this in mind during preoperative patient evaluations and obtaining informed consent. Further studies are needed to investigate the reason for this association and potential causality. [ABSTRACT FROM AUTHOR]

This study aimed to postoperatively evaluate the effects of intraoperative neural monitoring (IONM) on muscles and nerves in patients who underwent modified radical mastectomy (MRM). In the 11 patients included in the study, nerves were determined and protected by nerve monitoring during the axillary dissection (IONM group). In another 11 patients, nerve monitoring was not performed; however, protection of the same nerves was attempted through careful nerve dissection (cautious nerve dissection [CND] group). The control group consisted of 22 healthy subjects. Muscle and nerve functions were blindly evaluated by an experienced physical therapy and rehabilitation specialist using electromyography (EMG) and ultrasonography (US) methods. The EMG values of the pectoralis major muscle were similar in the IONM and control groups (1.97 mV/1.98 mV, p = 0.97) but significantly lower in the CND group (1.57 mV, p < 0.05). Significant differences were found in the US values of the pectoralis major and minor muscles between the IONM and CND groups. No significant difference was found between the IONM and control groups in terms of EMG values of the serratus anterior muscle. This is the first prospective randomized study to objectively evaluate preservation of the nerve through nerve monitoring and its functional results. Monitoring of nerves during MRM is of great importance in terms of demonstrating the positive effects on muscle and nerve functions. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The aim of this long-term follow-up study was to investigate the association of local and systemic cardiovascular complications with endothelium-dependent and-independent microvascular relaxations and blood biomarkers and biochemicals in patients with peripheral arterial disease (PAD) caused by atherosclerosis. Methods: This prospective study included 67 patients with PAD who had not undergone any endovascular intervention, peripheral arterial surgery, or major amputation. Changes in the microvascular blood flow were measured using laser Doppler imaging after iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP). The biochemical markers of high sensitivity C reactive protein (hs-CRP), nitric oxide (NO), total antioxidant capacity (TAC), asymmetric dimethyl arginine (ADMA), and hydrogen sulfide (H2S) levels were measured from blood samples. All the patients were followed up for 5 years to determine the development of cardiovascular adverse events (CVAEs) and major amputation. At the end of the follow-up period, the patients were classified into two groups: those who had a CVAE [CVAE (+)] and those who did not experience CVAE [CVAE (-)]. Parameters such as demographic features, atherosclerotic risk factors, chronic ischemia category, microvascular endothelial functions, and plasma biomarkers were compared between the groups. Results: A total of 67 patients comprising 61 (91%) males and 6 (9%) females with a mean age of 62.3±9.7 years were included. During the follow-up period, 29 patients had CVAE (43.3%) and 38 patients did not have CVAE (56.7%). There was no difference between the groups in terms of ACh and SNP-induced vasodilation responses. Plasma high density lipoprotein (HDL) cholesterol values were lower in the CVAE (+) group [(CVAE+HDL: 38.4±9.1), (CVAE-HDL: 44.7±11.1), p=0.02]. Plasma hs-CRP values were significantly higher in the CVAE (+) group [(CVAE+ hs-CRP: 14.3±20.6), (CVAE-hs-CRP: 5.9±10.9), p=0.004]. No significant difference was observed between the groups in terms of plasma biomarkers and other biochemical levels. Conclusion: Based on the study findings, it was concluded that only low plasma HDL and high hs-CRP levels were risk factors for the development of CVAEs during follow-up of patients with PAD. [ABSTRACT FROM AUTHOR]

The article discusses a novel monitorization technique for nerve protection during axillary surgery of the breast cancer patients. Topics include the surgical option has evolved toward breast preservation and oncoplastic breast surgery techniques; and median intraparticular LPN and lateral localized MPN in the interpectoral dissection area are found via placing the needle electrodes in the pectoral major muscle.

Aim: Evaluation of histopathological results after wire guidance and BI-RADS (breast imaging and reporting data system) scores of cases with nonpalpable mammary lesions like mass in breast, microcalcification and structural distortion diagnosed via screening techniques. Materials and Methods: The wire guided biopsy results of cases who were diagnosed as nonpalpable mammary lesion and had BI-RADS scores of 3,4,5 between March 2007 and March 2012 were evaluated. 107 cases were included to the study.Patients admitted to our general surgery clinic were assesed with physical examination, mammography (older than 35 years) and mammary ultrasound . BI-RADS categories were determined according to the results of mammography and mammary ultrasound. The lesions of the cases having mammary cancer risk were excised after wire guidance at the same day. Status of having mammary cancer in first degree relatives, radiomorphologic diagnosis before wire guidance, BI-RADS scores and histopathologic results of the lesions were noted. Results: The mean age of the patients were 51.4 (36-72) years. In 24 (22.4%) of the cases a mammary cancer history in first degree relatives was present. The radiologic diagnosis of the mammary lesions before wire guidance was 65 (60.7%) microcalcification, 26 (24.2%) mass lesion with irregular borders, 9 (8.4%) asymmetric density area, 6 (6%) specular lesions. 58 (54.2%) of the lesions were localized in left breast and 49 (45.8%) were localized in right breast. Of the 107 cases wire guidance was performed with the aid of ultrasound in 62 (57.9%) and with the aid of mammography number and percentage missing. Of the 107 lesions excised under guidance 24 (22.4%) took malign diagnosis, where 83 (77.6%) took benign diagnosis. 32 (29.9%) lesions were categorized as BI-RADS III, 71 (66.4%) as BI-RADS IV and 4 (3.7%) as BI-RADS V. Conclusion: In conclusion, to diagnose the mammary cancer in early stages, the results gathered from the technique of wire guided biopsy of the nonpalpable masses detected as suspicious in ultrasound and mammography support that this technique should be efficiently used. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study is to evaluate demograhic characteristics, indications and complications of patients who were performed percutaneous endoscopic gastroenterostomy in our endoscopy unit. Material And Method: 36 patients with different indications were performed percutaneous endoscopic gastroenterostomy between January 2007 and March 2012 in our endoscopy unit. PEG were placed in all of the patients by Pull method. demographic characters, indications, major and minor complications were determined retrospectively. Results:Patients who were enrolled in the study were consisted of 22 (%61.2) male and 14 (% 38.8) female patients. Patients with norologic disease comes first with the rate of % 77 between the indications of PEG. There was one major complication. One patient was died because of major complication and septic shock that was occured during and after the procedure. Furthermore systemic candidiasis because of gastroenterostomy tube was seen in one patient. Different minor complications including the superficial infections (% 22.2, 8 patients) which was the most common were occured. Discussion:Percutaneous endoscopic gastroenterostomy is the longstanding enteral nutrition tecnique that is cheap, is performed easily and does not need operation room. Although low rates of complications, it must not be forgetted that this is an invasive procedure and can cause fatal complications. [ABSTRACT FROM AUTHOR]

Hilar cholangiocarcinoma, is a relatively rare tumor arising from the bile ducts, was first described by Klatskin in 1965. It usually ocurs in adults in their sixth decade of life and there is slight male predominance. It is most frequently located in the confluence of the hepatic ducts, where it is called hilar cholangiocarcinoma or Klatskin tumor. The etiology of hilar cholangiocarcinoma remains unknown but there are predisposing conditions and environmental risk factors such as primary sclerosing cholangitis, Caroli disease, bile duct malformations, industrial toxins and parasitic infections. If 30% of the liver is drained jaundice can be relieved, but the presence of undrained bile ducts may result in pruritus and a continued risk of cholangitis and hepatic abscess. This study aimed to emphasize the current treatment approaches for hilar cholangiocarcinoma in the light of literature. [ABSTRACT FROM AUTHOR]

Although pancreatic cystic lesions are monitored frequently, there still occure diffuculties in the diagnosis and treatment. Most of the cystic lesions are pseudocysts and retention cysts. Basically, pancreatic cystic neoplasms can be divided into four groups: serous cystic neoplasm (SCN), mucinous cystic neoplasms (MCN), intaduktal papillary mucinous neoplasm (IPMN) and solid pseudopapiller neoplasy (SPN). The diagnosis of the pancreatic cystic neoplasms is challenging, since clinical signs and symptoms are not typical. The treatment varies across types or even sub-type of the disease. For this reason, making the differential diagnosis of pancreatic cysts is crucially important. [ABSTRACT FROM AUTHOR]

Introduction: The goal of surgical treatment of thyroid diseases is to provide the most effective treatment with low complication and recurrence rates. Total thyroidectomy was prefered only in patients with cancer, due to high complication rates. The surgical aim can be reached in the total thyroidectomi operations with capsular dissection. Material and Methods: We evaluated patients, who underwent totally thyroidectomy for benign or malignant thyroid disease between August 2006 and August 2010 in our Department of General Surgery. The age, sex, indication of operation, postoperative complication ratas were recorded for each patient. Results: The median age of patients was 50.34+12.24 years (range 19-78) and 202 (77%) patients were female. Indications of operations were 216 ( 81.8%) multinoduler goitre, 34 (12.9%) diffuse goitre, 14 (5.3%) malignant condition. Postoperative complications were presented in postoperative period in 18(6.8%) patients; corresponding to recurrent laryngeal nerve injuries 5 (2 permanent) and hypoparathyroidisms 6 ( 1 permanent). Conclusion: Total thyroidectomy operation can be performed confidentally in appopriate patients with low complication rates. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Surgery / Ulusal Cerrahi Dergisi is the property of Turkish Surgery Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Appendiceal mucocele is a rare entity which is characterised by cystic dilatation due to abnormal accumulation of mucus in the lumen of the appendix. Patients are often diagnosed incidentally by abdominal screening or abdominal surgery for other causes. Pain in the right lower quadrant of the abdomen, which may present as acute or chronic appendicitis, is the most common symptom of appendix mucocele, when the patient is symptomatic. This study describes the case of a 26 year old female for whom surgical intervention for a complex ovarian cyst was planned, but who instead underwent laparoscopic appendectomy because appendiceal mucocele was determined during laparoscopic exploration. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Surgery / Ulusal Cerrahi Dergisi is the property of Turkish Surgery Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article describes the case of a 24-year-old woman who was diagnosed with appendicocutaneous fistula due to appendicitis. Her symptoms included nausea, vomiting and abdominal pain. Information on the results of her physical and laboratory examinations is provided. Plastron appendicitis was detected via abdominal computerized tomography (CT). She also developed an increase in leukocyte count and abdominal mass during her hospital stay. She underwent appendectomy and resection of the fistula.

Background: Traumatic diaphragm ruptures (TDR) are rarely seen. Although TDR does not cause morbidity in the acute period, undiagnosed TDR may cause clinical states, such as herniation, strangulation, pneumonia, pleural effusion, empyema, and cardiac tamponade, which have high morbidity and mortality rates in the late period. This study aims to evaluate the epidemiology, clinical characteristics, diagnosis and treatment methods of TDR encountered in thoracoabdominal trauma and to identify the factors affecting mortality.
 METHODS: A retrospective examination was carried out on the patients who were operated in our clinic because of traumatic diaphragm injury between January 2012 and December 2017. Each patient operated because traumatic diaphragm injury was evaluated in respect of age, gender, manner of injury, preoperative examination findings, laboratory test results, imaging methods, time of diagnosis, operation findings, concomitant injuries to other organs, operations performed, length of stay in hospital, the development of postoperative morbidity and mortality, and the calculated Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS).
 RESULTS: Between January 2012 and December 2017, a total of 1066 patients were operated in our clinic because of thoracoabdominal trauma, and of 1066 patients, 45 of the patients were determined with TDR. Of the 45 patients, surgery was applied because of penetrating trauma in 32 cases (7 firearms injuries, 25 penetrating cutting injuries), blunt trauma in nine cases, and in four cases, diaphragm rupture was seen to have developed associated with iatrogenic injury during an operation. The most common injuries concomitant to traumatic diaphragm rupture were hemopneumothorax (70%), liver (43%), spleen (32%), colon (20%), stomach (17%) injuries and rib fractures (15%), respectively. Mortality developed in seven (17%) patients; five patients were lost because of hemorrhagic shock intraoperatively or in the early postoperative hours, and two because of multiorgan failure during follow-up in the intensive care unit.
 CONCLUSION: In high energy blunt and penetrating thoracoabdominal traumas, diaphragm injuries should be suspected. Factors affecting mortality were found to be the AISS, ISS, number of concomitant organ injuries and the combination with pneumohemothorax.

Background: The aim of the present study was to investigate the role of body mass index (BMI) and trauma severity score systems on the mortality rates of patients undergoing surgery due to falls from height., Methods: This retrospective study included 45 consecutive adult patients with multitrauma who were admitted and operated on due to a fall from height between January 2008 and December 2016. Patients were divided into mortality and recovery groups (n=10 and n=35, respectively). The groups were compared in terms of age, gender, weight, cause of the fall, height of the fall, location of the fall, BMI, trauma scores (Injury Severity Score [ISS], New Injury Severity Score [NISS], Glasgow Coma Scale [GCS], Abbreviated Injury Score [AIS], Revised Trauma Score [RTS]), hospital stay, and postoperative complications., Results: There was no statistically significant difference between the two groups in terms of age, gender, and height or cause of the fall (p>0.05), whereas there was a statistically significant difference with respect to weight and BMI values (p<0.01). A statistically significant difference was determined between the groups in terms of hospital stay and postoperative complications (p<0.01) and ISS, NISS, GCS, AIS, and RTS scores (p<0.05)., Conclusion: The effect of weight and BMI on the mortality rate of patients presenting with trauma as a result of a fall from height was objectively demonstrated in the present study.