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There are certain problems experienced while retightening the seton material during the patient follow-ups, such as pain and anaesthesia requirements in perianal fistula. The aim of the present study was to compare a sailor's knot with other seton tightening methods for the surgical treatment of perianal fistulas.The records of 105 patients who underwent surgeries for perianal fistulas using the seton method between 2016 and 2019 were analysed retrospectively. The demographic characteristics, complaints, fistula localizations, surgery types, hospital stay lengths, postoperative complications and imaging modalities of the patients included in the study were recorded. The patients were divided into two groups according to the surgical treatment method. Those patients who underwent seton procedures with a sailor's knot were included in Group 1. Group 2 included those patients who underwent other seton procedures, including silk and penrose drain procedures. Groups were compared with regard to success rates and postoperative recurrence.There was no statistically significant difference between the groups in terms of the age, gender, fistula type and follow-up duration. Success rate in all patient was 88.6%, 91.2% in group 1 and 87.1% in group 2 (p=0.36). The number of patients with a kind of incontinence was 7 (7.1%), 3 (5.8%) in Group 1 and 4 (7.4%) in Group 2 (p = 0.297).There were no statistically significant differences with regard to complications and recurrences between the sailor's knot and the other seton tightening methods used for the treatment of anal fistulas. The sailor's knot is recommended with regard to its easy application and seton retightening with satisfactory outcomes.Perianal fistula, Sailor's knot, Seton.Si sono riscontrati alcuni problemi al momento di incrementare la stretta del setone nel corso del follow-up del paziente con fistola perianale, in rapporto al dolore e l’anestesia. Lo scopo del presente studio è quello di confrontare il nodo marinaro con altri metodi di serraggio del setone per il trattamento chirurgico di queste fistole. Sono stati analizzati retrospettivamente i documenti clinici di 105 pazienti sottoposti a interventi chirurgici per fistole perianali utilizzando il metodo del setone tra il 2016 e il 2019. Sono state registrate le caratteristiche demografiche, le lamentele, le localizzazioni delle fistole, i tipi di interventi chirurgici, la durata delle degenze in ospedale, le complicanze postoperatorie e le modalità di imaging dei pazienti inclusi nello studio. I pazienti sono stati divisi in due gruppi secondo il metodo del trattamento chirurgico adottato. I pazienti sottoposti a procedure del setone con nodo marinaro sono stati inclusi nel I gruppo. Il II gruppo comprendeva i pazienti sottoposti ad altre procedure del setone, tra cui il drenaggio con seta o con penrose. I due gruppi sono stati posti a confronto per quanto riguarda il tasso di successo e le recidive postoperatorie. RISULTATI: Non sono state rilevate differenze statisticamente significative tra i gruppi in termini di età, sesso, tipo di fistola e durata del follow-up. La percentuale di successo in tutti i pazienti è stata dell’88,6%, del 91,2% nel gruppo 1 e dell’87,1% nel gruppo 2 (p = 0,36). Il numero di pazienti con una sorta di incontinenza era 7 (7,1%), 3 (5,8%) nel gruppo 1 e 4 (7,4%) nel gruppo 2 (p = 0,297). CONCLUSIONI: Non ci sono state differenze statisticamente significative per quanto riguarda le complicanze e le recidive tra il nodo marinaro e gli altri metodi di serraggio del setone usati per il trattamento delle fistole anali. Il nodo del marinaio è raccomandato per quanto riguarda la sua facile applicazione e il suo riserraggio con esiti soddisfacenti.

Objectives: The aim of this study was to evaluate acute abdomen cases that developed as a result of spontaneous perforations of hydatid liver cysts in our regions, where hydatid cyst disease is endemic.Methods: The records of 218 hydatid cyst patients who underwent surgery at our clinic between 01.01.2012 and01.08.2016 were retrospectively reviewed.Twelve (5.5%) cases who required emergency surgerydue to the ruptureof hydatid cysts were included in this study. The cases were reviewed with respect to age, sex, current symptoms, radiological findings, laboratory results and post-operative results.Results: Ten (83.3%) of the 12 patients were females, and two (16.7%) were males, and their me an age was 40.4 y (23–69). All patients with spontaneous perforationshadhydatid liver cysts. Eleven of the patients had a single cyst, and one hadmultiple cysts. Nine patients were diagnosed withultrasonography (US), and three patients were diagnosed with computed tomography (CT).Conclusions:Hydatid cystic rupture should be considered in cases of an acute abdomen in regions where hydatid cystic disease is endemic. We believe that patients with a single cyst that is peripherally located in the liver ha ve ahigh risk of spontaneousperforation.Patients who are diagnosed with hydatid cystic rupture should undergo emergency surgery, followed bymedical treatment.

To investigate the effect of constipation on the development of inguinal herniation and type of herniation using the Constipation severity scale. A total of 100 patients who underwent surgical inguinal hernia repair (study group) and 100 healthy volunteers without inguinal herniation (control group) were included in this study. The constipation severity scale was administered to all patients. The type of the herniation was classified using Nyhus scale during surgery and the side of the herniation was recorded on completed questionnaires. The obstructive defecation sub-scale score, colonic inertia sub-scale score, pain sub-scale score, and the total score were recorded for each patient and the association between constipation and the development of inguinal herniation was investigated. The mean age of patients in Group 1 and 2 was 40.92 ± 17.80 and 33.71 ± 9.13, respectively. There was a significant difference between the two groups in terms of obstructive defecation and colonic inertia sub-scale scores (p

Background: Although LC-MS/MS is preferred as a reliable method, therapeutic enzyme drugs in the blood matrix may lead to false results. Objective: The purpose of this article is to experimentally investigate the effect of five different enzymes used in the treatment of metabolic diseases on blood immunosuppressant measurement. Methods: Five different enzyme drugs (galsulfase, alglucosidase alfa, imiglucerase, elosulfase alfa, laronidase) were added to control materials containing tacrolimus, everolimus, sirolimus, and cyclosporine A drugs. Measurements were performed using an LC-MS/MS instrument (Shimadzu 8040, Japan). The amount of deviations from the target values was calculated. Results: Blood Immunosuppressant levels significantly changed after the administration of enzyme drugs. Four different enzyme drugs led to false-positive results in the tacrolimus levels at a rate of 10.58% (95% CI, 9.83-11.32) to 37.28% (95% CI, 33.55-41.27). The highest deviations were observed with the administration of galsulfase and alglucosidase alpha in the sirolimus levels at rates of 336.54% (95% CI, 306.25-366.82) and 395.88% (95% CI, 360.25-431.50), respectively. Imiglucerase was the least effective enzyme for the sirolimus level (0.80% (95% CI, 0.71-0.89). Different deviations between the ratios of - 9.37% (95% CI, -10.40 - -8.33) and 8.33% (95% CI, 7.41-9.24) were determined at the cyclosporin A level. Conclusion: Galsulfase, alglucosidase alpha, imigluserase, elosulfase alpha and laronidase can significantly interfere with immunosuppressant measurements with LC-MS/MS. False immunosuppressant results associated with enzyme injection may result in immunosuppression failure, organ rejection. For the measurement of immunosuppressant levels, sampling should be done before the enzyme infusion. Clinicians should question the time of enzyme infusion and sampling when confounding results in immunosuppressant measurement.

Background: The MF07-01 trial is a multicenter phase III randomized controlled trial of treatment naive stage IV BC patients comparing loco-regional surgery (LRS) followed by appropriate systemic therapy (ST) versus ST alone. Aims: To evaluate the importance of loco-regional tumor burden and surgery on overall survival rate in patients with de novo stage IV breast cancer. Methods: At initial diagnosis patients were randomized 1:1 to LRS group or ST group. The surgery was a lumpectomy (L) or mastectomy (M) and sentinel lymph node biopsy (SLNB) ± axillary lymph node dissection (ALND). After surgery all patients received systemic treatment + endocrine treatment (ET) and Trastuzumab based on pathology results. The demographic, pathologic, and clinical characteristics of the patients were recorded. Results:274 patients were accrued; 138 in the LRS group and 136 in the ST group. The groups were comparable regarding age, BMI, HER2 neu, tumor type and size, histologic grade, and bone and visceral metastasis (all p>0.05). In the LRS group 36 patients (26%) had L+ALND, 92 patients (67%) had M+ALND and 10 patients (7%) had M+SLNB, respectively. The patients and tumor characteristicsPatients and Tumors Characteristics and Surgical TreatmentSurgerySystemic TherapyP ValueAge (mean /year±SD)51.8 ±12.651.5±13.6NSMedian follow-up (25%,75%)41.0 (24,54)37 (18,49) Tumor Size (%) T18.7 (12) NST252.2 (72) NST321.7 (30) NST417.4 (24) NSHistologic Grade (%) I4.4 (6)9.6 (10)NSII39.9 (55)31.7 (33)NSIII55.8 (77)58.9 (61)NS Surgical Treatment Lumpectomy+ ALND26 (36)--M + SLNB7 (10)--M + ALND67 (92)---SLNB17 (23)--ALND92.8 (128)--pN+89.1 (123)--30-day mortality1.4 (2)1.5 (2)0.98SLNB-Sentinel Lymph Node Biopsy; ALND-Axillary Lymph Node Dissection; M-Mastectomy The axillary positivity rate was 89.1%. There were 76 (55%) deaths in the LRS group and 101 (74%) in the ST group during the median 40 (20-51) month follow-up. Overall survival (OS) was 34% higher in the LRS group compared to the ST group (HR: 0.66, 95%CI 0.49-0.88: p = 0.005). Overall survival rate was higher in LN (+) (p=0.01), tumor size Conclusion: In this subgroup analysis, we observed that patients with high grade tumor, without skin or chest wall involvement and positive axilla who underwent surgery for primary breast tumor and axilla had better overall survival than ST in de novo stage IV breast. These results can be considered in clinical research design for stratification. Citation Format: Ozmen V, Ozbas S, Karanlik H, Muslumanoglu M, Igci A, Canturk Z, Utkan NZ, Ozaslan C, Evrensel T, Uras C, Aksaz E, Soyder A, Ugurlu UM, Col C, Cabioglu N, Bozkurt B, Sezgin E, Dagoglu T, Uzunkoy A, Dulger M, Koksal N, Cengiz O, Gulluoglu B, Unal B, Atalay C, Yildirim E, Erdem E, Salimoglu S, Sezer A, Koyuncu A, Gurleyik G, Alagol H, Ulufi N, Berberoglu U, Soran A. The importance of loco-regional tumor burden and surgery on survival in patients with de novo stage IV breast cancer; post-hoc analyses of protocol MF07-01 [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-16-01.

Background: The MF07-01 trial is a multicenter, phase III, randomized, controlled study comparing locoregional treatment (LRT) followed by systemic therapy (ST) with ST alone for treatment-naïve stage IV breast cancer (BC) patients. Methods: At initial diagnosis, patients were randomized 1:1 to either the LRT or ST group. All the patients were given ST either immediately after randomization or after surgical resection of the intact primary tumor. Results: The trial enrolled 274 patients: 138 in the LRT group and 136 in the ST group. Hazard of death was 34% lower in the LRT group than in the ST group (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.49–0.88; p = 0.005). Unplanned subgroup analyses showed that the risk of death was statistically lower in the LRT group than in the ST group with respect to estrogen receptor (ER)/progesterone receptor (PR)(+) (HR 0.64; 95% CI 0.46–0.91; p = 0.01), human epidermal growth factor 2 (HER2)/neu(–) (HR 0.64; 95% CI 0.45–0.91; p = 0.01), patients younger than 55 years (HR 0.57; 95% CI 0.38–0.86; p = 0.007), and patients with solitary bone-only metastases (HR 0.47; 95% CI 0.23–0.98; p = 0.04). Conclusion: In the current trial, improvement in 36-month survival was not observed with upfront surgery for stage IV breast cancer patients. However, a longer follow-up study (median, 40 months) showed statistically significant improvement in median survival. When locoregional treatment in de novo stage IV BC is discussed with the patient as an option, practitioners must consider age, performance status, comorbidities, tumor type, and metastatic disease burden. © 2018, Society of Surgical Oncology.

Objective: The aim of this study was to investigate the effects of lycopene (Lyc) on methotrexate (Mtx)-induced intestinal damage in rats. Method: Twenty-eight male Sprague Dawley rats were divided into four equal groups: control, Mtx, Lyc, and Mtx-L. Control group: Rats were given only the vehicle. Lyc group: Rats were given Lyc (10 mg/kg) with corn oil by oral gavage for 10 days. Mtx group: Rats were injected intraperitoneally with a single dose of 20 mg/kg of Mtx and given corn oil by oral gavage. Mtx-L group: Rats were treated with Lyc (10 mg/kg) for 10 days after a single dose of Mtx (20 mg/kg). All of the rats were euthanized using terminal anesthesia, and the intestinal tissues were removed for histological examination and for pro-inflammatory cytokine measurement (tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β)), total oxidative status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI). Results: Mtx administration increased histopathological damage and increased TNF-α, IL-1β, TOS, TAC, and OSI levels in the small intestine tissues. Lyc therapy applied to the Mtx-L group provided significant improvement in all parameters of histopathological damage to the small intestine and significantly reduced the levels of IL-1β, TOS, and OSI in the intestinal tissues. Conclusions: The results of this study indicate that Lyc might be useful for protecting intestinal damage induced by Mtx in rats by reducing the increased oxidative stress and pro-inflammatory cytokine (IL-1β) levels.

Laparoscopic appendectomy is increasingly being performed because of its quick recovery time, low instance of wound infection, and early return of patients to home and work. Operating time should be short yet safe. Therefore, in this study, we compared the effects of various sealing systems on the length of surgery and examined whether these systems could be used to separate the appendix from its stump successfully. This prospective and randomized ex vivo study was conducted on 20 consecutive patients diagnosed with acute appendicitis. All patients underwent classical open appendectomy. The patients were classified into two groups according to the type of sealing system used. The LigaSure® system was used for coagulation in Group L and the Harmonic® system in Group H. After coagulation, a pressure system was used to evaluate the closure of the appendix. Results showed that the use of ultrasonic instruments alone to close the appendiceal stump caused an incomplete closure.Appendicular stump, Laparoscopic appendectomy.

Gallbladder tumours rank fifth in the world among gastrointestinal system tumours. Coincidental gallbladder tumours are diagnosed during cholecystectomies, or by examining the cholecystectomy material.In this study, we aimed to evaluate the incidence of gallbladder cancer among patients undergoing cholecystectomies due to gallbladder disease.Retrospective study METHODS: The files of 341 patients who had undergone routine cholecystectomy operations between January 2013 and March 2016 were reviewed, and their pathology results were recorded. Those patients with gallbladder carcinomas were evaluated in terms of age, gender, preoperative findings, existing symptoms, radiological findings, surgical findings and follow-up. The cancer invasion depth was classified according to the American Joint Commission on Cancer (AJCC) atlas, and this study was approved by the ethical committee of our university.Among the 341 patients who participated in this study, 253 (74.41%) were female, 88 (25.80%) were male, and their average age was 49.61 years old (17-86). Seven of the patients (2.05%) had gallbladder tumours; six of which were female, one was male and their average age was 67.71 years old (62-76). One tumour was diagnosed as a frozen specimen during the operation, while the others were diagnosed during the postoperation phase. Three of the patients had T1b and four had T2 tumours.Gallbladder tumours detected incidentally could extend survival rates with proper surgical intervention and chemotherapy. The possibility of a tumour should not be dismissed in those patients with advanced age, females or patients with gallbladder stones. Frozen specimens should be created during a cholecystectomy, and if there is any doubt about the diagnosis, a postoperative histopathological examination of the gallbladder should be conducted.Cholecystectomy, Gall bladder stone, Incidental gallbladder carcinoma.I tumori della colecisti occupano il Quinto posto nel mondo tra i tumori del sistema gastroenterico. Accidentalmente essi vengono diagnosticati durante una colecistectomia oppure all’esame anatomopatologico del pezzo anatomico. Lo scopo di questo studio retrospettivo è stato quello di valutare l’incidenza del cancro della colecisti nei pazienti sottoposti a colecistectomia per patologia della colecisti. Sono state sottoposte a revisione le cartelle cliniche di 341 pazienti sottoposti a colecistectomia tra il gennaio 2013 e il Marzo 2016, registrando i referti anatomo-patologici. Dei pazienti con carcinoma della colecisti sono state considerate l’età, il genere, gli esami preoperatori, la sintomatologia esistente, i referti radiologici, i reperti chirurgici ed il follow up. La profondità di invasione carcinomatosa è stata classificata secondo la American Joint Commission on Cancer (AJCC) e lo studio è stato approvato dal comitato etico della nostra università. Risultati: tra i 341 pazienti partecipanti allo studio 253 (74,41%) erano donne, 88 (25,80%) uomini, e l’età media era di 49,61 anni (range 17-86). Sette di questi pazienti (2,05%) avevano tumori della colecisti; sei di essi erano donne ed uno un uomo, dell’età media dii 67,71 anni (range 62-76). Un tumore è stato diagnosticato all’esame estemporaneo al congelatore durante l’intervento, mentre gli altri sono stati diagnosticati nella fase postoperatoria. Tre dei pazienti avevano tumori T1b e quattro T2. In conclusion I tunori della colecisti diagnosticati accidentalmente possono aumentare l’incidenza della sopravvivenza con trattamento chirurgico opportuno e chemioterapia. La possibilità di un tumore non dovrebbe essere trascurata in pazienti in età avanzata, di sesso femminile o in pazienti con calcolosi della colecisti. Durante l’intervento chirurgico dovrebbe essere effettuato l’esame estemporaneo al congelatore, e se c’è un dubbio circa la diagnosi dovrebbe essere effettuato l’esame istologico postoperatorio.

Acute appendicitis is the most frequent abdominal condition that requires non-obstetric surgical intervention during pregnancy. This study aims to scan pregnant patients operated on for acute appendicitis to evaluate the efficiency of using the Alvarado Score (AS) for diagnosis. Our study included 48 pregnant patients who were pre-diagnosed with acute appendicitis and operated on at our department of general surgery from January 2010 to July 2016 and whose files were accessed. Fifty-three non-pregnant female patients of reproductive age who were operated on for appendicitis during the same period were included in the study as the control group. The patients in both groups were divided into two groups based on their AS total score being 7 and ≥ 7. The mean age of the 48 pregnant patients was 28 (19–42) years, while the mean age of the 53 control patients was 31 (18–45) years. Among pregnant and non-pregnant women, about a third of patients had an AS

Background The aim of this study was to investigate the effects of lycopene (Lyc) on methotrexate (Mtx) induced liver toxicity in rats. Methods Twenty-eight male Sprague-Dawley rats were divided into four equal groups: control, Lyc, Mtx and Mtx-L: Control group: Rats were given only the vehicle. Lyc group: Rats were given Lyc (10 mg/kg) with corn oil by oral gavage for ten days. Mtx group: Rats were injected intraperitoneally with a single dose of 20 mg/kg of Mtx and given corn oil by oral gavage. Mtx-L group: Rats were post-treated with Lyc (10 mg/kg) for ten days after a single dose of Mtx (20 mg/kg). Results Mtx administration increased histopathological damage, TNF-α, IL-1β, TOS, TAS and OSI levels in tissues; AST, ALT levels in the blood. Sinusoidal dilatation, inflammatory cell infiltration and congestion were significantly improved in the Mtx-L aon histopathologic examination of the rats.In Mtx-L group that were treated at the Lyc, TNF-α and IL-1β levels of liver tissue were decreased significantly compared to Mtx group whereas the decrease in OSI was not significant. Lyc treatment improved the AST and ALT values in Mtx-L group. But only AST improvement was significant. Conclusions The results of this study revealed that Lyc might be useful in protecting the liver from injury due to Mtx in rats by reducing the increased proinflammatory cytokine levels (Tab. 4, Fig. 1, Ref. 44).

Objective: We aimed to evaluate our diagnosis and treatment approach to pregnant patients with acute cholecystitis in our high birth rate region. Methods: Twenty-one patients who suffering from acute cholecystitis during their pregnancy were analyzed retrospectively between January 2010 August 2014 at Harran University Medical School, Department of General Surgery. Treatment methods, complications, demographic and laboratory data were recorded for each patient. Results: Twenty one patients with abdominal pain and diagnosed as acute cholecystitis were included in this study. The mean age and gestational weeks of patients were 28 ± 7.4 years, 23.4 ± 8.5 respectively. Upper abdominal pain and nausea-vomiting were the most frequent complaints of the patients to hospital admissions. For the surgical treatment one patient underwent open cholecystectomy due to bladder perforation during the second trimester of her pregnancy, laparoscopic cholecystectomy was performed in one patient due to recurrent cholecystitis and in two patients due to decline cholecystitis findings. All other patients were treated medically. Maternal or fetal complication after treatment was not observed. Conclusion: Although, during pregnancy acute cholecystitis episodes are seen rare successful results can be obtained with medical therapy. When medical therapy has failed, especially in the second trimester, laparoscopic surgery can be considered as reliable surgical intervention for mother and fetus., Amaç: Bu çalışmada amacımız, yüksek doğum oranı olan bölgemizde akut kolesistitli gebe hastalarda tanı ve tedavi yaklaşımlarımızı değerlendirmektir. Yöntemler: Harran Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalında Ocak 2010- Ağustos 2014 tarihleri arasında gebeliği sırasında akut kolesistit hastalığı geçiren 21 hastanın verileri retrospektif olarak analiz edildi. Hastaların demografik ve laboratuar verileri ile uygulanan tedavi yöntemleri ve komplikasyonları not edildi. Bulgular: Çalışmamıza gebeliği sırasında üst karın ağrısı şikayeti ile başvuran ve akut kolesistit tanısı konan toplam 21 hasta dâhil edildi. Hastaların yaş ortalaması 28±7,4, ortalama gebelik haftası 23,4±8,5 olarak tespit edildi. En sık hastaneye başvuru şikâyetlerinin üst karın ağrısı ve bulantı-kusma olduğu görüldü. Tedavi olarak; bir hastada ikinci trimester sırasında gelişen kese perforasyonu nedeniyle açık kolesistektomi, bir hastada tekrarlayan kolesistite bağlı, iki hastada ise kolesistit bulgularının medikal tedavi rağmen gerilememesi nedeniyle laparoskopik kolesistektomi yapıldı. Diğer bütün hastalara ise medikal tedavi uygulandı. Uygulanan tedaviler sonrasında maternal ya da fetal herhangi bir komplikasyon tespit edilmedi. Sonuç: Gebelik sırasında akut kolesistit atağı nadir görülmekle beraber, medikal tedavi ile başarılı sonuçlar alınmaktadır. Medikal tedavinin başarısız olduğu durumlarda özellikle ikinci trimesterde laparoskopik cerrahi hem anne hem de fetüs açısından güvenilir bir cerrahi girişim olarak kabul edilebilir.

Background The MF07-01 trial is a multicenter randomized study comparing locoregional treatment (LRT) followed by systemic therapy (ST) with ST alone in de novo stage IV breast cancer (BC) patients. The aim of this study is to evaluate the importance of LRT in patients who lived at least 5 years after the diagnosis of de novo Stage IV BC. Methods At initial diagnosis, patients were randomized 1:1 to either the LRT or ST group. All the patients were given ST either immediately after randomization or after surgical resection of the intact primary tumor. Continuous and categorical variable differences between LRT and ST groups were analyzed using t-test and Chi-square test, respectively. Overall survival (OS) and 5-year survival rates were compared using Kaplan-Meier log-rank tests. Univariate and multivariate Cox models were used to estimate hazard ratios. Results During 124 months of follow-up, 26% of patients in LRT group and 11% of patients in ST group remained alive. Median survival was 46 months for LRT (n = 134) and 35.5 months for ST (n = 132) [HR:0.65, 95%CI;0.49-0.85, p = 0.002]. Solitary bone metastasis patients’ median survival was 14.5 months longer in the LRT group compared with the ST group [HR:0.53, 95%CI; 0.29-0.98, p = 0.04]; 22% of solitary bone metastasis patients in the LRT group and 5% in the ST group were alive. Regarding the patients who lived at least 5 years since randomization, LRT (p = 0.004), hormone receptor positivity (p = 0.007), hormonotherapy (p = 0.0001), bisphosphonates usage (p = 0.02), T2 tumor (p = 0.0008) and 2 or more organ metastases (p = 0.007) were associated with OS in univariate analysis, and in a multivariate Cox proportional model with a significant baseline and clinical characteristics, LRT [OR = 1.75, p = 0.05)], bisphosphonates usage [OR = 1.93, p = 0.05), T2 tumor [OR = 3.5, p = 0.003), and 2 or more organ metastases [OR = 0.48, p = 0.03] were found to be significantly related with OS. Conclusions In the current analysis, patients at the diagnosis of de novo stage IV BC who underwent LRT followed by ST had a 75% higher chance to live at least 5 years compared with the patients who received only ST. Longer follow-up of the study discloses that LRT should be presented to the patient when discussing treatment options. Clinical trial identification NCT00557986. Legal entity responsible for the study Turkish Federation of Breast Diseases Societies. Funding Turkish Federation of Breast Diseases Societies. Disclosure All authors have declared no conflicts of interest.

Giriş ve Amaç:Endoskopi ünitemizde alt gastrointestinal sistem endoskopisi uygulanan hastaların makroskopik tanılarını ve kolorektal kanser sıklığını retrospektif olarak belirleyip sunmak. Gereç ve Yöntem:Karabük Üniversitesi Eğitim ve Araştırma Hastanesi Endoskopi Ünitesinde 2006-2012 yılları arasında alt gastrointestinal sistem endoskopi yapılarak video arşivleme sistemine kaydedilen 1800 olgunun yaşı, cinsiyeti ve endoskopi raporlarındaki kolorektal hastalıkları belirlendi. Bulgular:Alt gastrointestinal sistem şikâyeti nedeniyle altı yıllık süreçte 1800 hastaya endoskopik işlem yapıldı. Hastaların 920 (%51.11)’si erkek ve 880 (%48.88)’i kadın idi. Hastaların yaş aralığı 24-91 (ort: 58,68) idi. Hastaların 601’inin (%33,38) endoskopisi normal olarak rapor edildi. Alt gastrointestinal sistem endoskopisi uygulanan olgularda kolorektal kanser oranı %6.11 idi. Yapılan endoskopik işlemler sırasında komplikasyon oranı %0.16 idi ve mortalite olmadı. Sonuç:Alt gastrointestinal sistem endoskopisi, alt gastrointestinal sistem hastalıklarının teşhisinde hala altın standarttır, bu yöntem ile kanser saptama sıklığı yakla-şık %6’dır. Alt gastrointestinal sistem endoskopisi morbidite ve mortalitesi çok düşük tanısal bir işlemdir.

Introduction: Hydatid cyst disease is characterized by the occurrence of cysts as a result of the transmission of Tenia echinococcus larvae to humans. The most frequent location is the liver (60-70%). The larvae which fail to attach to the liver pass through the lungs (20-25%), and can be located in all organs and tissues connected to the systemic circulation (10%). They create hydatid cysts in the organs in which they are located. In our multi-center study, we aimed to present differ ent types of surgical treatment, its results, and the associated complications on the basis of a wide series of cases. Material and methods: 599 patients who received surgical treatment were included in our study. The patients’ data from archive records were examined retrospectively. Patients with unusual locations of the cysts (without liver or lung involvement) were excluded from the study. Results: 381 of the patients were women and 218 were men. It was established that the disease was more frequent among women than among men, which was in accordance with the literature [9]. The ratio of women to men was 1.747. The average age was 35.6; the youngest patient was 3, while the oldest was 83. When the patients were evaluated with regard to organ involvement, liver cysts were found in 425 patients, while lung cysts occurred in 236 patients. Both liver and lung involvement was revealed in 62 patients. Conclusions: In the case of lung cysts, surgical treatment is preferred to medical treatment if there are no serious contraindications for operation. Even if only single cysts are found in the liver, lungs, or both of these organs, the stomach and the thoracic space must also undergo radiological screening.

WOS: 000396361900004, PubMed ID: 28251020, Background: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT) patients. Aims: To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions. Study Design: Retrospective, clinical-based multicentric study of 694 patients with pHPT. Methods: Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH) levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s), histology, as well as the presence of ectopia, presence of dual adenoma, and multiple endocrine neoplasia (MEN)- or familial-related disease. Results: The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria. Conclusion: Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT.

Acute appendicitis is the most common surgical abdominal emergency. In the early diagnosis of acute appendicitis, the fact that there is no a sign which could be a reliable indicator in most of the patients increases the complications. In this study we aimed to search the relation between Ultrasonography(US) findings in patients with diagnosis of acute appendicitis and postoperative histopathologic investigation on remoced appendix..The files of 174 patients who came in our emergency department with lower right abdominal pain were studied retrospectively from January 2013 to May 2014. Of them, 26 patients were excluded, because these patients were not studied with US. US findings and histopathology reports of 148 patients with suspected acute appendicitis and studies preoperatively with abdominal US were enrolled. Greater than 6-mm diameter of the appendix under compression was accepted as positive sign of appandicitis in US. The demographic characteristics of the patients, US findings (acut appendicitis or not) and the pathology results were recorded on the standard proform.Of these 148 patients, 100 were acute appendicitis in preoperative US, and of these 100 patients, 93 histopathologic reports were acute appendicitis, 7 were normal appendices. The sensitivity of US was 75.6 % and specificity was 72 %. Positive predictive value (PPV) was 93 %, negative predictive value (NPV) was 14.6 % and the accuracy of US value was 81.7%. As a result, although US in diagnosis of acute appendicitis is a reliable technique, negative result doesn't mean no acute appendicitis. In order to determine an accurate diagnosis of acute appendicitis clinical and laboratoary findings should be assessed together.Abdominal pain, Acute appendicitis, Ultrasonography.L’appendicite acuta rappresenta la più comune causa di urgenza chirurgica. Il fatto che per la diagnosi precoce non c’è un segno indicativo caratteristico accresce le complicazioni. Con questo studio si è cercato di riconoscere un rapporto tra i casi di appendicite acuta posta con gli US ed i riscontri istopatologici sull’appendice asportata. Sono state esaminate retrospettivamente le cartelle cliniche di 174 pazienti del dipartimento di emergenza che via vevano fatto ricorso per dolori in fossa iliaca destra da gennaio 2013 a maggio 2014. 26 di questi paziente sono stati esclusi perchè non studiati preoperatoriamente con l’ecografia, includendo nello studio i referti istopatogici di 148 pazienti che erano stati sospettati di appendicite acuta. Era stata accettata la diagnosi ecografica di appendicite acuta nel caso di un diametro appendicolare superiore ai 6 mm sotto compressione. Sono state registrate in un modulo standard le caratteristiche demografiche dei pazienti ed i reperti ecografici, positivi o meno per appendicite acuta. In 100 di questi 148 pazienti la diagnosi ecografica preoperatoria era stata di appebdicite acuta, ed il referto istopatologico aveva confermato la diagnosi in 93 casi, mentre in 7 casi si trattave di appendici normali. La sensibilità degli US è risultata del 75,6% e la specificità del 72%. Il valore predittivo positivo (PPV) è stato del 93% e quello negativo (NPV) 14,6% con accuratezza del valore ecografico 81,7% Risulta che l’ecografia è una tecnica affidabile per la diagnosi di appendicite acuta, ma la negatività non significa negazione della diagnosi. Per una diagnosi più accurata i dati ecografici devono essere associati ai rilievi clinici ed ai dati di laboratorio.

The aim of this study is to evaluate the thyroid function tests in order to examine whether 10 % of Povidone-Iodine(PI), the medication we applied in 1/5 ratio diluted with 0.9 %NaCl, joins the systemic circulation during clean contaminated, contaminated and dirty operations for solid organ hydatid cysts in abdominal area to avoid abscess formation and spreading. 7 men and 6 women were included to the present study, prospectively. The mean age was 33.69(± 13.49). TSH, free T3 (fT3) and free T4 (fT4) hormone levels were measured before the operation and at the third day of postoperative period. Amount of used povidone-iodine for patients was recorded. As a result of statistical analysis applied, the preoperative and post operative values were not significantly different regarding with the measured hormone levels (preTSH vs postTSH: p= 0.984; prefT3 vs postfT3: p= 0.101; prefT4 vs postfT4: p=0.146). Thus, it has been shown that the dose we used is effective, and it does not enters at all or at quite low levels into the systemic circulation. Patients whom this application performed, abscess and intestinal adhesions have not been observed in our clinical experience. We recommend the use of suggested doses of Povidone-Iodine in the presence of intraabdominal perforation and abscess or in cases such as carrying a risk of cyst spreading to intraabdominal area in hydatid cysts.Povidone-iodine, Surgical adhesions, Surgical wound infections, Thyroid function tests.Scopo di questo studio è quello di valutare i test di funzione tiroidea per indagare se una soluzione di Povidone- Iodine (PI) al 10%, che usiamo nella diluizione 1/5 con 0,9% NaCl in area addominale durante interventi puliti- contaminati, contaminati e sporchi in caso di idatidosi in organi parenchimatosi, al fine di evitare la formazione di ascessi e la disseminazione, raggiunge la circolazione sistemica. In questo studio sono stati inclusi 7 uomini e 6 donne in maniera prospettica. L’età media era di 33,69 (± 13.49). Preoperatoriamente ed al terzo giorno postoperatorio sono stati dosati i livelli ormonali di TSH, T3 libero (FT3) e T4 libero (FT4). È stata presa nota della quantità di PI usata per ogni paziente. Dall’analisi statistica non sono risultati valori significativamente differenti tra il preoperatorio ed il postoperatorio relativamente al livello degli ormoni tiroidei (preTSH vs postTSH: p= 0.984; preFT3 vs postFT3: p= 0.101; preFT4 vs postFT4: p=0.146). Così si è dimostrato che la dose di PI usata è efficace e non entra, o quanto meno a livello piuttosto basso, nella circolazione sistemica. I pazienti in cui tale procedura è stata usata non sono andati incontro in questa nostra esperienza ad ascessi addominali o aderenze intestinali. Raccomnadiamo dunque l’uso di queste dosi suggerite di PI in caso di perforazioni intestinali o ascessi, o in caso di possibile rischio di disseminazione in area intraaddominale di cisti idatidee.

The purpose of this study was to investigate endotracheal tube cuff pressure alteration in patients during laparoscopic cholecystectomy surgery. Forty patients with ASA I–II physical status, who were scheduled for elective laparoscopic (group I) or open abdominal surgery (group II) were enrolled in the study. Tracheal intubation was always performed by an experienced anesthesiologist. The endotracheal tube cuff was inflated with air through a 10-ml syringe. The cuff was connected to a manometer. The endotracheal cuff pressure was registered every 5 min after tracheal intubation. At the time of discharge from the Post-Anesthesia Care Unit (PACU) and 12 h after tracheal extubation, patients were asked about their laryngotracheal condition by an independent observer who was uninformed of the patient allocation groups. We investigated laryngotracheal complaints such as sore throat, dysphasia, and hoarseness. The endotracheal cuff pressures in group I were significantly higher than those in the group II at all time points studied (P

We aimed to retrospectively analyze patients who underwent surgical treatment in our clinic for hydatid cysts in terms of the surgical methods implemented and their results.Archival records of the patients who underwent surgery for the treatment of hydatid cysts between 2007 and 2014 were analyzed retrospectively.The records of 425 patients who underwent surgery with varying ages of 16 to 88 years (mean: 44.5) were obtained. Among the patients, 33.9% (n=144) were male and 66.1% (n=281) were female. The most frequent symptoms were abdominal pain (46.4%) and dyspepsia (30.9%). About 79.5% of the patients had hydatid cysts in their livers, and 66.8% of these cysts were on the right lobe of the liver. Surgical intervention was performed on 513 cysts. The average diameter of these cysts was 8.3 cm. About 85.5% (n= 438) of the interventions implemented were partial cystectomy. Laparotomy was performed through the right subcostal incision on 81% (n=345) of the patients who underwent conventional surgery. The most frequently encountered complication was biliary fistula. The mortality rate was 0%.The results showed that most of the cases were uncomplicated isolated hepatic hydatid cysts frequently found on the right lobe of the liver. The most frequently implemented surgical procedure was partial cystectomy. This procedure was simple, fast and applicable for uncomplicated hepatic hydatid cysts.Hepatic hydatid cyst, Mortality, Partial cystectomy.

Uterin perforation on pyometra is a rare complication. Clinical symptoms look like gastrointestinal perforation but it is in rare reasons of acute abdomen. In so many cases certain diagnosis can be made by laparotomy. In our case report; a 62 years old female patient presented for literature who came to our clinic with generalize peritonitis diagnosis and uterin perforation due to cervix carcinoma which detected at explorative laparotomy.Keywords: Pyometra, cervical carcinoma, peritonitis, Piyometrada spontan uterin perforasyon nadir bir komplikasyondur. Klinik belirtiler gastrointestinal traktın perforasyonlarına benzemekle birlikte akut batının nadir nedenleri arasındadır. Pek çok vakada kesin tanı laparatomi ile konulmaktadır. Olgu sunumumuzda; generalize peritonit tanısı ile kliniğimize başvuran ve eksploratif laparotomide serviks karsinomuna bağlı uterin perforasyon tespit edilen 62 yaşında kadın hasta literatür eşliğinde sunulmuştur.Anahtar Kelimeler: Piyometra, serviks karsinomu, peritonit

Appendix invagination is a rare condition. It can be seen in both males and females at every age but is seen primarily in males during the first decade of life. Diagnosis is generally made incidentally on patients who are operated on with the suspected preliminary diagnsosis of acute appendicitis. Colonoscopy may be incidentally diagnosed with appendiceal invagination. Endoscopists should be careful because it is possible to come across with caecum polyps. We report on a case concerning a female patient who had occasional abdominal pain. Invagination of the appendix was suspected following colonoscopic examination. The mass was excised with wedge resection. The mass surroundings were fibrotic and blue-black in color. In conclusion, appendix invaginaton is a rare situation and perioperative colonoscopy might be helpful in its diagnosis., Appendiks invajinasyonu çok nadir görülen bir durumdur. Bütün yaş gruplarını ve her iki cinsiyeti de etkileyebilir ancak sıklıkla 1. dekattaki erkek çocuklarında görülür. Genellikle akut apandisit ön tanısıyla ameliyat edilen hastalarda insidental olarak tanı konur. Kolonoskopi ile appendiks invajinasyonu tanısı rastlantısal olarak konulabilir. Çekumdaki poliplerle karışabileceği için endoskopistlerin bu duruma dikkat etmeleri gerekir. Olgumuz 45 yaşında, 1 yıldır aralıklı karın ağrısı olan kadın hasta idi. Hastanın kolonoskopik muayenesinde appendiks invajinasyonu olabileceği düşünüldü. Kitle cerrahi olarak çekumdan wedge rezeksiyonu ile çıkarıldı. Kitle çevresi fibrotik, mavi-siyah rekli görünümdeydi. Sonuç olarak, appendiks invajinasyonu nadir görülen bir durum olup, preoperatif dönemde yapılan kolonoskopi tanı koymaya yardımcı olabilir.

Aim: Perianal Fistula is the chronic stage of anorectal infection and is characterized by intermittent pain associated with purulent drainage or abscess formation followed by spontaneous abscess drainage. In this study, we aimed to investigate the recurrence rates according to the type of surgery performed for patients who underwent surgery for perianal fistula. Material and Methods: The records of 201 patients who underwent surgery in our hospital between the dates of January 2015 and May 2018 were analyzed retrospectively. In addition to the demographic information of the patients included in the study, their complaints, localization of the fistula, type of surgery performed, length of stay in the hospital, postoperative complications, and imaging methods were recorded. Loose or incisional seton stitch, fistulotomy and fistulectomy were performed according to the localization and the type of fistula. The seton stitch method was applied to complex fistulas, and the fistulotomy and fistulectomy methods were applied to simple fistulas. Results: Of the patients included in the study, 178 (88.5%) were males and 23 (11.5%) were females. Their mean age was 41.65 (27-77) years. Of the patients, 136 (67.7%) had complex and 65 (32.3%) had simple fistulas. The fistulas were intersphincteric in 90 (44,8%) patients, transsphincteric in 51 (25.4%) patients, suprasphincteric in 33 (16.4%) patients, and extrasphincteric in 27 (13.4%) patients. Conclusion: The complications and recurrence rates were found to be low postoperatively in all types of surgical procedures performed in our clinic. No statistically significant difference was found between the type of surgery and the recurrence rate.

Background Bowel washout solutions may damage colonic mucosa and cause shallow ulceration, which may result in diagnostic errors and complications. The effects of polyethylene glycol (PEG) and sodium phosphate on rat colon were investigated histologically and by measurement of indicators of oxidative stress. Methods Thirty Wistar albino rats were divided into three groups and received PEG, sodium phosphate or tap water alone (control). After 8 h, histological changes in colonic mucosa were evaluated. The tissue concentration of malonyldialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in colon homogenates was also measured. Results Animals in the sodium phosphate and PEG groups had significantly more colonic mucosal damage than controls, the damage induced by sodium phosphate being worse than that caused by PEG. MDA levels were significantly higher in the sodium phosphate and PEG groups than in controls and were higher in the sodium phosphate group than in the PEG group, whereas differences in SOD and GSH-Px activities were significant only between control and both sodium phosphate and PEG groups. Conclusion Sodium phosphate and PEG cause histological damage and trigger oxidative stress on colonic mucosa. The tissue damage and oxidative stress induced by sodium phosphate is more profound than that produced by PEG.

Background: Rectal prolapse (RP) is a rare condition characterized by rectum’s protrusion through the anus with all of its layers. RP is a condition deteriorating the quality of life. Although more than 100 surgical procedures were described so far for the treatment of RP, the ideal treatment method still remains unclear. In this study, demographical data and clinical results of 13 patients who were treated at our clinic for RP for a period of 3 years were retrospectively studied, with the aim of comparing with the results of other repair methods mentioned in the literature. Methods: Total of 13 patients admitted to the general surgery unit and the emergency units between January 2008 and December 2010 were included in the study. All of the cases were treated by modified Notoras technique using various synthetic materials. Results: Of the patients, 8 were male, and 5 were female. Average age was 45.6 years (range: 23 - 79 years), and the average hospitalization time was 11.3 days (range: 3 - 19 days), with the symptom time being an average of 12 years (range: 1 - 30 years). All patients having complaints described mass prolapsing from the anal canal during defecation, rectal pain, and constipation. Six of our patients also had complaints of rectal bleeding. Average follow-up time was 24 months. No recurrence and mortality were monitored in patients who were followed. Conclusions: The main purposes in the surgical treatment of RP were to control the prolapse, and to achieve continence and remedy constipation . We believe that the modified Notoras technique made using synthetic materials the most suitable one compared to other rectopexy methods in the treatment of RP because it is safe and easily applicable. doi:10.4021/jocmr339w

Gastric cancer during pregnancy is extremely rare and there are problems in its diagnosis and treatment due to the presence of fetus. Beside the difficulties in diagnosis owing to the common symptoms of pregnancy, there are different practices during treatment procedure. Major concern in these cases is the situation of the fetus. There are different views on whether terminate the pregnancy or keep it until the term. It is undisputable that there must be not only medical but also ethical, social, cultural and religious considerations during decision making process. In this report, we planned to present our treatment process, medical outcomes, ethical issues and family involvement in a 23 weeks pregnant woman with gastric cancer. We performed total gastrectomy to the patient before the termination of pregnancy. There was no problem either in the mother or in the fetus at post-op stage. After 3 months, the patient gave birth to a healthy child in term. There was no recurrence or metastasis in postop 9th month control. This information suggests us to be more sensitive on trying to keep fetuses alive until the term and reevaluate our ‘reflexive’ attitude on terminating the pregnancy. Furthermore, we believe that terminating the pregnancy may –and will- cause biological and psychological trauma on mother which may –and will- affect the prognosis negatively.

Objective: To compare systemic stress responses after laparoscopic and open hernia repair to find out if the laparoscopic approach caused less stress than an open operation. Design: Prospective randomised trial. Setting: Teaching hospital, Sanliurfa, Turkey. Subjects: 50 patients who required preperitoneal hernia repair were randomised to be treated by either the open or laparoscopic approach (n = 25 in each). Interventions: Samples of venous blood were taken before operation and at 2, 24, and 48 hours afterwards for measurement of the concentrations of: glucose, cortisol, malonyldialdehyde (MDA), C-reactive protein (CRP), creatine phosphokinase (CPK), caeruloplasmin, transferrin, fibrinogen, and albumin, and counts of leucocytes, neutrophils, and lymphocytes. Main outcome measures: Changes in these indicators of a stress response. Results: Concentrations of glucose, cortisol, CRP, MDA, and CPK, and counts of leucocytes and neutrophils increased significantly, and the concentration of albumin decreased significantly, in both groups postoperatively. Lymphocyte counts were lower postoperatively but not significantly so. Concentrations of CRP, MDA, and CPK, and leucocyte counts were significantly lower in the laparoscopic group. Conclusion: These findings suggest that there is less systemic stress response after laparoscopic than after open hernia repair. Copyright © 2000 Taylor and Francis Ltd.

PURPOSE: This study was planned to evaluate prospectively the results of 112 pilonidal sinus cases treated surgically by using asymmetric excision and primary closure with suction drain and subcuticular skin closure. It is aimed at elimination of the causative factors of pilonidal sinus. METHOD: The patient's age, profession, weight and height, symptoms and signs, duration of symptoms, previous treatments, operation time and cost, hospital stay, return to normal activity, complications, pathologic and microbiologic examinations, and recurrences were noted. All pilonidal sinus cases except pilonidal abscess and extensive gluteal involvement were treated surgically. The procedure consists of an eccentric, elliptical excision of the affected tissue, mobilization of the flap to the sacrococcygeal fascia and the suturing of its edge to the lateral one. Penrose drains were placed in the first eight (7.14 percent) cases, but suction drains were placed in others. The cases were followed up for a mean of 2.4 years. RESULTS: Twenty-eight (25 percent) cases had undergone previous operative procedures. Of 112 patients 106 (94.6 percent) were male. Mean age was 22.1 years. Mean history of disease was 4.2 years. The overall complication rate was 7.14 percent. Two (1.8 percent) wound infections, two wound breakdowns, three (2.7 percent) collections, and one (0.9 percent) recurrence were recorded. The collections were reduced to zero after first eight cases by using a suction drain. Sixty-eight of the patients (60.7 percent) had body weight over 90 kg, and the mean body mass index was 24.8. The mean hospital stay was 2.6 days, and the mean time off work was 12.4 days. The average healing time was 13.2 days. There were no anesthetic or surgical deaths. CONCLUSION: The natal cleft is flattened and the incision scar and the incision line is transferred from the midline to the lateral side by performing the asymmetric excision and primary closure, and thus the essential cause of pilonidal sinus is eliminated. The procedure is simple, the complications and recurrences are very low, and it is seen to be an excellent procedure in the surgical treatment of uncomplicated pilonidal sinus disease.

PURPOSE: The effects of antiadhesive agents on the healing of intestinal anastomosis were investigated. METHODS: Eighty rats were divided into eight groups. Colotomy and anastomosis were performed to all rats. Saline solution (control), carboxymethylcellulose, aprotinin, verapamil, tenoxicam, cyclosporine, and dextran 70 were administered intraperitoneally. Vitamin E was administered intramuscularly. The rats were killed 15 days later. Anastomotic healing was assessed by bursting pressure and the hydroxyproline content of the anastomotic tissues. The results were evaluated by Mann-WhitneyU test. RESULTS: The mean (± standard deviation) bursting pressures of carboxymethylcellulose, cyclosporine, and aprotinin groups (108 ± 6.73, 122.5 ± 14.39, and 127 ± 20.23, respectively) were significantly lower than those of the control group (234 ± 6.19). The mean level of hydroxyproline in the anastomotic tissues was significantly lower in the carboxymethylcellulose and cyclosporine groups (8.92 ± 0.6 and 8.32 ± 0.63) than that in the control group (16.33 ± 0.68). CONCLUSION: These findings indicate that carboxymethylcellulose and cyclosporine had adverse effects on intestinal anastomosis in rats.

Amyand’s hernia is an inguinal hernia with an appendix involved. It is a rare condition. Perforated appendicitis is much less common in this situation and very few cases have been reported in the literature. Preoperative diagnosis is difficult. If additional pathologies exist, the diagnosis is more troublesome. We aimed to present a patient with Amyand’s hernia mimicking acute scrotum which is rare in the literature.

Objective: To study the incidence and causes of pilonidal sinus in Turkish soldiers.Design: Open study by questionnaire.Setting: Military and University hospitals, Turkey.Subjects: 1000 soldiers who presented for their first medical examination.Main outcome measures: Correlation between factors known to be associated with pilonidal sinus, and incidence of pilonidal sinus.Results: 88/1000 soldiers had pilonidal sinuses; in 48 they were symptomatic and in 40 asymptomatic. The factors associated with the presence of a pilonidal sinus were: family history of pilonidal sinus (18/88 compared with 32/912, p < 0.0001); obesity defined as weight over 90 kg (34/88 compared with 32/912, p < 0.0001); being the driver of a vehicle (58/88 compared with 308/912, p < 0.0001); and the incidence of folliculitis or a furuncle at another site on the body (22/88 compared with 64/912, p < 0.0001).Conclusions: Pilonidal sinus is an acquired condition, penetration of hair is the main cause, and the disease can be prevented if th...

Giris ve Amac: Endoskopi unitemizde ust gastrointestinal endoskopi uygulanan hastalarda ozofagus, mide, proksimal duodenum hastaliklari sikliginin retrospektif olarak arastirilmasi amaclanmistir. Gerec ve Yontem: Karabuk Universitesi Egitim ve Arastirma Hastanesi endoskopi unitesinde 2006-2012 yillari arasinda ust gastrointestinal sistem endoskopi yapilarak video arsivleme sistemine kaydedilen hastalarin yasi, cinsiyeti ve endoskopi raporlarindaki ozofagus, mide ve proksimal duodenum hastaliklari belirlendi. Bulgular: Ust gastrointestinal sistem sikayetleri nedeniyle 7703 hastaya endoskopik islem yapildi. Hastalarin 4578’i (%59,4) kadin, 3125’i (%40,6) erkekti. Kadinlarin yas araligi 18-83 (ortalama: 57.8), erkeklerin 20-93 (ortalama: 54.3) yas idi. Hastalarin 565’inin endoskopisinde patoloji tespit edilmedi. Olgularin %99.2’sinde ust gastrointestinal sistem endoskopisi topikal farenks aneztezisi ile yapildi. Ust gastrointestinal sistem endoskopisi uygulanan olgularda mide kanseri orani %1.4 bulundu. Yapilan endoskopik islemler sirasinda komplikasyon ve mortalite orani %0 idi. Sonuc: Ozofagogastroduodenoskopi, ust gastrointestinal sistem hastaliklarin teshisinde hala altin standarttir, topikal farenks aneztezisi ile kolaylikla uygulanabilir, mortalite ve komplikasyon orani oldukca dusuk, tanisal bir islemdir.

Background and Aim: Postoperative pain is an important surgical problem. Recent studies in pain pathophysiology have led to the hypothesis that with pre-operative administration of analgesics (pre-emptive analgesia) it may be possible to prevent or reduce postoperative pain. This study was planned to investigate the efficacy of pre-emptive analgesia on postoperative pain after laparoscopic cholecystectomy. Methods: 45 patients undergoing laparoscopic cholecystectomy were randomized into three groups. Bupivacaine was injected into the area of skin incision before trocar entry and after trocar removal in group 1 and 2, respectively; however, this procedure was not applied to the control group. The pain score of the patients was evaluated by the visual analogue scale (VAS) at 1, 4, 12and 24 h after surgery. The daily analgesic requirement was evaluated in terms of diclophenac sodium (Diclomec, Abdi Ibrahim, 75 mg) intake/day. Analgesics were given to the patients whose VAS was 5 or higher. Results: While there was no significant difference in VAS scores between group 1 and 2, the mean pain scores of these two groups were found to be significantly lower than of the control group although the analgesic requirement of the patients in each group was not statistically significant. Conclusion: Pre-emptive analgesia is as effective as postsurgical local anaesthesia in reducing postoperative pain.

Benign schwannoma is a very rare confronted entity in the liver. Only a very few cases have been reported in the medical literature. A 56-year-old woman was admitted to our hospital with epigastric pain. In the computed tomography scan a cystic mass was observed in the liver. The mass was resected with a prediagnosis of hydatid cyst; intraoperatively a 15x10x10 cm mass filled with hemorrhagic fluid was found. The histological examination confirmed the diagnosis of a benign schwannoma, proven by verocay bodies and a positive immunoreaction with the neurogenic marker S-100 protein.

To compare 2 laparoscopic appendectomy techniques.We describe a modified technique, the handmade endoloop technique, for closing the base of the appendix. This prospective study was carried out at Harran University Medical Faculty, Sanliurfa, and Gulhane Military Medical Academy, Ankara, Turkey from September 2006 to February 2008. We evaluated the safety and efficacy of the procedure in 98 acute appendicitis cases: 57 patients handmade endoloop patients, and 41 endoloop technique patients. Operative time, postoperative complications, need for analgesics, and procedure cost were measured for both groups. The endoloops and sutures used to manage appendectomy were listed at current prices, summarized as number consumed per case, and compared. Data were analyzed by appropriate test.The average price of material used for closing the base of appendix was 81 American Dollars (USD) for laparoscopic appendectomy with endoloop, and 8 USD for the technique described by this article. Overall, postoperative complications, operative time, and the need for analgesia did not show a statistical difference in comparing both groups.This procedure is simple, safe, and cheap.

Colorectal cancer (CRC), also called colon cancer or bowel cancer, includes cancerous growths in the colon, rectum and appendix. The immune system is an important defence mechanism against cancer and is often dysfunctional in patients with malignancies. Cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) and CD28 genes encode receptors that provide negative and positive signals, respectively. Polymorphisms in these genes can affect their functions. In this study, we aimed to investigate the association of cancer with the frequencies and roles of CTLA-4/+49A > G (exon 1) and -318C > T (promoter), and CD28/IVS3 + 17T > C (intron 3 position + 17). These polymorphisms were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 218 Turkish subjects (56 patients with CRC and 162 healthy controls). No statistically significant differences in the genotype distributions of CTLA-4/+49GG (1.8% vs. 6.8%, odds ratio (OR) = 0.250, P = 0.305) and CTLA-4/-318TT (0% vs. 0.6%, OR = 1.006, P = 1.000), and CD28/IVS3 + 17CC (8.9% vs. 3.7%, OR = 0.2411, P = 0.155) between patients with CRC and healthy controls, were observed. We also found that there were no significant differences in the frequencies of CTLA-4/+49G (18.8% vs. 20.1%, OR = 0.920, P = 0.891) and CTLA-4/-318T (7.1% vs. 4.3%, OR = 1.653, P = 0.314), and CD28/IVS3 + 17C alleles (25.9% vs. 19.1%, OR = 1.353, P = 0.139) between two study groups. Present results suggested that CTLA-4 and CD28 gene polymorphisms did not play an important role in Turkish patients with CRC.

Dihydropyrimidine dehydrogenase (DPD) is a critical enzyme in the catabolism of 5-fluorouracil (5-FU), a drug frequently used in cancer therapy. One of the possible causes of severe 5-FU toxicity is genetic polymorphisms in the DPYD gene, such as IVS14+1GA. In this study we aimed to investigate the frequency of the IVS14+1GA mutation in the DPYD gene in Turkish patients with colorectal cancer (CRC) and healthy controls.Blood samples were collected from 218 individuals (56 patients with CRC and 162 healthy individuals), and the DNA was isolated. A polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to detect the frequency of the IVS14+1GA mutation in our population.The IVS14+1GA mutation (heterozygous) in the DPYD gene was identified in two healthy subjects in this Turkish population.The apparently high prevalence (allele frequency of 0.6%) of the IVS14+1GA mutation warrants genetic screening for this mutation in cancer patients before the administration of 5-FU.

Aim: Acute appendicitis is the most common cause of abdominal pain resulting in surgery. This study aims to investigate the efficiency of Alvarado Score (AS) in diagnosis of acute appendicitis. Materials and Method: The files of 185 patients operated due to acute appendicitis between January 2013 and February 2015 were retrospectively examined. The Alvarado Scores of the patients were calculated. The patients were divided into 2 groups as