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Pancreatic head adenocarcinoma (PHAC) is one of the most aggressive malignancies, and it has low long-term survival rates. Surgery is the only option for long-term survival. The difficulties associated with PHAC include higher frequencies of regional or distant lymph node metastases and vascular involvement, and positive resection margins in pancreatic and retroperitoneal tissues. Radical resections increase margin negativity and life expectancy; however, the extend of the surgery applied is controversial. Thus, western and eastern centers may use different approaches. Multiorgan, peripancreatic nerve plexus, and vascular resections have been discussed in relation to radical surgery for pancreatic cancer as have the roles of neoadjuvant and adjuvant therapy regimens. Determining the appropriate limits for surgery, standardizing definitions and surgical techniques according to guidelines, and centralizing pancreatic surgery within high-volume institutions to reduce mortality and morbidity rates are among the most important issues to consider. In this review, we evaluate the basic concepts underlying and the roles of radical surgery for PHAC, and lymphadenectomy, nerve plexus, retroperitoneal tissue, vascular, and multivisceral resections, total pancreatectomy, and liver metastases are discussed. WOS:000465470700004 31057699 Q3

In the differential diagnosis of biliary obstruction with unknown etiology, biliary fascioliasis should be considered in endemic and nonendemic regions. After diagnostic evaluation, endoscopic retrograde cholangiopancreatography (ERCP) was performed for etiological evaluation and/or treatment of biliary obstruction in five patients with a mean age of 55.8 years. Endoscopic sphincterotomy and cholangiogram revealed linear filling defects in the biliary system. Fasciola hepatica parasites were extracted using balloon and basket catheters in two and three patients, respectively. No morbidity or mortality was observed. F. hepatica infection should be considered as a differential diagnosis of biliary obstruction with unknown etiology in endemic and non-endemic regions. ERCP can be the standard diagnostic and/or therapeutic procedure in cases of biliary obstruction due to fascioliasis. Due to slippery and gel-like characteristics of the parasite, use of a basket catheter in semi-opened position may be required in case of unsuccessful extraction using a balloon catheter.

We used self-expandable metallic stents in benign disease-related fistulas of the esophagus and report our experience pertaining to three cases. All the cases were implanted with retrievable stents under direct endoscopic view and fluoroscopic control. The fistulas were closed within two weeks in all cases. While one of the stents was endoscopically retrieved, the other two were not taken out due to the adverse general condition of the patients. In benign esophageal fistulas, SEMS can be an alternative to surgical intervention because of their easiness of placement and the possibility of retrieval at an early stage., Benign özofagus hastalıklarına bağlı fistüllerde kendiliğinden genişleyen kaplı metal stentlerin kullanımını 3 olguda değerlendirdik. Tüm olgulara çıkarılabilir stentler endoskopik olarak direkt görüş altı nda ve floroskopik kontrol yapılarak yerleştirildi. Olguların tümünde fistülün 2 hafta sonra kapanmış olduğu görüldü. Stentlerin 1 olguda endoskopik olarak çıkarılırken, diğer iki stent hasta genel durumu bozukluğu nedeniyle çıkarılmadı. Benign özofagus fistüllerinde metal stent kolay yerleştirilmeleri, erken dönemde çıkarılabilmeleri nedeniyle cerrahi girişime alternatif olarak seçilmiş vakalarda kullanılabilirler.

RReessiimm 33..Bulbus apeks ön duvar tavanda koledokoduedonosto- mi anastomoz hattı ve anastomoz orifisinde koledok lümeninde distale doğru uzanan yabancı cisim görülerek çıkarıldı. Safra ve pü akışı gözlendi

Mide içinde çok çeşitli yabancı cisim görülebilmektedir. Bazıları kaza ile yutulurken, çoğunda hastanın mental retardasyonu veya psikiyatrik sorunu olması nedeniyle istemli ya da istemsiz olarak uzun süreli bir yutma söz konusudur. Sonuçta ağızdan alınıp, özofagustan geçebilecek herşeyi yabancı cisim olarak mide’de görmek mümkündür

Complications during arthroscopic procedures of the knee are reported in a low rate. Although vascular injuries are unusual, popliteal artery injury is a serious complication which can results in an amputation. In this study, we report a case who was admitted to our department with calf pain, swelling, decreased temparature and loss of motor function. Popliteal vein injury and pseudoaneurysm due to popliteal artery injury were diagnosed. We operated the patient immediately., Diz eklentinin artroskopik girişimlerinde düşük oranlarda komplikasyonlar bildirilmektedir. Vasküler ya-ralanmalar nadir olarak görülmekle birlikte popliteal aner yaralanmaları amputasyona sebep olacak kadar ciddi komplikasyonlardan biridir. Bu çalışmada, artroskopik girişim sonrası bacakta ağrı, şişme, soğukluk ve hareket kaybı şikayetleri ile kliniğimize başvuran, tetkiklerinde sağ popliteal arter yaralanmasına bağlı psodoanevrizma ve popliteal ven yaralanması saptanarak ameliyat edilen bir olgu takdim edilmektedir.

A 31 years old male patient is presented on whom compartment syndrome developed spontaneously on his right leg without any initiative reason. An emergency four compartment fasciotomy was performed. Debridment was not performed as he did not have necrosis. 1 month later the patient was discharged with full range of motion and muscle strength., 31 yaşındaki bir erkek hastada tipik bir başlatıcı neden olmadan sağ crusta spontan olarak gelişen kompartman sendromu sunulmaktadır. Hastaya acil 4 kompartman fasiotomisi uygulanmıştır. Nekroz olmadığı için debridman yapılmamıştır. 1 ay sonunda hasta full hareket ve kas gücüne sahip olarak taburcu edilmiştir.

Papiller bölgenin tümörleri majör papilla, ampulla Vater veya periampuller duodenum kaynaklı olabilen oldukça heterojen bir gruptur. Bu bölge tümörlerinin malignite potansiyeli olması nedeniyle rezeksiyonları zorunludur. Endoskopik rezeksiyon, transduodenal lokal eksizyon ve pankreatikooduodenektomi tedavi seçenekleri arasındadır. Yazıda, kliniğimize tıkanma sarılığı bulgularıyla başvuran ve endoskopik biyopsi sonucu villöz adenom olarak gelen bir hastanın, endoskopik papillektomi ile tedavisini ve sonuçlarını tartıştık. Papillary region's tumors are a heterogeneous group that can be derived from major papilla, the ampulla of Vater or periampullary duodenum. Because of their malignant potential, resection of these lesions is mandatory. Endoscopic resection, transduodenal local excision and pancreaticoduodenectomy are the treatment options. In the case, we emphasize the result of an endoscopic approach to a patient with symptoms of obstructive jaundice due to villous ampullary adenoma, treated with endoscopic snare papillectomy.

WOS: 000345115100025 PubMed ID: 25386073 Most cases of hepatic hydatid disease exhibit uncomplicated clinical course and management. However, the diagnosis and management of complicated hepatic hydatid disease is a special issue. One of the most common and serious complications of hepatic hydatid disease is the rupture of the cyst into intrahepatic bile ducts. The clinical appearance of intrabiliary rupture can range from asymptomatic to jaundice, cholecystitis, cholangitis, liver abscess, pancreatitis and septicemia. Current treatments for major ruptures can result in high morbidity and mortality rates. Furthermore, ruptures that cannot be diagnosed preoperatively can induce complications such as biliary fistulae, biloma, cavitary infection and obstructive jaundice. In the past, these complications were diagnosed and treated by surgical methods. Currently, complications in both the pre- and postoperative periods are diagnosed and treated by non-invasive or minimally invasive methods. In clinical practice, endoscopic retrograde cholangiopancreatography (ERCP) is indicated for patients with preoperative frank intrabiliary rupture in which hydatid elements are clearly seen in the bile ducts, or for biliary adverse events after surgery, including persistent biliary fistulae and jaundice. However, controversy concerning routine preoperative ERCP and prophylactic endoscopic sphincterotomy in patients suspected of having minor cystobiliary communications still remains. In this article, the role of ERCP in the diagnosis and management of hepatic hydatid disease during the pre- and postoperative periods is reviewed.