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Aim:In this study, we aimed to share our surgical experiences and clinical results in non-traumatic small bowel perforations.Method:Patients who underwent surgical treatment for non-traumatic small bowel perforation between 2009-2019 were included in the study. Patients were divided into two groups according to postoperative 90-day mortality status: Group 1 (no mortality), Group 2 (mortality). The demographic, clinical features, treatment methods and results of the patients were compared between the groups.Results:Forty-two patients participated in our study. Group 1 consisted of 25, and Group 2 consisted of 17 patients. Male sex was dominant in Group 2 (48% vs 76.5%, p=0.062). Mean age was higher in Group 2 (54 vs 61, p=0.218). American Anesthesiology Association score (ASA) was statistically significantly higher in Group 2 (12% vs 58.8%). Forty-two percent of patients had abdominal surgery and 30% had a history of malignancy. The presence of electrolyte imbalance was similar in the groups (56% vs 76.5%, p=0.049). The days between the first complaint and laparotomy were similar between the groups (6.40 vs. 5.70 p=0.699). In perforated areas, jejunum was dominant in Group 2 with 64.7%, and ileum in Group 1 with 68%. The multiple perforation rate was higher in Group 2, but was not statistically significant (12% vs 23.5%, p=0.284). From postoperative complications, anastomosis leakage was higher in Group 1, but it was not statistically significant (12% vs 5.9%, p=0.501).Conclusion:Morbidity and mortality of non-traumatic small bowel perforations is high. While the ASA score and hypoalbuminemia were associated with postoperative mortality in non-traumatic small bowel perforations, we did not find the localization of the perforation and the time between the first complaint and laparotomy to be related to mortality.

SUMMARY OBJECTIVE: In multicentric/multifocal breast tumors, there may be immunological and histological differences between foci that may affect survival and treatment choice. We aimed to evaluate the effect of focal heterogeneity seen in multicentric/multifocal breast tumors on survival. METHODS: We retrospectively collected and analyzed the clinicopathological data of 89 female patients with multifocal/multicentric breast cancer, whose surgical and medical treatment was completed and who were followed up for 5 years. RESULTS: Of all patients, 29.2% (26/89) were heterogeneous. Heterogeneity of these foci was as follows: histologic heterogeneity of index foci (mix type): 15.7% (14/89), histologic heterogeneity of inter-foci: 7.9% (7/89), and immunohistochemical heterogeneity of inter-foci: 10.1% (9/89). When additional foci were evaluated, oncological therapy was changed for 3 (3.3%) of 89 patients. Heterogeneity does not have a significant (p>0.05) effect on recurrence and survival in multicentric/multifocal breast cancers. Pathological N stage is an independent risk factor for disease-free survival (hazard ratio=2.29, 95% confidence interval=1.39–3.76, p=0.001). CONCLUSIONS: In multifocal/multicentric breast cancers, less than 4% of patients may experience heterogeneity requiring change in the therapeutic decision. However, heterogeneity does not have a significant effect on recurrence and survival in multifocal/multicentric breast cancers. The pathological N stage is an independent risk factor for disease-free survival.

Objective: The shift in stomach cancer localization has led to new perspectives in the treatment of proximal one-third of the stomach cancer, focusing on the type of resection between total gastrectomy and proximal gastrectomy. We compared the results of patients with proximal gastric cancer, which were treated either with PG or TG regarding postoperative complications, symptoms of reflux esophagitis, the number of dissected lymph nodes, short-term survival, and the compliance to the postoperative planned diet. Materials and Methods: This study included 58 patients who underwent surgery for proximal gastric adenocarcinoma. Of the patients, 32 patients underwent total gastrectomy, while 26 patients underwent proximal gastrectomy. The total and proximal gastrectomy groups were retrospectively compared concerning the number of lymph nodes dissected, postoperative reflux symptoms, dietary compliance, and short-term survival. Results: Reflux symptoms were seen in 10 patients (31.2%) who underwent total gastrectomy versus in 12 patients (46.1%) treated with proximal gastrectomy (p=0.08). Mean number of lymph nodes dissected was 24.6+-13.5 in patients treated with total gastrectomy, whereas 18.8+-6.1 in patients who underwent proximal gastrectomy (p=0.06). Dietary compliance was better in the PG group (p=0.03), while no significant differences were detected between groups about postoperative complications and short-term survival. Conclusion: In the surgical treatment of proximal gastric cancers, proximal gastrectomy performed using an anti-reflux technique, maybe an alternative to total gastrectomy, providing better functional results without compromising oncologic principles.

Choledochal cysts are an uncommon anomaly of unknown etiology of the bilious system. This anomaly, characterized by cystic dilatations on intrahepatic or extrahepatic bile ducts, can be seen at any age from birth. Most rare congenital bile duct cysts choledochocele (type III) is usually diagnosed in adults. Since the congenital choledochal cyst has not a unique clinical finding, the basic criteria for diagnosis are based on imaging findings. This article presents a case of choledochocele accompanying recurrent pancreatitis in a 19-year-old male patient.

Aim:In the present study, we aimed to investigate the seasonal characteristics of presentations to the hospital due to diverticular disease.Method:The patients who were admitted to the hospital between January 1st, 2015 and January 1st, 2020 due to diverticular disease were included in the study. The study was designed retrospectively. The patients were divided into groups according to the treatment method, namely Group 1: patients who received surgical treatment, and Group 2: patients who received medical treatment. Age, sex and seasonal periods were compared. Also, the patients were separated into three groups according to age: those between 18 and 40 years of age, those between 40 and 60 of age and those over 60 years of age. The sex and the treatment methods of the patients were also examined in the season groupsResults:One hundred fifty seven patients participated in our study. Group 1 consisted of 39 patients and Group2 consisted of 118 patients. Presentations to the hospital with acute diverticulitis occurred most frequently in the winter (39.5%). The average age was higher in Group 1 (60.61 vs 54.42, p=0.030). The sex distribution was similar in the groups (p=0.152). Winter was dominant in treatment groups (30.8% vs 42.4% p=0.060). In winter, the average age of the patients who received surgical treatment was higher than those who received medical treatment (68 vs 50 p=0.001). In winter, all patients who received surgical treatment were over 60 years of age. In summer, the ratio of patients who received medical treatment was highest for the group over 60 years of age (p=0.040).Conclusion:In our study, we displayed the seasonal change in hospital admissions due to diverticular disease. We detected an increased rate of presentations to the hospital in winter. Selection of the treatment method did not display a seasonal variation. However, when we made an additional evaluation according to the age groups, it was seen that greater number of patients who were older than 60 years received surgical treatment in winter whereas the greater number of them received medical treatment in summer. Pathophysiological mechanism of this change could not be fully revealed.

SUMMARY OBJECTIVE: Our aim was to investigate the hemogram index parameters and their clinical significance in the evaluation of the inflammatory response of patients with male breast cancer, who are rarely observed in the literature. METHODS: In total, 22 (n=22) healthy male and 28 (n=28) male breast cancer patients without synchronous/metachronous tumors were included in this study. They were grouped as the healthy male control group (Group 1) and the male breast cancer patient group (Group 2). The male breast cancer was divided into two subgroups, namely, early stage [(stage: 0/I/II) (Group 2A)] and late stage [(stage: III/IV) (Group 2B)], and their hemogram index parameters were compared. RESULTS: A significant (p>0.05) increase was observed in neutrophil/lymphocyte ratio (NLR) and·platelet/lymphocyte ratio (PLR) values in the late stage (Group 2B: stage III/IV) compared to the early stage (Group 2A: stage 0/I/II) and healthy control (Group 1) groups. CONCLUSIONS: In male breast cancer patients, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio values were significantly higher as the stage of cancer increased. These readily available simple tests can be used to evaluate the host’s inflammatory response in male breast cancer.

BACKGROUND

Objective: Granulomatous mastitis (GM) is a rare chronic inflammatory disease of the breast. The etiological role of bacteria in granulomatous mastitis, which is the most common type of non-lactational mastitis, is not exactly known. Methods: Our study was carried out with tissue and/or abscess cultures of 46 patients who applied to Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty Hospital, Department of General Surgery, Breast Outpatient Clinic, and Emergency Surgery Service, between January 2015-January 2016 and were diagnosed with GM according to the results of histopathological and clinical examinations. In addition to conventional methods, aerobic bacteria isolated from the samples were identified with the BD Phoenix (Becton, Dickinson Company, Maryland, USA) and anaerobic bacteria with the API 20A (bioMerieux, Marcy l'Etoile, France) kit, and bacterial identification was made by PCR amplification of 16S rRNA from samples in which bacteria were seen in Gram staining but not grow in culture. Antimi-crobial susceptibilities of the bacteria were determined by disc diffusion and gradient test methods. The results were evaluated according to EUCAST 2016 criteria. Results: When the culture results of the patients diagnosed with GM were evaluated, growth was observed in 20 (43.7%) patient materials, and it was not detected in 26 (56.5%) patient materials. Corynebacterium species were detected in 12 (26.1%) of 46 patients. C. kroppenstedtii was isolated in 7 (15.2%), C. urealyticum in 3 (6.5%), and C. amycolatum in 2(4.3%) patients. S. aureus grew in 2 (4.3%) patients, and Klebsiella spp. and Proteus spp. grew in 1 patient each. Peptostreptococcus spp. (3 samples, 6.5%) and B. fragilis (2 samples, 4.3%) were the anaerobic bacteria grown in cultures. Different bacterial species grew together in 6 (30%) of 20 GM patient samples. PCR amplification of 16S rRNA made from pus samples of 19 Gram stain positive but culture-negative cases resulted in C. kroppenstedtii (3 samples), S. epidermidis (3 samples), and anaerobic bacteria such as Peptostreptococcaceae bacterium, Cutibacterium spp., C. acnes, B. breve have been isolated in 1 sample each. Conclusions: We believe that determining aerobic and anaerobic agents that cause granulomatous mastitis and applying specific treatment for the etiological agents rather than using broad-spectrum antibiotics which could lead the antimicrobial resistance, will be beneficial. Antibiotics such as penicillin, gentamicin, vancomycin, and linezolid, which are effective on Gram-positive rods (Corynebacterium species), can be added to the treatment, especially in culture negative cases of granulomatous mastitis.

We aim to evaluate the prognostic significance of tumor volume in esophageal cancer.Patients who underwent curative resection due to esophageal cancer between the years 2015 and 2019 were included in the study. The Tumor Depth Parameter (TDP) was defined as mucosa and submucosa =1, muscularis propria =2, adventitia =3, and invasion into adjacent organs=4. The Tumor Volume Index (TVI) was defined as the major axis X the minor axis X TDP. Two groups were formed based on TVI: Group 1 (low TVI) and Group 2 (high TVI). In the groups; patients were compared in terms of demographic and clinical features, intraoperative and postoperative outcomes, characteristics of the tumor and average survival.The patients were divided into two groups based on the cut-off value of 4,000. Group 1 (low TVI) consisted of 16 patients and Group 2 (high TVI) consisted of 28 patients. Male sex ratio was higher in Group 2 (50% vs 85%, p:0.011) Tumor diameter was observed to be larger in Group 2 (3.06 vs 5.54, p:0.000). Adenocarcinoma histologic type was more common in Group 2 (25% vs 64.3%, p:0.012). Incidence of respiratory complications was higher in Group 2 (0% vs 35.7%, p:0.024),Survival time (months) was shorter in Group 2 (36 vs 11, p:0.005). TVI's being over 4000 (HR)(95%-Confidence Interval ((Cl) 0.057 (0.011-0.311),p:0.001) was an independent risk factor to determine the rate of survival.TVI can be used as a prognostic factor in patients with esophageal cancer who underwent surgical therapy. TVI is closely associated with tumor histology and postoperative outcomes.Esophageal cancer, Prognosis, Postoperative complication, Surgical manangment, Survey, Tumor volume.Si è voluto valutare il significato prognostico del volume del tumore nel cancro esofageo. Per questo sono stati inclusi nello studio i pazienti sottoposti a resezione curativa di cancro esofageo nell’intervallo tra il 2015 e il 2019. Il Tumor Depth Parameter (TDP) è stato definito come mucosa e sottomucosa = 1, muscolare propria = 2, avventizia = 3 e invasione negli organi adiacenti = 4. Il Tumor Volume Index (TVI) è stato definito come l’asse maggiore X l’asse minore X TDP. Sono stati formati due gruppi sulla base del TVI: Gruppo 1 (TVI basso) e Gruppo 2 (TVI alto). Nei gruppi; i pazienti sono stati confrontati in termini di caratteristiche demografiche e cliniche, esiti intraoperatori e postoperatori, caratteristiche del tumore e sopravvivenza media. RISULTATI: I pazienti sono stati divisi in due gruppi in base al valore di cut-off di 4.000. Il gruppo 1 (TVI basso) era composto da 16 pazienti e il gruppo 2 (TVI alto) era composto da 28 pazienti. Il rapporto tra i sessi maschili era più alto nel gruppo 2 (50% vs 85%, p: 0,011) Il diametro del tumore è stato osservato essere maggiore nel gruppo 2 (3,06 vs 5,54, p: 0,000). Il tipo istologico di adenocarcinoma era più comune nel gruppo 2 (25% vs 64,3%, p: 0,012). L’incidenza delle complicanze respiratorie è stata maggiore nel Gruppo 2 (0% vs 35,7%, p: 0,024), il tempo di sopravvivenza (mesi) è stato più breve nel Gruppo 2 (36 vs 11, p: 0,005) .TVI è superiore a 4000 (HR) (95 L’intervallo di confidenza% ((CI) 0,057 (0,011-0,311), p: 0,001) è stato un fattore di rischio indipendente per determinare il tasso di sopravvivenza. CONCLUSIONE: TVI può essere utilizzato come fattore prognostico nei pazienti con cancro esofageo sottoposti a terapia chirurgica. La TVI è strettamente associata all’istologia del tumore e agli esiti postoperatori.

The discovery of ectopic adrenal tissue in the hernial sac is very rare, and in the majority of reported cases it is in children, while it is never described in adult subjects. This could be due to a progressive previous atrophy of the ectopic tissue or to an insufficient examination of the sac removed surgically. The most frequent site of these ectopias is the kidney, adjacent to the adrenal glands. The presence of ectopic adrenal tissue is important because of its neoplastic and hyperplastic potential. We report a case of a 69-year-old male patient who underwent a surgical operation of a left inguinal hernia and that the presence of ectopic adrenal tissue was reported in the pathologist's report. Preoperative abdominal ultrasound should therefore be performed in patients destined for an inguinal hernia surgery, because also the rare existence of ectopic adrenal tissue in the hernial sac should be kept in mind. KEY WORDS: Adrenal, Adult, Ectopia, Herni sac.Il ritrovamento di tessuto surrenalico ectopico nel sacco erniario è molto raro, e per la maggior parte dei casi segnalati si tratta di bambini, mentre non risulta mai descritto in soggetti adulti. Questo potrebbe dipendere da una progressiva precedente atrofia del tessuto ectopico o per insufficiente esame del sacco asportato chirurgicamente. La più frequente sede di queste ectopie è il rene, in adiacenza con le ghiadole surrenali. La presenza di tessuto surrenale ectopico è importante a causa del suo potenziale neoplastico e iperplastico. Segnaliamo un caso di un paziente maschio di 69 anni, sottoposto a rièarazione chirurgica di un’ernia inguinale sinistra e che nel referto dell’anatomo-patologo è stato segnalata la presenza di tessuto surrenalico ectopico. L’ecografia addominale preoperatoria anedrebbe dunque eseguita in pazienti destinati ad un intervento per ernia inguinale, perchè deve essere tenuta presente la pur rara esistenza di tessuto surrenalico ectopico nel sacco erniario.

In this study, we aimed to determine the clinical value and prognostic significance of the Neutrophil / Lymphocyte Ratio in patients undergoing curative surgery due to esophageal cancer.Patients who underwent curative resection for esophageal cancer between 2015-2019 were included in the study. Two groups, Group1 (low NLR) and Group2 (high NLR), were created. Demographic and clinical features, intraoperative and postoperative results, tumor characteristics and mean survival were compared in the groups.A total of 48 patients participated in our study. Group 1 consisted of 18 patients and Group 2 consisted of 30 patients. Male sex was dominant in both groups (66.7% vs 73.3%, p. 0.431). Preoperative CEA was higher in Group 2 (3.97 vs 9.57, p. 0.032). Tumor diameter was larger in Group2 (3.33 vs 5.40 cm, p. 0.000). Adenocarcinoma was higher in Group 2 (33% vs 53.3%, p. 0.047), while squamous cell carcinoma was higher in Group 1 (66.7% vs 33.3%, p. 0.047). Lymph node positivity was higher in Group 2 (66.7% vs 93.3%, p. 0.024). The anastomosis leak was higher in Group 2 (0% vs 20%, p. 0.048). Postoperative hospital stay was longer in Group 2 (13.27 vs 23.9 days, p. 0.009). 90-day readmission was higher in Group1 (33.3% vs 3.3%, p. 0.008). Survival duration was shorter in Group 2 (29 vs 15 months, p. 0.005).This study revealed that preoperative high NLR was associated with poor survival, along with greater tumor diameter, increased lymph node metastasis rate, and increased anastomosis leakage in patients with esophageal cancer. These results suggest that modifying inflammatory responses and modulating the immune system may improve survival outcomes in patients with esophageal cancer.Esophagus cancer, Neutrophil/lymphocyte ratio, Preoperative neutrophil/lymphocyte ratio, Prognosis.Questo studio è finalizzato a determinare il valore clinico e il significato prognostico del rapporto neutrofili / linfociti (NLR) in pazienti sottoposti a chirurgia curativa per cancro dell’esofago. Sono stati inclusi nello studio i pazienti sottoposti a resezione curativa per carcinoma esofageo tra il 2015-2019, suddividendoli in due gruppi, Gruppo 1, con NLR basso e Gruppo 2 con NLR alto. Nei gruppi sono state confrontate le caratteristiche demografiche e cliniche, i risultati intraoperatori e postoperatori, le caratteristiche del tumore e la sopravvivenza media. Hanno partecipato al nostro studio un totale di 48 pazienti hanno. Il gruppo 1 era composto da 18 pazienti e il gruppo 2 era composto da 30 pazienti. Il sesso maschile era dominante in entrambi i gruppi (66,7% vs73,3%, p: 0,431). Il CEA preoperatorio era più elevato nel Gruppo 2 (3.97vs9.57, p: 0.032). Il diametro del tumore era maggiore nel Gruppo 2 (3,33 vs5,40 cm, p: 0.000). L’adenocarcinoma era di grado più elevato nel Gruppo 2 (33% contro 53,3%, p: 0,047), mentre il carcinoma a cellule squamose era più rappresentato nel Gruppo 1 (66,7% contro 33,3%, p: 0,047). La positività dei linfonodi era più elevata nel Gruppo 2 (66,7% vs 93,3%, p: 0,024). La deiscenza anastomotica è stata maggiore nel Gruppo 2 (0% vs 20%, p: 0,048). La degenza post-operatoria è stata più lunga nel Gruppo 2 (13,27 contro 23,9 giorni, p: 0,009). Un nuovo ricovero a 90 giorni si è verificato nel Gruppo 1 (33,3% vs 3,3%, p: 0,008). La durata della sopravvivenza è stata più breve nel Gruppo 2 (29vs15 mesi, p: 0,005). Questo studio ha rivelato che un elevato NLR preoperatorio si è associato a una scarsa sopravvivenza, insieme a un maggiore diametro del tumore, a un aumento del tasso di metastasi dei linfonodi e ad una maggiore incidenza di deiscenza anastomotica in questi pazienti con carcinoma esofageo. Questi risultati suggeriscono che la modifica delle risposte infiammatorie e la modulazione del sistema immunitario possono migliorare gli esiti di sopravvivenza nei pazienti con carcinoma esofageo.

Purpose To investigate the effects of bradykinin on reperfusion injury in an experimental intestinal ischemia reperfusion model. Methods We used 32 Wistar-Albino rats. We composed 4 groups each containing 8 rats. Rats in sham group were sacrified at 100 minutes observation after laparotomy. Thirty minutes reperfusion was performed following 50 minutes ischaemia in control group after observing 20 minutes. Ischaemic preconditioning was performed in one group of the study. We performed the other study group pharmacologic preconditioning by infusional administration of 10 μg/kg/minute bradykinin intravenously. We sacrified all of the rats by taking blood samples to evaluate the lactate and lactate dehydrogenase (LDH) after resection of jejunum for detecting tissue myeloperoxidase (MPO) activity. Results Lactate and LDH levels were significantly higher in control and study groups than the sham group (P0.05). The results were the same for MPO levels. Although definitive cell damage was determinated in the control group by hystopatological evaluation, the damage in the study groups observed was lower in different levels. However, there was no significant difference between the study groups statistically (P>0.05). Conclusion Either ischeamic preconditioning or pharmacologic preconditioning made by bradykinin reduced the ischemia reperfusion injury at jejunum.

Objective: Gastric cancer consists of many histological subtypes. Prognostic value of histological types in gastric cancer has not been very well defined. In this study, we aimed to investigate the relationship between different histological types and clinicopathologic features and prognosis in gastric cancer.

Objective: The most common cause of acute abdomen requiring surgical intervention globally is acute appendicitis (AA). In this study, we aimed to investigate how AA diagnosis is affected by seasonal changes in Central Anatolia. Materials and Methods: In this study, patients who underwent appendectomy with the diagnosis of (AA) between January 1, 2015 and January 1,2019 were evaluated retrospectively. We divided the patients into three groups based on their histopathological results: Group 1 Acute Appendicitis (AA), Group 2 Appendix vermiformis (AV) and Group 3 Perforated appendicitis (PA). Patients were evaluated concerning age, sex and season of operation. Results: Seven hundred ninety-five patients participated in our study. They were separated into the following groups: Group 1 (n=614), Group 2 (n=125), and Group 3 (n=56). Concerning the sex variable, no statistically significant differences were found between the groups (p=0.061). The mean age of the patients in the perforated appendicitis group was higher when compared to the other groups (p=0.001). When evaluated by season, it was seen that during winter, the patients in Group 1 were significantly higher than the patients in the other groups (p=0.009). In our study, acute appendicitis was most frequently diagnosed during winter (28.7%); appendix vermiformis was most frequently diagnosed during spring (32%) and perforated appendicitis was most frequently diagnosed during summer (41%). Conclusion: Although the diagnosis of acute appendicitis varies seasonally, age and seasonal changes may be effective in the frequency of acute appendicitis. In Central Anatolia, the incidence of acute appendicitis increased during winter, while the rate of perforated appendicitis increased in summer and the rate of negative appendectomy increased in spring.

Warfarin is an oral anticoagulant, which is commonly used in the treatment and prophylaxis of thromboembolic conditions. Bleeding is the primary adverse effect associated with warfarin. The majority of warfarin-related bleedings are spontaneous minor hemorrhages occurring in the subcutaneous or intramuscular tissues and can be treated by decreasing the dose of oral anticoagulants. However, although rare, it is possible to encounter spontaneous major bleedings with increased risk of mortality. Conservative approach is the preferred initial therapy for hemodynamically stable patients with major intra-abdominal hemorrhages that we define as the intermediate group patients. Nevertheless, surgery is required for hemodynamically unstable patients with acute abdominal pain in cases of ongoing active hemorrhage, generalized peritonitis, obstruction, acute abdomen, intestinal ischemia, and perforation. In this article, we present a rare case of acute abdomen and spontaneous intra-abdominal hemorrhage resulting from uncontrolled use of warfarin and a new classification requirement.

Of all ingested foreign bodies, 2.4% comprise of sewing needles. Through perforation of gastrointestinal tract, which occurs in 1% of cases, they can migrate into the liver and pancreas. Foreign bodies in pancreas should be considered in the differential diagnosis of chronic abdominal pain. Computed tomography scans provide valuable information for the localization of the lesion, which guide the surgeon during the operation. Secondary to foreign bodies that migrate to the pancreas, complications with high mortality such as pancreatitis, pseudoaneurysm, and pancreas abscess can be seen. Thus, for this patient group, diagnostic laparoscopy is recommended, considering its advantages of decreased postoperative pain, decreased wound infection, and faster recovery time. Here we present a case of a 23-year-old female patient, from whom an ingested needle that migrated from the back wall of the stomach to the pancreas was extracted by laparoscopic surgery.

Appendiceal diverticular disease (ADD) is a rare pathology which is associated with an increased mortality risk due to rapid perforation and high rates of neoplasm. In our study, we aimed to evaluate the clinical and histopathological characteristics of ADD with differences from acute appendicitis (AA) diagnosis and to determine the association with neoformative processes. The 4279 patients who underwent appendectomy were evaluated retrospectively. ADD patients histopathologically classified into four groups. Patients’ demographic characteristics, imaging and preoperative laboratory findings, additionally postoperative histopathology results were compared between groups. The prevalence of ADD was 2.29% (n = 98). In addition, the male/female ratio was 2.37 in ADD patients who were found to be significantly older than those with AA patients. Type III was the most frequently (62.2%) identified sub-group of ADD. The incidence of neoplasms, plastrone, and Littre’s hernia was found statistically higher in ADD group than AA group. Mucinous adenomas (10.2%) was the most common neoplasm while the carcinoid tumor (1%) and precancerous serrated adenomas (4.1%) were also reported. As a result, high neoplasm in ADD patients can be shown with incidence of perforation and plastron, and in order to avoid possible neoplasm or major complications, it is necessary to carry out new studies for the right diagnosis of ADD whether the diagnosis is done preoperatively or intraoperatively. We recommend surgical resection of the ADD, which may even be incidentally detected during any surgical procedure, due to its high risk of neoplasm and rapid perforation.

Aim: In our study, we aimed to investigate the effect of BMI on surgical treatments and general outcomes, as well as on the severity of the injury caused by the sharp object. From an anatomical point of view, increased body mass index (BMI) is expected to have a protective effect in limiting organ damage in the case of sharp object injuries. Material and Methods: Data of the patients with penetrating abdominal injuries who applied to the emergency service of the University between January 2015 and January 2020 were analyzed retrospectively. Patients’ ages, genders, body mass indexes (BMIs), needs for surgical intervention, injury severity scores (ISS) and mortality were evaluated. Patients were divided into 2 groups: obese patients (BMI>30; Group1) and non-obese patients (BMI30; Group2). Results: Seventy-eight patients whose data were available were included in the study. Thirty-three of the patients were determined to be obese (Group1) while 45 were determined to be non-obese (Group2). The mean age of the patients in group1 was significantly higher than the patients in group 2 (p=0.011). The mean ISS of the patients in group 1 was 11.03±8.24 while it was 16.93±13.68 in group 2. The ISS was significantly higher in group2 (p=0.031). Alcohol intoxication levels of the patients in Group 2 were significantly higher than Group 1 (p=0.006). A statistically significant difference was not present between the groups in terms of number of past surgical interventions (p=0.627); however, it was determined that 57% of the surgical interventions in Group 1 were performed for diagnostic purposes and that no pathologies were detected in 45% thereof. Discussion: As a result, increased BMI is associated with lower injury severity scores and decreased need for operation in sharp object injuries. Slim patients are more likely to need surgery and be severely injured.

Aim: In this study, we aimed to investigate the factors related to postoperative mortality after pancreatoduodenectomy in our clinic. Materials and Methods: Patients who underwent pancreatoduodenectomy due to a periampullary region tumor between 2010 and 2019 were included in the study. Mortality that occurred within 30 days after PD was defined as postoperative mortality and groups were formed according to this definition Group 1(Postoperative Mortality) and Group 2(No mortality). The demographic and clinical features, laboratory parameters, and tumor features of the patients were compared between the groups. Risk factors for mortality were analyzed by univariate analysis and multivariate logistic regression analysis. Results: 155 patients participated in our study. We found our postoperative mortality rate as 11.6%. Accordingly, Group 1 consisted of 18 and Group 2 consisted of 137 patients. The sex was similar (p: 0.235). The average age was higher in Group 1 than 2 (71.2 vs 63.7, p:0.013). Tumor localizations were similar in groups (p:0.275). Lymph node positivity was similar in the groups (50% vs 41.6%, p:0.333). The pancreatic fistula was higher in Group 1, but not statistically significant (33% vs 18.2%, p:0.119). Preoperative white blood cell count (9490 mm3 vs 8050 mm3) and neutrophil count (6898 mm3 vs5442 mm3) were higher in Group 1. In multivariate analysis, no parameters were single-handedly risk factors. Conclusion: No factor was found to be effective alone in the development of mortality after pancreaticoduodenectomy. We think that postoperative mortality may decrease by revealing the factors in the preoperative, intraoperative and postoperative periods.

Aim: In this study, we aimed to determine the clinical value and prognostic significance of neutrophil / lymphocyte ratio in predicting pancreatic fistula in patients who underwent pancreatoduodenectomy due to periampullary tumor.Material and Methods: Patients who underwent pancreatoduodenectomy for periampullary tumor between 2010-2019 were included in the study. Group 1 (LowNLR) and Group 2 (HighNLR) were formed. Demographic and clinical characteristics, intraoperative and postoperative outcomes, and mean survival were compared between the groups. The significance of NLR in predicting pancreatic fistula at the cut off value was examined.Results: Patients were divided into two groups according to the 3.15 cut off value. Group 1 consisted of 61 patients and Group 2 consisted of 62 patients. In Group 2, albumin gr/dl value was lower (3.25 vs 3.70, p:000). in Group 2 pancreas tumors were more common (59.7% vs 42.6%, p: 0.041). The number of metastatic lymph nodes was higher in Group 1 (1.21 vs 0.63, p: 0.043), and the postoperative pancreatic fistula rate was similar (14.8% vs 21%, p: 0.254). Postoperative complications were higher in Group 2 (41.9% vs 14.8%, p: 0.032) NLR predicted pancreatic fistula with a sensitivity of 31.8% and specificity of 86.4%. In multivariate analysis, we found NLR to be a risk factor for survival (HR 1.760, 95% CI,1.179-2.627; p:0.006).Conclusion: Patients with a preoperative high NLR have a worse prognosis than patients with low NLR. It cannot be used alone to predict pancreatic fistula. NLR has the potential to be used in the management of patients.

Background The determination of a definitive preoperative diagnosis of acute appendicitis (AA) remains a challenge; however, delays in diagnosis increase complication rates. The aim of this study was to investigate the contribution of the Alvarado score (AS) alone and the AS combined with the use of the biological indicators of C-reactive protein (CRP), procalcitonin (PCT) and neopterin (NP) in the diagnosis. Methods Serum was collected from 100 patients who were admitted to the general surgery clinic of Istanbul University, Cerrahpasa Medical Faculty between March 4, 2014 and July 29, 2015 with the pre-diagnosis of AA and who agreed to take part in the study. The serum samples were stored at -70°C. The patients were divided into 2 groups: AA-positive (n=60) and AA-negative (n=40). The AA positive group was divided into subgroups of complicated (n=11), uncomplicated AA (n=49) and the AS, CRP, PCT, NP levels were compared. Results The study population consisted of 45 men (45%) and 55 women (55%), with a mean age of 32.8+-13.7 years (range: 18-92 years). There was no significant difference between the groups in age and gender. There were 24 patients with an AS ≤4 (3 had surgery), 35 patients with an AS of 5-7 (22 had surgery), and 41 patients with an AS of 8-10 (38 had surgery). Three of the 63 patients who underwent surgery were diagnosed with a normal appendix. The serum CRP, PCT, and NP measures were found to be inadequate to make an AA diagnosis alone, these values increased the sensitivity and specificity of the AS. The biological indicators were also significant in differentiating between the complicated and uncomplicated AA groups (p Conclusion Although the AS is useful, additional testing and clinical approaches are valuable to inform the diagnostic procedure. When considered alone, serum CRP, PCT and NP values are insufficient for a diagnosis of AA. However, they increased the diagnostic value of the AS and can be helpful in distinguishing complicated AA cases.

Here, we report the case of an 84-year-old woman with acute mechanical intestinal obstruction (AMIO) who was admitted to our Emergency Department. Computed tomography (CT) scan revealed an incarcerated bilateral obturator hernia, and the defect was resolved using transabdominal preperitoneal (TAPP) technique with polypropylene mesh. The patient was administered an oral regimen two days after the operation. The patient stayed in the intensive care unit for 4 days and was uneventfully discharged on the 9th postoperative day. Follow-up was scheduled at the 6th month, during which no adverse events were detected and the patient did not report any complaints. Obturator hernia is among the differential diagnoses of intestinal obstruction requiring early diagnosis and prompt surgical intervention. Laparoscopic approach is less invasive compared with open surgery, and it can be attempted in cases presenting with no sign of ischemia or peritonitis. TAPP technique should be preferred since it allows the control of all intraabdominal pathologies and the viability of the intestines.

Introduction: This study aimed to compare endo-loop and polymer locking clip (Hem-o-lok) for the closure of the appendix base during laparoscopic appendectomy. Materials and Methods: In this prospective clinical study, two groups (Group 1: endo-loop and

The most common clinical causes of metallic foreign body in the breast are surgical clips, pieces of guide-wire and gunshot wounds. Metallic foreign bodies can lead to local breast pain, abscesses, pneumothorax after granulomas or migration, and cardiac tamponade. Mammotome biopsy, fluoroscopy, guide-wire biopsy and radio-guided occult lesion localization (ROLL) are the standard techniques applied for surgical excision of non-palpable breast lesions. This article presents the second case in the literature undergoing the ROLL technique for the removal of a metallic foreign body from the breast.