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BACKGROUND Currently, pancreaticoduodenectomy (PD) is considered a commonly performed surgery for periampullary tumours; but, it is still a high-risk surgical procedure with potential morbidity and mortality rates. Previous studies have identified a significant volume–outcome relationship for hospitals performing pancreaticoduodenectomy (PD). We intended to present the results of patients who underwent pancreatic resection with the diagnosis of malignancy in a low-volume centre. METHODS Patients who underwent pancreatic resection with the diagnosis of malignancy at the 2nd stage state hospital between 2014 and 2018 were included in the study. Patients who underwent pancreatic surgery due to trauma and benign reasons were excluded from the study. Clinical data of the patients have been analysed retrospectively. RESULTS 12 patients participated in our study. 8 patients were male. The average age was 65.75 and the oldest patient was 85 years old. The mean values of preoperative laboratory parameters were HGB gr / dl: 12.3; Albumin gr / dl 3.8 Cea ng / ml 4.08 Ca19.9 U / ml 194 Whipple procedure and the other half was applied distal pancretectomy, the mean tumor diameter was 3.67, the mean number of lymph nodes dissected was 18.1. Postoperative morbidity rate was 33.3. Pancreatic fistula, biliary fistula, wound infection and pulmonary embolism were seen in one patient each. Average hospital stay was 10.66 days. Mortality occurred in patient who had developed pulmonary embolism. CONCLUSIONS Pancreatic resections can be performed safely in low-volume centres, with morbidity and mortality rates comparable to high-volume centers. Patients who have difficulty in accessing high-volume academic centers can be operated in low volume centers. KEY WORDS Pancreatic Cancer, Low Volume Center, Morbidity

Background: In this study, we aim at investigating the effect of post partial hepatectomy Ankaferd blood stopper (ABS) on liver regeneration in rats. Methods: Twenty-four rats were included in our study divided into three groups. (Group A = (Sham) 8 rats, Group B = (control) 8 rats, Group C = (experimental) 8 rats). Two-thirds hepatectomy was employed in all rats. Intraperitoneal 0.9% saline was administered to the rats in the control group, and intraperitoneal 1 ml Ankaferd was administered to the rats in the experimental group. The rats were sacrificed on the 7th day. Tissue samples were taken from the liver tissue for histopathological evaluation. Results: The number of mitosis and the cytoplasmic vacuolization/hdyropic degeneration scores were statistically different between the groups (Group A: 11.63 vs Group B: 17.00 vs Group C: 8.88 (p:0.028) and Group A: 8.56 vs Group B: 16.63 vs Group C: 12.31 (p:0.034), respectively). The presence of binuclear hepatocytes score was p: 0.258 and disorganized distribution in cell proliferation in the parenchyma score was :0.076; There was no statistical difference between the groups. The number of mitosis was p:0116 for Group A-B, p:1.00 for Group A-C and p:0.017 for Group B-C Conclusions: Positive results indicating an increase in liver regeneration due to Ankaferd were not obtained in our study.

BACKGROUND Worldwide, colorectal carcinomas are the third most common carcinomas in men and the second most common carcinomas in women. Pathological examination of rectum specimens requires special attention for correctly evaluating many prognostically important factors. In this study, we present pathological results of 173 lower anterior resection (LAR) and abdominoperineal resection (APR) specimens retrospectively evaluated. MATERIAL AND METHODS We included 173 LAR and APR specimens in this study. Patients were evaluated in the Istanbul Ekin Private Pathology Laboratory and underwent surgery at Canakkale State Hospital, General Surgery Clinic. RESULTS Of the 173 specimens, 15 (8.7%) were APR and 158 (91.3%) were LAR specimens. Ninety-four patients (54.3%) were males and 79 patients (45.7%) were females. The mean age of the patients was 63.5 years (range 26-90 years). In the histopathological examination, malignant neoplasm was detected in 172 of the cases (99.4%) and benign endometriosis was detected in 1 of the cases (0.6%). There were 151 (87.2%), 8 (4.6%), 5 (2.9%), 1 (0.6%), 1 (0.6%), 1 (0.6%), 1 (0.6%), 1 (0.6%), and 4 (2.3%) patients with adenocarcinoma, mucinous adenocarcinoma, intramucosal adenocarcinoma in the setting of a high-grade tubulovillous adenoma, synchronous colon/prostate adenocarcinoma, malignant melanoma, signet ring cell carcinoma, gastrointestinal stromal tumor, endometriosis, and adenocarcinoma diagnosed by the examination of colonoscopic biopsy specimens that showed complete regression with neoadjuvant therapy, respectively. CONCLUSIONS When evaluating specimens from patients with colorectal carcinoma, pathological evaluation, which is one of the most fundamental pillars in managing patients with cancer, must be performed carefully and meticulously. Each pathological parameter should be evaluated carefully and clinicians and pathologists should evaluate these cases together.

Purpose: To investigate the effects of pycnogenol on peritoneal adhesions and additionally to investigate the immunohistochemical effects of free oxygen radicals and reactive lymph nodes detected in the adhesive tissue that was sampled surrounding the cecum on intra-abdominal adhesions. Methods: Twenty-seven Wistar Albino rats were divided into three groups. In group 1 (sham), laparotomy was performed and stitched up. In group 2 (control), after laparotomy was performed, punctate hemorrhage was induced by cecal abrasion in the cecum and each rat was intraperitoneally administered 2 cc of saline. In group 3 (experimental), after laparotomy was performed, punctate hemorrhage was induced by cecal abrasion in the cecum and each rat was intraperitoneally administered a sterile Pycnogenol derivative. The rats in all groups were re-laparotomized on postoperative day 7; samples were obtained from the peritoneal tissue surrounding the cecum, and the rats were sacrificed. Results: In group 3, there was a statistically significant difference in terms of inflammation, lymph node size, and free oxygen radicals; these parameters tended to increase. In terms of fibrosis evaluated using H&E and MT, there was no significant difference between groups 2 and 3. Conclusions: No positive outcomes indicating that pycnogenol reduces intra-abdominal adhesions were obtained. However, it caused severe inflammation in the tissue. Moreover, a significant increase in lymph node size was detected secondary to inflammation. Additionally, in immunohistochemical analyses conducted to detect oxidative stress, pycnogenol increased the production of free oxygen radicals in the tissue.

Idiopathic granulomatous mastitis (IGM) is a benign disorder of the breast, for which the optimal treatment modality remains missing. A total of 124 patients with a histopathologically proven diagnosis of IGM were enrolled in a prospective, randomized parallel arm study. Patients were treated with topical steroids in Group T (n: 42), systemic steroids (0.8 mg/kg/day peroral) in Group S (n: 42), and combined steroids (0.4 mg/kg/day peroral + topical) in Group C (n: 40). Compliance with the therapy, response to the therapy, the duration of therapy, side effects and the recurrence rates were compared. Sixteen patients did not comply with the treatment, and the highest ratio of compliance with therapy was seen in Group T (p

Splenic abscess is a rare condition, which is often asymptomatic in the absence of comorbidity and is associated with high mortality rates. Given the importance of the differential diagnosis of patients who present to the emergency department with fever or septic shock, we report the case of a patient with amoebic splenic abscess who presented to our clinic with widespread skin rash and signs of septic shock following amoebic dysentery caused by Entamoeba histolytica, which is rarely reported in the literature. KEY WORDS: Amoebic Spleen Abscess, Amoebic Abscess, Entamoeba Histolytica, Splenic Abscess.L’ascesso splenico è una condizione rara, che è spesso asintomatica in assenza di comorbilità ed è associata ad alti tassi di mortalità. Data l’importanza della diagnosi differenziale dei pazienti che si presentano al pronto soccorso con febbre o shock settico, riportiamo il caso di un paziente con ascesso splenico amebico presentatosi alla nostra clinica con diffusa eruzione cutanea e segni di shock settico in seguito a dissenteria amebica causata di Entamoeba histolytica. Tale evenienza è raramente riportata in letteratura.

The goal of the study is to describe postoperative complications observed after colostomy reversal and to define possible risk factor(s) for complication.s after colostomy closure PATIENTS-METHODS: Patients who underwent colostomy closure in Department of General Surgery, Dr Lutfi Kirdar Kartal Education and Research Hospital between January 2007 and January 2015 were enrolled. Patients with double-barrel ileo-colostomy, Devine's colostomy and tube cecostomy were excluded from study. Demographics, data regarding the first operation and those regarding the reversal operation were analyzed and compared.Total 168 patients [118 (70.1%) male, average age=52.8±15.6] were included. Most common reasons for stoma formation were malignancy [n=63 (37.5%)] and diverticular perforation [40 (23.8%)]. Index operation was performed under emergency conditions in 142 (84.5%) patients. End colostomy was the most common stoma type in emergent cases and loop sigmoidostomy in elective cases. Postoperative complication was observed in 36 (21.4%) patients. Nine (5.3%) patients developed anastomotic leak. Of those, 8 (4.8%) was necessitated reoperation and 1 (0.6%) was treated conservatively. Postoperative mortality was 5 (2.9%). At multivariate analysis, DM was the independent risk factor for surgical site infection and evisceration (p0.01). DM was present in 6 (66.7%) cases who had had an anastomotic leak and leak was more common compared to non-diabetics (p0.05). Patients waiting more than 3 months before stoma reversal had experienced more anastomotic leak compared to those waiting less (p0.05).Closure of colostomy has a significant morbidity and mortality, and the physician should be more careful in postoperative follow-up in patients who had comorbidities, especially diabetes mellitus.Anastomotic leak, Colostomy, Postoperative complication.Lo scopo dello studio è la descrizione delle complicanze postoperatorie che possono osservarsi dopo la chiusura di una colostomia per definire possibili fattori di rischio per tali complicanze. Sono stati studiati i pazienti sottoposti a colostomia nel Dipartimento di Chirurgia Generale “Education and Research Hospital Dr. Lutfi Kirdar Kartal” tra gennaio 2007 e gennaio 2015. Sono stati esclusi dallo studio i pazienti con ileo-colostomia a doppia canna, con colostomia di Devine e ciecostomia su tubo. Sono stati analizzati e confrontati i dati demografici, quelli relativi alla prima operazione e quelli riguardanti l’operazione di chiusura della colostomia. Sono stati compresi 168 pazienti in totale, di cui 118 (70,1%) uomini dell’età media di 52,8 ± 15,6 anni. Le ragioni più comuni del ricorso alla colostomia erano state un tumore (n = 63 casi, pari al 37,5%) e la perforazione diverticolare (n=40 casi, pari al 23,8%). L’indicazione all’intervento era stata d’urgenza in 142 casi (84,5%). La colostomia terminale era il tipo più comune nei casi in emergenza, e la sigmoidostomia su bacchetta nei casi in elezione. Una complicanza postoperatoria è stata osservata in 36 pazienti (21,4%). Nove pazienti (5,3%) hanno sviluppato una deiscenza anastomotica. Di questi in 8 casi (4,8%) è stato necessario un reintervento e in 1 caso (0,6%) la questione è stata risolta in modo conservativo. La mortalità postoperatoria si è avuta in 5 casi (2,9%). All’analisi multivariata, il diabete mellito è risultato il fattore di rischio indipendente per l’infezione e l’eviscerazione del sito chirurgico (p0,01). Diabete mellito era presente in 6 casi (66,7%) che avevano avuto una deiscenza anastomotica, la causa più comune rispetto ai non diabetici (p0,05). I pazienti restati in attesa della chiusura dello stoma per più di 3 mesi hanno presentato una maggiore incidenza di deiscenza rispetto a quelli in attesa inferiore ai 3 mesi (p0,05). Si conclude che la chiusura della colostomia ha una morbilità e una mortalità significative e il medico deve prestare maggiore attenzione nel follow-up postoperatorio nei pazienti che presentavano comorbilità, in particolare il diabete mellito.

Necrotizing fasciitis (NF) is a rare, life-threatening soft tissue infection that affects the skin, subcutaneous tissue, fascia, and muscle, and is characterized by rapid spread and invasion of pathogens. Treatment is possible with early diagnosis, appropriate antibiotic therapy, and quick surgical intervention. Nevertheless, despite all interventions, it is sometimes difficult to manage NF. The Authors present the case of a patient with extensive NF caused by multidrug-resistant Acinetobacter baumannii (A. baumannii) that developed following an intramuscular injection of diclofenac sodium administered at home by someone who was not a healthcare professional. Wound sample culture revealed multidrug-resistant A. baumannii. The patient was treated using negative-pressure wound therapy along with antibiotic treatment and extensive surgical debridement. KEY WORDS: Multidrug-resistant acinetobacter baumannii, Necrotizing fasciitis, Negative-pressurelf-injection, Wound therapy.La fascite necrotizzante (NF) è una rara infezione dei tessuti molli che mette a rischio la vita, ed interessa la pelle, il sottocutaneo, la fascia ed I muscoli, caratterizzata da una rapida diffusione ed invasività di germi patogeni. Il tratta,emto è possibile in caso di diagnosi precoce, trattamento antibiotico appropriato e rapido intervento chirurgico di sbrigliamento e necrosectomia. Ciononostante nonostante tutti i provvedimenti il trattamento della NF è difficile. Qui viene presentato il caso di una paziente con NF estesa causata da un Acinetobacter baumannii resistente a molti antibiotici, insorto a seguito di una iniezione intramuscolare di diclofenac sodio praticata a domicilio da un profano della professione sanitaria. Lo studio colturale della ferita ha dimostrato la presenza del A.baumannii antibiotico- multi-resistente. La paziente è stata trattata con terapia a pressione negativa insieme a trattamento antibiotico e sbrigliamento chirurgico esteso della ferita.

Hepatocellular adenomas (HA) are benign naturally occurring masses that are rarely reported, and rarely reaching tumor size up to 30 cm. Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and usually caused by cirrhosis and more commonly reported tumors in males. It has been reported that presentations may occur with masses that are often less than 5 cm or rarely more than 10 cm. We aimed to present a case of hepatocellular carcinoma 72-years old man with fatigue and pain spread on the right upper quadrant; a histopathologic image similar to both telangiectatic variant hepatic adenoma and false diagnosis as "cavernous hemangioma" in the first biopsy specimen. KEY WORDS: Hepatocellular carcinoma, Liver Adenoma.

INTRODUCTION[|]The aim of this study was to compare the effects of breast-conserving surgery (BCS) and subcutaneous mastectomy with implant reconstruction (SMIR) in terms of postoperative psychosocial effects, sexuality, and quality of life.[¤]METHODS[|]Demographic data and clinical breast cancer parameters of patients who underwent BCS (n=48) or SMIR (n=27) between January 2012 and December 2016 were reviewed retrospectively. The data were collected via face-to-face interview using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the breast cancer-specific submodule, EORTC QLQ-BR23.[¤]RESULTS[|]In this study group, 23 (48%) patients who underwent BCS and 25 (92.6%) patients who underwent SMIR were premenopausal (p0.05). Fatigue scores on the QLQ-C30 were greater for SMIR patients, as well as arm symptoms in the QLQ-BR23 side effects scale (p

Aim: This study aims to share our experience of our first field experience after endoscopic retrograde cholangiopancreatography (ERCP) training and share our “The starting strategy for new ERCP performer” protocol which we created to prevent severe complications in our first year on field experienceMaterials and Methods: 190 ERCP cases performed at Health Sciences University - Kartal Dr. Lutfi Kirdar Research and Education Hospital ERCP unit between June 2018 to November 2019 are documented retrospectively. All the cases were taken to procedure through our protocol rules. The protocol is described fully with details in the text.Results: A total of 190 (89 female-101 male) patients had undergone ERCP, of which 39 were diagnostic, 151 was therapeutic. 16 (8.4%) cases were aborted during the protocol described points during the ERCP procedure to avoid complications. Five of these cases were referred to another hospital, 7 cases were performed in another session, and 3 cases underwent surgery without performing another session of ERCP due to a given diagnosis of malignancy during ERCP. All other cases are performed regularly with a cannulation success rate of 88%. Complications occurred in 7 (3.6%) cases; 2 cholangitis due to persisting bile stone, 4 pancreatitis (highest hospitalization for 4 days), and one hemorrhage. No surgery needed complications or mortality has been reported.Conclusion: We believe a new performer can reduce the rate and risk of complications for the first year of his/her to high volume and experienced centers’ rate by using a predefined protocol.

This study presents data about the intraoperative performance of Endoscopic Retrograde Cholangiopancreatography (ERCP) for different types of cases with acute, complex pathologies of the biliary tract.We retrospectively enrolled cases with intraoperative ERCP performed for different acute complex bile duct pathologies (including injury and cystic stump leak). All patients were analyzed according to demographic findings, etiologies, management and results.Intraoperative ERCP was performed in 4 patients of whom 2 (50%) were female and 2 (50%) were male with different diagnoses. The median age of patients was 46.8 (range of 28-75) years. The diagnosis was bile duct injury in three patients and one had a complicated hydatid cyst with jaundice (T Bil: 18 mg dl-1). All patients were in septic condition. Patients underwent laparotomy and intraoperative ERCP was performed successfully by using the Rendezvous technique. For the last patient, intraoperative ERCP was used for diagnosis and management of bile leak in the cavity.Intraoperative endoscopic retrograde cholangiopancreatography is a safe and effective method for treatment of acute complex bile duct pathologies.Bile Duct Injury, Intraoperative ERCP, Rendezvous Technique.Viene presentata un’esperienza relativa all’esecuzione intraoperatoria della CPRE (colangiopancretocgrafia retrograde endoscopica) in una piccola serie di casi con patologia acuta e complessa delle vie biliari. Si tratta di uno studio retrospettivo di casi scelti in cui è stata effettuata la CPRE per differenti condizioni di patologia acuta della via biliari (compresi danni e deiscenze del dotto cistico). Per tutti i pazienti l’analisi è stata comprensiva dei dati demografici, all’etiologia, al trattamento ed ai risultato. La CPRE intraoperatoria è stata adottata in 4 pazienpazienti, 2 donne e 2 uomini, con differenti diagnosi. L’età media era di 46,8 anni (da 28 a 75). In tre pazienti si è trattato di danni alla via biliare, e in un caso di un cisti idatidea complicata con ittero (bilirubinemia totale 18 mg%). tutti i pazienti si presentavano in stato settico. Nel corso della laparotomia è stata eseguita con successo una CPRE con la tecnica del rendezvous. Per l’ultimo paziente la CPRE intraoperatoria è stata impiegata per la diagnosi ed il trattamento della perdita biliare nella cavità In conclusione la CPRE si è dimostrata una metodica sicura ed efficace per il.

Foreign body reactions may develop against exogenous or certain endogenous materials. Cases of suture granuloma that develop against nonabsorbable suture material are rare complications of thyroid surgery. Because of these postoperative complications, a history of cancer prior to the operation suggests recurrence of cancer. Appropriate clinical, radiological, and pathological evaluation is highly important in such cases. Postoperative foreign bodies may remain undetected for years, but they sometimes cause lethal complications.Cancer mimicking, Foreign body, Suture granuloma, Thyroid surgery.In presenza di materiali esogeni introdotti nel corso di interventi chirurgici può svilupparsi una reazione da corpo estraneo. Nel caso della chirurgia della tiroide in corrispondenza delle allacciature vascolari con filamenti non assorbibili può svilupparsi raramente questo tipo di reazione, che in caso di sospetto di natura neoplastica dell’intervento effettuato può ingenerare il dubbio che possa trattarsi di una recidiva. In tali casi è molto importante un’indagine clinica, radiologica ed il nuovo controllo istopatologico. Il corpo estraneo può rimanere ignorato per anni, ma talvolta può provocare complicazioni negative.

A 22-year-old patient underwent fine needle aspiration of a nodule at the outer center of the right lobe of the thyroid, and it was reported to be Bethesda system category IV, Hurthle cell follicular neoplasia. The patient, who persented to Onsekiz Mart University Research and Application Hospital, underwent surgery. During right total thyroidectomy, an almost totally infarcted nodule and papillary structures around these infarcted areas were detected. Herein, we report on diagnostic challenges faced in confirming whether the infarcted nodule was a case of reactive papillary changes or an underdiagnosed papillary carcinoma and how the challenges were overcome using immunohistochemistry analysis and molecular genetic testing. In addition, we examined the case along with a literature review because an accompanying synchronous brain stem astrocytoma was detected in the patient after thyroidectomy.

Aim: Colorectal carcinoma (CRC) is the third most common cancer in both men and women in the United States and the second leading cause of cancer-related mortalities overall. This study aimed to determine and present the risk factors contributing to mortality and morbidity in 149 retrospectively-evaluated patients with CRC who had been urgently and electively operated on in a secondary healthcare facility.Material/Methods: Overall, 149 patients with CRC who underwent emergency and elective surgery in Canakkale State Hospital between January 2014 and March 2018, were retrospectively evaluated.Results: Of the 149 patients, 79 (53.1%) were male and 70 (46.9%) were female. The mean age was 68.49 ± 10.79 years. Rectum was the most common anatomic tumor location (31.5%) and the least common location was the transvers colon (2.1%). Histopathologically, the most common tumor type was adenocarcinoma (88.6%), followed by mucinous adenocarcinoma (8.6%). 67.7% of the patients underwent elective surgery and 32.2% underwent emergency surgery. The most common complication was wound site infection (14.7%). Although the mortality rate was 4.7% in all cases (emergency/elective), it was 12.5% in emergency cases. The mortality rate for patients over 80 years of age were 27.3%.Discussion: CRCs have a high mortality rate if they are widespread, especially in patients of 80 and if they require emergency intervention. When morbidity, mortality, and costs, such as postoperative patient care and stoma, are considered; it can be concluded that screening programs for low mortality and early diagnosis of CRC in patients before the age of 80 should be developed further, risk factors should be identified, and protective measures should be implemented.Conclusion: A demographic study of colorectal cancer with 149 patientsKeywords: Colon carcinoma; rectum carcinoma; emergency colorectal surgery; elective colorectal surgery.