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Aim: Therapeutic modalities for elderly gastric cancer (GC) patients have enlarged with extended life expectancy. The aim of this study was to investigate the outcomes of surgical therapies for GC patients of age 65 and older with a single center experience.Materials and methods: Eighty-eight patients who underwent laparoscopic surgery for GC were included in the study. The relationships between surgical methods and clinicopathological or prognostic features were analyzed.Results: The median age of the patients was 72(65-91)years. Sixty patients (75%) were male. The median BMI was 25 kg/m2 (17.5-42). The most common ASA score was 2 (n=58, 72.5%) and tumors were mostly localized in the distal 1/3 of the stomach (n=39, 48.7%). The median CEA and CA19-9 levels were 1.94 ng/ml(0.07-93.8)and 10IU/ml (0.05-449.3), respectively. Eleven patients (13.8%) hadprevious abdominal surgery history. The most common operation type was subtotal gastrectomy (n=33, 41.3%). The median operation time was 300 min (45-720) and the median intraoperative blood loss was 100 ml (0-800). There were eleven conversion (13.8%). The median first time to oral intake was 2 days (1-10) and length of hospital stay was 7 days (1-48). Postoperative serious complications occurred in fourteen (17.5%) patients. The mean of retrieved lymph node was 30.27 ± 17.08. The most common pathological T stage was T4 (53.75%). The mediantime to chemotherapy was 41 days (6-220).Conclusion:Laparoscopic gastric surgery is a safe and feasible method that can be performed in elderly patients with appropriate oncological principles. The risk of surgery is substantially higher in elderly patients.Therefore, maximal attention should be paid to perioperative care for the prevention and treatment of perioperative complications.

Tam Metin / Full Text It is thought that the sensitivity of computed tomography (CT) in detecting peritoneal metas tases (PM) is low. In this study, we aimed to present our experience on gastric cancer (GC) patients with intraoperatively detected PM whose preoperative CT was normal in terms of distant metastasis. Materials and Methods: We retrospectively analyzed the demographics and perioperative data of ten pa tients with gastric adenocarcinoma whose preoperative CT was normal in terms of PM, but intraoperatively PM was detected. Results: The mean age of the patients was 68.30±9.44 years. Six patients (60%) were male. Tumors were mostly localized in the distal 1/3 of the stomach (n=5, 50%). The median carcinoembryonic antigen and carbohydrate antigen 19.9 levels were 2.00 ng/ml (0.60–37.50) and 30.76 IU/ml (3.28–449.30), respectively. There were PM on the visceral peritoneum (small bowel mesentery) in two patients (20%) and on the parietal peritoneum in eight patients (80%). The operations were terminated in five patients (50%) when the PM de tected as they did not have any complications due to cancer. Laparoscopic feeding jejunostomy (n=2, 20%), laparoscopic tube gastrostomy (n=1, 10%), and laparoscopic gastroenterostomy (n=2, 20%) were performed on the patients with oral intake deficiency due to GC. Conclusion: Preoperative staging with CT before GC surgery is still valid. Multidetector CT scan should be preferred. However, it is still not enough for detecting all PM before surgery. Staging laparoscopy should be in mind, especially for patients with a high risk of PM.

Total splenectomy can cause many perioperative and postoperative complications. Partial splenectomy has been preferred in recent years in order to minimize the immunological complications associated with splenectomy. With this case series, we aim to present our own experiences with 3 patients.

Meckel divertikülü (MD), gastrointestinal sistemin en sık görülen kojenital anomalisi olup, toplumda %2 oranında görülmektedir. Çocukluk çağında daha çok kanama ve obstrüksiyon bulguları ile ortaya çıkarken, erişkinlerde ise sıklıkla obstrüksüyon bulguları veya insidental olarak saptanmaktadır. Komplikasyon gelişen vakalarda tedavi olarak rezeksiyon önerilmektedir. Bu komplikasyonlardan biri olan perforasyon nadir olarak oluşmaktadır ve genelde yabancı cisim varlığında görülmektedir. Bu çalışmada akut apandisit ön tanısıyla operasyona alınan, ancak yabancı cisime (kürdan) bağlı meckel divertikül perforasyonu saptanan bir olgu sunulmuştur., Meckel’s diverticulum is the most common congenital anomaly of gastrointestinal system and occurs %2 of the population. Common clinical presentations in childhood are bleeding and obstruction, while in adults it is usually with obstruction or incidentally detected. If complication occurs treatment must be resection. One of complications is perforation and it’s rarely develops due to foreign body. In this study the patient that have diagnosed as appendicitis before the operation and meckel diverticulum perforation detected during the operation because of the foreign body (toothpick) presented.

Parathyroid crisis is a rare clinical entity characterized by life-threatening hypercalcemia of a sudden onset in patients with primary hyperparathyroidism (pHTP) and rarely results from a cystic adenoma. We describe a 53-year-old woman with acute hypercalcemic crisis who presented with severe gastrointestinal symptoms. She had severe hypercalcemia (calcium level: 18.6 mg/dl) in conjunction with an elevated parathyroid hormone level of 1063 pg/ml. Ultrasonography of the neck revealed a 25x15 mm partly cystic mass at the superior pole of the right thyroid lobe. The patient underwent surgery immediately because hypercalcemia could not be controlled with medical treatment. The pathologic diagnosis was a cystic parathyroid adenoma.

Purpose: To determine the main causes of thyrotoxicosis and to compare the clinical and biochemical fetaures of the patients according to the underlying cause of thyrotoxicosis.Material and Method: Five hundred ninety-two patients, who were consecutively diagnosed with thyrotoxicosis, were retrospectively analysed. Symptoms of thyrotoxicosis, serum thyroid-stimulating hormone (TSH), free T3 and free T4 levels, anti-thyroglobulin autoantibody (TGAb), antithyroid peroxidase autoantibody (TPOAb) and ultrasonographic features were recorded. To determine the cause of thyrotoxicosis, Tc-99m pertechnetate thyroid scintigraphy was performed in all patients except for pregnant women. The clinical and biochemical results were compared between the patients with different diagnosis of thyrotoxicosis.Results: 40.9% of patients were diagnosed with toxic multinodular goiter (TMNG). The other main causes of thyrotoxicosis were: Graves’ disease (GD) (22%), thyroiditis (14.8%), gestational thyrotoxicosis (12.7%), and toxic adenoma (9.6%). The clinical presentation and severity of thyrotoxicosis varied according to the underlying cause. Weight loss was more frequently observed in patients with GD (p=0.0001), while cardiac arrhythmia dominated in patients with TMNG (p=0.0001). Moderate (27%) or severe (23.9%) thyrotoxicosis was more common in patients with GD than in patients with other forms of thyrotoxicosis (p=0.0001).Discussion: Toxic multinodular goiter is the most common cause of thyrotoxicosis in our region. © 2014, Galenos Yayincilik. All rights reserved.

A 39 years old woman was admitted to the hospital due to swelling and pain on her left lumbar region. In family history we learned that; her 19 years old daughter was operated due to primary muscular hydatid cyst located on gastrocnemius muscle one year ago. A painful painful mass with a size of 6x5 cm was palpated on patients\' left lumbar region during physical examination. Her indirect hemaglutination (IHA) for Echinococcus granulosus was positive. The lesion was reported as muscular hydatid cyst during ultrasound and computed tomography ex­aminations. Hydatid disease was not in the previous his­tory of the patient. Partial cystectomy and drainage was performed under spinal anesthesia on prone position. Excised material was confirmed as a hydatid cyst in histo­pathological examination. Albendazol (15 mg/kg/day) was given to patient for three months following the operation. There were no postoperative complications. After 6 month follow up, the patient showed no evidence of recurrent hy­datid disease. A hydatid cyst should be considered in the differential diagnosis of muscular cystic lesions in regions where hydatid cysts are endemic. Positive family history may help us in suspicion to this disease. If total excision is impossible, partial cystectomy and drainage can be the choice as surgical treatment for a muscular hydatid cyst., Otuz dokuz yaşındaki bayan hasta sol lumbar şişlik ve ağrı şikayetleri ile polikliniğe başvurdu. Hastanın aile öy­küsünde 19 yaşındaki kızının sol gastrokinemius kasında primer kist hidatik sebebiyle bir yıl önce ameliyat olduğu öğrenildi. Hastanın fizik muayenesinde sol lomber böl­gede derin palpasyonla ele gelen düzgün sınırlı 6x5 cm boyutlarında ağrılı kitle palpe edildi. Hastanın ecchino­coccus granulosus indirekt hemaglutinasyon testi pozitifti. Radyolojik incelemelerde, lezyonun kist hidatikle uyumlu olduğu rapor edildi. Hastanın geçirilmiş kist hidatik öyküsü yoktu. Hastaya spinal anestezi altında parsiyel kistektomi ve drenaj uygulandı. Kistektomi materyali, asellüler lamel­ler tabaka (kist hidatik) olarak rapor edildi. Postoperatif komplikasyon olmadı. Operasyon sonrası hastaya 15 mg/kg/gün Albendazol tedavisi 3 ay süreyle verildi. Hastanın 6 aylık izleminde kist hidatit nüksüne rastlanmadı. Kist hi­datiğin endemik olduğu bölgelerde kas içi yerleşimli kistik kitlelerin ayırıcı tanısında kist hidatit de hatırlanmalıdır. Ai­lede geçirilmiş kist hidatit öyküsünün olması yol gösterici olabilir. Tedavide kist total çıkarılamıyorsa, parsiyel kis­tektomi ve drenaj kas içi kist hidatiğin cerrahi tedavisinde seçilebilir.

Objectives: Our aim was to compare the clinical, hormonal and metabolic features between overweight and obese patients with PCOS and normal weight women with polycystic ovary syndrome (PCOS). Methods: 119 patients with PCOS (15-39 years) were included in the study. We evaluated anthropometric, hormonal and metabolic parameters in all patients. Results: Ferriman- Gallwey hirsutism score was similar in overweight or obese patients with PCOS (n=78) and normal weight patients with PCOS (n=41) (p=0.373). While 71.8% of the obese group had irregular menses, this ratio was 60.9% in normal weight group (p=0.160). HOMA-IR values were higher in the obese group (1.7±0.7 vs 3.3±1.7, p, Amaç: Bu çalışmanın amacı fazla kilolu ve obez polikistik over sendromu (PKOS)\'lu hastalar ile normal kilolu PKOS\'lu kadınları klinik, hormonal ve metabolik özellikler açısından karşılaştırmaktı. Yöntemler: Çalışmaya yaşları 15-39 arasında değişen 119 PKOS\'lu hasta dahil edildi. Tüm hastalarda antropometrik, metabolik ve hormonal ölçümler yapıldı. Bulgular: Fazla kilolu ve obez PKOS\'lu hastalarla (n=78) normal kilolu hastalar (n=41) arasında Ferriman- Gallwey hirsutizm skoru açısından bir fark saptanmadı (p=0,373). Obez grubun %71,8\'inde menstruel düzensizlik görülürken, normal kilolu grupta bu oran %60,9 idi (p=0,160). HOMA-IR değerleri obez grupta anlamlı derecede daha yüksekti (1,7±0,7\'ye karşın 3,3±1,7, p

Jejunum diverticulum's are generally pseudo diverticulum's and located at mesenteric side. Jejunum diverticulum's perforation is an unusual cause of acute abdomen. Segmental intestinal resection is recommended in surgical treatment. A 51 years old male patient was operated on due to acute abdomen. In the operation a perforation that was associated with solitary jejune diverticulums at location 15 cm far from the Treitz ligament was identified. Diverticulectomy and primary closure was performed. Key words: Jejunum, Diverticulum, Perforation, Jejunum divertiküllerinin çoğu mezenterik yerleşimli psödodivertiküllerdir. Jejunal divertikül perforasyonu nadir görülen bir akut karın nedenidir ve tedavide segmenter barsak rezeksiyonu önerilir. Elli bir yaşındaki erkek hasta akut karın sebebiyle ameliyat edildi. Ameliyatta Treitz ligamanının 15 cm distalinde Jejunumun antimezenterik tarafında 6.6x9x3cm boyutlarında perfore gerçek divertikül mevcuttu. Divertikülektomi ve primer onarım yapıldı. Anahtar kelimeler: Jejunum, Divertikül, Perforasyon

Objectives: To investigate the correlation between preoperative serums CEA, CA19-9, and alphafetoprotein (AFP) levels and clinic pathological factors. Methods: The correlation between the records of pre-operative serum CEA, CA19-9, and alpha-fetoprotein levels and some clinic-pathological factors (tumor stage, liver metastasis, peritoneal metastasis, presence of ascites, unresectable tumors) of 74 patients with gastric adenocarcinoma operated in Ankara Yildirim Beyazit Education and Training Hospital 2nd Surgery Clinic was investigated. Results: Preoperative elevated serum CEA, CA19-9, and alpha-fetoprotein levels were found 31.4%, 30.3, and 16.4, respectively. While 31 (41.8%) out of 74 patients had one or more positive tumor markers, all three markers were found to be high in 8 patients (13.1%). Six of these patients were in stage 4, and the other two patients were in stage 3. Conclusion: Preoperative serum CEA, CA19-9, and alpha-fetoprotein levels were found high in patients with advanced stage, liver metastases, and unresectable gastric adenocarcinoma. Keywords: Gastric Adenocarcinoma, CEA, CA19-9, AFP, Clinicopathologic Factors, Amaç: Gastrik adenokarsinomlu hastalarda preoperatif serum karsinoemriyonik antijen (CEA), CA19-9 ve alfa-fetoprotein (AFP) düzeyi ile klinikopatolojik faktörlerin korelasyonunu araştırmak. Metot: Gastrik adenokarsinom sebebiyle Ankara Yıldırım Beyazıt Eğitim Hastanesi 2. Cerrahi Kliniğinde ameliyat edilen 74 hastanın kayıtları retrospektif olarak incelendi. Hastaların preoperatif serum CEA, CA19-9, AFP düzeyleri ile bazı klinikopatolojik faktörler (tümör evresi, karaciğer metastazı, peritoneal metastaz, asit varlığı, tümörün rezeke edilebilirliği) arasındaki korelasyon araştırıldı. Bulgular: Hastaların preoperatif serum CEA, CA19-9, AFP pozitiflik oranları sırası ile %31.4, 30.3 ve 16.4 olarak bulundu. Hastaların 31'inde (%41,8) bir veya birden fazla tümör markırı yüksek iken, 8'inde (%13.1) üç markır da yüksek bulundu. Bu 8 hastanın 6'sı evre 4, 2'si evre 3 teki hastalardı. Sonuç: Gastrik adenokarsinomlu hastalarda preoperatif serum CEA, CA19-9, AFP seviyelerinin ileri evreli, karaciğer metastazı yapmış, rezektabıl olmayan tümörlerde anlamlı oranda yüksek olduğu görüldü. Anahtar kelimeler: Gastrik Adenokarsinom, CEA, CA19-9, AFP, Klinikopatolojik Faktörler

Amaç: Bu çalışmada sağ lob canlı vericili karaciğer naklinde greftte karşılaşılan portal ven anomalilerine bağlı sorunları ortadan kaldırmak amacı ile birleştirilmiş iki veya üç portal ven ağzı en az 1-2 cm kadar daha uzamış, orjinalinden daha geniş ve tek bir ağız haline getirilerek ortaya koyulan ve Malatya Yaklaşımı olarak adlandırılan yeni bir cerrahi tekniği tanımlamak ve bu tekniğin etkinliğini araştırmaktır.Hastalar ve yöntem: Nisan 2002 ve Mart 2011 tarihleri arasında merkezimizde karaciğer nakli yapılan 558 hastanın 440?ı (%79.4) canlı vericili karaciğer nakli olup, canlı vericili karaciğer nakillerinin 396?sı (%90) sağ lob canlı vericili karaciğer naklidir. Bu çalışma yalnızca sağ lob grefti kullanılarak yetişkin canlı vericili karaciğer nakli yapılan hastaları kapsamaktadır. Sağ lob canlı vericili karaciğer nakli yapılan 396 hastanın 50?sinde (%12.6) Nakamura sınıflamasına göre anormal portal ven dallanması vardı. 396 sağ lob greftinin 346?sı Tip A (%87.6), 20?si Tip B (%5), 18?si Tip C (%4,6), 12?i Tip D (%3) olan vakalardan oluşmaktadır. Anormal portal ven dallanması olan (Tip B, C, D) greftlerin transplante edildiği alıcıların 10?unda primer yaklaştırma, 7?sinde Y-Plasty, 3?ünde duble anastomoz, 3?ünde komplike venoplasti, 27?sinde Malatya Yaklaşımı tekniği uygulandı.Sonuçlar: Malatya Yaklaşımı tekniği kullanılan 27 hastada tekniğin etkili ve kolay uygulanabilir olduğu görüldü. Konvansiyonel yöntemlerle portal ven anastomozu yapılan gruptaki hastalardan istatistiksel olarak anlamlı oranda portal ven trombozu gözlenmedi. Mortalitenin ve postoperatif relaparatominin konvansiyonel yöntemlerle portal ven anastomozu yapılan grupta daha fazla olduğu görüldü.Yorum: Bu tezin sonuçları çift portal ven olan sağ lob greftlerinin rekonstrüksüyonunda, Malatya Yaklaşımı tekniğinin kullanımının kolay, etkili bir yöntem olduğu ve anormal portal ven dallanmalarında standart prosedür olabileceği kanaatindeyiz.Anahtar kelimeler: Canlı vericili karaciğer nakli, Anormal poral venöz dallanma, Malatya Yaklaşımı Aim: The aim of this study is to remove the difficulties based on portal vein anomalies faced with graft in liver transplant with right lobe living donor and to define a new technique called as Malatya Approach combined two or three portal ven orifice extended at least 1-2 cm, wider than its original one and presented as transforming into just one orifice and to define a new surgical technique and research the efficiency of this technique.The patients and method: Between April 2002 and March 2011 the liver transplant was carried on 558 patients in our centre, 440 of who are living donors ones and 396 of whom (90 %) are right lobe living donor liver transplantations. This study covers only those patients on whom living donor liver transplant has been performed by using right lobe graft. According to Nakamura classification, there was abnormal portal vein branch in 50 (12.6 %) out of 396 patients on whom the right lobe living donor liver transplant has been performed. 346 out of 396 right lobe graft consists of Type A (87.4%), Type B out of 20 (5%), Type C out of 18 (4.6%), Type D out of 12 (3%). Premier approximation in 10 patients with abnormal portal vein branch (type B,C,D) grafts , Y-Plasty in 7 patients, double anastomos in 3 patients, complicated venoplasty in 3 patients, in 27 patients Malatya Approach technique has been implemented.Results: The technique of Malatya Approach implemented on 27 patients has been found out to be efficient and easily applicable. Portal vein trombosis has not been observed in the statistical meaningful rate on patients on whom portal vein anastomosis has been operated through conventional techniques. The rate of relaparatomy and mortality has been seen to be more on patients on whom portal ven anastomoz has been operated through conventional techniques.Comment: We are of the opinion that results of the thesis have confirmed that the use of Malatya Approach technique in the reconstruction of right lobe grafts with double portal vein is easy, an efficient method and can be standard procedure in abnormal vein branch.Key words: Live donor liver transplantation, Abnormal portal venous branch, Malatya Approach 43

vn. ÖZET Bu çalışmada, tavşanlarda deneysel olarak oluşturulan kafa travmasından 1 saat sonra oluşan lipid peroksidasyonu ve sonucunda oluşan serbest oksijen radikallerine deferoksaminin etkisi araştırıldı. Deferoksamin (50mg/kg IV yavaş bolus infizyonla) kafa travması takiben 5 dk. sonra femoral venden verildi. Sham grubundaki tavşanlara travma uygulanmadı. Kontrol grubundaki tavşanlara ise sadece travma uygulandı. Lipid peroksidasyonu ve sonucunda oluşan serbest oksijen ladikallerinin son ürünü olan malondialdehid (MDA), serbest oksijen radikallerinin oluşum endikatörü olarak ölçüldü. Kontrol grubu tavşanlarda MDA'nın beyin dokusundaki konsantrasyonu 142.43±8.69 nmol/gr. yaş doku olarak ölçüldü. Sham grubu tavşanlarda MDA konsantrasyonu 66.21±8.69 nmol/gr. yaş doku idi. Femoral venden deferoksamin enjeksiyonu takiben beyin dokusundaki MDA değerleri ortalama 96.77±9.07 nmol/gr. yaş doku olarak ölçüldü. Sonuçlar göstermiştir ki; tavşanlarda kafa travmasının akut fazında verilen deferoksamin serbest radikal oluşumunu anlamlı derecede azaltmıştır (p