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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.

Aim: We aimed at analysing the patients, who underwent surgical treatment in our hospital after having abdominal wounding by firearm in the war at Syria, retrospectively. Material and Method: The files of Syrian patients, who applied to Emergency Service of Harran University Medical Faculty because of gunshot wounds and had operation after being hospitalized in General Surgery Clinic due to abdominal injuries between the years of 2011 and 2014, were analysed retrospectively. Results: 175 Syrian patients, who had abdominal injuries by firearms, underwent operation in our general surgery clinic. 99.4% (n=174) of the patients were male, and 0.6% (n=1) were female. Trauma-admission to hospital times of all cases were %u2265 6 hours. 62.8% (n=110) of the patients had isolated abdominal injuries, and 37.1% (n=65) had two or more system injuries. The frequency of more than one organ injuries in abdominal region was 44.5% (n=78) and the most frequent complication was wound infection (10%). Negative laparoscopy was 2.8% (n=5), support for intensive care was 38.2% (n=67), average duration of intensive care unit stay was 5.57 days and mortality was 9.7% (n=17). Discussion: In our study, it was seen that infectious morbidity and mortality increased for the patients, who applied to our hospital because of abdominal injuries by firearm, particularly the ones with gastrointestinal perforation, if trauma-admission to hospital times were %u2265 6 hours. And this shows us that the early intervention to injuries that perforate gastrointestinal tract was an important factor for decreasing morbidity and mortality.

Hermansky-Pudlak syndrome (HPS) is a rare inherited platelet disorder characterized by bleeding diathesis, oculocutaneous albinism (OCA) and a myriad of often-serious clinical complications. We established the clinical and laboratory phenotype and genotype of six unrelated pedigrees comprising ten patients with clinical suspicion of HPS; including platelet aggregation, flow cytometry, platelet dense granule content, electron microscopy and high-throughput sequencing (HTS). The clinical presentation showed significant heterogeneity and no clear phenotype-genotype correlations. HTS revealed two known and three novel disease-causing variants. The Spanish patients carried a homozygous p.Pro685Leufs17* deletion (n = 2) in HPS4, or the novel p.Arg822* homozygous variant (n = 1) in HPS3. In the case of two Turkish sisters, a novel missense homozygous HPS4 variant (p.Leu91Pro) was found. In two Portuguese families, genetic studies confirmed a previously reported nonsense variant (p.Gln103*) in DTNBP1 in three patients and a novel duplication (p.Leu22Argfs*33) in HPS6 in two unrelated patients. Our findings expand the mutational spectrum of HPS, which may help in investigating phenotype-genotype relationships and assist genetic counselling for affected individuals. This approach is a proof of principle that HTS can be considered and used in the first-line diagnosis of patients with biological and clinical manifestations suggestive of HPS.Key messagesWe established the relationships between the clinical and laboratory phenotype and genotype of six unrelated pedigrees comprising ten patients with clinical suspicion of HPS.Molecular analysis is useful in confirming the diagnosis and may offer some prognostic information that will aid in optimizing monitoring and surveillance for early detection of end-organ damage.This approach is a proof of principle that HTS can be considered and used in the first-line diagnosis of patients with biological and clinical manifestations suggestive of HPS. We established the relationships between the clinical and laboratory phenotype and genotype of six unrelated pedigrees comprising ten patients with clinical suspicion of HPS. Molecular analysis is useful in confirming the diagnosis and may offer some prognostic information that will aid in optimizing monitoring and surveillance for early detection of end-organ damage. This approach is a proof of principle that HTS can be considered and used in the first-line diagnosis of patients with biological and clinical manifestations suggestive of HPS.

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.

Bezoar, yabancı cisim veya gıdaların beslenme yolunda oluşturduğu kitlelerdir. Mide operasyonu geçirmiş olanlarda bezoar sıklığı artmaktadır. İnce barsakta bezoar az görülür ve nadiren ileusa neden olabilir. Bu yazıda, duodenuma yerleşmiş bezoarı olan, gastrik ameliyat geçirmiş, 55 yaşında kadın hasta sunulmuştur. Hastada bezoarın mideye alınmasını takiben ileus gelişmiş ve laparotomi yapılmıştır. Hasta ameliyattan bir hafta sonra şifa ile taburcu edilmiştir.

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.

Objective: Aimed to investigate the incidence of neuroendocrine tumors (NET) in the appendectomy specimens of the patients who underwent appendectomy for various indications. Methods: 2252 cases, that were performed appendectomy at Harran University Faculty of Medicine and examined histopathologically in Pathology department between January 2004 and May 2014, were analyzed retrospectively. Results: In the study, it was reported NET in only 3 (0.13%) of these patients. All of the patients with NET were women and mean age ± SD was 58,33 ± 18.14 years. All of the patients had been operated for acute appendicitis and the tumor was detected incidentally during microscopic examination. The tumor was localized to the distal portion of the appendix in all cases, the tumor sizes were 1.4cm, 1cm, 0.7cm (mean: 1,03 ± 0,35), respectively. Although, muscular layer and periappendicular fatty tissue involvement was present in each case, cellular atypia was minimal. Mitotic activity was calculated as 1-2 in 10 high power field. Immunohistochemical staining was performed in all cases and tumor cells showed positive staining with pancytokeratin, synaptophysin and chromogranin in all. Ki-67 proliferative indices were found 1-2%. In all cases, the presence of acute appendicitis had been reported in the peritumoral appendix. Conclusion: On histopathological examination of the excised appendiceal materials, NET should be constantly kept in mind in differential diagnosis and should be evaluated by an appropriate sampling. J Clin Exp Invest 2014; 5 (4): 563-566, Amaç: Bu çalışmada çeşitli endikasyonlarla apendektomi yapılan olguların apendektomi materyallerinde rastlantısal olarak saptanan nöroendokrin tümör (NET)\'lerin sıklığını araştırmak amaçlanmıştır. Yöntemler: Ocak 2004- Mayıs 2014 tarihleri arasında Harran Üniversitesi Tıp Fakültesi hastanesinde apendektomi yapılan ve Patoloji anabilim dalında histopatolojik incelemesi yapılan 2252 olgu retrospektif olarak incelendi. Bulgular: Çalışmaya alınan 2252 olgunun 3 (%0,13)\'ünde NET rapor edilmiş idi. NET\'li olguların hepsi kadın olup, ortalama yaş ± SD 58,33 ± 18.14 yıl idi. Olguların tamamı akut apandisit nedeni ile opere edilmiş olup, tümörler mikroskopik inceleme sırasında rastlantısal olarak saptanmıştı. Tüm olgularda tümör apendiksin distal kısmına yerleşimli olup, tümör boyutları 1,4cm, 1cm ve 0,7cm (ort:1,03 ± 0,35cm) idi. Her olguda müsküler tabaka ve periapendikal yağlı doku tutulumu mevcut olmakla birlikte, hücresel atipileri minimaldi. Mitotik aktiviteleri 10 büyük büyütme alanında ortalama 1-2 olarak hesaplanmıştı. Tüm olgulara immunohistokimyasal boyama yapılmış ve tamamında tümör hücreleri pansitokeratin, sinaptofizin ve kromogranin ile pozitif boyanma göstermişti. Ki-67 proliferasyon indeksi %1-2 olarak saptanmıştı. Tüm olgularda tümör çevresi apendikste akut apandisit varlığı rapor edilmişti. Sonuç: Apendiks materyallerinin histopatolojik değerlendirmesinde NET ayırıcı tanıda akılda bulundurulmalı ve uygun örneklemeler ile değerlendirilmelidir.

Hydatid cyst disease continues to be a problem in developing countries. They are divided into different types according to the Gharbi classification. Percutaneous or surgical treatment can be applied according to their anatomic location and types. Furthermore, laparoscopy is a technique of minimally invasive surgery. PAIR (Percutaneus aspiration, Irrigation, Reaspiration) should perform to some cysts if there has been an experienced radiologist. If stones in gallbladder and hydatid cysts in the liver are detected and there is no experienced radiologist, laparoscopic cholecystectomy and percutaneous drainage should be performed in the same session. In this method, an external used veress needle was used for aspirating the cyst content, and povidone-iodine was administered as a proto-scholastic agent. No problem was observed at the patient’s follow-ups, and the patient was discharged.

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.

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.

Introduction Hermansky-Pudlak syndrome (HPS) is an inherited platelet disorder characterized by bleeding diathesis, oculocutaneous albinism (OCA) and, sometimes, serious clinical complicationssuch as immunodeficiency, granulomatous colitis, and/or pulmonary fibrosis. Heterogeneous clinical symptoms and a large number of possible genetic culprits (10 HPS genes, >120 exons) complicate an unequivocal diagnosis of HPS. This study aimed to assess the clinical and platelet phenotype in ten patients with suspected HPS, and to identify the underlying genetic defects. Methods Ten patients from six families (F1 and F3 were Spanish, F2 was Turkish and F4, F5 and F6 were Portuguese) presenting with OCA (confirmed by skin biopsy) and bleeding diathesiswere included. Bleeding was evaluated by ISTH-BAT score. Phenotyping included, in patients with fresh blood samples available, platelet aggregation and ATP release, flow cytometry (FC), 14C-serotonin uptake and whole-mount electron microscopy (EM). Patients DNA was analyzed using two different targeted panels by high throughput sequencing (HTS). Sequence variants classification was performed according to ACMP recommendations. Results Patient characteristics are summarized in table 1. In F1, that had no history of consanguinity, there were two affected sisters. Patients 1 (P1) had several episodes of gastrointestinal bleeding (GI), which was attributed to granulomatous colitis. F2 is a consanguineous Turkish family, were P3 had severe rectal bleeding, requiring colectomy combined with ileostomy surgery. Pathological examination of the colon was reported as non-granulomatous colitis. Her older sister (P4) had exhibited dyspnea and shortness according to diffuse bilateral pulmonary fibrosis (BPF) diagnosis. In F3, P5 had been referred with acute GI bleeding secondary to angiodysplasia. In the non-consanguineous F4, HPS was first confirmed in P6, who showed blonde hair, nystagmus and low visual acuity; his older sister was diagnosed with HPS later, at the age of 56 years old (P7), because her OCA was masked using dark brown hair-coloring products. In P8, born from a non-consanguineous family (F5), HPS was suspected early in life, four months of age, upon recognition of OCA, nystagmus, deep visual deficiency and exotropia with compensatory torticollis. Lastly, in the consanguineous Portuguese family (F6), the two affected children (P9 and P10) had also showed a horizontal and torsional nystagmus and reduced visual activity. P10 also suffered from epilepsy and mild development delay. In phenotyping studies, the Spanish patients (P1, P2, P5) showed impaired platelet aggregation to mild agonists and reduced platelet dense granules by FC and EM. No platelet studies could be performed in F2. In Portuguese patients (F4, F5 and F6), the ATP release studies demonstrated a dense granule deficiency (Table 1). Molecular diagnosis was achieved, as a first-line approach, by means of HTS gene panels that revealed: a) F1 (P1 & P2) a homozygous deletion c.2054delC (p.P685L fs17*) in exon 13 of the HPS4, which had been previously reported in one Asian patient who showed BPF; b) F2 (P3 & P4): anovel missense homozygousvariant c.272T>C (p.L91P) in exon 4 of the HPS4. Remarkably, the phenotype of the two Turkish sisters was different, with one having had severe GI bleeding requiring colectomy, and the other had developed BPF. C) F3 (P5): a novel heterozygous variant c.2464C>T (p.R822*) in exon 13 of the HPS3 was detected; d) F4 (P6 & P7) and F5 (P8): here a nonsense variant c.307C>T (p.Q103*) was identified in exon 5 of the DTNBP1, which was previously reported in a Portuguese patient. E) F6 (P9 & P10): these patients carried a novel five base pair duplication in the single exon of HPS6, c.60_64dup (p.L22R fs*33). Conclusions This study reports 10 new HPS patients, which demonstrates the heterogeneous nature of this syndrome and the complex phenotype-genotype correlations. The novel HTStechnology has facilitated the molecular diagnosis of HPS in these patients. Among the underlying molecular pathology, we identified a novel p.L91P variant in HPS4 that is associated with a severe clinical phenotype. Funding Gerencia Regional de Salud (GRS 1647/A/17), Fundación Séneca (19873/GERM/15), Instituto de Salud Carlos III (ISCIII, PI17/01966, PI17/01311,CB15/00055), Grupo de trabajo SETH and Instituto de Investigación Biomédica de Salamanca (IBSAL, IBY17/00006). Table Table. Disclosures No relevant conflicts of interest to declare.

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.

Objective: We report a case of leukocytoclastic vasculitis as a manifestation of propylthiouracil hypersensitivity. Clinical Presentation and Intervention: A 66-year-old woman with a history of a toxic adenoma was referred for evaluation of a purpuric rash on the legs and buttocks bilaterally. She was biochemically hyperthyroid. Biopsy of the skin lesions revealed leukocytoclastic vasculitis. Propylthiouracil therapy was discontinued, and methimazole started. The purpuric rash resolved and surgical treatment for toxic adenoma resulted in euthyroid state. Conclusion: This report indicated that leukocytoclastic vasculitis should be considered in the differential diagnosis of patients with a vasculitic rash. The discontinuation of the propylthiouracil was associated with disappearance of the lesions.

Aim: Laparoscopic cholecystectomy is a widely performed technique worldwide. The use of laparoscopic threaded holders for this is routine but takes a lot of time and may tear the gallbladder. There are no wide-mouthed and short endoscopic instruments that can be used for removing the gallbladder without perforation. We look at gallbladder removal methods that are quick and do not involve damage at the end of laparoscopic cholecystectomy.Materials and Methods: This prospective study was conducted on 30 laparoscopic cholecystectomy patients divided into two equal groups, one employing conventional laparoscopic cholecystectomy (CLC) and the other using a sponge holding forceps (SHF) (n=15, both groups) to demonstrate the effectiveness of our management. In the CLC group, the number of male patients was two (13.3 %) and female patients 13 (86.7%); in the SHF group, number of male patients was six (40%) and female patients nine (60%). When we compared the results statistically for bladder removal time, total operation time, gallbladder perforation, and wound infection, the p values were found to be 0.016, 0.182, 0.169, and 1, respectively.Results: Thirty patients were analyzed. The SHF group showed significantly better results than the CLC group for gallbladder removal time and better although not significantly better results for perforation of bladder, while there was no difference between the groups for wound infection.Conclusion: Removing the gallbladder with an SHF significantly shortens the duration of removal and also reduces perforations as compared to CLC.Keywords: Laparoscopic Cholecystectomy; Forceps; Techniques.

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.

The umbilical region is particularly susceptible for development of incisional hernia after laparoscopic cholecystectomy (LC). To evaluate the effects of port-closure techniques on the complications seen after umbilical port-site closure, we compared closure with Berci's needle and the standard technique of a hand-sutured closure.A hundred patients underwent LC were randomly divided into two groups. We evaluated the required time for closure, the security of techniques and the factors affecting postoperative complications for both closure groups in a prospective manner.Closure of the umbilical port site was performed faster with the Berci's needle compared to standard hand-sutured technique. Postoperative hospital stay and complication rates were not altered significantly depend on the closure technique. Skin dimpling on the trocar site was observed predominantly after closure with Berci's needle. Spontaneous improvement on skin dimpling was observed within the 2 weeks after operation in all patients. During the follow-up period, there was no trocar site hernia observed in the study group.Closure of the umbilical port site with Berci's needle is found as an effective and safe method for laparoscopic cholecystectomy.

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

Cystic adrenal masses are a relatively rare condition, and are usually nonfunctioning and asymptomatic. Differential diagnosis includes pheochromocytoma (PHEO) and adrenal carcinoma; 8–10% of patients with PHEO may be completely asymptomatic. Moreover, fewer than 10% of PHEOs secrete pure epinephrine. We report a case of a E-secreting pure cystic PHEO presenting with an incidental adrenal mass. A 49-year-old Turkish woman was hospitalized at Farabi Hospital for further examinations of a right adrenal cystic mass with a thick wall that was incidentally discovered by abdominal ultrasonography during examination for nausea, vomiting, headache, and angina-like chest pain in another hospital. On admission, her blood pressure was 100/60 mmHg. Tension Holter monitoring revealed paroximal hypertension (178/136 mmHg) and hypotension (78/54 mmHg) attacks. Of urinary catecholamines and its metabolites, only urine metanephrine was markedly increased, despite a urine epinephrine level near the upper limit of normal ranges. Abdominal computed tomography and magnetic resonance imaging studies revealed a cystic round tumor approx 5 cm in diameter, located in the right adrenal gland. Right adrenalectomy was performed; the surgical specimen revealed pure cystic PHEO. Postoperatively, the urine metanephrine level returned to normal range and urine epinephrine level was decreased approx 60%. In conclusion, a diagnosis of E-secreting PHEO should be considered in patients with nonspecific symptoms, presenting with an incidental cystic adrenal mass, even in the absence of hypertension.