Trocar site herniation after laparoscpic cholesystectomy

Trocar site hernia is a clinical manifestation which leads to variety of clinical pictures and which is difficult to diagnose since it may occur at any time in postoperative period.Patient-related factors such as diabetes mellitus, obesity and age beside the trocar diameter and design, pre-existing fascial defects, direction of port insertion and the site of the port significantly affect the development of trocar site herniation. Early diagnosis and treatment are life-saving for patients who experience intestinal obstruction due to trocar site herniation after laparascopic interventions. This study is about a sixty-six years old female patient who had early-onset trocar site herniation after she applied to our clinic with dyspeptic complaints and underwent elective laparoscopic cholecystectomy after cholelithiasis diagnosis

The Importance of TAPSE, RV/LV Ratio and Biomarkers for Prognosis and Follow-Up in Patients With Pulmonary Thromboembolism

Pulmoner tromboemboli (PTE) tedavi edilmediğinde mortalitesi yüksek seyreden bir hastalık olup tanı anında hastaların yüksek, orta veya düşük riskli olarak belirlenmesi tedavi seçeneklerini ve prognozu belirlemektedir. Çalışmamızın amacı; tanı anındaki serum proBNP ve troponin T, ekokardiyografi (EKO) değerlendirmesindeki PAB (pulmoner arter basıncı) ve TAPSE (triküspit anüler düzlemde sistolik yer değiştirme), pulmoner BT anjiyografide ölçülen RV/LV (sağ ventrikül/sol ventrikül) oranı değerlerinin birbiri ile korelasyonunu incelemek ve bu bulguların mortalite ve prognoz tahminindeki önemini araştırmaktır. Ayrıca PTE nin önemli bir komplikasyonu olan kalıcı pulmoner arter basıncı yüksekliğini öngörmede bahsedilen parametrelerin rolü olup olmadığı da incelenmiştir. Bu kesitsel çalışmaya, Kasım 2013 ile Haziran 2015 tarihleri arasında kliniğimize PTE tanısıyla yatırılıp tanı ve takibi gerçekleştirilen toplam 80 hasta alındı. Hastaların proBNP, troponin T, EKO daki PAB ve TAPSE değerleri kaydedildi ve 3 aylık antikoagulan tedavi sonrasında EKO tekrarlanarak PAB ve TAPSE değerleri tekrar ölçüldü. Pulmoner BT anjiyografi görüntülerinden RV/LV oranı elde edildi. Hastaların yaş ortalaması 63,6 ± 16,34 iken %61,2 si kadın idi. Korelasyon analizi sonucunda, RV/LV oranı ile PAB ve biyobelirteçler arasında orta derecede, PAB ile proBNP arasında orta derecede korelasyon saptanırken TAPSE ile diğer parametreler arasında anlamlı negatif korelasyon bulundu. Tanı anında PAB &#8805;35 mmHg olması ve immobilite advers klinik sonlanım riskini artıran faktörler olarak bulundu. Tanı anındaki PAB yüksekliği tahmininde ise TAPSE 106,5 pg/ml olması bağımsız risk faktörü idi (sırası ile OR=12,5, p <0,001 ve OR=6,5, p=0,016). Ayrıca başlangıç PAB ın 41 mmHg ve üzerinde olmasının, antikoagulan tedavi sonrası kalıcı PAB yüksekliği riskini 7,37 kat artırdığı saptandı.Classification of patients with pulmonary tromboembolism as low, intermediate and high risk groups at admission has importance for determination of treatment methods and prediction of prognosis. In this study, blood proBNP and troponine T values, TAPSE (tricuspid annular plane sysytolic excursion) and PAP (pulmonary artery pressure) calculations received from echocardiography (ECHO), RV/LV (right ventricle/left ventricle) ratio obtained from pulmonary CT angiography images were evaluated. We aimed to find out the importance of these parameters for prognosis and mortality prediction. Also correlation analysis between parameters performed. Moreover, we also intended to find out role of these parameters to predict permanent high PAP which is known as an important complication of pulmonary embolism. This cross-sectional study includes 80 patients with pulmonary thromboembolism between November 2013 and June 2015. All patients' proBNP, troponine T values and RV/LV ratio were noted. Also, PAP and TAPSE values that were gained from ECHO had recorded at admission and after 3 months anticoagulant therapy. Mean age for patients was 63,6 (± 16,34) and 61,2 % of patients were women. It is found that there were positive correlations between serum biomarkers, PAP value and RV/LV ratio where there were negative correlations with TAPSE value. Higher values than 35 mmHg for PAP at admission and immobility were predictive of adverse outcomes. TAPSE <19,5 mm and proBNP >106,5 pg/ml were independent risk factors for prediction of high PAP at admission (OR: 12,5, p<0,001 and OR: 6,5, p=0,016 respectively). Furthermore, a PAB value of 41 mmHg and higher causes an increase in permanent high PAP after 3 months anticoagulant treatment for 7,37 times

Rectal eversion and double-stapled ileal pouch anal anastomosis in familial adenomatous polyposis syndrome

INTRODUCTION: Surgery is the only treatment option for familial adenomatous polyposis (FAP). Aim of surgery in FAP is to minimize colorectal cancer risk without need for permanent stoma. There are especially two operation options; Total colectomy with ileorectal anastomosis (IRA) and total proctocolectomy with ileo-pouch anal anastomosis (IPAA). We report here a patient with FAP who had resection via rectal eversion just over the dentate line under direct visualization and ileoanal-J pouch anastomosis by double-stapler technique. PRESENTATION OF CASE: A 40 yr. old female patient with FAP underwent surgery. Firstly, colon and the rectum mobilized completely, and then from the 10 cm. proximal to the ileo-caecal valve to the recto-sigmoid junction total colectomy was performed. Rectum was everted by a grasping forceps which was introduced through the anus and then resection was performed by a linear stapler just over the dentate line. A stapled J-shaped ileal reservoir construction followed by intraluminal stapler-facilitated ileoanal anastomosis. Follow up at six months anal sphincter function was found normal. DISCUSSION: There is only surgical management option for FAP patients up to now. Total colectomy with IRA and restorative proctocolectomy with IPAA is surgical options for FAP patients that avoid the need for a permanent stoma. Anorectal eversion may be used in the surgical treatment of FAP, chronic ulcerative colitis and early stage distal rectal cancer patients. CONCLUSION: J-pouch ileoanal anastomosis can safely be performed by rectal eversion and double stapler technique in FAP patients

What is the Best Way to Diagnose Possible Asthma Patients with Negative Bronchodilator Reversibility Tests?

Buket Ba&scedil;a Akdo&gbreve;an, Ilkay Koca Kalkan, Gözde Köycü Buhari, Özlem Özdedeo&gbreve;lu, Hale Ate&scedil;, Kurtulu&scedil; Aksu, Ferda Öner Erkekol Department of Chest Diseases, Division of Immunology and Allergy, University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, TurkeyCorrespondence: Buket Ba&scedil;a Akdo&gbreve;an, Department of Chest Diseases, Division of Immunology and Allergy, University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Incirlist, No: 57 Floor:3, 34147 Bakirkoy/Istanbul, Ankara, Turkey, Tel +90 5053518861 ; +90 850 4339393, Email [email protected]: The best method and strategy for the diagnosis of asthma remains unclear, especially in patients with negative bronchodilator reversibility test (BDRT). In our study, we aimed to investigate the diagnostic yield of peak expiratory flow (PEF) variability for this patient group.Methods: A total of 50 patients with suspected asthma, all with negative BDR test, were included in the study. Demographic information and symptoms were recorded and PEF variability was monitored for 2 weeks. Metacolinbronchial provocation test (mBPT) was performed. Asthma was diagnosed when PEF variability ≥ 20% and/or positive mBPT was observed.Results: 30 of 50 patients were diagnosed with asthma. After 1 month, 17 patients were evaluated for treatment outcomes. The sensitivity and specificity of PEF variability for different cut-off values (≥ 20%, > 15% and > 10%) were 61.5– 83.3, 88.5– 62.5 and 100– 16.7, respectively. One of the most important findings of our study was the absence of variable airflow limitation or airway hyper reactivity in 39% patients with a previous diagnosis of asthma. Multiple logistic regression analysis revealed that a low baseline FEF25-75 value was an independent predictive factor for the diagnosis of asthma (p= 0.05).Conclusion: The most efficient diagnostic test for asthma is still unclear due to many factors. Our study is one of the few studies on this subject. Although current diagnostic recommendations generally recommend a PEF variability of 10% for the diagnosis of asthma, this threshold may not be appropriate for the BDR-negative patient group. Our results suggest using a threshold value of < 15% for PEF variability when excluding asthma and ≥ 20% when confirming the diagnosis of asthma in patients with clinically suspected but unproven reversibility. Furthermore, FEF25-75 is considered to be an important diagnostic parameter that should be included in diagnostic recommendations for asthma.Keywords: diagnosis of asthma, reversibility, peak expiratory flow (PEF) variability, bronchial challenge test, forced expiratory flow (25-75%