Necrotizing Pancreatitis with Hypertriglyceridemia Development Results: A Case Report

Acute pancreatitis due to hypertriglyceridemia is a relatively rare clinical entity. Acute pancreatic necrosis is a life threatening form of acute pancreatitis in which early recognition and treatment is important. Necrotising pancreatitis should be treated immediately. We presented a case of pancreatic necrosis due to hypert¬riglyceridemia which required surgical intervention. We performed necrosectomy. After surgery the patient recovered. We presented the case in order to mention necrotising pancreatitis arising from hypertriglyceridemia and requiring surgical exploration

Rare cause of intestinal obstruction, Ascaris lumbricoides infestation: two case reports

Ascaris lumbricoides is common resident of intestine especially low socioeconomic areas in the world. Complication of Ascaris lumbricoides has been reported include obstruction of the small intestine, intestinal volvulus and intussusception. We report two children with severe sequelae of intestinal obstruction

Unusual cause of gastric outlet obstruction: giant gastric trichobezoar: a case report

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Delayed diagnosis of traumatic diaphragmatic hernia may cause colonic perforation: a case report

Early diagnosis of diaphragmatic rupture after traumas may be difficult, and delayed diagnosis may result in increased morbidity and mortality. This paper describes the case of a 32-year-old man who experienced a traffic accident and had diagnosis of traumatic diaphragmatic hernia nearly four months later. The patient was referred to our emergency room suffering from ileus symptoms. Physical examination demonstrated an apparent abdominal distention, tenderness at the upper abdominal quadrants, rebound, and defense. Thoraco-abdominal X-rays and computerized tomography imaging demonstrated intestinal segments with air-fluid levels in thorax. Laparotomy was performed after a preoperative diagnosis of a strangulated-diaphragmatic hernia. At abdominal exploration, it was found that transverse colon and omentum entered into thorax through diaphragmatic defect located at the left diaphragm. Herniating colon segment was complicated with ischemic necrosis and perforation. In conclusion, colon necrosis and perforation may develop when early diagnosis of diaphragmatic ruptures are missed

Karaciğer hidatik kistleri tedavisinde güncel yaklaşımlar

Karaciğer kist hidatikleri tedavisinde temel prensipler, hastalığa sebep olan parazitin ara konak formunun öldürülmesi ve/veya vücuttan uzaklaştırılması, kistin yol açabileceği komplikasyonların önlenmesi boşaltılması ve sorunsuz kapanmasının sağlanmasıdır. İdeal tedavi hem hastalığın iyileştirilmesini tam olarak sağlamalı, hem de morbidite-mortalitesi minimal olmalıdır.Main principles in the teratment of liver hydatid cysts are to kill and/or to remove the intermediate host form of the parasite which has caused the disease, to prevent the complications which the cyst may cause, evacuation of the cyst and to ensure a trouble-free closure. The ideal treatment should provide not only a full irecovery but also minimal morbidity and mortality

Investigation of the effect of intercostal blockade in palliation of pain in patients with rib fracture

Amaç: Bu çalışmada interkostal sinir blokajının kaburgası kırık hastalarda ağrıya etkisi ve kullanılan opioid gereksinimini azaltmaya yönelik etkisi araştırıldı. Çalışma planı: Ağustos 2008 - Temmuz 2010 tarihleri arasında Antakya Devlet Hastanesi ve Mustafa Kemal Üniversitesi Tıp Fakültesi’nde kaburgası kırık 120 hasta, bu klinik randomize prospektif çalışmaya dahil edildi. Hastalar iki gruba ayrıldı. Grup 1’e (n=60) tramadol (200 mg/gün) ile lornoksikam (8 mg/gün) uygulandı. Grup 2’ye (n=60) 50 mg/gün tramadol ile lornoxicam (8 mg/mg) tedavisine ilaveten interkostal sinir blokajı (%0.5 bupivakain 3 ml) yapıldı. İstirahatte ve öksürürken hasta memnuniyeti görsel analog skalası (GAS) değerleri kaydedildi. Yirmi dört saat sonunda toplam kullanılan tramadol miktarı ve analjezik istemi sayısı kaydedildi. Bulgular: İki grup arasında GAS değerleri açısından istatistiksel olarak anlamlı fark bulunamadı (p<0.05). Ancak kullanılan tramadol miktarı ve analjezik istem sayısı interkostal blokaj yapılan grupta anlamlı derecede düşük idi (p<0.05). Sonuç: Kaburga kırığı olan hastalarda ağrı tedavisinde interkostal sinir blokajın opioid dozunu ve böylece oluşabilecek yan etkileri azaltmada etkili olduğu sonucuna varıldı.Background: This study aims to investigate the effect of intercostal nerve blockade on pain in patients with rib fracture and its effect in reducing the opioid use requirement. Methods: Between August 2008 and July 2010, 120 patients with rib fractures in Antakya State Hospital and Mustafa Kemal University, Faculty of Medicine were included in this clinical randomized prospective study. Patients were divided into two groups. Group 1 (n=60) received tramadol (200 mg/day) and lornoxicam (8 mg/day). In group 2 (n=60), intercostal nerve blockade (0.5% bupivakain 3 ml) was performed in addition to tramadol (50 mg/day) and lornoxicam (8 mg/day) treatment. Scores of patient satisfaction visual analogue scale (VAS) were recorded both at rest and during coughing. At the end of 24 hours, total amount of tramadol used and the number of analgesic demands were recorded. Results: No statistically significant difference in VAS scores between the two groups was observed (p&lt;0.05). However, the amount of tramadol used and the number of analgesic demand were significantly lower in the intercostal nerve blockade group (p&lt;0.05). Conclusion: We concluded that intercostal blockade in the pain management in patients with rib fractures was effective in decreasing the dosage of opioid and thus reducing side effects which might occur

Cystic echinococcosis : Family infection

Kistik ekinokokkozis, Echinococcus granulosus’un neden olduğu ülkemizde de görülen zoonotik bir enfeksiyon hastalığıdır. Mustafa Kemal Üniversitesi Göğüs Cerrahisi Kliniği’ne başvuran bir olgunun akciğer ve karaciğerinde kist hidatik tespit edildi. Olgunun öyküsünden oğlunun karaciğerde kist hidatik nedeni ile ameliyat olduğu öğrenildi. Diğer aile bireylerinin incelenmesinde de bir olguda akciğerde, iki olguda da karaciğerde kist hidatik saptandı ve serolojik incelemeleri de pozitif olarak bulundu. Aynı ailede akciğerde ve karaciğerde kistik ekinokokkozis saptanması, ekinkokkoziste genetik faktörlerin de etkin olabileceğini, rutinde aile fertlerinin araştırılması gerekmese de, risk faktörü mevcut olan yörelerde aile bireylerinin araştırılmasının faydalı olabileceğini düşünerek olguları sunmaya değer gördük.Cystic echinococcosis is a zoonotic infectious disease caused by Echinococcus granulosus, and it is also seen in our country. Cyst hydatid was detected in the lung and liver of a patient who presented to Mustafa Kemal University, Department of Thoracic Surgery. The patient&amp;#8217;s history revealed that his son underwent an operation due to hydatid cyst of the liver. When the other members of the family were studied, it was determined that one of them had hydatid cyst of the lung and the other 2 had hydatid cyst of the liver. Their serological evaluations were also positive. Detection of lung and liver cystic echinococcosis within the family suggests that genetic factors may also be effective in echinococcosis. It is not necessary to study the family members routinely, but investigation of the family members in regions with risk factors may be helpful. We thus thought that the patients warranted presentation in this report

Esophagitis corrosive treatment of N-acetyl cysteine preventing early Stricture use development activity

Özofagus korozif yanıklarında erken dönem striktürün engellenmesinde N-asetil kullanımının etkinliğini araştırmaktır. Gereç ve Yöntemler: Özofagusun yakıcı maddeler nedeniyle gelişen darlıkları, sıvı veya katı nitelikteki yakıcı maddelerin ağız yoluyla alınması sonucu ortaya çıkmaktadır. Bulgular: Konvansitonel+N-Asetil sistein kullanılan grupta 1 hastada, konvansiyonel tedavi uygulanan grupta 7 hastada darlık gelişti. Sonuç: Tek başına konvansiyonel tedavi ve konvansiyonel tedavi + N-asetil sisteinin birlikte kullanım etkinliğini değerlendirmek için randomize prospektif bir çalışma yapıldı. Evre 2b ve evre 3 yanıklı 50 hasta incelendi. Yoğun n-asetil sistein tedavisi ileri evre korozif özofajiti bulunan hastalarda striktür gelişim sıklığını azaltabilir. Daha fazla sayıda hasta içeren gruplar veya deneysel çalışmalarla bulgularımızın destekleneceğini umuyoruz. (JAEM 2011; 10: 73-5)Esophageal stricture early corrosive burns to investigate the eff ectiveness in preventing the use of N-acetyl-cysteine. Strictures of the esophagus due to caustic substances occur with the ingestion of solid or liquid corrosive materials. Materials and Methods: A prospective randomized study was performed to evaluate the eff ectiveness of conventional therapy alone and conventional therapy + N-acetyl cysteine. Fifty patients with grade 2b and grade 3 burnt were analyzed. Intensive n-acetyl cysteine therapy can reduce the incidence of stricture development in patients with advanced grade corrosive esophagitis. Results: N-acetyl cysteine group+ Konvansitonel used in 1 patient, stenosis developed in 7 patients in the group with conventional treatment. Conclusion: We believe that our fi ndings will be better supported with the groups including larger number of patients or with the experimental studies. (JAEM 2011; 10: 73-5

Thoracic trauma : 156 patient assessment

Amaç: Travma nedeniyle acil servise başvuran hastaların, ölüm nedenlerinin önde gelen sebeplerinden önemli bir kısmını, toraks travmaları oluşturmaktadır. Gereç ve Yöntemler: Antakya Devlet Hastanesi ve Mustafa Kemal Üniversitesi Tıp Fakültesi’nde 2008-2010 yılları arasında kliniğimize başvuran 156 toraks travmalı hasta retrospektif olarak değerlendirildi. Hastaların 95’i erkek, 61’i kadındı. Yaş ortalaması künt travmalarda (18-65), penetran travmalarda (13-55) idi. Bulgular: Hastaların 112 ‘si künt, 44’ü penetran toraks travması nedeniyle başvurdu.Doksan hastada kot fraktürü, 11 hastada klavikula, 9 hastada skapula, 10 hastada sternum fraktürü mevcuttu. İlave olarak 20 hastada yelken göğüs deformitesi saptandı. En sık intratorasik komplikasyon olarak 60 pnömotoraks, 20 hastada hemotoraks, 15 hastada kontüzyo akciğer saptandı. Hastaların 81’ine tüp torakostomi, 10 hastaya mekanik ventilasyon, 6’sına torakotomi, uygulandı. Hastaların ortalama hastanede yatış süresi (7-14) olarak belirlendi. Sonuç: Toraks yaralanmaları hastalar zaman kaybedilmeden acil travmatoloji deneyimi olan genel cerrahi, göğüs cerrahi, ortopedi, beyin cerrahi ve anestezi uzmanlarından oluşan multidisipliner bir ekip tarafından karşılanmalı ve tedavi edilmelidir. Özellikle penetran travmaların genç nesilde artma eğiliminde olması dikkat çekici olmalıdır.Objective: To assess trauma patients admitted to the emergency services, because a significant portion of the thoracic trauma cases make up the leading cause of death. Materials and Methods: 156 patients with chest trauma in our clinic admitted to the Antakya public hospital and medical school at the University of Mustafa Kemal between 2008-2010 were retrospectively reviewed. Of the patients, 95 were male and 61 female. The average age of patients with blunt trauma was 18-65years, and with penetrating trauma 13-55. Results: Of the admitted patients,112 had blunt, and 44 had penetrating chest trauma. Rib fractures were present in 90 patients, clavicle in 11 patients,scapula in nine patients, and 10 patients had fracture of the sternum. In addition,flail chest deformity was detected in 20 patients. Pneumothorax was the most common intrathoracic complication in 60 patients, hemothorax in 20 patients, and lung contusion in 15 patients. 81 tubes were inserted in patients with thoracotomy, mechanical ventilation was performed in 10 patients, and thoracotomy in 6. The mean duration of hospitalization was 7-14 days. Conclusion: Patients with chest injuries and traumatology must be met and treated by a multidisciplinary team of experts in thoracic surgery, orthopedics, brain surgery and anesthesia, without losing the experience of emergency general surgery as soon as possible. Penetrating trauma, especially in the younger generation, tends to be increased

Our experience with esophageal foreign bodies

Amaç: Özofagus yabancı cisim aspirasyonları; tanı ve tedavisi geciktiğinde ölümle sonuçlanabilen komplikasyonlara yol açabilmektedir. Bizde kliniğimi- ze özofagus yabancı cismi tanısıyla başvuran olguları retrospektif olarak de- ğerlendirip, erken tanının önemini ve tedavi yöntemlerini irdelemeyi amaçladık. Gereç ve Yöntemler: Ağustos 2008 ile Haziran 2011 tarihleri arasında Antakya Devlet Hastane’si ve Mustafa Kemal Üniversitesi Göğüs Cerrahi kliniği’nde özofagus yabancı cismi tanısıyla yatarak tedavi gören 52 olguyu; yaş, cinsiyet, yabancı cisim tipi, hastaneye başvurma süresi, yabancı cismin lokalizasyonu, uygulanan tedavi, semptom ve komplikasyonlar açısından retrospektif olarak değerlendirildi.Bulgular: Olguların en küçüğü 12 aylık, en büyüğü 80 yaşında olup 24’ü(%46) erkek, 28’i (%54) kadın idi. 34’ü (%65) 60 yaş ve üzeriydi. Bu yaş grubunda çıkarılan yabancı cisimlerin %50’sini kemik oluşturuyordu. Olgularda; en sıkyakınmayı hipersalivasyon (%58) oluşturmaktaydı. Bunu disfaji (%20), batmahissi (%15), dispne (%7) takip ediyordu. Hastalarda yabancı cisim çıkarılma işlemi sonrasında komplikasyonla karşılaşılmadı. Sonuç: Özofagus yabancı cisimleri hayatı tehdit edebilecek komplikasyonla- rından dolayı çok önemlidir. Bu nedenle erken tanı ve tedavi önemlidir. Te- davisinde; rijit özofagoskopi en güvenilir yöntem olmaya devam etmektedir. (JAEM 2012; 11: 77-80)Objective: Foreign bodies in the esophagus can lead to fatal complications if diagnosis and treatment are delayed. The importance of early diagnosis and treatment methods were evaluated in this retrospective study on cases ad- mitted to our clinics with a diagnosis of esophageal foreign body. Material and Methods: Fifty-two patients who had been admitted to An- takya State Hospital and the Department of Thoracic Surgery at Mustafa Ke- mal University with a diagnosis of esophageal foreign body between August 2008 and June 2011 were evaluated retrospectively for age, gender, type of foreign body, time interval to admission, location of the foreign body, treat- ment method, symptoms and complications. Results: Twenty-eight of the patients were female (54%) and 24 were male (46%). The youngest patient was 12 months old and the oldest was 80 years old. Thirty-four patients (65%) were aged 60 and over. In this age group, 50% of the removed foreign bodies were bone. Hypersalivation was the most com- mon symptom among patients (58%), followed by dysphasia (20%), a sting- ing sensation (15%) and dyspnea (7%). No patients developed complications after the removal of the foreign body. Conclusion: Esophageal foreign bodies are significant due to the life-threat- ening complications they may cause. Thus, early diagnosis and treatment are crucial. Rigid esophagoscopy is still the most reliable method of treatment. (JAEM 2012; 11: 77-80