Unilateral primary adrenal B-cell lymphoma clinically mimicking chronic gastritis

Background: Primary adrenal lymphomas are a very rare type of extranodal lymphoma, and they usually are found bilaterally. Symptoms of the disease are variable and depend on the type of lymphoma and/or presence of adrenal insufficiency. Magnetic resonance imaging is the best radiologic modality for differentiating lymphomas from other adrenal malignancies; however, histopathology is considered as the gold standard method for diagnosing extranodal lymphomas. Case Report: We present a case of unilateral adrenal lymphoma that was initially diagnosed as an infectious disease and chronic gastritis, based on clinical and laboratory findings. Ultrasonography detected an adrenal mass, and magnetic resonance imaging excluded common lesions of the adrenal gland and showed lymphadenopathy around the major vessels of the abdomen. A percutaneous biopsy of the mass and bone marrow biopsy confirmed the diagnosis of primary adrenal lymphoma withoutbone marrow metastasis. Conclusions: Extranodal lymphomas can occur in almost every organ, and if nonspecific clinical findings are combined with the presence of a solid organ mass, lymphoma should be included in the differential diagnosi

MTHFR C677T mutasyonunun neden olduğu süperior mezenterik ven trombozu

Amaç: Akut süperior mezenterik ven trombozu, tüm mezenterik iskemik olayların yaklaşık % 5 -15’ini oluşturan nadir görülen bir intestinal iskemi nedenidir. Bu yazıda süperior mezenterik ven trombozu gelişen kalıtsal trombofilili 2 hastanın sunulması amaçlanmıştır. Olgu sunumu: Otuz bir ve 51 yaşında iki hastaya akut batın, mezenter iskemi nedeni ile laparotomi ve ince barsak rezeksiyonu yapıldı. Genetik incelemede her iki hastada homozigot MTHFR C677-T mutasyonu saptandı. Ameliyat sonrası dönem sorunsuz geçen hastalar 10. ve 12. günde taburcu edildi. Sonuç: Akut süperior mezenterik ven trombozu mortalitesi yüksek olan ciddi bir sağlık problemidir. Doğru tanı koyabilmek için hastalıktan şüphelenmek oldukça önemlidir. Nekroz varlığında acil eksplorasyon ve nekrotik dokuların rezeksiyonu gerekmektedir. Trombofilili hastalar tanınmalı ve uzun dönem antikoagülan kullanımı planı yapılmalıdı

Penetrating anterior abdominal stab injury

AMAÇ: Acil cerrahi servislerinde sık karşılaşılan karına penetre delici kesici alet yaralanmalarında (DKAY) tedavi yaklaşımı, zaman içinde rutin eksploratis laparotomiden selektif konservatif yaklaşıma doğru değişim göstermiştir. Konservatif yaklaşımda fizik muayene, laboratuar ve görüntüleme sonuçlarına göre laparotomi kararı verilir. Çalışmamızın amacı karın anterior bölgesine penetre DKAY'lı hastalarımızın takip ve tedavi sonuçlarının irdelenmesidir. YÖNTEMLER: Nisan 2009 - Kasım 2011 tarihleri arasında karın anterior bölgesine penetre DKAY' sı olan ve acil cerrahi ünitesine başvuran hastalar prospektif olarak incelendi. Hemodinamisi stabil, akut karın bulguları olmayan hastalar konservatif tedaviye alınırken, hemodinamisi instabil ve/veya akut karın bulguları olan hastalara acil laparotomi yapıldı. Yaralanmanın lokalizasyonu, zamanlaması (acil,erken,geç), laparotomi bulguları (terapötik,nonterapötik,negatif) ve tedavi sonuçları değerlendirildi. BULGULAR: Toplam 85 hasta çalışmaya dahil edildi. İlk değerlendirme sonucunda hemodinamisi stabil olan ve peritonit bulguları olmayan 80 hasta konservatif tedaviye (grup 1) alınırken, 5 hastaya acil laparotomi (grup 2) uygulandı. Grup 1'de 11 hastaya erken, 5 hastaya geç dönemde laparotomi yapıldı. Bu grupda ki hastaların 13'ünde laparotomi terapötik, 2'sinde nonterapötik ve 1'inde negatif idi. Grup 2'de laparotomi endikasyonları; 3 hastada akut batın, 1 hastada hemodinamik instabilite ve 1 hastada organ eviserasyonu idi. Bu grup da 4 terapötik, 1 negatif laparotomi yapılırken bir hasta peroperatif exitus oldu. SONUÇ: Bu çalışmada 64 hastaya (% 75) konservatif tedavi, 21 hastaya (% 25) laparotomi uygulandı. Laparotomilerin; 17'si (% 80) terapötik, 2'si (%10) nonterapötik ve 2'si (%10) negatif idi. Klinik takip ve tanı metodlarının birlikte kullanımı gereksiz laparotomi oranlarını azaltmaktadır. OBJECTIVE: Penetrating anterior abdominal stab injuries (PAASI), frequently encountered in Emergency Unit and traditionally managed with mandatory laparotomy, are nowadays managed conservatively. The decision of laparotomy is based on physical examination, laboratory and imaging results during follow-up. The purpose of this study was to analyze the outcome of patients with PAASI. METHODS: From April 2009 to November 2011, patients with diagnosis of PAASI admitted in Emergency Unit were prospectively included in the study. While hemodinamically stable patients without signs of peritonitis were managed conservatively, unstable and/or patients with signs of peritonitis underwent emergency laparotomy. Location of the injury, type of management (emergency, early, late), laparotomy findings (therapeutic, non-therapeutic, negative), and treatment results were analyzed. RESULTS: Totally 85 patients were included in the study. Hemodynamically stable 80 patients without signs of peritonitis were treated conservatively (group 1), while emergency laparotomy was performed in 5 patients (group 2). In group 1, early laparotomy was performed in 11 patients and late laparotomy in 5 patients. Totally 13 therapeutic, 2 nontherapeutic and 1 negative laparotomy were performed. In Group 2, the indications for laparotomy were acute abdomen (n=3), hemodynamic instability (n=1), and organ evisceration (n=1). Group 2 included 4 therapeutic, 1 negative laparotomy and in this group 1 patient died intraoperatively. CONCLUSION: In this study, 64 patients (75%) were managed conservatively, whereas 21 patients (25%) underwent laparotomy, including 17 therapeutic (80%), 2 nontherapeutic (% 10) and 2 negative (10%). Clinical follow-up and use of diagnostic methods decrease the rate of unnecessary laparotomy

The results of caustic ingestions

Background/Aims: The ingestion of caustic substances is a common condition, which may result in serious injuries of the upper gastrointestinal system. The purpose of this study is to assess the outcomes of patients who had a history of the ingestion of caustic substances

Bleedings caused by warfarin overdose

Objectives: Warfarin is used in prophylaxis and treatmentof many diseases. Low doses of warfarin increaserisk of thrombosis and high doses increase risk of bleeding.In this study, we evaluated patients having warfarinrelatedbleedings in aspect of demographic data, durationof hospitalization, morbidity and mortality.Materials and methods: Between dates of January2010 and December 2010, patients with history of usingwarfarin and complaint of bleeding, whose internationalnormalized ratio (INR) values 6 or above, were evaluatedretrospectively.Results: Twenty-three patients (64%) were female, andthirteen (36%) were male with a total number of 36 patients.The mean age is 67.5 years (range 43-84 year).Mean duration of drug use was 37.2 ± 49.7 months with amedian value of 24 months. In six patients (16.7%), warfarinuse was initiated for the first time, three (8.3%) wasgoing to change a new dose. INR checks on a regularbasis in 18 patients (50%) were achieved.Hematuria and hematemesis/melena were the mostcommon forms of admission. Eleven patients (30%) hadboth erythrocyte (mean 3.8 units) and fresh frozen plasmatransfusions. Thirty (83%) patients had fresh frozenplasma transfusions (mean 2.53 units), 19 of them hadonly fresh frozen plasma. Rate of mortality due to bleedingwas 5,5%. The average of length of hospital stay was3.28 days (range 1-8 days).Conclusions: Warfarin users need careful INR monitoring.Patients should be informed about importance of INRmonitoring and potential complications

Colonic cancers fistulised to other segments of the digestive tube. Case series and review of literature.

BackgroundOccurrence of enteric fistulas caused by colon cancer is a rare. Preoperative diagnosis has some difficulty because of non-specific presentation and lack of appropriate combination of diagnostic techniques. MethodsFrom November 2008 to April 2012, patients with entero-enteric fistulas caused by colon cancer were reviewed with regard to demographic variables, clinical presentation, diagnostic evaluation, intra-operative findings, type of surgical procedure and pathologic examination.ResultsThere were four (3.92%) fistulas caused by colon cancer among 102 patients with adenocarcinoma of the colon. Fistulas were one colo-duodenal, one colo-gastric, one ceco-sigmoidal and one sigmoido-rectal in patients with a mean age 56.5 years. Presence of fistulas was not diagnosed preoperatively in any of the patients by using standard diagnostic techniques, i.e., endoscopy and computed tomography. Complete resection of tumor with tract of fistula was performed in all patients. Mean duration of follow-up period was 12.25 months, liver metastasis was detected in one patient, entero-cutaneous fistula in one.ConclusionsMalignant fistula formation caused by colon cancers is a rare event. Preoperative diagnosis could be achieved by using a combination of barium enema or meal and endoscopy. Surgical treatment via oncologic en bloc resection with negative microscopic margins is important for long-term survival

Attitudes and barriers towards using complementary and alternative medicine among university students in Jordan

WOS: 000453498000025PubMed: 30477835Background Perceptions towards Complementary and Alternative Medicine (CAM) are highly variable but are improving globally. However, studies conducted in Jordan about CAM are insufficient. This study aims to explore the attitudes and barriers towards using CAM among university students in Jordan. Design and methods: This cross-sectional study was conducted at the University of Jordan. A self-administered paper questionnaire was distributed to 475 students from the Faculties of Medicine, Pharmacy and Engineering of all academic years. Descriptive and multivariate data analysis was done using SPSS v.20. Results: Seventy percent of all the participants have used at least one type of CAM. Younger female pharmacy students were most likely to use CAM. There were significant differences between students of different academic years regarding their opinions on CAM (p < 0.024). The percentage of medical students who believed that combining CAM with modern medicine would improve the overall treatment quality was significantly lower than the other two faculties (p < 0.001). Of the students who never used CAM, 39% did not do because they doubted its effectiveness. Conclusion: There is a need for including CAM in the universities' curriculum as mandatory courses for health faculties and elective courses for other disciplines

Uganda'da Fıtık Cerrahisi: Yeryüzü Doktorları Deneyimi

Amaç: Yeryüzü Doktorları Türkiye'nin gönüllü cerrahi ekibinin Uganda'daki faaliyetleri ile ilgili deneyimlerini değerlendirerek bildirmeyi amaçladık.Gereç ve Yöntemler: Yeryüzü Doktorları Türkiye tarafından 3-8 Şubat 2015 tarihleri arasında Uganda'nın Butambala ve Kampala bölgelerinde cerrahi kamp düzenlendi. Bu kampın amacı, diğer cerrahilere ek olarak, tüm karın duvarı fıtık tipleri için fıtık tamirlerinin gerçekleştirilmesiydi. Hastaların demografik verileri ile uygulanan anestezi ve cerrahi prosedürlerin tipleri kayıt edilerek incelendi.Bulgular: Toplam 115 cerrahi hastasında operasyonlar genel, spinal ya da lokal anestezi ile yapıldı. Bunlardan 80'i (%69,57) kasık fıtığı, 15'i (%13,04) göbek fıtığı ve 9'u (%7,82) epigastrik fıtık tanısı almıştı. Ek olarak hidrosel tanısı ile 11 (%9,57) olgu ameliyat edildi. On (%8,70) hastada postoperatif minör komplikasyonlar gözlenirken, ameliyatların sonunda postoperatif mortalite gelişmedi.Tartışma ve Sonuç: Yeryüzü Doktorları; etkin bir tedavi modalitesi olarak cerrahinin, insani sağlık yardımı programlarının düzenlenmesi sırasındaki planlamalarda en önemli önceliklerden birini oluşturması gerektiği kanısındadırlar.Aim: Our aim was to evaluate, and report the experiences of the volunteer surgical team of Doctors Worldwide (DWW) Turkey during their medical activites in Uganda.Materials and Methods: A surgical camp was organized by DWW Turkey between 3-8 February 2015 in the Butambala and Kampala districts of Uganda. The surgical camp, in addition to other surgeries, was intended to conduct herniorrhaphies for all forms of abdominal wall hernias. Outcomes obtained as results of all surgical practices, including the demographic data of the patients, the types of anaesthesiological, and surgical procedures performed were recorded, and analyzed.Results: Surgical interventions were carried out under either general, spinal, or local anesthesia in a total of 115 patients with the diagnosis of inguinal hernia in 80 (69.57%), umbilical hernia in 15 (13.04%), and epigastric hernia in 9 (7.82%) cases. Additionally, operations were performed for hydrocele in 11 (9.57%) cases. Postoperative minor complications were met in 10 (8.70%) patients, and no postoperative mortality took place at the end of all operations.Discussion and Conclusion: DWW Turkey Surgical Team conclude that, as an efficacious modality of treatment, surgery should be considered as one of the most important priorities when conducting humanitarian health aid programs

Approach to the lower gastrointestinal tract bleeding in patients with normal colonoscopic findings Kolonoskopik bulgulari normal olan alt gastrointestinal kanamalara yaklaşim

BACKGROUND: Lower gastrointestinal bleeding is a commun clinical entity. Although colonoscopic examination is the first choice for diagnosis, it may not be enough to reveal the cause of bleeding in all subjects. METHODS: Eight patients who had massive lower gastrointestinal bleeding having normal colonoscopic findings were retrospectively evaluated at the Department of Trauma and Emergency Surgery, Istanbul University, Faculty of Medicine RESULTS: There were 5 male and 3 female patients with mean age of 51 (28 to 82). Patients received a mean of 13 U (range 2 to 23) with transfused erythrocyte concentrates. Four patients had found to be normal during angiographic, scintigraphy or enterocylytic examinations. Angiography was diagnostic in 4 patients, and identified bleeding from ileocolic pseudoaneurisms (n= 2) branches of jejunal artery (n=2). Embolization procedure were performed in these 4 patients and 3 of them developed intestinal necrosis and underwent surgery. One did not require further treatment. Two of the patients who underwent surgery expired due to sepsis. Patients were hospitalized for a mean of 17 days (range 5 to 37). CONCLUSION: Despite employment of all diagnostic procedures, the cause of bleeding were not detected in half of patients who had normal colonoscopic findings. If angiographic treatment is necessary, superselective arterial embolization should be performed