Esophageal squamous papilloma

Özofagus skuamoz papillomu, genellikle alt özofagusta soliter bir lezyon olarak görülen, iyi huylu skuamoz epitelyal polipoid bir tümördür. Prevalans oranları çok düşüktür ve 1959’dan bu yana literatürde yaklaşık 250 vaka bidirilmiştir. Kronik mukozal irritasyon ve human papilloma virus enfeksiyonu suçlanan etyolojik nedenlerdir. Tipik özofagus skuamöz papillomunun hiçbir özgün semptomu yoktur. Bizim vakamız kronik dispeptik şikayetleri olan ve endoskopik olarak reflü özofajiti saptanan 51 yaşındaki erkek hasta idi. Endoskopik incelemede özofagus 25. cm’de 3-4 mm’lik polipoid oluşum izlendi. Buradan aldığımız biyopsi örneğinin patolojik inceleme sonucu özofagus skuamoz papillomu olarak geldi.Esophageal squamous papilloma is a benign squamous epithelial polypoid tumor and is usually seen as a solitary lesion of the lower esophagus. They have a low prevalence, and about 250 cases have been reported in the literature since 1959. Chronic mucosal irritation and infection with human papilloma virus are proposed etiologies. There are no pathognomonic symptoms for the typical esophageal squamous papilloma. Our patient was a 51-yearold man who had chronic dyspeptic complaints and endoscopically detected reflux esophagitis. A 3-4 mm sized polypoid formation was seen at the 25’th cm of his esophagus during the endoscopic examination. Pathologic inspection of the biopsied specimen taken from this part of his esophagus indicated esophageal squamous papilloma

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The Treatment of Recurrent Urothelial Tumors of the Upper Urinary System and at Urostomy Site following Radical Cystectomy with Intraureteral Bacillus Calmette-Guérin and Cryotherapy.

Urinary bladder carcinoma is the second most common cancer of the urinary system. The recurrence rate in the upper urinary system (UUS) for urothelial cancers is around 3% following radical cystectomy. The followup generally consists of imaging studies and urinary cytology, although there are no prospective data on the frequency, the mode, and the duration of followup. In patients carefully selected according to risk factors, kidney-sparing minimally invasive methods (ureteroscopic procedures, percutaneous approach, and local drug instillation) appear as contemporary alternatives for low-grade and low-stage primary UUS. In this paper, we present the patient who underwent radical cystectomy with urinary diversion ureterocutaneostomy, was diagnosed with widespread bilateral UUS tumors and recurrent tumor at the urostomy site at active followup, for which he was given local Bacillus Calmette-Guérin (BCG) and cryotherapy, and was followed by disease-free for 2 years thereafter

Kolonun benign anastomoz darlığında rektal mesalazin tedavisi sonrası endoskopik balon dilatasyonu

Anastomoz darlıkları kolorektal cerrahinin bilinen bir komplikasyonu olma-sına rağmen benign hastalıklarda komplet kolonik anastomoz obstrüksiyonu nadirdir. Benign darlıklar low-anterior rezeksiyon sonrası yapılan kolorektal anastomozda nispeten sık görülen bir komplikasyondur ve kolorektal anas-tomozların %5-22’sinde gelişebilir. Günümüzde benign anastomoz darlık-larının tedavisinde ilk seçenek endoskopik girişimlerdir. Çeşitli endoskopik teknikler tarif edilmesine rağmen optimal yaklaşım için kontrollü prospek-tif çalışma verileri eksiktir. Bu çalışmada ileri derecede anastomoz darlığı gelişmiş ve endoskopik balon dilatasyon uygulanan bir hastanın sunulması amaçlandı. Hastaya bir haftalık rektal mesalazin tedavisinden sonra bir kez ayaktan balon dilatasyonu uygulandı ve darlık giderildi. Rektal mesalazin uygulamasının darlık bölgesindeki inflamutuvar sürece olumlu etkisi oldu ve balon dilatasyon sayısını azalttı. Kolorektal darlıkların tedavisinde endos-kopik balon dilatasyon 1985’ten beri kullanılmaktadır. Minimal invaziv bir yöntemdir, başarı oranı yüksektir, güvenle direkt görüş altında yapılabilir, tekrarlanabilir ve hastanede yatış gerektirmez.Although anastomotic strictures are a recognized complication of colorectal surgery, complete colonic anastomotic obstruction from benign disease is rare. A benign stricture is a relatively common complication of colorectal anastomosis after low anterior resection and may develop colonic anasto-mosis in 5%-22% of cases. Today, endoscopic interventions have become the preferred first-line treatment for postoperative large bowel strictures. A variety of endoscopic techniques have been described, but there is a lack of data from controlled prospective trials regarding the optimal approach. In this study, a case of severe anastomotic stricture of the colon, during which endoscopic balloon dilatation was performed, is presented. After a one-week course of treatment with rectal mesalazine, the ambulatory patient under-went balloon dilation only once and the stricture resolved. Rectal mesalazine administration had a positive effect on the inflammatory process at the site of stenosis and reduced the number of balloon dilatations. Endoscopic balloon dilatation has been used since 1985 for the treatment of colorectal strictures. It is a minimally invasive method, has a high success rate, can be performed safely under visual control, can be performed repeatedly, and does not re-quire hospitalization

Clinicopathologic characteristics and reproductive outcomes of patients with borderline ovarian tumors (BOTs): A single institute experience and a review of the literature

OBLECTIVES: In borderline ovarian tumor (BOT) cases, evaluating the therapy forms, the percentage of recurrence and survival and the condition of fertility after conservative surgery, for those with a fertil- ity wish. STUDY DESIGN: The files, follow-up forms and pathological reports of 96 cases, diagnosed with BOT, at our clinic, treated between 1994-2009, have been retrospectively evaluated. RESULTS: The mean age of the evaluated cases was 39.54±13.4. On the basis of histopathological data, 46 cases (47.9%) had serous and 41 cases (42.7%) had mucinous, and 9 cases (9.4%) had other histological subtypes. 88 cases were in stage I, 2 cases (2.1%) were in stage II and 6 cases (6.2%) were in stage III. 89 (92.7%) cases were operated with laparatomy, 7 (7.3%) cases were operated with laparoscopy. In 52 cases (54.1%), conservative (fertility preserving) surgery was applied (27 cases USO, 8 cases cystectomy, 17 cases USO-staging), in 44 cases (45.8%) radical surgery (in 32 cases, complete staging, TAH-BSO in 11 cases, TAH-USO in 1 case). 26% of the cases (25 cases) underwent postoperative adjuvant chemotherapy. In 39 cases with fertility wish, 8 pregnancy occured after therapy. In the follow-up, 10 cases (10.4%) had recurrence. The rate of recurrence was 4% (2/44) after radical surgery and 15% (8/52) after conservative surgery. The general disease-free survival rate of the cases (DFS) was 89.6%, and there was no significant difference between radical and conservative surgery in view of DFS (95.45% vs 84.62%, p=0.97). CONCLUSION: In cases of borderline ovarian tumor, the best therapy is surgical debulking and the post-operative recurrence rate is generally low. Although the recurrence risk in patients who underwent conservative surgery is relatively higher, disease free survival rates are no different than those who had radical surgeryOBLECTIVES: In borderline ovarian tumor (BOT) cases, evaluating the therapy forms, the percentage of recurrence and survival and the condition of fertility after conservative surgery, for those with a fertil- ity wish. STUDY DESIGN: The files, follow-up forms and pathological reports of 96 cases, diagnosed with BOT, at our clinic, treated between 1994-2009, have been retrospectively evaluated. RESULTS: The mean age of the evaluated cases was 39.54±13.4. On the basis of histopathological data, 46 cases (47.9%) had serous and 41 cases (42.7%) had mucinous, and 9 cases (9.4%) had other histological subtypes. 88 cases were in stage I, 2 cases (2.1%) were in stage II and 6 cases (6.2%) were in stage III. 89 (92.7%) cases were operated with laparatomy, 7 (7.3%) cases were operated with laparoscopy. In 52 cases (54.1%), conservative (fertility preserving) surgery was applied (27 cases USO, 8 cases cystectomy, 17 cases USO-staging), in 44 cases (45.8%) radical surgery (in 32 cases, complete staging, TAH-BSO in 11 cases, TAH-USO in 1 case). 26% of the cases (25 cases) underwent postoperative adjuvant chemotherapy. In 39 cases with fertility wish, 8 pregnancy occured after therapy. In the follow-up, 10 cases (10.4%) had recurrence. The rate of recurrence was 4% (2/44) after radical surgery and 15% (8/52) after conservative surgery. The general disease-free survival rate of the cases (DFS) was 89.6%, and there was no significant difference between radical and conservative surgery in view of DFS (95.45% vs 84.62%, p=0.97). CONCLUSION: In cases of borderline ovarian tumor, the best therapy is surgical debulking and the post-operative recurrence rate is generally low. Although the recurrence risk in patients who underwent conservative surgery is relatively higher, disease free survival rates are no different than those who had radical surger

Endoscopic balloon dilatation after rectal mesalazine treatment within an uncertainty of colonic anastomosis

Anastomoz darlıkları kolorektal cerrahinin bilinen bir komplikasyonu olma-sına rağmen benign hastalıklarda komplet kolonik anastomoz obstrüksiyonu nadirdir. Benign darlıklar low-anterior rezeksiyon sonrası yapılan kolorektal anastomozda nispeten sık görülen bir komplikasyondur ve kolorektal anas-tomozların %5-22’sinde gelişebilir. Günümüzde benign anastomoz darlık-larının tedavisinde ilk seçenek endoskopik girişimlerdir. Çeşitli endoskopik teknikler tarif edilmesine rağmen optimal yaklaşım için kontrollü prospek-tif çalışma verileri eksiktir. Bu çalışmada ileri derecede anastomoz darlığı gelişmiş ve endoskopik balon dilatasyon uygulanan bir hastanın sunulması amaçlandı. Hastaya bir haftalık rektal mesalazin tedavisinden sonra bir kez ayaktan balon dilatasyonu uygulandı ve darlık giderildi. Rektal mesalazin uygulamasının darlık bölgesindeki inflamutuvar sürece olumlu etkisi oldu ve balon dilatasyon sayısını azalttı. Kolorektal darlıkların tedavisinde endos-kopik balon dilatasyon 1985’ten beri kullanılmaktadır. Minimal invaziv bir yöntemdir, başarı oranı yüksektir, güvenle direkt görüş altında yapılabilir, tekrarlanabilir ve hastanede yatış gerektirmez.Although anastomotic strictures are a recognized complication of colorectal surgery, complete colonic anastomotic obstruction from benign disease is rare. A benign stricture is a relatively common complication of colorectal anastomosis after low anterior resection and may develop colonic anasto-mosis in 5%-22% of cases. Today, endoscopic interventions have become the preferred first-line treatment for postoperative large bowel strictures. A variety of endoscopic techniques have been described, but there is a lack of data from controlled prospective trials regarding the optimal approach. In this study, a case of severe anastomotic stricture of the colon, during which endoscopic balloon dilatation was performed, is presented. After a one-week course of treatment with rectal mesalazine, the ambulatory patient under-went balloon dilation only once and the stricture resolved. Rectal mesalazine administration had a positive effect on the inflammatory process at the site of stenosis and reduced the number of balloon dilatations. Endoscopic balloon dilatation has been used since 1985 for the treatment of colorectal strictures. It is a minimally invasive method, has a high success rate, can be performed safely under visual control, can be performed repeatedly, and does not re-quire hospitalization