Tıkanma sarılığının nadir sebebi: Kolanjiyokarsinomu taklit eden Fasiola hepatika

Fasiola hepatika, Turkiye ve komşu ulkelerinde gorulen endemik bir hayvan hastalığıdır. Parazitin hayat siklusunda insanlar rastlantı olarak konakcı olurken asıl konakcı koyunlardır. Hastalığın hepatik (akut) ve biliyer (kronik) olmak uzere iki evresi vardır. Parazitler biliyer sisteme ulaştıklarında kolestaza ba.lı kolanjit semptomları gorulur ve bu durum kolaylıkla tıkanma sarılı.ının diğer nedenleri ile karıştırılabilir. Biz bu calışmada kolanjiyokarsinomdan guclukle ayırt edilebilen Fasiola hepatikalı bir olguyu sunuyoruz. Turkiyenin doğu kesiminde yaşıyan 47 yaşında kadın hasta ateş, sarılık ve karın sağ üst kadranda ağrı şikayeti ile klini. imize başvurdu. Total bilirubin değeri 4.2 mg/dl, aspartat aminotransferaz 55 iu/L, alanin aminotransferaz 65 iu/L, alkalen fosfataz 325 iu/L, ve gamma-glutamil transpeptidaz 172 iu idi. Ca19.9 ve karsinoembriyonik antijen dahil tum tumor belirtecleri normal sınırlardaydı. Detaylı bir değerlendirmeden sonra laparatomi yapılarak, kolesistektomi, koledokotomi ve T-tup drenaj yapıldı. Koledoktan cok sayıda parazit cıkartıldı. Cıkartılan parazitlerden biri parazitoloji laboratuvarına gonderildi. İndirekt hemaglunitasyon testi 1/320 (+) bulundu. Sonuc olarak bu paraziter hastalığın kronik evresi tıkanma sarılı.ının di.er nedenleri ile kolaylıkla karışabilir. Bu nedenle Fasiola hepatika, ozellikle endemik bolgelerde, tıkanma sarılığının ayırıcı tanısı yapılırken akılda tutulmalıdır.Fasciola hepatica is an endemic zoonotic disease in Turkey and neighboring countries. The usual definitive host is the sheep; humans are accidental hosts in the life cycle of the Fasciola. There are two disease stages: the hepatic (acute) and biliary (chronic) stages. When the flukes enter the bile ducts, the symptoms of cholestasis and cholangitis may present, which can easily be misdiagnosed as obstructive jaundice of other causes. We present a case of fascioliasis, which was difficult to differentiate from cholangiocarcinoma. A 47-year-old woman from Eastern Turkey presented with fever, right upper quadrant abdominal pain, and jaundice. Total bilirubin was 4.2 mg/dl, aspartate aminotransferase 55 IU/L, alanine aminotransferase 65 IU/L, alkaline phosphatase 325 IU/L, and gamma-glutamyl transpeptidase 172 IU/L. All tumor markers including carcinoembryonic antigen and Ca19-9 were in normal values. After extended evaluation, an explorative laparotomy with cholecystectomy, choledochostomy and T-tube drainage was performed. Multiple flukes were removed from the choledochus. One of the parasites was sent to the parasitological clinic for identification. The result of an indirect hemagglutination test for F. hepatica was 1/320 (+). In conclusion, the chronic phase of this zoonotic infection can be easily misdiagnosed as any other cause of obstructive jaundice. Thus, F. hepatica should be considered in the differential diagnosis of common bile duct obstruction, especially in endemic areas. To

An efficient method for snore/nonsnore classification of sleep sounds

A new method to detect snoring episodes in sleep sound recordings is proposed. Sleep sound segments ( i.e., 'sound episodes' or simply 'episodes') are classified as snores and nonsnores according to their subband energy distributions. The similarity of inter- and intra-individual spectral energy distributions motivated the representation of the feature vectors in a lower dimensional space. Episodes have been efficiently represented in two dimensions using principal component analysis, and classified as snores or nonsnores. The sound recordings were obtained from individuals who are suspected of OSAS pathology while they were connected to the polysomnography in Gulhane Military Medical Academy Sleep Studies Laboratory ( GMMA-SSL), Ankara, Turkey. The data from 30 subjects (18 simple snorers and 12 OSA patients) with different apnoea/hypopnea indices were classified using the proposed algorithm. The system was tested by using the manual annotations of an ENT specialist as a reference. The accuracy for simple snorers was found to be 97.3% when the system was trained using only simple snorers' data. It drops to 90.2% when the training data contain both simple snorers' and OSA patients' data. ( Both of these results were obtained by using training and testing sets of different individuals.) In the case of snore episode detection with OSA patients the accuracy is 86.8%. All these results can be considered as acceptable values to use the system for clinical purposes including the diagnosis and treatment of OSAS. The method proposed here has been used to develop a tool for the ENT clinic of GMMA- SSL that provides information for objective evaluation of sleep sounds

A case of uneventful ABO-incompatible liver transplantation from a deceased donor managed with routine immunosuppressive treatment

ABO-incompatible liver transplantation (ILT) was formerly contraindicated because of the increased risk of antibody-mediated humoral graft rejection due to preformed anti-A/-B antibodies on recipient endothelial cells. A 2.5-year-old girl with end-stage liver disease underwent cadaveric donation ILT because of acute liver failure and esophageal variceal bleeding before transplantation. The patient's blood type was A Rh (-) and the donor's blood type B Rh (+). The operation and postoperative course were uneventful. The immunosuppression consisted of steroids, and tacrolimus was initiated on the day of the surgery. The patient's hemoglobin level did not change, and direct Coombs test performed daily was consistently negative. Anti-B titer was observed at a maximum of 1/8. The patient was followed up during the first year. This case of ILT from a cadaveric donor is significant because the 2.5-year-old recipient did not experience any complications after undergoing routine immunosuppressive treatment.ABO-incompatible liver transplantation (ILT) was formerly contraindicated because of the increased risk of antibody-mediated humoral graft rejection due to preformed anti-A/-B antibodies on recipient endothelial cells. A 2.5-year-old girl with end-stage liver disease underwent cadaveric donation ILT because of acute liver failure and esophageal variceal bleeding before transplantation. The patient's blood type was A Rh (-) and the donor's blood type B Rh (+). The operation and postoperative course were uneventful. The immunosuppression consisted of steroids, and tacrolimus was initiated on the day of the surgery. The patient's hemoglobin level did not change, and direct Coombs test performed daily was consistently negative. Anti-B titer was observed at a maximum of 1/8. The patient was followed up during the first year. This case of ILT from a cadaveric donor is significant because the 2.5-year-old recipient did not experience any complications after undergoing routine immunosuppressive treatment

Hydatid disease involvement of primary subcutaneous tissue in the posterior proximal thigh - an unusual localization

WOS: 000254501400024PubMed ID: 18377614

Comparison of open and laparascopic splenectomy in elective cases

WOS: 000458742100026Purpose: The aim of this study was to compare open splenectomy (OS) and laparoscopic splenectomy (LS) in patients undergoing elective splenectomy. Materials and Methods: The study included 95 patients who underwent elective splenectomy between January 1, 2013 and January 1, 2018 in the Department of General Surgery, Faculty of Medicine, cukurova University. Demographic information, etiology, duration of operation, amount of blood loss and preoperative spleen size were measured. The necessity to switch from laparoscopic surgery to open surgery, duration of hospitalization, postoperative blood products replacement and postoperative complications were examined. Results: A total of 95 patients, 79% (n=75) who underwent OS, and 21% (n=20) who underwent LS were included in our study. The mean age in the study group was 43.0 +/- 17 (18-78) for OS and 39.3 +/- 13.9 in LS (1962). Of the patients who underwent OS, 31 were male (41.3%) and 44 were female (58.7%). Of the patients who underwent LS, 7 were male and 13 were female (65%). Of the 75 cases who underwent OS; 19 (25.3%) were treated for splenomegaly, 16 (21.3%) for immune thrombocytopenic purpura (ITP), 11 (14.7%) for a mass, and 7 (9.3%) cases were operated on for Thalassemia. Of the 20 cases who underwent LS; 12 (60%) cases were operated on for ITP, 3 (15%) cases for hemolytic anemia and 2 (10%) cases for lymphoma.The length of hospital stay, amount of bleeding and spleen size were superior in LS; while the duration of surgery was significantly higher in OS. Conclusion: LS is a stronger alternative to OS because of its lower complication rate, hospitalization time and cost

Synchronous haemangioma of liver and diaphragma

Karaciğerde görülen en sık benign neoplazm hemanjiyomdur. Genellikle asemptomatik olup ender olarak komplikasyon oluşturabilir. Karaciğer ve senkron organ tutulumu görülebilir. Genellikle medikal takip edilir. Semptomatik, hızlı büyüme gösterir ve tanı kesin değilse cerrahi tedavi uygulanmalıdır. Bu yazıda karaciğer ve diaframda aynı dönemde görülen senkron hemanjiyomu olan bir olgu sunulmuştur.The most common benign neoplasm seen in the liver is haemangioma. It is usually asymptomatic and rarely causes complications. Liver and synchronous organ involvement can be seen. It is usually followed by medical. If symptomatic, rapid growth and diagnosis is uncertain, surgical treatment should be performed. In this article, a case who presented with synchronous haemangima on liver and diaphragma has been reported

Synchronous haemangioma of liver and diaphragma

Karaciğerde görülen en sık benign neoplazm hemanjiyomdur. Genellikle asemptomatik olup ender olarak komplikasyon oluşturabilir. Karaciğer ve senkron organ tutulumu görülebilir. Genellikle medikal takip edilir. Semptomatik, hızlı büyüme gösterir ve tanı kesin değilse cerrahi tedavi uygulanmalıdır. Bu yazıda karaciğer ve diaframda aynı dönemde görülen senkron hemanjiyomu olan bir olgu sunulmuştur.The most common benign neoplasm seen in the liver is haemangioma. It is usually asymptomatic and rarely causes complications. Liver and synchronous organ involvement can be seen. It is usually followed by medical. If symptomatic, rapid growth and diagnosis is uncertain, surgical treatment should be performed. In this article, a case who presented with synchronous haemangima on liver and diaphragma has been reported

Abdominal extragenital endometriosis: single centre experience

WOS: 000437950900019Purpose: This study aimed to present our clinical experience on symptomatic intaabdominal extragenital endometriosis cases. Materials and Methods: In this study, patients undergoing surgery various indications and for which final histopathologic results reported as endometriosis were evaluated. Demographic characteristics, clinical presentations, localization of disease, surgical procedures and recurrence rates within follow-up period were presented. Results: Histopathologically confirmed 778 endometriosis patients were retrospectively analyzed. Extragenital abdominal endometriosis were present in 32 (4.1%) patients and all cases were symptomatic. The most common symptoms at index admission were mass detected within abdominal wall (n: 13; 40.6%) and chronic recurrence abdominal/pelvic pain (n: 9, 28.1%). 22% (n=7) of patients with abdominal extragenital endometriosis were diagnosed preoperatively. The operations performed were as follows: mass excision from the abdominal wall (n=14, 43.8%), appendectomy (n=5, 15.7%), pelvic mass excision(n=6, 18.8%), anterior resection (n=3, 9.4%), right hemicolectomy (n=2, 6,3%), and laparotomy with urinary stenting (n=2, 6,3%). Recurrence is reported in 6 (18.7%) cases at median follow-up of 42 months. Conclusion: Due to extragenital involvement, endometriosis should be part of differential diagnosis in all women who are reserved for abdominal surgery during reproductive era. Along with the complete excision, wound protector use can potentially decrease recurrence rates in cases diagnosed pre- or intraoperatively as endometriosis

A case of hepatolithiasis mimicking tumor

WOS: 000437950900036

Effectiveness of nitric oxide derivates in hydatid disease

WOS: 000249907000012Background: The purpose of this study was to assess the possible alterations of the levels of plasma NO derivates which are thought to reflect the immune status of the body against cystic echinococcus ( CE). Materials and Methods: Plasma NO2 and NO3 levels of 95 patients with CE were analyzed before treatment and then after a 1 year. All patients were classified according to the WHO-IWGE classification of cystic hydatid disease. The levels of NO2 and NO3 were detected from sera by using a photometric endpoint determination on the basis of absorbance in the visible range at 550 nm. Results: Pretreatment levels of plasma NO2 and NO3 of the CE group were significantly higher than those in the control group ( p < 0.001). However, the posttreatment NO2 and NO3 levels of the CE group were significantly lower than the pretreatment levels ( p < 0.001). Hence, a positive correlation was found between fertile capacity of CE and the levels of NO2 and NO3 ( p < 0.05). Conclusion: The analysis of the levels of plasma NO derivates should be considered for the at preoperative detection of hydatid disease and postoperative follow-up in addition to radiological and serological methods