Isolated Hepatic Tuberculosis Presenting as Cystic-Like and Tumour-Like Mass Lesions

Hepatic tuberculosis is a rare manifestation of extra-pulmonary tuberculosis. Hepatic tuberculous lesions are especially mimicking tumour-like mass or cystic lesions in the liver and so can be misdiagnosed with several diseases. Histopathological examination of the specimen is essential in the diagnosis for hepatic tuberculosis. In this report, two cases with hepatic tuberculosis having cystic solid mass and abscess liver lesions are described

Karın iç basınç artışınn kardiyak, renal ve solunum sistemleri üzerine bir araştırma

TEZ3766Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2001.Kaynakça (s.64-69 ) var.v, 69 s. ; res. ; 30 cm.

Türkiye'de organ aktarımının yasal ve etik boyutuna ilişkin monografik bir değerlendirme

Organ transplantation is a method of solution for the problems in situations that severely impair the maintenance of life in an individual, because of functional disorders in a tissue or organ. Organ transplantations are no longer operations that carry risks, but they are safe and successful surgical interventions that maintain long-lasting recovery periods, increase quality of life, and are more commonly applied in a gradually increasing manner. Besides its medical aspects, organ transplantation has an extremely wide range of social, legal and ethical features. Validation of the moment of death, permission of donor, and cash benefit from organ transplantation are the matters of debate all over the world, regarding the ethical considerations. Regulation of all these issues by laws does not mean that the procedures are proper for ethical norms, but since compliance with laws has been maintained, limits of the criminal or legal liabilities are also defined. The National Coordination System is the most fair regulation in the organ allocation. The organs controlled by the Turkey Organ Control System are legally provided for the proper patient who is medically the most urgent and in a great need, according to the order of priority in the list. The aim of this study is to evaluate the problems associated with the organ and tissue transplantations, by considering the legal and ethical aspects that are specific for Turkey

Adana’da (Türkiye) kolorektal kanser sıklığının anatomik lokalizasyon, yaş ve cinsiyete göre 15 yıllık zamansal değişimi: 1993-2008

Giriş ve Amaç: Kanser insidans hızlarının zamansal eğilimlerin analizi, önemli coğrafi farklılıkların yorumlanmasına yeni bakış açıları geliştirilmesini sağlayabilir. Bu çalışmada, Türkiye’nin Akdeniz Bölgesi’nde yer alan Adana’da kolon ve rektum kanser sıklığının anatomik lokalizasyon, cinsiyet ve yaş gruplarına göre 15 yıllık zamansal değişimi değerlendirilmiştir. Yöntem: Onbeş yıl (1993-2008) süresince topluma dayalı yerel kanser kayıt merkezinde histopatolojik tanı ile kaydedilen 47.783 kanser olgusu incelenmiş ve kolorektal kanser tanısı almış 2.749 (%5,8) vakada anatomik yerleşim ile cinsiyet ve yaş grubu arasındaki ilişki 5’er yıllık zaman dilimlerine göre analiz edilmiştir. Bulgular: Onbeş yıllık dönemde sağ kolon kanserlerinde anlamlı artış olduğu gözlenmektedir; (1993-1997 dönemi için %19.8, 1999-2003 için %24.4 ve 2004-2008 için %25.6) (p=0.048). Bu artış kadınlarda istatistiksel olarak anlamlı iken (p=0.041) erkeklerde anlamsızdır. Sağ kolon kanserleri, kadınlarda 50 yaş üzerinde artış gösterirken erkeklerde sadece 70 yaş üzeri grupta artış göstermektedir. Sağ kanserlerdeki artışa karşılık distal kanserlerde azalma görülmez iken her iki cinste de rektum kanserlerinde sürekli bir azalma olduğu görülmektedir. Sonuç: Çalışmada kolon kanserlerinin görülme sıklığının, batı toplumlarına göre daha düşük bulunmasına rağmen yıllar içinde sağ kolonda gözlenen artışın bu ülkelerdeki artışa benzer olduğu saptanmıştır. Sağ kolon kanserlerindeki artışının genç kadınlarda daha fazla olması, son on yılda kullanılan tanı yöntemlerinin farklılığına ve tanıda cinsiyet yanlılığına iflaret ediyor olabilir. Subsegmental kolorektal kanserlerin zamansal değişimi, farklı etiyolojik, demografik ve coğrafik faktörler ve tanı yöntemlerindeki gelişmeler ile ilişkili olabileceğini düşündürmektedir. Elde edilen bulgular, ayrıntılı analitik çalışmalara temel oluşturması ve konuya dikkat çekmesi için kanser hızlarındaki değişimlerin düzenli toplanan kanser istatistikleri ile yakından izlenmesinin önemine işaret etmektedir.Background/aims: Analyzing temporal trends in cancer incidence rates can generate new insights for the significance of geograp- hical and epidemiological variations of the disease. This study evaluated the time trends over a 15-year period in the frequencies of colon and rectum cancers at various subsites by gender and age. Materials and Methods: Data were obtained from a population- based cancer registry in Adana (a Mediterranean city of Turkey). Among the 47.783 microscopically-confirmed cancer cases during the 15-year period (1993 to 2008), 2.749 (5.8%) colorectal cancer cases were analyzed in three separate 5-year time periods. Results: The incidence of right-sided colon cancer was found to be increasing compared to the left-sided colon cancer (p=0.048) over time in total (19.8% in 1993-1997, 24.4% in 1999-2003, and 25.6% in 2004-2008). This proximal shift of cancers demonstrated a significant increase for females (p=0.041), but not for males. The incidence of right-sided colon cancer was found to increase in advanced age groups (over 70) of males and increase in younger age groups (over 50) of females. There was a corresponding continuous decline in the percentage of rectal cancer (not in distal cancers) in both genders. Conclusions: Although the frequency of colorectal cancer ca- ses was found to be lower in our country when compared to Western countries, a similar right-sided colon cancer shift was obser- ved. The apparent shift of colorectal cancer in young female patients may be related to the advances in diagnostic techniques and may indicate possible diagnostic bias for the female gender. These results also emphasize the importance of collecting regular can- cer statistics and of closer follow-up to generate basic epidemiological data and to draw attention to this issue in further detailed analytical research studies

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

WOS: 000254501400024PubMed ID: 18377614

Mide kanserini taklit eden primer mide tüberkülozu

Daha önceden herhangi bilinen bir hastalığı olmayan yemeklerden sonra epigastrik ağrı ve kilo kaybı şikayeti olan, radyolojik ve endoskopik olarak mide kanseri düşünülen ancak endoskopik biyopsi ile tanı konulamayan 42 yaşında kadın hastaya laparotomi ile primer mide tüberkülozu tanısı konuldu. Anti-tüberküloz tedavi sonrası klinik, radyolojik ve endoskopik tam yanıt elde edildi.A 42-year-old female patient with no previous known diseases who had complaints of postprandial epigastric pain and weight loss and who could not be diagnosed by endoscopic biopsy, although gastric cancer was suspected radiologically and endoscopically, was diagnosed with primary gastric tuberculosis by laparotomy and frozen section. Following anti-tuberculosis treatment, a complete clinical, radiological, and endoscopic response was achieved

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism

Background:Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. It may result in potentially seri-ous complications including metabolic bone diseases, severe athero-sclerosis and undesirable cardiovascular events. Parathyroidectomy is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years. Aims:The aim of the current study was to evaluate the short-term and long-term outcomes of patients with secondary hyperparathyroidism who had undergone total parathyroidectomy with autotransplantation and thymectomy or subtotal parathyroidectomy with thymectomy by the same surgical team during the study period. Study Design: Retrospective comparative study.Methods:Clinical data of 50 patients who underwent parathyroid surgery for secondary hyperparathyroidism between 2003 and 2011 were reviewed retrospectively. Patients were divided into two sub-groups of total parathyroidectomy with autotransplantation or sub-total parathyroidectomy. Thymectomy was routinely performed for both groups. Short term outcome parameters included intact parathy-roid hormone, ionized calcium and alkaline phosphatase levels. Bone pain, bone fractures, persistent or recurrent disease were included in long term outcome parameters.Results:The mean duration of dialysis was eight years. The mean ionized calcium levels dropped significantly in the total parathyroid-ectomy with autotransplantation group (p=0.016). No serious post-operative complications were observed. Postoperative intravenous calcium supplementation was required in four patients in the total parathyroidectomy with autotransplantation group (total PTX+AT) and in three patients in the subtotal parathyroidectomy group (subto-tal PTX). Postoperatively, all patients received oral calcium carbonate and calcitriol. The length of average hospital stay was 5 (3-10) days. Including nine patients who underwent successful renal transplanta-tion pre-operative bone symptoms, hypercalcemia, hyperphosphate-mia, and an increased alkaline phosphatase levels were improved or resolved in all patients. After a mean follow-up of 65 months, three patients (6%) had persistent and one (2%) had recurrent disease.Conclusion:Total parathroidectomy with autotransplantation is a beneficial and safe surgical procedure for patients on chronic di-alysis with otherwise uncontrollable secondary hyperparathroidism and even in patients who have undergone renal transplantation after parathyroidectomy. Careful cervical exploration and routine thymec-tomy should be considered as a routine part of the surgical approach regardless of the preferred techniqueBackground:Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. It may result in potentially seri-ous complications including metabolic bone diseases, severe athero-sclerosis and undesirable cardiovascular events. Parathyroidectomy is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years. Aims:The aim of the current study was to evaluate the short-term and long-term outcomes of patients with secondary hyperparathyroidism who had undergone total parathyroidectomy with autotransplantation and thymectomy or subtotal parathyroidectomy with thymectomy by the same surgical team during the study period. Study Design: Retrospective comparative study.Methods:Clinical data of 50 patients who underwent parathyroid surgery for secondary hyperparathyroidism between 2003 and 2011 were reviewed retrospectively. Patients were divided into two sub-groups of total parathyroidectomy with autotransplantation or sub-total parathyroidectomy. Thymectomy was routinely performed for both groups. Short term outcome parameters included intact parathy-roid hormone, ionized calcium and alkaline phosphatase levels. Bone pain, bone fractures, persistent or recurrent disease were included in long term outcome parameters.Results:The mean duration of dialysis was eight years. The mean ionized calcium levels dropped significantly in the total parathyroid-ectomy with autotransplantation group (p=0.016). No serious post-operative complications were observed. Postoperative intravenous calcium supplementation was required in four patients in the total parathyroidectomy with autotransplantation group (total PTX+AT) and in three patients in the subtotal parathyroidectomy group (subto-tal PTX). Postoperatively, all patients received oral calcium carbonate and calcitriol. The length of average hospital stay was 5 (3-10) days. Including nine patients who underwent successful renal transplanta-tion pre-operative bone symptoms, hypercalcemia, hyperphosphate-mia, and an increased alkaline phosphatase levels were improved or resolved in all patients. After a mean follow-up of 65 months, three patients (6%) had persistent and one (2%) had recurrent disease.Conclusion:Total parathroidectomy with autotransplantation is a beneficial and safe surgical procedure for patients on chronic di-alysis with otherwise uncontrollable secondary hyperparathroidism and even in patients who have undergone renal transplantation after parathyroidectomy. Careful cervical exploration and routine thymec-tomy should be considered as a routine part of the surgical approach regardless of the preferred techniqu

Role of angiography in diagnosis of insulinoma

İnsülinoma, pankreasın sık görülen beta hücreli bir adenomudur. Her yaş grubunda görülebilen ve spontan hipoglisemilere neden olan bir tümördür. Biz, 30 yaşında, psikiatrik semptomları nedeni He psikoz tanısı konmuş, tesadüfen hipoglisemi tesbit edilmesi üzerine kliniğe başvuran kadın hasta bildirdik. Labaratuar ve radyolojik incelemelerde tanı konamayan hastaya yapılan selektif anjiyografi ile İnsülinoma tanısı konmuş ve cerrahi tedavi uygulanmıştır. İnsülinomanın santral sinir sistemi belirtileri ile ortaya çıkabileceği ve tanısal zorluk yaşandığında anjiyografinin birinci basamakta başarıyla kullanılabileceği akılda tutulmalıdır.İnsülinoma is a frequently seen beta-cell adenoma at the pancreas. It can be seen in all age groups and causes hypoglicemia. We present a case of 30 years old woman who had a diagnosis of psychtric and found to have hypoglicemia incidentally. Labaratory and radiological findings were not diagnostic. She was diagnosed as insülinoma by selective angiography and treated surgically. We can say that patients with insülinoma may present with findings related to central nervous system and diagnosed succesfully with angiography in case of diagnostic diffuculty

Lymphatic metastasis of signet ring cell gastric carcinoma located on mucosa layer

Erken mide kanserleri lenf nodu metastazı durumuna bakılmaksızın midenin mukoza ve submukozasına sınırlı tümör olarak tanımlanmaktadır. Erken mide kanseri, mukoza tabakasına sınırlı ise, lenf nodu metastazı nadiren görülür. Taşlı yüzük hücreli histolojide ve 2 cm'den küçük intramukozal mide tümörlerinde lenf nodu metastazı daha da nadirdir. Bu yazıda mukoza tabakasına sınırlı ve lenf nodu metastazlı taşlı yüzük hücreli kanser olgusu sunulmaktadır. Preoperatif evreleme araçları ile invazyon derinliğinin ve lenf nodu metastazının saptanması seçilecek cerrahi tedavi protokolünde belirleyicidirEarly gastric cancer is described as tumors limited to mucosa and submucosa layers regardless of lymphatic metastasis. If early gastric cancer is limited to mucosa layer, metastasis of lymph node would be seen rarely. Further if intramucosal gastric tumors have signet ring cell histology and a size smaller than 2 cm, then lymph node metastasis are even rarer. In this paper we present a case that have signet ring cell gastric cancer limited to mucosa layer and had lymph node metastasis. It is decisive to evaluate depth of invasion and lymph node metastasis with preoperative tools to choose surgical treatment protoco

Koroziv özofajitte sükralfatın belirgin etkinliği: Randomize ve prospektif çalışma

Kimyasal madde içilmesi hastalarda ciddi sonuçlar oluşturabilir. Bu sonuçlardan biri olan striktür gelişimini önlemek için çeşitli tedavi prokolleri kullanılmaktadır. Biz tek başına konvansiyonel tedavi ile beraberinde oral yoğun sükralfat tedavisinin bir arada uygulanmasını karşılaştırmak amaçlı randomize prospektif bir çalışma planladık. Yöntem: 2004-2007 yılları arasında hastanemiz gastroenteroloji, genel cerrahi ve yoğun bakım ünitelerine kabul edilmiş evre 2b ve 3 koroziv özofajiti olan hastalar çalışmaya dahil edilmiştir. Hastalar iki gruba ayrılmıştır. Birinci gruptaki hastalara (n=8) konvansiyonel tedavi ile birlikte yoğun sükralfat, ikinci gruba (n=7) ise sadece konvansiyonel tedavi verilmiştir. 0, 21, 45, 90 ve 180. günlerde ortaya çıkabilecek komplikasyonları değerlendirmek için üst gastrointestinal endoskopik inceleme uygulanmıştır. Bulgular: Birinci grup hastanın sadece bir tanesinde semptom olarak disfajiye neden olmayan, 45. günde yapılan üst endoskopide saptanan ve 9,2 mm'lik endoskopun geçişine izin veren striktür oluşmuştur. Üçüncü ve altıncı ayki takiplerinde striktürde her hangi bir progresyon izlenmemiştir. İkinci grupta ise 6 hastada disfaji ve daralmaya neden olan striktür oluşumuna rastlanmıştır. Sonuç: Yoğun sükralfat tedavisi ileri evre koroziv özofajiti bulunan hastalarda striktür gelişim sıklığını azaltabilir. Daha fazla sayıda hasta içeren gruplar ile yapılacak çalışmalarla bulgularımızın destekleneceğini umuyoruz.Ingestion of a chemical agent is a serious problem, and several treatment protocols to prevent stricture formation have been proposed. We conducted a randomized prospective study to evaluate the effectiveness of oral intensive sucralfate plus conventional therapy compared to conventional therapy alone. Methods: Fifteen patients with stage 2b and 3 corrosive esophagitis admitted to our gastroenterology, general surgery and intensive care units between 2004 and 2007 were included. Patients were divided into two groups. The patients in the first group (n=8) received intensive sucralfate therapy plus conventional therapy, while the other group (n=7) received only conventional therapy. We performed upper endoscopic procedures on days: 0, 21, 45, 90 and 180 to identify the emergent complications. Results: In the first group, only one patient had stricture formation, allowing passage of a 9.2 mm endoscope and causing no dysphagia, on day 45. There was no progression in the stricture on follow-ups at the 3rd and 6th months. In the second group, 6 patients had stricture formation causing narrowing and dysphagia. Conclusions: Intensive sucralfate therapy may decrease the frequency of stricture formation in patients with advanced corrosive esophagitis. Further studies with large groups of patients are required to confirm our findings