Endometriosis mimicking incisional hernia detected in the rectus abdominis muscle after caesarean section

Azerbaycan Tıp Üniversitesi, 3. Cerrahi Hastalıklar Kliniği, BaküNumune Eğitim ve Araştırma Hastanesi, Genel Cerrahi (Cerrahi Onkoloji) Kliniği, AnkaraYıldırım Beyazıt Üniversitesi, Tıp Fakültesi Genel Cerrahi Anabilim Dalı, AnkaraMedical Park Ankara Hastanesi, Genel Cerrahi Kliniği, AnkaraEndometriozis, fonksiyonel endometrium bez ve stromanın, uterus boşluğu dışında büyümesi olarak tanımlanır. Sezaryen, histerektomi, apendektomi ve laparoskopi sonrası trokar yerinde; epizyotomi ve amniyosentez sonrasında skar dokusunda endometriozis saptanabilmektedir. Karın duvarı endometrioması ise sezaryen başta olmak üzere yapılan jinekolojik girişimler sonrası, insizyon skar dokusunda veya komşuluğunda gelişebilen endometrium bez ve stromasından oluşan bir kitledir. Bu yazıda, rektus abdominis kası içinde insizyonel herniyi taklit eden ağrılı kitlesi olan, beş yıl önce sezaryen ile doğum öyküsü olan, 41 yaşında bir kadın hasta sunuldu. Geniş eksizyonla tedavi edilen hastanın histopatolojik incelemesi endometriozis olarak rapor edildiEndometriosis is defined as the growth of functional endometrial gland and stroma outside the uterine cavity. Endometriosis can be detected at the trocar site after caesarean section, hysterectomy, appendectomy, and laparoscopy; and within the scar tissue after episiotomy and amniocentesis. Abdominal wall endometrioma, on the other hand, is a mass composed of endometrial gland and stroma that may develop within or adjacent to incisional scar tissue after gynecological procedures, mainly caesarean section. In this article, we present a 41-year-old female patient with a history of giving birth via caesarean section five years ago, who presented with a painful mass mimicking an incisional hernia within rectus abdominis muscle. The patient was treated with a large excision and we report the histopathological examination to be endometriosis

Laparoscopic Nissen fundoplication with mesh-hiatoplasty: Single center experience and early-term results

Purpose: In this study we report early-term results of laparoscopic Nissen fundoplication with mesh hiatoplasty that we perform to treat gastroesophageal reflux disease. Methods: We retrospectively reviewed the medical records of 68 patients who underwent laparoscopic Nissen fundoplication with mesh hiatoplasty at our clinic. Thirty-six (53%) patients were male and 32 (47%) were female. The mean age of the study population was 46.1 (25-72) years. All patients underwent endoscopy, esophagus pH metry and manometry before the operation. All operations were performed under general anesthesia using five ports. In addition to Nissen fundoplication, all patients also underwent polypropylene mesh placement. Results: Preoperatively, all patients reported a burning sensation in the chest and regurgitation of the stomach contents up into the mouth. The mean time from symptom onset to operation was 28 (6-84) months. All patients were diagnosed with  esophagitis in the preoperative endoscopic examination. The mean operative time was 80 (40-125) minutes, the median duration of hospital stay was 1.2 (1-4) days and the median follow-up time was 12 (2-30) months. Functional outcome was excellent in 65% of patients, good in 24.5%, moderately good in 7% and poor in 3.5%. Conclusion: Fundoplication with mesh hiatoplasty is a surgical procedure performed for the traetment of gastroesophageal reflux disease and hiatal hernia. Surgery can be safely carried out with low morbidity and mortality rates and constitutes an alternative to long-term drug therapy. We believe that this operation is beneficial since it reduces the rate of recurrences to a significant degree

A real-world, retrospective, observational study of dabigatran and rivaroxaban in Turkey: Elderly patients receive inappropriately low dose of rivaroxaban

WOS: 000406058200090Thromboembolic complications are the most important outcomes of atrial fibrillation (AF). New oral anticoagulants (NOACs) have been presented to protect non-valvular AF patients from thromboembolic complications. In this study, we aimed to evaluate effectiveness and safety of NOACs and also reveal prescribing habits of physicians, retrospectively. NOACs and their effectiveness and safety retrospectively. Patients with non-valvular AF using either rivaroxaban or dabigatran were included in the study in five different tertiary centers. Patients were identified by scanning their medication reports. Appropriate patients were called and face-to-face interviews were done. Follow-ups were carried out on the phone. 183 out of 201 identified patients, taking rivaroxaban and dabigatran, were reached. General clinical characteristics were not significantly different between drug groups. Vascular disease and persistent AF were significantly higher in the rivaroxaban group. The rate of low dose medication in the dabigatran group was higher compared to the rivaroxaban group. Average age of the patients taking low dose medication were prominently higher in both groups. Between high and low dose users of the dabigatran group, creatinine clearance (CrCl) were not differed. Among rivaroxaban group, CrCl of the low dose users were lower than of the high dose users. However, among low-dose-prescribed patients, only 6 out of 38 patients had a CrCl value in the range of 30-49 ml/min, revealing that remaining 32 patients were receiving inappropriately low rivaroxaban dose. The rate of all-cause mortality, thromboembolism and bleeding complications were not statistically significant between the medication groups. While prescribing NOAC for non-valvular AF patients, physicians seem to consider patients' ages rather than CrCl values. In terms of protecting from thromboembolism, rivaroxaban and dabigatran seem to be equally effective and safe