Diagnosis and treatment in cystic neoplasms of the pancreas: Analysis of 12 cases and review of the literature

Objectives: Cystic Neoplasms of the Pancreas (CNP)accounts for only 1-5% of all pancreatic neoplasms but inrecent years approximately 30% of all pancreatic resectionsare performed for CNP. In this study we aimed toargue diagnosis, treatment and outcomes of the patientswhom operated in our clinic for CNP.Materials and methods: The demographic characteristics,preoperative findings, surgical procedures, histopathologicaldiagnosis, postoperative complications andlong term follow-up outcomes of the CNP patients operatedin our clinic between 2009 -Jan and 2012-Feb wereevaluated.Results: One patient was male,11 patients were femaleand mean age was 51,5 years (19-73 years).Localizationsof the lesions were in the head of pancreas for 4 patients,in the body for 2 patients and in tail for 6 patients.Mean size of the cysts was 5.1 cm (3-10 cm).Pylorus-reservedpancreaticoduodenectomy for 4 patients, subtotal/distal pancreatectomy + splenectomy for 7 patients andspleen reserved distal pancreatectomy was performedfor 1 patient. Histopathological diagnosis was reportedas serous cystadenoma in 6, mucinous cystadenoma in3, mucinous cystadenocarcinoma in 2 and pseudocystin 1 patient respectively. Postoperative complication ratewas 33%. Mean follow-up time was 18.4 months (2-38months).Conclusions: Management should be based upon oncarefully weighting the malignant potential of a pancreaticcystic lesions and the risk of surgery.Key words: Pancreas, cystic neoplasm, resectio

A Case Report of Soft Tissue Necrosis Due to the Use of Topical Steroid During Varicella Infection

Systemic absorbtion of topical steroids increases the risk of severe or fatal varicella infection due to the surface applied and duration of application. Suppression of normal cutaneous immun response causes the spread of varicella infection and secondary bacterial infections. A previously healthy two years old boy was hospitalized because of the necrotic lesions on his right thigh and submandibular area during varicella infection. With a detailed history of the patient, we learned that his parents have applied a topical steroid (beclasone pamoat) on his itchy vesicular varicella lesions without informing a physician. This case is presented to attract attention to the complications due to the use of topical steroid during varicella infection

Comparison of intracorporeal knotting and endoloop for stump closure in laparoscopic appendectomy

BACKGROUND: Several appendiceal stump closure tecniques such as intracorporoeal-knotting, endoloop, stapler and clips are used during laparoscopic appendectomy. This study aimed to compare intracorporoeal-knotting and endoloop tecniques used to close appendiceal stump in laparoscopic appendectomy.METHODS: This study included patients who underwent laparoscopic appendectomy with preliminary diagnosis of acute appendicitis in General Surgery Department of Adana Numune Training and Research Hospital between June 2009 and July 2013. The demographics, appendiceal stump closure tecniques, operation time, complications, and length of hospital stays of the patients were compared.RESULTS: A total of one hundred and twenty-six patients underwent laparoscopic appendectomy (Female: 81, Male: 45). Intracorporeal-knotting (Group 1) was performed in sixty-five patients; whereas, endoloop (Group 2) was performed in sixty-one patients in order to close appendiceal stump. The operation time was longer in Group 1 compared to Group 2 (62.0±10.67 min., 56.80±11.94 min., p=0.01). The length of hospital stays were nonsignificant between the groups. Four patients were complicated by superficial surgical site infection in both groups.CONCLUSION: In the present study, the operation time was found to be longer for intracorporeal knotting tecnique compared to endoloop tecnique; however, there was no significant difference regarding the length of hospital stay and complications. Performing intracorporeal-knotting technique is suggested since it is cheaper than endoloops and it may also improve hand manipulations of the surgeons who intend to advanced laparoscopyBACKGROUND: Several appendiceal stump closure tecniques such as intracorporoeal-knotting, endoloop, stapler and clips are used during laparoscopic appendectomy. This study aimed to compare intracorporoeal-knotting and endoloop tecniques used to close appendiceal stump in laparoscopic appendectomy.METHODS: This study included patients who underwent laparoscopic appendectomy with preliminary diagnosis of acute appendicitis in General Surgery Department of Adana Numune Training and Research Hospital between June 2009 and July 2013. The demographics, appendiceal stump closure tecniques, operation time, complications, and length of hospital stays of the patients were compared.RESULTS: A total of one hundred and twenty-six patients underwent laparoscopic appendectomy (Female: 81, Male: 45). Intracorporeal-knotting (Group 1) was performed in sixty-five patients; whereas, endoloop (Group 2) was performed in sixty-one patients in order to close appendiceal stump. The operation time was longer in Group 1 compared to Group 2 (62.0±10.67 min., 56.80±11.94 min., p=0.01). The length of hospital stays were nonsignificant between the groups. Four patients were complicated by superficial surgical site infection in both groups.CONCLUSION: In the present study, the operation time was found to be longer for intracorporeal knotting tecnique compared to endoloop tecnique; however, there was no significant difference regarding the length of hospital stay and complications. Performing intracorporeal-knotting technique is suggested since it is cheaper than endoloops and it may also improve hand manipulations of the surgeons who intend to advanced laparoscop

Unusual Presentations of Actinomycosis; Anterior Abdominal Wall and Appendix: Report of Three Cases

Background: Primary actinomycosis of the anterior abdominal wall and appendix are very rare clinical entities. An accurate diagnosis is generally obtained by histological examination, and treatment often requires surgical resection. Case Report: In this study we presented two cases of primary actinomycosis involving the anterior abdominal wall and a third one located in the appendix. Conclusion: Actinomyces Israelii can involve all anatomic structures of the abdomen. Although preoperative diagnosis is difficult, the combination of surgery and antibiotic treatment results in complete treatment in the majority of cases

Isolated Duodenal Crohn's Disease: A Case Report and a Review of the Surgical Management

Crohn's disease may affect any segment of the gastrointestinal tract; however, isolated duodenal involvement is rather rare. It still remains a complex clinical entity with a controversial management of the disease. Initially, patients with duodenal Crohn' s disease (DCD) are managed with a combination of antiacid and immunosuppressive therapy. However, medical treatment fails in the majority of DCD patients, and surgical intervention is required in case of complicated disease. Options for surgical management of complicated DCD include bypass, resection, or stricturoplasty procedures. In this paper, we reported a 33-year-old male patient, who was diagnosed with isolated duodenal Crohn’s diseases, and reviewed the surgical options in the literature

Spontaneous rupture of hydatid cyst due to strain-defecation

We report a case of strain-induced spontaneous rupture of hydatid cyst. Hydatid cyst rupture was diagnosed in a 19-year-old girl who presented with swelling and pain in the the right upper quadrant of sudden onset after straining for defecation

The impact of Onco type DX® recurrence score of paraffin-embedded core biopsy tissues in predicting response to neoadjuvant chemotherapy in women with breast cancer

BACKGROUND: Oncotype DX® test is beneficial in predicting recurrence free survival in estrogen receptor positive (ER+) breast cancer. Ability of the assay to predict response to neoadjuvant chemotherapy (NCT) is less well-studied. OBJECTIVE: We hypothesize a positive association between the Oncotype DX® recurrence score (RS) and the percentage tumor response (%TR) after NCT. METHODS: Pre-therapy RS was measured on core biopsies from 60 patients with ER+, HER2.. invasive breast cancer (IBC) who then received NCT. Pre-therapy tumor size was measured using imaging. %TR, partial response (PR; 50%), pathologic complete response (PCR) and breast conserving surgery (BCS) rates were measured. RESULTS: Median RS was 20 (2 69). Median %TR was 42 (0 97)%. PR was observed in 43% of patients. There was no association between %TR and pre-NCT tumor size, age, Nottingham score or nodal status (p 0:05). No statistically significant association with %TR was seen with RS as a categorical or continuous variable (p = 0:21 and 0.7, respectively). Response to NCT improved as ER (p = 0:02) by RT-PCR decreased. Lower ER expression by IHC correlated with response (p = 0:03). CONCLUSIONS: In patients with ER+ IBC receiving NCT, RS did not predict response to NCT using %TR. The benefit of the assay prior to NCT requires further study

The Frequency of Fabry Disease in Patients with Cardiac Hypertrophy of Various Phenotypes Including Prominent Papillary Muscle: The TUCARFAB Study in Turkey

BACKGROUND: The present study aimed to identify the frequency of Fabry disease in patients with cardiac hypertrophy of unknown etiology and to evaluate demographic and clinical characteristics, enzyme activity levels, and genetic mutations at the time of diagnosis. METHODS: This national, multicenter, cross-sectional, single-arm, observational registry study was conducted in adult patients with a clinical echocardiographic diagnosis of left ventricular hypertrophy and/or the presence of prominent papillary muscle. In both genders, genetic analysis was performed by DNA Sanger sequence analysis. RESULTS: A total of 406 patients with left ventricular hypertrophy of unknown origin were included. Of the patients, 19.5% had decreased enzyme activity (≤2.5 nmol/mL/h). Although genetic analysis revealed GLA (galactosidase alpha) gene mutation in only 2 patients (0.5%), these patients were considered to have probable but not 'definite Fabry disease' due to normal lyso Gb3 levels and gene mutations categorized as variants of unknown significance. CONCLUSION: The prevalence of Fabry disease varies according to the characteristics of the population screened and the definition of the disease used in these trials. From cardiology perspective, left ventricular hypertrophy is the major reason to consider screening for Fabry disease. Enzyme testing, genetic analysis, substrate analysis, histopathological examination, and family screening should be performed, when necessary, for a definite diagnosis of Fabry disease. The results of this study underline the importance of the comprehensive use of these diagnostic tools to reach a definite diagnosis. The diagnosis and management of Fabry disease should not be based solely on the results of the screening tests

Efficacy and safety of folfiri plus aflibercept in second-line treatment of metastatic colorectal cancer: Real-life data from Turkish oncology group

Aims: The addition of aflibercept to the fluorouracil and irinotecan (FOLFIRI) regimen significantly improved clinical outcomes in patients with metastatic colorectal cancer (CRC) previously treated with oxaliplatin. We aimed to investigate the efficacy and safety of second-line FOLFIRI and aflibercept combination in patients with metastatic CRC in real-life experience. Materials and Methods: Four hundred and thirty-three patients who treated with FOLFIRI and aflibercept in the second-line were included in the study. The clinical and pathological features of the patients were recorded retrospectively. Survival (overall and progression-free survival [PFS]), response rates, and safety data were analyzed. Results: The median age was 61. Majority of patients (87.5%) received first-line bevacizumab and 10.1% of patients received anti-epidermal growth factor receptor agents. About 80% of patients had KRAS, 18.6% of patients had NRAS, and 6.4% of patients had BRAF mutations. The median OS was 11.6 months (95% confidence interval [CI], 10.6-12.6) and the median PFS was 6 months (95% CI, 5.5-6.5). About 4.6% of patients had complete response and 30.6% of patients had partial response as best tumor response. Grade 1-2 toxicities were seen in 33.4% of patients, while grade 3-4 toxicities were recorded in 27% of patients. Eight patients (2%) died due to treatment toxicity. Conclusions: Overall and PFS were similar in routine clinical practice compared to phase III pivotal VELOUR trial. However, response rates were found to be higher. It was observed that there were fewer adverse events compared to the VELOUR trial