Transduodenal Local Resection of Ampullary Neuroendocrine Tumors with Bleeding

Duodenal neuroendocrine tumors in the Ampulla of Vater occur very rarely and are very difficult to diagnose preoperatively. Duodenal ulcer bleeding due to the destruction of the duodenal mucosa is very rare. In this study, we present the case of a duodenal neuroendocrine tumor presented with upper gastrointestinal bleeding, which was treated by means of transduodenal local resection. As a conclusion, endoscopic or transduodenal local excision is relatively safe to be used in ampullary neuroendocrine tumors with no distant metastasis or local invasions. Endoscopic resection is recommended in patients with low grade tumors within the submucosa, smaller than 2 cm and with a low KI-67 index. In support of this, EUS has been adopted as an important tool to measure the depth of invasion and evaluate the lymph node status in staging the gastrointestinal tumors as well as collecting specimens simultaneously. Finally, endoscopic procedures (ESD - EMR) present a higher risk of perforation, so that a large number of prospective controlled studies are needed to establish a consensus on this therapeutic approach

İstanbul İlinde Görev Yapan Kamu ve Özel İlköğretim Öğretmenlerinin İş Tatmin Düzeylerinin Belirlenmesine Yönelik Bir Araştırma

DergiPark: 326420trakyasobedEven though it has been observed that the number of researches relating to job satisfaction made recently has increased, the number of researches which determine the satisfaction level that the teachers who are the milestones of education feel for their work is very few. The main survey field of the work can be summarized as measuring of the job satisfaction level of the teachers who work at public and private elementary schools within Istanbul, comparing the levels obtained and presenting the reasons if any, also statistically analyzing the minor factors of job satisfaction conceptSon yıllarda yapılan iş tatmini araştırmalarının sayısında artış gözlense de eğitimin temel taşları olan öğretmenlerin işlerinden aldıkları tatmin düzeylerini belirleyen araştırmaların sayısı çok fazla değildir. Çalışmanın temel inceleme alanı İstanbul ili dahilinde kamu ve özel ilköğretim okullarında çalışan öğretmenlerin iş tatmin düzeylerinin ölçülmesi, elde edilen bu düzeylerin ve alt düzeylerin karşılaştırılması, farklılar varsa nedenlerinin ortaya koyulması ve alt düzeylerin istatistiki olarak ele alınmasıdı

The Relationship Between Arthroplasty Surgeons' Experience Level and Optimal Cable Tensioning in the Fixation of Extended Trochanteric Osteotomy

Introduction: In this study, our aim was to examine the relationship between the arthroplasty surgeons' experience level and their aptitude to adjust the cable tension to the value recommended by the manufacturer when asked to provide fixation with cables in artificial bones that underwent extended trochanteric osteotomy (ETO). Materials and Methods: A custom-made cable tensioning device with a microvoltmeter was used to measure the tension values in Newtons (N). An ETO was performed on 4 artificial femur bones. Surgeons at various levels of experience attending the IXth National Arthroplasty Congress were asked to fix the osteotomized fragment using 1.7-mm cables and the tensioning device. The participants' demographic and experience data were investigated and recorded. The surgeons with different level of experience repeated the tensioning test 3 times and the average of these measurements were recorded. Results: In 19 (35.2%) of the 54 participants, the force applied to the cable was found to be greater than the 490.33 N (50 kg) value recommended by the manufacturer. No statistically significant difference was determined between the surgeon's years of experience, the number of cases, and the number of cables used and the tension applied over the recommended maximum value (P = .475, P = .312, and P = .691, respectively). Conclusions: No significant relationship was found between the arthroplasty surgeon's level of experience and the adjustment of the cable with the correct tension level. For this reason, we believe that the use of tensioning devices with calibrated tension gauges by orthopedic surgeons would help in reducing the number of complications that may occur due to the cable

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

Amyand Herniye Eşlik Eden Komplike Akut Apandisit Vakası

Amyand's hernia is a very rare form of hernia in the inguinal hernia sac. Presently described is a case of Amyand's hernia complicated by acute appendicitis. A 62-year-old male patient presented at the emergency department with complaints of pain in the right inguinal region. He had acute appendicitis in the right inguinal hernia. An appendectomy was performed. Due to the high risk of infection, a mesh application was avoided. The patient was discharged on the rst postoperative day. The incidence of Amyand's hernia accompanied by acute appendicitis is quite low. The current literature generally does not recommended an Amyand's hernia mesh repair with a la- paroscopic appendectomy in the presence of acute appendicitis. In this case, the appendectomy was completed laparoscopically and the hernia sac was repaired intraperitoneally with primary suturing

Transduodenal Local Resection of Ampullary Neuroendocrine Tumors with Bleeding

Duodenal neuroendocrine tumors in the Ampulla of Vater occur very rarely and are very difficult to diagnose preoperatively. Duodenal ulcer bleeding due to the destruction of the duodenal mucosa is very rare. In this study, we present the case of a duodenal neuroendocrine tumor presented with upper gastrointestinal bleeding, which was treated by means of transduodenal local resection.As a conclusion, endoscopic or transduodenal local excision is relatively safe to be used in ampullary neuroendocrine tumors with no distant metastasis or local invasions. Endoscopic resection is recommended in patients with low grade tumors within the submucosa, smaller than 2 cm and with a low KI-67 index. In support of this, EUS has been adopted as an important tool to measure the depth of invasion and evaluate the lymph node status in staging the gastrointestinal tumors as well as collecting specimens simultaneously.Finally, endoscopic procedures (ESD - EMR) present a higher risk of perforation, so that a large number of prospective controlled studies are needed to establish a consensus on this therapeutic approach

Fallopian tube herniation from trocar-site after laparoscopic appendectomy

Trocar site hernias are a type of incisional hernias and may occur within a variable time shift after surgery. A mean incidence of 1.85% was reported, and the first trocar site hernia was narrated by Maio et al. in 1991 describing small bowel obstruction due to trocar site herniation after laparoscopic cholecystectomy. The 10-mm-trocar port is more frequently problematic, and a trocar site hernia in 5 mm port is very rare. This report unveils a 5mm trocar site herniation of right fallopian tube following laparoscopic appendectomy. In this case study, a 19-year-old female patient applied to the emergency department because of a discharge in the right lower quadrant was reported. She explained that she had undergone laparoscopic appendectomy two days before and discharged the next day uneventfully. The surgical report described a suction drain in the right lower quadrant where the patient was suffering from the discharge. The physical examination revealed no tenderness, but an abdominal CT disclosed an edematous tubular structure herniating from the 5 mm trocar site where the drain was put. She was re-operated laparoscopically due to early trocar site hernia, and the right fallopian tube was observed herniating through the defect. After the reduction into the abdomen, the fallopian tube was observed fine, and the defect was closed using 2/0 polypropylene suture. Trocar site hernias are rare but may cause serious complications after laparoscopic surgery. They may occur early after the surgery, but the time shift is variable. Although mechanical bowel obstructions are more frequent endpoint, it should be remembered that any organ within the abdominal cavity may herniate

Cholecystoduodenal Fistula related Acute Cholecystitis

Cholecystenteric fistulas are abnormal formations that occur spontaneously between the gallbladder and the gastrointestinal tract. Asymptomatic cases can be diagnosed incidentally as well as during surgery in patients with acute abdomen diagnosis. We present a case of cholecystoduodenal fistula detected in a patient who underwent laparoscopic exploration with a preliminary diagnosis of gallbladder perforation. Cholecystoduodenal fistulas are difficult to diagnose preoperatively and are very rare hepatobiliary emergency surgery cases