Metastatic Serous Carcinoma Initially Presented As An Incarcerated And Strangulated Umbilical Hernia: A Rare Case Report

Introduction: We report a rare case of a metastatic serous ovarian carcinoma presented as an incarcerated and strangulated umbilical hernia.Presentation of case: A 54 year-old female was admitted to the hospital with a painful mass around the umblical region. It was elucidated during clinical history that the mass had been present for 3 to 4 years without pain. An incarcerated and strangulated umbilical hernia including a solid mass and mesenteric fat was detected on physical examination. She underwent an urgent operation for strangulated umbilical hernia. The pathological diagnosis of the hernia material was reported as carcinoma compatible with serous ovarian carcinoma metastasis. Concurrently, total abdominal histerectomy and bilateral salphingo-oopherectomy, pelvic and paraaortic lymph node dissection, omentectomy and sigmoid colon resection were performed. Histopathological evaluation confirmed the serous carcinoma originated from the left ovary.Conclusion: In the literature, some metastatic tumors have been reported to be presented as umbilical metastasis rarely. However, the present case is the first metastatic ovarian cancer that initially presented as an incarcerated and strangulated umbilical hernia in the literature, to the best of our knowledge. 

Normative size evaluation of IAC with MRI: Review of 3786 patients

Background: A narrow internal auditory canal (IAC) is significantly associated with congenital sensorineural hearing loss. It would therefore seem likely that any patient with an IAC measured radiographically to be under the normal range represents an abnormality and probable IAC stenosis. If narrow IAC is diagnosed with routine magnetic resonance imaging (MRI), then the cochlear nerve may be evaluated with special MRI studies. However, there is no consensus in the literature on the normal measurements of the IAC or on what parameters should be used to determine narrow IAC using MRI. In this study, we aimed to assess the normative size of IAC in normal-hearing ears and to determine whether canal size varies with age and gender using MRI.Material and methods: A retrospective review was undertaken from 2010 to 2012. A total of 7572 normal-hearing ears of 3786 patients were assessed, who had MRI due to various reasons except hearing loss. Patients under 20 years old and over 60 years old were excluded, and the subjects were divided into 4 groups at 10-year intervals. All subjects were divided by gender also. Anteroposterior (AP) and craniocaudal (CC) measurements were obtained in the middle of the IAC on axial and coronal images of 1.5-T MRI.Results: The mean age was 42 years (range 20–60 years). The mean IAC diameters were 5.93 mm with a standard deviation of 0.25 mm (max 6.99 mm, min 4.73 mm) on AP measurements and were 5.70 mm with a standard deviation of 0.26 mm (max 6.82 mm, min 4.71 mm) on CC measurements. There were no differences in the IAC diameters between males and females or with age groups.Conclusions: These measurements should provide a normative reference for comparison in radiographic assessment of any patient with suspected IAC stenosis. This measurement can help the diagnosis of narrow IAC. To our knowledge, this is the first study using MRI with a large group of patients in the literature

Açık Kaynak Kodlu Öğrenme Yönetim Sistemleri Üzerine Bir Karşılaştırma Çalışması

Web tabanlı uzaktan eğitim son yıllarda, üniversitelerin, eğitim organizasyonlarının ve kamu ya da özel birçok kuruluşun, çeşitli (çalışan, bedensel engeli olan, bulunduğu yerde eğitim alma olanağı bulunmayan kişilere bu hizmeti vermek veya zamandan kazanmak ve maliyetleri azaltmak gibi) sebeplerle tercih ettikleri bir çözüm haline gelmiştir. Web tabanlı eğitimde, öğretim materyallerinin öğrencilere sunumu, çeşitli kurs kataloglarını yönetme, sınavlar hazırlama ve uygulama, öğrencilerin öğrenme sürecini kayıt altına alma gibi öğrenme aktivitelerinin yönetimi, raporlama işlemlerinin gerçekleştirilmesi ve eğitim faaliyetlerinin sistematik ve planlı bir şekilde sürdürülebilmesi için Öğrenme Yönetim Sistemleri(ÖYS)’nden yararlanılmaktadır. Günümüzde birçok ticari ÖYS'nin yanı sıra çok sayıda açık kaynak kodlu ÖYS de bulunmaktadır. Açık kaynak kodlu ÖYS'ler; açık kaynak kodu felsefesinin gücü, esnekliği ve bu sistemleri kullanan kişilerin tercihi doğrultusunda ticari ürünlere rakip olabilmektedir. Bu çalışmada; alanyazın taraması sonucunda en sık karşılaşılan Moodle, Sakai, ATutor, Dokeos, Claroline ve OLAT ÖYS'leri, araştırmacılar tarafından geliştirilen "ÖYS Değerlendirme ve Seçim Envanteri" kullanılarak incelenmiş ve değerlendirme sonuçları karşılaştırılmıştır. Araştırma sonuçlarının gerek üniversitelerin ve eğitim organizasyonlarının gerekse kamu ve özel kuruluşların ÖYS seçim ve karar verme sürecine rehberlik etmesi amaçlanmaktadır

Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide