Eggshell calcification after intrathyroidal hemorrhage of retrosternal thyroid

We report a rare event of old hemorrhage into a thyroid causing respiratory distress. A 67-year-old man with chronic cough and recent dysphagia was found to have a retrosternal mass extending into the visceral mediastinum on chest roentgenogram. A computed tomographic (CT) scan confirmed eggshell callcification, which was 53 × 53 × 80 mm in size a retrosternal thyroid mass and revealed significant tracheal deviation to the right due to an extensive mass surrounded by a calcificated capsule in the left lobe of the thyroid gland with extension to the upper mediastinum. He successfully underwent left lobectomy of the thyroid gland with sternotomy. The pathological examination revealed intrathyroidal hemorrhage of the thyroid gland with massive intracystic old bleeding

Expression of homeodomain protein CDX2 in colorectal adenoma and adenocarcinoma

CDX2 is a homeobox domain-containing transcription factor that is important in the development and differentiation of the intestine. In this study, we examined CDX2 expression in normal and neoplastic human colon using a newly isolated monoclonal antibody. When compared to the intensity observed in adjacent normal mucosal epithelial cells, strong nuclear staining for CDX2 was observed in 10 (100%) of 10 colonic adenomas, 30 (88.2%) of 34 colorectal adenocarcinomas, including 17(94.47%) of 18 well-or moderately differentiated tumors and 13(81.2%) of 16 high-grade tumors. The percentage of CDX2 immunopositive cells was generally lower in carcinomas than in adenomas (p<0.001) and lower in moderately or poorly differentiated tumors than in well-differentiated tumors (p<0.001). There was an inverse correlation between CDX2 expression and tumor grade, tumor stage and lymph node metastasis (respectively, p<0.001; p<0.05; p<0.001), but this was not associated with age, gender, or tumor location and size. These results indicate that loss of expression of CDX2 protein may play an important role in the tumorigenesis of colorectal cancers. Down-regulation of CDX2 may cause dedifferentiation of gastrointestinal epithelial cells

THE OUTCOME OF MAJOR HEPATECTOMIES FOLLOWING DIFFERENT DURATIONS OF PORTAL VEIN LIGATION IN RATS

Aim: Atrophy/Hypertrophy complex constitution (AHC) by portal vein ligation (PVL) before major hepatectomies (Hx) has got beneficial effects on the functional capacity of the remnant liver tissue by increasing its volume. We aimed to evaluate whether longer duration of PVL has any additive benefit on regenaration speed, weight, biochemical, histological examination and mortality, before major hepatectomies in rats. Methods: One-hundred and twenty Wistar Albino rats were divided into four groups (PVL, PVL+Hx, Hx, Sham+Hx). Group I ( PVL ), Group II ( PVL + Hx ); 70% Hx and relaparotomy after 21 days from PVL, Group III ( Hx ); 70% Hx, Group IV ( Sham + Hx); 70% Hx after 21 days from Sham ligation. Hepatic tissue regeneration speed, weight, liver function tests and histological examination were evaluated on postoperatively 3rd , 7th , 14th and 21st days. Also, mortality rate was evaluated. Results: The regeneration speed increased in all groups except PVL+Hx. The weight of all rats decreased on postoperative 3rd day, however, then reached nearly preoperative values on 7th day and the higher values were seen on 28th day in all groups. Serum alkaline phosphatase levels increased in all groups postoperatively and decreased to normal values on postoperative 7th day. Mitosis has been seen until 3rd day in Hx, and Sham+Hx, until 14th day in PVL, and not in PVL+Hx. 1, 6, and 7 rats were lost in PVL+Hx, Hx, and Sham+Hx groups respectively in first three days. Mortality rates were significantly lower than Hx and Sham+Hx groups in PVL and PVL+Hx groups Conclusion: In this study the lesser liver tissue had to be resected in rats constituted AHC with long term PVL, so we had more remnant liver tissue to be able to have enough function. The lengthening of the duration of PVL will be better for decreasing morbidity and mortality of major hepatectomies in benign liver pathologies

Comamonas testosteroni bacteremia in a patient with perforated acute appendicitis

Comamonas testosteroni is an uncommon isolate in the clinical laboratory as a human pathogen. C. testosteroni most commonly emerges in abdominal pathologies especially in perforated appendicitis. In Turkey we report first time a case of bacteremia due to this organism, in a 22-year-old man with perforated acute appendicitis. The organism was shown to be susceptible to routine antibiotics so it was easily eliminated even after having caused a bacteremia

Association of granulomatous appendicitis and simple laboratory tests. Controlled observational study.

Aim: Granulomatous appendicitis (GA) is evaluated as different clinical situation from specific causes, and very rare. It is defined as the presence of granulomatous inflammation in the appendix. Its etiology can be infectious, or noninfectious. However its differentiation from tumor can be challenging with macroscopic appearance in the operation. In this study, we aimed to present a case series of GA cases, evaluate prediction and association of GA before surgery. Material and methodsA descriptive study is designed. All appendectomies between 2007 and 2015 were reviewed. The patients who diagnosed with GA by histopathological evaluation constituted study group. The rest constituted the control group.  Demographic data, complete blood count parameters (22 parameters for each) were recorded. Categorical variables were expressed as frequencies and percentages. Baseline characteristics were compared using the t-test and Mann-Whitney U test. Fisher’s exact test was used to compare categorical variables. The differences were considered statistically significant if the p value was less than 0.05 at a 95% confidence interval.ResultsDuring study period, 4570 patients were operated for acute abdomen with the presumptive diagnosis of acute appendicitis. Eight (0.2%) patients constituted study group. For control group sample size was calculated as 527 cases (95% power to show a 50% difference in the rate of the primary outcome, with a 2-sided type I error rate of 5%. Additional 142 to decrease errors). Demographic findings like age and gender didn’t show difference between the groups (p=0.499 and p=0.477, respectively). EOS# and EOS% were higher in study group than control group (p&lt;0.0001 and p&lt;0.0001, respectively). Logistic regression analysis showed that EOS% effect was significant with p of &lt;0.0001, odds ratio of 0.522 and Nagelkerke R2 of 0.191.ConclusionDiagnosis of GA with macroscopic appearance in operation is a challenging for a surgeon. We found that EOS# and EOS% are associated with GA

Serum paraoxonase (a high-density lipoprotein-associated lipophilic antioxidant) activity in clinical follow-up of patients with acute pancreatitis, with particular emphasis on oxidative stress parameters and lipid profile: a prospective pilot trial

The purpose of this study was to investigate the possible role of PON-1, an antioxidant lipophilic enzyme linked to HDL-C (high-density lipoprotein cholesterol), on the pathophysiology and clinical follow-up of acute pancreatitis. Biochemical tests, PON-1 and oxidative stress parameters (malonyl dialdehyde, MDA; superoxide dismutase, SOD; total antioxidant capacity, TAC) were evaluated in the sera of patients with acute pancreatitis at admission (day 0), day 3 and day 10 of follow-up, between June and September 2017. SPSS 13.0 statistical software package programme was used for statistical analyses.Mean age was 51.4 of the total 25 patients. Ranson scores were 0–1 points (60%), 3–4 points (24%) and 5–6 points (16%). CTSI (computed tomography severity index) scores were calculated, and most of the patients were seen to have mild or average pancreatitis (96%). While total cholesterol, triacylglycerol and LDL-C (low-density lipoprotein) levels stayed in their normal limits, there was a significant decrement tendency. HDL-C level was seen to rise significantly above its upper limit at day 10 (p < 0.001). Mean PON-1 levels were measured as 69.23, 76.72 vs. 113.15 U/mL at days 0, 3 and 10, respectively; and it was positively correlated with HDL-C (p < 0.001). Serum SOD increased also in parallel with PON-1 (20.49 vs. 39.46 U/mL) while MDA level decreased significantly (3.9 vs. 2.28 μM, p < 0.001). TAC was seen to rise significantly after treatment (0.52 vs. 1.22 mM). In conclusion, decreased PON-1 and HDL-C together with antioxidants SOD and TAC at the early period of acute pancreatitis were seen to rise after treatment, while the previously higher MDA level decreased in parallel. This reveals the importance of the balance between oxidative stress and antioxidant defense mechanisms in clinical progression of the disease, and the potential of PON-1 as a promising clinical marker

Evaluation of mortality related factors in peptic ulcer perforation: Retrospective case-control study

Aim: Although there has been significant progress in current medical treatments for the treatment of peptic ulcer, there has been no change in the incidence of peptic ulcer perforation (PUP). PUP has an important place in urgent surgery due to mortality rates. In this study, it was aimed to determine the factors related to death related to PUP. Material and method: Observational type study was planned. Patients who underwent surgery due to PUP in 2009-2016 included to study. The number of samples was set at 225 to show 30% difference with a 5% α error at 90% safety interval. Twenty patients were added to reduce the error. Patients were screened for demographic data, presence of chronic disease (diabetes, cardiac), smoking status, nonsteroidal anti-inflammatory (NSAID) use, reference leukocyte level, complaint-to-intervention time and surgical site infection (SSI). The death in the perioperative period (first month) was determined as the main outcome parameter. Patients were divided into two groups according to the presence of death (Group 1: study group, Group 2: control group). Descriptive statistics, number, percentage, mean ± standard deviation, median (quartile range) were used for statistics. T-test, Mann-Whitney, Fisher's exact and Chi-square test  were used for comparisons. A p value of less than 0.05 was considered significant at 95% safety interval. Results: 245 patients (group 1: 11 (4.5%), group 2: 234 (95.5%) were included in the study. The groups were divided into two groups according to sex (group 1: Male/Female=1,2, group 2: Male/Female=6,1) and age (group 1: 62,8±16,6, group 2: 40±16,8) The difference was detected (p=0.016, p=0.0001). Chronic cardiac diseases were more common in the study group (p=0.0001). There was no difference in the presence of diabetes, smoking, and NSAID use (p=0.092, p=0.624, p=0.214). Leukocyte levels were found to be low in the study group (group 1: 9 (10) thousand/mm3, group 2: 13 (6), p=0.032). Complaints-operation times were higher in the study group (group 1: 12 (14) hours, group 2: 4 (4), p=0.0001). All the patients were repaired by Graham Rapha and drained. The duration of post-operative stay was similar between the groups (group 1: 4 (5) days, group 2: 5 (2), p=0.443). SSI was more frequent in the study group (p=0.008). Conclusion: Patients with female gender, advanced age, and chronic heart disease should be more cautious due to the high mortality risk