Laparoscopic treatment of morgagni hernia: Two case reports

Morgagni hernias account for only 2–3% of all diaphragmatic hernias, and most of them (91%) are rightsided. Most Morgagni hernias are diagnosed in childhood, but rarely diagnosis may be late because they can be asymptomatic or present nonspecific-nonrespiratory symptoms. Thus, Morgagni hernia diagnosis is incidental in the majority of adulthood cases. The defect arises from a fusion failure of the diaphragm with the central arches. Surgery is the main treatment modality of the Morgagni hernia due to defect enlargement and strangulation- incarceration risks. In this paper, we present two Morgagni hernia cases treated with laparoscopic surgery. Minimal invasive techniques can be used in Morgagni hernia with all advantages

In a real-life setting, direct-acting antivirals to people who inject drugs with chronic hepatitis c in Turkey

Background: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. Methods: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization’s objective of eliminating viral hepatitis

Retrospective Review of Pilonidal Sinus Patients With Early Discharge After Limberg Flap Procedure

The aim of this study was to evaluate the results of cases with pilonidal sinus (PS) disease that underwent Limberg flap (LF) transposition and to compare the short and long-term results of early discharge cases with those in the literature. A total of 345 patients who underwent rhomboid excision and LF transposition for PS were evaluated retrospectively. No major anesthetic or surgical complications occurred. Partial wound dehiscence, localized flap necrosis, hematoma, wound infection, and seroma rates were determined as 4.0, 2.1, 1.5, 3.3, and 3.7% respectively. All patients other than those with a hematoma or localized necrosis were discharged with a drain in place 24 hours after the operation. The recurrence rate was 3.9% after a mean 33.1-month follow-up (range, 6-72 months). As a result, we found that short and long-term results of patients who underwent LF and were discharged 24 hours after the operation were similar to those in the literature. We suggest that patients without postoperative complications, such as hematoma or flap necrosis, can be discharged early

Idiopathic Granulomatous Mastitis: An Autoimmune Disease?

Purpose. This study aimed to investigate the autoimmune basis of idiopathic granulomatous mastitis (IGM) by determining the anti-nuclear antibody (ANA) and extractable nuclear antigen (ENA) levels of patients diagnosed with IGM. Material and Methods. Twenty-six IGM patients were evaluated. Serum samples were analyzed for autoantibodies by indirect immunofluorescence (IIF) using a substrate kit that induced fluorescein-conjugated goat antibodies to human immunoglobulin G (IgG). IIF patterns were read at serumdilutions of 1 : 40 and 1 : 100 for ANA positivity. Using the immunoblot technique, the sera of patients were assayed at dilutions of 1 : 40 and 1 : 100 for human autoantibodies of the IgG class to 15 lines of highly purified ENAs. Results. In the IIF studies for ANA, positivity was identified for four different patterns in the 1 : 40 diluted preparations, for three different patients in the 1 : 100 diluted preparations and only one pattern was identified at the 1 : 320 dilution. In the ENA studies, positivity was identified for four different pattern in the 1 : 40 dilution, and only one pattern was identified at the 1 : 100 dilution. Conclusion. This study was not able to support the eventual existence of an autoimmune basis for IGM

Our Results of Under Knee Percutaneous Balloon Angioplasty in Patients with Critical Leg Ischemia

Objective: Percutaneous endovascular interventions has become an effective treatment in supra popliteal atherosclerotic disease. However there is stil no gold standart treatment in infrapopliteal atherosclerotic disease with critical limb ischemia. In this study we aimed to present the outcomes of patients with critical limb ischemia underwent percutaneous transluminal balloon angioplasty. Material and Method: We included 67 patients (mean age 62.4, 82% male). Procedural success was defined as <20% residual vessel stenosis. Clinical success was defined as the relieve of rest pain, prevention of amputation and achievement of wound healing. Results: Procedural success was achieved in 92.5%. Clinical success was achieved in 92.5%, 89.5% and 85.0% in 1.3 and 12 months fol- low-up, respectively. There were no procedure related death, acute thrombosis, distal embolization or need for urgent surgical inter- vention. Conclusion: Our results show that percutaneous balon angioplasty procedure has with low complication and high success rates in pa- tients with critical limb ischemia

The first report in Turkey of in vivo cultivation in Rattus norvegicus of Echinococcus multilocularis human strain

The adult form of the small cestode Echinococcus multilocularis is found in carnivorous animals, especially in the fox. This cestode, which is found in the northern hemisphere in the world, is the cause of a generally fatal disease in humans, known as alveolar echinococcosis (AE). The metacestodes of Echinococcus multilocularis can be experimentally developed in the Meriones unguiculatus species of rodents, and it is possible to use these metacestodes for numerous purposes, primarily for supplying the antigens required for serological diagnosis of the disease. It is with this aim that in this study for the first time in Turkey, Echinococcus multilocularis metacestodes were developed using different kind of rodent, Rattus norvegicus, and an indigenous strain was isolated using the surgical material of a patient diagnosed with alveolar echinococcosis.Echinococcus multilocularis'in erişkin formu, tilkiler başta olmak üzere etçillerde bulunan küçük bir sestoddur. Dünyanın Kuzey Yarımküresinde görülen bu sestod insanlarda genellikle ölümcül seyreden bir hastalık olan alveolar echinococcosisin etkenidir. Echinococcus multilocularis metasestodları Rattus norvegicus (sıçan) türü kemirgenlerde deneysel olarak geliştirilebilmekte, elde edilen metasestodlardan başta tanı için gerekli antijenler olmak üzere çok amaçlı yararlanılabilmektedir. Bu amaçla, Echinococcus multilocularis ile enfekte insandan alınan materyal, farklı bir kemirgen türü olan Rattus norvegicus (sıçan)'a inokule edilerek Echinococcus multilocularis suşu izole edilmiştir

Comparison of two procedures for symptomatic hemorrhoidal disease: Ligation under Vision and Ferguson Hemorrhoidectomy - A retrospective cohort study

Conclusions: LUV is a safe, and practical procedure with similar outcomes compared to FH. LUV may be a better choice than excisional hemorrhoidectomies when three or four quadrants of the anal canal are involved with hemorrhoids as this reduces mucosal defect related possible complications such as ectropion and anal stenosis

İntraoperatif splenik hilus kanaması ve splenomegali robotik ve laparoskopik splenektomiden açık cerrahiye geçişe etki eden risk faktörleridir

Objective: Minimal invasive surgery is one of the most popular treatment approaches which is safe and effective in experienced hands in different_x000D_ clinical practices. In the present study, we aimed to evaluate the risks factors for conversion to open splenectomy and the performance of indirect hilum_x000D_ dissection technique._x000D_ Material and Methods: A total of 56 patients who underwent laparoscopic or robotic splenectomy for isolated spleen diseases were included into the_x000D_ study. Patients were divided into two groups as robotic or laparoscopic splenectomy (Group 1; n= 48) and conversion to open surgery (Group 2; n= 8)._x000D_ Patients were retrospectively evaluated according to clinical, biochemical, hematological and microbiological parameters and morbidity._x000D_ Results: No statistically significant difference was found between the groups in terms of age, gender, body mass index (BMI), ASA score, co-morbid disease,_x000D_ operation time, hospital stay, follow-up period, accessory spleen, diagnosis, international normalized ratio (INR), red cell distribution width (RDW), platelet_x000D_ distribution width (PDW), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), reapplication, splenosis, surgical site infection, vascular_x000D_ thrombus and incisional hernia (p> 0.05). On the other hand, intraoperative splenic hilum hemorrhage and increased spleen size (p< 0.05) were higher_x000D_ in the conversion to open surgery group. In logistic regression analysis, intraoperative splenic hilum hemorrhage (B= 4.127) (OR= 61.974) (95% CI= 3.913-_x000D_ 981.454) (p= 0.003) and increased spleen volume (B= 3.114) (OR= 22.509) (95% CI= 1.818-278.714) (p= 0.015) were found as risk factors for conversion to_x000D_ open surgery._x000D_ Conclusion: Intraoperative hemorrhage from the splenic hilum and increased spleen volume (> 400 cm3_x000D_ ) are risk factors for conversion to open splenectomy in patients undergoing elective robotic or laparoscopic splenectomy. Indirect splenic hilum dissection can decrease intraoperative hemorrhage and conversion to open surgery.Giriş ve Amaç: Minimal invaziv cerrahi tüm dünyada farklı klinik pratiklerde etkili ve güvenli popüler tedavi yöntemlerinden biridir. Bu çalışmada_x000D_ amacımız, robotik veya laparoskopik splenektomi (RLS)’den açık cerrahiye geçişe etki eden risk faktörlerini ve indirekt hilum diseksiyonu tekniğinin performansını ortaya koymaktır._x000D_ Gereç ve Yöntem: Çalışmaya izole dalak hastalıkları nedeniyle RLS splenektomi yapılan 56 hasta kabul edildi. Hastalar iki gruba ayrıldı; RLS yapılan_x000D_ hastalar (grup 1) (n= 48) ve açık cerrahiye geçilen hastalar (grup 2) (n= 8). Hastalar yaş, cinsiyet, beden kütle indeksi (BKİ), yandaş hastalık, tanı, ASA_x000D_ skoru, dalak çapı, biyokimyasal, mikrobiyolojik parametreler ve morbiditeler açısından retrospektif olarak değerlendirildi._x000D_ Bulgular: Yaş, cinsiyet, BKİ, ASA skoru, yandaş hastalık, operasyon süresi, hastanede kalış süresi, takip süresi, aksesuar dalak, tanı, Uluslararası_x000D_ Normalizasyon Oranı (INR), eritrosit dağılım genişliği (RDW), trombosit dağılım genişliği (PDW), trombosit-lenfosit oranı (PLR), nötrofil-lenfosit_x000D_ oranı (NLR), tekrar başvuru, splenozis, cerrahi alan infeksiyonu, vasküler trombüs ve insizyonel herni açısından gruplar arasında istatistiksel olarak_x000D_ farklılık yoktu (p> 0,05). Diğer taraftan, açık splenektomiye geçilen grupta intraoperatif splenik hilustan kanama ve dalak çapı istatistiksel olarak_x000D_ daha fazlaydı (p< 0,05). Multivaryant analizde açığa geçişe etki eden faktörler; intraoperatif hilustan kanama (B= 4,127) (OR= 61,974) (%95 GA=_x000D_ 3,913-981,454) (p= 0,003) ve artmış dalak çapı (> 400 cm3) (B= 3,114) (OR= 22,509) (%95 GA= 1,818-278,714) (p= 0,015) olarak tespit edilmiştir._x000D_ Sonuç: İntraoperatif splenik hilustan kanama ve artmış dalak çapı (> 400 cm3_x000D_ ) elektif RLS’den açık splenektomiye geçişe etki eden risk faktörleridir._x000D_ İndirekt splenik hilum diseksiyonu intraoperatif kanama ve açık cerrahiye geçişi azaltabilir