Laparoscopic Cholecystectomy in Elderly Patients

Laparoscopic surgery can be safely applied in the elderly. Complications can be minimized by carefully selecting patients aged 80 years or older and operating on these patients with experienced teams with good technical capabilities

Ectopic mediastinal thyroid tissue: cervical or mediastinum originated?

A 22-year-old female patient was admitted to our clinic after both clinical and laboratory findings suggested hyperthyroidism. At pre-operative magnetic resonance imaging (MRI), we detected a substernal goitre with lobulated outlines at the inferior of the right lobe that extended 5 cm inferior to the carina. The thyroid mass extended to the mediastinum and was totally extracted by cervical incision. Postoperatively, a residual thyroid mass of 8.5×9×10 cm in size, was detected on MRI at the median part of the anterior mediastinum. The isolated mediastinal thyroid mass was then extracted by sternotomy. We believe that, because of the close anatomical relationship between the thyroid tissue extending cervically and the mass detected in the mediastinum, the mediastinal mass might have developed from the cervical thyroid tissue residues by pushing the cervical thyroid or it might have mechanically entered the mediastinum

Synchronous Occurrence of Primary Breast Carcinoma and Primary Colon Adenocarcinoma

A 65-year-old female patient presented to the emergency clinic with abdominal pain, meteorism, and intermittent rectal bleeding. Colonoscopy was performed, and a hepatic flexure tumor was detected. Histopathological examination of biopsy revealed adenocarcinoma. Thoracoabdominal CT was performed for staging, and a spiculated contour mass was found incidentally on the left breast. Mammography and ultrasonography were performed for the cause of these findings, and suspicious lesions of malignancy were seen in the left breast. Invasive ductal carcinoma was detected in core needle biopsy samples from lesions. In the multidisciplinary council consisting of oncologist, pathologist, radiologist, and general surgery specialist, it was decided to perform breast operation first and then colon operation, followed by adjuvant chemotherapy. In the first operation, left total mastectomy and sentinel lymph node biopsy were performed. One week after her initial operation, the patient underwent right hemicolectomy. After operations, the patient did not develop postoperative complications and was sent to medical oncology department for adjuvant chemotherapy

Giant true cyst of the spleen with elevated serum markers, carbohydrate antigen 19-9 and cancer antigen 125

A 19-year-old woman presented with a left upper abdominal mass. Computed tomography of the abdomen showed a solitary cystic lesion in the splenic hilum, approximately 20×16 cm in size, demonstrating almost total displacement of the remaining splenic parenchyma. She had high serum concentrations of carbohydrate antigen 19-9 and cancer antigen 125. A splenectomy was performed. Immunohistochemical study confirmed the existence of an epithelial cyst. Following surgery, the serum concentrations of the tumour markers decreased gradually. True splenic cysts are rare and their origin is controversial. In splenic cysts with high serum concentrations of tumour markers, such as occurred in our patient, cystectomy or splenectomy were preferred to remove tumour marker-producing epithelium and to prevent recurrence after treatment. If the epithelial lining of the cyst cannot be detected under light microscopy, immunohistochemical study should be performed

Effects of chitosan on healing and strength of colonic anastomosis in rats Efeitos de quitosana na cicatrização e resistência de anastomose colônica em ratos

PURPOSE: To investigate whether chitosan application over colonic anastomosis line, provide reinforcement, and subsequently improve anastomotic healing. METHODS: Forty eight Wistar albino female rats were used and were randomly divided into four groups, 12 rats in each: The control groups (1 and 3) received no further treatment. The experimental groups (2 and 4) received chitosan application over the colonic anastomosis. After sacrifying rats at the end of the experiment (either on day three or on day seven, depending on the group), colonic bursting pressure, a hihydroxyproline level and histopathologic characteristics of the perianastomotic tissue were examined. RESULTS: At three days, chitosan and control groups had similar values for histopathologically. On day seven, chitosan group had significantly higher mean score of collagenization (p=0.007) and a significantly higher bursting pressure (p=0.038). CONCLUSION: Our study emphasizes the positive effect of chitosan in the process of collagenation in colonic anastomosis healing.<br>OBJETIVO: Investigar se a aplicação de quitosana em anastomose colônica promove resistência à tração e consequentemente a melhora na cicatrização. MÉTODOS: Foram utilizados 48 ratos Wistar fêmeas distribuídos em quatro grupos, 12 ratos em cada. Grupos controle (1 e 3) não receberam tratamento. Grupos experimento (2 e 4) receberam aplicação de quitosana na anastomose colônica. Após eutanásia após 3º ou 7º dias foram examinadas a tensão, o nível de hidroxiprolina e aspectos histopatológicos da anastomose. RESULTADOS: Após três dias os grupos controle e quitosana não apresentaram alterações histopatológicas. No sétimo dia o grupo quitosana apresentou significante elevação do escore de colagenização (p=0,007) e da tensão de ruptura (p=0,038). CONCLUSÃO: A quitosana apresentou bons resultados nos processos de colagenização e cicatrização de anastomose colônica