Superior mesenteric artery syndrome causing growth retardation

Superior mesenteric artery syndrome is a rare and lifethreateningclinical condition caused by the compressionof the third portion of the duodenum between the aortaand the superior mesenteric artery’s proximal part. Thiscompression may lead to chronic intermittent, acute totalor partial obstruction. Sudden weight-loss and the relateddecrease in the fat tissue are considered to be the etiologicalreason of acute stenosis. Weight-loss accompaniedby nausea, vomiting, anorexia, epigastric pain, andbloating are the leading complaints. Barium radiographs,computerized tomography, conventional angiography,tomographic and magnetic resonance angiography areused in the diagnosis. There are medical and surgical approachesto treatment. We hereby present the case ofa patient with superior mesenteric artery syndrome withdelayed diagnosis.Key words: superior mesenteric artery syndrome, nausea-vomiting, anorexi

A Rare Recurrent Hydatid Cyst Complication: Cystoduodenal Fistula

Karaciğer kist hidatiği dünya çapında görülen bir hastalıktır. Kist ciddi boyutlara ulaştığı zaman dispepsi, karın ağrısı gibi spesifik olmayan bası semptomlarına yol açabilir. Sık görülen komplikasyonlar rüptür ve sekonder enfeksiyondur. Bununla birlikte hidatik kistin gastrointestinal sisteme fistülizasyonu oldukça nadir görülen bir komplikasyondur. Altı yıl önce hidatik kist nedeni ile kistektomi yapılan 56 yaşında erkek hasta dispeptik yakınmaları olması üzerine kliniğimize başvurdu. Batın ultrasonografisinde nüks kiste rastlanan hastaya ileri tetkik olarak BT, MRCP görüntüleme ve üst gastrointestinal sistem endoskopisi yapıldı. Nüks hidatik kist ve kistoduodenal fistül tespit edildi. Cerrahi müdahale planlandı ve perikistektomi ile beraber fistül traktı eksize edildi. Ameliyat sonrası dönemde herhangi bir komplikasyon gelişmeyen hastaya antihelmitik tedavi uygulandı. Primer ve nüks hidatik kist olgularında kistoduodenal fistül gibi çok nadir komplikasyonlar görülebileceği akılda tutulmalıdır.A Rare Recurrent Hydatid Cyst Complication: Cystoduodenal Fistula Hepatic hydatid cyst is a disease seen worldwide. The cyst may cause non-specific pressure symptoms like dyspepsia and abdominal pain when it grows into significant sizes. Rupture and secondary infections are the frequently seen complications. Nonetheless, the fistulization of the hydatid cyst into the gastrointestinal system is a very rare complication. A 56-year-old male patient had had cystectomy because of hydatid cyst 6 years ago. He presented to our clinic with dyspeptic complaints. The patients abdominal ultrasonography showed recurrent mass and CT and MRCP imaging and upper gastrointestinal system endoscopy procedures were performed for the patient as advanced diagnostic techniques. The patient was seen to have recurrent hydatid cyst and cystoduodenal fistula. The case was followed-up for two years and did not have any other recurrences. It should be noted that very rare complications like cystoduodenal fistula may be seen in primary and recurrent hydatid cyst cases

A Case Of Sporadic Mesenteric Fibromatosis Mimicking Pancreatic Mass

Abdominal fibromatozis sporadik, pelvik, mezenterik lezyonlar ile garder sendromunda görülen fibromatozis lezyonlarının hepsi için kullanılmaktadır. Sporadik fibromatozis ise çok daha nadirdir ve literatürde az sayıda vaka bildirilmiştir. 14 yaşında kadın hasta, 2 aydır olan epigastrik bölgede müphem karın ağrısı, dispeptik yakınmalar ve yemeklerden sonra olan kusma nedeni ile başvurdu. Yapılan gastroskopide mideye dıştan bası yapan kitle lezyonuna rastlanması üzerine endoskopik ultrasonografi yapıldı. Pankreas kuyruğundan kaynaklandığı düşünülen 9x5 cm ebadında hiperekoik kitle lezyonu görüldü.Cerrahi olarak kitle eksize edildi. Mezenterik fibromatozis patolojik olarak benign bir tümör özelliği göstermesine rağmen klinik olarak ileri derecede agresif ve nüks oranı oldukça yüksektir.Bu hastalara malign gibi davranıp mümkün olduğunca geniş cerrahi rezeksiyon uygulanmalıdır.The term abdominal fibromatosis refers to sporadic, pelvic, and mesenteric lesions and to all the fibromatosis lesions seen in Gardner's syndrome. Sporadic fibromatosis, however, is very rarer and literature offers a limited number of cases. The 14-year-old female patient presented to our clinic with complaints of indefinite abdominal pain in the epigastric area for the last 2 months, dyspeptic problems, and vomiting after eating. Upon the patient's gastroscopy revealed a mass lesion pressuring the stomach, endoscopic ultrasonography was performed. A hyperechoic mass lesion of 9x5 cm thought to have originated from the pancreatic tail was detected. The mass was surgically excised. Although mesenteric fibromatosis shows the characteristics of a benign tumor pathologically, it is extremely aggressive clinically and has a very high rate of recurrence. These patients should be treated like they have malign tumors and surgeons should perform surgical resection as wide as possible

Sıra Dışı Bir İzole Çekum Nekrozu Olgusu

İzole çekum nekrozu genel olarak daha çok ileri yaş hastalarda görülmekle beraber erken yaşlarda oldukça nadir bir durumdur ve kronik kalp hastalığı, sistemik enfeksiyonlar, fırsatçı mantar enfeksiyonları, hipovolemik şok, romatoid ateş, kronik böbrek yetmezliği gibi sistemik hastalıklarla birliktelik gösterir. Daha önceden bilinen herhangi bir hastalığı ve geçirilmiş cerrahisi olmayan 36 yaşında kadın hasta 2 gündür olan sağ alt kadran ağrısı, bulantı-kusma ve iştahsızlık şikayetleri ile başvurdu. Hastada fizik muayene ve laboratuvar bulguları eşliğinde ön planda akut apandisit düşünülerek ameliyatı planlandı. Ameliyat esnasında izole çekum nekrozu ile karşılaşıldı, iskemik alana kısmi çekum rezeksiyonu ve primer onarım işlemi uygulandı.Her ne kadar literatürde sunulan vakaların tamamına yakını ileri yaş ve ek problemi olan hastalar olsa da sunduğumuz vaka göstermiştir ki izole çekum nekrozu genç ve herhangi bir ek hastalığı olmayan kişilerde de sağ alt kadran ağrısının ayırıcı tanısında akla gelmelidi

Giant primary adrenal hydatid cyst

Adrenal bezin kistik lezyonları nadir görülür ve bunların ancak %6'sını hidatik kistler oluşturur. Adrenal bezi tutmuş dev hidatik kist olgusunu literatür eşliğinde sunmayı amaçladık. 30 yaşında kadın hasta, 3 aydır karın şişliği ve ağrısı mevcuttu. Fizik muayenede batın sağ yarısın da belirgin bir asimetri ve düzgün yüzeyli kitle lezyonu palpe edilmekte idi. Yapılan tetkiklerde sağ sürrenal hidatik kist tanısı kondu. Laparoskopik parsiyel kistektomi işlemi uygulandı ve hasta ameliyat sonrası 3. günde 20 mg/kg albendazol tedavisi ile sorunsuz şekilde taburcu edildi. Adrenal kaynaklı kistlerin ayırıcı tanısında, özellikle endemik olduğu bölgelerde hidatik kist de mutlaka akılda tutulmalıdır.Cystic lesions of the adrenal gland are rarely seen and only 6% of these account for hydatid cysts. We aim at presenting a case of giant hydatid cyst involving the adrenal gland alongside with literature. 30-year-old female patient was presented with abdominal distensi- on and pain present for 3 months. The patient's physical examination revealed a distinctive asymmetry and a palpable mass lesion with a smooth surface on the right side of the abdomen. The patient was diagnosed with right surrenal hydatid cyst through the imaging techniques. Laparoscopic partial cystectomy was performed and the patient was discharged without any problems on post-op 3rd day with 20 mg/kg albendazole treatment. Hydatid cyst should be kept in mind of the differential diagnosis of adrenal cyst, especially in areas where it is endemi

Appendix in recurrent hernia sac (Amyand’s hernia)

Amyand herni enflame, perfore ya da normal apendiksin fıtık kesesi içerisinde bulunması olarak tarif edilmektedir. Kasık fıtıklarının%1 ini oluşturmaktadır ve ameliyat öncesi tanı konması zordur. Sağ kasık fıtığı nedeni 2 yıl önce ile dış merkezde meshli onarımişlemi uygulanan 67 yaşında erkek hasta, yaklaşık 2 aydır olan sağ kasık bölgesinde ağrı, öksürmekle, ıkınmakla belirginleşen şişlikşikâyeti ile kliniğimize başvurdu. Nüks inguinal herni nedeni ile operasyonu planlanan hastada ameliyat esnasında fıtık kesesi içerisindeapendiks dokusuna rastlandı. Görünümü normal olması üzerine apendektomi yapılmadı. Fıtığa gerilimsiz mesh hernioplastiişlemi uygulandı. Ameliyat sonrası 1. günde sorunsuz şekilde taburcu edildi. Amyand herni tanısı genelde ameliyat esnasındakonan, kendisine özgü semptomları olmayan nadir görülen bir fıtık şeklidir. Bu olgu sunumunda nüks nedeni ile opere edilenbir hastada dahi fıtık kesesi içerisinde apendiksle karşılaşılabileceği gösterilmiş ve Amyand hernisinin literatür eşliğinde gözdengeçirilmesi amaçlanmıştır.Amyand’s hernia refers to the condition in which an inflamed, perforated, or normal appendix is present in the hernia sac. Itaccounts for 1% of all inguinal hernias and its preoperative diagnosis in patients is difficult. A 67-year-old male patient who underwentright-sided inguinal hernia repair with a mesh approximately 2 years before at another healthcare center was referredto our clinic with complaints of pain in his right inguinal area and swelling, which became evident while coughing or straining,for approximately 2 months. A surgical procedure to repair his recurrent inguinal hernia was planned, and appendiceal tissue wasobserved in the hernia sac during the procedure. Appendectomy was not performed because the appendix was observed to benormal. Tension-free mesh hernioplasty was performed. The patient was discharged on postoperative day 1, without any complications.Amyand’s hernia is generally intraoperatively diagnosed and is a rare form of hernia with no specific symptoms. In this casereport, we showed that despite the patient undergoing a surgical procedure, the appendix was present in the hernia sac becauseof recurrence, and we aimed at reviewing Amyand’s hernia with the literature

Retroperitoneal necrotizing fasciitis: Analysis of seven cases and review of the literature

Nekrotizan fasciitis deri altı dokunun nadir, fakat hızlı yayılan enfeksiyoz bir hastalığıdır. Sunulan bu olgular ile amacımız retroperitoneal nekrotizan fasciitis vakalarında kliniğimizin cerrahi deneyimini ve yaklaşımını, hastalığın klinik görünümünü ve uzun dönem takip sonuçlarını literatür eşliğinde ortaya koymaktır. Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi genel cerrahi kliniğinde Ocak 2010 ve Ocak 2015 tarihleri arasında retroperitoneal nekrotizan fasciitis nedeni ile ameliyat edilen 7 hastanın verileri geriye dönük olarak değerlendirildi. Nekrotizan fasciitis, tanıda gecikildiği takdirde apandisit, ya da kas içi enjeksiyon gibi basit bir hadise sonrasında bile gelişebilecek, erken dönemde retroperitoneal alana yayılarak hastanın ölümüne sebep olabilecek ciddi bir rahatsızlıktır. Ameliyat öncesinde, özellikle gecikilmiş olduğu düşünülen vakalarda, bilgisayarlı tomografinin yardımı ile retroperitoneal bölgenin gözden geçirilmesi hem yapılacak cerrahi girişimin planlanması, hem de yetersiz arzetmektedir.Necrotizing fasciitis is a rare but rapidly spreading infectious disease of the subcutaneous tissue. Our aim, with these presented cases, is to present the surgical approach and experience of our clinic in the cases of retroperitoneal presentation, long-term follow-up results of disease with the literatüre. The data collected from 7 patients, who had had surgeries because of in Necmettin Erbakan University Medical School's general surgery clinic between January 2010 and January 2015, were retrospectively studied. Necrotizing fasciitis is a significant disease which can develop even after a simple incident like intramuscular injection or appendicitis and can lead to the death of a patient by spreading to the retroperitoneal area in the early phase in case of a delay in diagnosis. Pre-operative review of the retroperitoneal area by computerized tomography, especially in cases with potential delay, is important for both the planning of the surgical procedure and preventing insufficient debridement

Course of sepsis in rats with thyroid dysfunction

WOS:000410004200009PubMed ID: 28944329Objective: Numerous studies show the relationship between sepsis and thyroid hormones. Virtually all these studies investigate changes in post-sepsis thyroid hormones and the relationship between these changes and the progression of the disease. Our aim in this study was to investigate the progression of sepsis in rats with thyroid dysfunction. Material and Methods: The study involved four groups, each containing seven female Wistar albino rats: Group 1: Sham, Group 2: Control (Sepsis), Group 3: Hyperthyroidism-Sepsis, and Group 4: Hypothyroidism-Sepsis. Group 1 only received laparotomy. Group 2 only had sepsis. Sepsis was induced in Group 3 and Group 4 following formation of hyperthyroidism and hypothyroidism, respectively. After 24 hours, relaparotomy and thoracotomy were performed, and tissue and blood samples were drawn. Results: Dysfunctions seen in the liver, lungs, and kidneys during sepsis and other findings of sepsis were milder in the hyperthyroidism group in comparison to both the control and hypothyroidism groups. Conclusion: The results of Simon’s grade, histopathological organ damage, and laboratory parameters revealed that the progression of sepsis was milder in the hyperthyroid group than in the hypothyroid and euthyroid groups. The progression in the hypothyroid group was the most severe. Therefore, the results of the study raise the question of whether immediate treatment in cases of hypothyroidism and slow return of thyroid function to normal levels in cases of hyperthyroidism are adequate treatment approaches in patients who may develop sepsis or septic shock.” To determine the answer to this question, more detailed studies are required with a higher number of subjects

A Novel Agent-Supported Academic Online Examination System

Proper execution of exams aimed at assessment & evaluation is of critical importance in Learning Management Systems (LMS). Problems arising from human-centered errors or technical difficulties may lead to questioning of exams, and thus of reliability and efficiency of the distance education systems. Online examination system architecture proposed in this paper provides for integrated management of main functions such as question pool creation and update, exam authoring, execution and evaluation, and management of the feedbacks from students, along with ensuring use of analysis reports related to the questions and exams created by an intelligent agent in the decision-making processes. After conducting analyses on the distance education (DE) system of Sakarya University, it was found that the proposed intelligent agent supported online exam system detects the problems that arise to a large extent and enables the instructors to decide more easily in a shorter time. This system, which is possible to expand with its flexible structure to include additional intelligent features with the aim of resolving different problems, can also be adapted to different institutions that use online examination systems

A Novel Agent-Supported Academic Online Examination System

Proper execution of exams aimed at assessment & evaluation is of critical importance in Learning Management Systems (LMS). Problems arising from human-centered errors or technical difficulties may lead to questioning of exams, and thus of reliability and efficiency of the distance education systems. Online examination system architecture proposed in this paper provides for integrated management of main functions such as question pool creation and update, exam authoring, execution and evaluation, and management of the feedbacks from students, along with ensuring use of analysis reports related to the questions and exams created by an intelligent agent in the decision-making processes. After conducting analyses on the distance education (DE) system of Sakarya University, it was found that the proposed intelligent agent supported online exam system detects the problems that arise to a large extent and enables the instructors to decide more easily in a shorter time. This system, which is possible to expand with its flexible structure to include additional intelligent features with the aim of resolving different problems, can also be adapted to different institutions that use online examination systems