Isolated diaphragmatic rupture and herniation related with a minor blunt trauma-a case report

Künt travma sonrası diafragma rüptürü nadir görülür. Künt travma nedeniyle hospitalize edilen hastaların ortalama % 0.8- 1.6 sında meydana gelmektedir. Bu çalısmada minor künt travma nedeniyle görülen izole diafragma rüptürü ve ince barsak herniasyonu olan bir olgu sunulmustur. Hastada toraks bosluguna herniasyon nedeniyle intestinal obstruksiyon mevcuttu. Minor künt travmalardan sonra ortaya çıkan izole diafragmatik rüptüre baglı intestinal obstruksiyon olguları oldukça nadirdir. Preoperatif dönemde izole diyafragma rüptürlerinin tanısını koymak oldukça güçtür. Künt veya penetran travma sonrası gelisen diafragma rüptürlerinde tanı koyabilmek için bu olasılık akla gelmelidir. Geç dönemde, travma öyküsünün arastırılması, bu tanının konmasını kolaylastıracaktır. Diyafragma yaralanmalarında tanı koymada süpheci yaklasım, toraksın fizik muayenesi, ve akciger grafisi yararlı olacaktır.Rupture of the diaphragm after blunt trauma is uncommon, occurring in approximately 0.8%-1.6% of patients who are hospitalized with blunt trauma. A case of diaphragmatic rupture and intestinal herniation following a minor blunt trauma is reported in this article. The patient experienced intestinal obstruction owing to herniation into the thoracic cavity An isolated injury after minor blunt trauma, the cases of diaphragmatic rupture with intestinal obstruction have been rarely reported. Isolated diaphragmatic rupture in general may be a difficult injury to recognize during preoperative period. Following blunt or penetrating traumas, in order to diagnose diaphragmatic ruptures, this possibility should be considered. In the later phases, questioning history of trauma would make it an easier diagnosis.Ahigh index of suspicion, physical examinaton of the chest, and x-ray film are helpful for diagnosis of diaphragmatic injury

Zależności między występowaniem nowotworów tarczycy a przewlekłym limfocytarnym zapaleniem tarczycy: zmiana zasad leczenia chirurgicznego?

Wstęp: Istnieją kontrowersje na temat zależności między występowaniem nowotworów tarczycy a przewlekłym limfocytarnym zapaleniem tarczycy (CLT). Wykazano, że ogniskowe limfocytarne zapalenie tarczycy rozwija się wtórnie do zmian nowotworowych, jednak nadal nie wyjaśniono, czy osoby z rozsianą postacią limfocytarnego zapalenia tarczycy mają skłonność do zapadania na raka tarczycy. Celem badania było określenie zależności między CLT i złośliwymi nowotworami tarczycy oraz ocena chirurgicznego leczenia CLT. Materiał i metody: Retrospektywnie analizowano dane 917 chorych operowanych z powodu chorób tarczycy. Siedemdziesiąt siedem (8,4%) osób z histopatologicznie zdiagnozowanym CLT (nieswoiste zapalenie tarczycy lub choroba Hashimoto) przebadano pod kątem nowotworów tarczycy. Do analizy włączono 15 chorych, u których stwierdzono współwystępowanie CLT i nowotworu tarczycy. Wyniki: Ocena histopatologiczna 917 przypadków wykazała zmiany nowotworowe tarczycy u 97 (10,6%) chorych, natomiast u 77 osób stwierdzono CLT. U 16 (20,8%) osób z tej grupy rozpoznano chorobę Hashimoto (swoiste CLT), natomiast u 61 (79,2%) chorych — CLT. U 15 pacjentów nowotwór tarczycy współwystępował z CLT. Wśród stwierdzonych nowotworów odnotowano 9 przypadków (60%) raka brodawkowatego, 3 przypadki (20%) raka rdzeniastego, 1 przypadek (6,6%) raka pęcherzykowego, 1 przypadek (6,6%) raka z komórek Hurtle’a i 1 przypadek (6,6%) chłoniaka. W niniejszej analizie częstość rozwoju nowotworu na podłożu CLT wynosiła 19,48%; natomiast w grupie bez CLT nowotwór rozwinął się u 9,76%; różnica między grupami jest statystycznie istotna (p = 0.008). Wnioski: Należy z większą uwagą oceniać chorych z CLT ze względu na możliwość procesów rozrostowych. W przypadku wykrycia guzka u chorego z zapaleniem tarczycy minimalna interwencja chirurgiczna powinna obejmować lobektomię. Totalna tyroidektomia jest lepszym rozwiązaniem niż subtotalna tyroidektomia, ponieważ wiąże się z większymi korzyściami, do których należą kontrola zapalenia tarczycy, eliminacja ryzyka reoperacji i stabilizacja zaburzeń hormonalnych. (Endokrynol Pol 2011; 62 (4): 303–308)Background: The relation between thyroid neoplasms and chronic lymphocytic thyroiditis (CLT) is controversial. While it is accepted that focal lymphocytic thyroiditis develops secondarily to malignancy, it is not clear whether diffuse lymphocytic thyroiditis has a tendency to develop into thyroid cancer. The aim of this study was to investigate the relation between CLT and malignant tumours of the thyroid and evaluate the surgical approach to CLT cases. Material and methods: In this study, 917 patients operated on for thyroid diseases were investigated retrospectively. Seventy-seven (8.4%) patients histopathologically diagnosed as having CLT (either non-specific or Hashimoto’s thyroiditis) were investigated for any concurrent malignant neoplasm. Fifteen patients in whom CLT and thyroid malignancy were coexisting were included in the study. Results: In the pathological evaluation of 917 cases, malignancy in the thyroid was found in 97 (10.6%) cases. Seventy-seven cases were categorised as CLT. Of these 77, 16 (20.8%) were Hashimoto’s thyroiditis (specific CLT) and the other 61 (79.2%) were non-specific CLT. In 15 cases, thyroid malignancy was found to be concurrent with CLT. Of the malignities, nine (60%) were papillary carcinoma, three (20%) medullar carcinoma, one (6.6%) follicular carcinoma, one (6.6%) Hurthle cell carcinoma, and one (6.6%) lymphoma. In our series, the rate of the development of malignancy against the background of CLT was 19.48%, while the rate in the groups without CLT was 9.76%, with a statistically significant difference between the groups (p = 0.008). Conclusions: CLT cases should be evaluated more carefully in terms of malignancy. If a nodule is detected on thyroiditis, the minimal surgical intervention should be lobectomy. Total thyroidectomy should be considered as preferable to subtotal thyroidectomy because of its many advantages such as controlling thyroiditis, removing the probability of reoperation, and hormonal stability. (Pol J Endocrinol 2011; 62 (4): 303–308

Gastrointestinal quality of life in patients with asymptomatic cholelithiasis after laparoscopic cholecystectomy

To assess the outcome of laparoscopic cholecystectomy for asymptomatic cholelithiasis before and after laparoscopic cholecystectomy using a specific quality of life instrument for gastrointestinal disorders in adults : The Gastrointestinal Quality of Life Index (GIQLI) was used to study the quality of life in patients before and after laparoscopic cholecystectomy : Seventy one patients completed the GIQLI questionnaire both preoperatively and after a minimum postoperative follow-up of three months. Mean preoperative score was 126.8±14.07 out of a theoretical maximum score of 144.After three months, the score had significantly improved to 136.6±9.31, close to the range for the normal population. Not only items assessing gastrointestinal symptoms but also the domains of physical, social, and emotional function improved significantly. The most marked improvements were achieved in patients with the lowest preoperative scores. Laparoscopic cholecystectomy significantly improves the quality of life in patients with cholelithiasis who are asymptomatic or have nonspecific gastrointestinal symptoms that cannot be explained by another gastrointestinal pathology.Bu çalısmada asemptomatik kolelitiyazis olgularının ameliyat öncesi ve ameliyat sonrası hayat kalitesi degerlendirilmistir. Hastaların ameliyat öncesi ve sonrası hayat kalitelerinin ölçümü gastrointestinal hayat kalitesi indeksi parametreleri kullanılarak belirlenmistir. Çalısmaya alınan 71 hasta ameliyat öncesi ve ameliyattan en az 3 ay sonra gastrointestinal hayat kalitesi indeksine göre sorgulanmıstır. Preoperatif dönemde ortalama skor 126.8±14.07, 3 ay sonra yapılan sorgulamada ise ortalama 136.6±9.31 olup normal populasyona yakın bir oranda saptanmıstır. (toplam skor 144). Gastrointestinal semptomlarının yanı sıra fiziksel, sosyal ve duygusal durumlarında da anlamlı düzelme gözlenmistir.Düsük skorlu hastalarda bu iyilesmedaha belirgindir. Asemptomatik kolelitiyazisli hastalarda baska gastrointestinal patolojilerle açıklanamayan nonspesifik semptomların laparoskopik kolesistektomiyle iyilesme gösterdigi, hastaların hayat kalitelerinde anlamlı bir artıs oldugu görülmektedir

Koroner arter hastalığında güncel tedavi yaklaşımlarını ne düzeyde gerçekleştirebiliyoruz?

In this study, we aimed to investigate the level and efficacy of treatment approaches to coronary artery disease(CAD) in a tertiary center. The study population consisted of 100 consecutive patients who were hospitalised in the previous month due to angina pectoris and CAD was verified by elective coronary angiography. The patients' demographic and clinical data, coronary risk factors, medicines prescribed before hospitalisation and on discharge, lipid levels, biochemical tests, blood pressures, coronary angiographic data, suggested treatment plan and information about the attending assistant doctor were obtained from the hospital's archive. The patients' mean age was 58;plusmn;10 year, and 21% of them were female. Sixty-six percent of all patients were hyperlipidemic, 59% were hypertensive, and 18% diabetic. Five percent and twenty percent of all cases were not aware that they were hypertensive and hyperlipidemic, respectively. On admission, 46% and on discharge 66% of the patients were on beta blockers. Of the 34 patients, who were not prescribed beta blockers on disharge, 13 patients had absolute or relative beta-blocker contraindications and 7 were taking cardioselective calcium antagonists. No contraindications for beta blocker therapy were noted in the remaining 14 cases. On admission 31%, and on discharge 65% of patients were receiving statins. Of the 35 patients who were not on statins, 11 patients had indications for statin use. None of the patients had contraindications for statins. Thirty-two percent of patients were receiving angiotensin converting enzyme (ACE) inhibitors before admission and 66% were prescribed ACE inhibitors before discharge. Of the 34 patients who were not prescribed ACE inhibitors, only one patient had contraindication for ACE inhibitors. According to the guidelines, ACE inhibitors were indicated for 11 of these patients. Hence, use of beta blockers, ACE inhibitors and statins that have proved to be favourable on morbidity and mortality in CAD, has approached the levels reported in series abroad but it is still not satisfactory. In-hospital prescription of medicines, very important in increasing the patient's compliance, should be enhanced, and patients and physicians should be knowledged and encouraged about these agents.Kardiyovasküler alanda tedavinin başarısını artırmak için ilgili tedavi kılavuzlarını etkin bir şekilde uygulayıp, bu kılavuzlardaki hedeflere ulaşılması gerekmektedir. Bu çalışmada koroner arter hastalığında (KAH) bir tersiyer merkezdeki tedavi yaklaşımlarının düzeyi ve etkinliğinin araştırılması amaçlanmıştır. Hasta popülasyonu, bir üniversite hastanesi kardiyoloji kliniğine angina pektoris yakınması ile başvuran ve elektif koroner anjiyografi amacı ile son 1 ay içinde yatırılarak KAH saptanan ardışık 100 olgudan oluşmuştur. Bu olguların hastane dosya kayıtlarından demografik ve klinik özellikleri, koroner risk faktörleri, yatmadan önce ve hastaneden çıkarılırken verilen tedavi, lipid düzeyleri, biyokimyasal tetkikleri, kan basınçları, anjiyografik bulguları, önerilen tedavi planı ve izlemi yapan asistan doktorlara ait faktörler elde edildi. Olguların yaş ortalaması 58±10 olup %21'i kadındı. Tüm olguların %66'sı hiperlipidemik, %59'u hipertansif ve %18'i diyabetikti. Tüm olguların %5'i hipertansif, %20'si hiperlipidemik olduğunu bilmiyordu. Olguların yatışta %46, taburcu olurken %66'sı beta bloker kullanmaktaydı. Taburcu olurken beta bloker verilmeyen 34 hastadan sadece 13'ünde gerçek veya nisbi beta-bloker kontrendikasyonu varken, 7'si kardiyoselektif kalsiyum kanal blokeri kullanıyordu. Onbir hastada ise kullanımı engelleyecek bir durum söz konusu değildi. Olguların yatışta %31'i taburcu olurken %65'i statin kullanmaktaydı. Statin kullanmayan 35 hastadan 11'inde kesin olarak statin endikasyonu vardı ve hiçbir hastada statin kullanımı açısından kontrendikasyon yoktu. Yatışta %32 ve taburcu olurken %66 hasta anjiyotensin dönüştürücü enzim (ACE) inhibitörü kullanmaktaydı. ACE inhibitörü verilmeyen 34 hastanın sadece 1 tanesinde ACE inhibitörü kontrendikasyonu varken 11 olguda tedavi kılavuzlarına göre ACE inhibitörü endikasyonu mevcuttu. Sonuç olarak, koroner arter hastalığında mortalite üzerine olumlu etkileri kanıtlanmış olan beta bloker, ACE inhibitörü ve statin grubu ilaçların kullanımları yabancı serilerde bildirilenlere yaklaşmakla birlikte hala yeterli düzeylere ulaşabilmiş değildir. Tedaviye hastanın uyumunu artırmada çok önemli olan hastane içi dönemde ilaç uygulamasının artırılması, hasta ve doktorların bu ajanlar konusunda bilinçlendirilmesi ve cesaretlendirilmesi gereklidir

A Rare Presentation of Xanthogranulomatous Cholecystitis as Bouveret’s Syndrome

The purpose of this paper is to present sonographic and CT imaging findings of xanthogranulomatous cholecystitis (XGC) presented as Bouveret’s syndrome, a very rare cause of gastric obstruction. While the patient’s physical examination, upper GI endoscopy, and radiological findings all pointed to Bouveret’s syndrome, CT differential diagnosis suggested either XGC or gallbladder carcinoma, and the final diagnosis was done histopathologically. Our paper aims to increase awareness in radiologically diagnosing XGC cases by introducing the possibility of existence of Bouveret’s syndrome