MTHFR C677T mutasyonunun neden olduğu süperior mezenterik ven trombozu

Amaç: Akut süperior mezenterik ven trombozu, tüm mezenterik iskemik olayların yaklaşık % 5 -15’ini oluşturan nadir görülen bir intestinal iskemi nedenidir. Bu yazıda süperior mezenterik ven trombozu gelişen kalıtsal trombofilili 2 hastanın sunulması amaçlanmıştır. Olgu sunumu: Otuz bir ve 51 yaşında iki hastaya akut batın, mezenter iskemi nedeni ile laparotomi ve ince barsak rezeksiyonu yapıldı. Genetik incelemede her iki hastada homozigot MTHFR C677-T mutasyonu saptandı. Ameliyat sonrası dönem sorunsuz geçen hastalar 10. ve 12. günde taburcu edildi. Sonuç: Akut süperior mezenterik ven trombozu mortalitesi yüksek olan ciddi bir sağlık problemidir. Doğru tanı koyabilmek için hastalıktan şüphelenmek oldukça önemlidir. Nekroz varlığında acil eksplorasyon ve nekrotik dokuların rezeksiyonu gerekmektedir. Trombofilili hastalar tanınmalı ve uzun dönem antikoagülan kullanımı planı yapılmalıdı

Primer retroperitoneal tümörlü olguların analizi

WOS: 000464102400007Objective: Retroperitoneal tumors are rare and most of them arise from mesodermal or neuroectodermal tissues and residues of the embryonic urogenital body. Retroperitoneal malignant tumors are seen more often than benign lesions. Due to their anatomic location and slow growth, pain and neurological symptoms do not appear until later stages. In this article, we aim to present our experience in eight cases with primary retroperitoneal tumor. Methods: Eight patients who underwent retroperitoneal tumor excision between April 2009 and April 2016 were included in the study. Gender, age, patients' complaints, the location, type and size of the tumor, surgical techniques, and morbidity, recurrence, and mortality rates were evaluated. The mean follow-up period was 41.3 months. Results: Four of the eight patients were females and the mean age was 48.6 years. The retroperitoneal mass was located in the abdomen (n= 4) and in the pelvis (n= 4). In addition to abdominal pain, some patients experienced back and leg pain, difficult urination, and constipation. Intra-operative biopsy was performed previously during a laparotomy (n= 2). Mass excision was performed by open and laparoscopic surgery. Variable histopathological diagnoses were determined, such as schwannoma, cystic mesothelioma, angiomyolipoma, epidermoid cyst, liposarcoma, ganglioneuroma, and neurofibroma. Morbidity included intra-operative bleeding (n= 1), post-operative deep vein thrombosis (n= 2), and pulmonary embolism (n= 1). Postoperatively there were neither recurrences nor mortality. Conclusion: Primary retroperitoneal tumors can be located in different regions, but we did not find any tumors localized in the left lumbar region. The pathological diagnoses were heterogeneous, including seven benign lesions and one malignant lesion.Amaç: Retroperitoneal tümörler nadirdir ve çoğu mezodermal veya nöroektodermal kökenli olup ve embriyonik ürogenital cismin kalıntılarından kaynaklanmaktadır. Retroperitoneal malign tümörler benign lezyonlardan daha sık görülür. Anatomik yerleşimleri ve yavaş büyümeleri nedeniyle, ağrı ve nörolojik semptomlar gecikmiş aşamalara kadar görülmez. Bu yazıda primer retroperitoneal tümörlü sekiz olguluk deneyimimizi sunmayı amaçladık. Yöntemler: Nisan 2009-Nisan 2016 tarihleri arasında retroperitoneal tümör eksizyonu yapılan sekiz hasta çalışmaya dahil edildi. Cinsiyet, yaş, hastanın şikayetleri, yeri, tümör tipi ve boyutu, cerrahi teknikler, morbidite, nüks ve mortalite oranları değerlendirildi. Ortalama izlem süresi 41,3 ay idi. Bulgular: Sekiz hastadan dördü kadın, yaş ortalaması 48.6 idi. Retroperitoneal kitlelerin 4’ü batın (n=4) ve 4’ü pelvis (n=4) yerleşimliydi. Karın ağrısına ek olarak, bazı hastalarda sırt ve bacak ağrısı, zor idrara çıkma ve kabızlık şikayetleri tespit edilmiştir. Laparotomi öncesi intraoperatif biyopsi 2 hastada uygulandı. (n=2). Kitle eksizyonu açık ve laparoskopik cerrahi ile yapıldı. Schwannoma, kistik mezotelyoma, anjiomyolipom, epidermoid kist, liposarkom, ganglionöroma ve nörofibrom gibi değişken histopatolojik tanılar belirlendi. Hastaların dördünde intraoperatif (kanama (n=1), ameliyat sonrası derin ven trombozu (n=2) ve pulmoner emboli (n=1)) morbidite izlendi. Postoperatif dönemde rekürrens ya da mortalite izlenmedi. Sonuç: Primer retroperitoneal tümörler farklı bölgelerde yerleşebilmekle birlikte sol lumbar bölgede herhangi bir tümör lokalizasyonu izlenmedi. Yedi benign lezyon ve bir malign lezyon da dahil olmak üzere patolojik tanı heterojen olarak belirlendi

Is there a place for a holistic approach in surgical training?

Abstract Introduction: The holistic approach in medicine is a framework that considers and treats all aspects of a patient’s needs, as it relates to their health. The goal of such an approach is to prevent illness, and to maximise the well-being of individuals and families. Holistic medicine is also referred to as integrative, which has been interpreted by some professionals as the combination of evidence-based medicine and complementary medicine. The problem: The speciality of FamilyMedicine (FM) is often referred to as General Practice (GP), a terminology which emphasises the holistic nature of that discipline. Furthermore, GP/FM professional bodies in some countries have incorporated the holistic and integrative approach into curricula and guidelines for doctors in training, which reflects its acceptance as a component of medical training. However, despite this validation, and despite research showing the effectiveness of such strategies in enhancing the outcomes of surgery, a holistic framework or integrative approach has not been equally integrated into speciality training for would-be surgeons. Conclusion: We argue that it would be advisable to include holistic approaches into surgical training and help surgeons to recognise their role in the continuum of care

An integrative approach for idiopathic granulomatous mastitis

The World Health Organization established a strategy on traditional medicine activities to facilitate integration of traditional medicine into the national health care system. Traditional and complementary medicine is now addressed by a legislation in Turkey. The aim of this study is to explore an integrative approach from for idiopathic granulomatous mastitis. This is a retrospective study. Study was carried out on idiopathic granulomatous mastitis patients who were followed in the Breast Clinic at Istanbul Medipol University Hospital for between May 2015 and September 2018. Hirudotherapy and medical cupping therapy were applied as traditional and complementary medicine integratively in accordance with the related Regulation. Radiological imaging, microbiological and histological testing, side effects, and relapses were analyzed. Radiological response was evaluated at the end of the treatment. Follow-up consisted of clinical breast exam and imaging. Thirty patients with a mean age of 34.6 years were analyzed. The average duration of symptoms was 4.6 months. Common symptoms were breast mass (100%), tenderness to palpation (73.3%), erythema (56.6%), fistula formation and deformity (43.4%), and axillary lymph nodes (43.4%). After confirmation of diagnosis of idiopathic granulomatous mastitis, patients were treated with hirudotherapy combined with medical cupping therapy. Symptoms had completely resolved within 110.3 +/- 24.70 days (range 90-180) after starting treatment, and complete radiological response was confirmed 3 months after the end of the therapy by breast ultrasound or magnetic resonance imaging (MRI). All patients were successfully treated, and no evidence of relapse was experienced within the follow-up period of 22.87 +/- 12.47 months. Hirudotherapy and medical cupping therapy were observed as efficient methods. Further investigations are required to validate the results in larger numbers of patients with longer follow-up. ( Identifier: NCT04096300)

Bleedings caused by warfarin overdose

Objectives: Warfarin is used in prophylaxis and treatmentof many diseases. Low doses of warfarin increaserisk of thrombosis and high doses increase risk of bleeding.In this study, we evaluated patients having warfarinrelatedbleedings in aspect of demographic data, durationof hospitalization, morbidity and mortality.Materials and methods: Between dates of January2010 and December 2010, patients with history of usingwarfarin and complaint of bleeding, whose internationalnormalized ratio (INR) values 6 or above, were evaluatedretrospectively.Results: Twenty-three patients (64%) were female, andthirteen (36%) were male with a total number of 36 patients.The mean age is 67.5 years (range 43-84 year).Mean duration of drug use was 37.2 ± 49.7 months with amedian value of 24 months. In six patients (16.7%), warfarinuse was initiated for the first time, three (8.3%) wasgoing to change a new dose. INR checks on a regularbasis in 18 patients (50%) were achieved.Hematuria and hematemesis/melena were the mostcommon forms of admission. Eleven patients (30%) hadboth erythrocyte (mean 3.8 units) and fresh frozen plasmatransfusions. Thirty (83%) patients had fresh frozenplasma transfusions (mean 2.53 units), 19 of them hadonly fresh frozen plasma. Rate of mortality due to bleedingwas 5,5%. The average of length of hospital stay was3.28 days (range 1-8 days).Conclusions: Warfarin users need careful INR monitoring.Patients should be informed about importance of INRmonitoring and potential complications

Comparison of common surgical procedures in non-complicated pilonidal sinus disease, a 7-year follow-up trial

Background: Pilonidal disease is a common problem in primary health care which may require immediate surgical referral. Although various management options have been proposed, so far there is no gold standard treatment. The aim of the present study was to determine which of the following techniques was superior as regards postoperative complications and recurrence, midline unshifted adipofascial turn-over flap, midline shifted adipofascial turn-over flap or Karydakis flap. Methods: A randomized clinical trial was conducted in the Department of General Surgery. Patients with non-complicated pilonidal sinus were enrolled in the study from April 2009 to January 2012. All patients were randomized the day of surgery at the coordinating center by means of a computer program. Patients were randomized to receive midline unshifted adipofascial turn-over flap, midline shifted adipofascial turn-over flap or Karydakis flap. All procedures were performed under local anesthesia and patients were discharged 6 h after surgery. Demographic characteristics, skin color, body hair type, family history, preoperative complaints and duration of symptoms, cyst size, intraoperative iatrogenic cyst rupture, the presence of a tuft of hairs in the cyst, surgical techniques, duration of drainage, length of hospital stay, postoperative complications and recurrence were evaluated. Results: One hundred and ninety-two patients with non-complicated pilonidal sinus were enrolled. Seventy-two patients were randomized to midline unshifted adipofascial turn-over flap, 67 patients to midline shifted adipofascial turn-over flap and 53 patients to Karydakis flap. The mean age was 25.66 ± 7.67 years. At 76-month follow-up, the overall complications and recurrence rates were not significantly different between groups (p > 0.05). Conclusion: In cases of non-complicated pilonidal sinus, we recommend surgical management using local anesthesia, outpatient surgery and the surgical approach with which the surgeon is most familiar