Agenesis of Isthmus of the Thyroid Gland in a Patient with Graves-Basedow Disease and a Solitary Nodule

The thyroid is a vascular endocrine gland with two lateral lobes connected by a narrow, median isthmus. Although a wide range of congenital anomalies of the thyroid gland has been reported in the literature, agenesis of the thyroid isthmus is a very rare congenital anomaly. Thyroid isthmus agenesis does not manifest clinical symptoms, and it can be confused with other thyroid pathologies. We describe a patient with no isthmus of the thyroid, associated with Graves-Basedow disease. Thyroid isthmus agenesis should be kept in mind in order for surgical procedures involving thyroid pathologies to be carried out safely

Laparoscopic Repair of Combined Right Diaphragm and Liver Injuries with a Sharp Object: A Case Report

Introduction. Diaphragm injuries develop following penetrating or blunt traumas. The purpose of the case report is to present a 28 year old male patient with stable hemodynamic findings treated with laparoscopic approach following a liver injury combined with a right diaphragm injury caused by a sharp penetrating object. Case. 4 cm long transverse laceration was observed near the middle axillary line in the 6th right intercostal space in the examination performed on a 28 year old male patient who applied to the emergency service due to sharp penetrating object injury. Respiratory sounds were decreased in the right side and the examination revealed sensitivity in the abdomen. Elevation in the right diaphragm and hemopneumothorax was monitored in chest X-ray and computerized tomography. Closed subaqueous thorax drain was placed and the patient was taken to the surgery with a right diaphragm injury prediagnosis. Laparoscopic exploration was performed to the patient with stable hemodynamic findings by entering through 10 mm port above the abdomen. 6 cm long injury at the right side of diaphragm and approximately 2 cm deep at the deepest point and 5 cm long linear laceration was observed in the 7th segment of the liver. The diaphragm was repaired laparoscopically with sutures that do not melt on their own. Tampon was applied to the laceration in the liver and bleeding control was performed with suture. Patient was discharged on the 3rd day because he had no problems during postoperative follow-ups. Result. No noticed right side diaphragm rupture and possible concomitant visceral organ injuries following a penetrant injury that can cause significant mortality and morbidity should be definitely kept in mind. The detection of right side diaphragm and liver injury is vital with high mortality in case of delayed diagnosis, and direct radiography and computerized tomography are helpful in the diagnosis. Surgical treatment with laparoscopic approach is a method that leads to less hospitalization duration and less pain in cases that are hemodynamically stable

A questionaire study evaluating the knowledge and approach by physicians about arterial blood gas

Background and Aims: Arterial blood pressure analysis is a frequently applied method in the diagnosis and follow-up of respiratory insufficiency and in the treatment of patients under risk. It is very important to take and analyze the blood gas sample properly. Therefore, a questionary study was performed which evaluated the knowledge and the approach of doctors working in various specialties. Materials and Methods: A questionary form consisting of 27 questions were filled by 100 specialist physicians who participated in the study. Results: It was observed that doctors participating in our study had partly sufficient knowledge regarding administration and evaluation of arterial blood gas. It was considered that in intensive care unit experience of participant doctors during their intern periods was a very important factor. But it was observed that most of the participant specialist physicians performed Allen test before radial artery puncture, and they frequently preferred femoral artery for their first puncture option, and they did not pay attention in the proper transportation of the samples and in sending cultures from arterial cannula against risk of infection. The majority of doctors who participated in our study stated that they would like to receive training in arterial blood gas administration and evaluation. Discussion: In conclusion, to take samples from arterial blood gas is an invasive operation and if not performed correctly it can cause complications to develop. Transportation and evaluation is as much important as sampling. It is very important to provide sufficient education to candidates of specialist physicians and to organize training courses aimed to increase their knowledge and experience during the period of their speciality without taking their speciality into account. Clin Ter 2014; 165(3):e194-198. doi: 10.7417/CT.2014.1718. © Società Editrice Universo (SEU)

Fournier's gangrene current approaches

WOS: 000387667600070PubMed ID: 25145578Fournier's gangrene is a rare but highlymortal infectious disease characterised by fulminant necrotising fasciitis involving the genital and perineal regions. The objective of this study is to analyse the demographics, clinical feature and treatment approaches as well as outcomes of Fournier's gangrene. Data were collected retrospectively from medical records and operative notes. Patient data were analysed by demographics, aetiological factors, clinical features, treatment approaches and outcomes. Twelve patients (five female and seven male) were enrolled in this study. The most common aetiology was perianal abscess (41.6%). Wound cultures showed a mixture of microorganisms in six (50%) patients. For faecal diversion, while colostomywas performed in six cases (50%), Flexi-Seal was used in two cases (16.6%). In four patients (33.4%), no faecal diversion was performed. Negative pressure wound therapy (NPWT) system was effective in the last four patients (33.4%). The mean hospitalisation period in patients who used NPWT was 18 days, while it was 20 days in the others. NPWT in Fournier's gangrene is a safe dressing method. It promotes granulation formation. Flexi-Seal faecal management is an alternative method to colostomy and provides protection from its associated complications. The combination of two devices (Flexi-Seal and NPWT) is an effective and comfortable method in the management of Fournier's gangrene in appropriate patients