Unusual Noncommunicating Isolated Enteric Duplication Cyst in Adults

Duplication cysts are rare gastrointestinal congenital abnormalities and can occur anywhere within the gastrointestinal tract. Duplication cysts are firmly attached to or share the wall of the alimentary tract and have a common blood supply with the adjacent segment of the bowel. Completely isolated duplication cysts are an extremely rare variety of gastrointestinal duplications with their own exclusive blood supply, and they do not communicate with the intestine. These cysts are usually diagnosed during early childhood, and very rarely detected in adults, mostly incidentally, due to a lack of symptoms. A 28-year-old male was admitted to our hospital with a chief complaint of lower abdominal pain and distention and a palpable mass for 1 month. Based upon computed tomography and sonographic findings, a small bowel duplication cyst was tentatively diagnosed. The cyst had no connection to the gastrointestinal tract. Herein we report the case of a noncommunicating isolated ileal duplication cyst in an adult. Resection of the cyst was performed safely without requiring bowel resection

Mesenteric venous thrombosis due to protein c deficiency: report of four cases

AMAÇ: Akut mezenter iskemilerinin %5-15'ini mezenter ven trombozları oluşturur. Genellikle mezenter ven trombozu, hiperkoagulasyon bozuklukları ile iliskilidir ve bir hiperkogulasyon bozukluğu olan Protein C eksikliği, mezenter ven trombozu oluşumu için önemli bir risk faktörüdür. Bu çalışmada, protein C eksikliğine bağlı mezenter ven trombozu gelişen 4 olguyu inceledik. OLGULAR: Olgularımızın ikisi bayan, ikisi ise erkek olup, ortak hastaneye başvuru şikayetleri karın ağrısı idi. Fizik muayenede 3 olguda akut batın bulguları bulunduğundan laparotomi yapıldı. Nekroze barsak segmentlerine rezeksiyon yapıldıktan sonra hastalara jejunojejunal anastomoz (olgu 1), uç jejunostomi (olgu 2) ve çifte namlulu enterostomi (olgu 3) yapıldı. Intestinal nekroz bulgusu saptanmayan diğer olguda (olgu 4) mezenter ven trombozu tanısı, batın tomografisi ile konuldu. Bu olguya 5.000 Ü bolus ve 1.000 Ü/ saat olacak şekilde heparin infüzyonu 10 gün süre ile yapıldı. Olguların hiperkoagulabilite testleri yapıldığında protein C düzeyi sırası ile %42.20, %38.50 , %35.40 ve %29.25 seklinde düşük oldukları saptandı. Bütün hastalara düşük molekül ağırlıklı heparin verildikten sonra warfarin tedavisine geçildi. SONUÇ: Mezenter ven trombozu tanısı konulan hastalarda etiyolojik sebep mutlaka araştırılmalıdır. Protein C eksikliği mezenter ven trombozu gelişmesi için önemli bir risk faktörüdür. Intestinal nekroz gelisen hastalarda laparotomi yapılmalı ancak intestinal nekroz bulgusu olmayan hastalarda ise nonoperatif tedavi uygulanabilir.OBJECTIVE: Mesenteric venous thrombosis is seen in 5-15% of acute mesenteric ischemia patients. Mesenteric venous thrombosis is generally related to hypercoagulation disorders and proteinCdeficiency, which is a hypercoagulation disorder and one of the important risk factors for mesenteric venous thrombosis development. In this study, we investigated 4 cases of mesenteric venous thrombosis related to protein C deficiency. CASES: Cases included 2 male and 2 female patients and the main symptom was abdominal pain. The patients with physical examination findings of acute abdomen undergone emergency laparotomy. During operation, following resection of necrotic part of bowel; in Case 1, jejunojejunal anastomosis; in Case 2 end jejunostomy and in Case 3 double jejunocolic ostomy were performed. In one patient, mesenteric venous thrombosis was diagnosed by abdominal tomography without any finding of acute abdomen. This patient had 5000 U bolus and 10000 U/h heparin infusions for 10 days. Hypercoagubility tests' results for Protein C levels were as 42.20%, 38.50% , 35.40% and 29.25%, for Cases 1-4, respectively. All patients had low molecular heparin initially then continued with warfarin therapy. CONCLUSION: Etiology of mesenteric venous thrombosis must be investigated in patients diagnosed with mesenteric venous thrombosis. Protein C deficiency is one of the important risk factors of mesenteric venous thrombosis development. Laparotomy is necessary in patients with intestinal necrosis whereas patients without intestinal necrosis might be followed with nonoperative treatment

Splenectomy in patients with idiopathic thrombocytopenic purpura: Analysis of 109 cases

Objectives: Splenectomy is performed in order to provide the treatment in the patients with severe idiopathic thrombocytopenic purpura, refractory to medical treatment. In this study, we aimed to investigate the postoperatif and longterm outcomes in the patients who underwent splenectomy with the diagnosis of idiopathic thrombocytopenic purpura.Materials and Methods: Between 2001-2010 at Dicle University Medical Faculty, General Surgery Department, a retrospective review of the 109 patients who had undergone splenectomy for ITP was reviewed. Age, gender, presence of accessory spleens and location, duration of the operation, number of preoperative platelet tranfusion, number of preoperative and postoperative blood transfusion, length of hospital stay, long-term outcomes, morbidity and mortality were recorded.Results: The mean age was 37.10 ± 16.62 (16-72), and there were 88 (80.7%) female and 21 (19.3%) male patients. The mean operation time was 44.87 ± 10:32 (30-120) minutes. The average postoperative blood and preoperative platelet transfusion were 1.63 ± 0.85 (0-3) and 2.01 ± 0.71 (1-3) units, respectively. The accessory spleens were encountered in 20 (18.3%) patients at the ultrasonographic examination. And also the accessory spleens were encountered in 23 (21.1%) patients during operation and confirmed with histopathologic examination. The most common localization of accessory spleens were splenic hilus. The postoperative complications were occurred in 16 patients (14.7%) and the most complication was atelectasia. The mean length of hospital stay was 4:56 ± 2:45 (2-12) days. Patients were followed for an average of 28 (9-48) months. At the follow-up period, 1 (0.9 %) patient had died.Conclusion: Splenectomy can be performed safely in the treatment of the patients with idiopathic thrombocytopenic purpura unresponsive to medical treatment. Long-term good results can be obtained with splenectomy in these patients. The accessory spleens should not be overlooked to prevent recurrences

Coexistence of hyperthyroidism and thyroid cancer

Objective: Thyroid cancer can be associated with thyrotoxicosis caused by Graves' disease, toxic multinodular goiter, or toxic nodular goiter. The aim of this study was considered to be endemic in our region have received the diagnosis of hyperthyroidism, thyroid cancer is detected thyroidectomy performed and patients were retrospectively evaluate. Methods: We retrospectively studied 69 patients assessed for hyperthyroidism between 2006 and 2012. Clinical hyperthyroidism was diagnosed by elevated tri-iodothyronine/thyroxine (T3/T4) ratios and low thyroid-stimulating hormone (TSH) levels, with clinical signs and symptoms. The criteria for surgery were cytological evidence of malignancy, a goiter causing symptoms of tracheal or esophageal compression, side effects of antithyroid drug therapy, or Graves’ disease with multiple relapses after therapy withdrawal or responsiveness to antithyroid drugs. Results: Totally 69 patients were included. In 20 (28.9%) patients there was toxic multinodular goiter, in 28 (40.6%) Graves’s disease, and in 21 (30.5%) patients there was toxic nodular goiter. Of these patients, 12 (17.4%) had thyroid cancer. Conclusions: As a result; low likelihood of malignancy in patients with hyperthyroidism, though suspicious lesions detected in the lymph nodes and neck adenopathies be examined in detail

Retrospective Analysis of 5100 Mammography Imaging in a Tertiary University Hospital

Objective: In this study, our aim is to retrospectively evaluate, in the light of literature, mammographic find­ings of 5100 patients whose mammography imaging was performed from 2010 to 2015 in the Medical Faculty, Dicle University, and Children’s and Obstetrics Hospital, Diyarbakır. Methods: We retrospectively examined 5400 mam­mograms. Since the report and age data regarding 300 cases were missing, they were excluded from the study, and hence 5100 cases were included into the study. Each patient’s age, mammography findings were evaluated. Breast imaging results were categorized according to BI­RADS (Breast imaging reporting and data system) clas­sification. Results: The mean age of 5100 patients included into the study was 51.0 years. The localization of the lesion was detected most in the upper outer quadrant in both right and left breasts (62.9% in the right breast, 58.3% in the left breast). When BIRADS 4 and 5 lesions were assessed, they all were observed to be at equal rate in both breasts, and the lesions were mainly located in the upper outer quadrant. When BIRADS scores were com­pared according to age groups, the incidence of BIRADS 4 and BIRADS 5 lesions was determined to be higher in >35 years of age than under 35 years of age, which was statistically significant (p <0.001), whereas BIRADS 3 le­sions were found more in those patients under 35 years of age. Conclusion: When mammographic imaging results of patients coming from Diyarbakir and the surrounding area were evaluated, it was determined that BIRADS 4 and 5 lesions showed increase in those cases > 35 years of age, and that they were most frequently located in the up­per outer quadrant

Preoperative Seroprevalence of HBsAg, Anti-HCV, Anti-HIV in general surgery patients

Objectives: Exposure to blood borne pathogens is the most serious occupational health risk faced by health-care workers. The aim of this study was to evaluate the preoperative seroprevalences of HBsAg, anti-HCV and anti-HIV.Materials and methods: In this study we evaluated the seroprevalence of HBsAg, anti-HCV and anti-HIV in 486 preoperative patients who admitted to Dicle University Medical Faculty General Surgery Clinic for elective sur-gical procedures between January 2007 and July 2007; retrospectively. The results were compared with those of 14354 blood donations during the same period as con-trol group.Results: The seroprevalence of HBsAg and anti-HCV were; %6.6 and %1.6 subsequently in preoperative pa-tients. HBsAg and anti-HCV seropositivity rates were lower in the control group. Thus, the positively rates of HBsAg and anti-HCV for preoperative patients should be assessed higher than the data obtained from the blood bank. Anti-HIV seropositivity was not detected in both patient and control group. Conclusion: All healthcare workers must be trained about occupational diseases and vaccinated against he-patitis B. Establishment of universal precautions is nec-essary and these precautions must be strictly followed particularly in the operating room. In addition all patients should be considered as potential carriers

Primer Hydatid Cyst In Paravertebral Muscle

Hydatid cysts may occur in any area of the body, but usually localize to the liver and the lungs. Primary localization in muscle isn’t common, accounting for 2-3 % of all sites. We presented a patient with hydatid cyst, diagnosed by ultrasonography and computed tomography, and the cyst was located in the paravertebral muscle of the patient. Surgical and medical treatment combination.The intact intramuscular cyst was completely excised. Postoperatively, the patient began receiving albendazol 400 mg twice daily, for 6 months. At two years postoperatively, a clinical and radiological examination yielded no evidence of recurrence

The evaluation of microbiology and Fournier's gangrene severity index in 27 patients

SummaryObjectivesThe objectives of this study were to identify the causative microorganisms and factors associated with survival in patients with Fournier's gangrene and to determine the accuracy of the Fournier's gangrene severity index.Materials and methodsWe retrospectively evaluated 27 patients with Fournier's gangrene who were treated and followed up at our hospital between January 2005 and December 2006. Biochemical, hematologic, and bacteriologic study results at admission and at the final evaluation, etiologic and predisposing factors at admission, physical examination findings, the timing and extent of surgical debridement, and antibiotic therapy used were all recorded.ResultsThe admission laboratory parameters that were significantly correlated with outcome included urea, creatinine, sodium, and potassium; at the final evaluation, in addition to these parameters, hematocrit, albumin, and bicarbonate levels were also significantly associated with outcome. The mean Fournier's gangrene severity index score (FGSIS) at admission for survivors was 5.04±2.49 compared with 13.6±4.61 for non-survivors. There was a strong correlation between the FGSIS and mortality (p<0.0001). Escherichia coli and Pseudomonas aeruginosa were the most commonly isolated microorganisms.ConclusionsPatient metabolic status and predisposing factors are important in the prognosis of Fournier's gangrene. Hence, we believe that the FGSIS should be used clinically to evaluate therapeutic options and assess results