Midede sıradışı bir yabancı cisim: Yemek çatalı

18 yaşında erkek hasta acil servisimize çatal yutma şikayeti ile başvurdu. Çekilen karın grafisinde midede çatal olduğu görüldü. Hastanın laboratuvar bulguları normal değerlerdeydi. Hastanın midesindeki çatal cerrahi olarak çıkarıldı.An 18-year-old male patient applied to the emergency department with complaint of fork swallowing. Abdominal film of the patient showed meal fork in the stomach. Laboratory signs of the patient were normal. The fork in the stomach of the patient was removed surgically

Midenin glomus tümörü

Altmış dört yaşında erkek hasta masif üst gastrointestinal sistem kanaması ile acil servise başvurdu. Distal gastrektomi uygulanan hastada ameliyat sırasında antral bölge küçük kurvaturda submukozal yerleşimli, 2.4 cm çapında, iyi sınırlı bir kitle palpe edildi. Kitlenin histopatolojik incelemesinde, düzensiz dallanan, ince duvarlı damarların arasında yuvalanmalar, kordonlar ve tabakalar oluşturan berrak sitoplazmalı uniform tümör hücreleri görüldü. İmmünohistokimyasal olarak vimentin ve SMA ile pozitif; sitokeratin, CD34, sinaptofizin, kromogranin A, NSE, CD117 (C-kit) ve S-100 protein ile negatif sonuç elde edildi. Elektron mikroskopik olarak berrak sitoplazmalı, kaba kromatinli yuvarlak nukleusa sahip hücrelerinin damar yapıları etrafı nda gruplar oluşturdukları görüldü. Klinik bulgular, makroskopik görünüm, tümör paterni, immünohistokimyasal ve elektron mikroskopik bulgular glomus tümörü ile uyumlu bulundu.A sixty-four-year old male patient presented to the emergency room with massive upper gastrointestinal tract bleeding. During distal gastrectomy, a submucosal, well demarcated mass with a diameter of 2.4 cm was palpable in the antral region of the lesser curvature. Histopathological examination of the mass revealed uniform tumor cells with clear cytoplasms and round nuclei, forming nests, strands and sheets between dense, irregularly branching, thin-walled vessels. Immunohistochemistry was positive for vimentin and SMA and negative for cytokeratin, CD34, synaptophysin, chromogranin A, NSE, CD117 (C-kit) and S-100 protein. Electron microscopy demonstrated tumor cells with clear cytoplasms and round nuclei with coarsely dispersed chromatin, forming groups around vascular structures. Clinical findings, gross appearance, tumor pattern, immunohistochemical findings and electronmicroscopic findings were all consistent with a glomus tumo

İntratorasik ekstra abdominal agresif fibromatozis

Fibröz doku kaynaklı tümörler toraksta ve mediastinumda nadir olarak görülmekte ve rapor edilmektedirler. Biz burada, agresif fibromatozisin, toraks içi dokulardan kaynaklanan nadir bir formunu bildirmek istedik. Otuz altı yaşında bayan hasta hastanemize sol göğüs ağrısı ve sıkışma hissi ile başvurdu. Çekilen PA grafi ve toraks bilgisayarlı tomografisinde, sol toraks alt kısmını üçte iki oranında dolduran dev kitle görüldü. Bunun üzerine hastaya sol yedinci interkostal aralıktan yapılan torakotomi ile geniş rezeksiyon uygulandı. Tümör patolojisi 20x15x15 cm çapında agresif fibromatozis olarak geldi. Hasta 15 aydır takip altında ve kontrollerinde yineleme görülmedi.Tumors of fibrous tissue origin (fibromatosis) in chest and mediastinum have been rarely reported in the literature. Herein, we report a rare case of aggressive fibromatosis presenting as an intrathoracic tumor. A 36-year-old woman admitted to our hospital due to a feeling of oppression and pain in the left chest. A chest X-ray, thorax computed tomography revealed a large mass filling two thirds of lower left thorax. Widely surgical resection of the tumor was performed thoracotomy via seventh intercostal space. The tumor was 20x15x15 mm in size and diagnosed pathologically as aggressive fibromatosis. The patient has been well without recurrence for 15 months after surgery

Assessing the correlation between FDG PET findings of IDC breast carcinoma and histopathology of coexisting ductal carcinoma in-situ

Background: Ductal carcinoma in-situ (DCIS) often coexists with invasive ductal carcinoma (IDC) of the breast. DCIS is considered as a non-obligate precursor of IDC when both coexist. 18F-fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) imaging is commonly used in the staging and follow-up assessment of breast cancer. In this study, we aimed to assess if there is any correlation between primary tumor PET and histopathology findings and histopathological features of the coexisting DCIS. Material and methods: FDG PET/CT images and histopathology results of the patients with newly diagnosed breast cancer (IDC) with coexisting DCIS were analyzed in this retrospective study. The grade and size of the primary tumor and histopathological features of the coexisting DCIS (nuclear grade and architectural pattern) were obtained from the postoperative histopathology results. Maximum standardized uptake values (SUV: SUVmax and SULmax) of the primary tumor normalized by weight and lean body mass were measured. Statistical analysis was performed to assess the correlation between various parameters of IDC and DCIS. Results: This study included sixty-two (62) patients with IDC-DCIS. Primary tumor grade was significantly correlated and associated with the nuclear grade of the coexisting DCIS (polychoric correlation r = 0.736, and Fisher exact test, PV < 0.001, respectively). Primary tumor SUV was not correlated with the nuclear grade and architectural pattern of the coexisting DCIS (polyserial correlation r = 0.172, PV = 0.155, and Point Bi-Serial correlation r = –0.009, PV = 0.955, respectively). Median primary tumor size was marginally significantly different among DCIS nuclear grades but it was not significantly different in comedo and non-comedo cases (Kruskal-Wallis test PV = 0.053, and Mann-Whitney U test PV = 0.890, respectively). Conclusions: Primary tumor grade is correlated with the nuclear grade of the coexisting DCIS. SUV of primary tumor does not seem to be correlated with the histopathological features of coexisting DCIS (nuclear grade and architectural pattern) but this may be further studied in a larger number of patients

Combined Effects of Tauroursodeoxycholic Acid and Glutamine on Bacterial Translocation in Obstructive Jaundiced Rats:

Background: Bacterial Translocation is believed to be an important factor on mortality and morbidity in Obstructive Jaundiced. .Aims: We investigated the probable or estimated positive effects of tauroursodeoxycholic acid, which has antibacterial and regulatory effects on intestinal flora, together with glutamine on BT in an experimental obstructive jaundiced rat model. Study Design:Animal experimentation.Methods: Forty adult, male, Sprague Dawley rats were used in this study. Animals were randomised and divided into five groups of eight each: sham (Sh); control (common bile duct ligation, CBDL); and supplementation groups administered tauroursodeoxycholic acid (CBDL+T), glutamine (CBDL+G), or tauroursodeoxycholic acid plus glutamine (CBDL+TG). Blood and liver, spleen, MLN, and ileal samples were taken via laparotomy under sterile conditions for investigation of bacterial translocation and intestinal mucosal integrity and hepatic function tests on the tenth postoperative day. Results: There were statistically significant differences in BT rates in all samples except the spleen of the CBDL+TG group compared with the CBDL group (p=0.041, p=0.026, and p=0.041, respectively). Conclusion: It is essential to protect hepatic functions besides maintaining intestinal mucosal integrity in the active struggle against BT occurring in obstructive jaundice. The positive effect on intestinal mucosal integrity can be increased if glutamine is used with tauroursodeoxycholic acid, which also has hepatoprotective and immunomodulatory features

Karaciğer kist hidatik olgularımız

Amaç: Kist hidatik hastalığı halen bölgemiz ve ülkemiz için yaygın bir sağlık sorunu olarak önemini korumaktadır. Bu klinik geriye dönük çalışmada intraperitoneal rüptür nedeniyle acil cerrahi uygulanan dört olgu ile birlikte aynı dönemde tedavi edilen tüm karaciğer kist hidatik olguları incelendi. Hastalar ve Yöntemler: Ocak 2004 ve Haziran 2007 tarihleri arasında kliniğimizde karaciğer kist hidatiği nedeniyle tedavi edilen toplam 44 hastanın (24 kadın, 20 erkek; ort. yaş 47.5; dağılım 16-83) tıbbi kayıtları geriye dönük olarak incelendi. Hastalar yaş, cinsiyet, kistin yerleşim yeri, uygulanan cerrahi yöntem, hastanede kalış süresi, meydana gelen ameliyat öncesi ve sonrası komplikasyonlar ve komplikasyonlara yönelik uygulanan tedavi yöntemleri açısından irdelendi. Bulgular: İntraperitoneal rüptür nedeniyle dört hasta (%9) acil olarak ameliyat edildi. Olguların 15’inde (%34) ameliyat sonrası dönemde kist poşuna safra kaçağı oluştu. Bu hastaların altısında (%40) kaçak herhangi bir müdahaleye gerek kalmadan kapandı, sekizinde (%53) ise 10 günden fazla sürdü ve günlük debi 100 cc’nin üzerinde idi. Bu olgulara endoskopik sfinkterotomi uygulandı. Mortalite oranı %4 (n=2) olarak tespit edildi. Sonuç: Hidatik kist rüptürü karaciğerde kistik kitlesi olan ve intraperitoneal serbest sıvısı bulunan travma hastalarında akılda bulundurulması gereken bir durumdur. Bu hastalarda anaflaktik reaksiyon riski olduğu göz önüne alınarak hızla müdahale edilmelidir. Karaciğer kist hidatik cerrahisi sonrasında safra fistülü gelişen hastalarda endoskopik sfinkterotomi etkin bir tedavi yöntemidir

The frequency of Duchenne muscular dystrophy/Becker muscular dystrophy and Pompe disease in children with isolated transaminase elevation: results from the observational VICTORIA study

IntroductionElevated transaminases and/or creatine phosphokinase can indicate underlying muscle disease. Therefore, this study aims to determine the frequency of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD) in male children and Pompe disease (PD) in male and female children with isolated hypertransaminasemia.MethodsThis multi-center, prospective study enrolled patients aged 3–216 months with serum alanine transaminase (ALT) and/or aspartate transaminase (AST) levels >2× the upper limit of normal (ULN) for ≥3 months. Patients with a known history of liver or muscle disease or physical examination findings suggestive of liver disease were excluded. Patients were screened for creatinine phosphokinase (CPK) levels, and molecular genetic tests for DMD/BMD in male patients and enzyme analysis for PD in male and female patients with elevated CPK levels were performed. Genetic analyses confirmed PD. Demographic, clinical, and laboratory characteristics of the patients were analyzed.ResultsOverall, 589 patients [66.8% male, mean age of 63.4 months (standard deviation: 60.5)] were included. In total, 251 patients (188 male and 63 female) had CPK levels above the ULN. Of the patients assessed, 47% (85/182) of male patients were diagnosed with DMD/BMD and 1% (3/228) of male and female patients were diagnosed with PD. The median ALT, AST, and CPK levels were statistically significantly higher, and the questioned neurological symptoms and previously unnoticed examination findings were more common in DMD/BMD patients than those without DMD/BMD or PD (p < 0.001).DiscussionQuestioning neurological symptoms, conducting a complete physical examination, and testing for CPK levels in patients with isolated hypertransaminasemia will prevent costly and time-consuming investigations for liver diseases and will lead to the diagnosis of occult neuromuscular diseases. Trial RegistrationClinicaltrials.gov NCT04120168

Extra-Abdominal Aggressive Fibromatosis Presenting As an Intrathoracic Tumor

Tumors of fibrous tissue origin (fibromatosis) in chest and mediastinum have been rarely reported in the literature. Herein, we report a rare case of aggressive fibromatosis presenting as an intrathoracic tumor. A 36-year-old woman admitted to our hospital due to a feeling of oppression and pain in the left chest. A chest X-ray, thorax computed tomography revealed a large mass filling two thirds of lower left thorax. Widely surgical resection of the tumor was performed thoracotomy via seventh intercostal space. The tumor was 20x15x15 mm in size and diagnosed pathologically as aggressive fibromatosis. The patient has been well without recurrence for 15 months after surgery