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

The potential role of BMI, plasma leptin, nesfatin-1 and ghrelin levels in the early detection of pancreatic necrosis and severe acute pancreatitis: A prospective cohort study

AbstractBackground: Early prediction of disease severity in acute pancreatitis (AP) is crucial. The aim of this study was to investigate the body-mass index (BMI), plasma leptin, nesfatin-1 and ghrelin levels as potential markers predicting peripancreatic necrosis and severity in acute pancreatitis. Methods: In the study period, 97 consecutive patients with AP were prospectively analysed. Severe AP was defined according to the Atlanta Criteria. BMI was also calculated. To measure plasma Leptin, Nesfatin-1 and Ghrelin concentrations, the blood samples were obtained from patients within 24 hours of admission. Results: Out of 97 patients, 92(70 females, 22 males) were considered eligible for analysis. Of the 92 patients, 30 patients (32.6%) were assessed as severe pancreatitis. BMI and leptin levels were significantly higher in patients with severe pancreatitis. The pooled sensitivity and specificity of BMI as a predictor for the development of pancreatic necrosis were 0.90(95%CI = 0.56–0.99) and 0.70(95%CI = 0.58–0.79), respectively; with an overall area under curve value of 0.78.The pooled sensitivity and specificity of leptin levels as a predictor for development of pancreatic necrosis were 1(95%CI = 0.69–1) and 0.73(95%CI = 0.62–0.82),respectively; with an overall area under curve value of 0.82.Nesfatin-1 and ghrelin levels showed no significant difference in patients with mild pancreatitis (6.97 ± 0.84 ng/ml and 2.3(1.0–9.9);respectively) and severe pancreatitis (6.74 ± 0.65 ng/ml and 2.0(1.9–9.9); respectively) (p = 0.1923 and 0.8531;respectively). Conclusion: BMI and plasma leptin levels both were correlated with the severity of pancreatitis. Leptin levels showed better area under the curve, sensitivity and specificity values compared to BMI in prediction of pancreatic necrosis.Nesfatin-1 and ghrelin levels were not found to be predictors of the severity of disease

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

Granulomatous mastitis: A retrospective review of 49 patients

Objective: Idiopathic granulomatous mastitis, a rare, benign, chronic inflammatory condition of the breast, which usually mimics breast carcinoma. In this study, we report on the management of 49 cases of idiopathic granulomatous mastitis and their clinical presentation. Methods: The breast and anatomical databases of one center were reviewed from 2007 to 2012 to identify patients with histological diagnosis of idiopathic granulomatous mastitis. Clinical and demographic characteristics were retrieved and treatment modalities were were recorded. Results: The mean patient age was 37.71±7.1 years. There were no differences between the management groups about etiological and demographic factors. The rate of recurrence in group 1, group 2, and group 3 was 8.3%, 14.8% and 20%, respectively; there were no statistically significant difference among the groups. Conclusion: Steroids and surgical methods codified in idiopathic granulomatous mastitis may be preferred. We recommend steroid therapy as first-line treatment. However, prospective, randomized clinical trials are needed to determine the treatment algorithm

A planned delayed laparoscopy in a gunshot injury case with spleen and diaphragmatic damage

The basic treatment of thoracoabdominal gunshot injury is surgery. However, a conservative approach is increasingly becoming widespread in selected cases. In this study, the management of a patient with a spleen and diaphragm damage due to a gunshot injury who treated with delayed surgery was presented. A 37-year-old man was admitted with a gunshot injury and a computed tomography showed splenic and left diaphragmatic injury. His vital signs were stable and after a 3 days of conservative treatment, laparoscopic repair of the diaphragm was performed and the patient was discharged uneventfully. When a diaphragmatic injury is accompanied by splenic injury in the case of the patient is stable and there is no need for emergency surgery, the repair of the diaphragm may be delayed to prevent unnecessary splenectomy

Our clinical experience on laparoscopic splenectomy: Outcomes of 38 patients

Objective: Laparoscopic splenectomy has gained widespread acceptance in the treatment of hematological diseases in recent years. In this study, we aimed to present the outcomes of the patients who underwent laparoscopic splenectomy. Methods: Between 2012 and 2015, the data of 38 patients, who underwent laparoscopic splenectomy for hematological diseases at our clinic, were evaluated retrospectively. Results: 15 males and 23 females patients were underwent laparoscopic splenectomy, and the average age was 33.9 ± 12.9 years. Indications for splenectomy were idiopathic thrombocytopenic purpura (ITP) in 34 patients, and hereditary spherocytosis in 4 patients. During the surgical exploration, accessory spleen was detected in 7 patients, and removed. Laparoscopic cholecystectomy was performed at the same session in 2 hereditary spherocytosis patients who had stones in the gallbladder. One patient was converted to the open surgery due to the bleeding which was eliminated the exposure during the dissection. At the postoperative period, we observed atelectasis in one patient, and wound fat necrosis in one patient. In addition, thrombocytosis was observed in one patient. Hematological treatment was continued because of persistent refractory thrombocytopenia in two patients, and temporary thrombocytopenia in four patients. An accessory spleen was detected with splenic scintigraphy in one of these patients at the postoperative period. The average hospitalization time was 2.6 ± 0.7 days. Conclusion: Laparoscopic splenectomy for hematological diseases may be considered as first-line therapy with less hospital stay and morbidity