Post-transplant lymphoproliferative disorder presented as small bowel intussusception in adult liver transplant patient

Intestinal obstruction after liver transplant is a rare complication, with diverse clinical manifestations. Intestinal adhesion is the most common cause. However, internal hernia, abdominal wall hernia, and neoplasm are also reported. Intussusception is another rare cause of intestinal obstruction, which has been reported primarily in pediatric patients. Herein, we report a case of intestinal obstruction from intussusception in an adult liver transplant patient associated with post-transplant lymphoproliferative disorder

HSP27 is involved in the pathogenesis of kidney tubulointerstitial fibrosis

We hypothesized that heat shock protein 27 (HSP27), a small heat shock protein with actin-remodeling properties, is involved in the pathogenesis of kidney tubulointerstitial fibrosis. We first examined its expression in the rat unilateral ureteral obstruction (UUO) model of kidney fibrosis and epithelial-to-mesenchymal transition (EMT). Immunoblot analyses showed that UUO resulted in significant upregulation of TGF-β1, α-smooth muscle actin (α-SMA), total and phosphorylated HSP27, and phosphorylated p38MAPK. Immunofluorescence studies showed that HSP27 costained with TGF-β1, α-SMA, and E-cadherin in areas of tubulointerstitial injury. We next attempted to translate these studies in an in vitro model of EMT using rat proximal tubular epithelial cells (NRK52E). TGF-β1 (20 ng/ml) treatment resulted in EMT (upregulation of α-SMA and downregulation of E-cadherin) and significant upregulation of total and phosphorylated HSP27 and p38MAPK after 3 days. Real-time PCR analyses showed that HSP27, vimentin, and fibronectin increased whereas E-cadherin mRNA levels decreased. Double-staining immunofluorescence studies showed intracytoplasmic colocalization of HSP27 with both F-actin and E-cadherin in cells undergoing EMT. HSP27 overexpression by transient transfection significantly increased E-cadherin while decreasing E-cadherin repressor Snail levels. In aggregate, these studies show that HSP27 is involved in the pathogenesis of TGF-β1-induced EMT and chronic tubulointerstitial fibrosis. HSP27 overexpression may delay injury by upregulating E-cadherin through downregulation of Snail

Thyroid malignancy in hypoactive nodules in endemic nodular goitre

Amaç: Bu çalışma endemik nodüler guatrlarda hipoaktif tiroid nodüllerinin malignite oranlarını araştırmak amacı ile planlandı. Gereç ve Yöntem: Nisan 2001-Mayıs 2002 tarihleri arasında Genel Cerrahi Kliniği'nde tiroid cerrahisi uygulanan hastalar değerlendirildi. Multinodüler guatrı olan 30, soliter nodülü olan 2 hastadaki (26 kadın, 6 erkek) hipoaktif nodüllerden ince iğne aspirasyon biyopsisi yapıldı. Hastalara hipoaktif nodülün olduğu loba istmektomi ile birlikte total lobektomi, kontrlateral loba ise totale yakın lobektomi uygulandı ve histopatolojik bulgular değerlendirildi. Bulgular: Tiroid cerrahisi uygulanan 79 hastanın 32'sinde (26 kadın, 6 erkek) hipoaktif tiroid nodülü mevcuttu. Hastaların kadın/erkek oranı 3/1 (58/21) ve ortalama yaş 43.57 (21-75) olarak tespit edildi. 36 olguda (%46) hipertiroidi mevcuttu. İnce iğne aspirasyon biyopsilerinin sitolojik incelemelerinde malignite veya şüpheli bulgular saptanmadı. Cerrahi rezeksiyon sonucunda histopatolojik değerlendirmelerde hipoaktif nodüllerden birinde okült papiller karsinom tespit edildi. Sonuç: Endemik multinodüler guatrlardaki hipoaktif nodüllerin malignite açısından değerlendirilmesinde tiroid ince iğne aspirasyon biyopsisi önemli bir yere sahip olmakla birlikte güvenilirliği tartışılabilir. Endemik multinoduler guatrlardaki hipoaktif nodüllerin malignite oranlarını daha sağlıklı olarak ortaya koyabilmek için daha geniş hasta serilerine ihtiyaç vardır.Objective: The aim of the study was to present the epidemiology of thyroid cancers in hypoactive nodules in endemic multinodular goitres. Material and Methods: The patients who underwent thyroid surgery in general surgery between April 2001 and May 2002 were evaluated. We performed fine-needle aspiration biopsy (FNAB) of cold nodules who had multinodular goitres. We perform a total lobectomy on the hypoactive nodule side with isthmectomy and a near total contralateral lobectomy on the other lobe and pathologic findings were evaluated. Results: In 32 (26 women, 6 men) of 79 patients who were treated surgically had hypoactive nodules. The female/male ratio was 3/1 (58/21) and the mean age was 43.57 (21-75). 36 patients (%46) had hyperthyroidism. The FNAB results of the patients who had hypoactive nodules were normal cytologic findings. In the pathologic evaluations of hypoactive nodules there was an occult papillary carcinoma. Conclusion: In the malignancy evaluation of hypoactive nodules in endemic multinodular goitre, fine needle aspiration biopsy has an important role but it's reliability can be discussed. In order to show the malignancy ratios of hypoactive nodules in endemic multinodular goiter we need larger patient series

Algorithms for reducing the complications of laparoscopic cholecystectomy

Amaç: Kolelitiazis tedavisinde laparoskopik kolesistektomi günümüzde altın standart olarak kabul edilmekle birlikte açık kolesistektomideki son derece düşük komplikasyon oranları bu metotla artış göstermiştir. Açık kolesistektomiye göre daha fazla deneyim gerektiren laparoskopik kolesistektomi için belirli algoritmalar ve cerrahi prosedür standardizasyonları geliştirmek komplikasyonları azaltmada yararlı olmaktadır. Gereç ve Yöntem: ZKÜ Tıp Fakültesi Genel Cerrahi Kliniği'nde Nisan 2001 ile Nisan 2004 tarihleri arasında yapılan 120 laparoskopik kolesistektomi vakası komplikasyonlar açısından ele alınarak uyguladığımız algoritmaların güvenilirliği gözden geçirilmiştir. Bulgular: Toplam 120 hastanın hiç birinde majör komplikasyon görülmemiştir. Altı hastada açık cerrahiye dönme, bir hastada 15 gün süren safra sızıntısı görülmüş ve endoskopik retrograd kolanjiopankreatografi sonrası gerilemiştir. Uyguladığımız preoperatif hasta değerlendirme algoritması ve cerrahi prosedürlerde uyguladığımız tehlikeli noktaların standardizasyonu ile 120 vakalık serimizde majör komplikasyon ile karşılaşılmamıştır. Sonuç: Sonuçta laparoskopik kolesistektomi vakaları için iyi bir preoperatif değerlendirme ve cerrahi detaylarda dikkatli olunması daha başarılı sonuçlar doğuracaktır.Objective: Laparoscopic cholecystectomy is accepted as a gold standard in the surgical treatment of cholelithiasis. As laparoscopic cholecystectomy needs more training then open cholecystectomy there is a need for algorithms for surgical procedures in order to have low complication rates. Material and Method: We tested our algorithms using 120 laparoscopic cholecystectomy performed in Zonguldak Karaelmas University General Surgery Department between April 2001 and April 2004. Results: There were no major complications. In six cases, cholecystectomy was performed by open surgical procedure. In one case there was a biliary leakage which lasted more than fifteen days and needed an endoscopic retrograde cholangiopancreatography. By the use of preoperative evaluation algorithm and the standardization of surgical procedures there were no major complications in our patient group. Conclusion: In conclusion, we can say that using preoperative evaluation and performing intensive surgery lower the complication rates in laparoscopic cholecystectomy

Imaging-guided needle placement of non-palpaple breast lesions

Amaç: Cerrahi biyopsi öncesinde Stereotaktik yöntemle tel kullanılarak işaretlenen palpe edilmeyen meme lezyonlarına ait mamografi bulguları ile histopatolojik tanıları karşılaştırmaktır. Gereç ve Yöntem: Mart 2002-Ağustos 2003 tarihleri arasında palpe edilmeyen fakat mamografisinde meme lezyonu saptanan 26 kadın olguya Stereotaktik yöntemle tel ile işaretleme ve cerrahi biyopsi uygulanmıştır. Bulgular: 5 olguda (%19) meme kanseri saptanmıştır (1 olguda lobüler komponenti bulunan infiltratif duktal karsinom, 4 olguda ise infiltratif duktal karsinom). Spiküler lezyon ve yapısal distorsiyonlarda kanser oranı sırası ile %80 ve %20 bulunmuştur. 21 olguda (%81) benign meme patolojisi saptanmıştır (20 olguda fibrokistik değişiklikler ve 1 olguda normal meme dokusu). Bu olguların mamografisinde ise polimorf mikrokalsifikasyon kümesi (%19) ve asimetrik dansite (% 81) lezyonu saptanmıştır. Sonuç: Stereotaktik yöntemle tel ile işaretleme, meme kanserinin erken evre tanısında yararlı minör invaziv bir yöntemdir.Objective: To compare the mammography findings and histopathological results of nonpalpable lesions localised stereotactically using a needle-wire system before open biopsy. Materials and Methods: Mammoguided stereotactic system added on to mammography device was performed to breast lesions in 26 women during March 2002-August 2003. Results: Breast cancer was detected in 19% of the biopsies (in 1 case invasive ductal carcinoma with lobular component, in 4 cases invasive ductal carcinoma). Cancer rate was 80% and 20% in spicular lesions and architectural distortion, respectively. Benign breast lesion was found in 81% of the biopsies (in 20 cases fibrocystic changes and in 1 case normal breast tissue). Benign lesion rate was 19% and 81% in microcalcifications and asymmetric densities, respectively. Conclusion: Localisation of nonpalpable breast lesions under mammography guidance is a minor invasive modality which is useful for early diagnosis of breast cancers

Comparison of the measurement methods of bursting pressure of intestinal anastomoses.

BACKGROUND/AIMS: This study was designed to determine whether there exists a difference between in vivo and in vitro measurements of bursting pressure (BP) of experimental intestinal anastomosis studied in Wistar-albino rats. METHODOLOGY: In the first group (n=8), the BP was measured using in vivo method without detaching the adhesions around the anastomosis. BP was determined with digital manometer, and then anastomotic region was removed to measure tissue hydroxyproline (HP) levels. In the second group (n=8), the BP was measured with in vitro method after the segment of intestine including the anastomosis was dissected and isolated. The isolated specimen was then submerged in a normal saline bath. BP was determined with a digital manometer and anastomotic region was removed to measure tissue HP levels. RESULTS: While HP value in the first group was 105.60 +/- 9.43 microg/mg dry tissue, it was found to be 121.11 +/- 16.26 microg/mg dry tissue in the second group and this difference was not statistically significant (p=0.195). The BP was determined as 240.71 +/- 11.65 mmHg in the first group, 144.71 +/- 16.41 mmHg in the second group and the difference was statistically significant (p=0.002). The anastomotic resistances to intraluminal pressure were found to be statistically different whereas tissue HP levels were normal between the groups. CONCLUSIONS: These results make us consider that mechanical changes occur about the isolated anastomotic line and dissection of adhesions weakens the anastomosis