Four mucinous cystadenoma of the appendix treated by different approaches.

Appendiceal mucocele is a rare clinical entity characterized by dilatation of the appendiceal lumen due to abnormal mucinous secretion. It may be of inflammatory or tumoral origin. It may occur as a result of mucoceles, mucosal hyperplasia, mucinous cystadenoma or mucinous cystadenocarcinoma. Mucinous cystadenoma of the appendix is the most common form, although it manifests itself in many different clinical presentations. It is detected in 0.6% of appendectomy specimens. Preoperative diagnosis is difficult, and it is often detected at laparotomy. Despite existing reservations due to the risk of rupture, laparoscopic surgery is gaining acceptance. Although there is no consensus on the choice of surgery, either appendectomy or right hemicolectomy is applied. In this article, we discussed four patients with appendix mucinous cystadenoma where different surgical methods were applied in light of the literature.

Influence of preemptive analgesia on pulmonary function and complications for laparoscopic cholecystectomy.

Pain and diaphragmatic dysfunction are the major reasons for postoperative pulmonary complications after upper abdominal surgery. Preoperative administration of analgesics helps to reduce and prevent pain. The objective of this study was first to research the rate of pulmonary complications for laparoscopic cholecystectomy (LC) and then analyze the influence of preemptive analgesia on pulmonary functions and complications. Seventy patients scheduled for elective LC were included in our double-blind, randomized, placebo-controlled, prospective study. Randomly, 35 patients received 1 g etofenamate (group 1) and 35 patients 0.9% saline (group 2) intramuscularly 1 h before surgery. All patients underwent physical examination, chest radiography, lung function tests, and pulse oxygen saturation measurements 2 h before surgery and postoperatively on day 2. Atelectasis was graded as micro, focal, segmental, or lobar. With preemptive analgesia, the need for postoperative analgesia decreased significantly in group 1. In both groups mean spirometric values were reduced significantly after the operation, but the difference and proportional change according to preoperative recordings were found to be similar [29.5 vs. 31.3% reduction in forced vital capacity (FVC) and 32.9 vs. 33.5% reduction in forced expiratory volume in 1 s (FEV(1)) for groups 1 and 2, respectively]. There was an insignificant drop in oxygen saturation rates for both groups. The overall incidence of atelectasia was similar for group 1 and 2 (30.2 vs. 29.2%). Although the degree of atelectesia was found to be more severe in the placebo group, the difference was not statistically significant. We concluded that although preemptive analgesia decreased the need for postoperative analgesia, this had no effect on pulmonary functions and pulmonary complications.

[Paraduodenal internal hernias: clinical analysis of two cases]. / Paraduodenal internal herniler: Iki olgu nedeniyle klinik analiz.

Paraduodenal hernias, or so called "congenital intraperitoneal hernias"are rare cause intestinal obstruction. These hernias are caused by variations in intestinal rotation and the patients present with symptoms ranging from intermittent abdominal pain to acute obstruction. We report two cases of obstructive paraduodenal hernias which are at left and right each and review of its clinical features and surgical management.

Differentially regulated ADAMTS1, 8, 9, and 18 in pancreas adenocarcinoma.

INTRODUCTION: Despite recent diagnostic and therapeutic improvements, pancreas cancer remains one of the highly lethal cancers. The extracellular matrix (ECM) is a physiological barrier that limits the spread of cancer cells into surrounding tissues and distant organs. Disintegrin and metalloprotease with thrombospondin motifs (ADAMTS) is a family of 19 proteases, which is involved in various biological processes such as ECM remodelling and anti-angiogenesis. AIM: To investigate the expression of ADAMTS1, 8, 9, and 18 proteinases in pancreas adenocarcinoma and its nodal metastasis. MATERIAL AND METHODS: The immunostaining status of ADAMTS1, 8, 9, and 18 were investigated in formalin-fixed paraffin-embedded samples of 25 patients who underwent pancreaticoduodenectomy for an adenocarcinoma located at the head of the pancreas. RESULTS: In semi-quantitive grading pathologically, ADAMTS1, 8, 9, and 18 were found to be highly stained in all cancerous pancreas samples compared with normal pancreas. In addition, the immune positivity of ADAMTS1, 9, and 18 was found to be higher in metastatic lymph nodes than in non-metastatic lymph tissue. Tumour size was correlated with ADAMTS9 and 18 expressions in cancerous pancreas. CONCLUSIONS: According to the data obtained from the study, we suggest that these four ADAMTSs may have significant roles in the tumorigenesis and nodal spread of pancreas adenocarcinoma.

The Role of Doctors and Patients in Appendicitis Perforation.

In this study, we aimed to determine factors that cause appendix perforations and to identify the role of physicians and patients in contributing to the cause of these perforations. This study was conducted between April 2010 and May 2015 and included 64 patients with perforated appendicitis. Patients' medical records were examined for factors that might have contributed to perforation, and the roles of patients and physicians in perforation appendicitis were evaluated. The perforation rate of patients with appendicitis was 16.0 per cent. The average duration from symptom onset to hospital admission was 4.4 days (29 patients were admitted to hospital within two days, 35 were admitted later). In total, 38 patients had visited a different hospital before admission. Furthermore, six out of 26 patients who had not visited any other hospital had consumed analgesics. Factors contributing to appendix perforation included misdiagnosis at the patient's initial visit (56.0%), delayed admission to hospital (11.0%), and use of analgesics (9.0%). The cause of perforation was mostly physician-related in children and adults, and patient-related in older adults.

Breast tuberculosis.

Tuberculosis is the most widespread and persistent human infection in the world. Tuberculosis of the breast is an uncommon disease with an incidence range between 0.1-3%, for all the breast diseases treated surgically. We present a case with primary breast tuberculosis. The diagnosis was made based on result of pathological examination of incision biopsy and cure had been obtained with anti-tuberculosis therapy with 4 drugs. Especially for patients from the areas where tuberculosis is endemic, tuberculosis must be considered in differential diagnosis of breast lesions.

Male Breast Cancer.

Male breast cancer (MBC) is a rare disease, accounting for less than 1% of all breast cancer diagnoses worldwide. Although breast carcinomas share certain characteristics in both genders, there are notable differences. Most studies on men with breast cancer are very small. Thus, most data on male breast cancer are derived from studies on females. However, when a number of these small studies are grouped together, we can learn more from them. This review emphasizes the incidence, etiology, clinical features, diagnosis, treatment, pathology, survival, and prognostic factors related to MBC.

Intraperitoneal hyperthermic perfusion may induce bacterial translocation.

BACKGROUND/AIMS: Intraperitoneal hyperthermic perfusion (IPHP) has been used widely in oncologic practice. Hyperthermia is known to decrease the interstitial pressure. Also intraperitoneal hyperthermia may alter the intestinal mucosal barrier and the intestinal bacterial flora. These changes may lead to bacterial translocation (BT). To the best of our knowledge, there is no data about the possible role of IPHP on BT. METHODOLOGY: Fifty-one rats were divided into two groups. Group I (n=36) received IPHP by heated isotonic salt solution at a temperature of of 43.0 degrees C and group II (n=15) received intraperitoneal normothermic lavage by isotonic salt solution at 37.0 degrees C. Each group was divided into three subgroups which were sacrificed at 1st (Ia, IIa), 3rd (Ib, IIb) and 7th (Ic, IIc) days. Mesenteric lymph nodes (MLN), spleen and liver were sampled and cecal aspirates were obtained. The presence of viable bacteria in samples was noted. Cecal bacterial population levels (CBPL) were reported as colony forming units (CFU). Groups were compared in terms of BT and CBPL. RESULTS: BT was not detected in the Ia (IPHP, 1st day) and IIa,b,c (all control groups). However, statistically significant BT was observed in group Ib and Ic (83.3% and 66.6%, respectively) in comparison to control group (p<0.01). Also there was positive correlation between CBPL and BT. CONCLUSIONS: Intraperitoneal hyperthermia causes remarkable BT. This may explain septic complications after IPHP. Further studies are necessary to better understand the effects of IPHP on the pathophysiology of BT.

Incidentally found retroperitoneal ganglioneuroma in an adult.

The ganglioneuroma is a very rare tumor arising from sympathetic nerve system. An asymptomatic retroperitoneal ganglioneuroma was found incidentally in a 35-year-old woman. Ultrasonography, computed tomography, and magnetic resonance imaging showed a retroperitoneal mass extending to the left adrenal gland, and surrounding abdominal aorta, celiac axis, left renal and adrenal arteries, and veins. The tumor was resected and histologic examination showed ganglioneuroma.

A simplified laparoscopic technique for enteral access in cancer patients.

BACKGROUND/AIMS: A feeding jejunostomy may be required for cancer patients who have obstructed upper gastrointestinal tract. Numerous minimally invasive techniques have been described for laparoscopic enteral access. We presented here a simple technique for laparoscopic jejunostomy that requires only two ports and no specialized tools. METHODOLOGY: Seven patients with laryngeal and foregut tumors underwent laparoscopic feeding jejunostomy. Briefly, umbilical port houses the camera and a second port placed at the proposed jejunostomy site are used to identify the appropriate segment of jejunum and exteriorize through the port opening. After jejunostomy a catheter is placed in the usual fashion, intestine segment is returned to the abdomen, then the jejunostomy site is secured to fascia edges by several non-absorbable sutures. Operative time and postoperative complications were evaluated. RESULTS: All patients tolerated the procedure well. Average operative time was 35 min. The only complication seen after the procedure was minor skin extrusion in two patients. CONCLUSIONS: This technique appears as a minimally invasive, safe, quick and easily applicable method for enteral access in selected patients.

Effects of the histamine H2 receptor antagonist famotidine on the healing of colonic anastomosis in rats.

BACKGROUND: Failure of anastomotic healing is one of the major complications in colorectal surgery. Because histamine plays an important role in immune and inflammatory reactions, we demonstrate the effects of famotidine on the healing of colonic anastomosis in rats. METHODS: Twenty-eight Sprague-Dawley rats were used in the study. Excision and end-to-end anastomosis was performed in the distal colon of the rat. The Famotidine Group received 2 mg/kg/day famotidine; the Control Group received the same amount of saline. Bursting pressure of anastomoses and hydroxyproline content of perianastomotic tissues were evaluated on the third and seventh days following surgery. RESULTS: Bursting pressures and hydroxyproline contents for the Famotidine Group were significantly lower than the equivalent parameters for the Control Group on both the third and seventh days post-surgery. CONCLUSIONS: According to our findings, famotidine exerts detrimental effects on the anastomotic bursting pressure and hydroxyproline content of perianastomotic tissues in the colon of rats.

Effects of the histamine H2 receptor antagonist famotidine on the healing of colonic anastomosis in rats

BACKGROUND: Failure of anastomotic healing is one of the major complications in colorectal surgery. Because histamine plays an important role in immune and inflammatory reactions, we demonstrate the effects of famotidine on the healing of colonic anastomosis in rats. METHODS: Twenty-eight Sprague-Dawley rats were used in the study. Excision and end-to-end anastomosis was performed in the distal colon of the rat. The Famotidine Group received 2 mg/kg/day famotidine; the Control Group received the same amount of saline. Bursting pressure of anastomoses and hydroxyproline content of perianastomotic tissues were evaluated on the third and seventh days following surgery. RESULTS: Bursting pressures and hydroxyproline contents for the Famotidine Group were significantly lower than the equivalent parameters for the Control Group on both the third and seventh days post-surgery. CONCLUSIONS: According to our findings, famotidine exerts detrimental effects on the anastomotic bursting pressure and hydroxyproline content of perianastomotic tissues in the colon of rats.