Cutaneous Bone Formation Associated With Melanocytic Nevus.

AIM: Cutaneous bone formation is an uncommon lesion of the skin. It may be primary or secondary. Secondary lesions are mostly associated with melanocytic nevi. Although many different theories have been proposed to explain the etiology, extraskeletal bone formation is complex and poorly understood phenomenon.Here the authors report a series of melanocytic nevi with cutaneous bone formation and the authors described morphologic and clinicopathologic features such as age, sex, location, focus number and size of the lesion. MATERIAL AND METHOD: Through a single center, this retrospective study presents total number of 20 patients with melanocytic nevus with or without osseous metaplasia. Histologic and clinicopathologic features such as age, sex, location, focus, and size of lesion were compared. RESULTS: Lesions were identified in 10 female patients. All of the cases were seen in the head and neck region such as face, forehead, eyebrow, lip, and neck and most of them were solitary. The nevi were usually associated with the single focus of ossification. Most of patients (50%) had acne symptoms and treatment anamnesis. Granulomatous dermal inflammation was seen in 2 patients. There was no difference in nevus morphology and the size of the nevi between the osteonevi and the other types of nevi. CONCLUSION: In conclusion, this study revealed that although it is rare it has distinctive features such as female patients, face location, and acne anamnesis. Therefore it may be speculated that the osteogenic factors may be involved with inflammatory-induced metaplastic ossification and tend to be related female sex.

The effect of pneumoperitoneum on the cross-sectional areas of internal jugular vein and subclavian vein in laparoscopic cholecystectomy operation.

BACKGROUND: Increased central venous pressure secondary to an increase in intraabdominal pressure has been reported during laparoscopic surgery. However, no study has yet determined the effect of pneumoperitoneum on cross-sectional area (CSA) of central veins by ultrasonography during laparoscopic cholecystectomy. Herein, we aimed to quantify changes in CSAs of internal jugular (IJV) and subclavian veins (SCV) by ultrasonography during this surgery. METHODS: This study included 60 ASA I-II patients scheduled for laparoscopic cholecystectomy surgery under general anesthesia. Pneumoperitoneum was performed with CO2 at 12 mmHg. The CSAs of right IJV and right SCV were measured using a 6 Mhz ultrasonography transducer in supine and neutral positions before anesthesia induction (T1), 5 min after connecting to mechanical ventilator (T2), 5 min after creation of pneumoperitoneum (T3), at the end of pneumoperitoneum (T4), and 5 min after desufflation and before extubation (T5) both at end-expiration and end-inspiration. RESULTS: The comparison of IJV CSA at inspiration showed significant increase in T3 value compared to T2 value (p < 0.001). Similarly the expiratory measurements of IJV CSA demonstrated significant increase in T3 value compared to T2 value (p < 0.001). The comparison of inspiratory CSA measurements of SCV showed significantly increased in T3 (p = 0.009) than T2 value. In expiratory measurements there was a significant increase in T3 (p = 0.032) value compared to T2. All measurements of IJV and SCV SCAs both end-inspiration and end-expiration T5 values significantly decreased compared to T4 values (p < 0.001). CONCLUSIONS: Pneumoperitoneum with an intraabdominal pressure of 12 mmHg produces significant increases in IJV and SCV CSAs during laparoscopic cholecystectomy procedure. We believe that this finding may enhance our understanding of pneumoperitoneum-induced hemodynamic changes and facilitate catheterization attempts. TRIAL REGISTRATION: Date of registration 21/07/2016, ISRCTN Registry ( No: ISRCTN15164056 , registered retrospectively).

Estimation of the capacity of emergency surgery in Konya: Nine-year multicenter study.

OBJECTIVE: Although the number of surgical emergencies continues to increase, comprehensive data on emergency surgical admissions are scarce. The aim of this multicenter study was to evaluate the causes, management, and outcomes of the general surgical emergencies in the city of Konya, Turkey. MATERIAL AND METHODS: The relevant details of the cases admitted and considered to be general surgical emergencies in Konya over a nine-year period (January 2003-January 2012) were analyzed. All demographic data were analyzed statistically. RESULTS: The study group comprised 21954 cases from 4 hospitals in Konya: 7154 from Konya Numune Hospital, 6,654 from Konya Education and Research Hospital, 6,400 from Necmettin Erbakan University Meram Medical Faculty, and 1,390 from Baskent University Konya Education and Research Hospital. Their mean age was 59.6 years, and the average hospitalization time was 3.3 days. The diagnoses of the admitted patients were as follows: acute appendicitis (59.57%), bowel obstruction (11.12%), trauma (7.97%), strangulated inguinal hernia (5.46%), acute cholecystitis (4.87%), peptic ulcer perforation (4.09%), mesenteric ischemia (2.73%), necrotizing fasciitis (2.73%), gastrointestinal system bleeding (1.79%), and others (1.1%). CONCLUSION: The findings of the study indicate a steady increase in surgical admissions to emergency units. Non-traumatic acute abdomen was the most common reason for general surgical emergencies. Although the number of elderly patients increased, the hospital stay and mortality rates decreased over the study period.

Bilateral breast necrosis due to local injection of fish oil.

The breast is as aesthetically important as it is physiologically. Physicians and women have practiced various methods for breast aesthetics and augmentation. We report a female veterinarian who injected fish oil into her breast, which led to inflammation and necrosis of breast tissue. When all medical therapies failed, bilateral subcutaneous mastectomy was performed. We did not find a case in the literature where fish oil had been used for breast augmentation. However, we did find that many agents have been injected for breast augmentation, the results of which were tragic, just as the case presented herein.

Comparison of Ultrasound-Guided Erector Spinae Plane Block and Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia after Laparoscopic Cholecystectomy: A Randomized, Controlled Trial.

PURPOSE: Laparoscopic cholecystectomy causes moderate to severe pain despite its minimally invasive nature. This study was performed to compare the efficacy of the bilateral erector spinae plane block (ESPB) and the subcostal transversus abdominis plane block (STAPB) under ultrasound guidance. METHODS: 64 patients were included in this prospective, randomized study. The patients were allocated into two groups as those receiving ESPB (n = 32) and those receiving STAPB (n = 32). Pain scores at rest and during movement, fentanyl requirement, postoperative walking time, and duration of hospital stay were compared. The complications which related to block were also recorded. RESULTS: In the ESPB group, the Numeric Rating Scale (NRS) scores at rest were lower at hour 0 [at the time of post-anesthetic care unit (PACU) admission] and postoperative hours 2, 4, 6, and 12 (p < 0.05). In the same group, the NRS scores at movement were lower at hours 0, 2, 4, 6, 12, and 24 (p < 0.05). In the ESPB group, the time to first analgesic need was longer (p < 0.05), intraoperative and postoperative Fentanyl requirement (p < 0.0001 for both) and PACU rescue analgesic requirement were lower (p < 0.05), the lengths of PACU and hospital stay were shorter (p < 0.0001), and unassisted walking time was shorter (p < 0.0001). There were no complications related to the block in either group. CONCLUSION: Bilateral ultrasound-guided ESPB provides superior analgesia after laparoscopic cholecystectomy surgery compared to STAPB and further reduces unaided walking time and hospital stay.

Neuroendocrine Tumour of the Gallbladder Diagnosed after Cholecystectomy.

Gallbladder cancer is a rare but aggressive malignancy. Neuroendocrine tumour of the gallbladder make up 2-3% of all the gallbladder tumour. A 67-year female patient underwent laparoscopic cholecystectomy because of symptomatic cholelithiasis and the histopathology revealed a neuroendocrine tumour of the gallbladder, stage pT2a. The patient's imaging study for metastasis workup were normal. A radical cholecystectomy procedure was planned as the tumour stage was pT2a. Postoperative chemotherapy and/or radiotherapy were recommended. The patient, who had comorbidities, was refused both surgery and other treatment alternatives. The patient's one-year clinical, laboratory, and radiological follow-up did not reveal any findings of recurrence or metastasis. There is no standardised staging system for neuroendocrine tumours of the gallbladder since the number of such cases is quite limited. Guidelines are also insufficient. Multi-centred and large studies are needed in order to develop standardisation in treatment, prognosis, and factors affecting survival. Key Words: Cholecystectomy, Neuroendocrine Tumour, Gallbladder.

Factors Affecting Recurrence of Idiopathic Granulomatous Mastitis.

OBJECTIVE: To investigate factors that may have an effect on recurrence by retrospectively analysing the data of patients who were followed up and treated for idiopathic granulomatous mastitis in this clinic. STUDY DESIGN: Analytic study. PLACE AND DURATION OF STUDY: Department of General Surgery, Faculty of Medicine, Baskent University, Konya and Adana Practice and Research Hospitals between January 2010 and January 2021. METHODOLOGY: The data of patients who were histopathologically diagnosed with granulomatous mastitis were retrospectively analysed. The patients included in the study were divided into two groups: Recurrence (Group 1) and non-recurrence (Group 2). Patients with underlying etiological factors that may cause granulomatous inflammation such as infection, trauma, tuberculosis, sarcoidosis, and autoimmune disease were excluded from the study. The effects of other parameters (involvement area, follow-up duration, the time from the onset of complaints to diagnosis, side of involvement, breastfeeding, oral contraceptive use, redness, ulceration and/or discharge, preoperative histopathological diagnosis, diagnosis by any of the preoperative imaging techniques, preferred treatment method) on recurrence, were statistically analysed. RESULTS: Furthermore, the analysis results showed no significant difference between the groups with and without recurrence with regard to any of the other variables such as follow-up period, size of the involvement area, presenting complaints, breast-feeding, preferred treatment alternative (steroid, steroid + surgery, surgery), and preferred surgical technique (p>0.05). The time from the onset of complaints to diagnosis was significantly longer in the recurrence group (p=0.001). In addition, the frequency of oral contraceptive use was statistically significantly higher in the recurrence group (Odds ratio=7.6, p=0.044). CONCLUSION: The results of this study suggest that early diagnosis could prevent recurrence in patients with idiopathic granulomatous mastitis. Prospective randomised controlled studies are needed to support this thought. Key Words: Idiopathic granulomatous mastitis, Malignancy, Oral contraceptive, Steroid.

A model for acute kidney injury in severe burn patients.

INTRODUCTION: In patients with severe burns, morbidity and mortality are high. One factor related to poor prognosis is acute kidney injury. According to the AKIN criteria, acute kidney injury has 3 stages based on urine output, serum creatinine level, and renal replacement therapy. In this study, we aimed to create a decision tree for estimating risk of acute kidney injury in patients with severe burn injuries. METHODS: We retrospectively evaluated 437 adult patients with ≥20% total burn surface area injury who were treated at the Baskent University Ankara and Konya Burn Centers from January 2000 to March 2020. Patients who had high-voltage burn and previous history of kidney disease were excluded. Patient demographics, medical history, mechanism of injury, presence of inhalation injury, depth of burn, laboratory values, presence of oliguria, need for renal replacement therapy, central venous pressure, and prognosis were evaluated. These data were used in a "decision tree method" to create the Baskent University model to estimate risk of acute kidney injury in severe burn patients. RESULTS: Our model provided an accuracy of 71.09% for risk estimation. Of 172 patients, 78 (45%) had different degrees of acute kidney injury, with 26 of these (15.1%) receiving renal replacement therapy. Our model showed that total burn surface area was the most important factor for estimation of acute kidney injury occurrence. Other important factors included serum creatinine value, burn injury severity score, hemoglobin value, neutrophil-to-lymphocyte ratio, and platelet count. CONCLUSION: The Baskent University model for acute kidney injury may be helpful to determine risk of acute kidney injury in burn patients. This determination would allow appropriate treatment to be given to high-risk patients in the early period, reducing the incidence of acute kidney injury.

Effectiveness of multiple neurectomies to prevent chronic groin pain after tension-free hernia repair.

The question of which nerve--the ilioinguinal or the iliohypogastric--most often causes chronic groin pain after hernia repair remains to be answered. We sought to evaluate the effects of prophylactic neurectomies on the incidence of persistent groin pain after Lichtenstein repair. Two hundred forty patients were randomized to 1 of 4 groups: the all-nerve preservation group, the ilioinguinal neurectomy group, the iliohypogastric neurectomy group, and the neurectomies group. During follow-up visits, pain was characterized through use of the McGill Pain Questionnaire and the visual analog scale, and quality of life was assessed with the Short Form 6 Dimension. Significant differences regarding chronic groin pain at 1 year were found between the preservation group and both neurectomies groups, in favor of the latter. No statistically significant differences in quality of life were noted in any of the groups. In conclusion, both nerves seem to be responsible for neuropathic postherniorrhaphy pain. Elective excision of the nerves can be done safely during tension-free hernia repair.

[A rare cause of left lower quadrant abdominal pain: acute appendicitis with situs inversus totalis]. / Karin sol alt kadran agrisinin nadir bir sebebi: Situs inversus totalisli hastada akut apandisit.

For the patient admitted with right lower quadrant abdominal pain, acute appendicitis is the most frequently considered diagnosis. Appendectomy is the most common of all emergency operations. However, there may be several reasons for left lower quadrant abdominal pain. Situs inversus totalis is an anomaly that occurs during embryonic development when intraabdominal and intrathoracic organs have reverse localization. In this case report, we present a patient who was admitted with left lower quadrant abdominal pain and was diagnosed as situs inversus totalis and acute appendicitis. In view of the legal repercussions for doctors as a result of erroneous diagnosis and treatment, we think that adequate evaluation of the studies in the emergency service is important and that the radiological investigations have to be used appropriately and sufficiently.

The Number of Patients Diagnosed with Brain Death and Organ Donation Rates at the Baskent University Konya Hospital: 6-Year Experience.

OBJECTIVES: Kidney transplant started at Baskent University Konya Hospital in July 2016. In this study, we compared the causes of brain death and the organ donation rates in our center between 2013 and 2016 versus between 2016 and 2019. MATERIALS AND METHODS: Patient files and records were analyzed retrospectively. Age, biologic sex, cause of brain death, and organ donation rates of patients diagnosed with brain death were examined and compared. RESULTS: The number of patients who were diagnosed with brain death and became deceased donors at our center increased 4-fold during the period from 2016 to 2019 compared with that shown from 2013 to 2016. In addition, organ donation rates increased to 71.4%, which is much higher than the average in Turkey (24%-28%). Between 2013 and 2016, trauma was the leading cause of brain death (42.8%), whereas between 2016 and 2019 cerebral hemorrhages rose to first place with a rate of 89.3%. In 2018 and 2019, there were 199 and 62 brain deaths, respectively, reported in our organ donation coordination region with an approximate organ donation rate of 25%. In our center, 12 patients were diagnosed with brain death in 2018 and 8 of these patients (66.7%) became donors; 6 brain deaths were diagnosed in 2019, and 4 patients (66.7%) became donors. Since we started kidney transplant at our center in 2016, the number of patients diagnosed with brain death has increased significantly. CONCLUSIONS: Establishing a healthy communication with relatives of patients and having a dedicated organ transplant center are important reasons for our much higher organ donation rates compared with the general rate in Turkey. A healthy communication is the most effective way to establish trust with next-of-kin and the general public.

Malignancy rates in operated patients with hyperthyroidism in an area of endemic goiter.

We aimed to evaluate the incidence of thyroid cancer in Turkish patients with hyperthyroidism who had undergone thyroid surgery. The data of 344 patients who had been operated on for hyperthyroidism between 1998 and 2006 at our center were evaluated retrospectively. Sixty-five of the subjects had single toxic adenomas, 223 had toxic multinodular goiter, and 56 had Graves' disease. In 35 of 344 patients (10.1%), papillary carcinoma was diagnosed. Other forms of thyroid carcinomas were not observed. The rate of carcinoma was found to be 11.6% in patients with toxic multinodular goiter, 7.7% in patients with single toxic adenomas, and 7.1% in patients with Graves' disease. Occult papillary carcinoma was found in 62.9% of all malignancy diagnoses. The primary aim in the surgical treatment of hyperthyroidism should be to abolish the hyperthyroid state. However, the probability of malignancy, especially occult carcinoma, should always be considered.

Effects of the application of intra-abdominal low pressure on laparoscopic cholecystectomy on acid-base equilibrium.

The objective of this study was to determine the effects of low-pressure intra-abdominal application on laparoscopic cholecystectomy on acid-base equilibrium. Thirty patients were included in this study. Group 1 patients had 8 mmHg intra-abdominal pressure and Group 2 had 12 mmHg intra-abdominal pressure when they were operated on. There were no significant differences between the groups in terms of their age, sex, body mass index, insufflation and operation time, and anesthesia duration. The acid-base equilibrium situations were similar. Short-term metabolic, respiratory, and mix-type acidosis was observed during the operation and becomes normal in the recovery room. Acidosis is more likely related to the absorption of CO2 in the peritoneum rather than to secondary changes caused by intra-abdominal pressure increases. No positive effects of the application of intra-abdominal low pressure on laparoscopic cholecystectomy on acid-base equilibrium were observed in our study.

Acute abdomen caused by primary torsion of the omentum in hydatid disease.

Hydatid disease is a considerable social health problem because of its endemic distribution in many countries. Although hydatid disease is usually seen in the liver or lung, it may present anywhere in the body. Here, we present a patient with a primary torsion of a hydatid cyst attached to the greater omentum with a peduncle that caused acute abdomen. This is the first report of a primary torsion of the omentum in hydatid disease. Clinicians are urged to be cognizant of the different and rare locations of hydatid disease, especially in endemic countries.

Effects of Single-Dose Preemptive Pregabalin and Intravenous Ibuprofen on Postoperative Opioid Consumption and Acute Pain after Laparoscopic Cholecystectomy.

PURPOSE: Non-opioid medications as a part of multimodal analgesia has been increasingly suggested in the management of acute post-surgical pain. The present study was planned to compare the efficacy of the combination of pregabalin plus iv ibuprofen. METHODS: 58 patients were included in this prospective, randomized, double-blinded study. The pregabalin group (Group P, n = 29) received 150 mg pregabalin, the pregabalin plus ibuprofen group (Gropu PI, n = 29) received 150 mg pregabalin and 400mg iv ibuprofen before surgery. Postoperative fentanyl consumption, additional analgesia requirements and PACU stay were recorded. Postoperative analgesia was performed with patient-controlled IV fentanyl. RESULTS: VAS scores in the group PI were statistically lower at PACU, 1and 2 hours at rest, at PACU, 1, 2, 4, 12 and 24 hours on movement compared to the group P (P < 0.05). Opioid consumption was statistically significantly higher in the group P compared to the group PI (130.17 ± 60.27 vs 78.45 ± 60.40 µq, respectively, P < 0.001) and reduced in the 4th 24 hours by 55% in group PI. Rescue analgesia usage was statistically significantly higher in the group P than in the group PI (16/29 vs 7/29, respectively, P < 0.001). Four patient in the group PI did not need any opioid drug. Besides, PACU stay was shorter in the group PI than the group P (10.62 ± 2.38 vs 15.59 ± 2.11 min, respectively, P < 0.001). CONCLUSION: Preemptive pregabalin plus iv ibuprofen in laparoscopic cholecystectomy reduced postoperative opioid consumption. This multimodal analgesic aproach generated lower pain scores in the postoperative period.

Alvarado scores and pain onset in relation to multislice CT findings in acute appendicitis.

PURPOSE: To determine the correlation between clinical and multislice computed tomography (MSCT) findings of early- and late-stage acute appendicitis. MATERIALS AND METHODS: The study was conducted between June 2003 and February 2006 with 143 patients. Patients were divided into 3 groups according to Alvarado scores: group 1 (n = 18; 13%; score: 1-4), group 2 (n = 70; 49%; score: 5-7), and group 3 (n = 55; 38%; score: 8-10). Abdominal MSCT results were compared to histopathological diagnoses. Patients were then divided into 2 other groups according to pain onset (MSCT performed within the first 12 h of pain onset and MSCT performed thereafter). RESULTS: Histopathological findings were normal in 13 of the 143 patients (9%). The positive predictive value of MSCT did not significantly differ between the 3 Alvarado groups (92.8% in group 1, 95.1% in group 2, and 98.0% in group 3). Additionally, the positive predictive value of MSCT did not differ whether the scans were performed within the first 12 h of pain onset or thereafter (88% and 89%, respectively; P = 0.89). CONCLUSION: MSCT should be performed even in patients in whom the clinical suspicion of appendicitis is low. MSCT is effective in patients with early-stage appendicitis.

The Rare Benign Lesion That Mimics a Malignant Tumor in Breast Parenchyma: Nodular Fasciitis of the Breast.

We herein report the clinical and pathological findings of a rare case of nodular fasciitis in the breast parenchyma of a 48-year-old female. Because of potentially malignant findings on ultrasonography and during clinical examination, the patient underwent an excisional biopsy. Histologically, the lesion was composed of spindle to round shaped cells arranged in short bundles in a storiform pattern. Immunohistochemically, the cells were positive for vimentin and SMA and negative for desmin, S100, and CD34. Based on these morphological and immunohistochemical features, a diagnosis of nodular fasciitis was made. We emphasize that nodular fasciitis of the breast may show clinical features and imaging findings similar to those of breast cancer. The histopathologic diagnosis of nodular fasciitis can also be challenging. The purpose of this case report is to highlight the characteristics and the differential diagnosis of this rare neoplasm.

Scalding in Turkish children: comparison of burns caused by hot water and hot milk.

INTRODUCTION: Our aim in this study was to compare the clinical differences and etiologic risk factors for hot water and hot milk scald burns in Turkish children. METHODS: The retrospective study examined the cases of 140 children aged 0.1-7 years who had scald burns treated in three burn units of a Turkish hospital network between March 2000 and December 2004. The patients were categorized in two groups: hot water burns or hot milk burns. RESULTS: Ninety-five (67.9%) patients had hot water burns and 45 (47.1%) had hot milk burns. The proportion of patients with hot milk burns who lived in rural areas was significantly higher than the corresponding proportion for the hot water cases (75.6% versus 52.6%, respectively; p<0.01). In 20 (44%) of the hot milk cases, the burn was caused by milk being boiled in large pots outdoors for cheese production. The other 25 hot milk cases were caused by milk being boiled in the kitchen. The mean (+/-S.D.) percentage total body surface area burned in the hot milk cases was higher than that in the hot water cases (33.6+/-2.24% versus 21.42+/-1.43%, respectively; p<0.001), and the corresponding mean percentages of TBSA with full-thickness burns were 9.2+/-2.52% versus 3.13+/-0.83%, respectively; (p=0.083). The mean percentages of TBSA with second-degree burns showed the same trend (29.0+/-12.39% versus 18.8+/-1.47%, respectively; p<0.001) higher percentage of the children with hot milk burns required antibiotics (78% versus 52.8%, respectively; p<0.006). Seven (7.4%) of the hot water burn patients and 15 (33.3%) of the hot milk burn patients died during the study period (p=0.025; overall mortality rate 15.7%). CONCLUSION: Children scalded with hot milk tend to have more extensive burns, and thus have higher mortality, than those scalded with hot water. To create effective programs for preventing scald injuries in Turkey and elsewhere, it is essential to consider ethnic and cultural issues based on these characteristics. Simple precautions should be explained and methods of using liquids such as hot milk should be researched in different geographic locations in order to formulate good prevention strategies.