Hydatid cyst of the thyroid gland: report of three cases.

Cystic Echinococcosis is a parasitic infestation that is distributed world-wide. It may be found in nearly any part of the body, most often in the liver and the lungs, but occasionally in other structures such as the thyroid gland. The present study reports three cases of hydatid cysts of the thyroid gland, in patient ranging from 18 to 25 years of age. Two patients had concomitant hydatid disease involving organs other than the thyroid gland (secondary disease), and one had, sole, involvement of the thyroid gland itself (primary disease). Moreover, an occult papillary thyroid carcinoma was detected incidentally in one case, involving the unilateral thyroid lobe as the hydatid cyst. While several surgical procedures including left lobectomy and isthmectomy were undertaken in one patient, two patients underwent total thyroidectomy. No disease recurrence was observed in any of the three patients during the postoperative follow-up period. No study reporting the concomitance of hydatid cyst and neoplasia of the thyroid gland has been previously published. This concomitance indicates the importance of the differential diagnosis of lesions characterized by calcifications in the thyroid gland, especially in endemic regions.

Acute acalculous cholecystitis induced by aortic dissection: report of a case.

Acute acalculous cholecystitis (AAC), inflammation of the gallbladder without evidence of calculi, comprises approximately 10% of all cases of acute cholecystitis. Although the mechanism of AAC has not yet been sufficiently clarified, the most commonly postulated theories regarding its pathogenesis are bile stasis, sepsis and ischemia. We present a case of AAC associated with ischemia of the gallbladder caused by aortic dissection Bakey type III.

Melatonin prevents cyclosporine-induced hepatotoxicity in rats.

OBJECTIVES: Cyclosporine A (CsA) is a widely used immunosuppressive agent that is implicated in the formation of free oxygen radicals. Melatonin is known to be a free radical scavenger and an antioxidant agent. This study was designed to investigate the effects of melatonin on CsA-induced liver damage by histopathological examination. MATERIALS AND METHODS: Thirty-two male rats of Sprague-Dawley origin were divided into 4 groups of 8 and treated for 28 days as follows: group 1 received daily doses of 0.1 ml/kg olive oil s.c.; group 2 received 4 mg/kg of melatonin; group 3 received 10 mg/kg CsA diluted in 0.1 ml/kg olive oil; group 4 was treated with 4 mg/kg melatonin i.p. and 10 mg/kg CsA s.c. Finally, the rats were sacrificed by terminal anesthesia, and liver tissue specimens were processed for light microscopy, stained with HE and examined under a light microscope. RESULTS: Specimens of the control group showed normal liver histology, whereas group 3 showed major histopathological changes, such as cytoplasmic vacuolization, dilatation of the sinusoids, apoptosis and many mitotic figures. In group 4, the normal histology of the liver was preserved, although apoptosis, mitotic figures and cytoplasmic vacuolization were still infrequently observed. Nevertheless, there were significant differences between group 2 (melatonin) and group 3 (CsA) and between group 3 (CsA) and group 4 (CsA + melatonin) concerning these 3 parameters (vacuolization, sinusoidal dilatation and apoptosis). CONCLUSION: The results of this study suggest that CsA-related liver toxicity in rats could be significantly reduced by melatonin administration.

[A case of alveolar echinococcosis in Malatya province]. / Malatya'da Alveolar Echinococcosis Olgusu.

The disease resulting from being infected with the larval stage of Echinococcus multilocularis is called alveolar echinococcosis (AE). In our country AE is seen in eastern and southeastern regions of Anatolia. Previously no case of AE had been reported by any hospital in Malatya. In this one case, a 70 year-old woman who presented at the Inönü University Turgut Ozal Medical Center with a right upper quadrant abdominal pain was given a diagnosis of cystic echinococcosis (CE) by dynamic liver computed tomography. The pathological examination following the cystectomy revealed the presence of AE. This is a report of the first AE case detected in Malatya province.

Oral L-arginine protects against cyclosporine-induced hepatotoxicity in rats.

Cyclosporine A (CyA) leads to liver injury, probably by causing the production of free radicals and resulting in nitric oxide (NO) deficiency. We evaluated CyA-mediated liver damage histopathologically to determine the possible beneficial effects of L-arginine (L-Arg). In this study, 7 groups of Sprague-Dawley rats; (1) Control group; (2) 0.9% NaCl group; (3) CyA group: 7.5mg/kg/day; (4) L-Arg group: 2g/lt/day; (5) l-NAME (N-nitro-L-arginine methyl ester) group: 5mg/100ml/day; (6) CyA+L-Arg group: L-Arg (2g/lt/day)+CyA (7.5mg/kg/day); and (7) CyA+L-NAME group: CyA (7.5mg/kg/day)+L-NAME (5mg/100ml/day) were included. At the end of the treatments, animals were killed and hepatic tissues were treated for morphological (hematoxylin and eosin) and biochemical (NO and malondialdehyde, MDA) analyses, and serum was processed for biochemical (alanine transaminase (ALT), aspartate transaminase (AST), bilirubin, alkaline phosphatase (ALP) and total protein) study. The results indicated that CyA-induced hepatotoxicity was characterized by sinusoidal dilatation, hepatocellular vacuolization, neutrophilic infiltration and hepatocellular necrosis. These findings were less pronounced in the CyA+L-Arg group than CyA alone group. L-NAME group showed moderate changes. The CyA+L-NAME (Group 7) had more severe changes. We found changes in tissue NO and MDA levels. We think that the tissue damage caused by CyA is mild and reversible at the period when biochemical parameters are just starting to become abnormal and that L-Arg may have a protective effect against CyA damage on liver.

Kaposi's sarcoma after liver transplantation from a donor with a history of ventriculoperitoneal shunt and craniotomy for primary central nervous system lymphoma: report of a case.

The transplantation of organs from donors who have undergone shunt surgery or craniotomy for a malignant central nervous system (CNS) tumor is controversial. We report a case of Kaposi's sarcoma (KS) developing as a result of immunosuppression in the recipient of a liver transplant from a donor who underwent craniotomy and ventriculoperitoneal shunt surgery for primary CNS lymphoma. Polymerase chain reaction assay did not isolate human herpes virus-8 in the Kaposi lesions. To our knowledge, this is the only case ever reported of KS developing after liver transplantation from a donor with lymphoma. Thus, with appropriate screening to exclude possible dissemination, patients with a history of high-grade primary CNS lymphoma treated by ventriculoperitoneal shunt and craniotomy may be accepted as donors.

Appendiceal Enterobius vermicularis infestation in adults.

The objective of this study is to evaluate the incidence of Enterobius vermicularis in the appendices of the adult population and a possible relationship between E. vermicularis and acute appendicitis. E. vermicularis was identified in 18 (2%) of 890 patients. Six hundred sixty-five operations were performed for presumptive diagnosis of acute appendicitis, and E. vermicularis was found in 12 (2%) patients. The histopathological examination revealed acute inflammatory cells in four cases (33%). Three of these four specimens included luminal ova and one E. vermicularis. Histopathological examination of six cases revealed E. vermicularis in 225 incidental appendectomies with no evidence of either acute or chronic inflammatory cells. This study suggests a relationship between the presence of E. vermicularis ova and acute inflammation, but the presence of the pinworm in the lumen of the appendix is coincidental. On the other hand E. vermicularis in the appendix lumen can cause symptoms of acute appendicitis.

Primary mucosa-associated lymphoid tissue lymphoma of hypopharynx.

Mucosa-associated lymphoid tissue lymphomas are low-grade B-cell lymphomas that arise from a number of extranodal sites, including both nonmucosal and mucosal organs such as the hypopharynx. We reported a patient with a primary hypopharynx mucosa-associated lymphoid tissue lymphoma presenting with a swallowing dysfunction and severe throat pain. The clinical, radiologic, and histopathologic findings are presented. The patient was followed up for 5 years and treated with nonspecific antibiotics, chemotherapy, and radiation therapy. Because of prevertebral fascia invasion at the initial presentation, surgical treatment was not preferred. The last biopsies of the hypopharynx revealed no evidence of lymphoid infiltrate. Mucosa-associated lymphoid tissue lymphoma involving the hypopharynx is rare and there is no consensus on its treatment. The treatment protocol is presented and the relevant literature is reviewed.

Abdominal compartment syndrome due to distended rectal stump.

Abdominal compartment syndrome is a serious and life-threatening condition that requires early recognition and urgent decompressive laparotomy. This case report describes an abdominal compartment syndrome due to a distended rectal stump. The patient had a previous sigmoid resection with colostomy performed for sigmoid volvulus. As far as we know, this is the first report of abdominal compartment syndrome due to rectal stump. In such cases, high index of suspicion and early intervention affect the clinical course.

A life-saving but inadequately discussed procedure: tube duodenostomy. Known and unknown aspects.

OBJECTIVE: The most successful method of managing the difficult duodenum, including the stump leakage, has been the tube duodenostomy technique, but it has not gained wide acceptance and is rarely used. The purpose of this study is to describe the details of the procedure for indication, technical approach, and postoperative care. METHODS: During the period from 1998 to 2006, a tube duodenostomy was performed in 31 patients for possible insecure duodenal stump closure during gastric resection, postoperative duodenal stump leakage, duodenal leak after primary closure of duodenum for perforation or injury, or anostomotic leak after choledochoduodenostomy. All of the tube duodenostomies were performed through the open end of the duodenum. We also inserted a T-tube into the common bile duct in 19 of 31 patients (61.2 %) with tube duodenostomy. RESULTS: A tube duodenostomy was performed in the primary operation in 15 of 31 patients. None of those 15 patients required a second operation, and there were no leaks and no deaths. Among the larger group (31 patients), there was one (3.2 %) duodenal stump leak after tube duodenostomy, and it ceased spontaneously; one patient had a subhepatic collection after removal of the duodenostomy tube, and three patients had associated incisional infections. Two patients died; one after a myocardial infarction and the other from irreversible sepsis. The mean length of hospital stay was 26.9 days. CONCLUSIONS: We conclude that tube duodenostomy is a simple, effective, and safe method to prevent rupture of an insecure duodenal stump or to treat the leakage from the duodenal stump or primary repair on the duodenum.

Transabdominal approach in the surgical management of Morgagni hernia.

PURPOSE: Morgagni hernias are uncommon diaphragmatic hernias that are generally asymptomatic, and so far only limited data have been reported. The objective of this retrospective study was to evaluate the outcome of patients presenting with a complicated Morgagni hernia and who undergo a transabdominal repair. METHODS: Between September 1999 and October 2005, 11 patients with Morgagni hernia were operated on in our department. Eight of them had acute presentations because of a complicated Morgagni hernia. The patient demographics, presenting symptoms, operative approach, and complications were collected. The postoperative course was evaluated for morbidity and mortality. RESULTS: The patients' ages ranged from 42 to 85 years (mean 69.4). Two (18.2%) patients were male and nine (81.8%) patients were female. Chest roentgenograms, computed tomography, and contrast meal studies were used as diagnostic utilities. A transabdominal approach was used for all patients. One patient died due to pulmonary failure. The mean follow-up was 2.8 years. There was no recurrence or symptoms regarding the operation in the remaining patients. CONCLUSION: We recommend the transabdominal approach in patients with Morgagni hernia as it makes it easy to reduce the hernia contents and repair of the hernia sac. Moreover, when complicated with strangulation, incarceration or perforation, a surgical repair through a transabdominal approach is mandatory.

The effect of resveratrol on surgery-induced peritoneal adhesions in an experimental model.

Adhesion formation is a common cause of complications following surgery. The aim of this study was to investigate the effect of resveratrol on intra-abdominal adhesion prevention in a rat model. Twenty one Wistar-Albino rats weighing 200-250 g were assigned to three groups, of 7 rats each. After a midline laparotomy was performed, a 1 cm area of the ceacum was abraded in two of the groups. They were then given either resveratrol (Group 1), or saline (Group 2) intraperitoneally. Group 3 rats (sham operation) received no treatment, without the serosal damage. On the 14th day, the rats were killed and the adhesion score was determined according to Mazuji's adhesion grade scale. The tissue levels of malondialdehyde (MDA), nitric oxide (NO), and reduced glutathione (GSH) were measured. The mean Mazuji's adhesion grade in the resveratrol group was 1.0 +/- 0.0, in the saline group 2.57 +/- 1.51, and zero in the sham operated group (p < 0.05 between the resveratrol group and saline group comparison). The levels of MDA and NO in the resveratrol group were significantly lower than those of the saline group (p < 0.001). The level of GSH in the resveratrol group was significantly higher than in the saline and sham operated groups (p < 0.001 and p < 0.001, respectively). Introduction of resveratrol into the peritoneal cavity at the time of surgery reduced adhesion formation effectively in this model. Resveratrol probably acts through reduction of lipid peroxidation products.

Resveratrol, a red wine constituent polyphenol, protects gastric tissue against the oxidative stress in cholestatic rats.

This experimental study was designed to determine the effects of resveratrol on the level of malondialdehyde (MDA), reduced glutathione (GSH), and nitric oxide (NO) in gastric tissue after bile duct ligation (BDL). Swiss albino rats were divided into three groups: Group 1, sham (n = 7); Group 2, BDL (BDL only group; n = 7); and Group 3, BDL plus resveratrol (n = 7). Animals in the resveratrol group were treated with 10 mg/kg resveratrol (i.p.) once a day throughout 28 days. In the resveratrol group, levels of MDA and NO in gastric tissue were significantly lower than in the BDL-only group (P < 0.001). The level of GSH in the resveratrol group was significantly higher than in the BDL-only group (P < 0.001). The present study demonstrates that intraperitoneal administration of resveratrol maintains antioxidant defenses and reduces oxidative gastric damage. This effect of resveratrol may be useful to preserve gastric tissue under oxidative stress due to cholestasis.

Single or multiple perforations with varying locations as a complication of intestinal Behçet's disease: report of three cases.

Intestinal ulcers in Behçet's disease (BD) tend to cause perforation with significant morbidity. The optimal surgical procedure in such cases is controversial and the postoperative period can be eventful with an unpredictable course. We report three cases of perforations with varying locations in three patients with long-standing Behçet's disease. Two patients required two and one patient required four operations. It is emphasized that the clinician must be alert in a patient with BD when abdominal symptoms accompany the clinical picture. As soon as the diagnosis is reached, surgical intervention with limited resection must be performed. Endoscopic examination and careful medication play major roles in the follow-up.

Spontaneous small bowel perforations due to intestinal tuberculosis should not be repaired by simple closure.

Intestinal tuberculosis is a major problem in many regions of the world. The incidence of it is rising in Western countries due to immigration from Third World countries and human immunodeficiency virus infection. The difference between the simple closure and resection and anastomosis was evaluated in this study. Retrospectively, 12 patients with intestinal tuberculosis diagnosed histopathologically among 50 patients with free intestinal perforations operated on between 1995 and 2003 at Turgut Ozal Medical Center were evaluated. Each patient underwent routine laboratory tests and radiologic studies. The most common symptoms of patients were abdominal pain, night sweats, and weight loss. Sites of perforation were ileum in 10 patients (multiple perforation in 4) and jejunum in 2 patients (both had multiple perforations). The perforation was closed by primary closure in 7 patients. Resection-anastomosis was performed in 5 patients. Leaks occurred in overall 3 of 7 patients with primary closure. Three of the 7 patients with leaks due to septicemia died. The mortality rate among all patients was 25%. Intestinal tuberculosis should be kept in mind as a cause in free intestinal perforations. Because of high mortality rate, the resection of the affected area and anastomosis may be the treatment of choice rather than primary closure.