Gastric volvulus as a deadly cause of acute abdominal pain: Presentation of three cases.

Gastric volvulus is usually associated with non-specific abdominal pain and is a very rare condition. Diagnosis of gastric volvulus is difficult because of the lack of specific findings. Its acute form usually requires urgent surgical treatment and is associated with high mortality. In this study, gastric volvulus was diagnosed in three patients who presented with abdominal pain in the emergency department and had non-specific abdominal findings on physi- cal examination. We evaluated this situation, which is rarely seen, on different patients.

Is Youtube a potential training source for total extraperitoneal laparoscopic inguinal hernia repair?

BACKGROUND: The aim of this study is to evaluate the quality of the most commonly viewed total extraperitoneal laparoscopic inguinal hernia repair (TEP) videos on Youtube, which is the largest social and medical media broadcasting service, concerning educational purposes. METHOD: A search with the keyword "total extraperitoneal laparoscopic inguinal hernia repair" was performed on Youtube. The first 120 videos among the search results were downloaded and 55 of them were included in the study. A scoring system developed by the authors according to the recent literature was utilized for evaluation of the videos. Video demographics were evaluated for the quality and upload source. RESULTS: Among the enrolled videos, video quality was rated as good in 13 (23.6%), as moderate in 22 (40%), and as poor in 20 (36.4%). Video length, presence of narration, number of likes, and comments were significantly higher in the good group. Upload source was an academic center in 14 (25.5%), a community hospital in 22 (40.0%), and a physician in 19 (34.5%). The mean video score of the academic center group (8 ± 4.095) and community hospital group (8.64 ± 3.259) was significantly higher than the physician group (5.47 ± 2.632) (p = 0.010). Video quality was not correlated with total views or views per day. CONCLUSION: Total extraperitoneal laparoscopic inguinal hernia repair procedure videos uploaded to Youtube demonstrate considerable heterogeneity in terms of educational quality and the number of good quality videos is significantly low. This heterogeneity is attributed to the lack of peer review process for the evaluation of educational quality of the videos. Therefore, a physician intending to learn and practice a surgical procedure properly (TEP repair in this situation) should not consider a broadcasting service without a peer review process as a reliable training source.

Effect of LigaSure™, Monopolar Cautery, and Bipolar Cautery on Surgical Margins in Breast-Conserving Surgery.

BACKGROUND: We compared the differences in thermal damage at the surgical margin between monopolar cautery, bipolar cautery, and LigaSure™ in breast cancer lumpectomy specimens and assessed the effect of these techniques on the evaluation of the surgical margins. METHODS: 30 patients scheduled for breast-conserving surgery for breast cancer were included in this study. During lumpectomy, each of the superior, inferior, lateral, and medial borders of the tumour was excised using one of the following: a scalpel, monopolar cautery, bipolar cautery, and LigaSure technology. The surgical margins of frozen and paraffin-embedded tissue sections of the lumpectomy specimen were evaluated. Thermal damage was defined as the maximum depth of thermal damage (in mm) from the surgical margin, and the level was categorized as none, low (≤1 mm), or high (>1 mm). RESULTS: There was no statistically significant difference between monopolar cautery, bipolar cautery, and LigaSure in terms of thermal damage. There was no thermal damage at the surgical margin in tissues dissected by scalpel. CONCLUSION: Thermal damage due to the excision method may cause false-negative and false-positive results in the surgical margin evaluation of lumpectomy specimens. More research is needed on the effects of different energy modalities on surgical margin evaluation in breast-conserving surgery.

Gastric cancer with adenocarcinoma and yolk sac tumor components: A rare entity.

Despite a sharp worldwide decline in the incidence and mortality due to gastric cancer during the second half of the 20th century, gastric cancer remains the world's second leading cause of cancer-related deaths. Variants of gastric cancer account for approximately 5% of all stomach carcinomas. Herein, we report on a rare case of combined germ cell tumor and adenocarcinoma that arose in the stomach of a 68-year-old woman with a high level of alpha-fetoprotein in the serum. Clinical and pathological findings are presented.

Prognostic efficacy of inflammation-based markers in patients with curative colorectal cancer resection.

AIM: To evaluate the prognostic significance of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and prognostic nutritional index (PNI) and other clinicopathological factors in patients undergoing curative resection of colon cancer. METHODS: 183 patients with histologically proven colorectal cancer who had undergone potentially curative resection between 2010 and 2016 at Ankara Numune Training and Research Hospital were retrospectively analyzed and clinicopathological characteristics included age, sex, tumor type, grade, size and localization, the number of metastatic and total number of lymph nodes removed, vascular and perineural invasion of the tumor, TNM stages, tumor marker levels (CEA, CA19-9, AFP, CA-125, CA15-3), complete blood counts, albumin levels, overall survival (months), NLR, PLR, LMR and PNI ratios were retrospectively reviewed and analyzed from the electronic database. The primary outcome measure was overall survival. RESULTS: Regarding overall survival, on univariate analysis the following variables were significantly associated with poor outcome following resection: T-stage (P = 0.037), lymph node invasion (P = 0.037), cancer stage (P = 0.034), CEA (P = 0.042), CA19-9 (P = 0.004), and PNI (P = 0.001). To evaluate the independent prognostic value, multivariate Cox proportional hazard analysis to control for other prognostic factors was used. Using cancer-specific death as an end point for NLR, PLR, LMR, PNI and CA19-9 the optimal cut off values were calculated by ROC analysis. Regarding overall survival, on multivariate analysis high CA19-9 (HR = 1.001, 95%CI: 1.00-1.002, P = 0.012) and low PNI (HR = 0.938, 95%CI: 0.891-0.987, P = 0.014) were the only variables independently associated with shortened overall survival. Patients with a PNI < 35 had a median OS of 52.25 mo. In contrast, patients with an PNI > 35 had a median OS of 66 mo. Patients with a CA 19-9 < 17 had a median OS of 66 mo and in patients with a CA19-9 > 17 had a median OS of 53.76 mo. CONCLUSION: This study shows that decrease in the PNI and increase in CA 19-9 is associated with poor survival in patients with resectable colon cancer.

External Jugular Vein Thrombosis as a Sign of Metastatic Breast Cancer.

External jugular vein thrombosis is a rare vascular event which may lead fatal complication such as sepsis and pulmonary embolism. Its relation to the visceral solid tumor as an etiologic factor has been established well. Although external jugular vein thrombosis may be seen in malignancy, it is unusual to see as a sign of breast cancer. Most of the external jugular vein thrombosis occurs secondary to compression of the vein. Vascular thrombosis due to hypercoagulability is known as Trousseau syndrome. Herein, we present a case of metastatic breast cancer which presented with external jugular vein thrombosis; Trousseau syndrome.

Laparoscopic Nissen fundoplication with mesh-hiatoplasty: Single center experience and early-term results.

PURPOSE: In this study we report early-term results of laparoscopic Nissen fundoplication with mesh hiatoplasty that we perform to treat gastroesophageal reflux disease. METHODS: We retrospectively reviewed the medical records of 68 patients who underwent laparoscopic Nissen fundoplication with mesh hiatoplasty at our clinic. Thirty-six (53%) patients were male and 32 (47%) were female. The mean age of the study population was 46.1 (25-72) years. All patients underwent endoscopy, esophagus pH metry and manometry before the operation. All operations were performed under general anesthesia using five ports. In addition to Nissen fundoplication, all patients also underwent polypropylene mesh placement. RESULTS: Preoperatively, all patients reported a burning sensation in the chest and regurgitation of the stomach contents up into the mouth. The mean time from symptom onset to operation was 28 (6-84) months. All patients were diagnosed with  esophagitis in the preoperative endoscopic examination. The mean operative time was 80 (40-125) minutes, the median duration of hospital stay was 1.2 (1-4) days and the median follow-up time was 12 (2-30) months. Functional outcome was excellent in 65% of patients, good in 24.5%, moderately good in 7% and poor in 3.5%. CONCLUSION: Fundoplication with mesh hiatoplasty is a surgical procedure performed for the traetment of gastroesophageal reflux disease and hiatal hernia. Surgery can be safely carried out with low morbidity and mortality rates and constitutes an alternative to long-term drug therapy. We believe that this operation is beneficial since it reduces the rate of recurrences to a significant degree.

Acute Appendicitis in Pregnant Women: Our Clinical Experience.

PURPOSE: The purpose of this study was to analyse 13 patients who were treated in our clinic due to acute appendicitis during pregnancy. METHODS: Records of the patients who received appendectomy with appendicitis diagnosis in our Turgut Özal University Research and Application Hospital between January 2007 and December 2015 have been analyzed retrospectively. RESULTS: Appendectomies were performed on 13 pregnant patients with an acute appendicitis diagnosis. Average age of the patients was 27.69 years (between 22-37 years). Most frequent complaint of the patients was abdominal pain and most frequent examination finding was tenderness at right lower quadrant. Ultrasonography was used in all cases for diagnosis. Surgery was decided with clinical diagnosis for five cases (38.5%) where appendix had not been identified with ultrasonography. While laparoscopic appendectomy was applied in one case (7.7%) and open appendectomy was applied using a McBurney incision in 12 cases (92.3%). Average hospitalization duration was 1.69 days. All patients were tracked together through the Gynaecology Department for two weeks after they had been discharged from the hospital. Preterm delivery, maternal and fetal loss did not occur. CONCLUSION: It is considered appropriate to apply ultrasonography routinely to all pregnant patients in whom acute appendicitis is suspected. Concern for maternal or fetal complication that may occur in consequence of an unnecessary surgery should not be at a level that will delay surgical treatment needed by the patient.

Is there a link between upper gastrointestinal polyps and colonic polyps? A retrospective study from a Turkish cohort / Existe conexão entre pólipos gastrointestinais proximais e pólipos colônicos? Estudo retrospectivo de uma coorte turca

OBJECTIVE: To investigate the incidence and associated demographical and clinical factors related to lower GI polyps and neoplasms in patients with upper GI polyps and neoplasms. METHODS: We investigated 99 patients who had upper GI polyps and neoplasms and who were screened with colonoscopy: the following data were collected: demographical and clinical data consisting of age, sex, smoking status, presence of H. pylori infection, placement of upper GI polyps or neoplasms, presence of gastric atrophy, usage of proton pump inhibitors (PPI), presence of lower GI polyp or neoplasm, type of colon polyp, pathological grade of colon polyp. The patients were grouped according to having/not having lower GI polyps and neoplasms; data was compared between groups. RESULTS: Smoking rate was significantly higher in patients with lower GI polyps and neoplasms (χ2: 4.35, p: 0.03). Furthermore, there was a signifant association between presence of lower GI polyps and neoplasms vs. smoking (OR: 2.44 CI: 1.01-5.84, p: 0.04). CONCLUSIONS: Patients with upper GI polyps and neoplasms who are smokers should be considered as candidates for having lower GI polyps and neoplasms and should be screened and followed more carefully. Additionally, we believe that large sampled and prospective studies are needed to higligt the association between upper GI polyps and presence of lower GI polyps and neoplasms.

OBJETIVO: investigar a incidência, demografia associada e fatores clínicos relativos a pólipos e neoplasias gastrointestinais distais em pacientes com pólipos e neoplasias do trato gastrointestinal superior. MÉTODOS: Foram investigados 99 pacientes que apresentaram pólipos ou neoplasias gastrointestinais superiores selecionados através de colonoscopia: os seguintes dados foram coletados: dados demográficos e clínicos consistentes em idade, sexo, tabagismo, presença de infecção por H. pylori, a presença de pólipos ou neoplasias gastrointestinais proximais, presença de atrofia gástrica, uso de inibidores da bomba de prótons (IBP), presença de pólipo ou neoplasia gastrointestinal distal, tipo de pólipo de cólon, grau patológico de pólipo de cólon. Os pacientes foram agrupados de acordo com ter/não ter pólipos ou neoplasias distais; os dados foram comparados entre os grupos. RESULTADOS: A taxa de tabagismo foi significativamente maior nos pacientes com pólipos e neoplasias distais (χ2: 4.35, p: 0,03). Além disso houve uma associação significante entre a presença de pólipos e neoplasias distais e tabagismo (OR: 2,44 CI: 1,01-5,84, p: 0,04). CONCLUSÕES: Os pacientes fumantes com pólipos e neoplasias do trato gastrointestinal superior devem ser considerados candidatos a pólipos e neoplasias distais e devem ser rastreados e seguidos com mais cuidado. Adicionalmente, grandes amostras e estudos prospectivos são necessários para esclarecer a associação entre pólipos gastrointestinais superiores e a presença de pólipos e neoplasias gastrointestinais distais.

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.

Docetaxel-induced Scleroderma in A Breast Cancer Patient: A Case Report.

Paclitaxel and docetaxel are antineoplastic drugs derived from the yew tree, Taxus brevifolia. They are the members of the taxane family and act by inhibiting mitotic activity due to the suppression of microtubule depolymerization. They are used in the treatment of ovarian cancer, breast cancer, gastric cancer, small cell lung cancer, and head and neck cancer. In addition to side effects such as cardiotoxicity, neutropenia, arthralgia, and myalgia, they may also cause alopecia, urticaria, mucositis, acral erythema, pustular dermatitis, erythema multiforme, and scleroderma-like mucocutaneous lesions. Scleroderma is among the uncommon side effects of taxane antineoplastic agents. As was the case in few cases in literature, it usually begins with edematous changes in the proximal aspect of the extremities, and subsequently, sclerosis is developed in the skin. Scleroderma, which usually regresses with the discontinuation of the drug and with steroid therapy, may lead to severe contractions that require physical therapy and rehabilitation in some patients. In this paper, we presented a 60-year-old female patient in whom scleroderma developed because docetaxel chemotherapy for breast cancer because it is encountered rarely.