Changes in olfactory function and olfactory bulb after treatment for acromegaly.

PURPOSE: This study aimed to investigate the olfactory functions of the acromegaly patients and to discuss the possible causes of olfactory dysfunction in acromegaly patients. METHODS: A case-control study was carried out in a tertiary referral center. 52 patients with acromegaly (Acromegaly group) and 52 healthy individuals (Control group) were included in the study. All acromegaly patients included in the study were in the late postoperative period. The Connecticut Chemosensory Clinical Research Center (CCCRC) test was carried out and olfactory bulb (OB) volumes were measured in both of the groups. RESULTS: There was a significant difference between the mean CCCRC total scores of the acromegaly and control groups (p = .000). The mean of right and left OB volumes in the acromegaly group was significantly higher than the control group (p = .004) CONCLUSION: In this study, we found that acromegaly patients are likely to experience olfactory dysfunction. It is important to examine these patients' olfactory functions at the time of diagnosis and clinic follow-up. CLINICAL TRIAL NUMBER: NCT04138537.

Clinical characteristics of appendiceal diverticular disease.

BACKGROUND: Appendiceal diverticular disease (ADD) is a rare pathology which is associated with an increased mortality risk due to rapid perforation and high rates of neoplasm. In our study, we aimed to evaluate the clinical and histopathological characteristics of ADD with differences from acute appendicitis (AA) diagnosis and to determine the association with neoformative processes. METHODS: The 4279 patients who underwent appendectomy were evaluated retrospectively. ADD patients histopathologically classified into four groups. Patients' demographic characteristics, imaging and preoperative laboratory findings, additionally postoperative histopathology results were compared between groups. RESULTS: The prevalence of ADD was 2.29% (n = 98). In addition, the male/female ratio was 2.37 in ADD patients who were found to be significantly older than those with AA patients. Type III was the most frequently (62.2%) identified sub-group of ADD. The incidence of neoplasms, plastrone, and Littre's hernia was found statistically higher in ADD group than AA group. Mucinous adenomas (10.2%) was the most common neoplasm while the carcinoid tumor (1%) and precancerous serrated adenomas (4.1%) were also reported. CONCLUSIONS: As a result, high neoplasm in ADD patients can be shown with incidence of perforation and plastron, and in order to avoid possible neoplasm or major complications, it is necessary to carry out new studies for the right diagnosis of ADD whether the diagnosis is done preoperatively or intraoperatively. We recommend surgical resection of the ADD, which may even be incidentally detected during any surgical procedure, due to its high risk of neoplasm and rapid perforation.

Incidental gallbladder cancers: Our clinical experience and review of the literature.

OBJECTIVE: Gallbladder carcinomas are rare and aggressive neoplasms. They are usually advanced at the time of diagnosis. We aimed to evaluate incidental gallbladder cancers in our clinic, in terms of patients' demographics, diagnosis, treatment and follow-up, and compared our results with the literature. MATERIAL AND METHODS: Patients who underwent laparoscopic cholecystectomy in the last 9 years were retrospectively reviewed, and features of the patients diagnosed with gallbladder cancer after histopathological evaluation were further evaluated. RESULTS: Thirteen patients were female and two were male. The mean age was 67 years. Additional treatment was applied in seven patients. All patients were operated on laparoscopically, with conversion to open surgery in four patients. The rate of incidental gallbladder cancer was 0.17% in our patients. Survival rates were found to be 22.2% in patients who had been operated at least 5 years ago. CONCLUSION: Surgery is the only curative treatment in gallbladder cancers; however, they are usually at advanced stages at the time of diagnosis. In incidental gallbladder cancers, survival can be prolonged with appropriate treatment models if they are identified at early stages. The relatively low rates that have been reported in our population may be due to geographical differences and problems in study design.

Endoscopic stent placement in the management of malignant colonic obstruction: Experiences from two centers.

OBJECTIVE: Intestinal obstruction due to colorectal tumors requires immediate surgical decompression. Endoscopic stent placement for acute malignant colonic obstruction is gaining widespread acceptance as an alternative to emergency surgery. Our aim in this study was to evaluate the success and complication rates of endoscopic stenting for malignant colonic obstruction. MATERIAL AND METHODS: Patients with acute malignant colonic obstruction who underwent endoscopic stenting between 2011-2014 were retrospectively reviewed. Data included demographic features, localization of obstruction, endoscopic stenting indications, rate of technical and clinical success, complications, morbidity and mortality. RESULTS: Endoscopic stent was successfully placed in 77 out of 82 procedures (93.9%). A colostomy was placed in five cases in which endoscopic stent could not be inserted. There were complications in seven patients with technically successful stents (9.0%). These included three stent migrations, one perforation, and rectal hemorrhage in three patients. There were no stent-related deaths. CONCLUSION: The mortality rate of emergency surgery for malignant bowel obstruction is relatively high. The use of colonic stents can avoid surgery in patients who are not suitable for emergency surgery and may allow adequate time for preoperative preparation, counseling and staging for those who are suitable for further intervention. We believe that self-expandable metallic stent placement is a safe, effective, and minimal invasive alternative treatment method for malignant colonic obstruction.

Isolated cecal necrosis: our surgical experience and a review of the literature.

OBJECTIVE: Isolated cecal necrosis is a rare cause of ischemic colitis. Ischemic colitis is further divided into two groups: occlusive mesenteric ischemia and non-occlusive mesenteric ischemia. The aim of this study was to investigate the cause of isolated cecal necrosis. MATERIAL AND METHODS: We operated on 3 male and 3 female patients with a mean age of 60.3±18.7 (38-85) years with a preliminary diagnosis of acute appendicitis between 2007 and 2012. Four of these patients were on hemodialysis, 1 patient had an aortofemoral bypass, and 1 patient had coronary artery disease with atrial fibrillation. RESULTS: The diagnosis was made intraoperatively in all cases. Five patients died postoperatively. One patient survived. CONCLUSION: In the case of right lower quadrant pain, the possibility of isolated cecal necrosis should be kept in mind, especially in patients on hemodialysis, elderly patients with diabetes, and heart disease; surgical strategies should be planned accordingly, and it should be understood that a high mortality rate will be inevitable.

Comparison of clinical outcomes of robotic-assisted and video-assisted esophagectomy for esophageal cancer.

INTRODUCTION: Robotic-assisted minimally invasive esophagectomy (RAMIE) is a recently developed technique for the treatment of resectable esophageal cancer. The present study compares the outcomes of RAMIE and video-assisted thoracoscopic esophagectomy (VATE). METHOD: Patients undergoing minimally invasive esophageal surgery between December 2020 and September 2022 were included in the study, while those undergoing conventional surgery were excluded. The patients were divided into two groups, as those undergoing RAMIE (Group 1) and those undergoing VATE (Group 2). The demographic and clinical characteristics, intraoperative parameters, pathological data, and postoperative parameters of the groups were compared. RESULTS: A total of 28 patients were included in the study, with 13 patients in Group 1 and 15 patients in Group 2. The gender distribution was similar (P = 0.488), and the mean age was 64.7 and 59.0 years in Groups 1 and 2, respectively (P = 0.068). The majority of the sample was in the ASA2 category (46.2% vs. 66.7%, P = 0.341); Ca19.9 levels were higher in Group 1 than in Group 2 (25.7 vs. 13.7, P = 0.027); preoperative Hb was lower in Group 1 than in Group 2 (10.9 g/dL vs. 12.2 g/dL, P = 0.043); the most commonly performed surgery was the McKeown procedure (69.2% vs. 66.7%, P = 0.492); an intraoperative feeding jejunostomy was placed only in Group 2; the operation time was similar between the groups (338.5 min vs. 340 min, P = 0.916); and the distribution of tumor localizations was similar between the groups (P = 0.407). In terms of tumor histology, squamous cell carcinoma (SCC) was the most common tumor type in the two groups (84.6% vs. 80%, P = 0.636); the tumor diameter was similar between the groups (14.9 vs. 18.1, P = 0.652); the number of removed lymph nodes was similar between the groups (24.9 vs. 22.5, P = 0.419); and the number of metastatic lymph nodes was higher in Group 2 (0.08 vs. 1.07, P = 0.27). One patient in Group 2 underwent repeat surgery due to suspected ischemic anastomosis; the distribution of postoperative complications according to the Clavien-Dindo classification system was similar in the two groups (P = 0.650); there was no early mortality within the first 30 days in either group; one patient in Group 2 was re-admitted within 90 days of discharge with decreased oral intake; the length of hospital stay was shorter in Group 1 (9 days vs. 16.5 days, P = 0.006); and the patients in Group 2 more often received neoadjuvant therapy in proportion to the disease stage (15.4% vs. 60%, P = 0.016). CONCLUSION: Robotic procedures can be safely performed in esophageal cancers with complication rates and oncological radicality similar to those of other minimally invasive techniques.

Prevalence of sacrococcygeal pilonidal sinus as a silent disease.

PURPOSE: The aim of this research was to determine the prevalence of sacrococcygeal pilonidal sinus disease (SPSD) based on clinical examination and histopathological evaluation. METHODS: Between January 1, 2010 and December 30, 2010, 432 corpses were evaluated in the Istanbul Central Office of Forensic Medicine Institute of the Turkish Ministry of Health. RESULTS: 41 of the 432 cases (9.4 %) had SPSD-related findings. 20 (4.6 %) had at least one sinus tract (clinical SPSD) and all of them had at least three positive histopathologic parameters. 16 of 41 cases (3.7 %) were clinically normal but had at least three positive histopathologic parameters (silent SPSD). CONCLUSION: Prevalence of SPSD with clinical examination is 4.6 %. These data are according to the literature. But with inclusion of the silent cases, the prevalence rate increases to 8.3 %. We conclude that inflammatory process does not result in SPSD in nearly half of the cases.

A Rare Tumor in Adulthood: Extrapancreatic Pancreatoblastoma.

Pancreatoblastoma is a rare malignant epithelial neoplasm of the pancreas. It primarily occurs in the pediatric population and is extremely uncommon in adults. A 64-year-old male patient with no known systemic disease presented to our clinic with abdominal pain and dyspeptic complaints. On physical examination, a tender epigastric mass was palpated. The patient was operated on with a preliminary diagnosis of gastrointestinal stromal tumor. Enbloc resection of the mass was performed. The transverse colon was segmentally resected with wedge resection of the gastric corpus. A stapled side-to-side anastomosis was performed. The macroscopic examination of the case revealed a tumoral lesion of approximately 16x13.5x10m, located in the submucosal area between the gastric corpus and the transverse colon. The microscopic examination showed acini, which have a highly cellular appearance, contain areas of necrosis, and form nested structures in places, stratification in places. The immunohistochemical examination demonstrated positive Trypsin expression, while focal positive expression of neuroendocrine markers such as Synaptophysin, Chromogranin, and Insulinomaassociated protein 1 (INSM-1) was observed. In betacatenin staining, aberrant nuclear and cytoplasmic positive expression was observed, and this staining pattern and morphology confirmed the diagnosis of pancreatoblastoma. Pathological Stage:pT3,N0,Mx the patient had an uneventful postoperative period and was referred to the oncology department for adjuvant chemotherapy. Pancreatoblastoma is an extremely rare type of pancreatic cancer and there are no established guidelines for the treatment of this aggressive disease. Surgical resection is recommended if anatomically possible. Pancreatoblastoma should be considered in the differential diagnosis of asymptomatic masses containing cystic-solid components and reaching very large sizes. Key words: Pancreas,Rare tumor, Pancreatoblastoma.

An early experience with the Da Vinci Xi surgical system in colorectal surgery. A single-center study.

AIM: Surgery is the optimum treatment approach in cases of colorectal cancer, with open or minimally invasive surgery options applied to patients in general surgery clinics. We present here an assessment of our use of robotic colorectal surgery for the treatment of colorectal cancer. METHOD: The outcomes of robotic colorectal surgeries performed in the General Surgery Clinic of Basaksehir Cam and Sakura City Hospital were evaluated. The demographic data, indications, type of surgery, complications, duration of postoperative stay and pathology results of the patients were recorded, and the surgical results were evaluated retrospectively. RESULTS: Of the 50 patients who underwent robotic colorectal surgery selected for the study, 19 were female and 31 were male, with a mean age of 60.9 years. Among the patients, 48% received neoadjuvant treatment and the most common tumor localization was the rectosigmoid region (40%), the most frequently performed operation was low anterior resection (44%). An ostomy was created in 50% of the patients, and two patients were converted. The mean duration of surgery was 191 minutes, the mean tumor diameter was 36 mm, the mean total number of lymph nodes dissected was 22.2 and the rate of complications of Clavien Dindo grade 3 or higher was 10%, namely anastomotic leak, anastomotic bleeding and chylous fistula. The mean length of hospital stay was 5 days, and one patient was reoperated due to the development of stomal necrosis. The rate of 90-day unplanned readmission was 10% and the most frequent cause was sub-ileus. One patient died in the postoperative period. CONCLUSION: Robotic surgery is a minimally invasive surgical approach that can be successfully applied in centers where perioperative and postoperative complications can be managed. KEY WORDS: Colorectal Cancer, Minimally Invasive Surgery, Robotic Surgery.

Short-term surgical outcomes of robotic gastrectomy. A single center/single surgeon experience.

AIM: Surgical resection is considered the optimum approach to the treatment of gastric cancer. The present study evaluates the efficacy of robotic surgery for the treatment of gastric cancer. METHOD: Included in the study were 30 patients who underwent robotic surgery for gastric cancer at the General Surgery Clinic between July 2021 and 2022. The demographic and clinical properties of the patients,intraoperative and postoperative results, tumor Characteristics, and early morbidity and mortality values were evaluated. RESULTS: The mean age of the 30 (F/M:8/22) patients was 63.9 (42-83) years, among which 20 (66.7%) had undergone neoadjuvant treatment. The mean surgery duration was 252.82 (110-380) minutes. A subtotal gastrectomy was performed in 10 patients (33%), while the remaining 20 patients (67%) underwent a total gastrectomy. The operation was converted to open surgery in four patients (13.2%). No intraoperative complications were seen, although one patient (3%) underwent re-anastomosis on postoperative day 3 due to an obstruction in the gastroenterostomy anastomosis. The mean largest diameter of the tumor was 4.6 (0-9) cm; the mean number of resected lymph nodes was 30.8 (11-58); and the mean duration of hospital stay was 5.9 (3-12) days. Early mortality within the first 30 days was seen in one patient with a cardiac cause. The rate of re-admission to hospital within the first 90 days was 11% (3 patients). CONCLUSION: Robotic surgery in patients with gastric cancer can be applied efficiently considering the successful clinicopathological results, short hospital stay, and low morbidity and mortality rates. KEY WORDS: Cancer, Morbidity, Mortality, Robotic Surgery, Stomach.

Radiomics of locally advanced rectal cancer: machine learning-based prediction of response to neoadjuvant chemoradiotherapy using pre-treatment sagittal T2-weighted MRI.

PURPOSE: Variable response to neoadjuvant chemoradiotherapy (nCRT) is observed among individuals with locally advanced rectal cancer (LARC), having a significant impact on patient management. In this work, we aimed to investigate the potential value of machine learning (ML)-based magnetic resonance imaging (MRI) radiomics in predicting therapeutic response to nCRT in patients with LARC. MATERIALS AND METHODS: Seventy-six patients with LARC were included in this retrospective study. Radiomic features were extracted from pre-treatment sagittal T2-weighted MRI images, with 3D segmentation. Dimension reduction was performed with a reliability analysis, pair-wise correlation analysis, analysis of variance, recursive feature elimination, Kruskal-Wallis, and Relief methods. Models were created using four different algorithms. In addition to radiomic models, clinical only and different combined models were developed and compared. The reference standard was tumor regression grade (TRG) based on the Modified Ryan Scheme (TRG 0 vs TRG 1-3). Models were compared based on net reclassification index (NRI). Clinical utility was assessed with decision curve analysis (DCA). RESULTS: Number of features with excellent reliability is 106. The best result was achieved with radiomic only model using eight features. The area under the curve (AUC), accuracy, sensitivity, and specificity for validation were 0.753 (standard deviation [SD], 0.082), 81.1%, 83.8%, and 75.0%; for testing, 0.705 (SD, 0.145), 73.9%, 81.2%, and 57.1%, respectively. Based on the clinical only model as reference, NRI for radiomic only model was the best. DCA also showed better clinical utility for radiomic only model. CONCLUSIONS: ML-based T2-weighted MRI radiomics might have a potential in predicting response to nCRT in patients with LARC.

Diagnostic Value of Preoperative Haemoglobin, Albumin, Lymphocyte and Platelet (HALP) Score in Predicting Tumour Budding in Colorectal Cancer.

OBJECTIVE: To investigate the value of preoperative haemoglobin, albumin, lymphocyte, and platelet (HALP) score in predicting tumour budding in colorectal carcinoma. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: University of Health Sciences, Basaksehir Çam and Sakura City Hospital Istanbul/Turkey, between May 2020 and May 2021. METHODOLOGY: The colorectal cancer patients who underwent surgery were divided into two groups according to the presence or absence of tumour budding. A total of 110 patients were included in the study, and there were 31 patients in group 1 and 79 patients in group 2. The predictive value of the HALP score in predicting tumour budding at the determined cut-off point was evaluated. RESULTS: The mean HALP score was similar in both groups (p=0.459). The rate of lymphovascular invasion was higher in group 2 (p=0.002), and T3 and T4 tumours were more common in group 2 (p<0.001). The number of metastatic lymph nodes was higher in group 2 (p=0.049). When the patients in group 2 were divided into subgroups according to the degree of tumour budding, the HALP score differed between intermediate and high budding groups (p=0.032). A HALP value of >31.6 predicted the presence of tumour budding with a sensitivity of 70.89% and a specificity of 48.39%. CONCLUSION: The presence of tumour budding is associated with aggressive phenotypic features in colorectal carcinoma. The preoperative prediction of tumour budding can serve as a guide in the development of individualised therapy plans. The HALP score was associated with the presence of intermediate or high degree of tumour budding. KEY WORDS: Colorectal cancer, Tumor, Pathology, Hemoglobin, Albumin.

Type of lateral internal sphincterotomy incision: parallel or vertical?

BACKGROUND: The lateral internal sphincterotomy (LIS) technique is considered the optimal surgical treatment for chronic anal fissures (CAFs), although questions remain regarding the best technique. The present study investigated whether the type of anoderm incision (vertical or parallel to the anus) affects wound healing, wound-related complications, incontinence, and recurrence rates in CAF patients undergoing open LIS. METHODS: This prospective randomized clinical study divided 52 patients undergoing LIS for CAF into two groups. In group 1 (n=25) the incision was made vertical to the anus; and in group 2 (n=27) it was made parallel to the anus. Incision sites were not sutured in either group. Wound site complications, wound healing times, perianal itching, incontinence, and recurrence rates were evaluated. RESULTS: Complications involving bleeding, hematoma, abscess formation, or fistulization were not observed in either group. Complications were observed in 5 patients of group 1 (1 wound infection, 1 ecchymosis, 2 flatus incontinence, 1 recurrence) and in three patients of group 2 (2 wound infections, 1 flatus incontinence). Overall wound complication, incontinence, and recurrence rates were 7.7, 5.8, and 1.9%, respectively. The two groups did not differ significantly in terms of wound complications, incontinence, or recurrence. Itching duration was significantly longer in group 1 (p<0.0001) Complete wound healing was slower in group 1 than group 2 (19.44±6.82 vs. 10.59±3.48 days, p<0.0001). CONCLUSIONS: Wound healing time and perianal itching duration were significantly reduced when anoderm incisions were made parallel to the anus compared to those made vertical to the anus.

Gastrointestinal tract schwannomas and brief review of literature.

Schwannomas originating from Schwann cells arise from the peripheral nerve sheath and are slow-growing, benign tumors that originate mostly from the mesenchyme. It appears equally in both sexes. Schwannomas are often seen in the 3rd and 5th decades of life. Schwannomas can be seen everywhere where peripheral nerves are seen. Gastrointestinal schwannomas constitute 2-6% of all submucosal masses, and the stomach is the most common region (60-70%). Endoscopic Ultrasound (EUS)-guided sampling of gastrointestinal submucosal lesions has made it possible to achieve preop- erative differential diagnosis. Patients diagnosed with gastrointestinal schwannomas between January 2005 and December 2017 were included in this study. Three out of six patients were females. Median age was 52.5 (44-76) years. Schwannomas were found in two patients in the gastric region, one patient in the appendiceal region, two patients in the colon and one patient in the perianal region. Primary schwannomas are usually benign. Radical resection with free margin is necessary because of the risk of malignant degeneration; chemo and radiotherapy response is indeterminate, and local recurrence rates are high.

The effect of mutation status, pathological features and tumor location on prognosis in patients with colorectal cancer.

OBJECTIVE: Colorectal cancer is the most common malignancy of the gastrointestinal tract. It is the third most common tumor in both genders and the second reason of cancer-related deaths. In recent years, tumor location has gained importance as a prognostic indicator. In this study, we aimed to analyze if there was a prognostic effect of tumor location, the pathological features, and the mutation status of patients on survival. METHODS: Two-hundred and ten colorectal cancer patients aged 18 years and older were included into the study. One-hundred and forty-two patients had left-sided tumor and 68 patients had right-sided tumor. Patients who had other malignancies rather than squamous cell skin cancer and in situ cervical cancer were excluded. All statistical tests were carried out using two-sided process, and a p≤0.05 was considered statistically significant. RESULTS: There were 140 men and 70 women in the study. The median age of the patients was 62 years old. There was no statistically significant difference according to tumor location and survival of patients. The overall survival of patients with right-sided tumors was 60.5 months and 47.2 months for left-sided tumors. Disease-free survival of patients was 63.7 months for right-sided tumors and 46 months for left-sided ones. Perineural invasion, grade and stage were crucial prognostic parameters. Disease-free survival was longer for female colorectal cancer patients. CONCLUSION: According to our study, survival of patients was similar regardless of tumor location. This can be explained by the different sequencing of treatment strategies and divergent population genetics.

Effects of contractubex on the prevention of postoperative peritoneal adhesion.

BACKGROUND: There are numerus techniques and agents in use for reducing peritoneal adhesion formation. But in this research we believe this is the first research to reveal that contractubex (allium cepae, sodium heparin, and allantoin mixture) is reducing formed peritoneal adhesions. So it may be used to reduce the number of re-laparotomies/re-laparoscopies caused by peritoneal adhesions related complications. OBJECTIVE: To evaluate the effects of contractubex (CT) in a rat model of postoperative peritoneal adhesion (PPA). METHODS: Fifty rats were divided into four equal groups. In group 1, 1 g of CT was injected into the peritoneal cavity. In group 2, adhesions were generated. In group 3, adhesions were generated, and 1 g of CT was immediately applied into the peritoneal cavity. In group 4, adhesions were generated, and at postoperative d 7, 1 g of CT was applied into the peritoneal cavity. In group 5, adhesions were generated, and at postoperative d1, 3, 5, and 7, 1 g of CT was applied into the peritoneal cavity. The adhesions were scored both macroscopically and microscopically. RESULTS: The mean macroscopic adhesion scores in groups 1-5 were 0 ± 0, 2.9 ± 0.21, 2.3 ± 0.54, 0.8 ± 0.63, and 2.2 ± 0.72, respectively (P < 0.0001); the mean microscopic values were 0 ± 0, 2.8 ± 0.42, 2.8 ± 0.42, 0.6 ± 0.52, and 2.3 ± 0.48, respectively (P < 0.0001). The mean macroscopic adhesion score in group 4 was lower than that in group 2 (P = 0.001). The mean macroscopic adhesion scores in groups 3 and 5 were higher than those in group 4 (P = 0.045 and P = 0.038, respectively) but did not significantly differ from those in group 2 (P = 0.171 and P = 0.124, respectively). COMMENTARY: A single dose of contractubex did not prevent PPA formation but did diminish the amount of formed PPAs.

Abdominal wall endometrioma; a 10-year experience and brief review of the literature.

BACKGROUND: Abdominal wall endometrioma is a rare condition, which usually develops in a surgical scar of Cesarean section or hysterectomy. Certain factors relating to knowledge of the clinical pattern of this disease make correct diagnosis and treatment difficult. The aim was to identify the different forms of presentation of this disease entity through publishing the results from our experience of surgical management of such lesions. METHODS: Patients diagnosed with abdominal wall endometrioma over a period of 10 y were identified from the comprehensive surgical database of our institution. The age, parity, symptoms, previous surgeries, initial diagnosis, diagnostic modalities, current operation, and recurrences were surveyed and analyzed. RESULTS: There were 40 patients with a mean age of 32.3 ± 5.2 y. All of the patients (100%, n = 40) had an abdominal mass in or adjacent to surgical scars. The main symptom was pain, noncyclic (45%, n =18), or cyclic (40%, n = 16) in nature. The mean duration of symptoms was 18.2 ± 23.4 mo. The preoperative diagnosis was correct in 47.5% (n = 19) of the cases. Surgical treatment failed in 3 cases (3/33, 9.1%), and the operations were performed once again. CONCLUSIONS: Abdominal wall endometriosis may be difficult to diagnose as it is comparatively an unfamiliar entity that has not received its due attention among general surgeons, so far. Therefore, in patients with a palpable subcutaneous mass in or around surgical scars with a history of violation of uterus, a thorough history and physical examination is necessary, and usually sufficient to make correct diagnosis of endometrioma.

The impact of Western physicians on the modernization of Turkish surgery and medicine, 1827-1936.

Efforts of modernizing the Ottoman Empire and society started during the 19th century. Initially reforms have been limited by institutions such as the armed forces, faculty of engineering and medicine. For this reason, a large number of western physicians invited to state to take prestigious positions in its few existing medical schools and other state establishments, in particular help with reforming its higher education. After the establishment of young Turkish Republic, western forms of science, medicine, art and literature penetrated the culture and continued to flourish. This article brings to light the efforts of these surgeons, and physicians and tells about their contributions to surgery and medicine in Turkey.

Efficacy of glycerol in preventing postoperative peritoneal adhesions.

AIM: To evaluate the efficacy of glycerol in preventing postoperative peritoneal adhesions. MATERIALS AND METHODS: Forty Wistar albino female rats were randomly assigned into four groups of 10 rats each. Rats in group 1 were each injected intraperitoneally with 0.1 mL glycerol. In group 2, the adhesion model was created with no injection of glycerol. In group 3, the adhesion model was created and the area was covered with 0.1 mL glycerol. In group 4, 0.1 mL glycerol was used to cover the area where the model was to be formed and the adhesion model was created. The rats were killed on postoperative day 10, and the size and severity of adhesions were evaluated, together with histopathological fibrosis parameters. RESULTS: Mean macroscopic adhesion scores in groups 1-4 were, 0, 5.8 +/- 0.42, 0.30 +/- 0.95 and 0, respectively (P = 0.0001), with the score in group 2 higher than those of groups 1 (P < 0.001), 3 (P < 0.01) and 4 (P < 0.001). Mean histopathological fibrosis values were 0, 2.8 +/- 0.32, 1.60 +/- 0.70 and 0.60 +/- 0.51, respectively (P < 0.0001). Group 3 and 4 scores were different than group 2 (P < 0.0001) and group 3 was also different than group 4 (P < 0.001). CONCLUSION: Covering peritoneal surfaces with glycerol, both before and after peritoneal trauma, is effective in decreasing peritoneal adhesion formation. The efficacy of glycerol covering was greater in the group receiving glycerol prior to trauma because it decreased the direct effects of trauma on the surface.

Mechanical Jaundice and Bile Duct Stricture Caused by the Migration of Endoclip and Silk Suture Material into the Common Bile Duct.

It is quite rare the migration of metal clips and silk suture materials into the common bile duct (CBD) that were used for the closure of cystic duct in conventional or laparoscopic cholecystectomy. The most common cause of postoperative jaundice is unrecognised or overlooked stones in the bile ducts during operation. The authors present four patients who developed jaundice and in one case  biliary tract stricture,  caused by the migration of metal clip and silk suture material into CBD  following conventional and laparoscopic cholecystectomy. The migration of endoclip and suture material in to CBD is very rare and it should be kept in mind in post-cholecystectomy jaundice. Key Words: Cholecystectomy, Endoclip migration, Mechanical jaundice, Endoscopic retrograde cholangiopancreatography.