Gossypiboma mistaken for a hydatid cyst: case report.

Although considered a rare complication, gossypiboma continues to be a clinically important and probably more frequently encountered than reported situation. This study aimed to report a case of gossypiboma that was mistaken for a hydatid cyst in the preoperative evaluation. A 34-year-old male patient with a history of Nissen Fundoplication presented with a large mass palpable in the epigastrium and both the left upper and lower quadrants of the abdomen. Computerized tomography was reported to show a 20x18 cm cystic mass with a collapsed germinative membrane inside it. Laparotomy, which was performed with a suggested diagnosis of type 3 hydatid cyst, revealed that the mass was caused by a 30x30 cm surgical abdominal compress. We believe gossypiboma should be kept in mind in the differential diagnosis of abdominal hydatid cysts in the presence of a former abdominal operation, especially when the result of indirect hemagglutination test is negative.

Colonic anastomosis can be protected from ischemia reperfusion injury with intra-peritoneal Montelukast treatment.

BACKGROUND: Ischemia reperfusion injury is unavoidable in the setting of transplantation and may lead to primary dysfunction of the transplanted organ. Similarly, intestinal ischemia reperfusion injury may have deleterious effects causing intestinal failure. Montelukast is a selective reversible cysteinyl-leukotriene type 1 receptor antagonist used in clinical practice for its anti-inflammatory effects. In this study, we investigated the effects of Montelukast on colon anastomosis performed after intestinal ischemia reperfusion injury. METHODS: 40 adult male Wistar Albino rats were used. All rats underwent intestinal ischemia reperfusion injury. Afterwards, the entire group was divided into two for either right or left colonic resection and anastomosis. Rats in the control groups were given intra-peritoneal normal saline for 1 week while the animals in the treatment groups were given intra-peritoneal Montelukast (10 mg/kg; 1 ml). All animals were subjected to ischemia reperfusion injury followed by either right or left colonic segmental resection and anastomosis in the first day of the experiment. On postoperative day 7 adhesion scoring, anastomotic bursting pressure, anastomotic tissue hydroxyproline content were assessed for all groups. RESULTS: Significant differences were detected in adhesion scores between the treatment and control groups regardless of the colonic resection site. Anastomotic bursting pressures and hydroxyproline content of the anastomotic sites were significantly higher in the treatment groups when compared with the control groups. Anastomotic tissues treated with Montelukast showed more prominent vascularization in histopathological examinations. CONCLUSION: Montelukast has a potential to attenuate the detrimental effects of ischemia reperfusion injury on intestinal anastomosis.

Role of calcium-sensing receptor, Galectin-3, Cyclin D1, and Ki-67 immunohistochemistry to favor in the diagnosis of parathyroid carcinoma.

BACKGROUND: As histopathological findings of parathyroid carcinoma are not certain, the diagnosis of tumors with degenerative changes may be difficult. In these cases, immunohistochemical markers are beneficial. We aimed to research the acceptability of calcium-sensing receptor (CaSR), Galactin-3, Cyclin D1, and Ki-67 as helpful markers in parathyroid tumors in cases which are difficult to diagnose. MATERIALS AND METHODS: Those cases who had been diagnosed with atypical parathyroid adenoma and parathyroid carcinoma between 2010 and 2015 were reevaluated. Immunohistochemical markers were applied to this cases. RESULTS: About 21 cases were parathyroid adenoma, 14 were atypical adenoma, and 10 cases were parathyroid carcinoma. According to the immunohistochemical results, global loss of CaSR staining was seen in 50% (5/10) of the patients with carcinoma while there was no loss of staining in those with parathyroid adenoma (P = 0,001). Global loss of CaSR staining was found in only one out of 14 cases with atypical adenoma. The expression of Galactin-3 was found to be positive in 40% (4/10) of carcinoma cases, 71.4% (10/14) of those with atypical adenoma, and 14.3% (3/21) of those with adenoma (P = 0,002). Cyclin D1 expression was determined to be positive in 70% (7/10) of patients with carcinoma, 71.4% (10/14) of atypical adenoma cases, and 23.8% (5/21) of those with adenoma. The Ki-67 proliferation index was seen to be above 5% in 50% (5/10) of carcinoma cases and 35,7% (5/14) of those with atypical adenoma. CONCLUSION: In these studies, it has been emphasized that the global loss of CaSR staining was used as a negative marker in the diagnosis of carcinoma. In this study, we have also confirmed that the global loss of CaSR staining is a useful marker to determine potential increased malignancy.

Surgeons' approach toward clinical nutrition: A survey-based study.

OBJECTIVE: Although many surgical patients face postoperative problems due to a poor nutritional status, there is evidence that many cases of malnutrition still go unnoticed and untreated in surgical wards. This study aims to define the current attitudes of surgeons toward nutritional screening and support. MATERIAL AND METHODS: A questionnaire with 13 questions was e-mailed to 1500 surgeons. Cross-queries were made over the responses. RESULTS: The response rate was 20.9%. Most of the respondents (89.5%) implemented nutritional screening. However, only 24.6% of these surgeons screened every patient for malnutrition. The time to initiate nutritional support varied among respondents, and only 25.5% started nutritional support early enough prior to surgery. Only 9.9% of respondents implemented evidence based practices for preoperative fasting, and 21.2% preferred immunonutrition products for patients undergoing major abdominal surgery for cancer. The responses of surgeons, who participated in at least one scientific meeting on nutrition per year, were more coherent with the nutrition guidelines. CONCLUSIONS: The results of this study reveal that the awareness and knowledge of clinical nutrition need improving amongst surgeons. To increase this awareness and knowledge, continuous learning throughout their career seems essential.

Modified single stapler technique in anterior resection for rectal cancer.

Technical difficulties during colorectal surgery increase the complication rates. We introduce a modified single stapler technique for patients in whom technical problems are encountered while performing double stapler technique. Before pelvic dissection, descending colon is divided at minimum 10 cm proximal to the tumoral segment. Tumor specific mesorectal excision is performed and two purse string sutures are placed at the distal margin with an interval of 1 - 2 cm. After introducing a circular stapler via the anus, the distal purse string suture is tied around the central shaft of the stapler and the proximal purse string suture around the colonic lumen. After the resection is completed between the two sutures, the anvil shaft is connected to the central shaft and the stapler is closed and fired. None of the patients had an anastomotic leak. This technique may be a safe alternative particularly in patients with narrow pelvis and distal tumors.

Traumatic Abdominal Wall Hernia: Early or Delayed Repair?

Traumatic abdominal wall hernia after blunt trauma is a rare entity. They can easily be overlooked in patients who have multiple trauma, as its signs and symptoms may be variable due to the presence of multiple injuries. Imaging with computed tomography or ultrasound confirms the diagnosis as well as identifying any associated injuries. Although surgery is the standard treatment for traumatic abdominal wall hernias, there is no consensus on the early or late repair of the defect. Some authors recommend early surgical intervention in order to avoid the risk of intra-abdominal organ injury, incarceration, and strangulation. In this study, we report our experience in three cases, which did not involve emergency surgery. Long-term outcome is successful. Elective hernia repair may be safe and feasible in stable patients.

Management of idiopathic granulomatous mastitis: dilemmas in diagnosis and treatment.

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease. Because of it's uncommon etiology and rareness, diagnosis and treatment is still a challenge. Owing to wide spectrum of IGM it is difficult to standardize and optimize the treatment. The aim of this study was to report and describe the clinical signs, radiological findings, management, clinical course and the recurrence rate of the patients which were treated due to IGM. METHODS: In this retrospective review of patients diagnosed with IGM histopathologically between January 2006 and December 2011, medical reports, ultrasonography (US) and mammograhy (MMG) findings, follow-up information and recurrence were obtained from records. RESULTS: Painful, firm and ill defined mass was the symptom of all patients. While parenchymal heterogeneity, abscess and mass were the findings of US, increased asymmetric density was the main finding of MMG. Wide local excision was performed in 15 (62.5%) patients, incisional biopsy with abscess drainage was performed in 9 (37.5%) patients. Median follow-up was 34.8 (range 10-66) months. CONCLUSIONS: While the physical examination give rise to thought of breast carcinoma, the appearance of parenchymal heterogeneity and abscess formation on US especially with enlarged axillary lymph nodes support the presence of an inflammatory process. But these findings do not exclude carcinoma. Hereby, histopathologic confirmation is mandatory to ensure that a malignancy is not missed.

Do repeatedly nondiagnostic fine needle aspirations of thyroid nodules predict malignancy risk?

Fine needle aspiration biopsy (FNAB) is a common, minimally invasive, cost-effective, and rapid method to manage thyroid nodules, but nondiagnostic FNAB (ND-FNAB) is still a common problem due to high prevalence (2%-20%). Our purpose in this study is to investigate risk of malignancy of repeating ND-FNABs and correlation between clinical and ultrasound findings. Our cohort study included 75 patients who had 2 or more times ND-FNABs and, finally, undergone surgical resection. We evaluated demographic, clinical, ultasonographic, and pathologic features. Fifty-seven patients were female, and 22 patients were male. Seventy-five patients' histopathologic results were 76% (n=57) benign and 24% (n=18) malignant. Of malignant nodules, 94.4% (n=17) were papillary carcinoma, whereas 5.6% (n=1) were follicular carcinoma. We did not find any predictive factor for malignancy and any differences associated with clinical and ultrasonographic features between benign and malignant nodules. Reaspiration followed by surgery for appropriate patients is recommended.

Effects of nasal cleansing and topical decongestants on patient tolerance during upper gastrointestinal endoscopy: a prospective randomized study.

UNLABELLED: Adequate patient tolerance is essential for successful completion of safe endoscopic examination. Although there are many reported methods to increase patient tolerance, none of these fully resolve this problem. The aim of this study was to investigate whether relaxing the nasal airways increase patient tolerance to upper gastrointestinal endoscopy (UGE). A total of 300 patients scheduled for diagnostic UGE were randomized into three separate groups. Prior to the UGE procedure the first group was administered intranasal cortisone spray following nasal cleansing (INC). Patients in the second group were administered intranasal saline after nasal cleansing (INSP). The patients in the third group were treated with the standard endoscopic procedure alone (SEP). After the UGE procedure, both endoscopists and patients were asked to evaluate the ease of performing the procedure. Furthermore, patients who had undergone endoscopy before were asked to compare their current experience to their most recent endoscopy. Results shown that INC and INSP groups had significantly better tolerance than the SEP group. When comparing their current experience with the previous one, INC and INSP groups reported that the current experience was better. CONCLUSIONS: Taking measures to relax the nasal airways makes breathing more comfortable and increase patient tolerance during UGE.

Restorative proctocolectomy for familial adenomatous polyposis coexisting with colorectal cancer.

The aim of this study was to assess whether restorative proctocolectomy was suitable as an initial procedure for selected familial adenomatous polyposis patients with coexisting colorectal cancer. Six malignancy patients who underwent restorative proctocolectomy for familial adenomatous polyposis were reviewed. At the time of restorative proctocolectomy, cancer was not suspected in four patients. The two remaining familial adenomatous polyposis patients had a known associated colorectal cancer. Operative procedures, pathological findings, complications and long-term follow-up were evaluated. All patients were Stage I-II cancers. There was no mortality or pouch failure. No evidence of tumor recurrence was found and all the patients are still alive and disease-free in follow-up (mean 28 months). As an initial procedure, restorative proctocolectomy for patients with familial adenomatous polyposis with coexisting Stage I-II colorectal cancer seems to be a dependable procedure.

Nasogastric decompression after total gastrectomy.

BACKGROUND/AIMS: Although it is clearly known that there is no need of routine nasogastric decompression after some abdominal operations, we still do not know whether it is necessary for esophageal anastomosis. Traditionally, nasogastric decompression is mandatory after total gastrectomy complemented with esophagojejunostomy. METHODOLOGY: Consecutive 66 patients with gastric cancer who underwent total gastrectomy and esophagojejunostomy were prospectively evaluated. Patients were divided into two groups, those with nasogastric decompression and those without decompression. RESULTS: Postoperative complications were similar among the groups. Vomiting, distention, belching, hiccupping, dysphagia complaints were similar among the groups, but sore throat (100% vs. 22%, p<0.001), nausea (32% vs. 13%, p=0.054), fever (35% vs. 16%, p=0.068) and pulmonary complications (26% vs. 9%. p=0.072) were much more in the nasogastric decompression than the no-tube group. Starting oral feeding and postoperative hospital stay were similar in both groups. CONCLUSIONS: Omission of nasogastric decompression after elective total gastrectomy complemented with esophagojejunostomy did not increase postoperative complications, on the contrary it decreased postoperative fever and pulmonary problems, and improved patient comfort by decreasing sore throat and nausea. Therefore, we do not recommend the routine use of nasogastric tubes after total gastrectomy complemented with esophagojejunostomy.