Effects of Anatolian Propolis and Hypertonic Saline Combination Nasal Spray on Allergic Rhinitis Symptoms: A Prospective, Multicenter Study.

Objectives: This study aimed to evaluate how Rhinapi nasal spray affects symptoms of allergic rhinitis. Methods: In this prospective, multicenter, observational study, 10,000 patients (comprising 5028 males and 4972 females) exhibiting symptoms of allergic rhinitis (namely, nasal discharge, sneezing, nasal itching, and nasal obstruction) from different centers in different regions of Turkey were enrolled in the study between March 2022 and March 2023. All the patients wanted to participate in the study and were administered Rhinapi one puff to each nostril three times a day, for a period of 3 weeks. Total symptom scores, quality of life (QoL) scores, and otolaryngological examination scores were evaluated before and 3 weeks after treatment. Results: The scores for discharge from the nose, sneezing, nasal pruritus, and blockage of the nose all indicated improvement when compared to pre-medication and post-medication. This difference achieved statistical significance (P < .001). The mean total symptom score fell following treatment (P < .001): whilst the score was 11.09 ± 3.41 before administering Rhinapi; after administration, the average score was 6.23 ± 2.41. The mean QoL scores also altered after medication (P < .001), improving from a mean value of 6.44 ± 1.55 to a mean of 7.31 ± 1.24. Significant improvement was also noted in the scores for conchal color and degree of edema after the treatment had been administered (P < .001). Conclusion: The study demonstrates that Rhinapi nasal spray decreases total symptom scores, and results in improved QoL and otolaryngological examination scores. Propolis spray may be recommended for patients with allergic rhinitis alongside other treatments.

Synchronous and metachronous neoplasms of different histogenesis with gastrointestinal stromal tumor (GIST): 10 years experience of a single institution.

AIM: Gastrointestinal stromal tumors (GISTs) are the most common primary mesenchymal neoplasms of the gastrointestinal tract. Significant advances have been made in its pathogenesis, diagnosis, and treatment over the past few decades. However, little is known about the occurrence of synchronous or methacronous tumors with other histogenesis in addition to GISTs. The aim of this study was to present a series of 15 patients diagnosed with a second primary neoplasm in addition to GIST. MATERIAL AND METHODS: Patients who were diagnosed with both GIST and other primary neoplasm between January 2010 and December 2019 were included in the study. Demographic, clinicopathologic and immunohistochemical parameters of the patients were analyzed along with the follow-up results RESULTS: This study included 12 men and 3 women with a median age of 68 years (range: 57-83 years). Of the GISTs, 93.3% were localized in the stomach and 73.3% were at very low / low risk category. Of the second primary tumors, 66.6% were in the gastrointestinal tract. Detection of the GIST was synchronous in 9 cases, metachronous in 2 cases and preceded the GIST diagnosis in 4 cases. GIST was incidentally found intra-operatively in 3 of the cases. The mean size of the synchronous GISTs was 20 mm while the most common GIST-associated malignancy was gastric adenocarcinoma. The median follow-up times was 62 months (range: 13-129 months). CONCLUSIONS: The prevalence of secondary malignancies in GIST patients is significantly higher than the healthy population. The high occurrence rate of additional primary tumors in GIST patients has focused the attention of surgeons on this problem. While it is not yet clear if there is a causal association or a common genetic mechanism for the concomitant occurrence of GIST with other malignancies, a closer surveillance of GIST patients is needed due to their proved increased prevalence of a second primary tumor especially during the first year after diagnosis. KEY WORDS: Gastrointestinal stromal tumor, Coexistence, Synchronous malignancy, Second neoplasm, Gastric adenocarcinoma.

Invasive and Non-invasive Ductal Carcinoma within Malignant Phyllodes Tumour with Axillary Lymph Node Metastases.

Phyllodes tumours are uncommon breast neoplasms constituting 1-2% of breast malignancies. Metastasis is usually haematogenous, and axillary lymph node dissection is not routinely performed. A phyllodes tumour with concomitant invasive ductal carcinoma (IDC) is even rarer. When IDCor ductal carcinoma in-situ (DCIS) is detected, the management of the condition changes completely. We report a case of a 22-year female presenting with a mass in the right breast and palpable axillary lymph nodes. The pathological examination demonstrated a malignant phyllodes tumour with concomitant IDC and DCIS. The patient elected to have modified radical mastectomy, and the pathological examination showed metastasis in the axillary lymph nodes. The patient was administered appropriate therapy. At the last visit, she did not have the clinical signs of disease. This is the first youngest case of axillary lymph node metastases with both DCIS and IDC on pathological examination in malignant phyllodes tumour. Key Words: Malignant phyllodes, Invasive ductal carcinoma, Ductal carcinoma in-situ, Lymph node metastasis.

Assessment of hearing levels in children with nephrotic syndrome.

OBJECTIVE: Due to the similarities in the physiological mechanisms and antigenicity of the kidney and cochlea, they are simultaneously affected by certain diseases and drugs. Therefore, the purpose of this study was to investigate whether the hearing functions of patients with nephrotic syndrome (NS) were affected by the severity of the disease and the cyclosporine treatment. METHODS: The sample of this study consisted of 87 participants, including 65 patients (130 ears) with NS and 22 age- and sex-matched normal hearing children (44 ears). Based on the severity of the disease, the patients were divided into two groups: infrequently relapsing nephrotic syndrome (IRNS) and steroid-dependent or frequently relapsing nephrotic syndrome (SD/FRNS). Their audiologic tests, including Pure-tone Audiometry and Distortion-Product Otoacoustic Emission (DPOAE), were compared with the tests of the control group. In addition, the audiologic tests of the NS patients who received cyclosporine were compared with those who did not. RESULTS: In the pure-tone audiometry, there were statistically significant differences between the IRNS, SD/FRNS, and control groups at 2000, 4000 Hz, and pure-tone average (PTA). Hearing levels of the SD/FRNS group at 2000, 4000 Hz, and PTA were higher than those of the control group. At 6000 Hz in pure-tone audiometry, there was a very weak positive correlation between the hearing level and the number of relapses. At 250 Hz and PTA, hearing levels of the group that received cyclosporine were higher compared to the group that did not receive it. In DPOAE, there was no significant difference between the groups according to the severity of the disease and the use of cyclosporine. CONCLUSION: During the follow-up of the patients with NS, their hearing functions should be questioned, especially in patients with SD/FRNS and receiving cyclosporine treatment.

Evaluation of inner ear and hearing functions in lichen planus patients.

BACKGROUND: Lichen planus (LP), which affects skin, nails, hair, and mucosal surfaces, is a chronic, autoimmune, and inflammatory disease, and autoimmune diseases may affect the inner ear. AIMS: This study aims to investigate hearing and inner ear functions of the LP patients. PATIENTS/METHODS: The present study was formed by 49 patients who were clinically and histopathologically diagnosed with LP and did not receive any treatment. The healthy group consisted of 52 healthy individuals. Pure tone audiometry (PTA) and distortion product otoacoustic emission tests were used in the hearing evaluation. RESULTS: At frequencies of 1, 2, 4, 6, and 8 kHz in the right ear and 0.5, 1, 2, 4, 6, and 8 kHz in the left ear in PTA, the lichen group's hearing thresholds were higher than the healthy group's. Upon comparing the hearing thresholds of LP patients with oral mucosa involvement and LP patients without oral mucosa involvement, there were significant differences between the groups at 1, 4, and 8 kHz in the right ear and at 0.25, 0.5, 2, 4, 6, and 8 kHz in the left ear. CONCLUSION: Because of the increasing hearing thresholds, we think that hearing and inner ear functions of LP patients, particularly with oral mucosal involvement, are negatively affected.

Effectiveness of sialendoscopy on the symptoms of chronic obstructive sialadenitis and patient satisfaction degree.

OBJECTIVES: The purpose of this study was to assess the effectiveness of sialendoscopy (SE) on the symptom severity of chronic obstructive sialadenitis (COS) and patient satisfaction by using the Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire and the Patient Satisfaction Scores (PSS). PATIENT AND METHODS: COSS questionnaire was employed to 51 Turkish patients with COS before and three months after SE. Patients' satisfaction with SE was evaluated by analyzing the PSS. RESULTS: Gland preservation rate of the SE operation was 96.2%. The sialolith extraction rate was 74.2%. A significant decrease in the COSS scores of all of the patients in the study sub-groups was observed (p < 0.05). The effectiveness of SE was more pronounced for patients with sialolithiasis and submandibular gland (SG) involvement (p < 0.001, p = 0.03, respectively). Totally extracted stone and symptom duration were the only independent factors that significantly affected the COSS score gain values in patients with and without sialolithiasis, respectively (p < 0.001). There was a statistically significant correlation between COSS score gain values and PSS values. (r = 0.786) CONCLUSION: The benefit of SE was more pronounced in patients with sialolithiasis and SG involvement. Successful stone extraction and symptom duration were two independent factors that influenced both clinical improvement and patient satisfaction for patients with and without sialolithiasis, respectively. COSS questionnaire results correlated with the PSS values; thus, this questionnaire can also be used to evaluate the patients' satisfaction with SE.

Risk Factors of Postoperative Clinically Relevant Pancreatic Fistula following Distal Pancreatectomy with Stapler Closure.

OBJECTIVE: To analyse clinicopathological variables to determine risk factors of postoperative pancreatic fistula in patients having distal pancreatectomy with stapler closure. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Adana City Training and Research Hospital, Adana, Turkey, from January 2015 to May 2020. METHODOLOGY: Medical files of 38 cases having distal pancreatectomy with stapler closure of the pancreatic remnant for conditions emerging from the pancreas or other organs were analysed. Data about demographics, perioperative and pathological findings, postoperative outcomes were gathered. Univariate analysis was utilised for comparisons of categorical data. The possible risk factors found to be significant in the univariate analysis were included into the logistic regression analysis. RESULTS: Based on the description reported by the International Study Group of Pancreatic Surgery, 23.7% and 31.6% of the patients had biochemical leakage and clinically relevant postoperative pancreatic fistula (POPF) respectively. Univariate and multivariate analyses made to determine risk factors of POPF showed a relation between stapler closure alone (p = 0.018) and soft parenchymal texture (p = 0.002) and clinically relevant POPF. Multivariate analyses revealed that parenchymal texture was the sole independent predictor of clinically relevant POPF (OR, 0.016, p = 0.039). CONCLUSION: Soft pancreatic texture is independently predictive of clinically relevant POPF following distal pancreatectomy with stapler closure. However, reinforcement of the stapler line with extra sutures decreases the risk of clinically relevant POPF. Key Words: Distal pancreatectomy, Pancreatic fistula, Stapler closure, Suture reinforcement.

Abdominal wall reconstruction for desmoid tumors following radical resection from the abdominoplasty incision: Case report.

Desmoid tumours are rare and locally invasive neoplasms that originate from the muscles and their aponeurosis. Incomplete excision causes recurrences; therefore, patients require aggressive resection that essentially entails tumour excision with a clear surgical margin. After radical resection, the resultant wide defect may lead to difficulty in closure of the anterior abdominal wall. Here, we report a case having surgery for large desmoid tumour of the anterior abdominal wall through an abdominoplasty incision followed by an abdominal wall reconstruction with a dual-sided composite mesh.

Laparoscopic revisional surgery for failed anti-reflux procedures.

AIM: Failure ratio of an anti-reflux surgery is 2-17% in adults. After unsuccessful fundoplications, if necessary, revisional surgeries can be performed. Revisional surgeries are technically difficult to perform and require professionally advanced experience. On the other hand, it is still controversial which technique should be used in revisional surgery. The aim of this study is to present our experience with revisional surgical procedures for complications or recurrences after anti-reflux surgeries. MATERIAL AND METODS: A total of 18 patients, 16 of whom were referred to our clinic from other centers, and who underwent revisional surgery for failed fundoplication between 2014 and 2019 were retrospectively analyzed RESULTS: Five patients were male and 13 were female. The mean age was 40.3±11.7 years. The most common symptom was the persistence of reflux symptoms (61.2%). Indications for revisional surgery were recurrent hiatal hernia in 10 patients, thightness in 4 patients, mesh migration in 2 patients, mesh migration with recurrent hiatal hernia in 1 patient, and mesh migration with thightness in 1 patient. The mean operative time was 107.2+29.2 minutes. The median hospital stay was 2.9 days (range: 1-6 days). The most common surgical procedure performed was the repair of hiatal crura with mesh, and reconstruction of fundoplication and fixation of neo-fundoplication to the right crus (44.4%). In addition, other surgical procedures performed were takedown of the previous fundoplication (16.6%), takedown of the previous fundoplication and reconstruction of fundoplication (11.1%), cruroplasty and fundoplication with gastric wedge resection (11.1%), removal of the mesh and takedown of the previous fundoplication (5.6%), removal of sutures from the hiatal crura (5.6%), and gastric wedge resection (5.6%). Four patients (27.8%) developed morbidity due to gastric perforation and pleural opening during these procedures. The median follow-up period was 29 months (range: 6-69 months). Two cases (11.1%) who underwent revisional surgery failed, and re-revisional surgery was performed. CONCLUSIONS: Revisionary surgical procedures performed for failed anti-reflux surgery are not limited to re-fundoplication. Different procedures such as takedown of the previous fundoplication, reconstruction of fundoplication, removal of the mesh, removal of the sutures or wedge resection may be necessary. These procedures can successfully be performed laparoscopically by experienced surgeons in well-equipped centers. KEY WORDS: Fundoplication, Gastroesophageal reflux, Laparoscopy, Revisional Surgery, Antireflux surgery.

Laparoscopic versus open complete meso-colic excision for right-sided colon cancer. Analysis of short-term outcomes.

SCOPO DELLO STUDIO: L'emicolectomia destra per escissione mesocolica completa (EMC) laparoscopica mostrerebbe benefici comparabili a breve termine, nonché esiti patologici e oncologici per la chirurgia a cielo aperto. Lo scopo di questo studio era di confrontare la tecnica laparoscopica e la EMC aperta per i tumori del colon sul lato destro in termini di campioni patologici e risultati a breve termine. MATERIALE E METODI: I dati dei pazienti sottoposti a EMC laparoscopica (n=31) e EMC aperto (n=35) per adenocarcinoma del colon destro tra gennaio 2016 e giugno 2019 sono stati analizzati retrospettivamente. Sono stati confrontati dati demografici, parametri preoperatori, peroperatori e postoperatori e campioni di patologia dei due gruppi. RISULTATI: Non ci sono state differenze statistiche tra il gruppo laparoscopico di EMC e il gruppo aperto di EMC in termini di età, sesso, indice di massa corporea, posizione del tumore, punteggio dell'American Society of Anesthesiologists (ASA), presenza di comorbidità, storia di altre neoplasie e precedente chirurgia addominale (p>0,05). I pazienti nel gruppo EMC laparoscopico presentavano lunghezze d'incisione più brevi, tempi operativi più lunghi, minore perdita di sangue operativa, tempi di mobilizzazione più brevi, recupero precoce del movimento intestinale, tempo più breve per dieta leggera, durata ridotta della degenza e dimensioni del tumore più piccole (p<0,05). Il numero medio di linfonodi raccolti in gruppi laparoscopici e di EMC aperti non era statisticamente significativo (29,83+8,90 e 31,34+13,10, rispettivamente). Non ci sono state differenze statistiche in termini di lunghezza del campione tra i gruppi laparoscopici e aperti di EMC (35,19+9,8 cm e 32,71+11,12 cm, rispettivamente). Il tasso di complicanze postoperatorie di 30 giorni era più elevato nel gruppo EMC aperto (35,5% contro 42,9%, rispettivamente), ma non statisticamente significativo (p>0,05). CONCLUSIONI: Patologici (lunghezze dei campioni, lunghezze dei margini di resezione, numero di linfonodi e resezione R0) e risultati a breve termine del gruppo laparoscopico di EMC erano comparabili. Inoltre, la EMC laparoscopica ha conferito benefici a breve termine in termini di lunghezze di incisione più brevi, minore perdita di sangue operativa, riduzione dei tempi di mobilizzazione, recupero precoce dei movimenti intestinali, minor tempo di dieta leggera e riduzione della durata della degenza ospedaliera. Sulla base di questi risultati, la EMC laparoscopica può essere considerata come un approccio elettivo di routine per il carcinoma del colon destro.

Evaluation of Bell's palsy in the cerebellopontine angle: An MRI study.

BACKGROUND: Evaluation of cranial nerve morphology through measuring cross-sectional area (CSA) on magnetic resonance imaging (MRI) is increasing day-by-day in clinical diseases. In Bell's palsy (BP), the manifestation of the enlarged CSA of the facial nerve (FN) may be used for diagnosis. This study aims to evaluate whether there is an enlargement of the cisternal FN in BP. METHODS: This retrospective study included 43 patients diagnosed with BP. In the reconstructed MRI, the long (LD) and short (SD) diameters of the paralytic and normal sides of the FNs located in the cerebellopontine angle were measured, and the CSA was calculated using the Radinsky formula. Before the radiologic measurement, a preliminary experiment was carried out on the rat sciatic nerve to be able to determine the actual nerve boundary on MRI. FINDINGS: There was a statistically significant relationship between paralytic and normal sides in the measurements of LD, SD, and CSA. The paralytic side was larger than the normal side in the cisternal FN. According to the Receiver Operating Characteristic (ROC) curve, BP can be estimated with 60% sensitivity and 70% specificity by the CSA of the FN more than 1.04 mm2 . As a result of the preliminary experiment, it was found that the actual nerve boundary was at approximately 50% intensity between the minimum and maximum values. CONCLUSION: Although entrapment of FN in the labyrinthine segment in BP was known, this study showed that the cisternal FN, which could be evaluated more conveniently, enlarged in the paralytic side compared with the normal side, and revealed the necessity of performing the comparison amongst the MRI studies on BP patients by a standardised measurement method. This study will also help clinicians to make a decision in the diagnosis of BP by giving a cut-off value for the CSA.

Evaluation of cochlear involvement and hearing function in lipoid proteinosis patients.

BACKGROUND: Lipoid proteinosis (LP) is a rare genodermatosis involving amorphous hyaline accumulation in the skin, oral mucosa, larynx, mucous membranes, and viscera. AIMS: In this study, we aimed to investigate the effects of hyaline accumulation on cochlear function and hearing in LP patients. PATIENTS/METHODS: In this prospective study, 20 patients who were followed up with a diagnosis of LP between October 2016 and April 2020 in our clinic and 20 healthy individuals of the same age and gender, as a control group, were included. Pure-tone audiometry, tympanometry, and distortion-product otoacoustic emission tests of the patient and control groups were performed. The audiological results of the LP and control groups were compared statistically. RESULTS: In the comparison of air-conduction thresholds between groups in pure-tone audiometry, hearing thresholds in the patient group were found to be higher than the control group at frequencies of 250, 4000, 6000, and 8000 Hz for the right ear, and 500 and 4000 Hz for the left ear. In the comparison of signal-noise responses between groups in distortion-product otoacoustic emission (DP-OAE) test, signal-noise responses in the right and left ear at frequencies of 1000, 2000, 4000, and 6000 Hz were lower in the patient group than in the control group. CONCLUSION: We found that the cochlear functions of patients with LP were affected due to the increase in hearing thresholds and decreased signal-noise responses. We think that LP patients are candidates for hearing loss in their later life.

Neutrophil-lymphocyte and platelet-lymphocyte ratios in otitis media with effusion in children: Diagnostic role and audiologic correlations.

AIM: To investigate the relationship between hearing loss and complete blood count parameters including neutrophil, lymphocyte, platelet (PLT), mean platelet volume (MPV), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in children with otitis media with effusion (OME). MATERIALS-METHOD: The study group was formed by 244 paediatric patients who underwent ventilation tube placement because of OME, and was split into two groups as serous and mucoid. The control group included 112 individuals who have no hearing problems. Hearing levels were determined with pure tone audiometry in the study group, preoperatively, and control group. The blood parameters were compared between the serous, mucoid and control groups. The correlation analysis was performed between the blood parameters and hearing levels in the study group. The blood parameters were compared between the groups identified by hearing loss classification. FINDINGS: There were significant negative correlations between hearing levels and each of NLR, PLR and MPV. There were significant positive correlations between hearing levels and each of the lymphocyte and PLT. According to the receiver operating characteristic (ROC) curves, serous OME can be estimated with 68% sensitivity and 61% specificity by the NLR value more than 1.1, and 77% sensitivity and 77% specificity by the PLR value more than 102.4. The ROC curve revealed that slight hearing loss could be estimated with 70% sensitivity and 73% specificity by the NLR value more than 1.31, and 78% sensitivity and 77% specificity by the PLR value more than 102.4. CONCLUSION: The present study revealed that NLR and PLR values were valuable parameters in the diagnosis of serous OME and predicting a hearing loss. These parameters may provide additional information to the audiogram that could influence the therapeutic decision.

Giant pedunculated colonic lipoma causing colo-colic intussusception in a patient with mechanical ileus.

A giant colonic lipoma causing colo-colonic intussusception is extremely rare in adults. A 35-year-old woman visited our emergency room with abdominal pain, abdominal distension, nausea and vomiting. Physical examination showed a painful distended abdomen. Abdominal computed tomography revealed that there was a soft-tissue mass with a fat density of approximately 6 cm in diameter in the distal part of the transverse colon. Since the clinical presentation was that of a mechanical ileus, a laparotomy was performed. An intussusception was detected in the transvers colon. A soft and mobile mass was palpated in the transverse colon. Therefore, an extended right hemicolectomy with ileo-transversostomy was performed. Pathological examination revealed a giant pedunculated lipoma of 7 cm in diameter with no evidence of malignancy. Colonic lipomas are the third most common benign pathology seen in the colon. They are more common in women with a peak incidence between 50 and 60 years of age. The most common site of lipomas in the large bowel is the right hemicolon. Colonic lipomas are usually asymptomatic but may cause bleeding, obstruction, intussusception, or abdominal pain. Colonic lipoma causing colo-colic intussusception is extremely rare in the current literature. Surgical approach remains the treatment of choice for giant colonic lipomas. A colonic lipoma causing colo-colic intussusception should be considered in the differential diagnosis of mechanical bowel obstruction. The most important factor for establishing the diagnosis of intussusception caused by a colonic lipoma is awareness of the possibility, especially in adult patients with abdominal symptoms and episodes of intestinal obstruction. KEY WORDS: Colon, Lipoma, Colonic lipoma, Intussusception, Intestinal obstruction, Ileus.

Is There any Possible Role of Neurotrophin 3 in the Pathogenesis of Antrochoanal Polyp?

OBJECTIVE: Antrochoanal polyp (ACP) is a benign soft tissue lesion arising from the inner wall of the maxillary sinus that extends into the nasal cavity and choana. Although it was first explained by Killian in 1906, the underlying pathogenesis has not been yet fully understood. Neurotrophins have been demonstrated to have a possible role in the pathogenesis of allergic rhinitis, idiopathic rhinitis and nasal polyps. To date any study has not investigated the function of neuronal inflammation and neurotrophins in the development of ACP. The objective of this study was to investigate the possible effect of neurotrophin-3 (NT-3) in ACP pathogenesis. METHOD: Twenty adult patients with ACP who underwent endoscopic sinus surgery in our department were included in the study group. The control group included 15 patients with concha bullosa of middle concha who underwent lateral excisional surgery. Nasal tissue NT-3 staining scores were evaluated using immunohistochemical methods. Blood NT-3 levels of both groups were evaluated by enzyme-linked immunosorbent assay (ELISA). RESULTS: There were no statistically significant differences between these two groups regarding tissue NT-3 staining scores (p=0.843) and blood NT-3 levels (p=0.463). In addition, no statistically significant correlation has been observed between tissue NT-3 staining scores and blood NT-3 levels in both ACP (p=0.578) and control (p=0.359) group patients. CONCLUSION: NT-3-related neuronal inflammation does not seem to have any role in ACP pathogenesis.

Prolapsed giant rectal gastrointestinal stromal tumor presented with incarceration A rare case of emergency rectal lesion.

Prolapse of the tumor is an extremely rare clinical presentation in patients with rectal gastrointestinal stromal tumor (GIST). A 79-year-old male patient was consulted in the in-patient ward of internal medicine clinic of our hospital due to his incarcerated hemorrhagic mass protruding from the anal canal. Anal inspection revealed an incarcerated prolapsed hemorrhagic mass larger than 10 cm in diameter that looked like a cauliflower. The incarcerated rectal GIST protruding from the anal canal was removed by transanal excision under the emergency conditions. Clean surgical margins were obtained. No postoperative complications occurred. The histological diagnosis of high-risk GIST was made. Imatinib mesylate treatment was started postoperatively. The colorectum are the less common primary sites in adult GISTs (5%). Giant GISTs of the anorectum represent a real potential for anorectal emergency. They may be involved in rectal bleeding, obstruction, prolapse or incarceration. Prolapse of the tumor is an extremely rare clinical presentation in cases of rectal GISTs, and only a few cases have been reported in the medical literature so far. Complete surgical resection with en bloc excision of the tumor is the treatment of choice. Lower rectal GISTs are a rare entity that requires multidisciplinary management and long-term surveillance. We recommend, in case of lower rectal GIST, to perform an initial transanal local excision that achieves the essential R0 resection and define the risk of aggressive behavior and the involvement of the resection margins. Patients' close follow-up is mandatory to disclose as soon as possible local recurrences or metastases. Preoperative imatinib mesylate therapy and downstaging of the tumor may play an important role. KEY WORDS: Gastrointestinal stromal tumor, Incarceration, GIST, Prolapse, Transanal excision.

Intractable external pancreatic fistula post-necrosectomy treated successfully with a fistulojejunostomy.

Pancreatic fistula formation is a known complication of pancreatic surgery, pancreatitis, and pancreatic injury. We here report a case of a 65-year-old man who was diagnosed with gallstone-induced acute pancreatitis with walledoff pancreatic necrosis. The patient initially underwent medical treatment and percutaneous drainage at 4 weeks. After a four-week period, a formal laparotomy with necrosectomy, and the catheter drainage of the cavity were performed. Having postoperatively developed a pancreatic fistula, the patient was managed conservatively. After 6 weeks of medical treatment, patient underwent an endoscopic retrograde pancreatography and was diagnosed with disconnected duct syndrome. The conservative management was continued for 3 more months. Pancreatic duct stenting was attempted but was not successful in cannulating the disconnected duct, and he was finally planned for a Roux-en-Y fistulojejnuostomy. The fistulojejunostomy was performed on an average of 6 months after placement of peri-pancreatic drain. The patient recovered uneventfully and is doing well at a 12-month follow-up. Refractory external pancreatic fistula is defined as an external pancreatic fistula not resolving with these measures for longer than 6 weeks. Most fistulas developing after acute pancreatitis are related directly to the need for necrosectomy to treat infected necrosis. Patients are initially approached conservatively. When patients fail to respond to either percutaneous drainage, endoscopic interventions, or novel techniques, operative intervention is the most viable approach to treat the fistula. Fistulojejunostomy is a safe and effective treatment for intractable pancreatic fistula having the benefit of avoiding a difficult major pancreatic resectional surgery, along with low postoperative morbidity and mortality. KEY WORDS: Acute pancreatitis, Pancreatic necrosis, Pancreatic fistula, Fistulojejunostomy.

Primary mesenteric fibromatosis: A single Center experience.

AIM: Primary mesenteric fibromatosis is a rare, locally invasive, non-metastasizing type of intra-abdominal fibromatoses with a very high rate of recurrence. In this study, we aimed to present our surgical approach, tumor characteristics, clinical presentation and long-term follow-up results in cases of primary mesenteric fibromatosis. MATERIAL AND METODS: The data collected from 11 patients who underwent surgery due to primary mesenteric fibromatosis in our clinic between 2010 and 2019 were analyzed retrospectively. RESULTS: Abdominal ipain, abdominal distention, and two patients (18.2%) were operated on with a diagnosis of acute abdomen in the emergency setting due to mechanical bowel obstruction in one patient There were 11 patients in our study. Six patients were female and 5 were male. The mean age was 44.2±15.8 years. Abdominal mass was detected in 5 patients (45.5%) who had complaints of mechanical bowel obstruction such as nausea and vomitingand gastrointestinal perforation in other patient. Mesenteric mass was detected in 3 patients (27.3%) with vague abdominal pain. One patient (9.1%) presented with abdominal pain and swelling of the right leg. After a mean follow-up period of 43.4±28.4 months, only 1 patient (9.1%) had recurrence and required reoperation approximately 80 months after the first operation. One patient (9.1%) died of anastomotic leakage and sepsis in the first 30 days postoperatively, and other patient (9.1%) idied of other reasons 1 year later postoperatively. CONCLUSIONS: Although mesenteric fibromatosis is a benign tumor pathologically, the main principle in the treatment of this tumor which is clinically aggressive and has high recurrence rate is wide surgical resection. Mesenteric fibromatoses have a varied clinical presentation. Radiological imaging methods helps diagnosis and planning the surgical treatment. Immunohistochemical characteristics confirms the diagnosis and differentiates from other similar tumors. KEY WORDS: Desmoid tumor, Fibromatosis, Mesentery, Mesenteric tumor,Mesenteric fibromatosis.

Quantitative Analysis of the Vascular and Neural Compartments of the Jugular Foramen in Dry Skulls.

AIM: To compare the right and left sides and the endo?exocranial orifices of the jugular foramen (JF) considering the vascular compartment (VC) and the neural compartment (NC). MATERIAL AND METHODS: A total of 20 human dry skulls belonging to the inventory of Medical Faculty, Department of Anatomy, were included in this study. Numerical values were obtained using direct anatomical and also computed tomography measurements. RESULTS: The endocranial and exocranial VC occupied wider areas on the right side than on the left side (p < 0.05). However, there was no statistically significant difference between the surface area of the endocranial and exocranial NC in terms of the sides (p > 0.05). The length of the endocranial VC was greater on the right than on the left side. The right exocranial VC was wider than the left exocranial VC. However, the widths and lengths of the endocranial and exocranial NC showed no statistically significant difference between the sides (p > 0.05). CONCLUSION: The right-sided dominance of JF observed in this study was attributed to the length of endocranial VC and the width of exocranial VC.

Growth dynamic of the geniculate ganglion in children: a retrospective computed tomography study.

PURPOSE: The main aim of this retrospective computed tomography (CT) study was to examine the morphometric development of the geniculate ganglion (GG) in children aged between 1 and 18 years for surgical approaches. METHODS: This study was placed on 41 patients (20 females and 21 males) including cochlear implantation cases aged from one to 18 (at mean, 6.44 ± 5.79) years. All the measurements belonging to the length, width and area of GG were performed with a CT scanner. RESULTS: The morphometric values of GG were not different in terms of sex or side, statistically (p > 0.05). The length (p = 0.155) of GG was not correlated with the increasing ages from one to 18 years; however, its area (p < 0.001) and width (p = 0.003) were found to be increased in the childhood period. Linear functions for the length, width and area of GG were calculated as y = 2.028 + 0.011 × age (years), y = 1.496 + 0.014 × age (years), and y = 3.239 + 0.035 × Age (years), respectively. The dehiscence of GG was found in 22 (26.8%) out of 82 temporal bones. CONCLUSION: Our data suggested that the area and width of GG were progressively increasing with age in the childhood period. The calculated formula representing the growth dynamic of GG in children and the incidence of the presence of the dehiscent GG can be useful for radiologists and otologists to estimate its size and to avoid iatrogenic injury during early childhood surgeries.