Reliability of Hem-o-Lok clip in laparoscopic appendectomy is an uncharted territory.

AIM: Laparoscopic appendectomy is increasingly used in the treatment of acute appendicitis. We aimed in the present report to evaluate the reliability of the Hem-o-Lok clip used in appendix stump capping for occluding orifice . MATERIAL AND METHODS: In this study, sequential laparoscopic appendectomy cases, in whom Hem-o-Lok clips was employed, in a single center between January 2017 and June 2020 because of acute appendicitis were retrospectively analyzed. RESULTS: The study was completed with a total of 305 cases who underwent laparoscopic appendectomy with hem-o-lok clips within the specified date range. There were no intraoperative complications in any of the cases. The number of women was 94 (30.8%) and the number of men was 211 (69.2%). The average age was 32.7 years. There were 275 (90.2%) patients without appendix perforations and 30 (9.8%) patients with perforations.Postoperative complications occurred in 13 patients. Surgical site infection in five patients, mechanical intestinal in two patients, intraabdominal abscess in five patients, and hematoma at the trocar entry site in one patient were observed. There were no intraoperative complications in any of the patients. CONCLUSIONS: Hem-o-Lok clip can be applied safely in laparoscopic appendectomy for the capping of the appendix stump, with its easy-to-use and low-cost features. KEY WORDS: Acute appendicitis, Laparoscopic appendectomy, Hem-o-lok clip.

The evaluation of the Myxovirus Resistance 1 protein in serum and saliva to monitor disease activation in primary Sjögren's syndrome.

OBJECTIVE: Primary Sjögren's syndrome (pSjS) is a chronic autoimmune disease that causes dry eye and mouth. No laboratory parameters to monitor the activation of this disease have been identified. Therefore, any possible relationships between salivary and blood myxovirus resistance 1 (MX1) and pSjS must be prospectively studied. METHODS: Thirty female patients with pSjS, 30 women with rheumatoid arthritis (RA) without secondary Sjögren's syndrome (SjS) and 28 healthy control women were enrolled in this investigation. Analyses of MX1 by the enzyme-linked immunosorbent assay (ELISA) method, SS-A (Ro) and SS-B (La) tests by the strip immunoblot method, anti-nuclear antibody (ANA) tests by immunofluorescence and the measurement of serum rheumatoid factor (RF), C3, C4, immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin G (IgG) were performed. RESULTS: The serum level of MX1 in patients without Raynaud phenomenon was higher than in those with Raynaud phenomenon (p:0.029, p<0.05, statistically significant). There was a statistically significant positive association between hemoglobin levels and MX1 serum levels. No statistically significant association was found among the other parameters. Low MX1 levels were shown to be associated with both a low disease activity score based on the European League Against Rheumatism (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI) and hydroxychloroquine use in all patients. CONCLUSION: MX1 levels have a considerable impact on the assessment of the disease activity in SjS. We believe that more-comprehensive studies should be performed on patients with pSjS who do not use hydroxychloroquine to prove this relationship and that MX1 levels should be used as a routine marker for the assessment of pSjS disease activity. Further studies are needed to create awareness of the role that MX1 has in the diagnosis of pSjS, which may help to uncover novel pathways for new therapeutic modalities.

The evaluation of the Myxovirus Resistance 1 protein in serum and saliva to monitor disease activation in primary Sjögren's syndrome

OBJECTIVE: Primary Sjögren's syndrome (pSjS) is a chronic autoimmune disease that causes dry eye and mouth. No laboratory parameters to monitor the activation of this disease have been identified. Therefore, any possible relationships between salivary and blood myxovirus resistance 1 (MX1) and pSjS must be prospectively studied. METHODS: Thirty female patients with pSjS, 30 women with rheumatoid arthritis (RA) without secondary Sjögren's syndrome (SjS) and 28 healthy control women were enrolled in this investigation. Analyses of MX1 by the enzyme-linked immunosorbent assay (ELISA) method, SS-A (Ro) and SS-B (La) tests by the strip immunoblot method, anti-nuclear antibody (ANA) tests by immunofluorescence and the measurement of serum rheumatoid factor (RF), C3, C4, immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin G (IgG) were performed. RESULTS: The serum level of MX1 in patients without Raynaud phenomenon was higher than in those with Raynaud phenomenon (p:0.029, p<0.05, statistically significant). There was a statistically significant positive association between hemoglobin levels and MX1 serum levels. No statistically significant association was found among the other parameters. Low MX1 levels were shown to be associated with both a low disease activity score based on the European League Against Rheumatism (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI) and hydroxychloroquine use in all patients. CONCLUSION: MX1 levels have a considerable impact on the assessment of the disease activity in SjS. We believe that more-comprehensive studies should be performed on patients with pSjS who do not use hydroxychloroquine to prove this relationship and that MX1 levels should be used as a routine marker for the assessment of pSjS disease activity. Further studies are needed to create awareness of the role that MX1 has in the diagnosis of pSjS, which may help to uncover novel pathways for new therapeutic modalities.

THE ROLE OF SERUM CK-18, MMP-9 AND TIPM-1 LEVELS IN PREDICTING R0 RESECTION IN PATIENTS WITH GASTRIC CANCER.

BACKGROUND: Gastric cancer is the 3rd most common cause of death in men and the 5th common in women worldwide. Today, surgery is the only curative therapy. Currently available advanced imaging modalities can predict R0 resection in most patients, but it can only be detected with certainty in the perioperative period. AIM: To determine the role of serum CK18, MMP9, TIMP1 levels in predicting R0 resection in patients with gastric cancer. METHODS: Fifty consecutive patients scheduled for curative surgery with gastric adenocarcinoma diagnosed between 2013-2015 were included. One ml of blood was taken from the patients to analyze CK18, MMP9 and TIMP1. RESULTS: CK18, MMP9 and TIMP1 levels were positively correlated with pathological N and the stage (p<0,05). CK-18, MMP-9 and TIMP-1 averages in positive clinical lymph nodes and in clinical stage 3, were found to be higher than the averages of those with negative clinical lymph nodes and in clinical stage 2 (p<0,05). CONCLUSION: Although serum CK-18, MMP-9 and TIMP-1 preoperatively measured in patients scheduled for curative surgery did not help to evaluate gastric tumor resectability, they were usefull in predicting N3-stage.

Morgagni's Hernia: Analysis of 21 Patients with Our Clinical Experience in Diagnosis and Treatment.

A Morgagni's hernia is a congenital defect found in the anterior aspect of the diaphragm between the costal and the sternal portions of this muscle. This defect is also referred to as the space of Larrey. It has been reported that 70% of patients with Morgagni's hernia are female, 90% of the hernias are right-sided, and 92% of the hernias have hernia sacs. This type of hernia is a rare clinical entity and accounts for 3% of all surgically treated diaphragmatic hernias. There are no large retrospective or prospective studies on this topic. This type of hernia is a rare type among adults without a well-described prevalence and without well-established definitive management strategies. There are also few clinical reports about this clinical entity and its surgical treatment. We treated 21 patients with Morgagni's hernia in a 12-year period, and we report our experience while discussing the surgical treatment of this disease. We performed a retrospective review of the 21 patients who were operated between 2003 and 2015. These patients had undergone surgical repair of Morgagni's hernia. For each subject, demographic data, symptoms of presentation, physical examination findings, preoperative imaging studies and diagnosis, and surgical procedures were documented. Location of the hernia sac and its contents, postoperative complications, and duration of hospital stay were recorded and evaluated. Twelve patients were females and nine were males. The mean age of patients was 63.85 years. Dyspnea was the most prominent symptom in our patients. Morgagni's hernias were located on the right side in 19 patients and on the left side in 2 patients. Chest X-ray in 10 patients and abdominal computerized tomography in 17 patients were the major diagnostic tools. Four patients were operated as emergency while others underwent elective surgery (17 patients). Twelve patients were operated with laparoscopy and the remaining nine were operated with the conventional open abdominal technique. Hernia sacs were observed in all of the patients and removed except in four of them. The omentum and the transverse colon were the most commonly seen organs in hernia sacs. Hernia defects were repaired with primary sutures in four patients (all open cases) and primary closure supported with mesh in six patients (four laparoscopic, two open cases). In the remaining 11 patients, hernia defects were closed with synthetic meshes (eight laparoscopic, three open cases). Mean postoperative hospital stay was 9.8 days. No recurrence was observed in any patients. Only one of our patients died during follow-up. In Morgagni's hernias, surgical intervention is necessary as the hernia may cause complications such as strangulation of the colon or intestines. A laparoscopic approach has increased its popularity in recent years because of the well-known advantages of laparoscopy.

Analysis of 89 patients who underwent tube thoracostomy performed by general surgeons.

OBJECTIVE: Death due to thoracic trauma accounts for 20% of all trauma deaths. The aim of this study was to discuss the approach applied by general surgeons to thoracic trauma in our center. MATERIAL AND METHODS: A total of 89 patients (82 male, 7 female; mean age: 26.8 years; range: 7 to 77 years) with thoracic trauma who were admitted to the emergency department and underwent thoracostomy performed by general surgeons between January 2008 and December 2013 were retrospectively analyzed. RESULTS: Penetrating trauma was found in 61 patients (68%); this was the most common cause of thoracic trauma. Pneumothorax, the most common clinical sign, was found in 57 patients (64%). Abdominal pathologies, the most common concomitant extra-thoracic pathologies, were found in 17 patients (19%). Fifteen patients (17%) underwent laparotomy due to intra-abdominal organ injuries. Splenic trauma and diaphragmatic injury were detected in five patients. Complications were seen in two patients (2.2%): one had an air leak and one had persistent pneumothorax. Three patients with multi-trauma died in the early period due to additional pathologies. No mortality was seen in any patient due to thoracic trauma. CONCLUSION: All general surgeons should be highly familiar with approaches to thoracic trauma, and necessary interventions should be performed in emergency situations. It is also essential to correctly identify patients who require timely and appropriate referral to a tertiary center to reduce the rates of mortality and morbidity.

The Role of Serum CK18, TIMP1, and MMP-9 Levels in Predicting R0 Resection in Patients with Gastric Cancer.

Gastric cancer is the third most common cause of death in men and the fifth common cause of death in women worldwide. Currently, available advanced imaging modalities can predict R0 resection in most patients in the perioperative period. The aim of this study is to determine the role of serum CK18, MMP-9, and TIMP1 levels in predicting R0 resection in patients with gastric cancer. Fifty consecutive patients scheduled for curative surgery with gastric adenocancer diagnosis between 2013 and 2015 were included in the study. One milliliter of blood was taken from the patients included in the study to examine CK18, MMP-9, and TIMP1. CK18, MMP-9, and TIMP1 levels were positively correlated with pathological N and the stage (P < 0.05). The CK18, MMP-9, and TIMP1 averages of those with positive clinical lymph nodes and those in clinical stage 3 were found to be higher than the averages of those with negative clinical lymph nodes and those in clinical stage 2 (P < 0.05). Although serum CK18, MMP-9, and TIMP1 preop measurements in patients scheduled for curative surgery due to gastric adenocarcinoma did not help to gain any idea of tumor resectability, we concluded that our study had valuable results in significantly predicting N3 stage.

The role of serum ck-18, mmp-9 and tipm-1 levels in predicting r0 resection in patients with gastric cancer / O papel dos níveis séricos de ck-18, mmp-9 e tipm-1 na predição da ressecção r0 em pacientes com câncer gástrico

ABSTRACT Background: Gastric cancer is the 3rd most common cause of death in men and the 5th common in women worldwide. Today, surgery is the only curative therapy. Currently available advanced imaging modalities can predict R0 resection in most patients, but it can only be detected with certainty in the perioperative period. Aim: To determine the role of serum CK18, MMP9, TIMP1 levels in predicting R0 resection in patients with gastric cancer. Methods: Fifty consecutive patients scheduled for curative surgery with gastric adenocarcinoma diagnosed between 2013-2015 were included. One ml of blood was taken from the patients to analyze CK18, MMP9 and TIMP1. Results: CK18, MMP9 and TIMP1 levels were positively correlated with pathological N and the stage (p<0,05). CK-18, MMP-9 and TIMP-1 averages in positive clinical lymph nodes and in clinical stage 3, were found to be higher than the averages of those with negative clinical lymph nodes and in clinical stage 2 (p<0,05). Conclusion: Although serum CK-18, MMP-9 and TIMP-1 preoperatively measured in patients scheduled for curative surgery did not help to evaluate gastric tumor resectability, they were usefull in predicting N3-stage.

RESUMO Racional: Câncer gástrico é a terceira causa mais comum de morte em homens e a quinta em mulheres em todo o mundo. Atualmente a cirurgia é a única terapia curativa. As modalidades de imagem avançadas atualmente disponíveis podem prever a ressecção R0 na maioria dos pacientes, mas ela só pode ser detectada durante o perioperatório. Objetivo: Determinar o papel dos níveis séricos de CK18, MMP9 e TIMP1 na predição da ressecção R0 em pacientes com câncer gástrico. Métodos: Foram incluídos no estudo pacientes consecutivos agendados para operação curativa entre 2013-2015. Foi retirado 1 ml de sangue dos pacientes incluídos para estudar CK18, MMP9 e TIMP1. Resultados: Os níveis de CK18, MMP9 e TIMP1 foram positivamente correlacionados com o N patológico e o estadiamento (p<0,05). As médias CK-18, MMP-9 e TIMP-1 das pessoas com linfonodos positivos e aqueles em estágio clínico 3 foram superiores às médias das pessoas com linfonodos negativos e estágio clínico 2 (p<0,05). Conclusão: Embora as dosagens séricas de CK-18, MMP-9 e TIMP-1 em pacientes agendados para operação curativa por adenocarcinoma gástrico não ajudem a ter ideia de ressecabilidade tumoral, ela foi útil na predição de estadiamento N3.

Is it possible to reduce the surgical mortality and morbidity of peptic ulcer perforations?

OBJECTIVE: Peptic ulcer perforation is a life-threatening situation requiring urgent surgical treatment. A novel vision in peptic ulcer perforation is necessary to fill the gaps created by antiulcer medication, aging of the patients, and presentation of resistant cases in our era. In this study, we aimed to share our findings regarding the effects of various risk factors and operative techniques on the mortality and morbidity of patients with peptic ulcer perforation. MATERIAL AND METHODS: Data from 112 patients presenting at our Training and Research Hospital Emergency Surgery Department between January 2010 and December 2015 who were diagnosed with PUP through physical examination and laboratory and radiological tests and operated at the hospital have been retrospectively analyzed. Patients were divided into three groups based on morbidity (Group 1), mortality (Group 2), and no complication (Group 3). RESULTS: Of the 112 patients included in the study, morbidity was observed in 21 (18.8%), mortality in 11 (9.8%), and no complication was observed in 80 (71.4%), who were discharged with cure. The differences between group for the average values of the perforation diameter and American Society of Anesthesiologists, Acute Physiology and Chronic Health Evaluation II, and Mannheim Peritonitis Index scores were statistically significant (p<0.001 for each). The average values for the group with mortality were significantly higher than those of the other groups. CONCLUSION: In this study where we investigated risk factors for increased morbidity and mortality in PUPs, there was statistically significant difference between the average values for age, body mass index, perforation diameter, and Acute Physiology and Chronic Health Evaluation II and Mannheim Peritonitis Index scores among the three groups, whereas the amount of subdiaphragmatic free air did not differ.

Comparison of the effects of spinal epidural and general anesthesia on coagulation and fibrinolysis in laparoscopic cholecystectomy: a randomized controlled trial: VSJ Competition, 2nd place.

INTRODUCTION: Laparoscopic cholecystectomy (LC) is usually performed under general anesthesia. Recently, laparoscopic cholecystectomy under regional anesthesia has become popular, but this creates a serious risk of thromboembolism because of pneumoperitoneum, anesthesia technique, operative positioning, and patient-specific risk factors. AIM: This randomized controlled trial compares the effects of two different anesthesia techniques in laparoscopic cholecystectomy on coagulation and fibrinolysis. MATERIAL AND METHODS: This randomized prospective study included 60 low-risk patients with deep vein thrombosis (DVT) who underwent elective LC without thrombo-emboli prophylaxis. The patients were randomly divided into two groups according to the anesthesia technique: the general anesthesia (group 1, n = 30) and spinal epidural anesthesia (group 2, n = 30) groups. Measurement of the prothrombin time (PT), thrombin time (TT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), and blood levels of D-dimer (DD) and fibrinogen (F) were recorded preoperatively (pre), at the first hour (post 1) and 24 h (post 24) after the surgery. These results were compared both between and within the groups. RESULTS: The mean age was 51.5 ±16.7 years (range: 19-79 years). Pneumoperitoneum time was similar between group 1 (33.8 ±7.8) and group 2 (34.8 ±10.4). The TT levels significantly declined postoperatively in both groups. The levels of PT, aPTT, INR, D-dimer and fibrinogen dramatically increased postoperatively in both groups. CONCLUSIONS: While there was not any DVT, there was a significant decline in TT. There was a dramatic rise in the PT, INR, D-dimer, fibrin degradation products (FDP), and fibrinogen following LC. This may be attributed to the effects of pneumoperitoneum and anesthesia techniques on portal vein flow.

Spinal anesthesia is safe in laparoscopic total extraperitoneal inguinal hernia repair. A retrospective clinical trial.

INTRODUCTION: Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is an effective and safe method for the treatment of inguinal hernia. There are very few studies on regional anesthesia methods in TEP surgery. AIM: To compare TEP inguinal hernia repair performed when the patient was treated under spinal anesthesia (SA) with that performed under general anesthesia (GA). MATERIAL AND METHODS: All total of 80 patients were studied between December 2015 and March 2017. Hyperbaric bupivacaine and fentanyl were used for SA, to achieve a sensorial level of T3. Propofol, sevoflurane, rocuronium, fentanyl, and tracheal intubation were used for GA. Intraoperative events related to SA, surgical times, intra- and postoperative complications, and pain scores were recorded. RESULTS: The mean operative time in the SA TEP group was 70.2 ±6.7 min, which was significantly longer than the mean operative time in the GA TEP group of 67.2 ±6.2 min (p < 0.038). The mean pain scores in the SA TEP group were 0.23 ±0.42 at the first hour, 1.83 ±0.64 at 6 h and 1.28 ±0.45 at 24 h. These scores were significantly lower than the corresponding scores of 5.18 ±0.84 (p < 0.001), 2.50 ±0.55 (p < 0.001) and 1.58 ±0.55 in the GA TEP group. Generally, patients were more satisfied with SA than GA (p < 0.004). CONCLUSIONS: Spinal anesthesia TEP is significantly less painful in the early postoperative period, leading to earlier ambulation than GA TEP. Additionally, SA TEP results in significantly less need for analgesics and better patient satisfaction results. SA TEP seems to be a better alternative than the existing GA TEP.

Predictive value of fine needle aspiration biopsy of axillary lymph nodes in preoperative breast cancer staging.

OBJECTIVE: Diagnosis of axillary nodal involvement is significant in the management of breast cancer as well as in predicting prognosis. In this prospective study, we evaluated the efficiency of US-guided fine needle aspiration biopsy (FNAB) in preoperative axillary staging of early breast cancer. MATERIAL AND METHODS: Between January 2011 and July 2013, 46 women were prospectively enrolled in the study. Ultrasound guided-FNABs for axillary assessment were performed preoperatively. Cytology results were compared with histopathology reports to determine its sensitivity, specificity, negative and positive predictive value and accuracy. RESULTS: Nineteen cases that had malignant cytology on FNAB also had axillary involvement in axillary lymph node dissection (ALND) without any false-positive results. The sensitivity and specificity of US-guided FNAB were 63.3% and 100%, respectively. US-guided FNAB was accurate in predicting the status of the axilla in 76.1% of patients. CONCLUSION: Although this technique is favorable due to its minimally invasive nature, it is not as effective as sentinel lymph node biopsy (SLNB) in terms of detecting axillary metastasis preoperatively. The low sensitivity and low accuracy rates decrease the usefulness of the technique. Therefore, it seems that US-guided FNAB alone could not replace SLNB. Nevertheless, combining some other molecular studies may be useful in increasing the technique's sensitivity. These issues should be determined by comprehensive clinical trials.

Retained Textile Foreign Bodies: Experience of 27 Years.

INTRODUCTION AND AIM: Retained intracorporeal textile products (gossypiboma-textiloma) are undesired and accidental surgical results for both patients and surgeons, which are underreported because of medicolegal remifications. Fourteen textiloma cases, who had been treated or whose treatment procedures had been followed-up personally by two general surgeons in a period of 27 years almost during their whole professional lives were presented to describe and define the clinical and pathological characteristics. MATERIAL AND METHODS: Patient characteristics including gender and age, areas of location within the body, time intervals until diagnosis, clinical presentations and complaints, treatment modalities, complications, causative surgical interventions, and diagnostic approaches were retrospectively evaluated. RESULTS: Nine female and five male patients with a mean age of 43.07 ± 15.23 (median: 45) years at diagnosis were enrolled in the study. Cesarean section in three, inguinal hernioraphy in four, explorative laparotomy because of acute abdomen in one, sigmoid colon resection in one, appendectomy and right salpingoophorectomy in one, etrangulated incisional hernia after a previous surgical intervention because of an ovarian mass in one, thyroidectomy in one, epigastric hernioraphy in one, and bilateral segmental mastectomy with bilateral axillary sentinal lymph node dissection in one were the causative surgical interventions. Locations of textilomas were the abdominal cavity in seven, inguinal surgical wound in four, epigastric surgical wound in one, thyroidectomy lodge in one, and bilateral axillary cavities in one patient. The mean time interval until diagnosis was 14.48 (median: 5.5) months. DISCUSSION: Earlier recognition of foreign bodies can provide a better outcome. CONCLUSION: Gossypibomas are preventable iatrogenic faults which create severe problems. Strict adherence to the rules of the operation room is a must to keep the tip of the iceberg shut in the Pandora's box.

Introdução e Objetivos: A retenção de materiais têxteis após a cirurgia é uma situação indesejada, tanto para o doente como para o cirurgião. Frequentemente são subnotificados por questões de natureza médico-legal. Apresentamos 14 casos de textilomas (compressoma) que foram tratados ou seguidos pessoalmente por dois cirurgiões gerais num período de 27 anos para descrever e definir as características clínicas e patológicas. Material e Métodos: Foram avaliados retrospectivamente os dados relativos a uma serie de casos, nomeadamente: características dos doentes (sexo e idade), localização anatómica do corpo estranho, intervalo de tempo até ao diagnóstico, apresentação clínica, queixas, abordagem diagnóstica, motivo de cirurgia, tipo de tratamento cirúrgico e complicações. Resultados: Foram identificados nove doentes do sexo feminino e cinco do sexo masculino, com uma média de idades de 43,07 ± 15,23 (mediano: 45) anos para o momento do diagnóstico. Em três doentes a cirurgia prévia foi cesariana, em quatro casos herniorrafia inguinal, um doente submetido a laparotomia exploradora por abdome agudo, um doente no qual foi realizado uma sigmoidectomia, uma doente submetida a apendicectomia e salpingooforectomia direita, uma doente na qual a cirurgia anterior tinha sido para corrigir uma hérnia incisional após laparotomia por neoplasia do ovário, um caso de tiroidectomia total, uma herniorrafia por hérnia epigástricae uma doente submetida cirurgia conservadora bilateral da mama com pesquisa de gânglio sentinela. A localização mais frequente dos compressomas foi intra-abdominal em sete casos, em quatro doentes a localização foi inguinal, um caso localizado na incisão da correcção da hérnia epigástrica, um doente com textiloma na loca de tiroidectomia, e no caso da doente submetida a cirurgia conservadora da mama em ambas regiões axilares se encontraram corpos estranhos/compressomas. O intervalo de tempo foi em média14,48 (mediano: 5,5) meses. Discussão: A identificação precoce de corpos estranhos pode assegurar um desfecho mais positivo. Conclusão: Os compressomas são uma forma de iatrogenia evitável com consequências graves. O cumprimento rigoroso das normas no bloco operatório é essencial para manter a ponta do iceberg fechado na caixa de Pandora.

Multiple caeco-appendiceal fistulas and diverticulosis: a newly defined congenital anomaly of the appendix-report of the first case.

INTRODUCTION: Congenital anomalies of the appendix are extremely rare. They are usually found incidentally during operations other than appendectomies. Congenital appendix diverticula are even less frequent. DISCUSSION: Congenital caeco-appendiceal fistulae have not been reported until today. Herein, we present real diverticula of the appendix with multiple caeco-appendiceal fistulae which, to our knowledge, is the first in the literature.

Paratesticular liposarcoma: a radiologic pathologic correlation.

Spermatic cord liposarcoma is an uncommon paratesticular tumor. Patients usually present with a painless scrotal or inguinal mass, mimicking inguinal hernia. Clinical examination suggested an inguinal hernia. Computed tomography demonstrated a fat-containing mass in the right inguinal region. The mass was surgically removed, along with the right testis and spermatic cord. Histopathological examination revealed a well-differentiated liposarcoma. No evidence of recurrence or metastases has been noted during the two-year follow-up with postoperative adjuvant therapy.

Gastrointestinal Stromal Tumors with Unusual Localization: Report of Three Cases with a Brief Literature Review.

The most common tumors derived from the mesenchyme of the gastrointestinal system are stromal tumors. These tumors are typically seen in the stomach and small intestine and less frequently in the colon, rectum and esophagus and are very rarely located outside the gastrointestinal system. Cure is provided with complete surgical resection with resection borders free of tumor. Tumor size, mitotic index, localization, CD117 and CD34 negativity in immunohistochemical studies, mucosal ulceration and presence of necrosis help to predict recurrence of the illness and patient survival. In high-risk gastrointestinal stromal tumors (GISTs) there is an increased rate of recurrence and shortened survival despite complete surgical resection. Thus patients with a high-risk GIST should be given adjuvant therapy with imatinib mesylate. Sunitinib maleate is another FDA-approved agent only for cases who cannot tolerate imatinib or who are resistant to it. Herein we present three cases with GISTs in different locations of the gastrointestinal system with a review of the relevant literature.