Investigation of the effects of post-operative intraperitoneal, oral, and rectal phenytoin administration on colorectal anastomosis in rats.

BACKGROUND: Anastomotic leakage is the most feared complication after colonic anastomosis. The purpose of the study is to determine the effects of phenytoin applied by different application routes, on the healing process of colorectal anastomoses. METHODS: Wistar Albino rats were divided into Intraperitoneal Phenytoin Group, Oral Phenytoin Group (OAP), Rectal Phenytoin Group (RAP), and control groups. The molecular effect of phenytoin on the expression of vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF-ß), fibroblast growth factor 2 (FGF2), and p53 genes was evaluated at mRNA and protein level. The effects of phenytoin on anastomotic bursting pressure analysis measured as well as pathohistological examinations. RESULTS: There are statistically significant increase in anastomotic bursting pressure values between control and application groups. Inflammatory cell infiltration of all groups increased in the intestinal anastomosis region compared to control. Collagen scores were found to be significantly higher in the OAP and RAP groups compared to the control group. mRNA of TGF-ß and FGF2 expression increased in all routes of phenytoin applications. CONCLUSION: Three different administration routes show considerably increase on the bursting pressure. Regarding the results of the expression of FGF2, TGF-ß, p53, and VEGF genes, there is a significant increase FGF2 and TGF-ß at mRNA and protein level in most administration routes.

Importance of HALP Score in Breast Cancer and its Diagnostic Value in Predicting Axillary Lymph Node Status.

OBJECTIVE: To determine the diagnostic value of the haemoglobin, albumin, lymphocyte, and platelet (HALP) score in predicting axillary lymph node (ALN) involvement. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of General Surgery, Balikesir University and Mersin City Hospital, Turkey from January 2016-December 2021. METHODOLOGY: Included in the study were 307 patients who underwent surgical treatment for breast cancer. HALP values were calculated by multiplying the haemoglobin, albumin, and lymphocyte values and dividing the resulting value by the platelet number. The patients were divided in two groups, being those with low HALP (Group 1) and high HALP (Group 2) scores. We examined the potential of the HALP score for the prediction of ALN involvement. RESULT: Group 1 had 65 patients and the Group 2 had 242 patients. At the cut-off point, a HALP score of <29.01 predicted the presence of axillary involvement with a sensitivity of 84.33% and a specificity of 26.1%. The sentinel lymph node sampling rate was similar in both groups (12.3% vs. 16.9% p=0.365). The presence of positive lymph nodes in the axilla was higher in group 1 (67.7% vs. 53.3% p=0.038). There was no correlation between HALP score, and the metastatic lymph node and total lymph node count. CONCLUSION: The use of HALP score alone for the prediction of axillary lymph node positivity in patients with breast cancer is not advised. In the present study, a low HALP score was associated with aggressive tumour activity, such as advanced tumour and axillary lymph node positivity. KEY WORDS: Breast cancer, Axillary lymph node involvement, Immunity, Nutrition.

Endometriosis within the inguinal hernia sac.

Endometriosis is characterized by the presence of histologically normal endometrial tissue outside the uterine cavity. Endometriotic implants are usually located in the pelvic organs, but they have been described in almost every location of the female body. It may also be present after cesarean section or other gynecological operations. In this study, we reported a rare case of endometriosis located in an indirect inguinal hernia sac.

Ectopic Adrenal Gland Tissue In The Inguinal Hernia Sac Occuring In An Adult.

Ectopic adrenal tissue is a benign lesion generally determined incidentally during a surgical intervention applied for another reason. This tissue may be present along the path of the testicles and groin discovered during surgery. While the condition has been mainly reported in the pediatric population, it is very rarely reported in adults. The aim of this study was to present an adult patient with ectopic adrenal tissue which was determined incidentally within an indirect inguinal hernia sac.

Localization of Helicobacter pylori gastritis and the relation of existing histopathological features with reflux esophagitis.

Background/aims: Interactions between Helicobacter pylori (Hp) and gastroesophageal reflux disease (GERD), which are common diseases worldwide, are confusing. In this study, the aim was to compare and evaluate the relationship between reflux esophagitis (RE) and Hp infection in adult patients with both the gastric localization of Hp and its histopathologic features.Materials and methods: 248 patients with RE were compared with 249 age and sex matched control groups. Biopsy specimens obtained from the gastric antrum and corpus were histologically evaluated.Findings: The incidence of Hp infection was significantly lower in patients with RE than in the control group (Ratio 1.53, 95% CI 1.07-2.20; p = .02, p < .05). Corpus Hp colonization and corpus gastritis scores were notably lower in the study group (p = .01, p < .05), whereas there was no significant difference in Hp colonization and antrum gastritis scores in the antrum. Corpus Hp colonization and gastritis scores were found to be negatively correlated with esophagitis development (r = -0.11; p = .01; (r = -0.14; p = .00 respectively, p < .05). There was no difference between the groups in terms of atrophy development (p > .05).Conclusion: This study showed that the presence of Hp infection in the corpus and corpus gastritis score was significantly lower in patients with erosive reflux esophagitis than in the control group. It also showed that Hp colonization and corpus gastritis scores were negatively correlated with esophagitis development. This inverse relationship was independent of atrophy.

A rare breast tumor: primary neuroendocrine carcinoma.

Breast cancer is the most frequently seen cancer in females but primary neuroendocrine carcinoma of the breast, which was defined as a separate entity in the 2003 World Health Organisation tumour classification, is seen extremely rarely. This entity, which is still not well-defined and has not been well-researched, demonstrates a more aggressive course than invasive ductal carcinoma. As metastatic breast neuroendocrine tumours are more widespread and the treatment strategy is different, preoperative differential diagnosis is important. The basic diagnostic method is pathological examination. If a neuroendocrine pattern is determined in microscopy, then immunohistochemical study of neuroendocrine markers should be made. It is necessary to be vigilant in terms of synchronous tumours and metachronous tumours which may develop in the postoperative period as the incidence of synchronous and metachronous cancers in patients with neuroendocrine tumours is higher compared to the general population. The case presented here is of a 73-year old patient who presented with complaints of a breast lump, which was thought to be invasive breast cancer, and as a result of the operation with pathological and immunohistochemical examination, primary neuroendocrine carcinoma of the breast was determined. With more advanced evaluations, no synchronous or metachronous tumours were determined.

Pneumatosis cystoides intestinalis: A rare cause of intraabdominal free air.

Pneumatosis cystoides intestinalis is a rarely seen disease characterized by cysts filled with multiple gases in the wall of the small or large intestine. Many factors have been suggested in the etiology and pathogenesis, including peptic ulcer, pyloric stenosis, and endoscopic trauma. Because various clinical characteristics and symptoms are observed together, diagnosis is generally difficult. It may be a cause of free air observed on direct radiographs. Treatment is directed at the cause and although there is generally a good course, it can sometimes lead to severe complications. In this paper, we present the case of a 33-year old male being prepared for surgery for pyloric stenosis due to a peptic ulcer. In the preoperative tests, because acid was determined within the abdomen and free air below the diaphragm, pneumatosis cystoides intestinalis was considered in the differential diagnosis. Definitive diagnosis was made during the operation and surgical treatment was applied.

Development of acute cholecystitis following laparoscopic partial cholecystectomy.

In cases where the dissection of Calot's triangle is difficult during laparoscopic cholecystectomy, laparoscopic partial cholecystectomy is an alternative to total cholecystectomy to prevent bile duct damage. However, recurrent symptoms and bile duct problems associated with the remaining gallbladder tissue may develop in patients over time. The case of a 45-year-old male who underwent laparoscopic partial cholecystectomy one year previously is presented here. In the postoperative period, as a result of tests for the continuing symptoms of cholecystitis, stones and surrounding abscess were detected in the remaining gallbladder tissue, so open completion cholecystectomy was applied. In acute cholecystitis, as severe inflammation of the hilar structures does not allow safe dissection, partial cholecystectomy can be applied. However, in these patients, there is a risk of recurrence of cholecystitis symptoms and the development of biliary pancreatitis and choledocolithiasis because of the remaining tissue. Therefore, it should not be forgotten that endoscopic and/or surgical intervention may be necessary at least in some patients.

Foreign body in the stomach: Dentures.

Although it is mostly observed in childhood, swallowing foreign bodies causes morbidity and mortality of a high percentage in the adult age group. Swallowed foreign bodies can be both harmless as well as life-threatening. The number, shape, size, and time of the swallowed foreign body to get deposited in the specific location determines the type of treatment. Late diagnosis and treatment is an important problem that causes perforation and obstruction. In this article, we presented a 39-year-old male patient who swallowed his denture while sleeping.

Bogota Bag Use in Planned Re-Laparotomies.

BACKGROUND Planned re-laparotomies are a series of surgical interventions that are rarely used and have a high mortality rate. The aim of this study was to investigate the factors affecting mortality and the effectiveness of the use of the Bogota bag for temporary closure of the abdomen in patients for whom re-laparotomy was planned. MATERIAL AND METHODS A retrospective examination was made of data of patients in whom a Bogota bag was used in planned re-laparotomies for various reasons in the General Surgery Department of Suleyman Demirel University Medical Faculty between June 2008 and April 2014. RESULTS Bogota bags were used in a total of 38 patients, comprising 23 (60.5%) males and 15 (39.5%) females, with a mean age of 58.94±17.89 years. The mean period of hospitalization was 14.5 days (range, 1-143 days) and the mean number of operations during that time was 3 (range, 1-11). The mean duration of intensive care unit stay was 6 days (range, 1-143 days). Malignancy was determined in 8 patients (21.1%). Indications were intra-abdominal sepsis in 23 patients (60.5%), mesenteric vascular disease in 10 patients (26.3%), and packing was required in 5 patients (13.2%). Mortality developed in 25 patients (65.8%). A significant relationship was determined between mortality and a diagnosis of mesenteric artery ischemia (p: 0.035). The mortality rate was 56% (n: 13) in patients diagnosed with intra-abdominal sepsis. A relationship was determined between mortality and age (p: 0.015), duration of hospital stay (p: 0.007), need for cardiac inotrope (p: 0.01), and need for mechanical ventilation (p: 0.01). The mean Apache II score was 26.4±5 for patients who died and 15.8±5.2 for surviving patients (p<0.001). In 5 (38.4%) of the 13 surviving patients, primary repair was applied to the abdomen, and in the remaining 8 patients abdominal wall repair was performed using dual mesh. CONCLUSIONS In patients in whom a Bogota bag was used, which is a cheap and easy method for temporary closure of the abdomen, the high mortality rates seen are related to diagnosis, Apache II score, age, and organ failure.

Factors Affecting Morbidity in Solid Organ Injuries.

Background and Aim. The aim of this study was to investigate the effects of demographic characteristics, biochemical parameters, amount of blood transfusion, and trauma scores on morbidity in patients with solid organ injury following trauma. Material and Method. One hundred nine patients with solid organ injury due to abdominal trauma during January 2005 and October 2015 were examined retrospectively in the General Surgery Department of Dicle University Medical Faculty. Patients' age, gender, trauma interval time, vital status (heart rate, arterial tension, and respiratory rate), hematocrit (HCT) value, serum area aminotransferase (ALT) and aspartate aminotransferase (AST) values, presence of free abdominal fluid in USG, trauma mechanism, extra-abdominal system injuries, injured solid organs and their number, degree of injury in abdominal CT, number of blood transfusions, duration of hospital stay, time of operation (for those undergoing operation), trauma scores (ISS, RTS, Glasgow coma scale, and TRISS), and causes of morbidity and mortality were examined. In posttraumatic follow-up period, intra-abdominal hematoma infection, emboli, catheter infection, and deep vein thrombosis were monitored as factors of morbidity. Results. One hundred nine patients were followed up and treated due to isolated solid organ injury following abdominal trauma. There were 81 males (74.3%) and 28 females (25.7%), and the mean age was 37.6 ± 18.28 (15-78) years. When examining the mechanism of abdominal trauma in patients, the following results were obtained: 58 (53.3%) traffic accidents (22 out-vehicle and 36 in-vehicle), 27 (24.7%) falling from a height, 14 (12.9%) assaults, 5 (4.5%) sharp object injuries, and 5 (4.5%) gunshot injuries. When evaluating 69 liver injuries scaled by CT the following was detected: 14 (20.3%) of grade I, 32 (46.4%) of grade II, 22 (31.8%) of grade III, and 1 (1.5%) of grade IV. In 63 spleen injuries scaled by CT the following was present: grade I in 21 (33.3%), grade II in 27 (42.9%), grade III in 11 (17.5%), and grade IV in 4 (6.3%). The mean length of hospital stay after trauma was 6.46 days in the medically followed patients. This ratio was 8.13 days in 22 patients with morbidity and 5.98 days in 78 patients without morbidity. There was a morbidity in 22 (22%) patients medically followed after trauma. In this study, nonoperative treatment was observed to be performed safely in solid organ injuries after trauma in case of absence of hemodynamic stability and peritoneal irritation. It has been emphasized that injury of both liver and spleen (p < 0.01), high respiratory rate (p < 0.01), trauma scores (GKS, ISS, RTS) (p < 0.0001), and elevation of ALT AST values (p < 0.01) are stimulants for morbidity that may occur during follow-up. Conclusion. Medical follow-up can be considered in patients with high grade injuries similar to patients with low-grade solid organ injury after trauma. The injury of both liver and spleen, high respiratory rate, high GCS and ISS, low RTS, and elevation of ALT AST values were found to increase morbidity again in the follow-up of these patients.

A giant ancient schwannoma mimicking an adnexal mass: Case report.

INTRODUCTION: Ancient schwannoma is a rare tumor of the peripheral nerve sheath. As degenerative properties are defined histologically, it can be wrongly interpreted as malignant. CASE PRESENTATION: The case presented here is of a giant ancient schwannoma with a pelvic retroperitoneal location, which was mimicking an adnexal mass. CONCLUSION: In the rarely seen cases in the retroperitoneum, it may reach very large dimensions.

A rare cause of acute abdomen: spontaneous common hepatic duct perforation.

Spontaneous extrahepatic bile duct perforation is generally seen in infants. Although rarely seen in adults, it may be seen with fatal bile peritonitis. Therefore, for a patient presenting with acute abdominal symptoms, differential diagnosis must be made with radiological imaging such as abdominal ultrasonography or computed tomography, without any loss of time. In these imaging tests, in cases of gallstone disease together with perihepatic free fluid or choledocus which can not be monitored, it should be considered in the differential diagnosis. An emergency surgical intervention should be planned to avoid serious complications. The aim of this paper was to present the rare cause of acute abdomen which developed associated with spontaneous common hepatic canal perforation in an adult.

Small bowel perforation due to fish bone: A case report.

Accidental ingestion of foreign bodies are a common condition in clinical practice. However, small bowel perforation which dues to ingestion foreign bodies has been rarely seen. In this article, we report a case of small bowel perforation which dues to ingestion foreign body. A 80-year-old female patient, presenting with complaints of acute abdomen, was admitted to the emergency department. She denied abdominal pain, nausea and vomiting. The patient had tenderness and defense on the right lower quadrant. Contrast enhanced abdominal computed tomography has been used on the patient's diagnosis. This revealed small bowel perforation due to the ingestion of foreign body. The patient was operated emergency. A microperforation due to fish bone was detected on the terminal ileum. The patient underwent debridement and primary repair. The patient was discharged postoperative 7th day without problem. Bowel perforation due to the ingestion of foreign bodies should be considered in the differential diagnosis of acute abdomen.

A Urachal Cyst Case with Painful Mass Locates at Ileal Mesentery.

Urachal cyst is an unusual clinical condition, which is usually asymptomatic. In some adult cases, it may lead to complications. The cyst is between umbilicus and urinary bladder. It is diagnosed via ultrasonography and computed tomography. However, in some cases, the diagnosis is made by means of surgical exploration and histopathological evaluation. In this paper, we report a case of a 17-year-old female presenting with painful abdominal mass. At the first evaluation, the case was diagnosed as a mesenteric cyst because the mass located in the mesentery, and final histopathological report revealed the urachal cyst.

Asymptomatic far-migration of an intrauterine device into the abdominal cavity: A rare entity.

Uterine perforation is a serious problem which can happen after intrauterine device (IUD) insertion. Migration of the IUD to the pelvic and abdominal cavity or adjacent organs may be seen following perforation of the uterus. Migration of an IUD to a far intra-abdominal site is extremely rare. The patient reported here had undergone an IUD placement 30 years previously and had no problems during this period. The IUD was incidentally found at the left upper quadrant of the abdomen in the mesentery.

Efficacy of azithromycin dihydrate in treatment of cryptosporidiosis in naturally infected dairy calves.

The objective of this study was to evaluate the therapeutic efficacy of azithromycin treatment of cryptosporidiosis in naturally infected calves under field conditions. Fifty Holstein calves with cryptosporidiosis infection were divided into 5 groups: 1 group (10 calves) was unmedicated and served as the control group and was given distilled water only, whereas the other groups (10 animals per group) were medicated orally with azithromycin at the doses of 500 (group 1), 1,000 (group 2), 1,500 (group 3), and 2,000 mg (group 4) PO once daily for 7 days. The animals were examined clinically and fecal samples were collected on the 1st (inclusion day), 7th, 14th, and 21st days of the study. Drug efficacy was assessed by evaluating diarrhea, oocyst shedding, and weight gains from days 1 to 21 (4 assessments). Significant differences were observed in reductions of oocyst shedding (P < .05) and the fecal diarrhea incidence (P < .05) in groups 3 and 4 when compared with groups 1 and 2 and the control group. Weight gain of medicated calves was significantly higher than that of the unmedicated calves throughout the study (P < .05). The drug significantly suppressed oocyst shedding and resulted in significant improvements in clinical signs. Therefore, this suppression may have significant effect on the reduction of environmental contamination by cryptosporidial oocysts. From the economic point view, authors suggest that the most effective dose of azithromycin for the treatment of cryptosporidiosis in calves should be at 1,500 mg/d for 7 days.