Contrast Enhanced [99mTc] MIBI SPECT/CT in Primary Hyperparathyroidism.

OBJECTIVE: The aim of the present study was to compare the surgical results with contrast-enhanced [99mTc]methoxyisobutylisonitrile ([99mTc]MIBI) single-photon emission computed tomography (SPECT)/computed tomography (CT) results by adding the simultaneous single phase contrast to the [99mTc]MIBI SPECT/CT examination. METHOD: Between November 2016 and January 2018, 24 (21 female, 3 male) patients who underwent an operation after preoperative contrast-enhanced [99mTc]MIBI SPECT/CT, and 49 asymptomatic patients (42 female, 7 male), who did not undergo surgery, were included in the study. RESULTS: Sensitivity and specificity rates of contrast enhanced [99mTc]MIBI SPECT/CT were 100% and 100% when evaluated together with surgical results. The rate of detection in asymptomatic patients was found to be 93.8%. CONCLUSIONS: With the contrast-enhanced [99mTc]MIBI SPECT/CT imaging, both high sensitivity and specificity values were achieved in the preoperative localization of parathyroid adenomas (PTAs) and high detection rates were obtained in the asymptomatic group. The use of contrast IV during the [99mTc]MIBI SPECT/CT in patients without contraindications increased both preoperative localization rates of adenomas and detection rates of asymptomatic hyperparathyroidism cases. KEY WORDS: Parathyroid adenoma, Primary Hyperparathyroidism, [99mTc]MIBI, SPECT/CT.

Factors affecting mortality in patients with splenic injuries.

there are not a sufficient number investigating the factors in splenic injuries influencing mortality. In this study, we aimed to investigate the factors affecting mortality in splenic injuries. MATERIALS AND METHODS: All 237 patients with splenic injury between 2005 to 2014 were retrospectively analyzed. The patients were divided into two groups, survivors and non-survivors. Age, gender, mechanism of injury, grade of splenic injury, pulse, respiratory rate, systolic blood pressure, hemoglobin levels, number of transfusions, surgical procedure, ISS, RTS and hospitalization period were recorded. Univariate and multivariate analysis were used to compare survivors and non-survivors. RESULTS: The average age of the patients was 32 and most (82.7%) were male. Mortality was observed in 18 patients (7.6%). Mortality was found significantly lower in patients who had isolated splenic injury (p=0.048). In univariate analyses, decreased RTS (p<0.001), increased number of blood transfusion (p<0.001), decreased hemoglobin level (p=0, 025) and increased ISS (p<0.001) were found significant in non-survivors. In multivariate analysis; number of transfusions, ISS and RTS were found as independent risk factors for mortality. CONCLUSIONS: We found high number of transfusions, high ISS and low RTS as independent risk factors for mortality in patients with splenic injury. KEY WORDS: Mortality, ISS, RTS, Splenic trauma.

Therapeutic effects of ellagic acid on L-arginin induced acute pancreatitis.

PURPOSE: To investigate the therapeutic effects of ellagic acid on L-arginin induced acute pancreatitis in rats. METHODS: Thirty-two were split into four groups. Group 1 (control) rats were performed only laparotomy, no drugs were administered. Group 2 (control+EA) rats were administered 85mg/kg EA orally. Rats were sacrificed by cardiac puncture 24 hours after the administration. Group3 (AP) 24 hours after intraperitoneal L-arginine administration, rats were sacrificed by cardiac puncture. Group 4 (EA)-(AP): 85mg/kg EA was administered orally after the L-arginine administration. 24 hours later, rats were sacrificed by cardiac puncture. Serum TNF-α, IL-1ß, IL-6, total oxidative status (TOS), total antioxidant capacity (TAC), amylase levels were determined in all groups. RESULTS: Group 3 (AP) rats showed significantly raised TOS level as compared to Group1 (control) rats (p<0.001). Following the EA therapy, a decrease in TOS was observed in Group 4 (AP+EA). TAC levels were significantly raised in the Group 4 (AP+EA) compared to the Group 3 (AP) (p=0.003). Group 3 (AP) showed significantly increased TNF-α, IL-1ß and IL-6 serum levels as compared to Group 4 (AP+EA). Histopathological changes were supported our result. CONCLUSION: The healing effects of ellagic acid on inflammatory and oxidative stress were confirmed by histopathological and biochemical evaluations of the pancreatic tissue.

The impact of type D personality on health-related quality of life in patients with symptomatic haemorrhoids.

INTRODUCTION: Haemorrhoids are one of the most common reasons that patients seek consultation from a colon and rectal surgeon. Health-related quality of life (HrQoL) is a significant factor in describing the burden of illness and the impact of treatment in patients with gastrointestinal disease. Type D (distressed) personality is defined as the co-occurrence of negative affect and social inhibition. AIM: To assess the prevalence of type D personality in patients with haemorrhoids and to investigate whether the presence of a type D personality would affect HrQoL in patients with haemorrhoids. MATERIAL AND METHODS: One hundred and six outpatients with symptomatic haemorrhoids with no psychiatric comorbidity were consecutively enrolled, along with 96 healthy controls. The Type D Scale (DS14) and the General Health Survey Short Form-36 (SF-36) were used in the collection of data. RESULTS: Of 106 patients evaluated, 29.2% met criteria for type D personality. Patients with haemorrhoids scored lower on bodily pain and vitality dimensions of SF-36 than did healthy subjects (p < 0.001). Patients with a type D personality were found to score lower on bodily pain domain of HrQoL than patients without a type D personality. Linear regression analysis revealed a significant independent association of type D personality with bodily pain dimension of the SF-36 in patients with symptomatic haemorrhoids (r = -0.315, p < 0.01). CONCLUSIONS: Type D personality was associated with increased perceived bodily pain in patients with haemorrhoids. Consideration of type D personality construct personality traits could improve risk stratification in research and clinical practice in this patient group.

Health-related quality of life in patients with anal fissure: effect of type D personality.

INTRODUCTION: Health-related quality of life (HRQL) is a significant factor in describing the burden of illness and the impact of treatment in patients with gastrointestinal disease. Type D (distressed) personality is defined as the co-occurrence of negative affect and social inhibition. AIM: To assess the prevalence of type D personality in patients with anal fissure and to investigate whether the presence of a type D personality would affect HRQL in patients with anal fissure. MATERIAL AND METHODS: One hundred outpatients with anal fissure with no psychiatric comorbidity were consecutively enrolled, along with 100 healthy controls. Type D Scale (DS14) and General Health Survey Short Form-36 (SF-36) were used in the collection of data. RESULTS: Patients with anal fissure scored lower on physical roles and bodily pain dimensions of SF-36 than healthy subjects (p < 0.05). Thirty-three patients with anal fissure (33%) and 16 controls (16%) had scored above the cut-off score of the DS14 (p < 0.05). Patients with a type D personality were found to score lower on bodily pain and social roles domains of HRQL than patients without a type D personality. CONCLUSIONS: Type D personality was associated with increased perceived bodily pain and social roles in patients with anal fissure. Type D personality construct may be an important consideration when assessing HRQL outcomes. A multidimensional approach may be valuable in the assessment of patients presenting with anal fissure, because a subgroup with type-D personality might benefit from psychological therapies.

Cesarean scar endometrioma: Case series.

AIM: To evaluate endometrioma located at cesarean scatrix. METHODS: Medical data of 6 patients who presented to our institution with abdominal wall endometrioma were evaluated retrospectively and reviewed literature in this case series. The diagnostic approaches and treatment is discussed. RESULTS: All patients had a painful mass located at abdominal scars with history of cesarean section. The ages ranged from 31 to 34 and Doppler ultrasonography (US) detected hypoechoic mass with a mean diameter of 30 mm. Initial diagnosis was endometrioma in 4 and incisional hernia in 2 of 6 patients. Treatment was achieved with surgical excision in 5 patients, and one is followed by hormone suppression therapy with gonadotropin. CONCLUSION: Malignant or benign tumors of abdominal wall and incisional hernias should be kept in mind for diagnosis of endometrioma. Imaging methods like doppler US, computed tomography and magnetic resonance imaging should be used for differential diagnosis. Definitive diagnosis can only be made histopathologically. The treatment should be complete surgical excision and take care against intraoperative auto-inoculation of endometrial tissue in order to prevent recurrences.

Evaluation of results of lower gastrointestinal endoscopic biopsi.

AIM: The endoscopic examination is widely used and also the the gold standard in lower gastrointestinal system (LGIS) in the diagnosis and treatment of mucosal pathology. Colon and rectum often hosts premalignant lesions and relatively easily accessible organs. Therefore, colorectal cancer (CRC) is a early detectable disease. And to prevent the development of CRC and to capture at early stage the screening tests such as screening endoscopy are used. In our study was aimed to evaluate the biopsy results of the lower gastrointestinal endoscopy. MATERIALS AND METHODS: The lower gastrointestinal endoscopy (LGE) biopsy results of 135 cases and demographic characteristics of the patients were evaluated retrospectively who admitted to Department of Pathology between January 2013-November 2013. RESULTS: 135 patients enrolled in the study, 89 (65.92%) of male and 46 (34.07%) were female. The age of patients were between 15 and 82 with a mean age of 53.00 ± 14.6. 85 of 135 cases (62.96%) were colitis, 3 (2.22%) were hyperplastic polyps, 22 (16.30%) were tubular adenoma, 15 (11.11%) of them tubulovillous adenoma, 1 (0%, 74) of submucosal lipoma, 9 (6.67%) patients were diagnosed with cancer. All of the cancer cases were in adenocarcinoma histology, one of developing from villous adenoma, one of them from tübülovillous adenoma. Cases of adenomas were included to only cancer groups because there is no duplication of data. CONCLUSION: Colonoscopy in the detection of both benign and malignant LGIS pathologies is the gold standard method. The upper and lower gastrointestinal endoscopy(LGE) must be remembered as a reliable method in the population, with a low complication rate and high diagnosis rate and when there is clinical necessity gastrointestinal endoscopy should not be avoided as planned.

Comparison of the three surgical flap techniques in pilonidal sinus surgery.

We aimed to study the efficacy of three surgical flap techniques in pilonidal surgery. Pilonidal disease is characterized by chronic inflammation and infection in the sacrococcygeal region. Complications and recurrence are common after treatment and optimal treatment for the disease has not been established yet. We enrolled a total of 401 patients in this study. Patients have been treated with Karydakis (n = 113), modified Limberg (n = 179), or Limberg (n = 109) flap techniques. Mean off-work period, time to walk without pain, time to sit on the toilet, time to take the drainage catheter off, maceration rates, recurrence, and hypoesthesia rates were significantly better in the modified Limberg group. In conclusion, we showed the modified Limberg technique is superior than both Limberg and Karydakis techniques.

Transcutaneous electrical posterior tibial nerve stimulation for chronic anal fissure: a preliminary study.

PURPOSE: Recent studies showed that sacral nerve stimulation might be an effective treatment option for chronic anal fissure. We aimed to evaluate the efficacy of transcutaneous electrical nerve stimulation as a noninvasive alternative treatment for chronic anal fissure by stimulating the sacral nerve in the ankle via the posterior tibial nerve. METHOD: In this prospective study, transcutaneous electrical nerve stimulation was applied for 10 days in addition to conventional medical treatment in ten patients. Wexner's constipation score, visual analog scale for pain, quality of life (Short Form-36), Hamilton anxiety and depression scores, symptom relief, compliance, fissure healing, and side effects were evaluated before and after treatment (days 0, 5, and 10). RESULTS: Ten patients (eight females/two males) with a mean age of 50.7 ± 18.5 years were enrolled in the study. Pain and bleeding resolved in all patients 2 days after the treatment, and mucosal healing was observed in six patients 10 days after the treatment. Wexner's constipation and visual analog scale scores for pain decreased significantly (p = 0.001 and p = 0.002, respectively). Hamilton anxiety and depression scores decreased as well (p = 0.001 and p = 0.01, respectively). Among Short Form-36 subscales, only mental health score increased significantly (p = 0.003). One patient underwent surgery at follow-up due to recurrence of symptoms, and rubber band ligation was applied to another patient who had internal hemorrhoidal rectal bleeding at the end of 10 days. CONCLUSIONS: Transcutaneous electrical nerve stimulation application to the posterior tibial nerve has the potential to be an alternative treatment option for chronic anal fissure patients who seek noninvasive treatment modality.

Platelet parameters in hepatic hydatid cysts.

Background. Hepatic hydatid cyst infection is caused by microorganisms named Echinococcus which belong to family Taeniidae. Platelets are considered as a mediator in inflammation and infectious diseases because of the various proinflammatory substances that they contain. Design and Methods. Thirty-three patients who were admitted to Dogubayazit State Hospital's General Surgery Clinic with a diagnosis of hepatic cyst hydatid were enrolled in this retrospective study. Laboratory data of the patients in pre- and postoperative periods were obtained from computerized medical records database of the hospital. Results. Preoperative mean platelet volume (MPV) of the patients was significantly increased compared to postoperative MPV values. Conclusion. We claim that MPV is a useful follow-up marker after surgery in patients with hydatid cyst.