Open-tension free three-dimensional Cooper ligament repair for femoral hernia.

BACKGROUND: The objective of this study was to investigate the outcome of modified three-dimensional (3D) anterior polypropylene mesh technique for recurrent inguinal and femoral hernias. METHODS: This study was designed as a prospective cohort clinical trial and 75 patients with femoral hernia and/or recurrent hernia were recruited between 2005 and 2014. Patients were operated upon using a modified 3D anterior polypropylene mesh technique. RESULTS: Sixty-three femoral and 12 recurrent hernias in 75 patients were treated by a single surgeon through a 9-year period using a modified 3D polypropylene mesh, fashioned by the same surgeon. Forty-six female and 29 male patients, with a mean age of 43.6 years, were evaluated for postoperative chronic pain, wound issues, and recurrences. Any complications or complaints were recorded through office visits and by telephone calls. Urinary retention in one patient and wound infections in two patients were treated within 2 weeks postoperatively. Six patients had wound swelling (2 patients with hematoma and 4 with seroma) in early term (2 weeks to 2 months) and were treated by simple drainage and compression. No chronic pain or recurrent hernia was detected. CONCLUSION: Modified 3D anterior polypropylene mesh technique allows anatomical support for the potential hernia area and can be confidently applied with low morbidity and recurrence rate.

Can the timing of laparoscopic cholecystectomy after biliary pancreatitis change the conversion rate to open surgery?

BACKGROUND: Biliary pancreatitis (BP) constitutes 30-55% of all cases of acute pancreatitis. Laparoscopic cholecystectomy (LC) has become the gold standard for the surgical treatment of gallbladder disease. We aimed to compare and evaluate the relation between the timing of LC and the rates and reasons of conversion to open surgery (OS) after BP. METHODS: Data were collected of patients who presented for the first time with acute BP and underwent LC. The patients were divided into two groups: early cholecystectomy (Group 1), patients who underwent cholecystectomy during the first pancreatitis attack upon admission and before discharge from hospital (1-3 days); and late cholecystectomy (Group 2), patients who received medical treatment during their first pancreatitis episode and underwent surgery after 4-10 weeks. Sex, Ranson scores, American Society of Anesthesiology scores, and conversion reasons were compared. RESULTS: Group 1 and Group 2 included 75 patients (20 men, 55 women) and 87 patients (25 men, 62 women), respectively. The mean age was 44.7 years (range, 21-82 years). Obscure anatomy with adhesions was detected in 16 patients (5 in Group 1, 11 in Group 2) as the leading cause of conversion to OS, but it was not statistically significant (p=0.054). Acute inflammation with empyema and peripancreatic liquid collection was observed in 14 patients (12 in Group 1, 2 in Group 2), and conversion to OS was statistically significantly higher in Group 1 (p=0.016). CONCLUSION: Timing of LC does not influence the conversion rates to OS after BP.

A previously diagnosed mitochondrial neurogastrointestinal encephalomyopathy patient presenting with perforated ileal diverticulitis.

Mitochondrial neurogastrointestinal encephalomyopathy is an autosomal recessive multisystem disorder characterized clinically by severe gastrointestinal dysmotility; cachexia; ptosis, opthalmoparesis or both; peripheral neuropathy; leukoencephalopathy and mitochondrial abnormalities in muscle. Gastrointestinal dysmotility causes intestinal pseudo-obstruction and small intestinal diverticula. In this case report, we present a previously diagnosed 32-year-old female mitochondrial neurogastrointestinal encephalomyopathy syndrome patient who was hospitalized and operated due to ileal diverticulitis perforation and died due to postoperative respiratory complications, and we discuss the characteristic manifestations of the disease.

Leiomyosarcoma of the female breast: report of a case.

Sarcomas of the breast account for less than 1% of breast tumors. Leiomyosarcoma is an extremely rare form of primary breast sarcoma. We presented here a case of primary leiomyosarcoma of the breast in a 44-year-old woman. We present a case of primary leiomyosarcoma of the breast in a middle-aged female in whom fine-needle aspiration cytologic features uneventful.

Gallstones associated with nonalcoholic steatohepatitis (NASH) and metabolic syndrome.

BACKGROUND/AIMS: We aimed to evaluate the prevalence of non-alcoholic steatohepatitis and metabolic syndrome in patients with symptomatic gallstones undergoing laparoscopic or open cholecystectomy. METHODS: A study of 95 patients was performed. Simultaneous liver biopsies were taken during cholecystectomy between 2006 and 2007. There were no postoperative complications. Patients with significant alcohol intake, hepatitis B or C (virus-positive), autoimmune diseases, and Wilson's disease were excluded. Demographics, liver function tests, lipid profile, and ultrasound findings of patients with and without non-alcoholic steatohepatitis were compared. RESULTS: A total of 95 patients completed the study. The mean age was 52.15 years, and 29 patients were male and 66 female. Fifty-two patients (55%) had biopsies compatible with non-alcoholic steatohepatitis. CONCLUSIONS: Fifty-five percent of patients with gallbladder stones had associated non-alcoholic steatohepatitis. Awareness of this association may result in an earlier diagnosis. The high prevalence of non-alcoholic steatohepatitis in patients with gallbladder stone may justify routine liver biopsy during cholecystectomy to establish the diagnosis and stage and possibly direct therapy.

[Ambulance in emergency medicine]. / ACIL SAGLIK HIZMETLERINDE AMBULANSIN YERI.

BACKGROUND: The ambulance service is very important in emergency medicine. The aim of this study was to investigate the new governing statuate of private ambulance service and to propose some new ideas. METHODS: We examinated the new governing statuate of private ambulance service, rules of patient transporte between the hospitals and reports written by SSK Goztepe Educational Hospital ambulance drivers. CONCLUTION: We concluded that SSK Goztepe Educational Hospital ambulance drivers have a iot of problems especially at the rules of patient transport between the hospitals and there are some defiencies at the new governing statuate of private ambulance service. RESULTS: We concluded that it is necesssary to manage all the ambulance services in one center; all the private ambulance services have to have a specialist and all these must be determinated by the special rules. Key words: Regulation ofprivate ambulance, emergency head maintanence, ambulance services