Perforated double appendicitis: Horseshoe type.

Appendix vermiformis duplex is an infrequent malformation. However if it is missed out, there might be some complications and medicolegal troubles. A surgeon must be aware of any other appendix during appendectomy. Therefore, the possible locations and shapes described in the Cave-Wallbridge classification should be considered by the surgeon. In this case report, we present a patient with a horseshoe-type dupplication of appendix in a perforated appendicitis diagnosed during an emergency laparotomy.

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.

The clinical presentation of pilonidal sinus and selection of the appropriate minimally invasive approach. A retrospective evaluation of 5338 cases.

OBJECTIVE: Pilonidal Sinus is a considerably problematic disease due to its recurrences which tend to become chronic and are exacerbated by abscess formation. There is little consensus regarding treatment - most probably due to limited understanding of its pathophysiology and progression. Despite this, it is accepted that accurate identification of pathogenesis and the clinical grade of PS are crucial for the determination of surgical approach. METHOD: This study presents the surgical treatment techniques we employed for Pilonidal Sinus disease with retrospective analysis of management and follow-up data of 5338 outpatient cases from 16 years of practice. RESULTS: At the follow-up period of 16 years, recurrence was 12.5%. All recurrences were also treated with an individualized minimally invasive surgical approach, which was proportional to the clinical presentation. CONCLUSION: The importance of designing surgical technique according to the needs of the patient and the condition of the disease is clear. Our results with over 5000 patients indicate that effective treatment for PS is individualized minimally invasive surgery. KEY WORDS: Classification, Grade, Minimally invasive surgery, Pilonidal sinus, Pilonidal cyst.