Unusual location of median raphe cyst presenting as perianal polyp: a case report.

Median raphe cysts (MRC) are uncommon, benign congenital lesions that may present anywhere in the midline between the urinary meatus and the anus, with the shaft of the penis and the glans penis being the most common sites. We report a 52-year-old man with median raphe cyst unusually located in perianal region and treated by surgical excision.

Latent Tuberculosis Infection Management in Solid Organ Transplantation Recipients: A National Snapshot.

OBJECTIVE:  Latent tuberculosis infection (LTBI) screening is strongly recommended in the pre-transplant evaluation of solid organ transplant (SOT) recipients, although it remains inadequate in many transplant centers. We decided to investigate pre-transplant TB risk assessment, LTBI treatment, and registry rates in Turkey. MATERIAL AND METHODS:  Adult SOT recipients who underwent tuberculin skin test (TST) and/or interferon-gamma release test (IGRA) from 14 centers between 2015 and 2019 were included in the study. An induration of ≥5 mm on TST and/or probable/positive IGRA (QuantiFERON-TB) was considered positive for LTBI. Demographic features, LTBI screening and treatment, and pre-/post-transplant TB history were recorded from the electronic database of transplantation units across the country and pooled at a single center for a unified database. RESULTS:  TST and/or IGRA were performed in 766 (33.8%) of 2266 screened patients most of whom were kidney transplant recipients (n = 485, 63.4%). LTBI screening test was positive in 359 (46.9%) patients, and isoniazid was given to 203 (56.5%) patients. Of the patients treated for LTBI, 112 (55.2%) were registered in the national registry, and 82 (73.2%) completed the treatment. Tuberculosis developed in 6 (1.06%) of 563 patients who were not offered LTBI treatment. CONCLUSION:  We determined that overall, only one-third of SOT recipients in our country were evaluated in terms of TB risk, only 1 of the 2 SOT recipients with LTBI received treatment, and half were registered. Therefore, we want to emphasize the critical importance of pretransplant TB risk stratification and registration, guided by revised national guidelines.

Two drugs with paradoxical effects on liver regeneration through antiangiogenesis and antifibrosis: Losartan and Spironolactone: a pharmacologic dilemma on hepatocyte proliferation.

BACKGROUND: There is a strong relationship between liver regeneration and angiogenesis and fibrosis. It is known that Spironolactone, an aldosterone antagonist, acting on rennin-aldosterone axis, and Losartan, an angiotensin II type I antagonist, have both antifibrotic and antiangiogenic effects. Theoretically, the end result of these mechanisms with contradictory influences on liver regeneration is not known well. In this study, we aimed to reveal the effects on liver regeneration of administration of Spironolactone and Losartan, having contradicting effects on regeneration through antiangiogenesis and antifibrosis. MATERIALS AND METHODS: A total of 72 Wistar albino rats were divided into control, Spironolactone, and Losartan groups and subdivided to conduct examinations on days 1, 3, 5, and 7. The specimens were treated with proliferating cell nuclear antigen to evaluate the characteristics of liver regeneration; with phosphorylated Smad2 (phospho-Smad2), serum transforming growth factor beta (TGF-B) 1, and tissue TGF-B1 to evaluate the termination of regeneration and with vascular endothelial growth factor receptor 2, Flk-1/KDR, to evaluate angiogenesis. RESULTS: The proliferating cell nuclear antigen-labeling index was found to be significantly higher in Spironolactone and Losartan groups than in the control group on days 1, 3, and 5 (P = 0.031, 0.0023, and 0.032, respectively). Vascular endothelial growth factor receptor 2, Flk-1/KDR, expression was significantly lower in Spironolactone and Losartan groups than in the control group on days 3, 5, and 7 (P = 0.032, 0.0024, and 0.007, respectively). Phospho-Smad2 was significantly lower on days 1, 3, and 5 in Spironolactone and Losartan groups than in the control group (P = 0.011, 0.0020, and 0.05, respectively). Tissue TGF-B1 levels were significantly lower in Spironolactone and Losartan groups than in the control group only on day 3 (P = 0039). Serum TGF-B1 levels in Losartan groups were significantly different from those of control and Spironolactone groups only on day 1 (P < 0.05). CONCLUSIONS: Liver regeneration, expected to decrease on day 3, was prolonged and increased even on day 5 despite antiangiogenic effects of Losartan and Spironolactone, which in fact inhibit fibrosis through phospho-Smad2 and increase regeneration. In addition, serum and tissue TGF-B1 levels are not sensitive enough to show active TGF-B1 for the evaluation of regeneration.

Surgical management of endoscopic retrograde cholangiopancreatography related injuries.

BACKGROUND/AIMS: The aim of this study was to determine timing and outcomes of surgical treatment options of endoscopic retrograde cholangiopancreatography (ERCP) related injuries. METHODOLOGY: Nine patients with ERCP related injury were underwent surgical treatment at our institution. Data about these patients and outcomes of the treatment options used were retrospectively analyzed. RESULTS: Out of 9 patients, 5 were female and mean age of 68.2 years (36-92 years). Out of 5 patients with duodenal injury (55.6%), 4 patients were treated with simple repair and 1 patient was treated with duodenostomy. Six patients were treated with pyloric closure and gastrojejunostomy. A T tube was placed in 5 patients with choledochal calculus and 1 patient with biliary fistula. One patient with a tumor in the periampullary region underwent pancreaticoduodenectomy. A total of 4 patients died (44.4%). Out of 5 patients followed, 5 (60%) had postoperative problems such as sepsis, wound infection and abdominal abscess. The mean hospital stay was 22.6±7.9 days. CONCLUSION: Duodenal injuries should be treated with surgery immediately. Findings from physical examination and computed tomography should guide in making decisions about surgery. ERCP indications, type of injuries and abdominal inflammation should be kept in mind in decisions for the type of surgical treatment.

Cardiac Function in Children After Kidney Transplant.

OBJECTIVES: Renal transplant improves echocardiographic markers of systolic and diastolic heart functions. The aim of this study was to evaluate the gradual changes in left and right ventricle functions in children and young adults before and after renal transplant. MATERIALS AND METHODS: Thirty kidney recipients of median age 13 years (range, 5-19 years) were included the study. Tissue Dopplerimaging from the septal and lateral mitral annulus ofthe left ventricle and free wall of the right ventricle was performed. Right ventricle systolic excursion velocity and tricuspid annular plane systolic excursion were calculated. Systolic and diastolic heart functions-which gained just before transplant, were compared with posttransplant early- term (6 months to 1 year) and long-term (longer than 1 year) functions. RESULTS: Twelve patients received deceased-donor and 18 patients received living donor renal transplant. Follow-up after transplant was 44 ± 23 months. Left ventricle ejection fractions were normal. The left ventricle, right ventricle, and interventricular septalTei indices were significantly higher before transplant.The posttransplantation early- and late-term results of left ventricle,right ventricle, and interventricular septal Tei indices were similar. Tricuspid annular plane systolic excursion levels were abnormal in 11 patients (36%), and right ventricle systolic excursion velocities were abnormal in 7 patients (23%) before transplant. All tricuspid annular plane systolic excursion levels and 94% ofright ventricle systolic excursion velocities were normal, but left ventricle Tei indices were higher in 8 (26%) and right ventricle Tei indices were higher in 14 patients (46%) at late-term follow-up. CONCLUSIONS: The systolic and diastolic dysfunctions of both ventricles appear to be highly prevalent in pediatric renal transplant recipients, especially soon after transplant, and were shown to usually decrease with time. Improvements in right ventricle dysfunction are slower, even in optimally treated posttransplant patients.

Relationship Between Angiotensin II Type 1 Receptor Antibody Positivity and Cytokine Gene Polymorphism in Renal Transplant Patients When Organ Rejection Occurs.

OBJECTIVES: Kidney transplant remains the gold standard for the treatment of end-stage renal disease. Relationships between the presence of non-HLA antibodies, antibodies to AT1R, and cytokine gene polymorphisms with rejection have recently been shown. We sought to determine whether the presence of antibodies to AT1R and cytokine gene polymorphisms affected the development of rejection in pediatric and adult patients, whether a relationship is present between cytokine polymorphism and level of antibodies to AT1R, and whether their presence can be a biomarker pretransplant. MATERIALS AND METHODS: Our study included 100 pediatric and adult kidney transplant patients plus 50 healthy controls. Levels of AT1R antibodies (by enzyme-linked immunosorbent assay) and gene polymorphisms of the cytokines transforming growth factor ß, tumor necrosis factor α, interleukins 6 and 10, and interferon gamma cytokines (by sequence- specific primer-polymerase chain reaction) were studied retrospectively and evaluated with the SPSS statistical program. RESULTS: We found no statistically significant relationship between levels of antibodies to AT1R and gene polymorphisms among the studied cytokines in patients with rejection compared with the healthy controls and patients with uneventful courses posttransplant. However, higher levels of antibodies to AT1R were observed in pediatric compared with adult transplant recipients (P < .001). A statistically significant relationship was also observed between transforming growth factor ß1 C/C G/C low-release and interleukin 6 G/C high-release gene polymorphism and levels of antibodies to AT1R (P < .001). CONCLUSIONS: Because we observed that some gene polymorphisms among the studied cytokines may affect AT1R antibody levels, future studies are needed to understand the mechanism of the relationship. In addition, studies with larger groups are required to sufficiently confirm that higher antibody levels are present in pediatric versus adult patients.

Effects of a tissue sealing-cutting device versus monopolar electrocautery on early pilonidal wound healing: a prospective randomized controlled trial.

BACKGROUND: Monopolar electrocauterization produces thermal effects on neighboring tissues, causing tissue damage. Recently, tissue sealing-cutting devices, which are easy to use and achieve simultaneous selective sealing and cutting with less production of heat, have been used. OBJECTIVE: The aim of this study was to investigate the effects of a tissue sealing-cutting device vs monopolar electrocautery on wound healing in the early postoperative period after pilonidal sinus surgery. DESIGN: This study was a prospective randomized clinical trial. SETTING: This study was conducted at Military Hospital, Eskisehir, Turkey. PATIENTS: In total, 128 patients with chronic pilonidal disease were randomly assigned into 2 clinically comparable groups between December 2009 and June 2010. INTERVENTION: Pilonidal sinus excision was performed with monopolar electrocautery in the control group (n = 64) and with a tissue sealing-cutting device in the study group (n = 64). Data regarding wound healing, demographic variables, history, physical examination findings, defect dimensions, and scores for a visual analog scale were recorded. MAIN OUTCOME MEASURES: The main outcomes measured were surgical site infection, early wound failure (dehiscence), and unhealed wound rate. RESULTS: : Wound infection and dehiscence rates were significantly lower (P = .01 and .02), but the duration of surgery was significantly longer (P < .01) in the tissue sealing-cutting group. The unhealed wound rate was 12.5% in the electrocautery group and 4.7% in the tissue sealing-cutting group (P = .01). When the distance from the lowest margin to the anus was 5 cm or less, wound infection and dehiscence rates were lower in the tissue sealing-cutting group (P < .01 and .03). LIMITATIONS: We could not obtain data regarding the cost-effectiveness of the instruments. CONCLUSIONS: A tissue sealing-cutting device in pilonidal sinus surgery yields better wound healing than monopolar electrocautery.

[Factors affecting morbidity in urgent repair of abdominal wall hernia with intestinal incarceration in adults]. / Intestinal inkarserasyon için acil karin duvari fitik onarimi yapilan eriskinlerde morbiditeyi etkileyen faktörler.

BACKGROUND: The aim of this study was to investigate factors that affect morbidity in adults with incarcerated intestinal hernia of the abdominal wall. METHODS: 124 patients with a mean age of 61 ± 13.87 years (73 males) underwent emergency surgery for incarcerated intestinal hernia between March 1999 and March 2008. The median duration of the hernia was 5 years (0.1-30). Type and duration of hernia, accompanying diseases, surgical procedure, and operation-related complications were retrospectively evaluated. RESULTS: Twenty-five patients (20%) had complications. Twelve patients (10%) had surgical site infection and 10 patients (8%) had septic complications. Four patients (3%) died in the postoperative period. Out of 40 patients developing strangulation, 18 underwent bowel resection. The only independent variable concerning bowel resection other than inguinal hernia was found to be ventral hernia (p=0.039). There was no statistical significance between duration of hernia and incarceration and complications. The rate of complications was significantly high in the patients with accompanying diseases (p<0.001). The relation between age and complications was also significant (p=0.034). Multivariate analyses showed high ASA scores as the only independent variable for development of complications (p<0.001). CONCLUSION: Patients with comorbid diseases and high ASA scores should be informed about the elevated risk of complications, and scheduled surgery before the development of incarceration should be recommended.

[Use of drainage in surgery for perforated appendicitis: the effect on complications]. / Perfore apandisit ameliyatinda dren kullaniminin komplikasyonlara etkisi.

BACKGROUND: We aimed to investigate the use of drainage in surgery for perforated appendicitis and to determine its effect(s) on complications. METHODS: Two-hundred and eight patients diagnosed with perforated appendicitis between May 1999 and January 2009 were retrospectively evaluated in terms of using drainage with respect to surgical infections and other complications and duration of hospital stay. RESULTS: A total of 208 patients diagnosed with perforated appendicitis underwent surgery. The mean age of the patients was 41.05±16.30 years. Of the 208 patients, 128 (61.5%) were male. The median duration of complaints was 2 days (1-15 days). Drainage was applied in 83 patients (39.9%). The median duration of drainage was 3 days (1-7 days). Surgical infections, wound dehiscence, other complications, and re-hospitalization rates were significantly higher in patients with drainage. The mean time from appearance of complaints to surgery, the duration of hospitalization and antibiotic treatment were also longer in the drainage group (p=0.001 for all). A higher rate of the patients with an accompanying disease (39.8%-19.2%) and midline incision (20.5%-3.2%) and of the elderly patients had drainage. Multivariate analyses showed that using a drain independently affected surgical infections (p<0.001). CONCLUSION: It can be concluded that using a drain after surgery for perforated appendicitis increases surgical infections and in turn the duration of hospital stay.

Effect of Kidney Transplant on Balance and Fall Risk.

OBJECTIVES: Kidney transplant offers an improved quality of life and prolonged survival for patients with end-stage renal disease. This study aimed to compare balance and fall risk between kidney transplant recipients and healthy adults and to determine the relationship between biochemical parameters and fall risk and balance in kidney transplant recipients. As far as we know, this is the first study in the literature that evaluated whether balance changes occur in kidney transplant recipients using the Tetrax Interactive Balance System (Sunlight Medical Ltd., Ramat Gan, Israel). MATERIALS AND METHODS: Our study included 131 kidney transplant recipients (80 male/53 female; mean age of 39 ± 12 y) and 158 healthy volunteers (86 male/69 female; mean age of 40 ± 15 y). Groups were statistically matched in age, male/female patients, and body mass index. Fall index percentages were calculated using the Tetrax posturography device. Risk of falling was compared between kidney transplant recipients and healthy participants. Kidney transplant recipients were divided into 3 groups based on risk of falling. Demographic and clinical characteristics of kidney transplant recipients were recorded, and statistical analyses were performed to analyze these parameters versus balance measurements. RESULTS: Risk of falling was not significantly different between groups according to Tetrax measurements (32.4 ± 23.4 vs 31.6 ± 21.7; P = .08). Serum creatinine levels were significantly higher in kidney transplant recipients with a higher risk of falling (1.17 ± 0.37 vs 1.63 ± 1.18 mg/dL; P = .01). The use of oral antidiabetic drugs was shown to increase the risk of falling (P = .02). CONCLUSIONS: Although patients with end-stage renal disease are thought to have balance impairments, kidney transplant recipients in our study had balance control similar to that shown in the healthy population. Graft function in kidney transplant recipients is important for the balance system.

Risk Factors for Urinary Tract Infection After Kidney Transplant: A Retrospective Analysis.

OBJECTIVES: Urinary tract infections are the most common type of infections in kidney transplant recipients. They are also important factors for increased morbidity and mortality. The aims of this study were to evaluate the number of urinary tract infections, to identify possible donor/receiver-based risk factors, and to evaluate the impact of these infections on graft function. MATERIALS AND METHODS: Medical records of patients who had undergone kidney transplant between 2010 and 2017 were retrospectively analyzed. RESULTS: Our study included 145 patients (49 women [33.8%] and 96 men [66.2%]), with mean age of 35.2 ± 12.4 years. There were 105 episodes of urinary tract infections in 55 of 145 patients (37.9%) during the first year after transplant. Female sex (P = .001), glomerulonephritis as primary kidney disease (P = .04), pretransplant diabetes (P = .05), and presence of ureteral stent (P = .03) were significant risk factors for the development of urinary tract infections. The most frequent pathogens identified were Escherichiacoli and Klebsiella pneumoniae. Mean glomerular filtration rate t 12 months was significantly lower in patients with urinary tract infection than in patients without infection (80 ± 25 vs 68 ± 28 mL/min; P = .006). CONCLUSIONS: In kidney transplant recipients, urinary tract infections are common complications and have negative outcomes on graft function. These infections remain an important disease that requires frequent investigations and new ways of approach for prevention.

Preoperative therapeutic plasma exchange in patients with thyrotoxicosis.

The purpose of this report was to determine the effectiveness of therapeutic plasma exchange (TPE) in preoperative preparation of patients with thyrotoxicosis scheduled for either thyroid or nonthyroid surgery. We retrospectively reviewed 11 patients with thyrotoxicosis and those who prepared surgery with plasmapheresis between 1999 and 2008 at our institution. Ten patients underwent thyroid surgery and one patient was operated for femur fracture during antithyroid drug treatment. The indications for plasmapheresis in all patients with severe thyrotoxicosis were poor response to medical treatment (seven patients), agronulocytosis due to antithyroid drugs (three patients), iodine-induced thyrotoxicosis (Jodd Basedow effect in one patient), and rapid preparation for urgent orthopedic operation (one patient). After TPE, we observed a marked decrease in free thyroxin (FT3) and free triiodothyronin (FT4) levels; however, the decline in the biochemical values were not statically significant (P > 0.62, P > 0.15). Although both FT3 and FT4 levels remained above the normal limits in two of 11 patients, the signs and symptoms of thyrotoxicosis improved in all patients and no thyroid storm observed during the perioperative period. TPE can be considered a safe and effective alternative to prepare patients with thyrotoxicosis for surgery when drug treatment fails or is contraindicated and when emergency surgery is required.

Acute Respiratory Failure in Renal Transplant Recipients: A Single Center Experience.

OBJECTIVES: We evaluated the frequency and cause of acute respiratory failure in renal transplant recipients. MATERIALS AND METHODS: Our single-center retrospective observational study included consecutive renal transplant recipients who were admitted to an intensive care unit for acute respiratory failure between 2011 and 2017. Acute respiratory failure was defined as oxygen saturation < 92% or partial pressure of oxygen in arterial blood < 60 mm Hg on room air and/or requirement of noninvasive or invasive mechanical ventilation. RESULTS: Of 187 renal transplant recipients, 35 (18.71%) required intensive care unit admission; 11 of these patients (31.4%) were admitted to the intensive care unit with acute respiratory failure. Six of these patients (54.5%) had pneumonia and had shown infiltrates on chest radiography, which were shown in a minimum of 3 zones of the lung (2 with Klebsiella pneumonia, 1 with Acinetobacter species, 1 with Proteus mirabilis, 2 with no microorganisms). The other reasons for acute respiratory failure were cardiogenic pulmonary edema (2 patients), acute respiratory distress syndrome (2 patients, due to acute pancreatitis and acute cerebrovascular thromboembolism), and exacerbation of chronic obstructive pulmonary disease (1 patient). Six patients (54.5%) needed invasive mechanical ventilation because of pneumonia (3 patients), cardiogenic pulmonary edema (2 patients), and cerebrovascular thromboembolism (1 patient). Hemodialysis was administered in 5 patients (45%). Six of 11 patients died due to pneumonia (3 p atients), cardiogenic pulmonary edema (2 patients), and cerebrovascular thromboembolism (1 patient). Among the 5 survivors, 3 (60%) had recovered previous graft function. CONCLUSIONS: Acute respiratory failure is associated with high mortality and morbidity in renal transplant recipients. Main causes of acute respiratory failure were bacterial pneumonia and cardiogenic pulmonary edema in our study population. Extended chemoprophylaxis for bacterial and fungal infection and early intensive care unit admission of patients with acute respiratory failure may improve outcomes.

Mucinous cystadenoma of the appendix: a rare cause of acute abdomen.

BACKGROUND: We aimed to assess the acute abdominal conditions due to appendiceal mucinous cystadenomas. METHODS: We retrospectively evaluated 11 patients with histopathologically confirmed appendiceal mucinous cystadenoma. Patient charts and data on patient demographics; clinical features; ultrasonography (US), colonoscopy and computed tomography (CT) findings; pathology reports; and operative and postoperative management were reviewed. RESULTS: The incidence of appendiceal mucinous cystadenoma was 0.95% of all appendectomy specimens reviewed. In our review, there were 11 patients, five of whom were women. The median age was 70 years (50-85 years), and the most common presentation was abdominal pain (81.8%). On US in eight patients, findings were abdominal cystic mass and cyst wall calcification. The CT finding was well-encapsulated cystic mass in eight patients. In one case, a colonic mass was found in colonoscopic examinations. There was one patient with concomitant colon cancer. Appendectomy was performed in nine patients and right hemicolectomy was performed in two patients. CONCLUSION: Colonoscopy, US, and CT are useful tools in diagnosing mucocele and synchronous cancer. However, diagnosis is usually made intraoperatively or postoperatively on histopathological examination. Appendectomy is the standard of care for mucinous cystadenoma. Furthermore, it is important to prevent spillage of the mucocele content.

Comparison of the Early-Term Complications and Patency Rates of the Standard (Parachute) and Diamond-Shaped End-To-Side Anastomosis Techniques in Arteriovenous Fistulas Created for Hemodialysis.

OBJECTIVE: To compare the early-term patency and complication rates of the end-to-side anastomosis techniques parachute and diamond-shaped techniques in arteriovenous fistulas. STUDY DESIGN: Prospective randomised study. PLACE AND DURATION OF STUDY: Department of General Surgery, Adana Baskent University Application and Research Hospital, Adana, Turkey, between October 2014 and January 2015. METHODOLOGY: Patients with end stage renal disease who underwent arteriovenous fistula creation for hemodialysis were grouped into two according to the anastomosis technique performed. Group 1 was composed of the patients undergoing the standard parachute technique and Group 2 consisted of the patients operated with the diamond-shaped anastomosis technique. The two groups were compared with each other with respect to clinical and demographic data, operative and postoperative variables, and complication and patency rates. RESULTS: A total of 56 patients underwent arteriovenous fistula creation. The overall complication rate was 12.5%. The early-term patency rate was higher in the diamond-shaped anastomosis technique than the standard parachute end- to-side anastomosis technique. Effective dialysis was established after 4 weeks in 48 (85.7%) patients in the overall study group, 23 (82.1%) in Group 1, and 25 (89.2%) in Group 2. However, there was no significant difference between both the techniques with respect to effectiveness of dialysis. CONCLUSION: Both end-to-side anastomosis techniques have their own advantages and disadvantages. Using a patient- specific suitable technique rather than a standard technique would be more appropriate in arteriovenous fistulas formation.

Assessment of Atrial Fibrillation and Ventricular Arrhythmia Risk After Transplant in Patients With End-Stage Renal Disease by P-wave/QT Interval Dispersion, T-Wave Peak-End Interval, and T-Wave Peak-End/QT Interval Ratio.

OBJECTIVES: The association between end-stage renal disease with atrial fibrillation and ventricular arrhythmias is well documented. The aim of this study was to investigate whether kidney transplant has any effect on P-wave dispersion, a predictor of atrial fibrillation and corrected QT interval dispersion, T-wave peak-end interval, and T-wave peak-end/corrected QT ratio, which are predictors of ventricular arrhythmias in patients with end-stage renal disease. MATERIALS AND METHODS: In a retrospective study, 234 patients (125 kidney transplant and 109 healthy control patients) were examined. P-wave dispersion, corrected QT dispersion, T-wave peak-end interval, and T-wave peak-end/corrected QT ratio values before and 3, 6, and 12 months after transplant were calculated and compared in transplant recipients. Baseline values of the control group were compared with 12-month values of kidney transplant patients. RESULTS: We observed a statistically significant decline in P-wave dispersion, corrected QT dispersion, T-wave peak-end interval, and T-wave peak-end/corrected QT ratio values among the pretransplant and 3-, 6-, and 12-month posttransplant measurements (P < .001 for all comparisons). However, the values of these measurements in the transplant group at 12 months were significantly higher than baseline values of the control group (P < .001 for all comparisons). CONCLUSIONS: P-wave dispersion, corrected QT dispersion, T-wave peak-end interval, and T-wave peak-end/corrected QT ratio were shown to be attenuated after transplant, although they remained higher than baseline measurements in healthy individuals. These results indirectly offer that there may be a reduction in risk of atrial fibrillation and ventricular arrhythmias after transplant.

Synchronous GIST with osteoclast-like giant cells and a well-differentiated neuroendocrine tumor in Ampula Vateri: coexistence of two extremely rare entities.

Mesenchymal tumors of the gastrointestinal system with variable histopathological appearances and constant expression of CD117 are known as gastrointestinal stromal tumors (GISTs). Neuroendocrine tumors may be seen in the gastrointestinal system and other organ systems of the body. We report a 44-year-old male patient with a 6.5 x 3 x 6cm mass located in the Ampulla of Vater. Histopathologic examination revealed a GIST with a marked nuclear pleomorphism and a high mitotic rate, and that was rich in osteoclast-like giant cells (OGC). Immunohistochemically, GIST was positive for CD117, while OGCs were negative for CD117 and positive for CD68 and alpha1-antitrypsin. There was also found a well-differentiated neuroendocrine tumor near the GIST, in the serosal aspect of the duodenum at the point of the Ampulla of Vater. This second tumor was 20mm in diameter, and was relatively well circumscribed with few glands invading the GIST. This tumor was positive for synaptophysin and chromogranin. Neither mitosis nor vascular invasion was observed. The patient had no familial history or clinical manifestations of neurofibromatosis. This case presents the unique synchronous existence of two extremely rare entities, a GIST with OGC and a well-differentiated neuroendocrine tumor, both located in the Ampulla of Vater.

Can red cell distribution width be used as a predictor of acute cholecystitis?

OBJECTIVE: Acute cholecystitis is a common disease requiring accurate markers for diagnosis and proper treatment. The aim of this study was to investigate the role of red cell distribution width (RDW) in acute cholecystitis. MATERIAL AND METHODS: 299 were included in the study. The subjects were divided into 2 groups; group 1 (n: 46) acute cholecystitis group and group 2 (n: 253) chronic cholecystitis group. The patients were compared with respect to demographic characteristics, white blood cell count, C-reactive protein, and red cell distribution width. RESULTS: A statistically significant difference was observed between groups with respect to gender, white blood cell count, C-reactive protein, and red cell distribution width level (p<0.05). The mean red cell distribution width level of group 1 and 2 was 14.19±2.02% and 15.03±2.51%, respectively. CONCLUSION: Red cell distribution width level can be used as a predictor of acute cholecystitis. Multicenter prospective studies should be performed to elucidate the exact role of RDW level in acute cholecystitis.

Four-Year Analyses of Renal Graft Biopsies: A Single-Center Pathology Experience.

OBJECTIVES: Kidney transplant is the best treatment for patients with end-stage renal disease. Long-term graft survival depends on the protection of renal allograft function. Renal allograft biopsy is the most important method for examining an allograft function. Biopsy provides critical information, enabling diagnosis and grading of pathologic changes, prediction of response to therapy, and long-term graft prognosis. MATERIALS AND METHODS: We reviewed the medical records of patients who underwent renal transplant from living and deceased donors at Baskent University Adana Teaching and Research Hospital between 2010 and 2014 and who had an indication for biopsy. Clinical characteristics and laboratory results of patients were recorded. Patient biopsy samples were examined according to the Banff 2009 classification. RESULTS: Between 2010 and 2014, there were 175 renal transplants performed at our hospital, with 134 recipients (76.6%) having living-donor and 41 recipients (23.4%) having deceased-donor transplants. Fifty-one patients (29.1%) were children, and 124 patients (70.9%) were adults. We found that there were 123 biopsies made from 75 transplant patients over a 4-year period. When examined according to Banff 2009 criteria, the biopsy samples revealed acute T-cell-mediated rejection alone in 14.1% of the samples, acute antibody-mediated rejection in 4%, and a combination of the 2 rejections in 5.7%. Specific infections were detected in 12 patients. The graft nephrectomy rate was 5.1%. CONCLUSIONS: This study investigated biopsy results, their relation with patient clinical status and 4-year survival rates, and our pathology experience and found that rejection and infection rates were similar to the literature. Our future studies with a longer follow-up and a larger sample size will likely provide more accurate information about graft survival and biopsy results.

Long-term results of retromuscular hernia repair: a single center experience.

INTRODUCTION: Incisional hernia (IH) is one of the most frequent postoperative complications after abdominal surgery. There are multiple surgical techniques described for IH repair. The aim of the study is to evaluate the effect of primary fascial closure on long-term results in retromuscular hernia repair (RHR) for incisional hernias. METHODS: A total of 132 patients underwent RHR for IH were included in our study. 109 patients were evaluated in 2009 and 55 patients in 2015 for short and long-term results. RESULTS: Among 132 patients perfromed RHR, fascia was closed in 107 (81%) and left open in 25 (19%) patients. The mean age of patients was 57.9 ± 11.8 years. Average mesh area was 439.8 ± 194.6 cm2, hernia area was 112 ± 77.5 cm2 and open area after repair was 40.8 ± 43.3 cm2. Mean follow-up of 104 patients regarding postoperative complications evaluated in 2009 was 30.7 ± 14.1 months. Recurrent IH was observed in 6 (4.5%) patients according to data collected in 2009. Long-term results were; mean follow-up period was 91 ± 20.2 months (20-112 months) and recurrent IH was observed in 4 (7.3%) patients. CONCLUSION: Retromuscular repair for incisional hernia regardless of the fascial closure gives high patient satisfaction, less recurrence rates and complications in long-term follow-up.