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To investigate the value of preoperative haemoglobin, albumin, lymphocyte, and platelet (HALP) score in predicting tumour budding in colorectal carcinoma.Observational study.University of Health Sciences, Başakşehir Çam and Sakura City Hospital İstanbul/Turkey, between May 2020 and May 2021.The colorectal cancer patients who underwent surgery were divided into two groups according to the presence or absence of tumour budding. A total of 110 patients were included in the study, and there were 31 patients in group 1 and 79 patients in group 2. The predictive value of the HALP score in predicting tumour budding at the determined cut-off point was evaluated.The mean HALP score was similar in both groups (p=0.459). The rate of lymphovascular invasion was higher in group 2 (p=0.002), and T3 and T4 tumours were more common in group 2 (p0.001). The number of metastatic lymph nodes was higher in group 2 (p=0.049). When the patients in group 2 were divided into subgroups according to the degree of tumour budding, the HALP score differed between intermediate and high budding groups (p=0.032). A HALP value of31.6 predicted the presence of tumour budding with a sensitivity of 70.89% and a specificity of 48.39%.The presence of tumour budding is associated with aggressive phenotypic features in colorectal carcinoma. The preoperative prediction of tumour budding can serve as a guide in the development of individualised therapy plans. The HALP score was associated with the presence of intermediate or high degree of tumour budding.Colorectal cancer, Tumor, Pathology, Hemoglobin, Albumin.

The present study presents the factors associated with early complications and mortality in patients undergoing total gastrectomy.The study included patients who underwent curative total gastrectomy for gastric adenocarcinoma between January 2001 and December 2016 in the General Surgery Department of the Çukurova University Medical Faculty Hospital. The patients were divided into D1, D2, and D3 groups depending on the lymph node dissection width, and the demographic and clinical data and mortality were compared. In addition, mortality-associated factors were analyzed.The study sample included 148 (62.7%) males and 88 (37.3%) females, with a mean age of 65.5±11.4 years. There were 87 patients in the D1 group, 117 in the D2 group, and 23 in the D3 group. As expected, the duration of the operation was longer in the D2 and D3 groups (179 vs. 224 vs. 252; p0.001), and these groups had also higher numbers of lymph nodes dissected (8 vs. 20 vs. 32; p0.001) and metastatic lymph nodes (2.6 vs. 7.5 vs. 9.2; p0.001). The analysis of the operation type in terms of complications revealed a significant relationship only with stump blowout, which was significantly more common after D3 dissection than following D2 and D1 dissections (p:0.01). The male gender (87.5 vs 60.9 p:0.03) was more associated with mortality.D1, D2 and D3 Lymph node dissection in gastric cancer surgery can be safely performed with low mortality and morbidity rates by surgeons with sufficient technical knowledge, and in centers with sufficient hospital volume.Complications, Gastric Cancer, Mortality, Lymph Node Dissection.Questo studio presenta i fattori associati alle complicanze precoci e alla mortalità nei pazienti sottoposti a gastrectomia totale, e si riferisce ai pazienti sottoposti a gastrectomia totale curativa per adenocarcinoma gastrico tra gennaio 2001 e dicembre 2016 presso il Dipartimento di Chirurgia Generale dell’Ospedale della Facoltà di Medicina dell’Università di Çukurova. I pazienti sono stati divisi in gruppi D1, D2 e ™D3 a seconda dell’ampiezza della dissezione linfonodale e sono stati confrontati i dati demografici e clinici e la mortalità. Inoltre, sono stati analizzati i fattori associati alla mortalità. RISULTATI: Il campione di studio comprendeva 148 (62,7%) maschi e 88 (37,3%) femmine, con un’età media di 65,5±11,4 anni. C’erano 87 pazienti nel gruppo D1, 117 nel gruppo D2 e ™ 23 nel gruppo D3. Come previsto, la durata dell’operazione è stata più lunga nei gruppi D2 e ™D3 (179 vs. 224 vs. 252; p0,001), e questi gruppi avevano anche un numero maggiore di linfonodi sezionati (8 vs. 20 vs. 32; p0,001) e linfonodi metastatici (2,6 vs 7,5 vs 9,2; p0,001). L’analisi del tipo di intervento in termini di complicanze ha rivelato una relazione significativa solo con la deiscenza del moncone, che è risultata significativamente più comune dopo la dissezione D3 rispetto alle dissezioni D2 e ™D1 (p:0,01). Il genere maschile (87,5 vs 60,9 p:0,03) è risultato essere maggiormente associato alla mortalità. In conclusione la dissezione dei linfonodi D1, D2 e D3 nella chirurgia del cancro gastrico può essere eseguita in sicurezza con bassi tassi di mortalità e morbilità da chirurghi con sufficienti conoscenze tecniche e in centri con volume ospedaliero sufficiente.

Aims: Spleen masses, which are discovered on imaging studies, usually create difficulty in diagnosis and treatment. Except for lymphomas involving the spleen, primary and secondary neoplasms are rare and discovered by chance. This study analyses a series of splenectomies in a surgical clinic to evaluate the management of incidentally diagnosed splenic masses. Study Design: This retrospective study included patients operated for spleen masses between 2010 and 2021. Patients with a history of lymphoproliferative disease and splenectomy performed as part of a larger resection were excluded. Methodology: The patients were divided into three groups, i.e. cystic, benign and malignant, based on the results of pathological examinations. The groups were compared in terms of age, gender, tumor size, and previous history of malignancy. Results: Splenectomy was performed in 512 patients in 11 years, 62 of whom had solid and cystic lesions detected on imaging. Thirty-five patients (56,5%) were female and the median age was 40 years (range: 18-80 years). Forty-four patients (71%) had distinct symptoms. Radiological evaluations of all the patients were made. Diagnostic biopsy could not be performed in any of the patients. The final pathological examination showed cysts in 38 patients (61,3%), benign lesions in nine patients (14,5%) and malignant lesions in 15 patients (24,2%). Out of 15 patients with malignant lesions, one patient had Hodgkin’s lymphoma, four patients had diffuse large B cell lymphoma and ten patients had metastatic tumors. There was a significant difference in age between the groups and the malignant group was older (p = 0.017). The size of the lesions also significantly differed and the malignant lesions had a significantly smaller diameter (p = 0.014). A significantly higher rate of the malignant group had a previous history of cancer (p˂0,001). Conclusion: Spleen neoplasms are masses that are difficult to diagnose. Most of them are asymptomatic and are found after splenectomies by coincidence. Splenectomy can be utilized as both a diagnostic and curative method. It should be kept in mind that the lesions detected in the spleen in patients with a history of malignancy can be metastatic.

Objective:This study aimed to investigate the factors associated with pancreatic fistula (PF) development after pancreaticoduodenectomy (PD) at our clinic.Methods:Patients who underwent PD for periampullary tumours between 2010 and 2019 were included in the study and categorised into Group I (with PF) and Group II (without PF). The demographic and clinical characteristics, laboratory parameters, tumour characteristics and post-operative results were compared between the groups. Risk factors for PF were analysed by univariate analysis and multivariate logistic regression analysis.Results:In total, 155 patients participated in the study (Group I: n=31; Group II: n=124). The rate of PF was 20%. The two groups were comparable with regard to sex (p=0.348) and age (64.8 vs 66.9 years, p=0.916). Compared with Group II, Group I had a higher number of metastatic lymph nodes (1.61 vs 0.87, p=0.041), a higher number of post-operative complications (58.1% vs 21.8%, p=0.000) and a longer duration of post-operative hospital stay (25.25 vs 16.43 days, p=0.000). Haemoglobin (p=0.493) and albumin (p=0.698) levels were similar between the groups. Total survival duration was shorter in Group I (23.9 vs 38.18 months, p=0.024). In multivariate analyses, being ≥65 years (p=0.040), tumour localisation (p=0.021), lymph node stage (p=0.008) and performedtumour diameter ≥2 (p=0.021) were the independent risk factors for developing pancreatic fistula.Conclusion:In our study, tumour diameter, patient age and lymph node status were associated with PF development. The development of PF reduced expected survival. We believe that identifying the preoperative, intraoperative and post-operative factors related to PF formation may help decrease its development.

Aims: Mucinous, medullary, and papillary carcinomas are rarely encountered types of breast cancer. This study aims to contribute to the literature by comparing the clinical and prognostic features and treatment alternatives of rare breast carcinomas. Study Design: Thirty-four patients with rare breast cancer out of a total of 1368 patients who underwent surgery for breast cancer in our clinic between January 2011 and December 2020 were included in the study. Methodology: The patients were assigned into three groups, i.e., medullary carcinoma group (Group 1), mucinous carcinoma group (Group 2) and papillary carcinoma group (Group 3). Demographic and clinical features, treatment modalities used, surgical approaches, pathological features of tumors and survival were compared between the groups. Results: Thirty-four patients were included in the study. The mean age of the patients in Group 3 was higher, though it was not statistically significant. Modified radical mastectomy was more frequently performed in all the groups. The number of the lymph nodes removed through axillary dissections and the number of the positive lymph nodes were similar in all the groups. The tumors in all the groups were also of comparable sizes (30 mm in Group 1, 42.5 mm in Group 2 and 30 mm in Group 3; p:0.464). Estrogen receptors were negative in a significantly higher rate of Group 1(66.7% of Group 1, p

Purpose: In this study, it is aimed to evaluate the prognostic importance of lymphocytexalbumin (LA) combination in patients having colorectal cancer who underwent curative resection, besides its relationship with postoperative complications. Method: Patients who underwent curative surgery for colorectal cancer between the dates of January 2015 and January 2019 were included in the study. We defined the LA as lymphocyte count (/L)×albumin (g/L). The cut-off point was determined by ROC curves. The patients were divided into two groups according to the cut-off point: Group 1 (Low LA) and Group 2 (High LA). Demographic, clinical and pathological characteristics and survival times were compared between the two groups. Results:Patients are divided into two groups based on the cut off point of 4413 Groups were comparable with respect to age, gender, ASA score, The rate of rectal tumor location was higher in Group 1 (60% vs 32.9 pConclusion: This study indicated decreased overall and DFS associated with low LA index in patients managed with curative treatment for colorectal cancer. No association was found between LA index and postoperative quality markers. LA might be a new prognostic biomarker for colorectal carcinoma.

We aimed to evaluate (immunohistochemically) the YAP expression in breast cancer patients undergoing neoadjuvant chemotherapy and to clarify the relationship between the molecular characteristics, treatment response and survival data and the YAP expression, and hence, to clarify the prognostic significance.One hundred and four patients who were diagnosed with Breast Cancer between 2015-2020 and underwent Neo Adjuvant Chemotherapy were included in the study. Estrogen Receptor(ER), Progesterone Receptor(PR), Human Epidermal Growth Receptor-2(HER2) and Ki-67. Expression are routinely stained immunohistochemically. In this study, existing immunohistochemical markers were reviewed and also, the relationship of YAP with these biological markers was evaluated by using immunohistochemistry and its effect on prognosis has been investigated.The average age of the patients was 52.37. While YAP was positive in 78 patients (75%), it was negative in 26 patients (25%). In the evaluation after neoadjuvant therapy, pathological complete response (MillerPayne Grade5 response) in 28 patients (26.9%), relapse in 6 patients (5.8%), and exitus in 6 patients (5.8%) were detected. In the pathological evaluation, invasive Ductal Carcinoma was the most common one observed in 88 patients (84.6%). As a result of the statistical evaluation, no significant result was obtained between the parameters and YAP negative/positive.As a result of staining with additional YAP in patients who were diagnosed with breast cancer and routinely stained with ER, PR, Cerb B2 and Ki-67 in pathology samples, we could not reach a result that would contribute positively to survival. Longer studies to be conducted prospectively will be meaningful.Breast Cancer, Chemotherapy, Neoadjuvant, Yes Associated Protein.Valutazione immunoistochimica dell’espressione di YAP in pazienti con carcinoma mammario sottoposte a chemioterapia neoadiuvante e a chiarire la relazione tra le caratteristiche molecolari, la risposta al trattamento e i dati di sopravvivenza e l’espressione di YAP, e quindi, per chiarire il significato prognostico. Nello studio sono state incluse centoquattro pazienti cui è stato diagnosticato un cancro al seno nell’intervallo 2015-2020 e sottoposte a chemioterapia neoadiuvante. Il recettore degli estrogeni (ER), il recettore del progesterone (PR), il recettore della crescita epidermica umana-2 (HER2) e l’espressione Ki-67 sono sottoposti a colorazione immunoistochimica di routine. In questo studio, sono stati esaminati i marcatori immunoistochimici esistenti e inoltre, è stata valutata la relazione di YAP con questi marcatori biologici utilizzando l’immunoistochimica ed è stato studiato il suo effetto sulla prognosi.L’età media dei pazienti era di 52,37 anni. Mentre YAP era positivo in 78 pazienti (75%), era negativo in 26 pazienti (25%). Nella valutazione dopo la terapia neoadiuvante, sono state rilevate una risposta patologica completa (risposta MillerPayne di grado 5) in 28 pazienti (26,9%), recidiva in 6 pazienti (5,8%) e exitus in 6 pazienti (5,8%). Nella valutazione patologica, il carcinoma duttale invasivo è stato il più comune osservato in 88 pazienti (84,6%). Come risultato della valutazione statistica, non è stato ottenuto alcun risultato significativo tra i parametri e YAP negativo / positivo. CONCLUSIONE: a seguito della colorazione con YAP aggiuntivo in pazienti a cui è stato diagnosticato un cancro al seno e colorate di routine con ER, PR, Cerb B2 e Ki-67 sul pezzo anatomico, non siamo riusciti a raggiungere un risultato che avrebbe potuto contribuire positivamente alla sopravvivenza. Studi prospettici di più lunga durata saranno significativi.

Gallstone ileus occurs when a gallstone passes into the intestinal system through a fistula between the gallbladder or biliary tract, and the duodenum, stomach or colon, and causes an obstruction. Although it is usually seen in advanced ages, it has rarely been reported in patients who are 100 years old. A 100-year-old female patient, without significant medical or surgical history, was admitted to the emergency department for diffuse abdominal pain, nausea, vomiting, and constipation. Abdominal computed tomography showed air in the biliary tract and obstruction in the small intestine. Patient was operated under emergency conditions. Enterolithotomy was performed and the stone was extracted. Postoperative recovery was uneventful. Bilioenteric fistulas, a major complication of chronic gallbladder diseases, usually develop secondary to intense inflammation. Patients’ age, concomitant disease, clinical condition and intraoperative findings should be taken into consideration while planning the treatment. The data in the literature generally supports the employment of enterolithotomy in high-risk patients and reserves cholecystectomy and resection of the fistula for less comorbid patients with feasible anatomy.

IntroductionCholangiocarcinoma (CCA) is a cancer arising from the intra- or extrahepatic bile ducts Here, we evaluated the prognostic significance of a new inflammation-based scoring system derived from preoperative lymphocyte count x albumin (LA) in cholangiocarcinoma patients.Material and methodsThe study included 36 patients who underwent surgical treatment for cholangiocarcinoma between 2010 and 2021. We defined the LA as lymphocyte count (/L)×albumin (g/L) The cut-off point was determined by ROC curves. The patients were divided into two groups according to the cut-off point: Group1 (Low LA) and Group2 (High LA). These groups were compared for clinical characteristics, recurrence, and overall survival.ResultsThe patients were divided into two groups as Group1 (Low LA) and Group2 (High LA) according to the cut-off point of 5400. The male sex was dominant in the groups (76.2% vs. 86.7%; p:0.434). Hgb was lower (11.7 vs. 13.7; p:0.002) and CA19.9 was higher (310 vs. 71; p:0.013) in Group1. The length of hospital stay, reoperation, and 90-day readmission rate, were similar in the groups. The tumor size (2.8 cm vs. 3.13 cm; p:0.683) was similar in the groups. At follow-up, 33% of the patients in Group1 and 6.7% of the patients in Group2 developed recurrence (p:0.104). The survival was shorter in Group 1 (18 vs. 41.5 months; p:0.003).ConclusionsOur study established that an LA score below the cut-off point of 5400 was a prognostic factor associated with reduced survival. LA scores can be used to predict prognosis and make more individualized decisions in cholangiocarcinoma.

To determine the diagnostic value of the haemoglobin, albumin, lymphocyte, and platelet (HALP) score in predicting axillary lymph node (ALN) involvement.Observational study.Department of General Surgery, Balıkesir University and Mersin City Hospital, Turkey from January 2016-December 2021.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.Group 1 had 65 patients and the Group 2 had 242 patients. At the cut-off point, a HALP score of29.01 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.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.Breast cancer, Axillary lymph node involvement, Immunity, Nutrition.

Schwannoma is a peripheral nervous system tumor arising from Schwann cells of the neural sheath, and they are very rarely seen in the upper digestive tract. In this study, we aimed to present the clinicopathologic characteristics and surgical management of patients who underwent surgical treatment for esophageal or gastric schwannoma.Patients who were diagnosed with esophageal or gastric schwannoma between January 2013 and January 2020 were included in the study. Demographic, clinicopathological and immunohistochemical parameters of the patients were analyzed along with the follow-up results.There were 13 patients in our study. Nine patients had gastric schwannoma and 4 patients had esophageal schwannoma. Female gender was dominant (61.5%). The mean age was 56 years. Esophageal tumors were all enucleated. Minimal invasive approach was preferred in 3 patients. Gastric tumors were most commonly localized in the lesser curvature. Three patients underwent laparoscopic wedge resection, 3 patients open wedge resection, 2 patients subtotal gastrectomy, and one patient proximal gastrectomy. Intraoperative or postoperative complications did not develop in any patient. No patient required reoperation, and there were no deaths within 90 days postoperatively. In the postoperative 90-day period, there was no unplanned re-admission to the hospital. The mean follow-up period was 53.4 months (range: 23-93 months). No recurrence was detected in any patients.Definitive diagnosis of schwannomas is made only by histopathologic examination postoperatively. S-100 expression has diagnostic significance. The preferred treatment is complete surgical excision with negative margins, and the long-term outcome is excellent as these lesions are mostly benign.Esophagus, Enucleation, Schwannoma, Stomach, Wedge resection.Lo Schwannoma è un tumore del sistema nervoso periferico derivante dalle cellule di Schwann della guaina neurale e si incontrano molto raramente nel tratto digerente superiore. Lo scopo di questo studio è quello di considerare le caratteristiche clinicopatologiche e la gestione chirurgica dei pazienti sottoposti a trattamento chirurgico per schwannoma esofageo o gastrico.Sono stati inclusi nello studio i pazienti a cui è stato diagnosticato uno schwannoma esofageo o gastrico tra gennaio 2013 e gennaio 2020, analizzando gli elementi demografici, clinicopatologici e immunoistochimici oltre ai risultati del follow-up.Sono entrati nello studio 13 pazienti, nove con schwannoma gastrico e 4 con schwannoma esofageo. Il sesso femminile era dominante (61,5%). L’età media era di 56 anni. I tumori esofagei sono stati tutti enucleati con approccio mininvasivo preferito in 3 pazienti. I tumori gastrici erano più comunemente localizzati nella picccola curvatura: tre pazienti sono stati sottoposti a resezione laparoscopica a cuneo, 3 pazienti a resezione a cuneo in laparotomia, 2 pazienti sono stati trattati con gastrectomia subtotale e un paziente con gastrectomia prossimale. Non si sono registrate complicanze intraoperatorie o postoperatorie in nessuno dei pazienti. Per nessun paziente c’è stata necessità di un reinterbento e non si sono verificati decessi entro 90 giorni dall’intervento. Nel periodo postoperatorio di 90 giorni, non vi è stato nessun nuovo ricovero ospedaliero programmato. Il periodo medio di follow-up è stato di 53,4 mesi (range: 23-93 mesi). Non è stata registrata alcuna recidiva in nessuno dei pazienti.La diagnosi definitiva degli schwannomi viene fatta solo dall’esame istopatologico postoperatorio. L’espressione di S-100 ha un significato diagnostico. Il trattamento preferito è l’escissione chirurgica completa con margini negativi e il risultato a lungo termine è eccellente poiché queste lesioni sono per lo più benigne.

Amac: Gastrektomi halen mide kanseri tedavisinde en onemli yere sahip iken son yillarda laparoskopik cerrahilerin avantajlarinin gastrik kanser cerrahisinde de oldugunu gosteren yayinlarin cikmasi ile daha populer hale gelmistir. Midenin komsu organ ve damarlar ile yakin iliskisi ve farkli lenfatik yollarin olmasi laparoskopik gastrik kanser tedavisini zorlu kilmaktadir. Tumor histolojisi, cerrahi sinir pozitifligi, batin yikama sitolojisindeki (+) ve yetersiz lenfatik disseksiyon lokal ve sistemik metastazlarin olusmasindaki en onemli faktorlerdendir. Bu calismada Cukurova universitesi genel cerrahi kliniginde gerceklestirilen laparoskopik gastrektomilerin erken donem sonuclarinin paylasilmasi amaclanmistir. Gerec ve Yontem: Eylul 2015 - Eylul 2018 tarihleri arasinda yapilan laparoskopik gastrektomiler total ve distal olmak uzere iki gruba ayrilmis teknik, patolojik sonuc ve erken postoperatif komplikasyonlar acisindan incelenmistir. Bulgular: Calismaya 11’i erkek, 7’si kadin olmak uzere 18 hasta dahil edilmistir. Yas ortalamasi 57,4 olup, ortalama BMI 26,3 idi. 13 hastada cerrahi ilk planda tutulmus sadece bes hastaya neoadjuvan tedavi protokolu uygulanmistir. Total gastrektomi 14 hastada , distal gastrektomi 4 hastada tercih edilen ameliyat yontemidir. Tum hastalara tumor yerlesimine gore standart D2 lenf disseksiyonu uygulandi ve Total gastrektomi grubunda Ortalama 33,2 distal gastrektomi grubunda 32 lenf nodu disseke edildi. Ortalama oral baslama suresi ve Total gastrektomi grubunda 6,4 gun distal gastrektomi grubunda 2,5 gun idi. Duodenal guduk kacagi 4 hastada, ozefagojejunostomi kacagi 2 hastada tespit edilirken 1 hastada da dren yerinde kanama goruldu. Sonuc: Laparoskopik gastrektomi ve lenfatik disseksiyonun yeterliligini gosteren bir cok calisma bulunmaktadir. Ancak ogrenim sureci uzun, teknik zorluklari fazla olan bu ameliyatlarda deneyim ve tecrube arttikca ameliyat surenin kisalacagini ve komplikasyon oraninin azalacagini dusunmekteyiz.

Objectives: The aim of this study was to assess whether ultrasound-guided (US-guided) percutaneous drainage of breast abscesses could be used as an alternative to surgery. Methods: We performed a retrospective study. Twenty patients were included in the study who were diagnosed as having a non-specific breast abscess. Eleven patients underwent surgery whereas nine patients were treated with US-guided drainage. Ultrasonographic findings, results of treatment and follow-up were evaluated between the two groups. Results: In the US-guided drainage group, 5 patients were treated with needle aspiration and 4 were treated with catheter drainage. All cases within the needle aspiration group totally recovered. However, one case within the catheter drainage group failed. The total success rate of US-guided drainage was 88.8%. The median follow-up period was 21.0 days in the US-guided drainage group and 45.0 days in the surgical drainage group. There were no statistically significant differences in terms of recovery (p = 0.450) and follow-up periods (p = 0.112) between the surgical drainage and US-guided drainage groups. Conclusions: US-guided percutaneous drainage may be preferred as a first method of choice in treatment of a breast abscess. The most appropriate approach to breast abscess treatment will be possible with a multidisciplinary approach of surgery and radiology.

Künt abdominal travmanın neden olduğu izolejejunal perforasyon nadirdir ve çoğu kez motorlu taşıt kazalarından sonra veyüksekten düşmeler sonrası görülür. Bu yazıda ; acil servise yüksekten düşmeşikayeti ile başvuran ve ilk muayene, radyolojik incelemeleri normaldeğerlendirilen künt karın travmalı bir olgunun müşahede altında ikentekrarlanan fizik muayene ve kontrol görüntülemeleri ile 24 saat sonra tespitedilen izole jejnum perforasyonu sunulmuştur. Künt travmalı hastalarda da izole ince bağırsak yaralanmasıolabileceği düşünülerek yapılan tetkik ve muayenelerin normal olduğu durumlarda bile, tekrarlayan fizikmuayenelerle hastaları takip etme, görüntüleme ve müşahede süresini uzatmanınönemi büyüktür Bu tür travmaolgularının gözlem altında tutulması hayati sorunların tespiti için sonderece önemlidir .Erken tanı ve tedavi olası komplikasyonların ve mortaliteninönlenmesi açısından önemlidir., Isolated jejunal perforation caused by blunt abdominal trauma is rare andmost often seen after motor vehicle accidents and falling down from height. Inthis article, a case of blunt abdominal trauma which was admitted to theemergency department with the complaint of falling from the high places is presented. Even though the first physical and radiological examinationswere normal, isolated jejunal perforation was detected in control examinationsand control radiological images while the patient was under observation.Control examinations, control radiological images and prolonging theobservation time are very important even when the examinations performed withthe idea of isolated small bowel injury in blunt trauma patients are normal.Keeping such trauma cases under observation is extremely important to detect life threatening problems. Early diagnosis and treatment is veryimportant for prevention of possible complications and mortality.

In this study, we aimed to determine the relationship between HALP score and postoperative complications (According to Clavien-Dindo classification 3 and above), in patients with colo-rectal cancer who underwent curative surgical resection and to determine its clinical value in predicting prognosis.279 patients who underwent curative surgery for colorectal cancer between 2015-2018 were included in the study. The HALP value was calculated by dividing the product of hemoglobin (g/L), albumin (g/L), lymphocytes (/ L) by the number of platelets (/ L). In order to generate a cut off value for the HALP value, ROC analysis and ROC curve were created. The patients were divided into two groups according to survival, and cut off value was found by ROC analysis: Group 1 (Low HALP) and Group 2 (High HALP). Demographic, clinical characteristics, intraoperative , postoperative results and mean survival were compared between the groups.The patients were divided into two groups according to cut off value of 15.73. Group 1 consisted of 113 patients; Group 2 consisted of 166 patients. Average age was similar in the groups (62vs61, p:0.480). Patients in Group 1 received more neoadjuvant therapy (31%vs21%, p:0.064). CEA levels were higher in Group 1 (7.6vs4.3 p:0.034). Mucinous adenocarcinoma histological type was more common in Group 1 (24%vs13% ,p:0.040). Pathological grade poorly differentiated was more common in Group 1 (27%vs13%). Postoperative outcomes was similar to groups We found the HALP score as a risk factor for survival in multivariate analysis (HR=0.8552 95% (CI:0.6575-1.1125, p:0.007). If the HALP value is below 15.73, it is assumed that the average survival is 28 months with 45.4% sensitivity and 66.938% specificity.Our results showed that the HALP score is closely related to clinic pathological features and is an independent prognostic factor for survival. Its value in estimating mean survival is limited.Colorectal cancer, HALP score, Immunity, Nutrition.Lo scopo di questo studio è stato quello di determinare la relazione tra il punteggio HALP e le complicanze postoperatorie (secondo la classificazione Clavien Dindo 3 e successive), in pazienti con carcinoma del colon-retto sottoposti a resezione chirurgica curativa e per determinare il suo valore clinico in prevedere la prognosi. Sono stati inclusi nello studio 279 pazienti sottoposti a chirurgia curativa per carcinoma del colon-retto tra il 2015 e il 2018. Il valore HALP è stato calcolato dividendo il prodotto di emoglobina (g/L), albumina (g / L), linfociti (/ L) per il numero di piastrine (/ L). Al fine di generare un valore di cut off per HALP, sono state effettuate l’analisi ROC e la curva ROC. I pazienti sono stati divisi in due gruppi in base alla sopravvivenza e il valore di cut-off è stato trovato mediante analisi ROC. Sono stati creati due gruppi in base al valore cut-off di HALP: gruppo 1 (Low HALP) e gruppo 2 (High HALP). Sono stati confrontati tra i gruppi le caratteristiche demografiche, cliniche, i risultati intraoperatori, postoperatori e la sopravvivenza media. Risultati - I pazienti sono stati divisi in due gruppi in base al valore di Cut-off di 15,73. Il gruppo 1 era composto da 113 pazienti; Il gruppo 2 era composto da 166 pazienti. L’età media era simile nei gruppi (62 vs 61, p: 0.480). I pazienti del gruppo 1 hanno ricevuto più terapia neoadiuvante (31% vs21%, p: 0,064). I livelli di CEA erano più alti nel Gruppo 1 (7.6vs4.3 p: 0.034). Il tipo istologico di adenocarcinoma mucinoso era più comune nel Gruppo 1 (24% vs13%, p: 0,040). Il grado patologico scarsamente differenziato era più comune nel Gruppo 1 (27% vs13%). I risultati postoperatori erano simili ai gruppi Abbiamo trovato il punteggio HALP come fattore di rischio per la sopravvivenza nell’analisi multivariata (HR = 0,8552 95% (CI: 0,6575-1,1125, p: 0,007). Se il valore HALP è inferiore a 15,73, si presume che la sopravvivenza media è di 28 mesi con una sensibilità del 45,4% e una specificità del 66,938%. In conclusione i nostri risultati hanno mostrato che il punteggio HALP è strettamente correlato alle caratteristiche clinico-patologiche ed è un fattore prognostico indipendente per la sopravvivenza. Il suo valore nella stima della sopravvivenza media è limitato.

In this study, we aimed to investigate the clinical features of Papillary thyroid carcinoma(PTC) Tall cell variant(TCV), long-term outcomes and surgical experience in papillary thyroid carcinoma.33 patients who were operated in our clinic between August 2012 and March 2018 and diagnosed as TCV in their pathology evaluation were included in the study. The demographic and clinical features of the patients, pathological features of the tumor and long-term results were examined.A total of 33 patients were included in our study. The mean age was 55.2(18-85) years. The female sex was more dominant (75.8%). The most common presenting complaint was swelling in the neck (75.7%).Total thyroidectomy was performed in 84.8% and completion thyroidectomy after lobectomy was performed in 15.2%. Neck dissection was performed in 33% of the patients. The mean tumor diameter was 3.6 (1-10) cm. The tumor was multifocal in 36.3% of the patients. The capsule invasion rate of the tumors was present in 69.7% of the patients, extrathyroidal rate was 39.4%, Metastatic lymph nodes were detected in 30.3% of the cases. The mean follow-up duration was 39.3+22.4(5.25-78.63) months. 39.4% of patients had distant metastasis during follow-up. Disease free survival rate was 57.6%, total survival was 42.4 + 3.8 (34.7-50.0) months.TCV is closely associated with larger tumor diameter, multifocal location, extrathyroidal spread and lymph node involvement, We believe that more aggressive surgery should be performed in the treatment of TCV cases and it is important to follow up the patients more closely.Esophagus cancer, Neutrophil/lymphocyte ratio, Preoperative lymphocyte /neutrophil ratio, Prognosis.Questo studio è finalizzato ad analizzare le caratteristiche cliniche del carcinoma papillare della tiroide (PTC), variante a cellule alte (TCV), gli esiti a lungo termine e l’esperienza chirurgica nell’ambito del carcinoma papillare della tiroide. Nella nostra clinica tra agosto 2012 e marzo 2018 sono stati operati 33 pazienti, e diagnosticati come TCV dall’anatomo- patologo, e su questi si è rivolto in nostro studio retrospettivo, esaminando le caratteristiche demografiche e cliniche, le caratteristiche patologiche del tumore e i risultati a lungo termine. L’età media dei 33 pazienti era di 55,2 (18-85) anni. Il genere femminile era più dominante (75,8%). Il sintomo più frequente è stato il gonfiore del collo (75,7%), la tiroidectomia totale è stata eseguita nell’84,8% e la tiroidectomia di completamento dopo la lobectomia è stata eseguita nel 15,2%. La dissezione del collo è stata eseguita nel 33% dei pazienti. Il diametro medio del tumore era 3,6 (1-10) cm. Il tumore era multifocale nel 36,3% dei pazienti. Il tasso di invasione della capsula dei tumori era presente nel 69,7% dei pazienti, il tasso di sviluppo extratiroideo era del 39,4%, i linfonodi metastatici sono stati rilevati nel 30,3% dei casi. La durata media del follow-up è stata di 39,3 + 22,4 (5,25-78,63) mesi, ed il 39,4% dei pazienti ho presentato metastasi a distanza nel corso del follow-up. Il tasso di sopravvivenza libera da malattia è del 57,6%, la sopravvivenza totale è di 42,4 + 3,8 (34,7-50,0) mesi. In conclusione il TCV è strettamente associato a dimensioni maggiori del tumore maggiore, sviluppo multifocale, diffusione extratiroidea e coinvolgimento dei linfonodi. Riteniamo che si debba eseguire un intervento più aggressivo nel trattamento dei casi di TCV ed è importante seguire più da vicino i pazienti.

Achalasia is a well-known disease among esophageal motility disorders, and all treatments for this disease are aimed at relaxing the lower esophageal sphincter (LES). Recently, endoscopic and surgical myotomy techniques are used more frequently because they give better results than other conservative techniques. In this study, we aimed to present the early results of surgical myotomy and anterior fundoplication techniques in the treatment of achalasia-related dysphagia.Our study enrolled patients who operated with laparoscopic myotomy and anterior fundoplication for achalasia between 2014 and 2019. Patients' demographic and clinical properties, operative details, and postoperative shortterm outcomes were retrospectively analyzed.A total of 25 patients (11 women, 14 men) were enrolled. The mean age was 40.72±13.6 (range 18-66) years. The mean LES pressure was 26.6±11.2 (range 16-50) mmHg. The mean esophageal myotomy length was 7.83±1.88 (range 7-12 cm). Esophagus perforation developed in one patient during myotomy. The mean time to start oral feeding was 2.56±0.76 (range 2-4) days, and the mean length of hospital stay was 4.96±1.17 (range 3-8) days. During the follow-up, symptom regression was observed in 92 % of patients at the end of a 1-year.According to our results and available literature, myotomy with Dor fundoplication is an effective technique that can be used to treat achalasia disease.Achalasia, Dor fundoplication, Heller myotomy.

In this study, we aimed to evaluate patients who underwent curative surgical treatment for primary duodenal adenocarcinoma and to present our experience.Patients diagnosed with primary duodenal adenocarcinoma between 2006 and 2018 participated in the study. The demographic and clinical characteristics of the patients, details of the operation, pathological features of the tumors, short- and long-term follow-up results, and mean survival were evaluated retrospectively.Nine patients with a mean age of 54.7 participated in the study. 55% of the patients were male. The most common presenting symptom was abdominal pain (n: 6; 67%). The most common tumor localization was D2-3 (n: 7; 78%), and the most common surgical operation was pancreaticoduodenectomy (n: 7; 78%). There were no intraoperative complications in any patient. The mean tumor diameter was 3.5 cm. The mean number of lymph nodes dissected was 8.3 and the mean number of metastatic lymph nodes was 2. The most common postoperative complication was pancreatic fistula (n: 3; 33%). The mean length of stay was 21.8 days. One patient developed septic shock and mortality happened within the 30-day period. The most common cause of unplanned admission to the hospital within 90 days was wound infection (n: 2; 22%). One patient developed local recurrence and two patients had systemic metastasis. We found an average survival of 40 months.Pancreaticoduodenectomy is the most common approach in its curative surgery and it has a long survival despite the high postoperative complication rate. We recommend radical resection in the surgical treatment of primary duodenal adenocarcinoma.Adenocarcinoma, Duodenum, Pancreaticoduodenectomy.Questo studio è finalizzato a presentare la nostra esperienza su pazienti sottoposti a trattamento chirurgico curativo per l’adenocarcinoma duodenale primario. Lo studio è stato effettuato sui pazienti con diagnosi di adenocarcinoma duodenale primario trattati tra il 2006 e il 2018. Sono stati valutati retrospettivamente le caratteristiche demografiche e cliniche dei pazienti, i dettagli dell’operazione, le caratteristiche patologiche dei tumori, i risultati di follow-up a breve e lungo termine e la sopravvivenza media. Sono stati inclusi nello studio nove pazienti con un’età media di 54.7 anni: 55% dei pazienti era di sesso maschile. Il sintomo più comune al ricovero era il dolore addominale (n. 6; 67%). La localizzazione del tumore più comune è stata la D2-3 (n. 7; 78%) e l’operazione chirurgica più frequentemente eseguita è stata la pancreaticoduodenectomia (n. 7; 78%). Non ci sono state complicanze intraoperatorie in nessun paziente. Il diametro medio del tumore era di 3,5 cm. Il numero medio di linfonodi dissezionati era 8,3 e il numero medio di linfonodi metastatici era 2. La complicazione postoperatoria più comune era la fistola pancreatica (n. 3; 33%). La durata media della degenza è stata di 21,8 giorni. Un paziente è andato incontro a shock settico e mortalità seguita entro 30 giorni. La causa più comune di ricovero non programmato in ospedale entro 90 giorni è stata l’infezione della ferita (n. 2; 22%). Un paziente ha presentato recidiva locale e due pazienti hanno presentato metastasi sistemiche. Abbiamo registrato una sopravvivenza media di 40 mesi. La pancreaticoduodenectomia è l’approccio più comune quale chirurgia curativa con lunga sopravvivenza nonostante l’alto tasso di complicanze postoperatorie. Raccomandiamo dunque la resezione radicale nel trattamento chirurgico dell’adenocarcinoma duodenale primario.

Humans are integrated with the environment where they live. Gravitational force plays an important role in shaping the universe, lives, and even cellular biological processes. Research in the last 40 years has shown how exposure to microgravity changes biological processes. Microgravity has been shown to have significant effects on cellular proliferation, invasion, apoptosis, migration, and gene expression, specifically in tumor cells, and these effects may also exist in stem and cancer stem cells. It has also been shown that microgravity changes the effects of chemotherapeutic drugs. Although studies have been carried out in a simulated microgravity environment in cell culture lines, there are few animal experiments or true microgravity studies. Cancer remains one of the most significant problems worldwide. Despite advances in medical science, no definitive strategies have been found for the prevention of cancer formation or to inform treatment. Thus, the microgravity environment is a potential new therapeutic strategy for future cancer treatment. This review will focus on current knowledge on the impact of the microgravity environment on cancer cells, stem cells, and the biological behavior of cancer stem cells.

Fluxgate magnetometers are widely used in many places for the measurement of weak magnetic field, but are sensitive to variations of sensor temperature. Therefore, their stabilization against temperature variation is required especially for outdoor applications. In this work, temperature dependencies of fluxgate sensors having the cores of one homemade, one commercially obtained finemet alloy, and a commercially obtained supermalloy alloy in ribbon form were examined. It was observed that the heat treatments of the studied cores affect the sensitivity of the sensors in different ways. For instance, while the scale factor of the sensor with the core from in-house prepared finemet ribbon increased from 1.19 MV/T to 3.12 MV/T, the scale factor of the sensor with the supermalloy core increases by 20 times in magnitude (41.6 kV/T to 0.92 MV/T) after heat treatment. Our analysis performed in the temperature interval from -50 degrees C to +85 degrees C reveals that temperature dependencies of the sensors also show differences depending on the core material. In addition to differences seen on the temperature dependence of the studied cores, the most stable one was the sensor with the heat treated in-house prepared finemet core. The variation of the scale factor in the 135 degrees C temperature range was 9.8 %. However, by analyzing the temperature dependences of the scale factors we could decrease the error coming from temperature variations to less than 1.0 % in magnitude of the output signal due to the observed linear dependence between the scale factor and the temperature of this sensor.

We aim to evaluate the prognostic significance of tumor volume in esophageal cancer.Patients who underwent curative resection due to esophageal cancer between the years 2015 and 2019 were included in the study. The Tumor Depth Parameter (TDP) was defined as mucosa and submucosa =1, muscularis propria =2, adventitia =3, and invasion into adjacent organs=4. The Tumor Volume Index (TVI) was defined as the major axis X the minor axis X TDP. Two groups were formed based on TVI: Group 1 (low TVI) and Group 2 (high TVI). In the groups; patients were compared in terms of demographic and clinical features, intraoperative and postoperative outcomes, characteristics of the tumor and average survival.The patients were divided into two groups based on the cut-off value of 4,000. Group 1 (low TVI) consisted of 16 patients and Group 2 (high TVI) consisted of 28 patients. Male sex ratio was higher in Group 2 (50% vs 85%, p:0.011) Tumor diameter was observed to be larger in Group 2 (3.06 vs 5.54, p:0.000). Adenocarcinoma histologic type was more common in Group 2 (25% vs 64.3%, p:0.012). Incidence of respiratory complications was higher in Group 2 (0% vs 35.7%, p:0.024),Survival time (months) was shorter in Group 2 (36 vs 11, p:0.005). TVI's being over 4000 (HR)(95%-Confidence Interval ((Cl) 0.057 (0.011-0.311),p:0.001) was an independent risk factor to determine the rate of survival.TVI can be used as a prognostic factor in patients with esophageal cancer who underwent surgical therapy. TVI is closely associated with tumor histology and postoperative outcomes.Esophageal cancer, Prognosis, Postoperative complication, Surgical manangment, Survey, Tumor volume.Si è voluto valutare il significato prognostico del volume del tumore nel cancro esofageo. Per questo sono stati inclusi nello studio i pazienti sottoposti a resezione curativa di cancro esofageo nell’intervallo tra il 2015 e il 2019. Il Tumor Depth Parameter (TDP) è stato definito come mucosa e sottomucosa = 1, muscolare propria = 2, avventizia = 3 e invasione negli organi adiacenti = 4. Il Tumor Volume Index (TVI) è stato definito come l’asse maggiore X l’asse minore X TDP. Sono stati formati due gruppi sulla base del TVI: Gruppo 1 (TVI basso) e Gruppo 2 (TVI alto). Nei gruppi; i pazienti sono stati confrontati in termini di caratteristiche demografiche e cliniche, esiti intraoperatori e postoperatori, caratteristiche del tumore e sopravvivenza media. RISULTATI: I pazienti sono stati divisi in due gruppi in base al valore di cut-off di 4.000. Il gruppo 1 (TVI basso) era composto da 16 pazienti e il gruppo 2 (TVI alto) era composto da 28 pazienti. Il rapporto tra i sessi maschili era più alto nel gruppo 2 (50% vs 85%, p: 0,011) Il diametro del tumore è stato osservato essere maggiore nel gruppo 2 (3,06 vs 5,54, p: 0,000). Il tipo istologico di adenocarcinoma era più comune nel gruppo 2 (25% vs 64,3%, p: 0,012). L’incidenza delle complicanze respiratorie è stata maggiore nel Gruppo 2 (0% vs 35,7%, p: 0,024), il tempo di sopravvivenza (mesi) è stato più breve nel Gruppo 2 (36 vs 11, p: 0,005) .TVI è superiore a 4000 (HR) (95 L’intervallo di confidenza% ((CI) 0,057 (0,011-0,311), p: 0,001) è stato un fattore di rischio indipendente per determinare il tasso di sopravvivenza. CONCLUSIONE: TVI può essere utilizzato come fattore prognostico nei pazienti con cancro esofageo sottoposti a terapia chirurgica. La TVI è strettamente associata all’istologia del tumore e agli esiti postoperatori.

Intraabdominal schwannomas are rare benign tumors. In this study, we aimed to present our clinical experience in patients with intrabdominally located Schwannoma.Patients who received the diagnosis of intrabdominal schwannoma between 2011-2019 were retrospectively examined. Demographic and clinical characteristics, treatment methods, short- and long-term results and immunohistochemical characteristics of the patients were analyzed.A total of 7 patients were included in the study. Four patients were female and three were male. The mean age was 51.5 (31-63) years. The most common clinical presentation was abdominal pain (57.1%). Tumor location was stomach (n=2), pelvic region (n=2), rectum (n=1), retropancreas (n=1), and left juxtadrenal space (n=1). Postoperative wound infection developed in one patient and pancreatic fistula complication was seen in one patient. Re-admissions to the hospital were due to anemia and pleural effusion in two patients. The mean tumor diameter was 6 cm (0.3-13 cm). All patients were S 100 strongly positive Mitoses / 50 HPFs (high power field),2 Ki673%. The mean follow- up period was 60 months. Currently, 5 patients are being followed without disease, 1 patient survives despite recurrence and 1 patient has died due to non-cancer reasons.Intrabdominal schwannomas are rare tumors which most commonly exhibit gastrointestinal involvement. Since these tumors are mostly benign, the long-term prognosis of patients is good. Schwannoma should be kept in mind in the differential diagnosis of intrabdominal masses. Radical resections with high morbidity and mortality should be avoided if preoperative diagnosis is made.Abdominal tumor, Mesenchymal tumor, Nerve sheath tumor, Schwannoma.Gli schwannomi intraaddominali sono tumori benigni rari. In questo studio, intendiamo presentare la nostra esperienza clinica di pazienti con Schwannoma intraaddominale localizzato. Sono stati esaminati retrospettivamente i pazienti in cui è stato diagnosticato uno schwannoma intra-addominale tra il 2011-2019, analizzando le caratteristiche demografiche e cliniche, i metodi di trattamento, i risultati a breve e lungo termine e le caratteristiche immunoistochimiche dei pazienti. Nello studio sono stati inclusi 7 pazienti: quattro donne e tre uomini. L’età media era di 51,5 (31-63) anni. La presentazione clinica più comune è stata il dolore addominale (57,1%). La posizione del tumore era stomaco (n = 2), regione pelvica (n = 2), retto (n = 1), retropancreas (n = 1) e spazio iuxtadrenale sinistro (n = 1). In un paziente si è avuta l’infezione della ferita postoperatoria, e in uno la complicazione di una fistola pancreatica. I ricoveri in ospedale erano dovuti all’anemia e al versamento pleurico in due pazienti. Il diametro medio del tumore era di 6 cm (0,3-13 cm). Tutti i pazienti erano S 100 Mitosi fortemente positive / 50 HPF (campo ad alta potenza),2 Ki673%. Il periodo medio di follow-up è stato di 60 mesi. Attualmente, 5 pazienti vengono seguiti senza malattia, 1 paziente sopravvive nonostante la recidiva e 1 paziente è deceduto per motivi non cancerosi. Conclusione: gli schwannomi intra-addominali sono tumori rari che presentano più comunemente un coinvolgimento gastrointestinale. Poiché questi tumori sono per lo più benigni, la prognosi a lungo termine dei pazienti è buona. Lo Schwannoma dovrebbe essere tenuto presente nella diagnosi differenziale delle masse intraaddominali. Le resezioni radicali con elevata morbilità e mortalità dovrebbero essere evitate se viene fatta una diagnosi preoperatoria.

In this study, we aimed to convert subjective findings to objective findings and to determine the effect of anorectal physiology tests on the diagnosis and treatment of patients with defecatory complaints.Two hundred and forty patients who applied to the proctology unit between January 2015 and August 2017 were included in our study. The patients were divided into 3 groups based on their presentation complaints; Group 1: Obstructive defecation syndrome(ODS), Group 2: Peroperative except anal incontinence and control after sphincter repair, Group 3: Anal incontinence.Group 2 and Group 3 were divided into subgroups. The demographic data of the patients were retrospectively analyzed. The number of anorectal physiological tests in groups and the rates of referral to surgical or medical treatment were evaluated.Two hundred and forty patients were included in our study. The highest mean age was in Group 3 (46.2±17.8) (p: 0.356) 43.3% of the patients in our study were female. Anorectal manometry was performed in all patients. Endoanal USG was most commonly performed in Group 2 (42.6%, p:0.013), defecography in Group 1 (47.4%, p: 0.0001), and EMG in Group 3(25.3%, p: 0,001). In Group 1, 33% of the patients with pathological defecography findings had surgical treatment (p0.05). In Group 2a, the rate of surgical treatment was higher in patients who underwent anal USG with anorectal manometry (%25.6vs %40). In Group 3, the rate of surgical treatment was higher in patients who underwent anal ultrasound with manometry (%1.9 vs %32.6 p0.005) DISCUSSION: Anorectal physiological tests are important for accurate diagnosis and treatment planning. The combined use of anorectal physiological tests in anal incontinence groups increased the rate of referral to surgical treatment.Lo studio è finalizzato alla traduzione in dati obbiettivi dei sintomi soggettivi, e a valutare l’effetto dei test di fisiologia anorettale sulla diagnosi e sul trattamento dei pazienti con problemi defecatori. Sono stati compresi nello studio 240 pazienti che hanno fatto accesso alla nostra Unità Proctologica tra gennaio 2015 e agosto 2017. I pazienti sono stati divisi in 3 gruppi in base ai loro sintomi alla presentazione; Gruppo 1: Sindrome da defecazione ostruita (ODS); Gruppo 2: Peroperatorio, tranne l’incontinenza anale e controllo dopo la riparazione dello sfintere; Gruppo 3: Incontinenza anale. Il Gruppo 2 e il Gruppo 3 sono stati suddivisi in sottogruppi. I dati demografici dei pazienti sono stati analizzati retrospettivamente. Sono stati valutati il numero di test fisiologici anorettali eseguiti nei gruppi e le percentuali di rinvio a trattamenti chirurgici o medici. L’età media è risultata più elevata nel gruppo 3 (46,2 ± 17,8 (p: 0,356), il 43,3% dei pazienti nel nostro studio era di sesso femminile. La manometria anorettale è stata eseguita in tutti i pazienti. p: 0,013), la defecografia nel gruppo 1 (47,4%, p: 0,0001) ed elettromiografia (EMG) nel gruppo 3 (25,3%, p: 0,001). Nel gruppo 1, il 33% dei pazienti con reperti di defecografia patologica ha subito un trattamento chirurgico (p0,05). Nel gruppo 2a, il tasso di trattamento chirurgico era più elevato nei pazienti sottoposti a ultrasonografia (USG) anale con manometria anorettale (% 25,6 vs% 40). Nel gruppo 3, il tasso di trattamento chirurgico è stato maggiore nei pazienti sottoposti a USG anale con manometria (% 1,9 vs% 32,6 p0,005) Dalla studio si conferma l’importanza dei test fisiologici anorettali ai fini di un’accurata diagnosi e pianificazione del trattamento. L’uso combinato di test fisiologici anorettali nei gruppi di incontinenza anale ha aumentato il tasso di precisione alle indicazioni per il trattamento chirurgico.

The aim of this study is to compare the oncologic efficacy of laparoscopic total gastrectomy (LTG) versus open total gastrectomy (OTG) for gastric cancer and to provide our experiences regarding this surgery.A total of 107 patients who underwent curative total gastrectomy for gastric adenocarcinoma between September 2015 and September 2018 were included in this study. Demographic characteristics, operative parameters, histopathological results, postoperative morbidity and mortality results of the patients were evaluated.Of 107 patients, 70 were men and 37 women. OTG consisted of 89 patients and LTG consisted of 18 patients. The mean age in OTG was 59.4 years, the mean age in LTG was 57.3 years. The mean number of lymph nodes harvested was 30.5 14.6 in OTG and 33.0 10.1 in LTG. The number of metastatic lymph nodes harvested was 7.4 10.5 in OTG and 10.0 11.8 in LTG (p= 0.366), and there was no statistical difference between the two groups. The time of onset of oral intake, anastomotic leakage, and postoperative mortality was similar in both groups. Operative duration and length of hospital stay were significantly higher in LTG. Postoperative survival duration was similar in both procedures CONCLUSION: Laparoscopic total gastrectomy for gastric cancer is an oncologically safe procedure but had a longer operation time and a longer hospital stay. There was no significant difference number of harvested lymph nodes, number of metastatic lymph nodes, and tumor localization between the two groups KEY WORDS: Gastric cancer, Laparoscopy, Gastrectomy.Lo scopo di questo studio di confrontare l’efficacia oncologica della gastrectomia totale laparoscopica (LTG) rispetto alla gastrectomia totale ad addome aperto (OTG) per il cancro gastrico e di fornire le nostre esperienze in merito a questo intervento chirurgico. Sono stati inclusi in questo studio un totale di 107 pazienti sottoposti a gastrectomia curativa totale per adenocarcinoma gastrico tra settembre 2015 e settembre 2018, e ne sono state valutate le caratteristiche demografiche, i tempi operatori, i risultati istopatologici, la morbilit postoperatoria e i risultati di mortalit dei pazienti. RISULTATI: Di 107 pazienti, 70 erano uomini e 37 donne. La chirurgia ad addome aperto ha riguardato 89 pazienti e quella laparoscopica 18 pazienti. Et media in OTG 59,4 anni; et media in LTG 57,3 anni. Il numero medio di linfonodi raccolti stato di 30,5 14,6 in OTG e 33,0 10,1 in LTG. Il numero di linfonodi metastatici raccolti stato 7,4 10,5 in OTG e 10,0 11,8 in LTG (p = 0,366) senza alcuna differenza statistica tra i due gruppi. Il tempo di ripresa dell’alimentazione orale, e l’incidenza di deiscenza anastomotica e di mortalit postoperatoria risultata simile in entrambi i gruppi. La durata dell’intervento e la durata della degenza ospedaliera sono risultate significativamente pi elevate nella LTG. La durata della sopravvivenza postoperatoria stata simile in entrambe le procedure. CONCLUSIONE: la gastrectomia totale laparoscopica per carcinoma gastrico una procedura oncologicamente sicura ma ha avuto un tempo di intervento pi lungo e una degenza ospedaliera pi lunga. Non risultata alcuna differenza significativa nel numero di linfonodi raccolti, numero di linfonodi metastatici e localizzazione del tumore tra i due gruppi.

In our study, we aimed to evaluate the complications after total gastrectomy by Clavien-Dindo classification and to determine the related risk factors.Patients who underwent total gastrectomy due to gastric cancer between 2015-2019 were included in the study. Patients were divided into two groups according to postoperative complication classification Clavien Dindo, those with 3 or higher were Group 1 and the others were Group 2. Demographic and clinical features, laboratory parameters, tumor characteristics, postoperative results and mean survival were compared in the groups. Risk factors for Clavien Dindo 3 and above were analyzed by univariate analysis and multivariate logistic regression analysis.A total of 104 patients participated in our study. Group1 consisted of 25 and Group2 consisted of 79 patients. Male sex was high in both groups (52% vs67.1%, p:0.130). BMI (26 vs 23, p:0.023), albumin (3.24 vs 3.51, p:0,040), postoperative mortality (%28vs% 2.5, p:0.001), postoperative duration of hospitalization (17.60vs9.25 days, p:0.000) were different between the groups, but total survival (month) was not statistically significantly different (19.60vs18.53, p:0.377). In multivariate analysis, tumor Stage 3C (OR =0.177,95% CI = (0.067-0.468), p:0.000), operation duration ≥240 min (OR =2.105,95% CI = (1.080-4.100, p:0.029) and application of neoadjuvant treatment (HR =3.026,95%CI =(1.682-5.446), p:0.000) were indepent risk factors DISCUSSION: In conclusion, obesity, hypoalbuminemia, anemia, tumor stage, duration of operation, and taking neoadjuvant therapy were closely related to postoperative complications. Although the development of postoperative complication increased the length of hospitalization and postoperative mortality, it did not decrease survival in the long term.Gastric cancer, Postoperative complication, Total gastrectomy.Nel nostro studio, abbiamo mirato a valutare le complicanze dopo la gastrectomia totale secondo la classificazione Clavien-Dindo per determinare i relativi fattori di rischio. Sono stati inclusi nello studio pazienti sottoposti a gastrectomia totale per cancro gastrico tra il 2015-2019, divisi in due gruppi in base alla classificazione delle complicanze postoperatorie Clavien Dindo. Quelli con 3 o più complicanze sono il Gruppo 1 e gli altri il Gruppo 2. Sono stati confrontati nei gruppi elementi demografici, caratteristiche cliniche, parametri di laboratorio, caratteristiche del tumore, risultati postoperatori e sopravvivenza media I fattori di rischio per Clavien Dindo 3 e superiori sono stati analizzati mediante analisi univariata e analisi di regressione logistica multivariata. Sono stati utilizzati per il nostro studio un totale di 104 pazienti: il gruppo 1 era composto da 25 pazienti e il gruppo 2 da 79 pazienti, il sesso maschile era elevato in entrambi i gruppi (52% vs67,1%, p: 0,130); erano differenti tra i gruppi BMI (26 vs 23, p: 0,023 ), albumina (3,24 vs 3,51, p: 0,040), mortalità postoperatoria (% 28vs% 2,5, p: 0,001), durata postoperatoria del ricovero in ospedale (17.60vs9.25 giorni, p: 0.000), ma la sopravvivenza totale (in mesi) non è stata statisticamente significativamente diversa (19.60vs18.53, p: 0.377). Nell’analisi multivariata sono risultati fattori di rischio indipendenti, lo stadio tumorale: Stage 3C (OR = 0,177,95% CI = (0,067-0,468), p: 0,000), durata dell’operazione ≥240 min (OR = 2.105,95% IC = (1.080-4.100, p: 0.029) e l’applicazione del trattamento neoadiuvante (HR = 3.026,95% IC = (1.682-5.446), p: 0.000) In conclusione, obesità, ipoalbuminemia, anemia, stadio del tumore, durata dell’operazione e terapia neoadiuvante erano strettamente correlati a complicanze postoperatorie. Sebbene lo sviluppo di complicanze postoperatorie ha aumentato la durata della degenza e della mortalità postoperatoria, non ha ridotto la sopravvivenza a lungo termine.

Aim: We aimed to evaluate (immunohistochemically) the YAP expression in breast cancer patients undergoing neoadjuvant chemotherapy and to clarify the relationship between the molecular characteristics, treatment response and survival data and the YAP expression, and hence, to clarify the prognostic significance. Methods: One hundred and four patients who were admitted to Erciyes University Faculty of Medicine after the approval of the Ethics Committee and were diagnosed with Breast Cancer between 2015-2020 and underwent NeoAdjuvant Chemotherapy were included in the study. The diagnoses of these patients were determined by any of the methods of Breast USG, Mammography, Breast MRI and, if necessary, PET/CT, and among pathological samples, Estrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal Growth Receptor-2 (HER2) and Ki-67 Expression are routinely stained immunohistochemically. In this study, existing immunohistochemical markers were reviewed and also, the relationship of YAP with these biological markers was evaluated by using immunohistochemistry and its effect on prognosis has been investigated. Results: The average age of the patients was 52.37. While YAP was positive in 78 patients (75%), it was negative in 26 patients (25%). In the evaluation after neoadjuvant therapy, pathological complete response (Miller Payne Grade 5 response) in 28 patients (26.9%), relapse in 6 patients (5.8%), and exitus in 6 patients (5.8%) were detected. In the pathological evaluation, invasive Ductal Carcinoma was the most common one observed in 88 patients (84.6%). As a result of the statistical evaluation, no significant result was obtained between the parameters and YAP negative / positive. Conclusion: As a result of staining with additional YAP in patients who were diagnosed with breast cancer and routinely stained with ER, PR, Cerb B2 and Ki-67 in pathology samples, we could not reach a result that would contribute positively to survival. Longer studies to be conducted prospectively will be meaningful.

Amaç: Bu çalışmada elektif splenektomi uygulanan olgularda Açık Splenektomi (AS) ile Laparoskopik Splenektominin (LS) karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmamıza Çukurova Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı’nda 1 Ocak 2013- 1 Ocak 2018 tarihleri arasında elektif splenektomi ameliyatı yapılan 95 hasta dahil edildi. Hastaların demografik bilgileri etyolojik neden, ameliyat süresi, kan kaybı miktarı, preoperatif dönemde dalak boyut ölçümü yapıldı. Laparoskopik cerrahiden açık cerrahiye geçme zorunluluğu, hastanede yatış süresi, postoperatif kan ürünleri replasmanı ve postoperatif gelişen komplikasyonlar incelendi.Bulgular: Çalışmamıza dahil edilen hastaların %79‘una (n=75) açık splenektomi, % 21 ‘ine (n=20) laparaskopik splenektomi olmak üzere toplam 95 olgu dahil edildi. Çalışmaya alınan olgularda ortalama yaş AS’ de 43.0±17 (18-78), LS’ de ise 39.3±13.9 idi (19-62). AS uygulanan olguların 31 tanesi erkek (% 41.3), 44 tanesi ise kadın (%58.7) cinsiyette idi. LS uygulanan olguların 7 tanesi erkek (%35), 13 tanesi ise kadın cinsiyette (%65) idi. AS uygulanan 75 olgudan 19 (% 25.3) olgu splenomegali, 16 (% 21.3) olgu immün trombositopenik purpura (ITP), 11(% 14.7) olgu kitle,7 (% 9.3) olgu ise Talasemi nedeniyle opere edildi.LS uygulanan 20 olgudan 12 (% 60) olgu ITP, 3 (% 15) olgu Hemolitik anemi, 2 (% 10) olgu ise lenfoma nedeniyle opere edildi. LS’de yatış süresi, kanama miktarı ve dalak boyutu üstün iken; AS’de ameliyat süresi anlamlı derecede üstün bulundu .Sonuç: Komplikasyon oranı, hastanede yatış süresi ve maliyetinin daha az olması nedeni ile LS, OS’ye göre daha güçlü bir alternatiftir.

Background Sepsis is a systemic inflammatory response to infection and is one of the leading causes of morbidity and mortality. The second hit after trauma causes increased inflammatory response and multiple organ failure (MOF). The infection which develops after burn injury is a suitable model for a two-hit trauma study. Sepsis causes the release of biochemical mediators, such as Free Oxygen Radicals (FORs), which may lead to lipid peroxidation, which may play a key role in multiple organ failure. In this study, we aimed to investigate the effects of phosphodiesterase (PDE) inhibitors (sildenafil, milrinone, pentoxifylline) and N-acetylcysteine (NAS) on oxidative stress and organ damage in two-hit models. Methods In this experimental study, peritonitis was created by cecal ligation and puncture (CLP) method in 40 rats, 72 hours after creating a 30% scalding injury. Rats were divided into five groups of eight rats each as follows: Group I: No treatment; Group II: 10/mg/kg/day dosage of intraperitoneal (i.p) sildenafil treatment was applied for 72 hours after CLP; Group III: 1/mg/kg/day dosage of i.p milrinone treatment was applied for 72 hours after CLP; Group IV: 150/mg/kg/day dosage of i.p NAS treatment was applied for 72 hours after CLP; Group V: 50/mg/kg/day dosage of i.p pentoxifylline treatment was applied for 72 hours after CLP. All rats were sacrificed on the seventh day of this study. Malondialdehyde (MDA), Glutathione Peroxidase (GPx), Superoxide Dismutase (SOD), catalase, Tumor Necrotic Factor-alpha (TNF-α) levels, and tissue (lung, kidney) and serum samples were taken for histopathological study. Results When compared to the control group, the tissue damage score was found to be lower in all treatment groups. Sildenafil, milrinone and NAS groups had higher kidney GPx levels compared to the control group. Milrinone and pentoxifylline were higher in the lung tissue compared to the SOD control group. TNFα levels were lower in pentoxifylline and milrinone groups compared to the control group. Conclusion This experimental study has shown that PDE inhibitors and NAS have a decreasing effect on oxidative stress and distant organ damage in the two-hit model. Further clinical and experimental studies are needed on this subject.

In this study, we aimed to determine the clinical value and prognostic significance of the Neutrophil / Lymphocyte Ratio in patients undergoing curative surgery due to esophageal cancer.Patients who underwent curative resection for esophageal cancer between 2015-2019 were included in the study. Two groups, Group1 (low NLR) and Group2 (high NLR), were created. Demographic and clinical features, intraoperative and postoperative results, tumor characteristics and mean survival were compared in the groups.A total of 48 patients participated in our study. Group 1 consisted of 18 patients and Group 2 consisted of 30 patients. Male sex was dominant in both groups (66.7% vs 73.3%, p. 0.431). Preoperative CEA was higher in Group 2 (3.97 vs 9.57, p. 0.032). Tumor diameter was larger in Group2 (3.33 vs 5.40 cm, p. 0.000). Adenocarcinoma was higher in Group 2 (33% vs 53.3%, p. 0.047), while squamous cell carcinoma was higher in Group 1 (66.7% vs 33.3%, p. 0.047). Lymph node positivity was higher in Group 2 (66.7% vs 93.3%, p. 0.024). The anastomosis leak was higher in Group 2 (0% vs 20%, p. 0.048). Postoperative hospital stay was longer in Group 2 (13.27 vs 23.9 days, p. 0.009). 90-day readmission was higher in Group1 (33.3% vs 3.3%, p. 0.008). Survival duration was shorter in Group 2 (29 vs 15 months, p. 0.005).This study revealed that preoperative high NLR was associated with poor survival, along with greater tumor diameter, increased lymph node metastasis rate, and increased anastomosis leakage in patients with esophageal cancer. These results suggest that modifying inflammatory responses and modulating the immune system may improve survival outcomes in patients with esophageal cancer.Esophagus cancer, Neutrophil/lymphocyte ratio, Preoperative neutrophil/lymphocyte ratio, Prognosis.Questo studio è finalizzato a determinare il valore clinico e il significato prognostico del rapporto neutrofili / linfociti (NLR) in pazienti sottoposti a chirurgia curativa per cancro dell’esofago. Sono stati inclusi nello studio i pazienti sottoposti a resezione curativa per carcinoma esofageo tra il 2015-2019, suddividendoli in due gruppi, Gruppo 1, con NLR basso e Gruppo 2 con NLR alto. Nei gruppi sono state confrontate le caratteristiche demografiche e cliniche, i risultati intraoperatori e postoperatori, le caratteristiche del tumore e la sopravvivenza media. Hanno partecipato al nostro studio un totale di 48 pazienti hanno. Il gruppo 1 era composto da 18 pazienti e il gruppo 2 era composto da 30 pazienti. Il sesso maschile era dominante in entrambi i gruppi (66,7% vs73,3%, p: 0,431). Il CEA preoperatorio era più elevato nel Gruppo 2 (3.97vs9.57, p: 0.032). Il diametro del tumore era maggiore nel Gruppo 2 (3,33 vs5,40 cm, p: 0.000). L’adenocarcinoma era di grado più elevato nel Gruppo 2 (33% contro 53,3%, p: 0,047), mentre il carcinoma a cellule squamose era più rappresentato nel Gruppo 1 (66,7% contro 33,3%, p: 0,047). La positività dei linfonodi era più elevata nel Gruppo 2 (66,7% vs 93,3%, p: 0,024). La deiscenza anastomotica è stata maggiore nel Gruppo 2 (0% vs 20%, p: 0,048). La degenza post-operatoria è stata più lunga nel Gruppo 2 (13,27 contro 23,9 giorni, p: 0,009). Un nuovo ricovero a 90 giorni si è verificato nel Gruppo 1 (33,3% vs 3,3%, p: 0,008). La durata della sopravvivenza è stata più breve nel Gruppo 2 (29vs15 mesi, p: 0,005). Questo studio ha rivelato che un elevato NLR preoperatorio si è associato a una scarsa sopravvivenza, insieme a un maggiore diametro del tumore, a un aumento del tasso di metastasi dei linfonodi e ad una maggiore incidenza di deiscenza anastomotica in questi pazienti con carcinoma esofageo. Questi risultati suggeriscono che la modifica delle risposte infiammatorie e la modulazione del sistema immunitario possono migliorare gli esiti di sopravvivenza nei pazienti con carcinoma esofageo.

Psoriasis is a chronic inflammatory skin disease with an incidence of 1-3%. Psoriasis usually occurs in the scalp, knee, elbow, sacral region and joints. The nipple-areola complex involvement is rarely encountered in the literature.31-year-old female patient, who presented at the dermatology outpatient clinic with a lesion characterized by bright, pearlescent-white squamous lesions on an erythematous plaque, limited to the nipple-areola complex for the past three years, and who was diagnosed with "Psoriasis" following incisional biopsy.The benign or malignant distinction should be made for lesions observed in the nipple-areola complex. It should not be forgotten that psoriasis may also be present in the differential diagnosis of dermatitis-like benign lesions that do not respond to long-term and various drug treatment, although they are rare.Complex Benign lesions, Breast, Nipple areola, Psoriasis.La psoriasi è una malattia infiammatoria cronica della pelle con un’incidenza dell’1-3%, che si manifesta di solito a livello del cuoio capelluto, del ginocchio, del gomito, della regione sacrale e delle articolazioni. Il coinvolgimento complesso del capezzolo-areola si incontra raramente in letteratura. Il caso clinico presentato riguarda una paziente di 31 anni, riscontratat affetta presso l’ambulatorio di clinica dermatologica una lesione caratterizzata da lesioni squamose bianche, perlacee su una placca eritematosa, limitata al complesso areola-capezzolo, manifestatasi negli ultimi tre anni, e che è stata diagnosticata come “psoriasi” a conclusione di un prelievo tissutale bioptico. La distinzione di benignità o malignità dovrebbe essere fatta per tutte le lesioni osservate nel complesso areolacapezzolo. Non bisogna dimenticare che la psoriasi può anche essere presente nella diagnosi differenziale di lesioni benigne simili a dermatiti che non rispondono al trattamento farmacologico a lungo termine e variato, sebbene siano rare.

Fluxgate magnetometers are widely used in many places for the measurement of weak magnetic field, but are sensitive to variations in sensor temperature. Therefore, their stabilization against temperature is required especially for outdoor applications. In this paper, temperature dependencies of fluxgate sensors using four cobalt-based cores, two homemade, and two commercially obtained were analyzed at temperature interval of −50 °C to +85 °C in the climatic chamber. In addition to differences seen on the temperature dependence of the studied cores, the most stable one was the sensor using Co65Fe6Cr7Si8B14 core. Although the variation of the scale factor in the 135 °C temperature range was 17% in magnitude, it was decreased to 6% with a serial resistor connected to the pick-up coil, where the sensor signal is induced by measured dc field. By specifying the scale factor versus temperature dependence curves, we could decrease the error coming from temperature variations to less than 2%. Experimental results reveal that the sensors cored with Vitrovac6025 and Metglas2714A ribbons can also be preferred when they are evaluated in terms of both temperature dependence and noise levels.

In this study, we have shown that fluxgate sensors can be used for different application areas. Alternative sensor configurations have been developed for three different application areas. These are mainly rod- and ring-type fluxgate sensors. In the first study, a measurement system with the rod-type fluxgate sensor has been developed in order to monitor the local magnetic field distributions on a magnetic tape (e.g., credit card). With this system, the magnetic recording data on the credit card were measured and imaged successfully. The second and the third application areas, which are monitoring the influence of solar storms on the earth field and heartbeat analysis of mankind, were carried out by using a ring-core fluxgate sensor geometry.

WOS: 000485707300017 Although traumatic diaphragmatic ruptures are rare, it is a critical condition that can cause life-threatening complications. Traumatic diaphragmatic rupture may be discovered years after the presentation of the injury, with gastrointestinal or pulmonary symptoms due to a diaphragmatic hernia. Intestinal obstruction due to an isolated diaphragmatic rupture that emerges after a penetrating trauma is highly rare. The present study presents the case of a male patient who underwent laparotomy for intestinal obstruction due to a diaphragmatic hernia caused by a sharp object-induced injury to the thorax 1 year prior to his presentation. We believe that diaphragmatic ruptures are one of the reasons of mechanical intestinal obstruction and that they require urgent surgery.

Rapidly solidified Nd15Fe77B8 magnetic alloy powders have been produced by using melt-spinning method. Different wheel surface structures such as smooth and textured were tested to investigate the effect of wheel surface morphology on powder shape, microstructure, Curie temperature, and magnetic properties. Produced powders were subjected to surfactant-active ball-milling process for powder size reduction and to enhance magnetic and thermal properties. Generally, flaky-shaped powders were obtained with smooth surface wheels and spherical-shaped powders were produced with textured surface wheel. Microstructure of flaky-shaped powders consisted of polygonal fine equiaxed grains with an average grain size of 0.45 µm. Spherical-shaped powders had dendritic microstructure regardless of their sizes. Both flaky and spherical powders involved hard magnetic Nd2Fe14B phase located in the grain interior and a fine network of Nd-rich phase at the grain boundaries. Surfactant-active ball-milling process significantly contributed to magnetic and thermal properties of powders. The coercivity values of flaky-shaped powders milled for 90, 150, 210, 270, 330, and 390 min milling times were substantially higher than that of spherical-shaped powders milled for the same period of times. The Curie temperatures of Nd15Fe77B8 ingot alloy and spherical- and flaky-shaped powders were found as 279, 305, and 321 ∘C, respectively. On the other hand, the Curie temperatures of flaky- and spherical-shaped powders milled for 390 min were measured as 331 and 311 ∘C, respectively.

Highlights • Biliary plastic stent placements are commonly performed to treat a variety of biliary disorders. This procedure presents short-term complications such as hemorrhage, pancreatitis, cholangitis, and perforation, in addition to long-term complications such as stent migration and late perforation., Introduction Meckel’s diverticulum is the most common congenital lesion of the small intestine. The incidence varies between 0.5% and 2% Biliary stents can be used for the treatment of patients with bile duct complications. Intestinal perforation due migrated stents is a very rare and life threatening complication. “Perforation of the Meckel diverticulum due to stent”, and no case was found in the literature. For this reason, our case has been identified as the first case seen in the literature. Case presentation A 20 year old male patient liver transplantation was performed from a live donor. 3 years ago The patient presented at our clinic with abdominal pain, nausea and vomiting that has been present for 2 days. Abdominal computed tomography showed a foreign body in the small intestines Patient was operated in emergency conditions. Meckel Diverticulum 40 cm proximal to the ileocecal valve and a biliary drainage catheter perforating the diverticule was seen Meckel's diverticulum was excised, primary repair was performed, Postoperative recovery was uneventful. Discussion Complication rates due to a biliary stent range between 8–10% with a mortality below 1% (Konstantinidis et al. [1]). The most feared complication due to a biliary stent is stent migration. The perforation rate due to stent migration is below 1%. It most commonly occurs in the duodenum. Patients with stent related perforations are surgically managed as other GIS perforations. Conclusions Perforation due to stent migration should also be considered in differential diagnosis in patients with a biliary stent and Acute Abdomen.

The effect of Pb 2+ substitution on structural, magnetic and microwave properties of Ba 0.5 Sr 0.5 Fe 12 O 19 was investigated. Samples were synthesized using solid state reaction route with 1 wt% B 2 O 3 addition which was used as a catalyst for better crystal growth. Both lattice parameters (a and c) and crystallite sizes increased initially with Pb substitution and then they started to decrease according to the calculations based on Rietveld Refined XRD patterns. Magnetic properties of Pb substituted samples degraded compared to Pb-free hexaferrite, for instance, coercivity decreased substantially from 3.35 to 1.4 kOe. On the other hand, Pb 2+ substitution enhanced microwave absorption properties of the samples, for example the reflection loss increased from −40 dB to −57.5 dB in a 2 mm-thick Ba 0.3 Sr 0.4 Pb 0.3 Fe 12 O 19 sample. The mechanisms of microwave absorption appeared to be natural resonance of magnetic moments and relaxation of electrical dipoles for the reflection loss observed at high frequencies (>10 GHz) and quarter wave cancellation at matching thickness at frequencies ≤ 10 GHz. There is a very good agreement between experimentally measured and calculated matching frequency values for thicknesses between 2 and 5 mm. Finally, it was observed that matching thickness decreases exponentially with matching frequency in the 2–10 mm thickness range.

Although lateral internal sphincterotomy (LIS) is the most preferred surgical treatment for chronic anal fissure, In this study, we aimed to investigate the effect of preoperative anorectal manometry on surgical treatment choice in patients presenting with anal fissure.Between January-2015 and August-2017 and whose physical examination revealed chronic anal fissure findings were included in the study. Patients were divided into two groups as Group 1 LIS and Group 2 non-LIS. In addition to the demographic characteristics of the patients, anal manometry findings and its effect on surgical treatment options were examined.20 patients (M/F:13/7) were included in the study. The mean age was 48.3+17.4 in Group 1 and 45.25 +24.45 in Group 2 (p:0.797). In the preoperative manometric examination, resting pressure(mmHg) range was 93.2+15.9 in Group 1, and44+11.2 in Group 2 (30-57) (p:0.001). Endurance to squeezing time was shorter in Group 2 (p:0.0138). There were no differences between the groups in terms of mean squeezing pressure, rectal sensation, and rectoanal inhibitor reflex (p0.05). Of the four patients with low sphincter pressures, 3 underwent botulinum toxin injection and 1 underwent advancement flap instead of LIS. There was no significant difference between preoperative and postoperative CCFI scores in the LIS group (0.6±1.8 vs. 1.2±1.85, p0.05).In the treatment of chronic anal fissure, non-LIS methods were selected in 20% of the patients with the help of preoperative anal manometric examination. Manometric examination is important to minimize the risk of incontinence and to determine the choice of treatment correctly.Anal fissure, Anal incontinence, Anal manometry.Sebbene la sfinterotomia interna laterale (LIS) sia il trattamento chirurgico più preferito per la ragade anale cronica, In questo studio, abbiamo mirato a studiare l’effetto della manometria anorettale preoperatoria sulla scelta del trattamento chirurgico in pazienti che presentano ragade anale. Tra gennaio-2015 e agosto-2017 sono stati studiati 20 pazienti il cui esame fisico ha rivelato esiti cronici di ragade anale. I pazienti sono stati divisi in due gruppi: gruppo 1 trattati con sfinterotomia laterale interna (LIS) e gruppo 2 non trattati con LIS. Oltre alle caratteristiche demografiche dei pazienti, sono stati esaminati i risultati della manometria anale e il suo effetto sulle opzioni del trattamento chirurgico. Risultati: L’età media dei 20 pazienti (M / F: 13/7) era di 48.3 + 17.4 nel Gruppo 1 e 45.25 +24.45 nel Gruppo 2 (p: 0.797). Nell’esame manometrico preoperatorio, l’intervallo della pressione a riposo (mmHg) era 93,2 + 15,9 nel gruppo 1 e 44+11,2 nel gruppo 2 (30-57) (p: 0,001). La resistenza al tempo di compressione è stata più breve nel gruppo 2 (p: 0,0138). Non ci sono state differenze tra i gruppi in termini di pressione di compressione media, sensazione rettale e riflesso dell’inibitore del rectoanale (p0,05). Dei quattro pazienti con basse pressioni dello sfintere, 3 sono stati sottoposti a iniezione di tossina botulinica e 1 ha subito un lembo di avanzamento anziché LIS. Non vi era alcuna differenza significativa tra i punteggi CCFI preoperatori e postoperatori nel gruppo LIS (0,6 ± 1,8 contro 1,2±1,85, p0,05). Conclusione: nel trattamento della ragade anale cronica, nel 20% dei pazienti sono stati selezionati metodi non LIS con l’aiuto dell’esame manometrico anale preoperatorio. L’esame manometrico è importante per ridurre al minimo il rischio di incontinenza e determinare correttamente la scelta del trattamento.

Appendix vermiformis agenesis is quite rare. It is seen in 1/100,000 of patients who underwent laparotomy with an initial diagnosis of appendicitis. A 72-year-old woman who had not undergone any previous surgery was operated on for mechanical intestinal obstruction. Right hemicolectomy was performed due to obstructive tumoral mass in the hepatic flexure. There was no appendix vermiformis in exploration. Before deciding on the diagnosis of appendix agenesis, a thorough and rigorous exploration should be performed in ileocecal region and ascending colon. In our case, the diagnosis of appendix agenesis was incidental. However, it should be kept in mind that appendix agenesis may be present in patients undergoing surgery with the diagnosis of acute appendicitis. KEY WORDS: Appendicular agenesis, Colorectal carsinoma, Congenital Abnormalities.La agenesia dell’appendice vermiforme è abbastanza rara, e si riscontra in 1 su 100.000 pazienti sottoposti a laparotomia con una diagnosi iniziale di appendicite. Una donna di 72 anni che non aveva subito alcun intervento chirurgico precedente è stata operata per ostruzione intestinale meccanica. L’emicolectomia destra è stata eseguita a causa della presenza di una massa tumorale ostruttiva a livello della flessura epatica. All’esplorazione del pezzo operatorio non si è trovata l’appendice vermiforme. Prima di concludere per una diagnosi di agenesia dell’appendice, deve essere eseguita un’esplorazione approfondita e rigorosa nella regione ileocecale e nel colon ascendente. Nel nostro caso, la diagnosi di agenesia dell’appendice è stata casuale.Tuttavia, va tenuto presente che l’agenesia dell’appendice può essere presente in pazienti sottoposti a chirurgia con diagnosi di appendicite acuta.

In this study, we aimed to investigate the early results of the safety and efficacy of adipose-derived stem cells (ADSCs) injection along with the repair of the internal orifice in the recovery of complex perianal fistula.The study included patients who underwent autologous adipose tissue-derived stemcell injection for complex perianal fistula between December2017 and January2018. The FDA-approved Lipogems® system was used to prepare autologous micro-fragmented adipose stem cells. Demographic characteristics, history of inflammatory bowel disease, fistula type and length of fistula tract determined by endoanal ultrasound, mean operation duration, postoperative complications, and fistula healing of the patients were evaluated. Fistula healing was evaluated on the 30th ,90th days and 9th months.A total of 10 patients, with male predominance, were included in our study. The mean age was 47±13.1 and mean BMI was 28.3±4.79. None of the patients had inflammatory bowel disease Based on endoanal ultrasound findings, fistula type was transsphincteric, extrasphincteric and suprasphincteric for 7, 2 and 1 patients, respectively. Calculated length of fistula tract based on ultrasound was 4.45±1.69(2.5-6.4). Mean duration of operation was 45±7 minutes. None of the patients had any treatment related toxicity, however, two patients experienced bruising at the liposuction site. Healing rate in the follow-up of 30-day, 90-day and 9-month was 70%, 80% and 70%, respectively.In addition to surgical treatment in the form of curettage and closure of the fistula tract, autologous micro-fragmented adipose tissue injection is a safe, feasible, and reproducible procedure that can be performed based on the early results in complex anal fistula healing.Lipogems®, Mesenchymal stem cell, Regenerative medicine, Adipose tissue-derived mesenchymal stem cell.Si comunicano i primi risultati sulla sicurezza ed efficacia dell’iniezione di cellule staminali di derivazione adiposa (ADSC) insieme alla riparazione dell’orifizio interno per il trattamento della fistola perianale complessa. Sono stati inclusi nello studio un totale di 10 pazienti, in prevalenza machi, sottoposti a iniezione autologa di cellule staminali di derivazione dal tessuto adiposo per il trattamento di fistola perianale complessa tra il dicembre 2017 e il gennaio 2018. Per preparare cellule staminali adipose micro frammentate autologhe è stato utilizzato il sistema Lipogems® approvato dalla FDA. Sono state valutate le caratteristiche demografiche, la storia della malattia infiammatoria intestinale, il tipo di fistola e la lunghezza del tratto di fistola determinati con ecografia endoanale, la durata media dell’operazione, le complicanze postoperatorie e la guarigione della fistola dei pazienti. La guarigione della fistola è stata valutata il 30°, 90° giorno e 9° mese. L’età media dei pazienti era di 47 ± 13,1 e l’IMC media era di 28,3 ± 4,79. Nessuno dei pazienti aveva una malattia infiammatoria intestinale In base ai risultati ecografici endoanali, il tipo di fistola era transsfincterico, extrasincincico e soprasfincterico rispettivamente in 7, 2 e 1 paziente. La lunghezza calcolata del tratto di fistola basato sull’ecografia era 4,45 ± 1,69 2,5-6,4. La durata media dell’operazione è stata di 45 ± 7 minuti. Nessuno dei pazienti ha presentato tossicità correlata al trattamento, tuttavia, due pazienti hanno manifestato lividi nel sito di liposuzione. Il tasso di guarigione nel follow-up di 30 giorni, 90 giorni e 9 mesi è stato rispettivamente del 70%, 80% e 70%. Si può concludere che oltre al trattamento chirurgico per curettage e chiusura del tratto di fistola, l’iniezione di tessuto adiposo micro frammentato autologo è una procedura sicura, fattibile e riproducibile che può essere eseguita sulla base dei primi risultati nella complessa guarigione della fistola anale.