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Vogt-Koyanagi-Harada (VKH) disease is a rare inflammatory ocular disorder that is characterized by bilateral granulomatous panuveitis, neuropathy, and aseptic meningitis, along with various extraocular manifestations. VKH disease has been reported to be associated with various immune disorders. In this report, a case of VKH disease is presented that is associated with mesenteric vascular disease and intestinal necrosis, with an emphasis on the fact that this is the first case documented in the literature of both diseases occurring simultaneously. [ABSTRACT FROM AUTHOR]

<b> Introduction:</b> Inguinal hernia repair is the most common operation worldwide. The essential factors in hernia repair have been the postoperative quality of life, early return to work, low recurrence rate, and chronic pain prevention. </br></br> <b>Aim:</b> The aim of this study was to compare the short- and long-term results of the self-adhesive mesh and the conventional polypropylene mesh in Lichtenstein repair. </br></br> <b> Material and methods:</b> A total of 100 male patients were randomized and operated on, 50 with the self-adhesive mesh (S group), 50 with the conventional polypropylene mesh (P group). Prospectively, the patients were followed for an average of 36 months. The two groups were compared for the duration of surgery, duration of hospital stay, duration of daily activity/resumption of work, postoperative pain, chronic pain, recurrence, wound infection, hematoma/seroma formation, and postoperative analgesic consumption. </br></br> <b>Results:</b> The study involved 39 patients in the P group and 37 patients in the S group who underwent inguinal hernia surgery. The P group had a longer mean operation time than the S group, and the difference between the two groups was statistically significant (45.1 ± 6.6 min vs. 28.8 ± 3.0 min, P = 0.0001). In recurrence, postoperative discomfort, chronic pain, length of hospital stay, daily activity/return to work, wound infection, hematoma/seroma, and postoperative analgesic use, there was no statistically significant difference between the two groups. </br></br> <b>Conclusion:</b> It was found that the self-adhesive mesh did not produce statistically significant advantages over the conventional polypropylene mesh, except for operative time, in the Lichtenstein repair.

<b>Introduction:</b>Minimizing recurrence in hernia surgery is one of the major aims. Defining surgeon-dependent risk factors for recurrence is therefore of great importance in laparoscopic ventral hernia repair (LVHR). This study aims to analyze the predictive value of the mesh area/defect area ratio (M/D ratio) in terms of recurrence as a new criterion in LVHR.</br> </br> <b>Methods:</b> A total of 124 patients were enrolled in the study. Age, gender, hernia type, body mass index, defect size, size of the mesh, mesh overlapping, area of the defect, area of the mesh, M/D ratio, postoperative complications, follow-up time, recurrences and timing of recurrence were also recorded. The potential variables that may affect recurrence were examined by univariate and multivariate analysis.</br> </br> <b>Results:</b> There were 12 (9.7%) recurrences in our series. A statistically significant difference was found if either the mesh/defect ratio was ≤6 or >6 (p = 0.012). Multivariate analysis confirmed that M/D ratio was the only independent parameter for recurrence. </br></br><b>Conclusion:</b> Understanding M/D ratio concept and using it in surgical clinical practice may help reduce recurrence rates after LVHR.</br&gt.

Background: Selective versus routine histopathological examination after cholecystectomy is still in debate. This study aims to investigate the effect of histopathology results on treatment modality and surgery strategy. The validity of the selective histopathology approach was questioned., Methods: The data of patients undergoing laparoscopic cholecystectomy between January 2009 and December 2019 were retrospectively analyzed. The demographics and histopathology results, whether the operation was emergent or elective, and the reasons for conversion to open surgery were recorded. Malignant and precursor histopathology diagnoses were examined, and their relationship with the surgical strategy was questioned., Results: A total of 2723 patients were included in the study. Of these patients, 2600 (95.5%) were operated under elective, while 123 (4.5%) were operated under emergency conditions. While the surgery was completed laparoscopically in 2685 (98.6%) patients, it was converted to open surgery in 38 (1.4%) patients. Age, gender, the presence of primary gallbladder cancer, acute cholecystitis, and xanthogranulomatous cholecystitis in histopathological examination were found to be independent predictive factors for conversion to open surgery (P < .05). The rate of primary invasive carcinoma in the series was 0.1%., Conclusion: Routine histopathological examination of the gallbladder is important for demonstrating a wide spectrum of pathological changes in this organ. Invasive cancer or precursor lesions can be detected even in patients without any macroscopic abnormality. Histopathological examination also plays a role in determining follow-up, further examination, and treatment modality in addition to the diagnosis in these patients.

Objectives: Acute appendicitis during pregnancy may be associated with severe maternal and fetal complications. The clinical, laboratory and radiological parameters used in diagnosis and the effects of the surgical method and timing on the results are controversial. The present study aims to reveal the relationship between clinical approach, surgical treatment methods and complications in pregnant women with suspected acute appendicitis., Methods: Between December 2007 and August 2019, 21 pregnant women who underwent appendectomy were included in this study. Age, gestational age, complaints at admission, leukocyte count, radiological examination results, type of surgery (conventional or laparoscopic), histopathology results, time from admission to operation, maternal and fetal complications were retrospectively evaluated., Results: The number of patients who developed complications was six (28.6%). Three (14.3%) of these patients had preterm birth and three (14.3%) had an abortion. There was no statistically significant relationship between trimester and complication (p=0.747). Fourteen patients (66.7%) underwent laparoscopic surgery and seven patients (33.3%) underwent conventional surgery. Although the complication rate was higher in the laparoscopic group, there was no statistically significant difference (p=0.306). The fetal loss rate in the series was 14.3% and all were in the laparoscopic group. However, there was no statistically significant difference between the groups (p=0.158)., Conclusion: Pregnancy-related limiting factors may complicate the diagnosis of acute appendicitis. These patients definitely need a more skeptical assessment and additional diagnostic tools beyond the standard clinical approach. Although laparoscopic appendectomy appears to be a safe option in treatment, its relationship with a higher risk of fetal loss should be kept in mind., Competing Interests: Conflict of Interest: None declared., (Copyright: © 2020 by The Medical Bulletin of Sisli Etfal Hospital.)

Purpose: Lichtenstein repair has been the gold standard in inguinal hernia surgery. The aim of this study was to investigate the role of mesh fixation in terms of postsurgical chronic pain and recurrence., Methods: Sixty patients with primary inguinal hernias were treated between March 2007 and December 2008. Thirty patients underwent conventional Lichtenstein repair while a self-adhesive mesh was used for the second group. The primary outcome parameters were the rate of recurrence and chronic pain. The operating time, postoperative pain, complications, and time when patients returned to work were recorded., Results: Fifty-one patients completed the survey. Early pain scores were lower in the self-adhesive mesh group. The main advantage of the self-adhesive mesh was the shorter operating time (23.70 ± 5.57 vs 36.90 ± 11.36, P = 0.006). Both techniques were almost identical in terms of long-term chronic pain (P = 0.294), and the rates of recurrence at the end of a median of 31 months' follow-up were identical., Conclusion: Self-adhesive mesh repair of inguinal hernias is superior to the conventional Lichtenstein method in terms of shorter operative time and less pain in the early postoperative period. The rates of chronic pain and recurrence are similar with the suture-fixed repairs.

Prosthetic materials have gained popularity for ventral hernia repair. There are situations when the use of a mesh is either unnecessary or contraindicated. This study compares 51 patients with ventral hernia who underwent laparoscopic or open primary suture repair. Results were determined by a median follow-up of 33 months. Recurrence rates and operative time were the major parameters of outcome. Mean operative time was insignificantly shorter in the laparoscopic group (14.8 ± 4.3 vs. 15.6 ± 3.7 min). There were no short-term complications in groups. One patient in each group had recurrence. Conclusively, laparoscopic primary repair of small ventral hernias is simple and can be performed as an initial approach for small defects. Compared with open repair, it has the advantages of better exposure, reduced pain, and less morbidity. It can also be performed as a component of a combined laparoscopic operation. However, this technique is not recommended for repair of large ventral hernias.

Epigastric, umbilical, incisional, parastomal, and trocar site hernias are all classified as "ventral" hernias, which constitute a great portion of the surgery in a general surgical practice, and debate still continues regarding the optimal surgical strategy to correct these anatomical defects. Although repairing these hernias using a synthetic material, whether placed open or laparoscopically, has gained wide popularity, there are some situations where the use of a mesh is either unnecessary or contraindicated. This article presents the cases of 10 patients with some kind of ventral hernia which were all repaired laparoscopically with a primary suturing technique.

Background: Phyllodes tumor (PT) is a rare neoplasm comprising less than 1% of all breast tumors. Its clinical spectrum ranges from a benign and locally recurrent form of behavior to malignant and metastatic forms. The aim of the study was to evaluate the clinical characteristics, treatment regimens, survival and late complications in patients with PT., Patients and Methods: We retrospectively reviewed the medical records of 10 women who were treated for PT in our center between 1998 and 2002. All cases were histologically examined by an experienced breast pathologist, and tumors were classified as benign, borderline malignant or malignant according to standard histological criteria., Results: The median age at diagnosis was 45.5 years (range: 21-69 years). Seven (70%) of 10 tumors were benign and 3 (30%) were malignant. The median tumor size was 29 mm (range: 12-80 mm). The least safe margin was 1 cm. Three of 10 patients had malignant PT and underwent simple mastectomy. Local recurrence was determined in no patients. Only one patient had lung metastasis. Median follow-up period was 62 months (range, 12-96 months). The patient with lung metastasis was treated with doxorubicine but died one year after the operation., Conclusion: PT is a rare neoplasm of the breast. It resembles fibroadenoma. Local excision with appropriate surgical margins seems adequate in all patients (Tab. 1, Fig. 3, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

Breast ductoscope is a fiberoptic endoscope used for examining the distal breast ducts under direct vision in order to identify the source of pathologic nipple discharge. The purpose of this study was to investigate the reliability of intra-operative breast ductoscopy in patients with pathologic nipple discharge, which could not be identified by radiologic tests. Between April 2002 and March 2007, breast ductoscopy was performed in 34 patients who had pathologic nipple discharge with no radiologic evidence about the source. The procedures were carried out under general anesthesia and ductoscopic findings were as well as the histopathology of the specimens were recorded and documented. In 88%, (30 of 34) of the patients, endoscope was successfully introduced into the external orifice of the ducts at the nipple and proximal breast ducts were successfully visualized. Ductoscopy revealed intraductal lesions (i.e., ductal obstruction, intraductal papilloma, red patches, and erythematoid platter) in 20 patients (66%). Among the 20 patients with visible endoluminal pathology, nine had a papilloma and eight had signs of either acute inflammation (bleeding, erythema) or previous inflammation with healing (adhesions and blocked ducts). In two cases, invasive breast carcinoma was identified, one of which was ductal carcinoma in situ (DCIS) with minimal invasion. In both cases, there had been blocked ducts. In one case DCIS was identified. Breast ductoscopy is a reliable and easy-to-use method to demonstrate the source of pathologic nipple discharge in cases with bleeding and other intraductal lesions.

Xanthogranulomatous inflammation is a well-defined disease most frequently reported in the kidney and gallbladder. The occurrence of this disease in the colon is extremely rare, with only five cases of appendix vermiformis involvement in the literature. Its clinical importance is that it can be misinterpreted as a malignant process clinically and intraoperatively as well as in the imaging studies. In this report, a 57-year-old patient presented with a cecal mass that caused recurrent lower gastrointestinal bleeding and anemia, mimicking colon cancer. This is the first report of this lesion involving the cecum with typical macroscopic and microscopic features but with atypical clinical symptoms and findings.

Purpose: The surgical treatment of sacrococcygeal pilonidal disease varies widely. This study reports outcomes of cleft lift procedure combined with pit excision performed both in primary and recurrent pilonidal disease., Methods: A total of 76 consecutive patients with primary or recurrent pilonidal disease who received cleft lift procedure or combined (cleft lift with pit excision) procedure in our clinic between March 2005 and May 2007 were investigated prospectively. Rate of postoperative complications and disease recurrence were the primary outcomes., Results: Mean follow-up was 16.4 months (SD 7.0, range 5-34). The most common early postoperative complications were minor wound dehiscence (11 patients, 14.5 percent), followed by infection (10 patients, 13.2 percent), and wound break (4 patients, 5.3 percent). One recurrence (1.3 percent) was observed during the follow-up., Conclusions: The results of the current study supported that cleft lift procedure fulfills the requirements of an ideal operation for pilonidal disease. The cleft list procedure was a relatively simple procedure that was easy to learn, to teach, and perform under either spinal or local anesthesia. The procedure can be performed as a "day-surgery" procedure with low postoperative morbidity, acceptable time to return to work, and low recurrence rate.

Background: Acute mesenteric ischemia is an entity characterized by rapid developing of circulatory failure. Reperfusion following ischemia causes further mucosal injury., Methods: In our study, an experimental model of 15 minutes of reperfusion following 45 minutes of superior mesenteric artery occlusion was established. The segments which underwent I/R injury were histopathologically examined, and blood samples obtained from the heart were analyzed for alkaline phosphatase and creatine kinase levels., Results: The results of the study demonstrated that mucosal injury in anandamide injected group was less expressed than in other groups suggesting that anandamide might have a protective effect on the mucosa. After L-NAME and indomethacin injection, the protective effect of anandamide seems to disappear due to inhibition of NO and prostaglandins. The results of histopathological examination of specimens from CB1 receptor and anandamide injected group indicate that I/R injury has regressed., Conclusion: The protective effect of endogenous anandamide on I/R injury may take place through CB2 receptors in the small intestine; NO and prostaglandin, which are activated through the stimulation of CB2 receptors may be responsible for this protective effect (Fig. 8, Ref. 29). Full Text (Free, PDF) www.bmj.sk.

Background: Abdominal surgery can lead to postoperative intra-abdominal adhesions (PIAAs) with significant morbidity and mortality. This study compares the use of honey with a standard bioresorbable membrane (SEPRAFILM) to prevent the formation of PIAAs in rats., Methods: Thirty rats underwent laparotomy, and PIAAs were induced by scraping the cecum. The animals were divided into three groups, each containing ten rats. Group 1 (control) represented the cecal abrasion group, with no intraperitoneal administration of any substance. Group 2 (honey group) underwent cecal abrasion and intraperitoneal administration of honey. Group 3 (Seprafilm group) underwent cecal abrasion and intraperitoneal Seprafilm application., Results: Group 1 exhibited higher adhesion scores for adhesions between the abdominal wall and the organs. Groups 2 and 3 had decreased adhesive attachments to the intra-abdominal structures. Compared to group 1, the incidence of adhesion formation was lower in both group 2 (p=0.001) and group 3 (p=0.001). The incidence of fibrosis was also lower in group 2 (p=0.016) and group 3 (p=0.063) compared to group 1. There was no significant difference between the histopathological fibrosis scores for the rats in group 2 and those in group 3 (p= 0.688)., Conclusion: This study suggests that both honey and Seprafilm decrease the incidence of PIAAs in the rat cecal abrasion model. Although the mechanism of action is not clear, intraperitoneal administration of honey reduced PIAAs. The outcome of this study demonstrates that honey is as effective as Seprafilm in preventing PIAAs.

Background: The purpose of this study is to compare the complications of different types of thyroidectomy for benign and malignant thyroidal diseases., Methods: Between January 2001 and March 2006, 982 patients underwent thyroidectomy in single institute. A retrospective analysis was performed on demographic characteristics and pathology reports of patients, complications of surgery as well as the follow-up of patients. Sixty patients could not be fully followed up and were excluded., Results: The types of the surgical procedures were as follows; 451 (48.9%) total, 137 (14.9%) subtotal, 60 (6.5%) near-total thyroidectomy and 274 (29.8%) lobectomy with isthmectomy. In the benign group, temporary recurrent laryngeal nerve injury (RLNI) was the most common complication in patients with toxic diffuse goiter (TDG 2%) while this complication occurred in patients with differentiated thyroid cancer (DTC 1.5%) in the malign group. Permanent RLNI in benign thyroidal diseases was seen more commonly in patients with toxic multinodular goiter (1.3%). In benign thyroidal diseases, temporary hypoparathyroidism (THPT) was mostly found in patients with TDG (8%), whereas in malignant thyroidal diseases this was found more in patients with DTC (2%). Permanent HPT (PHPT) in benign thyroidal diseases was observed more commonly in patients with multinodular goiter (0.9%). In malignant thyroidal diseases, it was more frequently observed in patients with DTC (0.5%). Infective complications after thyroid surgery are rarely observed and have a low incidence (0.4%)., Conclusion: RLNI and HPT are the most common complications of after thyroid surgery but they may be avoided with an accurate technique (Tab. 3, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

Meckel diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract that is generally asymptomatic and only manifests in a specific way when complications exist. An unusual complication of MD is known as Littre hernia. It comprises less than 1% of all MD. Littre hernia is the protrusion of an MD through a potential abdominal opening. Usual sites of Littre hernia are right inguinal (50% of cases), umbilical hernia (20%), and femoral hernia (20%). We report a case of Littre hernia in a boy who presented with acute scrotal pain and swelling.

Background: Blunt hepatic trauma is frequently seen, particularly as a result of traffic accidents. Given that surgical therapy may have high rates of morbidity and mortality, a selected group of patients may can benefit from conservative management. We herein present, a group of patients with blunt hepatic trauma who were managed without any invasive diagnostic tools and / or surgical intervention., Methods: Nineteen hemodynamically stable patients (9 males, 10 females; mean age 46,6; range 19-73 years) with blunt hepatic trauma were included in the study. Vital signs, hemodynamic parameters, liver function tests, need for transfusion, hospital stay and results of radiological tests were recorded as well as demographic characteristics. Classification of injury was done according to the American Association for the Surgery of Trauma's Organ Injury Scaling System., Results: Nineteen patients had radiologically-proven liver injury. Nine patients had grade I injury, five had grade II, two had grade II and three had grade IV injuries. Twelve patients required blood transfusions. Fourteen patients had mild elevation of transaminases while the remaining five were completely normal. Mean hospital stay was 7.6 days. Blunt trauma was associated with a large abdominal wall hernia in one patient; the defect was repaired laparoscopically three months later. No patient underwent surgery due to the failure of conservative management and there was no death., Conclusion: For blunt hepatic trauma patients, non-operative management may be the initial therapy if haemodynamic stability can be maintained. The decision for surgical intervention should be given according to the presence of associated intraabdominal injuries. Liver injury score of patients is not as important as the hemodynamic status for determining conservative management.

Background: Surgical patients frequently need some type of intestinal stomas for a wide spectrum of disorders. Maintaining effective and enough decompression of gastrointestinal tract, securing distal bowel segments and anastomosis are the primary goals of ostomy formation as well as providing a minimum complication rate of closure or "take-down"., Method: In this report, we present five adult patients who were operated for some kind of intestinal disease and required enterostomy. We preferred Santulli type of enterostomy which was formerly used by pediatric surgeons. In this technique, the proximal afferent bowel is fashioned into a stoma and anastomosed side-to-end with double layer sutures into the distal efferent bowel., Result: One of the five patients died of systemic problems, other four did well in terms of surgical outcome of the stoma., Conclusion: We concluded that; although indications are limited, Santulli enterostomy can be performed in adult patients as effective as pediatric age group, particularly for its advantages in early restoration of intestinal continuity and diminished risk for post-closure complications.

Aim: To evaluate the mechanical and biochemical parameters of colonic anastomotic healing in hypercholesterolemic rats., Methods: Sixty rats were divided into two groups of 30 each according to their dietary regimens. The test group was fed with a high cholesterol-containing diet for two months while the control group had standard diet. These two groups were further divided into three subgroups consisting of ten rats each. After hypercholesterolemia was established, left colon resection and anastomosis were performed in both groups and samples from liver and abdominal aorta were taken to evaluate the systemic effects of hypercholesterolemia. Anastomotic wound healing, blow-out pressures and tissue hydroxyproline levels were evaluated., Results: The test group had a significant weight gain in two months. Microscopic examination of the abdominal aorta revealed no atherosclerotic change in none of the groups, but liver tissue specimens showed significant steatosis in the test group. Tissue hydroxyproline levels and anastomotic blow-out pressures were significantly lower in the test group than in the controls., Conclusion: Hypercholesterolemia not only increases hydroxyproline levels and blow-out pressures but also worsens anastomotic wound healing.

Peutz-Jeghers syndrome is an infrequently encountered disease with potential complications including bleeding, intestinal obstruction, intussusception, and malignant transformation. We report on two patients, father and daughter, with Peutz-Jeghers syndrome who were admitted to hospital with similar complaints of abdominal pain. The father was 37 years old and the daughter was 17. Physical examination and laboratory tests revealed small intestinal intussusception in both patients. In the daughter, the intussuscepted segment was resected. An electrosurgical snare was also used for enteroscopic excision of multiple jejunal and ileal polyps. In the father, two 4-cm polyps were surgically resected while an enteroscopic surgical snare was used for polyps of smaller size. Both patients were discharged on postoperative day 7.

The role of extended lymphatic dissection on the prognosis and outcome of thoracic esophageal carcinoma is still controversial. The aim of this study was to determine the impact of three-field lymphatic dissection on the survival and recurrence rates of patients with thoracic carcinoma of the esophagus. Forty-six patients with primary squamous cell carcinoma of the thoracic esophagus underwent esophagectomy with three-field lymphatic dissection between 1992 and 2003. Recurrence and survival rates were examined as well as complications. Overall survival for the patients was 45.6 months and 5-year survival rate was 56%. Five-year survival rates for patients with Stage 2A, 2B, 3 and 4 were 68%, 0%, 53% and 33%, respectively. There was no Stage 1 patient. Mean disease-free survival was 41.4 months. Sixty three percent of patients had node-negative disease (5-year survival rate, 68.9%) and 37% had nodal metastases (5-year survival rate, 33.7%) (P = 0.002). Surgical morbidity was seen in 35 patients (76.1%). Conclusively, lymph node involvement in patients with thoracic esophageal carcinoma is the major determinant of prognosis and survival. Extended lymphatic dissection provides higher disease-free and overall survival rates and our study revealed the highest survival rate for thoracic esophageal carcinoma, to best of our knowledge.

Background: Intestinal anastomotic healing is a complex procedure in which several mediators, cytokines and other substances play roles, as well as calcitonin gene-related peptide (CGRP). CGRP is capable of stimulating DNA synthesis and cell proliferation in endothelial cells by increasing vasodilatation and inflammatory response and promoting epithelial, vascular and mesothelial cell proliferation. This study was undertaken to investigate whether CGRP has a beneficial effect on intestinal anastomotic healing, even in septic conditions., Methods: Four groups of 10 rats were administered normal saline (0.5 mL), lipopolysaccharide (LPS) (0.5 mg/kg), CGRP (0.5 mL 6.5 x 10(-10) mol/L) and LPS + CGRP (0.5 mg/kg + 0.5 mL 6.5 x 10(-10) mol/L) via intraperitoneal route, respectively, 24 h prior to operation and postoperatively. All rats underwent ileo-ileal end-to-end anastomosis. Anastomotic bursting pressure and tissue hydroxyproline levels were measured on postoperative day 7., Results: Calcitonin gene-related peptide was found to have positive effects on both parameters of healing. The LPS-injected group showed intestinal anastomotic healing disorder suggesting impaired collagen production, which showed improvement after CGRP administration., Conclusions: Calcitonin gene-related peptide increases anastomotic wound healing in experimental intestinal anastomosis in the presence of endotoxin.

Minimally invasive surgery is widely used in hernia repair given its advantages such as minimal disturbance to the surrounding tissues, shorter hospital stay, and promising long-term results. Efforts are still being made to make this minimally invasive procedure even more minimal. New tissue adhesives avoid the use of foreign materials and the postoperative pain that might be attributed to staples. We present the first two cases of bilateral inguinal hernia repair performed with a totally extraperitoneal procedure using fibrin sealant instead of staples for the fixation of the mesh.

A 70-year-old man on enoxaparin and warfarin sodium therapy due to pulmonary embolism was admitted for evaluation of a sudden, sharp pain in the left inguinal region. Physical examination revealed a 5 x 10 cm tender mass. Abdominal ultrasound showed a 9 x 9 x 10 cm left retroperitoneal hematoma. INR was 2.1, and anticoagulation therapy was discontinued. A regimen of supportive therapy (vitamin K, fresh frozen plasma and blood transfusion) was started, but the hemorrhage continued to enlarge, up to 9 x 10 x 20 cm, and the patient experienced a significant deterioration in his overall status. He underwent an urgent laparotomy and the hematoma was evacuated. A retroperitoneal abscess developed during the postoperative period which was drained percutaneously. He was discharged on postoperative day 33 with no further complaints. This case demonstrates the importance of surgical therapy in the treatment of spontaneous retroperitoneal hemorrhage caused by anticoagulant therapy.

This study evaluates the effect of the low molecular weight dextrans as a perfusion solution on early graft function of twenty living donor kidneys. Ten kidneys were perfused with +4 degrees C Ringer lactate after nephrectomy while other ten with +4 degrees C Ringer lactate + 10% Dextran. Immediate and delayed kidney function, blood creatinine, postoperative hemodialysis requirement, Doppler US and renal scintigraphy, third month graft survival and number of removed grafts were examined postoperatively as well as kidney biopsies. No statistical difference was found between the groups regarding the post-transplant ATN period. But the microscopic examinations demonstrated less damage-more function in Ringer lactate+Dextran group compared to Ringer lactate alone.

Objective: Assessment of malignancy criteria in Huerthle cell neoplasm., Methods: This study intends to review retrospectively the patients who were operated for Huerthle cell neoplasia at Gazi University, Department of General Surgery between January 1986 and October 1999. Pathological specimens from 63 patients (20 males and 43 females) were investigated in this study, 48 of which revealed Huerthle cell adenoma and 15 revealed Huerthle cell carcinoma. The mean age of the patients with Huerthle cell adenoma was 40.7+/-1.59 yr while it was 51.3+/-1.83 yr in patients with Huerthle cell carcinoma. Mann-Whitney U and Chi-square tests were used for statistical analysis., Results: . Fifty-two of the 63 patients had fine needle aspiration (FNA) biopsy prior to operation, 49 of those were reported to have suspected Huerthle cell neoplasia (HCN) and three had suspected Huerthle cell carcinoma (HCC). The sensitivity of FNA for HCN was 20 %, specificity was 100 %, positive predictive value was 100 % and negative predictive value was 76 %. For all patients, peroperative frozen section (FS) biopsy was examined. Fifty-nine of the FS specimens revealed HCN and four revealed HCC. The sensitivity, specificity, positive predictive value and negative predictive value of FS biopsy were 27 %, 79 %, 28.5 % and 77.5 %, respectively. In this retrospective study, there was a statistically significant correlation between malignancy and the size of the tumor (P<0.05) according to Chi-square test, and also a statistically significant correlation between malignancy and the age of the patient (P<0.05) according to Mann-Whitney U test., Conclusions: In cases where FS and FNA biopsies cannot adequately define the benign or malignant behaviour of the tumor, the age of the patient and the diameter of the tumor must be taken into consideration for accurate surgical strategy. Particularly for 50 year-old and elderly, incidence of malignancy is statistically significant without considering sex of the patient.

In this study, the effects of BQ123 (an ET(A) receptor antagonist), bosentan (a nonselective ET(A)-ET(B) antagonist), and phosphoramidon (an endothelin converting enzyme inhibitor) were investigated on intestinal mucosal lesion formation and changes in tissue PGE2 and LTC4 levels due to intestinal ischemia-reperfusion (I/R) injury in rats. Following 30 min of ischemia, the substances were given via the inferior caval vein, and 10 min later the intestine was subjected to reperfusion for 30 min. The intestinal specimens were evaluated both microscopically and the tissue PGE2 and LTC4 levels were obtained for each group. The histopathologic examination revealed a significant reduction in tissue injury in both BQ123 and phosphoramidon pretreated groups compared with the control group. Bosentan, on the contrary, did not decrease the injury. The pharmacologic examination revealed a significant reduction of PGE2-like activity in both BQ123 and phosphoramidon pretreated groups, compared with the control group, while LTC4-like activity remained unchanged except for an increase in the bosentan pretreated group.

Cystic lymphangioma is a very rare condition generally accepted to be the result of a developmental malformation of the lymphatic system. Usually seen in children, it occurs infrequently in adults. The neck (75%) and axillary regions (20%) are the most common locations of lymphangioma, but it can occur in the retroperitoneum, mediastinum, mesentery, omentum, colon, pelvis, groin, bone, skin, scrotum, and spleen. We present a cystic lymphangioma of the spleen with emphasis on its rarity in this site and problems of differential diagnosis with hydatid disease.