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Hemorrhage and coagulopathy are the leading causes of preventable death in war and trauma injuries, constituting approximately 50 percent of deaths in the first 24 hours. The importance of damage control resuscitation by establishing a permissive hypotension, minimizing crystalloid use, and early implementation of blood products is well understood today. The aim of the present review is to highligt the role of massive transfusion protocols with balanced blood component ratios. Physicians dealing with trauma must quickly and accurately predict when a massive transfusion protocol (MTP) should be activated. There have been several validated transfusion scores developped for this purpose. Earlier balanced blood transfusion by using massive transfusion protocol, may be more effective in resuscitating coagulopathic patients. Transfusion ratios approaching 1: 1: 1 of packed red blood cells (PRBCs) to fresh frozen plasma (FFP) to platelet have been shown to improve the survival of the severely injuried patient. Trauma institutions should develop and regularly activate MTPs for trauma and war surgery in proper indications. [ABSTRACT FROM AUTHOR]

Purpose:Anastomotic leaks following intestinal operations may cause devastating effects on patients. Ischemia may also occur at the intestinal walls in the presence of strangulations. In this study, we examined the effects of human recombinant (Hr)-epidermal growth factor (EGF) given at a single intramural dose into the intestinal walls and daily intraperitoneal cavity on ischemia and the healing process of anastomosis.Materials and Methods:Sixteen male New Zeland white rabbits were randomly divided into four groups (n= 4 in each group). In Group 1, two different segments of ileum were identified and, then, transected and the free ends were sutured each other. In the other groups, ischemia was induced by ligating the mesenteric vascular arcade. After the ischemic induction, Group 2 received intramural injections of %0.9 saline, Group 3 received intramural injections of a single dose of EGF, and Group 4 received intramural and intraperitoneal injections of EGF. Bursting pressures and tissue hydroxyproline levels were analyzed. Necrosis, fibroblastic activity, collagen deposition and neovascularization were also studied.Results:The mean levels of bursting pressures in Group 4 (148.6 ± 25.3 mmHg) were higher than Group 2 (70 ± 21.5 mmHg) (p= 0.001). The mean level of bursting pressures was not statistically significant between Group 1 (170.1 ± 35 mmHg) and Group 4 (p= 0.073). Hydroxyproline levels in Group 2 were lower than Groups 3 and 4. There was a statistically significant difference in the mucosal ischemia, mucosal healing and degree of adhesion, but not in the mural anastomotic healing among the groups.Conclusions:Intramural injection with daily intraperitoneal administration of low-dose EGF enhances the bursting pressure and collagen accumulation in ischemic anastomosis, improving many histological variables associated with ischemic intestinal anastomosis. [ABSTRACT FROM AUTHOR]

Hydatid disease of the liver caused by the larval form of Echinococcus granulosus still remains a common and challenging problem in Turkey. Operative treatment is the most common and well known option. Percutaneous aspiration, injection and reaspiration (PAIR) has resulted as an alternative treatment to surgery and is becoming popular. Therefore, the treatment of hydatid cyst has been shifted from traditional surgical approach to less invasive PAIR. Large cysts with multiple daughter cysts, cysts communicating with the biliary tree, cysts exerting pressure on vital organs and single superficial hepatic cysts are indications for surgical treatment. While preoperative albendazol treatment is planned to decrease the cyst viability before surgery or percutanaeous drainage, postoperative chemotherapy is administered to reduce recurrence rates. PAIR is a promising treatment approach but randomised clinical trials with long follow-up are required to decide its efficiency. The aim of this study is to evaluate the effectiveness and indications of different treatment modalities in the management of liver hydatid cyst. [ABSTRACT FROM AUTHOR]

Differentiated thyroid cancer constitutes approximately 90% of all thyroid tumors. Despite the excellent prognosis in the majority of patients, recurrence rates remain high. Although many scoring systems (TNM, AMES, MACIS etc) have been described to predict the prognosis, there is lack of scoring systems related to recurrence. We aimed to analyse the effect of scoring systems in predicting the recurrences rates. We retrospectively reviewed 106 patients with differentiated thyroid cancer. The patients were divided into risk groups, based on MACIS and MSKCC scoring system. The predictive value of the scoring system for assessing the recurrence rates were calculated. The rate of papillary, folicular and hurthle cell cancer were 82%, 10.4 % and 7.6% respectively. During a 35-month followup period, 16 patients were diagnosed with the locoregional recurrence. With MACIS scoring sytems, the locoregional recurrence rates were 9.1%, 42.9%, 50% and 42.9% for stage I, II, III and IV respectively. MSKCC calculated the recurrence risks as 4%, 20.9% and 38.5 for low, median and high risk, respectively. The most important factors for locoregionel recurrence were tumor size and extracapsular invasion. Scoring systems may be helpful in predicting locoregional recurrence and thus patients who will benefit from adjuvant therapy can be determined. [ABSTRACT FROM AUTHOR]

Breast cancer is the most common cancer of women, and it ranks as the second leading cause of cancer death in women. Although breast cancer incidence in western countries is higher than developping countries, very favorable survival rates in the developed countries have been attributed to early detection by screening. Despite screening mammography have been used for a long time, there is not a strong consensus related to when to start? How frequently to screen?, and when to finish screening. Many factors including the risk stratification of patient, incidence of breast cancer, social and economic status, the availability of mammography and medical team should be considered when creating national screening programs. Today, the most effective way to reduce breast cancer mortality is early diagnosis and treatment. By the help of effective screening programmes and organizations related to breast cancer awareness, downstaging of breast cancer and reduction in mortality rate in community could be possible. [ABSTRACT FROM AUTHOR]

Objective: Whole-body fluorodeoxyglucose-positron emission tomogra-phy (FDG-PET) has proved effective in the diagnosis of recurrent colorectal cancer (CRC) and in the monitoring of cancer therapy. However there have been limited studies considering the effect of FDG-PET in the initial evaluation of CRC. We analysed how FDG-PET affects the management of patients with CRC preoperatively. Material and Methods: A prospective study of 26 consecutive patients with known or suspected CRC was undertaken. The patients were evalu-ated by computed tomography (CT) and FDG-PET. FDG-PET results were compared with those of CT and correlated with histopathologic findings or with clinical course. Results: FDG-PET had a sensitivity of 96% and positive predictive value of 100% forthe diagnosis of primary cancer, while CT had values of 68% and 95%, respectively. FDG-PET was superior to CT in detecting additional metastatic disease with a sensitivity of 89%, while CT had 33%. FDG-PET resulted in altered management for 8 patients of whom three avoided inappropriate surgery. Conclusion: It is concluded that FDG-PET is highly sensitive for the diagnosis and staging of patients with CRC. Its use in conjunction with CT results in a more accurate selection of patients for surgical treatment with curative intent. [ABSTRACT FROM AUTHOR]

Spontaneous subcapsular liver hematoma (SLH) is extremely rare. We report here a case of a 74-year-old male, with a rare complication of anticoagulant therapy. The patient was admitted to the emergency unit with complaints of pain in the right upper quadrant and respiratory distress. He had abnormal coagulation parameters with a prolonged prothrombin time and elevated INR value. Computed tomography (CT) scan showed a giant hematoma, measuring more than 18 cm in diameter, in the right lobe of the liver. Despite a two-months conservative treatment, abdominal complaints persisted and the liver hematoma eventually progressed in size. The patient underwent laparotomy, the capsule was opened and approximately 2 liters of hematoma was evacuated. His postoperative course was generally downhill. On the 22nd day of follow-up he died due to respiratory insufficiency and sepsis. Conservative management is the mainstay therapy for the non-ruptured SLH unless the patient's general condition worsens due to enlarging hematoma. SLH should be considered in the differential diagnosis in patients presenting with abdominal pain while receiving oral anticoagulants. [ABSTRACT FROM AUTHOR]

Solid pseudopapillary tumor of pancreas is a very rare, low-grade malignant tumor of pancreas and it has a tendency of affecting young women. In the preoperative period, it is difficult both to diagnose and to differentiate it from the pancreatic cancers. Recently, there has been a steady increase in the number of solid pseudopapillary tumors of pancreas, but still, the pathogenesis and apparent therapeutic algorithm remain unclear. In the present study, we aimed to define the clinicopathological characterictics of solid pseudopapillary tumor and the effects of surgical intervention via three cases. [ABSTRACT FROM AUTHOR]