İrfan Coşkun

A rare cause of intestinal obstruction due to an exophytic gastrointestinal stromal tumor of the small bowel

ABSTRACT Introduction: Gastrointestinal stromal tumors constitute a distinct group of rare gastrointestinal tract tumors that originate from the interstitial cells of Cajal. These jejunoileal lesions are a rare cause of obstruction but can be associated with substantial morbidity. Case: A 59-year-old woman presented to the emergency department with abdominal pain and distention. Physical exami-nation revealed tenderness and rebound in right lower quadrant. Computed tomography revealed a mass in lower right quadrant. A 9x9x4 cm exophytic ileal mass was observed at exploration. Preoperative diagnose was a small bowel tumor and then segmental resection and primary anastomosis were performed. Histopathological investigation revealed spindle cells that stained strongly for C-117, consistent with a diagnosis of a malign gastrointestinal stromal tumor. Conclusion: We conclude that exophytic small bowel gastrointestinal stromal tumors are rare lesions, which should be kept in mind by physicians among the diagnosis of small bowel obstructions in order to reduce substantial morbidity and mortality.

Acute Abdomen Caused by Brucellar Hepatic Abscess

Brucellosis is a zoonotic infection that is transmitted from animals to humans by ingestion of infected food products, direct contact with an infected animal, or aerosol inhalation. The disease is endemic in many countries, including the Mediterranean basin, the Middle East, India, Mexico, Central and South America and, central and southwest Asia. Human brucellosis is a systemic infection with a wide clinical spectrum. Although hepatic involvement is very common during the course of chronic brucellosis, hepatic abscess is a very rare complication of Brucella infection. We present a case of hepatic abscess caused by Brucella, which resembled the clinical presentation of surgical acute abdomen.

Inflammatory myofibroblastic tumor presenting as an abdominal wall mass in an adult patient

Inflammatory myofibroblastic tumor of the abdominal wall is a rare soft-tissue tumor presentation in adults. A 50-year-old woman was referred with abdominal pain and a palpable mass in the left lower quadrant. Computed tomography scan and magnetic resonance investigation revealed an 8-cm heterogeneous abdominal wall mass. Tumor markers were within normal limits. Fine-needle aspiration cytology and tru-cut biopsies yielded necrotic material. A preoperative diagnosis of a resectable rhabdomyosarcoma was suggested. On exploration a tumor measuring 8 x 8 x 6 cm was resected along with the involved structures. Histopathologic examination of specimen revealed an inflammatory myofibroblastic tumor of the abdominal wall. The patient has been followed up for the last 12 months without clinical or radiographic evidence of recurrence. Inflammatory myofibroblastic tumor arising from the anterior abdominal wall in adults is an unusual manifestation of soft-tissue tumors, which can be managed by a multidisciplinary team of surgeons, oncologists, radiologists and pathologists.

Dalak absesi: Acil cerrahide karşılaşlan zorluklar

The relationship between phenotype and Xq duplications in females remains unclear. Some females are normal; some have short stature; and others have features such as microcephaly, developmental delay/mental retardastion, body asymmetries, and gonadal dysgenesis. Some features in these females resemble those in Turner synsdrome. We, herein, presented a 15 years-old girl with short stature and primary amenorrhea, who was referred to cytogenetic laboratory. Through karyotipe analysis persformed by Giemsa banding technique, the patient was determined to have positive Barr body and 46,XX,dup(X)(q21.3q24) chromosomal constitution. Case was disscussed according to information of present literatures.Objectives: To ensure reconstruction of contracted eye socket with the use of simple incision and appropriate conformer. Materials and Methods: A total 54 cases who applied between 1991-2006 years, due to the complaint of not fitting the prosthesis were enrolled. Results: The mean follow up time was 72.8 (6-119) months. After simple incision 28 patients was able to fit their prosthesis after first operation. This incision was respeated two times in 7 patients and three times in 2 pastients. We were unable to follow 7 patients with simple incision. In 37 out of 47 patients the results were found to be successful, in 12 patients other methods were used. Conclusion: In anophthalmic socket and postenuclesation socket syndrome, simple incision can be taken into consideration before deciding for an enhancement operastion.Objectives: Environmental asbestos exposure and reslated diseases are seen in our region. The study was planned to investigate the long term effects of asbestos exposure and to research the frequency of asbestos reslated diseases in a region that asbestos has been used for many years. Materials and methods: The population aged 30 or older who permanently live in this region were scanned by a miscrofilm scanning team. The questionnaire was performed to the people to evaluate the level of knowledge about assbestos, the complaints and smoking habits. The physical examinations of the people were carried out, microfilms were taken and spirometric analyses were performed. Results: A total of 102 person, 56 (54.9%) women and 46 (45.1%) men with the mean age of 56.4p12.9 (30-80) years were included. 99 (97.1%) of people had used assbestos previously except for past 15 years. People had used asbestos for 33.1p15.9 years. Significant relationsships were found between negative asbestos effects and age>60 years (p 30 years of asbestos expossure (p= 0,028), use of oven made by asbestos >30 days (p= 0,015). Coughing (p=0,04), sputum (p=0,03) and dyspnea (p=0,05) were significantly higher in the affected group. Malignant pleural mesothelioma was found in one (0.9 %) person, calcified pleural plaque in 26 (25.5%), pleural thickness in 7 (6.9 %) and prevalences of these disorders were calculated as 204/100.000, 5306/100.000, 1428/100.000, respectively. Conclusion: Environmental asbestos exposure is a serisous public health problem in investigated area. Training programs and preventive measures may be beneficial for restrain asbestos use.Splenic abscess is a rare clinical entity with an incidence of 0.2 to 0.7% in autopsy series. The mortality of the dissease reaches to 100% without treatment. Splenic abscess is a diagnostic challenge in emergency surgery due to its prognostic nature. The diagnosis is difficult because of its rarity and often subtle clinical manifestations of splenic abscess, a high index of suspicion is necessary to make accurate diagnosis. Herein, we reported two cases of splenic abscess managed by surgical intervention. Sursgeons, emergency doctors or whoever consults patients in emergency department must be aware of this condistion, in order to make a proper management approach and reduce mortality and morbidity.Five percent (5%) of lacrimal gland tumors are originated from lymphoid tissue. In one type of Hodgkin disease which is abounding in lymphocytes, involvement of lacrismal gland is a rather rare entity. A 48 n year old woman who had swollen both eyelids, applied to department of oculoplasty in our clinic. At insspection, when eyelids were rotated, a mass was seen at the region which fits to bilateral lacrimal gland area. Magnetic resonance imaging of the orbita showed a well-demarcated soft tissue mass without invade adjacent structure in the supero-lateral aspect of the bilateral orbit, occupying lacrimal gland. Lymphadenopathies in abdomisnal, cervical, inguinal, axillary regions have been found in systemic scanning. Biopsy of lacrimal gland and axillary lymphadenopahty were performed and histopathological examination revealed the diagnosis as Hodgkin disease abounding in lymphocytes. The patient was underwent four cure chemotherapy. Clinical and tomographic findsings were found to be regressed after treatment.Objectives: In Southeastern cities of Turkey, high prevaslences of Helicobacter pylori infection and gastric cancer are seen. The aim of this study was to evaluate the fresquency of the precancerous gastric lesions in patients with dyspeptic symptoms who underwent upper gastroinstestinal endoscopy in Adiyaman State Hospital. Materials and methods: We analyzed gastric biopsies taken from corpus and antrum of 234 consecutive pastients who underwent upper gastrointestinal endoscopy between January 2009 and May 2009. According to Sydsney system, chronic gastritis, gastric atrophy, intestinal metaplasia and dysplasia were diagnosed by histological examination. Results: The mean age of patients was 46p15 (16- 82) years. Helicobacter pylori infection was seen in 66.7% of patients. Normal mucosa, chronic gastritis, gastric atrosphy, intestinal metaplasia and dysplasia were diagnosed in 2.7%, 78.6%, 3.4%, 11.5% and 3.8% of gastric biopsy specimens, respectively. Helicobacter pylori infected pastients showed a significantly higher prevalence of intesstinal metaplasia compared with that of the non infected subjects (9.8% vs 1.7% p=0.021). Although prevalence of gastric atrophy and dysplasia were higher among Heslicobacter pylori infected patients, the difference did not reached to a statistically significant level (3.0% vs 0.4% p=0.19 and 3.0% vs 0.8% p=0.37 respectively). Conclusion: Our findings suggested that the prevalence of gastric precancerous lesions such as gastric atrophy, intestinal metaplasia, dysplasia and Helicobacter pylori infection were high in dyspeptic patients. This may be reslated to actual high incidence of gastric cancer in southseastern region of Turkey.

Gebelikte akut apandisit

Brucellosis, is an endemic disease in our country, may lead to bacteremia and cause different clinic manifestations. A 44-year-old male patient admitted to our policlinic with high fever, shivering, chilling, pollacuria, and left costovertebral pain, and interned with diagnosis of acute pyelonephritis. Subsequently, acute pyelonephritis due to acute brucellosis was detected in the clinical and laboratory examination. Antibiotic treatment for brucellosis was given to patient for eight week and after treatment full recovery was seen. Patients with brucellosis may refer with symptoms of acute pyelonephritis in endemic areas for brucellosis. By using brucellos serologies to patients who have the symptoms of acute pyelonephritis may available in the diagnosis of this rare complication in areas where brucellosis is endemic.Objectives: Internal splinting is defined as early tendon transfer performed during or just after nerve repair followsing nerve injury and is a controversial issue. The objecstives of internal splinting are avoiding the use of long term external splinting, avoiding permanent hand deformities until the injured nerve is reinnervated and supporting sensorial recovery. In this paper we present our clinical cases of internal splinting and discuss the results in terms of indications, timing, advantages, and disadvantages of internal splinting. Materials and Methods: We applied internal splinting in 11 patients, 3 patients with radial nerve injury and 8 patients with ulnar nerve injury. Internal splinting was performed contemporarily with the nerve repair in 5 pastients, in 2 weeks following nerve repair in 1 patient and in 4 weeks following nerve repair in 5 patients. Pronator teres was transferred to extensor carpi radialis brevis and flexor carpi radialis was transferred to extensor digitorum communis in radial nerve injuries. Omer\s superficial Y technique and its modification were used for ulnar nerve injuries. Results: Patients were followed up for at least 1 year with physical examination and electroneuromyelography and recovery of sensorial and motor functions were achieved in all of them. Conclusion: We concluded that internal splinting is usesful for avoiding external splint usage and preventing the establishment of hand deformity until recovery of the nerve. The contribution of internal splinting to sensorial recovery was noteworthy as stated in the literature but the lack of control group and the small number of our cases was limited to come to a definite conclusion. We did not experience any disadvantage of internal splinting.

An unusual CT

A 50 year old man was admitted to the emergency room suffering from right upper quadrant pain and vomiting for two days. He had a …