Leyla Ozel

Abdominal wall endometriosis in the cesarean section surgical scar: A potential diagnostic pitfall

Aim:  The abdominal wall is an uncommon site of extrapelvic endometriosis. It usually develops in a previous surgical scar and should be considered in the differential diagnosis of any abdominal swelling. Classical symptoms of endometriosis may resemble abdominal wall lesions such as an incisional hernia, hematoma, granuloma, abscess or various soft tissue tumors; therefore, a definitive preoperative diagnosis is not always easy to determine in every case. The aim of this article is to review the clinical findings, imaging results and histopathology of those of our patients who have had cesarean scar endometriosis.

Association of laryngopharyngeal manifestations and gatroesophageal reflux

The aim of this study was to investigate the prevalence of gastroesophageal reflux disease (GERD) in patients with laryngopharyngeal symptoms, the relationship between laryngopharyngeal reflux (LPR) and Helicobacter Pylori infection and treatment response to proton pump inhibitors. Forty-five patients with suspected gastroesophageal reflux diseases related symptoms (sore throat, throat burning, throat clearing, globus sensation, cough, halitozis, dysphonia, dysphagia, postnasal dripping, vocal fatigue, and sputum) were included in this study. For pre-therapeutic and post-therapeutic comparison, symptoms and laryngological findings were graded on a 4-point scale. The patients underwent upper gastrointestinal system endoscopy. During endoscopy, antral biopsies from the stomach were obtained to detect H. Pylori. Antireflux medication with proton pump inhibitors (PPI) and H. Pylori eradication therapy if present were prescribed to the patients. The improvement in symptoms and laryngological findings were evaluated after treatment. By means of esophagogastroduodenoscopy (EGD), reflux was detected in only 11% of patients. But there can be reflux patients other than the detected ones. Although, H. Pylori was present in 62% of patients, no correlation was found between H. Pylori positivity and symptoms. All patients responded well to antireflux treatment and H. Pylori eradication therapy. Laryngopharyngeal symptoms and findings can be predictors of gastroesophageal diseases when response to reflux treatment is taken into account.

Predictors of hypocalcemia occurring after a total/near total thyroidectomy

PurposeThe aim of this study was to identify the predictors of early postoperative hypocalcemia after a total/near total thyroidectomy in order to select patients for prompt treatment to prevent symptomatic hypocalcemia.MethodsPatients with hypocalcemia within 24 h of surgery were identified as Group I and normocalcemic patients as Group II. The perioperative serum total calcium (tCa, ionized calcium (iCa) and intact parathormone (iPTH) were measured perioperatively. Skin closure (SC) was accepted as the reference time point. Data are expressed as the mean ± SEM.ResultsThe study included 73 patients. Hypocalcemia (Group I) was detected in 40 patients (54%) within the first 24 h postoperatively. Symptomatic hypocalcemia was detected in 40% of the patients in Group I. Intact parathormone values at 10 min of SC were significantly lower in Group I (P = 0.001). IPTH measurement at 10 min of SC showing a ≥30% decrease had a 92.3% sensitivity and 92.6% specificity in predicting hypocalcemia after a total/near total thyroidectomy. The postoperative day 15 mean tCa, iCa, and iPTH values were similar in both groups of patients. The mean iPTH level was 16.79 ± 2.5 pg/dl at 10 min after SC in patients who developed symptomatic hypocalcemia.ConclusionsIntact parathormone measurement 10 min after SC is helpful to predict early postoperative hypocalcemia. An IPTH decrease ≥30% at this time point estimates the risk of postoperative hypocalcemia.

Acute abdomen in pregnancy requiring surgical management: a 20-case series

OBJECTIVES The obstetrician often has a difficult task in diagnosing and managing the acute abdomen in pregnancy. A reluctance to operate during pregnancy adds unnecessary delay, which may increase morbidity for both mother and fetus. In this study, we present our experience in pregnant patients with acute abdomen. STUDY DESIGN Pregnant patients with acute abdomen requiring surgical exploration were enrolled from 2007 to 2010. Demographics, gestational age, symptoms, fetal loss, preterm delivery, imaging studies, operative results, postoperative complications and histopathologic evaluations were recorded. Ultrasound (US) and magnetic resonance (MR) imaging studies were evaluated. Data analyses were performed with Microsoft Excel and statistical evaluations were done by using Students t-test. RESULTS There were 20 patients with a mean age of 32 years. The rate of emergency surgery was seen to be significantly higher in the second trimester (p<0.05). Most common symptoms were abdominal pain (100%) and nausea (80%). US was done in all patients while MR imaging was used in 30%. However, US findings were consistent with surgical findings in only 55%, while MR was successful in assigning the correct diagnosis in 83.3%. Appendicitis and adhesive small bowel obstruction were the most common etiologies causing acute abdomen (30% and 15%, respectively). All patients tolerated surgery well, and postoperative complications included wound infection, 10%, preterm labor, 5%, and prolonged paralytic ileus, 5%. One patient died from advanced gastric carcinoma and the only fetal death was seen in this case. CONCLUSIONS Prompt diagnosis and appropriate therapy are crucial in pregnant with acute abdomen. The use of US may be limited and CT is not desirable due to fetal irradiation. MR has thus become increasingly popular in the evaluation of such patients. Adhesive small bowel obstruction should be kept in mind as an important etiology.

Investigation of gastric pepsinogen in middle ear fluid of children with glue ear

Abstract Conclusion: The presence of pepsinogen in middle ear effusion (MEE) supports the relationship between gastroesophageal reflux (GER) and otitis media with effusion (OME). Measurement of pepsin/pepsinogen can be considered as a simple and reliable method for assesment of reflux in children. However, further research is needed to establish a definite association between GER and OME before beginning antireflux treatment in the management of MEE. Objective: The aim of this study was to investigate the relationship between GER and chronic OME, and to confirm the presence of gastric enzyme in the MEE of children with OME. Methods: This was a prospective study. MEE and blood samples were obtained from 42 children undergoing tympanostomy tube placement. Total pepsinogen concentrations of effusions and serum samples were measured with a commercial ELISA using a human pepsinogen I specific antibody. Albumin levels of effusions and serum samples were also measured with ELISA for comparison with pepsinogen levels. Results: Measurable pepsinogen was present in all MEEs from patients, with levels higher than the serum values. The difference between the levels of pepsinogen measured in MEE and serum was statistically significant (p < 0.01), but albumin levels were higher in serum than in MEE and the difference was statistically significant (p < 0.01).

Evaluation of intraoperative parathormone measurement for predicting successful surgery in patients undergoing subtotal/total parathyroidectomy due to secondary hyperparathyroidism.

The aim of this study is to investigate the predictive value of intraoperative parathormone measurement addressing successful surgical resection in patients with secondary hyperparathyroidism.

Elective and Emergency Surgery in Chronic Hemodialysis Patients

Abstract Purpose: Aim of this study was to report our experience in elective and emergency surgery on chronic hemodialysis (CH) patients for end-stage renal disease (ESRD). Methods: All patients on CH for ESRD who underwent various surgical procedures in our unit within the past 9-year period (2001–2010) were included in this study. These patients were divided into two groups according to the type of surgery performed: elective or emergency. Demographic data, indications for surgery, primary causes of ESRD, surgical procedures, postoperative complications, and mortality rates were studied. Results: Of 130 patients, 121 underwent elective surgery while 10 were addressed for emergency operation. In the elective surgery group, the most common diseases were secondary hyperparathyroidism, kidney diseases, cholelithiasis, and diabetic foot gangrene. Complications occurred in nine patients (morbidity rate, 7%) and only one patient died (mortality rate, 0.8%). In the emergency surgery group, the most common diseases were diabetic foot gangrene and obstructed sigmoid colon cancer. In this group, complications occurred in seven patients (total morbidity rate, 70%) and two patients died (mortality rate, 20%). Conclusions: Elective surgery in patients on CH for ESRD can be performed with acceptable surgical risks provided careful preoperative preparation, intraoperative, and postoperative precautions are taken.

Comparative outcomes of antireflux treatment for laryngopharyngeal reflux symptoms and upper abdominal symptoms in patients with endoscopic esophagitis

The objectives of this prospective study are to determine the prevalence of laryngopharyngeal reflux (LPR) symptoms in patients with endoscopic esophagitis, to investigate the relationship between LPR symptoms and upper abdominal symptoms of gastroesophageal reflux disease (GERD) and to compare the treatment responses of both symptom groups. 120 consecutive patients having complaints of GERD were included. Group I consisted of 62 patients with a diagnosis of endoscopic esophagitis. The second group consisted of 58 subjects with no detectable pathology at gastroscopy. LPR symptoms and upper abdominal symptoms were graded. Proton pump inhibitors (PPI) were prescribed to patients. Both groups of symptoms were compared in two groups of patients. The improvement in symptoms was evaluated after treatment. The frequencies of LPR symptoms were statistically higher in patients with endoscopic esophagitis. All LPR symptoms were statistically relieved in their frequency after treatment. The decrease in LPR symptom scores after treatment in group I was statistically significant. FSSG (frequency scale for the symptoms of GERD) scores were statistically higher in group I than in group II before treatment. After treatment, FSSG scores were significantly decreased in group I. There was statistically significant positive correlation between the LPR symptom scores and FSSG scores before treatment. In conclusion, there is a high incidence of LPR symptoms and upper abdominal symptoms in patients with endoscopic esophagitis. LPR and upper abdominal symptoms responded well to antireflux treatment in patients with endoscopic esophagitis.

D-Dimer and Carcinoembryonic Antigen Levels: Useful Indicators for Predicting the Tumor Stage and Postoperative Survival

The purpose of this prospective study is to determine the preoperative plasma D-dimer and serum Carcinoembryonic Antigen (CEA) levels of patients scheduled for curative surgical resection for colorectal cancer and to evaluate the significance of these levels on the prognosis and postoperative survival rate. One hundred sixty-five patients with colorectal cancer, who were scheduled to have elective resection between January 2008 and January 2011, were included in the study. A significant increase was observed in the D-dimer levels, particularly in poorly differentiated tumors. The distance covered by the tumor inside the walls of the colon and rectum (T-stage) was significant for both D-dimer and CEA levels. As the T-stage increased, there was also a significant increase in the D-dimer and CEA levels. A high significance and correlation level was detected between the TNM staging and both D-dimer and CEA. A significant relationship was found between the advanced tumor stage and short postoperative survival rate of patients with colorectal cancer. Therefore, the analysis of preoperative D-dimer and CEA levels can be useful in predicting the stage and differentiation of the tumor and the postoperative survival rate.

Skin–Areola, Nipple Sparing, and Subcutaneous Mastectomy and Immediate Implant-Based Breast Reconstruction Using a Titanium-Coated Polypropylene Mesh

Skin sparing and nipple areola complex sparing subcutaneous mastectomies are both oncologically safe surgical procedures. Although autologuous breast reconstruction has been considered as a standard means of surgical approach, excellent cosmetic results have been obtained by implant based breast reconstruction. In this report, we present the result of titanium coated polypropylene mesh (Tiloop Bra; Pfm Medical, Cologne, Germany), an ultimate support material utilized in the reconstruction of a patient with breast cancer.