Nazif Erkan

Management of rectal foreign bodies

BackgroundEntrapped anorectal foreign bodies are being encountered more frequently in clinical practice. Although entrapped foreign bodies are most often related to sexual behavior, they can also result from ingestion or sexual assault.MethodsBetween 1999 and 2009, 15 patients with foreign bodies in the rectum were diagnosed and treated, at Izmir Training and Research Hospital, in Izmir. Information regarding the foreign body, clinical presentation, treatment strategies, and outcomes were documented. We retrospectively reviewed the medical records of these unusual patients.ResultsAll patients were males, and their mean age was 48 years (range, 33–68 years). The objects in the rectum of these 15 patients were an impulse body spray can (4 patients), a bottle (4 patients), a dildo (2 patient), an eggplant (1 patient), a brush (1 patient), a tea glass (1 patient), a ball point pen (1 patient) and a wishbone (1 patient, after oral ingestion). Twelve objects were removed transanally by anal dilatation under general anesthesia. Three patients required laparotomy. Routine rectosigmoidoscopic examination was performed after removal. One patient had perforation of the rectosigmoid and 4 had lacerations of the mucosa. None of the patients died.ConclusionsForeign bodies in the rectum should be managed in a well-organized manner. The diagnosis is confirmed by plain abdominal radiographs and rectal examination. Manual extraction without anaesthesia is only possible for very low-lying objects. Patients with high- lying foreign bodies generally require general anaesthesia to achieve complete relaxation of the anal sphincters to facilitate extraction. Open surgery should be reserved only for patients with perforation, peritonitis, or impaction of the foreign body.

Primary Non-Hodgkin's T-Cell Lymphoma of the Thyroid Gland Complicating Hashimoto's Thyroiditis: Case Report

This case report presents an extremely rare case of primary non-Hodgkins T-cell lymphoma of the thyroid gland complicating Hashimotos thyroiditis and discusses the clinical history, findings, treatment, and prognosis. Although the place of surgery in the treatment of thyroid lymphoma is controversial, in this case, surgery followed by three rounds of chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone, and radiation therapy to neck and mediastinum were a very effective treatment for the disease so that no relapse has been detected during 3-year follow-up.

Papillary carcinoma arising in a thyroglossal duct cyst with associated microcarcinoma of the thyroid and without cervical lymph node metastasis: a case report

IntroductionThis is a case report of a 44-year-old woman with papillary carcinoma of a thyroglossal duct cyst.Case presentationA 44 year-old woman presented to the otolaryngology outpatient clinic with an asymptomatic anterior midline neck mass. A cervical ultrasound showed a lesion which appeared to be a thyroglossal duct cyst and surgical resection using Sistrunks procedure was performed. The histopathologic diagnosis showed papillary carcinoma evolving from a thyroglossal duct cyst, confined to the thyroglossal cyst, with a tumor diameter of 2 cm. The patient then underwent total thyroidectomy and bilateral neck dissection. The final pathology reported an 8 mm papillary cancer in the left lobe of the thyroid without any metastasis to the cervical lymph nodes. The patient was treated with radioactive iodide and thyroid suppresion therapy was given as adjuvant treatment. The patient has been following for two years without any metastasis.ConclusionMalignancy within a thyroglossal duct cyst is very rare but should be considered in the differential diagnosis of a midline neck mass.

Metastatic tumours to the thyroid gland: report of 3 cases and brief review of the literature.

Metastatic tumours to the thyroid gland: report of 3 cases and brief review of the literature Background. Metastases to the thyroid are encountered rarely in clinical practice, but the number of cases seems to have increased in recent years. The reason of this increase may be a more frequent use of fine-needle aspiration biopsy (FNAB) and the use of more sophisticated, complicated imaging techniques in patients with thyroid masses. Also, in addition to these reasons, the use of more organo-specific immunohistochemical antibodies in the examination of surgical specimens may affect the differential diagnosis of malignant tumours. Case reports. Three metastatic tumours to thyroid were found in the retrospective review of malignant thyroid tumours diagnosed between January 1993 and December 2007. The primary tumours were clear cell carcinoma of the kidney, squamous cell carcinoma of the lung and breast carcinoma-ductal type. Conclusions. A detailed clinical history, careful histological examination and essential immunohistochemistry helped in attaining the correct diagnosis.

Substernal Goiter: When is a Sternotomy Required?

The presence of substernal goiter is, per se, an indication for surgical management. Surgical approach of substernal goiter can most commonly be performed using the cervical access, but at times, a sternotomy or thoracotomy is necessary. The aim of this study was to identify the preoperative predictors of a sternotomy in the management of substernal goiter in order to provide better preoperative planning and patient consent. Between 2005 and 2012, 665 patients were referred to our clinic for thyroidectomy, 42 patients (6.3%) had substernal goiter and were included in this study. All substernal goiters were treated surgically, 38 (90.5%) by a cervical approach and 4 (9.5%) by full median sternotomy. All surgeries were successful, with no major postoperative complications. Minor postoperative complications of transient hypocalcemia and transient paralysis of the recurrent laryngeal nerve occurred in 5 (11.9%) and 2 (4.7%) cases, respectively. Indication of median sternotomy was as follows: extension of goiter below the aortic arch, large thyroid tissue extending towards tracheal bifurcation, and ectopic thyroid tissue in the mediastinum. Substernal goiter can be removed through a cervical incision, but on rare occasions, a median sternotomy may be required.

Vertical Banded Gastroplasty in the Aegean Region of Turkey

Background: Obesity is increasing in Turkey. The first experience with vertical banded gastroplasty (VBG) with regular intermediate-term follow-up in the Aegean Region of Turkey is presented. Methods: From November 1993 to August 1999, 40 morbidly obese patients underwent VBG. The patients were evaluated on the basis of excess weight loss (EWL) and satisfaction with the operation. Results: Regular follow-up was obtained in 38 patients (95%), with mean follow-up 27.2 months (14-85). Average preoperative body weight (BW) was 141.4 kg (93-238) and body mass index (BMI) was 52.3 kg/m2 (41-77.8). Average EWL was 64.1% (21.2-92.3). Average postoperative BW and BMI were 93.3 kg (70-145) and 34.4 kg/m2 (25.1-53) respectively. 35 of 38 patients (92%) lost more than 25% of EW and 28 of 38 (73.6%) lost more than 50% of EW. After weight loss, hypertension disappeared or improved in 86% of patients and diabetes resolved in 75%. Sleep apnea disappeared in 100% of patients. The early and late complication rates were 7.9% and 15.8% respectively. 33 of 38 patients (87%) were satisfied with the operation. Conclusion: VBG was safe and effective, resulted in acceptable weight loss, and the vast majority of patients were satisfied.

Rupture of the medial gastrocnemius muscle during namaz praying: an unusual cause of tennis leg.

PURPOSE The aim of this retrospective study is to report a unique group of patients in whom rupture of the medial gastrocnemius muscle (tennis leg) occurred during namaz praying. MATERIAL AND METHODS We reviewed the sonographic and/or MR imaging findings of 543 patients who were referred for the evaluation of leg pain and swelling during the last 7 years. Fourteen patients with a final diagnosis of tennis leg that occured during namaz praying were included in this study. RESULTS Nine of 14 (64.2%) patients had incomplete and the remainder 5 (35.8%) patients had a partial tear at the musculotendinous junction (MTJ). Four of 14 (28.6%) patients were mistaken for deep vein thrombosis (DVT) on the basis of clinical findings and presentation. Associated fluid collection between the gastrocnemius and soleus muscle was noted in 11 (78.5%) patients. Isolated fluid collection between the gastrocnemius and soleus muscle without disruption of the gastrocnemius muscle was seen in 1 patient. CONCLUSION Rupture of the medial gastrocnemius muscle may occur during namaz praying. The clinical presentation is not always characteristic and may simulate DVT. US and MRI are useful diagnostic tools to establish the correct diagnosis and prompt further treatment.

Retroperitoneal fibrosis mimicking a rectal tumor

PURPOSE: The study contained herein was undertaken to report an original case of retroperitoneal fibrosis that resembled a rectal tumor both symptomatically and radiologically. METHOD: Reported is a case of retrorectal fibrosis with a brief literature review of the topic. RESULT: Although many forms of retroperitoneal fibrosis have been reported, extension below the pelvic rim is very unusual. Compression of the rectum and right ureter, with constipation as a chief complaint, made this case presentation unusual. Although computerized tomographic findings and needle biopsies supported the diagnosis of retroperitoneal fibrosis, an exploratory laparotomy was necessary to rule out a malignancy and to release the ureter. CONCLUSION: A fibrotic mass involving the retrorectal region may mimic a rectal tumor. To reach a final diagnosis, an exploratory laparotomy may be necessary, despite sophisticated evaluation techniques, because it is difficult to differentiate whether the mass is malignant.

Pancreatic Carcinosarcoma: Case Report of a Rare Type of Pancreatic Neoplasia

CONTEXT Carcinosarcoma of the pancreas is a rare entity comprising a small subset of all pancreatic neoplasms. Diagnosis is usually established by immunohistochemical examination of the resected specimen. Prognosis is limited to several months after resection. CASE REPORT We review the current literature on this rare type of neoplasia, considering histopathological and clinical features. The pathologic findings revealed areas of both adenocarcinoma and sarcoma of the pancreas. The adenocarcinomatous areas localized to the tumor within the head of the pancreas whereas the sarcomatous areas localized to regions of the intraductal component. DISCUSSION Carcinosarcoma of the pancreas is a rare disease having a dismal prognosis. To our knowledge, this carcinosarcoma is the very rare reported case of a primary pancreatic neoplasm with mixed carcinomatous and sarcomatous components.

Treatment of hypertriglyceridemia-induced acute pancreatitis with insulin

Introduction Hypertriglyceridaemia (HT)-induced pancreatitis rarely occurs unless triglyceride levels exceed 1000 mg/dl. Hypertriglyceridaemia over 1,000 mg/dl can provoke acute pancreatitis (AP) and its persistence can worsen the clinical outcome. In contrast, a rapid decrease in triglyceride level is beneficial. Insulin-stimulated lipoprotein lipase is known to decrease serum triglyceride levels. However, their efficacy in HT-induced AP is not well documented. Aim To present 12 cases of AP successfully treated by insulin administration. Material and methods Three hundred and forty-three cases of AP were diagnosed at our clinic between 2005 and 2012. Twelve (3.5%) of these cases were HT-induced AP. Twelve patients who suffered HT-induced AP are reported. Initial blood triglyceride levels were above 1000 mg/dl. Besides the usual treatment of AP, insulin was administered intravenously in continuous infusion. The patients’ medical records were retrospectively evaluated in this study. Results Serum triglyceride levels decreased to < 500 mg/dl within 2–3 days. No complications of treatment were seen and good clinical outcome was observed. Conclusions Our results are compatible with the literature. Insulin may be used safely and effectively in HT-induced AP therapy. Administration of insulin is efficient when used to reduce triglyceride levels in patients with HT-induced AP.