Necdet Fatih Yaşar

Spontaneous common bile duct perforation due to chronic pancreatitis, presenting as a huge cystic retroperitoneal mass: a case report

Spontaneous perforation of the bile duct, is a disease in which spontaneous perforation occurs in the wall of the extrahepatic or intrahepatic duct without any traumatic or iatrogenic injury and more often described in neonates. In this report, we present a 38-year-old female patient who underwent surgery due to an intraabdominal cystic mass. The diagnosis of spontaneous rupture of the common bile duct and huge retroperitoneal biloma was made by intraoperative abdominal exploration. The biloma was drained, ruptured portion of the common bile duct was primarily repaired over a T-tube.

Pneumomediastinum and subcutaneous emphysema caused by sigmoid diverticulum perforation secondary to blunt abdominal trauma: report of a case.

Pneumomediastinum and subcutaneous emphysema are very rare reported signs of colonic perforation most often associated with diverticulitis, toxic megacolon and colonoscopy. We report a case of a 60-year-old man with subcutaneous emphysema and pneumomediastinum, which developed three days after a car accident without pneumothorax. A computed tomography scan demonstrated perforation of a sigmoid diverticulum in conjunction with air. A laparotomy was performed and revealed a perforated sigmoid diverticulum, fistulized into the retroperitoneal cavity. We suspect that this diverticular perforation was caused by the deterioration of the sigmoid mesocolon secondary to the blunt abdominal trauma. To our knowledge, this is the first report in the literature about pneumomediastinum and subcutaneous emphysema caused by sigmoid diverticular rupture following mesosigmoid trauma.

Colonic perforation during barium enema in a patient without known colonic disease: a case report

The barium enema is a safe and accurate diagnostic study of the colon but, in rare cases, causes complications, such as colonic perforation. A colon weakened by iatrogenic trauma due to the enema tip and/or retention balloon, or by disease is more likely to perforate during an enema than is a normal healthy bowel. Rarely the colon may burst due to excessive transmural pressure alone. We report a case of colonic perforation during barium enema in a 72-year-old female patient, due to excessive barium applied into the rectum.

Pancreatic extragastrointestinal stromal tumor invading the duodenum

Extragastrointestinal stromal tumors that arise in the pancreas are extremely rare and managing them can be difficult, particularly if located in the head of pancreas. This case report aims to contribute to the existing data in the literature regarding extragastrointestinal stromal tumors with rare and unusual locations. We present a 56-year-old man who presented with recurrent mild right upper quadrant abdominal pain. Abdominal computed tomography and magnetic resonance imaging revealed a mass lesion with a diameter of 10 cm localized in the head of pancreas. Pancreaticoduodenectomy with complete tumor excision was performed. He was discharged on the postoperative day 14. Only 15 extragastrointestinal stromal tumors cases have been reported. Of these 15 cases, tumors were located in the head of pancreas in six cases. Here we report the seventh case of pancreatic extragastrointestinal stromal tumor arising in the head of pancreas and also the largest of these seven tumors.

Konvansiyonel skorlama sistemleri ile nekrotizan fasiitisli hastalarda mortaliteyi öngörebilir miyiz

BACKGROUND This study compared the predictive accuracy of four scoring systems, namely Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology Score II (SAPS II), and Mortality in Emergency Department (MEDS), for estimating prognosis in patients with necrotizing fasciitis. METHODS Seventy-four patients who presented with necrotizing fasciitis were retrospectively examined. The ability of the scoring systems to predict mortality was assessed by comparing the estimated mortality rates in mortality groups (survivors/non-survivors), and mortality rates among survivors and non-survivors with an estimated mortality of >10%, 30%, and 50% in the scoring systems were compared in pairs. RESULTS Estimated mortality rates in the survivor and non-survivor groups were different for all the scoring systems. The estimated mortality rates of APACHE II and SAPS II were much closer to the actual mortality rates than the other two scoring systems. When the predicted mortality rates were analyzed as limits for a mortality risk, the predicted mortality rate by APACHE II was superior to that by SAPS II. CONCLUSION The studied scoring systems had significantly higher predicted mortality rates in non-survivors than in survivors; however, they all underestimated the mortality rate. APACHE II and SAPS II were relatively superior for estimating mortality in patients with necrotizing fasciitis. APACHE II rather than the other scoring systems should be currently used.

Yaşlı Bir Hastada Nadir Bir İnguinal Kitle Nedeni; Dev Epididim Kisti: Olgu Sunumu

Epididim kistleri; ozellikle peripubertal cagdaki erkek cocuklarinda gorulen, nadir olarak da yetiskin erkek ve bebeklik caginda gorulebilen rete testis, ductuli efferentes ve epididimin nadir gorulen iyi huylu kistleridir. Skrotal agri, sislik gibi sikayetlerle kendini belli edebilirken fizik muayene veya operasyon esnasinda tesadufi olarak da saptanabilirler. Bu yazida, dev bir epididim kistine sahip 70 yasindaki erkek hastayi sunmayi amacladik. Anahtar Kelimeler: Epididim kistleri, herni, agri Abstract Epididymal cysts are rare and benign cysts of rete testis, ductuli efferentes and epididymis that usually present in peripubertal males and rarely seen in adult males and infancy. They usually present with scrotal pain or mass and can also be diagnosed during physical examination or peroperatively. In this papier, we aimed to present a 70 year-old male patient who had a giant epididymal cyst. Key Words: Epididymal cysts, hernia, pain

Effects of Sleep Quality on Melatonin Levels and Inflammatory Response after Major Abdominal Surgery in an Intensive Care Unit

Disruption of nocturnal sleep in an intensive care unit may remarkably affect production of melatonin, which is also known to have anti-inflammatory properties. In the present study, we aimed to investigate the effect of sleep quality on melatonin levels and inflammation after surgery. Thus, we compared the patients, who were screened in the side-rooms where the lights were dimmed and noise levels were reduced, with the patients who received usual care. Preoperative and postoperative urine 6-sulphatoxymelatonin, serum interleukin-1 (IL-1), interleukin-6 (IL-6), and c-reactive protein (CRP) levels were measured and data on sleep quality was collected using the Richards–Campbell Sleep Questionnaire. Postoperative CRP and IL-6 levels were greater in the control group than in the experimental group, whereas postoperative 24 h melatonin levels were greater than preoperative levels and the difference was steeper in the experimental group in concordance with sleep quality scores. Thus, the regulation of light and noise in ICUs may help the recovery after major surgeries in patients, potentially by increasing melatonin production, which has anti-inflammatory properties.

Is there a relation between the changes in circulating lymphocyte counts due to neoadjuvant chemoradiotherapy and intratumoral lymphocytic response and tumor regression grade in locally advanced rectal cancers

There are controversies about the relation between the peripheral lymphocyte levels and response to neoadjuvant therapy. While some authors have reported that a positive correlation between peripheral lymphocyte levels and tumor response, others have suggested the opposite. In the present study, we aimed to investigate the possible relations between the changes in circulating lymphocyte counts due to neoadjuvant chemoradiotherapy (CRT) and intratumoral lymphocytic response (ILR) and tumor regression grade (TRG) in locally advanced rectal cancers. Lymphocyte levels before, during and after CRT as well as before surgery and pathologic findings including ILRs and TRGs were recorded. Lymphocyte levels before CRT were accepted as absolute values. After the changes in the lymphocyte levels during and after CRT and before the surgery were recorded as ratios to the absolute values, the relation between the changes in lymphocyte levels, ILR and TRG were studied by using Pearson and Spearman correlation tests. There was a positive correlation between changes in peripheral lymphocytic levels after neoadjuvant CRT and ILRs. However, there were no other correlations between changes in lymphocytic levels and TRGs and ILRs. The changes in the peripheral lymphocyte counts after CRT may be predictive for ILR. Further studies may provide more information about the relation between peripheral lymphocytes and TILs and tumor response to neoadjuvant CRT.

2000–2010 yılları arasında hiperparatiroidi nedeniyle ameliyat edilen 75 hastanın geriye-dönük olarak değerlendirilmesi

Birincil hiperparatiroidi (PHPT) semptomatik veya asemptomatik acilardan tum toplumda sik gorulen bir endokrin hastalik olup poliklinik hastalarinda gorulen hiperkalseminin de en sik nedenidir (1,2). Hiperkalseminin nedeni, parathormonun (PTH) uygunsuz olarak asiri salinimidir (3). PHPT, cogunlukla bir veya daha fazla sayida paratiroid bezinin asiri derecede parathormon salgilamasi ile olusur. PHPT’nin klinik tablosu degiskendir; gecmiste hastalarin onemli bir kismi semptomatik hiperkalsemi, nefrolitiazis ve kemik bozukluklari nedeniyle kliniklere basvururken, gunumuzde cogunda hafif hiperkalsemi disinda bir bulguya rastlanmamaktadir (4). Calismalara gore PHPT’si olan olgular cogunlukla asemptomatiktir veya orta derecede semptomlari varken rutin biyokimyasal testler sonucu tani almaktadir (5,6). PHPT’de, kemik hastaligi, bobrek taslari ve spesifik olmayan gastrointestinal, kardiyovaskuler ve noromuskuler disfonksiyon semptomlari gozlenebilir. Hastalarda gucsuzluk, cabuk yorulma ve depresyon gibi bulgulara da rastlanabilir (7-9). PHPT tanisi yuksek serum kalsiyum duzeyi ile birlikte uygunsuz PTH saliniminin saptanmasi ile konulur (1,2).