Osman Toktaş

Ultrasound Elastography for Distinction Between Parathyroid Adenomas and Thyroid Nodules

The aim of this study was to detect the level of stiffness of parathyroid adenomas and to distinguish them from benign and malignant thyroid nodules using ultrasound elastography with acoustic radiation force impulse imaging.

Hepatic Artery Pseudoaneurysm: Delayed Presentation after a Blunt Trauma

Summary Background Ruptured hepatic artery pseudoaneurysm is a rare condition that is life-threatening if not diagnosed and treated rapidly. We present a case of a spontaneously ruptured hepatic artery pseudoaneurysm that occurred after a blunt trauma, and provide a review of the current literature on this topic. This case study demonstrates a spontaneously ruptured hepatic artery pseudoaneurysm which emerged following a blunt trauma and it also presents current literature studies on the topic. Case Report A man at the age of 34 years with blunt trauma dating back to 1.5 month was admitted to the emergency department of a hospital with hematemesis and epigastric tenderness. He also had a duodenal ulcer, blood in the gastric lumen and a large pseudoaneurysm that developed from the left hepatic artery. Soon after the diagnosis, the patient worsened and underwent distal gastrectomy and cholecystectomy that included removing the bleeding aneurysm. Conclusions Ruptured hepatic artery pseudoaneurysm stands as a deadly condition which has to be diagnosed and managed as soon as possible. Physicians need to take aneurysms of abdominal arteries into consideration after routine diagnostic practises as long as the cause of gastrointestinal haemorrhage is unidentified.

Transcervical resection of two parathyroid adenomas located on the anterior mediastinum

The mediastinum is a possible location of ectopic parathyroid adenoma. Most ectopic parathyroid glands in the mediastinum are found in the superior mediastinum within the thymus. In this article, two cases with ectopic mediastinal parathyroid adenomas that were excised via transcervical resection are presented. Preoperative examination of the two cases was performed. Laboratory tests supported hyperparathyroidism. For both patients, the results of radiologic and scintigraphic examinations of the cases were compatible with parathyroid adenoma masses in the anterior mediastinum. Transcervical resection was performed via suprasternal incision through the sternal notch and the posterior wall of the sternum space by blunt dissection with the finger. The soft lesions were removed en bloc in both cases. The parathyroid hormone levels of the two cases decreased dramatically after the operation. Transcervical resection may be an alternative method to major surgery in anterior mediastinal small masses.

Management of gastric cancer with liver metastasis in a pregnant woman

Gastric cancer arises from the upper gastrointestinal tract and is usually seen before the age of 40. The incidence of gastric cancer varies across the world. Most of the studies and case reports are from Japan which has the highest incidence of gastric cancers worldwide and its prevalence in Japan is 80 per 100.000. The prevalence in Western Europe and the US is 10-40 per 100.000 (1). Each year approximately 700.000 people die worldwide due to gastric cancer (2). The incidence of cancer during pregnancy is rare at approximately 0.1%, and that of gastric cancer is 0.026 to 0.1% of all pregnancies (3). Nonspecific complaints related to the gastrointestinal system are seen during the early stage of gastric cancer cases. In the advanced stages, complaints such as nausea-vomiting, abdominal pain, postprandial saturation, loss of appetite, dysphagia and weight loss may be seen (4). We aim to present the case of a pregnant woman with gastric cancer with liver metastasis and to emphasize the importance of early diagnosis and treatment.

Changing trends and experience with esophageal cancer surgery in a single university hospital: are the results similar or not?

Objective: The main treatment modality for esophageal cancer remains to be surgery. Over the last decades, surgical strategies have evolved remarkably. When neoadjuvant chemoradiotherapy became standard, discussions about the role, type, and timing of surgery began. In this study, we share results we obtained after operating our patients using various surgical techniques. Material and Methods: Reliable data from 51 esophageal cancer patients were evaluated retrospectively. Of the 51 cases, 31 were operable. These operable cases were further classified according to surgical method and neoadjuvant therapy status. Median survival time in months, complications, hospital mortality, length of hospital stay, and pathology results (total lymph nodes harvested and pathologic tumor node metastasis stage [p_TNM]) were documented for the different surgical approaches. Results: Open surgical methods were performed in 21 cases, while in 10 cases the Minimally Invasive Surgery (MIS) method was used. The MIS group received neoadjuvant therapy more frequently than the open surgical methods group (p=0.013). Although more complications were observed in the MIS group, the difference to the open esophagectomy methods group was not significant. Patients in the MIS group also had longer hospital stays, but again the difference was not significant. Although a pathologic complete response was seen in 8 of the 11 (72.7%) patients in our study who received chemoradiotherapy as neoadjuvant treatment, the surgical results of patients who received chemoradiotherapy were worse, although not to a statistically significant extent. Conclusion: Despite changing trends and treatment options in esophageal cancer surgery, we have yet to see the expected improved results.

Thoracoscopic-Laparoscopic Esophagectomy for Carcinoma of the Esophagus: Preliminary Reports of Seven Cases from the High-Volume Institution

Gereç ve Yöntem: Aralık 2013Nisan 2014 yılları arasında kliniğimize başvuran özefagus SCC tanılı erken evre 7 hasta çalışmaya alındı. Hastalara 3 aşamalı ameliyat yapıldı. Sağ torakoskopik 4 trokar yöntemi ile torakal özefagus tamamen serbeştleştirildi. Batına 4 port girilerek laparoskopik olarak mide endo GIA ile tüp haline getirildi. Sol servikal insizyonla proksimal özefagus bulunup piyes yukarı çekildi. Özefagogastrostomi tek kat anastomoz yapıldı.

Intrahepatic splenosis after splenectomy performed for idiopathic thrombocytopenic purpura

The term splenosis describes autotransplantation or implantation of ectopic splenic tissue within the abdominal cavity or in any other unusual body compartment. In addition to the diagnostic dilemma it causes, splenosis may also lead to persistence or recurrence of hematologic dysfunctions by its preserved immune activity especially in cases of splenectomy due to hematologic indications. Herein, we present a 40-year-old female who had splenectomy for idiopatic thrombocytopenic purpura, and was identified to have splenic tissue within left lobe of the liver during further assessment of ongoing thrombocytopenia.