Sebahattin Celik

Postpartum ovarian vein and inferior vena cava thrombosis.

Postpartum ovarian vein thrombosis (POVT), which generally occurs 2–15 days postpartum, is a rare complication. It can be confused with acute appendicitis, pelvic infection, ovarian torsion, tubo-ovarian abscess, and pyelonephritis. It is associated with morbidity and mortality. Here, we present a patient with postpartum OVT and IVC diagnosed by US and CT findings. She was treated successfully with no further need for any interventional procedures.

Intraoperatively Testing the Anastomotic Integrity of Esophagojejunostomy Using Methylene Blue

Background: Intraoperative testing of gastrointestinal anastomosis effectively ensures anastomotic integrity. This study investigated whether the routine use of methylene blue intraoperatively identified leaks to reduce the postoperative proportion of clinical leaks. Methods: This study retrospectively analyzed consecutive total gastrectomies performed from January 2007 to December 2014 in a university hospital setting by a general surgical group that exclusively used the methylene blue test. All surgeries were performed for gastric or junctional cancers (n = 198). All reconstructions (Roux-en Y esophagojejunostomy) were performed using a stapler. The methylene blue test was used in 108 cases (group 1) via a nasojejunal tube. No test was performed for the other 90 cases (group 2). Intraoperative leakage rate, postoperative clinical leakage rate, length of hospitalization, and mortality rate were the outcome measures. Results: The intraoperative leakage rate was 7.4% in group 1. The postoperative clinical leakage rate was 8.6%. The postoperative clinical leakage rate was 3.7% in group 1 and 14.4% in group 2 (p = 0.007). There were no postoperative clinical leaks when an intraoperative leak led to concomitant intraoperative repair. The median length of hospital stay was 6 days in group 1 and 8 days in group 2 (p < 0.001). One death occurred in each group. No test-related complications were observed. Conclusion: The methylene blue test for esophagojejunostomy is a safe and reliable method for the assessment of anastomosis integrity, especially in cases with difficult esophagojejunostomic construction.

Potential diagnostic and prognostic significance of plasma prolidase activity in gastric cancer

AIM Plasma prolidase activities (PPAs) in cases of gastric cancer. METHODOLOGY/RESULTS This study was based on a prospective design. 60 patients with gastric cancer (operable cases: 48; inoperable: 12) and 60 healthy controls were included in the study. Prolidase activity was analyzed. The mean PPA levels in the operable, inoperable and control groups were 45.60 ± 4.20, 54.35 ± 4. 9 and 10.92 ± 0.79 U/l, respectively (p < 0.001). PPA decreased significantly after tumor resection. PPA level was significant in differentiating operable cases from inoperable (sensitivity: 91.7%; specificity: 85.2%). DISCUSSION/CONCLUSION PPA was significantly higher in patients with inoperable gastric cancer than in operable cases and the control group. A strong correlation was found between tumor volume and PPA.

Factors affecting mortality in emergency surgery in cases of complicated colorectal cancer.

AIM To evaluate retrospectively demographic, clinical and histopathological variables effective on mortality in patients who had undergone emergency surgery due to complicated colorectal cancer. METHODS A total of 39 patients underwent urgent surgical interventions due to complicated colorectal cancer at the Department of General Surgery, Dursun Odabaş Medical Center, between January 2010 and January 2015. Thirty three of these were included in the study. Six patients were excluded because complete medical records had been missing. Medical records of the 33 cases were retrospectively reviewed. RESULTS There were 14 (42.5%) male and 19 (57.5%) female patients. Mean age was 60 years (range: 32- 83 years); 14 (42.5%) patients were less than 60 years old , while 19 (57.5%) were 60 years old or older. Operations were performed due to perforation (39.3%) and obstruction (60.6%) in 13 and 20 patients, respectively. Tumor localization was in the right and transverse colon in nine (21.2%) and in the left colon in 24 cases (72.7%). Eleven (33.3%) patients underwent resection and anastomosis, 13 (39.3%) resection and ostomy, and nine (27.2%) patients underwent ostomy alone without any resection. Postoperative mortality occurred in nine cases (27.2%). CONCLUSIONS High mortality should be expected in females older than 60 years with a left sided colon tumor or with another synchronous tumor and in perforated tumors. Unnecessary major resections should be avoided and primary pathology should be in the focus of treatment in order to decrease the mortality and morbidity rates.

MATERNAL AND FETAL OUTCOMES AFTER LAPAROSCOPIC VS. OPEN APPENDECTOMY IN PREGNANT WOMEN: DATA FROM TWO TERTIARY REFERRAL CENTERS

Objectives Appendectomy is the most common cause of non-obstetric surgery in pregnant women. Our aim was to compare the clinical characteristics, peri-and post-operative data of pregnant women undergoing either laparoscopic appendectomy (LA) or open appendectomy (OA). Materials and methods This was a retrospective study of medical records of all pregnant women diagnosed and treated surgically for acute appendicitis at two referral centers of Yuzuncu Yil University Medical Faculty and Kafkas University Medical Faculty, from January 2010 to January 2015. Results The study included 48 patients, divided to two groups (12 - LA and 36 - OA). There were no significant differences in demographic characteristics of the studied population, including age, BMI, gestational age at operation, gravidity, parity, and history of cesarean sections. A far as obstetric and fetal outcomes are concerned, no significant differences were found in terms of preterm delivery, fetal loss, delivery mode, birth weight, APGAR score, and maternal death between the two investigated groups. One perioperative complication of intra-abdominal abscess was noted in the OA group. However, the LA group had shorter hospital stay (3.25±2.45 vs. 4.28±3.31, p=0.004), earlier mobilization time (8.1±2.2 vs. 10.1±1.6, p=0.025), and shorter time to first flatus (2.3±0.3 vs. 4.0±1.6, p=0.032) as compared to the OA group. The OA group had statistically shorter operation time than the LA group (38.61±11.5 vs. 49.42±11.38, p=0.007). Conclusion LA is related to shorter hospital stay, faster return to daily activities, and shorter time to first flatus. LA appears to be as safe and effective as OA in pregnant patients without increasing adverse perinatal outcomes.

A case of pancreatic cancer with concomitant median arcuate ligament syndrome treated successfully using an allograft arterial transposition

An association of pancreatic cancer and median arcuate ligament syndrome (MALS) is a rare and challenging situation in terms of treatment. A 60-year-old man diagnosed with pancreatic cancer underwent laparotomy. A pancreaticoduodenectomy was planned, but during the resection part of the operation, a celiac artery stenosis was noticed. The patient was diagnosed with MALS causing almost total celiac artery occlusion, with no radiological solution. The patient was re-operated the next day, and an iliac artery allograft was used for aorta-proper hepatic artery reconstruction, concomitant with the total pancreaticoduodenectomy. Preoperative meticulous evaluation of vascular structures of the celiac trunk and its branches is important, especially in pancreatic surgery. A vascular allograft may be a lifesaving alternative when vascular reconstruction is necessary.

The Relationship between Eating and Lifestyle Habits and Cancer in Van Lake Region: Another Endemic Region for Esophagealand Gastric Cancers

Purpose. To examine the relationship between esophageal and gastric cancers commonly seen in Van Lake region and the traditional eating habits of the geography. Materials and Methods. Esophageal and gastric cancer cases, who underwent surgery between January 1, 2012, and December 31, 2013, were examined. Pathology reports of the patients and presence of Helicobacter pylori (HP) were recorded. Surveys were filled by face to face meeting or telephone call. Control group was created with randomly selected individuals without any cancer diagnosis having age, gender, and socioeconomic characteristics similar to patient group. All data were analyzed using SAS.9.3 statistical programme. Results. Compared with the control group, herby cheese consumption (a component of eating habits) and smoking were significantly higher in the patient group (P < 0.001). Tandoor exposure is compared in terms of female gender, and significant difference was found between the groups (P = 0.0013). As a result of the analysis with logistic regression more than 150 gr of herby cheese consumption per day was found to increase the cancer risk (odds ratio 1.017; 95% CI: 1.012–1.022). Conclusion. A high consumption of herby cheese, cooking bread on tandoor, and heavy smoking were seen to be important risk factors for esophageal and gastric cancers.

Contribution of Ultrasound Strain Elastography to the Differentiation of Benign and Malignant Thyroid Lesions: Randomized Controlled Study

Objective: We aimed to investigate the contribution of strain elastosonography to the distinction of benign and malignant thyroid nodules. Materials and Methods: The retrospective study included 135 patients who were detected with thyroid nodules on ultrasonography and then underwent fineneedle aspiration biopsy (FNAB). Semi-quantitative strain elastographic evaluation was performed and mean strain ratio was calculated for each nodule. The elastograms were classified using the Tsukuba fivepattern visual scoring system. Accordingly, the lesions with scores 1 and 2 were accepted as soft nodules (benign), score 3 as moderately hard nodules, and scores 4 and 5 as hard nodules (malignant). The nodules were divided as benign and malignant depending on the histopathological results. The FNAB results were compared with elasticity scores. Results: The patients included 18 (13.3%) men and 117 (86.7%) women. Of the 135 lesions, 113 (83.7%) were benign and 22 (16.3%) were malignant. Strain ratio value was statistically higher in malignant lesions compared to benign lesions (p<0.01). When compared with the histopathological results, elastosonography scoring had a sensitivity of 81.8%, specificity of 89.4%, positive predictive value (PPV) of 96.2%, and negative predictive value (NPV) of 64.7%. However, compared with the strain ratio values, elastosonography scoring had a sensitivity of 77.3%, specificity of 87.6%, PPV of 95.2%, and NPV of 54.8% at a cutoff point of 4.850. Conclusion: Elastosonography is highly effective in the differentiation of benign and malignant lesions.

Are Serum Mac 2-Binding Protein Levels Elevated in Esophageal Cancer? A Control Study of Esophageal Squamous Cell Carcinoma Patients

Objective Elevated serum Mac 2-binding protein (M2BP) levels have been observed in some cancers. As far as we know, its importance has not been investigated in esophageal squamous cell carcinoma (ESCC). The investigated problem of this study was to evaluate whether there was a difference between ESCC patients and the control group in terms of M2BP. Also, we evaluated the diagnostic performance of serum M2BP alone or in combination with the CEA for patients with ESCC. Material and Methods Blood serum samples were collected from 50 healthy donors and 150 patients with ESCC. M2BP levels of all 200 samples were quantified by ELISA (enzyme-linked immunosorbent assay). Patients who had been diagnosed with ESCC and did not have any other malignancies were enrolled to study. Results The two groups did not significantly differ in terms of age (p > 0.05). In the control group, the mean serum M2BP level was 14.97 ± 3.46 ng/mL. The mean serum M2BP level of the ESCC patients was 176.65 ± 22.14 ng/mL. The serum M2BP level was significantly higher in patients with ESCC than in the control group (p < 0.001). Gender was also comparable in both groups (p = 0.695). Conclusions Our analysis demonstrated that this marker may be associated with the mechanism of the disease. Despite that serum M2BP is not a specific marker for ESCC, it can be used as an adjuvant biomarker for the diagnosis of ESCC.

Parasitic Appendicitis: A Novel Laparoscopic Approach for the Prevention of Peritoneal Contamination

Background/Aim Although rare, parasitic infection can cause acute appendicitis and result in contamination of the peritonea during appendectomy. The goal of this study was to summarize our experiences with parasitic appendicitis and describe a novel laparoscopic technique to prevent contamination. Method All patients diagnosed with acute appendicitis who underwent appendectomy between January 2016 and January 2017 were included in the study. All appendectomies were performed using the standard three-port laparoscopic method, and a video recording was made of each procedure. Following separation of the mesoappendix, a single endoloop was placed in the base of the appendix, and the appendix was then transected 3-4 mm above the clamp with the aid of a thermal cauterizing/sealing device. The appendix was extracted from the 10 mm trocar hole below the umbilicus and placed inside a bag prepared from a glove. After pathological confirmation of parasitic appendicitis, medical records were retrospectively analyzed in each case for whether peritoneal contamination had occurred or not. Results Out of 97 appendectomies, parasitic infection was observed in 4 cases, as confirmed by pathological examination. In two of these patients, E. vermicularis was detected, while the other two were infected with Balantidium coli. Intraoperative contamination did not occur in any of the cases, and retrospective review of the video recordings indicated no peritoneal contamination. Conclusion As a result of the coagulation and sealing effects of thermal devices, airtight seals were created on the residual appendiceal stumps, and consequently, no contamination was observed in any of the cases.