Tuba Atak

Comparison of Results of Laparoscopic Gastric Banding and Consecutive Intragastric Balloon Application at 18 Months: A Clinical Prospective Study

BACKGROUND Obesity is a serious health problem that leads to serious physical and psychological problems. The methods used in treating obesity include diet and behavioral changes, pharmacotherapy, and surgery. Laparoscopic adjustable gastric banding (LAGB) and intragastric balloon (IGB) applications are two of the methods used to treat obesity. The aim of this study was to compare the effects of LAGB with those of two consecutive IGB applications in weight loss management of obese patients. METHODS Thirty-two patients (F/M:24/8) admitted in the study were divided into two groups. In the first group of 16 patients, LAGB was performed, and in the other group two consecutive IGBs were applied. Total weight loss, body mass index (BMI), excess weight loss percent (EWL %), and excess body mass index loss percent (EBMIL %) were recorded at months 6, 12, and 18 for both groups. RESULTS At the end of the 6th month, BMI values of LAGB and IGB groups were 36.0 and 30.6  kg/m(2), EWL % were 32.3% and 39.3%, and EBMIL % were 36.3% and 47.1%, respectively. The results were similar. At the end of 12 months, median BMI was 36.6  kg/m(2) for LAGB and 27.5  kg/m(2) for IGB (P<.05). The EWL % and EBMIL % at the end of the 12th month were 57% and 70%, which is significant in favor of IGB. The last evaluation was made at the 18th month of applications, and the three parameters for two applications were found to be similar. CONCLUSIONS The achieved weight losses at the 6th month were similar for both groups. However, at the 12th month, two consecutive IGB applications were more effective. At the end of the 18th month, the results were again similar. Two consecutive IGB applications may be offered to obese patients who do not feel ready for surgery.

Strategies to treat idiopathic granulomatous mastitis: Retrospective analysis of 40 patients

BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare benign breast disease which often mimics breast carcinoma both clinically and radiologically. Confirmation of diagnosis is only made by histopathological analysis. This study aims to define clinical and demographic features of IGM patients and discuss the results of treatment modalities. METHODS Forty patients with IGM who were assigned in Istanbul Medeniyet University General Surgery Clinic between March 2008 and October 2013 were retrospectively analyzed. RESULTS Mean age was 39.07 ± 11.5. The most common complaint was breast mass (55%). Nipple retraction was present in 6 patients (15%) and 9 patients (22.5%) had fistulizing abscess. Two patients had erythema nodosum on the lower extremity. Breast ultrasonography (USG) (n:40), mammography (MG) (n:20), and magnetic resonance imaging (MRI) (n:20) were used for imaging. Selected treatment methods were antibiotics and anti-inflammatory agents (27.5%), steroids (15%), abscess drainage (40%), and surgical excision (17.5%). Fifteen patients had recurrence after their first line treatment protocol. Mean follow-up period was 24.85 ± 19.7 months. CONCLUSION Surgical excision still seems to be the best treatment method for IGM patients. Administration of steroids for large lesions prior to surgery may help minimize the lesion size and obtain better cosmesis.

Single Incision Laparoscopic Cholecystectomy in situs Inversus Totalis.

Situs inversus totalis (SIT) is a rare genetic anomaly characterized by arrangement of the abdominal and thoracic organs in a perfect mirror image reversal of the normal positioning. Transposition of the organs causes difficulty in diagnosis and treatment of the diseases related to abdomen and thorax. Single incision laparoscopic surgery (SILS) is a new technique and it is increasingly used with better cosmetic results. In this paper, a single incision laparoscopic cholecystectomy (SILC) performed in a patient with SIT is presented. SILC can be performed safely in the patients with SIT with better cosmetic results.

The Role of Interleukin-33 as an Inflammatory Marker in Differential Diagnosis of Idiopathic Granulomatous Mastitis and Breast Cancer

ABSTRACT Introduction: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory breast disease that can clinically and radiographically mimic breast carcinoma and bacterial mastitis. The aim of this study is to investigate the importance of levels of the inflammation markers, interleukin-33 (IL-33), soluble ST2 receptor of IL-33 (sST2), procalcitonin (PCT), and CRP on differential diagnosis of IGM and breast cancer (BC). Methods: 25 patients with IGM and 32 patients with primary BC who applied to General Surgery Clinic, and 30 healthy volunteer women with similar demographic condition were enrolled in the study. While the IL-33, sST2, and PCT levels were measured with ELISA method, other biochemical parameters were studied with autoanalyzer. Results: IL-33, sST2 levels were significantly higher in both BC and IGM groups than in control (p < 0.001). More importantly, the IL-33 levels of IGM group were found to be significantly higher when compared to the group with BC (p < 0.001). Accordingly the sST2 levels of the patients with IGM were significantly lower than the patients with BC (p < 0.001). There was no statistical significance between PCT levels BC and IGM groups (p > 0.05). Conclusion: The results of our study suggest that measurement of IL-33 and its receptor sST2 levels, alongside radiological studies can help distinguishing IGM from BC. Findings of our study need to be supported with additional studies.

Endoscopic Management of Penetrated Adjustable Gastric Band with Its Connecting Tube: Report of a Case

Aim: Laparoscopic adjustable gastric banding (LAGB) is a widely performed surgical procedure for the treatment of morbid obesity. Late complications mainly originate from either the injection port or the gastric band. Complications from the tube and band together are also described. Case Report: We here report a case of adjustable gastric band migrated subserosally into the stomach with its whole connecting tube, which was removed endoscopically using a band cutter. Conclusion: In selected patients endoscopic techniques in combination with minimally invasive procedures can safely be used in the treatment of complete gastric band migration.

Spontaneous Perforation of Pyometra; a Rare Cause of Acute Abdomen: Report of a Case

Spontaneous perforation of pyometra; a rare cause of acute abdomen: report of a case Pyometra is defined as pooling of purulent material in the uterine cavity. We report a perforated pyometra presented with acute abdomen who was initially diagnosed as gastrointestinal perforation. A 68 year old woman was admitted as an emergency having developed sudden lower abdominal pain. Plain abdominal X-ray revealed free air in the peritoneal cavity. At laparotomy, enlarged perforated uterus of 12x7x4 cm in size was revealed. Hysterectomy and bilateral salpingooophorectomy was performed. Postoperative period was uneventful. Patient was discharged at thirteenth day. Although rare, perforation of pyometra should be considered in the differential diagnosis in an elderly woman with an acute abdomen.

Situs inversus totalisli olguda akut apandisit: Nadir bir akut karın olgusu

GİRİŞ Acil servise başvuran hastaların şikayetlerinin %4-8’ini karın ağrısı oluşturmaktadır. Bu hastaların %30 kadarına yanlış tanı konulmaktadır (1-3). En sık cerrahi gerektiren karın ağrısı nedeni akut apandisittir (1). Situs inversus totalis (SİT) ve intestinal malrotasyon anomalilerinde apendiks karın sol alt kadranda yerleşmektedir (2,3). SİT, akut abdominal ağrının tanı ve tedavisini güçleştiren nadir bir anatomik anomalidir (4). Situs inversus totaliste, organ veya organ sistemleri normal lokalizasyonlarından vücudun karşı tarafına (normalin ayna görüntüsü) transpoze olmustur (5). Bu durumda apandisit tanısı zor olabilmektedir. Bu olgularda apandisite geç tanı koyulması nedeni ile karşılaşılabilecek apse, perforasyon gibi komplikasyonları önlemek için seyrek görülen klinik durumların da iyi bilinmesi gerekmektedir. Bu durumlardan biri de situs inversus nedeni ile sol alt kadranda yerleşimli apandisittir.

İntestinal obstruksiyona sebep olan dev over tümörü: İki olgu sunumu

Intestinal obstruction due to huge ovarian tumor: Report of two cases Borderline ovarian tumours account for approximately 10 to 20% of all ovarian tumors and have low malignant potential and seen early age at onset. Mucinous ovarian tumors may reach to big sizes and represent 12-15% of all ovarian tumor. In this article we present two cases of a huge ovarian tumour causing intestinal obstruction.

Mukosele bağlı appendiks intusepsiyonu: Olgu sunumu

Appendix intussusception due to mucocele: case report The mucocele of the appendix is an uncommon disorder which is often asymptomatic but sometimes causes acute appendicitis-like symptoms. In this article, we present a case of appendicitis complicated with plastrone which appendectomy was performed. The histopathological examination revealed appendicular mucocele formation due to the intussusception. Preoperative suspicion and diagnosis of appendiceal mucocele are important. Ultrasonography and computed tomography are useful tools for the diagnosis of appendiceal mucocele. It may be also detected by colonoscopy as a smooth submucosal lesion in the cecum. Preoperative diagnosis is paramount to minimize intraoperative and postoperative complications.