Ugur Deveci

The comparison of single incision laparoscopic cholecystectomy and three port laparoscopic cholecystectomy: prospective randomized study

Purpose Laparoscopic techniques have allowed surgeons to perform complicated intra-abdominal surgery with minimal trauma. Single incision laparoscopic surgery (SILS) was developed with the aim of reducing the invasiveness of conventional laparoscopy. In this study we aimed to compare results of SILS cholecystectomy and three port conventional laparoscopic (TPCL) cholecystectomy prospectively. Methods In this prospective study, 100 patients who underwent laparoscopic cholecystectomy for gallbladder disease were randomly allocated to SILS cholecystectomy (group 1) or TPCL cholecystectomy (group 2). Demographics, pathologic diagnosis, operating time, blood loss, length of hospital stay, complications, pain score, conversion rate, and satisfaction of cosmetic outcome were recorded. Results Forty-four SILS cholesystectomies (88%) and 42 TPCL cholecystectomies (84%) were completed successfully. Conversion to open surgery was required for 4 cases in group 1 and 6 cases in group 2. Operating time was significantly longer in group 1 compared with group 2 (73 minutes vs. 48 minutes; P < 0.05). Higher pain scores were observed in group 1 versus group 2 in postoperative day 1 (P < 0.05). There was higher cosmetic satisfaction in group 1 (P < 0.05). Conclusion SILS cholecystectomy performed by experienced surgeons is at least as successful, feasible, effective and safe as a TPCL cholecystectomy. Surgeons performing SILS should have a firm foundation of advanced minimal access surgical skills and a cautious, gradated approach to attempt the various procedures. Prospective randomized studies comparing single access versus conventional multiport laparoscopic cholecystectomy, with large volumes and long-term follow-up, are needed to confirm our initial experience. (ClinicalTrials.gov Identifier: NCT01772745.)

Is the Use of a Drain for Thyroid Surgery Realistic? A Prospective Randomized Interventional Study

Background. The use of a suction drain in thyroid surgery is common practice in order to avoid hematomas or seromas. The aim of this study was to determine the efficacy of routine drainage after thyroid surgery. Methods. In this prospective randomized trial, 400 patients who underwent either a total thyroidectomy or lobectomy for thyroid disorders were randomly allocated to either the nondrainage (group 1) or the drainage (group 2) group. The volume of fluid collection in the operative bed, postoperative pain, complications, and length of hospital stay were then recorded. Results. Both groups were homogeneous according to age, gender, thyroid volume, type of procedure performed, and histopathological diagnosis. After assessment by USG, no significant difference was found between the groups in the fluid collection of the thyroid bed (P = 0.117), but the length of hospital stay was significantly reduced in group 1 (P = 0.004). Conclusions. In our experience, the use of drain for thyroid surgery is not a routine procedure. However, it should be used in the presence of extensive dead space, particularly when there is retrosternal or intrathoracic extension, or when the patient is on anticoagulant treatment. This trial was registered with clinical Trials.gov NCT01771523.

Effects of Spirulina on Cyclophosphamide-Induced Ovarian Toxicity in Rats: Biochemical and Histomorphometric Evaluation of the Ovary

Cyclophosphamide (Cyc) is known to cause ovotoxicity and infertility in women. Our aim is to investigate the possible ovotoxic effects of Cyc and possible antioxidant and protective effects of blue-green algae, Spirulina (Sp), in rat ovaries. Eighteen rats were given: group I (n = 6, control); group II (n = 6, CP), a single dose Cyc; group III (n = 6, Sp+Cyc), 7 days Sp+single dose Cyc. Tissue malondialdehyde (MDA) levels, superoxide dismutase (SOD), and catalase (CAT) activities are assessed biochemically. Normal and atretic primordial and primary follicle counts for all sections obtained for each ovary are calculated. Mean number of follicle counts for each group are compared. In Sp+Cyc group, tissue MDA levels were significantly lower than those in the CP and higher than those in the C group (CP > Sp+Cyc > C). Tissue SOD activity was significantly higher in Sp+Cyc group than that in the CP group and lower than that in the C group (C > Sp+Cyc > C). No statistically significant difference was found between the ovarian CAT activities in any group. Histomorphometrically, there was also no significant difference between the mean numbers of normal and atretic small follicle counts. Our results suggest that single dose Cyc has adverse effects on oxidant status of the ovaries and Sp has protective effects in Cyc-induced ovotoxicity.

Giant tubular adenoma of the breast: a rare entity.

infiltrate like small nests and strands of tumor cells, which are usually of the signet ring type. This morphology may mimic other primary tumors, i.e., gastric carcinoma. The lack of dysplasia or atypia in adjacent colonic epithelium suggests a metastatic growth. Immunohistochemistry may also be useful in reaching the correct diagnosis. The GCDFP-15 and ER and PgR receptors are usually positive in MBC. Unlike the original tumor, this was also confirmed in our case. Although GI tract metastases are an underdiagnosed complication of BC, we suggest that an alert physician should always suspect this possibility whenever a patient with such a medical history experiences GI symptoms.

Bilateral Nipple Leiomyoma

Cutaneous leiomyomas are benign smooth muscle neoplasms of the skin. They arise from vascular, arrector pili, genital, and areolar smooth muscles. The most common localizations of cutaneous leiomyomas are the extensor surfaces of the extremities and the trunk. To our knowledge, only few cases of one-sided nipple leiomyomas have been reported, but two-sided nipple leiomyomas have not been presented. For the first time, here, we report a bilateral nipple leiomyoma.

Vacuum-assisted stereotactic biopsy for isolated BI-RADS 4 microcalcifications: evaluation with histopathology and midterm follow-up results

PURPOSE The aim of this study was to evaluate the 10-gauge vacuum-assisted stereotactic biopsy (VASB) of isolated Breast Imaging Reporting and Data System (BI-RADS) 4 microcalcifications, using histology and follow-up results. METHODS From January 2011 to June 2013, VASB was performed on 132 lesions, and 66 microcalcification-only lesions of BI-RADS 4 were included into our study. VASB was performed using lateral decubitis stereotaxy for all patients. Pathologic results of VASB and further surgical biopsies were reviewed retrospectively. Patients who were diagnosed to have benign lesions by VASB were referred for follow-up. VASB and surgical histopathology results were compared to determine the underestimation ratios. RESULTS Fifteen out of 66 lesions from 63 patients (median age, 47 years; range, 34-88 years) were identified as malignant by VASB. Pathological results after surgery revealed three cases of invasive ductal carcinoma among the 12 VASB-diagnosed ductal carcinoma in situ (DCIS) lesions, for a DCIS underestimation rate of 25%. The atypical ductal hyperplasia underestimation rate was 0% for the three lesions. The follow-up period was at least 10 months, with an average of 22.7 months for all patients and 21.2 months for patients with VASB-diagnosed benign lesions. None of the patients had malignancy during the follow-ups. The false-negative rate was 0% in the follow-up of 48 patients. CONCLUSION VASB should be the standard method of choice for BI-RADS 4 microcalcifications. This method obviates the need for a surgical procedure in 73% of BI-RADS 4 microcalcification-only patients.

Anaplastic Thyroid Carcinoma

Anaplastic thyroid carcinoma (ATC) is a relatively uncommon highly malignant tumor originating from the follicular cells of the thyroid gland having a poor prognosis. It accounts for 2–5% of all thyroid carcinomas, and patients typically present with a rapidly growing anterior neck mass with aggressive symptoms. A 66-year-old male presented with dyspnea, neck pain, and voice changes. Ultrasonographic neck examination demonstrated an enlarged thyroid gland and substernal extension of the right thyroid lobe. Fine needle aspiration (FNA) from the thyroid nodule biopsy showed benign cytology. Because of symptomatic disease and radiologic malignancy doubt, operation has been done. Histopathologic examination with frozen section demonstrated anaplastic thyroid carcinoma. After total thyroidectomy, the patient is discharged. The patient died 20 days after the start of systemic treatment because of septic multiorgan failure derived from bronchopneumonic lung infection. In the evaluation of sudden growing neck masses in elderly patients, anaplastic thyroid cancer should be considered as a differential diagnosis, even if the needle biopsy is normal.

Is the late hypersensitivity reaction in nephritic syndrome following multiple bee stings dosedependent

Is the late hypersensitivity reaction in nephritic syndrome following multiple bee stings dosedependent? We read with great interest the article by Nag et al. who reported a case of nephritic syndrome which was caused by a late hypersensitivity reaction following multiple bee stings (about 200 in number). Although they emphasised that the renal insufficiency in this patient was thought to result in an immune-mediated type III hypersensitivity reaction rather than shock from an anaphylactic reaction, acute pigmentary tubulopathy secondary to haemolysis or rhabdomyolysis and direct toxin-related acute kidney injury, they did not mention that this late hypersensitivity reaction is idiosyncratic rather than dose-dependent; also, the title of the article suggests that the nephritic syndrome in the child developed in a dose-dependent manner. We previously reported a case of nephrotic syndrome following a bee sting which was considered to develop from an immune-mediated idiosyncratic reaction and the patient recovered following a course of corticosteroids. Insect bites can cause different clinical reactions which are categorised as local, large local, generalised cutaneous, systemic, toxic, and delayed/late. Stings from a large number of insects at the one time can result in toxic reactions such as fever, malaise and emesis owing to chemical properties of the venom in large doses. Delayed/late reactions are serum sickness, vasculitis, nephrotic syndrome, neuritis or encephalopathy caused by immune-mediated reactions. Pathological findings of renal involvement following insect sting are diverse and include minimal change lesions, mesangial proliferative glomerulonephritis, membranous glomerulonephritis and glomerulosclerosis. In nephrotic syndrome, bee venom mediates immunological disturbances with involvement of T-lymphocytes and their cytokines which influence the permeability of the glomerular basal membrane with subsequent development of proteinuria. It is our view that delayed/late presentation of renal involvement following bee sting is caused by an immune-mediated idiosyncratic reaction, regardless of the dose of venom. Therefore, cases of insect bite, particularly bee sting, should be closely followed up in order to detect the late-onset multiple immunemediated complications such as nephritic syndrome, which might be life-threatening. We declare no competing interests. Mustafa Aydin, Ugur Deveci dr1mustafa@hotmail.com

Foreign body in liver: sewing needle.

atric populations, and up to 75% of cases occur in patients <4 years of age (1). Children ingest a variety of foreign bodies, some of which are more harmful and life threatening than others. However, hepatic foreign bodies are rare. Foreign bodies can reach the liver by one of three routes: direct penetration through the abdominal or thoracic wall, migration from the gastrointestinal tract, or through the blood (2). Most hepatic foreign bodies enter the liver via transmigration from the gastrointestinal tract (stomach, duodenum, and transverse colon) (3). Rapid diagnosis and early intervention are important to avoid morbidity and mortality (4).

Non-spesifik karın ağrısı bulunan hastalarda kolonoskopik incelemenin yeri

Hastaların NSKA grubunda olup olmadığına karar vermek ciddi bir problemdir. Öncelikli olarak akut karın dışlanmalıdır. Bunu yapabilmek için fizik muayene sonrası pek çok laboratuar tetkiki ve radyolojik inceleme gereklidir. Karın ağrısının altında yatan patolojiyi ortaya koymak bazen uzun süreli takip gerektirir ve yine de altta yatan bir hastalığın atlanma olasılığı mevcuttur. De Dombal (3), 50 yaş üzeri NSKA ile başvuran hastalarda %10 sindirim sistemi malignitesi geliştiğini bildirmiştir.