[show abstract][hide abstract] ABSTRACT: Injuries of the biliary tree, which mainly occur as a complication of laparoscopic cholecystectomy, are a potentially life threatening cause of high morbidity and mortality. The reported frequency of biliary injuries after laparoscopic cholecystectomy is from 0.5-0.8%. Such injuries may sometimes become too complicated for surgical repair. Presented here is the case of a patient with a major bile duct injury for whom bile duct continuity was achieved using a T-tube.
A 53-year-old man, who developed bile duct injury following a laparoscopic cholecystectomy performed in another center for cholelithiasis, was referred to our clinic. A Roux-en-Y hepaticojejunostomy was performed in the early postoperative period. However, ensuing anastomotic leakage prompted undoing of the hepaticojejunostomy followed by placement of a T-tube by which bile duct continuity was achieved.
For injuries with tissue loss requiring external drainage, T-tube bridging offers a feasible option in that it provides bile duct continuity with biliary flow into the duodenum, as well as achieving external drainage, thus alleviating the need for further definitive surgery.
The American journal of case reports. 01/2012; 13:247-9.
[show abstract][hide abstract] ABSTRACT: Acute-phase response proteins (APRPs), cytokines, and hormones have been claimed to be an independent, important factor of cancers. We suggest that in gastrointestinal system cancers, changes in APRP, cytokines, and hormones are associated.
C-reactive protein (CRP), albumin, interleukin 1α (IL-1α), IL-1β, IL-6, IL-8, IL-10, tumor necrosis factor α (TNF-α), midkine, vascular endothelial growth factor-A(VEGF-A), VEGF-C, VEGF receptor 1 (VEGFR1), leptin, adiponectin, and ghrelin serum levels are studied in 148 gastrointestinal system cancer types and 40 healthy controls.
We found statistically significant differences and correlations between groups. We found significantly higher serum CRP, IL-1α, IL-1β, IL-6, IL-8, IL-10, TNF-α, VEGF-A, VEGF-C, VEGFR1, and leptin concentrations in patients with esophageal, gastric, pancreas, colon, and rectum cancers than controls (p < 0.001, p < 0.0001). But, we found lower levels of the serum albumin, midkine, adiponectin, and ghrelin in patients with esophageal, gastric, pancreas, colon, and rectum cancers compared to control subjects (p < 0.05, p < 0.001).
Cachexia in gastrointestinal system cancer types is associated with changes in APRP, cytokines, and hormone concentrations. This may be reflected between the outcomes in malignancies and the biomarkers.
Human & Experimental Toxicology 07/2011; 31(2):117-25. · 1.31 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate the levels of preoperative serum matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in gastric cancer.
One hundred gastric cancer patients who underwent gastrectomy were enrolled in this study. The serum concentrations of MMP-1 and TIMP-1 in these patients and in fifty healthy controls were determined using an enzyme-linked immunosorbent assay.
Higher serum MMP-1 and TIMP-1 levels were observed in patients than in controls (P < 0.001). Serum MMP-1 and TIMP-1 levels were positively associated with morphological appearance, tumor size, depth of wall invasion, lymph node metastasis, liver metastasis, perineural invasion, and pathological stage. They were not significantly associated with age, gender, tumor location, or histological type.
Increased MMP-1 and TIMP-1 were associated with gastric cancer. Although these markers are not good markers for diagnosis, these markers show in advanced gastric cancer.
World Journal of Gastroenterology 04/2011; 17(16):2109-12. · 2.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: YKL-40 is secreted by several types of tumors. Increased serum YKL-40 levels have been reported in prostate, glioblastoma, breast and colorectal cancers. Determination of YKL-40 levels may serve as a valuable biomarker for the diagnosis and treatment of gastric cancer. The purpose of this study was to determine the serum YKL-40 levels expressed in gastric carcinomas.
Between 2009 and 2011, we retrospectively reviewed 100 patients with gastric cancer and compared their serum samples to 75 healthy volunteers. YKL-40 levels were determined by an enzyme-linked immunosorbent assay (ELISA).
We found significantly higher serum levels of YKL-40 in patients with gastric cancer compared to the healthy population (P < 0.0001). We also found significant differences in serum YKL-40 levels between female and male patients with gastric cancer (P < 0.01).
YKL-40 is over-expressed in gastric cancer, suggesting a more aggressive phenotype. YKL-40 may be a useful serum biomarker for gastric cancer identification, and future studies should focus on the role of YKL-40 in the tumorigenesis of gastric cancer and responsiveness toward treatment.
[show abstract][hide abstract] ABSTRACT: To represent our clinical experience in the treatment of intestinal perforation arising from typhoid fever.
The records of 22 surgically-treated patients with typhoid intestinal perforation were evaluated retrospectively.
There were 18 males and 4 females, mean age 37 years (range, 8-64 years). Presenting symptoms were fever, abdominal pain, diarrhea or constipation. Sixteen cases were subjected to segmental resection and end-to-end anastomosis, while 3 cases received 2-layered primary repair following debridement, one case with multiple perforations received 2-layered primary repair and end ileostomy, one case received segmental resection and end-to-end anastomosis followed by an end ileostomy, and one case received segmental resection and end ileostomy with mucous fistula operation. Postoperative morbidity was seen in 5 cases and mortality was found in one case.
Intestinal perforation resulting from Salmonella typhi is an important health problem in Eastern and Southeastern Turkey. In management of this illness, early and appropriate surgical intervention is vital.
World Journal of Gastroenterology 09/2010; 16(33):4164-8. · 2.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: We report on a case of gossypiboma. A 54-year-old woman was admitted to our hospital with abdominal mass. She had undergone a caesarean operation 23 years previously. The mass in the right abdominal quadrant was suspected by abdominal computed tomography and magnetic resonance imaging. The mass was removed by laparotomy excision and the final diagnosis was gossypiboma.
[show abstract][hide abstract] ABSTRACT: Meckel's diverticulum is the most common congenital anomaly of the small intestine. Common complications related to a Meckel's diverticulum include haemorrhage, intestinal obstruction, and inflammation. Small bowel obstruction due to mesodiverticular band of Meckel's diverticulum is a rare complication. Herein, we report the diagnosis and management of a small bowel obstruction occurring due to mesodiverticular band of a Meckel's diverticulum.
[show abstract][hide abstract] ABSTRACT: A 48-year-old man who had a complaint of swelling in the left submandibular region and right side of the neck was referred to our radiology clinic for sonographic examination that revealed a type 1 hydatid cyst with a diameter of 32 mm in the left submandibular gland, and a type 3 hydatid cyst with a diameter of 33 mm in the right thyroid gland. The diagnosis was verified by computed tomography, magnetic resonance imaging, and hemagglutination tests. To the best of our knowledge, this is the second case in the literature of hydatid cysts involving both submandibular and thyroid glands. There was no abdominal, thoracic or brain involvement. The patient was a singer and did not accept surgical treatment, and percutaneous drainage with the PAIR (Puncture-Aspiration of cyst contents-Injection of hypertonic saline solution-Reaspiration) technique was performed for both cysts. There were no complications during or after the intervention. During 4 months of follow up the sizes of both cysts were decreased and the germinative membranes were shrunken, having a pseudotumor appearance. To the best of our knowledge, this is the first case in the literature that the PAIR method was applied for thyroid and submandibular gland hydatid cysts. Percutaneous treatment of thyroid and submandibular gland hydatid cysts seems to be a safe and effective procedure as a possible alternative to surgery.
[show abstract][hide abstract] ABSTRACT: Colorectal cancers are rare during pregnancy and the management is controversial and challenging. Prognosis is usually unfavorable due to late diagnosis since the presenting symptoms of colorectal cancer are attributable to the usual manifestations of pregnancy. Management depends on the patient's age and desire for future pregnancy, gestational age, cancer stage and religious principles. Thus, the treatment should be individualized. We present two cases of rectal cancer during pregnancy.
European journal of gynaecological oncology 02/2009; 30(1):100-2. · 0.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: Intestinal obstruction due to sigmoid volvulus during pregnancy is rare. The presenting signs/symptoms seen in these patients are the same as with non-pregnant patients. Fetal and maternal mortality rates are higher during pregnancy due to delays in diagnosis. We aimed to present four patients diagnosed with sigmoid volvulus during pregnancy and puerperium in our clinic. Diagnosis requires a high index of suspicion in a patient who presents with complaints of abdominal pain and evidence of bowel obstruction. Prompt intervention is necessary to minimize maternal and fetal morbidity and mortality.
[show abstract][hide abstract] ABSTRACT: Perforation is a rare complication of gastric carcinoma and generally not diagnosed preoperatively. To clarify the clinicopathologic characteristics of patients with this condition we reviewed 13 cases of gastric cancer perforation who required emergency surgery.
A total of 13 patients with gastric cancer perforation were retrospectively reviewed. The clinicopathological features including tumor stage and survival and also the type of treatment were analyzed and compared to literature data.
There were 13 patients (10 males and 3 females) with a mean age of 59.0 +/- 9.56 years. The incidence of perforated gastric cancer was 9.6% among gastric carcinoma and 4.2% of all gastric perforation cases. The perforation was more frequently in stage III-IV (2-10), but one case of stage II (T3N0M0) gastric cancer was also observed. None of the patients had curative resection or radical lymph-node dissection. Six (46%) patients were treated by palliative, local surgery. Emergency gastrectomy were performed in 7 (54%) patients. Overall 30-day mortality rate was % 46. The overall survival time was 128.2 +/- 184.8 days for all patients, it was 52.8 +/- 52.9 days for locally treated group, and 192.9 +/- 235.4 days for patients who underwent resectional surgery. The difference between the treatment groups was not significant
Perforation usually occurs in advanced stages of gastric cancer. These patients had a poor prognosis because of the presence of advanced cancer.
[show abstract][hide abstract] ABSTRACT: Effects of erythropoietin on parathyroid cell function has not been studied before.
We aimed to demonstrate whether erythropoietin receptor present in parathyroid cells.
The specimens of normal parathyroid gland, parathyroid adenoma and hyperplasia were retrieved from our pathology archives. The sections were stained immunohistochemically. Quantitative gene expression study was performed for erythropoietin and erythropoietin receptor.
Erythropoietin receptors were detected by immunohistochemical staining and by its gene expression. Its density was higher in normal parathyroid, followed by parathyroid adenoma and hyperplasia.
Erythropoietin receptor is present in normal parathyroid, parathyroid adenoma, and hyperplasia.
Journal of endocrinological investigation 01/2008; 30(11):RC35-7. · 1.65 Impact Factor
[show abstract][hide abstract] ABSTRACT: A primary fistula between the abdominal aorta and the duodenum is rare and usually fatal. Atherosclerosis remains the most common etiologic factor, accounting for more than two-thirds of the cases reported. Other etiologies include carcinoma, ulcers, radiation, aortitis and foreign bodies including sewing needle, cocktail stick, open safety pin and fishbone. We report a case of a 17 year-old girl who underwent surgical treatment because of severe upper gastrointestinal bleeding which was related to an aortoduodenal fistula caused by a swallowed sewing needle. At operation, a chronic aortoduodenal fistula that contained the sewing needle was found and repaired. This is the fourth case in the literature in which a needle was found to be associated with the development of an aortoenteric fistula.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 05/2007; 13(2):154-7. · 0.34 Impact Factor
[show abstract][hide abstract] ABSTRACT: Repeated deliveries might disturb the levator function and increase defecation disorders. In this prospective study, we determined the electric activity of the levator ani muscle (LAM) in nullipara, multipara, grand multipara, and great grand multipara (20 subjects for each group). Multiparity, grand multiparity, and great grand multiparity were defined as women having 2 - 5, 6 - 9, and 10 and over deliveries, respectively. The number of deliveries of multipara, grand multipara and great grand multipara were 4.05 +/- 1.14 (2 - 5), 7.55 +/- 1.23 (6 - 9) and 12.2 +/- 2.16 (10 - 17), respectively. All women were asked whether they had experienced constipation, fecal or urinary incontinence, and/or pelvic pain. All women were also evaluated for pelvic organ prolapse. Electromyography (EMG) of the LAM at rest and on contraction was recorded. EMG is an electrical recording of muscle activity. Constipation, incontinence and pelvic organ prolapse were encountered in multipara, grandmultipara and great grand multipara women. The LAM EMG at rest and on contraction in the nullipara was accepted as control. Both the resting and contractile activities of the LAM were as follows: nullipara > multipara > grand multipara > great grand multipara. These findings indicate that levator dysfunction and defecation disorders are increased with repeated deliveries because of pudendal and/or levator ani nerve injury and traumatic injury to the LAM occurred with the mechanical stresses of vaginal deliveries.
The Tohoku Journal of Experimental Medicine 01/2007; 210(4):365-72. · 1.37 Impact Factor
[show abstract][hide abstract] ABSTRACT: Pheochromocytomas and functioning paragangliomas are rare tumors arising from the primitive neural crest. Approximately 10% of adrenal pheochromocytomas are malignant. Malignant pheochromocytomas usually recur in the retroperitoneum or appear as metastatic deposits in bone, lung, or liver. Here, we report a 51-year-old woman with malignant pheochromocytoma with a peritoneal metastasis, which is a very unusual metastatic site. She was referred to the hospital with headache, abdominal pain, and ileus. A right adrenal mass was surgically removed in May 1997. Pathologic examination revealed pheochromocytoma and capsular with adjacent muscle invasion. During the next 3 years, the patient remained well. The disease recurred in 2001, with hypertensive episodes and peritonitis carcinomatosa. Further investigation revealed no other metastatic sites. Peritoneal metastasis is very rare in malignant pheochromocytoma and generally is attributed to direct peritoneal seeding during surgery.
The Endocrinologist 08/2005; 15(5):286-288. · 0.12 Impact Factor
[show abstract][hide abstract] ABSTRACT: Thyroid carcinoma and benign thyroid diseases associated with primary hyperparathyroidism (PHPT) may cause difficulties in the diagnosis, localization and therapy of PHPT. In this study, we analysed coexistent thyroid pathologies in 51 patients who underwent neck exploration with a diagnosis of PHPT between 1999--2002. Five hundred thirteen patients who underwent thyroidectomy for nodular thyroid disease without a parathyroid pathology in histopathological examination served as controls. In patients with PHPT there were 43 cases (84.3%) of coexistent thyroid pathology. Nine patients (17.6 %) had coexistent papillary thyroid cancer. Nine patients (17.6 %) had lymphocytic thyroiditis, two (3.9%) had benign thyroid adenoma and 24 (47%) had nodular hyperplasia. In one patient (2%), there was intrathyroidal metastasis from a parathyroid cancer. One patient had coexistent lymphocytic thyroiditis and multifocal papillary cancer. One of the two cases with thyroid adenomas was Hürthle cell type. In the control group only 28 patients (5.5%) had thyroid malignancy (27 papillary cancer and one follicular cancer). In conclusion, the coexistent thyroid pathologies are highly prevalent in patients with PHPT and pre- and intra-operative thyroid examination should be performed to avoid overlooking important thyroid pathologies.
[show abstract][hide abstract] ABSTRACT: Primary appendicular adenocarcinoma is a rare type of appendicular carcinoma. We report mucinous appendicular adenocarcinoma during pregnancy. To our knowledge, this is the third reported case.
A 35-year-old woman at 21 weeks of gestation presented with acute abdominal symptoms for the previous 10 days and underwent appendectomy. Histopathologically, examination of the appendectomy material was reported as "mucinous appendicular cystadenocarcinoma." The pregnancy was terminated by misoprostol induction. A right hemicolectomy and staging procedure were performed on the third postpartum day with relaparotomy.
Although it rarely coexists with pregnancy, primary appendicular adenocarcinoma should be considered in pregnant women with atypical acute abdominal symptoms of long duration. Primary adenocarcinoma of the appendix should be treated with right hemicolectomy even if it is a secondary procedure. Termination of pregnancy is not essential to the surgical procedure, and the decision on the outcome of the pregnancy should be made with the patient.
The Journal of reproductive medicine 11/2003; 48(10):831-3. · 0.75 Impact Factor
[show abstract][hide abstract] ABSTRACT: In recent years, many surgeons dealing with endocrine surgery have increasingly performed total thyroidectomy for benign thyroid disease. However, total excision of the thyroid in the treatment of benign lesions has been surrounded by even more controversy than its role in cancer treatment. The complication rate appears to be higher when the operation is done by inexperienced surgeons who have no special skills in endocrine surgery using proper techniques. The aim of this study is to determine whether surgeons experience and the refinement of surgical techniques are associated with postoperative recurrent laryngeal nerve (RLN) palsy or hypocalcemia after total thyroidectomy for benign thyroid disease.
A total of 68 consecutive patients who underwent total thyroidectomy for benign thyroid disease were reviewed. Twenty-six of these were from between January 1998 and June 1999 (first period) and 42 from between June 1999 and September 2000 (second period). Patients were divided into two subgroups according to different periods and different surgical techniques to identify the RLNs and the parathyroid glands. RLNs function was evaluated pre- and postoperatively by an otolaryngologist, and serum calcium levels were measured at the postoperative follow-up.
During the first period of the study, transient hypocalcaemia was determined in 8 (31%) patients. Hypocalcaemia was clinically symptomatic in 5 (19%) patients. Transient RLN palsy developed in 4 (15%) patients. Unilateral permanent RLN palsy due to operative injury was observed in 1 (4%) patient. During the second period, we noted transient hypocalcemia in 11 (26%) patients and symptomatic hypocalcemia in 6 (4%) patients. Serum calcium levels returned to normal within 4 weeks after operation in all patients. Neither transient nor permanent RLN palsy was observed during this period.
Complications of total thyroidectomy can be minimized with increasing experience and the refinement of surgical technique.