Safra kesesi torsiyonu nadir rastlanan ve siklikla intraoperatif tani konulan bir akut batin nedenidir. Wendel tarafindan ilk kez tanimlanmasindan sonra yaklasik 300 olgu bildirilmistir. Olgumuzda ayirici tanida akilda tutulmasi gerektigi sonucuna ulastigimiz inkomplet torsiyone olmus safra kesesinin yol actigi tablo sunulmus ve ek olarak hastaligin etyolojisi, klinik prezentasyonu ve tedavisi degerlendirilmistir. Anahtar Kelimeler: Safra kesesi, torsiyon, kolesistit, akut batin

BACKGROUND:Lymphoedema resulting from axillary lymph node dissection remains a challenging complication after modified radical mastectomy.OBJECTIVE:To examine the effects of supportive therapy such as rehabilitation and medical and physical treatment on the development of lymphoedema, in an attempt to establish non-surgical ways to help prevent or reduce it.METHODS:Patients (N=5 064) who underwent breast cancer surgery in the Department of General Surgery, Ankara Oncology Research and Training Hospital, Turkey, between 1995 and 2010 were included. Data were collected by retrospectively examining all the patients' files and the pre- and postoperative breast cancer follow-up forms.RESULTS:Of the patients in the study, 19.9% developed lymphoedema. It was significantly less common in patients who participated in physiotherapy than in those who did not, and it was more common in patients with a body mass index (BMI, kg/m²) between 30 and 34.9 than in patients with lower BMIs. Postoperative axillary radiotherapy did not affect the occurrence of lymphoedema.CONCLUSION:It is clear that the most successful method to reduce the impact of lymphoedema is to prevent it. We believe that educating patients about the risk factors for developing lymphoedema and referring them to postoperative physical therapy and rehabilitation clinics are the most important ways to avoid this distressing condition.

BACKGROUND:Thyroid carcinoma in pediatric patients continues to be a rare albeit significant condition because local recurrence or distant metastases may be revealed during its diagnosis, or even years after completion of treatment.METHODS:This study was prepared by retrospective analysis of patient files to focus on the clinical presentation of thyroid carcinoma in pediatric patients, and proposes to investigate the clinical parameters that differ from, or that correspond to, those in adult patients.SUBJECTS:A total of 108 patients, of whom 22 were children and adolescents and 86 were adults, and who were operated on for differentiated thyroid carcinoma during the period 2001-2009, were included in the study.RESULTS:The rate of large thyroid, multinodular goiter, or tumor >1 cm was significantly higher in the adult group than in the pediatric group. Our analysis also revealed that that the frequency of lymph node metastasis was significantly higher in the pediatric group than in the adult group. Moreover, the frequencies of total lymph node and positive lymph node presentations were significantly higher in the pediatric group than in the adult group.CONCLUSION:Although thyroid carcinoma has a good prognosis in young patients, one must stress that late diagnosis and ineffective treatment are the main criteria for poor prognosis and, most important, that it is advisable to keep the management of thyroid carcinoma on a path that differs from the management of adult thyroid carcinomas, in nearly all aspects from presentation to treatment.

Objective: The aim of this study is to investigate the complication rates between thy roidectomy procedures in order to help optimizing the surgical management of malignant and benign thyroid diseases with minimum complication rates.Material and Method: During the period from 2004 to 2009, 417 thyroidectomies were performed in Ankara Oncology Hospital at Department of 1st General Surgery. 181 were total and 120 were near-total thyroidectomies. During this same period 116 completion thyroidectomy performed. The complications investigated are tracheostomy performed due to recurrent laryngeal nerve palsy, temporary hypocalcemia, permanent hypocalcemia, temporary vocal cord dysfunction, permanent vocal cord dysfunction, postoperative hematoma and postoperative death.Results: In our study analysis between total ve near-total thyroidectomy groups in respect to tracheostomy (1.10%/0.8%; p=0,81), temporary hypocalcemia (8.84%/10%; p=0.734), permanent hypocalcemia (0.55%/0.8%; p>0.05), temporary vocal cord dysfunction (9.94%/11.7%; p=0.635) and permanent vocal cord dysfunction (p>0.05) showed no statistically significant difference. On the other hand, analysis between total and completion thyroidectomy groups in respect to tracheostomy (1.10%/15.5%; p<0.001), temporary hypocalcemia (8.84%/46.6%; p<0.001), temporary vocal cord dysfunction (9.94%137.9; p<0.001) and permanent vocal cord dysfunction showed statistically significant difference. There was no statistically significant difference between groups in respect to permanent hypocalcemia (p>0.05). Evaluation could not be performed in respect to postoperative hematoma and death due to absence of those.Conclusion: This data suggest that total thyroidectomy is a safe procedure in the hands of experienced surgeons. Based on our study we think that it may be safer to prefer total thyroidectomy to near-total thyroidectomy when there is a thyroid disease which effects the whole gland in order to avoid the high complication risk of the reoperative thyroid surgery.

Intraabdominal basinc artisina yol acan prostat hipertrofisinin varligi ve yaslanmayla beraber dokulardaki zayiflama inguinal herni etyolojisinde yer alan ve iyi bilinen faktorlerdir. Bu calismada inguinal herni tanisi almis hastalarda prostatizm insidansini belirleyerek, inguinal herni etyolojisinde prostat kaynakli obstruksiyonlarin katkisini incelemeyi amacladik. 2007-2010 yillari arasinda inguinal herni tanisi alan ve alt uriner sistem semptomlari olan 223 hasta calismaya dâhil edildi. Yas, tespit edilen urolojik patoloji ve bu patolojiye yonelik yapilan girisimler degerlendirildi. Incelenen 223 hastanin %53’unde urolojik patoloji tespit edilmezken, %35,4’unde beningn prostat hipertrofisi, %6,3’unde prostat kanseri tanisi kondu. Prostatizme bagli alt uriner sistem obstruksiyonunun varligi hem inguinal herni etyolojisinde hem de rekurrensinde onemli bir faktor olabilmektedir. Inguinal herni tanisiyla operasyonu planlanan olgularda preoperatif urolojik degerlendirmenin son derece onemli oldugu sonucuna varilmistir.

INTRODUCTIONWe aimed to determine whether levels of thyroglobulin measured in blood from the inferior-superior thyroid veins and the peripheral antecubital vein could predict the presence of thyroid carcinoma in patients undergoing surgery for thyroid diseases.MATERIAL AND METHODSSixty-one patients were prospectively enrolled in the study. Levels of thyroglobulin were analysed. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of these markers were investigated.RESULTSTwenty-six out of 61 patients (42.6%) with malignancy were diagnosed. The levels of thyroglobulin in the inferior-superior thyroid veins were higher than those in the peripheral antecubital vein (p = 0.001). The levels of thyroglobulin in the blood taken from the antecubital vein and the inferior-superior thyroid veins did not differ between benign and malignant thyroid disorders. For thyroglobulin, sensitivity was 33.3%, specificity 60.6%, PPV 27.8%, and NPV 66.7% respectively.CONCLUSIONThyroglobulin levels in the antecubital vein compared to the inferior-superior thyroid veins were not significant either in benign or malignant disorders.

Introduction: We aimed to determine whether levels of thyroglobulin measured in blood from the inferior-superior thyroid veins and the peripheral antecubital vein could predict the presence of thyroid carcinoma in patients undergoing surgery for thyroid diseases. Material and methods: Sixty-one patients were prospectively enrolled in the study. Levels of thyroglobulin were analysed. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of these markers were investigated. Results: Twenty-six out of 61 patients (42.6%) with malignancy were diagnosed. The levels of thyroglobulin in the inferior-superior thy- roid veins were higher than those in the peripheral antecubital vein (p = 0.001). The levels of thyroglobulin in the blood taken from the antecubital vein and the inferior-superior thyroid veins did not differ between benign and malignant thyroid disorders. For thyroglobulin, sensitivity was 33.3%, specificity 60.6%, PPV 27.8%, and NPV 66.7% respectively. Conclusion: Thyroglobulin levels in the antecubital vein compared to the inferior-superior thyroid veins were not significant either in benign or malignant disorders. (Pol J Endocrinol 2012; 63 (3): 202-205)

OBJECTIVE:Fine needle aspiration cytology of a thyroid nodule with Hürthle cells can be present in both benign and malignant diseases of the thyroid. The aim of this study was to identify the factors that predict malignancy in patients who underwent thyroidectomy with a preoperative fine needle aspiration cytology that contains a predominance of Hürthle cells.STUDY DESIGN:Retrospective data collection.SETTING:Tertiary referral center.SUBJECTS AND METHODS:Medical records of 70 consecutive patients were reviewed between March 2005 and August 2010. Predictive factors, as well as age, gender, preoperative serum thyroid-stimulating hormone level, the microscopic findings of fine needle aspiration, ultrasonographic appearance, and size and number of nodules in the pathology report, were correlated with final histopathologic diagnosis of benign or malignant disease.RESULTS:Patients' final pathology showed that 21 patients (30%) had malignant disease, of whom 15 patients (71.4%) had papillary carcinoma and 6 patients (28.6%) had Hürthle cell carcinoma. Forty-nine (70%) patients had benign disease (hyperplastic/adenomatoid nodule in 24 patients, Hashimoto thyroiditis in 18 patients, Hürthle cell adenoma in 5 patients, and follicular adenoma in 2 patients). The rate of malignancy was higher in male patients (42.9% vs 28.6%), with nodules measuring ≥2 cm (36.7% vs 25.0%), the presence of a solitary nodule (34.3% vs 27.7%), and the presence of metaplasia in fine needle aspiration (36.4% vs 27.1%), although none was found to be significant (P > .05).CONCLUSION:Thyroid nodules that are reported in cytology as Hürthle cell lesions require surgery to differentiate benign from malignant disease.

A 54-year-old male complained of a continuous pain together with an irreducible swelling of the left inguinal region 8 hours prior to admission to the surgical emergency department. His physical examination revealed a very painful, erythematous, irreducible swelling in the left inguinal region without abdominal peritoneal irritation. Routine blood tests disclosed mild leukocytosis. Abdominal plain X-ray film was not specific, and ultrasonography revealed a 10 cm in length inactive, edematous intestinal section within the inguinal hernia. With the diagnosis of strangulated inguinal hernia, he underwent surgical exploration through a transverse inguinal incision. By opening the hernia sac, 6-8 cc inflammatory fluid drained out, and an inflamed vermiform appendix adhered to the inner surface of the sac was seen. Appendicectomy and primary hernia repair were performed at the same time through the inguinal incision. The postoperative course was uneventful, and the histological examination of the specimen revealed an inflamed appendix.

Objective: To investigate the association between cancer antigen (CA) 15-3 and clinicopathological parameters in patients who had breast cancer with isolated bone metastases at the time of diagnosis and to analyse the effect on clinical outcomes.Methods: Between June 2004 and January 2007, the data of 129 consecutive patients were examined.Results: Elevated CA 15-3 levels were associated with poor disease-free survival (p = 0.001) and overall survival (p = 0.006). In multivariate analysis, serum CA 15-3 level (p = 0.003) was found to be an independent factor in overall survival.Conclusion: Elevated CA 15-3 level is a useful parameter for predicting clinical outcomes.

BACKGROUND: Leptin has physiological roles in multiple systems, and has possible effects on several carcinogenesis steps. The aim of this study was to investigate the leptin levels in thyroid papillary carcinoma (TPC) patients.METHODS: Forty-three female TPC patients and 30 healthy female control subjects were recruited for the Study. TPC was diagnosed by fine needle aspiration biopsy. TPC patients had a bilateral total thyroidectomy operation and their leptin levels were measured before and 20 days after the operation.RESULTS: Serum leptin levels of TPC patients.vere higher than in control group Subjects (21.15 +/- 14.12 ng/mL vs. 9.89 +/- 0.21 ng/mL, p < 0.05). The leptin levels decreased after total thyroidectomy (13.92 +/- 10.55 ng/mL) compared to prethyroidectomy levels (22.94 +/- 14.67 ng/mL) in 34 patients who came to the Follow-up visit (p < 0.05). However, the decreased post-thyroidectomy levels of leptin were still statistically significantly higher than the control group levels. Multivariate regression analysis showed that the leptin levels in TPC patients were not related to age, menopausal status or pathologic occult status but were directly related to the cancer group.CONCLUSION: Leptin levels were elevated in thyroid cancer, decreased after total thyroidectomy, and might be associated with thyroid papillary carcinogenesis. [Asian J Surg 2009;32(4):216-23]

The objective was to examine changes in serum copper (Cu) levels due to thyroid cancer in humans. 47 papillary thyroid cancer patients (mean age 41 ± 13 years) who had undergone total thyroidectomy and 37 control subjects (mean age 42 ± 13 years) were included in this study. Serum Cu levels were detected with atomic absorption spectrophotometer. The serum levels of Cu were 131.61 ± 33.9 μg/dL before surgery and 120.81 ± 30.4 μg/dL 20 days after from surgery. These results were compared with control values 105.87 ± 10.68 μg/dL. Pre-and postoperative serum Cu levels were significantly higher when compared to control group (p < 0.05). However, postoperative serum Cu levels were significantly decreased compared to those of pre-op (p < 0.05). Increasing serum levels of Cu in thyroid cancer patients and its decrease after surgery may be linked to the disease conditions. It is suggested that this change; (a) may be used to demonstrate successful cancer surgery and (b) may have implications for a long-term follow-up of thyroid cancer patients.

Amac. Bu calismada meme kanserli hastalarda kemik iligindeki mikrometastazlar ile konvansiyonel prognostik parametreler (yas, menopozal durum, tumor buyuklugu ve lenf nodu tutulumu) ve immunhistokimyasal belirleyiciler ve ekstensif intraduktal komponent (EIK) arasindaki iliski arastirildi. Yontem. Ankara Onkoloji Hastanesinde tedavi edilen meme kanseri histolojik tanisi konmus, operabl, 49 kadin hasta basvuru sirasi ile degerlendirildi. Tum hastalarda akciger grafisi, karin ultrasonografisi ve tum vucut kemik taramasi ile uzak organ metastazi varligi arastirildi. Uzak organ metastazi bulunan hastalar calismaya alinmadi. Hastalara modifiye radikal mastektomi veya meme koruyucu cerrahi uygulandi ve sternumdan intraoperatif kemik iligi biyopsisi alindi. Tum hastalardan alinan orneklerden polimeraz zincir reaksiyonu (PCR) yontemi ile sitokeratin-19 (CK-19) mRNA arastirilmasi yapildi. Mastektomi materyalleri tumor capi ve derecesi ve lenf nodu durumu ile EIK varliginin arastirilmasi icin histopatolojik degerlendirmeye gonderildi. Ostrojen reseptoru (ER), progesteron reseptoru (PR), Cerb-B2 ve P53 ekspresyonu immunhistokimya yontemi ile analiz edildi. Bulgular. Hastalarin yas ortalamasi 49,1(en az 20, en cok 79) idi. Tum hastalarda histolojik olarak tani konmus invaziv duktal karsinom mevcuttu. Onsekiz hasta premenopozal, 9 hasta perimenopozal ve geri kalan 22 hasta postmeonopozal idi. On hastada tumor santral kesimde yerlesik iken, 13 hastada ust-dis kadran, 7 hastada alt-dis kadran, 8 hastada ust-ic kadran ve 11 hastada alt-ic kadranda yerlesikti. Sekiz hastada tumor capi 2 cm’den kucuk iken, 14 hastada 2-5 cm araliginda ve 27 hastada da 5 cm’den buyuktu. Sekiz hastada koltuk altinda lenf bezi metastazi (LBM) saptanmazken, 10 hastada 1-4 arasi LBM, 19 hastada 4-9 arasi ve 12 hastada 9’un uzerinde LBM saptandi. ER 32 hastada ve PR 30 hastada pozitifti. P53 ekspresyonu 14 hastada ve Cerb-B2 19 hastada pozitifti. Alti hastada grade 1, 18 hastada grade 2 ve geri kalan 25 hastada da grade 3 tumor saptandi. EIK 11 hastada goruldu. Pozitif CK-19 ekspresyonu 13 hastada goruldu. Kemik iligi mikrometastazlari ile tumor capi, 9 ve uzerinde lenf nodu tutulumu ve EIK arasinda anlamli iliski vardi. Sonuc. Meme kanseri olgularinda tumor capinin artmasi, 9 ve uzerinde lenf nodu tutulumu ve EIK varligi kemik iligi mikrometastazi olasiligini artirir

Male breast cancer is rare. Retroareoler lump is the most frequent symptom, presentation with other various symptoms with absence of retroareolar lump is extremely rare. We report a case of ductal carcinoma in situ presented with bloody nipple discharge and there was no lump in the breast. The patient underwent a modified radical mastectomy. Tamoxifen (20mg/d) was given. Modified radical mastectomy is the preferred surgical approach for this disease. Adjuvant hormonal therapy with tamoxifen is recommended as first-linetreatment. As shown by this case there is various presentation of male breast cancer. We think that itcan be helpful to keep mind there is various presentations of male breast cancer to prevent late diagnosis and compose an optimal treatment strategy in male patients with breast symptoms.

OBJECTIVE:To investigate the effects of octreotide on mechanical ileus without surgical intervention. METHODS:This study was organized to investigate the effects of octreotide Sandostatine one microgram/ml- Sandoz, a long acting analogue of somatostatin, in a mechanical ileus model in Sprague-Dowley rats. The study was performed at Ankara Oncology Hospital, Ankara, Turkey in April 2005. The animals were randomly separated into 3 groups. 1 control group n:10 2 ileus group n:12, and 3 ileus + octreotide group n:13. Intraluminal liquid volume, as well as concentrations of sodium, chlorine, calcium, and phosphorous were measured in systemic circulation, proximal, and middle bowel segments. We also evaluated the leukocyte count, and hematocrit levels in all animals. RESULTS:There was no difference in leukocyte count and hematocrit levels. The effects of octreotide in decreasing intestinal liquid volume, and electrolytes were significant. However, these effects were not beneficial on the mortality rates, and intestinal edema (p>0.05). CONCLUSION:We believe additional animal studies, and subsequently controlled clinical trials are necessary before using octreotide as a clinical adjunct in the treatment of small bowel obstruction.

Seroma formation is the most common complication of a modified radical mastectomy for breast cancer. Postoperative wound seromas ocur in up to 53% of all patients undergoing mastectomies. We present a case who developed a seroma with a fibrous capsule after a modified radical mastectomy for breast cancer. The seroma was refractory to all conventional treatments,and required surgical resection. Altough seroma formation is the most frequent complication corelated with mastectomy and axillary dissection, seroma with fibrous capsule formation requiring surgical resection is a really rare antity. To our knowledge this is the second report of such a case. When lack of patient's life quality and serious morbidity of the complication considered, it seems to be important to diagnose early and perform maximum effort to prevent such complication with associate various methods.