BACKGROUND:Acute pancreatitis remains a common intraabdominal disease with a complex pathophysiology. The overall outcome has improved, but specific treatment remains elusive. The challenge is the early identification and treatment of patients who will develop severe acute pancreatitis. Therefore, the aim of the present study is to investigate plasma levels of copeptin in the initial phase of predicted severe acute pancreatitis. METHODS:Between August 2008 and December 2011, 57 patients with acute pancreatitis and 30 healthy individuals were included in the study. Four blood samples, for serum copeptin measurement, were taken from each individual in each group. The first measurement was taken from the admission blood sample. The subsequent 3 samples were taken at 12, 24, and 48 hours after the onset of pain. RESULTS:Copeptin plasma concentrations were significantly higher in patients with acute pancreatitis when compared with healthy controls. Copeptin plasma concentrations in severe pancreatitis patients were significantly higher than in mild pancreatitis patients. CONCLUSIONS:Copeptin plasma concentrations were significantly higher in patients with acute pancreatitis when compared with healthy controls. Copeptin plasma concentrations in severe pancreatitis patients were significantly higher than in mild pancreatitis patients.

Torsion of the extraperitoneally transplanted kidney is rare complication with no clinical data in the literature. The authors present the case of a 44-year-old man with end-stage renal disease who received a kidney transplant from his father. On postoperative day 4, serum urea and creatinine levels increased and urine output decreased. Renal ultrasonography revealed the renal hilum to be rotated to the lateral pelvic border, causing mild pelvocaliectasis, and Doppler ultrasonography, the patients showed a poststenotic flow pattern. After the patient underwent urgent reoperation, all laboratory values and ultrasonography findings returned to normal. To the authors' knowledge, this is the first published case report of torsion of the extraperitoneally transplanted kidney. When posttransplant deterioration in renal function occurs, renal torsion should be considered in the differential diagnosis.

A solid pseudopapillary tumour (SPT) is an uncommon pancreatic tumour. Very rarely it has also been described outside the pancreas, usually arising from heterotopic pancreatic tissue. In this paper, we described a case arising from the transverse mesocolon without heterotopic pancreatic tissue in an 18-year-old girl.

The clinical importance of the novel adipokine visfatin are still largely unknown. Our aim was to evaluate diagnostic accuracy of visfatin serum concentrations in Acute appendicitis(AA). Total of 34 patients with preoperative AA diagnosis (18 men and 16 women, mean age 28.8 +/- 10.9 years) were enrolled this study. The appendix specimens were classified as normal appendix (10 patients), acute appendicitis (24 patients). The serum levels of visfatin measured Diagnostic value of the preoperative serum visfatin levels as assessed through the corresponding ROC curve was well. (area under the curve [AUC] = 0.926, P < .001). In this small case series, visfatin level was found to be useful marker for diagnosis of AA.

Thyroid nodules constitute the main indication for fine-needle aspiration biopsy (FNAB). The nodules that are diagnosed as microfollicular lesion by FNAB are usually excised because of the low but real probability that the nodule is malignant. In this study, the authors retrospectively assess the clinical factors that can be used to distinguish malignant versus benign nodules in patients with a FNAB specimen from microfollicular lesions in multinodular goiter patients.FNABs of thyroid nodules with a microfollicular structure were included in the study. All cases were reviewed to assess the following clinical features: sex, thyroid functional status, age, and nodule size.A total of 41 patients with microfollicular lesion in the FNAB specimen underwent total thyroidectomy. Final pathology result revealed 6 malignant nodules (14.6%) and 35 (85.4%) benign nodules. There were no differences in age, sex, functional status, and nodule size between patients with benign versus malignant disease.Clinical factors (sex, age, nodule size, etc) are not helpful for predicting malignancy in thyroid nodules with a microfollicular structure by FNAB.

Hydatid cysts have a worldwide distribution and are most prevalent in sheep- and cattle-raising regions like Australia, South America, the Middle East, South Africa, Eastern Europe, and the Mediterranean region. Hydatid cysts may be found in almost any part of the body, resulting either from primary inoculation or via secondary spread.1Zulfikaroglu B. Ozalp N. Keskek M. et al.Primary echinococcal cyst of the thyroid: Report of a case.Surg Today. 2008; 38: 833-835Crossref PubMed Scopus (13) Google ScholarThe disease is typically asymptomatic, and is commonly diagnosed alongside other illnesses.2Ozturk G. Aydinli B. Yildirgan M.I. et al.Posttraumatic free intraperitoneal rupture of liver cystic Hydatid cysts : a case series and review of literature.Am J Surg. 2007; 194: 313-316Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar Sometimes symptoms can mimic other acute abdominal disorders and should be included in the differential diagnosis in emergency service patients. It can become symptomatic due to expansion, rupture or pyogenic infection. Rupture of the cyst is the most common complication, either internally or externally, followed by secondary infection, jaundice, and anaphylaxis.2Ozturk G. Aydinli B. Yildirgan M.I. et al.Posttraumatic free intraperitoneal rupture of liver cystic Hydatid cysts : a case series and review of literature.Am J Surg. 2007; 194: 313-316Abstract Full Text Full Text PDF PubMed Scopus (37) Google ScholarIn this study, we analyzed demographic and clinical characteristics of the hydatid cyst patients who are admitted the emergency service due to complications of the hydatid cysts.The medical records of patients admitted to the Department of Emergency at Ankara Numune Hospital between January 2006 and August 2008 with a final diagnosis of complicated hydatid cysts were reviewed for demographic information, admission symptoms, laboratory findings and evaluation techniques.Ten patients (7 men, 3 women) with final diagnosis of complicated hydatid cyst included the study with mean age of 42.4 (range 17-75). All were from rural areas in Middle Anatolia. All of the patients had abdominal pain. While the pain was diffuse in the entire abdomen in 7 patients, it was located in the right upper quadrant in 3 patients. Patient's complaints were nausea (10 patients), vomiting (7), jaundice (4), ileus, (2), and urticaria (2). Physical examination revealed rebound tenderness in all patients, and 4 patients had fever. Nine of the patients had elevated leukocyte counts ranging from 12,000 to 20,000/μL.Plain abdominal radiographs were normal in 7 patients. While 2 patients had air fluid levels of small intestine origin, 1 patient had an elevated right hemi-diaphragm, which was also observed on plain thorax films.Ten patients underwent ultrasound examination. The primary findings on ultrasound were cystic lesions of the liver (10 patients), free intraperitoneal fluid (4 patients), and subdiaphragmatic abscess (1 patient). The cysts were located mainly in the right lobe (8 patients) based on the ultrasound examination.After initial evaluation patients were referred to general surgery clinic for surgical intervention.Hydatid cysts is a zoonotic human infection caused by the larval hydatid worm of echinococcus granulosus. Humans can become accidentally involved in the life cycle of the parasite by ingesting the eggs shed in the feces of the infected definitive host. Hydatid cysts are endemic in many countries where sheep, dogs, and humans live in close contact. There is variability in the incidence rates that have been reported.1Zulfikaroglu B. Ozalp N. Keskek M. et al.Primary echinococcal cyst of the thyroid: Report of a case.Surg Today. 2008; 38: 833-835Crossref PubMed Scopus (13) Google Scholar, 2Ozturk G. Aydinli B. Yildirgan M.I. et al.Posttraumatic free intraperitoneal rupture of liver cystic Hydatid cysts : a case series and review of literature.Am J Surg. 2007; 194: 313-316Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar In our study all of the patients come from rural areas of central Anatolia.Hydatid cysts develop most frequently in the liver (65%), lungs (25%), and rarely in the spleen, kidneys, heart, bone, central nervous system, or other internal organs.1Zulfikaroglu B. Ozalp N. Keskek M. et al.Primary echinococcal cyst of the thyroid: Report of a case.Surg Today. 2008; 38: 833-835Crossref PubMed Scopus (13) Google Scholar, 2Ozturk G. Aydinli B. Yildirgan M.I. et al.Posttraumatic free intraperitoneal rupture of liver cystic Hydatid cysts : a case series and review of literature.Am J Surg. 2007; 194: 313-316Abstract Full Text Full Text PDF PubMed Scopus (37) Google ScholarThe symptoms of hydatid cysts may be related to local and mechanical effects depending on the location and nature of the cyst but hydatid fluid can be irritating, due to toxic reaction.3Chautems R. Buhler L.H. Gold B. et al.Surgical management and long-term outcome of complicated liver hydatid cysts caused by Echinococcus granulosus.Surgery. 2005; 137: 312-316Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar In our group there were 2 patients with toxic reaction. Other patients presented with abdominal pain, icterus, ileus and fever.Various incidence rates of direct rupture have been reported (1.75-8.6%). 2Ozturk G. Aydinli B. Yildirgan M.I. et al.Posttraumatic free intraperitoneal rupture of liver cystic Hydatid cysts : a case series and review of literature.Am J Surg. 2007; 194: 313-316Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar, 4Sozuer E.M. Ok E. Arslan M. The perforation problem in hydatid disease.Am J Trop Med Hyg. 2002; 66: 575-577PubMed Google Scholar, 5Beyrouti M.I. R. Beyrouti R. Abbes I. et al.Acute rupture of hydatid cysts in the peritoneum: 17 cases.Presse Med. 2004; 33: 378-384Crossref PubMed Google Scholar The clinical signs and symptoms of hydatid cyst rupture are not always severe, but hydatid fluid can irritate, which can cause peritonitis as occurred in our series of patients, all of whom had acute abdominal signs. In the study of Patel and Butt,6Patel S.S. Butt A.A. Inadvertent rupture of an echinococcal cyst: case report and review of literature.Am J Med Sci. 2004; 327: 268-271Crossref PubMed Scopus (8) Google Scholar 76% of the patients with ruptured hydatid cysts had abdominal pain. In our series, this rate was 100%. Thus, the clinical presentation of hydatid cyst rupture is not always silent. The severe clinical presentation and infrequency of hydatid cyst perforation has been held partially responsible for the misdiagnosis by the clinician.The use of diagnostic imaging studies can be helpful. Ultrasound is widely used with an acceptable sensitivity and sensitivity for diagnosis and specificity of 90% with rupture.2Ozturk G. Aydinli B. Yildirgan M.I. et al.Posttraumatic free intraperitoneal rupture of liver cystic Hydatid cysts : a case series and review of literature.Am J Surg. 2007; 194: 313-316Abstract Full Text Full Text PDF PubMed Scopus (37) Google ScholarCompression and displacement of the biliary ducts are frequent. At the point of contact with a biliary duct, a rupture may occur. In frank rupture daughter vesicles and fragmented membranes escape into the biliary tree causing obstruction, cholangitis or septicemia.7Bedirli A. Sakrak O. Sozuer E.M. et al.Surgical management of spontaneous intrabiliary rupture of hydatid liver cysts.Surg Today. 2002; 32: 594-597Crossref PubMed Scopus (62) Google ScholarMechanical bowel obstruction is an uncommon clinical presentation for hydatid disease, although intestinal obstruction due to rupture or fistulization of a hepatic, splenic, pancreatic, mesenteric, or retrovesical cysts into the gastrointestinal tract has been reported.4Sozuer E.M. Ok E. Arslan M. The perforation problem in hydatid disease.Am J Trop Med Hyg. 2002; 66: 575-577PubMed Google ScholarIn conclusion, in endemic areas, complicated hydatid cysts should be included in the differential diagnosis of acute abdomen. Ultrasound is an extremely helpful diagnostic aid. Hydatid cysts have a worldwide distribution and are most prevalent in sheep- and cattle-raising regions like Australia, South America, the Middle East, South Africa, Eastern Europe, and the Mediterranean region. Hydatid cysts may be found in almost any part of the body, resulting either from primary inoculation or via secondary spread.1Zulfikaroglu B. Ozalp N. Keskek M. et al.Primary echinococcal cyst of the thyroid: Report of a case.Surg Today. 2008; 38: 833-835Crossref PubMed Scopus (13) Google Scholar The disease is typically asymptomatic, and is commonly diagnosed alongside other illnesses.2Ozturk G. Aydinli B. Yildirgan M.I. et al.Posttraumatic free intraperitoneal rupture of liver cystic Hydatid cysts : a case series and review of literature.Am J Surg. 2007; 194: 313-316Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar Sometimes symptoms can mimic other acute abdominal disorders and should be included in the differential diagnosis in emergency service patients. It can become symptomatic due to expansion, rupture or pyogenic infection. Rupture of the cyst is the most common complication, either internally or externally, followed by secondary infection, jaundice, and anaphylaxis.2Ozturk G. Aydinli B. Yildirgan M.I. et al.Posttraumatic free intraperitoneal rupture of liver cystic Hydatid cysts : a case series and review of literature.Am J Surg. 2007; 194: 313-316Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar In this study, we analyzed demographic and clinical characteristics of the hydatid cyst patients who are admitted the emergency service due to complications of the hydatid cysts. The medical records of patients admitted to the Department of Emergency at Ankara Numune Hospital between January 2006 and August 2008 with a final diagnosis of complicated hydatid cysts were reviewed for demographic information, admission symptoms, laboratory findings and evaluation techniques. Ten patients (7 men, 3 women) with final diagnosis of complicated hydatid cyst included the study with mean age of 42.4 (range 17-75). All were from rural areas in Middle Anatolia. All of the patients had abdominal pain. While the pain was diffuse in the entire abdomen in 7 patients, it was located in the right upper quadrant in 3 patients. Patient's complaints were nausea (10 patients), vomiting (7), jaundice (4), ileus, (2), and urticaria (2). Physical examination revealed rebound tenderness in all patients, and 4 patients had fever. Nine of the patients had elevated leukocyte counts ranging from 12,000 to 20,000/μL. Plain abdominal radiographs were normal in 7 patients. While 2 patients had air fluid levels of small intestine origin, 1 patient had an elevated right hemi-diaphragm, which was also observed on plain thorax films. Ten patients underwent ultrasound examination. The primary findings on ultrasound were cystic lesions of the liver (10 patients), free intraperitoneal fluid (4 patients), and subdiaphragmatic abscess (1 patient). The cysts were located mainly in the right lobe (8 patients) based on the ultrasound examination. After initial evaluation patients were referred to general surgery clinic for surgical intervention. Hydatid cysts is a zoonotic human infection caused by the larval hydatid worm of echinococcus granulosus. Humans can become accidentally involved in the life cycle of the parasite by ingesting the eggs shed in the feces of the infected definitive host. Hydatid cysts are endemic in many countries where sheep, dogs, and humans live in close contact. There is variability in the incidence rates that have been reported.1Zulfikaroglu B. Ozalp N. Keskek M. et al.Primary echinococcal cyst of the thyroid: Report of a case.Surg Today. 2008; 38: 833-835Crossref PubMed Scopus (13) Google Scholar, 2Ozturk G. Aydinli B. Yildirgan M.I. et al.Posttraumatic free intraperitoneal rupture of liver cystic Hydatid cysts : a case series and review of literature.Am J Surg. 2007; 194: 313-316Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar In our study all of the patients come from rural areas of central Anatolia. Hydatid cysts develop most frequently in the liver (65%), lungs (25%), and rarely in the spleen, kidneys, heart, bone, central nervous system, or other internal organs.1Zulfikaroglu B. Ozalp N. Keskek M. et al.Primary echinococcal cyst of the thyroid: Report of a case.Surg Today. 2008; 38: 833-835Crossref PubMed Scopus (13) Google Scholar, 2Ozturk G. Aydinli B. Yildirgan M.I. et al.Posttraumatic free intraperitoneal rupture of liver cystic Hydatid cysts : a case series and review of literature.Am J Surg. 2007; 194: 313-316Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar The symptoms of hydatid cysts may be related to local and mechanical effects depending on the location and nature of the cyst but hydatid fluid can be irritating, due to toxic reaction.3Chautems R. Buhler L.H. Gold B. et al.Surgical management and long-term outcome of complicated liver hydatid cysts caused by Echinococcus granulosus.Surgery. 2005; 137: 312-316Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar In our group there were 2 patients with toxic reaction. Other patients presented with abdominal pain, icterus, ileus and fever. Various incidence rates of direct rupture have been reported (1.75-8.6%). 2Ozturk G. Aydinli B. Yildirgan M.I. et al.Posttraumatic free intraperitoneal rupture of liver cystic Hydatid cysts : a case series and review of literature.Am J Surg. 2007; 194: 313-316Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar, 4Sozuer E.M. Ok E. Arslan M. The perforation problem in hydatid disease.Am J Trop Med Hyg. 2002; 66: 575-577PubMed Google Scholar, 5Beyrouti M.I. R. Beyrouti R. Abbes I. et al.Acute rupture of hydatid cysts in the peritoneum: 17 cases.Presse Med. 2004; 33: 378-384Crossref PubMed Google Scholar The clinical signs and symptoms of hydatid cyst rupture are not always severe, but hydatid fluid can irritate, which can cause peritonitis as occurred in our series of patients, all of whom had acute abdominal signs. In the study of Patel and Butt,6Patel S.S. Butt A.A. Inadvertent rupture of an echinococcal cyst: case report and review of literature.Am J Med Sci. 2004; 327: 268-271Crossref PubMed Scopus (8) Google Scholar 76% of the patients with ruptured hydatid cysts had abdominal pain. In our series, this rate was 100%. Thus, the clinical presentation of hydatid cyst rupture is not always silent. The severe clinical presentation and infrequency of hydatid cyst perforation has been held partially responsible for the misdiagnosis by the clinician. The use of diagnostic imaging studies can be helpful. Ultrasound is widely used with an acceptable sensitivity and sensitivity for diagnosis and specificity of 90% with rupture.2Ozturk G. Aydinli B. Yildirgan M.I. et al.Posttraumatic free intraperitoneal rupture of liver cystic Hydatid cysts : a case series and review of literature.Am J Surg. 2007; 194: 313-316Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar Compression and displacement of the biliary ducts are frequent. At the point of contact with a biliary duct, a rupture may occur. In frank rupture daughter vesicles and fragmented membranes escape into the biliary tree causing obstruction, cholangitis or septicemia.7Bedirli A. Sakrak O. Sozuer E.M. et al.Surgical management of spontaneous intrabiliary rupture of hydatid liver cysts.Surg Today. 2002; 32: 594-597Crossref PubMed Scopus (62) Google Scholar Mechanical bowel obstruction is an uncommon clinical presentation for hydatid disease, although intestinal obstruction due to rupture or fistulization of a hepatic, splenic, pancreatic, mesenteric, or retrovesical cysts into the gastrointestinal tract has been reported.4Sozuer E.M. Ok E. Arslan M. The perforation problem in hydatid disease.Am J Trop Med Hyg. 2002; 66: 575-577PubMed Google Scholar In conclusion, in endemic areas, complicated hydatid cysts should be included in the differential diagnosis of acute abdomen. Ultrasound is an extremely helpful diagnostic aid.

Muslim countries celebrate 2 great festivals annually. The first is the great festival that follows the month of Ramadan. The second occurs about 2 months later, when an animal is sacrificed in commemoration of Ibrahim's sacrifice of his son, Ismail, to God. The Sacrifice Festival, called “Kurban Bayrami” in Turkish, is a 4-day period. Part of the celebration involves sacrificing a sheep, cow, goat, calf, camel, or any other animal (bullock, buffalo) allowed and sharing it with neighbors, relatives, and most importantly with the poor people. Most of the people are sacrificing animals themselves. Although they are not experienced, they usually do not get any professional assistance. Because many of these animals are sacrificed by nonprofessionals, accidental injuries occur frequently.1Avşaroğullari L. Ikizceli I. Szüer E. et al.Hand injuries during a Muslim Sacrifice Festival.Am J Emerg Med. 2004; 22: 508-509Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar, 2Sarifakioğlu N. Levent A. Terzioğlu A. et al.Do we sacrifice ourselves?.Plast Reconstr Surg. 2003; 111 (1173): 1762Crossref PubMed Scopus (6) Google Scholar The aim of this study is to analyze the features of patients presenting during the sacrifice festival in order to ensure appropriate staffing to meet the needs of patients who present to an emergency department (ED). One hundred twenty-two patients with injuries occurring while sacrificing animals were found in Ankara Numune Hospital ED charts during the 4-day periods of the last 3 Sacrifice Festivals (January 10-13, 2006, December 31, 2006-January 3, 2007 and December 20-23, 2007). The demographic and clinical data regarding their injuries is reported. There were 103 male and 19 female patients, with a mean age of 35 ± 15 (range 10 to 85).The majority of patients presented to the ED on the first day of the festival (87%). Laceration with the knife used in the sacrificing of the animal was the leading (97.5%) mechanism of injury. Demographic distrubution, type of injuries and location of injuries are summarized in Table 1, Table 2, Table 3. Patients with tendon injuries, nerve injuries, vascular injuries and amputations were hospitalized and referred to orthopedic surgery, vascular surgery and plastic surgery. All other patients were managed in the ED and followed up as outpatients.Table 1Demographic distributions of patients.DemographicsOverallLaceration With KnifeAnimal KicksPatients (%)122 (100)119 (97.5)3 (2.5)Male (%)103 (85.5)100 (82)3 (100)Female (%)19 (15.5)19 (18)0Age (Mean±SD)35 ± 1535 ± 1443 ± 7 Open table in a new tab Table 2Type of injuries.Type of InjuriesOverallLaceration With KnifeAnimal KicksSimple lacerations (%)74 (60.6)71 (59.6)3(100)Tendon injuries (%)33 (27)33 (27.7)N/AVascular and nerve injuries (%)7 (5.8)7 (5.9)N/AAmputations (%)8 (6.6)8 (6.7)N/A Open table in a new tab Table 3Location of injuries.Location of InjuriesOverallLaceration With KnifeAnimal KicksUpper extremity (%)99 (81.1)99 (83.2)N/ALower extremity (%)17 (13.9)14 (11.8)3(100)Head and neck (%)5 (4.1)5 (4.2)N/AOther (%)1 (0.9)1 (0.8)N/A Open table in a new tab Most of the injuries presented on the first day of the festival because traditionally there is tendency to sacrifice on the first day. Avsaroğullari1Avşaroğullari L. Ikizceli I. Szüer E. et al.Hand injuries during a Muslim Sacrifice Festival.Am J Emerg Med. 2004; 22: 508-509Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar and Sarifakioğlu2Sarifakioğlu N. Levent A. Terzioğlu A. et al.Do we sacrifice ourselves?.Plast Reconstr Surg. 2003; 111 (1173): 1762Crossref PubMed Scopus (6) Google Scholar found similar tendency. Most of the patients were male, because it is thought that sacrifice is man's work. Women were injured when they were preparing meat. In our study, most of the injuries were on the left side. Similarly, in the Sarifakioğlu study most of the injuries were on the left side.2Sarifakioğlu N. Levent A. Terzioğlu A. et al.Do we sacrifice ourselves?.Plast Reconstr Surg. 2003; 111 (1173): 1762Crossref PubMed Scopus (6) Google Scholar On the other hand, Avsaroğullari et al found that injuries were distributed almost equally between hands.1Avşaroğullari L. Ikizceli I. Szüer E. et al.Hand injuries during a Muslim Sacrifice Festival.Am J Emerg Med. 2004; 22: 508-509Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar While slaughtering a cow or sheep, one uses the nondominant hand to position and stabilize the animal, and the dominant hand to hold the knife. They conclude that this explains the left hand injuries, and the high number of left hand extensor tendon injuries.1Avşaroğullari L. Ikizceli I. Szüer E. et al.Hand injuries during a Muslim Sacrifice Festival.Am J Emerg Med. 2004; 22: 508-509Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Rahman et al also found a much higher frequency of left hand involvement because of this mechanism.3Rahman M.M. Al-Zahrani S. Al-Qattan M.M. ”Outbreak” of hand injuries during Hajj festivities in Saudi Arabia.Ann Plast Surg. 1999; 43: 154-155PubMed Google Scholar Lower extremity injuries may also occur, while bending over during sacrificing of the animal. In our study, lower extremity injuries were superficial but these injuries may be with vascular injuries.2Sarifakioğlu N. Levent A. Terzioğlu A. et al.Do we sacrifice ourselves?.Plast Reconstr Surg. 2003; 111 (1173): 1762Crossref PubMed Scopus (6) Google Scholar Animal kicking was another injury mechanism. These injuries were not serious. All patients were managed in the ED and followed up as outpatients. In conclusion, upper extremity injuries are the most common injury during Sacrifice Festival (especially in the first day). In order to decrease the incidence of these injuries, sacrificing should be done by skilled persons and ED staff must be trained in the proper management of hand and upper extremity injuries. We want to add the 2-week hand surgery rotation to our ED staff's program.

Surgical site infection (SSI) is a potentially morbid and costly complication of surgery. We conducted this study to establish the preoperative and operative factors predisposing to SSI after gastric resection and D2 lymphadenectomy. Data on all patients undergoing gastrectomy and D2 lymphadenectomy within a 2-year period, at a tertiary reference hospital in Turkey, were collected retrospectively. The outcome of interest was a diagnosis of incisional SSI as defined by the Centers for Disease Control and Prevention. Multivariate analysis by stepwise logistic regression was then performed on those variables associated with incisional SSI. We identified 72 patients with SSI after gastrectomy and D2 lymphadenectomy. The median age of the patients was 61 years (range 31–81 years) and 43 were men. Incisional SSI was diagnosed in 15 (20.8%) patients. Of all the preoperative and operative variables measured, an increased patient body mass index was an independent predictor of incisional SSI. An increased incidence of SSI was found in overweight patients, but these infections were transient and not life threatening.

INTRODUCTION:Gastric cancer is still one of the most common fatal types of cancer in the world. The abnormalities in purine metabolism are a characteristic feature of many human tumors. Little is known about the correlation between the activities of key enzymes of purine nucleotide pathway and some clinical indicators of gastric cancer invasiveness and aggressiveness.METHOD:Seventeen (11 men, 6 women) patients with gastric cancer were admitted to the hospital. The activities of Adenosine deaminase (ADA) and 5'-nucleotidase (5'NT) in their cancerous and non-cancerous tissues were measured.RESULTS:5'NT activities were significantly higher in cancerous tissues than in non-cancerous tissues.CONCLUSION:5'NT activities increased in gastric cancer tissues but had no association with clinicopathologic findings (Tab. 2, Ref. 9). Full Text (Free, PDF) www.bmj.sk.

BACKGROUND:The parasitic infection hydatidosis or echinococcosis, is a parasitic infection caused most frequently by flatworm Echinococcus granulosus. Hydatidosis is endemic in Turkey where animal husbandry is common. Eventhough, Hydatid disease can develop anywhere in the human body it is most frequently occurs in the liver and then the lungs. Rupture of hydatid cysts into the peritoneal cavity, although rare, still presents a challenge for the surgeon.CASE:A 20-year-old man presented with ileus after 24 hours of mild abdominal distention, pain and nausea. On examination his abdomen was tender, with guarding and rebound tenderness and had a 3 cm long subcostal incision scar. All laboratory investigations were in the normal range. Exploratory laparotomy revealed multiple peritoneal cyst hydatid lesions with the largest measuring 10 cm in size and one also located in the right lobe of the liver.CONCLUSIONS:Rupture of hydatid cysts into the peritoneal cavity, although rare, still presents a challenge for the surgeon. This pathology should be included in the differential diagnosis of acute abdomen in endemic areas, especially in patients with a history of cyst hydatid (Fig. 1, Ref. 12). Full Text (Free, PDF) www.bmj.sk.

A case of primary hydatid disease of the thyroid, a rare location, is presented. The patient was a 50-year-old woman who presented with a neck mass at the thyroid region, which was noticed 2 months before her presentation. Although the clinical impression was of a neoplastic lesion (adenoma or carcinoma), a hydatid cyst was considered intraoperatively and confirmed by a frozen section histology. It was completely removed. No other sites of hydatid disease were found and the patient remained well postoperatively. In patients with a solitary cyst in the thyroid, the possibility of hydatid disease, though rare, should be always kept in mind, because a needle aspiration biopsy is a potentially harmful procedure.

Yoldaş, Ömer MD; Koç, Mahmut MD; Karaköse, Nazile MD; Klç, Mehmet MDıı; Tez, Mesut MD Author Information

BACKGROUND:The aim of this study was to determine if there is any predictive factor indicating the risk of bile leakage before surgery for hepatic hydatid disease in clinically asymptomatic patients. METHODS:The data of 116 patients who underwent surgery for hepatic hydatid disease were reviewed retrospectively. There were 43 men (37%) and 73 women (63%) with a mean age of 45 +/- 15 years. Because of high preoperative serum bilirubin and liver function test levels, 12 patients were excluded from the study. These patients underwent preoperative endoscopic retrograde cholangiopancreatography. In addition, 2 medically treated patients were excluded from the study. The following variables were analyzed as potential predictors of biliary-cyst communication: age, sex, physical examination findings, leukocyte count, liver function test results, and ultrasonographic cyst features (type, diameter, number, and localization). RESULTS:Bile leakage was detected in 24 out of 102 patients. There were no differences in age, sex, cyst type, alkaline phosphatase level, gamma-glutamyl transpeptidase level, alanine aminotransferase level, aspartate aminotransferase level, bilirubin level, and number of cysts and cyst locations between the patients with and without bile leakage. The mean cyst size in patients with biliary leakage was 10.2 cm as compared with 6.1 cm in patients with no biliary leakage (P < .05). When the cut-off value of cyst diameter was accepted as 7.5 cm, the specificity and sensitivity for biliary-cyst communication were 73% and 79%, respectively. CONCLUSIONS:These data suggest that cyst diameter is an independent factor that is associated with a high risk of biliary-cyst communication in clinically asymptomatic patients. Preoperative endoscopic retrograde cholangiopancreatography should be performed in these asymptomatic patients to reduce the incidence of postoperative complications.

BACKGROUND:The aim of this study was to evaluate the predictive accuracy of different scoring systems on patients undergoing emergency colorectal surgery. METHODS:The Acute Physiology and Chronic Health Evaluation II or III, the Simplified Acute Physiology Score II, the Mortality Probability Model II, and the Colo-rectal POSSUM scoring systems were applied to 102 patients who underwent colorectal resection for cancer. Validation of scoring systems was tested by assessing calibration and discrimination. Calibration was assessed using Hosmer-Lemeshow goodness-of-fit test and the corresponding calibration curves. Evaluation of the discriminative capability of both models was performed using receiver-operating characteristic curve analysis. RESULTS:Overall, 17 deaths occurred. The Simplified Acute Physiology Score II showed good calibration (x(2) = 1.079, P = .982) and discrimination (areas under the receiver-operating characteristic curve .83). CONCLUSIONS:These data suggest that the SAPS II scoring system was accurate in predicting outcome for patients undergoing emergency colorectal surgery.