ÖZ Objective: Sonoelastography is increasingly used in the evaluation of breast lesions in recent years. The aim of our study is to compare the sonoelastography scores found in the sonoelastography examination and histopathological results of Breast Imaging Reporting and Data System (BI-RADS) 5 breast lesions and to determine the usefulness of sonoelastography for identifying the malignancy of the breast tumors. Material and Methods: Our prospective study evaluated the age, mass location, size, elastography score, and excisional biopsy results of 44 patients assessed as BI-RADS 5 on ultrasonography between December 2014 and February 2015. Results: The mean age of the study population was 50.02±14.28 years. In 52.3% of the patients, the mass was located in the left breast the masses had a mean length of 16.93±12.96 mm and a mean width of 23.39±14.77 mm. Ninety-seven-point seven percent of the cases were malignant in nature. The most common mass histopathology was invasive ductal carcinoma (86.4%). The sensitivity of sonoelastography was 97.7%. No relationship between the elasticity score and the presence of malignancy in the malignant group (p>0.05). Conclusion: Sonoelastography, which is a noninvasive, reproducible and easy-to-use imaging method is a highly sensitive test for showing malignant breast lesions (BI-RADS 5) can be used for distinction of malignant breast lesions. Amaç: Son yıllarda meme lezyonlarının değerlendirilmesinde sonoelastografi giderek daha fazla kullanılmaktadır. Çalışmamızın amacı Meme Görüntüleme Raporlama ve Veri Sistemi (BI-RADS) 5 olan meme lezyonların sonoelastografi incelemesi ile saptanan elastografi skoru ve histopatolojik sonuçlarını karşılaştırmak ve sonoelastografinin meme tümörlerinin malignitesini belirlemedeki kullanılabilirliğini belirlemektir. Gereç ve Yöntemler: Prospektif çalışmamız Aralık 2014 Şubat 2015 tarihleri arasında yapıldı. Ultrasonografide BI-RADS 5 olarak değerlendirilen 44 hastanın yaş, kitle yeri, büyüklüğü, elastografi skorları ve eksizyonel biyopsi sonuçları değerlendirildi. Bulgular: Çalışmamızdaki hastaların yaş ortalaması 50.02±14.28 yıl idi. Hastaların %52.3’ünde kitle sol memede idi ve kitlelerin ortalama boyu 16.93±12.96 mm ve ortalama eni 23.39±14.77 mm’idi. Olguların %97.7’si maligndi. En sık rastlanılan kitle patolojik tipi invazif duktal karsinomdu (%86.4). Çalışmamızda elastografinin duyarlılığı %97.7 olarak saptandı. Malign grubun elastikiyet skoru ve malignite varlığı arasında anlamlı ilişki saptanmadı (p>0.05). Sonuç: Non-invaziv, tekrarlanabilir ve kullanımı kolay bir görüntüleme yöntemi olan sonoelastografi, malign meme lezyonlarının (BI-RADS 5) gösterilmesinde sensitivitesi oldukça yüksek bir test olup, malign meme lezyonlarının ayrımında kullanılabilir.

Objective: Thyroid nodules are the most important pathologies of the thyroid gland. The presence of certain features in thyroid nodules increases the likelihood that the nodule is malignant. In our study, we aimed to investigate the relationship between malignancy and nodule diameter, and other risk factors that we encountered on ultrasonography (USG) in terms of malignancy. Material and Methods: This study was carried out on 271 cases operated between 2006 and 2012 at the Clinic of General Surgery, Ankara Numune Training and Research Hospital. Features such as age, gender, USG (nodule size, structure, number, echogenicity, contour features, calcification status) were evaluated according to the findings and the results of fine needle aspiration biopsy (FNAB). Results: Of the 271 patients included in the study, 227 (83.8%) were female and 44 (16%) were male. The mean age for all groups was 49.2 ± 13. When single nodule diameter and malignancy were evaluated, there was a significant correlation between nodule diameter and post-operative outcome of the patients (p = 0.001). The proportion of nodules with a diameter less than 1 cm was lower in benign nodules while nodules with a diameter less than 1 cm were more common among malignant nodules. In the multinodular group, the relationship between malignancy and diameter was not significant (p = 0.679). Conclusion: There is a significant relationship between nodule diameter and malignancy, which is more significant in solitary nodules, and smaller nodules are more malignant. In conclusion, nodule diameter is important in the follow-up of the thyroid nodule, but it does not make much sense in distinguishing benign lesions from malignant.

Objective: The incidence of papillary thyroid cancer (PTC) is rising all over the world. The trace elements copper (Cu) and zinc (Zn) are essential for many physiological functions. Concurrent exposure to Cu and Zn may result in remarkable epithelial toxicity and stress. We evaluate the serum Cu and Zn concentrations as well as the Cu/Zn ratio to predict the possible malignancy of PTC in patients who underwent thyroid fine needle aspiration biopsy (FNAB) before total thyroidectomy. Material and methods: Serum Zn and Cu concentrations as well as the Cu/Zn ratio of 111 patients (23 male and 89 female) who underwent total thyroidectomy and in whom preoperative thyroid FNAB was non-diagnostic or demonstrated atypia of undetermined significance (AUS) or was suspicious for follicular neoplasm (SFN) or showed benignity were evaluated. Postoperative pathology results were classified as benign or malignant. The amount of Cu and Zn was determined using atomic absorption spectrometry. In the malignant group, preoperative serum Cu levels correlated with tumor size, localization, and focality. Results: In the malignant group, the preoperative Cu level and Cu/Zn ratio was found higher than in the benign group; also postoperative serum Cu difference and serum Cu/Zn difference showed a significant decrease when compared to the preoperative state (p = 0.001, 0.034, 0.002, 0.003, respectively). In receiver-operating characteristics (ROC) analysis, the optimal cut-off value of preoperative Cu for differentiating malignant tumor from benign tumor was found to be 158.88 mg/dL (p = 0.001; sensitivity: 48%, specificity: 84%). In subjects in whom FNAB results were non-diagnostic or revealed benignity, AUS, or SFN, preoperative Cu levels over 158.88 mu g/dL to predict malignancy were found to have a sensitivity of 24%, 67%, 54%, and 50%, respectively, and a specificity of 70%, 82%, 93%, and 100%, respectively. Conclusions: Before thyroid surgery, if FNAB was non-diagnostic or revealed indeterminate cytology like AUS and SFN, the assessment of serum Cu is considered to be a useful diagnostic tool for surgical decisions in patients with thyroid nodules and for determining PTC cases.

Rectal prolapse is an uncommon anorectal disease that is characterized by protrusion of full thickness rectal wall through the anus. Rectal prolapse generally affects adults, but can be seen in children under three years of age. It is more common in women than men.1 Rectal prolapse generally occurs during defecation and reduces spontaneously, sometimes require manual reduction. Common complaints that include constipation, tenesmus, incontinence, less frequently bleeding, pain, and pruritus could be the presenting symptoms. There have been over 50 surgical procedures have been described for rectal prolapse, suggesting that none has not been shown superior to others. These procedures consist of abdominal and perineal approaches. Abdominal procedures are the first-line treatment modalities that have low recurrence rates. However, perineal procedures are suitable for older patients with significant medical problems but have some disadvantages as continued incontinence and high recurrence rates.1 Altemeier’s procedure is one of the two most common perineal-based procedures, which was popularized in the United States in 1971 byWilliam Altemeier.2 There is still lack of large randomized trial to compare the techniques. Therefore, surgeon can select the best technique based on the patient risk factors and the underlying diseases. In this study, we report the early and late follow-up results of 10 patients who underwent perineal rectosigmoidectomy (Altemeier’s procedure). Ten consecutive patients who underwent perineal rectosigmoidectomy for rectal prolapse between January 2010 and September 2013 were evaluated retrospectively. All patients underwent clinical examination and colonoscopy before operation. Demographic characteristics, physical examination findings, postoperative data including early and late complications, recurrence, and mortality rates were recorded. In our study, we evaluated 10 patients who underwent Altemeier’s procedure between January 2010 and September 2013. The female:male ratio was 7:3, the median age at surgery was 68 years (26–87 years). The most frequent complaint was fecal incontinence, rectal prolapse, and mucous discharge. Hypertension was present in two patients and diabetes mellitus was present in one patient. All of the patients had fullthickness rectal prolapses at the time of the diagnosis. Surgery was performed under general or regional anesthesia. The mean length of excised rectum and sigmoid colon was 23.4 ± 0.7 cm (15–32 cm) (Table 1). Anastomotic leak was not observed in any patients. We did not observe early complications in the postoperative period. Oral intake was started on the fourth day (4–6 days), and the median length of hospital stay was six days. In three of these patients who had fecal incontinence at the time of the diagnosis, were completely resolved at the third week after operation. There were no mortalities, and the mean follow-up period was 34 months with a range of 8 to 48 months. We did not observe significant early and late complications and recurrence in our patients. More than 50 different operation procedures have been described for rectal prolapse, however none has been shown superior to others.1 Therefore, choice of surgical treatment modalities should be based on the patient characteristics such as the concomitant morbidities, age, pelvic floor abnormalities, length of prolapse, and clinical status. Treatment consists of abdominal and perineal approach, indeed both of them have advantages and disadvantages. Perineal procedures generally indicated for older patients with comorbid conditions cause high anesthesiologic risks because perineal procedures are performed under general or regional anesthesia. Altemeier and Delorme procedures are the two most commonly perineal-based procedures, the choice should be based on the extent of Address correspondence and reprint requests to Erdinç Çetinkaya, M.D., Department of Colorectal Surgery, General Surgery, Ankara Numune Education and Training Hospital, Sihhiye 06100, Ankara, Turkey. E-mail: drerdinccetinkaya@ gmail.com.

Aim intestinal obstruction is one of the most common emergent disorders in general surgery practice. Postoperative adhesions, hernias and cancers constitute the majority of cases with intestinal obstruction. However, small bowel obstruction due to an inflatable penile prosthetic device is an extremely rare condition. A 59-year-old male patient was admitted to emergency room with abdominal pain, nausea, vomiting and diarrhea. Clinical and ultrasonograpic findings were consistent with perforated appendicitis. At operation, a small bowel obstruction caused by a fibrous strand between migrated reservoir of the penile prosthesis and ileum was detected. Bridectomy without resection of bowel loop was performed for the patient. Inflatable penile prosthesis is widely used for the patient with erectile dysfunction refractory to medical treatment. Although rare, a penile prosthesis should always be kept in mind as a cause of intestinal obstruction in such cases. Therefore, these patients should be evaluated in detail preoperatively.

Although foreign bodies ingestion occurs commonly in children, it is also seen in adults with several associated factors, such as alcohol consumption, psychiatric disorders, and mental retardation [1]. Most of the ingested foreign bodies pass through the gastrointestinal (GI) tract without any problem. However, GI perforation may develop in less than 1% of these patients [2]. Furthermore, penetration of the foreign body from GI tract to the liver is a rare entity, and only few single cases have been reported in the literature [3]. A 45-year-old male patient presented to emergency room with acute abdomen findings. He had a diagnosis of schizophrenia for more than 20 years. At admission, his vital signs were normal, but more than one foreign bodies located at the middle and right upper quadrants were seen at abdominal X-ray (Figure 1). Computed tomography revealed a giant subcapsular hepatic hematoma, 10×5 cm in size, caused by a foreign body, resembling a spoon or knife, between stomach and the left lobe of liver (Figure 2A, B). There was not another organ injury. An emergent operation was planned, but the patient left the hospital without notice. Penetration of an upper GI foreign body to the abdominal organs such as liver is an extremely rare life-threatening condition, and should be kept in mind especially in patients with psychiatric disorders such as schizophrenia.