Radiotherapy for head and neck carcinoma (HNC) has both curative and palliative purposes. This study investigated mouthrinse aMMP-8 levels, molecular forms of MMP-8, blood neutrophil counts and neurophil/lymphocyte ratios before and 3 weeks after HNC radiotherapy started. Thirteen HNC patients undergoing radiotherapy were included. Mouthrinse samples (before and 3 weeks after HNC radiotherapy had started) were assayed quantitatively by aMMP-8 point-of-care-kit (PerioSafe®/ORALyzer®) and by western immunoblot. Total neutrophil counts and neutrophil/lymphocyte ratios were evaluated in the hemogram results. Three weeks after HNC radiotherapy started, significant increases in aMMP-8 levels and neutrophil/lymphocyte ratios were observed. No significant difference was found in total neutrophil counts. Elevations of the activated and fragmented MMP-8 levels after HNC radiotherapy application were observed on western immunoblot analysis. The increase in the aMMP-8 levels and neutrophil/lymphocyte ratios indicate inflammation both locally and systemically suggesting increased risk for periodontitis due to the HNC radiotherapy.

Calcified fibrous tumor (CFT) is a rare benign tumor of mesenchymal origin. Between 1988 and 2019, a total of 272 CFT cases were reported. CFTs can be seen in all anatomical regions with soft tissue. Histologically, mononuclear inflammatory infiltrates and the presence of psammomatous calcification in dense hyalinized collagen are characteristic features of the tumor. Currently, if the tumor is located in only one focus, surgical removal is recommended. Although CFT is a benign tumor, it may cause complications. Diagnosis is often difficult due to the confusion of tumor findings with many diseases. We present a patient with CFT, whose omental lesions were detected on abdominal computed tomography, and the diagnosis was confirmed by histopathological examination.

Amaç: Kolon anastomozu (CA) sonrası gelişen anastomoz kaçağı morbidite ve mortaliteyi artırır.Kalsiyum dobesilate (CaD) anjiyoprotektif, antioksidan, lenfatik kan akımını artırıcı ve nöroprotektif etkilere sahiptir.Bu kapiller ve hücresel sahadaki etkilerine rağmen CaD'nin

Objective: We evaluated the efficiency of 3-dimensional Computed Tomographic Angiography (3D CTA) performed with 64-channel Multidetector Computed Tomography (MDCT) to assess vascular anatomy before laparoscopic gastrectomy.Materials and Methods: 20 patients with early gastric cancer scheduled for laparoscopic gastrectomy were evaluated. Dual phase IV contrast CTA was performed before laparoscopic gastrectomy. Arterial and venous phase images were obtained after rapid infusion of contrast agent with an interval of 15 seconds serially during single breath hold of 31 seconds.Results: In all patients, 3D CTA showed Left Gastric Artery (LGA), Left Hepatic Artery (LHA), Right Gastric Artery (RGA) and Left Coronary Vein (LCV) with celiac trunk. Celiac trunk branching pattern was classified according to Michel’s method and in 18 cases, Michel’s type 1, in 2 cases Michel’s type 2 were identified. RGA was originated from Gastro Duodenal Artery (GDA) in 16 cases, from Superior Mesenteric Artery (SMA) in 2 cases and from Proper Hepatic Artery (PHA) in 2 cases. LCV was draining into Superior Mesenteric Vein (SMV) in 18 cases and into Portal Vein (PV) in 2 cases. In 12 of the cases LCV was coursing dorsal to PHA, Common Hepatic Artery (CHA) and Splenic Artery (SA), in 6 cases LCV was coursing ventral to these vessels and was joined to SMV. In 2 cases whose LCV was draining into PV, it was coursing ventral to CHA.Conclusion: Dual phase CTA is successful to define perigastric vascular structures and reduces the risk of vascular injuries when performed before laparoscopic gastrectomy.

Metastatik kolon kanserinde metastaz yerine ve sayisina gore primer cerrahi ya da neoadjuvant tedavi secenekler arasindadir. Karaciger metastazlarinda senkron cerrahi ya da iki asamali cerrahi yapilabilir. Adrenal metastaz kolorektal kanserde genellikle yaygin hastalik belirtecidir. Bu yazida on tani olarak karaciger ve adrenal metastazi olan obstruksiyona neden olmus inen kolon kanserinde cerrahi sonrasi adrenal lenfoma tanisi alan hasta sunulmustur.

A 28-year-old woman, gravida 1 para 1, presented to the obstetrics department with pelvic pain and intermittent fever. Body temperature was 38.9°C. Widespread abdominal sensitivity and rebound were observed on physical examination. C-Reactive Protein was elevated to 31.1 mg/dl and White Blood Cell count remained at 11,000/mm3. The diameter of the appendix was measured as about 8.1 cm on Computed Tomography. Diagnostic laparoscopy was performed and appendectomy was done because of acute appendicitis. Postpartum appendicitis is a very rare condition and only a few cases have been reported in the literature however acute appendicitis has to be kept in mind in the differential diagnosis.

A 28-year-old woman, gravida 1 para 1, presented to the obstetrics department with pelvic pain and intermittent fever. Body temperature was 38.9°C. Widespread abdominal sensitivity and rebound were observed on physical examination. C-Reactive Protein was elevated to 31.1 mg/dl and White Blood Cell count remained at 11,000/mm3. The diameter of the appendix was measured as about 8.1 cm on Computed Tomography. Diagnostic laparoscopy was performed and appendectomy was done because of acute appendicitis. Postpartum appendicitis is a very rare condition and only a few cases have been reported in the literature however acute appendicitis has to be kept in mind in the differential diagnosis.

Introduction Metabolically supported chemotherapy (MSCT), is defined as the application of standard chemotherapy protocols concomitant to the administration of pharmacological doses of regular insulin and the development of hypoglycemia, and following fasting starting the previous day. This study aims to present the effects of MSCT on the overall survival of locally advanced and metastatic (stage III and stage IV, respectively), or simply unresectable pancreatic adenocarcinoma patients. Material and methods This study is a retrospective analysis of a prospectively maintained database of patients. It includes all patients that applied to our clinic between July 2012 and December 2014 that were diagnosed with unresectable (stage III-IV) pancreatic adenocarcinoma. The demographic data of all the patients as well as the chemotherapy regimen received, date of treatment initiation, date of disease remission, mortality and overall survival of all patients were analyzed using SPSS 20.0. Patient follow-up was performed by means of CT and PET-CT scans. Results 33 patients, 24(73%) males and 9(27%) females, were included in our study. The majority, 27(81%) patients, had metastatic disease at the time of diagnosis and were stage IV. While 11(33%) of the patients were treated using a gemcitabine-based protocol, 13(39%) received FOLFIRINOX. 9(27%) of the patients were initially treated using gemcitabine, but began receiving FOLFIRINOX following progression as second-line chemotherapy. Statistical analysis revealed a median survival of 19.5 months and a 1-year survival rate of 82.5%. Presently, 18(54%) of the patients remain healthy and alive, free of disease progression with ECOG performance statuses ranging between Grade 0 -1. 4(22%) of these patients ultimately underwent radical pancreatic surgery: 3(17%) having undergone pancreaticoduodenectomies (Whipple procedures) and 1(5%) having undergone a distal pancreatectomy. Conclusion This study demonstrates that a metabolically supported form of applying standard chemotherapy regimens may enhance the overall survival rates of unresectable (stage III-IV) pancreatic adenocarcinoma patients.

It is known that some of the enzymes and substances secreted by 2nd and 3rd stages of the Lucilia sericata larvae to have bacteriostatic and bactericidal effects. From this point of view, we investigated the anti-leishmanial effect of larval secretions of the L. sericata on the Leishmania tropica both in vitro and in vivo conditions. In vitro: It was observed that promastigotes of L. tropica had undergone lyzis within 1 min in the larval secretions of L. sericata. However, larval secretion was ineffective on the promastigotes within Novy-MacNeal-Nicolle (NNN) cultures and RPMI 1640 medium. In vivo: Seven groups of male Balb/C mice (6 study groups and 1 control group), each composed of eight weeks old 10 mice were formed. L. tropica promastigotes were injected subcutaneosly to the soles of the SG mice' feet. In study groups, cutaneous lesions were developed Limoncu et al., 1997 in 2 (20%) and 1 (10%) of the SG-1 and SG-2, respectively after 15 days. There were L. tropica in the smears prepared from the lesions and L. tropica was observed in the cultures. Cutaneous lesions were not developed in 8 (80%), 9 (90%) and 10 (100%) of the SG-I, SG-II and SG-III, respectively. There were no cutaneous lesions developed in the soles of the feet. There were no L. tropica in the smears prepared from the infected soles of the feet neither L. tropica was observed in the cultures. Larval secretions were given into the cutaneous lesions to the feet soles of the SG-IV, V and VI mice after 6 months. No healing was observed in the cutaneos lesions of 4 (40%), 5 (50%) and 1 (10%) of SG-IV, SG-V and SG-VI, after 6 months, respectively. There were L. tropica in the smears prepared from the lesions and L. tropica was observed in the cultures. On the other hand, the lesions of 6 (60%), 5 (50%) and 9 (90%) of SG-IV, SG-V and SG-VI were diminished in size and disappeared completely after 6 months. There were L. tropica observed in the smears prepared from the infected soles of the feet and no growth was observed in the cultures. In the smears prepared from the cutaneous lesions developed in the soles of the feet of the control group mice, L. tropica was visualized and observed in the cultures. A statistical significant difference was observed between study groups and control group (p<0.001). In our study we demonstrated for the first time that the secretions of the 2nd and 3rd stages sterile and pure larvae of L. sericata had effects on promastigotes of L. tropica in in vitro and very effective on amastigote forms in in vivo conditions.

With the advent of single-port laparoscopy, the spectrum of abdominal surgeries performed is widening. The retraction of the left lobe of the liver in the upper gastrointestinal procedures is a critical maneuver with its added possible complications. In our study, we used the Cerrahpasa retractor (trademark pending by E. Eyuboglu and T. Ipek) for the retraction of the left liver in 22 patients with a different concept other than using the suturing or silk lace techniques described in previous studies. In our technique, the potential of tearing the liver or other anatomical structures is minimal. We believe that, with the aid of our Cerrahpasa retractor, the problem of liver retraction is being solved by a simple and safe technique.

BACKGROUND/AIMS:Since its original description in 1956 by Rudolph Nissen, minor changes were made in technical details of Nissen fundoplication. After the introduction of laparoscopic fundoplication, in order to reduce the rate of complications, some technical modifications led to the development of 'floppy' Nissen fundoplication.METHODOLOGY:From August 1993 to August 2009, laparoscopic Nissen fundoplication was performed on 2100 patients, 17 of whom underwent classical and 2083 underwent floppy fundoplication. All the operations were performed by the same surgical team. Preoperative work-up included 24-h pH monitoring, esophagogastroduodenoscopy and barium cineradiography. Esophageal manometry was not performed due to the physical impossibility of this tool at our clinic. Key steps of the operation were dissection of the hepatogastric and Laimer's ligament, dissection and closure of the hiatus, and short, floppy Nissen fundoplication. Phrenoesophageal ligament was divided to obtain at least of 4cm of an abdominal esophagus.RESULTS:On the follow-up, dysphagia lasted for 1 month in 5.2% (110), between 1-3 months in 0.7% (16) and more than 3 months in 0.1% (3) of patients. Mortality was seen in 1 (0.05%) patient, and it was related to fatal pulmonary vein injury during perioperative bougienage.CONCLUSIONS:Laparoscopic floppy Nissen fundoplication seems to be a safe and feasible technique for surgical treatment of gastroesophageal reflux disease.

Yazılar, çift satır aralıklı, alt-

Isolated abdominal wall actinomycosis in the presence of an intrauterine contraceptive device (IUCD) is extremely rare and only six such cases have been reported in the literature. We report a case where clinical and radiological examinations revealed a pseudotumor within the anterior abdominal wall. After being lost to follow-up, the patient presented two years later with the enlargement of the mass. The mass including the affected anterior abdominal wall was completely excised. The diagnosis of actinomycosis was established postoperatively by histopathological examination. Further questioning concerning her gynecological history revealed long-term use of the same IUCD. Surgical excision of the actinomycotic pseudotumour and removal of the IUCD followed by antibiotic therapy resulted in the full recovery of the patient.

BACKGROUND The division of the short gastric vessels (SGVs) is a common practice during laparoscopic floppy Nissen fundoplication (NF) to achieve an adequate mobilization of the gastric fundus. However, the terminal branches of splenic vessels can also be ligated during SGV division, resulting in splenic infarction (SI). The aim of this study was to evaluate our results with SI as a complication of laparoscopic floppy NF. MATERIALS AND METHODS All patients with direct laparoscopic evidence of SI during laparoscopic floppy NF, between August 1993 and August 2009 and under the care of two surgeons, were included in this retrospective study. RESULTS Over the past 16-year period, 2100 patients underwent laparoscopic floppy NF, and splenic infarction was demonstrated in 20 cases (0.95%). There were 11 women (55%) and 9 men (45%), with a mean age of 35.2 years (range, 25-68). The classic pattern, in all cases, was a small area of infarction, less than 10-15% of the total splenic volume, localized mainly in the upper pole. There were no conversions. The mean length of hospital stay was 1.2 days (range, 1-2). During the follow-up period of 3 months, only 2 patients (10%) had persistent abdominal pain, in which computed tomography demonstrated the infarcted areas involving less than 15% of the splenic parenchyma. All cases were managed succesfully with observation alone. CONCLUSIONS Based on the results, partial SI is a recognizable condition during laparoscopic floppy NF. Conservative therapy and close follow-up, without any unnecessary intervention, is an appropriate management that provides a favorable outcome.

The aim of using chemotherapy for inactivating protoscoleces is to prevent dissemination. The most suitable way to apply chemotherapy is to inject killing substances directly to the hydatid cysts protoscoleces. We performed our experiments with 95% live hydatid cyst protoscoleces. In in-vivo experiments, in survey group mice, no hydatid cyst was observed in the first and second group which 1 g/L and 100 mu g/ml albendazole was added to their waters, respectively and in the third group, 1/10 povidone-iodine was added for 30 min during the 6 months. All of the above groups were given 4 - 6 live hydatid cyst protoscoleces. However, hydatid cysts were developed in the control group mice in the 87th day. In in-vitro studies; all of the hydatid cysts pre-treated with 1/10 povidone-iodine and 100 mu g/ml albendazole lost their viability after 15 min and the viability of the hydatid cysts, which were kept at room temperature were not lost.