Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign lesion that can present as a palpable nodule or as an incidental finding in breast biopsies. The development of PASH is subject to hormonal influence and is most commonly seen in premenopausal woman. Imaging findings are indistinguishable from those of the more common type of fibroadenoma, and they are categorized as BIRADS type 3 lesions (probably benign lesions). Their benign condition and behavior compared with other similar cases, allows the recommendation that surgical excision be avoided, and the patients monitored with periodic follow-up. Here we report a case of PASH presenting in a 41-years-old woman who had breast mass which was sent for intra-operative frozen-section procedure by surgery to our pathology laboratory.

Herniation of the urinary bladder into the inguinal canal is rare. It constitutes 1-3% of all inguinal hernias. Bladder herniation is usually asymptomatic, and it is usually diagnosed during surgery or as a result of intra-operative bladder injury. Male patients with lower urinary tract symptoms or with a history of previous hernia surgery are at increased risk of bladder herniation. Typically, patients complain of inguinal or scrotal swelling, dysuria and shrinkage of scrotal swelling after voiding. Early diagnosis with radiological imaging is important to prevent complications during surgery. Intravenous pyelography, retrograde cystography, pelvic ultrasound, computed tomography and magnetic resonance imaging can be used for preoperative diagnosis. In this report, a patient is presented who presented to our clinic with scrotal swelling and was diagnosed with scrotal bladder herniation by retrograde cystography, taken due to clinical suspicion based on his history.

BackgroundPlanned re-laparotomies are a series of surgical interventions that are rarely used and have a high mortality rate. The aim of this study was to investigate the factors affecting mortality and the effectiveness of the use of the Bogota bag for temporary closure of the abdomen in patients for whom re-laparotomy was planned.Material/MethodsA retrospective examination was made of data of patients in whom a Bogota bag was used in planned re-laparotomies for various reasons in the General Surgery Department of Suleyman Demirel University Medical Faculty between June 2008 and April 2014.ResultsBogota bags were used in a total of 38 patients, comprising 23 (60.5%) males and 15 (39.5%) females, with a mean age of 58.94±17.89 years. The mean period of hospitalization was 14.5 days (range, 1–143 days) and the mean number of operations during that time was 3 (range, 1–11). The mean duration of intensive care unit stay was 6 days (range, 1–143 days). Malignancy was determined in 8 patients (21.1%). Indications were intra-abdominal sepsis in 23 patients (60.5%), mesenteric vascular disease in 10 patients (26.3%), and packing was required in 5 patients (13.2%). Mortality developed in 25 patients (65.8%). A significant relationship was determined between mortality and a diagnosis of mesenteric artery ischemia (p: 0.035). The mortality rate was 56% (n: 13) in patients diagnosed with intra-abdominal sepsis. A relationship was determined between mortality and age (p: 0.015), duration of hospital stay (p: 0.007), need for cardiac inotrope (p: 0.01), and need for mechanical ventilation (p: 0.01). The mean Apache II score was 26.4±5 for patients who died and 15.8±5.2 for surviving patients (p<0.001). In 5 (38.4%) of the 13 surviving patients, primary repair was applied to the abdomen, and in the remaining 8 patients abdominal wall repair was performed using dual mesh.ConclusionsIn patients in whom a Bogota bag was used, which is a cheap and easy method for temporary closure of the abdomen, the high mortality rates seen are related to diagnosis, Apache II score, age, and organ failure.

Background and Aim. The aim of this study was to investigate the effects of demographic characteristics, biochemical parameters, amount of blood transfusion, and trauma scores on morbidity in patients with solid organ injury following trauma. Material and Method. One hundred nine patients with solid organ injury due to abdominal trauma during January 2005 and October 2015 were examined retrospectively in the General Surgery Department of Dicle University Medical Faculty. Patients' age, gender, trauma interval time, vital status (heart rate, arterial tension, and respiratory rate), hematocrit (HCT) value, serum area aminotransferase (ALT) and aspartate aminotransferase (AST) values, presence of free abdominal fluid in USG, trauma mechanism, extra-abdominal system injuries, injured solid organs and their number, degree of injury in abdominal CT, number of blood transfusions, duration of hospital stay, time of operation (for those undergoing operation), trauma scores (ISS, RTS, Glasgow coma scale, and TRISS), and causes of morbidity and mortality were examined. In posttraumatic follow-up period, intra-abdominal hematoma infection, emboli, catheter infection, and deep vein thrombosis were monitored as factors of morbidity. Results. One hundred nine patients were followed up and treated due to isolated solid organ injury following abdominal trauma. There were 81 males (74.3%) and 28 females (25.7%), and the mean age was 37.6 ± 18.28 (15–78) years. When examining the mechanism of abdominal trauma in patients, the following results were obtained: 58 (53.3%) traffic accidents (22 out-vehicle and 36 in-vehicle), 27 (24.7%) falling from a height, 14 (12.9%) assaults, 5 (4.5%) sharp object injuries, and 5 (4.5%) gunshot injuries. When evaluating 69 liver injuries scaled by CT the following was detected: 14 (20.3%) of grade I, 32 (46.4%) of grade II, 22 (31.8%) of grade III, and 1 (1.5%) of grade IV. In 63 spleen injuries scaled by CT the following was present: grade I in 21 (33.3%), grade II in 27 (42.9%), grade III in 11 (17.5%), and grade IV in 4 (6.3%). The mean length of hospital stay after trauma was 6.46 days in the medically followed patients. This ratio was 8.13 days in 22 patients with morbidity and 5.98 days in 78 patients without morbidity. There was a morbidity in 22 (22%) patients medically followed after trauma. In this study, nonoperative treatment was observed to be performed safely in solid organ injuries after trauma in case of absence of hemodynamic stability and peritoneal irritation. It has been emphasized that injury of both liver and spleen (p < 0.01), high respiratory rate (p < 0.01), trauma scores (GKS, ISS, RTS) (p < 0.0001), and elevation of ALT AST values (p < 0.01) are stimulants for morbidity that may occur during follow-up. Conclusion. Medical follow-up can be considered in patients with high grade injuries similar to patients with low-grade solid organ injury after trauma. The injury of both liver and spleen, high respiratory rate, high GCS and ISS, low RTS, and elevation of ALT AST values w...

ÖZETAmaç: Mide kanseri Avrupa'da kadınlarda ve erkeklerde görülme sıklığı açısından beşinci sırada yer almaktadır. Erkek kadın oranı ise 1.6:1 olarak belirlenmiştir. Mide kanseri, kansere bağlı ölümlerde ülkemizde erkeklerde ikinci, kadınlarda ise üçüncü sırada yer almaktadır. Mide kanserinin prognozu genellikle kötüdür. Bunun sebebi de tanıda gecikme ve tanı konan olguların ileri evrede olmasıdır. Gereç ve Yöntemler: Süleyman Demirel Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı 1995 -2009 yılları arasında mide kanseri tanısı ile cerrahi işlem yapılan 204 olgu geriye dönük olarak incelendi. Bu olgulardan 131'ine küratif cerrahi rezeksiyon yapıldığı belirlendi. Olguların %80'i lokal ileri evre olgulardı (evre IIIa, IIIb ve IV). Olguların yaş, cinsiyet, başvuru semptomları, tümör lokalizasyonu, T, N, M, evre, tümör diferansiyasyonu, histolojik tipleri, tümör çapı, vasküler ve perinöral invazyon varlığı, yapılan cerrahi işlem, rezeksiyon tipi, diseksiyon tipi, diseke edilen toplam lenf nodu sayısı, metastatik lenf nodu varlığı, metastatik lenf nodu sayısı ve toplam lenf nodu sayısına oranı, komplikasyonlar, cerrahi mortalite, adjuvan kemoterapi, adjuvan radyoterapi ve diğer adjuvan tedavileri ve sağkalım süreleri belirlendi. Bu verilerin sağkalım üzerine etkileri lojistik regresyon analizi ile değerlendirildi. Sağkalım açısından 3 ve 5 yıllık sağkalım eğrileri Kaplan-Meier yöntemiyle çıkarıldı Bulgular: Küratif rezeksiyon ve diseksiyon yapılan 131 olguda morbidite %15.2, mortalite ise %7.6 idi. Evre ve metastatik lenf nodlarının toplam lenf nodu sayısına oranı sağkalım üzerinde en önemli faktörler olarak bulundu (p<0.05). Evrelere göre sağkalımda 5 yıllık sağkalım oranlarının evre Ia için %79.1, Ib için %78.3, II için %61.8, IIIa için %46, IIIb için %24.8 ve IV için %25.8 olduğu görüldü. Sonuç: Sonuç olarak olgularımızın çoğunun lokal ileri evre olgular olmasına karşın yapılan radikal cerrahi işlemlerden fayda gördüğü ve sağkalım oranlarının bu anlamda olumlu olduğunu söylemek mümkündür. ABSTRACTObjective: Gastric cancer is the fifth most commen neoplasm in terms of incidence in men and women in Europa. Male to female ratio was determined as 1.6:1. Gastric cancer is the second most commen neoplasm in men and third most commen neoplasm in female in deaths due to cancer in our country. Prognosis of gastric cancer is generally reserved. The low survival rate is due to the delay in diagnosis, most cases being diagnosed in an advanced stage. Material and Methods: Between 1995 and 2009, 204 gastric cancer patients were retrospectively evaluated who was treated surgically in Faculty of Medicine, Suleyman Demirel University. It was observed that tumors of the 131 patients were curatively resected. The great portion (80%) of these patients were in locally advanced stages (stage IIIa, IIIb and IV). Age, gender, symptoms, tumor localisation, T, N, M, stage, tumor differantiation, histologic type, occurence of vascular and perineural invasion, surgery type, resection type, dissection type, count of dissected lymph n...