In this report, an adult patient with tubulopapillary adenoma of the common bile duct that manifested with jaundice is presented. Diagnostic challenges were analyzed. Although adenomas of the common bile duct are rare, they should be kept in mind in the differentiation of lesions of this region. It should be remembered that these lesions radiologically could mimic carcinoma and choledocholithiasis. Endoscopic resection should be considered as the primary method for treatment. Histopathology is the gold standard in diagnosis.
Colonic perforation is a well−known, lead− ing complication of colonoscopy. The in− cidence of colonic perforation ranges from 0.03 % to 0.65 % in diagnostic colo− noscopies and from 0.07 % to 2.14 % in therapeutic colonoscopies [1, 2]. A 66−year−old woman was admitted for left colonic stricture. This patient had been treated for colonic perforation al− most 1 year previously. At that time, she had been undergoing investigation by the gastroenterology department be− cause of intermittent diarrhea. Colonos− copy was otherwise unremarkable with completely normal colorectal findings. The patient developed abdominal pain, nausea, and slight abdominal distension a few hours after colonoscopy. Plain ab− dominal radiography showed free air un− der the right diaphragm. Nasogastric de− compression, intravenous fluids, and an− tibiotic treatment were immediately started. The physical examination find− ings improved gradually. The nasogastric tube was removed on day 5. A computed tomography scan was performed, which showed a normal abdominal image, and the patient was discharged on day 12.Upon her second admission 9 months la− ter, the patient declared that her bowel habits had gradually changed during the past 3 months. Colonoscopy was inten− ded, but the colonoscopy could not pass through a stricture found on the sig− moid−left colon region. Barium enema confirmed the stricture on the sigmoid junction with inadequate passage of the contrast to the proximal segments (l " Fig. 1 a). The length of the stricture segment was 2±3 cm. We considered per− forming a balloon dilatation of the short stricture; however, the patient's family did not consent to this treatment. Laparo− tomy was performed for the symptomatic colonic stricture of unknown nature. A thin, benign−looking stricture that resem− bled an anastomotic stenosis was found on the very proximal sigmoid colon (l " Fig. 1
Amaç: Laparoskopik kolesistektomi uygulanan olgularda safra kesesi hastalıklarının dağılımını belirlemek amaçlanmıştır. Hastalar ve Yöntem: Laparoskopik kolesistektomi uygulanan toplam 404 olguya ait kolesistektomi spesimeninin patolojik özellikleri tekrar gözden geçirildi. Olgulara ait lamlar ve patoloji raporları yeniden değerlendirildi. Bulgular: Üçyüz iki olgu (%74,75) kadın, 102 olgu (%25,25) ise erkekti. Olguların yaş aralığı 16-80, yaş ortalaması 47,68±12,93 idi. En çok rastlanan hastalıklar 393 olguda görülen kolelitiazis ve 363 olguda görülen kronik kolesistitti. Ksantogranulomatöz kolesistitli tek olgumuzda safra kesesi intraoperatif olarak malignite açısından kuşkulu bulunmuştur. Kırk altı olguda metaplazi, dört olguda displazi ve sadece bir olguda insidental olarak adenokarsinom belirlendi. Sonuç: Laparoskopik kolesistektomi uygulanan olgularda safra kesesinde malign tumor insidansı çok düşüktü (%0,24). Klinik olarak bulgu göstermeyen malignitelerin saptanabilmesi veya ksantogranulomatöz kolesistit gibi malignite kuşkusu oluşturan bulguların ekarte edilmesi için kolesistektomi spesimenlerinin rutin olarak, yeterli sayıda örneklerin histopatolojik incelemeye alınması gerektiği görüşündeyiz.
These results indicate that CO2 pneumoperitoneum applied with 10 and 15 mm Hg pressure gradually decreases the adrenal medulla TH activity; TH is an indispensable enzyme for the biosynthesis of catecholamines. CO2 pneumoperitoneum with 15 mm Hg pressure significantly elevated hypothalamus TH activity.
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