OBJECTIVE:Acute appendicitis is one of the most common acute surgical pathology we encountered. In this study we investigated our pregnant cases of appendicitis, and reviewed literature.METHODS:A total of 21 pregnant women who underwent appendectomy with the initial diagnosis of acute appendicitis in Istanbul Medeniyet University Clinics of General Surgery between January 2012, and December 2014 were retrospectively analyzed. The patients’s ages, trimesters, complaints, abdominal examination, laboratory, and ultrasonographic findings, surgical techniques, complications and hospital stay were noted.RESULTS:The patients were in their first (n=12; 57.1%), second (n=5; 23.8%), and third trimesters (n=4; 19.0%) of their pregnancies Median age was 23.9 years. All of the patients had abdominal pain. Median value of WBC count was 13.297/mm³. Ultrasound was positive in 12 patients (57.1%). In 14 (66.6%) patients McBurney incision, and in 6 (28.6%) cases right paramedian incision were used. One patient (4.8%) underwent laparoscopic appendectomy. Nineteen cases were acute appendicitis (90.5%), and two cases were perforated appendicitis (9.5%). Average hospital stay was 3.8 days. Two cases with perforated acute appendicitis developed wound infection and treated conservatively. There were no fetomaternal mortality.CONCLUSION:Physiologically anatomic and biochemical changes occurring during pregnancy can delay the diagnosis of acute appendicitis threaten the lives of both the mother and the fetus Therefore, rapid diagnosis and appropriate treatment convey importance.
OBJECTIVES: We aimed to analyze the factors that affect the axillary lymph node involvement in Turkish breast cancer patients with clinically non-palpable axillary lymph node. BACKGROUND: Sentinel lymph node biopsy is the gold standard technique to evaluate the axillary lymph node status that directly infl uences the prognosis and the treatment options in breast cancer. METHODS: Breast cancer patients without axillary lymph node involvement in clinic examination were enrolled the study. Patients were categorized into the two groups according to existence of axillary lymph node metastasis or not. Demographic, histopathological and clinical data of patients were revealed retrospectively. RESULTS: One-hundred and eighty-seven patients were analyzed and 101 of patients fulfi lled the criteria and were included the study. Metastatic lymph node was detected in 38 (37.6 %) patients (Group 1), and was negative in 63 (62.4 %) patients (Group 2). Sentinel lymph node metastasis were statistically signifi cant higher in patients with Ki-67 ≥ 14 % than patients with Ki-67 < 14 % (51.9 % vs 22.4 %; p < 0.01). Likewise, the mean size of the sentinel lymph node was statistically signifi cant higher in Group 1 compared to Group 2 (p < 0.01). CONCLUSION: Ki-67 proliferation index and sentinel lymph node size may provide a higher prediction about the sentinel lymph node involvement in patients with clinically negative axillary lymph nodes (Tab.
Background/aim: Microcalcifications are generally accepted as highly specific for thyroid malignancy, especially for papillary thyroid carcinoma (PTC). The aim of this study was to determine the significance of microcalcification within nodules that were classified as being of "indeterminate cytology" (IC) according to fine-needle aspiration biopsy. Materials and methods:Patients who underwent thyroidectomy between January 2010 and 2013 were included in the study. Nodules identified as "atypia/follicular lesion of undetermined significance", "follicular neoplasm/suspicious for follicular neoplasm", or "suspicious for malignancy" were categorized as IC. Patients were subcategorized depending on the presence of microcalcification (Group 1) or its absence (Group 2). The relationship between microcalcification and PTC was evaluated in the IC group retrospectively.Results: Indeterminate cytology was detected in 135 (28.5%) of 473 patients. Microcalcification was detected in 27 (20%) of 135 nodules and classified as Group 1, while the remaining 108 (80%) patients were classified as Group 2. According to the final pathology results, PTC was diagnosed in 13 of 27 (48.1%) patients in Group 1 and 29 of 108 (26.8%) patients in Group 2. A statistically significant relation between microcalcification and malignancy was determined in the IC group (P < 0.05). Conclusion:Surgery might be considered primarily for patients harboring nodule(s) with IC accompanied by microcalcification due to increased risk of PTC.
ÖZETLipomlar erişkinlerde adipöz dokunun en sık görülen benign tümörleridir. Vücudun heryerinde görülebilmekle beraber, karın içinde özellikle de preperitoneal bölgede nadiren saptanmaktadırlar. Genel olarak farklı patolojiler için yapılan inceleme ve ameliyat esnasında rastlantısal olarak tespit edilmelerine rağmen çok nadir olarak da lipomun kendisi akut karını taklit eden patolojilere yol açabilmektedir. Bu yazıda, akut apandisiti taklit eden bulgularla acile başvuran ve laparaskopik eksplorasyonda karın sağ alt kadranda preperitoneal yerleşimli torsiyone olmuş saplı lipom saptanan 35 yaşındaki kadın hasta literatür eşliğinde sunuldu.Anahtar sözcükler: Akut karın; karın duvarı lipomu; minimal invaziv cerrahi. GİRİŞLipomlar yağ dokusunun iyi diferansiye, kapsüllü mezenkimal tümörleridir. Klinik olarak en sık 40-60 yaş arasında bulgu verirler. Soliter veya multiple olabilen lipomlar vücudun çeşit-li bölgelerinde, nadiren de karın içinde bulunabilmektedirler. [1][2][3][4] Gastrointestinal sistemde lipomlar submukoza veya subserozal bölgede yerleşerek intusepsiyona yol açabilirler. Preperitoneal bölge saplı lipomu ise çok nadir görülmekte olup, literatürde torsiyon nedeniyle akut karın bulgusu oluşturan sadece dört vaka bildirilmiştir. [5][6][7][8] Bu yazıda, karın sağ alt kadranda akut apandisiti taklit eden karın ağrısı bulguları ile acil servise başvuran ve tanısal laparaskopi sonucu karın sağ alt kadranda preperitoneal saplı lipom torsiyonu saptanan hasta sunuldu. OLGU SUNUMU OLGU SUNUMUOtuz beş yaşında kadın hasta, yaklaşık iki gün önce başlayan karın sağ alt kadran ağrısının artması üzerine acil polikliniği-mize başvurdu. Özgeçmişinde özellik olmayan hastanın muayenesinde akut apandisit ile uyumlu olacak şekilde karın sağ alt kadranda hassasiyet ve rebound saptandı. Kan tahlillerinde WBC: 13.300 K/mm 3 , CRP: 4 mg/dl olarak tespit edildi. Yapı-lan karın ultrasonografisinde sağ alt kadranda, çekuma yapışık ve sınırları net ayırt edilemeyen, yaklaşık 4x2 cm boyutunda, nekroze lipom ile uyumlu lezyon saptandı. Hastaya akut karın ön tanısı ile diyagnostik laparaskopi kararı alındı. Göbekten yapılan insizyondan karbondioksit insüflasyonu sonrası 10 mm'lik trokar ile batına girildi. Eksplorasyonda karın sağ alt kadranda omentum tarafından sarılmış, çekum ön duvarına yapışık, ince bir sap ile karın ön duvar peritonuna asılı olduğu gözlenen, yüzeyi düzgün, kapsüllü, yaklaşık 4x2 cm'lik enflame ve ödemli kitle lezyonu tespit edildi (Şekil 1a, b). Suprapubik bölgeden 5 mm'lik ikinci bir trokar girildi. Kitlenin çekum ön duvarına yapıştığı ve burada enflamasyona yol açtığı görüldü. Paraçekal bölgede yaklaşık 40 cc reaksiyonel mayi saptanarak aspire edildi. Grasper yardımıyla kitlenin omentum ve çe-kumla olan yapışıklıkları ayrıştırıldı. Kitlenin karın ön duvarı peritonuna tutunduğu ince sapın etrafında dönerek torsiyone olduğu ve gangren geliştiği görüldü. Laparaskopik makas ile lezyonun sap kısmı koterize edilerek kesildi. 5 mm'lik teleskop ile suprapubik trokardan girildi ve lezyon 10 mm'lik trokardan endobag yardım...
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