AMAÇLiteratürde, yaşlılarda akut apandisitin özellikleri bazı ça-lışmalarda tarif edilmiştir, ancak skorlama sistemlerinin uygulanabilirliğini değerlendiren bir çalışma yoktur. Bu çalışmanın amacı 65 yaşından yaşlı hastalarda Alvarado ve Lintula skorlarını karşılaştırmaktır. GEREÇ VE YÖNTEMTanısı patolojik inceleme ile kesinleşmiş 65 yaşından yaş-lı hastalar, büyük acil polikliniğine başvuruları sonucunda spesifik olmayan karın ağrısı tanısı almış aynı yaş grubundaki hastalarla başvuru yılına göre sınıflandırılarak karşı-laştırıldı. Alvarado ve Lintula skorları hasta dosyalarından retrospektif olarak hesaplandı. BULGULARHer iki skorlama metodu da apandisite bağlı karın ağrısı ve spesifik olmayan karın ayrısını ayırt etmede başarılı bulundu. Alvarado skoru, Lintula skoruna göre öngörme özelliği açısından üstündü. Kontrol ve apandisit gruplarında iki parametrenin (tınlayıcı, tiz bağırsak sesleri olması veya bağır-sak seslerinin alınamaması ve bulantı) prevalansı benzerdi. İki skor, bu iki parametre olmadan tekrar hesaplandı. Dü-zenleme sonrası iki skorda daha iyi ve birbirlerine daha çok benzer sonuçlar verdi. SONUÇGeriatrik yaş grubunda hem Alvarado hem de Lintula skorlarının akut apandisitin tanısında yüksek sensitivite ve spesifitesi vardır. Bu skorların performansları "bulantı" ve "tınlayıcı, tiz bağırsak sesleri olması veya bağırsak seslerinin alınamaması" parametreleri çıkartıldığında daha iyi hale gelmektedir.Anahtar Sözcükler: Akut apandisit; Alvarado skoru; yaşlı; Lintula skoru.

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BackgroundThe role of methylation status of the thyroid stimulating hormone receptor gene (TSHr) in the discrimination of benign and malignant thyroid nodules has already been studied using paraffin blocks and cell lines. As cytological sampling plays an important role in assessment of thyroidal nodules, we have investigated the potential clinical use of TSHr methylation status of fine needle aspiration specimens reported according to Bethesda System.MethodSixty nine patients who had both cytological and pathological diagnosis of the same nodule were selected. Four groups were composed according to cytological and pathological diagnoses: Benign (B), papillary thyroid carcinoma (PTC), atypia of unknown significance (AUS) and follicular neoplasia (FN). The latter 2 groups were further sub-classified into 2 as benign (AUS-B and FN-B) and malignant (AUS-M and FN-M) according to final pathological diagnosis. DNAs were isolated from the fine needle aspiration cytology specimens and the methylation status of TSHr promotor region was investigated by using methylation specific polymerase chain reaction.ResultsOverall, TSHr methylation was present in 58 % of cases; 71 % of malignant and 46 % of benign nodules. PTC group showed the highest TSHr methylation rate (87 %), followed by 61 % in AUS, 44 % in B, and 30 % in FN (p = 0.016). TSHr methylation rate was significantly higher in PTC group when compared to B (p = 0.013) and FN-B (p = 0.004) groups; but not in FN-M (p = 0.115) or AUS (p = 0.096) groups. All 9 cases of papillary thyroid carcinoma with lymph node metastasis showed TSHr methylation. Positive predictive value, negative predictive value, sensitivity and specificity of TSHr methylation in determination of malignancy were calculated as 60, 66, 71 and 54 %, respectively.ConclusionThe eminent ratio of TSHr methylation in well-differentiated thyroid carcinoma against benign thyroidal nodules adduced that TSHr methylation status can be utilized as a tumor marker for well-differentiated thyroid cancer; however, it has a limited value. The determination of methylation status of TSHr gene had no efficiency on decision of the malignant potential for the nodules which are cytologically classified as atypia of undetermined significance.

Antral gastric vascular ectasia is a rare cause of chronic anemia. When encountered, the diagnosis is usually delayed. Endoscopic findings are well established, although radiologic findings are not. Patients respond well to surgery. Our case was of a 62-year-old female with chronic anemia who required multiple blood transfusions and iron replacement therapy, without significant response. Computed tomography revealed a focal thickening of the gastric antrum. Endoscopy showed vascular ectasia between the antrum and corpus. The patient underwent gastrectomy. We reviewed the literature on gastric angiodysplasia and have presented our unique tomography findings in this first report on a novel association between ectopic pancreas and gastric angiodysplasia.

Internal biliary fistula is a rare complication of a common surgical disease, cholelithiasis. It is seen in 0.74% of all biliary tract surgeries and is thought to be a result of repeated inflammatory periods of the gallbladder. In this report we present a case of incomplete cholecystogastric and cholecystoduodenal fistulae in a single patient missed by ultrasonography and endoscopic retrograde cholangiopancreatography and diagnosed intraoperatively. In the literature there is only one report of an incomplete cholecystogastric fistula. To our knowledge this is the first case of double incomplete internal biliary fistulae.