Amaç 2013-2018 yılları arasında Gülhane Eğitim ve Araştırma Hastanesi Genel Cerrahi ABD'de opere edilen hastaların sonuçları ve klinik deneyimimizi irdeledik. Çalışmamızda benign ve malign adrenal gland bezi hastalıkları nedeni ile Laparaskopik adrenektomi uygulanan hastalar ile açık cerrahi uygulanan hastaların sonuçlarını ortaya koymayı amaçladık. Gereç ve Yöntem Adrenal Gland kitlesi nedeni ile opere edilen 44 hastanın retrospektif olarak verilerinin sunulduğu bir çalışmadır. Hastaları yaş, cinsiyet, adrenal kitle büyüklüğü, preoperatif teşhis, operasyon şekli, final histopatoloji açısından değerlendirdik. Sonuç Adrenal gland kanseri nedeniyle ameliyat edilen 28'i erkek 16'sı kadın toplam 44 hasta sunulmuştur. Hastaların yaşları 20-83 arasında değişmekte olup yaş ortalaması 45.2 ±11.7'dir. Bu şekilde 44 hastanın 30'unda (%68,18) LA, 14'ünde (%31,82) ise AA yapılmıştır. Histopatolojik incelemelerine göre değerlendirildiğinde adrenal gland kitlelerinin 33'ü (%75) AKA, NFA, adrenal cyst, Feo gibi benign hastalık iken 11'inde (%25) AKK veya metastatik adrenal gland kanseri tespit edilmiştir. Malign patolojiler nedeniyle adrenalektomi yapılan 11 hastanın 6'sı başka organ-ların kanserine ait metastaz, 5'i ise primer AKK idi. Hastaların postoperatif dönemde hastanede yatış süresi 2-11 gün arasında değişmekte olup ortalama yatış süresi 3.3±2.5 gün olarak tespit edilmiştir. Sonuç Adrenal insidentalomalar % 1-4 oranında abdominal görüntüleme çalışmalarında ortaya konulabilmektedir ve yaş ile birlikte adrenal insidentolomların görülme riski artmaktadır. Cerrahi sürrenalektominin endikasyonları çoğunlukla non fonksiyone adenomalarveya diğer benign adrenal bez tümörleridir. Buna karşın AKK veya metastatik adrenal gland tümörleri daha az görülmektedir. Bunların rekürrens oranları daha yüksektir ve kötü prognostik seyire sahiptirler. AKK ve metastatik tümörlerin cerrahisi açık cerrahi veya bazı karşıt görüşler olmasına rağmen lalaraskopik olarak yapılabilmektedir.
Amyand herni, inguinal herni kesesi içinde normal veya enflame apendiksin bulunduğu nadir bir durumdur. Amyand herninin sıklığı tüm inguinal herni olguları içerisinde yaklaşık %1'dir. İnguinal herni kesesi içerisinde apendiks vermiformis varlığı ilk kez 1735 yılında Claudius Amyand tarafından tanımlanmıştır. Amyand herni tanısı genellikle intraoperatif olarak konulmaktadır. Ayrıca Amyand hernisi tedavi modaliteleri günümüzde halen tartışma konusu olmaktadır. Bu olguda Amyand herni ve akut apandisit tanısı alan, ameliyat edilen 64 yaşında erkek hasta ve literatür bilgileri sunulmaktadır Amyand hernia is a rare condition in which a normal or inflamed appendix is present in the inguinal hernia sac. The incidence of amyand hernia is about 1% of all inguinal hernia cases. The presence of appendix vermiformis in the inguinal hernia sac was first described by Claudius Amyand in 1735. Amyand hernia diagnosis is usually made intraoperatively. Amyand hernia treatment modalities are still controversial today. In this case, we present a 64year-old male patient who was diagnosed with Amyand's hernia and acute appendicitis in the preoperative period.
The main method of fighting against colon cancer is targeted treatment. BRAF inhibitors, which are accepted as standard treatment for V600E mutant malign melanomas, are the newest approach for targeted treatment of V600E mutant colorectal cancers. In this case report, we share our experience about the use of BRAF inhibitor vemurafenib on a V600E mutant metastatic right colon adenocarcinoma patient. A 59-year-old male with only lung multiple metastatic V600E mutant right colon cancer presented to our clinic. The patient was evaluated and FOLFOX + bevacizumab treatment was initiated, which was then continued with vemurafenib. A remarkable response was achieved with vemurafenib treatment in which the drug resistance occurred approximately in the sixth month. Even though the patient benefited majorly from vemurafenib, he died on the 20th month of the diagnosis. The expected overall survival for metastatic V600E mutant colon adenocarcinoma patients is 4.7 months. BRAF inhibitors provide new treatment alternatives for V600E mutant colorectal cancers, with prolonged overall survival. BRAF inhibitors in combination with MEK inhibitors are reported as feasible treatment to overcome BRAF inhibitor drug resistance on which phase studies are still in progress. To conclude, BRAF inhibitors alone or in combination with other drugs provide a chance for curing BRAF V600E mutant colorectal cancer patients.
The incidence of cysts of the biliary system is approximately 1 in 100,000 to 150,000 in Western populations. The pathophysiology of biliary tree cysts is believed to be a result of an anomalous pancreaticobiliary junction. Although surgery is the preferred treatment for biliary tree cysts, surgical resection of the cyst does not eliminate the risk of malignancy, but rather it reduces the risk. The main goal of surgery is complete resection of the cyst and reconstruction of the biliary tree. In addition to the complexity of the procedure, variations of the biliary tree and the hepatic hilum luminal structures make the surgery more difficult for the surgeon. In this report, the case of a 46-year-old male patient is described. He presented at the clinic with a previously diagnosed choledocal cyst of Todani class 1 and a history of peptic ulcer perforation surgery. Further evaluation verified a choledocal cyst measuring 6x4 cm. Robotic complete surgical resection of the cyst and reconstruction of the biliary tree with hepaticojejunostomy was performed. During the bladder dissection, a luminal structure localized near Calot's triangle was observed and determined to be the left hepatic artery coursing over the anteromedial gall bladder and entering the liver at the level of the bladder fundus. The cyst and gall bladder were dissected while preserving the left hepatic artery. In conclusion, a minimally invasive approach for choledocal cyst resection should be performed at experienced centers because of frequent variations in both the hepatic arterial system and the biliary tract.
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