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Aim: Anastomotic leakage in colon anastomosis (CA) increases morbidity and mortality. Calcium dobesilate (CaD) has angioprotective, antioxidant, lymphatic flow enhancing-and neuroprotective effects. Despite these capillary and cellular effects, there is no data in the literature regarding the effects of CaD on CA healing. Method: Fifty Wistar-albino rats were randomly divided into five groups. All rats underwent CA after transverse colon transection. CaD was not administered to the control group (Group 1). CaD was administered to the experimental groups (Groups 2, 3, 4 and 5) intraperitoneally or by gavage at doses of 50 or 100 mg/kg/day. CaD was given as a single dose daily during postoperative five days. Bursting pressure values (BPV) and hydroxyproline values (HV) were measured. At the end of histopathological evaluation, polymorphonuclear leukocytes (PNLS), mononuclear leukocytes (MNLS), neovascularization (VS) and collagen fibers (CFS) were scored. Results: CaD increased BPV and HV in experimental groups. We found a decrease in PNLS, MNLS, VS, and an increase in CFS in experimental groups. These increases seemed to be related to the administration doses of CaD. The decreases in PNLS, MNLS and VS were much more evident in Groups 4 and 5 than the other groups. There was no significant difference in terms of VS between experimental groups. Conclusion: We found that CaD not only decreased the pathological parameters of inflammation, but also increased the strength of CA mechanically and biochemically. Although VS reduction seemed to have negative outcomes on CA, we know that CaD inhibits over-expression in angiogenesis. As a result, these effects of CaD appear to be dose-dependent rather than the administration methods.

Lipomas are benign soft tissue tumours that can occur anywhere on the body and are rarely encountered on the chest. The pathophysiology between soft tissue trauma and lipoma development is not fully understood, and various theories have been presented. We present the case of a violinist with a 40-year occupational history who presented with swelling of the left upper chest wall. The microscopic sample of the resected lipoma showed inflammatory cells with fat necrosis, which are features thought to be involved in the development of a lipoma following soft tissue trauma.

Summary Background Liposarcoma is a common soft tissue neoplasm but its presence within the gastrointestinal system, especially the esophagus, is quite rare. It usually presents as an intraluminal or an intramural mass, with symptoms such as dysphagia and throat discomfort. Liposarcoma must be differentiated from benign tumors of the esophagus and managed appropriately. Case presentation In this report, we present the case of a 26-year-old woman who complained of dysphagia to liquids and solids and vague abdominal discomfort. The radiological modalities and endoscopic examination revealed a near-obstructing esophageal polypoid mass of 15 × 7.5 cm in size in the thoracal esophagus. A diagnosis of atypical lipomatous tumor/well-differentiated liposarcoma was made with morphological and immunohistochemical findings. Discussion Esophageal liposarcomas originate from primitive mesenchymal cells and are divided into several subtypes, with well-differentiated liposarcoma being the most common subtype. Various diagnostic tests are available, such as barium swallow, computerized tomography, magnetic resonance imaging, and esophagogastroduodenoscopy. Depending on the size and location of the tumor, minimally invasive endoscopic resection or more radical surgery such as esophagectomy can be performed. Conclusion Modern radiological imaging modalities have allowed better understanding and early diagnosis of lipomatous tumors of the esophagus. Optimal management varies, but minimally invasive techniques allow easy removal of the tumor stalk. However, more radical surgery such as esophagectomy is still performed. Due to its rarity, little is known about the prognosis of esophageal liposarcoma. Patients should be followed-up closely in the long term regarding recurrence.

Obturator hernia is a very rare abdominal hernia that is located in the anterior pelvis. Patients apply to a hospital with a clinical intestinal obstruction table in this type of hernia. Prognosis in obturator hernia remains quite poor because of delayed diagnosis and surgical management. Nowadays, radiological techniques, especially computed tomography, are very advanced. Nevertheless, obturator hernia is a serious problem with its increased mortality, because it is detected quite hardly. We tried to offer an 82-year-old woman with acute abdomen that was considered on mechanic intestinal obstruction table for us in this article. Computed tomography is useful on these patients, just as it is useful in this article. For this reason, we scanned computed tomography and recognized a strangulated obturator hernia on the left. Afterwards, we planned a surgical operation and repaired the obturator hernia laparoscopically. The patient was transferred to the intensive care unit because of respiratory failure after the operation was finished. The patient, who was followed in the intensive care unit, died five days later because of acute respiratory failure. Obturator hernia is a rare cause of acute intestinal obstruction. Therefore, increased mortality rates should be remembered in elderly patients because of delayed diagnosis and accompanying chronic diseases. (JAREM 2014; 1: 31-4)

Isolated abdominal wall actinomycosis in the presence of an intrauterine contraceptive device (IUCD) is extremely rare and only six such cases have been reported in the literature. We report a case where clinical and radiological examinations revealed a pseudotumor within the anterior abdominal wall. After being lost to follow-up, the patient presented two years later with the enlargement of the mass. The mass including the affected anterior abdominal wall was completely excised. The diagnosis of actinomycosis was established postoperatively by histopathological examination. Further questioning concerning her gynecological history revealed long-term use of the same IUCD. Surgical excision of the actinomycotic pseudotumour and removal of the IUCD followed by antibiotic therapy resulted in the full recovery of the patient.

BACKGROUND: Leakage from colonic anastomoses is a major complication causing increased mortality and morbidity, and ischemia is a well-known cause of this event. Inadequate tissue oxygenation could be reversed by using hyperbaric oxygen. This study was designed to investigate the effects of hyperbaric oxygen on the healing of ischemic and normal colon anastomoses in the rat model. METHODS: Standardized left colon resection 3 cm above the peritoneal reflection and colonic anastomosis were performed in 40 Wistar rats divided into four groups. The control group (I) received no further treatment. To mimic ischemia, 2 cm mesocolon was ligated on either site of the anastomosis in group II and IV rats. Hyperbaric oxygen therapy was started immediately after surgery in group III and IV rats (therapeutic groups). All animals were sacrificed on the fourth postoperative day. After careful relaparotomy, in situ bursting pressure was measured. The hydroxyproline contents of the anastomotic segments in equal length were determined. RESULTS: The hydroxyproline assay revealed that rats in group II with ischemic colonic anastomosis have significantly lower levels ( P <0.05). The highest levels are in the group III rats with normal colonic anastomosis treated by hyperbaric oxygen ( P <0.05). There was no significant difference in hydroxyproline levels between group II and group IV animals ( P >0.05). Group III animals had significantly higher bursting pressures than any other group ( P <0.05). Group II rats had lowest bursting pressures ( P <0.05). Group IV animals had significantly higher levels than group II ( P <0.05). Mean bursting pressure values both in groups III and IV and hydroxyproline levels in group III were significantly increased by hyperbaric oxygen therapy ( P <0.05). CONCLUSIONS: Ischemia impairs anastomotic healing. Hyperbaric oxygen increases anastomotic healing of both normal and ischemic colonic anastomosis and reverses ischemic damage. This study demonstrated that hyperbaric oxygen improves anastomotic healing.

Background: To analyze the diagnosis and the surgical treatment of intrabiliary ruptured hydatid disease of the liver. Methods: Between 1990 and 1995, 263 patients with hydatid cysts of the liver underwent surgery in a university hospital. Twenty-five (9.43%) patients with intrabiliary rupture of hepatic hydatid cyst were retrospectively reviewed. Results: Diagnosis was principally made using ultrasonography and computed tomography scanning and was confirmed by the findings of other tests. In 12 patients (48%) partial cystectomy with primary closure; 5 patients (20%) partial cystectomy with drainage; 5 patients (20%) cystotomy with drainage; 3 patients (12%) left hepatic resection (atypic, segmentary or lobar) was performed. Omentoplasty was performed in 6 patients. The common bile duct was explored in all patients and it was drained by a T-tube in 22 patients, and by a choledochoduodenostomy in 3 others. The average postoperative hospitalization time was 8.3 and 22.5 days in patients treated with choledochoduodenostomy and T-tube drainage respectively. Cholecystectomy was performed in 18 patients. Complications were seen in 4 patients (16%) with 1 pleural effusion and 3 wound infections. There was only 1 death (4%) due to duodenal peptic ulcus perforation with intrabiliary ruptured hydatid cyst. Conclusion: This study indicates that T-tube drainage and choledochoduodenostomy in intrabiliary ruptured hydatid cysts are effective procedures with low morbidity and mortality rates.