Explore the vast range of titles available.

Summary Background Acute mechanical small bowel obstruction is commonly caused by intraabdominal adhesions and various pathological processes such as malignancy or inflammatory bowel disease. It can also be the result of a metastatic disease such as lung cancer. Case presentation In this report, we present the case of a 57-year-old male patient who presented to the emergency room with epigastric pain, vomiting, and absent passage of stool or flatus. The work-up of the patient revealed a 3-cm obstructive tumor within the wall of the distal jejunum. The pathological result was consistent with squamous cell carcinoma of the jejunum, and this was believed to be a metastasis of the primary cancer of the lung since patient’s thoracic CT revealed a mass surrounding the right main bronchus. Discussion Metastasis to the small bowel is rare and often indicates an advanced stage of disease since the condition often goes undiagnosed. Patients may present with symptoms due to ileus such as nausea, vomiting, and abdominal pain, or due to bleeding such as hematochezia or melena. The work-up of the patient should include CT and thorough history taking should be accomplished to rule out metastasis. Conclusion Patients presenting with small bowel metastasis from primary lung cancer often present with severe complications such as perforation, hemorrhage, or obstruction, since the diagnosis is delayed. Metastasis should be included in the differential diagnosis in patients presenting with acute mechanical bowel obstruction and the work-up should include CT of the thorax, abdomen, and pelvis to rule out primary tumor.

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.

Introduction Intra-abdominal and pelvic seeding of hepatic cystic echinococcosis to various organs is a known feature of the disease. Dissemination into distal extremities is uncommon and in this report, we present a case of disseminated cystic echinococcosis extending toward the right popliteal fossa. Case Presentation A 68-year-old male presented with swelling in the right upper leg and discomfort in the right popliteal region. Work-up revealed various cystic mass lesions of different sizes within the liver, intra-abdominal cavity, right inguinal region, right femoral region, and right popliteal fossa. Diagnosis of hepatic cystic echinococcosis was made and the patient was started on medical therapy. Discussion Hepatic cysts can be easily observed with ultrasonography and the WHO-Informal Working Group on Echinococcosis (WHO-IWGE) classification system is commonly used to further classify cysts. The work-up of the disseminated disease involves further radiological modalities such as computerized tomography and magnetic resonance imaging. Management includes medical therapy, percutaneous drainage, or surgery depending on hepatic cyst localization and the presence of dissemination. Conclusion Extrahepatic dissemination of cystic echinococcosis is commonly encountered in endemic areas. Rarely, hepatic cysts can spread beyond the abdomen towards the distal extremities. Therefore, cystic echinococcosis should be included in the differential diagnosis in endemic areas where patients present with cystic masses.

Background and Objectives. One way to measure arterial stiffness is the ambulatory arterial stiffness index (AASI), which is the relationship between diastolic and systolic ambulatory blood pressure (BP) over 24-hours. Methods. We studied the difference in AASI between obese and lean children. AASI was calculated from 24- hour ambulatory blood pressure monitoring in 53 obese children (33 girls) and compared with age-matched 42 healthy subjects (20 girls). Hypertension was defined according to the criteria of the American Heart Association. To evaluate inflammation, the blood level of high-sensitive C-reactive protein was measured. Results. The mean age was 10.6 ± 2.83 years in obese children and 11.3 ± 3.17 years in healthy subjects. Hypertension was determined in three (5.6%) obese children. The median heart rate-SDS, pulse pressure and blood pressure values did not differ between the two groups. The mean AASI was significantly higher in obese children compared to healthy subjects (0.42 ± 0.15 vs. 0.29 ± 0.18, p < 0.001). AASI significantly correlated with nighttime SBP-SDS, nighttime SBP-load, systolic and diastolic nocturnal dipping, with no independent predictor. Conclusion. This study confirms that AASI is increased in obese children. AASI calculation is a useful, costeffective, and an easy method to evaluate arterial stiffness. Early detection of increased arterial stiffness can help clinicians come up with preventive measures in the management of patients.

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.

Acute appendicitis is one of the most common abdominal surgical emergencies worldwide. Clinical diagnosis is possible in most of the cases although imaging modalities may become necessary if the diagnosis is uncertain. Appendectomy, preferably the laparoscopic ap-proach, still remains the gold standard treatment to date. The pathophysiology usually includes luminal obstruction by an appendicolith or lymphoid hyperplasia and rarely parasitic infections. In this report, we present an extremely rare case of a patient with diagnosis of bipolar disorder and a history of trichophagia resulting in trichobezoar formation within the appendiceal lümen leading to acute appendicitis.

OBJECTIVE: The aim of this study was to determine normative reference values for major thoracic arterial vasculature in Turkiye and to evaluate differences according to age and gender. METHODS: Low-dose unenhanced chest computerized tomography images acquired with pre-diagnosis of COVID-19 between March and June 2020 were evaluated retrospectively. Patients with known chronic lung parenchymal disease, pleural effusion, pneumothorax, chronic diseases such as diabetes, hypertension, obesity, and chronic heart diseases (coronary artery disease, atherosclerosis, congestive heart failure, valve replacement, and arrhythmia) were excluded from the study. The ascending aorta diameter (AAD), descending aorta diameter (DAD), aortic arch diameter (ARCAD), main pulmonary artery diameter (MPAD), right pulmonary artery diameter (RPAD), and the left pulmonary artery diameter (LPAD) were measured in the same sections by standardized methods. The variability of parameters according to age (<40 years; [greater than or equal to] 40 years) and gender (male to female) was evaluated by statistical methods. The Student's t test was used to compare the normal distribution according to the given quantitative age and gender, while the data that did not fit the normal distribution were compared with the Mann-Whitney U test. The conformity of the data to the normal distribution was tested with the Kolmogorov-Smirnov, Shapiro-Wilk test, and graphical examinations. RESULTS: Totally 777 cases between the ages of 18-96 (43.80 [+ or -] 15.98) were included in the study. Among these, 52.8% (n=410) were male and 47.2% (n=367) were female. Mean diameters were 28.52 [+ or -] 5.13 mm (12-48 mm in range) for AAD, 30.83 [+ or -] 5.25 mm (12-52 mm in range) for ARCAD, DAD 21.27 [+ or -] 3.57 mm (11-38 mm in range) for DAD; 23.27 [+ or -] 4.03 mm (14-40 mm in range) for MPAD, 17.27 [+ or -] 3.19 mm (10-30 mm in range) for RPAD, and 17.62 [+ or -] 3.06 mm (10-37 mm in range) for LPAD. Statistically significantly higher values were obtained in all diameters for cases over 40 years of age. Similarly, higher values were obtained in all diameters for males compared to females. CONCLUSION: The diameters of all thoracic main vascular structures are larger in men than in women and increase with age. Keywords: Ascending aorta diameter; descending aorta diameter; left pulmonary artery; main pulmonary artery; right pulmonary artery

[LANGUAGE= \"English\"] BACKGROUND: Early prediction and diagnosis of perforation in acute appendicitis allow surgeons to choose the most appropriate treatment. The purpose of this study is to evaluate whether pre-operative routine laboratory examinations have a role in predicting complicated acute appendicitis.METHODS: In the study, 783 patients operated with the diagnosis of acute appendicitis between the years 2014 and 2019 were analyzed retrospectively. Among the patients with non-perforated and perforated acute appendicitis, pre-operative laboratory tests include leukocyte (WBC), neutrophil, lymphocyte, platelet (PLT), mean platelet volume (MPV), platelet distribution width (PDW), C-reactive protein (CRP), and neutrophil-to-lymphocyte rate (NLR) parameters were compared.RESULTS: Appendicitis was not detected histopathologically in 81 cases. In the study, 89.9% (n=631) of the 702 patients were non-perforated and 10.1% (n=71) were perforated acute appendicitis cases. Perforation rate was higher in elderly patients (p<0.01). It was seen that lymphocyte count was significantly lower in the perforated group, and CRP and NLR were significantly higher (p=0.048, p=0.001, p=0.028, respectively). In the diagnosis of perforated acute appendicitis, cutoff values were 44.0 mg/dL for CRP, 7.65 for NLR and 1.7/mm3 for lymphocytes. There was no statistical difference between the groups in terms of WBC, neutrophil, PLT, MPV, and PDW values.CONCLUSION: Low lymphocyte count, high CRP, and high NLR were found to be reliable and strong predictive parameters in the diagnosis of complicated acute appendicitis.[LANGUAGE= \"Turkish\"] AMAÇ: Akut apandisitte perforasyonun erken tahmini ve teşhisi cerrahların en uygun tedaviyi seçmesine olanak tanır. Bu çalışmanın amacı, ameliyat öncesi rutin laboratuvar incelemelerinin komplike akut apandisiti öngörmede rolü olup olmadığını değerlendirmektir.GEREÇ VE YÖNTEM: Çalışmada 2014–2019 yılları arasında akut apandisit tanısı ile ameliyat edilen 783 hasta geriye dönük olarak incelendi. Perfore olmayan ve perfore akut apandisiti olan hastalar arasında ameliyat öncesi laboratuvar testleri arasında lökosit (WBC), nötrofil, lenfosit, trombosit (PLT), ortalama trombosit hacmi (MPV), trombosit dağılım genişliği (PDW), C-reaktif protein bulunur. Çalışmada CRP ve nötrofil-lenfosit oranı (NLR) parametreleri karşılaştırılmıştır.BULGULAR: Toplam 81 olguda histopatolojik olarak apandisit saptanmamıştır. Çalışmada 702 hastanın %89.9’u (n=631) perfore bulunmamıştır, %10.1’i (n=71) perfore akut apandisit tanısı almıştır. Yaşlı hastalarda perforasyon oranı daha yüksek bulunmuştur (p<0.01). Lenfosit sayısının perfore grupta anlamlı olarak daha düşük olduğu, CRP ve NLR’nin anlamlı olarak yüksek olduğu görüldü (sırasıyla p=0.048, p=0.001, p=0028). Perfore akut apandisit tanısında eşik değerleri CRP için 44.0 mg/dL, NLR için 7.65 ve lenfositler için 1.7/mm3 idi. Gruplar arasında WBC, nötrofil, PLT, MPV ve PDW değerleri açısından istatistiksel olarak fark yoktu.TARTIŞMA: Düşük lenfosit sayısı, yüksek CRP ve yüksek NLR, komplike akut apandisit tanısında güvenilir ve güçlü prediktif parametreler olarak bulunmuştur.

Purpose The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator is a risk stratification tool to help predict risks of postoperative complications, which is important for informed decision-making. The purpose of this study was to evaluate the accuracy of the calculator in predicting postoperative complications in patients undergoing common bile duct (CBD) exploration. Methods A retrospective chart review was completed for 305 patients that underwent open and laparoscopic CBD exploration at a single institution from 2010 to 2018. Patient demographics and preoperative risk factors were entered into the calculator, and the predicted complication risks were compared with observed complication rates. Brier score, C-statistic, and Hosmer–Lemeshow regression analysis were used to assess discrimination and calibration. Results The observed rate exceeded the predicted rate for any complication (35.1% vs. 21%), return to operating room (5.9% vs. 3.6%), death (3.3% vs. 1%), and sepsis (3% vs. 2.4%). The model performed best in predicting serious complication (Brier 0.087, C-statistic 0.818, Hosmer–Lemeshow 0.695), surgical site infection (Brier 0.068, C-statistic 0.670, Hosmer–Lemeshow 0.292), discharge to rehabilitation facility (Brier 0.041, C-statistic 0.907, Hosmer–Lemeshow 0.638), and death (Brier 0.028, C-statistic 0.898, Hosmer–Lemeshow 0.004). In multivariable analysis, there was no statistically significant predicted complication type that affected the type of surgery. Conclusion The calculator was accurate in predicting serious complication, surgical site infection, discharge to rehabilitation facility, and death. However, the model displayed poor predictive ability in all other complications that were analyzed.

PurposeThe aim of this study is to evaluate the clinicopathologic associations of tumor budding (Bd) as well as other potential prognosticators including lymphovascular invasion (LVI) in T3/4aN0 colon cancer patients and to investigate their impact on the outcome.MethodsThe patients were enrolled in three groups according to the number of budding as Bd1 (0–4 buds), Bd2 (5–9 buds), and Bd3 (> 10 buds). These groups were retrospectively compared in terms of demographic features, other tumor characteristics, operative outcomes, recurrences, and survival. The mean follow-up time was 58 ± 22 months.ResultsA total of 194 patients were divided as follows: 97 in Bd1, 41 in Bd2, and 56 in Bd3 groups. The Bd3 group was associated with significantly higher LVI and larger tumor size. The rate of recurrence increased progressively from 5.2% in Bd1 to 9.8% in Bd2 and to 17.9% in Bd3 group (p = 0.03). More importantly, the 5-year overall survival (OS: Bd1 = 92.3% vs. Bd2 = 88% vs. Bd3 = 69.5%, p = 0.03) and disease-free survival (DFS: Bd1 = 87.9% vs. Bd2 = 75.3% vs. Bd3 = 66%, p = 0.02) were significantly worse in Bd3 group. In addition, in the subgroup of patients with the presence of Bd3 and LVI together, the 5-year OS (60% vs. 92%, p = 0.001) and DFS (56.1% vs. 85.4%, p = 0.001) were significantly worse. In multivariate analysis, Bd3+LVI was significantly associated with poor OS and DFS (p < 0.001).ConclusionIn patients with T3/4aN0 colon cancer, high tumor budding negatively affects long-term oncological outcomes. These findings strongly suggest that adjuvant chemotherapy be considered for the patients with Bd3 and LVI together.