Fatal Rupture of a Giant Hydatid Cyst in an Elderly Patient

Hydatid cyst (HC) disease, which is endemic in Turkey, is mainly located in the liver. Cyst rupture is the most common complication of HC. Ultrasonography (US) and computerized tomography (CT) are the main diagnostic modalities for HC disease. Presented herein was a case of an elderly female patient who died shortly after presenting to the emergency department with severe abdominal pain. A giant HC was detected on initial evaluation by US. However, the presence of significant amounts of free fluid in the peritoneal space following a CT of the abdomen. The patient died despite medical and surgical intervention.

Effect of autotransfusion system on tumor recurrence and survival in hepatocellular carcinoma patients

AIM:To investigate the therapeutic efficacy and safety of continuous autotransfusion system(CATS) during liver transplantation of hepatocellular carcinoma patients.METHODS:Eighty-three hepatocellular carcinoma(HCC) patients who underwent liver transplantation with intraoperative CATS(n = 24,CATS group) and without(n = 59,non-CATS group) between April 2006 and November 2011 at the Liver Transplant Institute of Inonu University were analyzed retrospectively.Postoperative HCC recurrence was monitored by measuring alpha-fetoprotein(AFP) levels at 3-mo intervals and performing imaging analysis by thoracoabdominal multidetector computed tomography at 6-month intervals.Inter-group differences in recurrence and correlations between demographic,clinical,and pathological data were assessed by ANOVA and χ 2 tests.Overall and disease-free survivals were calculated by the univariate Kaplan-Meier method.RESULTS:Of the 83 liver transplanted HCC patients,89.2% were male and the overall mean age was 51.3 ± 8.9 years(range:18-69 years).The CATS and nonCATS groups showed no statistically significant differences in age,sex ratio,body mass index,underlying disease,donor type,graft-to-recipient weight ratio,Child-Pugh and Model for End-Stage Liver Disease scores,number of tumors,tumor size,AFP level,Milan and University of California San Francisco selection criteria,tumor differentiation,macrovascular invasion,median hospital stay,recurrence rate,recurrence site,or mortality rate.The mean follow-up time of the nonCATS group was 17.9 ± 12.8 mo,during which systemic metastasis and/or locoregional recurrence developed in 25.4% of the patients.The mean follow-up time for the CATS group was 25.8 ± 15.1 mo,during which systemic metastasis and/or locoregional recurrence was detected in 29.2% of the patients.There was no significant difference between the CATS and non-CATS groups in recurrence rate or site.Additionally,no significant differences existed between the groups in overall or disease-free survival.CONCLUSION:CATS is a safe procedure and may decrease the risk of tumor recurrence in HCC patients.

Graft-versus-host disease after liver transplantation:A comprehensive literature review

AIM:To determine the factors affecting mortality in patients who developed graft-versus-host disease (GvH) after liver transplantation (LT) METHODS:We performed a review of studies of GvH following LT published in the English literature and accessed the PubMed, Medline, EBSCO, EMBASE, and Google Scholar databases Using relevant search phrases, 88 articles were identified. Of these, 61 articles containing most of the study parameters were considered eligible for the study. Risk factors were first examined using a univariate Kaplan-Meier model, and variables with a significant association (P < 0 05) were then subjected to multivariate analyses using a Cox proportional-hazards model RESULTS:The 61 articles reported 87 patients, 58 male and 29 female, mean age, 40.4 ± 15.5 years (range:8 mo to 74 years), who met the inclusion criteria for the present study. Deaths occurred in 59 (67.8%) patients, whereas 28 (32.2%) survived after a mean follow-up period of 280.8 ± 316.2 d (range:27-2285 d). Among the most frequent symptoms were rash (94.2%), fever (66.6%), diarrhea (54%), and pancytopenia (54%). Theaverage time period between LT and first symptom onset was 60.6 ± 190.1 d (range: 2-1865 d). The Kaplan-Meier analysis revealed that pancytopenia (42.8% vs 59.3%,P = 0.03), diarrhea (39.2%vs 61.0%,P = 0 04), age difference between the recipient and the donor (14.6 ± 3.1 yearsvs 22.6 ± 2.7 years,P < 0.0001), and time from first symptom occurrence to diagnosis or treatment (13.3 ± 2.6 mo vs 15.0 ± 2.3 mo, P < 0.0001) were significant factors affecting mortality, whereas age, sex, presence of rash and fever, use of immunosuppressive agents, acute rejection before GvH , etiological causes, time of onset, and donor type were not associated with mortality risk The Cox proportional-hazards model, determined that an age difference between the recipient and donor was an independent risk factor (P = 0 03; hazard ratio, 7.395, 95% confidence interval, 1.2-46.7). CONCLUSION:This study showed that an age difference between the recipient and donor is an independent risk factor for mortality in patients who develop GvH after LT.

Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis

AIM: To investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. METHODS: The demographic and histopathological data of 1621 patients (≥ 16 years-old) who underwent appendectomy to treat an initial diagnosis of acute appendicitis between January 1999 and November 2011 were retrospectively assessed. Microscopic findings were used to classify the patients under six categories: appendix vermiformis, phlegmonous appendicitis, gan- grenous appendicitis, perforated appendicitis, supurative appendicitis, and unusual histopathologic findings. The demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and re-analysis of archived resected appendix specimens was carried out. RESULTS: A total of 912 males and 709 females, from16 to 94 years old, were included in the study and comprised 789 cases of suppurative appendicitis, 370 cases of appendix vermiformis, 243 cases of perforated gangrenous appendicitis, 53 cases of flegmaneous appendicitis, 32 cases of gangrenous appendicitis, and 134 (8.3%) cases of unusual histopathological findings. The unusual histopathological findings included fibrous obliteration (n = 62), enterobius vermicularis (n = 31), eosinophilic infiltration (n = 10), mucinous cystadenoma (n = 8), carcinoid tumor (n = 6), granulomatous inflammation (n = 5), adenocarcinoma (n = 4; one of them mucinous), and mucocele (n = 3), adenomatous polyp (n = 1), taenia sup (n = 1), ascaris lumbricoides (n = 1), appendiceal diverticula (n = 1), and B cell non-hodgkin lymphoma (n = 1). None of the 11 patients with subsequent diagnosis of tumor were suspected of cancer prior to the appendectomy. CONCLUSION: Even when the macroscopic appearance of appendectomy specimens is normal, histopathological assessment will allow early diagnosis of many unusual diseases.

Resection and primary anastomosis with or without modified blow-hole colostomy for sigmoid volvulus

AIM: To evaluate the efficacy of resection and primary anastomosis (RPA) and RPA with modified blow-hole colostomy for sigmoid volvulus. METHODS: From March 2000 to September 2007, 77 patients with acute sigmoid volvulus were treated. A total of 47 patients underwent RPA or RPA with modified blow-hole colostomy. Twenty-five patients received RPA (Group A), and the remaining 22 patients had RPA with modified blow-hole colostomy (Group B). The clinical course and postoperative complications of the two groups were compared. RESULTS: The mean hospital stay, wound infection and mortality did not differ significantly between the groups. Superficial wound infection rate was higher in group A (32% vs 9.1%). Anastomotic leakage was observed only in group A, with a rate of 6.3%. The difference was numerically impressive but was statistically not significant. CONCLUSION: RPA with modified blow-hole colostomy provides satisfactory results. It is easy to perform and may become a method of choice in patients with sigmoid volvulus. Further studies are required to further establish its role in the treatment of sigmoid volvulus.

Coexistence of duodenum derived aggressive fibromatosis and paraduodenal hydatid cyst: A case report and review of literature

Intra-abdominal aggressive fibromatosis is a locally aggressive tumor mostly originating from the mesentery or retroperitoneal space, infiltrating adjacent tissues, and very rarely metastasizing to distant organs. There are only two case reports in the English language literature where intra-abdominal aggressive fibromatosis originated from the intestinal wall. In this study, we aimed to report a case of aggressive fibromatosis originating from the muscularis propria layer of the duodenum and invading pancreas. Another interesting aspect of this case is that a primary paraduodenal hydatid cyst was incidentally detected in the surgical specimen. A 46-year-old female patient presented to our clinic with postprandial nausea and vomiting. A contrast-enhanced abdominal computerized tomography revealed a mass lesion with a size of 100 mm × 80 mm which originated from the distal pancreas and compressed the gastric pilor externally. Upon exploration the distal part of duodenum, proximaljejunum, and pancreatic mass were noted to form a conglomerated structure. Therefore, the fourth part of the duodenum, a 25 cm part of the proximal jejunum, distal pancreas, and the spleen were excised enbloc. The pathology report of the specimen indicated fibromatosis with a diameter of 55 mm that originated from the muscularis propria of the duodenum and extended into the pancreatic parenchyma. There was also an incidentally detected 10 mm paraduodenal hydatid cyst. No tumor recurrence was detected at a follow-up period of 24 mo. In conclusion, the most ideal treatment of desmoid-type fibromatosis is surgical resection of the mass lesion with clean surgical borders. Although rare, this tumor may originate from the intestinal wall. Histopathological verification is of great significance for a proper diagnosis.

Some Biological Features of Tinca tinca Population in Asartepe Reservoir(Ankara)

Tinca tinca(L.,1758)grafted into Turkish inland waters in 1970 has shown constantly widening distribution since then.It is a locally consumed species with limited economic value.The elucidation of length-weigh relation,condition factor and biological features are of great importance in the determination of the effects of different habitats on particular species.T.tinca is regarded as an important species to be monitored among the fish taxa.This study was intended to study some biological aspects of T.tinca population in Asartepe Reservoir and to compare the results with the available information.The study has been carried out on 131 T.tinca species caught in Asartepe Reservoir between the periods of March 2015-February 2016.The morphometric and meristic properties and the ratio of some diagnostic features to the standard length were elucidated.The highest and the lowest variations observed among the morphometric features were in body length with 21.35%and eye diameter with 8.31%.The corresponding values for the meristic features were pectoral fin unbranched rays with 30.09%and number of vertebrae with 2.68%.The highest percentage relative to the standard length was found in predorsal distance with 56.95%.The age distribution of T.tinca population was between the ranges of 1-9 years of age.The average weight and length were found to be 520.58±207.84 g(103-1,302 g)and 308.68±41.38 mm(190-429 mm).The parameters of a and b of length and weight relation and the correlation coefficient were found to be 0.9692,3.0522 and 1.6807±0.1264(1.4199-2.0368),respectively.The results indicate that the growth level of T.tinca population is satisfactory.

三轴拖车后轮的操纵

一、前言对整体式三轴拖车的动力学研究可知,当前轮转弯时,后轮会产生滑动,但这种滑动可以通过后轮的同步操纵加以避免。后轮的操纵方向应该和前轮相反,操纵角度取决于两轴的距离、轴的长度及前轮的操纵角度。