Laparoscopic vs open complete mesocolic excision with central vascular ligation for right-sided colon cancer

Complete mesocolic excision (CME) is being performed more frequently and has recently become an established oncologic surgical method for right hemicolectomy. Despite its advantages, such as its association with early mobilization, a short hospital stay, early bowel movement, mild postoperative pain, and good cosmesis, CME is technically demanding and carries the risk of severe complications. This study aims to compare the clinical, pathological, and oncological results of open and laparoscopic right hemicolectomy with CME.The data of 76 patients who underwent right hemicolectomy with CME and high vascular ligation were reviewed retrospectively. The patients were divided into 2 groups according to whether the open or laparoscopic technique was used.Thirty-two patients underwent open right hemicolectomy, and 44 patients underwent laparoscopic right hemicolectomy. The 2 groups were similar in age, sex, American Society of Anesthesiologists class, abdominal surgical history, tumor localization, and operation time. No significant differences were found regarding the specimen length, tumor size, harvested lymph nodes, number of metastatic lymph nodes, or tumor grade. According to the Clavien–Dindo classification system, the laparoscopic group had significantly fewer complications than did the open group (11.4% vs 31.2%; P = .04). The open group had a longer postoperative hospital stay than did the laparoscopic hemicolectomy group (9.9 ± 4.7 vs 7.2 ± 3.1 days; P = .002). In addition, the groups were similar with respect to disease-free survival (P = .14) and overall survival (P = .06).The data in this study demonstrated that no differences exist between the open and laparoscopic techniques concerning pathological and oncological results. However, significantly fewer complications and a shorter length of hospital stay were observed in the laparoscopic group than in the open group. Laparoscopic right hemicolectomy with CME and central vascular ligation is a safe and feasible surgical procedure and should be considered the standard technique for right-sided colon cancer.     

Evaluation of 80 children with prolonged fever

BACKGROUND: Several studies have been published regarding the etiology and evaluation of a child with prolonged fever, however, the reasons for the prolonged fever have changed during the years. The present study aims to determine the causes of prolonged fever, to investigate the relationship of fever using some basic laboratory tests, and to establish guidelines for the approach in those children. METHODS: The charts of 80 out of 17490 hospitalized children who were seen between 1996 and 2001 with prolonged fever of longer than 2 weeks and unknown origin were reviewed in the university hospital of Izmir, Turkey. Their charts were evaluated in respect of age, sex, growth curves, educational level of their families, the duration and the magnitude of fever, causes of fever, and basic laboratory investigations such as white blood cell, blood smear, hemoglobin, erythrocyte sedimentation rate, and C-reactive protein. RESULTS: Forty-four (55.00%) were boys and 36 (45.00%) were girls. Forty-four children (55.00%) were aged between 1 month and 2 years, 21 (26.25%) were aged 3-6 years, seven (8.75%) were aged 7-10 years, and eight (10.00%) were older than 10 years. The mean age was 3.87 +/- 4.17 years (range 3 months-17 years). Forty-six children (57.50%) had a prolonged fever that had lasted from 15-30 days, 18 (22.50%) from 31-60 days, and 16 (20.00%) had fever lasting more than 60 days. Final diagnosis had been reached in 70 of the 80 children (87.50%). The most common causes were infection (47/80), followed by immune deficiency (6/80), collagen tissue disorder (5/80), neoplasia (2/80), and miscellaneous (10/80) such as central fever in three, diabetes insipidus in two, familial Mediterranean fever in two, Kawasaki disease, foreign body in the respiratory system, and Crohn disease in one patient each. Among the laboratory tests white blood cell count, hemoglobin level and blood smear distribution of infection group were statistically significant. CONCLUSIONS: The most common cause of fever of unknown origin remains infection. The proportion of collagen tissue disorders and neoplasia have been found to be decreased. Unusual reasons such as diabetes insipidus and foreign body in the respiratory system in the miscellaneous group have been detected. Age plays important role in the diagnosis of prolonged fever, while some basic laboratory tests might give clues in the evaluation and may suggest a diagnosis.     

Emery-Dreifuss muscular dystrophy with unusual features

Two families with Emery-Dreifuss muscular dystrophy (EMD) are described. Several unusual features for EMD are emphasized. One of the patients had severe neuromuscular disability with inability to walk during early childhood. This patient also had mild bifacial paresis. His brothers had the typical slow progression of EMD. In some of the patients, muscle weakness distribution was more widespread than has usually been reported, with prominent involvement of finger extensors. It is suggested that there is a wide phenotypic spectrum in EMD. In both families, the disease segregated with markers spanning the EMD locus in Xq28. © 1993 John Wiley & Sons, Inc.     

Pyosalpinx caused by the tubal migration of an intrauterine device--a case report

Migration of an intrauterine device (IUD) is a complication occurring at or following insertion. After having perforated the uterine wall, the IUD usually will settle into the peritoneal cavity. Tubal migration of an IUD is extremely rare and little is known about its mechanism. We describe a case of pyosalpinx caused by the tubal migration of a copper IUD. The tail of the device was embedded in the mesocolon.     

Multimodality Imaging of Cor Triatriatum Sinister in an Octagenerian

Cor triatriatum sinister (CTS) is a rare congenital cardiac anomaly in which a fibromuscular membrane divides the atrium into two chambers. As CTS can occur as an isolated anomaly, it is frequently associated with other cardiac anomalies. Although symptoms are usually encountered in infancy, CTS may rarely present in adulthood when the membrane contains large fenestration or other escape drainage exists. We herein, present an 82‐year‐old patient with a typical late diagnosis of asymptomatic CTS.     

Immediate and six months clinical and angiographic results of intracoronary Ephesos stent implantation: the "Ephesos-1" study

BACKGROUND: This study was conducted to evaluate the clinical and angiographic results of the Ephesos stent implantation in patients with symptomatic coronary artery disease. The Ephesos stent is a new balloon-expandable, stainless steel, tubular stent with multicellular design. METHODS: One hundred ten patients with native coronary artery disease were included in the study. The Ephesos stents were implanted in 163 de novo lesions detected in these patients. Immediate and long-term clinical and angiographic follow-up results were evaluated. RESULTS: Most of the patients had unstable angina 63.6%, and 36.7% of the lesions were type B and C. Mean lesion length was 12.7 +/- 4.7. In 62% of the patients the reference lumen diameter was < 3 mm. One Q-wave and one non-Q-wave myocardial infarction (MI) occurred due to acute thrombotic occlusion during hospital stay. The 6-month event-free survival rate was 77.3%. No patients died in the six-month follow-up period, but 2 patients had non-Q wave MI and 1 patient experienced Q-wave MI within this period. Control angiographic data was collected from 110 patients (100% of patients and a total of 163 lesions). Angiographic restenosis rate was 18.1%. Twenty-two patients with restenosis had repeated target lesion balloon dilatation. CONCLUSION: The results of the present study showed that the Ephesos stent is a safe and effective choice with a low incidence of major adverse cardiac events and restenosis rate within six months of follow-up.     

A rare case and a rapid tumor response to therapy: dramatic reduction in tumor size during octreotide treatment in a patient with TSH-secreting pituitary macroadenoma

Thyrotropin (TSH)-secreting pituitary adenomas are the less frequent form of presentation of pituitary tumors. The presence of somatostatin receptors on TSH-secreting adenomas allows treatment of central hyperthyroidism with somatostating analogs. We report a 21-yr-old woman with TSH-secreting pituitary macroadenoma, who was diagnosed based on the symptoms of hyperthyroidism, the lack of inhibition of serum TSH despite an increased serum free thyroxine (FT₄), a low response of serum TSH to thyrotropin-releasing hormone, and a pituitary tumor as revealed by magnetic resonance imaging. The treatment with the somatostatin analog octreotid resulted in inhibition of serum TSH and FT₄ to euthyroid levels with concomitant clinical improvements such as the disappearance of sweating, tachycardia, and finger tremors within 7 d. The tumor size diminished dramatically within 6 wk during treatment of one monthly im injection of 20 mg octreotide-LAR. These effects were continued over 2 yr after the start of octreotide-LAR therapy. Therefore, octreotide-LAR appears to be a useful therapeutic tool to facilitate the medical treatment of TSH-secreting pituitary tumors.     

A 20-Year Study on 190 Patients With Primary Hyperparathyroidism in a Developing Country: Turkey Experience

The aim of this study was to present our 20-year experience regarding primary hyperparathyroidism (PHPT). PHPT patients who underwent parathyroidectomy in our clinic were reviewed retrospectively. There were 190 PHPT patients, of whom 137 were asymptomatic (72%). The mean serum calcium at the time of diagnosis was 11.9 ± 2.2 mg/dL. The mean parathyroid hormone (PTH) level was 467 ± 78 pg/mL. Ultrasonography (USG) identified all abnormal glands accurately (82.6%) and Technetium-99m sestamibi scintigraphy (MIBI) was used in 89.4% of the patients and magnetic resonance imaging (MRI) in 61%. The common use of USG and MIBI detected 92% of the lesions. Bilateral neck exploration (BNE) was performed in 12.2% of the patients and focused unilateral neck exploration (FUNE) in the remaining 87.8%. Surgical intervention was unsuccessful in 1 patient (0.5%). The conversion ratio from FUNE to BNE was 5.2%. The mean operation time and mean hospital stay decreased significantly in patients with FUNE. Pathologic examination revealed single adenoma in 93% of the patients. New imaging techniques result in the conversion of surgical treatments of PHPT. FUNE in parathyroidectomy performed by an experienced surgeon may provide successful treatment rates.Key words: Primary hyperparathyroidism, Focused surgical neck exploration, Developing countryPrimary hyperparathyroidism (PHPT) is defined as hypercalcemia with an excessive, uncontrolled parathyroid hormone (PTH) secretion by 1 or more parathyroid glands in the absence of secondary or tertiary factors. In some cases, normocalcemia can be present with osteopenia and vitamin-D deficiency, and normal PTH can occur with high markers of bone formation and bone resorption. The prevalence varies between 1 or 2 people out of 1000 in the USA and the incidence varies between 27 and 30 people out of 100,000 per year, according to the population and research methods.^1–3The first parathyroidectomy was performed in 1924 by Mandl with the exploration of 4 parathyroid glands and excision of an enlarged single parathyroid adenoma.⁴ This operation was followed by the discovery of parathormone and the development of many measurement methods of PTH.⁵ In the last 30 years, the wide use of the multichannel autoanalyzer; use of USG, MIBI, computed tomography (CT), and MRI for the diagnosis of PHPT; and new surgical methods and techniques for the surgical treatment of PHPT have resulted in easier diagnosis of the disease, correct localization of pathologic lesions, and different surgical approaches.^1,5–17The aim of this study was to present our 20-year-experience with 190 patients diagnosed with PHPT, their clinical features, diagnostic methods, surgical treatment and pathology, and review of the literature.