Umit Turan

Aim: The increasing use of imaging modalities has led to a higher detection rate of adrenal incidentalomas. Surgical treatment is recommended for hormonally active (functional) lesions and for non-functional lesions larger than 4 cm due to the risk of malignancy. Determining the functional status of adrenal masses generally requires multiple hormonal tests, which may prolong hospitalization and increase healthcare costs. In this study, we aimed to evaluate whether radiological parameters could help predict the functional status of adrenal masses.Materials and Methods: This retrospective study included 60 patients who underwent adrenalectomy between January 2017 and December 2023. Demographic characteristics, clinical findings, hormonal evaluation results, and radiological parameters were analyzed. Computed tomography measurements included the lateral and medial limb lengths and the density of the contralateral adrenal gland. Patients were divided into two groups according to the functional status of their adrenal masses.Results: Among the 60 patients, 65% (n=39) were female, and the mean age was 51.5±13.2 years. Functional adrenal tumors were identified in 70% (n=43) of patients. Most surgeries were performed laparoscopically (n=47), with conversion to open surgery in three cases. When the groups were compared according to the functional status of the mass, no significant differences were found in terms of age, sex, tumor localization, contralateral adrenal gland limb lengths, or adrenal density (p>0.05). However, the adrenal gland volume on the tumor side was significantly smaller in patients with functional tumors compared to those with non-functional tumors (p=0.007).Conclusion: Radiological parameters alone do not appear to be sufficient for reliably differentiating the functional status of adrenal adenomas. Hormonal evaluation remains essential in determining the functional status of adrenal masses. Larger prospective studies are needed to clarify the potential diagnostic value of radiological findings.Keywords: Adrenal incidentaloma, Adrenalectomy, Computed tomography

Aim: The aim is to guide the clinical practices of general surgeons in extraordinary disaster situations and to contribute to the preparation processes and surgical procedures for large-scale disasters that may occur in the future.Methods: This study was planned as a retrospective descriptive study. Twenty-nine patients who underwent emergency fasciotomy by general surgery were excluded from the study. In the study, data of 50 patients who were admitted to the general surgery clinic and underwent surgery due to earthquake-related injuries between February 6-28 were analyzed. Demographic data, affected organs, surgical procedures performed, complications, intensive care unit stay, hospital stay, and outcomes of the patients were recorded.Results: Twenty-nine of the patients were women (58%), and 21 were men (42%). The average age was 38.78 years. The number of patients who were followed up for non-surgical reasons was 33 (66%), and 3 patients were pregnant. In our study, 30 (52%) of the patients admitted to our clinic for follow-up and treatment had intra-abdominal fluid findings following intra-abdominal organ bleeding. In our study, when the affected organs were evaluated, the liver was the most frequently injured organ. Of the patients followed up non-surgically in our study, 14 had liver trauma. The most frequent complication was acute renal failure, which occurred in 38 patients (76%).Conclusion: Considering the limited diagnostic and treatment options in large-scale earthquakes, it should be taken into account that intraperitoneal free air detected on abdominal CT may not always indicate gastrointestinal perforation, and selected patients can be managed without emergency laparotomy under appropriate clinical monitoring.Keywords: Earthquake, abdominal injuries, general surgery, complications, mortality.

Background Obesity is a prevalent health problem in both developed and developing countries. There is no consensus on the incidence of gastro-oesophageal reflux following MGB, and the underlying factors affecting reflux remain unclear. Aim This study aimed to investigate factors that may influence the development of gastro-oesophageal and biliary reflux after MGB surgery. Methods This study was designed as a retrospective cohort study. Patients aged 18–65 years who underwent MGB surgery were included in the study. Reflux symptoms were assessed using the GerdQ questionnaire preoperatively and at 6 months and 1 year postoperatively, and the results were compared. Results A total of 256 patients were included in the study, with an average age of 44.51 ± 10.07 years. The mean preoperative body mass index (BMI) was 47.8 ± 8.32 kg/m², decreasing to 28.05 ± 5.44 kg/m² at the one-year postoperative mark. The proportion of patients experiencing severe reflux decreased significantly from 42.7% preoperatively to 7.8% at 1 year postoperatively (p < 0.001). However, reflux symptoms at six and twelve months postoperatively were significantly higher in patients with a preoperative hiatal hernia (p < 0.001). Conclusion Mini gastric bypass surgery is an effective option for managing reflux; however, as symptoms do not improve in patients with a preoperative hiatal hernia, this procedure should be avoided in patients with both gastro-oesophageal reflux and a hiatal hernia. Furthermore, the increased risk of biliary reflux should always be considered in patients with a hiatal hernia but without gastro-oesophageal reflux.

This study explores the disparity in ER, PR, HER-2, and Ki-67 status between primary breast tumors (PBT) and axillary lymph node metastasis (ALNM) at initial admission in patients undergoing neoadjuvant chemotherapy (NAC). Demographic-clinicopathological characteristics and histopathological response to NAC in both PBT and ALNM were recorded. Immunohistochemical analysis of ER, PR, HER-2, and Ki67 was performed separately in PBT and ALNM, with discordance rates compared. The disparity in biomarkers was assessed in relation to the histopathological response to NAC in both PBT and ALNM. In 96 female patients, discordance rates between PBT and ALNM were 16.67% for ER, 16.67% for PR, 20.83% for HER-2, and 15.63% for Ki-67. Statistically significant differences in ER and PR discordance between PBT and ALNM were observed. Additionally, a significant difference in histopathological response to NAC was noted based on ER discordance. Precise assessment of ER and HER-2 status in axillary lymph node biopsy specimens is crucial in breast cancer patients with ALNM, potentially optimizing systemic and surgical treatment selection.

Appendicitis,cancer,hemicolectomy,pericecal mass

Objectives: Although the relationship between breast cancer (BC) risk factors and mammographic density (MD) patterns is not clear, high MD is well known as an independent risk factor for BC. Thus, the aim of this study was to examine the association between MD and BC risk factors in BC patients and find a correlation between MD and tumor characteristics in BC patients. Methods: Our data included 242 patients with BC. Furthermore, the MD (type 1- 75%) was categorized according to percentile density, and the various types of MD were compared using risk factors for BC and tumor characteristics of patients. Results: The results of this study indicated that younger age, pre-menopausal status, younger menarche age, nulliparity, low body mass index, and smoking significantly increase the percentage of MD (p<0.001, p<0.001, p=0.04, p<0.001, p=0.003, and p=0.01, respectively). Moreover, the distribution of MD patterns showed significant differences according to tumor subtypes. Type 4 mammographic pattern was higher in patients with human epidermal growth factor receptor 2 (Her2) type of tumor (p=0.01). Conclusion: Higher MD is related to reproductive risk factors and tumor subtypes, especially Her2 type, in BC patients. Further studies are needed to identify the factors related to breast density.

Background: The aim of this study was to investigate the efficacy of post-neoadjuvant chemotherapy (NAC) ultrasound (US), magnetic resonance imaging (MRI), and F-18fluorodeoxyglucose positron emission tomography (F-18 FDG-PET/CT) for detecting post-NAC axillary lymph node(ALN) metastasis in patients who had ALN metastasis at the time of diagnosis. Methods: This study included all breast cancer patients who received NAC for ALN metastasis; underwent axillary assessment with US, MRI, or F18FDG-PET/CT; and then were operated on in the General Surgery Clinic, Adana City Research and Training Hospital, Turkey. Patients’ data were recorded, including demographic data, clinicopathological parameters, NAC regimens, and operation types. The axillary response to chemotherapy on post-NAC US, MRI, and F-18 FDG-PET/CT was compared with the postoperative histopathological result of the ALN. Results: The study included a total of 171 female patients. The mean age of the patients was 53.28 ± 10.62 years. The post-NAC assessment revealed that the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US for detecting ALN metastasis were 59.42%, 82.35%, 82.00%, and 60.00%, respectively, while the same measures regarding MRI for detecting ALN metastasis were 36.67%, 77.78%, 73.33%, and 42.42%, respectively. The sensitivity, specificity, PPV, and NPV of F-18FDG-PET/CT were 47.50%, 76.67%, 73.08%, and 52.27%, respectively. The evaluation of dual combinations of these three imaging techniques showed that the specificity and PPV of the combined use of US and F-18FDG-PET/CT was 100%. Conclusions: The results showed that US has the highest sensitivity and specificity for detecting ALN metastasis after NAC. Furthermore, ALND may be preferred for these patients instead of SLNB if both examinations simultaneously indicate lymph node metastasis in the post-NAC assessment with US and F-18 FDG-PET/CT. SLNB may be preferred if these two examinations simultaneously show a complete response.

Background The aim of this study was to investigate the effects of the COVID-19 pandemic on emergency anterior abdominal wall hernia surgeries (EAAWHS) by comparing the pandemic period with the control period a year ago and to share our experiences in the pandemic period. Methods This single-center retrospective cohort study included all patients who underwent EAAWHS during the pandemic (from 11 March 2020 to 25 January 2021) and control period (1 year before the same period, from 11 March 2019 to 25 January 2020). Demographic data, preoperative clinical and pathological parameters, intraoperative findings and postoperative complications secondary to operation and COVID-19 infection, length of intensive care and hospital stay of patients were recorded, and the pandemic and control groups were compared. Results Of the 87 patients who underwent anterior abdominal wall hernia surgery during the COVID-19 pandemic, 41 (47.1%) were operated emergently and 46 (52.9%) were operated electively. Of the 485 patients who underwent anterior abdominal wall hernia surgery during the control period, 24 (4.95%) were operated emergently and 461 (95.05%) were operated electively. The decrease in the number of elective operations and the increase in the number of emergency operations were significant during the pandemic (p < 0.001).There was a decrease in the number of emergency inguinal hernia operations and an increase in the number of emergency ventral (incisional, umbilical) hernia operations during the pandemic period compared to the control period (p < 0.05).The mortality rates were similar (8.3 vs. 9.8%, p > 0.05) in both periods. Conclusion Despite the increase in the number of EAAWHS during the COVID-19 pandemic, there was no significant difference in mortality and morbidity rates. EAAWHS can be performed safely during the pandemic by taken necessary and adequate precautions.

Context. Primary hyperparathyroidism related hypercalcemic crisis (PHHC) is a condition that may result in fetal course. So, the early diagnosis and treatment of these patients are important Objective. This study aimed to investigate the clinical features for hypercalcemic crisis (HC) by comparing the groups with and without primary hyperparathyroidism related calcemic crisis. Design. All patients operated with primary hyperparathyroidism (PH) diagnosis in a single clinic between March 2015 and March 2020 were included in this retrospective study. Subjects and Methods. 119 patients included the study.Patients with serum calcium (Ca) level > 14 mg/dl were regarded as HC and the patients were divided into two groups as HC and non-HC. These two groups were compared for demographic data, preoperative biochemical parameters, preoperative localization studies, histopathological assessment and postoperative results. Results. Serum Parathormone (PTH), Ca, Alkaline phosphatase (ALP) and creatinine values among preoperative biochemical parameters were higher in the HC group than the non-HC (p<0.005). The hyper-functional parathyroid size of the patients in the HC group was also bigger compared to non-HC (p0.05). Conclusions. PH is usually an elective operation and PHCC treatment should be relatively more urgent as it can be mortal. Higher HC occurrence possibility should be considered in PH patients with high serum PTH, ALP and creatinine values and large tumor diameters and those patients should be prioritized for treatment.