Selçuk Tıp Dergisi Arşiv

More than 90% of pnömoperitoneum occur as a result of gastrointestinal perforation. However, sometime spneumoperitoneum is not associated with visceral perforation. In this study, we aimed to introduce the four cases of idiopathic spontaneous pneumoperitoneum and to review the literature. Ages were between 58 and 83 years old and intra-abdominal free air was determined during the emergency room imaging applications with undetermined etiology. One patient was diagnosed with idiopathic spontaneous pömoperitoneum after medical follow-up, and the others were diagnosed after surgery. All patients were male and did not have any etiologic factors other than diagnosis of COPD to create pneumoperitoneum. A detailed history and physical examination findings may prevent unnecessary laparotomy for diagnosis spontaneous pnömoperitoneum. In spontaneous pnömoperitoneum patients, it is suggested that COPD history should be questioned if no other etyological factor was found.

Early stage cervical cancers involve stage I and stage IIA. The treatment is radical hysterectomy and pelvic lymph node dissection. Besides the operation can be performed by laparotomy, with the development of laparoscopic technology, the treatment has been started with laparoscopic radical hysterectomy and laparoscopic lymph node dissection. The advantages of laparoscopic approach are less analgesic requirement, minimal postoperative discomfort, shorter hospital stay and faster return to normal daily activities. In this article, a patient was presented having early stage cervical cancer at 30 years old; therefore, applied laparoscopic radical hysterectomy (type III), laparoscopic bilateral pelvic para-aortic lymph node dissection. Also, despite possibility receive radiotherapy, laparoscopic bilateral ovarian transposition was applied due to remove ovaries from radiation area. This operation can not be performed at any center, because it requires advanced experience.

Eosinophilic pulmonary diseases (EPD) are defined as a group of diseases characterized by the in crease of eosinophils in the air way and/or lung tissue. While a part of the sedis orders mainly affects the pulmonary, others show systemic in volvement. Chronical eosinophilic pneumonia (CEP) should be kept in mind in the existence of subacute or chronic respiratory and general symptoms, alveoler and/or bloode osinophilia and peripheral pulmonary in filtrates on chest radiography. A 53-year-old male patient was admitted to our clinic with on going complaints of cough, occasional fever and malaise for six months. When two-sided apical, subapical and the infiltration around hiluses were detected on chest x-ray, the case was hospitalized with the prediagnosis of pulmonary tuberculosis. Eosinophilia in hemogram, bilateral infiltrative lesions with irregular contours and bilateral cystic bronc hiectasis foci were detected on high resolution computed tomography (HRCT). Bronchoscopy revealed purulent secretions and thick mucous in hibations. No specific etiologic cause was defined in the etiology, and the case wase valuated as CEP. Due to unusual bronchoscopic and radiological findings, the case was presented and discussed.

Familial Mediterranean fever (FMF) is an auto inflammatory disorder characterized by recurrent febrile polyserositis and arthritis attacks. Coexistence of FMF and rheumatoid arthritis (RA) is very rare in the literature. Here, we present a case with FMF and RA. Clinicians should there fore consider the possibility of RA development in FMF patients exhibiting morning stiffness and erosive polyarthritis.

Patients with hydatid cysts generally show an asymptomatic progress until they are randomly diagnosed or until they develop a complication.A The 80-year-old patient, who was being followed-up in the ICU of the neurology department because of hypoxic brain, was evaluated for a swelling in the epigastric area which was existent for a while. The patient’s physical examination revealed an exophytic mass lesion of about 5x6 cm on the epigastric area. During the surgery it was seen that the patient had an infected hydatid cyst originating from the left lobe of liver with percutaneous fistulization.The patient was discharged on post-op day 7 without any problems with 20 mg/ kg albendazole treatment. Consequently, it should be noted that hepatic hydatid cysts could give way to very rare complications like skin involvement and percutaneous fistulization even if they are on advanced stages.

Schizencephaly is a slit covered with gray matter, that lies from the ependimal surface to the piadressing a long the hemisphere. If the walls of the slitscovered with gray matter of are close to each other it is named as Type 1 (closedlip), if they are further from each other, it is called astype 2 (openlip). Clinics in children has a large range of spectrum from mental motor retardation, seizure to focal neurological disorders. Most of the patients have epilepsy which are usually characterized by focalseizures. There are only a few cases where schizencephaly causes status epilepticus. Here in, we report a schizencephaly case of a 7 year old boy who was accepted with a status epilepticus clinics that started locally and progressed generally. We emphasize the important role of schizencephaly in epilepsy and status epilepticus.

Lipomas are benign mesenchymal tumours derived from mature adipose tissue. It is very rare to see a giant size of lipomas. A 70 year old male patient applied with an ulcerated and painful mass sizing 20x16 cm on his axilla extending to his back. The mass was suspected as a malignant soft tissue tumour because of showing ulceration and being painful and it was totally excised surgically. The histopathological examination revealed as lipoma. The case was presented as being very rare and mixing malignant soft tissue tumour.

Hiccup is the sudden onset of erratic diaphragmatic and intercostal muscle contraction and followed by immediate laryngeal closure. Hiccup is usually a self-limited disorder; however when it is prolonged beyond 48 hours, it is considered persistent whereas longer than 2 months are called intractable. The pharmaco therapy of hiccup includes chlorpromazine, gabapentin, baclofen,serotonergic agonists and lidocain. Non-pharmacological approaches are nerve blockade and acupuncture. We report 3 cases presenting with persistent hiccup in brain stem lesions and treated with baclofen.

Fatal anaphylactic reaction due to ceftriaxone is quite rare. Taking into consideration that cephalosporins may also cross-react with beta-lactam antibiotics, the risk of allergic reactions in patients using cephalosporins for serious reasons should not be disregarded. Here, we present a patient with fatal anaphylactic reaction following the first dose administration of ceftriaxone who had been followed in our clinic for liver cirrhosis due to hepatitis C (HCV) and was hospitalized for pneumonia. Detailed allergy history including betalactam antibiotic allergy should carefully be questioned in patients to whom cephalosporin treatment is planned. Even in the first dose of administration, caution should be taken and drug administration should be performed after appropriate measures.

Necrotizing fasciitis (NF) is an infectious disease with a possible fulminant course that it is characterized by necrosis of the skin, soft tissues, fascia or muscle. Treatment involves extensive debridement and antibiotherapy. Although, debridement may not always be possible due to limitations in the administration of general and/or block anesthesia in some patients based on such reasons as overall health, bleeding diathesis or medications being used by the patient. There is limited information or studies exploring possible options in such patients, although those that are available support the lifesaving advantages of early fasciotomies performed under local anesthesia. A 76-year-old male patient was admitted with generalized edema to the right forearm and arm, erythema, and a lesion with a bulla and purulent discharge. An NF diagnosis was confirmed with a positive finger test and emergency surgery was planned; however, general anesthesia could not be administered due to the impaired overall health status of the patient, who was using aspirin, preventing blockage. Accordingly, the abscess was drained through arm and forearm fasciotomies that were performed under local anesthesia, and samples were obtained for culture.In conclusion, NF can be fatal when left untreated, while successful results can be achieved with early diagnosis, sufficient debridement and treatment with appropriate antibiotics. That said, drainage of the abscess through multiple fasciotomies can improve the laboratory findings and support treatment in NF patients who cannot undergo rapid debridement or can not tolerate general anesthesia. A fasciotomy may be performed as a supportive treatment prior to debridement in such patients.

During our routine dissection studies, we encountered an accessory head of biceps brachii in the left upper extremity of a 73-year-old formalin-fixed male cadaver. The other two heads of the muscle and other arm muscles were as usual. Humeral accessory head of biceps brachii muscle was classified according to the originated location of the head of biceps brachii muscle by some researchers as infero-medial humeral, superior humeral and inferolateral humeral head. In this case, the accessory head was originated from middle third of the humerus, superior and medial to the origin of brachialis muscle and inserted to the common tendon of biceps brachii. In the literature, this head was named as infero-medial humeral head and its incidence changes between 7.7-12% according to ethnicity. In Turkish population, its incidence changes between 2.5-6.15%. We think that knowledge of this type of the variation is important for prevention of possible surgical complications and diagnostic procedures.

Elastofibroma dorsi is a rare, benign tumor, characterized by fibroblastic proliferation and accumulation of abnormal elastic fibers. It is located in the subscapular region between the scapula and the thoracic wall. Especially, the suspicion of soft tissue sarcoma may produce anxiety. Magnetic resonance imaging and computed tomography findings are usually typical; and, positron emission tomography may also contribute to the diagnosis. Diagnosis can be made easily with typical localization and imaging findings. We present clinical and imaging findings in three cases of elastofibroma dorsi.

Moebius syndrome is a rare, non-progressive congenital syndrome presenting with complete or partial facial paralysis. It is usually associated with orofacial malformations, musculoskeletal defects, brainstem dysplasia, and other cranial nerve palsies. Mean incidence is 2-20/million, although there is considerable regional variation. The most common presentation is with bilateral lateral rectus palsies and facial diplegia. Frequently, the 5th, 10th, 11th and 12th cranial nerves are involved and may cause cough, difficulty in chewing and swallowing, and respiratory insufficiency. Complete or partial facial nerve palsy is necessary for a diagnosis of Moebius syndrome. A 4-month-old girl was brought to our clinic with complaints of inability to close her right eye completely and internal deviation in that eye, beginning from birth. She had micrognathia and an inability to completely close the right eye. Both eyes were turned inwards during primary gaze. She had limited lateral gaze, a pes equinovarus deformity in her feet, and flap ears. Cranial magnetic resonance imaging was performed because of the dysmorphic features and revealed micrognathia and volume loss at the tongue. Bilateral facial nerves could not be visualised by a 3D FIESTA scan, suggesting bilateral facial nerve agenesis. This case is presented to highlight Moebius syndrome in the differential diagnosis of cases presenting with congenital facial weakness.

Penetrating cardiac injuries are one of the most important urgent traumas which can cause life-threatening hemorrhage and cardiac tamponade. A significant number of cases die before reaching the hospital. Rapid response to those who reached the hospital determines the prognosis. Most of cases die because of inefficiencies in transport, delays in transport to operation room and late intervention. We aim to present, early operated penetrating cardiac injury case by a general surgeon without thoracic/cardiovascular surgeon and thorax surgery set in a distinct hospital.

Endometriosis is a common pathology in fertile women. Perianal involvement is rare and painful swelling is seen on episiotomy incision scars. Uncommon involvement of perianal region by endometriosis should be kept in mind in recurrent anal abscess. In this case report, we aimed to present a 35 year old woman with endometriosis mimicking recurrent anal abscess.

Hydatid disease which is caused by Echinococcus granulosus, is endemic in the husbandry regions. Primary localization of the disease is liver; however, echinococcosis may infect every organ and tissue of the human body. Aim of this report is to emphasize that primary peritoneal hydatidosis may clinically be presented with an acute mechanical intestinal obstruction in endemic regions.

Simple kidney cysts are common, benign and asymptomatic masses and usually unrequire any treatment. However, this simple cyst can grow over time, may become symptomatic and develop complications they may require treatment. In our study, we aim to present, the 63 -years-old male patient admitted to our clinic with dyspnea, abdominal pain and asymmetric abdominal distension. Abdominal ultrasonography (USG) showed that exophytic renal cyst reached 195x180 mm. We underwent sclerosing agents in the presence of continuous percutaneous catheter drainage and dyspnea decreased at the follow-up. Subsequent USG after six months revealed disparition of the cysts.

Hereditary angioedemais a genetic autosomal dominant disease caused by C1-esterase inhibitor protein (C1INH) deficiency that sometimes results in death due to obstruction of upperair ways from severe edema. Here in, we present a young male,who secon dition was known before, faces a severe brea thing difficulty because of uvula and diffuse face edema after a minor travma on his head. His condition rapidly and complete lyimproved with in 2 hours after two units of fresh frozen plasmain fusion.

Dyke-Davidoff-Masson Syndrome (DDMS) is rarely seen and a clinical entity with features of drug-resistant epileptic seizures, cerebral hemiatrophy, contralateral hemiparesia, facial asymmetry, mental retardation or learning disability. A 27 year-old-male patient presented with complaint of seizure. His first attack was occurred when he was three-days-old. His seizures were complex partial seizures. He has used varios of antiepileptics but seizures could not be controlled since he was three-years-old. Neurological examination revealed mild hemiparesis, hyperactive deep tendon reflexes and Babinsky’s sign positivity at the right side. Magnetic resonance imaging (MRI) of the brain revealed left cerebral cortical hemiatrophy. The patient was diagnosed with DDMS considering that learning difficulties in additon to the above clinical features. He has used 1000 mg/day carbamezepine and 200 mg/day topiramate for 10 months and he is seizure free now. Absence, complex partial or secondary generalized seizures may seen in patients with DDMS. Surgical procedures like hemispherectomy may be performed in patients who have frequent and drug-resistant seizures. In our patient, seizures were controlled with oral antiepileptic drugs without any need of surgery. This case is presented because of the rarity of the syndrome and demonstratively of the brain MRI.

The Zenker’s diverticulum (pharyngeal pouch) is a rare pulsion diverticulum of the mucosa of the pharynx just above the cricopharyngeal muscle. It occurs at the left side and was commonly seen in elderly patients. Maintypical symptoms include dysphagia, regurgitation, chronic cough, aspiration and weight loss. Symptomatic patients with large diverticulum should be treated surgically. Although in recent years successful results with endoscopic therapy has been reported, diverticulectomy and myotomy are still seems to be the best treatment. In this study, a case of 36 years old woman with rightsided Zenker’s diverticulum, clinical presentation, and management are reviewed.

Organizing pneumonia (OP) is characterized histopathology cally by tufts of fibroblasts and immature collagen filling of respiratory bronchioles and alveoli. Symptoms are usually nonspecific and include cough and dyspnea. Radiograph cally, OP frequently manifests as patchy bilateral infiltrates that can be relapsing and migratory. Cryptogenic organizing pneumonia (COP) may be defined as having non-specific symptoms which can ultimately be described as a subset of the OP that cannot be attributed to any reason. Forty-nine-year-old female patient admitted with the complaints of 2 year exertional dyspnea and 20 day dry cough. The patient was diagnosed of pneumonia and prescribed with antibiotics; however, no improvement was observed in her complaints and lung graphics. The physical examination of the patient, routine laboratory analyses, collagen tissue markers and bronchoscopy were normal. In chest X-Ray, there were 4 nodular density approximately 1 cm in size, in the upper zone. In thorax CT, there were irregular contours multiple nodules, and the biggest one was approximately 35x7 mm in the upper lobes and in the superior of the left lower lobe of lungs. Acid fast bacteria was negative at bronchoalveolar lavage. The patient was diagnosed COP as clinically and radiologically. Then, systemic cortico steroid therapy was started. A complete clinical recovery was observed in the sixth month of the treatment and at the control thorax CT displayed that nodular lesions were disappeared completely. In the cases that were not respond to antibiotic therapy and patients having radiologically mobile and temporary infiltrations may be taken into consideration in the differential diagnosis.

Tuberculosis is still an important public health problem in the World, especially, in undeveloped and developing countries. In this study, the primary diagnosis of intestinal tuberculosis was reported from a 14 months old female patient. The patient applied to our clinic with complaints of refusing breastfeeding, fever, abdominal distention, vomiting and loss of weight, then, the patient was taken to emergency operation due to the acute abdomen. In the operation, cheese-shaped lesions on whole intestines were macroscopically observed. Its histopathological examination revealed intestinal tuberculosis. Tuberculosis treatment for patient who were not diagnosed in the early stage was lost. In this study, details related with clinical findings, diagnosis and curation were reported with the aim of making an awareness on this rare case.

Congenital lobar emphysema (CLE) is a rare anomaly of lung development that presents in the neonatal period. A 13-day-old girl baby was admitted to our unit because of primary pulmonary hypoplasia. She had presented with severe dyspnea and cyanosis, where chest radiograph and chest computed tomography showed CLE and pulmonary hypoplasia. Pulmonary hypoplasia may worsen prognosis of patient. There fore, we performed a pulmonary magnetic resonance angiography in our patient. Pulmonary vasculature was normal on magnetic resonance angiography. After ward, our patient was operated. In here we would like to highlight that the use of advanced imaging techniques can identify additional pathologies which may affect prognosis after surgery.

Lipomas are benign mesenchymal neoplasm commonly occurring throughout the whole body and comprise mature fat tissue. However, intestinal mesentery originated lipomas are rarely seen. A 42-yearold female patient presented with right sided abdominal distension. Exploratory laparotomy was performed and fat tissue was excised. Lipomas might or might not present with any symptoms. Complete surgical excision is the only treatment with a very good prognosis.