General Surgery Outpatient Clinic Research Articles

Giant Bilateral Adrenal Leiomyoma Case Report

Introduction: Adrenal leiomyoma is extremely rare and is thought to arise from the smooth muscle wall of the central adrenal vein and its branches; Clinically they may present as abdominal pain or flank pain. These tumors generally have a low biological potential. The surgical indication for adrenal tumors is based mainly on functionality and the risk of malignancy. Clinical Case: 39-year-old male, with no significant history. Who comes to the general surgery outpatient clinic due to the presence of progressive abdominal distension and long-term abdominal pain. An abdominopelvic CT scan was performed, which revealed bilateral, well-circumscribed tumor with heterogeneous characteristics located in the left and right adrenal area, negative functional tests. An exploratory laparotomy was performed, revealing two giant adrenal tumors, definitive study reporting bilateral adrenal leiomyoma. Conclusion: We present a rare case of bilateral primary adrenal leiomyoma of which no similar case was found in the reviewed literature. These tumors are very difficult to diagnose preoperatively. as they are often not counted in adrenal samples and clinical suspicion is very low. As a result, they are diagnosed postoperatively after pathological examination of the surgical specimen. At the moment, early and complete surgical resection is the main treatment.

Determining the role of remote consultations in general surgical practice in Scotland: a qualitative questionnaire-based study

INTRODUCTION Telemedicine consultations became widespread during the COVID-19 pandemic to deliver healthcare while minimising viral transmission. Research around establishing the role of remote appointments in general surgery outpatient clinics after the pandemic has not been undertaken. The aim of this study was to investigate views on remote consultations to determine this. METHODS Patients attending the adult general surgical outpatient clinic at Aberdeen Royal Infirmary between August 2021 and January 2022 as well as general surgeons from three neighbouring hospitals were invited to complete an anonymous questionnaire on the acceptability of remote and face-to-face (F2F) appointments in pre and postoperative scenarios. Differences in patients’ preferences between demographic groups, and between patients’ and surgeons’ views were analysed. RESULTS A total of 51 patients and 26 surgeons responded. Patients’ views differed depending on demographic parameters and the scenario. Patients and surgeons had similar views on preoperative consultations. Given the choice of telephone, video or F2F appointments, the F2F option was overall most popular. Patients and surgeons differed in their views on remote consultations following surgery and acute admissions. In some scenarios, young patients, those who lived in remote regions and those in employment/education preferred remote appointments. CONCLUSIONS While telemedicine is feasible and acceptable in general surgery clinics, there are differences in preferences between surgeons and patients. Patients’ preferences varied depending on their background, home circumstances and clinical context. Service provision should ensure that when remote consultations are available, patient preference is prioritised rather than surgeon ease.

FP3.7 - Do we need to follow up perianal abscesses in clinic?

Abstract Aim The Association of Coloproctology of Great Britain and Ireland (ACPGBI) states those who present with their first perianal abscess do not require routine follow up in clinic after surgical intervention. This audit aimed to assess the percentage of perianal abscess patients being referred to clinic and their subsequent clinic outcome. An additional outcome was a cost analysis of clinic waste. Methods We reviewed the patient records of all patients who underwent an incision and drainage of perianal abscess between 1st January 2022 to 31st December 2022 within a district general hospital setting. We recorded the number of these patients being referred to clinic and their clinic outcome. The 2022/23 National Tariff Workbook resource was used to analyse the cost of clinic wastage. Results A total of 72 incision and drainages of perianal abscesses were performed in 2022 and 92% (N=66) were first presentation perianal abscesses. 46% (N=33) had a post-operative outpatient clinic appointment requested; and of these 67% (N=22) were first presentation perianal abscesses. This culminated in a total cost burden of £1568; in addition to prolonging patient anxiety, increasing their need for time off work and adding to NHS clinic wait time. Conclusion As per guidance, first presentation perianal abscesses do not need to be seen in clinic. The results suggest that we are referring too many patients to colorectal or general surgery outpatient clinics, which is increasing workload, adding to financial costs and affecting patient care.

Evaluation of systemic inflammation markers in patients with Hashimoto's thyroiditis.

To investigate markers of systemic inflammation and the effect of thyroid dysfunction on these parameters in patients with Hashimoto's thyroiditis (HT). Patients with HT and volunteer healthy individuals admitted to the general surgery outpatient clinic between January 2020 and June 2023 were enrolled into the study. Patients with HT were divided into euthyroid, hypothyroid, and hyperthyroid subgroups. All participant data were retrospectively extracted from the hospital database. A total of 268 patients (euthyroid, n = 131; hypothyroid, n = 83; and hyperthyroid, n = 54) and 124 controls were included. The platelet-to-lymphocyte ratio was lower in the euthyroid group versus control group, and the neutrophil-to-lymphocyte ratio was lower in controls than the three patient subgroups. Euthyroid and hypothyroid patients with HT exhibited a higher systemic inflammation index than the control group. The pan-immune inflammation index was lower in controls than in euthyroid, hypothyroid, and hyperthyroid patients with HT. In patients with HT, inflammation markers did not significantly differ between subgroups. Markers of systemic inflammation provide meaningful and reliable information in patients with HT, but do not differentiate between euthyroid, hypothyroid, or hyperthyroid patients.

Splenectomy Reports

Introduction It was seen that splenectomy creates a disability situation in an individual, and in order to eliminate it, people applied to health boards to get a report to eliminate their social and economic losses recognized to them. Objective To examine the reason for surgery, method of surgery and the type of report they wanted to receive in splenectomised patients who applied to the general surgery committee polyclinic in 2017-2018-2019-2020 and 2023 when the pandemic ended. Materials and Methods Patients who applied to general surgery outpatient clinics were asked whether they had any surgery related to general surgery, and epicrises and pathology results of splenectomised patients were seen and recorded. Results Of the 23 splenectomised patients, 15 were female and 8 were male. Of the 15 female patients, 3 were splenectomised for ovarian ca, 3 for gastric ca, 2 for distal pancreatic ca, 2 for lymphoma, 1 for colon ca, 1 for traumatic cause, 2 for ITP, 1 for sarcoidosis. In male patients, 4 were splenectomised for traumatic, 1 for colon ca, 1 for ITP, 1 for thalassemia major and 1 for CML. The mean age of female patients was 48.1 years and the mean age of male patients was 37.4 years. The most common reason for splenectomy in women was malignancy and the most common reason for splenectomy in men was trauma. Conclusion Splenectomized patients had applied to receive the most DSR.

Effects of probiotic addition to standard treatment of Helicobacter pylori on eradication success and side effect profile

Aims: To reveal the effect of probiotics added to standard Helicobacter pylori eradication treatment on the eradication success and side effect profile. Methods: This is a prospective cross-sectional study that included male and female patients between the ages of 18-65 who presented to internal medicine and general surgery outpatient clinics with dyspeptic complaints and had a positive stool Helicobacter pylori antigen test. The patients were divided into two groups with the first receiving standard treatment consisting of amoxicillin 1000 mg 2x1, clarithromycin 500 mg 2x1, and lansoprazole 30 mg 2x1. In addition to standard treatment, the second group also received a probiotic supplement containing 1.5 billion colony-forming units (CFU) per tablet twice a day. Both groups were treated for 14 days and were called 1 month later for a stool Helicobacter pylori antigen check. In addition, a questionnaire was administered to the patients aiming to determine the presence and severity of common side effects due to antibiotic use. These side effects were determined as epigastric burning, flatulence, diarrhea, nausea and vomiting, bitter taste and retrosternal burning. 0 means none, 1 means mild, 2 means moderate, and 3 means severe. Patients were asked to score the symptoms they felt while using antibiotics according to this scale. The aim was to investigate whether there was a difference between the two groups in terms of eradication success and side effect profile. Results: The study included 150 patients (87 males and 63 females) with a mean age of 43.37±12.13 (range 23-65). Group 1 consisted of seventy-five patients who received only antibiotic treatment and group 2 consisted of 75 patients who received antibiotic and probiotic treatment. Eradication percentage was 77.33% in the antibiotic group and 85.33% in the antibiotic+probiotic group. On the other hand, the difference between groups was found to be non-significant (p=0.295). The odds ratio for association between treatment and eradication was 1.705 (95% CI: 0.738-3.940, p=0.212). The percentages of epigastric burning, flatulence, diarrhea, and nausea/vomiting were significantly higher in the antibiotic group than in the antibiotic+probiotic group (p

A Retrospective Cross-Sectional Study on the Effect of Socio-Cultural Factors and Edication in Early Detection of Breast Cancer

Backgrounds: The aim of this study is to investigate the preferences of female patients regarding the choice of surgeon for breast examination and the factors impacting this preference. Methods: A questionnaire was administered by interviewing 746 patients who applied to the General Surgery outpatient clinic with complaints of breast disease, and the results were analyzed statistically. The questionnaire form included the patient's age, marital status, hormonal status, history of delivery, complaints, factors that may impact the choice of physician, educational status, physical examination findings, and imaging results. Results: The study group included 746 patients aged between 14 and 76 years. While 284 (38%) of our patients applied to the outpatient clinic within 7 days of their first symptoms, 462 (62%) applied more than 7 days later. Due to late admission, advanced-stage breast cancer was detected in 2.8% of the patients. The most common reason for the delay in admission was the feeling of embarrassment in females of all age groups. Conclusion: Women with breast disease apply to the physician in the late period due to feeling embarrassed, religious beliefs, spouse pressure, and having a reservation for being examined by a male doctor. Breast diseases could be detected and treated in an earlier period, by enabling patients to apply to a physician earlier, with training, especially for women.

A Retrospective Study of the Presentation and Management of Perianal Disease in HIV-Positive Patients Referred to a Surgical Outpatient Unit in Turkey.

BACKGROUND The incidence of human immunodeficiency virus (HIV) infection is on the rise, and perianal region diseases in HIV-infected patients have become increasingly prevalent. This study aimed to analyze the surgical treatment outcomes of HIV-infected patients presenting with perianal concerns. MATERIAL AND METHODS We included 311 HIV-positive patients admitted to the Infectious Diseases Clinic of Samsun Training and Research Hospital between January 2014 and December 2022. From this group, we selected those who sought care at the general surgery outpatient clinic for perianal and anal concerns, retrospectively reviewing their medical records. RESULTS Out of 311 patients, 54 (17.3%) were referred to the general surgery outpatient clinic with anal and/or perianal region complaints. Of these cases, 38 (70.3%) had a single disease, while 16 (29.6%) had combined diseases. There were 20 males (95%) and 1 female (5%). Among these 54 patients, 33 (61.1%) received medical treatment from the outpatient clinic, while 21 (38.9%) underwent surgical intervention. The diagnoses included 22 hemorrhoidal diseases, 24 anal condylomas, 15 anal fissures, 11 anal abscesses, and 4 anal fistulas. We evaluated the postoperative results and recurrence status of these patients. CONCLUSIONS Perianal diseases in HIV-positive patients can be categorized as isolated or combined. The management of patients with postoperative follow-up compliance problems and combined diseases with low CD4 counts may pose treatment challenges.

Treatment of fibromyalgia among patients with mastalgia and fibromyalgia improved mastalgia.

The aim of this study is to examine the effect of fibromyalgia (FM) treatment on mastalgia by performing fibromyalgia screening in patients who applied for mastalgia and whose underlying cause could not be found. Patients who applied to Kocaeli University General Surgery Outpatient Clinic between November 2017 and November 2020 with breast pain were included (n=120). Patients without cancer, systemic disease, previous breast surgery, and breast mass larger than 3 cm (n=30) were referred to the Physical Therapy and Rehabilitation Outpatient Clinic. A total of 13 patients (43%) were diagnosed with FMS. Twelve of them were given selective serotonin-noradrenaline reuptake inhibitor (duloxetine) treatment for 3 months. Turkish version of the Short Form - 36 (SF-36) quality of life scores, Visual Analog Scale (VAS), Cardiff breast pain score before and after treatment were compared. The remaining 17 patients were followed as only mastalgia. Patients with fibromyalgia and mastalgia had similar demographic results. At the end of the 3rd month, the complaints of breast pain completely regressed in all of the patients. Statistically significant changes were detected in VAS score, the number of trigger points, and SF-36 quality of life scores, Cardiff breast pain score after duloxetine treatment. In the presence of unexplained mastalgia, fibromyalgia should be kept in mind. Duloxetine treatment improved the breast pain and quality of life in patients with mastalgia and fibromyalgia.

Frequency of night eating syndrome and its relationship with impulsivity in bariatric surgery candidates

Aims: Eating attitude disorders are more common in obese individuals compared to the normal population and cause resistance to treatment. In our study, it is aimed to determine the frequency of night eating syndrome, which is an eating disorder, and to reveal its relationship with impulsivity, which is a personality trait, in bariatric surgery candidates with severe obesity . Methods: Between May 2022 and December 2022, 93 patients aged 18-65 years who were planned for bariatric surgery were applied to Balıkesir University Health Practice and Research Hospital General Surgery outpatient clinic, Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD), Barratt impulsivity scale (BIS-11), Night Eating Questionnaire (ADL) were applied. Results: 69 (74.2%) of the participants were women. There was no significant difference between genders in terms of ADL scores (p=0.683). h Night eating syndrome was detected in one third of the patients. (N=31). Barratt -not planning and total scale scores of patients with an ADL score above 25 were found to be higher than those with an ADL score of 25 and below (p=0.010, p=0.044, respectively). Conclusion: Considering that night eating syndrome is associated with one third of obesity and it is associated with impulsivity, addressing the impulsivity of individuals with overeating in cognitive behavioral therapy before the operation will contribute to the success of the treatment.

The Correlation Between Eating Behaviors and Depression Levels After Bariatric Surgery

In recent years, the prevalence of obesity has been increasing. Obese patients can be treated with medication, diet, exercise, and bariatric surgery. Studies on bariatric surgery have mostly focused on the physiological aspect of the surgery, with little attention paid to its psychological effects. There are a limited number of national and international studies that investigate eating behaviors and depression after bariatric surgery together. This descriptive and correlational study aimed to determine the correlation between eating behaviors and depression levels of patients after bariatric surgery. The study was conducted at Fırat University Hospital General Surgery Outpatient Clinic between July 2018 and August 2019. The population of the study was 1,000 adult patients. The sample consisted of 278 patients determined by the power analysis. The Descriptive Characteristics Form was used to determine the descriptive characteristics of the patients, the Dutch Eating Behavior Questionnaire to determine the patients' eating behaviors, and the Beck Depression Inventory to determine their depression levels. Data was gathered through face-to-face interviews at least 1 month after the surgery. The data was assessed using percent distribution, arithmetic mean, and Pearson's correlation analysis. The eating behaviors of the participants were found to be high (104.38 ± 10.29), while their depression levels were low (17.87 ± 7.71). It was determined that there was a positive and weak correlation between the patients' eating behaviors and depression levels, which was statistically significant ( r = 0.190, P = 0.002). Consequently, it was determined that the eating behaviors of the patients improved, and their depression levels were low. Furthermore, as the patients' depression levels increased, so did their eating behaviors. To improve the mental health of patients after bariatric surgery, we must identify mental problems and develop solutions. We suggest that nurses plan training to help patients regulate their eating behaviors and reduce their depression levels. [ Psychiatr Ann . 2023;53(8):374–380.]

Surgical treatment of gastric stump carcinoma after Whipple procedure: A case report.

Gastric stump carcinoma (GSC) is very exceptional and little known after Whipple procedure, and its diagnosis and treatment are extremely difficult to handle. The patient, a 68-year-old man, visited our hospital's General surgery outpatient clinic complaining of upper abdominal pain that had been bothering him for half a month. The endoscopy revealed lesions in the stomach residual, and the pathological results suggested adenocarcinoma. The patient underwent Whipple procedure for periampullary adenocarcinoma in the 4th year ago. The final diagnosis was gastric adenocarcinoma and its pathological stage was Ⅱ A (T3N0M0). The patient underwent stump gastrectomy and end-to-side esophagojejunostomy (Roux-en-Y reconstruction). The operation went smoothly and the patient recovered well with only mild bloating and nausea, and the symptoms completely disappeared during the hospital stay. The development of GSC several years after Whipple procedure is uncommon. This is the first case from China that has received international attention. Early diagnosis is crucial. Surgery is considered to be the most effective treatment for GSC after Whipple procedure if long-term survival is possible and surgical risks are controllable.

Analysis of Knowledge About Male Breast Cancer Among Patients at Tertiary Medical Center.

In the overall population, the incidence of breast cancer in men is lower than in women. Men's breast cancer awareness is affected both by the low incidence of breast cancer in men and by the presence of a perception that breast cancer can only be seen in women in society. This study aims to determine this awareness and guide future studies on improving social awareness. This study examined male and female patients aged 18 to 75 years who were admitted to our hospital's general surgery outpatient clinic. A questionnaire containing questions about male breast cancer was administered to the patients, and the study was conducted face-to-face voluntarily. A total of 411 patients, 270 female and 141 male, participated in the study. The results showed that 61.1% of the participants were unaware of the possibility of breast cancer in men. Evaluation of the relationship between awareness and gender revealed that women were more knowledgeable than men (p = .006). Educational status also had a significant influence on awareness (p = .001). Awareness of male breast cancer in society is low. Raising public awareness of this issue will enable men to be diagnosed earlier, at a lower stage, and thus to better respond to treatment, increasing their survival time.

Investigation of the clinical efficacy of thiol-disulfide homeostasis, delta neutrophil index, and ischemia-modified albumin in cases of incarcerated and strangulated hernia.

The treatment of patients presenting with the diagnosis of incarcerated and/or strangulated inguinal hernia is mostly surgery. If strangulation and necrosis are present, the need for laparotomy arises, which may increase the risk of morbidity. Currently, it is not possible to clearly determine whether there is bowel ischemia and necrosis before surgery. In this study, we aimed to investigate the clinical efficacy of the thiol-disulfide homeostasis, delta neutrophil index (DNI), and ischemia-modified albumin (IMA) parameters in incarcerated and strangulated hernia cases. Patients that presented to the general surgery outpatient clinic due to inguinal hernia or to the emergency department of the hospital with a preliminary diagnosis of incarcerated and/or strangulated hernia in April 2021-November 2021 were included in the study. The patients were divided into the following four groups: patients that underwent elective repair for inguinal hernia (Group 1), those who were followed up without surgery due to incarcerated hernia (Group 2), those who underwent hernia repair without bowel resection due to incarceration (Group 3), and those who underwent bowel resection due to strangulation (Group 4). Group 1 was defined as the control group, while Groups 2, 3, and Group 4 were evaluated as the incarcerated/strangulated hernia group. The demographic data of the patients, length of hospital stay, body mass index, comorbidities, medical history and physical examina-tion findings, radiological examinations, treatments applied, white blood cell (WBC) count, lactate, and DNI, thiol-disulfide and IMA parameters were evaluated. The WBC count, disulfide/native thiol, disulfide/total thiol, and IMA values were significantly higher in the incarcerated/strangulated hernia group than in the control group, while the native thiol and total thiol values were higher in the latter than in the former (P<0.05). There was no statistically significant difference between the groups in terms of lactate (P>0.05), but the mean WBC count was higher in Group 4 compared to Group 1, and the mean DNI was significantly higher among the patients who underwent bowel resection and anastomosis than in those that were followed up and discharged (P<0.05). We consider that the preoperative evaluation of the thiol-disulfide homeostasis, IMA, and DNI parameters in incarcerated/strangulated hernia cases can be an effective and easily applicable method in predicting difficulties that may be encountered intraoperatively and the surgical procedure to be applied to the patient.

Identification of Risk Factors for Mastalgia and Its Relationship with Benign or Malignant Breast Diseases.

Mastalgia is a medical condition that primarily affects women of all age groups. Affected individuals experience excruciating pain, tightness, or a burning sensation in the breast tissue. The aim of this study is to observe the clinicopathologic features of women with mastalgia and compare these features with asymptomatic cases. A total of 524 female patients who applied to the general surgery outpatient clinic were prospectively evaluated. The patients were divided into two groups. Group 1 (G1) included patients with mastalgia, while Group 2 (G2) included asymptomatic patients. The two groups were compared in terms of clinical, radiological, and pathological features. This study was conducted on 524 women, among whom the prevalence of mastalgia was found to be 61.45%. There were 322 patients in G1 and 202 patients in G2. The mean age was significantly higher in G2 compared to G1 (46.33±10.33 vs. 43.58±10.33, respectively; p=0.001). Premenopausal women rates for G1 and G2 were 73.91% and 59.4%, respectively (p=0.001). The regular exercise rate in G1 was 18.01%, while it was 25.74% in G2 (p=0.034). The past history of breast cancer rate was significantly higher in G2 than in G1 (p=0.015). The consumption of analgesics was significantly lower in G2 compared to G1 (p=0.05). Non-steroidal anti-inflammatory drugs were the most commonly used analgesic drug class in both groups, with significant intergroup differences (G1: 27.63%, G2: 19.8%, p=0.043). Screening mammography with or without ultrasound examination was performed significantly more often in G2 compared to G1 (66.33% vs. 55.27% and 82.17% vs. 72.98%, p=0.012 and p=0.016, respectively). No significant difference was found concerning the frequency of benign or malignant pathologies between the groups. Breast pain is common and should be considered physiological without other breast symptoms and after excluding non-breast causes. It is safe to provide symptom control advice and reassurance to patients who have breast pain but do not have signs or symptoms indicating a possible serious underlying condition requiring further medical intervention.

Rapid utilisation of telehealth services for specialist paediatric general surgery outpatient clinics in response to COVID-19

BackgroundThe COVID-19 pandemic is highly infectious and prompted, amongst other changes, strict social distancing requirements for medical practitioners in Western Australia. Despite significant previous research into telehealth, uptake had been limited beyond servicing rural patients, in spite of numerous purported benefits.ResultsRapid adoption of telehealth for a majority of outpatient appointments was instituted in the sole tertiary paediatric general surgery with high overall success rates — a satisfactory outcome being achieved without requiring an in-person appointment (97.1% for telephone consults, 93.8% for videoconferencing) during the initial COVID-19 crisis from April to June 2020. Success of appointments was lowest for new referrals for undescended testicles at 81.3%. Operations booked through telehealth consultations were only altered in 1 case (5%), and this was not significantly different to in-person bookings (p > 0.05). No cases of COVID-19 were incurred by the surgical team or patients during the study period.ConclusionsWe found that with existing technology and minimal training, paediatric surgical consultations were able to be performed via telehealth with high success, high accuracy, and without significant adverse outcomes.

Evaluation of knowledge and practice regarding mammography among a group of Turkish women attending a tertiary hospital.

Early detection is the most important cornerstone of breast cancer in determining treatment outcome and survival. In this study, it was aimed to investigate the level of knowledge, attitude, and practice of mammography in the early diagnosis of breast cancer in a group of women. Data of this descriptive study were collected under observation with the help of a questionnaire. Female patients over 40 years of age or over 30 years of age with a family history of breast cancer admitted to our general surgery outpatient clinic for a health problem other than breast were included. A total of 300 female patients with a mean age of 48.7 ± 10.9 years (min-max, 33-83 years) were included. Median frequency of correct answers among the women participating in the study was 83.7% (76.0-92.0). Mean score obtained by the participants from the questionnaire was 75.7 ± 15.8 (the median score 80; 25th-75th centiles, 73.3-86.7). Slightly more than half of the patients (159 patients, 53%) had at least one mammography scan before. The level of mammography knowledge was negatively correlated with age and the number of previous mammographies, and positively correlated with education level (r= -0.700, p <0.001; r= -0.419, p <0.001 and r= 0.643, p <0.001, respectively). Although the level of knowledge about breast cancer and early diagnosis methods in women was at a satisfactory level, it is obvious that mammography screening practice of women without any breast symptoms is very low. Therefore, it should be aimed to increase women's awareness of cancer prevention and compliance with early diagnosis methods and to promote participation in mammography screening.

Surgical treatment of liver hydatic cyst and evaluation of cystobiliary fistula: experience of two centers

Objective: Intrabiliary rupture or cystobiliary fistula is the most common complication of hepatic hydatid cyst. In this article, our objective is to evaluate the clinical, laboratory, imaging, surgical treatment and results of cystobiliary fistulas, which is the most common complication of hydatid cysts. Material and Method: In our study, patients who underwent open surgery and were followed up and treated for hydatid cyst in the gastroenterology and general surgery outpatient clinic and service between years 2015-2021 were included. The clinical, laboratory, radiological and surgical results of 171 patients with hydatid cysts were retrospectively analyzed. Results: The mean age of 171 patients who underwent surgery for hydatid cyst was 44.8 (18-71), 68 of whom were men and 103 were women. Bile leakage was present in 50 patients (50 (29.23%)). There were 24 (48%) men and 26 (52%) women with bile leakage. The cyst diameter was 74.2 (36-170) mm and the number of cysts was 1.2 (1-2). The cysts were located in the right lobe of the liver in 116 (79%) patients, in the left lobe in 30 (15%) patients, and in both lobes in 25 (6%) patients. Cystobiliary fistula developed more frequently, especially in cysts located in the right lobe(36 (72%)). Cystobiliary fistula was most common in CE3 (Gharbi type 2) type (30 (60%)). Cystectomy+drainage was performed in 137 (80%) patients in all groups. Cystectomy and drainage were the most common surgical procedures. The cyst diameter was 10 cm in the group with cystobiliary fistula and was significant compared to the group without fistula (p&amp;lt;0.001). Aminotransferase (AST and ALT) levels were high in patients with cystobiliary fistula (p=0.012, p=0.054). However, there was no significant difference between the two groups in alkaline phosphatase, total bilirubin, and gamma glutamyl transferase (p=0.231, p=0.097, p=0.544). Conclusion: Liver hydatid cyst is endemic in our country as well as in many other countries in the world. Complicated hepatic hydatid cysts require timely and appropriate treatment because of their life-threatening complications. Cytobiliary fistula is the most common complication. In the surgical treatment of hydatid cyst disease, the earlier the diagnosis of occult cystobiliary fistulas is made (especially in the preoperative or peroperative period), the easier the treatment is, and the risk of bile leakage and consequently the morbidity and mortality decreases. Our results and experience showed that treatment and complications are related to the location and size of the cyst, occult/large cystobiliary fistula, detectability of occult fistulas, experienced center and surgeon.

Is Polycystic Ovary Syndrome a Predisposing Factor for Pilonidal Sinus Disease?

The incidence of pilonidal sinus may be increased in women with polycystic ovary syndrome. This study aimed to compare the prevalence and risk factors of pilonidal sinus disease in women with and without polycystic ovary syndrome in the same population. This was a case-control study. This study was conducted in a Turkish rural district state hospital. This study included 40 female patients with polycystic ovary syndrome and 120 female patients without polycystic ovary syndrome. The prevalence of pilonidal sinus, age, BMI, number of baths per week, daily sitting time, and family history of pilonidal sinus were recorded. Pilonidal sinus was detected in 22.5% (12.5% asymptomatic pits, 10% symptomatic) of patients with polycystic ovary syndrome and 1.7% of the control group ( p < 0.001). No difference was noted between the 2 groups in terms of BMI ( p = 0.219). Family history was similar between the case and control groups ( p = 0.520). No significant difference was noted between the 2 groups in terms of insufficient hygiene and daily sitting time ( p = 0.763, p = 0.706). Multivariate analysis showed that the risk of pilonidal sinus was significantly higher in patients with a positive family history ( p = 0.008). The number of patients in the case and control groups in the study was limited. In addition, the control group may not fully reflect the general population because it was composed of only patients who presented to the general surgery and gynecology outpatient clinic for other reasons. The control group was not age matched. In our study, we found that the prevalence of pilonidal sinus was significantly higher in patients with polycystic ovary syndrome. See Video Abstract at http://links.lww.com/DCR/B945 . ANTECEDENTES:La incidencia de enfermedad del seno pilonidal puede aumentar en mujeres con síndrome de ovario poliquístico.OBJETIVO:El objetivo fue comparar la prevalencia y los factores de riesgo de la enfermedad del seno pilonidal en una misma poblacion de mujeres con y sin síndrome de ovario poliquístico.DISEÑO:Este fue un estudio de casos y controles.ENTORNO CLÍNICO:Se llevó a cabo en un hospital estatal de un distrito rural turco.PACIENTES:Este estudio incluyó a 40 pacientes mujeres con síndrome de ovario poliquístico y 120 pacientes mujeres sin síndrome de ovario poliquístico.PRINCIPALES MEDIDAS DE VALORACIÓN:Se registraron la prevalencia del seno pilonidal, la edad, el IMC, el número de duchas por semana, el tiempo diario para sentarse y los antecedentes familiares de seno pilonidal.RESULTADOS:El seno pilonidal se detectó en el 22,5 % (12,5 % fosas asintomáticas, 10 % sintomáticas) de las pacientes con síndrome de ovario poliquístico y en el 1,7 % del grupo control ( p < 0,001). No se observaron diferencias entre los dos grupos en términos de IMC ( p = 0,219). Los antecedentes familiares fueron similares entre los grupos de casos y controles ( p = 0,520). No se observaron diferencias significativas entre los dos grupos en términos de higiene insuficiente y tiempo de sedentarismo diario ( p = 0,763, p = 0,706). El análisis multivariante mostró que el riesgo de seno pilonidal fue significativamente mayor en pacientes con antecedentes familiares positivos ( p = 0,008).LIMITACIONES:El número de pacientes en los grupos de casos y controles en el estudio fue limitado. Además, es posible que el grupo de control no refleje completamente a la población general, ya que está compuesto solo por pacientes que acudieron a la consulta externa de cirugía general y ginecología por otras razones. El grupo de control no fue emparejado por edad.CONCLUSIONES:En nuestro estudio encontramos que la prevalencia de seno pilonidal fue significativamente mayor en pacientes con síndrome de ovario poliquístico. Consulte Video Resumen en http://links.lww.com/DCR/B945 . (Traducción-Dr. Ingrid Melo ).

Benign nodules of the thyroid gland and 25-hydroxy-vitamin D levels in euthyroid patients.

BACKGROUND: The presence of nodules in the thyroid gland is common in iodine-deficient areas of the world. Recently, vitamin D levels were found to be lower than normal and sometimes deficient in malignant nodules of the thyroid.OBJECTIVE: Evaluate the relationship between the serum vitamin D levels and benign thyroid nodules in euthyroid patients.DESIGN: Cross-sectional.SETTING: Tertiary care center in Turkey.PATIENTS AND METHODS: Patients referred to the general surgery outpatient clinic and diagnosed with thyroid nodules were the study group. The control group consisted of healthy individuals without thyroid nodules. Age, BMI, thyroid ultrasonography, serum 25-hydroxyvitamin D, free T3, free T4, thyroid stimulating hormone, calcium, magnesium, phosphorous, total protein, albumin, glucose, creatinine levels and glomerular filtration rate (GFR) were compared between groups.MAIN OUTCOME MEASURE: Serum 25-hydroxy-vitamin D levels and size of the thyroid nodules.SAMPLE SIZE AND CHARACTERISTICS: Of 849 individuals, 453 were patients with thyroid nodules and 396 were healthy individuals.RESULTS: The mean serum vitamin D levels of patients with thyroid nodules were significantly lower than controls (P<.001). Serum vitamin D levels along with serum total protein levels and eGFR were independent variables associated with the presence of a thyroid nodule (P<.001, p=.005 and P=.017, respectively).CONCLUSION: These findings suggest vitamin D deficiency might be one of the pathophysiologic factors in development of thyroid nodules.LIMITATION: Single-center and possible information bias.CONFLICTS OF INTEREST: None.