Giant left atrial myxoma presenting as cerebral embolism

Primary cardiac neoplasms are uncommon with an overall incidence of 0.0017 to 0.02%. The majority of these tumors are benign and half of these tumors are myxomas. About 75% of them are located in the left atrium. Acute embolic cerebral stroke is major problem with increased mortality and morbidity. Embolus arising from cardiac origin costitutes about 20% of ischemic strokes. Atrial fibrillation is cause of more than 50% of cardiogenic emboli. Congenital heart diseases, such as atrial septal defect, patent foramen ovale, prosthetic and rheumatic heart valvular disease, dilated cardiomyopathy and endocarditis are predisposing factors for cardiogenic emboli. Emboli from primary tumors of the heart are extremely rare, with an incidence of 0.02 %. Myxoma is a potential source of systemic embolization to the brain or peripheral arteries. Thus, cerebral stroke may be the first manifestation of the presence of left atrial myxoma.

Pseudomyxoma peritonei presenting with port site hernia

Pseudomyxoma peritonei (PMP) is a rare disease with an incidence of two per million. Acute appendicitis, ovarian mass, and abdominal distension are the most common presentations. A 72-year-old male patient with a history of laparoscopic cholecystectomy was admitted to the hospital with abdominal pain and increased supraumbilical port site swelling. Radiological examination revealed a mass in the terminal ileum and severe intraabdominal mucinous fluid. Intraabdominal gelatinous fluid protruding from the port site defect and a mass in the distal ap-pendix were observed during operation. He underwent a right hemicolectomy, ileocolic anasto-mosis and peritoneal debridement; cytoreductive surgery was administered two months later due to mucinous tumor of the appendix. There are only a few case reports describing PMP presen-ting with an incisional hernia after open surgical procedures. To the best of our knowledge, this report describes the first case of PMP presenting with a port site hernia after a laparoscopic in-tervention.

Ultrasound assisted catheterization of internal jugular vein

An appropriate vascular access is always needed for the success of hemodialysis. Internal jugular vein is the safest and less complicated access in between central veins. At the same time, it is the most commonly used temporary vascular access for hemodialysis. The blind method after anatomical marking for the central vascular path is the most used technique in many centers. The use of ultrasound in the placement of hemodi-alysis catheters in the central vein increases the success rate of catheterization. Ultrasound can show IJV locali-zation, anatomical variations, the presence of thrombus in the vein, and whether the vein is open. The aim of this study is to compare the success rate and complication frequency of temporary catheters placed in the IJV with and without ultrasound for hemodialysis. A total of 124 consecutive patients who required hemodialysis catheters in Haydarpaşa Numune Trai-ning and Research Hospital between February 2012 and December 2012 were randomized to the study. The patients were divided into two groups as non USG-assisted (blindly) (Group 1) and ultrasound-assisted (Group 2). The use of ultrasound significantly increased the successful catheterization rates of both experienced specialist and resident. In addition, there was no statistical difference between the success rates between the specialist and the resident. USG-assisted vein catheterization can be performed safely, easily, quickly, more painlessly and with minimal complication rates. Catheter intervention should be performed under the guidance of USG in risky patient groups who need temporary catheters. In centers that do not have USG, especially in such risky patients, blind catheter interven-tion should not be attempted after anatomical marking. USG-assisted vein catheterization can be easily perfor-med by all clinicians and residents, since the training period is short, practical and much more safe.

A clinical study of varicose veins and their management in patients attending the surgical department of a tertiary hospital

Varicose veins are abnormally dilated, tortuous and elongated veins that occur in the lower limbs. The patients usually present to the surgical outpatient department with various clinical presentations such as, dilated veins, venous ulcers over the legs, pigmentation of the skin and lipodermatosclerosis to name a few. Venous doppler is a very important investigation that must be done in a cases of varicose veins.The surgical treatment involves sapheno-femoral junction flush ligation with stripping of the varicose vein. Several other modalities are also available today such as, sclerotherapy and endovascular laser ablation (EVLA). The objective of this study was to determine the clinical profile of the patients who presented with vari-cose veins and to determine the treatment that was offered to them to treat the varicose veins. This study was carried out from September 2015 to August 2018. A total of 62 patients were studied. The statistics were analy-sed using SPSS package 20.0. Ethical clearance was obtained from the institutional ethics committee. The presence of dilated veins was the most common complaint with which patients presented to the surgical outpatient department. The most common surgical procedure that was performed was the sapheno-femoral junction flush ligation with stripping of the varicose vein. This study shows the importance of diagno-sing a case of varicose veins and to determine as early as possible the treatment modality that should be offered to the patient.

A case of solitary fibrous tumor incidentally detected during COVID-19 infection and treated with video-assisted thoracoscopic surgery

Although solitary fibrous tumor is the most common benign pleural tumor, it is encountered incidentally and very rarely. A mass in the chest wall was detected in a computerized chest tomography taken due to COVID-19 infection in a 36-year-old female patient. The case with solitary fibrous tumor originating from the parietal pleura was treated with video-assisted thoracoscopic surgery. During the COVID-19 epidemic, compute-rized tomography of the thorax, which is frequently taken for lung involvement, can reveal pathologies related to thoracic structures as well as tumors originating from the pleura. Video-assisted thoracoscopic surgery re-commended for the excision of pedunculated and less than 5 cm lesions; We would like to emphasize that it can be safely applied in the treatment of solitary fibrous tumors that are sessile and do not exceed 5 cm.

Impacts of perioperative warming on vital findings and blood parameters of patients having cholecystectomy

This study was carried out to determine the effects of preoperative, preoperative, and postoperative warming on vital signs and blood parameters in patients undergoing laparoscopic cholecystectomy. This study was carried out in operating room A of a research and practice hospital. Necessary permissi-ons were obtained from the university research ethics committee, hospital, and patients. Eighty patients who had undergone medical operations in the hospital in the last six months were included in the sampling method. Body temperatures and physiological findings of the patients and room temperature were also given as percen-tages. Repeated measurements of variance and t-test evaluated postoperative physiological results of each patient. The average body temperature of the patients was 36.36+ 2.81°C, and the average body temperature after the operation was 36.33+ 2.80°C (p >0.05). The mean arterial pressure (MAP) of the patients before the operation was 102.64+11.529 mm Hg. The mean arterial pressure of the patients in the recovery room after the operation was 98.55+ 9.940. During the operation, the MAP was between 96 and 98 Hg. There was a significant difference in terms of the mean arterial pressure of the patients (p <0.05). The average hemoglobin, lymphocyte, platelet counts, activated partial thromboplastin time levels, and values were within the normal range, and there was a significant difference in terms of importance and levels before and after the operation (p < 0.05). The average preoperative, preoperative and postoperative blood urea nitrogen (BUN) values of the patients were 13.79+ 6.126, 13.70+6.752, and 13.52+7.637, respectively. They were within the normal range, and there was no statistical difference (p >0.05). As a result, it can be said that keeping the preoperative, preoperative, and postoperative body tempera-tures of the patients positively affects blood pressure, respiration, and oxygenation and help to normalize these values. In addition, it keeps erythrocyte, hemoglobin, leukocytes, lymphocytes, thrombocyte, APTT, BUN, AST, ALT values within the normal range. It contributes positively to the healing process of the wound. In order to increase the accuracy of this study, it is recommended to conduct studies that include more control and experi-mental groups.

Pleurodesis methods in the surgical treatment of primary spontaneous pneumothorax

Pneumothorax is the collection of air in the pleural space. Pneumothorax can be spontaneous, traumatic or iatrogenic. Primary spontaneous pneumothorax mostly occurs in healthy individuals without an apparent cause, probably due to the rupture of subpleural emphysematous bullae located on the apex of the lung. It usually occurs in tall and healthy males younger than 40 years old. Primary spontaneous pneumothorax has a recurrence rate of 20-30% after the first attack, 50% after the second attack, and 80% after the third attack. Surgery is presented as a treatment option to reduce the high recurrence rate after the second attack. It has been reported that recurrence is between 10 and 20% in patients who undergo bullectomy or wedge resection with endoscopic steps alone. Therefore, various pleural pleurodesis methods are applied in addition to bulla resection in order to reduce the recurrence rate after surgery. In mechanical pleurodesis, adhesion between visceral and parietal pleura is achieved by mechanical abrasion of the parietal pleura or by total or partial removal of the parietal pleura. In chemical pleurodesis, the visceral pleura is adhered to the parietal pleura by creating irritation in the pleura with chemical agents. In cases where pleurodesis was added, the recurrence rate was reported to be between 1.7 and 2.8%. Whether the pleurectomy, pleural mechanical or chemical abrasion methods performed with video-assisted thoracoscopic surgery is superior for preventing recurrence is still a matter of debate. In this article, we aimed to discuss the advantages and disadvantages of pleurodesis methods in the surgical treatment of primary spontaneous pneumothorax in the light of the literature.

Bilateral giant inguinoscrotal hernia with hydrocele. A case report

Giant inguinoscrotal hernia (GIH) is a high morbidity and mortality disease. Giant inguinoscrotal hernia containing omentum, intestinal segments or urinary bladder is a challenging surgical disease. The patient was diagnosed with bilateral giant inguinoscrotal hernia at the age of 81. The case had 22 years history of this uncommon disease. Ultrasound revealed a voluminous hernia sac containing bowel loops, greater omentum, and hydrocele. According the new classification of GIH, the patient was type II. He underwent complete surgical hernioplasty involving omentectomy and orchiectomy. After the surgery, any emerging complications were closely monitored. When giant inguinoscrotal hernia is diagnosed, operation should be recommended immediately. Treatment procedure of hernia should be according the classification of GIH. The Lichtenstein tension-free technique seems to be the best surgical procedure for the patient who have bilateral hernia. It should be used whenever possible in such cases. The patients should be carefully follow up postoperative in terms of abdominal compartment syndrome and respiratory insufficiency.

External and internal oblique abdominis muscle release (eimr) for complex incisional hernia repair: Modification of partition surgical technique

Incisional hernia is the name given to hernias that form in the incision site after abdominal operations. The only treatment option for incisional hernias is surgery and the repair of incisional hernias is still a serious issue for surgeons. The aim of this study is to present an alternative surgical treatment procedure for the treatment of incisional hernias. The study included patients who were diagnosed with complex incisional hernia and underwent surgery between November 2016 and December 2017. In addition to demographic data such as age and gender, the operative and postoperative morbidity and mortality rates were documented. The patients who underwent additional surgical procedure other than herniography were excluded from the study. The study included 16 patients who met the inclusion criteria. Of 16 patients, nine (56.25%) were male and seven (43.75%) were female. The mean age of the patients was 51.25 years and the mean body mass index was 25.3 kg/m2. The hernia size measured in the computed tomography was 11.01 cm on average in men and 11.56 cm on average in women. The intravesical pressure measured intraoperatively before the surgery was 3.4 mmHg on average. While the mean intravesical pressure was found as 12.25 mmHg after the abdomen was closed, the mean intravesical pressure was measured as 6.43 mmHg after the relaxation incision and graft installment. The duration of the surgery was 48 minutes on average. In the postoperative period, paralytic ileus responsive to treatment was observed in two patients and skin necrosis was observed in one patient. No pulmonary embolism, respiratory problems and compartment syndrome that may cause mortality developed in patients. No recurrence was observed in patients in the control one year after the surgery. The golden standard surgical method for the incisional hernia surgery has yet to be determined. There is still a need for prospective randomized studies. We believe that our technique can be an alternative to other techniques in the incisional hernia surgery due to its easy applicability and low rate of complications.

Effects of propofol, desflurane and isoflurane on perioperative blood glucose level in intracranial mass operation: A randomized controlled trial

The aim of this study is to compare the effects of the propofol, desflurane and isoflurane on blood glu-cose levels in cranial surgery. Ninety, ASA I-II patients aged between 18-60 years old were scheduled for study. Induction was per-formed with fentanyl, propofol and cisatracurium in all patients. Anaesthesia was maintained using propofol 4-6 mg/kg/h in propofol group (Group P), desflurane and isoflurane 0.5-1 MAC in group desflurane (Group D) and group isoflurane (Group I). Remifentanil infusion was applied 0.5 µg/kg/min in all groups. Plasma glucose (PG) levels, systolic arterial pressure (SAP), diastolic arterial pressure, mean arterial pressure and heart rate measured. In the 1st, 2nd and 5th hour, PG levels were significantly lower in group P than group D. In the 2nd and 3rd hour, PG levels were significantly lower in group P than group I (p <0.05). In addition, SAP values in group D were found to be significantly lower than group P and group I. With this study, it was concluded that total intravenous anesthesia with propofol infusion in intracranial mass surgery is more effective than inhalation anesthesia such as desflurane and isoflurane in preventing the hyperglycemic response caused by surgical stress.