In laparoscopic appendectomy, using a titanium endoclip for optimizing and controlling the appendiceal stump closure is safe and is associated with shorter operation time. This also simplifies the procedure, so it can be a useful alternative to intracorporeal knot-tying for appendiceal stump closure.

We conclude that tube duodenostomy is a simple, effective, and safe method to prevent rupture of an insecure duodenal stump or to treat the leakage from the duodenal stump or primary repair on the duodenum.

No abstract

In this study, we evaluated the diagnosis, epidemiology, risk factors, and treatment of chylous ascites developing after liver transplantation (LT). Between 2002 and 2011, LT was performed 693 times in 631 patients at our clinic. One-hundred fifteen of these patients were excluded for reasons such as retransplantation, early postoperative mortality, and insufficient data. Chylous ascites developed after LT (mean 6 SD ¼ 8.0 6 3.2 days, range ¼ 5-17 days) in 24 of the 516 patients included in this study. Using univariate and multivariate analyses, we examined whether the following were risk factors for developing chylous ascites: age, sex, body mass index, graft-to-recipient weight ratio, Model for End-Stage Liver Disease score, vena cava cross-clamping time, total operation time, Child-Pugh classification, sodium level, portal vein thrombosis or ascites before transplantation, donor type, albumin level, and perihepatic dissection technique [LigaSure vessel sealing system (LVSS) versus conventional suture ligation]. According to a univariate analysis, a low albumin level (P ¼ 0.04), the presence of ascites before transplantation (P ¼ 0.03), and the use of LVSS for perihepatic dissection (P < 0.01) were risk factors for developing chylous ascites. According to a multivariate Cox proportional hazards model, the presence of pretransplant ascites [P ¼ 0.04, hazard ratio (HR) ¼ 2.8, 95% confidence interval (CI) ¼ 1.1-13.5] and the use of LVSS for perihepatic dissection (P ¼ 0.01, HR ¼ 5.4, 95% CI ¼ 1.5-34.4) were independent risk factors. In conclusion, the presence of preoperative ascites and the use of LVSS for perihepatic dissection are independent risk factors for the formation of chylous ascites. To our knowledge, this study is the most extensive examination of the development of chylous ascites. Nevertheless, our results should be supported by new prospective trials.

A lthough classical textbooks state that hamartomas are rare tumors, radiologists who use both mammography and ultrasonography (US) frequently encounter hamartomas in their daily practices. These tumors present as painless and mobile masses with well-defined borders. They are composed of variable amounts of glandular tissue, fat and fibrous elements that produce a mass of disorganized but mature specialized cells or tissues (1-3). The complete resemblance of the tissues to normal breast parenchyma and an occasional admixture of other elements limit the contribution of the pathological examination to the diagnosis. The correlation between clinical and radiological findings is of paramount importance (4, 5). Although mammographic and US findings of breast hamartomas have been well defined, advanced magnetic resonance imaging (MRI) findings in such cases have not been previously described. This study provides a description of dynamic contrastenhanced MRI (DCE-MRI), diffusion-weighted imaging (DWI) and MR spectroscopy (MRS) findings in breast hamartomas. Materials and methodsThe study was executed retrospectively based on the records of our breast imaging center over a 24-month period. During that time, all examinations were performed by the same radiologist (G.E.), who is a specialist in breast imaging. Eight patients with a diagnosis of breast hamartoma were found in the center's registry. The ages of these patients ranged from 22 to 54 years (mean age, 38.6 years; SD, 14.6 years). These patients were initially examined with US and/or mammography either as part of a routine screening or as a work-up for palpable breast masses. Cases in which the masses were diagnosed as hamartomas were further examined via MRI. These patients each underwent an MRI examination to reveal advanced imaging characteristics of these rare lesions as part of an institutional research study on DCE-MRI, DWI and MRS. Informed consent was obtained from all patients. MRI scans were conducted using a 1.5 T scanner (Intera Master, Gyroscan, Philips, The Netherlands) with a gradient force of 32 mT/m. Images were obtained in the prone position using a standard breast coil.Axial and sagittal T1-weighted (TR/TE, 550/11 ms), T2-weighted (TR/ TE, 2429/120 ms), and fat-suppressed T1-weighted images were obtained for conventional MRI examinations. DCE-MRI was performed after intravenous administration of 0.1 mmol/kg gadopentetate dimeglumine (Gd-DTPA) with an automatic injector (Spectris, Medrad, USA). In this study, 12 consecutive T1-weighted fast field echo (FFE) sequences, each lasting 20 seconds, were obtained in four minutes. After subtracting the initial unenhanced images from the remaining enhanced images, the regions of interest (ROIs) PURPOSEAlthough it has been stated that breast hamartomas are rare tumors, radiologists frequently encounter them in their daily practices. Fat, glandular and fibrous tissues all produce a mass of disorganized but mature specialized cells. Because hamartomas do not have specific diagnostic histological features, ...