Our results indicate that both CO(2) pneumoperitoneum and laparotomy increase the incidence of bacterial translocation from the peritoneal cavity into the bloodstream. Thus, the risk of translocation to extraperitoneal organs such as lung and kidney is increased significantly by laparoscopy. Therefore, laparoscopic surgery should be avoided or used cautiously in the setting of acute peritonitis.

Hydatid disease is endemic in several Mediterranean countries, posing an important health problem for these countries. The hydatid cyst is characterized by cystic lesions with clear boundaries, which can be observed in all parts of the body. Approximately 70 % of hydatid cysts are situated in the liver, followed by the lung (25 %). The kidneys, spleen, bile ducts, mesentery, soft tissue and brain are less frequent sites. We investigated patients who were treated for hydatid disease in our departments in the last 5 years with respect to localization of the disease, symptoms, surgical intervention, length of hospitalization, diameters of the cyst, and classification by Gharbi. In this retrospective and descriptive study, 176 patients are evaluated who were treated for hydatid disease between 1995 and 1999 in our departments. Of these patients, 14 were included with localization other than in the liver and lungs. Fourteen of the patients diagnosed with unusually located hydatid disease were men, six were women. Their mean age was 41.6 +/- 20.8 years; the length of hospital stay was 7.07 +/- 0.4 days. Overall, 28.6 % of patients with unusually located hydatid cyst had recurrent disease. The time period since last cyst operation was 5.25 +/- 3.5 years. The mean cyst diameter was 96.5 +/- 54.5 mm. According to Gharbi's classification, three cases (21.4 %) of the unusually located hydatid cysts were type I, two (14.3 %) type II, and eight (57.1 %) type III. There was only one case of type IV and no cases of type V. Spleen and kidneys are the organs where hydatid disease is most frequently observed after the liver and lung. It can be observed in all parts of the body including the brain, peritoneum, mesenterium, choledochus, pancreas, bone and muscles. The type of treatment is determined by the localization and type of hydatid disease. Surgical treatment for splenic hydatid cysts is splenectomy. The functional kidney should be saved in non-communicable hydatid disease. Total excision is almost never possible; endocystectomy and drainage procedure should be preferred for hydatid disease of the brain, pancreas and choledochus. Chemotherapy is usually given because of the risk of recurrence; this medical treatment consists in albendazole and mebendazole administration for 3-6 months in the postoperative period.

We present a case of an immature teratoma of the liver and the mediastinum. A 21-year-old female patient presented with dyspnea, abdominal pain, and abdominal mass. Abdominal ultrasonography showed a liver tumor which is located in the right lobe and composed of cystic and solid elements. Computed tomography (CT) also showed a big mass which contained multiple high density, nodular, semi-solid, heterogenic structures in the liver and another mass which contained multiple low density cystic lesions in the anterior mediastinum. Right thoraco-abdominal approach was performed on the patient and a complete macroscopic resection of tumors was achieved without complications. Both tumours were evaluated as having an intact capsule. The mediastinal tumour extended to the diaphragm on the right side, and is dissected from the 'surrounding lung, pericardium' and excised from diaphragm. Right hepatic lobectomy was performed for liver tumour. Intraoperative frozen sections of the liver tumor revealed teratoma. But the final pathological diagnosis was immature teratoma. Chemotherapy was given after surgery. The patient tolerated the procedure well and her postoperative course was unremarkable. At the first follow up 4 months after surgery she was alive and well and there was no evidence of recurrence, but the patient died within seven months with hepatic recurrence and spreading metastasis.

Hydatid disease of the urinary tract is very rare. We report a case of pure renal hydatid cyst, with its clinical presentation and management.

SUMMARYThe aim of this study was to determine the correlation between serum gastrin and resectability in patients with gastric cancer, and to see whether any difference could be demonstrated according to the histologic type and survival. Between 1994 and 1996 records of 34 consecutive patients with gastric carcinoma serum gastrin levels were measured and correlated with age, gender, lymph node positiveness, metastasis, Lauren's classification and survival. The mean serum gastrin level of patients was 98.38 pg/ml (normal range: 25–125 pg/ml). Twenty‐six of 34 patients (76.5%) had normal gastrin levels and eight patients (23.5%) had high gastrin levels. Sixty‐five per cent of patients with normogastrinaemia underwent resection with extended lymphadenectomy, while 38% patients with hypergasthnaemia underwent extended resection. All the hypergastrinaemic patients died within the first year, but in the normogastrinaemic group one, two and five‐year survival rates were 39%, 23% and 4%, respectively. Even though these results are not statistically significantly different in regard to preoperative serum gastrin levels, we conclude that preoperative hypergasthnaemia is associated with unresectability and poor survival in patients with gastric cancer.