INTRODUCTIONSurgery is the only treatment option for familial adenomatous polyposis (FAP). Aim of surgery in FAP is to minimize colorectal cancer risk without need for permanent stoma. There are especially two operation options; Total colectomy with ileorectal anastomosis (IRA) and total proctocolectomy with ileo-pouch anal anastomosis (IPAA). We report here a patient with FAP who had resection via rectal eversion just over the dentate line under direct visualization and ileoanal-J pouch anastomosis by double-stapler technique.PRESENTATION OF CASEA 40 yr. old female patient with FAP underwent surgery. Firstly, colon and the rectum mobilized completely, and then from the 10 cm. proximal to the ileo-caecal valve to the recto-sigmoid junction total colectomy was performed. Rectum was everted by a grasping forceps which was introduced through the anus and then resection was performed by a linear stapler just over the dentate line. A stapled J-shaped ileal reservoir construction followed by intraluminal stapler-facilitated ileoanal anastomosis. Follow up at six months anal sphincter function was found normal.DISCUSSIONThere is only surgical management option for FAP patients up to now. Total colectomy with IRA and restorative proctocolectomy with IPAA is surgical options for FAP patients that avoid the need for a permanent stoma. Anorectal eversion may be used in the surgical treatment of FAP, chronic ulcerative colitis and early stage distal rectal cancer patients.CONCLUSIONJ-pouch ileoanal anastomosis can safely be performed by rectal eversion and double stapler technique in FAP patients.

IntroductionNutrition plays an important role for every patient who is admitted to a hospital. For critically ill patients receiving treatment in intensive care units (ICUs), it becomes more important, since they are usually dependent on a physician for nutritional intake. Proper calculation of calories for these patients should be done to prevent further negative impact of malnutrition on the primary disease. The general condition of the patients might be the most accurate evaluation method for nutritional status, since bad nutrition can cause progression of the primary disease. Furthermore, many medical conditions require different additional nutritional support. This should be considered when calculating the total nutritional intake of patients.In this study, we focus on the importance of early intake of nutritional dietary supplements and on ways to follow up on nutritional status. Materials and methodsIn this retrospective study, we scanned 198 files and the personal information of patients hospitalized in ICUs for at least 5 days between 2009 and 2012 due to various medical conditions. We evaluated the follow-up notes that were retrieved from the files. Biochemical parameters were determined as albumin, prealbumin, and C-reactive protein (CRP) levels. In addition, fundamental electrolyte levels were considered when evaluating nutritional status. Main and additional medical conditions and their additive effects on malnutrition were noted carefully. Daily followup notes were read to understand the general condition of the patient during hospitalization. Malnutrition was defined as low albumin level (below 2 mg/dL) and weight loss of more than 10% during follow-up. Periodically measured prealbumin levels were also taken into consideration. We aimed to report the nutritional status of long-term ICU patients and the prevalence of Background/aim: Malnutrition is a common medical condition among intensive care unit patients. It should be monitored carefully, since early management of malnutrition can dramatically improve the medical condition of the patients. A general consideration of enteral feeding shows that it is much more useful than parenteral administration, because it is more physiological and poses a lower risk of hyperalimentation. Materials and methods:In this retrospective study, we scanned all files and personal information of patients hospitalized in intensive care units between 2009 and 2012 due to various medical conditions. We evaluated the nutritional status of patients with biochemical parameters that were retrieved from the files.Results: In total, 198 patients were identified from hospital records. Almost every patient was given nutritional support either through enteral or parenteral feeding. The albumin levels of 56 patients did not increase, even when they were fed with calculated nutritional support (36.6%). The prealbumin levels of the patients had a tendency to increase after the provision of nutritional additives. Conclusion:In appropriately selected critically ill patients, the role o...

Background: Harmonic scalpel (Ultracision) is a device that simulta-

Aim: For adrenal lesions which are functional and bigger than four centimeters, the optional therapy is surgery. Laparoscopy for the surgery of adrenal masses is increasingly used today. In the past, total adrenalectomy was performed for any adrenal lesions without any exception; however, bilateral involvement of tumors like pheochromocytoma causes trouble and forced surgeons to try partial adrenalectomy. Recently, partial adrenalectomy is a routine surgical procedure for bilateral lesions and also becoming common for unilateral lesions. We aimed to present short-term results for patients who undergo laparoscopic total or partial adrenalectomy. Material and Method: We collect data retrospectively for 33 patients who were operated on in our clinic for adrenal mass between January 2010 and December 2014. 3 patients were excluded from the study. All data were gained from personal patient medical records. Follow-up records were noted with one-by-one interviews by questioning steroid usage and symptoms of adrenal insufficiency. Results: Patients were divided into two groups as total adrenalectomy group with 19 patients and partial adrenalectomy group with 11 patients. All patients who underwent total adrenalectomy have unilateral lesions, while 4 for 11 partial adrenalectomy patients have bilateral adrenal masses. Adrenal insufficiency developed in 3 patients for total adrenalectomy, 1 patient for unilateral partial adrenalectomy, and 1 patient for bilateral partial adrenalectomy. Conclusion: Partial adrenalectomy appears to be protective for adrenal insufficiency for bilateral cases with a ratio of 75%. there was no significant difference between the total or partial unilateral adrenalectomy group, considering postoperative complications, recurrence rates, and insufficiency. As a result, laparoscopic partial adrenalectomy has similar results with less morbidity for unilateral lesions and an alternative method with less adrenal insufficiency for bilateral lesions. Laparoscopic partial adrenalectomy could be performed safely after the learning period was completed and should be considered for adrenal surgeries.

Abstract:Introduction: Riedel thyroiditis is a form of thyroiditis characterised by inflammatory proliferative fibrotic process leading to destruction of thyroid gland and its capsule until reaching the surrounding tissue. Case Report: Herein, the placement of intratracheal stent along with surgical treatment is discussed in a patient of Riedel thyroiditis with pressure symptoms and nonresponsive to medical treatment. Discussion: Patients usually present with hard enlarged mass in the neck and pressure symptoms. Surgical treatment may be required when tracheal and esophageal pressure symptoms occur. Since Riedel thyroiditis involves surrounding tissues as well, it prevents a thyroidectomy at surgical anatomic plane and increases the probability of injury to recurrent laryngeal nerve and parathyroid glands. Conclusion: When pressure symptoms recur in patients with Riedel thyroidits, who were operated previously, the placement of intratracheal permanent stent should be kept in mind among treatment options.