The performance of prompt, individualized surgical treatment in conjunction with the use of advanced measures of critical care to combat the disastrous consequences of multiple organ failure would contribute greatly to improve survival rate in victims of this dreadful entity.

Background: One of the most important factors in breast cancer (BC) mortality is treatment delay. The primary goal of this survey was to identify factors affecting the total delay time (TDT) in Turkish BC patients. Methods: A total of 1031 patients with BC were surveyed using a uniform questionnaire. The time between discovering the first symptom and signing up for the first medical visit (patient delay time; PDT) and the time between the first medical visit and the start of therapy (system delay time; SDT) were modelled separately with multilevel regression. Results: The mean PDT, SDT and TDT were 4.8, 10.5 and 13.8 weeks, respectively. In all, 42% of the patients had a TDT >12 weeks. Longer PDT was significantly correlated with disregarding symptoms and having age of between 30 and 39 years. Shorter PDT was characteristic of patients who: had stronger self-examination habits, received more support from family and friends and had at least secondary education. Predictors of longer SDT included disregard of symptoms, distrust in success of therapy and medical system and having PDT in excess of 4 weeks. Shorter SDT was linked to the age of >60 years. Patients who were diagnosed during a periodic check-up or opportunistic mammography displayed shorter SDT compared with those who had symptomatic BC and their first medical examination was by a surgeon. Conclusion: TDT in Turkey is long and remains a major problem. Delays can be reduced by increasing BC awareness, implementing organized population-based screening programmes and founding cancer centres.

Left paraduodenal hernia is the result of abnormal rotation of the gut during embryonic development. Although rare, this hernia is important because it usually causes intestinal obstruction. These hernias are also called congenital mesocolic hernia. mesentericoparietal hernia or retroperitoneal hernia. Case reportAn 18-year-old man was admitted with a ?-day history of abdominal pain. nausea. vomiting and absolute constipation. He appeared fit. The abdomen was distended and slightly tender with an increase in bowel sounds. Erect X-ray films demonstrated many small gas fluid levels on the left side of the abdomen.An exploratory operation was performed through a midline incision. All the small intestine except a small part of the terminal ileum was seen in a thin sac. The anterior wall of the sac was the descending mesocolon. The small intestine was pulled out of the sac easily. The opening of the sac was near the duodenum. lowards the right side of the abdomen and about lOcm long. On the anterior wall of the opening was the inferior mesenteric vein. The opening of the sac was closed by suturing the anterior and posterior walls; there was no problem with the inferior mesenteric vein. The patient did well.

Diffuse biliary papillomatosis is a rare bile duct tumour. We report a case of multiple biliary papillomatosis treated surgically with a transhepatic stent.Diffuse biliary papillomatosis involving intra and extrahepatic bile ducts is extremely rare. It is regarded as having low grade malignant potential. In this report a case of diffuse biliary papillomatosis with obstructive jaundice is presented.

Amaç: Genel cerrahi servisine yatırılan benign ve malign hastalığı olan hastalardaki malnutrisyon sıklığını saptamak, malnutrisyonun tanınmasında kullanılan yöntemleri değerlendirmek ve malnutrisyonun postoperatif komplikasyon gelişimindeki rolünü incelemektir. Hastalar ve Yöntem: Şubat 2004-Mayıs 2005 tarihleri arasında Genel Cerrahi kliniği'nde opere edilen 723 hastada, beş ayrı yöntemle (nutrisyonel risk indeksi, subjektif global değerlendirme, kilo kaybı oranı, serum albümin düzeyi, vücut kitle indeksi) malnutrisyon sıklığı araştırıldı. Medikal tedavi alan hastalar çalışmaya dahil edilmedi. Hastalar uygulanan nutrisyonel destek, komplikasyon ve mortalite yönünden takip edildi. Bulgular: Toplam malnutrisyon oranı %30.5, ağır malnutrisyon oranı %8.9 olarak tespit edildi. Benign hastalığı olanlarda %25.8, malign hastalığı olanlarda ise %53.3 malnutrisyon saptandı. Toplam ve hafif malnutrisyonu tespit etmede en yüksek sıklık, Nutrisyonel Risk İndeksi ile elde edildi. Ağır malnutrisyonu tanımada yöntemler arasında fark saptanmadı. Malnutrisyonu olmayan hastalarda %10.9, malnutrisyonu olan hastalarda ise %28.6 oranında komplikasyon gelişti. Sonuç: Malnutrisyon, cerrahi hastalarda sık karşılaşılan, komplikasyon ve mortalite riskini önemli derecede arttıran klinik problemlerden birisidir. Preoperatif dönemde malnutrisyonun tespit edilerek, ihtiyaç gösteren hastalara nutrisyonel desteğin uygulanması halinde, komplikasyon sıklığı önemli derecede azaltılabilir.