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Rare etiology of mechanical intestinal obstruction: Abdominal cocoon syndrome

World Journal of Clinical Cases 2014年第11期2卷 728-731页

作者： Yener Uzunoglu Fatih Altintoprak Omer Yalkin Yasemin Gunduz Guner Cakmak Orhan V Ozkan fehmi celebi Departmentof General Surgery Sakarya University Research and Educational Hospital 54100 Sakarya Turkey Department of General Surgery Faculty of Medicine Sakarya University 54100 Sakarya Turkey Department of Radiology Faculty of Medicine Sakarya University 54100 Sakarya Turkey

Abdominal cocoon syndrome is a rare cause of intestinal obstruction with unknown etiology. Diagnosis of this syndrome, which can be summarized as the small intestine being surrounded by a fibrous capsule not containing the mesothelium, is difficult in the preoperative period. A 47-year-old male patient was referred to the emergency department with complaints of abdominal pain, nausea, and vomiting for two days. The abdominal computed tomography examination detected dilated small intestinal loops containing air-fluid levels clustered in the left upper quadrant of the abdomen and surrounded by a thick, saclike, contrast-enhanced membrane. During exploratory surgery, a capsular structure was identified in the upper left quadrant with a regular surface that was solid-fibrous in nature. Ab-dominal cocoon syndrome is a rarely seen condition, for which the preoperative diagnosis is difficult. The combination of physical examination and radiological signs, and the knowledge of "recurrent characteristics of the complaints" that can be learned by a careful history, may be helpful in diagnosis.

关键词： Intestinal obstruction Abdominal cocoon syndrome Preoperatively diagnosis Adult patient

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Rare entity: Ectopic liver tissue in the wall of the gallbladder- A case report

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World Journal of Clinical Cases 2014年第12期2卷 924-926页

作者： Yusuf Arslan Fatih Altintoprak Kursat R Serin Taner Kivilcim Omer Yalkin Orhan V Ozkan fehmi celebi Department of General Surgery Faculty of Medicine Sakarya University 54100 Sakarya Turkey Department of General Surgery LIV Hospital 34340 Istanbul Turkey

Ectopic liver tissue(ELT) is a rare condition, which is usually not diagnosed preoperatively, but coincidentally during abdominal surgery. While the location of ELT can vary, it is usually localized on the gallbladder wall or in close proximity. ELT is associated with various complications, a major complication being extrahepatic hepatocellular carcinoma. A 59-year-old female underwent elective surgery for chronic cholecystitis with stones. During laparoscopic exploration, a 2-cm-diameter ELT was detected in the anterior gallbladder wall and a laparoscopic cholecystectomy was performed. The case is presented due to the rare nature of ELT and as a reminder of ELT-related complications.

关键词： Ectopic liver tissue Laparoscopic cholecystectomy Hepatocellular carcinoma

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Elevated Ferritin Levels and the Relationship with Fasting Insulin Levels in Elderly Patients with Metabolic Syndrome

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Journal of Diabetes Mellitus 2014年第3期4卷 242-248页

作者： Fulden Sarac Sumru Savas Sefa Sarac fehmi Akcicek Department of Cardiology Katip Celebi University Ataturk Training and Research Hospital Izmir Turkey Department of Internal Medicine Section of Geriatrics Medical Faculty Ege University Izmir Turkey

Introduction: Elevated serum ferritin levels are associated with insulin resistance, type 2 diabetes and metabolic syndrome (MetS) as well as systemic inflammation and cardiovascular disease. The associations between ferritin and hemoglobin levels with individual components of MetS are unclear. The aims of the study were 1) to compare the ferritin levels, and 2) to investigate the relationships between ferritin, high-sensitivity CRP (hs-CRP), fasting glucose, fasting insulin and homeostasis model assessment (HOMA-IR) levels in elderly patients. Subjects and Methods: Study population included 121 (mean age 64.3 ± 14.1 yrs) (80 female, 41 male) elderly patients. The study population was evaluated for MetS by Adult Treatment Panel III (ATPIII). Demographic and biochemical data such as fasting insulin, hs-CRP, fasting glucose and ferritin levels were evaluated. Biochemical data were evaluated retrospectively. Insulin resistance (IR) was estimated using the HOMA. Results: Metabolic syndrome was diagnosed in 39 elderly patients (32.2%). In elderly patients with MetS, mean levels of ferritin, hs-CRP, fasting glucose, fasting insulin and HOMA were found to be 72.9 ± 33.1 ng/ml, 0.90 ± 0.01, 99.1 ± 20.1 mg/dl, 13.4 ± 1.1 μU/l, 3.0 ± 0.1, respectively. However, mean levels of ferritin, hs-CRP, fasting glucose, fasting insulin and HOMA were found to be 54.1 ± 33.1 ng/ml, 0.67 ± 0.1, 91.9 ± 17.0 mg/dl, 8.4 ± 2.7 μU/l, 2.71 ± 0.9, in the other elderly patients, (p?= 0.0012), (p?= 0.70), (p?= 0.70), (p?= 0.003), (p?= 0.80) respectively. Mean levels of ferritin were positively correlated with diastolic (r = 0.850,?p =?0.03), systolic blood pressures (r = 0.700,?p =?0.02), and fasting insulin (r = 0.444,?p =?0.003) in elderly with MetS. Conclusions: Mean levels of ferritin were increased in elderly patients with metabolic syndrome. And also, ferritin levels were positively correlated with systolic and diastolic blood pressures as well as fasting insulin but not with hs-CRP levels i

关键词： Metabolic Syndrome Ferritin Fasting Insulin Elderly

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