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    Agenesis of Isthmus of Thyroid Gland in the Presence of Ectopic Thyroid Tissue Associated with Papillary Carcinoma
    (Coll Physicians & Surgeons Pakistan, 2019) Ugur, Kesici; Sevgi, Kesici; Tugrul, Kesicioglu; Demet, Sengul
    The thyroid is an endocrine gland composed of two lateral lobes connected by a strip of thyroid tissue called an isthmus. The thyroid gland is usually associated with extensive morphological variations and developmental anomalies. During the 4th intrauterine week, the thyroid gland begins to develop mainly from the invagination of the endodermal cells of the ventral floor of the primitive pharynx. One of the anomalies of the thyroid gland is the agenesis of the isthmus of the thyroid. It is a rare condition and very few cases have been reported in the literature. Another rare developmental abnormality is the presence of ectopic thyroid tissues, which are characterised by the presence of thyroid tissue in locations other than the anterolateral region of the second and fourth tracheal cartilages. Ectopic thyroid tissues are most commonly found in the lingual region but are also found in the other head/neck localisations as well. In this present case report, a 54-year-old female patient with the agenesis of the isthmus of the thyroid gland with accompanying tissues of multifocal and multicentric papillary thyroid carcinoma will be discussed. When an agenesis of the isthmus of the thyroid is detected, the agenesis of the thyroid lobes or the presence of an ectopic thyroid tissue must be considered. Especially in the patients who will undergo a thyroid surgery, it should not be forgotten that the identification of an agenesis of the isthmus as well as the other thyroid anomalies during the preoperative examination, will make a remarkable contribution in deciding the strategy of the surgery and will help in preventing the development of surgical complications. However, it is not always possible to detect the presence of these anomalies, during the preoperative examinations of the patients who will undergo thyroid surgeries; therefore, one must be careful with regard to these type of anomalies in the perioperative examinations. To the best of authors' information, the present case is considered to be the first in the literature in English, presenting with an agenesis of the isthmus of the thyroid gland in the presence of ectopic thyroid tissues associated with papillary carcinoma.
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    Perforation of Cecal Diverticulum after Appendectomy
    (Coll Physicians & Surgeons Pakistan, 2019) Ugur, Kesici
    Solitary cecal diverticulum was first described by Potier in 1912. Although it is a rare condition, however, there is an increased prevalence in Asian populations. The cecal diverticula are usually asymptomatic, however, 10-20% of the cases become symptomatic due to complications. The most common diverticulum-related complication is diverticulitis. Other complications include perforation, hemorrhage, and rarely intestinal obstruction. To conclude, cecal diverticulum is a rare condition that usually presents itself with complications. It is mostly diagnosed perioperatively in the cases of acute appendicitis, and rarely preoperatively. Cecal diverticulitis is commonly misdiagnosed as acute appendicitis. This is why USG, CT, and MRI are commonly used in the preoperative diagnosis. There are very few cases that are confirmed to have both cecal diverticulitis and acute appendicitis. When the condition is majorly diagnosed perioperatively after an acute appendicitis diagnosis; it should be remembered that in the case of determining cecal diverticulitis during the appendectomy, the best course of action is to simultaneously apply diverticulectomy. In this case report, a 54-year male patient is presented, where a cecal diverticulum perforation developed in the early postoperative phase following the appendectomy. At the time of admission, the patient had the complaints of distension, extensive sensitivity, and rebound. The patient underwent laparotomy and the diverticulectomy was performed with a linear stapler. In this case, the presence of a combination of acute appendicitis and cecal diverticulitis was confirmed through histopathological examination.