A new prognostic marker in patients undergoing Hartmann's procedure for acute tumoral obstruction of the left colon.

BACKGROUND: In acute obstructive left-sided colorectal cancers (AOLCRC), damage to the colon wall may occur as a result of distension of the colon segments proximal to the tumor. In this study, we aimed to evaluate the relationship between the ratio of dilated colon diameter (CD) to lumbar vertebral corpus diameter on preoperative abdominal computed tomography (CT) scan in patients undergoing Hartmann's Procedure (HP) and post-operative complications. METHODS: The tumor group consisted of 49 patients who underwent HP for AOLCRC under emergency conditions. The control group consisted of 49 age-and gender-matched individuals (compatible with tumor group) that had an abdominal CT due to pathologies outside the gastrointestinal tract and without a history of abdominal surgery. In both group, the ratios of the CD to the diameter of the first lumbar vertebra corpus (L1-VD) measured on axial CT images of each patient. These ratios were compared between groups. In the tumor group, the relationship between post-operative complications (Clavien-Dindo classification-major (grade ≥III), minor (grade

Transient asystole related to carbon dioxide embolism during transoral endoscopic parathyroidectomy vestibular approach.

BACKGROUND: Rarely, during the endoscopic thyroidectomy, carbon dioxide (CO2 ) embolism may occur. METHODS: Case 1: A 65-year-old female who was seen with prolonged fatigue and generalized bone pain was diagnosed primary hyperparathyroidism (PHPT) based on her preoperative biochemical profile. Transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) was planned. Case 2: A 52-year-old male patient was seen with weakness and hepatosteatosis and was diagnosed PHPT based on the laboratory workup. TOEPVA was planned. RESULTS: After subplatysmal dissection with vascular tunnel probe, both of the patients developed severe bradycardia and hypotension leading to asystole during the CO2 insufflation. The possibility of CO2 embolism was considered and insufflation was terminated. After a successful cardiac massage, sinus rhythm returned. CONCLUSION: TOEPVA may develop CO2 embolism leading to asystole during the CO2 insufflation.

The Importance of Extensive Intraoperative Peritoneal Lavage as a Promising Method in Patients with Gastric Cancer Showing Positive Peritoneal Cytology Without Overt Peritoneal Metastasis and Other Therapeutic Approaches.

Peritoneal invasion is more common and has a worse prognosis in gastric cancer than most of other intestinal cancers. Advanced gastric cancers have a poor course in terms of the development of peritoneal carcinomatosis and prognosis, even if the curative resection has been performed. Patients usually die within the first 2 years of the postoperative period mainly due to peritoneal metastasis. It is, therefore, essential to eradicate intraperitoneal free cancer cells to prevent peritoneal recurrences. A standard therapy has not been developed yet for patients with gastric cancer with a positive peritoneal cytology or a gross peritoneal metastasis. Curative resection following neoadjuvant chemotherapy, postoperative oral S-1 chemotherapy, intraoperative intraperitoneal chemotherapy (IPC), and extensive intraoperative peritoneal lavage (EIPL)-IPC are recommended as therapeutic approaches. Although there is a limited number of studies on EIPL, which is a promising and exciting method in this patient population, unexpected results of survival have been demonstrated. We consider that the results of ongoing and further studies would lead to an extensive use of EIPL, which is a simple and easy method which can be applied anywhere and anytime, in patients with advanced gastic cancer and/or peritoneal cytology positive but peritoneal metastasis negative (CY+/P0) gastric cancer.

Clinical significance of serum claudin-1 and claudin-7 levels in patients with colorectal cancer.

The present study aimed to investigate the serum levels and clinical relevance of claudin (CLDN) 1 and CLDN7 in patients with colorectal cancer (CRC). A total of 140 patients with a pathologically confirmed diagnosis of CRC were enrolled in this study. The serum levels of CLDN1 and CLDN7 were determined using the solid-phase sandwich ELISA method. A total of 40 healthy age- and gender-matched controls were included in the analysis. The median age of the patients was 60 years (range, 24-84 years). The localization of the tumor in the majority of the patients was the colon (n=81, 58%). Of the 55 metastatic patients who received palliative chemotheraphy, 31% were chemotherapy-responsive. The baseline median serum CLDN1 and CLDN7 levels were significantly lower in non-metastatic and metastatic patients compared with those in healthy controls (CLND1, P=0.008 and 0.002; and CLND7, P=0.002 and 0.002, respectively). Moreover, known clinical variables, including poor performance status and high carcinoembryonic antigen (CEA) levels were found to be associated with lower serum CLDN1 concentrations for all patients (P=0.03 and P=0.03, respectively). High T stage and high CEA levels were found to be correlated with lower serum CLDN7 concentrations for all patients (P=0.04 and 0.03, respectively). A correlation was identified between CLDN1 and CLDN7 levels in non-metastatic and metastatic CRC patients (both P-values <0.001). Our study results did not reveal any statistical significance for serum CLDN1 or CLND7 concentrations regarding progression-free and overall survival rate. Therefore, reduced serum levels of CLDN1 and CLND7 may be useful markers in the differential diagnosis of CRC.

Self-expanding metallic stents in acute mechanical intestinal obstructions resulting from colorectal malignancies.

Endoscopic colonic stenting with self-expanding metallic stents is now widely used to treat malignant large bowel obstruction, where temporary or permanent decompression of the large bowel is desired. The medical records of patients who underwent endoscopic colonic stenting for malignant large bowel obstruction between May 2004 and May 2011 were reviewed. Success rate, morbidity, and mortality rate along with patient characteristics were documented. Sixty-seven patients were included. The procedure was used as a bridge to surgery in 38 and as a palliative measure in 29. Success rate was 95.5 per cent. Perforation and reobstruction occurred in three and three patients, respectively. All of the patients who developed perforation or reobstruction underwent emergency surgery. Endoscopic stenting offers a safe and effective treatment option in patients with malignant large bowel obstruction with comparable outcomes.

Coexisting anal human papilloma virus infection in heterosexual women with cervical HPV infection.

AIM: To evaluate the prevalence of coexisting anal human papillomavirus (HPV) infection and concordance of HPV types in women with cervical HPV infection and to investigate the possible predictors for anal HPV infection. METHODS: Study group was composed of women referred with documented cervical HPV infection. All patients had undergone anal HPV DNA testing. RESULTS: One hundred and six patients presenting with cervical HPV infection were eligible for the study. Overall, 24 and 20 distinct HPV genotypes were detected from cervical and anal specimens, respectively. We observed a considerably high prevalence (51.9 %) of coexisting anal HPV infection in our study group. A majority of the women who were found to have anal HPV infection were infected with oncogenic or probable oncogenic types (64.6 %). There were 20.0 and 58.3 % rate of total and partial concordance between the two sites, respectively. We found that no demographic parameter but history of anal intercourse was related with the risk of anal HPV infection. CONCLUSION(S): Women with cervical HPV infection have a considerable risk for coexisting anal HPV infection. Concordance of HPV types infecting the cervix and anal canal is relatively high. There is no strong predictor for anal HPV infection in this population.

Public awareness of colorectal cancer in a Turkish population: importance of fecal occult blood testing.

To date, there was no controlled-study regarding awareness and knowledge of colorectal cancer in the Turkish population. We therefore designed a questionnaire consisting of items related to socio-demographic parameters, medical and family history and questions of awareness and knowledge about colorectal cancer for use in a descriptive cross-sectional study. An interviewer-administered technique was applied and 450 subjects were interviewed in the outpatient clinics at Near East University Hospital. Among all subjects, 337 were found to be eligible for the study group. Exclusion criteria were age below 18 years, any cancer history, family history of colorectal cancer, current colorectal problems, history of any diagnostic or therapeutic interventions for colorectal diseases.All participants stated that they heard about colorectal cancer. When asked about the lifetime risk of colorectal carcinoma, only 25.4% of women and 37.9% of men estimated correctly. Univariate analysis revealed that the total awareness score was significantly correlated with age, marital status, parenthood and fecal occult blood testing history. On multivariate analysis of independent predictors for awareness of colorectal cancer were found to be history of fecal occult blood testing, age and marital status were found to be the most important determinants. As a conclusion, opportunistic screening with fecal occult blood test by physicians from non-gastrointestinal specialties not only helps to reduce the mortality but also increases the awareness of colorectal cancer.

Living-donor liver transplant in 3 patients with Budd-Chiari syndrome: case report.

Budd-Chiari syndrome is a rare but life-threatening disorder characterized by obstruction of the hepatic venous outflow. Treatment depends on the underlying cause, the location, and extent of the obstruction, and the functional capacity of the liver. A stepwise therapeutic approach is commonly accepted. When all other therapy options are unsuccessful, or in case of end-stage liver disease, transplant should be considered. We present case reports of 3 patients with Budd-Chiari syndrome who underwent living-donor liver transplant. Characteristic features of Budd-Chiari syndrome, diagnostic and therapeutic interventions, complications, and overall outcomes are discussed. We believe that when a deceased donor graft is unavailable, a living-donor liver transplant can be a safe option for patients with end-stage liver disease associated with Budd-Chiari syndrome.

Hepatitis B prophylaxis in living donor liver transplantation: single center experience.

BACKGROUND/AIMS: Until recently chronic hepatitis B virus (HBV) infection was considered a formal contraindication for liver transplantation, since recurrence of infection without prophylaxis occurs in 75%-90% of the patients. However, the introduction of hepatitis B immunoglobulin (HBIg) plus lamivudine has reduced the reinfection rates of the grafts less than 10%. The purpose of this study is to report our experience in a single transplant center and contribute to arguments about prophylaxis in areas where the prevalence of HBV is high. METHODOLOGY: From July 2004 to September 2008, 50 living donor liver recipients with HBV were included in our study. Preoperative HBV-DNA was positive in 25 patients and negative in the remaining 25. HBIg was first administered during the unhepatic phase of surgery as intravenous (i.v.) bolus and repeated in daily doses as intramusculary (IM) until seroconversion was achieved. Two different low dose HBIg protocols were used for HBV-DNA negative patients. First 15 patients transplanted until January 2006 received 1200 IU HBIg during the operation. From 2006 onwards, 10 patients who were transplanted received 2000 IU HBIg. HBV-DNA positive patients received 5000 IU HBIg during surgery. Until postoperative anti-HBs levels were above 100 mIU/mL and seroconversion was achieved; patients received maintenance doses of HBIg as detailed below: patients with negative preoperative HBV-DNA who received 1200 HBIg preoperative dose received 300 IU/day, those who received 2000 IU had 500 IU/day, those with DNA positivity had 1000 IU/day of maintenance HBIg. Lamivudine was given to all recipients begining on postoperative day 1. RESULTS: Three of 15 patients who were HBV-DNA negative and who received 1200 IU HBIg intraoperatively developed HBV reinfections. The following 10 DNA negative patients who received 2000 IU of HBIg prophylaxis during the operation and those 25 patients who were DNA positive and received 5000 IU HBIg did not have any HBV reinfections. CONCLUSIONS: Higher doses of HBIg plus lamivudine therapy is a very effective prophylactic regimen for recipients with pre-operative HBV-DNA positivity in preventing a recurrent HBV infection. For preoperative HBV-DNA negative patients, low doses of HBIg plus lamivudine therapy is a feasable prophylactic option when ease of use, cost and low incidence of side effects are taken into consideration. However, it is still a controversial issue how much the required lowest dose should be and at the same time safe for prophylaxis.