Is sporadic colorectal cancer more aggressive in young people and should the age of colonoscopy screening be reduced?

OBJECTIVES: The present study aims to report the incidence of colorectal cancer patients under 50 years of age and to compare its aggressiveness with colorectal cancer patients over 50 years of age. BACKGROUND: Recently, the incidence of colorectal cancer at younger ages has increased, and colorectal cancers in young people have a more aggressive course due to late screening programs. METHOD: The files of patients who were operated for colorectal cancer were reviewed retrospectively. Information on the patients such as gender, age, BMI, type and duration of symptoms, location of the tumor, TNM staging, pathology results, operative procedure, morbidity and mortality rates were recorded. Admission complaints, symptom onset time, tumor locations, pathological findings and tumor stages were compared between patients under and over the age of 50. RESULTS: The incidence of colorectal cancer under 50 was 21 % (56/267). The age group of 40‒49 was found to be the most common age range under the age of 50, with a colorectal cancer rate of 68%. In patients under the age of 50, higher invasion of the tumor to the serosa, low differentiation of the tumor in terms of histological findings in a higher number of patients and higher mucin component of the tumors and higher N2 lymph node involvement ratio and the tumor was located more in the lower rectum were statistically significant when compared to patients over the age of 50 (p=0.026, p=0.018, p=0.002, p=0.042, p=0.006; respectively). CONCLUSION: The incidence of colorectal cancer has increased at younger ages and has a more aggressive course. Screening programs should be modified (Tab. 4, Fig. 2, Ref. 45).

Emergency surgery of the abdominal wall hernias: risk factors that increase morbidity and mortality-a single-center experience.

PURPOSE: Morbidity and mortality are higher in urgently operated abdominal hernia cases compared to elective surgeries. The present study aims to investigate the factors that cause increased morbidity and mortality in emergency surgical operations. METHODS: The files of a total of 426 patients who were operated for non-reducible abdominal hernia between 2015 and 2020 were reviewed retrospectively. Patients' ages, genders, comorbidities, Charlson Comorbidity Index (CCI), ASA score, BMI, hernia types, duration of symptom, laboratory values, intestinal strangulations or necroses, whether intestinal resection was performed, whether mesh was preferred for hernia repair, and rates of morbidity and mortality were recorded. Factors affecting morbidity and mortality rates were analyzed. RESULTS: Factors such as gender, BMI (> 30), duration of symptom (> 24 h), presence of bowel necrosis and resection, type of hernia and prolonged operation time were found to cause an increase in morbidity. In the multivariate analysis, however, gender, duration of symptom and BMI (> 30) were statistically significant factors causing increased morbidity (p = 0.009, p < 0.001, p = 0.032, respectively). Advanced age, high ASA scores, CCI and duration of symptom were determined as factors affecting the increase in mortality. In the multivariate analysis, the effect of high ASA scores and advanced age on high mortality rate was statistically significant (p < 0.023, p = 0.039, respectively). CONCLUSIONS: The mortality rate is higher, especially in elderly patients with high comorbidity. Therefore, we argue that the cases of abdominal wall hernia should be operated under elective conditions even if they do not give any clinical findings to prevent problems in older ages.

Changes in VGF and C3aR1 gene expression in human adipose tissue in obesity.

The VGF gene, which has been shown to be metabolically associated with energy balance, glucose homeostasis, insulin secretion process, and biological processes related to overeating, is prominent in relation to obesity. TLQP-21 neuropeptide, derived from the VGF, is considered to promote lipolysis by the beta-adrenergic pathway through targeting the C3aR1 receptor located in the adipocyte membrane. In this study, we aimed to measure the expression levels of the VGF and C3aR1 genes in the adipose tissue of obese subjects and individuals with normal weight determined based on body mass index (BMI), and to reveal the correlation of these levels with obesity. VGF and C3aR1 gene expression levels were measured using Real Time Polymerase Chain Reaction (RT PCR) in the visceral adipose tissue (VAT) samples of 52 obese patients (BMI ≥ 35 kg/m2) and 21 non-obese controls (BMI = 18.5-24.9 kg/m2). The results were statistically analyzed. The VGF expression was lower and the C3aR1 gene expression was higher in obese patients compared to the non-obese control group (p < 0.05). In obese patients, there was a statistically significant positive correlation of 85.6% between VGF and C3aR1, in which when one level increased, the other also increased (p < 0.05, r = 0.856). The findings show that the VGF may be significantly associated with obesity and is very important since it is the first to measure the level of VGF gene expression in human adipose tissue. This research provides new evidence of a link between obesity and VGF/C3aR1 and in the future may help design strategies to combat obesity.

Comparison of elasticity values of the right lobe of the liver of normal weight and morbidly obese Turkish patients.

INTRODUCTION: Shear wave elastography is a method for the measurement of tissue stiffness. The advantage of this method is that its outcome is not operator dependent. Our aim was to compare the elastiscity values of the right lobe of the liver of normal weighted and morbidly obese patients. MATERIALS AND METHODS: The mean elastiscity values of the right lobe of the liver were calculated for 38 normal weighted and 37 morbidly obese patients. All the patients had no history of liver disease. RESULTS: The mean elastiscity value was significantly higher in morbidly obese patients than (25,7 +3,30 kPascal) in normal weighted patients for the right lobe of liver (10,55 +2,20 kPascal). CONCLUSION: Morbidly obese patients have a potential risk for liver fibrosis even in the absence of hepatosteatosis.

Admission after the gold interval in acute calculous cholecystitis: Should we really cool it off?

PURPOSE: The aim of this study was to compare early and delayed cholecystectomy for the treatment of acute calculous cholecystitis (ACC). MATERIALS AND METHODS: The medical records of patients who were diagnosed to have ACC by combined clinical and radiological examination were evaluated retrospectively. The patients were divided into two non-randomized groups according to the duration between the onset of symptoms and cholecystectomy. Group 1 included the patients who underwent cholecystectomy within the first 72 h after the onset of symptoms and Group 2 those who underwent beyond the 72nd hour after the onset of symptoms. RESULTS: We reviewed records for 203 patients. There were 109 patients in Group 1 and 74 patients in Group 2. Access-related complications occurred in four patients. One patient in Group 1 and two patients in Group 2 had trocar site bleeding. In one patient in Group 1, liver trauma occurred. Two patients had bile duct injury in Group 1 as Type D injury according to the Strasberg classification in one patient and E2 injury in other. CONCLUSION: Early cholecystectomy in acute cholecystitis with biliary stones could be performed regardless of time with similar complication, mortality and conversion rates.

Colonoscopic decompression should be used before neostigmine in the treatment of Ogilvie's syndrome.

BACKGROUND: Performance of urgent colonoscopy for the purposes of diagnosis and treatment of Ogilvie's syndrome remains controversial. However, no trials have directly compared neostigmine with endoscopic therapy. This study aimed to compare the effect of neostigmine and colonoscopic decompression in the treatment of Ogilvie's syndrome. METHODS: This study was designed as a retrospective, non-randomized clinical study of sequential patients. Patients who were diagnosed as having acute colonic pseudo-obstruction were separated into two groups after conservative treatment. Group 1 comprised patients who underwent colonoscopic decompression, because they had a poor first response to neostigmine treatment. Group 2 constituted patients who had a poor first response to colonoscopic decompression, and neostigmine was added to the treatment regimen. Groups 1 and 2 were compared for the success of disease management. RESULTS: In groups 1 and 2, the average age of the patients was 63.19 years (±14.71 years) and 59.45 years (±15.31 years) (p = 0.312), respectively. No significant difference was determined between the groups in terms of distribution of sex, hospital stay, etiologies, and initial cecal sizes in imaging (p > 0.05). Response to first intervention was statistically significant (p < 0.01). Also, the total response was determined statistically significant for hospital stay if colonoscopic decompression was performed (p < 0.01). No recurrence was determined during the 1-month follow-up in both groups. Although there was no etiologic factor for neostigmine response according to univariate analysis results, colonoscopic success was decreased due to age, sex, and the presence of a cardiac disease. CONCLUSIONS: Although the success rate of neostigmine treatment was significantly lower in our homogeneous groups, no significant decrease was determined in terms of hospital stay, intensive care unit stay, and requirement of colostomy compared with colonoscopic decompression. By comparison, colonoscopic decompression, which was performed by experienced endoscopists as a first-line treatment option, was more effective as an initial therapy and was more effective at avoiding a second treatment modality.

Serum nectin-2 levels are diagnostic and prognostic in patients with colorectal carcinoma.

INTRODUCTION: Nectins are a family of integral protein and immunoglobulin-like cell adhesion molecules involved in the formation of functioning adherence and tight junctions. Aberrant expression is associated with cancer progression, apoptosis and cell proliferation but little is known how these effects change in cell behavior. The objective of this study was to evaluate the serum levels of nectin-2 with regard to diagnostic, predictive and prognostic value in colorectal cancer (CRC) patients. MATERIALS AND METHODS: One-hundred and forty CRC patients were enrolled in this study. Serum nectin-2 levels were determined by enzyme-linked immunosorbent assay method. Age- and sex-matched 40 healthy controls were included in the analysis. RESULTS: Median age of patients was 60 years old, range 24-84 years. The localization of tumor in majority of the patients was colon (n = 81, 58 %). Non-metastatic (stage II and III) and metastatic patients' baseline serum nectin-2 levels were significantly higher than those in the healthy control group (p < 0.001; for two group). However, known clinical variables including response to CTx (chemotherapy) were not found to be correlated with serum nectin-2 concentrations (p > 0.05). While non-metastatic group patients with elevated serum nectin-2 levels showed significant adverse effect on PFS, metastatic group patients with elevated serum nectin-2 levels showed no significant adverse effect on PFS (p = 0.05 and p = 0.29, respectively). On the other hand, our study results did not show statistically significant serum nectin-2 concentrations regarding overall survival rates. CONCLUSION: Serum levels of nectin-2 may have diagnostic roles for CRC patients. Moreover, our study results show the prognostic role of nectin-2 in non-metastatic group patients.

Is laparoscopic appendectomy going to be standard procedure for acute appendicitis; a 5-year single center experience with 1,788 patients.

PURPOSE: To evaluate whether laparoscopic appendectomy can be the gold standard for acute appendicitis regarding the applicability and cost effectivity. MATERIALS AND METHODS: The study included patients who were operated by laparoscopically for acute appendicitis between January 2008 and September 2012. Patients' sex, ages, hospitalization time, the type for closure of the appendiceal stump, complication rate, surgery time and other parameters were recorded. RESULTS: 1,788 patients with acute appendicitis on laparoscopic evaluation constituted the study population. Average age of the patient group was 30.1 ± 2.3 years old. Average hospitalization time was 1.2 ± 1.1 days. Metal clips were used in 1,100 (61.5%) patients, intracorporeal knotting was performed in the remaining. Total complication rate was 3.8%. CONCLUSION: By the using of metal clips and increased experience; laparoscopy may be gold standard for acute appendicitis.

Is Hashimoto's thyroiditis a prognostic factor for thyroid papillary microcarcinoma?

AIM: The relationship between papillary thyroid carcinoma (PTC) and accompanying Hashimoto's thyroiditis (HT) has been investigated extensively. However, there is no agreement among the authors. We aimed with this study to investigate this relationship in a limited subtype of PTC called papillary thyroid microcarcinoma (PTMC). PATIENTS AND METHODS: Between January 1999 and December 2012, 1923 thyroids were surgically resected in two referral centers and thoroughly inspected for evidence of PTMC. Of these patients, 172 who were diagnosed with PTMC had demographic and pathological features recorded. RESULTS: Fourteen patients (8.1%) were found to have CLN metastases. Eleven (78.6%) of the patients with CLN metastases had tumors larger than 5 mm, and 3 (21.4%) patients with CLN metastases had small tumors (≤ 5 mm), but there was no statistical significance (p > 0.05). Accompanying Hashimoto's thyroiditis (HT) was detected in 67 (39%) patients. The CLN metastasis rate was slightly higher in cases with HT in surrounding thyroid tissue. However, there was no statistical significance; the CLN rate was 6.7% (n=7) in patients without thyroiditis and 10.4% (n=7) with Hashimoto's thyroiditis. Insufficient FNA results in patients with thyroiditis were associated with HT (p < 0.05). CONCLUSIONS: Surgeons and other clinicians who play a role in the treatment of thyroid cancers should be aware that some PTMC cases may show a worse course, as with some PTCs, contrary to expectations.

Acutely incarcerated abdominal wall hernia: what if it is a consequence?

PURPOSE: The aim of this study was to emphasize the importance of differential diagnosis in patients with acutely incarcerated abdominal wall hernia (AWH). METHODS: The medical records of patients who underwent emergency surgery with preoperative diagnosis of acutely incarcerated AWH and in whom acutely incarcerated AWH was the consequence of increased intraabdominal pressure due to other abdominal emergencies were reviewed. The following data were collected: demographics, the duration between the onset of symptoms and admission, clinical findings, biochemical test results that were abnormal, radiological findings, preoperative and intraoperative diagnosis, operative findings, surgical procedure, different diagnosis made in the postoperative period, reoperation, morbidity, mortality, and the length of hospital stay. RESULTS: Ten patients were included to the study. The primary pathology was found to be perforated peptic ulcer disease in three, bowel obstruction due to neoplastic mass in three, complicated appendicitis in two, acute mesenteric ischemia in one, and acute diverticulitis in one. The correct diagnosis was made during emergency surgery for hernia repair, whereas the primary pathology was identified postoperatively in two patients. CONCLUSIONS: Patients who are diagnosed to have acutely incarcerated AWH preoperatively should undergo further diagnostic workup, if any level of clinical suspicion for differential diagnosis is present. Moreover, the surgeon should consider general abdominal exploration if contradictory findings are encountered during the exploration of the hernia sac, even if preoperative diagnostic studies reveal no gross pathology or non-specific findings.

The impact of early diagnostic laparoscopy on the prognosis of patients with suspected acute mesenteric ischemia.

PURPOSE: To assess the impact of early diagnostic laparoscopy in patients with suspected acute mesenteric ischemia in whom other diagnostic studies are inconclusive or unavailable. METHODS: The medical records of patients who underwent diagnostic laparoscopy with a preoperative diagnosis of acute mesenteric ischemia between January 2008 and January 2012 were reviewed. The patients who had a preoperative diagnosis of acute mesenteric ischemia based on computed tomography or angiography were excluded. Outcome variables were the time between admission and diagnostic laparoscopy, overall revascularization rate, successful revascularization rate, and in-hospital mortality rate. RESULTS: Fifty-three patients were included in the study. Twelve patients (22.6 %) had negative diagnostic laparoscopy. In 43 patients (77.4 %) who were found to have acute mesenteric ischemia at diagnostic laparoscopy, the mean time between admission and diagnostic laparoscopy, overall revascularization rate, successful revascularization rate, and in-hospital mortality rate were 10.2 h, 32.5 %, 13.9 %, and 74.4 %, respectively. The mean time between admission and diagnostic laparoscopy was significantly shorter in patients who underwent successful revascularization, and in those who survived with or without developing short bowel syndrome. CONCLUSIONS: Diagnostic laparoscopy is a safe and reliable diagnostic tool that can have a positive impact on the prognosis of patients with suspected acute mesenteric ischemia if carried out in a timely manner when radiological diagnostic studies are inconclusive or unavailable.

Metal endoclips for the closure of the appendiceal stump in laparoscopic appendectomy.

Closure of the appendiceal stump in laparoscopic appendectomy is the most crucial part of the procedure. In this retrospective clinical study, we describe a technique for laparoscopic appendectomy, in which the appendiceal stump is secured by metal endoclips. Medical data of the patients who underwent laparoscopic appendectomy for acute appendicitis between January 2005 and January 2011 at our institution were reviewed. The patients who had their appendiceal stump secured by metal endoclips were recruited for the study. The outcome measures were the rate of intraoperative and postoperative complications, operative time, and the length of hospital stay. A total of 233 patients were included to the study. The rate of intraoperative and postoperative complications, the mean operative time, and median length of hospital stay were 3 and 4%, 31.1 (15-75) min, and 18 (8-96) h, respectively. The closure of the appendiceal stump with metal endoclips in laparoscopic appendectomy is simple, quick, and safe with outcomes comparable to those of other methods.

Cervical segment nervus vagus neurofibroma with associated neurofibromatosis type 1: a case report.

INTRODUCTION: Neurofibroma occurs as an isolated or multiple lesions frequently associated with neurofibromatosis type 1 (NF-1). Neurofibroma is a benign peripheral nerve sheath tumor composed of a variable mixture of Schwann, perineurial-like, and fibroblastic cells, as well as ones with features intermediate between these various cells, immersed in a collagenous or myxoid matrix. CASE REPORT: A 10-year-old boy visited the outpatient clinic with complaints of swelling and pain on the left side of his neck, which has been present for a year. A mass was discovered adjacent to the left internal carotid artery (ICA) and was removed by a microsurgical technique. No postoperative neurological deficit was identified and the pathological diagnosis was once more reported as neurofibroma. DISCUSSION: Nerve sheath tumors may be observed in patients with von Recklinghausen's disease, although vagal neurofibromas are noted more frequently than schwannomas among these patients. For unknown reasons, neoplasms associated with von Recklinghausen's disease occur more frequently on the right side. Cervical vagal neurofibromas most often present as asymptomatic, slowly enlarging, lateral neck masses. When symptoms are observed, hoarseness is the most common. Dysphonia, dyspnea, dysphagia, cough, syncopal episodes, tongue weakness and atrophy, and Horner's syndrome have also been reported as presenting complaints.

Hydatid cysts in uncommon locations in the same patient: simultaneous cardiac and spinal involvement.

INTRODUCTION: The spine and cardiac cavities are uncommon locations for hydatid disease. Spinal and cardiac hydatid cases separately constitute only 0.5-1% of all hydatid cases. We reported a case with spinal and cardiac involvement simultaneously. Clinical and radiological findings of this unique case are discussed. CASE REPORT: A thirty-four-year-old male patient was admitted to hospital with pain at the low back and left thigh. He had undergone surgery for lumbosacral hydatidosis twice before. Cysts had been removed totally in the last operation. The disease relapsed with widespread involvement of the sacropelvic region. During the investigation, we diagnosed a cyst in the cardiac cavity, incidentally. The cyst in the cardiac cavity was removed totally. DISCUSSION: Hydatid disease is still an endemic disease in South America and some Mediterranean countries including Turkey. Cysts rarely involve the spine and cardiac cavities. The simultaneous involvement of the sacropelvic region and the cardiac cavity is an extremely rare condition. Cardiac cysts have a poor prognosis. Prompt surgical extraction of the cyst is a critical mainstay of the management.

Effect of taurine on oxidative stress and apoptosis-related protein expression in trinitrobenzene sulphonic acid-induced colitis.

Ulcerative colitis (UC) is a multi-factorial inflammatory disease of the colon and rectum. The present study was undertaken to investigate the effect of taurine, an anti-oxidant amino acid, on oxidative stress and the expression of apoptosis-related proteins, pro-apoptotic Bax and anti-apoptotic B cell lymphoma-2 (Bcl-2) in colon tissue in rats with 2,4,6-trinitrobenzene sulphonic acid (TNBS)-induced colitis. Rats received taurine (1.5% w/v) in drinking water for 15 days before and 15 days after administration of TNBS solution. Then, colonic myeloperoxidase (MPO) activity, malondialdehyde (MDA) and glutathione (GSH) levels, and Bax and Bcl-2 expression were measured. TNBS-induced colitis caused significantly increased MPO activity and MDA levels and decreased GSH levels in colon tissue compared to controls. Increase in Bax expression and decrease in Bcl-2 expression were detected in colon of rats with TNBS-induced colitis. Taurine treatment was associated with amelioration in macroscopic and microscopic colitis scores, decreased colonic MPO activity and MDA levels and increased GSH levels in TNBS-induced colitis. In addition, taurine reduced the expression of Bax and prevented the loss of Bcl-2 proteins in colon tissue of rats with TNBS-induced colitis. The results of this study show that taurine administration may exert beneficial effects in UC by decreasing inflammatory reactions, oxidative stress and apoptosis.

Surgical intervention may not always be required in gossypiboma with intraluminal migration.

Gossypiboma is the technical term for a retained surgical sponge. Because of legal-ethical concerns, there have not been many publications on this topic. Delays in diagnosis and treatment might increase mortality and morbidity. Radiological imaging is used in diagnosis. We present a case of gossypiboma that had fistulized to bulbous following hydatic cyst surgery. We established the diagnosis with endoscopy and followed its migration endoscopically.

Successful therapy combined with surgery for severe post-transplant nocardiosis.

We report a case of a 35-year-old man with nocardiosis infection involving soft tissue and the central nervous system who had received a cadaveric donor kidney. The patient was admitted with fever, malaise and right shoulder pain. Soft tissue abscess was seen on ultrasound examination. It was presumed due to gram (+) microorganisms, so 4 g day (IV) ampicillin/sulbactam was started empirically once the abscess was drained. Nocardia asteroides was found in the pus specimen. On the second day in hospital, severe headache, ataxia and signs of meningeal irritation appeared. The cranial CT showed two intracranial abscesses in the frontal lobe and cerebellum. We assumed Nocardia asteroides was the infective agent for the cerebral abscesses, so antibiotic therapy was switched to trimethoprim-sulphamethox-asole (3x160/800 mg/d). Nausea and vomiting occurred on the fifth day of therapy, improving after drainage from the frontal abscess. However, these complaints recurred five days later. CT showed cerebellar abscess had become bigger. The patient's complaints improved after the second surgical drainage. N. asteroides was again grown in the aspiration fluids of both cerebral abscesses. Complete regression of the abscesses was seen in the CT after two months. Co-trimoxazole was continued for six months then withdrawn. Graft dysfunction was not observed. Early medical and surgical interventions may be life-saving in this potentially lethal disease.