Effect of preoperative skeletal muscle area and prognostic nutritional index values on postoperative morbidity and mortality in patients with gastric cancer: a single-center retrospective analysis.

INTRODUCTION: The aim of this study was to determine the impact of preoperative prognostic nutritional index (PNI) value and skeletal muscle area (SMA) on short-term outcomes of patients with gastric cancer. PATIENTS AND METHODS: A total of 107 patients underwent gastrectomy due to gastric cancer between January 2016 and December 2019 were retrospectively analyzed. The patients were divided into groups according to the determined PNI and SMA cutoff values. Clinicopathological features and short-term results were compared. RESULTS: Overall morbidity was 29% (n = 31) in patients who underwent gastrectomy. Preoperative PNI value was ranged from 24.5 to 61.5 (median, 49.5). Preoperative SMA values were ranged respectively from 55.7 to 142 (median, 98.9) in women and 77.5 to 203.3 (median, 129.3) in men. It was observed that the risk of postoperative complications increased in patients with low PNI (OR 0.270, p = .003). The average postoperative length of hospital stay was 12.1 days. The longer postoperative hospital stay was seen in lower PNI group (PNI ≤ 48, 15.1 days vs. PNI> 48, 10 days; p = .033). Clavien-Dindo classification was high in patients with low PNI and sarcopenia (PNI ≤ 48, p = .004 and Sarcopenia, p = .006). Likewise, mortality was significantly increased in patients with low PNI and sarcopenia (PNI ≤ 48, 20% vs. PNI > 48, 0%; p < .001 and Sarcopenia, 13.7% vs. Nonsarcopenia, 3.6%; OR 0.233, p = .053). CONCLUSIONS: As a result, preoperative SMA and PNI values were found closely related to the postoperative hospital stay, morbidity and mortality results of patients with gastric cancer. Preoperative nutritional support may help to overcome longer hospital stay, higher mortality and morbidity rates in patients with gastric cancer.

Risk Factors for the Morbidity and Mortality of Stoma Closure.

OBJECTIVE: To identify the risk factors for postoperative complications of stoma closures. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of General Surgery, Izmir University of Health Sciences, Tepecik Training and Research Hospital, Izmir Turkey from October 2008 to December 2018. METHODOLOGY: A total of 179 patients were divided into two groups according to presence or absence of postoperative complications. Differences between these two groups were analysed with tests of proportion; p <0.05 value was considered statistically significant. The results are reported as odds ratios (ORs) with 95% confidence interval (CI). RESULTS: The median age of the patients with postoperative complications was 57.00 (40.00-67.00) and 30/55 (54.5%) of them were males. American Society of Anesthesiology (ASA) score and coronary artery disease had significant association with postoperative complications of stoma closure (p=0.033, p=0.024). Although colostomy was not associated with presence of postoperative complications, but when the authors analysed correlations of colostomy with postoperative complications separately, it was found that colostomy was a risk factor for postoperative ileus (OR 0.257, 95% CI 0.081-0.821; p= 0.026). CONCLUSION: ASA score and coronary artery disease should be considered as risk factors for complications of stoma closure. Colostomy should be considered as a risk factor for postoperative ileus. Key Words: Colostomy, Ileostomy, Stoma closure, Risk factors.

Ectopic ureter associated with Zinner's syndrome in a kidney recipient: case report and literature review.

INTRODUCTION Zinner's Syndrome is a triad of mesonephric duct anomalies comprising unilateral renal agenesis, seminal vesicle cyst, and ejaculatory duct obstruction. In this study, we present a kidney recipient with ectopic ureter associated with Zinner's syndrome and a literature review. CASE PRESENTATION A 59-year-old male with a history of chronic kidney disease and left renal agenesis underwent deceased donor kidney transplantation. After securing optimal renal functions, the patient underwent abdominal computed tomography (CT) scan for the seroma that occurred under the incision. The final diagnosis was an ectopic distal ureter ending in the seminal vesicle cyst's wall and ipsilateral renal agenesis. The patient was discharged without any complications and the clinical follow up was uneventful. DISCUSSION AND CONCLUSION Congenital seminal vesicle disorders are usually associated with ipsilateral urinary duct anomalies stemming from the same embryonic structure. To our knowledge, this is the first case report that describes kidney transplantation in a patient with ipsilateral renal agenesis and ectopic ureter ending in the seminal vesicle cyst. In patients with renal agenesis, during the ipsilateral urinary tract anastomosis, the possibility of ectopic ureter should be kept in mind otherwise graft loss can occur with a high morbidity rate.

Ectopic ureter associated with Zinners syndrome in a kidney recipient: case report and literature review

SUMMARY INTRODUCTION Zinner's Syndrome is a triad of mesonephric duct anomalies comprising unilateral renal agenesis, seminal vesicle cyst, and ejaculatory duct obstruction. In this study, we present a kidney recipient with ectopic ureter associated with Zinner's syndrome and a literature review. CASE PRESENTATION A 59-year-old male with a history of chronic kidney disease and left renal agenesis underwent deceased donor kidney transplantation. After securing optimal renal functions, the patient underwent abdominal computed tomography (CT) scan for the seroma that occurred under the incision. The final diagnosis was an ectopic distal ureter ending in the seminal vesicle cyst's wall and ipsilateral renal agenesis. The patient was discharged without any complications and the clinical follow up was uneventful. DISCUSSION AND CONCLUSION Congenital seminal vesicle disorders are usually associated with ipsilateral urinary duct anomalies stemming from the same embryonic structure. To our knowledge, this is the first case report that describes kidney transplantation in a patient with ipsilateral renal agenesis and ectopic ureter ending in the seminal vesicle cyst. In patients with renal agenesis, during the ipsilateral urinary tract anastomosis, the possibility of ectopic ureter should be kept in mind otherwise graft loss can occur with a high morbidity rate.

RESUMO INTRODUÇÃO A Síndrome de Zinner é uma tríade de anomalias do ducto mesonéfrico que compreende agenesia renal unilateral, cisto da vesícula seminal e obstrução do ducto ejaculatório. Neste estudo, apresentamos um receptor de rim com ureter ectópico associado à Síndrome de Zinner e revisão da literatura. APRESENTAÇÃO DO CASO Homem de 59 anos com história de doença renal crônica e agenesia renal esquerda foi submetido a transplante de rim de doador falecido. Após função renal ideal, foi realizada tomografia computadorizada do abdome (TC) devido ao seroma sob incisão. O diagnóstico final foi um ureter distal ectópico que termina na parede do cisto da vesícula seminal e agenesia renal ipsilateral. O paciente recebeu alta sem complicações e o acompanhamento clínico ocorreu sem intercorrências. DISCUSSÃO E CONCLUSÃO Os distúrbios congênitos da vesícula seminal geralmente estão associados às anomalias do ducto urinário ipsilateral devido a uma mesma estrutura embrionária. Até onde sabemos, é o primeiro relato de caso que descreve o transplante renal em um paciente com agenesia renal ipsilateral e ureter ectópico terminado no cisto da vesícula seminal. Em pacientes com agenesia renal, durante a anastomose do trato urinário ipsilateral, deve-se ter em mente a possibilidade do ureter ectópico, caso contrário, poderá ocorrer perda do enxerto com alta taxa de morbidade.

Robotic-Assisted Transthoracic Esophageal Diverticulectomy.

INTRODUCTION: Esophageal diverticulum is a rare entity with symptoms that include dysphagia, halitosis, chest pain, and regurgitation. Indications for surgery include the presence of any of these symptoms and a diverticulum larger than 3 cm because of the increased risk of malignancy and aspiration. Treatment is open or minimally invasive surgery performed from the transhiatal or transthoracic approach. CASE DESCRIPTION: Three patients were investigated by esophagogastroduodenoscopy, esophageal manometry, and computed tomography and were given the diagnosis of epiphrenic diverticulum of the esophagus. MANAGEMENT AND OUTCOME: The patients underwent robot-assisted surgery by a transthoracic approach for esophageal diverticulectomy. The mean operative time was 211 min, with no significant blood loss or intraoperative complications. DISCUSSION: This report of robot-assisted surgery for esophageal diverticulectomy from a transthoracic approach adds to the literature regarding surgical treatment of epiphrenic esophageal diverticulum. It is a feasible method that can be used in selected patients with esophageal diverticulum.

Fatigue in the mothers of children with cerebral palsy.

PURPOSE: To evaluate fatigue in the mothers of children with cerebral palsy (CP), and to determine its associations with clinical parameters of CP, depression and quality of life (QoL). METHOD: Ninety children (50 girls and 40 boys) with spastic CP and their mothers were included. Control group comprised mothers of healthy children. Gross motor function classification system (GMFCS) was used for determining functional status. Spasticity was evaluated by using modified Ashworth scale. Fatigue symptom inventory (FSI) was used for assessing maternal fatigue, Nottingham health profile (NHP) for maternal QoL, and Beck Depression Scale (BDS) for maternal depression. RESULTS: Mothers of children with CP scored significantly higher in all FSI subgroups (intensity of fatigue, duration of fatigue and interference with QoL), all NHP subgroups and BDS (p < 0.05) when compared with controls. FSI was found to be correlated with BDS and all subgroups of NHP (p <  0.01). No association was found between FSI and clinical parameters of children with CP including age, gender, type of CP, tonus and functional impairment (p > 0.05). CONCLUSIONS: Our findings indicate that fatigue levels of mothers with CP children are higher than those with healthy children and associated with depression and deterioration in QoL in terms of physical, social and emotional functioning. This should be considered while designing a family centred rehabilitation programme for children with CP. Implications for Rehabilitation Caring for a child with cerebral palsy has psychological, social and financial impacts on familiesand is associated with increased levels of fatigue among mothers. The capacity of current programs and services needs to be strengthened to accommodate theneeds of children with CP and their mothers in order to reduce fatigue of mothers. New programs need to be developed to provide psychosocial support for the mothers andto reduce their fatigue as they continue to care for their children. Provision of assistive technology devices (particularly suitable wheelchairs) will be useful inreduction of fatigue levels of mothers.

The impact of smoking status on antioxidant enzyme activity and malondialdehyde levels in chronic periodontitis.

BACKGROUND: The aim of this study is to investigate the impact of smoking status on the systemic and local superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) activities and malondialdehyde (MDA) levels in subjects with chronic periodontitis (CP). METHODS: Sixty-five CP patients (23 smokers [CP-S], 23 former smokers [CP-FS], and 19 non-smokers [CP-NS]) and 20 periodontally healthy non-smoker controls (PH-NS) were included in the study. After the clinical measurements, serum and gingival tissue samples were collected. SOD, GSH-Px, and CAT activities and MDA levels in hemolysates and gingival tissue samples were spectrophotometrically assayed. RESULTS: Blood MDA levels in all the periodontitis groups were higher than in the PH-NS group but only the difference between CP-FS and PH-NS groups was significant (P <0.01). Gingival tissue MDA levels in the periodontitis groups were significantly higher than that in the control group (P <0.01). However, the control group had the highest gingival SOD, GSH-Px, and CAT activities compared with all the periodontitis groups (P <0.01). The CP-S group had the highest gingival MDA levels and SOD, GSH-Px, and CAT activities among the periodontitis groups, whereas the lowest values were observed in the CP-NS group (P <0.01). The blood and gingival MDA levels in the CP-FS group were similar in the CP-NS group, whereas they were lower than in the CP-S group. CONCLUSIONS: Systemic and local MDA levels are increased by smoking in addition to the impact of periodontitis. The decreased local SOD, GSH-Px, and CAT activities observed in periodontitis patients may increase with smoking.

Does the periodontal health of thalassemia major patients have an impact on the blood lipid profiles? A preliminary report.

Cardiac symptoms and premature death from cardiac causes are still suggested to be a major problem in thalassemic patients. One of the main reasons for the cardiovascular events in thalassemia major (TM) patients has suggested having iron overload, in addition to other reasons such as hypoxia, abnormal lipoproteins levels, atherosclerotic conditions, etc. This study aims to investigate whether the periodontal health has an impact on the blood lipid levels. Twenty-four TM patients and sex-matched controls (C) enrolled to this study. The measurements of the periodontal parameters (gingival index, plaque index, bleeding on probing, probing depth, and clinical attachment level) were recorded. Besides, in venous blood samples the lipid profile was investigated. All of the periodontal parameters were significantly higher in TM group than in C group (P<0.05). Triglyceride and cholesterol/high density lipoprotein ratio had significant positive correlations with the periodontal parameters (P<0.05). Multiple regression analyses present significant associations between gingival index, plaque index scores, and the cholesterol/high density lipoprotein ratio (P<0.001). Our study results showed that the lipid profile of TM patients might be affected by their periodontal health. Further studies are needed to determine the lipid profile involvement magnitude and the cardiovascular disease risk caused by the periodontal health of TM patients.