Early postoperative changes of sphingomyelins and ceramides after laparoscopic sleeve gastrectomy.

BACKGROUND: This study aimed to determine early postoperative changes of serum sphingomyelin (SM) and ceramide (CER) species following laparoscopic sleeve gastrectomy (LSG). METHODS: Twenty obese patients [mean body mass index (BMI) 45,64 ± 6,10 kg/m2] underwent LSG and normal weight control patients (mean BMI 31,51 ± 6,21 kg/m2) underwent laparoscopic cholecystectomy. Fasting blood samples were collected prior to surgery, at day 1 and day 30 after surgery. Circulating levels of C16-C24 SMs, C16-C24 CERs and sphingosine-1-phosphate (S1P) were determined by an optimized multiple reaction monitoring (MRM) method using ultra fast-liquid chromatography (UFLC) coupled with tandem mass spectrometry (MS/MS). Serum activity of neutral sphingomyelinase (N-SMase) was assayed by standard kit methods, and ceramide-1-phosphate (C1P) levels were determined by enzyme-linked immunosorbent assay (ELISA). Lipid profile, routine biochemical and hormone parameters were assayed by standard kit methods. Insulin sensitivity was evaluated using homeostatic model assessment for insulin resistance (HOMA IR). RESULTS: A significant decrease was observed in serum levels of very-long-chain C24 SM, very-long-chain C22-C24 CERs, HOMA-IR, N-SMase and C1P in LSG patients after postoperation day 1 and day 30 compared to preoperation levels. At 30 days postsurgery, BMI was reduced by 11%, fasting triglycerides were significantly decreased, and insulin sensitivity was increased compared to presurgery values. A significant positive correlation was found between HOMA-IR and serum levels of C22-C24 CERs in LSG patients. CONCLUSION: We conclude that very long chain CERs may mediate improved insulin sensitivity after LSG.

The effect of rs9939609 FTO gene polymorphism on weight loss after laparoscopic sleeve gastrectomy.

PURPOSE: Remarkable differences in weight loss have been observed in obese patients undergoing laparoscopic sleeve gastrectomy (LSG). These high variations might be partly explained by genetic factors. The rs9939609 fat mass and obesity-associated gene (FTO) polymorphism has been implicated in the susceptibility of obesity. We aimed to explore the effects of the rs9939609 FTO gene polymorphism on weight loss among severely obese patients applying for LSG. MATERIALS AND METHODS: All individuals were analyzed for the FTO rs9939609 gene polymorphism. A total of 74 morbid obese patients (20 male, 54 female) were operated. Body weight and body mass index (BMI) were measured at before LSG and after surgery at the sixth month. RESULTS: Twenty-eight patients (37.8%) had genotype TT (wild-type allel), 36 patients (48.6%) had genotype TA, and 10 patients (13.5%) had genotype AA. In both wild-type group and mutant group, BMI and weight levels decreased at the sixth month after surgery. Percent of excess weight loss (EWL) at 6 months of follow-up was similar in both groups. There were no differences between the mutant and wild-type groups percent of EWL at the sixth month after applying LSG. CONCLUSION: Our data showed that the rs9939609 FTO gene polymorphism is not a useful genetic test prior to LSG to help clinicians predicting the weight loss for severely obese patients in short-term follow-up.

Why scientists perform animal experiments, scientific or personal aim?

OBJECTIVE: Although all animal studies are conducted in line with a specific purpose, we think that not all animal studies are performed for a scientific purpose but for personal curiosity or to fulfill a requirement. The aim of the present study is to reveal the purposes of experimental studies conducted on animals. MATHERIAL AND METHODS: We searched for experimental studies performed on rats in general surgery clinics via PubMed, and obtained the e-mail addresses of the corresponding authors for each study. Afterwards, we sent a 7-item questionnaire to the authors and awaited their responses. RESULTS: Seventy-three (22.2%) of 329 authors responded to the questionnaire. Within these studies, 31 (42.5%) were conducted as part of a dissertation, while the remaining 19 (26.0%) were conducted to meet the academic promotion criteria. Only 23 (31.5%) were conducted for scientific purposes. The cost of 41% of those studies was higher than 2500 $. CONCLUSION: As shown in this study, the main objective of carrying out animal studies in Turkey is usually to prepare a dissertation or to be entitled to academic promotion. Animal experiments must be planned and performed as scientific studies to support related clinical studies. Additionally, animal studies must have well-defined objectives and be carried out in line with scientific purposes that may lead to useful developments in medicine, rather than personal interests.

Methods for closure of appendix stump during laparoscopic appendectomy procedure.

The most frequent abdominal pathology requiring emergent surgery is acute appendicitis. Laparoscopic appendectomy has been performed for the treatment of acute appendicitis since 1983. Closure of the appendix stump is vital to prevent severe postoperative complications. Different methods are described for closure such as stapler, endoloop, titanium clips, non-absorbable polymer clips (hem-o-lok clip), handmade loops, transsection by Ligasure or with bipolar cautery. The ideal method should be safe, applicable and cheap. The most appropriate method remains to be controversial. All methods are reported as safe, but some have higher costs, and some prolong the operation. In this article, we reviewed clinical and experimental studies on different methods of stump closure, and we tried to compare the benefit of these methods over others.

Most cited articles in general surgery from Turkey.

OBJECTIVE: The citation number of an article gives us information about its quality and contribution to science. In this article, we aimed to find the most frequently cited article in general surgery from Turkey, and evaluate how these articles in general surgery contributed to the world literature. MATERIAL AND METHODS: We used the science citation index expanded database to find the most frequently cited articles in general surgery from Turkey. RESULTS: Among the 52 articles found, the most common subjects were as follows: hydatid cyst (21.1%), pilonidal disease (15.4%), laparoscopic operations (15.4%), breast diseases (11.5%), and inguinal hernia (7.7%). Two articles were cited in more than 100 articles. Furthermore, 48.8% of the articles were published from three major cities. Most articles were published between 2000 and 2004, and 65.4% of articles were case series. CONCLUSION: Most of the cited articles were about hydatid cyst and pilonidal disease, which are more common in the Turkish population compared with other countries. Evaluation of most cited articles is important to identify the fields in which Turkey contributes to the world literature.

The approach of general surgeons to the use of vessel sealing device in thyroid surgery.

OBJECTIVE: Vascular sealing devices (VSD) can be safely used in thyroid surgery. The purpose of this survey was to investigate general surgeons' approach to the use of VSD in thyroid surgery in Turkey. MATERIAL AND METHODS: A questionnaire containing 10 items was prepared and announced via the Dialogue in Endocrinology Society website. The results were then analyzed. RESULTS: Fifty surgeons (65.8%) stated that they always use VSD, 20 (26.3%) stated that they sometimes use these devices and six (7.9%) declared that they never use VSD. Thirty-six surgeons (47.4%) reported that they use ligation all the time, and 42 (55.3%) stated that upper pole vessels should be ligated at least once. Twenty two point four percent of the responders stated that they faced a complication, which they thought was related to VSD. CONCLUSION: The vast majority of surgeons routinely uses VSD and accepts it as a safe tool. However, the observed complication rate was very high.

The diagnostic significance of trophoblast cell-surface antigen-2 expression in benign and malignant thyroid lesions.

CONTEXT: Thyroid cancers are the most common malignancy of the endocrine system. Over-expression of trophoblast cell-surface antigen 2 (TROP-2) in various tumors has been found to correlate with poor prognosis and aggressive tumor behavior. AIMS: The aim of this study was to evaluateTROP-2 expression in thyroid neoplasms. SUBJECTS AND METHODS: This study contained 152 cases, including 48 follicular nodular disease (FND), 29 follicular adenoma (FA), 57 papillary thyroid carcinoma (PTC), 12 follicular thyroid carcinoma (FTC), 3 medullary thyroid carcinoma (MTC), 2 poorly differentiated thyroid carcinoma (PDTC) and 1 undifferentiated thyroid carcinoma (UDTC). TROP-2 expression was investigated via immunohistochemistry in sections prepared from paraffin blocks of the cases. RESULTS: The cases comprised 32 (21%) males and 120 (79%) females with a mean age of 46.8 years (range, 15-85 years). TROP-2 expression was observed in 74.6% of the malignant lesions of the thyroid except for medullary carcinoma, poorly differentiated and undifferentiated thyroid carcinoma. Immunoreactivity was 3.4% in FA, 41.7% of cases with FTC and 81.8% in PTC follicular variant (PTC fv). The difference between FA/FTC and FA/PTC follicular variant were both significant (P < 0.005, P < 0.001, respectively). There was no difference between FTC/PTC fv (P = 0.089). CONCLUSION: TROP-2 can be considered a useful marker for distinguishing PTC fv cases from follicular nodular disease and follicular adenoma cases because of its high sensitivity in the identification of papillary carcinomas of the thyroid.

Effects of different intraabdominal pressure levels on oxidative stress markers in laparoscopic cholecystectomy.

OBJECTIVE: To evaluate the effect of laparoscopic cholecystectomy performed under different intraabdominal pressure on oxidative stress markers. MATERIAL AND METHODS: This prospective, randomized, controlled study examined 90 consecutive healthy patients who underwent elective laparoscopic cholecystectomy with the diagnosis of symptomatic cholelithiasis. The patients were divided into three groups, 30 patients in each. Group 1 included patients who underwent laparoscopic cholecystectomy at a CO2 pneumoperitoneum pressure of 7 mmHg, Group 2 patients who underwent laparoscopic cholecystectomy at a CO2 pneumoperitoneum pressure of 10 mmHg, and Group 3 patients who underwent laparoscopic cholecystectomy at a CO2 pneumoperitoneum pressure of 13 mmHg. Blood samples were collected preoperatively, perioperatively, and postoperatively for measurement of the serum levels of ischemia modified albumin and an analysis of total antioxidant status and total oxidant status. Intra-group comparisons were made. RESULTS: Group 1 experienced a significant increase in the postoperative ischemia modified albumin values compared to preoperative ischemia modified albumin values (p=0.013). Group 2 experienced a significant decrease in the perioperative total antioxidant status values compared to preoperative and postoperative total antioxidant status values (p=0.009). Group 3 experienced a significant increase in the perioperative total oxidant status and oxidative stress index values compared to preoperative values (p<0.001). Group 3 experienced a significant increase in the perioperative and postoperative ischemia modified albumin values compared to preoperative values (p<0.001). CONCLUSION: Increased levels of oxidative stress markers were detected in patients who underwent laparoscopic cholecystectomy at a high intraabdominal pressure level.

Analysis of the publishing rate and the number of citations of general surgery dissertations.

OBJECTIVE: A dissertation is a scientific document. However, if it is not published in a scientific journal, it will gain access to only a limited audience and thus will be unable to achieve its objective. Nevertheless, the rate of publishing in journals is not high among dissertations. In this study, we aimed to investigate the publishing rates of general surgery dissertations in journals and the total number of citations. MATERIAL AND METHODS: All medical dissertations that have been prepared at general surgery departments of university hospitals and presented between the years 2006 and 2008 were analyzed. The authors checked whether the dissertations were published in a journal or not, by searching the dissertation in 4 different resources with the name of their authors. RESULTS: Two hundred and thirty-two dissertations were included. Half of those dissertations were experimental animal studies. Seventy dissertations were published in various journals. Fifty one (22%) of these were published in Science Citation Index Expanded journals, while 19 (8.1%) of them were published in Turkish non-Science Citation Index Expanded journals. There was no significant difference in terms of publishing rates between study types. The number of annual citations per article was 1.1. The writer of the dissertation was the first author in 35 (68,6%) articles. CONCLUSION: The publishing rates of dissertations in general surgery is low, with only 22% being published in Science Citation Index Expanded journals. The citation rate was also detected to be low in our study. Consequently, a dissertation should be considered as a scientific research study and planned as such, not as obligatory assignments. The publishing rates of dissertations should be increased, and authors should be led and encouraged to publish their dissertations.

Effects of bariatric surgery on urinary incontinence.

INTRODUCTION: Obesity is an important modifiable etiological factor associated with several diseases. There is strong evidence that urinary incontinence (UI) is positively correlated with body mass index (BMI). AIM: One of the many benefits experienced by obese patients after bariatric surgery is decrease in UI. To investigate this correlation, we aimed to examine the effects of weight loss on UI in female patients who had undergone laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS: Obese female patients (n=120), ≥18 years of age, and planning to undergo LSG were included in this prospective study. We administered the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) and Incontinence Impact Questionnaire (IIQ-7) to the patients prior to surgery and 6 months after the surgery. Using the collected data, we determined the incidence of UI and examined the relationship between the preoperative and postoperative BMI and UI values. RESULTS: The mean age of the patients was 39.19 (standard deviation [SD] =9.94) years and the mean preoperative BMI was 46.17 (SD =5.35). Of the 120 patients, 72 (60%) complained of UI preoperatively. Among these 72 patients, 23 (31.95%) described urge incontinence, 18 (25%) stress incontinence, and 31 (43.05%) mixed-type incontinence. At 6 months postoperatively, the percentage of excess weight loss was 70.33% (SD =14.84%). For all three UI subtypes, the 6-month postoperative ICIQ-UI-SF and IIQ-7 scores decreased significantly compared to the preoperative scores (P<0.05). CONCLUSION: LSG results in a clinically significant improvement in most common types of UI, regardless of patient reproductive history, existence of comorbid conditions, and smoking status.

Expression of claudin 1, 4 and 7 in thyroid neoplasms.

The distinction of thyroid carcinoma from benign thyroid neoplasm, as well as the subtyping of papillary carcinoma (PC) and follicular carcinoma (FC), may be performed histopathologically in the majority of cases. However, in certain cases, it is difficult to histopathologically distinguish between PC and FC, as well as follicular adenoma (FA), FC and the dominant nodule of multinodular goiter (MNG-DN). The present study aimed to determine the roles of the expression levels of the tight junction proteins claudin 1, 4 and 7 in the differential diagnosis of PC, FC, FA, MNG-DN, medullary carcinoma (MC) and anaplastic carcinoma (AC). The current study included 114 cases of histopathologically diagnosed thyroid neoplasia, which were distributed as follows: 29 FA, 18 MNG-DN, 47 PC, 10 FC, 5 MC and 5 AC. The expression levels of claudin 1, 4 and 7 were examined using immunohistochemical methods. The results revealed a significant difference in claudin 1 expression between malignant and benign thyroid neoplasms (P<0.001). Claudin 1 expression was not detected in any of the MNG-DN cases, and no significant difference in claudin 1 expression levels was identified between FA and FC (P=0.653). However, a statistically significant difference was observed between FC and PC (P<0.001). Claudin 4 expression did not differ between malignant and benign thyroid neoplasms, neither between MNG-DN, FA and FC, nor between FC and PC (P=0.068, P=0.502 and P=0.481, respectively). Claudin 7 exhibited positive immunohistochemical staining in 107 patients (94%); however, no significant difference in claudin 7 expression §levels was identified between malignant and benign thyroid neoplasms among MNG-DN, FA and FC (malignant, P=0.135; benign, P=0.470). Claudin 7 exhibited positive staining in all PC and FC cases. Therefore, claudin 1 expression levels may be useful in distinguishing cases of FC and PC with overlapping histopathological features, and provide a novel immunohistochemical marker for the subtyping of thyroid carcinoma.

The scolicidal effects of honey.

Echinococcosis is a zoonosis that is caused by adult or larval tapeworms belonging to the genus Echinococcus. Until now, no studies have sought to determine the scolicidal effects of honey. Therefore, the present study was undertaken to explore the scolicidal effects of honey in different concentrations for various exposure times. Tubes that contained at least 500 protoscolices were supplemented with 1%, 5%, 10%, 25%, and 50% concentrations of honey. Tubes were maintained at room temperature for 0.5, 1, 2, 3, 4, 5, and 10 min. At the end of the incubation times, the viability of protoscolices was assessed through a trypan blue exclusion test. The effective dose of honey was applied intraperitoneally to determine whether it caused an anaphylactic reaction or hyperglycemia. Honey concentrations of 10% or greater killed all protoscolices. The scolicidal effects of honey began at the end of the third minute. Honey did not cause adverse effects when applied intraperitoneally. In this study, an investigation of the scolicidal effects of honey showed that it is highly effective at a 10% concentration. On the basis of in vivo study results, the investigators concluded that honey is a potent scolicidal agent.

Incidental gastric glomus tumor after laparoscopic sleeve gastrectomy.

Gastric glomus tumors (GGTs) are unusual benign, subepithelial, mesenchymal neoplasms of modified smooth muscle cells representing a neoplastic counterpart of glomus bodies. A 38-year-old woman was admitted to our clinic presenting morbid obesity. Routine preoperative evaluations, such as laboratory analysis, abdominal ultrasonography, and upper gastrointestinal endoscopy, were performed. She underwent a classical laparoscopic sleeve gastrectomy (LSG). The postoperative course was uneventful and she was discharged for outpatient control. Her histopathology report revealed a GGT 0.8 cm in diameter. No further treatment was done and she had lost 28 kg at the postoperative sixth month. Here, we present the case of GGT, which was diagnosed incidentally after LSG.

The effects of laparoscopic sleeve gastrectomy on head, neck, shoulder, low back and knee pain of female patients.

As the rise on the prevalence of obesity, it is related with physical impairment of joints, especially in the lumbar spine and knee joints. Losing body weight can reduce or eliminate pain of head, neck, shoulder, lumbar spine and knees. By performing a laparoscopic bariatric surgery we demonstrated a significant improvement on the pain by body weight reduction. In this study we aimed to explore the efficacy and safety of Laparoscopic Sleeve Gastrectomy (LSG) on the relief of pain on head and neck, shoulder, low back and knee among the severely morbid obese female patients. A total of 39 morbidly obese female patients who underwent LSG for morbid obesity were included in this study. Body weight, height, body mass index (BMI), head and neck, shoulder, low back and knee pain intensity were measured with Visual Analog Scale (VAS) before and after LSG at the 6(th) month. 39 morbidly obese female patients were enrolled to this study. The mean age of the patients was 37.69 ± 11.33 years. Preoperative and postoperative body weights were 127.3 kg and 91.21 kg, respectively. Mean height was 165.23 ± 5.78 cm. Preoperative and postoperative BMIs were 46.49 kg/m(2) and 32.33 kg/m(2), respectively. A significant correlation between preoperative and postoperative parameters was found according to BMI. Our data showed that LSG is an efficient and safe procedure on severely obese patients and showed a predictive remission of head and neck, shoulder, low back and knee pain intensity of female patients by analyzing with VAS during the first 6 months.

Does alfa lipoic acid prevent liver from methotrexate induced oxidative injury in rats?

PURPOSE: To determine the antioxidant and anti-inflammatory effects of alfa lipoic acid (ALA) on the liver injury induced by methotrexate (MTX) in rats. METHODS: Thirty two rats were randomly assigned into four equal groups; control, ALA, MTX and MTX with ALA groups. Liver injury was performed with a single dose of MTX (20 mg/kg) to groups 3 and 4. The ALA was administered intraperitonealy for five days in groups 2 and 4. The other rats received saline injection. At the sixth day the rats decapitated, blood and liver tissue samples were removed for TNF-α, IL-1ß, malondialdehyde, glutathione, myeloperoxidase and sodium potassium-adenosine triphosphatase levels measurement and histological examination. RESULTS: MTX administration caused a significant decrease in tissue GSH, and tissue Na+, K+ ATPase activity and which was accompanied with significant increases in tissue MDA and MPO activity. Moreover the pro-inflammatory cytokines (TNF-α, IL- ß) were significantly increased in the MTX group. On the other hand, ALA treatment reversed all these biochemical indices as well as histopathological alterations induced by MTX. CONCLUSION: Alfa lipoic acid ameliorates methotrexate induced oxidative damage of liver in rats with its anti-inflammatory and antioxidant effects.

Effects of a Glutamine Enema on Anastomotic Healing in an Animal Colon Anastomosis Model.

PURPOSE: Anastomotic leakage in colorectal surgery is a very important issue. Although many studies have shown the positive effects of enteral glutamine (Gln) on anastomotic healing, none has assessed the effects of administering Gln via an enema for anastomotic healing. To fill this study gap, this study investigated the intraluminal effect of administration of Gln enema on the healing of colonic anastomosis in a rat model. METHODS: Thirty Wistar albino rats were divided into three groups containing 10 rats each and were subjected to distal left colon transection and anastomosis. Postoperatively, group I (the control group) was administered no treatment, group II was administered daily placebo enemas containing physiological saline, and group III was administered daily 2% L-Gln enemas. After sacrifice on postoperative day 5, anastomotic healing, burst pressure, tissue hydroxyproline levels, and histological parameters were measured, and group values were compared via statistical analysis. RESULTS: Group III was found to have the highest mean bursting pressure and tissue hydroxyproline levels and the lowest mean ischemia score. While the values of these parameters were not found to differ significantly among the groups, the lack of significance may have been due to the limited number of subjects examined. CONCLUSION: Administration of a Gln enema may have a positive effect on anastomosis in terms of bursting pressure and histopathological parameters. Future research should examine administration of a preoperative Gln enema as a means of decreasing the traumatic effects of the enema and identifying its applicability in surgical practice.

Laparoscopic appendectomy with hand-made loop.

INTRODUCTION: Acute appendicitis is the most common abdominal pathology requiring emergent surgical procedure. For treatment, laparoscopic surgery is commonly performed. For appendix stump closure different procedures are used. AIM: Evaluation of the results of patients in whom the stump of the appendix was closed with a hand-made loop during laparoscopic appendectomy (LA). MATERIAL AND METHODS: Patients in whom the stump of the appendix was closed with a hand-made loop during LA were included in the study. Reports of patients were collected from patient files retrospectively. Laparoscopic appendectomy was applied through 3 ports. Two loops were placed in the stump of the appendix. Loop was a modification of the Roeder loop that has been described in the literature and has been shown to be safe. RESULTS: Sixty-one patients were included in the study. Twenty-four of them (39%) were female, 37 of them (61%) were male. The age range is from 13 to 60 (average age is 30) years. During the postoperative period, one surgical wound infection and two intraabdominal abscesses were detected. There was no leakage from the stump of the appendix in any patients. CONCLUSIONS: One of the most important components of cost of LA is the technique of closure of the stump. Stapler, endoloop, various clips or a hand-made loop could be used for closure. We recommend using a hand-made loop for closure as an easy, safe and cheap method.

Safety and effectiveness of three-port laparoscopic cholecystectomy.

UNLABELLED: Most commonly performed laparoscopic surgery is laparoscopic cholecystectomy. Although cholecystectomy through three port is not commonly preferred, researches have shown that it is a safe and feasible way of surgery. Material and Methods. We evaluate 100 patient that have undergone elective laparoscopic cholecystectomy through three port (group one). These patients were compared with 50 patients that have undergone laparoscopic cholecystectomy through four port (group two). Complications, lenght of stay in hospital, operation time, conversion to open surgery rate were compared in two group. RESULTS: In group one, fourth port was necessary for nine (9%) patients. Duration of operation in group one was in average 31 min and in group two, 31, 3 min. Operation time, lenght of stay in hospital, complication rate, conversion to open surgery rate was similar in both groups. CONCLUSION: Three port laparoscopic cholecystectomy is a safer method when performed by experienced surgeons. Laparoscopic cholecyctectomy can be tried through three ports firstly and can be continued with addition of fourth port if necessary.

Carcinosarcoma of the Breast: Case Report.

Carcinosarcoma of the breast represents less than 1% of primary breast mailgnancies. Both malign epithelial and malign mesenchymal elements exist together in the breast. A 59 year old postmenopausal women presents with a bloody nipple discharge and mass in breast. In left breast 2×1 cm mss detected and excisied. At pathological examination breast carcinosarcoma was detected. Then modified radical mastectomy was performed. Tumor measured 4×4×3.5 cm. Tumor cells were negative for estrogen, progesteron. C-erb-B2 was negative. There was no metastasis in axillary lymph node metastasis. Carcinosarcoma of breast is rare tumor. It mass be consider in diagnosis of patients with large breast mass.