Germline pathogenic variant spectrum in 25 cancer susceptibility genes in Turkish breast and colorectal cancer patients and elderly controls.

Inherited pathogenic variants account for 5% to 10% of all breast cancer (BC) and colorectal cancer (CRC) cases. Here, we sought to profile the pathogenic variants in 25 cancer susceptibility genes in Turkish population. Germline pathogenic variants were screened in 732 BC patients, 189 CRC patients and 490 cancer-free elderly controls, using next-generation sequencing-based multigene panel testing and multiplex ligation-dependent probe amplification testing. Pathogenic variants were detected in 17.2% of high-risk BC patients and 26.4% of high-risk CRC patients. More than 95% of these variants were clinically actionable. BRCA1/2 and mismatch repair genes (MLH1, MSH2 and MSH6) accounted for two-thirds of all pathogenic variants detected in high-risk BC and CRC patients, respectively. Pathogenic variants in PALB2, CHEK2, ATM and TP53 were also prevalent in high-risk BC patients (4.5%). BRCA1 exons 17-18 deletion and CHEK2 c.592+3A>T were the most common variants predisposing to BC, and they are likely to be founder variants. Three frequent MUTYH pathogenic variants (c.884C>T, c.1437_1439delGGA and c.1187G>A) were responsible for all MUTYH biallelic cases (4.4% of high-risk CRC patients). The total pathogenic variant frequency was very low in controls (2.4%) and in low-risk BC (3.9%) and CRC (6.1%) patients. Our study depicts the pathogenic variant spectrum and prevalence in Turkish BC and CRC patients, guiding clinicians and health authorities for genetic testing applications and variant classification in Turkish population.

Bag-1 stimulates Bad phosphorylation through activation of Akt and Raf kinases to mediate cell survival in breast cancer.

BACKGROUND: Bag-1 (Bcl-2-associated athanogene) is a multifunctional anti-apoptotic protein frequently overexpressed in cancer. Bag-1 interacts with a variety of cellular targets including Hsp70/Hsc70 chaperones, Bcl-2, nuclear hormone receptors, Akt and Raf kinases. In this study, we investigated in detail the effects of Bag-1 on major cell survival pathways associated with breast cancer. METHODS: Using immunoblot analysis, we examined Bag-1 expression profiles in tumor and normal tissues of breast cancer patients with different receptor status. We investigated the effects of Bag-1 on cell proliferation, apoptosis, Akt and Raf kinase pathways, and Bad phosphorylation by implementing ectopic expression or knockdown of Bag-1 in MCF-7, BT-474, MDA-MB-231 and MCF-10A breast cell lines. We also tested these in tumor and normal tissues from breast cancer patients. We investigated the interactions between Bag-1, Akt and Raf kinases in cell lines and tumor tissues by co-immunoprecipitation, and their subcellular localization by immunocytochemistry and immunohistochemistry. RESULTS: We observed that Bag-1 is overexpressed in breast tumors in all molecular subtypes, i.e., regardless of their ER, PR and Her2 expression profile. Ectopic expression of Bag-1 in breast cancer cell lines results in the activation of B-Raf, C-Raf and Akt kinases, which are also upregulated in breast tumors. Bag-1 forms complexes with B-Raf, C-Raf and Akt in breast cancer cells, enhancing their phosphorylation and activation, and ultimately leading to phosphorylation of the pro-apoptotic Bad protein at Ser112 and Ser136. This causes Bad's re-localization to the nucleus, and inhibits apoptosis in favor of cell survival. CONCLUSIONS: Overall, Bad inhibition by Bag-1 through activation of Raf and Akt kinases is an effective survival and growth strategy exploited by breast cancer cells. Therefore, targeting the molecular interactions between Bag-1 and these kinases might prove an effective anticancer therapy.

Hollow viscus injury due to blunt abdominal trauma: a tertiary trauma center experience.

BACKGROUND: Hollow viscus injuries (HVIs) present less frequently than solid organ injuries in patients with blunt abdominal trauma, potentially leading to significantly increased morbidity and mortality rates. Modern imaging equipment, confidently used for diagnosing solid organ injuries, may fail to identify hollow viscus injuries. In this study, we aim to present our tertiary center's experience with this entity. METHODS: Patients treated in our clinic from April 2011 to December 2021 for hollow viscus injury following blunt abdominal trauma were included in this study. We recorded and retrospectively evaluated patients' demographic data, injury site and mechanism, preoperative and perioperative findings, and mortality rates in a prospective database. RESULTS: Of the 607 blunt trauma patients, 35 (5.8%) had hollow viscus injuries, with 88.6% being male. Motor vehicle accidents were the leading cause of injury (80%). The mean duration between admission and surgical exploration was 26±21.2 hours. The mean Injury Severity Score was 21.8±13.6. Rigidity was the most frequent clinical finding (60%). The jejunum and ileum were the most frequently injured organs (54.1%). Mortality and morbidity rates were 11.4% and 17.1%, respectively. CONCLUSION: Nondeclining white blood cell (WBC) counts within 24 hours of admission, alongside any physical or radiological finding indicating an HVI, should prompt immediate surgical exploration.

Is it possible to predict mortality in patients with high-grade blunt liver injury? A single trauma center study.

BACKGROUND: Blunt abdominal trauma constitutes a significant portion of trauma cases and is often associated with liver injury. Given that high-grade liver injuries remain life-threatening, identifying patients who will likely require more vigilant attention and care is crucial. This study aims to determine the parameters that increase mortality in patients with high-grade liver trauma. METHODS: This study enrolled 38 patients with Grade III or higher liver injuries, treated by the general surgery department between 2008 and 2023. Eleven patients who died were categorized into Group 1, and 27 survivors were placed in Group 2. We evaluated their respective mechanisms of injury, imaging results, Glasgow Coma Scale scores, Base Excess, Lactate levels, pH, and Injury Severity Score findings. Receiver Operating Characteristics (ROC) analysis was performed for parameters with significant differences, and certain cutoff values were determined. RESULTS: The grade of liver injury and additional abdominal organ injuries were significantly higher in Group 1 (p<0.05). The difference in extra-abdominal injury sites was statistically insignificant between the groups (p>0.05). Erythrocyte suspension requirements were significantly higher in Group 1 (p<0.05). Average lactate and base deficit values were also significantly higher in Group 1 (p<0.05), while leukocyte counts were significantly lower in Group 1 (p<0.05). CONCLUSION: Base deficit, hemoglobin (Hb), lactate levels, injury severity, liver injury grade, accompanying abdominal injuries at admission, and erythrocyte suspension demands were found to be associated with increased mortality rates. Certain cutoff values for the aforementioned parameters could be established. However, further data are required to confirm these findings.

Blunt splenic trauma: Analysis of predictors and risk factors affecting the non-operative management failure rate.

BACKGROUND: Non-operative management (NOM) has become a standard treatment in hemodynamically stable patients with blunt splenic trauma. Studies have identified numerous predictors and risk factors for NOM. However, these factors' role in NOM failure continues to be debated. This study aimed to reveal the role of these factors in NOM failure through retrospective analysis of data from patients who underwent non-operative treatment. METHODS: After the initial evaluation of 189 patients brought to the emergency department between March 2009 and June 2021 and diagnosed with blunt splenic trauma, 13 patients underwent emergency surgery due to hemodynamic instability (immediate splenectomy), and 18 patients who died were excluded from the study. NOM was planned for the remaining 158 patients (stable or stabilized). Patients scheduled for NOM were grouped as either successful NOM (s-NOM; n=139) or failure NOM (f-NOM; n=19) and analyzed the results, retrospectively. RESULTS: Of the 158 patients scheduled for the NOM, 115 were male. The mean age in s-NOM and f-NOM was 32.2±14.5 versus 36.1±16.1. The mean hospital stay was 8 (4-21) days. The mean follow-up period was 12 (6-18) months. Used USG for 60 (43.2%) patients and CT for 137 (98.6%) in the NOM. The number of Grades I-V in the NOM planned patients (n=158) was 20 (12.6%), 54 (34.1%) 56 (35.4%), 26 (16.4%), and 2 (1.3%), respectively. The success rates according to the Grades I-V were 20 (100%), 52 (96.3%), 52 (92.8%), 15 (57.7%), and 0 (0.0%), respectively. There were 102 units of red cell transfusions administered (mean, 2.46 units) to 41 patients in the s-NOM group, while 81 units (mean, 4.26 units) were administered to 19 patients in the f-NOM group (p=0.001). ISS score >15 was 57.5% (mean score, 22.8) and those in the f-NOM group were 78.9% (mean score, 34.8), respectively (p<0.001). Overall NOM success was 88.0%, total complications were 10.1%, and mortality was 1.2% in this study. CONCLUSION: Grades I-III blunt splenic trauma patients were successfully treated using the NOM protocol in this study. However, more than half of Grade IV (57.7%) splenic injuries were successfully treated using NOM. Identifying predictors and risk factors based on a standardized plan will likely increase this success.

CRISPR/Cas9-mediated Bag-1 knockout increased mesenchymal characteristics of MCF-7 cells via Akt hyperactivation-mediated actin cytoskeleton remodeling.

Bag-1 protein is a crucial target in cancer to increase the survival and proliferation of cells. The Bag-1 expression is significantly upregulated in primary and metastatic cancer patients compared to normal breast tissue. Overexpression of Bag-1 decreases the efficiency of conventional chemotherapeutic drugs, whereas Bag-1 silencing enhances the apoptotic efficiency of therapeutics, mostly in hormone-positive breast cancer subtypes. In this study, we generated stable Bag-1 knockout (KO) MCF-7 breast cancer cells to monitor stress-mediated cellular alterations in comparison to wild type (wt) and Bag-1 overexpressing (Bag-1 OE) MCF-7 cells. Validation and characterization studies of Bag-1 KO cells showed different cellular morphology with hyperactive Akt signaling, which caused stress-mediated actin reorganization, focal adhesion decrease and led to mesenchymal characteristics in MCF-7 cells. A potent Akt inhibitor, MK-2206, suppressed mesenchymal transition in Bag-1 KO cells. Similar results were obtained following the recovery of Bag-1 isoforms (Bag-1S, M, or L) in Bag-1 KO cells. The findings of this study emphasized that Bag-1 is a mediator of actin-mediated cytoskeleton organization through regulating Akt activation.

Conservative management of 154 patients with idiopathic granulomatous mastitis: Simple is better?

PURPOSE: Both the aetiology and treatment of idiopathic granulomatous mastitis (IGM) is controversial and unnecessary resections can lead to over-treatment in such a benign disease. Our aim was to report our experience in patients with IGM managed mainly with conservative methods, such as antibiotics, drainages and corticosteroids. MATERIAL AND METHODS: Pathology database from 2008 to 2018 was reviewed retrospectively. Demographics and symptoms were documented from patient charts. Follow-up information was obtained from clinical reviews, and severity and duration of symptoms were documented. All data were transferred to Excel file and the parameters were compared. RESULTS: All 154 patients were women. Mean age was 35.9 years. Empiric broad-spectrum antibiotic, abscess drainage and steroid treatments were seen to be successful in most of the cases (95.4%). In patients with limited regression (2.5%) or persistant lesions (1.9%), a second cycle was employed with a total regression rate of 100%. Recurrence was seen one or two times in 23 (14.9%) and 2 (1.2%) patients in a mean follow-up period of 5.3 years. The average time of recurrence was 2.5 years (range, 9-74 months). CONCLUSIONS: Conservative management could be efficacious for IGM, and less and simpler can be enough to achieve more effective results. KEY WORDS: Abscess drainage, Antibiotics Idiopathic granulomatous mastitis (IGM), Conservative management, Corticosteroids.

Primary neuroendocrine carcinoma of the breast: a 5-year experiences.

PURPOSE: Breast neuroendocrine carcinomas constitute approximately 0.3-0.5% of all breast cancers. In this study, we aimed to evaluate the data of patients diagnosed with primary breast neuroendocrine carcinoma. METHODS: Patients with more than 50% neuroendocrine differentiation identified in the histopathological examination between January 2010 and January 2015 and who had no other focus on imaging were evaluated retrospectively from the hospital registry system. Patients with secondary neuroendocrine tumor of the breast and male patients were excluded from the study. All patients gave informed consent. Patients were staged according to TNM classification. RESULTS: During the study period, 425 patients were operated for breast cancer. Eleven patients were included in the study. The mean age of the patients was 68 (range 49-86). Immunohistochemical examinations revealed positive staining with neuron-specific enolase, synaptophysin and chromogranin in all patients. Ten patients had strong positive estrogen and progesterone receptors and receptor status was not specified in one patient. Distant organ metastasis was detected in 1 patient during the follow-up period, no local recurrence and mortality were seen in any patient. CONCLUS ON: The most widely used specific markers of neuroendocrine differentiation are chromogranin and synaptophysin. There is no standard treatment protocol for primary breast neuroendocrine tumors. Most of the treatments reported in the literature and in this study are breast sparing surgery or mastectomy, followed by anthracycline and taxanebased chemotherapy and/or hormonotherapy, similar to the treatment of ductal carcinoma. The distinction of primary metastases in breast neuroendocrine tumors is important, so the presence of neuroendocrine tumors should be investigated in other organs. In this case the treatment is changed. The issue of how neuroendocrine differentiation affects clinical outcome is yet to be debated. KEY WORDS: Chromogranin, Neuroendocrine tumor, Synaptophysin.

Synchronous pancreas and liver resection during CRS ± HIPEC. Results of 35 consecutive patients.

AIM: To evaluate the results of synchronous pancreas and liver resection in patients with metastatic carcinoma accompanied by peritoneal carcinomatosis (PC) who underwent cytoreductive surgery (CRS)/hyperthermic intraperitoneal chemotherapy (HIPEC). MATERIAL AND METHODS: Overall, 35 patients with PC who underwent CRS/HIPEC at Umraniye Education and Research Hospital owing to different etiological causes were evaluated for operation procedure, age, sex, comorbid diseases, ASA score, systemic chemo/radiotherapy, duration of surgery, chemotherapy (CT) protocol applied in HIPEC, amount of bleeding, synchronous hepatobiliary resection interventions during operation and short/long-term mortality and morbidity. RESULTS: Fifteen patients were male and 20 were female. Mean age was 58.375 ± 13.02 (range, 27-85) years. CRS/HIPEC was performed in 12 patients (34.3%), whereas only CRS was performed in 23 (65.7%) patients. The lowest and highest perioperative bleeding amount was 50 cc and 2000 cc, respectively, and 6 (17.1%) patients had intraoperative bleeding of ≥1000 cc. Synchronous isolated pancreatic resection, hepatic + pancreatic resection and isolated liver resection was performed in 3 (8.6%), 5 (14.3%) and 27 (77.1%) patients treated with CRS/HIPEC. Two patients died within postoperative day 30, and the mortality rate was 5.7%. CONCLUSION: Hepatopancreatobiliary surgery is a difficult intervention and is associated with serious morbidities. Synchronisation of hepatopancreatobiliary surgery with CRS/HIPEC may be challenging for the surgeon and clinician. Here we emphasise that this combination can be performed safely by an experienced team with a multidisciplinary approach and good patient preparation. KEY WORDS: Cytoreductive surgery, HIPEC, Hepatopancreatobiliary surgery, Peritoneal carcinomatosis.

Serum paraoxonase (a high-density lipoprotein-associated lipophilic antioxidant) activity in clinical follow-up of patients with acute pancreatitis, with particular emphasis on oxidative stress parameters and lipid profile: a prospective pilot trial.

The purpose of this study was to investigate the possible role of PON-1, an antioxidant lipophilic enzyme linked to HDL-C (high-density lipoprotein cholesterol), on the pathophysiology and clinical follow-up of acute pancreatitis. Biochemical tests, PON-1 and oxidative stress parameters (malonyl dialdehyde, MDA; superoxide dismutase, SOD; total antioxidant capacity, TAC) were evaluated in the sera of patients with acute pancreatitis at admission (day 0), day 3 and day 10 of follow-up, between June and September 2017. SPSS 13.0 statistical software package programme was used for statistical analyses.Mean age was 51.4 of the total 25 patients. Ranson scores were 0-1 points (60%), 3-4 points (24%) and 5-6 points (16%). CTSI (computed tomography severity index) scores were calculated, and most of the patients were seen to have mild or average pancreatitis (96%). While total cholesterol, triacylglycerol and LDL-C (low-density lipoprotein) levels stayed in their normal limits, there was a significant decrement tendency. HDL-C level was seen to rise significantly above its upper limit at day 10 (p < 0.001). Mean PON-1 levels were measured as 69.23, 76.72 vs. 113.15 U/mL at days 0, 3 and 10, respectively; and it was positively correlated with HDL-C (p < 0.001). Serum SOD increased also in parallel with PON-1 (20.49 vs. 39.46 U/mL) while MDA level decreased significantly (3.9 vs. 2.28 µM, p < 0.001). TAC was seen to rise significantly after treatment (0.52 vs. 1.22 mM). In conclusion, decreased PON-1 and HDL-C together with antioxidants SOD and TAC at the early period of acute pancreatitis were seen to rise after treatment, while the previously higher MDA level decreased in parallel. This reveals the importance of the balance between oxidative stress and antioxidant defense mechanisms in clinical progression of the disease, and the potential of PON-1 as a promising clinical marker.

In vitro effectiveness of different chemical agents on scolices of hydatid cyst.

In the surgical history of hepatic hydatid disease, multiple scolicidal agents have been used for sterilization of the cyst contents. However, none of these agents can be safely used, because most have unacceptable side effects, such as toxicity, caustic sclerosing cholangitis, bile duct stricture, and hypernatremia. Protoscolices were aseptically removed from liver hydatid cysts obtained from sheep slaughtered at the municipal abattoir in Kahramanmaras, Turkey. In this study, the effects of 0.9% NaCl (control group), 20% NaCl (hypertonic saline), 20% silver nitrate, albendazole 20 mg/cm3, 50% dextrose (hypertonic glucose), and 20% mannitol and aminomix-1 solutions on echinococe cysts were investigated under in vitro conditions. After 5, 10, 15, 20, 25, 30, 45, and 60 min for each concentration, the first 100 protoscolices were counted on the 10x microscopical field. Protoscolices, which showed positive staining by eosine were considered as dead ones. The averages of dead and total protoscolices were calculated. Our results showed that all observed protoscolices were dead after the treatments by 20% silver nitrate in 20 min, by 50% dextrose and by aminomix-1 solution in 30 min, and by 20% NaCl and by 20% mannitol in 45 min. Albendazole at 20 mg/cm3 was observed to lead to death of 65% of protoscolices in the first 5 min and 70% of protoscolices at the end of 60 min. Compared with 0.9% NaCl (saline), all of these scolicidal agents were significantly effective (p < .05). Aminomix-1, 20% mannitol, and 50% dextrose solutions may be used in percutaneous and surgical treatment of hydatid cyst. They may be preferred because they are readily available, can be administered intravenously, and have an equal or greater effectiveness than 20% hypertonic saline.

The effect of intraperitoneal catalase on prevention of peritoneal adhesion formation in rats.

The objective of our study was to investigate the efficacy of catalase in preventing the formation of peritoneal adhesions induced by cecal serosal laceration in rats. A research study was set up using a randomized complete block design. This study was performed in the Experimental Surgical Research Center, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey. Thirty Wistar albino rats were assigned to 3 groups of 10 animals each. The animals were anesthetized, a median laparotomy was performed, and the cecum was traumatized. In the final stages of surgery, the first group received 30,000 U of catalase intraperitoneally (ip) (catalase group), the second group received 2 mL of saline solution ip (isotonic group), and the last group received no treatment (control group). All rats were sacrificed on day 14. Adhesions were counted and blood samples were taken for measuring the catalase level. There were significant differences between the adhesion scores among all groups (p < .05, Kruskal-Wallis test). The catalase group had significantly lower adhesion scores than the other groups (post hoc Mann-Whitney test). At day 14, blood catalase levels in the catalase group were significantly lower than in the other groups (p < .05). We conclude that introduction of catalase into the peritoneal cavity during surgery inhibited adhesion formation.

Intraperitoneal EMLA (lidocaine/prilocaine) to prevent abdominal adhesion formation in a rat peritonitis model.

OBJECTIVE: The accelerative effect of EMLA (eutectic mixture of lidocaine 2.5% and prilocaine 2.5%) in the wound healing process is known. We hypothesised that post-operative peritoneal adhesions may be reduced with intra-peritoneal EMLA administration in a model of bacterial peritonitis. STUDY DESIGN: Bacterial peritonitis was induced in 24 rats by cecal ligation and puncture. The rats were randomly assigned to one of four groups. Group 1 (n=6)) received EMLA intraperitoneally, group 2 (n=6) received 2% lidocaine hcl solution intraperitoneally, the third group received one dose (100 mg/kg) of ceftriaxone sodium (Rocephin, Roche, 1 g) intraperitoneally one day after cecal ligation and puncture procedure, and in control group (group 4, n=6), no fluid or medicine was introduced into the abdomens of the rats. All animals were killed 14 days later in order to assess the adhesion score. Tissue antioxidant levels were measured in 1 g tissue samples taken from the abdominal wall. RESULTS: The adhesion score was significantly lower in the EMLA group than in the lidocaine and control groups. The catalase levels were higher in the lidocaine and control groups than in EMLA group. CONCLUSIONS: Intraperitoneal EMLA inhibited the formation of postoperative intra-abdominal adhesions without compromising the wound healing in this bacterial peritonitis rat model. EMLA also decreased the oxidative stress during peritonitis (Tab. 1, Fig. 7, Ref. 27). Full Text (Free, PDF) www.bmj.sk.

Identification of a BRCA2 mutation in a Turkish family with early-onset breast cancer.

We used a multi-gene panel testing to identify the germline variants in a mother-daughter pair with early-onset breast cancer, and detected one pathogenic protein-truncating variant in BRCA2. Our results highlight the importance of genetic testing in identifying the pathogenic mutation running in cancer families.

An unusual cause of hypercalcemic crisis: Water-clear cell double parathyroid adenoma.

OBJECTIVE: To evaluate the clinical characteristics of a patient operated for water-clear cell adenoma and to discuss these in the light of relevant literature. MATERIAL AND METHODS: PubMed and Google Scholar were searched to identify articles related to water-clear cell adenoma using the following keywords: parathyroid tissue, parathyroid gland, parathyroid cells, parathyroid adenoma, parathyroid hyperplasia, water-clear-cell, and water clear cell. The search included case reports, review articles, and original articles that had been published between January 1990 and November 2014 without any restrictions on language. All articles that contained information on the study population and treatment related data were identified and retrieved. In addition, an evaluation was of a case of a 47-year-old male patient with PHC who was treated at our clinic was conducted. RESULTS: A total of 19 patients, including our new case, (age range: 18 to 81 years, mean±SD: 57.47±16.31 years) were included in the analysis. Eleven patients were female. Information about adenoma location was available from studies involving 17 patients and they indicated the following distribution of locations: left inferior (n=10), right superior (n=4). When preoperative imaging methods were examined, a false negative result was given by ultrasonography in 28.5% of patients and only 57.1% were positive on scintigraphy. Concomitant thyroid papillary carcinoma was determined in 1 patient. The mean tissue dimensions were 3.47±1.73 cm (range, 0.8-6.8 cm). CONCLUSION: Water-clear cell adenoma, which shows similar clinical characteristics to other parathyroid adenomas, is an uncommon cause of hyperparathyroidism.

Percutaneous cholecystostomy: A curative treatment modality forelderly and high ASA score acute cholecystitis patients.

BACKGROUND: Acute cholecystitis (AC) is a common emergency seen by general surgeons. Optimal treatment is laparoscopic cholecystectomy (LC); however, in cases where surgery cannot be performed due to high risk of morbidity and mortality, such as in elderly patients with comorbid diseases, other treatment modalities may be used. Percutaneous cholecystostomy (PC) is one alternative method to treat AC. PC can be used to provide drainage of the gall bladder and control infection. Subsequently, interval cholecystectomy can be performed when there are better conditions. Presently described is experience and results with PC in high risk, elderly patients with AC. METHODS: Medical records of all consecutive patients who underwent PC between January 2011 and January 2014 were identified. Tokyo Guidelines were used for definitive diagnosis and severity assessment of AC. Senior surgeon elected to perform PC based on higher risk-benefit ratio due to comorbidity, age, or duration of symptoms. All PC procedures were performed by the same interventional radiologist under local anesthesia with ultrasonographic guidance. RESULTS: Total of 40 PC procedures were performed during the study period. Of those, 22 (55%) were male and 18 were (45%) were female, with median age of 70.5 years (range: 52-87 years). All of the patients had American Society of Anesthesiologists classification of either 3 or 4. Success rate of PC was 100% with complication rate of 2.5% (n=1). One patient was operated on shortly after PC procedure due to bile peritonitis complication. PC drains were kept in place for 6 weeks. Total of 16 patients (40%) had surgery following removal of PC drain. In 3 (18.8%) cases, conversion from LC was required. Remaining 23 (57.5%) patients did not have subsequent operation after drain removal. No disease recurrence was observed in follow-up. CONCLUSION: When elderly patients present in emergency setting with AC and LC cannot be performed due to comorbid disease or poor general condition, PC can be performed safely. After removal of PC drain, LC may be performed with acceptable conversion rate of 18.8%.

Myoid differentiation and EMA expression in fibrosarcomatous dermatofibrosarcoma protuberans.

Dermatofibrosarcoma protuberans (DFSP) is a relatively unusual, locally aggressive cutaneous tumor of intermediate malignancy. Fibrosarcomatous DFSP (FS-DFSP), a rare variant of DFSP, has a higher tendency for recurrence and metastasis. Recently, a small number of cases of another variant of FSDFSB characterized by areas of myoid differentiation have been reported. We present here a 35 yearold female patient with myoid differentiation in FS-DFSP. The tumor on the left scapular region had slowly grown over six years. Examination revealed a domeshaped, firm, nontender, violaceous dermal nodule. Histologically, it was composed of a monotonous spindle cell population arranged predominantly in a storiform pattern and to a lesser extent in a fascicular fibrosarcomatous pattern with a parallel arrangement of the cells. Immunohistochemically, the tumor cells showed diffuse expression for vimentin and CD34. In the center of the tumor areas with frequent mitosis, hypercellular and negative reactive for CD34 were seen. In addition, approximately 10% of the cells were positive for epithelial membrane antigen. Myoid differentiation was found around the blood vessels. The myoid areas were positive for smooth muscle actin and negative for desmin. It is possible that the presence of hyperplastic myofibroblasts is a reactive phenomenon to the proliferation of tumor cells. We believe that this finding around blood vessels may be present in DFSP or FS-DFSP. However, when myoid areas, myoid fascicles and myoid nodules are seen in the stroma, it may be a new morphological variant of DFSP and/or FS-DFSP.

Effects of the intraperitoneal lornoxicam on the formation of intraperitoneal adhesions in rat peritonitis model.

BACKGROUND: To investigate the effects of intraperitoneally administered lornoxicam on adhesion formation, bursting pressure, tissue antioxidant levels, morbidity and mortality after ileocolic anastomosis in a rat bacterial peritonitis model. METHODS: Thirty-six rats were divided into three random groups. Bacterial peritonitis was induced by performing a cecal ligation and puncture, then the cecal was resected and ileocolic anastomosis was performed. Rats of groups 1, 2 and 3 were given 2 mL normal saline, 2 mL lornoxicam, and nothing, respectively. All groups were killed at day 14. Adhesions were scored, and the presence of intra-abdominal abscesses and fistulas were noted. Anastomotic healing was assessed by bursting pressure. Tissue antioxidant levels were tested from left abdominal walls. RESULTS: One day after cecal ligation and puncture, microbiological examination showed polymicrobial bacterial peritonitis. The rats treated with lornoxicam had significantly lower adhesion scores than did the saline and nothing treated rats (P = 0.007). Bursting pressures of groups were unaffected by the treatment. Tissue antioxidant levels of groups were affected by the treatment. Morbidity and mortality were similar in all groups. CONCLUSIONS: The present study demonstrated that a single intraperitoneal instillation of lornoxicam in buffer solution at the end of the surgery reduces adhesion formation in rats bacterial peritonitis model. It was also determined that lornoxicam had no negative effect on the healing of intestinal anastomosis, abscess and anastomotic leakage. Use of lornoxicam in peritonitis was effective in decreasing the oxidative stress of tissue during peritonitis.

[Diffuse lipid infiltration and squamous metaplasia accompanying amyloid goiter: case report]. / Amiloid guatra eslik eden diffüz yag infiltrasyonu ve skuamöz metaplazi: olgu sunumu.

Systemic amyloidosis is one of the serious complications of Familial Mediterranean Fever (FMF). Amyloid accumulation secondary to FMF can cause pressure symptoms in thyroid gland rarely. A 17-year-old male patient with the diagnosis of FMF performed the complaints of dyspnea during his follow-up period. He has demonstrated a rapidly increasing mass localized in front of his neck within the last three months that was diagnosed as a diffuse, hyperplasic and pressuring thyroid gland. Total thyroidectomy was performed. Histopathological investigation of the material obtained aft er thyroidectomy revealed diffuse lipid infiltration in parenchyma, intense amyloid accumulation around and between the follicles that caused pressure on the follicles, and cystic areas in the tissue. Squamous metaplasia foci in cyst epithelium were detected. Upon these findings the case was diagnosed as amyloid goiter accompanied by metaplastic variations. In conclusion, it can be appropriate to take into account the possibility that metaplastic variations could accompany amyloid goiter in patients with long-term FMF.

A rare cause of dyspnea in a patient presenting to the emergency department: a case report and review of the literature of laparoscopic cholecystectomy complication.

UNLABELLED: In recent years, there has been an emerging preference by patients for emergency services due to the efficiency of transactions and the increased quality of service. As a result, emergency departments have experienced an extreme density of patients. Nevertheless, patients require the same standard of care and should be evaluated carefully. The emergency physician should evaluate the patient as a whole in light of the findings and not merely according to the recommendations of the consultant. We describe in this case report a rare complication occurring after laparoscopic cholecystectomy, shortness of breath, which could easily be disregarded. KEYWORDS: Laparoscopic cholecystectomy complication; Dyspnea; Intrahepatic subcapsular hematoma.