Investigation of the IL7Rα Gene Polymorphism rs6897932 and the Expression Levels of the CDH1, TTPAL, and FHIT Genes in Patients with Breast Cancer.

OBJECTIVE: The aim of this study was to determine the expression levels of CDH1, FHIT, and TTPAL genes and to determine the genotype and allele frequencies of the IL7Rα gene polymorphism rs6897932 in patients with breast cancer. METHODS: The expression levels of genes and the distribution of the IL7Rα gene polymorphism rs6897932 were analyzed by real-time polymerase chain reaction. RESULTS: No differences in genotype ratios or allele frequencies were observed between the 2 groups for the IL7Rα gene polymorphism rs6897932. The frequency of the IL7Rα rs6897932 T risk allele was found to be similar between breast cancer patients and controls. CDH1 messenger RNA (mRNA) levels decreased (0.714-fold and 0.834-fold, respectively), and TTPAL mRNA levels increased (2.675-fold [P < .05] and 1.169-fold, respectively) in tumor tissues and peripheral blood samples. FHIT mRNA levels decreased (0.559-fold) in tumor tissue samples and increased (2.21-fold) in peripheral blood samples. CONCLUSION: Our results are compatible with those reported in the literature. It can be suggested that the upregulation observed in the TTPAL gene might be a marker for breast cancer. The downregulation of CDH1 and FHIT gene expression has been validated in our study. An increase in the copy numbers of FHIT mRNA in blood samples and a decrease in the tumor samples can also be considered an abnormal condition.

Evaluation of different stapler line strengthening techniques with burst pressures in patients undergoing sleeve gastrectomy. An experimental study.

AIM: Obesity is a leading cause of preventable death worldwide and is increasing in both adults and children. Bariatric surgery is the most effective treatment for this condition and its related comorbidities. We aimed to evaluate the effectiveness of different staple line reinforcement techniques on staple line reinforcement through bursting pressures. METHODS: Different stapler line strengthening techniques were performed on resected stomach patterns of 48 patients. The patients were enrolled prospectively into 4 groups according to surgeons preferred type of staple line reinforcement. Data concerning patient demographic variables, surgical parameters, postoperative complications, postoperative readmissions, burst pressure and burst point were collected. None of the obese patients were excluded from this study. RESULTS: There were no statistically significant differences in the characteristics of the groups. The number of staple cartridges fired and the linearity of the staple line were similar in all groups, (p 0.524-0.265). However, there were significant differences in the burst pressure measurements in groups I, II, IIIand IV (p .001). In all groups, the burst point on the staple line of resected stomach was most commonly in the fundus section. CONCLUSIONS: We believe that the burst pressure in Fibrin sealant group is significantly higher and that fibrin glue can be effective in preventing stapler line leakage. We believe that more advanced studies are needed. KEY WORDS: Fibrin Sealant, Leakage, Reinforcement.

The effect of suture selection in complex anal fistulas on the success of cutting seton placement and patient comfort.

OBJECTIVE: The aim of our study was to compare the success rates of suture selection, recovery times and pain associated with local wound infection and seton placement in patients undergoing cutting seton placement for complex anal fistula. METHODS: The study included a total of 90 patients who were admitted with the diagnosis of complex anal fistula between January 2015 and July 2018. RESULTS: The first session and other revision appointments demonstrated that the number of patients who required fistulotomy was significantly higher in group-1 as the seton failed to complete the transection (p = 0.001). When the patients were asked to rate pain for 3 different conditions according to numeric rating scale (NRS), the patients in group-2 had significantly higher pain in all 3 cases compared to the patients in group-1 (p 0.001). The impact of the suture material on local infection was examined and it was determined that the results of cultures for seton material were significantly more positive in group-1 (p = 0.001). CONCLUSIONS: We conclude that a multi-stage tight seton placement with silk material can lead to satisfactory results by aiming to shorten the cutting time of silk seton.

Can superior mesenteric artery syndrome really be treated surgically?

AIM: Superior mesenteric artery (SMA) syndrome is a rare reason of small bowel obstruction (SBO). It is a complicated sickness. We aim to analyze the diagnosis, clinical presentation, SMAS management and postoperative outcomes after laparoscopic duodenojejunostomy. MATERIAL AND METHODS: A total of 19 patients who were diagnosed with SMAS and did not respond to the traditional treatment between January 2010 and November 2017 in Afyon Health Sciences University Hospital were included in the study. RESULTS: Their average age was 22.3 years (17-31 years). Number of males and females were 6 and 13, respectively. Clinical presentations of patients are as follow: 14 patients were referred to as postprandial distress syndrome, 3 were unexplained weight loss, and 2 were gastroesophageal reflux disease. Considering CT angiography findings, 14 patients had duodenal dilatation. The mean aortamesenteric angle was 10.6 mm. The mean of aorta-SMA distance was 5.1 mm. The mean hospital stay and follow-up times were 3.7 days and 40.2 months, respectively. No morbidity or mortality was found within patients. Preoperative, postoperative 6th month and postoperative 12th month CONUT scores were 9.1, 3.7, and 0.8, respectively. CONCLUSIONS: Laparoscopic duodenojejunostomy can be performed safely to the patients who do not benefit from conservative treatment. KEY WORDS: Aortamesenteric angle, Duodenojejunostomy, Weight loss.

Should intraoperative nerve monitoring be used routinely in primary thyroid surgeries?

OBJECTIVE: This study presents the effects of intraoperative nerve monitoring on RLN injuries in patients who underwent primary surgery for benign thyroid pathology. METHODS: We retrospectively evaluated the data of 273 patients who had primary thyroidectomy due to benign thyroid pathology between January 2012 and July 2017. The patients were classified into two groups. Group-1 consists of patients whose nerves were monitored. We separated the patients whose nerves were not monitored into Group-2. RESULTS: There were 140 and 133 patients in Groups 1 and 2, respectively. Regarding the age, gender and surgical indication between the groups, statistically significant difference was not found (P > 0.05). In Group-1, transient paralysis developed in four patients (2.9%). The permanent paralysis developed in one patient (0.7%). In Group-2, transient paralysis developed in nine patients (6.8%). The permanent paralysis developed in four patients (3%). When the groups were evaluated, there was statistically significant difference in terms of transient and permanent paralysis (P=0.01, P =0.001, respectively). CONCLUSIONS: In view of the negative effects of RLN injury on the patient, we think that intraoperative nerve monitoring should be used routinely in benign thyroid surgeries.

Topical folinic acid enhances wound healing in rat model.

PURPOSE: Folic acid is an essential vitamin participating in DNA synthesis and repair. Recently folic acid has been shown to stimulate DNA-repair capacity in dermal fibroblasts in response to injury. Thus, the present study aimed to investigate the effects of topical folinic acid, a 5-formyl derivative of tetrahydrofolic acid, on wound healing using rat wound model. MATERIALS AND METHODS: A rat wound model was established, and the wound healing was evaluated by macroscopic and histological analyses among vehicle control, 2.5% folinic acid, 1% folinic acid, and dexpanthenol treatment groups. While an image-analysis program was used to evaluate macroscopic wound closure, connective tissue properties, mast cell numbers, and the expressions of matrix metalloproteinase 1 (MMP-1) and 9 (MMP-9) were evaluated by microscopy. RESULTS: The 2.5% folinic acid-treated group exhibited enhanced wound healing by increased reepithelialization, neo-vessel formation, inflammatory cell migration, collagen deposition and progressive mast cell increase. Furthermore, 2.5% folinic acid induced higher expressions of MMP-1 and MMP-9. CONCLUSIONS: Folinic acid enhances both macroscopic and microscopic wound healing in rat wound model.

Endoscopic retrograde cholangiopancreatography for biliary system parasites.

OBJECTIVE: Endoscopic retrograde cholangiopancreatography may be useful in the diagnosis and management of biliary system parasites. MATERIAL AND METHODS: Investigators retrospectively evaluated patients with biliary system parasites who underwent endoscopic retrograde cholangiopancreatography procedures over an eight-year period. We collected data regarding patient demographics, clinical features, and parasite type. We aimed to determine the utility of endoscopic retrograde cholangiopancreatography as a diagnostic and therapeutic intervention in patients with biliary system parasites. RESULTS: We identified 22 patients with biliary system parasites from a total of 3,450 endoscopic retrograde cholangiopancreatography procedures performed during an eight-year period. Parasite types included Echinococcus granulosus (n=19), Fasciola hepatica (n=2), and Ascaris lumbricoides (n=1). Fifteen patients with liver hydatid cysts underwent endoscopic retrograde cholangiopancreatography prior to surgery due to obstructive jaundice. The endoscopic retrograde cholangiopancreatography procedure enabled definitive treatment without the need for surgery in the remaining two patients. Two patients with fascioliasis underwent endoscopic retrograde cholangiopancreatography due to clinical presentation of cholangitis, cholecystitis, and obstructive jaundice, leading to presumptive diagnosis of cholangiocarcinoma. However, the final diagnosis was made using endoscopic retrograde cholangiopancreatography following inspection of flat, leaf-shaped, motile flukes extracted from the bile duct. In one patient with ascariasis, a longitudinal tubular structure was identified in the bile duct; emergency surgery was required. CONCLUSION: The diagnosis of parasitic diseases is clinically challenging, and definitive diagnosis requires endoscopic retrograde cholangiopancreatography in some cases. Moreover, endoscopic retrograde cholangiopancreatography provides a therapeutic option for ascariasis, fascioliasis, and some forms of hydatidosis. Accordingly, the use of endoscopic retrograde cholangiopancreatography may change preoperative management and treatment strategies for biliary system parasite infections.

Evaluation of Patients with Cystic Echinococcosis.

OBJECTIVE: Cystic echinococcosis (CE) is a globally prevalent zoonotic disease. METHODS: Demographic, clinical, laboratory, and follow-up data of patients between May 2009 and 2015 were retrospectively analyzed by screening data from a hospital automation system. RESULTS: A total of 238 (females, n=139 and males, n=99) patients with a mean age of 40.6±20.58 years were included. Less than half (40.8%) of the patients were living in the countryside. Hepatic involvement of CE was most frequently (72.2%) seen. A majority (75.6%) of the patients were symptomatic, but abdominal pain was the most frequently seen symptom. For diagnosis, in all patients, imaging modalities were used, while in 66% of the patients, serological methods were also employed. The patients received both medical and surgical treatments (78.5%, n=187), only surgical treatment (10.5%, n=25), or only medical treatment (8.8%, n=21). Surgical treatment was performed for patients with hepatic (n=139/176, 80.6%), pulmonary (n=78/94, 82.9%), splenic (n=7/9; 77.7%), and mesenteric (n=6/7, 85.1%) cysts, and patients cases with brain, bone, muscle, omentum, bladder, and adrenal cysts had undergone surgical intervention. CONCLUSION: Publication of regional data is important in terms of epidemiological considerations and may aid in the formulation of standard treatment approaches.

The impact of combined interpretation of localization studies on image-guided surgical approaches for primary hyperparathyroidism.

BACKGROUND: The impact of single and combined interpretations of ultrasonography and sestamibi scintigraphy to select the appropriate surgical approach in patients with primary hyperparathyroidism were evaluated retrospectively. METHODS: A total of 183 patients with primary hyperparathyroidism who were evaluated preoperatively using both ultrasonography and sestamibi scintigraphy were included in the study. The results of preoperative localization studies were correlated with intraoperative findings and postoperative histopathological results. The localization rates of individual and combined interpretations of ultrasonography and sestamibi scintigraphy were evaluated. RESULTS: The overall sensitivity and the positive predictive value of ultrasonography and sestamibi scintigraphy were 76% and 90%, and 81% and 91%, respectively. Both imaging studies were concordant for the same localization(s) in 121 (66%) of 183 patients. The prevalence rates of single-gland and multiglandular disease were 90% (N.=109) and 10% (N.=12), respectively, in patients with concordant results (P=0.0001). The overall rate of localization was 91% (N.=110) in these patients. In these patients with concordant results, the sensitivity and the positive predictive value of imaging were 91% and 100%, respectively. The localization rates were 96% and 42% for single-gland and multiglandular disease, respectively (P=0.0001). Of the remaining 62 patients, 50 had negative imaging with either ultrasonography (N.=29) or MIBI (N.=21). Of the 29 patients with negative ultrasonography results, sestamibi scintigraphy was positive in 23. Of the 21 patients with negative sestamibi scintigraphy imaging, ultrasonography was positive in 15. Thus, 38 patients had a single positive imaging result. The majority (95%) of these 38 patients had single-gland disease, and the rate of multiglandular disease was 5% (P=0.0001). The rate of localization was 95% (36/38) in patients with a single positive imaging study. Eighteen patients had discordant imaging results. CONCLUSIONS: The overall rate of localization in primary hyperparathyroidism is greater than 90% if ultrasonography and sestamibi scintigraphy are concordantly positive for the same localization, and the prevalence of multiglandular disease is low in patients with concordant imaging. An image-guided surgical approach and selective parathyroidectomy exhibit high cure rates in the setting of concordantly positive sestamibi and ultrasonography results, even if intraoperative parathormone monitoring is not used.

Spontaneous postoperative choledochoduodenal fistula due to bile duct injury following laparoscopic cholecystectomy.

INTRODUCTION: Bile leak after cholecystectomy which is the frequency less than 2% is an important problem for patients. Some bile duct injuries occuring after laparoscopic cholecystectomy are the complex bile duct injuries and can cause bile leak and fistula. PRESENTATION OF CASE: A 74-year-old woman has high output bile drainage from abdominal drain after laparoscopic cholecystectomy so an ERCP was performed. It was clear that there was a complete transaction of bile ducts, however this finding was inconsistent with the patient's clinical situation. The bile drainage of the patient was ceased and she was discharged to home without any problem. Four months later the patient was admitted again for recurrent cholangitis episodes. Patient was operated to perform a biliary-enteric diversion for the suspicion of biliary stricture. There was a thin fistula tract over the duodenum that was previously seperated from the proximal choledochus. The distal part of the bile duct was ended blindly. A hepaticojejunostomy anastomosis over a transhepatic stenting was performed. DISCUSSION: The circumferential injuries are the most common and devastating injuries leading to bile leak, peritonitis and varying degrees of sepsis. The probability of a bile fistula to close spontaneously is almost impossible in cases of iatrogenic circumferential full thickness injuries. CONCLUSION: In the present case we have reported a case of Bismuth type 2 (Strasberg type E2) injury in which the biliary drainage was closed spontaneously with the formation of spontaneous biliary-duodenal fistula. It is an extremely interesting case that has not been reported in the literature previously.

Open Versus Laparoscopic Surgery for Rectal Cancer: Single-Center Results of 587 Cases.

PURPOSE: We aimed to compare the short-term and long-term results of laparoscopic and open rectal resections. METHODS: A total of 587 rectal cancer patients were included. The main measures were demographic data, duration of surgery, early postoperative results, pathologic data, and long-term follow-up. RESULTS: There were no significant differences in demographic data, morbidity rate, tumor location, and sphincter-preservation rates between the 2 groups. The duration of surgery (155 vs. 173 min, P<0.001), time to gas passage, defecation, and solid food intake and length of hospital stay were significantly shorter in the laparoscopic group than the open group (P<0.05). According to the univariate and multivariate analysis, laparoscopic surgery did not have an effect on local recurrence but had a favorable effect on survival rates. CONCLUSIONS: Laparoscopic rectal surgery has advantages over open surgery with respect to short-term and long-term clinical results and when performed in high-volume centers.

A rare condition: Ectopic liver tissue with its unique blood supply encountered during laparoscopic cholecystectomy.

INTRODUCTION: Developmental abnormalities of liver including ectopic liver tissue (ELT) are rare conditions. Few cases presenting ELT have been reported in literature till now. Even though the most common area seen is gallbladder, it is detected both abdominal and thoracic sites. There is a relationship between HCC and ectopic liver that necessitates the removal. PRESENTATION OF CASE: A 51-year-old female was hospitalized because of abdominal pain. Gallstone and bile duct dilatation were determined during ultrasonographic (USG) evaluation. The patient was operated for cholecystectomy following a successful endoscopic retrograde cholangiopancreatography (ERCP). During operation, a mass located on gallbladder with its unique vascular support was identified and resected together with gallbladder. The mass had a separate vascular stalk arising from liver parenchyma substance and it was clipped with laparoscopic staples. The histopathological examination revealed that the mass adherent to gallbladder was ectopic liver confirming the intraoperative observation. The postoperative course of patient was uneventfull and she was discharged at the second day after the operation. DISCUSSION: Ectopic liver tissue is incidentally found both in abdominal and thoracic cavity. ELT can rarely be diagnosed before surgical procedures or autopsies. It can be overlooked easily by radiological techniques. Although it does not usually produce any symptom clinically, it can rarely result in serious complications such as bleeding, pyloric and portal vein obstruction. ELT also has the capacity of malignant transformation to hepatocellular carcinoma that makes it essential to be removed. CONCLUSION: Although ELT is rarely seen, it should be removed when recognized in order to prevent the complications and malignant transformation.

Results of the open surgery after endoscopic basket impaction during ERCP procedure.

AIM: To report the results of open surgery for patients with basket impaction during endoscopic retrograde cholangiopancreatography (ERCP) procedure. METHODS: Basket impaction of either classical Dormia basket or mechanical lithotripter basket with an entrapped stone occurred in six patients. These patients were immediately operated for removal of stone(s) and impacted basket. The postoperative course, length of hospital stay, diameter of the stone, complication and the surgical procedure of the patients were reported retrospectively. RESULTS: Six patients (M/F, 0/6) were operated due to impacted basket during ERCP procedure. The mean age of the patients was 64.33 ± 14.41 years. In all cases the surgery was performed immediately after the failed ERCP procedure by making a right subcostal incision. The baskets containing the stone were removed through longitudinal choledochotomy with the stone. The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients. All patients were also performed cholecystectomy additionally since they had cholelithiasis. In patients with T-tube placement it was removed on the 13(th) day after a normal T-tube cholangiogram. The patients remained stable at postoperative period and discharged without any complication at median 7 d. CONCLUSION: Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases.

The role of the laparoscopy on circumferential resection margin positivity in patients with rectal cancer: long-term outcomes at a single high-volume institution.

BACKGROUND: The aim of this study was to evaluate the influence of laparoscopic rectal cancer surgery on circumferential resection margin (CRM) involvement. MATERIALS AND METHODS: The data from 579 consecutive patients who underwent laparoscopic or open resection of rectal cancer from October 2002 to August 2008 were analyzed retrospectively. The primary endpoint was CRM status. The secondary endpoints were morbidity, local recurrence rate, overall survival, and disease-free survival. RESULTS: Laparoscopic resections were performed in 266 patients (46%), and the remainder of the patients underwent open resection. The rates of CRM involvement were similar between the laparoscopic and open groups (5.6% vs. 5.4%). The perioperative morbidity rates between the 2 groups were not significantly different (P=0.2). The incidence of local recurrence for the CRM-negative group was 8.4% (8.3% laparoscopic vs. 8.45% open; P=0.99), whereas the local recurrence rate was 34.3% for the CRM-positive group. The local recurrence rate was 20% for the CRM-positive patients in the laparoscopic group and 47% for the CRM-positive patients in the open group (P<0.001). We did not observe any significant differences in local recurrence rates between the Lap R and Open R groups after omitting CRM status. CRM positivity was correlated with both 5-year survival and the 5-year disease-free survival rate (P=0.009 and P=0.001, respectively). We did not observe any significant differences in morbidity, local recurrence, or overall or disease-free survival rates between the overall laparoscopic and open resection groups. CONCLUSIONS: Laparoscopic surgery for rectal cancer is associated with similar complication rates, CRM involvement status, and long-term outcomes as those associated with open surgery but with the advantages of minimally invasive surgery. Although laparoscopic surgery might necessitate more advanced technical skills, similar long-term oncological results can be obtained with this technique.

An atypical cause of rapidly progressing breast lump with abscess formation: Pure squamous cell carcinoma of the breast.

Squamous cell carcinoma (SCC) is a rare type of breast malignancy and little is known about long-term outcome. In the present report, the clinical features, histopathologic findings and postoperative course of a patient with squamous cell carcinoma are described. We have treated a 47-years-old woman who admitted for right breast mass without any discharge, bleeding and pain. The tumor was, 3 × 2 × 1.5 cm in size with central abscess formation. The result of surgical biopsy revealed large cell keratinizing type of SCC. The metastatic work-up studies ruled out any other probable sources of primary tumor. The patient was performed modified radical mastectomy and axillary dissection and received two cycles of chemotherapy. Squamous cell carcinoma of the breast (SCCB) is a rare entity and should be considered in patients with rapidly progressing breast mass. It should also be considered in breast lesions with abscess formation. The initial therapeutic approach should be surgical excision after histopathological diagnosis.

Bilateral elastofibroma dorsi: A case report.

INTRODUCTION: Elastofibroma dorsi(EFD) is slow-growing, benign, soft tissue tumor of unclear pathogenesis, typically located at the subscapular region of elderly people. It may be unilateral or bilateral. As it exhibits benign behavior, it should be surgically removed only in symptomatic patients. Magnetic resonance imaging (MRI) is a useful tool for assessment of EFD and can potentially help avoid the need for unnecessary biopsy and surgery. PRESENTATION OF CASE: A 62-year-old woman presented with 2 years complaint of back pain, particularly aggravated with shoulder movements and swelling with bilateral elastofibroma dorsi. Both masses were totally excised with bilateral posterolateral subscapular incision. Symptoms were completely controlled and significant discomfort from the surgical procedure was completely resolved with in a few weeks interval from the operation. DISCUSSION: The pathogenesis of the EFD still remains unclear. Elastofibroma dorsi has an unspecific clinical presentation and can be confused with other tumors of the periscapular region Imaging studies are useful for diagnosis. CONCLUSION: Elastofibroma dorsi is benign soft tissue tumor mostly observed in the subscapular regions of elderly female patients. The surgery is indicated in symptomatic cases and must be confined to simple excision of the lesion.