Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study.

BACKGROUND: There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients undergoing surgery for PPU and to identify variables associated with these. METHOD: We performed an international study of adults (≥ 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (≤ 50 and > 50 years) and time from onset of symptoms to hospital presentation (≤ 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality. RESULTS:  1874 patients from 159 centres across 52 countries were included. 78.3% (n = 1467) of the patients were males and the median (IQR) age was 49 years (25). Thirty-day morbidity and mortality were 48.5% (n = 910) and 9.3% (n = 174) respectively. Median (IQR) hospital stay was 7 (5) days. Open surgery was performed in 80% (n = 1505) of the cohort. Age > 50 years [(OR = 1.7, 95% CI 1.4-2), (OR = 4.7, 95% CI 3.1-7.6)], female gender [(OR = 1.8, 95% CI 1.4-2.3), (OR = 1.9, 95% CI 1.3-2.9)], shock on admission [(OR = 2.1, 95% CI 1.7-2.7), (OR = 4.8, 95% CI 3.2-7.1)], and acute kidney injury [(OR = 2.5, 95% CI 1.9-3.2), (OR = 3.9), 95% CI 2.7-5.6)] were associated with both 30-day morbidity and mortality. Delayed presentation was associated with 30-day morbidity [OR = 1.3, 95% CI 1.1-1.6], but not mortality. CONCLUSIONS: This study showed that surgery for PPU was associated with high 30-day morbidity and mortality rate. Age, female gender, and signs of shock at presentation were associated with both 30-day morbidity and mortality.

Surgical management of insulinomas at the Azerbaijan Medical University: a retrospective study of 21 cases over a 10-year period

Background/aim: This study represents the first report that evaluates the experience gathered from diagnosis, surgical treatment and outcome of insulinoma patients from Azerbaijan. Materials and methods: We retrospectively review of insulinoma patients for a 10-year period. Collected data included patient demographics, laboratory and imaging tests, detailed surgical reports, histopathological examination of resected specimens, and clinical follow-up. Results: Twenty-one insulinoma patients were identified. Male patients comprised 52.4%; mean age was 44 years. Mean time to diagnosis was 14 months; 61% patients had ≥3 medical referrals due to hypoglycemia-related symptoms. Diagnosis sensitivity of CT, MRI and US was 85%, 80%, and 55%, respectively. The mean glucose, insulin, C-peptide levels were 35.7 ± 9.5 mg/dL, 33.5 ± 21.9 µU/mL, and 3.74 ± 1.88 ng/mL, respectively. Pancreatic head and tail were the most frequent tumor locations; mean tumor size was 1.5 ± 0.7 cm. No statistical association was found between the tumor size and preoperative glucose, C-peptide and insulin levels. Distal pancreatectomy and enucleation were the most common surgical procedures. Local tumor recurrence rate was 14%. There was no mortality. Conclusions: To prevent delayed diagnoses, physicians should be familiar with the typical symptoms of these rare tumors.

The Prognostic Importance of Cancer Stem Cells in Colorectal Polyps.

BACKGROUND: This purpose aims to investigate the usefulness of CD133, a stem cell marker, for the prognosis of colon polyps. This study aimed to assess the adenomatous polyps that have an essential role in the development of colorectal cancer. The risk of colorectal carcinogenesis can be reduced by polypectomy and close medical supervision of the patients with adenomatous polyps. The prominence of stem cells in carcinoma development is also a recognized verdict. It must be noted that stem cell evaluation in adenomatous polyps may provide information about carcinoma development. METHOD: Previously pathologically assessed colorectal polyps in 60 males and 40 females at Azerbaijan Medical University were reevaluated at the Pathology Department under the Meram Medical Faculty. Hematoxylin-eosin stained preparations were examined, and cases with and without dysplasia were determined. The image analysis program re-examined the preparations, and the same image analysis system automatically counted CD133 positive stained cells in the unit area. At the end of the follow-up period after polypectomy, the cases of malignancy were detected. RESULTS: The relationship between CD133 expression of dysplasia and malignancy was statistically compared. During the investigation, the statistically significant relationship between CD133 expression and dysplasia, as well as malignancy development, was observed in this study. CONCLUSION: During the examination, the statistical significance of CD133 expression was detected in cases with dysplasia and malignancy. The investigation of CD133 expression in colorectal polyps is crucial in determining the presence of dysplasia and malignancy development, particularly in obtaining prognostic data in colorectal polyps.

Multiple Swaps Tested: Rehearsal for Triple and Five Liver Paired Exchanges.

Despite several advances in living donor liver transplant (LDLT), many potential living liver donors cannot donate their organs to their relatives because of blood group incompatibility and unsuitable anatomy. Liver paired exchange (LPE) can be used to overcome incompatibilities between living donor-recipient pairs. In this study, we report the early and late results of three and five LDLTs performed simultaneously to initiate the more complex LPE program. By demonstrating that our center is capable of performing up to five LDLTs, we have taken an essential step for establishing a complex LPE program.

Multiple Swaps Tested: Rehearsal for Triple and Five-Liver Paired Exchanges.

Despite several advances in living donor liver transplant (LDLT), many potential living liver donors cannot donate their organs to their relatives because of blood group incompatibility and unsuitable anatomy. Liver paired exchange (LPE) can be used to overcome incompatibilities between living donor-recipient pairs. In this study, we report the early and late results of 3 and 5 LDLTs performed simultaneously to initiate the more complex LPE program. By demonstrating that our center is capable of performing up to 5 LDLTs, we have taken an essential step for establishing a complex LPE program.

Association of miR-149 T>C and miR-196a2 C>T Polymorphisms with Colorectal Cancer Susceptibility: A Case-Control Study.

The principal aim of the current study was to investigate the relationship between miR-149 T>C (rs2292832) and miR-196a2 C>T (rs11614913) small non-coding RNA polymorphisms and the risk of developing CRC in the Azerbaijani population. The study included 120 patients diagnosed with CRC and 125 healthy individuals. Peripheral blood samples were collected from all the subjects in EDTA tubes and DNA extraction was performed by salting out. Polymorphisms were determined using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. While comparing without gender distinction no statistical correlation was found between the heterozygous TC (OR = 0.66; 95% CI = 0.37-1.15; p = 0.142), mutant CC (OR = 1.23; 95% CI = 0.62-2.45; p = 0.550), and mutant C (OR = 1.03; 95% CI = 0.72-1.49; p = 0.859) alleles of the miR-149 gene and the CT (OR = 1.23; 95% CI = 0.69-2.20; p = 0.485), mutant TT (OR = 1.29; 95% CI = 0.67-2.47; p = 0.452), and mutant T (OR = 1.17; 95% CI = 0.82-1.67; p = 0.388) alleles of the miR-196a2 gene and the risk of CRC. However, among women, miR-149 TC (OR = 0.43; 95% CI = 0.19-1.01; p = 0.048) correlated with a reduced risk of CRC, whereas miR-196a2 CT (OR = 2.77; 95% CI = 1.13-6.79; p = 0.025) correlated with an increased risk of CRC. Our findings indicated that miR-149 T>C (rs2292832) might play a protective role in the development of CRC in female patients, whereas the miR-196a2 (rs11614913) polymorphism is associated with an increased risk of CRC in women in the Azerbaijani population, highlighting the importance of gender dimorphism in cancer etiology.

A Brief History of Organ and Tissue Transplantation in Azerbaijan.

OBJECTIVES: The aim of this study was to provide a brief history of transplantation in Azerbaijan. MATERIALS AND METHODS: Published information on transplant in Azerbaijan is limited; therefore, we contacted transplant centers and asked questions of heads or members of transplant teams. Answers to the survey provided the basis of this report. RESULTS: In Azerbaijan, history of transplantation started with corneal transplants in the 1920s and kidney transplant from living and deceased donors in the 1970s. Organ transplants, except corneal transplants, were stopped from 1983 to 2002. Living donor kidney transplant and bone marrow transplant were started around 2002. Living donor liver transplant and stem cell transplant have been performed since 2008 and 2015, respectively. Until 2021, 898 kidney, 252 liver, 112 bone marrow, 22 stem cell, approximately 2000 unpreserved and 72 preserved corneal transplants, and 3 left ventricular assist device implantations have been performed in our country. Currently, organ transplant is performed in 7 hospitals of Azerbaijan (the Surgical Clinic of Azerbaijan Medical University, Republican Treatment and Diagnostic Center, Central Clinic Hospital, Central Customs Hospital, Thalassemia Center, Bona Dea Hospital, and National Ophthalmology Center). CONCLUSIONS: We hope that the enactment of a new law on transplantation and the establishment of the Coordination Center and Ethics Committee in the near future will create great opportunities for future progress in transplantation, allowing the thousands of patients waiting for transplant to regain their health.

Investigation of the DNMT3B -579 G>T Promoter Polymorphism in Patients with Colorectal Cancer in an Azerbaijani Population.

OBJECTIVE: The main aim of the present study was to determine the clinical significance of the DNA methyltransferase 3B (DNMT3B) gene -579 G>T polymorphism in colorectal cancer (CRC) patients. METHODS: A total of 140 patients with CRC and 164 healthy individuals were included in the study. According to the manufacturer's instructions, DNA was isolated from blood, and genotypes were determined on agarose gel by the PCR-RFLP method. Genotype confirmation was performed using Sanger sequencing in randomly selected samples. RESULTS: When comparing the case and control groups, heterozygous GT (OR=0.53; 95% CI=0.32-0.88), under the dominant model (OR=0.53; 95% CI=0.33-0.87), and the mutant T allele (OR=0.71; 95% CI=0.51-0.98) were statistically associated with a reduced risk of CRC. However, when the age, pathological tumor grade and stage, smoking habit, and alcohol consumption were compared, no significant relationship was determined (P>0.05). Furthermore, among males, heterozygous GT was associated with a reduced risk of CRC (OR=0.40; 95% CI=0.19-0.84). CONCLUSION: Our study highlighted that the -579 G>T polymorphism of the DNMT3B gene plays a protective role against CRC development.

Perception of COVID-19 Pandemic Among IBD Clinicians and IBD Surgeons in Black Sea Region: A Cross-Sectional Questionnaire Study.

BACKGROUND: Since December 2019, the COVID-19 pandemic has created an increasing challenge in managing inflammatory bowel dis- ease patients both medically and surgically. Although several international and national medical/surgical associations published guide- lines in this area, there is still a huge difference between daily practices and these guidelines, especially depending on regional practices and governmental policies. Therefore, we aimed to investigate and define gastroenterologists' and surgeons' fear of COVID-19 and how they have managed inflammatory bowel disease patients during this pandemic in the Black Sea region. METHODS: A 20-question survey was administered to 70 gastroenterology specialists and 80 general surgeons who are mainly focused on the management of inflammatory bowel disease in 5 countries in the Black Sea region. RESULTS: The majority of respondents (81.3%) mentioned that they have concerns that their inflammatory bowel disease patients were at risk of contracting COVID-19. In addition, the majority of respondents (80.3%) believed that inflammatory bowel disease itself, inde- pendent of medications, might increase the risk of contracting COVID-19. The majority of gastroenterologists told that they did not stop inflammatory bowel disease medications due to the COVID-19 pandemic unless patients had COVID-19 disease. Surgeons overwhelm- ingly reached a consensus on how to test patients for COVID-19 perioperatively and came to a conclusion on which of the patients can- not wait to be operated. Both gastroenterologists and general surgeons, usually have similar perceptions. CONCLUSION: Despite the increasing number of definitive studies, it seems that there are still regional differences in the perception of COVID-19 and inflammatory bowel disease patient care during the pandemic.

The role of "Prominin - 1" marker in adenomatous colorectal polyps.

<b>Introduction:</b> Adenomatous polyps are pivotal to the development of colorectal cancer. The risk of colorectal carcinogenesis can be reduced through polypectomy and close surveillance of the disease. Early-stage polyps can be detected and removed endoscopically, therefore, reducing the incidence of carcinoma. The identification of CSC in colon polyps allows for assessment of their potential malignancy. Therefore, it is very relevant to study the prognostic significance of the prevalence of stem cells in colorectal polyps in early detection and prevention of cancer. </br></br> <b> Method:</b> Previously pathologically evaluated adenomatous tumors (60M, 40F) at Azerbaijan Medical University were reevaluated in Meram Medical Faculty Pathology Department. Hematoxylin-Eosin-stained slides were examined and cases with and without dysplasia were determined. New sections were taken from paraffin blocs. Prominin-1 staining was performed immunohistochemically on these sections. Stained slides were examined by an image analysis system. Prominin-1-positive cells were automatically counted with the same image analysis system. The cases that developed malignancy after polypectomy were determined. The relationship between CD133 expression of dysplasia and malignancy was statistically analyzed. </br></br> <b> Results:</b> Statistically significant prominin-1 expression was detected in cases with dysplasia and malignancy. </br></br> <b> Conclusion:</b> The investigation of prominin-1 expression in colorectal polyps may be important to determine malignancy development.

Extracellular Histones H3 as a Prognostic Blood Marker for Delayed Liver Function Recovery After Donor Hepatectomy.

BACKGROUND: Early prediction of liver dysfunction after liver resection remains a challenge. We hypothesized that extracellular histone concentrations are a promising new biomarker for the detection of liver injury after donor hepatectomy. METHODS: This prospective study considered 93 living donors who underwent hepatectomy. Blood samples of donors were collected on postoperative day 1, and histone levels in the plasma samples of the patients were measured with total histone H3 sandwich ELISA kits. Among 86 right lobe donors, 23 (26.7%) were deemed to have a delayed liver function recovery according to the International Study Group of Liver Surgery's definition of posthepatectomy liver failure, whereas 63 (73.3%) were considered to have an adequate liver function recovery. RESULTS: The area under the receiver operating characteristic (ROC) curve for circulating histones in predicting persistent liver dysfunction was 0.618 ± 0.06 (95% confidence interval [CI], 0.501-0.735; P = .091). The cutoff point value obtained from the analysis of ROC curves was 0.895, with a sensitivity of 95.7% and a specificity of 32.9%, respectively, for examining a delayed liver function recovery (P = .015). The Fisher analysis significantly verified these results empirical influence function % 7.90 (95% CI, 3.91-11.90; P = .006). The univariate analysis determined that postoperative histones were identified as an independent risk factor of delayed liver function recovery (odds ratio, 10.8; 95% CI, 1.4-84.9; P = .024). CONCLUSIONS: The circulating histone negatively correlates with liver dysfunctions after donor hepatectomy and had the best value in predicting liver dysfunction within 24 hours after liver resection.

The Effectiveness and Feasibility of Laparoscopic Re-sleeve Gastrectomy.

BACKGROUND: Weight regain following laparoscopic sleeve gastrectomy (LSG) may be due to dilation of the gastric reservoir. Laparoscopic re-sleeve gastrectomy (LrSG) is among the revisional surgery options. OBJECTIVES: We aimed to investigate the effectiveness of LrSG for weight loss after a 12- and 24-month follow-up period. SETTING: Bariatric surgery center in Baku/Azerbaijan. METHOD: From June 2016 to June 2019, a total of 34 LSG patients with weight regain, underwent LrSG. We prospectively followed outcomes data were BMI changes, excessive weight loss, changes in laboratory values, and the presence of complications. RESULTS: The mean age at revision surgery was 36 ± 7.09 (range, 22-51) years, and the mean body mass index (BMI) before LrSG was 40 ± 5.2 kg/m2. The mean time between the primary and revision surgery was 50 ± 7.8 months. The main reasons for the revisions were weight regain and inadequate weight loss. The mean BMI value decrease at the 12th and 24th months were 27.7 ± 2 and 24.3 ± 1.02, which were statistically significant (p < 0.05). Analyses of hemoglobin A1C (A1C) values showed that the differences at the baseline, 12th and 24th months were statistically significant (95% 1.96 to 3.39, p < 0.001 and 95% CI 0.34 to 2.08, p = 0.005, respectively). CONCLUSIONS: In patients with weight regain or inadequate weight loss after LSG, LrSG may be a feasible and safe revisional procedure in a selected group of patients. Larger studies that compare other revisional surgery options (LRYGB, OAGB, duodenal switch, single anastomosis duodeno-ileal bypass) with LrSG are required.

The importance of colonoscopy in the treatment of colorectal polyps and colorectal cancer screening.

AIM: Colorectal polyp is the most commonly encountered intestinal colon pathology in patients over 50 years of age, and 5% of which develops a "colorectal cancer". The early-stage polyps can be detected and removed endoscopically, which reduce the incidence of carcinoma. Our study is aimed to investigate the role of colonoscopy in colorectal adenoma treatment and screening for colorectal cancers, and to answer the question of whether the colorectal polyps would become malignant or not malignant by means of the comparative analysis of their histological features. METHODS: In the interval between 2011 and 2016 years, endoscopic polypectomy was performed in 118 out of 1375 patients at the Endoscopy Department of the Central Customs Hospital, either with a snare loop and a biopsy clamp. The age group of the patients was between 20 and 65years. A retrospective analysis was performed in 100 of these patients, of whom 18 were later excluded. RESULTS: Grounding on the histopathological evaluation, adenomatous polyps were differentiated into tubular (65-80%), tubulovillous (25%), and villous (5-10%) adenomas. In particular, 90% of 1 cm (small) polyps were tubular. Dysplasia was found in 42 out of the 100 polyps. The 42 patients with dysplasia were reevaluated, and 26 (61.9%) later developed a malignancy. Malignancy did not occur in the case of any of the 58 polyps without dysplasia. The study also revealed that the size of polyps is directly correlated with their path-morphological structures. In this study, two giant polyps were detected and then treated surgically, one patient had perforation after the polypectomy, and a surgical intervention immediately was performed upon him. During the colonoscopy, three patients had bleeding, hemoclip was applied to one of those patients, and sclerothreapy was performed upon the rest of two patients. After the polypectomy, in two patients, there was a feeling of pain, fever, discomfort in the abdomen, which was assessed as a "postpolypectomy" condition CONCLUSION: Also in our experience adenomatous polyps play a crucial role in the development of colorectal cancer. Therefore, it seems quite essential to avert colorectal cancers gradually. Colonoscopy is a non-invasive method of diagnosis and a treatment of colorectal polyps. Proper and careful colonoscopy examination is indispensable in the discovery of colorectal polyps and subsequent follow-up. Timely and routine colonoscopy is considered as an important approach for thwarting the development of malignant neoplasms. KEY WORDS: Adenomatous polyps, Colorectal cancer, Colorectal polyps, Post-polypectomy.

Preoperative Evaluation of Liver Parenchyma of Potential Donors in Living Donor Liver Transplantation.

BACKGROUND: Hepatic steatosis carries a risk of postoperative liver dysfunction in donors and graft nonfunction in recipients. This article discusses the evaluation of fatty infiltration in donor liver parenchyma on multidetector computed tomography. MATERIALS AND METHODS: The methods of hepatic fat estimation include measurement of hepatic attenuation in HU and calculation of the liver attenuation index (LAI). Liver attenuation values reflect the degree of steatosis. Average attenuation of liver parenchyma is calculated by placing the circular region of interest of at least 1 cm2 area at multiple places in the liver on noncontrast CT images. Splenic attenuation is measured by placing the circular region of interest at its upper, middle, and lower poles. The LAI is the difference between mean hepatic attenuation and mean splenic attenuation. RESULTS: A total of 52 donors were evaluated as potential recipients (34 men, 18 women; mean age, 33.2 years; range, 23-55 years). In 34 donors liver attenuation index (LAI) values were from 2 HU to 22 HU. An LAI > 5 HU correctly predicted the absence of significant macrovesicular steatosis. These donors were acceptable for a liver transplant. The LAI values of -10 to 5 HU were suggestive of mild to moderate steatosis (6%-30%); 18 (34.6%) volunteers did not proceed to donation because of negative LAI < -5 HU. In 2 cases with LAI of -7 and LAI of -8 liver biopsy was performed, and 30% steatosis was confirmed in the pathohistologic examination. Unacceptable liver biopsy result was considered as contraindication for donation. The LAI values of < -10 HU were suggestive of moderate to severe hepatic steatosis of 30% or greater. In these cases liver biopsy is not needed, as such donors are not acceptable for liver transplant. CONCLUSION: Computed tomography imaging provides a detailed evaluation of fatty infiltration in donor liver parenchyma.

Liver Graft and Spleen Elastography After Living Liver Transplantation: Our First Results.

AIM OF THE STUDY: Liver transplantation is widely applied as a standard and effective management of end-stage liver diseases, hepatocellular carcinoma, and acute liver failure. Investigation of morphologic and functional changes in the transplanted graft, gastrointestinal system, and spleen after transplantation is an important ground for assessment of post-transplantation results, early changes related to complications, and evaluation of response to treatment modalities. The aim of this study was to investigate the dynamics of changes in elastography of the liver graft and spleen after living-related liver transplantation. MATERIAL AND METHODS: The study included 14 cirrhotic patients after living-related liver graft transplantation. Stiffness of the spleen and liver was evaluated before transplantation and at 1, 3, and 6 months after transplantation with a Supersonic Aixplorer Multi Wave device. Each procedure consisted of measuring the density in 10 points (spots) of the organ. The final result was calculated as the mean value of successful measurements (must have been > 60% of all measurements) and expressed in kilopascals. RESULTS: The mean value of the liver and spleen stiffness before transplantation was 27 kPa (14-31 kPa) and 51 kPa (38-92 kPa), respectively. The stiffness of the spleen gradually reduced after transplantation to 40.3, 35.4, and 24.1 kPa (P = .001) at 1, 3, and 6 months. The stiffness of the liver graft in patients without complications was stable at 4-5 kPa, whereas the same value in patients with complications was increased (≥ 7.5 kPa). In 5 patients, endoscopic investigation confirmed the significant reduction of varicose veins after surgery. CONCLUSION: Elastography of the liver graft and spleen after liver transplantation can be recommended as a useful-for-patient 1-off method of investigation.

Living donor liver transplantation with replacement of vena cava for Echinococcus alveolaris: A case report.

INTRODUCTION: There is no medical treatment for alveolar echinococceal disease (AED) of liver till now. Curative surgical resection is optimal treatment but in most advanced cases curative resection can't be done. Liver transplantation is accepted treatment option for advanced AED. AED in some case invade surrounding tissue especially inferior vena cava (IVC). Advanced AED with invasion to IVC can be treated with deceased liver transplantation. Although living donor liver transplantation is very difficult to perform in patients with advanced AED with resected IVC, it come into consideration, since there is very few cadaveric liver. PRESENTATION OF CASE: Here we present a case with advanced stage of AED of liver which cause portal hypertension and cholestasis. AED invaded surrounding tissue, right diaphragm, both lobes of liver and retrohepatic part of IVC. Invasion of IVC forced us to make resection of IVC and reconstruction with cryopreserved venous graft to reestablish blood flow. After that a living donor liver transplantation was done. DISCUSSION: Curative surgery is the first-choice option in all operable patients with AED of liver. Advanced stage of AED like chronic jaundice, liver abscess, sepsis, repeated attacks of cholangitis, portal hypertension, and Budd-Chiari syndrome may be an indication for liver transplantation. In some advanced stage AED during transplantation replacement of retrohepatic part of IVC could be done with artificial vascular graft, cadaveric aortic and caval vein graft. CONCLUSION: Although living donor liver transplantation with replacement of IVC is a very difficult operation, it should be considered in the management of advanced AED of liver with IVC invasion because of the rarity of deceased liver.