Gastrointestinal stromal tumors: A clinical and histopathological presentation of 27 cases.

OBJECTIVE: Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that express type 3 tyrosine kinase receptors and are thought to develop from the neoplastic transformation of the interstitial Cajal cells. The present study was performed to morphologically and immunohistologically evaluate GISTs, to compare their qualities using a GIST risk categorization system, and to identify the diagnostic and prognostic parameters of GISTs. MATERIAL AND METHODS: A total of 27 patients with GISTs underwent treatment and were followed up at the Gaziosmanpasa Taksim Training and Research Hospital. Descriptive statistics was used to calculate the mean and median values. Survival analysis was performed by the Kaplan-Meier method. The analyses were performed using the SPSS version 22.0 software. RESULTS: The mean follow-up time was 3.5 (5 months to 13 years) years. The mean age was 60.4 (29-82) years. The tumors were localized in the stomach (62.9%), extraintestinal areas (14.8%), intestine (7.4%), esophagus (7.4%), and rectum (7.4%). Twenty-four patients were classified according to the Fletcher system. Of these patients, 7 (25.9%) were classified as very low risk, 8 (29.6%) as low risk, 7 (25.9%) as intermediate risk, and 2 (7.4%) as high risk. Twenty-four patients underwent surgery. Of the 3 patients who did not undergo surgery, 1 had metastatic disease at the time of diagnosis, and 2 had mini- or micro-GISTs in the stomach. On endoscopic surveillance, all tumors remained stable. Three out of the 27 patients were lost to follow-up. Two patients developed recurrence, and 1 patient died of GIST. CONCLUSION: We analyzed the clinical and pathological characteristics of GIST. The most common site of tumor origin was the stomach. The size, mitotic index, and Ki-67 values were to be found high in intermediate- and high-risk groups and metastatic diseases.

The effect of epidermal growth factor on anastomosis, fascia, and skin wound healing.

BACKGROUND: The effect of epidermal growth factor (EGF) on gastrojejunostomy (anastomosis), fascia, and skin wound healing in rats was investigated. METHODS: The animals (rats) were separated into two main groups. In the first group (control group n: 23), rats were fed on standard diet and tap water without administration of EGF. In the second group (EGF group, n: 19), EGF was added to the diet. Skin, fascia, and anastomosis wounds were created on three different locations via laparotomy and gastrojejunostomy in all rats. In both groups, the rats divided into three subgroups were sacrificed on the 3rd, 7th, and 21st days post operatively. Tensile strength of skin and fascia and bursting pressure strength were measured for wound healing in both groups on 3rd, 7th, and 21st days. RESULTS: Anastomosis tensile strength of EGF group on the 3rd day of postoperation was found to be significantly higher than that of the control group and when we compared anastomosis bursting pressure, fascia tensile strength, and skin tensile strength in both groups, we did not find any significant differences. CONCLUSION: The measurements indicated that on the 3rd day EGF administered group, which had a more remarkable fibroblastic activity at gastrojejunostomy site, was superior to the control group only in terms of anastomosis breaking tensile strength.

The Effects of Early Enteral Nutrition Products on the Healing of Colo-Colonic Anastomosis.

OBJECTIVES: Complications after colorectal surgery have not been reduced in recent years. Anastomotic leakage is responsible for nearly all morbidity in colonic surgery and for about one third of the mortality. MATERIAL AND METHODS: For the study, 34 albino Wistar rats (about 155-190 g in weight) were divided into four experimental groups. Each of the rats underwent an abdominal incision and resection of the colon 4 cm distal to the cecum to form a colo-colonic anastomosis. In the post-operative period, the first group (n=8) were fed with standard rat food and water, the second group (n=9) with dextrose+Ringer solution, the third group (n=9) with Biosorb® (Nutricia, Zoetermeer, The Netherlands), and the fourth group (n=8) with Impact® (Novartis Nutrition, USA). RESULTS: The blow-out pressure of the anastomoses was significantly different in the group fed 5% dextrose+Ringer solution group than in the Biosorb® and Impact® groups. CONCLUSIONS: None of the various nutrients investigated in the present study were significantly superior to standard foods in terms of the blow-out pressures. On the other hand, immunonutrients were more beneficial effects than other nutrients in terms of the healing of colonic anastomoses and post-operative weight loss.

Risk factors for operative mortality and morbidity in gastric cancer undergoing D2-gastrectomy.

AIM: We have assessed the risk factors for mortality and morbidity subsequent to D2-gastrectomy in gastric cancer cases. PATIENTS AND METHOD: The records (age, gender, comorbidity, ASA score, POSSUM score, type of gastrectomy, additional organ resection and pathologic TNM stage) were reviewed in 49 cases of D2 gastrectomies (between 2003 and 2008) retrospectively. RESULTS: Mean age was 60.4 (range: 35-82). The factors of comorbidity (n=38) in 27 patients. The average quantity of lymph nodes was 21.2 (range: 16-31) in D2 dissections. The rate of mortality was 8.2% (4/49). All the patients who died had major comorbid diseases and all were submitted to total gastrectomy. Twenty-one morbidities were detected in 13 patients [morbidity rate was 26.5% (13/49)]. We have observed a nearly statistically significant (p=0.074) disadvantage of total gastrectomy versus subtotal gastrectomy [those who died had undergone total gastrectomy, and the morbidity rates were 36.4% vs 14.8%] in concordance with literature. CONCLUSION: In these studies, we have observed that our mortality (8.2%) and morbidity (26.5%) rates are in concordance with the data from medical literature, and POSSUM scores are the only parameter in positive statistical correlation with mortality. Preoperative and postoperative resuscitation are of great importance if the patients have POSSUM score >20.