Is Airway Management More Risky in Bariatric Surgery?

PURPOSE: Airway problems may be experienced more often during anesthesia management in bariatric surgery. In this prospective study, we aimed to compare the incidence of difficult ventilation and intubation between bariatric surgery and other surgeries. DESIGN: This was a case-control study. METHODS: Medical records of 156 patients over the age of 18 who were scheduled for bariatric (n = 68) and nonbariatric surgery (n = 88) under general anesthesia were evaluated. FINDINGS: The percentage of ASA III, diabetes mellitus, and obstructive sleep apnea syndrome (75%, 33.8%, and 16.2%, respectively) was significantly higher in bariatric surgery patients compared to nonbariatric patients (14.8%, 10.2%, and 3.4%, respectively). No significant difference was found in mean thyromental distance and history of difficult intubation, restriction of cervical extension, beard presence, tooth loss, mallampati, Cormack-Lehane score, intubation score, difficult ventilation, difficult intubation and intubation device used. An increase in neck circumference (>50 cm) rather than body mass index was a more significant indicator in predicting difficult intubation and difficult ventilation. CONCLUSIONS: The incidences of difficult ventilation and difficult intubation were similar in bariatric and nonbariatric surgeries in circumstances where the necessary equipment and experienced anesthesiologists are available.

Effects of sleeve gastrectomy on neutrophil-lymphocyte ratio.

OBJECTIVES: Obesity and related diseases have become one of the most important health problems in the modern age. In addition to its clinical use in the treatment of obesity, bariatric surgery reduces obesity-induced inflammation. Neutrophil-lymphocyte ratio (NLR) is a cheap and easily attainable inflammatory marker. The purpose of this study is to show the effect of bariatric surgery on NLR at preoperative and postoperative 3rd, 6th, and 12th months after SG. METHODS: 298 patients, who underwent sleeve gastrectomy (SG) in general surgery clinic between 2015 and 2017, were included in the study. We excluded the patients younger than 18 years old, and did not have any inflammatory, infectious, hematological, and comorbide diseases such as diabetes mellitus, cardiovascular diseases, ischemic heart disease, hypertension, renal insufficiency, cancer, and respiratory problems like asthma, obstructive sleep apnea syndrome. We evaluated the levels of NLR at preoperative and postoperative 3rd, 6th, and 12th months visits. RESULTS: There were a total of 298 adult patients (age: mean 38.6, minimum 18, maximum 69 years old). Of whom 247 were female (82.9%) and 51 were male (17.1%). We found that NLR levels decreased significantly at 3rd, 6th, and 12th month visits after SG (p<0.001). CONCLUSIONS: We concluded that NLR levels decrease after surgery in a proportional reduction in adipose tissue. The decrease in NLR levels may also be associated with the protective effects of sleeve gastrectomy against low-grade inflammation-related diseases.

New Findings on Autoimmune Etiology of Idiopathic Granulomatous Mastitis: Serum IL-17, IL-22 and IL-23 Levels of Patients.

BACKGROUND: Idiopathic Granulomatous Mastitis (IGM) is a benign chronic inflammatory breast disease that mimics breast cancer, and the etiopathogenesis has not yet been fully evaluated. Autoimmunity has received the most focus as a possible etiology. Our aim in this prospective clinical study was to investigate the possible association between the cytokines, interleukin IL-17, IL-22, IL-23 and IGM. MATERIALS AND METHODS: The current study was conducted in 26 women with histopathologically diagnosed IGM, and 15 control women of reproductive age having no breast disease history. Blood samples were collected, and serum concentrations of IL-17, IL-22, and IL-23 were determined. RESULTS: In the analysis of variables, the patients with IGM and the control group had statistically significant differences between serum IL-22 titers (p = 0.0378) and IL-23 titers (p = 0.0469. No statistically significant difference was found between IGM patients and the control group in serum IL-17 titers (p = 0.9724). CONCLUSION: The results of the current study, especially pertaining to serum IL-22 and IL-23 levels, support the etiopathogenesis of IGM in favor of the autoinflammatory thesis. Nevertheless, this thesis should be supported by a large case number and prospective clinical studies.

Is it necessary to always resect elastofibroma dorsi?

BACKGROUND: Elastofibroma dorsi (ED) is a benign soft tissue tumour of the subscapular region of the chest wall. It is a frequent lesion, especially seen in females and in the elderly. It remains unclear whether the size or symptomatology of the tumour is important to make a resection decision. Our aim in this study is to reveal the results between asymptomatic or symptomatic ED cases, and to reveal which factors are important for making a resection decision. METHODS: Patients operated between January 2010 and December 2019 were included in the study, and divided into two groups as patients who were asymptomatic or with various symptoms. Patients were evaluated in terms of demographic and operational factors. RESULTS: The study included 57 patients with the average age of 56.1 ± 11.5 years. Whilst 31 (54.4%) of these patients were asymptomatic, 26 (45.6%) were symptomatic. There was a statistical significance between groups in terms of occupation (P < 0.001), comorbidity (P = 0.042) and the duration of complaints (P = 0.001). A statistically significant difference was analysed between comorbidity versus early and late complications (P = 0.011 and P = 0.002, respectively). CONCLUSION: ED probably occurs as a result of repeated trauma in the subcapular region in people who use their arms extensively. Regardless of the size of the lesion, surgery should be avoided as much as possible, especially in asymptomatic patients. However, in patients who are symptomatic, a precise surgical procedure can give satisfactory results. In these patients, who are generally elderly, early and late complications can be seen more, if they have comorbidity.

The role of platelet parameters in thrombosed hemorrhoids / O papel dos parâmetros plaquetários nas hemorróidas trombosadas

ABSTRACT Objectives: The most common disease of anus is hemorrhoids. The definition of external hemorrhoids suggests the acute phase, often characterized by thrombosis or edema. External thrombosed hemorrhoid is a specific complication. In this study, we aimed to investigate the effects of different platelet parameters in the presence of internal or external thrombosed hemorrhoids. Methods: Patients examined were divided into two groups: Group 1: Thrombosed hemorrhoids group (THG), Group 2: Hemorrhoidectomy group (HG). Demographic and clinical data were identified. In terms of laboratory findings, preoperative hemoglobin, hematocrit and all platelet parameters were recorded. Main results: Fifty-two patients in THG, and 75 patients in HG were included in the study. In female sex and young age group, the risk of developing thrombosed hemorrhoids was statistically significant (p= 0.029, p= 0.039, respectively). When the platelet parameters were evaluated; while PDW was higher in THG (p= 0.008), any significant difference could not found in all other values (p> 0.05). Thrombosed hemorrhoids were mostly (59.25%) found to be located in the left laterodorsal part of anus. Conclusion: Internal hemorrhoids are frequently seen in the ages of 45-65 with similar rates in both sexes, while external thrombosed hemorrhoids occur at a younger age (<45) and more often in women. Comparing in terms of platelet indexes, PDW value was found to be significantly higher in THG. In young people, thrombosed hemorrhoids may develop more frequently, as the connective tissue that forms the anal pads is not loose enough to form an internal hemorrhoid, as more seen in older patients.

RESUMO Objetivos: A doença anal mais comum são as hemorróidas. A definição de hemorróidas externas sugere a fase aguda, muitas vezes caracterizada por trombose ou edema. A hemorroida externa trombosada é uma complicação específica. Neste estudo, objetivamos investigar os efeitos de diferentes parâmetros plaquetários na presença de hemorróidas trombosadas internas ou externas. Métodos: Os pacientes examinados foram divididos em dois grupos: Grupo 1, Grupo de Hemorróidas Trombosadas (GHT); Grupo 2, Grupo de hemorroidectomia (GH). Os dados demográficos e clínicos foram identificados. Em termos de achados laboratoriais, a hemoglobina pré-operatória, o hematócrito e todos os parâmetros plaquetários foram registrados. Resultados principais: Cinquenta e dois pacientes em GHT e 75 pacientes em GH foram incluídos no estudo. No sexo feminino e na faixa etária jovem, o risco de desenvolver hemorróidas trombosadas foi estatisticamente significativo (p = 0,029, p = 0,039, respectivamente). Os parâmetros plaquetários avaliados mostraram que, enquanto a Amplitude de Distribuição de Plaquetas (PDW, do inglês platelet distribution width) foi maior no GHT (p = 0,008), nenhuma diferença significativa foi encontrada para todos os outros valores (p > 0,05). A maioria das hemorróidas trombosadas (59,25%) localizava-se na região lateral-dorsal esquerda do ânus. Conclusão: As hemorróidas internas são frequentemente vistas nas idades de 45 a 65 anos com taxas semelhantes em ambos os sexos, enquanto as hemorróidas externas trombosadas ocorrem em uma idade mais jovem (<45) e mais frequentemente em mulheres. Comparando em termos de índices de plaquetas, foi observado que o valor de PDW foi significativamente maior no GHT. Em pessoas jovens, as hemorróidas trombosadas podem se desenvolver com mais frequência, pois o tecido conjuntivo que forma as almofadas anais não é flácido o suficiente para formar uma hemorroida interna, como ocorre com mais frequência em pacientes mais velhos.

The role of the lactate level in determining the risk rates of small bowel resection in incarcerated hernias.

BACKGROUND: An incarcerated hernia is a part of the intestine or abdominal tissue that becomes trapped in the sac of a hernia. An increase in morbidity and mortality occurs after intestinal resections from strangulated hernias. This study aims to examine the markers that may be effective in determining the risk of small bowel resection due to incarcerated hernias. In particular, we aimed to investigate the effect s of blood lactate levels in determining this risk. METHODS: A cross-sectional retrospective study was designed. Patients, whose preoperative diagnosis were reported as incarcerated hernia and had essential information, were included in this study. They were divided into two groups according to whether they had resection or not. Age, gender, hernia type, hernia side, resection material, blood lactate level (BLL), white blood cell (WBC), neutrophil count (NE), lymphocyte count (LY), neutrophil/lymphocyte ratio (NLR), platelet count (PLT), lactate dehydrogenase (LDH), radiologic bowel obstruction sign and comorbidities were evaluated. RESULTS: Sixty-seven patients were included in this study. It was observed that 16 (23.9%) of these patients underwent small intestinal resection, 16 (23.9%) had an omentum resection, while no resection was performed on 35 (52.2%) patients. There was a statistically significant difference regarding radiologically intestinal obstruction (p=0.001), hernia type (p=0.005), BLL (p<0.001), WBC, NLR and LDH values (p<0.05). In incarcerated hernia patients with a lactate value ≥1.46 mg/dL, sensitivity was observed to be 84.0% and specificity 86.0% (p<0.001). CONCLUSION: In patients with a preliminary diagnosis of an incarcerated hernia, the risk of possible small bowel resection is the most important point in deciding for an operation. The presence of an intestinal obstruction in radiological examinations, and particularly the high levels of WBC, NLR, LDH and BLL, may indicate a necessity for possible small bowel resection. Concerning the risk associated with small bowel resection, blood lactate levels ≥1.46 mg/dL may be alerting.

Electrochemical synthesis and corrosion protection of poly(3-aminophenylboronic acid-co-pyrrole) on mild steel.

Synthesis of poly(3-aminophenylboronic acid-co-pyrrole) (p(APBA-co-Py)) is carried out potentiodynamically on a pre-passivated mild steel (MS) surface in an oxalic acid solution containing 3-aminophenylboronic acid (APBA) and pyrrole (Py) monomers. The monomer feed ratio was determined using electrochemical impedance spectroscopy (EIS) and adhesion tests. The p(APBA-co-Py) coating is characterized by electrochemically and spectroscopically comparing with poly(3-aminophenylboronic acid) (p(APBA) and polypyrrole (p(Py) homopolymers. SERS, FTIR, XPS, scanning electron microscopy-wavelength dispersive X-ray and- energy dispersive X-ray spectroscopy results indicate the presence of both APBA and Py segments in the p(APBA-co-Py) backbone. The protective properties of the coating are investigated by Tafel and EIS measurements in a 0.50 M HCl solution. The corrosion resistance of p(APBA-co-Py)-coated MS (66.8 Ω cm2) is higher than that of p(APBA)- and p(Py)-coated, passivated, and uncoated MS. The p(APBA-co-Py) coating embodies the advantageous features of both homopolymers. Py units in p(APBA-co-Py) chains improve the protective property while APBA units carrying the -B(OH)2 group develop the adhesive property of the layer. EIS results show that the p(APBA-co-Py) coating, due to its homogeneous and compact distribution and the formation of a stable interface, enhanced corrosion resistance of MS by 87.4% for 10 hours in HCl corrosive medium.

Correlation of pelvic fractures and associated injuries: An analysis of 471 pelvic trauma patients.

BACKGROUND: In most respects, the vast majority of pelvic injuries is not of a life-threatening status, but co-presence of other injuries needs to be diagnosed. This study aims to evaluate associated pelvic and extra-pelvic visceral organ injuries of the patients with closed pelvic fractures. METHODS: This retrospective study was conducted with 471 adult patients who had been admitted to our Emergency Service with the diagnosis of pelvic fractures. Type of fractures, accompanying visceral organ injuries, the demographic data, type of operation, mortality rates were recorded and analysed statistically. RESULTS: The rate of operations carried out by the general surgery clinic or other surgical clinics in each type of fracture according to AO classification did not differ (p=0.118). In patients with A2, A3 and B1 types of fractures, the operation rate of general surgery clinic did not show a significant difference. However, most of the patients who had extrapelvic surgery were in the mild severity pelvic trauma, such as AO A2 and A3. A total of 31 patients were ex-patients, 17 of whom had AO-A2 type of fractures. The findings showed that there was a significant difference between abdominal ultrasonography outcome that was normal and non-orthopedic surgery types (p<0.001). There was no significant difference between the types of surgery performed and Abdominal CT outcome, which was normal (p=0.215). CONCLUSION: In the management of patients with pelvic fractures irrespective of its type or grade, the findings suggests that greater attention should be paid to not to overlook the associated injuries. Early blood and imaging tests are encouraged after the patient's hemodynamic status is stabilized.

The role of flow cytometry in the diagnosis of non- Hodgkin's lymphoma, Hodgkin's lymphoma, granulomatous inflammation and reactive lymph node specimens.

PURPOSE: In this study we aimed to compare the flow cytometry (FC) results of patients with B cell lymphoma, T cell lymphoma, Hodgkin's lymphoma, granulomatous inflammation and reactive lymph node and investigate the role of FC in malignant or non malignant conditions. METHODS: Ninety patients were divided into 5 groups according to histopathology results. Patients were compared according to cytokeratin and positivity percentage of the following surface markers: CD45, CD19, CD5, CD19-CD5, CD4, CD8, CD3,CD16-CD56, CD10, CD10-CD19, CD23, CD20, CD4-CD8, CD3-CD16-56, CD30, CD38, kappa and lambda light chains, CD20-CD23. Patients were also compared according to the intensity of the expression (exp) of same markers. ROC curve analysis was performed for CD19+ cell percentage, CD38 exp, kappa/lambda and lambda/kappa ratios. RESULTS: 1) Kappa/lambda and lambda/kappa ratios can distinguish B cell lymphoma from T cell lymphoma, Hodgkin's lymphoma, granulomatous inflammation and reactive lymph node; 2) CD19+ cell percentage can distinguish T cell lymphoma from Hodgkin's lymphoma, granulomatous inflammation and reactive lymph node; 3) CD38 exp can partly distinguish B cell lymphoma from T cell lymphoma, Hodgkin's lymphoma, granulomatous inflammation and reactive lymph node and T cell lymphoma from granulomatous inflammation, T cell lymphoma from reactive lymph node, Hodgkin's lymphoma from reactive lymph node. CONCLUSION: Flow cytometry has a role in distinguishing lymphomas from non malignant lesions.

Differentiation of incidental intestinal activities at PET/CT examinations with a new sign: peristaltic segment sign.

PURPOSE: The aim of this study was to present the effect of the peristaltic segment sign for the differential diagnosis between malignant, physiological and gastrointestinal focal fluorodeoxyglucose (FDG) uptakes as an alternative method to maximum standardized uptake value (SUVmax). MATERIALS AND METHODS: Gastrointestinal tract (GIT) sections of 823 FDG positron emission tomography/computed tomography (FDG-PET/CT) performed in our center were reviewed retrospectively. Images of these cases that have been reported for positive intestinal focal FDG uptake areas were included. Through the sectional images, any accompanying short segment expanded with air just after or before the uptake area was marked as "positive peristaltism sign". The cases were confirmed with endoscopy plus biopsy (n:42), endoscopy (n:5), laparotomy (n:1), transabdominal biopsy (n:1), enteroclysis (n:1), CT-colonoscopy (n:5), rectal contrast enhanced CT (n:4). Distinguishing features of the sign were analyzed statistically compared to the conventional method for differentiation of malignity. RESULTS: Localized FDG uptake was reported in 59 of 823 cases. A SUVmax greater than 2.5 with intestinal wall thickening allowed the diagnosis of malignity with sensitivity 33%, specificity 65%, positive predictive value 69% and negative predictive value 46%. The peristaltic segment sign, considered as a benign finding, increased the statistical values to 68%, 80%, 82% and 65%, respectively. CONCLUSION: In case of gastrointestinal increased focal FDG uptake, the new parameter of peristaltic segment sign may differentiate the physiologic uptakes from the malignant ones more accurately than the conventional SUVmax.

The value of ultrasound elastography-guided fine-needle aspiration biopsy of thyroid nodules in reducing nondiagnostic results.

Fine-needle aspiration biopsy (FNAB) is an important tool for diagnosing thyroid nodules; however, nondiagnostic results are a problem with FNAB. We evaluated the optimal targeting area of thyroid nodules for FNAB by using ultrasound elastography (USE) to reduce nondiagnostic results. Between December 2008 and November 2010, 96 consecutive prospective subjects scheduled to undergo FNAB were included in the study. Initially, the dominant nodule was evaluated with ultrasound, after which USE was performed. FNABs were performed from both the red (hard foci) and the green (soft foci) color-coded areas using the same technique according to the USE maps. The cellularity of all the specimens was evaluated cytopathologically. Nondiagnostic results from the red and green color-coded areas were compared by Chi-square test. In the red color-coded regions on USE images, the diagnostic rate was 76.0 % and the nondiagnostic rate was 24.0 %. In the green color-coded regions on USE images, the diagnostic rate was 53.1 % and the nondiagnostic rate was 46.9 %. Seven nodules were malignant and 89 were benign. Nondiagnostic results were significantly fewer in red color-coded regions (P = 0.0001). USE can help to enhance the cellularity of biopsy of thyroid nodules to reduce the nondiagnostic results if the red color-coded (less elastic or hard) areas are preferred.

Ultrasound elastography for the differential diagnosis of nipple retraction.

PURPOSE: Nipple retraction is difficult to diagnose radiologically and extremely worrisome for patients. It occurs most commonly due to pathologies such as previous mastitis or an infiltrative malignancy. With this in mind, the goal of this study was to differentiate benign from malignant lesions of nipple retraction, using the differential characteristics of retroareolar area stiffness, observed by means of the new technological modality of ultrasound elastography (USE). MATERIALS AND METHODS: Nineteen unilateral nipple retraction cases, including five cases of mammary ductal carcinoma posteriorly infiltrated the areola, two cases of Paget disease, and 12 cases of mastitis, were investigated. Imaging findings [gray-scale ultrasound (US) and USE analyses of the breasts' nipple-areolar complex], pathological evaluation, and the results of 4 years of follow-up treatment were obtained. The recorded images were evaluated by two different radiologists, and all data were analyzed statistically. RESULTS: Statistical analysis showed that there was a strong correlation between the two radiologists' evaluations. The US images were not diagnostic for either the malignant or benign conditions. The correlation between the diagnosis using US and the final diagnosis was calculated as 0.436 (p = 0.006). However, the USE images were more informative since the correlation ratio between the USE results and the final diagnosis was found to be 0.723 (p < 0.001). While the area under the concentration curve (AUC) values that were used for the diagnostic determination of the US results were inconclusive at 0.274 (p < 0.021), the AUC values for USE were significant, with a diagnostic value of 0.866 for all cases (p < 0.01). CONCLUSION: The USE modality, which is not commonly used in routine practice, has the potential to solve the problem of differentiation of nipple retraction etiologies in the near future.

Clinical significance of reticulocyte hemoglobin content in the diagnosis of iron deficiency anemia.

OBJECTIVE: The aim of this study was to evaluate the clinical significance of reticulocyte hemoglobin content (CHr) in the diagnosis of iron deficiency anemia (IDA) and to compare it with other conventional iron parameters. MATERIALS AND METHODS: A total of 32 female patients with IDA (serum hemoglobin <120 g/L and serum ferritin <20 ng/ mL) and 18 female patients with iron deficiency (serum hemoglobin > 120 g/L and serum ferritin <20 ng/mL) were enrolled. RESULTS: CHr was 24.95±3.92 pg in female patients with IDA and 29.93±2.96 pg in female patients with iron deficiency. CHr showed a significant positive correlation with hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, serum iron, and transferrin saturation and a significant negative correlation with transferrin and total iron-binding capacity. The cut-off value of CHr for detecting IDA was 29 pg. CONCLUSION: Our data demonstrate that CHr is a useful parameter that can be confidently used in the diagnosis of IDA, and a CHr cut-off value of 29 pg predicts IDA. CONFLICT OF INTEREST: None declared.

Determination of ascorbic acid by polypyrrole potentiometric detector in ion chromatography.

A potentiometric detector, based on electrodeposition of polypyrrole onto Pt electrode, was investigated in this study. The chromatographic performance of the PPy detector was investigated in ion chromatography. The resulting PPy detector exhibited good performance for AA determination with a wide linear range (1.0 x 10(-6) to 1.0 x 10(-2)M), a highly reproducible response (R.S.D. of 2.45%), without any interference and long-term stability. The calculated detection limit was 7.0 x 10(-5)mM at 3 sigma. The calibration results showed good Nernstian behavior and also satisfactory low detection limit. In order to verify the reliability of the PPy detector, it was applied to the determination of AA in pharmaceutical samples. The results were satisfactory and agreed closely with the manufacturers' stated contents. The PPy electrode can be used as an alternative novel potentiometric detector material for determination of AA in standards and pharmaceutical samples.

Management and mid- to long-term results of early referred bile duct injuries during laparoscopic cholecystectomy.

BACKGROUND/AIMS: Bile duct injuries (BDI) usually need operative repair and remain as a challenge even for surgeons who specialize in hepatobiliary surgery. The objective of this study was to define the presentation, in-hospital management, and mid- to long-term outcome of BDIs during laparoscopic cholecystectomy (LC) referred to a tertiary center in their early period. METHODOLOGY: From January 1996 to January 2006, 31 patients with BDI sustained during or after LC were treated at our institution. Patients were referred to our center from 18 community hospitals in their first 15 postoperative days. Patients' charts were retrospectively reviewed; presentation, management, and follow-up details recorded at the primary hospitals and at our institution were documented. RESULTS: There were 5 patients with type-A and one with type-C injury, according to Strasberg classification. The remainders had a major BDI. The mean time to referral was 3.45 (median 2) days. Treatment methods chosen after referral were as follows: drainage-observation in 2 patients (6.5%), nasobiliary drainage in 4 (12.9%), endoscopic sphincterotomy plus biliary stenting in 1 (3.2%), and surgical intervention (duct-to-duct anastomosis or biliary-enteric reconstruction) in 24 patients (77.4%). Although a success rate of 83.3% was achieved in the early period, 10 patients (32.3%) had late postoperative complications (stricture and cholangitis), and of these, 3 required endoscopic stent placement, and 7 patients underwent a biliary diversion with Roux-en-Y Hepaticojejunostomy. One out of 24 patients with long-term follow-up developed biliary cirrhosis, and one patient with malignancy expired. CONCLUSIONS: Minor BDIs can be satisfactorily treated with endoscopic interventions. Extended lateral injuries, complete CBD transsections, and long segment stenosis usually require surgical therapy. Duct-to-duct anastomosis may be an option as the first-line therapy in selected patients after early referral, though many patients eventually require a Roux-en-Y hepaticojejunostomy.

Cytokine and immune cell levels in peritoneal fluid and peripheral blood of women with early- and late-staged endometriosis.

OBJECTIVE: To investigate the level of cytokines and immune cells in the peripheral blood (PB) and peritoneal fluid (PF) of different stages of endometriosis. METHODS: A prospective study was conducted to include 97 women with (n 60) and without (n 37) histopathologically confirmed endometriosis. Based on rASRM classification, stage I/II and stage III/IV were categorized as early-and late-staged endometriosis. Prior to surgery, 10 ml of blood was withdrawn from antecubital vein and serum was obtained. Aliquots were made and stored at -70 degrees C until assayed for cytokines. PF was aspirated from the pouch of Douglas. Peripheral and PF samples were analyzed by ELISA in terms of IL-2, IL-4, IL-10 and IFN-gamma. Determinations of T helper, T suppressor, NK, and B cells were assessed by using cluster determinant-3 (CD-3), CD4, CD8, CD25, CD28, CD45, CD16, CD23 and antibodies against early T cell activation antigens such as CD45RA/CD45RO, CD-69 and late activation antigens such as HLA-DR. A multiparameter flow cytometry was applied to detect the cell activation antigen expression. RESULTS: In terms of cytokine levels in PB and PF's of control group and early- and late-staged endometriosis cases, no significant difference was depicted in the cytokine levels (p > 0.05). Levels of immune cells did not differ between three groups (p > 0.05). CONCLUSIONS: The result of this study did not show any significant difference in PB and PF cytokine and lymphocyte subgroups between normal and early- and late-staged endometriosis.

Apoptosis patterns in eutopic and ectopic endometrium, adhesions and normal-looking peritoneum from women with or without endometriosis.

OBJECTIVE: To assess the apoptosis rate in eutopic and ectopic endometrial stromal and glandular cells, normal peritoneum and adhesions in women with endometriosis. METHODS: A total number of 97 women with (n:60) and without (n:37) histopathologically confirmed endometriosis who underwent laparoscopy or laparotomy in the early follicular phase of the menstrual cycles for pain and infertility were included in this study. Stage I/II and stage III/IV were categorized as early staged and late-staged endometriosis. The endometrial samples were obtained with a Novack cannula from the corpus of the uterus. Normal-looking peritoneum, peritoneal implants and adhesions were sampled and fixed in formaldehyde for immunohistochemical staining with Bcl-2 and Bax. Tissue samples were fixed in formaldehyde for the assessment of apoptosis via terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) and M30 cytoDEATH antibody. RESULTS: The intensity of Bax staining of normal-looking peritoneum in early staged endometriosis was higher, compared to women with late-staged and women without endometriosis (P = 0.03). However, degree of Bcl-2 staining did not differ among early and late-staged endometriosis and women without endometriosis (P = 0.1). In terms of Bcl-2 and Bax staining in the stromal and glandular parts of the eutopic endometria, no significant differences were detected among three groups. In cases with early- and late-staged endometriosis the intensity of Bax and Bcl-2 stainings did not differ in both stromal and glandular parts of ectopic endometria. Number of cells with positive apoptotic signals assessed via TUNEL (P = 1.0) and M30 cytoDEATH antibody (P = 0.59) in normal-looking peritoneum did not differ between three groups. In addition, no difference in term of numbers of apoptotic cells obtained from adhesions was observed between three groups (for TUNEL, P = 0.29, for M30, P = 0.19). CONCLUSIONS: Apoptosis patterns did not differ in the eutopic and ectopic endometria as well as adhesions of women with or without endometriosis.

In situ electrochemical solid-phase extraction of anions and cations using polypyrrole and overoxidized sulfonated polypyrrole.

A new method for the extraction of both anions and cations is proposed using electro-synthesized polypyrrole (PPy) and overoxidized sulfonated polypyrrole film (OSPPy). In situ anion (chloride, nitrate, sulfate) and cation (calcium, magnesium) uptake and release were examined under controlled potential conditions for prospective applications in electrochemically controlled solid-phase extraction (EC-SPE). The PPy film was used as an anode (anion-exchanger) and OSPPy film was used as a cathode (cation-exchanger) material and reverse order of the electrodes were investigated in EC-SPE. This new cell arrangement containing two ion exchanger polymer electrodes was developed to provide in situ removal of both anions and cations from aqueous solution. Simple preparation of the film coatings on a platinum plate was possible using a constant potential method. Applied positive and negative potentials facilitated the in situ extraction and desorption of ions, respectively. Both anions and cations were desorbed into sample aliquot and were determined by ion chromatography (IC). The method was validated using a standard reference material and tested for the determination of the ions in real water samples.

Electrochemical Preparation of a Molecularly Imprinted Polypyrrole-modified Pencil Graphite Electrode for Determination of Ascorbic Acid.

A molecularly imprinted polymer (MIP) polypyrrole (PPy)-based film was fabricated for the determination of ascorbic acid. The film was prepared by incorporation of a template molecule (ascorbic acid) during the electropolymerization of pyrrole onto a pencil graphite electrode (PGE) in aqueous solution using a cyclic voltammetry method. The performance of the imprinted and non-imprinted (NIP) films was evaluated by differential pulse voltammetry (DPV). The effect of pH, monomer and template concentrations, electropolymerization cycles and interferents on the performance of the MIP electrode was investigated and optimized. The molecularly imprinted film exhibited a high selectivity and sensitivity toward ascorbic acid. The DPV peak current showed a linear dependence on the ascorbic acid concentration and a linear calibration curve was obtained in the range of 0.25 to 7.0 mM of ascorbic acid with a correlation coefficient of 0.9946. The detection limit (3σ) was determined as 7.4x10-5 M (S/N=3). The molecularly-imprinted polypyrrole-modified pencil graphite electrode showed a stable and reproducible response, without any influence of interferents commonly existing in pharmaceutical samples. The proposed method is simple and quick. The PPy electrodes have a low response time, good mechanical stability and are disposable simple to construct.

Extracapsular extension is associated with increased ratio of metastatic to examined lymph nodes in axillary node-positive breast cancer.

BACKGROUND: Extracapsular extension of nodal tumor cells, although it is not a parameter of staging, has recently been shown to be correlated with the high number of metastatic lymph nodes in patients with axillary-positive breast cancer. It is suggested that the use of involved/examined lymph node ratio instead of the number of metastatic lymph nodes in axillary evaluation would obtain standardized prognostic data for patient management. This study investigated the association of the extracapsular extension with the lymph node ratio in a node-positive group of patients. PATIENTS AND METHODS: Medical records of 170 patients with positive axillary status were retrospectively reviewed. Of these, 54 were extracapsular extension positive, and the remaining were extracapsular extension negative. A comparison was made between extracapsular extension-positive and extracapsular extension-negative groups with respect to some potential prognostic indicators. RESULTS: Number of metastatic lymph nodes, number of examined lymph nodes, and involved/examined lymph node ratio were found to be significantly higher in patients with a presence of extracapsular extension. CONCLUSION: The results suggest that the presence of extracapsular extension might force physicians to perform more aggressive adjuvant therapies and that the extracapsular extension could be a valuable parameter in the management of breast cancer because it has a strong relationship with the proven prognostic factors.