Protective effects of thymoquinone on the healing process of experimental left colonic anastomosis.

PURPOSE: Colorectal cancer is globally the third most common cancer. Anastomotic complications remain to be an important issue for colorectal surgery. The aim of this study was to investigate the protective effects of thymoquinone (TQ) on the healing process of left colonic anastomosis in an experimental model. METHODS: Thirty-two male rats were divided into two groups, as the TQ group and the control group. TQ was administered to the TQ group, whereas the control group was given a standard feed and water for 2 wk. Following the creation of a left colonic anastomosis, subjects in both groups were sacrificed on the postoperative (PO) third and seventh days. Anastomotic burst pressures were measured mechanically. Immunohistochemical stainings for proliferating cell nuclear antigen, cluster of differentiation (CD) 31, CD45 were performed, and the matrix metalloproteinase-2 levels were measured. Histologic total scores were calculated according to Ehrlich-Hunt model. A value of P < 0.05 was considered as statistically significant. RESULTS: One rat in the control group that died on the PO fourth day was excluded. Anastomotic burst pressures on the PO seventh day were higher in the TQ group than the control group (P < 0.01). Histopathological total scores on the PO third and seventh days were higher in the TQ group (P < 0.01). In addition, the TQ group revealed lower matrix metalloproteinase-2 scores on the PO third day and higher hydroxyproline levels on the PO seventh day (P < 0.05 and P < 0.01, respectively). CONCLUSIONS: The use of TQ in colorectal surgery cases with left-sided colonic anastomosis resulted with increased anastomotic burst pressures and increased tissue hydroxyproline levels.

Agenesis of the gallbladder diagnosed by magnetic resonance cholangiography: report of a case and review of the literature.

Gallbladder agenesis (GA) is a rare congenital anomaly of the biliary system often associated with other congenital abnormalities. Patients become symptomatic in 23% of cases (Richards et al., 1993). GA is often misinterpreted as other diseases, therefore, leading to unnecessary surgery. Many of these patients develop a typical symptomatology of cholelithiasis that leads them to operating theatre. If an operative procedure is done, it is better to remain at the level of laparoscopy because further surgical investigation may lead to detrimental biliary tract injuries (Waisberg et al., 2002). We present a case of GA, diagnosed by magnetic resonance with cholangiopancreatography.

Prevalence and Potential Correlates of Family Refusal to Organ Donation for Brain-Dead Declared Patients: A 12-Year Retrospective Screening Study.

BACKGROUND: This study was designed to determine prevalence and potential correlates of family refusal to organ donation for patients declared brain dead thorough a 12-year retrospective data analysis. METHODS: Of 111 cases declared brain dead by our hospital within a 12-year period between 2008 and 2019, a total of 82 potentially brain-dead organ donors were included in this retrospective study. Data on sociodemographic characteristics, length of intensive care unit stay, cause of death, decedent's wishes, interview time, family decision, and reasons for refusal were recorded. RESULTS: The rate of family refusal to organ donation was 51.2% and because of religious concerns (64.3%) in most of cases. The likelihood of family consent to organ donation was significantly higher for an adult vs a child (60.0% vs 25.9%, P = .004) and for a schooler and adolescent age vs a younger child (55.6 vs 22.5%, P = .004). Patients who were declared brain dead after nontraumatic intracranial hemorrhage (60.4%) vs encephalitis (18.2%) had higher rates of family consent to organ donation (P = .023). CONCLUSIONS: In conclusion, our findings revealed family refusal to organ donation in at least half of cases and higher likelihood of family consent to organ donation depending on age of patient (adult vs children) and cause of death (brain injury vs encephalitis). The religious concerns and distrust in the health care system were the 2 major causes of family refusal, whereas no significant difference was noted across different family refusal reasons in terms of sociodemographic factors, length of intensive care unit stay, awareness of decedent's wishes, or time of family interview.

Comparison of high and low-dose epinephrine & endoclip application in peptic ulcer bleeding: A case series analysis observational study.

ABSTRACT: Peptic ulcer disease accounts for 50% to 70% of acute upper gastrointestinal bleeding cases. There is no consensus on the treatment of peptic ulcer bleeding (PUB) using endoscopic techniques. This study aimed to compare endoscopic techniques for PUB.Patients with PUB who were hospitalized between January 2014 and June 2020 were included in this study. They were divided into 3 groups: endoclip and low-dose epinephrine injection (0-2 mg, Group 1, n = 62), endoclip and high-dose epinephrine injection (2-4 mg, Group 2, n = 54), and endoclip only (Group 3, n = 64).Early bleeding and permanent hemostasis were higher in Group 2 (P = .014, .035). When evaluated in terms of late hemostasis and urgent surgical need, there was no significant difference between the groups (P > .05). Group 2 received a higher amount of blood. Thirty-day mortality occurred in 16.5%, 22.2%, and 9.4% of patients in Groups 1, 2, and 3, respectively. Group 2 had a longer hospital stay than Groups 1 and 3 (P = .008). The endoscopic success rates were 80.6%, 72.2%, and 90.6% in Groups 1, 2, and 3, respectively.In PUB, if the patient's Rockall score is high and the ulcer size is larger than 2 cm, endoclip application can be used as the main treatment. Addition of epinephrine may be considered when necessary.

Gastric hepatoid carcinoma: Report of a case.

Gastric hepatoid carcinoma (GHC) is a rare type of gastric cancer with a tendency to have poor prognosis and metastasize to the liver. GHCs generally show histopathologically hepatocellular differentiation and secrete alpha fetoprotein (AFP). AFP production can occur in cancers originating from the embryologically similar liver, gastrointestinal tract, and yolk sac and often metastasizes to the liver. Although GHC is aggressive, it may not always cause liver metastasis and may invade into the other abdominal organs by direct contact. In this article, we present a case of locally advanced GHC with high AFP levels.

Diffusion-weighted magnetic resonance imaging for the detection of thyroid cancer. / Utilidad de la resonancia magnética ponderada por difusión cervical en la detección del cáncer tiroideo.

BACKGROUND: Nodular thyroid disease possesses the potential to harbor malignancy. Our aim was to evaluate the significance of cervical diffusion-weighted magnetic resonance imaging (DW-MRI) for the detection of malignant thyroid nodules. METHODS: Sixty-five thyroid nodules from 58 patients who had undergone surgery were evaluated. Preoperative parameters, demographic data, ultrasound findings, fine-needle aspiration biopsy results and apparent diffusion coefficient (ADC) values of the nodules at DW-MRI were compared with the results from postoperative pathology examinations. RESULTS: The "benign group" included 50 (76.9%) nodules, while 15 (23.1%) nodules constituted the "malignancy group". Minimum, maximum and mean ADC values of the nodules were significantly lower in the malignancy group (p < 0.05). The best cutoff value for the mean ADC value was 1.33 × 10-3 mm2/s, with a sensitivity of 66.67%, a specifity of 89.13%, a positive predictive value of 53.63% and a negative predictive value of 89.13%. A mean ADC value equal to or lower than 1.33 × 10-3 mm2/s was associated with 9 times higher risk of malignancy (odds ratio: 9.111, 95% confidence interval: 2.49-33.21). CONCLUSIONS: The ADC value detected by cervical DW-MRI can be considered a predictive parameter for the detection of thyroid cancer.

Immunohistochemical Profile of Tumor Pathways and Prognostic Significance in Colon Adenocarcinomas.

The current study examined the immunohistochemical expression levels of molecules on carcinogenesis pathway and evaluated their clinicopathologic significance in colorectal adenocarcinoma (CRA). A total of 189 CRA and 20 colonic mucosal tissue samples were evaluated by immunohistochemical staining using 38 antibodies targeting the known molecules that play roles in developmental pathways of various tumors. The immunoexpression data of the patients were compared to clinicopathologic parameters. Expression loss of MLH1, MSH2, MSH6, PMS2, PTEN, Smad4 and E-cadherin, and overexpression of ALDH1, CD44, CAIX, P504S (AMACR), TGFΒ, and ZEB1 were statistically significant in CRA compared to normal colon mucosa. Long-term clinical follow-up findings in our cases suggested that AMACR, CAIX, ALDH1, TGFΒ, ZEB1 overexpression, and cyclinD1, p53, E-cadherin, and PTEN inactivity might be useful markers of a poor prognosis in CRA. In survival analyses, the expression of CAIX and AMACR were significantly associated with overall survival in both the univariate and multivariate analyses (log-rank test; p < 0.01 and p < 0.05, respectively).

Isolated chylous injury due to blunt abdominal trauma: Report of a case and a review of the literature.

The chyle duct (CD) lies close to the spine behind the right renal vein and vena cava. Forces capable of tearing the CD may also injure other adjacent structures or organs. Cases of isolated chylous injury are rarely reported in the literature. Our aim was to report a case of isolated chylous injury due to blunt abdominal trauma that was successfully treated non-operatively. A 54-year-old man was involved in a deceleration-type traffic accident. His physical examinations, radiologic evaluations, paracentesis, and laboratory findings revealed isolated chylous injury resulting from intra- and retroperitoneal chylous fluid collection. The patient was treated via percutaneous drainage and medical therapy. This condition is generally self-limited and resolves without the necessity of any surgical interventions. However, if medical treatment is unsuccessful, the decision of diagnostic laparoscopy or exploratory laparotomy becomes inevitable.

Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery.

AIM: To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes. METHODS: This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy (RG), laparoscopic gastrectomy (LG), open gastrectomy (OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided. RESULTS: The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients (RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery (P = 0.42) and stage of the disease (P = 0.16). Intraoperative blood loss was significantly lower in the LG (95.93 ± 119.22) and RG (117.91 ± 68.11) groups compared to the OG (127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG (27.78 ± 11.45), LG (24.58 ± 13.56) and OG (25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay (P < 0.0001). A similar complications rate was found (P = 0.13). The leakage rate was not different (P = 0.78) between groups. CONCLUSION: Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.

Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy.

OBJECTIVE: The present study evaluated effects of incidental parathyroidectomy, surgical technique, and presence of thyroiditis or hyperthyroidism on occurrence of postoperative persistent or transient hypocalcemia. METHODS: Patients who underwent thyroidectomy at Istanbul Medeniyet University between 2013 and 2015 were included in the study. Patient information, postoperative serum calcium levels, and pathology reports were investigated retrospectively. Group 1 was made up of patients who were found to have hypocalcemia (calcium ≤8.5 mg/dL) according to postoperative serum level and normocalcemic patients were placed in Group 2. Groups were compared statistically in terms of rate of incidental parathyroidectomy, surgical technique, and presence of thyroiditis or hyperthyroidism. RESULTS: Mean age was 49.8±12.8 years (range: 20-88). A total of 417 patients were included in the study, 74 (17.7%) were male and 343 (82.3%) were female. Group 1 consisted of 205 (49.2%) patients who had hypocalcemia according to postoperative serum level, and remaining 212 (50.8%) patients were placed in Group 2. In Group 1, 38 (18.5%) patients had incidental parathyroidectomy, and with only 18 (8.5%) patients in Group 2, a statistically significant relationship was found between incidental parathyroidectomy and hypocalcemia (p=0.003). There was no statistically significant difference in terms of presence of thyroiditis or hyperthyroidism between groups. There was statistically significant decrease in postoperative hypocalcemia rate in patients with lobectomy compared to patients with bilateral total thyroidectomy or central neck dissection (p<0.01). CONCLUSION: Risk of postoperative hypocalcemia may be reduced with lobectomy for selected patients. In addition, delicate dissection during thyroidectomy is important in order to protect parathyroid glands and prevent hypocalcemia.

Clinical Significance of the Glasgow Prognostic Score for Survival after Colorectal Cancer Surgery.

Glasgow prognostic score (GPS) has been found to be a useful tool in various cancer types. Our aim was to evaluate the significance of GPS in patients operated on for colorectal cancer (CRC). Patients with CRC who underwent radical resections between April 2010 and January 2015 were retrospectively evaluated. GPS was estimated based on the preoperative measurement of C-reactive protein and serum albumin levels. Data including demographics, laboratory and pathological parameters, surgical outcomes, and late-term follow-up results were analyzed. The study group of 115 patients consisted of 51 (44 %) women and 64 (56 %) men with a median age of 66 (range 32-91) years. The mean follow-up period was 20 (range 7-41) months. Tumor size and wound infection rates were significantly increased in patients with higher GPS (p = 0.019 and p = 0.003, respectively). According to multivariate analyses, CEA and GPS were found to be independent risk factors significantly effecting mortality (p = 0.001 and p = 0.009, respectively). At the end of the late-term follow-up period, it was detected that cancer-specific survival significantly decreased as the GPS increased (p = 0.016). The GPS is a significant prognostic factor in CRC and should be included in the routine preoperative assessment of all surgically treated CRC patients.

Analysis of surgically treated gastric cancers: a tertiary hospital experience in Turkey.

OBJECTIVE: Gastric cancer (GC) is the fifth most common cancer worldwide, and in Turkey, GC is placed among the 10 most frequently seen cancers. However, analyzing the epidemiology of cancers and improving screening programs for cancers are not still the top priorities for healthcare professionals. This study aims to show distribution of GC based on stages in a tertiary hospital of Istanbul, Turkey. METHODS: All surgically treated GC cases in the General Surgery Department, between January 2009 and January 2014 were retrospectively reviewed. Data including the operation year, the demographic, clinical and histopathological parameters were recorded and statistically analyzed. RESULTS: The study group consisted of 111 patients. Seventy-four (66.66%) patients were men, and 37 (33.33%) patients were women with a mean age of 63.49±11.83 years. Stage 3 and 4 were the most frequently observed stages with 62 and 18 cases, respectively. Stage 3 was the most common stage found during the study period (p<0.05). During 5 years of the study period, GC was less frequently located on the cardia (n=31) when compared with other locations (n=75) for GC (p<0.05). CONCLUSION: Turkey's population has generally advanced stage GC disease. New strategies are needed for achievement of early diagnosis and better outcomes.

Current status of minimally invasive surgery for gastric cancer: A literature review to highlight studies limits.

BACKGROUND: Gastric cancer represents a great challenge for health care providers and requires a multidisciplinary approach in which surgery plays the main role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and more recently with the spread of robotic surgery, but a number of issues are currently being investigate, including the limitations in performing effective extended lymph node dissections and, in this context, the real advantages of using robotic systems, the possible role for advanced Gastric Cancer, the reproducibility of completely intracorporeal techniques and the oncological results achievable during follow-up. METHOD: Searches of MEDLINE, Embase and Cochrane Central Register of Controlled Trials were performed to identify articles published until April 2014 which reported outcomes of surgical treatment for gastric cancer and that used minimally invasive surgical technology. Articles that deal with endoscopic technology were excluded. RESULTS: A total of 362 articles were evaluated. After the review process, data in 115 articles were analyzed. CONCLUSION: A multicenter study with a large number of patients is now needed to further investigate the safety and efficacy as well as long-term outcomes of robotic surgery, traditional laparoscopy and the open approach.

Robotic, laparoscopic and open surgery for gastric cancer compared on surgical, clinical and oncological outcomes: a multi-institutional chart review. A study protocol of the International study group on Minimally Invasive surgery for GASTRIc Cancer-IMIGASTRIC.

INTRODUCTION: Gastric cancer represents a great challenge for healthcare providers and requires a multidisciplinary treatment approach in which surgery plays a major role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and recently with the spread of robotic surgery, but a number of issues are currently being debated, including the limitations in performing an effective extended lymph node dissection, the real advantages of robotic systems, the role of laparoscopy for Advanced Gastric Cancer, the reproducibility of a total intracorporeal technique and the oncological results achievable during long-term follow-up. METHODS AND ANALYSIS: A multi-institutional international database will be established to evaluate the role of robotic, laparoscopic and open approaches in gastric cancer, comprising of information regarding surgical, clinical and oncological features. A chart review will be conducted to enter data of participants with gastric cancer, previously treated at the participating institutions. The database is the first of its kind, through an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centres. ETHICS AND DISSEMINATION: This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. A multicentre study with a large number of patients will permit further investigation of the safety and efficacy as well as the long-term outcomes of robotic, laparoscopic and open approaches for the management of gastric cancer. TRIAL REGISTRATION NUMBER: NCT02325453; Pre-results.