Pancreaticobiliary maljunction in Turkish patients: a multicenter case series.

BACKGROUND AND AIMS: Pancreaticobiliary maljunction (PBM) is a malformation in which the pancreatic and bile ducts join outside the duodenal wall. It is associated with various biliary and pancreatic diseases. In addition, patients with PBM carry a substantial lifetime risk of developing biliary or gallbladder carcinoma. We aimed to present a multicenter case series of PBM from Turkey. METHODS: This study was conducted in adult and pediatric PBM patients who were referred to three tertiary reference centers of Turkey for endoscopic retrograde cholangiopancreatography (ERCP) between July 2007 and May 2020. The clinical presentations, types of PBM, ERCP findings, surgical histories, and the postoperative courses, including the development of biliary malignancies, were retrospectively reviewed. RESULTS: The study group included 47 (31 adult and 16 children) patients. Type D PBM was more frequent (13/41: 27.7%) than that reported in Eastern studies. Type A PBM was more common in the adults (51.6% vs. 12.5%, p < 0.05), whereas type C was more common in pediatric patients (31.3% vs. 13.2%, p < 0.05). Although fusiform anatomy was predominant in both of the groups, cystic dilatation was more common (25.8% vs. 12.5%) in adults and the common bile duct diameter was greater [22 mm (range 11-58) vs. 12 mm (range 5-33)] in adult patients compared to pediatric patients. Resective surgeries were more frequently done in pediatric patients (73.3% vs. 53.6%), whereas cholecystectomy was more frequently performed in adult patients (21.4% vs. 6.7%). CONCLUSION: Although our findings were compatible with Eastern studies, type D PBM (associated with pancreas divisum) was more frequent in our study population.

Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients

Background/aim/AIM: This study aimed to evaluate the regression pattern with the distal intramural spread (DIS) of rectum cancer after preoperative chemoradiation. Materials and methods: Specimens from 56 patients who underwent radical resection after preoperative chemoradiation for rectal cancer were examined. The regression pattern (total, fragmented) of the tumor was recorded. DIS status was evaluated by creating sections 0.2 to 0.3 cm thick. Results: A single macroscopic residual area was detected in all specimens. In 10 patients (17.8 %), pathologically complete responses were identified, and DIS was detected in 33 patients (58.9%). The average DIS distance was 0.56± 0.3 cm (range 0.2 ­ 1.8 cm); the spread was < 1 cm in 87.9% of the patients (29/33). The overall survival rates for 5 and 7 years were 76.8% and 73.2%, respectively. The survival rates between patients with and without DIS were not statistically different (94.6± 5.5 vs. 75.1 ± 10.2 months, respectively). In all of the patients, tumor regression pattern was total shrinkage of the tumor. Conclusion: A sufficient distal resection margin for rectal cancer after preoperative chemoradiation is 1 cm in the vast majority of cases. However, DIS may exceed 1 cm in a small proportion of patients.

Detection of HPV DNA in Esophageal Lesions: a Cross-Sectional Study.

BACKGROUND: Several studies have documented human papillomavirus (HPV) in extra-cervical tumors. We aimed to detect HPV type 16 and HPV other than type 16 (OT-16) DNA in esophageal papilloma and esophagus squamous cell carcinoma (ESCC) samples and to compare clinicopathological features of HPV positive and negative patients. METHODS: Materials were obtained from a tertiary care public hospital and studied in an university hospital for this cross-sectional study. Seventy-six tissue samples (50 papilloma and 26 ESCC) were included. After deparaffinization by xylene and DNA extraction by phenol chloroform-isoamyl-alcohol, 76 samples were studied with a G6PDH control kit. Forty-four papilloma and 21 ESCC samples with enough tissues were studied for HPV DNA. HPV OT-16 DNA and HPV type 16 were detected by real time-polymerase chain reaction. RESULTS: Twelve (27.3%) and one (2.3%) of the papilloma samples were HPV type 16 and other than type 16 positive, respectively. Eleven (52.4%) and one (4.8%) of ESCC samples were HPV type 16 and mixed type positive, respectively. CONCLUSIONS: We suggest that HPV infection is common in esophageal papilloma and ESCC. Due to the wellknown association of HPV with premalignant and malignant conditions, follow-up of these patients accompanied by HPV should be implemented.

The effect on morbidity of the use of prophylactic abdominal drain following elective laparoscopic cholecystectomy.

BACKGROUND AND OBJECTIVE: To evaluate the clinical role of the routine use of a drain in an elective laparoscopic cholecystectomy operation applied to patients with symptomatic cholelithiasis not showing acute inflammation. METHOD: Following laparoscopic removal of the gallbladder, patients were separated into two groups of 30 each, either with subhepatic drain placement or without. The presence of subhepatic fluid collection was evaluated with transabdominal ultrasonography (USG) at 24 hours postoperatively and on the 7th day. The other parameters evaluated were postoperative morbidity, shoulder and abdominal pain. RESULTS: No statistically significant difference was found between the two groups in respect of demographic characteristics and operative details. The median pain score was determined to be statistically significantly higher in the group with a drain applied compared to the group without a drain (p=0.007). In the comparison between the groups of fluid collection on USG at 24 hours and shoulder pain persisting until the 7th day, although seen less in the group with no drain applied, no statistically significant difference was determined (p=0.065, p=0.159). In the examinations made on the 7th day, no hematoma or significant fluid collection was determined on USG and no wound infection was observed in any patient of either group. CONCLUSION: The routine application of prophylactic subhepatic drain in laparoscopic cholecystectomy procedure did not show any benefit to the patient.

Unresectable pancreatic adenocarcinoma with complete clinical response following chemoradiotherapy.

Locally advanced or metastatic disease is present in 2/3s of patients with pancreatic cancer. Pancreatic cancer patients are assessed as resectable, potentially resectable (borderline) and unresectable according to pre-operative examinations. The chance for operability may be enhanced by using adjuvant-neoadjuvant systemic chemotherapy, radiotherapy or both. The rates of R0 resection may be increased by means of treatment delivered this way. This case report presents a pancreatic adenocarcinoma case that was assessed to be resectable but was identified to be unresectable during surgical exploration, thus received adjuvant chemoradiotherapy. The patient was then re-evaluated, identified as resectable and received pancreaticoduodenectomy.

A prospective observational study of 468 patients undergoing D2 or D3 lymphadenectomy for gastric cancer.

BACKGROUND/AIMS: A single-center, prospective observational study was performed to evaluate outcomes in patients undergoing D2 or D3 lymphadenectomy for gastric cancer. METHODOLOGY: Lymphadenectomies were performed according to the classification published by the Japanese Gastric Cancer Association. RESULTS: Of 468 consecutive patients, 370 underwent D2 and 98 underwent D3 lymphadenectomy. Postoperative complications were significantly less common in the D2 group than in the D3 group (19.2% vs. 35.7%, p=0.001). Postoperative mortality in the two groups was similar, being 3.8% in the D2 group and 5.1% in the D3 group (p>0.05). Median postoperative survival times were also similar, in the D2 group being 37.8 months (95% CI: 23-52.5), and in the D3 group 30.2 months (95% CI: 13-47.3, p>0.05). CONCLUSIONS: In patients who underwent gastrectomy with curative intent, lymphadenectomy that was more extensive than D2 did not provide a survival benefit compared to D2 dissection.

Colon cancer associated transcript-1: a novel RNA expressed in malignant and pre-malignant human tissues.

Early detection of colorectal cancer (CRC) is currently based on fecal occult blood testing (FOBT) and colonoscopy, both which can significantly reduce CRC-related mortality. However, FOBT has low-sensitivity and specificity, whereas colonoscopy is labor- and cost-intensive. Therefore, the discovery of novel biomarkers that can be used for improved CRC screening, diagnosis, staging and as targets for novel therapies is of utmost importance. To identify novel CRC biomarkers we utilized representational difference analysis (RDA) and characterized a colon cancer associated transcript (CCAT1), demonstrating consistently strong expression in adenocarcinoma of the colon, while being largely undetectable in normal human tissues (p < 000.1). CCAT1 levels in CRC are on average 235-fold higher than those found in normal mucosa. Importantly, CCAT1 is strongly expressed in tissues representing the early phase of tumorigenesis: in adenomatous polyps and in tumor-proximal colonic epithelium, as well as in later stages of the disease (liver metastasis, for example). In CRC-associated lymph nodes, CCAT1 overexpression is detectable in all H&E positive, and 40.0% of H&E and immunohistochemistry negative lymph nodes, suggesting very high sensitivity. CCAT1 is also overexpressed in 40.0% of peripheral blood samples of patients with CRC but not in healthy controls. CCAT1 is therefore a highly specific and readily detectable marker for CRC and tumor-associated tissues.

Effects of thyroid hormone supplementation on anastomotic healing after segmental colonic resection.

BACKGROUND: Alterations of thyroid hormones in colorectal surgery were previously studied. The aim of the present study was to determine the effects of triiodothyronine (T3) supplementation on anastomotic healing after segmental colectomy. MATERIAL AND METHODS: Thirty male Wistar albino rats were divided into sham (n = 6), control (n = 12), and experimental (n = 12) groups. Sham group rats were immediately sacrificed after segmental colonic resection. Control and experimental group rats underwent resection and anastomosis. Experimental group rats received a single dose of T3 (400 µg/100 g) in postoperative day 1. Half of both control and experimental group rats were sacrificed on postoperative d 3 and the remaining half were sacrificed on postoperative d 7. Hydroxiproline (HP), myeloperoxidase (MPO), thyroid stimulating hormone (TSH), free T3 (FT3), and free thyroxine (FT4) levels, bursting pressure, and histologic analyses of the anastomotic segments were compared. RESULTS: FT3 levels significantly decreased in control groups rats compared with the sham group (P < 0.01). However, T3 hormone given rats had no decline in FT3 levels. Anastomotic bursting pressure was significantly higher in the experimental group rats on postoperative d 7 (P = 0.015). Histopathologic analyses of the anastomotic segments determined significantly more severe edema and necrosis in control group rats (P < 0.05). Collagen deposition in the anastomotic tissue was significantly higher in experimental group rats on postoperative d 7 (P = 0.015). CONCLUSION: Anastomosis after colon resection is associated with decreased FT3 level. T3 supplementation ameliorates the reduction in FT3 and seems to provide constructive therapeutic effects on anastomotic healing.

Is serum placental growth factor a prognostic marker for stage III colorectal cancer patients?

BACKGROUND/AIMS: To evaluate the clinical usefulness of serum placental growth factor (sPIGF) levels in stage III colorectal adenocarcinomas (CRC). METHODOLOGY: Serum PIGF were measured in 70 healthy controls and in 80 stage III CRC patients. Also the association between preoperative sPGF levels, clinicopathological features and patients survival were evaluated in stage III CRC patients. RESULTS: sPIGF levels in stage III CRC patients were significantly higher than those in controls. There was no significant association between sPIGF levels and clinicopathological features and sPIGF is not a prognostic factor for survival. Multivariate regression analysis showed the sPIGF levels (hazard ratio=3.28; 95% CI=1.10-9.5, p=0.032) to be significant independent factors for local recurrence. CONCLUSIONS: Serum PIGF levels in stage III CRC patients are significantly higher compared with normal controls and may be an indicator of local recurrence in stage III CRC patients.

Presence of free cancer cells in the peritoneal cavity of patients who underwent curative gastrectomy with lymph node dissection.

BACKGROUND/AIMS: The aim of this study was to determine the ratio of patients with positive peritoneal cytology who underwent radical gastrectomy for gastric cancer, to evaluate the factors effecting risk of positive cytology and to analyze the effects cytology findings on survival. METHODOLOGY: Peritoneal lavage samples were obtained from 255 patients who underwent radical gastrectomy with D2 (184 patients) or D3 (71 patients) lymph node dissection between January 2000 and December 2007. RESULTS: Thirty-six (14.1%) of 255 patients had free cancer cells in the wash cytology samples. T stage (T4) and differentiation were found to be independent risk factors for positive peritoneal cytology in multivariate analysis. Survival rate of cytology negative patients was significantly higher, however cytology findings were not found to be an independent prognostic factor for survival. T stage, lymph node metastasis and Borrmann classification (Borrmann type 4) appeared to be independent prognostic factors for survival in multivariate analyses. CONCLUSIONS: Peritoneal cytology does not provide additional information according to the TNM (1997) staging system. However, it should be employed intraoperatively before potentially curable serosa involved gastric carcinomas, especially for T4 tumors. Surgery alone will not be enough for patients with positive cytology and further therapies should be employed.

A novel screening biomarker in gastric cancer: serum Dickkopf-1.

BACKGROUND/AIMS: Despite all the knowledge about gastric cancer, there is no prognostic biomarker which could be useful for early detection. Dickkopf-1 (DKK-1), a secreted protein, is known as a negative regulator of the Wnt signaling pathway. DKK-1 is reported to be over expressed in many malignant tissues. The purpose of this study was to elucidate the normal level of serum DKK-1 (sDKK-1) levels in healthy Turkish peoples and to investigate the clinical utility of sDKK-1 levels for gastric cancer screening. METHODOLOGY: Serum DKK-1 levels were measured in 69 healthy controls and in 60 gastric adenocarcinoma patients with ELISA and sDKK-1 levels were compared with clinicopathological features and outcomes in gastric cancer patients. RESULTS: Serum concentrations of DKK-1 in gastric adeno cancer patients were significantly higher than control patients (p<0.001). The optimal cut-off for sDKK-1 levels order to discriminate control group from gastric cancer patients was 25U/mL with sensitivity equal to 100% and specificity equal to 100%. CONCLUSIONS: Serum DKK-1 levels may be a potentially useful novel serologic marker for gastric cancers.

Management of choledochal cysts in adults: a retrospective analysis of 23 patients.

BACKGROUND/AIMS: Choledochal cysts are rare congenital anomalies of the pancreaticobiliary system, whose etiology remains unknown. We aimed to review patients with choledochal cysts and to compare our results with current literature. METHODOLOGY: Twenty-three patients diagnosed as having choledochal cysts between January 2004 and July 2010 were evaluated retrospectively. RESULTS: Thirteen patients had type I (56.5%), 3 patients type II (13%), 3 patients type III (13%), 1 patient type IV-A (8.3%) and the remaining 3 patients had type V (13%) choledochal cysts. All patients with type I cysts underwent cyst excision with Roux-en-Y hepaticojejunostomy. Two patients with type II cysts underwent cyst excision with choledochoduodenostomy, whereas cyst excision with T-tube drainage was applied to the other. Endoscopic unroofing was performed type III cysts. The patient with type IV-A cyst was not eligible for surgery due to low cardiopulmonary performance status but ERCP was applied successfully more than 3 times for the extraction of the stones which fell from the intrahepatic ducts into the common bile duct. Patients with Type V cysts underwent left hepatectomy, choledocoduodenostomy and cadaveric liver transplantation, respectively. Wound infection developed in 5 patients and anastomotic leakage occurred in 3; one died from sepsis. CONCLUSIONS: Choledochal cysts are rare congenital malformations. Although treatment varies depending on the type of the cysts, complete excision of the cysts should be performed if possible.

Preoperative serum levels of soluble endoglin for prediction of recurrence in stage III colorectal cancer patients.

BACKGROUND: To evaluate the clinical usefulness of serum levels of soluble form of endoglin in stage III colorectal adenocarcinomas (CRC) patients for detection of recurrence. METHODS: The case-control study consisted of 80 stage III CRC patients who underwent surgery with curative intent and 70 age-and sex-matched healthy volunteers. Serum levels of soluble form of endoglin (sol-end) were measured in both groups. Also, predictive factors of recurrence were evaluated using multivariate analyses. RESULTS: Serum levels of sol-end in stage III CRC patients were significantly higher than those in controls. There was not a significant association between serum levels of sol-end and clinicopathological features in CRC patients. Multivariate regression analysis showed the LNR (hazard ratio, 2.54; 95% CI, 1.46-4.34; p < 0.001), to be significant independent factors to estimate local recurrence in stage III CRC patients. CONCLUSION: Preoperative serum levels of sol-end do not seem useful as a marker for detection of recurrence in stage III CRC patients.

Repair of an extensive iatrogenic tracheal rupture with a pleural patch and a vascular graft.

Here we describe a 48-year-old woman who suffered a 7-cm rupture in the lower trachea after intubation with a double-lumen tube. We repaired the rupture with a new technique using a pleural patch reinforced by a ringed vascular graft. This technique appears to be appropriate for use in patients who have large tracheal ruptures to avoid tracheal stenosis.

Timing of elective laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography with sphincterotomy: a prospective observational study of 308 patients.

PURPOSE: Endoscopic retrograde cholangiopancreaticography (ERCP) with sphincterotomy is associated with higher rates of conversion to open surgery during subsequent laparoscopic cholecystectomy (LC). The mechanisms of this association are unclear. The aim of this study was to investigate whether the time interval between the two procedures can affect the course of LC in terms of conversion rate or complications. METHODS: In this prospective observational study, 308 consecutive patients underwent ERCP with sphincterotomy followed at various intervals by elective LC. According to these intervals, the patients' data were assigned to one of three groups: short-interval (2 days or less), medium-interval (3-42 days), or long-interval (43 days or more). Groups were also defined in terms of whether gallstones were extracted during ERCP and in terms of the number of ERCPs performed (single or multiple) prior to LC. The main outcome measures for all groups were the frequency of complications during or after LC and the frequency of conversions to open surgery. RESULTS: Of the 308 patients, 43 required conversion to open cholecystectomy (14%). The short-interval (95 patients), medium-interval (100 patients), and long-interval (113 patients) groups did not differ significantly in terms of intraoperative complications, postoperative complications, or conversion to open surgery (p = 0.985, 0.340, and 0.472, respectively). The conversion rate also did not differ significantly according to the presence or absence of gallstones on ERCP (14.7% versus 12.8%, respectively, p = 0.392). However, compared with patients who underwent single ERCP (n = 290), those who underwent multiple ERCPs (n = 18) experienced significantly more conversion to open surgery (p = 0.026). CONCLUSIONS: The length of time between endoscopic sphincterotomy and LC did not affect the latter procedure in terms of complications or conversion to open surgery. However, the lack of an association between conversion rate and gallstone presence on ERCP and the higher conversion rate among patients who underwent multiple ERCPs, suggest that ERCP with sphincterotomy itself may be a factor in the higher conversion rates that have been observed after this procedure.

Effects of carbon dioxide pneumoperitoneum on hepatic function in obstructive jaundice: an experimental study in a rat model.

BACKGROUND AND AIMS: The physiology of the patient during laparoscopy differs from that of open surgery. Both pneumoperitoneum and obstructive jaundice impair the hepatic function, but the combined insult has not been previously examined. In this study, we aimed to investigate the effects of carbon dioxide (CO(2)) pneumoperitoneum on hepatic function in a rat model of obstructive jaundice. METHODS: Forty-four male Sprague-Dawley rats were divided into four groups: group 1 (n = 10), sham-operated group; group 2 (n = 12), obstructive jaundice group; group 3 (n = 10), CO(2) pneumoperitoneum group; and group 4 (n = 12), obstructive jaundice and CO(2) pneumoperitoneum group. Common bile duct was ligated and divided in the obstructive jaundice groups. After 6 days, a 12-mmHg pneumoperitoneum was induced, maintained for 60 min, and released for 120 min. Blood samples were drawn for the measurement of white blood cell and platelet counts, serum liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], total bilirubin). Tissue samples were obtained for analyses of malondialdehyde (MDA), glutathione (GSH), and superoxide dismutase (SOD) levels. We evaluated the degree of liver injury on a grading scale from 0 to 4, histopathologically. RESULTS: Pneumoperitoneum after biliary obstruction resulted in an increase in AST and ALT levels and a decrease in white blood cell and platelet counts. However, changes in liver tissue MDA, GSH, and SOD levels did not correlate with the changes in AST and ALT levels and white blood cell and platelet counts. After sham operation with pneumoperitoneum, the GSH levels in liver homogenate were significantly decreased in the group 3 when compared to the group 2. On the other hand, obstructive jaundice itself caused significant reduction in the SOD activity of liver homogenate in comparison to the group 3. Histopathologically, sinusoidal congestion and vacuolization were more severe in the group 3. CONCLUSIONS: Alterations in hepatic function occur in pneumoperitoneum applied jaundiced subjects. However, there were no statistically significant differences between the groups 2 and 4 with regard to white blood cell and platelet counts, serum liver enzymes including AST, ALT, and total bilirubin values, MDA and GSH levels and SOD activity of liver homogenate, and histologic damage. These results indicate that there is no additional risk on liver function associated with pneumoperitoneum performed in obstructive jaundice.

Postoperative hemorrhagic complications after elective laparoscopic cholecystectomy in patients receiving long-term anticoagulant therapy.

BACKGROUND AND AIMS: Among patients on long-term anticoagulant therapy who undergo laparoscopic cholecystectomy (LC), bleeding complications have not been extensively investigated. The objective of this study was therefore to investigate postoperative bleeding complications prospectively in patients on chronic oral anticoagulation. MATERIALS AND METHODS: In the period of January 2002 to December 2007, 44 patients on long-term anticoagulation with warfarin, an oral anticoagulant (OAC), underwent LC in our center. Oral anticoagulant was discontinued 5 days before the planned date of surgery, and patients were admitted to the hospital 3 days before. Upon admission, bridging anticoagulation with enoxaparin, a low molecular weight heparin (LMWH), was started. When their international normalized ratio (INR) decreased to <1.5, patients underwent LC. In the absence of postoperative bleeding complications, OAC and LMWH were resumed on the evening of the day of surgery, and LMWH was continued until each patient's target INR was reached. A comparison group was comprised by 1,421 consecutively enrolled patients with no comorbid disease who underwent LC during the same period. RESULTS: In the comparison group, postoperative bleeding was encountered in 21 patients (1.5%). In the anticoagulation group, postoperative bleeding was encountered in 11 patients (25%) and ranged from minor oozing from a port incision in one patient to hemorrhage, sepsis, and fatality in one patient. In the anticoagulation group, no significant differences were found between patients with and without postoperative bleeding in terms of age, gender, body mass index, American Society of Anesthesiologists score, INR, or other hemostasis parameters. CONCLUSIONS: In patients who underwent LC with bridging anticoagulation, postoperative bleeding was markedly more frequent than expected and was not predicted by the usual coagulation parameters. This suggests a need for methods that can indicate which patients on long-term anticoagulation are at risk for postoperative bleeding.

Surgical treatment for gastric cancer in Turkish patients over age 70: early postoperative results and risk factors for mortality.

PURPOSE: The aim of this study was to evaluate the effects of advanced age on early postoperative results and to investigate risk factors for mortality in Turkish gastric cancer patients. METHODS: From 2002 to 2007, 549 patients who underwent gastrectomy for gastric cancer were divided into two groups as patients younger than 70 years and patients aged 70 years or older. RESULTS: There were 387 patients in the younger group and 162 in the older group. Morbidity rates were similar (25.1% vs. 29.0%). Mortality was higher among the elderly patients (2.6% vs. 9.9%). Advanced age, albumin levels lower than 3 mg/dl, higher American Society of Anesthesiologists score, palliative resections and resection of two or more additional organs were independent risk factors for mortality. CONCLUSION: Age alone should not preclude gastric resection in elderly patients. However, for patients with multiple risk factors, more limited surgery should be considered.

Laparotomy with a curative intent in patients with suspected locally recurrent gastric cancer.

AIMS AND BACKGROUND: Most recurrent gastric tumors are unsuitable for further resection or palliative surgery. The aim of the present study was to evaluate the role of re-resection in patients with local-regional recurrences of gastric cancer. METHODS AND STUDY DESIGN: Between 1998 and 2007, 26 patients underwent laparotomy for local-regional gastric cancer recurrence. Length of time to recurrence, recurrence patterns, operative procedures, morbidity, mortality and survival after re-resection were evaluated. RESULTS: Re-resection was possible in 13 patients (50%). Among patients with resectable tumors, survival times were markedly longer, with 2 patients reaching 60 months of survival and 2 other patients reaching 48 and 28 months, respectively. Among patients with early recurrence, peritoneal carcinomatosis was more common. After re-resection, morbidity and mortality were seen, each in one patient. CONCLUSIONS: Most of the re-resected recurrences were intraluminal. In patients with early recurrences of gastric cancer, peritoneal carcinomatosis was encountered most frequently. Re-resection was beneficial and long-term survival was achieved after re-resection.

[Evaluation of the enrichment broth cultures in the isolation of methicillin-resistant Staphylococcus aureus]. / Metisiline dirençli Staphylococcus aureus izolasyonunda zenginlestirme buyyonu ekimlerinin degerlendirilmesi.

The detection of the methicillin-resistant Staphylococcus aureus (MRSA) carriers and the establishment of isolation precautions are of crucial importance to prevent the development of nosocomial infections due to MRSA. Previous studies have demonstrated that the use of enrichment broths increased the rate of MRSA isolation both in clinical samples and surveillance cultures. The aim of this study was to evaluate the MRSA isolation results obtained by inoculation of surveillance cultures in enrichment broth, for the patients staying in intensive care unit of our hospital during September 2006-January 2007 period. A total of 1536 samples (deep tracheal aspirate, nose, throat, pus, inguinal and axial swabs) from 250 patients were inoculated on routine primary media including sheep blood agar, EMB agar and 6 microg/ml oxacillin containing Mueller-Hinton agar (Ox-MH Agar) and also in an enrichment broth (EB) containing 6.5% NaCl in brain-heart infusion. After incubation for 24 and 48 hours, primary plates were examined for MRSA growth and enrichment broths were examined for turbidity. Turbid tubes were subcultured on Ox-MH agar. Tubes with no turbidity after 48 hours were discarded as negative; MRSA growth in both primary plates and in EBs were evaluated as "parallel growth". Parallel MRSA growth was detected in 15.2% (234/1536), MRSA growth only in EB was detected in 5.9% (91/1536) and MRSA growth only on primary plates was detected in 0.26% (4/1536) of the samples. Among the 71 patients in whom the first MRSA isolation was detected, 19 (27%) yielded MRSA only in EB, 44 (62%) exhibited parallel growth and 8 (11%) yielded MRSA either in EB or as parallel growth of different samples of the same patient. The use of the EB increased MRSA isolation 5.9% (91/1536) on specimen basis and 7.6% (19/250) on patient basis. It can be concluded that, inoculation of surveillance culture samples into an enrichment broth in addition to primary plate media aids to the early isolation of MRSA from colonized patients.