Original contribution: sleeve gastrectomy reduces soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) levels in patients with morbid obesity.

BACKGROUND: Early diagnosis of subclinical cardiovascular disease (CVD) in patients with morbid obesity is important. We investigated the effects of sleeve gastrectomy (SG) on serum soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1), oxidized LDL (oxLDL), and other metabolic and inflammatory parameters associated with atherosclerosis in patients with morbid obesity. METHODS: Body mass index (BMI) measurements and assays of metabolic and inflammatory markers were taken in patients in an SG surgery group and a healthy control group and compared at baseline and 12 months after SG. Correlations with changes in these parameters and variations in sLOX-1 were analyzed. RESULTS: Metabolic and inflammatory marker values in the surgery (n = 20) and control (n = 20) groups were significantly different at baseline (p < 0.001). The majority of surgery group biomarker levels significantly decreased with mean BMI loss (- 11.8 ± 9.0, p < 0.001) at 12 months, trending toward control group values. Baseline albumin level as well as percentage reductions in oxLDL and the cholesterol retention fraction (CRF) were found to be significantly correlated with percentage reduction in sLOX-1 at 12 months following SG. CONCLUSION: Metabolic and inflammatory biomarkers elevated at baseline significantly decreased after SG weight loss. Weight loss induced by SG may limit endothelial damage by reducing levels of oxLDL and LOX-1 as assessed by sLOX-1. These findings suggest that sLOX-1 may function as a marker of atherosclerotic disease states in patients with morbid obesity and that metabolic/bariatric surgery can play a meaningful role in CVD prevention.

Interpretation of the effect of CYP2C9, VKORC1 and CYP4F2 variants on warfarin dosing adjustment in Turkey.

It was aimed to underline the importance and explain the meaning of genetic testing in warfarin dosing and investigate and evaluate the contributions of the CYP2C9, VKORC1, and CYP4F2 variants in a Turkish population. Two hundred patients were genotyped for CYP2C9 (rs1799853, rs1057910 and rs56165452), VKORC1 (rs9934438, rs8050894, rs9923231, rs7294 and rs2359612) and CYP4F2 (rs2108622), yet, only 127 patients were found suitable for further evaluation in terms of their personal response to warfarin due to long term usage and available INR and dose usage information. The DNA sequences were determined by the ABI PRISM 3100 Genetic Analyzer to 3130xl System (Applied Biosystems, Foster City, California). Warfarin dose application suggestions by warfaringdosing.org, FDA and MayoClinic were followed. Dose requirements in the Turkish population were found higher than the suggested doses by warfarindosing.org. The multivariate logistic regression analysis reveals the utilization of VCORC1 genetic evaluation is valuable in warfarin dosing (low and moderate vs. high) in this study (p < 0.001). The present study provides findings for clinicians to adapt the genetic data to the daily practice. We observed that the VKORC1 variant showed a more potent impact in warfarin dosing in this study.

Inflammatory mediators in the diagnosis and treatment of acute pancreatitis: pentraxin-3, procalcitonin and myeloperoxidase.

INTRODUCTION: Acute pancreatitis (AP) is the third most common gastrointestinal disease at hospital admission. The etiology and pathogenesis of this disease are not completely clear. Our study was intended to determine the systemic levels of pentraxin-3 (PTX-3), myeloperoxidase (MPO), procalcitonin (PCT), and C-reactive protein (CRP) as prognostic parameters in early stages of AP. We also determined the effects of treatment on PTX-3, MPO, PCT and CRP levels in AP. MATERIAL AND METHODS: The study group comprised 44 AP patients (22 male, 22 female; age: 49.3 ±16.9 years) referred to our outpatient clinic. Additionally, our investigation included a control group of 30 healthy volunteers (18 male, 12 female; age: 50.8 ±12.6 years). RESULTS: Leukocytes, glucose, aspartate aminotransferase (AST (SGOT)), alanine aminotransferase (ALT (SGPT)), alkaline phosphatase (ALP), total and direct bilirubin levels were significantly higher in the AP group (p < 0.05, all). CRP, PTX-3, MPO and PCT were considerably higher in the AP group (p < 0.001, all), and after treatment, CRP, PTX-3, MPO and PCT levels were significantly lower (p < 0.001, all). CONCLUSIONS: Our findings indicated that the CRP, PTX-3, MPO and PCT levels increase in patients with AP and hence these indicators can be used as diagnostic factors to predict inflammation severity in AP. It was revealed that after treatment, there were significant reductions in biomarker levels. However, further research is needed in order to understand how these biomarkers can help to monitor inflammatory responses in AP.

The Effects on Obesity Related Peptides of Laparoscopic Gastric Band Applications in Morbidly Obese Patients.

BACKGROUND: The aim of this study was to examine the relationship between weight loss and resistin, apelin, chemerin, and visfatin after laparoscopic adjustable gastric banding (LAGB). METHODS: The study group consisted of 19 patients who were operated on for morbid obesity (BMI: 48.7 ± 6.6 kg/m2), and 22 healthy, normal-weight (BMI: 22.9 ± 2.5 kg/m2) subjects formed the control group. We obtained blood samples from the study subjects at three different times: before undergoing surgery and at one month and 6 months after surgery. Blood was obtained once from the control group. RESULTS: Significant weight loss was achieved at one and 6 months after surgery. Plasma levels of apelin, resistin, chemerin, and visfatin were higher in morbidly obese patients compared with the control group. Obesity-related peptides decreased one month and 6 months after surgery. CONCLUSIONS: Elevated plasma resistin, apelin, chemerin, and visfatin levels in morbidly obese patients are gradually reduced after weight loss. According to these findings, LAGB surgery is found to be an important and efficient means for morbidly obese patients both to lose weight and to develop a better metabolic risk profile in a short time period.

Postoperative Wound Myiasis Caused by Sarcophaga carnaria.

Myiasis is a parasitic infection caused by dipteran larvae settling in living tissue and organs. Infestation is generally found in tropical and rural areas, where interaction with animals is common. It is diagnosed based on the evidence of the existence of dipteran larvae in tissues and organs. When planning the treatment, identifying the type of larvae is as important as identifying the infected organ or system. In this case report, we present the case of a female who had a biliary tract injury caused by laparoscopic cholecystectomy and who developed a postoperative enterocutaneous fistula and myiasis caused by third-stage Sarcophaga sp. larvae at the incision area.

Effect of ankaferd blood stopper in experimental peritoneal adhesion model.

PURPOSE: Ankaferd Blood Stopper (ABS) is an herbal extract attained from 5 different plants. It has the therapeutic potential to be used for the management of external hemorrhage and controlling gastrointestinal bleedings. To date, the safety of ABS for intraperitoneal usage is not clear. In this study, we investigated the effectiveness and safety of using intraperitoneal ABS in an experimental peritoneal adhesion model. METHODS: Twenty-four male Wistar Albino rats were used in the study. The rats were randomly divided into 3 groups: saline, ABS, and control. On the 10th day, all rats were euthanized. The adhesions were evaluated by Nair's macroscopic adhesion classification, and pathologically evaluated with Zühlke's microscopic adhesion classification. RESULTS: macroscopic and microscopic comparison between the ABS and saline groups did not show any differences but both the ABS and saline groups were superior when compared to the control group. CONCLUSION: ABS was found equally effective with saline on the abdominal adhesions and to no effect on postoperative adhesion formation.

Comparison of (18)F-fluorodeoxyglucose PET/CT findings with vascular endothelial growth factors and receptors in colorectal cancer.

The purpose of this study was to evaluate the association of (18)F-fluorodeoxyglucose (FDG)-PET/CT findings with the vascular endothelial growth factor (VEGF) family and its receptor (VEGFR) levels in metastatic and nonmetastatic colorectal cancer (CRC). Fluorine-18 FDG-PET/CT scans were performed for initial staging and restaging of patients with CRC. FDG-PET/CT findings of tumor (such as the presence of a primary tumor, the lymphatic or distance metastases, and the maximum standardized uptake value (SUVmax) of the primary tumor), serum VEGF A-C-D-E levels, and serum VEGF receptor 1-2-3 levels were analyzed. A total of 63 patients were included into the study (35 males, mean age 61.3 ± 11.9 years). Patients were divided into two groups, based on positive and negative PET/CT findings. Patients were also categorized according to the presence of metastasis. All evaluated parameters were significantly higher in the PET/CT-positive group than the PET/CT-negative group (p < 0.001). All those parameters were also positively correlated with each other. The highest correlation for SUVmax of primary tumor was found with VEGFR-3 (p < 0.001, r = 0.665). Patients with metastases had high levels of VEGF-D, VEGF-A, VEGF-C, VEGF-E, and VEGFR-3 than those without metastases. These parameters had better specificity and sensitivity values than the SUVmax of the primary tumor for detection of metastases. However, VEGF-D was the best indicator of metastasis in all of those parameters (VEGF-D vs SUVmax; sensitivity 100 vs 100 %; specificity 76 vs 76 %; AUC 0.903 vs 0.835; p < 0.001, respectively). Vascular endothelial growth factor family and its receptors were significantly higher in metastatic CRC patients. VEGF-D was the best indicator of metastasis than all VEGF family, VEGFR-3, and primary tumor SUVmax. VEGF family (A-C-D-E) and VEGFR-3 may help to determine the prognosis and management of CRC.

Pyoderma gangrenosum with common variable immunodeficiency.

Pyoderma gangrenosum (PG) is a rare ulcerative skin disease of unknown etiology. It can be seen on normal skin or secondary to traumas such as injections and biopsies. Half of reported cases are associated with systemic diseases such as arthritis, inflammatory bowel diseases, hematological disorders, hepatic disease, and necrotizing vasculitis. These lesions often occur on the trunk and extremities. Abscess drainage, debridement, or necrosectomy are contraindicated in PG, and false management of these indications aggravates the lesion. A diagnosis of PG is based on medical history as well as physical and laboratory examination according to standard criteria. Presented here is a case of a male patient with a medical history of recurrent abscess of injection and splenectomy due to splenic abscess. The patient presented with a subcutaneous abscess which transformed rapidly to an ulcer after abscess drainage. Consequently, the patient received the final diagnosis of PG with common variable immunodeficiency and was treated accordingly.

The effects on oxidative DNA damage of laparoscopic gastric band applications in morbidly obese patients.

BACKGROUND: Obesity may induce oxidative stress, causing oxidative damage of DNA. We examined associations between decreasing serum and urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels and weight loss in morbidly obese patients before and 6 months after laparoscopic adjustable gastric banding (LAGB). METHODS: We compared patients who had surgery for morbid obesity with healthy, nonobese controls. Urine and fasting blood samples were collected once from the controls and from the morbidly obese patients before and 6 months after the LAGB. The serum and urinary 8-OHdG levels were evaluated in these groups using an enzyme-linked immunosorbent assay kit. RESULTS: We included 20 patients who had surgery for morbid obesity (8 men, 12 women, mean body mass index [BMI] 46.82 ± 4.47) and 20 healthy, nonobese people (10 men, 10 women, mean BMI 22.52 ± 2.08) in our study. There was no significant difference in serum 8-OHdG levels between the groups, whereas urinary 8- OHdG levels were significantly higher in morbidly obese patients than in controls. Weight, BMI and serum and urinary 8-OHdG levels were significantly decreased in morbidly obese patients 6 months after LAGB. CONCLUSION: The LAGB provides efficient weight loss in patients with morbid obesity. The systemic oxidative DNA damage was increased by the morbid obesity, but this increase was not related to weight gain, and it was more evident in serum than urine samples. After LAGB for morbid obesity, the oxidative DNA damage declined both in serum and urine.

CONTEXTE: L'obésité peut provoquer stress oxydatif qui endommage l'ADN. Nous avons analysé les liens entre une baisse des taux de 8-OHdG (8-hydroxy-2'-désoxyguanosine) sériques et urinaires et la perte de poids chez des patients atteints d'obésité morbide avant, puis 6 mois après la pose d'un anneau gastrique ajustable par laparoscopie (AGAL). MÉTHODES: Nous avons comparé des patients qui ont subi cette chirurgie pour un problème d'obésité morbide à des témoins non obèses en bonne santé. Nous avons prélevé des échantillons d'urine et de sang à jeun chez les témoins 1 fois et chez les patients atteints d'obésité morbide, avant, puis 6 mois après l'intervention pour AGAL. Les taux de 8-OHdG sériques et urinaires ont été mesurés dans les 2 groupes à l'aide d'une trousse de test ELISA (enzyme-linked immunosorbent assay). RÉSULTATS: Notre étude a inclus 20 patients soumis à la chirurgie pour obésité morbide (8 hommes, 12 femmes; indice de masse corporelle [IMC] moyen 46,82 ± 4,47) et 20 témoins non obèses en bonne santé (10 hommes, 10 femmes; IMC moyen 22,52 ± 2,08). Nous n'avons noté aucune différence significative des taux de 8-OHdG sériques entre les 2 groupes, mais les taux de 8-OHdG urinaires étaient significativement plus élevés chez les patients souffrant d'obésité morbide que chez les témoins. Le poids, l'IMC et les taux de 8-OHdG sériques et urinaires avaient significativement diminué chez les patients atteints d'obésité morbide 6 mois après l'intervention pour AGAL. CONCLUSION: L'AGAL est une technique efficace de perte de poids chez les patients souffrant d'obésité morbide. L'atteinte oxydative systémique de l'ADN était exacerbée par l'obésité morbide, mais cette hausse n'était pas reliée au gain pondéral, et elle était plus évidente dans les échantillons sériques que dans les échantillons urinaires. Après la pose d'un AGAL pour obésité morbide, l'atteinte oxydative de l'ADN a diminué dans le sérum et dans l'urine.

Effects of laparoscopic gastric band applications on plasma and fundic acylated ghrelin levels in morbidly obese patients.

BACKGROUND: It has been proposed that laparoscopic adjustable gastric banding (LAGB) procedure might play a role in modulation of fundic ghrelin production. To test this hypothesis, we examined plasma and tissue concentrations of acylated ghrelin in morbidly obese patients before and 6 months after LAGB. Baseline levels of acylated ghrelin in morbidly obese patients were also compared with those in age-matched, healthy, non-obese controls. METHODS: We studied 21 patients who had been operated on for morbid obesity (M/F = 9/12, BMI = 49.3 ± 5.3 kg/m(2)) and 16 healthy, non-obese persons (M/F = 7/9, BMI = 23.0 ± 1.7 kg/m(2)). Fasting blood samples were collected once from the non-obese controls as well as the morbidly obese patients before and 6 months after the LAGB. The morbidly obese patients and their respective controls underwent gastroscopy for fundic biopsy. The plasma and fundic acylated ghrelin levels were evaluated in these groups by enzyme-linked immunosorbent assay. RESULTS: The plasma and fundic acylated ghrelin concentrations were significantly lower in obese patients than in non-obese controls (2.8 ± 1.0 ng/ml, 727 ± 171.7 ng/g tissue, respectively; p = 0.000). These parameters were significantly increased in morbidly obese patients 6 months after LAGB (4.1 ± 1.2 ng/ml and p = 0.001; 999 ± 292.1 ng/g tissue and p = 0.003, respectively). CONCLUSIONS: We showed that fundic production of acylated ghrelin was significantly increased in morbidly obese patients 6 months after LAGB. Moreover, the weight loss after LAGB occurred in spite of the significant increase in the plasma and fundic acylated ghrelin levels. The potential role of ghrelin as being responsible for the weight loss after bariatric surgery needs to be elucidated in further studies.

Amelogenin (an extracellular matrix protein) application on ischemic colon anastomosis in rats.

BACKGROUND: Ischemia is a troublesome problem that can cause intestinal emergencies and complicate the treatment. Identification of a chemical agent with beneficial effects on the healing process in risky colon anastomosis with the aim of reducing leakage rates is a popular topic in the era of surgical research. Data is lacking about the role of amelogenin, an extracellular matrix protein, during the healing process of gastrointestinal anastomosis. In this study, the effects of amelogenin treatment on ischemic colon anastomosis were evaluated. METHODS: Adult male Wistar Albino rats weighing 200-250 g were divided into three weight-matched groups as normal colon anastomosis group (n=8), ischemic colon anastomosis group (n=8), and amelogenin-treated ischemic colon anastomosis group (n=8). Sufficient equal volume of amelogenin to cover the anastomosis area entirely was applied topically. All animals were sacrificed on postoperative day four. Bursting pressure levels were measured. Peri-anastomotic colon tissue hydroxyproline levels were also assessed. RESULTS: Bursting pressure level of the ischemic colon anastomosis group was significantly lower than the normal colon anastomosis and the amelogenin-treated ischemic colon anastomosis groups, respectively (p=0.006, p=0.008). CONCLUSION: Amelogenin treatment supports the physical strength of ischemic colon anastomosis.

Surgical treatment of axillary accessory breasts.

Accessory breast tissue is a remnant persisting after normal embryological development of the breast. Although accessory breasts may be asymptomatic, they can cause discomfort during menstruation, anxiety, cosmetic problems, pain, or restriction of arm movement. The data of all patients who presented with axillary accessory breasts between January 2000 and September 2008 were recruited from a computer database. Medical charts, outpatient records, operative notes, and pathology reports were reviewed. A total of 29 patients underwent surgical treatment of axillary accessory breasts in the Department of Breast Surgery and Department of Plastic, Reconstructive and Aesthetic Surgery. The ages of the patients at the time of surgery ranged from 19 to 54 years. The mean age was 28.8 years. All patients were female. Sixteen patients had unilateral accessory breast and 13 patients had bilateral accessory breasts. Fourteen patients had breast hypertrophy. Twenty-one patients had excision, five patients had liposuction, and three patients had both. Axillary accessory breasts can be satisfactorily treated with excision, liposuction, or both. In patients with concomitant macromastia, reduction mammaplasty and removal of accessory breasts can be performed at the same time with no additional morbidity.

Plasma adhesion and inflammation markers: asymmetrical dimethyl-L-arginine and secretory phospholipase A2 concentrations before and after laparoscopic gastric banding in morbidly obese patients.

BACKGROUND: The aim of this study was to examine the relationship between subclinical inflammation and weight loss by laparoscopic adjustable gastric banding (LAGB). METHODS: Plasma concentrations of intercellular adhesion molecule-1 (ICAM-1), vascular adhesion molecule-1 (VCAM-1), sensitive C-Reactive Protein (sCRP), asymmetrical dimethyl-L-arginine (ADMA), Secretory Phospholipase A2 (sPLA2), and metabolic markers, such as homeostatic model assessment insulin resistance (HOMA-IR) and body mass index (BMI) were determined in morbidly obese patients (n=18, BMI 48.6 +/- 1.7 kg/m2) at baseline and 1 month after operations. Baseline levels in patients were also compared with age-matched controls (n=20, BMI 21.3 +/- 1.8 kg/m2). Plasma ICAM-1, VCAM, sCRP and ADMA, and sPLA2 concentrations were determined by enzyme-linked immunoassay methods and colorimetric method, respectively. RESULTS: Plasma sCRP, ICAM-1, ADMA and sPLA2 concentrations and HOMA-IR were significantly higher in morbidly obese patients than in controls (for each, P<0.01). Plasma VCAM-1 concentration was not changed in obese patients. HOMA-IR was significantly correlated with ICAM-1, ADMA and sPLA2 in the obese group at baseline (for each, P<0.01). There was a significant correlation between plasma sCRP and plasma glucose, VCAM-1, ICAM-1, ADMA and sPLA2 concentrations (for each, P<0.01). 1 month after LAGB, mean body weight loss was 13.2 +/- 6.3 kg, and plasma sCRP and ADMA concentrations and HOMA-IR and BMI were significantly decreased (for each, P<0.01). However, these levels cannot be decreased to the levels of the controls. CONCLUSION: Obesity and insulin resistance appear to be associated with low-grade inflammation and endothelial dysfunction. Insulin resistance and endothelial dysfunction were improved by weight loss after LAGB.