Indoleamine-2,3-dioxygenase-related anti-inflammatory effects of 3-aminobenzamide and infliximab in experimental colitis.

OBJECTIVE: This study aimed to investigate the presence of indoleamine-2,3-dioxygenase and bacterial translocation after the administration of 3-aminobenzamide and infliximab in the TNBS model of rat colitis. METHODS: The study group was divided into five categories as follows: group 1: (control), group 2: colitis+saline, group 3: colitis+3-aminobenzamide, group 4: colitis+infliximab, and group 5: colitis+3-aminobenzamide+infliximab. Intestinal mesenteric cultures were incubated on specific agar media plates under aerobic and anaerobic conditions, bacterial translocation was evaluated and assessed as colony-forming units per gram of tissue. Colonic tissue samples were evaluated by Western blotting method to detect the presence of indoleamine-2,3-dioxygenase. RESULTS: The results obtained were as follows: group 1: normal gut flora; group 2: eight of nine samples had bacterial translocation, of which six of them had positive indoleamine-2,3-dioxygenase protein; group 3: five of nine samples had bacterial translocation, of which seven of them had positive indoleamine-2,3-dioxygenase; group 4: three of nine samples had bacterial translocation, of which seven of them had positive indoleamine-2,3-dioxygenase; and group 5: only one sample had exact indoleamine-2,3-dioxygenase protein. CONCLUSION: Altered expression of indoleamine-2,3-dioxygenase results in a lower bacterial translocation via infliximab compared with 3-aminobenzamide treatment. Combined treatments emphasized different approaches for the new molecules related to indoleamine-2,3-dioxygenase.

Endocrine Surgery during the COVID-19 Pandemic: Recommendations from the Turkish Association of Endocrine Surgery.

The 2019 novel coronavirus disease (COVID-19) was initially seen in Wuhan, China, in December 2019. World Health Organization classified COVID-19 as a pandemic after its rapid spread worldwide in a few months. With the pandemic, all elective surgeries and non-emergency procedures have been postponed in our country, as in others. Most of the endocrine operations can be postponed for a certain period. However, it must be kept in mind that these patients also need surgical treatment, and the delay time should not cause a negative effect on the surgical outcome or disease process. It has recently been suggested that elective surgical interventions can be described as medically necessary, time-sensitive (MeNTS) procedures. Some guidelines have been published on proper and safe surgery for both the healthcare providers and the patients after the immediate onset of the COVID-19 pandemic. We should know that these guidelines and recommendations are not meant to constitute a position statement, the standard of care, or evidence-based/best practice. However, these are mostly the opinions of a selected group of surgeons. Generally, only life-threatening emergency operations should be performed in the stage where the epidemic exceeds the capacity of the hospitals (first stage), cancer and transplantation surgery should be initiated when the outbreak begins to be controlled (second stage), and surgery for elective cases should be performed in a controlled manner with suppression of the outbreak (third stage). In this rapidly developing pandemic period, the plans and recommendations to be made on this subject are based on expert opinions by considering factors, such as the course and biology of the disease, rather than being evidence-based. In the recent reports of many endocrine surgery associations and in various reviews, it has been stated that most of the cases can be postponed to the third stage of the epidemic. We aimed to evaluate the risk reduction strategies and recommendations that can help plan the surgery, prepare for surgery, protect both patients and healthcare workers during the operation and care for the patients in the postoperative period in endocrine surgery.

Radioguided occult lesion localization for minimally-invasive parathyroidectomy without quick PTH monitoring and frozen section: impact of the learning curve.

OBJECTIVES: Minimally-invasive parathyroidectomy (MIP) is a surgical procedure that reduces the duration of operation, hospital costs, and hypocalcemia, and shortens the length of hospital stay. This study addressed the important procedural details of the radioguided occult lesion localization (ROLL)-MIP technique and evaluated the consequences of the learning curve from a series of patients. PATIENTS AND METHODS: A total of 80 patients who underwent ROLL-MIP for a single parathyroid adenoma were included into this retrospective study. In order to analyze the effect of the learning curve, these subjects were then divided into 2 groups per time period and the operative times were compared. Group A consisted of 22 previously reported patients who served as the control group. Group B consisted of 58 consecutive patients. RESULTS: Serum calcium and parathyroid hormone (PTH) levels were normalized in all of the patients within 2 days and remained normal during the follow-up period (31 ± 18.5 months). None of the patients who underwent ROLL-guided parathyroidectomy suffered temporary or permanent recurrent laryngeal nerve injuries. Mean operation time (time from incision to excision of the adenoma) was 23 ± 6 min in Group A and 18 ± 7 min in Group B. Mean operative times were significantly shorter in group B. CONCLUSION: The success of MIP administered with the ROLL technique in a single adenomatous patient was quite high. This method seems especially valuable in patients with atypically located or small adenomas.

Does early removal of double J stents reduce urinary infection in living donor renal transplantation?

INTRODUCTION: Prophylactic use of double J (DJ) stents in recipients is highly accepted in renal transplantation. In this study, the association between the frequency of urologic complications (UC) and urinary tract infections (UTI), and the early or late removal of DJ stents was investigated. MATERIAL AND METHODS: A total of 116 live-donor renal transplant patients were included in the study during a 4-year period, with a mean follow-up of 29.2 ±15.3 months. In all, DJ stents were used. All patients were clinically monitored for graft function by assessment of the complete blood count, renal biochemistry, urine analysis and blood drug level according to our follow-up protocol. RESULTS: The patients were divided into 2 groups according to the time of their stent removal: group I (n = 44), removal within the first 14 days; and group II (n = 72), removal after 14 days. No urinary leaks were detected in either of the groups. Three patients suffered from anastomotic stricture (group I, n = 1; group II, n = 2). The rates of UTI were similar in groups I and II (13.6% vs. 16.6%, respectively, p = 0.79). The rate of UTI in women was found to be 3.8 times higher than in men. CONCLUSIONS: The results of our study demonstrated that DJ stent removal within 14 days did not reduce the risk of UTI when compared to stent removal after 14 days. Similar effects on complication rates for ureteral stenting for these 2 removal periods were observed.

Comparison of intestinal ischemia after on-pump versus off-pump coronary artery bypass grafting surgery

Background/aim: Acute mesenteric ischemia (AMI), one of the gastrointestinal system complications, which occurs following cardiac surgery, is challenged in the literature with a diminished incidence of AMI by heart surgery without cardiopulmonary bypass (CPB) or with pulsatile CPB. This study aims to compare the incidence and mortality rate of mesenteric ischemia in a series of consecutive patients undergoing coronary artery bypass grafting (CABG) through on-pump and off-pump techniques. Materials and methods: This study included patients who underwent CABG between 1 January 2010 and 31 June 2016. All patients were divided into two groups: Group 1 comprised 6396 CABG patients operated on with the off-pump technique. Group 2 included 1210 patients who received CABG with the on-pump technique. Preoperative data were collected on the studied variables. Postoperative data included the development of intestinal ischemia and in-hospital mortality. Results: Of 7606 consecutive CABG patients, a total of 31 (0.4%) developed intestinal ischemia. The incidence of postoperative mesenteric ischemia was 0.28% in Group 1 and 1.07% in Group 2 (P = 0.000). The survival rates after AMI were 61.1% in Group 1 (off-pump) and 7.7% in Group 2 (on-pump) (P = 0.003). Time from the first occurrence of nonspecific GI complaints to laparotomy was similar in the off-pump and on-pump groups and had no effect on mortality. Conclusions: With regard to the incidence of mesenteric ischemia and survival after laparotomy, off-pump CABG patients revealed significant improvement compared with those operated on with the on-pump technique.

A new surgical approach for pilonidal sinus disease: "de-epithelialization technique''.

OBJECTIVE: In the treatment of pilonidal sinus disease different approaches are used such as conservative treatment and fasciocutaneous rotation flap. The aim of this study was to evaluate the efficacy of "de-epithelialization technique" as a new approach in pilonidal sinus disease treatment. MATERIAL AND METHODS: Forty pilonidal sinus disease patients treated with de-epithelialization method were evaluated retrospectively. Patient age, gender, body mass index, wound healing time, visual analog scale scores, operation times, hospital stay duration, drain removal time, cosmetic satisfaction rates, complications, and recurrence rates were evaluated. RESULTS: The numbers of male and female patients in this study were 39 and 1, respectively. The median age of the patients was 25 years and the mean BMI was 26.6. The mean operating time was 43 min, and all patients were discharged 5 h after the operation. Wound healing time varied from 10 to 20 days. Median follow-up period was 9 months (4-17 months). One patient with high body mass index suffered from partial wound separation. No other complications such as infections and fluid collections (hematoma and seromas) were observed. Maximum cosmetic satisfaction rate was 90% (n=36), and no patient had a recurrence during the follow-up period. CONCLUSION: "De-epithelialization" may be considered as a complementary and/or alternative approach to other surgical techniques such as primary closure, rhomboid excision, and Limberg flap in the treatment of pilonidal sinus disease, with acceptable cosmesis and recurrence rates.

Single-incision laparoscopic adrenalectomy in a patient with acute hypokalemic paralysis due to primary hyperaldosteronism.

Acute hypokalemic paralysis is a relatively rare cause of acute weakness. It may resolve spontaneously; however, it may be a potential life-threatening condition. Hypertension may be considered the most important finding in combination with hypokalemic paralysis for raising the suspicion of primary hyperaldosteronism (PHA). A 55-year-old hypertensive Mexican woman was admitted to the Emergency Unit with a sudden onset of generalized paralysis. An endocrinological workup and an abdominal magnetic resonance imaging revealed PHA with a 1.5 cm left adrenal tumor. After preoperative medication, left adrenalectomy was performed with single-incision laparoscopic surgery (SILS). The duration of the surgery was 45 min, and no postoperative complication was encountered. The patient was discharged after 24 h. Hypokalemic paralysis may be due to different conditions, but it may raise the suspicion of PHA in combination with a history of generally mild hypertension. Laparoscopic adrenalectomy is the preferred operation for unilateral adrenal adenomas that cause PHA. Single-incision laparoscopic surgery is a step-forward technique that improves the cosmesis, decreases access-related morbidity, and increases the postoperative recovery. We report a case with acute hypokalemic paralysis due to PHA and treated with SILS.

Can balneotherapy improve the bowel motility in chronically constipated middle-aged and elderly patients?

Balneotherapy or spa therapy is usually known for different application forms of medicinal waters and its effects on the human body. Our purpose is to demonstrate the effect of balneotherapy on gastrointestinal motility. A total of 35 patients who were treated for osteoarthritis with balneotherapy from November 2013 through March 2015 at our hospital had a consultation at the general surgery for constipation and defecation disorders. Patients followed by constipation scores, short-form health survey (SF-12), and a colonic transit time (CTT) study before and after balneotherapy were included in this study, and the data of the patients were analyzed retrospectively. The constipation score, SF-12 score, and CTT were found statistically significant after balneotherapy (p < 0.05). The results of our study confirm the clinical finding that a 15-day course of balneotherapy with mineral water from a thermal spring (Bursa, Turkey) improves gastrointestinal motility and reduces laxative consumption in the management of constipation in middle-aged and elderly patients, and it is our belief that treatment with thermal mineral water could considerably improve the quality of life of these patients.

Cavernous Hemangioma in the Breast.

Although the observation of breast vascular tumors is rare, the most common tumor is hemangioma in the benign group, and these tumors are observed incidentally in lumpectomy or mastectomy specimens during histological examinations. They are classified into capillary, cavernous, and venous hemangiomas. Cavernous hemangioma is the most common subtype. Cavernous hemangiomas are benign vascular tumors, which malformation from mature blood vessels. Hemangiomas in the benign group may show a suspicion of ductal carcinoma in situ (DCIS) in mammographic analysis. Ultrasonography (US) and magnetic resonance imaging (MRI) are the most useful imaging methods for analyzing the structure of breast vessels. In this case, a 54-year-old female who have any complaint. Scanning mammography (MG) detected the tumor, but physical examination and US could not identify the mass. According to the MG analysis, the lesion was evaluated as BIRADS 4b, and the patient underwent excisional biopsy after wire localization. Pathological analysis revealed cavernous hemangioma.

Invasive Ductal Carcinoma Developing From Fibroadenoma.

Fibroadenomas are the most common benign breast lesions in adolescent and young women. It is most frequently observed in the 3rd decade. Although it is considered benign, evidence of malignant transformation is available. Cancer development may be from ground of fibroadenoma or near breast tissue. A case of a fibroadenoma coexisting with an invasive ductal carcinoma of the breast in a 31-year-old female is presented. The patient presented with the chief complaint of having a palpable mass in her right breast for the last 10 years. Mammography revealed a mass with microcalcifications. Core biopsy was performed, and the results indicated an invasive carcinoma. Breast-conserving surgery with sentinel lymph node biopsy was performed. The pathological features revealed a fibroadenoma coexisting with an invasive ductal carcinoma. This case suggests that clinicians and radiologists should always pay attention to the associated malignant imaging characteristics whenever a mass was followed up as fibroadenoma.

Radioguided occult lesion localization for minimally invasive parathyroidectomy: technical consideration and feasibility.

PURPOSE OF THE REPORT: Minimally invasive parathyroidectomy (MIP) constitutes one of the main surgical approaches for the patient with primary hyperparathyroidism (PHPT) caused by a single parathyroid adenoma. The purpose of the study was to investigate the feasibility of radioguided occult lesion localization (ROLL) for MIP and the potential effects of the method in histopathologic evaluation. MATERIALS AND METHODS: Twenty-two patients, diagnosed with PHPT biochemically and candidates for surgery, underwent ROLL-guided MIP (ROLL-MIP). Parathyroid adenomas were searched for and identified with the guidance of an intraoperative gamma probe. The final diagnosis was confirmed by histopathologic analysis. All specimens were analyzed for the presence of parenchymal hemorrhage, congestion, neutrophil leukocyte infiltration, necrosis, cystic degeneration, subcapsular hematoma, subcapsular fibrin/neutrophil leukocyte infiltration, and disarray of the fibrous capsule of adenoma. RESULTS: All injected lesions were effectively located over the skin with very high count rates depending on the injected activity and location of the lesion. Serum calcium and parathyroid hormone (PTH) levels normalized in all patients and stayed within the normal range during the follow-up period. None of the patients who underwent ROLL-MIP suffered temporary or permanent recurrent laryngeal nerve injuries. The mean operative time was 23 ± 7 min. Parenchymal hemorrhage, congestion, subcapsular hematoma, and fibrin/neutrophil leukocyte infiltration were common histopathologic features. CONCLUSION: The use of ROLL-MIP in patients with PHPT due to a single parathyroid adenoma in the neck is technically safe and effective. It is more valuable in scintigraphy-negative patients when parathyroid adenoma is either demonstrated on ultrasonography by typical findings or confirmed by PTH washout. The ROLL-MIP technique does not impair the postoperative histopathologic examination of the parathyroid glands.

Invagination of the appendix due to endometriosis presenting as acute appendicitis.

Appendicitis and endometriosis are commonly encountered surgical problems. Endometrial involvement of the appendix is rare and very few cases have been reported in the literature. True diagnosis of appendix invagination is highly difficult due to variable symptoms. Noting the findings which are in favour of invagination in patients diagnosed with acute appendicitis is of great significance in order to be prepared for changing surgical attempts. This case describes a 34 year old female patient diagnosed with infertility who was operated on for acute appendicitis. In the pathological assessment, endometrial involvement of the appendix was seen. The classification, symptoms, radiological appearance and treatment of appendix invagination described in the literature are discussed.