Clinicopathological outcomes of microsatellite instability in colorectal cancer.

AIMS: This study aims to evaluate the histopathological features and prognostic parameters of tumors with microsatellite instability (MSI) compared with those without MSI in patients who underwent surgery for colorectal cancer (CRC). SETTING AND DESIGN: Follow-up for CRC at Istanbul Sultan 2. Abdulhamid Han Training and Research Hospital was retrospectively evaluated between March 2017 and March 2021. METHODS AND MATERIAL: The patients were divided into two groups: those with and without MSI. Groups were compared in survival parameters. As a secondary result, groups were compared in pathological parameters such as stage, tumor diameter, degree of differentiation, and lymphovascular, and perineural invasion. STATISTICAL ANALYSIS USED: Survival calculations were performed using the Kaplan-Meier analysis method. The effects of various prognostic factors related to tumor and patient characteristics on disease-free and overall survival (OS) were investigated by log-rank test. RESULTS: Two hundred fourteen patients were analyzed. The median age of the patients was 66 (30-89), and 59.3% (n = 127) were male. There were 25 patients in the MSI group and 189 patients in the non-MSI group. We found that MSI tumors had a significantly higher differentiation degree than non-MSI tumors and larger tumor diameters. MSI tumors frequently settled in the proximal colon, and more lymph nodes were removed in the resection material. MSI tumors had longer disease-free survival, cancer-specific survival, and overall survival. CONCLUSIONS: By diagnosing microsatellite instability, CRCs can be divided into two groups. The histopathological features of the tumor and the prognosis of the disease differ between these groups. MSI can be a predictive marker in the patient's follow-up and treatment.

Clinical significance of miR-140-5p and miR-193b expression in patients with breast cancer and relationship to IGFBP5.

The functional role of IGFBP5 in breast cancer is complicated. Experimental and bioinformatics studies have shown that IGFBP5 is targeted by miR-140-5p and miR-193b, although this has not yet been proven in clinical samples. The aim of this study was to evaluate the expression of miR-140-5p and miR-193b in breast cancer and adjacent normal tissue and assess its correlation with IGFBP5 and the clinicopathological characteristics of the tumors. IGFBP5 protein expression was analyzed immunohistochemically and IGFBP5, miR-140 and miR-193b mRNA expression levels were analyzed with real-time RT-PCR. Tumor tissue had higher miR-140-5p expression than adjacent normal tissue (p = 0.015). Samples with no immunohistochemical staining for IGFBP5 showed increased miR-140-5p expression (p = 0.009). miR-140-5p expression was elevated in invasive ductal carcinomas (p = 0.002), whereas basal-like tumors had decreased expression of miR-140-5p compared to other tumors (p = 0.008). Lymph node-positive samples showed an approximately 13-fold increase in miR-140-5p expression compared to lymph node-negative tissue (p = 0.049). These findings suggest that miR-140-5p, but not miR-193b, could be an important determinant of IGFBP5 expression and clinical phenotype in breast cancer patients. Further studies are needed to clarify the expressional regulation of IGFBP5 by miR-140-5p.

Comparison of emergency surgeries for obstructed colonic cancer with elective surgeries: A retrospective study.

OBJECTIVE: Colon cancer patients presented with obstruction were known to have worse postoperative morbidity and mortality rates, but conflicting data has been reported in recent years. We aimed to investigate postoperative complication rates, and short and long-term oncological outcomes in patients with colon cancer treated with either emergency surgery due to obstruction or elective surgery. METHODS: Two hundred fifty two patients were analyzed. Patients presented with obstruction and underwent an emergency surgery, and patients operated under elective circumstances were compared according to their demographic variables, tumor characteristics, and short and long term treatment outcomes. RESULTS: Distribution of age, gender and comorbidities were similar between both the groups. Need for an end colostomy was significantly higher in obstructed patients (22.7% vs 1.6%, respectively). Obstructed patients were tending to be at an advanced stage. Postoperative morbidity and mortality, and prognosis of colon cancer patients presented with obstruction is worse than patients operated under elective circumstances. CONCLUSIONS: Colon cancer patients presented with obstruction constitutes more than one quarter of all patients. These patients have significantly higher morbidity and mortality rates. Obstructed colon cancer usually appears at advanced stage. Primary resection and anastomosis is safe in most of the cases.

Comparison of 4 % icodextrin and omega 3 Fatty acids in prevention of peritoneal adhesions.

Postoperative peritoneal adhesions are major concerns in abdominal surgery. In this experimental study, the effects of 4 % icodextrin and omega-3 fatty acids (ω-3 FA) on prevention of postoperative peritoneal adhesions were evaluated. Twenty-four Wistar albino rats were divided into three groups. After laparotomy, serosal abrasion was carried out by cecal brushing. Intraperitoneally 3 cm(3) 0.9 % NaCl, 3 cm(3) 4 % icodextrin, and 200 mg/kg ω-3 FAs for each group were applied, and then the abdomen was closed. All subjects sacrificed 10 days postoperatively. Macroscopic and histopathological cellular reactions as a function of giant cell, lymphocyte/plasmocyte, neutrophil, histiocyte, intracellular adhesion molecule-1 (ICAM-1), and platelet endothelial cell adhesion molecule-1 (PECAM-1) were assessed and hydroxyproline levels were measured in all three groups and compared using Kruskal-Wallis and ANOVA tests when appropriate. Macroscopically, both ω-3 FAs and 4 % icodextrin reduced adhesion formation but the difference was not statistically significant (P = 0.253). Histopathological examination revealed that there was no statistical significance in terms of giant cell, lymphocyte/plasmocyte, neutrophil, ICAM-1, and PECAM-1 scores; however, both ω-3 FAs and 4 % icodextrin were found to be prone to reduce fibrosis (P = 0.047), whereas in the ω-3 FA group, histiocytic reaction was significantly increased (P = 0.001), and hydroxyproline levels were significantly lower than other groups (P = 0.044). In this study, ω-3 FAs were found to be superior to 4 % icodextrin with the lower hydroxyproline level and greater histiocytic reaction. Considering these results, ω-3 FAs can be a promising agent in the prevention of adhesion formation.

Rectocutaneous fistula with imperforate anus in an adult.

Adult presentation of a rectocutaneous fistula with imperforate anus is rare. We report the case of a 22-year-old man who presented with an anorectal malformation and a rectocutaneous fistula. The patient complained of faecal matter passing through the external orifis of a fistula located at the distal part of his scrotum. He was continent for solid faeces, but had leakage of flatus and faecal soiling. He had no other associated anomaly. The patient subsequently underwent a surgical procedure where anal transposition was done. Postoperative recovery was uneventful, and the patient was fully continent at control examination.

Surgical treatment of caustic esophageal strictures in adults.

BACKGROUND AND AIMS: Caustic esophageal injury is a rare clinical condition in adult patients. Although dilatation, or the conservative approach, is the primary treatment method, some patients require surgical intervention. Because of the rarity of such cases, standard surgical treatment algorithms cannot be utilized. In this article, we present our surgical experience and discuss the challenges in the surgical management of corrosive injury of the esophagus in adults. METHODS: A retrospective review was conducted of 28 patients who suffered from a corrosive esophageal injury between 1996 and 2011. Patient demographics, history of corrosive material ingestion, preoperative findings, treatment strategy, operative technique, postoperative course, requirements for further treatment, and the current status of the patients were investigated. RESULTS: All patients underwent a transhiatal esophagectomy in addition to a gastric pull-up with a cervical esophagogastrostomy. The mean follow-up time was 62 (12-140) months. One patient developed a deep surgical infection; anastomotic stenosis was noted and treated with dilatation in 13 patients. The mean time period between the operation and the first dilatation for 12 patients was 81 (45-161) days. The mean dilatation count for the patients was 3 (1-10). CONCLUSION: Although it comes with high anastomotic stenosis rates, transhiatal esophagectomy and gastric pull-up with cervical anastomosis is a safe procedure, which can be performed for the treatment of corrosive esophageal stricture.

Adhesion-preventing properties of 4% icodextrin and canola oil: a comparative experimental study.

OBJECTIVE: Postsurgical abdominal adhesions are common, serious postoperative complications. The present study compared the usefulness of 4% icodextrin and canola oil in preventing postoperative peritoneal adhesions. METHODS: Twenty-four Wistar albino rats were divided into three groups. Following a laparotomy, a serosal abrasion was made by brushing the cecum, and 3 mL of 0.9% NaCl, 4% icodextrin, or 3 mL of canola oil were intraperitoneally administered for the control, icodextrin, and canola oil groups, respectively. The abdomen was then closed. All of the rats were sacrificed at day 10. Macroscopic, histopathological, and biochemical evaluations were performed. The results were statistically analyzed using Kruskal-Wallis and ANOVA tests. RESULTS: Macroscopic analyses revealed that both canola oil and 4% icodextrin reduced adhesion formation, but the difference was not statistically significant (p = 0.17). The histopathological examinations revealed no significant differences in terms of giant cell, lymphocyte/plasmocyte, neutrophil, ICAM1, or PECAM1 scores. However, both canola oil and 4% icodextrin significantly reduced fibrosis (p = 0.025). In the canola oil group, the histiocytic reactions were significantly increased (p = 0.001), and the hydroxyproline levels were significantly lower than those in the other groups (p = 0.034). CONCLUSIONS: In the present study, canola oil was determined to be superior to 4% icodextrin in lowering hydroxyproline levels and increasing histiocytic reactions. Considering these results, we believe that canola oil is a promising agent for preventing adhesion formation.

Adhesion-preventing properties of 4% icodextrin and canola oil: a comparative experimental study

OBJECTIVE: Postsurgical abdominal adhesions are common, serious postoperative complications. The present study compared the usefulness of 4% icodextrin and canola oil in preventing postoperative peritoneal adhesions. METHODS: Twenty-four Wistar albino rats were divided into three groups. Following a laparotomy, a serosal abrasion was made by brushing the cecum, and 3 mL of 0.9% NaCl, 4% icodextrin, or 3 mL of canola oil were intraperitoneally administered for the control, icodextrin, and canola oil groups, respectively. The abdomen was then closed. All of the rats were sacrificed at day 10. Macroscopic, histopathological, and biochemical evaluations were performed. The results were statistically analyzed using Kruskal-Wallis and ANOVA tests. RESULTS: Macroscopic analyses revealed that both canola oil and 4% icodextrin reduced adhesion formation, but the difference was not statistically significant (p = 0.17). The histopathological examinations revealed no significant differences in terms of giant cell, lymphocyte/plasmocyte, neutrophil, ICAM1, or PECAM1 scores. However, both canola oil and 4% icodextrin significantly reduced fibrosis (p = 0.025). In the canola oil group, the histiocytic reactions were significantly increased (p = 0.001), and the hydroxyproline levels were significantly lower than those in the other groups (p = 0.034). CONCLUSIONS: In the present study, canola oil was determined to be superior to 4% icodextrin in lowering hydroxyproline levels and increasing histiocytic reactions. Considering these results, we believe that canola oil is a promising agent for preventing adhesion formation.

[Hydatid cyst presenting with multiple recurrence and pelvic involvement: case report]. / Multiple rekürrensle seyreden pelvik tutulumlu hidatik kist: olgu sunumu.

Hydatid cyst disease is a parasitic infection which is caused by the metacestode form of Echinococcus granulosus and affects primarily the liver and lung. Bone involvement is found in 1% of patients afflicted with this disease. The spine is involved in about 50% of these cases. Herein, we report a 70 year old male case with pelvic and spinal hydatid cyst who was operated on eleven times.

Persistent high postoperative carcinoembryonic antigen in colorectal cancer patients--is it important?

INTRODUCTION: Evaluation of pre- and postoperative serum CEA levels together has seldom been assessed for the prognosis of colorectal cancer (CRC). OBJECTIVE: To concurrently evaluate pre- and postoperative CEA as factors of relapse and survival. METHODS: The study consisted of 114 patients who had undergone surgery from February 2002 to June 2006 for CRC. All patients were classified into four groups according to their pre- and postoperative CEA levels. Data obtained for clinicopathologic parameters, lymph node metastasis, stage, recurrence, and CEA levels were analyzed to determine their association with survival. Multivariate analysis by the Cox proportional hazard regression model was performed to identify the independent prognostic factors associated with survival. RESULTS: Postoperative serum CEA levels remained high in Group 3 (n = 32). Nineteen patients (59.3%) demonstrated a detectable cause for persistent high CEA levels, while the reasons for those in the other thirteen patients (40.6%) remained obscure. Abnormal preoperative CEA levels significantly correlated with the depth of tumor invasion, lymph node metastasis, TNM stage, and recurrence (p < 0.05). Abnormal postoperative CEA levels were significantly related to the depth of tumor invasion, TNM stage, and postoperative relapse (p<0.05). Patients in Group 3 demonstrated the worst survival rate. Abnormal postoperative CEA levels, lymph node metastasis, and location of the tumor were independent prognostic factors for survival. CONCLUSION: The survival of patients with high postoperative CEA levels due to unknown reasons may be extended if they are exhaustively tested with sensitive diagnostic methods and treated at an early stage.

Persistent high postoperative carcinoembryonic antigen in colorectal cancer patients- is it important?

INTRODUCTION: Evaluation of pre- and postoperative serum CEA levels together has seldom been assessed for the prognosis of colorectal cancer (CRC). OBJECTIVE: To concurrently evaluate pre- and postoperative CEA as factors of relapse and survival. METHODS: The study consisted of 114 patients who had undergone surgery from February 2002 to June 2006 for CRC. All patients were classified into four groups according to their pre- and postoperative CEA levels. Data obtained for clinicopathologic parameters, lymph node metastasis, stage, recurrence, and CEA levels were analyzed to determine their association with survival. Multivariate analysis by the Cox proportional hazard regression model was performed to identify the independent prognostic factors associated with survival. RESULTS: Postoperative serum CEA levels remained high in Group 3 (n = 32). Nineteen patients (59.3 percent) demonstrated a detectable cause for persistent high CEA levels, while the reasons for those in the other thirteen patients (40.6 percent) remained obscure. Abnormal preoperative CEA levels significantly correlated with the depth of tumor invasion, lymph node metastasis, TNM stage, and recurrence (p < 0.05). Abnormal postoperative CEA levels were significantly related to the depth of tumor invasion, TNM stage, and postoperative relapse (p<0.05). Patients in Group 3 demonstrated the worst survival rate. Abnormal postoperative CEA levels, lymph node metastasis, and location of the tumor were independent prognostic factors for survival. CONCLUSION: The survival of patients with high postoperative CEA levels due to unknown reasons may be extended if they are exhaustively tested with sensitive diagnostic methods and treated at an early stage.

[A rare cause of bleeding intestinal intussusception in adult: jejunal lipoma]. / Eriskinde nadir bir intestinal intussusepsiyon ve kanama nedeni: Jejunal lipom.

Small bowel neoplasms are usually diagnosed when patients are referred with complications such as hemorrhage or obstruction. Intestinal lipomas are the third most frequent benign tumors among all intestinal neoplasms and their definite diagnosis is usually obtained after histopathological examination of the resected specimen. A 76 year-old male patient with partial intestinal obstruction and rectal bleeding at admittance was found to have an abdominal mass on ultrasound. The density pattern of the mass at abdominal CT was supporting a jejunal lipoma leading an intussusception. Then an enteroclysis localized and reduced the jejunojejunal intussusception. The diagnosis of lipoma was confirmed with histopathological examination of the mass removed by an elective intestinal resection. This case was reported as the intestinal lipoma leading a jejunojejunal intussusception associated with bleeding, could be diagnosed preoperatively.

Lower extremity venous changes in pneumoperitoneum during laparoscopic surgery.

BACKGROUND: The effect of pneumoperitoneum on veins of the lower limbs related to the intra-abdominal working pressures during laparoscopic cholecystectomy has not been thoroughly investigated. We tested the hypothesis that working pressures do not affect the venous haemodynamics in the lower limbs. METHODS: The cross-sectional area and peak flow rates of femoral and saphenous veins in the right groin were measured in 60 patients divided into two groups according to the intra-abdominal working pressures (11 vs 14 mmHg). All measurements were carried out preoperatively and at predetermined periods during and after laparoscopic cholecystectomy by colour Doppler ultrasonography. One-way anova and chi(2) test were used for the analysis of demographic data. For the repeated measures, anova and Student's t-test were used for statistical analysis. The probabilities less than 0.05 were accepted as statistically significant. RESULTS: The cross-sectional area of the veins increased, whereas the peak flow rate in veins decreased during pneumoperitoneum. Comparing the peak flow rate in the saphenous vein at the third intraoperative measurement, there is statistically significant difference between the two groups (P < 0.05). CONCLUSION: The degree of intra-abdominal pressure affects the haemodynamics of the peripheral veins. Pneumoperitoneum during laparoscopy causes stasis in the peripheral veins. It is reasonable to use routine prophylaxis for deep vein thrombosis, in the light of these findings.

Abdominal heterotopic tissues: review of 24 cases diagnosed on postoperative histological evaluation.

BACKGROUND/AIMS: Heterotopy is defined as abnormal localization of well-differentiated tissue. Heterotopic tissues usually tend to be asymptomatic and noncomplicated but sometimes may cause serious clinical problems. Malignancy potential is the most important issue in this clinical entity. In this study we reviewed medical records of 24 patients with heterotopic tissues. METHODS: Between 1995-2004, 24 patients with heterotopic tissues who were diagnosed during gastrointestinal system or abdominal wall surgery or upper gastrointestinal endoscopy were included in this study. Patients' medical data were retrospectively reviewed. RESULTS: Sixteen patients with heterotopy were younger than 30 years and eight patients were older than 30 years. Nineteen (0.21%) heterotopic tissues were diagnosed in 8,945 patients who underwent gastrointestinal system surgery or upper gastrointestinal endoscopy, whereas five (0.21%) heterotopic tissues were diagnosed in 2,320 patients who underwent abdominal wall surgery. Overall, 24 (0.21%) heterotopic tissues were found in a total of 11,265 patients. The majority were pancreatic heterotopy, followed in decreasing order by gastric, adrenal and osseous heterotopy. In patients who underwent gastrointestinal surgery-endoscopy, pain was the main symptom (n=13)(68.4%), followed by dyspepsia (n=3)(15.7%) and vomiting- nausea (n=2)(10.5%). The main symptom in patients who underwent abdominal wall surgery was palpable mass. heterotopic tissues presented as wall thickening in 13, polypoid mass in five and whole solitary mass or intraparenchymal lesion in six patients. CONCLUSION: Although incidence of heterotopic tissues is low, in case of its suspicion or diagnosis, early treatment should be performed by surgical or endoscopic resection or patients must be followed up carefully due to risk of malignancy.

Multiple endocrine neoplasia 2B presenting with pseudo-Hirschsprung's disease.

Multiple endocrine neoplasia type 2B (MEN 2B) is a rare syndrome characterized by medullary thyroid carcinoma (MTC), pheochromocytoma and typical phenotypic features, such as marfanoid habitus, multiple mucosal ganglioneuromas and thickened corneal nerves. Individuals with MEN 2B may develop megacolon and pseudo-obstruction due to intestinal ganglioneuromatosis simulating Hirschsprung's (HSCR) disease. We hereby describe the clinical and genetic features of a 21-year-old male patient with MEN 2B associated with pseudo-HSCR disease. The patient had MTC, pheochromocytoma, marfanoid habitus, multiple mucosal ganglioneuromas, thickened corneal nerves and severe gastrointestinal involvement. Emergent laparotomy was performed when he was presented with acute bowel obstruction. The myenteric and submucosal nerve plexuses in the small and large intestines were composed of diffusely hyperplasic, disorganized, mature ganglion cells. Genetic testing revealed a de novo ret proto-oncogene germline mutation in codon 918 in exon 16. Megacolon and pseudo-obstruction similar to the HSCR disease may develop in patients with MEN 2B. However, the observed dysmotility is the result of an abnormal proliferation of intramural ganglion cells in contrast to the absence of enteric ganglia which were present in the HSCR disease. Attentiveness about the phenotypic characteristics and unusual findings might lead to early and correct diagnosis of the MEN 2B syndrome. This approach improves the survival rate and quality of life considerably.

The addition of O2 to the CO2 does not prevent the systemic effects of the CO2 pneumoperitoneum in a rabbit model.

CO2 pneumoperitoneum used in endoscopic surgery induces systemic effects by CO2 absorption. It was claimed that a reduction in CO2 pneumoperitoneum-induced metabolic hypoxemia was achieved by the addition of small amounts of O2 to the CO2 in a rabbit ventilated model. We reevaluated the effects of the addition of O2 to the CO2 pneumoperitoneum upon CO2 absorption in a rabbit model. The effects of a pneumoperitoneum using 100% CO2, 90% CO2 + 10% O2, 95% CO2 + 5% O2, or 100% O2 on arterial blood gases, acid base and O2 homeostasis were evaluated in nonintubated rabbits. A pneumoperitoneum pressure of 10 cm H2O (approximately 7.35 mm Hg) was used. CO2 pneumoperitoneum of 120 minutes affected blood gases and acid base homeostasis. Whereas partial pressure of CO2 and HCO3 increased (P < 0.001) during pneumoperitoneum, pH and partial pressure of O2 decreased (P < 0.001). Similar results were obtained in O2-CO2 pneumoperitoneum (P > 0.05). CO2 pneumoperitoneum profoundly affected blood gases and acid base homeostasis, resulting in metabolic hypoxemia. The addition of O2 to the CO2 did not prevent the systemic effects of CO2 pneumoperitoneum in nonintubated animals.

Intrahepatic arterioportal fistula and its treatment with detachable balloon and transcatheter embolization with coils and microspheres.

BACKGROUND: Although intrahepatic arterioportal fistula (APF) due to acquired or congenital causes are infrequent, they are listed among the causes of portal hypertension. PURPOSE: The aim of this study was to present the results of intrahepatic APF treatment with embolotherapy in six cases. MATERIAL AND METHODS: Transarterial detachable balloon and coil embolization was used on six consecutive cases with traumatic intrahepatic APF from 1989 to 2003. Six-month follow-up angiography was obtained in every case. RESULTS: Successful disconnection of hepatic arterial and portal system was achieved in five cases. At least symptomatic improvement was achieved in one. CONCLUSION: Transcatheter embolization may be the first line of treatment for intrahepatic APF.

Assessment of oxidative stress in the early posttransplant period: comparison of cyclosporine A and tacrolimus-based regimens.

BACKGROUND: Oxidative stress is one of the leading causes of cardiovascular morbidity and mortality in chronic kidney disease. Although it is clear that many metabolic abnormalities improve, the effects of kidney transplantation on oxidative state are obscure. METHODS: Twenty-three kidney transplant patients were included in the study. Eleven patients (mean age 27.9+/- 9.1 years) were treated with cyclosporine A (CsA) whereas 12 patients (mean age 22.4 +/- 3.4 years) were treated with tacrolimus. Twenty-three healthy subjects served as controls. None of the patients or controls suffered from diabetes mellitus or an acute infection at the time of the study. Plasma malondialdehyde (MDA), plasma selenium (Se), erythrocyte glutathione peroxidase (GSH-Px), erythrocyte superoxide dismutase (SOD), erythrocyte Zn (EZn), and erythrocyte Cu (ECu) levels were studied before and in the 1st, 3rd, 7th, 14th and 28th days after the transplantation. RESULTS: The GSH-Px, SOD, ECu, EZn and selenium levels were lower and MDA levels were higher in patients than controls before transplantation (p < 0.001 for all). MDA levels decreased and SOD, GSH-Px, ECu, EZn levels increased in parallel to the decrement of serum creatinine levels following the renal transplantation. No difference was found among the patients regarding the treatment regime. CONCLUSION: The study data suggest that the improvement in oxidative state parameters begins at the first day of renal transplantation and continues at the 28th posttransplant day in living donor transplantations.