Predictivity of aspartate aminotransferase to alanine aminotransferase (De Ritis) ratio for detecting bowel necrosis in incarcerated inguinal hernia patients.

PURPOSE: Early diagnosis of necrotic bowel segment resulting from incarcerated inguinal hernia (IIH) is crucial for reducing morbidity and mortality. The aim of this study was to investigate the efficacy of the De Ritis ratio (DRR), also known as the ratio of aspartate aminotransferase to alanine aminotransferase, as a biomarker for intestinal necrosis. METHODS: This retrospective study included 132 patients who underwent emergency surgery for IIH. Patients were divided into two groups: those who underwent bowel resection for necrosis (Group 1) and those who did not (Group 2). Patients' demographic and clinical data were recorded. Using laboratory test results, DRR, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and lymphocyte-to-CRP ratio (LCR) were calculated. RESULTS: The morbidity and mortality rates and the length of stay for Group 1 were statistically significantly different (p < 0.0001). The DRR, NLR, PLR, LMR, and LCR values of the same group were also significantly different (p < 0.05). CONCLUSION: DRR can be used as a biomarker for early diagnosis of bowel necrosis in patients with IIH.

ANTECEDENTES: El diagnóstico temprano del segmento intestinal necrótico resultante de una hernia inguinal incarcerada es crucial para reducir la morbilidad y la mortalidad. OBJETIVO: Investigar la eficacia del índice de De Ritis (IDR), también conocido como cociente de aspartato aminotransferasa a alanina aminotransferasa, como biomarcador de necrosis intestinal. MÉTODO: Estudio retrospectivo que incluyó a 132 pacientes que fueron intervenidos de urgencia por hernia inguinal incarcerada. Los pacientes se dividieron en dos grupos: los que se sometieron a resección intestinal por necrosis (grupo 1) y los que no (grupo 2). Se registraron los datos demográficos y clínicos de los pacientes. Usando los resultados de las pruebas de laboratorio, se calcularon el IDR, el índice neutrófilos-linfocitos (INL), el índice plaquetas-linfocitos (IPL), el índice linfocitos-monocitos (ILM) y el índice linfocitos-proteína C reactiva (ILPCR). RESULTADOS: Las tasas de morbilidad, mortalidad y duración de la estancia para el grupo 1 fueron estadísticamente significativas (p < 0.0001). Los valores de IDR, INL, IPL, ILM, ILPCR del mismo grupo también fueron significativamente diferentes (p < 0.05). CONCLUSIONES: El IDR puede utilizarse como biomarcador para el diagnóstico precoz de necrosis intestinal en pacientes con hernia inguinal incarcerada.

Postoperative parathormone level and permanent hypoparathyroidism following total thyroidectomy: a clue for the clinician.

AIM: Hypoparathyroidism (HPP) is among the most commonly observed severe complications of total thyroidectomy (TT). Therefore, any permanent hypoparathyroidism (PHPP) that may develop in the postoperative period must be predicted as early as possible. This study aims to investigate the predictive value of intact parathormone (iPTH) levels on the first postoperative day after TT for PHPP. MATERIALS AND METHODS: The study included 407 patients who underwent TT. Demographic information (sex and age), preoperative thyroid function, postoperative histopathological findings, the presence of a parathyroid gland on the pathology specimen and the length of hospital stay were recorded for all patients. iPTH and total serum calcium and albumin levels™ were measured on the first postoperative day. According to the postoperative day 1 iPTH level (above or below 12 pg/ml), the patients were divided into two groups and compared in terms of risk factors for postoperative HPP. Patients with HPP who had low iPTH and calcium levels at the end of a 6-month follow-up were considered to have PHPP. RESULTS: No significant differences were found between groups regarding demographic characteristics, preoperative diagnosis, type of operation and histopathological results (p > 0.05). The long-term follow-up of patients with HPP revealed PHPP in two patients and transient HPP in 98 patients. PHPP did not develop in patients with an iPTH level higher than 1 pg/ml on postoperative day 1. The mean time for patients to reach normal serum iPTH levels was 38.53 (± 58.22) days. CONCLUSION: iPTH levels higher than 1 pg/ml on the first postoperative day after TT may be a clinical indicator that PHPP will not develop in these patients. KEY WORDS: Calcium, Hypocalcaemia, Hypoparathyroidism, Total Thyroidectomy.

Invasive and Non-invasive Ductal Carcinoma within Malignant Phyllodes Tumour with Axillary Lymph Node Metastases.

Phyllodes tumours are uncommon breast neoplasms constituting 1-2% of breast malignancies. Metastasis is usually haematogenous, and axillary lymph node dissection is not routinely performed. A phyllodes tumour with concomitant invasive ductal carcinoma (IDC) is even rarer. When IDCor ductal carcinoma in-situ (DCIS) is detected, the management of the condition changes completely. We report a case of a 22-year female presenting with a mass in the right breast and palpable axillary lymph nodes. The pathological examination demonstrated a malignant phyllodes tumour with concomitant IDC and DCIS. The patient elected to have modified radical mastectomy, and the pathological examination showed metastasis in the axillary lymph nodes. The patient was administered appropriate therapy. At the last visit, she did not have the clinical signs of disease. This is the first youngest case of axillary lymph node metastases with both DCIS and IDC on pathological examination in malignant phyllodes tumour. Key Words: Malignant phyllodes, Invasive ductal carcinoma, Ductal carcinoma in-situ, Lymph node metastasis.

The Relationship Between Mammographic Density and Factors Affecting Breast Cancer Risk.

Objectives: Although the relationship between breast cancer (BC) risk factors and mammographic density (MD) patterns is not clear, high MD is well known as an independent risk factor for BC. Thus, the aim of this study was to examine the association between MD and BC risk factors in BC patients and find a correlation between MD and tumor characteristics in BC patients. Methods: Our data included 242 patients with BC. Furthermore, the MD (type I - <25%; type II - 25-50%; type III - 51-75%; and type IV - >75%) was categorized according to percentile density, and the various types of MD were compared using risk factors for BC and tumor characteristics of patients. Results: The results of this study indicated that younger age, pre-menopausal status, younger menarche age, nulliparity, low body mass index, and smoking significantly increase the percentage of MD (p<0.001, p<0.001, p=0.04, p<0.001, p=0.003, and p=0.01, respectively). Moreover, the distribution of MD patterns showed significant differences according to tumor subtypes. Type 4 mammographic pattern was higher in patients with human epidermal growth factor receptor 2 (Her2) type of tumor (p=0.01). Conclusion: Higher MD is related to reproductive risk factors and tumor subtypes, especially Her2 type, in BC patients. Further studies are needed to identify the factors related to breast density.

The effects of COVID-19 pandemic on emergency anterior abdominal wall hernia surgery: is it safe to postpone elective hernia surgery in the pandemic?

BACKGROUND: The aim of this study was to investigate the effects of the COVID-19 pandemic on emergency anterior abdominal wall hernia surgeries (EAAWHS) by comparing the pandemic period with the control period a year ago and to share our experiences in the pandemic period. METHODS: This single-center retrospective cohort study included all patients who underwent EAAWHS during the pandemic (from 11 March 2020 to 25 January 2021) and control period (1 year before the same period, from 11 March 2019 to 25 January 2020). Demographic data, preoperative clinical and pathological parameters, intraoperative findings and postoperative complications secondary to operation and COVID-19 infection, length of intensive care and hospital stay of patients were recorded, and the pandemic and control groups were compared. RESULTS: Of the 87 patients who underwent anterior abdominal wall hernia surgery during the COVID-19 pandemic, 41 (47.1%) were operated emergently and 46 (52.9%) were operated electively. Of the 485 patients who underwent anterior abdominal wall hernia surgery during the control period, 24 (4.95%) were operated emergently and 461 (95.05%) were operated electively. The decrease in the number of elective operations and the increase in the number of emergency operations were significant during the pandemic (p < 0.001).There was a decrease in the number of emergency inguinal hernia operations and an increase in the number of emergency ventral (incisional, umbilical) hernia operations during the pandemic period compared to the control period (p < 0.05).The mortality rates were similar (8.3 vs. 9.8%, p > 0.05) in both periods. CONCLUSION: Despite the increase in the number of EAAWHS during the COVID-19 pandemic, there was no significant difference in mortality and morbidity rates. EAAWHS can be performed safely during the pandemic by taken necessary and adequate precautions.

Efficacy of US, MRI, and F-18 FDG-PET/CT for Detecting Axillary Lymph Node Metastasis after Neoadjuvant Chemotherapy in Breast Cancer Patients.

BACKGROUND: The aim of this study was to investigate the efficacy of post-neoadjuvant chemotherapy (NAC) ultrasound (US), magnetic resonance imaging (MRI), and F-18fluorodeoxyglucose positron emission tomography (F-18 FDG-PET/CT) for detecting post-NAC axillary lymph node(ALN) metastasis in patients who had ALN metastasis at the time of diagnosis. METHODS: This study included all breast cancer patients who received NAC for ALN metastasis; underwent axillary assessment with US, MRI, or F18FDG-PET/CT; and then were operated on in the General Surgery Clinic, Adana City Research and Training Hospital, Turkey. Patients' data were recorded, including demographic data, clinicopathological parameters, NAC regimens, and operation types. The axillary response to chemotherapy on post-NAC US, MRI, and F-18 FDG-PET/CT was compared with the postoperative histopathological result of the ALN. RESULTS: The study included a total of 171 female patients. The mean age of the patients was 53.28 ± 10.62 years. The post-NAC assessment revealed that the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US for detecting ALN metastasis were 59.42%, 82.35%, 82.00%, and 60.00%, respectively, while the same measures regarding MRI for detecting ALN metastasis were 36.67%, 77.78%, 73.33%, and 42.42%, respectively. The sensitivity, specificity, PPV, and NPV of F-18FDG-PET/CT were 47.50%, 76.67%, 73.08%, and 52.27%, respectively. The evaluation of dual combinations of these three imaging techniques showed that the specificity and PPV of the combined use of US and F-18FDG-PET/CT was 100%. CONCLUSIONS: The results showed that US has the highest sensitivity and specificity for detecting ALN metastasis after NAC. Furthermore, ALND may be preferred for these patients instead of SLNB if both examinations simultaneously indicate lymph node metastasis in the post-NAC assessment with US and F-18 FDG-PET/CT. SLNB may be preferred if these two examinations simultaneously show a complete response.

The effect of Farnesoid X receptor agonist tropifexor on liver damage in rats with experimental obstructive jaundice.

PURPOSE: To investigate experimentally the effects of Tropifexor, a farnesoid X receptor agonist, on liver injury in rats with obstructive jaundice. METHODS: Forty healthy Wistar albino female rats were divided randomly in selected groups. These groups were the sham group, control group, vehicle solution group, Ursodeoxycholic acid group and Tropifexor group. Experimental obstructive jaundice was created in all groups, except the sham one. In the blood samples obtained, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), total bilirubin and direct bilirubin levels were established and recorded. Additionally, liver malondialdehyde, myeloperoxidase and catalase enzyme activity in the tissue samples were studied. Histopathological analysis was also performed. RESULTS: No statistical difference was found between the control group and the Tropifexor group when AST, ALT and ALP values were compared. However, it was found that the Tropifexor group had statistically significant decreases in the values of GGT, total bilirubin and direct bilirubin (p < 0.05). Additionally, Tropifexor decreased the median values of malondialdehyde and myeloperoxidase, but this difference was not statistically significant compared to the control group. Finally, the Tropifexor group was statistically significant in recurring histopathological liver damage indicators (p < 0.05). CONCLUSIONS: Tropifexor reduced liver damage due to obstructive jaundice.

The reliability of breast cancer surgery in a regional pandemic hospital during the COVID-19 pandemic: Delay or Do?

PURPOSE: The purpose of this study was to examine the effect of COVID-19 infection on the morbidity and mortality rates of breast cancer patients performed in the East Mediterranean region of Turkey during the COVID-19 pandemic and to share the results of those investigations. METHODS: This retrospective study included all breast cancer patients that underwent surgery during the COVID-19 pandemic in the General Surgery Clinic of Adana City Training and Research Hospital, a regional pandemic hospital, between March 11, 2020 and December 25, 2020. The patients were evaluated preoperatively and postoperatively (the first 30 days) in terms of COVID-19 infection. Moreover, these patients were also evaluated in terms of admission to the hospital, length of hospital stay, and mortality due to COVID-19 infection during the follow-up period of the study. RESULTS: Included in the study were 139 patients that underwent surgery for breast cancer during the pandemic period, with no observed mortality or morbidity associated with COVID-19 in any patient postoperatively within the first 30 days. In addition, within 121.22±70.05 days, the mean and standard deviation of the study's follow-up period, 19 patients (15.7%) were admitted to the hospital with a suspected COVID-19 infection (after the first 30 days postoperatively) and 6 of them (4.3%) returned a positive PCR test. All of the COVID-19 positive patients (6 patients, 4.3%) were hospitalised and 3 of them (2.2%) died due to the COVID-19 infection. CONCLUSION: Breast cancer surgery can be performed safely during the COVID-19 pandemic period after taking the necessary precautions.

The effect of Farnesoid X receptor agonist tropifexor on liver damage in rats with experimental obstructive jaundice

ABSTRACT Purpose: To investigate experimentally the effects of Tropifexor, a farnesoid X receptor agonist, on liver injury in rats with obstructive jaundice. Methods: Forty healthy Wistar albino female rats were divided randomly in selected groups. These groups were the sham group, control group, vehicle solution group, Ursodeoxycholic acid group and Tropifexor group. Experimental obstructive jaundice was created in all groups, except the sham one. In the blood samples obtained, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), total bilirubin and direct bilirubin levels were established and recorded. Additionally, liver malondialdehyde, myeloperoxidase and catalase enzyme activity in the tissue samples were studied. Histopathological analysis was also performed. Results: No statistical difference was found between the control group and the Tropifexor group when AST, ALT and ALP values were compared. However, it was found that the Tropifexor group had statistically significant decreases in the values of GGT, total bilirubin and direct bilirubin (p < 0.05). Additionally, Tropifexor decreased the median values of malondialdehyde and myeloperoxidase, but this difference was not statistically significant compared to the control group. Finally, the Tropifexor group was statistically significant in recurring histopathological liver damage indicators (p < 0.05). Conclusions: Tropifexor reduced liver damage due to obstructive jaundice.

Surgical Management of Penetrating Duodenal Injury: Role of Primary Repair.

OBJECTIVE: To evaluate the outcome of primary repair in penetrating duodenal injuries. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Adana City Training and Research Hospital, Adana, Turkey, between March 2011 and September 2018 Methodology: Patients with penetrating duodenal injury, who underwent primary repai, were reviewed retrospectively. The patients who had early death, grade 1 duodenum injuries and operative procedures except primary repair, were excluded from the study. Age, gender, mechanism of penetrating injury, grade of the duodenal injury, associated intra-abdominal injuries, length of intensive care unit and hospital stay, duodenum-related mortality and morbidity were analysed. Fisher's exact test was used to compare the outcomes between survivor and non-survivor groups. RESULTS: Data of 26 patients with primary repair (5 females, 21 males) were reviewed. The mean age was 33.11 ±12.07 years; and gunshot (n=19, 73.1%) was the most common cause of the duodenal injury. Twenty-five had a total of 103 (3.9 injuries per patient) associated intra-abdominal organ injuries. 20 (76.9%) patients had grade 2 duodenal injuries; and the most injured portion of the duodenum was segment IV (n: 9, 34.6%). Three (11.5%) patients had duodenal leakage and postoperative complication rate was 53.8%. Duodenum-related mortality (DRM) was 3.8% (n:1) and overall mortality was 19.2% (n:5). The anatomic localisation of duodenal injury and associated vascular trauma were significantly different between survivor and non-survivor groups (p: 0.038, and p: 0.034, respectively). CONCLUSION: Associated intra-abdominal organ and vascular injuries were predictive factors of overall mortality in duodenal injuries. Duodenum-related mortality was low, for this reason minimally invasive procedures such as primary repair will be more accurate in surgical management of penetrating duodenal injuries. Key Words: Duodenal injury, Primary repair, Surgical management.

A Novel Oxidative Stress Mediator in Acute Appendicitis: Thiol/Disulphide Homeostasis.

Aim. To investigate the role of a novel oxidative stress marker, thiol/disulphide homeostasis, in patients diagnosed with acute appendicitis (AA). Methods. In this study, seventy-one (43 male and 28 female) patients diagnosed with AA and 71 (30 male and 41 female) healthy volunteers were included. Age, gender, body mass index (BMI), haemoglobin (Hb), white blood cell (WBC), c-reactive protein (CRP), and thiol/disulphide homeostasis parameters (native thiol, total thiol, disulphide, disulphide/native thiol, native thiol/total thiol, and disulphide/total thiol ratios) were compared between the groups. Thiol/disulphide homeostasis was determined by a newly developed method by Erel and Neselioglu. Results. The native thiol, total thiol, and the native thiol/total thiol ratio levels were statistically significantly decreased in the AA compared with the control group (p < 0.001). Disulphide level and the ratios of disulphide/native thiol and disulphide/total thiol were higher in the AA group than in the control group (p < 0.001). There was a negative correlation of CRP with native thiol, total thiol, and native thiol/total thiol ratio while there was a positive correlation of CRP with disulphide/native thiol and disulphide/total thiol in the AA group. In the stepwise regression model, risk factors as disulphide/native thiol (OR = 1.368; p = 0.018) and CRP (OR = 1.635; p = 0.003) were determined as predictors of perforated appendicitis compared to the nonperforated group. Conclusion. This is the first study examining the thiol/disulphide homeostasis as a diagnostic aid in AA and establishing thiol/disulphide homeostatis balance shifted towards the disulphide formation due to thiol oxidation. Further studies are needed to optimize the use of this novel oxidative stress marker in AA.

The Effects of Direct Oxygen Supply During Static Cold Preservation of Rat Livers: An Experimental Study.

OBJECTIVES: We aimed to determine the biochemical and histopathologic effects of direct oxygen supply to the preservation fluid of static cold storage system with a simple method on rat livers. MATERIALS AND METHODS: Sixteen rats were randomly divided into 2 groups: the control group, which contained Ringer's lactate as preservation fluid; and the oxygen group, which contained oxygen and Ringer's lactate for preservation. Each liver was placed in a bag containing 50 mL Ringer's lactate and placed in ice-filled storage containers. One hundred percent oxygen supplies were given via a simple, inexpensive system created in our laboratory, to the livers in oxygen group. We obtained samples for histopathologic evaluation in the 12th hour. In addition, 3 mL of preservation fluid was subjected to biochemical analysis at 0, sixth, and twelfth hours. Aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and pH levels were measured from the preservation fluid. RESULTS: In oxygen-supplemented group, the acceleration speed of increase in alanine aminotransferase and lactate dehydrogenase levels at sixth hour and lactate dehydrogenase, alanine aminotransferase, and lactate dehydrogenase levels at 12th hour were statistically significantly reduced. In histopathologic examination, all parameters except ballooning were statistically significantly better in the oxygen-supplemented group. CONCLUSIONS: This simple system for oxygenation of liver tissues during static cold storage was shown to be effective with good results in biochemical and histopathologic assessments. Because this is a simple, inexpensive, and easily available method, larger studies are warranted to evaluate its effects (especially in humans).

Rhomboid Flap Technique in Breast-conserving Surgery: An Alternative Method for the Reconstruction of Lumpectomy Defects.

OBJECTIVE: We aimed to present our experience with rhomboid flap reconstruction, which is a simple technique, in breast cancer patients who underwent breast-conserving surgery. METHODS: We reviewed the medical records of 13 patients with breast cancer who underwent rhomboid flap reconstruction. The patients were evaluated for tumor size, safe surgical margin, and other clinical and pathological features. RESULTS: The mean age of the patients was 43.1 years (range: 28-69 years). The mean tumor diameter was 30.8 mm (range: 15-60 mm). The mean of the safe margin of resection was evaluated to be 17.8 mm (range: 5-30 mm). Re-excision was required for one patient in the same session. CONCLUSION: Rhomboid flap reconstruction can facilitate the applicability of breast-conserving surgery in early breast cancer patients with large tumor-to-breast-size ratio or tumors close to the skin.