The Underestimated Impact of Hashimoto Thyroiditis on Thyroid Papillary Carcinoma.

It is stated that Hashimoto's Thyroiditis (HT) is a risk factor for the development of Papillary Thyroid Cancer (PTC). However, the effect of HT on the coexistence of HT and PTC is still controversial. In this study, our aim is to investigate the effect of the presence of HT on clinicopathological data in patients with PTC. All 356 patients whose pathology was reported as PTC who were operated between 2015 and 2023 were included in the study. PTC patients were divided into 2 groups as those with and without HT. The effect of HT association on clinicopathological features was investigated. In 356 PTC patients, the rate of HT was 31.2%. PTC patients with HT had less multifocality (p < 0.05), more lymph node metastases (LNM) (p < 0.01) compared to PTC patients without HT. The presence of HT did not affect the bilaterality of the tumor, tumor diameter, lymphovascular invasion, or capsule invasion. While multifocality was observed less frequently in PTC patients with HT, lymph node metastasis rates were higher.

A novel index to predict postoperative hypocalcemia in primary hyperparathyroidism.

BAKGROUND: Vitamin D (Vit D) deficiency is common in patients with hyperparathyroidism, but the importance of replacement before surgery is controversial. It can be predicted that hypocalcemia risk will be higher in patients with high bone turnover. AIM: In this study, the effect of preoperative ALP/Vit D ratio on postoperative hypocalcemia was investigated. METHODS: Among the primary hyperparathyroidism cases who were operated between 2015 and 2022, 158 patients with complete data were included in the study. Preoperative laboratory results, radiological images, and pathology reports of the patients were evaluated retrospectively. The cross-sectional value of the ALP/Vit D value predicting hypocalcemia was calculated. The effect of these parameters on postoperative hypocalcemia was investigated. RESULTS: The mean age of our patients was 54 (21-81 years). When factors affecting postoperative hypocalcemia were evaluated by univariable analysis, Vit D deficiency and insufficiency (p < 0.001), ALP (p < 0.001), ALP/Vit D ratio (p < 0.001), and T score (p = 0.026) found to be factors affecting postoperative hypocalcemia. In multivariate analysis, the ALP/Vit D ratio was found to be an independent variable in predicting hypocalcemia. It was found that hypocalcemia was 45 times more common in patients with ALP/Vit D > 6.34 (p < 0.001). ALP/Vit D ratio predicts patients who will develop postoperative hypocalcemia with 87.2% sensitivity and 87.1% specificity. CONCLUSIONS: Vit D deficiency increases the risk of postoperative hypocalcemia, but it is not sufficient alone to predict it. The risk increases more in patients with high bone turnover. The preoperative ALP/Vit D ratio is the strongest predictor of postoperative hypocalcemia risk.

The unexpected effect of parathyroid adenoma on inflammation.

Primary hyperparathyroidism (PHPT) is an endocrinological disease that affects systemic inflammation. This study is aimed to investigate the preoperative and postoperative effect of PHPT on systemic inflammation. A total of 203 patients who were successfully operated for PHPT and 98 healthy controls were included in the study. The blood tests of the patients in the last month preoperatively and in the postoperative 6th month were compared. In addition, preoperative and postoperative tests were compared with the healthy control group. When the preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic inflammation index (SII) values of the patients who were operated for parathyroid adenoma were compared with the control group (p values were < 0.05, 0.01, 0.19, < 0.05), the NLR, PLR, and SII values were significantly lower in the patient group with parathyroid adenoma than in the control group. When the preoperative and postoperative 6th month NLR, PLR, LMR, and SII values of the patients were compared (p values: 0.026, 0.56, 0.023, 0.016, respectively), there was a significant increase in NLR and SII values after excision, while a significant decrease was observed in the LMR value. When the postoperative 6th month NLR, PLR, LMR, SII values were compared with the healthy control group (p values: 0.22, 0.29, 0.19, 0.29, respectively), no significant difference was observed between all values. We found that the immune system was suppressed in PHPT and this returned to normal levels after a successful surgery.

FAR Ratio as Prognostic Biomarker in AMI.

Acute mesenteric ischemia (AMI) is a vascular emergency resulting from decreased blood flow caused by the occlusion of the mesenteric vessels, hypoperfusion, or vasospasm. This study aimed to investigate the prognostic value of the fibrinogen-to-albumin (FAR) ratio in patients with acute mesenteric ischemia. A total of 91 patients were enrolled in the study. Patients' demographics such as age and gender, pre- and postoperative hemoglobin, CRP, white blood cell (WBC), neutrophils, preoperative lymphocyte, alanine transaminase (ALT), aspartate transaminase (AST), thrombocytes, and postoperative D-dimer values were recorded. In addition, pre- and postoperative fibrinogen and albumin levels were recorded, and FAR was calculated. Patients were divided into two groups, survivors and non-survivors. The mean pre- and postoperative fibrinogen levels were statistically significantly higher in the non-survivor group than in the survivor group (p < 0.001). The mean pre- and postoperative albumin levels were significantly lower in the non-survivors than in the survivors (p = 0.059, p < 0.001; respectively). The mean pre- and postoperative FAR ratios were considerably higher in the non-survivor than in the survivor groups (p < 0.001). The change between pre- and postoperative fibrinogen, albumin, and FAR values was statistically significant between the non-survivors and the survivors (for all, p < 0.05). The preoperative and postoperative fibrinogen levels were significantly lower, and albumin levels were significantly higher in the survivor compared to the non-survivor patients with AMI. Furthermore, the preoperative and postoperative FAR ratio was significantly higher in the non-survivors. The FAR ratio may be a valuable prognostic biomarker for patients with AMI.

Should multifocality be an indication for prophylactic central neck dissection in papillary thyroid cancer?

Although multifocality is common in patients with papillary thyroid cancer, its effects on lymphatic metastasis and the necessity of central dissection in the presence of multifocality are still controversial. In our clinic, 258 patients who underwent thyroidectomy between 2015 and 2020 and were found to have papillary thyroid cancer in postoperative pathology reports were analyzed. The tumor characteristics contributing to central lymph node metastasis positivity were evaluated. Lymph node metastases were not significantly increased in the presence of multifocality. In cases with bilateral multifocal tumors, compared to cases with unilateral multifocal tumors, capsular invasion (p = 0.02), vascular invasion (p = 0.01) and cervical lymphatic metastasis (p = 0.004) were observed to increase. Bilateral multifocal tumors have more aggressive clinicopathological features than unilateral tumors. We found that the risk of central lymph node metastasis increased significantly in bilateral multifocal tumors in our study. Prophylactic central lymph node dissection may be considered in patients with no preoperative or intraoperative lymph node metastasis but thought to have a multifocal tumor.

Double peptic ulcer perforation in a Covid-19 patient, extremely rare entity.

Peptic ulcer perforation is one of the leading causes of acute abdomen, presenting with acute abdominal pain and severe distress for the patient. In one-third of patients, the presentation is less dramatic, resulting in significant delays in diagnosis. Herein, we present a very rarest case operated on for diffuse purulent peritonitis with double perforation of the stomach in a COVID-19-positive patient, which had a depressing outcome.

Effects of cognitive status on outcomes of groin hernia repair using various anesthesia techniques.

BACKGROUND AND AIM: Because of increasing life expectancy, there is an increasing number of cognitively impaired older individuals undergoing surgeries such as groin hernia repair. Here, we evaluated the effects of cognitive status on postoperative complication rates in patients undergoing groin hernia repair using various anesthesia techniques. We also analyzed the rate of same-day hernia surgery in patients with cognitive decline. METHODS: Patients who presented to our general surgery clinic for unilateral or bilateral inguinal or femoral hernia were prospectively classified into general (group 1), local (group 2), and spinal (group 3) anesthesia groups. The Mini-Mental State Examination (MMSE) was used for preoperative evaluation of each patient's cognitive status. The Visual Analog Scale (VAS) was used to evaluate postoperative pain. Groups were compared in terms of age, MMSE and VAS scores, cognitive decline and complication rates, and surgery duration. RESULTS: In total, 33 (35.1%), 30 (31.9%), and 31 (33.0%) of 94 patients underwent surgery using general, local, and spinal anesthesia, respectively. The mean MMSE score did not differ among groups (p = 0.518). Cognitive decline was present in 18 (19.2%) patients, and the proportion did not significantly differ among groups. The complication rate did not differ between patients with and without cognitive decline. The mean surgery duration was similar among the three groups (p = 0.127). Group 2 had a lower mean postoperative VAS score, compared with the other groups (p < 0.001). Complications because of anesthesia and surgery were significantly more common in group 3 than in the other groups (p = 0.025). In the local anesthesia group, 7 patients had cognitive decline and 22 patients had normal cognition. There were no significant differences between patients with and without cognitive decline in terms of mean surgery duration (50.3 ± 15.4 min vs. 45.2 ± 10.7 min; p = 0.338) or mean VAS score (3.14 ± 0.90 vs. 3.13 ± 0.77; p = 0.985). Among the 22 and 7 patients without and with cognitive decline, 11 (50%) and 0 patients were discharged on the same day (p = 0.025). In the local anesthesia group, the respective median ages were 70, 52, and 59 years for patients with cognitive decline, patients with normal cognition discharged on the same day, and patients with normal cognition who were not discharged on the same day (p = 0.001). CONCLUSION: Groin hernia repair was successfully performed under local anesthesia in all patients, including older patients with cognitive decline. Patients with cognitive decline were not discharged on the day of surgery, although the mean surgery duration and postoperative VAS score did not differ between patients with and without cognitive decline. Prolonged hospitalization in patients with cognitive decline may be related to their advanced age. Further studies are needed to determine the safety of same-day surgery in patients with cognitive decline.

ANALYSIS OF DIAGNOSTIC EXCISIONAL LYMPH NODE BIOPSY RESULTS: 12-YEAR EXPERIENCE OF A SINGLE CENTER.

Lymph node biopsy is indicated in patients with suspected malignancy or lymphadenopathy due to unclarified reasons. Lymph node biopsy can be performed as fine needle aspiration biopsy, core biopsy, or excisional lymph node biopsy. In particular, the diagnosis of malignant lymphoma is considered insufficient for oncological treatment unless classified into subgroups. Core biopsy and excisional biopsy can be performed to diagnose lymphoma and classify it into subgroups. Core biopsy may also be limited in some cases for the diagnosis of lymphoma. Therefore, patients are referred to surgical departments for excisional lymph node biopsy. It was aimed herein to analyze the results of excisional lymph node biopsies performed for diagnostic purposes in our department. Data on 73 patients having undergone diagnostic excisional lymph node biopsy at Sakarya University Medical Faculty Training and Research Hospital between January 2008 and January 2020 were retrospectively analyzed. Patients were evaluated in terms of age, gender, biopsy site, pathological diagnosis, number and diameter of lymph nodes excised. Patients younger than 18 years of age, those with sentinel lymph node biopsies, and lymph node dissections performed for any known malignancy were excluded from the study. Statistical data analysis was done using SPSS statistical software. There were 37 (50.7%) female and 36 (49.3%) male patients, mean age 52.07 (18-90) years. Axillary lymph node biopsy was performed in 32 patients, inguinal lymph node biopsy in 29 patients, cervical lymph node biopsy in 3 patients, intra-abdominal lymph node biopsy in 6 patients, mediastinal lymph node biopsy in 1 patient, and supraclavicular lymph node biopsy in 2 patients. All of the lymph node biopsies were performed as excisional biopsy. Malignancy was detected in 36 (49.3%) patients. In 37 (50.3%) patients, the causes of lymphadenopathy were found to be benign pathologies. When the causes of malignant disease were examined, it was observed that 23 (31.5%) patients were diagnosed with lymphoma. Hodgkin lymphoma was detected in 5 patients diagnosed with lymphoma, and non-Hodgkin lymphoma was found in 18 patients. Metastatic lymphadenopathy was observed in 13 (17.8%) patients. Reactive lymphoid hyperplasia (26%) and lymphadenitis (20.5%) were found among the causes of benign lymphadenopathy. The number of excised lymph nodes was between 1 and 4, and their diameter was between 9 and 75 mm (mean: 29.53±15.56 mm). There was no statistically significant difference between benign and malignant patients according to gender, age, lymph node diameter, number of lymph nodes excised, and excisional lymph node biopsy site. For diagnostic lymph node biopsy, fine-needle aspiration biopsy and core biopsy should be performed primarily. If lymphoma is suspected in the diagnosis, fine-needle aspiration biopsy is not necessary. In this case, it is believed that it is more appropriate to perform core biopsy first. If the core biopsy is insufficient for diagnosis, it is more appropriate to perform surgical biopsy in order to cause no delay in diagnosis and treatment. Excisional biopsy is a method that can be safely performed and does not cause severe morbidity in palpable peripheral lymphadenopathies. Although it does not cause severe morbidity because it is an invasive procedure, excisional biopsy should be performed in a selected patient group.

Comparison of treatment methods in plastron appendicitis: a tertiary center experience.

Background: It is controversial which treatment method is superior in plastron appendicitis and the research is still going on. The aim of this study is to compare treatment methods for plastron appendicitis in the adult population with our experience. Materials and Methods: The data of 92 patients who were diagnosed with plastron appendicitis in university hospital between 2015 and 2021 were analyzed retrospectively. Data were taken from the hospital database. The patients were divided into three groups: those treated with primary surgery, with interval appendectomy and only with conservative method. Results: Interval appendectomy resulted in a lower rate of conversion to open surgery compared to primary surgery, shorter operative time, and lower complication rates. Surgical procedures were found to be superior in detecting neoplasms compared to conservative treatment. After conservative treatment, one of three patients was retreated with the diagnosis of acute appendicitis. Conclusion: In plastron appendicitis, routine interval appendectomy can be performed due to its advantages over other treatments such as the frequency of attacks after conservative treatment, the risk of the tumor being overlooked in conservative treatment, and the high rate of complications and conversion to open surgery in the primary surgery group.

Diagnostic Accuracy Rates of Appendicitis Scoring Systems for the Stratified Age Groups.

Background: Many scoring systems have been developed for acute appendicitis, which is the most common emergent disorder in surgical practice. Considering the physiological changes and chronic diseases occurring with advancing age, an applied scoring system may not produce the same score in similar patients in all age groups. Objectives: We aimed to compare the predictive values of scoring systems in different age groups. Methods: In this prospective study, the patients operated on in our clinic with a prediagnosis of acute appendicitis between March 2020 and March 2021 were included. We divided them into three age groups as 18-45 years (group 1), 46-65 years (group 2), and >65 years (group 3). We compared the scores of the nine acute appendicitis scoring systems most commonly used in the literature for these age groups. Results: A total of 203 patients were included in our study. The Alvarado scoring system yielded the most accurate results for group 1, whereas the Fenyo-Linberg scoring system was the most accurate system for group 2 and the Eskelinen scoring system for group 3. Conclusion: Age should be considered as a major parameter during the selection of the scoring system to be applied for patients with prediagnosis of acute appendicitis. Our study revealed the Alvarado and the Fenyo-Lindberg scoring systems as the most accurate systems for the differential diagnosis of appendicitis in the 18-45 and 46-65 years age groups, respectively. Although we found the Eskelinen scoring system as the most accurate one in the >65 years age group, the confidence intervals indicated that it may not be appropriate for use alone in this group.

The neglected surgery - Hernioscopy - Maybe the best choice for strangulated groin hernias in the COVID-19 pandemic.

<b>Introduction:</b> While elective surgeries have been postponed worldwide due to the COVID-19 pandemic, emergency operations cannot be delayed and are continuously being performed just like before the pandemic outbreak [1]. </br></br> <b>Aim:</b> Although elective surgeries have been postponed worldwide due to the COVID-19 pandemic, emergency operations cannot be delayed and are continuously being performed. In general surgery practice, incarcerated / strangulated inguinal hernias take a prominent place among emergency surgeries. In 1% of these patients, the hernia contents retreat spontaneously into the abdomen until the hernia sac is opened. It is strongly recommended that these bowel segments be evaluated for possible intestinal necrosis.</br></br> <b>Results:</b> Patients who underwent emergency surgery and hernioscopy in the Sakarya Training and Research Hospital General Surgery Service due to incarcerated or strangulated inguinal hernia between March 2020 and October 2020 were included in the study. Hernioscopy procedure was performed using the single-port and glove-port methods. For each patient, the following variables were recorded: age, duration of complaints, comorbidities, hernia repair method, operation time, incarcerated organ, postoperative complications and whether ischemia improved after reduction or resection was required. </br></br> <b> Conclusion:</b> Hernioscopy is a procedure performed under spinal anesthesia which prevents unnecessary laparotomies and should be considered as first-line treatment during the COVID-19 pandemic in patients who undergo emergency surgery for strangulated inguinal hernia.

Comparison of scoring systems regarding the gender as a parameter with the traditional scoring systems for predicting appendicitis.

Although acute appendicitis remains the most common cause of acute abdomen in General Surgery practice, negative appendectomy rates are still high in particularly female patients. Appendicitis scoring systems considering gender can help the clinician to reduce negative appendectomy rates in females. This present study aims to compare the Lintula, Ripasa, Fenyo-Lindberg scoring systems, which use gender as a variable, with the Alvarado, Karaman, scoring systems to evaluate which CSS is more successful in the differential diagnosis of appendicitis in females. We analyzed the records of the patients operated on with a prediagnosis of acute appendicitis in our clinic between 2020 and 2021, retrospectively. Alvarado, adult appendicitis score (AAS), appendicitis inflammatory response score (AIRS), Ripasa, Karaman, Lintula, and Fenyo Lindberg scores were calculated for each patient. The patients were divided into two groups as male and female, according to gender. Receiver operator characteristic (ROC) curve analysis was used to identify the best cut-off value and assess the performance of the test score for appendicitis. Three hundred and sixty-three patients were included in the study. One hundred seventy-two (47.4%) of the patients were male, and 191 (52.6%) were female. Alvarado and AAS were the most valuable score in female (AUC: 0.805, sensitivity: 0.63, specificity: 0.83; and area under curve (AUC): 0.794, Sensitivity 0.71, Specificity: 0.76, respectively), male group (AUC: 0.828, Sensitivity: 0.71, Specificity: 0.83; and AUC: 0.834, Sensitivity 0.74, Specificity: 0.77, respectively), and when patients were not categorized by gender (AUC: 0.818, Sensitivity: 0.67 Specificity: 0.83; and AUC: 0.794, Sensitivity 0.71, Specificity: 0.76, respectively). Although the Alvarado scoring system is the first defined appendicitis scoring system, it seems as superior to the many scoring systems defined after it in predicting appendicitis, even in female patients.

Management of solitary cecum diverticulitis - Single-Center Experience.

<b> Objective: </b> Cecal diverticulitis may be encountered as a real etiological factor in 1/300 appendectomies. Differential diagnosis of acute appendicitis and cecal diverticulitis is crucial because of the different treatment methods. Our aim is to reveal the importance of distinguishing acute appendicitis from cecal diverticulitis. <p> <b>Methods: </b> The data of patients who were admitted to the hospital between 2015 and 2019 with the complaint of abdominal pain and then finally diagnosed with colon diverticular disease, colon diverticulitis, or acute appendicitis, analyzed retrospectively. <p><b>Results: </b> A total of 19 cecum diverticulitis patients were detected during surgery for acute appendicitis or during clinical and radiological evaluation. 1247 appendectomies were evaluated; the final diagnosis was observed as cecal diverticulitis in 5 patients (0,4%). One hundred nineteen patients diagnosed with colonic diverticulitis at admission were evaluated, while 105 (88,2%) of them had left-sided diverticulitis, 14 (11,7%) of them had solitary cecal diverticulitis. All of the solitary cecal diverticulitis patients were treated conservatively, except one patient who has Hinchey 3 diverticulitis.<p><b> Conclusion: </b> Differential diagnosis of cecum diverticulitis with acute appendicitis is important because cecum diverticulitis can be managed as conservatively in most cases. In order to prevent unnecessary surgical interventions, this importance has increased, especially during the COVID-19 pandemic period.

Corrective Effect of Verbascoside on Histomorphological Differences and Oxidative Stress in Colon Mucosa of Rats in Which Colon Ischemia-Reperfusion Injury was Induced.

BACKGROUND: This study aims to show the corrective effect of verbascoside on histomorphological and biochemical differences in the colon mucosa of rats in which colon ischemia-reperfusion (I/R) injury was induced. METHODS: Fifty Sprague Dawley male rats were divided into 5 groups, of control, sham, ischemia (I), I/R, and I/R+verbascoside. Ischemia and reperfusion were applied to the suitable groups for 30 minutes and 120 minutes respectively, and 10 mg/kg verbascoside was administered intraperitoneally. Histomorphological assessment was done in the colon tissues obtained, and the goblet cells were assessed using the Alcian blue method. Proliferating cell nuclear antigen (PCNA), TUNEL, and hypoxia-induced factor 1 (HIF-1α) assays were used to assess oxidative stress with the immunohistochemical method. Malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), and total thiol (TT) levels were checked, for a biochemical analysis of oxidative stress. RESULTS: Compared with the I/R group, histomorphological differences were seen to be corrected in colon epithelium in the I/ R+verbascoside group. The goblet cell number increased and cell proliferation was increased, as seen with the PCNA assay; and apoptosis was decreased, as seen with the TUNEL assay. HIF-1α expression also decreased in the drug group. In the drug group, SOD, GSH-Px, TAS, and TT levels increased, but TOS, OSI, and MDA levels decreased. CONCLUSION: It was seen that verbascoside had a corrective effect on histomorphological and biochemical differences caused by I/R injury.

Appendix Neuroendocrine Tumor: Retrospective Analysis of 4026 Appendectomy Patients in a Single Center.

BACKGROUND/AIM: Appendix tumors are mostly incidentally identified in patients who were operated with the diagnosis of acute appendicitis. They are detected in approximately 1% of appendectomy specimens. Neuroendocrine tumors (NETs) account for over 50% of appendix neoplasms. NETs appearing in the appendix can cause carcinoid syndrome. In our study, we aimed to retrospectively examine the clinical features of patients who underwent appendectomy with the diagnosis of acute appendicitis and diagnosed with appendix NET in the postoperative period. Materials/Methods. The records of 4026 patients who were operated with the diagnosis of acute appendicitis between January 2008 and January 2020 at the Department of General Surgery at the Sakarya University Faculty of Medicine, were evaluated retrospectively. Clinical findings, demographic data, surgical findings, and results of the patients with appendix NET, as a result of histopathology, were examined in detail. RESULTS: 16 of 4026 patients were reported as NET. Nine of the patients were male, and seven were female. The average age was 33 (19-49). Any of the patients had no signs and symptoms of carcinoid syndrome. All tumors were located at the tip of the appendix, and the mean tumor diameter was 0.85 cm (0.3-2.5 cm). As a result of pathology, one patient had mesoappendix and one patient had serosa invasion. Right hemicolectomy was applied to both patients. In other patients, meso, serosa, and lymphatic invasion were not detected. Tumor size was 2.5 cm in one of the patients, 1.5 cm in one, and 1.4 cm in the other, and the others were below 1 cm. In the postoperative follow-up, all the patients were discharged on average 2.71 (2-6 days) days without any complications. CONCLUSION: Appendix NETs are mostly asymptomatic and localized in a distal third of the appendix. Symptoms are mostly related to tumor size and distant metastases. Clinical behavior and prognosis can best be predicted by tumor size. Complementary hemicolectomy is recommended for tumors larger than 2 cm and tumors smaller than 1 to 2 cm, such as mesoappendix invasion, positive or uncertain surgical margin, high proliferative rate, and angioinvasion. For tumors whose diameter is less than 1 cm, simple appendectomy alone is sufficient.

Objectively structured verbal examination to assess surgical clerkship education: An evaluation of students' perception.

OBJECTIVE: The objectivity and reliability of examining methods are controversial. We subjected fourth-year medical students to a specially designed verbal exam which we called objectively structured verbal examination. We aimed to evaluate feedback from students about objectively structured verbal examination as an assessment instrument for gauging their surgical knowledge. MATERIAL AND METHODS: Objectively structured verbal examination modules were developed according to the learning goals of the surgical clerkship. Upon finishing surgery rotation, the students were subjected to objectively structured verbal examination as part of their final evaluation. The students' perception of objectively structured verbal examination was assessed by their responses to a questionnaire. RESULTS: Forty-two of 58 students returned filled questionnaires. Objectively structured verbal examination was accepted by 72% of the students as an objective tool, and 86% of them found it enabled unbiased evaluation. Overall, most students expressed positive feedback regarding objectively structured verbal examination. CONCLUSION: The feedback received from students showed that objectively structured verbal examination is a reliable and objective method to assess their knowledge. This feedback reflects that objectively structured verbal examination merits further development and enhancement.

Bridge treatment for early cholecystectomy in geriatric patients with acute cholecystitis: Percutaneous cholecystostomy.

BACKGROUND: The main cause of acute cholecystitis (AC) is gallstones, and the incidence of gallstones in elderly patients is high. METHODS: In this study, we aimed to investigate the efficacy of percutaneous cholecystostomy (PC) before early cholecystectomy in geriatric patients with AC. This retrospective study included 85 patients undergoing laparoscopic or conventional cholecystectomy during early stage of calculous AC. RESULTS: All patients were over 65 years old and were divided into two groups: Group I, PC plus early cholecystectomy and Group II, only cholecystectomy without PC. Data on age, sex, status of PC before surgery, postoperative complications, postoperative mortality, surgical method, and postoperative hospitalization duration were recorded in our study. The average age in the groups I and II was 75.7±7.5 and 73.7±7.2 years, respectively, indicating insignificant difference (p=0.223). Although postoperative complication rate was two fold in the non-PC group, the PC plus cholecystectomy group has a few complications (p=0.032). Postoperative mortality was evidently lower in patients who first underwent PC and followed by cholecystectomy (p=0.017). The average hospitalization duration in groups I and II were 5.6±2.4 days and 11.2±7.7 days, respectively (p<0.001). CONCLUSION: Urgent laparoscopic cholecystectomy is still the best surgical treatment modality for calculous AC. Further, our study results showed that in geriatric patients, bridge treatment, such as PC, can be useful for reducing postoperative complication rates.

Foreign bodies in the rectum: 2 Case reports.

Encountering a foreign object in the rectum is rare; however, the incidence has greatly increased in recent years. Treatment of these patients requires a multidisciplinary approach because this condition may have serious complications. Presently described is management of 2 cases of rectal foreign body treated in the clinic.

Differential effects of p38 MAP kinase inhibitors SB203580 and SB202190 on growth and migration of human MDA-MB-231 cancer cell line.

p38 mitogen-activated protein kinase (MAPK) belongs to the MAPK superfamily, phosphorylating serine and/or threonine residues of the target proteins. The activation of p38 MAPK leads to cell growth, differentiation, inflammation, survival or apoptosis. In this study, we tested the effect of two highly specific and potent inhibitors of p38 MAPK (namely, SB203580 and SB202190) on human breast cancer cell line MDA-MB-231 to elucidate the controversial role of p38 MAPK on cell proliferation and/or cell migration/metastasis further. It was determined that the IC50 value of SB203580 was 85.1 µM, while that of SB202190 was 46.6 µM, suggesting that SB202190 is slightly more effective than SB203580. To verify the effect of each inhibitor on cell proliferation and cytotoxicity, the cells were treated with various doses of SB203580 and SB202190 and examined using iCELLigence system. No significant effect of 1 and 5 µM of both inhibitors were seen on cell proliferation as compared to the DMSO-treated control cells for up to 96 h. On the other hand, both SB203580 and SB202190 significantly prevented cell proliferation at a concentration of 50 µM. SB202190 was again more effective than SB203580. Afterwards, we tested the effect of each inhibitor on cell migration using wound assay. Both SB203580 and SB202190 significantly reduced cell migration in a time-dependent manner at a concentration of 50 µM. However, interestingly it was observed that a low and noncytotoxic dose of 5 µM of SB203580 and SB202190 also did cause significant cell migration inhibition at 48 h of the treatment, corroborating the fact that p38 MAPK pathway has a critical role in cell migration/metastasis. Then, we tested whether each p38 MAPK inhibitor has any effect on cell adhesion during a treatment period of 3 h using iCELLigence system. A concentration of only 50 µM of SB202190 reduced cell adhesion for about 1.5 h (p < 0.001); after that period of time, cell adhesion in 50 µM SB202190-treated cells returned to the level of the control cells. To determine the mechanism of growth and cell migration inhibitory effects of p38 MAPK inhibitors, the activation/inactivation of various proteins and enzymes was subsequently analyzed by PathScan® Intracellular Signaling Array kit. The ERK1/2 phosphorylation level was not modified by low concentrations (1 or 5 µM) of SB202190 and SB203580; while a high concentration (50 µM) of both inhibitors caused significant reductions in the ERK1/2 phosphorylation. In addition, it was determined that both p38 MAPK inhibitors caused significant increases on the Ser15 phosphorylation of mutant p53 in MDA-MB-231 under these experimental conditions; while SB202190 was more potent than SB203580.