Early and Long-Term Morbidity and Mortality Following Pancreaticoduodenectomy for Periampullary Tumors in Elderly Patients.

AIM: The growing elderly population is facing an increasing risk of cancers, consequently raising the pancreatic cancer surgery rate. This study aimed to determine whether advanced age is a risk factor for morbidity and mortality following pancreaticoduodenectomy (PD) for periampullary tumors. MATERIALS AND METHODS: The present study included 90 patients who underwent PD for periampullary tumors. Patients were divided into two age-related groups, including those aged 60-74 years (n = 60) (Group 1) and those aged ≥75 years (n = 30) (Group 2). Each patient's characteristics, perioperative features, morbidity, and long-term results were evaluated retrospectively. RESULTS: In both univariate and multivariate logistic regression analyses, old age (≥75 years) was not a risk factor for morbidity and hospital mortality. The multivariate analysis demonstrated that male gender (p = 0.008), pancreatic duct diameter (<3 mm) (p < 0.001), and length of hospital stay (p = 0.005) were independent risk factors for pancreatic fistula post-operation and reoperation. Additionally, hospital mortality was significantly associated with reoperation (p = 0.011). The overall median survival was 27 ± 4.1 (18.8-35.1) months. Lymph node positivity (p < 0.001), neural tumor invasion (p = 0.026), and age ≥75 years (p = 0.045) were risk factors affecting the overall survival rate. Moreover, there was no statistically significant difference in terms of PD rates during the Coronavirus disease-19 (COVID-19) period among groups, and PD during this period was not related to the occurrence of pancreatic fistula. CONCLUSION: PD can be performed effectively in selected elderly patients with tolerable morbidity and mortality rates.

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.

Identification and molecular characterization of two papillomavirus genotypes in teat papillomatosis cases in hair goats, in Türkiye.

Papillomaviruses can cause benign or malignant proliferations on the host's skin and mucous membranes. Recent genetic studies have identified many new papillomavirus types. In this study, molecular detection and typing was performed on papilloma samples from eight hair goats with teat papillomatosis. The papilloma samples were tested with degenerate (FAP59/FAP64,MY09/MY11) and type-specific primers. One sample was positive with degenerate (MY09/MY11) and two samples were positive with Caprahircus papillomavirus-1 type specific primers. The MY09/MY11 primer sequence indicated identity to the closest Ovine papillomavirus type-2 (77.9%). The ChPV-1 primer sequence was similar to the closest ChPV-1 (99.4%). Investigating papillomavirus types in different animal species is important for determining the evolution, prevalence, host range, and interspecies transmission potential of papillomaviruses, and to indicate suitable therapeutics for later development.

Diagnosis and phylogenetic analysis of bovine papillomaviruses in cattle papillomatosis cases by different methods.

Papillomaviruses, known as epitheliotropic, cause proliferation in the skin, mucosa, and different visceral organs. In this study, it was aimed to diagnose bovine papillomavirus (BPV) by using different methods in the lesion taken from twenty cattle with papillomas in different areas of the body and to reveal its molecular characterization. In our study, molecular, immunohistochemistry, and transmission electron microscopy (TEM) methods were used for virus identification. Additionally, sequencing analysis was used to ascertain the phylogenetic relationship between the obtained field strains and other isolates submitted to GenBank. Histopathological analyses of the collected samples were done in addition to diagnostic procedures. Intranuclear virus particles were detected when the papillomas were investigated with TEM. In PCR analyses using degenerate and type-specific primer sets, the presence of BPV nucleic acid was determined in 70% (14/20) and 90% (18/20) of the samples, respectively. No virus could be detected in PCR applications using MY 09/11 degenerate primer sets. Twenty animals of different ages, races, and genders included in the study by random sampling method from different herds were divided into 4 groups according to the body regions where the lesions were located. Sequence analysis was performed on a sample from each group that showed strong positivity in the PCR technique using FAP 59/64 degenerate primer set and type-specific primer set. Sequence analyses were performed using FAP 59/64 degenerate primers of amplicons for phylogenetic research. In these analyses, three of the isolated strains were identified as BPV-1, which is in the Deltapapillomavirus 4 genus, and one as BPV-2. As a result of the study, it was concluded that molecular and phylogenetic studies using type-specific primers are more beneficial in order to fully reveal the etiology of papillomatosis in cattle and it would be correct to determine BPV types before prophylactic (vaccine, etc.) applications.

Evaluating the Efficiency of Various Treatment Methods in Cattle Cutaneous Papillomatosis.

In this study, we compared the effectiveness of various methods used in the treatment of cattle with cutaneous papillomatosis. Ivermectin, Tarantula cubensis extract, levamisole, autovaccine, and a combination of T. cubensis extract + levamisole were administered to the animals. The animals were divided into six equal groups. Animals in the control group (n = 10) did not receive any treatment. The animals in the experimental group were administered Ivermectin [three times a week, n = 10, subcutaneous, (SC)], Tarantula cubensis extract (twice a week, n = 10, SC), autologous vaccine (three times at 10-day intervals, n = 10, SC), levamisole [twice at one-week intervals, n = 10, intramuscular (IM)], and levamisole + Tarantula cubensis extract (concurrently). All animals used in the study were monitored for three months at an interval of 15 days. No regression was detected in the papillomas of the control group animals, but recovery was recorded in animals treated with ivermectin at a rate of 70% (7/10), while it was 60% (6/10) in those treated with T. cubensis extract, 100% (10/10) in those treated with autovaccine, 50% (5/10) in those treated with levamisole, and 90% (9/10) in those treated with the combination of T. cubensis extract + levamisole. Significant differences were found between the control group and all treatment groups. Recovery mostly occurred within 45-60 days (P < 0.05). The five treatment modalities applied for the treatment of bovine cutaneous papillomatosis were statistically evaluated and all methods of treatment were effective at different rates. The most precise and effective treatment method was the autovaccine one.

Phylogenetic analysis and searching bovine papillomaviruses in teat papillomatosis cases in cattle by performing histopathology, immunohistochemistry, and transmission electron microscopy.

Papillomaviruses are epitheliotropic in nature and cause proliferation in the skin, mucosa, and various internal organs of various animal species. The lesions they cause, specifically in cattle teats, lead to significant economic losses in the milk industry. In this study, we identified the bovine papillomaviruses (BPVs) responsible for teat papillomas in cattle. The tissue damage caused by the virus was examined histopathologically using immunohistochemical, transmission electron microscopy (TEM), and molecular methods. Additionally, sequence analyses were performed on the isolated field strains to better understand their genetic and phylogenetic relationships with previously reported isolates. Teat papillomatosis was confirmed in the collected samples by histopathological and immunohistochemical methods, which were followed by other diagnostic methods. Intranuclear virus particles were found in the epithelial cells during a TEM examination of teat lesions. BPV was detected in seven samples by performing PCR using degenerate primers and specific primers. The positive samples were used for typing through sequence analysis/PCR with type-specific primers. Three isolates from teat tissues with BPV infection were identified as BPV-6, two as BPV-10, one as BPV-2, and one as BPV-8. The five isolates identified through sequence analysis of positive samples belonged to the Xipapillomavirus 1 genus (one), the Epsilonpapillomavirus 1 genus (one), and the Deltapapillomavirus genus (one) (three). Furthermore, type-specific primers were found to be useful for molecular diagnosis of BPV, which occurs in the etiology of teat papillomas, followed by genotyping and primer generation during characterization. The detection of BPV types and their prevalence, biosafety measures in animal breeding, and the importance of vaccine research are all important.

A Benign Rare Lesion of the Breast: Giant Epidermal Inclusion Cyst.

An epidermal inclusion cyst can be seen at any location. Epidermal cysts are commonly found on the scalp, face, trunk, neck, and extremities. They are rarely seen in the breast parenchyma. These benign lesions are important in that they may undergo neoplastic differentiation, although very rarely. Epidermoid cysts usually develop as a result of the implantation of superficial epidermal tissue into the dermis or subcutaneous tissue after trauma or surgical procedures. In this study, a 37-year-old female patient who underwent a histopathological examination that showed a 10-cm epidermal cyst without a history of trauma or a surgical procedure was discussed.

The impact of weight gain during adjuvant chemotherapy on survival in breast cancer.

OBJECTIVE: Weight gain can be detected during adjuvant chemotherapy in breast cancer patients, leading to administration of lower drug doses than planned and a decrease in long-term survival. In this study, the effect of weight gain on survival in breast cancer patients was investigated. MATERIAL AND METHODS: Breast cancer patients treated with adjuvant chemotherapy between May 2002 and May 2003 were prospectively included in the study. Patients treated with neoadjuvant chemotherapy or with chemotherapy for metastatic disease were excluded from the study. Data regarding patients' demographic, clinical and pathologic characteristics and chemotherapy protocols were recorded. Patients were grouped as those with weight gain less than or more than 3 kg, and those with a body mass index of less than or more than 30. The impact of weight gain on patients' disease-free and overall survival was investigated. Log-rank test and Cox regression analyses were utilized for survival analyses. P<0.05 value was accepted as statistically significant. RESULTS: Eighty-eight consecutive female patients with a median age of 46 (29-71) were included in the study. Patients received anthracycline based chemotherapy protocols. Weight gain was detected in 79 patients (89.8%), with more than 3 kg weight gain detected in 38 patients (43.2%). In a median follow-up time of 98 months (62-120), distant metastases were detected in 21 patients (23.9%), and 11 patients (12.5%) died. Mean disease-free survival of patients with a weight gain less than and more than 3 kg during chemotherapy was 89.1±3.9 and 84.7±4.2 months (p=0.007), whereas mean overall survival was 95.6±2.2 and 92.5±2.1 months (p=0.01), respectively. Mean disease-free survival of patients with a body mass index less than and more than 30 was 87.3±2.3 and 85.1±3.6 months (p=0.4), whereas mean overall survival was 94.2±2.3 and 92.1±1.1 months (p=0.35), respectively. CONCLUSION: Weight gain during adjuvant chemotherapy has a negative effect on both disease-free and overall survival in patients with breast cancer.

The Relationship between Surgery and Phase of the Menstrual Cycle Affects Survival in Breast Cancer.

PURPOSE: The impact of time of surgery based on the menstrual cycle is a controversial issue. Two decades after the first interest in this topic, a number of studies with conflicting results have not helped to resolve this problem. This study aimed to prospectively evaluate the impact of timing of surgery based on the menstrual cycle on survival rates of breast cancer patients, and various clinical and hormonal classifications of the menstrual cycle were compared in order to determine the phase of the menstrual cycle which showed the highest degree of surgical survival. METHODS: Premenopausal breast cancer patients treated with curative surgery between 1998 and 2002 were prospectively included in this study. Patients were divided into different groups according to the first day of their last menstrual cycle using three different classifications (clinical, Hrushesky, Badwe), and were also grouped according to their serum hormone levels. Serum levels of follicle stimulating hormone, luteinizing hormone, estrogen, and progesterone were measured on the day of surgery. RESULTS: Ninety patients were included in the study. Median follow-up time was 90 months. Nineteen patients (21.1%) had loco-regional recurrence and/or distant metastases while 12 patients (13.3%) died during follow-up. Five-year (78.6% vs. 90.6%) and 10-year (66.7% vs. 90.6%) disease-free survival (DFS) rates of patients in the clinically defined follicular phase were significantly decreased compared to luteal phase. On the other hand, hormonally determined phases of the menstrual cycle and grouping of patients according to clinical classifications did not show an impact on prognosis. CONCLUSION: In the current study performing surgery in the follicular phase of the menstrual cycle decreased DFS in premenopausal patients. According to these results, performing surgery during the luteal phase of the menstrual cycle might have a beneficial effect on survival.

First report of a case with needle track sinus after aspiration biopsy of a benign thyroid nodule resulted in an unexpected postoperative complication.

Fine needle aspiration biopsy is the most feasible, safe, and accurate diagnostic tool for thyroid nodule diagnosis. The development of a sinus tract between thyroid gland and the skin through needle tract after fine needle aspiration biopsy is an extremely uncommon phenomenon. In this paper, a 71-year-old man presenting with a swelling and discharge on the anterior neck wall was reported. Similar complaints were present 15 to 20 days after fine needle aspiration biopsy of thyroid gland four years ago. Bilateral total thyroidectomy was performed considering a thyroid malignancy infiltrating the skin. Histopathologic examination confirmed a sinus tract between the thyroid gland and skin and thyroid nodule was benign in nature. It must be kept in mind that inflammatory reactions might also occur after fine needle aspiration biopsy of benign thyroid nodules. In patients with needle biopsy-related inflammation, surgery may be delayed until the inflammation subsides.

An international comparison of grade 6 students' understanding of the equal sign.

This study extends the scope of international comparisons examining students' conceptions of the equal sign. Specifically, Korean (n = 193) and Turkish (n = 334) Grade 6 students were examined to assess whether their conceptions and responses were similar to prior findings published for Chinese and U.S. students and to hypothesize relationships about problem types and conceptual understanding of the equal sign. About 59.6% of the Korean participants correctly answered all items providing conceptually accurate solutions, as compared to 28.4% of the Turkish sample. Comparison with previous studies in China and the USA indicated that the Chinese sample outperformed those from other nations, followed by Korea, Turkey, and the USA. In large-scale international studies such as Trends in International Mathematics and Science (TIMSS) and the Programme for International Student Assessment (PISA), students from China and Korea have been among the high achievers.

[Evaluation of tuberculin reactivity in different age groups with and without BCG vaccination]. / BCG asisi olan ve olmayan farkli yas gruplarinda tüberkülin reaktivitesinin arastirilmasi.

Tuberculin skin test (TST) which is used in the diagnosis of tuberculosis disease and evaluation of latent tuberculosis cases, is an easily applied, reproducible and low cost test. This study was carried out to determine the tuberculin reactivity in BCG vaccinated and unvaccinated population, to investigate the variables (BCG vaccination, the number of BCG scars, age, sex) affecting tuberculin reactivity. It was also aimed to determine the annual risk of tuberculosis infection (ARTI). The study which was a cross-sectional epidemiological one, was carried out during July 2006-January 2007 in Antalya district center and the number of objects to be applied with TST was determined by Power analysis method. A total of 408 participants; 147 children aged 5-7, 165 young adults aged 14-25 and 96 elderly people aged over 60, were included to the study. TST was applied by Mantoux method using 0.1 ml of purified protein derivative (PPD) RT 23/tween 80 antigen containing 5 tuberculin unit (TU). Evaluation of the test is done according to the domestic tuberculin skin test evaluation criteria. It was determined that 83.5% (341/408) of the cases were vaccinated with BCG and the diameter of TST was significantly higher in the vaccinated group when compared to the unvaccinated group (p= 0.005). Mean tuberculin reactivity (diameter of the TST induration) was 2.70 +/- 2.96 mm in 5-7 years age group, 6.44 +/- 4.11 mm in 4-25 years age group and 4.48 +/- 3.72 mm in > or = 60 years age group. Mean TST diameter was statistically significantly higher in 14-25 years age groups compared to 5-7 years (p= 0.003) and > or = 60 years (p= 0.002) age groups. Among the BCG unvaccinated group TST positivity was none in 5-7 years, 2% in 14-25 years and 7% in > or = 60 years age group. These rates were none in 5-7 and > or = 60 years age groups and 1% in 14-25 years age group in the BCG vaccinated population. It was also observed that TST diameters increased with increasing number of BCG scars and there was no difference in sex dependent TST reactivity. Average ARTI was determined to be 6%. It was concluded that to determine the risk of tuberculosis, annual variation in the ratio of ARTI has to be determined by nationwide evaluation of tuberculin skin test.