Cytoreductive surgery and perioperative intraperitoneal chemotherapy for gynecological malignancies: a single center experience.

INTRODUCTION: The objective of this study was to assess the outcome of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) plus early postoperative intraperitoneal chemotherapy (EPIC) in patients with advanced gynecological malignancies. MATERIALS AND METHODS: A retrospective series of 51 patients with advanced gynecologic cancer, evaluated between May 2008 to February 2014. Peritoneal Cancer Index (PCI) and Completeness of Cytoreduction (CCR) score were used in the study group. The study group consisted of the cancers of ovarian, fallopian tube, endometrial, and uterine sarcomas. RESULTS: Mean PCI score of the study group was 18, and the postoperative complications were similar with the literature. Patients were followed in a period of 15 days to 64 months and the mean survival time was 22.8 months. Fifty-two percent of the patients were alive without evidence of the disease and overall one-year survival was found 56%. CONCLUSIONS: The authors concluded that CRS, HIPEC, EPIC, and peritonectomy are a crucial options in patients with advanced gynecological cancers.

The effects of intraperitoneal chemotherapeutic agents on adhesion formation.

PURPOSE: Intra-abdominal adhesions are a major complication of healing. Furthermore these adhesions may cause morbidity and sometimes mortality for patients, and also are a financial burden to the health system. MATERIALS AND METHODS: Cecum abrasion was performed in all rats and solutions containing saline to group 1, 5-fluorouracil to group 2, cisplatin to group 3, paclitaxel to the group 4, and mitomycin-C were administered into the abdomen of the groups, respectively. The intra-abdominal adhesions were scored after the macroscopic evaluation. RESULTS: Among the chemotherapeutic drugs, paclitaxel significantly increases occurring of intra-abdominal adhesions in comparison with the control group and the other drugs according to the evaluation of scoring and statistical studies. CONCLUSION: It is suggested to use the drugs which have a proven anti-adhesion feature or barriers to the patients who are going to be applied intraperitoneal chemotherapy with paclitaxel.

Effects of the Pringle manoeuvre on the healing of left colonic anastomoses in rats.

BACKGROUND: Whether to perform colorectal cancer and liver metastasis resections simultaneously or in separate procedures is controversial. The aim of the present study was to investigate the effect of the Pringle manoeuvre on the healing of left-sided colonic anastomoses in rats. METHODS: Sixteen rats were randomly separated into two groups. In Groups 1 and 2, 1 cm of descending colon was resected and a primary anastomosis was performed. In Group 2, an intermittent pedicle clamp (the Pringle manoeuvre) was performed. On postoperative day 5, laparotomy was performed and the bursting pressures of all colon anastomoses were determined. Tissues were sampled for assay of hydroxyproline levels. Cultures of intraperitoneal swabs were also performed. RESULTS: Clostridium was twice as abundant in the Pringle manoeuvre group as in the control group (p < 0.05). Anastomosis-bursting pressures and tissue hydroxyproline levels were significantly lower in the Pringle manoeuvre group than in the control group (p < 0.05). CONCLUSIONS: The Pringle manoeuvre may compromise the viability of colonic anastomoses.

Antitumor effects of Origanum acutidens extracts on human breast cancer.

PURPOSE: There has been a long-standing interest in the identification of medicinal plants and derived natural products for developing anticancer agents. This work aimed at investigating the antiprolipherative properties of Origanum acutidens (OA) on breast cancer. METHODS: OA water extracts were studied for cytotoxicity against the breast cancer cell lines MCF-7, MDA-MB-468 and MDA-MB-231. In vitro apoptosis studies of these cancer cell lines were performed by annexin V staining in flow cytometry analyses. Immunohistochemistry studies for Ki-67 and caspase-7 of tumor tissue sections of dimethylbenzanthracene (DMBA) -induced mammary cancer in rats were also performed. TUNEL assay was used to detect apoptotic cells of tumor tissue. In vivo anticancer activity testing was carried out by inhibiting the growth of DMBA-induced mammary cancer in rats. RESULTS: OA showed cytotoxicity on all 3 cancer cell lines. Annexin-positive cells level in OA-treated cell lines were significantly higher compared with untreated control cells (p=0.002). The expressions of caspase-7 protein and TUNEL-positive cells were much higher for the rats treated by OA, compared with the untreated control group (p<0.05). The expressions of the Ki-67 decreased in the treated groups compared with the control group (p<0.05). In vivo studies showed that the mean tumor volume inhibition ratio in OA-treated group was 41 % compared with the untreated rats (p<0.05). CONCLUSION: These results indicate that OA has antitumor activity against breast cancer cell lines.

[Effectiveness of topical ciclosporin A treatment after excision of primary pterygium and limbal conjunctival autograft]. / Efficacité du traitement topique de ciclosporine A après excision du ptérygion primaire et autogreffe conjonctivo-limbique.

AIM: To study the efficacy and safety of topical ciclosporin A (CsA) as an adjunctive therapy after surgical treatment of primary pterygium including excision and limbal conjunctival autograft (LCA) with respect to postoperative pain and complications. PATIENTS AND METHOD: A prospective randomized clinical study was conducted in 60 consecutive patients with primary pterygium. Sixty eyes were operated on using the same surgical technique including excision and LCA. Thirty eyes were randomly treated with topical 0.05% CsA for 3 months after the surgery as a supplement to the standard topical therapy. All patients were followed for postoperative pain using the visual analog scale (VAS) for 1 week after surgery and for complications including recurrences for a period of 1 year. RESULTS: The average VAS was significantly lower in the CsA group (p=0.034). There was only one recurrence (3.4%) in the CsA group (n=28) and five recurrences (17.9%) in the control group (n=29). The other complications were substantial graft scarring (one in the CsA group, three in the control group), Tenon's granuloma (0/2), and fibrovascular proliferation (1/3). The ratio of the cases with no complications was statistically significantly higher in the CsA group (p=0.017). CONCLUSION: This study shows that topical CsA therapy after pterygium surgery may reduce postoperative pain and also decreases complications including recurrences.

Telomerase activity could be used as a marker for neoplastic transformation in gastric adenocarcinoma: but it does not have a prognostic significance.

Telomerase activity is responsible for telomere maintenance and is believed to be crucial in most immortal cells and cancer cells; however, its clinicopathological significance in gastric cancer remains to be clarified. The aim of the present study was to assess whether malignant progression of gastric adenocarcinoma correlates with telomerase activity. We also investigated the correlation between telomerase activity and histopathological findings. We examined telomerase activity in tumor specimens and adjacent normal tissues from 43 patients with gastric adenocarcinoma. Telomerase activity was measured quantitatively by the TRAPEZE Gel Based Telomerase Detection Kit. Approximately 98% of the tumor tissues were telomerase positive, but telomerase activity was detected not only in tumor tissues but also in normal gastric mucosa. Although telomerase activity was found to be higher in tumor samples than normal tissue for each subject, we could not find a general cut-off level for telomerase activity in gastric adenocarcinoma. In addition, telomerase activity was not correlated with tumor invasion, lymph node involvement and histological stage. Our results support the idea that telomerase reactivation is a common event in gastric adenocarcinoma and it is not related to histopathological parameters. Since it is difficult to set a cut-off level for this type of cancer, we suggest that the prognostic utility of telomerase assay has not yet reached the clinic in terms of predicting outcome for patients with gastric adenocarcinoma. For the assessment of gastric carcinoma, telomerase activity should be evaluated in both tumor and normal tissues, because normal gastric mucosa samples show appreciable telomerase activity.

The effects of artificial tear application on contrast sensitivity in dry and normal eyes.

PURPOSE: To investigate the effects of artificial tear application on contrast sensitivity in dry and normal eyes. METHODS: A total of 55 patients with normal (10/10) corrected or uncorrected visual acuity referring to GATA Gulhane Military Medical Academy Haydarpasa Ophthalmology Outpatient Clinic were evaluated in regard to dry eye diagnostic criteria, and assigned into the dry eye group (Group 1; 35 patients) and the control group (Group 2; 20 patients). All patients were given a contrast sensitivity testing at low and high spatial frequencies using the gradual contrast sensitivity chart before and at 5 minutes after application of artificial tears, and the two groups were compared. Wilcoxon test was used in statistical analysis, accepting a p value of <0.05 as significant. RESULTS: In the dry eye group, there was a statistically significant increase in contrast sensitivity scores both at low and high frequencies after application of artificial tears (p<0.05). In the control group, although there was a significant increase in low frequency scores after artificial tear application (p< 0.05), there was not a significant change in high frequency scores (p>0.05). CONCLUSIONS: The decreased contrast sensitivity in dry eyes improves with application of artificial tears. Therefore, the impeded quality of vision seen in dry eye patients could be restored closer to normal with artificial tear therapy. Besides, contrast sensitivity testing could be used in the follow-up of artificial tear therapy.

The effects of artificial tear application on contrast sensitivity in dry and normal eyes.

PURPOSE: To investigate the effects of artificial tear application on contrast sensitivity in dry and normal eyes. METHODS: A total of 55 patients with normal (10/10) corrected or uncorrected visual acuity referring to GATA Gulhane Military Medical Academy Haydarpasa Ophthalmology Outpatient Clinic were evaluated in regard to dry eye diagnostic criteria, and assigned into the dry eye group (Group 1; 35 patients) and the control group (Group 2; 20 patients). All patients were given a contrast sensitivity testing at low and high spatial frequencies using the gradual contrast sensitivity chart before and at 5 minutes after application of artificial tears, and the two groups were compared. Wilcoxon test was used in statistical analysis, accepting a p value of <0.05 as significant. RESULTS: In the dry eye group, there was a statistically significant increase in contrast sensitivity scores both at low and high frequencies after application of artificial tears (p<0.05). In the control group, although there was a significant increase in low frequency scores after artificial tear application (p< 0.05), there was not a significant change in high frequency scores (p>0.05). CONCLUSIONS: The decreased contrast sensitivity in dry eyes improves with application of artificial tears. Therefore, the impeded quality of vision seen in dry eye patients could be restored closer to normal with artificial tear therapy. Besides, contrast sensitivity testing could be used in the follow-up of artificial tear therapy.

Isolated hepatic tuberculous pseudometastasis co-existent with adenocarcinoma of the stomach; report of a case.

A 10 x 9 mm metastasis-like lesion in segment V of the liver was detected, when a 70-year-old man was operated on for adenocarcinoma of the stomach. Since exact diagnosis of the hepatic lesion could not be made by frozen sections, the lesion was excised, considering it to be a metastasis of gastric adenocarcinoma. Bacteriologic and pathologic studies established a diagnosis of isolated tuberculosis of the liver. A good response to antituberculous drug therapy was noted.

Peripancreatic tuberculous lymphadenitis mimicking carcinoma: report of a case.

Peripancreatic tuberculous lymphadenitis is a rare clinical entity and it usually raises serious diagnostic problems. We report a case of a solitary abdominal tuberculoma. A 45-year old woman was admitted to hospital with obstructive jaundice. An exploratory laparotomy was performed. A conglomerated mass, penetrating into the pancreas was found. Since exact diagnosis could not be obtained by peroperative frozen sections, standard Whipple procedure, segmental portal vein resection and reconstruction with autogenous saphenous vein were performed. Histopathological examination of the resected specimen revealed tuberculous lymphadenitis. The patient was given an anti-tuberculous treatment and a good response was noted. Abdominal tuberculoma is often mistaken for a malignant neoplasm and a high grade of suspicion is neccessary in order to make the exact diagnosis and optimal medical treatment of this entity.

Our sigmoid colon volvulus experience and benefits of colonoscope in detortion process.

BACKGROUND/AIMS: The sigmoid colon is the most frequent site for a volvulus. In this report, we review our experience with sigmoid colon volvulus. METHODOLOGY: We present our experience of 81 cases of sigmoid volvulus admitted to our department. RESULTS: Preoperative endoscopic volvulus detortion was attempted in all patients, and in 39 of them the procedure was successful. The success rate of endoscopic detortion for sigmoid colon volvulus with a flexible colonoscope (60%) was higher than with a rigid rectosigmoidoscope (42%). In 19 of these 39 non-operatively devolvulated patients, sigmoid resection with primary anastomosis was performed within 7-10 days after reduction, but 20 patients did not accept the elective operation after a non-operative treatment. Among the 61 patients undergoing urgent or elective operation for sigmoid volvulus, there were 17 laparotomies with only detortion, 19 resections with elective anastomosis, 6 resections with primary anastomosis, and 19 resections with a Hartmann's pouch. There were 9 deaths (21%) among 42 patients who underwent an emergency operation, and one (5.2%) among the 19 patients who had elective surgery died because of a cerebral embolus. CONCLUSIONS: Initial therapy with endoscopy affords decompression and an adequate preparation of patients for surgical resection, and a flexible colonoscope has notable advantages over rigid instruments for the detortion process.

The effect of capsulorhexis size on development of posterior capsule opacification: small (4.5 to 5.0 mm) versus large (6.0 to 7.0 mm).

PURPOSE: The most common surgically related cause of reduced vision after extracapsular cataract extraction is posterior capsule opacification (PCO), which occurs in up to 50% of eyes following cataract extraction. This study examined whether small capsulorhexes of 4.5 to 5.0 mm, which lie completely on the 5.5 mm intraocular lens (IOL), and large capsulorhexes of 6.0 to 7.0 mm, which lie completely off the lens optic, are effective in preventing PCO development. METHODS: In this prospective study, 496 eyes of 367 patients underwent standardized phacoemulsification with capsulorhexis and capsular bag foldable acrylic IOL implantation. The patients were randomly assigned to receive either a small capsulorhexis of 4.5 to 5 mm to lie completely on the IOL optic or a large capsulorhexis of 6 to 7 mm to lie completely off the lens optic. Retroillumination photographs were taken at 6 months and then yearly. RESULTS: Throughout the follow-up, there was less PCO in the small capsulorhexis group than in the large capsulorhexis group. CONCLUSIONS.:Small capsulorhexes were associated with less wrinkling of the posterior capsule and less PCO than were large capsulorhexes. PCO after IOL implantation has a multifactored pathogenesis. Small (4.5 to 5.0 mm) capsulorhexis and capsular bag implantation of 5.5 mm acrylic IOL are likely to reduce the PCO incidence when compared with the 6.0 to 7.0 mm capsulorhexis. The significance of the IOL optic diameter in association with the capsulorhexis size should also be documented by further studies.

Comparison of postoperative acute-phase reactants in patients who underwent laparoscopic v open cholecystectomy: a randomized study.

PURPOSE: We investigated the effect of laparoscopic v open cholecystectomy on acute-phase reactants. PATIENTS AND METHODS: Fifty patients were randomized to laparoscopic (Group 1) and 50 to open (Group 2) cholecystectomy. Preoperative and postoperative values for acute-phase reactants (ceruloplasmin, fibrinogen, Westergren sedimentation rate, alpha-1-antitrypsin, haptoglobin, and C-reactive protein) in blood samples were compared. RESULTS: Acute-phase reactants and length of hospitalization were significantly lower in patients who underwent a laparoscopic cholecystectomy than in those who underwent an open cholecystectomy. CONCLUSION: Laparoscopic cholecystectomy appears associated with a less intense stress response and less tissue damage than open cholecystectomy.