Percutaneous biliary stone clearance: is there still a need? A 10-year single-centre experience.

AIM: To evaluate the safety and efficacy of percutaneous biliary stone clearance in a single hepatopancreaticobiliary (HPB) centre. MATERIALS AND METHODS: All patients who underwent percutaneous biliary stone clearance between 2010 and 2020 at a HPB centre were identified from the radiology information system. Their demographic data, presentation, previous surgery, number/size of biliary calculi, success and complications were collected from patient records. Unpaired student's t-test was used to compare numerical variables and the Chi-square test was used to compare categorical data. RESULTS: Sixty-eight patients aged between 58.5-91.1 years underwent the procedure, and 42.6% (29/68) had the procedure due to surgically altered anatomy precluding endoscopic retrograde cholangiopancreatography (ERCP). The most common presentation was cholangitis (62%). The success rate of percutaneous stone clearance was 92.7%. The average number of calculi was two (range 1-12). Of the patients included, 4.4% developed pancreatitis, 4.4% developed cholangitis, and 1.5% had hepatic artery branch pseudoaneurysm successfully treated with transarterial embolisation. There was no significant difference in success or complication rates between the different access sites (right lobe, left lobe, roux-loop, T-tube, p=0.7767). CONCLUSION: Percutaneous biliary stone clearance is safe and effective and will continue to play an important role where ERCP fails or is impossible due surgically altered anatomy.

Effects of dexmedetomidine and thymoquinone on erythrocyte deformability in lower limb ischemia reperfusion injury in streptozotocin-induced diabetic rats.

OBJECTIVE: In this study we aimed to evaluate the effect of dexmedetomidine and thymoquinone on erythrocyte deformability in lower limb ischaemia-reperfusion (IR) injury in streptozotocin-induced diabetic rats. MATERIAL AND METHODS: Thirty Wistar albino rats were equally divided into 5 groups (n = 6); randomized control group (Group C), diabetes control group (Group DC), DIR group (Group DIR), DIR group with thymoquinone 25 mg.kg‒1 intraperitoneally (Group DIRT) and Group DIR with dexmedetomidine 100 µg.kg‒1 intraperitoneally (Group DIRD). Erythrocyte packs were prepared from heparinized blood samples and deformability measurements were performed. RESULTS: IR significantly increased the relative resistance, a marker of erythrocyte deformability when compared to control group (p < 0.05). There were significant differences among the groups in comparisons with ANOVA test (p < 0.0001). Comparisons of the groups DIRD and DIRT revealed similar results (p = 0.824). The values of Group DIR were significantly higher than those of the control, DC, DIRD and DIRT groups (p < 0.0001, p = 0.001, p = 0.004, p = 0.002, respectively). The values of the DC, DIR, DIRD and DIRT groups were significantly higher than those of the control group (p < 0.0001, all). CONCLUSION: Erythrocyte deformability may cause more problems in microcirculation. Dexmedetomidine and thymoquinone may be useful in reducing the adverse effects of this type of injury (Fig. 1, Ref. 41).

Effect of different doses of pregabalin on skeletal muscle ischaemia-reperfusion injury in rats.

AIM/INTRODUCTION: Analgesic, anti-inflammatory and anti-apoptotic effects of pregabalin have been shown previously. In this study, we investigated the protective effect of different doses of pregabalin on skeletal muscle IR injury in rats. MATERIALS AND METHODS: 24 rats were randomly divided into 4 groups (Control, Ischaemia-Reperfusion (IR), IR-Pregabalin 50 mg, IR-Pregabalin 200 mg). Following IR, serum Ischemia Modified Albumin (IMA) and tissue Paraoxonase (PON) were studied and gastrocnemius muscle tissue was removed for histopathologic examination. RESULTS: Interstitial inflammation was higher in the IR group than in the control and Pregabalin 200 mg groups (p = 0.037, p = 0.037, respectively). Congestion was higher in the IR group than in the control, Pregabalin 50 and 200 mg groups (p = 0.001, p = 0.004, p = 0.004, respectively). PON was lower in the IR group than in the Control, Pregabalin 50 and 200 mg groups (p = 0.001, p = 0.007, p = 0.015, respectively). IMA was higher in the IR group than in the Control, Pregabalin 50 and 200 mg groups (p < 0.0001, all). CONCLUSION: We think that administration of pregabalin, more prominent at 200 mg, can reverse the injury that occurs in the skeletal muscle of IR-induced rats. Pregabalin can be safely used for analgesia in cases of IR (Tab. 2, Fig. 9, Ref. 41).

Selecting housekeeping genes as references for the normalization of quantitative PCR data in breast cancer.

OBJECTIVE: The common reference genes of choice in relative gene expression studies based on quantitative real time polymerase chain reaction, ACTB and B2M, were shown to be regulated differently in respect to tissue type. In this study, the stability of the selected housekeeping genes for normalizing the qPCR data were identified in the tumor and its adjacent tissues in invasive breast cancer, and the variability of their levels according to the stages and the histopathologic subtypes was analyzed. METHODS: Four housekeeping genes: PUM1, RPL13A, B2M, and ACTB were analyzed in 99 surgically excised tissue specimens (50 tumor, 45 tumor adjacent and 4 normal breast tissues). Three of the most common softwares (GeNorm, NormFinder, and BestKeeper) were used for calculation purposes. RESULTS: When all of the tissue samples were included in analyses, PUM1 was the most stable gene according to calculations made with both NormFinder and BestKeeper; while PUM1/RPL13A combination was the most stable by GeNorm software. The PUM1 gene was also identified as the most stable gene among the four in all sample groups (in both Estrogen Receptor positive and Estrogen Receptor negative subgroups of invasive breast carcinoma and in normal breast tissue) according to calculations made using the NormFinder software. CONCLUSION: While suggesting PUM1 is one of the most stable single gene and the PUM1/RPL13A pair as one of the best housekeeping genes for the normalization of expression studies in invasive breast tumor studies, it will be more practical to evaluate stability once more and decide upon the reference gene accordingly within the sample group itself.

Promoter methylation and expression changes of CDH1 and P16 genes in invasive breast cancer and adjacent normal breast tissue.

We studied the promoter methylation status and expression levels of P16 and CDH1 genes in breast cancer and their adjacent normal tissues with normal control breast tissues, to correlate with their histopathological parameters. Hundred twenty four samples (tumor and adjacent nonmalignant tissues) from 62 breast cancer patients and 4 normal control breast tissues were included in the study. We used methylation specific PCR to evaluate methylation status and quantitative RT-PCR to measure the gene expression levels. Methylation incidence of P16 gene and CDH1 gene in tumor tissues were 24.2 % and 33.9 %, respectively. CDH1 and P16 gene were not methylated in normal control tissues. CDH1 underexpression is found to be significant in correlation with advanced stage, histologic type, high tumor grade and lymph node involvement. P16 expression is found not to be significantly related with any histopathological parameters. But 60% of cases which overexpresses P16 were estrogen negative, and 40% of them were histologic grade 3. Both P16 and CDH1 had different expression levels in tumor tissues compared to the adjacent normal tissues and in adjacent normal tissues compared to the normal non-tumor tissues.

External validation of Cleveland Clinic Foundation colorectal cancer model in a University Clinic in terms of predicting operative mortality.

BACKGROUND: The aim of this study was to perform an external validation of Cleveland Clinic Foundation colorectal cancer model in a single center. METHODS: Relevant data of 771 patients who underwent surgery for colorectal cancer between January 1997 and November 2008 were retrospectively collected. The performance of the scoring system was evaluated by discrimination and calibration. Discrimination was evaluated by using the area under the receiver operator characteristics curve and calibration by using the Hosmer-Lemeshow goodness-of-fit test. RESULTS: Mean age was 60.8 (18-91). Forty-four percent of patients were female, and 56% were male. Overall mortality was 3.9%. Cleveland Clinic Foundation colorectal cancer model showed good discrimination but poor calibration. CONCLUSION: These data suggest that the Cleveland Clinic Foundation colorectal cancer model is a suitable model to be used in our center for patients with colorectal cancer but requires recalibration.

A pilot study for human tumor/DNA banking: returned more questions than answers.

A pilot study was performed for setting up the Dokuz Eylül University Breast Tumor DNA Bank (DEUBTB) to facilitate the sharing of tumor DNA/RNA samples and related data from cases collected by collaborators specializing in the breast cancer diseases between 2004 and 2006. The pilot study aimed to provide answers for certain questions on: (1) ethical concerns (informing the volunteer for donating specimen, anonymizing the sample information, procedure on sample request), (2) obtaining and processing samples (technical issues, flowchart), (3) storing samples and their products (storing forms and conditions), (4) clinical database (which clinical data to store), (5) management organization (quality and quantity of personnel, flowchart for management relations), (6) financial issues (establishment and maintenance costs). When the bank had 64 samples, even though it is quite ready to supply samples for a research project, it revealed many questions on details that may be answered in more than one way, pointing that all biobanks need to be controlled by a higher degree of management party which develops and offers quality standards for these establishments.

Prospective, double-blind, comparative fast-tracking trial in an academic emergency department during a period of limited resources.

The aim of this study was to determine the effectiveness of 'fast-tracking' in an academic emergency department (ED) during a period of limited resources and space constraints. This was a prospective, double-blind, comparative clinical trial. Fast-tracking was applied every other day between 08.00 and 17.30 hours. Patients meeting fast-tracking criteria, which were determined as allergy, dyspepsia, hypertension, urinary tract infection, urolithiasis, gastroenteritis, upper airway infection, minor lacerations, and soft tissue injuries with no sign or symptom of life-threatening illness or acute abdomen, were treated by a designated fast-tracking team. In the alternate days fast-tracking was not done, and the patients having the same criteria were recorded and followed as the control group. ED length of stays were determined for each patient, and at time of discharge a questionnaire was applied to determine patient satisfaction. Follow-up was performed by telephone survey at the 5th day of discharge. The median length of stay was 36 minutes for the fast-tracked group compared with 63 minutes for the control group. The application of fast-tracking decreased ED length of stay and improved patient satisfaction in patients presenting with allergy, dyspepsia, upper airway infection, minor laceration, and soft tissue injury, but not in patients with gastroenteritis, urinary tract infection, hypertension, and urolithiasis. The rate of follow-up was 81% (n = 217), and there were no complications or hospitalizations to another hospital. It is concluded that fast-tracking is an applicable and useful system in an academic ED with limited resources, and decreases ED length of stay and improves patient satisfaction in a selected group of patients. Determination of fast tracking criteria must be individualized for each hospital according to resources. Additionally, fast-tracking seems to be safe when performed under strict criteria for patient selection.

Cytokine activation in patients undergoing open or laparoscopic cholecystectomy.

BACKGROUND: Laparoscopic surgery is estimated to produce a minor surgical injury in comparison with open and laparoscopic cholecystectomies. Studies in the past compare almost data of the first hours until day two. However, the surgical injury and the wound healing metabolism has to be detected. METHODS: A prospective study was designed to investigate cytokine responses after surgical injury. Twenty-three patients with symptomatic cholelithiasis were admitted to the study. Eleven patients underwent conventional (open) and twelve patients laparoscopic cholecystectomy. Circulating concentrations of cytokines-including Interleukin-6 (IL-6), Tumor necrosis factor-alpha (TNF-alpha) and neopterin, were compared between both groups. In addition, association of the cytokines with clinical parameters including leucocytes, urea, fever and C-reactive protein (CRP) were assessed. We are using ELISA-test of Medgenix GmbH, Ratingen, Germany and BRAHMS Diagnostica, Berlin, Germany. RESULTS: Enhanced cytokine responses were observed in the conventional group compared to the laparoscopic group. On day 3 after operation, the second increase in cytokine levels (but smaller than the first increase) were observed in both groups. In the conventional group, a slightly high correlation ratio between the urea and cytokine levels was found. However, only neopterin and urea association on postoperative day 3 (r = 0.65) was significant (p < 0.05). There was no significant association between CRP and cytokine levels in both groups. CONCLUSIONS: Cytokine response after cholecystectomy demonstrates the lesser degree of surgical injury in the laparoscopic group, however, TNF-alpha demonstrates on day 4 a similar increase in both groups. This is a new result of studies working in this field. In conclusion, the benefit of laparoscopic surgery results only in the minimal access to the abdominal cavity, the wound healing metabolism is at last the same in both groups.