Retrospective Analysis of Parameters Affecting Metastatic Breast Cancer.

Objectives: While metastatic breast cancer (MBC), which is the most common cause of death in women, has been seen as an incurable surgical problem in the past decade, as the heterogeneous nature of breast cancer becomes clear with increasing molecular studies and advances in oncological protocols, life expectancy is increasing. In this study, we aimed to examine the clinicopathological features of the patients we followed up with MBC. Methods: Patients who were operated on with the diagnosis of breast cancer in our hospital between 2018 and 2023 and who were later found to have metastases were retrospectively analyzed from the database. The age of the patients, the histological and molecular type, stage and grade of the tumor, the time from diagnosis to metastasis, the location of metastasis, the duration of treatment and follow-up were investigated. Patients who were operated on in other centers and/or were out of follow-up were excluded from the study. For the statistical analysis of the findings, number cruncher statistical system (NCSS) 2020 statistical software (NCSS LLC, Kaysville, Utah, USA) was used at a significance level of 0.05. Results: Metastasis was detected in 77.1% (n=37) of a total of 48 female patients, and recurrence was found in 22.9% (n=11). The mean age of the patients was 57 years. There was no statistically significant difference between the patients in terms of demographics. When evaluated according to the TNM stage, 24.3% (n=9) of the patients were in the early stage and 75.7% (n=28) were in the locally advanced stage; the number of locally advanced patients was found to be higher than the early stage. In histology examination, 27.1% (n=13) of the patients were luminal A, 31.3% (n=15) luminal B, 16.7% (n=8) HER2 positive, and 25% (n=12) triple negative. Ki67 was higher than 14% in 64.6% (n=31) patients. Breast conserving surgery was performed in 41.6% (n=20) of the patients, and mastectomy was performed in 58.3% (n=28) patients. Metastasis in 34.2% (n=13) of the cases within 1-2 years, in 42.1% (n=16) within 2-5 years, and in 23.7% (n=9) after 5 years took place. Sites of metastasis were bone (37.7%, n=28), liver (28.9%, n=11), brain (10.5%, n=4), and lung (7.9%, n=3). More than one metastasis site was observed in 21.05% (n=8) of patients with metastases. There was no statistically significant difference between luminal A, luminal B, HER 2 groups and triple-negative breast cancer in terms of metastasis time and location (p>0.05). Adjuvant hormone therapy was more common in the luminal A group, whereas neoadjuvant therapy was more common in the HER2+ group. A total of 20 deaths were observed in 48 patients (41.7%). The median disease-free survival was 64 months. Conclusion: Despite all the developments in metastatic breast cancer, the 5-year survival rate is 27%. Targeted personalized therapies may be promising when the mechanism of metastasis and specific pathways in breast cancer emerge.

Feasibility and accuracy of targeted axillary dissection in breast cancer patients; single center experience.

Introduction: Axillary complete response (pCR) was observed in approximately half of breast cancer patients who received neoadjuvant chemotherapy (NAC) due to axillary positivity. Preventing axillary morbidity due to unnecessary axillary lymph node dissection (ALND) is extremely important for patients' quality of life. Targeted axillary dissection (TAD) is a technique developed to improve axillary staging and reduce the false negative rate in sentinel lymph node biopsy. Methods: Patients with cN1-N2 (clinically node) breast cancer whose axillary lymph node metastasis was confirmed by biopsy and who received NAC marked with a clip were included in the study. Patients who achieved clinical response after systemic treatment underwent sentinel lymph node biopsy (SLNB) with additional methods such as methylene blue guided dissection, skin marking for clip on lymph node (CLN) localization, and wire guided with imaging excision of the CLN. TAD and ALND pathology results were evaluated and analyzed with patient and tumor characteristics. Results: 83 patients who met the eligibility criterias for the study were examined retrospectively. 21 of the patients underwent TAD alone, and 62 patients underwent ALND after TAD. CLN rate was 98.8% in patients underwent only TAD and this rate was increased to 100% in patients underwent ALND after TAD. FNR in SLN, CLN, and TAD were 28.6%, 10.7%, and 3.6%, respectively. Conclusion: TAD is a feasible and reliable surgical approach to detect axillary residual disease with a high success rate.

Antibiotic Use among Patients Hospitalized with COVID-19 and Treated in Three Different Clinics.

Objective: In this study, we aimed to determine and compare the rates of empirical antibiotic use and duration between the chest diseases clinic (CDC), infectious disease clinic (IDC), and internal medicine clinic (IMC) among patients hospitalized because of COVID-19. Methods: This cross-sectional study was performed in a single university hospital. The study included all patients aged 18 years and older hospitalized with a PCR-confirmed COVID-19 between May 30, 2021, and August 30, 2021. Clinical and laboratory findings were recorded from the electronic medical records database. Results: The study included a total of 581 inpatients, of whom 310 (53.4%) were women. Of the 581 patients, 475 (81.8%) were prescribed antibiotics. The rate of antibiotic prescription was 71.6% for IDC, 88.5% for CDC, and 87.4% for IMC. The most commonly used antibiotic was moxifloxacin in all groups. The mean treatment duration was 8.9±6.16 days. The mean duration of antibiotic treatment was 11.1±5.90 days for CDC, 11.3±6.74 days for IMC, and 5.3 days±3.76 for IDC. Conclusion: Patients with COVID-19 who were treated in IDC had a lower rate and shorter duration of antibiotic use compared to the other clinics. However, the rate of antibiotic prescription in all three groups was very high. Therefore, antimicrobial management programs should be meticulously conducted to reduce unnecessary antibiotic use.

Percutaneous cholecystostomy instead of laparoscopy to treat acute cholecystitis during the COVID-19 pandemic period: single center experience.

BACKGROUND: Laparoscopic cholecystectomy (LC) is the accepted standard treatment for acute cholecystitis (AC) in patients eligible for surgery. Percutaneous cholecystostomy (PC) can provide a permanent treatment for high-risk patients for surgery or act as a bridge for later surgical treatment. This study is an evaluation of the use of PC during the current coronavirus 2019 (COVID-19) pandemic at a single hospital. METHODS: Fifty patients with AC were admitted as of the start of the COVID-19 pandemic in Turkey through June 2020. Patients with pancreatitis, cholangitis, and/or incomplete data were excluded from the study. Data of the remaining 36 patients included in the study were recorded and a descriptive statistical analysis was performed. The patients were divided into three groups: PC (n=14), only conservative treatment with antibiotherapy (OC) (n=14), and LC (n=8). The findings were compared with a group of 70 similar patients from the pre-pandemic period. RESULTS: The mean age of the pandemic period patients was 53 years (range: 26-78 years). The female/male ratio was 1.11. PC was preferred in eight (11%) patients in the same period of the previous year, whereas 14 (39%) patients underwent PC in the pandemic period. Four of the 36 pandemic patients were positive for COVID-19, including one member of the PC group. There was one (7.1%) mortality in the pandemic-period PC group due to cardiac arrest. The length of hospital stay between the groups based on the type of treatment was not statistically significant. CONCLUSION: LC is not recommended during the pandemic period; PC can be an effective and safe alternative for the treatment of AC.

Identification of red blood cell membrane defects in a patient with hereditary spherocytosis using next­generation sequencing technology and matrix­assisted laser desorption/ionization time­of­flight mass spectrometry.

Hereditary spherocytosis (HS) is characterized by the morphological transformation of erythrocytes into a spherical shape due to a hereditary defect in cell membrane proteins (ghosts) associated with disruption of erythrocyte skeletal structures. Contrary to the literature, pores were detected in the erythrocytes of a patient with HS. The aim of the present study was to determine the affected proteins and genes that were responsible for the pores. Ghost isolation was performed to determine the proteins responsible for the pores observed on the erythrocytes of the patient. Erythrocyte membrane proteins were visualized using SDS­PAGE. Exome and matrix­assisted laser desorption/ionization time­of­flight mass spectrometry (MALDI TOF MS) analyses were used to identify the genes and proteins responsible for the observed defect. Quantitative protein assessments were performed using MALDI TOF MS. A difference was detected in the components of the erythrocyte membrane proteins. Band 3 and protein 4.2, which serve a particular role in membrane structure, decreased 4.573 and 4.106 fold, respectively. Through proteomic analyses, a non­synonymous exonic mutation region was identified in the Golgi membrane protein 1 (GOLM1) gene (Chr9 rs142242230). Sorting Intolerant From Tolerant and Polymorphism Phenotyping Scores, Likelihood Ratio Tests and MutationTaster revealed that the mutation was deleterious. The pores observed in the morphology of the erythrocytes may have developed due to the decrease in these proteins, which reside in the erythrocyte membrane structure. Furthermore, genetic profiling of the patient with HS and her family was conducted in the present study. Next­generation sequencing was used, and the genetic source of HS was identified as a GOLM1 gene mutation. The assessment of specific molecular defects is often not performed as the majority of mutations are unique to a family. However, molecular analyses should be performed in severe cases where prenatal diagnosis is required, or for unique HS phenotypes to aid scientific investigation.

Nicotine reduces effectiveness of doxorubicin chemotherapy and promotes CD44+CD24- cancer stem cells in MCF-7 cell populations.

Breast cancer is the most common type of cancer in females and the second most common cause of cancer mortality after lung cancer. Cancer stem cells represent a novel approach to target cancer and reduce cancer recurrence and metastasis. Many patients with breast cancer continue to smoke after receiving their diagnosis. Nicotine is a key factor in tobacco addiction and also changes some cellular functions, such as activation of mitogenic pathways, angiogenesis and cell proliferation. In the present study, the impact of nicotine was assessed in a population of MCF-7 human breast cancer cells. Cluster of differentiation (CD)44+CD24- cancer stem cell population of MCF-7 cells were evaluated using flow cytometry and scanning electron microscopy. Chemoresistance effects of nicotine were demonstrated in these cells. These findings demonstrated harmful effects of nicotine following metastasis of cancer, owing to the chemoresistance produced through uninterrupted smoking, which may impact the effectiveness of treatment.

Effect of intra-abdominally administered mesalazine (5-aminosalicylic acid) in experimental peritonitis.

OBJECTIVE: In this study, the effect of mesalazine was studied on TNF alpha IL-1 beta, IL-6, and C-reactive protein (CRP) levels and inflammatory changes in rat lungs with experimental peritonitis. METHODS: In total, 24 male Sprague-Dawley rats weighing 250-280 g were used in the study.The rats were divided into three groups based on no irrigation or irrigation with isotonic solution or mesalazine. Secondary peritonitis was generated by cecum penetrations. Group I, no irrigation was given after the development of peritonitis; Group II, irrigation was performed using isotonic solution 24 h after the development of peritonitis. GROUP III: irrigation was performed using mesalazine 24 h after the development of peritonitis. Blood samples were taken in the 48th hour for measuring TNF alpha, IL-1 beta, IL-6, and CRP levels. Lung tissue samples were taken for examining the effect of mesalazine in the development of systemic sepsis. RESULTS: TNF alpha, IL-1 beta, and CRP levels were significantly low in Group III than in the other groups (p<0.005). In the histologic examination, leucocyte infiltration in the lung was found low in Group III. CONCLUSION: TNF alpha, IL-1 beta, and CRP levels and leucocyte infiltration in the lung were found to be low in rats that were administered peritoneal irrigation using mesalazine after the development of secondary peritonitis. Peritoneal irrigation using mesalazine may be useful in patients requiring surgery due to secondary peritonitis.

[Factors affecting morbidity and mortality in mechanical intestinal obstruction]. / Mekanik bagirsak tikanikliklarinda morbidite ve mortaliteyi etkileyen faktörler.

BACKGROUND: We evaluated the effects of factors related to both the patient and the treatment on morbidity and mortality of patients with mechanical intestinal obstruction. METHODS: A total of 152 patients (83 males, 69 females; mean age 55.05 years; range 15 to 90 years) who underwent surgery for intestinal obstruction were retrospectively evaluated. The effect of several factors on morbidity and mortality during hospitalization (mean 8.6 days; range 1 to 105 days) was assessed, including age, sex, associated diseases, the presence of intestinal necrosis, previous abdominal operations, the time of the operation, and the level of obstruction. Statistical evaluations were made with the use of a multiple logistic regression analysis. RESULTS: Complications were encountered in 52 patients (34.2%), the most common being systemic complications (15.8%) followed by wound site infections (11.2%). During hospitalization, mortality occurred in six patients (4%), all of whom had at least one associated disease. Logistic regression analysis showed that age beyond 75 years (p<0.01), male gender (p<0.01), associated disease (p<0.05), non-viable strangulation (p<0.001), previous operations (p<0.05) and malignancies (p<0.05) were significant independent factors affecting the complication rate. On the other hand, only non-viable strangulation (p<0.05) had significant independent effect on mortality. CONCLUSION: Patient-related factors should be taken into consideration in the evaluation and treatment of mechanical intestinal obstruction.