Investigation of the IL7Rα Gene Polymorphism rs6897932 and the Expression Levels of the CDH1, TTPAL, and FHIT Genes in Patients with Breast Cancer.

OBJECTIVE: The aim of this study was to determine the expression levels of CDH1, FHIT, and TTPAL genes and to determine the genotype and allele frequencies of the IL7Rα gene polymorphism rs6897932 in patients with breast cancer. METHODS: The expression levels of genes and the distribution of the IL7Rα gene polymorphism rs6897932 were analyzed by real-time polymerase chain reaction. RESULTS: No differences in genotype ratios or allele frequencies were observed between the 2 groups for the IL7Rα gene polymorphism rs6897932. The frequency of the IL7Rα rs6897932 T risk allele was found to be similar between breast cancer patients and controls. CDH1 messenger RNA (mRNA) levels decreased (0.714-fold and 0.834-fold, respectively), and TTPAL mRNA levels increased (2.675-fold [P < .05] and 1.169-fold, respectively) in tumor tissues and peripheral blood samples. FHIT mRNA levels decreased (0.559-fold) in tumor tissue samples and increased (2.21-fold) in peripheral blood samples. CONCLUSION: Our results are compatible with those reported in the literature. It can be suggested that the upregulation observed in the TTPAL gene might be a marker for breast cancer. The downregulation of CDH1 and FHIT gene expression has been validated in our study. An increase in the copy numbers of FHIT mRNA in blood samples and a decrease in the tumor samples can also be considered an abnormal condition.

Investigation of the expression levels of CDH1, FHIT, PTEN, and TTPAL genes in colorectal tumors.

BACKGROUND: The main aim of the study is to assess expression levels of CDH1, FHIT, PTEN, and TTPAL genes in tumors and peripheral bloods of colorectal cancer patients in staged I-IV. METHODS: Gene expression analysis of related genes were performed for tumor tissues and peripheral blood samples of 51 colorectal cancer patients and colon tissues and blood samples of 5 healthy individuals. The real-time-PCR reaction method was used for the analysis. RESULTS: Alteration of mRNA levels of related genes in tumor tissues of colorectal cancer cases was determined compared to control tissues. GAPDH and TBP were used for the normalization. While the mRNA levels of CDH1 decreased, the mRNA level of the FHIT and TTPAL genes increased in the tumor tissues. There was no PTEN gene expression difference in tumor tissues (total). The mRNA levels of the CDH1 and PTEN genes were increased while the mRNA levels of FHIT and TTPAL genes decreased in the blood (total). T he mRNA levels of the CDH1 gene decreased at each stage (I-IV) in the tumor tissues and increased at each stage (I-IV) in the blood. T he PTEN gene mRNA levels at each stage were controversial. The mRNA levels of the FHIT gene increased at stage I-II-III, decreased at stage IV in the tissues and decreased at each stage (I-IV) in the blood. The mRNA levels of TTPAL gene increased at each stage (I-IV) in the tissues and decreased at each stage (I-IV) in the blood.

The relationship of tumour-associated macrophages (CD68, CD163, CD11c) and cancer stem cell (CD44) markers with prognostic parameters in breast carcinomas.

INTRODUCTION: In invasive breast cancer (IBC), tumour-associated macrophages and cancer stem cells in the tumour microenvironment are thought to be associated with poor prognosis, tumour growth, and metastasis. MATERIAL AND METHODS: In this study, we evaluated the relationship of CD68, CD163, CD11c, and CD44 expressions in the tumour microenvironment of IBC with prognostic parameters by immunohistochemical method. RESULTS: A correlation was found between high histological grade, oestrogen receptor/ progesterone receptor negativity, and high Ki-67 index in IBC, and the number of CD68-, CD163-, and CD11c-positive macrophages in the tumour microenvironment. In addition, in the tumour microenvironment, a correlation was found between IBC-specific subtypes and CD68, luminal A subtype relative to luminal B and CD163, HER2 score 3 cases, and CD11c-positive macrophage count. It was observed that CD44 expression in the tumour in IBC was not associated with the parameters examined. In addition, a high-level linear correlation was found between CD68- and CD163- and CD11c-positive macrophage counts. Tumour-associated macrophages in the tumour microenvironment in IBC may be a novel prognostic factor and an alternative avenue for targeted therapies. CONCLUSIONS: The fact that CD44 positivity in the tumour is not associated with prognostic parameters will contribute to the literature in this direction.

Evaluation of different stapler line strengthening techniques with burst pressures in patients undergoing sleeve gastrectomy. An experimental study.

AIM: Obesity is a leading cause of preventable death worldwide and is increasing in both adults and children. Bariatric surgery is the most effective treatment for this condition and its related comorbidities. We aimed to evaluate the effectiveness of different staple line reinforcement techniques on staple line reinforcement through bursting pressures. METHODS: Different stapler line strengthening techniques were performed on resected stomach patterns of 48 patients. The patients were enrolled prospectively into 4 groups according to surgeons preferred type of staple line reinforcement. Data concerning patient demographic variables, surgical parameters, postoperative complications, postoperative readmissions, burst pressure and burst point were collected. None of the obese patients were excluded from this study. RESULTS: There were no statistically significant differences in the characteristics of the groups. The number of staple cartridges fired and the linearity of the staple line were similar in all groups, (p 0.524-0.265). However, there were significant differences in the burst pressure measurements in groups I, II, IIIand IV (p .001). In all groups, the burst point on the staple line of resected stomach was most commonly in the fundus section. CONCLUSIONS: We believe that the burst pressure in Fibrin sealant group is significantly higher and that fibrin glue can be effective in preventing stapler line leakage. We believe that more advanced studies are needed. KEY WORDS: Fibrin Sealant, Leakage, Reinforcement.

Can superior mesenteric artery syndrome really be treated surgically?

AIM: Superior mesenteric artery (SMA) syndrome is a rare reason of small bowel obstruction (SBO). It is a complicated sickness. We aim to analyze the diagnosis, clinical presentation, SMAS management and postoperative outcomes after laparoscopic duodenojejunostomy. MATERIAL AND METHODS: A total of 19 patients who were diagnosed with SMAS and did not respond to the traditional treatment between January 2010 and November 2017 in Afyon Health Sciences University Hospital were included in the study. RESULTS: Their average age was 22.3 years (17-31 years). Number of males and females were 6 and 13, respectively. Clinical presentations of patients are as follow: 14 patients were referred to as postprandial distress syndrome, 3 were unexplained weight loss, and 2 were gastroesophageal reflux disease. Considering CT angiography findings, 14 patients had duodenal dilatation. The mean aortamesenteric angle was 10.6 mm. The mean of aorta-SMA distance was 5.1 mm. The mean hospital stay and follow-up times were 3.7 days and 40.2 months, respectively. No morbidity or mortality was found within patients. Preoperative, postoperative 6th month and postoperative 12th month CONUT scores were 9.1, 3.7, and 0.8, respectively. CONCLUSIONS: Laparoscopic duodenojejunostomy can be performed safely to the patients who do not benefit from conservative treatment. KEY WORDS: Aortamesenteric angle, Duodenojejunostomy, Weight loss.

Should intraoperative nerve monitoring be used routinely in primary thyroid surgeries?

OBJECTIVE: This study presents the effects of intraoperative nerve monitoring on RLN injuries in patients who underwent primary surgery for benign thyroid pathology. METHODS: We retrospectively evaluated the data of 273 patients who had primary thyroidectomy due to benign thyroid pathology between January 2012 and July 2017. The patients were classified into two groups. Group-1 consists of patients whose nerves were monitored. We separated the patients whose nerves were not monitored into Group-2. RESULTS: There were 140 and 133 patients in Groups 1 and 2, respectively. Regarding the age, gender and surgical indication between the groups, statistically significant difference was not found (P > 0.05). In Group-1, transient paralysis developed in four patients (2.9%). The permanent paralysis developed in one patient (0.7%). In Group-2, transient paralysis developed in nine patients (6.8%). The permanent paralysis developed in four patients (3%). When the groups were evaluated, there was statistically significant difference in terms of transient and permanent paralysis (P=0.01, P =0.001, respectively). CONCLUSIONS: In view of the negative effects of RLN injury on the patient, we think that intraoperative nerve monitoring should be used routinely in benign thyroid surgeries.

Results of the open surgery after endoscopic basket impaction during ERCP procedure.

AIM: To report the results of open surgery for patients with basket impaction during endoscopic retrograde cholangiopancreatography (ERCP) procedure. METHODS: Basket impaction of either classical Dormia basket or mechanical lithotripter basket with an entrapped stone occurred in six patients. These patients were immediately operated for removal of stone(s) and impacted basket. The postoperative course, length of hospital stay, diameter of the stone, complication and the surgical procedure of the patients were reported retrospectively. RESULTS: Six patients (M/F, 0/6) were operated due to impacted basket during ERCP procedure. The mean age of the patients was 64.33 ± 14.41 years. In all cases the surgery was performed immediately after the failed ERCP procedure by making a right subcostal incision. The baskets containing the stone were removed through longitudinal choledochotomy with the stone. The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients. All patients were also performed cholecystectomy additionally since they had cholelithiasis. In patients with T-tube placement it was removed on the 13(th) day after a normal T-tube cholangiogram. The patients remained stable at postoperative period and discharged without any complication at median 7 d. CONCLUSION: Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases.

An atypical cause of rapidly progressing breast lump with abscess formation: Pure squamous cell carcinoma of the breast.

Squamous cell carcinoma (SCC) is a rare type of breast malignancy and little is known about long-term outcome. In the present report, the clinical features, histopathologic findings and postoperative course of a patient with squamous cell carcinoma are described. We have treated a 47-years-old woman who admitted for right breast mass without any discharge, bleeding and pain. The tumor was, 3 × 2 × 1.5 cm in size with central abscess formation. The result of surgical biopsy revealed large cell keratinizing type of SCC. The metastatic work-up studies ruled out any other probable sources of primary tumor. The patient was performed modified radical mastectomy and axillary dissection and received two cycles of chemotherapy. Squamous cell carcinoma of the breast (SCCB) is a rare entity and should be considered in patients with rapidly progressing breast mass. It should also be considered in breast lesions with abscess formation. The initial therapeutic approach should be surgical excision after histopathological diagnosis.

Modified elliptical rotation flap for sacrococcygeal pilonidal sinus disease.

BACKGROUND: Although various surgical procedures have been described for pilonidal sinus disease, the best surgical technique is still controversial. The aim of this study was to evaluate the short-term results of modified elliptical rotation flap (MERF) for pilonidal sinus disease in terms of post-operative complications, recurrence and quality of life. METHOD: Data of 121 patients (10 women, 111 men) who were operated on for sacrococcygeal pilonidal sinus disease between 2011 and 2013 were analysed. Elliptical rotation flap procedure which was described by Nessar et al. was modified. Complications, quality of life and recurrence were evaluated. RESULTS: The mean operating time was 31 (range, 20-55) min. The mean time for complete healing was 2.26±0.72 weeks. The mean time for returning to daily activities was 9.0±2.2 days. There were no flap necrosis and recurrence. Post-operative infection developed in five (4.1%) patients, which was managed by removal of a few skin sutures, drainage and prolonged antibiotic use. Four patients (3.3%) developed a seroma, three of them having a partial wound dehiscence (2.5%). Neither haematoma formation nor complete dehiscence were observed. CONCLUSION: MERF seems to be an effective and reliable procedure having low morbidity rates and no recurrence. Further prospective randomized studies comparing the MERF with other flap techniques will provide better information about the technique.

Leptin increases mitotic index and regeneration ratio in hepatectomized rats.

BACKGROUND: The aim of this study was to evaluate the potential effect of intraperitoneal administration of leptin on the hepatic regeneration and the mitotic index. MATERIAL AND METHODS: 56 Sprague-Dawley rats were divided into 7 groups each containing 8 rats. Group 1 was evaluated as the sham group and no surgical procedure was performed on animals. The rats in groups 2, 3, and 4 (named C24, C48, C72, respectively) were given intraperitoneal injection of 2 ml/kg normal saline 60 minutes before the surgical procedure consisting of laparotomy and 70% hepatectomy. These groups were used as controls at 24, 48, and 72 hours. The rats in groups 5, 6, and 7 (named L24, L48, and L72, respectively) were given intraperitoneal injection of 20 µg/kg doses of recombinant mouse leptin 60 minutes before the same surgical procedure. These groups were evaluated as the experiment groups at 24, 48, and 72 hours. Blood samples were collected for aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and the remaining tissue samples were obtained for liver histopathology, regeneration rate, and mitotic index (MI). The weights of the remaining livers were also noted. RESULTS: The values of AST and ALT were higher in the groups that were administered leptin and they had significantly higher mitotic index than the other groups. Leptin also significantly increased the regeneration ratio as compared to the control group. The weights of the remaining livers were also higher in the leptin groups. CONCLUSIONS: Intraperitoneal administration of leptin was observed to increase liver regeneration and mitotic rate in 70% hepatectomized rats.

Laparoscopic preconditioning protects against oxidative injury in cerulein-induced pancreatitis rats (an experimental study).

BACKGROUND: Laparoscopic cholecystectomy, particularly in the same hospital stay, has been widely recommended to treat gallstone-pancreatitis over the last decade. Although pancreatitis produces severe oxidative injury, laparoscopy exerts an additional effect over that is produced by pancreatitis. The preconditioning phenomenon previously reported as protective in open surgery is a beneficial maneuver also in laparoscopic surgery. So in the present study we have tried to find out the effect of laparoscopic preconditioning over the pancreatitis in cerulein-induced pancreatitis rats. METHODS: Acute pancreatitis was induced in 24 rats weighing between 280 and 350 g by three subcutaneous injection of 80 µg/kg of body weight cerulein. A 1-cm midline laparotomy was performed for all rats, and then they were randomly assigned to one of the following three groups (n=8 for each): Group I (control), Group II (laparoscopy), and Group III (laparoscopic preconditioning [L-Pre]). After that, a catheter was placed into the peritoneum for the creation of the pneumoperitoneum (Pp) in all the animals except the control group. The rats of Groups II and III were subjected to 60 minutes of Pp with 15 mm Hg intraabdominal pressure followed by 30 minutes of deflation. The L-Pre procedure was applied to Group III immediately before the laparoscopic procedure. Blood samples were taken for biochemical assays. Pancreas tissue samples were taken for light microscope analysis. RESULTS: The light microscopy of the pancreas tissues revealed that cerulein injection caused edema and sparse inflammatory cell infiltration mimicking the edematous pancreatitis. However, the application of laparoscopy over the pancreatitis produced significant inflammatory cell infiltration, acinus vacuolization, and necrosis (in one case) in addition to edema. But, the laparoscopic preconditioning maneuver applied before the laparoscopy significantly decreased in particular acinary vacuolization and cell infiltration. Therefore the total sum of the histopathological score of the L-Pre group was significantly less than that of the laparoscopy group. The biochemical analysis of the groups revealed that laparoscopy caused significant elevation of malondialdehyde levels and decrease of reduced glutathione values. However, the addition of preceding preconditioning produced significant amelioration of these parameters. CONCLUSION: Laparoscopic preconditioning may be a useful method to decrease the oxidative injury in cases undergoing cholecystectomy for biliary pancreatitis. But, it should be emphasized that this was a restricted experimental study, and further clinical studies are needed to adopt these results into clinical settings.