The Role of Serum Dickkopf1 and CKAP4 Levels in Diagnosing Colorectal Cancer and Measuring the Disease Severity: A Prospective Study.

Background and Objective: Colorectal cancer (CRC) is among the most common types of cancer. Although the disease is treatable in its early stages, five-year survival falls below 20% in the later stages. CEA and CA19-9 are tumor markers used in the diagnosis and follow-up of the disease in clinical practice; however, their diagnostic effectiveness is insufficient. Therefore, the identification of biomarkers that can be easily studied from serum and can diagnose CRC and determine its severity is highly important. In this context, dickkopf1 (DKK1) and cytoskeleton-associated protein 4 (CKAP4) are both promising biomarkers. Materials and Methods: Serum DKK1 and CKAP4 levels were measured in 55 patients with CRC and 40 healthy controls. The patients with CRC were divided into groups based on pathological stages and histological differentiation. The serum levels of both proteins in patients with CRC were measured preoperatively and 10 and 30 days postoperatively. Results: Serum DKK1 and CKAP4 were significantly higher in the CRC group than in the healthy controls (p < 0.05). Serum levels of both proteins rose in line with the disease stage and grade but decreased following surgical resection. A positive correlation was observed between tumor diameter and protein blood levels. The diagnostic efficacy of DKK1 and CKAP4 in CRC (approximately 95%) was higher than that of markers such as CEA and CA19-9. Conclusions: The DKK1 and CKAP4 serum values of patients with CRC are promising biomarkers. They can potentially be used in CRC management, namely, in the diagnosis and treatment of tumor response access and in tumor aggressiveness prediction.

Diagnostic value of serum levels of galanin and obestatin in patients with gastric cancer.

OBJECTIVE: Gastric cancer ranks the third among the cancer-related deaths. It is diagnosed at advanced stage in many patients due to malignant proliferation and has a poor prognosis. Currently, no instrument or biomarker has been proven to diagnose the disease before the advanced stages. This study aimed to measure the serum levels of galanin and obestatin, which were examined in various studies including cancer studies, and to discuss their diagnostic value in gastric cancers. METHODS: In this study, 30 adult patients with gastric cancer and 30 healthy adults in the control group were examined prospectively. The demographic characteristics and serum levels of galanin and obestatin in the patient and control groups were recorded. RESULTS: The mean serum level of galanin in the patient and control groups was 19.73±5.04 and 35.59±10.94 pg/mL, respectively. The mean serum level of obestatin in the patient and control groups was 40.21±5.82 and 15.15±3.32 ng/mL, respectively. A significant difference was found between the groups (p<0.001). CONCLUSION: Serum levels of galanin were lower and serum levels of obestatin were higher in patients with gastric cancer compared to the healthy individuals. Serum levels of obestatin and galanin can be used as potential biomarkers in the diagnosis of gastric cancer.

Diagnostic value of serum levels of galanin and obestatin in patients with gastric cancer

SUMMARY OBJECTIVE: Gastric cancer ranks the third among the cancer-related deaths. It is diagnosed at advanced stage in many patients due to malignant proliferation and has a poor prognosis. Currently, no instrument or biomarker has been proven to diagnose the disease before the advanced stages. This study aimed to measure the serum levels of galanin and obestatin, which were examined in various studies including cancer studies, and to discuss their diagnostic value in gastric cancers. METHODS: In this study, 30 adult patients with gastric cancer and 30 healthy adults in the control group were examined prospectively. The demographic characteristics and serum levels of galanin and obestatin in the patient and control groups were recorded. RESULTS: The mean serum level of galanin in the patient and control groups was 19.73±5.04 and 35.59±10.94 pg/mL, respectively. The mean serum level of obestatin in the patient and control groups was 40.21±5.82 and 15.15±3.32 ng/mL, respectively. A significant difference was found between the groups (p<0.001). CONCLUSION: Serum levels of galanin were lower and serum levels of obestatin were higher in patients with gastric cancer compared to the healthy individuals. Serum levels of obestatin and galanin can be used as potential biomarkers in the diagnosis of gastric cancer.

Endoscopic Retrograde Cholangiopancreatography in Pediatric Patients.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic technique used in the diagnosis and treatment of pancreaticobiliary system. ERCP is used less frequently in children than in adults due to the rarity of pancreaticobiliary diseases and technical difficulties. However, ERCP is a safe, effective diagnosis and treatment tool for children. Methods: All patients within the age range of 1-19 years, who underwent ERCP between 2010 and 2021 at our endoscopy unit, were retrospectively examined. Patient demographics, use of imaging methods, indications, type of sedation, interventions, success of ERCP, findings, and complications were evaluated. Results: Overall, 105 ERCPs were performed in 66 children (29 male and 37 female). The indications were choledocholithiasis, cyst hydatic, choledochal cyst, biliary atresia or anomaly, liver transplantation-related disorders, and pancreatic disorders, respectively. ERCP was finished as diagnostic ERCP in 20% and as therapeutic in 80%. Therapeutic procedures were sphincterotomy, stent placement or removal, stone or debris extraction, and balloon sweep or dilatation, respectively. The success rate in the procedures was 75.23%. The overall complication rate was 15.23%. Postprocedure pancreatitis occurred in 11.42%, hemorrhage occurred in 2.85%, and aggravation of cholangitis in 0.95%. All complications were managed conservatively. Conclusion: ERCP in pediatric patients is a safe procedure that can be performed by adult endoscopists with high success rates. Since our region is an endemic region for hydatid cyst disease, the most common ERCP indication after choledocholithiasis is procedures related to liver hydatid cyst disease. The most common complication was pancreatitis, and complications were treated medically.

A Focus on Intra-Abdominal Sepsis with Biomarkers: A Literature Review.

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection according to the Third International Consensus Definitions for Sepsis and Septic Shock definitions. It is a clinical condition with high morbidity and mortality due to its complex pathophysiology and lack of a complete treatment. It constitutes a significant economic burden because it constitutes a substantial part of intensive care patients, and the treatment process is lengthy and costly. Therefore, early diagnosis and treatment of the disease are essential. After pneumonia, an essential source of sepsis is intra-abdominal infection. Due to the presence of multiple and polymicrobial sources of infection, abdominal sepsis progresses more seriously. The effective treatment of intra-abdominal infection consists of early recognition of the disease, control of the source, appropriate antibiotic therapy, and stabilization in the intensive care setting with an excellent surgical approach. We searched PubMed, EMBASE, MEDLINE, and the Cochrane Library. Two authors reviewed all identified abstracts and selected articles for full-text review. We included original studies assessing mediators in intraabdominal sepsis. Inflammatory and protein mediators such as acute phase protein and chemokine cytokines play an essential role in intra-abdominal sepsis. In clinical practice, white blood cell count, C-reactive protein, and procalcitonin are the most used parameters in the definition of abdominal infection. Tumor necrosis factor-alpha, interleukin-6, high-mobility group protein B1, and presepsin are other markers with high diagnostic efficiency, even though they are not used routinely. Despite everything, there is a need for highly effective markers that can be used in the diagnosis and follow-up of sepsis. Great hope is attached to these markers. This review aims to discuss the importance of the most used markers in the diagnosis and follow-up of abdominal sepsis and the markers on which there are essential studies in light of current literature.

Factors affecting the mortality at patients with burns: Single centre results.

BACKGROUND: Burns are a primary cause of mortality along with the severe physical and psychological morbidities in patients and their families. Such kinds of injuries bring about considerable financial burdens due to the treatment processes and sequels. The present study aims to investigate the factors that affect the mortality of burns. METHODS: The archives files of the patients admitted because of burn injuries in our burn centre between September 2008 and December 2016 were examined in this study. Some of the lab values, such as age, sex, percentage of total burn surface area (TBSA), referral status, burning site, degree of burns, time of admission to hospital, aetiology of burning, blood and blood products collection, complete blood count, routine biochemistry, coagulation parameters, C-reactive protein (CRP), sedimentation rate, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), were examined while evaluating the patients' mortalities. RESULTS: A total of 133 patients were included in this study. The patient's age (p=0.001), the degree of burns (p<0.001), surface area of burns (p<0.001), the time of hospital admission (p<0.001), burning aetiology (p=0.006), erythrocyte suspension, fresh frozen plasma, along with the administration of albumin transfusion (p<0.001), mean platelet volume (MPV) (p=0.028), NLR (p<0.001) and PLR (p<0.030) values were found to be associated with mortality in patients with burns. CONCLUSION: In this study, age, burn grade, TBSA, hospital admission time, burn aetiology, erythrocyte, fresh frozen plasma and albumin transfusion, MPV, NLR and PLR values were found to be associated with mortality in patients with burns. With this study, it is possible to produce the treatment guidelines to reduce mortality by taking these parameters into consideration, which were determined to be associated with mortality while evaluating the patients with burns.

A retrospective analysis of 2713 hospitalized burn patients in a burns center in Turkey.

BACKGROUND: Burn trauma is a significant health problem that has physical, psychological, and economic repercussions on affected patients. The aim of this study was to present epidemiological and demographic characteristics of patients treated over an 8-year period at a reference burn treatment center located in the northeast of Turkey and serving a population of approximately four million people. METHODS: Each patient's medical record was reviewed, and demographic features, source of burns, place of residence, total body surface area (TBSA), surgical treatment, duration of hospital stay, and mortality rates were analyzed. RESULTS: The most frequent cause of burn was scalding from hot liquids (2013 cases, 74.2%). Freeze burn was observed in 16 (0.6%) cases due to climatic conditions of the region where our burn center is located. Grouping based on TBSA revealed that 88.7% patients had TBSA of 0%-15%, 8% patients had TBSA of 15%-30%, and 3.3% patients had TBSA ≥ %30.The most common microorganism was Pseudomonas aeruginosa. A total of 24 patients (0.9%; 8 males, 16 females) died, including 7 children and 17 adults. CONCLUSION: Removal of tandirs and replacement with high ovens, restriction of cheese and butter production under primitive circumstances, encouraging cheese and butter production via dairy farm systems, and raising people's awareness through training programs could greatly reduce the number of the burn accidents occurring in this region.

Breast Recurrent Hydatid Cyst Disease.

Introduction: Hydatid cyst is a zoonotic disease seen in endemic areas. It is an important health problem in our country and especially in our Eastern and South-eastern Anatolia Region. Involvement of isolated breast tissue is very rare in hydatid cystdisease. As far as we know, isolated recurrent breast cyst hydatidosis has not been found in the literature. CASE REPORT: We aimed to present the case of a patient who was diagnosed with recurrent isolated cyst hydatid in the same breast, operated on because of hydatid cyst in the right breast 9 years ago. CONCLUSION: A hydatid cyst should be considered, particularly in endemic regions, in the differential diagnosis of cystic masses of the breast. If the patient has previously undergone surgery for breast cyst hydatid disease, recurrent cyst hydatid disease should be considered at the differential diagnosis.

Resistin: New serum marker for predicting severity of acute pancreatitis.

OBJECTIVE: To assess the effectiveness of resistin in predicting the severity of acute pancreatitis. METHODS: Patients with acute pancreatitis who presented at the Gastroenterology Clinic, Erzurum Education and Research Hospital, Turkey were enrolled in this prospective study. White blood cell (WBC), C-reactive protein (CRP) and resistin levels were measured on admission and at 24 h, day 3 and day 7 following admission, along with other blood parameters. Patients were divided into two groups: mild acute pancreatitis and moderate/severe acute pancreatitis. RESULTS: Of 59 patients with acute pancreatitis (mild, n = 37; moderate/severe, n = 22), significant between-group differences were found in terms of resistin and CRP levels. Receiver operating curve analysis showed that resistin levels were better for predicting severe cases of acute pancreatitis than CRP or WBC levels on day 3 (area under the curve [AUC], 0.88 versus 0.81 and 0.63, respectively). Resistin levels on day 3 were better than CRP levels for predicting necrosis development (AUC, 0.70 versus 0.69, respectively). CONCLUSIONS: Resistin may represent a new, effective indicator to predict the severity of acute pancreatitis and presence of necrosis in patients with acute pancreatitis.

The role of diminishing appetite and serum nesfatin-1 level in patients with burn wound infection.

BACKGROUND: The burn wound represents a susceptible site for opportunistic colonization by organisms of endogenous and exogenous origin. Diminishing appetite is known to occur in patients with burn infection, yet its underlying reason is not fully understood. We have examined the levels of nesfatin 1, a protein that we consider to be a potential new treatment target for the solution of appetite and nutrition problem in patients with burn infection. OBJECTIVES: The aim of the present study was therefore to examine nesfatin levels in patients with burn infection. MATERIAL AND METHODS: Laboratory values, medication and dietary records, and patient notes with diagnostic information of burn wounds patients who were admitted to the Division of Burn Treatment Center were obtained from the Erzurum Region Education and Research Hospital electronic database. Post-burn wound infection was objectively assessed by culturing wound homogenates from skin tissue. The main immediate inflammatory stress response parameters assessed were serum CRP concentrations, WBC counts, and blood nesfatin concentrations. RESULTS: Scalding was the predominant cause of burns in both categories of patients. In 19 (61.3%) burn wound infection patients, the burns were due to a scald. A significant difference was found for the nesfatin, CRP, and WBC levels between the patients and the control group (P = 0.000). A significant difference was also determined between the nesfatin, CRP, and WBC figures at the time of hospitalization and at discharge from the hospital (P = 0.000). The most predominant bacterial isolate was Pseudomonas aeruginosa 16 (51.6%) followed by Methicilline resistant Staphylococcus aureus (MRSA) 7 (22.6%). CONCLUSIONS: We showed that the serum nesfatin 1 level was significantly lower in the patients with burn than in the control group in our study. We considered that the central nesfatin 1 system should be taken into consideration, rather than the peripheric nesfatin 1 system, when considering the regulation of appetite in patients with burns and particularly those accompanied by infection. In other explanation of the observed negative correlation between nesfatin 1 and burn wound infection suggests that nesfatin 1 may indicate the possible contribution of nesfatin 1 to the energy homeostasis.

Laparoscopic cholecystectomy in patients with situs inversus totalis: literature review of two patients.

Situs inversus totalis is a rare condition, which presents difficulties in diagnosis and treatment of gallstones due to the reversal location of abdominal organs. In this article we present 2 cases of women in age of 51 and 55 years with situs inversus totalis and gallstones. There are described the clinical and imaging features, also the laparoscopic surgery with the difficulties encountered by right handed surgeon. In patients with situs inversus totalis, laparoscopic surgery may be performed safely by a surgeon with experience.

Biochemical and histopathological investigation of the protective effect of disulfiram in ischemia-induced ovary damage.

It was biochemically and histopathologically investigated whether disulfiram has protective effects on ischemia-induced ovary damage. For this purpose, levels of tGSH, superoxide dismutase (SOD), malondialdehyde (MDA), and 8-OH Gua/Gua were investigated in ischemic rat ovary tissue. Results show that used doses of disulfiram (10, 25, and 50 mg/kg) prevent MDA, a product of ischemia-induced lipid peroxidation, formation in female rat ovary tissue and prevent decrease of enzymatic and non-enzymatic (SOD, GSH) antioxidant parameters. Additionally, all doses of disulfiram significantly prevent DNA damage when compared to control group. Fewer histopathological findings were observed in tissues with higher antioxidant levels and lower oxidant and DNA damage levels.

A case of bacillary angiomatosis developed at a burn site.

Bacillary Angiomatosis (BA) is frequently seen in patients with human immunodeficiency virus (HIV)-induced immunodeficiency. Our patient was a case that developed granuloma-like lesions in the area of a burn, 8 days after being burnt on the upper right arm by scalding water. No indication of immune deficiency was observed and no history of direct contact with cats was evident. By the sixth day of the patient's admission to our clinic, some of the lesions had reached a diameter of 2.5 cm. An excision biopsy was carried out from the lesions present on the patient. Electron microscopy revealed solitary bacilli located close to the capillary wall. Oral erythromycin treatment was implemented at 250 mg, 4 times a day for 2.5 months. Within this period of treatment, the lesions regressed completely, and a complete cure was achieved. This case demonstrates that BA must be considered in the differential diagnosis of both HIV-infected and immunocompetent patients.

Liver alveolar echinococcosis metastasized to the breast.

BACKGROUND: Alveolar echinococcosis (AE) is a potentially fatal and chronically progressive infestation produced by the multivesicular metacestode of Echinococcus multilocularis, which most commonly affects the liver, lungs, and brain. CASE REPORT: We present a case of AE in which an alveolar cyst, as a result of exophytic growth, adhered to intra-abdominal and pelvic organs and metastasized to the breast. Exploration showed that the exophytic cyst in the liver filled the entire abdominal cavity, reaching to the uterus and bladder, and was adherent to the neighboring tissues and organs. This cystic lesion was totally excised, as was the 7×6 cm cystic lesion in the right breast. CONCLUSIONS: The liver is the most common site for echinococcal cysts of the pastoral strains (>65%), followed by the lungs (25%); the cyst is seen less frequently in the spleen, kidneys, heart, bone, and central nervous system. AE must be considered in areas where liver cysts are endemic and in the presence of a liver cyst, and the organs where a metastasis is possible must be thoroughly investigated. Furthermore, in these areas, when cystic disorders of the breast are present, AE should not be discounted among possible definitive diagnoses.

The effects of testosterone on intestinal ischemia/reperfusion in rats.

ABSTRACT Ischemic injury to the gut is believed to occur in many serious clinical conditions. Our aim was to investigate the postischemia/reperfusion (I/R) effects of exogenously administered testosterone on the intestines of normal and orchiectomized rats.Forty-eight rats were divided into eight groups of six animals: (1) Sham-operated control group; (2) Sham-operated + testosterone-treated group; (3) I/R group: Rats were subjected to the surgical procedures and underwent intestinal ischemia for 60 min followed by reperfusion for 60 min; (4) I/R + testosterone-treated group: Rats were subjected to the surgical procedures and received testosterone 100 mg/kg (i.p.); (5) I/R + orchiectomy group: Rats were subjected to the surgical procedures as well as orchiectomy; (6) orchiectomy group: Rats were subjected to the surgical procedures as well as orchiectomy; (7) orchiectomy + testosterone-treated group: Rats were subjected to the surgical procedures as well as orchiectomy and received testosterone 100 mg/kg (i.p.); and (8) I/R + orchiectomy + testosterone-treated group. The histological findings of this study paralleled the observed degree of lipid peroxidation (LPO) and protein oxidation. Intestinal mucosal injury was extensive in the I/R, I/R + orchiectomy, and I/R + orchiectomy + testosterone groups, but was less in the I/R + testosterone group. Histopathological injury also paralleled the degree of oxidative stress. Apoptotic enterocytes were more numerous in the I/R, I/R + orchiectomy, and I/R + orchiectomy + testosterone groups. Administration of testosterone in the presence of testes significantly protected intestinal tissue against I/R mucosal injuries, while administration of testosterone in the absence of testes did not significantly protect intestinal tissue against I/R mucosal injuries.

Effects of epinephrine and cortisol on the analgesic activity of metyrosine in rats.

Some endogenous hormones (epinephrine and cortisol) can change an individual's pain threshold. Propranolol is a non-selective ß adrenergic receptor blocker which antagonises the anti-inflammatory effect of non-steroidal anti-inflammatory drugs via the ß1 and ß2 adrenergic receptors. The roles of epinephrine and cortisol were investigated in the analgesic activity of metyrosine in rats with reduced epinephrine levels induced by metyrosine. Pain threshold measurement was performed using an analgesimeter with different doses and the single or combined usage of metyrosine, prednisolone, metyrapone and propranolol in rats. Epinephrine and corticosterone levels were measured by high-performance liquid chromatography in metyrosineadministered rats. Metyrosine reduces the epinephrine levels without affecting the corticosterone levels, thereby creating an analgesic effect. It was determined that prednisolone did not have an analgesic effect in rats with normal epinephrine levels, but its analgesic activity increased with a parallel decrease in the epinephrine levels. Similarly, the combined use of prednisolone and metyrosine provided a stronger analgesic effect than that rendered by metyrosine alone. The strongest analgesic effect, however, was observed in the group of rats with the lowest epinephrine level in whom the metyrosine + prednisolone combination was administered. The findings of this study may be useful in severe pain cases in which the available analgesics are unable to relieve the individual's pain.

A comparison of the morbidity and mortality of tandir burns and non-tandir burns: experience in two centers.

BACKGROUND: We examine herein the demographic characteristics, implemented treatment methods, infection rates, and morbidities of patients with tandir burns from two burn centers. METHODS: In this study, gender, age, socioeconomic status, total body burn ratio, burn area, burn level, microorganisms isolated in burn wounds, implemented treatments, length of hospital stay, debridement and grafting operations, extremity amputations, and mortality among burn patients were investigated. RESULTS: Tandir burn patients were treated in the hospital for an average of 27.6 ± 9.5 days, while non-tandir burn patients were treated for a period of 16.5 ± 12.5 days. A significant difference was found between the hospitalization periods of the two groups (p<0.001). Similarly, while the total burn surface area average of the tandir burn patients was 17.4% ± 12.3%, the total burn surface area average of the non-tandir burn patients was 10.6% ± 9.9%, and a significant difference was found between the two (p<0.001). CONCLUSION: In our study, it was determined that tandir burns were deeper than other burns, and that hospitalization durations were longer than for other burn causes. Surgical intervention was also more prevalent among patients with tandir burn than among those with other burn causes.

Intraoperative sentinel lymph node mapping in patients with colon cancer: study of 38 cases.

BACKGROUND/AIMS: Sentinel lymph node mapping has become a cornerstone of oncologic surgery because it is a proven method for identifying nodal disease in melanoma and breast cancer. In addition, it can ameliorate the surgical morbidity secondary to lymphadenectomy. However, experience with sentinel lymph node mapping for carcinoma of the colon and other visceral malignancies is limited. The purpose of this study was to evaluate the feasibility and reliability of in vivo sentinel lymph node mapping in patients with colon cancer. METHODS: In the period March 2004 through June 2009, 38 patients underwent curative surgery for colon cancer. Thirty-eight patients with intraperitoneal colon tumors undergoing resection were studied prospectively. Sentinel lymph nodes were identified as the first blue-stained node(s) after in vivo peritumoral injection of Isosulfan blue dye. RESULTS: Detection of sentinel lymph nodes was successful in 36 out of 38 colon cancer patients. In 94.7% of the patients with colon cancer, at least one sentinel lymph node was found. No patients had a false negative sentinel node. The sensitivity was 100%, with a negative predictive value of 100%. Aberrant lymphatic drainage was not identified in any patient. CONCLUSION: The technique of in vivo sentinel lymph node mapping is technically feasible with high sensitivity, high negative predictive value, and high accuracy. Although sentinel lymph node mapping did not alter the surgical management of colon cancer, it does make possible a more focused and cost-effective pathologic evaluation of nodal disease.

Mesenteric calcified cystic lymphangioma in an adult patient.

Abdominal cystic lymphangiomas are rare congenital benign malformations of the lymphatic system. To the best of our knowledge, only 6 mesenteric calcified cystic lymphangiomas have ever been reported. We herein describe a woman who presented to our hospital with stomachache that had been continuous for approximately 8 months. An abdominal computed tomography showed a cystic lesion. In the exploration, the cyst was totally excised. Based on the histomorphological data, a case of "calcified cystic lymphangioma" was diagnosed. Although mesenteric lymphangiomas are rare, especially in adults, they should be considered as a possible cause of abdominal pain. Treatment is surgical with resection of the mass, sometimes including resection of adjacent bowel.