Immobilization techniques' influence on treatment plan results in postmastectomy radiotherapy.

Purpose: To compare different immobilization devices used for chest wall and nodal irradiation in breast cancer dosimetrically. Materials and Methods: All patients with left-sided breast cancer received chest wall and lymphatic irradiation. Treatment plans were created for radiotherapy in single arm (SA) lift board, double arm (DA) lift board, and wing board (WB) positions. Dose-volum e histograms (DVH) were used for evaluation based on planning target volume (PTV) coverage and organs at risk (OARs). One-way analysis of variance (ANOVA) test was performed to identify the dose-volume differences among different immobilization techniques. Results: Clinically acceptable plans were generated with all immobilization boards. Significantly lower doses in the body except target volumes were found in the SA lift board group compared to other groups (P < 0.05). No relevant differences were observed among the plans according to the other dose parameters of target volumes and OARs. Conclusion: SA board is an immobilization device that can be used safely for three-dimensional conformal radiotherapy in young left-sided breast cancer with an unfavorable anatomy as it significantly reduces low-dose exposure.

A biomechanical study: Comparison of three different implant options in high Tibial osteotomy.

BACKGROUND: Many implant options could be preferable for fixation after osteotomy in varus knee medial compartment arthrosis. Due to usage characteristics, it is important to compare the biomechanical properties of them. For this purpose, we aimed to examine three different implant types biomechanically in our study. METHODS: Ovine tibiae undergoing medial open-wedge high tibial osteotomy were fixed in vitro with three different implants using an angular wedge plate, a metal block plate and an external fixator system. The fixed ovine tibiae were subjected to axial tensile, axial loading and three-point bending tests in a test machine. All biomechanical tests were repeated five times, the maximum and minimum values were ignored, and the average values of the remaining three test results were taken into account. The test results were interpreted after converted into force-elongation curves in Trapezium-X software. FINDINGS: Biomechanical test results revealed some differences between implant types. While the metal block plate had the highest axial tensile strength value, it was the fixation group showing the lowest strength in axial load tests. The used fixator system was the highest strength in axial load tests and the lowest strength in axial tensile tests. INTERPRETATION: Considering the clinically significant forces related to the biomechanical stability of the three different implants used for high tibial osteotomy, the fixator system would appear to be slightly superior, although it should be noted that torsional forces, as well as parameters that could change in living tissue, might affect the results.

Indoleamine-2,3-dioxygenase-related anti-inflammatory effects of 3-aminobenzamide and infliximab in experimental colitis.

OBJECTIVE: This study aimed to investigate the presence of indoleamine-2,3-dioxygenase and bacterial translocation after the administration of 3-aminobenzamide and infliximab in the TNBS model of rat colitis. METHODS: The study group was divided into five categories as follows: group 1: (control), group 2: colitis+saline, group 3: colitis+3-aminobenzamide, group 4: colitis+infliximab, and group 5: colitis+3-aminobenzamide+infliximab. Intestinal mesenteric cultures were incubated on specific agar media plates under aerobic and anaerobic conditions, bacterial translocation was evaluated and assessed as colony-forming units per gram of tissue. Colonic tissue samples were evaluated by Western blotting method to detect the presence of indoleamine-2,3-dioxygenase. RESULTS: The results obtained were as follows: group 1: normal gut flora; group 2: eight of nine samples had bacterial translocation, of which six of them had positive indoleamine-2,3-dioxygenase protein; group 3: five of nine samples had bacterial translocation, of which seven of them had positive indoleamine-2,3-dioxygenase; group 4: three of nine samples had bacterial translocation, of which seven of them had positive indoleamine-2,3-dioxygenase; and group 5: only one sample had exact indoleamine-2,3-dioxygenase protein. CONCLUSION: Altered expression of indoleamine-2,3-dioxygenase results in a lower bacterial translocation via infliximab compared with 3-aminobenzamide treatment. Combined treatments emphasized different approaches for the new molecules related to indoleamine-2,3-dioxygenase.

Fibrinogen-to-albumin ratio may be a predictor for ascending aortic aneurysm.

OBJECTIVE: The predictive value of the fibrinogen-to-albumin ratio has been evidenced in coronary artery disease. Available data demonstrated that inflammation and oxidative stress are the relevant mechanisms of ascending aortic aneurysm formation and dilatation. The fibrinogen-to-albumin ratio reflects oxidative stress and inflammation. This study investigated the correlation between fibrinogen-to-albumin ratio and ascending aortic aneurysm. METHODS: A total of 250 consecutive patients with ascending aortic aneurysm and 250 consecutive patients with normal ascending aortic diameter were included in the study using comprehensive transthoracic echocardiography. All data and fibrinogen-to-albumin ratio were compared between two groups. RESULTS: The fibrinogen-to-albumin ratio levels were significantly higher in ascending aortic aneurysm group compared with normal ascending aortic diameter group (p<0.001). Also, there was significantly positive correlation between the diameter of the ascending aorta and the fibrinogen-to-albumin ratio (p<0.001). CONCLUSION: Fibrinogen-to-albumin ratio is associated with ascending aortic aneurysm and may serve as blood marker for identifying high-risk patients.

Association of XRCC1 and ERCC2 promoters' methylation with chromatin condensation and sperm DNA fragmentation in idiopathic oligoasthenoteratozoospermic men.

The aim of the study was to investigate whether the promoter methylation of XRCC1 and ERCC2 genes is associated with sperm DNA fragmentation and chromatin condensation in idiopathic oligoasthenoteratozoospermic men. This study involved 77 infertile men with idiopathic oligoasthenoteratozoospermia and 51 normozoospermic controls. The methylight method, TUNEL assay and aniline blue staining were used for the evaluation of XRCC1 and ERCC2 genes' methylation, SDF and sperm chromatin condensation, respectively. SDF (p = .004) and XRCC1 methylation (p = .0056) were found to be significantly higher in men with idiopathic OAT than in the controls, while mature spermatozoa frequency was higher in controls as compared to infertile men (p < .0001). No significant association was found between SDF and methylation of XRCC1 and ERCC2 genes (p = .9277 and p = .8257, respectively). However, compared to the cut-off point obtained by receiver operating characteristic analysis, a significant association was found between SDF and XRCC1 methylation, positive and negative methylation groups, generated according to the cut-off value for XRCC1. XRCC1 methylation was found to have a significant effect on chromatin condensation (p = .0017). No significant difference was detected among ERCC2 methylation, male infertility and SDF. In conclusion, XRCC1 methylation may have a role in sperm chromatin condensation and idiopathic OAT.

Frontal plane QRS-T angle may be a predictor for post-coronary artery bypass graft surgery atrial fibrillation.

BACKGROUND: New-onset postoperative atrial fibrillation (POAF) is the most common arrhythmia following coronary artery bypass graft surgery (CABG) and is associated with prolonged hospitalization, stroke, and mortality. The frontal plane QRS-T [f(QRS-T)] angle, which is defined as the angle between the directions of ventricular depolarization (QRS-axis) and repolarization (T-axis), is a novel marker of ventricular repolarization heterogeneity. The f(QRS-T) angle is associated with adverse cardiac outcomes. In light of these findings, in this study, we aimed to investigate the potential relationship between the f(QRS-T) angle and POAF. METHODS: 180 patients who underwent CABG between August 2017 and September 2018 were included in the study retrospectively. Two groups were established as patients who preserved postoperative sinus rhythm (n=130) and those who developed POAF (n=50). The f(QRS-T) angle and all other data were compared between groups. RESULTS: The fF(QRS-T) angle (p<0.001), SYNTAX score (p=0.039), serum high-sensitivity CRP levels (p=0.026), mean age (p<0.001), electrocardiographic left ventricular hypertrophy rate (LVH) (p=0.019), and hypertension rate (p=0.007) were higher, and the mean left ventricular ejection fraction (LVEF) (p<0.001) was lower in the POAF group. Multivariable logistic regression analyses demonstrated that lower LVEF (p=0.004), LVH (p=0.041), and higher age (p=0.008) and f(QRS-T) angle (p<0.001) were independently associated with POAF. CONCLUSIONS: High f(QRS-T) angle level is closely associated with the development of POAF. The f(QRS-T) angle can be a potential indicator of POAF.

Frontal plane QRS-T angle may be a predictor for post-coronary artery bypass graft surgery atrial fibrillation

SUMMARY BACKGROUND: New-onset postoperative atrial fibrillation (POAF) is the most common arrhythmia following coronary artery bypass graft surgery (CABG) and is associated with prolonged hospitalization, stroke, and mortality. The frontal plane QRS-T [f(QRS-T)] angle, which is defined as the angle between the directions of ventricular depolarization (QRS-axis) and repolarization (T-axis), is a novel marker of ventricular repolarization heterogeneity. The f(QRS-T) angle is associated with adverse cardiac outcomes. In light of these findings, in this study, we aimed to investigate the potential relationship between the f(QRS-T) angle and POAF. METHODS: 180 patients who underwent CABG between August 2017 and September 2018 were included in the study retrospectively. Two groups were established as patients who preserved postoperative sinus rhythm (n=130) and those who developed POAF (n=50). The f(QRS-T) angle and all other data were compared between groups. RESULTS: The fF(QRS-T) angle (p<0.001), SYNTAX score (p=0.039), serum high-sensitivity CRP levels (p=0.026), mean age (p<0.001), electrocardiographic left ventricular hypertrophy rate (LVH) (p=0.019), and hypertension rate (p=0.007) were higher, and the mean left ventricular ejection fraction (LVEF) (p<0.001) was lower in the POAF group. Multivariable logistic regression analyses demonstrated that lower LVEF (p=0.004), LVH (p=0.041), and higher age (p=0.008) and f(QRS-T) angle (p<0.001) were independently associated with POAF. CONCLUSIONS: High f(QRS-T) angle level is closely associated with the development of POAF. The f(QRS-T) angle can be a potential indicator of POAF.

RESUMO OBJETIVO: A fibrilação atrial pós-operatória de início recente (Poaf) é a arritmia mais comum após a cirurgia de revascularização do miocárdio (CABG) e associada a hospitalização prolongada, acidente vascular cerebral e mortalidade. O ângulo QRS-T [f(QRS-T)] do plano frontal, que é definido como o ângulo entre as direções da despolarização ventricular (eixo-QRS) e repolarização (eixo-T), é um novo marcador da heterogeneidade da repolarização ventricular. O ângulo f(QRS-T) está associado a desfechos cardíacos adversos. À luz desses achados, neste estudo, objetivamos investigar a relação potencial entre o ângulo f(QRS-T) e a Poaf. MéTODOS: Cento e oitenta pacientes submetidos a CABG entre agosto de 2017 e setembro de 2018 foram incluídos no estudo retrospectivamente. Dois grupos foram estabelecidos como pacientes com ritmo sinusal pós-operatório (n=130) e com Poaf (n=50). O ângulo f(QRS-T) e todos os dados foram comparados entre os grupos. RESULTADOS: Ângulo f(QRS-T) (p<0,001), escore Syntax (p=0,039), níveis séricos de PCR de alta sensibilidade (p=0,026), idade média (p<0,001), taxa de hipertrofia ventricular esquerda eletrocardiográfica (LVH) (p=0,019) e taxa de hipertensão (p=0,007) foram maiores; a fração de ejeção média do ventrículo esquerdo (LVEF) (p<0,001) foi menor no grupo com Poaf. As análises de regressão logística multivariável demonstraram que menor LVEF (p=0,004), LVH (p=0,041), maior idade (p=0,008) e maior ângulo f(QRS-T) (p<0,001) foram independentemente associados à Poaf. CONCLUSÕES: Níveis de ângulo altos f(QRS-T) estão intimamente associados à Poaf. O ângulo f(QRS-T) pode ser um indicador potencial de Poaf.

Endocrine Surgery during the COVID-19 Pandemic: Recommendations from the Turkish Association of Endocrine Surgery.

The 2019 novel coronavirus disease (COVID-19) was initially seen in Wuhan, China, in December 2019. World Health Organization classified COVID-19 as a pandemic after its rapid spread worldwide in a few months. With the pandemic, all elective surgeries and non-emergency procedures have been postponed in our country, as in others. Most of the endocrine operations can be postponed for a certain period. However, it must be kept in mind that these patients also need surgical treatment, and the delay time should not cause a negative effect on the surgical outcome or disease process. It has recently been suggested that elective surgical interventions can be described as medically necessary, time-sensitive (MeNTS) procedures. Some guidelines have been published on proper and safe surgery for both the healthcare providers and the patients after the immediate onset of the COVID-19 pandemic. We should know that these guidelines and recommendations are not meant to constitute a position statement, the standard of care, or evidence-based/best practice. However, these are mostly the opinions of a selected group of surgeons. Generally, only life-threatening emergency operations should be performed in the stage where the epidemic exceeds the capacity of the hospitals (first stage), cancer and transplantation surgery should be initiated when the outbreak begins to be controlled (second stage), and surgery for elective cases should be performed in a controlled manner with suppression of the outbreak (third stage). In this rapidly developing pandemic period, the plans and recommendations to be made on this subject are based on expert opinions by considering factors, such as the course and biology of the disease, rather than being evidence-based. In the recent reports of many endocrine surgery associations and in various reviews, it has been stated that most of the cases can be postponed to the third stage of the epidemic. We aimed to evaluate the risk reduction strategies and recommendations that can help plan the surgery, prepare for surgery, protect both patients and healthcare workers during the operation and care for the patients in the postoperative period in endocrine surgery.

Desmoplastic small round cell tumor of the kidney: a case report.

BACKGROUND: Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive neoplasm seen in children and young adults, usually manifested by involvement of abdominal serosa. Here, we present an unusual case of primary DSRCT of kidney. CASE PRESENTATION: The patient was an 8-year-old girl with a large renal mass which was confused with primitive neuroectodermal tumor (PNET) in the needle biopsy. The tumor had a variegated histology revealing frequent pseudo-rosette formations, pseudopapillary architecture, rhabdoid, clear or pleomorphic cells in addition to typical small round cell morphology and desmoplasia. It showed immunohistochemical features of DSRCT, and EWSR1 re-arrangement. CONCLUSIONS: Proffering this diagnosis is particularly difficult for tumors of viscera because of the incognizance of the entity in these locations. Moreover, DSRCT is a great mimicker and may get easily confused with more common kidney malignancies of childhood such as Wilms tumor, PNET/EWS, rhabdoid tumor, clear cell sarcoma, and other small round cell tumors as well as renal cell carcinomas. The distinction is critical as the accurate therapeutic approach will require correct diagnosis.

Association of Abl interactor 2, ABI2, with platelet/lymphocyte ratio in patients with renal cell carcinoma: A pilot study.

There are many unknown aspects of the pathogenesis of renal cell carcinoma (RCC). The aim of the current study was to define new RCC-related genes and measure their associations with RCC and clinical parameters, especially platelet/lymphocyte ratio which may be an independent predictor of prognosis in patients with RCC and other forms of cancer. Via in silico analysis upon RCC-specific deleted genes in chromosome 3, four possible ceRNAs (ATXN3, ABI2, GOLGB1 and SMAD2) were identified. Then, the expression levels of these genes in tumour and adjacent healthy kidney tissues of 19 RCC patients were determined by real-time PCR. ATXN3 and GOLGB1 gene expression levels increased but ABI2 gene expression level decreased in tumour kidney tissues when compared to normal ones. ATXN3, ABI2 and GOLGB1 gene expression levels were significantly higher in Fuhrman grade 4 than other grades (P < .001). ABI2 gene expression levels were significantly associated with higher platelet/lymphocyte ratio of the patients with RCC (P < .05). ATXN3, ABI2 and GOLGB1 may predict higher RCC grades. Also, ABI2 may regulate platelet/lymphocyte ratio which may be an independent predictor of RCC and other forms of cancer.

Radioguided occult lesion localization for minimally-invasive parathyroidectomy without quick PTH monitoring and frozen section: impact of the learning curve.

OBJECTIVES: Minimally-invasive parathyroidectomy (MIP) is a surgical procedure that reduces the duration of operation, hospital costs, and hypocalcemia, and shortens the length of hospital stay. This study addressed the important procedural details of the radioguided occult lesion localization (ROLL)-MIP technique and evaluated the consequences of the learning curve from a series of patients. PATIENTS AND METHODS: A total of 80 patients who underwent ROLL-MIP for a single parathyroid adenoma were included into this retrospective study. In order to analyze the effect of the learning curve, these subjects were then divided into 2 groups per time period and the operative times were compared. Group A consisted of 22 previously reported patients who served as the control group. Group B consisted of 58 consecutive patients. RESULTS: Serum calcium and parathyroid hormone (PTH) levels were normalized in all of the patients within 2 days and remained normal during the follow-up period (31 ± 18.5 months). None of the patients who underwent ROLL-guided parathyroidectomy suffered temporary or permanent recurrent laryngeal nerve injuries. Mean operation time (time from incision to excision of the adenoma) was 23 ± 6 min in Group A and 18 ± 7 min in Group B. Mean operative times were significantly shorter in group B. CONCLUSION: The success of MIP administered with the ROLL technique in a single adenomatous patient was quite high. This method seems especially valuable in patients with atypically located or small adenomas.

Glutamate transporter SLC1A1 is associated with clear cell renal cell carcinoma

Background/aim: This study aimed to comparatively analyze the expression levels of the SLC1A1 gene in renal specimens from tumors and adjacent healthy kidney tissues of patients with clear cell renal cell carcinoma (ccRCC). Materials and methods: Nineteen patients diagnosed with ccRCC were included in the study. The expression levels of the SLC1A1 and GAPDH genes were measured in tumor and formalin-fixed paraffin-embedded (FFPE) tissue specimens from the adjacent healthy kidney of each subject. Via the GEPIA database, the distribution of SLC1A1 gene expressions in ccRCC and healthy kidney tissues was obtained. The relative expression of SLC1A1 was evaluated for the association with the clinical parameters of the patients. Results: The expression of the SLC1A1 gene was significantly higher in males than females (P = 0.029). Also, there were statistically significant associations between stages II­IV and Fuhrman grades 2­4 with respect to SLC1A1 gene expression (P < 0.001 for both). Moreover, low levels of red blood cell and hemoglobin counts were significantly associated with the SLC1A1 expression (P < 0.001 and P = 0.005, respectively). The expression of the SLC1A1 gene in tumor tissues increased approximately 3 times compared with normal kidney tissues (P < 0.05). According to the GEPIA database, SLC1A1 gene expression is significantly higher in ccRCC patients than healthy persons (P = 0.01). Conclusion: The change in the expression of SLC1A1 may be crucial for ccRCC pathophysiology.

Does early removal of double J stents reduce urinary infection in living donor renal transplantation?

INTRODUCTION: Prophylactic use of double J (DJ) stents in recipients is highly accepted in renal transplantation. In this study, the association between the frequency of urologic complications (UC) and urinary tract infections (UTI), and the early or late removal of DJ stents was investigated. MATERIAL AND METHODS: A total of 116 live-donor renal transplant patients were included in the study during a 4-year period, with a mean follow-up of 29.2 ±15.3 months. In all, DJ stents were used. All patients were clinically monitored for graft function by assessment of the complete blood count, renal biochemistry, urine analysis and blood drug level according to our follow-up protocol. RESULTS: The patients were divided into 2 groups according to the time of their stent removal: group I (n = 44), removal within the first 14 days; and group II (n = 72), removal after 14 days. No urinary leaks were detected in either of the groups. Three patients suffered from anastomotic stricture (group I, n = 1; group II, n = 2). The rates of UTI were similar in groups I and II (13.6% vs. 16.6%, respectively, p = 0.79). The rate of UTI in women was found to be 3.8 times higher than in men. CONCLUSIONS: The results of our study demonstrated that DJ stent removal within 14 days did not reduce the risk of UTI when compared to stent removal after 14 days. Similar effects on complication rates for ureteral stenting for these 2 removal periods were observed.

Comparison of intestinal ischemia after on-pump versus off-pump coronary artery bypass grafting surgery

Background/aim: Acute mesenteric ischemia (AMI), one of the gastrointestinal system complications, which occurs following cardiac surgery, is challenged in the literature with a diminished incidence of AMI by heart surgery without cardiopulmonary bypass (CPB) or with pulsatile CPB. This study aims to compare the incidence and mortality rate of mesenteric ischemia in a series of consecutive patients undergoing coronary artery bypass grafting (CABG) through on-pump and off-pump techniques. Materials and methods: This study included patients who underwent CABG between 1 January 2010 and 31 June 2016. All patients were divided into two groups: Group 1 comprised 6396 CABG patients operated on with the off-pump technique. Group 2 included 1210 patients who received CABG with the on-pump technique. Preoperative data were collected on the studied variables. Postoperative data included the development of intestinal ischemia and in-hospital mortality. Results: Of 7606 consecutive CABG patients, a total of 31 (0.4%) developed intestinal ischemia. The incidence of postoperative mesenteric ischemia was 0.28% in Group 1 and 1.07% in Group 2 (P = 0.000). The survival rates after AMI were 61.1% in Group 1 (off-pump) and 7.7% in Group 2 (on-pump) (P = 0.003). Time from the first occurrence of nonspecific GI complaints to laparotomy was similar in the off-pump and on-pump groups and had no effect on mortality. Conclusions: With regard to the incidence of mesenteric ischemia and survival after laparotomy, off-pump CABG patients revealed significant improvement compared with those operated on with the on-pump technique.

Expression profiles of proto-oncogene TWIST1 and tumor metastasis suppressor gene LASS2 in bladder cancer.

Transcription factor proto-oncogene TWIST1 and tumor metastasis suppressor gene LASS2 have been reported to be involved in various carcinomas but their expression profiles and prognostic significances in bladder cancer are largely unknown. We aimed to determine these genes' expression levels both at mRNA and protein level in bladder cancer. mRNA expression levels of TWIST1 and LASS2 genes were examined using real-time quantitative PCR (qPCR) in human bladder tumors and paired normal adjacent tissues obtained from 44 patients. Protein expression profiles of both genes were detected by immunohistochemical staining in formalin-fixed and paraffin-embedded tissues from the same patients. The expression profiles of TWIST1 mRNA in bladder tumors were significantly lower than the normal adjacent tissues and linked to both the stage and the grade. The expression profiles of LASS2 mRNA in bladder tumors were also significantly lower than the normal adjacent tissues reflecting the potential tumor suppressor profile of the gene, independently from stage or grade. By immunohistochemistry, TWIST1 and LASS2 positive expression rates were found as 14.3% (6/42) and 38.1% (16/42), respectively. As potential molecular markers for bladder carcinoma, both TWIST1 and LASS2 transcripts seem to play role during the tumorigenesis and development of bladder cancer. Lack of a functional link and/or weak inverse link between TWIST1 and LASS2 transcripts and immunohistochemical findings may reflect the potential associations of transcription regulation mechanisms and merit further investigations. To the best of our knowledge, this is the first report investigating the combined expression profile of TWIST1 and LASS2 in bladder cancer both at mRNA and protein level.

Promoter methylation analysis of CDH1 and p14ARF genes in patients with urothelial bladder cancer.

BACKGROUND/AIM: Urothelial bladder cancer arises from the accumulation of multiple epigenetic and genetic changes. We aimed to investigate the specificity and sensitivity of gene-specific promoter methylation of CDH1 and p14ARF genes in the early diagnosis of bladder cancer and compare those with other diagnostic tests in our population. PATIENTS AND METHODS: In the current study, 65 patients with urothelial bladder cancer and 35 controls without any history of cancer were recruited. Methylation profiles of CDH1 and p14ARF genes from tumor and urine samples were determined by methylation-specific polymerase chain reaction method. RESULTS: Methylation of CDH1 and p14ARF genes in tumor samples was 95.4% and 78.5%, respectively. The methylation frequencies were found to be 68.8% for CDH1 gene and 72.9% for p14ARF gene in urine samples. Sensitivities of CDH1, p14ARF and urine cytology were found to be 67.4%, 72.1% and 34.9%, respectively, while their specificities were 93.9%, 63.6% and 93.9%, respectively. CONCLUSION: Aberrant promoter methylation of CDH1 and p14ARF genes can be used to detect urothelial bladder cancer. In low-grade tumors, when compared with urine cytology, combined methylation analysis of CDH1 and p14ARF genes may not increase the sensitivity to identify malignant cells in urine samples.

A new surgical approach for pilonidal sinus disease: "de-epithelialization technique''.

OBJECTIVE: In the treatment of pilonidal sinus disease different approaches are used such as conservative treatment and fasciocutaneous rotation flap. The aim of this study was to evaluate the efficacy of "de-epithelialization technique" as a new approach in pilonidal sinus disease treatment. MATERIAL AND METHODS: Forty pilonidal sinus disease patients treated with de-epithelialization method were evaluated retrospectively. Patient age, gender, body mass index, wound healing time, visual analog scale scores, operation times, hospital stay duration, drain removal time, cosmetic satisfaction rates, complications, and recurrence rates were evaluated. RESULTS: The numbers of male and female patients in this study were 39 and 1, respectively. The median age of the patients was 25 years and the mean BMI was 26.6. The mean operating time was 43 min, and all patients were discharged 5 h after the operation. Wound healing time varied from 10 to 20 days. Median follow-up period was 9 months (4-17 months). One patient with high body mass index suffered from partial wound separation. No other complications such as infections and fluid collections (hematoma and seromas) were observed. Maximum cosmetic satisfaction rate was 90% (n=36), and no patient had a recurrence during the follow-up period. CONCLUSION: "De-epithelialization" may be considered as a complementary and/or alternative approach to other surgical techniques such as primary closure, rhomboid excision, and Limberg flap in the treatment of pilonidal sinus disease, with acceptable cosmesis and recurrence rates.

Efficacy of anakinra in a patient with systemic amyloidosis presenting as amyloidoma.

Amyloidosis is a heterogeneous group of disorders characterized by extracellular deposition of unique protein fibrils. The least common presentation of an amyloid deposition is as a discrete mass called amyloidoma or amyloid tumor. We report a case of a soft tissue amyloidoma in the abdomen of a 16-year-old girl who was diagnosed as having systemic amyloidosis. A girl aged 16 years was referred to our hospital with a pre-diagnosis of a retroperitoneal mass documented with abdominal ultrasonography and tomography. A laboratory examination revealed nephrotic syndrome. She underwent surgery for a complete resection of the lesion. A histopathologic examination with Congo red and crystal violet dyes verified the diagnosis of amyloidoma. An immunohistochemical study for amyloid A protein was positive. A renal biopsy was also compatible with AA amyloidosis. A detailed search for the etiology of systemic amyloidosis revealed heterozygous mutation in the Mediterranean fever gene. Treatment with colchicine and anakinra were started with the diagnosis of familial Mediterranean fever because the other causes of secondary amyloidosis were ruled out. After 3 months of anakinra treatment, the laboratory findings returned to normal and excessive proteinuria disappeared. In countries where FMF and other autoinflammatory diseases are prevelant, systemic amyloidosis should be kept in mind in the differential diagnosis of children who present with nephrotic syndrome and abdominal mass. Taking previously reported cases and our case together, it appears that anti-interleukin-1 treatment represents a promising new approach in a subset of patients with systemic amyloidosis secondary to autoinflammatory diseases.

Single-incision laparoscopic adrenalectomy in a patient with acute hypokalemic paralysis due to primary hyperaldosteronism.

Acute hypokalemic paralysis is a relatively rare cause of acute weakness. It may resolve spontaneously; however, it may be a potential life-threatening condition. Hypertension may be considered the most important finding in combination with hypokalemic paralysis for raising the suspicion of primary hyperaldosteronism (PHA). A 55-year-old hypertensive Mexican woman was admitted to the Emergency Unit with a sudden onset of generalized paralysis. An endocrinological workup and an abdominal magnetic resonance imaging revealed PHA with a 1.5 cm left adrenal tumor. After preoperative medication, left adrenalectomy was performed with single-incision laparoscopic surgery (SILS). The duration of the surgery was 45 min, and no postoperative complication was encountered. The patient was discharged after 24 h. Hypokalemic paralysis may be due to different conditions, but it may raise the suspicion of PHA in combination with a history of generally mild hypertension. Laparoscopic adrenalectomy is the preferred operation for unilateral adrenal adenomas that cause PHA. Single-incision laparoscopic surgery is a step-forward technique that improves the cosmesis, decreases access-related morbidity, and increases the postoperative recovery. We report a case with acute hypokalemic paralysis due to PHA and treated with SILS.

Histopathological effects of mesenchymal stem cells in rats with bladder and posterior urethral injuries

Background/aim: To evaluate the effects of mesenchymal stem cell (MSC) therapy in an experimental bladder and posterior urethral injury model. Materials and methods: The study subjects consisted of 40 male Wistar albino rats that were divided into four groups: control group (n = 10) (the bladder was only surgically opened and closed), sham group (n = 10) (surgical procedure), IVMSC group (n= 10) (surgical procedure and intravenous MSC treatment), and LMSC group (n = 10) (surgical procedure and local MSC treatment). Histopathological evaluation was performed for the degree of fibrosis and inflammation and the extent and intensity of staining of vascular endothelial growth factor (VEGF) and endoglin (CD105). Results: There were no significant differences between the control and LMSC groups with respect to fibrosis (P = 0.070) or inflammation (P = 0.048). Fibrosis and inflammation were significantly lower in the IVMSC (P = 0.034 for fibrosis, P = 0.080 for inflammation) and LMSC (P = 0.01 for fibrosis, P = 0.013 for inflammation) groups when compared with the sham group. No significant differences regarding fibrosis and inflammation were observed between the IVMSC and LMSC groups (P = 0.198 for fibrosis, P = 0.248 for inflammation). A significant difference was noted between the sham and LMSC groups concerning VEGF staining intensity (P = 0.017). However, no significant difference was found among the groups with regard to the extent or intensity of CD105 staining (P > 0.05). Conclusion: MSC treatment significantly decreased the development of fibrosis in a uroepithelial injury model.