Unveiling the incidences and trends of the neglected zoonosis cystic echinococcosis in Europe: a systematic review from the MEmE project.

The neglected zoonosis cystic echinococcosis affects mainly pastoral and rural communities in both low-income and upper-middle-income countries. In Europe, it should be regarded as an orphan and rare disease. Although human cystic echinococcosis is a notifiable parasitic infectious disease in most European countries, in practice it is largely under-reported by national health systems. To fill this gap, we extracted data on the number, incidence, and trend of human cases in Europe through a systematic review approach, using both the scientific and grey literature and accounting for the period of publication from 1997 to 2021. The highest number of possible human cases at the national level was calculated from various data sources to generate a descriptive model of human cystic echinococcosis in Europe. We identified 64 745 human cystic echinococcosis cases from 40 European countries. The mean annual incidence from 1997 to 2020 throughout Europe was 0·64 cases per 100 000 people and in EU member states was 0·50 cases per 100 000 people. Based on incidence rates and trends detected in this study, the current epicentre of cystic echinococcosis in Europe is in the southeastern European countries, whereas historical endemic European Mediterranean countries have recorded a decrease in the number of cases over the time.

Platelet-rich fibrin can accelerate the healing of common bile duct anastomosis in a rat.

OBJECTIVES: This study aimed to evaluate the effect of platelet-rich fibrin (PRF) concentrate on the bile duct anastomosis healing process in rats. MATERIAL AND METHODS: Thirty male Sprague Dawley (SD) rats were used for the study. The animals were allocated into three groups: Group I Control Group (n=10): Anastomosis to the common bile duct (CBD) with a stent. Group II PRF Group (n=10): Anastomosis to the CBD with a stent and covered with PRF. Group III Sham Group (n=10): Preparation of the common bile duct, no anastomosis. The animals were followed up for 1 month, then sacrificed. Study parameters were adhesions around the anastomosis, thickness of the bridging bile duct tissue over the stent, and histopathologic examination of the bridging bile duct tissue. RESULTS: CBD anastomosis using a stent caused severe adhesion around the anastomosis, bridging bile duct tissues were weak and histopathologically, healing was incomplete in most of the control animals. However, PRF application significantly reduced the adhesions, increased the quality of the bridging bile duct tissues, and caused complete healing histologically. CONCLUSION: PRF is an autologous, easily prepared membrane. The present study findings show that PRF prevents local complications and increases the healing capacity of the bile duct after CBD anastomosis. Therefore, it might be a new treatment option for preventing complications following common bile duct anastomosis in liver transplantation patients.

Protoscolicidal effect of oleuropein: an in vitro study.

OBJECTIVES: Hydatid disease is a parasitic disease caused by Echinococcus granulosus and is still endemic in many parts of the world. Scolicidal solutions are generally used in any type of intervention, either surgical or percutaneous, to neutralize the cyst contents, although completeness of their effect is obscure and solid evidence is scarce. On the other hand, the use of these scolicidal solutions is not devoid of complications and many serious complications such as caustic sclerosing cholangitis may be seen in relation with their usage. Recent investigations proved protoscolicidal properties of olive leaf extract although the active ingredient has not been attributed to any component. The aim of this experimental study was to isolate oleuropein and test for in vitro protoscolicidal activity. MATERIAL AND METHODS: Oleuropein, a phenolic compound found in olive leaves, is extracted and prepared in different concentrations. Echinococcal cyst containing livers of sheep are obtained from the government slaughterhouse. Cysts were punctured and live protoscolex suspensions were prepared under aseptic conditions. Different concentrations of oleuropein solutions were prepared and protoscolicidal property is analyzed and compared with positive and negative controls for different exposure times. RESULTS: Oleuropein 2% concentration was found to be protoscolicidal in all exposure times starting from 5 minutes. CONCLUSION: 2% oleuropein is a powerful, natural protoscolicidal agent which should be evaluated clinically before its application in routine treatment practice.

Two cases of intestinal injuries due to seat belt without seat belt sign.

Although seat belts save lives after motor vehicle accidents, they may cause different types of injuries such as abdominal wall, intra-abdominal, neck and spine or vascular injuries. Seat belt sign indicates the severity of injuries, and usually the risk of intra-abdominal injuries is high when the seat belt sign exists. Here, we present two cases of intra-abdominal injuries caused by seat belts without seat belt sign.

Risk factor assessment for breast cancer in North Cyprus: a comprehensive case-control study of Turkish Cypriot women

Background/aim: This case-control study aims to assess the strength of associations between reproductive, lifestyle, sociodemographic, and dietary factors as well as other potential breast cancer risks and breast cancer (BC) in a North Cyprus population. Materials and methods: The study includes 408 BC patients and 412 age-matched controls recruited from Near East Hospital and Dr. Burhan Nalbantoglu State Hospital in North Cyprus. Information regarding clinical and epidemiological characteristics was collected through a standardized interview. Age-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by logistic regression before and after adjusting for the potential confounders. Results: In addition to various recognized BC risk factors, strong associations with BC were reported from women with fertility drugs used for >6 cycles (OR = 3.305, 95% CI 1.850­5.906, P < 0.001), depression (OR = 2.10, 95% CI 1.33­3.30, P < 0.001), exposure to radiation (OR = 1.74, 95% CI 1.02­2.98, P = 0.041), and excess consumption of oil (OR = 2.703, 95% CI 1.62­4.48, P < 0.001) and sugar (OR = 3.42, 95% CI 1.39­8.40, P = 0.007). Parental consanguinity (OR = 0.16, 96% CI 0.09­0.30, P < 0.001) and daily water intake of 1­2 L (OR = 0.36, 95% CI 0.19­0.66, P < 0.001) were strong protective factors. Conclusion: Our results demonstrate the presence of classical as well as several additional BC risks. The findings will be of great benefit in establishing adequate evidence-based awareness and preventative measures in the North Cyprus population.

Adult multicentric burkitt lymphoma with bowel obstruction due to intussusception.

Primary malignant tumors of the small intestine are very rare, accounting for 2%-3% of all gastrointestinal malignancies. Lymphoma constitutes about 15%-20% of all small intestine neoplasms and 20%-30% of all primary gastrointestinal lymphomas. The ileum is the most common site for gastrointestinal lymphomas. Because the symptoms and physical findings are non-specific, the preoperative diagnosis is usually difficult. In this case report, we describe the highly unusual case of sporadic Burkitt lymphoma with complete intestinal obstruction due to intussusception of the proximal jejunum and discuss the treatment options.

Role of platelet-rich fibrin on intestinal anastomosis wound healing in a rat.

OBJECTIVES: The aim of the present study is to investigate the role of platelet-rich fibrin (PRF) on the intestinal anastomotic wound healing in a mesenteric ischemia/reperfusion (I/R) rat model. METHODS: Forty male Sprague Dawley rats were allocated into four groups: Group I (n = 10): anastomosis to normal bowel; Group II (n = 10): anastomosis after I/R injury; Group III (n = 10): anastomosis and PRF; Group IV: anastomosis after I/R and PRF. Animals were followed up for 7 days, then sacrificed. Anastomotic complications, anastomosis bursting pressures and histopathologic evaluations of the anastomoses were the study parameters. RESULTS: The I/R injury caused more anastomotic adhesion and very low anastomotic bursting pressure when compared with the other groups (p < 0.01). Application of PRF onto the bowel, however, dramatically decreased the local complications and significantly increased the anastomosis bursting pressures (p < 0.01). Histologic evaluation of the anastomoses showed almost complete healing in all animals. The mean histologic scores of the animals were not different between the groups. CONCLUSION: PRF has a beneficial effect on the intestinal healing process by prevention of local complications and increases the tensile strain of the anastomosis. This effect was more prominent, particularly when healing is disrupted. Therefore, we conclude that PRF could be an alternative treatment option to prevent anastomotic complications for elderly, co-morbid and emergency patients.

Evaluation of Breast Cancer Cases Diagnosed In the Breast Cancer Screening Program In the Near East University Hospital of North Cyprus.

OBJECTIVE: This study is about determination and eveluation of the breast cancer cases which were diagnosed during the early diagnosis and screening programs covering a three years of digital mammography images at the Near East University Hospital. MATERIALS AND METHODS: This study covers 2136 women patients who applied to the early diagnosis and screening program of the Near East University Hospital between July 2010 and July 2013. The mamographic images were re evaluated retrospectively according to ACR's (The American College of Radiology) BIRADS (Breast Imaging Reporting and Data System). The mamographic results as required were correlated with breast ultrasound (US) and compared with the pathologic results of materials obtained by surgery or biopsy. The results were analyzed statistically in comparison with the literature data. RESULTS: The women who were screened aged between 34-73 years with a median of 53.5 (SD = 27.5). Suspected malignancy were evaluated in 54 patients, which 42 of them were diagnosed BIRADS 4 and 12 patients BIRADS 5 and 21 patients were correleted breast cancer based on histopathologic examination. 17 patients had the breast-conserving surgery and 4 patients were treated with mastectomy. CONCLUSION: Breast cancers that are detected at early stages by breast cancer screening tests are more likely to be smaller and still confined to the breast resulting in more simple operations and more succesfull treatment. Promoting the breast cancer screening and registration programs in our country will help to control the desease at our region.

Primary anestrus due to dietary hyperthyroidism in a miniature pinscher bitch.

A 2-year-old intact miniature pinscher bitch that had been on a bones and raw foods diet since birth showed no signs of estrus despite a 40-day course of cabergoline. Elevated levels of thyroxine were detected in the serum (51 nmol/L) and in the juice of the meat (183 nmol/L) fed to the dog. Change in diet and treatment with oral cabergoline resulted in signs of proestrus in 13 d, pregnancy, and normal birth of 5 puppies.

Anœstrus primaire attribuable à un hypothyroïdisme alimentaire chez une chienne Pinscher miniature. Une chienne Pinscher miniature intacte âgée de 2 ans qui avait consommé une diète composée d'os et d'aliments crus depuis la naissance ne manifestait aucun signe d'œstrus malgré une série de traitements de 40 jours à la cabergoline. Des niveaux élevés de thyroxine ont été détectés dans le sérum (51 nmol/L) et le jus de la viande (183 nmol/L) consommée par la chienne. Une modification de la diète et un traitement à la cabergoline orale ont produit des signes de pro-œstrus après 13 jours, puis la gestation et la naissance normale de 5 chiots.(Traduit par Isabelle Vallières).

Public awareness of colorectal cancer in a Turkish population: importance of fecal occult blood testing.

To date, there was no controlled-study regarding awareness and knowledge of colorectal cancer in the Turkish population. We therefore designed a questionnaire consisting of items related to socio-demographic parameters, medical and family history and questions of awareness and knowledge about colorectal cancer for use in a descriptive cross-sectional study. An interviewer-administered technique was applied and 450 subjects were interviewed in the outpatient clinics at Near East University Hospital. Among all subjects, 337 were found to be eligible for the study group. Exclusion criteria were age below 18 years, any cancer history, family history of colorectal cancer, current colorectal problems, history of any diagnostic or therapeutic interventions for colorectal diseases.All participants stated that they heard about colorectal cancer. When asked about the lifetime risk of colorectal carcinoma, only 25.4% of women and 37.9% of men estimated correctly. Univariate analysis revealed that the total awareness score was significantly correlated with age, marital status, parenthood and fecal occult blood testing history. On multivariate analysis of independent predictors for awareness of colorectal cancer were found to be history of fecal occult blood testing, age and marital status were found to be the most important determinants. As a conclusion, opportunistic screening with fecal occult blood test by physicians from non-gastrointestinal specialties not only helps to reduce the mortality but also increases the awareness of colorectal cancer.

Turkey's evaluation in kidney transplantation research.

OBJECTIVES: The objective this study is to evaluate the trend of Turkey's contribution in terms of number of publications included in the Science Citation Index Expanded in kidney transplantation between 1980 and 2009. MATERIALS AND METHODS: All scientific papers published included in Science Citation Index Expanded in the English language between 1980 and 2009 were analyzed using the "Web of Science." A general search was conducted using key words of "kidney transplantation," "renal transplantation," "kidney transplant," and "renal transplant." We analyzed these results using the "analyze" function of the software in terms of countries, documentation types, number in years of publications, journals, and institutes. We also used the same function separately analyze papers from Turkey in last 3 decades between 1980 and 1989, 1990 and 1999, and 2000 and 2009 for statistical evaluation. RESULTS: In total, we found 46 983 papers related to kidney transplant were published included in the Science Citation Index Expanded in the English language between 1980 and 2009. Overall, 964 of those papers were from Turkey (2.05%). There were 12 papers from Turkey between 1980 and 1989, 200 papers between 1990 and 1999, and 752 papers between 2000 and 2009. The rank of Turkey among other countries, ranked by the number of papers published, was 33 between 1980 and 1989 and 11 between 2000 and 2009. CONCLUSIONS: Turkey has shown a significant positive trend in publishing papers in the field of kidney transplantation-further evidence of the progress Turkey has made in its contributions to the field of kidney transplantation in recent decades.

Occult intrabiliary rupture of hydatid cysts in the liver.

The aim of this study was to investigate the effects of various surgical modalities directed at the cavity of hydatid cysts in patients with occult intrabiliary rupture. In this respect, 324 patients with hydatid cyst of the liver operated on during 1983-2003 were analyzed; among them, 39 patients with occult intrabiliary rupture were included in the study. Clinical symptomatology, physical examination, laboratory findings, results of imaging studies, the localization and size of the cyst, and operative findings were reviewed. Twelve patients had complications, and there was no mortality. The most common complication was bile fistula. The average postoperative hospital stay was 7.0 +/- 3.8 days for patients with omentoplasty and 6.0 +/- 2.5 days for those who underwent cavitary drainage. For patients who do not have bile-stained cystic fluid, the utilization of scolicidal agents is appropriate. Although the opening of the duct is sutured when it is identified, the risk of biliary fistula is not clearly correlated with this approach. In such cases, omentoplasty provides a good alternative to cavitary drainage.

Unusual locations of hydatid disease and surgical approach.

BACKGROUND: Hydatid disease is an endemic parasitic disease of the Mediterranean countries. Although the liver is the most commonly involved organ, the disease can be seen anywhere in the body. In the present study, we present our experience with uncommonly located hydatid disease diagnosed and treated between 1983 and 1999 in the Sixth Surgical Department of Ankara Numune Training and Research Hospital, Ankara, Turkey. METHODS: Forty-nine patients with unusually located hydatid disease were retrospectively analysed. There were 21 men and 28 women in the present series. Of those, 26 patients were harbouring both hepatic and extrahepatic cysts, while 23 had only extrahepatic cysts. Peritoneal cavity, spleen, retroperitoneum, thyroid gland, anterior abdominal wall, thigh, kidney, presacral space and pancreas were the organs or tissues involved in the cases. Spleen and peritoneal cavity were the two most frequent locations in the present series. RESULTS: Partial or total cystectomy with or without tube drainage or omentopexy was the operation of choice for hydatid cyst of the peritoneal cavity. Splenectomy was performed for splenic hydatidosis. Mean postoperative stay was 7 days (4-23). Three diaphragmatic and one inferior vena cava lacerations occurred during operations that were repaired successfully in the same sessions. No mortality occurred in the present series. CONCLUSION: Hydatid disease can affect any organ or area throughout the body and suspicion of this disease should be justified in patients presenting with a cystic mass in endemic areas.

[Pancreatic injuries: analysis of 20 cases]. / PANKREAS YARALANMALARI: 20 OLGUNUN ANALIZI.

BACKGROUND: The aim of this study is to stage pancreatic injury and to assess the appropriate surgical approach. Trauma leading to pancreatic injury, factors responsible for the mortality and complication rates are evaluated and compared with the literature. METHODS: Records of 20 patients with pancreatic injuries treated at the Emergency Surgical Unit of Research Hospital between January 1997 to October 2001 were retrospectively evaluated. RESULTS: In this series 20 per cent of the mortality occurred within the first 48 hours. The factor responsible for the mortality in these patients was major bleeding; related to major vascular, hepatic, splenic, renal or thoracic injuries. Late mortality was seen in 3 patients (15 per cent) due to sepsis, respiratory insufficiency or ARDS. ln the literature mortality rate is between 5 to 30 per cent and morbidity rate is 30 to 64 per cent. In this series, these percentages were 35 per cent and 43 per cent respectively. CONCLUSION: The surgical therapy should be tailored up to the presence of ductal injury and the extent and anatomical localization of the injured segment. In principle the control of bleeding and contamination, and application of the appropriate surgical treatment can lower the morbidity and mortality. Key words: Abdominal trauma, pancreatic injury, pancreatic drainage

Use of laparoscopic splenectomy in developing countries: analysis of cost and strategies for reducing cost.

BACKGROUND: In general, laparoscopic surgery is more expensive than open surgery. However, recent reports showed lower overall cost. PATIENT AND METHODS: Fourteen patients underwent laparoscopic splenectomy (LS) and 15 patients open splenectomy (OS). Patients were evaluated with regard to blood loss, complication rate, length of hospital stay, operative time, presence of accessory spleens, hospital cost, and total cost. For the OS group, there was no laparoscopic instrument cost, and the total cost was equal to the hospital cost. In the LS group, total cost was calculated by adding the hospital cost to the cost of laparoscopic instruments. RESULTS: The postoperative hospitalization was shorter in the LS group than the OS group (3.4 vs. 7.5 days), but the operating time was significantly longer for the LS group. The mean hospital cost was calculated as US $1,055 in the LS group and $1,664 in the OS group. The overall total cost was $1,664 for the OS group and $2,064 for the LS group. In the LS group, less morbidity and shorter postoperative hospital stay resulted in lower hospital cost. CONCLUSION: The cost for laparoscopic instruments is the main factor responsible for the high total cost of LS. Resterilization of disposable laparoscopic instruments is feasible and a more economic way of treatment compared with splenectomy with totally disposable laparoscopic instruments and has costs comparable to those of open surgery.

Hemodynamic changes during gaseous and gasless laparoscopic cholecystectomy.

PURPOSE: The main disadvantage of gaseous laparoscopic surgery is the need for CO(2) insufflation and the elevation of intra-abdominal pressure. Gasless laparoscopic surgery is an alternative to gaseous laparoscopic surgery, which avoids the hazardous effects of pneumoperitoneum. This study was conducted to investigate the hemodynamic effects of pneumoperitoneum and to compare gasless and gaseous laparoscopic cholecystectomy on a hemodynamic basis. METHODS: The gasless laparoscopic procedure uses an electromechanical retractor system to lift the abdominal wall. We performed 20 gaseous and 11 gasless laparoscopic cholecystectomies in a collective total of 31 patients with symptomatic gallstones. The mean arterial pressure, heart rate, end diastolic index, systemic vascular resistance index, cardiac index (CI), ejection fraction (EF), and stroke index (SI) values were monitored noninvasively by thoracic electrical bioimpedance. RESULTS: In the gaseous group, statistically significant changes were detected in CI, EF, and SI values after insufflation as compared to the values before pneumoperitoneum. In the gasless group, only minimal changes were detected in the SI values, which were not significant. CONCLUSION: Gasless laparoscopy has little effect on the hemodynamic parameters of patients and provides an alternative to the gaseous technique in selected cases.

Prevention of intraabdominal adhesions produced by polypropylene mesh.

Polypropylene mesh (PPM) is widely used in ventral hernia repair, however is also associated with visceral adhesions when the mesh is exposed to intraabdominal organs. In this study, a composite mesh [ePTFE (expanded polytetrafluoroehylene) + PPM] and sodium hyaluronate/carboxymethyl cellulose (NaHA/CMC) membrane laid under PPM are evaluated in terms of adhesion formation in a rat model of ventral hernia repair. In this experimental study, a 2 x 1 cm of peritoneum and underlying muscle defect was created at the right side of the anterior abdominal wall of 37 male Wistar albino rats. These defects were repaired with 2.5 x 2 cm PPM in group 1 (n = 13), with composite mesh in group 2 (n = 12) and with PPM+NaHA/CMC in group 3 (n = 12). Rats were sacrificed after 14 days and the prosthetic materials were examined for the calculation of surface area percentage covered by adhesions, for organ involvement in the adhesions and for histological evaluation. There was a reduction in the adhesion-covered area in group 2 and group 3. Organ involvement was predominantly seen in group 1. Neoperitoneum was perfect in group 2. Fibrosis and inflammation were higher in group 1. All groups showed adhesiogenic potential to some extent. This potential was maximum with PPM. Both ePTFE and NaHA/CMC displayed similar effects in preventing adhesion formation.