Oxaliplatin-Induced Immune Thrombocytopenia in a Patient with Pancreatic Cancer.

Oxaliplatin-induced immune thrombocytopenia is a rare but potentially serious complication of chemotherapy. We present the case of a 55-year-old man with stage 4 pancreatic carcinoma who developed immune thrombocytopenia during the 18th cycle of folinic acid, fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) chemotherapy, immediately after oxaliplatin infusion. Despite treatment with methylprednisolone and platelet infusion, the patient's platelet count remained low. Subsequent plasmapheresis and continued steroid therapy resulted in a gradual improvement in platelet count and resolution of symptoms. This case highlights the importance of considering immune thrombocytopenia in patients receiving oxaliplatin-based chemotherapy, and the potential role of plasmapheresis in refractory cases. Further research is needed to elucidate the optimal management of this rare complication. LEARNING POINTS: Oxaliplatin-induced immune thrombocytopenia is a rare but potentially life-threatening side effect of chemotherapy.Management of drug-induced immune thrombocytopenia involves discontinuation of the offending drug and the use of steroids.Monitoring and follow-up are crucial in patients receiving oxaliplatin-based chemotherapy to promptly detect and manage potential hematologic emergencies, including immune thrombocytopenia.

Implementation of a triangular probabilistic distribution for optimal parametrization of the SEIR model recovery rates with delay.

Dynamical analysis of epidemiological models received significant attention after the global disaster of the Covid-19 pandemic. Although much of the attention has focused on choosing the appropriate model to describe and interpret the epidemiological data and on predicting the spread of the disease, working on uncovering the hidden dynamics by analyzing the predictive data and studying the algebraic properties of the models such as the invariant spaces, the center manifolds, and the Lyapunov functions in the general parameter space still have the potential to make a significant contribution to our understanding of the dynamics of spread. In this paper, in order to determine the recovery rate based on characteristic model parameters, the triangular probabilistic distribution is implemented in an epidemic delay differential equation with delays. By defining generic coefficients derived from field surveys and population characteristics, we propose a way to reduce the number of model parameters that need to be obtained during model fitting in order to find an effective way to handle the cultural and physiological diversity of societies and isolate the effect of counter measures for the epidemics.

Changes in cerebral oxygen saturation with the Trendelenburg position and increased intraabdominal pressure in laparocopic rectal surgery.

Objectives: Position changes and increased intra-abdominal pressure in laparoscopic interventions lead to some physiopathological changes. There is no definite information in the literature regarding cerebral oxygen saturation in patients undergoing colorectal surgery. Our aim was to investigate whether there is oxygen saturation change in the brain tissue in pneumoperitoneum and the Trendelenburg position during laparoscopic rectal surgery. Material and Methods: Cerebral oxygen saturation was measured in 35 patients who underwent laparoscopic rectal surgery in the Trendelenburg position. Measurements were made under general anesthesia in the pneumoperitoneum and the Trendelenburg position. Results: The values that are statistically affected by the position are systolic blood pressure, mean arterial blood pressure and cerebral oxygen saturation. The Trendelenburg position does not disturb the cerebral oxygen saturation and it causes an increase in saturation. After pneumoperitoneum occurred, changes in systolic blood pressure, mean arterial blood pressure and brain oxygen saturation were detected. Cerebral oxygen saturation increases with the formation of pneumoperitoneum. Conclusion: The Trendelenburg position and increased intraabdominal pressure during laparoscopic rectal surgery do not impair brain oxygen saturation.

Wandering spleen, which is torsioned with the distal pancreas.

There are many causes of acute abdominal pain. One of them is wandering splenic torsion. We aimed to discuss a case in which the distal pancreas and spleen were torsion together and underwent splenectomy in the light of the literature. A 19-year-old male patient with sudden onset of abdominal pain underwent splenectomy after physical examination and imaging revealed splenic torsion. Early diagnosis is important as life-threatening complications may develop. Emergency surgery should be performed in patients with splenic ischemia. It should be kept in mind that the pancreas may be torsioned along with the spleen. Surgeons need to be careful during splenectomy to avoid injury to the pancreas.

Clinicopathological Characteristics of Gastroenteropancreatic Neuroendocrine Tumors: 10 Years of Experience From a Single Center.

OBJECTIVES: Gastorenteropancreatic neuroendocrine (GEP-NET) tumors are the second most common tumors of the gastrointestinal tract. We aimed to investigate the clinicopathological features and factors affecting the prognosis of patients with GEP-NET. METHODS: Clinicopathological features of 158 patients were evaluated, including tumor location, TNM stage and grade, pathological features, presence of lymph nodes and distant metastases at the time of diagnosis, maximum tumor diameter and treatment details. Also, follow-up information was analyzed to discover possible prognostic factors. RESULTS: The most common primary site is pancreas (45.6%, n = 72). Most of the GEP-NETs were nonfunctional (93.6%, n = 148). Of the 158 patients, 94 (59.5%) were grade 1, 46 (29.1%) grade 2, and 18 (11.4%) grade 3. The 1-year, 3-year, and 5-year survival rates were 82.3% (130/158), 61.4% (70/114), and 47.2% (35/74), respectively. In multivariate analysis, histological grade (P = 0.04) and TNM stage (P < 0.001) were independent prognostic factors for survival in patients with GEP-NET. CONCLUSIONS: They are increasing in frequency and are the most common tumors in the pancreas. Nonfunctional tumors made up the majority of cases. The main treatment was surgical resection. Histological grade and TNM stage are independent prognostic factors.

Role of thiol-disulfide hemostasis in early diagnosis of acute mesentery ischemia: An experimental study.

BACKGROUND: Acute mesenteric ischemia (AMI) is a rarely observed acute abdominal disease that may be mortal and is difficult to diagnose early. The aim of our study is to assess the role of Thiol-Disulphide Haemostasis (TDH), a new method for AMI which still has no specific biochemical markers for early diagnosis, and to assess it together with Ischemia-Modified Albumin (IMA) which has previously proven reliability for AMI. METHODS: The study included 32 Wistar albino rats in four groups. The 1st group (n=8) was the control group, 2nd group (n=8) was the sham group, 3rd group (n=8) had 3 h of arterial mesentery ischemia and the 4th group (n=8) had 6 h of arterial mesentery ischemia. TDH, IMA, and serum lactate values were measured at h 0, 1, 3, and 6. RESULTS: In the 3rd and 6th h, serum total thiol and native thiol values significantly reduced (p<0.001), while serum disulfide, IMA, and lactate values clearly increased (p<0.001). Serum thiol values were observed to reduce from the 1st h. CONCLUSION: TDH changes in the early period of AMI. The TDH parameters can be used with IMA as diagnostic parameters for patients with suspected AMI in the early period.

Stent Applications for Palliative Treatment in Advanced Stage Esophageal Cancers.

METHODS: We examined cases of endoscopic stenting for palliative treatment of advanced stage esophageal cancers between January 2014 and July 2019. Age, gender, location of mass, adverse events, survival time, and stent type were evaluated. Outcomes of fully covered and uncovered self-expanding stents were compared with regard to adverse events, including stent migration and occlusion. RESULTS: The mean age of the patients was 66.4 ± 1, 52 were male, and 8 were female. Patients were followed up for a mean of 133 days. The most common complication due to stenting was migration. 13 patients developed adverse events. Migration was the most common adverse event, occurring in 8 (13%) patients. Although the migration rate of fully covered stents was higher than uncovered stents, there was no statistically significant difference (p = 0.47). Stent occlusion was observed in 4 patients. In three cases, it was due to the tumor; an uncovered stent was placed again in these cases. Food-related occlusion developed in one patient. There was no statistical difference in terms of overall adverse event rate when comparing fully covered stents to uncovered stents (p = 0.68). CONCLUSION: Endoscopic stenting is a viable palliative method with low morbidity and mortality in experienced centers. Though there are relative advantages with covered versus uncovered stents in individual cases, the overall adverse event rate is low and relatively similar.

Comparison of the efficacy of growth factor collagen and antibiotic collagen on colon anastomosis in experimental animals with peritonitis.

INTRODUCTION: In spite of advances in surgical techniques, the significance of anastomosis leak continues in colorectal surgery. There is no ideal method in spite of all studies and technical advances in this field. Our aim of this study was to use fibroblast growth factor collagen (FGF-C) and antibiotic collagen (AB-C) to increase the rate of anastomosis healing in experimental animals with peritonitis. METHODS: This animal experimental study received ethics committee approval. The animals were divided into three groups of seven animals each; the first group was control, the second group was the fibroblast growth factor collagen group, and the third group was the antibiotic collagen group. Under anesthesia, more than 50% of the colonic lumen was opened 4-5 cm distal to the ileocecal junction to create a defect. Twenty-four hours later, primary anastomosis was performed. The second group had the anastomosis line covered with a cover containing FGF-C. The third group had the anastomosis line covered by material containing AB-C. The experiment was concluded on the postoperative 7th day, and the anastomosis burst pressure, tissue hydroxyproline level, and histopathological assessment were performed. RESULTS: Though the burst pressure was higher in the experimental groups, it was not statistically significant. In the second and third groups, vascular proliferation and fibroblastic activity appeared to be better than in the control group. Hydroxyproline values were statistically significant in the experimental groups compared to the control group. CONCLUSION: FGF-C and AB-C may have potential utility in anastomosis healing, especially in those susceptible to infection due to anastomosis leak.

Approach to Traumatic Diaphragm Injuries: Single Center Experience.

BACKGROUND: Traumatic diaphragm injuries are rare. After blunt trauma, injuries occur with a 1-7% rate. This rate increases up to 15% in penetrating injuries. Diagnosis may be diffi cult and imaging tests may be misleading. The misdiagnosis may lead to herniated abdominal organs towards the intrathoracic cavity, with a mortality rate between 30% and 60%. This study was designed to investigate the data of patients operated for diaphragmatic injury in our clinic. METHODS: The files of trauma patients admitted to our hospital between 2014-2019 were reviewed retrospectively. The files of cases with diaphragmatic injury were examined. Patients were evaluated in terms of age, sex, type of injury, localization, additional organ injuries, grade, surgical method, and mortality. Values were statistically analyzed. RESULTS: A total of 20 patients were included in the study. Of the patients, 7 were female and 13 were male. The mean age was 32.7 (17-52) years. Of the cases, 10 were with stab wounds while 4 were incar traffi c accidents and 6 were gunshot wounds. Although all patients had thoracoabdominal injuries, 4 patients had additional pelvic injuries. Of the cases, 14 were accompanied with lung injury while 5 with intestinal, 4 with the spleen, 3 with liver, and 2 with cardiovascular injury. Patients with intestinal resection performed had a longer hospitalization period than others. When the severity of the injury was evaluated, grade 3 injuries were detected most commonly, whereas 3 patients had grade 1, 2, and 4 injuries. Grade 5 injury was detected in 1 patient. Primary repair was performed in 18 patients and mesh repair was performed in 2 patients. In three cases, the repair was performed with a thoracic way. One patient died on the postoperative fi rst day. CONCLUSIONS: Diaphragmatic injuries that may be missed during imaging may be damaged with many organs. Diaphragmatic injuries should be kept in mind in the upper abdominal and thoracic injuries.

Acute appendicitis in pregnancy.

BACKGROUND: Acute appendicitis is the most common cause of non-obstetric acute abdomen in pregnant women. We examined the patients who were admitted to our emergency department with abdominal pain and diagnosed with acute appendicitis in the light of the literature. METHODS: Seventeen pregnant patients with acute appendicitis who were admitted to the emergency department of Sanliurfa Training and Research Hospital between the years of 2016-2019 were retrospectively analyzed using an electronic recording system. Our patients were evaluated concerning age, gestational week, clinical status, the operation performed, ultrasonography results, pathology results, presence of additional diseases, laboratory results and hospital stay length. RESULTS: The mean age of our patients was 25.5 (18-41) years. Three patients were in the first trimester (17.6%), 11 patients were in the second trimester (64.8%), and three patients were in the third trimester (17.6%) at the time of admission. All of our patients had abdominal pain. Acute appendicitis was detected in 11 patients, while it was not detected in six patients on the USG examination. Two patients having term delivery underwent caesarean section with concurrent appendectomy. The mean hospital stay length was 2.9 (2-5) days. Histopathologically, 13 (86.7%) of our operated patients were diagnosed with appendicitis. No additional problems were observed in the mothers and infants in the postoperative period. CONCLUSION: Acute appendicitis should be considered as a non-obstetric pathology in pregnant patients admitted to the emergency department with abdominal pain. We think that it is important for both maternal and infant health to examine this condition, which shows differences concerning clinical course and physical examination, with a meticulous and multidisciplinary approach.

Lifestyle and Chronic Constipation in Medical Students.

AIM: Constipation is one of the most common complaints of the digestive system indicated with an increase in defecation frequency, difficulty in defecation, and hard and strained defecation. Environmental, personal, and genetic factors may be affecting constipation although the affecting factors have not yet been thoroughly explained. The aim of this study was to investigate constipation frequency and lifestyles in medical students. METHOD: The population was selected among medical students for the study, which was planned as a survey study. Demographic data of all the participants and the factors suggested to affect constipation were questioned and analyzed. RESULTS: The study covered a total of 425 medical students. Among the students reporting constipation, 2.86% were in their first year of medical school, while 7.53% were in the third year and 9.09% were in the sixth year. The rate of students reporting constipation and familial history was statistically significant. While regular eating habits were reported in the first and third years, this rate was much lower in the sixth year group working at clinical departments. The results of our study did not reveal any significant relationship between daily intake of water and constipation. There was, however, a significant relationship between stress and constipation. CONCLUSION: The results of our study showed that medical education did not curb constipation frequency. We believe that stress is significant in constipation. The data we collected indicate that regular eating habits and excess liquid intake are not as effective as suggested in the treatment of constipation.

The Investigation of 14 Appendiceal Mucocele Cases Encountered in 4850 Appendectomy Patients.

BACKGROUND: Appendiceal mucocele is a rarely seen disease which occurs when the appendix lumen is filled and obstructed by mucous. In our study, we aimed to reveal the surgical approach of our clinic, features of tumors, and clinical presentations in line with literature in cases of appendix mucocele. METHODS: Fourteen appendix mucocele patients who were admitted in our hospital between 2012 and 2019 were examined retrospectively in the electronic recording medium. Our patients were evaluated in terms of age, gender, clinical status, operation, imaging results, and pathology results. RESULTS: Of the fourteen patients, 12 applied to the emergency department and 2 to the general surgery clinic. All of our patients had abdominal pain at the time of admission. In the physical examination, 5 (35%) patients had defenses, 10 (71%) patients had rebound tenderness, and 12 (85%) patients had tenderness. In preoperative imaging studies, 11 patients were interpreted as having acute appendicitis and 3 patients were evaluated as having appendix mucocele. The pathological results were reported as 6 patients had appendiceal mucocele and 8 patients had appendiceal mucocele together with acute appendicitis. CONCLUSION: Appendiceal mucocele is a disease which generally causes similar clinical findings of acute appendicitis. Ultrasound and CT may be useful in preoperative diagnosis. Surgical treatment options of mucocele are open or laparoscopic appendectomy, cecum resection, and right hemicolectomy. Although its incidence is low, due to pseudomyxoma peritonei, it is a pathology that requires careful surgery.

Clinicopathologic and Surgical Characteristics Study of 151 Cases of GIST.

BACKGROUND: Gastrointestinal stromal tumor (GIST) is the most appearing mesenchymal tumor of the gastrointestinal system. In this study, we are aiming to share the most up to date knowledge about diagnosis and treatment of these tumors by transferring our clinical experience about GISTs. METHODS: The 151 patients who were operated between 2006-2020 and whose pathological examination was reported as GIST were analyzed retrospectively. Demographic, clinical, and pathological features and treatment methods of patients were evaluated. RESULTS: Seeventy-six of the patients were women and 75 of them were men whose age averages were 66.1 (31-86). The most common location was the stomach (55.6%), followed by the small intestine, retroperitoneal, large intestine, rectum, esophagus, and another organ. With surgical intervention, 139 of them had been cured. Twelve of cases were accepted as inoperable. The diameter of tumors in our cases were between 0.4 cm and 35 cm. Determined mitotic activity was ≤ 5 in 71 patients and 5 < in 80 patients. In 8 of 12 unresectable cases, it has been seen that partial remission after the treatment of 12-month tyrosine kinase inhibitors, C-KIT, was positive in 96.7% of our cases. CD34 and Ki-67 was analyzed in patients. CD34 was found positive in 98 (64.9%) of them, Ki-67 was positive in 82 (54.3%) patients. Patients had been observed for 40 months. CONCLUSION: Despite GISTs are not appearing frequently, nowadays they have started to be seen more frequently than before with the growing present-day diagnostic methods. The ideal treatment is performing radical resection without leaving any tumor cells behind. Tyrosine kinase inhibitors have an important place in unresectable cases.

Comparison of primary repair and repair with polyglycolic acid coated tube in recurrent laryngeal nerve cuts (an experimental study).

BACKGROUND: Recurrent laryngeal nerve (RLN) injury is an important complication of thyroid surgery. In our study, we aimed to compare the effects of primary repair and polyglycolic acid (PGA) coated tube repair on nerve function and regeneration in RLN cuts in rats. METHODS: Twenty seven rats were used for the study. Group-1 with only nerve cuts, group-2 with primary repair, and group-3 with conduit repair. The study was planned over two-stage surgery. In the first step, nerve defect formation and nerve repair were performed in the same session. In the second step, samples were taken from the subjects for histopathological. RESULTS: Vocal cord mobility was proportionally higher in group-3 than other groups. However, there was no statistically significant difference between the groups (p < 0.239). The mean number of highest axons were detected the group-3. CONCLUSIONS: We think that PGA coated conduit can provide a more accurate orientation of nerve fibers by creating an isolated environment when compared to the primary repair. And this may be the cause of functional improvement in the nerve.