Robotic gastrectomy is safe in geriatric patients with gastric cancer: a retrospective cohort study.

OBJECTIVE: The efficacy of robotic surgery in oncological operations has been demonstrated, but its applicability in the elderly population (≥70 years) is limited in studies. This study aims to investigate the feasibility, safety, and short-term outcomes of robotic surgery in gastric cancer surgery in geriatric patients. PATIENTS AND METHODS: Patients who underwent robotic surgery for gastric cancer between July 2021 and September 2023 were included in the study. Patients were divided into two groups: the elderly group (≥70 years) and the younger group (<70 years). Demographic data, clinical findings, perioperative outcomes, and pathology results were analyzed and compared between the two groups. RESULTS: 63 patients were included in our study. Group 1, the younger patients (<70 years), consisted of 44 patients, while Group 2, the older patients (>70 years), consisted of 19 patients. The male gender was dominant in both groups (70.5% vs. 78.9%, p=0.486). ASA 2 was the most common score in both groups (70.5% vs. 52.6%, p=0.261). Group 2 had lower hemoglobin (11.3 vs. 10.1, p=0.017) and albumin levels (39.9 vs. 37.6, p=0.049). The average operation times were similar in both groups (255 min vs. 242 min, p=0.457). The median postoperative hospital stay was 5 days in both groups. The distributions of postoperative complications according to the Clavien-Dindo classification were similar. Postoperative 30-day mortality was observed in one patient in Group 2. The 90-day hospital readmission rates were similar (11.3% vs. 10.6%, p=0.459). The average tumor diameters were similar (38 mm vs. 48 mm, p=0.165), as were the numbers of dissected lymph nodes (35 vs. 34, p=0.796). According to pathology results, T4a tumors were most common in Group 1 and T0 tumors in Group 2 (34.1% vs. 31.6%, p=0.149). The most common lymph node involvements were N0 in Group 1 and N1 in Group 2 (36.4% vs. 36.8%, p=0.515). CONCLUSIONS: Robotic surgery in gastric cancer is considered a safe and feasible method in the elderly population due to its successful early outcomes, suggesting its reliability and effectiveness.

Effect of main pancreatic duct suture ligation on the prevention of clinically relevant pancreatic fistula after distal pancreatectomy: analysis of 82 consecutive patients.

OBJECTIVE: This study aimed to examine the factors linked to the development of clinically significant pancreatic fistulas following distal pancreatectomy (DP) and to assess the efficacy of suture ligation of the main pancreatic duct. PATIENTS AND METHODS: A single-center retrospective study was performed on the medical records of 82 patients who underwent DP in our institution between January 2011 and December 2019. RESULTS: There were 28 males (34.1%) and 54 females (65.9%). The patients' age ranged from 18 to 86 years (median: 55.5 years). Indications for DP included primary pancreatic disease (n=63, 76.8%) and non-pancreatic disease (n=19, 23.2%). Postoperative mortality and morbidity rates were 3.7% and 48%, respectively. Pancreatic parenchymal closure was accomplished by a hand-sewn technique or mechanical stapling in 89 and 13 patients, respectively. Identification of the pancreatic duct and suture ligation was performed in 46 patients (56.1%). Pancreatic fistula was developed in 20 patients (24.4%); 12 fistulas were classified as Grade B, and 8 as Grade C. Biochemical leaks (Grade A) were identified in 8 patients (9.8%). Multivariate analysis indicated that failure to ligate the main pancreatic duct was the only variable associated with an increased risk for pancreatic leak (p=0.031; odds ratio=0.233; 95% confidence interval, 0.062-0.879). CONCLUSIONS: Pancreatic leak remains a common complication after DP. The incidence of leaks is reduced significantly when the main pancreatic duct is identified and directly ligated during DP.

The relationship between microsatellite instability in colorectal adenocarcinoma and tumor budding and histopathological parameters.

OBJECTIVE: This study aims to investigate the correlation between the presence of microsatellite instability (MSI) and tumor budding, as well as their relationship with histopathological parameters in patients diagnosed with colorectal adenocarcinoma. PATIENTS AND METHODS: The study encompassed patients who underwent curative surgery to treat colorectal cancer. These patients were classified into groups based on their MSI status. The International Tumor Budding Consensus Conference (ITBCC) 2016 guidelines were utilized to identify tumor budding. Demographics, clinical data, tumor budding, and histopathological attributes were assessed across study groups. RESULTS: The study analyzed 268 patients, out of which 32 (11.9%) were identified as having MSI. Microsatellite Stable (MSS) patients were placed in Group 1, and those with MSI were classified into Group 2. The average age was lower in Group 2 compared to Group 1 (55.9 years vs. 61.4 years, p=0.034). Tumor localizations in the caecum (5.9% vs. 18%) and the ascending colon (11.9% vs. 25%) were more prevalent in Group 2 (p=0.019). The occurrence of tumor budding (75% vs. 62.5%, p=0.133) and the budding degree in those with tumor budding were comparable between the groups. Poorly differentiated tumors were more prevalent in Group 2 (5.5% vs. 25%, p=0.001). Additionally, the tumor diameter was larger in Group 2 (3.58 cm vs. 4.35 cm, p=0.007). CONCLUSIONS: MSI is a significant biomarker, possessing diagnostic, prognostic, and predictive value in colorectal cancer (CRC). Understanding the connection between MSI and tumor budding in CRC may provide clinicians with insights to enhance patient management.

The investigation of biochemical and microbiological properties of four different honey types produced in turkey and the comparison of their effects with silver sulfadiazine on wound healing in a rat model of burn injury.

BACKGROUND: To determine and compare the effects of different honey types on wound healing in an animal model, with silver sulfadiazine as the standard treatment. MATERIALS AND METHODS: Five different groups were created with eight rats in each group. Partial-depth burns were created, and different types of honey and silver sulfadiazine were applied to the respective groups. Rats were monitored for 21 days, and wound cultures were obtained. Histopathological evaluation and cytokine analysis of final tissue samples were performed. In addition, the biochemical and microbiological analyses of the four types of honey used in the study were performed. RESULTS: Wound shrinkage comparisons showed that all four honey-treated groups (Bingöl, Konya, cotton, and citrus) performed better than the silver sulfadiazine group (honey groups, respectively, 86.86%, 84.72%, 89.61%, and 95.33% vs. control 82.90%). However, only citrus honey caused a significant difference in wound shrinkage rate when compared with other groups as well with control group (95.34% vs. 82.9%, P < 0.05). In tissues, all honey groups had higher cytokine (interleukin [IL]-6, IL-1B, tumor necrosis factor [TNF]-α) values compared with controls (P < 0.001). Honey analysis showed a significant inverse relationship between Fe (iron) and the number of diastases. CONCLUSIONS: The results of this study support the role of honey in wound healing, due to its antibacterial and immunomodulatory effects. More studies are needed to identify the role of honey composition in wound healing.

The effect of Allium sativum in experimental peritoneal adhesion model in rats

Abstract Purpose: To evaluate the effect of garlic on formation of postoperative adhesions in rats. Methods: Twenty-four Sprague dawley rats were divided into three groups. In Group 1 (sham), laparotomy was performed and stitched up. In Group 2 (control), after laparotomy was performed, punctate hemorrhage was induced by cecal abrasion in the cecum and 2 cc of saline was intraperitoneally administered to each rat. In Group 3 (experimental), after laparotomy was performed, punctate hemorrhage was induced by cecal abrasion in the cecum and each rat was intraperitoneally administered a sterile Allium sativum derivative. The rats in all groups were re-laparotomized on postoperative day 7; samples were obtained from the peritoneal tissue surrounding the cecum Results: In Group 3, there was a statistically significant difference in terms of inflammation, lymph node size, and free oxygen radicals; these parameters tended to increase. In terms of fibrosis evaluated using H&E and MT, there was no significant difference between groups 2 and 3. Conclusions: No positive outcomes indicating that Allium sativum reduces intra-abdominal adhesions were obtained. However, it caused severe inflammation in the tissue. Additionally, in immunohistochemical analyses conducted to detect oxidative stress, allium sativum increased the production of free oxygen radicals in the tissue.

Polyorchidism: a three-case report and review of the literature.

The presence of more than two testes confirmed by histology is called polyorchidism. Polyorchidism is an extremely rare congenital anomaly with a few more than 100 cases reported in the literature. The majority of reported cases are asymptomatic patients, others present with cryptorchidism, hydrocele, varicocele, epididymitis, infertility, testicular malignancy and testicular torsion. Over a 2-year period, we encountered three patients who were found to have polyorchidism; two men presented with cryptorchidism and one with chronic scrotal pain. Physical examination of the first and the third patient revealed normal testes in the scrotal sac, the other scrotal sac was empty and small solid mass (atrophic left testes) was palpated in the inguinal canal. Ultrasonographic examination of the scrotum and inguinal region confirmed the findings of the physical examination. Ultrasonographic examination of the second patient revealed supernumerary testes within the scrotum. Orchiectomy was made on the first and third patients' supernumerary testes and ipsilateral inguinal high ligation was applied for herniorrhaphy. A conservative approach was preferred for the second patient, maybe preserving a potentially functional supernumerary testis to improve the capacity for spermatogenesis. The risk of malignancy justifies the removal of an atrophic and ectopic testis in polyorchidism. However, it would appear safe to preserve a viable intrascrotal supernumerary testis found incidentally at surgery, provided that the patient is followed-up in the long term.

Assessment of the acute effects of tadalafil on the cardiovascular system based on examination of serum oxidative status and paraoxonase activity in men with erectile dysfunction: a preliminary study.

Phosphodiesterase type 5 inhibitors were initially approved for the treatment of erectile dysfunction in men and were later suggested for some systemic disorders, mostly due to their possible beneficial effects on endothelial functions. Paradoxically, though, phosphodiesterase type 5 inhibitors may have some life-threatening effects, for which there is weak evidence, it appears that they are associated with cardiovascular problems such as myocardial infarction and stroke. This study aimed to investigate the acute effects of tadalafil citrate on the cardiovascular system by evaluating serum oxidative status and paraoxonase-1 activity. Sera of 36 patients with erectile dysfunction were analyzed for total antioxidant status, total oxidant status and paraoxonase-1, before and after the administration of tadalafil citrate. Pre- and post-tadalafil citrate serum levels of total antioxidants, total oxidants and paraoxonase-1 were 1.1+/-0.0 and 1.6+/-0.0 micromol H(2)O(2) equiv l(-1), 10.3+/-1.1 and 6.9+/-1.2 micromol H(2)O(2) equiv l(-1), and 111.6+/-17.8 and 168.0+/-18.1 U l(-1), respectively (P<0.0001 for all results). This preliminary study confirmed that tadalafil citrate exerts a beneficial acute effect on the cardiovascular system by reducing serum levels of oxidative stress and increasing serum levels of paraoxonase-1.

Oxidative Stress in BPH.

INTRODUCTION: In the present study, we investigated the relationship between potency of oxidative stress and BPH and this may assist to contribute to the realistic explanation of the ethiopathogenesis of BPH. METHODS: Seventy four newly diagnosed men with BPH (mean age: 54+/-11.2), who had not undergone any previous treatment for BPH, and 62 healthy volunteers (mean age: 55+/-14) were enrolled in the present study. To determine the antioxidative status of plasma, total antioxidant capacity (TAC) was calculated, and to determine the oxidative status of plasma (TOS) total peroxide levels were measured. The ratio of TAC to total peroxide was accepted as an indicator of oxidative stress (OSI). Data are presented as mean SD +/- unless specified. Student t-test and correlation analyses were used to evaluate the statistical significance differences in the median values recorded for all parameters between BPH and control group. RESULTS: Plasma TAC TOS were found in patients and controls (1.70 +/- 0.32, 1.68 +/- 0.19 micromol Trolox Equiv./L), (12.48 +/- 1.98, 12.40 +/- 1.14 micromol / L) respectively. OSI was calculated as 7.57 +/- 1.91, 7.48 +/- 1.33, respectively. Plasma TAC, TOS and OSI levels were not found to be significantly difference between patients and control subjects (p>0.05, p>0.05, p>0.05). CONCLUSIONS: The present study has shown that there were not relationship between potency of oxidative stress and BPH. Further well designed studies should be planned to find out whether the oxidative stress-related parameters play role in BPH as an interesting pathology in regard of the etiopathogenesis.

Eosinophilic mastitis.

In this report a case with eosinophilic mastitis is described. The non specific radiologic findings of eosinophilic mastitis are illustrated. Diagnosis was established by histopathological exam of needle biopsy material. Knowledge of this rare entity may be helpful in diagnosis and clinical management.

Effect of needle tract bleeding on occurrence of pneumothorax after transthoracic needle biopsy.

PURPOSE: Occasionally bleeding along the needle trajectory is observed at post-biopsy computed tomographic sections. This study was designed to evaluate the possible effect of needle tract bleeding on the occurrence of pneumothorax and on requirement of chest tube insertion. MATERIALS AND METHODS: Two hundred eighty-four needle biopsies performed in 275 patients in whom the needle traversed the aerated lung parenchyma were retrospectively reviewed. Bleeding along the needle tract, occurrence of pneumothorax and need for chest tube insertion, type and size of the needle, size of the lesion, length of the lung traversed by the needle, presence or absence of emphysema were noted. Effect of these factors on the rate of pneumothorax and needle-tract bleeding was evaluated. The data were analyzed by chi2 test. RESULTS: Pneumothorax developed in 100 (35%) out of 284 procedures requiring chest tube placement in 16 (16%). Variables that were significantly associated with an increased risk of pneumothorax were depth of the lesion (P < 0.001) and severity of emphysema (P < 0.05). There was bleeding along the needle tract in 18.6% (n = 53) of the procedures. Pneumothorax occurred in 18 (33.9%) out of 53 procedures in which tract-bleeding was observed and in 82 (35.4%) out of 231 procedures in which tract-bleeding was not seen. The difference between the two groups was not significant (P > 0.05). However, analysis of the relation between length of lung traversed by the needle, tract-bleeding and pneumothorax rate indicated that tract-bleeding had a preventive effect on development of pneumothorax (P < 0.001). Occurrence of tract bleeding also had preventive effect on pneumothorax in the presence of emphysema (P < 0.05). The only variable which had effect on occurrence of tract-bleeding was the length of the lung traversed by needle (p < 0.001). Requirement for chest tube insertion was smaller in the tract-bleeding group than non-tract bleeding group, 11% (2/18) to 17% (14/82), respectively. But this difference was not significant statistically (P > 0.05). CONCLUSION: Bleeding in the needle tract has a preventive effect on the occurrence of the pneumothorax in deep-seated lesions and in the presence of emphysema, although it does not affect the overall rate of pneumothorax.

Factors influencing cosmetic results after breast conserving management (Turkish experience).

We aimed to determine predictive factors affecting cosmetic results after breast conserving management in breast cancer. Data on 96 patients with 97 breast cancer cases, who had been admitted to Uludag University M.A. Radiotherapy Center between October 1995 and December 1998 and managed with breast-conserving treatment, were analysed to determine the factors affecting cosmetic outcome. Possible factors affecting cosmesis were grouped as patient-related, tumor-related and treatment-related. Mann-Whitney U test was used in univariate analyses whereas logistic regression was used in multivariate analyses. Median follow-up time was 29.5 months ranging between 11 and 53 months and median age at admission was 50 (range 22-84). Cosmetic results were grouped in five categories; excellent; good; fair; poor and, very poor, using criteria, such as presence of fibrosis, telangiectasia, shape of breast, asymmetry, status of areola, pigmentation. Treated breasts were scored by the patients, three radiation oncologists and a breast surgeon independently. In the analysis performed using scores given by the patients, cases with scores 3 and above (unsatisfactory) were compared with cases with scores below 3 (satisfactory). Eighty-two patients (84%) considered cosmetic result as satisfactory (excellent/good) whereas 15 patients (16%) considered unsatisfactory (fair/poor/very poor). In univariate analysis using Mann-Whitney U test, type of surgery (P=0.0655) was the statistically significant factors affecting cosmetic results. In multivariate analysis using logistic regression, tumor quadrant (P=0.0060) and elapsed radiation therapy days (P=0.0090) were the most significant factors. Median values were taken into consideration for the scores given by the physicians and cases with scores 3 and above (unsatisfactory) were compared with cases with scores below 3 (satisfactory). Eighty-two cases were evaluated as satisfactory (84%) whereas 15 cases were unsatisfactory (16%). In this set of data, patient age (P=0.0144), menopausal status (P=0.0111), institution which surgery was performed (P=0.0045), type of surgery (P=0.0044), placement of metallic clips (P=0.0083) and skin fibrosis (P=0.038) were found to be significant in univariate analysis using Mann-Whitney U test. In multivariate analysis using logistic regression, institution where surgery took place (P=0.0015), menopausal status (P=0.0087) and telangiectasia (P=0.0657) were the most significant factors.

Preoperative screening for lung volume reduction surgery: usefulness of combining thin-section CT with physiologic assessment.

OBJECTIVE: This study was performed to assess the usefulness of preoperative thin-section CT alone and in combination with physiologic measurements in emphysema patients being evaluated for lung volume reduction surgery. SUBJECTS AND METHODS: Six 1-mm collimation sections through the chest were obtained in 20 patients being evaluated for lung volume reduction surgery. Extent and severity of emphysema were assessed by visually scoring the images. CT scores ranged from 0 to 144. Inspiratory resistance was measured in 12 of 20 patients and was also used to discriminate between responders (change in forced expiratory volume in 1 sec, > or = 150 ml after surgery) and nonresponders (change in forced expiratory volume in 1 sec, < 150 ml after surgery). RESULTS: Four of 20 patients with mild emphysema as revealed by thin-section CT (scores of < 50) did not improve lung function after lung volume reduction surgery. Eight of the remaining 16 patients with moderate to severe emphysema as revealed by thin-section CT (scores of > 50) underwent inspiratory resistance measurement. Those seven patients whose inspiratory resistance measurement exceeded 8.5 cm H2O/l per second did not respond favorably to lung volume reduction surgery (change in forced expiratory volume in 1 sec, < 150 ml). The remaining five patients whose inspiratory resistance measurement was less than 8.5 cm H2O/l per second responded favorably to lung volume reduction surgery. Thus, only five of the 20 patients showed improvement in forced expiratory volume in 1 sec after surgery. CONCLUSION: Our data suggest that among patients with moderate to severe emphysema who are being examined for lung volume reduction surgery, the combination of radiologic and physiologic assessment is more accurate for predicting a favorable response to lung volume reduction surgery than radiologic assessment alone. However, in patients with chronic obstructive pulmonary disease by the American Thoracic Society criteria, mild emphysema as revealed on thin-section CT virtually precludes further workup because these patients are unlikely to respond favorably to lung volume reduction surgery.

Choledochoduodenal fistula secondary to duodenal peptic ulcer. A case report.

Spontaneous choledochoduodenal fistula (CDDF) is a rare form of biliary enteric fistula which usually occurs as a complication of duodenal peptic ulcer disease. The more common form is cholecystoduodenal fistula (CCDF) which is generally associated with gallbladder disease. We report on a case of ulcerogenic CDDF diagnosed by upper gastrointestinal barium study, ultrasonography, and gastroduodenal endoscopy.