Effect of hyperbaric oxygen in hepatopulmonary syndrome: an innovative experimental study.

OBJECTIVE: This study aimed to analyze the effect of hyperbaric oxygen treatment (HBOT) in hepatopulmonary syndrome (HPS). MATERIALS AND METHODS: Five-month-old female Wistar-Albino rats were randomly divided into three groups: Group I, the control group; Group II, the cirrhosis group; and Group III, the cirrhosis group + HBOT group. Rats were exposed to HBO sessions (2.4 atm./60 min) for 20 days. Animals were sacrificed 24 hours after the last HBO session. Biochemical analysis, oxygenation parameters, NO and NO synthase (NOS) levels, histopathological changes in the liver and lungs, and pulmonary artery diameter were measured. RESULTS: A total of 24 rats (10 rats were included in Group I, six rats in Group II, and eight rats in Group III) weighing 220-250 g were included in the study. Significant differences were observed for NO and NOS (9.10±1.05 to 12.17±1.85 µmol/L, p<0.05 and 0.46±0.31 to 1.17±0.39 U/ml, p<0.05, respectively) at baseline and day 36 only in group II. Inflammatory cell infiltration and bronchial injury were significantly increased in group II compared to group I (p=0.007 and p=0.008, respectively) but not in group III (p=0.266 and p=0.275, respectively). Pulmonary artery diameter was significantly lower in group III compared with group II at all sites in both lungs (p<0.05). CONCLUSIONS: HBOT may be a promising treatment for HPS by reducing NO and NOS activity, perialveolar arteriolar dilation, lung inflammation, and injury and guiding future clinical trials.

Changes in and the relationships between alpha-klotho, oxidative stress, and systemic inflammation in cigarette smokers.

Background: Although smoking is known to accelerate aging, the mechanisms by which this occurs have not been fully clarified. Serum-soluble α-Klotho (sαKl), antiaging, anti-inflammatory, and developing resistance to oxidative stress properties are known. Aim: This study aimed to determine the relationship between cigarette smoking, sαKl (antiaging hormone), inflammation, and oxidative stress. Materials and Methods: Participants included in the study were divided into smoking and nonsmoking groups. sαKl, high-sensitivity C-reactive protein (hsCRP), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were assessed and compared in the study participants. Results: There were one hundred and forty-six study participants comprising 47 (32.2%) females and 99 (67.8%) males. There were 79 (54.1%) in the nonsmoking group and 67 (45.9%) in the smoking group. A significant difference was found between the groups in respect of TAS (P < 0.001), OSI (P = 0.017), sαKl (P = 0.013), and hsCRP (P = 0.024) values. A significant negative correlation was found between the sαKl values of the smoking group and the years of smoking (r = -0.271, P = 0.038) and pack-years (r = -0.299, P = 0.021). Among the smoking group, a lower median sαKl value of <3.84 pg/ml was significantly associated with years of smoking (P = 0.028) and pack-years (P = 0.012). Conclusions: This study found that sαKl, OSI, and hsCRP were elevated in those who smoke cigarette. Large prospective studies are needed to further elucidate this area of research.

Does onlay mesh placement in emergency laparotomy prevent incisional hernia? A prospective randomized double-blind study.

PURPOSE: The objective of this study is to assess the effectiveness and safety of onlay mesh closure of emergency midline laparotomy to prevent incisional hernia. METHODS: This is a prospective randomized double-blind study and was carried out in the General Surgery Clinic, Konya City Hospital, from August 1, 2020 to August, 1, 2021. The study included 108 patients who were randomly grouped in 2 groups: patients with conventional abdominal closure and closure using additional onlay mesh (1:1). The follow-up period was for a year. The primary outcome was the incidence of incisional hernia and secondary outcomes were clinical data like complications, hospital length of stay, re-operations. RESULTS: It was observed that incisional hernia was present in 14 patients (27.4%) in conventional abdominal closure group and was in 2 patients using mesh (4%), (p = 0.001). Clavien-Dindo 3B complications were in rise in conventional closure group (p = 0.02). Of all complications, burst abdomen was significantly more common in conventional closure group (p = 0.04). The rate of surgically treated complications were higher in conventional closure group (p = 0.02). Clavien-Dindo 3A complications were more common in patients with contaminated wound in mesh group (p = 0.02). CONCLUSION: The use of mesh while closing the abdomen in emergency midline laparotomy reduces the risk of incisional hernia. Thus, to lower the risks of incisional hernia and its complications, prophylactic mesh can be used in high-risk patients.

Evaluation of knowledge level related to obstructive sleep apnea syndrome.

OBJECTIVE: Our aim in this study is to evaluate the knowledge level of outpatients about obstructive sleep apnea syndrome (OSAS). SUBJECTS AND METHODS: This cross-sectional analytical study included 1651 patients and patient relatives who applied to Konya Training and Research Hospital outpatient clinics. Sociodemographic data form and OSAS knowledge level questionnaire were applied to participants. SPSS 21 package program was used for the statistical analysis of the data. It was accepted that p value was <0.05. RESULTS: The average knowledge score in the knowledge level questionnaire was 15.1 (3-33). 61% of the participants had never heard of OSAS before. Those who are married, those living in the city center and women have a higher level of knowledge. When age, education level and income level increased, the score of information also increased. Most of the participants' information source was the social media with 56.5% (n = 364) and least were health workers with 19.8% (n = 127). The knowledge level of people whose information sources were doctors, were significantly higher than other information sources such as nurses, friends, internet and television as. There was no significant difference between the other groups. CONCLUSION: In our study, it was concluded that the level of knowledge about OSAS in the society was not sufficient and that the society had to be informed about this disease which has serious complications and awareness should be established.

The effects of smoking cessation on visceral adiposity index levels.

BACKGROUND: : Known to cause important metabolic disturbances, weight gain becomes a major health problem after smoking cessation. Visceral adiposity index (VAI) is becoming increasingly popular in the detection of cardiometabolic risks in several disorders and general population. Here, we aimed to investigate the effects of quitting smoking on VAI levels. MATERIALS AND METHODS: : Of 350 participants included into the cigarette cessation program, 70 (20%) completed the study and were enrolled into the analyses. VAI levels were calculated at the baseline and 3rd month after cigarette cessation. RESULTS: : Thirty-eight (54.3%) out of 70 participants were male. While the mean age was found as 42 ± 1.0 years, mean starting age of smoking was found to be 16.87 ± 0.45 years, and mean smoking time was 23.07 ± 1.18 years. While VAI levels were found higher in men at the baseline, VAI levels were found similar in both genders at the end of the study. Higher VAI levels were found in those smoking >20 cigarettes/day, compared to those smoking ≤20 cigarettes/day. Although weight, waist circumference, body mass index (BMI), and high-density lipoprotein cholesterol levels increased, VAI levels were found to decrease significantly at the 3rd month. In subgroup analyses, VAI levels were seen to decrease significantly only in men (P = 0.005). Furthermore, VAI levels were found to decrease (P < 0.001) in those with BMI ≥25 kg/m2, whereas no significant change was observed in those with BMI <25 kg/m2. CONCLUSIONS: Although body weight increases significantly after quitting smoking, VAI levels, an indicator of cardiovascular risks, decrease significantly, especially in men or obese patients.

Effects of smoking on thiol/disulfide homeostasis.

OBJECTIVE: Cigarette smoking is an important risk factor for many diseases. This study aimed to evaluate whether cigarette smoking is associated with changes in the thiol/disulfide homeostasis (TDH), a novel biomarker of systemic oxidative stress. PATIENTS AND METHODS: Eighty-four smokers and 86 non-smoking healthy volunteers were enrolled. Serum native thiol, disulfide and total thiol levels, disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios were analyzed using a new colorimetric method. Carbon monoxide (CO) levels were measured by a piCO smokerlyzer instrument. RESULTS: The native, total, and native/total thiol levels of smoking patients were significantly lower (p<0.001 for each), and disulfide, disulfide/native thiol, and disulfide/total thiol levels were significantly higher in smokers than the healthy controls (p<0.001 for each). The CO levels of all study participants were negatively correlated with native thiol (r= -0.627, p<0.001), total thiol (r= -0.569, p<0.001), native thiol/total thiol (r= -0.515, p<0.001), and positively correlated with disulfide (r=0.398, p<0.001), disulfide/native thiol (r=0.515, p<0.001) and disulfide/total thiol (r=0.515, p<0.001) levels. CONCLUSIONS: To our knowledge, this investigation is the first in the literature that investigated TDH in cigarette smokers. Our results show that cigarette smoking may lead to oxidative stress and TDH shifts through disulfide side compared to the healthy group. Further studies with larger sample size are needed to confirm our results for showing the changes in TDH to contribute to the clinical practice.

The effects of smoking on neutrophil/lymphocyte, platelet/ /lymphocyte ratios.

OBJECTIVE: The aim of this study was to compare the Neutrophil to Lymphocyte ratio (NLR), Platelet to Lymphocyte ratio (PLR) and Mean Platelet Volume to Platelet (MPV/Plt) ratio of smokers and non-smokers. METHODS: Two hundred smokers and two hundred non-smoking healthy volunteers were enrolled in this study. Sociodemographic data and hematologic parameters of all patients were recorded. NLR, PLR and MPV/Plt ratios were calculated. RESULTS: The mean age of the case group was 35.88 ± 10.56 and the mean age of the control group was 38.97 ± 10.56. 80 % (n = 160) of the smokers were male and 20 % (n = 40) were female. 27.5 % (n = 55) of the control group were male and 72.5 % (n = 145) were female. The smoker group had higher NLR and MPV/Plt ratio (p < 0.05). PLR was significantly higher for the non-smoker group (p < 0.05). CONCLUSION: As a result of our study, an increase in the NLR which is used as a systemic inflammatory marker, a decrease in the PLR and an increase in the MPV/Plt ratio which indicates thromboembolism risk were found for the smoker group (Tab. 3, Ref. 32).

Extra-nodal extension of sentinel lymph node metastasis is a marker of poor prognosis in breast cancer patients: A systematic review and an exploratory meta-analysis.

Invasive breast cancer is the most common malignancy in women. Its most common site of metastasis is represented by the lymph nodes of axilla, and the sentinel lymph node (SLN) is the first station of nodal metastasis. Axillary SLN biopsy accurately predicts axillary lymph node status and has been accepted as standard of care for nodal staging in breast cancer. To date, the morphologic aspects of SLN metastasis have not been considered by the oncologic staging system. Extranodal extension (ENE) of nodal metastasis, defined as extension of neoplastic cells through the nodal capsule into the peri-nodal adipose tissue, has recently emerged as an important prognostic factor in several types of malignancies. It has also been considered as a possible predictor of non-sentinel node tumor burden in SLN-positive breast cancer patients. We sought out to clarify the prognostic role of ENE in SLN-positive breast cancer patients in terms of overall and disease-free survival by conducting a systematic review and meta-analysis. Among 172 screened articles, 5 were eligible for the meta-analysis; they globally include 624 patients (163 ENE+ and 461 ENE-) with a median follow-up of 58 months. ENE was associated with a higher risk of both mortality (RR = 2.51; 95% CI: 1.66-3.79, p < 0.0001, I(2) = 0%) and recurrence of disease (RR = 2.07, 95% CI: 1.38-3.10, p < 0.0001, I(2) = 0%). These findings recommend the consideration of ENE from the gross sampling to the histopathological evaluation, in perspectives to be validated and included in the oncologic staging.

Three complications of Pair (puncture, aspiration, injection, reaspiration) in one case: Recurrent hemobilia, cyst infection and pneumonia.

INTRODUCTION: With the appropriate indications, puncture, aspiration, injection and reaspiration (PAIR) is the most effective minimal invasive method used in the treatment of hydatic cysts. Hemobilia is the hemorrhagia in bile ducts in consequence of any reason. In literature there is no case with hemobilia because of PAIR. This is the first case with recurrent hemobilia, infection in cyst cavity and pneumonia because of PAIR. CASE: A 66 years old female patient was admitted to hospital with complaints of abdominal pain, hematemesis and melaena. She gave the history of PAIR for two hydatic cysts. At physical examination, there were jaundice, tenderness at right subcostal area and melaena at rectal digital examination. Hemobilia was detected by abdominal ultrasonography and magnetic resonance cholangiopancreaticography (MRCP). An endoscopic retrograde cholangiopancreaticography (ERCP) and endoscopic sphincterotomy were performed. The patient was discharged after 6 days hospital stay. One day after the discharge the patient was admitted to hospital with the same complaints again. Performing ERCP and balloon extraction, the hematoma filling the common bile duct was removed. After the patient was hemodynamically stable for 3 days, she was discharged from the hospital. A week after that the patient was admitted to hospital with the clinical findings of infected hydatic cyst and pneumonia. The patient was treated medically with mechanical ventilation support for 8 days. CONCLUSION: It should not be underestimated that, there can be serious complications of PAIR like hemobilia. Therefore, PAIR should be performed only in centers having appropriate medical and surgical facilities.

Evaluating the effectiveness of spleen autotransplantation into the liver and the omentum.

BACKGROUND: Experimental research into the viability and functionality of splenic tissue placed in the liver and the omentum. METHODS: There were 4 groups in this study. First group: sham laparotomy, 2nd group: splenectomy, 3rd group: splenectomy and splenic autotransplantation into the greater omentum and 4th group: splenectomy and splenic autotransplantation into the liver. Blood levels of haemoglobin, leukocytes, thrombocytes, immunoglobulin G (IgG), immunoglobulin M (IgM) and complement protein 3 (C3) were studied 1 day before and 6 weeks after the procedure. At the end of 6 weeks, scintigraphy was performed. Splenic tissue in the liver and the omentum were subjected to macroscopic and histopathologically. RESULTS: Pre- and postoperatively, no significant differences were found in terms of haematological and immunological measurements of groups I, III and IV. An increase in the numbers of thrombocytes and leukocytes and a decrease in the levels of IgG, IgM and C3 were observed in the postoperatively in group II.When the postoperative hematological and immunological values of the second group are compared to those of groups III and IV, the difference was significant in terms of levels of thrombocyte, leukocyte and IgM; insignificant in terms of levels of IgG and C3. In the microscopic and scintigraphic analyses the spleen tissue was found to be viable in all of the six rabbits in groups III and IV. CONCLUSIONS: The liver is a suitable organ for splenic autotransplantation (Tab. 6, Fig. 2, Ref. 17).

Minimally invasive parathyroidectomy under local anesthesia.

BACKGROUND: More than 85% of primary hyperparathyroidism (PHPT) cases are due to solitary, benign parathyroid adenomas. Recently, the success rate of Tc99m sestamibi scintigraphy in localization has made minimally invasive parathyroidectomy (MIP) more prominent. MIP is as effective as conventional bilateral neck exploration. Moreover, it offers lower morbidity, cost effectiveness, and better cosmetics effects. AIM: We aimed to evaluate the success of MIP, which happens only under local anesthesia, in this study. MATERIALS AND METHODS: Total of 63 patients were operated for PHPT, of which 54 had solitary adenoma. Five patients underwent bilateral neck exploration under general anesthesia for thyroid nodules or unlocalizated adenomas. A total of 49 patients underwent MIP under local anesthesia without any sedation. During MIP, gamma probe was used for all patients. The patients were followed for parathyroid functions. RESULTS: The mean age of 49 patients with MIP (5 male, 44 female) was 59 years. The mean follow-up time was 16.4 (±10.1) months (range: 2-36 months). Of the 49 patients, 47 (96%) were totally cured. In 2 patients, the procedure was switched to conventional bilateral neck exploration. Temporary hypocalcaemia was noted in 4 patients. CONCLUSIONS: If the adenoma is localizated, MIP under only local anesthesia can be performed with a high success rate. Gamma probe-guided MIP under local anesthesia is an effective and safe method. It has the advantage of being minimally invasive and, therefore, it should be preferred over the conventional method.

A comparison of sutureless and antibacterial suture abdomen closure.

PURPOSE: This experimental study aimed at comparing the cyanoacrylate abdomen closure to the effectiveness of triclosan coated polidioxanone abdomen closure. METHODS: The abdomen layers were closed with 3/0 polidioxanone suture in the first group. In the second group, the layers were closed with triclosan coated polidioxanone suture in a single layer. The abdomen layers of rats in the third group were attached with cyanoacrylates without sutures. The rats were sacrificed on the 14th day and the adhesive level was recorded. The incision resistance strength was measured. The tissue was examined blindly in the terms of inflammatory cell infiltration, capillary proliferation, fibrosis and micro-abscess by the pathologist. RESULTS: No significant difference was determined between the 1st and 2nd groups in the terms of inflammatory cell infiltration, capillary proliferation, collagen deposition, fibroblast activity, adhesive and tissue distension strength. The fibrosis and adhesive rate of the 3rd group was significantly higher than the 1st and 2nd groups statistically. The tissue distension strength was lower than in the other groups and the differences between the groups were found to be significant (p < 0.05). No significant difference was determined between the groups in the term of micro-abscess. CONCLUSIONS: Antibacterial suture is not superior to the conventional suture. It is concluded that cyanoacrylate is not an appropriate molecule for abdomen closure (Tab. 1, Fig. 3, Ref. 17).

Hartmann colostomy with LigaSure.

PURPOSE: While LigaSure is commonly used for blood vessel closure, our aim was to research the effectiveness of using the latter tool for the purpose of closing intestines in rats. METHODS: Twenty Wistar albino rats were divided into two groups per 10 each. In Group 1, the sigmoid colon was cut from its middle and its distal was closed with 4/0 silk. In Group 2, on the other hand, the sigmoid colon was divided from the middle with LigaSure LS1200 probe and its distal was closed with LigaSure. In both groups, the proximal sigmoid colon was entered by means of colostomy with 4/0 silk to the left part of the abdomen. Operation durations, adhesion levels and explosion pressures were recorded. Tissue samples were taken for tissue hydroxyproline level. RESULTS: While the average duration of the operation was 25.7 minutes in Group 1, it was 18.8 minutes in Group 2 and the difference between them was significant in favour of LigaSure. (p<0.001). Stump explosion pressure was 181.4 (160-190) mmHg in average in the suture group (Group 1), and 173.3 (150-190) mmHg in the LigaSure group (Group 2) and the difference between them was not statistically significant. Tissue hydroxyproline level was 123.6 (13-232) in Group 1, and 123.3 (32-216) in Group 2 and no significant difference was determined between the groups. Adhesion level between the groups was also similar. CONCLUSIONS: This study experimentally shows that the duration of effective stump closure as part of Hartman colonostomy can be shortened with LigaSure (Tab. 1, Fig. 4, Ref. 12).

Male breast cancer: a retrospective study of 15 years.

PURPOSE: To retrospectively evaluate the 15-year experience with breast cancer in males at a single institution. METHODS: The data from 25 male patients who had undergone surgery for breast cancer at a single center were retrospectively analysed. Their medical records were studied for clinical characteristics, therapeutic modalities used and factors associated with disease free (DFS) and overall survival (OS), like local recurrence/distant metastasis. RESULTS: The median patient age was 67 years (range 38-83). The most frequent presenting symptom was a palpable lump. Eighteen (72%) patients underwent modified radical mastectomy (MRM), while sentinel lymph node biopsy (SLNB) was performed in 14 (56%) cases. Of 25 patients, 21 (84%) underwent axillary lymph node dissection (ALND) and 15 (71.4%) of them had pathological axillary lymph node involvement. Two of 25 (8%) patients with bone and liver metastases underwent toilet mastectomy due to breast ulceration. Estrogen receptor (ER) was positive in 15 (60%) patients, while progesterone receptor (PR) and C-erbB2 (HER-2) were positive in 10 (40%) and 2 (8%) patients, respectively. Ten patients (40%) had both ER(+) and PR(+). The median follow-up period was 19 months (range 3-102). Local recurrence developed in one (4%) patient and distant metastasis in 4 (16%). Five-year OS and DFS were 53 and 49%, respectively. In univariate and multivariate analysis, pathological tumor size (<2 vs. >2 cm), pathological lymph node involvement and preoperative skin involvement over the breast were not associated with breast recurrence. Only in univariate analysis local recurrence/distant metastasis were associated with poor OS. CONCLUSION: Large cooperative studies are needed using strict clinical and laboratory criteria to advance the understanding of this disease and to identify the most effective treatment approaches.

Breast conserving surgery in patients with multifocal/multicentric breast cancer.

PURPOSE: To retrospectively evaluate the outcome of patients with multifocal (MF) and multicentric (MC) breast cancer treated with conservative surgery. METHODS: We evaluated 59 patients who had undergone breast conserving surgery (BCS) for MF/MC cancer between 1998-2008. We used sentinel lymph node (SLN) biopsy for all 59 patients and we performed axillary lymph node dissection in those with positive SLN. Local control, overall survival (OS), disease-free survival (DFS) and identification of predictive factors for recurrence were evaluated. RESULTS: Twenty patients with modified radical mastectomy because of persistent positive margins were excluded from the study. Evaluated were 55 patients with MF (93.2%) and 4 (6.8%) with MC disease. Thirty-four patients (57.6%) had 2, 20 patients (33.9%) had 3 and 5 (8.5%) had 4 or more tumor foci. Median follow up time was 20 months (range 2- 97). The projected 5- and 8-year OS were 95% and 89% respectively, and DFS 92.3%. At multivariate analysis, overexpression of human epidermal growth factor receptor 2 (HER-2) was associated with a higher ipsilateral breast cancer recurrence. Menopausal status, MF/MC disease, number of tumor foci (2 vs. ≥3), histological grade, extracapsular extension (ECE), lymphovascular invasion (LVI), and hormone receptor status were not associated with ipsilateral breast cancer recurrence. CONCLUSION: Our study demonstrates that in selected patients with MF/MC breast cancer, wide conservative surgery is a safe therapy.