Association between vitamin D receptor gene FokI polymorphism and mortality in patients with sepsis.

BACKGROUND: Sepsis is life-threatening organ dysfunction as a result of the host's dysregulated immune response to infection. The vitamin D receptor (VDR) gene FokI polymorphism influences immune cell behavior. In the present study, we aimed to investigate the association between VDR FokI polymorphism and mortality in sepsis and non-sepsis patients in the intensive care unit (ICU). METHODS AND RESULTS: This is a prospective observational study involving 96 sepsis and 96 non-sepsis patients admitted to the Ege University ICU. VDR FokI polymorphisms were investigated, as well as the relationship between the identified polymorphisms and mortality.  In-hospital mortality was 27.1% in the sepsis group and 8.33% in the non-sepsis group (p = 0.001). The frequencies of VDR FokI TT, TC, and CC genotypes were 8 (8.33%), 48 (50.0%), and 40 (41.7%) in the sepsis group, and 11 (11.5%), 42 (43.8%), and 43 (44.8%) in the non-sepsis group, respectively (p = 0.612). In the sepsis group, the frequencies of Fokl TT, TC, and CC genotypes did not differ significantly between survivors and non-survivors. However, homozygous C allele carriers had lower overall mortality (p = 0.047). CONCLUSION: The VDR FokI polymorphism, particularly the CC genotype, appears to be associated with lower mortality in ICU patients.

Perceptions of porta-celiac vascular models for hepatic surgery and their use in residency training.

BACKGROUND: Primary aspect of hepatic navigation surgery is the identification of source vascular details to preserve healthy liver which has a vascular anatomy quite challenging for the young surgeons. The purpose was to determine whether three-dimensional (3D) vascular pattern models of preoperative computed tomography (CT) images will assist resident-level trainees for hepatic surgery. METHODS: This study was based on the perception of residents who were presented with 5 different hepatic source vascular patterns and required to compare their perception level of CT, and 1:1 models in terms of importance of variability, differential of patterns and preoperative planning. RESULTS: All residents agree that models provided better understanding of vascular source and improved preplanning. Five stations provided qualitative assessment with results showing the usefulness of porta-celiac models when used as anatomical tools in preplanning (p = 0.04), simulation of interventional procedures (p = 0.02), surgical education (p = 0.01). None of the cases had scored less than 8.5. Responses related to understanding variations were significantly higher in the perception of the 3D model in all cases, furthermore 3D models were more useful for seniors in more complex cases 3 and 5. Some open-ended answers: "The 3D model can completely change the operation plan" One of the major factors for anatomical resection of liver transplantation is the positional relationship between the hepatic arteries and the portal veins. CONCLUSION: The plastic-like material presenting the hepatic vascularity enables the visualization of the origin, pattern, shape, and angle of the branches with appropriate spatial perception thus making it well-structured.

Solid pseudopapillary neoplasms of the pancreas: Case series with a review of the literature.

BACKGROUND/AIMS: The solid pseudopapillary neoplasms are quite rare tumors of the pancreas, comprising roughly 1-2% of all pancreatic neoplasms. It has a low malignant potential and usually affects young females. Despite increasing number of articles in the last decade, there is still debate on the pathogenesis, malignant potential and optimal surgical strategy for the solid pseudopapillary neoplasms. MATERIALS AND METHODS: Medical recordings of 326 patients who were operated due to pancreatic mass were retrospectively analyzed. Patient demographics, presenting symptoms, surgical and pathologic characteristics of the tumor, postsurgical course, long-term survival, and other relevant data were extracted from patients' charts. RESULTS: Majority of the patients were female in consistency with the classic data in the literature. All the patients underwent curative intent resections. Tumors were commonly localized in the tail of the pancreas making distal pancreatectomy the most commonly performed surgical procedure. Mean tumor diameter was 5.8 centimeters with tumor sizes ranging from 1 to 19 cm. CONCLUSION: The solid pseudopapillary neoplasms of the pancreas is a rare tumor with low malignant potential, which is more common in females of reproductive age, with abdominal pain being their most common presentation. The short-term outcomes in patients following surgical R0 resection are excellent. However, proximal placement of the tumor and female gender may have slightly worse prognosis. We hope that our findings from a series of patients represent a contribution to the existing literature on SPN, and authors declare their willingness to provide further details for future meta-analyses.

An Alternative Method for Percutaneous Treatment Of Hydatid Cysts: PAI Technique.

OBJECTIVE: Surgery is still the first choice in complicated cystic echinococcosis. However, percutaneous methods have performed increasingly in recent years. The Puncture, Aspiration, Injection, Reaspiration (PAIR) technique is mostly the preferred percutaneous method. The Puncture, Aspiration, Injection (PAI) technique is the new modified method, which is differentiated from PAIR technique by its applicability to all types of hydatid cysts (types 1-5) and unperforming of reaspiration. METHODS: The 52 hydatid cysts were prospectively examined in the study. Thirty-four of them were Types I and II, 13 of them were Type III, and 5 of them were Types IV and V. The technique was performed using the 20 G Chiba needle under the guidance of ultrasonography. Maximum cyst contents were aspirated immediately after the puncture to reduce the intracystic pressure. After confirming that aspirated liquid does not contain bile and that cyst has no cystobiliary connection, 95% alcohol was injected into the cavity, safely. Reaspiration of alcohol was not performed. RESULTS: The cyst sizes were reduced after PAI on ultrasonographic evaluations in all cases. The liquid component disappeared and the cyst got solid characteristic three months after the procedure. CONCLUSION: All hydatid cyst types can be treated safely and effectively with PAI technique without considering dimensions and whether.

Prognostic factors in peptic ulcer perforations: a retrospective 14-year study.

Regarding the complications of peptic ulcer, a perforation remains the most important fatal complication. The aim of our retrospective study was to determine relations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer. In total, 239 patients who underwent emergency surgery for perforated peptic ulcer in Ege University General Surgery Department, between June 1999 and May 2013 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively. One hundred seventy-five of the 239 patients were male (73.2%) and 64 were female (26.8%). Mean American Society of Anesthesiologists (ASA) score was 1 in the patients without morbidity, but mean ASA score was 3 in the morbidity and mortality groups. Primary suture and omentoplasty was the selected procedure in 228 of the patients. Eleven patients underwent resection. In total, 105 patients (43.9%) had comorbidities. Thirty-seven patients (67.3%) in the morbidity group had comorbid diseases. Thirteen (92.9%) patients in the mortality group had comorbid diseases. Perforation as a complication of peptic ulcer disease still remains among the frequent indications of urgent abdominal surgery. Among the analyzed parameters, age, ASA score, and having comorbid disease were found to have an effect on both mortality and morbidity. The controversial subject in the present study is regarding the duration of symptoms. The duration of symptoms had no effect on mortality nor morbidity in our study.

Unusual treatment of Kasabach-Merritt syndrome secondary to hepatic hemangioma: embolization with bleomycin.

Kasabach-Merritt syndrome (KMS) is a rare complication of cavernous hemangiomas characterized with anemia, thrombocytopenia, and consumption coagulopathy. This syndrome usually develops due to superficial soft tissue hemangiomas in infancy and childhood. KMS developing secondarily to hepatic hemangioma is very rare. In this report, we aimed to present the treatment of KMS developing secondarily to giant cavernous hemangioma of the liver with transarterial chemoembolization using bleomycin.

Endovascular treatment of delayed hemorrhage developing after the pancreaticoduodenectomy procedure.

AIM AND BACKGROUND: Delayed hemorrhage after pancreaticoduodenectomy (PD) is still one of the most common causes of mortality. However, the case series regarding interventional treatment of delayed hemorrhage after PD are limited. In this retrospective study, we aimed to evaluate functional outcomes of interventional treatment of late hemorrhages developing after PD. MATERIAL AND METHODS: We retrospectively evaluated 16 patients who received endovascular treatment for delayed arterial hemorrhage after PD procedure. Postsurgical nonhemorrhagic complications, time of hemorrhage, site of hemorrhage, endovascular treatment technique, postprocedural complications, and mortality rates were obtained. RESULTS: Mean duration of delayed hemorrhage after PD was 18 days. Computed tomography angiography images for the hemorrhage period were available for 15 patients. We observed extravasation alone in seven patients and pseudoaneurysm alone in five. Pushable coil was used in 15 patients and covered stent in 1. Two patients died due to hepatic failure, and one patient died because of multiple organ dysfunction syndrome (MODS). CONCLUSIONS: Delayed hemorrhage after PD is difficult to identify, but accurate and early diagnosis is of vital importance. To date, most appropriate management of this complication remains unclear. Although endovascular treatment techniques may vary for every patient, it is a reliable and effective method for halting hemorrhage. Therefore, interventional procedures must be primarily considered rather than surgical interventions.

Hepatic artery pseudoaneurysm as a cause of gastrointestinal system bleeding: a case report with a brief review of the literature.

A hepatic artery pseudoaneurysm is, by definition, a pulsatile hematoma due to a leakage of blood through a tear or disruption of the arterial wall, and the blood is contained only by the hepatic parenchyma or surrounding hematoma. It can be a very rare cause of gastrointestinal system bleeding. These pseudoaneurysms are usually very well managed by angiographic intervention. However, in some cases, surgery is inevitable. Herein, we present a 63-year-old female presenting with gastrointestinal system bleeding 45 days after surgery for cholangiocarcinoma. She was found to be bleeding from a pseudoaneurysm of the hepatic artery and underwent surgical intervention.

The effects of the Pringle maneuver on the pancreas: can octreotide be protective?

OBJECTIVE: The aim of this study was to evaluate the negative effects of the Pringle maneuver on pancreatic tissue with respect to the time of performing the maneuver. Moreover, the efficacy of octreotide therapy on pancreatic changes at the time of the Pringle maneuver was assessed. ANIMALS: Fifty male Wistar Albino rats were randomized into 5 groups. DESIGN: The groups were formed as follows: Group A: sham operation, Group B: Pringle maneuver for 30 min plus octreotide (PM30-OCT), Group C: Pringle maneuver for 60 min plus octreotide (PM60-OCT) and Group D: Pringle maneuver for 30 min plus 0.9 % saline solution (PM30-SS), Pringle maneuver for 60 min plus 0.9 % saline solution (PM60-SS, Group E). MAIN OUTCOME MEASURES: Blood samples for the evaluation of both amylase and lipase levels were taken via the portal vein. Levels of glutathione, glutathione reductase, catalase, myeloperoxidase, nitric oxide, xanthine oxidase, malondialdehyde, tumour necrosis factor alpha (TNF-alpha), and interleukin-1 beta (IL-1 beta) were assessed in the excised pancreatic tissue. RESULTS: In the octreotide-treated groups, the catalase level was significantly higher in Group B (PM30-OCT) as compared to Group C (PM60-OCT). Amylase, lipase, NO and IL-1 beta levels were higher in Group C (PM60-OCT). In the saline solution-treated groups, the catalase level was significantly higher in Group E (PM60-SS) than in Group D (PM30-SS) while nitric oxide and glutathione levels were found to be significantly lower in Group E (PM60-SS) than in Group D (PM30-SS). Comparison of those groups using the Pringle maneuver for 30 minutes, the octreotide-treated group (Group B, PM30-OCT) was found to have a higher degree of edematous change than the saline-treated group (Group D, PM30-SS). Among the treatment groups, TNF-alpha expression decreased with increasing occlusion time. CONCLUSION: In this study, pancreatic damage and the duration of the Pringle maneuver are directly proportional to each other. Moreover, the administration of octreotide prior to the Pringle maneuver contributed to the pancreatic damage.