The Relationship Between Serum Lipids and the Formation of Colorectal Polyps.

BACKGROUND AND AIMS: Obesity, metabolic syndrome, and hyperlipidemia are known as risk factors for colorectal tumors. Colorectal polyps are accepted as potential precursors of colorectal cancer (CRC). This study was designed to clarify the association between the levels of serum lipids and the presence of colorectal polyps. METHODS: This study was conducted at Basaksehir Cam and Sakura City Hospital, Gastroenterological Surgery Clinic, Istanbul, Turkey. We retrospectively analyzed patients who underwent colonoscopy with serum lipid profile within one month for a one-year period. Groups were analyzed in terms of the correlation between hyperlipidemia and the formation of polyps. The study group was also evaluated in terms of the polyp type, localization, and number. RESULTS: Among 453 patients, females were 248 and males were 211, with a mean age of 56.7. The study and control groups involved 259 and 194 patients, respectively. The age and serum levels of low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triglyceride (TG) were found to be statistically significant in terms of polyp presence and number (p < 0.05). CONCLUSION: Colorectal polyps are well-known precursors of CRC. We found that the combination of elevated serum levels of low-density lipoprotein cholesterol, total cholesterol, and triglycerides may be a risk predictor for the presence of colorectal polyps, which can be advantageous in cancer screening.

Antioxidant effect of Rosa pimpinellifolia L. fruit extract on cholestatic liver injury: an experimental study.

BACKGROUND: Antioxidants have been considered a rational curative strategy to prevent and cure liver diseases involving oxidative stress. An acute obstructive jaundice rat model was established to investigate the in vivo hepatoprotective efficacy of Rosa pimpinellifolia L. METHODS: The experimental jaundice model was performed by binding the main bile duct in 25 male Sprague-Dawley rats. All rats were randomly divided into five groups: first group: laparotomy-sham-only, second group: biliary tract binding (control), and third, fourth, and fifth groups: treatment groups with 250, 500, and 750 mg/kg fruit extracts daily, respectively. RESULTS: Considering dosage, although there was no significant therapeutic effect in the 250 mg/kg of Rosa pimpinellifolia L. group, the best results were found in the 500 mg/kg dose group, while results in the 750 mg/kg dose group showed consistent correlation with proinflammatory response. With regard to biochemical parameters, lipid hydroperoxide level in the rat serum and liver tissue was significantly decreased in all treatment groups. Amadori products, which are one of the early markers of glycol-oxidative stress, showed statistical significance in the treatment. CONCLUSION: It was revealed that the antioxidant effect of Rosa pimpinellifolia L. was more prominent in the early stages of hepatic injury secondary to oxidative stress.

Colonoscopy following the positron emission tomography/computed tomography scan in patients with incidental colorectal uptake: what is the most effective management?

OBJECTIVE: Colorectal cancer is one of the most common malignancies. Survival rates are directly related to the stage of cancer at the time of diagnosis, emphasizing the value of early diagnosis. Positron emission tomography with 18F-fluorodeoxyglucose is the gold standard imaging technique in staging, monitoring after treatment, and follow-up. We aimed to assess the importance of incidental 18F-fluorodeoxyglucose uptake by colon and rectum in positron emission tomography-computed tomography imaging to determine a significant cutoff value for further investigation using colonoscopy and histopathological assessment. METHODS: We performed a retrospective analysis of patients with both 18F-fluorodeoxyglucose-positron emission tomography/computed tomography scan and colonoscopy during 1 year and included the cases who had undergone a colonoscopy within 3 months following the positron emission tomography/computed tomography scan due to an incidental positive finding. Patients with a diagnosed colorectal malignancy or with a history of previous colorectal operations were excluded. RESULTS: A total of 81 patients were included in this study. Among 81 colonoscopic evaluations, histopathology revealed malignancy in 8 patients, and the prevalence of incidental colorectal cancer 18F-fluorodeoxyglucose uptake was found to be 9.87%. SUVmax was found to be significantly related to malignancy and other colonoscopic findings (p<0.001). SUVmax cutoff value to suggest colorectal cancer was found to be median [7.9 (4.1-12.7)] (p<0.001). CONCLUSION: Regarding the studies determining a significant cutoff value, incidental colonic 18F-fluorodeoxyglucose uptake on positron emission tomography/computed tomography should lead the clinician to further investigation with colonoscopic biopsy, although the cutoff values for SUVmax are not certain and different in almost every published study, and negative positron emission tomography.computed tomography findings should not completely rule out malignancy, especially in high-risk patients.

Difficult Management of Giant Gallstone Ileus of a Post-cardiopulmonary Resuscitation Patient: A Case Report.

Gallstone ileus is a rare form of mechanical intestinal obstruction. It is associated with high mortality and morbidity in the elderly population. The treatment of gallstone ileus includes more than one surgical option and it is appropriate to determine the surgical technique according to the general condition of the patient. In our case report, we present an 83-year-old patient who was admitted to the emergency room due to nausea and vomiting, was diagnosed with gallstone ileus, and had a cardiac arrest just before surgery. The patient management and the following surgical approach are also explained in detail.

Low Vitamin D Status is Not Associated with the Aggressive Pathological Features of Papillary Thyroid Cancer.

Objectives: In the present study, we investigated the effects of Vitamin D (vit D) deficiency on aggressiveness of papillary thyroid cancer (PTC). Methods: Patients with PTC confirmed with pathological examination, whom were operated by a single surgeon between 2012 and 2017, were included in the study. The data of the patients were analyzed retrospectively. Cancers other than PTC, patients with hyperthyroidism and/or using antithyroid drugs were excluded from the study. The patients were classified as four quartiles according to serum Vit D levels; category 1 (<7.1 ng/mL), category 2 (7.2-11.8 ng/mL), category 3 (11.9-23.4 ng/mL) and category 4 (>23.5 ng/mL). Results: A total of 133 patients (103 female, 30 male) with mean age of 46.4±13.6 (17-82) years were included in the study. There was no significant difference between the categories in terms of preoperative Vit D values according to the evaluated tumor aggressiveness characteristics. It was determined that the presence of tumor with a size above 1 cm and T3/4 tumor were not affected by Vit D level. There was no significant difference between Vit D categories regarding the characteristics of aggressiveness such as multicentricity, lymphovascular invasion, central, and lateral metastases. Conclusion: According to our results, serum Vit D levels are not associated with the aggressive tumor characteristics of PTC.

Relationship Between Thyroid-Stimulating Hormone Level and Aggressive Pathological Features of Papillary Thyroid Cancer.

Objectives: Thyroid-stimulating hormones (TSHs) are associated with the risk of differentiated thyroid cancer. The relationship between pre-operative TSH levels and aggressive features is unclear. We aimed to evaluate the relationship between pathological features of papillary thyroid carcinoma (PTC) and high TSH levels. Methods: Patients who were operated between 2012 and 2017 and who were found to have PTC in their pathology were included in the study. The relationship between TSH and the features of tumor aggressiveness was evaluated in the patients. Results: Of the 132 patients, TSH level was significantly higher in those with lymphovascular invasion than those without (p=0.048), in those with central metastases than in those without (p=0.014), and in those with extrathyroidal spread than in those without (p=0.003). When patients were categorized into four 25% quartiles according to TSH (mUI/mL) level; the rate of extrathyroidal invasion increased as the TSH level increased, and the level was significantly higher in quartile 1 than the others, with significant difference (p=0.030). Conclusion: Pre-operative increase in TSH level is associated with an increased risk of extrathyroidal spread and central lymph node metastasis. TSH level may be a pre-operative valuable predictive factor for patients' risk of central metastasis.

The Potential Role of Model for End-Stage Liver Disease (MELD)-Sodium Score in Predicting the Severity of Acute Pancreatitis.

Background and aim Acute pancreatitis is a common inflammation of the pancreas which can be severe and even potentially mortal. High rates of mortality showed the importance of immediate identification of patients at high risk and led the clinicians to refer to various scoring systems. Our aim was to investigate a clinical predictive model using the Model for End-Stage Liver Disease-Sodium (MELD-sodium) scoring system, adapting it to acute pancreatitis patients referring to the systemic inflammatory nature of the disease and potential multi-organ failures in severe form. Methods Our multicenter study was designed retrospectively. The medical records were reviewed for the period of two years. Demographics, biochemical results, MELD-sodium scores and mortality rates were analysed. Results MELD-sodium score was found to be statistically correlated with both mortality and the severity of pancreatitis (p<0.001) and significant difference between both mild and severe (p<0.001), moderate and severe groups (p<0.001). Mortality was found to be significantly higher in patients with MELD-Na score when the cut-off value was accepted as '≥11'. Conclusion We found that MELD-sodium score was significantly associated with both severity of disease and mortality rates and also significantly effective between both mild/severe and moderate/severe groups which may be a guide for future multi-center reviews with larger patient and control groups, which can define the potential role of this non-invasive and easy-to-use predictive model in acute pancreatitis patients.

Invasive lobular carcinoma of the breast: clinicopathological features and patient outcomes.

AIM: The incidence of invasive lobular carcinoma (ILC), a breast cancer type comprising several variants with distinct morphological and molecular features and clinical behaviors, has been increasing in recent years. Unlike the well-defined classical lobular carcinoma, the most common ILC variant, some uncertainties remain regarding the features of other ILC variants. Therefore, we investigated the clinicopathological features and survival outcomes of specific ILC variants. MATERIAL AND METHODS: This retrospective study compared the tumor and patient characteristics and outcomes according to specific ILC variants in 77 patients who underwent surgery for ILC between January 2010 and December 2016 at a single center in Turkey. RESULTS: The mean patient age was 54.58 ± 11.7 years. The ILC variants were classical, pleomorphic, tubulolobular, solid, and signet ring cell in 49(63.6%), 14(18.2%), 10(12.8%), 2(2.7%), and 2(2.7%) patients, respectively. The mean tumor diameter, histological grade, Ki-67 proliferation index, nodal metastasis, E-cadherin expression, lymphovascular invasion, and type of surgery were significantly different among the variants. However, there were no significant differences in the rates of local recurrence, distant metastasis, and overall survival among the variants. CONCLUSIONS: Despite the good prognostic characteristics and good response to treatment, several studies have reported that ILC is associated with poor long-term outcomes. Therefore, significant challenges remain in the management of ILC. Although it is believed to be a specific histological type, ILC is clinically and pathologically heterogenous. Therefore, the identification of patients with poor prognostic variants should aid in the implementation of efficient and personalized treatment options. KEY WORDS: Breast cancer, Invasive cancer, Invasive lobuler carcinoma, Prognosis, Variants of lobuler carcinoma.

The Relationship of Magnesium Level with the Recovery of Parathyroid Function in Post-thyroidectomy Hypoparathyroidism.

OBJECTIVES: Hypocalcemia is the most common complication and acute parathyroid gland insufficiency is the main cause of it after thyroidectomy. In this study, we aimed to evaluate the relationship between the recovery time of parathyroid gland function and patient characteristics, preoperative and postoperative electrolyte changes, and intraoperative parathyroid findings in patients with postoperative hypoparathyroidism. METHODS: Patients who underwent total thyroidectomy (TT) with or without central neck dissection ± lateral neck dissection with a parathyroid hormone (PTH) value of <15 pg/mL within the postoperative 4th hour were included in this study. Postoperative calcium level of <8mg/dL was defined as biochemical hypocalcemia and a PTH value of <15 pg/mL was defined as hypoparathyroidism. The patients were divided into three groups according to the time of PTH recovery (>15 pg/mL); within the first 24 hours, between one day and 30 days, after 30 days, respectively. RESULTS: One hundred eleven patients (mean age, 49.3±14.4 years) consisted of Groups 1, 2 and 3, including 19 (16F, 3M), 67 (54F, 13M) and 25 (19F, 6M), respectively. Vitamin D deficiency rates for Groups 1, 2, 3 were 41.7%, 53.1% and 88.2%, respectively (p=0.018). Postoperative day 0 PTH values were 11.69±2.79pg/mL, 6.92±3.45 pg/mL, 4.99±2.36 pg/mL, (p<0.001). Biochemical hypocalcemia rates of Groups 1, 2, 3 on postoperative day 1 were 15.8%, 53.7%, 64%, (p=004) respectively, and calcium values were 8.68±0.67 mg/dL, 8.15±0.66 mg/dL, 7.75±1 mg/dL, (p=0.014), respectively. Magnesium values on postoperative day 1 and 7 for Groups 1, 2, 3 were 1.85±0.1 mg/dL, 1.77±0.17 mg/dL, 1.64±0.17 mg/dL, (p=0.005), and 1.86±0.16mg/dL, 1.82±0.21mg/dL, 1.59±0.15mg/dL (p=0.001), respectively. PTH values on postoperative day 1 and 7 in Groups 1, 2, 3 were 20.5±6.4 pg/mL, 7.06±4.35 pg/mL, 4.66±3.26 pg/mL (p<0.001), and 31.04±10.54pg/mL, 18.72±13.84pg/mL, 4.55±4.9pg/mL (p<0.0001), respectively. Parathyroid function improved in 106 patients, and permanent hypoparathyroidism developed in five patients (4.5%). CONCLUSION: Hypoparathyroidism can recover rapidly in the first 24 hours in patients with a PTH value of around 10 pg/mL at postoperative 4th hour. As the number of preserved parathyroids increased, recovery time decreased. In patients with postoperative hypoparathyroidism, postoperative low magnesium levels may be associated with delayed recovery of parathyroid function.

The Effects of Diverticulum Localization and Hinchey Classification on Recurrence and Complications in Acute Colonic Diverticulitis.

OBJECTIVES: Diverticular disease of the colon is a pathology that arises from outward ballooning of the mucosa due to some weakness in the muscle layer. Diverticular disease may range from symptomatic uncomplicated diverticular disease to symptomatic disease with complications, such as acute diverticulitis or diverticular bleeding. Acute colonic diverticulitis occurs in about 10- 25% of patients. METHODS: In this study, 134 patients who were admitted to our emergency clinic with complaints of abdominal pain between 2016-2019 and hospitalized with the diagnosis of acute diverticulitis were included. Patients' sex, age, presence of additional disease, increase in leukocyte and C-reactive protein (CRP), localization of diverticulitis, Hinchey classification, mean length of hospital stay and treatment were evaluated. The effects of these parameters on complications and recurrence were statistically analyzed. RESULTS: The length of hospital stay was statistically significantly associated positively with the Hinchey classification (p<0.001). While 18 patients who were medically treated developed recurrence later, and this rate was statistically significant (p<0.001). When one of the factors, localization, which may play a role in the severity of the disease and recurrence are examined, was evaluated concerning its results in our study, we found that rectosigmoid location is an important factor for recurrence. We found that the localization in the colon and the severity of the disease were effective in the prognosis of acute diverticulitis. CONCLUSION: We believe that localization and the severity of the disease should be taken into consideration when planning surgery in these patients.

Factors Influencing the Relationship of the External Branch of the Superior Laryngeal Nerve with the Superior Pole Vessels of the Thyroid Gland.

OBJECTIVES: In a thyroidectomy, the external branch of the superior laryngeal nerve (EBSLN) is a potential risk during the superior pole dissection due to its close anatomical relationship with the superior thyroid artery and its highly variable anatomy. In this study, we aimed to evaluate the relationship of EBSLN with the superior pole considering Cernea classification and the factors affecting this relationship. METHODS: The data of thyroidectomized 126 patients (95 female, 31 male) with 200 neck sides (mean age of 45.6±12.1 years) using intraoperative neuromonitoring (IONM) for the EBSLN exploration were evaluated retrospectively. During the superior pole dissection, the EBSLN course was classified according to Cernea classification after being confirmed with IONM. It was defined as a large goiter in the case of the thyroid lobe volume being >50 cc. The factors influencing the presence of type 2b, which has the highest risk of injury, were evaluated using logistic regression analysis. RESULTS: Of the 200 EBSLNs evaluated, 52 (26%) were type 1, 134 (68%) were type 2a, and 14 (7%) were type 2b. The mean volumes of the resected thyroid lobes were 22±25 cc (min-max: 2-136), 23±20 cc (3-163), and 39±24 cc (3-65) in type 1, 2a and 2b, respectively, which was significantly higher in type 2b (p=0.035). Presence of large goiter rates were 5.8% (n=3), 8.2% (n=11), 64.3% (n=9) in type 1, 2a, and 2b, respectively, and was significantly higher in type 2b (p=0.0001). There was no significant difference between EBSLN Cernea types concerning age, sex, nerve side, presence of cancer and hyperthyroidism. In logistic regression analysis, large goiter was the only independent factor associated with Cernea type 2b. In case of a lobe volume greater than 50 cc, the probability of type 2b presence was approximately 25 times higher (p<0.001, odds ratio: 25.262). CONCLUSION: Type 2b course of EBSLN is more common in large goiters, and it is 25 times more likely to be seen in the presence of a lobe volume over 50 cc. Thus, it should be considered that the probability of this high-risk course is significantly higher in large goiters.

Antioxidant effect of Rosa pimpinellifolia L. fruit extract on cholestatic liver injury: an experimental study

SUMMARY BACKGROUND: Antioxidants have been considered a rational curative strategy to prevent and cure liver diseases involving oxidative stress. An acute obstructive jaundice rat model was established to investigate the in vivo hepatoprotective efficacy of Rosa pimpinellifolia L. METHODS: The experimental jaundice model was performed by binding the main bile duct in 25 male Sprague-Dawley rats. All rats were randomly divided into five groups: first group: laparotomy-sham-only, second group: biliary tract binding (control), and third, fourth, and fifth groups: treatment groups with 250, 500, and 750 mg/kg fruit extracts daily, respectively. RESULTS: Considering dosage, although there was no significant therapeutic effect in the 250 mg/kg of Rosa pimpinellifolia L. group, the best results were found in the 500 mg/kg dose group, while results in the 750 mg/kg dose group showed consistent correlation with proinflammatory response. With regard to biochemical parameters, lipid hydroperoxide level in the rat serum and liver tissue was significantly decreased in all treatment groups. Amadori products, which are one of the early markers of glycol-oxidative stress, showed statistical significance in the treatment. CONCLUSION: It was revealed that the antioxidant effect of Rosa pimpinellifolia L. was more prominent in the early stages of hepatic injury secondary to oxidative stress.

Colonoscopy following the positron emission tomography/computed tomography scan in patients with incidental colorectal uptake: what is the most effective management?

SUMMARY OBJECTIVE: Colorectal cancer is one of the most common malignancies. Survival rates are directly related to the stage of cancer at the time of diagnosis, emphasizing the value of early diagnosis. Positron emission tomography with 18F-fluorodeoxyglucose is the gold standard imaging technique in staging, monitoring after treatment, and follow-up. We aimed to assess the importance of incidental 18F-fluorodeoxyglucose uptake by colon and rectum in positron emission tomography-computed tomography imaging to determine a significant cutoff value for further investigation using colonoscopy and histopathological assessment. METHODS: We performed a retrospective analysis of patients with both 18F-fluorodeoxyglucose-positron emission tomography/computed tomography scan and colonoscopy during 1 year and included the cases who had undergone a colonoscopy within 3 months following the positron emission tomography/computed tomography scan due to an incidental positive finding. Patients with a diagnosed colorectal malignancy or with a history of previous colorectal operations were excluded. RESULTS: A total of 81 patients were included in this study. Among 81 colonoscopic evaluations, histopathology revealed malignancy in 8 patients, and the prevalence of incidental colorectal cancer 18F-fluorodeoxyglucose uptake was found to be 9.87%. SUVmax was found to be significantly related to malignancy and other colonoscopic findings (p<0.001). SUVmax cutoff value to suggest colorectal cancer was found to be median [7.9 (4.1-12.7)] (p<0.001). CONCLUSION: Regarding the studies determining a significant cutoff value, incidental colonic 18F-fluorodeoxyglucose uptake on positron emission tomography/computed tomography should lead the clinician to further investigation with colonoscopic biopsy, although the cutoff values for SUVmax are not certain and different in almost every published study, and negative positron emission tomography.computed tomography findings should not completely rule out malignancy, especially in high-risk patients.

Approach to inguinal hernia in high-risk geriatric patients: Should it be elective or emergent?

BACKGROUND: Elderly patients are more prone to have inguinal hernia due to weakened abdominal musculature. However, surgical repair of inguinal hernia (SRIH) may not be performed or may be delayed due to greater risk in presence of comorbidities. Present study is investigation of outcome of elective and emergency SRIH in geriatric patients. METHODS: Records of total of 384 high-risk (American Society of Anesthesiology classification III-IV) patients aged >65 years who underwent SRIH between January 2010 and December 2014 were reviewed. Patients were divided into 2 groups according to procedure type: elective (Group EL) or emergency (Group EM). Demographic features and surgical and postoperative period data of 2 groups were recorded and compared. RESULTS: Demographic data were similar, but number of ASA IV patients was greater in Group EM. Frequency of intestinal resection was significantly greater in emergency surgery group (1% vs 21%; p<0.01). Length of hospital stay (1.3 days vs 7.9 days; p<0.01) and intensive care unit stay (0.17 days vs 4.04 days; p<0.01) were also greater in Group EM. Morbidity (1% vs 24%; p<0.01) and mortality (0.3% vs 11%; p<0.01) were also significantly higher in Group EM compared to elective SRIH group. CONCLUSION: Emergency inguinal hernia surgery is associated with significantly higher morbidity and mortality compared with elective SRIH in high-risk geriatric patients. Elective hernia repair in these patients should be considered to reduce risk of need for intestinal resection as well as length of hospital stay.