Histopathological effects of Algan hemostatic agent (AHA) in liver injury model in rats.

Background and Aim: In this study, we aimed to assess the hemostatic and histopathological impacts of the Algan hemostatic agent (AHA) with the liver injury model. Materials and Methods: 24 male rats, 10-12 week old, were randomly divided into three equal groups (n=8) as control (physiological saline solution), AHA liquid and AHA powder. A total of three iatrogenic cut injuries were performed on the anterior surface of the left liver lobe. After bleeding started, sponges soaked with physiological saline, AHA liquid, AHA powder were gently pressed on the injured area for 20 seconds in corresponding groups, respectively. The bleeding time was measured with a timer. Failure to stop bleeding after three consecutive applications was considered as a failure. Animals were euthanized at the tenth minute of the procedure. Left liver lobes were removed for histopathological examination. Results: Bleeding control success rates of AHA liquid were significantly higher than that of the AHA powder group, and both forms were more effective than physiological saline. A superficial thick granulation tissue with entrapped powder residual materials was detected in the AHA powder group. Liver parenchyma was intact in liquid and powder groups. Conclusion: AHA is a fast-acting and applicable hemostatic agent in the liver bleeding model. However, further comparative studies in various organs are needed.

The first Turkish family with Rotor syndrome diagnosed at the molecular level.

Rotor syndrome is defined as a self-limiting hyperbilirubinemia characterized by jaundice that does not need treatment, cause any morbidity or affect life expectancy. As far as the literature is evaluated, the number of patients with Rotor syndrome diagnosed at the molecular level is less than 20 until today. In this case presentation, we aimed to present two siblings with Rotor syndrome who were diagnosed at the molecular level. To the nest of our knowledge, these patients are the first Turkish patients with Rotor syndrome diagnosed at the molecular level.

Is a Combination of the Serratus Intercostal Plane Block and Rectus Sheath Block Superior to the Bilateral Oblique Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy?

OBJECTIVE: The serratus intercostal plane block (SIPB) is a recently defined interfascial plane block. The oblique subcostal transversus abdominis plane block (OSTAP) is another type of interfascial plane block, and it is also used as a part of multimodal analgesia in patients undergoing laparoscopic cholecystectomy (LC). In this retrospective study, we evaluated the effects of the bilateral OSTAP and a combination of the right SIPB and bilateral rectus sheath block (RSB) on the postoperative pain and analgesia requirement in patients undergoing LC. MATERIALS AND METHODS: Data of the patients who underwent LC between May 2018 and November 2018 were evaluated retrospectively. Postoperative pain was evaluated using the numeric rating scale (NRS), and 24-hour tramadol consumption and rescue analgesia requirements were compared. RESULTS: Bilateral OSTAP was applied to 47 patients, and SIPB+RSB was applied to 25 patients. Postoperative pain scores were similar between the two groups. In the first 24 hours, tramadol requirement in the SIPB+RSB group was significantly lower than in the OSTAP block group (p<0.001). There was no statistically significant difference between the NRS averages at different time frames between the two block groups. CONCLUSION: We found that when SIPB is used as a part of multimodal analgesia in a combination with RSB in LS, it improves the quality of analgesia and decreases the analgesic requirement compared to patients undergoing a bilateral OSTAP block. Randomized controlled trials are necessary to compare the effects of SIPB alone and in a combination with other blocks in LC.

Regional Clinical and Biochemical Differences among Patients with Primary Hyperparathyroidism.

BACKGROUND: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT) patients. AIMS: To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions. STUDY DESIGN: Retrospective, clinical-based multi-centric study of 694 patients with pHPT. METHODS: Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH) levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s), histology, as well as the presence of ectopia, presence of dual adenoma, and multiple endocrine neoplasia (MEN)- or familial-related disease. RESULTS: The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria. CONCLUSION: Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT.

The effect of heme oxygenase-1 induction by glutamine on radiation-induced intestinal damage: the effect of heme oxygenase-1 on radiation enteritis.

BACKGROUND: Radiation enteritis is a significant clinical problem in patients receiving ionizing radiation directed at the abdomen or pelvis. The small intestine is the most radiosensitive gastrointestinal organ. Myeloperoxidase (MPO) activity and malondialdehyde (MDA) levels of the small intestine were measured to determine the oxidative damage caused by radiation. In addition, caspase-3 activity of the small intestine was measured to define the degree of apoptosis. The present study was undertaken to investigate the effect of glutamine administration on heme oxygenase-1 (HO-1) expression of the radiation enteritis model. METHODS: Rats received 1 g/kg/d glutamine (HO-1-inducer) for 7 days before irradiation and continued for 3 days after irradiation. Zn-prothoporphyin (Zn-PP) 40 micromol/kg was delivered subcutaneously for 1 day before irradiation. Intestinal MPO activities and MDA levels are indicators of oxidative damage, whereas caspase-3 activities show the degree of apoptosis of the small intestine. At histopathologic examination, terminal ileum tissue was analyzed for morphologic changes. Also, the nuclear factor-kappa (NF-kappa) expression level of the terminal ileum was determined with immunohistochemistry methods to show the mucosal inflammatory process. RESULTS: Irradiation significantly increased the intestinal MPO and caspase-3 activities, MDA levels, and HO-1 expression in comparison with the sham group. Glutamine treatment was associated with increased HO-1 expression, decreased MPO activity, caspase-3 activity, and MDA levels. Inhibition of HO-1 activity by Zn-PP completely eliminated the protective effects of glutamine. Histopathologic examination showed that the intestinal mucosal structure was preserved in the glutamine-treated group. In the irradiation group, NF-kappaB overexpression was detected. NF-kappaB positivity was strongest in the intestine of animals in the radiation alone group and the Zn-PP-treated irradiation group. CONCLUSIONS: Glutamine appears to have protective effects against radiation-induced intestinal damage. This protective effect is mediated in part by the induction of HO-1 activity because inhibition of Zn-PP resulted in the complete abolishment of the protective effect of glutamine.

Percutaneous peritoneal drainage in isolated neonatal gastric perforation.

A comment on the article by He et al, "Idiopathic neonatal pneumoperitoneum with favorable outcome: A case report and review", published on World Journal of Gastroenterology that reported a case of idiopathic neonatal pneumoperitoneum, possibly due to gastric perforation, with a favorable outcome without surgical intervention.

Vacuum-assisted stereotactic biopsy for isolated BI-RADS 4 microcalcifications: evaluation with histopathology and midterm follow-up results.

PURPOSE: The aim of this study was to evaluate the 10-gauge vacuum-assisted stereotactic biopsy (VASB) of isolated Breast Imaging Reporting and Data System (BI-RADS) 4 microcalcifications, using histology and follow-up results. METHODS: From January 2011 to June 2013, VASB was performed on 132 lesions, and 66 microcalcification-only lesions of BI-RADS 4 were included into our study. VASB was performed using lateral decubitis stereotaxy for all patients. Pathologic results of VASB and further surgical biopsies were reviewed retrospectively. Patients who were diagnosed to have benign lesions by VASB were referred for follow-up. VASB and surgical histopathology results were compared to determine the underestimation ratios. RESULTS: Fifteen out of 66 lesions from 63 patients (median age, 47 years; range, 34-88 years) were identified as malignant by VASB. Pathological results after surgery revealed three cases of invasive ductal carcinoma among the 12 VASB-diagnosed ductal carcinoma in situ (DCIS) lesions, for a DCIS underestimation rate of 25%. The atypical ductal hyperplasia underestimation rate was 0% for the three lesions. The follow-up period was at least 10 months, with an average of 22.7 months for all patients and 21.2 months for patients with VASB-diagnosed benign lesions. None of the patients had malignancy during the follow-ups. The false-negative rate was 0% in the follow-up of 48 patients. CONCLUSION: VASB should be the standard method of choice for BI-RADS 4 microcalcifications. This method obviates the need for a surgical procedure in 73% of BI-RADS 4 microcalcification-only patients.

The efficacy of ampicillin and Lactobacillus casei rhamnosus in the active management of preterm premature rupture of membranes remote from term.

BACKGROUND: We aimed to investigate the treatment efficacy of ampicillin prophylaxis accompanied by Lactobacillus casei rhamnosus over the latency period following preterm premature rupture of membranes (PPROM). METHODS: Records of 40 patients who presented with PPROM between 23(0/7)-31(6/7) weeks were analyzed retrospectively. Patients were divided into two groups: group 1 (n=20), treated with ampicillin; and group 2 (n=20), treated with ampicillin plus L. casei rhamnosus. Clinical and laboratory parameters were compared. Delta (Δ) values of each laboratory parameter were calculated by subtracting the value at delivery from the values at admission to the clinic. RESULTS: Gestational weeks at delivery (28.1 ± 0.3 weeks versus 31.5 ± 0.4 weeks), latency periods (12.3 ± 1.5 days versus 41.4 ± 4.4 days), 5-minute APGAR scores (6.8 ± 0.1 versus 7.8 ± 0.1), and birth weights (1,320 ± 98 g versus 1,947 ± 128 g) were significantly higher in group 2. White blood cell (WBC) (12,820 ± 353/mm(3) versus 11,107 ± 298/mm(3)), and neutrophil counts (10.7 ± 0.5 × 10(3)/L versus 8.2 ± 0.5 × 10(3)/L) were significantly lower in group 2 at delivery. The ΔWBC (2,295 ± 74/mm(3) versus -798 ±- 406/mm(3)), ΔC-reactive protein (5 ± 0.04 mg/L versus 1.6 ± 0.2 mg/L), and Δneutrophil (3 ± 0.2 × 10(3)/L versus 0.2 ±- 0.1 × 10(3)/L) were significantly lower in group 2. CONCLUSION: It seems that addition of L. casei rhamnosus to ampicillin prolongs the latency period in patients with PPROM remote from term.

Bilateral nipple leiomyoma.

Cutaneous leiomyomas are benign smooth muscle neoplasms of the skin. They arise from vascular, arrector pili, genital, and areolar smooth muscles. The most common localizations of cutaneous leiomyomas are the extensor surfaces of the extremities and the trunk. To our knowledge, only few cases of one-sided nipple leiomyomas have been reported, but two-sided nipple leiomyomas have not been presented. For the first time, here, we report a bilateral nipple leiomyoma.