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Objective: Gastrointestinal stromal tumors are believed to play a role in immunosuppression with their local effect. In some cancers with associated inflammation, an increased pretreatment neutrophil lymphocyte ratio is considered as an indicator of poor prognosis. The aim of our study was to assess the relationship of increased blood neutrophil lymphocyte ratio with disease prognosis in patients with gastrointestinal stromal tumors., Material and Methods: The data of 78 patients who underwent surgery with the diagnosis of primary gastrointestinal stromal tumor in our clinic were evaluated retrospectively. The preoperative neutrophil lymphocyte ratio in the peripheral blood was determined. The neutrophil lymphocyte ratio and its relationship with tumor risk and prognosis were compared. The data were evaluated by Pearson's correlation analysis and the Welch ANOVA test., Results: The preoperative neutrophil lymphocyte ratio was significantly increased in the high-risk groups (p<0.05). An increased preoperative neutrophil lymphocyte ratio was associated with shorter survival (r=-0.32, p=0.009). In addition, an increase in the neutrophil lymphocyte ratio was associated with an increase in the mitotic activity of the tumor (r=-0.364, p=0.025)., Conclusion: The preoperative neutrophil lymphocyte ratio in gastrointestinal stromal tumors can be used as an indicator of high-risk tumors and poor prognosis.

Objective: Retrospective proctocolectomy is a distinguished, sphincter saving treatment used for the treatment of ulcerative colitis and FAP disease. We aimed to evaluate ileal pouch interventions performed at our clinic and their results in the light of literature., Material and Methods: Medical records of 35 restorative proctocolectomy and J pouch ileo-anal anastomosis surgeries performed at Necmettin Erbakan University, Meram School of Medicine between the years 2006-2013 were retrospectively examined. The patients were assessed according to their age, gender, length of hospital stay, diagnosis, follow-up duration and pouch-related complications. All patients were contacted by phone and they were scheduled for controls at the outpatient clinic., Results: Nineteen patients were male (54%) and 16 were female (46%). Their mean age was 45 years (21-74). The mean length of hospital stay was 11 (5-20) days. Twenty two (63%) patients were operated on due to FAP, 12 (34%) due to synchronous rectum cancer and colon tumor or polyp, and one (3%) due to ulcerative colitis. All patients received J pouch and protective ileostomy. After the closure of ileostomy, two cases were identified to have J pouch fistulas. The patients were followed up for 6 months to 7 years. They were contacted by phone and they were questioned about their active complaints, number of defecations, urinary and sexual dysfunctions. It was identified that they had 5 (3-8) defecations per day on average and that 4 (11%) cases had one nocturnal defecation. No pouchitis was identified in the follow-up endoscopic examinations., Conclusion: Restorative proctocolectomy and ileo-anal anastomosis technique is a surgical procedure that can be performed with low rates of morbidity and mortality, including the elderly.

Background/aims: Although various drugs can be used in adults for Helicobacter pylori eradication in adults, treatment options are limited in children. The aim of this study was to compare the effects of the standard lansoprazole, amoxicillin, and clarithromycin (LAC) protocol to those of LAC+vitamin E (LACE) combination for H. pylori eradication., Materials and Methods: The study included 90 children (age range: 10-17 years) who were admitted to four pediatric gastroenterology centers between March 2011 and November 2012 with dyspeptic symptoms and who had tested positive for H. pylori by 14C-urea breath tests. The patients were randomized into two groups. The LAC group [45 patients (pts)] was treated with a standard regimen consisting of lansoprazole (1 mg/kg/day), amoxicillin (50 mg/kg/day), and clarithromycin (14 mg/kg/day), each of which was given in two equally divided doses every 12 h for 14 days; the LACE group (45 pts) was given the standard regimen and vitamin E at 200 IU/day for 14 days. H. pylori eradication was assessed using the 14C-UBT in the 6th week after the cessation of treatment., Results: H. pylori was eradicated in 21 (46.6%) pts in the LAC group, while it was eradicated in 29 (64.4%) pts in the LACE group. There was no statistical difference between the two groups (p=0.13)., Conclusion: The eradication rate of H. pylori in children while using the LAC regimen has decreased in the last years. The LACE regimen has been associated with an increased eradication rate but can reach to statistically significance. Further studies with larger cohorts are needed to examine the success of the LACE regimen for H. pylori eradication.

Background/aims: Data about the efficiency and outcome of therapeutic endoscopic techniques in children with nonvariceal upper gastrointestinal bleeding (UGB) are scarce. We aimed to analyze our experience with endoscopic hemoclip application in children with non-variceal UGB., Materials and Methods: During a 3-year period, a total of 1715 endoscopies were performed in our pediatric endoscopy unit; 182 (10.6%) of them were performed for UGB to 158 patients. Fifty-six of them had emergent endoscopy. Among them, 15 cases with nonvariceal UGB were only given endoscopic hemoclips. Demographic, clinical, and laboratory findings at initial admission; endoscopic appearance of bleeding lesions; and outcome of hemoclip application were recorded from the hospital files and endoscopy records., Results: Ten patients (66.6%) had gastric ulcer, 3 (20%) had duodenal ulcer, 1 (6.7%) had Dieulafoy lesion, and 1 (6.7%) had bleeding at the post-polypectomy site. Initial homeostasis after hemoclip application was achieved in all patients (100%). Rebleeding was seen in only one patient (6.5%) with a Dieulafoy lesion, who needed hemoclip application for a second time, and the bleeding was controlled successfully. Permanent hemostasis was 100%. The median number of hemoclips used per case and per application was 3.4 and 3.2, respectively. None of the patients experienced any complication related to hemoclip application. Median duration of hospitalization was 6 days. On follow-up, none of the patients received surgical therapy, and 30-d mortality related to bleeding was 0%., Conclusion: The use of hemoclips for nonvariceal UGB in children is an effective modality to control bleeding without any complications in children.

Hydatid cysts cause diseases most frequently by localizing in the liver and the lungs. Hydatid cysts with retroperitoneal localization are very rare. A 45-year-old female patient presented to our hospital with complaints of back pain, weight loss, and fatigue. The computerized tomography (CT) revealed that the patient had a septated cystic lesion of about 8x7x6 cm localized in the posterior of the left kidney, in the paravertebral site causing destruction of the neighboring costa. During laparotomy, the wall of the cyst with retroperitoneal localization was partially excised and the remaining cavity was drained. The drain was removed on post-op day 5. The histopathological diagnosis was reported to be a hydatid cyst. No problems were seen during the follow-ups of the patient who was administered post-op albendazole. Hydatid cysts are an endemic disease in our country and it should be kept in mind that they also have atypical localizations.

Recent neuroimaging studies have implicated prefrontal and parietal cortices for mathematical problem solving. Mental arithmetic tasks have been used extensively to study neural correlates of mathematical reasoning. In the present study we used geometric problem sets (tangram tasks) that require executive planning and visuospatial reasoning without any linguistic representation interference. We used portable optical brain imaging (functional near infrared spectroscopy--fNIR) to monitor hemodynamic changes within anterior prefrontal cortex during tangram tasks. Twelve healthy subjects were asked to solve a series of computerized tangram puzzles and control tasks that required same geometric shape manipulation without problem solving. Total hemoglobin (HbT) concentration changes indicated a significant increase during tangram problem solving in the right hemisphere. Moreover, HbT changes during failed trials (when no solution found) were significantly higher compared to successful trials. These preliminary results suggest that fNIR can be used to assess cortical activation changes induced by geometric problem solving. Since fNIR is safe, wearable and can be used in ecologically valid environments such as classrooms, this neuroimaging tool may help to improve and optimize learning in educational settings.