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<b>Introduction:</b> Colorectal cancer (CRC) prognosis is typically determined based on clinical stage and histopathological findings, yet patients with the same stage and histological structure can exhibit varying survival outcomes. This highlights the need for additional prognostic biomarkers. Serum biomarkers are gaining increasing significance due to their affordability and accessibility. The albumin-alkaline phosphatase ratio (AAPR) has been associated with prognosis in hepatocellular and gastric cancers, but its role in CRC remains underexplored.<b>Aim:</b> This study aimed to evaluate the effect of the albumin-alkaline phosphatase ratio (AAPR) on the prognosis of patients with colorectal cancer (CRC).<b>Material and method:</b> Data from 358 patients who had undergone surgery for CRC were analyzed retrospectively to identify factors that could predict overall survival (OS). The Roc-Curve test was applied to determine the power of the preoperative AAPR in predicting mortality. Kaplan Meier and log-rank tests were used to examine the survival times of the patients.<b>Results:</b> Our findings revealed that an albumin-alkaline phosphatase cut-off ratio above 0.67 predicted mortality with a sensitivity of 17.54% and a specificity of 92.22%. Although patients with a lower AAPR exhibited a slightly shorter mean survival time compared to those above the cut-off value, this difference did not reach statistical significance (P = .112).<b>Conclusions:</b> The results of this study did not provide evidence to support the AAPR as a potential prognostic factor in patients with colorectal cancer.

Background: Colorectal cancer (CRC) is the third most common cancer worldwide, and despite advances in treatment, molecular biomarkers are needed for both early diagnosis and prognosis monitoring. It is known that microRNAs (miRNA), one of the epigenetic mechanisms, are effective in the initiation and development of cancer by regulating the activity of tumor suppressors and/or oncogenes. In this study, the potential of the molecules let-7, miRNA125b, and miRNA30a, which are known to play a role in cellular processes, as biomarkers for colorectal cancer and their molecular mechanisms were investigated in this model. The aim was to evaluate the diagnostic, prognostic, and predictive utility of the target miRNAs in colorectal cancer patients., Material and Methods: The expression changes of miRNAs let-7, miRNA125b, and miRNA30a were investigated by miRNAs isolation and cDNA synthesis from the serum samples of 60 patients diagnosed with CRC or from the serum samples of 20 healthy individuals. The calculation was performed using the quantitative real-time polymerase chain reaction method to determine the expression level. The results were compared with clinical parameters., Result: An 8-fold decrease in the expression of let-7 and miRNA125b and a 60-fold decrease in the expression of miRNA30a were found in the serum samples of patients diagnosed with colorectal cancer (CRC) compared to the healthy group. A decrease in let-7 was observed in 53.3%, miRNA125b in 58.3%, and miRNA30a in 55% of patients. A significant correlation was found between the reduced expression status and the stage, lymph nodes, local recurrence, and metastasis (p < 0.05). The ROC analysis showed that the miRNA30a level could be a diagnostic biomarker for CRC (p < 0.001). No significant impact of target miRNA expression changes on overall disease survival was observed., Conclusion: It is thought that the target miRNA30a can be used for early diagnosis and screening and that the target miRNA let-7, miRNA125b, and miRNA30a can be used as non-invasive biomarkers for disease follow-up, with larger patient studies being conducted on CRC patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier GmbH. All rights reserved.)

Aim: This work investigated the effect of an abdominal corset on the colonoscopy completion rate, as well as cecum and ileum intubation time, total colonoscopy time, and pain score in centrally obese patients., Methods: Patients were randomized into two groups, with 50 patients in each group. A colonoscopy was performed using the abdominal corset in Group 1 and the standard method in Group 2. The comparison between the groups evaluated demographic data, procedure details, circulatory dynamics, anesthesia data, and visual analogue scale (VAS)., Results: Of the patients included in the study, 60 were female, and 40 were male, with a mean age of 57.3 ± 13.6 years. Cecal intubation time (Z: -2.66 p: 0.008), total colonoscopy time (Z: -2.180 p: 0.029), number of maneuvers (χ2: 8.391 p: 0.039), and VAS (Z: -3.087 p: 0.002) were significantly lower in the abdominal corset group., Conclusions: An abdominal corset that applies external abdominal compression reduces the cecal intubation time, the total colonoscopy time, the number of maneuvers, and the pain level., Clinical Trial Registration: NCT03128645 (https://clinicaltrials.gov/study/NCT03128645?tab=results).

Aim: The aim of this study was to investigate the effect of the largest metastatic lymph node (MLN) size on postoperative outcomes of patients with stage II-III gastric cancer (GC)., Methods: A total of 163 patients with stage II/III GC who underwent curative surgery were included in this single-center retrospective study. The lymph nodes were counted, each lymph node was analyzed for metastatic involvement by histopathological examination, and the diameter of the largest metastatic lymph node was recorded. The severity of postoperative complications was assessed by Clavien-Dindo classification system. Two groups of 163 patients were defined according to ROC analysis with cut-off value of histopathologically maximum MLN diameter. A comparative analysis of demographic and clinicopathological characteristics of the patients and their postoperative outcomes were performed., Results: The median hospital stay was significantly longer in patients with major complications compared to patients without major complications [18 days (IQR: 13-24) vs. 8 days (IQR: 7-11); ( p  < 0.001)]. The median MLN size was significantly larger in deceased patients compared to survived [1.3 cm (IQR: 0.8-1.6) vs. 0.9 cm (IQR: 0.6-1.2), respectively; ( p  < 0.001)]. The cut-off value of MLN size predicting mortality was found as 1.05 cm. MLN size ≥1.05 cm had nearly 3.5 times more negative impact on survival., Conclusions: The largest metastatic lymph node size had a significant association with survival outcomes. Particularly, MLN size over 1.05 cm was associated with worse survival outcomes. However, the largest MLN was not shown to have any effect on major complications. Further prospective and large-scale studies are required to draw more precise conclusions., Competing Interests: The reviewer EB declared a past co-authorship with the author SO to the handling editor., (© 2023 Omeroglu, Gulmez, Yazici, Demir, Guven, Capkinoglu, Uzun, Senger, Polat and Duman.)

Purpose: The hepatic bridge as an anatomical variation may lead to recurrence and treatment failure in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) by constituting an obscure region during surgery. This report aimed to highlight the relationship between the hepatic bridge and various prognostic factors in peritoneal carcinomatosis., Methods: Data of 101 patients who underwent CRS/HIPEC for peritoneal carcinomatosis in a single centre were retrospectively reviewed. Demographic characteristics, primary origin of peritoneal carcinomatosis, classification of hepatic bridge, Peritoneal Cancer Index (PCI) score, and completeness of cytoreduction (CC) score were analysed., Results: The tumour was proven histopathologically in 18 (28.6%) of 63 patients who underwent distal round ligament (DRL) resection. The PCI score was found to be significantly higher in patients with tumour in DRL compared to the ones without tumour (p < 0.001). The median PCI score of patients with implant positive DRL was 18 (12-20) and this score was 3 (2-6) for patients with implant negative DRL (p < 0.001). The ROC curve concerning the risk of an implant penetrating the round ligament revealed the optimal cut-off value of PCI at 10 with 88.9% sensitivity and 79.3% specificity., Conclusion: The round ligament should be removed, regardless of the PCI score, as a standard in mucinous adenocarcinoma of the appendix and malignant peritoneal mesothelioma. DRL should be removed when PCI is equal or higher than 10 for PC due to colorectal and ovarian cancers., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Mitochondrial diseases are a clinically heterogeneous group of rare hereditary disorders that are defined by a genetic defect predominantly affecting mitochondrial oxidative phosphorylation. Mitochondrial diseases are caused by mutations of genes encoded by either nuclear DNA or mitochondrial DNA. Hundreds of different mitochondrial DNA point mutations and large-scale mitochondrial DNA rearrangements have been shown to cause mitochondrial diseases including Kearns–Sayre syndrome, Leber’s hereditary optic neuropathy, Leigh syndrome, myoclonic epilepsy with ragged-red fibers, mitochondrial encephalopathy lactic acidosis stroke., Aims: To investigate new variants that could be associated with mitochondrial diseases and to determine the effect of mitochondrial DNA mutations on the clinical spectrum., Study Design: Cross-sectional study., Methods: We screened whole mitochondrial DNA genome using next-generation sequencing in 16 patients who are considered to have mitochondrial disease. CentoGene and Mikrogen Genetic Diseases Diagnostic Center’s database were used to investigate sequence variants. Detected variants were evaluated in bioinformatic databases to determine pathogenicity and were classified as class 1 (pathogenic), class 2 (likely pathogenic), and class 3 (variant of uncertain significance) according to CentoGene-ACMG database., Results: As a result of the study, 2 patients were diagnosed with Leigh syndrome as previously reported class 1 mutations in MT-ATP6 and MT-ND5 genes. Four variants were identified for the first time in literature and 2 variants, previously reported but with uncertain pathogenic effect, are thought to be associated with mitochondrial disease., Conclusion: Mitochondrial DNA screening should be among the primary clinical tests in patients with suspected mitochondrial disease to rule out DNA-associated mutations.

Aim: The prognostic nutritional index (PNI) is a valuable parameter that indicates the immunonutritional status of patients with malignant tumors., Material and Methods: Patients operated for colorectal cancer between January 2013 and December 2019 were analyzed retrospectively. The relationship between PNI and morbidity was investigated in the 314 patients included in the study. Based on previous studies, the PNI cutoff value was set at 45, and the patients were duly divided into two groups: PNI <45 and PNI ≥45. The demographic and clinicopathological characteristics, as well as postoperative complications in the two groups, were compared., Results: There was no statistical difference in gender, localization, T stage, N stage, perineural invasion, lymphovascular invasion, stage, Ca19-9 values, and body mass index(BMI) between the two groups. In contrast, there was a statistically significant difference in age, complications, and CEA values. (p=0.008, p<0.001, p=0.043, respectively). The median age was lower in patients with high PNI scores than in the low PNI group (61 vs. 64 years). When the patients were examined for complications, 36 (37.1%) patients were observed in the high PNI group, compared to 155 (71.4%) in the low PNI group. In terms of overall survival, the mean life expectancy was 68.112 2.646 months for patients with low PNI group, compared to 84.626 2.701 months in the high-PNI group, and the difference was statistically significant (p=0.001)., Conclusion: This study's findings suggest that the preoperative prognostic nutritional index may indicate postoperative complications and prognosis. The most significant benefit of this marker is that it can be improved preoperatively and practically., Key Words: Nutritional Status, Morbidity, Colorectal Neoplasms.

Objective: The etiopathogenesis of spondyloarthropathies (SpA) is still unclear. Recently, anti-CD74 antibody has been suspected to play a role in SpA etiopathogenesis. This study aimed to examine the levels of anti-CD74 antibody in patients with SpA and investigate their association with disease activity., Methods: This study was conducted using data from patients who were treated at the departments of rheumatology and gastroenterology between June 2013 and November 2013. The demographic and clinical characteristics of the participants and their serum IgG-type antibodies against anti-CD74 were analyzed., Results: We analyzed 111 patients with ankylosing spondylitis (AS), 108 patients with inflammatory bowel disease (IBD), and 101 healthy controls. The rate of human leukocyte antigen-B27 positivity was 86.5% in patients with AS and 21.3% in patients with IBD. The mean levels of anti-CD74 antibodies in the AS, IBD, and control groups were 6.99±3.24 ng/mL, 6.25±3.34 ng/mL, and 7.83±4.72 ng/mL, respectively. Anti-CD74 levels were higher in healthy controls than in patients with IBD (p=0.009). There was no significant difference in anti-CD74 levels between the AS and IBD groups and the AS and control groups. In addition, there was no correlation between anti-CD74 levels and disease activity., Conclusion: This study could not find an association between anti-CD74 levels and SpA in Turkish patients.

Aim: The present study evaluates the prognostic significance of perineural invasion (PNI) on 2-year, 5-year, and overall survival in patients undergoing gastrectomy and D2 lymphadenectomy due to locally advanced gastric cancer., Materials and Methods: Included in the study were 231 patients who underwent surgery between November 2006 and October 2018 due to stage 1B and over locally advanced gastric cancer, whose records were reviewed retrospectively., Statistical Analysis: The variables in the presence or absence of PNI were compared between the two groups with a Chi-square test, a Fisher's exact test, a likelihood ratio, and a Mann-Whitney U test. Overall survival data were evaluated with a Kaplan-Meier test. Prognostic factors were evaluated with a stepwise Cox regression analysis., Results: PNI was identified in 167 (72.3%) of the patients. The 2-year, 5-year, and overall survival rates at the end of the follow-up period were 85.9%, 70.3%, and 64.1% in those without PNI, and 52.7%, 38.3%, and 36.5% in those with PNI, respectively. In a multivariate analysis, PNI appeared to be a significant prognostic factor for 2-year survival (P = 0.04) but had no effect on 5-year and overall survival., Conclusions: Survival was shorter in patients with PNI than in patients without PNI, and PNI had no effect on overall survival, although it was found to be of prognostic significance for 2-year survival.

Background: Sarcopenia is a syndrome that can have negative consequences after gastric cancer (GC) surgery. This study aims to determine the effect of sarcopenia on surgical site infection (SSI) that develops after open GC surgery. Patients and Methods: In this retrospective design study, data were collected for patients who underwent GC surgery between January 2013 and August 2019. The diagnosis of sarcopenia was made according to the skeletal muscle index (SMI) calculated from pre-operative computed tomography images. Patients with sarcopenia and those without sarcopenia were compared in terms of SSIs; the risk factors for SSI were also analyzed. Results: One hundred forty-nine patients were included in the study and had a mean age of 59.3 years. Post-operative complications developed in 59 patients (39.6%) and SSIs in 28 patients (18.7%). Sarcopenia was detected in 57 (38.3%) patients; the mean age was 59.9 years in the sarcopenic group (SG) and 58.9 years in the non-sarcopenic group (NSG; p = 0.55). The mean SMI was 382.5 mm 2 /m 2 and 646.2 mm 2 /m 2 in the SG and NSG, respectively (p < 0.001). A relation between SSIs and sarcopenia was detected; 17 patients in the SG (29.8%) versus 11 patients in the NSG (11.9%; p = 0.007). Surgical site infection was not found to be statistically significantly related to obesity, hypoalbuminemia, intra-operative blood loss, or duration of operation, although the sarcopenic obesity patients were found to have the highest SSI rate (40%). Conclusion: The present study identified a relation between sarcopenia and SSIs occurring after GC surgery. The authors believe that studies seeking to reduce the incidence of SSIs, which are a leading cause of morbidity after GC surgery, should be supported.

Background: In July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines for gastroenterological endoscopy in patients receiving antithrombotic therapy. Colonoscopic polypectomy procedures are associated with a high risk of bleeding., Objectives: The present study evaluated the safety of colonoscopic polypectomy procedures in terms of bleeding, among patients receiving antithrombotic therapy., Design and Setting: Prospective observational study conducted in a tertiary-level public cardiovascular hospital in Istanbul, Turkey., Methods: Colonoscopic polypectomies carried out in a single endoscopy unit between July 2018 and July 2019 were evaluated prospectively. The patients' data, including age, gender, comorbidities, whether antithrombotic drug use was ceased or whether patients were switched to bridging therapy, polyp size, polyp type, polyp location, histopathology, resection methods (hot snare, cold snare or forceps) and complications relating to the procedures were recorded., Results: The study was completed with 94 patients who underwent a total of 167 polypectomy procedures. As per the advice of the physicians who prescribed antithrombotic medications, 108 polypectomy procedures were performed on 60 patients without discontinuing medication and 59 polypectomy procedures were performed on 34 patients after discontinuing medication. The age, gender distribution and rate of bleeding did not differ significantly between the patients whose medication was discontinued and those whose medication was continued (P > 0.05)., Conclusion: This study found that the colonoscopic polypectomy procedure without discontinuation of antithrombotic medication did not increase the risk of bleeding. This procedure can be safely performed by experienced endoscopists in patients with an international normalized ratio (INR) below 2.5.

Aim: The aim of this study is to determine the incidence of intraoperative hyperlactatemia and its risk factors in patients undergoing laparoscopic colorectal surgery., Material and Methods: We retrospectively enrolled 75 patients who underwent laparoscopic resection for colorectal cancer. Initial lactate levels were determined from blood gas analysis before the incision. The end lactate values were recorded after the termination of the pneumoperitoneum. Hyperlactatemia defined as lactate levels between 2 mmol/L and 5 mmol/L without evidence of acidosis. The patients were divided into two groups as normolactatemia and hyperlactatemia according to lactate values at the end of the surgery., Results: Of the 75 patients, 45 (60.0%) had higher lactate levels than normal at the end of the surgery. The median age of the study population was 62 (24-84) years. Forty (53.3%) of the patients were male. Most of the patients in the study had colon cancer origin [56 cases (74.7%)]. Univariate logistic regression analysis for a possible independent risk factor in terms of hyperlactatemia showed that Charlson comorbidity index (CCI) ≥ 3, body mass index (BMI) ≥ 30 kg/m2, the operative time, and the tumor size were significant (p < 0.05). Multivariate analysis found that only BMI ≥ 30 kg/m2 and the operative time were significant (p = 0.004, and p < 0.001, respectively)., Conclusion: According to our work, obesity (BMI ≥ 30 kg/m2) and the operative time in laparoscopic colorectal surgery were independent risk factors for intraoperative hyperlactatemia at the end of the operation. Therefore, clinicians should be vigilant about the inevitable consequences of surgery by making appropriate preparation., Key Words: Colorectal cancer, Lactate, Hyperlactatemia, Laparoscopy.

Introduction: In recent years, the incidence of gastroesophageal junction tumors has increased rapidly in worldwide., Aim: To evaluate pretreatment serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 in oesophagogastric junction (OGJ) adenocarcinomas regarding clinicopathologic characteristics and overall survival., Material and Methods: Patients undergoing curative surgery diagnosed with OGJ adenocarcinoma in the gastrointestinal surgery clinic between 2007 and 2019 were included in the study retrospectively. Kaplan Meier and Log Rank tests were performed in survival analyses. Logistic regression analysis was performed to state the independent variables affecting survival., Results: The mean age of the 70 patients included in the study was 59.78 ±10.49 (31-76) years. Serum CEA and CA 19-9 were high in 19 (27.1%) patients. CEA ≥ 5 ng/ml was found to be statistically significant in patients receiving neoadjuvant chemotherapy (NAC) and in patients with a high number of positive lymph nodes (N +) ( p = 0.041 and p = 0.042, respectively). CA 19-9 positivity was statistically higher in patients with lymphovascular invasion (LVI) and diabetes mellitus (DM) ( p = 0.042 and p = 0.012, respectively). The age and N+ findings of the patients in the CA 19-9-positive group were statistically significant compared to the patients in the CA 19-9-negative group ( p = 0.039 and p = 0.007, respectively). Overall survival rates of 1-3 and 5 years were statistically significantly lower in patients who were CA 19-9 positive ( p = 0.016). For patients in whom both tumour markers were positive, the N+ mean value was statistically significantly higher ( p = 0.001)., Conclusions: In our study, a significant relationship was found in terms of overall survival and serum CA 19-9 in OGJ adenocarcinoma, and it was associated with both tumour markers being positive and the mean N+ value., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Termedia.)

Purpose: The role of sarcopenia in pathologic complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT) in non-metastatic locally advanced rectal cancer is currently unknown. The present study investigates the association between sarcopenia and post-nCRT pCR., Methods: The data of patients operated on following nCRT between January 2013 and January 2020 were collected retrospectively. Sarcopenia was diagnosed based on the calculation of the skeletal muscle index (SMI) from computed tomography carried out at the time of the initial diagnosis. A statistical analysis was then conducted for predictors of pCR., Results: The study included 61 patients with an average age of 57.3 years, 28 of whom formed the non-sarcopenic group (NSG) and 33 the sarcopenic group (SG). Of the patients, 32.7% were at clinical stage 2, and 67.3% were at clinical stage 3. Pathologic data following a mesorectal excision revealed a pCR rate of 21.4% in the NSG compared with 3% in the SG, which was a statistically significant difference (p = 0.025). The TNM downstaging rate was higher in the NSG than in the SG, although the difference was not statistically significant (50% vs. 33.3%, p = 0.28). A univariate analysis revealed the factors affecting pCR to be non-sarcopenia (p = 0.025), age < 61 years (p = 0.004), interval to surgery ≥ 8 weeks (p = 0.029), and serum CEA < 2.5 ng/ml (p = 0.035)., Conclusion: Sarcopenia was found to be a negative marker of pCR following nCRT in non-metastatic locally advanced rectal cancer.

Objective: To investigate the prognostic factors affecting survival in patients with a deep gastric wall invasion of T3-T4 advanced gastric cancer., Study Design: Descriptive study., Place and Duration of Study: Department of Gastroenterological Surgery, Kartal Koşuyolu High Specialty Training and Research Hospital, between November 2006 and December 2018., Methodology: A retrospective review was made of 252 patients; and the clinicopathological characteristics and survival status in the presence of T1-T2 and T3-T4 patients were investigated. The cumulative survival of the two groups was analysed with a Kaplan-Meier test, and the differences were analysed with a log-rank test. The prognostic factors for T3-T4 patients were established through a stepwise Cox regression analysis., Results: Of the total, 52 (20.6%) patients had T1-T2 and 200 (79.4%) had T3-T4 gastric wall invasion. Statistical differences were noted in the Lauren classification as gender, tumor size, presence of lymph node involvement, presence of vascular and perineural invasion, and overall survival (p <0.001). A univariate analysis of the prognostic factors affecting survival in T3-T4 patients revealed a difference in the tumor localisation, tumor size, the presence of involved lymph nodes, perineural invasion, and vascular invasion. A multivariate analysis of the prognostic factors affecting survival identified differences in tumor size, the presence of involved lymph nodes and perineural invasion., Conclusion: The most significant prognostic factor affecting survival in patients with T3-T4 gastric cancer, based on the depth of gastric wall invasion, was the tumor size, lymph node involvement and perineural invasion. Key Words: Advanced gastric cancer, Prognostic factor, Survival.

Background: Sarcopenia is a syndrome that can be associated with unfavorable outcomes after colorectal cancer surgical procedures. The present study evaluates the relationship between sarcopenia and surgical site infections (SSIs) that can occur after colorectal cancer operations and that are a significant cause of morbidity. Methods: The research was designed as a retrospective study in which data were collected on patients who underwent colorectal cancer surgical procedures between January 2013 and July 2019. A diagnosis of sarcopenia was established based on the skeletal muscle index (SMI), calculated from pre-operative computed tomography scans. The SSI scores of patients with sarcopenia (sarcopenic group, SG) and those without sarcopenia (non-sarcopenic group, NSG) were compared, and a logistic regression analysis was performed to determine the risk factors for SSI. Results: A total of 209 patients with a mean age of 61.2 years were included in the study. Post-operative complications (Clavien-Dindo ≥1) developed in 97 (46.4%) patients, SSIs developed in 46 (22%) patients, and sarcopenia developed in 97 (46.4%) patients. The mean age was 64.8 years in the SG group and 58.1 years in the NSG group (p = 0.016). No significant relationship was found between the development of SSI and sarcopenia (20 (20.6%) patients in the SG vs. 26 (23.2%) patients in the NSG, p = 0.65). Those in whom superficial SSIs developed in the early period formed the largest group (20 patients). The most commonly detected micro-organism was Escherichia coli with a rate of 55%. In a multi-variable logistic regression analysis, only the non-laparoscopic approach was identified as a risk factor (odds ratio 3.83; 95% confidence interval 1.26-11.58; p = 0.017). Conclusions: The present study reports no relationship between sarcopenia and SSI after colorectal cancer operations. The authors consider that studies that endeavor to reduce the incidence of SSI, as a significant cause of morbidity after colorectal surgical procedures, should be supported.

Introduction: In July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines on gastroenterological endoscopy in patients undergoing antithrombotic therapy, although the safety of endoscopic procedures in patients receiving antithrombotic drugs has yet to be sufficiently studied., Aim: This study evaluates the safety of upper gastroenterological endoscopic biopsy in patients receiving antithrombotic drugs. We evaluated the prospective observational safety of endoscopic biopsy performed in the endoscopy unit of our patients using antithrombotic drugs., Material and Methods: Oesophagogastroduodenoscopies (OGD) and biopsies performed at a single endoscopy unit between July 2018 and February 2019 were examined in this prospective observational study. Patients receiving antithrombotic drugs due to cardiovascular and neurological reasons, who underwent an endoscopic mucosal biopsy for diagnostic purposes, were included in the study., Results: The study was completed with 166 patients who underwent an endoscopic biopsy, from whom a total of 327 biopsies taken. The patients were examined in two groups: those "receiving antithrombotic drugs" and those who had "stopped taking antithrombotic drugs". There was no statistically significant difference between the two groups with respect to bleeding., Conclusions: This prospective observational study showed that performing an endoscopic biopsy without the cessation of antithrombotic drugs does not increase bleeding risk. Low-risk procedures, such as endoscopic mucosal biopsies, can be performed confidently by experienced endoscopists., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Termedia.)

Aim: Prognostic significance assessment of different lymph node classification systems in stage III colorectal cancer patients., Material and Methods: A total of 85 stage III colorectal cancer patients, who had undergone surgery between January 2013 and December 2018, were divided into 3 different groups comprising of lymph node ratios (LNR) and log odds of positive lymph nodes (LODDS) as per the cutoff values of 25 and 75 percentile threshold values. They were accordingly classified as: LNR1 <0.069, LNR2 0.069-0.24, LNR3 >0.24 and LODDS1 <-0.99; -0.99≥ LODDS2 <-0.47; LODDS3 ≥-0.47. Further the LNR was assessed according to the cutoff values proposed by Berger et al. The pN statuses of all patients were also categorized as pN1 and pN2 in line with the AJCC 8th Edition. The Kaplan-Meier test and Cox regression analysis were performed to analyze the relationship among the LNR, LODDS, pN and overall survival., Results: While 55 patients included in the study had tumors in their colons, the localization of the tumors of 30 patients was the rectum. The means for survival time was 63.3 months +/- 3.6 [95% CI(56.2-70.4)]. When univariate analyses were conducted for the factors affecting 3 and 5-year survival of the patients, it was ascertained that there was a significant relationship only between perineural invasion (PNI) and survival. Accordingly, the 3-year survival of those with PNI was found to be 31.4% in comparison to 56% of those without PNI (p=0.025), while the figure was 5.7% for the 5-year survival of the former group and 22% for the latter (p=0.040). When the relation between the survival time of the patients and the LNR classification conducted according to the staging system developed by Berger et al. was studied, no significant relationship could be found (p>0.05). Similarly, and 0.321 respectively., Conclusion: Although numerous studies have shown that there was a significant relationship between high LNR and increased survival, as opposed to the results of our study, the greatest obstacle before LNR's survival prediction is the absence of a consensus for standard cutoff values., Key Words: Colorectal cancer, Lymph node classification systems, Lymph node ratio.

Introduction: Studies have shown that sarcopenia is associated with poor outcomes in patients with gastrointestinal cancer undergoing surgery. We aimed to investigate the relationship between postoperative complications of sarcopenic patients who had been operated on for colon cancer and the effects on short-term mortality., Material and Methods: In this study, patients who had undergone colon cancer surgery between January 2013 and December 2018 were collected retrospectively. Sarcopenia was diagnosed by the skeletal muscle index (SMI) derived from a preoperative computed tomography scan. Multiple logistic regression analysis was performed to determine whether sarcopenia is associated with postoperative major complications (POMC)., Results: The study included 160 patients with a mean age of 62.4 ±12.6 years. Clavien-Dindo grade 1-2 (minor) complications were not significantly different between the groups ( p = 0.896). However, grade ≥ 3 (major) complications were detected in 13 (17.8%) patients in the sarcopenic group (SG) and in 5 patients in the non-sarcopenic group (NSG) (5.7%) ( p = 0.016). Length of intensive care unit (ICU) stay was longer in SG ( p = 0.002) and there was no difference between 1-month and 6-month mortality rates ( p = 0.273 and p = 0.402, respectively). According to univariate analyses, sarcopenia and age over 65 years were related to POMC. In multivariate analyses, sarcopenia (odds ratio = 3.039; 95% confidence interval 1.008-9.174; p = 0.048) and advanced age (odds ratio = 3.246; 95% confidence interval 1.078-9.803; p = 0.036) were found to be independent risk factors for POMC., Conclusions: This study showed that while sarcopenia is a risk factor for POMC, sarcopenia also prolongs the duration of ICU stay. Also sarcopenia has no effect on short-term mortality., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2019 Termedia & Banach.)

Objectives: With the widespread use of esophagogastroduodenoscopy (EGD) in recent years, upper gastrointestinal system polyps have started to be encountered more often. Although most patients with gastric polyps are asymptomatic, these are important due to their malign potential, and gastric cancer may develop if left untreated., Material and Methods: Records of 12.563 patients who underwent EGD at Kartal Kosuyolu High Specialization Health Application and Research Center for any reason between January 2013 and June 2016 were reviewed retrospectively. Patients with at least 1 histopathologically proven polyp were included in this study., Results: A total of 12.563 endoscopic procedures of the upper gastrointestinal system were investigated and 353 (2.8%) polypoid lesions were detected. Mean age of these patients was 56.3 years and 241 (68.3%) of the patients were female. Gastric polyps were found most commonly in the antrum (50.1%) and of all gastric polyps, 245 (69.5%) were less than 1 cm. Histopathological evaluation showed that hyperplastic polyp (HP) (n= 151, 42.8%) was the most common polyp type, followed by fundic gastric polyp (FGP) (n= 51, 14.4%). Non-polyp gastric mucosa evaluation of 298 patients revealed that 34.9% of the cases were Helicobacter pylori positive, 19.4% had intestinal metaplasia, and 11.4% had atrophic gastritis., Conclusion: Polyps of the upper gastrointestinal system are generally detected coincidentally as they have no specific symptoms. Polypectomy is required for gastric polyps because of their potential for malign transformation according to medical evidence., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare., (Copyright © 2019, Turkish Surgical Society.)

Introduction: Trauma is the most frequent cause of splenic rupture. In contrast to traumatic rupture of the spleen, spontaneous splenic rupture (SSR) is a rare and life-threatening condition., Aim: To present the cases of patients with SSR, who had no history of trauma, and who had been receiving anticoagulant and/or antiaggregant treatment while hospitalised for cardiac reasons., Material and Methods: The cases of 6 patients with SSR at Gastroenterological Surgery Department, Kartal Koşuyolu High Speciality and Training Hospital were retrospectively evaluated. The clinicodemographic factors and the diagnostic and therapeutic methods utilised for these patients with SSR while hospitalised were investigated as well., Results: Five (83.3%) of the patients were male and 1 (16.6%) was female. The median age of the patients was 71 (61-73) years. Three of the patients had only been receiving antiaggregant treatment, while 2 had only been receiving anticoagulant treatment; only 1 patient had been receiving both anticoagulant and antiaggregant treatments. The decrease in haematocrit (HCT) levels ascertained on the day of SSR diagnosis and the HCT levels ascertained on the day of hospitalisation were statistically significant. All the patients received a blood transfusion. While 5 (83.33%) of the 6 patients had splenectomy, 1 (16.66%) patient received conservative treatment. Mortality was seen in 4 (66.6%) patients., Conclusions: Spontaneous splenic rupture is a condition that should be taken into consideration in the differential diagnosis of patients hospitalised for cardiac reasons, who are receiving anticoagulant and/or antiaggregant treatment in cases of newly developed abdominal pain and low HCT levels., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2019 Termedia Sp. z o. o.)

Introduction: Anatomical changes after surgery and fibrotic adhesions increase the organ laceration risk, including that of the ureter, in recurrent cases and secondary operations. The aim of this study was to investigate the changes in the anatomical localisations of the ureters via computed tomography urography in patients undergoing rectal cancer surgery., Material and Methods: The study involved prospectively collected data on the changes of ureteral location preoperatively and postoperatively in patients with operated rectal cancer. Distances (mm) of ureters determined midline in the computed tomography urogram phase., Results: A total of 18 patients were included. The mean distances between the right ( R 1 ) and left ( L 1 ) ureters and the mid-vertebral line before the surgery were 30.9 ±5.4 mm and 34.5 ±9.9 mm, respectively. The postoperative distances between them ( R 2 and L 2 ) were 26.4 ±9.1 mm and 29.5 ±9.9 mm, respectively. The R 2 measurement showed that 83.3% (15/18) of the right ureters had deviated medially, whereas 16.7% (3/18) of them had deviated laterally. The L 2 measurements showed that 88.8% (16/18) of the left ureters had deviated medially, whereas 11.2% (2/18) of them had deviated laterally. The differences between the preoperative and postoperative measurements of the right and left ureter positions were 4.5 ±9.2 mm and 4.9 ±4.6 mm, respectively, with the displacement in the left ureter being statistically significant ( p ≤ 0.001)., Conclusions: Rectal cancer surgery causes medially deviated changes in the positions of the ureters., (Copyright: © 2019 Termedia Sp. z o. o.)

Objective: Esophagojejunal anastomotic leakages, which occur in the reconstruction procedures performed after total or proximal gastrectomy, still account for one of the most significant causes of morbidity and mortality in spite of the developments seen in the perioperative management and surgical techniques in gastric cancer surgery. The aim of the presentstudy was to ascertain the risk factors for Esophagojejunal anastomotic leakages., Materialand Methods: A total of 80 patients with gastric cancer, who had total gastrectomy + D2 lymph node dissection and Esophagojejunal anastomotic between January 2013 and December 2016, were retrospectively evaluated. Patients who did not have anastomotic leakages during their clinical follow-ups were allocated to Group 1, whereasthose who had anastomotic leakages were allocated to Group 2., Results: A total of 58 (72.5%) out of 80 patients were males, whereas 22 (27.5%) were females.The mean age of the patients was 61.2±11.2 years. There were no demographic differences between the groups. Postoperative recurrent fever (p=0.001), C-reactive protein values on postoperative days 3 and 5 (p=0.01), and neutrophil-to-lymphocyte ratio on postoperative day 5 (p=0.022) were found to be statistically significant with regardto Esophagojejunal anastomotic leakages and other postoperative complications. The duration of operation (p=0.032) and combined organ resection (p=0.008) were ascertained as risk factors for Esophagojejunal anastomotic leakages., Conclusion: Surgeons should be careful about Esophagojejunal anastomotic leakages thatare significant postoperative complications seen especially in cases where the duration of operation is prolonged, and additional organ resections are performed. Recurrent fever, high C-reactive protein levels, and neutrophil-to-lymphocyte ratio may serve as warnings for complications in postoperative follow-ups.

Objective: Our aim in this study was to present the cases of our patients who contracted colonic perforation during elective colonoscopy and became emergency cases; we also discuss treatment modalities along with literature reports on the subject., Material and Methods: Cases of patients who contracted iatrogenic colonic perforation following endoscopy of the colorectal system between January 2009 and December 2015 at Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital's Endoscopy Unit were reviewed retrospectively., Results: Within the duration of the study, 5.586 patients underwent colonoscopies at our hospital; 7 (0.12%) of these patients contracted iatrogenic colonic perforation. Three (42.8%) of these patients were male, four (57.2%) were female, and their mean age was 69 years (46 to 84). Six (85.7%) patients were diagnosed intraoperationally, while one (14.3%) patient was diagnosed 12 hours after the procedure. The perforation area was the sigmoid colon in six patients and the ascending colon in one patient; all patients underwent surgery. Four patients were discharged with no complications. One of the remaining three patients had enterocutaneous fistula, one had acute renal failure, and one died of sepsis., Conclusion: The progress of perforation due to colonoscopy varies according to the underlying diseases, the mechanism of perforation formation, the treatment modality used, and the experience of the physicians treating the patient. Special attention should be paid to senior and comorbid patients receiving therapeutic procedures during colonoscopy., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Background: This study presents the relationship between mortality and spontaneous rectus sheath hematoma (RSH) in inpatients receiving anticoagulant and antiaggregant treatment for cardiac pathology at cardiology and cardiovascular surgery clinics., Methods: Within the scope of our study, the cases of 27 patients who were diagnosed with spontaneous RSH between January 2010 and December 2015 at Kartal Kosuyolu High Speciality Training and Research Hospital were retrospectively evaluated., Results: Of the 27 patients, 19 (70.4%) were female and 8 (29.6%) were male. The mean age was 63±12 (32-84) years. All the patients had at least one comorbidity that necessitated follow-up. Fourteen patients received only anticoagulant treatment, 8 received only antiaggregant treatment, and the remaining 5 received both types of treatment. Physical examination of all patients revealed painful palpable masses in the lower quadrants of the abdomen. According to the results of computed tomography (CT) scans, which showed the size and localization of the masses, 7 of the cases were classified as Type I, 6 as Type II, and 14 as Type III. Although 23 of the cases received medical treatment, the remaining 4 patients received surgical treatment. Eight (29.6%) patients suffered mortality., Conclusion: RSH is rare, but its prevalence is increased among patients receiving anticoagulant and antiaggregant treatment for cardiac reasons. The mortality rate markedly increased among patients who contracted RSH during hospitalization for cardiac reasons, had comorbidities, and experienced additional complications due to extended hospitalization.

Introduction: There is little information available on the clinical aspects, results, treatment and management of cardiac catheterization-related retroperitoneal hematoma. Data on the subject are rather limited, and current publications are based on a limited number of retrospective cohort studies and case reports., Aim: To perform a retrospective analysis of the demographic, clinical, and in-hospital results of patients who developed retroperitoneal hematoma (RPH) after cardiac catheterization (CC)., Material and Methods: The cases of 124,064 patients who had CCs between January 2010 and October 2016 were retrospectively analyzed. Patients diagnosed with RPH were classified into three groups depending on the method of treatment: conservative (group 1), endovascular stenting (group 2), and surgery (group 3). The independent risk factors, based on RPH-related mortality, were determined by logistic regression analysis., Results: Of the 68 (0.054%) patients with RPH, 75% received conservative treatment, 13.2% underwent angiographic stent placement, and 11.7% had surgical treatment. Red blood cell packets (RBCPs) ( p = 0.043), duration of hospitalization ( p = 0.007), and mortality rates ( p = 0.006) were statistically significantly higher in group 3 in comparison to the other groups. Multivariate subgroup analysis was conducted to determine mortality rates, with post-procedural highest creatinine ≥ 2 mg/dl and RBCPs ≥ 10 established as independent risk factors., Conclusions: Hemodynamically stable patients with no active hemorrhaging are shown to have good results with conservative treatment. We believe that endovascular methods should be used initially for hemodynamically unstable patients, while surgical treatment should be employed in cases where endovascular methods fail or abdominal compartment syndrome develops., Competing Interests: The authors declare no conflict of interest.

Small intestinal stricture forming in the late phase following nonpenetrating abdominal trauma is rare cause of ileus. It has often been suggested that it is result of localized feeding deficiency on the intestinal wall related to minor trauma in the mesentery. Laparoscopy has been increasingly used for diagnosis and treatment. Diagnosis should be supported by pathological analyses in case of intestinal stenosis related to blunt abdominal traumas.

Warfarin is the most commonly used oral anticoagulant and is widely prescribed to prevent thromboembolic events. Warfarin-dependent spontaneous breast hematoma is a very rare complication. Presently described is rare case of warfarin-induced breast hematoma.

Aim of the Study: Examination of esophagojejunal (EJ) anastomosis with aqueous contrast swallow after total gastrectomy is still routinely conducted by many centres. The present study aimed to answer the question: Is it necessary to evaluate EJ anastomosis in terms of leakage by having every patient drink oral contrast agent before initiation of oral food intake after total gastrectomy (TG) performed due to gastric cancer?, Material and Methods: Clinical and radiological results of patients on whom total gastrectomy was performed due to gastric cancer between January 2013 and December 2016 were retrospectively reviewed. Diagnostic method used for patients in whom leak developed and therapeutic interventions were assessed. Evaluation results from aqueous contrast agent and clinical, laboratory, and tomographic findings were studied., Results: Sixty of the 69 patients who underwent total gastrectomy with a diagnosis of gastric adenocarcinoma swallowed aqueous contrast agent on postoperative day 7 ±2 days and were evaluated in terms of anastomotic leak. Leak developed in 14 patients (20.2 %), 10 of whom ingested contrast agent. Leak was identified in 6 of those patients; however, diagnosis was made with multislice computed tomography (CT) in four patients (40%). The sensitivity of the examination with aqueous contrast agent was 60%., Conclusions: Evaluating anastomotic leak with aqueous contrast agent after TG has low sensitivity, and it would be wise to resort to this procedure in cases with clinical suspicion, rather than routinely performing it in every patient., Competing Interests: The authors declare no conflict of interest.

This work aims to investigate the antiproliferative properties of Allium sivasicum (AS) on breast cancer. AS extracts were studied for cytotoxicity against the breast cancer cell lines. In vitro apoptosis studies of breast cancer cells were performed by annexin V staining in flow cytometry analyses. AS showed cytotoxicity to three cancer cell lines. Annexin-positive cells level in AS treated cell lines were higher than the untreated control cells. The expressions of caspase-7 protein and TUNEL positive cells were much higher for the rats treated by AS, compared with the untreated control group. The expressions of the Ki-67 decreased in treatment groups compared with the control group. In vivo studies showed that mean tumor volume inhibition ratio in AS treated group was 38 % compared with the untreated rats. These results indicate that A. sivasicum has antitumoral potential against breast cancer.

Aim: To investigate the in vitro effects of pantoprazole on rat lower esophageal sphincter (LES) tone., Methods: Rats weighing 250-300 g, provided by the Yeditepe University Experimental Research Center (YÜDETAM), were used throughout the study. They were anesthetized before decapitation. LES tissues whose mucosal lining were removed were placed in a standard 30-mL organ bath with a modified Krebs solution and continuously aerated with 95% oxygen-5% carbon dioxide gas mixture and kept at room temperature. The tissues were allowed to stabilize for 60 min. Subsequently, the contractile response to 10(-6) mol/L carbachol was obtained. Different concentrations of freshly prepared pantoprazole were added directly to the tissue bath to generate cumulative concentrations of 5 × 10(-6) mol/L, 5 × 10(-5) mol/L, and 1.5 × 10(-4) mol/L. Activities were recorded on an online computer via a 4-channel transducer data acquisition system using the software BSL PRO v 3.7, which also analyzed the data., Results: Pantoprazole at 5 × 10(-6) mol/L caused a small, but statistically insignificant, relaxation in the carbachol-contracted LES (2.23% vs 3.95%). The 5 × 10(-5) mol/L concentration, however, caused a significant relaxation of 10.47% compared with the control. 1.5 × 10(-4) mol/L concentration of pantoprazol caused a 19.89% relaxation in the carbachol contracted LES (P < 0.001)., Conclusion: This is the first study to demonstrate that pantoprazole has a relaxing effect in isolated LESs. These results might have significant clinical implications for the subset of patients using proton pump inhibitors who do not receive full symptomatic alleviation from gastroesophageal reflux disease.

Background: The aim of the present study was to describe the clinical presentation, diagnostic work-up, surgical therapy, and prognosis of 13 patients with small bowel tumor admitted for surgical procedures in an emergency setting., Methods: From 1996 to 2008, 13 consecutive surgical cases of small bowel tumors were treated at the Cumhuriyet University Faculty of Medicine, Department of General Surgery, and Kütahya State Hospital, Department of General Surgery. Clinical and radiological charts of these patients were reviewed retrospectively from the department database., Results: Intestinal obstruction (7 cases) and perforation (5 cases) were the most common clinical presentations, followed by intussusception (1 case). Adenocarcinoma was the most frequent histologic type (4 cases), while small bowel sarcoma was seen in three cases and non-Hodgkin lymphoma in two cases. The remaining cases had carcinoid tumor, small bowel angioleiomyoma, Brunner's gland adenoma, and inflammatory pseudotumor of the small intestine., Conclusion: Small bowel tumors are rare, the symptoms often non-specific, and the accuracy of different diagnostic tests remains to be improved. Timing and type of the intervention to the process and biological behavior of the pathological cells predict the prognosis.

Background/aims: Nitric oxide (NO) is a major inhibitor in various parts of the gastrointestinal tract. This study was designed to compare the effects of YC-1, NO-independent soluble guanylate cyclase (sGC) activator, and DEA/NO, NO-nucleophile adduct, on sheep sphincters of Oddi (SO)., Methods: SO rings were mounted in a tissue bath and tested for changes in isometric tension in response to 3-(5'-hydroxymethyl-2'-furyl)-1-benzyl indazole (YC-1, 10(-10)-10(-5)M), diethylamine/NO complex (DEA/NO, 10(-8)-10(-4)M). We also evaluated the effect of YC-1 (10(-6) and 10(-5)M) and DEA/NO (10(-5) and 10(-4)M) on the levels cyclic GMP (cGMP) in isolated SO., Results: YC-1 (10(-10)-10(-5) M) and DEA/NO (10(-8)-10(-4)M) induced concentration-dependent relaxation of isolated SO rings precontracted with carbachol (10(-6)M). The pEC(50) value of DEA/NO was significantly lower than those for YC-1 (p < 0.05), with no change of E(max) values. YC-1 increased cGMP levels more than control, carbachol and DEA/NO groups (p < 0.05)., Conclusion: These results show that YC-1 is a more potent relaxant than DEA/NO and causes more elevation of cGMP levels in isolated SO rings.

Background: Intravenous anesthetics are often used for conscious sedation in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincter of Oddi (SO) manometry. This study was designed to investigate the direct effects of some intravenous anesthetics on SO in sheep., Methods: In sheep SO rings, changes in isometric tension in response to cumulative concentrations of intravenous anesthetics were determined, and values for Emax (mean maximal inhibition) and pD2 (i.e. the negative logarithm of the concentration for the half-maximal response, EC50) were compared., Results: Meperidine (10(-7) to 3 x 10(-5) M), fentanyl (10(-7) to 3 x 10(-5) M), midazolam (10(-7) to 3 x 10(-5) M) and propofol (10(-7) to 3 x 10(-4) M) induced concentration-dependent relaxations on SO precontracted with carbachol (10(-6) M). Emax and pD2 values following meperidine, fentanyl and midazolam administration were significantly greater than after propofol (p < 0.05). There were no significant differences in Emax and pD2 values for meperidine, fentanyl and midazolam., Conclusion: These results suggest that meperidine, fentanyl and midazolam are equipotent relaxants in the sheep SO in vitro. The relaxatory effect of propofol was 10 times less potent compared to the above agents, and it can be beneficial during SO manometry in controlled clinical human studies.