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White adipose tissue is the major energy storage depot for neutral lipids and is also a key endocrine regulator of a host of homeostatic activities, including metabolism, feeding behaviors, cardiovascular functions and reproduction. Abnormal fat accretion in the setting of obesity can lead to insulin resistance and type 2 diabetes, and has been linked to some cancers and arteriosclerosis. Thus, a thorough appreciation of the intricate signaling events that must take place as quiescent adipocyte precursors are recruited into the proliferating cell population that then must 'decide' to differentiate into fully functional fat cells is critical to our understanding of diseases related to excess adipogenesis. We are beginning to gain insights into the molecular regulators of adipocyte differentiation. A significant advance would be to construct mathematical modeling tools that would assist cell biologists in predicting how environmental and/or intrinsic inputs could influence preadipocyte fate decision making. We have developed a model of how preadipocytes may use the dynamic interplay of two transcription factors, nuclear factor-kappa B (NF-kappaB) and peroxisome proliferator-activated receptor-gamma (PPAR-gamma) in early proliferation and differentiation events in vitro. Critical to the model is the feedback signaling between NF-kappaB and its inhibitor, I kappaB. The model is based on differential equations that describe the interactions of stimuli for NF-kappaB activation and mitogen concentrations and allows one to make predictions about how mouse 3T3-L1 preadipocytes choose between proliferation, differentiation or quiescence. Those predictions are supported by experiments on mouse 3T3-L1 cells., ((c) 2010 Elsevier Ltd. All rights reserved.)

Primary candidiasis in the laryngeal mucosa is rare but has many predisposing factors, in particular immune insufficiency and long-term antibiotic use. This study involved a reassessment of 530 laryngeal biopsy specimens originally examined between 2004 and 2009, from which 11 cases of hyperplastic laryngeal candidiasis were identified according to their clinical and histopathological features. Among possible predisposing factors, immune insufficiency was identified in three patients, there was long-term antibiotic use in two cases, use of inhaled corticosteroids in four cases, smoking in eight cases and reflux symptoms in four cases. Dysplasia as well as hyperplasia was seen in two cases. Endolaryngeal lesion excision was performed in eight cases and biopsy leading to radical surgery was done in three. In clinical follow-up no lesions were observed in nine cases while two had new leukoplakic lesions.

Intragastric balloon therapy, as a part of a multidisciplinary weight management program, is an effective short-term intervention for weight loss. Although the insertion procedure is easy and generally well tolerated by patients, a few complications can occur. We report here a heavy smoker with intragastric balloon insertion complicated by colonization with opportunistic organisms. The 27-year-old female, body mass index 35.5 kg/m(2), had a BioEnterics Intragastric Balloon inserted under conscious sedation without any perioperative complications. Six months later, when the standard removal time arrived, the balloon was seen to be covered with a necrotic white-gray material. Microbiological examination revealed Enterobacter cloacae and Candida species yeast colonies. We recommend that asymptomatic fungal and/or bacterial colonization should be considered among the complications of the intragastric balloon procedure, despite its rarity.

Background: The aim of this prospective study was to evaluate the relationship between accessory nerve functions and level 2b-preserving selective neck dissection., Methods: Forty-one necks of 30 patients with laryngeal cancer who underwent unilateral or bilateral level 2b-preserving neck dissections, between February 2003 and July 2005, were evaluated. Neck and shoulder movements and muscle strengths were examined and electroneuromyography (ENMG) was performed preoperatively at the postoperative 21st day and 6th month. Pathological anatomical findings at the postoperative 6th month were also evaluated., Results: All shoulder movements and muscle strengths were preserved. Neck extension, rotation movements, and flexion strengths were restricted. ENMG values were affected moderately in the early postoperative period and improved slightly in the late postoperative period. None of the patients developed shoulder syndrome or adhesive capsulitis., Conclusion: Preserving level 2b during selective neck dissection decreases trauma to the accessory nerve and improves functional results., ((c) 2009 Wiley Periodicals, Inc. Head Neck, 2009.)

Omerli Reservoir is one of the major drinking water reservoirs of Greater Metropolis Istanbul, providing 40% of the overall water demand. Istanbul where is one of the greatest metropolitan areas of the world with a population over 10 million and a rate of population increase about twice that of Turkey. As a result of population growth and industrial development, Omerli watershed is highly affected by the wastewater discharges from the residential areas and industrial plants. The main objective of this study is to investigate the temporal assessment of the land-use/cover of the Omerli Watershed and the water quality changes in the Reservoir. It is not possible to adequately control urbanization and other pollution sources affecting the water quality. Responses of these detrimental effects are due to rapidly increasing population, unplanned and illegal housing, and irrelevant industries at the protection zones of the watershed, together with insufficient infrastructure. The study is focused on the assessment of urbanization in relation to land use and water quality using Remote Sensing (RS) and Geographic Information Systems (GIS) techniques for all the four protection zones of the Reservoir and a time variant analyzing model is obtained. IRS-1C LISS and IRS-1C PAN, LANDSAT-5 TM satellite data of 1997, 1998, 2000, 2001 and 2006 are analyzed by confirmation through the ground truth data. RS data have been transferred into UTM coordinate system and image enhancement and classification techniques were used. Raster data were converted to vector data that belongs to study area to analyze in GIS for the purpose of planning and decision-making on protected watersheds.

Accurate and timely information about land use and land cover (LULC) and its changes in urban areas are crucial for urban land management decision-making, ecosystem monitoring and urban planning. Also, monitoring and representation of urban sprawl and its effects on the LULC patterns and hydrological processes of an urbanized watershed is an essential part of water resource planning and management. This paper presents an image analysis study using multi temporal digital satellite imagery of LULC and changes in the Kucukcekmece Watershed (Metropolitan Istanbul, Turkey) from 1992 to 2006. The Kucukcekmece Basin includes portions of the Kucukcekmece District within the municipality of Istanbul so it faces a dramatic urbanization. An urban monitoring analysis approach was first used to implement a land cover classification. A change detection method controlled with ground truth information was then used to determine changes in land cover. During the study period, the variability and magnitude of hydrological components based on land-use patterns were cumulatively influenced by urban sprawl in the watershed. The proposed approach, which uses a combination of Remote Sensing (RS) and Geographical Information System (GIS) techniques, is an effective tool that enhances land-use monitoring, planning, and management of urbanized watersheds.

Background: The BioEnterics Intragrastric Balloon (BIB) together with restricted diet has been used for the treatment of obesity and morbid obesity., Methods: A prospective study was conducted on 100 patients who had undergone the BIB procedure between February 2005 and February 2007., Results: Mean age, mean weight, and mean BMI of the patients were 35.35 +/- 9.25 years, 113.23 +/- 24.76 kg (range 73-200 kg), and 39.28 +/- 6.98 kg/m(2) (range 30-69.2 kg/m(2)), respectively. Six months after the BIB procedure, mean weight and mean BMI were reduced to 100.46 +/- 26.05 kg (range 58-178 kg) and 34.70 +/- 11 kg/m(2) (range 21.83-61.59 kg/m(2)), respectively. There was a statistically significant reduction in weight and BMI at 6 months after the BIB procedure (p < 0.01). Excess weight loss (EWL) at 6 months ranged between 0 and 28 kg, with a mean value of 12.68 +/- 7.70 kg. The subjects had 0 to 99.2% %EWL (mean 28.63 +/- 19.29). Reduction in BMI at 6 months ranged between 0 and 12.3 kg/m(2), with a mean value of 4.51 +/- 2.85 kg/m(2), and percent excess body mass index loss (%EBMIL) was 38.20 +/- 28.78% (range 0-158%). At 6 months, there was a significant reduction in body weight and BMI (p < 0.01) in both groups. The reduction in BMI of the morbidly obese group was significantly greater than that of the obese group (p = 0.035), and both the %EWL and %EBMIL of the morbidly obese patients were significantly lower than those of the obese patients at 6 months (p = 0.001)., Conclusions: BIB application is a reasonable weight loss method with few complications.

Motivation: Cell motility is a critical part of many important biological processes. Automated and sensitive cell tracking is essential to cell motility studies where the tracking results can be used for diagnostic or curative decisions and where mathematical models can be developed to deepen our understanding of the mechanisms underlying cell motility., Results: We have developed CellTrack: a self-contained, extensible, and cross-platform software package for cell tracking and motility analysis. Besides the general purpose image enhancement, object segmentation and tracking algorithms, we have implemented a novel edge-based method for sensitive tracking of the cell boundaries, and constructed an ensemble of methods that achieves refined tracking results even under large displacements or deformations of the cells., Availability: CellTrack is an Open Source project and is freely available at http://db.cse.ohio-state.edu/CellTrack.

In this study we assessed the effectiveness of fluid viscosities placed in the peritoneal cavity to prevent postoperative peritoneal adhesions. Thirty-six Wistar albino female rats (average weight: 160 +/- 30 g, average age: 6.5 months) were divided into three groups of equal number. A standard adhesion pattern was formed in each group. Then, 3 ml isotonic sodium chloride solution (relative viscosity value: 1) was added into the peritoneal cavity of group 1; 3 ml standard 6% hydroxy ethyl starch solution (HES) (relative viscosity value: 2.9) was added into the peritoneal cavity of group 2; and a standard HES solution that was concentrated by dehydration (relative viscosity value: 249.7) was added into the peritoneal cavity of group 3. All rats were sacrificed on postoperative day 10 and the adhesions that formed were graded. In group 1, grade-3 adhesions developed in 9 (75%) rats, and grade-2 developed in 3 (25%) rats. In group 2, grade-3 adhesions developed in 1 (8.3%) rat, grade-2 developed in 6 (50%) rats, and grade-1 developed in 5 (41.6%) rats; in group 3, grade-3 adhesions developed in 9 (75%) rats, and grade-2 developed in 3 (25%) rats. The adhesion scores of group 3 and group 1 were equal to each other (P=1), while the adhesion score of group 2 was significantly less (chi(2): 18.23, P<0.001). Increasing the viscosity of fluids that are inserted in the peritoneal cavity may reduce the formation of postoperative peritoneal adhesions till a critical value of unknown viscosity is achieved. The mechanism behind this process remains unclear.

In the treatment of early-stage glottic cancers, radiotherapy and surgery have similar success rates. In our department, we have been using cold instruments coupled with surgical microscope and/or telescopes for several years in treatment of early stage glottic cancers. Our aims were, to present our experience with endolaryngeal resection of T1 glottic cancers with cold instruments coupled with surgical microscope and telescopes, to present our oncological results, to discuss the advantages of endolaryngeal cordectomy over open cordectomy or RT and to discuss whether laser is obligatory for this approach or not. Our study includes retrospective analysis of 38 patients with T1 glottic cancer, who have been treated with endolaryngeal surgery as the primary treatment. The median follow-up was 24 months. The most commonly performed procedure was type-II cordectomy (38.5%). Overall survival rate was 94.7%, while the disease-specific survival rate was 100%. Local recurrences occurred in two patients at 8th and 11th months, postoperatively. In the first patient, type-Vc cordectomy and in the second type-Va cordectomy had been performed. Both patients with recurrences could be salvaged by fronto-lateral laryngectomy, and are still alive in their 38th and 6th months following salvage surgery. Therefore, the local control rate and larynx preservation rate with endolaryngeal cordectomy were 94.7 and 100%, respectively, in this study group. All patients had a voice quality sufficient for communicating easily over telephone. We believe that lasers are not obligatory to perform endolaryngeal cordectomy for treatment of T1 glottic cancers, as the same oncological and similar functional outcomes may be achieved with the traditional cold instruments.

Aims and Background: The frequency of p53 mutations in primary tumors, the effect of the mutations on some clinical and pathological features of head and neck squamous cell carcinoma, and the impact of p53 mutations in the surgical margins on local recurrence were determined,, Material and Methods: We investigated the presence of p53 mutations in primary tumor samples and in the surgical margins of 34 patients with head and neck cancer using single strand conformational polymorphism and sequencing analysis., Results: The p53 mutations (codons 175addAT, 175delGC, 206G --> A, and 248delC) were found in the primary tumor samples of 15 of 34 patients (44.12%) and in the surgical margins of 5 of the 15 tumors (33.33%) with p53 mutations., Conclusions: We found no statistically significant association between the presence of p53 mutations in the primary tumor, the clinical and pathological features, or outcome of head and neck squamous cell carcinoma in this study. Furthermore, the presence of p53 mutations in the surgical margins may not increase the risk of local-regional recurrence, but probably increases the risk of developing distant metastases or second primary tumors.

In this article a mathematical model for ameboid cell movement is developed using a spring-dashpot system with Newtonian dynamics. The model is based on the facts that the cytoskeleton plays a primary role for cell motility and that the cytoplasm is viscoelastic. Based on the model, the inverse problem can be posed: if a structure like a spring-dashpot system is embedded into the living cell, what kind of characteristic properties must the structure have in order to reproduce a given movement of the cell? This inverse problem is the primary topic of this paper. On one side the model mimics some features of the movement, and on the other side, the solution to the inverse problem provides model parameters that give some insight, principally into the mechanical aspect, but also, through qualitative reasoning, into chemical and biophysical aspects of the cell. Moreover, this analysis can be done locally or globally and in different media by using the simplest possible information: positions of the cell and nuclear membranes. It is shown that the model and solution to the inverse problem for simulated data sets are highly accurate. An application to a set of live cell imaging data obtained from random movements of a human brain tumor cell (U87-MG human glioblastoma cell line) then provides an example of the efficiency of the model, through the solution of its inverse problem, as a way of understanding experimental data.

The aim of this study was to determine the incidence and role of c-erbB-2 overexpression as a predictive/prognostic marker in small-cell lung carcinoma (SCLC). We performed a retrospective study on subjects with a biopsy-proven diagnosis of SCLC. A chart review for demographic and clinical data was performed on patients with SCLC diagnosed between 1998 and 2004. c-erbB-2 overexpression was evaluated using immunohistochemistry performed on archival paraffin-embedded specimens. Sixty-seven patients with SCLC were identified (6 females, 61 males; median age- 56.5 yr, range-34-75) all of whom had adequate tissue specimens available for c-erB-2 testing. Of the 67 specimens, 12 (17.9%) showed c-erbB-2 overexpression. Seventy-five of the cases were positive for c-erbB-2, had extensive disease. The median overall survival of patients with SCLC whose tumors were positive and negative for c-erbB-2 were 8 +/- 0.9 months (95%CI 6.3-9.7) and 11 +/- 1.5 months (95%CI 8.0-14.0), respectively. c-erbB-2 overexpression detected using immunohistochemistry is observed in 17.9% of patients with SCLC and has statistically significant prognostic value. Our findings suggest that c-erbB-2 may be a potential target for site-specific immunotherapy in SCLC. Considering one technique examined, further molecular investigation is needed to confirm these preliminary findings.

Background: The purpose of this study was to compare the intra-abdominal adhesion formation following ventral hernia repair by using oxidized regenerated cellulose (ORC) as a barrier underneath polypropylene mesh (PPM), and sodium hyaluronate/carboxymethylcellulose (HA/CMC)-coated PPM., Methods: A ventral abdominal defect was created in each of 30 male rats which were divided into three groups. In group 1 (control) the defect was repaired with PPM; in group 2 ORC was laid over the viscera and the defect was repaired with PPM, and in group 3 HA/CMC-coated PPM was used for the repairing procedure. On the 28th postoperative day all the rats were sacrificed and adhesions were evaluated by laparoscopic exploration followed by histopathological examination., Results: Animals treated with ORC and PPM, and HA/CMC-coated PPM showed significantly less adhesions than the control group (p = 0.026) and the intra-abdominal adhesions of the rats in these two groups were significantly easier to release than in the control group (p = 0.001). There was no significant difference between the ORC and HA/CMC groups., Conclusions: ORC used together with PPM is as effective as HA/CMC-coated PPM and ORC can be used as an adhesion barrier in intra-abdominal hernia repair.

Background: We investigated the effects of Botox-A on weight loss and gastric emptying in an experimental obese rat model. Although there is evidence of weight loss in normal-weight rats after Botox-A injection, there are no studies indicating the effect of Botox-A injection on weight loss and gastric emptying time in obese rats., Methods: 37 female Wistar Albino rats were given high calorie diet for 90 days. They were separated into 3 groups. The first group (Botox group) consisted of 15 obese rats whose gastric antrum was injected with 20 U of Botulinum Toxin Type A. The second group (Saline group) consisted of 15 obese rats whose gastric antrum was injected with 20 U of saline. The third group (Control group) had no surgical intervention. Gastric scintigraphy was performed in the 3 groups pre- and postoperatively., Results: The saline group had a weight reduction in the early postoperative days but began to gain weight thereafter. The mean weight of the Botox group between the 16th and 28th days postoperatively was significantly lower than the mean weights of the control and the saline groups (P<0.05, P<0.001). The results of gastric emptying scintigraphy in all 3 groups at day 20 revealed significantly higher T1/2 values in the Botox-A group when compared to the results of the control and saline groups (P<0.001)., Conclusion: Botox-A application to the gastric antrum in obese rats leads to weight loss by increasing the gastric emptying time.

In this study, our four patients with angiofibroma with various atypical features are presented. Related literature is reviewed and criteria for atypicality are proposed. 14 patients, diagnosed and treated for angiofibroma in the Otorhinolaryngology Department of Faculty of Medicine in Uludag University between January 1992 and December 2003, have been evaluated. The files of the patients were examined and four patients with atypical characteristics have been included in the study. Angiofibromas presenting with at least one of the following criteria such as origin or location other than nasopharynx, presenting complaints other than nasal obstruction or epistaxis, aged younger than seven or older than 25, female sex, atypical histopathology and multifocalitiy were considered as "atypical". Four of 14 angiofibromas (28.5%), which were diagnosed and treated in our clinic, had atypical features. The reasons for atypicality were unusual localization in three patients and uncommon initial symptom in one case. In the atypical localization group, neoplasm was located in tonsil in one case, and in inferior turbinate in two patients. The only patient with atypical initial symptom presented with a bulging in the cheek. The patients, who have different characteristics other than classical angiofibromas, may be called "Atypical Angiofibroma (AAF)", under the scope of the related literature and our experience. These patients should be included in atypical group according to the characteristics such as, localization, symptom, age, sex, histopathology and multifocality.

Background: Solitary plasmacytoma localised to bone or soft tissue without myeloma., Aim: Clinical features and survival was analysed in patients from Central Anatolia., Methods: Twenty-three solitary plasmacytoma (18 male, 5 female) were evaluated retrospectively. Median age was 58 years (46-72). The major localisation was vertebral column., Results: All patients but one (larynx) had surgical resection and 21 patients received radiotherapy postoperatively. Multiple myeloma developed in eight patients (35%) and local relapse was detected in one patient. Eight patients died, causes of death were multiple myeloma progression in six patients, local relapse of intracranial plasmacytoma in one patient and cranial trauma in one patient who was in complete remission. Three and 5 years progression free survival were 45.6% and 22.8% respectively and overall survivals were 54.4% and 27.2% respectively., Conclusion: Solitary plasmacytoma cases should be followed carefully regarding local relapse and progression to myeloma.

In this phase II study, we aimed to detect efficacy and toxicity of the combination of CPT-11 and cisplatin administered to patients with metastatic gastric carcinoma. On d 1, CPT-11, 100 mg/m2, was administered by intravenous infusion for 90 min, followed by a 2 h infusion of cisplatin, at 70 mg/m2 every 3 wk. Forty-one patients were enrolled into the study. Twenty-eight patients were chemotherapy naive. The total number of chemotherapy cycles administered was 165, and the median number of cycles received was 4 (range, 1-8 cycles). The median follow-up time was 12 mo (range, 4-34 mo). There were 4 complete responses (9.7%) and 14 partial responses (34.2%), which result in a response rate of 43.9% (18 of 41 patients). The median time to progression was 8.0 +/- 0.8 mo with 56% and 13% of patients progression free at 6 and 12 mo, respectively. The median overall survival was 9.0 +/- 1.1 mo, with 68 % and 32% of patients alive at 6 and 12 mo, respectively. Grade 3-4 nausea and vomiting was observed in five patients (12%) and grade 3-4 neutropenia in five patients (12%). Grade 3 infection was observed in only one patient (2%). Grade 2 transient liver dysfunction related to chemotherapy was observed in one patient (2%). Chemotherapy was stopped due to nephrotoxicity in one patient (2%). There was no treatment-related death. In conclusion, administration of CPT-11 and cisplatin in this particular dose every 3 wk is effective and well-tolerated treatment regimen.

Purpose: Incisional hernias are not uncommon after abdominal surgery, but their repair is associated with a high risk of complications, including adhesions and recurrence. Many different types of meshes and adhesion barriers have been developed in an attempt to overcome these problems, some of which we have assessed in a rat model., Methods: We made a full-thickness 1.5 x 2.5-cm abdominal wall defect in 30 Sprague-Dawley rats, which were divided into three groups according to the materials used for repair: 2 x 3-cm polypropylene mesh (group 1); expanded polytetrafluoroethylene (PTFE) with double-layer polypropylene mesh (group 2); or polypropylene mesh with oxidized cellulose adhesion barriers (group 3). We assessed adhesion formation, tensile strength, and histopathologic findings., Results: The mean adhesion scores were 3.3, 1.3, and 0.7, in groups 1, 2, and 3, respectively (P < 0.001). The area involved by adhesions was significantly greater in group 1 than in groups 2 or 3 (P < 0.01, P < 0.05), but there was no significant difference between groups 2 and 3 (P < 0.05). The tensile strength in group 2 was less than that in groups 1 or 3 (P < 0.01, P < 0.05), but there was no significant difference between groups 1 and 3 (P > 0.05)., Conclusion: Although there was less adhesion formation with PTFE and oxidized cellulose, PTFE not only impaired the tensile strength, but also induced fibrosis and inflammation. An oxidized cellulose adhesion barrier can be safely used in incisional hernia repair to prevent intra-abdominal adhesions.

Background: This study was designed to observe the effect of preserving the spinal accessory nerve (SAN) during neck dissection (ND) and adjuvant radiotherapy (ART) after ND on shoulder function., Methods: Fifty-seven patients with head and neck cancer who had undergone primary tumor resection and various types of NDs were enrolled in this prospective study. Postoperative shoulder joint range of motion was evaluated by goniometry, and muscle strength was measured manually. SAN function was evaluated with electromyography (EMG) with respect to percentage of denervation and presence of neurogenic involvement. Patients were grouped by treatment as follows: radical ND (RND) versus modified radical ND (MRND)/selective ND (SND) and ART versus no ART., Results: Shoulder joint range of motion and shoulder muscle strength were significantly better in the MRND/SND group than in the RND group. However, EMG findings were similar in the RND and MRND/SND groups. When all patients who underwent ND, RND, or MRND/SND were compared with the control group, statistically significant changes in shoulder joint range of motion and shoulder muscle strength were found. Also, denervation and neurogenic involvement of the SAN were significantly higher after all NDs than in the control group. ART did not affect range of motion of the shoulder joint, shoulder muscle strength, or the degree of denervation and neurogenic involvement in any of the ND groups., Conclusions: ART does not have a negative effect on shoulder function after ND. SAN is always functionally impaired even if we preserve it macroscopically during ND.

The most common morbidity associated with selective neck dissection (SND; II-IV) is spinal accessory nerve dysfunction and related shoulder disability. Nerve dysfunction is usually attributed to stretching of the nerve during clearance of lymph nodes lying posterior and superior to the spinal accessory nerve (level IIb). If these lymph nodes were left in place and not removed, stretching of the spinal accessory nerve during neck dissection and postoperative shoulder disability could be avoided. 113 SNDs (II-IV) performed on clinically N0 necks of patients with laryngeal carcinoma were enrolled in this prospective study. During SND, level IIb was separately removed and processed. Mean number of lymph nodes in level IIb was 6.26 (range, 0-19). In none of the 113 SND (II-IV) specimens did level IIb contain metastases, thus providing an oncological basis that leaving these lymph nodes in place is an oncologically safe approach, probably avoiding postoperative shoulder disability.

Background/aims: The aim of this study was to evaluate the prognostic significance of serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA19-9) levels in patients with gastric cancer., Methodology: During the period January 2000 and January 2003, 36 patients operated for primary gastric cancer, at Sisli Etfal Training and Research Hospital, Department of General Surgery, were analyzed. Serum CEA and CA19-9 levels were determined preoperatively and the correlation between the elevated levels of tumor markers and several clinicopathological features, and survival were evaluated., Results: Elevated serum CEA and CA19-9 levels were determined in 10 of 35 patients (28.6%), and 9 of 31 patients (29%), respectively, and both markers were elevated in 3 of 31 patients (9.6%). Elevated levels of CEA correlated with depth of invasion (p=0.018) and pathological stage (p=0.029); elevated levels of CA19-9 correlated with lymph node metastasis (p=0.026); and elevated levels of both markers correlated well with lymph node metastasis (p=0.031). The survival of patients with normal CEA levels was significantly better than those with elevated levels (p=0.0072)., Conclusions: Preoperative serum CEA and CA19-9 levels may add useful information in patients with gastric carcinoma, and CEA level is a predictor of prognosis.

Hypothesis: This study was conducted to compare the effectiveness of two anti-adhesive barriers (Seprafilm and Interceed) for reducing adhesions after thyroidectomy in a rat model. The anti-adhesive barriers are suggested for use in repeated surgeries in general and the gynecologic fields in particular., Study Design: Controlled, randomized study., Methods: Twenty-eight male Wistar Albino rats that underwent right subtotal thyroidectomy were randomly assigned to three groups. One group received Seprafilm (n = 10), and the other received Interceed (n = 10) as anti-adhesive barriers. The third group was the control group (n = 8). At postoperative day 14, the rats were killed under general anesthesia, and the surgical fields were evaluated for the adhesion formation. The extent of the adhesion formation is scored from 0 (no adhesions) to 2 (fibrous adhesions that required sharp dissection). Histopathologically, chronic inflammation, histiocyte, fibroblast, fibrosis, collagen, vascularization, granuloma, giant cell, and fat necrosis were examined., Results: All the subjects in the control group, 7 of 10 in the Interceed group, and 4 of 10 in the Seprafilm group needed to be dissected bluntly or sharply. There was significant difference between the Seprafilm and the control group (P < .05) whereas there was no significant difference between the Interceed group and the control group (P > .05). When examined histopathologically, the criteria showing adhesion, such as fibrosis, fibroblast, and collagen were higher in the control group compared with the Seprafilm and Interceed groups. There was no significant difference between the Seprafilm and Interceed groups, whereas a significant difference was found between these two groups and the control group., Conclusion: This study suggests that both Seprafilm and Interceed decrease the incidence of posthyroidectomy adhesions in a rat model. Both agents showed no foreign body reaction.

The most common cause of a neck mass that increases in size on the Valsalva maneuver is laryngocele. Jugular phlebectasia is a congenital dilation of the jugular vein, which is extremely rare in adults, may present similarly. Duplication of the internal jugular vein (IJV), which is usually encountered coincidentally, is another rare anatomic variation. Isolated cases or cases associated with IJV ectasia have been reported. We report on an adult patient with coexisting external jugular phlebectasia and internal jugular duplication on the same side.

Background: Small cell lung cancer (SCLC) is a chemotherapy-responsive tumor type but most patients ultimately experience disease progression. SCLC is associated with alterations in the coagulation system. The present randomized clinical trial (RCT) was designed to determine whether addition of low-molecular-weight heparin (LMWH) to combination chemotherapy (CT) would improve SCLC outcome compared with CT alone., Methods: Combination CT consisted of cyclophosphamide, epirubicine and vincristine (CEV) given at 3-weekly intervals for six cycles. Eighty-four patients were randomized to receive either CT alone (n = 42) or CT plus LMWH (n = 42). LMWH consisted of dalteparin given at a dose of 5000 U once daily during the 18 weeks of CT. Results Overall tumor response rates were 42.5% with CT alone and 69.2% with CT plus LMWH (P = 0.07). Median progression-free survival was 6.0 months with CT alone and 10.0 months with CT plus LMWH (P = 0.01). Median overall survival was 8.0 months with CT alone and 13.0 months with CT plus LMWH (P = 0.01). Similar improvement in survival with LMWH treatment occurred in patients with both limited and extensive disease stages. The risk of death in the CT + LMWH group relative to that in the CT group was 0.56 (95% confidence interval 0.30, 0.86) (P = 0.012 by log rank test). Toxicity from the experimental treatment was minimal and there were no treatment-related deaths., Conclusions: These results support the concept that anticoagulants, and particularly LMWH, may improve clinical outcomes in SCLC. Further clinical trials of this relatively non-toxic treatment approach are indicated.

The purpose of this study was to evaluate the impact of granulocyte-colony stimulating factor (G-CSF) on the therapy for febrile neutropenia (FN). Our patient population differed significantly from those of previous studies as no patients received antimicrobial or CSF prophylaxis before randomization and all were solid tumor patients. When the diagnosis of FN was established, patients were started on intravenous meropenem 1 g every 8 hours and randomly assigned to receive G-CSF (5 microg/kg body weight per day subcutaneously) or not. Twenty-eight patients with 30 FN episodes received G-CSF and 25 patients with 30 FN episodes did not receive G-CSF according to randomization. The time to resolution of fever, recovery of neutrophil count over 1000/mm3, duration of hospitalization, need for erythrocyte and platelet transfusion and mortality rate were similar in both study groups. Side effects of therapy were mild. These results provide preliminary evidence that G-CSF administration, in addition to effective antibiotic therapy as treatment of febrile neutropenic patients with solid tumor, does not help improve infection-related morbidity and mortality.

High-grade gliomas are the most common primary brain tumors in adults. Twenty-seven patients with histopathologically proven anaplastic astrocytoma and glioblastoma multiforme were enrolled in this study from November 1998 to August 2002. Radiotherapy was administered after surgery and fotemustine (100 mg/m2) was sequentially administered every 3 weeks for 6 cycles. Overall, 111 cycles were administered to the 27 patients (median, 5 cycles; range, 1 to 6 cycles). Myelosuppression was mild to moderate. The median overall survival and progression free survival were 11+/-3.1 months (95%CI, 4.9-17.1) and 8+/-0.5 months (95%CI 7.1-8.9), respectively. One-year and two-year survivals were calculated at 48% and 7%, respectively. Significant prognostic factors (P<0.05) via univariate analysis were divided into two groups: completion of 6 cycles of chemotherapy versus incompletion of 6 cycles of chemotherapy. This trial demonstrates that postoperative radiotherapy and sequential fotemustine therapy is feasible, well tolerated, and may prolong survival in patients with newly diagnosed high-grade gliomas.

Background: Gastric and mucosal changes were studied when different synthetic materials were used for gastric banding., Methods: 60 Wistar-Albino rats (weight 200-250 g, age 12 weeks) were classified into 5 groups. Gastric banding was carried out with different materials: group 1 - polytetrafluoroethylene (PTFE), group 2 - polythylene (PE), group 3 - polypropylene (PP), group 4 - silicone; and group 5 - controls. Histopathological examination of proximal and distal gastric mucosa and esophagus were evaluated for foreign body reaction, lymphocytic infiltration, neutrophil infiltration, gastric wall invasion, and gastroesophageal reflux., Results: PE and PP caused a much more severe foreign body reaction that PTFE and silicone. Lymphocytic infiltration (chronic inflammation) was not significantly different between PP, PE, and PTFE, and was present in 80% of rats with these materials (P >0.05); in the silicone group, lymphocytic reaction was minimal. There was no neutrophilic infiltration in the silicone group (P =0.001), but this sign of acute inflammation was present in the other groups. However, the neutrophilic infiltration showed no difference between PE, PTFE and PP. PP, PE and PTFE migrated into the gastric wall at similar rates (no significant difference, P >0.05); in the silicone group, however, intragastric migration was not observed. With regard to gastroesophageal reflux, no significant difference was found between all the groups (P>0.05). In all groups, no histopathologic change was observed in the gastric mucosa proximal and distal to the bands., Conclusion: Silicone was the ideal material for banding, because it had good tissue adaptation and caused no inflammatory response.

Background: Adjustable gastric banding (AGB) is a minimally-invasive approach which allows adjustment of gastric restriction., Methods: The AGB was evaluated retrospectively in a consecutive series at 3 centers. From October 1998 to October 2001, 70 patients (49 women), mean age 34.3 years (18-59) with morbid obesity (preoperative mean BMI 45.2 kg/m(2)) underwent AGB The open approach was employed in the first 35 patients. Laparoscopic placement was used in the second 35 patients. Complete follow-up has been obtained in all patients., Results: Mean postoperative follow-up has been 18 months (12-39). Mean operative time was 120 minutes in the open approach and 150 minutes in the laparoscopic AGB. Mean hospital stay was 5 days after the open approach and 1.7 days after the laparoscopic surgery. The excess weight loss after 18 months was 59%. Incidence of early postoperative complications was 27.1%, including nausea and vomiting in 8 patients (5 in open approach, 3 in laparoscopic placement), wound infection in 10 patients (all 10 in open approach), and Wernicke's encephalopathy in 1 patient (open approach). Incidence of late complications was 28.5%, and included band migration in 2 patients (both by laparoscopic placement), pouch dilatation in 10 patients (6 in open approach, 4 in laparoscopic placement), incisional hernias in 4 patients (all by open approach), and port infections in 4 patients (all 4 in open approach)., Conclusion: AGB has been effective in achieving good weight loss to 3 years follow-up. The ability to adjust the degree of gastric restriction has enabled progressive weight loss.

Aim: In this study we determined the protective role of amifostine against the side effects of the combination of paclitaxel and carboplatin in patients with non-small cell lung cancer (NSCLC)., Patients and Methods: Chemo-naive patients with NSCLC were eligible. Thirty-eight patients were randomized to receive paclitaxel 175 mg/m2 and carboplatin AUC = 6 with amifostine 910 mg/m2 (group B) or chemotherapy alone (group A). The occurrences of hematologic, neurologic, cardiologic toxicities, and ototoxicity were evaluated., Results: All patients completed the six scheduled cycles of therapy. A total of 114 cycles of chemotherapy was given in both groups. Neutropenia grade 3-4 was observed in 11 cycles (9.6%) in group A and 19 cycles (16.6%) in group B (p = 0.16). Paresthesia grade 1 or 2 was observed in 18 of 19 patients of group A and in 8 of 19 patients of group B, following the sixth cycle of chemotherapy (p = 0.018). Two patients of group B and nine patients of group A suffered from sensory motor impairment grade 2 (p = 0.029). There was no clinical evidence in any patient for deterioration in cardiac function. Asymptomatic and transient sinus bradycardia or ventricular premature beats developed in four patients. None of the patients reported vertigo, tinnitus, or hearing loss., Conclusion: The addition of the amifostine to the combination of paclitaxel and carboplatin may prevent or reduce the incidence of neurotoxicity in the treatment of NSCLC. Amifostine does not appear to have a preventive role in neutropenia.

Purpose: This study was carried out to address the dilemma of managing incidentally associated squamous cell carcinoma of the head and neck and thyroid carcinoma., Materials and Methods: The patient group consists of 229 consecutive cases of squamous cell carcinoma of the head and neck and who were treated surgically at the Uludag University School of Medicine Department of Otolaryngology over a four-year period between 1997 and 2000., Results: Among these patients, 3 had additional thyroid papillary carcinoma metastases (1.3%, 3/229) within the surgical specimens of the surgical procedures performed for squamous cell carcinoma of the head and neck. Complementary thyroidectomy was recommended but could not be performed in one of three cases because of the patient's refusal, and the primary focus of thyroid carcinoma could be found in only one of these two cases who had undergone complementary thyroidectomy. All three patients received postoperative radioactive iodine and thyroid hormone suppression, and all are free of disease after 49, 46, and 19 months of follow-up, respectively., Conclusions: Management of thyroid carcinoma found incidentally during treatment of squamous cell carcinoma of the head and neck is still debatable, and all patients must be evaluated individually with regard to its benefit. Our limited experience suggests that total thyroidectomy may not be regarded as mandatory in managing these patients., (Copyright 2002, Elsevier Science (USA). All rights reserved.))

Objective: The study goal was to evaluate whether quantitative analysis of neck drainage contents is an important parameter of objective and early diagnosis of chylous fistula (CF) in the postoperative period., Study Design and Setting: We prospectively evaluated 103 consecutive neck dissections during a 2-year period at a tertiary academic referral center. Six of the patients (5.8%) had CF. The data obtained from the patients with CF were matched with normal data obtained from patients without CF., Results: A statistically significant difference was found between total drainage volumes of the patients with and those without CF (P < 0.05). In almost all patients with CF, drainage levels of triglycerides and cholesterol on postoperative day 1 were higher than serum levels. The difference between the drainage levels of triglycerides and cholesterol of the patients with and without CF was highly significant (P < 0.001)., Conclusions: Serum and drainage levels of triglycerides and cholesterol on postoperative day 1 can be used as objective and early predictive parameters of CF.

Recent studies suggested that the expression of P-Selectin on stored platelets is related to in vitro activation and loss of viability. We examined the effects of dimethylsulfoxide (DMSO) on in vitro function and P-Selectin expression of platelet concentrates. Fresh random-donor platelet units (n = 60) were divided into four equal groups. A DMSO-free group was chosen as a control. DMSO (0.5%, 1.0%, and 3.0%) was added to the other three groups. The samples were stored on a horizontal shaker at room temperature. Biochemical, morphological and platelet function tests and P-Selectin expression were monitored during storage. In all groups, P-Selectin expression, lactate and LDH levels, mean platelet volumes and PO2 increased but the aggregation response to agonist, the recovery response to hypotonic shock, platelet count, glucose level, pCO2, and HCO3 decreased during storage. In DMSO-containing groups, the P-Selectin expression which is a predictor of in vitro activation, was found significantly less often than in the DMSO-free group.

Granulocytic sarcoma is an extramedullary tumor associated with acute or chronic leukemias or myeloproliferative disorders. Rarely, the tumor may be seen before the diagnosis of leukemia. Symptomatic facial nerve paralysis and spinal cord invasion by granulocytic sarcomas are also relatively uncommon. We present here a 17-year-old-female patient who had facial nerve paralysis and paraplegia due to granulocytic sarcoma as the presenting symptoms of acute myeloid leukemia.

Purpose: This study was planned with 2 goals in mind: to evaluate the efficacy of prolonged and 1-day antibiotic regimens for prophylaxis and to evaluate the effect of various factors such as neck dissection, localization and stage of tumor, type of laryngectomy, and history of prior radiotherapy, tracheotomy, and diabetes mellitus on postoperative wound infection rates., Methods and Material: In this study, 408 head and neck procedures (201 clean and 207 clean-contaminated) performed at our institution were retrospectively reviewed., Results: Prolonged and 1-day antibiotic regimens for both clean and clean-contaminated procedures were similar in efficacy (7% vs 3% for clean procedures [P = 0.165] and 30% vs 28% for clean-contaminated procedures [P = 0.777]). The wound infection rate was higher (13%) after clean radical neck dissections versus other clean procedures (1%) (P = 0.001). For clean-contaminated procedures, factors affecting postoperative wound infection rates were performance of bilateral neck dissections (P = 0.014), disease stage (P = 0.002), type of laryngectomy (P = 0.002), and history of prior tracheotomy (P = 0.006).

Background: Wernicke's encephalopathy is an uncommon complication seen after morbid obesity surgery. Neurological and cardiac symptoms can occur. Early and adequate replacement of thiamin is crucial., Methods: A patient, who was operated by adjustable silicone gastric banding had severe vomiting 1 week after the operation. Physical examination showed no abnormalities except neurological signs consisting of ataxia, disorientation and diplopia. All radiological and biochemical parameters were in the normal range., Result: After replacement of vitamin B1 (thiamin) intravenously 20 mg twice daily, all the neurological signs regressed day by day. Oral thiamin pills have been continued., Conclusion: Wernicke's encephalopathy which occurs as a result of thiamin deficiency is a rare complication that has serious morbidity with rapidly progressing neurologic symptoms, and must be treated immediately. Surgeons who treat morbidly obese patients must follow the metabolic and nutritional status of the patient.

To detect the effect of the stem cell source, allogeneic peripheral blood stem cell transplantations (alloPBSCTs) performed between 1995 and 1997 from human leukocyte antigen (HLA)-identical siblings in 40 patients with acute and chronic hematological disorders were compared with a historical group of 40 patients with similar variables who had received allogeneic bone marrow transplants (alloBMTs) between 1993 and 1995. Patients in both groups were identical except that both the recipient and the donor ages were, on average, higher in the alloPBSCT group (26 vs. 36 [p = 0.005] and 27 vs. 32 [p = 0.024], respectively). Patients received similar therapy excluding posttransplant granulocyte colony-stimulating factor administration (97% in alloBMT vs. 12.5% in alloPBSCT). The median time to reach neutrophil counts >0.5 x 10(9)/L and platelet counts >20 x 10(9)/L was 13 and 14 days, respectively, in patients receiving alloPBSCTs compared with 19 and 27 days in patients receiving alloBMTs (p = 0.0014 and p = 0.0002). The alloPBSCT group required similar transfusions of red blood cells or platelets. The incidence of grade II-IV acute graft-vs.-host disease (aGVHD) was similar in both groups. However, chronic GVHD (cGVHD) of all grades developed in 78.1% of patients in the alloPBSCT group after a median follow-up period of 12.5 (range 0.5-34) months. In alloBMT recipients, cGVHD of all grades developed in 21.4% after a median follow-up period of 38 (range 0.5-62) months (p = 0.00001). Day 100 transplant-related mortality was also similar: 20% (8 of 40) in the alloBMT patients and 17.5% (7 of 40) in the alloPBSCT group. Although not statistically significant, a relatively higher relapse rate occurred in the alloBMT group (21.4 vs. 10.7%). The estimated disease-free survival in month 24 was 51.3% for alloBMT and 54.6% for alloPBSCT, and the estimated overall survival in month 24 was 56.1% for alloBMT and 64.6% for alloPBSCT. In conclusion, this retrospective comparison suggests that alloPBSCT from HLA-identical donors is associated with faster engraftment, fewer transfusions, and no greater incidence of aGVHD, but a high incidence of cGVHD.

The anatomic distribution of laryngeal cancer (LC) among the compartments of the larynx shows geographic variations. In the U.S., glottic cancers are more frequently seen, whereas most cases in the Mediterranean countries are supraglottic. We reviewed the anatomic sites of involvement in patients with laryngeal cancer seen in our clinic and at eight other university clinics between 1990 and 1994. The majority of cases were supraglottic cancers, accounting for 60% of all laryngeal tumors.

Lip, oral cavity, and oropharyngeal cancer are among the most common forms of the disease in the world. These types of cancer display significant geographic, ethnic, and socioeconomic variations. We examined the cases of cancer of the lip, oral cavity, and oropharynx diagnosed in the Department of Otolaryngology at the University of Uludağ School of Medicine during the last 5 years, July 1990 to June 1995, and recorded the epidemiological features of these tumors. The Department of Otolaryngology treated a total of 26,225 in- and outpatients during the 5-year period. 320 of these patients (1.2%) were seen for head and neck cancer. 42 of the 320 patients (13.1%) were diagnosed with cancer of the lip, oral cavity, and oropharrynx. After the larynx, this was the second most frequent location of malignant head and neck tumors. We discovered the following epidemiological and pathological features: (1) The incident rate was highest in patients between 41 and 60 years of age. (2) 70% of the patients were male, and 76% of them had a history of tobacco/alcohol use. (3) Occupation had no apparent relevance (four of the patients were farmers). (4) Approximately one third of the patients had undergone medical therapy prior to diagnosis. (5) One third of the patients had initially seen a dentist for treatment, and approximately half had poor dental and oral hygiene. (6) The most frequent symptom was ulceration. (7) Histopathological examination revealed squamous cell carcinoma in 88% of the cases. (8) The cancer was localized to the lip in 31% of cases, oral cavity, 50%, and oropharynx, 19%. (9) Almost half of the cancer cases were diagnosed in advanced stage (stages III and IV).

A case of primary fibrosarcoma of the heart, which was diagnosed in a 17 year old man, is presented. Extensive tumour resection and postoperative radiation therapy was carried out. The patient is alive after 18 months after the operation. Although these tumours are associated with very poor survival, early diagnosis and combined therapy may prolong life expectancy.