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Background: Duodenal injuries, due to their retroperitoneal location, are a diagnostic challenge to the surgeon; for this reason, they are identified in a late stage, and thus associated with increased morbidity and mortality. The diagnosis of duodenal injury requires a high level of suspicion. Delayed diagnosis and management of these injuries results in increased morbidity and mortality rates. It must be remembered that the retroperitoneal location of the duodenum usually precludes early detection of injury by physical examination, which is characterised by minimal findings. Signs of defence, abdominal rigidity and absence of bowel sounds indicate intra-abdominal injury and lead to a surgical procedure. There are many different surgical procedures based on injury complexity, one of which is the tube duodenostomy technique. Despite the advances in surgical technique, duodenal lesions are still associated with high morbidity and mortality rates. Purpose: The purpose of this presentation is to describe a new surgical technique in the management of duodenal injuries. Surgical Technique: The technique was performed on a patient, presented with Crohn’s disease together with intestinal tuberculosis, in the management of duodenal injury secondary to duodenocolic fistula and abscess during the postoperative follow-up. The patient was operated on due to invagination, intra-abdominal abscess and general condition deterioration. The second operation was performed because of contrast extravasation from the duodenum. Especially the third part of the technique, application of negative pressure through a tube enterostomy in order to prevent the accumulation of secretions and pressure increase in the duodenum, minimized the intra-duodenal pressure and decreased the risk of anastomotic dehiscence and fistula formation (Figure 1). For this purpose, continuous negative aspiration was performed with an aspiration cannula extended through the enterostomy tube during the first 14 days. The patient was recovered without any complications. Conclusion: The authors concluded that this new technique of “pyloric exclusion, the repair of the mucosal layer of the primary wound in the duodenum with a stapler and of serosa with vicryl, minimizing intra-duodenal pressure by applying negative pressure with the enterostomy tube” can be considered to be an alternative solution for duodenal injuries.

Introduction This study aimed to reveal the utility of age-platelet (AP) index and aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), which are non-invasive markers, in patients with chronic Hepatitis C virus (HCV) infection in prediction of fibrosis and evaluate whether viral markers could be used for that purpose or not. Methods A total of treatment-naïve 49 patients with chronic HCV who underwent liver biopsy were included in this retrospective study. Anti-HCV S/CO and HCV-RNA viral load (copy/ml) values measured simultaneously with biopsy were determined. AP index and AAR score were calculated and compared. Results Staging of liver biopsy samples of 49 HCV patients was assessed. Comparable diagnostic accuracies of AP index and AAR in prediction of significant fibrosis (F≥2) were showed with ROC curve analysis. The areas under the ROC (AUROCs) were 0.713 and 0.506 respectively. Diagnostic accuracy of API in prediction of significant fibrosis was superior to that of AAR (p=0.03). AUROC of HCV-RNA viral load in prediction of F≥2 was 0.531. Anti-HCV S/CO value (AUROC=0.464) was not found as a suitable marker in prediction of fibrosis. Conclusions AP index, AAR score and HCV viral load among non-invasive markers assessed in this study were useful in predicting significant fibrosis. Especially API was the most useful test in predicting significant fibrosis. AP index can be preferred in patients with near normal ALT values.

Background and Aims: Despite the known risk factors, it is not clear why the same treatment protocol for Helicobacter pylori infection (H. pylori) doesnot show a similar effect in patients with common risk factors. We hypothesized that as the severity of H. pylori - induced gastric mucosa inflammation and density increase, the rate of successful treatment decreases. This study aimed to explore the existence of a possible association between gastric H. pylori colonization density and the efficacy of bismuth-containing quadruple eradication therapy. Methods: A total of 330 patients with H. pylori positive gastritis were initially included; the diagnosis was based on the histopathological examination. H. pylori colonization density was graded according to the Sydney classification: mild (n=101), moderate (104) and severe (98). H. pylori eradication was determined via the 13C-Urea breath test performed eight weeks after therapy. Results: There was no significant difference in terms of the distributions of age, gender, alcohol consumption, and smoking status among the groups (p>0.05). The successful eradication rates of H. pylori were 87.1%, 78.8%, and 75.5%, respectively, for the mild, moderate, and severe H. pylori colonization groups by per-protocol analysis (p=0.038). The eradication rates of H. pylori were 81.5%, 73.2%, and 67.3% respectively, for the mild, moderate, and severe H. pylori colonization groups by intention-to-treat analysis (p=0.017). Conclusions: Helicobacter pylori colonization severity might predict the usefulness of eradication therapy in pre-treatment assessment. We recommend the use of more effective therapy regimens for H. pylori eradication in patients with severe densities.

Giriş ve Amaç: Karaciğer fibrozunu değerlendirmek için birçok invaziv olmayan biyokimyasal indeksler geliştirilmiştir. Bu çalışmada allbümin-bilirübin skorunun kronik hepatit C virüs enfeksiyonunda gelişen karaciğer fibrozunun tahmininde karaciğer biyopsisine alternatif bir tanı yöntemi olup olamayacağının değerlendirilmesi ve diğer biyokimyasal belirteçler olan fibrozis-4 ve aspartat aminotransferaz/trombosit oran indeksi ile karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Yaş aralığı 20 ile 82 arasında değişen, karaciğer biyopsisi yapılmış, 27’si erkek ve 11’i kadın toplam 38 kronik hepatit C virüs enfeksiyonlu hasta değerlendirildi. Albümin-bilirübin, fibrozis-4 ve aspartat aminotransferaz/trombosit oran indeks skorları hesaplandı. Albümin-bilirübin skorunun fibrozis evre >2 ve >4’ü ayırt etme yeteneği ROC analizi ile değerlendirildi ve fibrozis-4 ve aspartat aminotransferaz/trombosit oran indeks skoru ile karşılaştırıldı. Bulgular: Albümin-bilirübin skorunun fibrozis evre >2 ve fibrozis evre ≥4 tanısı için ROC eğrisi altında kalan alan sırasıyla 0.767 (95% Cl: 0.564-0.969) ve 0.956 (95% Cl: 0.889-1.000) bulunurken, fibrozis-4 için 0.863 (95% Cl: 0.714-1.000) ve 0.926 (95% Cl: 0.833-1.000), aspartat aminotransferaz/ trombosit oran indeks skoru için 0.667 (95% Cl: 0.450-0.884) ve 0.640 (95% Cl: 0.378-0.901) idi. Sonuç: Bulgulara göre albümin-bilirübin skorunun fibrozis evre >2 ve ileri karaciğer fibrozunu (fibrozis evre >4) tahmin edebileceği değerlendirilmiştir. Albümin-bilirübin skorunun fibrozis tahminindeki performansı, aspartat aminotransferaz/trombosit oran indeks skoru ve fibrozis-4 ile karşılaştırıldığında sonuçların benzer olduğu ancak fibrozis evre >2 tahmininde fibrozis-4’ün, fibrozis evre ≥4’de ise aspartat aminotransferaz/ trombosit oran indeks skorunun daha güvenilir sonuç verdiği değerlendirilmiştir.

Bu çalışma, rektum kanserli hastalarda neoadjuvan kemoradyoterapinin (nKRT) evre gerilemesine ve sfinkter koruyucu cerrahiye olan etkisini ortaya koymak amacıyla yapılmıştır. Neoadjuvan kemoradyoterapi uygulanan distal rektum kanseri olan hastalar çalışmaya alınmıştır. Hastaların verileri retrospektif olarak taranarak özel olarak hazırlanmış veritabanına kaydedilmiştir. Hastalara uygulanan neoadjuvan tedavi protokolleri, neoadjuvan tedaviye bağlı tümör boyutunda küçülme ve evre gerilemesi oranları ile sfinkter koruyucu cerrahi (SKC) oranları belirlenerek literatür eşliğinde değerlendirme yapılmıştır. Alt ve orta rektum kanseri nedeniyle nKRT uygulanan 88 hasta çalışmaya alınmıştır. Hastaların yaş ortalaması 57.6 (21-78), kadın erkek oranı 3/5’di. Neoadjuvan tedavi sonrası ortalama bekleme süresi 6.5 (4-8) haftaydı. Downsizing, downstaging ve sfinkter korunma oranları sırasıyla %80.7, %65.9, %63.6 (alt rektum için %32.5, orta rektum için %89.6) olarak değerlendirildi. Neoadjuvan tedaviye bağlı dört hastada patolojik tam yanıt (pTY) alınmıştı. Hastalardan 47’sine aşağı anterior rezeksiyon, sekizine çok aşağı anterior rezeksiyon ve bir hastaya intersfinkterik rezeksiyon uygulanmıştı. SKC uygulanan 5 hastada ileri derecede inkontinans olduğu (wexner skoru ≥ 9) ve genel olarak hastalarının yaşam kalitesinin bozulmadığı değerlendirildi. Sonuç olarak neoadjuvan tedavi sonrası ‘’downsizing’’ ’’downstaging’’ oranları ve SKC oranlarının literatürle uyumlu olduğu değerlendirildi. Yine literatürde de belirtildiği gibi SKC oranları üzerindeki en etkili faktörler; tümörün seviyesi, anal sfinkter mekanizması ile ilişkisi ve cerrahın tutumu olarak değerlendirildi., This study was conducted to reveal the effect of neoadjuant chemoradiotherapy to down-staging and sphincter sparing surgery in rectal cancer. Patients with lower and middle rectum cancer undergoing neoadjuvant chemoradiotherapy were included in the study. The data of the patients were collected retrospectively and recorded in a database. Neoadjuvant treatment protocols applied to the patients, downsizing, downstagings and sphincter sparing surgery rates were determined and evaluation was made in the light of the literature. 88 patients who received neoadjuvant chemoradiotherapy for lower and middle rectal cancer were included in the study. The mean age of the patients was 57.6 (21-78) years, and the ratio of women to men was 3/5. The mean waiting time after neoadjuvant therapy was 6.5 (4-8) weeks. Downsizing, downstaging and sphincter sparing rates were 80.7%, 65.9%, 63.6% (32.5% for the lower rectum, 89.6% for the middle rectum) respectively. The pathological complete response was obtained in four patients. Eight of the patients had undergone very low anterior anterior resection, 47 had low anterior resection and 1 patient had intersphincteric resection. It was evaluated that, 5 patients who underwent sphincter sparing surgery had advanced incontinence score (wexner≥9) and their quality of life was generally not impaired. As a result, the rates of downsizing, downstaging and sphincter-sparing surgery rates after neoadjuvant therapy were evaluated to be compatible with the literature. As stated in the literature, the most effective factors on sphincter sparing surgery rates are; the location of the tumor, its relation with the anal sphincter mechanism and the surgeon's attitude.

Giriş ve Amaç: Kolorektal premalign lezyonların en önemlisi poliplerdir. Poliplerin histopatolojisi ve boyutlarına göre malignite riski değişmektedir. Ayrıca mide mukozasında displazi, atrofi, intestinal metaplazi, polip ve Helicobacter pylori gibi faktörler de mide için prekanseröz durumlardır. Çalışmamızın amacı; kolorektal poliplerin yerleşimi, boyutu, sayısı ve patolojisi ile midenin premalign lezyonları arasındaki ilişkiyi ortaya koymaktır.Gereç ve Yöntem: Çalışmamız Ekim 2016 ile Ekim 2019 tarihleri arasında 18 yaş ve üzeri hastalara aynı gün yapılan özofagogastroduodenoskopi ve kolonoskopi verilerinin değerlendirildiği retrospektif bir çalışmadır. İnflamatuvar barsak hastalığı olan, mide kanseri ve kolorektal kanser tanısı alan, mide biyopsisi alınmayan, barsak temizliği yetersiz olan ve işlemi tamamlayamayan hastalar çalışmaya dahil edilmemiştir.Bulgular: İki yüz elli yedi hastanın %58.0’i erkek ve %80.9’u 50 yaşın üzerindeydi. Kolorektal poliplerin çoğunluğu distal yerleşimliydi (%59.1). İleri adenomatöz polip (İAP) sıklığı %24.9 olup ileri adenomatöz polip varlığı ile 50 yaş altı ve üzeri hastalar arasında ve cinsiyete göre istatistiksel fark yoktu (p: 0.659 ve p: 0.747). Helicobacter pylori, atrofi, intestinal metaplazi, displazi ve polip gibi midenin premalign lezyonları ile ileri adenomatöz polip arasında istatistiksel olarak anlamlı bir ilişki gözlenmedi (p: 0.301 ). Sonuç: Kolorektal poliplerin yeri, sayısı ve ileri adenomatöz polip ile premalign mide lezyonları arasında ilişki saptanmamıştır., Background and Aims: Polyps are the most important premalignant colorectal lesions. The risk for malignancy with polyps differs with its histopathology and size. Moreover, factors in the gastric mucosa such as dysplasia, atrophy, intestinal metaplasia, polyp, and Helicobacter pylori are precancerous conditions for the stomach. In this study, we studied the relationship between the location, size, number, and pathology of colorectal polyps and premalignant gastric lesions. Material and Methods: This was a retrospective study that analyzed the data of patients of age ≥18 years who underwent esophagogastroduodenoscopy and colonoscopy on the same day between October 2016 and October 2019. Patients with a history of an inflammatory bowel disease, diagnosis of gastric cancer and colorectal cancer, those who did not undergo gastric biopsy, and those in whom sufficient colonic irrigation was not performed and who could not complete the procedure were excluded from the study. Results: Of the 257 patients, 58% were men and 80.9% were >50 years of age. The location of the majority of colorectal polyps was distal (59.1%). The incidence of Advanced Adenomatous Polyp was 24.9%, with no statistical difference in the presence of Advanced Adenomatous Polyp between the ages younger and older than 50 years according to their gender (p=0.659 and p=0.747). No statistically significant relationship was observed between Advanced Adenomatous Polyp and premalignant gastric lesions, such as Helicobacter pylori, atrophy, intestinal metaplasia, dysplasia, and polyp (p=0.301). Conclusions: No relationship was observed among the location, number, and Advanced Adenomatous Polyp rate of colorectal polyps and premalignant gastric lesions.Keywords: , ,

Anastomotic leaks following intestinal operations may cause devastating effects on patients. Ischemia may also occur at the intestinal walls in the presence of strangulations. In this study, we examined the effects of human recombinant (Hr)-epidermal growth factor (EGF) given at a single intramural dose into the intestinal walls and daily intraperitoneal cavity on ischemia and the healing process of anastomosis.Sixteen male New Zeland white rabbits were randomly divided into four groups (n = 4 in each group). In Group 1, two different segments of ileum were identified and, then, transected and the free ends were sutured each other. In the other groups, ischemia was induced by ligating the mesenteric vascular arcade. After the ischemic induction, Group 2 received intramural injections of %0.9 saline, Group 3 received intramural injections of a single dose of EGF, and Group 4 received intramural and intraperitoneal injections of EGF. Bursting pressures and tissue hydroxyproline levels were analyzed. Necrosis, fibroblastic activity, collagen deposition and neovascularization were also studied.The mean levels of bursting pressures in Group 4 (148.6 ± 25.3 mmHg) were higher than Group 2 (70 ± 21.5 mmHg) (p = 0.001). The mean level of bursting pressures was not statistically significant between Group 1 (170.1 ± 35 mmHg) and Group 4 (p = 0.073). Hydroxyproline levels in Group 2 were lower than Groups 3 and 4. There was a statistically significant difference in the mucosal ischemia, mucosal healing and degree of adhesion, but not in the mural anastomotic healing among the groups.Intramural injection with daily intraperitoneal administration of low-dose EGF enhances the bursting pressure and collagen accumulation in ischemic anastomosis, improving many histological variables associated with ischemic intestinal anastomosis.

Objectives: To analyze the indications and types of eye removals at a military tertiary care hospital in Turkey. Methods: The medical records (age, gender, affected eye, type of surgical procedure, indications of surgery) of 123 patients who underwent evisceration and enucleation in the course of a 15-year period (January 2000 to December 2014) at Gulhane Military Medical Academy, Ankara, Turkey were reviewed retrospectively. Results: The mean age was 35.61±18.52 (range 3-80 years). The number of male in the patient group was 92 (74.8%) and female was 31 (25.2%). Patients who underwent evisceration were 95 (77.2%), whereas 28 (22.8%) of them underwent enucleation. The mean age of the eviscerated patients was 30.63±13.08, whereas the mean age of the enucleated patients was 52.50±23.92 ( p less than 0.001). The leading indications for eye amputations were trauma (n=62, 50.4%), malignancy (n=20, 16.3%), painful blind eye and absolute glaucoma (n=20, 16.3%), endophthalmitis (n=12, 9.7%), and phthisis bulbi, and cosmetic reasons (n=9, 7.3%). Conclusion: Trauma was the most common etiology for evisceration, and malignancy was the most common etiology for enucleation. Using protective eyewear and early detection of intraocular malignancy and glaucoma through routine ophthalmic examinations are essential for providing non-invasive treatment modalities instead of eye removal. Saudi Med J 2015; Vol. 36 (10): 1205-1209 doi: 10.15537/smj.2015.10.12031

Purpose: Ocular siderosis is a rare sight-threatening complication that occurs after a penetrating ocular injury by an iron-containing foreign body. The purposes of this study were to (i) investigate the histopathology, electrophysiology and iron levels/accumulation in ocular siderosis using an animal (Guinea pig) model and (ii) determine the appropriate timing for follow-up foreign body-removal surgery. Materials and methods: Thirty guinea pigs were divided into five groups (n = 6 animals/group). On day-1, an iron body was inserted into the vitreous of the right eye of all animals; the left eyes were left undisturbed and were used as controls. At the end of each week during the 5-week study period, electroretinography (ERG) was performed on all animals in one of the five groups. Each animal in that group was sacrificed, after which both eyes were enucleated for histopathological and pharmacological evaluation of intraocular iron. Results: Accumulated iron levels of study eyes were significantly higher than those of control eyes (135.13 and 13.55mg/g, respectively, p50.01). In addition, there was a significant decrease in electrophysiological responses of study eyes. During the first week, iron levels were higher in study eyes than control eyes, but neither histological iron accumulation nor decreased electrophysiological responses could be detected. By the end of the second week, increased iron accumulation was observed histologically in intraocular tissues, along with signs of retinal toxicity, as verified by decreased electrophysiological responses. Conclusions: The present study indicates that the 14th day after a penetrating eye injury by an iron-containing intraocular foreign body represents a clinically critical threshold, after which structural damage to and functional alterations in ocular tissues occur.

Objective To compare the barbed polyglyconate suture (BPS) with 2 commonly used conventional sutures, this prospective randomized trial was designed. The sutures applied in the urinary collecting system, in terms of long-term histopathologic and macroscopic suture material features. Materials and Methods Eight female and 6 male New Zealand rabbits were included in the study. Each animal served as its own control and was subjected to cystotomy. Watertight running cystorrhaphies were performed using 3 different sutures in a randomized fashion, namely Monocryl, Vicryl, and V-Loc 90. Seven animals were sacrificed after the third and 7 after the sixth week. Macroscopic and histopathologic examinations were performed. Tissue reaction, like inflammation and fibrosis, around the sutures were evaluated. Friedman and Wilcoxon signed ranks test was used for the statistical analysis. Results The BPS demonstrated no adhesion. However, in the six-week group, stone formation was recorded on 4 BPS and 1 Vicryl thread, a difference being statistically significant (P = .039). Additionally, in the third- and in the sixth-week group, 1 (P = .368) and 3 (P = .050) BPS threads migrated, respectively. The histopathologic analysis revealed less inflammation and fibrosis associated with the BPS thread in both the third and the sixth-week groups (P = .010 and P = .002, respectively). Conclusion The BPS appears to be superior to conventional sutures in terms of local inflammation and fibrosis. However, suture migration and stone formation following collecting system closure could be potential predicaments.

Background: The effect of the timing of the second laparotomy on wound healing is not clear. In an experimental study in rats, we aimed to investigate the effect of timing on wound healing after reoperations on the same surgical site. Material and methods: Forty-eight rats were divided into four groups. The control group (GC) didn't have another laparotomy whereas the relaparotomies on the same surgical site were performed either on the 3rd, 15th or the 30th postoperative days in the three study groups (G3, G15, G30 respectively). The midline tension pressure, collagen types I, III and, histological analysis were performed from the specimens in order to assess the wound healing and strength. Results: The tensile strength was the highest in GC and decreased gradually in G3, G15 and G30, the difference between the groups did not reach statistical significance. Higher collagen levels, increased fibrosis, and large defects were observed in relaparotomy groups than CG. The musculoaponeurotic gap was shortest in GC when compared to other three relaparotomy groups (P

Background/aims: The normal oral mucosa is usually tolerant to its special microenvironment. Epithelial integrity and a well- managed immune system are important in sustaining harmony. A close look at the role played by adaptive immunity during recur- rent aphthous ulcerations may throw some light into the pathogenesis. Materials and Methods: In this report, we provide a con- cise review of oral epithelial barrier function and present data on the possible pathogenetic mechanism of aphthous ulceration using immunohistocemical signs of nuclear factor kappa beta pathway activation on fourteen cases of mucosal aphthous ulcerations. Re- sults: We strongly support the hypothesis that oral aphthous ulcerations develop as a result of loss of epithelial barrier function and that nuclear factor kappa beta signaling pathway seems to be involved in this type of injury. Conclusion: Interventions that streng- then the mucosal barrier function or modulate inappropriate activation of nuclear factor kappa beta signaling pathway can be con- sidered in the treatment of oral aphthous ulcerations.

Purpose: Glaucoma filtration surgery remains the most effective surgical procedure for lowering intraocular pressure (IOP) in uncontrolled glaucoma. Modulation of wound healing is critical to ensure long-term surgical success. This study aimed to determine if bevacizumab is an alternative agent for wound modulation in glaucoma surgery. Materials and methods: Forty-eight eyes of New Zealand rabbits were divided into four groups undergoing standard trabeculectomy surgery in the right eye. In group 1, balanced salt solution injections (0.1 ml) were performed into the bleb. Bevacizumab (0.1 ml, 1.25 mg) was injected into the bleb in group two and into the vitreous body in group three. Subconjunctival injections of 5-fluorouracil (5-FU) were performed into the nonbleb area in group four. Postoperatively; IOP, bleb size, bleb height, bleb vascularity were evaluated. Right eyes of two animals from each group were enucleated in 10th, 20th and 30th d postoperatively and evaluated histopathologically for inflammation, neovascularization and fibrosis. Results: The length, the width and the height of the bleb in the group two were greater than other groups. Mean IOP values were lower in group two. IOP measurements in the operated eyes of group two were statistically significantly lower than the other groups until the 28th d. Inflammation (p = 0.030), neovascularization (p = 0.004) and fibrosis (p50.000) in group two were lower in histopathological evaluation. Conclusions: Post-operative subconjunctival injection of bevacizumab is more effective than intravitreal bevacizumab or subconjunctival 5-FU injections for bleb survival. Furthermore, IOP is lower for a long period with lower level of fibrosis, which increases the success of trabeculectomy.

Background A number of different therapies, including endoscopic resection, have been suggested for the treatment of Type 1 gastric neuroendocrine tumors (NETs). The current study aimed to determine the long-term efficacy of endoscopic resection for Type 1 gastric NETs. Methods Twenty-two patients (from 1999 to 2012) with Type 1 gastric NETs were included in the study. All patients were treated with endoscopic resection and received regular followed-up appointments at a tertiary referral center. Results All patients were initially diagnosed with hypergastrinemia, atrophic gastritis and intestinal metaplasia. Polyps' diameters were >1 cm in 4 patients, and between 0.5 and 1 cm in 18 patients. All detectable lesions were successfully resected. One patient required surgery due to gastric perforation during endoscopic mucosal resection. Recurrence was detected in four patients (18%) and endoscopic resection was performed again. Local or distant metastasis was not observed in any patient during follow-up. Median follow-up time was 7 years, with a maximum of 14 years. Seventeen patients (78%) completed a 5-year follow-up period, and overall disease-free survival rate was 100%. Conclusions Long-term follow-ups with 22 patients suggest that endoscopic resection of Type 1 gastric NETs is a safe and effective treatment option with a relatively low recurrence rate. J. Surg. Oncol. 2014 109:71–74. © 2013 Wiley Periodicals, Inc.

Background Mutations in the KRAS gene occur at an early stage in the development of colorectal carcinoma. Importantly, KRAS mutation predicts resistance to anti-epidermal growth factor receptor therapy in stage IV disease. Goals The aim of the current study is to correlate histologic features of colon cancer with the presence of KRAS mutations. Study Tumor tissue from 145 colon cancer resections was tested for KRAS mutations. KRAS mutation status was correlated with demographic and histologic characteristics. Statistical analysis was performed using the Pearson χ2 test and multivariate analysis. Results KRAS mutations were present in 55/145 cases (37.9%), consistent with reported rates. KRAS mutations were significantly associated with usual adenocarcinoma morphology (multivariate P=0.014), peritumoral lymphocytic response (χ2, P=0.028; multivariate P=0.017), T3-T4 status (χ2, P=0.012; multivariate P=0.015), right-sided location (multivariate P=0.027), absence of lymphovascular invasion (multivariate P=0.008), and metastases at the time of resection (multivariate P=0.034). No association was found between KRAS mutation status and other factors. Conclusions Specific morphologic features in colon cancer suggest a higher likelihood of the presence of KRAS mutations. These morphologic features overlap partially with those associated with DNA mismatch repair gene mutations. If confirmed, these results may suggest a paradigm for directed KRAS testing.

Fat necrosis (FN) of the breast is a benign nonsuppurative inflammatory process of the adipose tissue. The radiologic appearance ranges from benign to suspicious for malignancy; therefore, it is very important to know the distinguishing radiologic features of FN on different modalities. Mammography is more helpful in identifying FN than ultrasonography in most of the cases, and MRI may also be used to rule out malignancy as an adjunct to mammography and sonography. Even when modern diagnostic modalities are used, biopsy may still be unavoidable for some cases. In conclusion, an accurate history and familiarity with the radiologic findings are crucial to recognizing FN and avoiding unnecessary interventions.

Summary Background Anastomosis with tissue adhesives is an alternative method for conventional anastomosis. However, this method has several technical challenges. It requires the use of suture to prevent leakage into lumen and precise application onto all surfaces of the anastomosis site. To solve these problems, poloxamer 407 (P 407) was previously used as a stent. In this study, we made heparinized P 407 (h-P 407) as a new formula. We aimed to successfully use h-P 407 as a stent in sutureless anastomosis in a rat abdominal aorta model. Methods Sixty Sprague–Dawley rats were used. In the first group, end-to-end anastomoses were performed with suture; in the second and third groups, sutureless anastomoses were performed with 2-octyl cyanoacrylate. As an intraluminal stent, P 407 was used in the second group, and h-P 407 was used in the third group. Anastomosis time was measured. Lumen width, intimal hyperplasia, and foreign body reaction were assessed histologically. Velocity flow rates and vessel diameters were measured radiologically. Burst strength was measured, and the results were statistically evaluated. Results Sutureless anastomosis was more rapid than conventional anastomosis. Lumen width was narrower in the suture group. Inflammation and foreign body reaction were more severe in the suture group. There was no radiologic and biomechanical difference between the groups. We found that intimal hyperplasia was less in h-P 407 than in P 407. Conclusion h-P407 can be successfully used as an intraluminal stent for sutureless microvascular anastomosis with tissue adhesives.

Prevention of secondary infection is currently the main goal of treatment for acute necrotizing pancreatitis. Colon was considered as the main origin of secondary infection. Our aim was to investigate whether prophylactic total colectomy would reduce the rate of bacterial translocation and infection of pancreatic necrosis. Forty-two Sprague–Dawley rats were used. Pancreatitis was created by ductal infusion of sodium taurocholate. Rats were divided into four groups: group-1, laparotomy + pancreatic ductal infusion of saline; group-2, laparotomy + pancreatic ductal infusion of sodium taurocholate; group-3, total colectomy + pancreatic ductal infusion of saline; and group-4, total colectomy + pancreatic ductal infusion of sodium taurocholate. Forty-eight hours later, tissue and blood samples were collected for microbiological and histopathological analysis. Total colectomy caused small bowel bacterial overgrowth with gram-negative and gram-positive microorganisms. Bacterial count of gram-negative rods in the small intestine and pancreatic tissue in rats with colectomy and acute pancreatitis were significantly higher than in rats with acute pancreatitis only (group-2 versus group-4; small bowel, p =

Juvenile hyaline fibromatosis (JHF) is a rare autosomal-recessive hereditary disease, characterized by gingival hypertrophy, flexion contractures of joints, bone lesions, hyaline deposition in the extracellular spaces of the dermis and soft tissues, stunted growth, and skin lesions such as multiple nodules, tumors and pink, pearly papules. No case of JHF with a mandibular bone involvement, exists in the literature. Bone involvement in JHF is an uncommon finding and distinct solitary lesions in the calvarial bones has been reported by some authors. A 21-year-old male patient was referred to Diyarbakir Military Hospital, Department of Dental Service. Clinical findings were consistent with a solid alveolar mass in the right mandibular premolar-molar region and displaced right mandibular molar teeth. Orthopantomographic examination showed impaction of all lower right molars in a mixed radioopaque/radiolucent area. Microscopically, increased nodular connective tissue was seen under the lobulated mucosal surfaces of the resected area. The case presented here had a localized fibrous proliferation that infiltrated bone trabeculae and caused displacement of teeth. Juvenile hyaline fibromatosis should be considered in the differential diagnosis with the other intraosseous radiolucent-patchy opaque lesions of jaw bones. Based on the clinical and histopathological findings, a diagnosis of JHF was made.

Fascin is a -55 kDa-actin binding protein. Actin bundles rearranged by fascin proteins are concentrated in cell membrane protrusions and these protrusions provide motility of the cell. In this study, we evaluated fascin expression in glial tumors and its relation with histologic grade. Its prognostic value in glioblastomas (GBs) was also investigated. Seventy-six glial tumors including 44 glioblastomas with known survival time, 18 anaplastic astocytomas (AAs), six diffuse astrocytomas (DAs), and eight pilocytic astrocytomas (PAs) were examined immunohistochemically for fascin expression. Fascin was observed in the neurons of normal brain tissue and endothelium of vascular spaces in the glial tumors. Fascin expression was correlated with histologic grade in DAs. PAs expressed low levels of fascin. Half of the GBs showed high levels of fascin expression. In the GB group, overall survival was poor for cases with percentage of stained cells >50% having moderate or strong staining intensity. In GBs, overall survival was also poor for >50-year-old cases and cases that refused radiotherapy. Multivariate Cox regression analysis revealed that age (>50 years, P = 0.021) and higher level of fascin expression (immunohistochemical score >8, P = 0.040) were independent poor prognostic factors. In conclusion, fascin expression levels are correlated with histologic grade and fascin overexpression may play an important role in the biologic behavior of glial astrocytic tumors and in the prognosis of GBs.

The aim of this study is to investigate intranasal fungal incidence in Turkish patients with chronic rhinosinusitis (CRS). One hundred patients with CRS and 40 healthy subjects as a control group were included in the prospective study. Nasal lavage samples were investigated for the presence of fungus, using new culture techniques and histopathologic examination. Epidermal and intradermal hypersensitivity tests were used to find out fungal atopy. Levels of serum eosinophils, total IgE and presence of fungus-specific IgE were investigated in the blood samples. Quantitative parameters were analyzed using Pearson chi(2) test. Allergic fungal sinusitis (AFS) was diagnosed in 13 (13%) patients. There was no fungal growth in the control group. Eosinophilic mucin was detected in 94% of patients. Clinical and laboratory parameters of CRS were not significantly different in patient groups with or without intranasal fungi. As a result, fungal incidence was not as high as expected in Turkish patients with CRS. Furthermore, no significant correlation could be found between presence of intranasal fungus and type-1 hypersensitivity in patients with CRS.

The intercellular bridges are essential structures in maintaining the histologic organization of the epithelium, while providing a very efficient way to exchange molecules between cells and transduction of the cell-to-cell and matrix-to-cell signals. Derangement in those important structures' physical integrity and/or function, which can be assessed by the presence or absence of several intercellular bridge proteins including claudin-4, E-cadherin, and β-catenin, was found to be related to several phenomena in the path to the neoplastic transformation. However, these proteins have not been studied in the wide variety of the skin neoplasms, in detail. Herein, we immunohistochemically assessed the expression patterns of these 3 intercellular bridge proteins on a total of 86 epidermal and eccrine adnexal tumors including basal cell carcinoma, squamous cell carcinoma, poroma, spiradenoma, syringoma, and hidradenoma. We observed a selective and distinct claudin-4 expression in the ductal-type cells of all cases of spiradenomas. Similarly, in the poromas, syringomas, and hidradenomas, claudin-4 was only positive in the luminal cells of microcystic structures, although not as conspicuous as in the spiradenomas. On the other hand, E-cadherin and β-catenin were positive in almost all types of the tumors, in a way which was not contributory to differentiate from each other. In conclusion, we think that claudin-4 can be helpful at least in making a reliable differential diagnosis of spiradenoma when overlapping morphologic features do not allow to further subclassification in the overwhelming variety of the adnexal tumors.

Melanosis coli is a common condition characterized by dark pigmentation of colonic mucosa. Melanosis coli is thought to be a benign lesion that emerging related with the overuse of the anthraquinone containing laxatives. A complete relation with colorectal carcinoma could not be demonstrated. It is often related with constipation and it is mostly diagnosed as endoscopic or diagnosed in a histopathological research by chance. It is important to recognize the melanosis coli which can be regressed generally in a few months with the cutting of laxatives. Although it is seen as a benign disease, colonoscopic biopsies should be taken from the pigmente and nonpigmente areas because of the suspicion of colorectal adenoma and carcinoma. In this article we aimed to present the following case: A patient applied our hospital with some complaints after being operated with the diagnosis of colon carcinoma and melanosis coli was determined during the investigations and after discontinuation of the use of laxative the patient complaints were regressed.

Background The aim of the present study was to investigate the diagnostic value of alkaline phosphatase (ALP) intestine-isomerase, plasma lactate dehydrogenase (LDH), and D-dimer levels in acute mesenteric ischemia. Methods Thirty Wistar rats were divided into 5 groups of 6 rats each. In Group 1, blood samples were obtained to determine normal parameter levels. In the sham group, Group 2, blood samples were obtained following laparotomy. In Group 3, blood samples were obtained 2 hours after ligation. In Groups 4 and 5, blood samples were obtained at 4 and 6 hours after ligation, respectively. Ischemic damage was assessed using a pathological scoring system. Blood samples were analyzed for hourly changes in parameters. Results No statistically significant difference in D-dimer levels was found between ischemia groups (p=0.337). A statistically significant difference in LDH levels was found between the control group, Group 1, and Group 4 (p=0.018). ALP intestine-isomerase enzyme levels were not statistically significant in other groups (p=0.077). Conclusion Findings indicate that plasma LDH levels higher than 1900 IU/L may be a useful marker in the early diagnosis of acute mesenteric obstruction. However, ALP intestine-isomerase enzyme and D-dimer plasma levels were not found to contribute to the diagnosis.

To compare intravitreal bevacizumab (IVB) and steroid activity in an experimental uveitis (EU) model.EU was induced by intravitreal injection of bovine serum albumin (BSA) at baseline. Rabbits were randomly divided into three groups (n = 8) according to treatment with a single dose of IVB, steroid or saline on day 3. Aqueous humor (AH) samples were collected periodically (baseline and days 1, 3, 10 and 33). Rabbits were sacrified and eyes were enucleated for histopathology on day 33. AH vascular endothelial growth factor (VEGF) levels and histopathological changes were subjected to statistical analysis.VEGF levels increased significantly after BSA injection (day 1) when compared with baseline in all three groups. Mean VEGF levels were 794.46 pg/mL, 777.91 pg/mL and 872 pg/mL for IVB, steroid and control groups, respectively (p = 0.002, p = 0.019 and p = 0.014). Seven days after treatment (day 10), VEGF levels decreased significantly in both treatment groups. Mean VEGF levels were 0 pg/mL, 292 pg/mL and 872 pg/mL, repectively (p 0.001, p = 0.016 and p = 0.12). On day 33, the VEGF levels and inflammation had returned to baseline levels in both treatment groups, whereas no decrease in inflammation was observed in the control group. The histopathological evaluation revealed a mild congestion in ciliary tissue with a normal retina and choroidea in IVB group, a mild congestion in ciliary tissue with moderate inflammation in the posterior vitreus and a normal retina in steroid group and a severe inflammation in ciliary tissue with moderate inflammation in the retina in control group.These findings suggest that IVB may be used as an alternative to steroid treatment to reduce the acute effects of inflammation in patients with uveitis in whom intraocular steroids are contraindicated.

Background There are scarce data regarding the significance of the tumor size, hormonal activity and size of the pituitary tumor of the young; therefore, the study was designed to define the relation of the hormonal status of the large pituitary adenomas. Objective We compared those features with tumors of the elderly (>40) with the young patients, and analyzed the clinicopathologic and proliferative features of pituitary macroadenomas in young adulthood (≤40). Methods 20-year archives of pituitary tumors in our clinics were reviewed and macroadenomas with diameter ≥3 cm were included in the study. We identified 46 pituitary adenomas and immunohistochemically stained them with pituitary hormones, p53 and Ki-67. Twenty-four cases were ≤40-year with an age range of 11–40 years (mean 28.0). Twenty-two cases were >40 with an age range of 44–78 years (mean 58.8). Results In the young patient group, 15 (62.5%) were functional adenomas (6 prolactinomas, six growth hormone [GH], one adrenocorticotrophic hormone [ACTH] adenoma, two multihormonal [GH + ACTH]) and nine (37.5%) were either gonadotrophic or null cell adenomas. In the elderly group, five (22.7%) were functional adenomas (two adrenocorticotrophic hormone [ACTH] adenoma, one prolactinoma, one growth hormone [GH], one multihormonal [GH + ACTH]) and 17 (77.3%) were either gonadotrophic or null cell adenomas. Ki-67 proliferation index in adenomas of the young was approximately two-folds higher than the elderly (2.7% vs. 1.2%). Conclusion In both groups, rare p53 positivity was identified. In conclusion, pituitary macroadenomas of the young show hormonal expression frequently with relatively high Ki-67 proliferation indices.

Renal dysplasia, defined as abnormal parenchymal development from anomalous differentiation of metanephric tissue, implies irreversible renal damage. The functional capacity of an affected kidney depends upon the extent and severity of the dysplasia. Conglomerates of disorganized epithelial structures surrounded by abundant fibrous tissue characterize a dysplastic kidney. Cortical cysts are often, but not necessarily, present [1]. Fetal renal disease is commonly encountered in second-trimester anomaly screening. Detailed sonographic examination shows the enlarged cystic fetal kidneys as well as the oligohydramnios. Magnetic resonance imaging further aids in the diagnosis of fetal kidney anomalies. In this case, we report a prenatal magnetic resonance imaging diagnosis of a fetus with cystic renal dysplasia. A 26-year-old patient was admitted to the outpatient clinic at 23 weeks’ gestation. She was married to her second-degree relative. Family history was negative for polycystic renal disease. Sonographic examination of the fetus revealed a single umbilical artery, polydactyly in both feet (Figure 1) and left hand, right kidney 33×15 mm, and left kidney 36×21 mm. Both kidneys were enlarged and filled the whole retroperitoneal space (Figures 2 and 3). The sonography showed that both kidneys were polycystic and enlarged. Bilateral renal anteroposterior diameters were within normal limits. Fetal biometric measurements were: biparietal diameter 22 weeks and 4 days, femur length 22 weeks and 1 day; and amniotic fluid volume was normal. Fetal echocardiographic examination revealed normal results. The termination of pregnancy was performed by vaginal and oral misoprostol administration after obtaining the written informed consent of the family. FETAL MAGNETIC RESONANCE IMAGING OF BILATERAL CYSTIC RENAL DYSPLASIA

Giant symplastic leiomyoma of the gluteal region is a rarely seen situation. It is accepted as a benign illness. A 36-year- old woman presented to general surgery clinic because of a mass on her right thigh. On physical examination, there was a 7 x 6 cm mass that was mobile and bulging up from the surface of skin, 3 cm from her anus. Pathologic examination revealed symplastic leiomyoma. Leiomyomas are benign smooth muscle tumors. After excision, dermal lesions have a 40% recurrence rate. Even if mitotic activity can be shown microscopically, follow-up is important and unnecessary treatment for symplastic leiomyoma must be avoided. [Arch Clin Exp Surg 2015; 4(2.000): 101-102]

Introduction.Ingestion of corrosive substances may lead to stricture formation in esophagus as a late complication. Full thickness injury seems to exterminate tissue stem cells of esophagus. Mesenchymal stem cells (MSCs) can differentiate into specific cell lineages and have the capacity of homing in sites of injury.Aim and Methods.We aimed to investigate the efficacy of MSC transplantation, on prevention of esophageal damage and stricture formation after caustic esophagus injury in rats. 54 rats were allocated into four groups; 4 rats were sacrificed for MSC production. Group 1, untreated controls (n: 10). Group 2, membrane labeled MSCs-treated rats (n: 20). Group 3, biodistribution of fluorodeoxyglucose labeled MSCs via positron emission tomography (PET) imaging (n: 10). Group 4, sham operated (n: 10). Standard caustic esophageal burns were created and MSCs were transplanted 24 hours after. All rats were sacrificed at the 21st days.Results.PET scan images revealed the homing behavior of MSCs to the injury site. The histopathology damage score was not significantly different from controls. However, we demonstrated Dil labeled epithelial and muscle cells which were originating from transplanted MSCs.Conclusion.MSC transplantation after caustic esophageal injury may be a helpful treatment modality; however, probably repeated infusions are needed.

WOS: 000345001400004 PubMed ID: 25194444 The ends of chromosoms, telomeres are bound with a number of proteins which protect and stabilize telomeres against degredation, end to end fusion and aberrant recombinations. Telomeric DNA is bound of two groups of proteins, which are double-stranded telomeric DNA bindings proteins, and single stranded telomeric binding proteins. Among telomere binding proteins, protections of telomere 1 protein is a single stranded telomere binding proteins and suggested to be a significant player for telomere elongation and has an association with an enzyme called as telomerase which is an intrinsic reverse transcriptase. Telomerase synthesizes hexameric telomeric repeats onto the chromosomes thereby compansating telomere loss in immortal cells, such as tumor cells, whereas telomeres are shorthened with each division in normal cells. PCR-based TRAP (telomeric repeat amplification protocol) assay is a very sensitive assay for the detection of enzymatic activity of telomerase even if a few numbers of cancerous cells are available. The association between telomerase activity and hPOT1 expression in colorectal cancer is still unclear. Protein extraction was performed from specimens of matched normal and colorectal cancer specimens. Protein concentrations were determined by Bradford assay. Optimized protein concentrations were used for TRAP Assay. TRAP products were seperated by vertical gel electrophoresis on 12.5% polyacrylamide gels and visualized by silver staining. Gene expression of hPOT1 was determined by qPCR analysis. The results demonstrated that all tumor tissues were telomerase positive whereas all corresponding normal tissue was telomerase negative. Among clinicopathological findings, telomerase activity was found to be associated with stage, histology, localization, distant metastasis and lymph node metastasis of tumor in the current study. Although all of the clinicopathological findings differed in the expression of hPOT1 compared to normal tissues, they did not differ from each other significantly, except side of tumor and lymph node metastasis. Telomerase activity and hPOT1 gene expression may serve as a promising tumor marker for colorectal cancer and there is a close association between the enzymatic activty of telomerase and the expression of human protection of telomere 1 gene. (C) 2014 Elsevier Masson SAS. All rights reserved.

The aim of this study was to investigate the effects of systemic and topical ozone applications on alveolar bone healing following tooth extraction. One hundred and twelve male Wistar rats were divided into eight groups of 14 rats each; seven groups were experimental (A-G) and one formed the control group (K). The experimental groups were further divided into two sub-groups, with seven rats in each - sacrificed on days 14 and 28 (subgroups 1 and 2). The maxillary right central incisors were extracted under general anaesthesia following the administration of local anaesthesia. After sacrifice, semi-serial histological sections were prepared, and mineralized and trabecular bone and osteoid and osteoblast surfaces were measured. Measurements of the trabecular bone showed statistically higher values in the groups treated with systemic ozone (D(2): 50.01 ± 2.12; E(2): 49.03 ± 3.03; F(2): 48.76 ± 2.61; G(2): 50.24 ± 3.37) than in the groups that underwent topical ozone administration (A(2): 46.01 ± 3.07; B(2): 46.79 ± 3.09; C(2): 47.07 ± 2.12; P = 0.030 (G(2)-A(2), G(2)-B(2), G(2)-C(2))). Within the limitations of the current study, it may be concluded that postoperative long-term systemic ozone application can accelerate alveolar bone healing following extraction. However, additional studies are required to clarify the effects of the different ozone applications on new bone formation.

A number of different therapies, including endoscopic resection, have been suggested for the treatment of Type 1 gastric neuroendocrine tumors (NETs). The current study aimed to determine the long-term efficacy of endoscopic resection for Type 1 gastric NETs.Twenty-two patients (from 1999 to 2012) with Type 1 gastric NETs were included in the study. All patients were treated with endoscopic resection and received regular followed-up appointments at a tertiary referral center.All patients were initially diagnosed with hypergastrinemia, atrophic gastritis and intestinal metaplasia. Polyps' diameters were1 cm in 4 patients, and between 0.5 and 1 cm in 18 patients. All detectable lesions were successfully resected. One patient required surgery due to gastric perforation during endoscopic mucosal resection. Recurrence was detected in four patients (18%) and endoscopic resection was performed again. Local or distant metastasis was not observed in any patient during follow-up. Median follow-up time was 7 years, with a maximum of 14 years. Seventeen patients (78%) completed a 5-year follow-up period, and overall disease-free survival rate was 100%.Long-term follow-ups with 22 patients suggest that endoscopic resection of Type 1 gastric NETs is a safe and effective treatment option with a relatively low recurrence rate.

The number of mitotic figures in a predefined area is essential in pathologic evaluation for most tumors. This information sometimes provides clues in differentiating neoplastic lesions from nonneoplastic ones and sometimes in defining and grading of the tumors as well as prognosticating expected lifetime of the patient. As a generally accepted concept, scanning a certain number of consecutive nonoverlapping areas that are rich in viable tumor cells is required. Invasion fronts or the periphery of the tumors is preferred for counting mitosis. The target area to be counted for mitotic activity for various tumors is standardized as the number of mitosis in an established number of high-power fields. However, suggested mitotic counts, which constitute the basis of these studies, were obtained via the old microscopes, which usually had narrower visual fields than the state-of-the-art microscopes. Because the visual fields of the present microscopes provide larger areas compared with the older ones, corrections in mitosis counting are needed to make them compatible with the criteria, which had been put forward in the original reference studies.

WOS: 000310319900011, PubMed ID: 23067136, Background Eradication rates of Helicobacter pylori with standard triple therapy are not satisfactory. Sequential therapy is an alternative method to overcome this problem. Objectives The aim of this study was to assess efficacy of a modified sequential therapy with the addition of a bismuth preparation, as first-line treatment in the eradication of H. pylori infection. Materials and Methods One hundred and forty-two H. pylori-positive patients were included in the study. Patients were given a 14-day sequential therapy program consisting of pantoprazole, 40 mg (b.i.d. for 14 days); colloidal bismuth subcitrate, 300 mg 4 (two tablets before breakfast and dinner, for 14 days); amoxicillin, 1 g (b.i.d.for the first 7 days); tetracycline, 500 mg (q.i.d. for the second 7 days); and metronidazole, 500 mg (t.i.d. for the second 7 days). Eradication was tested by urea breath test (UBT) 6 weeks after completion of treatment. Results Of the 142 patients included, 131 completed the study. Per-protocol and intention-to-treat analyses revealed high eradication rates in this group (92.095% CI, 87.296.8%, and 81.095% CI, 74.587.4%, respectively). There was no relation to sex and age with this modified sequential therapy. Compliance was satisfactory (11 patients four women and seven men were unavailable for follow-up), and side effects were minimal (six patients had to stop treatment metronidazole-related facial swelling and numbness on the face and hands in two patients; tetracycline-related fever and epigastric pain and nausea and vomiting in two patients; and amoxicillin-related diarrhea and vaginal discharge in two patients). These side effects were reversible and resolved after the cessation of the related medication. Conclusions This 14-day modified sequential treatment, including bismuth, achieves a significantly high eradication rates in patients with H. pylori infection, with five satisfactory patient compliance and minor side effects.

WOS: 000307518400001 PubMed ID: 22767446 It has been shown that BRAF(V600E) mutation in papillary thyroid carcinomas (PTC) is associated both with pathogenesis and poor prognosis. In this study, we aimed to investigate the relationship of the BRAF(V600E) mutation and the established prognostic factors in a cohort of Turkish patients with PTC. Forty-six cases of papillary thyroid carcinoma have been evaluated for the presence of BRAF(V600E) mutation. BRAF(V600E) has been examined by restriction fragment length polymorphism. BRAF(V600E) mutation status has been compared with well-known histopathological and clinical prognostic parameters such as invasion of thyroid capsule, extrathyroidal extension, and the presence of lymph node and/or distant metastasis. We have found that BRAF(V600E) mutation was present in the majority of our cases (40/46). Considering the stage of the disease, five of the negative cases were in stage 1 while the remaining one was in stage 2. Only one BRAF(V600E) negative case has shown extrathyroidal extension and lymph node metastasis. All four patients with distant metastasis had BRAF(V600E) mutation. Statistical analyses revealed that there are no significant relationship between the BRAF(V600E) mutation and the established prognostic factors. We found a relatively higher BRAF(V600E) mutation rate in classical type PTC than in other similar studies. We think that the limited number of our cases may either weaken or mask some potentially important relationship between BRAF(V600E) mutation and the established prognostic factors. Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [19816] The authors would like to thank to Scientific and Technological Research Council of Turkey (TUBITAK) for their support (Grant No: 19816). We also would like to express our sincere appreciation to FAVOR (FMF Arthritis Vasculitis and Orphan Diseases Research) laboratories at Gulhane Military Medical Academy, Institute of Health Sciences for their supports in conducting the experiments and invaluable guidance for the preparation of the manuscript.

The main objectives of this retrospective cohort study were to evaluate reproductive endocrine and semen profiles before and after simple orchiectomy in patients with unilateral postpubertal cryptorchidism and to investigate the relationship between hormone levels and histopathology of the removed testis. We evaluated 40 adult males who were admitted to our clinic, between 2001 and 2007, with unilateral undescended testis. Right orchiectomy was performed in 27 patients and left orchiectomy in 13. Semen analysis, serum inhibin B, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels were examined in before and 3 months after orchiectomy. Orchiectomy materials were evaluated histopathologically. Semen parameters, as well as testosterone and LH levels, did not change in any histopathological subgroups in the postoperative follow-up. In patients with maturation arrest, mean serum inhibin B level statistically significantly decreased from 160.9 to 83.5 pg/ml, and mean FSH level significantly increased from 4.8 to 7.6 mIU/ml after orchiectomy (p value, 0.008 and 0.008, respectively). Though, the levels were still within the normal range of the two hormones. Simple orchiectomy does not have any effect on semen parameters and testosterone level in patients with postpubertal cryptorchidism. The change in inhibin B and FSH levels after orchiectomy in patients with maturation arrest is not clinically significant.