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PURPOSE: The purpose of this study was to investigate the significance of fascin expression in colorectal carcinoma. METHODS: This is a retrospective study of 167 consecutive, well-documented cases of primary colorectal adenocarcinoma for which archival material of surgical specimens from primary tumor resections were available. We chose a representative tissue sample block and examined fascin expression by immunohistochemistry using a primary antibody against "fascin". We calculated the "immunohistochemical score (IHS)" of fascin for each case, which was calculated from the multiplication of scores for the percentage of stained cells and the staining intensity. RESULTS: Fascin immunoreactivity was observed in 59 (35.3%) of all cases with strong reactivity in 24 (14.4%), moderate reactivity in 25 (14.9%) and weak reactivity in 10 (6.0%) cases. Strong/moderate immunoreactivities were mostly observed in invasive fronts of the tumors or in both invasive and other areas. Fascin immunoreactivity scores were significantly higher in tumors with lymph node metastasis (p:0.002) and advanced stage presentation (p:0.007). There was no relation between fascin expression and age, gender, depth of invasion, distant metastasis or histological grade (p>0.05). There was a higher and statistically significant correlation between fascin immunoreactivity in the invasive borders of tumors and lymph node metastasis (r:0.747, p:0.005). In stage III/IV tumors, two-year survival was 92.2% in tumors without fascin immunoreactivity, and only 60.0% in tumors with a fascin IHS>10 (p:0.003). CONCLUSION: These findings suggest that fascin is heterogeneously expressed in approximately one third of colorectal carcinomas with a significant association with lymph node metastasis, tumor stage and location. Moreover, these results indicate that fascin may have a role in the lymph node metastasis of colorectal carcinomas

Adequate lymph node evaluation is required for proper staging of colorectal cancer, and the number of lymph nodes examined is associated with survival. In this study, we aimed to evaluate the factors affecting the number of lymph nodes retrieved from specimens of patients operated for colorectal cancer. Medical records of 320 consecutive patients with colorectal cancer were evaluated retrospectively whom had curative resection between 2002 and 2007. Variables such as age, gender, tumor localization, depth of tumor invasion, number of lymph nodes retrieved, specimen length, stage and grade of disease, type of surgery, primary/recurrence disease' presence of preoperative chemo radiotherapy (CRT), surgeon, staff surgeon, pathologist, and staff pathologist were recorded and the results were evaluated statistically. Mean number of lymph nodes retrieved was 14.98 (0 to 129) and mean metastatic lymph node number was 2.37(0-25). Tumor localization, staging, primary/recurrence disease, length of specimen, type of operation, pathologist (resident pathologist), staff pathologist, staff surgeon, presence of CRT, affected statistically significiant in terms of lymph nodes harvested (p=0.05). The hypothesis that disease recurrence occurred due to inaccurate staging. Maximal attention should be paid while doing oncologic surgery and should be paid to the total number of lymph nodes retrieved. [ABSTRACT FROM AUTHOR]

Deals with a study which investigated the role of nitric oxide in the pathogenesis of lung injury associated with pancreatitis. Materials and methodology; Association between malondialdehyde and myeloperoxidase; Degree of neutrophil infiltration in the pancreas and lung; Information on acute pancreatitis.

In this study, we aimed to share our clinical experience with gallbladder paraganglioma. Paraganglioma of the gallbladder is the most rare neoplasm. This case was diagnosed incidentally during laparoscopic exploration for suspicion of gallbladder cancer. The patient's data were retrospectively collected and presented with literature. Irregular and solid mass of the gallbladder were observed while a contrast-enhanced computerize tomography on a 61 years old female patient. The main reason for contrast-enhanced computerize tomography was former kidney malignancy. After that malignant neoplasm could not be excluded because of its appearance and she operated with a suspicion of gallbladder cancer. Laparoscopic exploration and cholecystectomy were performed and frozen section of mass demonstrated gallbladder paraganlioma. The definitive diagnosis of patients was made intraoperatively. Cholecystectomy was enough and not required further treatment such as liver resection or lymphatic dissection. Postoperatively, the patient was investigated for any association with other endocrine tumors and was not found. The patient recovered without complications. Even though primary gallbladder paraganglioma is a rare case, it may occur and it should be considered in the differential diagnosis of mass of the gallbladder. A careful search must be carried out for the possible association with MEN syndrome. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Emergency surgery for colorectal cancer is related to higher morbidity and mortality rate compared with elective surgery. AIM: In this retrospective study, our aim was to assess the infl uence of an obstruction on recurrence rates in patients with colon cancer. METHODS: From February 2002 to December 2012, patients who underwent curative resection for colon carcinoma were classifi ed as either the obstruction group (n = 60) or the non-obstruction group (n = 259). Data were reviewed prospectively. Clinical and pathological fi ndings were compared between the 2 groups. Univariate and multivariate analyses were performed to identify independent prognostic factors correlated with survival and disease recurrence. RESULTS: 319 patients undergoing curative resection of colorectal cancer were eligible for study (81% non-obstructive and 19% obstructive). There was no difference in terms of mean age and ASA scores between the groups. There was a trend toward a higher rate of recurrence in patients with an obstruction; however, the difference was not statistically signifi cant. Recurrence rate was 22% in emergent cases and 19% in elective cases (p>0.05). CONCLUSION: This data indicate that emergency surgery performed to treat an obstruction does not negatively infl uence recurrence rates and postsurgical morbidity of patients with colorectal cancer. Recurrence rates of patients with obstructive colorectal cancer is correlated with certain pathological variables and less strongly associated with clinical variables. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Radiologic imaging is getting used commonly in the evaluation of acute abdomen in our daily practice. Computed tomography(CT) and ultrasonography are worthwhile for acute abdomen when clinical presentation (Alvarado score) doesn‘t concur with appendicites. In this study, we aimed to present a rare case of caecal polyp causing mucocele of appendicitis and mimicking acute appendicitis. METHODS: Case report and review of the literature. RESULTS: 36-years-old male patient presented with right lower quadrant pain and nausea. On physical examination, rebound tenderness was obtained but there was no muscular rigidity. All blood tests including biochemistry and hemogram were within normal limits. Ultrasonography showed an enlarged, non-compressible appendix with 2-cm diameter and caecal edema. As time passed during the evaluation of patient, physical examination fi ndings regressed. When a CT was performed to exclude a probable appendix tumor, a-25 mm diameter mass was obtained at posterior wall of caecum. For differential diagnosis, colonoscopy was applied resulting 2x3cm of polyp located at caecum encircling appendical orifi s. Biopsy was performed without polypectomy, due to its wide base. Histopathological diagnosis resulted hyperplastic polyp with no malignancy. Appendectomy + partial caecal resection involving the polyp was performed. Histopathology confi rmed ‚‘mucinous neoplasm with tumor free margin‘‘. Patient was discharged on postoperative fourth day without any complication CONCLUSION: Radiological imaging methods are benefi cial for evaluating and confi rming the diagnosis of acute abdomen. Negative laparatomies or second-step surgeries may be decreased by advanced radiological imaging, especially when there is discordant situation between clinical and laboratory fi ndings. [ABSTRACT FROM AUTHOR]

PURPOSE: The incidence of colorectal cancer (CRC) among young adults has been increasing. Young adults are more likely to have a poorer prognosis. Our aim was to evaluate clinicopathologic features and recurrence rates of young patients compared to older patients. METHODS: The study was conducted from 2006 to 2012 on patients undergoing elective CRC resection at our department of sugery. Data reviewed prospectively. Clinicopathologic features and recurrence rates were compared between age groups. RESULTS:. The patients were divided into three groups according to the ages: group I--patients < or = 40 years (n = 20), group II patients between 41-70 years (n = 108), group III > 70 years (n = 38). Group I presented with more advanced pathologic T and N stage than the other groups but there were no metastatic disease at the time of presentation in group I. Group II had 12 (%12) patients with metastatic disease and group III had 1 (%3) patients at the time of presentation. Recurrence occured more frequently in group I (%40 of all group I patients) compared to the other groups (%24 of all group II patients and %14 of all group III patients). CONCLUSIONS: This study indicate that patients undergoing CRC resection <40 years seemed to have advanced disease and develop recurrence more frequently. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the synergistic effect of hyperbaric oxygen (HBO) and granulocyte-colony stimulating factor (G-CSF) on adhesion formation in rats., Methods: 40 adult male Sprague-Dawley rats (250-350 g) were divided into 4 groups. In group-1, no further management was undertaken. Group-2 received HBO therapy, group-3 was treated with 50 ug/kg subcutaneous G-CSF once daily for 7 days following laparatomy and cecal abrasion and group-4 was given both G-CSF and HBO therapies. On the 7th day, all rats were sacrificed and adhesions were scored. Tissue samples from adhesions and peritonea and cecum wall were examined both pathologically and biochemically for tissue hydroxyproline content., Results: No mortality occurred in study groups. When the groups were evaluated according to the adhesion numbers and grades, there was a statistically significant difference between the control and groups 3 and 4 (P < 0.001). There was no statistically significant difference between groups 1 and 2 (p > 0.05). HBO + G-CSF group was significantly different from control, HBO and G-CSF groups, regarding hydroxyproline contents (p = 0.005). Inflammation and fibrosis did not differ significantly among the groups (p = 0.248), (p = 0.213)., Conclusion: HBO treatment could not reduce the adhesion formation alone. Combined use of HBO and G-CSF, has a markedly preventive effect on postoperative adhesion formation (Tab. 1, Fig. 2, Ref. 57).

Background/aims: Bile duct injuries (BDI) usually need operative repair and remain as a challenge even for surgeons who specialize in hepatobiliary surgery. The objective of this study was to define the presentation, in-hospital management, and mid- to long-term outcome of BDIs during laparoscopic cholecystectomy (LC) referred to a tertiary center in their early period., Methodology: From January 1996 to January 2006, 31 patients with BDI sustained during or after LC were treated at our institution. Patients were referred to our center from 18 community hospitals in their first 15 postoperative days. Patients' charts were retrospectively reviewed; presentation, management, and follow-up details recorded at the primary hospitals and at our institution were documented., Results: There were 5 patients with type-A and one with type-C injury, according to Strasberg classification. The remainders had a major BDI. The mean time to referral was 3.45 (median 2) days. Treatment methods chosen after referral were as follows: drainage-observation in 2 patients (6.5%), nasobiliary drainage in 4 (12.9%), endoscopic sphincterotomy plus biliary stenting in 1 (3.2%), and surgical intervention (duct-to-duct anastomosis or biliary-enteric reconstruction) in 24 patients (77.4%). Although a success rate of 83.3% was achieved in the early period, 10 patients (32.3%) had late postoperative complications (stricture and cholangitis), and of these, 3 required endoscopic stent placement, and 7 patients underwent a biliary diversion with Roux-en-Y Hepaticojejunostomy. One out of 24 patients with long-term follow-up developed biliary cirrhosis, and one patient with malignancy expired., Conclusions: Minor BDIs can be satisfactorily treated with endoscopic interventions. Extended lateral injuries, complete CBD transsections, and long segment stenosis usually require surgical therapy. Duct-to-duct anastomosis may be an option as the first-line therapy in selected patients after early referral, though many patients eventually require a Roux-en-Y hepaticojejunostomy.