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Macroautophagy/autophagy is an evolutionarily conserved cellular stress response mechanism. Autophagy induction in the tumor microenvironment (stroma) has been shown to support tumor metabolism. However, cancer cell-derived secreted factors that initiate communication with surrounding cells and stimulate autophagy in the tumor microenvironment are not fully documented. We identified CTF1/CT-1 (cardiotrophin 1) as an activator of autophagy in fibroblasts and breast cancer-derived carcinoma-associated fibroblasts (CAFs). We showed that CTF1 stimulated phosphorylation and nuclear translocation of STAT3, initiating transcriptional activation of key autophagy proteins. Additionally, following CTF1 treatment, AMPK and ULK1 activation was observed. We provided evidence that autophagy was important for CTF1-dependent ACTA2/α-SMA accumulation, stress fiber formation and fibroblast activation. Moreover, promotion of breast cancer cell migration and invasion by activated fibroblasts depended on CTF1 and autophagy. Analysis of the expression levels of CTF1 in patient-derived breast cancer samples led us to establish a correlation between CTF1 expression and autophagy in the tumor stroma. In line with our in vitro data on cancer migration and invasion, higher levels of CTF1 expression in breast tumors was significantly associated with lymph node metastasis in patients. Therefore, CTF1 is an important mediator of tumor-stroma interactions, fibroblast activation and cancer metastasis, and autophagy plays a key role in all these cancer-related events. Abbreviations: ACTA2/α-SMA: actin, alpha 2, smooth muscle CAFs: cancer- or carcinoma-associated fibroblasts CNT Ab.: control antibody CNTF: ciliary neurotrophic factor CTF1: cardiotrophin 1 CTF1 Neut. Ab.: CTF1-specific neutralizing antibody GFP-LC3 MEF: GFP-fused to MAP1LC3 protein transgenic MEF LIF: leukemia inhibitory factor IL6: interleukin 6 MEFs: mouse embryonic fibroblasts MEF-WT: wild-type MEFs OSM: oncostatin M TGFB/TGFβ: transforming growth factor beta

Background: Whether axillary lymph node dissection (ALND) following sentinel lymph node biopsy (SLNB) could be spared in patients with initially clinically positive axilla after neoadjuvant chemotherapy (NAC) is still controversial even though recent studies indicate that axillary recurrence seems to be a rare event. Our aim is to find out whether omitting ALND could be oncologically safe in patients undergoing SLNB after NAC. Material and Methods: Of patients presented with c T1-4N1-3M0 disease, those undergoing SLNB after NAC were included in the prospective multicentre registry trial " MF18-03/BHWG" (ClinicalTrials.gov/NCT04250129). Cases with inflammatory breast cancer, distant metastases, pregnancy, bilateral breast cancer, or other cancers and those without adjuvant nodal radiotherapy were excluded from the study. The end points of the present report are the axillary nodal recurrence (AR) and locoregional recurrence (LRR) rates at a median follow-up more than 2 years, and determine factors associated with AR and LRR . The locoregional recurrences included ipsilateral, and contralateral axillary recurrences, infra-and supraclavicular recurrences, and recurrences in the mammaria interna region. Results: Between January 2018 to January 2021, 2358 patients with cN(+) disease, who became cN0 after NAC, and underwent SLNB, were analyzed. Median age was 47 (range, 21-86). Of those, the majority of patients had cT1-2 (80.5%) and N1 (80.3%) disease. Following NAC, half of the patients (50%) had breast conserving surgery, whereas the remaining half had mastectomy (50%). Of 2358 patients, 908 (38.5%) had ALND following SLN (ypN+, 85%) and 1450 (61.5%) underwent SLNB alone (ypN0, 72%). SLNB was performed by using the blue dye technique-alone in 66.6% of patients and by targeted axillary dissection in 659 patients (27.9%). Of those, 819 (34.8%) were HER2(+) and 373 (15.8%) were triple negative. The pCR rates for the axilla, breast and both for the axilla and breast were 50%, 35% and 28%, respectively. At a median follow-up time of 28 months (range, 12-62), the LRR, AR and isolated AR rates were 0.6% (n=14), 0.25% (n=6) and 0.13% (n=3), respectively. Furthermore, no significant difference could be found in LRR- and AR- rates between SLNB-alone and ALND groups regardless of the definitive nodal pathology (Table 1). Nodal recurrences were seen at a median of 12 months after the surgery. Of 6 cases with AR, 3 had synchronous local recurrences in breast, and 2 of them also had lung metastases in addition to local recurrence. All patients with AR were interestingly found to have HER2(+) or triple negative breast cancer at the initial diagnosis, and had residual invasive cancer in the breast surgical specimen. Logistic regression analyses revealed that patients with AR were significantly more likely to be younger than 45 (RR=7.81 ; 95% CI, 0.91-66.91) and have a cN2-3 (RR=4.1; 95% CI, 0.83-20.38), and non-luminal breast cancer (RR=12.47; 95% CI, 1.45-106.9) at the initial diagnosis (Table 2). Similarly, patients with LRR were more likely to present with cN2-3 disease (RR=3.09; 95% CI, 1.07-8.94) and non-luminal pathology (RR=6.27; 95%CI, 1.96-20.06) . Conclusion: This large prospective registry data also suggest that nodal recurrences can be detected at very low rates within 3 years after surgery in patients with clinically node-positive disease following NAC regardless of the extent of axillary surgery or nodal pathology as long as regional nodal radiation is provided. Since patients with early nodal recurrences have an agressive tumor biology with a potential of systemic recurrences, effective adjuvant systemic therapies should be considered in those with HER2(+) or triple negative residual breast cancer after surgery following adjuvant nodal radiation. Table 1. Local locoregoinal and systemic recurrences in cT1-4N1-3 patients with ypN0/ypN(+) diseases (n =2358) Table 2. Factors associated with axillary and locoregoinal recurrences (AR = axillary recurrences, LRR = locoregoinal recurrences, pCR = pathologic complete response) Citation Format: Neslihan Cabıoğlu, Hasan Karanlik, Mehmet Ali Gulcelik, Abdullah İgci, Mahmut Muslumanoglu, Havva Belma Kocer, Cihan Uras, Gokhan Giray Akgul, Mustafa Tukenmez, Serkan Ilgun, Didem Can Trabulus, Guldeniz Karadeniz Cakmak, Ahmet Dağ, Nilufer Yıldirim, Baha Zengel, Ebru Sen Oran, Kazim Senol, Halil Kara, Selman Emiroglu, M. Umit Ugurlu, Bulent Citgez, Yeliz Emine Ersoy, Atilla Celik, Ece Dilege, Yasemin Bolukbaşı, Niyazi Karaman, Gul Basaran, Aykut Soyder, Ayfer Kamali Polat, Gurhan Sakman, Serdar Ozbas, Ayse Altınok, Leyla Zer, Alper Akcan, Ibrahim Ali Ozemir, Levent Yeniay, N. Zafer Utkan, Lutfi Dogan, Mutlu Dogan, Mehmet Velidedeoglu, Beyza Ozcinar, Fazilet Erozgen, Abut Kebudi, Kemal Atahan, Vafa Valiyeva, Serdar Yormaz, Ali Sevinc, Cumhur Arici, Atilla Soran, Vahit Ozmen. PD15-01 AXILLARY NODAL RECURRENCE IS RARE IN PATIENTS WITH NODE-POSITIVE BREAST CANCER UNDERGOING SLNB FOLLOWING NEOADJUVANT CHEMOTHERAPY : EARLY RESULTS OF THE NEOSENTITURK-TRIAL/MF-18-03 [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD15-01.

Amaç: Primer meme neoplazilerinin %0,3-1’ini oluşturan nadir görülen fibroepitelyal meme tümörü ’dür. Klinik, radyolojik ve histopatolojik olarak fibroadenomlar ile karışırlar. Bu yazıda, filloides meme tümörü nedeni ile tedavi edilen hastalarımızın demografik özellikleri, klinikopatolojik bulguları, takip sonuçları ve uygulanan tedavi yöntemlerinin incelenmesi amaçlanmıştır.Gereç ve Yöntem: Ocak 2010-Temmuz 2019 tarihleri arasında tedavi edilen 24 filloides tümör hastasının verileri retrospektif olarak incelendi.Bulgular: Yaş ortalaması 44,1 (20-64) yıl idi. En sık başvuru semptomu hızlı büyüyen kitle idi. Hastalık 12 hastada sağ memede, 2 hastada bilateral idi. Biyopsi yöntemi olarak, 10 hastada tru-cut biyopsi, 13 hastada eksiyonel, 1 hastada insizyonel biyopsi kullanıldı. Eksizyonel biyopsi (n:6), segmental mastektomi(n:11) ve mastektomi (n:7) uygulanan cerrahi prosedürler idi. Ortalama tümör boyutu 64,6 mm(20-220) olarak saptandı. Histopatolojik olarak, 9 benign, 6 borderline ve 9 malign filloides tümör tanısı konuldu. Ortalama takip süresi 18 (6-82)ay idi. Takipte, malign filloides tümörlü 4 hastada lokal nüks, 1 hastada uzak metastaz tespit edildi. 3 hasta kemoterapi ve 2 hasta radyoterapi tedavisi aldı. Sonuç: Filloid tümörler nadir görülen, miks tip meme tümörleridir. Klinik, radyolojik ve histopatolojik olarak meme fibroadenomları ile karışabilmektedir. Uygun cerrahi tedavinin yapılabilmesi için tru-cut biyopsi ile ameliyat öncesi tanının konulması önemlidir. Aksi taktirde re-operasyon ve lokal nüks oranları artmaktadır., Purpose: Phyllodes tumoris a rare fibroepithelial breast tumor that constitutes 0.3-1% of primary breast neoplasms. They are confused with fibroadenomas, clinically, radiologically and histopathologically. In this article, it is aimed to examine the demographic characteristics, clinicopathological findings, follow-up results and treatment methods of our patients treated due tophyllodes tumor.Materials and Methods: The data of 24 phyllodes tumor patients treated between January 2010 and July 2019 were analyzed retrospectively.Results: The average age was 44.1 (20-64) years. The most common symptom was the fast growing mass. The disease was on the right breast in 12 patients and bilateral in 2 patients. As a biopsy method, true-cut biopsy was used in 10 patients, excisional biopsy in 13 patients, and incisional biopsy in 1 patient. Excisional biopsy (n: 6), segmental mastectomy (n: 11) and masectomy (n: 7) were surgical procedures applied. The mean tumor size was determined as 64.6 mm (20-220). Histopathologically, 9 benign, 6 borderline and 9 malignant phyllodes tumors were diagnosed. The mean follow-up was 18 (6-82) months. During follow-up, local recurrence was detected in 4 patients and distant metastasis in 1 patient. 3 patients received chemotherapy and 2 patients received radiotherapy.Conclusion: Phyllodes tumors are rare, mixed-type breast tumors. It can be mixed clinically, radiologically and histopathologically with breast fibroadenomas. It is important to make a preoperative diagnosis with tru-cut biopsy for proper surgical treatment. Otherwise, re-operation and local recurrence rates increase.

Amac: Bu calismada lokal ileri evre meme kanserli hastalarda neoadjuvan kemoterapi ile tumor capi, tumorlu dokuda calisilan vaskuler endotelyal buyume faktoru (VEGF), ostrojen reseptoru (ER), progesteron reseptoru (PR), Ki-67 ve Cerb-B2 ekspresyonlarindaki degisimin gosterilmesi amaclanmistir. Gerec ve Yontem: Cukurova Universitesi Tip Fakultesi Genel Cerrahi ve Tibbi Onkoloji Bilim Dali’nda 2008 ve 2013 yillari arasinda lokal ileri meme kanseri nedeniyle tedavi goren 69 hastanin verileri prospektif olarak arastirilmistir. Tumor capi, tumorlu dokuda calisilan VEGF, Ki-67, ER, PR ve Cerb-B2 ekspresyonlari immunhistokimyasal (IHK) yontem ile neoadjuvan kemoterapi oncesi ve sonrasi donemde karsilastirmali olarak degerlendirilmistir. Bulgular: Neoadjuvan kemoterapi sonrasi tumor capi, VEGF, Ki-67, ER, PR ve Cerb-B2 ekspresyonlarinda istatistiksel olarak anlamli dusus saptandi. Sonuc: Tumor dokusunda calisilan VEGF duzeyindeki anlamli dusme, tumorun anjiyogenezinin ve bu yolla metastaz yapabilme yeteneginin neoadjuvan kemoterapi etkisiyle azalabilecegi sonucunu telkin etmektedir. Tumor dokusunda calisilan Ki-67 proliferasyon indeksinde anlamli degisim; malign hucre proliferasyonunun neoadjuvan kemoterapi etkisiyle azaldigini gosterebilir.

In this study, we aimed to investigate the clinical features of Papillary thyroid carcinoma(PTC) Tall cell variant(TCV), long-term outcomes and surgical experience in papillary thyroid carcinoma.33 patients who were operated in our clinic between August 2012 and March 2018 and diagnosed as TCV in their pathology evaluation were included in the study. The demographic and clinical features of the patients, pathological features of the tumor and long-term results were examined.A total of 33 patients were included in our study. The mean age was 55.2(18-85) years. The female sex was more dominant (75.8%). The most common presenting complaint was swelling in the neck (75.7%).Total thyroidectomy was performed in 84.8% and completion thyroidectomy after lobectomy was performed in 15.2%. Neck dissection was performed in 33% of the patients. The mean tumor diameter was 3.6 (1-10) cm. The tumor was multifocal in 36.3% of the patients. The capsule invasion rate of the tumors was present in 69.7% of the patients, extrathyroidal rate was 39.4%, Metastatic lymph nodes were detected in 30.3% of the cases. The mean follow-up duration was 39.3+22.4(5.25-78.63) months. 39.4% of patients had distant metastasis during follow-up. Disease free survival rate was 57.6%, total survival was 42.4 + 3.8 (34.7-50.0) months.TCV is closely associated with larger tumor diameter, multifocal location, extrathyroidal spread and lymph node involvement, We believe that more aggressive surgery should be performed in the treatment of TCV cases and it is important to follow up the patients more closely.Esophagus cancer, Neutrophil/lymphocyte ratio, Preoperative lymphocyte /neutrophil ratio, Prognosis.Questo studio è finalizzato ad analizzare le caratteristiche cliniche del carcinoma papillare della tiroide (PTC), variante a cellule alte (TCV), gli esiti a lungo termine e l’esperienza chirurgica nell’ambito del carcinoma papillare della tiroide. Nella nostra clinica tra agosto 2012 e marzo 2018 sono stati operati 33 pazienti, e diagnosticati come TCV dall’anatomo- patologo, e su questi si è rivolto in nostro studio retrospettivo, esaminando le caratteristiche demografiche e cliniche, le caratteristiche patologiche del tumore e i risultati a lungo termine. L’età media dei 33 pazienti era di 55,2 (18-85) anni. Il genere femminile era più dominante (75,8%). Il sintomo più frequente è stato il gonfiore del collo (75,7%), la tiroidectomia totale è stata eseguita nell’84,8% e la tiroidectomia di completamento dopo la lobectomia è stata eseguita nel 15,2%. La dissezione del collo è stata eseguita nel 33% dei pazienti. Il diametro medio del tumore era 3,6 (1-10) cm. Il tumore era multifocale nel 36,3% dei pazienti. Il tasso di invasione della capsula dei tumori era presente nel 69,7% dei pazienti, il tasso di sviluppo extratiroideo era del 39,4%, i linfonodi metastatici sono stati rilevati nel 30,3% dei casi. La durata media del follow-up è stata di 39,3 + 22,4 (5,25-78,63) mesi, ed il 39,4% dei pazienti ho presentato metastasi a distanza nel corso del follow-up. Il tasso di sopravvivenza libera da malattia è del 57,6%, la sopravvivenza totale è di 42,4 + 3,8 (34,7-50,0) mesi. In conclusione il TCV è strettamente associato a dimensioni maggiori del tumore maggiore, sviluppo multifocale, diffusione extratiroidea e coinvolgimento dei linfonodi. Riteniamo che si debba eseguire un intervento più aggressivo nel trattamento dei casi di TCV ed è importante seguire più da vicino i pazienti.

Background Periductal mastitis (PM) is a rare disease characterized by chronic inflammation of the terminal mammary ducts. Complete removal of terminal lactiferous ducts with Hadfield procedure is a previously defined technique in treatment but carries various complications risks. This study aims to evaluate the effectiveness of modified techniques in the treatment of PM. Methods Twenty women who underwent surgery due to PM between January 2012 and December 2019 were retrospectively analyzed. Types of PM were determined. All patients were operated on with three different incisions [Hadfield’s operation with periareolar incision (n:11), periareolar combined radial incision (n:7), and round block incision (n:2)]. Results The mean age was 37.5 ± 6.5 years (range: 24–49). Sixty percent of patients had type 3 PM. In Hadfield’s procedure, NAC retraction (n:2), seroma (n:1), and hematoma (n:1) were seen. In the periareolar incision combined radial incision group only one patient had complications (seroma) and none in the round block method. Follow-up was 12 ± 1.5 months and disease relapse occurred in two patients in the Hadfield group. Patients who underwent round block were more satisfied with the appearance of the nipple. Conclusions In the treatment of PM, the main principle of surgical treatment is the excision of the affected canal with a clear margin. Apart from the classical Hadfield procedure, the round block method and periareolar combined radial incision techniques can be performed in the treatment of PM.

Purpose: the COVID-19 pandemic brought unprecedented conditions for overall health care systems by restricting resources for non-COVID-19 patients. As the burden of the disease escalates, routine elective surgeries are being cancelled. The aim of this paper was to provide a guideline for management of endocrine surgical disorders during a pandemic. Methods: we used Delphi method with a nine-scale Likert scale on two rounds of voting involving 64 experienced eminent surgeons and endocrinologists who had the necessary experience to provide insight on endocrine disorder management. All voting was done by email using a standard questionnaire. Results: overall, 37 recommendations were voted on. In two rounds, all recommendations reached an agreement and were either endorsed or rejected. Endorsed statements include dietary change in primary hyperparathyroidism, Cinacalcet treatment in secondary hyperparathyroidism, alpha-blocker administration for pheochromocytoma, methimazole ± β-blocker combination for Graves’ disease, and follow-up for fine-needle aspiration results of thyroid nodules indicated as Bethesda 3–4 cytological results and papillary microcarcinoma. Conclusion: this survey summarizes expert opinion for the management of endocrine surgical conditions during unprecedented times when access to surgical treatment is severely disrupted. The statements are not applicable in circumstances in which surgical treatment is possible., NA

PURPOSE Breast cancer is the most frequent cancer in women, and there is a great variability in surgical practice for treating that cancer in different countries. The aims of this study were to analyze the effect of guidelines from the Turkish Federation of Breast Diseases Societies on academic institutions that have breast centers and to evaluate surgical practice in Turkey in 2018. PATIENTS AND METHODS Between January and March 2019, a survey was sent to breast surgeons who were working in breast centers in academic institutions. The sampling frame included 24 academic institutions with breast centers in 18 cities in Turkey to evaluate interdisciplinary differences among breast centers and seven regions in Turkey regarding patients’ choices, surgical approaches, and academic institutions. RESULTS All surgeons responded to the survey, and all 4,381 patients were included. Most of the surgeons (73.9%) were working in a breast center. Multidisciplinary tumor boards were performed in 87% of the breast centers. The average time between clinical evaluation and initiation of treatment was 29 days; the longest time was in Southeast Anatolia (66 days). Only 6% of patients had ductal carcinoma in situ. Sentinel lymph node biopsy was available in every region across the country and was performed in 64.5% of the patients. In 2018, the overall breast-conserving surgery rate was 57.3% in Turkey, and it varied from 72.2% in the Black Sea region to 33.5% in Central Anatolia ( P < .001). Oncoplastic breast surgery options were available at all breast centers. However, 25% of the breast centers from the Black Sea region and half the breast centers from Eastern Anatolia and the Mediterranean region did not perform this type of surgery. CONCLUSION Increasing rates of nonpalpable breast cancer and decreasing rates of locoregional recurrences favored breast-conserving surgery, especially in developed countries. Guidelines from the Turkish Federation of Breast Diseases Societies resulted in more comprehensive breast centers and improved breast health in Turkey.

Amaç: Bu çalışmada, 9 yıl içerisinde adrenal kitle nedeni ile ameliyat edilen olgularda konvansiyonel ve laparoskopik adrenalektominin sonuçlarının karşılaştırılması amaçlanmıştır.Gereç ve Yöntem: Adrenalektomi uygulanan 81 hasta çalışmaya dahil edildi. Grup 1 konvansiyonel, Grup 2 Laparaskopik cerrahi olarak hastalar iki grupa ayrıldı. İki grup, yaş, cinsiyet, vücut kitle indeksi (VKİ), Amerikan anestezistler derneği skoru (ASA), kitle lokalizasyonu, kitle büyüklüğü ve kitlenin hormonal aktivitesi, operasyon süresi, operasyonda kanama miktarı, yatış süresi, gıdaya başlama süresi, perioperatif mortalite, erken dönem komplikasyonlar ve 90 gün içinde hastaneye tekrar başvuru gibi özellikleri esas alınarak retrospektif olarak karşılaştırıldı. Bulgular: Grup 1’de 22, Grup 2’de 59 hasta mevcut idi. Gruplar arasında yaş, cinsiyet, VKİ, ASA skoru, tümör lokalizasyonu, operasyon endikasyonları, postoperatif komplikasyon, perioperatif mortalite ve 90 gün içinde tekrar başvuru açısından istatistiksel olarak anlamlı fark saptanmadı. Kitlenin hormonal aktivitesi Grup 2’de daha yüksek, boyutu ise daha küçük saptandı. Operasyon süresi (dak), ameliyatta kanama miktarı (ml), oral alım süresi (gün) ve hastanede yatış süresi (gün) Grup 1’de daha fazla ve istatiksel olarak anlamlı bulundu. Sonuç: Laparoskopik adrenalektomi uygun hastalarda, kısa operasyon süresi, az kan kaybı, oral gıdaya erken başlama süresi ve daha kısa hastanede kalış süresi gibi avantajları, ayrıca güvenli olması nedeni ile tercih edilmesi gereken cerrahi yöntem olmalıdır., Purpose: The aim of this study was to compare the results of conventional and laparoscopic adrenalectomy in adrenal mass cases operated on during a 9-year period.Materials and Methods: A total of 81 patients who underwent adrenalectomy were included in the study. Patients were divided into two groups as; Group 1 - conventional surgery and Group 2 - laparoscopic surgery. Two groups were compared retrospectively on characteristics such as; age, sex, body mass index (BMI), American Society of Anesthesiologists' score (ASA), mass localization, mass size and hormonal activity of the mass, duration of operation, amount of bleeding in operation, duration of hospitalization, duration until food intake, perioperative mortality, early complications and readmission to hospital within 90 days. Results: There were 22 patients in Group 1 and 59 patients in Group 2. No statistically significant difference was found between the groups in terms of age, sex, BMI, ASA score, tumor localization, indications for operation, postoperative complication, perioperative mortality and re-admittance within 90 days. The hormonal activity of the mass was higher and the mass was smaller in size in Group 2. The duration of operation (min), the amount of bleeding in the operation (ml), the duration until oral intake (days) and the length of hospital stay (days) were found to be statistically significantly higher in Group 1.Conclusion: Laparoscopic adrenalectomy should be the preferred surgical method because of its short duration of operation, low blood loss, early onset of oral food intake and shorter hospital stay, as well as its safety.

PubMedID: 25971825 BACKGROUND AND OBJECTIVES: The incidence of primary extrahepatic cystic echinococcosis (CE) is rare. Generally, radiological and serological findings can help establish the diagnosis of hepatic and pulmonary CE, but a CE in an unusual location with atypical radiological findings may complicate the differential diagnosis. The objective of this study is to present the characteristics of cases with extrahepatic CE in respect of sites of involvement, clinical presentations, radiological findings, serological diagnostic evaluations, and outcomes of infected patients. DESIGN AND SETTINGS: A retrospective analysis of surgically treated CE was conducted between January 1993 and January 2014 in the General Surgery, Pediatric Surgery, Urology, Cardiovascular Surgery, Neurosurgery, and Orthopedics departments of University of Cukurova, Faculty of Medicine, Balcali Hospital. PATIENTS AND METHODS: Among the 661 patients managed for CE, 134 had unusual sites of involvement. Radiological and serological examinations were used to differentiate CE from alveolar echinococcosis. RESULTS: Of 134 cases with unusual sites of involvement, 32 cases had liver CE (23.9%), 7 cases had lung CE (5.2%), and 2 cases had concomitant liver and lung CE (1.5%). In 93 (69.4%) cases, unusual organ involvement was isolated without any liver or lung involvement. The mean age was 45 years. Abdominal pain was the main symptom and was found in 104 patients. Thirty-one (23.1%) of 134 extrahepatic CE cases were evaluated as negative with indirect hemagglutination (IHA). However, positive results were obtained in 54 cases evaluated with Echinococcus granulosus IgG Western blot (WB), including 10 IHA-negative cases. CONCLUSION: CE with unusual localizations may cause serious problems of diagnostic confusion. The combination of clinical history, radiological findings, and serological test results (especially the WB) are valuable in diagnosing extrahepatic CE.

Background: Secondary hyperparathyroidism (SH) is major problem in chronic renal failure. There are studies to examine proliferation and apoptosis associated biomarkers expressions in parathyroid lesions to reveal specific features. In this study, we evaluated the expression of some growth factors and their receptors in parathyroid gland of patients with SH or primary hyperparathyroidism (PH). Materials and Methods: A total of 49 patients had been operated for PH and 26 for SH. Parathyroid tissue samples were evaluated histopathologically and immunohistochemically using antibodies to human p53, KI-67, anti-human p21, antitransforming growth factor (TGF) α, CPP32 (caspase 3), and epidermal growth factor receptor (EGFR). Results: Adenoma was higher in PH compared with SH as 48/49 and 3/26, respectively ( P = 0.000). Parathyroid hyperplasia was found in 23/26 patients with SH and 1/49 patient with PH. In parathyroid tissue there were no difference between PH and SH for p53, Ki-67, caspase, EGFR expressions; while there were significantly difference for TGFα ( P = 0.047) and borderline significant difference for p21 ( P = 0.06) expressions. Conclusion: Adenoma was priority present in PH patients, hyperplasia was present in SH. There were no differences between primary and SH or adenoma and hyperplasia for expressions of cycline-dependent kinase inhibitor p21, p53, EGFR, Ki67, caspase; while TGFα expression was found to be different.

Aim: Primary hyperparathyroidism is a clinical condition caused by excessive parathyroid secretion of the parathyroid glands and related hypercalsemia. Hyperparathyroidism is a common cause of hypercalcemia. In this study, we aimed to present the results of patients operated on due to parathyroidadenoma in our clinic.Material and Methods: IPatients who underwent surgery for parathyroid adenoma in our clinic between January 2007 and January 2019 were included in the study. Clinical characteristics, biochemical data, treatment methods and results of the patients were analyzed retrospectively.Results: 156 patients with a mean age of 50.8 years participated in the study. Female sex was 76.2%. Preoperative calcium level was found as 11.2+1.02 mg/dl, Parathormone level was found as 114.7+109.5 pg / ml. The most common clinical presentation was asymptomatic hypercalcemia (48.7%). While 89.7% of the patients had only parathoridectomy, 3.2% had total thyroidectomy and 7.1% had lobectomy due to associated thyroid pathology (10.3%). Intraoperative rapid parathormone was used in 54.4% of the patients. Frozen examination was performed in all patients. The most common localization was inferior left 39.7%. The most common ectopic localization was intratymic at 2.6%. The mean duration of postoperative hospital stay was 3.81+2.69 days. Three patients (1.9%) had persistent hyperparathyroidism and 6 patients (3.8%) had recurrent hyperparathyroidism. The mean follow-up was 57.2+39.5 months. Conclusion: Proper preoperative evaluation, careful exploration, frozen examination and rapid parathormone test increase the success of parathyroid adenoma surgery.

Aim: In this study, we aimed to compare the results of conventional and laparoscopic adrenalectomy in patients with adrenal masses greater than 6 cm.Material and Methods: Thirty-six patients with tumor size greater than 6 cm who underwent adrenalectomy between January 2011 and January 2018 were included in the study. Patients were divided into two groups as Group 1 conventional and Group 2 Laparoscopic surgery. The two groups were retrospectively compared in terms of age, sex, mass localization, mass size, duration of operation, amount of bleeding, duration of hospitalization, duration of onset of food intake, perioperative mortality, early period complications and re-admission to the hospital within 90 days. P0.05 was considered statistically significant.Results: There were 13 patients in Group 1 and 23 patients in Group 2. There was no statistically significant difference between the groups in terms of age, sex, tumor localization, tumor size, indications for operation, postoperative complications, perioperative mortality and readmission within 90 days. Duration of operation (min), amount of bleeding (ml), duration of oral intake (day) and duration of hospitalization (day) were higher in Group 1 and statistically significant.Conclusion: Laparoscopic adrenalectomy has demonstrated advantages in patients with a mass greater than 6 cm compared to conventional surgery, such as short operation duration, less blood loss, early onset of oral food intake and shorter hospital stay. It can be safely used in patients with a mass larger than 6 cm.

Aim: There is no examination to determine the exact diagnosis of parathyroid cancer before surgery. The aim of this study was to discuss our surgical experience and the intraoperative findings suggestive of cancer, in parathyroid cancers operated with the diagnosis of primary hyperparathyroidism.Material and Methods: Six patients with parathyroid cancer who were operated on between May 2012 and January 2017, in the Department of General Surgery, xxx were included in the study. Age, sex, complaints of the patients, calcium and parathormone values, imaging methods for localization, intraoperative findings from surgical notes were evaluated retrospectively.Results: Of the patients, 4 were females and 2 were males. The mean age was 61.6+7.28 (50-71). While the lesion was spotted incidentally in three patients, swelling in the neck, back and hip pain, pancreatitis were other reasons for admission. The mean calcium levels were 13.05+1.86 (10.5-15.7) mg/dL, mean parathormone values were 937.4+756.9 (370-1814) pg/ml. Ultrasonography (USG) and parathyroid scintigraphy were performed to all patients. Thyroid scintigraphy was additionally performed on one patient for hyperthyroidism and then FNAB was performed. This patient was operated on with suspected thyroid cancer. In intraoperative evaluation, all of the lesions were firm, adherent to the thyroid capsule and surrounding tissues. One patient had inferior laryngeal nerve invasion. In frozen examination, four patients with suspected parathyroid cancer was specified. Three patients had a lobectomy and 2 patients had en bloc lesion resection with total thyroidectomy. Lesion excision was performed in one patient. After final pathology results, re-operation was suggested, however the patient did not accept.Conclusion: The definitive diagnosis in parathyroid cancer is made by postoperative pathological examination. In cases of primary hyperparathyroidism, in case of intravesical invasion of the thyroid capsule and surrounding tissues during intraoperative examination, parathyroid cancer should be suspected. In case of suspicious findings in frozen examination and intraoperative findings, the surgical plan may be changed and the necessity of secondary surgery can be eliminated.Keywords: Parathyroidcarcinoma; thyroidectomy, hypercalcemia.

PubMedID: 18751948 Purpose. The aim of this study is to compare the results of different operating techniques and suture materials for pyloric exclusion procedures. Methods. The study was conducted on a sample of 125 rats. Transgastric pyloric exclusions with gastrojejunostomy were performed on the first 50 rats, which were divided into two groups each of 25: a resorbable (polyglactin) suture material was used in the first group and a nonresorbable (silk) material was used in the second group. External pyloric exclusion with a gastrojejunostomy were performed in a subsequent group consisting of 50 rats, again divided into two subgroups of 25 each with an absorbable (polyglactin) suture material used in one and a nonabsorbable (silk) material used in the other. For the last 25 rats external pyloric exclusion with a gastrojejunostomy were performed and a nonresorbable (polypropylene) material was used. Results. The ratio of pyloric reopening was higher in the transgastric group than the external exclusion group on the 14th day (P = 0.01). The external pyloric exclusion group with polypropylene suture material had the lowest ratio of pyloric reopening. Conclusion. The external pyloric exclusion technique with nonresorbable (preferably polypropylene) suture material was therefore found to provide a higher pyloric closure incidence on the 14th day, which is the necessary duration period for healing in duodenal injuries. © 2008 Springer.

Background: Pigmented mammary Paget’s disease (PMPD) of the male breast is extremely rare, and only few cases have been reported to date. Due to the scarcity of the disease, diagnosis as well as treatment is usually delayed. Men tend to present with earlier symptoms, nevertheless, prognosis is known to be worse, with only 20% to 30% of the patients surviving over a five year period. Methods: A case report of a 47-year-old male who presented with a chronic pigmented lesion on the nipple that was later on diagnosed as PMPD. Results: Microscopic pathological evaluation of mastectomy specimen of the nipple revealed invasive ductal carcinoma Grade II and in situ ductal carcinoma. Estrogen and progesterone receptors were 95% and 80% positive for tumor cells. Atypical cells stained positivite for anticytokeratin 7, c-erbB-2, and CEA on immunohistochemistry while cytoplasmic dusty melanin pigments stained focally positive for S-100 and HMB-45. Conclusion: Although being a rare entity; PMPD should always be kept in mind as a differential diagnosis in melanocytic lesions of the nipple. Histopathology including immunohistochemical staining should always be performed for the correct diagnosis and management.

PubMedID: 26093739 Objectives This study presents the overall long-term hepatitis B virus (HBV) recurrence rate with possible associated factors after hepatitis B immunoglobulin (HBIG) was given in combination with 4 different antiviral (lamivudine, adefovir, entecavir, and tenofovir) drugs. Patients and Methods Between September 2000 and October 2013, the medical records of 42 adult patients who underwent liver transplantation at the Cukurova University Medical Hospital for chronic liver failure or hepatocellular carcinoma (HCC) secondary to chronic HBV were reviewed retrospectively. The analyses of risk factors for recurrence were performed based on the efficacy of hepatitis B envelope antigen (HBeAg), hepatitis B core antibody (anti-HBc), HBV DNA, preoperative prophylaxis, and the presence of HCC. Posttransplantation HBV recurrence was defined as persistence of hepatitis B surface antigen (HBsAg) positivity after orthotopic liver transplantation, or the reappearance of HBsAg and HBV DNA after initial HBsAg undetectability despite prophylaxis. Results The mean follow-up of 28 patients having HBIG and lamivudine prophylaxis was 73.25 ± 37.5 months with a recurrence rate of 3.5%. The mean follow-up of 2 patients having HBIG and adefovir prophylaxis was 90 ± 46.6 months with a 50% recurrence rate. The mean follow-up of each 6 patients who received prophylaxis with entecavir and tenofovir groups were 27.5 ± 16.1 and 16.17 ± 5.3 respectively, with no posttransplantation recurrence for both groups. On univariate analysis, preoperative factors such as anti-HBc, HBV DNA, preoperative prophylaxis, and the presence of HCC did not show any correlation with recurrence. However, HBeAg showed statistical significance for recurrence. Conclusions Low-dose HBIG in combination with antiviral agents (lamivudine, entecavir, and tenofovir) is efficacious in preventing recurrence of HBV in posttransplantation patients. © 2015 Elsevier Inc. All rights reserved.

AMAÇ: Abdominal kompartman sendromu (AKS), sınırlı bir anatomik alana sahip karında basıncın akut ve patolojik artışı ile karakterize olup, tedavi edilmediği takdirde yüksek oranda mortaliteyle sonuçlananan klinik bir durumdur. Karıniçi basıncın progresif yükselmesi sonucu ortaya çıkan bu sendromun etkileri sistemik olarak ortaya çıkar. Abdominal kompartman sendromunun tedavisi, artmış karıniçi basıncın düşürülmesidir. Dekompresif laparotomi kararını vermede en önemli kriter hastanın klinik tablosudur. Grade 3 ve 4 hastalarda dekompresif laparatomiyi takiben ameliyat sonrası karıniçi basıncın tekrar yükselmesini engellemek için karın kapatılmaz, açık abdomen uygulanır. Bu çalışmada, dekompresif laparotomi uygulanmış evre 3 ve 4 AKS'li hastalara geçici karın kapatılmasında kullanılan Vacuum-assisted closure (VAC) ve Bogota bag yöntemlerinin randomize ileriye yönelik değerlendirilmesi amaçlandı. GEREÇ VE YÖNTEM: Bu çalışmaya Şubat 2007 ile Eylül 2010 tarihleri arasında Çukurova Üniversitesi Tıp Fakültesi Genel Cerrahi Yoğun Bakımı'na travma, geçirilmiş cerrahi sonrası ya da medikal takiplerinin izlemi sırasında AKS gelişmiş ve tedavilerinin bir parçası olarak dekompresif laparotomi uygulanmış 40 hasta alındı. Hastalar ardışık randomizasyon yöntemi ile VAC ve Bogota bag olmak üzere iki gruba ayrıldı. Geçici karın kapama yöntemleri olan bu yöntemlerin sonuçları gruplar arasında randomize ileriye yönelik olarak klinik, laboratuvar, morbidite ve mortalite yönünden karşılaştırılarak değerlendirilldi. BULGULAR: Her iki gruptaki hastaların yaş, cinsiyet, vücut kitle indeksi ve yandaş hastalıkları gibi demografik özellikleri arasında anlamlı fark yoktu. AKS gelişen hastalarda etiyolojik faktörler arasında en sık neden 12 hastada (%30) görülen gastrointestinal sistem perforasyonu idi. İnsizyon boyutu ölçümlerinde VAC grubunda daha anlamlı bir azalma vardı. Hastanın primer fasya kapatılması için uygun hale gelmesi için geçen zaman VAC grubunda 16.9 gün iken, Bogota bag'li grupta 20.5 gün idi. Karıniçi basıncı düşürme değerlendirildiğinde; her iki grupta 1., 4. ve 7. günlerde benzer oranlarda düşme saptanırken, ameliyat sonrası 14. günde VAC grubunda anlamlı olarak daha fazla düşme saptandı. Mortalite gelişen hasta sayısı 12 (%30) iken, beş (%12.5) hasta VAC grubuna, yedi (%17.5) hasta Bogota bag grubuna aitti. TARTIŞMA: Bulgulara dayanarak geçici karın kapama yöntemi olarak VAC uygulamasının daha uygun olduğu kanaatindeyiz. BACKGROUND: Abdominal compartment syndrome (ACS) is a clinical syndrome characterized by progressive intraabdominal organ dysfunction resulting from an acute increase in intra-abdominal pressure (IAP). In the absence of prompt treatment, ACS can lead to lethal organ failure. Treatment of ACS is achieved by immediate decompression of the abdominal cavity. As to how and when decompression laparotomy should be performed depends on the clinical condition of the patients. There is limited data regarding outcomes of abdominal closure techiques. The present study aimed to investigate two different temporary closure methods, the vacuum assisted closure (VAC) and Bogota bag techniques, in 40 patients who underwent decompressive laparotomy as part of the management of ACS.METHODS: The study included 40 patients who developed ACS during follow-up or following trauma and abdominal surgery. As part of the treatment for ACS, these patients underwent decompressive laparotomy at the Cukurova University Medical Faculty, General Surgery Department and followed up in the Intensive Care Unit of the same hospital. VAC and Bogota bag procedures were performed as temporary closure methods for the treatment of ACS. Patients were randomly assigned to each of the two groups according to the temporary closure method performed. Clinical, laboratory, mortality and morbidity results of the patients in both groups were compared.RESULTS: Demographic features of the patients (age, sex, body mass index, co-morbidities) were similar between the two groups. The most common reason of ACS was gastrointestinal perforation in 12 (30%) patients. Decrease in incision width was significantly faster in the VAC group than in the Bogota group. Primary closure of fascia was considered appropriate in 16.9 days in the VAC group and 20.5 days in the Bogota bag group. The decrease in abdominal pressure was similar between the two groups on days 1, 4 and 7 but appeared to be significantly lower on day 14 in the VAC group. 12 patients (30%) died during the study. Among the deceased patients, 5 (12%) were in the VAC group, whereas, 7 (17.5%) belonged to the Bogota bag group.CONCLUSION: Based on these results, it is suggested that VAC has advantages when compared to the Bogota bag as a temporary closure method in the management of abdominal compartment syndrome

In some patients of Fournier gangrene originated from perianal region, it is important to prevent fecal contamination in order to provide healing without wound infection. For this purposes, diverting colostomy or bowel management catheter methods were performed. In this study, it is aimed to carry out a comparison of prognosis and cost efficiency between diverting colostomy and bowel management catheter methods applied for preventing fecal contamination in Fournier’s gangrene patients. Fourty-eight patients with diagnosis of Fournier’s gangrene, serious perianal infections, and preserved sphincters and without rectum injury after debridement were included in the study. The cases were divided into two groups as patients who were subjected to colostomy for fecal diversion and who were subjected to bowel management catheter without colostomy. Then, the groups were compared in terms of age, predisposing factors, duration of hospital stay, mortality, additional surgery requirements, and cost. Fourty-eight patients were included the study. Sixteen patients were treated without colostomy. Decreased duration of total hospital stay, additional surgery requirements, and hospital expense in bowel management catheter group has determined. It is thought that preferring bowel management catheter method instead of colostomy in patients without rectum injury, who require diverting colostomy and have undamaged anal sphincters, can relieve patients, patients’ relatives, healthcare organizations, and the national economy of a serious burden. In addition, although patients’ satisfaction and workforce loss factors are not taken into consideration in this study, the bowel management catheter method is thought to have positive effects also on these parameters. © 2013, Association of Surgeons of India.

Background:Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. It may result in potentially seri-ous complications including metabolic bone diseases, severe athero-sclerosis and undesirable cardiovascular events. Parathyroidectomy is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years. Aims:The aim of the current study was to evaluate the short-term and long-term outcomes of patients with secondary hyperparathyroidism who had undergone total parathyroidectomy with autotransplantation and thymectomy or subtotal parathyroidectomy with thymectomy by the same surgical team during the study period. Study Design: Retrospective comparative study.Methods:Clinical data of 50 patients who underwent parathyroid surgery for secondary hyperparathyroidism between 2003 and 2011 were reviewed retrospectively. Patients were divided into two sub-groups of total parathyroidectomy with autotransplantation or sub-total parathyroidectomy. Thymectomy was routinely performed for both groups. Short term outcome parameters included intact parathy-roid hormone, ionized calcium and alkaline phosphatase levels. Bone pain, bone fractures, persistent or recurrent disease were included in long term outcome parameters.Results:The mean duration of dialysis was eight years. The mean ionized calcium levels dropped significantly in the total parathyroid-ectomy with autotransplantation group (p=0.016). No serious post-operative complications were observed. Postoperative intravenous calcium supplementation was required in four patients in the total parathyroidectomy with autotransplantation group (total PTX+AT) and in three patients in the subtotal parathyroidectomy group (subto-tal PTX). Postoperatively, all patients received oral calcium carbonate and calcitriol. The length of average hospital stay was 5 (3-10) days. Including nine patients who underwent successful renal transplanta-tion pre-operative bone symptoms, hypercalcemia, hyperphosphate-mia, and an increased alkaline phosphatase levels were improved or resolved in all patients. After a mean follow-up of 65 months, three patients (6%) had persistent and one (2%) had recurrent disease.Conclusion:Total parathroidectomy with autotransplantation is a beneficial and safe surgical procedure for patients on chronic di-alysis with otherwise uncontrollable secondary hyperparathroidism and even in patients who have undergone renal transplantation after parathyroidectomy. Careful cervical exploration and routine thymec-tomy should be considered as a routine part of the surgical approach regardless of the preferred technique Background:Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. It may result in potentially seri-ous complications including metabolic bone diseases, severe athero-sclerosis and undesirable cardiovascular events. Parathyroidectomy is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years. Aims:The aim of the current study was to evaluate the short-term and long-term outcomes of patients with secondary hyperparathyroidism who had undergone total parathyroidectomy with autotransplantation and thymectomy or subtotal parathyroidectomy with thymectomy by the same surgical team during the study period. Study Design: Retrospective comparative study.Methods:Clinical data of 50 patients who underwent parathyroid surgery for secondary hyperparathyroidism between 2003 and 2011 were reviewed retrospectively. Patients were divided into two sub-groups of total parathyroidectomy with autotransplantation or sub-total parathyroidectomy. Thymectomy was routinely performed for both groups. Short term outcome parameters included intact parathy-roid hormone, ionized calcium and alkaline phosphatase levels. Bone pain, bone fractures, persistent or recurrent disease were included in long term outcome parameters.Results:The mean duration of dialysis was eight years. The mean ionized calcium levels dropped significantly in the total parathyroid-ectomy with autotransplantation group (p=0.016). No serious post-operative complications were observed. Postoperative intravenous calcium supplementation was required in four patients in the total parathyroidectomy with autotransplantation group (total PTX+AT) and in three patients in the subtotal parathyroidectomy group (subto-tal PTX). Postoperatively, all patients received oral calcium carbonate and calcitriol. The length of average hospital stay was 5 (3-10) days. Including nine patients who underwent successful renal transplanta-tion pre-operative bone symptoms, hypercalcemia, hyperphosphate-mia, and an increased alkaline phosphatase levels were improved or resolved in all patients. After a mean follow-up of 65 months, three patients (6%) had persistent and one (2%) had recurrent disease.Conclusion:Total parathroidectomy with autotransplantation is a beneficial and safe surgical procedure for patients on chronic di-alysis with otherwise uncontrollable secondary hyperparathroidism and even in patients who have undergone renal transplantation after parathyroidectomy. Careful cervical exploration and routine thymec-tomy should be considered as a routine part of the surgical approach regardless of the preferred technique

Background: Behçet's disease (BD) is an inflammatory multisystem disorder, characterized by recurrent oral and genital ulcers, erythema nodosum-like lesions, papulopustular lesions, uveitis, large vessel thrombosis as well as neurologic and gastrointestinal manifestations. Case Report: A 55-year-old man with BD was admitted to the emergency room with perianal abscess and necrosis. One day after abscess drainage and débridement the patient developed peritonitis, and sepsis ensued. Histopathologic examination of the skin overlaying the débridement area revealed vasculitis and fibrinoid necrosis. Emergency laporatomy revealed multiple 'punchedout' perforations with 0.5-1 cm in diameter over the whole small intestine concentrating in the terminal ileum. Débridement - primary repair and partial ileal resection - of ileostomy was done. The patient died due to sepsis and multiple organ failure on the first postoperative day. Histopathologic examination revealed nonspecific inflammatory cell infiltrates surrounding capillaries and venules, especially in the submucosa and serosa (vasculitis) with no evidence of granulomatous inflammation. Conclusion: Anal abscess or necrosis in a patients with BD may be a clue to the presence of intestinal BD with imminent perforation, representing the widespread vasculitis of the gut in BD. © 2007 S. Karger GmbH.

Although epidermal cysts are frequently observed throughout the body, they are rarely found in the retrorectal/presacral regions. Retrorectal epidermal cysts are congenital lesions of ectodermal origin and generally occur in women during the reproductive period. In this case report, a 47 year old female patient with 25 years of complaint of a mass extending from the perianal region to the retro-coccygeal region is discussed. A total mass excision with paracoccygeal incision was performed under spinal anesthesia. The histopathologic examination demonstrated an epidermal cyst. Correct diagnosis and appropriate treatment when first detected significantly decrease the recurrence and complication risks in all retrorectal tumors. Any mass should be completely removed in the treatment.

Epidermal kistler vücudun her yerinde sık görülmesine rağmen, retrorektal/presakral bölgede oldukça nadir görülmektedir. Retrorektal epidermal kistler ektodermal orijinli, konjenital lezyonlar olup genellikle reprodüktif dönemdeki kadınlarda görülür. Bu olgu sunumunda yaklaşık 25 yıldır perianal bölgeden retrokoksigeal bölgeye uzanan kitle şikayeti olan, 47 yaşında bir kadın hasta tartışıldı. Hastaya spinal anestezi altında parakoksigeal insizyon ile total kitle eksizyonu uygulandı. Histopatolojik inceleme sonucu epidermoid kist tespit edildi. Tüm retrorektal tümörlerde, ilk karşılaşıldığında doğru tanı ve uygun tedavi nüks ve komplikasyon riskini önemli ölçüde azaltır. Tedavide kitle total olarak çıkarılmalıdır. Although epidermal cysts are frequently observed throughout the body, they are rarely found in the retrorectal/presacral regions. Retrorectal epidermal cysts are congenital lesions of ectodermal origin and generally occur in women during the reproductive period. In this case report, a 47 year old female patient with 25 years of complaint of a mass extending from the perianal region to the retro-coccygeal region is discussed. A total mass excision with paracoccygeal incision was performed under spinal anesthesia. The histopathologic examination demonstrated an epidermal cyst. Correct diagnosis and appropriate treatment when first detected significantly decrease the recurrence and complication risks in all retrorectal tumors. Any mass should be completely removed in the treatment.

Amaç: Bu çalışmada klinik olarak aksilla negatif erken evre meme kanserli hastalarda sentinel lenf nodu biyopsisinin etkinliği araştırıldı. Yöntemin sen- tinel lenf nodunu bulma ve yanlış negatiflik oranları hesaplanarak erken evre meme kanserli hastalarda aksillanın değerlendirilmesinde sentinel lenf nodu biyopsisinin yerinin belirlenmesi amaçlandı. Gereç ve Yöntem: Bu prospektif çalışma, erken evre meme kanseri tanısıyla Mart 2006 – Mart 2009 tarihleri arasında Çukurova Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı’nda tedavi edilen 57 hastada yapıldı. Hastalar iki farklı gruba ayrıldı. Grup I’de 35 hastada mavi boya tekniği, Grup II’de 22 has- tada kombine teknik uygulandı. İnvaziv kanser saptanan 46 hastaya sentinel lenf nodu biyopsisi sonrası aksiller lenf nodu diseksiyonu yapıldı. Bulgular: Grup I’de 2 hastada, Grup II’de 1 hastada olmak üzere toplam 3 hastada sentinel lenf nodu saptanamadı. Sentinel lenf nodu bulma oranı tüm hastalar için %94,7 olup bu oran Grup I’de %94,2 , Grup II’de %95,4 idi. Yanlış negatiflik oranı Grup I’de %22,2 , Grup II’de %30 olup tüm hastalar için %26,3 idi. Tekniği öğrenme sürecindeki ilk 15 olgu değerlendirme dışı bırakıldığında tüm grupta sentinel lenf nodu bulma oranı %96,8’e yükselirken yanlış negatiflik oranı %0’a geriledi. Sonuç-Yorum: Bu çalışmada erken evre meme kanserli hastalarda aksillanın evrelemesinde sentinel lenf nodu biyopsisinin etkin ve güvenli bir yöntem olduğu belirlendi. Her merkezin yeterli deneyim kazanıncaya kadar, sentinel lenf nodu biyopsisi ile aksiller lenf nodu diseksiyonunu beraber yapmasının daha güvenli olacağı düşünüldü. Purpose: In this study, sentinel lymph node identification and false negative rates were calculated and determination of the place of sentinel lymph node biopsy in the evaluation of axilla in patients with early stage breast cancer was aimed. Materials and Methods: This prospective study was performed on 57 patients with early stage breast cancer who were treated at the Department of Sur- gery in Medical Faculty of Çukurova University between 2006-2009. Blue dye technique was performed in 35 (Group I ) and the combined technique was performed in 22 patients (Group II). Axillary lymph node dissection was per- formed after sentinel lymph node biopsy on 46 patients who have invasive breast cancer. Results: Sentinel lymph node was not detected in two patients in Group I and one in Group II. Sentinel lymph node identification rate was 94.7% for all pa- tients, and it was 94.2% in Group I and 95.4% in Group II. False negative rate was 26.3% for all patients which was 22.2% in Group I and 30.0% in Group II. Sentinel lymph node identification rate was increased to 96.8% and false negative rate decreased to 0% when the first 15 patients within the learning period was excluded from the statistical analysis. Conclusion: Sentinel lymph node biopsy is a safe and effective technique on staging of axilla in patients with early stage breast cancer. Nevertheless, every medical center should perform sentinel lymph node biopsy and axillary lymph node dissection together untill getting experienced.

PubMedID: 22146169 BACKGROUND: There is no debate that laparoscopic fundoplication has become the standard procedure for surgical management of gastroesophageal reflux disease. However, there is still no consensus on whether to use prosthetic material routinely and on the preferred kind of prosthetic material. The aim of this study was to evaluate polyglactin mesh and polypropylene mesh use in laparoscopic antireflux surgery (LARS) with particular regard to symptomatic relief, patient satisfaction, and complications. METHODS: This prospective randomized study included 75 patients who underwent LARS with polypropylene mesh prosthesis and 75 patients who underwent LARS with polyglactin (vicryl) mesh prosthesis between January 2005 and January 2010. Preoperative and postoperative assessments of symptomatic and functional outcomes of patients were recorded. Outcome data analyzed included length of hospitalization, operative time, complications, and recurrence. RESULTS: Laparoscopic repair of hiatal crura with a polyglactin mesh resulted in good symptomatic and clinical outcomes similar to that of polypropylene mesh. The recurrence rate with the use of polyglactin mesh is comparable to that of synthetic or biological materials reported in the literature. CONCLUSIONS: Closure of hiatal crura with a prosthetic polyglactin (vicryl) mesh at LARS is an effective and safe procedure. © 2011 by Lippincott Williams & Wilkins.

Kimyasal madde içilmesi hastalarda ciddi sonuçlar oluşturabilir. Bu sonuçlardan biri olan striktür gelişimini önlemek için çeşitli tedavi prokolleri kullanılmaktadır. Biz tek başına konvansiyonel tedavi ile beraberinde oral yoğun sükralfat tedavisinin bir arada uygulanmasını karşılaştırmak amaçlı randomize prospektif bir çalışma planladık. Yöntem: 2004-2007 yılları arasında hastanemiz gastroenteroloji, genel cerrahi ve yoğun bakım ünitelerine kabul edilmiş evre 2b ve 3 koroziv özofajiti olan hastalar çalışmaya dahil edilmiştir. Hastalar iki gruba ayrılmıştır. Birinci gruptaki hastalara (n=8) konvansiyonel tedavi ile birlikte yoğun sükralfat, ikinci gruba (n=7) ise sadece konvansiyonel tedavi verilmiştir. 0, 21, 45, 90 ve 180. günlerde ortaya çıkabilecek komplikasyonları değerlendirmek için üst gastrointestinal endoskopik inceleme uygulanmıştır. Bulgular: Birinci grup hastanın sadece bir tanesinde semptom olarak disfajiye neden olmayan, 45. günde yapılan üst endoskopide saptanan ve 9,2 mm'lik endoskopun geçişine izin veren striktür oluşmuştur. Üçüncü ve altıncı ayki takiplerinde striktürde her hangi bir progresyon izlenmemiştir. İkinci grupta ise 6 hastada disfaji ve daralmaya neden olan striktür oluşumuna rastlanmıştır. Sonuç: Yoğun sükralfat tedavisi ileri evre koroziv özofajiti bulunan hastalarda striktür gelişim sıklığını azaltabilir. Daha fazla sayıda hasta içeren gruplar ile yapılacak çalışmalarla bulgularımızın destekleneceğini umuyoruz. Ingestion of a chemical agent is a serious problem, and several treatment protocols to prevent stricture formation have been proposed. We conducted a randomized prospective study to evaluate the effectiveness of oral intensive sucralfate plus conventional therapy compared to conventional therapy alone. Methods: Fifteen patients with stage 2b and 3 corrosive esophagitis admitted to our gastroenterology, general surgery and intensive care units between 2004 and 2007 were included. Patients were divided into two groups. The patients in the first group (n=8) received intensive sucralfate therapy plus conventional therapy, while the other group (n=7) received only conventional therapy. We performed upper endoscopic procedures on days: 0, 21, 45, 90 and 180 to identify the emergent complications. Results: In the first group, only one patient had stricture formation, allowing passage of a 9.2 mm endoscope and causing no dysphagia, on day 45. There was no progression in the stricture on follow-ups at the 3rd and 6th months. In the second group, 6 patients had stricture formation causing narrowing and dysphagia. Conclusions: Intensive sucralfate therapy may decrease the frequency of stricture formation in patients with advanced corrosive esophagitis. Further studies with large groups of patients are required to confirm our findings.

PubMedID: 19524183 The aim is to evaluate the antioxidant enzyme levels in tumoral tissues and accompanying normal tissues in gastrointestinal cancer; and compare the colorectal cancer (CRC) with gastric cancer (GC). Method: Antioxidant enzymes including glutathione reductase (GR), glutathione peroxidase (GPX), superoxide dismutase (SOD), malondialdehyde (MDA) and glucose 6 phosphate dehyrogenase (G6PD) which are important for anti-oxidant functions were evaluated in fresh tumor tissues and adjacent normal tissues obtained from a total of 58 patients. Results: All the enzyme levels were higher in tumoral tissues compared to normal tissue from non-cancerous disease. There was not a significant difference for enzyme levels between CRC and GC groups except GPx. GPx activity tended to be higher in cases without serosal involvement (SI), and this activity was higher in cases without lymph node (LN) involvement in normal tissue (p = 0.012). MDA activity was higher in cases without serosal involvement compared to with SI groups in tumor tissue (p = 0.050). G6PD activity in normal tissue was higher in cases with serosal involvement and LN involvement (p = 0.064, 0.046, respectively). GR activity was higher in signet ring cell cancer (SRC) than adeno cancer. In GC, G6PD activity in tumor was tended to be higher in undifferentiated cancer (p = 0.071). Conclusion: The antioxidant enzymes activities such as GPX, SOD, G6PD, MDA and GR were found to be related with malignant phenotype in gastrointestinal cancers. We need further studies to understand the biologic and clinical importance of these enzymes in GI cancers. © 2009 Elsevier B.V. All rights reserved.

PubMedID: 19010110 Background: Pilonidal sinus is a difficult disease to treat. Many treatment modalities from secondary-intention healing to various types of flaps have been used with each having different rates of success. Materials and methods: A perforator flap based on the superior gluteal artery perforators was designed at 45°-angle to the defect created by the excision of the pilonidal sinus and was transposed in 15 male patients with un-operated chronic pilonidal sinus. Defect and flap size, length of surgery, blood loss, time to mobilisation, hospital stay, time of return to work and rate of complications were evaluated. Results: The average defect size in length, width and depth were 6.9 cm, 3 cm and 3 cm, respectively. The cutaneous part of the flaps was exactly the same size as the defect. The average length of surgery was 45 min (sinus excision 10 min, flap harvest 15 min and closure 20 min) with blood loss being less than 25 cm3. Patients were mobilised and discharged home the morning after surgery (less than 24 h). The patients were able to return to normal daily activities after 3 days and to work 10 days after the surgery. There were no complications and no recurrences at an average of a 10-month follow-up. Conclusion: The superior gluteal artery perforator flap (SGAP) offers many advantages over random (better vascularity and flap safety) or larger flaps (decreased operating time and donor-area morbidity) in the treatment of pilonidal sinus disease. We present our results with the use of the SGAP flap, which is designed at a 45°-angle to the defect created by the excision of the pilonidal sinus. Compared to the previously described techniques, it has the advantage of closing defects of any size within a short surgical time and minimal blood loss. The hospital stay, time to mobilisation and return to daily activities and work are shortened, in addition to zero complications and recurrence rates. © 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons.

To evaluate the preoperative and postoperative values of serum levels of zinc, magnesium, and copper in patients with cystic echinococcosis (CE).This study was conducted on patients with CE between 2000-2005 at the Faculty of Medicine, University of Cukurova, Adana, Turkey. Serum levels of zinc, copper, and magnesium of 85 patients with CE were measured both before and one year after the operation. Patients with liver CE (85 patients, 48 males) and healthy adults (40 adults, 17 males) as the control group were enrolled in the study.When compared with the control group, the mean serum levels of zinc and magnesium were lower and the mean serum level of copper was higher in the preoperative period. It was found that as duration of symptoms increased, serum zinc and magnesium levels decreased and copper levels increased. The serum levels of these elements in postoperative and control patients after one year compared equally with the levels in the initial control.The probability of increased consumption of zinc and magnesium and secretion of copper by the parasite may lead to evaluating the follow up of hydatid surgery in addition to radiological and serological methods.

WOS: 000254501400024 PubMed ID: 18377614 …

Purpose : We report six cases of Alveolar Hydatid Disease (five in the liver and one in the gastrosplenic ligament invading the spleen) in which curative resection of the liver (five cases) and splenectomy (one case) were performed. Material and Methods: The records of the six patients with AHD were retrospectively evaluated. Demographics of the patients, symptoms, laboratory findings, including serology were recorded. Imaging studies determined the extent of the disease preoperatively. Classification of the lesions was done according to the PNM (P = parasitic mass in the liver, N = involvement of neighbouring organs, and M = metastasis) staging system designed by the World Health Organization. All the surgical procedures were performed as complete resections, where negative margins were approved by frozen sections. Chemotherapy with albendazole (10 mg/kg/day) was continued postoperatively for two years in five of the six patients who were alive. Results : All of the cases were from East Anatolia of Turkey, which is an endemic region. The mean age was 39.6 years (15-54 years). Major complications occurred post-operatively in all patients, possibly due to the extensive resection. No recurrence was seen during the 5 year follow-up of two cases and 2 year follow-up of three cases. Conclusion: The treatment of Alveolar Hydatid Disease is curative radical resection. Thus, pre-operative imaging studies to determine the extent and stage of the disease are of crucial importance.

PubMedID: 18026790 Background: Abdominal compartment syndrome (ACS) is a diffucult entity with two main problems during its course: (1) survival of the patient during the early period and (2) closure of the open wounds during the late period. In this study we evaluated the decision to decompress according to the level of intraabdominal pressure (IAP) and analysis of any recurrent or persistent increase in IAP. Methods: A prospective study was undertaken on 119 patients with increased IAP. The IAP was measured daily by obtaining the bladder pressure. Patients were monitored via a central venous line; and vital signs, arterial blood gases, the Acute Physiology, Age, and Chronic Health Evaluation II (APACHE II) score, and abbreviated mental tests were recorded. The suggestions of Meldrum et al. were taken as a guideline during the treatment. The sensitivity and specifity of IAP and APACHE II scores for different cutoff values were calculated using the receiver operating characteristic curve. Results: Hospital mortality was 33.6%, which increased with co-morbidities (p = 0.03). A cutoff value for IAP of 23 mmHg was considered an optimal point predicting mortality. The IAP within the first 3 days for patients who died was higher than the cutoff value. For patients with IAP of 15 to 25 mmHg, nonsurgical therapy increased the rate of mortality (odds ratio 5.2, 95% confidence interval 1.0-27.7; p = 0.03). Conclusions: In patients with ACS emergency, it is recommended that decompressive laparotomy to be performed even if the IAP falls below 25 mmHg. For patients with IAP levels higher than 25 mmHg, the IAP should be meticolusly brought below the cutoff level during the postoperative period. © 2007 Société Internationale de Chirurgie.

PubMedID: 17427114 Fasciola hepatica is a trematode rarely causing disease in humans. In symptomatic cases, while various pathologies such as damage to liver parenchyma, acute cholecystitis, and obstructive jaundice can be seen, the development of pancreatitis is rarely mentioned in the literature. The treatment of the disease is medical. In cases where no definite diagnosis can be made or in incidental cases where common bile duct exploration is being done, F. hepatica can be detected accidentally during operation. No consensus has yet been reached on the surgical procedure to be applied in this condition. We report on our case due to the rare occurrence of pancreatitis as a complication. In surgical cases, external drainage of the bile is both crucial in observing the response to the treatment, and also should be accepted as part of the treatment. © Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart.

WOS: 000247892800016 PubMed ID: 17685261 Chylous fistula is a complication related to thoracic duct injury, appearing in upper abdominal, thoracic and neck surgery. Occurrence of chylous fistula is very rare after modified radical mastectomy. We encountered a chylous fistula case after breast cancer surgery and successfully treated it conservatively. It is important that all surgeons dealing with breast surgery should be aware that, altough rarely, a chylous fistula can develop after axillary dissection. Experience related to the occurrence of this complication and its management when it occurs is quite restricted.

Background: Our aim was to compare drain materials with respect to their peritoneal reactions, abdominal infections, wound infections and omental covering. Materials and Methods: Pieces of silicon, plastic, caoutchouc and latex drains were placed in the abdominal cavity of rats. Laparotomies at intervals of 0, 2, and 5 days were performed in each group of animals. Drain infection, wound infection, reactional periteoneal fluid occurrence and omental covering of drain were noted. Results: Similar bacteria species were established in drain and wound cultures. While drain infections were observed mostly in the caoutchouc group on the 2nd day, drain infection was established in each group on the 5th day. Reactional fluid occurrence was observed most frequently in the latex group. The caoutchouc group exhibited the highest degree of omental covering. Conclusion: The placement of unnecessary drains should be avoided. Drains must be removed as early as possible. In surgery, silicon drains should be preferred because of their low complication, obstruction and foreign body reaction rates. © 2007 S. Karger GmbH.

Background: The purpose of this study was to assess the possible alterations of the levels of plasma NO derivates which are thought to reflect the immune status of the body against cystic echinococcus (CE). Materials and Methods: Plasma NO2 and NO3 levels of 95 patients with CE were analyzed before treatment and then after a 1 year. All patients were classified according to the WHOIWGE classification of cystic hydatid disease. The levels of NO2 and NO3 were detected from sera by using a photometric endpoint determination on the basis of absorbance in the visible range at 550 nm. Results: Pretreatment levels of plasma NO2 and NO3 of the CE group were significantly higher than those in the control group (p < 0.001). However, the posttreatment NO2 and NO3 levels of the CE group were significantly lower than the pretreatment levels (p < 0.001). Hence, a positive correlation was found between fertile capacity of CE and the levels of NO2 and NO 3 (p < 0.05). Conclusion: The analysis of the levels of plasma NO derivates should be considered for the at preoperative detection of hydatid disease and postoperative follow-up in addition to radiological and serological methods. © 2007 S. Karger GmbH.

To investigate the changes of serum malondialdehyde (MDA) level for the oxidative stress hypothesis in patients with cystic echinococcosis (CE).The study was conducted on patients with CE before the surgical treatment. Anti-Echinococcus granulosus antibodies were determined by serological method. We assayed MDA activities measured of 57 subjects and matched in 45 healthy controls. This study took place in the Faculty of Medicine, University of Cukurova, Balcali Hospital in Adana, Turkey, between March 2004 and October 2005.The mean +/- SD of MDA levels of patients with CE was 6.70 +/- 1.66 and healthy controls was 2.53 +/- 0.43. The difference between MDA levels of patients and controls was statistically significant (p0.001).The high infection/control ratio of MDA concentration and the significant correlation strongly indicate the occurrence of oxidative stress and lipid peroxidation as a mechanism of tissue damage in cases of CE. Our study highlights the usefulness of serum markers to investigate complex pathological situations, including distinct forms of chronic liver inflammation associated with CE.