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BACKGROUND: Considering the difficulty in predicting the biological behavior of gastrointestinal stromal tumors (GISTs) based on histological findings alone, genetic abnormalities have recently become an area of focus. Platelet-derived growth factor receptor (PDGFR), with 2 isoforms (α and β) is one of the mutations that play a role in the development of GIST. There are very little data determining the relationship of GIST with PDGFRβ which is associated with poor prognosis in other mesenchymal and epithelial tumors. In this study, we aimed to show the relationship between clinicopathological criteria and recurrence. We also wanted to evaluate the effect of PDGFRβ expression on recurrence and clinicopathological findings. METHODS: We evaluated 40 GIST patients retrospectively for detailed clinicopathological findings, postoperative immunohistochemical tumor markers (CD117, Ki67), and also for tumor recurrence. Immunohistochemical examination for PDGFRβ was performed for the all GIST cases. RESULTS: Tumor recurrence was related to male gender (P = .003), serosal localization (P = .004), surgical margins positivity (P = .001), risk group (P = .011), mitotic activity (P = .000), and Ki67 proliferation index (P = .000). PDGFRβ was not significantly associated with tumor recurrence (P = .277). CONCLUSION: We can say that the most important parameters related with recurrence of GISTs are mitotic activity and the Ki67 proliferation index. The determination of the cut-off value of the Ki67 proliferation index as 13% instead of 10% would be much more specific and sensitive. Although PDGFRβ may be used for the diagnosis of GIST as an alternative for PDGFRα in cases with cKIT negativity, it is not an indicator of tumor recurrence as in other tumors.

Introduction This study aimed to evaluate the effect of sono-scintigraphic correlation on the success of minimal invasive parathyroidectomy (MIP) via surgeon performed continuous intraoperative sonographic guidance in patients operated for primary hyperparathyroidism(PHPT) without intact parathormone (PTH) measurement. Materials and methods A retrospective analysis of a prospective database was conducted to review patients who underwent MIP (July 2017-October 2019). The screened parameters were preoperative PTH level, preoperative ultrasonography (US), preoperative scintigraphy, intraoperative US, intraoperative frozen section analysis, postoperative PTH level and permanent pathology report. Intraoperative intact PTH measurement was not employed due to institutional policy. Results Preoperative US alone localized the specific side (right/left, inferior/superior) of abnormality in 54 out of 74 (72.97%) cases. Scintigraphy alone localized the specific side in 58 (78.37%) cases. The sensitivity of preoperative US and scintigraphy alone was 76.05% and 86.56%, respectively. Sono-scintigraphic discordance was present in 6 cases (8.1%) and intraoperative real-time US predicted accurate localization of adenoma in 4 (66.6%) and scintigraphy in 2 (44.4%) patients. The frozen section analysis confirmed parathyroid cells in all cases evaluated. Conclusion Sono-scintigraphic concordance with intraoperative real-time imaging increases surgical success rates in cases where MIP is planned under the circumstances of limited resources regarding unavailability of intact PTH measurement.

Background: It has been known that the “atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS)” category is the most problematic category in Bethesda system due to its highly heterogeneous morphological features. Recently, it has been reported that aspirates including nuclear atypia in the AUS/FLUS category have a higher risk of malignancy. Aims: This study aimed to assess each nuclear property in aspirates with cytological atypia and also to determine the relationship with the risk of malignancy. Material and Methods: We reviewed 980 AUS/FLUS fine-needle aspirations (FNAs) performed between '2012 and 2019' at a single institution. We classified these aspirates into four groups: AUS-N (nuclear atypia), AUS-A (architectural atypia), AUS-H (Hurthle cell change), and AUS-O (other). Nuclear features were detailed sub-classified; size and shape (enlargement, elongation, and overlapping), membrane irregularities (irregular contours, grooves, pseudoinclusion), and chromatin characteristics (pale chromatin). The estimated risk of malignancy (ROM) was calculated for each subgroup. Results: Of 980 AUS/FLUS cases, follow-up histological outcome data were available for 209 cases. Among these cases, the estimated ROM was 27.8%. The ROM were 26.4%, 15.4%, and 22.5% for AUS-N, A, and H, respectively. The most common nuclear findings associated with ROM were nuclear groove (67.9%); irregular contours (76.9%) suspected pseudoinclusion (100%) and overlapping (56%) (P < 0,001). But nuclear findings such as nuclear enlargement, mild pleomorphism, or pale chromatin have a similar ROM as architectural atypia. Conclusion: Although it is known that the presence of cytological atypia in an AUS/FLUS nodule increases the estimated risk of malignancy, all nuclear properties are not equally effective in predicting malignancy risk. Emphasizing nuclear atypia details in reports of AUS case may be a more sensitive way to identify nodules with a high risk of malignancy.

Margin status is one of the significant prognostic factors for recurrence in breast-conserving surgery (BCS). The issue that merits consideration for oncologic safety and cost-effectiveness about the modalities to assure clear margins at initial surgical intervention remains controversial after neo-adjuvant chemotherapy (NAC). The presented study aimed to assess the impact of intraoperative ultrasound (IOUS)-guided surgery on accurate localization of tumor site, adequacy of excision with clear margins, and healthy tissue sacrifice in BCS after NAC. Patients who had IOUS-guided BCS ater NAC were reviewed. No patient had preoperative localization with wire or radiotracer. Intraoperative real-time sonographic localization, sonographic margin assessment during resection, macroscopic and sonographic examination of specimen, and cavity shavings (CS) were done as the standard procedure. No frozen assessment was performed. One hundred ninety-four patients were included, in which 42.5% had pCR. IOUS-guided surgery accomplished successful localization of the targeted lesions in all patients. Per protocol, all inked margins on CS specimens were reported to be tumor-free in permanent histopathology. No re-excision or mastectomy was required. For a setting without CS, the negative predictive value (NPV) of IOUS rate was 96%. IOUS was found to over and underestimate tumor response to NAC both in 2% of patients. IOUS-guided surgery seems to be an efficient modality to perform adequate BCS after NAC with no additional localization method. Especially, when CS is integrated as a standard to BCS, IOUS seems to provide safe surgery for patients with no false negativity and a high rate of NPV.

Gultekin, Fatma Ayca/0000-0002-4148-5871 WOS: 000505207100011 PubMed ID: 31895975 Background. Anastomotic leakage is a devastating complication of colorectal surgery. Neoadjuvant radiotherapy for colorectal cancer can affect the mechanical and biochemical parameters of anastomotic healing. It has been reported that ozone increases antioxidant enzyme activity and stimulates adaptive processes to oppose the pathophysiologic conditions mediated by reactive oxygen species (ROS). Objectives. The objective of this study was to investigate the effect of controlled administration of ozone on the healing of anastomosis and the activation of antioxidant enzymes in the colon after radiotherapy. Material and methods. Rats (n = 48) were randomly assigned to the following groups: control groups (1 and 2), saline-treated and irradiated (IR) groups (3 and 4) and ozone oxidative preconditioning (OOP) and IR groups (5 and 6). Rats were exposed to whole-body IR (6 Gy) after pretreatment with either saline or ozone. Rats in groups 1, 3 and 5 were euthanized on postoperative day 3, whereas those in groups 2, 4 and 6 were euthanized on postoperative day 7. The anastomoses were performed on day 7 post-IR. The anastomotic segment was resected to measure hydroxyproline (HPO) content, myeloperoxidase (MPO) activity and malondialdehyde (MDA) concentration and for histopathological evaluation. Results. The mean bursting pressure of the groups that underwent radiotherapy was lower than that of the control groups (p < 0.001). In groups 5 and 6, the tissue HPO concentrations were higher than those in groups 3 and 4. Although mean values for MPO activity in groups Sand 6 were higherthan those in groups 3 and 4, the differences were not significant. Regarding oxidative damage markers, MDA concentrations were significantly lower in group 5 than those in group 3. Conclusions. In this experimental model, OOP exerted favorable effects on colon anastomotic healing after radiation exposure.

WOS: 000461743400005, Aim: Whether it is possible to differentiate complicated from uncomplicated acute appendicitis (AA) by using complete blood count (CBC) is controversial. In this study, we analysed the predictive value of CBC in differentiating complicated from uncomplicated AA. Methods: In this retrospective study, we analyzed records of patients who underwent appendectomy in our clinic between January 1, 2015 and January 1, 2018. The demographic data and CBC reports were collected. Results: Two hundred thirty-five patients underwent appendectomy due to AA. Of the 235 patients, 164 (69.8%) had non-complicated and 71 (30.2%) had complicated AA. The mean white blood count (WBC), red cell distribution width (RDW), platelet and plateletcrit count were significantly higher in patients with complicated AA than in those with uncomplicated AA (p=0.001; p

INTRODUCTION: Preoperative evaluation is necessary for the surgical treatment of gastric cancer (GC). Nonetheless, there is no single best diagnostic modality to predict lymph node metastases prior to surgery. The aim of this study was to analyze of the diagnostic utility of positron emission tomography-computed tomography (PET-CT) and CT for the preoperative evaluation of lymph node (LN) metastases in GC. METHODS: Eighty seven patients with a history of GC, who underwent gastrectomy and D2 LN dissection were investigated. Imaging test results and pathology reports were collected from the patients’ charts. RESULTS: There was no statistical differences between PET/CT and CT scans in regard to predicting LN metastases in GC patients (p>0.05). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT scans in predicting LN metastases were 55.56%, 54.55%, 55.26%, 75%, and 33.3%, respectively, versus 60.47%, 57.69%, 59.42%, 70.27%, and 46.88% for CT scans, respectively. However, combined PET/CT and CT showed better outcomes and specificity with a PPV of 80% and 88.9%, respectively. No patients or tumor factors were found to increase the accuracy of LN metastasis prediction using either PET/CT or CT scans. DISCUSSION AND CONCLUSION: The combination of CT and PET/CT scans increases the specificity and PPV. This increases the prediction accuracy of LN metastasis in GC patients compared to the use of each type of imaging modality alone.

Although, most splenectomy is predictive due to preoperative tests, sometimes the decision to perform the splenectomy is made intraoperatively for non-primary splenic diseases. The aim of this study to investigate the risks, benefits and necessity of non-predictive of splenectomy and early outcomes. Splenectomy was performed as predictive splenectomy (PS) for primary splenic diseases and non-predictive splenectomy (Non-PS) for non-primary splenic diseases. Preoperative, operative, and 1-month postoperative data included to study. Between June 2012 and July 2018, 108 patients underwent splenectomy. Of these patients, 67 (62%) had PS for primary splenic disease, and 41 (38%) had non-PS due to non-primary splenic diseases. Patients with PS were statistically younger compared to Non-PS patients (52.82 ± 15.07 vs. 44.32 ± 19.23 years, p = 0.022). The most common cause of splenectomy in the PS group was immune thrombocytopenic purpura (ITP) in 16 (23.9%) and splenic trauma in 16 (23.9%), whereas in the non-PS group the major causes were gastric cancer in 16 (39%) and pancreas cancer in 10 (24.4%). Patients in the PS group had significantly lower postoperative hospital stay day (11.2 ± 7.3 vs. 6.4 ± 4.2, p = 0.001). The total complication rate was statistically higher in the non-PS patients (31.7% vs. 10.4%, p = 0.012). However, no significant differences were found in the postoperative infection rates (17% in non-PS versus 7.5% in PS, p = 0.22). Even if the preoperative investigation does not show any indication for splenectomy, but the surgeon has intraoperative concerns about sub-optimal oncological surgery without splenectomy, we recommend that the surgeon should perform the splenectomy. [Med-Science 2019; 8(1.000): 203-7]

Because radiation-induced cellular damage is attributed primarily to harmful effects of free radicals, molecules with direct free radical scavenging properties are particularly promising as radioprotectors. It has been demonstrated that controlled ozone administration may promote an adaptation to oxidative stress, preventing the damage induced by reactive oxygen species. Thus, we hypothesized that ozone would ameliorate oxidative damage caused by total body irradiation (TBI) with a single dose of 6 Gy in rat liver and ileum tissues. Rats were randomly divided into groups as follows: control group; saline-treated and irradiated (IR) groups; and ozone oxidative preconditioning (OOP) and IR groups. Animals were exposed to TBI after a 5-day intraperitoneal pretreatment with either saline or ozone (1 mg/kg/day). They were decapitated at either 6 h or 72 h after TBI. Plasma, liver and ileum samples were obtained. Serum AST, ALT and TNF-? levels were elevated in the IR groups compared with the control group and were decreased after treatment with OOP. TBI resulted in a significant increase in the levels of MDA in the liver and ileal tissues and a decrease of SOD activities. The results demonstrated that the levels of MDA liver and ileal tissues in irradiated rats that were pretreated with ozone were significantly decreased, while SOD activities were significantly increased. OOP reversed all histopathological alterations induced by irradiation. In conclusion, data obtained from this study indicated that ozone could increase the endogenous antioxidant defense mechanism in rats and there by protect the animals from radiation-induced organ toxicity. © The Author 2012. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Therapeutic Radiology and Oncology.