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Studies conducted in recent years have indicated a relationship between epilepsy and gut microbiota. Ion channels, excitatory/inhibitory balance and regulatory systems play a role in the pathophysiology of epilepsy. In addition, gut dysbiosis is also involved in the pathophysiology of epilepsy. This research investigated the impacts of probiotic mixture on epileptic seizures, Gamma aminobutyric acid (GABA), glutamate, and TAS and TOS levels in hippocampal tissue in the PTZ-induced acute seizure model in rats. Four groups were formed with male Wistar albino rats. The first and second groups were given 1 ml/day saline solution, and the other groups were given 0.05 mg/1 ml/day vehicle or 10 9 cfu/1 ml/day probiotic supplementation, respectively via gavage for 21 days. A single-dose PTZ (45 mg/kg) was administered to induce seizure. The stages of seizure were analyzed according to the Racine scale. While ELISA was used to determine GABA and glutamate levels in the hippocampus, an automated colorimetric method was utilized to measure oxidant/antioxidant biomarkers. It was found that by delaying the first myoclonic jerk (FMJ), and the onset of the generalized tonic-clonic seizures, the probiotic mixture demonstrated anticonvulsant effects against seizures. The probiotic mixture was found to increase the inhibitory neurotransmitter GABA. It was also found to decrease TOS levels and increase TAS concentration. The findings of this study showed that probiotic mixture reduced oxidative stress with its positive effects against PTZ-induced epileptic seizures. Further studies are needed to reveal potentially related mechanisms., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

After suspecting a plunge in the operative case logs in our clinic, we wanted to explore the COVID-19 impact on surgical training side of the lower gastrointestinal procedures to raise awareness of the possible cracks in the pillars of general surgery residency. Comparing the coronavirus impact to previous years starting from 2014, we examined the procedures of our residents for their roles in the operating room. We performed interrupted time-series analyses to get a sense of the magnitude and then used a new index to identify the trend of change in operator-to-first assistant rate of experience and searched for signs of learning-by-teaching motives. In total, 13,210 operative logs of residents were included; of procedures, 3483 (41%) were emergency. Both overall resident participations and learning-by-teaching dropped during first 3 months, followed by a rebound. The overall operator-to-first assistant rate of experience was 1.06 before and 0.86 after. Emergency procedures, obstruction, perforation, enterostomy closure, appendix, colon, anus and minimally invasive procedures, and COVID-19 were associated with learning-by-teaching (OR and 95% Cl were; 2.20, 1.76-2.75; 0.56, 0.36-0.85; 0.50, 0.38-0.67; 2.29, 1.44-3.63; 11.09, 8.33-14.75; 1.75, 1.32-2.32; 2.56, 2.03-3.22; 0.80, 0.65-0.99 and 1.93, 1.54-2.42, respectively) (p < 0.05). The study provided insights into a vastly underrated surgical education subject: learning-by-teaching. The training index introduced here was a valuable learning curve instrument that has the capacity of comparing different training parameters or different residency programs. The surge in learning-by-teaching after the pandemic was interpreted as a reflex, processing the teaching as a training tool., (© 2022. Italian Society of Surgery (SIC).)

Objective: To describe surgical procedures, previous failed pregnancies, methods for overcoming pregnancy failure and, most importantly, birth of a healthy infant, in a uterus transplantation from a deceased donor., Background: Majority of uterus transplants have involved live donors, but several advantages make deceased donor transplantation a practicable option, principally by eliminating surgical risks to the live donor., Methods: Uterus transplantation from a deceased donor was performed in September 2011 in Turkey. After 5 miscarriages, perfusion computed tomography revealed an obstructed blood-outflow. To overcome this blood flow obstruction, a saphenous vein graft was anastomosed between utero-ovarian and left ovarian vein with laparotomy. Follow-up computed tomography confirmed resolution of venous congestion and a decrease in uterine volume., Results: Following vascular augmentation surgery, fetal cardiac activity were observed 28 days after the first embryo transfer attempt. Preterm premature rupture of the membranes was diagnosed at 19 weeks' gestation. Cesarean section was planned at 28 weeks' gestation due to intrauterine growth restriction and suspected preeclampsia. A healthy 760 g male baby was delivered. The baby was discharged from the neonatal intensive care unit 79 days after delivery in good condition weighing 2475 g., Conclusions: Deceased donor uterus transplantation is a reasonable approach for treating uterine factor-related infertility. In case of recurrent miscarriages, regional vascular augmentation by arterial or venous supercharging may be required to overcome regional misperfused regions determined by imaging studies., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: There is little knowledge with regard to the management of intestinal failure in countries where home care services and dedicated intestinal rehabilitation centers are limited. This study presents a single-center experience of treating adult-type short bowel syndrome (SBS) with serial transverse enteroplasty (STEP)., Methods: Medical records were retrospectively reviewed from November 2009 to April 2018 on patients with adult-type SBS. All patients underwent STEP, and a representative quota sample of control patients treated with conventional measures were included. Clinico-demographic characteristics including baseline and post-treatment information about the orientation of bowel alignment and nutritional status were evaluated., Results: The mean patient age was 51.1 ± 16.2 in the STEP group and 57.6 ± 12.7 in the control group (P = .304). The median small bowel length was 60 cm (interquartile range (IQR): 40-90) in the STEP group (before the lengthening) and 90 cm (IQR: 70-100) in the control (at the initiation of intestinal rehabilitation) (P = .035). Durations of median follow-up were 18 months (IQR: 14-58) and 10 months (IQR: 3-14), respectively (P = .019). In the STEP group, the mean increase in bowel length after STEP was 37.3 ± 11.6 cm, and at their follow-up 7 patients (64%) had successfully progressed to enteral autonomy. In the control group, only 3 patients (27%) were successful. Mean time to wean parenteral nutrition was 45 ± 54 days, and the mean increase in enteral calorie intake was 1.79 ± 1.60-fold after lengthening in the STEP group., Conclusions: STEP is an easy-to-perform procedure in the surgical rehabilitation of adult-type SBS. When performed simultaneously with reconnection surgery, it may offer a cost-effective and comprehensive solution to the treatment strategy in middle income settings.

Introduction Adrenal incidentalomas (AI) are adrenal masses that are discovered during radiological examinations conducted for other reasons. In this study, we focused on the pathological and radiological properties of nonfunctional AI(NFAI) and the association with malignancy risk in our clinical series. Methods A total of 186 patients underwent adrenalectomy between 2010 and 2017; of these, 76 (40.8%) patients with non-functional AI were included in the current study. The radiological and pathologic characteristics of these AIs were retrospectively analyzed to determine the malignancy rate. Results There were 22 (28.9%) male and 54 (71.1%) female patients with nonfunctional AI included in this study. The median age was 55 (range: 24-85) years. Of the patients included, 37 (48.6%) had AI on the left and 39 (51.3%) had AI on the right adrenal gland. Sixty-one (80.2%) cases were treated laparoscopically, four (5.3%) required conversion to open surgery due to intraoperative difficulties such as bleeding and adhesions, and 11 (14.4%) were managed with open adrenalectomy. The rate of malignancy in the tumors with diameters of <4 cm, 4-6 cm, and >6 cm was found to be 0%, 2.9%, and 13.6%, respectively. Conclusions Determining the ideal cutoff value for surgical indication in an NFAI is challenging. Besides the malignancy risk, the rate of silent pheochromacytomas must be taken into account in the surgical decision., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Vural et al.)

Background: Oncoplastic surgery has been used in breast cancer patients for better cosmetic outcome over the last decades. The aim of this prospective randomized study is to show its place in excisional breast biopsy., Methods: An oncoplastic approach excision was compared with conventional excisional breast biopsies. The study included 80 patients, of whom half received oncoplastic intervention and half received the conventional. The primary endpoint was the cosmetic result. Patient, surgeon and independent observers rated the results on a four-point scale. Scores other than self-perceived were based on third-month medical photographs., Results: Between May 20, 2015 and April 27, 2016, 40 patients were randomly assigned to oncoplastic biopsy and 40 patients were assigned to conventional excisional biopsy. Median follow-up was 5.6 months (IQR 3.0-6.0). Self-perceived perfect scoring for general cosmetic outcome was found significantly higher after oncoplastic biopsy (73 0.5%) comparing with control group (32.4%) (p = 0.001). This impact did not change after adjusting patients for potential confounders. Margin clearance rates in malignant cases were comparable in both arms (p = 0.999); four patients in oncoplastic biopsy group (40%) and three patients in control group (33%) had positive margins., Conclusions: The oncoplastic biopsy achieved better cosmetic results with similar surgical margin positivity rates when compared with conventional breast biopsy. It may be a better biopsy option used for patients requiring excisional breast biopsy.

Purpose: To evaluate the effect of a new cross-linked hyaluronan (NCHA) gel on healing of the staple line in an experimental sleeve gastrectomy., Methods: Eighteen rats were randomly divided into three groups. The control group (n = 6) received no medication. In the saline group (n = 6) and NCHA gel group (n = 6), saline and NCHA gel were respectively administered onto the staple line and intraperitoneally into the abdominal cavity after the standard stapling procedure., Results: The fibroblast activity and collagen deposition were significantly higher in the NCHA gel group than in the control group (p = 0.00, p = 0.017) and saline group (p = 0.004, p = 0.015). The tissue hydroxyproline protein level was significantly higher in the NCHA gel group than in the control group (p = 0.041). Adhesion formation was significantly lower in the NCHA gel group than in the control and saline groups (p = 0.015, p = 0.041)., Conclusions: New cross-linked hyaluronan gel could be an effective approach to improve staple line wound healing and prevent potential leakage after sleeve gastrectomy. Moreover, NCHA gel helps to prevent adhesion formation without compromising healing of the staple line.

Deltamethrin, synthetic type II pyrethroid, is one of the most widely used pesticide in agriculture. Intense use of deltamethrin can cause permanant or temporary damages in nontarget plant species. In this study, we aimed to determine DNA methylation change and DNA damage level in Phaseolus vulgaris seedlings subjected to different concentrations of deltamethrin (0.02, 0.1 and 0.5 ppm). Coupled Restriction Enzyme Digestion-Random Amplification (CRED-RA) was performed to analyze the changes of DNA methylation as well as Randomly Amplified Polymorphic DNA (RAPD) was used for genotoxic influences estimation and genomic stability. The results showed that deltamethrin caused to increase in RAPD profile changes (DNA damage) and reduce in Genomic Template Stability (GTS). GTS declined markedly in relation to increasing concentration of deltamethrin applied. The lowest GTS value (71.4%) observed in 0.5 ppm deltamethrin treatment. Also, DNA hypermethylation was occurred in all treatments. Moreover, alleviative effect of 5-aminolevulinic acid (ALA) (20, 40 and 80 mg/l), one of the plant growth regulators, was tested against the 0.5 ppm deltamethrin. Adverse effects of deltamethrin on GTS decreased after ALA treatments, especially 20 mg/l concentration. As a result, we concluded that ALA has a strong anti-genotoxic agent against deltamethrin and it could be an alternative chemical to reduce genetic damage in plants under deltamethrin stress conditions., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Purpose: Ultrasonography (US) is an inexpensive, noninvasive and easy imaging procedure to comment on the kidney disease. Data are limited about the relation between estimated glomerular filtration rate (e-GFR) and all 3 renal US parameters, including kidney length, parenchymal thickness and parenchymal echogenicity, in chronic kidney disease (CKD). In this study, we aimed to investigate the association between e-GFR and ultrasonographic CKD score calculated via these ultrasonographic parameters., Methods: One hundred and twenty patients with stage 1-5 CKD were enrolled in this study. The glomerular filtration rate was estimated by the Chronic Kidney Disease Epidemiology Collaboration equation. US was performed by the same radiologist who was blinded to patients' histories and laboratory results. US parameters including kidney length, parenchymal thickness and parenchymal echogenicity were obtained from both kidneys. All 3 parameters were scored for each kidney, separately. The sum of the average scores of these parameters was used to calculate ultrasonographic CKD score., Results: The mean age of patients was 63.34 ± 14.19 years. Mean kidney length, parenchymal thickness, ultrasonographic CKD score and median parenchymal echogenicity were found as 96.2 ± 12.3, 10.97 ± 2.59 mm, 6.28 ± 2.52 and 1.0 (0-3.5), respectively. e-GFR was positively correlated with kidney length (r = 0.343, p < 0.001), parenchymal thickness (r = 0.37, p < 0.001) and negatively correlated with CKD score (r = -0.587, p < 0.001) and parenchymal echogenicity (r = -0.683, p < 0.001). Receiver operating characteristic curve analysis for distinction of e-GFR lower than 60 mL/min showed that the ultrasonographic CKD score higher than 4.75 was the best parameter with the sensitivity of 81% and positive predictivity of 92% (AUC, 0.829; 95% CI, 0.74-0.92; p < 0.001)., Conclusion: We found correlation between e-GFR and ultrasonographic CKD score via using all ultrasonographic parameters. Also, our study showed that ultrasonographic CKD score can be useful for distinction of CKD stage 3-5 from stage 1 and 2. We suggested that the ultrasonographic CKD score provided more objective data in the assessment of CKD.

Purpose: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were established showing the poor prognosis in some diseases, such as cardiovascular diseases and malignancies. The risk of mortality in patients with end-stage renal disease (ESRD) was higher than normal population. In this study, we aimed to investigate the relationship between NLR, PLR, and all-cause mortality in prevalent hemodialysis (HD) patients., Methods: Eighty patients were enrolled in study. NLR and PLR obtained by dividing absolute neutrophil to absolute lymphocyte count and absolute platelet count to absolute lymphocyte count, respectively. The patients were followed prospectively for 24 months. The primary end point was all-cause mortality., Results: Mean levels of neutrophil, lymphocyte, and platelet were 3904 ± 1543/mm(3), 1442 ± 494/mm(3), 174 ± 56 × 10(3)/mm(3), respectively. Twenty-one patients died before the follow-up at 24 months. Median NLR and PLR were 2.52 and 130.4, respectively. All-cause mortality was higher in patients with high NLR group compared to the patients with low NLR group (18.8 vs. 7.5 %, p = 0.031) and in patients with higher PLR group compared to patients with lower PLR group (18.8 vs. 7.5 %, p = 0.022). Following adjusted Cox regression analysis, the association of mortality and high NLR was lost (p = 0.54), but the significance of the association of high PLR and mortality increased (p = 0.013)., Conclusion: Although both NLR and PLR were associated with all-cause mortality in prevalent HD patients, only PLR could independently predict all-cause mortality in these populations.

Objective: The purpose of this study was to investigate the association of the neutrophil/lymphocyte ratio and platelet/lymphocyte ratio with the clinical outcomes in geriatric patients with stage 3-5 chronic kidney disease (CKD)., Material and Methods: A total of 165 patients over the age of 65, with stage 3-5 CKD, were enrolled in the study. The primary endpoints were all-cause of deaths and requirement of renal replacement therapy. The patients were divided into two groups according to delta neutrophil/lymphocyte ratio such as increased (group 1) and decreased or stable (group 2) groups., Results: The mean age was 73.8 ± 6.1 years and the mean follow-up was 30 ± 13 months. Thirty-one (18.7%) patients died during the follow-up period and 21 (13.4%) patients required renal replacement therapy. The neutrophil/lymphocyte ratio increased in 95 (57.5%) patients. The mortality rate (24.2%, 11.4%; p = 0.03) and requirement of renal replacement therapy (19.1%, 5.7%; p = 0.01) were higher in group 1 compared to group 2. In the Cox regression analysis, the basal neutrophil/lymphocyte ratio was the independent predictor of death (HR: 1.23 (95% CI 1.02-1.47), p = 0.02), and the basal eGFR was the independent predictor of requirement of renal replacement therapy (HR:0.938, 95% CI: 0.888-0.991, p = 0.02). However, platelet/lymphocyte ratio was not associated with death and requirement of renal replacement therapy independently., Conclusion: The neutrophil/lymphocyte ratio predicts all-cause of mortality in geriatric patients with chronic kidney disease.

Background: There are significant differences between countries in the mortality rates of haemodialysis (HD) patients. The extent of these differences and possible contributing factors are worthy of investigation., Methods: As of March 2009, all patients undergoing HD or haemodiafiltration for >3 months (n = 4041) in the Turkish clinics of the NephroCare network were enrolled. Data were prospectively collected for 2 years through the European Clinical Dialysis Database. Mean age ± standard deviation was 58.7 ± 14.7 years, 45.9% were female and 22.9% were diabetic. Comparison with US data was performed by applying an indirect standardization technique, using specific mortality rates for patients on HD by age, gender, race and primary diagnosis as provided by the 2012 US Renal Data System Annual Data Report as reference., Results: The crude mortality rate in Turkey was 95.1 per 1000 patient-years. Compared with the US reference population, the annual mortality rate for Turkey was significantly lower, irrespective of gender, age and diabetes. After adjustments for age, gender and diabetes, the mortality risk in the Turkish cohort was 50% lower than US whites [95% confidence interval (CI) 0.46-0.54, P < 0.001], 44% lower than US African-Americans (95% CI 0.52-0.61, P < 0.001) and 20% lower than Asian-Americans (95% CI 0.74-0.86, P < 0.05)., Conclusions: The annual mortality rate of prevalent HD patients was found to be significantly lower in the studied Turkish cohort compared with that published by the US Renal Data System Annual Data Report. Differences in practice patterns may contribute to the divergence.

Purpose: High fibroblast growth factor-23 (FGF-23) levels are associated with mortality and cardiovascular events in patients with chronic kidney disease. The aim of this cross-sectional study was to investigate the relationship between plasma FGF-23 levels and coronary artery calcification and carotid artery intima-media thickness (CA-IMT) in hemodialysis (HD) patients., Methods: In this cross-sectional study, plasma intact FGF-23 levels were measured in 229 patients who underwent coronary artery calcification scores (CACs) determined by multi-slice computerized tomography and CA-IMT assessed by using high-resolution color Doppler ultrasonography., Results: Median FGF-23 was 53.5 pg/ml (IQR 30.8-249.5). Median CACs was 98 (IQR 0-531), and the frequency of patients with severe calcification (CACs > 400) was 28.8%; 27.5% of cases had no calcification. Mean CA-IMT was 0.78 ± 0.20 mm, and the presence of carotid plaques was 51% with a mean length 2.1 mm. FGF-23 level was positively correlated with serum calcium (r = 0.337, p < 0.001), phosphate (r = 0.397, p < 0.001) and CACs (r = 0.218, p = 0.001). Neither CA-IMT nor the presence of carotid artery plaques correlated with FGF-23 levels. In adjusted ordinal regression analysis, FGF-23 level was an independent predictor for severe CACs together with age, gender, presence of diabetes, time on dialysis and CA-IMT (model r(2) = 0.44, p < 0.001). As a novel finding, the mean CACs was markedly higher in patients with FGF-23 level above median regardless of phosphate levels (p = 0.03)., Conclusions: In HD patients, plasma FGF-23 level is superior to phosphate in the prediction of coronary artery calcification. However, FGF-23 is not associated with carotid artery atherosclerosis in HD patients.

Background: Bisphenol A (BPA) has been implicated as an 'endocrine disruptor'. We aimed at exploring the association between serum BPA levels and patient characteristics, particularly the presence of diabetes mellitus, and laboratory parameters in hemodialysis patients., Methods: This study included 47 chronic hemodialysis patients. Patient characteristics were recorded. Blood was drawn before and after hemodialysis session. Serum BPA levels were measured by the high-performance-liquid-chromatography and laboratory parameters were measured by using standard methods., Results: In hemodialysis patients, postdialysis serum BPA levels were significantly higher than predialysis after a single hemodialysis session (5.57 ± 1.2 vs. 4.06 ± 0.73, p < 0.0001). Predialysis serum BPA levels were significantly higher in patients with diabetes than non-diabetics (4.4 ± 0.6 vs. 3.9 ± 0.7, p = 0.025). No association was found between serum BPA levels and patient characteristics, and particularly laboratory parameters., Conclusion: Serum BPA levels were rising significantly after a single dialysis session. Diabetic hemodialysis patients had higher predialysis serum BPA levels., (© 2016 S. Karger AG, Basel.)

Purpose: Lactic acidosis as a consequence of high serum lactate levels may deepen the metabolic acidosis in patients with end-stage renal failure. Besides, certain antidiabetic may also cause raised lactate levels in diabetic patients. Therefore, it is obvious that the risk of hyperlactatemia is increased by folds in diabetic patients on chronic hemodialysis program. In this study, it is aimed to evaluate the frequency and the impact of increased serum lactate levels in prevalent diabetic hemodialysis patients., Methods: A total of 100 diabetic patients who were under maintenance hemodialysis in five different dialysis centers were included in this study. All biochemical parameters, blood gas measurements, echocardiographic data and antidiabetic treatments were statistically analyzed in terms of serum lactate levels., Results: Out of 100 patients, 12 patients had serum lactate levels over normal limits. When the patients with normal or high serum lactate levels were defined as two different groups, statistical significance was detected between serum lactate levels and serum sodium (p = 0.019), potassium (p = 0.037) and bicarbonate levels (p = 0.028). Moreover, in patients with hyperlactatemia, the ejection fraction value was found significantly low (p = 0.005)., Conclusions: The frequency of hyperlactatemia was not rare in prevalent diabetic hemodialysis patients. We additionally found that serum lactate level measurement may particularly help to diagnose the occult cardiac failure. However, further large scale studies are required to define the clinical significance of hyperlactatemia in the end-stage renal failure patients with diabetes mellitus.

Various reasons such as malignancies and chronic infections may cause weight loss in kidney transplant patients. In this report, iron overload as a rare cause of weight loss in a kidney transplant patient is presented. Forty-seven-year-old male patient who transplanted from a deceased donor 5 years ago was hospitalized because of 20 kg of weight loss. In medical history, he had history of hemodialysis for 89 months and received 100-300 mg of intravenous iron therapy per week before transplantation and transfused eight units of blood. In physical examination, weight and height were 45 kg and 185 cm, respectively. Respiratory and cardiac auscultation was normal. Laboratory results revealed as follow: glucose 76 mg/dL, urea 60 mg/dL, creatinine 1.35 mg/dL, aspartate aminotransferase 74 U/L, alanine aminotransferase 77 U/L, C-reactive protein 2.59 mg/dL, albumin 3.3 g/dL, globulin 3.4 g/dL, white blood cells 3200/mm(3), hemoglobin 13.1 g/dL and platelets 190,000/mm(3). Chest and abdominal tomography didn't reveal any pathology. Portal Doppler ultrasound showed signs of early cirrhosis. Viral and autoimmune hepatitis markers were negative. Ferritin was 5300 ng/mL and transferrin saturation was 82%. In liver biopsy, hemosiderosis was diagnosed and heterozygous H63D gene mutation was detected. Totally, 19 units of phlebotomy were performed. Liver function tests and serum ferritin decreased gradually. At outpatient follow-up in 6 months, he returned to former weight. In conclusion, there can be several causes of weight loss in kidney transplant patients. Iron overload can come across as a rare cause of weight loss. In these patients, ferritin levels should be checked and diagnosis should be clarified by liver biopsy and gene mutation analysis.

The systemic absorption of the flush liquid, including sorbitol, glycine or mannitol, can lead to complications, such as hyponatremia, volume overload and pulmonary or cerebral edema. Acute hyponatremia is defined as a reduction in the plasma sodium level in less than 48 h. Acute symptomatic hyponatremia should be corrected aggressively because it may cause irreversible neurological damage and death. Rapid correction of hyponatremia causes severe neurologic deficits, such as central pontine myelinolysis; thus, the optimal therapeutic approach has been debated. This article examined acute symptomatic hyponatremia in a patient undergoing transcervical myomectomy for a submucosal myoma. A thirty-seven-year-old patient was evaluated in obstetrics and gynecology clinic because of altered mental status and agitation. There was no history of chronic illness or drug use. It was discovered that during the operation, 12 L of the flush fluid, which contained 5 % mannitol, had been infused, but only 7 L of the flush fluid had been collected. On physical examination, the patient's general condition was moderate, her cooperation was limited, she was agitated, and her blood pressure was 120/70 mmHg. The sodium level was 99 mEq/L. Furosemid and 3 % NaCl solution were given. Her serum sodium returned to normal by increasing 39 mEq/L within 14 h. Her recovery was uneventful, and she was discharged 24 h after her serum sodium returned to normal. In conclusion, if there is a difference between the infused and collected volumes of the mannitol irrigant, severe hyponatremia may develop due to the flush fluid used during transcervical hysteroscopy and myomectomy. In these patients, acute symptomatic hyponatremia may be corrected as rapidly as the sodium level dropped.

Solid organ transplantation is a risk factor for mucormycosis. Mucormycosis is a necrotizing opportunistic fungal infection with high morbidity and mortality. We report a fatal mucormycosis case with rhino-orbital-cerebral involvement in a renal transplant patient, which presented with orbital apex syndrome and hemiplegia.

Introduction: Secondary lymphedema is one of the major important long-term complications of breast cancer treatment. The aim of this study is to determine patient- and treatment-related risk factors of lymphedema in breast cancer patients., Patients and Methods: Patients, who had been operated on for primary breast cancer at Akdeniz University Hospital and followed regularly between August 1984 and December 2009 were included in the study. In order to evaluate the arm swelling objectively, measurements were performed with a flexible tape measure for both arms, and limb volume was calculated using a truncated cone volume formula. Participants, whose volume difference between the two arms was ≥ 5%, were considered as lymphedema-positive patients. The SPSS program (SPSS inc. Chicago, IL) was used for statistical analysis., Results: The mean age of 455 patients was 50.6 years and the median follow-up time was 53 months. Lymphedema was found in 124 (27%) patients. Most of the patients with a history of postoperative wound infection (52%) and lymphangitis (57%) had lymphedema (p=0.003 and p=0.002, respectively). Addition of radiation therapy increased lymphedema risk 1.83 times (p=0.007). The mean duration of the axillary drainage and number of the removed lymph nodes were 7.8 days and 19, respectively. The rate of lymphedema in patients with early stage breast cancer was less than patients with advanced breast cancer (24% and 35.3%, respectively, p=0.018). Most of the patients (92%) with lymphedema had a high body mass index (BMI ≥ 25 kg/m²), and obesity was another important factor for lymphedema (p<0.001)., Conclusions: The most important treatment and patient-related risk factors for breast cancer-related lymphedema were obesity (≥ 25 kg/m²), axillary lymph node dissection, postoperative radiotherapy, wound infection, history of lymphangitis, and duration of axillary drainage. Elimination or prevention of these risk factors may reduce the incidence of lymphedema.

Background: YKL-40 (chitinase-3-like protein 1) is a novel inflammation and endothelial dysfunction biomarker. Although YKL-40 is associated with albuminuria and predicts cardiovascular morbidity and mortality in a non-uremic population, it's status is not known in renal transplant recipients. The aim of this study was to investigate plausible links between serum YKL-40 and proteinuria., Material and Methods: A total of 110 renal transplant recipients were included in this study. The level of proteinuria was calculated from spot urine using the protein/creatinine ratio. The estimated glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease (MDRD) formula. Serum YKL-40 was determined by ELISA (R&D Systems, USA)., Results: The mean patient age was 40.5 ± 10 years. The mean YKL-40, GFR, and proteinuria levels were 66 ± 46 ng/ml, 49 ± 24 ml/min/1.73 m2, and 0.77 ± 1.15 g/day, respectively. Increases in the YKL-40 tertiles were correlated with increases in proteinuria and C-reactive protein and decreases in the GFR and serum albumin. An adjusted linear regression analysis demonstrated that the YKL-40 level (t=3.28, P=0.001), GFR (t=-3.00, P=0.003), and systolic blood pressure (t=2.51, P=0.01) were independently associated with proteinuria., Conclusions: This is the first study to show that increased serum YKL-40 levels are independently associated with proteinuria in renal transplant recipients. YKL-40 may be responsible for the pathogenesis of cardiovascular injury in this patient population.

Objective: Epicardial adipose tissue (EAT) is proposed as a cardiovascular risk marker in non-uremic subjects. However, little is known about its role in patients with higher cardiovascular risk profile such as chronic kidney disease. The aim of this study was to investigate the relationship between EAT and several cardiovascular surrogate markers (coronary artery calcification (CAC), arterial stiffness and atherosclerosis) in patients on maintenance hemodialysis., Methods: A total of 191 prevalent hemodialysis patients were enrolled in this cross-sectional study. EAT and CAC scores (CACs) were determined by multi-slice computerized tomography, arterial stiffness by carotid-femoral pulse wave velocity (PWV), and carotid artery intima-media thickness (CA-IMT) by B-mode doppler ultrasonography., Results: Mean age was 59 ± 13 years and time on hemodialysis 75 ± 44 months. Twenty percent of the patients had diabetes. Mean EAT volume was 62.6 ± 26.8 cm(3)/m(2). Mean CA-IMT and PWV values increased across the EAT tertiles. EAT was correlated with age, female gender, body mass index, albumin and lipid parameters. Additionally, CA-IMT and PWV values were positively correlated with EAT. EAT volume was significantly higher in patients with CACs >10 compared to the patients with CACs ≤10. Despite the univariate associations between EAT and cardiovascular surrogate markers, only age, body mass index and total cholesterol levels were associated with EAT in adjusted models., Conclusions: In prevalent hemodialysis patients, EAT is correlated with atherosclerosis, arterial stiffness and the presence of CAC. However, this correlation is not independent of other risk factors., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

The term cardiorenal syndrome (CRS) has been used to define interactions between acute or chronic dysfunction of the heart or kidney. When primary chronic kidney disease contribute to cardiac dysfunction, it is classified as type 4 CRS. Cardiac dilatation, valve regurgitations, and left ventricular dysfunction are observed in end-stage renal failure patients with uremic cardiomyopathy. Because of perioperative risks in these patients, they may not be considered a candidate for kidney transplantation. However, uremic cardiomyopathy can be corrected when volume control is achieved by appropriate dose and duration of ultrafiltration. By presenting two cases with occult hypervolemia in uremic cardiomyopathy whose cardiac functions improved early after kidney transplantation, attention is drawn to the importance of kidney transplantation on cardiac function in such patients primarily and the importance of strict volume control on cardiac function in dialysis patients waiting for kidney transplantation.

Background/aims: The association between thyroid hormones and arterial stiffness is unclear. In this study, we investigated, for the first time in a large cohort of euthyroid peritoneal dialysis patients, the relationship between thyroid hormone levels and arterial stiffness., Methods: Fifty-seven patients were enrolled. Serum TSH, free T3 and free T4 levels were measured by chemiluminescence immunoassay method. Pulse wave analysis [augmentation index (AIx) and subendocardial viability ratio (SEVR)] were measured to assess arterial stiffness., Results: Mean age was 49 ± 12.3 years, and 56.1% were female. Mean TSH, fT3 and fT4 levels were 1.97 ± 0.99 mIU/ml, 2.80 ± 0.42 pg/ml and 1.22 ± 0.16 ng/dl, respectively. Mean AIx and SEVR were 22.3 ± 11.3 and 136 ± 21%, respectively. AIx was negatively correlated with residual urine volume (r = -0.372, P: 0.03) and fT3 levels (r = -0.382, P: 0.005). SEVR was correlated only with TSH level (r = -0.394, P: 0.003). In linear regression analysis adjusted for age, gender, history of diabetes and cardiovascular disease and residual diuresis, fT3 level (t = -3.949, P < 0.001) remained associated with AIx. Only TSH level (t = -2.409, P: 0.02) was related to SEVR., Conclusion: Low serum fT3 level is associated with arterial stiffness, and high TSH level within the normal range is related to lower SEVR in euthyroid PD patients.

The serial transverse enteroplasty procedure is an autologous intestinal reconstruction technique defined and used originally in pediatric patients. In this paper, we describe the serial transverse enteroplasty method and outcomes in an adult male patient who underwent extensive bowel resection after mesenteric artery embolism and later developed short bowel syndrome. He was diagnosed with mesenteric artery embolism and related extensive bowel necrosis and underwent extensive bowel resection including the right colon. The remaining 60 cm was diverted to the proximal jejunum as the end stoma. He received total parenteral nutrition for five months and underwent serial transverse enteroplasty in the fifth postoperative month. The jejunum of 60 cm in length was elongated to 100 cm using the serial transverse enteroplasty method. The patient was 80% total parenteral nutrition-dependent preoperatively, but became totally total parenteral nutrition-free in the third month after the procedure, and nutrition needs could be met enterally. The serial transverse enteroplasty procedure can be used as an effective and reliable autologous intestinal reconstruction method in adult patients with intestinal insufficiency due to short bowel syndrome, just as in pediatric patients.