Ali Ekrem Unal

Primary Hydatid Cyst of the Axillary Region: Report of a Case

Abstract A 53-year-old woman presented to our hospital with a painful mass in her axilla. Magnetic resonance imaging revealed a lobular cystic mass localized in the right pectoralis major muscle, with no significant invasion of the peripheral soft tissue or bone structures and no pulmonary or hepatic involvement. An echinococcal hemagglutination test was positive. Excision of the cystic mass as definitive therapy and histopathologic examination of the resected specimen confirmed that it was a hydatid cyst. For treating hydatidosis in uncommon sites, the cyst must be totally removed whenever possible. The combination of albendazole and praziquantel seems to be the most effective medical treatment, but not an alternative to surgery. This case report serves to demonstrate that hydatid disease should be borne in mind as the possible cause of a palpable lesion in the breast, axillary region, or chest wall, especially in endemic locations.

Malpositioning of Hickman catheters, left versus right sided attempts

BACKGROUND Central venous catheters (CVC) are frequently used for stem cell collection and recurrent therapeutic hemapheresis procedures for patients with poor peripheral venous access. There is a tendency to prefer a right sided approach for insertion of a CVC via the subclavian route. We designed a sequential randomized study to examine the issue of catheter insertion side and analyzed all the technical data on surgical skill and observed complications. METHOD Seventy-five patients who are candidates for stem cell collection and high dose chemotherapy underwent placement of Hickman catheters via the percutaneous subclavian vein (SCV) route. One experienced surgeon inserted 12F, double lumen, tunnelled, silicon based catheters in the operation room via fluoroscopic control. All of the procedure related complications, morbidity and mortality were analyzed on the basis of the side of catheter insertion. RESULTS The total rate of malpositioning in this series was 14.66%. The Jugular vein was the most common malpositioning site (66.6%). We observed a statistically significant difference in malpositioning between left versus right sided attempts, at 5.55% versus 20.51%, respectively (p = 0.032). The routes of malpositioning encountered for left sided attempts were the right SCV and the left internal jugular vein, the right internal jugular vein (n = 5), the left SCV vein (n = 2), and one left internal jugular vein. There was no significant difference between the right and left sided attempts for mechanical complications other than malpositioning (p < 0.05). CONCLUSION In this study the rate of malpositioning was greater in the right sided approach (p = 0.032) and the other mechanical complication rates did not differ for the two methods. Our results indicate that there is no need for hesitancy in using left sided attempts at CVC insertion.

DNA copy number changes in gastric adenocarcinomas: high resolution-comparative genomic hybridization study in Turkey.

BACKGROUND AND AIMS Multiple genetic alterations are responsible for development and progression of gastric cancer which is one of the leading causes of cancer-related deaths worldwide. The aim of this study was to identify the genomic imbalances of gains and/or losses in gastric adenocarcinomas from Turkish patients and to investigate their association with development and progression of this type of cancer. METHODS Forty three patients with gastric adenocarcinoma were enrolled in this study and genomic imbalances were analyzed by high-resolution-comparative genomic hybridization (HR-CGH). RESULTS In 36/43 cases (84%) of gastric adenocarcinomas, genomic imbalances have involved all chromosomes in various combinations. The mean number of gains was 3.95+/-4.19 and the most common gains observed were 7q (35%), 8q (35%), 7p (28%), 1q (26%), 13q (26%), and 20q (21%). The calculated mean number of losses was 3.65+/-3.55 and the most common losses were found on arms 18q (26%), 5q (21%), and 14q (21%). High-level amplifications involved chromosomes 1, 7, 8, 9, 13, and 16. No significant differences in chromosomal imbalances were observed in different tumor stages, tumor grades, and Helicobacter pylori infection status groups. The most striking result in this study was the involvement of the 13q gains with increased lymph node metastasis (p=0.046). Late-stage tumors displayed a somewhat significantly higher number of losses than early-stage tumors (p=0.053). CONCLUSIONS A series of gains, losses and amplifications concerned with gastric adenocarcinoma identified in this study are presented in detail. In particular, 13q21-q32 was prominent because it has been linked to increased lymph node metastasis.

Effects of genomic imbalances on telomerase activity in gastric cancer: clues to telomerase regulation.

Telomerase is a specialized cellular reverse transcriptase that adds telomeric repeats (TTAGGG) at the ends of each chromosome. Nearly the complete spectrum of human cancers has been shown to be telomerase positive. The understanding of the telomerase regulation in concert with other genetic alterations in the process of malignant transformation of human cells has important clinical and practical implications. Regulation of telomerase activity (TA) is highly complex, and both putative positive and negative regulators have been reported. However, the mechanisms involved in telomerase regulation are not fully established. Identification of additional telomerase components and associated proteins will certainly contribute to further investigations of the effect of telomerase in telomere elongation, telomere length maintenance, oncogenesis, and functionally new, unidentified cellular functions. In this study our aim was to determine the chromosomal localizations of putative unidentified telomerase activator(s) and/or repressor(s) by high resolution-comparative genomic hybridization (HR-CGH) in highly telomerase expressing gastric tumor samples. For this purpose TAs and genomic imbalances were identified in the same tumor samples and relation between these was evaluated. Genomic changes affecting telomerase activity in 50 gastric tumor samples were investigated by HR-CGH. We have found that genomic imbalances including 1q+, 8p+, 8q+, 10q+, 17p-, and 20p+ are associated with the higher telomerase activity. Our results suggest that 1q24, 8p21-p11.2, 8q21.1-q23, 10q21-qter and 20pter-p11.2 may contain putative telomerase activator(s), whereas the 17p12 region may harbor candidate telomerase suppressor(s).

Splenic infarction as a complication of celiac artery thromboembolism: an unusual cause of abdominal pain

Splenic infarction is a relatively uncommon diagnosis and this clinical presentation can mimic other causes of acute abdominal pain. Cardiologic and hematologic disorders are common reasons for this entity. There have been a few series and single case reports of splenic infarction published in peer-reviewed medical journals. We report a 53-year-old patient who had splenic infarction caused by celiac artery thromboembolism. The importance of this case, without any etiological predisposing factors, is that this kind of clinical situation should be considered in the differential diagnosis of abdominal pain.

Early Diagnosis in Gastric Cancer: Pilot Project

ABS TRACT Objective: Gastric cancer, fourth most common cancer type around the world is the second leading cause of cancer related deaths. Nevertheless when appropriately treated at early stage 5 year survival rates are higher than 90%. In eastern countries extensive endoscopic screening increased early gastric cancer (EGC) diagnosis rate up to 70%. In Turkey EGC diagnosis rate is low, a pilot screening project therefore is planned by Department of Surgical Oncology, Ankara University School of Medicine. Material and Methods: 7316 subjects were included in the study to whom upper gastrointestinal endoscopy was applied. From 1120 of these participants 1139 biopsy samples were taken. Results: In gastric cancer patients (n:21) 4 had a diagnosis at the early stage. Also 14 (1.41%) mild dysplasia and 2 (0.2%) severe dysplasia were detected. In addition, 54.8% of volunteers with endoscopic biopsies were Helicobacter pylori positive and a rate of 41.23% and 22.47% for atrophic gastritis and intestinal metaplasia was detected, respectively. Previously EGC detection rate was 6.3% among the subjects admitted to a hospital with gastric cancer in Turkey. By this screening programme we found an almost 4 fold increase in EGC rate. Conclusion: We therefore recommend that endoscopic screeening for gastric cancer is a requirement for Turkey. This preliminary study should be followed by a more extensive project evaluating the cost effectiveness of screening and its effect on mortality rates.