Bahadır Öz

Comparison of lovastatin and hyaluronic acid/carboxymethyl cellulose on experimental created peritoneal adhesion model in rats

OBJECTIVES The aim of this experimental study was to compare the effectiveness and reliability of lovastatin and hyaluronic acid + carboxymethyl cellulose (Seprafilm). MATERIALS AND METHODS Thirty two female Wistar-Albino rats weighing between 250 and 300 g were used in the study. The rats were divided into four groups as sham, control, lovastatin and Seprafilm each of which contained 8 rats. All rats were sacrificed on the 14th day after surgery. Macroscopic adhesion, microscopic adhesion and tPA, MDA and NO values were evaluated. RESULTS Macroscopic adhesion formation was significantly lower in the sham and study groups than in the control group (p < 0.05). Microscopic classification adhesion formation was significantly lower in the sham and study groups than in the control group (p < 0.05), and the tPA, MDA and NO values showed statistically significant differences among the groups. CONCLUSION Lovastatin and Seprafilm were equally effective in preventing postoperative intra abdominal adhesions. The study groups were showed significant superiority to the control group.

The length of necrosis and renal insufficiency predict the outcome of acute mesenteric ischemia

BACKGROUND Acute mesenteric ischemia (AMI) is a potentially life-threatening condition because of its diagnostic difficulty, operative challenges, and comorbidities a patient may have. The aim of this study was to identify factors associated with adverse outcomes in patients with AMI. METHODS The hospital records and clinical data of all patients with AMI were reviewed for a recent 4-year period. Clinical outcomes and factors influencing mortality were analyzed. RESULTS Included in the study were 104 patients (46 females and 58 males) with an overall mean age of 66 ± 13.4 years. The cause of AMI was arterial pathology in 74 (71%) patients, venous thrombosis in 15 (14%) patients, and nonocclusive ischemia in 12 (12%) patients. Abdominal pain was the most common presenting symptom (97% of patients). The 30-day mortality rate was 66%. Univariate analysis showed that mortality was associated with renal insufficiency (p = 0.004), an age greater than 70 years (p = 0.02), the presence of comorbidities (p = 0.001), a leukocyte count greater than 18,000/mL (p = 0.04), and small bowel necrosis of more than 100 cm (p < 0.0001). Logistic regression analysis showed that independent predictors of mortality were small bowel necrosis of more than 100 cm (p = 0.002) and a serum creatinine level greater than 2 mg/dL (p = 0.04). CONCLUSION The length of the necrosis and renal insufficiency are the primary factors that result in a poor outcome in AMI patients. Prompt diagnostic evaluation and early therapeutic interventions may help to prevent the development of these fatal predictors.

Prediction of nonsentinel lymph node metastasis in breast cancer patients with one or two positive sentinel lymph nodes

OBJECTIVE The aim of the present study was to investigate the association between non sentinel lymph node metastasis (NSLNM) and clinicopathological factors, particularly in the case of sentinel lymph node (SLN) metastasis in one or two, in clinically node negative patients with breast cancer. METHODS Between 10/2010 and 10/2014, 350 sentinel lymph node biopsy (SLNB) were performed in patients with histologically proven primary breast cancer in our clinic. The data collection includes the following characteristics: age, pathological tumor size, histological type, histological grade, lymphovascular invasion (LVI), number of positive SLN, size of the SLN metastasis (macrometastasis, micrometastasis, isolated tumor cells), multifocality (MF), extracapsuler invasion (ECI) of the SLN, the estrogen receptor (ER) status, the progesterone receptor (PR) status and the Her 2 receptor status, Ki 67 reseptor status. Data were collected retrospectively and then analyzed. RESULTS A successful SLN biopsy were performed in 345 (98.5%) cases. SLN metastases were detected in 110 (31.8%) cases. These patients then underwent axillary dissection; among these patients, 101 (91.8%) had only one to two positive SLNs. Of the 101 patients with positive SLN biopsies, 32 (31.6%) had metastases in the NSLNs. Univariate and multivariate analysis showed that lymphovascular invasion, extracapsular invasion (ECI), Her-2 receptor positive, and Ki-67 > 14% were related to NSLNM (p<.0.05). CONCLUSION The predicting factors of NSLNM were LVI, ECI, Ki-67 level, Her-2 reseptor positive and but should be further validated in our institutions, different institutions and different patient groups prospectively.

Prognostic value of E2F1 in rectal cancer

OBJECTIVE To evaluate whether E2F transcription factor 1 is a potential prognostic marker in patients with rectal cancer. MATERIAL AND METHODS Eighty-two patients who were treated with curative resection because of rectal cancer in the Erciyes University School of Medicine, Department of General Surgery were included in the study and analyzed retrospectively. Data were obtained from patient files, pathology reports, and hospital information system. Nuclear and cytoplasmic staining of E2F transcription factor 1 was performed for immunohistochemical analysis on paraffin-embedded and blocked tumor tissue samples of patients. The findings of the study were assessed with using IBM Statistical Package for Social Sciences Statistics 20. RESULT In the 5-year follow-up period, 34 (41.5%) patients were alive. Local recurrence was identified in 7 patients. According to E2F transcription factor 1 nuclear staining, the average survival rate in patients was 60% for strong nuclear staining and 28% for weak nuclear staining. There was significant statistical difference between groups according to their degree of nuclear staining (p=0.017). When the patients were evaluated according to cytoplasmic staining with E2F transcription factor 1, the average overall survival rate of patients with positive E2F transcription factor 1 cytoplasmic staining was 48.0±4.6% versus 55.9±7.9% for patients without staining (p=0.408). CONCLUSION The survival rates are higher in rectal cancer patients with strong immunohistochemical nuclear staining of E2F transcription factor 1.

The effectiveness of gastric tonometry in the diagnosis of acute mesenteric ischemia in cases where a contrast-enhanced computed tomography cannot be obtained

OBJECTIVE The aim of the study was to evaluate the effectiveness of gastric tonometry in the diagnosis of acute mesenteric ischemia in cases where a contrast-enhanced computed tomography cannot be obtained. MATERIAL AND METHODS The gastric pH (pHi) and gastric CO2 (gpCO2) were measured with gastric tonometry catheter, preoperatively and postoperatively at 24 hours, in patients with suspicion of acute mesenteric ischemia. Simultaneous evaluation of blood gases and blood lactate levels were performed. Patients were divided into two groups after surgery. Group 1 included patients with mesenteric ischemia, and Group 2 consisted of patients without mesenteric ischemia. RESULTS Forty-two patients (26 males, 16 females) were evaluated. The mean age was 61.4±13.3 years. There was no significant difference between the groups in terms of demographic factors and co-morbid diseases. There were no significant differences between groups in terms of pHi and gpCO2 levels (7.24±0.2 and -3±12.0 in Group 1, 7.18±0.06 and -3±1.9 in Group 2, respectively), intra-abdominal pressure, lactate levels, and survival. Among all the study parameters, only arterial pH had statistical significance in the diagnosis of acute mesenteric ischemia (7.23±0.21 versus 7.35±0.07 for Groups 1 and 2, respectively,) (p<0.05). CONCLUSION Gastric tonometry is not a useful method in the early diagnosis of acute mesenteric ischemia.