Ilyas Sayar

Importance of Metastatic Lymph Node Ratio in Non-Metastatic, Lymph Node-Invaded Colon Cancer: A Clinical Trial

Background The aim of this study was to evaluate the prognostic importance of the metastatic lymph node ratio for stage III colon cancer patients and to find a cut-off value at which the overall survival and disease-free survival change. Material/Methods Patients with pathological stage III colon cancer were retrospectively evaluated for: age; preoperative values of Crp, Cea, Ca 19-9, and Afp; pathologic situation of vascular, perineural, lymphatic, and serosal involvement; and metastatic lymph node ratio values were calculated. Results The study included 58 stage III colon cancer patients: 20 (34.5%) females and 38 (65.5%) males were involved in the study. Multivariate analysis was applied to the following variables to evaluate significance for overall survival and disease-free survival: age, Crp, Cea, perineural invasion, and metastatic lymph node ratio. The metastatic lymph node ratio (<0.25 or ≥0.25) is the only independent variable significant for overall and disease-free survival. Conclusions Metastatic lymph node ratio is an ideal prognostic marker for stage III colon cancer patients, and 0.25 is the cut-off value for prognosis.

The effect of ozone and naringin on intestinal ischemia/reperfusion injury in an experimental model

BACKGROUND The aim of the study was to evaulate the effect of ozone and naringin on the intestine after intestinal ischemia-reperfusion(II/R) injury. METHODS Thirty five rats divided into 5 groups of 7 animals: control, II/R, ozone, naringin and naringin + ozone. Only laparotomy and exploration of the superior mesenteric artery (SMA) were done in control group. In the experimental groups, SAM was occluded for 1 h and reperfused for 1 h. 15 min after ischemia, ozone (25 μg/ml, 0.5 mg/kg), naringin (80 mg/kg) and naringin + ozone(80 mg/kg + 25 μg/ml, 0.5 mg/kg) were infused intraperitoneally to each groups. Ileum tissues were harvested to determine intestinal mucosal injury and oxidative stress markers. For SMA occlusion, different than literature, silk suture binding was used. RESULTS Oxidative stress markers were significantly low in experimental groups compared with II/R group (p < 0.05). Histopathologically, the injury score was significantly low at experimental groups compared with II/R group (p < 0.05). The lowest injury score was encountered at naringine + ozone group. CONCLUSIONS Ozone alone or combined with naringin has a protective effect for mesenteric ischemia. Instead of using instruments such as clamps in the II/R rat model, silk binding may be used safely.

Antioxidant Activity of Syringic Acid Prevents Oxidative Stress in l-arginine–Induced Acute Pancreatitis: An Experimental Study on Rats

The aim of this study was to investigate the possible protective role of antioxidant treatment with syringic acid (SA) on l-arginine-induced acute pancreatitis (AP) using biochemical and histopathologic approaches. A total of 30 rats were divided into 3 groups. The control group received normal saline intraperitoneally. The AP group was induced by 3.2 g/kg body weight l-arginine intraperitoneally, administered twice with an interval of 1 hour between administrations. The AP plus SA group, after having AP induced by 3.2 g/kg body weight l-arginine, was given SA (50 mg kg(-1)) in 2 parts within 24 hours. The rats were killed, and pancreatic tissue was removed and used in biochemical and histopathologic examinations. Compared with the control group, the mean pancreatic tissue total oxidant status level, oxidative stress index, and lipid hydroperoxide levels were significantly increased in the AP group, being 30.97 ± 7.13 (P < 0.05), 1.76 ± 0.34 (P < 0.0001), and 19.18 ± 4.91 (P < 0.01), respectively. However, mean total antioxidant status and sulfhydryl group levels were significantly decreased in the AP group compared with the control group, being 1.765 ± 0.21 (P < 0.0001) and 0.21 ± 0.04 (P < 0.0001), respectively. SA reduces oxidative stress markers and has antioxidant effects. It also augments antioxidant capacity in l-arginine-induced acute toxicity of pancreas in rats.

A case report of esophageal perforation: Complication of nasogastric tube placement

Patient: Male, 70 Final Diagnosis: Esophageal perforation Symptoms: Abdominal pain • nausea • vomiting Medication: — Clinical Procedure: — Specialty: Surgery Objective: Unusual clinical course Background: Esophageal perforation is a well-defined and severe clinical condition. There are several etiologies of esophagus perforation. Case Report: We report the case of a 70-year-old Caucasian man who underwent an emergency cholecystectomy due to acute cholecystitis. Two days after surgery, his condition deteriorated. Thorax computerized tomography revealed an esophageal perforation. Conclusions: Esophageal perforation due to nasogastric application is relatively rare but the consequences are potentially serious. The anatomy of the upper gastrointestinal system should be understood by all healthcare professionals involved in the treatment.

How could such a wide piece of tree root pass through the narrow pyloric orifice? An extremely rare case

Patient: Female, 30 Final Diagnosis: Phytobezoar Symptoms: Nausea • vomiting Medication: — Clinical Procedure: — Specialty: — Objective: Rare disease Background: Phytobezoars are a common type of bezoar known to accumulate in the gastrointestinal system. Case Report: A 30-year-old mentally retarded woman was operated on due to small bowel obstruction. A piece of tree root was extracted from the ileum. The patient was discharged from the hospital on postoperative day 7. Conclusions: Due to difficulties in determining the nature of the bezoar preoperatively, small bowel obstruction due to a phytobezoar is not a common diagnosis. For bezoars, prevention is considered preferable to treatment.

Protective effects of ellagic acid and ozone on rat ovaries with an ischemia/reperfusion injury

This study investigated the effects of the antioxidant agents, ozone (O) and ellagic acid (EA), on ischemia/reperfusion (I/R) injuries developed from an ovarian torsion‐detorsion model.

Does the intrathecal propofol have a neuroprotective effect on spinal cord ischemia

The neuroprotective effects of propofol have been confirmed. However, it remains unclear whether intrathecal administration of propofol exhibits neuroprotective effects on spinal cord ischemia. At 1 hour prior to spinal cord ischemia, propofol (100 and 300 µg) was intrathecally administered in rats with spinal cord ischemia. Propofol pre-treatment greatly improved rat pathological changes and neurological function deficits at 24 hours after spinal cord ischemia. These results suggest that intrathecal administration of propofol exhibits neuroprotective effects on spinal cord structural and functional damage caused by ischemia.

Bone Marrow Metaplasia in Multinodular Goiter With Primary Hyperparathyroidism

M ultinodular goiter (MNG) constitutes a mixed group of nodular entities. Structural and functional heterogeneity is the most characteristic feature of MNG and may exhibit degenerative alterations such as hemorrhagic and cystic changes, fibrosis, squamous metaplasia and calcification. Rarely, osseous metaplasia, mature bone formation and bone marrow metaplasia have been reported in thyroid tissue. However, according to our literature search, mature bone formation and bone marrow metaplasia in thyroid tissue with primary hyperparathyroidism (PHPT) have not been reported previously. We report a patient with bone marrow metaplasia in the thyroid tissue and PHPT. A 57-year-old white female patient was admitted to the general surgery department for swelling in the neck (over 5 years) and constipation lasting 3 months. On physical examination, a grade 2 goiter was palpated; there was no other pathology in the physical examination. The patient had a history of hyperparathyroidism (parathyroid hormone: 199; normal range: 11–54 pg/mL) and hypercalcemia (Ca: 11.7; normal range: 8.5–10.5 mg/dL). The common blood count and peripheral blood smear were within the normal ranges. The thyroid stimulating hormone and thyroid hormones were also within the normal ranges. On thyroid ultrasonography, a 21 3 14 mm solid nodule in the left lobe of the thyroid in an inferior location, with a peripheral hypoechoic area, was detected. In the middle of the same lobe, there was a calcified nodule (7 mm in diameter), and near the right thyroid lobe in the posteroinferior area, a 15 3 5-mm hypoechogenic lobulated solid nodule, similar to parathyroid adenoma in the sonographic view, was seen. In parathyroid scintigraphy, minimally focused activity retention in the right inferior lobe of the thyroid was detected, which could be a parathyroid adenoma. Because of a prediagnosis of MNG and parathyroid adenoma, a left thyroidectomy and parathyroid adenoma resection of the right inferior location of the right thyroid lobe, by frozen section, was performed. Based on the results of the frozen section, which were similar to the parathyroid adenoma, the operation was ended. On the 1st postoperative day, the patient had a PTH of 18 and Ca of 9.9. In the macroscopic view, a 4 3 3.5 3 2 cm-sized, 12-g weight, claret red–colored, localized, elastic-hard stiffness thyroid tissue was detected. In the cross-sectional view, a 1.5-cm-diameter claret red nodule and, near it, a 0.8-cm-diameter hard calcified region were seen. After decalcification of the tissue, localized degenerated hyalinizing areas and, near them, hypocellular bone marrow and lamellar bone trabeculae were seen (Figures 1 and 2). This was reported as an MNG consisting of bone marrow metaplasia. The frozen section material included parathyroid tissue of 13 0.53 0.4 cm in size, 0.7 g in weight, encapsulated and pink beige color. Using the light microscope, chief cells that compressed the normal parathyroid tissue were seen and described as an adenoma. There was no complaint from the patient during the postoperative follow-up time. Thyroid nodules are a common occurrence in clinical practice. The incidence of thyroid nodules has been on the rise in recent decades, mainly because of the wider use of imaging instruments. The incidence of nodular goiter in the general adult population is 3% to 5% clinically, about 50% discovered at autopsy, whereas it is nearly 100% in the endemic areas. Clinically, most patients are euthyroid and their clinical importance is primarily to exclude a malignancy. Thyroid nodules may undergo a broad spectrum of degenerative changes, such as infarction, hemorrhage or fibrosis, which are associated with calcification or even ossification. Osseous metaplasia, in contrast to calcification, is a rare event in any organ or tissue, and the detection of mature bone formation in a thyroid nodule is extremely rare. Osseous metaplasia could be seen secondary to ischemia, necrosis or inflammation in the tumor or surrounding tissue. Some studies have shown that bone formation might occur as a result of local or systemic inflammation. Additionally, there are studies reporting that hypercalcemia levels are closely associated with bone formation. PHPT is characterized by the autonomous production of PTH, in which there is hypercalcemia or normal to high serum FIGURE 1. Histopathologic view.

Prevention of Intraabdominal Adhesions by Local and Systemic Administration of Immunosuppressive Drugs

Background: Intraperitoneal adhesion formation is a serious postsurgical issue. Adhesions develop after damage to the peritoneum by surgery, irradiation, infection or trauma. Objectives: Using a rat model, we compared the effectiveness of systemic and intraperitoneally administered common immunosuppressive drugs for prevention of postoperative intraperitoneal adhesions. Materials and Methods: Peritoneal adhesions were induced in 98 female Wistar-Albino rats by cecal abrasion and peritoneal excision. Rats were randomly separated into seven groups, each containing fourteen rats, and the standard experimental model was applied to all of rats. 14 days later, rats were euthanized, intraperitoneal adhesions were scored and tissues were examined histologically using hematoxylin/eosin and Masson’s trichrome staining. Results: Throughout the investigation, no animal died during or after surgery. In all of experimental groups, decrease in fibrosis was statistically significant. Decrease in fibrosis was most prominently in intraperitoneal tacrolimus group (P = 0.000), and decrease was least in intraperitoneal cyclosporine group (P = 0.022). Vascular proliferation was significantly decreased in all experimental groups (P < 0.05) except for systemic tacrolimus group (P = 0.139). Most prominent reduction in vascular proliferation was in intraperitoneal tacrolimus group (P = 0.000). Conclusions: Administration of immunosuppressive drugs is effective for prevention of intraperitoneal adhesions.

The preventive role of levosimendan against bleomycin-induced pulmonary fibrosis in rats

BACKGROUND In this study, the effects of levosimendan used in the treatment of acute congestive heart failure upon pulmonary fibrosis in rats induced with bleomycin (BL) were analyzed. METHODS A total of 33 male Sprague-Dawley type rats were categorized into five groups randomly. About 2.5U/kg BL was intratracheally administered to the rats in the BL, BL+L1, BL+L2, and BL+L3 groups, and 0.9% saline was intratracheally administered at the same rate to the control group. 0.3, 1, and 3mg/kg levosimendan was intraperitoneally administered to the BL+L1, BL+L2, and BL+L3 groups, respectively. Blood and tissue samples were taken from the rats euthanized to determine the changes in erythrocyte enzyme activities and to conduct histopathological evaluations after 14 days. With values between 0 and 3, histopathological scoring damage was assessed by the presence of inflammation and fibrosis in a semiquantitative manner. RESULTS Compared with those in the C group, glutathione reductase (GR) and Catalase (CAT) enzymes decreased in the BL group; compared with that in the BL group, GR increased in the BL+L1 and BL+L3 groups, 6-phosphogluconate dehydrogenase (6PGD) increased in the BL+L3 group, and CAT increased in the BL+L2 and BL+L3 groups (p<0.05). In the histopathological evaluation, fibrosis occurred in all rats in the BL group, and tissue damage was noticed to be generally less in the BL+L1, BL+L2, and BL+L3 groups (p<0.001). CONCLUSIONS The results obtained from biochemical and histopathological evaluations indicate that levosimendan had an anti-fibrotic effect without a dose-dependent response on pulmonary fibrosis.