Kemal Peker

Management of Fournier's Gangrene: Review of 45 Cases

PurposeFourniers gangrene is a fatal synergistic infectious disease with necrotizing fasciitis of the perineum and abdominal wall along with the scrotum and penis in men and the vulva in women.MethodsThe clinical and operative records of 45 patients with Fourniers gangrene during a 14-year period were analyzed.ResultsThe etiology of the infection was identified in 39 patients. The most common causes were colorectal diseases and urogenital diseases. Four patients died with an overall mortality of 8.8%. The mortality rate was higher in patients with diabetes mellitus, but it was not statistically different. The age, duration of the symptoms, and the presence of rectal abscess were not found to be significant factors regarding mortality rate.ConclusionsSurgery with extensive debridement of all necrotic tissue is the main stay of treatment.

Comparison of iodine contents in gastric cancer and surrounding normal tissues

Abstract It has been suggested that iodine plays an important role in gastric cancer. Gastric cancer ranks first among the cancers in the north-eastern Anatolia region, Turkey, where iodine deficiency is common. In this study, iodine levels were determined in gastric cancer and surrounding normal tissues in 19 patients with gastric cancer. Tissue iodine levels were determined by the Foss method based on the Sandell-Kolt-hoff reaction. Tissue iodine levels were lower in gastric cancer tissue (17.8±3.4ngI/mg protein, mean±SEM) compared with surrounding normal tissue (41.7±8.0ngI/mg protein) (p<0.001). There was positive correlation between the iodine levels in gastric cancer tissue and surrounding normal tissue (r=0.845, p<0.001). There was no significant difference in iodine levels in cancer and surrounding normal tissue between male and female subjects. The iodine deficiency in our region may be one of the factors for increased gastric cancer prevalence. Our results support the hypothesis that iodine plays an important role in gastric cancer development.

Correlation of Bowel Wall Thickening Seen Using Computerized Tomography With Colonoscopies: A Preliminary Study

Purpose: Bowel wall thickening (BWT) is a common finding in abdominal computerized tomography imaging (CTi). The purpose of the present study was a prospective assessment and management of patients who have BWT in abdominal CTi. Materials and Methods: This study was conducted between January 2012 and July 2014 at Erzincan University Hospital, Turkey, with 64 patients who were admitted to the emergency and general surgery department. All of the patients had received colonoscopies due to BWT seen in abdominal CTi. Results: Twenty-three (36%) female and 41 (64%) male patients were included in the study. The mean age was 56.2 years (range, 14 to 84 y). The positive predictive value of CTi for BWT was 87.5%. The positive predictive value of a CTi diagnosis of the disease according to a radiologist’s report was 78.1%. Common pathologies detected by colonoscopy included neoplasia and inflammatory bowel disease. Conclusions: Diagnosis of BWT by abdominal CTi reveals pathologies in many cases. Colonoscopies will be helpful in the differential diagnosis.

Blood and urine iodine levels in patients with gastric cancer.

In this study, we aimed to investigate whether there is any relationship between gastric cancer and iodine concentrations in blood and urine in the northeast Anatolia region, where iodine deficiency is common. A total of 56 patients, diagnosed as gastric cancer and 25 healthy volunteers were included in the study. The methods used were based on the Sandell-Kolthoff reaction. The urine iodine concentration (UIC) and serum protein-bound iodine (PBI) levels were higher in patients with gastric cancer compared with healthy control subjects. The UIC in stage IV was higher than all other stages and the control group. The UIC was higher in stages III and IV compared with stages I and II. However, serum PBI levels in stage III were higher compared with stages I, and II and also control group. The serum PBI level in stage IV was higher than stage II and the control group. In the patient and control groups, there were no significant differences in serum PBI and UIC with regard to age or sex. Our results suggested that urinary and blood iodine concentration might be a useful marker for following the disease.

Relationship Between β-Catenin Expression and Prognostic Parameters of Colorectal Carcinomas / β-Catenin Ekspresyonunun Kolorektal Karsinomlarda Prognostik Parametreler ile İlişkisi

ABSTRACT Objective: Colorectal carcinomas are the most frequent tumors of the gastrointestinal tract. β-catenin, which is related to cadherins, is a cytoplasmic protein responsible for intercellular adhesion. It is also an important component in the Wnt signal pathway. Recent studies have shown structural alterations in the APC gene and axin in patients with colorectal carcinoma, along with β-catenin. We aimed to compare β-catenin expression, which is a prognostic factor itself, with other prognostic parameters. Material and Method: A total of 70 patients who had surgical intervention for colorectal malignancies between January 1994 and December 2003 were included in the study. Fifty-nine of the patients (84.3%) were male, 11 of the patients (15.7%) were female; their ages varied between 24 and 82 (mean 60.3 ±15.2) years. Paraffin blocks were immunohistochemically stained for β-catenin. The number of stained cell nuclei was assessed according to the stage of disease using the TNM classification, histological grade, lymphatic invasion, vascular invasion and tumor’s local invasion. Results: When groups constituted according to tumor histologic grade were compared for prognostic parameters in terms of stain density for β-catenin and number of stained cell nuclei, stain density was mild (+) and the number of stained nuclei was smaller in well-differentiated groups while stain density was strong (+++) and the number of stained nuclei was higher in poorly differentiated groups. There was a relation between β-catenin expression and differentiation grade, lymph node metastasis, stage and tumor size but not with vascular invasion. Conclusion : These data indicate that β- catenin, with functions in cell homeostasis and relations with the APC gene, has a substantial role in colorectal carcinogenesis. ÖZ Amaç: Kolorektal karsinomlar gastrointestinal sistemin en sık gorulen tumorleridir. Beta-catenin, kadherinlerle ilişkili, hucreler arası adezyonda gorevli sitoplazmik bir proteindir. Aynı zamanda Wnt sinyal yolağının da onemli bir komponentidir. Son donem calışmalarında kolorektal karsinomlu hastalarda, supressor APC geni ve axin ile birlikte beta-katenin yapısında da bozulmalar olduğu gosterilmiştir. Bu calışmada, kolorektal karsinomlarda bir prognostik faktor olan β-katenin ekspresyonunu, diğer prognostik parametrelerle karşılaştırmayı amacladık. Gereç ve Yöntem: Calışmaya 1994 -2003 yılları arasında kolorektal karsinom tanısı ile opere edilmiş olan 70 hasta dahil edildi. Hastaların 59’u (%84,3) erkek, 11’i (%15,7)’ si kadın olup yaşları 24 ile 82 (ortalama 60,3±15,2) yıl arasında değişmekteydi. Parafin bloklardan hazırlanan kesitlere beta-katenin antikoru immunohistokimyasal olarak uygulandı. TNM sınıflamasına gore tumorun diferansiasyon derecesi, evresi, lenf nodu metastazı, vaskuler invazyon ve tumorun lokal yayılımı ile boyanan nukleus sayısı arasında değerlendirme yapıldı. Bulgular: Tümörun histolojik derecesine gore oluşturulan grupların, β-katenin ile boyanma şiddetleri ve pozitif boyanan nukleus sayıları, prognostik parametreler ile karşılaştırıldığında; iyi diferansiasyon gosteren gruplarda boyanma şiddeti hafif (+), pozitif boyanan nukleus sayıları daha az iken, kotu diferansiyasyon gosteren gruplar da boyanma şiddetli (+++) ve pozitif boyanan nukleus sayısı daha fazla olarak tespit edildi. Beta-katenin ekspresyonu prognostik parametre olan diferansiyasyon derecesi, lenf duğumu metastazı, evre ve boyut ile ilişkili bulunurken, damar invazyonu ile ilişkisiz bulundu. Sonuç: Tüm bu bilgiler ışığında, beta-katenin’in hucredeki fonksiyonları ve APC geni ile olan ilişkileri nedeniyle kolorektal karsinogenezde onemli bir rolu olduğu acıktır.

Mekanik intestinal obstrüksiyona neden olan kolorektal anostomoz darlığnın endoskopik balon dilatasyonla tedavisi

1 Ibni Sina Hospital, Kayseri, Turkey 2 Erzincan University Department of General Surgery, Erzincan, Turkey Yazışma Adresi /Correspondence: Kemal Peker, Mengücek Gazi Eğitim ve Araştırma Hastanesi Genel Cerrahi Anabilim Dalı, Erzincan, Türkiye Email: k.peker@yahoo.com.tr Geliş Tarihi / Received: 16.01.2013, Kabul Tarihi / Accepted: 09.02.2013 Copyright