Kursat Dikmen

Neopterin as a prognostic biomarker in intensive care unit patients

PURPOSE The present study was undertaken to evaluate urinary neopterin in intensive care unit patients. MATERIALS AND METHODS Urinary neopterin levels were determined in systemic inflammatory response syndrome (n = 10), sepsis (n = 18), septic shock (n = 9), and multiple organ dysfunction syndrome (n = 5). It was tested whether neopterin is a differential parameter among the patient groups. Furthermore, the results were also evaluated by comparing with a healthy control group (n = 30), and the relationship between neopterin and mortality or Acute Physiology and Chronic Health Evaluation II scores were investigated. RESULTS Neopterin levels of the control group and patients were detected as 111 +/- 11 and 3850 +/- 1081 mumol/mol creatinine, respectively (P < .05). It was significantly increased in the sepsis and septic shock groups compared to the systemic inflammatory response syndrome group (P < .05). Neopterin levels were significantly higher in the patients with mortality and lower Acute Physiology and Chronic Health Evaluation II scores. CONCLUSION This study showed that monitoring of urinary neopterin profile can be used in intensive care units to show the degree and prognosis of the disease.

Neopterin, Catalase and Superoxide Dismutase in Females with Benign and Malignant Breast Tumors

Abstract The aim of the present study was to evaluate the relationship between the levels of neopterin among patients with benign and malignant breast disease and the relation with the stage of the malignant process. In this study, neopterin concentrations and enzyme activities of superoxide dismutase (SOD) and catalase (CAT) were determined in malign (n=30) and benign breast tumor patients (n=30) by high performance liquid chromatographic and spectrophotometric methods, respectively. Results were compared with a healthy control group (n=20). The correlations between neopterin, CAT and SOD were also evaluated in controls and patients. Urinary neopterin level of the control group was (mean value ± S.D.) 128.6 ± 64.6 μmol/mol creatinine. Neopterin concentrations in patients with breast malignancy were 153.6 ± 71.2 μmol/mol creatinine and 107.8 ± 32.1 μmol/mol creatinine in benign disorders patients. The mean neopterin level in the benign group was found to be statistically different from the malign tumor group (p = 0.039). SOD and CAT activities in controls were found as 3.57 ± 0.84 U/mg protein and 2.19 ± 0.20 U/mg protein, respectively. In patients with malignancy, the SOD activity was 3.84 ± 0.73 U/mg protein while CAT activity was 1.03 ± 0.13 U/mg protein. Patients with benign breast disorders, SOD activity was 4.09 ± 1.00 U/mg protein and CAT activity was 1.02 ± 0.18 U/mg protein. Whereas SOD activity did not differ between the groups of patients and controls, the mean catalase level in the control group was higher than in the benign and malign tumor groups (both p <0.001). Urinary neopterin concentration seems to be an important and useful biomarker in diagnosis of breast tumors in clinical practice.

Is neopterin level a predictive and differential biomarker in patients with thyroid disorders

Neopterin production provides information about the extent of cellular immune activation. Measurement of neopterin levels may also provide predictive and prognostic information in patients with malignant thyroid diseases. In the present study, neopterin levels were investigated in patients with thyroid disorders (no.=68). Twenty-four patients had papillary thyroid cancers and the rest of them benign thyroid disorders. Results were compared with a healthy control group (no.=30). It was observed that there was a significant difference in neopterin levels between the control group and the thyroid disorders group (p<0.05). The mean neopterin levels in malignant and benign patients were also significantly different (p<0.05). Monitoring of urinary neopterin profile may be used in early diagnosis of papillary thyroid cancer. Neopterin seems to be a differential biomarker for malignant and benign thyroid disorders.

The effect of pneumoperitoneum on intravascular fibrinolytic activity in rats.

BACKGROUND/AIM Venous stasis during pneumoperitoneum in laparoscopic surgery is closely related to fibrin synthesis and deposition. The etiologic factors underlying fibrinolysis or hypercoagulability are not clearly defined. This study aimed to determine the effects of pneumoperitoneum time and pressure on coagulation cascade and the fibrinolytic pathway. MATERIALS AND METHODS After the pneumoperitoneum model was established in rats, PAI-1, tPA, TAFI, D-dimer, and fibrinogen activities were evaluated in different time periods under different pressures in groups including 6 rats. Group 1 did not undergo any procedure. Group 2 received 8 mmHg of pressure for 30 min, Group III 8 mmHg for 60 min, Group IV 12 mmHg for 30 min, and Group V 12 mmHg for 60 min. RESULTS D-dimer levels had a tendency to decrease with increasing intraabdominal pressures. In both low and high pressure groups, fibrinogen had a tendency to increase with exposure time. There was no statistically significant difference among the study groups in terms of fibrinogen, D-dimer, and PAI-1. The levels of TAFI were significantly decreased with increasing pressure regardless of the exposure time. CONCLUSION Pneumoperitoneum of the coagulation system can be changed by duration of time and pressure.

Laparoscopic distal pancreatectomy

After technological advances and increased experiences, more complicated surgeries including distal pancreatectomy can be easily performed with acceptable oncologic results, and decreased mortality and morbidity. Laparoscopic distal pancreatectomy (LDP) has been shown to have several advantages including less blood loss, less hospital stay, less pain. Several studies comparing open distal pancreatectomy (ODP) and LDP resulted that both techniques have similar results according to pancreas fistulas, oncological results, costs and operation indications. Morbidity is very low in high volume centers, for this reason at least ten cases should be performed for the learning curve. Several authors remarked important technical points in LDP in order to perform safe and acceptable LDP in several studies. Here in this review, we aimed to overview the results of previous studies about LDP and discuss the technical points of LDP.

Prevention of inadvertent injury to aberrant hepatic artery arising from superior mesenteric artery during laparoscopic pancreaticoduodenectomy

Dissection during laparoscopic pancreaticoduodenectomy (LPD) is a complex surgical intervention and requires a comprehensive understanding of anatomical relationships and vascular variations around the duodenum and hepatoduodenal ligament (HDL). While the process carries a risk of inadvertent injury to the adjacent vasculature throughout the procedure, safe dissection along the superior mesenteric artery (SMA) is extremely vital because nearly one-fifth of patients have an aberrant hepatic artery (HA) coming off of SMA (1). If exists, the replaced or accessory HA typically courses just right and inferior to the portal vein (PV). With an accompanying video, this paper aims to share the technique that we adopt to avoid injury to the aberrant HA during LPD.

A case of Brunners gland adenoma mimicking tumors induced from head of the pancreas

Brunners Gland Adenoma is a very rarely seen benign tumor of duodenum. While it generally leads to obstruction and bleeding complaints, it may very rarely occur by mimicking a pancreatic tumor. A 48 years old male patient admitted to the gastroenterology clinic due to the epigastric pain spreading dorsally. No significant feature is present in his clinical history. A lesion containing cystic solid components in the size of 30x40 mm was detected in the head of pancreas as a result of the abdominal tomography. In the light of these findings, pancreaticoduodenectomy is applied to the patient. It is observed that tumor is in submucosal location and widely invaded the pancreatic head. In the histopathological examination, Brunners Gland Adenoma is reported in pancreatic head localization. In this manuscript a case of Brunners gland adenoma diagnosed by performing pancreaticoduodenectomy due to the mass in the head of the pancreas is presented.

Eleven patients with primary thyroid lymphoma: a single center experience

Background/aim: Primary thyroid lymphoma (PTL) is a very rare thyroid malignancy. It should be diagnosed and treated immediately and accurately. Our aim was to evaluate the diagnostic methods and treatment results for patients with PTL.Materials and methods: We retrospectively evaluated the records of 11 patients with PTL from 2009 to 2015, diagnosed at our institute. Age, sex, stage, histopathologic type, presence of Hashimotos thyroiditis, diagnostic methods, treatment types, and recurrence were examined.Results: Six patients were female, 5 were male, and the median age of the patients was 61 years (range: 15-76 years). All patients had a large palpable mass in the neck. Fine needle aspirate (FNA) biopsy was performed in all patients; however, it was useful only in the diagnosis of 7 patients. Excisional and surgical biopsy was performed in 4 patients. All patients had non-Hodgkin B-cell lymphoma, including 9 cases of diffuse large B-cell lymphoma (DLBCL), and 2 patients had mucosa-associated lymphoid tissue (MALT) lymphoma. Recurrence was observed in one patient. Median survival was 34 months.Conclusions: The preferred option for the diagnosis of PTL should be FNA biopsy, and the treatment should be decided on according to whether the disease is limited to the thyroid gland or not, its histological type, and its stage.

Coexistence of idiopathic granulomatous mastitis and erythemanodosum: successful treatment with corticosteroids

Background/aim: Idiopathic granulomatous mastitis (IGM) is a rare, chronic inflammatory disease of the breast. Erythema nodosum (EN) is a rare extramammary manifestation of IGM. The purpose of this study is to determine the clinical and demographic characteristics of 11 IGM and EN patients and to evaluate the efficacy of methylprednisolone treatment. Materials and methods: In our series, ten patients had EN bilaterally, whereas one patient had a lesion of the right pretibial area. The mean age of the patients was 35.5 years (range: 29-45 years). IGM and EN were diagnosed by the necessary serological, microbiological, radiological, and histopathological examination. After diagnosis, methylprednisolone was started in the first week at 0.8 mg/kg daily for treatment. The weekly dose was tapered to 0.1 mg/kg daily over 8 weeks.Results: We started with the treatment of methylprednisolone, and in all our cases the initial response was excellent. In 2 weeks the IGM symptoms had markedly declined, while signs of EN disappeared completely. Patients were followed for an average of 60 months after treatment. None of the 11 patients had recurrence.Conclusion: We herein report a rare series considering IGM cases complicated by EN. Few such cases have been reported in the literature. We advocate for an initial trial of methylprednisolone treatment, which proved to be very successful in our patients.

Plasma human leukocyte antigen-G (HLA-G) in patients with thyroid cancer

Background/aim: A number of tumor markers detected in the serum or pathological specimens using immunohistochemical methods are used for early detection of malignancies and postoperative follow-up. Human leukocyte antigen-G (HLA-G) is a nonclassic HLA class I molecule. Recent studies suggested a relationship between HLA-G positivity and the stage or the phenotype of the malignancy. In this study, the relationship between serum HLA-G positivity and thyroid cancer was investigated. Materials and methods: Fifty patients with thyroid cancer and 45 healthy volunteers were included in this study. Serum HLA-G levels were measured using ELISA. Results: HLA-G was positive in only 3 out of 50 patients with thyroid cancer (2 papillary, 1 follicular type). On the other hand, HLA-G was positive in 20 out of 45 healthy subjects (P < 0.001). The prevalence of detectable levels of serum HLA-G was independent of sex and age in the whole study population. No correlation was found between serum HLA-G value and thyroid hormone profile, neither in papillary thyroid cancer nor follicular thyroid cancer patients. Conclusion: In this study, serum HLA-G was significantly less common in patients with thyroid cancer than in healthy controls.