Salim Demirci

Effect of sphincter-sacrificing surgery for rectal carcinoma on quality of life in Muslim patients.

AbstractPURPOSE: Living with a permanent colostomy significantly diminishes a patient’s quality of life. However, little is known about its influence on worship patterns in Muslims. Therefore, the aim of this study was to assess the quality of life in Muslim patients after surgery for rectal carcinoma, especially with respect to religious worship. METHODS: We studied 178 patients who had undergone curative surgery for colorectal carcinoma. The patients fell into three groups based on the type of surgery they underwent: abdominoperineal resection (n = 75), sphincter-saving resection (n = 51), and anterior resection including sigmoid colectomy (n = 52). Quality of life was measured with the Medical Outcomes Study Short Form 36 Health Survey and a questionnaire that asked participants about their work responsibilities, sexual life, and religious worship. RESULTS: The scores for all eight subscales of the Short Form 36 in the abdominoperineal resection group were significantly poorer than those in the sphincter-saving resection and anterior resection groups (P < 0.001). In addition, social life and work responsibilities were significantly more affected in the abdominoperineal resection group than in the other two groups (P < 0.001). A significantly (P < 0.001) greater number of patients in the abdominoperineal resection group stopped praying daily (either alone or in a mosque) and fasting during Ramadan. CONCLUSION: Two aspects of religious worship (praying and fasting) were significantly impaired in the Muslim patients who had a stoma as a result of sphincter-sacrificing surgery. To improve quality of life in these patients, religious issues as they relate to the presence of a stoma should be discussed during preoperative counseling, the informed consent process, and counseling with local religious authorities.

Activities of adenosine deaminase, 5'-nucleotidase, guanase, and cytidine deaminase enzymes in cancerous and non-cancerous human breast tissues.

We measured activities of some DNA turnover enzymes in 9 breast tissues with stage II cancer, 6 breast tissues with stage IIIa cancer, and 9 non-cancerous adjacent breast tissues from the same patients with stage II cancer. We found higher Adenosine Deaminase (ADA) and 5′-Nucleotidase (5′NT) and lower Guanase (GUA) activities in the cancerous tissues compared with the non-cancerous ones. No meaningful differences were however found between Cytidine Deaminase (CD) activities. Regarding the correlation analysis, positive correlations were established between ADA and 5′NT activities of the cancerous tissues (r = 0.45 for the tissues with stage II and r = 0.60 for the tissues with stage IIIa cancer). No meaningful correlations were however found between other enzyme activities. Relating to activity ratios, no meaningful differences were found between ADA/5′NT values in the tissues. GUA/CD ratios were however lower and the other ratios higher in the cancerous tissues.Results indicated that ADA and 5′NT activities increased and GUA activity decreased in the cancerous breast tissues but CD activities did not change in the tissues affected. It has been suggested that increased ADA and 5′NT together with decreased GUA activities might be a physiologic attempt of the cancer cells to provide more substrates needed by cancer cells to accelerate the salvage pathway activity. Furthermore, high ADA activity might also play part in the detoxication process of high amounts of toxic adenosine and deoxyadenosine substrates produced from accelerated purine metabolism in the cancerous tissues.

The role of granulocyte‐macrophage‐colony stimulating factor, cortisol, and melatonin in the regulation of the circadian rhythms of peripheral blood cells in healthy volunteers and patients with breast cancer

Abstract: The circulating blood cells show highly reproducible circadian rhythms. However, the factors that regulate these rhythms are not well understood. In the current study, we examined the diurnal variations of peripheral blood cells (white blood cells, neutrophils, lymphocytes), granulocyte‐macrophage‐colony stimulating factor (GM‐CSF), and melatonin levels, and considered the role of melatonin on these rhythms in healthy volunteers and in patients with early breast cancer. Fourteen premenopausal patients with early stage breast cancer (T2, N1 tumors) and 10 premenopausal healthy volunteers were included in the study. Blood samples were taken every 4 hr for a period of 24 hr. Peripheral blood cells were counted by automated analyser and also from peripheral blood films. GM‐CSF levels were measured by ELISA and melatonin levels by radioimmunoassay (RIA). Serum melatonin, cortisol, and GM‐CSF levels, and peripheral blood cell counts showed significant circadian rhythms in healthy volunteers. Except for GM‐CSF, these circadian rhythms were found not to be suppressed in early breast cancer patients. While there were significant correlations of serum GM‐CSF and cortisol levels with peripheral blood cell counts in healthy volunteers, only lymphocyte counts were found to be significantly correlated with serum GM‐CSF and cortisol levels in patients with breast cancer. Serum melatonin levels were found to be significantly correlated with lymphocyte counts in both groups. Our results suggest that peripheral blood cells show significant circadian rhythms in both healthy volunteers and in patients with stage II (T2, N1) breast cancer, and GM‐CSF, cortisol, and melatonin may have a role in the regulation of peripheral blood cell counts.

Prevention of intra-abdominal adhesions by using Seprafilm® in rats undergoing bowel resection and radiation therapy

Intra‐abdominal adhesions are an important surgical problem. Colorectal operations are a major cause of adhesive obstruction. Radiation therapy (RT) is frequently used as an adjuvant therapy to surgery for rectal cancer, though its value for colon carcinoma remains unclear. Peritoneal injuries including the surgical trauma, tissue ischaemia as well as RT are associated with peritoneal fibrinolytic activity. A sodium hyaluronate and carboxymethylcellulose bioresorbable membrane (Seprafilm®) has been used to reduce intra‐abdominal adhesion formation. We have investigated the effect of Seprafilm® on intra‐abdominal adhesion in rats receiving RT after the resection of the left colon.

Neuroendocrine differentiation in colorectal carcinomas: assessing its prognostic significance.

Aims and Background There is evidence that colorectal carcinomas with extensive neuroendocrine features have a substantially worse prognosis than those without, but the frequency and clinical significance of neuroendocrine features in conventional carcinomas has not been settled since few studies have been performed, with conflicting results. The aim of the study was to investigate neuroendocrine differentiation in colorectal carcinomas in relation to its prognostic significance. Methods In 50 patients with colorectal carcinoma, the extent and intensity of staining with each of the three antibodies (chromogranin A, neuron-specific enolase and synaptophysin) were determined and correlated with the histologic type, grade, stage of the tumor and survival time of the patients. Results We observed chromogranin A expression in 38%, neuron-specific enolase expression in 26%, and synaptophysin expression in 6% of the tumors. Chromogranin A was the most frequently and strongly expressed marker in our study. Of the three antibodies studied, only chromogranin A positivity was correlated with grade and stage of the tumors and was associated with a decreased effect on survival. Conclusions Our results show that chromogranin A is the most sensitive and specific neuroendocrine marker. Chromogranin A positivity appears to bear a poor prognosis in patients with colorectal cancers.

Effect of granulocyte‐macrophage colony‐stimulating factor on hepatic regeneration after 70% hepatectomy in normal and cirrhotic rats

BACKGROUND Post-hepatectomy liver insufficiency is one of the most serious postoperative problems and its prevention is important after major hepatic resection, especially in the cirrhotic liver. Some growth factors and cytokines appear to play important roles in liver regeneration. In the present study we have investigated the effects of granulocyte-macrophage colony-stimulating factor (GM-CSF) on hepatic regeneration after 70% partial hepatectomy (PH) in cirrhotic and non-cirrhotic rats. METHODS A rat model of liver cirrhosis was prepared using thioacetamide (TAA) (a dose of 20 mg/100 g body w, intra-peritoneally) on three days a week for 12 weeks. Adult male rats were divided into four groups:Group 1 (n=10) no cirrhosis and no GM-CSF; Group 2 (n=10) no cirrhosis and GM-CSF; Group 3 (n=10) cirrhosis and no GM-CSF; and Group 4 (n=10) cirrhosis and GM-CSF. All the rats underwent a 70% hepatectomy, and GM-CSF was administrated immediately after operation in Groups 2 and 4. On postoperative days 2 and 7, fresh samples from the remnant liver were obtained to evaluate its regenerative capacity.The liver regenerative process was estimated by DNA synthesis, using flow cytometry. RESULTS Proliferation index (PI) of hepatocytes at 48 h was higher in Group 4 rats than Group 3 rats (p<0.05). On postoperative day 7, PI was elevated in Group 3 rats compared with Group 4 rats, but this difference was not statistically significant. In non-cirrhotic rats given GM-CSF, PI was increased compared with Group 1 rats at day 2 (p<0.05), but not at day 7. CONCLUSIONS The findings suggest that the proliferative capacity of liver cells is impaired and delayed after 70% PH in cirrhotic rat liver. GM-CSF administration might enhance the liver PI in both normal and TAA-induced cirrhotic rats.

Surgical treatment of advanced alveolar hydatid disease of the liver: A report of five cases

We report herein the cases of five patients with alveolar hydatid disease (AHD) of the liver who were diagnosed and underwent surgery at the Department of Surgery of Ankara University between 1989 and 1994. In all five patients, the final diagnosis was established by frozen section of the lesion during laparotomy. Lesions of AHD were found only in the liver. Hepatic resections including right lobectomy and segmentectomy were performed in three patients while palliative procedures were carried out in the remaining two patients with unresectable disease. There was no operative mortality, and only one late death occurred 3 years after the hepatic resection. In this paper, we present the clinical and operative findings of these five patients and their outcomes, followed by a review of the surgical treatment of AHD.

Retroperitoneal soft tissue sarcoma: effect of hyperthermic total abdominal perfusion.

Aims and Background Soft tissue sarcomas (STS) of the retroperitoneum are rare tumors. Surgery remains the principal modality of therapy in the management of primary and recurrent retroperitoneal STS. However, little is known about the effect of regional chemotherapy using hyperthermic total abdominal perfusion (HTAP). We analyzed independent prognostic variables in 33 patients with STS in the retroperitoneum admitted from November 1990 through December 1996. Methods and Study Design Data regarding patients’ age, gender, tumor size, histological tumor type, tumor location, type of operation (primary or secondary surgery), extent of surgical management (marginal or extended), use of HTAP, tumor grade, and tumor stage according to the TNM classification were examined by univariate and multivariate analyses. Results All 33 patients underwent complete resections (marginal or extended). Eleven of them received locoregional chemotherapy by HTAP. The overall cumulative 5-year survival rates in patients with stage IIA and advanced disease were 82% and 22%, respectively (log-rank test, P <0.01). Using Coxs proportional hazard model, tumor stage, use of HTAP and type of operation were found to have significant influence on overall survival (P <0.05). Conclusions Our results showed that complete resection along with HTAP chemotherapy may improve survival in patients with retroperitoneal STS. These phase II data could be used to support the initiation of a phase III trial to test HTAP in patients submitted to complete resection of retroperitoneal STS.

Deep venous thrombosis of the extremity diagnosed by color Doppler ultrasonography after isolated limb perfusion.

Aim Isolated limb perfusion (ILP) is used to treat locally advanced sarcoma and melanoma of the extremities. ILP is associated with a 1.7% to 10% incidence of deep venous thrombosis (DVT). The aim of the study was to examine the effect of ILP on the peripheral venous system and to evaluate the diagnostic accuracy of color Doppler ultrasonography (US). Methods A total of 26 patients with locally advanced sarcoma or melanoma of the extremities received a total of 38 ILP. The patients were evaluated preoperatively and postoperatively by color Doppler US as a noninvasive venous measurement. We used a color Doppler US system (SSA-270A, Toshiba) with a 7.5-MHz linear transducer for gray-scale imaging and a 5-MHz vascular transducer for color Doppler imaging. Results Seventeen patients underwent single ILP while the others were treated with multiple ILPs. Color Doppler US showed a reflux flow in three (7.9%) patients and DVT occurred subsequently in these patients. Conclusions Color Doppler US is a noninvasive and clinically useful diagnostic technique in the diagnosis of extremity DVT. We recommend anticoagulant therapy in patients with reflux on ultrasonographic examination.

Treatment of non-resectable pelvic malignancies by isolated pelvic perfusion. a preliminary study

Management of non-resectable pelvic tumours by intra-arterial local chemotherapy was shown to be beneficial but systemic toxicity limits its use. To overcome this problem isolated pelvic perfusion (IPP) was introduced as an alternative. This study summarizes our preliminary experience with IPP in the treatment of 18 non-resectable pelvic tumours [recurrent rectal adenocarcinoma (six), soft tissue sarcoma (STS) (five), bone tumour (three), epidermoid carcinoma (two), prostatic adenocarcinoma (one), malignant melanoma (one)]. Results of IPP were regarded as complete remission (CR), partial remission (PR), stable disease (SD) and disease progression (DP) according to the changes in three parameters including; scoring in pain, tumour marker and tumour size measurements. Complete and partial remission were established in five (27%) and seven (39%) patients respectively indicating a benefit ratio of 66%. Objective pain relief was encountered in 53% of the cases. All patients with STS had undergone further surgical treatment after IPP with successful curative resections in four. No residual tumour was found at the laparotomy of the fifth patient. Presenting symptom of the prostatic adenocarcinoma patient was symptomatic hypoglycaemia which resolved completely after IPP. To our knowledge, this represents the first case reported in the English literature in whom tumour related hypoglycaemia was successfully managed by IPP. In conclusion; management of non-resectable pelvic tumours by IPP seems to offer serious palliation and increase in the quality of life without any systemic toxicity. Our preliminary experience suggests even resectability may be achieved in a number of patients especially in those with STS.