Soykan Arikan

Abdominal wall endometriosis: a diagnostic dilemma for surgeons.

Objective: To report 3 cases of endometriosis of the abdominal wall, a disease which is unfamiliar to general surgeons because of the potential pitfalls in its diagnosis. Clinical Presentation and Intervention: Three patients were referred to our general surgery clinic for abdominal masses. Incisional hernia and an abdominal mass were initially suspected in 2 patients, while a preoperative diagnosis of a rectus abdominis hematoma was made in the third because she had no history of previous surgery. Pain was a remarkable complaint in only one of the present cases.Abdominal wall endometriosis was diagnosed only upon histological examination postoperatively. In all cases, ultrasonography revealed hypoechogenic masses, and computed tomography showed that these masses had spiculations, and macroscopic views of the resected masses revealed well-demarcated margins without peritoneal involvement. All patients were treated with wide radical resections followed by polytetrafluoroethylene patch grafting. They were discharged from hospital on either the 2nd or the 3rd postoperative day uneventfully, and during follow-up there were no signs of pelvic endometriosis, as confirmed by ultrasonography, CA 125 measurement, gynecological consultation and examination. Conclusion: Since the diagnosis of scar endometrioma is rarely established prior to surgery, endometriosis should be included in the differential diagnosis of masses on the abdominal wall.

Is there any correlation between TNF-related apoptosis- inducing ligand (TRAIL) genetic variants and breast cancer?

Introduction TNF-related apoptosis-inducing ligand (TRAIL) is a death ligand and also a member of the TNF superfamily. We aimed to investigate the possible relationship between TRAIL and breast cancer. Here, we report the results of the first association study on genetic variation in the TRAIL gene and its effect on breast cancer susceptibility and prognosis. Material and methods A C/T polymorphism at 1595 position in exon 5 of the TRAIL gene was genotyped in a Turkish breast cancer case-control population including 53 cases (mean age: 55.09 ±11.63 years) and 57 controls (mean age: 57.17 ±17.48 years) using polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) analysis. Results There were no differences in the distribution of TRAIL genotypes and frequencies of the alleles in the breast cancer patients and controls. A heterozygous TRAIL CT polymorphism in exon 5 was present in 8.3% of tumour stage III-IV and 48.8% of stage I-II patients, and in 42.1% of controls. The reduced frequency of this genotype in patients who had advanced tumour stage was statistically significant (p = 0.017). Conclusions Our findings indicate that genetic variants of TRAIL at position 1595 in exon 5 might be associated with progression of breast cancer.

VEGF-A and FGF gene therapy accelerate healing of ischemic colonic anastomoses (experimental study)

BACKGROUND Reducing ischemic damage is one of the goals of surgery. The aim of this study was to apply human VEGF-A and FGF-2 DNA-mediated gene therapy in order to identify their effects in the healing of ischemic colon anastomoses and eliminating the negative effects of ischemia. METHODS Forty male Wistar albino rats weighing 250-280 g were divided into five equal groups (n = 8) as follows: group 1: control, ischemic left colonic anastomosis; group; 2: ischemic left colonic anastomosis with control plasmid delivery; group 3: ischemic left colonic anastomosis with VEGF plasmid delivery; group 4: ischemic left colonic anastomosis with FGF plasmid delivery; group 5: ischemic left colonic anastomosis with VEGF and FGF plasmid delivery. All rats were sacrificed on the 4th postoperative day. Anastomosis burst pressures were measured for mechanical examination of anastomosis. Tissue hydroxyprolin, VEGF and FGF levels were determined as biochemical parameters. Necrosis, epithelisation, inflammatory processes, fibroblastic activity, collagen deposition and neovascularisation at the anastomic site were studied. RESULTS VEGF, FGF and combined therapy significantly accelerated many of the histological parameters of healing, including fibroblast activation, collagen deposition, and angiogenesis, and augmented the levels of hydroxyproline and bursting pressure. CONCLUSIONS This is the first study to use gene therapy with growth factors for the healing of ischemic colonic anastomosis. This therapy can be effectively used in increasing ischemic anastomosis wound healing.

Left thyroid lobe hemiagenesis with hyperthyroidism: report of a case.

Thyroidal hemiagenesis resulting from the failure of development of one thyroidal bud to develop accounts for fewer than 0.1% of thyroidal disorders necessitating surgery. This rare congenital anomaly usually occurs on the left side. Any nonfunctional lobe detected by scintigraphy needs to be evaluated further by ultrasonography, because thyroid hemiagenesis is associated with varying degrees of morbidity when it coexists with other anomalies requiring surgical intervention. We report the case of a 38-year-old woman with preoperatively diagnosed thyroidal hemiagenesis, who underwent surgery in our clinic. We review the literature in relation to this case, and discuss the problems and complications associated with this unusual congenital anomaly.

Identification of a novel BRCA2 and CHEK2 A-C-G-C haplotype in Turkish patients affected with breast cancer.

BACKGROUND Many breast cancers are caused by certain rare and familial mutations in the high or moderate penetrance genes BRCA1, BRCA2 and CHEK2. The aim of this study was to examine the allele and genotype frequencies of seven mutations in BRCA1, BRCA2 and CHEK2 genes in breast cancer patients and to investigate their isolated and combined associations with breast cancer risk. METHODS We genotyped seven mutations in BRCA1, BRCA2 and CHEK2 genes and then analyzed single variations and haplotype associations in 106 breast cancer patients and 80 healthy controls. RESULTS We found significant associations in the analyses of CHEK2- 1100delC (p=0.001) and BRCA1-5382insC (p=0.021) mutations in breast cancer patients compared to controls. The highest risk was observed among breast cancer patients carrying both CHEK2-1100delC and BRCA2- Met784Val mutations (OR=0.093; 95%CI 0.021-0.423; p=0.001). We identified one previously undescribed BRCA2 and a CHEK2 four-marker haplotype of A-C-G-C which was overrepresented (?2=7.655; p=0.0057) in the patient group compared to controls. CONCLUSION In this study, we identified a previously undescribed BRCA2 and CHEK2 A-C-G-C haplotype in association with the breast cancer in our population. Our results further suggest that the CHEK2-1100delC mutation in combination with BRCA2-Met784Val may lead to an unexpected high risk which needs to be confirmed in larger cohorts in order to better understand their role in the development and prognosis of breast cancer.

Do CDKN2 p16 540 C>G, CDKN2 p16 580 C>T, and MDM2 SNP309 T>G Gene Variants Act on Colorectal Cancer Development or Progression?

CDNK2 p16 plays a pivotal role in G1/S transition by regulating the p53 pathway, which was regulated by a nuclear oncoprotein, mouse double minute 2 (MDM2). Overexpression of the MDM2 gene has been shown in a number of tumor types, its gene amplification is found to associate with accelerated tumor development and failure to treatment in both hereditary and sporadic cancers. Although genetic association studies have revealed the relationship between certain genetic polymorphisms and genes that play important roles in the development and progression of colorectal cancer (CRC), it is still unknown. Therefore, the polymorphisms of p16 540 C>G, 580 C>T, and MDM2 SNP309 T>G designed to investigate the risk of CRC development and progression in a Turkish population. We enrolled 87 patients with CRC and 75 healthy controls into the study. Genotypings were determined using polymerase chain reaction-restriction fragment length polymorphism techniques. Genotype distributions of p16 540 C>G and 580 C>T were found in agreement with the Hardy-Weinberg equilibrium in patients and controls. MDM2 SNP309 T>G was found in agreement with the Hardy-Weinberg equilibrium in controls, but not in patients. The results of our study, the G allele of p16 540 C>G and GG genotype of MDM2 SNP309 T>G were found significantly lower in patients compared with controls (p<0.001, p<0.05, respectively). Haplotype analyses have shown that the C allele of both the CDKN2 p16 540 C>G and 580 C>T variants together indicate a risk haplotype for the patient group; besides, carrying the G allele of p16 540 and G allele of MDM2 also seems a risk haplotype for the patient group. Our study is the first study that investigates the relationship among variants of CDKN2 p16 540 C>G, 580 C>T, and MDM2 SNP309 T>G risk of CRC and the development and progression in the Turkish population.

Investigation of a Possible Relationship Between EPHX1 Gene Polymorphisms and Colorectal Cancer in Turkish Society

Metabolism of chemical carcinogens, including their activation and detoxification, plays a key role in carcinogenesis. Microsomal epoxide hydrolase (EPHX1) has an important role in the metabolism of polycyclic aromatic hydrocarbons and detoxification of procarcinogens. The aim of this study was to investigate the association between colorectal cancer (CRC) development and EPHX1 gene polymorphisms. We investigated the polymorphisms in exon 3 (T>C, Tyr113His) and exon 4 (A>G, His139Arg) of the EPHX1 gene in 68 CRC patients and 116 controls by polymerase chain reaction-restriction fragment length polymorphism. The frequencies of the Try113Try, Try113His, and His113His for EPHX1 exon 3 were 37.9%, 55.2%, and 6.9% in controls and 39.7%, 42.6%, and 17.6% in CRC patients, respectively. Frequencies of EPHX1 exon 4 genotypes were 62.1% His139His, 37.9% His139Arg, and 0% Arg139Arg in the control group and 76.5% His139His, 22.1% His139Arg, and 1.5% Arg139Arg in the patient group. Individuals carrying the EPHX1 exon 3 His113His genotype had a 2.5-fold increased risk (p=0.024), and those carrying the EPHX1 exon 4 His139Arg genotype had decreased risk of CRC compared with controls (p=0.019). Even though exon 3 Tyr113His and exon 4 His139Arg polymorphisms for EPHX1 gene appear to be important factors for CRC risk, further investigations with larger study groups are needed to fully elucidate the role of these polymorphisms in the development of CRC.

Comparison of endoscopic therapeutic modalities for postoperative biliary fistula of liver hydatid cyst: a retrospective multicentric study.

Background Hydatid disease most commonly affects the liver, and rupture into the bile ducts is a frequent complication occurring in 5% to 25% of patients. Biliary endoscopic procedures have become the treatment of choice for the management of biliary fistulae. Objective parameters for the endoscopic management of biliary fistulas are still necessary. Methods In this multicentric retrospective study, a total of 109 patients who underwent surgery for a hydatid cyst localized to the liver and presented with persistent drainage of bile from a lodge drain after surgical intervention were included in this study. All patients were treated by an endoscopic retrograde cholangiopancreatography. Patients were divided into 3 groups according to the therapeutic endoscopic procedure: group 1 (n: 70) included patients who underwent only endoscopic sphincterotomy; group 2 (n: 22) included patients who had a 10 F biliary stent inserted; and group 3 (n: 17) included patients who had a 7 F biliary stent inserted. Recorded data were reviewed and the groups were compared. Results The mean daily fistula output was 247 mL (range: 100 to 600 mL) in group 1, 534 mL (range: 200 to 1000 mL) in group 2, and 372 mL (range: 120 to 780 mL) in group 3, respectively. There were significant differences between the sphincterotomy group and the stenting groups (P<0.001). The closure time of the external biliary fistula was 23.7 days (range: 6 to 60 d) in group 1, 12.6 days (range: 7 to 23 d) in group 2, and 20 days (range: 6 to 33 d) in group 3, respectively. When compared with the sphincterotomy group, the fistula closure time was shorter in group 2 than in group 1 (P<0.001). There were no differences in this respect between the groups 1 and 3 (P=0.214). Group 2 also had a shorter fistula closure time than group 3 (P<0.001). There was no mortality in any of the study groups. Mild bleeding was observed in 3 cases in group 1 and in 1 in group 3. Conculusions Endoscopic retrograde cholangiopancreatography and related therapeutic procedures are safe and valuable in the postoperative management of external biliary fistulae in the hepatic hydatid disease. In high-output fistulae (>300 mL/d), indicating a major cystobiliary communication, stent placement may be preferred. The diameter of the stent should preferably be 10 F. This 10 F stent is superior to other endoscopic approaches in the treatment of biliary fistulas.

Close correlation between restriction fragment length polymorphism of L-myc gene and susceptibility to gastric cancer

AIM A common inherited RFLP of the L-myc proto-oncogene has been reported to correlate with cancer susceptibility. Our aim was to test the hypothesis that there was association between L-myc S allele in gastric cancer and predisposition to the disease. METHODS The distribution of L-myc polymorphism in 25 patients with gastric cancer was determined by polymerase chain reaction-based restriction fragment length polymorphism and compared with that of 83 healthy control subjects. RESULTS We found a significant difference, both in the distribution of the LL, LS and SS genotypes and in the allelic frequencies, between the control group and the patient group; that is, the frequencies of L-myc alleles were, L and S, 0.52 and 0.48, 0.64 and 0.36, respectively. This difference was primarily the result of a high frequency of the S allele among gastric cancer patients compared to controls. There was a significant difference in the distribution of both genotypes (P = 0.004) and allele frequencies (P = 0.005) between patients with gastric cancer and control groups. CONCLUSIONS Our results suggested that L-myc polymorphism may be significant in an individuals susceptibility to gastric cancer in Turkey and may be useful for identifying patients at high risk of developing gastric cancer.

Helicobacter pylori Stool Antigen Test : Results of a Prospective Study

PurposeThere are now many tests and pathological examinations to detect Helicobacter pylori (Hp), but most have disadvantages such as being invasive, expensive, or unobtainable for a widespread population. The Hp stool antigen (SA) test has been advocated as a safe and cost-effective method of diagnosing Hp. Thus, we conducted a prospective study to examine the reliability of the Helicobacter pylori stool antigen (HpSA) test.MethodsThe subjects were 100 patients who underwent endoscopic manipulation at Istanbul Haseki Education and Research Hospital. Endoscopy specimens were studied by a pathologist, for routine pathological analysis and for the presence of Hp. Fecal specimens were studied using the HpSA test in the laboratory of the Department of Infectious Diseases at our hospital. The pathology results were compared with the HpSA test results, since pathological examination was the reference standard of our study. The Χ2 test was used for statistical comparison of the values.ResultsAccording to the pathology results, Hp was present in 82 patients, whereas the HpSA test was positive in 77 patients and negative in 23 patients. The sensitivity, specificity, positive predictive value, and negative predictive value were 91%, 83%, 96%, and 65%, respectively.ConclusionThe HpSA test results were similar to the pathology results, with sensitivity and specificity of 91% and 83%, respectively. Thus, the HpSA test appears to be an effective method of detecting Hp in patients who are not candidates for endoscopy.