Tolga Özmen

Detection of PIK3CA Gene Mutations with HRM Analysis and Association with IGFBP-5 Expression Levels in Breast Cancer

Breast cancer is the second most common cancer and second leading cause of cancer deaths in women. Phosphatidylinositol-3-kinase (PI3K)/AKT pathway mutations are associated with cancer and phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) gene mutations have been observed in 25-45% of breast cancer samples. Insulin growth factor binding protein-5 (IGFBP-5) can show different effects on apoptosis, cell motility and survival in breast cancer. We here aimed to determine the association between PIK3CA gene mutations and IGFBP-5 expressions for the first time in breast cancer patients. Frozen tumor samples from 101 Turkish breast cancer patients were analyzed with high resolution melting (HRM) for PIK3CA mutations (exon 9 and exon 20) and 37 HRM positive tumor samples were analyzed by DNA sequencing, mutations being found in 31. PIK3CA exon 9 mutations (Q546R, E542Q, E545K, E542K and E545D) were found in 10 tumor samples, exon 20 mutations (H1047L, H1047R, T1025T and G1049R) in 21, where only 1 tumor sample had two exon 20 mutations (T1025T and H1047R). Moreover, we detected one sample with both exon 9 (E542Q) and exon 20 (H1047R) mutations. 35% of the tumor samples with high IGFBP-5 mRNA expression and 29.4% of the tumor samples with low IGFBP-5 mRNA expression had PIK3CA mutations (p=0.9924). This is the first study of PIK3CA mutation screening results in Turkish breast cancer population using HRM analysis. This approach appears to be a very effective and reliable screening method for the PIK3CA exon 9 and 20 mutation detection. Further analysis with a greater number of samples is needed to clarify association between PIK3CA gene mutations and IGFBP-5 mRNA expression, and also clinical outcome in breast cancer patients.

A retrospective analysis of 93 cases with anorectal abscess in a rural state hospital

OBJECTIVE Anorectal abscess is a clinical condition frequently encountered in daily surgical practice and recurrences may occur despite treatment with adequate incision and drainage. The primary aim of this study was to analyze the variables that may have resulted in recurrent anorectal abscess, retrospectively. MATERIAL AND METHODS Ninety-three patients out of 149 patients who underwent surgery for anorectal abscess at our center between 2011-2012 were included in this study. Data regarding age, gender, presence of recurrence, time to recurrence, abscess type, presence of fistula, fistula type, drain usage, length of hospital stay and follow-up duration were retrospectively recorded. RESULTS Patients were divided into two groups: the recurrence group and the treatment group. Eleven patients (11.8%) had a recurrence and the median time to recurrence was 3 months. None of the variables evaluated were found to be significantly associated with the presence of recurrence. CONCLUSION Variables such as age, gender, type of abscess, presence of fistula or drain usage were not associated with the development of recurrence in patients who underwent incision and drainage of an anorectal abscess.

Factors affecting surgical site infection rate after elective gastric cancer surgery

OBJECTIVE Surgical site infection (SSI) is a common complication after surgery and is an indicator of quality of care. Risk factors for SSI are studied thoroughly for most types of gastrointestinal surgeries and especially colorectal surgeries, but accumulated data is still lacking for gastric surgeries. We studied the parameters affecting SSI rate after gastric cancer surgery. MATERIAL AND METHODS Consecutive patients, who underwent elective gastric cancer surgery between June and December 2013, were included. Descriptive parameters, laboratory values and past medical histories were recorded prospectively. All patients were followed for 1 month. Recorded parameters were compared between the SSI (+) and SSI (-) groups. RESULTS Fifty-two patients (mean age: 58.87±9.25 [31-80]; 67% male) were included. SSI incidence was 19%. ASA score ≥3 (p<0.001), postoperative weight gain (p<0.001), smoking (p=0.014) and body mass index (BMI) ≥30 (p=0.025) were related with a higher SSI incidence. Also patients in the SSI (+) group had a higher preoperative serum C-reactive protein level (p=0.014). CONCLUSION We assume that decreasing BMI to <30, stopping smoking at least 3 weeks before the operation, and preventing postoperative weight gain by avoiding excessive intravenous hydration will all help decrease SSI rate after gastric surgery.

Endoscopic snare excision of adenoma of the papilla of Vater without prophylactic pancreatic-duct stent.

CONTEXT The endoscopic excision of adenomas of the papilla of Vater has gained increased popularity in the recent years. Temporary pancreatic drainage has been advised to accompany snare papillectomy in order to prevent ductal obstruction and serious pancreatitis. OBJECTIVES We evaluated treatment outcome of patients who had undergone endoscopic papillectomy without pancreatic drainage. METHODS Three consecutive adult patients with adenomas of the papilla of Vater presented with jaundice and pain were treated by endoscopic snare excision between October 2013 and February 2014 in a single center. ERCP procedures revealed papillary tumors and endoscopic biopsy specimens revealed tubular adenoma the papilla of Vater. Adenomas were treated by snare papillectomy method and a biliary stent was inserted as a prophylactic procedure immediately after excision of the adenoma in each case. In addition to physical examination, laboratory tests were repeated in the follow-up period after papillectomy in order to document if there is any complication particularly pancreatitis. RESULTS None of the patients experienced an immediate complication, including pancreatitis after papillectomy. Also neither patient experienced abnormal fluctuations of laboratory tests during the follow-up. Histopathologic evaluation of the resection specimens revealed a tubular adenoma with low grade dysplasia in the first two patients and a tubular adenoma with high-grade dysplasia in the third one. Endoscopy and pathologic evaluation revealed no recurrent/residual disease during the follow-up period of these patients. CONCLUSION Endoscopic snare resection of adenoma of the major papilla of the duodenum is a safe and minimal invasive alternative to surgical therapy. Biliary stent is sufficient to prevent biliary ductal patency and pancreatic stenting might not be necessary to prevent pancreatitis.

Appendiks mukoseli ve laparoskopik tedavisi

GIRIŞ Appendiksin mukoseli mukozanin neoplastik degisikliklerine ikincil olarak gelisen nadir bir hastaliktir. Appendiks lumeni, icerisinde anormal mukus birikimi sebebiyle siser ve kistik bir kitle halini alir (1,2,21). Appendektomi materyallerinin histopatolojik incelemelerinde appendiks mukoseli %0,1 – 0,3 oraninda saptanmaktadir (3,4). Malign mukosel spontan olarak veya ameliyat esnasinda rupture oldugunda psodomiksoma peritonei olarak tariflenen assite sebep olur ve sagkalim oldukca dusuktur . Bu nedenle mukoselin taninmasi ve uygun tedavisi onem kazanir.

Comparison of telomere length and insulin‐like growth factor‐binding protein 7 promoter methylation between breast cancer tissues and adjacent normal tissues in Turkish women

Both insulin‐like growth factor‐binding protein 7 (IGFBP7) and telomere length (TL) are associated with proliferation and senescence of human breast cancer. This study assessed the clinical significance of both TL and IGFBP7 methylation status in breast cancer tissues compared with adjacent normal tissues. We also investigated whether IGFBP7 methylation status could be affecting TL.