Unal Bakal

Irisin immunohistochemistry in gastrointestinal system cancers

Cancer is the leading cause of morbidity and mortality worldwide. Some studies have shown that high heat kills cancer cells. Irisin is a protein involved in heat production by converting white into brown adipose tissue, but there is no information about how its expression changes in cancerous tissues. We used irisin antibody immunohistochemistry to investigate changes in irisin expression in gastrointestinal cancers compared to normal tissues. Irisin was found in human brain neuroglial cells, esophageal epithelial cells, esophageal epidermoid carcinoma, esophageal adenocarcinoma and neuroendocrine esophageal carcinoma, gastric glands, gastric adenosquamous carcinoma, gastric neuroendocrine carcinoma, gastric signet ring cell carcinoma, neutrophils in vascular tissues, intestinal glands of colon, colon adenocarcinoma, mucinous colon adenocarcinoma, hepatocytes, hepatocellular carcinoma, islets of Langerhans, exocrine pancreas, acinar cells and interlobular and interlobular ducts of normal pancreas, pancreatic ductal adenocarcinoma, and intra- and interlobular ducts of cancerous pancreatic tissue. Histoscores (area × intensity) indicated that irisin was increased significantly in gastrointestinal cancer tissues, except liver cancers. Our findings suggest that the relation of irisin to cancer warrants further investigation.

A portable ultrasound based screening study on the prevalence and risk factors of cystic echinococcosis in primary school children in East Turkey

The tapeworm Echinococcus granulosus constitutes a major public health concern, since its larval stage causes cystic echinococcosis (CE) which is a life-threatening zoonotic disease in many parts of the world. The purpose of the present study was to perform a screening study in order to investigate the prevalence and risk factors of CE using a portable ultrasound (US) in a representative sample of 2500 primary school children aged 7-14 in East Turkey, where CE is known to be endemic. The students were scanned by portable US while standing, with special attention to the liver, spleen, pancreas, and kidneys. The US scan was followed by a physical examination. In addition, a questionnaire was distributed to all students for completion with the assistance of their teachers regarding their demographic and social characteristics as well as their hygienic habits possibly related to CE. Students found positive were subjected to serologic examination. The US based prevalence was 0.2%. Organ involvement was 0.12% for liver and 0.08% for kidney. The response rate of the questionnaire survey was 93%. The risk factors found to be significant (P<0.05) for CE infection were hand washing and family relative with CE. The results of this study indicate that CE infection is an important public health problem in East Turkey requiring appropriate control measures.

Abdominotransanal approach to pouch colon associated with rectal atresia

Pouch colon anomaly and high anorectal malformation are well-defined rare anomalies. The association of pouch colon anomaly with rectal atresia has previously been defined in only one case. In this study, a 2-day-old baby is presented with pouch colon anomaly without fistula and with rectal atresia. As a second case in the literature, this pathologic condition has been treated through the abdominotransanal route by using a single-stage endorectal coloanal pull-through. Being uncommon and having an important therapeutic approach, this case has been evaluated as worth presenting.

The effect of lipoic acid on macro and trace metal levels in living tissues exposed to oxidative stress.

Environmental pollution resulting from fast-paced industrialization, various chemicals used in agriculture, additives in food, smoking and use of alcohol, radiation, some viruses and poor dietary habits all have currently increased the incidence and types of cancer. Polycyclic hydrocarbons are an example of this type of carcinogens. Living things are exposed to this free radical-increasing substance due to various reasons. Oxidative stress caused by reactive oxygen species has an important place in the etiology of cancer, which develops in relation to many factors. Injury caused by cancer in the organism may affect other organs, as well as the tumors organs and tissues. In addition, it is known that some changes take place in the content of macro and trace elements due to cancer in the organism. Our study is intended to explore the protective role of alpha-lipoic acid, which has antioxidant characteristics in living tissues exposed to oxidative stress, in the macro and trace element levels.

A Study of Foreign Body Aspiration in Children.

Aim:To analyze diagnostic and therapeutic methods used in the diagnosis and treatment of foreign body aspiration (FBA) and to determine the impact of technical infrastructure on mortality and morbidity. Methods:Hospital records of patients diagnosed with FBA between the years 1987 and 2015 were retrospectively evaluated. The patients were grouped according to the length of time until their admission to the hospital as follows: Group I (0–24 h); Group II (1–7 days); Group III (>7 days). Age, sex, history, existing symptoms, physical examination, endoscopic and radiological findings, time to treatment, type and location of the foreign body, treatment modality, mortality and morbidity rates were recorded. A rigid bronchoscopy procedure was performed between 1987 and 2005 (Phase 1) without the need for an optic telescope, while between 2006 and 2015, it was performed using a rigid bronchoscope equipped with an optical telescope and HD camera (Phase 2). Results:A total of 513 patients [male, n = 328 (63.9%) and female, n = 185 (36%)] who had complaints of FBA were evaluated. The mean age of the patients was 3.7 ± 3.5 years. In order of decreasing frequency, sunflower seeds, peanuts, and hazelnuts (38% of all patients) were extracted. Bronchoscopy could not detect a foreign body in 127 (24.7%) patients. Foreign bodies were mostly observed in the right (43.3%) main bronchus. When the locations of the foreign bodies were analyzed, significant differences were found for subglottic foreign bodies (FBs) between Groups I and III and for FBs located within the bifurcation between Groups II and III. The most prevalent symptom was sudden onset of coughing in 231 (45%) patients. A significant difference was detected between Groups I and II, as well as Groups I and III, for sudden onset of coughing, decrease in breathing sounds, wheezing, and fever. No abnormal radiological signs were detected in 136 (26.5%) patients. Manifestations of emphysema were significantly more frequent in Group I, pneumonia in both Groups II and III, and pleural effusion in Group III. When complications related to bronchoscopy were evaluated, a significant increase was observed in transient complications in Group III compared with Groups I and II. The negative bronchoscopy rate in Phase I was statistically significantly higher than that in Phase II. Conclusions:When the length of time elapsed till admission to a hospital was considered, a decrease in morbidity rates was observed in patients who presented at a hospital within the first 24 hours. In the diagnosis of suspect patients, virtual bronchoscopy seriously decreased the incidence of negative bronchoscopy. The authors determined that for bronchoscopic procedures, the renewal of technical ultrastructure with technological advances strongly contributed to a decrease in mortality and morbidity as a result of FBA in paediatric patients.

Cystic abdominal masses in children: a pictorial essay.

Cystic abdominal masses in children are not an infrequently encountered condition of childhood. These lesions usually present with large size and mimick each other with similar presenting symptoms. Imaging examinations have an important role to determine the type of the cystic abdominal masses, which is crucial for management of patients and presurgical planning. In this pictorial essay, we summarized the imaging features of common cystic abdominal masses of children, including cystic lesions arising from liver, biliary ducts, kidney, pancreas, bowel, ovary, mesentery, and miscellaneous tissues.

Serum, Saliva, and Urine Irisin with and Without Acute Appendicitis and Abdominal Pain

A 112-amino-acid protein irisin (IRI) is widely expressed in many organs, but we currently do not know whether appendix tissue and blood cells express it. If appendix tissue and neutrophil cells express IRI, measuring its concentration in biological fluids might be helpful in the diagnosis of acute appendicitis (AA), since neutrophil cells are the currently gold-standard laboratory parameters for the diagnosis of AA. Therefore, the purpose of this study was to investigate the suitability of enzyme-linked immunosorbent assay-based measurements of the proposed myokine IRI for the discrimination of patients with AA from those with acute abdominal pain (AP) and healthy controls. Moreover, immunoreactivity to IRI was investigated in appendix tissues and blood cells. Samples were collected on admission (T1), 24 hours (T2), and 72 hours (T3) postoperatively from patients with suspected AA and from patients with AP corresponding to T1-T3, whereas control subject blood was once corresponding to T1. IRI was measured in serum, saliva, and urine by using enzyme-linked immunosorbent assay, whereas in appendix tissue and blood cells, IRI was detected by immunohistohcemistry. Appendix tissue and blood cells (except for erythrocytes) are new sources of IRI. Basal saliva, urine, and serum levels were higher in children with AA compared with postoperative levels (T2) that start to decline after surgery. This is in line with the finding that IRI levels are higher in children with AA when compared with those with AP or control subject levels, most likely due to a large infiltration of neutrophil cells in AA that release its IRI into body fluids. Measurement of IRI in children with AA parallels the increase or decrease in the neutrophil count. This new finding shows that the measurement of IRI and neutrophil count can together improve the diagnosis of AA, and it can distinguish it from AP. IRI can be a candidate marker for the diagnosis of AA and offers an additional parameter to neutrophil count. The promising receiving operating curve results indicate the following sensitivities and specificities, respectively, for IRI: serum 90% and 55%, saliva 90% and 60%, and urine 90% and 50%. Serum neutrophil count gave a sensitivity of 90% and a specificity of 90%. This promising result now needs to be confirmed in a larger group of patients.

Bladder perforations in children

CONTEXT Bladder perforations in children occur due to several different reasons. AIM In this clinical series study, we focused on bladder perforations due to the pelvic injury, and our aim also was to create awareness for a rare type of bladder injuries. SETTING AND DESIGN This was a retrospective study of the patients who were treated in our clinic for bladder perforation between 2006 and 2011. SUBJECTS AND METHODS We reviewed the documents of childhood bladder perforations, and demographic and clinical characteristics of the patients were obtained. No statistical analyses were used because of the limited number of cases. RESULTS There were ten patients who suffered from bladder perforation in 5-year period; 5 were male, and 5 were female. The mean age of the patients was 4.35 years. Four patients (40%) experienced iatrogenic perforation and six patients (60%) experienced perforation due to the accident. Common symptoms were hematuria, abdominal tenderness, and inability to urinate. Three patients were diagnosed via emergency laparotomy, without any radiological examinations performed before surgery. Four patients suffered from the intraperitoneal perforation, three patients suffered from extraperitoneal injury and three of them both of intraperitoneal and extraperitoneal injuries. Mean recovery time for patients was 15 days. One patient developed a urinary tract infection and one newborn died due to accompanying morbidities. Nine patients were discharged from the hospital. CONCLUSION If the patients had a pelvic injury, surgeons must pay attention for the bladder perforation. Isolated bladder perforations are rare, and they are generally associated with iatrogenic injuries. Clinicians should pay attention to findings such as anuria, inability to insert a urinary catheter, and free fluid in the abdomen in order to diagnose the bladder perforation in newborns. Novice surgeons should pay more attention to avoid causing iatrogenic bladder perforation during inguinal hernia repair.

Surgical and Molecular Evaluation of Pediatric Hydatid Cyst Cases in Eastern Turkey

Cystic echinococcosis (CE) caused by Echinococcus granulosus is a major public health problem worldwide, including Turkey. The aim of the current study was to identify the strains and to estimate the potential risk factors of E. granulosus in operated pediatric cases in eastern Turkey. Ten pediatric patients (7 boys and 3 girls) living in rural areas, with ages ranging from 3 to 15 years old and various clinical histories, were included in this study. Eight patients had only liver hydatid cyst, while 1 patient had liver and lung hydatid cyst and the other liver, lung, and spleen, together. There were 2 ruptured liver cysts. After surgery, during follow-up, no increase was observed in hemagglutination levels, there were no mortalities, and there was no evidence of recurrence at 2 years post operation in all patients. Molecular analysis was performed on hydatid cyst samples obtained from the 10 pediatric cases. According to mt-12S rRNA PCR results, all cases were found to be G1/G3 cluster of E. granulosus sensu stricto.

Congenital diaphragmatic hernia in identical twins.

Congenital diaphragmatic hernia (CDH, Bochdalek type) is rarely seen in both members of identical twins. Herein, we report a 37 weeks’ twins with CDH along with a brief review of the literature. Both the neonates survived.