Yeliz Emine Ersoy

DNA oxidation and antioxidant status in breast cancer.

Purpose Oxidant/antioxidant balance has been suggested as an important factor for initiation and progression of cancer. The objective of this study was to determine 8-hydroxydeoxyguanosine (8-OHdG) level as a marker of oxidative DNA damage, glutathione peroxidase (G-Px), and superoxide dismutase (SOD) activities as antioxidant activity, in sera from women with breast cancer. Methods Forty-nine patients with malign breast tumor were included in the study. Blood samples were collected before the surgical operation. Serum level of 8-OHdG was measured with a competitive enzyme-linked immunusorbent assay kit, SOD, and G-Px activities were measured by spectrophotometric kits. Results 8-Hydroxydeoxyguanosine level and SOD activity were found to be increased in breast cancer group as compared with control group. Glutathione peroxidase activity in the breast cancer group was lower than those in the control group. The ratio of 8-OHdG/G-Px in breast cancer patients was found to be higher than those in the controls. There were correlations between 8-OHdG and CA19-9 (r = 0.77; P < 0.01); age and G-Px (r = −0.84; P < 0.05) in the breast cancer group. Conclusions Data show that serum levels of 8-OHdG and SOD activities are higher in patients with breast cancer. Glutathione peroxidase activity is lower in the breast cancer group. Increased ratio of 8-OHdG/G-Px in breast cancer patients is the evidence for impaired oxidant/ antioxidant balance in breast cancer.

Stump appendicitis and generalized peritonitis due to incomplete appendectomy

Abstract.Stump appendicitis is a rare clinical situation when there is incomplete appendectomy. A wide spectrum of diseases in the differential diagnosis of right lower quadrant pain of the abdomen and presence of appendectomy operation in a patient’s history delay the diagnosis. We report such a case of perforated stump appendicitis and generalized peritonitis occurring eight months after appendectomy.

Gastro-intestinal bezoars: thirty-five years experience.

Abstract Background and aims: Because of their rarity and late diagnosis, gastro-intestinal bezoars can be treated after the occurrence of some complications such as acute intestinal obstruction, strangulation, decubitus ulceration and bleeding. In this study, reasons for bezoar formation, measures to be taken and treatment modalities were investigated. Patients and methods: The files of the patients who were found to have gastro-intestinal bezoars and who were treated at Istanbul University, Cerrahpasa Medical Faculty General Surgery Department and Emergency Unit between the years 1970 and 2005 were analysed. Results: Thirteen (30%) of the 44 patients in the study were women, 31 (70%) were men: the mean age was 55.5 ± 19.6 (range 22–96) years. Enzymatic dissolution (3 patients) and endoscopic fragmentation (four patients) were unsuccessful. Laparoscopic gastrotomy (n = 2), gastrotomy(n = 16), gastric resection (n = 3), enterotomy (n = 12), segmental intestinal resection (n = 3), gastroduodenotomy (n = 1), and gastrotomy + enterotomy (n = 3) were performed. In two patients, bezoars were fragmented and milked to caecum. There were no major postoperative complications, except abdominal wound infection in 4 patients and one patient who had a recurrent intestinal bezoar five years after the operation. One of the patients died because of heart failure on the 7th postoperative day. Mean hospital stay was 9.5 ± 3.6 days. Conclusion: Even though rarely seen in digestive tract diseases, the probability of BZ formation should always be remembered. After the removal of BZs by conservative methods or surgery, precautions should be taken against recurrence and possible underlying psychiatric disorders should be treated.

An unusual case caused by a common reason: Mondor's disease by oral contraceptives ,

INTRODUCTION Mondors disease (MD) of the breast is a rare condition at breast clinics. We do not have enough data to establish its real prevalence. As a known data, most of the patients that were admitted to breast clinics are not breast cancer. Also MD is a rare entity and diagnosing this entity and informing the patient about it is very important. We present here this case to remind breast clinic practitioners that MD can be seen without trauma (neither surgical nor physical). Also clinical and radiological findings and the treatmentof the MD were discussed. PRESENTATION OF CASE A 35 year old woman was admitted our clinic with cutaneous breast retraction. She had no risk for thrombosis else using oral contraceptives. Mondors Disease was diagnosed and supported by radiological findings. Rheumatologic and hematologic causes were also explored. Patient healed in four weeks only with non-steroidal anti-inflammatory drug. DISCUSSION Mondors Disease is rarely related with breast cancer. This rare entity can be diagnosed with doubt and patient should be informed about it. Anti-coagulant treatment does not required if disease is idiopathic. CONCLUSION Mondors Disease should be reminded at a patient with retracted breast skin.

Feasibility of breast conserving surgery in multifocal breast cancers

BACKGROUND Multifocal breast cancers (MFBCs) present a challenge to surgeons. Although its feasibility is still controversial, breast-conserving surgery (BCS) is not contraindicated for MFBCs. The investigators retrospectively evaluated the feasibility of BCS and reviewed histopathologic findings in patients with MFBC. METHODS A total of 222 patients with MFBC who were treated with either BCS (119 patients) or mastectomy (103 patients) at a single institution between January 2002 and December 2011 were retrospectively evaluated. RESULTS The median follow-up time was 55 months (range, 10 to 102 months). Lymphovascular invasion and lymph node involvement were significantly less frequent in the BCS group (48.8% vs 62.2% for lymphovascular invasion, P = .04; 52.1% vs 71.8% for lymph node involvement, P = .002). There were no differences in local recurrence rates between the 2 groups. The overall survival rates were 92% in the BCS group and 72% in the mastectomy group (P = .000). CONCLUSIONS BCS is a feasible and safe procedure for the removal of multifocal tumors. Extended lymphovascular invasion is associated with mortality in patients who undergo mastectomy.

Remission of Ulcerated Necrobiosis Lipoidica Diabeticorum after Bariatric Surgery

A 32-year-old woman with type 2 diabetes mellitus suffering from morbid obesity with BMI 45,14 kg/m2 was operated on. Not only the type 2DM but also one of its complication known as necrobiosis lipoidica diabeticorum remitted postoperatively. Obesity should no longer be regarded simply as a cosmetic problem affecting certain individuals but an epidemic that threatens global well-being. It causes or exacerbates many health problems, and in particular, it is associated with the type 2 diabetes. Necrobiosis lipoidica is a granulomatous skin disease of unknown etiology, associated mainly with diabetes mellitus. We presented in this paper a morbid obese case of necrobiosis lipoidica diabeticorum with dramatic good response to bariatric surgery.

Safe thyroidectomy with intraoperative methylene blue spraying

BackgroundWe aimed to minimalize operative complications by spraying of methylene blue stain on thyroid glands and the perithyroidal area.Material and methodsThe intra-operative methylene blue spraying technique was used prospectively on a total of 56 patients who had undergone primary (not recurrent) thyroid surgery for a variety of thyroid diseases. Bilateral total thyroidectomy was performed in all cases. After superior but before inferior pole ligation, 0.5ml of methylene blue was sprayed over the thyroid lobe and perilober area. Tissues, especially parathyroides, the recurrent laryngeal nerve, and the inferior thyroid artery, were identified and evaluated.ResultsRecurrent laryngeal nerve and arteries were not stained and thus they remained white in all cases while all other tissues were stained blue. Within three minutes parathyroid glands washed out the blue stain and the original yellow color was regained. Thyroid tissue wash-out time was not less than 15 minutes; perithyroideal muscles, tendinous and lipoid structures took no less than 25 minutes.ConclusionThe safety of intravascular methylene blue guidance on thyroid surgery is known. This research demonstrates the effectiveness of the spraying technique, a new technique which ensures not only identification of parathyroid glands within three minutes, but also identification of recurrent laryngeal nerves and inferior thyroid arteries.

Zinc and copper status in acute pancreatitis: an experimental study.

Metal ions are required as active components of several proteins, including pancreatic enzymes, and they can play important roles in the etiopathogenesis of acute pancreatitis. In the present study, we measured the concentrations of zinc (Zn) and copper (Cu) in both serum and pancreatic tissue, as markers of trace element status in an experiental acute pancreatitis model. Twenty-four male Wistar rats were divided into two groups: the experimental group (N=24) and the control group (N=10). Acute pancreatitis was induced by injection of 48% ethyl alcohol into the common biliary duct. The animals were sacrificed 24 h later to detect the concentrations of Zn and Cu. There was no significant difference in tissue Zn and Cu concentrations between control and experimental groups (p<0.05). However, in the acute pancreatitis group, serum Zn and Cu levels were very significantly lower (p<0.001 and p<0.0001, respectively). In conclusuion, these findings suggested that altered mineral metabolism in serum and pancreatic tissue may have contributed to the pathophysiology of acute pancreatitis.

Ischemia modified albumin can predict necrosis at incarcerated hernias.

Purpose. To evaluate the predictive effect of IMA in incarcerated hernias. Methods. Three groups (n = 7) of rats were operated. Group I aimed to mimic incarceration, group II aimed the strangulation, and group III was the sham group. IMA and LDH measurements were made. Results. IMA levels were significantly higher in strangulation mimicking group and IMA levels were normal at postoperative 6th hour in incarceration mimicking group. LDH levels were significantly higher in both incarceration and strangulation mimicking groups. Conclusion. IMA seems to be an effective marker in incarcerated hernias to predict necrosis. But we need further studies to generalise this hypothesis.

Treatment of hepatic hydatid disease complications using endoscopic retrograde cholangiopancreatography procedures

BACKGROUND Liver hydatidosis may lead to serious morbidity due to biliary complications, the management for which endoscopic sphincterotomy (ES) and biliary drainage are very efficient. We evaluated the effectiveness of endoscopic treatment for complications of hepatic hydatid disease. METHODS We retrospectively reviewed endoscopic retrograde cholangiopancreatography (ERCP) procedures performed between January 2000 and December 2009 and compared laboratory findings, localization of the lesions and ERCP procedures applied between patients with and without jaundice. RESULTS In all, 70 ERCP procedures were performed in 54 patients (24 men, 30 women). Of the 70 procedures, 24 were performed to treat jaundice. All patients with biliary fistulas and jaundice were managed with endoscopic procedures. The 70 ERCP procedures included sphincterotomy only (n = 40); sphincterotomy and stent placement (n = 7); stent placement only (n = 4); sphincterotomy and membrane extraction (n = 9); sphincterotomy, membrane extraction and pus drainage (n = 5); and sphincterotomy and pus drainage (n = 5). Laboratory results improved in 3-7 days, and bile leakage ceased in 2-21 days. CONCLUSION Endoscopic retrograde cholangiopancreatography is a safe and effective way to manage biliary complications of hepatic echinococcal disease. In most patients, ES is the most efficient treatment of postoperative external biliary fistulas, jaundice and accompanying cholangitis, as it enables clearing the bile ducts of hydatid remnants; ES should be performed since it accelerates the healing process by decreasing pressure in the choledochus.