The Necessity of Upper Extremity Neurologic Examination while Evaluating Breast Pain.

INTRODUCTION: Breast pain is one of the most frequent complaints and occurs in 45-69% of all women. Cervical disc herniation is a common cause of cervical radiculopathy with an incidence rate of 18.6 per 100,000, and it should be considered as a cause of breast pain. OBJECTIVE: To identify the extent to which upper extremity neurologic findings and cervical root disorders accompany breast pain. METHODS: We prospectively collected clinical features of patients with breast pain. An upper extremity neurologic examination was performed in patients and controls. Patients who had neurologic findings underwent cervical spine magnetic resonance imaging (MRI) to identify cervical root disorders. RESULTS: Out of the 554 participants, 233 had breast pain, and 321 were controls. Women with breast pain had more numbness (116 [49.8%] vs. 104 [32.4%], p < 0.001) and more dysesthesia (36 [15.5%] vs. 17 [5.3%], p < 0.001) than the controls, but they had similar upper extremity weakness (10 [4.3%] vs. 14 [4.4%], p > 0.05). The number of women with one neurologic finding was significantly greater in the group with breast pain (119 [51.1%] vs. 111 [34.6%], p < 0.001). Ninety (16.2%) patients underwent a cervical vertebra MRI, which showed that 86 (95.6%) patients had cervical root disorders including 21 (23.3%) cases of bulging, 9 (10%) of annular tear, and 56 (62.2%) of central disc protrusion; 4 (4.4%) patients had normal findings. The multivariate logistic regression analysis revealed that age was the only significant predictor of neurologic findings in patients with breast pain (p < 0.05, OR: 1.02, CI: 1.002-1.053). CONCLUSIONS: Cervical root disorders should be considered as a cause of extramammary breast pain.

Upregulation of SIRT1 gene in gastric adenocarcinoma.

BACKGROUND/AIMS: SIRT1 gene overexpression is reportedly associated with cancer development, via the triggering of DNA repair impairment, and cell proliferation. The study aimed to investigate SIRT1 expression in patients with gastric cancer and its correlations with the clinical and pathological characteristics of the disease. MATERIALS AND METHODS: All patients (64 patients) who underwent gastric biopsy and were diagnosed with gastric adenocarcinoma and signet ring cell carcinoma between January 2011 and December 2013 were enrolled in the study, and patients with benign gastric biopsy were enrolled in the control group (34 patients). The previously prepared gastric tissues were collected from the pathology department, and SIRT1 gene expressions were evaluated in the gastric tissues of all study patients. Patients were subclassified according to their demographic, clinical, and pathologic features, and the patient and control groups were compared. RESULTS: Sixty-four patients were included in the study (25 females and 39 males). The mean age of the patients was 66±1 (range: 33-88) years. The SIRT1 gene 2' Average delta cycle threshold (CT) value was 0.102 in the control group, whereas it was 0.292 in the patients with gastric cancer (relative risk: 2.86; p=0.014). The SIRT1 gene was upregulated in all tumor stage subgroups except stage I, female patients, young patients (<45 years), and corpus and cardia tumor subgroups compared to the control group. CONCLUSION: SIRT1 gene overexpression is associated with gastric adenocarcinoma, and it can be argued that SIRT1 gene upregulation is associated with unfavorable gastric adenocarcinoma prognosis.

Laparoscopic organ-preserving gastric resection improves the quality of life in stromal tumor patients An observational study with 23 patients.

AIM: The aim of this study is to investigate whether organ preserving gastrectomy (OPG) would yield a greater ability to save more tissue and functions of the stomach and eventually provide better quality of postoperative life (QoPL) for patients with primary gastric gastroinstestinal stromal tumor (PG-GIST). MATERIAL AND METHODS: A retrospective analysis of 23 consecutive patients with PG-GIST who underwent laparoscopic conventional surgery and OPG from June 2008 to December 2016 was performed. Gastrointestinal quality of life index (GIQLI), the area of tumor-free tissue (TFT), body mass index, and postoperative complications were recorded. RESULTS: Both first- and sixth-month GIQLI scores (mean = 105.4 ± 9.5 and 117.0 ± 11.1, respectively) were significantly higher than baseline scores (mean = 100.9 ± 10.2) of the study population (z = -3.32 and -3.86, p = 0.001 and 0.0001, respectively). GIQLI scores were inversely related to TFT area (r = -0.635, p = 0.001). Linear regression analysis revealed 0.130 decrease in GIQLI scores at 6 months each cm2 of removed TFT area. CONCLUSION: Laparoscopic OPG seems to be useful in terms of oncologic safety, minimizing the excessive resection of TFT and maximizing the gastric remnant, thereby improving the QoPL of the patients. KEY WORDS: Function-preserving surgery, Gastric stromal tumor, GIST, GIQLI, Laparoscopic gastrectomy.

Splenectomy proportions are still high in low-grade traumatic splenic injury.

OBJECTIVE: The spleen is the most vulnerable organ in blunt abdominal trauma. Spleen-preserving treatments are non-operative management with or without splenic angioembolization, partial splenectomy, and splenorrhaphy. The aim of the present study was to determine the rate of SPTs and to evaluate the usefulness of Injury Severity Score after traumatic splenic injury. MATERIAL AND METHODS: We searched our institution's database between May 2012 and December 2015. Patients' clinicopathological features, surgeon's title, type of treatment, admission and discharge dates, duration of surgery, intensive care unit requirement, and Glasgow Coma Scale were recorded. RESULTS: The mean age of patients was 33.36±11.58 years. Of the 33 patients, 26 (78.8%) were males, and 7 (21.2%) were females. Thirty (90.9%) had total splenectomy (TS), and 3 (9.1%) had spleen preserving treatment (2 Nonoperative management and 1 partial splenectomy). No fatal hemorrhage developed after nonoperative management. Exitus rates were 5/30 (15.1%) and 0/3 in the total splenectomy and spleen preserving treatment groups, respectively. Of the 18 hemodynamically stable patients, only 2 (11.1%) had spleen preserving treatment. Of the 19 patients with grade I-III splenic injury, only 3 (15.8%) had spleen preserving treatment. For academic and non-academic surgeons, spleen preserving treatment rates were 3/11 (27.3%) and 0/22 (0%), respectively (p<0.05). Injury severity score and mean arterial pressure, number of transfusions, control hematocrit, and GCS had statistically significant relationships. CONCLUSIONS: Spleen preserving treatment proportions were low after traumatic splenic injury. Following trauma, guidelines will not only improve spleen preservation rates but also improve the overall health status of the patients and it will also prevent complications of splenectomy.

Adherence to vaccination recommendations after traumatic splenic injury.

BACKGROUND: The occurrence of a serious infection called overwhelming post-splenectomy infection (OPSI) increases more than 50 times in patients who have hyposplenia. The aim of this study was to investigate the adherence to vaccination recommendations after traumatic splenic injury. METHODS: We identified patients who underwent total splenectomy due to abdominal trauma between May 2012 and March 2016. We recorded the clinical, laboratory, and pathological features of the patients. We calculated the vaccination proportions before discharge, after discharge, and final. RESULTS: Twenty-seven patients underwent total splenectomy. For the vaccination status before discharge, after discharge, and final, the number of patients who received all the three vaccinations were 0 (0%), 0 (0%), and 8 (18.5%) and those who received none were 13 (48.2%), 11 (40.8%), and 9 (33.4%), respectively. The data of 17 patients were available for developing OPSI. The median follow-up time was 17.8 (4.4-41.2) months, and no OPSI cases were observed. CONCLUSION: Adherence to vaccination recommendations remains still low. Establishing a vaccination tracking system and following vaccination recommendations will be helpful to prevent serious infections, such as OPSI, after traumatic splenectomy.

Distal scar-to-midline distance in pilonidal Limberg flap surgery is a recurrence-promoting factor: A multicenter, case-control study.

BACKGROUND: The Limberg flap (LF) procedure is widely performed for the treatment of sacrococcygeal pilonidal sinus (SPS); however, recurrences continues to be observed. The aim of this study was to assess the relationship between LF designs and the risk of SPS recurrence. METHODS: Sixty-one cases with recurrent disease (study group) and 194 controls, with a minimum of 5 recurrence-free years following surgery (control group), were included in the study. LF reconstructions performed in each group were classified as off-midline closure (OMC) and non-OMC types. Subsequently, the 2 groups were analyzed. RESULTS: After adjustment for all variables, non-OMC types showed the most prominent correlation with recurrence, followed by interrupted suturing type, family history of SPS, smoking, prolonged healing time, and younger age. The best cut-off value for the critical distance from the midline was found to be 11 mm (with 72% sensitivity and 95% specificity for recurrence). CONCLUSIONS: We recommend OMC modifications, with the flap tailored to create a safe margin of at least 2 cm between the flap borders and the midline.

Changes in Thiol-Disulfide Homeostasis of the Body to Surgical Trauma in Laparoscopic Cholecystectomy Patients.

OBJECTIVE: We aimed to investigate the short-term effect of laparoscopic surgery on serum thiol-disulfide homeostasis levels as a marker of oxidant stress of surgical trauma in elective laparoscopic cholecystectomy patients. MATERIALS AND METHODS: Venous blood samples were collected, and levels of native thiols, total thiols, and disulfides were determined with a novel automated assay. Total antioxidant capacity (measured as the ferric-reducing ability of plasma) and serum ischemia modified albumin, expressed as absorbance units assayed by the albumin cobalt binding test, were determined. RESULTS: The major findings of the present study were that native thiol (283 ± 45 versus 241 ± 61 µmol/L), total thiol (313 ± 49 versus 263 ± 67 µmol/L), and disulfide (14.9 ± 4.6 versus 11.0 ± 6.1 µmol/L) levels were decreased significantly during operation and although they increased, they did not return to preoperation levels 24 hours after laparoscopic surgery compared to the levels at baseline. Disulfide/native thiol and disulfide/total thiol levels did not change during laparoscopic surgery. CONCLUSIONS: The decrease in plasma level of native and total thiol groups suggests impairment of the antioxidant capacity of plasma; however, the delicate balance between the different redox forms of thiols was maintained during surgery.

Laboratory markers has many valuable parameters in the discrimination between acute appendicitis and renal colic.

BACKGROUND: Only one diagnostic parameter is not available for acute appendicitis. For the establishment of diagnosis, combination of medical history, clinical, laboratory tests, and radiological imaging modalities are used so as to decrease the rates of negative laparotomy and morbidity secondary to delay in diagnosis. Thepresent study aimed to determine haematological and inflammatory markers which will be used in the discrimination of acute appendicitis (AA) and renal colic which are the most frequent and indistinguishable causes of abdominal pain in patients applying to the emergency service. METHODS: A total of 215 patients who presented with abdominal pain and who were histopathologically diagnosed as AA, and 200 patients who presented with abdominal pain and who were diagnosed as renal colic were included into the study. Control group consisted of 61 patients without any complaints who came to the outpatient clinics of internal medicine only for blood counts. Analyzed blood samples were WBC, RDW, Hb, MCV, MPV, neutrophil, lymphocyte, NLR and PLR. All differences associated with a chance probability of.05 or less were considered statistically significant. RESULTS: A statistically significant intergroup difference was seen between AA and renal colic groups as for age, WBC, Hb, MCV, neutrophil, lymphocyte, NLR and PLR. A statistically significant intergroup difference was seen between AA and control groups regarding age, WBC, Hb, RDW, MPV, neutrophil, lymphocyte, NLR and PLR. A statistically significant intergroup difference was seen between renal colic and control groups as for age, WBC, RDW, MPV, neutrophil and NLR. In ROC curve analysis, the area under AUCs for WBC, neutrophil, NLR and PLR were 0.896, 0.916, 0.888 and 0.725, respectively (p≤0.05). CONCLUSION: In the discrimination between patients with renal colic and those without any illness, WBC, RDW, MPV, neutrophil and NLR; in the differentiation between the patients with AA and healthy individuals, WBC, RDW, MPV, neutrophil, lymphocyte, NLR and PLR; and more importantly in the discrimination between patients with AA and those with renal colic who presented to emergency services with abdominal pain WBC, neutrophil, lymphocyte, PLR and NLR can be useful parameters.

MTUS1 tumor suppressor and its miRNA regulators in fibroadenoma and breast cancer.

Breast cancer is major public health problem predominantly effects female population. Current therapeutic approaches to deal with breast cancer are still lack of effectiveness. Thus, identifying/developing novel strategies to fight against breast cancer is very important. The frequent deletions at 8p21.3-22 chromosomal location nearby D8S254 marker enabled the discovery of a novel tumor suppressor gene, MTUS1. Subsequently, MTUS1 was demonstrated to be less expressed in a variety cancer types including breast cancer. Also, it is obvious that gene expression is widely regulated by miRNAs. Here, we aimed to report differential expression of MTUS1 and its regulatory miRNAs in breast cancer and fibroadenoma tissues. Dynamic analysis of MTUS1 expression levels and its miRNAs regulators were attained by Fluidigm 96×96 Dynamic Array Expression chips and reactions were performed in Fluidigm BioMark™ HD System qPCR. Consequently, MTUS1 mRNA levels were significantly diminished in breast cancer tissues and elevated in fibroadenoma tissues. Also, among MTUS1 targeting miRNAs, miR-183-5p was identified to be overexpressed in breast cancer and down-regulated in fibroadenoma tissues. Also, expression levels of MTUS1 and miR-183-5p were well correlated with clinical parameters. In particular, MTUS1 expression was found to be diminished and miR-183-5p expression was elevated with the advancing stage. In conclusion, as a potential therapeutic target, miR-183-5p can be a chief regulator of MTUS1 and MTUS1-miR-183-5p axis may have significant influence in the pathology of breast cancer.

Conservative vs Surgical Interventions for Umbilical Pilonidal Sinus: A Multicenter, Double-Blind, Prospective, Randomized Clinical Trial.

BACKGROUND: Umbilical pilonidal sinus (UPS) is one of the most neglected disorders, and there is still no clear consensus regarding optimal treatment of the disease. We therefore present our data from a prospective, randomized, controlled clinical trial comparing conservative vs surgical treatment of UPS. STUDY DESIGN: The study was conducted in Turkey between January 2012 and November 2015. All eligible patients with the diagnosis of UPS (n = 84) were randomized for either conservative treatment (CT, n = 42) or surgical treatment (ST, n = 42). All patients were followed up for at least 2 years; then, the results of both groups were compared. The primary outcomes were initial healing, recurrence, and the cure rate of the disease after each treatment modality. RESULTS: Mean (± SD) age of the patients was 20.83 ± 5.73 years old, and the majority were men (94%). Nearly 60% of the patients had a deep navel, and 55% had intense hair status. The main symptoms were drainage and wetness, pain, itching, and malodor. Overall, in 10 (27.8%) patients, relapse of the disease was observed in the CT group; it was observed in only 1 patient in the ST group (p = 0.002). Initial healing time was significantly shorter in the ST group (p = 0.001). Of the 81 patients who completed the 2-year follow-up, a cure could be obtained in only 28 of 41 patients in the CT group; it was achieved in all 40 patients in the ST group (68.3% vs 100%, respectively; p = 0.0001). CONCLUSIONS: This study provided evidence that surgical treatment is superior to conservative surgery regarding the primary and secondary outcomes of UPS at least 2 years after surgery.

MTUS1 and its targeting miRNAs in colorectal carcinoma: significant associations.

Deregulated microRNA (miRNA) expression has been shown to be involved in the pathogenesis of several types of cancers including colorectal cancer (CRC). Thus, determining miRNA targets of genes that play critical role in the malignant transformation is very important. Here, expression levels of tumor suppressor microtubule-associated tumor suppressor 1 (MTUS1) and its regulatory miRNAs were reported. Predicted and validated targets of MTUS1 gene was determined by a computational approach. Expressions of MTUS1 and miRNAs were determined by using 96.96 Dynamic Array™ integrated fluidic circuit (Fluidigm). As a result, MTUS1 levels were found to be diminished in formalin-fixed, paraffin-embedded (FFPE) tissue samples of CRC patients compared to controls. Also, several of MTUS1 targeting miRNAs were found to be upregulated in CRC samples (miR-373-3p, 183-5p, 142-5p, 200c-3p, 19a-3p, -20a-5p, -181a-5p, -184, -181d-5p, -372-3p, 27b-3p, 98-5p, -let-7i-5p, -let-7d-5p, -let-7g-5p, -let-7b-5p, and -let-7c-5p). Of these miRNAs, miR-135b-5p, -373-3p, 183-5p, 142-5p, 200c-3p, 19a-3p showed marked expression levels. In contrast, expression levels of let-7a-5p, 7e-5p, 7f-5p, hsa-miR-125a-5p, and 125b-5p were found to be downregulated in CRC tissues. Accordingly, some of the overexpressed miRNAs especially the miR-135b-5p, -373-3p, 183-5p, 142-5p, 200c-3p, and 19a-3p may play key roles in CRC pathophysiology through MTUS1. In contrast, let-7a-5p, 7e-5p, 7f-5p, miR-125a-5p, and 125b-5p may play important roles in CRC carcinogenesis independent from the MTUS1. In conclusion, MTUS1 targeting miRNAs may play key roles in the development of CRC by downregulating tumor suppressor MTUS1.

Differential expressions of cancer-associated genes and their regulatory miRNAs in colorectal carcinoma.

Colorectal cancer is one of the frequently seen malignancies in the world. To date, several oncogenes and tumor suppressor genes have been identified and linked to colorectal cancer pathogenesis. Although recent advances in the diagnosis and therapy of colorectal cancer are promising, identifying novel genetic contributors is still high priority. In the present study, expression profile of some cancer-related genes and their regulatory miRNA molecules were evaluated by using a high-throughput real-time PCR method. For the study, a total of 54 patients diagnosed with CRC and normal colon tissue samples of 42 healthy controls were included. For the expression analysis, total RNA was extracted from FFPE tissue samples and converted to cDNA. All expression analyses were assessed by using Fluidigm Microfluidic Dynamic Array chips for 96 samples and the reactions were held in Fluidigm BioMark™ HD System Real-Time PCR. As a result of the study, expression of the ADAMTS1, FHIT, RUNX1, RUNX3 and WWOX genes was shown to be significantly altered in CRC tissues in contrast to normal tissue samples. Moreover, miR-378a-3p, miR-155-5p, miR-193b-3p, miR-96-5p, miR-17-5p, miR-27a-3p, miR-133b, miR-203a, miR-205-5p, miR-34c-5p, miR-130a-3p, miR-301a-3p, miR-132-3p, miR-222-3p, miR-34a-5p, miR-21-5p, miR-29a-3p and miR-29b-3p were found to be significantly deregulated in CRC. Consequently, results of the current study strongly suggest the involvement of novel cancer-related genes and their regulatory miRNAs in CRC physiopathology.

Cutaneous sinus formation is a rare complication of thyroid fine needle aspiration biopsy.

Fine needle aspiration biopsy (FNAB) is essential in the diagnosis and management of thyroid nodules. In this paper, we report a rare complication, cutaneous sinus formation, after diagnostic FNAB guided by palpation. Sixty-three-year-old female patient was admitted with the complaints of hoarseness and discharge from the anterior neck wall which were present for the last 6 months. The patient underwent a near total thyroidectomy 17 years ago. Recurrent nodular goiter was detected six months before and a diagnostic FNAB guided by palpation was performed. Two weeks later the patient had wound discharge and hoarseness. Physical examination of the patient revealed a sinus, which was located superior to the thyroidectomy incision. A 1 cm nodule was palpated in the left side of her neck. A cervical ultrasonography (USG) showed a 9 × 7 mm nodule in the remnant thyroid and a 9.5 × 3.5 mm fistulized fluid collection. The patient underwent sinus tract and remnant thyroid removal. This case report presents a cutaneous sinus formation deriving from the granulation tissue, probably due to the silk suture reaction in the previous surgery, by the FNAB guided by palpation procedure. We suggest USG guided FNAB to achieve more accurate and safe diagnosis in evaluating the thyroid nodules.

Neovaginal perforation following sexual intercourse in a transsexual patient.

BACKGROUND: Neovaginal perforation can develop following sexual intercourse in patients that have undergone male to female gender reassignment surgery. In such cases urinary tract symptoms may mimic acute cystitis and acute pyelonephritis. CASE PRESENTATION: A 33-year old white transsexual patient presented to the emergency department with dysuria, hematuria, difficulty urinating, widespread groin pain, bilateral side pain, clear vaginal discharge, abdominal pain, and nausea 2-3 h after sexual intercourse. Abdominal tomography showed fluid around the vaginal cuff and air throughout the abdomen. Vaginography showed contrast leaking to the abdomen from the vaginal cuff. The patient was considered as vaginal perforation and admitted to clinic. CONCLUSION: Vaginal perforation should be considered in transsexual patients that develop urinary system symptoms following sexual intercourse. Such cases were treated medically without the need surgery.

Intraperitoneal dedifferentiated liposarcoma: a case report.

Dedifferentiated liposarcoma is a variant of liposarcoma with a more aggressive course. Mutations of the p53 gene have been found in different types of soft tissue sarcoma. It is generally accepted that p53 mutations in human malignant tumors are often related to a poor prognosis. In our case, analysis of p53 gene mutation in tumor samples was performed. p53 gene mutation was observed in dedifferentiated tumor tissue samples but not in well-differentiated tumor tissue samples. It has been reported that p53 gene mutation occurs most commonly in the retroperitoneum and rarely in other anatomic locations. Herein we report a case of dedifferentiated liposarcoma located at intraperitoneum.