Both a biopsy method and a therapeutic procedure in BI-RADS 4A and 4B lesions: Ultrasound-guided vacuum-assisted breast biopsy.

OBJECTIVES: This study aimed to evaluate outcomes, complications, and follow-up results of ultrasound-guided vacuum-assisted breast biopsy (UG-VABB) in BI-RADS 4 A and B lesions. MATERIAL AND METHODS: Between Agust 2014 to January 2018, fifty BI-RADS 4A and BI-RADS 4B lesions of 41 patients biopsied with 10G vacuum needle by a single radiologist were retrospectively evaluated. RESULTS: All patients were females and mean age of the 41 patients was 50.12 ± 8.63. Of all lesions, 84% was benign, 6% was ADH, 4% was in-situ cancer, and 6% was diagnosed as malign. Follow-up duration after VABB was 0-51 months and mean was 20.92 months. Complications were as vasovagal-induced seizure in 3 patients (7.3%) and intramammary hematoma in 16 patients (39%). Hematoma was diagnosed in 3 patients (7.3%) at the 6th month follow-up and it was resolved in all patients at the 12th month follow-up. Higher breast density resulted in higher hematoma rates. There was no relationship between lesion BI-RADS subgroups, lesion size or sample number and hematoma development. During the follow-up, residue lesion in 1 (2.4%) patient and scar tissue in 2 (4.9%) patients was detected. CONCLUSION: US-guided VABB, with low complication rates and low scar development, is also a therapeutic excision method without remaining residue, which should be primarily preferred in smaller than 2 cm BI-RADS 4A and 4B lesions whose malignancy rates are relatively low. Hematoma, which is the most frequent complication, resorbed entirely in the 12th month in all patients.

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.

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.

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.

Obturator hernia should be considered in the differential diagnosis of hip and knee pain.

Obturator hernia is a rare disease usually occurring in debilitated elderly women. Pain radiating down the medial thigh and knee (Howship-Romberg sign) is a specific sign of the disease. Presently described is a case of obturator hernia in a 73-year-old female patient who presented with severe left hip pain radiating down the medial thigh and knee, nausea, and loss of appetite. Initially, vertebral disc herniation was thought to be cause, but abdomino-pelvic computed tomography scan revealed left strangulated obturator hernia. Diagnosis of obturator hernia can be challenging. Physicians should consider obturator hernia in the differential diagnosis of knee and hip pain, and investigate for Howship-Romberg sign. Early diagnosis of the disease not only decreases morbidity and mortality, but also presents opportunity to treat with minimally invasive methods.

Analysis of nervous fiber, muscle, and blood vessels using their ulraviolet near infrared reflectance characteristics.

Injury to the nervous system can lead to irreversible problems as nervous tissues have limited regenerative capability. Therefore it is imperative to find an objective, reliable, cheap, and easy-to-apply method that separates nervous fibers from muscles and blood vessels. The aim of this study is to determine structural differences that can aid in easy and reliable identification of nervous fibers. We analyzed light reflectance from these tissues from 230 nm to 1000 nm and found that in the range of 400 nm-600 nm nervous fibers have higher reflectance in comparison to others. Therefore, we generated distinct features in this range and utilized support vector machine to automatically classify samples. Classification performance demonstrated that light reflectance is a good candidate feature that can help to classify nervous tissue.

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.

ß-Catenin-independent noncanonical Wnt pathway might be induced in gastric cancers.

BACKGROUND/AIMS: Abnormal Wnt signaling is often observed in human cancers. Wnt5a is a representative Wnt ligand that can activate both ß-catenin-dependent canonical and ß-catenin-independent noncanonical Wnt pathways. However, the role of Wnt5a in carcinogenesis is controversial. This study was designed to understand whether Wnt5a in the Wnt pathway and its key downstream molecules such as MMP-7 and ß-catenin are involved in gastric cancers. METHODS: We analyzed the expressions of Wnt5a, MMP-7 and ß-catenin genes in 40 primary gastric normal and tumor biopsies by RT-PCR and the subcellular localization of ß-catenin by immunohistochemistry. RESULTS: Our results showed a specific combination of genes expressed significantly in the gastric tumor tissues: 65% of the tumor samples containing non-nuclear ß-catenin were Wnt5a-positive, 42.5% were MMP-7-positive, and 35% of the samples involved both. Interestingly, normal samples did not show any relevant coexpression of Wnt5a and MMP-7 in the ß-catenin-containing samples. CONCLUSIONS: These results suggest that the noncanonical Wnt pathway might be critically important in gastric carcinogenesis.

Axillary Web Syndrome after Sentinel Node Biopsy.

BACKGROUND: Axillary web syndrome (AWS) is a self-limiting cause of morbidity in the early postoperative period after axillary surgery, but it is encountered also after sentinel lymph node biopsy. The syndrome is characterized by cords of subcutaneous tissue extending from the axilla into the medial arm. CASE REPORT: Here, we report a patient presenting with AWS several weeks after sentinel lymph node biopsy. CONCLUSION: AWS has been reported to be resolved spontaneously in all patients 8-16 weeks after axillary surgery, and shoulder movements improve in this period. There is no definitive treatment modality for AWS. Patients should be reassured and informed that this condition will improve even without treatment.

[The effect of permanent ostomy on body image, self-esteem, marital adjustment, and sexual functioning]. / Kalici Ostomi Ameliyatinin Beden Algisi, Benlik Saygisi, Es Uyumu ve Cinsel Islevler Uzerine Etkisi.

OBJECTIVE: The aim of this study was to investigate the effects of permanent ostomy on body image, sexual functioning, self-esteem, and marital adjustment. METHOD: SCID-I outpatient forms were administered to 52 subsequent patients that underwent permanent colostomy or ileostomy operations, and 40 of them that did not fit any of the diagnostic criteria for psychiatric disorders were then administered a sociodemographic data questionnaire, and the Body Image Scale, Rosenberg Self-Esteem Scale, Dyadic Adjustment Scale, and Golombok Rust Sexual Functions scale. The control group consisted of 20 age- and gender-matched healthy volunteers. RESULTS: Body Image, Rosenberg Self-Esteem, and Dyadic Adjustment Scale scores were higher in permanent ostomy patients compared to controls, indicating more ostomy-related disturbance. Sexual functions were found to be impaired as well, except impotence and rapid ejaculation parameters. Complaints of anorgasmia were more frequent among female colostomy patients. Body image, and the touch, communication, and frequency parameters of sexual functioning were less disturbed in male patients than in females. Female patients with a psychiatric history experienced vaginismus problems more frequently. Patients with a history early childhood separation from parents had lower self-esteem scores and more frequently avoided sexual activity. Following ostomy surgery, the frequency of male impotence decreased over time. CONCLUSION: Permanent ostomy causes impairment in perceived body image, dyadic adjustment, and sexual functioning.