Risk Factors for Development of Biliary Complications after Surgery for Solitary Liver Hydatid Cyst.

Biliary leakage (BL) is the most common cause of postoperative morbidity after conservative liver hydatid cyst surgery. The objective of this study was to determine incidence of BL and related risk factors in patients with solitary liver hydatid cyst who underwent conservative surgery. A total of 186 patients were included in this study. Age, gender, cyst recurrence, diameter, and localization, World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) classification, cavity management techniques, cyst content, and alkaline phosphatase (ALP) levels were evaluated with univariate and multivariate analyses. Of these patients 104 were female and 82 were male. The mean age was 43.5 ± 14.7 years. Postoperative BL was detected in 36 (19.4%) patients. Cyst diameter (P = 0.019), cyst localization (P = 0.007), WHO-IWGE classification (P = 0.017), and ALP level (P = 0.001) were the most significant risk factors for BL. Independent risk factors for BL were perihilar localization, large cyst diameter, high ALP level, and advanced age according to WHO-IWGE classification.

A Single-Center Retrospective Comparison of Doxorubicin-Loaded HepaSphere Transarterial Chemoembolization with Conventional Transarterial Chemoembolization for Patients with Unresectable Hepatocellular Carcinoma.

PURPOSE: To compare doxorubicin-loaded HepaSphere transarterial chemoembolization versus conventional transarterial chemoembolization in terms of survival, time to recurrence, acute reversible hepatotoxicity, postembolization syndrome, and chemoembolization-related mortality and morbidity. MATERIALS AND METHODS: One hundred twenty-six patients (103 men, 23 women; mean age, 64.3 y) with unresectable hepatocellular carcinoma (HCC) who underwent conventional chemoembolization between January 2007 and March 2011 or drug-eluting embolic (DEE) chemoembolization (after the protocol change) between March 2011 and October 2014 were included in a retrospective analysis. Primary outcome measures were survival and time to recurrence. Secondary outcome measures were frequency of recurrence, technical success, acute reversible hepatotoxicity, postembolization syndrome, and chemoembolization-related mortality and morbidity. RESULTS: The technical success rate was 97.1%. There were no significant differences between the conventional and DEE chemoembolization groups with regard to mean survival duration (39.0 vs 37.4 mo), recurrence (32.9% vs 39.6%), postembolization syndrome (90% vs 89%), and chemoembolization-related mortality (5.5% vs 1.9%) and morbidity (9.6% vs 9.4%; P > .05). The time to recurrence was shorter in DEE chemoembolization-treated patients than in conventional chemoembolization-treated patients (5.0 vs 11.5 mo; P = .006), and acute reversible hepatotoxicity occurred more frequently after conventional chemoembolization (P = .019). CONCLUSIONS: Conventional chemoembolization and DEE chemoembolization were safe and effective interventions for unresectable HCC. DEE chemoembolization was not better than conventional chemoembolization in terms of survival and was associated with a shorter time to recurrence. Acute reversible hepatotoxicity occurred more frequently after conventional chemoembolization.

The rationality of resectional surgery and palliative interventions in the management of patients with gallbladder cancer.

The aim of the present study was to evaluate in a retrospective manner, the survival period and survival rate according to stages and groups after R0, R1, R2 resections and palliative interventions. Between 2003 and 2012, 67 patients diagnosed with gallbladder carcinoma were retrospectively analyzed. Patient demographics, the survival period, and survival rate according to stages and groups after R0, R1, R2 resections and palliative interventions were retrospectively analyzed. Sixty-seven patients were diagnosed with gallbladder carcinoma. Thirty-eight patients (56.7%) were female and 29 patients (43.3%) were male. The median survival period was significantly longer in stage II and III diseases than in stage IV disease (P < 0.001). The R0, R1, and R2 resection rates in patients who underwent surgery with curative intent were 67.7, 19.4, and 12.9 per cent, respectively. The R0 resection rate according to the tumor stages was 100 per cent for stage I, 87.5 per cent for stage II, 66.7 per cent for stage III, and 42.8 per cent for stage IV disease. The median follow-up period was six months (eight days to 36 months). During this follow-up period, 53 patients (79.1%) died. In conclusion, R0 resection rate decreases when tumor stage increases. The highest survival rates after R0 resection are achieved in patients with stage I, II, and III diseases. Radical surgery has no benefit over palliative surgery for stage IV disease in terms of survival.

Diagnostic significance of serum eotaxin-1 level in gastric cancer patients.

INTRODUCTION: Gastric cancer is the second cause of cancer-related deaths worldwide. Delayed diagnosis leads to high mortality rates. Eotaxin-1 was originally discovered as an eosinophil-selective chemoattractant and may play a role in a number of chronic inflammatory diseases, cancer, and other gastrointestinal disorders. The aim of this study was to analyse diagnostic and prognostic significance of serum eotaxin-1 (s-eotaxin-1) levels in gastric cancer. METHODS: Sixty gastric cancer patients and 69 healthy subjects were included into the study. S-eotaxin-1 levels were compared with clinicopathological features and outcomes in gastric cancer. RESULTS: Serum levels of eotaxin-1 in gastric cancer patients were significantly higher than controls (74.51 ± 16.65 pg/mL versus 16.79 ± 5.52 pg/mL, respectively (P < 0.001)). The s-eotaxin-1 levels did not differ significantly with histopathological grade, tumor-node-metastasis (TNM) stage, tumor localization, lymph node metastases, positive lymph node ratio, size, perineural and perivascular invasion. So there is no relationship found between s-eotaxin-1 level and prognosis. CONCLUSION: S-eotaxin-1 levels may be used as an easily available biomarker for gastric cancer risk and may alert physicians for early diagnosis. Due to the limited number of patients included in this study, larger cohort studies are warranted to validate the diagnostic value of s-eotaxin-1 level in gastric cancer.

Preoperative serum levels of soluble endoglin for prediction of recurrence in stage III colorectal cancer patients.

BACKGROUND: To evaluate the clinical usefulness of serum levels of soluble form of endoglin in stage III colorectal adenocarcinomas (CRC) patients for detection of recurrence. METHODS: The case-control study consisted of 80 stage III CRC patients who underwent surgery with curative intent and 70 age-and sex-matched healthy volunteers. Serum levels of soluble form of endoglin (sol-end) were measured in both groups. Also, predictive factors of recurrence were evaluated using multivariate analyses. RESULTS: Serum levels of sol-end in stage III CRC patients were significantly higher than those in controls. There was not a significant association between serum levels of sol-end and clinicopathological features in CRC patients. Multivariate regression analysis showed the LNR (hazard ratio, 2.54; 95% CI, 1.46-4.34; p < 0.001), to be significant independent factors to estimate local recurrence in stage III CRC patients. CONCLUSION: Preoperative serum levels of sol-end do not seem useful as a marker for detection of recurrence in stage III CRC patients.

Is serum placental growth factor a prognostic marker for stage III colorectal cancer patients?

BACKGROUND/AIMS: To evaluate the clinical usefulness of serum placental growth factor (sPIGF) levels in stage III colorectal adenocarcinomas (CRC). METHODOLOGY: Serum PIGF were measured in 70 healthy controls and in 80 stage III CRC patients. Also the association between preoperative sPGF levels, clinicopathological features and patients survival were evaluated in stage III CRC patients. RESULTS: sPIGF levels in stage III CRC patients were significantly higher than those in controls. There was no significant association between sPIGF levels and clinicopathological features and sPIGF is not a prognostic factor for survival. Multivariate regression analysis showed the sPIGF levels (hazard ratio=3.28; 95% CI=1.10-9.5, p=0.032) to be significant independent factors for local recurrence. CONCLUSIONS: Serum PIGF levels in stage III CRC patients are significantly higher compared with normal controls and may be an indicator of local recurrence in stage III CRC patients.

A novel screening biomarker in gastric cancer: serum Dickkopf-1.

BACKGROUND/AIMS: Despite all the knowledge about gastric cancer, there is no prognostic biomarker which could be useful for early detection. Dickkopf-1 (DKK-1), a secreted protein, is known as a negative regulator of the Wnt signaling pathway. DKK-1 is reported to be over expressed in many malignant tissues. The purpose of this study was to elucidate the normal level of serum DKK-1 (sDKK-1) levels in healthy Turkish peoples and to investigate the clinical utility of sDKK-1 levels for gastric cancer screening. METHODOLOGY: Serum DKK-1 levels were measured in 69 healthy controls and in 60 gastric adenocarcinoma patients with ELISA and sDKK-1 levels were compared with clinicopathological features and outcomes in gastric cancer patients. RESULTS: Serum concentrations of DKK-1 in gastric adeno cancer patients were significantly higher than control patients (p<0.001). The optimal cut-off for sDKK-1 levels order to discriminate control group from gastric cancer patients was 25U/mL with sensitivity equal to 100% and specificity equal to 100%. CONCLUSIONS: Serum DKK-1 levels may be a potentially useful novel serologic marker for gastric cancers.

In vitro effect of pantoprazole on lower esophageal sphincter tone in rats.

AIM: To investigate the in vitro effects of pantoprazole on rat lower esophageal sphincter (LES) tone. METHODS: Rats weighing 250-300 g, provided by the Yeditepe University Experimental Research Center (YÜDETAM), were used throughout the study. They were anesthetized before decapitation. LES tissues whose mucosal lining were removed were placed in a standard 30-mL organ bath with a modified Krebs solution and continuously aerated with 95% oxygen-5% carbon dioxide gas mixture and kept at room temperature. The tissues were allowed to stabilize for 60 min. Subsequently, the contractile response to 10(-6) mol/L carbachol was obtained. Different concentrations of freshly prepared pantoprazole were added directly to the tissue bath to generate cumulative concentrations of 5 × 10(-6) mol/L, 5 × 10(-5) mol/L, and 1.5 × 10(-4) mol/L. Activities were recorded on an online computer via a 4-channel transducer data acquisition system using the software BSL PRO v 3.7, which also analyzed the data. RESULTS: Pantoprazole at 5 × 10(-6) mol/L caused a small, but statistically insignificant, relaxation in the carbachol-contracted LES (2.23% vs 3.95%). The 5 × 10(-5) mol/L concentration, however, caused a significant relaxation of 10.47% compared with the control. 1.5 × 10(-4) mol/L concentration of pantoprazol caused a 19.89% relaxation in the carbachol contracted LES (P < 0.001). CONCLUSION: This is the first study to demonstrate that pantoprazole has a relaxing effect in isolated LESs. These results might have significant clinical implications for the subset of patients using proton pump inhibitors who do not receive full symptomatic alleviation from gastroesophageal reflux disease.

Postoperative hemorrhagic complications after elective laparoscopic cholecystectomy in patients receiving long-term anticoagulant therapy.

BACKGROUND AND AIMS: Among patients on long-term anticoagulant therapy who undergo laparoscopic cholecystectomy (LC), bleeding complications have not been extensively investigated. The objective of this study was therefore to investigate postoperative bleeding complications prospectively in patients on chronic oral anticoagulation. MATERIALS AND METHODS: In the period of January 2002 to December 2007, 44 patients on long-term anticoagulation with warfarin, an oral anticoagulant (OAC), underwent LC in our center. Oral anticoagulant was discontinued 5 days before the planned date of surgery, and patients were admitted to the hospital 3 days before. Upon admission, bridging anticoagulation with enoxaparin, a low molecular weight heparin (LMWH), was started. When their international normalized ratio (INR) decreased to <1.5, patients underwent LC. In the absence of postoperative bleeding complications, OAC and LMWH were resumed on the evening of the day of surgery, and LMWH was continued until each patient's target INR was reached. A comparison group was comprised by 1,421 consecutively enrolled patients with no comorbid disease who underwent LC during the same period. RESULTS: In the comparison group, postoperative bleeding was encountered in 21 patients (1.5%). In the anticoagulation group, postoperative bleeding was encountered in 11 patients (25%) and ranged from minor oozing from a port incision in one patient to hemorrhage, sepsis, and fatality in one patient. In the anticoagulation group, no significant differences were found between patients with and without postoperative bleeding in terms of age, gender, body mass index, American Society of Anesthesiologists score, INR, or other hemostasis parameters. CONCLUSIONS: In patients who underwent LC with bridging anticoagulation, postoperative bleeding was markedly more frequent than expected and was not predicted by the usual coagulation parameters. This suggests a need for methods that can indicate which patients on long-term anticoagulation are at risk for postoperative bleeding.

Extensive adult colo-colonic intussusception from ascending colon to sigmoid colon: report of a case.

Intussusception in adults is relatively rare. Here we report a 52-year-old man with an extensive colo-colonic intussusception caused by a polypoid mass in the ascending colon. The mass, which was 10 x 8 x 5 cm in size, had been palpated preoperatively and was suspected to be a sigmoid tumor. The patient was treated successfully by reduction of the invagination and subsequent right hemicolectomy.