Protective effects of amifostine on ischemia-reperfusion injury of rat kidneys.

OBJECTIVES: Amifostine is a drug which can eliminate free oxygen radicals that appear in the body after radiation or chemotherapeutic agent exposure. It is used to decrease the renal toxicity of cisplatin. The aim of this study was to determine the role of amifostine in warm ischemia kidney model for prevention of ischemia/reperfusion injury and also to find out the mechanism for prevention from ischemia/reperfusion injury if such an effect does exist. MATERIALS AND METHODS: Adult female rats (n = 40) that used in our study were divided into three groups. Group 1: Control (n = 8), group 2: Ischemia-control (n = 16), group 3: Amifostine treated (n = 16). The effect of amifostine on ischemia/reperfusion injury investigated in rat kidneys. RESULTS: At the 7(th) day, blood urea nitrogen level was statistically significantly higher in ischemia-control group than all groups (P = 0.001) and mean serum creatinine levels were found to be the highest in ischemia-control group (P = 0.091). Mean malondialdehyde levels in left kidneys removed on the 7(th) day were not significantly different (P = 0.105) at all three groups. Between ischemia-control group and amifostine group, there was a significant difference in reduced glutathione (GSH) levels (P = 0.001). In amifostine group, grade 4 necrosis was not detected neither on 7(th) day nor day 0. CONCLUSION: Amifostine could decrease the degree and severity of necrosis after reperfusion. Amifostine could not prevent membrane lipid peroxidation caused by superoxide anion radicals in kidney but they could protect tissues from the harmful effects of ischemia/reperfusion injury by increasing the level of reduced GSH which is a well-known oxygen radical eliminator.

Sexual function and long-term results following vaginal reconstruction with free vascular jejunal flap.

INTRODUCTION: Sexual adjustment and long-term results following vaginal reconstruction with free vascular jejunal flap are not well known. AIMS: The study aims to investigate sexual adjustment and long-term results among patients who underwent vaginal reconstruction with free vascular jejunal flap. METHODS: A total of 34 women, aged 16-31 years (mean 23.5), who underwent vaginal reconstruction with a vascular jejunal flap between 2005 and 2011 were evaluated. Indications for reconstruction included the following: Mayer Rokitansky Kuster Hauser syndrome (29 patients), isolated vaginal agenesis (2 patients), androgen insensitivity syndrome (2 patients), and (1) history of gynecologic-oncologic surgery. MAIN OUTCOME MEASURES: The study evaluates the perioperative results, complications, satisfaction with sexual function, length and width of the neovagina. RESULTS: All of the surgeries were completed without any intraoperative complications. Three patients required reoperation because of postoperative venous compromise in the grafts. The flap success rate was 100%, and no infection was observed for any case. The mean follow-up was 50 months (between 20 and 87 months). The mean vaginal depth and diameter were satisfactory for all cases. Postoperatively, six patients complained of jejunal hypersecretion, one patient complained of mucosal prolapse, and one patient complained of vaginal constriction. The neovaginal prolapse was repaired via minor surgery. Twenty-seven were married and sexually active. Twenty patients completed the questionnaire on sexual function. Sexual function was assessed using the Female Sexual Function Index (FSFI). Eleven patients were satisfied with their sexual lives after surgery (FSFI scores≥25). CONCLUSION: Based on our results, satisfactory sexual function was achieved using the free jejunal vascular flap.

Is sunlight a predisposing factor for triple negative breast cancer in Turkey?

UNLABELLED: INTRADUCTION: There is known to be a relationship between vitamin D level and more aggresive breast cancer subtypes, especially triple-negative breast cancer (TNBC). It was reported that sunlight exposure has an effect on the prognosis of patients with cancer, possibly related to the conversion of vitamin D to its active form with sunlight. We aimed to evaluate the effect of sunlight exposure on patients with TNBC. MATERIALS-METHODS: A total of 1,167 patients with breast cancer from two different regions of Turkey (Antalya and Kayseri, regions having different climate and sunlight exposure intensity over the year) were analysed retrospectively. The ratio of patients with TNBC was identified in those two regions. RESULTS: The ratio of patients with TNBC was 8% and 12% for Kayseri and Antalya regions, respectively, and this difference between the two groups was statistically significant (p=0.021). DISCUSSION: Sunlight exposure may be associated with more prevalent TNBC. This finding should be investigated with a prospective study.

Digital evaluation of the muscle functions of the lower extremities among inguinal hernia patients treated using three different surgical techniques: a prospective randomized study.

PURPOSE: An inguinal hernia is a common pathology that can be treated using several different surgical procedures. Although there have been many studies comparing the clinical results of these techniques, there has so far been no digital analysis of the alterations developing secondary to pain with regard to the muscle functions of the lower extremities. This prospective randomized trial was designed to compare this aspect for subjects treated using the laparoscopic techniques and those treated using the conventional method. METHODS: A total of 75 patients, 25 of whom who had undergone hernia repair using the total extraperitoneal technique, 25 of whom who had undergone repair using the transabdominal preperitoneal technique, and 25 who had undergone repair using the Prolene mesh graft technique, were evaluated preoperatively and on the third postoperative day by isometric and isokinetic measurements, the visual analog score (VAS), the necessity of postoperative analgesia, complications, and the time that had elapsed before returning to work, and these results were recorded. RESULTS: Hernia repair using the conventional method led to an average of 3 times more muscle function loss compared with the laparoscopic techniques, and this difference was shown to be statistically significant. The VAS, postoperative complications, and time elapsed before returning to work were lower for laparoscopic surgeries and also were compatible with the findings described in the previous literature. CONCLUSIONS: Use of a digital environment with numerical parameters and measurements recorded using a dynamometer demonstrated that in the early postoperative period and on the third postoperative day, open surgery causes more functional loss in the lower extremities than laparoscopic methods. Therefore, surgeons should use laparoscopic methods whenever possible to reduce both pain and loss of muscle function.

Hepatic artery reconstruction with gonodal vein interposition: First case in patients receiving liver from the living donor.

BACKGROUND: Technical problems such as graft and vascular size are more common in living donor liver transplantation (LDLT) than in deceased donor liver transplantation. It is usually possible to get enough length of vessels on the graft, but the opposite situation is devastating. Finding the suitable vessel graft is life-saving in those situations. In this paper we present a case of gonodal vein interpositioning for hepatic artery reconstruction in an LDLT recipient. To the best of our knowledge, this is the first such case to be reported in the literature. CASE REPORT: A 36-year-old man with cirrhosis secondary to hepatitis B underwent LDLT. Within minutes after completing the anastomosis, the artery was thrombosed. Disrupting the anastomosis showed subintimal dissection of the recipient right hepatic artery extending to the gastro-duodenal junction. A 4 cm segment of gonodal vein, which matched the diameter of the recipient hepatic artery, was used as a bridge. The patient's postoperative recovery was excellent and Doppler ultrasonography demonstrated sufficient hepatic arterial blood flow. At long-term follow-up (18(th) months), the patient's graft is still functioning. CONCLUSIONS: Gonodal vein interposition for hepatic artery reconstruction in living donor liver transplantation has not been previously reported. In light of the urgency of this situation, we believe it can be a life-saving reconstruction.

The effect of seasonal differences on prognostic factors in Turkish patients with breast cancer.

Several studies have shown that solar light affects the prognosis of breast cancer. This effect is mostly associated with vitamin D. In-vitro studies showed that vitamin D analogs change the receptor expression in breast cancer cell lines. In our study, we studied the effect of solar light on prognostic factors of breast cancer. Patients with breast cancer from two different regions of Turkey were included in the study. These regions have different seasonal features and solar light exposures. Nine hundred and eighty-six patients were from the Akdeniz University Medical Faculty of Antalya region, and 463 patients were from the Kayseri Education and Research Hospital of Kayseri region. The Antalya region has warm climate and more solar light exposure. The Kayseri region has relatively colder climate and less solar light exposure. When histological features are considered, the estrogen and progesterone receptor expressions were higher in the Kayseri group, and a significant difference was observed for the progesterone receptor (P=0.013). No significant difference was observed for the estrogen receptor but a significant trend was observed (P=0.056). No significant difference was observed in CerbB2 expression between groups. There were significant differences for histological and nuclear grade (P<0.001 and P=0.002). The ratio of histological grade 3 was higher in the Kayseri group and the ratio of nuclear grade 1 was higher in the Antalya group. Our study showed that, due to seasonal differences, solar light exposure leads to significant changes in prognostic factors for breast cancer. This result may be interpreted as the reflection of in-vitro findings in a clinical setting and may be accepted as one of the first such reports in the literature.

Genomic large rearrangement screening of BRCA1 and BRCA2 genes in high-risk Turkish breast/ovarian cancer patients by using multiplex ligation-dependent probe amplification assay.

In this study, MLPA assay was performed for detection of large rearrangements of BRCA1 and BRCA2 genes in 16 familial, 29 early onset, 3 male breast cancer, and 2 bilateral breast/ovarian cancer high risk Turkish index cases. MLPA assay for all exons of both genes and for 1100delC variant of CHEK2 gene were performed. Analyses, revealed no large genomic rearrangements in both genes, and, no 1100del variant in CHEK2 gene. Our data which represents the first results for Turkish patients, suggest that, the frequency of BRCA1 and BRCA2 genes' large rearrangements is very low.

Germline mutations of BRCA1 and BRCA2 genes in Turkish breast, ovarian, and prostate cancer patients.

Distribution and prevalence of germline mutations in BRCA1 and BRCA2 differ among different populations. For the Turkish population, several studies have addressed high-risk breast cancer and ovarian cancer (BC-OC) patients. In most studies, both genes were analyzed in part, and a quite heterogeneous mutation spectrum was observed. For high-risk Turkish prostate cancer (PCa) patients, however, there are no data available about mutations of germline BRCA genes. To accurately determine the contribution of germline mutations in BRCA1 and BRCA2 in Turkish BC, OC, and PCa high-risk patients, 106 high-risk BC-OC patients, 50 high-risk PCa patients, and 50 control subjects were recruited. The study represents the only full screening, to date, of a large series of Turkish high-risk BC-OC patients and the only study in Turkish high-risk PCa patients. Mutation screenings were performed on coding exons of both genes with either denaturing gradient gel electrophoresis or denaturing high performance liquid chromatography, or with both techniques. Three deleterious mutations in BRCA1 and three deleterious mutations in BRCA2 were detected in different BC-OC patients, and one truncating mutation was detected in a high-risk PCa patient. In addition, 28 different unclassified and mostly novel variants were detected in both genes, as well as several silent polymorphisms. These findings reflect the genetic heterogeneity of the Turkish population and are relevant to genetic counseling and clinical management.

The use of vascularized jejunum flap for vaginal reconstruction: clinical experience and results in 22 patients.

The ideal reconstructive method for a vagina should provide a durable, stable coverage, a patent tube passage for sexual intercourse, and a natural esthetic contour, while simultaneously minimizing morbidity in both the recipient and donor sites, and should be a single stage procedure obviating the use of stents, obturators, and lubrication. Twenty-two patients with absence of the vagina underwent vaginal reconstruction using the jejunal segment transfer technique. Two flaps required re-operation due to venous compromise postoperatively. The flaps were salvaged with venous anastomosis revisions. The overall flap success rate was thus 100%. No urinary tract or gastrointestinal system complication was observed in any case, nor any instance of vaginal introitus. The average follow-up period was 19 months (between 3 and 48 months). Both the depth and diameter of the neovagina were satisfactory postoperatively. After the immediate postoperative period, the only major and embarrassing problem was hypersecretion of the jejunal segment, but this gradually diminished, especially after the first 3 months. Those patients who engaged in sexual intercourse reported good patency and had no complaints in that regard. In conclusion with its evident advantages, the jejunal segment can serve as a reliable option for vaginal reconstruction. It provides quite satisfactory results from both the cosmetic and functional points of view.

Microvascular augmented pedicled jejunum transfer for vaginal reconstruction using a laparoscopy-assisted technique.

Although there is no distinct, absolute, and ideal method for vaginal reconstruction, intestinal transfers are preferable to the other described techniques in the main clinics. In this report, we describe the transfer of a jejunal segment for vaginal reconstruction in a 20-year-old female patient, harvesting the flap based on its vascular pedicle by means of a laparoscopic technique that obviates the use of midline laparotomy. To prevent any vascular compromise, two different vascular supply sources were provided for the flap performing additional arterial and venous microvascular anastomosis. The results have confirmed the feasibility of the technique. The functional, structural, and esthetic advantages of the jejunal flap and the lower donor site morbidity of the laparoscopy-assisted technique that were rather encouraging are described and discussed.

Biliary stent migration with duodenal perforation.

Intestinal perforation from a migrated biliary stent is a known complication of endoscopic biliary stent placement. We present a case of stent migration and resultant duodenal perforation after stent placement for a malignant biliary stricture in a 52-year-old woman. We review the current literature on the diagnosis and management of stent migration and intestinal perforation after endoscopic stent placement for biliary strictures. A plain abdominal radiograph is necessary for early diagnosis of biliary stent migration. If a stent becomes lodged in the gastrointestinal tract, endoscopic or operative extraction of the stent is necessary to prevent subsequent intestinal perforation and peritonitis. Intestinal perforation secondary to biliary stent dislocation should be considered in all patients presenting with fever and abdominal pain after biliary stent insertion. Any abnormality that prevents stent migration through the intestinal tract such as gastroenterostomy, abdominal wall hernia, extensive adhesions or colonic divertucula may be a contraindication for insertion of a plastic biliary stent because of increased perforation risk.

Analysis of risk factors predicting (affecting) mortality and morbidity of peptic ulcer perforations.

The goal of this study is to identify invariable risk factors predicting the morbidity and mortality of a serious complication of peptic ulcer perforation (PUP). One hundred fifty-four patients were operated for PUP. We selected 147 patients who underwent primary repair and omentoplasty for PUP. The Boey score used to determine the high mortality risk after open surgery for PUP. The mortality rates were 0%, 12%, 32%, and 63% in the patients who had zero, one, two, and three factors, respectively (P < 0.001). Total postoperative mortality was 13.6% (20/147). Complications occurred in 48 (32.7%) of a total of 147 patients. Age, pulse rate at admission, and creatinine levels can be independent factors associated with prognosis in PUP.

[Spontaneous spleen rupture due to primary splenic angiosarcoma: a case report]. / Primer dalak anjiyosarkomuna bagli spontan dalak rüptürü: olgu sunumu.

Primary spleen angiosarcoma is an infrequent disease and the diagnosis is usually difficult. In this report we discussed a case who presented with abdominal pain. In clinical follow symptoms of shock were observed. Laparotomy was performed and spleen rupture was detected. Spleen angiosarcoma must be considered in the differential diagnosis of patients with unexplained anemia, splenic mass and splenomegaly. It has rapid course and poor prognosis. Splenectomy must be performed because of threat of rupture.

[Ileal intussusception in adults]. / Eriskinde ileal intussussepsiyon.

BACKGROUND: Ileal intussusception is rare in adults, in contrast to the incidence in children. In this article we discuss the disease by evaluating four patients with ileal intussusception. METHODS: A retrospective review was performed at Department of Surgery of Akdeniz University School of Medicine to identify adult patients who had been operated with diagnosis of ileal intussusception. Data related to presentation, diagnosis, treatment and pathology were analyzed. RESULTS: Four patients were operated with a diagnosis of ileal intussusception. Three of them presented with signs and symptoms of mechanical intestinal obstruction and one of them presented with chronic gastrointestinal symptoms. In a patient, the intussusseption was associated with an ileal lipoma, whereas in another patient an ileal polyp was the etiological factor. Two patients had intussusseption without any lesion. All of patients were treated operatively and en bloc resection was performed. CONCLUSION: Ileal intussusseption presents with a variety of non-specific gastrointestinal symptoms, thus the preoperative diagnosis is difficult. It must be considered in patients who presents with mechanical intestinal obstruction. Surgical resection of the intussusseption without any reduction is the preferred surgical treatment, regarding that most of ileal intussusseptions are associated with benign or malign lesions.

[Investigation of cytomegalovirus seroepidemiology in Antalya with a population-based cross-sectional study and review of related data in Turkey]. / Antalya'da sitomegalovirus seroepidemiyolojisinin toplum kaynakli kesitsel bir çalisma ile arastirilmasi ve Türkiye verilerinin derlenmesi.

Since there are numerous studies on CMV seroprevalence in various groups in Turkey, the number of population based, age-stratified cross-sectional studies which include epidemiological characteristics of the virus are limited. The aim of the study was to investigate the age-stratified seroprevalence and epidemiological characteristics of CMV infection in Antalya (a province located in Mediterranean region of Turkey). Study group was selected by cluster sampling method. The sample size was calculated as 360 subjects (151 male, 209 female; age range: 1-49 years, mean age: 22.5 +/- 14.4 years), with an expected prevalence rate of 80%, at a confidence level of 95% and a sample error less than 5%. With the thought of the presence of maternal antibodies, 0-1 year age group was not included to the study. Serum samples have been screened for CMV-IgG, and those given negative results were also searched for CMV-IgM by a commercial microELISA (Radim, Italy) test. The overall seroprevalence of CMV-IgG was found as 93.6% (337/360) in Antalya municipality and IgM positivity was not detected in CMV-IgG negative sera. An increase in the seroprevalence rates was observed with age (p < 0.001), and the rate was found quite high (93.3%) for the first year of life. The seropositivities in the age groups of 1-6, 7-14 and 14-49 years were detected as 82.1%, 92% and 97.8%, respectively. The seroprevalence rate of 82.1% before the age of seven has rised to 96.8% after that age, and being > or =7 years old was found statistically significant in terms of CMV infection (p < 0.001, OR: 6.635). Ages one and seven were found to be the critical ages for CMV infection in our region. CMV seropositivity was 97.4% in woman at childbearing age (15-49 years). Gender, marital status, education, living area, residence, income, history of sexually transmitted diseases, surgery, blood transfusion and day care attendance did not contribute independently to the seroepidemiology of CMV (p > 0.01). In addition, the data of this study were evaluated and discussed together with the results obtained from the other Turkish studies, as far as accessible. In conclusion, since CMV seroepidemiology in Turkey differs as the socioeconomic changes occur, the changes in CMV serostatus and dire consequences of high seroprevalence rates on public health should be evaluated with prospective, population based studies in further years.

Lack of association between RNASEL Arg462Gln variant and the risk of breast cancer.

BACKGROUND: The RNASEL G1385A variant was recently found to be implicated in the development of prostate cancer. Considering the function of RNase L and the pleiotropic effects of mutations associated with cancer, we sought to investigate whether the RNASEL G1385A variant is a risk factor for breast cancer. PATIENTS AND METHODS: A total of 453 breast cancer patients and 382 age- and sex-matched controls from Greece and Turkey were analyzed. Genotyping for the RNASEL G1385A variant was performed using an Amplification Refractory Mutation System (ARMS). RESULTS: Statistical evaluation of the RNASEL G1385A genotype distribution among breast cancer patients and controls revealed no significant association between the presence of the risk genotype and the occurrence of breast cancer. CONCLUSION: Although an increasing number of studies report an association between the RNASEL G1385A variant and prostate cancer risk; this variant does not appear to be implicated in the development of breast cancer.

Symmetrical peripheral gangrene and dopamine.

We describe a case of a 55-year-old man with hypovolemic shock who developed a symmetrical peripheral gangrene (SPG) on hands and feet. The SPG syndrome consists of sudden onset of symmetrical gangrene of the fingers, toes and rarely, the nose, upper lip, ear lobes or genitals without large vessel obstruction or vasculitis. Vasopressors have been implicated directly or as a contributory cause in many cases. In this case, dopamine was used with high dose (> 20 microg/kg/min) which is inappropriate in hypovolemic shock states. SPG might be a severe and rare complication of dopamine. Care should be taken with the use of dopamine in patients with shock.

Germline mutations in the BRCA1 and BRCA2 genes in Turkish breast/ovarian cancer patients.

In this study we genotyped Turkish breast/ovarian cancer patients for BRCA1/BRCA2 mutations: protein truncation test (PTT) for exon 11 BRCA1 of and, multiplex PCR and denaturing gradient gel electrophoresis (DGGE) for BRCA2, complemented by DNA sequencing. In addition, a modified restriction assay was used for analysis of the predominant Jewish mutations: 185delAG, 5382InsC, Tyr978X (BRCA1) and 6174delT (BRCA2). Eighty three breast/ovarian cancer patients were screened: twenty three had a positive family history of breast/ovarian cancer, ten were males with breast cancer at any age, in eighteen the disease was diagnosed under 40 years of age, one patient had ovarian cancer in addition to breast cancer and one patient had ovarian cancer. All the rest (n=30) were considered sporadic breast cancer cases. Overall, 3 pathogenic mutations (3/53-5.7%) were detected, all in high risk individuals (3/23-13%): a novel (2990insA) and a previously described mutation (R1203X) in BRCA1, and a novel mutation (9255delT) in BRCA2. In addition, three missense mutations [two novel (T42S, N2742S) and a previously published one (S384F)] and two neutral polymorphisms (P9P, P2532P) were detected in BRCA2. Notably none of the male breast cancer patients harbored any mutation, and none of the tested individuals carried any of the Jewish mutations. Our findings suggest that there are no predominant mutations within exon 11 of the BRCA1 and in BRCA2 gene in Turkish high risk families.

[Peptic ulcer perforation: an analysis of risk factors]. / PEPTIK ULSER PERFORASYONU: AMELIYAT MORTALITESINE ETKI EDEN RISK FAKTORLERININ ANALIZI.

BACKGROUND: Despite decreasing incidence of peptic ulcer disease, peptic ulcer perforation remains a source of mortality. This retrospective study was performed to find riskfactors for mortality and to construct a score that predict outcome for patients with peptic ulcer perforation. METHODS: A review of94 patients operated (primer ciosure and omentoplasty) for perforated peptic ulcer in Iast ten years was undertaken to study. lndependent risk factors for mortality were found with Iinear regression analysis and risk score was constructed using standardized coefficients of risk factors. RESULTS: Acute renal failure (ARF) (p < 0,00 1 ), treatment delay more than 48 hours (> =48 hours) (p = 0,203 ) and age greater than 60 years (> 60 years) (p = 0, 199) were found signijicant factors independently injuencing mortality. The risk score was (Risk score = (ARF)XO,497 + (> =48 hours)XO,203 + (>60years)XO,199). The overall predictive accuracy of risk score was%95. CONCLUTION: Treatment delay and related acute renal failure and advanced age are determining factors for survival after ulcer perforation. Delay of treatment may be only changeable factor for mortality. lt is ciear that, the early diagnosis and treatment aredecreasing operative mortality of peptic ulcer perforation. Every effort to decrease the mortality should be this mannei: