Is sporadic colorectal cancer more aggressive in young people and should the age of colonoscopy screening be reduced?

OBJECTIVES: The present study aims to report the incidence of colorectal cancer patients under 50 years of age and to compare its aggressiveness with colorectal cancer patients over 50 years of age. BACKGROUND: Recently, the incidence of colorectal cancer at younger ages has increased, and colorectal cancers in young people have a more aggressive course due to late screening programs. METHOD: The files of patients who were operated for colorectal cancer were reviewed retrospectively. Information on the patients such as gender, age, BMI, type and duration of symptoms, location of the tumor, TNM staging, pathology results, operative procedure, morbidity and mortality rates were recorded. Admission complaints, symptom onset time, tumor locations, pathological findings and tumor stages were compared between patients under and over the age of 50. RESULTS: The incidence of colorectal cancer under 50 was 21 % (56/267). The age group of 40‒49 was found to be the most common age range under the age of 50, with a colorectal cancer rate of 68%. In patients under the age of 50, higher invasion of the tumor to the serosa, low differentiation of the tumor in terms of histological findings in a higher number of patients and higher mucin component of the tumors and higher N2 lymph node involvement ratio and the tumor was located more in the lower rectum were statistically significant when compared to patients over the age of 50 (p=0.026, p=0.018, p=0.002, p=0.042, p=0.006; respectively). CONCLUSION: The incidence of colorectal cancer has increased at younger ages and has a more aggressive course. Screening programs should be modified (Tab. 4, Fig. 2, Ref. 45).

Emergency surgery of the abdominal wall hernias: risk factors that increase morbidity and mortality-a single-center experience.

PURPOSE: Morbidity and mortality are higher in urgently operated abdominal hernia cases compared to elective surgeries. The present study aims to investigate the factors that cause increased morbidity and mortality in emergency surgical operations. METHODS: The files of a total of 426 patients who were operated for non-reducible abdominal hernia between 2015 and 2020 were reviewed retrospectively. Patients' ages, genders, comorbidities, Charlson Comorbidity Index (CCI), ASA score, BMI, hernia types, duration of symptom, laboratory values, intestinal strangulations or necroses, whether intestinal resection was performed, whether mesh was preferred for hernia repair, and rates of morbidity and mortality were recorded. Factors affecting morbidity and mortality rates were analyzed. RESULTS: Factors such as gender, BMI (> 30), duration of symptom (> 24 h), presence of bowel necrosis and resection, type of hernia and prolonged operation time were found to cause an increase in morbidity. In the multivariate analysis, however, gender, duration of symptom and BMI (> 30) were statistically significant factors causing increased morbidity (p = 0.009, p < 0.001, p = 0.032, respectively). Advanced age, high ASA scores, CCI and duration of symptom were determined as factors affecting the increase in mortality. In the multivariate analysis, the effect of high ASA scores and advanced age on high mortality rate was statistically significant (p < 0.023, p = 0.039, respectively). CONCLUSIONS: The mortality rate is higher, especially in elderly patients with high comorbidity. Therefore, we argue that the cases of abdominal wall hernia should be operated under elective conditions even if they do not give any clinical findings to prevent problems in older ages.

Analysis of general surgery outpatient clinic admissions and operations during COVID-19 pandemic in Turkey: Reactions of 12728 patients.

Covid-19 pandemic is spreading rapidly in Turkey. We aimed to examine the numbers and demographic data of patients who applied to the general surgery outpatient clinics and operated in this process. Our primary outcome is to reveal the response of general surgery patients to the Covid-19 pandemic.The first Covid-19 case in Turkey has appeared in March 11, 2020. Patients who were operated on due to a surgical emergency or trauma were evaluated separately. Patients in 3 periods were compared with each other. A total of 12728 patients were examined in general surgery outpatient clinics in 26 working days. It is seen that patients come to the outpatient clinic after the first time the Covid-19 patient is seen. All patients reduced hospitalization after the first death due to Covid-19. Women had reduced going to the hospital earlier than men. There was no change in the number of emergency surgeries. Rapid decrease was observed in the number of elective surgeries.It is not easy to control the entrance and exit of these busy hospitals. The remote diagnosis (mail, phone or video-call) and treatment methods that can be expected in the near future may be even closer with the Corona virus (Tab. 3, Fig. 4, Ref. 15). Keywords: general surgery, Covid-19, outpatient clinics, operation, reaction of patients.

Intermammary pilonidal sinus in women. Diagnosis and treatment.

BACKGROUND: Globally, the term pilonidal sinus disease (PSD) is most frequently used for lesions in the sacrococcygeal region. The inter-mammary sulcus is a rare location for pilonidal sinus abscesses. Our study examined the causes of inter-mammary PSD (IMPSD), which is rarely seen in the literature and our treatment approach. MATERIAL: We retrospectively analyzed patients referred to our hospital's general surgery clinic between 2012 and 2018. Twelve patients were operated on for IMPSD during these six years. An excision, including all sinus openings, was planned, and a D-shaped incision was performed. Sinus openings and tracts underlying the skin were excised in toto. Subcutaneous flaps were created to shift the incision from the midline plane to reduce the recurrence rate. The minimum duration for the follow-up was 24 months. Eight patients were suffering from polycystic ovary syndrome. Progesterone and testosterone levels of the patients were normal. Prior studies evaluating PSD and hormone levels of female patients showed no correlation. CONCLUSIONS: IMPSD is a disease that should be kept in mind if induration and abscess in the inter-mammary region are present. The risk of recurrence is high if no proper excision is planned. A D-shaped incision including all sinus tract openings and a midline shift prevented our series' possible recurrences. HIPPOKRATIA 2020, 24(2): 84-87.

THYROID SURGERY, IONM AND SUGAMMADEX SODIUM RELATIONSHIPS: BENEFITS IN SUGAMMADEX SODIUM USE FOR IONM.

BACKGROUND: It is important to protect recurrent laryngeal nerve (RLN) during thyroid surgery. Thus, intra- operative neuromonitoring (IONM) has got popularity. But, the half life of neuromuscular blocking agents used has a reverse correlation with reliability and effectiveness of IONM. This study aimed to research the effect of Sugammadex Sodium, a specific nemuromuscular blocking agent antagonist, on nerve conduction and IONM. MATERIALS AND METHODS: Twenty patients who underwent thyroidectomy under IONM followed an enhanced NMB recovery protocol-rocuronium 0.6 mg/kg at anesthesia induction and sugammadex 2 mg/kg at the beginning of operation. To prevent laryngeal nerve injury during the surgical procedures, all patients underwent intraoperative monitoring. At the same time, the measurement of TOF-Watch acceleromyograph of the adductor pollicis muscle response to ulnar nerve stimulation was performed; recovery was defined as a train-of-four (TOF) ratio ≥ 0.9. Age, sex, recurrent laryngeal nerve transmission speeds prior to and after operation, BMI, duration of surgery, the change in nerve transmission after drug administration and complications were analyzed. RESULTS: The mean age and the mean BMI were 47.6±11.82 years and 28.74±3.20, respectively. The mean operation duration was 52.65±5.51 minutes. There was no difference in either right or left RLN monitoring values before and after surgery. Following the drug injection, the TOF guard measurements on the 1st, 2nd, 3rd and 4th minutes were 23.5±4.90; 69.5±6.86; 88±4.1 and 135.9±10.62, respectively. CONCLUSION: Neuromuscular blocking antagonist use and monitoring nerve transmission speed with TOF-guard can provide a safer resection.

The effects of iloprost on lung injury induced by skeletal muscle ischemia-reperfusion.

PURPOSE: The aim of this study was to investigate the effects of iloprost (I) on lung injury as a remote organ following skeletal muscle ischemia-reperfusion injury in a rat model. MATERIALS AND METHODS: Twenty-four Wistar Albino rats were randomized into four groups (n = 6). Laparotomy was performed in all groups under general anesthesia. Only laparotomy was applied in Group S (Sham). Ischemia reperfusion group (Group I/R) underwent ischemia and reperfusion performed by clamping and declamping of the infrarenal abdominal aorta for 120 minutes. Group iloprost (Group I) received intravenous infusion of iloprost 0.5 ng/kg/min, without ischemia and reperfusion. Group I/R/I received intravenous infusion of iloprost 0.5 ng/kg/min immediately after 2 hours of ischemia. At the end of the study, lung tissue was obtained for determining total oxidant status (TOS) and total antioxidant status (TAS) levels, histochemical and immunohistochemical determination. RESULTS: Diffuse lymphocyte infiltration was detected in immunohistochemical examination of lung tissue in Group I/R. The connective tissue around bronchi, bronchioles and vessel walls was found to be increased. Although minimal local lymphocyte infiltration was detected in some fields in Group I/R/I, the overall tissue was found to be similar to Group S. iNOS expression was significantly higher in Group I/R, when compared with Group S and significantly lower in Group I/R/I compared to Group I/R.TOS levels were significantly higher in Group I/R, when compared with groups S and I (p = 0.028, p = 0.016, respectively) and significantly lower in group I/R/I, when compared with Group I/R (p = 0.048). TAS levels were significantly higher in Group I/R, when compared with groups S, I (p = 0.014, p = 0.027, respectively) and significantly lower in Group I/R/I, when compared with Group I/R (p = 0.032). CONCLUSION: These results indicate that administration of iloprost may have protective effects against ischemia reperfusion injury (Fig. 8, Tab. 1, Ref. 30)

Effect of iloprost on erythrocyte deformability in rat's lower extremity undergoing an ischemia reperfusion injury.

AIM: Ischemia reperfusion injury (I/R) in lower extremity is a frequent and important clinical phenomenon. The protective effect of iloprost on local and distant organ injury due to I/R has been well documented but its effect on erythrocyte deformability needs further investigation. Our aim was to investigate the effect of iloprost on erythrocyte deformability in the infrarenal aorta of rats undergoing I/R. MATERIALS AND METHODS: Our study was conducted with 18 Wistar albino rats. Rats were divided into the 3 groups; the randomized control group (group C; n=6), I/R group without iloprost (group I/R; n=6) and I/R group with iloprost - 10 mcg.kg-1, 30 min infusion (group I/R-I; n=6). Packs of erythrocytes were prepared from heparinized blood samples and deformability measurements were done. RESULTS: The comparisons of the control and I/R-I groups revealed similar results (p=0.951). The values of the IR group were significantly higher than those of the control and IR-I groups (p=0.006, p=0.011, respectively). CONCLUSION: In our study, we detected the unfavourable effects of I/R on erythrocyte deformability, which may lead to disturbance in blood flow and hence tissue perfusion in the infrarenal rat aorta. We also found that Iloprost had beneficial effects by reversing the undesirable effects of I/R (Fig. 1, Ref. 15).

Virtual endoscope-assisted intracranial aneurysm surgery: evaluation of fifty-eight surgical cases.

OBJECTIVE: Better visualization of the intracranial aneurysm may improve surgical outcomes. To this aim, we evaluated the effectiveness of using virtual endoscopy (VE) during intracranial aneurysm surgery. METHODS: Fifty-eight patients with 63 intracranial aneurysms were enrolled in this study. Every patient was examined by digital subtraction angiography (DSA) and a randomly selected twenty-six cases were also examined by computed tomography (CT). CT angiography data were linked via imaging software for reconstruction of VE images. All patients were operated on using standard microsurgical procedures. Among these cases, randomly selected cohorts of twenty-six patients with 28 intracranial aneurysms were operated on also using VE-assisted surgical procedures. The surgical results of both groups were compared to determine the efficacy of the VE-assisted surgical procedure. RESULTS: Aneurysm locations, surgical timing and Hunt-Hess grade distribution were not statistically significant between both groups (p=0.948). However, significantly reduced complication rates and increased post-operative Glasgow outcome scores were observed in the VE group (p<0.05) compared to control. CONCLUSION: Aneurysms and surrounding anatomic structures were well depicted by VE in three dimensions with interactive fly-through views. This method improved our surgical results by improving visualization of the aneurysm and increasing surgical orientation. We report that this method can be very helpful to surgeons during intracranial aneurysm surgery and may reduce post-surgical complications.

Intracranial meningiomas. Analysis of 344 surgically treated cases.

The authors present 344 (230 females, 114 males) surgical cases of intracranial meningioma. A total of 370 interventions (344 primary procedures, 10 reexplorations for neurologic deterioration, 16 operations for recurrence) were made. Mean follow-up was 38 months. The overall evaluation revealed that 306 (88.95%) patients were completely normal or in a better condition than before operation. 18 (5.23%) were in a worse condition after operation and 20 (5.81%) died. Results suggested that complications and mortality were mostly related to localization and large volume; we also still have problems with aggressive and malignant meningiomas.

Anterior pontine hydatid cyst: case report.

We report a rare case of anterior pontine hydatid cyst. Diagnosis was established on magnetic resonance imaging (MRI) findings preoperatively and was confirmed during surgery and by laboratory findings of cyst fluid, and section of cyst wall. A classical suboccipital craniectomy was performed, followed by an approach through the floor of the fourth ventricle. After a failed attempt at the Dowling technique, we punctured the cyst, aspirated the contents, then extirpated the cyst membrane. The patient survived suffering only minor morbidity. The surgical technique and pontine myelotomy are discussed.

Management of problematic intracranial hydatid cysts.

The authors report four patients with intracranial hydatic cysts. One patient had a pontine lesion which was punctured and aspirated and the cyst wall removed with a satisfactory outcome. The second patient had multiple cysts which was comparable to meningeomatosis. She had a rapidly deteriorating neurologic condition which proved to be fatal in spite of two consecutive surgical interventions. The third patient had nine lesions although only six were evident on the MRI. All of the cysts were removed, while two cysts ruptured. Multiple paracardial cysts of this patient were surgically removed shortly after the craniotomy. The last patient, again with multiple intracranial hydatid cysts had safe, total removal of all cysts. The first postoperative control CT raised the possibility of recurrence since the CT was highly suggestive of a hydatid cyst. However, this was not confirmed in the follow-up CT examination. Problems and the solutions of management are discussed.

Prostaglandin-independent decrease of sheep ureter contractility induced by bradykinin.

The mechanisms that mediate the actions of bradykinin on ureteral motility are poorly defined and mediation via prostaglandins has not been examined. Therefore, the effects of bradykinin on contractility and the possible mediator role of prostaglandins have been investigated in sheep ureter. At the concentrations of 10(-8), 10(-7) and 10(-6) M, bradykinin elicited marked reductions in contractile force. When ureteral strips were treated separately with 10(-6) M indomethacin, 2 x 10(-6) M sodium salicylate and 10(-5) M aspirin, each drug produced a significant decrease in contractile force. In strips in which prostaglandin synthesis was inhibited by the above concentrations of indomethacin, sodium salicylate and aspirin, 10(-7) M bradykinin significantly decreased the contractility. From these data, we concluded that in ureter bradykinin decreases contractility via a mechanism not involving prostaglandin generation.

Effects of vasoactive intestinal polypeptide on isolated rat urinary bladder smooth muscle.

The effect of vasoactive intestinal polypeptide (VIP) on the contractile activity of the urinary bladder was investigated in the rat. VIP caused a weak contraction and a small potentiation of carbachol- and acetylcholine-induced contractions. The present results may provide the evidence that VIP could be a modulator in the urinary bladder.

Erythrocyte sedimentation rates in patients with renal cell carcinoma.

The importance of erythrocyte sedimentation rate (ESR) in patients with renal cell carcinomas (RCCa) is still controversial. ESR levels increased in over half of these patients. In this study, ESR levels of 19 patients with RCCa were investigated (85.368 +/- 5.914). In 11 patients in whom carcinomas were only localized in the kidney, the ESR levels were detected as 78.182 +/- 8.686. In 8 patients who had metastasis, the ESR levels were found as 95.250 +/- 6.427. ESR levels were also estimated in 15 healthy adult persons as control group (18.133 +/- 2.180). Mean ESR values were significantly higher in the tumor group than in the control group (p less than 0.01). There was no statistical difference of the ESR levels between the patients who had local RCCa and advanced RCCa (p greater than 0.05, NS). The removal of the tumoral mass caused the ESR levels to diminish. In conclusion, the ESR levels were not a good criteria in patients with RCCa for evaluating either prognosis or metastasis.

Low density in the posterior aspect of the intervertebral disk in the patient with herniated nucleus pulposus. A prospective study of 50 cases.

It was previously reported that a low density are in the posterior aspect of the intervertebral disk is an additional computed tomography (CT) finding suggesting a herniated nucleuos pulposus. In this report the incidence of this finding, its correlation with the duration of symptoms and severity of herniation, were studied on 59 herniated intervertebral disks of 50 cases.

Diagnostic value of computed tomography in spinal and lateral recess stenosis, preoperatively and for long-term follow-up: a prospective study in 50 cases.

Preoperative measurements of lateral recess, anterior-posterior diameter of the spinal canal and interpedincular distance were made in 50 patients with low back pain. The results were compared with the surgical findings. The patients were followed up for two years. CT findings and clinical results were evaluated to determine whether preoperative CT could provide any evidence of failed spinal surgery in patients with recurrent symptoms.

Papillary carcinoma of the sphenoid sinus associated with sphenoid sinus abscess presenting as cavernous sinus syndrome. A case report.

Primary carcinoma of the sphenoid sinus is a rare tumor that may present with dramatic neuro-ophthalmological-symptoms and signs of which spheno-cavernous syndrome is the best known clinical entity. The most frequently encountered histological types of the sphenoid carcinomas are squamous cell carcinoma and papillary carcinoma, in decreasing order of frequency. In this article, a papillary carcinoma of the sphenoid sinus associated with sphenoid sinus abscess is presented. We are not aware of previously reported papillary carcinoma of the sphenoid sinus associated with sphenoid sinus abscess presenting as a cavernous sinus syndrome.

Effects of various acidic and alkaline solutions used to dissolve urinary calculi on the rabbit urothelium.

It is well known that infection-induced stones (apatite, struvite), uric acid and cystine calculi in the urinary tract can be managed by the use of certain chemical solutions. We investigated the effects of various acidic and alkaline solutions on the rabbit urothelium. Acidic solutions (pH: 4.2) caused more urothelial injury as compared to alkaline solutions (pH: 7.6). Ureteral injury was more severe than the bladder injury. Magnesium-containing solutions caused less injury to the urothelium.