Incidental presentation of appendix neuroendocrine tumor: Long-term results from a single institution.

BACKGROUND: Appendix neuroendocrine tumors (NETs) are the most common tumors of the appendix and are most often diagnosed incidentally. The aim of this study was to retrospectively evaluate appendix NETs diagnosed incidentally in our clinic. METHODS: Of 8304 patients who underwent appendectomy with the diagnosis of acute appendicitis in Ankara Training and Re-search Hospital, General Surgery Clinic between January 2009 and January 2022, 33 had histopathology results evaluated as appendix NET, and a retrospective analysis was made of these cases. The patients were evaluated in terms of age, gender, tumor infiltration, tumor location, tumor size, surgical margin, tumor World Health Organization grade, surgery performed, lymph node metastasis, Ki67 index, number of mitosis, follow-up time, and survival. RESULTS: The rate of appendix NET was found to be 0.4%. The 33 cases comprised 15 (45.5%) males and 18 (54.5%) females with a mean age of 35.48 years (range: 16-84 years). Positive surgical margin was determined in 1 (3.03%) case, in which right hemicolectomy was performed. All other cases were followed up after appendectomy. The median follow-up was 89 (7-145) months. No recurrence was observed in any case. Mortality developed during follow-up in one case due to non-tumoral causes. CONCLUSION: Appendix NETs are generally asymptomatic and appear incidentally after appendectomy due to acute appendicitis. Appendix NETs diagnosed incidentally are generally below 2 cm and have a good prognosis.

Effect of Topical Application and/or Systemic Use of Red Ginseng Extract on Wound Healing in Rats With Experimentally Induced Diabetes.

BACKGROUND: Red ginseng (Rg) is an herbal product that has been used in traditional medicine in Asian and European countries for many years. PURPOSE: To study the effects of Rg extract on wound healing when used systemically, locally, or in combination in rats with experimentally induced diabetes. METHODS: A total of 60 rats were randomly divided into 4 groups: saline (control), local Rg (LRg), systemic Rg (SRg), and local + systemic = combined Rg (CRg). A full-thickness wound (2 cm × 1 cm) was created on the back of the rats, and treatment protocols were carried out for 14 days. Wound areas of all rats were measured on days 0 and 14. Tissue samples were taken from the wound areas for histopathologic evaluation of inflammation, epithelialization, and fibrosis. Vascular endothelial growth factor (VEGF), CD4+, and CD8+ expressions were examined by immunohistochemistry. RESULTS: Wound contraction measurements were 63.8%, 80.5%, 88.5%, and 86.6% in the control, LRg, SRg and CRg groups, respectively. Although significant differences were observed for all treated groups (LRg, SRg, and CRg) compared with the control group in terms of wound contraction, there was no difference among the treatment groups. VEGF-positive vessel/mm2 was observed 4.00 ± 0.75, 5.93 ± 0.70, 5.93 ± 1.93, and 7.93 ± 0.70 in the control, LRg, SRg and CRg groups, respectively. There was no difference between LRg and SRg in terms of VEGF expression, but there was significant difference for all other groups compared with each other. CONCLUSION: All usage methods of Rg extract increased wound contraction, and differences were observed compared with the control group. However, the authors believe that the combined usage was more effective due to higher VEGF expression levels and lower CD4+:CD8+ ratio.

Impact of Muscle Mass Depletion on Surgical Outcomes in Patients with Primary High-grade Serous Ovarian Cancer Undergoing CRS and HIPEC.

OBJECTIVE: To investigate the effect of sarcopenia on surgical outcomes in patients with primary high-grade serous ovarian cancer undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Surgical Oncology, Faculty of Medicine, Ankara University Ankara, Turkey,  from January 2013 to January 2020. METHODOLOGY: Forty patients, who underwent CRS and HIPEC with the diagnosis of primary high-grade serous ovarian cancer and peritoneal carcinomatosis were included in the study. Preoperative staging CT images were used to determine total psoas index values by measuring psoas muscle area at the level of L3 vertebra. Patients with total psoas index values below the cut-off levels were considered sarcopenic. Demographic, clinicopathological and perioperative results were compared between sarcopenic and non-sarcopenic patients. RESULTS: Serious postoperative complications (36.4% vs. 6.9%, p=0.039)  and infective (54.5% vs. 17.2%, p=0.042) and pulmonary (72.7% vs. 34.5%, p=0.040 complications were significantly higher in sarcopenic patients. Hospital stay [20(12-25) vs. 12(9-16.5) days, p=0.017] and ICU stay [4(2-6) vs. 2(1-2.5) days, p=0.013)] were found to be longer in sarcopenic patients. In univariate analysis, advanced age (OR: 1.40 95% CI: 1.07-1.84; p=0.021) and sarcopenia (OR: 7.71% 95 CI: 1.17-51.06; p=0.039) were significantly associated with serious postoperative complications. The presence of sarcopenia (OR: 0.050 95% CI: 0.004-0.675; p=0.024) was found to be independent predictor of serious postoperative complications. CONCLUSION: Sarcopenia can easily be diagnosed without additional cost or radiation exposure with routine preoperative staging CT images. Identification of sarcopenic ovarian cancer patients in preoperative period may affect patient selection, predictability of possible serious complications, elective operation preparation process with a combination of nutrition and exercise therapy, thus postoperative complication rates may be reduced and short-term results may be improved. Key Words: Cytoreductive surgery, Ovarian cancer, Sarcopenia.

An Evaluation of the Effect of Preoperative Inflammation-based Factors on Survival in Gastric Cancer Patients.

OBJECTIVE: To investigate the predictive effect of preoperative inflammatory factors on overall survival (OS) in patients diagnosed with gastric adenocarcinoma (GAC). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of General Surgery, Ankara Training and Research Hospital, between January 2011 and October 2020. METHODOLOGY: A retrospective examination of 207 patients was made from the demographic, preoperative, and postoperative clinical pathology records of patients diagnosed with GAC. Demographic data, pathological tumor-node-metastasis (TNM) staging, preoperative inflammatory factors including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and aspartate transaminase (AST)-alanine aminotransaminase (ALT) ratio, red cell distribution width (RDW), and hypoalbuminemia were statistically analysed in respect of the effect on OS. RESULTS: Overall survival was determined to be significantly shorter in patients with age >65 years (p = 0.001), advanced TNM stage (p <0.001), tumor size >4.7 cm (p = 0.007), AST-ALT ratio >1.21 (p = 0.017), and hypoalbuminemia (<35 g / L) (p = 0.018). In Cox regression analysis for all factors affecting OS, age >65 years (p = 0.002) and TNM stage 1B (p = 0.004) and 2A (p = 0.039) were determined as independent predictors of survival. The values of NLR, PLR, and RDW were not statistically significant between the groups with and without mortality (p=0.066, p=0.283, p=0.501, respectively). CONCLUSION: Inflammation-based factors including AST-ALT ratio and albumin can help assess prognosis in patients with gastric cancer in standard clinical preoperative tests. Key Words: Gastric cancer, Inflammation-based factors, Aspartate transaminase-alanine aminotransaminase ratio, Neutrophil-lymphocyte ratio, Platelet-lymphocyte ratio, Albumin, Tumor-node-metastasis staging, Overall survival.

The effect of Ankaferd blood stopper on liver damage in experimental obstructive jaundice

Background/aims: To evaluate the potential protective effects of Ankaferd blood stopper (ABS) in an experimental obstructive jaundice (OJ) model. Materials and methods: The study included 26 female rats, which were divided into 3 groups. The sham group, consisting of 10 rats, (group 1) only received solely laparotomy. In the control group, consisting of 8 rats, (group 2), ligation was applied to the biliary tract and no treatment was implemented. In the treatment group, consisting of 8 rats, (group 3), following ligation of biliary tract, 0.5 mL/day ABS was given for 10 days. Liver tissue and blood samples were taken for histopathological and biochemical examination. Results: Compared to group 2, group 3 had higher aspartate aminotransferase (AST), total oxidant status (TOS) malondialdehyde (MDA), fluorescent oxidant products (FOP), and lower expression of albumin and total antioxidant status (TAS) (P < 0.05). In histopathological analysis, the mean scores of all histopathological parameters (fibrosis, portal inflammation, confluent necrosis, interphase activity, bile duct proliferation) have statistical significance between group 2 and group 3 (P < 005). Conclusions: ABS has promising results in the treatment of experimental OJ because of its antioxidant and antiinflammatory properties. It may be used in clinical practice after more extensive studies about the effects of ABS on OJ.

Assessment of Ankaferd Blood Stopper in experimental liver ischemia reperfusion injury

Background/aim: To investigate possible protective effects of Ankaferd Blood Stopper® (ABS) in an experimental liver ischemia reperfusion injury (IRI) model. Materials and methods: The study was carried out on 30 female rats separated into 3 groups as sham, control (IRI), and treatment (IRI + ABS) groups. In the IRI + ABS group, 0.5 mL/day ABS was given for 7 days before surgery. In the IRI and IRI + ABS groups, the hepatic pedicle was clamped for 30 min to apply ischemia. Then, after opening the clamp, 90-min reperfusion of the liver was provided. Blood and liver tissue samples were taken for biochemical and histopathological analyses. Results: Compared to the sham group, the IRI group had significantly higher levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total oxidant status (TOS), malondialdehyde (MDA), fluorescent oxidant products (FOP) and lower expression of albumin and total antioxidant status (TAS) (P < 0.05). Compared to the IRI group, the IRI+ABS group showed lower expression of AST, ALT, TOS, MDA and FOP and higher expression of albumin and TAS (P < 0.05). In the histopathological analysis, congestion scores were statistically significantly lower in the IRI + ABS group than in the IRI group. Conclusions: ABS has a strong hepatoprotective effect due to its antioxidant and antiinflammatory effects and could therefore be used as a potential therapeutic agent for IRI.

Regression in local recurrence in the contralateral breast following mastectomy in bilateral locally advanced breast cancer: A comparison of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios.

The neutrophil-to-lymphocyte ratio is clinically accepted as a marker of systemic inflammatory response. In breast cancer patients, neutrophil-to-lymphocyte ratio can be used as an important prognostic indicator of survival. In routine laboratory tests, the platelet-to-lymphocyte ratio can also be examined in addition to neutrophil-to-lymphocyte ratio. Although the effects on breast cancer survival of platelet-to-lymphocyte ratio, which is accepted as the twin of neutrophil-to-lymphocyte ratio, are not as widely accepted as those of neutrophil-to-lymphocyte ratio, platelet activation is known to be a feature of cancer. Here, we present the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio of a patient with locally advanced cancer of the left breast who underwent a simple mastectomy that reduced the tumor load. Following surgical therapy, a remarkable regression was observed in the local recurrence area of the right mastectomy site; at the same time, the patient's neutrophil-to-lymphocyte ratio and PLR values significantly decreased.

Do Histopathological Features and Microcalcification Affect the Elasticity of Breast Cancer?

OBJECTIVES: The aim of this study was to evaluate any association between histological grade, molecular subtypes of breast cancer, and strain elastography, and to investigate whether microcalcification affects the stiffness of tumor in breast cancers with the same histological grade. METHODS: Between April 2015 and March 2016, 94 lesions of 94 patients with the diagnosis of invasive ductal carcinoma were included in the study. Strain elastography was performed on all patients before biopsy. Histological grades (Grades 1, 2, and 3), molecular subtypes (luminal A, luminal B, Her-2, and basal-like), and strain ratio (SR) were compared. In the same histological grades, patients were divided into two groups according to the presence of microcalcifications, and the groups were compared with each other. RESULTS: Compared with Grades 1 (20.5) and 2 (23.7), Grade 3 (11.7) showed lower SR values (Grade 3-2, P = .01; Grade 3-1, P = .2). The groups with microcalcification had slightly higher SR in all histological grades, but not of statistical significance. In molecular subtypes, luminal A and B demonstrated higher SR, whereas HER2 and basal-like had lower SR (P > .05 for all group comparisons). CONCLUSIONS: Grade 3 invasive ductal carcinomas are different from other grades with lower SR values. The presence of microcalcifications and molecular subtypes do not affect elasticity like a high histological grade does.