Is laparoscopic appendectomy going to be standard procedure for acute appendicitis; a 5-year single center experience with 1,788 patients.

PURPOSE: To evaluate whether laparoscopic appendectomy can be the gold standard for acute appendicitis regarding the applicability and cost effectivity. MATERIALS AND METHODS: The study included patients who were operated by laparoscopically for acute appendicitis between January 2008 and September 2012. Patients' sex, ages, hospitalization time, the type for closure of the appendiceal stump, complication rate, surgery time and other parameters were recorded. RESULTS: 1,788 patients with acute appendicitis on laparoscopic evaluation constituted the study population. Average age of the patient group was 30.1 ± 2.3 years old. Average hospitalization time was 1.2 ± 1.1 days. Metal clips were used in 1,100 (61.5%) patients, intracorporeal knotting was performed in the remaining. Total complication rate was 3.8%. CONCLUSION: By the using of metal clips and increased experience; laparoscopy may be gold standard for acute appendicitis.

Is a High Body Mass Index Still a Risk Factor for Complications of Donor Nephrectomy?

BACKGROUND AND AIM: The incidence of obesity is increasing all around the world and Turkey is no exception. In Turkey, 80.1% of all kidney transplants performed in 2013 were living donor kidney transplants. In this study we compare the early postoperative complications of living kidney donors with a body mass index (BMI) over 30 to those with BMIs under 30. PATIENTS AND METHOD: All donor nephrectomies performed at the Ege University School of Medicine Hospital between May 2013 and May 2014 were included in the study. Donors' demographics, preoperative BMI, operation time, length of hospital stay, postoperative complications, and perioperative blood creatinine levels were analyzed. RESULTS: There were a total of 72 donors, 50 of whom had a BMI below 30 (group 1), whereas 22 had a BMI of 30 or higher (Group 2). The median age was 47 (±12.6) and 52.2 (±8.4) for Groups 1 and 2, respectively. The median BMI was 26.1 (±2.3) for Group 1 and 31.8 (±1.5) for Group 2. There was no significant difference in operation time (P = .980) between the 2 groups. There was no difference in the length of hospitalization with an average hospital stay of 3 days for both groups. No major complications were observed in either group. There was no difference in minor complication rates for both groups. CONCLUSION: High BMI donors can safely donate their kidney with no significant increase in complication rates at high-volume transplantation centers.

Comparison of Preemptive Kidney Transplantation With Nonpreemptive Kidney Transplantation in a Single Center: A Follow-up Study.

BACKGROUND AND AIM: The effect of preemptive transplantation of kidneys from living donors on patient and allograft survival is controversial. In this study, we aimed to evaluate whether preemptive kidney transplantation performed without the development of patient dialysis-related complications has a favorable effect on patient and graft survival. PATIENTS AND METHOD: The study included 334 adult renal transplant recipients. Patients who underwent renal transplantation between January 2008 and December 2012 at a tertiary referral teaching hospital were followed, and outcomes were obtained by retrospective chart review. A total of 244 patients underwent dialysis before renal transplantation, whereas 90 patients underwent preemptive transplantation. RESULTS: There were no significant differences between the 2 groups with regard to patients and graft survival rates (P > .05). Patient survival rates in preemptive and nonpreemptive groups were 98.9% and 96.3% in the first year, respectively (P = .199). Graft survival rates in preemptive and nonpreemptive groups were 96.7% and 93.0% in the first year, respectively (P = .163). Patient survival rates in preemptive and nonpreemptive groups were 98.9% and 95.7% in the third year, respectively (P = .155). Graft survival rates in preemptive and nonpreemptive groups were 93.5% and 88.5% in the third year, respectively (P = .138). There was a significant difference among years with regard to ratio of patients with preemptive transplantation (P = .009). The ratio was 17.5% in 2008, whereas it rose to 43.1% in 2012. CONCLUSION: Although preemptive kidney transplantation does not provide a significant patient and allograft survival advantage compared to nonpreemptive kidney transplantation, both therapeutic modalities provide good outcomes. Preemptive kidney transplantation has been an increasingly frequent renal replacement therapy option in recent years.

Comparison of Patients in Whom Double-J Stent Had Been Placed or Not Placed After Renal Transplantation in a Single Center: A Follow-up Study.

BACKGROUND: Double-J (DJ) stents play an important role in modern urology to prevent undesirable side effects after surgery. We aimed to investigate the relationship of DJ stents with the demographic characteristics, surgical complications, urinary tract infection (UTI), and hematuria in the patients who underwent renal transplantation (Tx). METHODS: Data of 354 patients who underwent renal Tx between 2008 and 2011 at Ege University were evaluated retrospectively; 331 patients were included in this study. The term DJ (-) represents patients in whom a DJ stent was not placed. "Primary DJ term" represents patients in whom the DJ stent was placed during the first Tx. "Secondary DJ term" represents the patients who had DJ after Tx for any complication. RESULTS: Two hundred fifty-four (76.7%) patients were in the DJ (-) group, 52 (15.7%) were in the primary DJ group, and 25 (7.6%) were in the secondary DJ group. There were significant differences between the groups in terms of anastomosis type (P = .000), stay-in-hospital time (P = .000), surgical complication (P = .000), re-operation (P = .000), percutaneous nephrostomy (P = .000), UTI (P = .000), first-time UTI (P = .000), recurrent UTI (P = .000), positive hemoculture (P = .000), hematuria (P = .000), duration of dialysis before Tx (P = .000), live/deceased donor (P = .000), and delayed graft function (P = .009). CONCLUSIONS: Our choice is to use the DJ stent in selected high-risk patients and to keep the indications for DJ stent wider in deceased donor transplants by considering possible surgical complications. The use of the stent only in selected cases will decrease surgical complications due to stent placement.

Complete hydatidiform mole coexisting with a live fetus.

The co-existence of a hydatidiform mole with a living fetus is a rare phenomenon. The condition is a dilemma with respect to the diagnosis and management of associated maternal (a risk of maternal complications, such as preeclampsia, hyperthyrodism, and a risk of malignancy) and fetal (elevated risk of spontaneous abortion, neonatal thyrotoxicosis) complications. A 27-year-old woman was referred to our hospital with a diagnosis of hydatidiform mole and live fetus. The pregnancy was unremarkable except for the complaints of excessive nausea and vomiting. Successive ultrasound examinations demonstrated a normally growing live fetus (14 weeks) alongside a normal placenta and an additional intrauterine echogenic mass with features of hydatidiform mole. Genetic amniocentesis at 18 weeks' of gestation showed normal diploid fetal karyotype. At 20 weeks of pregnancy, a control prenatal visit revealed intrauterine fetal death. The follow-up period for two years was unremarkable. In the case of a normal fetal karyotype and the absence of serious signs of maternal pathology, waiting until fetal viability is achieved can justifiably be proposed, however there is still a risk of prenatal complications such as intrauterine death.

Low risk stage I endometrial carcinoma: prognostic factors and outcomes.

OBJECTIVES: The aim of the study is to evaluate clinical features of patients with low-risk stage I endometrium cancer, who received adjuvant therapy or followed with observation only and to analyse the effects of known prognostic factors in this group of patients. MATERIALS AND METHODS: A total of 246 patients (median age: 53, range: 31-77) with low-risk stage I endometrial cancer, who were just followed postoperatively (156 patients) or received adjuvant radiotherapy (90 patients) between 1996 and 2007 were reviewed retrospectively. RESULTS: Local recurrence was detected in four patients, distant metastasis occurred in seven patients, and two patients had both local recurrence and distant metastasis. The 83.3% of recurrences were on the vaginal stump. Five- and ten-year local control (LC) and overall survival (OS) rates are 97.6%, 97.6% and 96.4%, 93.5% in the observation and adjuvant therapy groups, respectively, whereas distant control rates are 96.7% and 96.3%. In multivariate analysis, only age and lymphovascular invasion (LVI) were found to affect OS and disease-free survival (DFS). CONCLUSIONS: LC and OS rates are high in the low-risk group of patients; however, current adjuvant therapies did not improve the outcomes. Age over 60 years and the presence of LVI have negative effects on outcomes in this group of patients.

Prognostic factors and treatment outcomes in patients with operated endometrial cancer: analysis of 674 patients at a single institution.

PURPOSE: Endometrial carcinoma is the most prevalent gynecologic tumor in developed countries. The aim of the present study was to evaluate the clinical characteristics of the patients with endometrial cancer. METHODS: Six hundred and seventy-four patients who had received postoperative therapy were retrospectively investigated. Of the cases, 186 were only monitored, whereas 43 received intracavitary radiotherapy (ICRT) and 54 external beam radiotherapy (EBRT). Two hundred and fifty-nine patients received both EBRT plus ICRT. Eight patients received chemotherapy (CT), whereas 24 patients received both CT and EBRT plus ICRT. RESULTS: Statistical analyses revealed that age, menopausal status, tumor histology, stage, grade, tumor diameter, myometrial invasion, lymphovascular space invasion (LVI), positive cytology of abdominal fluid/washings, omental involvement, adnexal involvement and the type of the therapy significantly affected both the overall survival (OS) and disease- free survival (DFS). Survival was poor in patients over 60 years of age, who had advanced stage (higher than FIGO stage 2a), grade III tumor and myometrial invasion >50%. CONCLUSION: Age was the most important factor associated with local relapse while survival was affected by age, grade, myometrial invasion and stage.

Postoperative chemoradiation in patients with localized gastric adenocarcinoma: single center experience.

BACKGROUND: 5-Fluorouracil (FU)-based chemotherapy (CT) and concurrent 45 Gy radiotherapy (RT) is one of the standard postoperative approaches currently used in gastric carcinoma. The high toxicity rates of this treatment leads to interruption of treatment in the majority of patients. In our study, we investigated the rates of toxicity and treatment discontinuation observed during postoperative FU-based chemoradiotherapy (CRT); retrospectively evaluated the effect of CRT and the other prognostic factors on local and distant control and survival. PATIENTS AND METHODS: A total of 160 patients consisting of 97 total and 63 subtotal gastrectomy receiving postoperative CRT, have been studied retrospectively. RESULTS: Patients who had to discontinue the treatment for a median of 6 (range, 3-13) days experienced toxicity during treatment at a rate of 43%. During the 21 (range, 4-68) months of follow-up local recurrences were observed in 8 (5%) patients and distant recurrences were observed in 41 (25.6%) patients. While the 1-3 year overall survival (OS) rates were 75% and 42%, 13-year disease-free survival (DFS) rates were 63% and 42%, respectively. In the univariate analysis for OS and DFS demonstrated statistical significance for below those 60 years of age, D1-D2 dissection type, negative surgical margin, early treatment beginning, the absence of invasion, and early stage disease. D1D2 dissection type, early treatment beginning, age below 60 years and early stage disease significantly improve OS and DFS in multivariate analysis. CONCLUSIONS: Survival is worse in patients older than 60 years, had late treatment beginning, advanced stage and D0 dissection.

Radiotherapy for stage I seminoma of the testis.

BACKGROUND: After orchiectomy in stage I seminoma the standard is adjuvant radiation therapy. We analyzed the patients retrospectively to evaluate the contributions of the treatment volume and dosage to treatment outcomes. MATERIALS AND METHODS: Between January 1999 and December 2005, 91 stage I seminoma patients with a median age 36 (range;22-62) applied to our center, who were treated using anterior-posterior parallel opposed fields with linear accelerator or Co60 after orchiectomy. Twenty-five (27.5%) patients received irradiation to the paraaortic and ipsilateral pelvic nodes, and 66 (62.5%) patients only received to paraaortic nodes. RESULTS: With a follow up time of median 57 months (range; 27-104), paraaortic nodes treated group had 4 relapses (6%) - 3 of them pelvic, one of them both pelvic and paraaortic. Both paraaortic and ipsilateral nodes irradiated patients had only one relapse (4%) (P = 0.726). While the 5 year overall survival (OS) is 98.8%, it is 100% in the dog-leg group and 98.4% in the paraaortic group (P = 0.548). Univariate analyses of OS and Disease Free Survival (DFS) showed that there is no statistically significant difference related to factors as age, histologic subgroup, tumor size, rete testis involvement, radiotherapy (RT) fields, dose ranges and the therapy device. CONCLUSION: Adjuvant RT approach is the preferred for non-compliant low risk patients as well as intermediate and high risk patient in stage I seminoma. 20 Gy/ 10 fractions/ 2 weeks RT is the adequate treatment.

A retrospective comparison of concurrent 5-fluorouracil or oral UFT in postoperative chemoradiation for gastric adenocarcinoma.

PURPOSE: 5-fluoro-uracil (FU) is a common agent in postoperative chemoradiation in gastric adenocarcinoma. However, FU is not well tolerated in a significant proportion of patients. UFT, a fixed combination of the oral FU prodrug tegafur with uracil, is one of the agents used instead of FU in such cases. We retrospectively compared the toxicity, local and distant control and survival rates with FU or oral UFT during concurrent radiotherapy to assess the role of UFT instead of FU. PATIENTS AND METHODS: We conducted a retrospective analysis of survival, disease control and toxicity data in 52 patients treated with postoperative chemoradiation following total or subtotal gastrectomy for gastric adenocarcinoma with either FU or UFT between January 2003 and December 2004. RESULTS: Median follow-up was 20 months (range: 3-59), median survival time was 23 (+/-6.08) months and 1-3 years overall survival (OS) rates were 64.9-39% for all patients. Compared with the UFT regimen, the incidence of treatment interruption was greater with FU (p=0.023), but no significant differences were seen in local control (p=0.40), distant recurrences (p=0.83) and survival rates (p=0.8657) among patients. CONCLUSION: Concurrent UFT with radiotherapy seems to be a more tolerable and an equally effective regimen in the postoperative treatment of gastric adenocarcinoma when compared to FU.

Male breast cancer: a retrospective analysis.

BACKGROUND: To evaluate our results in the treatment of male breast cancer patients with respect to local control (LC), overall survival (OS) and possible prognosis factors for survival. PATIENTS AND METHODS: Thirty-nine patients with male breast cancer have been retrospectively studied with the trial aim to evaluate the results of our practice. Among them, 94.8% had invasive ductal carcinoma (IDC), 2.6% invasive papillary carcinoma (IPC) and 2.6% invasive lobular carcinoma (ILC) and the distribution according to stage was found to be 12.8, 46.2, 30.7 and 10.3% in Stages I, II, III and IV, respectively. Among the patients, 7.7% received radiotherapy (RT) and hormonotherapy (HT), 22.8% received chemotherapy (CT), 61.8% received chemoradiotherapy (CRT) and HT and 7.7% received HT in addition to surgery. RESULTS: The distant metastases rate was 36% and the local recurrence rate was 5%. All the local recurrences and the distant metastases had occurred after the first two years. The five-year disease free survival (DFS) and OS rates were 65.8 and 80.1% respectively. In our series, univariate analysis for OS demonstrated statistical significance for lymph node metastases (p=0.00001), stage (p=0.0098) and age (p=0.03); while RT in the treatment modality (p=0.6849), and tumor size (p=0.4439) demonstrated no significance. The presence of lymph node metastases significantly impairs OS (p=0.004) and DFS (p=0.014) in multivariate analysis. CONCLUSION: Postoperative radiotherapy was important in the management of male breast cancer to improve LC resulting in one local failure, but did not improve OS and DFS in our analysis. The presence of lymph node metastases significantly impaired OS and DFS.

Aeration efficiency of free-surface conduit flow systems.

Dissolved oxygen is a measure of the quantity of oxygen present in water and is one of the best indicators of the health of a water ecosystem. Dissolved oxygen levels in water can be increased by creating turbulent conditions where fine air bubbles are carried into the bulk of the flow. This is achieved by hydraulic structures. A free-surface conduit is a particular instance of this. In the present work, a series of experiments were conducted to investigate the aeration efficiency of free-surface conduit flow systems. The results indicate that free-surface conduit flow systems are very effective for oxygen transfer. At Froude numbers greater than 15, almost full oxygen transfer up to the saturation value was reached. Moreover, from experimental data, a regression equation was obtained with a very high correlation coefficient, showing the effect of various parameters on the aeration efficiency.

31 cases with oculoauriculovertebral dysplasia (Goldenhar syndrome): clinical, neuroradiologic, audiologic and cytogenetic findings.

Goldenhar syndrome (GS) or oculoauriculovertebral dysplasia (OAVD) is characterized by pre-auricular skin tags, microtia, facial asymmetry, ocular abnormalities and vertebral anomalies of different size and shape. The phenotypical findings of this syndrome are variable due to heterogenous aetiology. For that reason, the physician sometimes faces difficulty when making a definite diagnosis of OAVD. We reviewed the clinical and laboratory findings of 31 patients (15 boys and 16 girls) aged from 1 day to 16 years with the clinical diagnosis of GS. The characteristic features were pre-auricular skin tags (90%), microtia (52%), hemifacial microsomia (77%) and epibulbar dermoids (39%). Vertebral anomalies were noted in 70% of the patients. Cardiac malformations were found in 39% while a genitourinary anomaly was noted in 23% and various central nervous system malformations in 47%. There were 3 pregnancies following an intracytoplasmic sperm injection (ICSI) technique among the 31 patients. Two patients with GS came from the same family. Their relatives had hydrocephaly, myelomeningocele and neural tube defects. It is known that some chromosomal aberrations are seen in GS. We performed chromosome analysis of 29 patients. Among these cases, only one patient with severe mental and motor retardation had a 47,XX,+der(22)t(11,22)(q23; q11 karyotype due to a maternal balanced translocation t(11;22)(q23;q11). This translocation was demonstrated in her sister, brother and maternal uncle. Additionally CATCH 22 analysis in 13 cases with OAVD with a CATCH 22 phenotype revealed no deletion. OAVD patients present with different morphologic features and systemic manifestations. A multidisciplinary approach should be undertaken by departments such as pediatric cardiology, audiology, ophthalmology and plastic surgery when evaluating patients with OAVD. Chromosome analysis should be performed in every patient with Goldenhar syndrome.

Pulmonary involvement in rheumatoid arthritis.

The primary objective of this investigation was to assess the relationships between clinical characteristics, lung involvement, and frequency of pulmonary involvement in rheumatoid arthritis (RA). Using high-resolution computed tomography (HRCT) and pulmonary function tests (PFT), we prospectively evaluated 52 patients with RA (eight males and 44 females, mean age 53.6 years). The HRCT was abnormal in 35 patients (67.3%), the most frequent abnormalities being reticulonodular patterns, which were found in 22 patients (62.9%), ground-glass attenuation (20%), and bronchiectasis (17%). In this group of patients, PFT results were normal in 13 patients (37%). Titers of rheumatoid factor and erythrocyte sedimentation rate were significantly higher in abnormal HRCT presence. Higher Larsen's score, advanced age, and severe disease were significant risk factors for lung involvement (p<0.001, p<0.01, and p<0.01, respectively) and are suggested by our data to be statistically significant predictors of lung involvement in RA.

A new method of bone marrow transplantation leads to extension of skin allograft survival.

Tolerance induction through allogeneic bone marrow transplantation is an alternative method to chronic immunosuppression in maintaining long-term allograft survival. In this article, we introduce a new method of bone marrow allotransplantation, which preserves its natural microenvironment and does not require marrow processing or recipient conditioning. A total of 43 skin graft transplantations were performed in nine experimental groups between isogeneic [Lewis to Lewis (LEW, RT1(1))] and allogeneic [Lewis x Brown Norway (LBN --> F1, RT1(1+n)) to Lewis] rats under 35-day protocol of alphabeta T-cell receptor (TCR) monoclonal antibody (mAb) and cyclosporine (CsA) protocol. Monotherapies combined with "crude" bone marrow transplantation resulted in extended survival up to 21 days under CsA and up to 10 days under alphabeta-TCR mAb protocol. The use of combined protocol of alphabeta-TCRmAb/CsA with crude bone marrow transplantation resulted in the extension of skin allograft survival up to 65 days (P < .05). This new simple method of "crude" bone marrow allotransplantation without recipient conditioning is a promising, minimally invasive technique with a potential for direct clinical application.

Urinary tract infections in unplanned pregnancies and fetal outcome.

AIM: Many pregnant women are exposed to antibiotics for urinary tract infections during pregnancy. Our aim is to bring attention to antibiotherapy in unplanned pregnancies. METHOD: Among the 511 cases followed by our 'Toxicology Information and Follow-up Service' for drug exposure during pregnancy, 101 cases, unaware of their pregnancy, had been prescribed antibiotics and urinary antiseptic drugs in the first trimester of their unplanned pregnancies. The data on the outcome of these pregnancies and the babies were evaluated in this study. RESULTS: Of the 511 cases, 101 pregnant women were exposed to nine kinds of drugs. Seventy-five cases had healthy babies; two had babies with major malformations; one had a baby with congenital hypothyroidism; five had spontaneous abortions; and eight cases underwent induced abortions. The outcomes of eight pregnancies are unknown. Two pregnancies are still continuing without any problem. One baby had a fetal renal anomaly; however, the physical examination did not reveal any other malformations. The baby died 4 hours after delivery. Another baby had atrial septal defect, a major malformation, and one baby had congenital hypothyroidism. CONCLUSION: Urinary tract infection is one of the most frequently seen complications of pregnancy. Our study indicated that the possibility of pregnancy should be considered when prescribing antibiotics for urinary tract infections in women of reproductive age.

Alterations in human enamel surface morphology following the use of an office bleaching agent and consecutive application of 37% phosphoric acid in vivo.

OBJECTIVE: The aim of this in vivo study was to evaluate the effects of a visible light-activated in-office bleaching agent, Opalescence Xtra (35% hydrogen peroxide) on the external enamel surface of human teeth by using scanning electron microscopy (SEM). METHODS: The labial surfaces of nine upper incisors from nine different patients were divided into four parts, and a bleaching agent was applied to the mesial halves of the teeth. Three weeks following this treatment, the teeth were extracted and divided into four quadrants. Each quadrant was treated with a different procedure and the samples were examined under SEM. The SEM photographs were blindly evaluated by a jury of four experts. RESULTS: Although there were no statistical differences in the rating of surface morphology of bleached and control groups, the 37% phosphoric acid etched and acid etched + bleached enamel samples demonstrated a statistically significant dissimilar surface morphology (p < 0.05). CONCLUSION: The bleached + etched enamel treatment showed an uneven etched surface compared to the acid etched control.

"Air bubble": a new diagnostic CT sign of perforated pulmonary hydatid cyst.

The greatest difficulty in the CT diagnosis of perforated pulmonary hydatid cyst (PPHC) is the increase in the attenuation numbers following infection. Because of the solid density of infected hydatid cysts, the differentiation from an abscess or neoplasm is usually impossible. The aim of this study was to evaluate the value of "air bubble" as a new CT sign in the diagnosis of PPHC. Sixty-five patients (28 men and 37 women) with PPHC were included in the study. As a control group, 55 patients who had malignant (n = 36) or non-malignant (n = 19) pulmonary diseases were also examined. Radiological diagnosis with classical CT findings was made in only 38 of 65 patients (58.5 %) with PPHC. Air bubble sign was positive in 54 of the patients with PPHC (sensitivity 83.1 %) but only 3 of 55 patients in control group (specificity 94.5 %). When we analyzed the CT scans with classical CT findings including air bubble, the diagnosis of PPHC was made in 61 of patients (93.8 %). It is concluded that "air bubble sign" is a valuable CT finding in the diagnosis of PPHC.