The role of miRNAs targeting K-ras and APC genes in colorectal cancer.

OBJECTIVES: The occurrence of abnormal expression patterns in different types of cancer suggests that micro RNAs (miRNAs) may play an important role in tumorigenesis. The aim of this study was to examine the expression levels of miRNAs known to be associated with the regulation of the expression levels of the APC and K-ras, which are important in the development of colorectal cancer (CRC). METHODS: The expression levels of miR-27, miR-663, miR-217, miR-181d, APC and K-ras in the serum, tumor and adjacent tumor-free (healthy) tissues of the patients and serum of the healthy controls were investigated with qRT-PCR. RESULTS: Expression levels of miR-217, mR-181d, miR-663, miR-27 and K-ras were found to be higher in CRC tissues than in adjacent tumor-free tissues of the patients. In patient serum samples, miR-663 levels were statistically more elevated than in controls. In patient tumor tissues, miR-217, miR-181d and miR-27 expressions were found to be higher. CONCLUSIONS: Increased miR-181d and miR-217 expression levels are associated with increased K-ras expression in the tumor tissues, and the expression of K-ras, which takes part as an oncogene in the CRC development, might be regulated by these miRNAs (Tab. 4, Ref. 33).

Quality of life after thyroid surgery.

PURPOSE: The purpose of this study was to inquire how patients' quality of life is affected after thyroid surgery and the factors involved. METHODS: A semi-structured questionnaire and the World Health Organization Quality of Life Scale (WHOQOL-BREF) were applied to 101 patients prior to surgery. Thereafter data was collected in the early and again in the late post-operative period. RESULTS: Mean general health score for pre-operative quality of life was 6.72 ± 1.53 (3-10), mean physical field score was 22.81 ± 2.77 (17-31), mean psychological field score was 21.69 ± 2.78 (15-28), mean social field score was 11.10 ± 1.94 (5-15) and mean environmental field score was 27.86 ± 4.30 (18-39). In the early post-operative period, mean general health score was 7.05 ± 1.45 (4-10), mean physical field score was 22.84 ± 2.83 (14-29), mean psychological field score was 21.67 ± 2.32 (16-27), mean social field score was 10.89 ± 1.96 (5-15) and mean environmental field score was 28.56 ± 4.18 (18-40). In the late post-operative period, the general health score for quality of life was 7.43 ± 1.34 (4-10), mean physical field score was 23.59 ± 2.70 (17-35), mean psychological field score was 21.75 ± 2.34 (14-29), mean social field score was 11.23 ± 1.94 (6-15) and mean on-field environment score was 29.30 ± 3.96 (16-40). The pre-operative levels of symptoms were found to be higher than early and late post-operative periods. CONCLUSIONS: Quality of life increased after total thyroidectomy and statistically significant improvement was observed in late post-operative stage.

An evaluation of fecal incontinence in women with urinary incontinence.

OBJECTIVE: To investigate the occurrence of and risk factors for fecal and/or gas incontinence in female patients having urinary incontinence. PATIENTS AND METHODS: 741 consecutive adult female patients presenting with urinary incontinence alone (group 1, n = 700) or urinary incontinence with fecal and/or gas incontinence (group 2, n = 41) were enrolled into the study. As potential risk factors for fecal and/or gas incontinence in this population, the following variables were investigated: age, body mass index, type of urinary incontinence, childbirth history, menopausal symptoms, history of pelvic surgery, neurological disease, diabetes mellitus, tobacco use, constipation, cystocele, rectocele. Quality of life was assessed with the Urogenital Distress Inventory-Short Form (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). RESULTS: Of the women having urinary incontinence, 5.5% also had fecal and/or gas incontinence. Associated risk factors were history of difficult delivery, postmenopausal symptoms, history of pelvic surgery and constipation. Fecal and/or gas incontinence was also associated with a lower quality of life in terms of both questionnaires. CONCLUSIONS: Women have urinary incontinence may have also fecal and/ or gas incontinence. Particularly if they have chronic constipation, postmenopausal symptoms or history of difficult delivery or pelvic surgery they must be evaluated for this additional symptom. So we can treat these patients appropriately and increase their quality of life.

The use of Ligasure vessel sealing system in axillary dissection; effect on seroma formation.

BACKGROUND: Seroma formation is the most frequent postoperative complication after axillary dissection for breast surgery with an incidence of 10 - 50 %. This prospective clinical randomized study was carried out to evaluate the Ligasure vessel sealing system and its effect on seromaformation and other complications for axillary dissection. METHODS: Between January 2006 and November 2007, the patients with histopathological diagnosis of breast cancer were analysed prospectively. The patients with positive sentinel lymph node biopsy or clinical axillary involvement were included in the study, and the patients who underwent neoadjuvant therapy or using anticoagulants have been excluded from the study. Patients were divided into two study groups.Axillary dissection was performed in the first group by LigaSure and in the second group by linking and electrocautery. RESULTS: There were a total of thirty three patients with a mean age of 51.4 +- 13.7. In group one, mean age of patients was 54.1 +- 13.2 and 48.68 +- 14.1 in group two. There was no significant statistical difference between the groups regarding age, body mass index, excised tissue weight,tumour size and number of excised lymph nodes. The use of Ligasure reduced drainage amount and duration of drain till removal, but increased operative time. CONCLUSION: There were no significant differences between study groups regarding the complications. LigaSure electrothermal bipolar vessel sealing system can be safely used in axillary dissection as an alternative to traditional methods.

Evaluation of perinatal and intrafamilial hepatitis B prevention programmes in a well child clinic: 9-year follow-up study in Turkey.

Evaluating the performance of well child clinics on adherence to recommended perinatal hepatitis B prevention programmes as well as assessing the outcome of infants living with hepatitis B surface antigen (HBsAg)-positive parents is important. A retrospective study was performed of 336 babies who had at least one HBsAg-positive parent and were followed-up in the well child clinic of Gazi University Hospital (Ankara, Turkey) between 2001 and 2009. Rates of passive immunisation in 109 babies with HBsAg-positive mothers and initiation of hepatitis B vaccination of all 336 babies with HBsAg-positive parents were 98.8% and 100% respectively. Ninety-two babies (27.4%) were lost to follow-up before completing primary immunisation. The recommended perinatal hepatitis B prevention programme was performed successfully in 194 of the 306 infants who were old enough for post-vaccination serotesting (63.4%). One baby became HBsAg-positive, and 88.1% of babies were seroprotected. Hepatitis B surface antibody (anti-HBs) levels were found to be increased if the HBsAg-positive parent was the father. There was a negative correlation between serotesting time and anti-HBs titres. The study infants had a total of 187 siblings and 123 (65.8%) were serotested after completing primary immunisation with 108 found to be seropositive. Although the vaccination rate in the perinatal hepatitis B prevention programme is satisfactory, post-vaccination serotesting and evaluation of infants and their siblings are still deficient.

Endothelial function and endothelial nitric oxide synthase intron 4a/b polymorphism in primary hyperparathyroidism.

BACKGROUND AND AIM: Patients with symptomatic primary hyperparathyroidism (pHT) have increased cardiovascular morbidity and mortality. Endothelial nitric oxide synthase (eNOS) intron 4a/b polymorphism is associated with coronary artery disease and hypertension in various populations. Our aim is to evaluate endothelial function in patients with pHT during pre-operative hypercalcemic and post-operative normocalcemic periods and to determine whether intron 4a/b polymorphism of eNOS gene influences endothelial function. SUBJECTS AND METHODS: Forty patients with pHT (age 48.48+/-11.64 yr) were examined pre-operatively and reexamined 5.8+/-1.9 months after parathyroidectomy. Forty-three healthy subjects (age 47.13+/-8.14 yr) were served as control group. Endothelial function was determined by flow-mediated dilation of brachial artery (FMD). eNOS4a/b polymorphism was detected by polymerase chain reaction. RESULTS: FMD was significantly lower in patients pre-operatively compared with controls (8.48+/-1.78% vs 19.49+/-2.34%, p<0.001). FMD improved significantly after parathyroidectomy (16.19+/-2.16%, p<0.001 compared with pre-operative measurements), but was still significantly lower than controls (p<0.001). The distribution of eNOS4a/b genotype frequencies was not significantly different between patients and controls. Logistic regression analysis showed that increased serum calcium (>2.47 mmol/l) and PTH concentrations (>7.75 pmol/l) were significant independent predictors of lower FMD (<16.7%). ENOS4a/b polymorphism did not enter in this model. CONCLUSION: Impaired endothelial function in patients with pHT improves after successful parathyroid surgery. No compelling data are evident to suggest that eNOS4a/b polymorphism modifies the endothelial function in patients with pHT.

The role of human herpesvirus 6, human herpesvirus 7, Epstein-Barr virus and cytomegalovirus in the aetiology of pityriasis rosea.

AIM: To identify the role of human herpesvirus 6 (HHV-6), HHV-7, Epstein-Barr virus (EBV) and cytomegalovirus (CMV) in the pathogenesis of pityriasis rosea (PR). MATERIAL: Polymerase chain reaction with specific primers for HHV-6 and HHV-7 DNA sequences was performed on the blood and tissue samples of 25 patients with PR and on the blood samples of age- and sex-matched healthy controls. HHV-6, EBV, CMV immunoglobulin M (IgM) and IgG were analysed by enzyme-linked immunosorbent assay, HHV-7 IgM and IgG were analysed by indirect immunofluorescence on the serum samples of the study population. In the patient group, the values were studied 2 weeks later again (second control). RESULTS: There were no differences between the first and second controls of the patients and healthy subjects regarding HHV-6 IgM, HHV-7 IgM, CMV IgM, EBV IgM results. There were significant differences between the first [HHV-6 DNA (2 of 25), HHV-7 DNA (6 of 25)] and second control [HHV-6 DNA (1 of 25), HHV-7 DNA (11 of 25)] of the patients for the blood samples in favour of HHV-7. PR patients showed higher amounts of HHV-6 and HHV-7 DNA positivity when compared with that of healthy subjects. HHV-7 seemed to be more important regarding tissue samples [HHV-6 DNA (7 of 25), HHV-7 DNA (12 of 25) first control, HHV-6 DNA (6 of 25), HHV-7 DNA (12 of 25) second control] as well as blood samples. CONCLUSION: Though our results failed to support a causal relationship among EBV, CMV and PR, they indicated a possible role for HHV-6 and especially HHV-7 in a group of Turkish patients but other aetiological factors may exist.

Electrocautery for cutaneous flap creation during thyroidectomy: a randomised, controlled study.

BACKGROUND: Although electrocautery has been used widely in surgery, the fear of delayed wound healing and infection persists. We aimed to evaluate the risk factors for wound complications and the rate of wound complications, comparing the use of electrocautery or scissors in cutaneous flap creation during thyroidectomy. DESIGN: The study group comprised 239 consecutive patients scheduled for thyroidectomy. SUBJECTS: Patients were randomly assigned to cutaneous flap dissection by either electrocautery (group one, n = 126) or scissors (group two, n = 113). Age, gender, body mass index, American Society of Anesthesiology score, tissue weight, operating time, incision length, cutaneous tissue depth, thyroid function and surgeon experience were recorded and compared with the rate of post-operative wound complications in both groups. RESULTS: There were no significant differences between the overall rate of post-operative wound complications, comparing groups one and two (7.9 vs 10.6 per cent, respectively; p = 0.74). Significant positive correlations were found between wound complication and age (Spearman's rank coefficient (rs) = 0.135, p = 0.036), body mass index (rs = 0.379, p = 0.0001), cutaneous tissue depth (rs = 0.677, p = 0.0001) and tissue weight (rs = 0.643, p = 0.0001). According to logistic regression analysis, a body mass index of more than 27.5 kg/m2 was associated with a 13.7-fold increased rate of post-operative wound complications. CONCLUSION: When creating cutaneous flaps during thyroidectomy, the use of electrocautery is as safe as the use of scissors. Such electrocautery does not increase the risk of wound complications in thyroid surgery.

Lymphatic mapping for Merkel cell carcinoma.

Merkel cell trabecular carcinoma of the skin has a prognosis poorer than expected for a small skin lesion. An early diagnosis and prompt treatment can contribute to improve survival in cases of this aggressive skin tumor. A wide local excision is indicated for localized disease. Elective lymph node dissection is controversial. The authors report a rare case of Merkel cell tumor treated with wide local excision and sentinel lymph node biopsy.