Analysis of the Effect of Weight Loss on Eustachian Tube Function by Transnasal Videoendoscopy.

OBJECTIVE: To investigate the effect of weight loss after bariatric surgery on eustachian tube (ET) function with video endoscopy. MATERIALS AND METHODS: The present study was conducted as a prospective cohort and was completed with 19 patients. Three-step tympanometry (basal, Toynbee, Valsalva), dynamic slow-motion video endoscopy, and the Eustachian Tube Dysfunction Questionnaire-7 (ETDA-7) were applied to the patients preoperatively before bariatric surgery and in the postoperative 6th month. Dynamic slow-motion video endoscopy was graded between 0 and 3, or classified as patulous, as indicated in the literature. RESULTS: The mean body mass index of 6 male and 13 female patients decreased from 47.3 ±â€Š4.6 to 31.2 ±â€Š5.4. Grade decline (median 2 ±â€Š1) was experienced in all patients in DSVE, and 1 patient resulted as patulous ET. The ETDA-7 scores decreased in11 patients, remained stable in 7 patients, and increased in 1 patient with patulous ET. The statistical analysis of the preoperative and postoperative DSVE grading and ETDA-7 scores, excluding the patulous ET patient, was found to be significant (P  = 0.001 and P  = 0.003, respectively). There was no significant change in any of the tympanometry parameters (P > 0.05). CONCLUSIONS: Rapid weight loss with bariatric surgery results in an improvement in both the DSVE images and in the complaints of ET dysfunction in the majority of patients, but in some patients it may result in patulous ET. Therefore, preoperative evaluation of the ET with DSVE and questioning the patient's complaints are important in predicting patients who may develop patulous ET.

Acoustic parameter changes after bariatric surgery.

OBJECTIVE: To investigate the acoustic parameter changes after weight loss in bariatric surgery patients. MATERIALS AND METHODS: This prospective, longitudinal study was conducted with 15 patients with planned bariatric surgery, who were evaluated pre-operatively and at 6 months post-operatively. Fundamental frequency (F0), Formant frequency (F1, F2, F3, and F4), Frequency perturbation (Jitter), Amplitude perturbation (Shimmer) and Noise-to-Harmonics Ratio (NHR) parameters were evaluated for /a/, /e/, /i/, /o/, and /u/ vowels. Changes in the acoustic analysis parameters for each vowel were compared. The study group was separated into two groups according to whether the Mallampati score had not changed (Group 1) or had decreased (Group 2) and changes in the formant frequencies were compared between these groups. RESULTS: A total of 15 patients with a median age of 40 ± 11 years completed the study. The median weight of the patients was 122 ± 14 kg pre-operatively and 80 ± 15 kg, post-operatively. BMI declined from 46 ± 4 to 31 ± 5 kg/m2. The Mallampati score decreased by one point in six patients and remained stable in nine. Of the acoustic voice analysis parameters of vowels, in general, fundamental frequency tended to decrease, and shimmer and jitter values tended to increase. Some of the formant frequencies were specifically affected by the weight loss and this showed statistical significance between Group 1 and Group 2. CONCLUSION: The present study reveals that some specific voice characteristics might be affected by successful weight loss after bariatric surgery.HighlightsObesity reduces the size of the pharyngeal lumen at different levels.The supralaryngeal vocal tract size and configuration is a determinative factor in the features of the voice.Changes in the length and shape of the vocal tract, or height and position of the tongue can result in changes especially in formant frequencies in acoustic analysis.

D2 vs D2 Plus Para-aortic Lymph Node Dissection for Advanced Gastric Cancer.

OBJECTIVES: Gastric cancer is a common malignancy worldwide. Effective treatment by interdisciplinary cooperation is important, and surgery still plays an important role. MATERIAL AND METHODS: In a ten-year period, 355 patients were diagnosed to have gastric cancer. One hundred and sixty-two patients with a median (range) age of 58 (23-83) years were eligible for the study. There were 107 patients in D2 and 55 patients in D2 lymphadenectomy plus para-aortic lymph node (PALN) dissection group. The two groups were compared in terms of complications, morbidity, mortality and long-term survival. RESULTS: Length of stay was 12 (8-34) days for D2 and 14 (8-42) days for D2 plus PALND. Total number of operative mortality was 8/162 (5%), and it was not different between the groups. Twenty patients (18%) had complications in D2 group and 9 (17%) patients in D2 plus PALND group. Overall survival was also similar between the groups, but patients with T3-T4 tumors, patients with stage IIIA and IIIB disease had better survival with D2 plus PALN dissection. We found that the depth of invasion, PLN, ratio (PLN/TLN), stage and LND were all prognostic variables. CONCLUSION: This study showed that D2 plus PALN dissection for advanced gastric cancer can be performed as safely as a standard D2 dissection by experienced surgeons without increasing postoperative morbidity and mortality. D2 plus PALN dissection should be preferred in the advanced stage of the disease (IIIA-IIIB) as it increases the rate of survival.

Physical activity, musculoskeletal disorders, sleep, depression, and quality of life before and after bariatric surgery.

OBJECTIVES: This study aims to evaluate physical activity, sleep, depression, quality of life, and musculoskeletal problems pre- and postoperatively in morbidly obese patients who underwent bariatric surgery and analyze the factors that are strongly associated with physical activity. PATIENTS AND METHODS: This prospective study conducted between January 2016 and May 2017 included 27 patients (4 males, 23 females; mean age 37.1±10.4 years; range, 18 to 52 years) who underwent bariatric surgery and 20 healthy controls (3 males, 17 females; mean age 32.0±5.7 years; range, 26 to 46 years). All patients were evaluated by using the short form of International Physical Activity Questionnaire (IPAQ), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and short form 36 (SF-36). Patients were evaluated for regional musculoskeletal pain including back, waist, hip, knee, ankle, heel, and metatarsal pain using Visual Analog Scale. Presence of pes planus was recorded. The examinations and tests performed in the preoperative period were repeated at postoperative six months and the results were compared with the control group. RESULTS: The body mass index was 46.2±5.2 kg/m2 preoperatively and 33.8±5.0 kg/m2 postoperatively (p<0.001). The total IPAQ was 345.4±172.8 metabolic equivalent (MET)-min/week preoperatively and 672.8±227.8 MET-min/week postoperatively (p<0.001). Pittsburgh Sleep Quality Index was 7.6±3.0 preoperatively and 3.5±2.4 postoperatively, whereas BDI was 20.2±8.5 preoperatively and 9.9±7.4 postoperatively. The results were statistically significant (p<0.001, p<0.001, respectively). A statistically significant improvement was found in all subsections of the SF-36. Pre- and postoperative results of the 27 patients were compared with those of the control group. CONCLUSION: Obesity is significantly associated with joint pain, physical function impairment, depression, and sleep disorders. Significant weight loss after bariatric surgery improves functional recovery and patient's psychology in a short time.

STEAP4 and HIF-1α gene expressions in visceral and subcutaneous adipose tissue of the morbidly obese patients.

AIM AND BACKGROUND: Obesity is a multifactorial disease in which environmental and genetic factors play an integrated role. Determining such target genes will help to elucidate the mechanisms underlying complex diseases such as obesity and diabetes which are usually seen together. Present study investigates the expression levels of STEAP4 and HIF-1α in visceral and subcutaneous adipose tissue. PATIENTS AND METHODS: 30(6M) morbidly obese patients undergoing bariatric surgery were included in the study. The patients were grouped according to the BMI as Group I (BMI <50kg/m(2)) and Group II (BMI ≥50kg/m(2)). Samples from visceral (omentum) and subcutaneous adipose tissues were obtained from each patient and real-time PCR (qPCR) was carried out for STEAP4 and HIF-1α gene expressions. Correlations between expression levels and clinical parameters were analyzed. RESULTS: Mean age of the patients recruited to the study was 37.4 (18-64) years. Mean BMI was 46 (36-60) kg/m(2). STEAP4 expression in visceral adipose tissue was significantly higher than subcutaneous tissue. Visceral STEAP4 expression was also found to be reduced with increased BMI. It was also lower in patients with HbA1C over 6. Furthermore, expression of subcutaneous and visceral HIF-1α was significantly higher in Group II. There was a significant correlation between BMI, glycosylated hemoglobin, STEAP4 and HIF-1α gene expression. CONCLUSIONS: Obesity and related disease are linked with the fact that there is a low grade inflammation in the adipose tissue of the obese individuals. Counter-regulatory processes such as STEAP4 protein family are overwhelmed by the proinflammatory stimuli. HIF-1α expression is increased due to tissue hypoxia and pro-inflammatory stimuli in the obese individuals, which results in increased visceral STEAP4 expressions.

Prospective evaluation of crural repair with and without double-sided mesh reinforcement.

BACKGROUND: Laparoscopic Nissen fundoplication is gold standard treatment for gastroesophageal reflux disease. We examined the results of laparoscopic Nissen fundoplication with or without double-sided polypropylene mesh. PATIENTS AND METHODS: Sixty patients were prospectively evaluated. Primer cruroraphy and primer cruroraphy with mesh were performed in 31 and 29 patients, respectively. The Gastrointestinal Quality of Life Index (GIQLI) was used for assessment of the patient satisfaction preoperatively and postoperatively at 12 months. RESULTS: Sixty patients were included in the study, with a mean age of 42 years. There was no difference between the 2 groups with respect to age, sex, and duration of symptoms. GIQLI showed an equal improvement, and there were no differences in the quality of life in both the groups. All patients' endoscopic findings were normal at first year. CONCLUSIONS: Laparoscopic Nissen fundoplication appears to prevent reflux and its symptoms and create better quality of life. Double-sided polypropylene mesh for repair may result in better quality of life.

Relationship between LYVE-1, VEGFR-3 and CD44 gene expressions and lymphatic metastasis in gastric cancer.

AIM: To investigate the expression levels of lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1), vascular endothelial growth factor receptor-3 (VEGFR-3) and CD44 genes and the relationship between their levels and clinicopathological parameters in gastric cancer. METHODS: Tissue samples were obtained from 33 patients (8 females) with gastric cancer. mRNA levels of LYVE-1, VEGFR-3 and CD44 in normal and tumor tissues were quantitatively measured using real time polymerase chain reaction. The results were correlated with lymph node metastasis, histological type and differentiation of the tumor, T-stage, and presence of vascular, perineural and lymphatic invasions. The distribution of molecules in the tissue was evaluated using immunohistochemistry. RESULTS: LYVE-1, CD44 and VEGFR-3 gene expression levels were significantly higher in gastric cancer than in normal tissue. While there was no correlation between gene expressions and clinicopathologic features such as histologic type, differentiation and stage, gene expression levels were found to be increased in conjunction with positive lymph node/total lymph node ratio and the presence of perineural invasion. A significant correlation was also found between LYVE-1 and CD44 over-expressions and perineural invasion and lymph node positivity in gastric cancers. When the distribution of LYVE-1 antibody-stained lymphatic vessels in tissue was evaluated, lymphatic vessels were located intra-tumorally in 13% and peri-tumorally in 27% of the patients. Moreover, lymph node metastases were also positive in all patients with LYVE-1-staining. CONCLUSION: LYVE-1, VEGFR-3 and CD44 all play an important role in lymphangiogenesis, invasion and metastasis. LYVE-1 is a perfectly reliable lymphatic vessel marker and useful for immunohistochemistry.

Femoral vessel blood flow dynamics following totally extraperitoneal vs Stoppa procedure in bilateral inguinal hernias.

BACKGROUND: Both totally extraperitoneal (TEP) and open preperitoneal (Stoppa) procedures involve the placement of prosthetic material preperitoneally. Because the prosthetic material overlies the femoral artery and vein, the aim of this study was to assess its effect on the velocities and diameters of the artery and vein using color Doppler ultrasonography in both approaches. METHODS: Sixty-four patients with bilateral groin hernias were prospectively randomized to undergo either TEP (n = 32) or Stoppa (n = 32) repair. All patients underwent color Doppler ultrasound 6 months after the procedures, and the median follow-up period was 18 months. RESULTS: Neither mean diameter nor mean flow velocity was changed by the insertion of the mesh preperitoneally. The only change was observed in peak systolic femoral arterial blood velocity, which was significantly decreased in the Stoppa group. Also, no patient in this study developed clinically significant deep venous thrombosis during 6 months of follow-up. CONCLUSIONS: The insertion of a prosthetic mesh during TEP and Stoppa procedures does not influence the mean peak flow velocities and cross-sectional areas of the vessels in the inguinal region and can be used safely for open and laparoscopic preperitoneal approaches.

Ergonomic problems encountered by the surgical team during video endoscopic surgery.

BACKGROUND: The aim of this study is to analyze the problems related to the ergonomic conditions faced by video endoscopic surgical teams during video endoscopic surgery by means of a questionnaire. METHODS: A questionnaire was distributed to 100 medical personnel, from 8 different disciplines, who performed video endoscopic surgeries. Participants were asked to answer 13 questions related to physical, perceptive, and cognitive problems. RESULTS: Eighty-two questionnaires were returned. Although there were differences among the disciplines, participants assessment of various problems ranged from 32% to 72% owing to poor ergonomic conditions. CONCLUSIONS: As the problems encountered by the staff during video endoscopic surgery and the poor ergonomic conditions of the operating room affect the productivity of the surgical team and the safety and efficiency of the surgery, redesigning of the instruments and the operating room is required.

The effect of erythropoietin on healing of obstructive vs nonobstructive left colonic anastomosis: an experimental study.

BACKGROUND: Anastomotic leakage is an important problem following primary resection in the left colon and is even more prominent when obstruction is present. We aimed to evaluate the possible effects of erythropoietin on the healing of anastomosis under both obstructive and non-obstructive states. METHODS: Forty male Wistar albino rats were divided into four groups. In group I, two cm left colonic resection and primary anastomosis were done. In group II, left colon were completely ligated and 24 hours later animals were re-operated for segmental resection. The same procedures were performed for rats in group III and IV in respect to group I and II and, 500 IU/kg a day erythropoietin were given in the latter two groups for seven days. For the quantative description of anastomotic healing mechanical, biochemical and histopathological parameters were employed on the seventh day and the animals were sacrificied. RESULTS: Although erythropoietin had positive effects on bursting pressure in group IV when compared to group II, it has no effect in group III. Despite the increased tissue hydroxyproline levels in group IV, erythropoietin failed to show any effects in group III. Erythropoietin had positive effects on neovascularization, fibroblast proliferiation and storage of collagen in group IV. CONCLUSION: We failed to find any direct and evident effects of erythropoietin on healing of left colonic anastomosis. On the other hand, erythropoietin might prevent negative effects of obstruction on healing.

Recurrent acute pancreatitis due to a hydatid cyst of the pancreatic head: a case report and review of the literature.

CONTEXT: Primary pancreatic hydatid disease is rare and there have only been a few cases of recurrent acute pancreatitis due to a hydatid cyst of the pancreas. CASE REPORT: We describe a case of recurrent acute pancreatitis in which the definitive diagnosis of hydatid cyst of the pancreatic head was only made during a repeat operation and the patient subsequently underwent total pericystectomy. CONCLUSION: A hydatid cyst of the pancreas is an extremely rare condition but it may be a causative factor for recurrent acute pancreatitis, especially in endemic areas. In this case, pericystectomy might be the procedure of choice in order to release the pressure.

Diagnostic value of blood D-dimer level in acute mesenteric ischaemia in the rat: an experimental study.

OBJECTIVE: The high mortality rate of mesenteric ischaemia is mainly due to delay in diagnosis. For this reason, it is of great importance to find a specific and rapidly elevating marker. The present study investigated the diagnostic value of blood D-dimer level as a potential marker for acute mesenteric ischaemia in a rat model. METHODS: Thirty male Wistar albino rats were divided into three groups. Basal D-dimer and L-lactate levels were determined in the non-operative control group (I). In the operated control group (II), the superior mesenteric artery was simply manipulated, while the artery was ligated in Group III. Blood samples were drawn in all groups for D-dimer and L-lactate assays. RESULTS: Both Group II (p=0.016) and Group III (p=0.001) had significantly higher mean D-dimer levels in the first postoperative hour compared with the basal level in Group I. However, there was no difference between the levels in Groups II and III. The mean level in Group II in the sixth hour had dropped to a statistically insignificant level compared with the basal value, while the mean value in Group III kept rising during this period (p=0.001). Nevertheless, there was no significant difference between Groups II and III. On the other hand, the mean L-lactate level in the first postoperative hour in Group III was significantly higher than the basal level in Group I (p=0.003). No significant rises were recorded in Group II in the first and sixth postoperative hours. The difference between Groups II and III in the first hour was significant (p=0.005). Group III also had significantly higher mean serum L-lactate value in the sixth hour compared with both the basal value in Group I (p=0.001) and the sixth-hour value in Group II (p=0.003). CONCLUSION: These results do not adequately support the use of blood D-dimer level as an independent parameter in the diagnosis of mesenteric ischaemia due to arterial thrombosis. However, this parameter can be used together with other tests in eliminating the possibility of a thromboembolic event.

An unusual presentation of metastatic gastric cancer found during inguinal hernia repair: case report and review of the literature.

Inguinal hernia and intra-abdominal malignancies can coexist, and rarely the hernial sac provides the first evidence of primary or metastatic cancer. Tumors in the hernial sac occur in fewer than 0.5% of all surgically excised sacs. We report a case of metastatic gastric cancer in the inguinal hernial sac confirmed by histopathological examination. Postoperative investigations revealed an adenocarcinoma in gastric corpus. The case is discussed based on the English-language literature.