Obesity and Bariatric Surgery awareness in the Kocaeli province, a leading industrial city in Turkey.

OBJECTIVES: An increase in the prevelance of obesity is a worldwide problem. It many serious health problems, especially cardiovascular diseases and type-2 diabetes mellitus. Conservative therapies such as diet modification and exercise are the most preferable obesity treatments. Bariatric surgery is the most appropriate treatment in suitable patients. Several studies showed that a very low number of patients prefer bariatric surgery even though it would be appropriate. This study aimed to assess and raise awareness about the obesity level, its complications, and treatment methods, especially bariatric surgery among obese patients in Kocaeli, which is one of the most socio-economically developed cities, as well as the leading industrial city in Turkey. MATERIAL AND METHODS: A survey was designed to assess the knowledge about obesity, its complications, and bariatric surgery in the Kocaeli province. It was administered to 232 adult patients with a body mass index greater than 30 in different outpatient clinics where patients suffering obesity were treated. RESULTS: It has been seen that although the contribution factors and complications of obesity are well known, awareness of the body mass index was insufficient. Most of patients have tried to lose weight at least once and most patients have heard of bariatric surgery before. However, the details were not well known. The gastric band method is the most known method, and the most known risk of surgery was death. The main source of knowledge about bariatric surgery was television. The increasing body mass index affects patients' attitudes toward the surgery positively. CONCLUSION: Knowledge of bariatric surgery is inadequate in the Kocaeli province, which is one of the most socio-economically developed cities, as well as the leading industrial city in Turkey. More social responsibility projects and more objective elucidating via television and social media are also needed to increase the awareness of bariatric surgery.

Association of the nibrin gene (NBN) variants with breast cancer.

Nibrin, encoded by the NBN gene, participates in DNA repair. Mutations in the NBN gene lead to Nijemen breakage syndrome, which may result in several types of diseases, particularly susceptibility to cancer, including breast cancer. Polymorphic variants and defective mutations occurring in the NBN gene increase the risk of breast cancer through the double-stranded break repair mechanism. The aim of the present study was to investigate a possible association between breast cancer and NBN genetic variants, NBN 924 T>C, 8360 G>C and 30537 G>C, in women with breast cancer. Locus-specific primers were designed to study 3 genetic variants in DNA samples isolated from peripheral blood samples of 101 women with breast cancer and 115 healthy controls. Subsequently, 3 polymerase chain reaction-restriction fragment length polymorphism methods were performed and the obtained results were statistically analysed. The NBN gene 924 T>C variant was found to be significantly associated with breast cancer (χ2=5.722, P=0.017). There were no statistically significant differences between cases and controls in the NBN gene 8360 G>C variant (χ2=1,125, P=0.570) or the NBN gene 30537 G>C variant (χ2=4.301, P=0.116). In conclusion, the NBN gene 924 T>C variant may be a genetic risk factor for breast cancer development in women with breast cancer.

Evaluation of relationship between serum lipids levels with colorectal carcinoma: a single center prospective case control study.

BACKGROUND/AIMS: To evaluate association of serum lipids and fasting plasma glucose levels with colorectal cancer. METHODOLOGY: This prospective case control study was conducted with 347 patients with colorectal carcinoma and 310 age and gender matched healthy controls who were examined for annual check-up. Total cholesterol, serum lipids and fasting glucose levels were measured in both groups. Body weight and body mass indices were also evaluated. RESULTS: The mean serum cholesterol level was 167.4 +/- 43.6 mg/dL for patients with colorectal cancer and 210.1 +/- 30.7 mg/dL for controls. The mean fasting plasma glucose levels for both groups were respectively 107.7 +/- 22.4 and 90.2 +/- 10.3. Between the colorectal cancer and control groups, there was a statistically significant difference in fasting plasma glucose and serum lipid levels except LDL-C. Serum total cholesterol level was even lower in advanced stages of cancer. CONCLUSIONS: Our study suggests that there is an inverse association between low serum total cholesterol levels and colorectal cancer. Since cholesterol levels were lower in the advanced stages of colorectal cancer it is possible that low levels of serum cholesterol levels were a consequence of colorectal cancer. The association with hypertriglyceridemia and high fasting plasma glucose levels suggest the role of hyperinsulinemia in colorectal carcinogenesis.

Use of inferior gluteal artery and posterior thigh perforators in management of ischial pressure sores with limited donor sites for flap coverage.

BACKGROUND: Reconstructive surgery for ischial pressure sore defects presents a challenge because of high rates of recurrence. The aim of this study was to describe the use of inferior gluteal artery (IGA) and posterior thigh perforators in management of ischial pressure sores with limited donor sites. PATIENTS AND METHOD: Between September 2005 and 2009, 11 patients (9 male, 2 female) with ischial sores were operated by using IGA and posterior thigh perforator flaps. The data of patients included age, sex, cause of paraplegia, flap size, perforator of flap, previous surgeries, recurrences, complications, and postoperative follow-up. RESULTS: Nine IGA and 5 posterior thigh perforator flaps were used. Six patients presented with recurrent lesions, 5 patients were operated for sacral and contralateral ischial pressure sores previously. In 2 patients, IGA and posterior thigh perforator flaps were used in combination. Patients were followed for an average of 34.3 months. In 2 recurrent cases, readvancement of IGA perforator flap and gluteus maximus myocutaneous flap were treatment of choice. CONCLUSION: Treatment of patients with recurrent lesions or multiple pressure sores is challenging because of limited available flap donor sites. In this study, posterior thigh perforator flaps were preferred in patients in whom the previous donor site was the gluteal region. IGA perforator flaps were the treatment of choice in patients for whom posterior thigh region was previously used. Alternately, preserved perforators of previous conventional myocutaneous flaps enabled us to use these perforators in recurrences.

Superior and inferior gluteal artery perforator flaps in reconstruction of gluteal and perianal/perineal hidradenitis suppurativa lesions.

BACKGROUND: Hidradenitis suppurativa is a debilitating disease with a tendency to form abscesses, sinus tracts, and scar formation. In this report, our experience with reconstruction of hidradenitis lesions of the gluteal and perianal/perineal area using superior and inferior gluteal artery perforator flaps (SGAP and IGAP) are discussed. PATIENTS: A prospective study was conducted in collaboration with the general surgery department for patients with gluteal and perianal/perineal hidradenitis suppurativa between December 2005 and May 2010. Data of each patient included age, sex, disease localization, duration of symptoms, comorbidities, size of defect after excision, perforator flap chosen, complications, and postoperative follow-up. RESULTS: Eleven SGAP and six IGAP flaps were used in 12 patients with gluteal and perianal/perineal involvement. There was one flap necrosis for whom delayed skin grafting was performed. The mean follow-up period was 20 months without recurrences. CONCLUSION: Patients with gluteal and perineal/perianal hidradenitis suppurativa are usually neglected by surgeons because of lack of collaboration of general and plastic surgery departments. Most surgical treatment options described in the literature such as secondary healing after excision and skin grafting prevent patients from returning to daily life early, and cause additional morbidities. Fasciocutaneous flaps other than perforator flaps may be limited by design such that both gluteal regions may have to be used for reconstruction of large defects. SGAP and IGAP flaps have long pedicles with a wide arc of rotation. Large defects can be reconstructed with single propeller flap designs, enabling preservation of the rest of the perforators of the gluteal region.