Characterization and conceptualization of a relict Karst aquifer (Bilecik, Turkey)

The carbonate rocks in Turkey have different hydrogeological properties as a result of controlling karstification factors, such as lithostratigraphy, source of energy gradient, tectonic activity, type of erosion base, fluctuation in sea level, and climate change in their extended areas. This study was undertaken for the characterization and conceptualization of the hydrogeological behavior of a unique example of the dissected relict karst aquifer, which is known as the Harmanköy-Beyyayla Karst System (HBKS) in Central Turkey. In order to obtain the conceptualization of the HBKS, properties of recharge, flow, storage, and discharge was analyzed. The contribution of allogenic-point recharge to the Beyyayla and Döşkaya aquifers occurs from the Beyyayla and Tozman sinkhole with approximately 85% of total recharge. The rest of the recharge takes place as autogenic-diffuse/point type from the limestone rock-mass. The recharge on the Nardın aquifer originates from direct precipitation onto the limestone area mainly as autogenic-diffuse and, to lesser extent, as autogenic-point. Groundwater flow occurs as conduit flow at the Beyyayla and Döşkaya aquifers and as dispersed flow at the Nardın aquifer. The evaluation of all parameters shows that the HBKS can be divided into three distinct sub-catchments, namely, the Beyyayla, Döşkaya, and Nardın, while it has two different hydrogeological system so Beyyayla and Döşkaya have similar characteristics

TURKISH JOURNAL of ONCOLOGY Leptomeningeal Carcinomatosis in a Krukenberg Tumor Associated with Signet Ring Cell Gastric Cancer

SUMMARY Leptomeningeal carcinomatosis (LCM) is a rare complication of gastric cancer. It usually occurs late in advanced stage of disease and is sometimes misdiagnosed as toxicity of chemotherapeutic agents. Here we report a rare case of gastric cancer that developed LCM in follow-up. A 28-year-old woman with signet ring cell gastric cancer associated with Krukenberg tumor was admitted with persistent headache, nausea, vomiting, vertigo, and diplopia. Linear appearance of contrast enhancement in cerebellar fissures and around cranial nerves was seen in magnetic resonance imaging and cerebrospinal fluid was hypercellular with numerous carcinoma cells. LMC was confirmed and treated with intrathecal methotrexate and additional whole-brain irradiation. LCM is a rare complication, but occurs more often than expected and is often misdiagnosed. If patient who is being treated for gastric cancer presents with neurological symptoms, LCM should be kept in mind. Clinical improvement can be achieved with current treatment modalities, including radiotherapy, chemotherapy, or targeted molecules

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Recovery of Escherichia coli O157 from hamburgers: Evaluation and comparison of direct plating and immunomagnetic separation (IMS) in combination with various enrichment procedures

Escherichia coli O157 is one of the most common vehicles of foodborne outbreaks. Sensitive detection procedures are necessary to determine the small numbers of microorganisms in the sample because the infective dose of this agent is very low. In this study, the efficiency of two different enrichment media and two different incubation periods, besides the comparison of the sensitivity of direct plating method and immunomagnetic separation (IMS) were investigated for determining the most suitable method for isolating low count E coli O157 from raw hamburger samples. Enrichment in Buffered Peptone Water (BPW) and mBPW for either 6 or 18 hours was performed for experimentally contaminated samples with three different inoculation levels of E coli O157. Isolation was carried out both directly after the enrichment and after IMS application. The results of this study indicated that performing IMS improved the sensitivity of the isolation procedure significantly. 1 cfu/25 g E coli O157 can easily be isolated with this method. The enrichment procedure has an important effect on the sensitivity of the isolation. Using selective enrichment broth decreased the sensitivity compared to nonselective broth