Splanchnic vein thrombosis following renal transplantation: a case report

BACKGROUND: Recurrent episodes of venous thrombosis have been closely correlated with JAK2 V617F mutation. Upto date, JAK2 gene mutation has not been defined as a prothrombic risk factor in renal transplant recipients. Herein; we present a case of portosplenic vein thrombosis in a primary renal transplant recipient with JAK2 V617F mutation who had no history of prior venous thromboembolism or thrombophilia. CASE PRESENTATION: A 59 year old female caucasian patient with primary kidney transplant admitted with vague abdominal pain at left upper quadrant. Abdominal doppler ultrasound and magnetic resonance imaging angiography demonstrated splanchnic vein thrombosis (SVT). The final diagnosis was SVT due to MPD (essential thrombocytosis, ET) with JAK2 V617F mutation. After 3 months of treatment with warfarin (≥5 mg/day, to keep target INR values of 1.9-2.5), control MRI angiography and doppler USG demonstrated partial (>%50) resolution of thrombosis with recanalization of hepatopedal venous flow. The patient is still on the same treatment protocol without any complication. CONCLUSION: JAK2 V617F mutation analysis should be a routine procedure in the diagnosis and treatment of kidney transplant patients with thrombosis in uncommon sites

Phyllodes Tumor of Anogenital Mammary-like Glands with Diffuse Pseudoangiomatous Stromal Hyperplasia

Anogenital mammary-like glands may give rise to various pathologic lesions identical to those known in mammary pathology. Tumor occurring in the anogenital region is extremely rare. The histogenetic origin of this tumor is controversial as it is being debated whether such lesions evolve from ectopic breast tissue and most recently, anogenital mammary-like gland. We report a 28-year-old girl who presented with a painless mass in the anogenital region, which was subsequently excised. Microscopic examination revealed morphologic pattern characteristic of benign phyllodes tumor with pseudoangiomatous stromal hyperplasia. We present this case to emphasize the importance of recognizing this uncommon lesion occurring at an extremely unusual site. We also discuss the histogenesis of phyllodes tumor and related lesions occurring in the anogenital region in light of the current literature along with a brief review of the previously reported cases of anogenital mammary-like glands

Breast cancer and smoking: A comparison of 955 breast cancer patients according to their smoking status

Aim and objective Smoking is among the risk factors of breast cancer. The aim of this study was to compare breast cancer patients’ characteristics according to their smoking status. Methods This study is a retrospective evaluation of all breast cancer patients treated at the General Surgery Department of University of Health Sciences, Izmir Bozyaka Research and Training Hospital, between 1982 and 2018. A total of 1459 breast cancer patients’ charts were reviewed and 955 contained data on smoking and were included in this study. There patients were classified as ever versus never smokers. Pack-years data was available for 32.3% or ever smokers. Chi square, t test, Spearman’s correlation, Kaplan Meierand Cox Regression were used for analyses. Results Among the 955 breast cancer patients, 30.5% (n=291) were ever- and 69.5% (n=664) never smokers. According to years of diagnosis, the ratio of smokers was significantly increasing with 21.6% before 2000, 21.9% in 2000-2004, 31.1% in 2005-2009, 32.1% in 2010-2014 and 41.5% in 2015-2018 (p trend <0.001). Ever smokers were diagnosed at a younger age (49.9±11.8 vs.54.1±13.5, p<0.001). This was not confounded by year of diagnosis, since age at diagnosis significantly increased with increasing year of diagnosis (r=0.161, p<0.001). ER positivity was higher among ever smokers (70.5% vs.63.2%, p=0.040) and with significant changes according to pack-year groups.No difference was found in PR positivity, mean CEA, ER%, PR%, p53%, Ki67% values and number of positive sentinel or axillary lymph nodes of ever and never smokers, while the mean CA15-3 values were significantly lower among ever smokers (17.4±10.1 vs.24.5±27.8, p<0.001). Never smokers had a higher ratio of metastasis overall (19.5% vs.13.7%, p=0.040) and among sites, of bone metastasis (12.7% vs.6.8%, p=0.039). After adjustment for age at diagnosis, there was no significant difference in mean overall survival of ever and never smokers. Conclusions Among breast cancer patients, ever smokers are diagnosed at a younger age compared to never smokers. More detailed evaluations could provide deeper insight in smoking-induced breast cancer

Total Thyroidectomy for the Treatment of Recurrent Graves' Disease With Ophthalmopathy

Objective: To determine the outcome of recurrent Graves’ disease with ophthalmopathy (GO) following bilateral total thyroidectomy (TT) in patients with no history of anti-inflammatory treatment with steroids or radioactive iodine treatment. Methods: From May 2002 to August 2005, 35 patients (27 female, 8 male) with different stages of Graves’ disease underwent TT. The degree of ophthalmopathy was assessed by the NOSPECS scoring system and thyrotropin receptor antibody (TRAb) levels were measured for the detection of thyroidal and retro-orbital inflammatory activity before and after surgery. Results: The mean duration of thyroid disease was 21.4 months and mean follow-up was 422 days. Significant improvement, which was defined as complete regression of periorbital oedema accompanied by a > 1 point decrease in NOSPECS, was observed in 30 (85%) patients. The remaining five patients had stable eye disease. The mean TRAb value and NOSPECS score before and after TT were 33.8 U/L versus 3.4 U/L and 3.0 versus 1.52, respectively, and the differences were statistically significant (p < 0.0000). A major reduction in TRAb values achieved after TT was clearly indicative of undetectable inflammatory activity and all the patients demonstrated negative TRAb values within 6 months of the operation. TT was accomplished with very low morbidity (3%) and provided a significant reduction in TRAb levels with attendant improvement in GO in the vast majority of patients in this study. Conclusion: TT resulted in a significant reduction in TRAb levels with concomitant regression of recurrent GO in all patients. The operative morbidity was very low and mortality was nil. However, the long-term consequences of permanent hypothyroidism, which is the ultimate result of TT, are of major concern

Non-Gynecologic and Gynecologic Laparoscopic Surgery During Pregnancy

With the popularity of minimally invasive procedures in the last two decades, laparoscopy has been performed for gynecologic and non-gynecologic conditions during pregnancy. In spite of the fact that laparoscopic approach provides some advantages such as less post operative discomfort; many potantial risks including uterine and fetal injury, decreased uterine blood flow due to increased intraabdominal pressure and carbon dioxide absorption can take place during laparoscopy. This review evaluates the literature for laparoscopic surgery during pregnancy

Adjuvant versus neoadjuvant chemoradiotherapy in distal rectal cancer: Comparison of two decades in a single center

Objective: Standard surgery alone was not able to decrease local recurrence (LR) rate below 20% in rectal cancer treatment. Thus, many centers administered neoadjuvant radiotherapy (preopRTx) with or without concomitant chemotherapy for the prevention of LR. in this study, the results of 164 consecutive patients with mid- and distal rectal cancer who received surgery and adjuvant chemoradiotherapy (Group A) or neoadjuvant chemoradiotherapy (Group NA) followed by surgery are presented.Material and Methods: the staging system used in this study is that of the American Joint Committee on Cancer (AJCC), also known as the TNM system. Eligible patients were required to have radiologically assessed stage 1 (only T2N0M0) to stage 3C (T4bN1-2M0) tumor with pathologically confirmed R0 resection. the surgical method was total mesorectal excision (TME). Radiotherapy was applied with daily 180 cGy fractions for 28 consecutive days. Chemotherapy comprised 5-fluorouracil (450 mg/m2/d) and leucovorin (20 mg/m2/d) bolus at days 1-5 and 29-33.Results: Nine patients (13%) in Group NA achieved pathologic complete response (pCR). in Group NA and Group A, locoregional recurrence (LRR) rates were 6.7% and 30.8%, (p;lt;0.001), the mean LR-free survival was 190.0±7.3 months and 148.0±11.7 months (p=0.002) and the mean overall survival (OS) was 119.2±15.3 months and 103.0±9.4 months (p=0.23), respectively. A significant difference with regard to LR has been obtained with a statistical power of 0.92. Secondary outcome measures (DFS and OS) have not been met.Conclusion: Neoadjuvant chemoradiotherapy with TME is an efficient treatment protocol, particularly for the treatment of magnetic resonance imaging-staged 2A to 3C patients with two or three distal rectal adenocarcinomas. Given that a considerable proportion of patients with cT2N0M0 would develop pCR, this method of treatment can be considered for further studiesAmaç: Rektum kanserinin tedavisinde tek başına standart cerrahi tedavi lokal rekürrens oranını %20'nin altına düşürememektedir. Bu nedenle birçok merkez lokal rekürrensi önlemek için eşzamanlı kemoterapiyle birlikte veya tek başına neoadjuvan radyoterapi (preop RTx) uygulamaktadır. Bu çalışmada, cerrahi ardından adjuvan kemoradyoterapi (Grup A) alan ve neoadjuvan kemoradyoterapiyi takiben cerrahi uygulanan (Grup NA) orta ve distal rektum kanserli 164 ardışık hastanın sonuçlarını sunduk. Gereç ve Yöntemler: Bu çalışmada TNM evreleme sistemi olarak bilinen Amerikan Kanser Ortak Komitesi'nin (AJCC) evreleme sistemi kullanıldı. Radyolojik evre 1 (sadece T2N0M0) ile evre 3C (T4bN1-2M0) olarak değerlendirilen ve patolojik olarak R0 rezeksiyon uygulanan hastalar çalışmaya alındı. Cerrahi yöntem olarak total mezorektal eksizyon (TME) uygulandı. Radyoterapi günlük fraksiyone 180 cGy dozda 28 ardışık günde verildi. Kemoterapi; 5-fluorourasil (450 mg/m2/d) ve leucovorin (20 mg/m2/d) bolus olarak 1 ile 5. günler arası ve 29 ile 33. günler arası uygulandı.Bulgular: Grup NA'da 9 hastada (%13) patolojik tam yanıt (pCR) elde edildi. Grup NA ve Grup A'da, lokorejyonel rekürrens oranları sırasıyla %6,7 ve %30,8 idi (p0,001), ortalama lokorejyonel rekürrenssiz sağkalım sırasıyla 190,0±7,3 ay ve 148,0±11,7 ay idi (p=0,002) ve ortalama sağkalım sırasıyla 119,2±15,3 ay ve 103,0±9,4 ay idi (p=0,23). Lokorejyonel rekürrens yönünden 0,92 istatistiksel güç ile anlamlılık elde edildi. Çalışmanın sekonder sonlanımı olan hastalıksız sağkalım ve genel sağkalım yönünden anlamlı bir fark bulunmadı. Sonuç: Neoadjuvan kemoradiyoterapi ile birlikte TME, özellikle MRI-Evre 2A ve 3C distal 2/3 rektal adenokarsinomalar için etkili bir tedavi protokolüdür. Klinik olarak T2N0M0 hastaların önemli bir bölümünde patolojik tam yanıt elde edildi, bu nedenle bu tedavi yöntemi daha ileri çalışmalar için temel oluşturabili

Hepatitis B and C Seroprevalence in Solid Tumors - Necessity for Screening During Chemotherapy

Background: Hepatitis B and C are the leading causes of liver diseases worldwide. For hematological and solid malignancy patients undergoing chemotherapy, increases in HBV DNA and HCV RNA levels can be detected which may result in reactivation and hepatitis-related morbidity and mortality. The aim of this study was to determine the seroprevalence of Hbs ag and Anti HCV positivity in patients with solid malignancies undergoing chemotherapy and consequences during follow-up. Materials and Methods: The files of 914 patients with solid malignancies whose hepatitis markers were determined serologically at diagnosis were reviewed retrospectively. All underwent adjuvant/palliative chemotherapy. For the cases with HBV and/or HCV positivity, HBV DNA and HCV RNA levels, liver function tests at diagnosis and during follow-up and the treatment modalities that were chosen were determined. Results: Of 914 cases, Hbs Ag, anti Hbs and anti HCV positivity were detected in 40 (4.4%), 336 (36.8%) and 26 (2.8%) of the cases respectively. All of the Hbs ag positive patients received prophylactic lamuvidine before the start of chemotherapy. In the Hbs ag and anti HCV positive cases, liver failure was not detected during chemotherapy and a delay in chemotherapy courses because of hepatitis was not encountered. Conclusions: Just as with hematological malignancies, screening for HBV and HCV should also be considered for patients with solid tumors undergoing chemotherapy. Prophylactic antiviral therapy for HBV reduces both the reactivation rates and HBV related mortality and morbidity. The clinical impact of HCV infection on patients undergoing chemotherapy is still not well characterized

General status of cucurbit genetic resources in Turkey

AbstractTurkey is very rich in cucurbit genetic resources due to its diverse geographicaland ecological situation. Turkey is one of the important diversity centers forcultivated cucurbits because of the adaptation to diverse ecological conditions asresult of natural selection and also the farmers selection in accordance with theirpreference.National collection of Cucurbitaceae species at National Gene Bank of Turkey(AARI) consists of 2223 accessions. Collecting activities have been systematicallyconducted since early 1960s. 25.7 % of this amount is melon, 20.5 % is Cucurbitaspp., 16.1 % is watermelon, 13.4 % is cucumber, 7.7 % is bottle gourd, 7.2 % issquash, 4.2 % is winter squash, 3.3 % is snake melon, 1.3 % is pumpkin, 0.3 % isother cucumbers, 0.2 % squirting cucumber and 0.1 % of bryony.Melon and watermelon genetic resources collections and their morphologicaland molecular characterization trials were done in Çukurova University andapproximately 400 melon and 355 watermelon accessions were collected. Squash andpumpkin studies were done in Ondokuz Mayıs and Ankara University and 128 wintersquash, 40 pumpkin populations and 20 snack seed squash were collected andcharacterized. Selected pumpkins also were characterized molecularly. Bottle gourdcharacterization trials were done in Mustafa Kemal University and 188 accessionswere characterized. Snake melon research activities were conducted at Ankara andÇukurova Universities and 62 accessions were characterized. The evaluation andbreeding programs of these genetic resources are ongoing

Adjuvant versus neoadjuvant chemoradiotherapy in distal rectal cancer: Comparison of two decades in a single center

WOS: 000370846700008PubMed ID: 26668530Objective: Standard surgery alone was not able to decrease local recurrence (LR) rate below 20% in rectal cancer treatment. Thus, many centers administered neoadjuvant radiotherapy (preopRTx) with or without concomitant chemotherapy for the prevention of LR. In this study, the results of 164 consecutive patients with mid-and distal rectal cancer who received surgery and adjuvant chemoradiotherapy (Group A) or neoadjuvant chemoradiotherapy (Group NA) followed by surgery are presented. Material and Methods: The staging system used in this study is that of the American Joint Committee on Cancer (AJCC), also known as the TNM system. Eligible patients were required to have radiologically assessed stage 1 (only T2N0M0) to stage 3C (T4bN1-2M0) tumor with pathologically confirmed R0 resection. The surgical method was total mesorectal excision (TME). Radiotherapy was applied with daily 180 cGy fractions for 28 consecutive days. Chemotherapy comprised 5-fluorouracil (450 mg/m(2)/d) and leucovorin (20 mg/m(2)/d) bolus at days 1-5 and 29-33. Results: Nine patients (13%) in Group NA achieved pathologic complete response (pCR). In Group NA and Group A, lo-coregional recurrence (LRR) rates were 6.7% and 30.8%, (p<0.001), the mean LR-free survival was 190.0 +/- 7.3 months and 148.0 +/- 11.7 months (p=0.002) and the mean overall survival (OS) was 119.2 +/- 15.3 months and 103.0 +/- 9.4 months (p=0.23), respectively. A significant difference with regard to LR has been obtained with a statistical power of 0.92. Secondary outcome measures (DFS and OS) have not been met. Conclusion: Neoadjuvant chemoradiotherapy with TME is an efficient treatment protocol, particularly for the treatment of magnetic resonance imaging-staged 2A to 3C patients with two or three distal rectal adenocarcinomas. Given that a considerable proportion of patients with cT2N0M0 would develop pCR, this method of treatment can be considered for further studies