Unusual Presentation of Meckel’s Diverticulum: Gangrene due to Axial Torsion

Meckel’s diverticulum is the most common congenital anomaly of the small bowel. The majority of cases are asymptomatic; however, life-threatening complications can also take place. We present a case of a 37-year-old male who was admitted with symptoms of acute, severe abdominal pain in the right iliac fossa. The patient was operated on with the preoperative diagnosis of acute appendicitis but the operative findings were consistent with torted Meckel’s diverticulum due to presence of mesodiverticular band and he was treated successfully with surgical resection

The Effect of Lymph Node Dissection on Gallstone Formation in Patients Undergoing Total Gastrectomy for Gastric Adenocarcinoma

WOS: 000485683800007Objective: Formation of gallbladder stone is frequently observed after resection for gastric cancer. Extended lymph dissection is shown to be among risk factors. Materials and Methods: We compared patients with limited lymphatic dissection (D1) and extended lymphatic dissection (D2) in terms of gallstone formation and complications. Results: We observed gallbladder stone formation in 13 (12.8%) patients. Gallbladder stone formation was observed in 11.1% of patients in the D1 group and in 14.3% of patients in the D2 group, but no statistically significant difference was found between lymphatic dissections. Of 13 patients, 5 (38.4%) were symptomatic and 3 (23.1%) developed choledocholithiasis. Five patients who were symptomatic were operated without any problems. The groups did not show a statistically significant difference in terms of cumulative survival times. While patients who underwent D2 dissection had more formed gallbladder stone, there were no significant differences between the groups. Conclusion: The complications related to gallbladder stone developed after gastrectomy can be safely managed

Should tall cell thyroid cancers be evaluated differently from well-differentiated thyroid cancers?

OBJECTIVE: In this study, we aimed to investigate the clinical features of Papillary thyroid carcinoma(PTC) Tall cell variant(TCV), long-term outcomes and surgical experience in papillary thyroid carcinoma

Sekonder peritonitte prokalsitonin, CRP ve tiroit hormonlarının prognostik değeri; ileriye yönelik çalışma

AMAÇ: Enfeksiyon ve sepsis, sekonder peritonitli hastalarda morbidite ve mortalitenin en önemli sebeplerinden biri olmaya devam etmektedir. Klinisyenler helen septik komplikasyonların erken ve güvenilir tanı yöntemini bulma konusunda çaba sarfetmektedir. Bu çalışmada sekonder peritonitin şiddetini belirlemede enflamatuvar markır olarak Prokalsitonin (PKT), C-reaktif protein (CRP) ve tiroit hormonlarının yerini değerlendirmeyi amaçladık. GEREÇ VE YÖNTEM: Ocak 2008-Ocak 2010 tarihleri arasında, sekonder peritonit nedeniyle ameliyat olan 84 ardışık hasta üzerinde ameliyat öncesi ve sonrası 1-3-5-7-14. günlerde PKT, CRP ve tiroit hormaon seviyeleri incelendi. Veriler Statistical Package for Social Sciences 15.0 (SPSS 15.0) programında analiz edildi. BULGULAR: Organ perforasyonu (peptik ülserperforasyonu, ince bağırsak ve kolon perforasyonu) olan olgular değerlendirildiğinde, PKT anlamlı olarak düşük seyretti. Ameliyat sonrası komplikasyonu olan veya ölen hastalara göre ameliyat sonrası dönemi sorunsuz olan veya taburcu olan hastalarada yüksek tiroit hormon düzeyler gözlendi. PKT düzeyleri ise CRP düzeylerleri ve beyaz küre sayısıyla anlamalı olarak ilişkili bulundu. TARTIŞMA: Ameliyat sonrası komplikasyonların yokluğunda PKT, sekonder peritonit tanısında CRP'den daha iyi bir belirliyicidir. Çalışmamız sekonder peritonitin şiddetini belirlemede düşük tiroit hormon düzeylerinin önemli bir prognostik faktör olduğunu ortaya koymuştur.AMAÇ: Enfeksiyon ve sepsis, sekonder peritonitli hastalarda morbidite ve mortalitenin en önemli sebeplerinden biri olmaya devam etmektedir. Klinisyenler helen septik komplikasyonların erken ve güvenilir tanı yöntemini bulma konusunda çaba sarfetmektedir. Bu çalışmada sekonder peritonitin şiddetini belirlemede enflamatuvar markır olarak Prokalsitonin (PKT), C-reaktif protein (CRP) ve tiroit hormonlarının yerini değerlendirmeyi amaçladık. GEREÇ VE YÖNTEM: Ocak 2008-Ocak 2010 tarihleri arasında, sekonder peritonit nedeniyle ameliyat olan 84 ardışık hasta üzerinde ameliyat öncesi ve sonrası 1-3-5-7-14. günlerde PKT, CRP ve tiroit hormaon seviyeleri incelendi. Veriler Statistical Package for Social Sciences 15.0 (SPSS 15.0) programında analiz edildi. BULGULAR: Organ perforasyonu (peptik ülserperforasyonu, ince bağırsak ve kolon perforasyonu) olan olgular değerlendirildiğinde, PKT anlamlı olarak düşük seyretti. Ameliyat sonrası komplikasyonu olan veya ölen hastalara göre ameliyat sonrası dönemi sorunsuz olan veya taburcu olan hastalarada yüksek tiroit hormon düzeyler gözlendi. PKT düzeyleri ise CRP düzeylerleri ve beyaz küre sayısıyla anlamalı olarak ilişkili bulundu. TARTIŞMA: Ameliyat sonrası komplikasyonların yokluğunda PKT, sekonder peritonit tanısında CRP’den daha iyi bir belirliyicidir. Çalışmamız sekonder peritonitin şiddetini belirlemede düşük tiroit hormon düzeylerinin önemli bir prognostik faktör olduğunu ortaya koymuştur

Long-term Outcomes of Surgical Management of Insulinoma: Single Center Experience

Objective: Limited data are available in regards to the surgical management and outcomes of insulinoma. This study aimed to assess the outcomes associated with surgical treatment of insulinoma, as the most common pancreatic endocrine tumor. Methods: Medical records of patients who diagnosed as insulinoma from 2000 to 2010 at General Surgery Department of Cukurova University Hospital were retrospectively reviewed. Surgical treatment (resection vs. enucleation) was based on preoperative radiological investigations (abdominal spiral contrast tomography, ultrasound, selective angiography for selected cases) and intra-operative ultrasound imaging once indicated. Results: Surgically treated thirteen patients (F/M:9/4) who diagnosed with insulinoma were assessed with a mean follow-up of 5.3 (0.5-10) years. Enucleation and distal pancreatectomywere performed for 11 and 2 (one of those is spleen-preserving) patients, respectively. No mortality was recorded. All patients became normoglycemic after surgery without re-operation and with acceptable complication rates (n=3 pancreatic fistula, n=1 pancreatitis). Conclusion: Surgical treatment of insulinoma is associated with favorable outcomes.Intra-operative ultrasound with manual palpation is still the gold standard for localizing insulinoma. Location, size and relationship with main pancreatic duct of the lesions are key components for the selection of optimal surgical procedure

Tumor-derived CTF1 (cardiotrophin 1) is a critical mediator of stroma-assisted and autophagy-dependent breast cancer cell migration, invasion and metastasis

Macroautophagy/autophagy is an evolutionarily conserved cellular stress response mechanism. Autophagy induction in the tumor microenvironment (stroma) has been shown to support tumor metabolism. However, cancer cell-derived secreted factors that initiate communication with surrounding cells and stimulate autophagy in the tumor microenvironment are not fully documented. We identified CTF1/CT-1 (cardiotrophin 1) as an activator of autophagy in fibroblasts and breast cancer-derived carcinoma-associated fibroblasts (CAFs). We showed that CTF1 stimulated phosphorylation and nuclear translocation of STAT3, initiating transcriptional activation of key autophagy proteins. Additionally, following CTF1 treatment, AMPK and ULK1 activation was observed. We provided evidence that autophagy was important for CTF1-dependent ACTA2/alpha-SMA accumulation, stress fiber formation and fibroblast activation. Moreover, promotion of breast cancer cell migration and invasion by activated fibroblasts depended on CTF1 and autophagy. Analysis of the expression levels of CTF1 in patient-derived breast cancer samples led us to establish a correlation between CTF1 expression and autophagy in the tumor stroma. In line with our in vitro data on cancer migration and invasion, higher levels of CTF1 expression in breast tumors was significantly associated with lymph node metastasis in patients. Therefore, CTF1 is an important mediator of tumor-stroma interactions, fibroblast activation and cancer metastasis, and autophagy plays a key role in all these cancer-related events

A Multicenter Study of Genotype Variation/Demographic Patterns in 2475 Individuals Including 1444 Cases With Breast Cancer in Turkey

Objective: Breast cancer (BC) is the most common cancer type in women and may be inherited, mostly in an autosomal dominant pattern. The clinical diagnosis of BC relies on the published diagnostic criteria, and analysis of two genes, BRCA1 and BRCA2, which are strongly associated with BC, are included in these criteria. The aim of this study was to compare BC index cases with non-BC individuals in terms of genotype and diagnostic features to investigate the genotype/demographic information association. Materials and Methods: Mutational analyses for the BRCA1/BRCA2 genes was performed in 2475 individuals between 2013-2022 from collaborative centers across Turkey, of whom 1444 with BC were designated as index cases. Results: Overall, mutations were identified in 17% (421/2475), while the percentage of mutation carriers in cases of BC was similar, 16.6% (239/1444). BRCA1/BRCA2 gene mutations were detected in 17.8% (131/737) of familial cases and 12% (78/549) of sporadic cases. Mutations in BRCA1 were found in 4.9%, whereas 12% were in BRCA2 (p<0.05). Meta-analyses were performed to compare these results with other studies of Mediterranean-region populations. Conclusion: Patients with BRCA2 mutations were significantly more common than those with BRCA1 mutations. In sporadic cases, there was a lower proportion with BRCA1/BRCA2 variants, as expected, and these results were consistent with the data of Mediterranean-region populations. However, the present study, because of the large sample size, revealed more robust findings than previous studies. These findings may be helpful in facilitating the clinical management of BC for both familial and non-familial cases