Effect of cytokine genes in the pathogenesis and on the clinical parameters for the treatment of multiple myeloma

WOS: 000394527000002PubMed ID: 27611810In this study, we aimed to explore the association among gene variants of five cytokines, tumor necrosis factor alpha (TNF-alpha), transforming growth factor beta-1 (TGF-beta 1), interferon gamma (IFN-gamma), interleukin-6 (IL-6), and interleukin-10 (IL-10), and clinical parameters and prognosis in patients with multiple myeloma (MM) treated with novel therapeutic drugs in Turkish population for the first time except TNF-alpha. We analyzed five cytokine genes in 113 cases with MM and 113 healthy controls. Cytokine genotyping was performed by the polymerase chain reaction-sequence-specific primer method (PCR-SSP). AG genotype associated with high expression in TNF-alpha gene (-308) variant was found to be significantly higher (p = 0.019), and GG genotype associated with low expression in TNF-alpha gene (-308) variant was significantly lower in MM group as compared with controls (p = 0.012). IFN-gamma (+874) variant TT genotype was increased (p = 0.037), and AA genotype was decreased (p = 0.002) in MM group in contrast to controls. IFN-gamma (+874) T allele was higher inMMpatients compared with controls (OR = 1.985, p = 0.000), while A allele was significantly lower (OR = 0.5037, p = 0.0005). Multivariate analysis revealed that factors associated with 5-year overall survival (OS) were only IPI III (RR = 1.630, p = 0.018) and thrombocytopenia (RR = 2.207, Cox p = 0.021), while 5-year event-free survival (EFS) was associated with IPI III (RR = 1.524, p = 0.022), thrombocytopenia (RR = 2.902, p = 0.002), APSCT treatment (RR = 1.729, p = 0.035), and female gender (RR = 0.435, p = 0.002) with negative prognostic values. Our results suggested that TNF-alpha gene (-308) AG genotype and IFN-gamma (+874) TT genotype and T allele may have a role on MM, while other cytokines were not associated with the risk of MM

Erişkinlerde laparoskopik koledok kist rezeksiyonu: Türkiye’den bir seri

Objective: Choledochal cyst is a congenital disease in which surgical treatment is preliminary because of the potential for malignancy. In recent years, increase in technological developments and laparoscopic experience have popularised the use of laparoscopy in adult choledochal cyst surgery. This study aimed to present the results of eight adult patients undergoing laparoscopic choledochal excision surgery. Material and Methods: Patients who underwent laparoscopic choledochal cyst excision and hepatico-jejunostomy anastomoses between the years 2013 and 2018 were evaluated retrospectively. Demographic characteristics, preoperative and postoperative findings, pathological results and final condition of the patients were examined. Results: Of the eight patients, three were males and five were females. Median age was 41.5 years (22-49). One of the patients had Type IVa and the rest had Type I choledochal cysts. Laparoscopic choledochal cyst excision, cholecystectomy, and hepatico-jejunostomy anastomoses were performed on all of the patients. One patient was converted to open surgery. Three patients had postoperative biliary leakage. Duration of the operations was determined as median 330 (240-480) minutes and blood loss was 50 (10-100) mL. Hospitalization of the patients was median 6 (4-23) days and follow-up time was median 20 (2-65) months. In the late period, cholangitis occured in a patient who was treated with medical therapy and there was no mortality in the follow-up period. Conclusion: We suggest that laparoscopic choledochal cyst excision in adults may be an alternative to open surgery due to the satisfactory results in the late period in spite of early problems like self-limiting bile leakage.Giriş ve Amaç: Koledok kistleri malignite potansiyeli nedeniyle cerrahi tedavinin ön planda olduğu konjenital bir hastalıktır. Son yıllarda teknolo-jik gelişmeler ve laparoskopik tecrübede artış erişkin koledok kist cerrahisinde laparoskopinin kullanımını yaygınlaştırmaktadır. Bu çalışmada amacımız laparoskopik koledok eksizyonu yapılan sekiz erişkin hastanın sonuçlarını sunmaktır. Gereç ve Yöntem: Kliniğimizde 2013-2018 yılları arasında laparoskopik koledok kist eksizyonu ve hepatiko-jejunostomi uygulanan hastalar retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, peroperatif ve postoperatif bulguları, patolojik sonuçları ve son durumları irdelendi. Bulgular: Çalışmaya dahil edilen sekiz hastanın üçü erkek, beşi kadın idi. Yaşların median değeri 41.5 (22-49) idi. Hastaların bir tanesinde tip IVa, diğerlerinde ise tip 1 koledok kisti saptandı. Hastaların tamamına laparoskopik koledok eksizyonu, kolesistektomi ve heptiko-jejunostomi yapıldı. Bir hastada açık cerrahiye geçildi. Üç hastada postoperatif safra kaçağı oldu. Operasyon süreleri median 330 (240-480) dakika ve kan kaybı 50 (10- 100) mL olarak saptandı. Hastaların yatış süreleri median 6 (4-23) gün ve takip süreleri median 20 (2-65) ay olduğu tespit edildi. Geç dönemde; bir hastada medikal tedavi ile düzelen kolanjit atağı gözlendi, mortalite ise görülmedi. Sonuç: Kendini sınırlayan safra kaçakları dışında erken dönemde önemli sorun yaşamamamız ve geç dönemdeki tatminkar sonuçlar nedeniyle laparoskopik koledok kist eksizyonunun erişkinlerde açık cerrahiye bir alternatif olabileceğini söyleyebiliriz

J-pouch vs. side-to-end anastomosis after hand-assisted laparoscopic low anterior resection for rectal cancer: A prospective randomized trial on short and long term outcomes including life quality and functional results

WOS: 000414077500002PubMed ID: 28919097Purpose: To analyze the outcomes of j-pouch and side-to-end anastomosis in rectal cancer patients treated with laparoscopic hand-assisted low anterior resection. Methods: Prospective trial on cases randomized to have a colonic j-pouch or a side-to-end anastomosis after low anterior resection. Demographics, characteristics of disease and treatment, perioperative results, and functional outcomes and life quality were compared between the groups. Results: Seventy four patients were randomized. Reservoir creation was withdrawn in 17 (23%) patients, mostly related to reach problem (n = 11, 64.7%). Anastomotic leakage rate was significantly higher in j-pouch group (8 [27.6%] vs. 0, p = 0.004). Stoma closure could not be achieved in 16 (28.1%) patients. Life quality and functional outcomes, measured 4, 8 and 12 months after the stoma reversal, were similar. Conclusions: Colonic j-pouch and side-to-end anastomosis are similar regarding perioperative measures including operation time, rates of postoperative complications, reoperation and 30-day mortality, and hospitalization period except anastomotic leak rate, which is higher in j-pouch group. Postoperative aspects are not different in patients receiving either technique including functional outcomes and life quality for the first year after stoma closure. In our opinion, both techniques may be preferred during the daily practice while performing laparoscopic surgery; but surgeons may be aware of a possibly higher anastomotic leak rate in case of a j-pouch. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved

Risk factors for early postoperative morbidity and mortality in patients underwent radical surgery for gastric carcinoma: A single center experience

WOS: 000328492600014PubMed ID: 24075931Background: Aim of this study is to analyze the incidence and risk factors for early postoperative morbidity and mortality that occur after gastric carcinoma surgery. Materials and methods: All consecutive patients with gastric adenocarcinoma resected with curative intent between 2005 and 2011 were included to a retrospective analysis. Patient, disease and operation related parameters were questioned as risk factors for postoperative morbidity and mortality. Results: A total of 160 patients (103 [64.8%] male and the average age was 62.4 +/- 11.5) were abstracted. Early postoperative morbidity, operation related morbidity and mortality were observed in 46 (28.7%), 31 (19.4%) and 19 (11.9%) cases, respectively. No other factors but ASA score was found to be a risk factor for overall morbidity (p = 0.021 and 0.033 in univariate and multivariate analyses, respectively). The incidence of anastomotic leak was increasing in patients who received a D2 dissection in univariate analysis (p = 0.039), but not in multivariate calculation. There were no factors effecting surgical site infection risk. Although univariate analysis revealed that age over 70 (p = 0.008), ASA score (p = 0.018), operation time (p = 0.032), D2 dissection (p = 0.026) and type of anastomosis (p = 0.023) were effecting the risk for early mortality, multivariate analysis showed that age was the only risk factor (p = 0.005). Conclusion: Current study has revealed that early morbidity and mortality are not rare after gastric cancer surgery with curative intent. Since multivariate analyses have revealed that ASA score and older age may be only risk factors for postoperative morbidity and 30-day mortality, respectively; it may be logical to consider these factors during the preoperative decision making in patients with gastric cancer