Serum progranulin levels are elevated in infertile women with obesity

Introduction: The aim of the present study was to investigate the changes in serum progranulin and sex hormone levels in infertile women with obesity. Material and methods: A total of 171 infertile women who had fertility desire were included in this cross-sectional study. The initial assessment included measurements of weight, height, waist circumference, and hip circumference to calculate body mass index (BMI) and waist/hip ratio. All participants were categorised into two groups in accordance with BMI as a control group ( < 30 kg/m2, n = 135) and a study group (≥ 30 kg/m2, n = 36). After anthropometric measurements, venous blood samples were taken for analyses of oestradiol and follicle stimulating hormone (FSH), luteinising hormone, total testosterone (TT), 17-hydroxyprogesterone, dehydroepiandrosterone sulphate, anti-Müllerian hormone, and progranulin. Results: The present study demonstrated that the overweight women had higher FSH levels (p < 0.01). Elevated TT levels were detected in obese women (p < 0.05). Progranulin concentrations were higher in the study group than in the control group (p < 0.05). Regression analysis demonstrated that there was a relationship between the serum progranulin concentrations and BMI (p < 0.05). Conclusions: Our findings support that the elevated progranulin levels are associated with obesity in infertile women. Therefore, infertile and obese patients may benefit if their serum progranulin levels decrease. Further studies are needed to elucidate this issue

AMYAND HERNIA AND SURGERY: IS APPENDECTOMY NECESSARY? HOW SHOULD HERNIA REPAIR BE DONE?

Amaç: Amyand herni, kasık fıtığı kesesi içinde normal veya inflame appendiks vermiformisin bulunmasıdır. Amyand hernili olguların çoğunluğu erişkinler, geri kalan kısmı ise 0-1 yaş arası çocuklardır. Klinik olarak Amyand hernili hasta serimizi sunarak cerrahi tedavi protokolünü literatür eşliğinde tartışmayı amaçladık. Yöntemler: 1974 - 2010 yılları arasında Dışkapı Yıldırım Beyazıt Eğitim Araştırma Hastanesi genel cerrahi polikliniği ve acil servise kasıkta şişlik ve ağrı şikayeti ile başvuran ve inguinal herni tanısıyla operasyona alınan, fıtık kesesi içinde appendiks saptanarak apendektomi yapılan 15 hasta tedavi edilmiştir. Bulgular: On beş hastanın yaş ortalaması 40,36 ± 21,82 idi. Kadın /erkek oranı ¼ idi. Hastaların 14'ünde sağ inguinal bölgede, birinde situs inversus nedeniyle sol inguinal bölgede Amyand herni olgusu saptandı. On bir hasta elektif şartlarda opere olurken, 4 hasta irredükte inguinal herni nedeniyle ameliyata alındı. İntraoperatif 4 olguda akut apandisit hali saptandı. Hastaların tamamına apendektomi uygulanırken ve 3 hastaya mesh herniorafi, 12 hastaya da anatomik onarım yapıldı. Sonuç: Amyand herni tanısı genellikle intraoperatif olarak konur. Fıtık kesesi içinde inflame olmayan apendiks saptanmasında tedavi tartışmalıdır ama apandisit saptanan durumlarda apendektomi yapılmalıdır. Apandisit saptanması durumunda da fıtık onarım tipi tartışma konusudur. Genelde mesh herniorafi uygulanırken, peritonit hali mevcutsa anatomik onarım tercih edilmelidir Objective: Amyand hernia is determined as the presence of normal or inflamed appendix in the hernia sac. It is commonly encountered in adult patients or in children up to 1 year of age. We aimed to discuss the treatment protocol of Amyand hernia cases under the light of the literature. Methods: There were 15 patients included the study in 1974 - 2010. They were admitted to Dışkapı Yıldırım Beyazıt Teaching and Researsh Hospital for elective or incarcerated inguinal hernia repair and appendix was found incidentally in hernia sacs, so appendectomy operations were performed additional procedure to hernioraphy. Results: The mean age was 40.36 (std dev 21.823), female/male ratio was ¼. Fourteen patients had right, one had left inguinal hernia but also situs inversus. Eleven cases were operated in elective condition, four patients for incarcerated hernia. We found acute appendicitis findings intra operatively in four patients. Appendectomies were done for all of the patients. Hernia repairing were performed with mesh in 3 cases, but with anatomic repairing were done in 12 patients. Conclusion: Amyand hernia is generally diagnosed intra operatively. Operation in the presence of non-inflamed appendix in the sac is controversial but inflamed appendix undoubtedly should be operated. This time, in these cases mesh usage is controversial due to the risk of infection. Generally m

RATLARDA AKUT NEKROTİZAN PANKREATİT MODELİNDE CANDESARTAN’IN PANKREAS MİKRODOLASIM BOZUKLUKLARINA ETKİSİ

Amaç: Akut nekrotizan pankreatitte pankreatitin baslangıç döneminde etyopatogenezde mikrosirkülasyon bozuklukları son derece önemlidir. Mikrosirkülasyon bozukluklarının önlenmesinde bugüne kadar bir çok madde kullanılmıstır. Ancak bu maddelerin klinikte kullanımı sınırlıdır. Bu çalısmada bir AT-II reseptör antagonisti olan candesartan&#8217;ın pankreatik mikrodolasım üzerindeki etkinliginin ortaya konulması amaçlanmaktadır. Gereç ve Yöntem: Çalısma her grupta 10 rat olacak sekilde olusturuldu. Pankreatit ceruleinin intravenöz yolla, glycodeoxycholic asitin ise biliopankreatik kanala infüzyonları ile olusturuldu. 24. ve 48. saat tedavi gruplarına 6. ve 18. saatlerde candesartan verildi. 24. ve 48. saatte sakrifiye edilen ratlardan pankreatik doku kan akımı lazer doppler flowmeter ile ölçüldükten sonra, amilaz, myeloperoksidaz, IL-6 ve tümör nekroz faktör- için kan örnekleri, histopatolojik analiz, endotel hücre apoptozis degerlendirilmesi ve matriks metalloproteinaz-9 için pankreatik doku örnekleri alındı. Bulgular: Pankreatik doku mikrosirkülasyon düzeyleri candesartan verilen gruplarda daha yüksek idi (p<0.05). Myeloperoksidaz, IL-6 ve tümör nekroz faktör- düzeyleri candesartan verilen gruplarda daha düsük olarak bulundu (p<0.05). Pankreatik dokunun histopatolojik analizinde pankreatik dokudaki ödem ve inflamasyonda candesartan tedavisi ile azalma tespit edildi (p<0.05). Endotel hücre apoptozisinde candesartan tedavisi ile azalma tespit edildi ancak bu deger istatistiksel olarak anlamlı bulunmadı (p>0.05). Pankreatik dokudaki matriks metalloproteinaz-9 düzeylerinde ise candesartan tedavisi ile azalma tespit edildi (p<0.05). Sonuç: Akut nekrotizan pankreatitin erken döneminde kullanılan candesartan pankreatik doku mikrovasküler dolasımı üzerinde olumlu etkilere sahiptir.Aim: Microcirculatory disorders are important in the initial stages of the acute necrotizing pancreatitis. Various subtsances have been used in the prevention of microcirculatory disorders. Nevertheless the use of these substances the clinics are very limited. In the present study it is aimed to detect the effects of candesartan; a AT II antogonist; on pancreatic microcirculation. Materials and Methods: The rats were grouped into groups of ten in each. Pancreatitis was induced by cerulein intravenous injection concommitant with glycodeoxycholate infusion to biliopancreatic duct. Treatment groups recieved candesartan at 6. and 18. hours. The rats were sacrifced at 24th and 48th hours. Pancreatic perfusion was assesed via laser doppler flowmeter, blood was colected for amylase, myeloperxidase, IL-6 and tumor necrosis factor alpha. Tissue samples were collected for histopathologic analysis, endothelial cell apopthosis and matrix metalloproteinase-9 evaluation. Results: Tissue microcirculation was enhanced in candesartan group (p<0.05). Myeloperoxidase, IL-6 and TNF-alpha levels were lower in candesartan group (p<0.05). Endothelial cell apopthosis was reduced in candesartan but did not reach statisticly significance (p>0.05). Candesartan treatment reduced matrix metalloproteinase-9 levels in the tissue (p<0.05). Conclusion: Candesartan treatment in the early phase of necrotizing pancreatitis has beneficial effects on pancreatic microcirculation

Resection of synchronous ipsilateral giant bullae and bronchial carcinoid tumor

Synchronous bronchial carcinoid tumor and giant bullae are rare entities. In this article, we report a 62-year-old male presenting with dyspnea, cough and chest pain. No improvement was achieved with medical treatment. Examinations revealed right lower lobe endobronchial carcinoid tumor and upper lobe giant bullae. Simultaneous bullectomy and bronchotomy and carcinoid tumor resection through right thoracotomy, as well as postoperative tracheostomy were performed. The patient who had 2 lt/minute oxygen was discharged on the 16th postoperative day without any complication. Radiological, apprearance, clinical situation and pulmonary functions were improved and better quality of life was observed at six months after surgery. Forced expiratory volume in 1 second (FEV1) increased from 0.90 liter (29% predicted) to 1.13 liter (37% predicted). Patient continued to smoke and died due to cor pulmonale one year after discharge

Do Nuss bars compromise the blood flow of the internal mammary arteries?

OBJECTIVES: Minimally invasive repair of pectus excavatum, the so-called Nuss procedure, has become a popular technique in recent years. The internal mammary arteries (IMAs) lie on the posterolateral surface of the sternum, and the Nuss bar is likely to obstruct the blood flow in these arteries. This obstruction could become important in the later stages of the lives of these young people if they were to require coronary artery bypass grafting. The goal of this study is to investigate the extent of obstruction of the IMAs caused by Nuss bars. METHODS: Data were collected prospectively on all patients who underwent the Nuss procedure between October 2011 and May 2012. Patients with a history of pectus excavatum repair by open surgery and those who were younger than 16 years of age were excluded. Computed tomography-angiography (CTA) was performed for the detection of IMA blood flow preoperatively and on the 10th postoperative day. Blood flow in the IMAs was evaluated blindly by two radiologists and classified as blood flow unaffected (group I) or affected (group II) by comparing the assessment of preoperative and postoperative CTAs. The patients in group II were also categorized as having blood flow obstructed bilaterally, blood flow obstructed unilaterally and others (diminished unilaterally/diminished on one side or obstructed on the other side). RESULTS: Thirty-four patients (31 male and three female; mean age 20.7 +/- 4.2 years) underwent surgery. Blood flow was affected in 15 patients (44%), with bilateral obstruction in five, unilateral obstruction in seven, and unilateral diminished flow in two patients. In one patient, blood flow was diminished on one side and obstructed on the other. There was no significant difference between unaffected group I patients and affected group II patients in terms of sex, age, type of deformity, Haller index and the number of bars placed. CONCLUSIONS: Nuss bars cause pressure on the IMAs, but a risk factor for this effect could not be identified. This is a relatively common clinical consequence of minimally invasive repair of pectus excavatum, and the long-term effects will be apparent following bar removal

Intra-Operative Frozen Section Histology of the Pancreatic Resection Margins and Clinical Outcome of Patients with Adenocarcinoma of the Head of the Pancreas Undergoing Pancreaticoduodenectomy.

BACKGROUND The aim of this study was to compare the clinical outcome in patients with pancreatic ductal adenocarcinoma who underwent frozen section and paraffin section histology of the surgical resection margins during pancreaticoduodenectomy. MATERIAL AND METHODS Frozen section and routine paraffin section histopathology were performed using the following categories: R0 (no tumor cells at the surgical resection margin), R1 (tumor cells at, or within 1 mm, of the surgical resection margin), and R2 (tumor seen macroscopically at the surgical resection margin). R1 and R2 patients underwent additional resection to achieve R0. RESULTS Of 346 patients who underwent pancreaticoduodenectomy, frozen section histology showed positive resection margins in 22 patients (9.2%) and paraffin section histology was positive in 20 patients (8.4%). The OS was nine months in frozen section-positive patients and 20 months in frozen section-negative patients (p=0.001). The OS rates were significantly different between the paraffin section-positive and paraffin section-negative patients (11 months vs. 21 months) (p=0.001). Univariate and multivariate analysis showed that increased tumor size, high tumor grade, lymph node metastases, a positive superior mesenteric artery and retroperitoneal margin, and a positive resection margin on frozen section were significantly correlated with reduced OS (p<0.05). Twenty-two patients with positive resection margins on frozen section histology underwent further resection; R0 was achieved in 14 patients, with no significant difference in OS. CONCLUSIONS For patients who underwent pancreaticoduodenectomy for pancreatic carcinoma with positive resection margins on frozen section, further surgical resection to achieve R0 had no significant positive impact on OS

A case of Brunner's gland adenoma mimicking tumors induced from head of the pancreas.

Brunner's Gland Adenoma is a very rarely seen benign tumor of duodenum. While it generally leads to obstruction and bleeding complaints, it may very rarely occur by mimicking a pancreatic tumor. A 48 years old male patient admitted to the gastroenterology clinic due to the epigastric pain spreading dorsally. No significant feature is present in his clinical history. A lesion containing cystic solid components in the size of 30x40 mm was detected in the head of pancreas as a result of the abdominal tomography. In the light of these findings, pancreaticoduodenectomy is applied to the patient. It is observed that tumor is in submucosal location and widely invaded the pancreatic head. In the histopathological examination, Brunner's Gland Adenoma is reported in pancreatic head localization. In this manuscript a case of Brunner's gland adenoma diagnosed by performing pancreaticoduodenectomy due to the mass in the head of the pancreas is presented

Postoperative psychiatric disorders in general thoracic surgery: incidence, risk factors and outcomes

Objective: Postoperative psychiatric disorders (PPDs) may complicate the post-surgical outcome. We analysed the types, incidences, risk factors and outcomes of the PPDs in non-cardiac thoracic surgery patients. Methods: All patients (n = 100) undergoing major non-cardiac thoracic surgery from January 2004 to March 2005 were investigated prospectively. The diagnosis of PPD was made based on the Diagnosis and Statistical Manual of Mental Disorders. The patients were grouped into two according to the presence (group I) or absence (group II) of PPD. Data on pre-, per- and postoperative factors, and the adverse outcomes were analysed. Results: Eighteen patients (18%) developed PPD, including delirium in 44%, adjustment disorders in 22%, panic attack in 17%, minor depression in 11% and psychosis in 6%. The patients who developed PPD were older (58 +/- 17 vs 50 +/- 15 years, p = 0.05), had a longer operation time (6 +/- 1 vs 5 +/- 2 h, p = 0.015) and hospital stay (13 +/- 9 vs 8 +/- 5 days, p = 0.019). The morbidity and mortality rates were not significantly different between the groups (67% vs 46%; 11% vs 1%, respectively). The causative factors in the development of PPD were older age, longer operation time, abnormal serum chemistry values of sodium, potassium, calcium and glucose, hypoalbuminaemia, the presence of the postoperative respiratory distress and infection and blood transfusion (p < 0.05). Conclusions: PPDs are associated with adverse outcomes including a longer hospital stay, and increased morbidity and mortality rates. The identification, detection and elimination of these risk factors are recommended. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Investigation of the effects of thymoquinone on erythrocyte deformability in sepsis treatment which created by cecal perforation in rat

AIM: We aimed to study the effects of thymoquinone on erythrocyte deformability in an experimental model of sepsis given before or after the initiation of the sepsis model