A rare cause of intestinal obstruction due to an exophytic gastrointestinal stromal tumor of the small bowel

Introduction: Gastrointestinal stromal tumors constitute a distinct group of rare gastrointestinal tract tumors that originate from the interstitial cells of Cajal. These jejunoileal lesions are a rare cause of obstruction but can be associated with substantial morbidity. Case: A 59-year-old woman presented to the emergency department with abdominal pain and distention. Physical examination revealed tenderness and rebound in right lower quadrant. Computed tomography revealed a mass in lower right quadrant. A 9x9x4 cm exophytic ileal mass was observed at exploration. Preoperative diagnose was a small bowel tumor and then segmental resection and primary anastomosis were performed. Histopathological investigation revealed spindle cells that stained strongly for C-117, consistent with a diagnosis of a malign gastrointestinal stromal tumor. Conclusion: We conclude that exophytic small bowel gastrointestinal stromal tumors are rare lesions, which should be kept in mind by physicians among the diagnosis of small bowel obstructions in order to reduce substantial morbidity and mortality

Inflammatory myofibroblastic tumor presenting as an abdominal wall mass in an adult patient

Inflammatory myofibroblastic tumor of the abdominal wall is a rare soft-tissue tumor presentation in adults. A 50-year-old woman was referred with abdominal pain and a palpable mass in the left lower quadrant. Computed tomography scan and magnetic resonance investigation revealed an 8-cm heterogeneous abdominal wall mass. Tumor markers were within normal limits. Fine-needle aspiration cytology and tru-cut biopsies yielded necrotic material. A preoperative diagnosis of a resectable rhabdomyosarcoma was suggested. On exploration a tumor measuring 8 x 8 x 6 cm was resected along with the involved structures. Histopathologic examination of specimen revealed an inflammatory myofibroblastic tumor of the abdominal wall. The patient has been followed up for the last 12 months without clinical or radiographic evidence of recurrence. Inflammatory myofibroblastic tumor arising from the anterior abdominal wall in adults is an unusual manifestation of soft-tissue tumors, which can be managed by a multidisciplinary team of surgeons, oncologists, radiologists and pathologists

The effects of artistic and social activities during hemodialysis on the life quality, pain perception, anxiety status of the patients and intradialytic complications

Introduction: We aimed to investigate the effects of social and artistic activity support on quality of life, pain perception, and anxiety status in hemodialysis (HD) patients and the relation between occupational therapy and frequent complications of HD.Methods: Volunteer instructors trained 22 patients participated in this study for wood painting for 4 hours/day, 2-3 days a week for six months. The State-Trait Anxiety Inventory (STAI I and STAI II) and Visual Analog Scale were applied before the social activity and at the 6th month. The quality of life evaluated with Short Form-36.Results: The patients who participated in the social activity more than 25 hours formed the study group (n=9), and those participated less than 25 hours made control group (n=13). There were significant differences in initial and 6th month values in both STAI I and STAI II scores of the study group, and only in STAI II score in the control group (p=0.008, p=0.015, p=0.003, respectively). In the study group, while STAI I and II mean was 49.9 and 52.8 in the first month, respectively, it decreased to 30.0 and 38.8 in 6th month, respectively. In the control group, in the first month mean of STAI II score was 56.9 and it decreased to 45.3 in the sixth month. The mean of physical function capacity from SF-36 parameters increased from 73.9 to 84.4 (p=0.026) in the study group and from 47.7 to 75.8 (p=0.002) in the control group. The difference between study and control group was statistically significant (p = 0.029). Conclusions: Our results support that social and artistic activities during HD have positive effects on chronic HD patients in terms of physical functioning level

Total bilirubin and fasting plasma glucose levels are associated with coronary collateral development in elderly patients

Background and objective: We aimed to investigate biochemical factors affecting coronary collateral circulation development in an elderly population aged 75 years and over. Material and methods: The study group consisted of patients with a prior coronary angiography for stable coronary artery disease (CAD). Patients with total occlusion of at least one vessel were included in the study. Enrolled patients were divided into two groups, good collateral (GC; n = 73) and bad collateral (BC; n = 55), in accordance with the Cohen-Rentop’s classification system. Results: In comparison to the GC group, bilirubin levels were significantly lower (p < 0.001), and fasting plasma glucose (FPG) levels were significantly higher in the BC group (p = 0.026). Low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in the BC group when compared to the GC group (p = 0.002 and p < 0.001, respectively). Backward elimination stepwise logistic regression analysis identified bilirubin and FPG as variables that strongly predicted the presence of a well-developed coronary collateral circulation and a poorly developed coronary collateral circulation, respectively. Conclusion: Bilirubin and FPG were seemed as the most important factors affecting coronary collateral circulation development in patients with stable CAD who were older than 75 years

Serum Nuclear Factor Erythroid-2 Related Factor-2 (NRF2) as an Indicator of Oxidative Stress is Related to Coronary in-Stent Restenosis

Objective: In the treatment of coronary artery disease, stent implantation has become the standard treatment, but development of in-stent restenosis (ISR) limits the benefit of this treatment modality. Methods: Based on the connection between oxidative stress and thiol/disulphate and NRF2, it was intended to measure NRF2 and thiol/disulphate levels. Results: Coronary angiography images of 76 stable angina pectoris patients were evaluated. Of the 51 patients with a history drug eluting stent implantation, we determined 25 patients with ISR (Group 1) and 26 patients without ISR (Group 2). Twenty-five patients with normal coronary arteries were included in the study as control group (Group 3). NRF2 level was found to be significantly higher in patients who did not develop ISR (p=0.01). Total thiol was significantly higher in group 3 (738.76 micromole/L) compared to group 1 (626.11 micromole/L) and group 2 (630.27 micromole/L) (p=0.014). Native thiol was also significantly higher in group 3 (570.53 micromole/L) compared to group 1 (483.91 micromole/L) and group 2 (501 micromole/L) (p=0.006). Conclusion: We think that total and native thiol levels might be useful as an indicator of oxidative stress in early diagnosis of coronary artery disease, and the NRF2 level can be used in predicting patients who might develop coronary ISR

Ramucirumab plus docetaxel versus placebo plus docetaxel in patients with locally advanced or metastatic urothelial carcinoma after platinum-based therapy (RANGE): a randomised, double-blind, phase 3 trial

Few treatments with a distinct mechanism of action are available for patients with platinum-refractory advanced or metastatic urothelial carcinoma. We assessed the efficacy and safety of treatment with docetaxel plus either ramucirumab-a human IgG1 VEGFR-2 antagonist-or placebo in this patient population