The role of lymphocyte-monocyte ratio and platelet to lymphocyte ratio in predicting risk groups in gastrointestinal stromal tumors

Aim: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Armed Forces Institute of Pathology (AFIP) criteria which is the basis of our study, is also known as Miettinen’s criterion is used in classification of GIST. Lymphocyte-monocyte ratio (LMR), and platelet lymphocyte ratio (PLR) have been shown as novel markers in chronic systemic inflammatory response, therefore, we aimed to study LMR levels of the subjects with moderate to high risk GIST and to compare to those in the subjects with low or very low risk GIST. Methods: Thirty GIST patients who underwent surgery were retrospectively evaluated. Patients were divided into two groups according to the AFIP risk scoring system: the first group (group 1) included very low and low risk patients and the second group (group 2) included moderate and high risk patients. Inflammatory indicators; LMR and PLR of the groups were compared. Results: LMR value was higher in Group 1 (5.25 ± 2.55) than the LMR of group 2 (2.92 ± 1.76). PLR value was significantly lower in group 1 (139.68) compared to the PLR of group 2 (185.04). Conclusion: We think that LMR is effective in identifying low and very low risk patients compared to AFIP. From this point of view, we suggest that LMR can identify high and medium risk patients by excluding low and very low risk patients and may be an independent risk factor in GIST scoring systems

Minimally invasive surgery in primary hyperparathyroidism

Aim:  To describe the general and laboratory characteristics of patients with primary hyperparathyroidism (PHPT) who underwent surgery in our clinic, as well as surgery-related morbidity. Methods: The study population were selected: Patients with clinical and radiological diagnosis of PHPT were included in the study. Minimal invasive parathyroid surgery, aimed only the affected gland, was chosen for the patients. Preoperative calcium (Ca), parathyroid hormone (PTH), and postoperative Ca and PTH levels were recorded. Preoperative sonography and scintigraphy studies to determine localization were obtained from the same database. Results: 116 patients were undergone minimal invasive surgery for hyperparathyroidism, which is mainly focused on the pathological gland. The mean preoperative PHT was 397 ng/L and postoperative PTH was 53 ng/L. Preoperative and postoperative Ca levels were 11.7 mg/dL and 9.3 mg/dL, respectively. Histopathological evaluation revealed following results: 108 patients had adenoma. None of the subjects had malignancy. The mortality rate was 0% and the morbidity was 1.7%, related to this procedure. Conclusion: According to the data in present study, we suggest that minimally invasive surgical techniques should be preferred in sake of higher success and lower postoperative morbidity in patients with a single gland disease

ENDOSCOPY IN TIME CAN BE A LIFE SAVER: OUR UPPER ENDOSCOPY RESULTS

Objectives: Endoscopy is the best diagnostic test for the diseases in upper digestive system. In addition to diagnosis, endoscopy is also useful in treatment of specific conditions. Methods: The patients admitted to Doğubayazıt state hospital’s endoscopy unit between 2008 January and 2011 July enrolled to the study. Endoscopy was performed with a GIF- XQ30 Olympus device. We assessed endoscopic findings of 3158 patients retrospectively. Results: A total of 3158 patients (1434 male and 1724 female) enrolled to the study. Gastritis was the most common diagnosis in our series. Patients with duodenal ulcer (mean age: 38,3+/-14,3 years) were younger than those with gastric ulcer (mean age: 48,4+/-15,8 years). Conclusions: Although gastritis, esophagitis and bile reflux, which are benign conditions,  were common diagnosis in our series, endoscopy should not be delayed in symptomatic patients because, according to our findings, 2 or 3 of every 100 patients undergone endoscopic examination may have malign tumors in upper gastrointestinal system

Cholelithiasis and gastrointestinal cancer: Is there a relationship that increases the risk of developing cancer?

Aim: To investigate the co-existence of cholelithiasis in patients with gastrointestinal (GI) cancer both in preoperative and postoperative periods. Methods: We retrospectively analyzed the data of patients who underwent GI tract cancer surgery in the general surgery clinic of a university hospital between January 2013 and December 2019 for the presence of 'cholelithiasis' in the preoperative and postoperative periods. Age, gender, tumor type and localization and presence of the cholelithiasis in the patients were determined. In addition, the cases were divided into two as upper GI tract and lower GI tract according to tumor location and the relationship with cholelithiasis was evaluated. Results: A total of 680 GI cancer patients were included in the study. Localization of GI cancers were; colon in 211 cases (31%), rectum in 195 cases (28.7%), gastric in 187 cases (27.5%), periampullary region in 55 cases (8.1%), and small intestine in 32 cases (4.7%). In the preoperative period, 69 (10.1%) patients were associated with cholelithiasis. Thirty-one (5.1%) patients had accompanying cholelithiasis in the postoperative period. Coexistence of cholelithiasis according to cancer location was not statistically significant in the preoperative and postoperative periods. Conclusions: Our available data make it difficult to distinguish the roles of cholelithiasis on gastrointestinal cancers, because no statistically causal relationship was found between cholelithiasis and gastrointestinal cancers. However, the role of asymptomatic and symptomatic stones, which may or may not require cholecystectomy, in the development of GI tract cancers should not be ignored

Comparison of the efficiency of nomograms used to predict preoperative sentinel lymph node positivity in breast cancer with clinical findings, PET/CT images and laboratory parameters

Aim: To compare the efficacy of nomograms used to predict preoperative sentinel lymph node involvement in patients diagnosed with breast cancer and clinical findings, PET/CT imaging and laboratory parameters. Methods: In this retrospective study, patients who were operated for invasive breast carcinoma with sentinel lymph node biopsy in our Generel Surgery Department between 2015 and 2020, were identified from our database. Laboratory parameters (PLR, NLR, LMR and MPR) were calculated from the complete blood count taken within 24 hours before surgery. Memorial Sloan Kettering Cancer Center (MSKCC) method was used from nomograms. Patients were compared according to sentinel lymph node positivity. All obtained data were compared with statistical tests. Results: A total of 48 patients could be included in the study. A statistically significant correlation was found between physical examination, USG and PET/CT findings in terms of axilla positivity and pathology results (p<0.001, p=0.005 and p=0.002). The SUVmax value of the axilla was found to be statistically significantly higher in patients with positive SLNB group than in SLNB negative group (2.90±3.46 vs. 0.66±1.86, p=0.004). Although the rates of PLR, NLR, LMR and MPR among the laboratory parameters were higher in the SLNB positive group, they were not statistically significant (p=0.683, p=0.6, p=0.948 and p=0.354). MSKCC nomogram values were higher in SNLB positive group, however it was not statistically significant (p=0.243). Conclusion: In our study, clinical examination, laboratory testings, PET/CT imaging results and nomograms; on their own, have limited prediction about sentinel lymph node involvement. Therefore, we think it is necessary to design new algorithms that are more effective to predict axillary involvement and this will give better results in this regard

SREDNJI VOLUMEN TROMBOCITA: PREVIDJELI GLASNIK ZLOĆUDNIH ČVOROVA ŠTITNJAČE

Physicians and surgeons pay much attention to evaluating thyroid nodules due to the malignant potential of these growths. Inflammation has a crucial role in the development of cancer. Increase in the mean platelet volume (MPV) has been described in various inflammatory conditions. Since some of thyroid nodules are malignant, we aimed to compare MPV values between patients with malignant and benign thyroid nodules after precise pathologic diagnosis. We retrospectively analyzed hemograms of patients having undergone thyroid surgery for thyroid nodule between January 2013 and January 2015, and compared them to those recorded in healthy subjects. MPV was higher in the malignant thyroid nodule group than in the benign nodule group (9.1±1 fL vs. 7.8±0.8 fL). The difference was statistically significant (p<0.001). Increased MPV should be considered as an assistive diagnostic tool in differentiating malignant and benign thyroid nodules. However, further prospective studies are required to confirm its usefulness in this population.Liječnici i kirurzi pridaju veliku pozornost procjeni čvorova štitne žlijezde zbog malignog potencijala ovih novotvorina. Upala ima ključnu ulogu u razvoju raka. Povećani srednji volumen trombocita (mean platelet volume, MPV) opisuje se u raznim upalnim stanjima. Kako su neki od čvorova štitne žlijezde zloćudni cilj nam je bio usporediti vrijednosti MPV između bolesnika sa zloćudnim i dobroćudnim čvorovima štitnjače nakon precizne patološke dijagnoze. Retrospektivno su analizirani hemogrami bolesnika podvrgnutih operaciji štitne žlijezde zbog čvorova od siječnja 2013. do siječnja 2015. godine te uspoređeni s vrijednostima dobivenim u zdravih osoba. MPV je bio viši u skupini zloćudnih tireoidnih čvorova nego u skupini dobroćudnih čvorova (9,1±1 fL prema 7,8±0,8 fL), a razlika je bila statistički značajna (p<0,001). Povišeni MPV može se smatrati pomoćnim dijagnostičkim alatom u razlikovanju zloćudnih i dobroćudnih čvorova štitnjače. Međutim, potrebna su daljnja istraživanja kako bi se potvrdila njegova korist kod ove populacije

Surgical treatment of inguinal hernia: Our experience

Aim: In present retrospective analysis, we aimed to evaluate the treatment results of subjects with inguinal hernia whom underwent surgical repair. Methods: Surgical treatment of inguinal hernia for last 7 years have been retrospectively analyzed. Surgical procedures include anterior mesh, posterior mesh, Mc Vay, non-mesh repair, plug mesh. Results: A total of 2320 patients underwent hernia surgery were included to the study. While, 2224 of the cases were elective procedures while 96 were operated in emergency conditions. Incarceration 78 of emergent cases were incarcerated and 18 were strangulated. Patients requiring emergency surgery were significantly older than the patients underwent elective hernia repair. Duration of hospital stay was significantly longer in emergent cases compared to elective cases. Need for intestinal resection was more common in emergent cases compared to elective surgery cases. Mc Vay and plug mesh procedures were more commonly used in emergent cases compared to elective surgery cases. Intestinal laceration and development of recurrences were more common in emergent surgery cases compared to elective surgery. Conclusion: Inguinal hernia patients should be scheduled for elective surgery without delay since need for emergent surgery may increase by time and emergent cases are associated with more complications and surgical morbidity

Effects of magnesium sulphate on liver ischemia/reperfusion injury in a rat model

Aim: To investigate the protective efficacy of magnesium sulphate in a model of rat liver ischemia-reperfusion (I/R) injury. Method: 32 adult female Wistar-Albino rats (250 to 350 g) were used in this experimental study. Rats were divided into 4 groups according to liver ischemia and magnesium sulfate application methods. Group 1 (C); control, group 2 (M); magnesium sulphate, group 3 (I/R); liver I/R, group 4 (I/R+M); I/R + magnesium sulphate treated. The blood samples were centrifuged for the study of aspartate aminotransferase (AST), alanine aminotransferase, prothrombin time (PT), international normalized ratio (INR) troponin I, total antioxidant status (TAS), total oxidant status (TOS) assays. The livers of the animals were removed at the end of the study and samples were taken for histopathological examination. Results: AST and INR values were significantly decreased in I/R+M group compared to I/R group. There was no significant difference in ALT values of the groups. Although not statistically significant, the TAS values were increased in I/R + M group compared to I/R group rats. In addition, the value of TOS was found to be lower in I/R + M group rats. In the histopathological examination, the mean values of apoptosis and necrosis were lower in the IR+M group compared to the IR group. Conclusion: The main finding of the present study suggested that magnesium sulphate pretreatment moderately decreased the liver damage through its anti-inflammatory and anti-oxidant effects in a rat model of liver I/R

GENERAL CHARACTERISTICS AND TREATMENT OPTIONS OF THE PATIENTS WITH GASTROINTESTINAL STROMAL TUMOR

Background: Gastrointestinal stromal tumors (GIST) are rare mesenchimal tumors may develop in any site in the gastrointestinal system. KIT gene mutations are detected in 95% of cases. In this study, we aimed to assess treatment options and general characteristics of patients with GIST. Methods: GIST patients admitted to Abdurrahman Yurtaslan Oncology Education and Training hospital’s oncology clinic between February 2009 and May 2012 are observed retrospectively. Demographic characteristics of the patients and the treatment they received were recorded from hospital’s database. Results: Eighteen patients included to study havinng Mean age of 57.8 years (32-78).  Five (28%) of the patients were female and thirteen (72%) were male. Diagnosis were made in 16 patients by pathological assessment of surgical material. Trucut biopsy and gastroscopic biopsy used for diagnosis in remaining two patients. Localizations of the tumor were as follows: small intestine in 9 patients, colon in 5 patients, stomach in 4 patients. All of the patients were KIT positive. Tumor was defined at high risk in 62%, at moderate risk in 17% and at low risk in 21% of the cases. Imatinib was administered in 5 patients with metastatic disease. Mean follow up period for the patients was 48 months. Relapse or progression developed in 4 of all patients in follow up period. Only one of the five patients with metastaic disease developed progression. Other 3 cases were relapsed. Conclusion: Surgical resection of tumor without fragmentatin is the main treatment of localized GIST cases. Imatinib, a tyrosine kinase inhibitor, is used in metastatic/ inoperable tumors and in cases at high risk for metastasis, recently. In conclusion, after surgical resection of the tumor, we suggest Imatinib treatment in patients considered at high risk