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

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

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

Our experience and results of clinical incidental gallbladder carcinomas

This study aimed to eveluate our experience in incidental gallbladder carcinomas the effect of resection on life time .We suggest that liver resection may contribute to the disease free survival of the patients with incidental gallbladder carcinomas. Between January 2012 and December 2017, 3691 patients who underwent cholecystectomy in the Department of General Surgery of Abant Izzet Baysal University Medical Faculty and who did not consider biliary stricture in their preoperative evaluation were evaluated retrospectively.Patients were grouped according to age, sex, stone size, bile duct wall thickness and histopathological results. The preoperative diagnosis of all patients undergoing cholecystectomy was cholelithiasis. Of the 3691 patients, gallbladder cancer was detected in the evaluation of the pathology specimens of 16 patients (0.50%)Of the patients who were diagnosed with gallbladder carcinomas, 12 had female gender and 4 had male gender . All of the patients were found to have adenocarcinoma when the pathology specimens were examined. In the pathology specimens, 2 patients had carcinoma insitu, 2 patients had T1, 5 patients had T2, 7 patients had T3. In this study we share our experience in incidental gallbladder carcinomas and suggest that liver resection may contribute to the disease free survival of the patients with incidental gallbladder carcinomas. [Med-Science 2019; 8(2.000): 274-6

Does healthcare sector development affect inbound tourism? Evidence from ASEAN countries

Using the concepts of medical tourism and travel medicine, this research note proposes healthcare sector development has a positive impact on inbound tourism. This hypothesis is tested with the data of ASEAN countries from 2000 to 2018. Because of the presence of cross-section dependence and heterogeneity, appropriate panel cointegration test, panel coefficient estimation method and panel Granger causality test are used. The findings indicate that (1) evidence of cointegration between inbound tourism and healthcare sector development is found when inbound tourism is the dependent variable and (2) there is a Granger causality from healthcare sector development to inbound tourism. The findings suggest that there are temporal relationships from healthcare sector development to inbound tourism in both short-run and long-run. In summary, healthcare sector development has an impact on inbound tourism

Evaluation of the Urinary Kidney Injury Molecule-1 Levels in Patients With Diabetic Nephropathy

Purpose: Kidney Injury Molecule-1 is a protein that increases in urine following tubular damage. Kidney Injury Molecule-1 levels were correlated with the level of chronic kidney disease secondary to diabetic nephropathy in patients with type 2 Diabetes Mellitus. Methods: Clinical and laboratory findings of 142 patients with diabetic nephropathy and 34 control subjects were analysed. Creatinine and HbA1c levels in blood samples and albumin, creatinine and Kidney Injury Molecule-1 levels in urine samples were assessed. Results: Urinary Kidney Injury Molecule-1 levels were significantly increased both in subgroups of diabetic nephropathy (normo-/micro-/macro-albuminuria) and in chronic kidney disease (stage 2-4) compared with controls. Urinary Kidney Injury Molecule-1 levels in stage 2 chronic kidney disease patients were significantly higher than those of the patients with stage 3-4 chronic kidney disease. Urinary Kidney Injury Molecule-1 levels, along with urinary albumin excretion and the duration of diabetes, were found to be independent risk factors associated with low glomerular filtration rates. Conclusion: Urinary Kidney Injury Molecule-1 levels seems to predict renal injury secondary to diabetic nephropathy in early period independent of albuminuria, because urinary Kidney Injury Molecule-1 was elevated despite normal urinary albumin excretion in the normoalbuminuric subgroup. Urinary Kidney Injury Molecule-1 levels, which are elevated in primarily in stage 2, shows a gradual decrease in patients with chronic kidney disease stages 3 and 4; thus, urinary Kidney Injury Molecule-1 levels may be useful in tracking the progression of kidney disease