Background/Aim: The effect of surgical intervention on the quality of life and survival of patients presenting with metastatic breast cancer is a controversial issue. In this study, we aimed to reveal the survival, clinical, and pathological differences in patients with breast cancer who had metastatic disease at diagnosis and who underwent and did not undergo surgery for the primary tumor in our clinic and to evaluate the efficacy of surgical approach on the course of the disease. Methods: In this retrospective cohort study, the data of patients with metastatic breast cancer in our clinics between January 2000 and June 2021 were retrospectively analyzed. The study included those with primary metastatic disease. The study did not include male patients, patients with primary non-breast tumors, those who died of causes unrelated to breast cancer, those who underwent surgery for metastatic foci other than the primary tumor, and those who could not be followed up regularly for various reasons. In our study, there were two groups; those who received only systemic therapy were assigned to Group 1, while those who underwent surgical treatment for the primary tumor were assigned to Group 2. The clinicopathological and survival data of the groups were examined. Results: Surgical intervention was performed on 62 of our patients. The 4-year survival rates were higher than those who did not undergo surgery (Group 1: 59.6 [14.7%], Group 2: 83.5 [6%]). The comparison of the two groups showed a longer median survival in patients in Group 2 who underwent surgery, albeit not statistically significant (77 [11.23] months in Group 1 and 84 [18.91] months in Group 2 [P=0.16]). Conclusion: In conclusion, our study showed that surgical treatment may have positive effects on survival.

Aim: Pilonidal sinus is a disease localized in the sacrococcygeal region that mostly affects young adults and men and can be treated with conservative treatment methods. In this context, the objective of this study is to compare the efficacies of crystallized phenol and silver nitrate applications, two of the conservative treatment methods used in the treatment of pilonidal sinus disease. Material and Methods: The sample of this retrospective clinical study consisted of 90 patients diagnosed with pilonidal sinus disease and treated nonoperatively. Results: The primary complaints of the patients were discharge, pain and swelling. The mean age of the patients treated with crystallized phenol and silver nitrate was 22.5 (+/- 7.5) and 25 (+/- 7.5) years, respectively. Of the 90 patients, 42 (46.7%) had 2 sinus cavities, 18 (20%) had 3, 17 (18.9%) had 1, and 13 (14%) had 4. The number of times the treatment procedure was repeated was significantly higher in the silver nitrate group than in the crystallized phenol group [(2.95 (+/- 1.3) vs. 2.22 (+/- 0.82)]. Discussion: In conclusion, the silver nitrate treatment is an alternative treatment method to the crystallized phenol treatment or may even be the ideal treatment method in the treatment of pilonidal sinus.

Aim: While breast cancer may be de novo, that is, metastatic at the time of diagnosis, a local tumor at initial diagnosis may metastasize to other regions over the course of treatment and follow-up. This study aimed to reveal the clinical, pathological, and survival differences in patients with de novo metastatic and secondary metastatic breast cancer who were followed up and treated in our clinic, and to investigate factors that may have an effect on survival.Material and Methods: The data of female patients who were diagnosed with metastatic breast cancer, treated, and followed up in our clinic between January 2000 and May 2021 were retrospectively analyzed. Patients were divided into two groups: the de novo metastatic disease group (Group 1) and the secondary metastatic disease group (Group 2). Clinical and pathological data of the groups were analyzed.Results: Patients with de novo metastatic disease most commonly had bone metastases. But in the secondary metastatic disease group, the most common metastasis type was multiorgan metastases. The rate of triple negativity was significantly lower in Group 1. When the groups were analyzed in terms of survival, the median time was 77 +/- 10.89 months in the de novo metastatic group and 66 +/- 10.15 months in the secondary metastatic group (p=0.05).Discussion: Our study demonstrated that de novo metastatic breast cancers had a better prognosis than secondary metastatic breast cancers even though they tend to metastasize early.

This study aimed to evaluate the possible anticancer effects of two different pillar[5]arene derivatives (5Q-[P5] and 10Q-P[5]) on two different pancreatic cancer cell lines in vitro. For this purpose, changes in the expression of major genes that play a role in apoptosis and caspase pathways were investigated. Panc-1 and BxPC-3 cell lines were used in the study and the cytotoxic dose of pillar[5]arenes was determined by the MTT method. Changes in gene expression after pillar[5]arenes treatment were evaluated by real-time polymerase chain reaction (qPCR). Apoptosis was studied by flow cytometry. As a result of analysis, it was determined that proapoptotic genes and genes involved in major caspase activation were upregulated and antiapoptotic genes were down-regulated in Panc-1 cell line treated with pillar[5]arenes. Flow cytometric apoptosis analysis also showed an increased apoptosis rate in this cell line. On the contrary, although MTT analysis showed cytotoxic effect in BxPC-3 cell line treated with two pillar[5]arene derivatives, the apoptosis pathway was not active. This suggested that it may activate different death pathways for BxPC-3 cell line. Thus, it was first determined that the pillar[5]arene derivatives reduced cancer cell proliferation on pancreatic cancer cells.

Objectives:Position changes and increased intra-abdominal pressure in laparoscopic interventions lead to some physiopathological changes. There is no definite information in the literature regarding cerebral oxygen saturation in patients undergoing colorectal surgery. Our aim was to investigate whether there is oxygen saturation change in the brain tissue in pneumoperitoneum and the Trendelenburg position during laparoscopic rectal surgery. Material and Methods:Cerebral oxygen saturation was measured in 35 patients who underwent laparoscopic rectal surgery in the Trendelenburg position. Measurements were made under general anesthesia in the pneumoperitoneum and the Trendelenburg position. Results:The values that are statistically affected by the position are systolic blood pressure, mean arterial blood pressure and cerebral oxygen saturation. The Trendelenburg position does not disturb the cerebral oxygen saturation and it causes an increase in saturation. After pneumoperitoneum occurred, changes in systolic blood pressure, mean arterial blood pressure and brain oxygen saturation were detected. Cerebral oxygen saturation increases with the formation of pneumoperitoneum. Conclusion:The Trendelenburg position and increased intraabdominal pressure during laparoscopic rectal surgery do not impair brain oxygen saturation.

Objectives: Although there have been several advances in post-solid organ transplantation immunosuppression medications over the last two decades, the long-term survival of renal allografts did not significantly improve. Renal allograft biopsy is a helpful tool for determining the cause of graft dysfunction and adjusting patient management. Methods: Patients who received kidney transplantation and underwent allograft biopsy in Istinye University Hospital between January 2017 and January 2023 constituted the target population of this study. Demographic parameters, clinical data and biopsy indications, and histopathological assessment results of the patients were retrospectively analyzed. Results: Overall, 74 patients were included. The histopathology results included acute T-Cell mediated rejection (TCMR) (n = 15, 20%), tubular atrophy/chronic allograft nephropathy (IFTA) (n = 11, 15%), calcineurin inhibitor (CNI) toxicity (n = 2, 3%), chronic antibody-mediated rejection (ABMR) (n = 2, 3%), borderline pathology (n = 10, 13.5%), normal histology (n = 5, 6.5%), transplant glomerulopathy (TG) (n = 5, 6.5%), acute ABMR (n = 4, 5%), acute tubular necrosis (n = 7, 9%), polyomavirus nephropathy (n = 3, 4%) and non-specific changes (n = 10, 13.5%). The C4d was positive in 12% (n = 9) of the graft biopsies. In 73% (n = 54) of cases, the treatment strategy was changed based on biopsy results. Among all patients, 19 (25.6%) lost their grafts during follow-up. Conclusions: According to the histopathological analysis results, acute TCMR, IFTA, and borderline pathology were the most common causes of renal graft dysfunction. Renal allograft biopsy led to a remarkable change in treatment strategies in a significant number of cases.

Background: Postoperative paralytic ileus refers to the disruption of the normal coordinated propulsive motor activity of the gastrointestinal system following surgery. Surgery causes inflammation in the muscle walls of organs with an intestinal lumen that, in turn, leads to a decrease in intestinal motility. Aim: The aim of this study was to investigate the efficacy of gastrografin, neostigmine, and their combined administration in patients diagnosed with paralytic ileus in the postoperative period. Patients and Methods: One-hundred twelve patients were included from January 2017 and November 2019. The retrospective study is involving prolonged postoperative ileus cases following colorectal surgery. The effect of gastrografin, neostigmine, and gastrografin neostigmine combination was compared retrospectively in the treatment of prolonged ileus after surgery. Results: The study covered 112 patients. Gastrografin was administered to 63 patients; neostigmine was administered to 29, while 20 patients received the combination of the two. Data pertaining to the comparison of the two groups revealed that patients in the gastrografin group were discharged earlier than those in the neostigmine group. Further, patients in the combined group had earlier gas and/or stool discharge and were also discharged from the hospital earlier than those in the neostigmine group. Conclusion: Gastrografin and combined use of gastrografin and neostigmine are effective and viable methods for postoperative ileus cases. Gastrografin can safely be used in patients with anastomoses.

Aim: Femoral hernias often occur with incarceration, resulting in obstruction and strangulation. They usually require emergency surgical intervention and sometimes bowel resection may be required. The aim of this study is to compare the surgical results of femoral hernia cases in emergency or elective conditions.Material and Methods: The medical files of 38 patients who underwent surgery in January 2015-March 2022 with the diagnosis of femoral hernia at the general surgery service at Necmettin Erbakan University Meram Medical Faculty Hospital were retrospectively examined. Demographic data, party-relevant information, surgical technique, content of sac, length of hospital stay, recurrence and complications according to the last polyclinic were retrieved from the patient files and electronic database.Results: The gender distribution of the cases was 81.6% (n=31) females and 11.5% (n=7) males. The mean age was 45.74 +/- 16.11 years. The complication rate among the groups was significantly higher in those undergoing emergency surgery (p=0.014). No significant difference was found between the two groups in terms of the side of hernia (p=0.671).Discussion: Femoral hernia is more common in women. There are different repair techniques. More extensive prospective research is needed to compare surgical techniques and outcomes.

Aims: Constipation is one of the most common complaints of the digestive system. The prevalence of constipation in the general population is approximately 15%. The aim of this study was to investigate the frequency of constipation in medical students, their defecation habits and the correlation between the two. Methods: The study was conducted between 1 January and 1 June 2019 through questionnaires. The relationship between individuals’ defecation habits and chronic constipation was investigated within the scope of the study. Data on age, sex, constipation status, change in bowel habits within the last three months, defecation frequency, time of daily defecation, period spent in the toilet, reading in the toilet, and the type of toilet used were collected. Results: 425 medical students were included in the study. 2.86% of the students reporting constipation were first year undergraduates in medical school, while 7.53% were third and 9.09% were sixth year students. Irregular defecation was higher in all groups. The rate of constipation was high in groups with irregular defecation. It was observed that those with regular defecation habits defecated more in the mornings. When the time spent for defecation was studied, it was seen that it was mostly less than 10 minutes. Conclusion: In the younger population the incidence of constipation is lower compared to the elderly population. Bowel habits, however, vary according to societies and personal characteristics. Reading in the toilet has become a common habit among the younger population. Reading in the toilet elongates the time spent in the toilet.

ABSTRACT Background Hemorrhoidal disease is a common benign anorectal disease. Acute thrombosis that occurs during the course of hemorrhoidal disease is a painful complication. Factors affecting its etiopathogenesis are not known definitively. The aim of this study, therefore, was to assess predisposition to coagulation during the development of the disease. Method 30 patients with acute thrombosed hemorrhoidal disease and 30 other patients with hemorrhoidal disease but no thromboses were included in the study. Samples collected from these patients were analyzed with thromboelastography machines. The results were compared with patients’ demographic data. Results No statistically significant difference was found between the groups as per age, sex, diarrhea, history of a similar attack, history of surgical treatment, spicy food consumption, fibrous food consumption, and regular exercise. The results of our study revealed that the alpha angle was smaller in patients with acute thrombosed hemorrhoidal disease. Conclusion Hypercoagulability does not occur in patients with acute thrombosed hemorrhoidal disease

Background/Aim: Optic nerve sheath diameter (ONSD) measurement is one of the non-invasive techniques used for intracranial pressure (ICP) measurement. ICP changes have been evaluated based on ONSD measurements during many laparoscopic surgeries. However, such analyses in the obese patient populations are limited. This study aimed at investigating the effects of pneumoperitoneum and reverse Trendelenburg and head-up position on ICP based on ONSD measurements in obese patients undergoing laparoscopic cholecystectomy. Methods: This observational study included 60 female patients who were scheduled for laparoscopic cholecystectomy. Obese patients with a body mass index (BMI) of 30 and above were assigned to Group 1, while BMI < 30 patients were assigned to Group 2. The first ONSD measurement was performed just before insufflation (T1). The second measurement was taken 5 min after insufflation (T2), the third measurement 5 min after placing patients in the reverse Trendelenburg and head-up position (T3), and the last measurement 5 min after the deflation while the reverse Trendelenburg and head-up position was maintained (T4). Results: ONSD measurements at the T2 and T3 time points in Group 1 patients were higher than in Group 2 patients (P = 0.012 versus P = 0.020). Both measurement values were higher in obese patients. In Group 1 patients, T2 and T3 measurements were significantly higher than T1 and T4 measurements (T2 > T1; P < 0.001, T2 > T4; P < 0.001, T3 > T1; P < 0.001, and T3 > T4; P < 0.001). No significant difference between T2 and T3 and between T1 and T4 measurements were found. In Group 2 patients, T2 measurements were significantly higher than the T1, T3, and T4 measurements, while T3 measurements were significantly higher than T1 and T4 measurements (T2 > T1; P < 0.001, T2 > T3; P = 0.022, T2 > T4; P < 0.001, T3 > T1; P < 0.001, and T3 > T4; P = 0.048). No significant difference between T1 and T4 measurements was noted. Conclusion: Laparoscopic cholecystectomy does not cause an increase in ICP of obese patients with limited pneumoperitoneum pressure, reverse Trendelenburg and head-up position, and controlled anesthesia.

Abstract Background: Different attitudes are followed in the literature regarding the treatment of postoperative fistulas. We have concluded that the drain can be safely removed in appropriate patients after the fistula tract has matured. Methods: In patients with fistula, drain flow was monitored until the fistula tract developed. In general, we waited until the fifteenth day for safety to ensure that the fistula tract matured. The drain was removed unchanged and unshortened all at once. The patients were followed up with clinical and imaging methods in the next days, weeks, and months. Results: We had a total of 15 patients with fistula. The mean age of the patients was 44.6 (10-81) years. 9 of the 15 patients were male and 6 were female (60%, 40%). Eleven patients developed pancreaticobiliary fistulas, one had a tracheoesophageal fistula, and three had chylous fistulas. Conclusions: In the 15 patients we presented, drains were a mechanical obstacle to the closure of fistulas. After the drain removed patients stasis,leakage or spread did not occur. We think that our experience based on a limited number of patients will bring our thesis that the drain itself prevents fistula closure in some patients to the literature.

OBJECTIVES:In this study, we aimed to demonstrate the relationship between he neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), neutrophil/monocyte rate (NMR) and mean platelet volume (MPV) in patients with BIRADS grades of benign breast lesions.BACKGROUND:In many recent studies, NLR, PLR, NMR and MPV change significantly in connection with chronic inflammation and are suggested for use as prognostic markers in some diseases. However, the relationship between the cancer probability of benign breast diseases and mentioned hematological parameters has not been investigated in any previous study. We used the BIRADS classification to evaluate the malignancy probability of the cases.METHODS:The hospital database of records of patients who were over 15 years of age and examined with bilateral ultrasonography between October 2019 and February 2020 were retrospectively scanned.RESULTS:In total, 168 patients were included in the study. The average NLR and NMR values were higher in the BIRADS 2 group. There was no significant difference between the average PLR and MPV values of BIRADS groups.CONCLUSIONS:Although some results seem to be statistically significant, there was no significant relationship between the hematological parameters we examined and the BIRADS grades of benign breast lesions (Tab. 2, Ref. 18).

Anticoagulant therapy is part of the treatment of hospitalized COVID-19 patients. Low molecular weight heparin or oral anticoagulant drugs are used in its treatment. However this approach may increase the risks of bleeding. Rectus sheath hematoma (RSH) is a known complication of anticoagulant therapy and a source of potential morbidity and mortality. Here; we present a patient who developed rectus hematoma during the COVID-19 treatment and followed by us with conservative approach.

Background: Recurrent laryngeal nerve (RLN) injury is an important complication of thyroid surgery. In our study, we aimed to compare the effects of primary repair and polyglycolic acid (PGA) coated tube repair on nerve function and regeneration in RLN cuts in rats. Methods: Twenty seven rats were used for the study. Group-1 with only nerve cuts, group-2 with primary repair, and group-3 with conduit repair. The study was planned over two-stage surgery. In the first step, nerve defect formation and nerve repair were performed in the same session. In the second step, samples were taken from the subjects for histopathological. Results: Vocal cord mobility was proportionally higher in group-3 than other groups. However, there was no statistically significant difference between the groups (p < 0.239). The mean number of highest axons were detected the group-3. Conclusions: We think that PGA coated conduit can provide a more accurate orientation of nerve fibers by creating an isolated environment when compared to the primary repair. And this may be the cause of functional improvement in the nerve. (C) 2019 Elsevier Inc. All rights reserved.

BACKGROUND:Appendiceal mucocele is a rarely seen disease which occurs when the appendix lumen is filled and obstructed by mucous. In our study, we aimed to reveal the surgical approach of our clinic, features of tumors, and clinical presentations in line with literature in cases of appendix mucocele.METHODS:Fourteen appendix mucocele patients who were admitted in our hospital between 2012 and 2019 were examined retrospectively in the electronic recording medium. Our patients were evaluated in terms of age, gender, clinical status, operation, imaging results, and pathology results.RESULTS:Of the fourteen patients, 12 applied to the emergency department and 2 to the general surgery clinic. All of our patients had abdominal pain at the time of admission. In the physical examination, 5 (35%) patients had defenses, 10 (71%) patients had rebound tenderness, and 12 (85%) patients had tenderness. In preoperative imaging studies, 11 patients were interpreted as having acute appendicitis and 3 patients were evaluated as having appendix mucocele. The pathological results were reported as 6 patients had appendiceal mucocele and 8 patients had appendiceal mucocele together with acute appendicitis.CONCLUSION:Appendiceal mucocele is a disease which generally causes similar clinical findings of acute appendicitis. Ultrasound and CT may be useful in preoperative diagnosis. Surgical treatment options of mucocele are open or laparoscopic appendectomy, cecum resection, and right hemicolectomy. Although its incidence is low, due to pseudomyxoma peritonei, it is a pathology that requires careful surgery.