Aims: The reproductive toxicity of endocrine-disrupting chemicals (EDCs) is well known, but the underlying mechanism remains unclear. Receptor-interacting serine/threonine protein kinase 1 (RIPK1) mainly mediates cell death and inflammation. It is crucial to both necroptosis and apoptosis. Therefore, in this study, we aimed to investigate the changes in RIPK1 expression levels immunohistochemically in the adverse mechanism of EDCs on spermatogenic cells. Methods: Forty-two Wistar Albino male rats (10 weeks old, 250±50 g) were assigned into seven groups. Bisphenol A (BPA), 4-Nonylphenol (NP), and their mixtures at low 25 mg/kg doses and high 100 mg/kg doses were used. The control group received corn oil via gastric tube. At the end of the 21 days of the experimental protocol, the testis tissues were extracted and immersed in Bouin's solution. Five µm sections were taken from the tissue and stained immunohistochemically with an anti-RIPK1 antibody. Histo (H)-score was calculated by determining the intensity of immunoreactivity in the sections. Results: The results showed that the mixed dose group and all high-dose group round spermatids had excessive RIPK1 immunoreactivities compared to the control group and individually low-dose group of both (p<0.01). This result might be responsible for poor sperm quality, motility disruptions, or other reproductive consequences. Conclusion: In conclusion, RIPK1 overactivation may be essential in pathophysiological conditions caused by EDC exposure at high doses and their mixture. Further studies are now needed to evaluate RIPK1 overactivation in testis tissues.
{"title":"Immunohistochemical investigation of the effects of different doses of some endocrine-disrupting chemicals on receptorinteracting serine/threonine-protein kinase 1 (RIPK1) levels in the testis","authors":"Kıymet Kübra Tüfekci","doi":"10.51271/kmj-0119","DOIUrl":"https://doi.org/10.51271/kmj-0119","url":null,"abstract":"Aims: The reproductive toxicity of endocrine-disrupting chemicals (EDCs) is well known, but the underlying mechanism remains unclear. Receptor-interacting serine/threonine protein kinase 1 (RIPK1) mainly mediates cell death and inflammation. It is crucial to both necroptosis and apoptosis. Therefore, in this study, we aimed to investigate the changes in RIPK1 expression levels immunohistochemically in the adverse mechanism of EDCs on spermatogenic cells. Methods: Forty-two Wistar Albino male rats (10 weeks old, 250±50 g) were assigned into seven groups. Bisphenol A (BPA), 4-Nonylphenol (NP), and their mixtures at low 25 mg/kg doses and high 100 mg/kg doses were used. The control group received corn oil via gastric tube. At the end of the 21 days of the experimental protocol, the testis tissues were extracted and immersed in Bouin's solution. Five µm sections were taken from the tissue and stained immunohistochemically with an anti-RIPK1 antibody. Histo (H)-score was calculated by determining the intensity of immunoreactivity in the sections. Results: The results showed that the mixed dose group and all high-dose group round spermatids had excessive RIPK1 immunoreactivities compared to the control group and individually low-dose group of both (p<0.01). This result might be responsible for poor sperm quality, motility disruptions, or other reproductive consequences. Conclusion: In conclusion, RIPK1 overactivation may be essential in pathophysiological conditions caused by EDC exposure at high doses and their mixture. Further studies are now needed to evaluate RIPK1 overactivation in testis tissues.","PeriodicalId":369732,"journal":{"name":"Kastamonu Medical Journal","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136100336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
İdris Kurt, Doğan Albayrak, Osman Kula, Ali Rıza Soylu
Aims: We aimed to present the characteristics, indications, endoscopic ultrasonography procedure details, diagnoses and complication rate of patients who underwent endosonpgraphy in a single center. Methods: Forty six patients admitted to Trakya Unversity Faculty of Medicine and underwent EUS (±FNA) procedure between January 2021 and May 2022 were included in the study. Patients files were analysed retrospectively. Demographic characteristics, presence and types of comorbidity, presence and types of malignancy in the family, use of antithrombotic drugs, laboratory data, details of eus procedure, pathology results, adverse events were recorded. The data obtained in the study were analyzed using Statistical Package for Social Science for Windows 26 package program. Results: A total of 46 patients were included in the study. 46% (n=21) were women. The median age was 64 (28-87). Antithrombotic use was present in 25% of the patients. Comorbidities were present in 84% of patients. The indications for EUS were predominantly pancreatic lesions (n=31). Aspirations were performed in addition to ultrasonographic examination in 78% (n=36) of the patients. 19 G (Gauge) needles were used in 30 and 25 G needles were used in 6 patients. Biopsy stations were stomach (n=31), duodenum (n=4), esophagus (n=1). Median long axis of the lesions was 34 (7-173) mm and the short axis was 26 (1-76) mm. 42% of the biopsied pancreatic lesions were cystic and 58% were solid. The CA19-9 level in solid lesions was statistically significantly higher than cystic (1512 /28 U/ml; p= 0.008). CA19-9 level was found mean 2061±3295 U/ml in patients with adenocarcinoma (n=8), 71±106 U/ml in cystic neoplasm and 152±338 in benign disorders (p=0.026). Cut-off value predicting adenocarsinoma with %87,5 spesifity and %87,5 sensitivity in our cohort was 174 U/ml (( AUC 0.85 ( 0.63-1)). Spesifity and sensitivity of the level 40 ( nearest level to universaly detected upper limit: 37 U/mL) was %62,5 and %87,5 respectively. Comparing malignant and benign lesions of pancreas overall, no statistical significance was found of CA19-9 level in predicting the diagnosis of tumor (p=0.15). Of the patients who underwent biopsy, 61% were malignant and 39% were benign. Malignant diagnoses were: adenocarsinoma, cystic neoplasm, gastrointestinal stromal tumor, neuroendocrine tumor, mesenchymal tumor, lumphoma, metastasis. Benign diagnoses were: otoimmune pancreatitis, normal cyst, chronic pancreatitis, pseudocyst, walled-off necrosis, polyp, no lesion. Post-procedure complications were not observed in any of the patients. Conclusion: The availability of endoscopic ultrasonography is expanding nowadays. Endoscopy ultrasonography is a precise, advantageous, and risk-free technique when performed by trained personnel.
目的:介绍单中心超声内镜检查患者的特点、适应证、超声内镜检查程序、诊断及并发症发生率。方法:研究纳入了2021年1月至2022年5月期间在Trakya大学医学院接受EUS(±FNA)手术的46例患者。回顾性分析患者档案。记录人口统计学特征、合并症的存在和类型、家庭中恶性肿瘤的存在和类型、抗血栓药物的使用、实验室数据、eus手术的细节、病理结果、不良事件。使用Statistical Package for Social Science for Windows 26软件包程序对研究所得数据进行分析。结果:共纳入46例患者。46% (n=21)为女性。中位年龄为64岁(28-87岁)。25%的患者使用抗血栓药物。84%的患者存在合并症。EUS的适应症主要是胰腺病变(n=31)。78% (n=36)的患者在超声检查的同时进行了穿刺检查。30例使用19g (Gauge)针，6例使用25g针。活检部位为胃(31例)、十二指肠(4例)、食道(1例)。胰腺中位长轴34 (7-173)mm，短轴26 (1-76)mm。42%的活检胰腺病变为囊性，58%为实性。实性病变CA19-9水平显著高于囊性病变(1512 /28 U/ml;p = 0.008)。腺癌患者CA19-9水平平均为2061±3295 U/ml (n=8)，囊性肿瘤患者为71±106 U/ml，良性疾病患者为152±338 U/ml (p=0.026)。在我们的队列中，预测腺癌的特异性和敏感性分别为% 87.5和% 87.5的临界值为174 U/ml (AUC 0.85(0.63-1))。40级(最接近普遍检测上限37 U/mL)的特异性和敏感性分别为% 62.5%和% 87.5%。总体比较胰腺良恶性病变，CA19-9水平对肿瘤诊断的预测意义无统计学意义(p=0.15)。在接受活检的患者中，61%为恶性，39%为良性。恶性诊断:腺癌、囊性肿瘤、胃肠道间质瘤、神经内分泌瘤、间质瘤、肿块、转移瘤。良性诊断:耳免疫性胰腺炎，正常囊肿，慢性胰腺炎，假性囊肿，壁闭塞性坏死，息肉，无病变。所有患者均未出现术后并发症。结论:超声内镜检查的应用范围不断扩大。内窥镜超声检查是一种精确、有利和无风险的技术，当由训练有素的人员执行时。
{"title":"Characteristics and endoscopic ultrasound findings of gastrointestinal lesions: single-center experience","authors":"İdris Kurt, Doğan Albayrak, Osman Kula, Ali Rıza Soylu","doi":"10.51271/kmj-0118","DOIUrl":"https://doi.org/10.51271/kmj-0118","url":null,"abstract":"Aims: We aimed to present the characteristics, indications, endoscopic ultrasonography procedure details, diagnoses and complication rate of patients who underwent endosonpgraphy in a single center. Methods: Forty six patients admitted to Trakya Unversity Faculty of Medicine and underwent EUS (±FNA) procedure between January 2021 and May 2022 were included in the study. Patients files were analysed retrospectively. Demographic characteristics, presence and types of comorbidity, presence and types of malignancy in the family, use of antithrombotic drugs, laboratory data, details of eus procedure, pathology results, adverse events were recorded. The data obtained in the study were analyzed using Statistical Package for Social Science for Windows 26 package program. Results: A total of 46 patients were included in the study. 46% (n=21) were women. The median age was 64 (28-87). Antithrombotic use was present in 25% of the patients. Comorbidities were present in 84% of patients. The indications for EUS were predominantly pancreatic lesions (n=31). Aspirations were performed in addition to ultrasonographic examination in 78% (n=36) of the patients. 19 G (Gauge) needles were used in 30 and 25 G needles were used in 6 patients. Biopsy stations were stomach (n=31), duodenum (n=4), esophagus (n=1). Median long axis of the lesions was 34 (7-173) mm and the short axis was 26 (1-76) mm. 42% of the biopsied pancreatic lesions were cystic and 58% were solid. The CA19-9 level in solid lesions was statistically significantly higher than cystic (1512 /28 U/ml; p= 0.008). CA19-9 level was found mean 2061±3295 U/ml in patients with adenocarcinoma (n=8), 71±106 U/ml in cystic neoplasm and 152±338 in benign disorders (p=0.026). Cut-off value predicting adenocarsinoma with %87,5 spesifity and %87,5 sensitivity in our cohort was 174 U/ml (( AUC 0.85 ( 0.63-1)). Spesifity and sensitivity of the level 40 ( nearest level to universaly detected upper limit: 37 U/mL) was %62,5 and %87,5 respectively. Comparing malignant and benign lesions of pancreas overall, no statistical significance was found of CA19-9 level in predicting the diagnosis of tumor (p=0.15). Of the patients who underwent biopsy, 61% were malignant and 39% were benign. Malignant diagnoses were: adenocarsinoma, cystic neoplasm, gastrointestinal stromal tumor, neuroendocrine tumor, mesenchymal tumor, lumphoma, metastasis. Benign diagnoses were: otoimmune pancreatitis, normal cyst, chronic pancreatitis, pseudocyst, walled-off necrosis, polyp, no lesion. Post-procedure complications were not observed in any of the patients. Conclusion: The availability of endoscopic ultrasonography is expanding nowadays. Endoscopy ultrasonography is a precise, advantageous, and risk-free technique when performed by trained personnel.","PeriodicalId":369732,"journal":{"name":"Kastamonu Medical Journal","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136100172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aims: Spontaneous intracerebral hemorrhage (SIH) is a common cerebrovascular disease associated with high mortality and poor clinical outcomes. This study aimed to investigate the fundamental characteristics of patients with SIH, their treatment practices, and early results to provide a comprehensive overview. Methods: Patient records from 2017 to 2021 were reviewed following approval from the ethics committee of our hospital. Demographic data, surgical and medical treatments applied in the intensive care unit (ICU), and immediate clinical outcome data of patients meeting the study criteria were recorded and analyzed. Results: A total of 153 patients were included in this study. The mortality rate in SIH patients was identified as 53.59%. The mean age value of those who died was found to be higher. In these patients, "fainting" as the initial symptom was found to be more common, while "Focal Neurological Deficits" were less common. A lower median Glasgow Coma Scale (GCS) and higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were also observed. It was noted that the fresh frozen plasma (FFP) usage rate was higher, whereas the usage rate of oral antihypertensives was lower in those who died. It was determined that 33.33 of patients, 33.33% were transferred to a service (neurology or neurosurgery), 11.76% received palliative care, and 1.31% received home care. Conclusion: The mortality rate of patients with SIH is extremely high, and treatment in intensive care should be conducted according to current guidelines. More comprehensive studies are needed to standardize the appropriate treatment approaches. Alongside suitable treatment strategies to reduce mortality, identifying and supporting surviving patients' long-term treatment and rehabilitation needs are of great significance.
{"title":"Assessing characteristics, treatment approaches, and outcomes of spontaneous intracerebral hemorrhage patients in intensive care: a retrospective study","authors":"Serpil Ekin, Asiye Demirel, İlkay Ceylan, Şermin Eminoğlu, Şeyda Efsun Özgünay","doi":"10.51271/kmj-0113","DOIUrl":"https://doi.org/10.51271/kmj-0113","url":null,"abstract":"Aims: Spontaneous intracerebral hemorrhage (SIH) is a common cerebrovascular disease associated with high mortality and poor clinical outcomes. This study aimed to investigate the fundamental characteristics of patients with SIH, their treatment practices, and early results to provide a comprehensive overview. Methods: Patient records from 2017 to 2021 were reviewed following approval from the ethics committee of our hospital. Demographic data, surgical and medical treatments applied in the intensive care unit (ICU), and immediate clinical outcome data of patients meeting the study criteria were recorded and analyzed. Results: A total of 153 patients were included in this study. The mortality rate in SIH patients was identified as 53.59%. The mean age value of those who died was found to be higher. In these patients, \"fainting\" as the initial symptom was found to be more common, while \"Focal Neurological Deficits\" were less common. A lower median Glasgow Coma Scale (GCS) and higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were also observed. It was noted that the fresh frozen plasma (FFP) usage rate was higher, whereas the usage rate of oral antihypertensives was lower in those who died. It was determined that 33.33 of patients, 33.33% were transferred to a service (neurology or neurosurgery), 11.76% received palliative care, and 1.31% received home care. Conclusion: The mortality rate of patients with SIH is extremely high, and treatment in intensive care should be conducted according to current guidelines. More comprehensive studies are needed to standardize the appropriate treatment approaches. Alongside suitable treatment strategies to reduce mortality, identifying and supporting surviving patients' long-term treatment and rehabilitation needs are of great significance.","PeriodicalId":369732,"journal":{"name":"Kastamonu Medical Journal","volume":"89 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136100334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sacide Pehlivan, Ayşe Feyda Nursal, Yasemin Oyacı, Mustafa Pehlivan, Mehmet Bekerecioğlu
Aims: Microtia is defined as a congenital malformation of the middle and external ears. DNA methylation is the major epigenetic modification of genomic DNA that is regulated in the early embryonic stage. In this study, we analyzed the methylation status of the MB-COMT, APC2, NR3C1, and DRD2 genes in patients with microtia. Methods: The blood samples were taken from microtia patients and healthy controls. Genomic DNA was isolated using a commercial kit. The methylation status of the MB-COMT, APC2, NR3C1, and DRD2 genes was analyzed using the methylation-specific polymerase chain reaction (MS-PCR) method. The results were evaluated statistically. Results: The DRD2 methylation status was found to be associated with microtia (p?0.001). We found that the DRD2 gene was partially methylated in all patients with microtia. There was no significant difference between the methylation status of the MB-COMT, APC2, and NR3C1 genes and microtia. Conclusion: To our knowledge, this is the first study in our country to evaluate the relationship between the methylation of these genes and the risk of microtia. Our results demonstrate the presence of epigenetic changes in the DRD2 gene during microtia development. Methylation may have contributed to the pathogenesis of microtia as it affects gene expression. Studies with larger sample sizes and in different ethnic groups are needed to further investigate the role of these genes in microtia.
{"title":"Evaluation of the methylation status of the MB-COMT, APC2, NR3C1, and DRD2 genes in Turkish patients with microtia","authors":"Sacide Pehlivan, Ayşe Feyda Nursal, Yasemin Oyacı, Mustafa Pehlivan, Mehmet Bekerecioğlu","doi":"10.51271/kmj-0121","DOIUrl":"https://doi.org/10.51271/kmj-0121","url":null,"abstract":"Aims: Microtia is defined as a congenital malformation of the middle and external ears. DNA methylation is the major epigenetic modification of genomic DNA that is regulated in the early embryonic stage. In this study, we analyzed the methylation status of the MB-COMT, APC2, NR3C1, and DRD2 genes in patients with microtia. Methods: The blood samples were taken from microtia patients and healthy controls. Genomic DNA was isolated using a commercial kit. The methylation status of the MB-COMT, APC2, NR3C1, and DRD2 genes was analyzed using the methylation-specific polymerase chain reaction (MS-PCR) method. The results were evaluated statistically. Results: The DRD2 methylation status was found to be associated with microtia (p?0.001). We found that the DRD2 gene was partially methylated in all patients with microtia. There was no significant difference between the methylation status of the MB-COMT, APC2, and NR3C1 genes and microtia. Conclusion: To our knowledge, this is the first study in our country to evaluate the relationship between the methylation of these genes and the risk of microtia. Our results demonstrate the presence of epigenetic changes in the DRD2 gene during microtia development. Methylation may have contributed to the pathogenesis of microtia as it affects gene expression. Studies with larger sample sizes and in different ethnic groups are needed to further investigate the role of these genes in microtia.","PeriodicalId":369732,"journal":{"name":"Kastamonu Medical Journal","volume":"91 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136100173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Asude Ünal, Mehmet Eser Sancaktar, Ayşe Çeçen, Murat Ünal
Aims: To investigate the effects of patient-controlled analgesia with tramadol (PCA-T) applicated in the postoperative inpatient period for adult tonsillectomies (TT). Methods: The records of adult TTies were retrospectively scanned. The indications, surgical technique, postoperative complaints, length of stay (LOS) and re-admissions have been recorded in both groups treated with PCA-T and conventional analgesics during inpatient period. The data was analyzed with SPSS Statistics 23 program. Results: Totally 242 patients (n=242) met the inclusion criteria with a mean age of 28.47±8.44 years. PCA-T (n = 70) was mostly preferred in patients with the indications of tonsillar hypertrophy (TH) and recurrent tonsillitis (RH) + TH indications (p<0.05). In patients operated with a Plasma blade (PB), the PCA-T application rate (50.9%) was significantly higher than those operated with bipolar radiofrequency clamp (BRC) (22.1%) or cold dissection (CD) (23.0%) (p<0,001). No significant effects of PCA-T were observed on postoperative complications, LOS, and re-admission rates (p>0.05). Conclusions: Although PCA-T is more preferred for the adult TTies with an indication of TH and TTies performed with PB, it does not provide an advantage over conventional analgesic methods.
{"title":"The assessment of patient-controlled analgesia with tramadol in adult tonsillectomy","authors":"Asude Ünal, Mehmet Eser Sancaktar, Ayşe Çeçen, Murat Ünal","doi":"10.51271/kmj-0120","DOIUrl":"https://doi.org/10.51271/kmj-0120","url":null,"abstract":"Aims: To investigate the effects of patient-controlled analgesia with tramadol (PCA-T) applicated in the postoperative inpatient period for adult tonsillectomies (TT). Methods: The records of adult TTies were retrospectively scanned. The indications, surgical technique, postoperative complaints, length of stay (LOS) and re-admissions have been recorded in both groups treated with PCA-T and conventional analgesics during inpatient period. The data was analyzed with SPSS Statistics 23 program. Results: Totally 242 patients (n=242) met the inclusion criteria with a mean age of 28.47±8.44 years. PCA-T (n = 70) was mostly preferred in patients with the indications of tonsillar hypertrophy (TH) and recurrent tonsillitis (RH) + TH indications (p<0.05). In patients operated with a Plasma blade (PB), the PCA-T application rate (50.9%) was significantly higher than those operated with bipolar radiofrequency clamp (BRC) (22.1%) or cold dissection (CD) (23.0%) (p<0,001). No significant effects of PCA-T were observed on postoperative complications, LOS, and re-admission rates (p>0.05). Conclusions: Although PCA-T is more preferred for the adult TTies with an indication of TH and TTies performed with PB, it does not provide an advantage over conventional analgesic methods.","PeriodicalId":369732,"journal":{"name":"Kastamonu Medical Journal","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136100174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aims: This study presents a modified colorectal anastomosis method that consists of multi-task use of a circular stapler and anal eversion to perform a safer anastomosis. We aimed to describe the anorectal eversion and anastomosis techniques in detail and compare the results of the modified technique with those of the standard laparoscopic surgical technique. Methods: This retrospective study was conducted with fifty-five patients who underwent laparoscopic TME for middle and distal rectal cancer between 2016-2022. The patients were divided into two groups: those who underwent standard laparoscopic transabdominal surgery and those who underwent anorectal eversion (Modified ASET Method). The baseline features of the patients and the distribution of surgical outcomes between the two groups were statistically compared. Results: The Modified ASET group consisted of twenty-one patients. The morbidity rate associated with this procedure was 14.2%. CRM was positive in 9.5% of patients, and a safe distal surgical margin was achieved in all patients. The local recurrence rate is 4.7%. No statistically significant difference was observed between the Modified ASET and standard TME groups in terms of oncological outcomes (p = 0.828). Conclusion: Anorectal stump eversion and extra-abdominal transection-based modified colorectal anastomosis are reliable approaches that provide satisfactory surgical outcomes.
{"title":"A modified anal eversion technique for colorectal anastomosis in laparoscopic rectal cancer surgery","authors":"Mehmet Aslan, Oktay Karaköse","doi":"10.51271/kmj-0115","DOIUrl":"https://doi.org/10.51271/kmj-0115","url":null,"abstract":"Aims: This study presents a modified colorectal anastomosis method that consists of multi-task use of a circular stapler and anal eversion to perform a safer anastomosis. We aimed to describe the anorectal eversion and anastomosis techniques in detail and compare the results of the modified technique with those of the standard laparoscopic surgical technique. Methods: This retrospective study was conducted with fifty-five patients who underwent laparoscopic TME for middle and distal rectal cancer between 2016-2022. The patients were divided into two groups: those who underwent standard laparoscopic transabdominal surgery and those who underwent anorectal eversion (Modified ASET Method). The baseline features of the patients and the distribution of surgical outcomes between the two groups were statistically compared. Results: The Modified ASET group consisted of twenty-one patients. The morbidity rate associated with this procedure was 14.2%. CRM was positive in 9.5% of patients, and a safe distal surgical margin was achieved in all patients. The local recurrence rate is 4.7%. No statistically significant difference was observed between the Modified ASET and standard TME groups in terms of oncological outcomes (p = 0.828). Conclusion: Anorectal stump eversion and extra-abdominal transection-based modified colorectal anastomosis are reliable approaches that provide satisfactory surgical outcomes.","PeriodicalId":369732,"journal":{"name":"Kastamonu Medical Journal","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136100335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aims: Technological advancements have played a crucial role in the advanced development of organ support systems in intensive care units (ICUs). While the utilization of support systems enhances patient discharge rates, it also extends the ICU stay of patients with terminal comorbidities who have no chance of survival. This elongation of the dying process, which is the inevitable outcome, results in a suspension of life in a sense. Hence, the effective implementation of end-of-life decisions and care stands as one of the crucial steps in the intensive care process. The objective of this study is to identify barriers to end-of-life decision-making and care in intensive care settings. Its aim is to facilitate a comprehensive, suitable, and peaceful experience for patients at the end of life and their families by making the necessary arrangements. Methods: This survey study involved physicians and nurses evaluating the prepared questionnaire questions concerning the challenges encountered in intensive care settings. Results: The most important barriers to making end-of-life decisions in intensive care were; among clinician-related factors, concern about legal liability for withholding life-sustaining treatments was 98 (79.7%), among institutional and ICU-related factors, the lack of regulated protocols and standards for end-of-life decisions and care was 96 (78%), among family-related factors, unrealistic expectations of patients and/or families about the prognosis or effectiveness of ICU treatment was 83 (67.5%), and disagreements among family members about end-of-life decisions was 80 (65%).Regarding end-of-life care, the admission of patients to the intensive care unit who would not benefit from treatments in the intensive care unit was rated as 110 (89.4%) and the absence of palliative care services to which a dying patient could be transferred was rated as 108 (87.8%). Conclusion: Providing unavailing treatments to patients who will not benefit from intensive care interventions results in a decline in quality of life, increased distress among family members, and burnout among intensive care staff. Therefore, end-of-life decisions and care should be effectively implemented in intensive care units. Ensuring adequate training, fostering effective communication between clinicians and families, and maximizing collaboration and communication with the ICU team and other medical departments can facilitate prompt and effective decision-making regarding end-of-life care.
{"title":"Barriers to end-of-life decisions and care objectives in intensive care units","authors":"Ahmet Sari, Osman Ekinci","doi":"10.51271/kmj-0111","DOIUrl":"https://doi.org/10.51271/kmj-0111","url":null,"abstract":"Aims: Technological advancements have played a crucial role in the advanced development of organ support systems in intensive care units (ICUs). While the utilization of support systems enhances patient discharge rates, it also extends the ICU stay of patients with terminal comorbidities who have no chance of survival. This elongation of the dying process, which is the inevitable outcome, results in a suspension of life in a sense. Hence, the effective implementation of end-of-life decisions and care stands as one of the crucial steps in the intensive care process. The objective of this study is to identify barriers to end-of-life decision-making and care in intensive care settings. Its aim is to facilitate a comprehensive, suitable, and peaceful experience for patients at the end of life and their families by making the necessary arrangements. Methods: This survey study involved physicians and nurses evaluating the prepared questionnaire questions concerning the challenges encountered in intensive care settings. Results: The most important barriers to making end-of-life decisions in intensive care were; among clinician-related factors, concern about legal liability for withholding life-sustaining treatments was 98 (79.7%), among institutional and ICU-related factors, the lack of regulated protocols and standards for end-of-life decisions and care was 96 (78%), among family-related factors, unrealistic expectations of patients and/or families about the prognosis or effectiveness of ICU treatment was 83 (67.5%), and disagreements among family members about end-of-life decisions was 80 (65%).Regarding end-of-life care, the admission of patients to the intensive care unit who would not benefit from treatments in the intensive care unit was rated as 110 (89.4%) and the absence of palliative care services to which a dying patient could be transferred was rated as 108 (87.8%). Conclusion: Providing unavailing treatments to patients who will not benefit from intensive care interventions results in a decline in quality of life, increased distress among family members, and burnout among intensive care staff. Therefore, end-of-life decisions and care should be effectively implemented in intensive care units. Ensuring adequate training, fostering effective communication between clinicians and families, and maximizing collaboration and communication with the ICU team and other medical departments can facilitate prompt and effective decision-making regarding end-of-life care.","PeriodicalId":369732,"journal":{"name":"Kastamonu Medical Journal","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136099979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aims: Differential diagnosis of epilepsy and psychogenic non-epileptic seizures (PNES) is a great challenge. Intense neuronal activity during epileptic seizures can cause neuroinflammation. Immature granulocyte (IG) is a new inflammatory marker analyzed in hemogram. This study investigated the role of IG in differentiating epilepsy from PNES. Methods: In this retrospective study, patients who applied to the emergency department for the first time with seizures and were diagnosed with epilepsy/PNES (clinical evaluation and electroencephalography) after included the seizure by the neurology clinical follow-up. Of the 84 patients, 54 had epilepsy, and 30 had PNES. Hemogram analyses were performed within 2 hours of the onset of the seizure. Results: The IG count was 0.03 x109/L (0.02-0.06) and 0.03 x109/L (0.02-0.05) in the epilepsy and PNES groups, respectively. The two groups had no statistically significant difference (p=0.291). Only serum C-reactive protein (CRP) levels significantly differed between the two groups (p=0.031). The ROC curve analysis for the CRP test yielded a serum CRP value of 2.35 mg/L, with a sensitivity of 0.57 and a specificity of 0.73, as the optimal cut-off value for distinguishing epilepsy from PNES. The ROC analysis for the AUC yielded an estimate of 0.64 (95% confidence interval: 0.52-0.77). Conclusion: In conclusion, only CRP was useful in differentiating epilepsy from PNES in the study. However, the IG count did not help to separate the two seizures. Therefore, these findings should be confirmed by further prospective studies with large samples assessing the IG count. This study evaluating the IG count, a new inflammatory marker, will contribute to the literature.
{"title":"Can immature granulocyte (IG), an inflammatory marker, be used in the differential diagnosis of epilepsy and non-epileptic psychogenic seizure?","authors":"Mehmet Akif Bildirici, Idris Kocatürk","doi":"10.51271/kmj-0117","DOIUrl":"https://doi.org/10.51271/kmj-0117","url":null,"abstract":"Aims: Differential diagnosis of epilepsy and psychogenic non-epileptic seizures (PNES) is a great challenge. Intense neuronal activity during epileptic seizures can cause neuroinflammation. Immature granulocyte (IG) is a new inflammatory marker analyzed in hemogram. This study investigated the role of IG in differentiating epilepsy from PNES. Methods: In this retrospective study, patients who applied to the emergency department for the first time with seizures and were diagnosed with epilepsy/PNES (clinical evaluation and electroencephalography) after included the seizure by the neurology clinical follow-up. Of the 84 patients, 54 had epilepsy, and 30 had PNES. Hemogram analyses were performed within 2 hours of the onset of the seizure. Results: The IG count was 0.03 x109/L (0.02-0.06) and 0.03 x109/L (0.02-0.05) in the epilepsy and PNES groups, respectively. The two groups had no statistically significant difference (p=0.291). Only serum C-reactive protein (CRP) levels significantly differed between the two groups (p=0.031). The ROC curve analysis for the CRP test yielded a serum CRP value of 2.35 mg/L, with a sensitivity of 0.57 and a specificity of 0.73, as the optimal cut-off value for distinguishing epilepsy from PNES. The ROC analysis for the AUC yielded an estimate of 0.64 (95% confidence interval: 0.52-0.77). Conclusion: In conclusion, only CRP was useful in differentiating epilepsy from PNES in the study. However, the IG count did not help to separate the two seizures. Therefore, these findings should be confirmed by further prospective studies with large samples assessing the IG count. This study evaluating the IG count, a new inflammatory marker, will contribute to the literature.","PeriodicalId":369732,"journal":{"name":"Kastamonu Medical Journal","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136100175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aims: During the pandemic due to Coronavirus disease 2019 (COVID-19) many elective operations were postponed, while emergency surgical operations inevitably continued. Emergency general surgery procedures are known to have worse outcomes compared to elective ones. Besides, it is conceivable that COVID-19 itself may worsen surgical outcomes due to it may cause respiratory distress and multi-organ dysfunction. We aimed to present patients’ data who underwent surgery due to trauma and emergency general surgery diseases during the COVID-19 pandemic and the effect of COVID-19 on surgical outcomes in this study. Methods: Two hundred and thirty-five patients who underwent surgery due to trauma or emergency between March 2020 and January 2021 were enrolled. Two groups were created according to the COVID-19 status as positive (n=16) and negative (n=219). The demographics, clinical, laboratory, and perioperative data were analyzed and compared between these groups. Results: The median age of the patients was 51 (18-97) years, and 144 (61.2%) of them were male. The most common diagnosis was acute appendicitis (n= 121, 51.5%) followed by ileus. Subgroup comparisons showed that the COVID-19 (+) group had more patients with comorbidity and had higher C-reactive protein values, these differences were significant (p= 0.049, p= 0.001, respectively). Open surgery was performed significantly more in the COVID-19 (+) group (p= 0.037). Serious postoperative complications and mortality were seen more in the COVID-19 (+) group, but the differences were not significant. Patients with COVID-19 had significantly longer hospital stay (p= 0.007). Conclusion: COVID-19 positivity was found to have a negative impact on postoperative surgical outcomes in terms of emergency operations. It is not clear whether this negativity is due to the COVID-19 disease itself or the worse characteristics of patients with COVID-19.
{"title":"The impact of COVID-19 on postoperative outcomes of emergency general surgery operations","authors":"Bora Barut, Yusuf Murat Bag","doi":"10.51271/kmj-0116","DOIUrl":"https://doi.org/10.51271/kmj-0116","url":null,"abstract":"Aims: During the pandemic due to Coronavirus disease 2019 (COVID-19) many elective operations were postponed, while emergency surgical operations inevitably continued. Emergency general surgery procedures are known to have worse outcomes compared to elective ones. Besides, it is conceivable that COVID-19 itself may worsen surgical outcomes due to it may cause respiratory distress and multi-organ dysfunction. We aimed to present patients’ data who underwent surgery due to trauma and emergency general surgery diseases during the COVID-19 pandemic and the effect of COVID-19 on surgical outcomes in this study. Methods: Two hundred and thirty-five patients who underwent surgery due to trauma or emergency between March 2020 and January 2021 were enrolled. Two groups were created according to the COVID-19 status as positive (n=16) and negative (n=219). The demographics, clinical, laboratory, and perioperative data were analyzed and compared between these groups. Results: The median age of the patients was 51 (18-97) years, and 144 (61.2%) of them were male. The most common diagnosis was acute appendicitis (n= 121, 51.5%) followed by ileus. Subgroup comparisons showed that the COVID-19 (+) group had more patients with comorbidity and had higher C-reactive protein values, these differences were significant (p= 0.049, p= 0.001, respectively). Open surgery was performed significantly more in the COVID-19 (+) group (p= 0.037). Serious postoperative complications and mortality were seen more in the COVID-19 (+) group, but the differences were not significant. Patients with COVID-19 had significantly longer hospital stay (p= 0.007). Conclusion: COVID-19 positivity was found to have a negative impact on postoperative surgical outcomes in terms of emergency operations. It is not clear whether this negativity is due to the COVID-19 disease itself or the worse characteristics of patients with COVID-19.","PeriodicalId":369732,"journal":{"name":"Kastamonu Medical Journal","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136100171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 35-year-old male patient with a history of pigeon feeding was reported to have hypersensitivity pneumonia on thorax high-resolution computed tomography, which was taken after complaints of shortness of breath, fever, and weight loss. Firstly, hypersensitivity pneumonia due to pigeon feeding was considered a diagnosis. The patient's contact with the pigeon was cut off. His clinic improved with oral corticosteroid therapy. His symptoms recurred after oral corticosteroid therapy was discontinued. In the professional anamnesis taken, it was learned that he had been doing welding work for 14 years and his complaints increased on the days he worked. After other causes were excluded with the differential diagnosis, the case was diagnosed with hypersensitivity pneumonia due to metal dust contact. The rarity of occupational hypersensitivity pneumonia cases in welding workers makes it important to report individual cases and exposures. Occupational history can be skipped in hypersensitivity pneumonia patients, as it is often thought to be caused by contact with organic factors such as pigeon breeding. The importance of work history anamnesis is highlighted in the diagnosis of rare diseases such as occupational hypersensitivity pneumonia.
{"title":"A case of occupational hypersensitivity pneumonia in a welder","authors":"Başak Güven, İlke Karabağ, Ahmet Uğur Demir","doi":"10.51271/kmj-0122","DOIUrl":"https://doi.org/10.51271/kmj-0122","url":null,"abstract":"A 35-year-old male patient with a history of pigeon feeding was reported to have hypersensitivity pneumonia on thorax high-resolution computed tomography, which was taken after complaints of shortness of breath, fever, and weight loss. Firstly, hypersensitivity pneumonia due to pigeon feeding was considered a diagnosis. The patient's contact with the pigeon was cut off. His clinic improved with oral corticosteroid therapy. His symptoms recurred after oral corticosteroid therapy was discontinued. In the professional anamnesis taken, it was learned that he had been doing welding work for 14 years and his complaints increased on the days he worked. After other causes were excluded with the differential diagnosis, the case was diagnosed with hypersensitivity pneumonia due to metal dust contact. The rarity of occupational hypersensitivity pneumonia cases in welding workers makes it important to report individual cases and exposures. Occupational history can be skipped in hypersensitivity pneumonia patients, as it is often thought to be caused by contact with organic factors such as pigeon breeding. The importance of work history anamnesis is highlighted in the diagnosis of rare diseases such as occupational hypersensitivity pneumonia.","PeriodicalId":369732,"journal":{"name":"Kastamonu Medical Journal","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136100176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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