The increase in MDA levels and MPO activity and the concomitant decrease in GSH levels demonstrate the role of oxidative mechanisms in sepsis-induced tissue damage. Melatonin, by its free radical scavenging and antioxidant properties, ameliorated oxidative organ injury. Thus, supplementing antiseptic shock treatment with melatonin may be beneficial in the clinical setting.

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Since melatonin administration reversed these oxidant responses, it seems likely that melatonin has a protective effect against oxidative organ damage induced by I/R.

The aim of this study was to evaluate the clinical and radiological features of xanthogranulomatous cholecystitis (XGC) and the results of surgical treatment. This retrospective study concerns clinical, radiological, and surgical data as well as histopathological findings and postoperative results of 108 patients with XGC who were identified after evaluating 7916 cholecystectomy specimens between 2004 and 2014 in a single institute. One hundred eight patients with XGC were evaluated (56 males and 52 females, mean age 62.3 years). Clinical findings at referral included acute and chronic cholecystitis, Mirizzi's syndrome, choledocholithiasis, cholangitis, and acute pancreatitis. Ultrasound was performed in all patients, CT in 25, contrast-enhanced MRI in 29, and magnetic resonance cholangiopancreatography (MRCP) in 25 patients. None of the patients were diagnosed preoperatively, but mild-moderate degrees of wall thickening were present in most. Fifty-four patients received open cholecystectomy, while 54 received laparoscopic intervention, among whom 23 were converted to open. Partial cholecystectomy was performed in 11 patients. Two patients with gallbladder adenocarcinoma were treated with radical cholecystectomy. XGC has nonspecific clinical and radiological findings; thus, preoperative diagnosis is generally absent. Open cholecystectomy is the recommended treatment modality. Conversion to open is frequently necessary after laparoscopy. Complete cholecystectomy is the ultimate goal; however, partial cholecystectomy may be preferred to protect the structures of the hepatic hilum.

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Acutely increased intra-abdominal pressure (IAP) can lead to multiple organ failure. As blood flow to intra-abdominal organs is reduced by high venous resistance, ischemia-reperfusion (I/R) injury plays an important role in the pathogenesis of abdominal compartment syndrome (ACS) following IAP. Melatonin, a secretory product of the pineal gland, is known to have free radical scavenging and antioxidative properties in several oxidative processes. The objective of this study was to examine the potential protective properties of melatonin on the oxidative organ damage in a rat model of ACS. Under ketamine anesthesia, an arterial catheter was inserted intraperioneally (i.p.) and using an aneroid manometer connected to the catheter, IAP was kept at 20 mmHg (ischemia group; I) for 1 hr. In the ischemia/reperfusion (I/R) group, pressure applied for an hour was decompressed and a 1-hr reperfusion period was allowed. In another IR group, melatonin was administered (10 mg/kg, i.p.) immediately before the decompression of IAP. The results demonstrate that tissue levels of malondialdehyde (MDA) and myeloperoxidase activity (MPO; index of tissue neutrophil infiltration) were elevated, while glutathione (GSH; a key to antioxidant) levels were reduced in both I and I/R groups (P < 0.05-0.001). Melatonin treatment in I/R rats reversed these changes (P < 0.01-0.001). Moreover, melatonin given to the I/R group reduced the elevations in serum aspartate aminotransferase, alanine aminotransferase and blood urea nitrogen levels and abolished the increase in serum creatinine levels. Our results indicate that melatonin, because of antioxidant and free radical scavenging properties, ameliorates reperfusion-induced oxidative organ damage. In conclusion, the results of the present study suggest that the therapeutic value of melatonin as a 'reperfusion injury-limiting' agent must be considered in ACS.

INTRODUCTIONThe incidence of gastroesophageal junction (GEJ) tumors has been on a rapid upsurge in Western societies (1). Adenocarcinomas are the most frequent type within these tumors (2). Despite multimodality treatment, their prognosis is still poor with a 5-year survival rate of around 20% (1). The issue whether they should be treated like esophageal tumors or gastric tumors remains controversial due to their location. Siewert classified these tumors into three groups according to their anatomical locations in 1996 (3). By definition, all of these tumors invade the GEJ. The classification was revised in 2000, and type I tumors were defined as tumors within 1-5 cm above the GEJ, type II those within 1 cm above and 2 cm below the GEJ, and type III as tumors extending 2-5 cm below the GEJ (4). This classification is clinical and is based on barium study, endoscopy, computed tomography, and intraoperative evaluation findings (5). Type I tumors are distal esophageal tumors, type II tumors are true cardiac tumors, while type III tumors are subcardial gastric tumors. R0 resection is the most important determinant of long-term survival in GEJ tumors (6). The 5-year overall survival (OS) after R0 resection has been reported as 43.2%, and those of R1 and R2 resection as 11.1% and 6.2%, respectively (7). While Siewert I and II lesions are treated like esophageal tumors, Siewert III tumors are treated like gastric cancer (1). Due to screening and treatment of Barrett's esophagus, Siewert I tumors can be diagnosed at an early stage. Lymph node metastasis is another important predictor of survival, with a decrease from 53% to 11% in 5-year OS in case of presence of lymph node metastasis (8). For this reason, lymph node dissection should be included to surgery. The rate of lymph node metastasis increases from 10% to 67% in tumors with submucosal infiltration (9). The standard surgical treatment is subtotal esophagectomy and proximal gastrectomy with the exception of endoscopic treatment at a very early stage (10, 11). Distal esophagectomy and total gastrectomy are preferred in type II tumors (10, 11). The standard surgical approach in type III tumors is total gastrectomy and D1 lymph node dissection (12). Objective: The treatment of gastroesophageal junction tumors remains controversial due to confusion on whether they should be considered as primary esophageal or as gastric tumors. The incidence of these tumors with poor prognosis has increased, thus creating scientific interest on gastroesophageal cancers. Esophagogastric cancers are classified according to their location by Siewert, and the treatment of each type varies. We evaluated the prognostic factors and differences in clinicopathologic factors of patients with gastroesophageal junction tumor, who have been treated and followed-up in our clinics. Material and Methods:We retrospectively analyzed 187 patients with gastroesophageal junction tumors who have been operated and treated in the Oncology Department between 2005 and 2014. The chi-square test was used to eval...