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A 42-year-old female patient with no previous known diseases who had complaints of postprandial epigastric pain and weight loss and who could not be diagnosed by endoscopic biopsy, although gastric cancer was suspected radiologically and endoscopically, was diagnosed with primary gastric tuberculosis by laparotomy and frozen section. Following anti-tuberculosis treatment, a complete clinical, radiological, and endoscopic response was achieved.

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Certain genetic predisposition factors, such as BRCA1 and BRCA2 mutations play a pivotal role in familial breast cancer development in both males and females. Due to this, the importance and necessity of genetic screening to identify mutations affecting the population is paramount. Undergoing genetic screenings allows for a more knowledgeable risk assessment for the patients and their care providers. The aim of this study was to evaluate the prevalence of BRCA1/BRCA2 mutated genes in the Turkish population among unselected patients. To identify the molecular markers, we utilized a gene panel analysis consisting of BRCA1 and BRCA2 genes, with a next generation sequencing platform (MiSeq System, Illumina). Sequencing was performed using leukocyte DNA from breast cancer patients. In‐silico analysis for novel mutations was carried out using SIFT, PolyPhen2 and MutationTaster. BRCA1 and BRCA2 pathogenic variants were identified in 18 of 129 (14%) patients among the study population; of those 18 patients, seven (39%) were found in the BRCA1 gene and 11 (61%) in the BRCA2 gene. Ten of the eleven BRCA2 variants (90%) were novel mutations. Four of ten (40%) of the novel mutations were determined to be deleterious and six out of ten (60%) were identified as single nucleotide variations. Clinically significant mutations of the BRCA1/BRCA2 genes are related to an increased susceptibility for breast cancer. There is however, little known about BRCA mutations amongst the general population. Thus, it is important that patients are able to undergo genetic screenings and counseling. This also allows for greater care from health care providers and can only facilitate disease prevention which in turn can lead to a decreased cancer morbidity rate.

Purpose: Retrorectal tumors (RTs) are a rare incidence and recommendations on the ideal surgical approaches are lacking. This study aimed to evaluate outcomes and follow-up results of patients undergoing excision of RTs at our institution. Methods: A retrospective review was conducted for undergoing surgery for RT between January 2009 and January 2019. Demographic characteristics, presenting symptoms, preoperative diagnostic tests, surgical procedures, histopathological results, intraoperative and postoperative complications, postoperative hospital stay, postoperative 30-day mortality, 90-day unplanned readmission rate, and long-term outcomes were evaluated. Results: Twenty patients with a mean age of 48.3 ± 14.2 were analyzed. The most common presenting complaint was perineal pain (35.0%). Magnetic resonance imaging and computed tomography was preferred in 18 and 2 patients, respectively. Tumor localization was below the level of the third sacral vertebrae in 14 patients for whom the posterior surgical approach was used. No postoperative mortality was recorded at the end of follow-up of 53.8 ± 40 months. Mean length of postoperative hospital stay was 8.6 ± 9.4 days. Ten percent of the patients had unplanned hospital readmission within 90 days after discharge. Recurrence developed in 1 patient, for whom pathology were reported as chordoma. Conclusion: RT should be managed by a multidisciplinary team given the complexity and heterogeneity of these tumors despite the fact that the majority are benign. A good understanding of pelvic anatomy and characterization of lesions through detailed radiological imaging is crucial to optimize surgical planning. Complete surgical resection is key for prolonged disease-free and overall survival of patients diagnosed with RTs.

Öz Purpose: A significant number of the protective stomas temporarily applied in order to reduce the effects of anastomosis complications after rectal cancer surgery cannot be closed and become permanent. In this study, the causes that can lead to a permanent stoma were investigated. Materials and Methods: Patients who underwent elective surgery with low anterior resection and protective ileostomy due to rectal cancer were included in the study. Patients whose stoma could not be closed within one year were evaluated as permanent stoma. Results: 66 patients were included in the study. The mean closing time for the stomas were found as 5, 6 +2,5 (1-12)months. The stomas of twelve (18.2%) of the patients could not be closed and became permanent. The presence of metastatic disease at the time of diagnosis, the proximity of the anastomosis to the anal entry, coloanal anastomosis, and the final pathology showing stage IIIC were found to be risk factors for permanent stoma. Conclusion: Some of the stomas applied temporarily due to surgical treatment of rectal cancer became permanent. Before the index operation, the patient and their relatives should be informed that in the presence of certain risk factors, these stomas may not be closed and become permanent. Amaç: Rektum kanseri cerrahisi sonrası anastomoz komplikasyonlarının etkilerini azaltmak amacı ile geçici amaçla uygulanan koruyucu stomaların önemli bir kısmı kapatılamayarak kalıcı hale gelmektedir. Bu çalışmada kalıcı stomaya neden olabilecek nedenler araştırılmıştır. Gereç ve Yöntem: 2015-2018 tarihleri arasında elektif şartlarda rektum kanseri nedeni ile aşağıanterior rezeksiyon ve koruyucu ileostomi uygulanan hastalar çalışmaya alındı. Bir yıl içerisinde stoması kapatılamayan hastalar kalıcı stoma olarak değerlendirildi. Bulgular: Çalışmaya 66 hasta dahil oldu. Stomaların ortalama kapatılma süresi 5,6 +2,5 (1-12) ay olarak bulundu. On iki hastanın (%18,2) stoması kapatılamayarak kalıcı hale geldi. Tanı anında metastatik hastalık varlığı, anastomozun anal girime yakınlığı, koloanalanastomoz yapılması, cerrahi sonrası patoloji sonucunun evre IIIC olmasıstoma kapatılamaması açısından risk faktörü olarak bulundu. Sonuç: Rektum kanseri cerrahi tedavisinde geçici amaçla uygulanan stomaların bir kısmı kalıcı hale gelmektedir. İndeks operasyondan önce hasta ve yakınlarına, bazı risk faktörü ya da faktörleri varlığında bu stomaların kapatılamayarak kalıcı hale gelebileceği bilgisi verilmelidir.

This study aimed to determine the C-reactive protein (CRP) ratio for the survival of patients with Fournier gangrene (FG). Methods: Fifty-two patients with FG between January 2011 and September 2018 were retrospectively analyzed. Data on clinical presentation, Fournier Gangrene Severity Index (FGSI), CRP ratio, management, and outcome were analyzed. The CRP ratio was calculated as preoperative CRP/postoperative CRP value that measured 48 hours after surgical intervention. Possible alternative cutoff points for the FGSI and CRP were determined by receiver operating characteristic (ROC) analyses. The risk factors related to the prognosis were evaluated by univariate and multivariable logistic regression analyses. Results: The mean CRP ratios were 6.7 ± 6.6 in the survivor group and 1.2 ± 0.8 in the non-survivor group (P = 0.001). FGSI was significantly higher in the non-survivor group compared to survivor group (8.5 ± 2.5 vs. 3.5 ± 2.2, P = 0.001). There was a negative correlation between FGSI and CRP ratio (r = -0.51). ROC analysis determined the cutoff value as 1.78 for CRP (sensitivity, 86%; specificity, 82%; AUC, 0.90) to predict death. The incidence of death for patients with CRP ratio of ≤ 1.78 increased 26.7 fold for those with CRP ratio of > 1.78 (95% confidence interval [CI], 4.8-146.5; P = 0.001). In the multivariable logistic regression model, CRP ratio (odds ratio [OR], 10.3; 95% CI, 1.5-72.2; P = 0.019) and FGSI (OR, 17.8; 95% CI, 2.6-121.1; P = 0.003) were independent risk factors for death. Conclusion: The CRP ratio is a simple method to use to predict mortality in FG.

BACKGROUND:Infections and sepsis remain the leading cause of morbidity and mortality in secondary peritonitis. Clinicians are still challenged with the task of finding an early and reliable diagnosis of septic complications. The role of inflammatory markers (Procalcitonin (PCT), C-reactive Protein (CRP) and thyroid hormones in determining the severity of secondary peritonitis was evaluated in this study.