A Single Tertiary Center 14-year Experience With Mesenteric Panniculitis in Turkey: A Retrospective Study of 716 Patients.

BACKGROUND: Mesenteric panniculitis is a chronic inflammatory process seen in mesenteric tissue. The purpose of this study was to assess the prevalence, clinical, laboratory, and radiological findings, and malignancy in patients diagnosed with mesenteric panniculitis using computed tomography. METHODS: A total of 716 patients with mesenteric panniculitis were retrospectively evaluated by screening all computed tomography scans performed between January 2005 and December 2018. RESULTS: Among 65 278 patients undergoing CT, 716 were diagnosed with mesenteric panniculitis. The prevalence of mesenteric panniculitis was 1.1%. The mean age was 56 ± 14 (20-91) years. The malignant and nonmalignant groups comprised 354 (49.4%) and 362 (50.6%) patients, respectively. The mean age of the malignant group was significantly higher than the nonmalignant group (P < .001). The most common malignancy was breast cancer (12.2%). A history of abdominal surgery was present in 179 (25%) patients with mesenteric panniculitis and it is higher in the malignant group than the nonmalignant group (128 [36.1%], 51 [14%], respectively, P < .001). Mean hemoglobin level and leukocyte count were lower in the malignant group than in the nonmalignant group (P < .001, P < .001, respectively). The mean erythrocyte sedimentation rate was higher in the malignant group than in the nonmalignant group (P = .030). Radiological criterion 2 was less common and radiological criterion 5 was more common in the malignant group than the nonmalignant group (91.0%, 96.4%, P = .004; 35.9%, 27.1%, respectively, P = .011). CONCLUSIONS: It is recommended to conduct research for malignancy in patients with mesenteric panniculitis, especially in the presence of clinical, laboratory, and radiological findings with high-risk features.

Effect of Clinical, Endoscopic, Radiological Findings, and Complications on Survival in Patients with Primary Gastrointestinal Lymphoma.

BACKGROUND: The purpose of this study was to evaluate the clinical, endoscopic, and radiological characteristics, complications, survival outcomes, and prognostic factors of patients with primary gastrointestinal lymphoma. METHODS: This study retrospectively analyzed the demographic, laboratory, endoscopic, and radiological characteristics and treatment outcomes of 43 patients with newly diagnosed primary gastrointestinal lymphoma. RESULTS: The median age was 62 years (range: 26-83). The primary lesion location was the gastric in 33 (77%) patients and the intestinal in 10 (23%) patients. The most common lesions were the corpus (33%) and corpus+antrum (24%) in primary gastric lymphoma and the ileum (60%) in primary intestinal lymphoma. The most common endoscopic findings were diffuse infiltrative lesion (23%) and massforming (33%), while the most common computed tomography finding was wall thickening (53%). Wall thickening and mass-forming at computed tomography were greater in primary intestinal lymphoma than in primary gastric lymphoma (P = .034). Complications were observed in 9 (21%) patients and 13 (31%) patients who underwent surgery. Complication and surgery rates were higher in primary intestinal lymphoma than in primary gastric lymphoma (P = .003 and P = .014, respectively). Five-year overall survival and 5-year eventfree survival rates were 75% and 72%, respectively. Univariate analysis showed that intestinal involvement, advanced clinical stage, a high International Prognostic Index score, mass-forming and wall thickening at computed tomography, extranodal involvement, and complication were found to adversely affect survival. Multivariate analysis revealed that intestinal involvement and a high International Prognostic Index score were independent prognostic factors for overall survival and event-free survival. CONCLUSION: Patients with primary gastrointestinal lymphoma with intestinal involvement and high International Prognostic Index score should be followed closely.

Deep neural network approaches for detecting gastric polyps in endoscopic images.

Gastrointestinal endoscopy is the primary method used for the diagnosis and treatment of gastric polyps. The early detection and removal of polyps is vitally important in preventing cancer development. Many studies indicate that a high workload can contribute to misdiagnosing gastric polyps, even for experienced physicians. In this study, we aimed to establish a deep learning-based computer-aided diagnosis system for automatic gastric polyp detection. A private gastric polyp dataset was generated for this purpose consisting of 2195 endoscopic images and 3031 polyp labels. Retrospective gastrointestinal endoscopy data from the Karadeniz Technical University, Farabi Hospital, were used in the study. YOLOv4, CenterNet, EfficientNet, Cross Stage ResNext50-SPP, YOLOv3, YOLOv3-SPP, Single Shot Detection, and Faster Regional CNN deep learning models were implemented and assessed to determine the most efficient model for precancerous gastric polyp detection. The dataset was split 70% and 30% for training and testing all the implemented models. YOLOv4 was determined to be the most accurate model, with an 87.95% mean average precision. We also evaluated all the deep learning models using a public gastric polyp dataset as the test data. The results show that YOLOv4 has significant potential applicability in detecting gastric polyps and can be used effectively in gastrointestinal CAD systems. Gastric Polyp Detection Process using Deep Learning with Private Dataset.

Hepatitis B Virus Screening and Real Life Data in Patients with Solid Tumor Receiving Chemotherapy.

BACKGROUND: Reactivation of the hepatitis B virus (HBV) either during or after chemotherapy may cause serious and sometimes fatal hepatitis. All patients undergoing chemotherapy should therefore be screened in terms of HBV before chemotherapy. The purpose of this research was to identify HBV screening rates in patients with solid cancer undergoing parenteral chemotherapy and to determine the outcomes of patients undergoing HBV screening. METHODS: Data for patients undergoing parenteral chemotherapy for solid cancer from January 1, 2012 to December 30, 2018 were retrieved from our electronic health record patient files in this retrospective study. Screening was defined as hepatitis B surface antigen (HBsAg) and/or hepatitis B core antibody (HBcAb) tests carried out within six months prior the first chemotherapy session. RESULTS: Four thousand fifty-eight (63%) of the 6440 patients who underwent parenteral chemotherapy were screened for HBsAg and/or HBcAb. The proportions of patients screened for HBsAg and HBcAb improved from 38.8% (2012) to 76.3% (2018), and from 0.2% (2012) to 43% (2018), respectively (P<0.001). The HBsAg and HBcAb positivity rates were 2.9% and 36.5%, respectively. Antiviral prophylaxis was started in 11.8% of HBsAg-negative/HBcAb-positive patients and 40.5% of HBsAg-positive patients. HBV reactivation did not occur in patients receiving antiviral prophylaxis, but was identified in 7.2% of HBsAg-positive patients and 0.6% of HBsAg-negative/HBcAb-positive patients without antiviral prophylaxis. CONCLUSION: Although HBV screening rates before chemotherapy are increasing among solid cancer patients, the rate of initiation of antiviral prophylaxis is still low. It is therefore important to raise awareness regarding HBV reactivation during/after chemotherapy.

Sociodemographic characteristics and clinical risk factors of Helicobacter pylori infection and antibiotic resistance in the Eastern Black Sea region of Turkey.

BACKGROUND/AIMS: The aim of this study was to assess the clinical and sociodemographic risk factors of Helicobacter pylori infection and antibiotic resistance in the eastern Black Sea region of Turkey. MATERIALS AND METHODS: In total, 344 patients with dyspeptic symptoms who completed an extended questionnaire were enrolled in the study. Diagnosis of H. pylori infection was made by rapid urease test, histopathological investigation, and culture. Susceptibility of H. pylori strains was assessed by agar dilution (amoxicillin, tetracycline, metronidazole, levofloxacin) and E-test (clarithromycin) methods. RESULTS: The H. pylori positivity rate was 40.4% (139/344). Logistic regression analysis indicated that age and the presence of duodenal ulcer were independent risk factors associated with H. pylori positivity (odds ratio (OR): 0.96, 95% CI: 0.93-0.99, p=0.013; OR: 5.42, 95% CI: 1.96-14.98, p=0.001, respectively). Of 104 H. pylori-positive cultures, 43 strains (41%) were susceptible to all antibiotics, whereas 61 (59%) were resistant to at least one antibiotic. H. pylori resistance rates were 34% for levofloxacin, 31.1% for metronidazole, 28.2% for clarithromycin, 2.9% for amoxicillin, and 1% for tetracycline. Logistic regression analysis indicated that previous use of clarithromycin was the only independent risk factor for H. pylori resistance (OR: 6.25, 95% CI: 1.59-24.52, p=0.009). CONCLUSION: An understanding of the risk factors for H. pylori positivity and antibiotic resistance in an extended anamnesis may affect treatment choice and facilitate H. pylori eradication. In regions where antibiotic resistance rates are elevated, performing antibiotic susceptibility tests may lead to effective eradication treatment.

Constitutional Mismatch Repair Gene Defect Syndrome Presenting With Adenomatous Polyposis and Cafe au Lait Spots: A Case Report.

INTRODUCTION: Adenomatous polyps in the gastrointestinal system rarely occur in childhood and are accompanied by syndromes such as Familial adenomatous polyposis, attenuated familial adenomatous polyposis, and MUTYH-associated polyposis, Gardner and Turcot syndrome, and also mismatch repair (MMR) gene defects. In this article, we want to present a rare patient who had adenomatous polyposis and in situ carcinoma and was detected biallelic MMR gene defect. CASE: A 16-year-old female patient admitted with painless rectal bleeding, chronic abdominal pain, and anorexia for 1 year. Her physical examination was notable for multiple cafe au lait spots. The colonoscopic and histopathologic examination revealed multiple adenomatous polyps that one of them contains low-high grade dysplasia and in situ carsinoma. Genetic analysis revealed a homozygous mutation in the PMS2 gene [c.1164delT (p.H388Qfs*10) (p.His388GInfsTer10)] and she was diagnosed with constitutional MMR gene defect syndrome. Polypectomy was performed 4 times in 2 years period. Then, the patient's last colonoscopic examination revealed a large broad polyp in the rectum and multiple polyps in the other colon segments, and she underwent colectomy because of high risk of colorectal cancer. CONCLUSIONS: Adenomatous polyps are very important in childhood because of rarity. In particular, the presence of cafe au lait spots and a history of malignancy detected in relatives at an early age must be considered for CMMRD.

Higher Thrombin-Antithrombin III Complex Levels May Indicate Severe Acute Pancreatitis.

AIM: Coagulation disorders may develop in association with severe acute pancreatitis (AP). Plasma thrombin-antithrombin III complex (TAT) levels are one of the principal markers of coagulation disorder. The purpose of this study was to evaluate TAT and other hemostatic parameters in patients with AP and to examine whether or not these parameters indicate the severity of AP. METHOD: Forty-six patients with AP (14 severe, 32 non-severe) and a 30-member healthy control group were recruited. The severity of AP was determined using the revised Atlanta classification. ELISA was used to measure patients' plasma TAT levels. RESULTS: The TAT levels of AP patients at presentation were higher than those of the control group (p = 0.005). The plasma TAT levels of patients with severe AP were also significantly higher than those of patients with non-severe AP (p = 0.05) and of the control group (p < 0.001). The general accuracy, sensitivity and specificity of TAT levels in predicting the severity of AP were 77.4, 77.8, and 77.3% respectively. CONCLUSION: The coagulation cascade was activated in the AP patients in our study, and this was shown to become more pronounced as severity of the disease increased. Plasma TAT levels at the time of presentation in patients with AP can be used as a marker for predicting the severity of the disease.