Can fibrinogen level be a criterion in choosing the treatment option in patients with acute cholecystitis?

OBJECTIVE: We aimed to investigate whether there is a relationship between blood fibrinogen levels during hospitalization of patients hospitalized for conservative treatment due to acute cholecystitis (AC) in our clinic. Patients underwent surgery and were discharged with medical treatment. PATIENTS AND METHODS: The files of 118 patients who were hospitalized due to the diagnosis of AC and planned for conservative medical treatment in our clinic between January 2018 and February 2020 were recorded, prospectively. The patients were divided into two groups as those who responded to conservative treatment (Group 1), and those who were operated urgently despite conservative treatment (Group 2). Increase in gallbladder wall thickness, presence of pericholecystic fluid and hydrops sac on ultrasound and computed tomography (CT) were considered significant for the diagnosis of acute cholecystitis. Blood fibrinogen levels were measured in all patients during hospitalization. RESULTS: The mean age of 118 patients included in the study was 58.32 (19-96) years. There were 77 patients in Group 1 and 41 patients in Group 2. Serum fibrinogen level was found to be 298.34±111.7 mg/dl in Group 1 and 637±124.5 mg/dl in Group 2, and a statistically significant difference was found (p<0.001). When the cut-off value for the fibrinogen level was taken as 564.50 mg/dl, the sensitivity and specificity of the test were found to be 75.6% and 61%, respectively in showing surgical treatment. CONCLUSIONS: As a result of our study, we concluded that when the data obtained are evaluated, it should be kept in mind that despite medical treatment, there is an urgent need for an operation in patients with acute cholecystitis, and in patients with high plasma fibrinogen level (cut-off) at first admission.

Does diffusion weighted imaging have a prognostic value in differentiating gynecological diseases?

INTRODUCTION: Apparent diffusion coefficient (ADC) values are effective in the diagnosis of different gynecological lesions. METHODS: A retrospective evaluation was made of 12 patients with uterine cervix carcinoma and 151 patients with uterine lesions, comprising endometrial cancer, endometrial polyps, carcinosarcoma, submucous myoma, adenomyosis, endometrial hyperplasia, gestational trophoblastic neoplasm (GTN), and leiomyomas. As a control group, 20 healthy volunteers with normal endometrium and normal cervix were also evaluated. In three series, one-shot, spin echo, echo planar, b = 1000 s/mm2 value and diffusion-weighted imaging (DWI) were applied to all subjects and ADC values were obtained. RESULTS: The mean ADC values of Group 1 (Endometrial carcinoma) were lower than those of all the other groups (P < 0.001) and the mean ADC value of group 6 (GTN) was higher than that all other groups (P < 0.001). A statistically significant difference was found between the groups in terms of the lesion-myometrium ADC ratios (P < 0.001). CONCLUSION: There are few studies in literature related to ADC measurements in GTN. The ADC values of GTN were found to be significantly higher than the other uterine lesions. These results will aid in the design of future studies and might be used to guide management of patients with GTN. IMPLICATIONS FOR PRACTICE: Diffusion-weighted MRI seems to be a promising imaging technique in differentiating different uterine lesions.