Prognostic Significance of Tumor and Inflammatory Markers in Disease-Free and Overall Survival Duration in Colonic Adenocarcinoma Patients.

Introduction Colorectal carcinoma (CRC) continues to be a major global health concern, contributing substantially to cancer incidence and mortality. Colonic adenocarcinoma, a common subtype of CRC, is influenced by various prognostic factors, including tumor stage, histopathological characteristics, and tumor markers. Despite their routine use in clinical settings, the prognostic value of traditional tumor markers, such as carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), and others, is still under debate. In this study, we aim to analyze the tumor markers' prognostic significance in our CRC patients in terms of disease-free survival and overall survival. Methods A retrospective study was conducted on 71 patients who underwent surgery for colonic adenocarcinoma between January 1, 2018, and January 1, 2024. Data on patient demographics, recurrence rates, survival times, and tumor marker levels (CEA, CA 19-9, CA 125, AFP, and CRP to albumin ratio (CAR)), disease-free survival duration (DFS), and overall survival durations (OS) were collected and analyzed. Statistical analyses included Pearson and Spearman correlation coefficients, the Mann-Whitney U test, ROC curve analysis, and Kaplan-Meier survival analysis. Results The study found that elevated CAR and CA 125 levels were significantly associated with higher mortality and recurrence rates, whereas elevated CEA levels were strongly predictive of recurrence. Receiver operating characteristic (ROC) analysis identified optimal cutoff values for these markers, with CEA ≥ 47.145, CA 125 ≥ 15.85, and CAR ≥ 6.796 demonstrating high specificity and predictive value for recurrence. Kaplan-Meier analysis revealed that patients with CEA < 47.145 had a significantly longer DFS (67.7 months) compared to those with CEA ≥ 47.145 (24 months, p < 0.001). Similarly, patients with CA 125 < 15.85 and CAR < 6.796 showed longer DFS compared to those with higher values. Overall survival analysis also highlighted that patients with CA 125 < 21.71 and CAR < 4.09 had better survival outcomes, with significant differences of 26 and 10 months, respectively (p < 0.001 and p = 0.001). Conclusion Tumor markers, such as CEA, CA 125, and CAR, hold significant prognostic value in colonic adenocarcinoma, with higher levels correlating with poorer outcomes. These findings underscore the importance of integrating tumor markers into clinical decision-making to optimize treatment strategies and improve patient survival. Future research should focus on standardizing the use of these markers and exploring novel biomarkers for enhanced prognostication.

Diagnostic Accuracy of Ileocolic Artery and Vein Diameter for Acute Appendicitis.

BACKGROUND Regional inflammation-induced local vasodilation may exist in cases of appendicitis. In this study, the diameters of the ileocolic artery (ICA) and ileocolic vein (ICV) were measured using contrast-enhanced abdominal computed tomography (CT) scans in acute appendicitis cases. The study aimed to measure the diagnostic value of these measurements in the diagnosis of acute appendicitis. MATERIAL AND METHODS A total of 508 patients, including those with a diagnosis of acute appendicitis and a control group without appendicitis, were systematically evaluated. In all cases, the appendix was analyzed simultaneously on axial and coronal CT sections, and all measurement procedures were conducted with an electronic ruler after the actual images were magnified. Measurements of the ICA and ICV diameters were taken from the proximal 2-cm segments of the superior mesenteric artery and superior mesenteric vein in the axial plane. Demographic information, sex distribution, and ICA and ICV diameters were collected. RESULTS Of the 508 patients, 53.74% were men, and 46.26% were women. ICA and ICV diameters were significantly increased in the appendicitis group (P<0.001). Binomial logistic regression confirmed the independent predictive value of ICA and ICV diameters. Receiver operating characteristic curve analysis determined optimal cut-off values for distinguishing between the non-appendicitis and appendicitis groups (ICA: 2.475 mm, ICV: 3.885 mm) with high sensitivity and specificity. CONCLUSIONS ICA and ICV diameter measurements, in conjunction with major radiological findings, can enhance diagnostic accuracy in acute appendicitis cases. The use of ICA and ICV diameter measurements in diagnosing acute appendicitis offers a novel perspective in clinical practice.

Red Cell Distribution Width, Mean Platelet Volume, and Neutrophil/Lymphocyte Ratio in Patients With Irritable Bowel Syndrome.

Introduction Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder characterized by persistent abdominal pain and variable bowel patterns, impacting individuals' quality of life. Despite its functional nature, recent research has indicated the role of inflammatory processes in IBS development. This study aims to investigate the potential diagnostic value of routine blood parameters and their relationship with IBS. Methods In this retrospective analysis, patients diagnosed with IBS based on the ROME IV criteria were identified from the outpatient clinic of Hitit University Erol Olçok Teaching and Research Hospital between January 1, 2023, and May 1, 2023. Exclusion criteria encompassed specific medical conditions, psychiatric disorders, and organic bowel pathologies. A cohort of 100 IBS patients and 100 healthy controls were included for comparison. Comprehensive blood data, including neutrophil count, lymphocyte count, hemoglobin level, red cell distribution width (RDW), mean corpuscular volume (MCV), mean platelet volume (MPV), and platelet count, were collected. Statistical analyses were conducted using SPSS for Windows version 26.0 (IBM Corp., Armonk, NY). Descriptive statistics, Pearson's or Spearman's correlation coefficients, Mann-Whitney U test, and Chi-square test were used to analyze data. Results The study cohort consisted of 70 men (35%) and 130 women (65%). The average age was 51.65 ± 14.64 years (52 years). The mean neutrophil count was 4.6 ± 1.5 (4.29) in the control group and 4.7 ± 2.03 (4.12) in the IBS group. The mean lymphocyte count was 2.3 ± 0.86 (2.21) in the control group and 2.3 ± 0.82 (2.23) in the IBS group, indicating no statistically significant difference (p = 0.732). The mean RDW was measured as 13.62 ± 1.07 (13.4) in the control group and 13.68 ± 1.18 (13.55) in the IBS group, again demonstrating no significant difference (p = 0.915). Mean MCV and MPV values showed no substantial variation between the control and IBS groups (p = 0.649 and p = 0.406, respectively). Conclusion While this study did not yield statistically robust outcomes, it underscores the potential of utilizing neutrophil-to-lymphocyte ratio (NLR), RDW, and MPV as adjunctive diagnostic markers for IBS. These routine and cost-effective parameters could enhance the diagnostic process, especially in cases with suspected IBS. Continued research is essential to unravel their complete diagnostic potential and clinical applicability.

Clinicopathological and prognostic significance of PD-L1 expression in colon adenocarcinoma tumor budding.

OBJECTIVE: In this study, we investigated the relationship between programmed cell death ligand 1 (PD-L1) and programmed cell death protein 1 (PD-1) expression in colon adenocarcinoma tumor budding. METHODS: This study included 122 patients with colon adenocarcinomas. The largest sample of formaldehyde-fixed paraffin-embedded tumor tissues was selected for analysis. Expression of membranous PD-L1 (clone 22C3) and the Combined Positive Score (CPS) in tumor tissues was calculated and graded according to the percentages of peritumoral and intratumoral tumor cells (0 %, 1 %, 1-5 %, >5 %). The effects of these factors on the prognosis were analyzed. RESULTS: Tumor budding was associated with adverse clinicopathological features and poor overall survival. PD-L1 (CPS%) peritumoral tumor budding (1 %/<1 %) was statistically significant in the univariate model (p = 0.004). Age, organ metastases (liver, lung, liver, lung, and peritoneum), and metastases were statistically significant in the multivariate model (p = 0.001, p = 0.004, p = 0.001, p = 0.002, p = 0.004, and p = 0.032, respectively). PD-L1 positive staining was mostly observed around the tumor and during tumor budding. PD-L1 peritumoral tumor budding rates and patients' survival rates differed significantly (log-rank = 12.07, p = 0.007). CONCLUSION: We found that patients with PD-L1 (CPS%) > 1 % in tumor budding had a shortened life expectancy and demonstrated the importance of including tumor budding areas in the samples used for biomarker evaluation. We previously reported that PD-L1 expression in tumor budding is associated with more aggressive cancer biology and poor survival, although overall survival is of limited statistical significance.

Evolution of Inguinal Hernia Publications: A Bibliometric Analysis from 1980 to 2021.

BACKGROUND Despite the increasing number of studies published worldwide focusing on inguinal hernia, a major condition in the surgical field that affects the quality of life of many patients, a bibliometric study on inguinal hernia is yet to be conducted. The present study aimed to analyze the scientific articles published on inguinal hernia using statistical methods. MATERIAL AND METHODS Articles published between 1980 and 2021 on inguinal hernia were downloaded from the Web of Science database and analyzed using statistical methods. RESULTS A total of 11 761 publications were found. The top 5 contributors to the literature were the United States (n=2109, 27%), Germany (563, 6.7%), United Kingdom (595, 5.7%), Turkey (415, 5.3%), and Japan (388, 4.9%). The top 3 most influential journals by average number of citations per article were Annals of Surgery (citations: 67.4), British Journal of Surgery (citations: 49.9), and Surgical Clinics of North America (citations: 43.2). CONCLUSIONS In the current comprehensive bibliometric study on inguinal hernia, which has demonstrated an upward trend in the number of articles published recently, we present a summary of 7810 articles published from 1980 to 2021. According to the results of the analysis conducted to identify trending topics, the keywords studied in recent years are believed to include pediatric, outcomes, minimally invasive surgery, robotic, incisional hernia, umbilical hernia, chronic pain, obesity, bariatric surgery, NSQIP, seroma, surgical site infection, abdominal wall reconstruction, ventral hernia repair, and hiatal hernia repair.

Relationship Between Psychological Symptoms and Self-Esteem Levels Before and After Stomach Botox Treatment.

BACKGROUND Obesity is an exponentially increasing public health problem all over the world. When obesity is treated, many healing states begin to occur in obese individuals. Stomach Botox is also frequently used among non-surgical treatment methods. This prospective study examined the relationship between psychological symptoms and self-esteem levels before and after stomach Botox treatment. MATERIAL AND METHODS We administered a survey to gather baseline information, and used the form, Brief Symptoms Inventory and Rosenberg Self-Esteem scales. In total, 406 patients, including 369 females (90.9%) and 37 males (9.1%), participated in the research during February to August 2020. RESULTS Anxiety, negative personality, somatization, and hostility levels before Botox treatment were higher than after Botox treatment. Depression levels were higher after Botox treatment. Anxiety, somatization, and hostility increases were statistically significant (P<0.05). Depression and negative personality differences were insignificant (P>0.05). Before Botox treatment, all psychological symptom and self-esteem level correlations were insignificant (P>0.05). After Botox treatment, correlations between anxiety, negative personality and hostility levels with self-esteem level were statistically and negatively significant (P<0.05). Anxiety after Botox treatment had a significant effect on self-esteem level on multivariate level (P<0.05). CONCLUSIONS Obesity treatment methods positively affect physical health and mental health. While there are many confusing scientific studies on stomach Botox treatment, none of these studies seem to have had strict diet and movement monitoring. Stomach Botox treatment not only positively affects the physical appearance and mental health of individuals, but also their self-perception during the obesity treatment process.

Global productivity and research trends of colorectal carcinoma: A scientometric analysis of studies published between 1980 and 2021.

Although colorectal cancer (CRC) is a serious cause of death and has a significant impact on patients' quality of life and incidence rate of CRC has increased among the younger populations, bibliometric research of CRC has not been conducted yet. To perform a comprehensive analysis of scientific publications on CRC using various statistical and bibliometric techniques. Publications on CRC published between 1980 and 2021 were downloaded from the Web of Science database and analyzed using statistical methods. The trending topics, collaborations among countries, and citation relationships were analyzed using bibliometric network visualization mapping. The number of articles to be probably published in the next 5 years was estimated using the exponential smoothing estimator. The Spearman's correlation rank correlation coefficient was used to analyze the correlations among the variables. A total of 122,717 publications were found in the fields of oncology, gastroenterology, hepatology, and surgery. Of the published articles, 64,774 publications were research articles. The top five countries that contributed the most to the literature were the USA (16,604; 25.6%), China (10,567; 16.3%), Japan (7932; 12.2%), the UK (5009; 7.1%), and Italy (4287; 6.6%). The most prolific author, institution, and journal in the field of CRC were Zhang Y (n = 331), University of Texas System (n = 1646), and Diseases of the Colon and Rectum (n = 2090), respectively. The most influential journal based on the average number of citations received per article was CA-A Cancer Journal for Clinicians (citations per article; 286). There was a significant positive correlation between the number of articles produced by the countries on CRC and gross domestic product and human development index (r = 0.726, P < .001; r = 0.658, P < .001, respectively). Additionally, a significant moderate correlation of CRC was found with gross domestic product per capita (r = 0.711, P < .001). Keywords like overall survival, neoadjuvant chemoradiotherapy, locally advanced rectal cancer, robotic surgery, anastomotic leakage, chemoradiotherapy, metastatic colorectal cancer, KRAS, meta-analysis, colorectal surgery, and laparoscopic surgery were studied.

Comparison of the Efficiency of Epidermal Growth Factor and Negative Pressure Wound Therapy in Diabetic Foot Patients.

Advanced modalities are used for wounds where conventional treatment is insufficient in diabetic foot patients. In this study, we investigated the effects of using Epidermal growth factor (EGF) and NPWTmodalities alone or in combination on the frequency and level of amputation. In the retrospective study, which included 286 patients in total, 76 patients were referred with the decision of amputation or amputation was planned during hospitalization. After the treatments, amputation and distalization of amputation were found 73.3% and 33.3% in the conventional treatment patients. While 86.4% amp and 18.2% amp distalization were found in negative pressure wound therapy (NPWT) only patients, this rate was 52.4% and 90.5% in EGF + NPWT patients, 50% and 83.3% in EGF only patients. While amp and distalization rates were found to be significantly better in those receiving only EGF or EGF + NPWT (P = .015, P = .017 respectively for amputation and P = .000 for distalization), no difference was found in those receiving EGF and EGF + NPWT. As a result of our study, although npwt contributed positively to the number and level of amputations compared to conventional treatment, a significant improvement was found in the number and level of amps when EGF was used alone or combined with NPWT. With this result, EGF was thought to be an important treatment modality that should be evaluated in diabetic foot ulcers (DFUs) without amputation decision.

Effects of the COVID-19 pandemic on the management of diabetic foot ulcers: experiences from a dedicated diabetic foot care center.

INTRODUCTION: As did many other nations, the Turkish government implemented precautions and lockdown measures in response to the rapid spread of the COVID-19 viral infection. The pandemic has caused millions of deaths globally, resulted in the development of comorbidities, and negatively affected national health care systems. The increased workload at hospitals and spread of the virus among health care professionals have resulted in delays in health care services delivery. The fear of COVID-19 transmission has resulted in people mostly staying at home. OBJECTIVE: The aim of this study is to present the effects of the pandemic on the behavior of patients with diabetic foot ulcers (DFUs). MATERIALS AND METHODS: Patients with DFU were categorized into 2 groups: patients hospitalized during the COVID-19 pandemic and patients hospitalized during the same period in 2019 (prepandemic). Demographic data, length of hospital stay, place of residence, Wagner grade of DFU, comorbidities, laboratory parameters, wound duration, duration of diabetes, and treatments applied were recorded. RESULTS: During the pandemic, the length of hospital stay decreased, and patient referrals from other cities significantly decreased (P <.001). Hemoglobin A1c level was higher and Wagner grade was more advanced during the pandemic period (P =.014 and P =.033, respectively). The number of patients undergoing debridement alone decreased during the pandemic period, while those requiring amputation increased (P =.008 and P =.005, respectively). CONCLUSIONS: Patients with DFU delayed seeking timely proper medical advice during the pandemic. This resulted in a significantly higher amputation rate, with physical, psychosocial, and economic consequences. Virtual techniques (eg, video consultation) can be used to identify patients who require hospitalization. Close follow-up can be provided via home nursing care and by supplying advanced wound care products for in-home use. Patients with DFU should be encouraged to seek proper medical advice and take recommended precautions.

Pay for performance system in Turkey and the world; a global overview.

Objectives: This study aimed to compare the pay for performance system applied nationally in Turkey and in other countries around the world and to reveal the effects of the system applied in our country on the general surgery. Material and Methods: Current literature and countries' programs on the implementation of the pay for performance system were recorded. The results of the Turkish Surgical Association's performance and Healthcare Implementation Communique (HIC) commission studies were evaluated in light of the literature. Results: Many countries have implemented performance systems on a limited scale to improve quality, speed up the diagnosis, treatment, and control of certain diseases, and they have generally applied it as a financial promotion by receiving the support of health insurance companies and nongovernmental organizations. It turns out that surgeons in our country feel that they are being wronged because of the injustice in the current system because the property of their works is not appreciated and they cannot get the reward for the work they do. This is also the reason for the reluctance of medical school graduates to choose general surgery. Conclusion: Authorities should pay attention to the opinions of associations and experts in the related field when creating lists of interventional procedures related to surgery. Equal pay should be given to equal work nationally, and surgeons should be encouraged by incentives to perform detailed, qualified surgeries. There is a possibility that the staff positions opened for general surgery, as well as, all surgical branches will remain empty in the near future.

Comparison of Short-Term Results of Laparoscopic and Open Surgeries for Colorectal Cancer: A Single-Center Experience.

OBJECTIVE: Although laparoscopic colon cancer surgeries have increased in recent years, their oncological competence is questioned. In our study, we aimed to evaluate oncological competence by comparing laparoscopic and open surgery. METHOD: The study was planned retrospectively. A total of 94 patients were included in the study, 42 of whom underwent laparoscopy, and 52 patients underwent open surgery. Both groups were compared in terms of demographic characteristics, staging, number of benign/malignant lymph nodes, histological findings, and complications. RESULT: The final pathology report of all patients was adenocarcinoma. The median number of dissected lymph nodes was 20.9 in the open group (8-34) and 19.46 in the laparoscopy group (7-31) (p = 0.639). The median number of dissected malignant lymph nodes was 1 (0-13) in the open surgery group and 3.1 (0-8) in the laparoscopy group (p = 0.216). The laparoscopy group exhibited a longer operation time (281.2 ± 54.2 and 221.0 ± 51.5 min, respectively; p = 0.036) than the open surgery group, but a shorter intensive care unit (ICU) discharge, quicker initiation oral feeding, and shorter length of hospital stay (4.0 ± 0.9 vs 5.7 ± 2.0 days, respectively; p < 0.001). DISCUSSION: Laparoscopic surgery elicits many benefits such as less wound infection, lower requirement for blood transfusion, shorter hospitalization, quicker initiation of oral feeding, and mobilization. Our study has shown that laparoscopic surgery provides quite adequate lymph node dissection when compared to oncological surgery, which is viewed with suspicion in the light of these benefits of laparoscopy.

Is Right Unilateral Transversus Abdominis Plane (TAP) Block Successful in Postoperative Analgesia in Laparoscopic Cholecystectomy?

Background: Transversus abdominis plane (TAP) block is used for postoperative analgesia in laparoscopic cholecystectomy. In laparoscopic cholecystectomy, the incisions are located mainly on the upper right side of the abdomen. Aims: We aim to determine the efficacy of less-invasive ultrasound-guided right unilateral oblique subcostal TAP block in laparoscopic cholecystectomy on postoperative analgesia by comparing patients undergoing bilateral TAP block and a control group. Methods: Ninety patients were equally divided into control, unilateral, and bilateral TAP block groups. TAP blocks were conducted before anesthesia. No block was applied to the control group. Patients' demographics and postoperative pain, satisfaction, and nausea-vomiting scores and tramadol/ondansetron doses were evaluated. Results: There was no significant difference in the verbal numerical rating scale for pain scores at rest and during coughing (VNRS-R and VNRS-C) between unilateral and bilateral TAP block groups at postoperative 1 hour, 2 hour, 4 hour, 8 hour, 12 hour, and 24 hours. In addition, VNRS-R and VNRS-C scores were significantly higher in the control group than in the other two groups. Tramadol consumption in the control group was significantly higher than in the unilateral and bilateral TAP block groups (p ≤ 0.01), while no significant difference was identified between unilateral and bilateral TAP block groups (p=0.303). Nausea-vomiting scores and ondansetron consumption did not differ significantly between all the groups. Patient satisfaction was significantly higher in unilateral and bilateral groups (p < 0.01, p < 0.01) than in the control group, while there was no significant difference between unilateral and bilateral TAP block groups (p=0.793). Conclusions: Right unilateral TAP block provides postoperative analgesia as effective as bilateral TAP block in laparoscopic cholecystectomy.

Effect of C-Reactive Protein-to-Albumin Ratio on Prognosis in Gastric Cancer Patients.

PURPOSE: The ratio of c-reactive protein-to-albumin (CRP/Alb) is a biochemical marker of systemic inflammatory response and has been associated with poor survival in cancer. The purpose of this study was to investigate the effect of CRP/Alb ratios on prognosis in gastric cancers. METHODS: This study included a retrospective review of a total of 147 patients with locally advanced gastric cancer. Mean platelet volume (MPV) was analyzed statistically to find a prognostic relationship between monocyte/lymphocyte ratio, platelet distribution volume (PDW), MPV/platelet, c-reactive protein/albumin ratio (CAR), and gastric cancer. Patients were staged according to the American Joint Cancer Committee (AJCC) Staging Guidelines. RESULTS: The CRP/Alb ratio was independently associated with overall survival (OS) in patients with gastric cancer (GC). The CAR was above 0.25 in 52.7% (77) of the patients and below 0.25 in 47.3% (69) of the patients. Patients under 0.25 had statistically longer survival rates. CONCLUSION: A high preoperative CAR value could predict poor prognosis in locally advanced gastric patients. The same predictive value was not observed in other hematological parameters. This simple and cost-effective ratio can be used as a clinically accessible biomarker to assist clinicians in determining future treatment plans.

[Factors Influencing Pneumococcal Vaccination-Induced Total IgG, IgG2, and IgA Levels in Vaccinated Splenectomized Patients]. / Asili Splenektomili Hastalarda Pnömokok Asisi ile Indüklenmis Total IgG, IgG2 ve IgA Düzeylerini Etkileyen Faktörler.

Splenectomy is closely associated with a lifetime risk of pneumococcal and other encapsulated bacterial infections. In this study, it was aimed to investigate the change of antibody levels after vaccination against Streptococcus pneumoniae according to age, gender, years after splenectomy and the possible effect of splenectomy on IgG avidity. In addition the education and awareness levels of the participants about post-splenectomy vaccination and infectious diseases were also analyzed. In the first of the three phases of this study, 32 individuals with splenectomy were enrolled. The awareness of the patients about the possible risks after splenectomy was investigated with a simple questionnaire. Routine laboratory test results were obtained and clinical examinations were performed. In the second stage, total Ig values of 29 splenectomy patients were determined. In the third phase, 14 splenectomy and 5 healthy volunteers were vaccinated according to the Vaccination Practices Advisory Committee (ACIP) guidelines. Pneumococcal-specific antibody levels and IgG avidity were detected by enzyme linked immunosorbent assay (ELISA). It was determined that 68.8% of the splenectomized patients were unaware of their vaccination status and 78.2% of them were unaware of the increased risk of infectious diseases in asplenic conditions. . According to the hospital information management system, all 31 (96.87%) patients, except one, were vaccinated with PPV23. As expected, vaccinated patients exhibited high levels of vaccine-specific antibody production with IgG, IgG2, and IgA antibody concentrations of 321 ± 76.68 mg/l, 73.07 ± 8.273 mg/l, and 117.8 ± 14.94 mg/l, respectively, but unvaccinated patients had very low antibody (IgG, IgG2 and IgA antibody concentrations were 11.5 mg/l, 1.3 mg/l and 1.2 mg/l, respectively) levels. Although there was no correlation between antibody titers and gender, age groups or presence of fever history, the decrease in total IgG, IgG2 and IgA titers were strongly correlated with the time since splenectomy. Antibody titers were found to be significantly lower in splenectomized patients vaccinated more than 10 years ago. Routine laboratory results were at normal levels except for low platelet count. On the other hand, both splenectomized and healthy control subjects displayed similar IgG avidity index values (%61.8 ve %64.4% inhibition in control and splenectomized subjects, respectively) after the vaccination schedule. It was shown that post-splenectomy vaccination with PPV23 induced high levels of pneumococcus-specific antibody production that can last for more than five years. It was determined that more efforts should be made to increase the level of knowledge about pneumococcal and other overwhelming post-splenectomy infections (OPSI) as the awareness of the patients about the risks of infection after splenectomy was poor. In particular, patients with splenectomy operation more than 10 years ago should be very careful about being asplenic as they were determined to have significantly lower level of vaccine-specific antibody production. Our study was also the first to show that splenectomy does not alter IgG avidity induced by pneumococcal vaccination.

Malignant Tumors Misdiagnosed as Liver Hemangiomas.

Background and Aim: To derive lessons from the data of patients who were followed for various periods with the misdiagnosis of liver hemangioma and eventually found to have a malignancy. Material and Methods: The records of 23 patients treated between 2003 and 2018 were analyzed retrospectively. Results: Twelve patients were men and 11 were women; median (range) age was 55 (35-80). The principal diagnostic modality for the initial diagnosis was ultrasonography (n:8), magnetic resonance imaging (MRI) (n:13), and computed tomography (CT) (n:2). At our institution, MRI was performed in 16 patients; the diagnosis was made with the available MRI and CT studies in five and two patients, respectively. In other words, the ultrasonography interpretations were not confirmed on MRI; in others, the MRI or CT examinations were of low quality or they had not been interpreted properly. Fifteen patients underwent surgery; the other patients received chemotherapy (n:6) or chemoembolization (n:2). The misdiagnosis caused a median (range) 10 (0-96) months delay in treatment. The final diagnoses were hepatocellular carcinoma in 12 patients, cholangiocarcinoma in four patients, metastatic mesenchymal tumor, metastasis of colon cancer, metastatic neuroendocrine carcinoma, sarcomatoid hepatocellular carcinoma, angiosarcoma, thoracic wall tumor, and metastatic tumor of unknown primary in one patient each. Conclusions: High-quality MRI with proper interpretation and judicious follow up are vital for the accurate differential diagnosis of liver lesions.

A new variant of double common bile duct associated with choledochal cyst.

Extrahepatic bile duct duplication is a rare biliary anomaly often associated with conditions like cholecysto-choledocholithiasis, choledochal cyst and malignancy. Precise preoperative diagnosis using conventional radiologic imaging still remains a challenge and use of existing classification system is equally confusing. A female patient diagnosed with choledochal cyst by magnetic resonance cholangiopancreatography was found to have an associated new variant of double common bile duct during surgery. The variant discovered could not be classified by existing classification systems and was missed by preoperative imaging. Recognition of existence of this anomaly that warrants careful dissection during biliary surgery is necessary to avoid inadvertent biliary injury as preoperative diagnosis still remains a challenge. Review of existing classification systems is required to include newly discovered variants.

Comparison of Primary Midline Closure, Limberg Flap, and Karydakis Flap Techniques in Pilonidal Sinus Surgery.

BACKGROUND Pilonidal sinus (PS) is a common disease of the sacrococcygeal-natal region. There are many treatment options, but there is still no consensus on the ideal treatment. We compared the results of our PS patients who were treated with primary midline closure (PMC), Limberg flap repair (LFR), and Karydakis flap (KF). MATERIAL AND METHODS The data for 924 PS patients from 2013 to 2017 were retrospectively examined. Demographic data, surgical procedures, schedules, and recurrence rates were examined. RESULTS The mean age was 28.4 years (14-77 years), 82.5% were male (n=762), and 17.5% were female (n=162). PMC was performed on 53.7% (n=496) of the patients, 32.5% (n=300) received LFR, and 13.9% (n=128) underwent KF. PMC was the first choice among females but LFR was the first choice in recurrent patients. The recurrence rate was 10.8% in the PMC group, 8% in the LFR group, and 3.1% in the KF group. In Short Form Survey-36 (SF-36) scores, the best cosmetic outcomes were observed in cases of PMC (p<0.05). Overall, wound dehiscence (WD) was observed in 7.5%, surgical site infection (SSI) in 2.4%, and seroma in 8.5% of all patients. The KF group had the lowest complication rates (p<0.01). CONCLUSIONS According to the results of this study, the reason for preferring PMC among women is cosmetic concerns. PMC still remains important for treatment, but it should be noted that the recurrence rates due to inadequate excision are mostly observed in cases of PMC. Considering their low recurrence rates, LFR or KF should be considered first. When low recurrence rates, patient comfort, and cosmetic results are evaluated together, KF in particular emerges as a method preferred by physicians and patients.

Platelet-Rich Plasma May Offer a New Hope in Suppressed Wound Healing When Compared to Mesenchymal Stem Cells.

BACKGROUND: The present study investigated the effectiveness of platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) in wound healing suppressed by corticosteroid in rats. METHODS: Forty rats were separated into four groups. To disrupt the wound-healing processes, intraperitoneal single dose 10 mg/kg methylprednisolone was administered to all rats with the exception of Sham-S group. Then, full-thickness incision was performed to the abdominal skin of all animals, and PRP or MSCs were applied to the incision line except the Sham-S and Sham-M group animals. Ten days later, all animals were sacrificed to investigate: tissue collagenization, inflammation, and re-epithelialization grades histopathologically; and tissue hydroxyproline (HP), interleukin-1β (IL-1β), tumor necrosis factor-α levels biochemically. RESULTS: Collagenization (p = 0.003) and inflammation grade (p = 0.002) values were higher in PR group. Tissue HP level value was found to be high in MC group (p < 0.001). Tissue IL-1β level value of Sham-M group was lower than those of other groups (p < 0.001). CONCLUSIONS: This preliminary study revealed that PRP could improve the histopathological grades in wound healing which was suppressed by corticosteroid in rats, while MSCs could show their therapeutic effects via biochemical route. These positive effects were more salient in PR group.

Comparison of Effects of Vessel-Sealing Devices and Conventional Hemorrhoidectomy on Postoperative Pain and Quality of Life.

BACKGROUND The aim of this study was to investigate the early and late results of use of LigaSure, Harmonic Scalpel, and conventional hemorrhoidectomy in hemorrhoidectomy, to determine the least painful method, and to investigate the relationship between pain perception and personal differences in hemorrhoid bundles. MATERIAL AND METHODS Ninety patients undergoing hemorrhoidectomy between 2014 and 2017 were retrospectively evaluated. We investigated the duration of hospitalization and the presence of bleeding, incontinence, perianal wetness, urinary retention, stenosis, and recurrence during follow-up after surgery. Analgesic requirement was determined by Patient-Controlled Analgesia, as well as pain score by use of the Visual Analog Score and patient satisfaction by Short Form-36. We also assessed the relationship between pain and lateral thermal damage, the number of peripheral nerves, number of excised bundles, and the number of thrombosed vessels, as determined by histopathological examination. RESULTS No differences were found among the 3 methods in the duration of hospitalization, the presence of bleeding, fecal incontinence, perianal wetness, urinal retention, anal stenosis, recurrence rate, VAS, analgesic consumption, or results of the SF-36. There was no difference in the number of bundles, thrombosed vessels, or number of nerve fibers in a bundle, but the LigaSure Hemorrhoidectomy had more lateral thermal damage (p<0.001). While there was a difference between VAS of day 1 and 7 according to the hemorrhoid bundles, there was no difference in the other parameters. CONCLUSIONS There was no difference among the 3 methods in terms of complications, postoperative pain, or patient satisfaction, and pain intensity was positively correlated with the number of excised bundles.

The effect of splenectomy on the levels of PCV-13-induced memory B- and T cells.

AIM: Splenectomised patients are associated with lifelong risk of fatal overwhelming post-splenectomy infection (OPSI), which is mostly caused by Streptococcus pneumoniae. Today OPSI cases can still be reported even in patients with appropriate vaccination. In our study, the levels of vaccine-specific memory B- and T cells were compared between control and splenectomised patients to enlighten the underlying reason. MATERIALS AND METHODS: Five healthy and 14 post-traumatic splenectomised individuals were vaccinated with 13-valent pneumococcal conjugate vaccine (PCV-13) followed by 23-valent pneumococcal polysaccharide vaccine (PPV-23). The levels of memory B- and T cells were compared by ELISPOT analysis. RESULTS: Splenectomised patients generated reduced levels of memory IgG B cells in response to PCV-13 vaccination, while the memory IFN-γ T-cell levels were undetectable in asplenic patients. This was despite the detection of vaccine-induced memory T-cell levels in control patients, which were analysed simultaneously following the same experimental protocol. CONCLUSION: Our results suggest that spleen is important, but not essential, for survival and/or generation of memory IgG B cells. In contrast, it seems to be indispensable for PCV-13-specific memory TH 1-cell levels. Studies enhancing the levels of vaccine-induced memory cells and further enlightening the immune responses in asplenic individuals are required to develop more effective vaccination strategies against OPSI.