ANALYSIS OF DIAGNOSTIC EXCISIONAL LYMPH NODE BIOPSY RESULTS: 12-YEAR EXPERIENCE OF A SINGLE CENTER.

Lymph node biopsy is indicated in patients with suspected malignancy or lymphadenopathy due to unclarified reasons. Lymph node biopsy can be performed as fine needle aspiration biopsy, core biopsy, or excisional lymph node biopsy. In particular, the diagnosis of malignant lymphoma is considered insufficient for oncological treatment unless classified into subgroups. Core biopsy and excisional biopsy can be performed to diagnose lymphoma and classify it into subgroups. Core biopsy may also be limited in some cases for the diagnosis of lymphoma. Therefore, patients are referred to surgical departments for excisional lymph node biopsy. It was aimed herein to analyze the results of excisional lymph node biopsies performed for diagnostic purposes in our department. Data on 73 patients having undergone diagnostic excisional lymph node biopsy at Sakarya University Medical Faculty Training and Research Hospital between January 2008 and January 2020 were retrospectively analyzed. Patients were evaluated in terms of age, gender, biopsy site, pathological diagnosis, number and diameter of lymph nodes excised. Patients younger than 18 years of age, those with sentinel lymph node biopsies, and lymph node dissections performed for any known malignancy were excluded from the study. Statistical data analysis was done using SPSS statistical software. There were 37 (50.7%) female and 36 (49.3%) male patients, mean age 52.07 (18-90) years. Axillary lymph node biopsy was performed in 32 patients, inguinal lymph node biopsy in 29 patients, cervical lymph node biopsy in 3 patients, intra-abdominal lymph node biopsy in 6 patients, mediastinal lymph node biopsy in 1 patient, and supraclavicular lymph node biopsy in 2 patients. All of the lymph node biopsies were performed as excisional biopsy. Malignancy was detected in 36 (49.3%) patients. In 37 (50.3%) patients, the causes of lymphadenopathy were found to be benign pathologies. When the causes of malignant disease were examined, it was observed that 23 (31.5%) patients were diagnosed with lymphoma. Hodgkin lymphoma was detected in 5 patients diagnosed with lymphoma, and non-Hodgkin lymphoma was found in 18 patients. Metastatic lymphadenopathy was observed in 13 (17.8%) patients. Reactive lymphoid hyperplasia (26%) and lymphadenitis (20.5%) were found among the causes of benign lymphadenopathy. The number of excised lymph nodes was between 1 and 4, and their diameter was between 9 and 75 mm (mean: 29.53±15.56 mm). There was no statistically significant difference between benign and malignant patients according to gender, age, lymph node diameter, number of lymph nodes excised, and excisional lymph node biopsy site. For diagnostic lymph node biopsy, fine-needle aspiration biopsy and core biopsy should be performed primarily. If lymphoma is suspected in the diagnosis, fine-needle aspiration biopsy is not necessary. In this case, it is believed that it is more appropriate to perform core biopsy first. If the core biopsy is insufficient for diagnosis, it is more appropriate to perform surgical biopsy in order to cause no delay in diagnosis and treatment. Excisional biopsy is a method that can be safely performed and does not cause severe morbidity in palpable peripheral lymphadenopathies. Although it does not cause severe morbidity because it is an invasive procedure, excisional biopsy should be performed in a selected patient group.

Pyogenic liver abscess after laparoscopic sleeve gastrectomy.

An infected material in the gastrosplenic area after laparoscopic sleeve gastrectomy (LSG) due to hematoma or staple line leak has the potential to spread of the bacterial content to the liver which can result in pyogenic liver abscess. Presently described is a thirty-seven-year-old female patient with unilocular pyogenic liver abscess two weeks after LSG. The abscess resolved by Ultrasound guided percutaneous drainage plus intravenous antibiotic treatment. Review of the literature regarding 3 other cases with liver abscess after LSG is also presented.

The Underestimated Impact of Hashimoto Thyroiditis on Thyroid Papillary Carcinoma.

It is stated that Hashimoto's Thyroiditis (HT) is a risk factor for the development of Papillary Thyroid Cancer (PTC). However, the effect of HT on the coexistence of HT and PTC is still controversial. In this study, our aim is to investigate the effect of the presence of HT on clinicopathological data in patients with PTC. All 356 patients whose pathology was reported as PTC who were operated between 2015 and 2023 were included in the study. PTC patients were divided into 2 groups as those with and without HT. The effect of HT association on clinicopathological features was investigated. In 356 PTC patients, the rate of HT was 31.2%. PTC patients with HT had less multifocality (p < 0.05), more lymph node metastases (LNM) (p < 0.01) compared to PTC patients without HT. The presence of HT did not affect the bilaterality of the tumor, tumor diameter, lymphovascular invasion, or capsule invasion. While multifocality was observed less frequently in PTC patients with HT, lymph node metastasis rates were higher.

Investigation of the alterations in miRNA expression levels in thyroid nodules and malignancies.

The relationship between preoperative miR-146b and miR-155 expression levels and postoperative pathology results in patients operated on for nodular thyroid disease and thyroid malignancy was investigated. Sixty three patients who were operated on for thyroid nodules diagnosed as benign, malignant and atypia of undetermined significance (AUS) were included in the study. Preoperative miR-146b and miR-155 expression levels of these patients were compared according to postoperative pathology results. Twenty three of the patients were male (36.5%) and 40 patients were female (63.5%). According to the results of fine needle aspiration biopsy (FNAB) taken from the patients in the preoperative period, The number of benign patients was 26 (41.2%), the number of malignant patients was 17 (26.9%), the number of patients reported as suspicion of malignancy was 10 (15.8%), and the number of AUS patients reported was 10 (15.8%). The postoperative pathology of 58.7% (n = 37) of the patients was benign, and the postoperative pathology of 41.3% (n = 26) was malignant. Compared to the group with benign postoperative pathology results, miR-146b expression level significantly increased by 8.08-fold in the group with malignant postoperative pathology results (p < 0.01). Additionally, miR-146b expression level was significantly upregulated by 3.23-fold in AUS patients compared with benign pathology results (p < 0.01). Although a 1.88-fold increase in miR-155 expression level was detected in malignant patients compared to the benign group, it was determined that the expression level of miR-155 significantly increased by 2.36-fold in AUS patients (p < 0.001). Circulating miRNA could discriminate between patients with benign and malignant nodules. Our results suggest that both miR-146b and miR-155 expression levels increased in the group with malignant postoperative pathology results. Additionally, increased miR-155 expression level could be associated with AUS progression. Therefore, miRNAs could be used as preoperative malignancy biomarkers to determine the characteristics of nodules and the decision to undergo surgery.

YouTube as a Source of Information on Pilonidal Sinus Disease: A Reliability and Quality Analysis.

Aim This study aimed to assess the quality and reliability of the information in YouTube videos regarding pilonidal sinus disease (PSD). Methods A total of 100 most-viewed videos on PSD were included in the analysis by two general surgeons. Video duration and content, date of upload, qualification of the video uploaders, and number of daily and total view, like, and comment counts were analyzed. We grouped the videos as those uploaded by healthcare professionals and non-professionals. The quality of the video contents was assessed with the Global Quality Scale (GQS) and the reliability of the video content with the DISCERN scoring system. Results Eighty-five (85%) videos were uploaded by professionals and 15 (15%) videos by laypersons. The average DISCERN score of the reviewed video contents was 3.18 ± 1.23, and the average GQS score was 3.39 ± 1.24. In the overall subjective evaluation, the mean DISCERN value was found as 4.01 ± 1.24 and the mean GQS value as 4.25 ± 1.25 in the useful videos. The mean DISCERN value was found as 2.32 ± 1.22 and the mean GQS value as 2.48 ± 1.25 in the misleading videos. Conclusion Our results showed that most of the YouTube videos on PSD were loaded by healthcare professionals. However, the mean quality and reliability scores were lower in videos uploaded by laypersons. Given the prevalence of PSD, physicians should be promoted for uploading accurate and professional video contents to direct patients to the right solutions for their problems.

Double peptic ulcer perforation in a Covid-19 patient, extremely rare entity.

Peptic ulcer perforation is one of the leading causes of acute abdomen, presenting with acute abdominal pain and severe distress for the patient. In one-third of patients, the presentation is less dramatic, resulting in significant delays in diagnosis. Herein, we present a very rarest case operated on for diffuse purulent peritonitis with double perforation of the stomach in a COVID-19-positive patient, which had a depressing outcome.

Should multifocality be an indication for prophylactic central neck dissection in papillary thyroid cancer?

Although multifocality is common in patients with papillary thyroid cancer, its effects on lymphatic metastasis and the necessity of central dissection in the presence of multifocality are still controversial. In our clinic, 258 patients who underwent thyroidectomy between 2015 and 2020 and were found to have papillary thyroid cancer in postoperative pathology reports were analyzed. The tumor characteristics contributing to central lymph node metastasis positivity were evaluated. Lymph node metastases were not significantly increased in the presence of multifocality. In cases with bilateral multifocal tumors, compared to cases with unilateral multifocal tumors, capsular invasion (p = 0.02), vascular invasion (p = 0.01) and cervical lymphatic metastasis (p = 0.004) were observed to increase. Bilateral multifocal tumors have more aggressive clinicopathological features than unilateral tumors. We found that the risk of central lymph node metastasis increased significantly in bilateral multifocal tumors in our study. Prophylactic central lymph node dissection may be considered in patients with no preoperative or intraoperative lymph node metastasis but thought to have a multifocal tumor.

A different way to diagnosis acute appendicitis: machine learning.

<b><br>Indroduction:</b> Machine learning is a branch of artificial intelligence based on the idea that systems can learn from data, identify patterns, and make decisions with minimal human intervention.</br> <b><br>Aim:</b> Our aim is to predict acute appendicitis, which is the most common indication for emergency surgery, using machine learning algorithms with an easy and inexpensive method.</br> <b><br>Materials and methods:</b> Patients who were treated surgically with a prediagnosis of acute appendicitis in a single center between 2011 and 2021 were analyzed. Patients with right lower quadrant pain were selected. A total of 189 positive and 156 negative appendectomies were found. Gender and hemogram were used as features. Machine learning algorithms and data analysis were made in Python (3.7) programming language.</br> <b><br>Results:</b> Negative appendectomies were found in 62% (n = 97) of the women and in 38% (n = 59) of the men. Positive appendectomies were present in 38% (n = 72) of the women and 62% (n = 117) of the men. The accuracy in the test data was 82.7% in logistic regression, 68.9% in support vector machines, 78.1% in k-nearest neighbors, and 83.9% in neural networks. The accuracy in the voting classifier created with logistic regression, k-nearest neighbor, support vector machines, and artificial neural networks was 86.2%. In the voting classifier, the sensitivity was 83.7% and the specificity was 88.6%.</br> <b><br>Conclusions:</b> The results of our study show that machine learning is an effective method for diagnosing acute appendicitis. This study presents a practical, easy, fast, and inexpensive method to predict the diagnosis of acute appendicitis.</br>.

Comparison of treatment methods in plastron appendicitis: a tertiary center experience.

Background: It is controversial which treatment method is superior in plastron appendicitis and the research is still going on. The aim of this study is to compare treatment methods for plastron appendicitis in the adult population with our experience. Materials and Methods: The data of 92 patients who were diagnosed with plastron appendicitis in university hospital between 2015 and 2021 were analyzed retrospectively. Data were taken from the hospital database. The patients were divided into three groups: those treated with primary surgery, with interval appendectomy and only with conservative method. Results: Interval appendectomy resulted in a lower rate of conversion to open surgery compared to primary surgery, shorter operative time, and lower complication rates. Surgical procedures were found to be superior in detecting neoplasms compared to conservative treatment. After conservative treatment, one of three patients was retreated with the diagnosis of acute appendicitis. Conclusion: In plastron appendicitis, routine interval appendectomy can be performed due to its advantages over other treatments such as the frequency of attacks after conservative treatment, the risk of the tumor being overlooked in conservative treatment, and the high rate of complications and conversion to open surgery in the primary surgery group.

The prognostic and predictive values of differential expression of exosomal receptor tyrosine kinases and associated with the PI3K/AKT/mTOR signaling in breast cancer patients undergoing neoadjuvant chemotherapy.

PURPOSE: Cancer cell-derived exosomes are the mediator of the tumor microenvironment and the molecular content of exosomes presents a promising prognostic or predictive marker in tumor progression and the treatment response of cancer patients. The aim of this study was to identify the expression levels of receptor tyrosine kinases (RTKs) and AKT1 and mTOR before and after neoadjuvant chemotherapy (NACT) in the exosomes of BC patients compared with healthy females. METHODS: After isolating exosomes in the serum of 25 BC patients and characterization by flow cytometry, the mRNA levels of FGFR2, FGFR3, PDGFRB, AKT1 and mTOR in the exosomes were analyzed by RT-PCR. RESULTS: Our preliminary findings showed that FGFR2, PDGFRB, AKT1 and mTOR levels were significantly upregulated in BC patients before NACT compared with the healthy group (p < 0.05). Furthermore, the mRNA levels PDGFRB and AKT1 were significantly down-regulated after NACT compared with control. PDGFRB expression level could predict pathological non-response and significantly correlated with tumor size after NACT. CONCLUSION: Therefore, especially FGFR2, PDGFRB and AKT1 could be a therapeutic target as a prognostic marker, whereas PDGFRB may be a promising predictive indicator of therapy response in BC patients. However, the prognostic or predictive role of RTKs and PI3K/AKT/mTOR signaling in the exosomes should be further investigated in a large patient population.

Robotic Surgery for the Treatment of Achalasia Cardia: Surgical Technique, Initial Experiences and Literature Review.

Background The outcomes of surgical interventions for achalasia treatment improved with the advent of minimally invasive surgery and the introduction of robotic surgery. This article describes the technical details of robotic achalasia surgery, shares our initial experiences, and discusses why robotic surgery will become the first choice for the surgical treatment of achalasia. Methods The records of patients with a diagnosis of achalasia who underwent robotic surgery were evaluated retrospectively. The patients' data were examined in terms of demographic parameters, duration of complaints, treatment options applied previously, robotic surgery technique, and postoperative outcomes. Results Of the six patients evaluated, four (66.7%) were males and two (33.3%) were females. Their mean age was 32 years (20-51 years), and the mean symptom duration was 4.6 years (2-9 years). All of the patients underwent robotic Heller cardiomyotomy surgery. After the myotomy procedure, five of the six patients (83.3%) underwent partial anterior fundoplication (Dor) as an antireflux procedure. The cruroraphy procedure was performed in one patient (16.7%) due to accompanying hiatal hernia, whereas the procedures were completed in five patients (83.3%) without performing posterior dissection of the oesophagus. In the postoperative follow-up period, no surgical problem was encountered, while reflux symptoms developed in one patient (16.7%) and were controlled by medical therapy. Conclusions The success of surgical treatment of achalasia is incontrovertible. Due to the various advantages of robotic surgery, it is now frequently used in narrow-area surgeries, such as achalasia surgery.

The neglected surgery - Hernioscopy - Maybe the best choice for strangulated groin hernias in the COVID-19 pandemic.

<b>Introduction:</b> While elective surgeries have been postponed worldwide due to the COVID-19 pandemic, emergency operations cannot be delayed and are continuously being performed just like before the pandemic outbreak [1]. </br></br> <b>Aim:</b> Although elective surgeries have been postponed worldwide due to the COVID-19 pandemic, emergency operations cannot be delayed and are continuously being performed. In general surgery practice, incarcerated / strangulated inguinal hernias take a prominent place among emergency surgeries. In 1% of these patients, the hernia contents retreat spontaneously into the abdomen until the hernia sac is opened. It is strongly recommended that these bowel segments be evaluated for possible intestinal necrosis.</br></br> <b>Results:</b> Patients who underwent emergency surgery and hernioscopy in the Sakarya Training and Research Hospital General Surgery Service due to incarcerated or strangulated inguinal hernia between March 2020 and October 2020 were included in the study. Hernioscopy procedure was performed using the single-port and glove-port methods. For each patient, the following variables were recorded: age, duration of complaints, comorbidities, hernia repair method, operation time, incarcerated organ, postoperative complications and whether ischemia improved after reduction or resection was required. </br></br> <b> Conclusion:</b> Hernioscopy is a procedure performed under spinal anesthesia which prevents unnecessary laparotomies and should be considered as first-line treatment during the COVID-19 pandemic in patients who undergo emergency surgery for strangulated inguinal hernia.

Open versus laparoscopic technique in peptic ulcus perforation, how effective are score systems?Single-center experience and literature review.

BACKGROUND: One of the most common peptic ulcer complications is perforation (PUP) which also remains an important cause of morbidity and mortality. In this study, it was aimed to compare the results of patients who had similar pre-operative scoring index results (Boey, Charlson Comorbidity Index (CCI) and Mannheim Peritonitis Index (MPI), and type of surgery. METHODS: Pre-operative Boey, CCI, and MPI scores were calculated by retrospectively examining the files of patients who were operated under emergency conditions with the diagnosis of PUP. The patients divided into two groups those who underwent laparoscopic surgery/Group-1 and open surgery/Group-2. RESULTS: There was no statistical difference between the groups in terms of demographic data, hospital admission time, and length of hospital stay. The operation time was found to be longer in the laparoscopic group (110,2 SD20,6/75-150 min) than open group (54,2 SD15,7/30-120 min) (p<0.001). Morbidity was less in laparoscopic group (4% versus 14.6%) (p<0.001). CONCLUSION: The laparoscopic method may be used safely in PUP due to the lower post-operative complication rates and known advantages of minimally invasive surgery.

The Predictive Role of MMP-2, MMP-9, TIMP-1 and TIMP-2 Serum Levels in the Complete Response of the Tumor to Chemotherapy in Breast Cancer Patients.

OBJECTIVE: We investigated the serum levels of MMPs and TIMPs in breast cancer (BC) patients to predict the response rate to/after treatment with or without neoadjuvant chemotherapy. BC is the most common cancer in women and MMPs are responsible for the breakdown of ECM proteins during organogenesis and TIMPs are restricted the ECM destruction by MMPs. However, the predictive role of MMPs and TIMPs in the treatment response of BC patients has not identified. METHODS: This study consisted of 96 BC patients (34 neoadjuvant treatment and 62 surgically treated) and 35 healthy individuals. ELISA was used to determine the level of MMP-2, MMP-9, TIMP-1, and TIMP-2 from serum samples of BC patients. RESULTS: The mean levels of MMP-9 and TIMP-2 were significantly increased in all BC patients at diagnosis and after chemotherapy, but MMP-2 was considerably lower at diagnosis. There was only a significant difference in the TIMP-1 levels after chemotherapy as well as HER2 and ER status in the neoadjuvant and surgically treated group. Additionally, MMP-2 and MMP-9 serum levels negatively correlated with tumor size and metastatic lymph nodes in BC patients after chemotherapy. CONCLUSIONS: BC patients with high levels of MMP-9 and TIMP-2 can be used to predict the stage of the tumor and CR to chemotherapy and higher TIMP-1 serum level after chemotherapy could be related to better response to chemotherapy.

Isolated recto-vaginal septum injury during parturition: Single-center experience.

BACKGROUND: Traumatic rectal injuries are uncommon and can originate due to various causes. Rectal injuries have a high mor-bidity, regardless of cause, and detection at the time of occurrence is important to prevent fistula formation and/or stoma. In this article, treatment approaches in patients with isolated rectovaginal septum injury without perineal and sphincter injury during sponta-neous vaginal delivery are presented and the current literature is reviewed. METHODS: The records of spontaneous vaginal deliveries that resulted in live births between January 2015 and January 2020 were analyzed retrospectively at our center. The records of patients with isolated rectovaginal septum injury were evaluated in terms of demographic and obstetric data, trauma, classification of injury, and early and late results. RESULTS: Isolated septum injuries were detected 12 women (0.06%). Of the isolated rectovaginal septum injuries, 9 (75%) were clas-sified as Type III, 2 (16.6%) as Type IV, and 1 (8.3%) as a Type V injury according to the Rosenshein classification. Transvaginal repair was performed because all of the injuries underwent early surgical intervention, were limited, and exploration through the vagina was possible. CONCLUSION: Rectal examination should be performed simultaneously with a detailed perineal examination after vaginal delivery. For birth-related rectal injuries detected early in appropriate patients, a primary repair without diversion stoma may be the best option.

Comparison of Balloon Trocar versus Telescopic Dissection Method for TEP Inguinal Hernia Repair.

OBJECTIVE: To compare the outcomes between two methods of dissection (balloon trocar vs. telescopic dissection) used in total extra-peritoneal (TEP) inguinal hernia repair. STUDY DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Department of General Surgery, Faculty of Medicine, Sakarya University, conducted between January 2018 and January 2020. METHODOLOGY: The study included patients who underwent elective TEP inguinal hernia repair. Preoperative and early postoperative results were compared, after the patients had been divided into a balloon trocar group (Group 1) and telescopic dissection group (Group 2). The technique performed depended on equipment availability. Permission was obtained from the Institutional Review Board. The study data are presented as descriptive statistics (mean, standard deviation, median, first quartile, third quartile, frequency and percentage); p-value <0.05 was considered significant. RESULTS: A total of 189 patients were included; 95 patients in Group 1 and 94 patients in Group 2. No significant differences in age, gender, body mass index, body weight, ASA performance status, operating time, duration of hospitalisation or postoperative bleeding values were observed between the groups (p >0.05). European Hernia Society Quality of Life pain score values ​​ were higher in Group 2 than Group 1 (p = 0.016). CONCLUSION: Telescopic dissection was cheaper than balloon dissection. The bleeding values and operating time were similar between the two methods, but telescopic dissection caused more postoperative pain. Key Words: Inguinal hernia, Telescopic dissection, Balloon dissection, Total extra-peritoneal (TEP) surgery.

Coexistence of Neurofibromatosis Type 1 and Male Breast Cancer.

Breast cancer is one of the rarest types of cancer in men. Its incidence increases with age, as in women. Neurofibromatosis type 1 is an autosomal dominant genetic disease that predisposes to many cancer types. Neurofibromatosis and breast cancer have been more frequently distinguished and better studied in women. Characteristically, estrogen, progesterone receptors, negative, and overexpression of human epidermal growth factor receptor 2 (HER2) are detected in patients with female neurofibromatosis breast cancers. In cases reported so far, estrogen and progesterone receptors have been evaluated as positive and HER2 negative in male patients. With the high possibility of breast cancer development in female patients with neurofibromatosis at an earlier age, prompt and careful evaluation is required in terms of both examination and radiological imaging. Unfortunately, there are no thorough recommendations for breast cancer follow-up in male patients with neurofibromatosis. Here, we present a breast cancer, which is an uncommon type of cancer in male neurofibromatosis.

Endoscopic Detorsion Results in Sigmoid Volvulus: Single-Center Experience.

Endoscopic detorsion is the first-line recommended treatment modality in sigmoid volvulus patients who have no peritoneal irritation signs on admission. In this paper, we present the results of endoscopic detorsion procedures applied at the time of presentation with the diagnosis of sigmoid volvulus and review the current literature about this topic.

A Benign Rare Lesion of the Breast: Giant Epidermal Inclusion Cyst.

An epidermal inclusion cyst can be seen at any location. Epidermal cysts are commonly found on the scalp, face, trunk, neck, and extremities. They are rarely seen in the breast parenchyma. These benign lesions are important in that they may undergo neoplastic differentiation, although very rarely. Epidermoid cysts usually develop as a result of the implantation of superficial epidermal tissue into the dermis or subcutaneous tissue after trauma or surgical procedures. In this study, a 37-year-old female patient who underwent a histopathological examination that showed a 10-cm epidermal cyst without a history of trauma or a surgical procedure was discussed.