Changes in cytokines and chemokines in an acute pancreatitis model.

BACKGROUND: The immune response secondary to inflammation that develops in acute pancreatitis plays an important role in the clinical course of the disease. This study aims to evaluate the changes in various cytokines and chemokines according to the severity of pancreatitis. METHODS: Twenty-one female Wistar albino rats were divided into three equal groups. The control group received no intervention. Intraperitoneal cerulein was administered to the other groups once per hour for five hours at doses of 50 µg/kg and 80 µg/kg for the mild and severe pancreatitis groups, respectively. The development of pancreatitis and its severity level were confirmed by histological evaluation after euthanization. Blood samples were taken from all rats to measure levels of Interleukin-10 (IL-10), Interferon gamma (IFN-γ), C-X-C Motif Chemokine Ligand 1 (CXCL-1), Monocyte Chemoattractant Protein-1 (MCP-1), Tumor Necrosis Factor alpha (TNF-α), Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF), IL-18, IL-12p70, IL-1ß, IL-17A, IL-33, IL-1α, and IL-6. Additionally, the Schoenberg inflammation scores of pancreatic tissues were evaluated. RESULTS: The acute pancreatitis model was successfully induced in all cases within the study groups, according to histopathological examination. It was found that the levels of CXCL-1, MCP-1, and IL-6 were statistically significantly higher in rats with pancreatitis, with these parameters being elevated in the group with severe pancreatitis. In correlation analyses, MCP-1 and IL-6 showed a moderate correlation with the severity of pancreatitis. CONCLUSION: CXCL-1, MCP-1, and IL-6 exhibit predictive characteristics for the occurrence and clinical course of pancreatitis. Our results highlight the production and working pathways of these cytokines as potential targets for therapeutic intervention.

Predicting the Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer Using Soluble Immune Checkpoints.

Introduction: Personalizing neoadjuvant therapy for locally advanced rectal cancer (LARC) requires identifying biomarkers that predict treatment response. This study evaluates soluble immune checkpoints (sICPs) as predictive markers for neoadjuvant treatment response in LARC patients located in the middle and lower rectum. Materials and Methods: This prospective study included patients diagnosed with clinical stage T3 or T4 rectal cancer (RC) based on pelvic magnetic resonance imaging, with or without pelvic lymph node involvement. The modified Ryan scoring system was used to assess the response to neoadjuvant chemoradiotherapy (nCRT). Blood samples were collected from all RC patients before initiating nCRT. Various sICPs (sCD25, 4-1BB, B7.2, free active TGF-ß1, CTLA-4, PD-L1, PD-1, Tim-3, LAG-3, galectin-9), along with age, gender, stage, blood cell counts, and biochemical variables, were recorded and compared based on tumor regression grade (TRG). Results: Among 38 participants, lymphocyte count was higher, and platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and platelet count were lower in patients with complete/near-complete response (TRG 0/1). In addition, TRG 0/1 patients had significantly lower levels of soluble galectin-9 than TRG 2/3 patients. Furthermore, platelet count was the only parameter that showed a significant difference among the three groups (TRG 0/1, TRG 2, and TRG 3). PLR demonstrated the highest sensitivity and specificity, with >80% for both measures. Conclusions: Lymphocyte count, PLR, NLR, platelet count, and galectin-9 may help predict favorable neoadjuvant treatment response in LARC patients, although without providing a definitive outcome. Personalized therapy based on these markers could enhance treatment decision making in LARC management.

Prognostic effect of Nesfatin-1 on the diagnosis and staging of acute cholecystitis.

BACKGROUND: Gallbladder diseases are an important health concern affecting approximately 20% of the population in developed countries. Acute cholecystitis is the most common complication of gallstones. The aim of our study is to determine the use of Nesfatin-1, which is an easily applicable and fast resulting and is thought to have an association with inflammatory events, in the diagnosis and grading of acute cholecystitis. METHODS: Patients who admitted and were hospitalized and treated with the acute cholecystitis diagnosis in Istanbul Training and Research Hospital between July 1, 2020, and December 1, 2020, were included in the study. The patients were divided in threemain groups as mild, moderate, and severe according to Tokyo Guidelines 2018 based on their routine blood tests and imaging results. All patients who are included in the study were tested for their blood leukocyte, neutrophil, lymphocyte, Nesfatin-1 levels, and neutrophil/lymphocyte ratios within the first 24 h of their hospitalization. RESULTS: With at least 15 patients in each group, 61 volunteers in total were included in the study as healthy volunteers, mild, moderate, and severe cholecystitis. The average age of the participants were 58.11±19.76 years. About 47.54% of the participants were female and 52.46% weremale. In the study, Nesfatin-1 levels in the patient groups were found to be lower than the control group. In the subgroup analyzes, Nesfatin-1 values in the middle patient group were found to be significantly lower than the control group; however, there was no statistically significant relationship between the severity of the disease and Nesfatin-1. CONCLUSION: Nesfatin-1 may guide the clinician for the diagnosis of the disease; however, no significant relationship was found between Nesfatin-1 and the severity or stage of the disease.

Evaluation of the appendectomy cases performed under emergency conditions during the COVID-19 pandemic and discussed with the pathology reports.

BACKGROUND: The aim of this study is to examine the cases underwent appendectomy during the COVID-19 pandemic and to discuss the pathology reports of patients. METHODS: During the COVID-19 pandemic, the pathological reports of the appendectomy materials of 588 patients over the age of 15 who applied to the emergency department between January 1, 2020, and June 1, 2021, were examined. A total of 565 patients with a diagnosis of acute (AA), subacute (SA), or perforated appendicitis (PA) were included and divided into three groups according to diagnosis. Twenty-three patients were excluded from the study due to other pathologies. The age, gender, duration of pain, ASA score, operational technique, operation time, Clavien-Dindo score, hospitalization time, post-operative complications, pre- and post-operative PCR and thoracic tomography findings in suspected cases of COVID-19, and laboratory and radiological findings of patients were retrospectively analyzed. RESULTS: Of 565 patients diagnosed with appendicitis, 464 (82.1%) had AA, 35 (6.2%) SA, and 66 (11.7%) PA. The median age of the PA group was higher than in the AA group (p=0.0139). The incidence of diabetes mellitus in the PA group and of asthma in the SA group were highest among other groups (p=0.004 and 0.0037, respectively). The duration of pain was longer in the SA and PA groups than the AA group (p<0.0001), therefore, the patients applied to hospital later than the acute group. The rate of thorax CT-positive scans was 1.6% in patients suspected for COVID-19 (p=0.066). While laparoscopic surgery was preferred over 70% in all groups, the rate of conventional surgery (21.1%) in the AA group was highest and of transition from laparoscopic to open surgery was highest in the PA group (10.6%) (p<0.0001). Hospitalization duration was longest in the PA group (p<0.0001). CONCLUSION: COVID-19 pandemic not only changes all routines of social life but also complicates the treatment and manage-ment of cases with AA symptoms applied to hospital under emergency conditions. Follow-up of the appendectomy specimen is crucial in terms of excluding other pathologies.

The Role of 18F-FDG PET/CT in staging of gallbladder carcinomas.

BACKGROUND/AIMS: Gallbladder Carcinoma (GBC) is the most common and aggressive tumor of the biliary tract. Patients are typically diagnosed during advanced stages, and the mean overall survival is short. In our study, we aimed to demonstrate the uptake patterns of 18F-FDG PET/CT in GBC, as well as its association with survival and diagnostic value during the initial stage. MATERIALS AND METHODS: Overall, 17 patients with GBC were retrospectively included in the study. 18F-FDG PET/CT study was performed for pretreatment staging. Two different standardized uptake values (SUVmax and SUVmean), metabolic tumor volume 40% (MTV40), and tumor lesion glycolysis (TLG) of the primary tumors were compared between the clinical and histopathological groups. RESULTS: Of the 17 patients, 11 were women (64.7%), and 6 (35.3%) were men. The mean age of the patients was 69.7±8.8 years. 18F-FDG uptake was detected in all lesions. Mean SUVmax was calculated to be 15.4±13.7 (median=10.6, range=3.4-46.8). All distant metastases (52.9%) were detected in the liver. Semiquantitative metabolic parameters (SUVmax and SUVmean, MTV40, and TLG) obtained from patients with distant metastasis were not significantly higher than those without distant metastasis. Similar results were obtained in patients with and without nodal metastasis. No statistically significant intergroup difference was observed regarding metabolic parameters. However, a statistically significant negative correlation was observed between the patient's age and the SUVmax of the primary lesion and metastatic lymph nodes (r=-0.564, p=0.018). During 10.7±10.4 months of mean follow-up, the mean survival of patients with distant metastases (6.1±11.0 months) was significantly shorter than that of patients with no organ metastases (15.8±7.1 months). CONCLUSION: In our study, distant metastases and age were observed to be crucial prognostic factors in patients with gallbladder carcinoma (GBC). In addition, we believe that 18F-FDG PET/CT imaging will help to stage the GBC, detect nodal and distant metastasis, and evaluate the metabolic state of gallbladder lesions.

Stent experiences in emergency conditions in acute mechanical intestinal obstruction caused by colorectal cancer.

INTRODUCTION: Stent treatment can be applied to avoid surgery in surgically risky patients or to turn a high-risk emergency operation into a lower-risk elective operation and save time. AIM: In this study, the techniques, clinical efficacy, safety and complications of endoscopic stents applied in emergency conditions were evaluated in patients with acute mechanical intestinal obstruction (AMIO) due to colorectal cancer. MATERIAL AND METHODS: Between 2013 and 2015, 23 patients with an average age of 69.5 ±13.5 years who presented with AMIO and anastomosis stenosis secondarily to cancer to the emergency department were subjected to stent treatment under emergency conditions. RESULTS: Thirteen (56.5%) patients were diagnosed with colon cancer, 5 (21.7%) with rectal cancer, and 5 (21.7%) with stenosis in the previous anastomosis line. Fourteen (60.9%) patients were diagnosed with stage 4 cancer, 7 (30.4%) with stage 3 cancer and 2 (8.7%) with stage 2 cancer. The stents were applied to the sigmoid colon in 10 (43.5%) patients, to the recto-sigmoid area in 9 (39.1%) patients and to the rectum area in 4 (17.4%) patients. While 14 (60.9%) patients had local or locally advanced disease, 9 (39.1%) patients had metastases in different parts of their bodies, particularly in their livers. CONCLUSIONS: The study demonstrates that stents offer a favorable therapeutic alternative to emergency surgery and are associated with promising short-term outcomes as well as an acceptable safety profile for AMIO.

Clinicopathological features of gastroenteropancreatic neuroendocrine tumors: A retrospective evaluation of 42 cases.

OBJECTIVE: Neuroendocrine tumors arise from neuroendocrine cells in any part of the body; approximately two thirds of these tumors are located in the gastrointestinal tract and pancreas. Although gastroenteropancreatic neuroendocrine tumors are known as rare neoplasms, their prevalence has recently increased due to advanced diagnostic methods and increased awareness of the disorder. In the present study, we aimed to review patients who were treated and followed up for gastroenteropancreatic neuroendocrine tumors at our clinic in terms of clinical picture, pathological findings, and prognosis. MATERIAL AND METHODS: Data from 42 patients diagnosed with gastroenteropancreatic neuroendocrine tumors who were treated and followed up at our Training and Research Hospital from August 2011 to December 2015 were retrospectively evaluated. RESULTS: A total of 42 patients aged 17-81 years (mean age 46.9 years) were enrolled in the study. The most common symptom was abdominal pain, which was seen in 31 (73.8%) patients. gastroenteropancreatic neuroendocrine tumors were detected in the stomach (n=5, 35.7%), appendix (n=11, 26.2%), rectum (n=6, 14.3%), pancreas (n=4, 9.5%), ileum and colon (n=2, 4.8%), and duodenum and jejunum (n=1, 2.4%). Local excision was performed in seven (16.7%) patients. Nine (21.4%) patients underwent gastric wedge resections, either by a laparoscopic procedure (n=3) or by open surgery (n=6). Total gastrectomy and laparoscopic subtotal gastrectomy were performed on three (7.1%) patients and two patients (4.8%), respectively. After the surgical procedures, the patients were followed up for a mean period of 36 months (15-57 months); the one-year and three-year survival rates were determined to be 100% and 97.6%, respectively. CONCLUSION: Management of gastroenteropancreatic neuroendocrine tumors requires accumulation of knowledge and experience to establish a standardized approach. Therefore, we believe that collecting regular national data from these cases in every country will contribute to understanding the details of this entity worldwide.

Intraoperative acidosis is a new predictor for postoperative pancreatic fistula after pancreaticoduodenectomy.

BACKGROUND: Early diagnosis of postoperative pancreatic fistula (POPF) is important for proper interventions. The preoperative, intraoperative and early postoperative biochemical markers have predictive value of POPF. The present study was to evaluate several simple biochemical parameters in the prediction of POPF. METHODS: Patients who underwent pancreaticoduodenectomy in our center between 2006 and 2015 were reviewed retrospectively. Preoperative and early postoperative biochemical parameters were evaluated. Additionally, the relationship between POPF and pH and lactate level at the end of surgery were analyzed, and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and red cell distribution width-to-platelet ratio (RPR) were calculated for postoperative days (PODs) 1 and 3. Diagnosis and grading of POPF were performed according to the standards of the International Study Group on Pancreatic Fistula. The patients were divided into two groups: Group 1 with no fistula or grade-A fistula; group 2 with grade-B or -C fistula. These simple biochemical markers were then compared between the two groups. RESULTS: Serum amylase level was significantly higher at POD3, and pH level was significantly lower at the end of operation in group 2 compared with those in group 1. However, the serum amylase was below the upper limit of normal serum level and therefore, the difference was not significant in clinical practice. Receiver operating charecteristic curve analysis showed that pH level was a reliable predictor of POPF (area under the curve: 0.713; 95% CI: 0.573-0.853). CONCLUSIONS: A low pH level at the end of pancreaticoduodenectomy was a risk factor of POPF. NLR, PLR, and RPR had no predictive value of POPF after pancreaticoduodenectomy.

Diagnostic value of basic laboratory parameters for simple and perforated acute appendicitis: an analysis of 3392 cases.

BACKGROUND: The aim of the present study was to examine the efficacy of simple laboratory parameters including neutrophil-to-lymphocyte ratio (NLR), platelet count (PLT), mean platelet volume (MPV), and serum bilirubin level in the diagnosis of acute appendicitis and recognition of perforated appendicitis. METHODS: Records of 3392 patients who underwent appendectomy in a 10-year period were reviewed retrospectively. Patients were divided into 2 groups according to histopathological examination results: Group 1 had normal appendix, Group 2 had acute appendicitis. Patients with acute appendicitis were divided into subgroups: Group 2A had simple acute appendicitis, while Group 2B had perforated appendicitis. Efficacy of the aforementioned laboratory parameters was evaluated in the diagnosis of acute appendicitis and recognition of perforated appendicitis. Independent variables were determined by univariate analysis and multivariate analysis was performed. Receiver operating characteristic (ROC) curve analysis was used to identify significant parameters in multivariate analysis. Cut-off values, sensitivity, specificity, and accuracy calculations performed for parameters with area under curve (AUC) >0.600 were accepted as "significant parameters." RESULTS: White cell count (WCC), bilirubin, and NLR were significant parameters for the diagnosis of acute appendicitis. Cut-off values were 11900/mm3 for WCC (sensitivity: 71.2%; specificity: 67.2%; OR: 5.13), 1.0 mg/dl for bilirubin (sensitivity: 19.1%; specificity: 92.4%; OR: 2.96), and 3.0 for NLR (sensitivity: 81.2%; specificity: 53.1%; OR: 4.27). Serum bilirubin and NLR were independent variables for the diagnosis of perforated appendicitis. Cut-off values were 1.0 mg/dl for bilirubin (sensitivity: 78.4%; specificity: 41.7%; OR: 2.6) and 4.8 for NLR (sensitivity: 81.2%; specificity: 53.1%; OR: 2.6). CONCLUSION: Presence of at least 1 of the following findings in a patient suspected of having acute appendicitis was significantly associated with a definite diagnosis: WCC >11.900 mm3, serum bilirubin >1.0 mg/dl, NLR >3.0. In patients with acute appendicitis, serum bilirubin >1.0 mg/dl or NLR >4.8 were significantly associated with the presence of perforation. While WCC is a significant parameter for diagnosis of acute appendicitis, no significant association with perforated appendicitis was found. PLT and MPV were not useful parameters when diagnosing acute appendicitis.

Is the classification of intraoperative complications (CLASSIC) related to postoperative course?

INTRODUCTION: The Classification of Intraoperative Complications (CLASSIC) is one of two recent classification systems for intraoperative adverse events (iAEs), featuring simple but inclusive definitions. No data have been reported regarding the relation between CLASSIC and postoperative course. The aim of the present study was to evaluate the relation between the grade of iAEs and the grade of postoperative complications in patients who underwent hepatopancreaticobiliary (HPB) surgery. METHODS: Demography, preoperative laboratory parameters, iAEs, postoperative complications, and intraoperative pH and lactate levels of patients who underwent HPB surgery between December 2014 and December 2015 were evaluated retrospectively. The recorded parameters were compared according to the grade of iAEs and the grade of postoperative complications described in the Accordion Severity Classification of Postoperative Complications. RESULTS: Fifty-eight patients were considered. Mean age was 56 ± 15, 21 female vs. 37 male, 47 malign vs. 11 benign. Demographic features and preoperative status of the patients, and the presence of intraoperative acidosis were not significantly related to the grade of iAEs or postoperative complications. The grade of iAEs was directly proportional to the grade of postoperative complications (p = 0.031). Although it is not statistically significant, lactate level at the end of operation had a potential to predict the postoperative course (p = 0.057). CONCLUSIONS: The grade of iAEs has a predictive value for the grade of postoperative complications in HPB surgery patients; hence, high grade of iAEs is significantly related to high grade of postoperative complications. Lactate level at the end of operation has the potential to predict the postoperative course.

Preoperative localization of distal colorectal tumours.

BACKGROUND: The detection of true localization of the tumour are crucial to driving the proper treatment algorithm in distally-located colorectal cancers (CRCs). The performance of four methods; colonoscopy, computed tomography (CT), magnetic resonance imaging (MRI), and fluoro-deoxy-glucose-positron emission tomography scan (FDG/PET-CT), were evaluated to identify the localizations of distal colorectal malignancies according to the rectum, sigmoid colon and recto- sigmoid junction (RSJ). MATERIALS AND METHODS: Medical records of patients who underwent colorectal surgery for tumours located on the sigmoid colon, RSJ, or rectum were reviewed retrospectively. METHODS: In total, 156 patients were included in the study. In terms of overall accuracy, colonoscopy, CT, MRI and FDG/PET-CT had similar accuracy rates, with 74%, 67%, 75%, and 74%, respectively. Colonoscopy was relatively less sensitive for rectosigmoid tumours (33%), while CT was less sensitive for rectal tumours (26%). MRI was less specific for tumours located on the rectum (33%). CONCLUSIONS: It is crucial to correctly identify the location of distal colorectal tumours in order to plan accurate treatment strategies. Preoperative modalities, including colonoscopy, CT, MRI, and FDG/PET-CT, do not provide excellent accuracy for tumours of the distal colorectal tumours. To increase the success of these modalities; combined use could be more successful. KEY WORDS: Colonoscopy, Computed tomography Distal colorectal cancer, Magnetic resonance imaging.

Factors affecting disease-free survival in patients with human epidermal growth factor receptor 2-positive breast cancer who receive adjuvant trastuzumab.

Breast cancer is the most frequently diagnosed cancer in women worldwide and the second cause of cancer-related mortality. A total of 20-30% of patients with early-stage breast cancer develop recurrence within the first 5 years following diagnosis. Trastuzumab significantly improves overall survival and disease-free survival (DFS) in women with human epidermal growth factor receptor 2 (HER2)-positive early and locally advanced breast cancer. This study aimed to determine the factors that affect DFS following adjuvant transtuzumab therapy. A total of 62 patients treated with trastuzumab for early and locally advanced breast cancer were included in our study. Data, including pathology, treatment and treatment outcome, rate of recurrence and laboratory tests, were retrospectively collected. There was no significant association between DFS and age, menopausal status, disease stage and hormone receptor status. The median follow-up was 48.4 months. The median DFS of patients treated with adjuvant trastuzumab was 64.1 months. In addition, the median DFS was 44.3 vs. 66.8 months in patients with platelet-lymphocyte ratio (PLR) ≤200 vs. >200, respectively (log-rank test; P=0.001), and 70 vs. 45 months in patients with eosinophil count ≤70 vs. >70×103/mm3 (log-rank test; P=0.001). Our data revealed the prognostic relevance of a decrease in the peripheral blood eosinophil count and PLR value following trastuzumab therapy in breast cancer. PLR and eosinophil count measurements are cost-effective, readily available worldwide, non-invasive and safe. Combined with other markers, such as patient age, tumor stage and tumor histology, may be effectively used for patients with breast cancer.

Extraordinary cause of acute gastric dilatation and hepatic portal venous gas: Chronic use of synthetic cannabinoid.

Addiction to synthetic cannabinoids (SCs) is a growing social and health problem worldwide. Chronic use of SCs may cause adverse effects in the gastrointestinal system. We describe a very rare case of acute gastric dilatation (AGD) and hepatic portal venous gas (HPVG), with findings of acute abdomen resulting from chronic use of a SC, Bonzai. AGD and HPVG were detected by computerized tomography examination. Patchy mucosal ischemia was seen in endoscopic examination. Despite the findings of an acute abdomen, a non-surgical approach with nasogastric decompression, antibiotic therapy, and close radiologic and endoscopic follow-up was preferred in the presented case. Clinical and radiologic findings decreased dramatically on the first day, and endoscopic findings gradually disappeared over 7 d. In conclusion, this case shows that chronic use of a SC may cause AGD and accompanying HPVG, which can be managed non-surgically despite the findings of acute abdomen.

Upper gastrointestinal tract polyps: what do we know about them?

BACKGROUND: This study aimed to evaluate upper gastrointestinal polyps detected during esophago- gastroduodenoscopy tests. MATERIALS AND METHODS: We conducted a retrospective analysis on data regarding 55,987 upper gastrointestinal endoscopy tests performed at the endoscopy unit of Istanbul Education and Research Hospital between January 2006 and June 2012. RESULTS: A total of 66 upper gastrointestinal polyps from 59 patients were analyzed. The most common clinical symptom was dyspepsia, observed in 41 cases (69.5%). The localizations of the polyps were as follows: 29 in the antrum (43.9%), 15 in the corpus (22.7%), 11 in the cardia (16.7%), 3 in the fundus (4.54%), 3 in the second portion of the duodenum (4.54%), 2 in the bulbus (3.03%) and 3 in the lower end of the esophagus (4.54%). Histopathological types of polyps included hyperplastic polyps (44) (66.7%), faveolar hyperplasia (8) (12.1%), fundic gland polyps (4) (6.06%), squamous cell polyps (4) (6.06%), hamartomatous polyps (3) (4.54%), and pyloric gland adenoma (3) (4.54%). Histopathological analysis of the gastric mucosa showed chronic atrophic gastritis in 30 cases (50.84%), HP infection in 33 cases (55.9%) and intestinal metaplasia in 19 cases (32.20%). In 3 cases with multiple polyps, adenocarcinoma was detected in hyperplastic polyps. CONCLUSIONS: Among polypoid lesions of the upper gastrointestinal tract, the most common histological type is hyperplastic polyps. Generally, HP infection is associated with chronic atrophic gastritis and intestinal metaplasia. The incidence of adenocarcinoma tends to be higher in patients with multiple hyperplastic polyps.

Disseminated peritoneal leiomyomatosis with chronic constipation: a case report.

INTRODUCTION: Disseminated peritoneal leiomyomatosis is a rare disease. Almost all disseminated peritoneal leiomyomatosis cases described in the literature are associated with a gynecological disorder or a mass in the abdominal cavity. Disseminated peritoneal leiomyomatosis with only chronic constipation has not been reported in the English literature. We present a case of a patient with disseminated peritoneal leiomyomatosis who manifested solely with chronic constipation. CASE PRESENTATION: A 49-year-old premenopausal nulliparous Caucasian woman was admitted with complaints of abdominal distention and chronic constipation. Open subtotal colectomy with ileorectal anastomosis was performed. There were diffuse nodular and polypoid tumor formations in her colonic mesoderm. Based on morphological and pathological evaluation of the resection material, she was diagnosed with disseminated peritoneal leiomyomatosis. CONCLUSIONS: In general, disseminated peritoneal leiomyomatosis is seen in women who are of childbearing age with estrogen hypersecretion. Preoperative diagnosis of disseminated peritoneal leiomyomatosis is almost impossible and it can be confused with disseminated intra-abdominal malignancies. There are no specific methods to diagnose disseminated peritoneal leiomyomatosis in a preoperative period.

Gastric outlet obstruction caused by Riedel's lobe of the liver: a diagnostic and therapeutic challenge for surgeons.

Gastric outlet obstruction is commonly caused by gastric ulcers, pyloric stenosis, foreign bodies, and compression of the duodenum by pancreatic cancer and other intra-abdominal masses. There is no report on Riedel's lobe of the liver as a cause of this condition. This is the first report to describe Riedel's lobe of the liver as a cause of gastric outlet obstruction. An 81-year-old woman who complained of severe nausea and abdominal discomfort was admitted to our clinic. The physical examination revealed a mass in the right upper quadrant of the abdomen. An exploratory laparotomy showed an approximately 10x6-cm tongue-like mass arising from the left lobe of the liver, extending to the umbilicus and compressing the prepyloric area of the stomach. The nature and location of the mass were compatible with Riedel's lobe. A cholecystectomy was performed and the compressing mass was fixed to the abdominal wall with a simple suture. The patient did well postoperatively and was discharged from the hospital. We also reviewed the English-language literature to provide an update on this subject.

Multicenter prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease.

BACKGROUND: There is still no consensus as to the optimal treatment for sacrococcygeal pilonidal disease (SPD). Many recommend off-midline closure, if any excisional procedure is to be selected. METHODS: The authors prospectively studied 145 patients with SPD who presented at 3 hospitals. Patients were randomly assigned to undergo either modified Limberg flap (MLF) transposition (n = 72) or Karydakis flap reconstruction (n = 73). Surgical findings, complications, recurrence rates, and degree of patient satisfaction, evaluated via a standardized telephone interview, were compared. RESULTS: Operation time was longer in the MLF group. There were no significant differences between the two groups in terms of complication rate, length of stay, or recurrence rate. Patients in the Karydakis group reported feeling completely healed more quickly postoperatively. The two groups reported similar rates of satisfaction. Mandatory patient withdrawal from a given study arm because of the orifice straying from the midline occurred more frequently in the Karydakis group. CONCLUSIONS: The MLF technique and the Karydakis procedure appear to generate comparable outcomes. With laterally situated orifices, however, the applicability of the Karydakis method may be limited.

LigaSure versus clamp-and-tie in thyroidectomy: a single-center experience.

PURPOSE: LigaSure (ValleyLab, CO, USA) is a bipolar diathermy system that seals vessels with reduced thermal spread. The device has been used successfully in abdominal surgery and has been introduced as a new method for hemostasis during thyroidectomy. This study compares the efficacy and advantages of LigaSure, when used for thyroidectomy in benign nodular thyroid disease, with the conventional clamp-and-tie technique. METHODS: Between December 2003 and December 2008, 410 patients underwent thyroid surgery (333 with the conventional clamp-and-tie technique and 77 with LigaSure). Nine patients did not sign the ethical approval document and so were excluded from the study; the results of 68 LigaSure patients were evaluated. The main outcomes measured were age, sex, operating time, postoperative hypocalcemia, recurrent laryngeal nerve palsy, and drain use. Statistical analysis consisted of the chi-squared test and Student's t-test. RESULTS: The mean operating time was significantly shorter in the LigaSure group by 24.1+/-1.7 minutes for a total thyroidectomy (P<0.0001) and 7.6+/-0.1 minutes for one side total plus other side sub- total thyroidectomy (P<0.0001). Bleeding during surgery was significantly lower in the LigaSure group (P<0.0001). There were no significant differences between the study groups in terms of postoperative hypoparathyroidism, recurrent laryngeal nerve palsy, and postthyroidectomy hemorrhage. CONCLUSION: The LigaSure vessel sealer is a safe, effective alternative for thyroid surgery that reduces the overall operating time. However, its higher cost is a significant handicap for its use in surgery in developing countries.

Giant inflammatory fibroid polyp of ileum causing intussusception: a case report.

Inflammatory fibroid polyps are rare, localized, non-neoplastic lesions originating in the submucosa of the gastrointestinal tract. Intussusception due to inflammatory fibroid polyps is uncommon; moreover, ileo-ileal intussusception has only rarely been reported. Here, we report an 11 x 7 cm giant inflammatory fibroid polyp of the small bowel that presented as intussusception in a 73-year-old woman. Ultrasonography demonstrated a solid, homogeneous, echogenic mass surrounded by the typical mural layers of an invaginated ileum. The immunohistopathological diagnosis after segmental ileal resection was an ileal inflammatory fibroid polyp. Although encountered rarely in adults, physicians should be aware of invagination and consider it in each case of acute abdomen because of the wide spectrum of clinical settings.

Transmural migration of a surgical compress into the stomach after splenectomy: a case report.

A surgical compress retained in the abdominal cavity following surgery is a serious problem. Here, we describe a 33-year-old female who was admitted with abdominal pain, vomiting, no passage of gas or feces, and abdominal distension for 3 days. She had a splenectomy at another medical center 4 years previously. An upright plain abdominal film revealed small bowel obstruction with marked small bowel air-fluid levels. The physical examination revealed muscular guarding and rebound tenderness in the periumbilical region. Therefore, a laparotomy was performed. A surgical compress was removed at enterotomy and the final diagnosis was gossypiboma. Because a retained surgical compress may lead to medicolegal problems, it is important to count the material used before and after a surgical procedure to reduce the risk of this problem.