Efficacy of sentinel lymph-node biopsy after neoadjuvant chemotherapy in clinically axilla node-negative patients.

PURPOSE: Breast cancer is the most common cancer in women. Developments in breast cancer treatment have extended the life expectancy of these patients, raising the issue of morbidity of breast cancer surgery, the major cause of which is axillary dissection. The aim of the present study was to establish the safety of sentinel node biopsy (SLNB) in patients with a clinically node-negative axilla after neoadjuvant chemotherapy (NACT). METHODS: We recorded demographic data, as well as the findings of physical examination, imaging, and pathology before and after NACT. SLNB with indocyanine green + isosulfan blue and axillary dissection were performed and the surgical and pathology findings were recorded. RESULTS: A sentinel lymph node was detected in 80 of 90 patients who underwent surgery. When ≥ three sentinel lymph nodes were removed as negative in the patient group with cN0 after treatment, we evaluated the axilla as being negative with an accuracy of 100%. CONCLUSIONS: Axillary lymph-node dissection may not be necessary for patients with cNO confirmed by physical and radiological examination using positron emission tomography (PET) computed tomography (CT), and breast magnetic resonance imaging (MRI) after NACT, if ≥ three negative SLNB are removed. Further studies are needed to confirm our findings.

Influence of colonic mesenteric area on the number of lymph node retrieval for colon cancer: a prospective cohort study.

PURPOSE: The minimum harvested 12 lymph nodes (LNs) is regarded as the limit for accurate staging of nodal status in colorectal cancer patients. Besides the association of the lengths of resected intestinal segments and vascular pedicles, the mesocolic mesenteric area's impact on LN count has not been studied. We aimed to evaluate the associations between metric variables, including the mesocolic mesentery area on the nodal harvest. METHODS: All consecutive patients who underwent elective colectomy with a curative intention for colon adenocarcinoma were prospectively included. The metric variables included the lengths of resected intestinal segments, vascular pedicle, and colonic mesenteric area. The variables influencing the LN count and the correlation between the total LN count and the specimens' relevant metric measurements were analyzed. RESULTS: There were 46 patients with a median age of 64 years. The median count for total LNs was 22, and the LN positivity was 59.2%. There was an inadequate LN yield (<12) in 3 patients (6.1%). No significant associations were found between the adequacy of nodal harvest and the demographic, clinical, and tumoral features (P>0.05). There were significant positive correlations between total LN number and length of vascular pedicle and mesenteric area (r=0.576, P<0.001 and r=0.566, P<0.001). CONCLUSION: The length of the vascular pedicle and mesenteric area were significantly correlated with total LN counts. Although there was no significant impact on the length of resected segments, the colonic mesenteric area can be used alone as a measure for the assessment of the nodal yield in colon cancer.

The Efficiency of Simultaneous Systemic and Topical Use of Tranexamic Acid in Spinal Fusion Surgery.

BACKGROUND AND AIM: Multilevel posterior spinal fusion surgery in adults is associated with significant intra- and postoperative blood loss. Tranexamic acid (TXA) is an antifibrinolytic agent for reducing blood loss and allogenic blood transfusion. The purpose of this study was to evaluate the efficiency of TXA in reducing blood loss and improving hematologic parameters in adult patients undergoing posterior thoracic/lumbar instrumented spinal fusion surgery. PATIENTS AND METHODS: This is a retrospective observational study comparing the intra- and postoperative hemodynamic findings of two groups treated with and without TXA. The study included 112 adult patients receiving elective posterior thoracic/lumbar instrumented spinal fusion surgery. The patients were evaluated in terms of age, gender, type of surgery, intraoperative blood loss, pre- and postoperative hemoglobin (Hb) and hematocrit values, postoperative systemic anticoagulant use, intra- and postoperative use of blood products, and the volume of the drainage fluid as an indicator of postoperative blood loss. The TXA group received preoperative 10 mg/kg intravenous TXA, another dose of 10 mg/kg/h in isotonic solution during the operation, and local administration of TXA before the closure of the surgical site (1g in patients undergoing surgery in ≤3 segments, and 2g in patients undergoing surgery in ≥4 segment group). RESULTS: Intra- and postoperative blood loss and need for transfusion were significantly lower in the TXA group. Fifty-three of 112 patients required intra- and postoperative transfusion, and postoperative anticoagulants were given to 25/112 patients. The postoperative Hb level was lower, and the difference of pre- and postoperative Hb values was higher in the non-TXA group (not significant). CONCLUSION: Simultaneous systemic and topical application of TXA is a safe and efficient blood conservation strategy for adult patients undergoing major multilevel spinal surgery.

Can HALP (Hemoglobin, Albumin, Lymphocytes, and Platelets) Score Differentiate Between Malignant and Benign Causes of Acute Mechanic Intestinal Obstruction?

Background: Hematological parameters, including albumin and hemoglobin (Hb) levels and lymphocyte counts, are low-cost tests that can be used to determine inflammation and nutritional status. Recent studies have shown that inflammation plays a very important role in the development of carcinogenesis. Materials and Methods: The authors investigated whether preoperative hemoglobin, albumin, lymphocyte, and platelet (HALP) score can distinguish between benign and malignant causes in patients who are admitted to hospital and operated due to acute mechanical intestinal obstruction (AMIO). The patients were divided into two groups etiologically. Group 1 included the AMIO cases, which developed from benign causes, while Group II contained the AMIO cases, which developed as a result of malignancy. HALP score was calculated based on the latest preoperative Hb, albumin, lymphocyte, and platelet values of patients. Results: HALP variable was an independent prognostic factor (p < 0.001) in determining malignancy (odds ratio = 0.91; 95% confidence interval [CI] = 0.882-0.930). Based on the results, when a cutoff value <23.94 was used for HALP score in receiver operating characteristic analysis, sensitivity for determining the malignancy was 85%, while specificity was 78% (Area under the curve [AUC] ± standard error = 0.86 ± 0.029; 95% CI = 0.80-0.91; p < 0.001). Conclusions: The HALP score could be a useful parameter for the clinician in distinguishing between AMIO due to benign and malignant origins.

90-day readmission rates after cholecystectomy: A retrospective cohort study.

OBJECTIVE: Although readmission after surgical procedures has been recognized as a new problem, its association with cholecystectomy has not been solved. We aimed to investigate the rate of unplanned readmission after cholecystectomy and to evaluate the reasons and outcomes in these patients. METHODS: All consecutive patients who underwent open and laparoscopic cholecystectomy were retrospectively evaluated. Hospital readmission within the post-operative first 90 days after the procedure was searched. The rate and reasons for hospital readmission were the primary outcomes. RESULTS: There were 601 patients with a mean age of 53.2 ± 12.4 years. The rate of readmission was 6.16%. Obesity (p = 0.001), number of coexisting disease (p = 0.039), conversion to open surgery (p = 0.002), development of intraoperative complications (p < 0.001), use of drain (p = 0.001), and length of hospital stay > 1 day (p = 0.024) were significantly associated with higher readmission rates. Biliary surgical causes were detected in five patients (12.8%). Non-biliary surgical causes were seen in 34 patients (87.2%). Among these, post-operative pain, nausea, and vomiting were the most common diagnoses in 25 (67.6%) and 5 patients (12.8%). CONCLUSION: The readmission rate after cholecystectomy is low. Significant predictive factors may help physicians to be alerted during the discharge of the patients. Post-operative pain, nausea, and vomiting were the most common diagnoses.

OBJETIVO: Aunque el reingreso hospitalario posterior a la cirugía se reconoció como un problema nuevo, su asociación con la colecistectomía no ha sido resuelta. Nuestro objetivo fue investigar la tasa de reingreso al hospital no planificado después de la colecistectomía y evaluar las razones y los resultados en estos pacientes. MÉTODOS: Todos los pacientes consecutivos que se sometieron a colecistectomía abierta y laparoscópica fueron evaluados retrospectivamente. Se investigó el reingreso al hospital dentro de los primeros 90 días postoperatorios. La tasa y las razones de la readmisión hospitalaria fueron los resultados primarios. RESULTADOS: Se examinaron 601 pacientes con una edad media de 53.2 ± 12.4 años. La tasa de reingreso fue del 6.16%. Obesidad (p = 0.001), número de enfermedades coexistentes (p = 0.039), conversión a cirugía abierta (p = 0.002), desarrollo de complicaciones intraoperatorias (p < 0.001), uso de drenaje (p = 0.001) y longitud de estancia hospitalaria > 1 día (p = 0.024) se asociaron significativamente con tasas más altas de reingreso. Se detectaron causas quirúrgicas biliares en cinco pacientes (12.8%). Se observaron causas quirúrgicas no biliares en 34 pacientes (87.2%). Entre estos, el dolor postoperatorio, las náuseas y los vómitos fueron los diagnósticos más comunes en 25 (67.6%) y 5 pacientes (12.8%). CONCLUSIÓN: La tasa de reingreso después de la colecistectomía es baja. Factores predictivos significativos pueden ayudar a los médicos a estar alertas durante el alta de los pacientes. El dolor postoperatorio, las náuseas y los vómitos fueron los diagnósticos más frecuentes.

Curcumin Enhanced the Neomucosa Formation by Mediating the Antioxidation Mechanism in Rats.

Objectives: The purpose of the study was to examine the possible effects of curcumin on the formation of neomucosa in parietal peritoneum which was applied as a patch for terminal ileal defect in rats. Methods: Sixteen male Wistar Hannover rats were split into two groups. The control group was injected with saline and curcumin (2 mL/kg/day, by gavage) was given to the experimental group. In both groups, amounts of 8-hydroxy-2'-deoxyguanosine (8-OHdG) and malondialdehyde (MDA), the activities of glutathione peroxidase and superoxide dismutase were determined in serum. The development of neomucosa formation was examined morphologically. Results: Serum antioxidant levels and glutathione peroxidase activity in rats given curcumin were significantly higher than those of the control group (p<0.05). The levels of oxidative markers (MDA and 8-OHdG) in rats given curcumin were significantly lower than those of the control group (p<0.05). In the histopathological examination, 62.5% of rats in the curcumin group showed formation of neomucosa while 37.5% of control rats showed neomucosa. Conclusion: The use of curcumin in rats with terminal ileal defect enhanced the formation of neomucosa by decreasing the oxidation level and increasing the antioxidation level. Curcumin may be used in the patients with short bowel syndrome to increase the absorption surface area.

Effect of glutamine use on the formation of intestinal neomucosa on peritoneal surface in rats.

BACKGROUND: Short bowel syndrome (SBS) is a clinical condition with high mortality and morbidity, which leads to the lack of absorption of fluids or nutrients necessary for the body due to the decrease in the length of the small bowel (SB). Glutamine is an amino acid essential for the nutrition and proliferation of intestinal mucosa cells. The main aim of the present study was to investigate the effect of glutamine on intestinal neomucosa formation in rats which developed SBS. METHODS: Sixteen Wistar Hannover rats were randomly divided into two groups of eight rats. Saline was applied to the rats in Group 1 (control) following the enteroperitoneal anastomosis between mucosal surface of the ileum and the parietal peritoneum surface (adherent to abdominal wall) while glutamine was applied to the rats in Group 2 following the same anastomosis. Fourteen days later, the rats were euthanatized and blood samples were taken. Simultaneously, en bloc resection of the anastomosis part was performed and histopathological examination was carried out to observe neomucosa formation. The effects of glutamine on anastomosis were determined by microscopic and biochemical evaluations. RESULTS: Biochemical analyses were performed by measuring serum oxidant (malondialdehyde [MDA] and 8-hydroxy-2'-deoxyguanosine [8-OHdG]) and antioxidant (superoxide dismutase [SOD] and glutathione peroxidase [GPx]) parameters. Based on the biochemical evaluation results of the antioxidant values of the control and glutamine groups, it was found that while the serum antioxidant level (SOD and GPx activity) was significantly higher (p<0.05) in the glutamine-administered rats compared to the control group, the oxidative damage (MDA and 8-OHdG) was lower (p<0.05). In terms of the histological evaluations made for the neomucosa formation, the number of neomucosa formation was higher in the glutamine group, but the difference was not significant (p=0.315). CONCLUSION: The use of glutamine in patients with SBS may increase surface absorption by increasing neomucosa formation. However, additional studies of large statistical power are needed.

COVID-19 Outbreak and Oncological Surgery Practice.

The emergence of COVID-19 has caused a global public health emergency. With the World Health Organization (WHO) reporting the novel coronavirus outbreak a pandemic, the focus is needed on the influence of this rapidly spreading viral infection on cancer patients. In this study, we aimed to address cancer-related operations during the COVID-19 outbreak. We retrospectively reviewed 26 patients who had undergone cancer surgeries admitted from March 13 to May 13, 2020, during the COVID-19 epidemic at Istanbul Bagcilar Training and Research Hospital, as a pandemic hospital. A total of 26 cases of COVID-19 were enrolled in the study. Seventeen (65%) were female, and 9 (35%) were male. The mean age was 52.4 (range 28-74). The mean body mass index (BMI) is 27.8 kg/m2 (range 17.6-34.0). Eight of them had comorbidities. 7 patients needed an intensive care unit (ICU). Only one patient was COVID-19 positive in the PCR test, while the others were negative. In addition to this patient, 3 other patients were COVID-19 positive on computed tomography (CT). The patients included in this study underwent various oncologic surgery procedures. While 24 patients were discharged without any problems, 2 patients developed complications. Due to respiratory problems, the patient could not get out of intensive care and died on the sixth postoperative day. It is the obligation of the institutions and the medical staff to reassure patients by creating safe postoperative surgical environments free of COVID-19. Surgeon leaders need to synthesize actual data to make the best decisions for their cancer patients.

Shunt Valve Rupture in Ventriculoperitoneal Shunt Failure.

BACKGROUND: Shunt complications are common despite advances in surgical techniques and shunting technology. Proximal and/or distal catheter malfunctions are detected in pediatric and adult patients. However, valve dysfunction is rare in such cases. CASE DESCRIPTION: A 24-year-old woman presented with a history of ventriculostomy and ventriculoperitoneal shunt (VPS) secondary to hydrocephalus concomitant with Dandy-Walker syndrome. She has had undulant headache and vision loss episodes in both eyes for 15 days. Her VPS valve was normal when manually checked, and the VPS was observed as intact on x-ray and computed tomography scan. She had high-grade papilledema in both eyes with an optical coherence tomography scan value of 55/99. Lumbar puncture was performed. Cerebrospinal fluid opening pressure was 560 mm H2O under sedation. VPS exploration surgery was performed. There was a tiny defect over the shunt valve from where clear cerebrospinal fluid was leaking. We revised the old VPS valve with a new valve of 1.5 regular pressure. Her vision improved shortly after the surgery. CONCLUSIONS: This case is a very rare example of shunt valve dysfunction that required further investigation and a new valve replacement even though the preoperative imaging was normal.

Association between Shoulder Range of Motion and Pain Catastrophizing Scale in Breast Cancer Patients after Surgery.

BACKGROUND: Prolonged survival period as a result of early diagnosis and treatment in breast cancer has increased the importance of postoperative morbidities. The aim of the present study was to investigate the association of pain ca-tastrophizing with shoulder pain in patients with decreased shoulder range of motion in the postoperative period. PATIENTS AND METHODS: The present study included 53 patients who underwent surgery due to breast cancer. Patients who had bilateral mastectomy, distant metastases, cervical-cranial originated lesions, patients with problems involving one of the shoulders or upper extremities before the operation, and patients with cognitive impairment, heart failure, or low albumin levels (liver parenchyma disease or renal failure) were excluded. Shoulder range of motion was measured in the postoperative period, and two study groups were established: one with a limited shoulder range of motion level and the other with a normal level. Effects of pain catastrophizing and shoulder pain severity on shoulder range of motion limitation were compared between the two groups. RESULTS: The average age of 53 female patients who had breast surgery was 52.3 ± 10.5 years. In the group with limited shoulder range of motion, the median pain catastrophizing scale value was 27 (range 5-32) and the shoulder pain severity score was 4 (range 0-8), while in the group with normal shoulder range of motion these values were 11 (range 3-39) and 2 (range 0-6), respectively (p < 0.05). In addition, it was found that factors such as surgical treatment modality and postoperative radiotherapy did not significantly affect shoulder range of motion limitation. CONCLUSION: Determining the pain catastrophizing scale of patients and controlling pain in the early postoperative period could have positive effects on shoulder range of motion.

Results of Endoscopic Surgery in Patients with Pituitary Adenomas : Association of Tumor Classification Grades with Resection, Remission, and Complication Rates.

OBJECTIVE: The endoscopic endonasal transsphenoidal approach is a widely-used method for the surgical treatment of pituitary adenomas. We aimed to evaluate the results of endoscopic surgery by comparing preoperative classification methods and investigating their relationship with postoperative resection and remission rates and complications. METHODS: We retrospectively reviewed the medical records of 236 patients (118 males) who underwent surgery for pituitary adenomas. Preoperative Knosp classification, tumor size (TS), suprasellar extension (SSE), postoperative resection and remission rates, and complications were evaluated. RESULTS: The follow-up period was 3 months to 6 years. The patients' ages ranged between 16 and 84 years. Endocrinologically, 114 patients (48.3%) had functional adenoma (FA), and 122 patients (51.7%) had non-functional adenoma (NFA). Among the FA group, 92 (80.7%) showed remission. A statistically significant difference was found between patients with and without remission in terms of the Knosp, TS, and SSE classifications (p<0.01). Knosp, TS, and SSE classification grades were found to be correlated with the resection rates (p<0.01). Meningitis was seen in seven patients (3.0%), diabetes insipidus in 16 (6.9%; permanently in two [0.9%]), and rhinorrhea in 19 (8.1%). Thirty-six patients (15.3%) developed pituitary insufficiency and received hormone replacement therapy. CONCLUSION: The resection categories and remission rates of FAs were directly proportional to the adenoma sizes and Knosp grades, while the degree of suprasellar growth further complicated resection and remission rates. Adenoma sizes less than 2 cm and SSEs less than 1 cm are associated with favorable remission and resection rates.

Transrectal vacuum treatment for low colorectal anastomotic leaks.

BACKGROUND: Anastomotic leakage after rectal resection is a major complication which increases the rates of morbidity and mortality. A small number of patients with generalised peritonitis need radical surgical treatments. Stable patients with local peritonitis can be treated conservatively. The aim of this study is to evaluate the effects of transrectal vacuum treatment on the healing of low colorectal anastomotic leaks. METHODS: Medical records of fourteen patients managed conservatively with transrectal vacuum treatment for anastomotic leakage after rectal resection between September 2015 and September 2018, were retrospectively reviewed. Anastomotic leakage was documented and evaluated with computerised tomography and rectosigmoidoscopy. RESULTS: 10 of 14 patients had successful closure of the perianastomotic abscess cavity after a mean of 19 days of vacuum treatment. 2 patients in this group had stricture on the anastomotic site as a late complication which was successfully treated with repeated dilatations. 4 of 14 patients had eventually a permanent sigmoid colostomy. CONCLUSION: Our results suggest that transrectal vacuum treatment can be safely used to all stable patients without generalised peritonitis in the management of low colorectal anastomotic leakages. KEY WORDS: Anastomotic leakage, Rectosigmoidoscopy, Vacuum treatment, VAC.

Impact of Ultrasonographic Features for Thyroid Malignancy in Patients With Bethesda Categories III, IV, and V: A Retrospective Observational Study in a Tertiary Center.

INTRODUCTION: Although fine-needle aspiration biopsy (FNAB) with cytologic interpretation using the Bethesda System for Reporting Thyroid Cytopathology has been widely used for thyroid nodules, its efficiency in Bethesda categories of III, IV, and V has been questioned due to variable risk of malignancy. We aimed to evaluate the impact of radiological parameters in Bethesda category III, IV, and V for thyroid malignancy. METHODS: We performed a retrospective review of patients with Bethesda category III, IV, and V, and subsequent thyroidectomy. Demographic, ultrasonographic, and clinical variables were recorded. Independent variables for thyroid malignancy and the predictive power of imaging findings were analyzed. RESULTS: There were 159 patients with a mean age of 48.1±13.4 years. Hypoechogenicity of the index nodule was the most common finding in 87 patients (54.7%). There were 74 (46.5%), 34 (21.4%), and 51 patients (32.1%) with Bethesda III, IV, and V categories, respectively. There were 91 patients (57.2%) with a diagnosis of thyroid malignancy. Overall malignant pathology was detected in 18 (24.3%), 25 (73.5%), and 48 patients (94.1%) in Bethesda III, IV, and V categories, respectively (p=0.001). The presence of solitary nodule, hypoechogenicity, and solid structure of index nodule and Bethesda category IV and V were significant variables for final malignant pathology (p<0.05 for all). CONCLUSION: Hypoechogenicity and solid structure in a solitary index nodule should be regarded as significant ultrasonographic findings for thyroid malignancy. Bethesda category IV and V were also significantly associated with malignancy.

Association of Preoperative Risk Factors and Mortality in Older Patients following Emergency Abdominal Surgery: A Retrospective Cohort Study.

BACKGROUND: Older patients undergoing emergency laparotomy have high morbidity and mortality rates. Preoperative risk assessment with good predictors is an appropriate measure in this population. Frailty status is significantly associated with postoperative outcomes in older adults. This study aimed to investigate the effect of preoperative risk factors and frailty on short-term outcomes following emergency surgery for acute abdomen in older patients. METHODS: This study included older patients (≥65 years of age) who underwent emergency abdominal surgery. We retrospectively analyzed their demographic and clinical variables and used the modified Frailty Index-11 to evaluate their frailty status. The primary outcome was the 30-day mortality rate. We also analyzed risk factors of mortality in these patients. RESULTS: The study included 150 patients with a median age of 74 years. The mortality rate was 17.3% (n=26). We observed significantly higher mortality rates in patients who were obese and who had higher American Society of Anesthesiology (ASA grades) (p<0.05). Frailty status was worse in deceased group (p<0.001), when compared to individuals who survived. Septic shock was associated with the development of mortality (p<0.001). Multivariate regression analysis revealed that ASA grade was the only independent risk factor for mortality (odds ratio=19.642; 95% confidence interval, 3.886-99.274; p<0.001). CONCLUSION: Older patients with obesity and frailty presenting with higher ASA grades and septic shock had the worst survival following emergency abdominal surgery. The ASA grade was an independent risk factor for mortality.

Does a selective surgical approach to malignant bowel obstruction help in palliative care patients?

BACKGROUND: Malignant bowel obstruction (MBO) is a condition secondary to intra-abdominal metastatic spread of advanced-stage tumors. There is no consensus for the treatment approach of MBO. This study aims to present the results of medical treatment and palliative surgery in patients diagnosed with MBO. METHODS: The patients who were treated for advanced-stage tumors between 2010 and 2017 and for whom consultation was requested from the surgical clinic for MBO symptoms were identified. A selective approach together with palliative care for the indication of surgery was instituted. The patients with surgical treatment and medical treatment were compared concerning survival, oral food intake and symptom relief. RESULTS: Seventy-six patients (30 female, 46 male) aged 60.5±12.8 years (range: 27-88) were included in this study. Forty-eight of the patients (64.9%) underwent surgical treatment, while 28 (35.1%) had medical treatment. Although the patients with surgery had longer duration of stay in the hospital (median 16 days vs. 4 days) (p<0.001) and higher complication rates (27.1% vs. 3.5%) compared to medically treated patients; the restoring oral food intake was better (97.9% vs. 78.6%) (p=0.005) and the survival was longer (105 days vs. 43 days). CONCLUSION: This study revealed that surgical treatment resulted in better outcomes for life quality parameters in highly selected patients with malignant bowel obstruction evaluated by multidisciplinary team, including palliative care.

Two Different Clinical Approaches with Mortality Assessment of Four Cases: Complete and Incomplete Type of Abdominal Cocoon Syndrome.

Abdominal cocoon syndrome (ACS), also called sclerosing encapsulated peritonitis, is a condition characterized by encapsulation of all or some of small bowel loops by a thick fibrous membrane. Etiologic cause is not fully known. It is among the rare causes of intestinal obstruction in adults. Preoperative diagnosis is difficult, and high suspicion is required. Diagnosis is generally made during laparotomy performed due to mechanical obstruction. In treatment of the condition, large scale surgical resections should be avoided. In the present study, we aimed to evaluate all clinical and radiological characteristics and surgical treatment of ACS in light of the literature through four patients operated in our clinic.

Diverting Ileostomy Duration Is the Main Determinant of Ileostomy-Related Complications after Surgical Treatment of Rectum Cancer.

BACKGROUND: This study aimed to investigate factors associated with the development of ileostomy complications in rectal cancer patients, including those who received neoadjuvant treatment. METHODS: This retrospective trial included 133 consecutive patients who underwent surgery for rectal cancer with temporary diverting ileostomy. Patients' demographic characteristics as well as the pre- and postclosure outcomes and complications were analyzed. RESULTS: In logistic regression analysis, longer duration of ileostomy emerged as a significant independent predictor of any complication during ileostomy. The respective odds ratios for 3-6 months and >6 months vs. <3 months of ileostomy duration were as follows: OR, 4.5 (95% CI, 1.2-16.7), p=0.023; and OR, 15.2 (95% CI, 3.1-75.2), p=0.001. An additional stepwise model also identified hypertension as a significant predictor. In stepwise logistic regression model, adjuvant chemoradiotherapy emerged as significant independent predictor of "any ileostomy-related complication after ileostomy closure": OR, 4.5 (2.0-10.2), p < 0.001. CONCLUSION: Duration of ileostomy appears to be the main determinant of ileostomy-related complications. Patients who had received neoadjuvant or adjuvant therapy had longer ileostomy duration, which may be attributed to the concerns of the surgeon or to the complications themselves.

Acute Mono-appendicitis in a Case of Duplex Appendix: A Rare Finding.

Appendiceal duplication is an extremely rare entity in adulthood. It is usually diagnosed incidentally during laparotomy performed for another indication. Herein, we present a case of double appendicitis in a 31-year male who underwent laparotomy with a preliminary diagnosis of acute appendicitis. Two appendices attached via separate bases to a cecum were identified intraoperatively. One of them was thick-walled, partial 1 perforated from the apex region and the other one was normal looking. Both had their own radices. They were stuck together at their apical parts. Appendicectomy was performed for both of them. Due to the fact that appendicectomy is the most common abdominal surgery procedure, surgeons should always bear in mind this rare anomaly, in order to prevent complications. Key Words: Appendiceal duplication, Cecum, Anatomic variation.

Predictive value of ultrasonography and magnetic resonance cholangiopancreatography in the diagnosis of biliary obstruction.

OBJECTIVE: Use of diagnostic tools with high predictive value for common biliary duct (CBD) obstruction has the potential to provide valuable information. This study aimed to examine the respective diagnostic values of biochemistry, abdominal ultrasonography (US), and magnetic resonance cholangiopancreatography (MRCP) in patients with suspected biliary obstruction. MATERIALS AND METHODS: A total of 119 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) based on a suspicion of CBD obstruction were included. Patients also had data for biochemical and hematologic tests, abdominal US and MRCP. The respective sensitivity, specificity, negative predictive value, and positive predictive value of US, MRCP, and the laboratory parameters in the diagnosis of ERCP-confirmed CBD obstruction were estimated. RESULTS: ERCP did not show obstruction in 15.1% of the cases. Based on 95% confidence intervals, MRCP had greater sensitivity than ultrasound in predicting obstruction (95% vs. 62%). In addition, ultrasound had a very high 31.9% false negative rate when compared to MR (4.2%). On the other hand, a combined approach had better diagnostic value. None of the laboratory parameters exhibited a predictive value. However, old age was significantly associated with biliary obstruction. CONCLUSION: MRCP, particularly when combined with ultrasound, is a useful diagnostic tool for the diagnosis of common biliary duct obstruction and may have the potential to eliminate the need for further ERCP in some patients. On the other hand, US alone does not seem to have acceptable diagnostic value. Further large and prospective studies are warranted to draw firm conclusions. KEY WORDS: Biliary Obstruction, Endoscopic Retrograde Cholangiopancreatography (ERCP), Magnetic Resonance Cholangiopancreatography (MRCP), Ultrasonography.

The value of inflammatory markers in diagnosing acute appendicitis in pregnant patients.

BACKGROUND: Acute appendicitis (AA) is the most common extra-obstetric condition requiring surgery during pregnancy. AA diagnosis is made by laboratory tests along with anamnesis and physical examination findings. Due to the physiological and anatomical changes during the pregnancy, AA diagnosis is more challenging in pregnant women compared to non-pregnant patients. The present study evaluated the significance of white blood cell counts (WBC), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR) and lymphocyte-to-C-reactive protein ratio (LCR) to diagnose acute appendicitis during pregnancy. METHODS: Pregnant patients admitted to General Surgery Inpatient Clinic with AA pre-diagnosis in September 2015-December 2019 period were screened using International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10) diagnosis code (K35= acute appendicitis, Z33= pregnancy), and AA patients were identified retrospectively. The patients were divided into two groups. The Group I included the patients who had appendectomy due to AA and had a suppurative appendicitis diagnosis based on the pathological evaluation. On the other hand, Group II had the patients admitted as an inpatient with AA pre-diagnosis, but discharged from the hospital with full recovery without operation. Group III, i.e., the control group, on the other hand, was constituted by 32 randomly and prospectively recruited healthy pregnant women who were willing to participate in the study and who had matching study criteria among the patients followed in Obstetrics and Gynecology outpatient clinic of our hospital. RESULTS: This study included 96 pregnant women with an average age of 29.20±4.47 years (32 healthy pregnant women, 32 pregnant women followed for acute abdominal observation and 32 pregnant women who underwent appendectomy). Of these patients, three cases who turned out not to have suppurative appendicitis (negative appendectomy) and two cases found to have perforated appendicitis based on intraoperative and histopathological evaluations were excluded from this study. The results showed that Group I patients had significantly higher WBC (p=0.001), CAR (p=0.001) and NLR (p=0.001), but significantly lower LCR values (p=0.001) compared to the Groups II and III. Besides, based on logistic regression analysis, it was revealed that higher WBC, CAR and NLR values and lower LCR values were independent variables that could be used for the diagnosis of AA in pregnant women. CONCLUSION: Considering WBC, NLR, CAR and LCR parameters in addition to medical history, physical examination and imaging techniques could help clinicians diagnose acute appendicitis in pregnant women.