Acute malignant intestinal obstruction accompanied by synchronous multifocal intestinal cancer in Peutz-Jeghers syndrome: report of a case.

Acute mechanical intestinal obstruction is one of the most common modes of presentation in patients with Peutz-Jeghers syndrome (PJS). This report presents a case of PJS with malignant acute jejunal obstruction accompanied by synchronous foci of duodenal, jejunal, and ileal cancer originated from hamartomatous polyps. The follow-up endoscopic findings of the patient also revealed severe polyposis of the entire gastrointestinal tract, including the stomach and colon, in addition to the small intestine. Very few cases of multifocal synchronous small intestinal cancer in PJS patients have been reported in the previous literature.

Diffusion-weighted magnetic resonance imaging for the detection of thyroid cancer. / Utilidad de la resonancia magnética ponderada por difusión cervical en la detección del cáncer tiroideo.

BACKGROUND: Nodular thyroid disease possesses the potential to harbor malignancy. Our aim was to evaluate the significance of cervical diffusion-weighted magnetic resonance imaging (DW-MRI) for the detection of malignant thyroid nodules. METHODS: Sixty-five thyroid nodules from 58 patients who had undergone surgery were evaluated. Preoperative parameters, demographic data, ultrasound findings, fine-needle aspiration biopsy results and apparent diffusion coefficient (ADC) values of the nodules at DW-MRI were compared with the results from postoperative pathology examinations. RESULTS: The "benign group" included 50 (76.9%) nodules, while 15 (23.1%) nodules constituted the "malignancy group". Minimum, maximum and mean ADC values of the nodules were significantly lower in the malignancy group (p < 0.05). The best cutoff value for the mean ADC value was 1.33 × 10-3 mm2/s, with a sensitivity of 66.67%, a specifity of 89.13%, a positive predictive value of 53.63% and a negative predictive value of 89.13%. A mean ADC value equal to or lower than 1.33 × 10-3 mm2/s was associated with 9 times higher risk of malignancy (odds ratio: 9.111, 95% confidence interval: 2.49-33.21). CONCLUSIONS: The ADC value detected by cervical DW-MRI can be considered a predictive parameter for the detection of thyroid cancer.

Cyanoacrylate application on colonic anastomosis: is it safe or not?

INTRODUCTION: Major complications of colonic anastomosis include fistula, bleeding, and anastomotic stricture, and the most common one is anastomotic leakage. Many organic or inorganic tissue adhesives are being used such as fibrin glue or cyanoacrylate to strengthen or protect colonic anastomosis. Up to now, a great number of studies have been carried out to investigate the effects of these biomaterials. AIM: To determine the effect of cyanoacrylate application on anastomosis safety. MATERIAL AND METHODS: In this experimental study, rats were divided into two groups; a control group and an experimental group. Full-thickness incisions were done on the left colon of the rats, and then end-to-end anastomosis was performed by using 5/0 silk separated sutures. In the experimental group we applied cyanoacrylate over the sutures. The samples were taken on the 7th day. RESULTS: In the control group the average tissue hydroxyproline levels and the average bursting pressures were significantly higher than in the experimental group. CONCLUSIONS: The purpose of all the experimental studies is to prevent and reduce anastomotic complications. Despite all the studies that have been done, colonic anastomosis complications continue to be a problem. As a result, we suggest that cyanoacrylate has a negative effect on the healing process of colonic anastomosis.

Diagnostic Value of Hook Wire Localization Technique for Non-Palpable Breast Lesions.

BACKGROUND: The aim of this study was to investigate the validity of hook wire localization biopsy for non-palpable breast lesions which were detected by ultrasonography (USG) or mammography (MMG). METHODS: In this retrospective study, USG or MMG-guided hook wire localization technique was performed on 83 patients who had non-palpable breast lesions. Then histopathological examination was performed on surgically removed specimens. All patients' mammograms or ultrasonograms were categorized using Breast Imaging-Reporting and Data System (BI-RADS) classification. RESULTS: Radiologically, 27 (32.53%) patients were classified as BI-RADS 3, 49 (59.04%) BI-RADS 4, one (1.2%) BIRADS 5 and six (7.23%) BI-RADS 0. Histopathological results were benign in 68 (81.9%) and malignant in 15 (18.1%) patients. Twenty-seven patients were classified as BI-RADS 3 and definitive diagnoses for all were benign. Besides, 49 patients were classified as BI-RADS 4 and histopathologically 14 of them were reported as malignant, and 35 as benign. Sensitivity of MMG was 93% and specificity was 55%. For USG, the sensitivity was 100% and the specificity was 73%. CONCLUSION: In early diagnosis of breast cancer, the validity of the imaging-guided hook wire localization biopsy of non-palpable breast lesions has been proved. The cooperation of surgeon, radiologist and pathologist increases the successfull results of hook wire localization technique.

Surgical indicators for the operative treatment of acute mechanical intestinal obstruction due to adhesions.

PURPOSE: Our aim was to investigate the predictive factors indicating strangulation, and the requirement for surgery in patients with acute mechanical intestinal obstruction due to adhesions. METHODS: This study retrospectively evaluated the records of patients with adhesive acute mechanical intestinal obstruction. The surgical treatment (group S), conservative treatment (group C), intraoperative bowel ischemia (group I), and intraoperative adhesion only (group A) groups were statistically evaluated according to the diagnostic and surgical parameters. RESULTS: The study group of 252 patients consisted of 113 women (44.8%), and 139 men (55.2%). The mean age was 62.79 ± 18.08 years (range, 20-98 years). Group S consisted of 50 patients (19.8%), and 202 (80.2%) were in group C. Group I consisted of 19 patients (38%), where as 31 (62%) were in group A. In group S, the prehospital symptomatic period was longer, incidence of fever was increased, and elevated CRP levels were significant (P < 0.05). Plain abdominal radiography, and abdominal computerized tomography were significantly sensitive for strangulation (P < 0.05). The elderly were more prone to strangulation (P < 0.05). Fever, rebound tendernes, and urea & creatinine levels were significantly higher in the presence of strangulation (P < 0.05, P < 0.05, and P < 0.05, consecutively). CONCLUSION: Fever, rebound tenderness, urea & creatinine levels, plain abdominal radiography, and abdominal computerized tomography images were important indicators of bowel ischemia. Longer prehospital symptomatic period was related with a tendency for surgical treatment, and the elderly were more prone to strangulation. CRP detection was considered to be useful for the decision of surgery, but not significantly predictive for strangulation.

Utilidad de la resonancia magnética ponderada por difusión cervical en la detección del cáncer tiroideo / Diffusion-weighted magnetic resonance imaging for the detection of thyroid cancer

INTRODUCCIÓN: La enfermedad tiroidea nodular posee el potencial de desarrollar malignidad. El objetivo es evaluar la importancia de la resonancia magnética ponderada por difusión cervical (IRM-DP) para la detección de nódulos tiroideos malignos. MÉTODO: El grupo de estudio lo constituyen los pacientes intervenidos por enfermedad tiroidea, en los que preoperatoriamente se les realizó 3 métodos diagnósticos: biopsia guiada por PAAF, US e IRM-DP. El grupo de estudio total se dividió en 2 subgrupos, de acuerdo con la evaluación postoperatoria patológica final de los nódulos en 2 grupos: "grupo benigno" y "grupo de malignidad". Se evaluaron 65 nódulos tiroideos operados, en 58 pacientes. Los parámetros preoperatorios, (datos demográficos, los hallazgos ecográficos, los resultados de la biopsia por aspiración con aguja fina y los valores del coeficiente de difusión aparente (CDA) de los nódulos en IRM-DP), se compararon con los resultados de los exámenes patológicos postoperatorios. RESULTADOS: El "grupo benigno" lo constituyen 50 (76,9%) nódulos, mientras que 15 (23,1%) nódulos constituyeron el «grupo de malignidad». Los valores mínimos, máximos y medios de CDA de los nódulos fueron significativamente más bajos en el grupo con malignidad (p <0,05). El mejor valor de corte para el valor medio de CDA fue 1,33 × 10-3 mm2/s, con una sensibilidad del 66,67%, una especificidad del 89,13%, un valor predictivo positivo del 53,63% y un valor predictivo negativo del 89,13%. Un valor medio de CDA igual o inferior a 1,33 × 10-3 mm2/s se asoció a un riesgo 9 veces mayor de malignidad (p < 0,01, odds ratio: 9,111, intervalo de confianza del 95%: 2,49-33,21). CONCLUSIONES: El valor de CDA detectado en IRM-DP cervical puede considerarse como un parámetro predictivo para la detección de cáncer de tiroides

BACKGROUND: Nodular thyroid disease possesses the potential to harbor malignancy. Our aim was to evaluate the significance of cervical diffusion-weighted magnetic resonance imaging (DW-MRI) for the detection of malignant thyroid nodules. METHODS: Sixty-five thyroid nodules from 58 patients who had undergone surgery were evaluated. Preoperative parameters, demographic data, ultrasound findings, fine-needle aspiration biopsy results and apparent diffusion coefficient (ADC) values of the nodules at DW-MRI were compared with the results from postoperative pathology examinations. RESULTS: The "benign group" included 50 (76.9%) nodules, while 15 (23.1%) nodules constituted the "malignancy group". Minimum, maximum and mean ADC values of the nodules were significantly lower in the malignancy group (p < 0.05). The best cutoff value for the mean ADC value was 1.33 × 10-3 mm2/s, with a sensitivity of 66.67%, a specifity of 89.13%, a positive predictive value of 53.63% and a negative predictive value of 89.13%. A mean ADC value equal to or lower than 1.33 × 10-3 mm2/s was associated with 9 times higher risk of malignancy (odds ratio: 9.111, 95% confidence interval: 2.49-33.21). CONCLUSIONS: The ADC value detected by cervical DW-MRI can be considered a predictive parameter for the detection of thyroid cancer

Covered self-expandable metallic stents could be used successfully in the palliation of malignant cervical esophageal strictures: preliminary report.

PURPOSE: To present the authors' preliminary experience with covered self-expandable metallic stents in the palliation of malignant cervical esophageal strictures. METHODS: Covered self-expandable metallic stents were placed into the cervical esophagus of 6 patients with malignant cervical esophageal strictures under fluoroscopic guidance. RESULTS: Stent placement was technically successful in all patients, and the mean dysphagia score decreased from 3.3 to 0.5 according to the Ogilvie Dysphagia Scoring. Two patients complained of chest pain, which lasted for 24 to 48 hours. Foreign body sensation disappeared spontaneously within a week in all patients, but one. Migration, dysphagia, or obstruction was not observed in any of the patients during the follow-up period (47 d to 8 mo). CONCLUSIONS: According to our limited number of cases, placement of covered self-expandable metallic stents into the cervical esophagus can be performed safely, and significant improvement of dysphagia scores and life quality of patients can be obtained instantly after the procedure.