Role of serum levels of tumour necrosis factor-like weak inducer of apoptosis (TWEAK) in predicting severity of acute appendicitis.

Objectives: One of the most prevalent abdominal crises is acute appendicitis (AA). Clinical diagnosis, even for skilled surgeons, is frequently challenging, as indicated by the high proportion of negative investigations. The purpose of this study was to see if serum TWEAK levels might be used to diagnose acute appendicitis. Material and Methods: Between June 2017 and May 2019, all patients who had surgery with the original diagnosis of AA were included in the study. TWEAK, WBC, CRP, and bilirubin levels were compared. Results: The levels of WBC, CRP, and bilirubin were compared to pathology. All three blood indicators increased significantly in AA patients. However, no statistically significant difference in the levels of all three blood indicators was seen between individuals with simple AA and those with severe AA. TWEAK plasma concentrations were considerably greater in patients with severe AA than in the healthy control and NAA groups. TWEAK levels were significantly greater in individuals with severe AA compared to patients with simple AA. Conclusion: Serum TWEAK levels that are elevated may be used to diagnose acute appendicitis as well as prognostic indicators for the severity of appendicitis.

Investigation of the clinical efficacy of thiol-disulfide homeostasis, delta neutrophil index, and ischemia-modified albumin in cases of incarcerated and strangulated hernia.

BACKGROUND: The treatment of patients presenting with the diagnosis of incarcerated and/or strangulated inguinal hernia is mostly surgery. If strangulation and necrosis are present, the need for laparotomy arises, which may increase the risk of morbidity. Currently, it is not possible to clearly determine whether there is bowel ischemia and necrosis before surgery. In this study, we aimed to investigate the clinical efficacy of the thiol-disulfide homeostasis, delta neutrophil index (DNI), and ischemia-modified albumin (IMA) parameters in incarcerated and strangulated hernia cases. METHODS: Patients that presented to the general surgery outpatient clinic due to inguinal hernia or to the emergency department of the hospital with a preliminary diagnosis of incarcerated and/or strangulated hernia in April 2021-November 2021 were included in the study. The patients were divided into the following four groups: patients that underwent elective repair for inguinal hernia (Group 1), those who were followed up without surgery due to incarcerated hernia (Group 2), those who underwent hernia repair without bowel resection due to incarceration (Group 3), and those who underwent bowel resection due to strangulation (Group 4). Group 1 was defined as the control group, while Groups 2, 3, and Group 4 were evaluated as the incarcerated/strangulated hernia group. The demographic data of the patients, length of hospital stay, body mass index, comorbidities, medical history and physical examina-tion findings, radiological examinations, treatments applied, white blood cell (WBC) count, lactate, and DNI, thiol-disulfide and IMA parameters were evaluated. RESULTS: The WBC count, disulfide/native thiol, disulfide/total thiol, and IMA values were significantly higher in the incarcerated/strangulated hernia group than in the control group, while the native thiol and total thiol values were higher in the latter than in the former (P<0.05). There was no statistically significant difference between the groups in terms of lactate (P>0.05), but the mean WBC count was higher in Group 4 compared to Group 1, and the mean DNI was significantly higher among the patients who underwent bowel resection and anastomosis than in those that were followed up and discharged (P<0.05). CONCLUSION: We consider that the preoperative evaluation of the thiol-disulfide homeostasis, IMA, and DNI parameters in incarcerated/strangulated hernia cases can be an effective and easily applicable method in predicting difficulties that may be encountered intraoperatively and the surgical procedure to be applied to the patient.

Long-term impact of sleeve gastrectomy on serum uric acid levels.

BACKGROUND: Obesity is a risk factor for hyperuricemia. Bariatric surgery is an effective treatment method for metabolic control. The aim of our study was to evaluate the correlation between the preoperative and postoperative serum uric acid levels with body mass index, body weight, and excess weight loss in patients that underwent sleeve gastrectomy. METHODS: A total of 164 patients that underwent laparoscopic and open sleeve gastrectomy were evaluated in terms of the demographic characteristics, preoperative body weight, body mass index and serum uric acid levels, and postoperative body weight, body mass index, excess weight loss and serum uric acid levels at the first, third, sixth, 12th, 18th and 24th-36th months. RESULTS: There was a statistically significant increase in serum uric acid levels in the first postoperative month (p = 0.000). The patients with a high preoperative body mass index were found to have a lower excess weight loss in the first postoperative month, which was statistically significant (p = 0.000, R = -0.474). Serum uric acid levels were also positively correlated with body weight at the third and sixth postoperative months. DISCUSSION: The weight loss associated with sleeve gastrectomy is the main reason for the reduced postoperative serum uric acid levels.

Effects of different intraabdominal pressures on internal jugular vein, liver and kidney functions in obese patients undergoing laparoscopic sleeve gastrectomy.

OBJECTIVE: The aim of this study was to investigate whether there was a difference in laparoscopic sleeve gastrectomy (LSG) performed with either 10 mmHg or 13 mmHg intraabdominal pressures. Effects of these pressures on the internal jugular vein (IJV) diameter and flow along with the liver and kidney function tests were evaluated. MATERIALS AND METHODS: The patients were divided into two groups with respect to the intraabdominal pressure performed during LSG (either 10 or 13 mmHg). The patients' age, comorbidities, surgical history, height, weight, body mass index, family history, duration of surgery, length of hospital stay, serum liver and kidney function tests (Urea, creatinine, Aspartate transaminase, Alanine transaminase, Gamma-glutamyltransferase, Alkaline phosphatase, bilirubin) and the right IJV diameter and flow measured by Duplex ultrasound before intubation (t1), 10 min after insufflation (t2), and at the end of insufflation (t3) were recorded. RESULTS: Preoperative and postoperative kidney and liver function values of the patients in both groups were within the reference range. In both groups, there was a significant decrease in the IJV diameter and flow measurement values at t2 compared to t1, and a significant increase was observed at t3 compared to t2 (p < 0.05). The mean IJV diameter and flow were significantly higher in the 10 mmHg pressure group compared to the 13 mmHg group (p < 0.05). CONCLUSION: Neither of the peak pressures performed intraabdominal during LSG caused an adverse effect on liver or kidney functions. Our study emphasizes that low insufflation pressure does not have an advantage in terms of liver and kidney functions. But laparoscopic sleeve gastrectomy with low intra-abdominal pressure may be beneficial especially in patients who require central vein catheterization during the operation. We consider that LSG performed with CO2 pneumoperitoneum at 10 mmHg is a safe, effective and feasible method that can facilitate the insertion of the intraoperative central venous catheter due to lesser charges in the IJV diameter and flow compared to the standard technique.

Acute Appendicitis During Pregnancy: A Case Series of 42 Pregnant Women.

Introduction It is difficult to diagnose the symptoms of acute appendicitis in pregnant women due to its similarities with pregnancy physiology. In this study, we examined the diagnostic value of laboratory parameters in the diagnosis of acute appendicitis in pregnant women. Material and methods Forty-two patients who underwent appendectomy during pregnancy were evaluated. The demographic characteristics, laboratory parameters and imaging methods of the patients were examined. According to the pathology results, the patients were evaluated in two groups as normal appendix and acute appendicitis. In addition, a non-pregnant control group was formed to compare the results between the pregnant and control groups. Results The mean age of the 42 patients was 30±6 years, and the pathology results were evaluated as normal in 16 (38.1%) of the patients. As imaging methods, ultrasonography was undertaken in all patients, with MRI being additionally performed in two patients. When the normal appendix and acute appendicitis groups were compared, no significant difference was observed in terms of laboratory parameters (neutrophil, lymphocyte, white blood cell and platelet counts, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, mean thrombocyte volume, red cell distribution width, and pregnancy trimesters (P>0.05). The group that had undergone appendectomy had a significantly higher rate of negative appendectomy compared to the control group (P=0.001). Conclusion Laboratory parameters alone cannot be sufficient for the diagnosis of acute appendicitis in pregnant patients. If clinical examination, laboratory parameters and USG are not sufficient for diagnosis, MRI is the imaging method that should be considered to reduce negative appendectomy rate.

Xanthogranulomatous Cholecystitis and Gallbladder Cancer: Two Diseases with Difficult Differential Diagnoses.

BACKGROUND: Xanthogranulomatous cholecystitis (XGC) etiology has not yet been precisely determined; it is often confused with gallbladder cancer (GBC) in the differential diagnosis. METHODS: This study retrospectively evaluated patients who underwent surgery with the pre-diagnosis of cholelithiasis, cholecystitis, or gallbladder carcinoma at a tertiary center, and were confirmed to have XGC or GBC according to the histological examinations. RESULTS: In the GBC group, there was a higher number of female patients, patients with magnetic resonance imaging (MRI) and computed tomography (CT) imaging, those that directly underwent open surgery, and those requiring catheters and developed complications; while in the XGC group, there was a higher number of patients with ultrasonography (USG) imaging and those requiring conversion from laparoscopic to open surgery (P < .05). The rate of patients with a preoperative diagnosis of cholelithiasis was higher in the XGC group than in the GBC group, and cases with intrahepatic bile duct (IHBD) dilatation were higher in the GBC group than in the XGC group, and the GBC group also had a higher rate of cases with a malignant diagnosis in the preoperative examination compared to the XGC group (P < .05). CONCLUSION: When a suspicious malignant mass is detected in the localization of the gallbladder, XGC must be considered in the differential diagnosis. Although it is not a malignant pathology, early diagnosis and treatment are particularly important due to the associated complications and the possibility of coexistence with GBC.

Comparison of Crystallized Phenol Application and the Karydakis Flap Technique in the Treatment of Sacrococcygeally Localized Pilonidal Sinus Disease.

Objective To evaluate crystallized phenol application and the Karydakis flap procedure in terms of treatment success, postoperative complications, and recurrence in the treatment of pilonidal sinus disease (PSD). Materials and methods The study included patients who underwent the Karydakis flap procedure and crystallized phenol application with the diagnosis of PSD in our clinic between June 2016 and January 2019. Age, gender, preoperative body mass index (BMI), sinus number, number of crystallized phenol administrations, postoperative length of hospital stay, postoperative complications, and recurrence rates were compared between the Karydakis and crystallized phenol groups. Results Of the 88 patients included in the study, 29 (32.95%) were female, and 59 (67.05%) were male. The median age was 30 (27-33) years, and BMI was 29 (26-32) kg/m2. The median sinus number was 3 (2-3). There was no difference between the two groups in terms of age, BMI, sinus number, follow-up duration, gender, recurrence, wound infection, hematoma, wound dehiscence, and preoperative complaints (p > 0.05). A higher rate of drain requirement and more extended hospital stay were observed in the Karydakis group than in the crystallized phenol group, and the difference was statistically significant (p < 0.01 and p < 0.01, respectively). Conclusion The crucial advantages of crystallized phenol treatment in PSD are high wound healing rates, outpatient applicability, and no requirement of operating room conditions. Crystallized phenol application also has similar post-application complication rates to the Karydakis flap procedure. The results of our study support that crystallized phenol application is a less invasive alternative treatment method that can be applied before surgical treatment in selected patients.

Effects of regular whey protein consumption on rat thyroid functions

Background/aim: We aimed to investigate whether there was a significant difference in TSH, T3, T4 values and histopathologically evaluated thyroid tissues between rats that received isole hydrolyzed whey protein (IHWP) at different doses regularly and rats fed with only standard feed. Material & methods: Total 24 rats were randomly divided into three groups with 8 rats in each group. First group were fed with standard feed for 12 weeks. Second group were given standard feed + daily 0.3 g/kg IHWP and rats in the third group standard feed + 0.5 g/kg IHWP for 12 weeks. Blood samples were collected from all rats before and after IHWP administration. All rats were then sacrificed, and thyroid tissues were histopathologically examined. Results: Interfollicular connective tissue areas and TSH (0.35­4.90 µIU/L) were higher in the control group compared to 3 cc IHWP and 5 cc IHWP groups, while thyroid hormone T4 (0.7­1.48 ng/dL), and thyroid hormone synthesis parameters including intrafollicular colloid amount, follicular diameter, and epithelial height were significantly higher in 3 cc and 5 cc IHWP groups compared to the control. Conclusion: We think that regular daily use of IHWP may increase the synthesis of thyroid hormone due to its high amino acid content.

Predictive Efficacy of Delta Neutrophil Index in Diagnosis of Acute and Complicated Appendicitis.

Background The delta neutrophil index has been accepted as an inflammatory marker, especially in sepsis. This study aimed to evaluate the effectiveness of the delta neutrophil index in predicting acute and complicated appendicitis. Methods Patients aged 18 years and over who underwent appendectomy were reviewed. The demographic features, pathology results, and the delta neutrophil index, leukocyte, and C-reactive protein levels were evaluated. According to the pathology results, the patients were grouped as those having a normal appendix or acute appendicitis. Results In this study, 74 (8.1%) of the patients had a normal appendix, and 718 (86.1%) were diagnosed with simple appendicitis, and 116 (13.9%) with complicated appendicitis. In the acute appendicitis group, the leukocyte value and delta neutrophil index were found to be statistically significantly higher than in the normal appendix group. Age, C-reactive protein, and the delta neutrophil index ​​were statistically significantly higher in the complicated appendicitis group. In the receiver operating characteristic curve analysis for the prediction of acute appendicitis, the area under the curve values for leukocyte and the delta neutrophil index were calculated as 0.780 and 0.741, respectively. In predicting complicated appendicitis, the area under the curve of the delta neutrophil index and C-reactive protein were 0.671 and 0.709, respectively. Conclusion The delta neutrophil index was more significant than leukocyte values in diagnosing acute and complicated appendicitis. We consider that the delta neutrophil index ​​is an effective and reliable parameter in diagnosing acute appendicitis and differentiating simple/complicated appendicitis, especially when combined with the analysis of leukocyte and C-reactive protein.

An investigation into the clinical efficacy of thiol/disulfide hemostasis and ischemia-modified albumin in cases of gallbladder perforation.

BACKGROUND: In the presence of advanced age and comorbidities, patients with gallstones may face gangrenous and perforated cholecystitis during their follow-up. In the literature, dynamic thiol/disulfide homeostasis has been shown to play an important role in detoxification, antioxidant protection, regulation of enzymatic reactions, and apoptosis and cellular signaling mechanisms. In this study, we aimed to evaluate the efficacy of IMA and thiol/disulfide homeostasis in the preoperative diagnosis of patients with cholelithiasis, acute/chronic cholecystitis, and perforated gallbladder. METHODS: Sixty-six patients that presented to the General Surgery Clinic of Ankara City Hospital for a cholecystectomy operation between February 2019 and May 2020 were included in this study. The patients were divided into three groups depending on the condition for which they were scheduled for surgery: cholelithiasis, cholecystitis, and perforated gallbladder. The demographic data, history of cholecystitis, chronic disease, white blood cell (WBC), amylase, lipase and liver function tests (AST and ALT) were recorded before the operation. Gallbladder appearance was evaluated using hepatobiliary ultrasonography. The duration of surgery, pericholecystic adhesions, hospital stay, body mass index (BMI), postoperative complications, and pathology results of specimens were recorded. In addition, thiol/disulfide and IMA values were analyzed in the blood samples taken from the patients preoperatively. RESULTS: The mean native thiol and total thiol values of the patients with an adhesion score of 0 were significantly higher than those with an adhesion score value of 1, 2 or 3. In addition, the disulfide, disulfide/native thiol, native thiol/total thiol and IMA values of the cases with an adhesion score of 2 or 3 were significantly higher than those with an adhesion score of 0. The native thiol and total thiol averages of the patients with normal cholecystectomy were higher than the others. The disulfide, native thiol/total thiol and IMA averages of those who underwent cholecystectomy due to a perforated gallbladder were also higher than the other groups. The mean preoperative WBC of the patients who underwent cholecystectomy due to a perforated gallbladder was also significantly higher than the other groups. Lastly, the native thiol and total thiol values had a statistically significant negative correlation with age, operation time, and hospital stay, and a statistically significant positive relationship with BMI. CONCLUSION: We consider that in the preoperative diagnosis of the perforated gallbladder, the evaluation of thiol/disulfide hemostasis and IMA parameters can be used as an effective and reliable method to predict intraoperative difficulties.

Efficacy of bilirubin values in diagnosing acute appendicitis in patients with normal white blood cell count and predicting complicated appendicitis.

BACKGROUND: Laboratory parameters have important diagnostic value in the evaluation of acute appendicitis. This study aimed to evaluate the efficacy of bilirubin values in predicting acute and complicated appendicitis in patients with leukocyte values in the normal reference range. METHODS: This study included 200 patients aged 18 and over who underwent appendectomy with leukocyte values within the normal reference range. The demographic characteristics, total and direct bilirubin and C-reactive protein values of the patients were examined. According to the pathology results, the patients were divided into two groups as a normal appendix and acute appendicitis. Acute appendicitis was further classified as simple and complicated. RESULTS: Of the 200 patients included in this study, 110 (55%) were female and 90 (45%) were male, and the mean age was 37±16 years. The pathology results were reported as normal in 45 (22.5%) and acute appendicitis in the remainder of the sample. Of those diagnosed with acute appendicitis, 141 (91%) had simple appendicitis and 14 (9%) had complicated appendicitis. When the normal appendix and acute appendicitis groups were compared, the total and direct bilirubin levels were higher in the patients diagnosed with acute appendicitis. According to the receiver operator characteristic curve analysis, the area under the curve values of total bilirubin and direct bilirubin for the prediction of acute appendicitis were 0.597 and 0.625, respectively. CONCLUSION: In patients with normal leukocyte values, high bilirubin levels may be useful in predicting the diagnosis of acute appendicitis.

Gastric volvulus as a deadly cause of acute abdominal pain: Presentation of three cases.

Gastric volvulus is usually associated with non-specific abdominal pain and is a very rare condition. Diagnosis of gastric volvulus is difficult because of the lack of specific findings. Its acute form usually requires urgent surgical treatment and is associated with high mortality. In this study, gastric volvulus was diagnosed in three patients who presented with abdominal pain in the emergency department and had non-specific abdominal findings on physi- cal examination. We evaluated this situation, which is rarely seen, on different patients.

Central neck dissection is an independent risk factor for incidental parathyroidectomy.

OBJECTIVE: This study aims to determine the frequency of incidental parathyroidectomy (IP), to reveal the risk factors and to present the clinical importance of IP through the experiences of our clinic. MATERIALS AND METHODS: Patients undergoing thyroid surgery between June 2016 and May 2019 were reviewed retrospectively. Along with demographic data, surgery reports, pathology results and postoperative follow-up data were examined. Factors assumed to be associated with IP and postoperative hypocalcemia were compared between the IP group and the non-IP group. RESULTS: A total of 633 patients with a mean age of 48 ± 13 years were included in this study. IP was detected in 138 (21.8%) patients and parathyroid glands were localized 29.72% intrathyroidal. Postoperative hypocalcemia in the IP group was approximately 2-fold higher than the no-IP group (%15.94 to %7.27), (p < .001). Gender (p = .014), body mass index (p = .021), both preoperative and postoperative diagnosis of malignancy (p < .001) and performing central neck dissection (CND) (p < .001) were significantly associated with IP in univariate analysis. However, multivariate analysis demonstrated that CND was independently associated with IP (OR = 0.301, 95% Cl: 0.161-0.562, p < .001). CONCLUSION: This study reveals that IP increases the frequency of postoperative temporary and permanent hypocalcemia in patients undergoing thyroid surgery, and CND is the only independent risk factor for IP. Highlights of the study This study reveals that central neck dissection is the most important and only independent risk factor for incidental parathyroidectomy in patients undergoing thyroid surgery. According to our analysis, both temporary and permanent hypocalcemia, which occurs in the postoperative period, are associated with incidental parathyroidectomy.

Efficacy of Thiol Disulfide Homeostasis and Ischemia Modified Albumin Values in Estimating the Degree of Difficulty for Laparoscopic Cholecystectomy.

AIM: The aim of this study was to investigate the efficacy of thiol disulfide homeostasis and Ischemia Modified Albumin (IMA) values in predicting the technical difficulties that might be encountered during laparoscopic cholecystectomy. MATERIALS AND METHODS: The study included 65 patients who underwent laparoscopic cholecystectomy due to cholelithiasis at the General Surgery Clinic of Ankara Numune Training and Research Hospital. All patients' demographic data, previous history of cholecystitis, a history of chronic illness, preoperative white blood count (WBC), liver function tests (AST, ALT), amylase and lipase levels, intra-operative adhesion score, the ultrasonographic appearance of gall bladder, duration of hospital stay, duration of operation, thiol disulfide and IMA values were evaluated. RESULTS: Native thiol and total thiol averages were higher in patients without a history of cholecystitis, and on the other hand, disulfide, disulfide/native thiol rate, disulfide/total thiol rate, native thiol/total thiol rate and IMA averages were higher in patients with a history of cholecystitis. While there was a statistically significant negative correlation between native and total thiol values and age, duration of surgery and duration of hospital stay; IMA, disulfide, disulfide/Total thiol, Native/Total thiol and disulfide/Native thiol rates were higher in older patients with a longer duration of surgery and hospital stay. In addition, preoperative IMA, disulfide, disulfide/Total thiol, Native/Total thiol and disulfide/Native thiol were observed to increase as the degree of intraoperative pericholecystic adhesion increased. CONCLUSION: We believe that the evaluation of thiol disulfide homeostasis and IMA parameters prior to laparoscopic cholecystectomy can be used as an effective method for predicting intraoperative difficulties.

Efficacy of the delta neutrophil index in predicting 30-day mortality in COVID-19 patients requiring intensive care.

OBJECTIVES: Coronavirus-19 is a rapidly progressing disease that can result in mortality. We aimed to evaluate the efficacy of the delta neutrophil index in predicting mortality in intensive care patients diagnosed with Coronavirus-19. MATERIALS AND METHODS: Patients with a positive polymerase chain reaction test and/or computed tomography findings compatible with the disease were included in the study. The demographic characteristics of the patients, polymerase chain reaction test results, chest computed tomography findings, blood parameters at the time of presentation, 30-day mortality, and the number of days in the intensive care unit were assessed. RESULTS: Of the 388 patients receiving intensive care, 220 (56.7%) were men and 168 (43.3%) were women. The mean age was 70 ± 15 years. The evaluation of mortality, 264 (68%) of the patients survived and 124 (32%) died. The delta neutrophil index, neutrophil lymphocyte ratio, lactate, interleukin-6 and C-reactive protein values were statistically significantly higher and the lymphocyte value was significantly lower in the mortality group (P = .003, .034, .000, .002, .000 and .024, respectively). In the receiver operating characteristic curve analysis, the area under the curve values of the delta neutrophil index, lymphocyte, neutrophil lymphocyte ratio, lactate, interleukin-6 and C-reactive protein levels in predicting mortality were 0.718, 0.416, 0.628, 0.585, 0.701 and 0.684, respectively. CONCLUSION: We consider that the delta neutrophil index can be used as an effective prognostic parameter to show intensive care mortality in patients with Coronavirus-19.

Management of Bile Duct Injuries: A 6-year Experience in a High Volume Referral Center.

OBJECTIVES: The aim of our study was to determine operative and nonoperative treatments performed in bile duct injuries and the effect of a multidisciplinary approach on the treatment. BACKGROUND: Bile duct injuries may lead to morbidities such as biliary leakage, peritonitis, and mortality. MATERIALS AND METHODS: A total of 83 patients with biliary complications (37 patients with iatrogenic bile duct injury referred to our clinic from other centers were also included in this study) were evaluated. RESULTS: Of the operated 6,663 patients, iatrogenic bile duct injury occurred in 46 (0.69%) of these patients. The most common type of injury was Strasberg type A injury, which was found in 48 (57.83%) patients. The time interval between the diagnosis and initiation of treatment after the operation was shorter in patients with an inserted cavity drainage catheter (p < 0.05). Of the patients with bile duct injury, 32.6% received surgical and 62.6% endoscopic treatment, while 4.8% were followed-up without intervention. The rate of mortality was found to be 2.4%. CONCLUSION: Time interval to diagnosis is of great importance for management of the patients. HOW TO CITE THIS ARTICLE: Çavusoglu SD, Doganay M, Birben B, et al. Management of Bile Duct Injuries: A 6-year Experience in a High Volume Referral Center. Euroasian J Hepato-Gastroenterol 2020;10(1):22-26.

Clinicopathological Evaluation of Gastric Signet Ring Cell Carcinoma: Our Experience.

AIM: Gastric cancer is one of the most common cancers worldwide. In Turkey, stomach cancer is ranked 5th among men and 8th among women in all cancers and is located in the forefront in cancer-related deaths. Signet ring cell adenocarcinoma, which is the histopathological subtype of gastric cancer, has a poor prognosis. The incidence of signet ring cell adenocarcinoma is rising. In the present study, we aimed to describe the clinicopathologic features of signet ring cell adenocarcinoma. MATERIALS AND METHODS: A total of 79 patients with 30 being female (38%) and 49 male (62%) who were diagnosed with gastric signet ring cell adenocarcinoma in the Medical Oncology Department of Ankara Numune Training and Research Hospital between January 2004 and October 2015 were retrospectively evaluated. RESULTS: The baseline demographic characteristics of the patients, such as tumor localization, tumor stage, preoperative serum tumor markers, and treatment type (surgery and chemotherapy regimen), and the effects of these variables on survival and mortality were evaluated. Total surgery, stage III disease, moderate to poor grade, preoperative serum CA 19-9 and CEA levels were found as independent predictors of progression risk (p < 0.05). Each 1 ng/mL increase in preoperative serum CEA level was found to increase the risk of progression by 1.20 folds. Again, each 1 U/mL in preoperative serum CA 19-9 level was found to increase the risk of progression and mortality by 1.06 folds. CONCLUSION: The clinicopathologic features of signet ring cell stomach cancer were described. Tumor localization and disease, CA 19-9 and CEA levels, and treatment type (surgery and chemotherapy regimen) were effective on survival and mortality. However, further studies with larger patient groups are needed on this issue. HOW TO CITE THIS ARTICLE: Altay SB, Akkurt G, Yilmaz N, et al. Clinicopathological Evaluation of Gastric Signet Ring Cell Carcinoma: Our Experience. Euroasian J Hepato-Gastroenterol 2020;10(2):76-84.

Effect of LigaSure™, Monopolar Cautery, and Bipolar Cautery on Surgical Margins in Breast-Conserving Surgery.

BACKGROUND: We compared the differences in thermal damage at the surgical margin between monopolar cautery, bipolar cautery, and LigaSure™ in breast cancer lumpectomy specimens and assessed the effect of these techniques on the evaluation of the surgical margins. METHODS: 30 patients scheduled for breast-conserving surgery for breast cancer were included in this study. During lumpectomy, each of the superior, inferior, lateral, and medial borders of the tumour was excised using one of the following: a scalpel, monopolar cautery, bipolar cautery, and LigaSure technology. The surgical margins of frozen and paraffin-embedded tissue sections of the lumpectomy specimen were evaluated. Thermal damage was defined as the maximum depth of thermal damage (in mm) from the surgical margin, and the level was categorized as none, low (≤1 mm), or high (>1 mm). RESULTS: There was no statistically significant difference between monopolar cautery, bipolar cautery, and LigaSure in terms of thermal damage. There was no thermal damage at the surgical margin in tissues dissected by scalpel. CONCLUSION: Thermal damage due to the excision method may cause false-negative and false-positive results in the surgical margin evaluation of lumpectomy specimens. More research is needed on the effects of different energy modalities on surgical margin evaluation in breast-conserving surgery.

Dynamic MRI Evaluation of the Gastric Fundus and Splenic Circulation to Assess the Gastric Breves Dissection during Laparoscopic Nissen Fundoplication.

AIM: We aimed to evaluate the possible effects of dissecting gastric breves (GB) during the Laparoscopic Nissen Fundoplication (LNF) on the gastric fundus and splenic circulation using dynamic Magnetic Resonance Imaging (MRI). METHODS: In total 14 patients with gastroesophageal reflux disease (GERD) that was diagnosed with esophagogastroduodenoscopy and 24 - hour PH monitorization and undergoing LNF surgery were included. All patients underwent LNF surgery between October 2006 and March 2010. All patients were evaluated regarding gastric fundus and splenic circulation one week before and 15 days after the surgery with dynamic MRI. Alteration of the signal intensity before and after surgery was used to assess gastric fundus and splenic circulation. RESULTS: We detected a significant decrease in DeMeester score before and after surgery (p < 0.001). There were no statistical differences between preoperative and postoperative dynamic MRI measurements of the spleen, anterior wall measurements, posterior wall measurements in different MRI phases (Bonferroni corrected p < 0.01). Postoperative measurements of anterior and posterior gastric wall measurements were comparable (Bonferroni corrected p < 0.0033). CONCLUSIONS: We did not detect any significant differences in the abovementioned tissues regarding perfusion.

How to approach Incidentally detected Gastrointestinal Stromal Tumor during Laparoscopic Sleeve Gastrectomy: A Report of Two Cases.

Laparoscopic sleeve gastrectomy (LSG) is a frequently used bariatric surgery method. It is possible to incidentally detect gastrointestinal stromal tumors (GISTs) of stomach or other gastric tumors during this procedure. In the literature, there is limited data about cooccurrence of GIST in obesity, and treatment of such cases is still controversial. On the contrary, currently accepted treatment of local and nonmetastatic GIST cases is surgery alone, and of cases with systemic disease is surgery combined with imatinib mesylate therapy. Incidental detection of GIST during bariatric surgery may require a modification in the planned procedure, and an extensive exploration and picking a convenient surgical procedure will become necessary. Here, we present two cases - a gastric GIST and a GIST of small intestine - both of which were incidentally detected during LSG performed for obesity. HOW TO CITE THIS ARTICLE: Atas H, Bulus H, Akkurt G, Yavuz A, Tantoglu U, Alimogullari M, Aydin A. How to approach Incidentally detected Gastrointestinal Stromal Tumor during Laparoscopic Sleeve Gastrectomy: A Report of Two Cases. Euroasian J Hepato-Gastroenterol 2016;6(2):173-175.