The predictive value of computerized tomography-assessed sarcopenia for complicated appendicitis in geriatric patients.

Objective: Geriatric patients have more complicated appendicitis, which leads to higher morbidity and mortality rates. Sarcopenia has been shown to have a negative impact on patients undergoing surgery. This study aims to reveal the predictive value of computerized tomography-assessed (CT-assessed) sarcopenia for complicated appendicitis in geriatric patients. Methods: One-hundred fifty-four patients' with acute appendicitis age, gender, co-morbidities, appendicitis status, and body mass index (BMI) values were analyzed. The skeletal muscle index (SMI) and related measurements were evaluated. Results: Fifty-two percent of the patients had complicated, and 48% had uncomplicated appendicitis. There was a statistically significant difference between uncomplicated and complicated cases regarding BMI, SMI, and muscle area values (P < 0.05). The cutoff point by Receiver Operating Characteristic Curve analysis was conducted for SMI and showed 71% sensitivity and 52% specificity (P = 0.042). Multivariate analysis has shown that comorbidities are significantly more associated with complicated appendicitis than sarcopenia. Conclusion: Geriatric patients with lower BMI, decreased muscle area, and CT-detected sarcopenia have an increased risk of complicated appendicitis. Comorbidities are also important risk factors. Surgeons should be aware of factors leading to complicated appendicitis, which may cause higher morbidity and mortality rates in elderly patients.

Suburothelial hemorrhage and intestinal mural hemorrhage secondary to Coumadin use.

Both suburothelial hemorrhage and intestinal mural hemorrhage are very rare causes of abdominal pain and gross hematuria. Com-puted tomography (CT) is very valuable in both diagnoses. We present left suburothelial hemorrhage and intestinal mural hemorrhage with CT findings, in a case of Coumadin use for mitral valve replacement.

Diagnosis of Thyroid Micropapillary Carcinoma and Histopathological Changes after Fine-needle Aspiration Biopsy.

OBJECTIVE: To investigate "worrisome histologic alteration following fine-needle aspiration of the thyroid'' (WHAFFT) in thyroid papillary microcarcinoma and the importance of tumor size, fibrosis, depth and concomitant diseases in ultrasonographic diagno Place and Duration of Study: Department of Pathology, Kutahya Health Sciences University, Evliya Celebi Research and Training Hospital, Turkey, from December 2015 to December 2020. METHODOLOGY: A total of 208 TPMC nodules belonging to 87 (41.8%) fine-needle aspiration biopsy (FNAB)-case group and 121 (58.2%) non-FNAB-control group were included in the study. The thyroidectomy specimens were evaluated for worrisome histologic alteration following fine-needle aspiration of the thyroid (WHAFFT). The relationship between tumor size, depth and capsule distance and concomitant diseases were investigated, according to the detection status in ultrasonography. RESULTS: In the FNAB group, hemorrhage, capsular distortion and tumor diameter were greater, while there was less non-tumor fibrosis and granulation tissue. Dysplasia focus was found to be higher in Hashimoto thyroiditis and lower in nodular goiter (p = 0.000). The rate of ≥0.5 cm tumors (p = 0.000), the rate of 0-25% tumor fibrosis (p = 0.038) and tumor-capsule distance between <0.2 cm (p = 0.030) was higher in thyroid micropapillary carcinomas detected in US. CONCLUSION: In the FNAB group, hemorrhage, capsular distortion and tumor diameter were greater. While fibrosis was insignificant in the diagnosis with ultrasonography (US), tumor size and location were found to be more significant. Since US has a lower success rate in lesions <0.5 cm and is deeply located, it can be supported with radiological alternatives. KEY WORDS: Worrisome histologic alteration, Thyroid micropapillary carcinoma, Fine-needle aspiration, Ultrasonography.