Radiomics of locally advanced rectal cancer: machine learning-based prediction of response to neoadjuvant chemoradiotherapy using pre-treatment sagittal T2-weighted MRI.

PURPOSE: Variable response to neoadjuvant chemoradiotherapy (nCRT) is observed among individuals with locally advanced rectal cancer (LARC), having a significant impact on patient management. In this work, we aimed to investigate the potential value of machine learning (ML)-based magnetic resonance imaging (MRI) radiomics in predicting therapeutic response to nCRT in patients with LARC. MATERIALS AND METHODS: Seventy-six patients with LARC were included in this retrospective study. Radiomic features were extracted from pre-treatment sagittal T2-weighted MRI images, with 3D segmentation. Dimension reduction was performed with a reliability analysis, pair-wise correlation analysis, analysis of variance, recursive feature elimination, Kruskal-Wallis, and Relief methods. Models were created using four different algorithms. In addition to radiomic models, clinical only and different combined models were developed and compared. The reference standard was tumor regression grade (TRG) based on the Modified Ryan Scheme (TRG 0 vs TRG 1-3). Models were compared based on net reclassification index (NRI). Clinical utility was assessed with decision curve analysis (DCA). RESULTS: Number of features with excellent reliability is 106. The best result was achieved with radiomic only model using eight features. The area under the curve (AUC), accuracy, sensitivity, and specificity for validation were 0.753 (standard deviation [SD], 0.082), 81.1%, 83.8%, and 75.0%; for testing, 0.705 (SD, 0.145), 73.9%, 81.2%, and 57.1%, respectively. Based on the clinical only model as reference, NRI for radiomic only model was the best. DCA also showed better clinical utility for radiomic only model. CONCLUSIONS: ML-based T2-weighted MRI radiomics might have a potential in predicting response to nCRT in patients with LARC.

Treatment of a Cyst of the Canal of Nuck with an Inguinal Hernia by Laparoscopic Surgery.

A cyst of the canal of Nuck is a rare cystic structure along the inguinal canal extending to the labium majus, which forms due to non-obliterated processus vaginalis. In female patients presenting with painless swelling in the groin or labium, in addition to strangulated hernia, a cyst of the canal of Nuck should be considered. This paper presents a case of a 38-year woman with a right-sided cyst of the canal of Nuck and right inguinal hernia and its clinical and diagnostic features, differential diagnosis, and treatment. Laparoscopic diagnosis and total extraperitoneal hernioplasty (TEP) offer a useful alternative in patients with a superimposed inguinal hernia on top of the cyst of the canal of Nuck. Key Words: Cyst, Laparoscopic surgery, Inguinal hernia, Canal of Nuck.

Less postoperative pain and more frequent recurrence: Can this dilemma caused by the stapled haemorrhoidopexy procedure be avoided?

BACKGROUND: Although early studies highlighted the advantages of stapled haemorrhoidopexy (SH) (minimal pain and a rapid return to work), long-term follow-up revealed that residual skin tags, external prolapsed haemorrhoids and recurrence were frequent. The aim of our study was to investigate whether the above-mentioned problems could be prevented by performing additional interventions (AIs) during SH. We compared SH with and without AIs in terms of pain, wound-healing time, patient satisfaction and recurrence. METHODS: A total of 106 patients with Grade III-IV haemorrhoids diagnosed between 2016 and 2018 were included. There were four subgroups: Grade III-IV patients undergoing SH alone or SH + AI. RESULTS: Subgroup 1 (Grade III; SH alone) showed significant decreases in the visual analogue scale pain scores on days 1 and 15 (P = .004), but no significant decreases were found in subgroups 2-4 (P = .839, P = .092, and P = .781, respectively). Satisfaction was highest in subgroup 1 (4.22 ± 1.01), but there was no significant difference in satisfaction among the subgroups (P = .323). The overall recurrence rate was 13.2% and the difference among subgroups was significant (P = .023). CONCLUSIONS: Depending on the haemorrhoid characteristics, the use of more than one repair method provides the best results. Although AIs increase pain and wound-healing time, patient counselling enhances long-term satisfaction and success.

Computed tomography texture analysis in patients with gastric cancer: a quantitative imaging biomarker for preoperative evaluation before neoadjuvant chemotherapy treatment.

PURPOSE: The aim of the study is to explore the role of computed tomography texture analysis (CT-TA) for predicting clinical T and N stages and tumor grade before neoadjuvant chemotherapy treatment in gastric cancer (GC) patients during the preoperative period. MATERIALS AND METHODS: CT images of 114 patients with GC were included in this retrospective study. Following pre-processing steps, textural features were extracted using MaZda software in the portal venous phase. We evaluated and analyzed texture features of six principal categories for differentiating between T stages (T1,2 vs T3,4), N stages (N+ vs N-) and grades (low-intermediate vs. high). Classification was performed based on texture parameters with high model coefficients in linear discriminant analysis (LDA). RESULTS: Dimension-reduction steps yielded five textural features for T stage, three for N stage and two for tumor grade. The discriminatory capacities of T stage, N stage and tumor grade were 90.4%, 81.6% and 64.5%, respectively, when LDA algorithm was employed. CONCLUSION: CT-TA yields potentially useful imaging biomarkers for predicting the T and N stages of patients with GC and can be used for preoperative evaluation before neoadjuvant treatment planning.

Outcomes of Two Treatments for Uncomplicated Pilonidal Sinus Disease: Karydakis Flap Procedure and Sinus Tract Ablation Procedure Using a 1,470 nm Diode Laser Combined With Pit Excision.

BACKGROUND AND OBJECTIVES: An ideal treatment for pilonidal disease should feature a low recurrence rate, minimal incision, and rapid return to daily activities. We compared the outcomes of the well-defined Karydakis technique (KT) and a combination of pit excision (PE) and sinus tract ablation using 1,470-nm diode laser. STUDY DESIGN/MATERIALS AND METHODS: In this study, from January 2016 to January 2018, patients diagnosed with uncomplicated early-stage pilonidal sinus disease were enrolled and were treated randomly, using KT (n = 28) or a PE/laser ablation technique (PE + LAT; n = 30). RESULTS: The mean operative times were 36.4 (25-45) minutes in the KT group and 15.1 (12-20) minutes in the PE + LAT group. Postoperative Visual Analog Scale pain scores were 4.4 in the KT group and 2.1 in the PE + LAT group. The time periods to return to normal daily activities were 2.6 (1-5) days in the PE + LAT group and 12.8 (10-20) days in the KT group. The mean Likert satisfaction scores were 3.8 in the KT group and 4.8 in the PE + LAT group. The groups did not differ in terms of recurrence. CONCLUSIONS: Compared with the KT, the PE + LAT was associated with a shorter operative time, a more rapid return to normal activities, less pain, and a higher level of subjective satisfaction. We found that the PE + LAT was better than the KT for patients with early-stage disease. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

Is appendectomy always adequate for treatment?: Clinical manifestations of isolated actinomycosis in the appendix.

Isolated appendiceal actinomycosis is a rare chronic progressive suppurative infection. Its causative agent in humans is a Gram-positive saprophytic anaerobic bacteria, Actinomyces israelii. We present a case of an acute appendicitis that developed in a 54-year-old woman due to isolated appendiceal actinomycosis. Diagnosis of appendiceal actinomycosis causing acute appendicitis is generally performed postoperatively histopathologically, and appendectomy alone is not sufficient for treatment. It is an important factor that should be considered by clinicians that definitive treatment of the infection is possible by appropriate antibiotic use.

An Unusual First Manifestation of Hodgkin Lymphoma: Epitrochlear Lymph Node Involvement-A Case Report and Brief Review of Literature.

Although epitrochlear lymph nodes may be enlarged as a part of generalized lymphadenopathy, isolated enlargement of epitrochlear lymph nodes is rarely seen. We describe Hodgkin's lymphoma in a 55-year-old male who presented with isolated epitrochlear lymphadenopathy of his right arm. In the histopathological examination of the epitrochlear lymph node was a lymphocyte-rich Hodgkin lymphoma with a clinical grade (CS IA) diagnosed. The diagnosis was confirmed, via the bone marrow biopsy and positron emission tomography/computed tomography imaging, as pathological stage PS IA and clinical stage CS IA. Epitrochlear lymph node involvement, as a first presentation, is rarely seen in Hodgkin's lymphoma. The aim of this study was to recapitulate the possible background diseases arising on the basis of an asymptomatic epitrochlear lymphadenopathy, to review the Hodgkin lymphoma presenting with primary epitrochlear lymphadenopathy in light of the literature, and to highlight the importance of a careful examination of the elbow site in routine physical examination.