A Rare Cause of Hypoglycemia in Elderly Patients: Insulinoma.

Insulinoma is the most common pancreatic neuroendocrine tumor and is often solitary and benign. To make a diagnosis, high insulin levels must be demonstrated, and proinsulin and C-peptide measurements must be done. The presence of hypoglycemic measurements and symptoms in the 72-hour fasting test is diagnostic. We present a case of a 91-year-old patient with no known diagnosis of diabetes mellitus who was admitted to the emergency department due to confusion. As a result of the clinical evaluation and differential diagnosis, it was determined that her complaint was due to hypoglycemia, and she was admitted to the internal medicine service for further examination, diagnosis, and treatment.

Gastric cancer diagnosis and staging in coronavirus disease 2019 (Covid-19) pandemic.

AIM: The aim of the study was to analyze whether COVID-19 cause a delay in the diagnosis of gastric cancer patients particularly in the TNM staging of the tumor, or not. MATERIAL AND METHODS: This retrospective single-center study included the patients diagnosed with gastric cancer from March, 2019 to December 2020. The patients were divided into two groups: baseline and the pandemic groups. The following parameters were compared between the groups; demographic data, numbers of newly diagnosed patients, type of the surgery, location of the tumor, frequency of neoadjuvant treatment, ASA score, length of hospital stay, clinical staging and pathologic TNM staging. RESULTS: The mean monthly number of newly diagnosed gastric cancer patients showed a significant decline from 7.5 to 5.6 (p< .001). There were no statistically significant differences between the groups with regard to the demographic factors, except CA 19-9 levels. Patients in the pandemic group had higher both clinical and pathological T-stages (p < 0.05). CONCLUSIONS: Our study showed a decline in the number of the newly diagnosed patients with gastric cancer during the pandemic and also more patients presented with advanced stage during the pandemic period. This study showed that the pandemic causes a potential delay in the diagnosis of gastric cancer patients. KEY WORDS: Cancer surgery, COVID-19, Gastric cancer, Gastric surgery SARS-COV-2, Pandemic.

The effects of COVID-19 pandemic on emergency anterior abdominal wall hernia surgery: is it safe to postpone elective hernia surgery in the pandemic?

BACKGROUND: The aim of this study was to investigate the effects of the COVID-19 pandemic on emergency anterior abdominal wall hernia surgeries (EAAWHS) by comparing the pandemic period with the control period a year ago and to share our experiences in the pandemic period. METHODS: This single-center retrospective cohort study included all patients who underwent EAAWHS during the pandemic (from 11 March 2020 to 25 January 2021) and control period (1 year before the same period, from 11 March 2019 to 25 January 2020). Demographic data, preoperative clinical and pathological parameters, intraoperative findings and postoperative complications secondary to operation and COVID-19 infection, length of intensive care and hospital stay of patients were recorded, and the pandemic and control groups were compared. RESULTS: Of the 87 patients who underwent anterior abdominal wall hernia surgery during the COVID-19 pandemic, 41 (47.1%) were operated emergently and 46 (52.9%) were operated electively. Of the 485 patients who underwent anterior abdominal wall hernia surgery during the control period, 24 (4.95%) were operated emergently and 461 (95.05%) were operated electively. The decrease in the number of elective operations and the increase in the number of emergency operations were significant during the pandemic (p < 0.001).There was a decrease in the number of emergency inguinal hernia operations and an increase in the number of emergency ventral (incisional, umbilical) hernia operations during the pandemic period compared to the control period (p < 0.05).The mortality rates were similar (8.3 vs. 9.8%, p > 0.05) in both periods. CONCLUSION: Despite the increase in the number of EAAWHS during the COVID-19 pandemic, there was no significant difference in mortality and morbidity rates. EAAWHS can be performed safely during the pandemic by taken necessary and adequate precautions.

Efficacy of US, MRI, and F-18 FDG-PET/CT for Detecting Axillary Lymph Node Metastasis after Neoadjuvant Chemotherapy in Breast Cancer Patients.

BACKGROUND: The aim of this study was to investigate the efficacy of post-neoadjuvant chemotherapy (NAC) ultrasound (US), magnetic resonance imaging (MRI), and F-18fluorodeoxyglucose positron emission tomography (F-18 FDG-PET/CT) for detecting post-NAC axillary lymph node(ALN) metastasis in patients who had ALN metastasis at the time of diagnosis. METHODS: This study included all breast cancer patients who received NAC for ALN metastasis; underwent axillary assessment with US, MRI, or F18FDG-PET/CT; and then were operated on in the General Surgery Clinic, Adana City Research and Training Hospital, Turkey. Patients' data were recorded, including demographic data, clinicopathological parameters, NAC regimens, and operation types. The axillary response to chemotherapy on post-NAC US, MRI, and F-18 FDG-PET/CT was compared with the postoperative histopathological result of the ALN. RESULTS: The study included a total of 171 female patients. The mean age of the patients was 53.28 ± 10.62 years. The post-NAC assessment revealed that the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US for detecting ALN metastasis were 59.42%, 82.35%, 82.00%, and 60.00%, respectively, while the same measures regarding MRI for detecting ALN metastasis were 36.67%, 77.78%, 73.33%, and 42.42%, respectively. The sensitivity, specificity, PPV, and NPV of F-18FDG-PET/CT were 47.50%, 76.67%, 73.08%, and 52.27%, respectively. The evaluation of dual combinations of these three imaging techniques showed that the specificity and PPV of the combined use of US and F-18FDG-PET/CT was 100%. CONCLUSIONS: The results showed that US has the highest sensitivity and specificity for detecting ALN metastasis after NAC. Furthermore, ALND may be preferred for these patients instead of SLNB if both examinations simultaneously indicate lymph node metastasis in the post-NAC assessment with US and F-18 FDG-PET/CT. SLNB may be preferred if these two examinations simultaneously show a complete response.

Giant Meckel's Diverticulitis Perforation Due to Necrosis.

Although Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, its prevalence is approximately 2% in the general population. Most diverticula remain asymptomatic and can be diagnosed with obstruction, perforation, inflammation, and gastrointestinal hemorrhage. The treatment of complicated MD is surgery, but there is no clear treatment recommendation yet for incidentally detected cases. As in the case we present here, the development of perforation due to Giant Meckel's diverticulitis in an adult female patient is a very rare complication of a disease that can be diagnosed very rarely.