Correlation of TIRADS scoring in thyroid nodules with preoperative fine needle aspiration biopsy and postoperative specimen pathology.

INTRODUCTION: The aim of our study is to determine the value of Thyroid Imaging Reporting and Data Systems (TIRADS) scoring in predicting malignancy in thyroid nodules by examining its relationship with fine needle aspiration biopsy and postoperative histopathological results. MATERIALS AND METHODS: In this study, patients who underwent surgery after ultrasonographic examination and fine needle aspiration biopsy for thyroid nodules at the General Surgery Clinic of Çukurova University Faculty of Medicine between January 2014 and November 2021 were retrospectively analyzed. The thyroid ultrasonography and fine needle aspiration biopsy of the included patients were performed by a clinician with 15 years of experience. The ultrasonographic features of the nodules were re-evaluated by the same clinician, and the American College of Radiology (ACR) TIRADS score was determined. Fine needle aspiration biopsy results were grouped according to Bethesda criteria. Postoperative histopathological examination results were divided into two groups: benign and malignant. The ACR TIRADS score was compared with fine needle aspiration biopsy and histopathological results. The performance of the ACR TIRADS score in predicting malignancy was determined. RESULTS: 79.8% of the 397 patients were female, and the mean age was 50.9 ± 12.8 years. The mean diameter of the nodules was 27.4 ± 15.8 mm. There was a significant, positive, but weak correlation between ACR TIRADS and Bethesda (p < 0.001) (r = 0.33). When the ACR TIRADS score was compared with histopathological results, it was found that the rate of malignancy increased as the TIRADS score increased (p < 0.001). The rates of malignancy diagnosis were 0% for TR1, 13.2% for TR2, 21.7% for TR3, 50.3% for TR4, and 72.4% for TR5. The area under the receiver operating characteristic curve for TIRADS in predicting malignancy was 0.747 (95% CI: 0.699-0.796, p < 0.001). TIRADS can distinguish malignancy with 75% accuracy. The optimal cutoff point was determined as TR4 with 80.3% sensitivity and 60.8% specificity. CONCLUSION: The ACR TIRADS scoring system is an effective risk classification system for thyroid nodules, providing 75% accuracy in predicting malignancy, with 80.3% sensitivity and 60.8% specificity values.

Site specific genetic differences in colorectal cancer via Next-Generation-Sequencing using a multigene panel.

AIM: Next-generation sequencing (NGS) has been proposed as a comprehensive and efficient genomic profiling tool to guide personalized therapy for colorectal cancer. This study aimed to review the site-specific difference and the potential benefits of actionable mutation panel for colorectal cancer in relation to the clinicopathological features. MATERIAL AND METHODS: One hundred and six patients who underwent colorectal surgery with curative or palliative intent for histopathologically confirmed carcinoma between June 2016 and June 2018 were identified from a prospectively maintained database. Formalin-fixed, paraffin-embedded tumor tissues were analyzed for actionable variants in 11 genes via NGS (EGFR, ALK, KRAS, NRAS, KIT, BRAF, PDGFRA, ERBB2, ERBB3, ESR1, and RAF1). RESULTS: Most of the primary tumors were in the rectum (49 patients; 46.2%) followed by the right colon (32 patients; 30.1%) and left colon (25 patients; 23.5%), respectively. Of sequenced cases, 43 KRAS mutations, 7 EGFR mutations, 6 NRAS mutations, 6 BRAF mutations, 3 KIT mutations, 1 ERBB2 mutation, 1 PDGFRA mutation, and 1 RAF1 mutation were identified in 106 patients. The frequency of mutations is mostly concentrated on the right colon group. The highest drug resistance observed in all patients was against Cetuximab and Panitumumab, and the highest drug resistance was found in the right colon group (53.1%). CONCLUSIONS: The utility of actionable multigene panel revealed the value of a well-designed next-generation sequencing workflow in the practical use of clinical outcomes via the prediction of responsiveness to therapeutic agents or indications for novel treatment modalities in addition to prognosis estimate. KEY WORDS: Colorectal Cancer, Drug Resistance, Next-Generation Sequencing.

Reliability and validity of the Turkish version of the New Cleveland Clinic Colorectal Cancer Quality of Life Questionnaire.

PURPOSE: This study aims to adapt and validate the Cleveland Clinic Colorectal Cancer Quality of Life Questionnaire (CCF-CaQL) in Turkish, addressing the significant need for reliable, language-specific QoL measures for colorectal cancer (CRC) in Turkiye. This effort fills a critical gap in CRC patient care, enhancing both patient-provider communication and disease-specific QoL assessment. METHODS: The CCF-CaQL was translated into Turkish, verified for accuracy, and reviewed for clarity and relevance. Eligible patients who underwent colorectal surgery for cancer between July 2021 and July 2022 from six hospitals completed the CCF-CaQL and SF-36 questionnaires. For analysis, confirmatory factor analysis using Smart PLS 4 and descriptive statistics were employed. The questionnaire's reliability and validity were assessed using Cronbach alpha, composite reliability, and the heterotrait-monotrait (HTMT) ratio, along with multicollinearity checks and factor loadings. Nonparametric resampling was used for precise error and confidence interval calculations, and the Spearman coefficient and split-half method were applied for reliability testing. RESULTS: In the study involving 244 colorectal cancer patients, confirmatory factor analysis of the CCF-CaQL indicated effective item performance, with one item removed due to lower factor loading. The questionnaire exhibited high internal consistency, evidenced by a Cronbach alpha value of 0.909. Convergent validity was strong, with all average variance extracted (AVE) values exceeding 0.4. Discriminant validity was confirmed with HTMT coefficients below 0.9, and no significant multicollinearity issues were observed (VIF values < 10). Parallel testing with the SF-36 scale demonstrated moderate to very strong correlations, affirming the CCF-CaQL's comparability in measuring quality of life. CONCLUSION: The Turkish version of the CCF-CaQL was validated for assessing quality of life in colorectal cancer patients. This validation confirms its reliability and cultural appropriateness for use in Turkiye. The disease-specific nature of the CCF-CaQL makes it a useful tool in clinical and research settings, enhancing patient care by accurately monitoring treatment effects and interventions in the Turkish colorectal cancer patient population.

Management and Morbidity of Major Pelvic Hemorrhage in Complex Abdominopelvic Surgery.

INTRODUCTION: Hemorrhage is a challenging complication of pelvic surgery. This study aimed to analyze the causes, management, and factors associated with morbidity in patients experiencing major pelvic hemorrhage during complex abdominopelvic surgery. METHODS: Patients who had major intraoperative pelvic hemorrhage during complex abdominopelvic surgery at 11 tertiary referral centers between 1997 and 2017 were included. Patient characteristics, management strategies to control bleeding, short- and long-term postoperative outcomes were evaluated retrospectively. RESULTS: There were 120 patients with a mean age of 56.6 ± 2.4 years and a mean BMI of 28.3 ± 1 kg/m2. While 104 (95%) of the patients were operated for malignancy, 16 (5%) of the patients had surgery for a benign disease. The most common bleeding site was the presacral venous plexus 90 (75%). Major pelvic hemorrhage was managed simultaneously in 114 (95%) patients. Electrocauterization 27 (23%), pelvic packing 26 (22%), suturing 7 (6%), thumbtacks application 7 (6%), muscle welding 4 (4%), use of energy devices 2 (2%), and topical hemostatic agents 2 (2%) were the management tools. Combined techniques were used in 43 (36%) patients. Short-term morbidity and mortality rates were 48 (40%) and 2 (2%), respectively. High preoperative CRP levels (p = 0.04), history of preoperative radiotherapy (p = 0.04), longer bleeding time (p = 0.006), and increased blood transfusion (p = 0.005) were the factors associated with postoperative morbidity. CONCLUSION: Postoperative morbidity related to major pelvic hemorrhage can be reduced by optimizing the risk factors. Prehabilitation prior to surgery to moderate inflammatory status and prompt action with proper technique to control major pelvic hemorrhage can prevent excessive blood loss in complex abdominopelvic surgery.

Analysis of appendiceal neoplasms in 1,423 appendectomy specimens: a 10-year retrospective cohort study from a single institution.

OBJECTIVE: This study aimed to reveal the incidence, clinicopathological, and oncological outcomes of appendiceal neoplasms. METHODS: This is a retrospective cohort study from a single institution. Patients with a pathological diagnosis of malignancy who underwent appendectomy between January 2011 and 2021 were included in the study, and groups were formed according to pathological type. Clinical, pathological, and oncological results were compared in these groups. RESULTS: The incidence of neoplasia was 2.38% (n=34) in a cohort of 1,423 appendectomy cases. Of the cases, 56% (n=19) were female. The median age in the entire cohort was 55.5 (range: 13-106) years. In the cohort, the rate of neuroendocrine tumor mucinous cystadenoma adenocarcinoma, and low-grade appendiceal mucinous neoplasm, according to the American Joint Committee on Cancer classification of appendiceal neoplasms, was 32.3% (n=11), 26.4% (n=9), 26.4% (n=9), and 14.7% (n=5), respectively. Neuroendocrine tumor patients (median age: 35 years) were younger than the other groups (p=0.021). Secondary complementary surgery was performed in 66.7% (n=6) of adenocarcinoma patients and 27.3% (n=3) of neuroendocrine tumor patients. Right hemicolectomy was performed in all neuroendocrine tumor patients requiring secondary surgery, while right hemicolectomy was performed in three adenocarcinoma patients and cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in three adenocarcinoma patients. After a median follow-up of 44.4 months (95% confidence interval: 18.6-70.1), the mean survival rate was 55% in appendiceal adenocarcinoma patients compared to 100% in neuroendocrine tumor patients. CONCLUSION: Appendiceal neoplasms are rare but remain an important cause of mortality. Appendiceal adenocarcinomas are associated with poorer oncological outcomes compared to other neoplasms.

The role of C-reactive protein ratio in predicting mortality in patients with Fournier gangrene.

PURPOSE: This study aimed to determine the C-reactive protein (CRP) ratio for the survival of patients with Fournier gangrene (FG). METHODS: Fifty-two patients with FG between January 2011 and September 2018 were retrospectively analyzed. Data on clinical presentation, Fournier Gangrene Severity Index (FGSI), CRP ratio, management, and outcome were analyzed. The CRP ratio was calculated as preoperative CRP/postoperative CRP value that measured 48 hours after surgical intervention. Possible alternative cutoff points for the FGSI and CRP were determined by receiver operating characteristic (ROC) analyses. The risk factors related to the prognosis were evaluated by univariate and multivariable logistic regression analyses. RESULTS: The mean CRP ratios were 6.7±6.6 in the survivor group and 1.2±0.8 in the nonsurvivor group (P=0.001). FGSI was significantly higher in the non-survivor group compared to survivor group (8.5±2.5 vs. 3.5±2.2, P=0.001). There was a negative correlation between FGSI and CRP ratio (r=-0.51). ROC analysis determined the cutoff value as 1.78 for CRP (sensitivity, 86%; specificity, 82%; area under the ROC curve, 0.90) to predict death. The incidence of death for patients with CRP ratio of ≤1.78 increased 26.7 fold for those with CRP ratio of >1.78 (95% confidence interval [CI], 4.8-146.5; P=0.001). In the multivariable logistic regression model, CRP ratio (odds ratio [OR], 10.3; 95% CI, 1.5-72.2; P=0.019) and FGSI (OR, 17.8; 95% CI, 2.6-121.1; P=0.003) were independent risk factors for death. CONCLUSION: The CRP ratio is a simple method to use to predict mortality in FG.

Migration of Tenckhoff Catheter to Sigmoid Colon: A Rare Delayed Complication.

Bowel perforation associated with inserted peritoneal dialysis (PD) catheter mainly occurs during the perioperative period. Delayed bowel perforation is difficult to diagnose because of its different clinical signs and rarity. A 53-year-old woman developed acute abdomen after her PD catheter was changed. It was found that the changed catheter perforated the sigmoid colon. Primary repair of the perforated area of the sigmoid colon was performed, and the last inserted PD catheter was removed. The postoperative period and recovery were uneventful. Perforations due to the PD catheter may remain silent until the catheter is replaced. In patients with frequent episodes of peritonitis, a perforation area due to PD catheter which limited itself should be considered as the etiology.

Management of pericatheter dialysate leaks using hemostatic agents.

Continuous ambulatory peritoneal dialysis (CAPD) is one of the treatment modalities used in end-stage renal disease. The most common cause of failure is catheter-related complications. Dialysate leak represents a major noninfectious complication of PD. Here, we aimed to present the results of patients who had pericatheter dialysate leak following PD catheterization and who were administered a hemostatic agent (HaemoCer Plus, BioCer, Germany) around the catheter and the tunneled segment under the subcutaneous tissue under local anesthesia. We performed a local procedure on six patients in total. No major complications developed in any of the patients at postoperative follow-up. Five patients started to receive PD uneventfully within postoperative 3 days with no dialysate leak. We believe that this practice is effective in the management of peritoneal dialysate leak. The hemostatic agents administered in the present study can manage dialysate leak and ensure safe use of the catheter.

Prognostic significance of preoperative hemoglobin and albumin levels and lymphocyte and platelet counts (HALP) in patients undergoing curative resection for colorectal cancer.

BACKGROUND/OBJECTIVE: In this study, we aimed to determine the relationship between HALP score and postoperative complications (According to Clavien-Dindo classification 3 and above), in patients with colo-rectal cancer who underwent curative surgical resection and to determine its clinical value in predicting prognosis. METHODS: 279 patients who underwent curative surgery for colorectal cancer between 2015-2018 were included in the study. The HALP value was calculated by dividing the product of hemoglobin (g/L), albumin (g/L), lymphocytes (/ L) by the number of platelets (/ L). In order to generate a cut off value for the HALP value, ROC analysis and ROC curve were created. The patients were divided into two groups according to survival, and cut off value was found by ROC analysis: Group 1 (Low HALP) and Group 2 (High HALP). Demographic, clinical characteristics, intraoperative , postoperative results and mean survival were compared between the groups. RESULTS: The patients were divided into two groups according to cut off value of 15.73. Group 1 consisted of 113 patients; Group 2 consisted of 166 patients. Average age was similar in the groups (62vs61, p:0.480). Patients in Group 1 received more neoadjuvant therapy (31%vs21%, p:0.064). CEA levels were higher in Group 1 (7.6vs4.3 p:0.034). Mucinous adenocarcinoma histological type was more common in Group 1 (24%vs13% ,p:0.040). Pathological grade poorly differentiated was more common in Group 1 (27%vs13%). Postoperative outcomes was similar to groups We found the HALP score as a risk factor for survival in multivariate analysis (HR=0.8552 95% (CI:0.6575-1.1125, p:0.007). If the HALP value is below 15.73, it is assumed that the average survival is 28 months with 45.4% sensitivity and 66.938% specificity. CONCLUSION: Our results showed that the HALP score is closely related to clinic pathological features and is an independent prognostic factor for survival. Its value in estimating mean survival is limited. KEY WORDS: Colorectal cancer, HALP score, Immunity, Nutrition.

Intraabdominal Schwannomas Single-center experience.

OBJECTIVE: Intraabdominal schwannomas are rare benign tumors. In this study, we aimed to present our clinical experience in patients with intrabdominally located Schwannoma. MATERIAL-METHOD: Patients who received the diagnosis of intrabdominal schwannoma between 2011-2019 were retrospectively examined. Demographic and clinical characteristics, treatment methods, short- and long-term results and immunohistochemical characteristics of the patients were analyzed. RESULTS: A total of 7 patients were included in the study. Four patients were female and three were male. The mean age was 51.5 (31-63) years. The most common clinical presentation was abdominal pain (57.1%). Tumor location was stomach (n=2), pelvic region (n=2), rectum (n=1), retropancreas (n=1), and left juxtadrenal space (n=1). Postoperative wound infection developed in one patient and pancreatic fistula complication was seen in one patient. Re-admissions to the hospital were due to anemia and pleural effusion in two patients. The mean tumor diameter was 6 cm (0.3-13 cm). All patients were S 100 strongly positive Mitoses / 50 HPFs (high power field), <2 Ki67 <3%. The mean follow- up period was 60 months. Currently, 5 patients are being followed without disease, 1 patient survives despite recurrence and 1 patient has died due to non-cancer reasons. CONCLUSION: Intrabdominal schwannomas are rare tumors which most commonly exhibit gastrointestinal involvement. Since these tumors are mostly benign, the long-term prognosis of patients is good. Schwannoma should be kept in mind in the differential diagnosis of intrabdominal masses. Radical resections with high morbidity and mortality should be avoided if preoperative diagnosis is made. KEY WORDS: Abdominal tumor, Mesenchymal tumor, Nerve sheath tumor, Schwannoma.

Laparoscopic versus open complete meso-colic excision for right-sided colon cancer. Analysis of short-term outcomes.

SCOPO DELLO STUDIO: L'emicolectomia destra per escissione mesocolica completa (EMC) laparoscopica mostrerebbe benefici comparabili a breve termine, nonché esiti patologici e oncologici per la chirurgia a cielo aperto. Lo scopo di questo studio era di confrontare la tecnica laparoscopica e la EMC aperta per i tumori del colon sul lato destro in termini di campioni patologici e risultati a breve termine. MATERIALE E METODI: I dati dei pazienti sottoposti a EMC laparoscopica (n=31) e EMC aperto (n=35) per adenocarcinoma del colon destro tra gennaio 2016 e giugno 2019 sono stati analizzati retrospettivamente. Sono stati confrontati dati demografici, parametri preoperatori, peroperatori e postoperatori e campioni di patologia dei due gruppi. RISULTATI: Non ci sono state differenze statistiche tra il gruppo laparoscopico di EMC e il gruppo aperto di EMC in termini di età, sesso, indice di massa corporea, posizione del tumore, punteggio dell'American Society of Anesthesiologists (ASA), presenza di comorbidità, storia di altre neoplasie e precedente chirurgia addominale (p>0,05). I pazienti nel gruppo EMC laparoscopico presentavano lunghezze d'incisione più brevi, tempi operativi più lunghi, minore perdita di sangue operativa, tempi di mobilizzazione più brevi, recupero precoce del movimento intestinale, tempo più breve per dieta leggera, durata ridotta della degenza e dimensioni del tumore più piccole (p<0,05). Il numero medio di linfonodi raccolti in gruppi laparoscopici e di EMC aperti non era statisticamente significativo (29,83+8,90 e 31,34+13,10, rispettivamente). Non ci sono state differenze statistiche in termini di lunghezza del campione tra i gruppi laparoscopici e aperti di EMC (35,19+9,8 cm e 32,71+11,12 cm, rispettivamente). Il tasso di complicanze postoperatorie di 30 giorni era più elevato nel gruppo EMC aperto (35,5% contro 42,9%, rispettivamente), ma non statisticamente significativo (p>0,05). CONCLUSIONI: Patologici (lunghezze dei campioni, lunghezze dei margini di resezione, numero di linfonodi e resezione R0) e risultati a breve termine del gruppo laparoscopico di EMC erano comparabili. Inoltre, la EMC laparoscopica ha conferito benefici a breve termine in termini di lunghezze di incisione più brevi, minore perdita di sangue operativa, riduzione dei tempi di mobilizzazione, recupero precoce dei movimenti intestinali, minor tempo di dieta leggera e riduzione della durata della degenza ospedaliera. Sulla base di questi risultati, la EMC laparoscopica può essere considerata come un approccio elettivo di routine per il carcinoma del colon destro.

Perineal scar endometriosis involving the anal sphincter. A case report and review of the literature.

BACKGROUND: Perineal endometriosis is the presence of endometrial tissue in the perineal region. Early diagnosis and treatment is important due to anal sphincter involvement in almost half of the patients. Endoanal ultrasonography is a reliable technique in the assessment of perineal endometriosis with anal sphincter involvement. This report describes the presentation, clinical investigation, and surgical treatment of a perineal endometriosis case CASE REPORT: 32-year-old female patient presented with cyclic pain and swelling of an old episiotomy scar. Three-dimensional endoanal ultrasonography showed a lesion with involvement of the external anal sphincter muscles, and it was completely excised and primary sphincteroplasty was performed for the external anal sphincter defect.The final pathology result was reported as endometriosis. Postoperative periods were uneventful and anal incontinence was not observed. CONCLUSION: Perineal endometriosis is a rare disease and may involve the anal sphincter muscles. Incomplete excision to protect the sphincters is associated with high recurrence, while extensive excision can cause anal sphincter damage that may cause anal incontinence. Endoanal ultrasonography may be necessary in surgical planning. Primary sphincteroplasty with excision may be necessary in cases of perineal endometriosis with external anal sphincter muscle involvement. KEY WORDS: Case Report, External Anal Sphincter, Endoanal Ultrasound, Sphincteroplasty Perineal Endometriosis.

The effect of anorectal manometric examination on the surgical treatment plan in chronic anal fissure.

INTRODUCTION: Although lateral internal sphincterotomy (LIS) is the most preferred surgical treatment for chronic anal fissure, In this study, we aimed to investigate the effect of preoperative anorectal manometry on surgical treatment choice in patients presenting with anal fissure. MATERIAL AND METHODS: Between January-2015 and August-2017 and whose physical examination revealed chronic anal fissure findings were included in the study. Patients were divided into two groups as Group 1 LIS and Group 2 non-LIS. In addition to the demographic characteristics of the patients, anal manometry findings and its effect on surgical treatment options were examined. RESULTS: 20 patients (M/F:13/7) were included in the study. The mean age was 48.3+17.4 in Group 1 and 45.25 +24.45 in Group 2 (p:0.797). In the preoperative manometric examination, resting pressure(mmHg) range was 93.2+15.9 in Group 1, and44+11.2 in Group 2 (30-57) (p:0.001). Endurance to squeezing time was shorter in Group 2 (p:0.0138). There were no differences between the groups in terms of mean squeezing pressure, rectal sensation, and rectoanal inhibitor reflex (p>0.05). Of the four patients with low sphincter pressures, 3 underwent botulinum toxin injection and 1 underwent advancement flap instead of LIS. There was no significant difference between preoperative and postoperative CCFI scores in the LIS group (0.6±1.8 vs. 1.2±1.85, p>0.05). CONCLUSION: In the treatment of chronic anal fissure, non-LIS methods were selected in 20% of the patients with the help of preoperative anal manometric examination. Manometric examination is important to minimize the risk of incontinence and to determine the choice of treatment correctly. KEY WORDS: Anal fissure, Anal incontinence, Anal manometry.

Endosonograpy-confirmed long-term outcomes of ligation of the intersphincteric fistula tract procedure for complex perianal fistulas.

OBJECTIVE: As the short-term outcomes may overestimate the true success rates of sphincter-sparing techniques, and follow- up protocols that were reported based on clinical criteria do not ideally reflect real world outcomes associated with complex perianal fistulas (CPF), this study aimed to reveal clinically and three dimensional endosonograpy confirmed long-term outcomes and analyze the factors associated with recurrences of ligation of intersphincteric fistula tract (LIFT) procedure. PATIENTS AND METHODS: A retrospective cross-sectional review was conducted for patients who underwent the LIFT procedure for complex perianal fistulas between October 2015 and February 2017. Cox proportional regression model was used to estimate the mean failure free survival rates and log-rank test was used to compare the outcome distributions for patients who healed vs presented with failure. RESULTS: A total of 42 patients with the majority of males (n=34, %81), who underwent LIFT procedure for CPF were analyzed. None of patients were lost at follow-up. Endosonograpy-confirmed fistula types were high transsphincteric( n=35), horseshoe fistula (n=5) and suprasphicteric (n=2). After a median follow-up of 25.1 (15-36) months, the overall healing rate was 57.1%, which subsequently increased to 85.7% with a simple secondary intervention. Based on Cox regression analysis, previous perianal intervention was found to be independent risk factor for failure (p=0.025). Having prior perianal surgery significantly increased the risk of recurrence 6.7 times (OR:6,7 95% CI:1,9-24,1 p=0,003). Outcomes were confirmed by endoanal ultrasound for all patients. CONCLUSIONS: Endoanal ultrasound confirmed long-term assessment of the LIFT procedure provides an acceptable success rate, especially when combined with secondary simple interventions, without impairment on continence for the complex perianal fistulas. KEY WORDS: Complex perianal fistulas, Endoanal ultrasound, Ligation of intersphincteric fistula tract.

The importance of anorectal physiology tests in clinical diagnosis and treatment.

AIM: In this study, we aimed to convert subjective findings to objective findings and to determine the effect of anorectal physiology tests on the diagnosis and treatment of patients with defecatory complaints. MATERIAL AND METHOD: Two hundred and forty patients who applied to the proctology unit between January 2015 and August 2017 were included in our study. The patients were divided into 3 groups based on their presentation complaints; Group 1: Obstructive defecation syndrome(ODS), Group 2: Peroperative except anal incontinence and control after sphincter repair, Group 3: Anal incontinence.Group 2 and Group 3 were divided into subgroups. The demographic data of the patients were retrospectively analyzed. The number of anorectal physiological tests in groups and the rates of referral to surgical or medical treatment were evaluated. FINDINGS: Two hundred and forty patients were included in our study. The highest mean age was in Group 3 (46.2±17.8) (p: 0.356) 43.3% of the patients in our study were female. Anorectal manometry was performed in all patients. Endoanal USG was most commonly performed in Group 2 (42.6%, p:0.013), defecography in Group 1 (47.4%, p: 0.0001), and EMG in Group 3(25.3%, p: 0,001). In Group 1, 33% of the patients with pathological defecography findings had surgical treatment (p<0.05). In Group 2a, the rate of surgical treatment was higher in patients who underwent anal USG with anorectal manometry (%25.6vs %40). In Group 3, the rate of surgical treatment was higher in patients who underwent anal ultrasound with manometry (%1.9 vs %32.6 p<0.005) DISCUSSION: Anorectal physiological tests are important for accurate diagnosis and treatment planning. The combined use of anorectal physiological tests in anal incontinence groups increased the rate of referral to surgical treatment.

Retrorectal tumor: a single-center 10-years' experience.

PURPOSE: Retrorectal tumors (RTs) are a rare incidence and recommendations on the ideal surgical approaches are lacking. This study aimed to evaluate outcomes and follow-up results of patients undergoing excision of RTs at our institution. METHODS: A retrospective review was conducted for undergoing surgery for RT between January 2009 and January 2019. Demographic characteristics, presenting symptoms, preoperative diagnostic tests, surgical procedures, histopathological results, intraoperative and postoperative complications, postoperative hospital stay, postoperative 30-day mortality, 90-day unplanned readmission rate, and long-term outcomes were evaluated. RESULTS: Twenty patients with a mean age of 48.3 ± 14.2 were analyzed. The most common presenting complaint was perineal pain (35.0%). Magnetic resonance imaging and computed tomography was preferred in 18 and 2 patients, respectively. Tumor localization was below the level of the third sacral vertebrae in 14 patients for whom the posterior surgical approach was used. No postoperative mortality was recorded at the end of follow-up of 53.8 ± 40 months. Mean length of postoperative hospital stay was 8.6 ± 9.4 days. Ten percent of the patients had unplanned hospital readmission within 90 days after discharge. Recurrence developed in 1 patient, for whom pathology were reported as chordoma. CONCLUSION: RT should be managed by a multidisciplinary team given the complexity and heterogeneity of these tumors despite the fact that the majority are benign. A good understanding of pelvic anatomy and characterization of lesions through detailed radiological imaging is crucial to optimize surgical planning. Complete surgical resection is key for prolonged disease-free and overall survival of patients diagnosed with RTs.

Determination of the effects of cryoablation for atrial fibrillation on esophageal functions.

OBJECTIVE: Periesophageal vagal plexus injury is a complication of cryoablation for atrial fibrillation (AF). The aim of this study is to investigate the effect of cryoablation on esophageal functions and to determine the relationship between esophageal temperature and esophageal motility. METHODS: Twenty patients with symptomatic paroxysmal AF who underwent cryoablation were included in this study. The lowest cryoballoon temperature for each pulmonary vein (PV) was recorded. Esophageal temperature was measured using an esophageal probe during each cryoapplication. Esophageal manometry was performed before the procedure and one day after the procedure for each patient in order to assess the esophageal functions. RESULTS: During the procedure, the highest esophageal temperature change was found in the left-side PVs in 13 patients (65%) and in the right-side PVs in seven patients (35%). No correlation was found between the lowest cryoballoon temperature and esophageal temperature change (r=0.22, p=0.05). It was detected that the lower esophageal sphincter pressure and esophageal contraction amplitude pressure decreased after the procedure (before: 19.7±9.3 mm Hg, after: 14.3±4.9 mm Hg, p=0.001; before: 84.5±28.3 mm Hg, after: 72.7±34.3 mm Hg, p=0.005, respectively). Five patients (25%) developed gastrointestinal symptoms after the procedure. CONCLUSION: During cryoablation, esophageal temperature measurement can be performed to reduce the probability of esophageal injury. Cryoablation affects esophageal motility, and esophageal manometry can be performed to detect esophageal motility impairments in patients with gastrointestinal symptoms.

Jejunal diverticulosis complicated with perforation: A rare acute abdomen etiology.

INTRODUCTION: Jejunal diverticulosis is a rare intestinal pathology with an incidence of 0.5-1%. While most cases are asymptomatic, 30-40% of the cases may become symptomatic with chronic abdominal pain, malabsorption, hemorrhage, diverticulitis, obstruction, abscess formation and, rarely, diverticula perforation. It is generally localized on the mesenteric side and it develops from the entry points of the vessels into the jejunum. CASE PRESENTATION: Case 1 - A 36-year Case 2 a 75 old female patient patient was admitted to the emergency department with the complaint of widespread abdominal pain, Case 1 8 diverticules, one with diverticule perforation, was observed in the jejunum segment between the 50th and 90th centimeters after the Treitz Ligament. Case 2 - In the diverticulum 100 cm distal from the Treitz ligament, mesenteric perforation area of 4-5 mm were observed. RESULTS: Segmentary small bowel resection and side-by-side anastomosis were performed in these cases. In the histopathological examination, the Diverticula were seen to be pseudodiverticullar lesions including herniation of the mucosa and submucosa. CONCLUSION: Jejunoileal diverticulosis is a rare disease with life-threatening complications such as perforation, obstruction and bleeding, it is usually asymptomatic or presents with nonspecific symptoms. It should be considered in the differential diagnosis of acute abdomen.

Early propranolol treatment ameliorates endothelial dysfunction in experimental septic lung.

BACKGROUND: Recent reports have indicated an improved prognosis in sepsis with ß-blocker agents; however, the underlying action mechanism is still under debate. OBJECTIVES: The aim of this study was to investigate the potential effect of propranolol on endothelial dysfunction in septic rats. MATERIAL AND METHODS: The cecal ligation and puncture model (CLP) was used to generate sepsis. Adult male Wistar-Albino rats were divided into 4 groups: group 1 was a sham group, group 2 received sterile saline, group 3 received 10 mg/kg of propranolol 3 days before the intervention, and group 4 received 10 mg/kg of propranolol 30 min after CLP. Six rats from each group were sacrificed 24 h postoperatively. The remaining rats were followed for survival. We have also evaluated the effects on systemic inflammation, coagulation and the lung tissue with immunohistochemical and electron microscopic evaluation. RESULTS: Serum tumor necrosis factor alpha (TNF-α) and plasminogen activator inhibitor-1 (PAI-1) levels, as well as tissue TNF-α scores were elevated in septic rats. Electron microscopic examination of the lung tissue showed endothelial dysfunction in the sepsis group. Pretreatment significantly improved survival. Moreover, pre-treatment altered serum vascular endothelial growth factor receptor-1 (VEGFR-1) levels and post-treatment reduced serum PAI-1 and VEGFR-1 levels. In both the preand post-treatment groups, electron microscopic examination revealed improvement of the destroyed lung endothelium and showed only mild alterations in the cytoplasmic organelles, especially in the mitochondria of the endothelial cells. CONCLUSIONS: These results suggest that the improved outcome with ß-blockers in sepsis may be due to the ameliorated endothelial dysfunction. Further studies focusing on the potential effect of ß-blockers on the endothelium may lead to a better understanding of sepsis.

Short-term results of adipose-derived stem cell therapy for the treatment of complex perianal fistula A single center experience.

BACKGROUND: In this study, we aimed to investigate the early results of the safety and efficacy of adipose-derived stem cells (ADSCs) injection along with the repair of the internal orifice in the recovery of complex perianal fistula. METHODS: The study included patients who underwent autologous adipose tissue-derived stemcell injection for complex perianal fistula between December2017 and January2018. The FDA-approved Lipogems® system was used to prepare autologous micro-fragmented adipose stem cells. Demographic characteristics, history of inflammatory bowel disease, fistula type and length of fistula tract determined by endoanal ultrasound, mean operation duration, postoperative complications, and fistula healing of the patients were evaluated. Fistula healing was evaluated on the 30th ,90th days and 9th months. RESULTS: A total of 10 patients, with male predominance, were included in our study. The mean age was 47±13.1 and mean BMI was 28.3±4.79. None of the patients had inflammatory bowel disease Based on endoanal ultrasound findings, fistula type was transsphincteric, extrasphincteric and suprasphincteric for 7, 2 and 1 patients, respectively. Calculated length of fistula tract based on ultrasound was 4.45±1.69(2.5-6.4). Mean duration of operation was 45±7 minutes. None of the patients had any treatment related toxicity, however, two patients experienced bruising at the liposuction site. Healing rate in the follow-up of 30-day, 90-day and 9-month was 70%, 80% and 70%, respectively. CONCLUSIONS: In addition to surgical treatment in the form of curettage and closure of the fistula tract, autologous micro-fragmented adipose tissue injection is a safe, feasible, and reproducible procedure that can be performed based on the early results in complex anal fistula healing. KEY WORDS: Lipogems®, Mesenchymal stem cell, Regenerative medicine, Adipose tissue-derived mesenchymal stem cell.