Diagnostic Benefits and Surgical Implications of Methods for Tumor Localization in Sigmoid and Rectum Tumors.

(1) Background: In our study, we aimed to determine the accuracy rates of imaging methods for sigmoid, rectosigmoid colon, and rectum cancer. (2) Methods: Patients with tumors located in the rectosigmoid colon, sigmoid colon, and rectum who were operated on were included. Upon admission, we examined the patients' first diagnostic colonoscopies and their preoperative repeat control colonoscopies and computed tomography (CT) report. (3) Results: In this study, 23 patients (57.5%) were male. The overall accuracy rates were 80.0% (32/40) in colonoscopy, 65.0% (26/40) in preoperative CT, and 87.5% (35/40) in retro CT, and the differences among the examination methods were statistically significant (p = 0.049). The sensitivity levels decreased to 50.0% for colonoscopy and preoperative CT and 75.0% for retro CT in rectosigmoid colon tumors. In rectal tumors, the sensitivity levels were 75.0% in colonoscopy, 60.0% in preoperative CT, and 80.0% in retro CT. In two patients, the tumor location was given incorrectly, and postoperative pathological evaluations indicated T3N0 tumors; the initially planned treatment was thus changed to include radiotherapy in addition to chemotherapy in the postoperative period because the tumor was located in the middle rectum. (4) Conclusions: Accuracy in tumor localization in sigmoid, rectosigmoid, and rectum tumors still needs to be improved, which could be accomplished with prospective studies. CT evaluations for cancer localization in this patient group should be re-evaluated by a radiologist.

Is there a survival difference between older adult and younger adult patients with locally advanced gastric cancer with the same lymph node ratio?

INTRODUCTION: The aim of this study was to clarify the prognostic value of the pathological lymph node ratio for older adult and younger adult gastric cancer patients and to evaluate whether there is a difference in the survival of patients with the same lymph node ratio (LNR). MATERIALS AND METHODS: A total of 222 patients diagnosed with locally advanced gastric cancer who underwent upfront gastrectomy without neoadjuvant chemotherapy and had negative surgical margins were included. The patients were divided into two groups according to age. Clinicopathological properties of the two groups were compared. Potential prognostic factors affecting survival were analyzed. Subsequently, the effect of lymphadenectomy and LNR on survival in both groups was evaluated. RESULTS: Thirty patients with perioperative mortality were excluded and 192 patients were analyzed. Significant differences were detected in terms of hemoglobin and albumin levels between older adult patients and younger adult patients (p < 0.05). Overall survival (OS) was significantly worse in older adult patients (22 months vs. 67 months, p < 0.001). The survival rates in older adult patients were significantly lower from those of younger adult in the subgroup LNR Stage 2 (12.1% vs. 47.9%, p = 0.004) and LNR Stage 3 classification (9.1% vs. 34.1%, p = 0.039). LNR was found to be significant for OS with a cut-off point of 0.18. DISCUSSION: A survival difference was found between the older adult and younger adult patients with the same LNR. LNR was found to be an independent factor for survival especially in older adult patients. Survival was found to be further decreased in older adult patients compared to younger adult patients with increasing LNR.

Emergency surgical gastrostomy in an esophageal cancer patient unable to receive COVID-19 treatment due to obstruction, and operating room measures as per pandemic guidelines: Case report.

We present here a gastrostomy procedure performed on a patient diagnosed with COVID-19 with no oral intake due to esophageal cancer in order to permit the initiation of COVID-19 treatment, and the COVID-19 protocols followed as per the pandemic guidelines. A 55-year-old female patient diagnosed recently with esophageal squamous-cell carcinoma was consulted for a surgical gastrostomy in the absence of oral intake due to complete esophageal obstruction prior to neoadjuvant chemotherapy. The patient had a new-onset cough and elevated body temperature (38°C) on admission to our clinic, and so was tested for COVID-19, with the final diagnosis established with PCR. In order to initiate COVID-19 treatment, a surgical gastrostomy was performed under semi-emergency conditions, following COVID-19 infection prevention guidelines. COVID-19 treatment, nutrition, and supportive therapy were initiated through the gastrostomy catheter. The patient is clinically stable on day 7 of treatment. A COVID-19 patient may require emergency surgical intervention during the fight against pandemic. When a surgical procedure is performed, all guidelines defined to protect healthcare workers from COVID-19 infection should be followed.

Are YouTube Videos a Reliable Source for Obtaining Information About Colorectal Cancer Screening?

OBJECTIVE: This study aimed to assess the content, quality, and reliability of YouTube videos on colorectal cancer screening. Colorectal cancer is the third most common cause of death worldwide. METHODS: A basic search was conducted on the YouTubeTM website on November 19, 2020, using the English keywords "colorectal cancer screening," without using any filter. The videos were categorized into five groups according to the source and then each video was evaluated by three physicians. The videos were compared in terms of the quality of the information, and their reliability and comprehensiveness, according to the sources. RESULTS: Of the 137 videos included in the study, 74 (54%) were categorized in the useful information group and 63 (46%) in the misleading information group. It was found that most (47.3%) of the videos in the useful information group were uploaded by academic-based sources. Conversely, most (46%) of the videos in the misleading information group were uploaded by for-profit companies, private hospitals, and medical advertisements. An analysis of the video features according to the upload source revealed that the total views (p=0.023), likes (p=0.004), and viewer engagement with the video (p=0.026) were higher in the public spotlight videos group. Conclusionsː The quality of public spotlight videos with high viewing rates and audience interaction should be increased to inform the public. In addition, there is a need for videos containing comprehensive and accurate information to be uploaded to YouTube, which is an important source of information today, by universities, health organizations, and doctors who do not make a profit (financially) from the results.

Pancreatic inflammatory myofibroblastic tumor presenting with extracolonic obstruction.

Inflammatory myofibroblastic tumor is a rare soft tissue tumor which can be detected in many parts of the body. Its etiology and clinical behavior are not fully understood, and its treatment is controversial. This study aimed to present the management of a pancreatic tail case presenting with extracolonic obstruction findings. Unblock distal pancreatectomy + left surrenalectomy + left hemicolectomy + splenectomy operation was made with R0 resection principles. Although there are some medical treatments reported in children and unresectable tumors in the medical literature, complete surgical resection following oncological principles seems to be the most important and main treatment modality in the treatment of inflammatory myofibroblastic tumors. However, inflammatory myofibroblastic tumor has many aspects that are not yet clearly understood, and it is a disease being continuously researched.

The effect of trimethazidine on mortality in an experimental acute pancreatitis model1.

BACKGROUND/AIMS: Acute pancreatitis has a high morbidty and mortality. Its physiopathogenesis has not been enlightened up to the present. This study aims to investigate trimetazidine (antiischemic, antioxidant and cardioprotective agent) 's effects on the acute pancreatitis. MATERIALS AND METHODS: In this study, four aqual groups are formed with 43 female Spraque-dawley type rats weighed between230-300 gr (mean 265 gr). 0.9% NaCl is injected intraperitoneally after laparotomy to the Group 1 (n=6). Group 2 (n=6) is control group that without any intervention. Acute pancreatitis is formed in Group 3 (n=16) via injection of Na-taurokolat in the common bile duct. Group 4 (n=15) is being formed pancreatitis and treated with Trimetazidine. In group 4 Trimetazidine 10 mg/kg/day drugs were given, 30 minutes, 24 and 72 hours after formation of acute pancreatitis, in three equal doses by orogastric way. In all groups, the rats have been laparatomised 72 hours later under general anesthesia and pancreas tissues has been extracted and studied histopathologically. Amylase, lipase, lactate dehydrogenase, aspartate transaminase, alanine tranaminase levels in the rats serum and superoxide dismutase, catalase, glutathione, malondialdehyde, nitric oxide, protein carbonyl, glutathione peroxidase levels in the rats tissue also have been looked up. RESULTS: Serum and tissue findings and histopathologically examination of the pancreas tissues show significant decrease in the treatment group compare to study group. CONCLUSION: Trimetazidine protects pancreas tissue and decreases the mortality by significantly lowering the biochemical and histopathological changes in the early stages of acute pancreatitis.

Oncologic outcomes in patients undergoing maximal or optimal cytoreductive surgery for Stage 3C serous ovarian, tubal or peritoneal carcinomas.

The aim of this study was to evaluate overall survival (OS) and disease-free survival (DFS) of patients with Stage 3C serous ovarian, tubal and peritoneal carcinomas. A retrospective analysis of 111 patients who underwent maximal or optimal cytoreductive surgery was performed. Patients were divided into three groups as ovarian cancer (n = 47), tubal cancer (n = 24) and peritoneal cancer (n = 40). Median follow-up was 30 months. There was no significant difference in DFS and OS among the groups. Complete cytoreduction was an independent prognostic factor for DFS in all groups (HR 2.3, 95% CI 1.14-4.93; p=.020). Positive peritoneal cytology (HR 2.2, 95% CI 1.02-4.78; p=.044), and retroperitoneal lymph node involvement (HR 2.3, 95% CI1.11-4.89; p=.025) were independent risk factors for decreased OS, and extended cytoreduction (HR 2.7, 95% CI 1.05-6.99; p=.039) were independent risk factors for increased OS. In conclusion, these malignancies should be considered a single entity during treatment.IMPACT STATEMENTWhat is already known on this subject? Epithelial ovarian cancer is the second most common gynaecological cancer in women worldwide. There are different histological types including ovarian, tubal and peritoneal carcinomas in which malignant cells form in the tissue covering the ovary or lining the fallopian tube of peritoneum. Recent data have supported the view that these malignancies should be considered a single entity and should be treated the same way.What the results of this study add? In the present study, we evaluated overall survival and disease-free survival of patients with Stage 3C ovarian, tubal and peritoneal cancer undergoing maximal or optimal cytoreductive surgery. We found similar oncologic outcomes in all patient groups. To the best of our knowledge, this is the first study to compare oncologic outcomes of these similar and often confused malignancies in the literature. We, therefore, believe that the present study provides additional information to the body of knowledge on this topic.What the implications are of these findings for clinical practice and/or further research? This study is important, as it indicates similar oncologic outcomes in patients undergoing maximal or optimal cytoreductive surgery for Stage 3C ovarian, tubal and peritoneal cancer. Based on these findings, clinicians should keep in mind that these malignancies should be considered a single clinical entity and be treated the same way. We believe that our study would pave the way for further studies regarding this subject.

Non-operative management of abdominal gunshot injuries: Is it safe in all cases?

OBJECTIVE: In line with advances in diagnostic methods and expectation of a decrease in the number of negative laparotomies, selective non-operative management of abdominal gunshot wounds has been increasingly used over the last three decades. We aim to detect the possibility of treatment without surgery and present our experience in selected cases referred from Syria to a hospital at the Turkish-Syrian border. MATERIAL AND METHODS: Between February 2012 and June 2014, patients admitted with abdominal gunshot wounds were analyzed. Computed tomography was performed for all patients on admission. Patients who were hemodynamically stable and did not have symptoms of peritonitis at the time of presentation were included in the study. The primary outcome parameters were mortality and morbidity. Successful selective non-operative management (Group 1) and unsuccessful selective non-operative management (Group 2) groups were compared in terms of complications, blood transfusion, injury site, injury severity score (ISS), and hospital stay. RESULTS: Of 158 truncal injury patients, 18 were considered feasible for selective non-operative management. Of these, 14 (78%) patients were treated without surgery. Other Four patients were operated upon progressively increasing abdominal pain and tenderness during follow-up. On diagnostic exploration, all of these cases had intestinal perforations. No mortality was observed in selective non-operative management. There was no statistically significant difference between Group 1 and Group 2, in terms of length of hospital stay (96 and 127 h, respectively). Also, there was no difference between groups in terms of blood transfusion necessity, injury site, complication rate, and injury severity score (p>0.05). CONCLUSION: Decision making on patient selection for selective non-operative management is critical to ensure favorable outcomes. It is not possible to predict the success of selective non-operative management in advance. Cautious clinical examination and close monitoring of these patients is vital; however, emergency laparotomy should be performed in case of change in vital signs and positive symptoms concerning peritonitis.

Primary small bowel lymphoma presenting as invagination.

One of the causes of invagination in adults is primary small bowel lymphoma. Primary small bowel lymphomas are rare, present themselves with complications due to diagnostic difficulties, and are diagnosed only after surgical intervention. In case of invagination, one of the complications of these tumors, namely primary small bowel lymphoma, should also be considered as a cause in the diagnosis. In this paper, the diagnosis and therapy of a rare case of primary polypoid-type small intestinal lymphoma demonstrating findings of obstruction due to invagination have been presented and discussed in the light of the literature.

Publication rates of abstracts presented at the annual congress of the Turkish Society of Colorectal Surgery (years 2003-2011).

OBJECTIVE: The aim of our study is to examine the Publication Rate of Congress of Turkish Society of Colorectal Surgery meeting abstracts and determine the factors affecting publication rate. MATERIAL AND METHODS: All presentations at Congress of Turkish Society of Colorectal Surgery congresses held in 2003, 2007, 2009, 2011 were retrospectively assessed. Manuscripts indexed in Google-Scholar database were included. The meeting year, study type, presentation type, title and time to publication of studies were assessed. Actual impact factor values were assessed to introduce the scientific power of the journals. RESULTS: Among a total of 614 abstracts presented at these congresses, 139 (22.6%) presentations were published in various medical journals. The publication rate was higher in oral presentations as group compared to poster presentations (29.7% vs. 19.5%) (p<0.001). Mean time to publication period was 20.4 (±21.1) months. 78 (56.1%) of published articles were published in SCI-E journals while 61 (43.9%) were published in non-SCI-E journals. Experimental studies had a higher Publication Rate in analysis of publication rate according to study type (p<0.001). Prospective clinical studies had a higher publication rate than retrospective studies. The journals in which oral presentations had been published had greater impact factor than journals in which poster presentations had been published (p=0.02). If published; prospective clinical studies were published in journals with greater impact factor than retrospective studies (p=0.04). CONCLUSION: The quality of a meeting is correlated with the publication of abstracts accepted as presentations. Congress of Turkish Society of Colorectal Surgery congress is an efficient meeting for researchers, and have a lower PR as compared to international congresses while having a similar publication rate to equivalent scientific meetings. Being more selective during abstract acceptance should increase the Publication Rate and quality of Congress of Turkish Society of Colorectal Surgery congresses.

Extra-adrenal myelolipoma with hemolytic anemia.

Myelolipomas are rare benign tumors often detected as adrenal masses. Extra-adrenal myelolipomas are encountered even more rarely. The rate of detection of these lesions is increasing with improved radiological techniques. Because of their localization and morphological similarities to well differentiated liposarcomas, extra-adrenal myelolipomas need to be differentiated from other aggressive neoplasms. Preoperative imaging and percutaneous biopsy are important tools in the diagnosis of these lesions. We report a very rare case of an extra-adrenal perirenal myelolipoma associated with hemolytic anemia. The etiology, differential diagnosis, and treatment options for the lesion have been discussed. Fat-containing tumors of the retroperitoneum should be considered in the differential diagnosis. Accurate diagnosis is important to avoid over-treatment of these benign lesions.

Spontaneous idiopathic pneumoperitoneum with acute abdomen.

Pneumoperitoneum is often caused by visceral perforation, and usually manifests with symptoms of peritonitis requiring surgical intervention. Non-surgical spontaneous pneumoperitoneum (ie. not associated with organ perforation) is a rare entity due to intrathoracic, intra-abdominal, gynecologic, iatrogenic or other reasons, and is usually treated conservatively. Idiopathic spontaneous pneumoperitoneum is even rarer than visceral perforation or other causes of free intra-abdominal air. In this report, we present a case of idiopathic spontaneous pneumoperitoneum. A seventy-five-year-old female patient presented with acute abdominal pain, low-grade fever, and nausea. Her abdominal examination findings were vague, and she did not have leukocytosis. Free intra-abdominal air was detected on plain X-ray, she was followed-up with cessation of oral intake, nasogastric tube, fluid resuscitation and prophylactic antibiotics for one day. There were no signs of acute abdomen except diffuse abdominal tenderness by deep palpation on the first day examination. There was a mild leukocytosis with a shift to the left in leukocytes, and pneumoperitoneum on abdominal X-ray. The abdominal computed tomography revealed free intra-abdominal air and minimal free fluid in Douglas pouch. Her past medical history revealed cholecystectomy (10 years ago) with no chronic diseases, regular medications, smoking, or alcohol consumption. The patient underwent emergency laparotomy. Despite lack of an identifiable cause and uncertainty of etiology, the patient was discharged on postoperative day 5. A thorough medical history, appropriate laboratory tests and radiological techniques and physical examination should be combined for identification of patients with non-surgical pneumoperitoneum, and avoid unnecessary laparotomy, while minimally invasive techniques such as laparoscopy should be considered as part of evaluation.

Complications and risk factors for mortality in penetrating abdominal firearm injuries: analysis of 120 cases.

Due to the high kinetic energy, of bullets and explosive gun particles, their paths through the abdomen (permanent cavity effect), and the blast effect (temporary cavity effect), firearm injuries (FAI) can produce damage not only in the organ they enter, but in the surrounding tissues as well. Since they change route after entering the body they may cause organ damage in locations other than those at the path of entry. For example, as a result of the crushing onto bone tissues, bullet particles or broken bone fragments may cause further damage outside of the path of travel, For these reasons it is very difficult to predict the possible complications from the size of the actual injury in patients with penetrating abdominal firearm injuries. The factors affecting the mortality and morbidity from firearm injuries have been evaluated in various studies. Insufficient blood transfusion, long duration of time until presenting to a hospital and the presence of colon injuries are common factors that cause the high complication rates and mortality. A total of 120 cases injured in the civil war at Turkey's southern neighbouring countries were admitted to our hospital and evaluated in terms of: development of complications and factors affecting mortality; age, gender, time of presentation to the hospital, number of injured organs, the type of injuring weapon, the entrance site of the bullet, the presence of accompanying chest trauma, the amount of administered blood, the penetrating abdominal trauma index (PATI) and the injury severity score (ISS) scores were determined and evaluated retrospectively. The most significant factors for the development of complications and mortality include: accompanying clinical shock, high number of injured organs, numerous blood transfusions administered and accompanying thoracic trauma. It has also been observed that the PATI and ISS scoring systems can be used in predicting the complication and mortality rates in firearm injuries. Consequently, reducing the mortality and complication rates from firearm injuries is still a serious problem. Despite all of these efforts, there is still a need to determine the optimum treatment strategy to achieve this end goal.

A Retrospective Comparative Study of Image-Guided Excisional Biopsy in High-Risk Non-Palpable Breast Lesions: Predictive Factors for Malignancy.

OBJECTIVE: The use of mammography (MM) in breast cancer screening programs has been increasing in recent years. Thus, increasing the number of detected nonpalpable breast cancer patients, through early diagnosis and treatment also increased survival rates. In our study, we wanted to share the factors about imaging-guided exicional biopsies for non-palpable breast lesions in postoperative proven breast carcinoma patients. MATERIALS AND METHODS: The surgical data were reviewed for 83 patients with non-palpabl high-risk breast lesions undergoing imaging-guided surgery in our department between January, 2006 and May, 2011. Histopathologic results and age, ultrasound(US) results, MM image results, BI-RADS categorization, localization of lesion(quadrant) were assessed and factors for predicting malignity were detected. RESULTS: Median age was 52 (age range 32-80 years). 29 (34,9%) of patients were malign in histopathologic results. In four patient, re-excision performed because of positive surgical margins. Axillary examination results were normal in 24 (82,7%) of malignant patients. In MM examination; microcalcifications and nodular opasity were diagnosed in 74,6% of patients before surgery. There were no differance about malignity in these groups after surgery (p:0,428). 59% and 32,7% of patients were BI-RADS 4 and 3, respectively. Postoperative diagnosed malignancies in BI-RADS 4 group were significantly higher than BI-RADS 3 group (p:<0,001). CONCLUSION: In our study; we concluded that, preoperative BI-RADS categorization (US and MM) is correlated with histopathologic findings after surgery and imaging-guided breast surgery is effective for diagnosis of early-stage breast carcinoma.