Could we use PD-1 and PD-L1 expression on lymphocytes and monocytes as predictive markers for prognosis of acute biliary pancreatitis?

PURPOSE: This study aimed to assess the significance of immunophenotyping and serum cytokines in predicting the clinical progression of acute biliary pancreatitis (ABP). MATERIALS AND METHODS: Cytokine levels, T-helper, cytotoxic T, natural killer (NK) cells, monocytes, HLA-DR, and PD-1, as well as PDL-1 immune checkpoints, were measured in ABP patients at the time of diagnosis and compared with results from healthy volunteers. The study also compared leukocyte counts, hematocrit, immunophenotyping results, cytokine statuses, and PD-1, PDL-1 expression between healthy volunteers and ABP subgroups categorized by pancreatitis severity. RESULTS: The study included 65 ABP patients and 20 healthy volunteers. Significant differences were observed between groups in hematocrit, leukocyte counts, total monocytes, lymphocytes, CD3+ total T cells, CD4+ Th cells, PD-1 expression on CD4+ and CD8+T lymphocytes, HLA-DR expression on CD14+ monocytes, NK cells, PD-L1 expression on CD14+ monocytes, classical and intermediate monocytes, as well as levels of IL-6, IL-8, IL-10, IL-18, and IL-33 cytokines. Moderate correlations were found with lymphocyte counts, PD-1+CD4+ cells, PD-L1+CD14+ cells, and strong correlations with HLA-DR+CD14+ cells. Hematocrit, CD3+ total T cells, NK cells, CD4+PD-1 + T cells, and CD8+PD-1 + T cells showed independent associations with the severity of ABP. Lymphocyte counts, CD14+HLA-DR+ cells, CD14+PD-L1+ cells, CD4+PD-1 + T cells, classical, and intermediate monocytes exhibited the highest Area Under the Curve rates in determining organ failure. CONCLUSIONS: Hematocrit, lymphocyte counts, CD14+HLA-DR+ cells, CD14+PD-L1+ cells, and intermediate monocytes emerged as parameters most closely associated with the severity and these parameters could be useful in predicting the severity of ABP.

Retrospective Analysis of Parameters Affecting Metastatic Breast Cancer.

Objectives: While metastatic breast cancer (MBC), which is the most common cause of death in women, has been seen as an incurable surgical problem in the past decade, as the heterogeneous nature of breast cancer becomes clear with increasing molecular studies and advances in oncological protocols, life expectancy is increasing. In this study, we aimed to examine the clinicopathological features of the patients we followed up with MBC. Methods: Patients who were operated on with the diagnosis of breast cancer in our hospital between 2018 and 2023 and who were later found to have metastases were retrospectively analyzed from the database. The age of the patients, the histological and molecular type, stage and grade of the tumor, the time from diagnosis to metastasis, the location of metastasis, the duration of treatment and follow-up were investigated. Patients who were operated on in other centers and/or were out of follow-up were excluded from the study. For the statistical analysis of the findings, number cruncher statistical system (NCSS) 2020 statistical software (NCSS LLC, Kaysville, Utah, USA) was used at a significance level of 0.05. Results: Metastasis was detected in 77.1% (n=37) of a total of 48 female patients, and recurrence was found in 22.9% (n=11). The mean age of the patients was 57 years. There was no statistically significant difference between the patients in terms of demographics. When evaluated according to the TNM stage, 24.3% (n=9) of the patients were in the early stage and 75.7% (n=28) were in the locally advanced stage; the number of locally advanced patients was found to be higher than the early stage. In histology examination, 27.1% (n=13) of the patients were luminal A, 31.3% (n=15) luminal B, 16.7% (n=8) HER2 positive, and 25% (n=12) triple negative. Ki67 was higher than 14% in 64.6% (n=31) patients. Breast conserving surgery was performed in 41.6% (n=20) of the patients, and mastectomy was performed in 58.3% (n=28) patients. Metastasis in 34.2% (n=13) of the cases within 1-2 years, in 42.1% (n=16) within 2-5 years, and in 23.7% (n=9) after 5 years took place. Sites of metastasis were bone (37.7%, n=28), liver (28.9%, n=11), brain (10.5%, n=4), and lung (7.9%, n=3). More than one metastasis site was observed in 21.05% (n=8) of patients with metastases. There was no statistically significant difference between luminal A, luminal B, HER 2 groups and triple-negative breast cancer in terms of metastasis time and location (p>0.05). Adjuvant hormone therapy was more common in the luminal A group, whereas neoadjuvant therapy was more common in the HER2+ group. A total of 20 deaths were observed in 48 patients (41.7%). The median disease-free survival was 64 months. Conclusion: Despite all the developments in metastatic breast cancer, the 5-year survival rate is 27%. Targeted personalized therapies may be promising when the mechanism of metastasis and specific pathways in breast cancer emerge.

Feasibility and accuracy of targeted axillary dissection in breast cancer patients; single center experience.

Introduction: Axillary complete response (pCR) was observed in approximately half of breast cancer patients who received neoadjuvant chemotherapy (NAC) due to axillary positivity. Preventing axillary morbidity due to unnecessary axillary lymph node dissection (ALND) is extremely important for patients' quality of life. Targeted axillary dissection (TAD) is a technique developed to improve axillary staging and reduce the false negative rate in sentinel lymph node biopsy. Methods: Patients with cN1-N2 (clinically node) breast cancer whose axillary lymph node metastasis was confirmed by biopsy and who received NAC marked with a clip were included in the study. Patients who achieved clinical response after systemic treatment underwent sentinel lymph node biopsy (SLNB) with additional methods such as methylene blue guided dissection, skin marking for clip on lymph node (CLN) localization, and wire guided with imaging excision of the CLN. TAD and ALND pathology results were evaluated and analyzed with patient and tumor characteristics. Results: 83 patients who met the eligibility criterias for the study were examined retrospectively. 21 of the patients underwent TAD alone, and 62 patients underwent ALND after TAD. CLN rate was 98.8% in patients underwent only TAD and this rate was increased to 100% in patients underwent ALND after TAD. FNR in SLN, CLN, and TAD were 28.6%, 10.7%, and 3.6%, respectively. Conclusion: TAD is a feasible and reliable surgical approach to detect axillary residual disease with a high success rate.

Invasive lobular carcinoma of the breast: clinicopathological features and patient outcomes.

AIM: The incidence of invasive lobular carcinoma (ILC), a breast cancer type comprising several variants with distinct morphological and molecular features and clinical behaviors, has been increasing in recent years. Unlike the well-defined classical lobular carcinoma, the most common ILC variant, some uncertainties remain regarding the features of other ILC variants. Therefore, we investigated the clinicopathological features and survival outcomes of specific ILC variants. MATERIAL AND METHODS: This retrospective study compared the tumor and patient characteristics and outcomes according to specific ILC variants in 77 patients who underwent surgery for ILC between January 2010 and December 2016 at a single center in Turkey. RESULTS: The mean patient age was 54.58 ± 11.7 years. The ILC variants were classical, pleomorphic, tubulolobular, solid, and signet ring cell in 49(63.6%), 14(18.2%), 10(12.8%), 2(2.7%), and 2(2.7%) patients, respectively. The mean tumor diameter, histological grade, Ki-67 proliferation index, nodal metastasis, E-cadherin expression, lymphovascular invasion, and type of surgery were significantly different among the variants. However, there were no significant differences in the rates of local recurrence, distant metastasis, and overall survival among the variants. CONCLUSIONS: Despite the good prognostic characteristics and good response to treatment, several studies have reported that ILC is associated with poor long-term outcomes. Therefore, significant challenges remain in the management of ILC. Although it is believed to be a specific histological type, ILC is clinically and pathologically heterogenous. Therefore, the identification of patients with poor prognostic variants should aid in the implementation of efficient and personalized treatment options. KEY WORDS: Breast cancer, Invasive cancer, Invasive lobuler carcinoma, Prognosis, Variants of lobuler carcinoma.

The change in incidence of breast cancer by stage: how is it changed after the COVID-19 pandemic? A single-center retrospective study.

AIM: The impact of COVID-19 pandemic is pronounced in each healthcare process, including the management of breast cancer. The anxiety of COVID-19 changes patient preferences and some delay in routine controls and surgical managements occur. Some disintegration in medical care is to be expected during the pandemic, but the new coping strategies are needed in order to avoid delayed diagnosis of breast cancer. METHODS: A total number of 140 patients assigned for biopsy and diagnosed with breast cancer in our tertiary clinic between December 1st and August 31st were classified into 3 groups; A (December-February), B (March-May) and C (June-August) in order to compare the stage of breast cancer at the time of diagnosis before, during and after the peak period of pandemic. Clinical stage and age at presentation, family history of breast, ovarian and other types of cancer, BRCA (genetic testing), menopausal status, side of involvement (uni- or bilateral), histopathologic subtype, receptor positivity and molecular subtype were recorded for each patient. RESULTS: Group A included 20 stage I (27.77 %), 32 stage II (44.44 %), 16 stage III (22.22 %) and 4 stage IV (5.55 %) breast cancer patients. Group B had 5 stage I (22.72 %), 8 stage II (36.36 %), 7 stage III (31.81 %) and 2 stage IV (9.09 %) breast cancer patients. Whereas in group C there were 4 stage I (8.69 %), 21 stage II (45.65 %), 16 stage III (34.78 %) and 5 stage IV (10.86 %) patients with breast cancer. The number of late-stage cancer patients in group C was significantly higher in comparison with the other groups (p<0.05). CONCLUSION: We speculate that the change in incidence of breast cancer by stage is attributable to a delay in the diagnosis of breast cancer due to COVID-19 related restrictions and presentation of new cases at more advanced stages once the restrictions were eased. KEY WORDS: Biopsy, Breast cancer, COVID-19, PandemicStage.

The rapid effects of sleeve gastrectomy on glucose homeostasis and resolution of diabetes mellitus.

Aims: Type 2 diabetes caused by obesity is increasing globally. Bariatric surgical procedures are known to have positive effects on glucose homeostasis through neurohormonal action mechanisms. In the present study, we aimed to investigate the factors influencing glucose homeostasis independent of weight loss after the laparoscopic sleeve gastrectomy (LSG). Methods: Patients who underwent LSG for morbid obesity in a 3-year period were evaluated. Data on demographics, clinical characteristics (duration of diabetes, resected gastric volume, antral resection margin) and laboratory parameters (preoperative and postoperative blood glucose on fasting, preoperative HbA1c levels and first-year HbA1c levels) were retrospectively reviewed. Effect of patients' body mass index (<50 kg/m2, ≥50 kg/m2), first-year excess weight loss (EWL%) rates, age (≥50 years, <50 years), duration of diabetes (≥5 years, <5 years) and antral resection margin (≥3 cm, <3 cm) on postoperative blood glucose profile and diabetic resolution status were investigated. Results: Total of 61 patients constituted the study group. There were 40 female and 21 male patients with an average age of 43.8 ± 10.5 years (19-67 years). Preoperatively, mean BMI, blood glucose levels and HbA1c were 48.8 ± 8.5 kg/m2, 133.6 ± 47.4 mg/dL and 7.4 ± 1.1, respectively. The mean blood glucose level at the postoperatively 5th day was 88.0 ± 16.3 mg/dL (median: 84 mg/dL) (P < .001). Fifty-nine out of 61 patients improved their glycaemic control. Conclusions: It is noteworthy that LSG can control blood glucose levels in short term after surgery regardless of weight loss. Therefore, LSG should be preferred at earlier stages in the treatment of obesity-related T2DM in order to prevent T2DM-related complications.

Relationships between androgen receptor expression and clinicopathological parameters in male breast cancer.

INTRODUCTION: Most patients with male breast cancer (MBC) express the androgen receptor (AR). AR expression in these tumors may have both prognostic and predictive values because its presence indicates the potential benefits of an anti-androgen therapeutic approach. The present study aimed to investigate the relationship between AR expression and clinicopathological parameters in MBC. MATERIAL AND METHODS: The data of 35 patients who received a histological diagnosis of MBC at the pathology department of our hospital between January 2007 and December 2017 were retrospectively reviewed. The patients' demographic data, follow-up records and pathology reports were recorded. AR expression status and its relationship with clinicopathological parameters were evaluated. The chi-square test was used to compare independent groups. Univariate survival analyses were performed using the Kaplan-Meier survival procedure. A p value of ≤0.05 was considered statistically significant. RESULTS: There was no significant relationship between AR expression and AJCC stage (p=0.585), pathologic stage (p=0.696), histologic grade (p=0.685), lymph-node status (p=0.685), survival rate (p=1.000), age(p=1.000), lymphovascular invasion (p=0.700), perineural invasion(p=1.000), skin invasion (p=1.000), nipple involvement(p=1.000), DCIS presence(p=1.000), ER positivity(p=1.000), PR positivity (p=0.218), Her2 expression (p=0.523), Ki67 index (p=0.685), Luminal A group (p=0.700), Luminal B group (p=0.691), triple negative group (p=1.000). CONCLUSION: Further investigation of the relation between AR expression and clinicopathological parameters of patients with MBC might yield important information and lead to the development of additional treatment options. KEY WORDS: Androgen receptor, AR expression, breast cancer, Male Breast cancer, Prognosis, Receptor status.

Solitary caecal diverticulitis: Comparison of operative and non operative treatment.

OBJECTIVE: To evaluate the treatment options applied to solitary caecal diverticulitis patients, and to explore the possibility of non-operative treatments. METHODS: The retrospective study was conducted a tertiary referral centre, and comprised data of patients who presented with acute abdominal pain and were diagnosed either preoperatively or intraoperatively as cases of solitary caecal diverticulitis between January 2009 and December 2017. Data on demographics, physical examination findings, laboratory results, treatment modalities and outpatient clinical records was noted, and analysed analysed using SPSS 21. RESULTS: Of the 580 patients whose medical records were reviewed, 11(1.89%) were diagnosed as cases of solitary caecal diverticulitis. Of them, 6(54.5%) patients were treated conservatively, and 5(45.4%) surgically. The disease recurred in 1(9%) patient who was treated conservatively. Among those treated surgically, 1(20%) patient had hemicolectomy, and the rest had appendectomy and/or diverticulectomy and drainage procedures. There were no major complications during the follow- up. CONCLUSIONS: With accurate diagnosis during preoperative period, the spread of the pathology helps to choose the best suitable surgical technique. Appendectomy should be performed to avoid future diagnostic confusion.

The Effects of Diverticulum Localization and Hinchey Classification on Recurrence and Complications in Acute Colonic Diverticulitis.

OBJECTIVES: Diverticular disease of the colon is a pathology that arises from outward ballooning of the mucosa due to some weakness in the muscle layer. Diverticular disease may range from symptomatic uncomplicated diverticular disease to symptomatic disease with complications, such as acute diverticulitis or diverticular bleeding. Acute colonic diverticulitis occurs in about 10- 25% of patients. METHODS: In this study, 134 patients who were admitted to our emergency clinic with complaints of abdominal pain between 2016-2019 and hospitalized with the diagnosis of acute diverticulitis were included. Patients' sex, age, presence of additional disease, increase in leukocyte and C-reactive protein (CRP), localization of diverticulitis, Hinchey classification, mean length of hospital stay and treatment were evaluated. The effects of these parameters on complications and recurrence were statistically analyzed. RESULTS: The length of hospital stay was statistically significantly associated positively with the Hinchey classification (p<0.001). While 18 patients who were medically treated developed recurrence later, and this rate was statistically significant (p<0.001). When one of the factors, localization, which may play a role in the severity of the disease and recurrence are examined, was evaluated concerning its results in our study, we found that rectosigmoid location is an important factor for recurrence. We found that the localization in the colon and the severity of the disease were effective in the prognosis of acute diverticulitis. CONCLUSION: We believe that localization and the severity of the disease should be taken into consideration when planning surgery in these patients.

Male Breast Cancer with Radiological and Histopathological Findings.

OBJECTIVES: We aimed to remind and emphasize the importance of male breast cancer with radiological and histopathological results of the patients diagnosed in our institution. METHODS: Men who had proven breast cancer by histopathological analysis between February 2010-April 2018 were reviewed retrospectively. The mammographic, ultrasonographic, magnetic resonance and positron-emission-tomography imaging features and histopathological results of the masses were noted. RESULTS: Twenty-five men were included in this study. Mean age of the patients was 62.9 (min:42; max: 82) with a mean size of lesions was 26.4 mm (min:10 mm; max: 70 mm). All the lesions were presented as a palpable mass. According to imaging features of the five patients who had mammography, all the four patients were presented as a mass but one patient as asymmetrical density. According to imaging features of the 20 patients who had an ultrasound, 16 (80%) lesions were presented as hypoechoic solid masses with irregular margins, while four (20%) were presented as complex-cystic masses with irregular margins. All the patients were diagnosed as invasive ductal cancer with luminal subtype by histopathological analysis. CONCLUSION: Even at young ages, the palpable lesion may be the only symptom of male breast cancer. Male breast cancer is generally presented as retroareolar mass and detected in advanced stages, probably due to low awareness and lack of screening programme. Invasive ductal cancer is the most common type of male breast cancer with the luminal subtype.

The Impact of Micropapillary Component Ratio on the Prognosis of Patients With Invasive Micropapillary Breast Carcinoma.

Background and Objectives: Invasive micropapillary carcinoma (IMPC) of the breast is a rare and aggressive variant of invasive ductal carcinoma characterized by high-grade lymphovascular invasion and high rates of nodal metastasis. The prognostic significance of the micropapillary component (MC) ratio that constitutes this aggressive variation is controversial. In this study, we aimed to investigate the effect of the MC ratio on the prognosis of these patients. Methods: The data of 47 patients with IMPC were retrospectively reviewed. Patients were divided into two groups: MC ratio of 10-75% (Group 1) and greater than 75% (Group 2). The demographic characteristics of the patients, histopathologic features of the tumors, and survival rates were compared. Results: We detected no significant difference in demographic characteristics between groups 1 and 2 (p = 0.21). No significant difference was detected in terms of tumor diameter, lymph node metastasis, lymphovascular invasion, histologic grade, multicentricity, local recurrence, distant metastasis, and overall survival. Conclusion: In the micropapillary subgroup of invasive ductal carcinoma, although positive receptor characteristics are directly proportional to the increase in MC ratio, recurrence and survival rates are not affected by micropapillary component level.

How does the extent of antral resection affect the residual gastric volume and excessive weight loss?

AIM: To identify the effect of the extent of antral resection on the residual gastric volume (RdGV) and excess weight loss (EWL) among patients who underwent laparoscopic sleeve gastrectomy(LSG) due to the obesity. MATERIAL AND METHODS: The demographical data, operative details, postoperative morbidity, mortality and the percentages of EWL in the postoperative 3, 6 and 12 months of the patients who underwent LSG between January 2014 and August 2015 were analyzed. These patients were divided into three groups regarding the antral resection margin (ARM): Group 1(n=80): ARM≤3cm; Group2 (n=35): 3 6cm from pylorus) resulted in reduced operating cost and decelerated reach to optimal EWL% with similar postoperative outcomes. KEY WORDS: Antral resection margin, Excess weight loss, Laparoscopic sleeve gastrectomy, Residual gastric volume, Surgical technique.

Comparative analysis of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass procedures for the treatment of morbid obesity.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) has been considered as the most efficient method in bariatric surgery. Indeed, Laparoscopic Sleeve Gastrectomy (LSG) which is easier to do, has been increasingly used in the recent years. The aim of the present study was to compare short-and mid-term outcomes of RYGB and LSG. METHODS: Medical records of 62 patients who underwent either RYGB (GroupR) or LSG (GroupL) in our General Surgery Department between 2010 and 2013 were retrospectively reviewed. Demographics, comorbidities, preoperative laboratory values, length of hospital stay and postoperative complications were recorded. During follow-up in the postoperative period, body-mass-index (BMI), excess weight loss (EWL), triglyceride levels (TG), and low-density lipoprotein (LDL) levels were recorded at the 1st, 3rd, 6th, and 12th months. RESULTS: Mean length of hospital stay was significantly higher in GroupR (p = 0.001), which was also correlated with BMI. EWL at 1st, 3rd, 6th, and 12th months was significantly higher in GroupR. Hair loss was significantly higher in GroupR (p < 0.05). The rates of diabetes mellitus and hypertension in the preoperative period and at 6th and 12th months did not significantly differ between the groups. Preoperative TG and LDL values were significantly higher in GroupR (p < 0.05). CONCLUS ONS: This study indicated, that RYGB is statistically more effective than LSG, but LSG has clinically almost the same effect as RYGB, and also hospital stay, postoperative complications as hair loss are decreased in LSG. KEY WORDS: Laparoscopic Sleeve Gastrectomy, Morbid Obesity, Roux-en-Y Gastric Bypass.

Approach to the diagnosis and treatment of mesenteric panniculitis from the surgical point of view.

OBJECTIVE: To evaluate the diagnostic and treatment approaches for patients diagnosed with mesenteric panniculitis. MATERIAL AND METHODS: We retrospectively reviewed all patients diagnosed with mesenteric panniculitis between January 2010 and March 2016. We recorded the demographic features, clinical symptoms, laboratory values, radiological methods, treatment approach, and outcomes of the patients. RESULTS: We evaluated 22 patients (17 male and five female) with a mean age of 45.8±15.7 years. The most frequent complaint was abdominal pain. The patients' histories included colon cancer (n=1), prostatic cancer (n=2), renal cell cancer (n=1), diabetes mellitus (n=4), and chronic obstructive pulmonary disease (n=1). Laboratory values revealed elevated C-reactive protein levels in 14 patients (43%). Computed tomography was performed in all the patients. Only 10 patients were followed up in the surgical ward, the remaining 12 underwent outpatient treatment. No complication associated with hospitalization or during outpatient follow-up period was observed. CONCLUSION: Mesenteric panniculitis can be successfully treated conservatively without surgical intervention. Clinical doubt is of great importance for diagnosis, and plausible underlying malignancy should be kept in mind.

Anticorrosive Effects of Some Thiophene Derivatives Against the Corrosion of Iron: A Computational Study.

It is known that iron is one of the most widely used metals in industrial production. In this work, the inhibition performances of three thiophene derivatives on the corrosion of iron were investigated in the light of several theoretical approaches. In the section including DFT calculations, several global reactivity descriptors such as EHOMO, ELUMO, ionization energy (I), electron affinity (A), HOMO-LUMO energy gap (ΔE), chemical hardness (η), softness (σ), as well as local reactivity descriptors like Fukui indices, local softness, and local electrophilicity were considered and discussed. The adsorption behaviors of considered thiophene derivatives on Fe(110) surface were investigated using molecular dynamics simulation approach. To determine the most active corrosion inhibitor among studied thiophene derivatives, we used the principle component analysis (PCA) and agglomerative hierarchical cluster analysis (AHCA). Accordingly, all data obtained using various theoretical calculation techniques are consistent with experiments.

Is Interval Cholecystectomy Necessary After Percutaneous Cholecystostomy in High-Risk Acute Cholecystitis Patients?

OBJECTIVES: Percutaneous cholecystostomy (PC) for acute cholecystitis (AC) is frequently performed in high-risk surgical patients as an alternative treatment modality. However, debate remains over whether or not an interval cholecystectomy for these patients should be performed. The aim of this study was to investigate the outcomes of PC in high-risk surgical patients with AC. METHODS: Between September 2013 and June 2016, 27 of 952 patients with AC were treated with PC. The data collection included demographic variables, including comorbidities, the timing of the PC, the length of the hospital stay, the follow-up period, the complications related to PC, and readmission to hospital. RESULTS: There were 16 female and 11 male patients, with a mean age of 73±12.4 years (range: 49-97 years). Comorbid diseases included ischemic heart disease (n=6), diabetes mellitus (n=5), chronic obstructive pulmonary disease (n=6), and others (n=10). The mean timing of PC was 2.2±1.4 days (range: 1-3 days). The mean length of hospital stay was 9.6±2.1 days (range: 7-14 days), and the catheter was removed after the first month. The mean follow-up period after the PC catheter removal was 19.6±8.6 months (range: 10-38 months). Only 6 patients (22.2 %) were readmitted to the hospital. Cholecystectomy was performed in 4 cases, and 2 responded to medical treatment. CONCLUSION: Despite ongoing controversy about the management of AC in high-risk surgical patients, PC is an adequate and safely applicable procedure in this group of patients. However, an interval cholecystectomy should be considered in persistent cases, which account for a small percentage. Longer-term follow-up studies with a larger sample size are needed to support our results.

Completion Thyroidectomy in Patients Diagnosed with Papillary Thyroid Cancer: Is There a Predictive Factor for Contralateral Lobe Tumor?

OBJECTIVES: Completion thyroidectomy (CT) is defined as the removal of the residual thyroid tissue in the case of detected malignancy after lobectomy for an indeterminate or non-diagnostic biopsy. Factors such as tumor diameter, aggressive histology, extrathyroidal spread, and positive surgical margin in papillary thyroid cancer (PTC) constitute CT indications. However, the type of surgery is controversial especially in patients with a tumor diameter of 1-4 cm. Determination of predictive factors for contralateral lobe tumors (CLTs) in PTC may be helpful for rough or excessive treatment of patients with this common thyroid pathology.The aim of the present study was to determine the predictive factors and rate of detection of CLTs after CT in patients with papillary thyroid carcinoma after lobectomy. METHODS: Medical records of patients who underwent lobectomy with the final histological diagnosis of papillary thyroid carcinoma for the study period 2011 to 2016 were reviewed. Demographic data of the patients, diameter, multicentricity and subtype of tumor, extrathyroidal spread, and vascular invasion rate were obtained. Patients were divided into 2 groups as final histological examination after CT revealed benign (Group 1) and malignant (Group 2). RESULTS: Data of 49 patients were retrospectively analyzed during the study period. The female-to-male ratio was 33/16. The mean age of the patients was 47.59 (23-77) years. Groups 1 and 2 consisted of 30 and 19 patients, respectively. No significant difference was found between the two groups regarding demographic data and tumor characteristics. CONCLUSION: Despite the fact that we have not been detecting any predictive factor in predicting the presence of tumor on the contralateral lobe in our study, the detection of a tumor on the contralateral lobe is frequent.

The impact of gallbladder retrieval from an epigastric vs. umbilical port on trocar-site complications A prospective randomized study.

AIM: Port-site infection and hernias are among the most of the complications following laparoscopic cholecystectomy (LC). Although surgical technique of LC is described to obtain critical view of safety, there is still no consensus on ideal portsite for gallbladder retrieval. In this comparative study, we aimed to investigate the effects of gallbladder retrieval site on postoperative port site complications following LC. MATERIAL AND METHODS: In this prospective randomized study, 120 patients underwent LC for symptomatic gallbladder disease. Standard 4-port LC was routinely performed. Patients were divided into two groups consecutively. The gallbladder was removed through the umbilical port-site in Group A (n=60) and the epigastric port-site in Group B (n=60). Postoperative port site complications were recorded. Visual analogue scale (VAS) for pain was also applied to the patients on the postoperative day 1, 10 and 30. RESULTS: Demographic features were similar in both groups. Postoperative pain in terms of VAS score was significantly lower for Group B on the postoperative day 1 and 30 (p=0.019, and p=0.001 respectively). The need for enlargement and time of GB retrieval was similar between groups. There is no statistical difference in terms of port-site infection or hernia between groups. CONCLUSIONS: The findings of this study provide epigastric port retrieval in terms of plausible reasons including significantly lower postoperative pain scores in both short- and long-term and quite lower trocar site-related complications. Key words: Gallbladder disease, Laparoscopic cholecystectomy, Port-site complications.

A rare cause of acute abdomen: Chylous ascites.

Chylous ascites, defined as a lipid-rich fluid accumulation in the peritoneal cavity, is a rare pathology of the lymphatic system and is a very rare cause of acute abdomen. It is generally associated with diseases such as cancer, cirrhosis, inflammatory diseases, surgery, or trauma. In this study, we report a patient with chylous ascites, which mimics acute appendicitis. Diagnosis and treatment procedures were discussed.

Approach to inguinal hernia in high-risk geriatric patients: Should it be elective or emergent?

BACKGROUND: Elderly patients are more prone to have inguinal hernia due to weakened abdominal musculature. However, surgical repair of inguinal hernia (SRIH) may not be performed or may be delayed due to greater risk in presence of comorbidities. Present study is investigation of outcome of elective and emergency SRIH in geriatric patients. METHODS: Records of total of 384 high-risk (American Society of Anesthesiology classification III-IV) patients aged >65 years who underwent SRIH between January 2010 and December 2014 were reviewed. Patients were divided into 2 groups according to procedure type: elective (Group EL) or emergency (Group EM). Demographic features and surgical and postoperative period data of 2 groups were recorded and compared. RESULTS: Demographic data were similar, but number of ASA IV patients was greater in Group EM. Frequency of intestinal resection was significantly greater in emergency surgery group (1% vs 21%; p<0.01). Length of hospital stay (1.3 days vs 7.9 days; p<0.01) and intensive care unit stay (0.17 days vs 4.04 days; p<0.01) were also greater in Group EM. Morbidity (1% vs 24%; p<0.01) and mortality (0.3% vs 11%; p<0.01) were also significantly higher in Group EM compared to elective SRIH group. CONCLUSION: Emergency inguinal hernia surgery is associated with significantly higher morbidity and mortality compared with elective SRIH in high-risk geriatric patients. Elective hernia repair in these patients should be considered to reduce risk of need for intestinal resection as well as length of hospital stay.