Comparison of Imaging Modalities in the Diagnosis and Tumor Staging of Colorectal Adenocarcinoma.

BACKGROUND: Colorectal cancer is a malignancy that affects the gastrointestinal tract. Clinical diagnosis has routinely been done with colonoscopy in conjunction with digital rectal and histological examinations. OBJECTIVE: We show that CT, MRI, and MRI-DWI are all effective in T-staging colorectal adenocarcinoma when compared to pathology examination. However, differences in the detection and diagnostic agreement rates between the imaging modalities for the specific T-stages were observed. METHODS: Fifty-six patients diagnosed with colorectal adenocarcinoma and underwent contrastenhanced abdominal CT, non-contrast MRI, or MRI-DWI between January 2014 and March 2020 were retrospectively examined and compared to a biopsy or postoperative pathological T-stage. RESULTS: The total diagnostic agreement rate for CT, MRI, and MRI-DWI were 58.93%, 76.79%, and 85.71%, respectively. T-staging was statistically and significantly different across all four stages analyzed for all imaging modalities. The T1-stage for MRI and MRI-DWI compared to pathology rates were statistically significant, whereas MRI-DWI and CT both demonstrated statistical significance for T3 and T2 stage comparison, respectively. Furthermore, a statistical and significant difference between the total stage comparison of MRI, MRI-DWI, and CT compared individually to pathology was also observed. All imaging modalities were able to statistically and significantly identify tumors based on tumor size according to the ROC analysis. CONCLUSION: These data suggest that CT, MRI, and MRI-DWI can identify and aid visually in the diagnosis of adenocarcinoma colorectal cancer. MRI-DWI is more specific and sensitive in the diagnosis and staging of colorectal tumors.

Determining a Method to Minimize Pain After Laparoscopic Cholecystectomy Surgery.

BACKGROUND: Although many studies have investigated control of postoperative pain, inadequacy of treatment still remains. In this study, we aimed to identify a method with the capacity to minimize abdominal and right shoulder pain after laparoscopic cholecystectomy. MATERIALS AND METHODS: A total of 684 subjects, 77% (n=527) female and 23% (n=157) male, were included in this study. A T-drain was prescribed for patients requiring bile duct exploration and patients with acute cholecystitis were excluded from the study. Subjects were classified into groups as follows: Group 1: control group without drain and intraperitoneal analgesics; Group 2: a drain was placed but no intraperitoneal analgesic was applied; Group 3: no drain was placed and intraperitoneal subhepatic bupivacaine was applied; and Group 4: drain was placed and intraperitoneal subhepatic bupivacaine was applied. Parietal pain and visceral pain were evaluated with visual analog scale (VAS). RESULTS: A drain was present in 51.9% (n=355) of the cases. A statistically significant difference was found between the preoperative pulse rate measurements of the cases according to the groups ( P =0.009; <0.01). Subhepatic bupivacaine was administered in 50.1% (n=355) of the cases. A statistically significant difference was found between the second, fourth, sixth, 12th, and 24th hour VAS scores of the cases according to the groups [2 h VAS scores (mean±SD): Group 1: 3.58±1.07, Group 2: 3.86±1.12, Group 3: 1.20±0.67, and Group 4: 1.50±1.21 ( P <0.001)]; [4 h VAS scores (mean±SD): Group 1: 2.55±1.26, Group 2: 2.87±1.14, Group 3: 1.66±1.06, and Group 4: 2.02±1.23 ( P <0.001)]; [6 h VAS scores (mean±SD): Group 1: 2.50±0.91, Group 2: 2.53±1.14, Group 3: 1.66±1.06, and Group 4: 2.02±1.23 ( P <0.001)]; [12 h VAS scores (mean±SD): Group 1: 3.24±1.2, Group 2: 3.49±1.14, Group 3: 2.83±0.98, and Group 4 : 2.99±1.36 ( P <0.001)]; and [24 h VAS scores (mean±SD): Group 1: 3.75±0.99, Group 2: 4.01±0.91, Group 3: 3.61±1.34, and Group 4: 4.01±1.08 ( P <0.001)]. CONCLUSION: Bupivacaine spraying reduces postoperative abdominal pain, while drain placement minimizes shoulder pain by reducing CO 2 remaining under the diaphragm.

The role of mesalazine co-treatment in the prevention of recurrence in subjects with subclinical inflammatory bowel disease and perianal fistula who are scheduled for surgical intervention.

AIM: To investigate the impact of mesalazine co-treatment in addition to the surgical intervention on recurrence rate in subjects with subclinical inflammatory bowel disease (SIBD) who present with perianal fistula (PAF). MATERIALS AND METHODS: All consecutive patients who had undergone surgery for PAF in our institutes were included in this retrospective analysis. Ileal tissue samples were obtained during colonoscopy for pathological evaluation. Patients with active chronic ileitis, structural distortion, erosion, ulceration, cryptitis, crypt abscess, fibrosis, and Paneth cell hyperplasia were defined as SIBD. Patients were divided into two groups according to the presence or absence of SIBD on pathological evaluation of ileal tissue samples (Group 1: SIBD +; Group 2: SIBD -). Rectal 5-aminosalicylic acid (mesalazine) of 2 gr once daily was administered to half of the subjects in each group for 8 weeks. The difference in 6 months recurrence rates of subjects receiving or not receiving mesalazine was the primary outcome measure. RESULTS: The overall recurrence rate of subjects not receiving mesalazine was significantly higher than that of the subjects receiving mesalazine (9.7% vs. 4.4%, p = 0.020). Recurrence rate of the subjects with SIBD who received mesalazine co-treatment was significantly lower than those without mesalazine (1.6% vs. 12.6%, p=0.002). However, recurrence rate of the subjects without SIBD who received and not received mesalazine co-treatment was similar (6.8% vs. 7.8%, p=0.764). CONCLUSION: Mesalazine co-treatment in addition to the surgical intervention was associated with lower 6 months recurrence rate compared to surgical intervention alone in patients with SIBD and PAF. KEY WORDS: Inflammatory bowel disease, Mesalazine, Perianal fistula.

Comparing laparoscopic totally extraperitoneal inguinal hernia repair with and without mesh fixation.

AIM: To compare totally extraperitoneal (TEP) repair in uncomplicated primary inguinal hernia patients with and without mesh fixation using tack in terms of peri- and post-operative complications, recurrence, return to work, and hospital stay. MATERIAL AND METHODS: We retrospectively analyzed the medical records of patients who underwent TEP repair of uncomplicated primary inguinal hernia (American Society of Anesthesiologists score I/II) at our institute from January 2008 to December 2017. RESULTS: In total, 354 patients were included in this study. There was no statistical difference in the body mass index (BMI) and duration of operation between patients with and without fixation. The mean number of days to return to work was significantly (p=0.000) higher in patients with use mesh fixation (9.06+1.749) compared to patients without mesh fixation (7.31+2.097). There was no difference between the two groups in terms of post-operative complications, except for seroma of the inguinal region, subcutaneous emphysema, and post-operative pain (p<0.05). The mean number of days of hospital stay was significantly (p=0.002) higher in patients with mesh fixation (1.11+0.329) compared to patients without mesh fixation (1.02+0.149). Evaluation of peri- and post-operative complications in BMI groups showed that obese patients and other groups had no significant difference (p>0.05). CONCLUSIONS: Non-mesh fixation laparoscopic TEP repair is safe and feasible for primary and relapsed inguinal hernias. Patients experienced less chronic pain, shorter hospital stay, and shorter time to return to work. Furthermore, it might be safe in obese patients but requires additional study to confirm. KEY WORDS: Hernia, Inguinal hernia, Laparoscopy, Mesh, Surgery.

Comparison of Diagnostic Accuracies of USG, MG and MRI Modalities Defined with BI-RADS Classification System.

BACKGROUND: BI-RADS classification facilitates the information related to diagnosis for radiologists. It allows radiologists to interpret mammograms accurately. OBJECTIVE: We aimed to compare the diagnostic accuracy of the three modalities, USG, MG and MRI, with the BI-RADS classification system according to their imaging findings. METHODS: This study included 82 patients who underwent Tru-Cut biopsy under the guidance of USG, MG, and MRI. Mammography, sonography and MRI were performed in the prone position. RESULTS: Of the patients, 46.3%, 14.6%, and 39.0% were assessed in 4A, 4B, and 5 MRI BI-RADS categories, respectively. Based on the variable surgical/pathological diagnosis, 50%, 28.0%, and 22.0% of the patients were categorized as having malignant findings, benign findings, and infectioninflammation- mastitis, respectively. The determination of the endpoints for the parameter of long-axis diameter (mm) was found to be statistically significant according to ROC analysis as a gold standard based on specificity levels of benign and malignant findings (p<0.05). A significant correlation was detected between the gold standard and the categorical variable MRI BI-RADS (χ2=46.380, p<0.01). CONCLUSION: When the specificity and sensitivity of all three modalities in surgical/pathological diagnosis were compared, MRI was concluded to be superior to the other modalities and a valuable method for the prediction of lesion malignancy and determination of biopsy prediction and priority.

Multidetector CT angiography versus arterial duplex USG in diagnosis of mild lower extremity peripheral arterial disease: is multidetector CT a valuable screening tool?

OBJECTIVE: To prospectively compare the efficacy of 40-row multidetector computed tomography angiography (MDCTA) and duplex ultrasonography (DUS) to diagnose mild peripheral arterial occlusive disease (PAOD) in lower leg and to search whether MDCTA can be used as a screening tool. METHODS: Forty-three patients with intermittent claudication and leg pain, diagnosed as mild PAOD, had undergone DUS and MDCTA of lower limb. The arteries of lower leg were initially scanned by DUS, followed by MDCTA. Both modalities were compared for detecting the obstructed and stenotic segments. RESULTS: A total of 774 vessel segments were imaged by both modalities. When all arteries were considered, MDCTA detected obstructed or stenotic lesions in 16.8% of arteries, versus 11.1% compared to DUS. When suprapopliteal arteries alone were considered, MDCTA detected lesions in 15.0% of arteries, versus 11.0% with DUS. When infrapopliteal arteries only were considered, MDCTA detected lesions in 19.6% of arteries, versus 11.3% with DUS. MDCTA showed 5.7% (95% CI: [3.5%, 7.9%]) more lesions than DUS when all arteries were considered together, 8.3% (95% CI: [4.6%, 12.0%]) more lesions when only the infrapopliteal arteries were compared, and 4.0% (95% CI: [1.3%, 6.8%]) more lesions when only suprapopliteal arteries were compared (p<0.01 for all comparisons). CONCLUSION: 40-row MDCTA may be used as a screening tool in patients with mild lower extremity PAOD as it is a non-invasive and more accurate modality when compared to DUS.