Might simple peripheral blood parameters be an early indicator in the prediction of severity and morbidity of cholecystitis?

Purpose: The aim of this study is to examine the effectiveness of the neutrophil-lymphocyte ratio (NLR) and CRP/albumin ratio (CAR) in evaluating disease severity and predicting clinical outcomes in patients diagnosed with acute cholecystitis (AC). Methods: A total of 186 patients with AC were evaluated retrospectively. NLR, CAR, Mannheim Peritonitis Index (MPI), and P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) scores were compared with AC severity grade. Results: The rates of the grade 1 patients (group 1) and the grade 2-3 patients (group 2) were 57.5% (n = 107) and 42.5% (n = 79) according to the disease severity according to Tokyo Guidelines criteria (TG) 18/TG13, respectively. The morbidity rates determined in groups 1 and 2 were 26.7% (n = 28) and 51.9% (n = 41), respectively. No mortality was found in group 1, whereas the mortality rate in group 2 was 6.3% (n = 5). According to multivariate analysis, CAR (odds ratio [OR], 1.234; P < 0.001) and MPI (OR, 1.175; P = 0.001) were found to be associated with moderate-severe disease while CAR (OR, 1.109; P = 0.035) and P-POSSUM morbidity (OR, 1.063; P = 0.007) variables were found to be associated with the presence of morbidity. Conclusion: We have demonstrated that CAR can be used in predicting severity of AC and that CAR is an alternative simple parameter of P-POSSUM morbidity score in prediction of morbidity in these cases. In addition to other assessment methods, these scores can provide valuable and complementary information in assessment of disease severity and prognosis in AC.

Role of F-18 FDG PET/CT in Predicting Response to Neoadjuvant Chemotherapy in Invasive Ductal Breast Cancer.

Objective: The role of baseline and post-treatment standardized uptake value (SUVmax) values in predicting pathological response in patients with breast cancer after neoadjuvant chemotherapy (NAC). Materials and Methods: Thirty patients with invasive ductal breast cancer were included in this retrospective study. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) examinations were performed before and after NAC. Pretreatment SUVmax (SUVmax I), post-treatment SUVmax (SUVmax II) and ΔSUVmax values of primary breast cancer were obtained. Breast tumor pathology preparations were examined for the evaluation of tumor response according to the Miller and Payne classification. Patients were grouped as responding to treatment (pCR) and unresponsive to treatment (nonpCR). In all analyses, p<0.05 was considered statistically significant. Results: The mean age of the 30 patients included in the study was 51.2±11.98 years. In the study-defined grouping, 13 patients (43.3%) were nonresponders and 17 patients (56.7%) were responders. ΔSUVmax was significantly greater in the responders group compared to the nonresponders group, while SUVmax II was lower (p = 0.001 and p = 0.004, respectively). There was no significant difference between the responders and nonresponders in terms of age, tumor diameter, and SUVmax I values. Multivariate logistic regression analysis showed ΔSUVmax to be the only independent predictive factor for pCR. Conclusion: F-18 FDG PET/CT was an effective method in evaluating the treatment response after NAC in breast cancer, and ΔSUVmax and post-treatment SUVmax can be used to predict the response of the primary tumor to treatment.

Sleep quality, mental health, and quality of life in women with breast cancer.

Background: Breast cancer is the most frequent malignancy among women and its prevalence keeps growing. Today, it is important to optimize the quality of life of breast cancer patients because the survival rates increase with early diagnosis and treatments. Our aim was to examine the sleep quality of patients with breast cancer, compare them with the healthy control group, and evaluate the relationship between quality of life and mental health. Materials and Methods: This cross-sectional study included 125 patients diagnosed with breast cancer and 125 healthy control patients who were admitted to the general surgery department of a university. Results: In 60.8% of breast cancer patients, sleep quality was poor and sleep subscale scores were high. In addition, these patients had a poorer sleep quality, higher score of anxiety and depression, and lower quality of life (in terms of physical subcomponent) compared with the control group. Moreover, although age, marital status, education status, time of cancer diagnosis, menopausal status, surgical method did not have any effect on sleep quality in patient group; low income, accompanying chronic diseases, and increased levels of anxiety and depression worsened sleep quality and increased the risk. Conclusion: In patients with breast cancer, poor sleep quality, score of anxiety and depression were higher, and worsened the quality of life. In addition, low income, presence of concomitant chronic diseases, and anxiety score posed an increased risk for poor sleep quality. Therefore, physical and mental evaluation of breast cancer patients during and after treatment should not be ignored.

Spousal and living related kidney transplantation: our center experience.

BACKGROUND: Kidney transplantation is the most preferred type of renal displacement therapy for end stage renal disease (ESRD) patients. More patients developed ESRD. The most important source is the donations from unrelated spouses. In this study, we aimed to compare the transplantation data obtained from the spouses of the patients with the transplantation data obtained from other relatives. METHODS: The data including 167 living kidney transplantations performed between January 2006 and December 2019 were retrospectively collected. The patients were divided into two groups; spousal donor group (n: 53) and living-related donor group (n: 114). RESULTS: There was no significant difference in delayed graft function in both groups. There were no patients with acute rejection proven by biopsy or considered biochemically in the spousal donor group. With regard to 3-year results in the living-related donor group the patient survival rate was 100%, while it was 98.2% in terms of graft survival. CONCLUSIONS: In conclusion, similar patient and graft survival rates between spousal donor kidney transplantation and living-related kidney transplantation has made spousal donor kidney transplantation, with possible problems in terms of tissue compatibility, an acceptable alternative to donor supply.

Phyllodes Tumors of the Breast: A Single-Center Experience.

OBJECTIVE: We aimed to analyze the clinicopathological findings, treatment approach, and treatmen outcomes in patients diagnosed with phyllodes tumor (PT). MATERIALS AND METHODS: The clinicopathological data of 26 patients with PT, who were treated between 2008 and 2019, were retrospectively analyzed. RESULTS: Mean age was 35.07±13.95 years (range: 14-71), while mean tumor size was 54.76±29.24 mm (range: 25-135). Benign, borderline, and malignant PT were detected in 18 (69.2%), 3 (11.5%), and 5 (19.2%) patients, respectively. Marginless excision was performed in 20 patients (76.9%), while six (23.1%) patients underwent mastectomy. A statistically significant correlation of tumor type with mean tumor size and mean age was observed (p=0.041 and p=0.013, respectively). Margin positivity on first excision was more frequent in the malignant tumors (p=0.02). No statistically significant correlation of PT type with presence of breast cancer in the family history, and tumor localization was observed (p=0.79 and p=0.13, respectively). Mean postoperative follow-up duration was 56 months (range: 6-147). Local recurrence was not observed in any of the patients. Lung and left vastus lateralis muscle metastases were encountered. The patient with lung metastasis became exitus because of the same reason 6 months after detection of the metastasis. CONCLUSION: PT is a rare fibroepithelial tumor of the breast that is characterized by a mixed histology seen in younger ages when compared to the classical breast tumors. The probability of PT should be considered in the presence of a rapid-growing mass in the breast. In addition, it should also be considered that the contribution of imaging techniques may be limited.

Morgagni hernia and accessory liver lobe torsion in an adult.

Accessory liver lobe (ALL) is a rare congenital anomaly of the liver and is related to the focal excessive development of liver tissue. Accessory liver lobe torsion (ALLT) is a rare condition that can present with acute abdominal pain. Delay in diagnosis can lead to life-threatening complications such as sepsis and systemic inflammatory response syndrome. Imaging methods, especially computed tomography (CT), are of great importance for prompt diagnosis of acute abdominal pain causes, and CT images should be carefully examined. Herein we present a case of ALLT that was occurred due to Morgagni hernia in a 54-year-old male patient who presented with acute abdominal pain. Contrast-enhanced thoracoabdominal computed tomography (CT) was performed and CT demonstrated the Morgagni hernia and herniation of the accessory liver lobe into the hernia sac. CT showed decreased contrast-enhancement in the accessory liver lobe, compatible with ischemia. We also aimed to emphasize the clinical and CT imaging findings of ALLT.

Successful treatment of extreme drug resistant Acinetobacter baumannii infection following a liver transplant.

Orthotopic liver transplantation is a life-saving procedure for patients with end-stage liver failure. However, Acinetobacter baumannii infections and acute rejection are important causes of morbidity and mortality following transplants. Here we present a case report of a cadaveric donor liver transplantation with infectious complications detected after transplantation. The patient was a 64-year-old female. Because of non-alcoholic steatohepatitis due to hepatic insufficiency (model for end-stage liver disease (MELD): 12; Child-Pugh: 9B), liver transplantation from a cadaveric donor was performed. Following the transplantation, the patient developed a blood stream infection, urinary tract infection (UTI) and postoperative wound infection from biliary leakage. A. baumannii was isolated from blood, urine and wound cultures. Imipenem (4×500 mg), tigecycline (2×50 mg) and phosphomycin (4×4 g) were administered intravenously (IV). On the 14th day of treatment, the bile fistula closed and there was no bacterial growth in blood and urine cultures. The patient was discharged with full recovery. The duration of a transplant patient's hospital stay, intensive care unit stay, invasive interventions, blood transfusions and immunosuppressive treatments cause an increased risk of extensively drug-resistant (XDR) A. baumannii infections, and a high mortality rate is seen despite antibiotic treatment. Phosphomycin, used in combination therapy, may be an alternative in the treatment of XDR pathogens in organ transplant patients, due to its low side effect profile and lack of interaction with immunosuppressives.

Changes of normal appearing optic nerve head on diffusion-weighted imaging in patients with diabetic retinopathy.

PURPOSE: To investigate whether there is any change by measuring ADC values particularly of the optic nerve head (ONH) in patients with diabetic retinopathy (DR). MATERIAL AND METHODS: ADC values at the ONHs was measured in 56 patients and 68 controls. RESULTS: ADC values of ONHs were significantly higher in patients with DR compared to controls (p=0.011). ADC values in patients with macular edema were higher than those without macular edema (p=0.017). CONCLUSION: DWI of ONHs can be useful in cases where it is difficult to assess macular edema during fundus examination, especially in diabetic patients with cataract.

Comparing 1470- and 980-nm diode lasers for endovenous ablation treatments.

The purpose of this study was to compare the effectiveness of 1470- and 980-nm lasers with regard to power output, complications, recanalization rates, and treatment response. We prospectively evaluated the effectiveness of endovenous laser ablation (EVLA) in a total of 152 great and small saphenous veins from 96 patients. Lasers were randomly used based on the availability of the units. Patients were clinically evaluated for Clinical Etiologic Anatomic Pathophysiologic (CEAP) stage and examined with Doppler ultrasound. Treatment response was determined anatomically by occlusion of the vein and clinically by the change in the venous clinical severity score (VCSS). Seventy-eight of the saphenous veins underwent EVLA with a 980-nm laser and 74 underwent EVLA with a 1470-nm laser. Treatment response was (68) 87.2 % in the 980-nm group and (74) 100 % in the 1470-nm group (p = 0.004). The median VCSS decreased from 4 to 2 in the 980-nm group (p < 0.001) and from 8 to 2 (p < 0.001) in the 1470-nm group. At 1-year follow-up, seven veins treated with 980 nm and two veins treated with 1470 nm were recanalized (p = 0.16); the average linear endovenous energy density (LEED) was 83.9 (r, 55-100) J/cm and 58.5 (r, 45-115) J/cm, respectively (p < 0.001). Postoperative minor complications occurred in 23 (29.4 %) limbs in the 980-nm group and in 19 (25.6 %) limbs of the 1470-nm group (p = 0.73). EVLA with the 1470-nm laser have less energy deposition for occlusion and better treatment response.

Giant arteriovenous malformation located on the chest wall - diagnosis and endovascular treatment: report of a case.

Congenital arteriovenous malformations are usually found in the lower extremities, but a chest wall location is extremely rare. Extensive vascular malformations present difficulties for patients because of severe unsightliness and life-threatening bleeding. Surgical planning and therapeutic indications in vascular malformations are still a difficult problem. This report describes the case of a 27-year-old woman with a congenital giant arteriovenous malformation of the left chest wall. Preoperative embolization was planned prior to surgical intervention because of the increased risk of massive bleeding, and the malformation was completely embolized with absolute alcohol.

What would be left behind if subtotal thyroidectomy were preferred instead of total thyroidectomy?

BACKGROUND: The choice between subtotal thyroidectomy (STT) and total thyroidectomy (TT) for multinodular goiter (MNG) remains controversial. METHODS: Thyroid tissue samples of 34 patients who underwent TT for multinodular disease between October 2005 and June 2007 in Pamukkale University Hospital, Department of General Surgery were evaluated. Thyroid tissues weighing 2 g each from either side were separated from the main specimen to simulate the tissues that would be left behind if a subtotal resection were performed instead of a total resection. Ki-67 staining was performed. RESULTS: The mean age of subjects was 49.3 +/- 12 years and 25 (73.5%) were females. Papillary microcarcinomas were found in 4 patients, 1 of which was in a residual thyroid specimen (RTS). Micronodule formations were found in 73.5% of specimens simulating residual thyroid. While Ki-67 indexes of residual thyroid tissues were 4.65% in nodules and 1.91% in normal areas (P < .05), they were 5.42% and 2.84%, respectively, for nodular and normal areas in the main specimens (P < .05). CONCLUSION: Remnant thyroid tissues, following STT, have a high percentage of micronodule formation with a remarkable cellular proliferative activity.

Do cerebral blood flow velocities change in iron deficiency anemia?

Infants with iron deficiency had lower scores when tested for mental and motor development than their peers with better iron status. The aim of this study was to examine cerebral blood flow velocity in infants with iron deficiency anemia. Thirty-six infants (27 male, 9 female) with iron deficiency anemia, aged 6 to 36 months were divided into 2 groups according to the hemoglobin (Hb) values [group 1 (n=23) Hb<10 g/dL and group 2 (n=13) 11 >Hb> or =10 g/dL]. In anterior and middle cerebral arteries only end-diastolic velocity (EDV) was increased in group 1 as compared with group 2 (P=0.05 and P=0.016, respectively), whereas in posterior cerebral artery both EDV and peak-systolic velocity were different between the groups (P=0.024 and P=0.004). Both peak-systolic velocity and EDV showed significant correlation with Hb level in the posterior cerebral artery (r=-0.38, P=0.023 and r=-0.35, P=0.037) but not in the anterior and middle cerebral arteries. Increased cerebral blood flow velocities in children with lower Hb values may be due to increased cardiac output, decreased vascular resistivity caused by anemia.

High-resolution computed tomography findings in elderly patients with asthma.

OBJECTIVE: Based on the hypothesis that airway remodelling is related to the duration of asthma, HRCT scanning should show greater abnormalities in the early-onset than the late-onset asthmatics. It was, therefore, intended to assess the presence and the frequency of airway and parenchymal abnormalities with high-resolution computed tomography (HRCT) in elderly asthmatic patients, and to determine whether these abnormalities are related to the duration of asthma. PATIENTS AND METHODS: Sixty-eight clinically stable asthmatic patients aged > or =60 yr were included in this prospective study. The patients were separated into two groups according to the duration of symptoms as late-onset asthma (n=31) with disease duration of <5 yr, and early-onset asthma (n=37) with disease duration of > or =5 yr. All patients were lifelong non-smoker and had been using inhaled beta agonists and inhaled steroids. HRCT-scanning and histamine inhalation test were performed on all patients. RESULTS: In comparison with late-onset asthmatic patients, those with early-onset asthma had significantly higher frequency of emphysema (21.6% versus 0.0%, p=0.006), bronchial dilatation (13.9% versus 0.0%, p=0.03) and bronchial wall thickness (41.7% versus 12.9%, p=0.01). Multiple logistic regression analysis identified that early-onset of disease was an independent risk factor for the presence of irreversible HRCT-scan abnormalities in elderly asthmatics [odds ratio (OR): 9.4 (2.7-32.7), p=0.00001]. CONCLUSION: Present data suggest that HRCT abnormalities in early-onset elderly asthmatics reflect parenchymal and airway changes that become irreversible throughout the long course of the disease.

Changes in cerebral and ocular hemodynamics in Behçet's disease assessed by color-coded duplex sonography.

AIM: To quantify the cerebral and retrobulbar hemodynamics in Behçet's disease with and without ocular involvement and compared with that of healthy controls. MATERIALS AND METHODS: Of 51 people studied, 17 had Behçet's disease with ocular involvement, 17 had Behçet's disease without ocular involvement, and 17 were healthy controls. A single eye was examined in each patient. Peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged maximum velocity (Tamax), and resistance index (RI) were evaluated in the ophthalmic (OA), posterior ciliary (PCA), central retinal (CRA) and middle cerebral artery (MCA). Additionally, the average blood flow velocities in the central retinal vein (CRV), and acceleration time (AT) and pulsatility index (PI) in the MCA were calculated. RESULTS: The mean EDV in the PCA was 25% lower and RI was higher in patients with ocular involvement of BD than in patients without involvement (p = 0.006 and p = 0.005, respectively) and in healthy controls (p = 0.003 and p = 0.004, respectively). Differences were smaller in comparisons of the CRA and absent on comparisons of the OA and MCA. The acceleration time of the MCA was significantly higher in patients with Behçet's disease than in healthy controls (p = 0.03). CONCLUSION: This study suggests that the flow hemodynamics in retrobulbar circulation has more altered Behçet's disease with ocular involvement than without ocular involvement and healthy control. Additionally, the cerebral hemodynamic might be affected in patients with Behçet's disease compared with healthy controls.

Evaluation of gallbladder motility in patients with irritable bowel syndrome.

BACKGROUND: Abnormalities involving smooth muscle function in different systems of the body have been reported in irritable bowel syndrome (IBS). There are a few studies on gallbladder function in this disorder with conflicting results. OBJECTIVES: To investigate the motility of gallbladder in patients with IBS. PATIENTS AND METHODS: Forty-eight patients (15 male and 33 female) with IBS and 48 healthy volunteers (15 male and 33 female) were included into the study. Thirty-four patients (70.8%) had constipation predominant and 14 patients (29.2%) had diarrhoea predominant type of IBS. Fasting and postprandial gallbladder volumes were studied using real time ultrasonography and ejection fraction (EF) of gallbladder was calculated. RESULTS: While fasting gallbladder volume (FGV) was similar between IBS and control groups (18.0 +/- 4.0 ml vs. 17.8 +/- 4.9 ml, p >0.05), postprandial gallbladder volume (PGV) was lower in IBS group than in the control group (5.5 +/- 1.4 ml vs. 6.2 +/- 1.9 ml, p = 0.03). Accordingly, the mean EF of gallbladders was found to be higher in IBS group than in the control group (69.1% vs. 64.1%, p = 0.0001). There were no difference in FGV, PGV and EF of gallbladders between constipation predominant and diarrhoea predominant IBS patients (p >0.05). CONCLUSION: The results of this study indicated that IBS patients have increased emptying of gallbladder compared to healthy subjects.

MR spectroscopy of cervical spinal cord in patients with multiple sclerosis.

MR spectroscopy (MRS) of the brain in patients with multiple sclerosis has been well studied. However, in vivo MRS of the spinal cord in patients with MR spectroscopy has not been reported to our knowledge. We performed MRS of normal-appearing cervical spinal cords in multiple sclerosis patients and in healthy controls. N-acetyl aspartate was shown to be reduced within the cervical spinal cord of multiple sclerosis patients when compared with healthy controls. This finding supports axonal loss and damage within even normal-appearing spinal cords of multiple sclerosis patients.

Smoking prevents the expected postprandial increase in intestinal blood flow: a Doppler sonographic study.

OBJECTIVE: To assess whether cigarette smoking had an effect on superior mesenteric artery postprandial blood flow. METHODS: Forty-six subjects were studied in 3 groups with Doppler sonography. Group A consisted of nonsmokers; groups B and C consisted of smokers. In group B, subjects were allowed to smoke cigarettes postprandially, whereas in group C, postprandial smoking was prohibited. A baseline Doppler evaluation was performed in the fasting state, and consecutive Doppler evaluations were performed postprandially with 30-min intervals for 120 minutes. Doppler sonographic measurements of the superior mesenteric artery, including peak systolic and end-diastolic velocities, resistive index, and diameter, were calculated. Statistical analysis was performed by analysis of variance. RESULTS: All groups showed significant changes with time for all parameters (P < .001 for all). The changes in time were significantly different at 90 and 120 minutes for peak systolic velocity, at 90 minutes for end-diastolic velocity, and at 120 minutes for diameter between groups. Group B had the greatest differences. Compared with group A, changes in peak systolic velocity at 90 to 120 minutes were significantly lower in group B (P = .007 and .006, respectively), and compared with groups A and C, changes in end-diastolic velocity at 90 minutes (P = .006 and .004, respectively) and diameter at 120 minutes (P = .007 and .011, respectively) were significantly lower in group B. CONCLUSIONS: Smoking immediately after meals was associated with a superior mesenteric artery blood flow increase that was lower than expected, which may explain the belief that smoking reduces body weight. Postprandial smoking may have undesired results in patients with chronic intestinal ischemia.