10 research outputs found
Apparent diffusion coefficient histogram analysis for predicting neoadjuvant chemoradiotherapy response in patients with rectal cancer
PURPOSEThis study aimed to retrospectively evaluate the apparent diffusion coefficient (ADC) histograms in predicting chemoradiotherapy (CRT) response in patients with locally advanced rectal cancer (LARC).METHODSA total of 51 patients who underwent surgery in our institution for rectal cancer following neoadjuvant CRT between November 2013 and July 2019 were enrolled. Conventional magnetic resonance (MR) and diffusion-weighted images obtained before and after CRT were evaluated retrospectively. All tumor-containing regions of interests were drawn in 3 selected axial images, and special software for histogram analysis was used to evaluate ADC distribution. ADC cutoff values from post-CRT ADC histogram were calculated from receiver operating characteristic (ROC) analysis for evaluating CRT response.RESULTSIn histopathological analysis, 5 patients (9.8%) had minimal response (group 1), 31 patients (60.8%) had partial response (group 2), and 15 patients (29.4%) had complete or almost complete response (group 3). In the ADC histogram, minimum, maximum, 10th, 25th, 50th, 75th, and 90th percentile, mean ADC values, and skewness values of groups 2 and 3 showed significant changes before and after CRT, but no difference was found within group 1 values. The mean, 25th, 50th, 75th percent ADC values after CRT and skewness, and kurtosis values were significantly different between group 1 and group 3. Skewness value from the ADC histogram in postCRT magnetic resonance imaging had the best diagnostic performance with an area under the ROC curve of 0.851 (P =.003) for detecting group 3. The skewness cutoff calculated from the ROC analysis was 0.210 for evaluating CRT response. The sensitivity and specificity of the cut-off value were 100% and 61.4%, respectively.CONCLUSIONThe ADC histogram analysis seems to have potential application in predicting response to neoadjuvant CRT in patients with locally advanced rectal cancer
Correlation of minimum apparent diffusion coefficient with maximum standardized uptake on fluorodeoxyglucose PET-CT in patients with rectal adenocarcinoma
PURPOSE:The aim of this study was to retrospectively assess the correlation between minimum apparent diffusion coefficient (ADCmin) values obtained from diffusion-weighted magnetic resonance imaging (MRI) and maximum standardized uptake values (SUVmax) obtained from positron emission tomography-computed tomography (PET-CT) in rectal cancer. MATERIALS AND METHODS: Forty-one patients with pathologically confirmed rectal adenocarcinoma were included in this study. For preoperative staging, PET-CT and pelvic MRI with diffusion-weighted imaging were performed within one week (mean time interval, 3±1 day). For ADC measurements, the region of interest (ROI) was manually drawn along the border of each hyperintense tumor on b=1000 s/mm2 images. After repeating this procedure on each consecutive tumor-containing slice to cover the entire tumoral area, ROIs were copied to ADC maps. ADCmin was determined as the lowest ADC value among all ROIs in each tumor. For SUVmax measurements, whole-body images were assessed visually on transaxial, sagittal, and coronal images. ROIs were determined from the lesions observed on each slice, and SUVmax values were calculated automatically. The mean values of ADCmin and SUVmax were compared using Spearman’s test. RESULTS:The mean ADCmin was 0.62±0.19×10-3 mm2/s (range, 0.368–1.227×10-3 mm2/s), the mean SUVmax was 20.07±9.3 (range, 4.3–49.5). A significant negative correlation was found between ADCmin and SUVmax (r=-0.347; P = 0.026). CONCLUSION:There was a significant negative correlation between the ADCmin and SUVmax values in rectal adenocarcinomas
Treatment of recto-neovaginal fistula secondary to vaginoplasty in male-to-female reassignment surgery with endorectal mucosal advancement flap: Report of a case
Rektovajinal fistül kadınlarda fiziksel, psikolojik ve sosyolojik olarak en fazla yıkıma neden olan hastalıklardan biridir. Rektovajinal fistülün nedenleri, ülke ve bölgelere göre değişkenlik göstermekle birlikte etyolojisinde sıklıkla obstetrik travmalar, jinekolojik ve kolorektal cerrahi komplikasyonları, kriptoglandüler hastalık ve Crohn hastalığı sayılmaktadır. Erkek transseksüel vajinoplasti operasyonundan sonra ortaya çıkan rektovajinal fistül olgusu cerrahi literatürde nadir gözlenen bir durumdur. Biz burada vajinoplasti operasyonundan 2 yıl sonra ortaya çıkan bir abseyi takiben gelişen rektoneovajinal fistülün endorektal mucosa advancement flap yöntemi ile öpere edilip, 5 yıllık takip sonucunda nüks saptanmayan bir olguyu sunacağız.Rectovaginal fistula is one of the most deteriorating anal pathologies for women that cause physical, psychological and social trauma. Although the reasons for rectovaginal fistula varies to countries and geographic regions, etiology mostly depends obstetric trauma, complication of gynaecological and colorectal surgery, benign anorectal disease and Crohn's disease. Rectovaginal fistula secondary to vaginoplasty in male-to-female reassignment surgery is a rare condition in the literature. A case of repair of rectovaginal fistula secondary to an abscess occurring two years after initial surgery following vaginoplasty procedure with endorectal mucosal advancement flap technique without any recurrence after 5 year's follow-up is presented in this paper
Koloktomi açık ve laparoskopi: İlk sonuçlarımız
Amaç: Laparoskopik cerrahide kullanılan aletlerin çoğunu ithal eden ülkelerde yüksek maliyetler laparoskopinin kolorektal cerrahide kullanımını kısıtlamaktadır. Bu çalışma yeniden kullanılan aletlerle yapılmış laparoskopik kolektomilerin açık teknikle erken dönem sonuçları ve maliyet analizi açısından karşılaştırılmasının yapıldığı olgu-kontrol çalışmasıdır. Yöntem: Kasım 1999 ve Aralık 2001 tarihleri arasında 17 laparoskopik kolon rezeksiyonu uygulandı. Yaş, cins, preoperatif ASA skoru ve lezyonun histopatolojisi açısından uygun, aynı zaman aralığında açık kolon rezeksiyonu geçirmiş hastalardan bir kontrol grubu oluşturuldu. Bu iki grup ameliyat süresi, hastanede kalış süresi, postoperatif komplikasyonlar, çıkarılan dokulardaki lenf nodu sayıları ve maliyet analizi açısından karşılaştırıldı. Bulgular: Ortalama hastanede kalış süresi laparoskopik grupta 7.2 ± 1.5 gün iken açık grupta 10.9 ± 2,6 gündü. Diseke edilen lenf nodu sayıları (11.3 ± 3 / 13.7 ±2.4) ve maliyet analizi (1594.9 ± 500.6 $ / 2304.4 ± 647.7) açısından laparoskopik ve açık gruplarda istatiksel olarak anlamlı farklılık saptanmadı. Sonuç:Sonuç olarak Türkiye’de yeniden kullanılabilen aletlerle laparoskopik kolektomilerin yapılması mevcut fiyatlandırma politikalarıyla güvenli, uygun ve tasarruflu bir yöntemdir.Aim: In countries, which import most of the surgical equipments, high costs further restrict the use of laparoscopy in colorectal surgery. In this study, the short term results and the cost analysis of laparoscopic colectomies in which the re-usable equipment had been used was compared with the open technique, in a case-control study. Methods: Between November 1999 and December 2001, 17 laparoscopic colon resections were performed, each laparoscopic case was matched for age, gender, pre-operative ASA score and the histopathology of the lesion with control patients undergoing the equivalent open procedure in the same period. Operation times, length of hospital stay, post-operative complications, number of lymph nodes in harvested specimens and cost analysis were compared between these two groups. Results: Mean hospitalization period was 7.2+/-1.5 days in the laparoscopy group and 10.9 +/- 2.6 days in the open group. No statistically significant differences were found in regard of dissected lymph node numbers, 11.3+/-3 vs 13.7+/-2.4 and cost analysis, 1594.9+/-500.6 US dollars vs 2304.4+/-674.7 US dollars between the laparoscopic and the open groups. Conclusion: It is concluded, on condition that using the re-usable equipment, it is safe, feasible and cost effective to perform laparoscopic colectomies in Turkey with the current pricing policy
Validation of the Turkish translation of the low anterior resection syndrome (LARS) score
© 2023, Springer Nature Switzerland AG.Background: Long-term bowel dysfunction after resection for rectal cancer, known as low anterior resection syndrome (LARS), is observed in many patients. The LARS score was developed to assess this syndrome and its impact on the quality of life in Danish patients. Recently versions in English and many other languages have been validated. The aim of this study was to validate the Turkish translation of the LARS score in patients who have undergone treatment for rectal cancer. Methods: Rectal cancer patients who underwent low anterior resection in May 2000- May 2018 in three Turkish centers received the LARS score questionnaire, the European Organisation for Research and Treatment Of Cancer Core Quality of Life questionnaire [Ed.11] (EORTC QLQ-C30), and a single ad hoc quality of life question. The test–retest reliability of the LARS score was evaluated by asking a randomly selected subgroup of patients to repeat the assessment of the LARS score 2 to 4 weeks after their initial response. Results: A total of 326 patients were reviewed and contacted for the study, and 222 (68%) were eligible for the analyses (129 males, 93 females, median age 64 years [range:24–87 years, IQR = 14]) There was a strong association between the LARS score and quality of life (p < 0.01) and the test–retest reliability was high. The intraclass correlation coefficient was 0.78 (95% CI 0.73–0.83) for the whole study group and 0.79 (95% CI 0.68–0.87) for the subgroup, indicating strong reliability. Conclusions: The Turkish translation of the LARS score has psychometric properties comparable with previously published results in similar studies. The Turkish version of the LARS score can be considered a valid and reliable tool for measuring LARS in Turkish rectal cancer patients. Clinical trial registration: NCT05289531
Perception of COVID-19 Pandemic Among IBD Clinicians and IBD Surgeons in Black Sea Region: A Cross-Sectional Questionnaire Study
İntra-abdominal infeksiyonlar için öneriler "uzlaşı raporu"
Rehberler, konu ile ilgili farklı uzmanlık alanlarından uzmanların her ülkenin kendi verilerini dikkate alarak hazırladıkları önerileri içerir. Ancak ülkemizde bugüne kadar intra-abdominal infeksiyonlar (İAİ) için ortak dil oluşturmak adına, önerileri kapsayan bir rehber kullanıma sunulmamıştır. Bunun en önemli nedeni klinikte İAİ'ların tanı ve tedavisi ile ilgili veya İAİ tanılı hastalardan elde edilen mikroorganizma duyarlılıklarını değerlendiren laboratuvar çalışmalarının oldukça az sayıda olmasıdır. Oysa günümüzde farklılaşan konak özellikleri ve gelişen teknolojik tedavi yöntemleri nedeniyle "ortak dil kullanmak" zorunluluk haline gelmiştir. Bu amaçla Mayıs 2015'te; Türkiye Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Uzmanlık Derneği (EKMUD)'nin önderliğinde Türk Cerrahi Derneği, Türk Kolon ve Rektum Cerrahisi Derneği, Fıtık Derneği, Türk Hepatopankreatobilier Cerrahi Derneği, Türk Hastane İnfeksiyonları ve Kontrolü Derneği üyelerinden konuya ilgi duyan toplam 15 uzman tarafından yapılan toplantılarda çalışmalar değerlendirildi. Sonuçta, erişkinler için hazırlanan bu uzlaşı raporundaki öneriler, ağırlıklı olarak Amerika İnfeksiyon Hastalıkları [Infectious Diseases Society of America (IDSA)] ve Cerrahi İnfeksiyon Derneği (Surgical Infection Society) tarafından hazırlanan erişkin ve çocuklarda komplike İAİ'ların tanısı ve yönetimi 2010 rehberi olmak üzere, ulaşılabilen rehberlerden yararlanılarak ülkemiz verileriyle hazırlandı. Öneriler; hasta ile ilk karşılaşmadan başlayarak tanısal değerlendirme ve tedavi yaklaşımı olmak üzere iki bölümde oluşturuldu. Hazırlanan uzlaşı raporu ilk kez Antalya'da EKMUD 2016 kongresinde sunuldu. Takiben bir ay süre ile derneklerin sitelerinde önerilere açıldı. Öneriler alındıktan sonra gözden geçirilerek son hali makale olarak yazıldıGuidelines include the recommendations of experts from various specialties within a topic in consideration of data specific to each country. However, to date there has not been a guideline standardizing the nomenclature and offering recommendations for intra-abdominal infections (IAIs) in Turkey. This is mainly due to the paucity of laboratory studies regarding the clinical diagnosis and treatment of IAIs or the sensitivity of microorganisms isolated from patients with IAIs. However, due to the diversification of host characteristics and advancements in technological treatment methods, it has become imperative to 'speak a common language'. For this purpose May 2015, a group of 15 experts in intra-abdominal infections, under the leadership of the Infectious Diseases and Clinical Microbiology Specialty Society of Turkey (EKMUD) and with representatives from the Turkish Surgical Association, Turkish Society of Colon and Rectal Surgery, Hernia Society, Turkish Society of Hepato-pancreato-biliary Surgery, and the Turkish Society of Hospital Infections and Control, was formed to analyze relevant studies in the literature. Ultimately, the suggestions for adults found in this consensus report were developed using available data from Turkey, referring predominantly to the 2010 guidelines for diagnosing and managing complicated IAIs in adults and children by the Infectious Diseases Society of America (IDSA) and the Surgical Infection Society. The recommendations are presented in two sections, from the initial diagnostic evaluation of patients to the treatment approach for IAI. This Consensus Report was presented at the EKMUD 2016 Congress in Antalya and was subsequently opened for suggestions on the official websites of the Infectious Diseases and Clinical Microbiology Specialty Society of Turkey and Turkish Surgical Association for one month. The manuscript was revised according to the feedback receive
Recommendations for Intra-abdominal Infections “Consensus Report”
Guidelines include recommendations of experts from various specialties within a topic in consideration of data specific to each country. However, to date there has not been a guideline standardizing the nomenclature and offering recommendations for intra-abdominal infections (IAIs) in Turkey. This is mainly due to the paucity of laboratory studies regarding the clinical diagnosis and treatment of IAIs or the sensitivity of microorganisms isolated from patients with IAIs. However, due to the diversification of host characteristics and advancements in technological treatment methods, it has become imperative to “speak a common language”. For this purpose, meetings were formed under the leadership of the Infectious Diseases and Clinical Microbiology Specialty Society of Turkey (EKMUD) consisting of 15 experts in IAIs from the Turkish Surgical Association, Turkish Society of Colon, Turkish Hernia Society, Turkish Society of Hepato-Pancreato-Biliary Surgery, and the Turkish Society of Hospital Infections and Control; and relevant studies were analyzed.. Ultimately, the suggestions for adults found in this consensus report were prepared using available data from Turkey, and referring predominantly to the 2010 guidelines for diagnosing and managing complicated IAIs in adults and children by the Infectious Diseases Society of America and the Surgical Infection Society. Recommendations are conducted in two sections from the initial evaluation of patients for diagnosis to treatment approach for IAI. This Consensus Report was presented in Turkey EKMUD 2016 Congress/Antalya and subsequently opened for any suggestions in Turkey EKMUD and Turkish Surgical Association official web sites for a month. The manuscript was updated according to the suggestions
Factors affecting operative morbidity and long-term outcomes in patients undergoing surgery for presacral tumours: a multicentric cohort study from the Turkish Collaborative Group for Quality Improvement in Colorectal and Pelvic Surgery
Aim: Data regarding the operative management of presacral tumours present various dilemmas due to their rarity and heterogeneous nature. The aim of this study was to evaluate the management strategy, factors associated with operative morbidity and long-term postoperative outcomes in a large group of patients undergoing surgery for presacral tumours. Method: This study was designed as a multicentre retrospective cohort study. Records of patients who underwent surgery for presacral tumours at 10 tertiary colorectal centres between 1996 and 2017 were evaluated. Results: One hundred and twenty seven patients (44 men) with a mean age of 46 years and body mass index of 27 kg/m2 were included. Fifty eight per cent of the patients had low sacral lesions (below S3). The operative approaches were transabdominal (17%), transsacral (65%) and abdominosacral (17%). The postoperative morbidity was 19%. Thirty per cent of the patients had a malignant tumour. Longer duration of symptoms (p = 0.001), higher American Society of Anesthesiologists score (p = 0.01), abdominosacral operations (p = 0.0001) and presacral tumours located above S3 (p = 0.004) were associated with an increased risk of postoperative morbidity. Overall long-term postoperative recurrence and mortality were 6% and 5%, respectively, within a 3-year mean follow-up period in patients with presacral malignant tumours. Conclusion: Reduced physical condition, omission of symptoms prior to surgery, combined resections and high sacral tumours are the risk factors associated with postoperative complications in patients undergoing surgery for presacral tumours. Meticulous planning of the operation and intensified perioperative care may improve the outcomes in high-risk patients