Evaluation of risk factors associated with pancreatic adenocarcinoma in Black Sea region, Turkey

Aim: To evaluate the risk factors in patients with pancreatic adenocarcinoma in Turkey's Black Sea region and to determine groups at high risk for pancreatic cancer. Methods: 106 newly diagnosed pancreatic adenocarcinoma patients living in Black Sea region of Turkey who applied to our clinic between January 2015 and December 2016 were included in this study. In the same period a control group was formed with 92 patients of similar age. Both groups were asked to fill out a form that questioned the pancreatic cancer risk factors. Data were analyzed. Results: Pancreatic cancer risk was 3.5 times higher in people over 65 years of age. Patients with deficient level of serum vitamin D level (<20 ng/ml) had 10.2 times more risk of pancreatic cancer than patients with normal level of Vitamin D (≥30 ng/ml). While newly diagnosed type 2 diabetics had 19.5 times higher risk of pancreatic cancer, long term type 2 diabetics had 1.2 times higher risk than normal individuals. Those with pancreatic cancer in family had 4.3 times higher risk than those who did not. It was observed that people with rhesus (Rh) antigen negative blood group has 70% less risk of pancreatic cancer. Conclusion: Determination of pancreatic cancer risk factors, organization of imaging and screening programs for high-risk people can provide early diagnosis of the disease and prolong survival

Fournier's gangrene: etiology, treatment outcomes and factors affecting mortality in 38 patients

Aim: Fournier's gangrene (FG) is a rare, rapidly progressing and life-threatening disease of the genital, perianal and perineal regions. We aimed to evaluate etiological parameters, accompanying diseases, current treatment methods and factors affecting mortality in patients with FG. Method: The medical records of 38 patients who were operated by the same team with a diagnosis of FG from December 2015 to January 2021 were retrospectively reviewed. Those patients were divided into two groups: survivors (Group 1), and non-survivors (Group 2). Comparisons were made regarding clinical and demographic features; comorbid diseases; leukocyte count at first presentation; etiological factors; treatment outcomes; and mortality rates. Results: Thirty-eight patients (24 males, 14 females) were evaluated; mean age was 60.2 ± 13.2 years. While 76.3% (n = 29) of these patients recovered with treatment, the total mortality rate was 23.7% (n = 9). The most common cause of the FG and comorbidity were anorectal diseases (n = 22; 57.9%) and type 2 diabetes mellitus (n = 21; 55.3%), respectively. Female gender, septic shock, necrosis, abdominal wall and lumbar region involvement, chronic renal failure, FG development secondary to postoperative complications and ostomy rates were higher in non-survivors. There were no significant differences between the two groups regarding leukocyte count at first presentation, number of debridement, dressing methods, reconstruction methods, and length of hospital stay. Conclusions: Female gender, presence of septic shock and necrosis on physical examination, involvement of the abdominal wall and lumbar region in addition to the perianal region, chronic renal failure, disease secondary to postoperative complications and the necessity of ostomy play an important role in mortality

Thyroid fine needle aspiration reporting rates and outcomes before and after Bethesda implementation: A single-center experience over 8 years

Aimː To evaluate data from our hospital system before and after the implementation of the Bethesda System for Reporting Thyroid Cytology (TBSRTC) and comparison of our data with the previously published studies. Methods: Seven hundred seventy-one patients with thyroid nodules who underwent fine needle aspiration biopsy (FNAB) and surgery at our institution were analyzed retrospectively. FNAB results were divided into two parts in terms of the period they related to: pre-TBSRTC (between 2005 and 2010) and TBSRTC (between 2011 and 2013). Results: 341 FNAB were applied in the period of TBSRTC. Of the 341 FNAB, 53(16%) were non diagnostic, 82(24%) were benign, 62(18%) were atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 28(8%) were follicular neoplasms and/or suspicion of follicular neoplasms (FN/SFN), 95(28%) were suspicion for malignancy (SuspM), and 21(6%) were malignant. Rates of malignancy reported on follow-up histopathological examination were non diagnostic in 11%, benign in 4.9%, AUS/FLUS in 23%, FN/SFN in 32%, SuspM in 44%, and malignant in 95.3%. Conclusions: In this study, the distribution of cases in TBSRTC categories and malignancy rates, differed from, recommended by TBSRTC and some studies. Implementation of TBSRTC did significantly affect our institution’s reporting rates

The value of inflammatory indexes in colorectal cancers

In recent years, a relationship has been established between inflammatory indexes and the prognosis of many cancers. Although there are many studies investigating their relationship with colorectal cancers (CRC), there is a serious difference between the results in the related literature. The present study aimed to share our own experience with inflammatory indexes in CRC patients. Patients with a diagnosis of CRC who underwent surgery between January 2019 and June 2022 were retrospectively scanned. Exclusion criteria were as follows; being in a septic state before surgery, accompanying hematological disease, receiving neoadjuvant chemotherapy/radiotherapy, being diagnosed with recurrent CRC, undergoing emergency surgery, receiving immunosuppressive or anti-inflammatory treatment. Therefore, the study was conducted with 52 patients. Demographic information, tumor localization, stages and pathology data of the patients were examined. The relationship between these variables and the systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) was investigated. A significant correlation was found between pathological T stages and SII (p=0.008), NLR (p [Med-Science 2023; 12(2.000): 453-07

A First Report of Synchronous Intracapsular and Extracapsular Hepatic Adenoma

Although the gallbladder is the most common site of ectopic liver, it has been reported in many other organs, such as kidney, adrenal glands, pancreas, omentum, stomach, esophagus, mediastinum, lungs, and heart. Hepatocytes in an ectopic liver behave like normal hepatocytes; furthermore, they can be associated with the same pathological findings as those in the main liver. Ectopic liver in the gallbladder can undergo fatty change, hemosiderosis, cholestasis, cirrhosis, hemangioma, focal nodular hyperplasia, adenoma, and even carcinogenesis. The incidence of extracapsular hepatic adenoma is not known, but only two cases have been reported. Here, we provide the first case report of synchronous multiple intracapsular and extracapsular hepatic adenomas. A 60-year-old woman with multiple hepatic adenomas and one 7 × 5 × 5 cm ectopic hepatic adenoma attached to the gallbladder fundus complicated with abdominal pain is presented

A Pancreatic Fistula after the Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) is a popular surgical weight-loss procedure in the treatment of morbid obesity. There are some complications regarding this procedure in the literature. This report presents a pancreatic fistula (PF) case, which has not been previously seen

Factors affecting the conversion to open - surgery during laparoscopic cholecystectomy in patients with cholelithiasis undergoing ERCP due to choledocholithiasis

PubMed: 28874623BACKGROUND: The rate of conversion to open surgery is high in laparoscopic cholecystectomy (LC) after Endoscopic Retrograde Cholangiopancreotocography (ERCP). The present study aimed to evaluate the risk factors associated with the conversion to open cholecystectomy and minimize the rate of conversion to open surgery. METHODS: A total of 157 patients admitted to the Ondokuz Mayis University Medical Faculty Hospital due to cholelithiasis and choledocholithiasis between January 2002 and December 2012, and they receiving laparoscopic cholecystectomy were included in the study. The patients were analyzed retrospectively. The predictive factors for conversion to open cholecystectomy were evaluated. Patients were compared to each other in terms of time passing from ERCP to operation, number of ERCPs, stent usage, stone extraction and complications that occurred while waiting for the operation. Patients were separated into three groups according to the time passing from ERCP to laparoscopic cholecystectomy, as follows; group I (short time intervals: 7 days or less): 53 patients, group II (intermediate time intervals: 8-42 days): 70 patients and group III (long time intervals: 43 days and more): 34 patients. RESULTS: Of the 157 patients, 57 were male and 100 were female. The mean age was 54.5 (range: 19-87) years. Of these 157 patients who received laparoscopic cholecystectomy following ERCP, 22 (14%) underwent open surgery. The conversion to open cholecystectomy was distributed in groups, as follows: seven (13.2%) patients in group I, eight (11.4%) patients in group II and seven (20.6%) patients in group III. When the rate of conversion to open surgery was compared between groups, there was no statistically significant difference (p=0.406). The laparoscopic operations were converted to open surgery in 15 (11.3%) of the 133 patients who underwent single ERCP, and in seven (29.2%) of the 24 patients who underwent two or more ERCPs before surgery (p=0.048). The number of ERCPs was determined to be the most important factor that affects the conversion to open surgery in laparoscopic cholecystectomies following ERCP. The removal of stones from the common bile duct, stent placement in the common bile duct, and existence of biliary complications during waiting time from ERCP to LC had no effect on the conversion to open surgery (p=0.454, p=0.058, and p=0.465, respectively). CONCLUSIONS: The results of this study reveal that the timing of LC following ERCP, removal of stones from the common bile duct, stent placement in the common bile duct and the existence of biliary complications during the waiting period have no effect on the rate of conversion to open surgery. The number of ERCPs is the only factor that affects the conversion to open surgery in LC following ERCP

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care