The Diagnostic Value of Brush Cytology Alone and in Combination with Tumor Markers in Pancreaticobiliary Strictures

Aim. Differentiation of malignant and benign strictures constitutes a problem despite the increasing experience of the endoscopists, radiologists, and pathologists. The aim of our study is to determine the factors that affect the efficacy of the ERCP guided brush cytology in PBS and to evaluate its diagnostic success when used alone and together with tumor markers. Method. The data from brush cytologies of 301 PBS patients were collected retrospectively and analyzed. The final diagnosis was approved based on the histological examination of the tissue taken surgically or by other methods. In the absence of a histological diagnosis, the final diagnosis was based on radiological studies or the results of a 12-month clinical follow up. Results. A total of 28 patients were excluded from the study. From the remaining 273 patients 299 samples were analyzed. The sensitivity and the specificity of brush cytology in diagnosing malignancy are 62.4% and 97.7, respectively. The sensitivity of brush cytology increased to 94.1% when combined with CA-19.9 and CA-125. Conclusion. Brush cytology is a useful method in diagnosing pancreaticobiliary strictures. Advanced age, stricture dilatation before sampling, the presence of a mass identified by radiological studies, high levels of CA-19.9, ALT, and total bilirubin increase the sensitivity of brush cytology

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Diagnostic value of a urine strip test in spontaneous ascites infections

Sirozlu hastalarda, spontan asit enfeksiyonlarının hızlı ve doğru tanısı zamanında tedavi için zorunlu ve hayat kurtarıcıdır. Bu çalışmanın amacı spontan asit enfeksiyonunun hızlı, yatak başı tanısının konmasında idrar ayıraç şeritlerinin kullanışlılığını ve tanı değerini araştırmaktır. Çalışmaya nisan 2005 ile temmuz 2006 tarihleri arasında toplam 63 ardışık sirotik hasta (38 bay, 25 bayan) dahil edildi. Tüm asit sıvıları idrar stripi ile değerlendirildi ve asit sıvısı hücre kültürü ve hücre sayımı ile karsılaştırıldı. Asit enfeksiyonu, asit sıvısında nötrofil sayısının ≥ 250/mm3 olması olarak tanımlandı. Spontan asit enfeksiyonu 63 örneğin 15’inde tespit edildi. Eğer strip pozitifliği lökosit esteraz 2+ ve üstü kabul edilirse yöntemin sensitivitesi, spesifitesi, Pozitif prediktif değeri ve Negatif prediktif değeri sırasıyla % 93, %100, %100 ve %98 idi, nitrit için ise sensitivite, spesifite, Pozitif prediktif değer ve Negatif prediktif değeri sırasıyla %13, %93, %40, %77 idi. Nitrit ve lökosit esteraz pozitifliğinin birlikte değerlendirilmesinin ek tanısal faydası saptanmadı. Sonuç olarak asitli sirotik hastalarda spontan asit enfeksiyonun hızlı ve doğru tanısı için idrar stripleri faydalı olabilir. Test her yerde hasta yatağı başucunda uygulanabilir ve sonuçlar hızlı ve ucuz şekilde elde edilebilir. Ayrıca ayaktan büyük volümlü parasentez yapılan hastaların taranmasında da kullanışlı olabilir.Rapid and accurate diagnosis of spontaneous ascites infection (SAI) is mandatory for timely treatment and life savior in cirrhotic patients. The purpose of this study was to investigate the usefulness of urine strips, for the rapid bedside diagnosis of spontaneous ascites infections. Between April 2005 and June 2006, 63 consecutive cirrhotic patients (38 male, 25 female) with ascites were included in our study. All ascitic fluid was analyzed with the urine strips, and compared with the cell count with differential and ascitic fluid culture. Ascites infections was defined as an ascitic polymorphonuclear cell count ≥ 250/mm3. Spontaneus ascites infection was diagnosed in 15 of the 63 samples. If we considered the positive Leucocyte esterase result of 2 or more, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were respectively %93, %100, %100, %98. For nitrit, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were respectively, %13, %93, %40, %77. To realize the value of nitrite and leucocyte esterase together, is not fixed addition benefit diagnosis. In conclusion, urine strip test might be useful for rapid and accurate diagnosis of spontaneus ascites infection in cirrhotic patients with ascites. It can be used everywhere at the patient’s bedside and is rapid, and inexpensive. In addition may be useful as a screening test in patients on large-volume paracentesis

The Relationship Between Acute Pancreatitis Severity of Platelet Lymphocyte Ratio, Neutrophil Lymphocyte Ratio, Erythrocyte Distribution Width and Mean Platelet Volume

WOS: 000464326000004Amaç: Bu çalışmada sistemik inflamasyon ile ilişkili bir marker olduğu gösterilen; Nötrofillenfosit oranı (NLR), platelet-lenfosit oranı (PLR), ortalama trombosit hacmi (MPV) ve Eritrosit dağılım hacmi (RDW) ile akut pankreatitin (AP) başvuru anındaki ciddiyetini gösteren Ranson kriteri ile aralarındaki ilişkinin gösterilmesi amaçlanmıştır. Gereç ve Yöntem: Ocak 2017 ile Kasım 2018 tarihleri arasında AP tanısı ile takip eden hastaların verilerine retrospektif olarak ulaşıldı. 82 biliyer ve 15 nonbiliyer olmak üzere toplam 139 hasta çalışmaya alındı. Hastaların ilk başvuru anında bakılan hemogram ve biyokimyasal parametreleri, yaşları, cinsiyetleri, ko-morbiditeleri ve yatış süreleri kaydedildi. İlk başvuru anında bakılan Ranson Kriterlerine göre skoru < 3 ve skoru ≥ 3 pozitif olanlar olmak üzere 2 gruba ayrıldı ve bu gruplar karşılaştırıldı. Bulgular: AP tanısı ile takip edilen 139 hastanın 75 (%54)’i erkek, 64 (%46)’ü kadındı. Hastaların 113’ü Ranson kriterlerine göre 3’ün altında 26’sı ise 3 ve üzerindeydi. Ortalama yaş hafif AP grubunda 61±20 yıl, şiddetli AP grubunda ise 70±13 yıldı. MPV (P< 0.001) ve NLR (P< 0.001) değerleri gruplar arasında anlamlı olarak farklı saptandı. Korelasyon analizinde; NLR ile ranson skoru arasında pozitif korelasyon saptandı (r= 0,253 p<0,01). Yapılan Lineer Regresyon analizi sonucunda, NLR ve PLR’nin AP şiddetini göstermede bağımsız prediktör oldukları bulundu. Sonuç: Sistemik inflamasyonu gösteren çalıştığımız parametrelerden NLR, AP’nin şiddetini belirlemede basit ve güvenilir bir gösterge olarak kullanılabilir.Objective: In this study we have shown that there is a marker associated with systemic inflammation; The aim of this study was to determine the relationship between neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), mean platelet volume (MPV) and Erythrocyte distribution volume (RDW) and Ranson Criteria showing the severity of acute pancreatitis (AP) at the time of presentation. Methods: The data of the patients who were diagnosed with AP between January 2017 and November 2018 were retrospectively obtained. A total of 139 patients (82 biliary and 15 nonbiliary) were included in the study. Hemogram and biochemical parameters, age, gender, co-morbidities and duration of hospitalization were recorded. According to the Ranson Criteria used at the time of admission score = 3 positive and these groups were compared. Results: Of the 139 patients diagnosed with AP, 75 (54%) were male and 64 (46%) were female. 113 of the patients were divided into two groups according to the Ranson criteria. The mean age was 61 +/- 20 years in the mild AP group and 70 +/- 13 years in the severe AP group. MPV (P <0.001), NLR (P <0.001) values were significantly different between the groups. In the correlation analysis; there was a positive correlation between NLR and ranson score (r = 0.253 p <0.01). Linear regression analysis showed that, NLR and PLR were independent predictors of acute pancreatitis. Conclusion: NLR can be used as a simple and reliable indicator in determining the severity of AP

Gastric squamous cell carcinoma: A case report [Gastrik skuamöz hücreli karsinom: Olgu sunumu]

Gastric squamous cell carcinoma is rarely seen and affects mostly elder patients. A 78-year-old woman presented with nausea, vomiting, weight loss, and epigastric pain. There was an ulcero-vegetative mass in the posterior area from the large curvature to the antrum in the endoscopic examination. The gastroesophageal junction and cardia were also normal. We performed a diagnostic endoscopic biopsy. Histopathologically, it was composed of atypical squamous cells displaying infiltrating solid nests in a desmoplastic stroma. Immunohistochemically, the neoplastic cells also showed positivity for p40 and p63 and negativity for CEA. Besides, there was no radiological evidence of metastasis from other organs. We herein presented a case of gastric squamous cell carcinoma and discussed its clinical and morphological features with the literature. © 2019, Duzce University Medical School. All rights reserved

Choledocholithiasis without Cholecystolithiasis, After Endoscopic Retrograde Cholangiopancreatography Follow-Up without Cholecystectomy

Objective: The widespread use of imaging methods increases the diagnosis and incidence of cholelithiasis. In recent years, management of patients with cholelithiasishas improved significantly owing to significant advances in surgical and endoscopic intervention.Methods: Between February 2015 and January 2018, the data of patients who underwent ERCP at our institution were collected prospectively and analyzed retrospectively. Forty-four patients included in the study were patients with choledocholithiasis without stones in the GB.Results: The mean age of 52 subjects (group A) included in the study was 64.83 ± 17.06, of which 23 (44.2%) were <65 years old and 29 (55.8%) were ?65 years old. Twenty-four (46.2%) women and twenty-eight (53.8%) men were included in the study. Malignancy was suspected in 6 (11.5%) patients and no suspicion of malignancy was confirmed after Endoscopic Retrograde Cholangio-Pancreatography (ERCP) procedure. In group A, 14 patients (26.9%) required a second ERCP, while in group B, the number of patients requiring a second ERCP was 163 (21.3%). The mean length of hospital stay in group A and group B patients was 5.29 ± 3.38 and 6.29 ± 5.39, respectively, and the average cost was 474 $± 286$ and 564 $± 664$, respectively, with no statistical difference between the groups.Conclusions: In conclusion, we think that in patients with secondary or primary choledochal stones without gallstones and with functional GB might be following up without cholecystectomy after the stone is removed from the bile duct by ERCP.Amaç: Görüntüleme yöntemlerinin yaygın kullanımı kolelitiyazis tanı ve insidansını artırmaktadır. Son yıllarda, kolelitiazisli hastaların tedavisi, cerrahi ve endoskopik müdahaledeki gelişmeler nedeniyle önemli ölçüde iyileşmiştir. Gereç ve Yöntem: Şubat 2015 - Ocak 2018 tarihleri arasında kurumumuzda ERCP uygulanan hastaların verileri prospektif olarak toplandı ve geriye dönük olarak analiz edildi. Çalışmaya dahil edilen kırk dört hasta, Safra kese'de (SK) taşsız koledokolitiazis hastalarıdır. Bulgular: Çalışmaya dahil edilen 52 kişinin (grup A) ortalama yaşı 64,83 ± 17,06 idi, bunların 23'ü (% 44,2) <65 yaşında ve 29'u (% 55,8) ?65 yaşında idi. Çalışmaya 24 (% 46,2) kadın ve yirmi sekiz (% 53,8) erkek dahil edildi. 6 (% 11,5) hastada malignite şüphesi vardı ve Endoskopik Retrograd Kolanjiyo-Pankreatografi (ERCP) prosedürü sonrasında malignite şüphesi doğrulanmadı. Grup A'da 14 hasta (% 26,9) ikinci bir ERCP'ye ihtiyaç duyarken, grup B'de ikinci bir ERCP gerektiren hasta sayısı 163 (% 21,3) idi. Grup A ve grup B hastalarında ortalama hastanede kalış süresi sırasıyla 5,29 ± 3,38 ve 6,29 ± 5,39, ortalama maliyet sırasıyla 474 $± 286$ ve 564 $± 664$ idi ve gruplar arasında istatistiksel fark yoktu. Sonuç: Sonuç olarak, safra taşı olmayan sekonder veya birincil koledok taşı olan hastalarda fonksiyonel SK olan hastalarda taş ERCP ile safra kanalından çıkarıldıktan sonra kolesistektomi yapılmadan takip edilebileceğini düşünüyoruz.WOS:00062876870001

Efficacy and safety of endoscopic retrograde cholangiopancreatography in the very elderly by using a combination of intravenous midazolam, ketamine and pethidine

Aim The number of therapeutic endoscopic procedures in elderly individuals keeps increasing and this population has a high risk of adverse events related to sedation and general anesthesia. However, there is a paucity on data about the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in this population. Methods In total, 417 consecutive ERCP procedures were performed in 362 patients between September 2018 and January 2020. Of these, 59 patients (74 sessions) were aged >= 80 years (Group A) and 173 patients (193 procedures) were aged <= 65 years (Group B). We analyzed the prospectively collected data of patient- and procedure-related variables. Results The procedure time was significantly longer in Group A (P < 0.05). The prevalence of comorbidities, use of anticoagulants and American Society of Anesthesiologists (ASA) physical status classification levels were significantly higher in Group A (P < 0.05). The incidence of periampullary diverticula, malignancy, rate of difficult cannulation, mean number of stones, use of biliary stents and stent dysfunction was also significantly higher in Group A (P < 0.05). The medication doses used were significantly higher and emergence symptoms were significantly more frequent in Group B (P < 0.05). The rates of bleeding, pancreatitis, perforation, cholangitis, hypoxia, hypotension and the length of hospital stay did not significantly differ between the two groups. The overall success rate of the procedure was comparable in the two groups (P = 0.874). Conclusions ERCP can be safely performed in elderly patients using a combination of midazolam and ketamine without propofol. The incidence of complications is comparable with that observed in younger patients. Geriatr Gerontol Int center dot center dot; center dot center dot: center dot center dot-center dot center dot Geriatr Gerontol Int 2021; center dot center dot: center dot center dot-center dot center dot.WOS:0006873533000012-s2.0-85113207943PubMed: 3442703