Cholesterolosis in routine histopathological examination after cholecystectomy: What should a surgeon behold in the reports?

AbstractIntroduction: Cholecystectomy is one of the most common surgical procedures. Postoperative investigation of cholecystectomy specimen has a great value since histopathological reports may document some entities with significant clinical consequences. The aim of this study was to evaluate the association between cholesterolosis and the reports indicating some histopathological alterations in symptomatic cholecystitis. Methods: This paper is based on a retrospective study. Histopathological reports of 432 cholecystectomy specimens between January 2011 and June 2013 were reviewed. Three reports were excluded due to perioperative diagnosis of cancer. Reports of 429 cholecystectomy specimens of the acute and symptomatic chronic cholecystitis patients were analyzed. Standardization of the reporting was questioned. Age, gender, histopathological wall thickness of gallbladder, reporting rates of acute inflammation, cholesterolosis, polypoid lesions, epithelial hyperplasia, gastric or intestinal metaplasia, dysplasia and incidental cancer were investigated and compared between patients with and without cholesterolosis. Reported rates of histopathological findings were comparable between patients under and over 60 years old and patients with and without reported cholesterolosis. Results: Reported histopathological findings were presented as acute inflammation in 46 (10.7%), cholesterolosis in 79 (18.4%), gallbladder polypoid lesions in 7 (1.6%), epithelial hyperplasia in 16 (3.7%), metaplasia of any type in 34 (7.9%) of 429 patients. Dysplasia was excluded whereas one incidental gallbladder carcinoma was reported. Epithelial hyperplasia and metaplasia were found to be related to age. Gallbladder wall thickness was decreased with cholesterolosis. However, only a correlation between cholesterolosis and gender or metaplasia was noted. Conclusion: Recent study suggests that cholesterolosis is somehow associated with metaplasia. Thus, surgeons should carefully interpret the histopathology reports based on unusual or exceptional findings corresponding to the cholecystectomy specimens. Any abnormal finding in the reports should be investigated in terms of the progress of the pathology and also its clinical consequences

Analiza rezultata dijagnostičke ekscizijske biopsije limfnih čvorova: 12-godišnje iskustvo jednog centra

Lymph node biopsy is indicated in patients with suspected malignancy or lymphadenopathy due to unclarified reasons. Lymph node biopsy can be performed as fine needle aspiration biopsy, core biopsy, or excisional lymph node biopsy. In particular, the diagnosis of malignant lymphoma is considered insufficient for oncological treatment unless classified into subgroups. Core biopsy and excisional biopsy can be performed to diagnose lymphoma and classify it into subgroups. Core biopsy may also be limited in some cases for the diagnosis of lymphoma. Therefore, patients are referred to surgical departments for excisional lymph node biopsy. It was aimed herein to analyze the results of excisional lymph node biopsies performed for diagnostic purposes in our department. Data on 73 patients having undergone diagnostic excisional lymph node biopsy at Sakarya University Medical Faculty Training and Research Hospital between January 2008 and January 2020 were retrospectively analyzed. Patients were evaluated in terms of age, gender, biopsy site, pathological diagnosis, number and diameter of lymph nodes excised. Patients younger than 18 years of age, those with sentinel lymph node biopsies, and lymph node dissections performed for any known malignancy were excluded from the study. Statistical data analysis was done using SPSS statistical software. There were 37 (50.7%) female and 36 (49.3%) male patients, mean age 52.07 (18-90) years. Axillary lymph node biopsy was performed in 32 patients, inguinal lymph node biopsy in 29 patients, cervical lymph node biopsy in 3 patients, intra-abdominal lymph node biopsy in 6 patients, mediastinal lymph node biopsy in 1 patient, and supraclavicular lymph node biopsy in 2 patients. All of the lymph node biopsies were performed as excisional biopsy. Malignancy was detected in 36 (49.3%) patients. In 37 (50.3%) patients, the causes of lymphadenopathy were found to be benign pathologies. When the causes of malignant disease were examined, it was observed that 23 (31.5%) patients were diagnosed with lymphoma. Hodgkin lymphoma was detected in 5 patients diagnosed with lymphoma, and non-Hodgkin lymphoma was found in 18 patients. Metastatic lymphadenopathy was observed in 13 (17.8%) patients. Reactive lymphoid hyperplasia (26%) and lymphadenitis (20.5%) were found among the causes of benign lymphadenopathy. The number of excised lymph nodes was between 1 and 4, and their diameter was between 9 and 75 mm (mean: 29.53±15.56 mm). There was no statistically significant difference between benign and malignant patients according to gender, age, lymph node diameter, number of lymph nodes excised, and excisional lymph node biopsy site. For diagnostic lymph node biopsy, fine-needle aspiration biopsy and core biopsy should be performed primarily. If lymphoma is suspected in the diagnosis, fine-needle aspiration biopsy is not necessary. In this case, it is believed that it is more appropriate to perform core biopsy first. If the core biopsy is insufficient for diagnosis, it is more appropriate to perform surgical biopsy in order to cause no delay in diagnosis and treatment. Excisional biopsy is a method that can be safely performed and does not cause severe morbidity in palpable peripheral lymphadenopathies. Although it does not cause severe morbidity because it is an invasive procedure, excisional biopsy should be performed in a selected patient group.Biopsija limfnih čvorova indicirana je u bolesnika sa sumnjom na zloćudnu bolest ili s limfadenopatijom nejasnog uzroka. Biopsija limfnih čvorova može se izvesti kao tankoiglena aspiracijska biopsija, širokoiglena biopsija ili ekscizijska biopsija limfnih čvorova. Dijagnoza zloćudnog limfoma smatra se naročito nedostatnom za onkološko liječenje ako nije provedena klasifikacija u podskupine. Širokoiglena biopsija i ekscizijska biopsija mogu se provesti kako bi se dijagnosticirao limfom i klasificirao u podskupine. Širokoiglena biopsija može se također u nekim slučajevima pokazati ograničenom u dijagnosticiranju limfoma. Zato se bolesnici upućuju u kirurške odjele na ekscizijsku biopsiju limfnih čvorova. Cilj ovoga istraživanja bio je analizirati rezultate ekscizijskih biopsija limfnih čvorova izvedenih u dijagnostičke svrhe na našem odjelu. Retrospektivno su analizirani podaci za 73 bolesnika podvrgnutih dijagnostičkoj ekscizijskoj biopsiji limfnih čvorova u Sveučilišnoj bolnici Sakarya između siječnja 2008. i siječnja 2020. godine. Analizirani su sljedeći podaci: dob, spol, mjesto gdje je izvedena biopsija, patološka dijagnoza, broj i promjer ekscidiranih limfnih čvorova. Iz istraživanja su bili isključeni bolesnici mlađi od 18 godina, oni s biopsijom sentinel limfnih čvorova te oni s disekcijom limfnih čvorova zbog bilo kakve poznate zloćudne bolesti. Statistička analiza podataka provedena je pomoću statističkog programa SPSS. Bilo je 37 (50,7%) ženskih i 36 (49,3%) muških bolesnika srednje dobi od 52,07 (18-90) godina. Biopsija aksilarnih limfnih čvorova izvedena je u 32, ingvinalnih limfnih čvorova u 29, cervikalnih limfnih čvorova u 3, intra-abdominalnih limfnih čvorova u 6 bolesnika, mediastinalnih limfnih čvorova u 1 bolesnika i supraklavikularnih limfnih čvorova u 2 bolesnika. Sve biopsije limfnih čvorova izvedene su kao ekscizijske biopsije. Malignitet je otkriven u 36 (49,3%) bolesnika, dok su u 37 (50,3%) bolesnika uzroci limfadenopatije bile dobroćudne patologije. Ispitivanje uzroka zloćudne bolesti pokazalo je da je limfom bio dijagnosticiran u 23 (31,5%) bolesnika. Hodgkinov limfom otkriven je u 5 bolesnika u kojih je dijagnosticiran limfom, dok je ne-Hodgkinov limfom utvrđen u 18 bolesnika. Metastatska limfadenopatija zabilježena je u 13 (17,8%) bolesnika. Među uzrocima dobroćudne limfadenopatije nađeni su reaktivna limfoidna hiperplazija (26%) i limfadenitis (20,5%). Broj izvađenih limfnih čvorova bio je od 1 do 4, a njihov promjer bio je od 9 do 75 (srednja vrijednost 29,53±15,56) mm. Nije bilo statistički značajne razlike između bolesnika s dobroćudnom i zloćudnom limfadenopatijom u dobi, spolu, promjeru limfnih čvorova, broju izvađenih limfnih čvorova i mjesta izvođenja ekscizijske biopsije limfnih čvorova. Za dijagnostičku biopsiju limfnih čvorova treba najprije napraviti tankoiglenu aspiracijsku biopsiju i širokoiglenu biopsiju. Ako se dijagnostički posumnja na limfom tada tankoiglena aspiracijska biopsija nije potrebna. U tom slučaju smatra se da je primjerenije najprije napraviti širokoiglenu biopsiju. Ako se širokoiglena biopsija pokaže nedostanom za postavljanje dijagnoze tada je primjerenije napraviti kiruršku biopsiju kako ne bi došlo do kašnjenja u dijagnozi i liječenju. Ekscizijska biopsija je metoda koja se može sigurno izvoditi i ne uzrokuje teži pobol kod palpabilnih perifernih limfadenopatija. Iako ne uzrokuje teži pobol s obzirom na to da je invazivni postupak, ekscizijsku biopsiju treba izvoditi u odabranoj skupini bolesnika

Massive inguinoscrotal bladder hernia causing hydronephrosis: Two cases

• Complete bladder herniation are very rare compared to incomplete bladder herniation. • Massive scrotal cystocele is usually defined with voiding symptoms. • CT, ultrasonography and retrograde cystogram should be performed to determine the involvement of the bladder in cases of massive inguinoscrotal hernias. • In massive scrotal hernia cases, bladder can protrude with the ureter causing hydronephrosis on the affected side. • It is necessary to place urinary catheter to empty the urinary bladder to manage the pain and to decrease the risk of injury of bladder during the surgery

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Relationship Between the Neutrophil to Lymphocyte Ratio and Parathyroid Adenoma Size in Patients With Primary Hyperparathyroidism

The aim of our study was to evaluate the relationship between neutrophil to lymphocyte ratio (NLR) and adenoma size in parathyroidectomized patients who underwent a parathyroidectomy. The neutrophil to lymphocyte ratio has recently become popular as a biomarker for malignant diseases or for estimating tumor size preoperatively. This study aimed to estimate the relationship between adenoma size and NLR. Furthermore, we assessed whether a higher level of NLR is correlated with the presence of parathyroid carcinoma. A retrospective chart review was performed for patients with parathyroid adenoma who underwent parathyroidectomy between January 2012 and August 2014. Data related to age, sex, NLR, parathyroid hormone level (PTH), preoperative calcium, phosphorus, adenoma size, and pathology reports were collected. The neutrophil to lymphocyte ratio was significantly correlated with calcium levels, PTH levels, parathyroid adenoma size, and the presence of cancer. However, there was no correlation between NLR and age, sex, and phosphorus levels. This study is the first to document a positive correlation between NLR and parathyroid adenoma size, as well as the presence of cancer, in patients who underwent surgery as a result of primary hyperparathyroidism

Crystallized phenol application and modified Limberg flap procedure in treatment of pilonidal sinus disease: A comparative retrospective study

Pilonidal sinus treatment includes various surgical and minimally invasive procedures, but there is still no standard treatment. Flap reconstructions and minimally invasive treatment options such as crystallized phenol application have recently been in the center of interest. The aim of this study is to compare crystallized phenol application as a minimally invasive treatment with modified Limberg flap reconstruction from many aspects. Thirty-seven patients diagnosed with pilonidal sinus and treated with modified Limberg flap reconstruction, and 44 patients treated with crystallized phenol application were evaluated retrospectively in terms of age, sex, length of stay in hospital postoperatively, wound complications, and the cause and rate of recurrence. Length of hospital stay was decreased and no postoperative incision problems were found in the group treated with crystallized phenol application (p 24.9 kg/m2) and surgical site infection were strongly correlated with recurrence rate (p < 0.001). Crystallized phenol application is a good alternative to the modified Limberg flap procedure and other surgical procedures, because it has several advantages such as being a minimally invasive procedure performed under local anesthesia with higher success rate after multiple applications, decreased length of stay in hospital, and minimal scar tissue formation

Foreign bodies in the rectum: 2 Case reports

Encountering a foreign object in the rectum is rare; however, the incidence has greatly increased in recent years. Treatment of these patients requires a multidisciplinary approach because this condition may have serious complications. Presently described is management of 2 cases of rectal foreign body treated in the clinic