Effectiveness of laser hemorrhoidoplasty in the treatment of hemorrhoidal disease.

INTRODUCTION: Minimally invasive techniques still continue to maintain their popularity in hemorrhoidal disease. In this study, we aimed to present the symptomatic recovery and recurrence rates, post-operative pain levels, and complication rates of patients treated with the laser hemorrhoidoplasty (LHP) method in our clinic. METHODS: The data of patients who underwent LHP due to Grades 2, 3, and 4 internal hemorrhoidal disease in our clinic were reviewed retrospectively. The patients enrolled in the study were followed for at least 6 months (6 months, 1 year, and 2 years) and their results were analyzed. RESULTS: A total of 103 patients were included in the study. Seventy-five (72.8%) of them were male and the mean age was 41.6 ± 13.6 years. The mean operation time was 17.9 ± 5.2 min and minor complications developed in 3 (2.9%) patients postoperatively. Mean time to return to normal daily life was 2.17 (1-11) days. Recurrence developed in 16 (17.6%) patients with Grades 2 and 3 disease and in 6 (50%) of 12 patients with Grade 4 disease (p = 0.019). CONCLUSION: LHP is a popular procedure which is effective in selected patient groups with acceptable recurrence rates.

OBJETIVO: Presentar las tasas de recurrencia y recuperación sintomática, los niveles de dolor posoperatorio y las tasas de complicaciones de los pacientes tratados con hemorroidoplastia láser en nuestra clínica. MÉTODO: Los datos de los pacientes que se sometieron a hemorroidoplastia láser debido a enfermedad hemorroidal interna de grados 2, 3 y 4 en nuestra clínica se revisaron retrospectivamente. Los pacientes incluidos en el estudio fueron seguidos durante al menos 6 meses (6 meses, 1 año y 2 años) y se analizaron sus desenlaces. RESULTADOS: Se incluyeron en el estudio 103 pacientes, de los cuales 75 (72.8%) eran de sexo masculino. La edad media fue de 41.6 ± 13.6 años. El tiempo operatorio medio fue de 17.9 ± 5.2 minutos. Se desarrollaron complicaciones menores en 3 (2.9%) pacientes en el posoperatorio. El tiempo medio de reincorporación a la vida diaria normal fue de 2.17 (1-11) días. La recurrencia se observó en 16 (17.6 %) pacientes con enfermedad de grados 2 y 3, y en 6 (50%) de 12 pacientes con enfermedad de grado 4 (p = 0.019). CONCLUSIONES: La hemorroidoplastia láser es un procedimiento popular que es efectivo en grupos de pacientes seleccionados, con tasas de recurrencia aceptables.

Does the Thymus Index Predict COVID-19 Severity?

BACKGROUND: The COVID-19 (coronavirus disease 2019) pandemic is a global health emergency that is straining health care resources. Identifying patients likely to experience severe illness would allow more targeted use of resources. This study aimed to investigate the association between the thymus index (TI) on thorax computed tomography (CT) and prognosis in patients with COVID-19. METHODS: A multicenter, cross-sectional, retrospective study was conducted between March 17 and June 30, 2020, in patients with confirmed COVID-19. The patients' clinical history and laboratory data were collected after receiving a signed consent form. Four experienced radiologists who were blinded to each other and patient data performed image evaluation. The appearance of the thymus was assessed in each patient using 2 published systems, including the TI and thymic morphology. Exclusion criteria were lack of initial diagnostic thoracic CT, previous sternotomy, pregnancy, and inappropriate images for thymic evaluation. A total of 2588 patients with confirmed COVID-19 and 1231 of these with appropriate thoracic CT imaging were included. Multivariable analysis was performed to predict the risk of severe disease and mortality. RESULTS: The median age was 45 (interquartile range, 33-58) years; 52.2% were male. Two hundred forty-nine (20.2%) patients had severe disease, and 60 (4.9%) patients died. Thymus index was significantly associated with mortality and severe disease (odds ratios, 0.289 [95% confidence interval, 0.141-0.588; P = 0.001]; and 0.266 [95% confidence interval, 0.075-0.932; P = 0.038]), respectively. Perithymic lymphadenopathy on CT imaging had a significantly strong association with grades of TI in patients with severe disease and death ( V = 0.413 P = 0.017; and V = 0.261 P = 0.002, respectively). A morphologically assessable thymus increased the probability of survival by 17-fold and the absence of severe disease by 12-fold. CONCLUSION: Assessment of the thymus in patients with COVID-19 may provide useful prognostic data for both disease severity and mortality.

Prognostic Nutritional Index in Short-term Postoperative Outcomes in Hepaticojejunostomy.

OBJECTIVE: To investigate the utility of prognostic nutritional index (PNI) on short-term complications, biliary fistula, mortality, and morbidity in patients undergoing hepaticojejunostomy (HJ) procedure. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Tepecik Training and Research Hospital, Izmir, Turkey, between January 2018 and January 2020. METHODOLOGY: Patients who underwent elective HJ for benign and malignant reasons were scanned retrospectively using the hospital digital record system. Many data such as chronic diseases and PNI values of patients, postoperative 30-day mortality and morbidity, days of hospital stay (HS), postoperative complications, and data of surgery were analyzed. RESULTS: A total of 81 patients, of whom 42 (52%) were males and 39 (48%) were females, were included in the study. The mean age of the patients was 65.8 ±11.3. In 53 patients (65.4%), surgeries were performed due to malignancy. In 19 (23.4%) patients, grade 3 and 4 complications according to Clavien-Dindo Classification were observed in 12 patients (14.8%), and postoperative 30-day mortality was observed. The rate of grade 3 and 4 complications increased in patients with a PNI below 45, it was not statistically significant (p=0.165). The mortality rate was 4.5% in patients with PNI>45, and 18.6% in patients with PNI<45 but this difference was not significant (p=0.165). The mean HS was significantly shorter in patients with PNI>45 (p=0.02). CONCLUSION: At PNI>45, many complications and hospital stay become markedly shorter. Large multi-centre randomised future studies are required to confirm these findings. KEY WORDS: Prognostic nutritional index, Hepatic duct, Biliary tract, Biliary fistula.

National study on use of artificial intelligence in breast disease and cancer.

BACKGROUND: The aim of this study was to examine the thoughts, reservations, approaches and perspectives on the future of artificial intelligence (AI) held by physicians specializing in breast healthcare in our country. METHODS: Our survey was sent to the members of the Federation of Turkish Breast Disease Associations (MHDF) by e-mail. The survey investigates the attitudes towards the use of AI in breast disease and cancer, including demographic characteristics of the participants, their daily practice and approaches, and their stance on the future. RESULTS: The questionnaire was sent to a total of 1,890 people via e-mail. 108 (40.1 %) participants believed that the use of AI in breast disease would improve their field of expertise moderately, 103 (38.3 %) expected this improvement to be considerable. 169 (70.3 %) respondents identified 'rapid diagnosis' as the most important advantage of AI. 123 (45.7 %) participants considered concerns about potential medical errors and liability issues to be the most worrying aspects of AI. CONCLUSION: According to our study, the use of AI technology in the diagnosis and treatment of breast disease and cancer seems to be beneficial for both physicians and patients. However, physicians have some concerns about possible medical errors and liability issues that AI might cause (Tab. 1, Ref. 25).

Granulomatous Mastitis: A Clinical and Diagnostic Dilemma.

OBJECTIVE: Granulomatous mastitis (GM) is a challenging inflammatory disorder of the breast. In this study we aimed to present the detailed clinical and morphological features of GM cases, diagnostic clues for specific and idiopathic etiologies, the difficulties in evaluating trucut biopsies, and the results of different therapeutic approaches. MATERIAL AND METHOD: We retrospectively analysed the clinical, radiological and morphological features of 114 GM cases diagnosed with fine needle aspiration, and trucut, incisional, and excisional biopsy. RESULTS: The mean age was 35.8. Only eight cases were older than 45 years. Bilateral involvement was observed in 4 (3.5%) cases. The most common clinical symptoms were breast mass/abscesses, tenderness, and skin changes. Microbiological culture was positive in 4 cases for gram-positive bacteria. Only 3 cases showed a positive tuberculin/PCR test for tuberculosis. The major USG finding was a hypoechoic well-defined or ill-defined mass/abscess; MRI finding was heterogeneous non-mass contrast enhancement. Cases diagnosed with cytology (35 cases) did not have breast malignancy either in their history or clinical follow up period. Fine needle aspiration cytology materials revealed epitheloid granulomas mixed with neutrophils, lymphocytes accompanied by giant cells, and suppurative necrosis. Histopathological reevaluation of 65 trucut/incisional/ excisional biopsies revealed granuloma formation in 65 (100%), Langhans type giant cells in 59 (90.7%), microabscess formation in 41 (63%), caseous necrosis in 1 (1.5%), neutrophilic cysts in 30 (46.1%), eosinophilic infiltration in 48 (73.8%), interlobular inflammation in 14 (21.5%), fat necrosis in 5 (7.6%), ductal ectasia in 6 (9.2%), and lactational changes in 4 (6.1%) cases. Granulomas were lobulocentric in 58 cases, foreign body type/fat necrosis-related in 6 case, and periductular in 1 case. Cystic neutrophilic granulomatous mastitis was observed in one case. We also evaluated the histochemical stains of these 65 biopsies. Only one sample was positive for acido-resistant bacilli (ARB) by the EZN method and one sample was positive for gram-positive bacilli by gram stain. CONCLUSION: Small, superficial trucut biopsies may cause difficulties in determining the etiology and differential diagnosis of granulomatous mastitis. For optimal management and timing the appropriate therapy, the ideal biopsy procedure, special stains, and a multidisciplinary team consisting of the surgeon, pathologist, and radiologist are the most important issues.

Can Lymphovascular and Perineural Invasion be Additional Staging Criteria in Colorectal Cancer?

OBJECTIVE: To identify additional staging information, venous, lymphatic, and neural invasion  as potential prognostic factors in colorectal cancer (CRC). STUDY DESIGN: A descriptive study. Place and Duration of the Study: University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey; from May 2007 to June 2019. METHODOLOGY: Retrospective analyses were performed on 855 CRC patients, who were treated with surgery. Patient and treatment characteristics, lymphovascular (LVI), and perineural (PNI) invasion were documented. The impact of LVI and PNI was determined using Cox proportional hazards model. RESULTS: The cohort examined had 346 (40.5%) LVI and 150 (17.5%) PNI positive patients. After surgery, mortality was 18.4% for LVI and 8% for PNI patients. Although increased ASA score (for ASA 2 hazard ratio [HR]=0.555, p=0.001 and ASA 3-4 HR=0.723, p=0.014), adjuvant chemotherapy (HR=2.5, p<0.001), LVI (HR=1.961, p<0.001) and PNI (HR=1.625, p<0.001) involvement increased the risk of death based on univariate analysis, multivariate Cox analysis showed a risk of death increase with increased ASA score (for ASA 2 HR=0.53, p<0.001 and ASA 3-4 HR=0.703, p=0.008), adjuvant chemotherapy (HR=2.114, p<0.001) and LVI involvement (HR=1.640, p<0.001). CONCLUSION: LVI and PNI may be useful in identifying CRC patients who might benefit the most from adjuvant systemic therapy. On the other hand, the presence of LVI and PNI reflects a shorter patient survival. Key Words: Lymphovascular invasion, Perineural invasion, Colorectal cancer, Cancer staging.

A new antibiotic stewardship program approach is effective on inappropriate surgical prophylaxis and discharge prescription.

INTRODUCTION: This study aims to evaluate the efficacy of a new antimicrobial stewardship program (ASP) on surgical antibiotic prophylaxis (SP) and antibiotics in discharge prescriptions used as a continuation of SP. METHODOLOGY: The study included elective patients with clean and clean-contaminated wounds. The accuracy of the assigned SP was evaluated according to international guidelines. Primary outcome measures comprised appropriateness of prophylactic antibiotic indication, correct timing of initial dose, discontinuation of SP within 24 hours, and antibiotic prescription at discharge. A secondary outcome measure was to determine whether the effect of ASP was sustained long-term. RESULTS: The total compliance rate for all stages of SP increased from 8% to 52.1% after the intervention (p < 0.05). When analyzed according to individual SP components, it was found that although ASP did not change first dose timing rates, it did affect the rates of prophylactic antibiotic indication, discontinuation of SP within 24 hours and antibiotic prescription at discharge, with statistical significance (p < 0.05). In addition, ASP continued to increase its effectiveness throughout the 3rd year. CONCLUSIONS: Based on the findings of our study, it seems clear that the modified ASP introduced in our general surgery clinic can be used effectively and simply; in addition, this ASP increases its efficacy with time.