Gastric cancer diagnosis and staging in coronavirus disease 2019 (Covid-19) pandemic.

AIM: The aim of the study was to analyze whether COVID-19 cause a delay in the diagnosis of gastric cancer patients particularly in the TNM staging of the tumor, or not. MATERIAL AND METHODS: This retrospective single-center study included the patients diagnosed with gastric cancer from March, 2019 to December 2020. The patients were divided into two groups: baseline and the pandemic groups. The following parameters were compared between the groups; demographic data, numbers of newly diagnosed patients, type of the surgery, location of the tumor, frequency of neoadjuvant treatment, ASA score, length of hospital stay, clinical staging and pathologic TNM staging. RESULTS: The mean monthly number of newly diagnosed gastric cancer patients showed a significant decline from 7.5 to 5.6 (p< .001). There were no statistically significant differences between the groups with regard to the demographic factors, except CA 19-9 levels. Patients in the pandemic group had higher both clinical and pathological T-stages (p < 0.05). CONCLUSIONS: Our study showed a decline in the number of the newly diagnosed patients with gastric cancer during the pandemic and also more patients presented with advanced stage during the pandemic period. This study showed that the pandemic causes a potential delay in the diagnosis of gastric cancer patients. KEY WORDS: Cancer surgery, COVID-19, Gastric cancer, Gastric surgery SARS-COV-2, Pandemic.

Invasive and Non-invasive Ductal Carcinoma within Malignant Phyllodes Tumour with Axillary Lymph Node Metastases.

Phyllodes tumours are uncommon breast neoplasms constituting 1-2% of breast malignancies. Metastasis is usually haematogenous, and axillary lymph node dissection is not routinely performed. A phyllodes tumour with concomitant invasive ductal carcinoma (IDC) is even rarer. When IDCor ductal carcinoma in-situ (DCIS) is detected, the management of the condition changes completely. We report a case of a 22-year female presenting with a mass in the right breast and palpable axillary lymph nodes. The pathological examination demonstrated a malignant phyllodes tumour with concomitant IDC and DCIS. The patient elected to have modified radical mastectomy, and the pathological examination showed metastasis in the axillary lymph nodes. The patient was administered appropriate therapy. At the last visit, she did not have the clinical signs of disease. This is the first youngest case of axillary lymph node metastases with both DCIS and IDC on pathological examination in malignant phyllodes tumour. Key Words: Malignant phyllodes, Invasive ductal carcinoma, Ductal carcinoma in-situ, Lymph node metastasis.

MRI Findings of Borderline Retroperitoneal Serous Cystadenocarcinoma.

Retroperitoneal serous cystadenocarcinoma is an extremely uncommon lesion. Here, we present MR imaging findings of a 40-year woman who was admitted to the hospital due to abdominal pain. The patient was evaluated with abdominal Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Abdominal CT revealed a 13x18 cm large retroperitoneal and cystic mass with polypoid projections. MRI was superior than CT in showing polypoid projections. Contrast enhanced MRI detected enhancement of thin septations and cyst appearance inner the cyst. Diffusion-weighted MRI showed restricted diffusion in the polypoid component with contrast enhancement. Therefore, we thought malignant lesion. The findings of contrast-enhanced CT and MRI were helpful in the diagnosis of those lesions. In addition, diffusionweighted MRI with multiparametric modalities played unlimited role in the assesment of the differential diagnosis.

Postobstructive Cyst Formation in Pancreatic Duct affecting Surgical Approach.

How to cite this article: Ezer A, Parlakgumus A. Postobstructive Cyst Formation in Pancreatic Duct affecting Surgical Approach. Euroasian J Hepato-Gastroenterol 2018;8(1):99-100.

Solitary Cecal Diverticulitis Mimicking Cecal Carcinoma.

Cecal diverticulum is a rare clinical condition which may present as acute abdomen through diverticulitis and perforation of diverticulitis. Surgical treatment of cecal diverticulitis has been controversial, with studies recommending options ranging from conservative management with antibiotics alone to aggressive resection. Two cases, one of which was pre- diagnosed with cecal tumor perforation and the other with cecal tumor leading to intestinal obstruction, were urgently operated. To both patients, right hemicolectomy was applied. Pathologic evaluation revealed cecal diverticulitis in both patients. Right hemicolectomy is principally reserved for patients experiencing perforation of the diverticulum and extensive inflammatory reaction.

Utility of Diffusion Weighted Magnetic Resonance Imaging with Multiple B Values in Evaluation of Pancreatic Malignant and Benign Lesions and Pancreatitis.

OBJECTIVE: To determine the feasibility of diffusion-weighted imaging in evaluation of pancreatic lesions and in differentiation of benign from malignant lesions. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Baskent University Adana Teaching and Research Center, Adana, Turkey, between September 2013 and May 2015. METHODOLOGY: Forty-three lesions [pancreas adenocarcinoma (n=25)], pancreatitis (n=10), benign lesion (n=8)] were utilized with diffusion-weighted magnetic resonance imaging with multiple b-values. Different ADC maps of diffusion weighted images by using b-values were acquired. RESULTS: The median ADC at all b values for malignant lesions was significantly different from that for benign lesions (p<0.001). When ADCs at all b values were compared between benign lesions/normal parenchyma and malignant lesions/normal parenchyma, there was a significant statistical difference in all b values between benign and malignant lesions except at b 50 and b 200 (p<0.05). The lesion/normal parenchyma ADC ratio for b 600 value (AUC=0.804) was more effective than the lesion ADC for b 600 value (AUC=0.766) in differentiation of benign and malignant lesions. The specificity and sensitivity of the lesion/normal parenchyma ADC ratio were higher than those of ADC values of lesions. When the ADC was compared between benign lesions and pancreatitis, a significant difference was found at all b values (p<0.001). There was not a statistically significant difference between the ADC for pancreatitis and that for malignant lesions at any b value combinations (p>0.05). CONCLUSION: Diffusion-weighted magnetic resonance images can be helpful in differentiation of pancreatic carcinoma and benign lesions. Lesion ADC / normal parenchyma ADC ratios are more important than lesion ADC values in assessment of pancreatic lesions.

Long Segment Intestinal Invagination in an Adult Case.

How to cite this article: Karadeli E, Parlakgumus A, Tok S, Erbay G. Long Segment Intestinal Invagination in an Adult Case. Euroasian J Hepato-Gastroenterol 2017;7(1):99-100.

Abdominal CT Findings in Patients with Primary Lymphoma Causing Small Bowel Obstruction.

The purpose of this study was to investigate retrospectively CTfindings in patients with primary lymphoma causing small bowel obstruction. CTscans of 11 patients with small bowel lymphoma were separately analysed in terms of affected section of the small bowel, focality, wall thickness, pattern and degree of contrast enhancement, lymphadenopathy, organ involvement, perforation, and the presence of intraabdominal fluid. Eight patients had diffuse large B-cell lymphoma, and one patient each had marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT), T-cell lymphoma, and anaplastic T-cell lymphoma. Affected sections of the bowels involved were jejunum (n=5, 45.4%), ileum (n=2, 18.1%), and one case (9%) each of distal ileum, distal jejunum, distal jejunum and ileum, and distal jejunum and colon. Primary gastrointestinal (GI) lymphoma is an uncommon disease, that may lead to small bowel obstruction sometimes.

Polymeric Clips for Stump Closure in Laparoscopic Appendectomy.

Many different techniques are used to perform laparoscopic appendectomy in terms of locations of trocars and closure of the appendiceal stump. They include mechanical endostaplers, endoligature, metal clips, bipolar endocoagulation, polymeric clips and intracorporeal sutures. The method of choice for appendiceal stump closure should be inexpensive and easy to perform. Non-absorbable polymer clips is an acceptable option for this purpose. Polymeric clips provide considerable cost savings as compared with endoscopic staplers, and are easy to apply in comparison to suture ligature techniques. In this study, we aimed to investigate outcomes of appendectomy carried out by using polymeric clips in 123 patients without any intraabdominal collection of pus or abscess. As such, the authors found polymeric clips to be safe, cheap and effective for stump closure in laparoscopic appendectomy.

Delayed Reconstruction of a Traumatic Cloaca Following Obstetric Anal Sphincter Rupture.

Permanent communication between the rectum and the vagina along with full thickness of anal sphincter faults can be a result of an unsuccessful primary repair of fourth degree obstetric trauma. This results into complete fecal incontinence and impaired quality of life. Anterior overlapping sphincteroplasty can be chosen as a method of treatment for fecal incontinence due to obstetric injuries. However, large perineal body reconstructions are generally pretty challenging tasks for surgeons. What we will describe here for the repair of a traumatic cloaca, occurred 23 years ago during vaginal delivery, is the use of a transpositional flap following overlapping sphincteroplasty. Anatomic recovery and fecal continence restoration have been accomplished completely by a follow-up of 24 months.

High Dose Oral Furosemide with Salt Ingestion in the Treatment of Refractory Ascites of Liver Cirrhosis.

PURPOSE: We aimed to evaluate and compare the efficacy and safety of high-dose furosemide+salt orally by comparing HSS+ furosemide (i.v.) and repeated paracentesis in patients with RA. METHODS: This was a prospective study of 78 cirrhotic patients with RA, randomized into three groups: Group A (n= 25) i.v. furosemide (200-300 mg bid) and 3% hypotonic saline solution (HSS) (once or twice a day); Group B (n= 26) oral furosemide tablets (360-520 mg bid) and salt (2.5 g bid); and, Group C (n= 27) repeated large-volume-paracentesis (RLVP) with albumin infusion. Patients without hyperkalemia were administrated 100 mg of spironolactone/day. During the follow-up; INR, creatinine, and total bilirubin levels were measured to determine the change in MELD (model of end stage liver disease) score. RESULTS: Hepatic encephalopathy (HE), severe episodes of spontaneous bacterial peritonitis (SBP) and pleural effusions (PE) occurred more frequently in Group C. Improvement in Child-Pugh and MELD score was better in Group A and B than Group C. In Group B, improvements were seen in the Child-Pugh and MELD score, reduction in body weight, duration and number of hospitalization. In Groups A and B, remarkable increases in diuresis were observed (706±116 to 2425±633 mL and 691±111 to 2405±772 mL) and serum sodium levels also improved. HE and SBP were occurred more often in group C (p<0.002). Hospitalization decreased significantly in Group B (p<0.001). There was no significant difference in survival among groups. CONCLUSION: High dose oral furosemide with salt ingestion may be an alternative, effective, safe and well-tolerated method of therapy for RA.

Nasobiliary Drainage for Benign Recurrent Intrahepatic Cholestasis in Patients Refractory to Standard Therapy.

PURPOSE: Benign recurrent intrahepatic cholestasis (BRIC) is characterized by episodic cholestasis and pruritus without anatomical obstruction. The aim of this study was to evaluate the safety and efficacy of nasobiliary drainage (NBD) in patients with BRIC refractory to medical therapy and to determine whether the use of NBD prolongs the episode duration. METHODS: This was a multicenter retrospective study consisting of 33 patients suffering from BRIC. All patients were administrated medical treatment and 16 patients who were refractory to standard medical therapies improved on treatment with temporary endoscopic NBD. Duration of treatment response and associated complications were analyzed. RESULTS: Sixteen patients (43% females) underwent 25 NBD procedures. The median duration of NBD was 17 days. There were significant improvements in total and direct bilirubin and alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and gamma-glutamyl transpeptidase on the 3rd day of NBD. Longer clinical remission was monitored in the NBD group. Post-endoscopic retrograde cholangiopancreatography pancreatitis was observed in one of 16 cases. CONCLUSION: NBD effectively eliminates BRIC in all patients and improves biomarkers of cholestasis. It can be suggested that patients with attacks of BRIC can be treated with temporary endoscopic NBD; however, the results of this study should be confirmed by prospective studies in the future.

Plasma viscosity: a potential predictor of both medical treatment response and clinical stage of ulcerative colitis.

AIM: Ulcerative colitis (UC) is one of the major forms of chronic relapsing inflammatory bowel diseases. The ability to identify type, severity and responsiveness to therapy of UC using laboratory parameters has long been the aim of clinical studies. The aim of this study was to assess the relation betweenplasma viscosity (PV) and disease activity and response to medical treatment in patients with UC. MATERIAL AND METHODS: The study included 105 patients with UC and 42 healthy volunteers. Blood samples were assessed for PV, erythrocyte sedimentation rate (ESR), high sensitive C-reactive protein (hs-CRP), D-dimer, and fibrinogen. RESULTS: Patients with UC were grouped according to disease activity, i.e. active (n= 59) and remission (n= 46). PV was higher in those with active UC compared with those with UC in remission or healthy subjects. It was significantly higher in both UC refractory to steroid compared to UC responsive to steroid (p< 0.001) and UC refractory to cyclosporine compared to UC responsive cyclosporine (p= 0.003). IncreasedSimple Clinical Colitis Activity Index (SCCAI), Endoscopic Grading Scale (EGS), and Histological Disease Activity (HAD) scores were significantly associated with higher PV in patients with UC. CONCLUSION: PV is a useful marker in predicting response to steroid or cyclosporine treatment in patients with active UC. It could be replaced by ESR or hs-CRP as a measure of the acute phase response in UC since it is sufficiently sensitive. These findings may help identify patients with active UC who will require colectomy. KEY WORDS: Biomarkers, Disease activity, Medical treatment, Steroid-refractory ulcerative colitis, Ulcerative colitis.

A Novel Technique for Detection and Suturing of Biliary Fistula in a Giant Hydatid Cyst: Video-assisted Biliary Fistula Suturing in Hydatid Cyst.

Hydatid disease remains an important health problem in endemic areas; and by the way of travel and immigration, it can also be encountered in non-endemic areas. The most common cases with complications following hydatid liver surgeries are biliary fistulas with a frequency of 14.6 - 27.5%. Postoperative biliary leakage is generally due to unnoticed biliary tract communications. It is technically difficult to determine and suture the biliary fistulas, particulary for deep located ones with giant cavities for patients with high body mass index. We report a novel technique viavideo-assisted suturing of potentially unnoticeable biliocystic fistula in open surgery for patients with hydatid disease.

Diagnosis and management of retained foreign objects.

Retained surgical foreign objects (RFO) include surgical sponges, instruments, tools or devices that are left behind following a surgical procedure unintentionally. It can cause serious morbidity as well as even mortality. It is frequently misdiagnosed. It should be considered in the differential diagnosis of any postoperative case with unresolved or unusual problems. Risk factors for RFOs include emergency procedures, unplanned change in operation, and body mass index and are clarified as being more frequent approximately 1 in 700 emergent cases. Although human errors cannot be completely prevented, medical training and consistency to rules seem to reduce the incidence to a minimum. It is a legal issue and potentially dangerous medical error. The definition, types, incidence, risk factors, complications and prevention strategies from RFOs are reviewed, from the comprehensive series until the year 2014.

Results of surgery in general surgical patients receiving warfarin: retrospective analysis of 61 patients.

The aim of this study is to investigate postoperative complications, mortality rates, and to determine the factors affecting mortality on the patients receiving warfarin therapy preoperatively, as well as comparing the results obtained from emergency and elective surgeries. Surgical outcomes of 61 patients on long-term oral anticoagulation with warfarin who underwent surgery in our center were retrospectively reviewed over an 8-year period. Thirty-three (54.1%) patients were female, with a mean age of 53 years. Mitral valve replacement (62.3%) was the most frequent indication for chronic anticoagulation therapy. Twelve out of 61 (19.2%) patients underwent emergency surgery; 59 (96.7%) operations were classified as major surgery. We did not observe any thromboembolic events on patients receiving our bridging therapy protocol. Cardiopulmonary dysfunction (CPD; 19.7%) and hemorrhage (16.4%) were the most encountered postoperative complications. Presence of CPD, bleeding, endocarditis, and mortality were statistically significant for emergency surgeries when compared with the results obtained from elective surgeries. There were 5 (8.2%) deaths observed during follow-up. It was found that advanced age, prolonged duration of operations, and presence of CPD had a statistically significant effect on mortality (P < 0.05). The patients receiving oral anticoagulant had high postoperative complication and mortality rates. This case was more evident in emergency surgeries. It is recommendable that as mortality is more apparent in the patients who undergo emergency surgeries-being older, having long duration of operations as well as CPD. Therefore during the postoperative follow-up process, the patients should be closely monitored.