The Significance of Serum Tumor Markers CEA, Ca 19-9, Ca 125, Ca 15-3, and AFP in Patients Scheduled for Orthotopic Liver Transplantation: Do Elevated Levels Really Mean Malignancy?

AIM AND BACKGROUND: Preparation of the patients for liver transplantation is a meticulous process and includes evaluation of tumor markers to rule out occult malignancy. The present study evaluated the significance of serum tumor markers in patients bound for liver transplantation due to viral and other etiologies of liver failure. PATIENTS AND METHODS: Three hundred eighty-one patients who underwent liver transplantation were included in the study. Demographic data, model for end stage liver disease (MELD) scores, and serum tumor marker levels were prospectively collected. RESULTS: AFP levels were significantly higher in viral etiologies when compared to other etiologies (p < 0.05). Ca 19-9 was significantly higher in viral etiologies (p < 0.05). Among the viral etiologies, HCV-related liver failure had higher carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (Ca 19-9) levels (p < 0.05). A correlation was found between increasing MELD scores and serum levels of tumor markers (p < 0.05). CONCLUSIONS: Tumor markers such as AFP, CEA, Ca 125, and Ca 19-9 can be elevated in end stage liver disease. Their levels vary according to etiology and severity of disease. The diagnostic capabilities of these markers are reduced in end stage liver disease setting but they contribute to the evaluation of the pathophysiology of chronic liver disease. Transplantation can be performed safely in cases with high tumor marker levels provided that any occult malignancy is ruled out by means of imaging and endoscopic techniques. Tumor markers can guide the physician in determining the severity of liver cirrhosis, and further studies are needed to validate such a relationship.

Impact of coronavirus disease on acute appendicitis cases.

BACKGROUND: Disease profiles have changed in the COVID-19 pandemic. In this study, we aimed to compare acute appendicitis cases before and during the COVID-19 pandemic. METHODS: A total of 130 patients were diagnosed with AA and operated between the days of first COVID-19 case on March 11, 2020, and May 11, 2020, and the same period of the previous year. Data of the patients were extracted from electronic archive of the hospital. Those patients were stratified into two groups; pandemic group and pre-pandemic group. The pandemic group comprised 46 patients and the pre-pandemic group, 84 patients. The two groups were compared in terms of age, gender, duration of symptoms, length of hospital stay, white blood cell count, C-reactive protein levels, and post-operative complications. RESULTS: The median days passed from onset of abdominal pain to submission were 6.5 days in the pandemic period. However, it was 3 days in the pre-pandemic group (p<0.001). Other parameters were not statistically different between the groups (p>0.05). CONCLUSION: During the COVID-19 pandemic period, delay in hospital submissions has attracted attention. However, delayed treatment did not reflect to the clinic as more severe disease.

Role of digital infrared thermal imaging in diagnosis of acute appendicitis.

BACKGROUND: Acute appendicitis (AA) is one of the most common diseases requiring emergency surgery. Today, diagnosis of AA is made through anamnesis, physical examination along with advanced imaging methods. Thermal imaging confers advantages over conventional techniques for being portable, non-invasive, easily conducted, ionization radiation-free, and inexpensive. Digital infrared thermal imaging (DITI) has been the subject of research in various clinical scenarios. In this prospective randomized controlled study, diagnostic potential of DITI in AA was investigated. METHODS: Totally, 224 volunteers (112 healthy volunteers and 112 patient volunteers) were enrolled and divided into two groups; control group and patient group. All subjects were assessed by DITI. Steady-state images of both lower quadrants and sternum were taken. Thermal images were transferred to computer software and analyzed. Potential of thermal imaging as a diagnostic method was evaluated. RESULTS: Regarding temperature differences between the quadrants, statistical analysis delivered significant difference between the both groups (p<0.001). As a result of the analysis, the cutoff value for the diagnosis of AA was found to be 0.4°C difference between the average lower quadrant temperatures. CONCLUSION: This study has enlarged the application of DITI to abdominal pain, especially within context of AA. Thermal evaluation of patients with abdominal pain seems promising.

Different approaches in diagnosis, follow-up and treatment of acute biliary pancreatitis: Results of attitude survey.

BACKGROUND: Acute biliary pancreatitis is one of the most frequently encountered diseases among general surgeons in emergency surgical diseases. Differences in diagnosis and treatment management of these patients, varying from physician to physician, are common in clinical practice. We aimed to present these differences and discuss the results in the light of current guidelines in the literature. METHODS: In this study, 21 questions were prepared regarding the physicians' approach in the diagnosis, follow-up and treatment of acute biliary pancreatitis (Appendix).The questionnaires were completed by face to face interviews with 94 general surgery specialists at the 20th National Surgery Congress. RESULTS: In this study, 38 (40%) of the physicians who answered the questionnaire were working in the Training and Research Hospital, 27 (29%) in the State Hospital, 19 (20%) in the University Hospital and nine in private health care was working in the establishment. 85% of the physicians were general surgery specialists with 10 years of experience. 53% (50) of the surgeons reported that they had less than five cases of acute biliary pancreatitis each month, and 35% (34) stated that they wanted amylase value daily for follow-up. Ultrasonography and computed tomography were the most commonly used imaging modalities and 15% of the respondents indicated that each patient underwent magnetic resonance cholangiopancreatography. 45% of surgeons stated that antibiotics were started at the time of diagnosis of pancreatitis. The percentage of surgeons who did not undergo cholecystectomy early in patients with mild to moderate pancreatitis was 60%. The reason for not preferring surgery in the early period was the most frequent operation difficulty with 40% and not supporting the operation in the early period. CONCLUSION: According to the attitude survey results, there are differences between general surgery specialists in the diagnosis, follow-up and treatment of acute biliary pancreatitis.

Evaluation of the Bethesda System and the ACR TIRADS in an Endemic Goiter Region.

BACKGROUND: Various factors can affect incidence of thyroid disorders and disease profiles may show abrupt changes in endemic goitrous areas. In this study, it was aimed to analyze the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) and the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in terms of risk of malignancy and general recommendations in an endemic goiter region (EGR). METHODS: In this retrospective study, a total of 500 patients who had thyroidectomy following thyroid fine needle aspiration biopsy were enrolled. For the assessment of thyroid cytology, BSRTC was used and for the evaluation of ultrasound features of thyroid nodules, ACR TIRADS lexicon was adopted. For the assessment of thyroid cytology, Bethesda classification was used and for the evaluation of ultrasound features of thyroid nodules, ACR TIRADS lexicon was adopted. RESULTS: In the EGR setting, benign category of BSRTC had a cancer risk of 6.2% which was two times more than the 2017 BSRTC revision reported. Nodules 10-14.9 mm in diameter had nearly 4 times higher malignancy risk than nodules >15 mm. In this group of patients, the risk of malignancy for TIRADS level 1, 2, 3, 4 and 5 was 1.16%, 2.94%, 7%, 45.64% and 94.44%, respectively. The malignancy rates for Bethesda system category I, II, III, IV, V and VI were as follows: 14.43%, 6.2%, 19.05%, 36.73%, 75.68% and 100%. CONCLUSIONS: There are slight differences between the common set of standards and this study results regarding risk of malignancy. This brings up the question whether there is need for revision for the use of categories and the appropriate management in endemic goiter regions.

Role of computed tomography tractography in evaluation of back/flank stab wounds.

BACKGROUND: The clinical approach to back/flank wounds has evolved over the years. The aim of this study was to discuss the potential of computed tomography tractography in patients with a stab wound to the back or flank. METHODS: A total of 25 stable patients with stab wounds confined to the back/flank region were enrolled in this retrospective study. After initial resuscitation and physical examination, tractography was performed at the site of the stab wound. The patients subsequently underwent computed tomography with intravenous contrast. RESULTS: Computed tomography tractography helped avoid a laparotomy in 15 (60%) patients and accurately revealed a peritoneal breach in 10 (40%) patients. No missed injuries were reported in the conservatively followed patients. CONCLUSION: The addition of tractography to computed tomography is a safe, fast, and cost- and time-effective technique to evaluate back/flank stab wounds.

Spontaneous rupture of right gastroepiploic artery aneurysm: a rare cause of hemorrhagic shock. case report

ABSTRACT CONTEXT: Aneurysms of the gastroepiploic arteries are seen only rarely. They are usually diagnosed during autopsy or laparotomy in patients with hemodynamic instability. Although the operation to treat this condition is relatively easy, delay in making the diagnosis affects the course of the disease. Case Report: A 57-year-old woman was admitted to the emergency department with abdominal pain and unconsciousness. A computed tomography scan showed extravasation of contrast agent at the headcorpus junction of the pancreas, and the patient underwent exploratory laparotomy under general anesthesia. During laparotomy, aneurysmatic rupture of the right gastroepiploic artery was detected. Control over bleeding was achieved by ligating the right gastroepiploic artery at its origin. The aneurysm was also resected and sent for pathological examination. CONCLUSION: Especially in cases of unidentified shock, splanchnic artery aneurysms should be kept in mind. Moreover, in the light of the data in the literature, the possibility of death should be taken into account seriously and, if feasible, prophylactic aneurysmectomy should be performed.

Spontaneous rupture of right gastroepiploic artery aneurysm: a rare cause of hemorrhagic shock. case report.

CONTEXT: Aneurysms of the gastroepiploic arteries are seen only rarely. They are usually diagnosed during autopsy or laparotomy in patients with hemodynamic instability. Although the operation to treat this condition is relatively easy, delay in making the diagnosis affects the course of the disease. CASE REPORT: A 57-year-old woman was admitted to the emergency department with abdominal pain and unconsciousness. A computed tomography scan showed extravasation of contrast agent at the headcorpus junction of the pancreas, and the patient underwent exploratory laparotomy under general anesthesia. During laparotomy, aneurysmatic rupture of the right gastroepiploic artery was detected. Control over bleeding was achieved by ligating the right gastroepiploic artery at its origin. The aneurysm was also resected and sent for pathological examination. CONCLUSION: Especially in cases of unidentified shock, splanchnic artery aneurysms should be kept in mind. Moreover, in the light of the data in the literature, the possibility of death should be taken into account seriously and, if feasible, prophylactic aneurysmectomy should be performed.

Endoscopic Management of Colonic Perforation due to Ingestion of a Wooden Toothpick.

BACKGROUND Toothpick ingestion is implicated in bowel injuries that may cause violent complications, mimicking diseases causing acute abdomen. CASE REPORT A 18-year-old man was admitted with a 3-day history of a swallowed wooden toothpick. The patient had tenderness in the left flank area. Computed tomography indicated toothpick impaction at the splenic flexura of the colon. It was successfully removed with colonoscopy. After the procedure, abdominal radiography showed free air as a sign of perforation. Along with conservative management, the patient was discharged without surgery. CONCLUSIONS There is need for greater awareness of the hazardous of an ingested toothpick. Endoscopic approach should be considered in the first-line management of toothpick perforations.

Role of postmastectomy radiation therapy in breast cancer patients with T1-2 and 1-3 positive lymph nodes.

OBJECTIVE: To evaluate the role of radiotherapy (RT) in overall survival (OS) and disease-free survival in postmastectomy breast cancer patients with tumor size <5 cm, with 1-3 involved axillary lymph nodes (T1-2N1). PATIENTS AND METHODS: We conducted a retrospective study of 89 postmastectomy patients with T1-2N1 disease between 2005 and 2015 at the Radiation Oncology Clinic of Kayseri Training and Research Hospital. Clinicopathologic, demographic, and laboratory findings, as well as treatment regimens were investigated. OS and disease-free survival as well as factors that can be valuable in the prognosis were evaluated. RESULTS: A total of 89 female patients with an average age of 53 years (range: 30-81 years) were included in the assessment. Five-year and 10-year local recurrence rates were found to be 6.6% in the RT group and 7.1% in the non-RT group. In the RT group, the mean OS was 110.3 months and progression-free survival was 104.4 months. In the non-RT group, the corresponding figures were 104.3 months and 92.1 months, respectively. Statistically significant correlation was observed between RT and the American Joint Committee on Cancer stage (P<0.001), histological type (P=0.013), tumor size (P<0.001), and lymph node metastasis (P<0.001). During the assessment, locoregional recurrence and/or distant metastasis occurred in nine patients (10%). Locoregional recurrence was observed mostly in patients with invasive ductal carcinoma, tumor >3.0 cm in size, grade II tumors, and perinodal invasion, and who were premenopausal at the time of diagnosis. CONCLUSION: In T1-2N1 breast cancer patients who underwent modified radical mastectomy, when the effects of postmastectomy RT were evaluated, there were no differences in terms of OS and progression-free survival. In addition, when subgroup analysis was made, in patients with invasive ductal carcinoma, tumor diameter >2 cm, three lymph node metastasis, and stage 2b, postmastectomy RT was seen to be useful.

Benefits of CT tractography in evaluation of anterior abdominal stab wounds.

INTRODUCTION: The study aimed to identify the presence of peritoneal penetration in management of anterior abdominal stab wound by using computed tomography (CT) tractography. MATERIAL AND METHODS: Hemodynamically stabile, CT tractography-performed patients who were admitted to our emergency clinic with anterior abdominal stab wounds between the years 2012 and 2014 were included in this study, and all images were evaluated in terms of peritoneal penetration and possible intra-abdominal injury. RESULTS: In the study CT tractography identified necessity of laparotomy accurately in 90% of the patients, and none of the patients without peritoneal penetration needed surgical treatment in their follow-up. CONCLUSION: The procedure may be used for some selected cases of hemodynamically stable patient with anterior abdominal stab wounds to abstain from local wound exploration.

Intact parathormone measurement 1 hour after total thyroidectomy as a predictor of symptomatic hypocalcemia.

OBJECTIVE: Postoperative iPTH assay may predict significant hypocalcemia after thyroid surgery. The present study aimed to evaluate the ability of iPTH assay to monitor parathyroid function and to identify the risk of postoperative hypocalcemia in patients underwent thyroid surgery. MATERIALS AND METHODS: One hundred patients participated in the study (7 male and 93 female). Hypocalcemia was defined as a serum calcium concentration less than 8.0 mg/dL and symptoms of hypocalcemia. Concomitant serum calcium and iPTH levels were measured before operation and at 1(st) h for iPTH, 24(th) h for calcium after thyroidectomy. RESULTS: Postoperative hypocalcemia was observed in 31 patients. The mean postoperative serum calcium concentration in normocalcemic patients was 8.8 ± 0.5 mg/dL, whereas it was 7.6 ± 0.3 mg/dL in hypocalcemic patients. The mean postoperative 1(st) hour iPTH of patients in the hypocalcemia group was 9.1 ± 4.9 pg/mL, whereas patients of the normocalcemia group had a mean postoperative iPTH of 35.8 ± 20.2 pg/mL. CONCLUSION: Postoperative 1(st) hour iPTH < 8 pg/mL with drop in iPTH level ≥ 81.5% together showed the highest diagnostic accuracy in predicting postoperative hypocalcemia.