A Rare Case of Gastro-Caval Fistula Due to Penetrating Trauma: A Vital Emergency.

In the literature no case of gastro-caval fistula due to penetrating trauma has been reported. We aimed to present a case of gastro-caval fistula presenting with massive hematemesis after a penetrating injury. A 20-year-old male patient applied to the emergency department with a complaint of projectile hematemesis after a knife penetrated the epigastric region. Contrast-enhanced abdominal computerized tomography (CT) showed a large hematoma around the inferior vena cava (IVC) and a fistula tract extending between the IVC and the gastric antrum. The patient underwent vena cava ligation and primary gastric repair. The patient, who was hypotensive and intubated in the post-operative intensive care unit, died on the second day after the operation. Because of the risk of sudden hypotension and shock from massive bleeding, gastro-caval fistula should be kept in mind in penetrating trauma; a rapid diagnosis should be made using a contrast-enhanced CT scan.

Differences in apparent diffusion coefficient histogram analysis according to EGFR mutation status in brain metastasis due to lung adenocarcinoma.

BACKGROUND: The etiology, clinicopathological features, and prognosis of cancer in cases with EGFR mutations are different from those without mutations.OBJECTIVE:This study aims to evaluate the differences in ADC histogram analysis in brain metastases with EGFR mutation status in lung adenocarcinoma cases and the relationship between ADC histogram analysis differences and overall survival. METHODS: In this retrospective case-control study, 30 patients (8 EGFR+/22 EGFR-) and 51 brain metastases (15 EGFR+/36 EGFR-) were included. ROI markings are first performed from each section, including metastasis in ADC mapping using FIREVOXEL software. Next, ADC histogram parameters are calculated. Overall survival analysis after brain metastasis (OSBM) is defined as the time from initial brain metastasis diagnosis to the time of death or last follow-up. Patient-based (by evaluating the largest lesion) and lesion-based (by evaluating all measurable lesions) statistical analyses are then performed. RESULTS: In the lesion-based analysis, skewness values are lower in EGFR+ patients, which is statistically significant (p = 0.012). The two groups have no significant difference regarding other ADC histogram analysis parameters, mortality, and overall survival (p > 0.05). In the ROC analysis, the most appropriate skewness cut-off value is determined as 0.321 to distinguish the EGFR mutation difference, and this value is statistically significant (sensitivity: 66.7%, specificity: 80.6%, AUC: 0.730) (p = 0.006).CONCLUSION:The findings of this study provide valuable insights into the differences in ADC histogram analysis according to EGFR mutation status in brain metastases due to lung adenocarcinoma. The identified parameters, especially skewness, are potentially non-invasive biomarkers for predicting mutation status. Incorporating these biomarkers into routine clinical practice may aid treatment decision-making and prognostic assessment for patients. Further validation studies and prospective investigations are warranted to confirm the clinical utility of these findings and establish their potential for personalized therapeutic strategies and patient outcomes.

Determination of IDH1, IDH2, MGMT, TERT and ATRX Gene Mutations in Glial Tumors.

BACKGROUND/AIM: The most frequent and dangerous kind of primary brain tumor is glioblastoma multiforme (GBM). The survival rates associated with GBM are very short and molecular markers for predicting survival are needed. The aim of our study was to evaluate isocitrate dehydrogenase 1 and 2 (IDH1, IDH2), telomerase reverse transcriptase (TERT), O-6- methylguanine-DNA methyltransferase (MGMT) and alpha-thalassemia/mental retardation, X-linked (ATRX) genes with next-generation sequencing (NGS) to find potential pathological mutations and their effect on survival. MATERIALS AND METHODS: Thirty patients who had undergone craniotomy and were diagnosed with high-grade glioma were evaluated for this study. Peripheral blood samples were obtained from all participants. IDH1, IDH2, TERT, MGMT and ATRX genes were evaluated with next-generation sequencing from the samples. Survival analysis evaluated the effects of all these mutations on survival. RESULTS: The median age of the patients was 58.5 (range=11- 74) years, and 56.7% (n=17) were under 60 years of age. According to sex, male patients comprised 66.7%. Targeted NGS detected 21 chromosomal aberrations. When more than three chromosomal anomalies were accepted as a reference, anomaly in three or fewer chromosomes negatively affected overall survival (hazard ratio=2.83). CONCLUSION: Targeted NGS generates therapeutically meaningful information, providing better prognostic information than conventional histology. Our study shows that NGS provides important information on survival by helping to detect chromosomal changes that can be detected in routine blood samples. It is clear that incorporating molecular diagnostics into our standard-of-care routine will help us better understand our patients' outcomes.