Detection of Rare Gallbladder Microperforation by 18F-FDG PET/CT in a Patient with Maxillary Sinus Cancer.

Gallbladder perforation is one of the most serious complications of cholecystitis and is rarely seen in 2-11% of cases. Pericholecystic abscesses secondary to gallbladder perforation are rare. Rapid diagnosis is important because of high morbidity and mortalityrates. A subcapsular abscess secondary to gallbladder microperforation is presented on 18F-fluorodeoxyglucose positron emission tomography/computed tomography performed for restaging in a patient with maxillary sinus cancer.

Is peripheral blood immunophenotyping useful to understand the etiology of Idiopathic Granulomatous?

BACKGROUND: The etiology of idiopathic granulomatous mastitis (IGM) has not been clearly established. However, autoimmunity has recently become popular in etiopathogenesis. We aimed to investigate the immunophenotyping of immune cells to help clarify the etiopathogenesis of the disease. METHODS: Patients with IGM and healthy volunteers were included in the study. Patients were divided into active and remission groups based on their disease status. The ratios of total T cells, helper T cells, cytotoxic T cells, natural killer cells, regulatory T cells, and monocyte subtypes were measured using flow cytometry. In addition, age, complete blood count for leukocyte, lymphocyte, neutrophil, and eosinophil counts, and the smoking status of all volunteers were evaluated. RESULTS: A total of 33 volunteers, including 11 patients with active IGM, 10 patients with remission IGM, and 12 healthy volunteers, were included in the study. The neutrophil, eosinophil, neutrophil/lymphocyte, and non-classical monocyte values were significantly higher in IGM patients than in healthy volunteers. Additionally, the CD4+ CD25+ CD127- regulatory T cell was significantly lower in IGM patients than in healthy volunteers. Furthermore, neutrophil, neutrophil/lymphocyte ratio, CD4+ CD25+ CD127- regulatory T cells, and non-classical monocytes showed significant differences when IGM patients were divided into active and remission groups. IGM patients had higher smoking rates, but this was not statistically significant. CONCLUSION: The changes in many cell types evaluated in our study were similar to the cell profiles of some autoimmune diseases. This could provide minor evidence to suggest that IGM is an autoimmune granulomatous disease with a local course.

The Importance of Mapping Vagus and Laryngeal Nerves Monitoring During Thyroid Surgery.

OBJECTIVE: To determine the location of thyroid-related nerves by nerve monitoring and demonstrate the usefulness of Nerve Integrity Monitor in thyroid surgery. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of General Surgery, University of Health Sciences, Istanbul Training and Research Hospital, Turkey, from February 2017 to January 2020. METHODOLOGY: Patients, who underwent thyroid surgery, were evaluated for age, gender, preoperative diagnosis, type of surgery, histopathological result, postoperative hoarseness, and postoperative vocal cord examinations. The vagus nerve, recurrent laryngeal nerve (RLN), and superior laryngeal nerve (SLN) were mapped by nerve monitoring. RESULTS: A total of 328 patients were included in this study. On both sides, the vagus nerve was most often located in the posterior of the internal carotid artery and internal jugular vein and less frequently anterior to this vein. A total of 303 right RLNs and 305 left RLNs were verified. The SLN was visualised or motor activity was verified by nerve monitoring on the right side in 181 patients and on the left side in 179 patients. The SLN's location was classified most frequently as type I and least frequently as type IIb on the right and left sides. CONCLUSION: The reported variations, the experience of the surgeon, and these anatomical markers cannot be adequate in preventing nerve injuries. Furthermore, the variations can be identified more clearly peroperatively with the use of nerve monitoring. KEY WORDS: Laryngeal nerves, Nerve mapping, Nerve monitoring, Nervus vagus, Thyroid surgery, Zuckerkandl tubercles.

Flowcytometric Ratios of Immune Cells in the Prognosis and Staging of Acute Biliary Pancreatitis.

OBJECTIVE: To evaluate several lymphocyte subtypes with various parameters that can be applied easily and give fast results for their roles in evaluating the stage and prognosis of acute biliary pancreatitis. STUDY DESIGN: Case-control study. PLACE AND DURATION OF STUDY: The Emergency Department of Istanbul Training and Research Hospital, and Gaziosmanpasa Research and Training Hospital, Turkey, between June 2020 and April 2021. METHODOLOGY: Patients, who admitted to the Emergency Department with acute pancreatitis and treated after hospitalisation, were included in the study. The patients were divided into three groups; mild, moderately severe and severe, according to the 2012 revised Atlanta classification. Hematocrit, creatinine, potassium, sodium values, and flow cytometry ratios of lymphocyte, monocyte, CD4+, CD8+, and regulatory T cells were measured and the difference between the groups were evaluated. Their results were compared with healthy volunteers. RESULTS: A total of 53 persons including 40 with acute pancreatitis (14 mild, 14 moderately severe, and 12 in the severe pancreatitis groups) and 13 healthy volunteers, were included in the study. The average age of the studied participants was 50.9 ±13.42 years, 43.3% males and 56.7% females. Leukocyte values, lymphocyte rates, hematocrit rates, age, hospital staying duration, creatinine, potassium values, CD4+, and CD3+ lymphocyte rates were found to be different at a statistically significant level between the groups. CONCLUSION: High leukocyte, low lymphocyte, high hematocrit, advanced age, elevated creatinine, elevated potassium, low CD4+ T lymphocyte, low CD3+ T lymphocyte, and low lymphocyte/monocyte ratio were identified as poor prognostic indicators. KEY WORDS: Acute pancreatitis, Flow cytometry, Regulatory T cell, Atlanta.

Evaluation of the appendectomy cases performed under emergency conditions during the COVID-19 pandemic and discussed with the pathology reports.

BACKGROUND: The aim of this study is to examine the cases underwent appendectomy during the COVID-19 pandemic and to discuss the pathology reports of patients. METHODS: During the COVID-19 pandemic, the pathological reports of the appendectomy materials of 588 patients over the age of 15 who applied to the emergency department between January 1, 2020, and June 1, 2021, were examined. A total of 565 patients with a diagnosis of acute (AA), subacute (SA), or perforated appendicitis (PA) were included and divided into three groups according to diagnosis. Twenty-three patients were excluded from the study due to other pathologies. The age, gender, duration of pain, ASA score, operational technique, operation time, Clavien-Dindo score, hospitalization time, post-operative complications, pre- and post-operative PCR and thoracic tomography findings in suspected cases of COVID-19, and laboratory and radiological findings of patients were retrospectively analyzed. RESULTS: Of 565 patients diagnosed with appendicitis, 464 (82.1%) had AA, 35 (6.2%) SA, and 66 (11.7%) PA. The median age of the PA group was higher than in the AA group (p=0.0139). The incidence of diabetes mellitus in the PA group and of asthma in the SA group were highest among other groups (p=0.004 and 0.0037, respectively). The duration of pain was longer in the SA and PA groups than the AA group (p<0.0001), therefore, the patients applied to hospital later than the acute group. The rate of thorax CT-positive scans was 1.6% in patients suspected for COVID-19 (p=0.066). While laparoscopic surgery was preferred over 70% in all groups, the rate of conventional surgery (21.1%) in the AA group was highest and of transition from laparoscopic to open surgery was highest in the PA group (10.6%) (p<0.0001). Hospitalization duration was longest in the PA group (p<0.0001). CONCLUSION: COVID-19 pandemic not only changes all routines of social life but also complicates the treatment and manage-ment of cases with AA symptoms applied to hospital under emergency conditions. Follow-up of the appendectomy specimen is crucial in terms of excluding other pathologies.

Are the cytokines and chemokines important for the early diagnosis of mesenteric ischemia?

BACKGROUND: Acute mesenteric ischemia (AMI) has very high mortality and morbidity rates, and the most important factor in the prognosis of AMI is the duration of ischemia. This study aims to evaluate the changes of these markers according to the ischemia duration and possible use of cytokines and chemokines in the early diagnosis of AMI. METHODS: Twenty-one male Sprague-Dawley rats were divided into three equal groups. The Superior Mesenteric Artery and Superior Mesenteric Vein were tied tightly and exposed to ischemia for 2 h for Group 1 and 6 h for Group 2. There was no intervention for Group 3, and it was selected as a control group. Intracardiac blood samples were collected after 2 h in Group 1 and 6 h in Groups 2 and 3. The IL-1α, 1ß, 6, 10, 12p70, 17A, 18, 33, CXCL1/KC, CCL2/MCP-1, GM-CSF, IFN-γ, and TNF-α were measured using flow cytometry. RESULTS: Significant differences were observed between the groups in IFN-γ, CXCL1, MCP1, TNF-α, and IL-6 parameters. In the correlation analyses performed according to the mesenteric ischemia time, a very strong correlation was observed in CXCL1, as well as a strong level for MCP-1, TNF-α, and IL-6. Furthermore, a moderate level of correlation was found in IFN-γ, IL-10, and IL-18. CONCLUSION: The increased levels of CXCL1, MCP-1, TNF-α, and IL-6, which had a high correlation with the duration of ischemia in patients with intestinal ischemia, may help clinicians with diagnoses and treatment decision-making.

A New Cross-Linked Hyaluronic Acid Gel for Preventing Adhesion After Thyroid Surgery: An Animal Study.

BACKGROUND: Revision of any neck surgeries is usually associated with increased rate of complications compared to the initial surgery due to adhesions. Especially, recurrent laryngeal nerve injury and hypoparathyroidism are most important postoperative complications of thyroid revision surgery. This study aimed to reveal anti-adhesive effects of cross-linked hyaluronic acid gel (NCHAG) in thyroid surgery. MATERIALS AND METHODS: This study was performed in 16 adult male rats who underwent hemithyroidectomy in the right lobe and randomized into two experimental groups: Group I (control group) was given any substance and Group II (NCHA group) received NCHA spray into their perithyroidal area. The rats were sacrificed after three weeks of thyroidectomy for assessment. RESULTS: Gross adhesions score (x̄ = 2.500) was significantly higher in Group I than Group II (x̄=1.750; P = 0.031). Group II showed significantly less fibrosis compared to the Group I (P = 0.002). The rate of inflammation was found to be significantly higher in group I (P = 0.008). Vascular proliferation was not different between two groups (p=0.083). CONCLUSIONS: Our study showed that NCHA can reduce postoperative adhesion and might be effective in preventing fibrosis after the thyroidectomy. Although this study could not demonstrate that application of NCHA is able to reduce complication rate in revision neck surgery, it could be safely used after thyroidectomy and neck surgeries to prevent adhesions.

Single incision laparoscopic abdominal surgeries: case series of 155 various procedures, an observational cohort study.

OBJECTIVES: Over the last decade, surgeons have started to think of the ways in which to further reduce the trauma of surgery and improve cosmesis. Consequently, many surgeons have yielded to single incision laparoscopic surgeries (SILS) in order to maximize operative and postoperative outcomes. This study aimed to highlight the feasibility and challenges of different procedures by presenting our data about different fields of abdominal SILS practices with long term follow-up. MATERIAL AND METHODS: We retrospectively analysed an observational cohort of 155 patients who underwent surgery for different indications using the SILS technique. RESULTS: Of the 155 SILS procedures: 75 (48.4%) were cholecystectomies; 22 (14.2%) were splenectomies; 17 (11%) were hernia repairs; 11 (7.1%) were appendectomies; 8 (5.2%) were partial colon resections; 8 (5.2%) were adrenalectomies; 6 (3.8%) were distal pancreatectomy & splenectomies; 3 (1.9%) were subtotal gastrectomies; 3 (1.9%) were partial liver resections; and 2 (1.3%) were Nissen fundoplications. Ten (6.5%) early and 3 (1.9%) late postoperative complications were detected. No mortality or late morbidity (> 30 days) was detected due to SILS procedures. CONCLUSION: SILS is a feasible technique in experienced hands for specific procedures. Meticulous patient selection is also important for good cosmetic results and outcomes.

Comparison of Clinical Outcomes of Single-Incision Versus Conventional Multiport Laparoscopic Distal Pancreatectomy: A Single Institution Experience.

OBJECTIVES: Single-incision laparoscopic procedures have been gaining popularity in recent years due to their minimal incisional morbidity and improved cosmetic outcomes. Herein, we will compare the feasibility and outcomes of single-incision and conventional multiport laparoscopic distal pancreatectomy. METHODS: This study involves consecutive patients who underwent either single-incision or conventional multiport laparoscopic distal pancreatectomy from March 2007 to February 2014. The patients were divided into two groups, based on the surgical approach: single-incision laparoscopic surgery (Group 1) and conventional multiport laparoscopic surgery (Group 2). The parameters evaluated included estimated blood loss, operative time, postoperative pain, duration of hospital stay, complications, conversion, and final pathology. RESULTS: There were a total of 20 patients, 10 in each study group. Baseline characteristics were similar, and there was no mortality in either of the groups. The low-flow pancreatic fistula was the most commonly seen morbidity, but it was ceased spontaneously in each group by a ratio of 30%. The operative time was significantly shorter in Group 2, with a mean of 116 minutes versus a mean of 180 minutes for Group 1 (p<0.001). One of the procedures in Group 2 was converted to open surgery due to peroperative bleeding. The median follow-up periods of the patients were 22 months and 56 months. The spleen was preserved in only 1 patient from Group 1, whereas in Group 2, the spleen preservation was achieved in 5 patients. CONCLUSION: The single-incision laparoscopic technique is a safe and effective alternative to standard laparoscopic distal pancreatectomy.

Magnetic Probe-Guided Excision of Nonpalpable Neck Lesions.

BACKGROUND: Reoperative neck surgery is technically more demanding because of the presence of scar tissue and distorted anatomy. We aimed to investigate the magnetic probe-guided excision of nonpalpable neck lesions in patients with previously operated neck compartments. METHODS: This study included 9 patients with recurrent/persistent thyroid carcinoma, recurrent/persistent hyperparathyroidism with previously operated neck compartments. The pathologic lesions were localized by ultrasonography, and magnetic tracer (0.2 mL, iron oxide) was injected directly into the pathologic lesions. Careful dissection was carried out following the area of maximum magnetic activity until the nonpalpable lesions were identified and excised. RESULT: All neck lesions were removed in 9 patients. The median count from lesion was significantly higher than values from lesion bed (background activity; (9900/5 seconds vs 250/5 seconds, P < .001). During follow-up, all patients had negative ultrasonography. CONCLUSION: Magnetic probe-guided technique could provide access to nonpalpable lesion localization in centers without readily available access to nuclear medicine facilities.

Safety and feasibility of laparoscopic adrenalectomy: What is the role of tumour size? A single institution experience.

BACKGROUND: Although, there are studies in the literature having shown the feasibility and safety of laparoscopic adrenalectomy, there are still debates for tumour size and the requirement of the minimal invasive approach. Our hypothesis was that the use of laparoscopy facilitates minimally invasive resection of large adrenal tumours regardless of tumour size. MATERIALS AND METHODS: Within 7 years, 149 patients underwent laparoscopic adrenalectomy at one institution. The patients were divided into two study groups according to tumour size. Group 1 included patients with adrenal tumours smaller than 5 cm and group 2 included larger than 5 cm. Patient demographics and clinical parameters, operative time, complications, hospital stay and final pathology were analysed. Statistical analyses of clinical and perioperative parameters were performed using Student's t-test and Chi-square tests. RESULTS: There were 88 patients in group 1 and 70 in group 2. There were no significant differences between study groups regarding patient demographics, operative time, hospital stay, and complications. Estimated blood loss was significantly higher in group 2 (P = 0.002). The conversion to open rate was similar between study groups with 5.6% versus 4.2%, respectively. Pathology was similar between groups. CONCLUSION: Our study shows that the use laparoscopy for adrenal tumours larger than 5 cm is a safe and feasible technique. Laparoscopic adrenalectomy is our preferred minimally invasive surgical approach for removing large adrenal tumours.