Intestinal malrotation is usually diagnosed in early childhood. It results from failure of the normal gut rotation during embryological development. We present a case of a 62-year-old woman with a delayed presentation of an intestinal malrotation. She was admitted in the emergency department with an acute intestinal obstruction. Exploratory laparotomy revealed Ladd’s band with caecum volvulus and intestinal malrotation. Ladd’s procedure and right hemicolectomy were performed with uneventful recovery. Since both caecum volvulus and intestinal malrotation are rare events, particularly in adulthood, clinical diagnosis is challenging. Our aim is to increase the awareness of surgeons about this rare association as a cause of acute intestinal obstruction.
Introduction Thyroid nodules are lesions that are radiologically distinct from the thyroid parenchyma. Cervical ultrasound diagnoses 19–67% of nodules and is crucial in identifying those that lack cytological characterisation. Approximately 25% of biopsies reveal an indeterminate cytological result (Bethesda III), in which the risk of malignancy is variable (5–15%). The clinical importance of the diagnostic strategy used for thyroid nodules results from the need to exclude malignancy. The aim of this study was to evaluate the usefulness of serum thyroid-stimulating hormone (TSH) levels as a predictor of malignancy in cytologically indeterminate thyroid nodules. Methods Our retrospective study included 40 patients with cytologically indeterminate thyroid nodules seen in our hospital between January 2013 and December 2017. Clinical parameters were reviewed, including age, gender, serum TSH levels, family history of thyroid carcinoma, radiation exposure and some sonographic features of the nodules. Statistical analysis was performed using SPSS. Statistical significance was defined as p<0.05. Results Female gender was predominant (85%) and the mean (SD) age was 53.3 (15) years. Thyroid carcinoma was confirmed in 28% of patients. Median TSH levels were higher in patients with malignant (2.73µIU/ml) compared with benign (1.56µIU/ml) nodules (p<0.05). We demonstrated an increased risk of malignancy in patients with TSH levels of 2.68µIU/ml or above (p<0.05). Conclusion Higher serum TSH levels are associated with an increased risk of thyroid carcinoma in cytologically indeterminate nodules. TSH can become a fundamental diagnostic tool in stratifying the risk of malignancy and assist in diagnostic and therapeutic approaches to these nodules.
Introduction: Lower preoperative hemoglobin (H), albumin (A), lymphocyte (L) and platelet (P) score (HALP) has been identified as a predictive factor in LACC to categorize patients with higher risk of poor outcome. Therefore, it is important to identify biomarkers available in clinical practice that can predict survival and patient’s prognosis. Our aim is to evaluate preoperative HALP score and its prognostic value.
Materials and Methods: Our retrospective study included patients with LACC submitted to oncologic resection between January 2015 to December 2019 in our institution. LACC included stages II and III adenocarcinoma. HALP score was calculated as H (g/L) x A (g/L) x L (/L) / P (/L). A cutoff value was determined by ROC curve analysis and patients were divided accordingly into two groups (low and high HALP) to compare cancer-specific survival, through Kaplan-Meyer curve.
Results: In our study, 127 patients were included. The mean age was 70,7 ± 11,9 years and 67 (52,8%) were male. Stage II incorporated 65 patients (51,2%) and stage III 62 (48,8%). The median follow-up time was 37 months. The HALP cutoff value estimated was 22,5. Age ³ 65 years, right-sided tumor, surgical reintervention and cancer-specific survival were associated with a lower HALP scores (p=0,002; p=0,004; p=0,008 and p=0.001, respectively).
Conclusion: Nutritional and systemic inflammation status are extremely important in colon cancer prognosis. Serum biomarkers, such as HALP score could easily identify patients with a higher risk of poor outcome. Thus, this prognostic index may be useful as a clinical predictor of survival for LACC patients.
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