Background: Xanthogranulomatous cholecystitis (XGC) is an uncommon, focal, or diffuse destructive inflammatory disease of the gallbladder mimicking or being together with the gallbladder carcinoma. This study aimed to evaluate the diagnosis, treatment, and outcomes of patients with XGC as a single tertiary center experience in the light of literature. Materials and Methods: Data about 34 patients with XGC identified after evaluating 2212 cholecystectomy specimens between January 2013 and December 2018 in a single tertiary center were documented to determine demographics (sex, age), clinical symptoms and findings, biochemical and imaging clues and operative findings, duration of hospitalization, postoperative complications, and histopathologic results. Results: Thirty-four patients with XGC were evaluated (17 male and 17 female patients with a mean age of 53; range, 25 to 78). Preoperative diagnosis was chronic calculous cholecystitis in 5 patients, cholelithiasis in 12 cases, acute calculous cholecystitis in 16 and emphysematous cholecystitis in 1 patient. Ultrasound was performed in all patients, computerized tomography in 11, contrast-enhanced magnetic resonance imaging in 9, and magnetic resonance cholangiopancreatography in 7 patients. None of the patients were diagnosed preoperatively. All patients received laparoscopic cholecystectomy, among whom 9 were converted to open. Partial cholecystectomy was performed in 1 patient. One patient with gallbladder adenocarcinoma was treated with radical cholecystectomy. XGC has nonspecific clinical and radiologic findings; thus, preoperative diagnosis is generally absent. Open cholecystectomy is the recommended treatment modality. Conversion to open is frequently necessary after laparoscopy. Complete cholecystectomy is the ultimate goal; however, partial cholecystectomy may be preferred to protect the structures of the hepatic hilum. Preoperative imaging studies (ultrasound or computerized tomography) of 34 patients showed a gallbladder stone in 18 patients, microlithiazis in 12 patients, sludge in 10 patients, and gallbladder sclerosis in 5 patients. Conclusions: Diagnosis of XGC and differentiation from gallbladder carcinoma may be difficult through preoperative or peroperative studies, even imaging is useful; the definitive diagnosis depends exclusively on pathologic examination. The surgeon should be prepared for every possibility.
Objective: To determine the success rate of minimally invasive parathyroidectomies (MIPs) with preoperative scintigraphy and ultrasonography, and to assess whether these imaging modalities are sufficient.
Aim: The aim of this study is to reveal the value of preoperative neutrophil lymphocyte ratio in differential diagnosis between papillary thyroid carcinoma, papillary thyroid microcarcinoma and benign multinodular goiter. Materials and methods: Patients with papillary thyroid carcinoma, papillary thyroid microcarcinoma, and multinodular goiter whose histopathological diagnosis was confirmed by postoperative pathology reports were included in the study. Results: The TSH levels were statistically significantly different among the groups (p < 0.001). The intergroup comparison revealed that the TSH levels were significantly lower in the multinodular goiter group compared to the papillary thyroid carcinoma and papillary thyroid microcarcinoma groups (p < 0.001, p0.001). The mean neutrophil count was 4.98 ± 1.19 in the papillary thyroid carcinoma group, 4.68 ± 1.33 in the papillary thyroid microcarcinoma group, and 4.59 ± 1.40 in the multinodular goiter group. The neutrophil counts of the groups were found to be significantly different (p = 0.013). The papillary thyroid carcinoma group had a significantly higher neutrophil count than the multinodular goiter group. The mean Neutrophil lymphocyte ratio value was 2.20 ± 0.71 in the papillary thyroid carcinoma group and 2.02 ± 0.92 in the multinodular goiter group. Neutrophil lymphocyte ratio values were significantly higher in the the papillary thyroid carcinoma group (p = 0.006). Conclucion: We believe that increased neutrophil lymphocyte ratio may be an indicator of underlying malignant disease in patients with thyroid nodules in the preoperative period.
Ingestion of a foreign body is generally observed in the psychiatric patients and children. Healthy adult individuals may also swallow a foreign body unintentionally. Here, we report a case of a patient who swallowed a plastic fork and treated with laparoscopic repair. A 46-year man was admitted to the emergency room with the abdominal pain. His physical evaluation and diagnostic imaging revealed free air in the abdomen. Further imaging with CT scan showed a foreign body in the proximal ileum. On taking details of his swallowing history, he remembered swallowing a broken part of a plastic fork unwittingly during dinner. Following the removal of the foreign body, the perforation area was primarily repaired in double layers. The postoperative course was uneventful. An accurate diagnosis of the small intestinal perforation caused by the ingested foreign bodies, particularly in cases where the patient is unaware of the ingestion, can be difficult. CT scan is a useful tool when available to establish the diagnosis before the surgical intervention.
PURPOSE: The aim of this study is to determine risk factors for malignancy in gallbladder polyps. METHODS: 92 patients who underwent laparoscopic cholecystectomy due to gallbladder polyp were retrospectively analyzed. Demographic data of the patients, size and number of polyp, the presence of gallstones and histopathological features of the polyps were recorded. RESULTS: 92 patients were included. Mean age was 45.78±11.21 years (21-72). 59 of the patients (64.1%) were female and 33 (35.9%) were male. Mean polyp size was 8.17±2.19 mm and 35 patients (38.0%) had a single polyp, while 57 (62.0%) had multiple polyps (≥2). 47 of the patients (51.1%) had gallstone disease, while 45 (48.9%) had no stone disease. Benign polyps (Group 1) were found in 79 patients (85.9%) and adenocarcinomas (Group 2) were found in 13 (14.1%). Of the benign polyps, 71 (77.1%) were non-neoplastic polyps and 8 (8.8%) were neoplastic polyps (adenomas). Of the 13 patients with adenocarcinomas, 11 (11.9%) were T1a and 2 (2.2%) were T1b. Mean age was 44.32±11.03 years in Group 1 and 54.61±8.07 years in Group 2, the latter being significantly older (p=0.002). Mean polyp size was 7.47±5.51 mm in Group 1 and 12.46±1.89 mm in Group 2, with a significant difference (p<0.001). The cut-off value to detect malignant polyps was a polyp size of 10.5 mm with 92.3% sensitivity, 84.8% specificity, and 0.934 accuracy (p< 0.001). The cut-off value to detect malignant polyps was an age of 50.5 years with 76.9% sensitivity, 67.1% specificity, and 0.767 accuracy (p=0.002). Polyp size and age were important risk factors for malignant gallbladder polyps (p<0.001, OR=2.313; 95% CI: 1.502–3.561), (p=0.004, OR=1.100, 95% CI: 1.030–1.175). CONCLUCISION: We recommend cholecystectomy for asymptomatic patients aged above 50 years with gallbladder polyps larger than 10 mm due to the increased risk of malignancy.
Objective. This study was designed to compare the diagnosis, treatment, and results of acute appendicitis in pregnant and non-pregnant women. Material and Methods. Women between the ages of 18 and 40 who were operated for acute appendicitis between 2015 and 2020 were included in the study. Results. There were 27 (3.8%) patients in Group Pregnant, and 679 (96.2%) patients in Group non-Pregnant. The mean WBC values in Group P and Group non-P was 16.53±2.91 and 13.99±4.31 (x103), and there was a significant difference between the groups.Mean pain symptom duration time was 3.40±1.90 in Group P and 1.91±1.34 day in Group non-P, while it was significantly longer in Group P . When the preoperative USG reports were evaluated, no significant difference was found between the groups.The diagnosis was made by MRI in 2 (7.4%) pregnant patients who non-visualized according to the USG report. In Group P, 10 patients were laparoscopic, 17 patients open; In group non-P, 153 patients laparoscopic and 526 patients were operated using open surgery technique. While the mean operation time did not differ significantly between the groups. Length of hospital stay was significantly higher in Group P with 3.48±4.26 days to 1.95±1.45 days. Conclusion. Diagnosis and treatment of acute appendicitis during pregnancy may be difficult, but with advanced radiological examinations and experienced surgeons, these difficulties can be easily overcome.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.