The purpose of this prospective study is to determine the preoperative plasma D-dimer and serum Carcinoembryonic Antigen (CEA) levels of patients scheduled for curative surgical resection for colorectal cancer and to evaluate the significance of these levels on the prognosis and postoperative survival rate. One hundred sixty-five patients with colorectal cancer, who were scheduled to have elective resection between January 2008 and January 2011, were included in the study. A significant increase was observed in the D-dimer levels, particularly in poorly differentiated tumors. The distance covered by the tumor inside the walls of the colon and rectum (T-stage) was significant for both D-dimer and CEA levels. As the T-stage increased, there was also a significant increase in the D-dimer and CEA levels. A high significance and correlation level was detected between the TNM staging and both D-dimer and CEA. A significant relationship was found between the advanced tumor stage and short postoperative survival rate of patients with colorectal cancer. Therefore, the analysis of preoperative D-dimer and CEA levels can be useful in predicting the stage and differentiation of the tumor and the postoperative survival rate.
Background/Aims: The aim of this study was to measure the apparent diffusion coefficient (ADC) values detected by diffusion-weighted imaging (DWI) in acute pancreatitis and compare them with computerized tomography (CT) findings in acute pancreatitis subgrouped by the Balthazar classification. Materials and Methods: The study population included 50 patients diagnosed with clinical pancreatitis who were evaluated with both multidetector CT and magnetic resonance imaging (MRI) within 24 h of clinical presentation. We calculated pancreatic ADC values obtained from DWI (b=0 and b=1000 mm
Amaç: Çali §manin amací üikemizin genel cerrahi alaninda ilk tecrübesi olan robot yardimli laparoskopik (RO-YAL) kolesistektomi sonuçlanmn degerlendirilmesidirOlgu Sunumu: Ümraniye Egitim ve Ara §tirma Hastanesi Genel Cerrahi Klinigl'nde semptomatik safra kesesi ta §i nedeniyle 5 hastaya ROYAL kolesistektomi yapildi. Hastalann cinsiyeti, ya §i, robotun kurulma süresi, total /f tem süresi, hastanede kali § süresi ve komplikasyonlar degerlendirildi. Hastalarm tümü kadmdi ve ya § ortalamasi 47 idi. Hastalann silinmesi, örtülmesi, pozisyon verilmesi ve robotlk kollarm steril örtülerle giydirilmesi ortalama 63 dakika sürdü. Total i §lem süresi ortalama 138 dakika idi. Tüm giri §imler robotik olarak sonlandinldi. Hiçbir olguda intraoperatif veya postoperatif komplikasyon geli §medi. Hastanede kali § süresi ortalama 1.6 gün idi. Sonuç: Semptomatik safra kesesi ta §larinin cerrahi tedavisinde ROYAL kolesistektomi güvenle uygulanabilmektedir. Anahtar Kelimeler: Robotik cerrahi, "da Vinci" robotu, laparoskopik kolesistektomi, robot yardimli kolesistektomi GÍRÍ § Conciusion: Robot-assisted laparoscopic cholecystectomy can be performed safely in symptomatic gallbladder stones.
OBJECTIVE:The aim of this study was to analyze the predictive value of preoperative laboratory findings in acute appendicitis in geriatric patients aged >65 years.METHODS:We enrolled a total of 4121 patients. A retrospective evaluation of the demographic features was made using preoperative laboratory values such as the white blood cell (WBC), neutrophil, and lymphocyte counts; platelet counts; the mean platelet volume and bilirubin values; and postoperative pathological data of the patients from the electronic file system. The neutrophil-to-WBC and neutrophil-to-lymphocyte ratios were calculated. Patients were divided into two groups, as geriatric (≥65 years old, n=140) and non-geriatric (<65 years old, n=3981).RESULTS:The white blood cell and lymphocyte counts, and the neutrophil-to-WBC ratio, were significantly higher in the non-geriatric group (p<0.001, p=0.013, and p=0.021, respectively). The neutrophil and platelet counts were higher in the non-geriatric group, but this difference was not statistically significant (p=0.073 and p=0.072, respectively). A higher neutrophil-to-lymphocyte ratio was determined in the geriatric group, but the difference was not significant (p=0.176). According to the optimumal cutoff value of 12.11×103/µL for WBC, specificity and sensitivity values of 65.4% and 57.9% were calculated, respectively; the AUC value was 0.632±0.024 (p<0.001). A receiver operating characteristic (ROC) analysis was used to calculate the optimum cutoff values of neutrophil-to-WBC ratio, lymphocyte, and the mean platelet volume, but the diagnostic accuracy of these tests was inadequate with an AUC of <0.6.CONCLUSION:WBC values >12.11×103/µL were predictive of acute appendicitis in geriatric patients. The other parameters were not predictive, and further studies are required.
Many techniques are described for the ligation of a difficult cystic duct (CD). The aim of this study is to assess the effectiveness and safety of stapling of a difficult CD in acute cholecystitis using Endo-GIA. From January 2008 to June 2012, 1441 patients with cholelithiasis underwent laparoscopic cholecystectomy (LC) at the Department of General Surgery, Haydarpasa Numune Education and Research Hospital. Of these, 19 (0.62%) were identified as having a difficult CD and were ligated using an Endo-GIA stapler. All patients were successfully treated with a laparoscopic approach. The length of hospital stay was 3.4 days. There were umbilical wound infections in 4 patients (21%). The length of follow-up ranged from 1.0 to 50.4 months. In conclusion, Endo-GIA is a safe and easy treatment method for patients with a dilated and difficult CD. The cystic artery should be isolated and ligated if possible before firing the Endo-GIA stapler. If isolation and stapling are not possible, fibrin sealant can be applied to avoid bleeding. The vascular Endo-GIA can be applied in a large CD, but for acute cholecystitis with an edematous CD, the Endo-GIA roticulator 4.8 or 3.5 stapler is preferred.
SummaryBackroungTo investigate the diagnostic performance of the elastography-based strain index ratio in the differential diagnosis of malignant and benign breast lesions.Material/MethodsSeventy-nine breast masses that were classified as BI-RADS category 3, 4, and 5 on B-mode ultrasonography (US) were further prospectively evaluated by real-time sonoelastography (RTE). To obtain an optimal cut-off value of the strain ratio for differentiating between malignant and benign breast lesions, RTE findings were compared with histopathology of core needle biopsy samples or with ultrasound follow-up data of the analyzed masses.ResultsSeventy-nine breast lesions [BI-RADS category 3 (n=15), BI-RADS category 4 (n=34), and BI-RADS category 5 (n=30)] were classified as malignant (n=36) or benign (n=43). The mean strain index value was 6.59±3.44 (range 0.6–14) for malignant lesions and 2.79±2.16 (range 0.6–8.7) for benign lesions, respectively (p<0.05). As regards the detection of malignant lesions, US was characterized by sensitivity and specificity of 100% (CI 95%; 88–100) and 90% (CI 95%; 76–97), respectively. When an optimal value of the strain ratio (4.25) was obtained by ROC curve analysis, the sensitivity and specificity for diagnosing malignant lesions were 86% (CI 95%; 70–95) and 76% (CI 95%; 60–87), respectively.ConclusionsRTE can play an important role in the differentiation between malignant and benign breast masses, but it should be used in conjunction with ultrasonography.
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