OBJECTIVES:The efficacy of combined lumbar plexus-sciatic nerve blocks was compared to epidural anesthesia in patients undergoing total knee surgery.PATIENTS AND METHODS:The study included 80 American Society of Anesthesiologists (ASA) Physical Status I–III patients (age range 18 to 65) undergoing knee surgery. The patients were randomly divided into one of two groups. Epidural anesthesia was performed in the epidural anesthesia (EA) group (n=40), and the lumbar plexus and sciatic nerves were blockedin the lumbar plexus-sciatic nerve blocks (LPSB) group (n=40). For each patient, onset of sensory and motor block, degree of motor block, sign of sensory block in the contralateral lower limb for the lumbar plexus-sciatic nerve blocks group, success in providing adequate anesthesia, hemodynamic changes, time of first analgesic request, and patient and surgeon satisfaction with the anesthetic technique were recorded.RESULTS:One patient in the epidural anesthesia group and three patients in the lumbar plexus-sciatic nerve blocks group required general anesthesia due to failed block. There were no significant differences between the two groups regarding the success of providing adequate anesthesia. Eight patients in the lumbar plexus-sciatic nerve blocks group developed contralateral spread. The onset of sensory-motor block and the time of the first analgesic request were significantly later in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. Although there were no significant differences regarding patient satisfaction with the anesthetic technique between the two groups, surgeon satisfaction was significantly higher in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group.CONCLUSION:The lumbar plexus -sciatic nerve blocks provide effective unilateral anesthesia and may offer a beneficial alternative to epidural anesthesia in patients undergoing total knee surgery.

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Objectives: This study aimed to investigate the contributory role of histogram-based textural features (HBTFs) extracted from 18 fluorinefluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) in tumoral heterogeneity (TH) evaluation and invasive lung adenocarcinoma (ILA) prognosis prediction. Methods: This retrospective study analyzed the data of 72 patients with ILA who underwent 18 F-FDG PET/CT followed by surgical resection. The maximum standardized uptake value (SUV max ), metabolic tumor volume, and total lesion glycolysis values were calculated for each tumor. Additionally, HBTFs were extracted from 18 F-FDG PET/CT images using the software program. ILA was classified into the following five histopathological subtypes according to the predominant pattern: Lepidic adenocarcinoma (LA), acinar adenocarcinoma, papillary adenocarcinoma, solid adenocarcinoma (SA), and micropapillary adenocarcinoma (MA). Differences between 18 F-FDG PET/CT parameters and histopathological subtypes were evaluated using non-parametric tests. The study endpoints include overall survival (OS) and progression-free survival (PFS). The prognostic values of clinicopathological factors and 18 F-FDG PET/CT parameters were evaluated using the Cox regression analyses. Results: The median SUV max and entropy values were significantly higher in SA-MA, whereas lower in LA. The median energy-uniformity value of the LA was significantly higher than the others. Among all parameters, only skewness and kurtosis were significantly associated with lymph node involvement status. The median values for follow-up time, PFS, and OS were 31.26, 16.07, and 20.87 months, respectively. The univariate Cox regression analysis showed that lymph node involvement was the only significant predictor for PFS. The multivariate Cox regression analysis revealed that higher SUV max (≥11.69) and advanced stage (IIB-IIIA) were significantly associated with poorer OS [hazard ratio (HR): 3.580, p=0.024 and HR: 7.608, p=0.007, respectively]. Conclusion: HBTFs were tightly associated with clinicopathological factors causing TH. Among the 18 F-FDG PET/CT parameters, only skewness and kurtosis were associated with lymph node involvement, whereas SUV max was the only independent predictor of OS. TH measurement with HBTFs may contribute to conventional metabolic parameters in guiding precision medicine for ILA.

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Objectives: This study investigates the relationship between 18 fluoride-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) parameters and histopathological features in patients with early-stage invasive ductal breast carcinoma (IDBC). Methods: Patients with early-stage IDBC who underwent 18 F-FDG PET/CT scan for staging were included in this retrospective study. The status of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2, Ki-67 proliferative index, and grades of tumors were recorded. The conventional metabolic parameters [maximum standard uptake value (SUV max ) and average standard uptake value] and volume-based parameters [metabolic tumor volume (MTV) and total lesion glycolysis] of the primary tumor were obtained from the 18 F-FDG PET/CT images. The associations and correlations between the 18 F-FDG PET/CT parameters and histopathological features were assessed. Results: One hundred forty-three patients were included. 18 F-FDG PET/CT parameters, other than MTV, were significantly associated with the ER and PR status and Ki-67 index, while T-staging was significantly associated with all 18 F-FDG PET/CT parameters. In the axillary lymph node (ALN) involvement, no significant difference was found in the 18 F-FDG PET/CT parameters. In terms of the pathological stage, a significant difference was found in all 18 F-FDG PET/CT parameters. 18 F-FDG PET/CT parameters, other than MTV, were significantly higher in non-luminal breast tumors than luminal tumors and in high-grade tumors than low-grade ones. Triple-negative tumors had the highest 18 F-FDG PET/CT parameter, but the difference was insignificant for MTV. The SUV max had the strongest correlation with Ki-67 proliferative index. Conclusion: Tumors with aggressive histopathological features had higher 18 F-FDG PET/CT parameter values. This study suggests that 18 F-FDG PET/CT may provide prognostic information in patients with early-stage IDBC.

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Objective: In this study, we aimed to determine the independent predictive parameters of overall survival (OS) of patients with inoperable pancreatic ductal adenocarcinoma (PDAC) and to investigate whether these parameters can be used as potential biomarkers to shape precision medicine practices for PDAC patients. Material and Methods:The clinical and pathological data of patients who were diagnosed with inoperable pancreatic ductal adenocarcinoma between January 2016 and December 2019 and who underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in our department were retrospectively analyzed. Tumor diameter, maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated from FDG PET/CT images. Univariate and multivariate Cox regression analyzes were performed to investigate the variable affecting overall survival. Overall survival data were analyzed using the Kaplan-Meier method, using the log-rank test. Results: A total of 48 patients, 31 male and 17 female, with a mean age of 65.85 ± 1.64 were included in the study. In univariate Cox regression analyzes were performed to examine the factor affecting OS. Clinicopathological factors (tumor localization, tumor diameter, stage) and FDG PET/CT parameters (SUVmax, MTV and TLG) with a p-value of < 0.2 were compared to multivariate Cox regression analysis. TLG was found to be the only independent predictor of OS. In the Kaplan-Meier analysis, the median OS duration of the patients with a median value of TLG below 298.34 was 13.87 months, while the median OS duration was found to be 4.97 months in patients with a TLG value above this value. Conclusion: In our study, TLG value, which is an FDG PET/CT parameter that reflects both the metabolic activity and the volume of the tumor, was found to be the only independent predictor of the OS of inoperable PDAC patients. TLG can be used as a potential biomarker for survival in patients with inoperable PDAC and may assist precision medicine applications.