OBJECTIVE: This study aimed to examine the prognostic effect of the tumor-stroma ratio, which has been shown to have prognostic value in various cancers, in patients with gallbladder cancer who have undergone curative resection. METHODS: The records of gallbladder cancer patients who underwent surgical treatment in our clinic between December 2005 and March 2021 were analyzed retrospectively. The hematoxylin and eosin-stained sections representing the tumors were evaluated under light microscopy to determine tumor-stroma ratio, and based on the results, <50% was defined as the stroma-rich and ≥50% as the stroma-poor groups. RESULTS: A total of 28 patients, including 20 females and 8 males, with a mean age of 64.6 years, were included in this study. Stroma-poor and stromarich tumors were detected in 15 and 13 patients, respectively. There was no statistically significant relationship identified between tumor-stroma ratio and advanced age, gender, serum levels of carbohydrate antigen 19-9 and carcinoembryonic antigen, incidental or nonincidental diagnosis, jaundice, adjacent organ or structure resection, tumor location, grades 1-2 or 3, T1/T2 or T3/T4, N0 or N1/N2, M stage, American Joint Committee on Cancer stage, lymphovascular invasion, and perineural invasion. The stroma-poor and stroma-rich groups had a 5-year survival rate of 30% and 19.2% and a median overall survival of 25.7 and 15.1 months, respectively, with no statistically significant difference between the groups (p=0.526). CONCLUSIONS: A low tumor-stroma ratio tended to be a poor prognostic factor in gallbladder cancer, although not to a statistically significant degree. This can be considered one of the preliminary studies, as further studies involving larger groups are needed.
OBJECTIVE: COVID-19 outbreak has become widespread globally and caused a new global chaos. This outbreak that completely affected the lifestyle of individuals resulted in periods of isolation. Here, we evaluated the effects of lifestyle changes with isolation on constipation. METHODS: A survey on constipation was performed during the 12-week isolation period starting in March 2020 in Turkey. Data of 390 individuals who participated in the survey through the social media and who were actively employed prior to isolation were analyzed. Rome IV criteria were used to evaluate constipation. RESULTS: Among the participants in the study, 253 (64.9%) were women with the mean age of 39.5±9.5 years. A statistically significant association was found between the decreased water consumption during the isolation period and constipation after the isolation (p=0.020; p<0.05). A significant association was found between the changes in physical activity and constipation after the isolation (p=0.013; p<0.05). New development of constipation during the isolation or declaration of increased constipation was found to be statistically associated with post-isolation constipation according to Rome criteria (p=0.000; p<0.05). CONCLUSION:The data of this present study demonstrated that isolation period was effective on the newly developed constipation. Decreased physical activity and water consumption are also effective on constipation.
Akut pankreatit pankreasın akut inflamatuar bir hastalığıdır. Hastaların çoğunda hafif seyrederken, yaklaşık %10-20'sinde şiddetli seyredip ciddi morbidite ve mortalite riski taşır. Şiddetli akut pankreatit hastalarının, uygun merkezlerde ve gereğinde yoğun bakım ünitelerinde yapılan erken agresif tedavisi ile morbidite ve mortalite düşürülebilmekte olup akut pankreatit şiddetini erken ve güvenilir bir şekilde ön görebilmek önemlidir.Gereç ve Yöntemler: Bu çalışmada, akut pankreatit şiddetini öngörmede BISAP (bedside index for severity) skoru ile APACHE II (Acute Physiology and Chronic Health Evaluation score at admission) skorunun karşılaştırılması amaçlandı. Bu amaçla mart 2015 -temmuz 2016 arasında tedavi ettiğimiz 86 akut pankreatit hastası çalışmaya alındı. Hastaların ortalama yaşı 52,33 olup 48'i (%55,8) kadındı. Revize Atlanta kriterlerine göre 58 (%67,4) hastada hafif, 20 (%23,3) hastada orta şiddette ve 8 (%9,3) hastada şiddetli pankreatit saptandı. Şiddetli akut pankreatit olan bir hasta eksitus oldu. Genel mortalite %1,16 ve şiddetli akut pankreatit için mortalite %12,5 idi.Bulgular: Hastalar başvuruda, 24. saat ve 48. saatte APACHE II ve BISAP skorlaması ile değerlendirildi. BISAP skorlamasında ≥2 olan 11 (%12,8) hastanın 5'i (%45,45) şiddetli akut pankreatit, 5'i orta şiddette akut pankreatit ve 1'ide (%9,09) hafif akut pankreatit idi. Başvuruda BISAP skoru <2 olan 75 hastanın ise sadece 3'ünde (%4) şiddetli akut pankreatit saptandı. Başvuruda APACHE II skoru ≥8 olan 9 (%10,5) hastanın 6'sı (%66,7) şiddetli akut pankreatit, 3'ü ise orta şiddette akut pankreatit idi. Skoru <8 olan 77 hastanın ise sadece 3'ünde (%2,6) şiddetli akut pankreatit saptandı. 24. ve 48. saat APACHE II skoru ≥8 olan 4 hastanın (%4,7) tamamı şiddetli akut pankreatit idi. Şiddetli akut pankreatit gelişmesinin BISAP ile öngörülmesinde duyarlılık %62,50; özgüllük % 92,31; pozitif prediktif değer %45,45 ve negatif prediktif değer %96 olarak saptandı. Şiddetli akut pankreatit gelişmesinin APACHE II ile öngörülmesinde; başvurudaki APACHE II için duyarlılık %75; özgüllük % 96,15; pozitif prediktif değer %66,67 ve negatif prediktif değer %97,40 iken 24. saat ve 48. saat APACHE II için duyarlılık %50; özgüllük % 100; pozitif prediktif değer %100 ve negatif prediktif değer %95,12 olarak saptandı.. Sonuç: Çalışmamızda akut pankreatitin şiddetini öngörmede BISAP skorlaması ile gerek başvuruda gerekse 24. ve 48. saat APACHE II skorlamaları arasında istatistiksel anlamlı pozitif korelasyon saptandı. Etkinlikleri değerlendirildiğinde de benzer doğrulukta oldukları görüldü. Sonuç olarak; BISAP skorlamasının akut pankreatit şiddetini öngörmede, uygulaması zor ve karmaşık bir yöntem olan APACHE II skorlaması yerine daha kolay ve basit bir yöntem olarak uygulanabileceğini düşünmekteyiz.
Objective: Gallbladder cancer is relatively rare and traditionally regarded as having poor prognosis. There is controversy about the effects of clinicopathological features and different surgical techniques on prognosis. The aim of this study was to investigate the effects of clinicopathological characteristics of the patients with surgically treated gallbladder cancer on long-term survival. Material and Methods: We retrospectively analyzed the database of gallbladder cancer patients treated at our clinic between January 2003 and March 2021. Results: Of 101 evaluated cases, 37 were inoperable. Twelve patients were determined unresectable based on surgical findings. Resection with curative intent was performed in 52 patients. The one-, three-, five-, and 10-year survival rates were 68.9%, 51.9%, 43.6%, and 43.6%, respectively. Median survival was 36.6 months. On univariate analysis, poor prognostic factors were determined as advanced age; high carbohydrate antigen 19-9 and carcinoembryonic antigen levels; non-incidental diagnosis; intraoperative incidental diagnosis; jaundice; adjacent organ/structure resection; grade 3 tumors; lymphovascular invasion; and high T, N1 or N2, M1, and high AJCC stages. Sex, IVb/V segmentectomy instead of wedge resection, perineural invasion, tumor location, number of resected lymph nodes, and extended lymphadenectomy did not significantly affect overall survival. On multivariate analysis, only high AJCC stages, grade 3 tumors, high carcinoembryonic antigen levels, and advanced age were independent predictors of poor prognosis. Conclusion: Treatment planning and clinical decision-making for gallbladder cancer requires individualized prognostic assessment along with standard anatomical staging and other confirmed prognostic factors.
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