Erol Aksoy

The predictive value of mean platelet volume in differential diagnosis of non-functional pancreatic neuroendocrine tumors from pancreatic adenocarcinomas

OBJECTIVE The aim of the present study is to evaluate in a retrospective manner the diagnostic value of mean platelet volume (MPV) in pancreatic adenocarcinomas and pancreatic neuroendocrine tumors (PNETs). PATIENTS AND METHODS A total of 92 patients, who were admitted for pancreatic adenocarcinoma (n=76) and PNET (n=16) between March 2007 and December 2009, were analyzed retrospectively for demographics and clinical information. RESULTS Thirty-nine patients (51.3%) had a resectable, whereas 37 patients (48.7%) had an unresectable pancreatic adenocarcinoma. Nine patients (56.3%) had a non-functional PNET, 6 patients (37.5%) had an insulinoma, and the remaining one patient had a gastrinoma. The mean age was 59.3±10.5 for pancreatic adenocarcinomas and 45.1±10.6 for PNETs. The mean age at diagnosis was significantly higher in patients with pancreatic adenocarcinomas than the patients with PNET (p<0.001). Preoperative mean hemoglobin levels were significantly lower in patients with pancreatic adenocarcinoma than those with PNET (12.4±1.8g/dl vs 13.7±2.2g/dl), (p<0.013). The preoperative median MPV levels were significantly lower in patients with PNET 7.8fL (7.2-9.4) than in patients with pancreatic adenocarcinomas 8.6fL (6.6-13.5), (p<0.014). In subgroup analysis, a significant difference in MPV levels was mainly caused by the difference between pancreatic adenocarcinomas and non-functional PNETs (p=0.017). The cut-off value of MPV level for detection of PNETs was calculated as≤7.8fL using ROC analysis [Sensitivity: 66.7%, specificity: 75.9%, AUC: 0.734 (0.587-0.880) p=0.022]. In logistic regression analysis, independent predictive factors for determining PNETs in the differential diagnosis of pancreatic adenocarcinomas were calculated as age (OR=0.068, 95% CI: 0.012-0.398), Ca 19-9 (OR=0.039, 95% CI: 0.006-0.263), MPV (OR=0.595, 95% CI: 0.243-1.458), and hemoglobin (OR=1.317, 95% CI: 0.831-2.086). CONCLUSION Age, Ca 19-9, MPV, and hemoglobin levels have diagnostic value for distinguishing PNETs from pancreatic adenocarcinomas.

Effects of dexamethasone and pheniramine hydrogen maleate on stress response in patients undergoing elective laparoscopic cholecystectomy

BACKGROUND Laparoscopic cholecystectomy (LC) still leads to significant postoperative nausea and vomiting (PONV) and pain. Our aim was to evaluate the efficacy of dexamethasone or pheniramine hydrogen maleate, either alone or combined, in reducing the stress response and symptoms after LC. METHODS Patients were randomly assigned to 1 of 4 groups, each consisting of 20 patients: control, dexamethasone (8 mg/2 mL), pheniramine hydrogen maleate (45.5 mg/2 mL), and the combined group. The drugs were given before anesthesia induction. RESULTS C-reactive protein levels (CRP) and visual analog scale (VAS) scores were significantly less in the dexamethasone (P = .003) and combined groups (P < .001). Both dexamethasone (P < .001) and pheniramine hydrogen maleate (P = .005) significantly reduced PONV. CONCLUSIONS Dexamethasone significantly reduced postoperative pain and the systemic acute-phase response, whereas these effects were only partially attained with pheniramine hydrogen maleate. Both dexamethasone and pheniramine hydrogen maleate significantly reduced PONV. An additive effect seemed to occur if these drugs were used in combination.

Hepar lobatum carcinomatosum associated with metastatic rectal carcinoma: an unusual cause of liver dysmorphy.

Objective: The aim of this study was to present a case of hepar lobatum resulting from metastatic rectal carcinoma. Clinical Presentation and Intervention: A 50-year-old man presented with a 2-year history of bleeding per anum, tenesmus, malaise and weakness. Initially, the patient received neoadjuvant chemoradiotherapy followed by abdominoperineal resection of the rectum. Abdominal computed tomography showed lobar enlargement and lobulated contour, mainly in the left lobe of the liver, but no primary or metastatic lesions were detected. Laparotomy revealed an irregularly lobulated hepatic deformity. Liver biopsy showed a necrotic tumor growth from adenocarcinoma of the rectum in subcapsular localizationof the liver. Conclusion: This case showed a patient with hepar lobatum carcinomatosum caused by metastatic rectal carcinoma. The report further highlights the need for clinicians and surgeons to keep in mind the possibility of hepar lobatum carcinomatosum while caring for rectal carcinoma patients, especially when the lobulated contour of the liver is detected at preoperative imaging studies or when the coarsely lobated liver is encountered during surgery for carcinoma of the rectum.

The impact of PET/CT on the management of hepatic and extra hepatic metastases from gastrointestinal cancers

PURPOSE To investigate the efficacy of positron emission tomography/computed tomography (PET/CT) in detection and management of hepatic and extrahepatic metastases from gastrointestinal cancers. MATERIALS AND METHODS Between February 2008 and July 2010, patients histopathologically diagnosed with gastrointestinal cancer and showing suspected metastasis on CT screening were subsequently evaluated with PET/CT. All patients were subgrouped according to histopathological origin and localization of the primary tumor. Localization of gastrointestinal cancers was further specified as lower gastrointestinal system (GIS), upper GIS, or hepato-pancreato-biliary (HPB). Both accuracy and impact of CT and PET/CT on patient management were retrospectively evaluated. RESULTS One hundred and thirteen patients diagnosed histopathologically with gastrointestinal cancers were retrospectively evaluated. Seventy-nine patients had adenocarcinoma and 34 patients other gastrointestinal tumors. Forty-one patients were in the upper GIS group, 30 patients in the HPB group, and 42 patients in the lower GIS group. Evaluation the diagnostic performance of PET/CT for suspected metastasis according to histopathological origin of the tumor, revealed that the sensitivity of PET/CT - although statistically not different - was higher in adenocarcinomas than in non-adenocarcinomas (90% (95% CI, 0.78-0.96) vs. 71.4% (95% CI, 0.45-0.88), P=0.86). The specificity was not significantly different (85.7% (95% CI, 0.70-0.93) vs. 85% (95% CI, 0.63-0.94), P=1.00). In the overall patient group; CT was significantly more sensitive than PET/CT for detection of hepatic metastases (94.7% vs. 78.9%, P=0.042), whereas PET/CT was significantly more specific than CT (48% vs. 98.7%, P<0.001). In subgroup analysis, sensitivity was not significantly different (P>0.05) but specificity was significantly higher in PET/CT than CT (P<0.05). The specificity of PET/CT was highest in upper GIS (100%) and HPB (100%) subgroups. In the overall patient group; for detection of extrahepatic metastasis, the sensitivity of CT (75%) and PET/CT (87.5%) showed no significant difference (P=0.437). However, PET/CT was significantly more specific than CT (88.7% vs. 70.4%, P=0.007). In subgroup analysis, no significant difference was found between CT and PET/CT either in sensitivity or in specificity (P>0.05). The specificity of PET/CT was highest in the lower GIS subgroup (93%). The management of 45 patients (39.8%) was revised after PET/CT evaluation. CONCLUSIONS PET/CT has a higher specificity than CT in detecting suspected hepatic and extrahepatic metastases of gastrointestinal cancers, and has an impact of nearly 40% on changing patient management strategies.

Zenker divertikülünün cerrahi tedavisi

GIRIŞ Zenker divertikulu, faringeal pos veya hipofaringeal divertikul, ilk kez 1769 yilinda Ludlow tarafindan hayati boyunca yutma guclugunden yakinan bir hastanin otopsisinde farinks arka duvarinda cok buyuk bir kese seklinde olusumun tespit edilmesiyle tip literaturunde yerini almistir (1). Yaklasik yuzyil kadar sonra 1877’de Alman patologlar Zenker ve Ziemssen 27 hastayi iceren bir seri yayinlamis ve faringeal posu hipofarinksin ozofagusla birlestigi yerin arka duvarinda faringeal mukozanin fitiklasmasi olarak tanimlamislardir (2). Bu calismanin yayinlanmasinin ardindan faringeal pos, Zenker divertikulu olarak adlandirilmaya baslanmistir.

A rare case: Submucosal colonic splenosis

Splenosis may be encountered following elective splenectomy, although it usually occurs after secondary implantation due to splenic trauma. Splenosis cases of secondary implantation causing from trauma form at the seros allayer of bowel. In ourcase, pathological examination of the submucosal mass was consistent with splenosis. Frozen examination had avoided from an extended resection. Atypical localized splenosis should be kept in mind in traumatic cases and the extent of the operation should be minimalized due to peroperative frozen examination.

Five Years Experience in This Enigmatic Problem: Colorectal Endometriosis

Introduction Endometriosis affects primarily women of reproductive age and is responsible for impairing their quality of life. Presence of severe symptoms, stenosis of the intestinal lumen, diagnostic difficulty (suspicion of malignancy) and intolerance to hormonal therapy are indications for surgery. Despite numerous studies concerning endometriosis, there is still considerable controversy about its incidence, pathogenesis, diagnosis and optimal treatment. Methods This retrospective observational study includes 11 patients who were diagnosed with intestinal endometriosis between January 2009 and December 2013. Demographic data, clinical presentation, diagnostic modalities, localization of the disease and intraoperative data were collected. Results Median age of the patients was 43 (34–63). Eight patients had intermittent abdominal pain, seven had change in bowel habits and three had for rectal bleeding. Seven patients were operated on for severe stenosis of the intestinal lumen (intestinal obstruction) and three for a suspected malignancy. Postoperatively all of the patients who underwent resection were free of pain. No patient had any disease recurrence on USG or CT images. Discussion Intestinal endometriosis should be considered in female patients of reproductive age presenting with constipation, rectal bleeding and abdominal pain. Also repeated inadequate biopsies should raise suspicion of intestinal endometriosis. Intestinal endometriosis is a rare disease with diagnostic difficulties and despite medical management, treatment options are usually surgery. But in patients who were diagnosed preoperatively and did not have intestinal obstruction, medical therapy may be tried.Endometriosis primarily affects women of reproductive age, and is responsible for impairing their quality of life. The presence of severe symptoms, including stenosis of the intestinal lumen, diagnostic difficulty (suspicion of malignancy) and intolerance to hormonal therapy, are indications for surgery. Despite numerous studies on endometriosis, there is still considerable controversy about its incidence, pathogenesis, diagnosis and optimal treatment.

Roles of adiponectin and leptin as diagnostic markers in pancreatic cancer

NTRODUCTION Obesity is one of the most serious public health problem worldwide. Adipose tissue synthetize and secrete many growth factors and several cytokines known as adipokines. Studies demonstrated changes in the levels of these adipokines in many types of cancer associated with obesity. In this study, we aimed to evaluate the possible relationship between adiponectin and leptin levels with pancreas cancer and disease stage, representative of Turkish population. MATERIALS AND METHODS The study was conducted between April 2012 - November 2013. Study included 46 patients - 46 control subjects, who had pancreatic carcinoma. Results between the patients and the control group and relationship between the disease stage and results were evaluated. RESULTS The comparison of preoperative adiponectin and leptin levels of the study group with the levels of the control group showed that there was no correlation with adiponectin and pancreas cancer. In contrast, leptin levels in the study group were significantly lower than in the control group. There was no correlation between the disease stage and adiponectin and leptin levels. CONCLUSION There was a significant correlation between low leptin levels and pancreatic cancer, while adiponectin had no correlation. Differential diagnosis of pancreas cancer can be made by evaluating low leptin levels with elevated tumor markers (Tab. 3, Ref. 17).

Unresectable pancreatic adenocarcinoma with complete clinical response following chemoradiotherapy.

Locally advanced or metastatic disease is present in 2/3s of patients with pancreatic cancer. Pancreatic cancer patients are assessed as resectable, potentially resectable (borderline) and unresectable according to pre-operative examinations. The chance for operability may be enhanced by using adjuvant-neoadjuvant systemic chemotherapy, radiotherapy or both. The rates of R0 resection may be increased by means of treatment delivered this way. This case report presents a pancreatic adenocarcinoma case that was assessed to be resectable but was identified to be unresectable during surgical exploration, thus received adjuvant chemoradiotherapy. The patient was then re-evaluated, identified as resectable and received pancreaticoduodenectomy.

Response to: Platelet indices in differential diagnosis of pancreatic neuroendocrine tumors from pancreatic adenocarcinomas

We thank Varol for his interest in our article [1] and his comments on the method [2]. As we stated previously, MPV was studied preoperatively 1 h before surgery. This is thought to be as an acceptable time period. Because of its retrospective nature, data of patients including obesity, smoking andblood lipid values could not been found or re-evaluated. However, we were able to access the data of diabetes mellitus (DM) and hypertension (HT) in all patients having pancreas adenocarcinoma (n = 76) and in 13 of 16 patients who had pancreatic neuroendocrine tumor (PNET). DM co-existed in 33 patients (43.4%) with pancreatic adenocarcinoma, and in 3 patients (23.1%)with PNET. The difference between groups was not significant (p = 0.17). MPV values were not statistically different in DM (+) patients of the pancreatic adenocarcinoma group when compared with those who were DM (−) [MPV values in the pancreatic adenocarcinoma group: DM (+) vs. DM (−); 8.9 ± 1.3 vs. 8.7 ± 1.2, p = 0.52]. MPV values also were not statistically different in DM (+) patients of the PNET group when compared with those who were DM (−) [MPV values in the PNET group: DM (+) vs. DM (−); 7.6 (7.3–8.3) vs. 7.9 (7.2–9.4), p = 0.4]. HT was present in 14 patients (18.4%) of the pancreatic adenocarcinoma group, and in one patient (7.7%) of the PNET group, respectively. MPV values did not significantly differ whenwe compared patientswho have additionally HT in the pancreatic adenocarcinoma group with those who have not [MPV values in the pancreas adenocarcinoma group: HT (+) vs. HT (−); 8.6±0.9 vs. 8.8±1.3, p= 0.58].MPVvalues