Background: The apparent diffusion coefficient (ADC), the quantitative parameter of diffusion-weighted magnetic resonance imaging (DW-MRI), is a measure for this restricted diffusion, and its role in gastric cancer (GC) including distinguishing malignant segments from healthy gastric wall, metastatic perigastric lymph nodes from benign nodes and evaluating response of GC to neoadjuvant chemotherapy has been investigated in previous studies. Evidence suggests that ADC may also be of help in assessment of aggressiveness and preoperative staging of gastric cancer, which needs to be explored in further studies. Objective: To investigate the role of DW-MRI and its quantitative parameter, ADC in staging of gastric cancer. Methods: Forty-six patients (28 male, 18 female, mean age 62 years) with non-metastatic biopsy- proven GC who underwent abdominal DW-MRI before surgery were included in this retrospective study. Tumor invasion depth (T-stage) and nodal involvement (N-stage) were evaluated using signal increase on DW-MRI, and tumor ADC was measured. Diagnostic performance of these results was assessed by comparing them with postsurgical histopathology based on 8th TNM classification. Results: Sensitivity, specificity, and accuracy of DW-MRI in T-staging were 92.1%, 75%, 89.1% for ≤T2 vs. ≥T3; and 75%, 88.5%, 82.6% for ≤T3 vs. T4. However, sensitivity, specificity, and accuracy of DW-MRI in N-staging were 89.3%, 88.9%, 89.1% for ≤N1 vs. ≥N2; and 73.7%, 96.3%, 86.9% for ≤N2 vs. N3, respectively. Relative preoperative ADC values correlated with pT staging (r=-0.397, p=0.006). There was also a statistically significant difference of relative ADC values between ≤T3 and T4 stages, and a cut-off of 0.64 s/mm2 could differentiate these stages with an odds ratio of 7.714 (95% confidence interval, 1.479-40.243). The area under the receiver operating characteristic curve for differentiating ≤T3 and T4 stages was 0.725. Conclusion: DW-MRI may contribute to the clinical staging of non-metastatic GC. In particular, relative ADC of DW-MRI can distinguish T4 gastric cancer from less advanced T-stages.

Complication-free thyroid surgery is mainly based on the motor integrity of the recurrent laryngeal nerve (RLN). The nonrecurrent laryngeal nerve (non-RLN) is a rare anatomical variation that may increase the risk of vocal cord palsy. Early identification and exposure of the non-RLN may minimize injury risk. This case report presents functional detection of the nonRLN by intraoperative neuromonitoring (IONM). Total thyroidectomy was performed under the guidance of IONM on a patient with bulky multinodular goiter. The first step of IONM is pre-dissection stimulation (V1) of the right vagus nerve (VN). VI at a standard distal point was negative as indicated by the absence of both a sound signal and wave amplitude. The right VN was then followed proximally and dissected under the guidance of IONM. This dissection established a proximal point creating a positive signal that led us to determine the separation point of the non-RLN. The right non-RLN arising from the proximal VN was identified and fully exposed until laryngeal entry. Its motor integrity was confirmed with post-dissection signals. The left RLN was identified at the usual anatomical position that was fully exposed and preserved during thyroid surgery. Total thyroidectomy was then accomplished without complication. The postoperative period was uneventful. Postoperative laryngoscopy confirmed normal vocal cord function. The non-RLN is accurately identified by IONM during the early part of the thyroid surgery. The absence of a distal VN signal is predictive of the non-RLN. IONM-guided proximal dissection of the right VN leads to the identification of the non-RLN. The prediction of the non-RLN by the absence of a VN signal during an early stage of surgery may prevent or minimize the risk of nerve injury.

Acute appendicitis is a common condition requiring surgical intervention, with a lifetime risk of 7–8%. Differentiating between uncomplicated and complicated appendicitis is essential for appropriate treatment and improved patient outcomes. This study aimed to utilize minimal, non-invasive data to distinguish between these forms of appendicitis, using advanced analytical methods for faster and more precise diagnosis. This retrospective study analyzed acute appendicitis cases from January 2018 to December 2022 at a tertiary care hospital. Data were gathered from 3,045 patients, including demographic details, clinical features, laboratory tests (Red Cell Distribution Width [RDW] and Mean Platelet Volume [MPV]), and imaging results. Patients were classified as having uncomplicated or complicated appendicitis based on surgical and histopathological findings. Statistical analyses, including multivariate logistic regression and ROC curve analyses, were performed using SPSS. Complicated appendicitis was defined based on surgical findings and histopathological criteria, including perforation, abscess formation, or gangrene. Uncomplicated appendicitis was defined as inflammation confined to the appendix without evidence of perforation or abscess. The study population comprised 1,869 males (61.37%) and 1,176 females (38.62%), with a mean age of 36.4 years. The mean RDW was 27.81%, and the mean MPV was 8.68 fL. Among the appendectomy cases, 50.7% were acute appendicitis, 10.3% were negative appendectomies, and 38.9% had complicated appendicitis. RDW was significantly higher in acute appendicitis than in negative cases (t = 2.45, p = 0.02) and even higher in complicated cases (t = 3.78, p = 0.001). MPV was highest in complicated appendicitis, consistent with increased inflammation severity (t = 2.56, p = 0.01). The sensitivity and specificity of RDW for identifying complicated appendicitis were 0.85 and 0.75, respectively, and for MPV, they were 0.80 and 0.70. Univariate logistic regression identified male sex and appendix diameter as significant predictors of complicated appendicitis. In multivariate analysis, appendix diameter remained significant (p = 0.01), and male sex approached significance (p = 0.06). The optimal cutoff for appendix diameter to differentiate appendicitis types was 10 mm, with an AUC of 0.82. RDW, MPV, and appendix diameter provide a reliable method for distinguishing between uncomplicated and complicated appendicitis. Combining these biomarkers enhances diagnostic accuracy and enables precise risk stratification for better patient management.

The objective of this study was to evaluate and compare the histopathological, clinical, and treatment characteristics of xanthogranulomatous cholecystitis (XGC) in patients undergoing cholecystectomy at a single center. Aim: We aim to enhance the understanding of its presentation and improve its differential diagnosis from other gallbladder pathologies. Methods: We retrospectively reviewed 6783 cholecystectomy cases performed between January 2015 and January 2023 at the General Surgery Clinic of Haydarpaşa Numune Training and Research Hospital, and a diagnosis of xanthogranulomatous cholecystitis was histopathologically established in 131 patients. In this retrospective study, we examined the clinicopathological characteristics, preoperative imaging methods and findings, histopathological images, surgical procedure methods, and postoperative complications of 131 patients. Results: The study included 131 patients, with ages ranging from 18 to 88 years, of which 74 (56.5%) were female and 57 (43.5%) were male. Ultrasound imaging was performed on 128 patients. Ultrasound imaging revealed wall thickening in 72.7% of cases, hypoechoic nodules in 13.3%, biliary tract pathologies in 10.9%, and adenomyomatosis in 3.1%. A total of 59 cases had MRI. On MRI, wall thickening was observed in 50.8% of cases, biliary tract pathologies in 33.9%, adenomyomatosis in 10.2%, hypoechoic nodules in 3.4%, and hypoechoic nodules + wall thickening (HN + WT) in 1.7%. Histopathological diagnosis was diffuse in 79.4% of cases and focal in 20.6%. In addition to cholecystectomy, non-surgical interventions were not required in 77.1% of the cases, while 11.5% underwent ERCP, 9.2% underwent percutaneous procedures, 1.5% underwent both ERCP and percutaneous procedures, and 0.8% underwent other non-surgical interventions. Of the surgeries, 93.1% were elective and 6.9% were emergency. Postoperative complications were not observed in 84% of the patients; 5.3% experienced surgical complications, 5.3% had surgical site infection, and 5.3% had other complications (pneumonia and urinary infection). The length of hospital stay ranged from 0 to 26 days, with a mean of 5.27 ± 4.59 days and a median of 4 days. Conclusions: Xanthogranulomatous cholecystitis is a rare disease of the gallbladder with no characteristic radiological or clinical findings and can often be confused with gallbladder cancer. Further studies involving larger populations are needed to improve the preoperative diagnosis.

Background and Objectives: Mucinous adenocarcinoma (MAC) and mucinous components (MCP) in colorectal cancers (CRC) have shown conflicting results regarding their prognostic impact. This study aims to evaluate survival differences between MAC, MCP, and non-mucinous adenocarcinoma (nMAC) in stage II and III CRC patients. Materials and Methods: 224 CRC patients who underwent surgery between 2013 and 2021 were analyzed retrospectively. Patients were classified as nMAC, MCP, or MAC based on the percentage of extracellular mucin. Those who received neoadjuvant therapy, had stage I or IV TNM disease, and emergency cases were excluded. Survival analysis was performed using Kaplan–Meier curves and Cox regression models. Results: MAC patients showed worse survival outcomes compared to nMAC (p = 0.025). No difference in survival was found between MCP and nMAC (p = 0.055). Multivariate analysis identified MAC (OR: 2.814; p = 0.014) and perineural invasion (PNI) (OR: 2.283; p = 0.008) as independent factors associated with worse survival. Kaplan–Meier analysis revealed MAC’s worse prognosis than nMAC (p = 0.027). Conclusions: MAC was shown to have a worse prognosis than nMAC in stage II and III CRC patients, while MCP survival rates were similar with nMAC. These findings suggest that MAC requires more careful treatment approaches, while MCP and nMAC have better survival rates. Further studies focusing on molecular and genetic profiles are needed to better understand these outcomes.

Objective: This study aimed to evaluate the gender predisposition, risk factors, clinical outcomes, and microbiological profile of patients with pilonidal sinus disease (PSD) and to compare these findings with existing literature. Materials and Methods: A prospective analysis was conducted on 159 patients diagnosed with PSD at Haydarpasa Numune Hospital between 2022 and 2023. Demographic data, BMI, smoking status, presence of diabetes, and treatment outcomes were collected. Pathogens isolated from abscesses and antibiotic treatments were analyzed, and recurrence rates were documented post-treatment. Results: The study cohort had a mean age of 26.0±9.8 years, predominantly male (71.1%). Significant differences in mean age and body mass index were observed between females (n=46) and males (n=113), with females averaging 21.6 years and males 27.8 years (p<0.001), and BMI values of 22.06 and 24.33, respectively (p=0.003). Anaerobic bacteria were slightly more prevalent in abscess cultures (50.9%), and the most commonly used antibiotic regimen was ciprofloxacin with metronidazole (54.7%). Conclusion: This study confirms a male gender predisposition to PSD and highlights significant age and BMI differences between genders. Specific antibiotic therapies may contribute to reducing relapse rates. These findings underscore the importance of targeted therapeutic strategies, particularly considering the higher recurrence rates in females and the predominant antibiotic resistance patterns.