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    A new model for prediction of bowel gangrene in sigmoid volvulus
    (Turkish Assoc Trauma Emergency Surgery, 2023) Ceylan, Cengiz; Baran, Necip Tolga; Kocaaslan, Huseyin; Gungorur, Omer; Cengiz, Emrah; Guzel, Mehmet; Angin, Yavuz Selim
    BACKGROUND: Sigmoid volvulus is a pathology that can be mortal because it is frequently encountered in elderly patients. In case of bowel gangrene, mortality and morbidity increase further. We planned a retrospective study, in which the effectiveness of the model was evaluated by creating a model that aims to predict whether intestinal gangrene is present in patients with sigmoid volvulus only by blood tests and thus to quickly guide treatment methods.METHODS: In addition to demographic data such as age and gender, laboratory values such as white blood cell, C-reactive protein (CRP), lactate dehydrogenase (LDH), potassium, and colonoscopic findings and whether there was gangrene in the colon during the operation were evaluated retrospectively. In the analysis of the data, independent risk factors were determined by univariate and multivariate logistic regression analyzes as well as Mann-Whitney U and Chi-square tests. Receiver operating characteristic (ROC) analysis was performed for statistically significant continuous numerical data, and cutoff values were determined and Malatya Volvulus Gangrene Model (MVGM) was created. The effectiveness of the created model was again evaluated by ROC analysis.RESULTS: Of the 74 patients included in the study, 59 (79.7%) were male. The median age of the population was 74 (19-88), and gangrene was detected in 21 (28.37%) patients at surgery. In univariate analyzes, leukocytes <4000/mm3 and >12000/mm3 (OR: 10.737; CI 95%: 2.797-41.211, p=0.001), CRP >= 0.71 mg/dl (OR: 8.107 CI 95%: 2.520-26.082, p<0.0001), potassium >= 3.85 mmoL/L (OR: 3.889; 95% CI): 1.333-11.345, p=0.013), and LDH >= 288 U/L (OR: 3.889; CI 95%: 1.333-11.345, p=0.013), whereas, in multivariate analyzes, only CRP >= 0.71 mg/dL (OR: 3.965; CI 95%: 1.071-15.462, p=0.047) was found to be an independent risk factor for bowel gangrene. The strength of MVGM was AUC 0.836 (0.737-0.936). In addition, it was observed that the probability of bowel gangrene increased approximately 10 times if MVGM was >= 7 (OR: 9.846; 95% CI: 3.016-32.145, p<0.0001).CONCLUSION: Besides being non-invasive compared to the colonoscopic procedure, MVGM is a useful method for detecting bowel gangrene. In addition, it will guide the clinician in taking the patients with intestinal loop gangrene to emergency surgery without wasting time in the treatment steps, as well as avoiding complications that may occur during colonoscopy. In this way, we think that morbidity and mortality rates can be reduced.
  • Küçük Resim Yok
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    The coexistence of gastrointestinal stromal tumors and malignancies: Our 10-year results
    (Galenos Publ House, 2024) Angin, Yavuz Selim; Ceylan, Cengiz; Saglam, Kutay; Aydin, Cemalettin
    Objective: Gastrointestinal stromal tumor (GIST) is one of the most common mesenchymal tumors in the gastrointestinal system, occurring frequently after epithelial tumors. Although rare, secondary epithelial malignancies can be associated with GISTs. It was planned to conduct a retrospective cohort study evaluating the coexistence of GISTs with malignancies and their long-term outcomes through clinical and pathological findings. Material and Methods: Demographic and clinicopathological data of 69 patients who underwent surgery for GIST between January 2011 and November 2021 were retrieved from the patient database. Variables between the groups with only GIST and those with a secondary malignancy alongside GIST were analyzed using the Chi-square test and Mann-Whitney U test. Long-term survival analyses were conducted using the Kaplan-Meier test. A p-value of <0.05 was considered statistically significant. Results: Out of the 69 patients in our population, 40 (58%) were male, and the median age was 65 years (interquartile range= 56-75). GIST was the most commonly located in the stomach (59.4%), and nine (13%) patients had a secondary malignancy. Tumor size, smooth muscle antibody (SMA), and S100 antibody expression showed significant differences between the groups (p< 0.001, p= 0.015, p= 0.006). Shorter survival was observed in patients with GIST plus secondary malignancy (p= 0.005). Conclusion: The incidence of other intraabdominal malignancies occurring alongside GISTs is more common than have been previously thought. While the presence of a secondary malignancy does not impact the overall survival (OS) in GISTs, it was observed that survival is dependent on the primary malignancy. Patients diagnosed with GISTs require thorough investigation and close monitoring for secondary malignancies.