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    Effectiveness of X-ray film in diagnosing peptic ulcer perforation
    (2024) Ceylan, Cengiz; Bilen, Zafer; Aydın, Cemalettin
    Purpose: A retrospective case-control study was undertaken to assess the diagnostic efficacy of X-ray film in detecting peptic ulcer perforation (PUP). Materials and Methods: The study retrieved demographic data, perioperative observations, and postoperative results of 353 patients from the hospital repository. These individuals were categorized into two cohorts depending on the detection of intraperitoneal free air on X-ray imaging. Results: The study cohort exhibited a median age of 57 years (interquartile range: IQR 38-71), comprising predominantly males (82.4%). Intraperitoneal free air was evident in 73.1% of patients on X-ray imaging. In the multivariate analyses of the respective groups, time interval and diabetes mellitus (DM) emerged as independent risk factors. Notably, the sensitivity of X-ray film heightened with prolonged duration between symptom onset and emergency department admission, while specificity increased in the presence of DM. Conclusion: The imperative for supplementary imaging modalities in conjunction with clinical assessment is apparent in the diagnostic approach to PUP. Nonetheless, the fluctuation in sensitivity and specificity of X-ray film concerning DM and the duration from symptom onset to emergency department admission warrants careful consideration. Especially in cases where clinical suspicion of PUP exists despite the absence of intraperitoneal free air on X-ray, the utilization of advanced diagnostic techniques is advocated.
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    Results of Intrahepatic Cholangiocarcinoma Resections: a Single-Center Analysis
    (Springer, 2022) Saglam, Kutay; Bag, Yusuf Murat; Bilen, Zafer; Isik, Burak; Aydin, Cemalettin; Yilmaz, Sezai
    Introduction Intrahepatic cholangiocarcinoma (ICC) is the second most common primary neoplasm of the liver after hepatocellular carcinoma (HCC). Although an underlying cause is not usually found, liver flukes, cirrhosis, primary sclerosing cholangitis, and viral hepatitis have been found to increase the risk in recent years. In this study, we aimed to present our experience on ICC and compare the outcomes of patients with a concomitant liver pathology and with incidentally detected ICC. Patients and Methods Thirty-three patients who underwent surgical resection for ICC were included in the study. Patients were divided into two groups, group one (with concomitant liver disease, n = 13) and group two (incidentally detected ICC, n = 18). Demographics, perioperative findings, pathological properties, recurrence rates, and survival rates were retrospectively analyzed and compared between the groups. Results The mean age of patients was 59.77 +/- 9.81 years, of whom sixteen (51.6%) were males. Thirteen patients (41.9%) had concomitant liver disease, the most common being chronic hepatitis B infection. Eighteen patients (58.1%) had incidentally detected ICC. There were no significant differences between the groups except for follow-up time and recurrence rate. The recurrence rate was significantly higher in the incidentally detected ICC group (61.1% versus 7.7%, p = 0.003). Follow-up time was significantly higher in patients with concomitant liver disease (42 versus 17.5 months, p = 0.007). The mortality rate was higher in the incidentally detected ICC group (55.6 to 23.1%, p = 0.071) but the difference did not reach statistical significance. Conclusion Surgical resection in ICC patients with underlying liver disease is associated with better prognosis than in incidentally detected ICC patients. Incidental ICC may be a different tumor with different biology, hence the high recurrence rates.