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The construction of population-based variomes has contributed substantially to our understanding of the genetic basis of human inherited disease. Here, we investigated the genetic structure of Turkey from 3,362 unrelated subjects whose whole exomes (n = 2,589) or whole genomes (n = 773) were sequenced to generate a Turkish (TR) Variome that should serve to facilitate disease gene discovery in Turkey. Consistent with the history of present-day Turkey as a crossroads between Europe and Asia, we found extensive admixture between Balkan, Caucasus, Middle Eastern, and European populations with a closer genetic relationship of the TR population to Europeans than hitherto appreciated. We determined that 50% of TR individuals had high inbreeding coefficients (≥0.0156) with runs of homozygosity longer than 4 Mb being found exclusively in the TR population when compared to 1000 Genomes Project populations. We also found that 28% of exome and 49% of genome variants in the very rare range (allele frequency < 0.005) are unique to the modern TR population. We annotated these variants based on their functional consequences to establish a TR Variome containing alleles of potential medical relevance, a repository of homozygous loss-of-function variants and a TR reference panel for genotype imputation using high-quality haplotypes, to facilitate genome-wide association studies. In addition to providing information on the genetic structure of the modern TR population, these data provide an invaluable resource for future studies to identify variants that are associated with specific phenotypes as well as establishing the phenotypic consequences of mutations in specific genes.
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Variação Genética/genética , Genoma Humano/genética , Alelos , Consanguinidade , Exoma , Frequência do Gene/genética , Deriva Genética , Genética Populacional/métodos , Estudo de Associação Genômica Ampla/métodos , Genótipo , Haplótipos/genética , Migração Humana/tendências , Humanos , Turquia/etnologia , Sequenciamento do Exoma/métodosRESUMO
Background/aim: We aimed to search the relationship between the preoperative PVI (pleth variability index) and intraoperative respiratory parameters to reveal whether PVI can be used as a prediction tool in bariatric surgery. Materials and methods: Forty patients undergoing bariatric surgery were included. Noninvasive pleth variability index measured via finger probe before induction of general anesthesia. Following intubation each patient was ventilated in controlled mode. Intraoperative blood pressure, peak airway pressure, end-tidal CO2, SpO2, PEEP, and FiO2 were recorded every 5 min for the first 10 min and then every 10 min until extubation. Steroid and bronchodilator requirements were recorded. Results: The systolic pressure-PVI, oxygen saturation-PVI relationship was statistically significant (p = 0.03, p = 0.013). A relationship was found between pleth variability index and peak airway pressure (p = 0.002). No correlation was detected between end-tidal CO2 and pleth variability index. The relationship between steroid, bronchodilator use, and PVI was significant (p = 0.05, p = 0.01). A positive correlation between PEEP and PVI was detected at varying time points. A positive correlation was found between FiO2-PVI. Conclusion: A relationship was found between PVI and intraoperative peak airway pressures, oxygen saturation, PEEP, bronchodilatator, and steroid usage. This result may be inspiring to conduct larger studies addressing the issue of predicting intraoperative respiratory problems in bariatric surgeries.
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Cirurgia Bariátrica , Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Complicações Intraoperatórias/diagnóstico , Pletismografia/métodosRESUMO
PURPOSE: Airway problems may be experienced more often during anesthesia management in bariatric surgery. In this prospective study, we aimed to compare the incidence of difficult ventilation and intubation between bariatric surgery and other surgeries. DESIGN: This was a case-control study. METHODS: Medical records of 156 patients over the age of 18 who were scheduled for bariatric (n = 68) and nonbariatric surgery (n = 88) under general anesthesia were evaluated. FINDINGS: The percentage of ASA III, diabetes mellitus, and obstructive sleep apnea syndrome (75%, 33.8%, and 16.2%, respectively) was significantly higher in bariatric surgery patients compared to nonbariatric patients (14.8%, 10.2%, and 3.4%, respectively). No significant difference was found in mean thyromental distance and history of difficult intubation, restriction of cervical extension, beard presence, tooth loss, mallampati, Cormack-Lehane score, intubation score, difficult ventilation, difficult intubation and intubation device used. An increase in neck circumference (>50 cm) rather than body mass index was a more significant indicator in predicting difficult intubation and difficult ventilation. CONCLUSIONS: The incidences of difficult ventilation and difficult intubation were similar in bariatric and nonbariatric surgeries in circumstances where the necessary equipment and experienced anesthesiologists are available.
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Cirurgia Bariátrica , Intubação Intratraqueal , Adulto , Manuseio das Vias Aéreas , Estudos de Casos e Controles , Humanos , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND: Bariatric surgery is a critical risk factor for cholelithiasis. This study aimed to investigate the role of treatment with ursodeoxycholic acid (UDCA) in the prevention of gallstone formation after laparoscopic sleeve gastrectomy (SG) in morbidly obese patients. METHODS: Patients who underwent SG for morbid obesity from January 2016 to September 2016 were evaluated. Patients without hepatobiliary disorders were included. Patients were divided into two groups based on whether they did (Group I) or did not receive treatment with UDCA (Group II). Indication for UDCA treatment was symptomatic alkaline reflux. Demographic characteristics, comorbid diseases, preoperative blood parameters, early and late period weight loss rates, and gallstone development were monitored and compared between the groups. RESULTS: Ninety-six of 155 patients met the inclusion criteria. Group I and II included 49 and 47 patients, respectively. The mean age was 39.1 ± 10.8 (range 18-69) years and the mean follow-up period was 20.75 ± 6.6 (range 12-34) months. Gallstone formation was significantly lower in Group I compared to Group II [5 patients (10.2%) vs. 21 patients (44.6%), p<.001]. Moreover, the absence of UDCA treatment was independently and significantly associated with gallstone formation (hazard ratio: 3.08; 95% confidence interval: 1.73-5.50; p<.001) in multivariate analyses. There was no difference in weight loss rates between the two groups at the early or late periods. CONCLUSIONS: Treatment with UDCA seems to be effective in the prevention of gallstone formation after sleeve gastrectomy. Furthermore, early and late period weight loss rates were not found to have significant effects on the risk of cholelithiasis.
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Cálculos Biliares , Laparoscopia , Obesidade Mórbida , Pré-Escolar , Cálculos Biliares/etiologia , Cálculos Biliares/prevenção & controle , Cálculos Biliares/cirurgia , Gastrectomia/efeitos adversos , Humanos , Lactente , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Ácido Ursodesoxicólico/uso terapêuticoRESUMO
PURPOSE: Obesity and bariatric surgery are both risk factors for cholelithiasis (CL). However, most previous studies have focused on Roux-en-Y gastric bypass, and limited published data are available for sleeve gastrectomy (SG). METHODS: Patients were evaluated in two groups depending on the presence of gallstones (Group I, present; Group II, absent). Demographic characteristics, comorbid diseases, pre-operative blood values, and early and late weight loss rates were compared between the groups. RESULTS: The study included 111 patients with a mean age of 38.9. The mean follow-up period was 20.6 (12-39) months. During follow-up, gallstone formation was observed in 36.9% (n = 41) of patients. Thirteen patients (31.8%) had symptomatic cholelithiasis that was resolved with laparoscopic cholecystectomy. The mean interval between sleeve gastrectomy and the detection of cholelithiasis was 210 days and the mean time of post-operative cholecystectomy was 540 days. A multivariate analysis showed that only dyslipidemia was independently and significantly associated with gallstone formation. There was no significant difference in the weight loss rate between the groups. CONCLUSIONS: Although CL development was found to be associated with rapid weight loss in several published studies in post-SG patients, the present study showed no significant difference between the groups in terms of early or late weight loss. Pre-operative dyslipidemia may be associated with an increased risk of developing CL.
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Dislipidemias , Cálculos Biliares/etiologia , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Dislipidemias/complicações , Feminino , Seguimentos , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Fatores de Tempo , Redução de Peso , Adulto JovemRESUMO
Background/aim: Pregnancy after bariatric surgery is an issue of growing importance with increasing number of women undergoing bariatric surgery. Therefore, in this study we present patients who conceived after sleeve gastrectomy and evaluate the obstetric outcomes. Materials and methods: This retrospective case-control study includes 23 women who conceived after laparoscopic sleeve gastrectomy. Patients were evaluated in two groups according to the number of months between surgery and conception (group 1: ≤12 months; group 2: >12 months). Results: The mean body mass index of patients before surgery and at the time of conception was 46.6 kg/m2 and 29.7 kg/m2, respectively. Nine patients (39.1%) had a history of infertility. There was no statistical difference between groups 1 and 2 for haemoglobin, ferritin, and 25-OH Vit-D levels or maternofoetal complication rates and pregnancy outcomes. Enteral nutrition requirements and intravenous iron replacement needs were higher in group 1, although this difference was not statistically significant. Conclusion: Pregnancy in the first years after sleeve gastrectomy seems to have similar obstetric outcomes compared to pregnancies occurring later, but it remains a controversial issue. Although the results did not have statistical significance in our study, well-designed prospective series may determine the role of enteral nutrition and intravenous iron replacement in patient management.
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Cirurgia Bariátrica , Gastrectomia , Resultado da Gravidez , Adulto , Cirurgia Bariátrica/métodos , Feminino , Gastrectomia/métodos , Humanos , Laparoscopia , Gravidez , Estudos RetrospectivosRESUMO
Appendiceal mucocele is a rare entity which is characterized by cystic dilatation due to abnormal accumulation of mucus in the lumen of the appendix. Patients are often diagnosed incidentally by abdominal screening or abdominal surgery for other causes. Pain in the right lower quadrant of the abdomen, which may present as acute or chronic appendicitis, is the most common symptom of appendix mucocele, when the patient is symptomatic. This study describes the case of a 26-year-old female for whom surgical intervention for a complex ovarian cyst was planned, but who instead underwent laparoscopic appendectomy because appendiceal mucocele was determined during laparoscopic exploration.
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BACKGROUND/OBJECTIVE: Cholelithiasis is a common disease but pose significant global health and financial burdens. Mechanisms of the disease are associated with insulin resistance (IR), obesity, metabolic syndrome, and type 2 diabetes. Insulin resistance is commonly observed in cholelithiasis patients. More recently, the triglyceride-glucose (TyG) index has been proposed as an alternative marker of insulin resistance. In our study we aimed to understand whether the TyG index is correlated with HOMA-IR in cholelithiasis patients. And also we aimed the predict a cutoff value for determining insulin resistance in cholelithiasis patients. METHODS: A total of 184 cholelithiasis patients were matched in terms of age, gender, and BMI. They were divided into two groups based on their Homa IR levels (IR and Non-IR group). This study was a retrospective, observational study and clinical data was obtained from electronic medical records. Cutoff value for Tyg index was established through ROC Analysis. Binary Logistic Regression was used to identify factors affecting insulin resistance. RESULTS: A significant cutoff value was found for the TyG index in determining the presence of insulin resistance. Having a TyG index of ≥8.71 indicates the presence of insulin resistance. The sensitivity was 68.48%, the specificity was 58.70%. Binary Logistic Regression analyses showed that an increase in Tyg Index, waist circumference and waist-to-height ratio values increases the risk of insulin resistance by 2.705 (p = 0.001), 1.032 (p = 0.029), and 334.057 (p = 0.012) times respectively. CONCLUSION: Our study indicated that TyG index is positively correlated with HOMA-IR. TyG index was found as a risk factor for insulin resistance.
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Glicemia , Colelitíase , Resistência à Insulina , Triglicerídeos , Humanos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Colelitíase/sangue , Colelitíase/etiologia , Colelitíase/diagnóstico , Glicemia/análise , Triglicerídeos/sangue , Adulto , Biomarcadores/sangue , IdosoRESUMO
BACKGROUND: The aim of this study was to compare metabolic parameters, plasma Osteopontin (OPN) and Hepatocyte Growth Factor (HGF) levels between Sleeve Gastrectomy (SG) patients in their 6th post-operation month and healthy control patients. METHODS: Height, weight, Body Mass Index (BMI) and laboratory parameters of 58 SG patients aged 18â65 years (Group 1) and 46 healthy control patients (Group 2) were compared. In addition, preoperative and postoperative sixth-month BMI and laboratory parameters of the patients in Group 1 were compared. RESULTS: The mean age and gender distributions of the groups were similar (p > 0.05). Mean BMI was 28.9 kg/m2 in Group 1 and 27 kg/m2 in Group 2 (p < 0.01). While plasma HGF levels were similar between both groups, plasma OPN levels were higher in Group 2 (p < 0.001). Fasting plasma glucose, total cholesterol, triglyceride, fasting plasma insulin and insulin resistance values were higher in Group 1, while alanine aminotransferase and aspartate aminotransferase levels were higher in Group 2 (p < 0.05). There was a strong correlation between plasma HGF and OPN levels in Group 1, but not in Group 2 (Rho = 0.805, p < 0.001). CONCLUSION: OPN and HGF are promising biomarkers that can be used to better understand and detect problems related to obesity. The fact that patients in the early post-SG period had lower plasma OPN and similar plasma HGF compared to non-surgical patients of similar age and gender with higher BMI may be another favorable and previously unknown metabolic effect of SG.
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Diabetes Mellitus Tipo 2 , Resistência à Insulina , Laparoscopia , Obesidade Mórbida , Humanos , Gastrectomia , Obesidade , Obesidade Mórbida/cirurgia , Osteopontina , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , IdosoRESUMO
Objectives: We wanted to research the effect of acupuncture on postoperative nausea and vomiting (PONV) in morbidly obese adult patients who were scheduled for laparoscopic sleeve gastrectomy. Design: This prospective randomized controlled study included 62 American Society of Anesthesiologists physical status I-III, 18- to 60-year-old morbidly obese patients undergoing laparoscopic sleeve gastrectomy. Patients were assigned using a closed envelope method to both groups equally. Group I consisted of acupuncture and metoclopramide; Group II consisted of metoclopramide. Setting: The study was carried out in Kecioren Educational Research Hospital, University of Health Sciences, Ankara, Turkey. Interventions: Acupuncture was performed by needling PC6, LI4 acupoints bilaterally and Yin Tang acupoint in Group I. Metoclopramide was administered as an antiemetic drug in both groups. Measurements: Demographic parameters, SAMBA PONV risk, first analgesic requirement time and PONV of the patients at the recovery 0-1, 1-6, 6-12, and 12-24 hours after operation were recorded. We used the simplified PONV impact scale to determine the intensity of nausea and its effects on the patient. Results: Nausea was observed in 37.5% of patients in Group I and 63.3% of patients in Group II at the recovery. Nausea intensity was not different between the groups at the postoperative 1-6 hours, but vomiting count was found higher in Group II at the postoperative 12-24 hours. Apfel score of the patients were similar between the groups. PONV impact scale was found higher in Group II. First analgesic requirement time was found shorter and demand for additional analgesic treatment was found significantly higher in Group II. Conclusions: Combining acupuncture with antiemetic treatment reduced nausea intensity and vomiting in the postoperative follow-up period. Also, patient's first analgesic demand time was found longer and the requirement for additional analgesic treatment was found lower in the acupuncture group.
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Terapia por Acupuntura , Antieméticos , Laparoscopia , Obesidade Mórbida , Terapia por Acupuntura/métodos , Adolescente , Adulto , Analgésicos , Antieméticos/uso terapêutico , Método Duplo-Cego , Gastrectomia/métodos , Humanos , Laparoscopia/métodos , Metoclopramida , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Estudos Prospectivos , Adulto JovemRESUMO
INTRODUCTION: The goal in appendicitis is early diagnosis and early treatment. Complications develop as treatment is delayed. Therefore, there is a need for fast, low-cost markers that can be diagnosed earlier. The aim of this study is to show the effectiveness of immature granulocyte (IG) level in determining the complication of acute appendicitis. METHOD: In this retrospective cross-sectional study, 99 patients with acute appendicitis and 41 control groups were included in the study. Acute appendicitis patients were divided into two groups as acute simple appendicitis(n = 65) and acute complicated appendicitis(n = 34). In all groups, demographic data, immature granulocyte (IG) count(x103/µL), IG ratio (IG%), white blood cell (WBC), polymorphonuclear leukocytes (PNL), lymphocyte, monocyte, platelet, mean platelet volume (MPV), ferritin levels were recorded. The blood analyses were performed the Mindray BC6800 automated hematology analyzer using standard laboratory protocols. All statistical testing was undertaken using IBM SPSS Statistics for Mac. RESULTS: Compared to the acute simple appendicitis, acute complicated appendicitis patients had significantly higher levels WBC, PNL, monocyte, IG count, and IG% (p = 0.009, p = 0047, p = 0.001, p = 0.018; respectively) while there was no significant difference in ferritin between groups (p = 0.49). In the ROC analysis, AUC value was found for IG count and IG% (0.893 and 0.725, cut-off 0.005 and 0.05; respectively) for acute appendicitis. The negative predictive value of IG for Acute Appendicitis was 85% and was the same as that of WBC. In acute complicated appendicitis, the AUC for IG and IG% was 0.796 (cut-off 0.02) and 0.693 (cut-off 0.2), respectively. Positive Likelihood Ratio (+LR; 2.1) value of IG was found higher than other complete blood count (CBC) tests. CONCLUSION: The IG count is test with fast, more predictive value than another CBC tests, and without cost in the early diagnosis of acute complicated appendicitis. It is strong negative predictive test for Acute Appendicitis disease.
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Apendicite , Humanos , Apendicite/complicações , Apendicite/diagnóstico , Estudos Retrospectivos , Estudos Transversais , Granulócitos , Contagem de Leucócitos , Doença Aguda , BiomarcadoresRESUMO
BACKGROUND: Recognition and management of abdominal emergencies in geriatric patients are more complicated compared to the younger population. We aimed to investigate the demographic characteristics of geriatric patients diagnosed with acute appendicitis and to investigate the factors associated with perforation in the early stages in this study. METHODS: After obtaining local ethical committee approval, patients 65 years and older who had appendectomy between January 2015 and December 2019 were included the study. Demographic data of the patients, physical examination findings, and laboratory results were analyzed. Patients were divided into two groups based on surgical reports: Perforated and simple appendicitis. RESULTS: During the study period, 72 patients were evaluated. In our study, 48.6% of the patients were male, and the median age was 71.5 years (IQR 25-75, 68-80). Perforated appendicitis was detected in 28% of the patients. We were determined that the vast majority of patients with perforated appendicitis were male; had more frequent chronic kidney disease and post-operative local complications; had increased leukocytes, neutrophils, blood urea nitrogen, creatinine, and total bilirubin; and had reduced albumin; and these differences were statistically significant (all values p<0.05). Multivariate analysis shows increased neutrophil count and male sex was significantly associated with perforated appendicitis (p=0.035 and p=0.01, respectively). CONCLUSION: Geriatric patients with chronic kidney disease can be at higher risk of perforated appendicitis due to inadequate abdominal physical examination results. In addition, male gender and an elevated neutrophil count are independent predictors of perforation.
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Apendicite , Perfuração Intestinal , Doença Aguda , Idoso , Apendicectomia , Apendicite/complicações , Apendicite/epidemiologia , Apendicite/cirurgia , Proteína C-Reativa , Feminino , Humanos , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/etiologia , Contagem de Leucócitos , Masculino , Estudos RetrospectivosRESUMO
BACKGROUND: The aim of the study was to investigate the predictive value of hyponatremia as a new biochemical marker for the early and accurate preoperative diagnosis of complicated appendicitis in the adult population. METHODS: 732 patients who were operated for acute appendicitis (AA) and diagnosed as perforation intraoperatively were evaluated retrospectively. Serum sodium, C-reactive protein (CRP), and leukocyte levels of patients with perforated and nonperforated appendicitis were compared. RESULTS: Perforated appendicitis patients had statistically lower serum Na values (p<0.001). Similarly, patients without perforated appendicitis had higher serum CRP values (p<0.001). In patients diagnosed with perforated AA, the sensitivity of plasma sodium concentration was 63%, and the specificity was 66%. The threshold value of plasma sodium concentration ≤137.5 mEq/L had the best possible sensitivity and specificity. CONCLUSION: Hyponatremia is a new marker of perforated appendicitis and therefore, serum sodium level measurement should be considered in patients with a clinical presentation consistent with appendicitis if complications are suspected.
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Apendicite , Hiponatremia , Adulto , Apendicite/complicações , Apendicite/diagnóstico , Apendicite/cirurgia , Biomarcadores , Proteína C-Reativa/análise , Humanos , Hiponatremia/complicações , Hiponatremia/etiologia , Estudos Retrospectivos , Sensibilidade e Especificidade , SódioRESUMO
Background Acute appendicitis is one of the events most frequently encountered by general surgeons. Despite the high incidence, serious problems are experienced in the diagnosis and clinical follow-up. In the pathogenesis of the disease, oxidative stress and impaired antioxidant defense mechanisms created in the body by this stress play an important role. As dynamic thiol-disulfide hemostasis is closely related to oxidative stress and is known to have a crucial role in the pathogenesis of oxidative stress, this study aimed to compare its value with other inflammatory markers in the diagnosis and follow-up of acute appendicitis. Methodology This study included cases admitted for surgery with a diagnosis of acute abdomen at Keçiören Research and Training Hospital General Surgery Clinic between April 2015 and July 2015 who were intraoperatively diagnosed with acute appendicitis and underwent routine appendectomy. In the preoperative period and after clinical healing before discharge, blood samples were obtained to examine white blood cell (WBC), mean platelet volume (MPV), total bilirubin, C-reactive protein (CRP), and thiol-disulfide balance, and the results were recorded. Results A total of 68 cases were operated on for acute appendicitis, and 59 were evaluated comprising 23 (39%) females and 36 (61%) males with a mean age of 35.6 years (range = 19-65 years). The mean duration of hospital stay was two days (range = 1-8 days). The results of the tests performed preoperatively and before discharge and their p-values were as follows: native thiol (-SH) 393.5 ± 9.4 µmol/L and 369.3 ± 9.5 µmol/L (p = 0.04), total thiol 434 ± 9.7 µmol/L and 396.7 ± 10.2 µmol/L (p = 0.03), disulfide (-S-S) 16.8 ± 0.7 µmol/L and 15.7 ± 0.9 µmol/L (p = 0.3), WBC 13.2 ± 0.5 × 10³/mL and 9.2 ± 0.4 × 10³/mL (p = 0.0), CRP 8.17 ± 1.24 mg/L and 7.84 ± 0.82 mg/L (p = 0.17), MPV 7.4 ± 0.37 fL and 7.97 ± 0.19 fL (p = 1.0), and total bilirubin 0.86 ± 0.08 mg/dL and 0.69 ± 0.06 mg/dL (p = 0.08). Conclusions In the clinical follow-up of acute appendicitis patients, the decrease in WBC, total thiol, and native thiol values can be helpful to clinicians as markers of clinical healing. However, CRP may not be a useful marker of clinical healing in acute appendicitis patients who are discharged early.
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BACKGROUND: Acute cholecystitis is a severe disease that requires urgent operation in some cases. To select suitable patients for a conservative approach, there is a need for an affordable and reliable marker for determining complication risk. Evaluation of systemic inflammatory markers in combination with other parameters such as white blood cell and the C-reactive protein might help to decide the appropriate treatment option. This study aims to evaluate the diagnostic value of the neutrophil-lymphocyte ratio (NLR) and thrombocyte-lymphocyte ratio (PLR) in determining the risk of complicated acute cholecystitis and to compare with intraoperative and pathological findings. METHODS: A total of 229 patients operated on for acute cholecystitis were included in this study. Intraoperative and pathologically complicated acute cholecystitis in 78 cases and controls group was 151 cases. The two groups were compared in terms of inflammation markers. Then, we used the receiver operating characteristic curve analysis to determine the optimal value for NLR and PLR concerning the severity of cholecystitis. Then, the differences in clinical symptoms were investigated according to the cutoff value for NLR and PLR. RESULTS: The NLR and PLR levels were found to be significantly higher in the complicated group (4.18±4.53 vs. 15.23±20.99, 145.34±87.58, and 251.92±245.93, respectively, p<0.01). The best cutoff value for NLR and PLR was 5.5 and 146.90, respectively. Sensitivity for NLR was 80% and specificity was 80.1%. Sensitivity for PLR was 66.7% and specificity was 66.2%. CONCLUSION: Systemic inflammation markers can be used to predict the risk of complicated acute cholecystitis. They are inex-pensive tools that can be used to make surgical decisions, especially in resource scarce environments.
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Colecistite Aguda , Linfócitos , Biomarcadores , Plaquetas/patologia , Humanos , Inflamação/patologia , Linfócitos/patologia , Neutrófilos/patologiaRESUMO
BACKGROUND: Surgical planning is critical for ongoing treatment and prognosis of the disease's course after an appendicitis diag-nosis. Ischemia-modified albumin (IMA) has been used as a biomarker for a variety of ischemia-related disorders in the past. The aim of this study is to determine the IMA level in patients with AA and to evaluate its predictive significance. METHODS: A total of 139 participants were enrolled in the trial. After diagnosis and before surgery, the amount of plasma IMA was tested. Patients diagnosed with appendicitis in Group 1 (n=97) and volunteer surgical patients not diagnosed with appendicitis in Group 2 (n=42) were compared as the final diagnostic criterion. RESULTS: The data of 139 patients with a mean age of 36.15 were evaluated statistically. IMA values were analyzed in both groups. The mean IMA of all patients was 0.74±0.16 AbsU. When the two groups were compared, it was seen that IMA was statistically higher in Group 1 than in the control group. While the area under the curve for IMA was 0.670, the sensitivity for the cutoff value of 0.715 was 68%, the specificity was 62%. CONCLUSION: Our study shows that IMA values provide significant results in predicting acute appendicitis.
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Apendicite , Doença Aguda , Adulto , Apendicite/diagnóstico , Apendicite/cirurgia , Biomarcadores , Estudos de Casos e Controles , Humanos , Albumina Sérica/análise , Albumina Sérica HumanaRESUMO
BACKGROUND: Gallstone disease (GD) is a common condition worldwide. Several studies demonstrated that the presence of gallstones is strongly associated with cardiovascular disease. The metabolic syndrome is a highly prevalent cardiovascular condition. OBJECTIVE: To examine the relationship between complicated GD (CGD) and the metabolic syndrome or its components. METHODS: Two hundred seventeen patients with gallstones were examined. All patients underwent biliary ultrasonography after a complete medical history and laboratory examination. Data collection for the diagnosis of metabolic syndrome included measurements of waist circumference, blood pressure and lipids, and biochemical tests. RESULTS: Of the 217 patients examined, 115 patients (53%) had CGD and 102 patients (47%) had uncomplicated GD (UCGD). There was a significant difference between the number of patients with large gallstones in the CGD and UCGD groups (n=14 [12%] versus n=2 [2%], respectively; P=0.004). Metabolic syndrome, diabetes mellitus and large waist circumference were more prevalent in the CGD group than in the UCGD group. Homeostatic model assessment of insulin resistance scores were higher in the CGD group than in UCGD group (2.51 [95% CI 0.57 to 23.90] versus 2.20 [95% CI 0.09 to 8.87], respectively; P=0.032). Logistic regression analysis revealed that the presence of metabolic syndrome (OR 1.434; 95% CI 1.222 to 1.846, P=0.014), diabetes mellitus (OR 1.493; 95% CI 1.255 to 1.953; P=0.035) and large gallstones (OR 1.153; 95% CI 1.033 to 1.714; P=0.017) were independent predictors of CGD. CONCLUSION: Results of the present study demonstrated that metabolic syndrome, diabetes and gallstone size were associated with CGD. Further prospective studies are needed to understand the clinical importance of this association.
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Doenças Cardiovasculares/epidemiologia , Cálculos Biliares/epidemiologia , Síndrome Metabólica/epidemiologia , Adulto , Idoso , Feminino , Humanos , Resistência à Insulina , Modelos Logísticos , Pessoa de Meia-IdadeRESUMO
Liposarcoma of the head and neck represents approximately 1% of head and neck sarcomas. Atypical lipomatous tumor/well-differentiated liposarcoma rarely occurs in the neck. The size of the neck liposarcomas rarely exceeds 10 cm during presentation. Surgical excision is the treatment of choice for liposarcomas. We report a very unusual size, which has not been reported to our knowledge, of an atypical lipomatous tumor of the neck, reaching a size of 25 × 22 cm. The patient underwent complete resection of the lesion without morbidity. Three months after the surgery, the patient is free of recurrence.
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Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Lipossarcoma/patologia , Lipossarcoma/cirurgia , Idoso , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
Introduction Biomarkers such as the neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR) are associated with the colon tumor stage and prognosis. Therefore, in our study, we investigated whether these biomarkers are important in determining the colon cancer stage. Materials and methods The outcomes in 268 patients operated on with the diagnosis of colon cancer between January 2011 and March 2019 were retrospectively analyzed. The relationship of the stage of the patients with the NLR or PLR was evaluated. In addition, according to the stage of colorectal tumors, stage I and other stages (stages II, III, and IV) were compared in terms of NLR and PLR. Groups that had lymph node (LN) metastasis were compared with those that did not. Finally, groups with and without metastasis were also compared. Results In our cohort, 144 patients (57.6%) were male, and 84 (42.4%) were female. The mean age was found to be 68.28 ±12.71 years. The patients were evaluated according to their stages: 26 patients were stage I, 78 patients were stage II, 75 patients were stage III, and 19 patients were stage IV. There was a significant difference in NLR values between the groups (p: 0.05). Also, 104 patients were LN-negative (stages I-II), and 94 patients were LN-positive (stages III-IV). When PLR was compared between the two groups, no significant difference was found between tumor stages and these values (p: 0.099). However, there was a significant difference in NLR values (p: 0.034). Conclusion Based on our findings, it has been concluded that increased PLR may not be associated with the colon cancer stage. However, the increase in NLR was found to be correlated with tumor stage and LN metastasis.