Importance of the neutrophil-lymphocyte ratio and systemic immune-inflammation index in predicting colorectal pathologies in fecal occult blood-positive patients.

BACKGROUND: The fecal occult blood (FOB) test is one of the primary screening methods for colorectal cancer (CRC). In this study, we aimed to investigate the effect of the neutrophil/lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) in predicting CRC and other colorectal pathologies in patients with a positive FOB test. METHODS: This retrospective study included patients with a positive FOB test who underwent colonoscopy for the investigation of the etiology. The optimal cutoff levels of NLR and SII for predicting colorectal pathologies were determined using the receiver operating characteristic analysis. RESULTS: Of the 157 FOB+ patients, 35% were male and 65% were female, with a median age of 59 years. There were 96 patients in Group 1 and 61 patients in Group 2. The mean age of the patients in Group 2 was significantly higher (p < 0.001). The rate of male patients was significantly higher in Group 2. NLR and SII were significantly higher in Group 2 than in Group 1 (p < 0.001). The area under the curve values of NLR and SII in predicting colorectal pathologies in FOB+ patients were 0.817 and 0.825, respectively. At the cutoff values of 0.689 and 0.795, NLR and SII had a sensitivity of 60.66% and 95.83%, respectively, and a specificity of 95.83% and 100%, respectively. CONCLUSION: Neutrophil/lymphocyte ratio and SII can be used as important biomarkers in the early diagnosis of CRC and other colorectal lesions in patients with a positive FOB test.

Unroofing Curettage Versus Modified Limberg Flap in Pilonidal Disease: A Retrospective Cohort Study.

BACKGROUND: Sacrococcygeal pilonidal disease (estimated incidence, 25/100,000) is a chronic inflammatory condition that commonly affects young adults. However, the ideal surgical treatment for this disease remains undetermined. OBJECTIVE: This study aimed to compare the results of the unroofing curettage and those of the modified Limberg flap surgical technique. DESIGN: This is a retrospective cohort study. SETTINGS: Procedures were performed by 2 surgeons between January 2013 and January 2017. PATIENTS: The data of 278 patients who underwent surgery for the treatment of pilonidal disease were analyzed. INTERVENTIONS: Unroofing curettage was performed under local or spinal anesthesia, whereas spinal anesthesia was used for the modified Limberg flap procedure. MAIN OUTCOME MEASURES: The primary outcome was recurrence rate. Secondary outcomes included adverse events, limitation of daily activities, and healing time. RESULTS: Between the 2 groups (unroofing curettage, n = 135; modified Limberg flap, n = 143), recurrence was lower in the unroofing curettage group after a 60-month median follow-up period, but the difference was not statistically significant (1.5% vs 4.2%, p = 0.45). The duration of surgery and length of hospital stay were shorter in the unroofing curettage group (11.44 ± 3.56 minutes vs 52.47 ± 7.92 minutes and 0.27 ± 0.45 days vs 1.07 ± 0.26 days, p < 0.001). Postoperative complications were significantly higher in the modified Limberg flap group (9.8% vs 2.2%, p = 0.009). The time required to return to work or school was shorter in the unroofing curettage group (8.6 ± 7.8 days vs 25.01 ± 6.3 days, p < 0.001). The complete healing time was longer in the unroofing curettage group (35.3 ± 9.2 days vs 23.2 ± 5.4 days, p < 0.001). LIMITATIONS: The retrospective study design was a limitation of this study. CONCLUSIONS: Unroofing curettage provided more clinical benefits than the modified Limberg flap approach. Unroofing curettage should be considered as the first choice of surgical treatment for pilonidal disease. See Video Abstract at http://links.lww.com/DCR/B824 . DESTECHAMIENTO Y CURETAJE VERSUS COLGAJO DE LIMBERG MODIFICADO EN LA ENFERMEDAD PILONIDAL UN ESTUDIO DE COHORTE RETROSPECTIVE: ANTECEDENTES:La enfermedad pilonidal sacrococcígea (incidencia estimada, 25 / 100.000) es una enfermedad inflamatoria crónica que comúnmente afecta a adultos jóvenes. Sin embargo, el tratamiento quirúrgico ideal para esta enfermedad permanece indeterminado.OBJETIVO:Comparar los resultados del destechamiento y curetaje y los de la técnica quirúrgica con colgajo de Limberg modificado.DISEÑO:Estudio de cohorte retrospectivo.ENTORNO CLINICO:Los procedimientos fueron realizados por dos cirujanos, entre enero del 2013 y enero del 2017.PACIENTES:Se analizaron datos de 278 pacientes intervenidos quirúrgicamente para el tratamiento de la enfermedad pilonidal.INTERVENCIONES:Se realizó destechamiento y curetaje con anestesia local o raquídea, mientras que para el procedimiento de colgajo de Limberg modificado se utilizó anestesia raquídea.PRINCIPALES MEDIDAS DE RESULTADO:El resultado principal fue la tasa de recurrencia. Los resultados secundarios incluyeron eventos adversos, limitación de las actividades diarias y tiempo de curación.RESULTADOS:Entre los dos grupos (destechamiento y curetaje, n = 135; colgajo de Limberg modificado, n = 143), la recurrencia fue menor en el grupo con destechamiento y curetaje después de un período de seguimiento medio de 60 meses, pero la diferencia no fue estadísticamente significativa (1,5% vs 4,2%, p = 0,45). La duración de la cirugía y la estancia hospitalaria fueron más cortas en el grupo de destechamiento y curetaje (11,44 ± 3,56 min vs a 52,47 ± 7,92 min y 0,27 ± 0,45 días vs 1,07 ± 0,26 días, p < 0,001). Las complicaciones posoperatorias fueron significativamente mayores en el grupo de colgajo de Limberg modificado (9,8% vs 2,2%, p = 0,009). El tiempo necesario para regresar al trabajo o la escuela fue menor en el grupo de destechamiento y curetaje (8,6 ± 7,8 días vs 25,01 ± 6,3 días, p < 0,001). El tiempo de cicatrización completo fue mayor en el grupo de destechamiento y curetaje (35,3 ± 9,2 días vs 23,2 ± 5,4 días, p < 0,001).LIMITACIONES:El diseño del estudio retrospectivo.CONCLUSIONES:El destechamiento y curetaje proporcionó más beneficios clínicos que el abordaje con colgajo de Limberg modificado. El destechamiento y curetaje debe considerarse como la primera opción de tratamiento quirúrgico para la enfermedad pilonidal. Consulte Video Resumen en http://links.lww.com/DCR/B824 . (Traducción- Dr. Francisco M. Abarca-Rendon ).

The Effect of Epidermal Growth Factor on Anastomotic Leaks: An Experimental Study in Rats.

INTRODUCTION: To investigate the effects of local epidermal growth factor (EGF) use on anastomotic healing during primary repair of anastomosis in rats with anastomotic leaks (AL). METHODS: Thirty albino Wistar rats were divided into three groups. Anastomoses were performed in group 1 after colon transection. In groups 2 and 3, ALs were created with an incomplete colon anastomosis model. Relaparotomy was conducted on rats in groups 2 and 3 72 h after the first procedure. ALs of the rats were repaired with a primary suture in group 2 and with a primary suture and the application of submucosal EGF in group 3. All rats were sacrificed through cervical dislocation on the 6th day after the first procedure. Four-centimeter colonic segments containing 2-cm distal and proximal parts of the anastomotic lines of the subjects were resected. The primary outcome was anastomotic burst pressure (ABP). The secondary outcomes included limitation in inflammation, increased neovascularization, increased fibroblast activation and increased collagen synthesis. RESULTS: The ABP value of group 2 was significantly lower than that of group 3 (P < 0.05). No significant difference was detected in the ABP value between group 3 and group 1 (P > 0.05). There was significantly less inflammatory cell infiltration in group 3 than in group 2 (P < 0.05). Collagen synthesis and neovascularization were significantly higher in group 3 than in group 2 (P < 0.05). CONCLUSIONS: A single-dose of submucosal EGF applied to the AL line limited inflammation and stimulated neovascularization. It also had a positive effect on the strength of the anastomosis.

An evaluation of treatment results of emergency versus elective surgery in colorectal cancer patients.

OBJECTIVE: Colorectal cancer is still one of the most common causes of cancer related deaths in the world despite improvements in diagnosis and treatment modalities, and application of community-based screening methods. Symptoms of colorectal cancer are non-specific and usually manifest following local progression. A number of patients with advanced stage colorectal cancer present to emergency departments with obstruction as the first sign of disease without any previous symptoms. This presentation is an indication for emergency surgery that has a high rate of morbidity and mortality. In this study, we aimed to determine the factors associated with early diagnosis and survival by comparing postoperative results of colorectal cancer patients who underwent surgery under emergency or elective situation. MATERIAL AND METHODS: Files of colorectal patients treated between 2009-2013 were retrospectively analyzed. Data on patient age, gender, operation type, intraoperative results, length of hospital stay, co-morbidities, postoperative complications and pathological results were evaluated and compared. RESULTS: There was no statistical difference between groups in terms of age, gender, and pathology results (p>0.05). The difference between groups in terms of postoperative length of hospital stay, presence of co-morbid diseases, pathological stage, and postoperative complications was statistically significant (p<0.05). Length of hospital stay, advanced stage on admission, complications such as surgical site infection, evisceration, and anastomosis leakage rates were higher in patients in the emergency surgery group. CONCLUSION: Risk groups should be determined in order to diagnose colorectal cancer patients at an early stage while they are still asymptomatic, and this information should be incorporated into effective screening programs. This approach will be beneficial to treatment outcomes, complication rates, length of hospital stay, and survival and treatment results.

Role of glucose/potassium ratio and shock index in predicting mortality in patients with isolated thoracoabdominal blunt trauma.

BACKGROUND: The aim of this study, investigate the prognostic value of shock index (SI), which has been accepted for a long time, and glucose-potassium ratio (GPR), which has limited data in patients with trauma and those with isolated blunt thoracoabdominal trauma. METHODS: This retrospective observational study was conducted at the tertiary reference hospital. Consecutive patients aged 18 years and older treated for blunt thoracoabdominal trauma in the emergency department between August 2020 and February 2022 were included in the study. The ability of GPRs obtained from arterial blood gases and SI levels on admission to predict mortality and indication for surgery was evaluated by calculating areas under receiver operating characteristic curves Area under the curve (AUCs). RESULTS: A total of 102 patients, of which 91 in the survivor group and 11 in the non-survivor group, were analyzed. The AUCs for estimating mortality with GPR and SI were 0.854 (95% confidence interval [CI], 0.742-0.967) and 0.809 (95%, 0.666-0.952), respectively. The AUCs of GPR and SI to estimate the indication for surgery were 0.761 (95% CI, 0.657-0.864) and 0.582 (95% CI, 0.416-0.747), respectively. CONCLUSION: This study reported the efficacy of SI and GPR in predicting surgical indication and mortality in patients with isolated blunt thoracoabdominal trauma and the superior predictive role of GPR over SI.

Unroofing curettage for treatment of simple and complex sacrococcygeal pilonidal disease.

Purpose: Sacrococcygeal pilonidal disease is a chronic inflammatory condition with an incidence of 26:100,000 in the United States. However, its etiology and optimal treatment remain controversial. Methods: We included 129 and 74 patients with simple and complex sacrococcygeal pilonidal disease, respectively. The primary outcome was pilonidal sinus recurrence after unroofing curettage. Secondary outcomes were pain scores, time to return to work/school, and time to complete recovery. Results: At a median follow-up of 53 months, the recurrence rate was 4.9% in all patients, not significantly higher in subjects with the complex disease. Duration of surgery (15.4 minutes vs. 12.2 minutes), time to return to school/work (9.8 days vs. 7.7 days), and complete healing time (44 days vs. 36 days) were longer in patients with the complex disease. Postoperative complication rates, pain scores, and quality of life scores between the 2 groups did not differ. Conclusion: Unroofing curettage may be a good first-choice treatment for both simple and complex sacrococcygeal pilonidal disease.

The management of xanthogranulomatous cholecystitis.

OBJECTIVES: Xanthogranulomatous cholecystitis (XGC) is a rare variant of chronic cholecystitis. This rare pathology is characterized by severe and progressive fibrosis of the gallbladder wall as well as infiltration of fat-laden macrophages. MATERIAL AND METHODS: The final pathology report of 8213 cholecystectomies performed between 2011 and 2019 was evaluated retrospectively, and patients whose pathology result was reported as XGC were included in the study. Patients' demographic characteristics, pathology results, and surgical methods were evaluated. Logistic regression analysis was performed for risk factors on conversion to open cholecystectomy. RESULTS: The rate of XGC among cholecystectomies was 0.91%. Mean age of the patients was 57.32 years. Laparoscopic cholecystectomy was applied to 92% (n: 69) of the patients. None of the patients had cancer suspicion in the preoperative period, but cancer suspicion was found in 10.6% of the patients during the operation. With the frozen test, unnecessary surgeries were prevented in these patients. Conversion rate to open cholecystectomy was found to be 26.09%. The most common reason for conversion to open cholecystectomy (66.7%) was intense fibrosis. Increased gallbladder wall thickness and acute cholecystitis were found to be statistically significant risk factors in ultrasonography (p <0.05). Total complication rate in XGC cases was 3.9%. CONCLUSION: XGC is an extremely rare disease and is difficult to diagnose before cholecystectomy. Especially in preoperative USG, in cases with no suspicion of malignancy, but with suspected malignancy during the operation, histopathological examination with frozen method before extensive surgery may prevent unnecessary dissection and related morbidities.

Evaluation of Clinical Alvarado Scoring System and CT Criteria in the Diagnosis of Acute Appendicitis.

Aim. The aim was to evaluate the clinical Alvarado scoring system and computed tomography (CT) criteria for the diagnosis of acute appendicitis. Material and Methods. 117 patients with acute abdominal pain who underwent abdominal CT were enrolled in this retrospective study. Patient demographics, clinical Alvarado scoring, CT images, and pathologic results of the patients were evaluated. Results. 39 of the 53 patients who were operated on had pathologically proven acute appendicitis. CT criteria of appendiceal diameter, presence of periappendiceal inflammation, fluid, appendicolith, and white blood cell (WBC) count were significantly correlated with the inflammation of the appendix. The best cut-off value for appendiceal diameter was 6.5 mm. The correlation between appendiceal diameter and WBC count was 80% (P = 0.01 < 0.05). The correlation between appendiceal diameter and Alvarado score was 78.7% (P = 0.01 < 0.05). Conclusion. Presence of CT criteria of appendiceal diameter above 6.5 mm, periappendiceal inflammation, fluid, and appendicolith should prompt the diagnosis of acute appendicitis. Since patients with acute appendicitis may not always show the typical signs and symptoms, CT is a helpful imaging modality for patients with relatively low Alvarado score and leukocytosis and when physical examination is confusing.

Is there any association between vitamin D levels and isolated coronary artery ectasia?

INTRODUCTION: It has been postulated that low vitamin D levels are associated with coronary artery diseases. Coronary artery ectasia (CAE) is associated with atherosclerosis, congenital cardiac defects, immunological diseases and connective tissue diseases. In this study, we aimed to investigate whether there is an association between vitamin D and parathormone levels and isolated coronary artery ectasia and its extent. MATERIAL AND METHODS: The study included 93 participants: 47 patients (35 male, 12 female) with isolated CAE and 46 subjects (28 male, 18 female) with normal coronary arteries. Demographic characteristics of patients and controls were obtained from medical records, and Markis scores of patients were calculated. Serum vitamin D and parathormone levels were quantitatively measured by the paramagnetic particle chemiluminescence method. RESULTS: Serum vitamin D levels were found to be significantly lower in patients with isolated CAE than the control group (9.15 ±4.4 ng/ml, 13.35 ±5.9 ng/ml, p < 0.001). Parathormone levels were significantly higher in the CAE group than the control group (61.4 ±31.6, 48.7 ±25.5, p < 0.036). However, the study revealed no association between serum vitamin D levels and the extent of CAE according to the Markis classification (p = 0.23). CONCLUSIONS: This study revealed that lower vitamin D levels and higher parathormone levels were associated with isolated CAE, but there was no association between vitamin D levels and the extent of CAE.

The correlation between plasma human neutrophil peptide 1-3 levels and severity of coronary artery disease.

INTRODUCTION: Inflammation plays a key role in atherosclerosis, and discovering new biomarkers of inflammation is becoming important in order to uncover the pathogenesis of atherosclerotic coronary artery disease (CAD). Recent studies have focused on polymorphonuclear neutrophils. It has been suggested that human neutrophil peptide 1-3 (HNP1-3) is proatherogenic. In this study, we aimed to investigate the associations between plasma HNP1-3 levels and the severity of atherosclerosis via a generally accepted scoring system. MATERIAL AND METHODS: This cross-sectional, observational study included 107 consecutive patients suffering from stable angina pectoris and undergoing coronary angiography (CAG). Patients were divided into two groups according to the Gensini scoring (GS) system evaluating disease severity. Group 1 was composed of mild CAD patients with GS < 20 and group 2 consisted of severe CAD patients with GS ≥ 20. Plasma HNP1-3 levels were assessed by the ELISA method. RESULTS: The mean HNP1-3 levels were found to be lower in group 1 than group 2 (134.7 ng/ml vs. 147.5 ng/ml). HNP1-3 levels were significantly higher in the severe CAD group than the mild CAD group according to GS (p < 0.001). The results of multivariate logistic regression analysis revealed that only age > 62 years and HNP1-3 > 134 ng/ml were independent predictors of the severity of CAD after adjusting for gender, smoking, hypertension, hyperlipidemia, diabetes, family history of CAD and white blood cell count. In predicting the severity of CAD, the sensitivity and specificity of HNP1-3 were 83.9% (p < 0.001) and 58.8% (p < 0.001), respectively. CONCLUSIONS: This study revealed that the plasma levels of HNP1-3 were significantly higher in severe CAD than mild CAD.