Diagnostic Accuracy of Ileocolic Artery and Vein Diameter for Acute Appendicitis.

BACKGROUND Regional inflammation-induced local vasodilation may exist in cases of appendicitis. In this study, the diameters of the ileocolic artery (ICA) and ileocolic vein (ICV) were measured using contrast-enhanced abdominal computed tomography (CT) scans in acute appendicitis cases. The study aimed to measure the diagnostic value of these measurements in the diagnosis of acute appendicitis. MATERIAL AND METHODS A total of 508 patients, including those with a diagnosis of acute appendicitis and a control group without appendicitis, were systematically evaluated. In all cases, the appendix was analyzed simultaneously on axial and coronal CT sections, and all measurement procedures were conducted with an electronic ruler after the actual images were magnified. Measurements of the ICA and ICV diameters were taken from the proximal 2-cm segments of the superior mesenteric artery and superior mesenteric vein in the axial plane. Demographic information, sex distribution, and ICA and ICV diameters were collected. RESULTS Of the 508 patients, 53.74% were men, and 46.26% were women. ICA and ICV diameters were significantly increased in the appendicitis group (P<0.001). Binomial logistic regression confirmed the independent predictive value of ICA and ICV diameters. Receiver operating characteristic curve analysis determined optimal cut-off values for distinguishing between the non-appendicitis and appendicitis groups (ICA: 2.475 mm, ICV: 3.885 mm) with high sensitivity and specificity. CONCLUSIONS ICA and ICV diameter measurements, in conjunction with major radiological findings, can enhance diagnostic accuracy in acute appendicitis cases. The use of ICA and ICV diameter measurements in diagnosing acute appendicitis offers a novel perspective in clinical practice.

Prognostic Significance of Tumor and Inflammatory Markers in Disease-Free and Overall Survival Duration in Colonic Adenocarcinoma Patients.

Introduction Colorectal carcinoma (CRC) continues to be a major global health concern, contributing substantially to cancer incidence and mortality. Colonic adenocarcinoma, a common subtype of CRC, is influenced by various prognostic factors, including tumor stage, histopathological characteristics, and tumor markers. Despite their routine use in clinical settings, the prognostic value of traditional tumor markers, such as carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), and others, is still under debate. In this study, we aim to analyze the tumor markers' prognostic significance in our CRC patients in terms of disease-free survival and overall survival. Methods A retrospective study was conducted on 71 patients who underwent surgery for colonic adenocarcinoma between January 1, 2018, and January 1, 2024. Data on patient demographics, recurrence rates, survival times, and tumor marker levels (CEA, CA 19-9, CA 125, AFP, and CRP to albumin ratio (CAR)), disease-free survival duration (DFS), and overall survival durations (OS) were collected and analyzed. Statistical analyses included Pearson and Spearman correlation coefficients, the Mann-Whitney U test, ROC curve analysis, and Kaplan-Meier survival analysis. Results The study found that elevated CAR and CA 125 levels were significantly associated with higher mortality and recurrence rates, whereas elevated CEA levels were strongly predictive of recurrence. Receiver operating characteristic (ROC) analysis identified optimal cutoff values for these markers, with CEA ≥ 47.145, CA 125 ≥ 15.85, and CAR ≥ 6.796 demonstrating high specificity and predictive value for recurrence. Kaplan-Meier analysis revealed that patients with CEA < 47.145 had a significantly longer DFS (67.7 months) compared to those with CEA ≥ 47.145 (24 months, p < 0.001). Similarly, patients with CA 125 < 15.85 and CAR < 6.796 showed longer DFS compared to those with higher values. Overall survival analysis also highlighted that patients with CA 125 < 21.71 and CAR < 4.09 had better survival outcomes, with significant differences of 26 and 10 months, respectively (p < 0.001 and p = 0.001). Conclusion Tumor markers, such as CEA, CA 125, and CAR, hold significant prognostic value in colonic adenocarcinoma, with higher levels correlating with poorer outcomes. These findings underscore the importance of integrating tumor markers into clinical decision-making to optimize treatment strategies and improve patient survival. Future research should focus on standardizing the use of these markers and exploring novel biomarkers for enhanced prognostication.

Use of Parathyroid Function Index and Wisconsin Index to Differentiate Primary Hyperparathyroidism From Secondary Hyperparathyroidism: A Case-Control Study.

INTRODUCTION: Patients with primary hyperparathyroidism (PHPT) can be asymptomatic or have a normal calcium level (NHPT). Patients with 25(OH) vitamin D insufficiency, on the other hand, may present with a similar presentation. In regions where 25(OH) vitamin D deficiency is common, patients are usually diagnosed with secondary hyperparathyroidism (SHPT). Therefore, it is necessary to separate PHPT and NHPT from SHPT. Parathormone and calcium values are used for differentiation in the clinic. The predictive value of the newly developed parathyroid function test (PFindex), which previously had a high diagnostic value, was evaluated in this patient population in our investigation. METHODS: The study comprised 163 PHPT and NHPT patients with pathological confirmation and 56 SHPT patients. The PHPT, NHPT, and SHPT properties were defined using PFindex. The diagnostic power of PFindex was investigated using a receiver operating characteristic (ROC) curve of the results assessed in three groups. RESULTS: The PHPT group had the highest PFindex (1365.4±784.6) compared to the other two groups (NHPT: 723.5±509.4; SHPT:227.2±49.9, all p < 0.001). A PFindex threshold of 327.8 yielded 91.9% and 90.9% sensitivity and specificity rates for distinguishing PHPT and NHPT from SHPT, respectively. CONCLUSION: PFindex gave the outstanding diagnostic capacity to distinguish PHPT from SHPT due to our research. This straightforward tool can assist in making quick decisions about vitamin D therapy or surgery for PHPT.

Effect of C-Reactive Protein-to-Albumin Ratio on Prognosis in Gastric Cancer Patients.

PURPOSE: The ratio of c-reactive protein-to-albumin (CRP/Alb) is a biochemical marker of systemic inflammatory response and has been associated with poor survival in cancer. The purpose of this study was to investigate the effect of CRP/Alb ratios on prognosis in gastric cancers. METHODS: This study included a retrospective review of a total of 147 patients with locally advanced gastric cancer. Mean platelet volume (MPV) was analyzed statistically to find a prognostic relationship between monocyte/lymphocyte ratio, platelet distribution volume (PDW), MPV/platelet, c-reactive protein/albumin ratio (CAR), and gastric cancer. Patients were staged according to the American Joint Cancer Committee (AJCC) Staging Guidelines. RESULTS: The CRP/Alb ratio was independently associated with overall survival (OS) in patients with gastric cancer (GC). The CAR was above 0.25 in 52.7% (77) of the patients and below 0.25 in 47.3% (69) of the patients. Patients under 0.25 had statistically longer survival rates. CONCLUSION: A high preoperative CAR value could predict poor prognosis in locally advanced gastric patients. The same predictive value was not observed in other hematological parameters. This simple and cost-effective ratio can be used as a clinically accessible biomarker to assist clinicians in determining future treatment plans.

Predictive value of serum sodium level in determining perforated appendicitis.

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.

Comparison of Short-Term Results of Laparoscopic and Open Surgeries for Colorectal Cancer: A Single-Center Experience.

OBJECTIVE: Although laparoscopic colon cancer surgeries have increased in recent years, their oncological competence is questioned. In our study, we aimed to evaluate oncological competence by comparing laparoscopic and open surgery. METHOD: The study was planned retrospectively. A total of 94 patients were included in the study, 42 of whom underwent laparoscopy, and 52 patients underwent open surgery. Both groups were compared in terms of demographic characteristics, staging, number of benign/malignant lymph nodes, histological findings, and complications. RESULT: The final pathology report of all patients was adenocarcinoma. The median number of dissected lymph nodes was 20.9 in the open group (8-34) and 19.46 in the laparoscopy group (7-31) (p = 0.639). The median number of dissected malignant lymph nodes was 1 (0-13) in the open surgery group and 3.1 (0-8) in the laparoscopy group (p = 0.216). The laparoscopy group exhibited a longer operation time (281.2 ± 54.2 and 221.0 ± 51.5 min, respectively; p = 0.036) than the open surgery group, but a shorter intensive care unit (ICU) discharge, quicker initiation oral feeding, and shorter length of hospital stay (4.0 ± 0.9 vs 5.7 ± 2.0 days, respectively; p < 0.001). DISCUSSION: Laparoscopic surgery elicits many benefits such as less wound infection, lower requirement for blood transfusion, shorter hospitalization, quicker initiation of oral feeding, and mobilization. Our study has shown that laparoscopic surgery provides quite adequate lymph node dissection when compared to oncological surgery, which is viewed with suspicion in the light of these benefits of laparoscopy.

Pre-operative neutrophil/lymphocyte and platelet/lymphocyte ratios are effective in predicting complicated acute cholecystitis

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.

The predictive value of ischemia-modified albumin in the diagnosis of acute appendicitis: A prospective case-control study.

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.

Predictive Value of Preoperative Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratio in Determining the Stage of Colon Tumors.

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.

The role of the lactate level in determining the risk rates of small bowel resection in incarcerated hernias.

BACKGROUND: An incarcerated hernia is a part of the intestine or abdominal tissue that becomes trapped in the sac of a hernia. An increase in morbidity and mortality occurs after intestinal resections from strangulated hernias. This study aims to examine the markers that may be effective in determining the risk of small bowel resection due to incarcerated hernias. In particular, we aimed to investigate the effect s of blood lactate levels in determining this risk. METHODS: A cross-sectional retrospective study was designed. Patients, whose preoperative diagnosis were reported as incarcerated hernia and had essential information, were included in this study. They were divided into two groups according to whether they had resection or not. Age, gender, hernia type, hernia side, resection material, blood lactate level (BLL), white blood cell (WBC), neutrophil count (NE), lymphocyte count (LY), neutrophil/lymphocyte ratio (NLR), platelet count (PLT), lactate dehydrogenase (LDH), radiologic bowel obstruction sign and comorbidities were evaluated. RESULTS: Sixty-seven patients were included in this study. It was observed that 16 (23.9%) of these patients underwent small intestinal resection, 16 (23.9%) had an omentum resection, while no resection was performed on 35 (52.2%) patients. There was a statistically significant difference regarding radiologically intestinal obstruction (p=0.001), hernia type (p=0.005), BLL (p<0.001), WBC, NLR and LDH values (p<0.05). In incarcerated hernia patients with a lactate value ≥1.46 mg/dL, sensitivity was observed to be 84.0% and specificity 86.0% (p<0.001). CONCLUSION: In patients with a preliminary diagnosis of an incarcerated hernia, the risk of possible small bowel resection is the most important point in deciding for an operation. The presence of an intestinal obstruction in radiological examinations, and particularly the high levels of WBC, NLR, LDH and BLL, may indicate a necessity for possible small bowel resection. Concerning the risk associated with small bowel resection, blood lactate levels ≥1.46 mg/dL may be alerting.