Lymphocyte-to-C-reactive protein ratio as a new biomarker for predicting mortality and morbidity in Fournier's gangrene.

OBJECTIVE: The purpose of this study was to research the neutrophil-lymphocyte ratio (NLR), lymphocyte-to-C-reactive protein ratio (LCR), and Fournier's Gangrene Severity Index (FGSI) for predicting prognosis and mortality in patients with Fournier's gangrene (FG). MATERIAL AND METHODS: Patients diagnosed with FG and treated in a tertiary referral hospital in the period from January 2013 to June 2020 were reviewed. LCR, FGSI, and NLR values were calculated. RESULTS: Our series included a total of 41 patients. Of the patients, 78% survived and 21.9% (n = 9) died. Survivors were significantly younger than non-survivors (p = 0.009). Hospital costs were higher in non-survivors and close to statistical significance (p = 0.08). The ROC analysis revealed that the FGSI, LCR, and NLR parameters were significant in identifying survivors and non-survivors (AUC = 0.941 [0.870-1.000], p < 0.001; AUC = 0.747 [0.593-0.900], p = 0.025; and AUC = 0.724 [0.548-0.900], p = 0.042). CONCLUSION: A low LCR value can be used as a marker to assess mortality and disease severity in patients with Fournier's gangrene.

OBJETIVO: Investigar el cociente neutrófilos-linfocitos (CNL), el cociente linfocitos-proteína C reactiva (CLP) y el índice de gravedad de la gangrena de Fournier (IGGF) para predecir el pronóstico y la mortalidad en pacientes con gangrena de Fournier (GF). MÉTODO: Se revisaron los pacientes diagnosticados de GF y atendidos en un hospital de tercer nivel de referencia en el período de enero de 2013 a junio de 2020. Se calcularon los valores de CLP, IGGF y CNL. RESULTADOS: Nuestra serie incluyó 41 pacientes, de los cuales el 78% sobrevivieron y el 21.9% (n = 9) fallecieron. Los supervivientes eran significativamente más jóvenes que los no supervivientes (p = 0.009). Los costes hospitalarios fueron mayores en los no supervivientes y cercanos a la significación estadística (p = 0.08). El análisis ROC reveló que los parámetros IGGF, CLP y CNL fueron significativos para identificar supervivientes y no supervivientes (AUC: 0.941 [0.870-1.000], p < 0.001; AUC: 0.747 [0.593-0.900], p = 0.025; AUC: 0.724 [0.548-0.900], p = 0.042). CONCLUSIONES: Un valor bajo de CLP se puede utilizar como marcador para evaluar la mortalidad y la gravedad de la enfermedad en pacientes con GF.

A new model for prediction of bowel gangrene in sigmoid volvulus.

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.

Performance of Residents During Laparoscopic Cholecystectomy: Is Self-assessment Reliable?

BACKGROUND: To compare the self-assessment of surgical residents and observers (faculty members and nurses) during laparoscopic cholecystectomy (LC). MATERIALS AND METHODS: A prospective observational study was conducted between February 2020 and July 2020 at a medical school hospital. Seventy-four LC surgeries were performed by surgical residents in the presence of faculty members. A self-assessment of the technical and nontechnical performance of the residents was requested. The self-assessment of residents was compared with observer evaluations using the Kruskal-Wallis test. Gwet AC2 fit coefficient was used to determine the consistency between the observers' and residents' assessments. Bland-Altman plots were generated with 95% limits of agreement to describe the agreement between the total scores of the observers. RESULTS: The self-assessment of residents had a statistically significant higher score when compared with observers (faculty and nurses) (P<0.001). However, no significant difference was observed between the total scores given by the observers (faculty members and nurses) (P>0.05). There was a moderate agreement between the resident versus faculty members [0.503; 95% confidence interval (CI), 0.430-0.576] and resident versus nurse (0.518; 95% CI, 0.432-0.605) when evaluating technical skills. However, there was substantial agreement between faculty members and nurses (0.736; 95% CI, 0.684-0.789). Postoperative pain was significantly correlated with resident self-assessment (P=0.022). CONCLUSION: The self-assessment scores of surgical residents in LC operations were overestimated compared with observer assessments.

Could lymphocyte to C-reactive protein ratio predict the prognosis in patients with gastric cancer?

BACKGROUND: Development or progression of inflammation in neoplastic diseases is known to be part of the disease. Lymphocyte to C-reactive protein ratio (LCR) is a new indicator showing the inflammatory state. The aim of this study is to show the clinical importance of the relationship between the preoperative LCR and the prognosis of patients with gastric cancer. METHODS AND PATIENTS: We evaluated gastric cancer patients, who underwent surgery between 2010 and 2015. LCR and neutrophil-to-lymphocyte ratio (NLR) were calculated from pre-treatment of complete blood counts. Both ratios were compared to the perioperative outcomes and median survival times. Association between LCR and postoperative tumour stage was studied by using multivariate analysis with other clinicopathological variables. RESULTS: A total of 123 patients were included. The mean age of the patients was 65.36 ± 10.08. Preoperative low LCR value was associated with advanced tumour stage, adjacent organ invasion, lymph node metastasis and postoperative early complications. The receiver operating characteristic analysis results showed that LCR and NLR parameters were significant (CI 0.718-0.886; 95%); P < 0.001, CI 0.534-0.732; 95%). Cut-off value being 193, the mean survival of patients who had LCR values of overcut-off value was found to be significantly higher compared with the patients with lower LCR values (P < 0.001). CONCLUSION: LCR, a simple calculated ratio of values obtained from easy and widely available serum indicators could be an effective prognostic marker with gastric cancer.

Transrectal vacuum treatment for low colorectal anastomotic leaks.

BACKGROUND: Anastomotic leakage after rectal resection is a major complication which increases the rates of morbidity and mortality. A small number of patients with generalised peritonitis need radical surgical treatments. Stable patients with local peritonitis can be treated conservatively. The aim of this study is to evaluate the effects of transrectal vacuum treatment on the healing of low colorectal anastomotic leaks. METHODS: Medical records of fourteen patients managed conservatively with transrectal vacuum treatment for anastomotic leakage after rectal resection between September 2015 and September 2018, were retrospectively reviewed. Anastomotic leakage was documented and evaluated with computerised tomography and rectosigmoidoscopy. RESULTS: 10 of 14 patients had successful closure of the perianastomotic abscess cavity after a mean of 19 days of vacuum treatment. 2 patients in this group had stricture on the anastomotic site as a late complication which was successfully treated with repeated dilatations. 4 of 14 patients had eventually a permanent sigmoid colostomy. CONCLUSION: Our results suggest that transrectal vacuum treatment can be safely used to all stable patients without generalised peritonitis in the management of low colorectal anastomotic leakages. KEY WORDS: Anastomotic leakage, Rectosigmoidoscopy, Vacuum treatment, VAC.

Laparoscopic Removal of Gossypiboma.

Gossypiboma is defined as a mass caused by foreign body reaction developed around the retained surgical item in the operative area. When diagnosed, it should be removed in symptomatic patients. Minimal invasive surgery should be planned for the removal of the retained item. The number of cases treated by laparoscopic approach is rare in the literature. We present a case of forty-year-old woman referred to emergency room with acute abdomen diagnosed as gossypiboma and treated successfully with laparoscopic surgery.