Neutrophil to Lymphocyte Ratio on Appendectomy of Geriatric and Nongeriatric Patients.

PURPOSE: Acute appendicitis is the most frequent emergency procedure that requires acute surgical intervention. The mortality risk is higher in geriatric patients. There is not a single parameter to diagnose it easily and negative appendectomy is traditionally accepted however the operation itself can cause morbidity and mortality especially in elderly patients. The neutrophil-to-lymphocyte ratio is a predictor of acute inflammation and was recently studied for the diagnosis of AA. The aim of this study is to analyze the diagnostic value of NLR on positive appendectomy rates amongst geriatric and nongeriatric patients. MATERIALS AND METHODS: 755 patients admitted to the emergency department, with abdominal pain who underwent urgent laparotomy after diagnosed as acute appendicitis. Patients' ages, genders, laboratory results, and intraoperative findings were collected. Geriatric patients were analyzed in group one, and nongeriatric patients were in group 2. Groups then sorted into subgroups by means of positive and negative appendectomies. RESULTS: Although NLR was higher in positive appendectomy subgroup in group 1 it was not statistically significant. NLR could not independently predict positive appendectomy in geriatric patients. In group 2, male gender was significantly higher in the positive appendectomy group (p < 0.001). NLR was also significantly higher in the positive appendectomy group (p < 0.001). In group 2 NLR could independently predict positive appendectomy (p < 0.001). CONCLUSION: NLR could not predict positive appendectomy rates in the geriatric population but could in the nongeriatric patient group. To find the optimal NLR levels, prospective randomized studies are needed.

Impact of high dose chemoimmunotherapy after surgery on the overall and disease-free survivals in advanced stage malignant melanoma.

BACKGROUND: To investigate the impact of high dose chemoimmunotherapy in addition to surgery on the cumulative survival and disease-free survey of malignant melanoma patients. METHODS: A total of 86 malignant melanoma patients [35 females (40.7%), 51 males (59.3%), mean age: 55.5] were treated according to their stages between Februrary 1997 and June 2007. After surgery, adjuvant immunotherapy was applied to patients in Stage 2, while adjuvant chemotherapy and adjuvan immunotherapy were administered to those at Stages 3 and 4. RESULTS: Overall rate of mortality was 31.4% (27/86). The most frequent postoperative complications were wound infection (n=8, 9.3%) in the early period and lymphedema in lower extremities (n=4, 4.6%) in the late period. Temporary and tolerable complications ensourcing from chemoimmunotherapy were encountered in 9 (10.4%) patients. The survival rates and disease-free periods of combined treatment protocol were found to be similar to those in ECOG 1684 and ECOG 1690 studies. CONCLUSION: Adjuvant immunotherapy and chemoimmunotherapy seem to improve overall survival and disease-free survey in malignant melanoma. Further clinical studies are necessary to demonstrate the actual effectivity of this promising protocol in the management of malignant melanoma.