High levels of platelet/lymphocyte ratio are associated with metastatic gastric cancer.

PURPOSE: The predictive and prognostic value of cheap, easily accessible and commonly available complete blood count parameters has already been studied in a variety of cancers. In the present study, we aimed to investigate the association between pretreatment platelet/lymphocyte ratio (PLR) and metastatic gastric cancer. METHODS: The records of 228 patients dating from January 2010 to June 2014 were retrospectively evaluated. Patients who had undergone radical (N=157) or palliative gastrectomy (N=71) for metastatic gastric cancer were included and divided into two groups according to stage (early-advanced) and metastasis (absence-presence) status, and PLR values were compared. RESULTS: 38 (16.6%) of 228 patients had early gastric cancer (non metastatic cases). PLR values of advanced gastric cancer (not including metastatic cases) were significantly higher compared to early gastric cancer (231.6±107.45 and 160.3±71.5, respectively; p<0.001). Seventy one (31.1%) of 228 patients had distant metastasis. PLR values of metastatic gastric cancer were significantly higher than in non-metastatic gastric cancer (251.0±94.8 and 192.7±88.8, respectively; p<0.001). Logistic regression analysis showed that PLR was an independent predictive factor for tumor burden in both stage and metastasis groups (p<0.001 and p=0.003, respectively). Also, in correlation analysis, PLR showed mild correlation with stage and metastasis groups (r=0.291 and r=0.299, respectively). CONCLUSIONS: Pretreatment PLR values were correlated with tumor burden, and most higher values were detected in metastatic disease. Our findings may be useful, especially in the decision-making for laparoscopic staging in patients who have no radiological evidence of metastatic disease.

Mastalgia-Cancer Relationship: A Prospective Study.

OBJECTIVE: Mastalgia is an important symptom affecting approximately 70% of women and it disrupts the quality of life especially due to the worry of having cancer. In our study, the type and severity of mastalgia symptom of patients who presented to the outpatient clinic with mastalgia complaint were assessed along with their physical examination findings and radiology results. The purpose of the study is to demonstrate the relationship between mastalgia and malignity when assessed in combination with the risk factors of patients. MATERIALS AND METHODS: The age, family history, menopausal status, age at the first childbirth, menarche, presence/absence of hormone replacement therapy, type of mastalgia, comorbidities and examination findings of 104 patients, who presented to the General Surgery outpatient clinic with mastalgia symptom, were recorded and assessed in the light of radiological study results. RESULTS: With respect to the mastalgia types of the patients, 38.5% had cyclic pain, 57.7% non-cyclic pain and 3.8% other types of pain. Mild mastalgia was present in 46.2% of the patients, moderate mastalgia in 24% and severe mastalgia in 29.8% of them. According to the BIRADS category, 48.1% of the patients were identified to have BIRADS 1 mass lesions, 39.4% BIRADS 2, 9.6% BIRADS 3 and 2.9% BIRADS 5 mass lesions. The patients who were identified to have BIRADS 5 mass lesions described non-cyclic and severe pain in the post-menopausal period. They had palpable masses along with the pain symptom. CONCLUSION: Our study suggests that mastalgia symptom does not per se result in suspicion of malignancy, but physical examination and radiological imaging should also be used as needed for confirmation. Studies with a larger patient population are needed to shed light on the mastalgia epidemiology and its relationship with cancer.

Peptic ulcer complications requiring surgery: what has changed in the last 50 years in Turkey.

BACKGROUND/AIMS: The incidence and prevalence of peptic ulcer disease has decreased in recent years, but it is not so easy to make the same conclusion when complications of peptic ulcer are taken into consideration. The aim of this study is to determine the time trends in complicated peptic ulcer disease and to state the effects of H2 receptor blockers, proton pump inhibitors (PPI), and H. pylori eradication therapies on these complications. MATERIALS AND METHODS: This study retrospectively evaluated the patients who were operated on for complications (perforation, bleeding, and obstruction) of peptic ulcer for the last 50 years. Patients were grouped into four groups (G1-G4) according to the dates in which H2 receptor blockers, PPIs, and eradication regimens for H. pylori were introduced The time periods that were studied were: (G1) 1962-1980, (G2) 1981-1990, (G3) 1991-1997, and (G4) 1998-2012. RESULTS: In total, 2953 patients were operated on for complications of peptic ulcer disease, of which 86% of the patients were male. In G1, perforation and obstruction were significantly the most frequent complications (p<0.001), followed by bleeding. In groups G2 and G3, obstruction was still the most frequent complication requiring surgery (p<0.001). In G2 and G3, obstruction was followed by perforation and bleeding, respectively. In G4, perforation was significantly the most frequent complication (p<0.001). CONCLUSION: From 1962 to 1990 obstruction was the most common complication requiring surgery. In the last decade, perforation became the most common complication. In contrast to reports in the literature, bleeding was the least common complication requiring surgery in Turkey.

Are neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as effective as Fournier's gangrene severity index for predicting the number of debridements in Fourner's gangrene?

BACKGROUND: Fournier's gangrene (FG) is a rapidly progressive and necrotizing infection of the subcutaneous and fascial tissues with a high mortality rate. In the present study, we aimed to investigate prognostic factors and analyze the outcomes of 68 patients in a tertiary reference hospital. METHODS: Patients admitted to the emergency department were investigated retrospectively between January 2006 and January 2013 and divided into two groups. The patients in Group I (G1) required one debridement, and Group II (G2) patients required more than one. Patient demographic and clinical characteristics were encoded. Fournier's Gangrene Severity Index (FGSI) scores, neutrophil-lymphocyte ratios (NLR), and platelet-lymphocyte ratios (PLR) were calculated. Prognostic factors were compared between the groups. RESULTS: There were no statistically significant differences between the groups in terms of mean age, female-male ratio, or duration of symptoms on admission; however, there were more infection sources, predisposal factors, and positive culture results in G2. Additionally, hospital stay, total cost, and mortality rate values were high in G2. We found statistically higher NLR and PLR ratios in G2, but there was no significant difference in FGSI scores between the groups. CONCLUSION: The FGSI scoring system was not found to be valuable in determining prognosis. However, NLR and PLR were valuable, and previous use of NLR and PLR for determining Fournier's gangrene prognosis could not be found in the English literature.

Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis.

BACKGROUND: Accurately diagnosing appendicitis can be difficult. This retrospective study aimed to evaluate the ability of the neutrophil-to-lymphocyte ratio (NLR) to predict acute appendicitis pre-operatively and to differentiate between simple and complicated appendicitis. METHODS: A database of 1067 patients who underwent surgery was evaluated. Based on postoperative histopathological examination, the patients were divided into two groups: acute appendicitis (G1) and normal appendix (G2). Patients in the acute appendicitis group were further divided into two subgroups: simple appendicitis (G1a) and complicated (gangrenous and perforated) appendicitis (G1b). RESULTS: G1 included 897 patients and G2 included 170 patients. Among the 897 G1 patients, there were 753 G1a patients and 144 G1b patients. A NLR of 4.68 was associated with acute appendicitis (G1 vs G2, p<0.001). The sensitivity and specificity were 65.3% and 54.7%, respectively. A NLR of 5.74 was associated with complicated appendicitis (G1a vs G1b, p<0.001). The sensitivity and specificity of the two clinical features were 70.8% and 48.5%, respectively. CONCLUSION: We suggest that preoperative NLR is a useful parameter to aid in the diagnosis of acute appendicitis and differentiate between simple and complicated appendicitis, and can be used as an adjunct to the clinical examination.

Neutrophil-lymphocyte ratio as a predictive factor for tumor staging in colorectal cancer.

BACKGROUND/AIM: In the preoperative period, simple methods to identify the tumor stage of colorectal cancer patients are needed. In recent years, the neutrophil-lymphocyte ratio (NLR) has been used as a predictive parameter for systemic inflammatory response in many different clinical entities. This study aims to determine if the NLR predicts the tumor stage in colorectal cancer patients in the preoperative period. MATERIALS AND METHODS: A total of 206 patients diagnosed with colorectal cancer and admitted for surgical treatment over a 6-year period were identified from a retrospectively maintained database. NLR was calculated from preoperative full blood counts. NLRs were compared with the tumor stages as determined in histopathological reports and scanning tests to determine the extent of metastasis. RESULTS: We found NLRs to be statistically higher in patients with T3 and T4 tumors than in patients with T1 and T2 tumors (mean: 5.261 vs. 4.499, respectively, P = 0.010). Similarly, we found statistically higher NLR values in the N1 and N2 groups than in the NO group (mean: 6.597 vs. 4.501, respectively, P < 0.001). Additionally, NLRs were statistically higher in M1 patients than in MO patients (mean: 8.261 vs. 5.158, respectively, P = 0.004). CONCLUSION: In the preoperative period, NLR was found to be a valuable predictive parameter for tumor staging in patients with colorectal cancer, thus informing us as to the kind of tumor we will meet when we open the abdomen.

Toxoplasma lymphadenitis mimicking malign axillary lymphadenopathy of a left breast mass.

Toxoplasmosis is an infection caused by the intracellular parasite, Toxoplasma gondii. Immunocompetent persons with primary infection are usually asymptomatic, but latent infection can persist for the life of the host. There is a risk of reactivating infection at a later time should the individual become immunocompromised, even if infection was asymptomatic or only mildly symptomatic initially. Axillary lymph nodes receive 85% of the lymphatic drainage from the breast. Lymph node metastases are relatively common even with invasive breast cancers ≤1 cm in size. Here, we report a case of toxoplasma lymphadenitis in a female adult patient mimicking a malign breast lymphadenopathy of a left breast mass.

A life-threatening multilocalized hidradenitis suppurativa case.

The patient was a 38-year-old man. He had been suffering from hidradenitis suppurativa (HS) for approximately 20 years. He had active lesions at both axillas, hip, scrotum, and perineum, and inactive lesions located behind the ears, lower abdomen, and posterior neck. He was monitored and treated at different branches; he continuously used antibiotics and was given steroids at times. Antibiotic resistance developed subsequently. His general situation was bad; vital signs were poor; and he was in a state of sepsis and preshock, so this case was regarded as life-threatening. Total excision was performed first on the lesion at the right axilla, then on the lesion at the left axilla, and the parascapular fasciocutaneous flap was reversed. A skin graft was applied to the triangular defect on the scapula. No relapse occurred. Then the lesions at the hip were managed. Broad excision was used twice with the patient under general anesthesia; because the lesions spread to the retrococcygeal and gluteal muscles, coccyx resection and partial gluteal muscle resection were implemented. The defect was eliminated with a progressive flap. At the intergluteal sulcus, small lesions emerging at the median line were debrided with the patient under local anesthesia, and together with secondary recovery, the disease was completely managed. Lesions at the perineum and scrotum and at both inguinal areas were broadly excised and grafted. No lesion has relapsed so far. One year later, Hodgkin's lymphoma was diagnosed, and the patient was treated with chemoradiotherapy easily, because there was no infective focus. The disease is in remission now. The patient weighs 110 kg, is healthy, and is working again.

Comparative effectiveness of several agents for preventing postoperative adhesions.

Postoperative adhesions (PAs) are usually clinically asymptomatic. Symptomatic cases, however, may present with chronic abdominal and pelvic pain, infertility, and intestinal obstruction; and they may require intensive, costly therapeutic modalities. Various agents have been used to prevent PAs, but the results indicate general suboptimal effectiveness. Our objective was to evaluate the comparative effectiveness of two pharmacologic agents for preventing PA: nadroparine calcium (low-molecular-weight heparin, or LMWH) and aprotinin, as well as a barrier agent, sodium hyaluronate/carboxymethycellulose (SCMC). Our subjects were 40 male Wistar-Albino rats divided into four groups, each consisting of 10 rats, which underwent standard cecal abrasion preceding midline laparotomy. In the control group (group 1) 1 ml of 0.9% NaCl was administered intraperitoneally before abdominal closure. In the three preventive groups, 100 U AXa (anti factor X activity) LMWH, 1800 IU aprotinin, and SCMC were administered intraperitoneally to groups 2, 3, and 4, respectively. Relaparotomy was performed on the 14th postoperative day. Visceral and abdominal wall adhesions were scored in a blinded fashion. The adhesion scores (mean +/- SD) for groups 1, 2, 3, and 4 were 2.00 +/- 0.67, 0.6.00 +/- 0.84, 1.10 +/- 0.74, and 0.20 +/- 0.42, respectively. The differences in the adhesion scores among all three preventive groups (groups 2, 3, 4) were statistically significant when compared with the control group ( p < 0.001, p = 0.017, p < 0.001, respectively). Intraperitoneal SCMC and administration of LMWH were more effective than giving aprotinin.