Background/AimsThe most widely used method for diagnosing sarcopenia is the skeletal muscle index (SMI). Several studies have suggested that psoas muscle thickness per height (PMTH) is also effective for detecting sarcopenia and predicting prognosis in patients with cirrhosis. The aim of this study was to evaluate the optimal cutoff values of PMTH for detecting sarcopenia in cirrhotic patients.MethodsAll cirrhotic patients who underwent abdominal computed tomography (CT) scan including L3 and umbilical levels for measuring SMI and transverse psoas muscle thickness, respectively, were included. Two definitions of sarcopenia were used: (1) sex-specific cutoffs of SMI (≤52.4 cm2 /m2 in men and ≤38.5 cm2 /m2 in women) for SMI-sarcopenia and (2) cutoff of PMTH (<16.8 mm/m) for PMTH-sarcopenia.ResultsSix hundred fifty-three patients were included. The average age was 53.6 ± 10.2 years, and 499 patients (76.4%) were men. PMTH correlated well with SMI in both men and women (P<0.001). Two hundred forty-one (36.9%) patients met the criteria for SMI-sarcopenia. The best PMTH cutoff values for predicting SMI-sarcopenia were 17.3 mm/m in men and 10.4 mm/m in women, and these were defined as sex-specific cutoffs of PMTH (SsPMTH). The previously published cutoff of PMTH was defined as sex-nonspecific cutoff of PMTH (SnPMTH). Two hundred thirty (35.2%) patients were diagnosed with SsPMTH-sarcopenia, and 280 (44.4%) patients were diagnosed with SnPMTH-sarcopenia. On a multivariate Cox regression analysis, SsPMTH-sarcopenia (hazard ratio [HR], 1.944; 95% confidence interval [CI], 1.144–3.304; P=0.014) was significantly associated with mortality, while SnPMTH-sarcopenia was not (HR, 1.446; 95% CI, 0.861–2.431; P=0.164).ConclusionsPMTH was well correlated with SMI in cirrhotic patients. SsPMTH-sarcopenia was an independent predictor of mortality in these patients and more accurately predicted mortality compared to SnPMTH-sarcopenia.

Amaç: Anksiyete invaziv medikal giriflimlere maruz kalan hastalarda yayg›n bir problemdir. Kolonoskopi emek isteyen bir prosedürdür ve baflar›l› sonuç için hastan›n kooperasyonunun iyi olmas› gereklidir. Biz kolonoskopi öncesi rutin bilgilendirmeye ilave-

BACKGROUND: Acute pancreatitis (AP) is one of the major pathologies among gastrointestinal system diseases. The aim of this study was to determine the relationship between the red cell distribution width (RDW) value and the C-reactive protein (CRP)/ albumin ratio in patients with AP. METHODS: In this retrospective study, AP cases were enrolled and divided into 2 groups according to the Ranson criteria as moderate or severe pancreatitis. The RDW and CRP/albumin values, length of hospitalization and stay in the intensive care unit (ICU), and the complications experienced were compared between these 2 groups. RESULTS: A total of 264 patients were included in the study. Moderate pancreatitis was detected in 204 patients (77.2%) while severe pancreatitis was seen in 60 patients (22.8%) (p=0.081). There was no statistically significant difference in the RDW value between the groups (p=0.193). The CRP/albumin values were significantly higher in the severe pancreatitis group compared with the moderate group (p<0.001). The severe AP group also had a longer period of hospital care, both overall and in the ICU (p=0.001, p=0.047). CONCLUSION: RDW was not a specific marker for predicting prognosis in AP, but the CRP/albumin ratio is an easy-to-apply, inexpensive, and reliable marker.

Background/Aims: Hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis. In patients with severe HTG (TG level>1000 mg/dL), it may be beneficial to immediately lower the levels of triglyceride (TG) and chylomicrons. In this study, we present one of the largest case series on the use of therapeutic plasma exchange (TPE) for hypertriglyceridemia-induced acute pancreatitis (HTG-AP). Materials and Methods: Overall, 33 patients who were admitted to our clinic for HTG-AP and underwent TPE between January 2007 and July 2017 were included in the study. Clinical data and outcomes and the reduction of triglyceride levels were examined retrospectively. Results: The TG level decreased by 54.4%, and the total cholesterol level decreased by 52.1% after one TPE session. The TG decrease after the second TPE session was found to be 79.4%. There were 20 (60.6%) patients with mild acute pancreatitis, 10 (30.3%) patients with moderetaly severe acute pancreatitis, and 3 (9.1%) patients with severe acute pancreatitis based on the categorization according to the revised Atlanta criteria. Regarding local complications, the acute peripancreatic fluid collection was observed in 13 (39.4%) patients, acute necrotic collection was observed in 1 (3%) patient, walled-off necrosis was observed in 1 (3%) patient, and pancreatic pseudocyst was not observed in any patient. Mortality was not determined in patients with mild and moderately severe acute pancreatitis, and its rate was 33.3% in patients with severe acute pancreatitis. The overall mortality rate was 3%. No significant complications related to TPE were noted. Conclusion: TPE is a safe and helpful therapeutic treatment method for patients with HTG-AP and may be considered particularly in patients with severe acute pancreatitis.

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IntroductionEndoscopic retrograde cholangiopancreatography (ERCP) is used in the diagnosis and therapy of biliary tract diseases. The ERCP is an invasive procedure that does not increase complications in the elderly. Few studies have assessed the safety of ERCP in the elderly. Life expectancy is rising, which causes an increasing demand for ERCP in the elderly.AimTo show that therapeutic ERCP is safe and we compared the level of complications among the elderly (> 80 years of age) and the level among a younger group (< 65 years of age).Material and methodsThe study was designed retrospectively. The details of all patients 80 years of age and older undergoing ERCP were analysed. One hundred and fifty patients were included in each of the groups: > 80 years of age, older group A; and < 65 years of age, younger group B.ResultsIn group A, 4 cases (2.7%) of bleeding (all mild) was observed, and perforation was not observed. The ERCP-related mild pancreatitis was observed in 7 patients (4.6%). There were no cases of mortality during procedures of ERCP in group A. In group B 6 bleeding cases (4%) (all mild) were observed. Perforation was not observed in group B. ERCP-related mild pancreatitis occurred in 11 patients (7.3%). There were no cases of mortality during procedures of ERCP in group B. Our study showed that ERCP is a safe and effective procedure in elderly patients.ConclusionsOutcomes of ERCP for diagnostic and therapeutic success, and complication rates, are similar to those in younger patients. The ERCP is effective and safe in the elderly.

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Amaç: Laparoskopik kolorektal cerrahi günümüzde birçok merkezde yaygın olarak kullanılan bir prosedür halini almaya başlamıştır. Kliniğimizdeki ilk laparoskopik kolorektal cerrahi olgularımızın erken dönem sonuçlarını sunmayı planladık. Yöntem: Eylül 2014-Ağustos 2016 tarihleri arasında Adnan Menderes Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı Kliniği'nde laparoskopik kolorektal cerrahi uygulanan olgular çalışmaya dahil edilmiştir. Bulgular: Çalışmamıza toplam 30 hasta dahil edildi. On bir olguya (%36,7) Low anterior rezeksiyon, 10 olguya (%33,3) sağ kolektomi, yedi olguya (%23,3) anterior rezeksiyon, bir olguya (%3,3) total kolektomi, bir olguya da (%3,3) abdominoperineal rezeksiyon işlemi uygulandı. Ortalama ameliyat süresi 149,67 dakika (aralık, 100-300) olarak kaydedildi. Hastaların ortalama hastanede yatış süreleri 6,87 gün (aralık, 3-34) olarak belirlendi. Toplam iki hastada (%6,7) anastomoz kaçağı gelişirken, bir hastada (%3,3) üreter hasarı, beş hastada (%16,7) yara yeri enfeksiyonu gelişti. Sonuç: Laparoskopik kolorektal cerrahi sonuçlarımız literatür ile benzer sonuçlar vermektedir. Anahtar Kelimeler: Laparoskopi, kolorektal cerrahi, deneyim ABSTRACT ÖZAim: Currently laparoscopic colorectal surgery began to be a widely used procedure in many centers. We aimed to present early period outcomes of first group of patients who had laparoscopic colorectal surgery in our clinic. Method: Included were 30 patients who underwent laparoscopic colorectal surgery between September 2014 and August 2016 in Adnan Menderes University Faculty of Medicine General Surgery Clinic. Results: A total of 30 patients were included to this study. Low anterior resection were performed in 11 (36.7%) patients, right colectomy in 10 (33.3%) patients, anterior resection in seven (23.3%) patients, total colectomy in one (3.3%) patient, abdominal perineal resection in one (3.3%) patient. Median operation time was 149.67 (range, 100-300) minutes. The median postoperative length of stay was 6.87 (range, 3-34) days. Anastomic leakage occurred in two patients (6.7%), ureter damage in one patient (3.3%), and wound infection in five patients (16.7%). Conclusion: Our laparoscopic colorectal surgery outcomes and the literature shows similarity.