Colorectal cancer (CRC) is the third most common cause of cancer-related death in Europe. The aim of the present study was to elucidate the efficiency of the neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR), and the mean platelet volume (MPV) as tools for the preoperative diagnosis of CRC and their usefulness in the follow-up of CRC. A total of 144 CRC patients, as diagnosed by colonoscopy, and 143 age-matched and sex-matched healthy participants were included in the study. Medical records were used to compare preoperative and postoperative data including hemoglobin levels, platelet counts, MPV, NLR, and PLR. NLR, PLR, and MPV were significantly higher in CRC patients preoperatively, compared with healthy participants. Receiver-operating characteristic curve analysis suggested 2.02 as the cutoff value for NLR [area under the curve (AUC): 0.921, sensitivity: 86%, specificity: 84%], 135 as the cutoff value for PLR, (AUC: 0.853, sensitivity: 70%, specificity: 90%) and 8.25 fl as the cutoff value for MPV (AUC: 0.717, sensitivity: 54%, specificity: 76%). Subgroup analysis showed that NLR, PLR, and MPV levels were also significantly higher in nonanemic CRC patients compared with the control group, which is of great theoretical and clinical value for the early detection of CRC. Surgical tumor resection resulted in a significant decrease in NLR, PLR, and MPV. Our results suggest that NLR, PLR, and MPV may be used as easily available additional biomarkers for CRC in screening the general population, as well as in postoperative follow-up.

In conclusion, there is a strong association between PAD and higher rates of cannulation complications, independent of cannulation technique. In certain situations, and in the hands of experienced endoscopists, needle-knife fistulotomy might be a feasible option for successful biliary cannulation in certain patients with PAD.

We evaluated swallowing function in patients with myasthenia gravis (MG) with or without dysphagia symptoms using different evaluation parameters and compared the results with those of healthy subjects. A total of 36 patients with MG and 25 healthy volunteers were included in the study. The subjects were classified into three groups; patients without dysphagia (group 1), patients with dysphagia (group 2), and healthy participants (group 3). The presence and severity of dysphagia, the oropharyngeal, pharyngeal, pharyngoesophageal, and esophageal phases were assessed using a screening test, manometric test, electrophysiologic studies [electroneuromyography (EMG)], fiberoptic endoscopic evaluation of swallowing (FEES), and barium swallow pharyngeal esophagography (BSPE), respectively. There was a significant difference between group 1 and group 3 in terms of BSPE (p = 0.001) and manometry tests (p = 0.001). A significant difference was found in all methods between group 2 and group 3 (p = 0.001, for all). In the comparison of the patient groups, although the number of patients with dysphagia in group 2 was significantly higher in the clinical tests (p = 0.007), FEES (p = 0.001), and EMG (p = 0.043) than in group 1, no difference was detected for BSPE (p = 0.119) and manometry (p = 0.644). Swallowing functions in patients with MG may be affected even without symptoms. This condition should be considered in their follow-up.

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Signet ring cell carcinoma (SRCC) is an epithelial malignancy characterized by intracellular mucin production and appearance of specific cells on biopsy specimens. Ninetysex percent of SRCCs are observed in the stomach [1]. The colon, rectum, gallbladder, pancreas, prostate, urinary bladder, breast and mammalian and oropharyngeal small salivary glands are the other rare locations. The abdominal, mediastinal, supraclavicular and cervical lymph nodes and peritoneum, liver, lung and leptomeninges are the effected sites of metastasis. Primary colorectal and pancreatic SRCCs are rare and have an extremely poor prognosis [2]. Herein, we report an extremely rare case of SRCC with two exceeding sites of involvement in the same presentation.An 83-year-old man presented with weight loss, jaundice, itching and painless rectal bleeding. He had no history of any medication and smoking. Vital signs were in normal limits. On physical examination, jaundice and a distended abdomen with no palpable mass were present. Rectal examination was normal. Laboratory findings were AST 384 U/L, ALT 382 U/L, ALP 462 U/L, GGT 765 U/L, total bilirubin 38.9 mg/dL and direct bilirubin 26.8 mg/dL. CEA was 5.5 ng/mL (reference range, 0-5 ng/mL) and carbohydrate antigen 19-9 was 15.8 U/mL (reference range, 0-37 U/mL). Abdominal CT showed a 13× 15 mm hypodense lesion in the head of the pancreas and wall thickening in distal colon. Colonoscopy showed infiltration of the adjacent wall due to ulceration and irregular border of the mass at 11 to 16 cm from the anal verge (Fig. 1a). Endoscopic ultrasound (EUS) showed an irregular hypoechoic 33×20 mm mass in diameter, at the pancreatic head. Moreover, portal vein and superior mesenteric veins were infiltrated (Fig. 1b). EUSguided fine needle aspiration of the pancreatic lesion showed signet ring cell carcinoma similar to that found in the colonic sampling (Fig. 2a, b). The patient refused to undergo further treatment and was discharged after endoscopic drainage for biliary malignant stricture with a plastic stent.Identifying the primary origin and the metastatic SRCC can be difficult on histological basis. This case exemplifies that immunohistochemical (IHC) analysis of cytokeratin expression patterns can be useful. We evaluated the IHC expression of cytokeratin 7 (CK7) and cytokeratin 20 (CK20), and IHC analysis of the pancreatic and colonic mass demonstrated that the tumor cells were strongly positive for CK7, but negative for CK20. Our case was thought to be originating from pancreas because of the positive findings for CK7 and the negative finding for CK20 staining. But we think it is difficult to conclude that our case was a real pancreatic type using only these IHC findings. We also suppose that synchronous tumors developed in two places and synchronous pancreatic and colonic involvement of SRCCs have an extremely poor prognosis than the other sites of involvement alone. The liver is the primary location of metastasis of pancreatic

Increased levels of serum and ascitic fluid CRP were associated with malignant ascites.

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