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Objective: The aim of this study is to investigate the relationship between procalcitonin (PCT) level and the severity of acute cholecystitis. Materials and Methods:This study included 200 patients diagnosed with acute cholecystitis. To diagnose and assess the severity of acute cholecystitis; physical examination and abdominal ultrasound findings were evaluated and blood samples were taken to determine white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and levels of coagulation factors, blood gas, C-reactive protein (CRP) and PCT. Patients were classified into three stages, namely, mild, moderate, and severe, according to the severity of acute cholecystitis using the Tokyo guidelines. The role of PCT level in the assessment of severity of acute cholecystitis and the correlation between the stages and PCT level were statistically analyzed.Results: Among patients with acute cholecystitis, 110 (55%) were classified as mild, 61 (30.5%) as moderate, and 29 (14.5%) as severe. Leukocytosis or leukopenia was positive in 48.5%, ESR elevation was found in 72.5%, CRP positivity in 55.5%, PCT elevation in 27%, and positive findings of ultrasonographic imaging in 54.5% of the patients. Serum WBC count, ESR, and CRP and PCT levels increased as the severity of disease increased (p<0.05). PCT could discriminate grade I from grade II-III with 95.45% sensitivity and 46.67% specificity at the best cut-off value of ≤0.52 (p<0.001). PCT could also discriminate grade III from grade I-II with 72.4% sensitivity and 90.06% specificity at the best cut-off value of >0.8 (p<0.001).Conclusion: PCT level may be considered to be a parameter that could be added to the assessment of the severity of acute cholecystitis in the Tokyo guidelines, although further studies are needed to support our findings.Keywords: Procalcitonin, acute cholecystitis, severity of illness index ÖZ Amaç: Bu çalışmanın amacı akut kolesistitin şiddeti ile prokalsitonin (PCT) seviyesi arasındaki ilişkiyi araştırmaktır.Gereç ve Yöntem: Bu çalışmaya akut kolesistit tanısı alan 200 hasta alındı. Tanıyı koymak ve akut kolesistitin şiddetini belirlemek için; fizik muayene ve abdominal ulltrasonografi bulguları değerlendirildi ve beyaz küre sayımı (BKS), eritrosit sedimentasyon hızı (ESH), koagülasyon faktörleri, kan gazı, C-reaktif protein (CRP) ve PCT düzeylerini belirlemek için kan örnekleri alındı. Hastalar akut kolesistitin şiddetine göre Tokyo klavuzu kullanılarak hafif, orta ve ağır olmak üzere üç evrede sınıflandırıldı. Akut kolesistitin şiddetini değerlendirmede PCT düzeylerinin yeri ve PCT düzeyi ile evreler arasındaki korelasyon istatiksel olarak analiz edildi.Bulgular: Akut kolesistitli hastaların; 110 (%55)'u hafif, 61 (%30,5)'i orta ve 29 (14,5)'u ağır olarak sınıflan-dırıldı. Hastaların %48,5'inde lökositoz veya lökopeni, %72,5'inde ESH yüksekliği, %55,5'inde CRP pozitifliği, %27' sinde PCT yüksekliği ve %54,5'inde pozitif ultrasonografi bulguları saptandı. Serum BKS, ESH, CRP ve PCT düzeyleri hastalığın şiddetiyle beraber artış gösterdi...

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Objective: The aim of this study is to investigate the relationship between procalcitonin (PCT) level and the severity of acute cholecystitis. Materials and Methods:This study included 200 patients diagnosed with acute cholecystitis. To diagnose and assess the severity of acute cholecystitis; physical examination and abdominal ultrasound findings were evaluated and blood samples were taken to determine white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and levels of coagulation factors, blood gas, C-reactive protein (CRP) and PCT. Patients were classified into three stages, namely, mild, moderate, and severe, according to the severity of acute cholecystitis using the Tokyo guidelines. The role of PCT level in the assessment of severity of acute cholecystitis and the correlation between the stages and PCT level were statistically analyzed.Results: Among patients with acute cholecystitis, 110 (55%) were classified as mild, 61 (30.5%) as moderate, and 29 (14.5%) as severe. Leukocytosis or leukopenia was positive in 48.5%, ESR elevation was found in 72.5%, CRP positivity in 55.5%, PCT elevation in 27%, and positive findings of ultrasonographic imaging in 54.5% of the patients. Serum WBC count, ESR, and CRP and PCT levels increased as the severity of disease increased (p<0.05). PCT could discriminate grade I from grade II-III with 95.45% sensitivity and 46.67% specificity at the best cut-off value of ≤0.52 (p<0.001). PCT could also discriminate grade III from grade I-II with 72.4% sensitivity and 90.06% specificity at the best cut-off value of >0.8 (p<0.001).Conclusion: PCT level may be considered to be a parameter that could be added to the assessment of the severity of acute cholecystitis in the Tokyo guidelines, although further studies are needed to support our findings.Keywords: Procalcitonin, acute cholecystitis, severity of illness index ÖZ Amaç: Bu çalışmanın amacı akut kolesistitin şiddeti ile prokalsitonin (PCT) seviyesi arasındaki ilişkiyi araştırmaktır.Gereç ve Yöntem: Bu çalışmaya akut kolesistit tanısı alan 200 hasta alındı. Tanıyı koymak ve akut kolesistitin şiddetini belirlemek için; fizik muayene ve abdominal ulltrasonografi bulguları değerlendirildi ve beyaz küre sayımı (BKS), eritrosit sedimentasyon hızı (ESH), koagülasyon faktörleri, kan gazı, C-reaktif protein (CRP) ve PCT düzeylerini belirlemek için kan örnekleri alındı. Hastalar akut kolesistitin şiddetine göre Tokyo klavuzu kullanılarak hafif, orta ve ağır olmak üzere üç evrede sınıflandırıldı. Akut kolesistitin şiddetini değerlendirmede PCT düzeylerinin yeri ve PCT düzeyi ile evreler arasındaki korelasyon istatiksel olarak analiz edildi.Bulgular: Akut kolesistitli hastaların; 110 (%55)'u hafif, 61 (%30,5)'i orta ve 29 (14,5)'u ağır olarak sınıflan-dırıldı. Hastaların %48,5'inde lökositoz veya lökopeni, %72,5'inde ESH yüksekliği, %55,5'inde CRP pozitifliği, %27' sinde PCT yüksekliği ve %54,5'inde pozitif ultrasonografi bulguları saptandı. Serum BKS, ESH, CRP ve PCT düzeyleri hastalığın şiddetiyle beraber artış gösterdi...

Objective: Acute appendicitis (AA) is one of the most common surgical emergencies. Despite extraordinary advances in modern investigations, the accurate diagnosis of AA remains an enigmatic challenge. The aim of this study was to compare and evaluate the diagnostic accuracy of inflammatory parameters [C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR)], ultrasound (US) and Alvarado score (AS) in reducing the rate of negative appendectomies. Material and Methods:Two hundred seventy-eight patients were included in this study. Patients were separated into two main groups as the surgery group (n=184) and non-operative group (n=94). Complete blood count, ESR and PCT levels were assessed, abdominal US was performed and AS was calculated for all patients. Results:In the surgery group, clinical predictive factors for histopathologic results such as AS ≥7, AA signs on US, neutrophilia and leukocytosis were significant. Neutrophilia and leukocytosis had the highest accuracy rate among these factors. Inflammatory parameters were not predictive for histopathologic results, although higher CRP and PCT levels were significant in perforated and necrotizing appendicitis. Multifactorial regression analyses showed that AS was not of significant predictive value in the non-operative group. Conclusion:There was no superiority of AS and/or US in the diagnosis of AA. Recent findings have shown the most reliable parameters in the diagnosis of AA to be primarily 'neutrophilia' and secondarily 'leukocytosis'. Other results of this study indicated that inflammatory parameters (CRP, PCT, ESR) were not superior to other parameters but CRP and PCT levels were significantly high in complicated cases.

Background/aim: We aimed to show the role of determination of optic nerve sheath diameter (ONSD) by bedside ultrasonography in an emergency department in the diagnosis of cerebrovascular disorders and its correlation with the clinical picture. Materials and methods:This prospective cross-sectional study included 55 patients with cerebrovascular disorders and 53 controls. Age, sex, ONSD, comorbid disease status, and multidetector computed tomography results of all subjects and application periods and National Institutes of Health Stroke Scale (NIHSS) scores of the patient group were evaluated. Results:The ONSD of the patient and control groups was determined as a median of 5.7 mm and 3.6 mm, respectively. The ONSD of the patient group was determined to be significantly higher than that of the control group (P < 0.05). A positive relationship was determined between NIHSS scores and ONSD values (P < 0.05). The specificity and sensitivity values were determined as 98.1% and 81.8%, respectively, for a cutoff value of 5 mm and as 100% and 72.7%, respectively, for a cutoff value of 6 mm. Conclusion:This study showed that bedside measurement of ONSD is an easy, cheap, and noninvasive method that can be used to support the diagnosis and evaluation of patients with acute stroke.

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A CT tractography combined with an abdominal CT scan seems successful in detecting peritoneal violation in hemodynamically stable patients with abdominal stab wounds. Certainly, randomized controlled trials are required on this topic to recommend this as a routine diagnostic procedure.