Publications by authors named "Mustafa Fevzi Celayir"

14 Publications

  • Page 1 of 1

Relationship between Gastric pH Measurement and Intra-abdominal Pressure in Patients Undergoing Laparoscopic Surgery.

Sisli Etfal Hastan Tip Bul 2020 11;54(4):463-468. Epub 2020 Dec 11.

Department of General Surgery, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey.

Objectives: Laparoscopic surgery (LS) is a safe and widely used technique. During LS, carbon dioxide insufflation may produce significant hemodynamic and ventilatory consequences, such as elevated intra-abdominal pressure (IAP) and hypercarbia. Splanchnic and cardiovascular blood flow can be affected by the elevated IAP, which can result in ischemia in the splanchnic region prior to hemodynamic changes. Changes in gastric pH may be an early precursor of changes in splanchnic blood circulation. This study investigated the relationship between gastric pH measurement and IAP in patients undergoing LS.

Methods: This study included 49 patients aged 18-65 years with American Society of Anesthesiologists (ASA) physical status I - III who were undergoing elective laparoscopic cholecystectomy. A gastric pH tonometer probe was applied using an orogastric catheter. Simultaneously, insufflation pressure, cardiac apex beat (CAB), and mean arterial blood pressure (MAP) values were recorded. Indirect IAP was then measured through the bladder. Measurements were performed at baseline; at 15, 30, and 60 minutes after onset of insufflation (AI 15, AI 30, and AI 60, respectively); and at the end of insufflation (EI). Two pH measurements were obtained with a gastric tonometer pH probe, using an automated function of the gastric tonometer to improve measurement reliability.

Results: IAP was significantly higher than baseline at AI 15, AI 30, AI 60, and EI (p<0.001). The pH and pH levels were significantly lower at AI 15 and AI 30, compared with baseline (p<0.001). There were no significant differences between pH and pH measurements at AI 60 and EI. Compared with baseline, CAB was significantly lower at AI 15, AI 30, AI 60, and EI (p=0.001, p<0.001, p=0.006). There were no statistically significant differences in MAP changes at any time point.

Conclusion: Elevated IAP caused by CO insufflation during LS led to reductions of pH and pH. There was a correlation between gastric pH measurement and IAP. Measurement of gastric pH may be useful to assess blood circulation in the splenic area during LS.
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http://dx.doi.org/10.14744/SEMB.2020.34437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751236PMC
December 2020

The Effects of Diverticulum Localization and Hinchey Classification on Recurrence and Complications in Acute Colonic Diverticulitis.

Sisli Etfal Hastan Tip Bul 2020 11;54(4):451-456. Epub 2020 Dec 11.

Department of General Surgery, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey.

Objectives: Diverticular disease of the colon is a pathology that arises from outward ballooning of the mucosa due to some weakness in the muscle layer. Diverticular disease may range from symptomatic uncomplicated diverticular disease to symptomatic disease with complications, such as acute diverticulitis or diverticular bleeding. Acute colonic diverticulitis occurs in about 10- 25% of patients.

Methods: In this study, 134 patients who were admitted to our emergency clinic with complaints of abdominal pain between 2016-2019 and hospitalized with the diagnosis of acute diverticulitis were included. Patients' sex, age, presence of additional disease, increase in leukocyte and C-reactive protein (CRP), localization of diverticulitis, Hinchey classification, mean length of hospital stay and treatment were evaluated. The effects of these parameters on complications and recurrence were statistically analyzed.

Results: The length of hospital stay was statistically significantly associated positively with the Hinchey classification (p<0.001). While 18 patients who were medically treated developed recurrence later, and this rate was statistically significant (p<0.001). When one of the factors, localization, which may play a role in the severity of the disease and recurrence are examined, was evaluated concerning its results in our study, we found that rectosigmoid location is an important factor for recurrence. We found that the localization in the colon and the severity of the disease were effective in the prognosis of acute diverticulitis.

Conclusion: We believe that localization and the severity of the disease should be taken into consideration when planning surgery in these patients.
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http://dx.doi.org/10.14744/SEMB.2020.03453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751249PMC
December 2020

Solitary caecal diverticulitis: Comparison of operative and non operative treatment.

J Pak Med Assoc 2020 Nov;70(11):1926-1929

SBU Sisli Hamidiye Etfal Research and Education Hospital General Surgery Clinic Sisli Istanbul, Turkey.

Objective: To evaluate the treatment options applied to solitary caecal diverticulitis patients, and to explore the possibility of non-operative treatments.

Methods: The retrospective study was conducted a tertiary referral centre, and comprised data of patients who presented with acute abdominal pain and were diagnosed either preoperatively or intraoperatively as cases of solitary caecal diverticulitis between January 2009 and December 2017. Data on demographics, physical examination findings, laboratory results, treatment modalities and outpatient clinical records was noted, and analysed analysed using SPSS 21.

Results: Of the 580 patients whose medical records were reviewed, 11(1.89%) were diagnosed as cases of solitary caecal diverticulitis. Of them, 6(54.5%) patients were treated conservatively, and 5(45.4%) surgically. The disease recurred in 1(9%) patient who was treated conservatively. Among those treated surgically, 1(20%) patient had hemicolectomy, and the rest had appendectomy and/or diverticulectomy and drainage procedures. There were no major complications during the follow- up.

Conclusions: With accurate diagnosis during preoperative period, the spread of the pathology helps to choose the best suitable surgical technique. Appendectomy should be performed to avoid future diagnostic confusion.
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http://dx.doi.org/10.5455/JPMA.12674DOI Listing
November 2020

Complex Anal Fistula: Long-Term Results of Modified Ligation of Intersphincteric Fistula Tract=LIFT.

Sisli Etfal Hastan Tip Bul 2020 24;54(3):297-301. Epub 2020 Aug 24.

Department of Surgery, Sisli Hamidiye Etfal Traning and Research Hospital, Istanbul, Turkey.

Objectives: The anal fistula is a permanent infectious tunnel formed between the anal canal and skin in the perianal region. Fistulas are treated by surgery at any stage. Many surgical methods have been reported to treat anal fistula. One of the promising surgical methods with a high success rate is ligation of the intersphincteric fistula tract, which is performed in anatomical spaces without damage to the internal and external sphincters. We evaluated the success rate of a modified ligation of the intersphincteric fistula tract procedure for complex anal fistulas in which the technical differences were minimized by the surgery being performed by the same surgical team.

Methods: In this study, Data of the 56 patients were retrospectively collected. Data regarding patient history, visual and digital anal examination, Cleveland Clinic Florida Fecal Incontinence (CCF-FI) score, anal-phase pelvic magnetic resonance imaging (MRI), rectosigmoidoscopy or colonoscopy and anal manometry were recorded. The changes in data recorded during the preoperative and postoperative periods were compared in each other.

Results: The mean age of the patients was 41±15.5 years. The number of patients for each fistula type compromised in this study was as follows in accordance with frequency: high transsphincteric fistula, high intersphincteric fistula, and horseshoe abscess. The fistula recurred in seven patients during postoperative follow-up and the success rate of modified LIFT was calculated as 87.5%. The change in the mean±SD preoperative and postoperative CCF-FI scores and anal pressure was not statistically significant.

Conclusion: One promising advantage of the ligation of the intersphincteric fistula tract procedure is that it turns a complex fistula into a simple fistula that can be treated with minimal risk of sphincter damage.
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http://dx.doi.org/10.14744/SEMB.2020.89106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729717PMC
August 2020

Treatment of acute appendicitis: Urgent surgery or emergent surgery?

Ulus Travma Acil Cerrahi Derg 2020 Sep;26(5):742-745

Department of General Surgery, University Of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul-Turkey.

Background: The standard treatment of acute appendicitis, which is a rapidly progressive inflammatory disease, remains surgery. However, several studies have suggested antibiotics treatment for acute appendicitis, especially in centers where surgery at all hours is not possible. Therefore, in this study, we investigated the relationship between the preoperative waiting period and postoperative complications in patients who underwent interval surgery following conservative management during the same admission.

Methods: All patients who were diagnosed with uncomplicated acute appendicitis between October 2014 and February 2015 and underwent surgery at a single center were included in this retrospective study. Patients were divided into two groups based on the waiting period between the diagnosis and the time of surgery: group A (emergency, waiting period <10 h) and group B (urgency, waiting period ≥10 h). The demographic features, preoperative waiting period, antibiotics use, pathological diagnosis, postoperative complications, length of hospital stay, and readmission were compared between the two groups.

Results: This study comprised 160 patients, including 79 and 81 patients in groups A and B, respectively. The demographic features, comorbidities, and pathological diagnosis were comparable between the two groups. The average preoperative waiting period was significantly longer in group B than in group A. However, the mean length of hospital stay and the rate of postoperative complications, including infections at the surgical sites and intra-abdominal abscesses, were similar between the two groups.

Conclusion: Our analyses revealed that there were no disadvantages associated with a longer preoperative waiting period in patients diagnosed with uncomplicated appendicitis.
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http://dx.doi.org/10.14744/tjtes.2020.23236DOI Listing
September 2020

Pseudoangiomatous stromal hyperplasia causing severe breast enlargement in a 15-year-old girl: A case report.

J Pak Med Assoc 2020 Jul;70(7):1263-1265

General Surgery Clinic, University of Health Sciences, Sisli Hamidiye Etfal Education & Research Hospital, Turkey.

Pseudoangiomatous stromal hyperplasia (PASH), composed of proliferated stromal mesenchymal cells of myofibroblastic origin, is a benign lesion of the breast. A few cases associated with pseudoangiomatous stromal hyperplasia of the breast have been reported. We report this case of a 15-year-old girl with PASH accompanied by severe enlargement and painful mass in the right breast. There were no other palpable masses or lymph nodes. Biopsy of the mass showed histopathologic features characteristic of fibroadenoma. The palpable mass was around 6x5cm in diameter, while clinical manifestations aroused suspicion of malignancy mimicking sarcoma of the breast. Although, biopsy of the mass showed benign histopathologic features; surgical excision was performed because of the damage caused by enlarging breast tissue and clinical suspicion of malignancy.
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http://dx.doi.org/10.5455/JPMA.27271DOI Listing
July 2020

A Giant Squamous Cell Carcinoma Arising in a Patient with Hidradenitis Suppurativa.

Adv Skin Wound Care 2020 Oct;33(10):554-556

In the Department of Dermatology, University of Health Sciences, Şişli Etfal Training and Research Hospital, Istanbul, Turkey, Ezgi Özkur, MD, is a dermatologist; İlknur Kivanç Altunay, Prof Dr, is a dermatologist; Mustafa Fevzi Celayir, MD, is a general surgeon; Asli Aksu Çerman, Assoc Prof Dr, is a dermatologist; and Ramazan Uçak, MD, is a pathologist. The authors have disclosed no financial relationships related to this article. Submitted September 3, 2019; accepted in revised form October 31, 2019.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease of follicular pilosebaceous units. Chronic, active, and poorly controlled disease may lead to squamous cell carcinoma (SCC). The diagnosis and treatment of SCC in HS is particularly challenging because SCC lesions may be easily mistaken for HS lesions. Current medical literature recommends aggressive surgical excision with at least 2-cm margins. In this article, the authors describe a giant perianal SCC arising in a patient with HS who was treated with surgical resection and radiotherapy.
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http://dx.doi.org/10.1097/01.ASW.0000694152.07909.80DOI Listing
October 2020

How should be the Surgical Treatment Approach during the COVID-19 Pandemic in Patients with Gastrointestinal Cancer?

Sisli Etfal Hastan Tip Bul 2020 16;54(2):136-141. Epub 2020 Jun 16.

Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

COVID-19 was first seen in China at the end of December 2019. COVID-19 is a novel type of coronavirus that is defined as SARS-CoV-2, which can be mild or severe in the lungs, causing acute respiratory infection. The disease was first presented in the literature as Coronavirus Disease 2019 (COVID-19) in February 2020. The disease spread rapidly and was declared as a pandemic by the World Health Organization (WHO) on March 11, 2020. There have been approximately 7734185 reported cases, and 412369 reported deaths to date (09/June/2020). As COVID-19 spread in the world and our country, hospitals struggling with this disease have also become risky areas for transmitting the disease. Health workers also have a high risk of viral contamination from direct contact of droplets and surfaces. Personal protective equipment (PPE), such as masks, coveralls, gloves, face shields and/or goggles, are mandatory. The aim is to spread the flow of cases requiring hospitalization over time, thereby preventing possible accumulation in hospitals. All non-urgent procedures, such as elective surgeries and diagnostic interventions, were significantly affected. The hospitalization procedures were mostly allocated to patients with COVID-19 infection, and surgical operations were postponed. Only urgent surgical cases and oncological surgeries that cannot be postponed were performed during this pandemic process. Patients followed by oncology are immunosuppressed both because of the disease itself and the side effects of chemotherapy and/or radiotherapy taken. This makes patients more susceptible to infections, and the prognosis of infections in these patients is worse and more destructive. Cancer patients are almost twice as likely to catch COVID-19 compared to the general population. The choice of surgical procedures and perioperative management of the patients with malignancy has become even more important in the COVID-19 pandemic. In this study, we analyzed the treatment processes of our patients with malignancy that underwent a surgical oncological procedure during this pandemic.
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http://dx.doi.org/10.14744/SEMB.2020.93709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326676PMC
June 2020

Intraoperative Neuromonitoring in Thyroid Surgery: An Efficient Tool to Avoid Bilateral Vocal Cord Palsy.

Ear Nose Throat J 2020 Feb 18:145561320906325. Epub 2020 Feb 18.

Department of General Surgery, Health Sciences University, Sisli Hamidiye Etfal Health Practice and Research Center, Istanbul, Turkey.

Objectives: This study aimed to analyze the effects of intraoperative neuromonitoring (IONM) on the prevalence of vocal cord palsy (VCP) in thyroid surgery.

Methods: Data from 493 patients (839 nerves at risk [NAR]) who underwent thyroid surgery between July 2014 and May 2016 were retrospectively evaluated. The patients were divided into 2 groups: Group 1 (G1) consisted of patients who underwent surgery without IONM, whereas group 2 (G2) consisted of patients who underwent surgery with IONM. The surgical techniques were identical, and experienced surgeons performed the procedures in both groups. Intraoperative neuromonitoring was performed in compliance with the International Neural Monitoring Guidelines.

Results: In total, 211 patients (170 female, 41 male) with 360 NAR were included in G1, and 282 patients (220 female, 62 male) with 479 NAR were included in G2. The number of VCP per NAR in G1 and G2 was 33 (9.2%) and 27 (5.6%), respectively ( = .005). The number of transient VCP per NAR in G1 and G2 was 27 (7.5%) and 23 (4.8%; = .230), respectively. The number of permanent VCP per NAR in G1 and G2 was 6 (1.7%) and 4 (0.8%; = .341), respectively. Bilateral VCP was detected in 4 (2.7%) patients in G1, whereas there was no patient with bilateral VCP in G2 ( = .033).

Conclusions: Intraoperative neuromonitoring may decrease the incidence of total VCP and prevent the development of bilateral VCP, which has unfavorable results for both patients and health-care professionals.
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http://dx.doi.org/10.1177/0145561320906325DOI Listing
February 2020

Male breast cancer: A 10 year retrospective case series in a tertiary care hospital.

J Pak Med Assoc 2019 Aug;69(8):1209-1212

General Surgery Clinic, University of Health Sciences, Sisli Hamidiye Etfal Education & Research Hospital, Turkey.

Male breast cancer is a rare disease and it differs from breast cancer in women by some characteristics. The incidence of the disease has increased in the last 25 years. The records of male patients who underwent surgery for breast cancer between 2007 and 2017 were retrospectively reviewed in a tertiary care hospital in Istanbul, Turkey. The patients' ages, background, family history, clinical features, histopathological features of the tumour, its stage, the treatment and the survival were investigated. SPSS 15.0 for Windows programme was used for statistical analysis.Survival analysis was performed with Kaplan-Meier method.Determinants were analysed by univariate Cox regression analysis. A total of 15 patients were evaluated in our study. Fourteen patients had invasive ductal carcinoma and one patient had intraductal papillary carcinoma. The median followup period of the patients was 36 months The axillary lymph node metastasis positivity rate (number of metastatic lymph nodes/number of lymph nodes dissected) was statistically significantly higher in patients who died than in patients who survived.In univariate Cox regression analysis, the effects of age, tumour size, estrogen, progesterone, the presence of HER2/neu receptor and axillary metastasis on survival were not determined. We believe that raising awareness on male breast cancer in the community, genetic testing and screening mammography in high-risk patients will be useful in early diagnosis of the disease and improvement of its prognosis.
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August 2019

The Relationship of Clinicopathological Factors of the Tumor with Preoperative TSH Level in Papillary Thyroid Cancers.

Eurasian J Med 2019 Feb 3;51(1):8-11. Epub 2018 Dec 3.

Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.

Objective: Thyroid-stimulating hormone/thyrotropin (TSH) is known to induce malignancies and tissue growth of the thyroid gland. While the relationship of higher levels of TSH with advanced stages of cancer had been published in previous studies, the relationship of the tumor with the clinicopathological factors had not been completely evaluated. The aim of the present study was to evaluate the relationship between highly risky clinicopathological factors with preoperative high levels of TSH.

Materials And Methods: The records of 89 patients (67 females and 22 males) who underwent surgery for differentiated thyroid cancer between 2011 and 2013 were reviewed. The relationship of preoperative TSH between tumor size, multicentricity, lymphovascular invasion, extrathyroidal extension, central neck metastasis, and lateral neck metastasis was evaluated.

Results: The preoperative TSH levels were high in patients with multicentricity (p=0.022), lymphovascular invasion (p=0.018), and central neck metastasis (p=0.002). The prevalence of extrathyroidal extension (p=0.41), lymphovascular invasion (p=0.020), and central metastasis (p=0.009) was significantly high in patients with a TSH level ≥2.5 mIU/L. The preoperative TSH levels were determined as an independent predictive risk factor for central neck metastases (p=0.012) and extrathyroidal extension (p=0.041) in multinomial logistical regression analysis.

Conclusion: The power of radiological imaging for the identification of central neck metastases in preoperative evaluation is limited. The preoperative high level of TSH is an independent predictive factor for central metastases and extrathyroidal extension. It can help to predict tumor staging. Furthermore, related with multicentricity and lymphovascular invasion, it can affect the high risk characteristics of the tumor except the stage. The preoperative TSH level can be considered for the probability of preoperative metastases and can contribute to plan the extent of surgery.
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http://dx.doi.org/10.5152/eurasianjmed.2018.17381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422630PMC
February 2019

Stercoral perforation of the rectosigmoid colon due to chronic constipation: A case report.

Int J Surg Case Rep 2017 14;40:39-42. Epub 2017 Sep 14.

Sisli Hamidiye Etfal Research and Training Hospital, Department of General Surgery, Istanbul, Turkey.

Introduction: Chronic constipation is very common in elderly patients. As a result of this situation fecaloma is also frequently seen at these ages. However, the stercoral perforation caused by fecaloma is a rare situation to occur. The rectosigmoid colon is the most affected colonic segment. It is seen in older patients with concomitant diseases and a low quality of life.

Presentation Of Case: Here in this case, we have to report an 83 - year-old male patient who came to the emergency room with complaints of abdominal pain and constipation for two days. He had Type II Diabetes Mellitus, had a cardiac stent and also Alzheimer's disease. We diagnosed a rectosigmoid perforation due to a large fecaloma. This case presentation was prepared in accordance with the scare checklist guidelines (Agha et al., 2016 [1]).

Discussion: Constipation and faecal impaction are common entities, particularly in elderly and bedridden patients. Fecalomas are collections of dehydrated, hardened stool. They rarely can cause colonic ischemia and/or stercoral perforation. Stercoral perforation is the perforation or rupture of the intestine walls by a stercoraceous mass. Stercoral perforation is a very dangerous, life-threatening situation, as well as a surgical emergency, because the spillage of contaminated intestinal contents into the abdominal cavity leads to peritonitis, a rapid bacteremia with many complications.

Conclusion: Fecalomas can cause stercoral perforations. This situation can be confused with other causes of acuteabdomen in these patients. Early surgery can be life saving.
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http://dx.doi.org/10.1016/j.ijscr.2017.09.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607122PMC
September 2017

Delaying surgery after neoadjuvant chemoradiotherapy improves prognosis of rectal cancer.

World J Gastrointest Oncol 2016 Sep;8(9):695-706

Mehmet Mihmanlı, Esin Kabul Gürbulak, İsmail Ethem Akgün, Mustafa Fevzi Celayir, Pınar Yazıcı, Ayhan Öz, Sinan Ömeroğlu, Department of General Surgery, Şişli Etfal Training and Research Hospital, Şişli 34371, Istanbul, Turkey.

Aim: To investigate the prognostic effect of a delayed interval between neoadjuvant chemoradiotherapy (CRT) and surgery in locally advanced rectal cancer.

Methods: We evaluated 87 patients with locally advanced mid- or distal rectal cancer undergoing total mesorectal excision following an interval period after neoadjuvant CRT at Şişli Hamidiye Etfal Training and Research Hospital, Istanbul between January 2009 and January 2014. Patients were divided into two groups according to the interval before surgery: < 8 wk (group I) and ≥ 8 wk (group II). Data related to patients, cancer characteristics and pathological examination were collected and analyzed.

Results: When the distribution of timing between group I (n = 45) and group II (n = 42) was viewed, comparison of interval periods (median ± SD) of groups showed a significant difference of as 5 ± 1.28 wk in group I and 10.1 ± 2.2 wk in group II (P < 0.001). The median follow-up period for all patients was 34.5 (9.9-81) mo. group II had significantly higher rates of pathological complete response (pCR) than group I had (19% vs 8.9%, P = 0.002). Rate of tumor regression grade (TRG) poor response was 44.4% in group I and 9.5% in group II (P < 0.002). A poor pathological response was associated with worse disease-free survival (P = 0.009). The interval time did not show any association with local recurrence (P = 0.79).

Conclusion: Delaying the neoadjuvant CRT-surgery interval may provide nodal down-staging, improve pCR rate, and decrease the rate of TRG poor response.
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http://dx.doi.org/10.4251/wjgo.v8.i9.695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027025PMC
September 2016

Prediction of the grade of acute cholecystitis by plasma level of C-reactive protein.

Iran Red Crescent Med J 2015 Apr 25;17(4):e28091. Epub 2015 Apr 25.

Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

Background: Acute cholecystitis is the most common complication of gallbladder stones. Today, Tokyo guidelines criteria are recommended for diagnosis, grading, and management of acute cholecystitis.

Objectives: We aimed to evaluate the levels of C-reactive protein (CRP) at different cut-off values to predict the severity of the disease and its possible role in grading the disease with regard to the guideline.

Patients And Methods: This is a retrospective study, analyzing 682 cases out of consecutive 892 patients with acute cholecystitis admitted to two different general surgery clinics in Istanbul, Turkey. Records of patients diagnosed with acute cholecystitis were screened retrospectively from the hospital computer database between January 2011 and July 2014. A total of 210 patients with concomitant diseases causing high CRP levels were excluded from the study. The criteria of Tokyo guidelines were used in grading the severity of acute cholecystitis, and patients were divided into 3 groups. CRP values at the time of admission were analyzed and compared among the groups.

Results: Mean CRP levels of groups were found to be significantly different, 18.96 mg/L in Group I, 133.51 mg/L in Group II, and 237.23 mg/L in Group III (P < 0.001). Having examined CRP values among the groups, they were found to be highly and significantly correlated with the disease grade (P < 0.0001). After evaluating CRP levels according to the grade of the disease, group 2 was distinguished from group 1 with a cut-off CRP level of 70.65 mg/L, and from group 3 with a value of 198.95 mg/L. Those results were found to be statistically significant (P < 0.001).

Conclusions: CRP, a well-known acute phase reactant that increases rapidly in various inflammatory processes, can be accepted as a strong predictor in classifying different grades of the disease, and treatment can be reliably planned according to this classification.
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http://dx.doi.org/10.5812/ircmj.17(4)2015.28091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4443387PMC
April 2015