BACKGROUND: Although the red cell distribution width (RDW) has been reported as a reliable predictor of prognosis in several types of cancer, to our knowledge the prognostic value of RDW in gastric carcinoma has not been studied, so far. OBJECTIVE: W

Peri-hepatic packing procedure, which is the basic damage control technique for the treatment of hepatic hemorrhage, is one of the cornerstones of the surgical strategy for abdominal trauma. The purpose of this study was to evaluate the efficacy of the perihepatic packing procedure by comparing the outcomes of appropriately and inappropriately performed interventions. Trauma patients with liver injury were retrospectively evaluated. The patients who had undergone adequate packing were classified as Group A, and the patients who had undergone inappropriate packing, as Group B. Over a five-year period, nineteen patients underwent perihepatic packing. Thirteen of these patients were referred by other hospitals. Of 13 patients, 9 with inappropriate packing procedure due to insertion of intraabdominal drainage catheter (n=4) and underpacking (n=5) were evaluated in Group B, and the others (n=10) with adequate packing were assessed in Group A. Mean 3 units of blood were transfused in Group A and unpacking procedure was performed in the 24^th hour. Only 3 (30%) patients required segment resection with homeostasis, and the mortality rate was 20% (2/10 patients). In Group B, 4 patients required repacking in the first 6 hrs. Mean 8 units of blood were transfused until unpacking procedure. The mortality rate was 44% (4/9 patients). The length of intensive care unit stay and requirement of blood transfusion were statistically significantly lower in Group A (p < 0.05). The mortality rate of this group was also lower. However, the difference between the groups for mortality rates was not statistically significant. This study emphasizes that efficacy of the procedure is one of the determinants that affects the results, and inadequate or inappropriate packing may easily result in poor outcome.

Introduction: Bronchobiliary fistula is an uncommon complication secondary to hepatobiliary surgery. Bilioptysis is a pathognomic finding for bronchobiliary fistulas. Diagnosis may be easily established in the light of clinical history, which can be aided by imaging studies to pinpoint the exact location. Some diagnostic procedures such as endoscopic retrograde cholangiopancreatectomy are also useful for treatment. Case presentation: We present three Turkish patients with bronchobiliary fistula secondary to previous hepatic surgery due to hydatid cyst in two, a 19-year-old and a 47-year-old man, and iatrogenic trauma of the common bile duct by endoscopy in a 35-year-old man. All of the patients were successfully treated by minimally invasive methods including percutaneous drainage and endoscopic retrograde cholangiopancreatography. Conclusion: We suggest that bronchobiliary fistula could be managed through conservative treatment methods which do not require in-hospital follow-up, particularly in uncomplicated cases. Otherwise, surgical management can be unavoidable.

Since documented incidence of thyroid cancer has been rising over time, in part due to incidental small papillary cancer, several studies have been carried out to investigate the role of possible serum markers of thyroid cancer prior to surgery. Prospective cohort study. To investigate the role of thyroglobulin (Tg), thyrotropin (TSH) and the TSH:Tg, Tg:TSH ratio in the preoperative diagnosis of thyroid cancer. Between January 2014 and January 2015, 202 of 242 consecutive patients scheduled for surgical treatment for thyroid disorders at Şişli Etfal Training and Research Hospital, General Surgery Clinic were included in the study. Prospective data collection included demographics, thyroid function tests, Tg levels, fine needle aspiration biopsy (FNAB) results (208 FNABs in 187 patients), surgical procedures and final histopathological examinations. There were 134 patients with benign thyroid diseases and 68 patients with thyroid gland malignancy. Preoperative Tg level was significantly lower in the malignant group (64 ng/mL vs. 20ng/mL, p<0.001, respectively), whereas there was no difference in TSH between groups. TSH:Tg levels were found to be significantly higher in patients with malignant thyroid diseases (0.24±1 vs. 0.87±3.4, p=0.024). Although univariate analysis showed that the TSH:Tg ratio was a predictor for thyroid malignancy (OR 0.001; 95% CI, 0.01-0.125; p=0.007) in conjunction with FNAB, multivariate analysis failed to demonstrate any statistical significance for any factor except FNAB. Preoperative assessment of serum Tg and TSH levels appear not to be helpful in identifying patients with thyroid cancer. However, a higher preoperative serum TSH:Tg ratio may hint at an increased risk for thyroid carcinoma. Further studies are needed to elucidate the potential role of preoperative laboratory values of thyroid function.