Background and Objectives: Extubation success in ICU patients is crucial for reducing ventilator-associated complications, morbidity, and mortality. The Rapid Shallow Breathing Index (RSBI) is a widely used predictor for weaning from mechanical ventilation. This study aims to determine the predictive value of serial RSBI measurements on extubation success in ICU patients on mechanical ventilation. Materials and Methods: This prospective observational study was conducted on 86 ICU patients at Hitit University between February 2024 and July 2024. Patients were divided into successful and unsuccessful extubation groups. RSBI values were compared between these groups. Results: This study included 86 patients (32 females, 54 males) with a mean age of 54.51 ± 12.1 years. Extubation was successful in 53 patients and unsuccessful in 33. There was no significant difference in age and intubation duration between the groups (p = 0.246, p = 0.210). Significant differences were found in RSBI-1a and RSBI-2 values (p = 0.013, p = 0.011). The median RSBI-2a was 80 in the successful group and 92 in the unsuccessful group (p = 0.001). The ΔRSBI was higher in the unsuccessful group (p = 0.022). ROC analysis identified optimal cut-off values: RSBI-2a ≤ 72 (AUC 0.715) and ΔRSBI ≤ −3 (AUC 0.648). RSBI-2a ≤ 72 increased the likelihood of successful extubation by 10.8 times, while ΔRSBI ≤ −3 increased it by 3.4 times. Using both criteria together increased the likelihood by 28.48 times. Conclusions: Serial RSBI measurement can be an effective tool for predicting extubation success in patients on IMV. These findings suggest that serially measured RSBI may serve as a potential indicator for extubation readiness.

Objective: Although laparoscopic colon cancer surgeries have increased in recent years, their oncological competence is questioned. In our study, we aimed to evaluate oncological competence by comparing laparoscopic and open surgery. Method: The study was planned retrospectively. A total of 94 patients were included in the study, 42 of whom underwent laparoscopy, and 52 patients underwent open surgery. Both groups were compared in terms of demographic characteristics, staging, number of benign/malignant lymph nodes, histological findings, and complications. Result: The final pathology report of all patients was adenocarcinoma. The median number of dissected lymph nodes was 20.9 in the open group (8-34) and 19.46 in the laparoscopy group (7-31) (p = 0.639). The median number of dissected malignant lymph nodes was 1 (0-13) in the open surgery group and 3.1 (0-8) in the laparoscopy group (p = 0.216). The laparoscopy group exhibited a longer operation time (281.2 ± 54.2 and 221.0 ± 51.5 min, respectively; p = 0.036) than the open surgery group, but a shorter intensive care unit (ICU) discharge, quicker initiation oral feeding, and shorter length of hospital stay (4.0 ± 0.9 vs 5.7 ± 2.0 days, respectively; p < 0.001). Discussion: Laparoscopic surgery elicits many benefits such as less wound infection, lower requirement for blood transfusion, shorter hospitalization, quicker initiation of oral feeding, and mobilization. Our study has shown that laparoscopic surgery provides quite adequate lymph node dissection when compared to oncological surgery, which is viewed with suspicion in the light of these benefits of laparoscopy.

Acute appendicitis is one of the most common non-gynecological and non-obstetric causes of acute abdominal conditions requiring urgent surgery during pregnancy. Due to the similarity between the symptoms of the disease and those of pregnancy, laboratory findings become particularly important in diagnosis. This study aimed to evaluate these parameters for the first time using a new index definition. Between 2015 and 2021, a total of 120 patients were included in the study, divided into the four groups: healthy pregnant woman (HPW), healthy woman (HW), unhealthy pregnant woman (UPW, pregnant patient with acute appendicitis), and unhealthy woman (UW, non-pregnant patient with acute appendicitis). Laboratory parameters, including white blood cell count (WBC), C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), ischemia-modified albumin (iMA), and platelet-lymphocyte ratio (PLR), were assessed. In this study, significant differences were observed in various laboratory parameters between groups, such as WBC, CRP, NLR, and PLR, indicating potential markers for differentiating between pregnant women with and without appendicitis. An index was created for the diagnosis of acute appendicitis in pregnant women and was named the Pregnant Index. The Pregnant Index (PGIndex) values of pregnant women without appendicitis were compared with those of pregnant women with appendicitis. It was found that the PGIndex value was significantly higher in pregnant women with appendicitis (p < 0.001). Using the ROC curve and Youden index, the PGIndex cut-off value to best differentiate between the two groups was 10.62. This value provided a sensitivity of 73.3%, specificity of 96.7%, positive predictive value of 95.7%, negative predictive value of 78.7%, and test accuracy of 85% for identifying pregnant women with appendicitis. Compared to other markers, the PGIndex had the highest accuracy value, and it was observed that patients with a PGIndex value above 10.62 had a significantly increased likelihood of having appendicitis. These results indicate that the PGIndex is a significant marker for detecting appendicitis in pregnant women. Laboratory parameters, particularly NLR and PLR, show promise as diagnostic tools for appendicitis in pregnant women. Incorporating these markers, the Pregnant Index (PGIndex) demonstrated high sensitivity and specificity in distinguishing between pregnant women with and without appendicitis. This is the first study using the Pregnant Index in pregnant women to diagnose appendicitis. Early diagnosis is crucial for preventing maternal and fetal morbidity and mortality associated with appendicitis during pregnancy.

Introduction: Inflammation can adversely affect an operation. The ımportant markers of this inflammation are CRP (C-reactive peptide), WBC (white blood cell). Aim: The purpose of this study to predict adhesion related technical difficulties during operation by comparing preoperative CRP, WBC, Monocyte/Lymphocyte ratio and intra-operative adhesion findings. Method: This was a retrospective study. This study includes 116 elective and emergency cholelithiasis cases whose operation performed at Corum Erol Olcok Training and Research Hospital in 2020 and 2021. Adhesions on gallbladder were graded during operation and divided into two groups. Groups graded based on intra-operative findings were compared with preoperative CRP, WBC, and monocyte/lymphocyte ratio. Results: The patients were divided into two groups based on the adhesion grade as Grade 1-2 (n=84) and Grade 3-4 (n=32). Average WBC count of Grade 3-4 group was average 11.05 ± 4.45 109 /L and this value was statistically significantly higher (p=0.01) than Grade 1-2 group. Average CRP value of Grade 3-4 group was found as 50.91 ± 77.25 mg/L and this value was significantly elevated (p11.55 109 /L), monocyte/lymphocyte ratio (>0.2693) cut-off values. Conclusion: Preoperative estimation of adhesion grade helps the surgeon considerably. This study shows that high CRP, WBC, and Mo/Ly ratio values can help the estimation of intensity of adhesions and challenges during operation.

Background and Objectives: Anastomotic leakage (AL) is a major complication following sphincter-preserving surgeries for left-sided colorectal cancer. In this study, we aimed to evaluate the association between circular stapler diameter and the risk of AL. As a secondary objective, we investigated whether preoperative serum protein levels were associated with leakage development. Materials and Methods: We conducted a retrospective case–control study including 99 patients who underwent elective colorectal surgery with stapled anastomosis for left-sided colorectal cancer between January 2020 and May 2024. A total of 99 patients were included (60.6% male), with a mean age of 66.1 ± 10.7 years. The patients were categorized into small (≤29 mm) and large (≥30 mm) stapler groups. Demographic, clinical, and laboratory variables were collected. Anastomotic leakage was defined as an International Study Group of Rectal Cancer (ISREC) Grade B or C leak requiring intervention. Univariate analyses and multivariate logistic regression analyses were performed, and results were reported as odds ratios (ORs) with 95% confidence intervals (CIs). A STROBE-compliant flow diagram was prepared. Results: Anastomotic leakage occurred in 10 patients (10.1%), and leakage rates were not significantly different between stapler-size groups (≤29 mm: 10.9% vs. ≥30 mm: 7.5%, p = 0.365). In multivariate analysis, stapler size was not independently associated with leakage (OR 1.68, 95% CI 0.40–6.97, p = 0.480). Lower preoperative serum protein levels were identified as the only independent predictor of leakage (OR 0.28, 95% CI 0.10–0.74, p = 0.011). Postoperative hospital stay was significantly longer for patients with leakage (median 17 vs. 7 days, p < 0.001). Conclusions: We found no significant associations between circular stapler diameter and anastomotic leakage in left-sided colorectal cancer surgery. Conversely, low serum protein levels were independently associated with increased leakage risk, highlighting the importance of preoperative nutritional assessment. Given the retrospective design, small number of leakage cases, and unmeasured confounders, these findings should be interpreted with caution. Further multicenter, prospective studies should be conducted to clarify the influence of stapler size and patient-related factors on anastomotic outcomes.

Background and Objectives: Anastomotic leakage (AL) is a major complication of colorectal surgery (CRS), increasing morbidity, mortality, and healthcare costs. While several AL risk factors have been identified, the role of aortic calcification (AC) remains unclear. As a marker of systemic atherosclerosis, AC may impair tissue perfusion and anastomotic healing. Additionally, tumor factors (TNM stage, histology, and localization) and patient comorbidities (hypertension, cardiovascular disease, and neoadjuvant therapy) may contribute to AL risk. This study evaluates the association between preoperative AC and AL incidence while considering additional risk factors. Materials and Methods: This retrospective cohort study included 151 patients undergoing CRS from January 2020 to October 2023. Preoperative CT scans classified AC into Stage 0 (none), Stage 1 (50%) of the aortic circumference. Data on demographics, tumor characteristics, neoadjuvant therapy, and comorbidities were collected. AL risk factors were analyzed using univariate and multivariate logistic regression. Results: AL occurred in 5.96% (9/151) of patients. AL incidence was significantly higher in patients with >50% AC (44.47% vs. 11.27%, p = 0.012). Multivariate analysis confirmed AC as an independent AL predictor (OR = 10.38, 95% CI: 1.243–92.118, p = 0.032). Rectal tumor localization (p = 0.038), hypertension (p = 0.027), cardiovascular disease (p = 0.014), and neoadjuvant therapy (p = 0.045) were also associated with increased AL risk. Conclusions: Severe AC is an independent predictor of AL in CRS. Additionally, rectal tumors, hypertension, cardiovascular disease, and neoadjuvant therapy contribute to AL risk. Preoperative vascular assessments and comprehensive risk stratification models may help identify high-risk patients and guide perioperative management strategies to reduce AL incidence.