Background: Hematological parameters, including albumin and hemoglobin (Hb) levels and lymphocyte counts, are low-cost tests that can be used to determine inflammation and nutritional status. Recent studies have shown that inflammation plays a very important role in the development of carcinogenesis. Materials and Methods: The authors aimed to investigate whether preoperative hemoglobin, albumin, lymphocyte, and platelet (HALP) score can distinguish between benign and malignant causes in patients who are admitted to hospital and operated due to acute mechanical intestinal obstruction (AMIO). The patients were divided into two groups etiologically. Group 1 included the AMIO cases, which developed from benign causes, while Group II contained the AMIO cases, which developed as a result of malignancy. HALP score was calculated based on the latest preoperative Hb, albumin, lymphocyte, and platelet values of patients. Results: HALP variable was an independent prognostic factor (p < 0.001) in determining malignancy (odds ratio = 0.91; 95% confidence interval [CI] = 0.882–0.930). Based on the results, when a cutoff value <23.94 was used for HALP score in receiver operating characteristic analysis, sensitivity for determining the malignancy was 85%, while specificity was 78% (Area under the curve [AUC] ± standard error = 0.86 ± 0.029; 95% CI = 0.80–0.91; p < 0.001). Conclusions: The HALP score could be a useful parameter for the clinician in distinguishing between AMIO due to benign and malignant origins.

It has been estimated that currently 350-400 million people have been chronically infected with the hepatitis B virus (HBV) worldwide and approximately one million people die each year due to HBV related diseases. It has been suggested that the viral and host factors, especially the host immune system, may play a role in the chronicity of the HBV infection. Stimulator of interferon genes (STING) is one of the members of the pattern recognition receptor (PRR) that detects the presence of DNA in a human cell, activate synthesis of various cytokines and this protein is thought to be an important member of the immune system against HBV infection. Based on the assumption that there may be a relationship between the differences of STING expression in individuals and HBV chronicity, the aim of this study was to investigate STING gene expression levels in individuals naturally immunized against HBV, in chronic hepatitis B infected patients and in normal individuals who have not been exposed to HBV. A total of 90 volunteers have been included in the study from the age range of 18 to 65, in which the first group consists of 30 individuals naturally immunized against HBV, the second group consists of 30 chronically hepatitis B infected patients while the third group consists of 30 healthy population members who have not been exposed to HBV. Whole blood samples were taken from each participant and peripheral blood mononuclear cells (PBMC) were isolated afterwards. Total RNA was isolated from PBMC. After the synthesis of a:NA from the total RNA, STING gene expression levels were determined by real time polymerase chain reaction (Rt-PCR) method. Normalization was performed by applying the 2(-Delta)(Delta CT) formula after Rt-PCR procedure. STING expression level of the naturally immunized group was calculated as 0.084 +/- 0.026 on average, average STING expression level of healthy population group was 0.082 +/- 0.032 and STING expression level of chronically infected patients group was 0.075 +/- 0.022 on average. There was no statistically significant difference between the groups (p> 0.05). To our knowledge, this is the first study investigating the role of STING expression in the chronicity of HBV. Although there was no statistically significant difference between the groups, the data that showed STING expression levels in naturally immunized individuals were approximately 10% higher than those in chronic hepatitis B patients and was considered as an important finding.

Background: Malignant bowel obstruction (MBO) is a condition secondary to intra-abdominal metastatic spread of advanced stage tumors. In this study, we aimed to evaluate the results of in the patients who were diagnosed with complete MBO and underwent palliative surgery treatment and to bring them to the attention of physicians. Methods: The patients who were treated for cancer and who were consulted from the surgery clinic due to MBO symptoms between January 2022 and December 2023 were identified and recorded. The age of the patients included in the study, computed tomography findings, oral food intake at the time of diagnosis and after treatment, nasogastric tube removal, symptom relief, hospital readmissions, total length of hospital stay, development of complications, hospital stay, and survival rates of the patients were compared. Results: The average age of the 24 patients in the study (13 females and 11 males) were 64.2 ± 10.07 years (range: 45–80). All patients underwent surgical treatment. In terms of the primary diagnosis of the patients, 12 patients (50%) had colorectal, 4 patients (16.6%) gastric, 3 patients (12.5%) ovarian, and 2 patients (8.3%) bladder cancers, while 2 patients (8.3%) had intra-abdominal spread of lung tumor and 1 patient (4.1%) had cancer of small intestine origin. In the evaluation of the level of obstruction in patients, it was observed that 11 patients (45.8%) had small intestine, 7 patients (29.1%) had colon obstruction while 6 patients (25%) developed colon and small intestine obstruction together. The length of stay in the hospital was 8.8 ± 5.5 days, recovery from nasogastric tube was 100%, the rate of restoring the oral food intake was 79%, and the rate of readmission to the hospital with the same complaints was 25%. Conclusion: The aim of palliative treatment is to increase the quality of life by eliminating the symptoms that impair the patient’s quality of life. According to our results, palliative surgery treatment in appropriate patients had positive effects on the patient’s quality of life. Further studies are needed to develop a common algorithm that would facilitate physicians’ decision-making in the selection of medical or palliative surgical treatment.

1. ÖZET Amaç: Kliniğimizde ektopik gebelik tanısı konulan hastaların retrospektif olarak demografik özelliklerini değerlendirip, medikal tedavide kullanılan methotreksatın (MTX) tedavi sonuçlarının incelenmesi ve bölgemizdeki ektopik gebeliklerin mevsimlere göre dağılımının analiz edilmesidir. Gereç ve Yöntemler: Ocak 2015-Ocak 2018 tarihleri arasında, Trabzon Medicalpark Hastanesi Kadın Hastalıkları ve Doğum Kliniğine başvuran ve ektopik gebelik tanısı konulan 54 olgu retrospektif olarak değerlendirildi. Olguların başvuru tarihine göre mevsimsel dağılımı incelendi. Değişkenlerin tanımlayıcı istatistikleri ile olguların parite durumları, methotreksat tedavisinde başarı oranları ve başvuru tarihine göre mevsimsel dağılımları IBM SPSS 22.0 paket programı ortamında istatistiksel olarak analiz edildi. Geçirilmiş ektopik öyküsü olanlar ile ameliyata gönderilme arasındaki ilişki Ki-kare testi ile analiz edildi. Sonuçlar, istatistiksel olarak %95 güven aralığı ve α=0.05 anlamlılık düzeyinde değerlendirildi. Bulgular: Ektopik gebelik olgularının yaş ortalaması 33±4.6 idi. Tüm olgular geliş şikayetlerine göre değerlendirildiğinde, kasık ağrısı (%40.7) ve seconder amenore (%18.5) en sık görülen şikayetler idi. Hastalar risk faktörleri açısından değerlendirildiğinde öyküde en sık geçirilmiş ektopik gebelik ve sezaryen operasyonu görüldü. Tanı konulduğunda hastaların %66.7’sinin (n=36), gebelik haftası 4-6 hafta idi. Ayrıca hastaların %59.3’nün (n=32) MTX günü human koryonik gonodotropin (ß-HCG) değerleri 5-1500 mlU/ml arasında idi. Hastaların %85.2’ne (n=46) tek doz MTX yapıldı ve kür sağlandı. Hastaların mevsimlere göre dağılımı incelendiğinde, ektopik gebelik en sık %31.5 (n=17) oranla yaz mevsiminde görüldü. Sonuç: Ektopik gebelikte kliniğinin iyi değerlendirilmesi, gelişen teknolojiye paralel olarak tanının erken konması konservatif tedavi olanaklarını ön plana çıkarmıştır. Tek doz MTX protokolü rüptüre olmamış ektopik gebeliklerde yakın takip ile güvenli bir yöntemdir. Çalışmamızda ektopik gebeliklerin mevsimlere göre dağılımı değerlendirildiğinde olguların çoğunluğunun yaz aylarında olduğu tespit edildi. Bu sonuçta iklim ve mevsimsel değişikliklerin epidemiyolojide rol oynadığını düşündürmüştür. Anahtar kelimeler: Ektopik gebelik; tek doz methotreksat; mevsimsel dağılım. 2. SUMMARY Purpose: The aim of this study was to evaluate the demographic characteristics of the patients diagnosed with ectopic pregnancy in our clinic and to evaluate the methotrexate (MTX) treatment results used in the treatment and also to analyze the seasonal distribution of ectopic pregnancies in our region. Material and Methods: Between January 2015 and January 2018, a total of 54 patients who were admitted to Trabzon Medicalpark Hospital Gynecology and Obstetrics Clinic and diagnosed as ectopic pregnancy were evaluated retrospectively. Seasonal distribution was examined according to the application date of the cases. The descriptive statistics of the variables, parity status of the cases, success rates in methotrexate treatment and seasonal distribution according to the application date were analyzed statistically in IBM SPSS 22.0 package program environment. The relationship between the history of ectopic history and the referral to surgery was analyzed by Chi-square test. The results were evaluated statistically with 95% confidence interval and α=0.05 significance level. Results: The mean age of the ectopic pregnancy cases was 33±4.6. When all cases were evaluated according to the complaint of arrival, inguinal pain (40.7%) and secondary amenorrhea (18.5%) were the most common complaints. When the history of the patients were evaluated in terms of risk factors, the most common ectopic and caesarean operation was observed. When the diagnosis was made, 66.7% (n=36) of the patients were 4-6 weeks pregnant. In addition, 59.3% (n=32) of the patients human chorionic gonodotropin (ß-HCG) values ​​on MTX day were between 5-1500 mlU/ml. 85.2% (n=46) of the patients were treated with a single dose of MTX. When the distribution of patients according to the seasons was examined, ectopic pregnancy was viewed common mostly in summer months 31.5% (n=17). Conclusion: A good evaluation of the clinic in ectopic pregnancy and early diagnosis in parallel with the high technology have highlighted conservative treatment options. The single-dose MTX protocol was found as a safe method with a close follow-up in non-ruptured ectopic pregnancies. In our study, the distribution of ectopic pregnancies according to the seasons was evaluated in the summer months. This result suggested that climate and seasonal changes play a role in epidemiology. Key Words: Ectopic pregnancy; single dose methotrexate; seasonal distribution.

Amaç: Bu çalışmanın amacı stres üriner inkontinansın cerrahi tedavisinde uygulanan trans obturatuar tape (TOT) ve Burch operasyonlarını postoperatif rezidüel volüm, seksüel fonksiyon ve inkontinans skorları açısından karşılaştırmaktır. Gereç ve Yöntem: Çalışma prospektif gözlemsel olarak dizayn edildi. Eylül 2014- Ocak 2018 tarihleri arasında üriner inkontinans cerrahisi uygulanan olgular dahil edildi. Trans obturatuar tape ve Burch uygulanan hastalar postoperatif rezidü miktarı, Arizona Sexual Experiences Scale (ASEX) ve International Incontinence Questionnaire-Incontinence Short Form (ICIQ-SF) açısından karşılaştırıldı. İstatistiksel analiz için student t, mann-whitney u, wilcoxon testleri uygulandı. P<0,05 anlamlı kabul edildi. Bulgular: 29'u TOT, 23'ü de BURCH olmak üzere toplam 52 stress üriner inkontinans cerrahisi uygulanan olgu çalışmaya dahil edildi. Yaş ortalaması 55,50±9,71, ortalama izlem süresi 14,63±9,33 ay ve ortalama postoperatif rezidü miktarı 30,40±16,75 cc idi. Gruplar arasında post operatif rezidüel volüm idrar miktarı açısından istatistiki olarak anlamlı farklılık vardır (p<0,05). BURCH ve TOT grupları arasında yaş (53,60–57,00) ve vücut kitle indeksi (VKI) (27,60-30,45) ortalamaları yönünden anlamlı farlılık vardı (p<0,05). ICIQ-SF skorlarında ameliyat öncesi ve sonrası arasında istatistiki olarak anlamlı farklılık bulunmuştur (BURCH preop:11,09/postop:1,30 - TOT preop:16,59/postop:0,79) (p<0,05). BURCH grubunda operasyon sonrası ASEX skor ortalamalarındaki azalma (Preop 16,96 / postop 13,04) istatistiki olarak anlamlı bulunmuştur (p=0,03), TOT grubunda operasyon sonrası ASEX skorunda (preop 19 / postop 18,24) azalma görülmüştür. Sonuç: BURCH uygulanan olgularda seksüel fonksiyonlarda anlamlı olarak düzelme tespit edilmişken TOT uygulanan olgularda ise inkontinans skorlarında anlamlı düzelme tespit edilmiştir.