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Objective: The first COVID-19 pandemic wave was a period of reduced surgical activity and redistribution of resources to only those with late stage or critical presentations. This Vascular and Endovascular Research Network COVID-19 Vascular Service (COVER) study aimed to describe the six-month outcomes of patients who underwent open surgery and or endovascular interventions for major vascular conditions during this period. Methods: In this international, multicentre, prospective, observational study, centres recruited consecutive patients undergoing vascular procedures over a 12-week period. The study opened in March 2020 and closed to recruitment in August 2020. Patient demographics, procedure details, and post-operative outcomes were collected on a secure online database. The reported outcomes at 30 days and six months were post-operative complications, re-interventions, and all cause in-hospital mortality rate. Multivariable logistic regression was used to assess factors associated with six-month mortality rate. Results: Data were collected on 3 150 vascular procedures, including 1 380 lower limb revascularisations, 609 amputations, 403 aortic, 289 carotid, and 469 other vascular interventions. The median age was 68 years (interquartile range 59, 76), 73.5% were men, and 1.7% had confirmed COVID-19 disease. The cumulative all cause in-hospital, 30-day, and six-month mortality rates were 9.1%, 10.4%, and 12.8%, respectively. The six-month mortality rate was 32.1% (95% CI 24.2–40.8%) in patients with confirmed COVID-19 compared with 12.0% (95% CI 10.8–13.2%) in those without. After adjustment, confirmed COVID-19 was associated with a three times higher odds of six-month death (adjusted OR 3.25, 95% CI 2.18–4.83). Increasing ASA grade (3–5 vs. 1–2), frailty scores 4–9, diabetes mellitus, and urgent and or immediate procedures were also independently associated with increased odds of death by six months, while statin use had a protective effect. Conclusion: During the first wave of the pandemic, the six-month mortality rate after vascular and endovascular procedures was higher compared with historic pre-pandemic studies and associated with COVID-19 disease.

Aim: Chronic Venous Ulcer (CVU) accounts for nearly 70% of all chronic leg ulcers (CLU), seriously impacting the quality of life and creating a heavy economic burden. Here, we present CVU therapy with a four-layer bandage system in 113 patients retrospectively treated by the General Surgery Chronic Wound Unit and Cardiovascular Surgery Department. Material and Methods: From January 2022 to January 2023, 113 patients with CVU were evaluated retrospectively. All patients were documented by color Doppler ultrasonography (CDUS), ulcer size, and demographics. If there were multiple ulcers, the largest one was assessed. Immobile patients and patients with an Ankle Brachial Index (ABI) of [Turk J Vasc Surg 2023; 32(3.000): 147-52]

Background/Aim: Diabetic foot infection (DFI) occurs frequently in patients, followed up with diabetic foot ulcers (DFU). For this reason, antibiotic treatment is often used in patients followed with DFU. Inappropriate use of antibiotics and increasing antibiotic resistance threaten public health. We aimed to investigate the microbial spectrum and antimicrobial resistance patterns isolated from diabetic foot infections in Turkey and help clinicians to choose optimal antibiotics empirically. Materials and Methods: This study was planned as a retrospective, single-center, cross-sectional study. Two hundred sixty-two patients whose causative microorganism was isolated in culture of tissue between 1 January 2021 and 31 December 2022 were included in this study. Bacterial profile and antimicrobial resistance patterns were analyzed. Results: Four hundred thirty two isolates from 262 patients isolated in culture of tissue were evaluated. Of these microorganisms, 57.60% were Gram-negative, 41.20% were Gram-positive bacteria, and 1.2% were Candida spp. The most frequently detected Gram-positive microorganism was Staphylococcus spp. Gram-negative microorganisms were Escherichia coli (E. coli) and Pseudomonas aeruginosa (P. aeruginosa). Polymicrobial infections were observed in 40.5% of the patients. Methicillin-resistant Staphylococcus spp. rate was 51.3%, while extended-spectrum beta-lactamase (ESBL) resistance for E. coli was 66.7%. Conclusions: Due to increasing antibiotic resistance rates, treatment of common infections becomes more difficult. Knowledge of the microbiological profile and antibiotic resistance patterns of patients with DFIs is useful to guide empirical therapy.

Aim: Systemic immune-inflammation (SII) index may provide more promising prognostic information in patients with cancer surgery. However, to the best of our knowledge, the prognostic value of SII index in patients with pancreatic cancer who underwent pancreaticoduodenectomy has not been studied. Thus, this study aimed to evaluate and compare the prognostic value of SII index in patients with pancreatic cancer who underwent pancreaticoduodenectomy. Materials and Methods: All patients over 18 years-old that underwent successful pancreaticoduodenectomy due to pancreatic cancer between February 20, 2019 and June 30, 2021 at Ankara City Hospital Department of General Surgery were included. The main predictor of interest was SII index which was measured by neutrophil*platelet / lymphocyte count. The main outcome of the study was long-term all-cause mortality. Results: A total of 223 patients were included in the current study. Multivariable cox regression analysis revealed that history of congestive heart failure [HR (95%CI): 3.682 (1.140-11.892)], and SII index [HR (95%CI): 1.001 (1.001-1.001)] were independently associated with all cause long-term mortality. The accuracy of predicting mortality for SII index was assessed by the area under the ROC curve which was = 0.77. A higher value of 1305 of SII index was found with 76% sensitivity and 67% specificity for predicting all-cause long-term mortality. Conclusions: The results of the study suggest that measurement of the SII index, an easily available and relatively cheap marker, is an independent predictor of long-term survival after pancreaticoduodenectomy in patients with pancreatic cancer.

The prognostic nutritional index (PNI) is a new marker used to assess a patient’s nutritional and immune status. It is calculated using serum albumin levels and total lymphocyte count. The aim of this study was to investigate the relationship between PNI and amputation in patients with diabetic foot ulcer (DFU). Patients with DFU were enrolled in this retrospective study. In our study, a total of 386 patient data, of 110 (28.5%) amputated and 276 (71.5%) non-amputated patients, were statistically analyzed. PNI values were significantly lower in the amputated patient group than in the non-amputee patient group (p < 0.001). According to the ROC analysis results, PNI was significant in the prediction of amputation at an excellent level (AUC = 0.937 (0.911–0.963), p < 0.001). The optimal cut-off point for PNI was found to be 39,005. There was classification success for this cut-off point: sensitivity was calculated as 82.7% (74.1–89) and specificity as 93.1% (89.3–95.7). In the multivariate model, the odds ratio (OR) (95% CI) was calculated as 81.8 (38.5–173.7) for PNI. The PNI was associated with an increase in amputation rate in patients with DFU. By using PNI, patients can be directed to advanced centers and have access to early and appropriate interventions.

INTRODUCTION: The overdiagnostic analyses can be performed for evaluation of thyroid nodules which are commonly seen pathology in the population. Diagnostic tests in the evaluation of thyroid nodules, commonly-seen pathology in the population, mostly cause overdiagnosis. In fact, serum calcitonin(SC) measurement is a sensitive and specific method in the diagnosis of medullary thyroid cancer(MTC). If the patients with Bethesda Category III(atypia of undetermined significance -AUS) cytologies have also high risk clinical and ultrasonographical features, they can be evaluated for thyroidectomy. In this study, we aimed to evaluate the value of screening with serum calcitonin in patients with cytologies of Bethesda I and III categories. METHODS: The medical records of patients who had thyroidectomy between 2007-2018 were screened retrospectively. The patients with preoperative calcitonin, cytology results and postoperative histopathology reports were included in the study. RESULTS: Of the 6905 thyroidectomized patients, 881 had SC values. SC levels were evaluated as 10pg/mL and classified as Group 1, 2, and 3; respectively. 217 patients(24.6%) had nondiagnostic(ND) and 275(31.2%) had AUS cytologies. The gender distribution was similar between ND and AUS groups(p=0.7). However, SC levels of group 1, 2, and 3 were found in 84.8%, 14.3%, and 0.9% of patients with ND, it was found in 82.9%, 15.6%, and 1.5% in patients with AUS cytologies, respectively(p=0.786). In histopathology, malignancy was detected in 30% of patients with AUS and 11.6% patients with ND(p=0.006). Calcitonin levels of patients with malignant histopathology were evaluated in 82.9%, 15.4%, and 1.7% of patients as Group 1, 2, and 3, respectively. This was similar compared to patients with benign histopathology (p=0.16). In the present study, 2 female patients had high calcitonin levels(144pg/mL and 655pg/mL). Both patients had preoperative AUS cytologies and final malignant histopathologies. DISCUSSION AND CONCLUSION: We think that preoperative assessment of serum calcitonin levels can be useful in treatment decision of patients especially with Bethesda Category III thyroid nodules such as in follow-up and extent of surgery for cases planning surgery.

Amaç: Diferansiye tiroid kanserinin (DTK) büyük çoğunluğunu papiller tiroid Amaç: Diferansiye tiroid kanserinin (DTK) büyük çoğunluğunu papiller tiroid kanserleri (PTK) ve folliküler tiroid kanserleri (FTK) oluşturmaktadır. PTK varyantlarından olan folliküler varyant- PTK (FV-PTK) sıklığı son yıllarda artmaktadır. Ancak bu alt grup için klinikopatolojik, radyolojik ve sitolojik özelliklere ait literatür bilgisi kısıtlıdır. Bu çalışmada amaç, merkezimizde takip edilen FTK ve FV-PTK tanısı alan hastaların klinikopatolojik özelliklerin karşılaştırılması, preoperatif radyolojik ve sitolojik özellikler ile histopatolojik tümöral özellikler açısından bu iki grup arasında fark olup olmadığının araştırılmasıdır. Materyal ve Metot: Bu retrospektif çalışmaya toplam 177 (144 FV-PTK ve 30 FTK) hasta dahil edildi. Her iki hasta grubunun preoperatif tiroid fonksiyon testleri, tiroid antikorları, nodüllerinin ultrasonografik ve sitolojik özellikleri, operasyon sonrası histopatolojik özellikleri karşılaştırıldı. Bulgular: FV-PTK grubunda 23 (%16) erkek hasta, 121 (%84) kadın hasta var iken, FTK grubunda 11 (%36,70) erkek 19 (%63,30) kadın hasta mevcut olup erkek hastaların sayısı FTK grubunda istatistiksel olarak anlamlı derece fazla idi (p=0,009). Preoperatif ultrasonografik özellikler karşılaştırıldığında FTK grubundaki nodüllerin longitudinal çapı ve volümü FV-PTK grubundan istatistiksel olarak anlamlı derecede daha büyüktü (sırası ile p=0,007 ve p=0,005). Ultrasonografik diğer özelliklerden açısından istatistiksel anlamlı farklılık izlenmedi. Her iki gruptaki nodüllerin preoperatif sitoloji sonuçları Bethesda sınıflamasına göre karşılaştırıldığında folliküler neoplazi/folliküler neoplazi şüphesi (FN/FNŞ) sitoloji sonucu FTK grubunda istatistiksel olarak anlamlı derece daha fazlaydı (%15,80’e karşılık %5,30, p=0,017). Histopatolojideki tümöral özellikle değerlendirildiğinde FTK grubunda tümör çapı, FV-PTK grubundan istatistiksel olarak anlamlı derece daha büyüktü (median tümör çapı 25 mm’e karşılık 14,5 mm, p