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    Clinical utility of the Oakland score in rectal bleeding: Implications for admission decisions and cost efficiency
    (Springer, 2026) Cetin, Mehmet Fuat; Gonullu, Mehmet Emin; Yekenkurul, Erman; Gursoy, Fatih
    Background Rectal bleeding is a frequent cause of emergency admissions, yet objective criteria for hospitalization remain limited. The Oakland Score was developed to identify low-risk patients suitable for outpatient management. Methods This retrospective single-center study analyzed 346 patients presenting with rectal bleeding between 2015 and 2025. Patients were categorized as low-risk (Oakland <= 8, n = 142) or high-risk (Oakland >= 8, n = 204). Clinical parameters, transfusion, tranexamic acid (TXA) use, and total hospital costs were compared. Results High-risk patients were older (64.2 +/- 14.2 vs 52.4 +/- 14.1 years, p < 0.001), had lower hemoglobin (10.6 +/- 2.2 vs 12.6 +/- 1.9 g/dL, p < 0.001), lower systolic pressure (116.1 +/- 17.0 vs 124.3 +/- 15.2 mmHg, p < 0.001), and higher heart rate (92.5 +/- 14.1 vs 83.2 +/- 11.6 bpm, p < 0.001). Hospital admission (91.2% vs 40.8%), transfusion (35.3% vs 5.6%), and TXA use (73.5% vs 28.2%) were significantly greater in high-risk patients (all p < 0.001). The Oakland Score correlated positively with total cost (r = 0.55, p < 0.001) and length of stay (r = 0.52, p < 0.001). ROC analysis showed excellent discrimination for hospital admission (AUC = 0.86, p < 0.001). Conclusion The Oakland Score reliably predicts both clinical severity and healthcare burden in patients presenting with rectal bleeding. Integrating this simple and objective tool into emergency department protocols can help physicians identify low-risk patients who may be safely discharged, thereby reducing unnecessary hospitalizations, optimizing resource use, and improving overall cost-effectiveness of care.
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    Evaluating Lactate and CRP for Preoperative Risk Stratification in Acute Appendicitis: A Retrospective Study
    (Duzce Univ, Fac Medicine, 2026) Cetin, Mehmet Fuat; Gursoy, Fatih; Gonullu, Mehmet Emin; Yekenkurul, Erman
    Aim: Distinguishing complicated from uncomplicated appendicitis is important for patient management. Readily available biomarkers such as serum lactate and C-reactive protein (CRP) may contribute to this process, although their diagnostic accuracy remains debated. Material and Methods: This retrospective study included 156 patients who underwent appendectomy between 2018 and 2024. Patients were grouped as complicated or uncomplicated based on operative and histopathological findings. Preoperative serum lactate and CRP were analyzed using ROC curves, and multivariate logistic regression was performed to identify potential predictors. Results: Complicated appendicitis (n=60, 38.5%) was associated with higher lactate (median 2.5 vs 1.6 mmol/L, p<0.001) and CRP levels (median 85 vs 32 mg/L, p<0.001). ROC analysis suggested fair to good discriminative ability for lactate (AUC 0.82) and moderate performance for CRP (AUC 0.78). In multivariate analysis, lactate, CRP, and body temperature appeared as independent predictors, although effect sizes were modest. Conclusions: Preoperative lactate and CRP levels showed an association with complicated appendicitis and may provide supportive information in risk stratification. However, these biomarkers alone are not sufficient for diagnosis and should be interpreted cautiously in conjunction with clinical and imaging findings. Larger, prospective studies are required to validate their role.
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    Preoperative Inflammatory Markers as Predictors of Post-ERCP Pancreatitis: A Retrospective Cohort Study
    (Springer, 2026) Cetin, Mehmet Fuat; Gonullu, Mehmet Emin; Yekenkurul, Erman; Gursoy, Fatih; Torun, Serkan
    Objective Post-ERCP pancreatitis (PEP) is the most common complication of ERCP. Identifying simple and accessible biomarkers to predict PEP risk may enhance patient safety and guide clinical decisions. Material and Methods This retrospective, single-center study included 613 adult patients who underwent ERCP between January 2017 and December 2024. Demographic data, comorbidities, procedural details, and preoperative laboratory parameters were collected from institutional electronic health records. The primary outcome was the development of PEP, defined by standard diagnostic criteria. Results Post-ERCP pancreatitis occurred in 52 patients (8.5%). Demographic characteristics and comorbidities, including age, sex, body mass index, diabetes mellitus, and hypertension, were not significantly associated with PEP. Pancreatic duct cannulation was significantly more frequent among patients with PEP (53.8% vs. 24.8%, p < 0.001) and remained an independent risk factor in multivariable analysis (aOR: 3.05, 95% CI: 1.65-5.64, p < 0.001). Patients who developed PEP had higher preoperative neutrophil-to-lymphocyte ratio (NLR) (3.7 +/- 1.9 vs. 2.9 +/- 1.5, p = 0.001) and C-reactive protein (CRP) levels (18.5 +/- 11.2 vs. 11.4 +/- 8.3 mg/L, p = 0.001). In adjusted analysis, both NLR (aOR: 1.14, 95% CI: 1.02-1.28, p = 0.02) and CRP (aOR: 1.04, 95% CI: 1.01-1.08, p = 0.008) remained statistically significant but modest independent predictors of PEP. ROC analysis demonstrated limited discriminative ability for both NLR (AUC: 0.64) and CRP (AUC: 0.66), with moderate sensitivity and specificity. Conclusion Elevated preoperative NLR and CRP levels, together with pancreatic duct cannulation, were independently associated with an increased risk of post-ERCP pancreatitis. Although these inflammatory markers demonstrated statistically significant associations, their predictive strength was modest. Therefore, NLR and CRP should be interpreted as supportive parameters rather than standalone predictors and may contribute to pre-procedural risk stratification when integrated with established clinical and procedural risk factors. Further prospective, multicenter studies are warranted to validate these findings and clarify their role in clinical practice.
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    Radiation-induced angiosarcoma of the breast: A case report
    (Elsevier Sci Ltd, 2024) Gurleyik, Emin; Yekenkurul, Erman; Gursoy, Fatih; Gonullu, Emin
    Introduction and importance: Today, breast-conserving surgery (BCS) and adjuvant radiotherapy are preferred treatments for patients with early invasive breast cancer. Radiation-induced angiosarcoma (RIAS) of the breast is a rare but serious complication of radiotherapy. Case presentation: Seventy-one-year-old woman is presented to our department with a locally advanced dark red polypoid lesion on her left breast. She had left BCS, axillary dissection, and adjuvant radiotherapy for invasive breast cancer 8 years before presentation. A small tissue sample from the breast lesions was sent for histopathologic examination that the diagnosis was angiosarcoma of the breast. She had neoadjuvant chemotherapy. Following the completion of chemotherapy, a total mastectomy was performed as surgical treatment. The final histopathologic diagnosis was well-differentiated angiosarcoma. Clinical discussion: RIAS of the breast is rare disease that develops after a several-year latency period. Locally advanced disease was initially treated with neoadjuvant chemotherapy which appears to be effective for significant disease regression. Patients who respond well to chemotherapy in vivo may have higher disease-specific survival rates. After chemotherapy-induced regression of locally advanced sarcoma, total mastectomy was performed for radical treatment. Conclusion: RIAS of the breast is defined as the histological diagnosis of angiosarcoma in an irradiated region after a long latency period in a patient who has previously received radiotherapy for breast carcinoma. Based on clinical and nuclear imaging data, we may conclude that neoadjuvant chemotherapy can result in significant disease regression, and following neoadjuvant chemotherapy the treatment of angiosarcoma is completed by radical breast surgery.
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    Retrosternal thyrothymic remnant affects completeness of thyroidectomy: A case report
    (Elsevier Sci Ltd, 2024) Gurleyik, Emin; Gonullu, Emin; Yekenkurul, Erman; Gursoy, Fatih
    Introduction and importance: The majority of surgical thyroid disorders are treated by thyroidectomy (total or hemithyroidectomy). Anatomical variants of embryologic origin may threaten the effectiveness of thyroid surgery and complete removal of thyroid tissue. Case presentation: A female patient who underwent a total thyroidectomy, postoperatively had normal serum thyroid-stimulating hormone (TSH) levels without hormone replacement. Serum TSH and thyroglobulin levels were within normal range. A thyroid nuclear scan and chest magnetic resonance imaging (MRI) indicated a large retrosternal thyroid remnant. Clinical discussion: Separated thyroid remnant in the thyrothymic tract, forgotten during primary surgery, was the source of hormone production. Total thyroidectomy was not achieved due to embryologic remnant, and complete resection of thyroid tissue was affected by separated retrosternal thyrothymic rest. Conclusion: Surgeon awareness of anatomic variants of embryological origin undoubtedly improves thyroid surgery outcomes. Beside the anatomically based approach, total thyroidectomy could be achieved by an embryologically based approach.