INTRODUCTION: Laparoscopic cholecystectomy (LC) has become the gold standard for treating symptomatic gallbladder stones, yet 3–10% of patients may also harbor common bile duct (CBD) stones, complicating their management. Endoscopic retrograde cholangiopancreatography (ERCP) revolutionized CBD stone treatment in the 1970s by offering a minimally invasive alternative to open exploration. However, the optimal approach for patients with suspected choledocholithiasis undergoing LC remains controversial.
METHODS: This retrospective study aimed to identify predictors for selective preoperative ERCP in 206 patients who underwent LC at SSK Okmeydani Training Hospital between June 1996 and June 1998. Clinical, biochemical, and radiological data were analyzed to determine the most significant predictors for ERCP. Key criteria included a history of cholangitis, gallstone pancreatitis, or jaundice; elevated bilirubin and alkaline phosphatase levels; and a CBD diameter ≥8 mm on ultrasonography.
RESULTS: ERCP was performed in 24 patients (11.65%), with successful outcomes in 22 cases. Among these, 16 patients (72.8%) had a CBD diameter ≥8 mm, and 13 (81%) had positive ERCP findings. Biochemical abnormalities were present in 14 patients (63.6%), with 8 (57.1%) showing positive ERCP results. Notably, 6 of 8 patients (75%) with normal biochemical results also had positive ERCP outcomes.
DISCUSSION AND CONCLUSION: The study highlights the importance of selective ERCP based on clinical and biochemical parameters, particularly in patients with a dilated CBD and abnormal liver function tests. These findings align with previous research advocating for risk stratification to minimize unnecessary ERCP procedures and associated complications. By refining preoperative evaluation criteria, this study supports a more targeted approach to ERCP use, optimizing patient outcomes while reducing procedural risks.

INTRODUCTION: Studies suggest that Coronavirus Disease 2019 (COVID-19) may enter the human body via the angiotensin-converting enzyme 2 (ACE2) receptor, and that the use of renin-angiotensin system (RAS) blockers could increase ACE2 receptor expression. We aimed to investigate the effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) on the prognosis of COVID-19 patients with hypertension.
METHODS: This retrospective, single-center study included 1,130 hospitalized patients aged 18 and over who were diagnosed with COVID-19 via a positive PCR test or based on chest CT radiological findings between March 15, 2020, and July 1, 2021. Patients were divided into two groups: those with and without hypertension. Additionally, hypertensive patients were further categorized based on ACEI/ARB usage to evaluate the impact of these medications on disease prognosis. Statistical analyses were performed using SPSS Statistics 22.
RESULTS: The study included 511 (45%) female and 619 (55%) male patients. The prevalence of hypertension was significantly higher in patients admitted to the intensive care unit compared to those in the ward (63% vs. 41%; p<0.001; OR: 2.51; CI: 1.73–3.65). Similarly, hypertension was more prevalent among deceased patients than among those discharged (68% vs. 40%; p<0.001; OR: 2.9; CI: 1.99–4.21). Regression analysis revealed that ACEI/ARB use did not significantly affect mortality. Among biochemical parameters, a significant difference was observed only in CRP levels between ACEI/ARB users and non-users (7.19±9.75 vs. 8.74±10.18; p=0.032).
DISCUSSION AND CONCLUSION: No adverse effects of ACEI/ARB use on COVID-19 outcomes were observed. ACEIs and ARBs, which are primary agents in the treatment of coronary artery disease, heart failure, diabetes, and hypertension, can be safely used in patients with COVID-19.

INTRODUCTION: Acute ischemic stroke (AIS) is a significant cause of death and disability worldwide. Inflammation affects brain damage and prognosis in ischemic stroke, while malnutrition significantly impacts clinical outcomes. The prognostic nutritional index (PNI) and neutrophil-to-lymphocyte ratio (NLR) are used to assess nutritional and inflammatory status, respectively. The aim of our study was to determine the role of PNI and NLR in predicting the prognosis of ischemic stroke.
METHODS: A total of 215 acute ischemic stroke patients hospitalized in our neurology intensive care unit between September 2020 and November 2021 were retrospectively analyzed. Stroke classifications, vascular risk factors, laboratory parameters, and mortality rates of acute ischemic stroke cases were evaluated. PNI and NLR were calculated, and PNI values were dichotomized into two groups using a cutoff point of 42.5, determined via receiver operating characteristic (ROC) analysis.
RESULTS: Over a 60-day period, a multivariable logistic regression analysis for neurological prognosis revealed that coronary artery disease (hazard ratio [HR]: 3.9, p=0.021), initial National Institutes of Health Stroke Scale (NIHSS) score (HR: 1.16, p<0.001), and PNI (HR: 0.022, p<0.001) were significant independent predictors of neurological outcomes. Additionally, Cox regression analysis for overall patient survival indicated that age (HR: 1.93, p=0.009), initial NIHSS score (HR: 1.04, p=0.008), blood urea nitrogen (BUN) level (HR: 1.69, p=0.012), and PNI (HR: 0.27, p=0.007) were independent factors influencing mortality.
DISCUSSION AND CONCLUSION: PNI and NLR are accessible and cost-effective biomarkers. These indicators provide insights into patients’ inflammatory and nutritional profiles, enabling clinicians to make informed treatment decisions and serving as predictors of prognosis in AIS patients.

INTRODUCTION: This study investigates cardiac involvement in ankylosing spondylitis (AS) using cardiac magnetic resonance imaging (MRI). The findings are correlated with transthoracic echocardiography (TTE) and clinical and laboratory data.
METHODS: The study included patients diagnosed with HLA-B27 positive AS for at least 10 years, without any known cardiac complications or risk factors, but with diastolic dysfunction detected via TTE. The average patient age was 40 years. Contrast-enhanced cardiac MRI was performed to assess cardiac morphology and myocardial pathologies. Disease activity was evaluated using the Bath Ankylosing Spondylitis Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI). Laboratory markers, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were measured to determine disease activity.
RESULTS: Patients with increased clinical activation indices and prolonged E-wave deceleration time on tissue Doppler imaging exhibited myocardial pathology on cardiac MRI. MRI findings included intramural myocardial edema, late gadolinium enhancement, and myocardial thinning in the left ventricular wall. No statistically significant association was found between cardiac MRI findings and laboratory markers.
DISCUSSION AND CONCLUSION: AS patients with diastolic dysfunction may benefit from MRI to localize underlying myocardial pathology. Abnormal MRI findings were associated with higher disease activation indices, suggesting a role for inflammation in the pathogenesis of myocardial involvement in AS.

Gallstone ileus is a rare cause of mechanical ileus that often presents with delayed symptoms and nonspecific features. It should be considered in patients with chronic cholecystolithiasis presenting with symptoms of mechanical obstruction. Surgical removal of the gallstone to relieve intestinal blockage—typically resulting from a cholecys-toduodenal fistula—is the mainstay of treatment. A 60-year-old man with a four-year history of cholecystolithiasis presented with signs of mechanical intestinal obstruction. Abdominal computed tomography (CT) imaging revealed a cholecystoduodenal fistula and small bowel obstruction suggestive of gallstone ileus. The patient under-went laparotomy. Cholecystectomy, cholecystoduodenal fistula repair, and gallstone removal by enterotomy were performed. The patient was discharged on the seventh postoperative day without complications.

The corpus callosum serves as the primary commissural region of the brain, comprising white matter tracts that facilitate interhemispheric communication between the left and right cerebral hemispheres. It consists of approximately 200 million heavily myelinated axons, which form homotopic or heterotopic projections to contralateral neurons within the same anatomical layer. The corpus callosum is conventionally divided into four distinct parts: the rostrum, genu, body, and splenium. These components connect corresponding centers in the right and left cerebral hemispheres, thereby enabling comprehensive neural coordination.
Cytotoxic lesions of the corpus callosum (CLOCC) represent unusual clinical conditions characterized by diverse presentations. This study presents four cases of CLOCC. The first case involved a 41-year-old male patient who presented with symptoms of fever, blurred vision, and fatigue. The second case concerned a 21-year-old female patient who presented with headache, fever, tinnitus, and sore throat. The third case involved a 65-year-old female patient who presented with headache, focal seizures with impaired awareness, and confusion. The fourth case involved a 64-year-old female who presented with global aphasia and right hemiparesis; she developed a fever during clinical follow-up.
Upon evaluating the etiology of CLOCC, an undetermined infection following a dental procedure was identified in the first case, lobar pneumonia in the second case, and sinus venous thrombosis in the third case. Additionally, the third case developed epileptic seizures during follow-up. In the fourth case, a bacterial infection of undetermined origin that resolved with empirical antibiotic therapy was considered the etiology. Diagnosis involves identifying acute diffusion restriction in the corpus callosum using diffusion MRI. CLOCC should be considered in the differen-tial diagnosis of patients presenting with undiagnosed neurological findings. These lesions are often reversible and have a favorable prognosis, depending on the underlying cause. Radiological identification is crucial for selecting appropriate treatment options.