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Peptic ulcer perforation (PUP) accounts for 5% of all abdominal emergencies and is recognized as a gastrointestinal emergency requiring rapid and efficient clinical evaluation and treatment. The mortality rate ranges from 10% to 40% among patients with perforation. In the present retrospective study, we examined the potential utility of the neutrophil-to-lymphocyte ratio (NLR) in early diagnosis of PUP; we asked whether this ratio allowed PUP and peptic ulcer disease to be distinguished. We enrolled the following patients: 58 with PUP, 62 with noncomplicated peptic ulcer diseases (NCPU), and 62 controls, between May 2010 and 2015. Patients who underwent surgical repair to treat PUP were included in the study group. Another group consisted of NCPU patients who had a noncomplicated peptic ulcer. The control group consisted of patients presenting with nonspecific abdominal pain to the emergency department. The mortality rate was 5.2% in the PUP group. The white blood cell count, C-reactive protein, and NLRs were higher in the PUP compared to the other groups (P<.001 for all). The white blood cell count and NLR did not differ between the NCPU and control groups. The sensitivities, specificities, positive predictive values, and negative predictive values of the NLRs were 68.0%, 88.0%, 82.9%, and 72.9%, respectively. We suggest that preoperative NLR aids in the diagnosis of PUP and can be used to distinguish this condition from peptic ulcer disease. Thus, the NLR should be calculated in addition to the clinical examination.

Introduction/BackgroundThe role of office hysteroscopy in symptomatic or asymptomatic patients in the postmenopausal periodMethodologyThis retrospective document study comprised 347 patients who had undergone office hysteroscopy and endometrial biopsy in our hospital since 2015. Age, BMI, presence of symptoms, endometrial thickness in sonographic evaluation, and histological diagnosis were analyzed. The study population was divided into five groups based on their histological diagnoses: benign/physiological endometrium (group A), endometrial polyp (group B), endometrial hyperplasia or intraepithelial neoplasia(EIN)(group C), endometrioid carcinoma (group D) and non-endometrioid carcinoma (group E)ResultsA total of 347 patients underwent office hysteroscopy and endometrial biopsy (77 asymptomatic, 270 postmenopausal bleeding). The median age of the patients was 54, and the mean BMI was 29.8 kg/m2. The distribution of patients was n=157(%45.2) Group A, n=155 (44.7) Group B, n=14 (%4) Group C, n=17 (%4.9) Group D, n=4 (%1.2) Group E patients. Endometrial thickness was increasing from Group A to Group E. The mean endometrial thickness is 9.2mm, 10.4mm, 13.8mm, 14.4mm, 16.2mm, respectively.Cancer was detected in 20 (7.3%) of 271 patients with postmenopausal bleeding. Cancer was detected in only one of the asymptomatic patients. Endometrial cancer was present in 5.6% of the patients with postmenopausal polyps.When the endometrial thickness threshold was 10 mm, 7/35 (20%) patients could not be diagnosed with cancer. When the endometrial thickness threshold was 20 mm, this figure 1 increased to 25/35 (71.4%).ConclusionPostmenopausal bleeding is a condition that needs attention due to the risk of endometrial cancer. In asymptomatic patients, if there is no obvious focal lesion, office hysteroscopy may not be performed.DisclosuresOffice hysteroscopy is a very effective ’see and treat’ method in patients with postmenopausal bleeding. As the endometrial thickness increases in the postmenopausal period, the risk of endometrial cancer also increases considerably.