Selçuk Tıp Dergisi Arşiv

Aim: Accelerated Ponseti technique is aplication of manipulation and casting the clubfoot patients more frequent than the weekly technique. The aim of this study is to compare two different accelerated ponseti techniques applied to clubfoot patients.

Patients and techniques: Twelve patients (19 feet) treated with the accelerated Ponseti technique for severe clubfoot between September 2018 and April 2020 were included in the study. The patients were divided into 2 groups as group A and group B. Group A had casting twice a week  and Group B had 1st casting in first day of the treatment, with the 2nd, 3rd, 4th, 5th castings in the 4th, 5th, 6th, 7th day post-manipulation

Results: 6 patients ( 9 feet) were in group A, 6 patients ( 10 feet) were in group B. There was no significant difference regarding ages of patients’ between groups (P=0.206). There were no significant difference between groups regarding Pirani score after final cast removal (P=0.856) and after 6 weeks (P=0.930).

Conclusions: Although there is no definite interval determined for the accelerated Ponseti technique, successful results were obtained as a result of the techniques applied in the present study.

Aim: Cardiovascular events, including ventricular arrhythmias and sudden cardiac death (SCD), are the primary source of death in hemodialysis (HD) patients. Checking ECG parameters such as QT interval, QT dispersion (QTd), TPe interval, TPe/QT ratio, and cardiac-electrophysiological balance (iCEB = QT/QRS) can be useful for classifying patients with high arrhythmia and SCD risk. Our study aimed to compare the change of electrocardiographic parameters before and after the HD session with the healthy control group.

Methods: A total of 49 HD patients and 50 healthy volunteers were included in the study. The groups were divided into two groups as hemodialysis and control group. ECGs of the hemodialysis group were evaluated before and after dialysis. ECG data were scanned and evaluated on a digital platform. QT, cQT, QTd, TPe, TPe/QT, TPe/cQT, QT/QRS, and cQT/QRS were measured.

Results: While QTd, cQTd, TPe, TPe / QTc, and QRS decreased significantly after hemodialysis compared to pre-HD(p <0.05 for each), HR, iCEB, and iCEBc showed a significant increase after dialysis treatment (p <0.05 for each). Comparing pre-dialysis ECG parameters with the control group, QT, cQT, QTd, cQTd, TPe and iCEBc were significantly higher in pre-HD (p <0.05 for each). Comparing the ECG parameters after dialysis, HR, cQT, QTd, cQTd, iCEB, and iCEBc values were significantly higher than the control group (p <0.05 for each).

Conclusion: By evaluating the electrocardiographic parameters showing ventricular repolarization and depolarization together, the risk of arrhythmia and sudden cardiac death can be predicted in HD patients.

Objective: The aim of our study is evaluate the association between serum vitB12 levels at time of diagnosis and clinical and laboratory signs in multiple myeloma patients.

Material and Methods: Patients were divided into two groups; those had low and normal levels of vitB12. Groups were analized by using independent simple T, Mann Whitney U and chi-square tests considering by distrubition characteristics of data.

Results: Two hundred-and-twelve patients' records were examined retrospectively. Forty-one (32%) patients had low vitB12 levels. In patients with low vit B12 levels, bone marrow plasma cell ratios were also significantly lower than those found normal vit B12 levels (median %30 vs %50, respectively) (p: 0,024). There was no statistically significant difference between the two groups in terms of age, lytic bone lesion numbers, and serum levels of total protein, lactate dehydrogenase, ß2-microglobulin, calcium, creatinin, albumin. However, 11 patients (%26,8) in low vitB12 group had anemia, while 44 (%50,5) patients in normal vitB12 group had. So, anemia was more often in vitamin B12 normal group patients (p: 0,019). No difference was found in terms of myeloma ISS and R-ISS stages in two patient groups.

Conclusions: Bone marrow median plasma cell ratio was also low in the group with low vit B12 levels. Our data could not show its clinical reflection. Further studies with larger groups are required to evaluate the response to treatment, survival and recurrence rate.

Amaç: Sağlıklı bireylerde yaş ve cinsiyetin ganglion hücre kompleksi ve retina sinir lifi kalınlığı üzerine etkisinin RTVue optik kohorens tomografi ile değerlendirilmesi

Hastalar ve Yöntem: Yaşları 10-84 arasında değişen 393 sağlıklı katılımcıyı bu kesitsel çalışmada değerlendirdik.  Yaşa bağlı değişikler  lineer regresyon  analizi ve Pearson korelasyon analizi ile incelendi. Retina sinir lifi kalınlığı ve ganglion hücre kompleksi arasındaki ilişki pearson korelasyon testi ile değerlendirildi.

Bulgular: Tüm populasyonun ortalama retina sinir lifi kalınlığı 108.94±9.77 µm idi ve  yıllık  0.101 µm  (95% güven aralığında , -0.151, -0.051; lineer regresyon analizi ile, p<0.001) azalmaktaydı. En önemli azalma üst temporal bölümde ve yıllık 0.197 µm  (0.197 µm/yıl, 95% güven aralığı, -0.293, -0.101; lineer regresyon analizi ile, p<0.001) olarak görüldü. Üst kadran hariç retina sinir lifi kalınlığında cinsiyete göre fark bulunamadı. Ortalama ganglion hücre kompleksi kalınlığı 97.45±6.42  µm olarak bulundu ve her yıl  0.043 µm azalmaktaydı (95% güven aralığında, -0.079, -0.007; lineer regresyon analisi ile, p=0.019). Cinsiyetle ganglion hücre kalınlığı arasında bir ilişki bulunmazken retina sinir lifi ile ganglion hücre kompleksi arasında anlamlı korelasyon tespit edilmiştir (p<0.001 ve r=0.630).

Sonuç: Retina sinir lifi kalınlığı ve ganglion hücre kompleksi kalınlığı yaşla birlikte önemli ölçüde azalmaktadır ancak ganglion hücre kalınlığı daha az etkilenmektedir. Ek olarak bu çalışmada ganglion hücre kalınlığı ve retina sinir lifi kalınlığı RTVue veri tabanından yüksek bulunmuştur. Bu fark tanıda gecikmeye neden olabileceğinden dikkate alınmalıdır.

Aim: It was aimed to investigate  the relationship of disease clinical stage between the maximum diameter of primer lesion (LEGÇ), maximum of standardized uptake value (SUVmax), mean of standardized uptake value (SUVmean), tumor volüme (TV) and total lesion glycolysis (TLG) values derived from positron emission tomography/computed tomography (PET/CT) images.

Method: The information of 130 lung cancer patients diagnosed histopathologically between 01.01.2012 and 31.12.2014 in Necmettin Erbakan University Nuclear Medicine Department of Meram Medical Faculty scanned for PET-CT for lung cancer diagnosis and staging,  were included in this study. The values of the maximum diameter of primer lesion, SUVmax, SUVmean, TLG and MTV derived from PET-CT scanning and their histopathological subtypes, other clinical and radyological information of patients were noted. The non-small cell lung cancer patients were graded according to tumor diameter, nodal and involvement metastasis (TNM) staging system using clinical information, PET-CT and other radyological test results if any. On the other hand, the small cell carcinoma diagnosed were categorised as limited or extensive stage.

Findings: In this study, the mean age of 118 men and 12 women,  totally 130 patients, was evaluated  63,46 ±9,96 ( range 40-87 age ). The patients were classified as 106 non-small cell lung Cancer (NSCLC) (81.5%) ve 24 small cell lung cancer (SCLC) (18.5%).  The  histopathologically diagnosed NSCLC patients were consists of  62 squamous cell cancers, 39 adeno cancers, and 5  other types (3 carcinoid tumors, 1 large cell cancer and 1 sarcomatoid tumor). 

Results: In our study, it was observed that there was no significant relationship between the maximum diameter of the lesion, SUVmax, SUVmean, MTV and TLG values among SCLC and NSCLC patients. Additionally, it was also found that there was no correlation between these parameters and the SCLC stage.  The maximum diameter of the lesion, SUVmax, SUVmean, MTV and TLG parameters were related with stage.

Conclusion: Higher SUVmax, SUVmean, TV, and TLG values of the primary tumor were determined to predict the more advanced clinical stage in NSCLC. This relationship between metabolic parameters and the clinical stage suggest that PET / CT may be valuable in terms of providing prognostic information in NSCLC.

Objective: To investigage the effect of surgical approaches used in the treatment of degenerative cervical spondylotic myelopathy on cervical alingment and vertebral canal diameter measurements

Material and Methods: 45 patients were operated with degenerative cervical sponylotic myelopathy (CSM) in our clinic between 2016 and 2020. 23 of them including 5 females and 18 males, were operated  with open door laminoplasty; and 22 of them including 4 females and 18 males, were operated with  laminectomy with  lateral mass screw fusion. SVA (Distance between C2 midline and C7 superior end plate midline), Cobb angles (The angle between the lines passing through C2 lower end plate and C7 lower end plate), and VCD (vertebral canal diameter measured from MR images) values of patients ​​were measured.

Results: Collected data of patients in preoperative period and 1 year after operation were evaluated statistically.

Conclusion: Plate and screw systems not causing facet joint damage use in patients with CSM are more effecticve in the cervical alignment protection

Aim: Sarcoidosis is a multifactorial disease with unknown aetiology and characterized by non-caseous granulomatous inflammation. The pathogenesis of sarcoidosis is defined as inflammation and autoimmune activation. Here, we aimed to evaluate plasma clusterin (CLU) and α-klotho levels in those with sarcoidosis.                                        

Patients and methods: Forty patients with sarcoidosis (mean age: 52.10±12.60 years; 12 males, 28 females) and 40 healthy volunteers (mean age: 37.40±18.20 years; 12 males, 28 females) were enrolled into the study. Blood samples were drawn from both groups, and plasma CLU and α-klotho levels were investigated by enzyme-linked immunosorbent assay (ELISA) technique.                                                               

Results: Patients with sarcoidosis had significantly higher plasma CLU levels (309.73±40.68 ng/mL), compared with healthy controls (117.86±102.03 ng/mL) (p=0.005). The plasma levels of α-klotho were measured as 5.34±7.30 in the sarcoidosis patients and 7.21±9.84 ng/mL in the controls. A minimal decrease was observed, but there was no statistically significant difference (p=0.338). The hemoglobin levels of sarcoidosis patients were decreased, when compared with the control group (12.93±1.02 g/dL vs 14.06±1.50 g/dL) (p=0.012).                                                                    

Conclusion: We concluded that sarcoidosis is associated with high levels of CLU. Plasma CLU may be a potential biomarker of sarcoidosis. Based on literature and to the best of our knowledge, this is the first study to provide insight in the determination of plasma levels of CLU and α-klotho in sarcoidosis. Further and comprehensive investigations are needed to clarify the entity.

Aim: The aim of this study was to evaluate the demographic characteristics, emergency care needs and prognosis of patients aged 65 years and older who presented to our Emergency Medicine Clinic with abdominal pain for a period of one year.

Patients and Methods: In this single-center, retrospective, observational study included patients aged 65 years and older who presented to the emergency department with abdominal pain between June 15, 2015 and June 14, 2016. The related variables were recorded from the patients' electronic and written files. The general patient population and the differences of variables in the 65-74 age group, 75-84 age group and ≥85 age group were investigated.

Results: A total of 1330 patients were included in the study. The mean age of the patients was 75.2 ± 7.2 years and 582 (43.8%) were male. While 58.8% of the patients were discharged from the emergency department, the most common hospitalization wards were General Surgery (14.1%) and Gastroenterology (11.4%). The ICU admission rate increased with age (p<0.001; 3.3% - 5.8% - 11.6%). The mean length of stay in hospital was 5.9 ± 7.1 days and the in-hospital mortality rate was 3.4%. While 50.1% of the patients in the 65-74 age group were discharged from the emergency department without consultation, this rate decreased to 36.6% in the ≥85 age group and the difference was statistically significant (p<0.001). Abdominal ultrasound was performed in 34.1%, abdominal tomography in 20.0% and both of them in 7.5% of the patients.

Conclusion: The patients aged 85 years and older with abdominal pain are more likely to be characterized by more examination needs, more consultation needs, more hospitalization rates and higher mortality rates. Taking these differences into consideration during the management of the elderly patients with abdominal pain in emergency department will help to reduce morbidity and mortality rates while improving patient care quality.

Objective: The aim was to review the hormonal status, treatment and histopathological diagnosis of patients admitted to our endocrinology outpatient clinic with the diagnosis of adrenal incidentaloma.

Material and Methods:Between 2015-2018, 217 patients with adrenal incidentaloma who were admitted to the endocrinology outpatient clinic were included in the study. 1 mg overnight dexamethasone suppression test (DST), 24 hour urine free cortisol, 24-hour urine methanephrine and normetanephrine levels were evaluated in all patients.Patients who also have hypertension or hypokalemiawere screened for the plasma aldosterone/renin activity ratio. CT or MRI imaging properties of adrenal incidentalomas were screened.

Results: In the evaluation of cases; 180 (83%) of the masses were evaluated as non-functional and 37 (17%) as functional. Of the 37 patients evaluated as having functional adrenal mass; 10 (4.6%) pheochromocytoma, 5 (2.3%) Cushing's syndrome, 9 (4.1%) subclinical Cushing’s syndrome and 13 (6%) primary hyperaldesteronism were detected. In 180 patients who were evaluated as having non-functional adrenal mass; metastatic disease in 7 (3 non-small cell lung cancer, 1 breast cancer, 1 prostate carcinoma and 2 unknown primary cancer), myelolipoma in 4, ganglioneuroma in 1, hydatid cyst in 1, adrenocortical carcinoma in 2 patients were detected.

Conclusion: According to the results of this study, it is not uncommon for adrenal incidentalomas to be functional. It may be malignant in some cases. For this reason, adrenal incidentaloma is a condition that should be examined both in terms of
functionality and malignancy potential.

Abstract

Objective

There is still no consensus on nonoperative management (NOM) for the treatment of patients with liver injury due to multiple trauma. In this study, we aimed to present our experience in patients who underwent NOM in our hospital due to liver injury resulting from blunt trauma.

Material & Methods

In this study, a total of 104 patients who presented to our hospital with liver injury due to multiple trauma were retrospectively evaluated. Patients with successful NOM and those who underwent laparotomy due to failure of NOM were grouped.

Results

All of the 104 patients had solid organ injury due to blunt abdominal trauma, and 58 of these had thorax trauma. NOM was successfully performed in 94 patients with liver injury due to blunt abdominal trauma. The treatment was converted to surgery in 10 patients during conservative follow-up. According to injury grades; 35 patients were graded as Grade 1, 23 patients as Grade 2, 24 patients as Grade 3, and 12 patients as Grade 4. Data of 10 patients with liver trauma and NOM failed were compared with those of the NOM group.

Conclusion

The development of complications increases in patients with high-grade injury or those accompanied by thorax trauma. The rate of complications is high in patients who receive NOM in Grade 4 injury.

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Aim: We aimed to evaluate the relationship between magnetic resonance (MR) enterography and diffusion magnetic resonance imaging (MRI) investigations in inflammatory bowel disease (IBD) patients during active inflammation and remission phases. 

Patients and Methods: We included patients diagnosed with IBD between 01.12.2015-31.08.2016 at our hospital. 47 patients were included; 30 were male (63.8%) and 17 were female (36.2%). Thirty two (68.1%) of them had ulcerative colitis and 15 (31.9%) had Crohn’s disease. Standard institutional sequences for upper and lower abdomen scan included: sagittal and axial T2 TRUFI, axial and coronal fat suppressed T2 TRUFI and coronal and axial T1 VIBE following intravenous (at 60 seconds) contrast medium administration. First group of patients (n=10) had MRI investigations both at active and remission phases, whereas in the second group of patients (n=37) apparent diffusion coefficient (ADC) values, bowel wall thickness and contrast enhancement grades were compared between actively inflamed and non-inflamed bowel segments.

Results: A statistically significant difference was found regarding ADC values and bowel wall thickness measurements in the first group of patients when compared between active and remission phase MRI investigations (p=0.005). Bowel wall contrast enhancement degree did not differ between active and remission phases in the first group (p=0.059). In the second group, there was a statistically significant difference between active and normal bowel segments regarding ADC values, bowel wall thickness and contrast enhancement (p<0.001).

Conclusion: MR enterography and diffusion MRI may be beneficial to determine the degree of inflammation and response to treatment in IBD patients.

With the understanding that adipose tissue is not only a passive energy store, but also an endocrine organ, interest in bioactive factors secreted from adipose tissue has increased. Adipose tissue, consisting of pre-adipocytes, macrophages, endothelial cells, fibroblasts and leukocytes, as well as adipocytes, has an important role in systemic metabolic regulation. Chemerin, called tazarotene-induced gene 2 (TIG2) or retinoic acid receptor responder 2 (RARRES2), was first discovered in 1997 in psoriatic skin lesions as a retinoic acid-sensitive gene. It was later determined that chemerin regulates adipogenesis and adipocyte metabolism, with data showing that it alters adipocyte differentiation, expression of important genes in glucose and lipid metabolism, and is classified as a new adipokine. The effects of chemerin in circulating and inflammatory fluids are mediated through receptor G protein-bound receptor chemokine-like receptor 1 (CMKLR1). The increase in the number of clinical trials associated with increased levels of local and / or circulating chemerin in various diseases, from obesity, metabolic syndrome (MetS), type 2 diabetes mellitus (T2DM), polycystic ovarian syndrome (PCOS) to inflammatory diseases, supports the important roles of chemerin in the pathogenesis of these diseases. Although it is clear that serum chemerin levels increase in these diseases, the mechanisms regulating the expression of the chemerin are not fully understood. More randomized controlled studies are needed to understand the mechanisms of action of chemerin.

Wilm’s tumor, the most common childhood renal cancer, is a heterogeneous renal tumor in which diffuse anaplastic or negative histology represents poor prognosis. In Wilm’s tumor pathogenesis, a large number of factors remain uncertain. For this reason, the disease continues to be the focus of further research. MicroRNAs are small, protein-encoding RNA molecules that regulate gene expression at post-transcriptional stage. The role of microRNAs in cancer onset and progression has been demonstrated in most solid cancers. MicroRNAs also have a diagnostic potential, and microRNA-targeted treatment is a candidate for an important role in cancer treatment. In Wilm’s tumor, dysregulation of certain key oncogenic or tumor suppressor microRNAs, such as miR-17 ~ 92 cluster, miR-185, miR-204, and miR-483 has been documented. In this study, we will summarize the current evidence about the role of dysregulated microRNAs in the development of the Wilm’s tumor. The possible effects of MicroRNAs on the clinical diagnosis and prognosis of the Wilm’s tumor will also be discussed. Thus, an overview of the future place of microRNAs in the implementation of new treatment options will be presented.

Postburn contractures in the upper extremities limit the function of the hand and arm. A 25-year-old female patient was admitted to our outpatient clinic for contracture of the left wrist since the age of three. On examination, the patient had an extension contracture of approximately 120 degrees in the left wrist. The patient's contracture was opened with an incision and the defect was closed with an abdominal flap. We think that abdominal flap is a good alternative for the treatment of postburn contractures.

Sneddon syndrome(SS) is a rare, progressive vasculopathy with recurrent ischemic attacks. There is no specified treatment recommendation, various treatment methods such as anticoagulants, antiaggregants, and immunosuppressions are recommended. A 44-years-old woman who applied with a temporary numbness on her right side and speech disorder. In her neurological examination, there was central facial asymmetry on the right and mild dysarthria in his speech. In cranial diffusion MR, there was an acute ischemic change in the left lentiform nucleus and at the head of the caudate nucleus. In cranial MR, there were perivascular ischemic gliotic changes and diffuse cerebral cortical atrophy. The patient underwent a skin biopsy to have livedo reticularis-like lesions on both legs. Skin biopsy was compatible with vasculopathy. Due to the ischemic attack, periventricular ischemic changes, and livedoreticularis, the patient was accepted as SS. Since the antiphospholipid antibodies (APL) were negative, that she was followed up with dual antiplatelet therapy. There was no new attack within a year with dual therapy. Dual antiplatelet therapy may be used in SS patients with recurrent ischemic events and negative APL.