Makale Arama

Objectives:

Customer satisfaction surveys are a routine device used to assess performance. Surveys are used in hospitals to check physician and patient satisfaction. Hamad Medical corporation’s (HMC) histopathology laboratory is College of American pathologists (CAP) accredited with highly trained pathologists and technical staff that routinely undertake various educational courses and are involved in research related activities. The lab has state of the art staining and immunohistochemistry service as well. However, it was felt that not all clinicians are very comfortable approaching pathologists and some many times experience problems either contacting lab staff or updating histopathology orders. Hence to narrow down the problems encountered by the clinicians and improve the specimen flow through the lab along with the communication between clinician and pathologist, that we deem vital, we designed this pilot survey.

Methods:

The survey questionnaire was made online with 15 questions in total and the link was electronically mailed to all Consultant and Specialist physicians in Hamad medical corporation (HMC). Around 3500 emails were sent out but only 105 surveys were filled in two months’ time. The survey included questions pertaining to multiple facets of quality of histopathology services and information regarding the participant.

Results:

The overall satisfaction was highest for Multidisciplinary presentations (96%) and lowest (77%) for timeliness of reporting. The satisfaction was above 90% for clarity and format, Diagnostic accuracy and pathologists’ responsiveness to problems. Thirty six percent of the people rated MDT presentations as excellent while 46% of the people thought overall quality of professional interaction was good. The areas of improvement, as per this survey, was timeliness of reporting and notifications of significant abnormal results (overall satisfaction 79%). Majority of the people who took the survey (36%) were from internal medicine and half were members of multidisciplinary meetings (49%). Seventy-one of percent of the participants were from Hamad General hospital (HGH), while rest were from the other hospitals under HMC.

Conclusion:

The response rate for the survey was low, hence another survey with a wider reach, preferably by paper, is required to get more representative data. In general, the clinicians at HGH are satisfied with the services provided by the histopathology laboratory. Areas of improvement include Turnaround time (TAT), avoidance of descriptive reports and better communication with the ordering clinician.

Keywords:

Quality control, quality improvement, survey, histopathology, Laboratory

Aim: The clinical course of COVID-19 cases and the severity of symptoms vary according to the case.
However, it has been seen in the cases examined that it poses a greater risk for those with chronic
diseases and elderly individuals. In order to protect elderly individuals from COVID-19, governments
have introduced some restrictions. It is thought that the wrong evaluation of these restrictions may lead
to attitudes of ageism. This study aimed to determine the relationship between society's fear of COVID-19
and attitudes towards ageism.
Patients and Methods: This work is designed in descriptive type. This study was conducted with
volunteers between the ages of 18-65 683 people. The data of the study were collected using the Fraboni
Scale of Ageism and COVID-19 Fear Scale. Data were collected on 1-20 Jun e 2020.
Results: The mean Fraboni Scale of Ageism and COVID-19 Fear Scale scores were 67.87±6.15 and
18.81±6.16, respectively. The results showed a weak and negative correlation between COVID19 fear
and ageism.
Conclusion: In general, individuals had a positive attitude towards the elderly and had low levels of
COVID-19 fear.

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.

Aim: Small cell lung cancer (SCLC) is associated with an aggressive course and short survival. Conventional chemotherapy (CT) is the mainstay of SCLC treatment. However, the majority of information on chemotherapy (CT), as well as information on demographic data of patients, is based on studies from several decades ago. In this study, we aimed to determine the current demographic and clinical characteristics of patients with SCLC and to determine their responses to the treatments.

Patients and methods: This was a retrospective, cross-sectional, cohort study. Definitions of survival were overall survival (TOS) and survival after metastasis (MOS). TOS was calculated as the time from the diagnosis to the date of death or last visit. MOS was calculated as the time from the diagnosis of metastasis to the date of death or last visit.

Results: The data of 161 patients were analyzed. Response rates obtained with 1st line CT, 2nd line CT, and 3rd line CT were 72.2%, 43.3%, and 40.4%, respectively. The median TOS and median MOS were calculated as 15.7 months (0.03-106.97) and 13.79 months (0.03-79.54), respectively. Although they were metastatic, ten patients had never received first-line CT, and the median MOS was 1.88 months and 14.62 months, respectively, in those who did not receive CT and received CT. Twenty-one (18.9%) of the 111 patients who needed second-line treatment did not receive CT, and the median MOS was 8.39 months and 18.45 months, respectively, in those who did not receive CT and received CT. Eighteen of the 65 patients (27.7%) who required the third-line treatment did not receive CT, and the median MOS was found to be 15.36 months and 23.86 months, respectively, in those who did not receive CT and received CT. The presence of metastatic disease at the time of diagnosis and refusal of treatment were statistically significant parameters affecting the median TOS. And, poor performance status and refusal of treatment were statistically significant parameters parameters affecting the median MOS.

Conclusions: In this study, it was confirmed that early diagnosis of SCLC was associated with a survival advantage. It was shown that the patients who received and were able to tolerate the treatment had obtained a survival advantage, regardless of the disease phase.

Background

Hypertension (HT) is a controllable and preventable public health problem that is a risk factor for many serious diseases, especially cardiovascular diseases. Hypertension, which can be silent and lethal, can not be diagnosed in many people. HT constitutes a significant part of the daily practice of the primary care physician. Today, the Family Medicine is a medical discipline constitutes the first level of the health system in Turkey.

Aim

In our study, the effectiveness of family medicine practice in the diagnosis of arterial hypertension was investigated.

Material and Method

We retrospectively reviewed the data of the patients aged 18 years and older who had access to their data in our family medicine department between 2017-2018. A total of seven questions, including personal information (age, gender and education level) and disease identification information (how many years were diagnosed with hypertension, baseline symptom, where and how the diagnosis of hypertension was first established) were retrospectively reviewed from the Family Medicine Information System.

Results

A total of 286 patients, 178 female and 108 male were detected. 9% of the participants were illiterate while 94.1% were literate . 59.8% of the illiterate patients were in primary education, 10.5% in high school and 16.8% in graduate education. 7.7% of the participants were diagnosed in the family medicine polyclinic, and the remaining 92.3% were diagnosed in secondary health care facilities and other places except family medicine. According to education level, 7.7% were diagnosed in family medicine and 92.3% were diagnosed in second-level health facilities and elsewhere except family medicine.

Conclusion

In our study; patients with arterial hypertension were diagnosed more frequently in secondary health care institutions regardless of their education level. Although the rate of diagnosis of arterial hypertension was increased from 1.5% to 16.3% in primary care after starting the practice of family medicine in Konya, we believe that the role of family medicine practice on the diagnosis of arterial hypertension should be increased even more.

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.

\r\n Synesthesia is a phenomenon in which stimulation of one sensory system leads to a different experience in a second sensory system. There is more than sixty types of Synesthesia, like grapheme-color, sound-color (chromesthesia), sound-movement, sound-flavor, color- flavor etc. have been identified so far. Synesthesia is seen in 4% in general population. The grapheme-color and sound-color Synesthesia are the most common types. A case is discussed that has auditory-visual and smell-color types Synesthesia started at 6 yo but currently she has had fewer symptoms than before. An active psychiatric pathology is not found in clinical evaluation.  There is neither significant patient history nor family history for psychiatric disorders other than a younger sister who has similar symptoms. She has not experienced any seizures or trauma. Her MRI and EEG were within normal limits. Functional MR imaging showed greater activation in the cerebral hemisphere that indicate lateralization. Since there is a positive familial history, we might consider genetic predispositions.

Bronchogenic cysts (BC) are rare congenital malformations arising during the development of the ventral foregut. Bronchogenic cysts form as a result of abnormal budding of the bronchial tree during embryogenesis (between 4th-6th weeks). Most bronchogenic cysts originate in the mediastinum, while 15% to 20% occur in the lung parenchyma. According to the literature, most intrapulmonary cysts occur in the lower lobes. But bronchogenic cysts are commonly found in the middle and superior mediastinum. The bronchogenic cyst in our patient was subcarinal. It was striking in terms of its giant size and laying on two hemithoraxes.The bronchogenic cysts are usually asymptomatic and often diagnosed incidentally during routine chest roentgenogram for other reasons.They may not be detected until adulthood. Our patient was 56 years old. She had no obvious symptoms . The patient was referred to our clinic because of cough,and her bronchogenic cyst was determined. Basic treatment of bronchogenic cyst consists of surgical excision. However, in cases where resection cannot be performed, the epithelium should be peeled as in our case.

Erector spinae plane block (ESPB), one of the popular regional anesthesia techniques in recent years, has first been used for upper thoracic neuropathic pain. Later, it has been used in many different indications for both acute and chronic pain treatment at different lower thoracic and lumbar levels. Our limited experience demonstrates that bilevel bilateral sacral ESPB is an easy and effective method in the treatment of perianal chronic intermittent pain. However, many issues, such as the application site, the volume of local anesthetics and the sensory blockade, still remain being investigated. Due to the lack of clinical research, our review is currently unable to support the evidence and routine use of sacral ESPB. We consider that anatomical radiological and  clinical studies are needed to elucidate the efficacy and mechanism of action of sacral ESPB

Aim

The decision to start treatment in sarcoidosis is made based on clinical and radiological findings and changes in pulmonary function test findings during follow-up, and more useful tools are needed in treatment management. F-18 fluorodeoxyglucose (18F-FDG) positron required important tomography / computed tomography (PET/CT) contains important information about the extent of sarcoidosis. On the other hand, the neutrophil/lymphocyte ratio (NLR) opens as a good prognostic marker for tissue-related inflammation. This study evaluated the relationship between the 18F-FDG PET/CT findings of sarcoidosis and NLR and other clinical findings.

Material and methods

The data of the patient who was diagnosed with sarcoidosis after 18F-FDG PET/CT examination in our clinic were retrospectively reviewed. Patients' age, gender, NLR values, smoking status, extrathoracic involvement and symptoms, and 18F-FDG PET/CT findings were compared.

Results

This study consisted of 41 patients. There was a strong correlation between NLR and whole body total lesion glycolysis (TLG), and moderate correlation between  MAIA and NLR (r values: 0.852, 0.660, both of them p value: <0.001, respectively). There was a significant difference between the groups showing only thoracic involvement and additional extrathoracic involvement with MAIA, TLG and NLR values (p values,: 0.002, 0.001 and, 0.003, respectively). In the classification made according to the symptoms of the patients, there was no significant difference between the groups with SUVmax, MAIA, TLG and NLR values. Median values were found to be significantly higher in the elderly group (p values: 0.037 and 0.040, respectively). In the classification made according to gender; there was no significant difference in both PET/CT parameters and NLR values.

Conclusion

The close relationship between the NLR value, which is accepted as a prognostic indicator in sarcoidosis, and the 18F-FDG PET / CT findings which show the involvement of the disease in the whole body, may provide the clinician with significant benefits in treatment management.

ABSTRACT

Objective: The aim of this study was to investigate the effects of kinesiological banding on symptoms in carpal tunnel syndrome associated with pregnancy.

Materials and Methods: Patients who were admitted to the Physical Therapy and Rehabilitation Clinic due to carpal tunnel syndrome and who were diagnosed with carpal tunnel syndrome by electromyography and who were able to reach the visuel analog score, Short Form-36, Boston Carpal Tunnel Questionnaire and Pittsburgh Sleep Quality Index values were included in the study.

Results: In both groups, there was a significantly difference between the first visuel analog score day-night and the last visuel analog score day-night and first and last Pittsburgh Sleep Quality Index (p<0,05). While there was a significantly improvement in the Boston Symptom Severity Scale, there was no significantly difference in Boston Functional Capacity Scale. In the comparison between the groups, visuel analog score day, Short Form-36 pain parameter and decrease in Boston Symptom Severity Scale were found statistically significant.

Conclusions: In our study, although the superiority of kinesiological banding on hand-wrist rest splint could not be clearly shown, decreased pain and symptoms and an increase in sleep quality were observed.The kinesiological banding should be in mind in patients who have no response to resting splint because of low treatment options during pregnancy.

Backround: Myocardial infarction with coronary artery disease (MICAD) is the leading cause of myocardial injury. Myocardial injury non-related to atherosclerotic plaque disruption (non-MICAD) is a rare and heterogeneous diagnosis. Although MICAD is well studied, non-MICAD was not thoroughly identified in young patient population. We aimed to investigate the frequency, main etiologies, and five-year mortality of patients with non-MICAD younger than 40 years.

Methods: We retrospectively enrolled 292 patients with acute myocardial injury younger than 40 years between January 2010 and December 2014. Clinical, demographic, laboratory, angiographic features, and five-year all-cause mortality were compared between patients with non-MICAD (n=78) and MICAD (n=214).

Results: Median age of patients was 36. Non-MICAD group was younger than MICAD group [32 (28-37) vs 37 (34-39)]. The frequency of female patients with non-MICAD was higher than those with MICAD (24.4% vs 10.3%). Most of the patients with MICAD presented with STEMI (77.1%), while most of the patients with non-MICAD presented with non-STEMI (89.7%). Most common etiologies of non-MICAD in were myocarditis (32%) and vasospasm (9%). Age, female sex, no smoking and, absence of dyslipidemia were independent predictors for non-MICAD. Five-year all-cause mortality in non-MICAD group was significantly lower than MICAD group (2.6% vs 10.3%) (log-rank test p=0.04).

Conclusion: Non-MICAD represents a heterogeneous group of patients who had varying etiologies at different ages. Despite the lower mortality rate of non-MICAD group, different diagnostic and treatment strategies are required for management of patients with non-MICAD.

Objective: Epistaxis is a common condition in the childhood age group. However, it is important to diagnose the underlying bleeding disorders in children presenting with this complaint. Simple methods to be used in primary health care are needed to determine whether patients have bleeding disorders.

This study aims to evaluate patients presenting with epistaxis with the bleeding questionnaire and determine the diagnostic value of patients with symptomatic but normal hemostatic tests.

Methods: Seventy-seven children with epistaxis were included in the study group and 20 healthy children in the control group. Pediatric Bleeding Questionnaire (PBQ) was used for evaluation.

Results: In our study, 19.4% (n = 15) of the patients were diagnosed with bleeding diathesis (vWh: 10, rare factor deficiency: 5). The mean age at presentation was 8.99 ± 3.42 (3-17) years. Thirty-seven (48%) were girls and 40 were boys. In terms of PBQ epistaxis score, there was no statistically significant difference between those with and without bleeding diathesis. However, the overall score was not statistically different; it was higher in the group with bleeding diathesis. The cutaneous bleeding score was higher in the group with bleeding diathesis and there was a statistically significant difference.

 Conclusions: This study showed that bleeding scores can be used in patients with epistaxis who apply to primary health care institutions and patients with high overall scores and cutaneous bleeding scores should be directed to the hematologist for further research.Keywords: Epistaxis, bleeding diathesis, bleeding score

 Moyamoya disease is an entity, which is caused by obstruction or stenosis in the area between the internal carotid artery, and anterior and middle cerebral arteries, identified angiographically, and does not have an exactly known etiology. The most frequent symptoms of onset are hemorrhage in adults and ischemia in children. In this paper, we present a case of Moyamoya disease which was diagnosed with a 21 year old male patient who was admitted to our emergency department with headache, nausea vomiting and left hemiparasi complaints and whose radiological findings showed right basal ganglia hemorrhage.

\r\n Tubal torsion is a very rare case, especially in pregnancy. We present a case of a patient of 24 weeks gestation that was admitted to our clinic with acute abdomen. Radiological and biochemical investigations did not reveal the cause of abdominal pain which resulted in laparatomic exploration. During the operation, the Morgagni cyst, previously explored by ultrasonographic examination, and the right fallopian tube were found twisted among themselves. Cystectomy and detorsion was performed of the Morgagni cyst and the fallopian tube, respectively.  

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The disease was first described by Scheuermann as the dorsal kyphosis of juveniles in 1920. Scheuermann's disease is the most common cause of thoracic hyperkyphosis in adolescence. There are two sub-types: thoracic and thoracolumbar / lumbar. Histologically, when the irregularities in the vertebral end plates are examined, collagen fibrils are seen to decrease or vanish. As a result, end-plate continuity deteriorates and Schmorl nodules appear when the disc material protrudes into the corpus. Deformations cause wedging in the vertebral corpus, resulting in narrow angled kyphotic deformity. In the large series, the prevalence is up to 8%, and the genetic transition and mechanical stress come into prominence in the epidemiology of the disease. Pain can be accompanied by deformity in symptomatic state. Classical radiological features include irregular vertebral endplates and kyphosis more than 45 degrees with 5 degrees of wedging in 3 or more vertebrae. In some cases, minimal scoliosis may accompany to kyphosis. Periodic radiologic follow-up is recommended for patients below 50 degrees of kyphosis. Bracing is appropriate in uncompleted skeletal maturation with kyphosis up to 75 degrees. In cases above 75 degrees, it is appropriate to perform surgical treatment when bracing is unsuccessful in adolescence and presence of exceeding pain despite the conventional methods and obvious deformity in adults. 

Iron is a medication that is used more in iron deficiency anemia. The use of iron in high doses can cause a multisystemic effect. The toxicity of iron depends upon the amount of elemental iron ingested. The minimum toxic dose and the lethal doses of iron are not firmly established. However, side effects that may be life-threatening are seen on the heart and liver. This paper presents a 16-year-old patient who used 720 mg; 12mg / kg / dose preparation of iron for suicide purposes. The control blood tests performed while planning the discharge of the patient, who had no complaints but were followed up clinically, continued to be followed up because of the increase in the value of troponin. The patient who has no record of physical examination, electrocardiogram (ECG), echocardiography (ECO) and indication for iron chelation and in whose troponin level a decrease was diagnosed in the monitoring was discharged with recommendations. Due to the rare occurrence of cardiac involvement and being the first case reported in our country, the effects of the drug on toxicity were discussed in the light of the literature.

Chronic mesenteric ischemia is a rare disease caused by intestinal perfusion disorder. Increased abdominal pain after meals, loss of appetite, weight loss, such as the symptoms of the course. The patient was presented with intestinal ischemia, arterial dorsalis pedis obstruction, celiac artery and superior mesenteric artery involvement. The coexistence of all these lesions in a 35-year-old female patient was interesting because of its rarity. In this study, we wanted to share the surgical treatment of a young patient who was not suitable for endovascular treatment and underwent saphenous vein and aorta-hepatic bypass due to multiple lesions.

Aim: In the present study, the aim is to determine whether centromere protein H (CENPH) gene expression levels change in prostate carcinoma (PCa).
Materials and Methods: Prostate tissue sample of 40 patients with primary prostate cancer was used in the study. Hence, transcriptional analysis of the CENPH gene was conducted in the total paraffin embedded prostate tissues extracted from patients diagnosed with prostate cancer. The expression analyses were obtained from the comparison of the expressions within the tumoral and non-tumoral areas in the prostate tissue of the same patient.
Results: Separate RNA isolation was performed. Subsequent qRT-PCR analyzes were repeated three times and quality controls of the Ct values were performed on the obtained data. The Ct values of the expression of the housekeeping gene GAPDH and the target gene CENPH gene were compared in tissue (tumor and normal) and technical repeat groups. There was no statistically significant difference in CENPH gene expression between tumor and normal tissue specimens in prostate cancer. Moreover, on investigating the causes of death, in none of the patients PCa related death was determined. 
Conclusion: In our study, we could not find any relationship with prostate cancer tumorogenesis in CENPH gene expression anomalies. However, some cancers (non-small cell lung cancer, colon cancer, etc) with high CENPH gene expression are associated with tumor aggressiveness, poor prognosis and drugresistance. More studies are needed on CENPH gene expression and its effect on prostate cancer.

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\r\n Aim : In this study, it was aimed to determine burnout, occupational satisfaction, depression symptom levels and sociodemographic characteristics affecting health personnel working in the operating room.

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\r\n Patients and Methods:The sample of the study consisted of a total of 230 people, including an anesthesiologist, a surgical nurse and an anesthesia technician working in the Erzurum Regional Training and Research Hospital and Atatürk University Medical Faculty Hospital. In the study, the Sociodemographic Data Form, Maslach Burnout Inventory , Minnesota Satisfaction Scale  and Beck Depression Inventory were requested from participants

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\r\n Results:Emotional Exhaustion , Desensitization  and Beck Depression Inventory  scores were significantly higher and Personal Achievement scores were lower in operating room personnel working more than 60 hours a week (p <0.05). Desensitization scores were found to be significantly higher (p <0.05). Doctors' Emotional Exhaustion   and Desensitization scores were high. (p <0.05). There was a significant negative correlation between the Beck Depression Inventory  and the Minnesota Satisfaction Scale  and Personal Achievement scale scores of the employees; There was a significant positive correlation between the mean scores of the Emotional Exhaustion   and Desensitization subscales (p <0.05)

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\r\n Conclusion:The operating room, which is a unit under intensive work pressure that requires effective, accurate and rapid intervention, will be useful in evaluating the mental health and working conditions of employees, reducing the work pressure and burden of employees and increasing the quality of service by increasing mental health and functioning.

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Myotonic dystrophy is the most common muscular dystrophy of adulthood. Neurological manifestation of the disease is typical, however diagnosis could be challenge in patients presentig with predominant cardiac or systemic symptoms. 46 year old male was suffering from presyncope attacks for 16 years, and first examined by a cardiologist. Because of the recent complaints including walking difficulty, he was referred to neurology department. Following a detailed neurological examination and electrodiagnostic workup, he was finally diagnosed myotonic dystrophy type 1. The case highlights the necessitiy of neurological consultation in patients who present with conduction defects, arythmias or cardiomyopathies of unknown origin, accompanied by overt or subtle neurological symptoms. In such patients, neuromuscular disorders should be considered in the differential diagnosis; and in order to provide thorough diagnostic evaluation, multidisciplinary approach is essential.

Aim: In childhood, infectious mononucleosis cases caused by Epstein-Barr virus (EBV) are seen with high frequency. The signs and symptoms of acute EBV infection can manifest with different clinical pictures. Care should be taken in differential diagnosis for correct treatment. In our study, it was aimed to examine the clinical presentation of acute EBV infections by age and high-risk age groups among children.

Patients and Methods: A total of 337 pediatric patients with infectious mononucleosis who applied to our tertiary hospital in 2013-2020 were included in the study. EBV VCA IgM and IgG antibodies were studied by ELISA method (quantitative microplate ELISA, Euroimmun®, Germany) in accordance with company recommendations. Patient information and results were evaluated retrospectively.

Results: The mean age of the patients was 5.1 ± 3.4 years. 22.8% of the patients were in the group of 0-2, 43.0% of them were 3-5, 29.7% of them were 6-12, and 4.5% of them were 12 years old and above. The most common signs or symptoms in children diagnosed with acute EBV infection were lymphadenopathy (59.6%), lymphocytosis (45.1%), fever (40.9%), swelling in the throat (39.2%) and pharyngitis (30.0%). Fever complaints were significantly higher between the ages of 3-5 compared to other age groups. The seasonal distribution of the cases was similar. It was determined that the cases increased over the years and the most cases were seen in 2019 (23.4%). It was observed that the time between the start of complaints and the application to the hospital increased directly proportional to age groups.

Conclusion: In our study, it was concluded that there was no difference in acute EBV infection in childhood age groups in terms of signs and symptoms, and the number of cases increased slightly over the years, especially in children with lymphadenopathy, splenomegaly and hepatomegaly.

Background: Tyrosine rich crystals (TC) are curious structures, rarely encountered at histopathology, more so at cytology. These crystals have been documented exceptionally in various non-neoplastic and neoplastic lesions of salivary gland, lacrimal gland and rarely in larynx. The finding of these crystals in nasolabial cyst has not been reported till date.

Case: A 35-year-old female with a clinical and radiologic diagnosis of nasolabial cyst underwent fine needle aspiration cytology (FNAC). Tyrosine crystals in singles and in groups assuming ‘petaloid’ and ‘daisy head’ forms were noted along with few lymphocytes and histiocytes. Amylase crystals were also noted.

Conclusion:  Regardless of the precise cause, cytologic recognition of TC is important to avoid confusion. Identification of these crystals at FNAC is a matter of avid observation and encourages cytopathologist for meticulous examination of all fluids. The case also highlights that the occurrence of TC is not restricted to SG and the circumstances in which it occurs is diversified.

 Fourty one years old female and 64 years old man were admitted to our clinic  because of abdominal pain. In investigating the liver was reported with a giant hemangioma. It was symptomatic and look like malignancy for each cases so they were operated. In operation it was not a liver mass , one of them observed right giant adrenal adenoma and the second one is renal cell carsinoma.  Resection was performed for each cases. Adrenal mass could be noted that mixed hemangiomas.

ANTEGRAD URETERAL STENTING; INDICATIONS - METHODS - COMPLICATIONS AND RADIOLOGICAL APPROACH TO  COMPLICATIONS

Abstract:

Objectives

The aim of this study is to evaluate the indications, success rate, complications, technical success enhancing method, methods of antegrad ureteral stenting and the radiological management of complications due to retrograde and antegrade ureteral stenting in the treatment of ureteral obstructions and ureteral leaks caused by malignant and benign etiologies.

Materials and Methods

In this retrospective study, fluoroscopy and US-guided antegrade ureteral stenting procedures between January 2016 and December 2018 were examined. The study included 110 antegrade ureteral stenting and percutaneous nephrostomy in a total of 78 patients with 25 female patients (32.05 %), a mean age of 65.87 (20-90) and 53 male patients (67.94%) with a mean age of 68.73 (30-90).  Demographic data, antegrade ureteral stenting indications, procedure results and complications were evaluated for each patient.

Results

Antegrade ureteral stenting is a good alternative for patients with retrograde ureteral stent placement and already with percutaneous nephrostomy catheters. It has a high technical success rate and low complication risk. The use of the equipment used in other radiological procedures in antegrade ureteral stenting increases the technical success. Malposition,  perforation, hemorrhage, urinoma, abscess complications such as retrograde or antegrade ureteral stenting can be managed by radiological methods.

Key Words: Double J Ureteral stent, Ureteral obstruction, Percutaneous, Antegrade, Hydronephrosis,

Aim: Investigate the role of Magnetic Resonance Imaging (MRI) in the evaluation of response of the locally
advanced rectal cancer to the chemoradiotheraphy (CR T).
Patients and Methods: T2-weighted and Diffusion Weighted Imaging (DWI) of 24 cases with locally advanced
rectal cancer who have undergone total mesorectal excision 6-8 weeks following the CRT between 2015 and
2020 were evaluated retrospectively. The evaluated radiological parameters were as follows; Tumor morphology,
localization, length, mrT/mrN stages, and extramural vascular invasion (EMVI). Post-CRT MRI residue scoring
was performed (0: No residual tumor, 1: No significant residual tumor, fibrotic wall thickening, 2: Residual tumor
present). Regression grading was as follows; 1: No tumor, 2: Good response, mostly fibrosis, 3: Fibrosis and
mucin more than 50%, 4: Slight response, 5: No response.
Results: There was a significant decrease in the craniocaudal length of tumor and a significant increase
in the mean ADC of tumor after CRT (p=0.001). A significant and high correlation was observed between
histopathological T (pT) and post-CRT mrT (r=0.54, p=0.006). There was a significant correlation between pre-
CRT EMVI and perineural invasion (PNI) (r=0.53, p=0.008). A significant correlation was found between residue
scoring and regression grading (r=0.6; p=0.001), pT (r=0.48; p=0.02), and tumor length (r:0.51; p=0.01). There
was a significant correlation between regression grading and EMVI (r=0.43, p=0.036), PNI (r=0.46, p=0.02), pT
(r=0.41; p=0.048), pN (r=0.55; p=0.006), and metastatic/total lymph node ratio (r=0.46; p=0.02).
Conclusion: Post-CRT MRI is highly correlated with postoperative pathological evaluation of the locally
advanced rectal cancer. MRI is highly successful in re-staging as well as primary staging. The evaluation of
treatment response by MRI regression grading may contribute to the surgical planning.

Aim: It is important to identify allergens in reducing disease-related symptoms and improving quality of life in the allergic diseases. Therefore, we aimed to evaluate the frequency of aeroallergens in allergic patients in our region.

Method: 1078 patients (2-18 years) who applied to the pediatric allergy immunology outpatient clinic between September 2017- March 2018 were included to the study. The demographic and clinical characteristics of 642 patients with at least one allergic sensitization in the skin prick test were evaluated retrospectively. Total IgE levels, peripheral eosinophil counts in the blood, aeroallergen sensitivities in skin prick test were evaulated from the patient’s files. The study was approved by the Ethics Committee of the Alanya Alaaddin Keykubat Medical Faculty.

Results: In 642 of the patients (59.5%), a positive response was observed against at least one aeroallergen. Among patients, 34.8% had asthma, 73.7% had allergic rhinitis, 12.6% had atopic dermatitis, and 3% had chronic urticaria. 24.8% of the patients (159) had more than one allergic disease. When the evaulation of the patients with positive skin prick test, 57.3% were male and 42.7% were female. The mean age was 8.49 +/- 4.15 years. The sensitivity of house dust mites was the most common (76.1%). In the second and third frequency, molds (51.8% Alternaria alternata, 41.7% Claudosporum herbarum) and grass and cereal pollen (39.8%) sensitivity were observed. Other determined aeroallergen sensitivity frequencies were; weed pollen mixture (24.6%), trees pollen mixture (21.7%), cockroach (17.8%), cat hair (31.2%), olive tree (20%). The mean serum total IgE level was 215.6 IU/ml and the mean eosinophil count was 410.63/mm³.

Conclusion: Detection of responsible allergens is important to control symptoms and to give the chance the course of the disease with immunotherapy in the selected cases.

Aim: Psychological dependence and smoking desire are as important as physical dependence on smoking.
The aim of this study is to evaluate the effects of the addiction levels and smoking urge of people who want
to quit smoking on their success.
Patients and Methods: This study, which is a cross-sectional analytical study, was conducted people who
applied to a smoking cessation clinic between 10 January 2020 - 30 April 2020. Sociodemographic information
form, the Fagerström Nicotine Dependence Test (FNDT) and the Test for the Assessment of the Psychological
Addiction of Smoking (APAS) were applied and CO levels were measured. Motivational interviews were made
and treatments were arranged if necessary. The Carbon monoxide (CO) levels of the patients who were called
for control one month later were measured and the Questionnaire of Smoking Urges (QSU) was applied.
Those with a CO level of 5 ppm and above were considered to be unable to quit smoking.
Results: The average age of 176 patients participating in the study was 37.68±11.89 years and 81.3% were
male. The mean of cigarette consumption per pack was 23.42±16.06, the average FNDT was 6.13±2.39
and the CO was 13.33±6.31 ppm. APAS scale mean score was 15.19±2.63 points. According to the FNDT
score, 41.5% of the patients were highly dependent, and 6.8% according to the APAS score were severely
dependent. Control CO level of the patients who came for control one month later was found to be 5.03±3.03
ppm. Accordingly, 67.6% of the patients could not quit smoking, and the mean QSU score was 33.56±15.71.
FNDT, APAS and QSU scale mean scores of those who quit smoking were statistically significantly lower than
those who did not quit smoking (p=0.015, p<0.001 and p=0.025, respectively).
Conclusion: Those who are high psychological dependence to smoking have low success to quitting smoking.
Psychological addiction such as nicotine addiction of those who apply to smoking cessation clinics should be
evaluated and ways of coping with smoking desire should be expl ained during motivational interviews.

Aim: Although hepatitis C virus (HCV) is essentially hepatopathic, there are many extra-hepatic symptoms that may develop with associated HCV infection. Of these, dermatological findings constitute a significant proportion of extra-hepatic symptoms. The aim of this study was to evaluate dermatological diseases accompanying to chronic HCV infection in our region. 
Patients and Methods: From a total of 2050 patients diagnosed and followed up for chronic HCV infection in the Infectious Diseases and Clinical Microbiology Clinics in a 12-years period between 2008 and 2020, 394 determined with concurrent dermatological disease were included in the study. 
Results: Chronic HCV patients diagnosed with dermatological disease comprised 218 (%58.6) females and 176 (%41.4) males with a mean age of 56±17 years. In the patients with chronic HCV infection presenting at the dermatology outpatient clinic, pruritus was determined most (%18.5) and followed by contact dermatitis (%17.5). At univariate analyses female gender (p:0,005, OR:3,329, CI 95% [1,439-7,701]) and advanced age (p:0,013, OR:1,029, CI 95% [1,006-1,052]) were detected as significant variables of frequent dermatological diseases. The female gender ( p: 0,038, OR:2,682, CI 95% [1,054-6,826]) was detected as the predictor of most frequent dermatological diagnoses in chronic HCV infection at multivariate logistic regression analysis. 
Conclusion: The most common reasons for presentation of patients with HCV infection at the dermatology outpatient clinic were determined to be pruritus and contact dermatitis. The frequency and variability of the diagnoses seen in chronic hepatitis C patients after presentation at the dermatology outpatient clinic suggest the need for further studies in this area with more standardised patient groups using standard laboratory techniques.
 

Foreign body aspiration (FBA) is a serious problem especially in pediatric age group. Delay in diagnosis and intervention can lead to a life-threatening condition. Young children are more concerned with the environment and neuromuscular mechanisms do not develop sufficiently. Factors such as lack of molar teeth and failure to perform chewing are the main causes of high FBA in children under 3 years of age. It is of vital importance that the patient is referred to a hospital where a rigid bronchoscopy can be performed quickly after the diagnosis. We retrospectively evaluated 47 patients who were treated in our clinic such as clinical symptoms, age, gender, foreign body (FB), location, positive radiological findings, and duration of stay.

47 patients; 29 male (63%), 18 female (37%), age ranging from 3 months to 8 years. The age of the 37 patients (80%) was below the age of 3 years. The main complaint at the time of admission was cough (80%) in 37 patients, wheezing in 23 patients (50%), shortness of breath in 15 patients (32.6%), infection in 5 patients (10.8%), high in 2 patients. there was fever (4.3%). In 37 patients (78%), the foreign body was of organic origin (such as inside or outside the shell, peanuts, hazelnut pieces) while in 10 patients (22%), an inorganic foreign object was found (such as a pen tip, a toy part, plastic parts, etc.). FB was located in the right main bronchus in 18 patients (39%), in the left main bronchus in 25 patients (51%) and in the trachea in 4 patients (8.7). There were no radiological findings in 18 patients (39%). Although 11 patients (23.9%) were anamnesis, their findings were normal. Twenty-three patients applied to our clinic within the first 24 hours after the event, and 24 patients were admitted to our clinic 24 hours after the event.

Although the results were generally consistent with the literature, the left main bronchus was 51% in terms of the localization of FB.

Context: Alcohol dependence syndrome is a major problem affecting both individuals and their family. Children of alcohol dependent parents are vulnerable to a host of behavioural problems. Studies in the west have shown both internalizing and externalizing symptoms in these chi