Northern Clinics of Istanbul最新文献

Laparoscopic sleeve gastrectomy surgery is a procedure that has become more common in the past 10 years. Situsinversustotalis is an extremely rare condition. SG can be performed safely in SIT patients. However, pre-operative multidisciplinary evaluation is very important. In this article, we present a 25-year-old female patient with a body mass index of 47.6 who had no idea that she had SIT until pre-operative tests revealed it. The patient was discharged on the 3^rd post-operative day without any problem. We would like to emphasize the importance of imaging even if the patient does not have any disease or risk before bariatric surgery. We believe that more studies should be done with SIT and bariatric surgery.

Objective: Our goal in this study is to analyze the correlation between papillary thyroid cancer (PTC) with elevated thyroid-stimulating hormone (TSH) levels and deficiency of vitamin D.

Methods: Patients who underwent thyroidectomy, also with available vitamin D test results preoperatively, were included in the study. The patients were separated into two different categories as having papillary thyroid carcinoma (Group 1), benign diseases (Group 2). According to the TSH (mUI/mL) level and vitamin D values, patients were categorized into four quarters.

Results: Preoperatively, TSH level (mean±SDmUI/mL) was higher in Group 1 (2.04±1.55) compared to Group 2 (1.82±1.94) significantly (p=0.029). Preoperatively, vitamin D levels (mean±SD) were higher in Group 1 (15.88±10.88) than in Group 2 (12.94±10.26) significantly (p=0.011). There was no significant difference between Group 1 and Group 2 according to the vitamin D deficiency (65.5%, 72.8%; respectively (p=0.472)). When categorized with reference to pre-operative vitamin D levels, the proportion of patients in Group 2 and Category 1 was higher significantly (p=0.031).

Conclusion: Although the pre-operative TSH level was significantly higher in papillary thyroid carcinoma than benign thyroid diseases, the categorical distributions of the patients according to the TSH value were similar and the TSH values overlapped. Pre-operative mean vitamin D levels were similar in both PTC and benign thyroid disease groups so PTC was not associated with vitamin D deficiency.

During the coronavirus disease 2019 pandemic, global approach was to isolate populations with quarantine procedures to reduce the spread of this deadly virus until effective treatments are found or vaccines are developed. mRNA-based vaccines became available in the United States in March 2020. The Food and Drug Administration even issued an Emergency Use Authorization for individuals 16 years and older in December 2020. However, these rapid developments have brought along other problems such as possible side effects. As we develop and test a new treatment, it became clear how important side-effect management is. Here, we present a case of cutaneous vasculitis that developed on the fourth day of SARS-CoV-2 mRNA vaccination. The patient was successfully treated with medium-dose methylprednisolone.

Objective: This study aims to investigate inflammatory markers and their relationship with the degree of stenosis in ischemic stroke patients with carotid artery stenosis.

Methods: This retrospective case-control study was conducted with 70 newly diagnosed ischemic stroke patients and 70 age- and gender-matched healthy controls. Laboratory analyses were carried out including serum hemogram, biochemistry profiles, erythrocyte sedimentation rate, and C-reactive protein (CRP). Mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-high-density lipoprotein cholesterol ratio (MHR) values were calculated, and compared between the patients and healthy controls. Patients were divided into two groups according to the degree of arterial carotid stenosis. The degree of carotid stenosis was <50% in Group 1 and it was 50% and above in Group 2.

Results: In the patient group, neutrophil, monocyte, MPV, CRP, sedimentation, MHR, PLR, and NLR levels were significantly higher than the control group. There was no significant correlation between the level of carotid stenosis and inflammatory biomarkers. There was a significant correlation between the presentation NIHSS value and CRP, PLR, and NLR values.

Conclusion: Inflammatory biomarker values were higher in stroke patients with carotid artery stenosis than in healthy individuals. However, they should neither be used to predict the degree of carotid artery stenosis.

Objective: The assay of serum cobalamin (Cbl) level is commonly used to diagnose Cbl deficiency. Unexpectedly, the elevated Cbl levels may be determined in some of the patients and its interpretation is difficult. We investigated the association between elevated Cbl levels and a variety of clinical entities in patients presenting with various neurological symptoms.

Methods: The data were obtained from the patients' electronic medical records in a tertiary hospital affiliated with a university. The pediatric patients with serum Cbl levels above 1000 pg/mL were included in the study. The patients with serum Cbl levels below 900 pg/mL and above 200 pg/mL constituted the control group.

Results: The mean Cbl level of the patients with neurological problems was 1424.2±354.2 pg/mL, whereas the average Cbl level of neurologically healthy was 1316±317.8 pg/mL, and the difference was statistically significant. While the rate of having neurological deficits or symptoms in the study group was found to be 24%, this rate was only 18% in the control group. Unexpectedly, despite elevated Cbl level, the high mean corpuscular volume rate was higher in the study group compared to the control group.

Conclusion: This study highlights the importance of the disorders of Cbl metabolism in patients presenting with various neurological symptoms. In children with neurological deficits, serum Cbl levels should be checked. In case of high Cbl level is determined, patients should be followed up closely, and further investigations should be performed in terms of Cbl metabolism disorders.

Objective: Gastrointestinal stromal tumors (GISTs), often sporadic, arise from interstitial Cajal cells of the gastrointestinal tract or their stem cell-like precursors. Apart from tumor-associated syndromes, it has been reported that GISTs are also associated with other tumors. There is no clear information about the etiology of these synchronous tumors. In this study, we wanted to present the clinicopathological features of 13 cases diagnosed as synchronous GIST with other tumors.

Methods: Demographic characteristics of the cases, risk of progressive disease score, tumor localization, size, and the mitotic activity of tumors along with survival status were evaluated.

Results: Thirteen of 101 cases diagnosed with GIST had a primary tumor synchronous with GIST. Synchronous GISTs were located in the stomach and small intestine. Most of the cases were detected incidentally in the intraoperative and post-operative periods. Risk scores for progressive disease were categorized as low (n=1), very low (n=1), and no risk (n=11). Non-GIST tumors were located in the stomach, transverse colon, left colon, rectum, gallbladder, kidney, and retroperitoneal space. Histological tumor types were adenocarcinoma, diffuse large B-cell lymphoma, mesothelioma, and neuroendocrine tumor. Life expectancy was found to be significantly lower in synchronous GISTs.

Conclusion: In cases operated for non-GIST tumors, the possibility of incidental detection of GIST should always be kept in mind.

Objective: The aim of this study was to contribute to the differential diagnosis of transient pseudohypoaldosteronism (t-PHA).

Methods: Twenty-nine infants, younger than 24 weeks, and with high aldosterone levels were included in the study. The patients were divided into two groups as t-PHA and other diagnoses group. Of 29 patients, 18 were in the t-PHA group and 11 were in other diagnoses group.

Results: The means aldosterone, plasma renin activities (PRA), adrenocorticotropic hormone (ACTH), cortisol, and 17-hydroxyprogesterone (17-OHP) of those with t-PHA were 138±92.8 ng/dL, 8.39±10.57 ng/mL/h, 26.86±19.56 ng/L, 19.44±21.84 μg/dL, and 7.66±10.71 ng/mL, respectively. In other diagnoses group, the mean level of aldosterone, PRA, ACTH, cortisol, and 17-OHP levels was 100.9±70 ng/dL, 5.49±8.41 ng/mL/h, 408.28±491.9 ng/L, 19.99±14.43 μg/dL, and 11.99±12.21 ng/mL, respectively. In the t-PHA group, the number of patients with high PRA was eight (50%), while the number of patients with high levels was two (18.1%) in other diagnoses group. In the t-PHA group, although the average serum K levels were the same in both groups, serum aldosterone/K ratios were higher.

Conclusion: When an infant younger than 24 weeks, with urinary tract infection and/or urinary tract malformation has electrolyte abnormalities, pediatricians should primarily consider the diagnosis of t-PHA. Thus, many unnecessary investigations and inappropriate treatments can be avoided.

Objective: We explored the epidemiological characteristics of suicide attempts and identified suicide trends and associated factors.

Methods: This retrospective, cross-sectional, observational, and single-center study included consecutive 412 patients who were admitted to Emergency Department for follow-up and treatment after a suicide attempt between June 2019 and June 2022. We assessed patient demographics, suicidal behavior, previous suicide attempts, psychiatric disorders, drug use, visits to the psychiatry clinic within the past 6 months, the persistence of suicidal ideation, and clinical outcomes.

Results: The study population consisted of 259 females (62.86%) and 153 males (37.14%), with a mean age of 29.50±11.51 (range: 13-72) years. Females attempted suicide more often than males, but suicide completion was more common in males. Overall, 79.37% (n=327) of the suicide attempters were aged <40 years and most were 20-29 years old (n=147, 35.68%). Non-fatal suicide attempts were more common in single, unemployed, and poorly educated individuals, but this was not the case for suicide completers. However, there was no significant difference in marital status, education, and occupation among suicide completers. Drug poisoning was the major form of suicide attempt (n=345, 83.74%). Mental disorders, family or relationship conflicts, and separation from a partner were common causes of suicidal ideation. Patient numbers were particularly high in the autumn (i.e., September), and at night.

Conclusion: Females, young adults, singletons, the unemployed, and individuals with psychiatric disorders and low education levels are more likely to attempt suicide, particularly during hours when they are likely to be alone.

Objective: We compared the 15-variable trauma-specific frailty index and traditional injury scoring systems to determine trauma severity and predict discharge disposition in geriatric trauma patients based on the old and new World Health Organization age classifications.

Methods: This prospective, observational, single-center study included geriatric patients aged ≥65 years with blunt trauma. We categorized patients as elderly based on the old or new World Health Organization age classification into group I (aged 65-79 years) and group II (aged ≥a80 years), respectively. At admission, we used traditional injury scoring systems (e.g., the Glasgow coma scale, injury severity score, and revised trauma score) to determine trauma severity. We compared the Trauma-Specific Frailty Index and traditional injury scoring systems between the patient groups and evaluated them for correlations.

Results: We included 169 geriatric patients (80 and 89 in groups I and II, respectively). The mean Trauma-Specific Frailty Index score was significantly higher among females than males (p=0.025) and group II than group I (p=0.021). No significant correlations were observed in terms of the Trauma-Specific Frailty Index and traditional injury scoring systems in both groups. The mean Trauma-Specific Frailty Index score was significantly different between the hospitalized and discharged patients in group I (p=0.005), but not in group II (p=0.526).

Conclusion: The 15-variable Trauma-Specific Frailty Index score is superior to traditional injury scoring systems for managing and predicting discharge disposition in geriatric trauma patients aged 65-79 years.

Objective: The aim of this study was to explore the relationship between insight level and clinical and familial psychiatric features of children with obsessive-compulsive disorder (OCD).

Methods: Children's Yale-Brown Obsessive-Compulsive Scale-Symptom Checklist, 11^th item of the Children's Yale-Brown Obsessive-Compulsive Scale, Wechsler Intelligence Scale for Children Revised Form, Affective Disorders and Schizophrenia for School Aged Children Present and Lifetime Version 1.0, and Structured Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders-IV Axis I Disorders were applied to 92 pediatric OCD patients.

Results: In this study, the prevalence of OCD in the first children of the family was high (41.3%), and low insight was significantly related with concomitant intellectual disability (p=0.003). The level of insight was high in patients with comorbid OCD spectrum disorders (p<0.001). Attention deficit and hyperactivity disorder (ADHD) was the most common psychiatric diagnosis accompanying OCD (19.5%). Among the obsession-compulsion subscales, the symmetry/hoarding was higher in males (p=0.046). OCD patients with a family history of major depressive disorder (MDD) had high ADHD comorbidity rates (p=0.038). In OCD patients, whose family had psychiatric disorders besides MDD and anxiety disorders, the diagnosis rate of intellectual disability was higher than other diagnoses (p<0.001).

Conclusion: The sociodemographic, clinical, and familial features of pediatric OCD patients cannot be adequately clarified if the patient has limited insight. Therefore, the insight of children with OCD should be considered a range or continuity.