Northern Clinics of Istanbul最新文献

Steal syndrome causing limb ischemia is a rare but important complication of arteriovenous fistulas. When surgical or endovascular means to resolve ischemia are inconclusive, closure of the fistula becomes required. Our case presented with lower extremity ischemia resulting from an arteriovenous fistula graft. We present the successful endovascular closure of the lower extremity graft using the Amplatzer Vascular Plug.

Objective: Acute and chronic osteomyelitis generally require long-term antibiotic therapy and surgical debridement. Implant-associated osteomyelitis, particularly from methicillin-resistant Staphylococcus aureus (MRSA) strains, is difficult to treat. Rifaximin is an antibiotic derived from rifamycin which may be effective in the treatment of osteomyelitis in terms of its wide spectrum of action and pharmacological properties. The aim of this experimental study was to investigate the local efficacy of rifaximin in rat models with MRSA and implant associated osteomyelitis.

Methods: This study was carried out with 40 adult Wistar albino rats. The rats were randomly divided into 4 equal groups with 10 rats in each. An implant related MRSA osteomyelitis was created in the right tibia metaphysis of each rat by Norden's experimental osteomyelitis model. After 4 weeks, the implants of each tibia were removed and debridement was applied. Group 1 was designed as control group and no other treatment was applied other than debridement. Bone cement without any antibiotic was applied to Group 2, bone cement with teicoplanin was applied to Group 3 and bone cement with rifaximin was applied to Group 4. After 4 weeks from the second surgery, euthanasia was performed to the rats and the clinical, histopathological and microbiological results were compared.

Results: There was no statistically significant difference between the groups in clinical scoring. A statistically significant difference was found between the histopathological scores of Group 1 and Group 2 and the histopathological scores of Groups 3 and 4; the histopathological scores of Group 1 and Group 2 were found to be higher than Group 3 and Group 4. When the pre-and post-treatment colony numbers were compared, although there was a statistically significant difference between Group 3 and Group 2, no statistically significant difference was found between Group 4 and Group 1 results.

Conclusion: In spite of its wide spectrum, the local efficacy of rifaximin in the treatment of osteomyelitis could not be demonstrated. This study shows the ability to shed light on some future comprehensive studies with the inclusion of infection markers.

By applying pressure to nasal mucosa, anatomic variations at nasal cavity and paranasal sinuses may cause headache without any sign of inflammatory diseases such as sinusitis or nasal polyp. This phenomenon is called as contact point headache (CPH) and observed as a result of concha variations, mostly due to concha bullosa. Accessory middle turbinate (AMT) is a very rare variation and occurred as a result of mediale and inferior folding of uncinate process. When this folding is severe, AMT may cause double middle concha appearance in nasal cavity. To the extent, we know, bilateral double middle turbinate variation has not been defined before. Hereby, we present a CPH phenomenon in a patient with bilateral double middle turbinate variation which is related to contact of AMT to real middle turbinate.

The coronary artery perforation during percutaneous coronary intervention is a nightmare for interventional cardiologists and is always hard to manage timely and properly. We present a 60-year-old male with periprocedural coronary perforation during ST-segment elevation myocardial infarction. A coronary balloon was inflated in the proximal left anterior descending (LAD) artery just after perforation and the 600 cc of hemorrhagic fluid was drained with the pericardial drainage set. The covered stent was deployed in the LAD and he was discharged on the 7^th day. At an 18-month follow-up, he is on dual-antiplatelet therapy and the exercise stress test shows no ischemic changes.

Objective: This study aims to evaluate the technical and clinical success of uncooled microwave ablation (MWA) in the treatment of osteoid osteoma with two-dimensional fluoroscopy guidance in the operating room.

Methods: The clinical and imaging data of 9 patients were retrospectively evaluated. Mean patient age was 14.55 years. The mean size and volume of the lesions were 17.2 × 10.8 × 8.0 mm and the mean nidus size was 6.86±2.05 mm on computed tomography. MWA was performed with uncooled probe in operating room and in sterile conditions. Numerical pain score was recorded before the procedure, the day after, and at 1, 3 months after the procedure.

Results: Clinical and technical success was achieved in 100% of patients. The mean volume of MWA-induced necrosis was 20.8 × 12.8 × 10.7 mm, peripheral scar thickness was 3.5±0.75 mm, and none of the patients had nidus enhancement on first month follow-up magnetic resonance imaging. Fluoroscopic guidance was conducted under digital c-arm. Patients received four to 12 spot films (mean: 6.6 kVp, 2.66 mAs) over the lower extremity. Mean radiation exposure to the skin due to imaging was 0.02 mGy per patient per procedure. The dose area product-the total amount of radiation deliverable to the patient was 0.75±0.32 Gy.cm².

Conclusion: This study demonstrated the effectiveness and the safety of the uncooled MWA in osteoid osteoma. The technique may effectively be used in operating room under c-arm fluoroscopy. Such hybrid approach may ensure sterility, anesthetic safety, and lower radiation dose to patients.

Objective: Various techniques, needle types, and additional methods such as on-site pathological evaluation (ROSE) are used to increase the sensitivity of endoscopic ultrasound-fine needle aspiration (EUS-FNA), which is used in the diagnosis of pancreatic solid lesions. In this study, diagnosticity of the lesions according to the regions of the pancreas with EUS-FNA and ROSE performed with the slow pull technique using a 22 G needle will be evaluated.

Methods: A total of 82 patients who underwent EUS-FNA between January 2, 2015, and March 14, 2020, were included in the study. General and clinical information of the patients were recorded retrospectively. The patients were diagnosed according to The Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology Classification. If the diagnosis could not be made with EUS-FNA and ROSE, the diagnosis was made with alternative methods of surgery or percutaneous biopsy. Patients diagnosed as benign with EUS-FNA and ROSE were followed for at least 1 year and were accepted as benign.

Results: The mean age of the patients was 63.2±10.5 years and 54 (69.6%) of them were male. The mean lesion size was 36.8 mm and the number of needle passes was 2.87. The overall sensitivity was 82.9% and the specificity was 100%. The sensitivity of EUS-FNA and ROSE in solid lesions in the head and body of the pancreas was higher than in lesions in the tail region (p=0.024).

Conclusion: EUS-FNA and ROSE are an effective method in the diagnosis of pancreatic solid lesions. The use of a 22 G needle may be more diagnostic in the head and body of the pancreas than in the tail region.

Objective: Early and accurate diagnosis of acute respiratory infections is important because these diseases negatively affect public health and can lead to loss of workforce and an increase in health expenditures. In this study, we aimed to determine the respiration panel multiplex polymerase chain reaction (PCR) test results and seasonal distribution in our region.

Methods: Three thousand and seventy-four patients samples multiplex PCR (Anatolia, Bosphore^® Respiratory Pathogens Panel Kit v1) test results, which were sent to our laboratory, from 13 hospitals in our region between January 2018 and December 2018, were evaluated retrospectively.

Results: A total of 3074 patients samples, 1465 (48%) were positive and 1609 (52%) were negative test results. The most common factors were rhinovirus 30.2%, influenza A 23.1%, and respiratory syncytial virus (RSV) A/B 19.1%, respectively. When the distribution of these three most common viruses by months is examined, the most frequent months were determined as June for rhinovirus, November for influenza A, and February for RSV A/B. In the period between October and February, there was a significant increase in the positivity level of viral factors.

Conclusion: The use of molecular methods in the diagnosis of respiratory infections will prevent unnecessary use of antibiotics and ensure correct and rapid treatment.

Objective: Coronavirus disease-2019 (COVID-19) disease can cause asymptomatic and mild flu-like symptoms as well as severe symptoms ranging from respiratory failure and death. Growth hormone (GH) is produced in the anterior pituitary and plays an important role in the immune system. COVID-19 is severe in the elderly, men, obese, diabetics, and people with immune deficiency. The probability of GH deficiency is high in these patient groups. In this study, we aimed to investigate the relationship between the severity of COVID-19 infection and GH level.

Methods: A total of 456 patients, between 45 and 80-years-old, who were hospitalized with the diagnosis of COVID-19 disease were evaluated in the study. Our study was a retrospective study. Demographic data of the patients, GH, insulin-like growth factor-I (IGF-1), and biochemical parameters and thorax tomography results were evaluated. Patients with chronic diseases that would affect GH levels and those in need of intensive care were excluded from the study.

Results: 456 patients were included in the study, 168 female, 288 male, mean age 67.57±12.60 years. Patients were divided into two groups according to thorax tomography findings, patients with lung involvement in Group-1:352 (77%) and those without pulmonary involvement in Group-2:104 (23%). While the GH of Group-1 was 0.125 ng/ml, the GH of Group-2 was 0.238 ng/ml, the difference between them was statistically significant (p=0.000). IGF-1 in Group-1 was: 55.05 ng/ml, while IGF-1 in Group-2 was: 104.08 ng/ml, the difference between them was statistically significant (p=0.000). In multivariate regression analysis, low IGF-1 (p=<0,01, OR:1,06 [1028-1093]) level was found to be significantly effective in lung involvement in COVID-19 disease.

Conclusion: In our study, we found GH and IGF-1 deficiency in COVID-19 cases with lung involvement, regardless of age and gender. We can say that COVID-19 infection progresses worse in GH and IGF-1 deficiency.

Objective: The aim of the study was to determine the clinical profile of the patients with alopecia areata (AA) and whether or not any differences between the AA patients with and without comorbidity.

Methods: A total of 218 patients diagnosed with AA between January 1, 2016, and August 31, 2020, in our outpatient clinic were analyzed retrospectively.

Results: The mean age was 27.8±12.3. 61.5% of the patients were male (M/F=1.59). There were AA in 96.3%, alopecia universalis in 3.2%, and alopecia totalis in 0.5% of the patients. Most of them showed unifocal involvement (85.8%) and multifocal involvement to a smaller extent (10.5%). Number of patches was 1 in 75.2%, 2 in 16.7% and 3 or more in 8.1% of AA patients. Average disease duration was 18.1 months. Comorbid diseases were accompanying to 51.8% of the patients. Dermatological diseases were among the most common accompanying diseases (17.9%). However, hypothyroidism (12.8%) was the most frequent comorbid disease. There were thyroidal diseases in 15.1%, allergic disorders in 7.7%, psychiatric disorders in 7.3%, anemia in 5.9%, rheumatic diseases in 2.2%, other endocrine diseases in 1.8%, malignancy in 1.3%, and morbid obesity in 1.3% of the patients. Down syndrome accompanied in 0.9%. Vitamin-D deficiency (38.9%), low ferritin (13.8%), and B12 deficiency (9.6%) were also detected. Female gender (46.9 to 29.5%, p=0.008), extensive disease (p=0.085), Vitamin B12 deficiency (13.3 to 5.7%, p=0.059), and low ferritin level (20.4 to 6.7%, p=0.003) were observed more in patients with comorbidity than those without one.

Conclusion: AA accompanies various systemic, autoimmune, and psychiatric diseases. Dermatologists need to recognize potential comorbid diseases, evaluate and manage these patients with a multidisciplinary approach to achieve a better outcome.

Objective: Surgery on the ascending aorta incurs greater risk than other cardiac procedures. The primary aim of this study is to identify pre-operative and operative risk factors that play a role in extended length of stay (LOS) after elective surgery for ascending aortic aneurysms. The secondary aim is to determine post-operative outcomes associated with extended LOS.

Methods: Patients who underwent elective surgery aged >18 between January 2018 and December 2019 for ascending aortic aneurysm with or without concomitant interventions in a single heart surgery center were retrospectively identified. Patients with days of hospital stay longer than the median length made up the extended stay group. The extended stay group was compared against the rest of the patients for demographics and operative parameters, as well as post-operative outcomes.

Results: Patients with extended LOS were older (60.0±12.2 vs. 54.0±14.2, p=0.001) with more frequent coronary artery disease (CAD) (47.2% vs. 23.7%, p<0.001) and chronic obstructive pulmonary disease (COPD) (25.0% vs. 11.9% p=0.013). More patients in the extended LOS group required HCA for distal aortic anastomosis (43.5% vs. 17.5%, p<0.001) and cardiopulmonary bypass (CPB) durations were longer (283.1±83.9 vs. 225.3±84.2 min, p<0.001). Multivariate analysis revealed age, CAD, COPD, HCA, and CPB time as risk factors for extended LOS. Extended LOS patients had longer mechanical ventilation times (23.0±21.3 vs. 13.6±5.3 h, p<0.001), more frequently had acute renal failure (24.2% vs. 6.7%, p<0.001), reoperation for bleeding (20.7% vs. 6.7%, p=0.003), and stroke (14.3% vs. 4.3%, p=0.011).

Conclusion: In elective surgery for ascending aortic aneurysms older age, history of COPD and CAD, longer CPB times, and HCA during surgery are associated with extended LOS. Further studies are needed to investigate the association of prolonged hospital stay with long-term outcomes, as well as the impact of operation type on hospital stay.