Medical Bulletin of Sisli Etfal Hospital最新文献

Objectives: Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS). Still, the efficacy and safety in patients older than 85 years of age are not conclusive by the present randomized controlled trials' data (RCT). Aging is a multifactorial process and the impact of MT on this specific population needs to be further analyzed.

Methods: We retrospectively reviewed 169 patients, ≥85 years old who presented with AIS and underwent MT between 2018 and 2023. Perfusion-weighted imaging (PWI) and software data were also analyzed. Good functional outcome was defined as modified Rankin scale (mRS) ≤2 and assessed at 30 and 90-day follow-ups. Feasibility and safety assessments included First Pass Effect (FPE); hemorrhagic transformation (HT) evaluated according to European Cooperative Acute Stroke Study radiological classification.

Results: Patients were subdivided into two groups (85-90 and >90 years old). A total of 107 (66%) patients had baseline PWI software on onset and median ADC value of 24.19±32.70. Anterior circulation comprised 14.3% (n=24) of the patients; 19.6% (n=33) had middle cerebral artery (MCA) M2, 1.8% (n=3) MCA M3 and 1.8% (n=3) anterior cerebral artery occlusion. Posterior circulation only comprised basilar artery occlusions (n=18). The 3-month mRS of 0-2 was 27% and mRS of 6 was 23.1%. Overall HT was found in 29.2% (n=49) of the patients, but HT1 constituted the highest ratio (70.2%; n=33).

Conclusion: Sub-analysis of several RCTs considered age as a limiting factor for MT in elderly patients. We suggest MT should be considered safe in well-selected candidates older than 85 years.

Objectives: Despite being recognized for a long time as a characteristic of Parkinson's disease (PD), pseudobulbar affect (PBA) is still a symptom that is underdiagnosed and undertreated. This study aimed to assess the association between PBA and various mood disturbances, as well as the impact on quality of life in PD patients.

Methods: Sixty-eight patients with PD were enrolled in this study. Their demographic and clinical features, including age, gender, education, smoking, lateralization and duration of the disease, and comorbidity, were recorded. The scores on the Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn-Yahr Scale, The Mental Component Summary (MCS-12), the Physical Component Summary (PCS-12), The Montreal Cognitive Assessment, and Beck Depression Inventory were evaluated. The Center for Neurologic Study-Lability Scale (CNS-LS) was used to explore PBA.

Results: There were 12 patients (17%) with CNS-LS scores of ≥13, and 4 patients (5%) with CNS-LS scores of ≥4. BDI scores demonstrated a strong positive correlation with CNS-LS scores (Spearman correlation coefficient=0.64, p<0.001), and MCS-12 scores showed a significant negative correlation with CNS-LS scores (Spearman correlation coefficient=-0.70, p<0.001). The multivariate linear regression analysis showed that lower MCS-12 scores are related to higher CNS-LS scores, and higher BDI scores are also linked to higher CNS-LS scores.

Conclusion: Our results indicate that elevated depressive symptoms correspond with increased CNS-LS scores, while a lower quality of mental health is also linked to higher CNS-LS scores. These findings highlight the influence of mood and mental health status on PDA among patients with PD.

Pregnancy-related spontaneous coronary artery dissection (P-SCAD) is a life-threatening condition that occurs during or after pregnancy, is rare and can be overlooked. It is one of the most important causes of pregnancy-related acute myocardial infarction. A 25-year-old female patient was admitted with a complaint of chest pain in her 37th week of pregnancy. There was nothing specific in her medical history except for a cesarean section, performed 2 years ago. There was diffuse ST-segment depression, and ST-segment elevation in leads V1, V2, and AVR. The patient was evaluated multidisciplinary and it was decided to perform a cesarean section and then urgently perform coronary angiography (CAG). Dissection within the lumen of the left anterior descending artery (LAD) was observed. The LAD was filling retrogradely from the right coronary artery, but no antegrade filling was observed (Type 2 SCAD). The patient, whose hemodynamics were stable and whose electrocardiography (ECG) showed no change, was monitored intubated, and stabilized in the intensive care unit (ICU) to minimize cardiac demand and reduce the risk of further myocardial ischemia. After that, an on-pump beating heart coronary artery bypass grafting (CABG) was performed 2 days later due to the high risk of bleeding related to the recent cesarean section operation. The LAD and diagonal artery were anastomosed with the left internal thoracic artery and saphenous vein grafts. She was discharged from the intensive care unit on postoperative day 2 and discharged from the hospital on day 8. P-SCAD is an important condition that can occur especially at a young age, its diagnosis may be overlooked, but it can cause serious clinical consequences. The treatment strategy should be decided in a multidisciplinary manner and should be individualized for each patient. This diagnosis should be kept in mind, especially when a young pregnant patient without cardiovascular risk factors presents with myocardial infarction findings.

Acute generalized exanthematous pustulosis (AGEP) is a rare drug eruption characterized by the rapid occurrence of many sterile, non-follicular pustules, neutrophilic leukocytosis, high fever and spontaneous resolution usually within two weeks. The distribution of rash predilection in the trunk and intertriginous regions. In treatment, the causative drug must be initially discontinued. Topical corticosteroids, moisturizers, antipyretics, and systemic corticosteroids are generally used according to the patient's symptoms and AGEP severity. Cyclosporine and intravenous immunoglobulin therapy can be used in some patients with AGEP resistant to systemic corticosteroids in severe AGEP. We herein aim to report a unique case of AGEP that has different rash distribution and resistance to systemic corticosteroids.

Objectives: Cancer or its treatment can have direct or indirect effects on sexual functions. Routine assessment of sexual functioning is essential in cancer patients to identify sexual problems and provide counseling to patients about these issues. This study aimed to investigate the validity and reliability of the Turkish version of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire - Sexual Health 22 prepared for the assessment of sexual function in cancer patients.

Methods: The sample of the study consisted of 201 patients, aged between 18-75, who received inpatient or outpatient treatment and treatment follow-up in the medical oncology unit of two private hospitals in Istanbul, regardless of cancer type, treatment stage and form. Language equivalence has been achieved. The validity of the scale was evaluated by factor analysis and the suitability of the model was determined by Goodness of Fit Indices. For the reliability of the scale, internal consistency was tested with Cronbach's alpha value. For consistency, a relationship was sought between the data taken 3 weeks apart using the test-retest method and the Spearman Correlation Test.

Results: Goodness of Fit Indices; It was calculated as Comparative Fit Index (CFI)=0.98, Tucker-Lewis Index (TLI)=0.98 Goodness of Fit Index (GFI)=1.32, Root Mean Square Error of Approximation (RMSEA)=0.04, Standardized Root Mean Square Residual (SRMR)=0.088. All factor loadings were found statistically significant with p<0.0001. In the internal consistency analysis, Cronbach alpha values of 0.91, 0.79 and 0.88 were obtained for sexual satisfaction, sexual pain subscales and all questions, respectively, and all groups were found to be reliable. In the Spearman Correlation Test used for consistency analysis, all coefficients were calculated above 0.7 and strong relationships were observed between the data. It was concluded that the scale was consistent in all areas.

Conclusion: All data obtained from the Turkish version of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire - Sexual Health 22 are valid and reliable.

Parathyroid adenoma is the most common cause of primary hyperparathyroidism and rarely reaches huge sizes. As the gland enlarges it may exhibit atypical morphology and extension to the mediastinum which may complicate the excision of the tumor while preserving the capsular integrity. We present a 35-year-old male patient who was referred to our department with a complaint of severe hypercalcemia. Neck ultrasound and parathyroid scintigraphy revealed an adenoma of 45x25 mm in size in the left parathyroid lobe extending to the retrosternal area. The patient underwent an uneventful parathyroidectomy. The patient remained well with no evidence of biochemical recurrence during the 4-year follow-up. Here, we presented a very original case of one of the largest parathyroid adenomas (8 cm) with atypical configuration (having multiple spicular extensions from the main body) ever reported in the literature which was completely retrieved from the posterior mediastinum via cervical route.

Objectives: The extent of the surgical treatment for Graves' disease (GD) has evolved from subtotal to total thyroidectomy. This study analyzes the extent of thyroidectomy for GD and its impact on recurrence and complications, focusing on the relationship between remnant thyroid tissue and recurrence in subtotal thyroidectomy, comparing our current approach with historic data spanning over three decades.

Methods: A retrospective analysis of 427 GD patients who underwent surgery at a tertiary hospital from 1988 to 2022. Patients were categorized into total/near-total thyroidectomy (TT, n=302) and subtotal thyroidectomy (ST, n=125). The groups were compared for demographics, postoperative complications, and recurrent hyperthyroidism rates. ROC analysis determined the remnant cut-off value for recurrence in the ST group.

Results: Age and sex were similar across groups. Recurrent hyperthyroidism was found in 8% of ST patients but none in the TT group (p<0.001). Transient hypoparathyroidism was higher in the TT group (16.9% vs. 0.8%; p<0.001). Persistent hypoparathyroidism and vocal cord paralysis rates were comparable. ST patients with recurrence had more remnant tissue (5.3±0.94 g vs. 3.4±1.34 g; p<0.01). The remnant tissue cut-off for predicting recurrence was 4 g (<4 g: 0%, ≥4 g: 17.8%; p<0.001).

Conclusion: Total thyroidectomy has lower recurrence rates than subtotal thyroidectomy without significantly increasing long-term complications. Remnant tissue larger than 4 g in subtotal thyroidectomy increases the risk of recurrence.

Objectives: To describe a novel technique for dissecting cadaver brains without damaging medial brain structures and surfaces, ensuring preservation for neuroanatomical study and training.

Methods: Ten adult cadaveric brains were dissected using the supracerebellar suprapineal approach under an operative microscope with 6x to 40x magnification. This approach allowed for the separation of the brain into two hemispheres while providing direct visualization of the third ventricle and preserving midline structures.

Results: The supracerebellar suprapineal approach enabled accurate and feasible dissection of the hemispheres without causing damage to the medial brain structures. All midline structures, including the third ventricle, were preserved, producing high-quality specimens for anatomical study.

Conclusion: The supracerebellar suprapineal approach offers a significant advancement in the technique for hemispheric brain dissection, ensuring the preservation of medial brain structures and providing superior specimens for neurosurgical training and study.

Objectives: Inflammatory bowel diseases (IBD) are chronic, immune-mediated disorders of the gastrointestinal system. Pancreas can be affected in IBD patients with a wide array of clinical conditions including acu-te pancreatitis, abnormalities of pancreatic duct and pancreatic insufficiency. Pancreatic steatosis (PS) is an important but often overlooked pathology of pancreas. In this study, we aimed to investigate the prevalence of PS in IBD patients to reveal the possible association in between in a patient group already prone to pancreatic disease involvement.

Methods: This retrospective study included 153 IBD patients who had a computed tomography scan in the last five years to evaluate the presence of PS. PS was defined as a pancreas/spleen attenuation ratio of below 0.70 in accordance with previous studies available in the literature. Demographic data, IBD subtype and treatment modality used for IBD were recorded and analyzed.

Results: 78 patients had Crohn's disease and 75 patients had ulcerative colitis. Presence of PS in IBD patients was 23.5%. Age and treatment modality were found to be related to PS presence. Logistic regression analysis revealed a statistically significant relationship between PS and advanced age (p=0.000) but not with treatment modality (p=0.290).

Conclusion: PS is an important pathology of the pancreas with serious complications. In an already burdensome disease like IBD, PS can add more challenges to patient management. Although a direct correlation between PS and IBD prognosis is not established in current literature, evaluation of IBD patients for PS will help in prevention and management of PS-related conditions which will improve the overall well-being of IBD patients.