Medical Bulletin of Sisli Etfal Hospital最新文献

Objectives: The role of bone grafting in the surgical treatment of displaced intra-articular calcaneal fractures (DIACFs) remains controversial. Although bone grafts are commonly used to restore joint congruity and support anatomical reduction, recent evidence favors minimally invasive approaches that may eliminate the need for routine grafting. This study aimed to evaluate the impact of bone graft use on radiological parameters and functional outcomes in Sanders Type II, III, and IV calcaneal fractures treated surgically.

Methods: This retrospective cohort study included 115 patients who underwent open reduction and internal fixation (ORIF) for DIACFs between 2016 and 2022. Fractures were classified using the Sanders classification and subgrouped as grafted (+) or non-grafted (-). Böhler and Gissane angles and calcaneal height were measured at four time points. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. Intergroup and intragroup comparisons were made using appropriate statistical methods.

Results: Of the 115 patients, 38 had Type II, 43 had Type III, and 34 had Type IV fractures. Demographics and follow-up durations were comparable across groups (p>0.05). Both grafted and non-grafted groups demonstrated significant postoperative improvements in radiological parameters (p<0.05), which gradually declined over time. No statistically significant intergroup differences were observed at any time point (p>0.05). AOFAS scores and superficial wound infection rates were also similar.

Conclusion: Bone grafting did not yield superior radiological or functional outcomes in Sanders Type II, III and IV DIACFs treated with ORIF. These findings support a selective approach to grafting, especially in cases with significant comminution or bone loss, and align with current trends favoring biologically friendly and minimally invasive techniques.

Objectives: Mechanical thrombectomy (MT) has revolutionized stroke care over the past decade. Thus, we aimed to assess whether presenting during off-hours affects workflow times, clinical outcomes, and mortality of patients with acute ischemic stroke (AIS) undergoing MT at our center and, if there is an impact, to identify areas for improvement in the treatment of acute stroke.

Methods: A total of 263 consecutive patients who underwent MT between January 2020 and April 2023 were included in the study. The patients were categorized into two groups: those who presented during on-hours (Group 1) and those who presented during off-hours (Group 2).

Results: Among the 263 patients enrolled in the study (131 men and 132 women; mean age: 69.49±12.22 years; age range: 25-95 years), 74 (28.14%) were admitted to the hospital during on-hours, and 189 (71.86%) were admitted during off-hours. Of these patients, 30 (40.54%) and 68 (35.98%) from Groups 1 and 2, respectively, had good outcomes in the third month. The groups showed similar demographics, treatment-related characteristics, and outcomes, with no significant differences detected. The only notable difference was that the percentage of Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) was notably greater in the off-hours group (p=0.044).

Conclusion: The results indicate that MT performed on patients presenting during off-hours yielded similar workflow times, successful recanalization, and clinical outcomes to MT performed on patients presenting during on-hours.

Objectives: The quality of transurethral resection of bladder tumor (TURBT) significantly affects disease management. Pathology specimens that do not contain detrusor muscle (DM) may be associated with low clinical staging. The aim of this study was to evaluate the factors affecting the detection of DM in TURBT.

Methods: A total of 1014 patients who underwent TURBT between June 2016 and June 2024 and met the inclusion criteria were enrolled in the study. The requirements for good-quality TURBT were complete resection and detection of DM in the pathology specimen. All procedures were performed by a total of 17 residents under the supervision of a specialist doctor.

Results: DM was obtained statistically significantly more often in patients with large (≥3 cm), multiple, and solid tumors. In addition, DM was observed more frequently in the pathology specimens of patients with high-grade tumors, variant histology (VH), or accompanying carcinoma in situ (CIS). The effect of surgical experience on obtaining DM was evaluated, and senior residents (4th year and final year) were found to be more successful than junior residents (3rd year) (65.3% vs. 58%, p=0.021). Multivariate analysis revealed that tumor architecture and tumor size were significant factors influencing DM acquisition.

Conclusion: Surgical success in the TURBT procedure has not been clearly defined, but it is known to be affected by many factors. In our study, the rate of DM detection was found to be lower in low-risk tumors. Increasing experience during urology residency was associated with higher-quality TURBT outcomes.

Objectives: Anaphylaxis, which has been increasing in frequency parallel to other allergic diseases in recent years, is a life-threatening, acute systemic reaction. Physicians working in pediatric emergency departments (PED) should recognize the signs and symptoms of anaphylaxis and administer initial treatment. This study aims to evaluate the demographic, clinical, and laboratory findings of patients diagnosed with anaphylaxis in the pediatric emergency unit of a tertiary care facility.

Methods: Patients diagnosed with anaphylaxis in our unit at the PED were retrospectively reviewed between 2016 and 2023.

Results: A total of 100 patients were diagnosed with anaphylaxis in our pediatric emergency department, including 39 girls and 61 boys. Of these patients, 3% were under 2 years of age, 25% were between 2-6 years, and 72% were over 6 years old. In 83% of the cases, anaphylaxis occurred at home, while 11% occurred during medication administration at a hospital. Triggers were identified in 81% of the patients, whereas 19% were diagnosed with idiopathic anaphylaxis. The most common triggers were medications. Food-related anaphylaxis was the second most common trigger, with cow's milk being the most frequent at 8%. The most commonly affected system was the skin and mucosa in 97% of cases. When examining the relationship between age groups and triggers, food allergies were most frequent in children under 2 years old (p<0.001). The average tryptase level measured during anaphylaxis was 5.27 ug/L (1.43-33.6), with idiopathic cases showing a significantly higher average of 9.15 ug/L (6.29-33.6) (p=0.005).

Conclusion: Anaphylaxis is a systemic reaction that can be fatal if not treated quickly and accurately. Adrenaline is the single most effective treatment, and pediatric emergency physicians play a crucial role in this context. Our findings suggest that tryptase levels in pediatric patients are often below the widely accepted cut-off; however, larger studies are needed before reference ranges can be redefined.

Objectives: This study aimed to evaluate the therapeutic plasma exchange (TPE) procedures performed in our pediatric intensive care unit (PICU) and to review the relevant literature.

Methods: This retrospective study was conducted between 2020 and 2024. Forty-nine patients who received TPE at any point during their PICU stay were included. The groups were categorized as survivors and non-survivors.

Results: Of the 49 cases, 71.4% were male, with a median age of 54 months (range 20-135 months). A total of 274 TPE sessions were performed. The three most common indications for TPE were sepsis, trauma induced multiple organ dysfunction syndrome/disseminated intravascular coagulation, and neurological diseases. The non-survivor group had higher rates of chronic illness (p<0.001), pediatric risk of mortality score III, and pre- and post-procedure vasoactive inotropic scores (p=0.005, p<0.001, and p<0.001, respectively). The use of invasive mechanical ventilation and continuous renal replacement therapy (p=0.005, p<0.001, respectively), as well as TPE in cases with sepsis (p<0.001), were more frequent in non-survivors. The most common complication during the procedures was hypotension (9.9%).

Conclusion: Sepsis remains the most frequent indication for TPE in PICUs. Although the most common complication of TPE in our study was hypotension, there were no life-threatening complications, suggesting it is a safe treatment modality.

Objectives: The aim of this study is to evaluate whether the presence of other HPV genotypes in addition to HPV16 infection has a negative effect on pathological outcomes.

Methods: This retrospective study was conducted using data from patients followed up at the Gynaecological Oncology Clinic of Antalya Training and Research Hospital between 2017 and 2025. Patients who were HPV16-positive and also carried other genotypes in addition to HPV16 were included in the study. HPV genotyping was performed using the Hybrid Capture 2 and CLART Genomica systems.

Results: Of the total 2,700 HPV (Human Papillomavirus) -positive women, 524 were HPV16-positive only, while 358 were positive for HPV16 along with other genotypes. Histopathological results, including CIN 2/3, HSIL, and invasive cancer, did not show significant differences between the two groups (p>0.05). However, abnormal colposcopy findings were statistically more prevalent in the co-infection group (p=0.037). Cigarette smoking was associated with a 1.27-fold increased risk for co-infection (p=0.026).

Conclusion: The findings of this study indicate that HPV16 is the primary determinant in the development of high-grade cervical pathology, and the presence of other high-risk HPV types does not significantly worsen histopathological outcomes. The results support the importance of a risk-based approach in cervical cancer screening processes and emphasize the need to prioritise early diagnosis and preventive interventions in HPV16-positive individuals.

Objectives: Environmental smoke exposure is a poorly understood issue and might be a potential source of long-term respiratory exposure to toxic pollutants. Both secondhand and thirdhand smoke (THS) exposure are important matters of public health. We aimed to document the knowledge about smoke exposure of vulnerable groups with respiratory diseases.

Methods: A total of 911 currently smoking patients admitted to the outpatient clinics between October 2023 - October 2024 enrolled in our study. Following a medical examination and pulmonary function assessment, individuals were asked to complete the BATHS questionnaire on thirdhand smoking exposure.

Results: Of the 911smoker participants who comprised our sample, 322 (35.3%) had COPD, 227 (24.9%) had asthma and 570 (62.5%) experienced moderate to severe secondhand exposure. Patients with COPD had the lowest BATHS total and persistence scores (3.61±0.58 and 3.77±0.69, respectively), while asthmatics had the lowest BATHS health scores (3.41±0.46) (p<0.05). Total and subdimension scores were significantly higher among individuals aged 18-30, university graduates, employed in the workforce, and earning exceeds minimum wage (p <0.05). No gender difference was noted (p>0.05). BATHS total scores had significant negative correlation with secondhand smoke exposure and disease duration (p<0.05) whereas positively correlated with better pulmonary function values, attending a smoking cessation clinic, and living at home with children under sixteen (p<0.05).

Conclusion: This study identifies the knowledge gap about the detrimental effects of smoke exposure in patients with respiratory diseases. It underscores the importance of focusing initiatives to reduce both active and passive smoking through educational programs targeting active smokers at risk of lung illnesses.

Objectives: Alopecia areata (AA) is a common, chronic autoimmune disease that causes non-cicatricial hair loss. Its relapsing and remitting nature leads to the search for new, effective treatment options. The study aimed to evaluate the therapeutic efficacy of intralesional platelet-rich plasma (PRP) and intralesional steroid (ILS) injections in patients with AA.

Methods: A retrospective chart review was carried out from 2020-2021. A total of 75 patients with AA were included in the study. Thirty-six patients were treated with intralesional PRP, and 39 patients were treated with ILS injections for three sessions. The patients were evaluated with a hair pull test and SALT scores at months 0, 3, and 6.

Results: Of 75 patients, the mean age of the PRP group was 34.33±10.61, and the mean age of the ILS group was 33.82±13.31 years. After three PRP or ILS therapy sessions, at 3. and 6. months, SALT 3 and SALT 6 scores were statistically significantly lower in the PRP group than in the ILS group (p=0.038, p<0.001, respectively). When the treatment response was evaluated at the end of the 6th month in the PRP group, there was no response in 2 (5.5%) patients, partial response in 1 (2.7%) patient, good response in 3 (8.4%) patients, and very good response in 30 (83.4%) patients. Only 2 (5.9%) patients had a clinical relapse in a 6-month period. Side effects were seen in 16 (44.4%) patients in the PRP group and 8 (20.5%) patients in the ILS group, and the frequency of side effects in the PRP group was statistically significantly higher than in the ILS group (p=0.026). However, the side effects of both groups were minor, such as itching, pain, burning, ecchymosis, and folliculitis.

Conclusion: PRP seems to be an effective and safe treatment option for limited patchy alopecia areata, but its superiority over ILS has not been fully demonstrated, making ILS still the first-line treatment.