Medical Bulletin of Sisli Etfal Hospital最新文献

Objectives: Familial Mediterranean fever (FMF) is an autoinflammatory disease more commonly observed in the Eastern Mediterranean region. Studies have shown that inflammatory processes may decrease vitamin D, vitamin B12 and folate levels, but there is no clear data on the effect of attack frequency on these levels. Our study aimed to evaluate the effect of FMF attack frequency on vitamin levels.

Methods: FMF patients aged between 4-18 years were considered as the study group, while healthy children who had vitamin levels during the same period were considered as the control group. The study group was further subgrouped according to the number of attacks. Those experiencing 2 or fewer attacks per year are classified as the attack group, while those experiencing 6 or more attacks per year are classified as the frequent attack group.

Results: A total of 494 subjects were included. The study group was composed of 333 FMF patients, 108 of them in the attack group and 225 in the frequent attack group. Control group included 161 children. The median and interquartile range (IQR: P25-75) in the frequent attack, attack, and control groups for 25(OH)D levels were 14.3 (9.57-18.9), 14.85 (10.12-21.77), and 14.95 (9.92-20.12) ng/ml, for B12 levels were 320 (238-415), 328 (250.25-439.25), and 373 (273.75-519.25) pg/ml, and for folate levels were 6 (5.13-8.12), 6.8 (5.36-8.9), and 7 (5.3-9.9) ng/ml, respectively. There is no significant difference between groups for 25(OH)D and folate (p=0.436 and p=0.25, respectively). Vitamin B12 levels are significantly lower in study group (p=0.001) but there is no difference according to attack frequency (p=0.92).

Conclusion: There is no effect of attack frequency on 25(OH)D, vitamin B12 and folate levels. The fact that vitamin B12 levels are within normal limits in patients with FMF may be explained by the adequate dietary habits of these patients.

Objectives: Chronic Limb-Threatening Ischemia (CLTI) represents a complex manifestation of peripheral artery disease distinguished by symptoms such as ischemic rest pain, non-healing ulcers on the lower limb or foot, and the development of gangrene. CLTI is associated with a high risk of limb amputation, decreased quality of life, and substantial morbidity and mortality. The Prognostic Nutritional Index (PNI), which is calculated using albumin and lymphocyte levels, reflects the immunological and nutritional status. The objective of this study was to investigate the correlation between PNI levels and mortality among patients diagnosed with CLTI who underwent endovascular therapy.

Methods: Individuals diagnosed with CLTI who received endovascular therapy below the knee in our tertiary care center were enrolled in this retrospective study. The patients were divided into two groups: survivors and non-survivors. Logistic regression analyses were performed to detect independent predictors of mortality and using Cox regression model, we assessed the relationship between PNI and mortality. Survival curves were estimated using the Kaplan-Meier method.

Results: The study comprised 113 patients diagnosed with PAD who underwent EVT. The non-survivor group (42 patients) was older (62.9±10.9 vs. 67.7±9.9, p=0.045) and had a higher prevalence of chronic renal failure (22.5% vs. 42.9%, p=0.023) and congestive heart failure (8.5% vs. 21.4%, p:0.049) than the survivor group (71 patients). The median PNI value was lower in the non-survivor group than in the survivor group (35.9±5 vs 38.2±4.4, p=0.012). Cox regression analyses showed that Low PNI was associated with increased mortality (HR=0.931, CI=0.872-0.995, p=0.035). PNI cut-off of 37.009 showed 64.3% sensitivity, 64.8% specificity, and AUC of 0.642 for predicting all-cause mortality. Kaplan-Meier analysis supported higher PNI correlating with better survival.

Conclusion: The Prognostic Nutritional Index was independently associated with mortality among individuals diagnosed with Chronic Limb-Threatening Ischemia.

Hyperthyroidism is a clinical condition that develops due to the excessive production and secretion of thyroid hormones by the thyroid gland, leading to an elevated concentration of thyroid hormones in tissues. Hyperthyroidism is characterized by low TSH and elevated T3 and/or T4, with the most common causes being Graves' disease, toxic multinodular goiter, and solitary toxic adenoma. T3 is the peripherally active form of thyroid hormone, affecting nearly each tissue and system. The most prominent aspects of hyperthyroidism are related to the cardiovascular system. The treatment of hyperthyroidism includes three options: antithyroid drugs (ATDs), radioactive iodine therapy (RAI), and surgery. Among these treatment modalities, surgery is considered as the most effective one. For patients who are candidates for surgery, preoperative preparation is required to ensure that the thyroidectomy can be performed under optimal conditions. Preoperative preparation should be a combination therapy aimed at preventing the synthesis, secretion, and peripheral effects of thyroid hormones from the thyroid gland. Medications that can be used in this treatment include thionamides, beta-blockers, iodine, corticosteroids, cholestyramine, perchlorate, lithium, and therapeutic plasma exchange. These treatment options can be combined based on the patient's condition. While it is recommended that patients be made euthyroid through preoperative antithyroid treatment to prevent the feared complication, which is the thyroid storm, the supporting evidence is limited. Preoperative treatment does not prevent against thyroid storm whether the patient is euthyroid or hyperthyroid during surgery. Whether surgery should be delayed until biochemical euthyroidism is achieved in hyperthyroid patients remains a topic of debate. Recent studies suggest that thyroidectomy can be safely performed during the hyperthyroid phase by experienced anesthesiologists and surgeons without precipitating thyroid storm or increasing intraoperative and postoperative complications. Although achieving the euthyroid state before surgery is ideal in hyperthyroid patients, it is not always possible. Factors such as allergies to medications, drug side effects, treatment-resistant disease, patient noncompliance, and the urgency of definitive treatment are critical in determining whether hyperthyroidism can be controlled preoperatively. When surgery is necessary in hyperthyroid patients without achieving euthyroidism, the patient's overall condition and comorbidities should be evaluated together by the anesthesiologist, surgeon and endocrinologist, with particular attention to stabilizing the cardiovascular system. We believe that in hyperthyroid patients who are cardiovascularly stable during the hyperthyroid phase, thyroid surgery may not need to be delayed and can be performed safely.

Objectives: To compare the pain perception and treatment duration in patients undergoing panretinal photocoagulation (PRP) for high-risk proliferative diabetic retinopathy (PDR) using Navilas laser versus conventional laser.

Methods: A study was conducted involving 40 patients with bilateral high-risk PDR. Each patient underwent PRP with conventional laser in one eye and Navilas laser in the other. Laser parameters, including spot size and pulse duration were standardized. Pain perception was evaluated using Verbal Rating Scale (VRS) and Visual Analogue Scale (VAS).

Results: The Navilas and conventional laser groups showed no significant differences in baseline visual acuity, lens status, intraocular pressure, cup-to-disc ratio, or cystoid macular edema. The duration of laser treatment was significantly shorter with Navilas laser group (517.3±48.78 seconds, p<0.001). Pain scores (VAS and VRS) were significantly lower in the Navilas laser group (p<0.001, p=0.002 respectively) than in conventional laser group. There was no correlation between VAS and VRS scores and laser time in both the Navilas and conventional laser groups (p>0.05).

Conclusion: Utilizing the Navilas laser for PRP in PDR patients offers advantages over conventional lasers, including reduced pain and expedited procedures. These findings contribute valuable insights for optimizing clinical decisions, potentially enhancing patient compliance and minimizing the risk of visual deterioration in diabetic retinopathy treatment.

Objectives: Kidney stones are treated with many methods, but there is no consensus on which method should be preferred for 1-2 cm lower renal stones. In our study, we aimed to investigate the results of mini (Percutaneous Nephrolithotomy) PCNL and (Retrograde Intrarenal Surgery) RIRS in lower renal pole 1-2 cm stones.

Methods: Twenty-four mini PCNL and 55 RIRS patients were included in the study. Demographic data of the patients and information about stones on Non-Computed Tomography (NCCT) were recorded. Stone-free status (SFR), need for additional treatment and complications of both methods were compared.

Results: Operative time was 55.2±20.8 min in mini PCNL and 70.7±36.5 min in RIRS, which was statistically significantly lower (p=0.002). Length of hospital stay was 2.4±1.5 days in the mini PCNL and 1.3±0.7 days in the RIRS, which was statistically significantly longer (p=0.011). In the postoperative 1st month and 3rd month stone-free rates (SFR) were higher in the mini PCNL group. While the 1st month SFR was 91.6% and 54.5%, the 3rd month stone-free rates were 95.8% vs. 69.1%, respectively (p<0.001). The need for re-treatment was statistically lower in the mini PCNL group (p<0.001). In terms of complications, the incidence of complications was 16.6% (pain in 2 patients, fever in 1 patient, need for blood transfusion in 1 patient) in the mini PCNL group and 21.8% (pain in 2 patients, fever in 8 patients, sepsis in 2 patients) in the RIRS group. There was a significant difference between the two groups (p=0.008).

Conclusion: Mini PCNL has a higher SFR, less need for re-treatment and fewer complications.

Objectives: Coronary microvascular dysfunction is present in large percentage of the population, and it has been shown to have a pathological and prognostic role in many conditions. Therefore, early detection of microvascular dysfunction is important, especially in selected populations. The aim of this study was to investigate the association of galanin with coronary flow reserve (CFR) in prehypertensive individuals to determine whether it can be used as a marker to detect microvascular dysfunction.

Methods: A total of 100 participants, 50 prehypertensive and 50 normotensive were included in this prospective study. Serum galanin levels were measured and CFR was calculated by detailed transthoracic echocardiography.

Results: CFR was significantly lower in the prehypertensive group (p<0.001). Also, galanin values were numerically lower in the prehypertensive group, but the difference between the groups did not reach statistical significance (p=0.062). There was no significant correlation between CFR and galanin (r=-0.161, p=0.11).

Conclusion: Lower CFR values in prehypertensives suggest that microvascular dysfunction starts above normotensive values even if hypertension does not develop. The reason why low galanin levels were not statistically significant in prehypertensives and no correlation was found between galanin and CFR may be due to the small study population. Relationship between galanin, prehypertension and microvascular dysfunction will become clearer if large-scale population studies are carried out.

Objectives: There is still no clear relationship between the presence of Graves' disease (GD) and the development of papillary thyroid carcinoma. The aim of this study was to compare the clinicopathologic features of patients diagnosed with papillary thyroid carcinoma (PTC) with thyroid nodules and GD and patients with PTC with thyroid nodules but without autoimmune thyroid disease.

Methods: The study was designed in a retrospective manner and included a cohort of 239 patients with PTC who underwent total thyroidectomy. Age at diagnosis, disease stage, PTC subtypes, tumor size, radioactive iodine use, nodule ultrasonographic features, and risk of PTC recurrence were compared between patients with and without GD.

Results: Of 239 patients, 99 (41%) had GD, while 140 patients (without autoimmune thyroid disease) had only PTC. The tumor diameter was significantly smaller in the group with PTC + GD (1.45±1.28 cm vs. 1.81±1.34 cm, p<0.05). Significantly lower multifocal involvement rates were observed in the PTC + GD group compared to PTC-only group (p<0.05). The prevalence of the classic papillary thyroid carcinoma subtype was higher in patients without autoimmune thyroid disease (39% vs. 25.7%, p<0.05). Ultrasonographic features of nodules with GD and PTC do not have different characteristics from those of nodules with PTC without GD.

Conclusion: The risk of structural recurrence at the time of diagnosis appears to be similar when PTC is accompanied by GD as compared to PTC alone. Furthermore, the presence of smaller tumor sizes and less multifocality in GD-PTC coexistence may indicate a better prognosis.

Objectives: The incidence of papillary thyroid cancer (PTC) is increasing, and due to the favorable postoperative survival rates, the extent of surgery should be carefully determined, and complications during the operation should be avoided. The recurrent laryngeal nerve (RLN) divides the right paratracheal lymph node (RPTLN) into anteromedial and posterolateral compartments due to its anatomical course on the right and left sides of the neck, and the posterolateral lymph nodes are in close proximity to the RLN. Due to the risk of this complication, in this study, we aimed to determine the risk factors for the development of right paratracheal posterolateral lymph node (RPTPLLN) metastasis in PTC.

Methods: Between 2013 and 2022, patients who underwent central neck dissection (CLND) or central and lateral neck dissection due to the presence of PTC in the right lobe of the thyroid gland were included in the study. Descriptive data, along with preoperative imaging findings and postoperative pathology findings, were retrospectively evaluated.

Results: The data of 55 patients who met the criteria were statistically analyzed. Of these patients, 24 (43.6%) were male and 31 (56.4%) were female. The mean age was 47.9±17.5 years (range: 16-81). The mean tumor size was 2.17±1.43 cm (range: 0.4-7.0). RPTPLLN was observed in 13 patients (23.6%). Univariate analysis revealed that extrathyroidal extension (p=0.008), lymphovascular invasion (p=0.044), presence of right paratracheal anteromedial (RPTAMLN) metastasis (p=0.001), and presence of left paratracheal metastasis (p=0.049) were statistically significant factors. However, in the multivariate analysis, only the presence of RPTAMLN was determined to be a significant variable (p=0.035).

Conclusion: In patients undergoing surgery for PTC, the risk of metastasis in the RPTPLLN should be considered higher when there is metastasis in the RPTAMLN. We believe that formal dissection of the RPTLN should be considered for optimal evaluation in patients with tumors in the right lobe where central dissection is planned. Posterolateral dissection (PLD) should be routinely performed in the presence of clinical lymph nodes in the RPTAMLN. When a decision cannot be made, PLD may not be performed if the anteromedial tissue is examined with frozen pathology and the result is negative.

Objectives: Thyroglossal cysts (TGCs) usually present during childhood and before the age of 30, however, they can also be seen in adults, even in advanced age. Nodular thyroid disease is also common in adults. In the literature, there is an ongoing debate regarding the differences in clinical presentation, gender, and postoperative recurrence of TGC between children and adults. In this study, we aimed to process the data of adult patients who underwent surgery for TGC in our clinic, along with the data on concurrent thyroid disease and thyroid surgery.

Methods: The data of patients over 18 years old who were operated on for TGC at the General Surgery Clinic of Sisli Hamidiye Etfal Training and Research Hospital between 2018 and 2024 were retrospectively evaluated.

Results: A total of 16 patients with a mean age of 43.94±12.98 (21-67) years, were included in the study (11 F/5 M). The diagnosis of TGC was made in 12 patients (75%) by ultrasonography (USG), in 1 patient (6.25%) by computed tomography, in 1 patient (6.25%) by magnetic resonance imaging (MRI), and in 2 patients (12.5%) incidentally intraoperatively. 13 patients (81.25%) underwent the Sistrunk procedure, and 3 patients (18.75%) underwent cyst excision. Among the 16 TGC patients, papillary thyroid cancer in the cyst was detected in one patient (6.25%) preoperatively. During preoperative evaluation, nodular thyroid disease was found in 12 patients (75%). Of these, papillary thyroid cancer was detected in 3 patients (18.75%) preoperatively. Of the TGC group, 3 (18.75%) underwent thyroidectomy for thyroid malignancy, and five (31.25%) underwent additional thyroid surgery for nodular thyroid disease. The patients were followed for a mean of 22.63±18.32 months (3-67 months), and no recurrence of TGC was observed during the follow-up period.

Conclusion: In patients with TGC, thyroid diseases and the requirement for thyroidectomy due to benign or malignant thyroid disease are not uncommon. Patients with TGC should be evaluated for thyroid disease before surgical treatment. While the Sistrunk procedure is the standard surgical technique in the treatment of TGC, in adults, if the cyst terminates below the hyoid bone, total cyst excision without removing the central portion of the hyoid bone may be sufficient.