Medical Bulletin of Sisli Etfal Hospital最新文献

Objectives: Replantation surgery is one of the most difficult areas of reconstructive surgery. The aim of finger replantation is to restore sensation and adequate function of the amputated part in addition to restoring circulation. It is very crucial to investigate prognostic factors to improve the outcomes of this surgery. The type and severity of the injury, along with the duration between the injury and surgery, are the most significant factors influencing the success of replantation. This study investigates the impact of the type of anesthesia used on the success of replantation and other postoperative factors.

Methods: The finger replantation operations performed in our clinic between December 2018 and December 2023 were retrospectively analyzed. The effects of gender, smoking, type of injury, vein repair, nerve repair, use of vein graft, level of injury, type of anesthesia, preoperative and postoperative hemoglobin values on replantation success were statistically investigated in 192 patients (162 males, 30 females). Ratios in independent groups were compared by chi-square test. Comparisons of numerical variables in the independent groups were conducted using the Mann-Whitney U test, as the assumption of normal distribution was not satisfied.

Results: In the study, among the 192 patients, 91 received anesthesia via axillary nerve block (47.4%), 33 received general anesthesia (17.2%), and 28 received local anesthesia through digital block (14.6%). It was found that the type of anesthesia had no effect on the success of the replantation (p<0.05). A statistically significant difference was observed in the amount of change in hemoglobin levels between preoperative and postoperative measurements, according to the type of anesthesia. In the group receiving axillary nerve block, the decrease in hemoglobin levels was greater compared to the group receiving local anesthesia.

Conclusion: Our study found that smoking status and type of injury had no effect on the success of replantation.

Objectives: Wrist and forearm deformities are usually due to congenital or post-traumatic causes. These deformities cause progressive pain and limitation of motion and impair quality of life. Acute correction with radius and/or ulna osteotomy and fixation with plate or wire can be applied in treatment, but complications such as vascular/nerve damage, malunion and inadequate correction may be encountered. Treatment with circular external fixators provides correction without residual deformity and is safer because it can provide deformity correction and gradual lengthening both intraoperatively and postoperatively. Computer-assisted circular external fixators (Ca-CEF) facilitate the correction of complex deformities by allowing postoperative deformity planning to be redone. In this study, we analyzed wrist or wrist deformities treated with Ca-CEF.

Methods: The hospital database was searched for patients who underwent surgery for wrist and forearm deformity between 2010 and 2020. Demographic data, radiographic and functional measurements of the patients were evaluated. Preoperative and postoperative forearm supination, pronation, wrist flexion and extension, Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, Mayo Wrist Score and grip strength were measured. Radiological measurements of radius, ulna lengths, radial inclination and volar tilt were performed. Postoperative complications were analyzed. Preoperative and postoperative data of the patients were analyzed statistically.

Results: A total of 14 patients were included in the study. The mean age of the patients was 17.1 years (11-34), 8 were female and 6 were male. The mean follow-up period was 18.4 months (6.8-32.9). The planned anatomical correction was achieved in all patients. The mean differences between preoperative functional and radiographic data and postoperative data were 7.8 (p=0.029) for forearm supination, 14.64 (p<0. 001), 6.17 kg for Grip Strength (p=0.001), 3.07 for VAS (p<0.001), 21 points for DASH Score (p=0.003), and 22.14 points for Mayo Wrist Score (p=0.004), which were statistically significantly better. No major complications were observed in any patient.

Conclusion: The study showed that Ca-CEF provides functional improvement and radiological improvement and is a safe treatment method with low complication rates. This method stands out as an effective option in the treatment of complex deformities.

Objectives: Primary central nervous system lymphoma (PCNSL) is a rare and aggressive form of non-Hodgkin lymphoma (NHL). This study aimed to investigate the characteristics, treatment approaches, and outcomes of patients with PCNSL in a single institution.

Methods: We retrospectively analyzed 11 patients with PCNSL treated at our institution between October 2022 and July 2024. Patient demographics, clinical characteristics, treatment modalities, and outcomes were evaluated.

Results: The median age of the patients was 65 years, with male predominance (63.64%). The median follow-up duration was 10 months. All patients were immunocompetent, and 90.91% had diffuse large B-cell lymphoma. At diagnosis, 81% of the patients were considered fit to receive HDMTX treatment. R-MPV was the most common first-line treatment (45.45%). The complete response rate to initial treatment was 80%. The treatment-related mortality was 9.09%. Autologous stem cell transplantation (ASCT) was performed in 72.73% of the patients, with rituximab-thiotepa-carmustine as the predominant conditioning regimen (62.50%). Treatment-related toxicities occurred in 50% of patients, and 87.50% of patients experienced transplant-related complications. The transplantation-related mortality rate was 25%. The relapse rate was 25% among the patients undergoing ASCT. The mortality rate was 36.36%, and cerebellar involvement was significantly associated with a higher mortality rate (p=0.045).

Conclusion: This study demonstrated the efficacy of methotrexate-based regimens and ASCT in the treatment of PCNSL and achieved high complete response rates. However, the significant incidence of treatment-related toxicities and mortality underscores the persistent challenges of managing this disease. In addition, the association between cerebellar involvement and increased mortality requires further investigation. Larger prospective studies are needed to validate these findings.

Congenital morphological disorders of the vascular bed, especially located on the main arteries and veins of the extremities, can cause chronic venous insufficiency and venous claudication, creating exacerbated symptoms for the patient and which require intervention. In cases where interventional radiology is insufficient, surgical approaches should be prioritized. Sixty-five years old male patient admitted to our clinic with increased bilateral lower extremity swelling which revealed to be chronic venous insufficiency secondary to congenital disorders. Sapheno-femoral veno-venous bypass (Palma operation) was performed, and patient was discharged on post-operative day 15 without further complaints. Palma Operation is an effective surgical treatment option in venous malformations of lower extremity where interventional radiology is not sufficient.

Objectives: Chronic spontaneous urticaria (CSU) is a common disease characterized by wheals and/or angioedema. Since it is a chronic, itch-related disease, it may substantially affect the psychological status and quality of sleep. In this study, it was aimed to evaluate the impact of CSU on depression, anxiety, stress, and quality of sleep, as well as their relation to disease-specific factors.

Methods: This prospective case-control study included 86 patients with CSU and 86 controls. The sociodemographic and clinical characteristics of the patients, such as scores of urticaria activity score (UAS7) and chronic urticaria quality of life questionnaire (CU-Q2oL), were recorded. Depression, Anxiety, and Stress Scales-21 (DASS-21), Pittsburgh Sleep Quality Index (PSQI), and Dermatology Life Quality Index (DLQI) were used to evaluate their psychological status, quality of sleep, and life.

Results: Of 172 participants, the patient group comprised 86 patients with CSU, and the control group comprised 86 age and sex-matched volunteers. Of 86 patients with CSU, 60 (69.8%) were females and 26 (30.2%) males with a median age of 34.5 years. In the patients with CSU, the median scores (interquartile range) for depression, anxiety, and stress, according to DASS-21, were 6 (8), 5 (6.25) and 6 (7), respectively. Additionally, the median scores of PSQI and DLQI were 7 (5) and 5.5 (11), respectively. The median scores for depression, anxiety, and stress according to DASS-21, the median scores of PSQI and DLQI were statistically significantly higher in the patient group than in the control group. According to the PSQI classification, 68 (79.1%) patients had poor sleep quality, while 18 (20.9%) patients had good sleep quality. When the patient group was examined in two groups, those with good and poor sleep quality, UAS7, depression, anxiety, stress, and DLQI/CU-Q2oL scores were statistically significantly higher in the patients with poor sleep quality than in the patients with good sleep quality.

Conclusion: Treatment of urticaria is typically symptomatic and aims to reduce the symptoms of itching and wheals. However, clinicians can contribute to the well-being of patients if they are aware of psychological comorbidities and sleep disturbances.

Objectives: This study aimed to evaluate the etiology, clinical characteristics, and outcomes of mesenteric lymphadenopathy (ML) in children, with an emphasis on its clinical significance and management strategies.

Methods: This cross-sectional, single-center study was conducted between July 2016 and May 2017 and included pediatric patients aged 1 month to 18 years diagnosed with ML via abdominal ultrasonography. Patients with malignancies, acute infections, ongoing corticosteroid or antibiotic treatment, or incomplete follow-up were excluded. Data collection included demographic, clinical, and laboratory findings. Statistical analyses were performed using IBM SPSS Statistics version 25. The Mann-Whitney U test was used for comparisons of numerical variables between groups, while the chi-square and Fisher's exact tests were applied for categorical variables. A p-value less than 0.05 was considered statistically significant.

Results: A total of 106 patients were included with a median age of 7.4 years (range: 8 months-16.4 years), of whom 55.7% were male. The majority (63%) were aged 6-11 years. Abdominal pain was the most common symptom (64.2%), and 99.1% of the ML cases were localized in the right lower quadrant. At 1-month follow-up, lymph node sizes regressed to normal in 71.7% of cases, while 28.3% remained pathological. Antibiotic use did not significantly affect lymph node regression. At 6 months, no new symptoms or diagnoses were reported in the 91 patients contacted. ML was most often idiopathic (76.4%), with secondary causes including gastrointestinal and respiratory infections, acute abdomen, and Familial Mediterranean Fever.

Conclusion: In children, ML is predominantly benign and self-limiting, and in most cases, it resolves without medical intervention. Although its association with symptoms such as abdominal pain may cause anxiety in parents, careful monitoring of patients can prevent unnecessary interventions. This study underscored the importance of conservative management and highlighted the need for further research with larger cohorts and extended follow-up periods to explore rare etiologies and long-term outcomes.

Objectives: The primary aim of this study was to evaluate the effects of nocturnal enuresis (NE) on Health-Related Quality of Life (HRQoL) in children with a special emphasis on the domains of HRQoL.

Methods: This was a case-control study in which consecutive children with NE were recruited along with their parents. Age and sex-matched children without enuresis served as controls. Age-appropriate children and proxy versions of the German Quality of Life Questionnaire (KINDL) were used to evaluate HRQoL and its domains. The clinicodemographic characteristics and family data were collected. HRQoL and the domain scores were compared between the patients and the control subjects.

Results: 100 children (50 of whom are males) with enuresis along with their parents were included in the study. 100 children served as the control group. The mean age of the patients was 9.58±2.77 years, and was no different from that of the control group. 55% of the children were receiving treatment for NE. The most common treatment was the nighttime waking (40%). The most commonly used drug was desmopressin. The median score of the health-related quality of life was 78.8 [69.2-83.3] in children with NE versus 90 [86.7-91.7] in the control group (p<0.001). In all domains, the median scores were significantly lower in children with NE compared with the controls.

Conclusion: Turkish children with NE had a significantly lower HRQoL score compared with children without NE. All the domain scores were also significantly lower in children with NE compared with the control subjects.

Objectives: Nutritional status significantly impacts outcomes in allogeneic hematopoietic stem cell transplantation (allo-HSCT). Among various indices, the Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) scores hold potential as prognostic tools. This study compares their predictive utility for transplant outcomes.

Methods: A retrospective analysis was conducted on 41 patients who underwent their first allo-HSCT between October 2022 and July 2024. Nutritional scores were calculated using pre-transplant data, and their associations with mortality and non-relapse mortality (NRM) were assessed. Receiver operating characteristic (ROC) curves and multivariable logistic regression were employed to evaluate predictive accuracy.

Results: The high CONUT score demonstrated the highest prognostic accuracy for mortality (AUC: 0.771, p=0.026) and NRM (AUC: 0.806, p=0.047). It was the sole independent predictor of mortality (OR: 2.180, p=0.028). Both the NRI (AUC: 0.737, p=0.040) and PNI (AUC: 0.803, p=0.008) were also associated with mortality but lacked independent predictive value. Higher CONUT scores correlated with increased mortality rates.

Conclusion: The CONUT score emerged as the most effective nutritional scoring system for predicting mortality in allo-HSCT patients. Its simplicity and integration of key clinical parameters make it a valuable tool for early risk stratification and targeted interventions. Further studies with larger cohorts are warranted to validate these findings and refine nutritional management strategies.

Objectives: Venom-specific immunotherapy is recognized as the gold standard treatment for honey bee and wasp venom allergies. This study aims to evaluate the clinical characteristics and treatment outcomes of patients diagnosed with honey bee and wasp venom allergies who commenced immunotherapy.

Methods: This study encompasses data from 43 patients who presented with honey bee and wasp venom allergies at Ondokuz Mayis University and initiated venom immunotherapy (VIT). We retrospectively examined the patients' demographic characteristics, history of atopic diseases, allergy history, characteristics of honey bee and wasp venom stings, severity of reactions, laboratory values, administered treatments, and side effects.

Results: Among the 43 patients included in our study, 9 (20.9%) were female, and 34 (79.1%) were male. A history of atopic disease was present in 34.8% of the patients, and a family history in 51.1%. The severity of systemic reactions was evaluated according to Müller's classification, with grade 4 reactions being the most frequent (48.8%). Of the 43 patients who received VIT, 28 (65.1%) were treated for Apis mellifera, 9 (20.9%) for Vespula vulgaris, and 6 (14%) for both species. Twelve patients experienced side effects during VIT, leading to discontinuation in two cases due to patients' reluctance to continue. The remaining 22 patients, who were stung again during or after completing VIT, experienced milder systemic reactions.

Conclusion: This study delineates the demographic and clinical characteristics of patients with honey bee and wasp venom allergies, highlighting the efficacy of VIT treatment. Despite the occurrence of side effects related to VIT, both previous studies and our findings suggest that these side effects are not more severe than systemic reactions resulting from stings. The absence of severe systemic reactions in patients who were stung again during or after receiving VIT underscores the effectiveness of the immunotherapy.