Medical Bulletin of Sisli Etfal Hospital最新文献

American Thyroid Association (ATA) guidelines for the management of thyroid nodules and differentiated thyroid cancer (DTC) were first published in 1996 and subsequently updated in 2006, 2009, and 2015. In 2025, the ATA released a revised version focusing exclusively on DTC and excluding thyroid nodules from its scope. In our previous review, we summarized the updates regarding preoperative evaluation, diagnosis, and surgical management of DTC. In this second part of the series, we aimed to compare the 2015 and 2025 ATA guidelines in terms of initial postoperative management. The main changes are evaluated at the level of recommendations, with a particular emphasis on recurrence risk stratification, postoperative risk-adapted surveillance, adjuvant radioactive iodine (RAI) use, postoperative imaging, and radiation safety. This review provides a comprehensive comparison of the 2015 and 2025 ATA guidelines, outlining the key changes in early postoperative management of DTC and highlighting their potential impact on individualized patient care.

Objectives: Despite the prevalence of saphenous vein graft (SVG) failure following coronary artery bypass graft (CABG) surgery, SVGs continue to be widely used. This study aimed to investigate the value of the CHA2DS2-VASc score, originally developed for predicting thromboembolic events in atrial fibrillation, in predicting SVG failure post-CABG.

Methods: This retrospective study analyzed data from 526 patients with a history of CABG who presented with non-ST-elevation myocardial infarction between January 2017 and April 2024. SVG failure was defined as exhibiting stenosis of 70% or greater, or complete occlusion. Preoperative CHA2DS2-VASc scores were calculated for each patient. Multivariable analysis was conducted to identify independent predictors of SVG failure.

Results: Among the 526 patients, 242 (46%) experienced SVG failure. Patients with SVG failure exhibited higher CHA2DS2-VASc scores. Multivariable analysis identified the CHA2DS2-VASc score (OR: 2.203, 95% CI: 1.672-2.902, p<0.001), time interval after CABG (OR: 1.167, 95% CI: 1.081-1.259, p<0.001), and number of SVGs (OR: 2.378, 95% CI: 1.745-3.241, p<0.001) as independent predictors of SVG failure. Of those parameters, the CHA2DS2-VASc score demonstrated a higher AUC value (AUC=0.796, AUC=0.724, AUC=0.641, respectively).

Conclusion: Pre-operative CHA2DS2-VASc score may be predictive of late SVG failure after CABG.

With the increasing use of electronic toys, the number of cases involving battery ingestion has risen significantly in recent years. This case report presents a child who attended the emergency department with sudden chest pain and crying episodes. The electrocardiogram (ECG) revealed signs of myocardial ischemia in inferior leads, despite completely normal cardiac function. A chest X-ray detected a button battery lodged in the esophagus. A 4-year-old boy presented to the emergency department with sudden, intense chest pain and crying while playing with his toys. An electrocardiogram showed prolonged corrected QT interval (cQT 0.56), marked ST depression, and negative T waves in leads DII, DIII and aVF. Echocardiography (ECHO) revealed normal cardiac function. Cardiac enzyme and biochemical tests returned normal results (troponin-I ≤ 3.2 ng/L, CK-MB 29.8 U/L). A disc-shaped battery was detected on chest radiography, and electrocardiographic findings completely normalized after the battery was removed endoscopically. In the literature, rare adult cases of multiple cylindrical battery ingestion have been reported with ECG findings that mimic myocardial ischemia or infarction. Our case is notable as it presents a single disc battery lodged in the esophagus of a pediatric patient that mimicked an inferior myocardial infarction.

Myasthenia gravis (MG) is an autoimmune disorder characterized by abnormal neuromuscular conduction. The thymus is believed to play a key role in the pathogenesis of MG; therefore, thymectomy is an important treatment option for the disease. As MG exacerbations and new-onset MG cases following Coronavirus Disease 2019 (COVID-19) vaccinations have been previously reported in the literature, various complications highly related to autoimmunity, such as Guillain-Barré syndrome, have also been described after vaccination. A previously healthy girl developed her first life-threatening systemic MG attack following administration of the messenger RNA (mRNA) BNT162b2 COVID-19 vaccine. Despite receiving treatment targeting MG, her clinical status did not show significant improvement, which led to the decision to perform thymectomy via the video-assisted thoracoscopic surgery (VATS) approach. After the procedure, a significant improvement was observed in her clinical condition. We aimed to contribute to the literature on this rarely encountered condition by reporting the first paediatric case in our country presenting with BNT162b2 vaccination-associated generalized weakness and severe respiratory distress, who was diagnosed with MG and thymoma during follow-up, in the light of contemporary literature. This case also serves as a warning for other mRNA vaccines.

Objectives: This study was conducted to evaluate the radiological and clinical results of platelet-rich plasma (PRP) therapy in degenerative meniscal lesions.

Methods: Seventy patients with pain and grade 2 degenerative meniscal lesions on MRI (Magnetic Resonance Imaging) were included in the study. All patients underwent Knee Injury and Osteoarthritis Score (KOOS), Tegner-Lysholm, International Knee Documentation Committee Score (IKDC), Visual Analog Scale (VAS) clinical scores, and MRI scans before and 6 months after the injection.

Results: There was a statistically significant increase in Tegner-Lysholm, KOOS, and IKDC scores after the procedure (p=0.001; p<0.01), and a statistically significant decrease in VAS score after the procedure (p=0.001; p<0.01). However, no statistically significant difference was observed in MRI parameters (p>0.05).

Conclusion: It has been shown that the use of intra-articular PRP in painful degenerative meniscal lesions improves knee functions and helps reduce pain. However, no significant difference was observed in MRI controls. The results of our study indicate that the use of intra-articular PRP injection in patients with grade 2 meniscus degeneration improves clinical scores but does not result in significant improvement in degeneration as measured by MRI.

Iodine-containing antiseptics and contrast agents used in neonates can lead to hypothyroidism, which, although often transient, may require prolonged treatment in some cases. Untreated hypothyroidism, even if temporary, can negatively impact neurodevelopment, particularly in preterm infants. In addition, gastrointestinal disorders such as short bowel syndrome or ileus may hinder oral levothyroxine absorption, necessitating alternative administration routes. Here, we present a late preterm neonate who developed hypothyroidism after iodine-containing contrast agent use for diagnosing total intestinal aganglionosis. The patient failed to respond to oral and rectal levothyroxine administration due to functional ileus and persistent gastrointestinal drainage. Subsequently, levothyroxine was administered via the buccal route by diluting the tablet form. The treatment resulted in rapid normalization of thyroid function tests, with no adverse effects observed. In our case, buccal administration of diluted levothyroxine tablets was found to be a beneficial treatment approach for managing hypothyroidism in a patient unable to tolerate oral therapy due to intestinal dysmotility and malabsorption, particularly in the absence of alternative formulations. Furthermore, it highlights the importance of monitoring thyroid function in neonates exposed to iodine-containing agents, especially those with gastrointestinal motility disorders. Buccal levothyroxine may provide a practical solution for managing hypothyroidism in similar clinical scenarios.

Objectives: The aims of this study were to assess the 24-hour ambulatory BP levels and to determine the prevalence of abnormal circadian BP dipping patterns in women with hypopituitarism secondary to Sheehan syndrome.

Methods: This was a cross-sectional study including 35 women with complete anterior hypopituitarism secondary to Sheehan syndrome and 47 age- and body-mass index-matched control women. Subjects receiving treatment for hypertension were not included. All participants underwent clinical examination, laboratory tests, and BP measurement using ambulatory 24-hour monitoring.

Results: The mean age was 61.3±10.6 years in patients vs 60.5±8.5 years in controls (p=0.720). Compared to controls, women with Sheehan syndrome had a higher prevalence of dyslipidemia (p=0.032) and metabolic syndrome (p=0.028). The prevalence of hypertension was 68% in patients and 62% in controls (p=0.520). Altered day-night BP variation was more frequent in patients (85%) than in controls (54%) (p=0.004). Additionally, patients had a significantly higher prevalence of nocturnal hypertension (38% versus 3%; p=0.002). Sheehan syndrome was positively associated with a non-dipper and riser BP profile (Odds Ratio=4.7, 95% confidence interval: 1.54-14.33, p=0.004).

Conclusion: Women with hypopituitarism secondary to Sheehan syndrome had a higher disruption of the circadian BP rhythm than controls. Although the prevalence of newly diagnosed hypertension was comparable between patients and controls, women with Sheehan syndrome had a higher prevalence of nocturnal hypertension.

Objectives: Gastrointestinal Kaposi sarcoma (GI-KS) is a rare vascular neoplasm associated with human herpesvirus 8 (HHV 8), most often emerging in immunosuppressed individuals. Its endoscopic appearance-ranging from nodular and polypoid lesions to ulcerations-can be subtle. In addition, histopathological features of KS may mimic benign inflammatory conditions or other mesenchymal tumors, delaying accurate diagnosis. This study aimed to evaluate the histopathological features of GI-KS and to clarify the neoplastic and non-neoplastic diagnostic challenges in a single-center cohort.

Methods: We retrospectively reviewed 13 GI-KS cases diagnosed between 2005 and 2025. Clinical data and endoscopic findings were retrieved from the hospital's electronic medical records. Hematoxylin and eosin-stained sections, along with HHV-8 immunohistochemistry (IHC) slides, were retrospectively evaluated.

Results: Thirteen patients (11 male; mean age 47±18 years) were identified, of whom 84.6% were immunosuppressed (eight HIV-positive, two renal transplant recipients, and one receiving corticosteroids). Cutaneous or extraintestinal KS lesions were present in 11 cases. Endoscopic evaluation revealed nodular lesions (30.8%), polypoid lesions (23.1%), snake-skin-like hemorrhagic areas (7.7%), infiltrative lesions (7.7%), erythematous elevated lesions (7.7%), or nonspecific erythematous changes (7.7%). Suspicion of KS was documented in only three endoscopy reports. Lesions were most commonly located in the stomach (76.9%), followed by the rectum (15.4%) and colon (7.7%). Histologically, slit-like vascular channels and erythrocyte extravasation were observed in 84.6% of cases, hemosiderin deposits in 53.8%, chronic inflammatory infiltrates including plasma cells in 76.9%, and foveolar epithelial hyperplasia in 70% of gastric cases. The histologic spectrum included diagnostic pitfalls such as chronic gastritis-like features in three cases, reactive gastropathy-like changes in one case, granulation tissue-like appearance in one case, and GIST/leiomyoma-like spindle cell morphology in one case.

Conclusion: The histologic features of GI-KS can mimic both neoplastic and inflammatory conditions. Therefore, histopathological evaluation should be conducted alongside clinical information, as GI-KS may present with subtle or nonspecific findings. Given the potential for life-threatening complications such as obstruction, bleeding, or perforation, accurate diagnosis and timely treatment are critically important. Routine application of HHV-8 IHC -even in cases with minimal suspicion- is essential for ensuring diagnostic accuracy, guiding appropriate management, and preventing serious outcomes.

Objectives: The aim of this retrospective study was to evaluate and compare cervical ultrasound findings, fine needle aspiration biopsy (FNAB) results and excisional biopsy results in the diagnosis of patients presenting with cervical lymphadenopathy and to reveal the most common causes.

Methods: A total of 137 patients who underwent cervical ultrasonography and FNAB before excision were included in the study. Demographic data, cervical ultrasonographic findings, FNAB pathology results and final pathology results after excisional biopsy were analysed.

Results: The pathological results indicated that reactive follicular hyperplasia was diagnosed in 33.6% (n=46) of the patients. A diagnosis of non-Hodgkin lymphoma (NHL) was made in 27.7% (n=38) of cases, while 13.1% (n=18) were diagnosed with Hodgkin lymphoma. Malignant pathology was diagnosed in 66 patients. In the FNAB results of patients diagnosed as malignant, 57 were interpreted as non-diagnostic and suspicious, while 9 were interpreted as benign. Of these, 8 had a pathological examination of lymph node excision that revealed non-Hodgkin lymphoma (NHL), and in one patient with a benign FNAB result, the result of lymph node excision was reported as malignant.

Conclusion: Especially in cervical lymphadenopathies in patients over 40 years of age, the possibility of malignancy increases significantly. In lymphoproliferative diseases and in cases accompanied by clinical suspicion, it would be rational to use the direct excisional biopsy option. Although prior fine needle aspiration biopsy may provide significant guidance in metastatic diseases, it should be kept in mind that false negative rates may increase in the diagnosis and staging of lymphoma.

Objectives: This study aimed to identify the clinical factors independently associated with depressive symptoms in patients with multiple sclerosis (MS) and to evaluate the impact of depression on health-related quality of life (QoL).

Methods: In this prospective observational study, 90 patients with MS were evaluated. Age, sex, disease duration, MS subtype, and Expanded Disability Status Scale (EDSS) scores were recorded. The Fatigue Severity Scale (FSS), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) scale, and the EuroQol 5-Dimension 3-Level (EQ-5D-3L) questionnaire were administered. The presence of restless legs syndrome (RLS) was also recorded. Depression severity was measured using the Patient Health Questionnaire-9 (PHQ-9). First, univariable associations were examined, and relevant variables were subsequently entered into a multivariable linear regression model using backward elimination.

Results: Higher FSS, ISI, and EDSS scores were independently associated with higher PHQ-9 scores. FSS and ISI scores showed the strongest correlations with depression (ρ=+0.52 and +0.57; p<0.001). EDSS showed a modest association (ρ=+0.23, p=0.031). Age, sex, and disease duration were not significant predictors. S-LANSS scores, MS subtype, and RLS were significant in univariate analysis but excluded from the final model. Depression scores were significantly associated with higher EQ-5D-3L scores, indicating poorer QoL (p<0.001).

Conclusion: Fatigue and insomnia were the strongest independent predictors of depression in MS, surpassing traditional clinical indicators. Routine screening for these symptoms may facilitate earlier detection and treatment of depression and improve QoL in clinical practice.