Medical Bulletin of Sisli Etfal Hospital最新文献

Objectives: Atopic skin plays a significant etiological role in the development of prurigo nodularis (PN). In addition to atopic dermatitis (AD), atopic skin diathesis without eczema can also contribute to the development of PN due to its association with itching. This study aims to evaluate PN in terms of AD/atopic skin diathesis, associated comorbidities, and clinical findings.

Methods: Patients diagnosed with PN based on clinical and histopathological findings between 2014 and 2024 were included in the study. Associated diseases that could contribute to the etiology of pruritus were recorded as comorbidities. The diagnosis of AD was evaluated using the Hanifin-Rajka's diagnostic criteria and atopic skin diathesis using the Erlangen Atopy Score. Patients were classified as atopic and non-atopic groups, and these groups were compared in terms of demographic and clinical findings.

Results: The study included a total of 47 patients, of whom 15 (31.9%) were male and 32 (68.1%) were female. At least one comorbidity was identified in 89.4% (n=42) of the patients, and multiple comorbidities were found in 34% (n=16). Atopic dermatitis and/or atopic skin diathesis were present in 55.3% (n=26) of the patients. Among these, 53.8% (n=14) were diagnosed with AD, while 46.2% (n=12) had only an atopic skin diathesis. Compared to the non-atopic group, the atopic group had a lower median age (p=0.001) and higher serum total IgE levels (p=0.031).

Conclusion: In addition to AD, atopic skin diathesis without eczema also appears to play an important role in the etiology of PN. The lower age and higher IgE levels in patients are factors associated with atopic predisposition.

Objectives: Type 2 diabetes mellitus is a disease with a rising prevalence worldwide. Person-centered treatment factors, including comorbidities and treatment goals, should be considered in determining the pharmacological treatment of type 2 diabetes. ChatGPT-4 (Generative Pre-trained Transformer), a large language model, holds the potential performance in various fields, including medicine. We aimed to examine the reliability, quality, reproducibility, and readability of ChatGPT-4's responses to clinical scenarios about the medical treatment approach and management of type 2 diabetes patients.

Methods: ChatGPT-4's responses to 24 questions were independently graded by two endocrinologists with clinical experience in endocrinology and resolved by a third reviewer based on the ADA(American Diabetes Association) 2023 guidelines. DISCERN (Quality Criteria for Consumer Health Information) Measurement Tool was used to evaluate the reliability and quality of information.

Results: Responses to questions by ChatGPT-4 were fairly consistent in both sessions. No false or misleading information was found in any ChatGPT-4 responses. In terms of reliability, most of the answers showed good (87.5%), followed by excellent (12.5%) reliability. Reading Level was classified as fairly difficult to read (8.3%), difficult to read (50%), and very difficult to read (41.7%).

Conclusion: ChatGPT-4 may have a role as an additional informative tool for type 2 diabetes patients for medical treatment approaches.

Objectives: Restoring complex craniofacial deformities presents numerous challenges. Recent years have seen the development of new surgical techniques aimed at improving operation quality and reducing difficulty. However, designing the reduction volume for the affected region and achieving precise contouring remain difficult tasks. The use of three-dimensional (3D) solid models can provide significant assistance at all stages of the operations. This study aimed to investigate the validity of prototype 3D solid models for complex craniofacial operations.

Methods: Simulated 3D models of the patients were used. Conventional surgical instruments were employed for the planning of the operations. Patients had follow-up periods ranging from 6 to 18 months.

Results: Operations have been planned and performed using three-dimensional solid models. Intraoperative steps were executed as simulated during planning. No major complications were developed. All bone and soft-tissue reconstructions healed without major infection.

Conclusion: Stereolithographic models provide: 1) a better understanding of anatomy, 2) presurgical simulation, 3) intraoperative accuracy in lesion localization, 4) accurate fabrication of implants, and 5) improved education for trainees. An accurate method for intraoperative navigation and preoperative planning is clearly useful. This technology offers a direct representation of the patient's anatomy through computer reconstruction, allowing for the efficient and precise transfer of information in complex facial restorative procedures.

Objectives: This study aimed to evaluate the postoperative outcomes and recurrence rate in laparoscopic inguinal hernia repairs performed over a 5-year period with totally extraperitoneal (TEP) technique and use of partially absorbable meshes.

Methods: A total of 100 patients (mean (SD, min-max) age: 51.0 (14.6, 16-83) years, 91.0% were males) who underwent 150 laparoscopic TEP inguinal hernia repairs (bilateral in 50 patients) with use of the partially absorbable mesh were retrospectively reviewed. Data on patient demographics, hernia characteristics (side, subtype), date of operation, operating time, early and late postoperative complications as well as the recurrence rate were recorded over a 5-year period.

Results: The inguinal hernia was bilateral in 50 (50.0%) patients and indirect hernia was noted in 53 (53.0%) patients, while lipoma was evident in 17 (17.0%) cases. Median operating time was 45.0 min (range, 23.0 to 140.0 min). Overall, seroma occurred in 6 (6.0%) patients and was treated conservatively, while none of patients developed preperitoneal hematoma, infection or persistent chronic inguinal pain. Recurrence rate was 0.67% (1/150 operations) within a median 30.0 months (range, 2 to 60 months) of postoperative follow-up. Bilateral hernia was associated with significantly longer operating time compared to left or right unilateral hernia (median (min-max) 50.0 (34.0-140.0) vs. 40.0 (23-80) and 40.0 (25.0-130.0) min, p<0.01 and p<0.001, respectively). Operating time was positively correlated both with patient age (r=0.240, p=0.017) and BMI (r=0.205, p=0.044).

Conclusion: In conclusion, our findings indicate that laparoscopic TEP inguinal hernia repair with use of the partially absorbable meshes enables a favorable postoperative outcome with minimal early and late postoperative complications and 0.67% recurrence rate over a 5-year period.

Cardiac rhabdomyoma is the most common primary cardiac tumor in infants and can be diagnosed by fetal echocardiography. This benign tumor can be found in various locations within the heart, including the left ventricle, right ventricle, or septum, and is typically multiple. While spontaneous regression may occur, hemodynamic disorders, arrhythmias, and sudden death have also been reported. Surgical treatment is recommended for life-threatening ventricular outflow tract stenosis, heart failure, and arrhythmias. This case report presents a successful surgical treatment approach in a newborn with rhabdomyoma that caused severe left ventricular outflow tract stenosis.

Objectives: Cognitive impairment is a prevalent non-motor symptom of Parkinson's disease (PD), significantly impacting patient quality of life. The Clock Drawing Test (CDT) evaluates cognitive abilities, including planning, organization, and executive functions such as attention, memory, and visuospatial skills. This study aimed to determine the sensitivity of the CDT in diagnosing cognitive impairment in PD.

Methods: We reviewed the records of 44 PD patients (16 female, 28 male) diagnosed with dementia (30 patients) or mild cognitive impairment (14 patients) between 2018 and 2022. These patients were compared to 106 visitors to the neurological outpatient clinic, serving as a control group. A separate researcher assessed the patients' CDT scores, maintaining confidentiality of all other patient data except age and education level.

Results: Among the 44 PD patients, two with mild cognitive impairment were rated as normal, while all PD dementia cases were identified solely through the CDT. In the healthy control group, 72 out of 106 individuals reported no cognitive complaints, whereas 34 individuals (32.1%) reported cognitive complaints as assessed by a blind investigator. The CDT demonstrated a positive predictive value of 55.3% and a negative predictive value of 97.3%. Sensitivity was calculated at 95.5%, and specificity was 67.9%.

Conclusion: The findings suggest that the CDT is sensitive in detecting cognitive impairment in PD patients with cognitive deficits. While the CDT serves as an effective rapid screening tool, high scores indicate the absence of cognitive impairment, but low scores alone are insufficient for a definitive diagnosis of dementia. Comprehensive neurological evaluation and detailed cognitive assessment remain essential for confirming dementia diagnoses.

Objectives: To compare the usage of laryngeal mask airway (LMA) and orotracheal intubation (OTI), which are separate airway management methods in tracheal reconstruction surgeries, in terms of perioperative management, mortality, and morbidity.

Methods: Adult patients who underwent tracheal reconstruction surgery between June 2020 and June 2022 were included in the study, retrospectively. Patients with lost data or primary tracheal malignancy were excluded. Patients who underwent tracheal reconstruction were divided into two groups: LMA and OTI.

Results: Of a total of 57 included patients, the OTI and LMA groups had 30 (52.63%) and 27 patients (47.37%), respectively. The rate of intubated transfer to the intensive care unit and the length of stay in the intensive care unit were significantly higher in the OTI group (p=0. 014, p=0. 031) than those of the LMA group; further, in tracheal cultures, reproduction was also significantly higher in the OTI group (23.33%) (p=0. 007). The postoperative mortality rates were similar in both groups.

Conclusion: Since the absence of tension in end-to-end anastomosis of the trachea is vital for successful surgery, the LMA application (which has no tracheal contact) can be considered superior to OTI. In this study, LMA was successfully applied in all patients. Considering that the aim of anesthesia management should be to provide adequate oxygenation and normocarbia with minimally invasive intervention, we suggest airway management using LMA as the first option for tracheal reconstruction surgery because of the advantages described in this study.

Objectives: Current guidelines suggest that patients with cystic fibrosis (CF), who are over the age of 10, should be annually evaluated with oral glucose tolerance test (OGTT). In this study, it was aimed to evaluate the OGTT results in patients above the age of 10, who were followed up in our center with the diagnosis of CF.

Methods: In the study, 46 patients with CF at the age of 10 and above, who underwent OGTT were included. Data such as gender, age at diagnosis, anthropometric measurements, lung function (FEV1 %) and the OGTT results were obtained. In the analysis, the patient groups with normal glucose tolerance (NGT) and abnormal glucose tolerance(AGT) were compared.

Results: NGT was found in 37(80.4%) of the patients, and AGT was found in 9(19.5%) of the patients. The median fasting glucose levels of the patients in the NGT group and the mean glucose levels measured at 120 minutes in the OGTT were found to be lower compared to the patients in the AGT group(p<0.005). Although the mean body weight, height, VKİ-SDS, FEV1in the AGT group were found to be lower than the patients in the NGT group, the difference was not statistically significant (p>0.05).

Conclusion: We detected AGT in approximately 1 out of 5 patients with CF who were at the age of 10 and above. Almost half (44.4%) of the patients with AGT were found to have normal fasting blood glucose levels. Therefore, cystic fibrosis-related diabetes screening should be performed with OGTT instead of fasting blood glucose in patients with CF.

Objectives: Although rare, vascular injuries are common in elective abdominal or pelvic surgeries. When encountered, any problem in the relevant artery/vein (occlusion, stenosis, dissection, pseudoaneurysm or arteriovenous fistula) is associated with mortality and morbidity in both the short and long term. We aimed to share our treatment approach and short-term results for vascular injuries in elective surgery.

Methods: In this study, the clinical data of patients who underwent elective abdominal and pelvic surgery performed by a vascular surgeon and who sustained iatrogenic vascular injury between January 2018 and July 2023 were retrospectively examined. All patients with no iatrogenic vascular injuries were excluded from the study.

Results: In the present study, a total of 72 patients had iatrogenic vascular injuries and underwent vascular surgery. The average age of the patients was 50.8±14.6 years. Twenty-eight (38.8%) of the patients were male, and 44 (61.1%) were female. Iatrogenic vascular injury occurred in 21 (29.2%) patients who underwent urologic surgical interventions, 35 (48.6%) who underwent gynecologic surgical treatments, and 16 (22.2%) who underwent abdominal surgeries. Twenty-nine patients had isolated arterial injuries, 37 patients had isolated venous injuries, and 6 patients had both arterial and vein injuries. Embolectomy was performed on 24 patients. Primary sutures were applied in 22 patients, end-to-end anastomosis with a vein graft was performed in 13 patients, and end-to-end anastomosis with Dacron/PTFE was performed in 11 patients. In 10 patients, native vein end-to-end anastomosis was performed. During the 30-day follow-up period, 3 patients experienced arterial occlusion, and 2 patients experienced venous thrombosis. There was no mortality in the hospital or during the 30-day follow-up period.

Conclusion: Vascular injuries rarely occur in elective abdominal and pelvic surgeries. However, when they happen, they are fatal. For this reason, preoperative, multidisciplinary evaluation will minimize the risk of vascular complications, especially in patients requiring mass excision and lymph node dissection with close vascular proximity.

Objectives: In this retrospective study, we evaluated the effectiveness of the tumor volume, grade invasion depth in the prediction of cervical lymph node metastasis.Identification of diagnostic parameters reliably predicting cervical lymph node involvement can be useful in improving the management of laryngeal cancer.

Methods: One hundred and seven patients with squamous cell carcinoma of larynx and who underwent surgery were assessed retrospectively. Age, sex, Tumor-Node-Metastasis (TNM) stage, grade, invasion depth and computerised tomography (CT) volume of the tumors were analysed. The association between these parameters and cervical lymph node metastasis was determined.

Results: Thirty two patients (29.91%) had positive cervical lymph nodes. Lymph node metastasis is detected in 13 (46.43%) poorly differentiated tumors, and in 19 (24.05%) moderate-well differentiated tumors. Mean volume was 2.15±0.14 cc in lymph node negative patients and 2.97±1.05 cc in lymph node positive patients. Mean invasion depth was 10.1±0.87 mm in lymph node negative patients and in 11.3±1.05 mm lymph node positive patients. The tumor grade and volume predicted successfully lymph node metastasis in patients with squamous cell carcinoma of the larynx, however invasion depth was not associated with nodal metastasis (p=0.047, p=0.0022, p=0.916, respectively).

Conclusion: The tumor grade and volume could predict cervical lymph node metastasis in patients with squamous cell carcinoma of the larynx, whereas the depth of invasion did not. Calculation of the tumor volume radiologically can help predict lymph node metastasis by minimizing the variability in measurements such as the depth of invasion.