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.

Erythema multiforme (EM) is a self-limiting, immune-mediated condition characterized by target-like lesions, often triggered by infections, with herpes simplex virus (HSV) being the most common agent. In rare cases, EM may present following Blaschko's lines, a pattern of cutaneous mosaicism. We report a unique case of EM in a 17-year-old male with lesions distributed along Blaschko's lines across his arm, trunk, and leg, marking the most extensive presentation of EM in this pattern to date. The patient had no history of HSV infection or drug use, except for cannabis consumption, which was considered a probable trigger based on the Naranjo Adverse Drug Reaction Probability Scale. Histopathological analysis confirmed the diagnosis of EM, and the lesions resolved with topical clobetasol propionate. This case highlights the rare occurrence of EM along Blaschko's lines in a young patient and suggests cannabis as a potential trigger, contributing to the understanding of atypical presentations and etiology in EM.

Objectives: A common incidental radiological finding in asymptomatic adults is primary empty sella (PES). We examined the clinical, radiological and hormonal features of patients with PES to identify risk factors and guide follow-up strategies.

Methods: The study included 120 patients with PES. Data on patients was obtained retrospectively and included details on symptoms, diseases, as well as radiological, biochemical and hormonal findings. Patients were divided into two groups (partial and total) according to sella turcica cerebrospinal fluid volume and pituitary height. They were also classified as having isolated hormone deficiency (HD), hypopituitarism or panhypopituitarism according to the severity of pituitary insufficiency.

Results: HD was found in 83.3% of the study group. The most common causes were growth hormone deficiency and central hypogonadism. The two groups were indistinguishable with regard to pituitary insufficiency; however, panhypopituitarism was more prevalent in the total PES group (60.5% vs 30.5%). PES was more common in women, while both general and severe HD were more common in men. Pituitary height was positively correlated with thyroid stimulating hormone, free T4, insulin-like growth factor-1, testosterone, estradiol, adrenocorticotropic hormone and cortisol (r=0.275, p=0.002; r=0.277, p=0.002; r=0.394, p<0.001; r=0.319, p<0.001; r=0.195, p=0.032; r=0.220, p=0.016; r=0.310, p=0.001). Low pituitary height and male gender were associated with an increased risk of panhypopituitarism (p=0.002 vs p=0.015).

Conclusion: Pituitary insufficiency is common in PES, but panhypopituitarism is more common in total PES. Low pituitary height and male gender are risk factors for panhypopituitarism. Patients with these characteristics should be monitored more closely.

Objectives: This study aimed to investigate the risk of neoplasm (RON) and the risk of malignancy (ROM) in cases diagnosed as salivary gland neoplasm of uncertain malignant potential (SUMP), with subclassification based on cytomorphologic features.

Methods: A retrospective review was conducted on salivary gland fine-needle aspiration (FNA) specimens diagnosed as SUMP between 2018 and 2022 in a tertiary care setting. Each case was re-evaluated by two pathologists and subclassified into basaloid, oncocytic, or clear cell/other categories according to the dominant cytomorphologic pattern. RON and ROM were calculated for the overall SUMP category and for each cytomorphologic subgroup.

Results: Among 41 SUMP cases, the basaloid subtype was the most common (70.7%), followed by the oncocytic (19.5%) and the clear cell/others (9.8%). Histopathological confirmation was available in 65.9% of cases, all of which were neoplastic, resulting in a RON of 100%. The overall ROM was 29.6%. The ROMs by subgroup were 25% for basaloid, 40% for oncocytic, and 50% for clear cell/others. Pleomorphic adenoma was the most frequently encountered benign neoplasm (33.3%), and basal cell carcinoma was the most common malignant diagnosis (18.5%). The majority of malignant cases (87.5%) were located in the parotid gland.

Conclusion: This study confirms the consistently high neoplastic potential of SUMP lesions and highlights the variation in malignancy risk among different cytomorphologic subtypes. Although the ROM differed among the subgroups, they all demonstrated clinical relevance, supporting the utility of cytomorphologic subclassification in salivary gland cytopathology. These findings may contribute to more refined risk assessment and patient management within the Milan System framework.