Medical Bulletin of Sisli Etfal Hospital最新文献

People have used the traditional Turkish bath for centuries to cleanse themselves, maintain their health, and treat various diseases. The communal use of these areas may contribute to the development and spread of certain dermatoses due to contact with water and environmental factors. Tinea pedis, verruca, molluscum contagiosum, and Pseudomonas aeruginosa folliculitis are among these infections. Undoubtedly, pseudomonal infections are the most well-known waterborne infectious diseases. Pseudomonas aeruginosa folliculitis (hot tub folliculitis), Pseudomonas hot-foot syndrome, toe web infections, ear infections, and ecthyma gangrenosum are the most common clinical presentations. Public baths may provide suitable environments for fungal colonization in cases of insufficient disinfection, long-term public use, high user density, and elevated water temperatures. Common fungal infections, including tinea pedis, tinea corporis, and tinea unguium, are most likely attributed to increased exposure to fungal pathogens and skin maceration. Scabies and pediculosis are parasitic infections that can be transmitted in communal living spaces, but their treatment also involves bathing. There are limited data on the number of infectious dermatoses acquired from Turkish baths. Given that most baths undergo frequent disinfection and the water does not remain stagnant, it can be concluded that bath-related infections are uncommon.

Polydactyly is a congenital extremity malformation defined by the presence of additional digits. The mirror foot anomaly, regarded as a rare variant of preaxial polydactyly, is characterized by a mirror image duplication of the foot. Due to the variability of mirror foot patterns reported in the literature, defining the term "mirror foot" remains challenging. In this case study, we present the treatment of a five-year-old male patient with a mirror foot anomaly who was admitted to our outpatient clinic. There is no consensus on the optimal surgical management strategy, and very few cases have been documented in the literature.

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.

American Thyroid Association (ATA) guidelines for the management of thyroid nodules and differentiated thyroid cancer (DTC) were first published in 1996 and updated in 2006, 2009, and 2015. In 2025, the ATA released a revised version that, for the first time, focuses exclusively on DTC. In our previous reviews, we summarized the updates on preoperative, diagnostic, surgical, and early postoperative management of DTC. In this third and final part, we compare the 2015 and 2025 ATA guidelines with respect to long-term follow-up, TSH suppression strategies, thyroglobulin monitoring, follow-up of low-risk patients. Diagnostic radioiodine whole-body scanning, FDG-PET/CT, dynamic risk stratification, and the management of recurrent or metastatic disease, including local therapies, radioiodine preparation and dosing, and systemic treatments were also highlighted in this part. Particular emphasis is placed on the expanded recommendations for kinase inhibitor therapy, sequencing of systemic agents, targeted therapies (NTRK, RET, ALK, BRAF), redifferentiation approaches, immunotherapy, and supportive care strategies addressing bone and brain metastases, financial toxicity and psychosocial needs. This review provides a comprehensive synthesis of these updates and discusses their implications for individualized long-term management of DTC.

Objectives: Breastfeeding is accepted to be the optimum nutrition for term and preterm newborns. The objective of our study was to investigate the rates of exclusive breastfeeding (EBF) at discharge among infants less than 34 weeks of gestation (GWs), followed up in neonatal intensive care unit (NICU) and to analyze the factors influencing EBF practices at discharge and 6th months of age.

Methods: In this study, we retrospectively evaluated the medical records of neonates <34 GWs admitted to NICU within the first postnatal 24 hours of life between January 2022 and June 2023. The maternal and neonatal demographic data and the related medical and nutritional factors, morbidities were recorded. Data regarding the duration of exclusive breastfeeding, and the maintenance of breastfeeding were retrieved from the follow-up records of the high-risk newborn outpatient clinic post-discharge. The rate of breastfeeding at discharge and the factors influencing breastfeeding practices were analyzed.

Results: The study cohort comprised 114 neonates, of whom 44.8% were female and 55.2% were male. The mean gestational age was 29.8±2.6 weeks and the mean birth weight was 1365±474 grams. The exclusive breastfeeding rate was 57.8% at discharge and declined to 45.6% at six months. The mean duration of breastfeeding was 15.7±6.5 months. Maternal ethnicity and the language barrier were found to be statistically significantly associated with exclusive breastfeeding at discharge, respectively (p=0.04, p=0.05). Infants who were exclusively breastfed at six months had significantly higher gestational age and shorter duration of hospital stay, respectively (p=0.029, p=0.02). Exclusive breastfeeding at six months was statistically significantly associated with a reduced incidence of extrauterine growth retardation (EUGR) (p=0.04). Among exclusively breastfed infants at discharge, 96.9% (n=64) received breast milk as their first feed, significantly more than mixed-fed infants (p=0.005). Time to reach full enteral feeding was also statistically significantly shorter in the exclusively breastfed group (p=0.017). Infants with a shorter duration of feeding via orogastric/nasogastric tube had a significantly higher rate of exclusive breastfeeding at six months compared to the mixed-fed group (p=0.043).

Conclusion: To improve exclusive breastfeeding rates at discharge and six months postnatally, and to reduce the incidence of EUGR, feeding preterm infants with their mother's own milk from birth should be actively promoted. In addition, comprehensive and consistent maternal support should be provided in the NICU to facilitate both the initiation and continuation of breastfeeding under all circumstances from birth.

Idiopathic scrotal elephantiasis is a rare yet physically and psychologically debilitating condition characterized by chronic lymphedema of the scrotum. This case report presents an 18-year-old male with progressive scrotal enlargement over seven years. The patient applied to our clinic due to discomfort and occasional discharge. Clinical examination revealed scrotal edema without systemic involvement. Diagnostic imaging excluded other pathologies. Surgical intervention was planned, and 1.2 kg of excess tissue was meticulously excised while preserving the testes and spermatic cords. No complications were observed during the postoperative recovery period that necessitated secondary surgical intervention. Treatment options for idiopathic scrotal elephantiasis range from conservative management, such as elevation, compression therapy, and skin care, to surgical interventions, including vascularized lymph node transfer (VLNT) and lymphaticovenous anastomosis (LVA), in addition to tissue excision. This case report aims to underline the significance of early diagnosis, tailored treatment, and comprehensive postoperative care.

Objectives: Family physicians (FPs) are directly responsible for the care of people with epilepsy. However, their education about epilepsy may be inadequate or lacking. The aim of this study was to assess the basic knowledge and self-efficacy levels regarding epilepsy among FPs and to identify their educational needs in managing epilepsy.

Methods: The sample for this pre-test-intervention-post-test study consisted of 60 FPs. FPs attended a four-hour training on epilepsy management. The effectiveness of the training was assessed with the Epilepsy Knowledge and Self-Efficacy (EKSE) scale before and after the training. In addition, a survey was conducted to determine the problems encountered in the follow-up of epilepsy patients and their training needs.

Results: 60 physicians participated in the study [37 males (61.7%), mean age 37.97±8.92 years and professional duration 80.48±70.59 months]. While the total EKSE score of FPs was 90.23±10.97 before the training, it increased to 112.3±15.26 points after the training (p<0.001). After the training, significant score increases were observed in all subcomponents of the EKSE compared to before the training. After the training, there was a significant improvement in the physicians' ability to recognize diseases accompanying epilepsy, to have sufficient knowledge about antiseizure medications, and to follow up patients with epilepsy compared to before the training (p<0.001, p=0.001, and p=0.002, respectively).

Conclusion: This study demonstrated that FPs have need for education regarding epilepsy management and that the education provided has a positive impact.