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 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.

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.

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: 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.

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.