Medical Bulletin of Sisli Etfal Hospital最新文献

Objectives: This study aimed to compare the expression of midkine (MK) in the vitreous of patients with proliferative diabetic retinopathy (PDR) and non-diabetic individuals, elucidating its potential role in the pathogenesis of the disease.

Methods: This prospective cross-sectional study included three groups of patients who underwent pars plana vitrectomy (PPV) surgery. The first group (control) consisted of patients who underwent PPV for epiretinal membrane and macular hole and did not have diabetes mellitus (DM). The second group included patients who underwent PPV for vitreous hemorrhage (VH) and tractional retinal detachment (TRD) secondary to PDR without prior anti-VEGF treatment (No preoperative anti-VEGF application: NPa-VEGF). The third group comprised patients who underwent PPV for VH and TRD secondary to PDR and received a preoperative anti-VEGF injection one week before surgery (preoperative anti-VEGF application: Pa-VEGF). Vitreous samples were collected intraoperatively, and the concentrations of MK, interleukin (IL)-6, and IL-8 were measured using specific Enzyme-Linked Immunosorbent Assay (ELISA) kits.

Results: The study included a total of 49 eyes from 49 patients undergoing PPV. The concentrations of IL-6 and IL-8 in vitreous samples from the NPa-VEGF group (n=15) and the Pa-VEGF group (n=14) were not significantly different compared to the control group (n=20) (p>0.05). However, the vitreous fluid of patients in the NPa-VEGF group exhibited significantly higher MK concentrations compared to the control group (p<0.007). Similarly, MK concentrations were significantly elevated in the Pa-VEGF group compared to the control group (p<0.046). No significant difference in MK levels was detected between the NPa-VEGF and Pa-VEGF groups (p>0.05).

Conclusion: These findings suggest that increased MK expression in the vitreous may be associated with the pathogenesis of PDR. Further studies are warranted to elucidate the precise mechanisms underlying this association and to explore the potential of MK as a therapeutic target for PDR management.

Congenital hyperinsulinism (HI) is the leading cause of persistent hypoglycemia in infants and children. Focal pancreatic lesions account for 30-40% of cases with congenital HI. With early diagnosis, these patients can be treated by resection of the lesion, making long-term medical care unnecessary. In this case, a 5-day-old newborn boy presented with convulsion due to severe and persistent hypoglycemia at his hospitalization in neonatal intensive care unit. Laboratory studies revealed very low levels of ketone bodies with inappropriately normal insulin levels during hypoglycemia. The patient was unresponsive to diazoxide treatment. The molecular genetic analysis revealed a heterozygous pathogenic variant in the ABCC8 gene. 18F-DOPA-PET/CT scan showed increased uptake of 18F-DOPA consistent with focal lesion at the tail of the pancreas. A focal pancreatectomy operation was performed when he was three months old. Histopathological evaluation confirmed focal endocrine cell hyperplasia. Hypoglycemia did not recur after the operation. CHI patients with ABCC8 / KCNJ11 mutation are not easy to manage with pharmacotheraphy. In the case of an identifiable focal lesion associated with CHI, surgery is the most preferred option. In focal CHI, as in our case, the lesion may not be visually evident and requires a surgeon experienced in CHI.

Objectives: 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) is a widespread imaging technique for whole-body scanning. Incidental lesions may be detected in thyroid gland and the importance and management of these lesions are still a matter of debate. The aims of this study were the evaluation of the diagnostic success of ultrasonography and FDG-PET/CT for predicting malignancy and contribution of these techniques for the decision of Fine Needle Aspiration Biopsy (FNAB) in incidental thyroid lesions detected in FDG-PET/CT.

Methods: Patients who underwent FDG-PET/CT in Nuclear Medicine Unit in a single institution between January 2018 and December 2022 were screened for thyroid incidentaloma with increased focal FDG uptake. Imaging studies and pathology results of the patients with Focal Thyroid Incidentalomas (FTI) were reviewed retrospectively.

Results: A total of 14.003 FDG-PET/CT reports of 8.259 patients were evaluated. In FDG-PET/CT imaging, 495 (6.0%) patients had increased uptake in thyroid gland, 383 (4.6%) patients had focal and 112 (1.4%) patients had diffuse FDG uptake. The rate of malignancy in FTIs was 19.2%. In the ROC curve analysis, regarding the prediction of malignancy in FTIs with FDG uptake, a SUVmax value of 5.5 and above predicts malignancy with a sensitivity of 71.4% and a specificity of 68.6% (AUC:0.718, p=0.018, 95%CI:0.564-0.872). The sensitivity of ACR-TIRADS-5 was 35.7% (95%CI:14.6-61.7) and sensitivity of the combination of SUVmax>5.5 and ACR-TIRADS-5 was 30.0% (95%CI:8.5-60.7).

Conclusion: FDG-PET/CT findings can be used for determining malignancy risk and cutoff values such as 5.5 can be threshold for ordering FNAB. In patients with SUVmax less than 5.5, ultrasonographic risk classification criteria should be used for decision-making.

Objectives: The objective of this study is to examine the safety of percutaneous renal mass biopsy and compare the oncological outcomes between patients who had a renal biopsy prior to nephrectomy procedures and those who did not have a biopsy.

Methods: We evaluated a total of 145 patients who underwent nephrectomy for renal cancer between January 2017 and January 2021. Based on the pretreatment percutaneous renal mass biopsy, we categorized the patients into two groups: the biopsy (-) group and the biopsy (+) group. We performed a comparative analysis of the radiologic and histological characteristics of the tumors in all the groups. We also conducted an examination of the surgical margin outcomes in cases of partial nephrectomy between the two groups. In addition, we did an analysis of the overall survival (OS), recurrence-free survival (RFS), metastasis-free survival (MFS), and disease-free survival (DFS) between each group.

Results: Out of 145 patients meeting inclusion criteria, we analyzed 119 cases. The mean age and tumor diameter were 56.75±11.71 years and 53.77±23.99 mm, respectively. Operative time averaged 176.87±56.46 minutes, with a mean follow-up of 25.67±14.27 months (range: 8-60 months). Partial nephrectomy rates were 35.41% (biopsy (-)) and 43.47% (biopsy (+)), with left kidney tumors in 46/96 (biopsy (-)) and 16/23 (biopsy (+)) cases, respectively. Cystic and exophytic tumors varied significantly between groups (p=0.01 and p=0.03). During follow-up, 16 deaths occurred. Mean overall survival (OS) was 51.38±2.26 months. We noted local recurrence and metastatic progression in 4 and 7 patients, respectively, with lung metastases in all cases. RFS, MFS and DFS times averaged 57.94±1.00, 54.75±1.67, and 53.83±1.75 months, respectively. The biopsy (+) group showed a higher prevalence of papillary and chromophobe RCC subtypes. Pathological parameters and surgical outcomes were comparable between groups. OS, RFS, MFS, and DFS times did not significantly differ (p>0.05).

Conclusion: According to our findings, a percutaneous renal mass biopsy is a safe procedure. It can aid in the diagnostic evaluation of suspected renal masses and mitigate any adverse effects on oncological outcomes. Our opinion is that patients with suspected renal cancer can safely and successfully use routine percutaneous renal mass biopsy.

Objectives: This study aimed to investigate the relationship between smartphone use and musculoskeletal pain among healthcare workers of different occupations. The research sought to examine the connection between smartphone habits and the prevalence and severity of musculoskeletal pain, with a focus on work-related and personal smartphone use, physical activity, temporomandibular dysfunction and neck disability.

Methods: The study utilized a cross-sectional survey design conducted via Google Forms targeting healthcare workers affiliated with Sisli Hamidiye Etfal Training and Research Hospital. The survey comprised 99 questions assessing demographic and professional information, health conditions, smartphone addiction, physical activity level, musculoskeletal pain, and pain-related disability.

Results: A total of 207 hospital staff members' responses were included in the analysis. Participants with higher smartphone addiction scores exhibited a significantly younger mean age and increased smartphone usage post-pandemic. No significant differences were found in physical activity levels between groups. However, those with higher addiction scores reported more frequent pain in the jaw and elbows, greater neck disability score, and a higher prevalence of temporomandibular dysfunction. The study also revealed a significant association between smartphone addiction and multi-site musculoskeletal pain.

Conclusion: The findings indicate that smartphone addiction among healthcare workers is associated with specific patterns of musculoskeletal pain, particularly in the jaw and elbows, and increased neck disability scores. The study highlights the need for targeted interventions to promote healthier smartphone habits and mitigate musculoskeletal pain among healthcare professionals.

Objectives: Aluminum accumulates in the body, disrupts mental development, affects bone mineral structure and causes cholestasis in the liver. Aimed to investigate parenteral nutrition and aluminum transmission in preterm infants.

Methods: Our study was designed as a single-center prospective study. And 45 babies were included during pregnancy weeks ≤32 and/or under 1500 grams. Cord blood samples were taken at birth from all infants. And blood levels of aluminum on the 14th day compared with cord blood levels of aluminum.

Results: Aluminum levels evaluated from patients' cord blood were 3.35±1.73 g/L (18-9.7 g/L), while levels reported on day 14 were 4.79±3.54 (1.6-18.6 g/L). Aluminum levels increased by 1.44±3.86 (0.28-2.60) f/L, which was statistically significant (p=0.021). The increase in aluminum levels was highly associated with number of days that furosemide was administered (p=0.012). The increase in serum aluminum levels of patients receiving parenteral feeding for more than 10 days was found to be significantly higher. But there was no statistically significant difference. When the contents of parenteral solutions were examined, it was discovered that there was an important positive correlation between calcium and magnesium levels administered in the first seven days and serum aluminum levels on the fourteenth day (p=0.044 and p=0.008, respectively).

Conclusion: The increase in serum aluminum levels in preterm infants fed parenteral nutrition was found to be statistically significant. Longer parenteral nutrition was associated with a greater increase in serum aluminum levels.

Objectives: Replantation surgery is one of the most difficult areas of reconstructive surgery. The aim of finger replantation is to restore sensation and adequate function of the amputated part in addition to restoring circulation. It is very crucial to investigate prognostic factors to improve the outcomes of this surgery. The type and severity of the injury, along with the duration between the injury and surgery, are the most significant factors influencing the success of replantation. This study investigates the impact of the type of anesthesia used on the success of replantation and other postoperative factors.

Methods: The finger replantation operations performed in our clinic between December 2018 and December 2023 were retrospectively analyzed. The effects of gender, smoking, type of injury, vein repair, nerve repair, use of vein graft, level of injury, type of anesthesia, preoperative and postoperative hemoglobin values on replantation success were statistically investigated in 192 patients (162 males, 30 females). Ratios in independent groups were compared by chi-square test. Comparisons of numerical variables in the independent groups were conducted using the Mann-Whitney U test, as the assumption of normal distribution was not satisfied.

Results: In the study, among the 192 patients, 91 received anesthesia via axillary nerve block (47.4%), 33 received general anesthesia (17.2%), and 28 received local anesthesia through digital block (14.6%). It was found that the type of anesthesia had no effect on the success of the replantation (p<0.05). A statistically significant difference was observed in the amount of change in hemoglobin levels between preoperative and postoperative measurements, according to the type of anesthesia. In the group receiving axillary nerve block, the decrease in hemoglobin levels was greater compared to the group receiving local anesthesia.

Conclusion: Our study found that smoking status and type of injury had no effect on the success of replantation.

Objectives: Wrist and forearm deformities are usually due to congenital or post-traumatic causes. These deformities cause progressive pain and limitation of motion and impair quality of life. Acute correction with radius and/or ulna osteotomy and fixation with plate or wire can be applied in treatment, but complications such as vascular/nerve damage, malunion and inadequate correction may be encountered. Treatment with circular external fixators provides correction without residual deformity and is safer because it can provide deformity correction and gradual lengthening both intraoperatively and postoperatively. Computer-assisted circular external fixators (Ca-CEF) facilitate the correction of complex deformities by allowing postoperative deformity planning to be redone. In this study, we analyzed wrist or wrist deformities treated with Ca-CEF.

Methods: The hospital database was searched for patients who underwent surgery for wrist and forearm deformity between 2010 and 2020. Demographic data, radiographic and functional measurements of the patients were evaluated. Preoperative and postoperative forearm supination, pronation, wrist flexion and extension, Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, Mayo Wrist Score and grip strength were measured. Radiological measurements of radius, ulna lengths, radial inclination and volar tilt were performed. Postoperative complications were analyzed. Preoperative and postoperative data of the patients were analyzed statistically.

Results: A total of 14 patients were included in the study. The mean age of the patients was 17.1 years (11-34), 8 were female and 6 were male. The mean follow-up period was 18.4 months (6.8-32.9). The planned anatomical correction was achieved in all patients. The mean differences between preoperative functional and radiographic data and postoperative data were 7.8 (p=0.029) for forearm supination, 14.64 (p<0. 001), 6.17 kg for Grip Strength (p=0.001), 3.07 for VAS (p<0.001), 21 points for DASH Score (p=0.003), and 22.14 points for Mayo Wrist Score (p=0.004), which were statistically significantly better. No major complications were observed in any patient.

Conclusion: The study showed that Ca-CEF provides functional improvement and radiological improvement and is a safe treatment method with low complication rates. This method stands out as an effective option in the treatment of complex deformities.

Objectives: Primary central nervous system lymphoma (PCNSL) is a rare and aggressive form of non-Hodgkin lymphoma (NHL). This study aimed to investigate the characteristics, treatment approaches, and outcomes of patients with PCNSL in a single institution.

Methods: We retrospectively analyzed 11 patients with PCNSL treated at our institution between October 2022 and July 2024. Patient demographics, clinical characteristics, treatment modalities, and outcomes were evaluated.

Results: The median age of the patients was 65 years, with male predominance (63.64%). The median follow-up duration was 10 months. All patients were immunocompetent, and 90.91% had diffuse large B-cell lymphoma. At diagnosis, 81% of the patients were considered fit to receive HDMTX treatment. R-MPV was the most common first-line treatment (45.45%). The complete response rate to initial treatment was 80%. The treatment-related mortality was 9.09%. Autologous stem cell transplantation (ASCT) was performed in 72.73% of the patients, with rituximab-thiotepa-carmustine as the predominant conditioning regimen (62.50%). Treatment-related toxicities occurred in 50% of patients, and 87.50% of patients experienced transplant-related complications. The transplantation-related mortality rate was 25%. The relapse rate was 25% among the patients undergoing ASCT. The mortality rate was 36.36%, and cerebellar involvement was significantly associated with a higher mortality rate (p=0.045).

Conclusion: This study demonstrated the efficacy of methotrexate-based regimens and ASCT in the treatment of PCNSL and achieved high complete response rates. However, the significant incidence of treatment-related toxicities and mortality underscores the persistent challenges of managing this disease. In addition, the association between cerebellar involvement and increased mortality requires further investigation. Larger prospective studies are needed to validate these findings.

Congenital morphological disorders of the vascular bed, especially located on the main arteries and veins of the extremities, can cause chronic venous insufficiency and venous claudication, creating exacerbated symptoms for the patient and which require intervention. In cases where interventional radiology is insufficient, surgical approaches should be prioritized. Sixty-five years old male patient admitted to our clinic with increased bilateral lower extremity swelling which revealed to be chronic venous insufficiency secondary to congenital disorders. Sapheno-femoral veno-venous bypass (Palma operation) was performed, and patient was discharged on post-operative day 15 without further complaints. Palma Operation is an effective surgical treatment option in venous malformations of lower extremity where interventional radiology is not sufficient.