Erciyes Medical Journal最新文献

Background: Acute hepatitis-associated aplastic anemia (AHAAA) is a rare clinical syndrome characterized by the development of aplastic anemia 2-3 months following an episode of acute hepatitis. Several immunosuppressive agents, but not mycophenolate mofetil (MMF), and bone marrow transplantation are the standard treatment options for AHAAA.

Case report: In this report, we present a case of a young boy with AHAAA manifesting as acute liver failure. The etiology was type 1 autoimmune hepatitis responsive to the second-line therapeutic combination of steroids and MMF. The liver has fully recovered, but bone marrow failure ensued. After 4 months, Clinical and laboratory improvement occurred without the need for bone marrow transplantation. An important aspect of this case is the full recovery of aplastic anemia without calcineurin inhibitors, anti-thymocyte globulin utilization, or bone marrow transplantation.

Conclusion: Our case history supports MMF as a potentially crucial adjunctive therapy for patients with AHAAA who poorly respond to standard procedures.

Background: Von Hippel-Lindau disease (VHL) is a rare multisystem neurocutaneous disorder. The abnormalities in the corpus callosum have been observed in patients with phacomatosis, but this has not been previously described in VHL. In this report, we present a unique case of VHL with corpus callosum agenesis.

Case report: A 7-year-old boy was referred to the hospital because of left flank pain and vomiting. The abdominal ultrasound revealed multiple small simple cysts in both kidneys and pancreas. A radiological suspicion of VHL was raised, and further imaging examinations were recommended. Brain magnetic resonance imaging demonstrated a parallel arrangement of the lateral ventricles, confirming the diagnosis of complete agenesis of the corpus callosum. Brain hemangioblastomas were not detected.

Conclusion: Our case is the first to report a corpus callosum agenesis in a child with VHL, thus expanding the spectrum of neurocutaneous disorders associated with callosal anomalies.

Objective: Hand injuries are a common reason for emergency room visits, and it is critical to managing the pain process effectively. This study aims to look at the demographics, pain assessment, and management of patients who visited the emergency department with hand injuries.

Materials and methods: Healthy patients over 18 who presented to the emergency room within the first 24 hours of an acute hand injury between December 2020 and February 2021 were included. The Numerical Pain Rating Scale was employed to assess pain severity. The etiology of the trauma, pain scale, analgesic treatment, imaging requests, consultation, and tetanus vaccine situation were all documented.

Results: The patient's pain severity was classified at admission. It was found that 38.8% had mild pain, 39.2% moderate, and 21.9% had severe pain. The average pain scores of the patients were determined as 4.89±2.14. Analgesic was executed in 13.5% of the patients who applied, and 86.5% did not receive painkillers. Analgesia was applied to 2% of the patients with mild pain, 14.7% with moderate pain, and 31.6% with severe pain. We found that as pain severity increased, analgesia was more, and it was found to be statistically significant (p=0.0001).

Conclusion: Analgesia is a neglected step in trauma care. Emergency physicians should prioritize pain relief. All patients with hand trauma should be pain-scored and given appropriate analgesia.

Objective: Hepcidin is a peptide that acts as a hormone that provides iron homeostasis in the body and has antimicrobial activity. The synthesis of hepcidin is stimulated during inflammation and causes inflammation anemia. For this purpose, we aimed to determine the role of (pro)hepcidin in anemia in inflammatory bowel diseases (IBD) and its correlation with clinical and biochemical findings.

Materials and methods: A total of 61 patients, 19 (31.1%) of whom were diagnosed with Crohn's disease (CD), 42 (68.9%) with ulcerative colitis (UC), and a control group of 23 were included. Hepcidin and biochemical parameters which are related to anemia were measured.

Results: There was a significant difference between the CD group and vs control group in terms of hepcidin level. As the disease activity increases, the hepcidin level decreases with a probability of 83%. Hepcidin levels were found to be significantly lower in the CD group. Although hepcidin levels were lower in the UC group than in the control group, the result was not statistically significant.

Conclusion: We didn't detect a statistically significant difference in the level of hepcidin between IBD and the control group.

Background: During the course of primary malignant brain tumors, there is an increased tendency for both intracerebral hemorrhage and venous sinus thrombosis.

Case report: A 63-year-old man presented with a headache, and a brain computed tomography (CT) scan showed a hematoma in the right occipital lobe. Magnetic resonance imaging (MRI) revealed almost complete rim enhancement, and CT perfusion showed increased cerebral blood volume values. A new bleeding focus and a thrombus extending from the superior sagittal sinus to the cortical vein were seen on CT and MRI scans performed due to the headache that developed the day before surgery. After surgical evacuation of the hematoma, a giant cell glioblastoma diagnosis was made as a result of pathological examination of the lesion.

Conclusion: In challenging cases like this, perfusion techniques are useful. Cerebral venous sinus thrombosis should also be kept in mind during the perioperative and postoperative periods to avoid complications.

Background: Miller Fisher Syndrome is a variant of Guillain-Barre Syndrome, classically characterized by the triad of ataxia, areflexia and ophthalmoplegia. However, many conditions can mask the presentation of Miller Fisher Syndrome, potentially leading to grave consequences due to delayed diagnosis or even misdiagnosis.

Case report: We describe a case of Miller Fisher Syndrome mimicking acute sphenoid sinusitis with intracranial complications in an otherwise healthy 19-year-old man. Accurate diagnosis with prompt treatment led to full clinical recovery of our patient.

Conclusion: Sphenoid sinusitis warrants great vigilance and thorough neurological examination due to its proximity to structures such as the cavernous sinus and its associated cranial nerves. This case highlights its potential to mask more devastating conditions like Miller Fisher Syndrome and the successful role of medical management without the need for sphenoidotomy.

Objective: Determining risk factors prior to intubation is crucial for patient safety. This study aimed to assess the usability of the predictive tests and anthropometric measurements in identifying potential difficult intubation in children.

Materials and methods: This prospective study involved 200 pediatric patients aged 7 to 15 years who were scheduled to receive general anesthesia and were classified as American Society of Anesthesiologists (ASA) I-II with no pre-existing airway issues. Patients were categorized based on age into three groups: Group 1 (7-9 years, n=69), Group 2 (10-12 years, n=65), and Group 3 (13-15 years, n=66). Modified Mallampati Classification (MMC), mandibular protrusion (MP), tooth anomalies (missing tooth, decayed tooth, protruding upper incisor, and long upper incisor), thyromental distance (TMD), sternomental distance (SMD), and atlanto-occipital joint mobility (AOJM1 and AOJM2) were determined for each patient. These prediction tests were then compared with the Cormack-Lehane (CL) classification.

Results: Statistically significant differences were observed between the groups in terms of TMD, SMD, and missing tooth. The MMC exhibited the highest sensitivity and positive predictive value (PPV) (100% and 47%, respectively), while the MP had the highest specificity (94.5%). It was predicted that reference values of ≤6 cm for TMD and ≤12 cm for SMD would yield very low sensitivity and PPV for Group 1.

Conclusion: Reference values of ≤5 cm for TMD and ≤10 cm for SMD were found to provide useful predictive information for children aged 7-9 years.