Northern clinics of Istanbul最新文献

Objective: In this retrospective study, we aimed to investigate the etiology, success, and complication rate of percutaneous nephrostomy (PCN) in patients with non-dilated renal collecting system (NCT) using saline and diuretic agents.

Methods: PCN was performed on 62 kidneys from 35 patients with NCT. Prior to the procedure, a combination of saline and furosemide infusion was administered. Several parameters were evaluated, including pre- and post-procedure levels of creatinine and blood urea nitrogen, fluoroscopy time, total air kerma (TAK), dose area product (DAP), puncture number, success rate, and complication rate.

Results: Fistula was the most common etiology and was detected in 29 out of 62 kidneys. The other most common cause was ureteral injury, detected in 21 out of 62 kidneys. The success rate of our procedures was 96.7%, and the rate of minor complications was 1.7%. Transient macroscopic hematuria was one of the minor complications observed in one patient. No major complications were observed. During each procedure, the average number of needle passes was 1.44±0.5 (range: 1-3). The average duration of the complete procedure was 13.17±6.46 minutes (range: 8-31 minutes). The mean fluoroscopy time was 2.37 minutes (range: 0.8-11.6 minutes). In terms of radiation exposure, the mean DAP was 166.94±148.5 μGy•m² (range: 3.93-666.59 μGy•m²) with a median of 127.04 μGy•m², and the cumulative dose (TAK) was 72.43 mGy (range: 12-342 mGy) with a median of 42.05 mGy, respectively.

Conclusion: Diuretic infusion in saline is a safe and beneficial method for PCN in NCT. With its low complication rate and high success rate, PCN provides rapid treatment for various etiologies with the potential to address conditions such as fistula, ureteral injury, and urosepsis in the collecting system, which may otherwise have devastating consequences.

Objective: Acne vulgaris is a chronic and common disease among adolescents. The effects of acne vulgaris on the caregiver's quality of life and its relationship to patient's quality of life have been seldom studied. This study aims to investigate impact of adolescent acne vulgaris on the patients' and their caregivers' quality of life and to evaluate the relationship between these two variables.

Methods: Acne vulgaris patients aged between 10 and 18 years and their caregivers were included in this prospective study. CDLQI (Children Dermatologic Quality of Life Index) and DFIS (Dermatological Family Impact Scale) questionnaires were used to assess the impact of acne vulgaris on the quality of life of patients and caregivers. SPSS version 21 was used for the statistical analysis; Spearman correlation test and Mann Whitney U test were used.

Results: This study has shown a significant correlation between DFIS and CDLQI, between severity of acne and CDLQI, and between the previous use of systemic antibiotics and DFIS. There is no relationship of age, sex, disease duration, number of siblings, amount of money spent and previous treatment modalities to CDLQI. There is no relationship between age, sex, acne severity, disease duration, number of children and amount of money spent on DFIS.

Conclusion: Acne vulgaris not only has an impact on the patient's quality of life but also on the caregiver's quality of life, which in turn affects the patient's quality of life.

Objective: Dual-phase 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has demonstrated superiority over conventional imaging methods in various clinical conditions. However, its efficacy in detecting metastases from colorectal cancer is uncertain. We aim to reveal whether dual-phase FDG-PET/CT can be superior in detecting metastases compared to the standard PET-CT study in patients with an established diagnosis of colorectal cancer.

Methods: This is a single-center, retrospective case-control study involving 35 patients with colorectal cancer who underwent whole-body FDG PET-CT imaging. Late-phase FDG-PET-CT images were obtained 1-2 hours after the standard technique, emphasizing the identification of new lesions or clarified lesions.

Results: Among the 35 patients evaluated, 5 (14.3%) exhibited new cancer lesions, while 6 (17.1%) demonstrated more evident cancer regions at late-phase FDG-PET-CT. New lesions or more evident cancer regions with the dual-phase technique were described within the liver, in regional lymph nodes, and in peritumoral regions.

Conclusion: The study findings suggest that dual-phase FDG-PET-CT can reveal new and more evident metastatic lesions in a subset of colorectal cancer patients. This technique, precious in identifying liver metastases and lymph nodes, enhances the accuracy of colorectal cancer diagnosis and staging.

Objective: In this study, we aimed to examine the thirty-year effectiveness and trend of research on refugee mental health.

Methods: A bibliometric analysis methodology was used. Web of Science (WOS) database was used to obtain the necessary data. In particular, a review and analysis encompassed the quantity of publications featuring articles on refugee mental health, the most prolific countries and institutions, the highly cited articles, citation patterns, international collaboration, and the relevant journals. The study's timeframe was defined from 1992 to 2022.

Results: The number of documents obtained is 3912. The majority of the documents obtained were in the field of psychiatry. The quantity of publications and citations experienced a notable upsurge, particularly following the year 2016. The United States emerged as the leading country in terms of both the highest number of publications and citations on this subject. The institutions with the highest publication rates are, in order, the University of New South Wales in Australia, the University of Melbourne in Australia, and McGill University in Canada. This bibliometric study shows that publications on refugee mental health have been observed since 1992 and are gaining momentum, especially after 2016. In addition to the terms "refugees" and " mental health," the keywords "depression," " Post-traumatic stress disorder (PTSD)," and "children" were most commonly used.

Conclusion: Refugee communities also appear to have similar mental illnesses and experiences regardless of where and when they settled in the world. Research collaboration and networks should be encouraged to prioritize research in refugee mental health.

Objective: Parvovirus B19 is a very common infection, especially in school-age children, with its rapid spread. In the present study, Parvovirus B19 infection was detected in frequently ill nursery children. The present study aimed to determine the seroprevalence value, to determine whether there is an active infection and to determine to what extent it affects the relevant immune system parameters, to determine whether the obtained data will contribute to the epidemiology of childhood Parvovirus B19 infections in our country and also, to determine whether it is a reason for children to become ill frequently.

Methods: Parvovirus B19 DNA test results of 112 children aged 2-6 years who were grouped as frequently ill and infrequently ill and who went to nursery and kindergarten were examined quantitatively with the Real-Time PCR Method. Parvovirus B19 IgG and Parvovirus B19 IgM antibody presence was investigated with the ELISA Method. Flow Lymphocyte subgroups were analyzed with the Cytometry Method.

Results: Among the 112 patients who were included in the study, 105 (93.7%) Parvovirus B19 DNA results were negative and 7 (6.3%) were positive. Parvovirus B19 IgG test results were negative in 108 (96.4%) patients and positive in 4 (3.6%). When the Parvovirus B19 IgM results were evaluated, 109 (97.3%) were determined as negative and 3 (2.7%) positive. Natural Killer Cells (NK) from patients with positive Parvovirus B19 DNA, Parvovirus B19 IgG, and IgM were detected outside the normal limit value ranges in CD25, CD19, HLA DR, CD3, CD45RO, and CD8 values.

Conclusion: No significant relationships were detected between frequent illness and Parvovirus B19 infection, the infection did not significantly affect the immunodeficiency parameters, and although it is already known that Parvovirus B19 infection peaks every 3-4 years, the study did not coincide with this period of Parvovirus B19 infection.

Objective: We aimed to evaluate the feasibility of a mini-laparoscopic surgical approach versus standard laparoscopy.

Methods: 75 patients with endometrial cancer treated by mini-laparoscopic (n=25) or conventional laparoscopic surgery (n=50) at a tertiary-care university-based teaching hospital and academic affiliated private hospital were included.

Results: There was no significant difference between the mini-laparoscopy and the conventional laparoscopy group regarding surgical procedures. The mean operation time and the median estimated blood loss were similar (p=0.671 and p=0.158, respectively). No difference was found in terms of the number of lymph nodes removed. No intraoperative complications were observed in both groups. Return to daily routine and the rate of additional analgesia requirement were similar in the groups. The mean duration of hospitalization was 3.6±1.2 days in the mini-laparoscopy group and 4.9±3.6 days in the conventional laparoscopy group (p=0.025).

Conclusion: We demonstrated that mini-laparoscopic staging could be a competent technique performed regardless of harm by talented surgeons using state-of-the-art instruments. Mini-laparoscopic surgery appears to be a further possibility to minimize surgical trauma by reducing the size of the ports without decreasing the extent and effectiveness of the procedures.

Objective: Acute Scrotum (AS) is defined as pain associated with swelling and redness of the scrotum. This study investigates the hemogram and C-Reactive Protein (CRP) values obtained from patients diagnosed with AS, based on the hypothesis that blood parameters can be used as biomarkers in the diagnosis of Testicular Torsion (TT). The aim was to evaluate the predictability of these parameters in diagnosing AS in both pediatric and adult age groups.

Methods: Demographic data and blood parameters including Hemoglobin (Hb), Platelet (PLT), CRP, and White Blood Cell (WBC) levels of patients who presented to our Emergency Department with the diagnosis of AS (TT, epididymitis, varicocele) and received medical and surgical treatment were analyzed. The importance of these parameters in diagnosis was assessed.

Results: A total of 26 patients were included in the study. The mean age of the cases was 15.8±3.6 years. 20 of the patients (76.9%) were in the pediatric age group, while 6 (23.1%) were in the adult age group. 93.1% (27) of the cases were unilateral, while 6.9% (2) had bilateral acute scrotum symptoms. The highest incidence of cases occurred in spring with 9 cases (31%), followed by winter and summer with 7 cases each (24.1%), and autumn with 6 cases (20.7%). Significant differences in age, platelet, and hemoglobin levels were observed between the pediatric and adult age groups.

Conclusion: In conclusion, this study highlights significant age-related differences in the diagnosis and treatment of AS. The higher requirement for surgical intervention in pediatric patients further emphasizes the importance of early diagnosis and timely intervention. However, further studies with larger sample sizes are needed to validate these findings and better understand the etiological differences. Additionally, a more specific analysis of blood parameters in subgroups (such as epididymitis, orchitis, TT) under the term "acute scrotum" may contribute to the literature.

Objective: Biofeedback electromyography (EMG) involves the transmission of pelvic and abdominal muscle activity to the patient via visual and sometimes auditory feedback, with the ultimate goal of learning to contract and relax the pelvic muscles at the appropriate times through real-time analysis and feedback. To determine the optimal number of biofeedback therapy sessions required for a therapeutic response in the treatment functional voiding dysfunction.

Methods: The retrospective data of 779 patients who underwent biofeedback therapy at a tertiary pediatric hospital between 2017 and 2023 were analyzed. The study included patients referred for urinary symptoms and uroflow/EMG findings who did not respond to standard urotherapy and behavioral therapy and completed at least 8 biofeedback sessions. During treatment, methods such as EMG biofeedback, pelvic muscle training, and keeping symptom diaries were utilized. Statistical analyses were performed using the Mann-Whitney U test and Chi-Square test.

Results: Of the patients, 62.4% were female, 37.6% were male, and the mean age was 9.05±3.05 years. The most common urinary symptoms were daytime urinary incontinence (59.4%) and nocturnal enuresis (54%). The average number of sessions required for a therapeutic response was 6±1.3. Female patients showed an earlier response to treatment compared to males (p<0.01). Younger patients demonstrated faster recovery and better response to therapy (p<0.05). Patients who did not respond to therapy had a higher mean age and required more sessions (p<0.05). The higher mean number of sessions in non-responders compared to responders was found to be statistically significant (p=0.001; p<0.05).

Conclusion: Biofeedback is an effective and non-invasive treatment method for children with functional voiding dysfunction. Most patients show symptomatic improvement within 1.5-2 months (2-8 sessions - average 6). Male patients may require longer treatment durations, while younger children respond better to therapy. Future studies focusing on factors influencing biofeedback success may contribute to optimizing this treatment.

Objective: Ado-trastuzumab emtansine (T-DM1) is a key treatment for HER2-positive metastatic breast cancer (HER2+ MBC), yet the influence of progression sites and therapy lines on outcomes remains unclear.To assess the relationship between progression sites and the line of T-DM1 therapy with survival outcomes in HER2+ MBC.

Methods: We retrospectively analyzed 123 patients with HER2+ MBC treated with T-DM1. Data on metastatic progression sites (brain, liver, bone, lung, lymph nodes), line of T-DM1 therapy (2^nd-line vs ≥3^rd-line), and death status were examined. Due to limited survival time data, mortality was used as the primary outcome. Death rates were compared across subgroups using descriptive statistics.

Results: Brain and lung progression were associated with the highest mortality rates (76.7% and 73.1%, respectively). Liver and bone progression also showed elevated death rates (70.0% and 64.3%). Notably, more patients who used T-DM1 as the second-line therapy had a higher mortality rate at 66.7% compared to those treated with it in the third line or after (45.1%).

Conclusion: Progression to brain and lung during T-DM1 treatment correlates with higher mortality. Early-line use of T-DM1 may be linked with worse outcomes, possibly due to more aggressive disease biology. The obtained data could inform the decision-making process when treating patients with HER2+ MBC and predict their prognosis.

Objective: This study examines how demographic factors and disease conditions affect B-cell depletion and regeneration after Rituximab (RTX) infusion in pediatric patients with rheumatic conditions.

Methods: We retrospectively reviewed 27 patients approved by the Institutional Review Board, all of whom received at least one RTX infusion, analyzing 99 lymphocyte subunits. Inclusion: patients under 18 at their first RTX infusion, diagnosed with pediatric rheumatologist-confirmed autoimmune diseases. B-cell depletion was defined as a CD19 positive B Cells (CD19+) count below 10 cells/μL, assessed at 6- and 12-months post-RTX infusion. Complete regeneration was defined as CD19+ ≥170 cells/μL using adolescent norms.

Results: Most patients had connective tissue disorders (CTD); Systemic Lupus Erythematosus, Sjögren's Disease, Systemic Sclerosis; n=17; 63%), followed by vasculitis (n=5; 18.5%), juvenile dermatomyositis (n=4; 14.8%), and miscellaneous conditions (n=1; 3.7%). Among patients with CTD, 4 out of 12 (33%) had B-cell depletion at 6 months. At 12 months, 3 out of 6 (50%) achieved CD19+ counts ≥10 cells/μL, while 5 out of 6 (83%) did not reach normal levels of CD19+ (≥170 cells/μL). No significant correlation existed between immunosuppressants (mycophenolate mofetil, methotrexate, azathioprine, cyclosporine, cyclophosphamide) and CD19+≥10 cells/μL at 6 or 12 months. However, hydroxychloroquine significantly differed for persistent depletion at 12 months.

Conclusion: This study demonstrates that demographic factors and disease conditions influence B-cell depletion and regeneration in pediatric patients treated with RTX for rheumatic conditions. The findings highlight the variability in response to RTX and suggest that factors such as hydroxychloroquine use may impact long-term B-cell levels.