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: Migraine is one of the prevalent types of primary headache disorders in children and significantly affects their quality of life. Although pharmacological prophylaxis is often necessary, conventional treatments are frequently limited by adverse effects and modest efficacy. Magnesium, a vital intracellular cation involved in numerous neuronal and vascular functions, has been proposed as a safer alternative. However, data on its use in pediatric migraine remain limited. To investigate the effectiveness and safety profile of magnesium oxide prophylaxis in children diagnosed with migraine without aura.

Methods: This retrospective study included pediatric patients aged 7-18 years with a diagnosis of migraine without aura, treated exclusively with magnesium oxide at a dosage of 6-9 mg/kg/day or a fixed dose of 365 mg/day for four months. Headache frequency, migraine-related disability (assessed by PedMIDAS), and quality of life (measured by HIT-6) were evaluated before and after four months of prophylaxis.

Results: Following magnesium prophylaxis, a statistically significant reduction was observed in headache frequency, PedMIDAS scores, and HIT-6 scores (p<0.001 for all). Additionally, disability levels according to PedMIDAS grading improved significantly. No participants reported side effects during the study.

Conclusion: Magnesium oxide appears to be a well-tolerated, safe, and potentially effective prophylactic option for children with migraine without aura. It was associated with a significant reduction in attack frequency, disability scores, and improved quality of life. Despite promising results, the absence of a control group and serum magnesium data are notable limitations. Further prospective, randomized controlled studies are required to confirm these findings and establish the most effective dosage, duration, and formulation of magnesium for pediatric use.

Objective: Childhood epilepsy requires long-term antiepileptic drug (AED) therapy, and its potential endocrine effects are a critical consideration. While the impact of AEDs on thyroid function is well documented in adults, data on pediatric populations remain scarce. Levetiracetam (LEV), a broad-spectrum AED widely prescribed for children, has an unclear influence on thyroid function. This study aims to evaluate the effects of LEV on thyroid function in children with epilepsy.

Methods: A retrospective observational study was conducted at the Pediatric Neurology Clinic of Umraniye Hospital between 2020 and 2022. One hundred pediatric patients, aged 2.3 to 18 years, diagnosed with epilepsy and using LEV monotherapy for at least 12 months were included. Thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels were measured at baseline and at 3, 6, and 12 months. Statistical analyses were performed using paired t-tests, with a p-value <0.05 considered statistically significant.

Results: The mean TSH levels increased from 1.46±0.3 mIU/L at baseline to 1.60±0.3 mIU/L at 12 months (p=0.0017). Despite the statistically significant rise, TSH levels remained within normal reference ranges, and no clinically significant hypothyroidism was observed. Changes in fT4 levels were not statistically significant, except for a borderline increase at 12 months (p=0.05). Four patients exhibited transient TSH elevations but did not require thyroid hormone replacement therapy.

Conclusion: LEV monotherapy does not appear to significantly impact thyroid function in pediatric epilepsy patients. While a slight but statistically significant increase in TSH levels was observed, these changes were clinically insignificant. These findings suggest that LEV is a safe option regarding thyroid function in children with epilepsy. Further long-term prospective studies are warranted to confirm these results.

Objective: The study aimed to describe the clinical characteristics, endoscopic and histopathological findings of children admitted to the paediatric gastroenterology outpatient clinic for growth retardation.

Methods: The study was carried out with 90 patients aged 2-18 years who presented to our paediatric gastroenterology outpatient clinic with complaints of growth retardation and underwent oesophagogastroduodenoscopy (EGD) because growth retardation persisted despite adequate caloric support (at least 3 months).

Results: The mean age of the patients was 11.11±4.27 years, 56 (62.2%) were female and 52 (57.8%) were under 12 years of age. Of the patients, 36.7% had mild, 47.8% moderate and 15.6% severe acute malnutrition, 22.2% stunting and 7.8% severe stunting. Associated dyspeptic symptoms were present in 34 (37.8%) patients and celiac antibodies were positive in 20 (22.2%) patients. Iron deficiency was present in 28.9% and B12 deficiency in 41.1% of the patients. The most common endoscopic findings were pangastritis (88.9%), duodenitis (61.1%), bile reflux (35.6%) and bulbitis (31.1%). Chronic Helicobacter pylori (H. pylori) gastritis was found in 72.2%, celiac disease in 20.0% and reflux oesophagitis in 17.8% of the patients. No association was found between chronic H. pylori gastritis and iron deficiency anaemia and vitamin B12 deficiency (p=0.90, p=0.89). There was no association between chronic H. pylori gastritis and height-for-age, weight-for-height and BMI z scores (0.31, 0.57, 0.43).

Conclusion: In this study, positive endoscopic findings were found in all children with persistent growth retardation despite adequate caloric support, even in the absence of accompanying dyspeptic symptoms. More studies evaluating the usefulness of endoscopy in children with growth retardation are needed.

Objective: Fetal echocardiography is a vital diagnostic tool used during pregnancy to evaluate the structure and function of the fetal heart. It allows for the early detection of congenital heart diseases (CHDs) and fetal arrhythmias, enabling timely prenatal counseling, perinatal planning, and therapeutic interventions when necessary. While routine obstetric ultrasounds may detect basic structural anomalies, fetal echocardiography provides more detailed anatomical and functional information, particularly in high-risk pregnancies. This study presents a nine-year experience of fetal echocardiography at a tertiary center, focusing on diagnostic accuracy, clinical contribution, and postnatal outcomes.

Methods: We retrospectively analyzed 405 fetuses who underwent fetal echocardiography between March 2016 and March 2025. All evaluations were performed by an experienced pediatric cardiologist using standard imaging protocols. Fetal cardiac findings and postnatal confirmation data were assessed.

Results: Major structural cardiac anomalies were identified in 48 fetuses (11.9%), with the most common being Tetralogy of Fallot and Transposition of the Great Arteries. Minor findings such as echogenic intracardiac focus, premature atrial contractions, and small ventricular septal defects (VSDs) were seen in 104 cases (25.7%). Significant arrhythmias, including supraventricular tachycardia and complete heart block, were detected in 14 cases (3.5%).

Conclusion: Fetal echocardiography is a reliable, non-invasive method for the early and accurate diagnosis of fetal cardiac anomalies. It facilitates appropriate prenatal referral and postnatal care planning, ultimately improving neonatal outcomes.

Objective: This study aimed to investigate the in vivo radioprotective effects of Myrtus communis (MC) on the gastrointestinal system.

Methods: A total of 30 female rats were divided into four groups: i) Control; ii) irradiation (IR) only; iii) MC-pretreated; and iv) MC-treated. The rats received oral MC extract (100 mg/kg/day) for 4 days before exposure to 10 Gy IR or continued until sacrifice. On the fourth day of IR exposure, the rats were sacrificed, and histopathological and biochemical analyses were performed on the ileum, pancreas, and liver tissues.

Results: Malondialdehyde and myeloperoxidase levels decreased in both MC-treated groups, while glutathione levels and Na⁺-K⁺-ATPase activity increased (p<0.01), with significant histopathological improvements compared to the IR-only group.

Conclusion: The results of this study demonstrate that MC significantly decreases ionizing radiation-induced oxidative and inflammatory damage in the gastrointestinal systems of rats. Therefore, it may be regarded as a new candidate with radioprotective potential for future clinical application.

Objective: Microwave ablation (MWA) has emerged as a minimally invasive treatment for hepatocellular carcinoma (HCC), offering a promising alternative for patients ineligible for surgical resection. This study aims to evaluate the efficacy, safety, and clinical outcomes of MWA in a single-center cohort, focusing on treatment success, recurrence rates, and long-term survival.

Methods: A retrospective analysis was conducted on 54 patients who underwent percutaneous ultrasound-guided MWA for HCC between January 2019 and December 2023. Patient demographics, tumor characteristics, and procedural outcomes were assessed. Treatment success was defined as complete ablation confirmed by contrast-enhanced imaging one month post-procedure. Local tumor progression (LTP) and recurrence rates were evaluated during follow-up. Survival outcomes were analyzed based on follow-up data, considering overall survival and recurrence-free survival rate.

Results: A total of 71 tumors were treated in 54 patients. Complete ablation was achieved in 91.5% of tumors following the initial or secondary procedure. LTP was observed in 16.6% of patients during follow-up. No major complications were reported. The median follow-up period was 36 months, and survival outcomes were comparable to those reported for other ablative techniques. No statistically significant correlation was found between tumor size and ablation success (p>0.05).

Conclusion: MWA is an effective and safe treatment modality for HCC, demonstrating high technical success and acceptable recurrence rates. These findings support the continued integration of MWA in multidisciplinary HCC management, particularly for patients ineligible for surgery. Further research with larger cohorts and longer follow-up is needed to optimize patient selection and refine ablation strategies.

Objective: The aim of this study was to evaluate systemic and environmental risk factors, clinical findings and surgical trends in patients admitted to our clinic with the diagnosis of dermatochalasis.

Methods: Between January and March 2024, 114 patients with upper eyelid dermatochalasis were retrospectively analyzed cross-sectionally. Demographic data, history of systemic disease, surgical history, presenting complaints, tear tests (Schirmer, tear breakup time (TBUT)) and dermatochalasis grades were recorded.

Results: In the patient cohort, females constituted 66.66%, with a mean age of 53.08±6.35 years. The predominant complaint was a sensation of heaviness or fatigue in the upper eyelid, as reported by 41.22% of the patients. A substantial 70.17% of the participants presented with at least one systemic illness, with diabetes mellitus, hypertension, thyroid disorders, and rheumatologic diseases being the most common. Symptoms of dry eye were observed in 31.57% of the patients, with an average Schirmer test result of 11.03±3.07 mm and a TBUT of 5.87±1.86 seconds. No significant correlation was found between Schirmer and TBUT values and the severity of dermatochalasis (p>0.05). Among the patients, 37.71% were considering surgery, with 65.11% seeking it for cosmetic reasons and 34.88% for functional purposes.

Conclusion: Dermatochalasis is a complex condition associated with functional and systemic effects and aesthetic problems. A history of systemic disease, dry eye symptoms and visual field limitation should be considered in managing the disease. Therefore, a multidisciplinary approach should be adopted, and patient expectations should be considered in treatment planning. Prospective studies with a large sample size may better elucidate the etiopathogenesis and patient management.

Objective: Assessment of small airway function, respiratory mechanics, respiratory muscle strength, and exercise capacity plays a crucial role in both pharmacological and non-pharmacological treatment planning, as well as in evaluating treatment efficacy in patients with emphysema. Impulse oscillometry (IOS) allows for the evaluation of the physiological properties of both large and small airways, along with lung parenchyma involvement. This study aimed to in*vestigate small airway function and respiratory mechanics related to lung parenchyma using IOS and to examine their relationship with respiratory muscle strength and exercise capacity in emphysema patients.

Methods: Thirty patients diagnosed with emphysema by high-resolution computed tomography (HRCT) and airway obstruction based on GOLD (Global Initiative for Chronic Obstructive Lung Diseases) spirometric criteria were included in this study. Demographic characteristics, IOS parameters, respiratory muscle strength (MIP, MEP), and exercise capacity (Endurance Shuttle Walk Test [ESWT], VO₂ peak) were analyzed. The study was approved by the Ankara Kecioren Training and Research Hospital Ethics Committee (approval number: 2012-KAEK-15/2210) and conducted in accordance with the Declaration of Helsinki.

Results: There was a statistically significant positive correlation between GOLD spirometric stages and IOS parameters, particularly the resistance difference at 5 and 20 Hz (R5-R20) and reactance area (AX). A significant negative correlation was observed between GOLD stages and reactance at 5 Hz (X5), maximal inspiratory pressure (MIP), ESWT, and VO₂ peak. Additionally, MIP was negatively correlated with R5, R5-R20, and AX, but positively correlated with X5. VO₂ peak was negatively correlated with R5, R20, R5-R20, and AX, while it was positively correlated with X5, MIP, and maximal expiratory pressure (MEP). ESWT was negatively correlated with R5, R5-R20, and AX, and positively correlated with X5.

Conclusion: This study demonstrated that emphysema involves impairment of small airways and lung parenchyma, which can be effectively assessed using IOS. The impaired respiratory mechanics significantly decrease exercise capacity. Prioritizing therapies that target small airways may enhance pharmacological outcomes, and the observed correlation between IOS parameters and respiratory muscle strength may provide guidance for inhaler selection in clinical practice.