Northern clinics of Istanbul最新文献

Objective: Although breast cancer is the most common cancer type in women worldwide, it is a rare tumor in men, accounting for less than 1% of all male cancers. Therefore, the characteristics of the tumor, the management of the disease, and our overall survival data are quite limited.

Methods: We retrospectively analyzed the data of 51 male patients diagnosed and treated for breast cancer, whose follow-up processes continue, at our hospital. We examined in detail the patients' age, comorbid diseases, history of concomitant malignancies, family history, stage of the disease, tumor size, lymph node status, estrogen receptor (ER)/progesterone receptor (PR) along with Human Epidermal Growth Factor Receptor-2 (HER-2) status. Additionally, we analyzed the type of surgery, history of radiotherapy, and chemotherapy and hormonal treatments in the adjuvant and metastatic periods.

Results: In our study, where we determined a median survival time of 122 months (29-214), we found that the stage at diagnosis, Eastern Cooperative Oncology Group (ECOG) performance status, and discontinuation of adjuvant endocrine therapy significantly affected survival. While the median survival was not reached in stage 1 patients at diagnosis, the median survival times for stage 2, 3, and 4 patients were 118, 83, and 39 months, respectively. The differences between the groups were statistically significant (p=0.005). Similarly, the median survival was not reached for patients with an ECOG performance status of 0, but it was 84 months for those with a status of 1 and 98 months for those with a status of 2. The differences among these three groups were also statistically significant (p=0.001). The median survival was not reached for patients who completed adjuvant endocrine therapy, whereas it was 83 months for those who discontinued the therapy, with the difference being statistically significant (p=0.021). Besides these data, the presence of perineural invasion was found to be a factor close to statistical significance in terms of survival (p=0.066). Histological subgroups, grade, lymphovascular invasion, adjuvant chemotherapy, and Ki-67 were not significant parameters for survival.

Conclusion: Despite the differences in the stage at diagnosis, response to treatments, lower awareness of the disease, older age at diagnosis, and consequently, the increase in accompanying comorbid diseases, male breast cancer is managed according to studies and guideline recommendations for female breast cancer due to the lack of sufficient randomized studies. By presenting our clinical experience, we have emphasized the necessity for further studies in this field.

Objective: Primary hypertension (HT) is a global public health problem with increasing prevalence in recent years. HT may have caused decreased neurocognitive functions and learning difficulties. In this study, clinical characteristics of adolescents with primary HT were examined and the relationship between semester grade point average (GPA) and HT was evaluated.

Methods: This is an observational, cross-sectional, descriptive study conducted on adolescents with primary HT attending high school. Patient records (number of hospital visits, HT-related complaints, blood pressure measurements, and laboratory tests) were evaluated retrospectively. End-of-semester report card grades of Mathematics, Turkish Language and Literature and English courses were noted, and compared with the clinical characteristics of the patients.

Results: The study included 83 patients with a mean age of 15.6±1.2 years. Patients with higher body mass index had lower grades in Mathematics (p=0.007) and Turkish Language and Literature (p=0.004). Patients with HT-related symptoms such as headache, epistaxis and palpitations had lower GPAs for all courses. Also, patients with hyperuricemia or proteinuria had lower semester GPAs compared to patients with normal serum uric acid levels or without proteinuria (p<0.05). GPAs for Mathematics (p=0.000) and Turkish Language and Literature (p=0.006) decrease as the number of hospital visits increases.

Conclusion: HT may cause not only cardiovascular complications but also decreased neurocognitive functions through various mechanisms and may have a negative impact on academic skills. Therefore, HT should be followed up with a multidisciplinary approach and intensive efforts should be made to approach the goal of normotension.

Objective: Drug-drug interactions (DDIs) occur when one drug alters the effect of another drug. The aim of this study was to evaluate potential drug-drug interactions (pDDIs) associated with the use of systemic antibiotics in hospitalized patients.

Methods: The study included patients over the age of 18 who were hospitalized in our hospital on 12.07.2022 and were using at least two systemic drugs concurrently, with at least one being a systemic antibiotic. The study was conducted using the point prevalence method. The patients' medication was evaluated for pDDIs using the UpToDate^®/Lexicomp^® database system. According to this screening tool, pDDIs were classified into 4 groups according to their severity: B, C, D, and X, ranging from mild to severe.

Results: Out of the 296 patients included in the study, at least one pDDI was detected in 190 patients (64.2%). One hundred seventy-seven patients (59.8%) had at least one pDDI with non-antibiotic drugs. Fifty-seven patients (19.3%) had at least one pDDI with antibiotics. One hundred and six patients (35.8%) had no drug interactions. Patients with pDDIs related to antibiotics had significantly higher age, number of comorbidities, total number of medications and number of antibiotics (p=0.010, p=0.004, p<0.001, p<0.001, respectively) compared to patients without pDDIs related to antibiotics (n=239). For antibiotics, potential pDDIs were observed 25, 75, 6, and 6 times in groups B, C, D, and X, respectively. Out of the total of 398 antibiotics, penicillins (24.9%, n=99) and cephalosporins (24.4%, n=97) were the most frequently used. Respectively, eight and two pDDIs were detected with these drugs. While quinolones were used 47 times (11.8%), 74 pDDIs (59.7%) were identified with quinolones. Out of the 47 patients who used quinolones, 37 had pDDIs with antibiotics. The most frequent pDDI with antibiotics was associated with the use of quinolone systemic corticosteroids (15 patients). The second most prevalent interaction involves quinolone-angiotensin converting enzyme inhibitors or angiotensin 2 receptor blockers (13 patients).

Conclusion: Antibiotics should be checked for pDDIs before being prescribed. While beta-lactam antibiotics are generally considered safer in terms of pDDIs, greater caution should be exercised, particularly when prescribing quinolones.

Objective: Uveitis may occur in the course of systemic inflammatory rheumatic diseases (IRD), or it may be the first clinical manifestation of these diseases. The aim of this study was to determine the incidence of IRD in patients whose initial clinical manifestation was non-infectious uveitis.

Methods: The study included adult patients diagnosed as having noninfectious uveitis in the department of ophthalmology and referred to rheumatology for further investigation of potential rheumatic diseases as underlying etiology of uveitis. The patients' demographic and clinical features, laboratory, and imaging findings were examined.

Results: One hundred six patients who were diagnosed as having uveitis (42.4% anterior, 2.8% intermediate, 19.8% posterior, and 34.9% panuveitis) were included. Just over half (52.8%) of the patients were male and the mean age was 40.1±14.8 years. The mean age at the uveitis attack was 38.7±15 years. One-third (33%) of the patients were diagnosed as having rheumatologic disease (spondyloarthritis (SpA) n=10, Behcet disease (BD) n=17, vasculitides n=2, sarcoidosis n=2, undifferentiated connective tissue diseases n=3, rheumatoid arthritis n=1). SpA was diagnosed in 20% of patients presenting with anterior uveitis. BD was detected in 27% of patients referred with panuveitis and in 33.3% of patients whose first clinical finding was posterior segment involvement. Bilateral uveitis was detected in two-thirds of patients with posterior uveitis and tended to recur more frequently (p=0.014).

Conclusion: Rheumatic diseases have been identified in approximately one-third of patients presenting with different types of uveitis. Investigations addressing systemic rheumatic diseases are of paramount importance in patients with uveitis because they may change diagnosis and treatment processes.

Objective: There is a known association between lower urinary tract dysfunction (LUTD) and constipation. The objective of this study was to investigate any correlation between voiding and bowel symptoms in children with LUTD.

Methods: Children presenting with LUTD to our pediatric urology unit were prospectively included. Demographic data were recorded. All patients filled out the "Pediatric Lower Urinary Tract Symptom Score" (P-LUTSS) and "Constipation and Fecal Incontinence Symptom Severity" (CFISS) questionnaires. Symptom score correlation and associations with clinical findings were evaluated.

Results: 76 patients were included. The mean P-LUTSS was 11±7.1; mean CFISS was 7.7±7.5. According to P-LUTSS risk groups, median CFISS score increased as the risk group was increased. There was direct correlation between P-LUTSS and CFISS for all patients. 6^th, 7^th, 8^th, 9^th, 10^th and 13^th questions of P-LUTSS were correlated with CFISS; the 1^st and 7^th questions of CFISS were correlated with P-LUTSS. Patients who responded not to have constipation on P-LUTSS had lower CFISS scores compared to those who had constipation. Patients who had a 0 score on CFISS had a mean P-LUTSS of 7.7±6.2, which put the majority of patients in low-risk group. Also, out of these 11 patients, 10 of them responded to have no constipation on P-LUTSS.

Conclusion: A relationship between LUTD and bowel symptoms, as well as the positive correlation between P-LUTSS and CFISS was demonstrated in this study. Patients presenting with LUTD should undergo meticulous evaluation using special questionnaires for bowel symptoms. Only by then, a complete treatment approach can be provided.

Objective: The aim of this study is to investigate the relationship between post-treatment radiological findings and recurrences in idiopathic granulomatous mastitis (IGM).

Methods: Clinical data, ultrasound (US) and magnetic resonance imaging (MRI) examinations of 160 patients with IGM (mean age 34.6±7 years; range 20-56 years) who received only steroid or steroid+surgical treatment were evaluated retrospectively. Patients were grouped as radiological complete response (RCR) or radiological incomplete response (RIR).

Results: Only in the steroid group, 79 (54.1%) patients were in the RCR group and 67 (45.9%) patients were in the RIR group. Recurrence occurred in 42 (26.3%) patients, 27 (16.9%) in the same breast and 15 (9.4%) in the contralateral breast. Most of the recurrences in the same breast had residual lesions up to recurrence (74.1%).

Conclusion: Residual lesion after treatment is a risk factor for recurrence, and treatment can significantly reduce recurrences until the lesions disappear. The lesion size on MRI after treatment is not associated with recurrence.

Objective: Sepsis-induced acute kidney injury (AKI) is a significant threat, contributing to worse outcomes in intensive care unit (ICU) patients. Thus, understanding the complex relationship between sepsis and renal dysfunction in ICU patients is crucial. We aimed to investigate the factors that may predispose to the development and the clinical consequences of new-onset AKI in septic medical ICU patients in this study.

Methods: This retrospective cohort was conducted between December 2019 and April 2023 in the tertiary medical ICU of Gazi University Hospital, Ankara, Turkiye. Participants included septic medical ICU patients aged ≥18 without AKI on ICU admission. Data included demographics, comorbidities, disease severity and prognostic scoring, ICU admission, and ICU follow-up data. Statistical analyses, including logistic regression, were performed to identify independent risk factors for new-onset AKI development and ICU mortality.

Results: Patients with new-onset AKI (36% incidence) had higher APACHE-II (21 [16-27] vs. 16 [12-18]) and SOFA (6 [3-9] vs. 3 [2-5]) scores and lower GCS (10 [6-15] vs. 14 [10-15]) on ICU admission (p<0.01 for all results). Independent risk factors for both new AKI development and ICU mortality included invasive mechanical ventilation (IMV) (OR (95% CI): 5.02 [1.59-15] for AKI and OR (95% CI): 13.2 [3-58.8] for ICU mortality, p<0.01), new-onset shock (OR (95% CI): 3.98 [1.42-11.1] for AKI, OR (95% CI): 14.5 [4.4-43.5] for mortality, p<0.01), and higher APACHE-II score (OR (95% CI): 1.08 [1.01-1.16]), for AKI, p=0.05 and (OR (95% CI): 1.04 [1.01-1.08], for mortality, p=0.01). AKI was more frequent in patients whose source of infection was the respiratory system (45% vs. 29%, p=0.01) and catheter-related bloodstream infection (CRBSI) (17% vs. 8%, p=0.03) than those who did not. New AKI development was associated with longer ICU stay (9 [5-18] vs. 5 [3-10] days, p<0.01) and was independently associated with ICU mortality (OR (95% CI): 28.6 [6.6-125], p<0.01).

Conclusion: This study reveals new-onset AKI incidence of 36% in septic medical ICU patients. Additionally, it underlines the potential impact of infection sources on new AKI development. New-onset shock, IMV, and disease severity were independently associated with both new-onset AKI and ICU mortality in this population.

Objective: The aim of this study was to evaluate the relationship between the degree of visceral pleural invasion (VPI) and survival in patients operated for non-small cell lung cancer (NSCLC).

Methods: Between 2013 and 2015, 202 patients who were diagnosed with NSCLC in our center and followed up in our clinic were retrospectively evaluated. To examine the preoperative and postoperative prognostic factors of the patients, postoperative pathology results, demographic data and data on recurrence status were obtained from our hospital database and patient files.

Results: VPI Survival analysis was performed by dividing 3 groups: PL0, PL1 and PL2. Mean survival (MS) was calculated as 39.528±1.469 (36.655-42.402; 95% CI) months for PL0, 35.136±3.115 (29.031-41.240; 95% CI) months for PL1, and 24.688±3.697 (17.441-31.934; 95% CI) for PL2 (p=0.020). When we consider PL0 and PL1 as a single group and compare it with PL2, the MS time of the PL0-PL1 group was 38.358±1.346 (35.721-40.995; 95% CI) months, while the MS time of the PL2 group was 24.688±3.697 (17.441-31.934; 95% CI) months (p=0.020).

Conclusion: Although PL0, PL1 and PL2 were classified into a single group (all considered as T2), this study showed that the presence of PL2 was associated with a poor prognosis in terms of survival, independent of lymph node involvement, histopathological subtype of the tumor and tumor size.

Objective: Perioperative hypoxemia is common during minimally invasive repair of pectus excavatum (MIRPE). Oxygen Reserve Index (ORI™) is a noninvasive method that shows blood oxygenation status. In addition, this method provides information about hypoxemia earlier than pulse oximetry. The primary aim of this study was to examine the value of ORI monitoring as an early predictor of hypoxemia during surgery. The secondary aim was to evaluate the value of ORI monitoring as a guide for oxygen titration to prevent hyperoxemia.

Methods: This randomized controlled study enrolled 128 pediatric patients aged 8-18 years scheduled for elective MIRPE surgery. Patients were followed up with continuous peripheral oxygen saturation (SpO₂) measurement in the control group (Group C) and continuous ORI monitoring in the study group (Group O). After pneumothorax, a decrease of 1% in basal SpO₂ and 0.05 from basal ORI was considered clinically significant. Patient demographics, pre-induction, pre-first and second pneumothorax, and postoperative ORI, mean arterial pressure, temperature, perfusion index, end-tidal carbon dioxide values, length of hospital stay, anesthesia, and surgery durations were recorded.

Results: Desaturation time was 59.46±15.57 seconds in Group O based on ORI, and 177.64±20.94 seconds in Group C according to SpO₂, and the difference was significant (p<0.001). Use of FiO₂>0.6 was lower in Group O, compared with Group C (p<0.05). Length of hospital stay was lower in Group O (p=0.002).

Conclusion: ORI may detect hypoxemia earlier than SpO₂ monitoring during MIRPE surgery. ORI monitorization decreases exposure time to high oxygen concentrations and may increase patient safety during MIRPE surgery in pediatric patients.