Northern clinics of Istanbul最新文献

Objective: The aim was to evaluate the outcomes of conventional anorectal manometry (ARMM) testing and biofeedback therapy in adolescents with functional constipation.

Methods: A retrospective analysis of ARMM findings in patients aged 10-18 years with intractable constipation over a 4-year period was conducted.

Results: Of the 41 patients (mean age, 13.5±2.44 years) included, 20 (48.7%) were male. Rectoanal inhibitory reflex (RAIR) was positive in all patients. Group 1 had 31 patients with dyssynergic defecation (DD) and Group 2 had 10 patients without DD. Anal canal resting pressure, squeeze test pressure, rectal defecation pressure, and first and urge sensation volumes were similar between the groups. Maximum tolerated volume and the relaxation percentage of RAIR were higher in Group 1 than in Group 2 (p<0.05). Among 31 patients referred for biofeedback therapy, 8 (25.6%) completed the program with complete resolution of their symptoms. The mean follow-up period for these patients was 21±14.7 months.

Conclusion: DD is relatively common in patients with psychosocial adjustment disorders, and it can be diagnosed via ARMM. Despite the low rate of adherence to the therapy in the presented series, biofeedback therapy was highly effective in resolving the symptoms including soiling.

Objective: An old disease called the Marburg virus infection has just recently started to appear in some African nations in recent years. The disease is currently being scrutinized for its potential to become a new global public health issue.

Methods: The authors of this work employed a mathematical modeling technique to determine the final seroprevalence rate.

Results: The seroprevalence rate can be estimated based on the results of the current investigation. This incidence may indicate that the endemic nation has an asymptomatic Marburg virus infection.

Conclusion: This may also point to the significance of a possible asymptomatic Marburg virus sickness, which may be the cause of the disease's broad transmission. In light of the resurfacing Marburg virus disease concern, it is important to recognize this problem.

Objective: It has been reported that the shock index assists in the prediction of poor prognosis in stroke patients. However, the role of this index in predicting mortality and prognosis in patients with intracerebral hemorrhage has not been sufficiently investigated. The objective is to examine the correlation between the shock index and mortality and unfavorable clinical outcomes in individuals with intracerebral hemorrhage.

Methods: 110 consecutive cases of intracerebral hemorrhage were evaluated in the emergency department. The shock index values of the patients were calculated using their initial blood pressures and HR. For descriptive purposes, the shock index values were categorized into three groups: <0.50, 0.50-0.70, and >0.70. The relationships of these three values and the mean shock index with hematoma volume, hematoma rupturing into the ventricle, length of hospital stay, complications during this period, and in-hospital and three-month mortality were examined.

Results: There were 58 male patients in this study, with a mean age of 62.66±13.64 years. The mean baseline Glasgow Coma Scale score was 13.78±2.37, and the mean baseline shock index value was 0.51±0.13. The mean time of hospitalization was estimated to be 17.01±14.02 days. The mean in-hospital mortality rate was 19%, and the mean three-month mortality rate was 23%. No statistically significant differences were found in hematoma volume, hematoma rupturing into the ventricle, length of hospital stay, complications during this period, or in-hospital and three-month mortality according to the mean shock index value or shock index categories (<0.50, 0.50-0.70, and >0.70).

Conclusion: The shock index evaluated in the emergency department in patients with intracerebral hemorrhage is not related to mortality or morbidity.

Objective: Tongue reconstruction results following partial glossectomy using primary closure and local tissue rearrangement were evaluated in this study.

Methods: 7 patients diagnosed with tongue carcinoma were included. Tongue defects were reconstructed using local transposition, advancement and rotation of the remaining tongue tissue and closure of the defect. The patients were evaluated 6 months and 1 year following the surgery.

Results: None of the patients had permanent speech impairments or major swallowing problems following the surgery despite 33% to 50% reduction in tongue length.

Conclusion: Unnecessary utilization of microvascular flaps for partial tongue reconstruction should be avoided in partial glossectomy patients in which reduction in tongue length is below 50%.

Objective: The present study reviews the records of patients with solid pseudopapillary pancreas neoplasm (SPT).

Methods: A total of 13 patients diagnosed with SPT were included in the study. The criteria for SPT in the pathology specimens were the presence of cells with an oval round orthochromatic nucleus, with a thin chromatin structure and no nucleolus distinction, lined around a fibrovascular papilla in cystic areas.

Results: The study included 11 female and two male patients, with a mean age of 33.07 (range: 16-73) years. All operated patients underwent open surgery, with five undergoing a subtotal pancreatectomy and splenectomy; one a distal pancreatectomy and splenectomy; four a spleen-preserving distal pancreatectomy; and one a pancreaticoduodenectomy. None of the operated patients developed recurrence during the long-term follow-up. The mean follow-up time of operable patients was 69.18 (range: 22-97) months, and none had metastasis at follow-up. The mean follow-up time for the malignant SPT patients was 2.75 (1.5-4) months.

Conclusion: SPTs are rare pancreatic tumors encountered more frequently today due to advances in imaging methods and have a low potential of recurrence and a good prognosis.

Objective: Postural orthostatic tachycardia syndrome (POTS) is one of the orthostatic intolerance syndromes that are common in young adolescents and impair quality of life. POTS is a multi-systemic disease. Many mechanisms have been defined in POTS etiology, such as autonomic denervation, hypovolemia, hyperadrenergic stimulation, low condition, and hypervigilance. Recently, mast cell activation (MCA) has also been on the agenda in etiology. There are few studies in the literature on the relationship between MCA and POTS in adulthood. However, data on children and adolescents is limited. In light of this information, we aimed to evaluate the relationship between POTS and MCA by measuring serum tryptase levels, a specific marker for MCA.

Methods: This prospective study included patients who were admitted to Kocaeli University Faculty of Medicine Hospital Pediatric Cardiology outpatient clinic for syncope-presyncope between November 2018 and August 2019. Patients who underwent the TILT-table test were enrolled in the study. Patients with structural heart disease or chronic heart disease were not included in this study. Serum tryptase levels were obtained from all patients before the TILT-table test, and serum tryptase levels were re-studied after the test was terminated in patients with positive TILT-table tests for POTS. Patients diagnosed with POTS were classified as Group 1, and other patients were classified as Group 2.

Results: Twenty-eight of the 58 patients included in the study (mean: 14.4±2.0 years; 38 girls, 20 boys) were diagnosed with POTS. The remaining 30 patients were diagnosed with vasovagal syncope and included in Group 2. The increase in mean heart rate during the test was 38±6 beats/min and 47.05%±15.65% in patients with POTS. Basal serum tryptase levels were not different between groups (3.2±1.3 ng/ml and 3.84±1.78 ng/ml, respectively; p=0.129), while serum tryptase levels (both baseline and after 45-60 min of the TILT-table test) were higher in patients presenting with symptoms related to MCA compared to others.

Conclusion: In the literature, MCA was considered to be one of the mechanisms leading to POTS. Although other mechanisms, such as neuropathic and hypovolemic POTS, may be active in the patients, the symptoms of MCA in these patients should be routinely questioned.

Objective: Incidence of venous thromboembolism (VTE) is higher than the expected in patients with hematologic malignancies and duration of hospitalization period increases the risk of thrombosis. The objective of this study was to investigate the incidence of and risk factors for venous thrombosis in hospitalized patients with hematologic malignancies.

Methods: We designed a prospective cohort study and enrolled patients with hematologic malignancies, who had been hospitalized between 2020 and 2021. Thromboprophylaxis was given to all patients, other than those under a high risk of hemorrhage.

Results: 94 patients were enrolled. The incidence of superficial vein thrombosis was 11.7% and the incidence of deep vein thrombosis (including pulmonary embolism and catheter thrombosis) was 7.4%. Patients, who developed thrombosis, had statistically significantly longer hospital stays (21 vs. 11.5 days, p=0.023) and a higher number of hospitalizations (1 vs. 3, p=0.015) compared to those, who did not develop thrombosis. Patients, who had 3 or more risk factors for thrombosis, were found to be under the highest risk. (p=0.017, OR=4.32; 95% CI: 1.3-14.35). Furthermore, patients with recurrent hospitalizations (p=0.024, OR=1.49; 95% CI: 1.05-2.11) and higher fibrinogen levels (p=0.028, OR=1; 95% CI: 1-1.006) were under an increased risk of thrombosis.

Conclusion: Venous thrombosis is frequently seen in hospitalized patients with hematologic malignancies. A universally accepted risk scoring system is required for detection of patients, under a high risk for thrombosis.

Objective: The purpose of this study is to evaluate whether hepatosteatosis is associated with lung cancer in patients undergoing lung nodule biopsy.

Methods: 359 patients (248 males, 69.1%) who underwent lung biopsy between the years 2016 and 2022 were included in this retrospective study. The average age of the patients was 64.59±14.05 (range=30-90) years. These patients were undergoing follow-up for a lung lesion and had undergone thoraco-abdominal CT scans. Attenuation measurements were performed on non-contrast CT scans from the liver and spleen parenchyma.

Results: Pathology results showed that the majority of diagnoses were malignant (n=265, 73.8%). Statistical analysis revealed a significantly higher number of patients with malignancy among those with hepatosteatosis compared to those without hepatosteatosis (73% vs. 57%, p=0.006). Furthermore, patients with malignancy were more frequently male (73 vs. 27%, p=0.010), older (65.80±12.83 years vs. 61.20±16.63 years; p=0.06) and had a higher prevalence of diabetes mellitus (DM) (43.7 vs. 31.9%, p=0.046). Logistic regression analysis indicated that advanced age, DM, and hepatosteatosis were associated with an increased risk of malignancy (p=0.049, 95% CI (1.000-1.036), p=0.044, 95% CI (0.0347-0.98736), p=0.013, 95% CI (1.154-3.323), respectively).

Conclusion: The study findings suggest that hepatosteatosis might be associated with lung cancer. Therefore, due to its possible relationship with lung cancer, it should be taken very seriously, considering the chance of early diagnosis and treatment.

Objective: Urinary system injuries may occur iatrogenically during some surgical procedures especially gynecological and obstetrical surgeries. Unfortunately, these injuries can lead to serious complications in patients. In this multicentric study, we aimed to review and report our experiences and results of urinary tract injuries identified during gynecological and obstetrical surgery.

Methods: We included women with urinary tract injuries during gynecological and obstetrical surgeries between January 2018 and October 2023 at four centers. Detailed data collected include patient demographics, surgical details, injury characteristics, diagnostic and treatment methods, timing of injury diagnosis and management reports of the patients. The incidence of bladder and ureter injuries was evaluated and the rate of intraoperative urological consultations was recorded.

Results: In a total of 328 patients with a median age of 47 years (24-90), urinary tract injuries were diagnosed, including 227 (69.2%) iatrogenic bladder injuries (IBI) and 101 (30.8%) iatrogenic ureteral injuries (IUI). These injuries were diagnosed in 299 patients (91.2%) during surgery and in 29 patients (8.8%) after the surgical procedure. We observed intraoperative detection rates of 71.9% for IBI and 28.1% for IUI. IBI (71.9%) was diagnosed significantly more frequently than IUI (28.1%) (p=0.001). Cesarean section resulted in significantly more frequent IBI, whereas tumor debulking surgeries resulted in more IUI (n=52, 56.5%) than the other types of procedures (p<0.001).

Conclusion: Our study provides a comprehensive overview of iatrogenic urological injuries during gynecological and obstetrical surgeries. Although the bladder is the most frequently injured organ during gynecological and obstetric surgeries, early diagnosis and urological intervention are mandatory to prevent delayed complications. Surgeons must have a thorough understanding of the pelvic anatomy and appropriate surgical techniques to prevent iatrogenic injuries during surgery and ensure timely diagnosis and treatment of urinary tract injuries.