Search

Severe acute respiratory syndrome coronavirus-2 is an important infectious agent that was first detected in China, causing the pandemic and death of thousands of people. Although the clinic of this disease, called coronavirus disease-19 (COVID-19), is variable, cytokine storm and different mechanisms can cause increased mortality as a result of progressive and serious clinical presentations. Since it belongs to a well-known group of viruses, researchers have gained momentum after the isolation and the identification of the features of the virus. Although specific drugs began to be developed, the first potential candidate drugs were drugs such as broad-spectrum antibiotics, antiviral agents, anti-parasitic agents, and interferon, which were planned to be used with similar indications before pandemic. Trials on all steps such as prophylactic and supporting therapies, as well as care for critically ill patients and vaccine investigation studies are still ongoing. The drugs used in the light of the guidelines were frequently updated and some changes were made as a result of reports on side effects and efficacy evaluations. Especially in some drug combinations, side effects like prolonged QT interval, drug-drug interactions, and restrictions on the use of some drugs in the pediatric age group or pregnancy limit the specific, evidence-based and reliable treatment. Although there are many drugs in the trial phase for COVID-19 treatment, the most promising and most effective drugs are discussed and summarized under the light of national guidelines and clinical evidences with all aspects of the literature.

Percutaneous left atrial appendage (LAA) closure is a currently utilized procedure for the prophylaxis of thromboembolic cerebrovascular events in selected patients with nonvalvular atrial fibrillation. The presence of thrombus on closure device was reported at 1st and 3rd months after the procedure, but as far as our knowledge, there are no data about early thrombus formation on the device during procedure. We present a case demonstrating thrombus on the atrial side of the Amplatzer Amulet LAA occluder device early after the implantation.

Background: Laparoscopic partial nephrectomy, which minimizes renal function loss due to its nephron sparing nature, has become a standard technique among many experienced centers worldwide for surgical treatment of localized kidney tumors. Although partial nephrectomy will remain the gold standard, we need to improve perioperative management and surgical method to prevent postoperative acute kidney injury., Aims: To demonstrate the frequency of the development of postoperative acute kidney injury following laparoscopic partial nephrectomy in patients with healthy contralateral kidney and determine the early predictive effects of serum neutrophil gelatinase-associated lipocalin on ischemia-reperfusion injury and its association with warm ischemia time., Study Design: Cross-sectional study., Methods: Eighty patients were included. We analyzed tumor size, operating time, duration of anesthesia, and warm ischemia time. Serum samples were obtained for measurement of serum creatinine, estimated glomerular filtration rate, and neutrophil gelatinase-associated lipocalin level preoperatively, at the postoperative 2 nd hour, and on postoperative days 1 and 2. We used receiver operating characteristic curve for determining the cut-off point of neutrophil gelatinase-associated lipocalin to detect postoperative acute kidney injury. Correlation analysis was performed using Spearman’s test., Results: Twenty-seven patients developed acute kidney injury on postoperative day 2, and the neutrophil gelatinase-associated lipocalin level increased significantly at the postoperative 2 nd hour in the acute kidney injury group (p=0.048). For a cut-off of 129.375 ng/mL neutrophil gelatinase-associated lipocalin, the test showed 70.0% sensitivity and 68.3% specificity for the detection of acute kidney injury at the postoperative 2 nd hour. For a cut-off of 184.300 ng/mL neutrophil gelatinase-associated lipocalin, the test exhibited 73.3% sensitivity and 63.3% specificity for the detection of acute kidney injury on postoperative day 1. A significant correlation was found between warm ischemia time and neutrophil gelatinase-associated lipocalin level at the postoperative 2 nd hour (r=0.398, p=0.003). The creatinine values were significantly higher and the estimated glomerular filtration rates were significantly lower on postoperative days 1 and 2 in the acute kidney injury group compared with those in the non-acute kidney injury group (p<0.001)., Conclusion: The neutrophil gelatinase-associated lipocalin may be used as an alternative biomarker to serum creatinine in differentiation of ischemic damage in patients undergoing laparoscopic partial nephrectomy.

Objective: Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease of the oral mucosa that commonly affects the general population. The objective of this study was to conduct a research in assesing the relationship between psychological disorders including anxiety, depression and salivary cortisol levels in patients with RAS., Methods: Thirty-nine patients suffering from minor RAS were enrolled in the study after obtaining an informed consent. The control group consisted of 25 age and gender matched healthy individuals. All subjects were evaluated by using both psychological tests (Hamilton's anxiety rating scale [HARS] and Hamilton's depression rating scale [HDRS]) and physiological testing instrument (salivary cortisol level)., Results: While no statistical difference was found between the patients with RAS and controls for both salivary cortisol levels and anxiety, there was statisticaly significant difference between the groups for depression., Conclusion: There was no significant increase in salivary cortisol levels in patients with active disease when compared to the healthy subjects. But we found that depression scale values were significantly higher in patients with RAS., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare.

Purpose: We aimed to determine the feasibility and effectiveness of agent emission imaging - high mechanical index (AEI-High MI) mode ultrasonography (US) compared with gray-scale and color Doppler US, alone or in combination, for the diagnosis of urolithiasis with reference to unenhanced computed tomography (CT)., Methods: This prospective study included 72 consecutive patients (40 males, 32 females; mean age, 45.9±14.7 years) referred by the department of urology for acute or elective symptoms of urolithiasis and confirmed to have urinary calculi on unenhanced abdominal CT, between January 2015 and June 2015. Gray-scale, color Doppler, and AEI-High MI US were performed by two radiologists to determine the effectiveness of these methods in the diagnosis of urinary stones and to compare them with the reference modality., Results: A total of 189 calculi were detected on CT examination. Gray-scale US had a sensitivity of 66.1% and positive predictive value (PPV) of 88.7% for detecting calculi, while twinkling artifact of color Doppler had a sensitivity of 70.4% and PPV of 94.3%. The scintillation artifact of AEI-High MI mode had a sensitivity of 75.1% and PPV of 95.9%. When all ultrasound-based modalities were combined, the sensitivity and PPV rose to 83.1% and 88.2%, respectively. When calculi were grouped according to their size ( < 5 mm, 5-10 mm, > 10 mm), AEI-High MI mode had a higher sensitivity (60%) compared with gray-scale (32.5%) and color Doppler (41.3%) for calculi < 5 mm., Conclusion: AEI-High MI mode had a higher sensitivity compared with gray-scale and color Doppler for the detection of calculi smaller than 5 mm, but it did not make a significant contribution to detection of larger calculi. The combined use of gray-scale US with AEI-High MI mode could increase the detection rate of calculi smaller than 5 mm and provide a method for verification of suspected calculi on gray-scale US.

Patients who require laryngectomy usually do not want to completely or partially lose their larynx. Laryngeal transplantation (LT) is a composite tissue transplantation from a cadaver to an alive recipient and requires lifelong immunosuppression in postoperative term. The aims of LT are breathing without tracheostoma, normal swallowing, and voice production. To date, only two successful complete LT have been performed in human despite many researches. The requirement of post-transplant immunosuppressive treatment has ethical concern for the larynx, which is a non-vital organ. However, LT may be an option for improving the quality of life of patients undergoing laryngectomy. In this study, we discussed the LT procedure and researches with the literature., Competing Interests: Conflict of Interest: No conflict of interest was declared by the author.

Echinococcosis is endemic in many parts of the world. Although echinococcosis can be present in all parts of the human body, urinary tract involvement develops in only 2-4% of all cases, and isolated renal cysts are extremely rare. There are no specific clinical symptoms or signs that will reliably confirm the diagnosis of renal echinococcosis. Routine blood tests are generally normal except for eosinophilia, which is found in only 20% of the cases. Radiological studies have a more important place in the preoperative diagnosis of renal hydatic disease. However, there is no specific sign on plain urography or intravenous urography, and ultrasound or computed tomography cannot always show a echinococcosis as a specific lesion. Echinococcosis should be included in the differential diagnosis of cystic lesions in solid organs or other anatomic sites, especially in endemic countries. We presented a patient with isolated giant renal cystic echinococcosis mimicking a complicated cyst who was treated successfully with nephrectomy.

Purpose: We aimed to describe the long-term outcome of endovascular treatment of iliofemoral deep vein thrombosis in the postpartum period., Materials and Methods: Between 2002 and 2010, 18 consecutive female patients with acute or subacute iliofemoral deep vein thrombosis in the postpartum period who had endovascular treatment were retrospectively evaluated. Treatment consisted of manual aspiration thrombectomy with or without catheter-directed thrombolysis. Stents were placed in the iliac veins, if deemed necessary. Clot removal was graded as complete (>95%), partial (50%-95%), and poor (<50%)., Results: The initial treatment was technically successful in 17 patients (94%). There was complete clot removal in 15 of 22 limbs (68%). Twenty-three stents were implanted in 15 patients (83%). The primary and secondary patencies were 58% and 82% at one year, 58% and 72% at three years, and 58% and 58% at five years, respectively. There were recurrent thromboses in 11 patients (61%), which occurred within the first month in nine of these patients (81%). Ten patients had repeated intervention, and five had successful outcomes. At a mean follow-up of 30 months, 11 patients had uninterrupted in-line flow in the affected lim b, and six patients did not. Six of the patients with uninterrupted flow were asymptomatic, and five patients had minimal swelling at the ankle., Conclusion: Endovascular treatment of postpartum iliofemoral deep vein thrombosis with percutaneous aspiration thrombectomy alone or combined with catheter-directed thrombolysis and iliac vein stenting is an effective therapy resulting in a high rate of thrombus removal. However, recurrences are high, particularly in the first post-intervention month. Frequent patient followup in the first post-intervention month is necessary.

Purpose: The purpose of this study was to evaluate the outcomes of ultrasound-guided femoral artery access for total percutaneous endovascular repair of abdominal and thoracic aortic aneurysms., Materials and Methods: Total percutaneous aneurysm repair of the abdominal and thoracic aorta was performed in 52 consecutive patients (46 males, 6 females; mean age, 64.6±16 years; age range, 24-93 years) in a total of 85 access arteries. Of the aortic aneurysms repaired, 33 were abdominal, and 19 were thoracic. Ultrasound- guided puncture of the access artery was performed in all patients. The access artery was closed with a Prostar XL device at the end of the procedure., Results: The outer diameter of the vascular sheaths or the stent graft system ranged from 14 F to 27 F. All but one patient achieved successful closure of the arterial puncture with the closure device. One patient required surgical cutdown because of device failure. Two patients required long-duration manual compression. Technical success was achieved in 49 patients (94%). Forty-five patients (87%) were discharged on the first postoperative day. There were no complications of the access arteries one day or one month postoperatively, as determined by ultrasonography and computed tomography examinations, respectively. The mean diameters of the access arteries prior to and one month after the procedure were unchanged, as demonstrated by computed tomography., Conclusion: Ultrasound-guided puncture of the common femoral artery for percutaneous closure of the access site has a high technical success rate and a very low complication rate. The addition of ultrasound guidance decreases the difficulty of the procedure and helps to avoid some of its complications.