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OBJECTIVE To compare insulin infusion and heparin infusion, used to treat hypertriglyceridemia-induced acute pancreatitis in terms of efficacy. STUDY DESIGN Descriptive study. PLACE AND DURATION OF STUDY Department of Gastroenterology, Division of Internal Disease, Sivas Cumhuriyet University Hospital, Sivas, Turkey, from 1st January 2013 to 1st January 2020. METHODOLOGY Patients who presented with abdominal pain and were found to have edematous pancreatitis on computed tomography imaging were retrospectively reviewed. Thirty-six patients with hypertriglyceridemia were included. Eighteen of the patients were given insulin infusion, while the other 18 were given heparin infusion therapy. The patients' gender, age, admission amylase values, AST, ALT, total cholesterol, glucose, lactate dehydrogenase (LDH), CRP, leukocyte, pre-treatment and post-treatment first, second, and third-day triglyceride levels were recorded from the files. RESULTS The post-treatment third-day triglyceride levels of the insulin therapy group were statistically significantly lower compared to the heparin therapy group (432.5; 984, p

Nipple-sparing mastectomy (NSM) and implant-based immediate breast reconstruction are becoming preferred options with improved outcomes. However, reconstruction in patients with large and ptotic breasts is challenging. When mastectomy and skin reduction are combined in a single-staged procedure, the vasculature of the skin is disturbed leading to increased complication rates. This paper aims to compare complication rates of NSM and immediate implant-based reconstruction with or without reduction to determine the safety of reduction in this patient group. Breast cancer patients that underwent NSM and implant-based immediate breast reconstruction between November 2010 and 2018 were analyzed. All implants were placed submuscularly. Patients with skin reduction and nipple–areolar complex transposition were matched in a 1:1 fashion with patients without reduction. There were 50 patients (72 procedures) in each group. Demographics of the groups were similar as a part of matching process. Mean implant volume in the reduction group was higher (399.93 ± 97.54 vs. 360.21 ± 82.54, p = 0.009). Full thickness skin necrosis rate was higher in the reduction group [12/72 (%17) vs. 2/72 (3%), p = 0.009], and the most common site was over the suture line [6/12 (50%)]. Complications in the reduction group were more common in reconstructions with implant volumes greater than 500 cc (p = 0.008). When compared with no reduction, the skin necrosis rate of NSM and immediate implant-based reconstruction with skin reduction is higher. The described technique can only be considered in patients with moderate breast volumes, grade II–III ptosis, and when the planned implant volume is low (

Doğum sonrası dönem; ebeveynler ve bebekler için çok önemli bir süreçtir. Özellikle özel durumlara sahip ebeveynler (engellilik, infertilite, anomalili bebeği olan, istenmeyen gebelik, çoğul gebelik) doğum sonrası döneme adaptasyon sağlamakta zorlanmaktadır. Engelli ebeveynlerin doğum sonu döneme uyumları uzayabilirken, infertil ebeveynlerde doğum sonu dönemde postpartum depresyon görülebilmekte ve anomalili bir bebeğe sahip olan ebeveynlerde post-travmatik stres yaşayabilmektedir. İstenmeyen gebelik sonucu bebek sahibi olan ebeveynlerde öfke, hayal kırıklığı, bebeği istememe gibi tepkiler görülebilmekte, çoğul gebeliklerde doğum sonrası psikolojik ve sosyal desteğe ihtiyaç duyulmaktadır. Bu derleme özel durumlara sahip ebeveynlerin doğum sonrası döneme adaptasyon süreçleri ile ilgili ebe ve hemşirelere farkındalık kazandırmak amacıyla hazırlanmıştır.

The ability to inhibit an inappropriate action in a context is an important part of the human cognitive repertoire, and deficiencies in this ability are common in neurological and psychiatric disorders. An anti-saccade is a simple experimental task within the oculomotor repertoire that can be used to test this ability. The task involves an inhibition of a saccade to the peripheral target (pro-saccade) and generation of a voluntary eye movement toward the mirror position (anti-saccade). Previous studies provide evidence for a possible contribution from the basal ganglia in anti-saccade behavior. However, the precise role of different components in generation of anti-saccade behavior is still uncertain. Parkinson’s disease patients with implanted deep brain stimulation (DBS) in subthalamic nucleus (STN) provide us with a unique opportunity to investigate the role of STN in anti-saccade behavior. Previous attempts to show the effect of STN DBS on anti-saccades have produced conflicting observations. For example, the effect of STN DBS on anti-saccade error rate is not yet clear. Part of this inconsistency may be related to differences in dopaminergic states in different studies. Here, we tested Parkinson’s disease patients on anti- and pro-saccade tasks ON and OFF STN DBS and ON and OFF dopaminergic medication. We made three main observations. First, STN DBS increases the anti-saccade error rate while patients are OFF dopamine replacement therapy. Second, there is an interaction between dopamine replacement therapy and STN DBS. More specifically, L-dopa reduces the effect of STN DBS on anti-saccade error rate. Third, STN DBS can induce different effects on pro- and anti-saccades in different patients. These observations provide evidence for an important role for the STN in the circuitry underlying context-dependent modulation of visuomotor action selection.

The aim of the present study was to evaluate serum concentrations of copper (Cu) and zinc (Zn), in relation with metabolic profile and clinicopathologic features of patients with endometrial cancer. A total of 47 women with endometrial cancer and 45 controls were eligible for the study. Clinicopathologic features and metabolic profile as well as serum copper and zinc levels were evaluated in each subject. Patients with endometrial cancer (Cu mean 3.72 ± 2.15 mg/L, median 3.54 [0.41-9.16] mg/L and Zn mean 1.83 ± 0.71 mg/L, median 1.77 [0.71-4.02] mg/L) exhibited lower Cu and Zn levels than those of controls (Cu mean 6.06 ± 1.79 mg/L, median 6.32 [2.95-9.05] mg/L and Zn mean 2.48 ± 0.89 mg/L, median 2.23 [1.23-4.54] mg/L) (p 0.001). Cu/Zn ratio was also higher (0.85 ± 1.96 vs. 2.57 ± 0.73) in controls as compared with patients with endometrial cancer. While Cu levels showed no significant correlation with age, body mass index, gravidity, and parity, a positive correlation was found between Zn levels and parity. When cancer patients were evaluated on their own, both Cu and Zn levels showed positive correlation with age. Additionally, the cancer patients with myometrial invasion 1/2 exhibited lower Cu levels compared with the cancer patients with myometrial invasion 1/2. The data of the present study suggested that women with endometrial cancer are characterized by altered serum Cu and Zn levels as compared with controls. Imbalance of these trace element levels might be associated with endometrial cancer among Turkish patients.

Aim The aim of the present study was to investigate the familial and somatic mutations as well as polymorphisms of TP53 gene in patients with uterine leiomyoma. Methods The study included 35 women with histologically diagnosed as uterine leiomyomas at the Gynecology Department of Adnan Menderes University Faculty of Medicine. Tissue and blood samples were analyzed for mutations and polymorphisms of TP53 gene by next generation sequencing (Miseq-Illumina). Acquired data was compared with the normal data in Ensembl database. Data from 1000 genome project and data from exome sequencing analyses in Intergen Genetic Diagnosis Center (Ankara) were used as controls for polymorphism analyses. Results There were no mutations in tissue and blood samples. However, when the polymorphisms were evaluated, a significant difference was found in NM_000546.5(TP53):c.215C > G (p.Pro72Arg) polymorphism between the study and control groups. The results indicated that P72R/P72R genotype increased the risk of leiomyoma development by 6.3 fold (95% confidence interval [CI]: 2.880-13.793). There was a negative correlation between P72R/WT genotype and leiomyoma development (OR = 0.261, 95% CI: 0.114-0.596). P72R/P72R genotype was statistically higher in the patients with leiomyoma compared with the controls and 1000 genomes from Asian, European and World populations. Conclusion The results of the present study suggested that P72R/P72R genotype may be associated with development of uterine leiomyoma in the Turkish population in the Western part of the country.

Objectives: The mechanisms of acute liver failure resulting from epilepsy are poorly defined and appear to be multifactorial, including hypoxia and steatosis. The role of inflammation on liver damage after seizures is unclear. This study aimed to investigate the relationship between proinflammatory cytokines and liver damage after pentylenetetrazole-induced acute and chronic epilepsy models in rats.Materials and methods: Male Wistar albino adult rats (n = 18), weighing 220–240 g, were used in the experiment. The animals were divided into three groups: (1) Control Group (Control; n = 6); rats were treated with a single dose of saline intraperitoneally (i.p.), (2) Acute Epileptic Model Group (n = 6); rats were treated with a single dose of i.p. PTZ (45 mg/kg), (3) Chronic Epileptic Model Group (n = 6); rats were treated with repeated doses of i.p. PTZ (35 mg/kg) every other day for 15(fifteen) times.Result: There was a significant difference between the control and acute epileptic model in terms of serum AST, TNF-α, IL-1 β and IL-6 parameters (p

Objective: Galanin is a neuropeptide which has effects not only on metabolic syndrome but also on reproduction. Glypican-4 is an adipokine associated with insulin sensitivity by interacting directly with the insulin receptor. This study evaluated serum concentrations of galanin and glypican-4 in relation with the hormonal profile as well as metabolic and cardiovascular risk factors in patients with and without polycystic ovary syndrome (PCOS). Subjects and methods: A total of 44 women with PCOS and 44 age-matched controls were eligible. Hirsutism scores, hormonal profile, metabolic and cardiovascular risk factors as well as galanin and glypican-4 levels were evaluated in each subject. Results: Women with PCOS exhibited lower levels of galanin (20.2 pg/mL versus 26.4 pg/mL, p = 0.002) and higher concentrations of glypican-4 (3.1 ng/mL versus 2.6 ng/mL, p < 0.001) than controls. Both adipokines were correlated positively with body mass index (BMI), insulin, triglyceride and Homeostasis Model Assessment (HOMA) index; glypican-4 also showed positive correlations with fasting blood glucose, free testosterone, modified Ferriman-Gallwey scores (p < 0.05). Multiple Linear Regression analyses showed that PCOS and BMI were the best predictors affecting galanin levels with a decreasing and increasing effect respectively; however BMI was the best predictor affecting glypican-4 levels with an increasing effect (p < 0.001). Conclusion: Galanin levels were lower and glypican-4 levels were higher in women with PCOS than controls. Further studies are needed to determine whether these adipokines could be used as additional markers for insulin sensitivity and lipid profile and whether they might play a role in the pathogenesis of PCOS, in which metabolic cardiovascular risks are increased.

Introduction Achilles tendon rupture and soft tissue infections with wound dehiscence and tendon exposure following the tendon repair are not infrequent. Various procedures have been described for the reconstruction of soft tissue defects at the Achilles tendon region, yet there is lack of consensus on the ideal method. In this article we report our experience using the distally based peroneal artery perforator flap in reconstruction of combined defects of the Achilles tendon and overlying soft tissue. Methods 7 patients with Achilles tendon injury and full-thickness soft tissue defects over the Achilles region underwent tendon repair and soft tissue reconstruction with the distally based peroneal artery perforator flap. Perforator vessels were identified at the septum between the peroneus longus and soleus muscles. After choosing the perforator with the largest diameter, meticulous deep dissection of the perforator was performed and completed 6 cm proximal to the lateral malleolus. The peroneal artery was transected and ligated and transposition of the flap to the defect was performed through a subcutaneous tunnel. Results The size of the soft tissue defects and flaps ranged between 2×3 cm to 4×10 cm and 4×5 cm to 5×12 cm, respectively. Six out of 7 flaps survived completely without any complications. Post-operative venous congestion was observed in one patient which resulted in partial tip necrosis of the flap. The resulting wound healed with conservative treatment. Donor sites healed uneventfully in all patients. All flaps had excellent contour and provided stable soft tissue coverage. Conclusion Distally based peroneal artery perforator flap can be considered as a reliable alternative for the reconstruction of soft tissue defects around the Achilles tendon region. Advantages include (1) extended reach of the flap for the defects around the plantar and dorsal aspects of the foot, provided by the perforator dissection, (2) convenience with footwear and walking, provided by the skin texture similarity with the target region, (3) creating a protective surface to allow tendon gliding and prevent tissue adhesions after the tendon repair, provided by the crural fascia included in the flap, (4) obviating the need for microsurgical anastomosis and associated length of the operation.

Background In this study, we applied the ultra-mini percutaneous hepatolithotomy (UM-PHL) technique on hepatolithiasis patients with multiple and large stones on which other minimally invasive methods failed, and our aim was to report its results, sharing in series for the first time. Materials and methods Preoperative and postoperative data, laboratory parameters, radiologic findings, and preoperative and postoperative details were recorded for a total of 14 patients for whom the UM-PHL technique was applied between April 2017 and December 2019. As all patients had multiple stones and extreme stone load and had bile duct surgery, they did not have a normal anatomy. All patients were radiologically confirmed to have had preprocedural magnetic retrograde cholangiopancreatography. Results Operation duration of the patients was 137.6±44.9 minutes, while intraoperative blood loss was 69.2±24.9 mL, drainage catheter removal time was 2.85±0.86 days, and the hospitalization time was 4.28±2.55 days. Intraoperative balloon dilation was applied to enlarge the stricture area in 5 patients (35.7%). On the basis of the Clavien-Dindo classification, grade 2 complication was observed in 2 patients (14.2%) due to postoperative cholangitis. Patients were followed up for an average of 15 months, and nonsymptomatic radiologic stone recurrence was detected in the 12th month control of 1 patient (7.1%). Conclusion The UM-PHL technique is a successful method that facilitates stone clearance by providing minimal dilatation through percutaneous intervention and by using instruments with small diameter, and it can safely be applied with its low complication level, low recurrence ratio, and short hospitalization time.

In this study, the efficiency of intracavernosal alprostadil + oral clomiphene citrate (CC) treatment in late-onset hypogonadism (LOH) accompanied by penile vasculogenic erectile dysfunction (PVED) in patients irresponsive to phosphodiesterase type 5 inhibitor treatment was evaluated. A total of 31 patients with concurrent PVED and LOH were included in the study. The patients were given intracavernosal alprostadil (10-20 μg) and oral CC (50 mg) every day for 12 weeks. Before and after treatment, a 15-question International Index of Erectile Function (IIEF-15) questionnaire, Erection Hardness Score (EHS), Sexual Encounter Profile (SEP)2 and SEP3 levels were analysed, and follicle stimulating hormone (FSH), luteinising hormone (LH), total testosterone and prostate-specific antigen (PSA) levels were measured. In all, 41.9% of patients had pure arterial deficiency, 19.3% had pure venous deficiency, and 38.7% had arterial + venous (mixed) deficiency. A significant increase was detected in total testosterone, FSH, LH and PSA values after treatment when compared to values before treatment (p < .001, p < .001, p < .001 and p = .034 respectively). A significant recovery was observed in IIEF-15 subscores, EHS and SEP2-SEP3 results. In PVED patients accompanied by LOH, intracavernosal alprostadil and oral CC combination is an efficient, low cost, safely applicable and tolerable treatment.

Objective The aim of the present study was to investigate effects of resveratrol (RSV) over ovarian hyperstimulation syndrome (OHSS) in rat model. Materials and Methods 24 female Wistar rats (22 days old) were divided into four groups. Group 1 (control group; n = 6) received 0.1 ml intraperitoneal (IP) saline from days 22–26; group 2 (mild-stimulated group; n = 6) received 10 IU pregnant mare serum gonadotropin (PMSG) on day 24 and 10 IU of hCG 48 h later (day 26); group 3 (OHSS group; n = 6) was given 10 IU of PMSG for 4 consecutive days from day 22 and 30 IU hCG on the fifth day to induce OHSS; group 4 (OHSS + RSV group; n = 6) was treated the same as group 3, but received 60 mg/kg RSV 2 h before PMSG injection for 4 consecutive days and 2 h before the hCG injection on the fifth day. Results Weight gain was highest in the OHSS group. Ovarian weights were lower in the treatment group than OHSS group. Peritoneal fluid VEGF levels were lower for RSV group compared to group 2 and 3. Total VEGF immunoreactivity was higher in OHSS group than group 1, 2 and 4. Conclusion These results indicate that RSV is beneficial for prevention of OHSS by reducing the increases in body and ovarian weight and VEGF activity. These effects may be mediated by anti-inflammatory, anti-oxidant and anti-angiogenic capacity of RSV.

Objectives: This study aimed to evaluate the serum concentrations of PAPP-A (pregnancy associated placental protein-A), a biomarker which is associated with cardiovascular disease, in patients with polycystic ovary syndrome (PCOS). Materials and Methods: A total of 62 women with PCOS, and 68 age and body mass index (BMI) matched controls were eligible for the study. Hirsutism scores, hormonal and metabolic profile as well as PAPP-A levels were assessed in each subject. Results: Women with PCOS and controls yielded similar median serum levels of PAPP-A (1.7 ng/ml versus 1.8 ng/ml, respectively, p = 0.328). However, when patients were compared based on BMI; subgroup analyses found that among women with BMI

Objective: Chronic otitis media is the infection of the middle ear and mastoid air cells. Cholesteatoma is keratinized squamous epithelium formation in the middle ear. Although the two diseases may be recognized with clinical examination, sometimes it may not be possible. While treatment of chronic otitis media includes antibiotic therapy or surgery, cholesteatoma is treated surgically. In this study, we aimed whether quantitative measurement of the soft tissue density in the middle ear on temporal bone CT may be used as a criterion for discrimination of chronic otitis media and cholesteatoma. Materials and Methods: A total of 45 patients were included in the study. Multi-slice CT images were obtained in supine position for temporal bone CT. The soft tissue density was measured using free hand and circle region of interest (ROI) techniques on temporal bone CT examinations. Results: A statistically significant difference was not detected between cholesteatoma and COM with regard to HU values on temporal bone CT in ROC curve. P value and Mann Whitney U was not statistically significant. Conclusion: As a result, soft tissue density measurement is not statistically significant for differential diagnosis of COM and cholesteatoma.

Amaç:Bu çalışmada letrozol ve gonadotropinlerin evre 1-2 endometriozisli infertilhastalarda ovülasyon indüksiyonu üzerine etkilerinin karşılaştırılmasıamaçlanmıştır.Gereçve yöntem: Prospektif randomize olarak dizayn edilençalışmaya tanısal laparoskopi yapılan ve histolojik olarak tanı konulan evre1-2 endometriozisli 20 hasta dahil edildi. Zamanlanmış cinsel ilişki ile devametmeyi planlayan hastalar, en az üç en fazla beş ovulasyon indüksiyonu döngüsüiçin letrozol (n=10) veya gonadotropinler (n=10) olmak üzere iki tedavi grubunaardışık olarak randomize edildi.Bulgular:Ovulasyon, letrozol grubunda %82,2 (37/45 siklus) ve gonadotropin grubunda%86,4 (32/37 siklus) oranlarında gerçekleşti. İki grup arasında ovulasyonoranları istatistiksel olarak benzerdi (p=0,590). hCG uygulamasınınyapıldığı gün gonadotropin grubunda toplam folikül sayısı anlamlı olarakyüksekti (2,33±0,71 ve 3,05±0,91, p, Purpose: This study aimed to compare theeffects of letrozole and gonadotropins for ovulation induction in infertilepatients with stage 1-2 endometriosis. Materials and methods: Twenty patients who underwentdiagnostic laparoscopy and histologically diagnosed stage 1-2 endometriosiswere included in this prospective randomized study. Patients whoplanned to continue with timed sexual intercourse were randomized into twotreatment groups including letrozole (n=10) or gonadotropins (n=10) for minimumthree and maximum five treatment cycles. Results: Ovulation occurred in 37/45cycles (82.2%) in the letrozole group and 32/37 cycles (86.4%) in thegonadotropin group, without statistically significant difference (p=0.590).Total number of follicles was significantly higher in gonadotropin group on theday of hCG administration (2.33±0.71 vs. 3.05±0.91, p

Objective: Prevalence of lamivudine resistance in treatment-naive hepatitis B patients shows variation among populations. The present study aimed to determine the prevalence of lamivudine resistance in treatment-naive chronic hepatitis B (CHB) patients followed in Turkish population. Method: The study comprised 71 chronic hepatitis B patients that have never received treatment for chronic hepatitis B infection before (treatment-naive). HBV DNA was detected quantitatively by real-time polymerase chain reaction (RT-PCR) method in serum samples collected from the patients. Sequence analysis and reverse hybridization by string method were used to determine Lamivudine motif mutants. Liver biopsy was performed in all patients. Serum samples collected were used to determine HBeAg and anti-HBeAb levels. Results: Of the 71 patients participated in the study. Mutation was detected in a total of 8 patients and the prevalence was 11.3% (8/71). The prevalence of mutation was 8.3% (4/48) in HBeAg-negative patients and it was lower than HBeAg-positive patients, in whom the prevalence was 17% (4/23) (p=0.01). Comparing the patients with and without mutation in terms of demographic characteristics, ALT levels, HAI and fibrosis scores, no statistically significant difference was determined (p=0.29). Conclusions: In the present study, the prevalence of mutation was 11.3% in treatment-naive chronic hepatitis B patients. Therefore, determining local prevalence for all populations and planning the treatment accordingly may prevent future complications and thereby enhance efficacy of treatment. Choosing drugs with low resistance profile and starting treatment considering this resistance.

Objective: In this study we aimed to investigate heart rate recovery (HRR) in patients with inflammatory bowel disease (IBD). Subjects and Methods: A total of 40 patients with IBD and 30 healthy controls were included in this study. A treadmill stress test was performed in all the patients to calculate the HRR index based on the age-specific maximum heart rate. The HRR indices were calculated as follows: HRR1, 2, 3, 4, 5 = heart rate at peak exercise - heart rate at 1, 2, 3, 4, and 5 min. The independent samples t test was used to compare HRR indices between the patient and control groups. The Pearson correlation coefficient was used to examine the association between the duration of IBD and the HRR indices. Multivariate regression analysis was carried out to identify predictors of impaired HRR in patients with IBD. Results: HRR indices at various time intervals were significantly lower in the patients with IBD than in the controls: HRR1 (1.18 ± 8 vs. 31 ± 7, p < 0.001), HRR2 (36 ± 12 vs. 51 ± 8, p < 0.001), HRR3 (46 ± 12 vs. 62 ± 11, p < 0.001), HRR4 (54 ± 7 vs. 65 ± 8, p < 0.001), and HRR5 (55 ± 13 vs. 71 ± 15, p < 0.001). Mean duration of IBD was 7.8 ± 3.6 years. In addition, there was a significant negative correlation between disease duration and HRR at the first minute (r = -0.704, p < 0.001). Multivariate logistic regression analysis showed that symptom duration (OR: 1.742, 95% CI: 1.148-2.636, p = 0.009) was an independent predictor of impaired HRR in patients with IBD. Conclusion: In this study, the data showed that the HRR was impaired in patients with IBDs. Hence, given the prognostic value of the test, patients with IBD should be monitored for future cardiovascular events.

Avulsion injuries of the upper extremities are challenging injuries for microsurgeons, and almost always crush and degloving components are present. Due to the severe damage to the neurovascular structures, microsurgical treatment options are quite difficult, but technical advances in microsurgery have resulted in increases in the possibilities of success in crush-avulsion type replantation. Good functional outcomes can be obtained with successful replantation in these cases. In this case report, we present a successful replantation of the totally degloved thumb, the result of a crush-avulsion injury caused by silicone molding machine.

This study investigated the frequency of persistent median artery (PMA) in patients with carpal tunnel syndrome (CTS) and controls. A total of 84 CTS patient wrists, and 136 wrists of control subjects without CTS, were examined on ultrasonography (US) and color Doppler US (CDUS), and by electrophysiological evaluations. The frequency of PMA in CTS was evaluated. Of 84 CTS patient wrists, 2 (2.4 %) had a PMA (both on the right side). Of 136 control wrists, 12 (9 %) had a PMA, which was unilateral in eight (three right and five left), and bilateral in two, cases. There was no significant difference between the CTS patient and control groups with respect to the frequency of PMA (P > 0.05). There was no significant difference between the CTS patient and control groups in the frequency of PMA. We suggest that an ipsilateral PMA does not increase the risk of CTS.

Breast reconstruction with a Becker-type expander is a common technique following mastectomy. However, inconsistency remains in the literature regarding risk factors for the survival of a Becker-type expander following immediate breast reconstruction. This study’s purpose is to investigate possible risk factors for the Becker-type expander survival and to evaluate the complications related to expander removal following immediate breast reconstruction. We performed a retrospective chart review of consecutive women who underwent a mastectomy followed by immediate breast reconstruction with a Becker-type expander from November 2010 to November 2016. Electronic medical records were analyzed retrospectively for demographic, clinical, operative characteristics, and outcomes. Univariate Cox regression analysis was performed to determine the risk factors for the survival of the Becker-type expander following immediate breast reconstruction. A total of 74 Becker-type expanders were used in 72 patients who underwent immediate breast reconstruction. The patients’ ages ranged from 27 to 71 years, with a mean ± standard deviation age of 44.6 ± 9.1 years. The most frequent complication was capsular contracture which occurred in 25 breasts (33.8%) followed by mastectomy skin flap necrosis in 6 breasts (8.1%), seroma in 4 breasts (5.4%), nipple-areolar complex necrosis in 4 breasts (5.4%), hematoma in 3 breasts (4.1%), and infection in 2 breasts (2.7%). The mean intraoperative expander fill volume (109.6 ± 66.9 cc [p = 0.039]) and mean total volume (386.5 ± 94.7 cc [p = 0.034]) were both significantly lower for patients with capsular contracture compared with those without capsular contracture. In patients with partial NAC necrosis, the mean mastectomy specimen volume (737.5 ± 242.8 cc) was significantly higher compared with patients without partial NAC necrosis (489.8 ± 219.0 cc; p = 0.027). A univariate Cox regression analysis showed that smoking and neoadjuvant therapy were significantly associated with expander removal (p = 0.023 and p = 0.006, respectively). The total volume of the expander and intraoperative fill volume of the expander appear to be predictive factors in the development of capsular contracture. However, there is no statistically significant association between radiotherapy and capsular contracture or expander survival in contrast with other published reports. Our findings reveal that the main risk factors for the survival of Becker-type expanders following immediate breast reconstruction are smoking and neoadjuvant therapy. To our knowledge, this is the first study to evaluate the most likely risk factors associated with Becker-type expander survival in immediate breast reconstruction. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Objective: The aim of this study was to determine the alterations of walking energy expenditure and plantar pressure distribution in young adults with patellofemoral pain syndrome (PFPS). Methods: Thirty five individuals (mean age: 21.31 ± 1.76) with PFPS constituted the patient group and forty healthy participants (mean age: 21.40 ± 2.11) the control group. Preferred walking speeds (PWS) were determined on the over ground. Individuals walked on a treadmill for 7 min at their PWS and 30% above PWS and oxygen consumption was recorded via a metabolic analyzer. Net oxygen consumption was calculated for each walking trial. Borg scale was applied to assess perceived exertion during walking trial. Plantar pressure distributions were measured by a pedobarography device. Plantar area was subdivided into six zones to evaluate the dynamic plantar pressure data. Results: The mean PWS of PFPS and control groups were 4.69 ± 0.51 and 4.52 ± 0.60 km/h, respectively (p > .09). No significant difference was observed in energy expenditure during walking at PWS between 2 groups while oxygen consumption during 30% above PWS was higher in patient group (18.72 ± 3.75 and 16.64 ± 3.27) (p = .007). Net oxygen consumption was also found to be higher in PFPS group (15.12 ± 3.62 and 13.04 ± 3.24) (p = .005). The mean Borg scores were significantly higher in PFPS group at each walking trials (p .05). Conclusion: Although, rate of perceived exertion and energy expenditure during walking at 30% above PWS are affected negatively in young adults with PFPS, we may speculate that energy consumption and plantar pressure distribution can be compensated by a physiologic adaptation mechanism during walking at PWS. Level of evidence: Level III, Therapeutic Study. Keywords: Energy consumption, Patellofemoral pain syndrome, Plantar pressure distribution, Young, Walking

Aim The aim of the present study was to evaluate serum concentrations of apelin, a newly discovered adipocytokine, in relation with tumor markers, metabolic profile and clinicopathologic features of patients with endometrial cancer. Material and Methods A total of 46 women with endometrial cancer and 44 controls were eligible for the study. Clinicopathologic features and metabolic profile as well as apelin-36 levels were evaluated in each subject. Results Women with endometrial cancer exhibited higher serum concentrations of apelin levels than controls (215.1 ± 59.8 pg/mL vs 177.3 ± 55.2 pg/mL, P = 0.002). Apelin levels were significantly correlated positively with body mass index, fasting insulin levels and homeostasis model assessment index (P 160 pg/mL, and diabetes mellitus were found to be associated with risk of endometrial cancer. Conclusion The data of the present study suggest that higher levels of circulating apelin are associated with an increased risk of developing endometrial cancer in obese women.

WOS: 000368273200010, PubMed ID: 26834793, Background: Obstructive sleep apnea (OSA) is a major disease that can cause significant mortality and morbidity. Chronic intermittent hypoxia is a potential causal factor in the progression from fatty liver to nonalcoholic steatohepatitis. Objectives: This study evaluated the association between the degree of liver steatosis and severity of nocturnal hypoxia. Patients and Methods: In this study, between December 2011 and December 2013, patients with ultrasound-diagnosed NAFLD evaluated by standart polysomnography were subsequentally recorded. Patients with alcohol use, viral hepatitis and other chronic liver diseases were excluded. We analyzed polysomnographic parameters, steatosis level and severity of obstructive sleep apnea (OSA) in consideration of body mass index (BMI), biochemical tests and ultrasonographic liver data of 137 subjects. Patients with sleep apnea and AHI scores of

STUDY DESIGN Ligamentum flavum (LF) thickness was measured by using lumbar magnetic resonance imaging in patients with low back or leg pain. OBJECTIVE This study investigated whether LF thickening is due to hypertrophy or buckling related to disc degeneration and examined the correlations between the thickness of the LF and age, sex, body mass index (BMI), degree of pain, lumbar spinal stenosis (LSS), and disc herniation. SUMMARY OF BACKGROUND DATA "LF thickness" and "LF hypertrophy" are used interchangeably in the literature, although they are not necessarily the same thing. Thickness may increase by buckling without a change in the mass of the LF, and whether LF thickening is due to tissue hypertrophy or buckling remains controversial. METHODS The thickness of 896 LFs at the L2-L3, L3-L4, L4-L5, and L5-S1 levels of 224 (mean age, 47.8 ± 16.7 yrs) patients was measured prospectively on axial T1-weighed magnetic resonance images, obtained at the facet joint level. The presence of disc degeneration, spinal stenosis, and disc herniation was evaluated. RESULTS At all of the levels investigated, LF thickness was significantly greater in patients with grades IV to V degeneration compared with the patients with grades I to III degeneration (P < 0.05). LF thickness at all levels increased significantly with age (P < 0.05). Sex and the degree of pain were not correlated with the thickness of the LF. Patients with a BMI of 25 kg/m or greater had the thickest LF at the L3-L4 level (P < 0.01). LF thickness was significantly greater at the L2-L3, L3-L4, and L4-L5 levels in subjects with LSS and significantly greater at all levels in subjects with disc herniation (P < 0.05). CONCLUSION Thickening of the LF is correlated with disc degeneration, aging, BMI, LSS, spinal level, and disc herniation. The authors concluded that thickening of the LF is due to buckling of the LF into the spinal canal secondary to disc degeneration more than to LF hypertrophy. Sex and the degree of pain were not correlated with the thickness of the LF.

Background Iron-mediated cardiomyopathy is the main cause of death in thalassemia patients. Early detection of cardiac abnormalities is important as aggressive chelation therapy may improve prognosis in these patients. The aim of this study is to evaluate left ventricular (LV) functions by tissue velocity imaging (TVI) and strain imaging (SI) in thalassemia patients without overt heart failure. Methods At total of 32 patients with β-thalassemia major (mean age: 24.2±8.0 y, 22 male) and 25 healthy controls (mean age: 22.8±2.1 y, 20 male) were included. Conventional echocardiography, TVI, and SI were performed on all subjects. Tissue velocity imaging and SI measures included peak systolic, early and late diastolic myocardial velocities, peak systolic strain and strain rate, and early and late diastolic strain rate at the basal segments of the LV lateral and septal walls. Results There were no significant differences in LV ejection fraction and fractional shortening between the groups. However, systolic myocardial velocity of the lateral wall and systolic strain and strain rate of the septal and lateral walls were significantly lower in thalassemia patients. There was a significant negative correlation between LV mass index and systolic myocardial velocity of the lateral wall (r = − 0.29, P = .045) and septal systolic strain (r = − 0.45, P < .001). Conclusion Thalassemia patients have regional systolic dysfunction in the LV lateral and septal walls, even if they do not have overt heart failure. Strain imaging is helpful in early detection of LV systolic dysfunction in thalassemia patients. Copyright © 2010 Wiley Periodicals, Inc.

We aimed to retrospectively evaluate morbidity, mortality and treatment outcomes in 12 cases of Morgagni hernia diagnosed with multidetector computed tomography (MDCT) and treated appropriately. This is a retrospective study and data on the demographics, presenting symptoms, MDCT images, operative approach, morbidity and mortality were collected from hospital records. Of 12 patients with a mean age of 60 years, ten were female. The diagnosis was made with MDCT before surgery. All hernias were unilateral and located in the right part of the thorax. The contents of the hernias were omentum and colon in the majority of the patients, and the contents of the hernia as diagnosed with CT was confirmed at surgery. Six patients had surgery. Of these, one had emergency surgery for hernia, two laparoscopic hernia repair, three transabdominal repair and one transthoracic repair. MDCT is a good imaging technique to be used before surgery in that it is fast and non-invasive, helps to make an accurate diagnosis of Morgagni hernias and provides detailed information about the contents of the hernia and accompanying complications. Modern surgical techniques, including laparoscopy, help to achieve the repair of Morgagni hernias safely with short hospital stay and with little morbidity and mortality.

Cystic tumors of ovary, whether benign, borderline, or malignant may be associated with mural nodule of various types, including sarcomas, sarcoma-like mural nodules (SLMN), and foci of anaplastic carcinoma. Cases of serous borderline ovarian tumor with mural nodules of mixed type are very rare.A 54-year-old woman referred with abdominal swelling. Imaging studies revealed a huge mass localized in pelvis and lower abdomen and grade 1-2 left renal hydronephrosis. Preoperative Ca-125 was 798 U/ml. In exploratory laparotomy there was a 16 cm mass adherent to lateral abdominal wall and intestines. Adhesiolysis and de-bulking surgery were performed including bilateral pelvic, para-aortic lymphadenectomy, appendectomy and omentectomy. Left ureter was found to be dilated because of the infiltration of distal part by the tumor, so distal ureteral resection and neoureterocystostomy were performed. Final pathology revealed borderline serous ovarian tumor with mural nodules which were consisted of SLMNs, multiple and sharply demarcated from the adjacent tumor, and sarcomatous nodules showing infiltrative appearance in metastatic regions. Mural nodules showed a positive reaction for vimentin and SMA but were negative for cytokeratin and also necrosis, hemorrhage, and 10-15 mitoses in 10 high power fields were noted. She had postoperative chemotherapy and follow-up is going on without metastases in her first year.The existence of sarcomatous nodules combined with the SLMN necessitates a careful histologic analysis for treatment and the determination of prognosis. However, too few cases of mixed type mural nodules have been published to warrant a conclusion regarding their prognosis.

Sarcoidosis is a systemic granulomatous disorder of unknown origin that affects the lungs and mediastinal lymph nodes in most patients. The coexistence of sarcoidosis and breast cancer has been reported. An unfortunate consequence of the presence of both entities in the same patient is the risk of misdiagnosis. We report the case of a 70-year-old female with T1N0 cancer of the right breast that was initially diagnosed as stage IV because of mediastinal positron-emission tomography - positive lymphadenopathy. Biopsy of a mediastinal lymph node allowed us to diagnose sarcoidosis and correctly stage her disease as stage I breast cancer.

Background and Aims: Nasobiliary drainage is an established mode of treatment for acute suppurative cholangitis, bile leakage and biliary fistula. We retrospectively analyzed the safety and efficacy of nasobiliary drainage placement for biliary drainage in patients with acute cholangitis. Materials and Methods: Between January 2011 and December 2012, nasobiliary drainage was performed in 22 patients at Sisli Etfal Training and Education Hospital. The clinical characteristics, laboratory results, clinical outcomes, and complications were analyzed retrospectively. Results:Nasobiliary drainage was performed in 22 patients (11 female), and the mean age was 54,3±24,4 years (range, 12-84). Acute suppurative cholangitis (n=11), hydatid cyst with biliary communication (n=4), postoperative biliary leak (n=3), external biliary leakage (n=2), and hemobilia (n=2) were the main indications of nasobiliary drainage. The catheter was removed in 8,4±6,2 days, and time elapsed to normalization of total serum bilirubin levels was 4±0,6 days. There were no endoscopic retrograde cholangiopancreatography -related complications. Although it is not a comfortable treatment modality, there were no instances of displacement or kinking of the nasobiliary drainage.Conclusions: Biliary drainage by nasobiliary drainage is a safe and effective treatment in patients with severe cholangitis, postoperative bile leakage and bile fistula.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired immune-mediated demyelinating neuropathy. In this report, we detail the course of a 58-year-old male patient who had headache and double vision followed by progressive paresthesia and difficulty in walking. The patient had bilateral papilledema and mild leg weakness, absent ankle jerks and loss of sensation in distal parts of his lower and upper extremities. His electromyography (EMG) was concordant with CIDP and lumbar puncture revealed high opening pressure. The polyradiculoneuropathy as well as the papilledema and elevated cerebrospinal fluid (CSF) pressure improved under steroids. The improvement in intracranial hypertension (IHT) and papilledema under steroid treatment suggests that the IHT in this patient might be associated with CIDP.

Background: Liver biopsy, which is considered the best method for evaluating hepatic fibrosis, has important adverse events. Therefore, non-invasive tests have been developed to determine the degree of hepatic fibrosis in patients with chronic hepatitis B. Aim: To verify the usefulness of a new fibrosis index the globulin/platelet model in patients with chronic hepatitis B and to compare it with other noninvasive tests for predicting significant fibrosis. This study was the second to evaluate the globulin/platelet model in HBV patients. Methods: We retrospectively investigated 228 patients with chronic hepatitis B who performed liver biopsy from 2013 to 2014. The globulin/platelet model, APGA [AST/Platelet/Gammaglutamyl transpeptidase/Alfa-fetoprotein], FIB4, fibrosis index, cirrhosis discriminate score, and Fibro-quotient were calculated, and the diagnostic accuracies of all of the fibrosis indices were compared between the F0-2 (no-mild fibrosis) and F3-6 (significant fibrosis) groups. Results: All of the noninvasive markers were significantly correlated with the stage of liver fibrosis (p < 0,001). To predict significant fibrosis (F ≥ 3), the area under the curve (95% CI) was found to be greatest for APGA (0.83 [0.74-0.86]), followed by FIB-4 (0.75[0.69-0.80]), the globulin/platelet model (0.74 [0.68- 0.79]), fibrosis index (0.72 [0.6-0.78], cirrhosis discriminate score (0.71 [0.64-0.76]) and Fibro-quotient (0.62 [0.55-0.7]). The area under the receiver operating characteristic curves of APGA was significantly higher than that of the other noninvasive fibrosis markers (p < 0.05). Conclusions: While the APGA index was found to be the most valuable test for the prediction significant fibrosis in patients with chronic hepatitis B, GP model was the thirth valuable test. Therefore, we recommended that APGA could be used instead of the GP model for prediction liver fibrosis.

WOS: 000354258600097 Background and objectives: Neuromyelitis optica (NMO) and its spectrum disorders (NMOSD) are relatively rare disorders. We aimed to evaluate clinical characteristics and disease course of the NMOSD patients followed at our department. Patients and methods: All the patients with the diagnosis of NMO/ NMOSD followed since the establishment of our multipl sclerosis clinic in April 2011, were evaluated. Results: There were 86 patients (66 female, 20 male) with NMO/ NMOSD followed at our MS unit; 24 had NMO, 42 had recurrent optic neuritis (RON); and 20 had longitudinally extensive transverse myelitis (LETM). The disease course was relapsing in 70 patients e296 Abstracts / Journal of the Neurological Sciences 357 (2015) e295–e323 (81%). The first attack was bilateral ON (BON) and TM in 3 patients, ON and TM in 1 patient, ON in 50 patients (bilateral in 6) and TM in 26 patients. NMO IgG was positive in 12 patients with NMO (55%), 4 patients with LETM (25%), and 8 patients with RON (25%). Oligoclonal band was positive in 15 out of 44 patients (34%). In NMO/NMOSD patients, cranial magnetic resonance imaging (MRI) showed no abnormality in 48; nonspecific lesions in 37; and 1 patient had hypothalamic lesion. In spinal MRIs, 41 patients had LETM; six had suspected hyperintense T2 lesion in C5. Conclusion: This is one of the largest single center series collected over 4 years. NMO/NMOSD seems to be over-represented in our center since it is one of the few where NMO IgG testing is available. In NMO/NMOSD, early diagnosis and treatment is important to prevent the patient from the permanent disability.

Gallstone-induced ileus is a rare complication of cholelithiasis, and gastric outlet obstruction is even rarer. We describe the multidetector computed tomographic diagnosis of small bowel obstruction resulting from a gallstone impacted in the distal ileum and of gastric outlet obstruction from a gallstone impacted in the pyloric antrum (Bouveret syndrome).

Spontaneous intracranial hypotension is an important cause of new daily persistent headaches in young and middle-aged individuals. The diagnosis is made based on low cerebrospinal fluid pressure with characteristic findings upon brain and spinal magnetic resonance imaging (MRI). We present the case of a 15-year-old boy with spontaneous intracranial hypotension. Although his brain MRI was normal, his lumbar spinal MRI showed clustering of the nerve roots characteristic of arachnoiditis. Radionuclide cisternography revealed an epidural leak, which was treated with an epidural blood patch. The patient reached a near-full recovery within 24 h, and the lumbar spinal MRI findings mimicking arachnoiditis disappeared.

Background: Terminal ileum endoscopy and biopsy are the diagnostic tools of diseases attacking the ileum. However, abnormal histological findings can be found in endoscopically normal terminal ileum. Objective: This study was performed to evaluate the histopathological results of biopsies from endoscopically normal terminal ileum in order to determine pre-procedure clinical and laboratory factors predicting abnormal histopathological results, if any. Methods: A total of 297 patients who underwent colonoscopy and terminal ileum biopsy and had normal terminal ileum or a few aphthous ulcers in the terminal ileum together with completely normal colon mucosa were included in the study. The patients were grouped into two arms as normal cases and cases with aphthous ulcers. Histopathological and pre-procedural laboratory results of patients were analyzed according to their indications. Results : The terminal ileum was endoscopically normal in 200 patients, and 97 patients had aphthous ulcers. Chronic ileitis rate was present in 5.5% of those with endoscopically normal terminal ileum and in 39.2% of the patients with aphthous ulcers. In both groups, the highest rate of chronic ileitis was detected in the patients with known inflammatory bowel disease (IBD) (15.4 and 50%, respectively), anemia (9.5 and 43.5%, respectively), and in the patients having chronic diarrhea together with abdominal pain (7.7 and 44.8%, respectively). We found that the sensitivity of mean platelet volume for predicting chronic ileitis was 87% and the specificity was 45% at a cut-off value lower than 9.35 fl. Conclusion: In anemia indication or chronic diarrhea together with abdominal pain, the frequency of aphthous ulcers detected by ileoscopy and the frequency of chronic ileitis detected histopathologically despite a normal-appearing ileum were elevated. Keywords: Terminal ileum; ileoscopy; chronic ileitis; inflammatory bowel disease (Published: 19 February 2014) Citation: Libyan J Med 2014, 9 : 23441 - http://dx.doi.org/10.3402/ljm.v9.23441

Objective We evaluated the diagnostic value of gradient-echo (GRE) imaging in patients with "cerebral venous and sinus thrombosis" (CVST). Materials and Methods In total, 130 thrombosed venous segment signal intensities in 45 patients with CVST were analyzed retrospectively using magnetic resonance imaging and magnetic resonance venography. Results The T2* GRE sequence had a diagnostic value for detecting acute and subacute superior sagittal sinus (SSS) thrombosis and thrombosis of the deep veins (DVs), and cortical veins (CVs; P Conclusions The T2* GRE sequence had a high diagnostic value for detecting both acute and subacute SSS, DV, and CV thromboses.

Introduction The relationship between obstructive sleep apnea syndrome (OSAS) and bronchial hyperresponsiveness (BHR) is not well known. In this study, we investigated the association between BHR and disease severity in patients with OSAS. Materials and methods Fourty seven (37 male/10 female) OSAS patients admitted with polysomnography enrolled to the study. Histamine bronchial challenge test was performed and body mass index (BMI, kg/m2) was calculated. Presence of BHR was diagnosed as positivity of bronchial provocative test (BPT) (PD values ≤ 16 mg/mL). Patients were questioned with Epworth sleepiness scale (ESS). Results Histamine bronchial challenge test was positive in 21 of 47 patients. There were significant negative correlations between PD 20 value and AHI (r= -0.47, p= 0.03), BMI (r= -0.45, p= 0.03), and ESS score (r= -0.45, p= 0.03) in the patients with BHR. In addition, AHI (p= 0.03), BMI (p= 0.02), ESS scores (p= 0.03) were higher in patients with BHR (21 patients) than in patients not having BHR (26 patients). Significant negative relation was found between PD 20 value and AHI (b=-0.45, p= 0.03) and significant positive relation was found between presence of BHR and AHI (p= 0.04), BMI (p= 0.03) independently of age and sex in multiple regression analysis. Conclusion BHR is common in patients with OSAS. As severity of OSAS increased, severity of BHR increased. In addition, obesity may trigger presence of BHR in patients with OSAS.

Brain metastases are unusual from urethelial carcinoma of bladder and particularly the occurrence of leptomeningeal metastases is extremely rare, with few cases described in the literature. We present a case of a 45-year-old man with a rare brain metastases as the first metastatic manifestation secondary to urethelial carcinoma of bladder followed by leptomeningeal metastases without any other organ involvement. Eleven months after the diagnosis of high-grade urethelial carcinoma of bladder (T2N0M0), the patient was detected having brain metastases by MRI. FDG PET/CT images for the metastatic evaluation showed no abnormal FDG uptake elsewhere in the body except the brain. Histopathology examination from brain lesion demonstrated the cerebral lesion to be a metastatic urothelial carcinoma. Two months later, the patient was diagnosed to have leptomeningeal metastases by MRI. Our patient's condition gradually worsened, and he died 3 months after the diagnosis of leptomeningeal metastases.

von Willebrand factor (vWF) antigen (vWF:Ag) and vWF-collagen binding activity (vWF:CBA) were measured in plasma by parallel quantitative ELISAs in normal newborns and infants (n = 71). The medians for vWF:Ag (IU/ml) and vWF:CBA (U/ml), respectively, were 1.46 and 1.91 for 2-7 day-old (n = 43), 1.22 and 1.40 for 2-4 week-old (n = 14), 1.22 and 1.15 for 2-6-month-old (n = 14) infants and 0.98 and 1.08 (n = 36) in normal adults. Elevated levels of vWF:Ag, but particularly vWF:CBA were seen for up to 4 weeks of life reaching adult levels between 2 and 6 months of life. The elevated levels of the vWF parameters indicate that caution should be exercised when interpreting laboratory data and diagnosing von Willebrand disease in newborns and young infants and warrant the use of age-specific reference ranges. The efficient haemostasis observed during early neonatal life may in part be due to the increased ability of vWF to interact with collagen.

Spondylodiscitis is an infection of the intervertebral disc and adjacent vertebral bodies. Magnetic resonance imaging is the method of choice for the spondylodiscitis. The characteristic findings in the spondylodiscitis are hypointense on T1-weighted (W) image and hyperintense on T2W and fat-saturation T2W images, contrast enhancement on contrast- enhanced T1W with fat saturation images in the disc space and adjacent vertebral bodies, and phlegmon or abscess of the paraspinal soft tissues and epidural space. Phlegmon shows homogenous contrast enhancement, while abscess shows peripheral ring-enhancement on contrast- enhanced T1W with fat saturation images. Differentiation of tuberculous, brucellar and pyogenic spondylodiscitis is radiological difficult. Features that also favor tuberculosis infection include multilevel disease, large paravertebral abscess, meningeal involvement and subligamentous spread. Brucellar spondylodiscitis most commonly affects the lumbar spine. Bone destruction is less severe than in tuberculous spondylodiscitis. Osteophyte formation at the anterior vertebral endplate is typical., Spondilodiskit intervertebral disk ve komşu vertebranın enfeksiyonudur. Manyetik rezonans görüntüleme spondilodiskitte tercih edilen yöntemdir. Spondilodiskitin karakteristik bulguları diskte ve komşu vertebralarda T1ağırlıklı (A) görüntüde hipointens, T2A ve yağ baskılamalı T2A görüntüde hiperintens ve kontrastlı görüntülerde kontrastlanma, paravertebral yumuşak doku ve epidural mesafede abse ya da flegmonun izlenmesidir. Flegmon homojen boyanırken, abse peripheral ring tarzında boyanma gösterir. Tuberküloz, brusellar ve piyojenik spondilodiskitleri radyolojik olarak ayırt etmek zordur. Tuberküloz spondilodiskitte multipl seviye tutulumu, büyük paravertebral abse, meningeal tutulum ve subligamentöz yayılım izlenir. Brusellar spondilodiskit en çok lomber bölgeyi tutar. Kemik destrüksiyonu tuberkülozdan daha az şiddetlidir. Anterior vertebral endplatoda izlenen osteofit tipiktir.

A 25-year-old female patient with Crohn's disease had been using azathioprine and metronidazole for an extended period because of recurrent perianal and rectovaginal fistulae. Infliximab was added to the treatment regimen following postoperative recurrence of a rectovaginal fistula. Upon the development of severe neutropenia and thrombocytopenia after the third dose of infliximab, azathioprine and infliximab were stopped. Neutropenia work-up did not reveal any other cause. Neutropenia was ameliorated with use of granulocyte colony-stimulating factor. Treatment was restarted with infliximab alone upon leakage from the rectovaginal fistula with no hematologic toxicity. This case was considered as a serious adverse effect of infliximab and azathioprine combination therapy.

Endometriosis is a chronic gynecological disease characterized by the growth of hormonally responsive, endometrial tissue outside the uterine cavity. The present study aims to analyze two vascular endothelial growth factor (VEGF) polymorphisms (−460 C/T and +405 C/G) in Turkish women with and without endometriosis. A case–control study was undertaken at the Infertility Department of Zekai Tahir Burak Women’s Health Care Education and Research Hospital. The single nucleotide polymorphisms, −460 C/T and +405 C/G, in the 5′-untranslated region of the VEGF gene were tested in 98 affected women and 94 women with no laparoscopic evidence of disease. Endometriosis was also confirmed histologically. Following genomic extraction of genomic DNA, genotyping of the −460 C/T and +405 C/G polymorphisms of the VEGF gene were performed by polymerase chain reaction and restriction fragment length polymorphism assay. Nominal data were evaluated by Pearson Chi-square or Fisher’s Exact test, where applicable. Odds ratios and 95% confidence intervals were also calculated. A P value less than 0.05 was considered statistically significant. Demographic data were similar among groups. The genotype and allele frequencies of the −460 C/T polymorphism did not differ significantly between cases and controls. In contrast, the genotype (P

Ekici, Arif B/0000-0001-6099-7066 WOS: 000242662400003 PubMed: 17199838 Background: The purpose of this study was to clarify the correlations between the presence of comorbidities and psychological distress and health-related quality of life (HRQL). This was a population-based cross-sectional study. Methods: Parents and grandparents of students from seven randomly selected primary schools in the city centre were asked to answer questionnaires sent by their children. All subjects were questioned for somatic diseases, psychological distress and HRQL by Health Questionnaire, Hospital Anxiety and Depression scale and short-form-12 health survey, respectively. Results: Out of 5024 parents and grandparents (mean age 52.3 +/- 14.3 years, range 20-104 years) of primary school students 4605 returned the questionnaires, a figure that corresponds to the overall response rate of 91.6%. Chronic diseases substantially reduced HRQL and this effect did not differ markedly with the type of chronic disease. Association of comorbidities with psychological distress further impaired HRQL. As the number of chronic diseases was increased, HRQL and physical and mental functioning declined. The worst HRQL was observed in subjects who had five or more comorbidities associated with psychological distress. Conclusion: The present study indicates significant adverse effects of chronic diseases and psychological distress on HRQL in adults, the effect of psychological distress being the most important. Our results lead us to suggest that in the management of comorbidities, the detection of the presence and severity of associated psychological distress and its treatment, besides the specific treatment of comorbidities, may provide dramatic improvement in HRQL of the patients.

Amaç: Difüzyon ağırlıklı MR (DAG-MR) görüntüleme genellikle sistemik kanserli hastalarda parankim metastazı, abse ve infart gibi intraaksiyel beyin patolojilerinin tanısında kullanılmaktadır. Bu çalışmada DAG –MR’nin kranial kemik iliği metastazlarının tanısındaki değeri araştırılmıştır. Materyal ve Metod: Kranial kemik iliği metastazı saptanan 57 hastanın konvansiyonel MR ve DAG-MR görüntüleri geriye dönük olarak değerlendirildi. Görüntüler 2 nöroradyolog tarafından lezyon saptanması ve göze çarpıcılığı açısından incelendi. Radyologların kappa uyumuna bakıldı. Bulgular: Elli yedi hastada toplam 113 kranial kemik iliği metastazı saptandı. DAG-MR ve ADC’ nin lezyon saptama sensitivitesi sırasıyla %86 and %90 saptandı.T1, FLAIR, kontrastlı yağ baskılamalı T1 ve T2 ağırlıklı sekansların lezyon saptanmasında sensitivitesi sırasıyla %93, %90, % 89, ve %84 saptandı. DAG-MR’nin lezyon göze çarpıcılığı kontrastlı T1 ağırlıklı görüntülere eşit, diğer konvansiyonel sekanslara eşit ya da üstündü. Radyologların kappa uyumu mükemmeldi. Sonuç: DAG-MR sadece parankim tutulumunu değerlendirme değil, kemik iliği metastazlarını da değerlendirmede kullanılabilir

Background: Respiratory disorders in childhood may predispose to pulmonary disease in late adult life. Objectives: The aim of this study was to evaluate the relationship between their effects in adult life and the characteristics of the respiratory system in childhood. Methods: A total of 10,224 parents and grandparents of students from 14 randomly selected primary schools in the city center were asked to answer questionnaires given to their children. 9,853 of 10,224 persons (the overall response rate was 96.3%) were eligible for analysis. In the questionnaire subjects were asked about respiratory system-related symptoms and characteristics. Results: Chronic cough [14.3 vs. 4.7%, OR 3.4 (2.6–4.4), p < 0.001], chronic bronchitis [35.3 vs. 11.8%, OR 4.0 (3.4–4.8), p < 0.001] and asthma [34.2 vs. 5.1%, OR 9.6 (8.0–11.5), p < 0.001] in the childhood respiratory infection group were more common than in the control group. Childhood respiratory infections were associated with an increased risk of asthma (OR 5.6, p < 0.001), chronic bronchitis (OR 2.3, p < 0.001) and chronic cough (OR 1.5, p < 0.001), after adjusting for possible confounding factors. In addition, the presence of dampness or visible mould, wall-to-wall carpets, pets at home and parents’ smoking during childhood were associated with an increased risk of frequent childhood respiratory infections. Conclusion: These results indicated that frequentrespiratory infections during childhood might play an important role in the occurrence of chronic airway diseases in adult life. The removing of risk factors for frequent childhood respiratory infections may reduce the subsequent risk of chronic airway disease in late adult life.

Colonic herniation through the esophageal hiatus is an unusual condition. Isolated trans-hiatal herniation of the transverse colon is very rare and only five cases have been reported. All these reported patients were symptomatic, and had dysphagia, epigastralgia, vomiting, dyspnea, cough, or palpitations. Hiatal hernia is an important clinical problem. Because of the severe complications of hiatal hernia, including bleeding, strangulation, and perforation, early diagnosis and treatment are important. A 75-year-old man who had prostate carcinoma was evaluated with multidetector computed tomography (MDCT). In this case, CT findings and clinical emphasis of the incidentally discovered isolated transverse colonic hiatal herniation was reviewed.