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Objective: EuroSCORE is the most widely used risk prediction system. Standard EuroSCORE, which had been published in 1999, was revised as a Logistic EuroSCORE in 2003. Further, it was reconsidered and published as EuroSCORE II in 2011. In this study we compared Standard, Logistic EuroSCORE and EuroSCORE II in prediction of early mortality following coronary artery bypass grafting., Methods: We retrospectively analyzed 406 patients who underwent coronary artery bypass grafting operation between 2011-1012. Standard, Logistic and new version were compared with ROC analysis., Results: In general population, mean standard EuroSCORE was 3.25±1.05, mean logistic EuroSCORE was found 2.48±0.58, mean EuroSCORE II was found 1.30 ± 0.09 and overall mortality was 10 (10/406 2.46%). Area under curve (AUC) was found 0.992 95% CI: 0.978-0.998 for standard EuroSCORE, 0.992 95% CI: 0.977-0.998 for logistic EuroSCORE and 0.990 95% CI: 0.975-0.997 for EuroSCORE II. In high risk patients (patients with standard EuroSCORE ≥ 6) AUC was found 0.870 95% CI 0.707-0.961 for standard EuroSCORE, 0.857 95% CI 0.691-0.954 for logistic EuroSCORE, and 0.961 95% CI: 0.829-0.998 for EuroSCORE II., Conclusion: Standard, Logistic EuroSCORE and EuroSCORE II are similarly successful in mortality prediction. EuroSCORE II may be better in high-risk patients which needs confirmation in large prospective studies.

Orbital penetrating injuries may cause significant harm to optic nerves and eyeball as well as to the brain and cerebral vasculature. Defining surrounding neurovascular structures by CT angiography (CTA) is important for surgical removal. We present an uncommon case of a 3-year-old child with a penetrating orbital injury caused by a toothbrush. To the best of our knowledge, there is no report orbital injury with a toothbrush so far., (Copyright © 2013 by the American Society of Neuroimaging.)

Teratomas are a type of germ-cell tumour which may contain embryological tissues from more than one germ-cell layer, usually occurring in the gonads. Primary retroperitoneal teratomas account for 1-11% of retroperitoneal neoplasms and are most commonly found in neonates and young adults. In the clinical literature, retroperitoneal mature cystic teratoma arising from an intra-abdominal undescended testis in adult males has been very rarely reported. We report a case of surgically proven retroperitoneal mature cystic teratoma arising from an intra-abdominal undescended testis in an adult male by multislice helical computed tomography and magnetic resonance imaging., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Acute appendicitis is usually diagnosed on the basis of signs, symptoms, clinical history, physical examination, and results of laboratory tests.The position of the appendix can vary considerably, both in relation to the caecum and because of the inconsistent position of the caecum itself, and may cause variable clinical symptoms. We present the CT findings of surgically proven acute appendicitis associated with atypically located caecum in two patients.

Ectopic and/or supernumerary parathyroid glands are a major cause of persistent and recurrent Hyperparathyroidism (HPT). For this reason, it is widely accepted that preoperative localization should be performed to improve the surgical results in patients with persistent or recurrent HPT. Primary HPT (pHPT) was diagnosed incidentally in a 50-year old female patient during a preoperative examination for hernia. No pathologic parathyroid gland was detected in the preoperative Tc-99m Methoxybutylisonitrile (MIBI) scintigraphy and Ultrasonography (US). Cervical exploration was performed bilaterally. Four parathyroid glands were located adjacent to the thyroid gland. A fifth was detected in front of the cricoid cartilage. All five of them were of normal histology. Postoperatively, hypercalcemia persisted. Single Photon Emission Computed Tomography (SPECT) was performed before the second operation and radioguide surgery was carried out by median sternotomy. SPECT showed a parathyroid adenoma in the middle of the anterior mediastinum which was excised (size 1x0.5x0.5 cm) using a gamma probe. In conclusion, SPECT and intraoperative gamma probe application may help to detect the parathyroid adenomas, especially if they are small in size and buried in the adipose tissue. Such localization shortens the duration of the operation and reduces the possibility of complications.

Objective: To evaluate the effectiveness of gamma probe performed with technetium Tc 99m-labeled pertechnetate in patients who underwent completion thyroidectomy after pathologic detection of incidental thyroid cancer following subtotal thyroidectomy., Methods: In this prospective study, we evaluated findings from patients with multinodular goiter who underwent gamma probe-guided lateral approach completion thyroidectomy after the pathologic detection of incidental thyroid cancer following subtotal thyroidectomy where partial thyroid tissue was left unilaterally or bilaterally. Patients who underwent the procedure between January 2003 and January 2007 were included. Thyroid scintigraphy; thyroid and neck ultrasonography examinations; and concentrations of thyroid hormones, thyrotropin (TSH), thyroglobulin, and thyroglobulin antibodies were evaluated before the second operation. Patients were administered 3 mCi technetium Tc 99m pertechnetate during anaesthetic induction, and we extracted suspicious thyroid tissue and tissue with activity above background activity levels according to gamma probe. Extracted tissues were evaluated pathologically., Results: Completion thyroidectomy was performed in 23 patients. Seventy-nine tissue samples were extracted; 49 were thyroid tissue and 30 were nonthyroid tissue. Mean thyroid tissue to background activity ratio (T:B) was 6.4 +/- 3.9 (range, 2-14.3), and mean thyroid bed (after excision) to background activity ratio (Tbed:B) was 1.2 +/- 0.2 (range, 0.8-1.7) (P = .001). Mean T:B and Tbed:B ratios of the nonthyroid tissue were 1.2 +/- 0.3 (range, 0.2-1.7) and 1.1 +/- 0.2 (range, 0.4-1.4), respectively (P = .001). The thyroid tissue T:B ratio was significantly higher than that of non-thyroid tissue (P<.001). Gamma probe labeling contributed to extraction of small amounts of thyroid tissue that could not be viewed by scintigraphy in 43% of patients., Conclusions: Using gamma labeling, thyroid tissue shows significantly more activity than nonthyroid tissue. Gamma probe helps detect small, residual thyroid tissue that is buried in the scar tissue that cannot be distinguished by scintigraphy; therefore, it assists in the extraction of the maximum amount of thyroid tissue.

Aim: To evaluate the effects of ''Playstation EyeToy Games'' on upper extremity motor recovery and upper extremity-related motor functioning of patients with subacute stroke., Methods: The authors designed a randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 3 months. A total of 20 hemiparetic inpatients (mean age 61.1 years), all within 12 months post-stroke, received 30 minutes of treatment with ''Playstation EyeToy Games'' per day, consisting of flexion and extension of the paretic shoulder, elbow and wrist as well as abduction of the paretic shoulder or placebo therapy (watching the games for the same duration without physical involvement into the games) in addition to conventional program, 5 days a week, 2-5 hours/day for 4 weeks. Brunnstrom's staging and self-care sub-items of the functional independence measure (FIM) were performed at 0 month (baseline), 4 weeks (post-treatment), and 3 months (follow-up) after the treatment., Results: The mean change score (95% confidence interval) of the FIM self-care score (5.5 [2.9-8.0] vs 1.8 [0.1-3.7], P=0.018) showed significantly more improvement in the EyeToy group compared to the control group. No significant differences were found between the groups for the Brunnstrom stages for hand and upper extremity., Conclusion: ''Playstation EyeToy Games'' combined with a conventional stroke rehabilitation program have a potential to enhance upper extremity-related motor functioning in subacute stroke patients.

The purpose of this prospective study was to investigate the correlation of sentinel lymph node (SLN) and axillary lymph node (ALN) metastasis in early-stage invasive breast cancer in a single institution. One hundred and fifteen patients with early-stage invasive breast cancer first underwent SLND followed by an appropriate surgical procedure (modified radical mastectomy, lumpectomy + axillary dissection, simple mastectomy + mammoplasty). In this series, a radioactive agent (technetium) was used to investigate the sentinel lymph node/nodes. In 28 (24.3%) patients, metastases were found in both SLN and axillary dissections. There were no metastases in either of these procedures in 69 (60%) patients. SLN metastasis was found in 13 (11.3%) patients, but no axillary metastasis was found. No skip metastasis was detected. Five patients in whom the sentinel node was not found were also negative for axillary metastasis. As the studies progress in this direction, it might be possible to avoid axillary dissection in patients with early breast cancer in whom metastasis in SLN cannot be detected. We believe this will reduce morbidity from breast cancer surgeries.

Squamous cell carcinoma (SCC) is the second most common skin cancer in humans. Because the incidence of metastasis from SCC of the skin is rare, regional lymphadenectomy is generally not recommended for the patients with clinically node-negative disease. However, in patients with an intermediate and high risk of metastasis, evaluation of the lymph nodes to detect the absence of metastatic nodal disease is a difficult task. Here, we present a patient with a large SCC on the dorsum of the foot with clinically negative inguinal and popliteal lymph nodes. Intraoperative lymphatic mapping technique was used to make the decision of the inguinal node dissection. Two sentinel lymph nodes that were biopsy negative were found; therefore, only tumor excision was performed without adding complete inguinal node dissection. The defect was reconstructed with the free flap. After a 4-year carcinoma-free period, we determined that the pathology of the sentinel lymph nodes reflected that of the inguinal region. The use of selective lymphadenectomy technique in extremity SCC is very new. However, it might be useful in staging patients with SCC of the lower extremity by being able to detect absence or presence of occult metastatic nodal disease and avoid unnecessary complete inguinal node dissection.

Purpose: To determine the correlation of motor and musculoskeletal impairments with disability scores and life satisfaction. Musculoskeletal impairments might be due to the impact of motor impairments, however some cases may have these impairments even before the disease is diagnosed., Methods: 48 consecutive patients (32 male, 16 female) with Parkinson's disease with a mean age of 65.6, mean age of onset of the disease of 59.8, and Hoehn and Yahr staging system 1-4 participated. Unified Parkinson's disease rating scale, modified Schwab and England activities of daily living scale and life satisfaction index were used. Also New York modified mobility rating scale for c-spine and upper extremities and trunk and lower extremities was performed., Results: Motor and musculoskeletal impairments were correlated with the disability score. Bradykinesia, and tremor were correlated with upper and lower extremity range of motion limitation, but rigidity was not. Bradykinesia was correlated with life satisfication. Having had the disease longer was related to upper extremity range of motion limitation., Conclusions: Motor and musculoskeletal impairments are correlated with disability scores. Bradykinesia and musculoskeletal impairments are correlated with life satisfication. Patients with Parkinson's disease might benefit from a rehabilitation programme focusing on motor impairments such as bradykinesia as well as musculoskeletal impairments even in the early stages of the disease.

It has been suggested that reactive oxygen metabolites and trace elements play some role in the etiology and pathogenesis of rheumatoid arthritis (RA). Superoxide dismutase (SOD) is believed to exert an important protective role against oxygen toxicity. The aim of the study was to investigate the probable changes in the levels of trace elements and SOD activity in RA. Plasma and erythrocyte copper, zinc, and magnesium levels and erythrocyte SOD activity were measured in groups of controls and RA cases. Significantly increased erythrocyte SOD activity was found in RA patients in comparison with controls (p < 0.0001). A rise in erythrocyte Zn level (p < 0.0001) and plasma Cu level (p < 0.0001) and a decrease in erythrocyte Cu level (p < 0.05) and plasma Zn level (p < 0.05) were obtained in RA patients when compared to controls. Plasma and erythrocyte Mg levels of the RA patients showed slight and statistically insignificant reductions when compared to controls (p > 0.05). In RA patients, there were positive correlations between erythrocyte SOD activity and Mg level (r = 0.4345, p < 0.01) and between erythrocyte Zn level and plasma Cu level (r = 0.4132, p < 0.01). There were negative correlations between erythrocyte SOD activity and plasma Zn level (r = -0.3605, p < 0.05) and between plasma Zn level and erythrocyte Cu level (r = -0.4578, p < 0.01) in RA patients.