Search

Cutaneous melanoma is a malignancy which has an increasing incidence in all over the world especially due to increased UV exposure. Although it builds only 4% of all skin cancers, it is the major cause of death appears to be associated with skin cancer. As the disease progresses both cost of the treatment and worsening of the prognosis increases. Local excision of melanomas detected at an early stage may provide over 90% cure on the other hand despite surgery and chemotherapy 5-year survival rate of treatment of advanced-stage melanomas is about 20%. Melanoma staging is important in determining treatment planning and prognosis of patients. Different systems have been developed for staging melanoma to date but most of them considered inadequate. In parallel with developments in science, innovations in imaging and genetic studies brought a number of changes in the treatment and staging of melanoma. Some drugs which has been tried in the early nineties, now taken its place today as part of the treatment. Prognostic factors and treatment regimens considered to be effective on survival have uncovered with a number of studies. In this article it is intended to increase awareness of health care workers about cutaneous melanoma. In addition, the current staging system for melanoma, treatment modalities and factors thought to be effect on prognosis will be mentioned. [ABSTRACT FROM AUTHOR]

In this study we aimed to define the frequency of disorders that present with anterior knee pain among young male individuals. Study included 121 patients with no history of knee trauma or surgery whom were presented to Orthopedics department with anterior knee pain. All patients were examined and Q angle of each was measured. Anteroposterior, lateral and tangential knee radiography was obtained to define patellar alignment and patella types. Magnetic resonance imaging (MRI) with PD fat-suppression T2 sequence was used to evaluate cartilage and soft tissues. As for the patella types, right knees were Baumgartle type 2 in 66.11 % (n=80) of the patients, while left knees were Baumgartle type 2 in 63.63 % (n=77) of the patients. MRI showed chondromalacia patella in 5 patients (0.04 %), meniscal tear in 4 patients (0.03 %), Quadriceps fat sign in 4 patients (0.03 %), medial plica in 3 patients (0.02 %) and Osgood-Schlatter disease 1 patient (<0.01 %). Mean Q angle was 14.57±2.59 degrees for the right knees and 14.62±2.66 degrees for the left knees. Although physical examination mostly suggested chondromalacia patella in young male adults, this could not be confirmed by MRI. Type 2 patella was the most common type and Q angles were mostly within the normal range. [ABSTRACT FROM AUTHOR]

Objective: In this study, relationship between systolic and diastolic blood pressure and pentraxin-3 (PTX3) levels in hypertensive patients was investigated Methods: Overall, 80 patients with stage 1 hypertension between 40-61 years of age without any disease and 80 healthy volunteers were included to the study. Blood samples obtained to measure PTX3 levels and biochemical analysis. Relationship between PTX3 levels and clinical and biochemical parameters were analyzed using multivariate regression analysis Results: Although systolic and diastolic blood pressures were significant different, there were no differences regarding age and gender between hypertensives and normotensives. In each group, significant statistical differences were found between PTX3 and CRP levels (PTX3 (ng/mL) 35.25±5.45 and 0.27±0.24, p<0.001; CRP (mg/dL) 10.03±5.81 and 4.30±3.38, p<0.001; in hypertensive and normotensive groups respectively). It was observed that increase in PTX3 levels accompanies the increase in systolic and diastolic blood pressures (r2=0.78). It was observed that PTX3 levels are not effected from CRP, lipid levels and body mass index (p>0.05). On multivariate regression analysis PTX3 was found to strongly affect blood pressure (beta=0.82, 95% CI 0.644-0.799, p<0.001, and beta=0.84, 95% CI 0.422-0.799, p<0.001, respectively for systolic and diastolic blood pressures), CRP and total cholesterol are found to affect moderately (beta=0.115-0.265, 95% CI 0.101-0.572, p<0.05 and beta=0.107-0.141, 95% CI 0.041-0.110, p<0.05, respectively). Conclusion:This study showed that PTX3 levels are higher in newly diagnosed hypertensive patients than in healthy individuals. In addition, it was noticed that increased PTX3 levels causes increase in systolic and diastolic blood pressures. (Anadolu Kardiyol Derg 2012; 12: 298-304) [ABSTRACT FROM AUTHOR]

Aging is an inevitable and continuous process with a variable spectrum of manifestations of all organ systems including the skin. Aging skin undergoes progressive degenerative change. Dermatoses such as xerozis, pruritus, egzema, psoriasis and skin tumours are widespread in the elderly and create substantial suffering in those afflicted. It is not uncommon for older patients to have multiple impairments, with the potential for cognitive dysfunction as well as impaired vision, hearing or mobility. Management of dermatologic disorders in the elderly is often neglected, due to special needs, limitations, skin fragility, comorbidities, polypharmacy, lack of mobility and lack of social support. In this review, we aim to raise the family practitioners awareness about geriatric skin diseases. [ABSTRACT FROM AUTHOR]

Introduction: In this study, the effectiveness and safety of topiramate treatment in children with chronic daily headache were investigated. Materials and Method: This study was perfomed prospectively among 100 children who were diagnosed with chronic daily headache. Before the treatment, Pediatric Migraine Disability Assesment (PEDMİDAS) scores and grades of the patients were determined. Topiramate was given as 1 mg/kg/day then the dose was increased to 2 mg/kg/day at the tenth day of the treatment. At the third month, PEDMİDAS scores and grades were redetermined and compared with the first one. Results: The PEDMİDAS scores of the patients before and after the treatment were found as 34.60±22.28, 12.77±12.2, respectively. There was a statistical difference between these two values (p<0.001). When we group the patients according to the PEDMİDAS scores before the treatment 68% of the patients were grouped as grade 4, 23% as grade 3, 6% as grade 2 and 3% as grade 1; then after the treatment these percentages changed as 38.4% for grade 4, 29.4% for grade 3, 21.5% for grade 2 and 10.7% for grade1, respectively. Also forgetfulness in 8.8% (n=6) of patients, weight loss (average 250 grams) in 5.8% (n=4) and paresthesia in 4.4% (n=3) were determined. Conclusions: This study has shown that topiramate is safe, well tolerable and can be used with low doses in the treatment of chronic daily headache in childhood and is an alternative treatment choice that can be used in case no answers with other drugs. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Osteitis pubis, which caused by inflammation and edema of symphysis pubis is one of the most important reasons of pubic pain. Here, a case of osteitis pubis patient is presented. CASE: 20 years old male patient was admitted with complaint of inguinal pain. There was no abnormal finding in examination of abdomen and scrotum. No costo-vertebral angle tenderness, palpable mass in inguinal region found (hernia negative). Superficial tissue ultrasonography was performed and evaluated normal. In order to identify cause of pubic pain, coxofemoral joint movements were evaluated. Laseque, FABER, FADIR tests were negative. The patient underwent pelvic MRI. In pelvic MRI, bone marrow edema was observed in both ramus pubicus superior and symphysis pubis which has hypointense signal intensity on T1 weighted sequences and hyperintense on T2 weighted sequences (Figure 1). Distortion (beaking) was monitored on superoposterior of symphysis pubis. No signal change compatible with subchondral bone cysts, irregulatory and liquid in symphysis pubis was noticed. Patient was diagnosed as osteitis pubis according to symptoms and MRI findings.Figure 1: Osteitis pubis. Bone marrow edema was observed in both ramus pubicus superior and symphysis pubis which has hypointense signal intensity on T1 weighted sequences and hyperintense on T2 weighted sequences CONCLUSION: Despite osteitis pubis is mostly seen in athletes, it might be seen in young adults who were not sportive before and began to sport during military service. In this report a young male with osteitis pubis which was before considered to have nefrolithiasis, inguinal hernia and coxofemoral pathology ispresented. These patients who may admit to different branches because of symptoms can be diagnosed with advanced assessment and consideration of this situation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: In this report, an uncommon case of cavum septum pellucidum distension who admitted with headache and no pathology found in examination is presented.CASE: 43 years old male patient complaining from headache was admitted to family medicine clinic. In medical history it was learned that patient‟s headache was lasting for ten years, for this reason patient had admitted different clinics and receiving treatment for migraine. Also it was learned that patient had used different analgesics but did not get benefit at all. In physical examination, pain was in occipital region, head and neck examination and cerebellar tests were normal. A complete blood examination, fasting blood glucose, liver and renal function tests were within normal ranges. After this stage, the patient underwent magnetic resonance imaging of brain. In the brain magnetic resonance imaging of patient, cavum septum pellucidum (Figure 1) showing distention significantly with fluid in T2- weighted sequences was observed. According to the imaging results, patient was diagnosed as cavum septum pellucidum distension. CONCLUSION: This situation which is not often met in the literature should be considered as an uncommon condition in the differential diagnosis of headache. Although distention in the septum pellucidum was resulting only headache in this case, it might be associated with different symptoms. As a rare condition which can lead to headaches, distension of septum pellucidum is presented in order to raise awareness of the doctors. [ABSTRACT FROM AUTHOR]

OBJECTĠVE: In this study, we aimed to introduce a geriatric patient with normal pressure hydrocephalus. CASE: 63-year-old male patient was admitted to the emergency department with complaints of falling, head injury and nausea. In physical examination swelling and bruising in the frontal region was detected. Direct and indirect pupillary light reflexes were bilaterally positive. Neurological examination was normal; there were no sensory and motor deficits. Glasgow coma scale score was sixteen. Cranial CT of patient was taken. While there was no intracranial hemorrhage, space-occupying mass lesion and acute supratentorial ischemic attack in cranial CT scan of patient, dilatation of the ventricular system (hydrocephalus) detected. Current findings were evaluated to be nontraumatic. Detailed questioning of the patient revealed that patient was complaining of frequent urination and urinary incontinence for a long time and have been treated for benign prostatic hyperplasia (BPH). In evaluation of cognitive functions no disorder or forgetfulness was found. But there was reluctance to daily works. Cranial MRI examination and lumbar puncture was planned for the patient. Cranial MRI examination revealed hydrocephalus. Lumbar puncture pressure was normal. CONCLUSION: Patient was diagnosed for normal pressure hydrocephalus (NPH) due to imaging findings and normal spinal pressure. Reluctance to daily works, complaints of frequent urination urinary incontinence were evaluated in favor of the NPH. Patient referred to brain surgery in terms of shunt surgery and endoscopic 3rd ventriculostomy operations. [ABSTRACT FROM AUTHOR]

Objective: Coping attitudes play an important role in ensuring compliance with the person challenging with life situations. Resistance to the event or factors that cause stress on individual and showing cognitive, emotional and behavioral reactions to withstand all these conditions are defined as coping attitudes. Whereas syncope can be a symptom of epileptic seizure; it may be a form of self defense mechanism or coping attitude. The differential diagnosis of the two is often difficult. In this study, we aimed to investigate coping attitudes of patients with epileptic or nonepileptic seizures. Methods: This study was made in Gulhane Medical Faculty, Neurology Outpatient Clinic, in Turkey. We aimed to compare coping attitudes of a control group (n=98) with those of study groups with epilepsy history, which were enrolled and sub-classified as nonepileptic (n=147) and epileptic (n=112) patients. Participants' socio-demographic (age, gender, education level, marital status) and clinical characteristics were recorded by using a data collection form. COPE Inventory was applied to measure for coping attitudes. ANOVA test was used to compare groups in terms of age, education levels and COPE score. Also Turkey test was used for Post hoc analysis. Sex, smoking and marital status was compared with chi-square test. P value under or equal to 0.05 was accepted as significant. Results: There was a statistically significant difference between three groups in terms of total scores of dysfunctional coping attitudes (p<0.05). Religious coping subscale scores were higher than emotion focused coping attitudes, problem focused coping attitudes were lower than joke pounding subscale scores and other occupations suppression subscale scores were higher in epileptic and nonepileptic patients. Discussion: This study showed that patients with epileptic and non epileptic syncope (nonepileptic more) used dysfunctional coping attitudes more than control group. These patients used functional coping strategies less often whereas they mostly applied religious focused coping attitudes, which is subset of the emotional focused attitudes. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is an inflammatory multisystem disease of unknown etiology characterized by chronic destructive synovitis. It's prevalence is about 1% all over the world. Serologic markers are also important beside some clinical situations upon RA diagnosis. Today, the most commonly used laboratory test is rheumatoid factor (RF) in patients with suspected RA. RF is sensitive but not a specific biomarker for diagnosing RA. Early diagnosis of RA is essential to prevent of progressive joint damage. In recent years, anticyclic citrullinated peptide/protein antibody (anti-CCP) attracts the attention as a remarkable biomarker for early diagnosis. Anti-CCP which is a family of anti-citrullinated protein antibodies (ACPA) family, showed quite satisfactory specificity in the diagnosis of RA. Due to the prescence of ACPA was included to 2010 RA diagnostic criteria, in a manner of speaking, importance of anti-CCP was registered. [ABSTRACT FROM AUTHOR]

Purpose: the aim of this study was to assess the relationship of patient weight, height and body mass index (BMI) with the size of the quadrupled hamstring tendon used in anterior cruciate ligament (ACL) reconstruction., Methods: from patient records, we retrospectively assessed the weight, height, BMI and graft sizes of 126 patients who underwent ACL reconstruction using a quadrupled hamstring tendon autograft between January 2010 and January 2013 at our institution. The data obtained from perioperative measurements were studied using correlation analysis., Results: statistically significant relationships were found between patient height and graft diameter ( p = 0.033, r = 0.19) and between patient weight and graft diameter ( p < 0.0001, r = 0.33). No statistically significant relationships were found between graft diameter and BMI or between graft length and patient height, weight and BMI ( p > 0.05)., Conclusions: patient height and weight were found to be related to quadrupled hamstring graft diameter in our patient population. BMI was not related to the quadrupled hamstring graft size. The exact size of the graft cannot be predicted preoperatively on the basis of these variables., Level of Evidence: Level IV, retrospective case series.

Piriformis syndrome is a clinical picture of non-discogenic sciatica caused by compression of the sciatic nerve by the piriformis muscle. It has variable etiologies and the patho-physiology is not fully understood. The major etiology was known to be the spasm, edema and inflammation of the piriformis muscle and sciatic nerve compression of the muscle later on. Patients can be diagnosed immediately with a comprehensive clinical examination and early diagnosis makes the treatment much easier. Diagnosis of the piriformis syndrome, a very rare cause of low back pain, first requires that this syndrome is remembered, and then a differential diagnosis should be performed. A case of piriformis syndrome diagnosed in a patient who presented with low back pain is reported in this study.

Objective: To determine the appropriate dose of sublingual misoprostol administration before dilation and curettage (D&C) of the uterus in first trimester pregnancies., Study Design: Ninety nulliparous women who underwent surgical termination of first trimester pregnancy were analyzed prospectively. The first group (n = 30) received a single 200-microg dose, and the second (n = 30) and third (n = 30) groups were administered 2x 200 microg (400 microg) and 3 x 200 microg (600 microg) doses of misoprostol sublingually, respectively, with 1-hour intervals. The main outcomes evaluated were the degree of difficulty of cervical dilation, adverse effects of misoprostol according to dose administered, and participant satisfaction rate with the procedure., Results: The improvement in cervical dilation and the ease of the D&C procedure were more significant in the 600-microg misoprostol arm (p = 0.008). Because the prevalence and severity of the side effects of misoprostol were increased in a dose-dependent manner, the 400-microg arm was found to be the most efficient dose of the study with its high satisfaction rate (p < 0.001)., Conclusion: Premedication with misoprostol makes the D&C procedure easier by leading to cervical ripening. By sublingual route 400 microg of misoprostol regimen seems to be appropriate for planned first trimester surgical pregnancy termination under local anesthesia. Misoprostol should be administered only to select and hospitalized patients.