Selçuk Tıp Dergisi Arşiv

Aim: The aim of this study was to evaluate the efficacy of gadoxetic acid and gadopentate dimeglumine in the evaluation of liver metastases of patients with gastrointestinal malignancy by magnetic resonance. Patients and Methods: A total of 50 patients were diagnosed gastrointestinal malignancies histopathologically were included in the study and their hepatic metastases were examined by magnetic resonance for two contrast agent. Results: There was no statistically significant difference for these contrast agent at arterial, portal and late phase series. (p>0.05) But we found a statistically significant difference between the series obtained at the 20th minutes after administration of gadoxetic acid and late phase for gadopentate dimeglumine for hepatic parenchymal and metastatic lesion intensity. (p<0.05) After the administration of gadoxetic acid, arterial, portal, late phase and the 20th minute series intensity of hepatic enhancement significantly reduced. At this time there was not a significant enhancement of the metastatic lesions. (p>0.05) When the hepatic parenchymal enhancement increased and the enhancement of metastatic lesions reduced, thus the enhancement difference between normally hepatic parenchyma and metastatic lesions might help the detection of the lesions. Conclusion: Gadoxetic acid, a hepatoceluler contrast agent, have important diagnostic contribution to the assessment of the patients with liver metastases of gastrointestinal malignancies by magnetic resonance imaging.

Aim: The aim of the present study was to evaluate the general characteristics, survival time and prognostic factors affecting the high grade glial tumor after radiotherapy and chemotherapy. Patients and Methods: Data of 166 patients were retrospectively analyzed. Included histopathologically confirmed cases were grade 3 anaplastic astrocytoma and grade 4 glioblastoma multiforme. Patients were treated with curative radiotherapy and simultaneous ± adjuvant Temozolamide. Results: 73% of the patients were male, 27% were female and the median age was 57 years. 21% were anaplastic astrocytomas, 79% were glioblastom multiforme. 40% of the patients were total, 49% of the patients were subtotally operated and 11% of the patients had only biopsy for diagnostic purposes. The median Karnofski performance score of the patients before radiotherapy was 90. 3-dimensional conformal radiotherapy was applied to 37% of the patients, 63% of the patients were treated with intensity-adjusted radiotherapy technique. Simultaneous Temozolamide was administered with 92% of patients’ radiotherapy. The median follow-up time was 15 months. Overall survival rates were 82 months for anaplastic astrocytoma and 15.5 months for glioblastome multiforme (p <0.001). Overall survival rates at 1, 2, and 5 years were 77%, 59%, and 55% for anaplastic astrocytoma and 59%, 33%, and 4% for glioblastome multiforme, respectively. Median overall survival in patients aged <50 years was 39.3 months, while age ≥50 years was 12.4 months (p <0.001). Overall survival according to operation pattern was 33.2 months in total exposures, 13.8 months in subtotal resections, and 4.9 months in biopsies (p = 0.00). Overall survival was 8.1 months with a performance of <70, while overall survival was 22.3 22.3 months with ≥70 (p = 0.00). Overall survival was 12.9 months in patients who underwent three-dimensional conformal radiotherapy and 21.5 months in patients undergoing intensity-adjusted radiotherapy (p = 0.005). Overall survival was 7.8 months when applied to radiotherapy dose <60 Gy and 21.7 months when given 60 Gy (p = 0.00). Median survival was 18.4 months and 7.2 months, respectively, using concurrent Temozolamide (p = 0.03). Conclusion: In conclusion, the patient’s diagnosis, age, operative form, performance, radiotherapy dose, chemotherapy usage and survival were positive and our results are compatible with the literature.

Aim: Hyperemesis gravidarum (HG) refers to a disorder of early pregnancy that manifests with extreme, difficult-to-treat nausea and vomiting. Its pathogenesis is largely obscure, and studies investigating its link with anxiety depression have remained inconclusive. Herein, we aimed to study the depression and anxiety levels of a Turkish population of pregnant women with hyperemesis gravidarum. Patients and Methods: This was a prospective sectional study conducted at our Department of Obstetrics and Gynecology between January 2011 and June 2013. There were 50 pregnant women with HG and 50 healthy pregnant women without any history of nausea and vomiting, who were matched with the study group for age, parity, and body mass index. All subjects underwent baseline laboratory investigations including serum TSH. Results: The two groups were comparable with regard to the demographic and obstetric parameters and baseline laboratory investigations although the HG group had significantly greater mean serum AST and TSH levels (p=0.015 and p=0.0001, respectively). Additionally, the HG group had significantly greater BDI and BAI scores compared to the controls (p= 0.0001). Conclusion: Our results have shown that psychological stress may be one of the causes of HG. For this reason, emotional states as well as medical conditions of HG patients during pregnancy should be considered. However, these results should be confirmed by prospective and clinical studies.

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 Celiac disease is the only life-long continuing food intolerance. This intolerance, caused by gluten, endamages the structure of small intestine and prevents the absorption of nutritional elements. Celiac disease is usually related with other auto-immune diseases. Rate of this disease in our country is increasing in time. It can be seen in people of different ages and different clinical findings. In our day, the most efficient way of treatment is removal of gluten from daily diet. Gluten-free diet that step in treatment phase, affects the living of individual in a period in which growth and development is most rapid. By applying the gluten-free diet strictly, the risk of complications like low bone mineral density and intestine malignite related with the disease, can be decreased. However, it is not always easy to apply and keep track of gluten-free diet by family or child. Moreover, gluten-free diet can cause excess of some nutritional elements (saturated fat), gaining high calorie, and poorness of some nutritional elements (fiber, folic acid, vitamin B ₁₂, iron, zinc, magnesium). Particularly, gluten-free products, when compared with their gluten-including equivalents, have less magnesium, fiber, and folic acid, as well as they are far more expensive. It is determined that a lot of patient considered "resistant" to diet treatment are also eating gluten-including food. Therefore, gluten-free diet should be planned and followed well, and family and child should be educated. This editted article is about, celiac disease, diet treatment for celiac disease, principles of the diet treatment, concordance to the diet, and the factors that effects this concordance.

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Paroxysmal cold haemoglobinuria (PCH) is an uncommon form of autoimmune haemolytic anaemia the diagnosis of which is usually not considered at the initial presentation due to nonspecific symptoms. Neutrophilic erythrophagocytosis and neutrophil erythrocyte rosette formation in peripheral smear is an uncommon finding which has been reported rarely in autoimmune haemolytic anaemia, especially PCH. We report a case of a 25-year-old female who presented with acute onset fever and in whom these unusual peripheral smear findings directed the pathologist to initiate the work up for paroxysmal cold haemoglobinuria. Being vigilant about the presence of neutrophil erythrocyte rosette and erythrophagocytosis by neutrophils in peripheral smear will guide pathologist towards initiating a workup for PCH and avoiding unnecessary investigations.

Angiomatoid Fibrous Histiocytoma (AFH) is a rare soft tissue tumour of indeterminate differentiation usually occurring in children and young adults with low rate of metastasis and recurrence. AFH continues to be revised with various studies reporting recurrences but up till now, the diagnostic criterion remains unclear with pathologists relying mainly on Enzinger’s description and immunohistochemistry. Adding to the fact that it is a rare tumour, diagnosis usually is delayed. We present a case of a 10 year old male with AFH with atypical histology, immunoprofile and genetic testing. Opinions were sought from Heidelberg hospital Germany and Children Hospital of Philadelphia which had contrasting views regarding the diagnosis, which was finally confirmed by Brigham and Women’s hospital, Boston. We review literature and discuss the possible differential diagnosis.

Actinomyces is a chronic suppurative infection caused by Gram positive anaerobic bacteria which grows hardly in bacterial culture. It is commonly isolated from cervicofacial, respiratory, and gastrointestinal system. Its exact pathogenesis is still unknown. Actinomyces located in the cervicofacial region is frequently accompanied by maxillofacial trauma and dental procedures. Herein, we report a 45-year-old female case of actinomyces in tongue which was treated with antibiotherapy and good oral hygiene.

\r\n A decrease in retinal nerve fiber layer thickness can be secondary to glaucoma, several neurologic diseases, optic nerve diseases other than glaucoma, retinal diseases, toxic, nutritional or vascular causes such as shock optic neuropathy. Glaucoma, which is among the commonest causes of blindness worldwide, is a progressive optic neuropathy characterized by a decrease in retinal nerve fiber layer thickness secondary to retinal ganglion cell death, cupping of optic nerve head and visual field loss. Although the best known risk factor associated with glaucoma is high intraocular pressure, it is thought that systemic vascular disorders, which are among the risk factors of glaucoma, play role especially in the pathogenesis of normotensive glaucoma where intraocular pressure is low. In our study, we described a patient with decreased retinal nerve fiber layer thickness and thought normotensive glaucoma as the most probable diagnosis, who also had multiple systemic vascular diseases. 

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