Makale Arama

Objective: The aim was to review the hormonal status, treatment and histopathological diagnosis of patients admitted to our endocrinology outpatient clinic with the diagnosis of adrenal incidentaloma.

Material and Methods:Between 2015-2018, 217 patients with adrenal incidentaloma who were admitted to the endocrinology outpatient clinic were included in the study. 1 mg overnight dexamethasone suppression test (DST), 24 hour urine free cortisol, 24-hour urine methanephrine and normetanephrine levels were evaluated in all patients.Patients who also have hypertension or hypokalemiawere screened for the plasma aldosterone/renin activity ratio. CT or MRI imaging properties of adrenal incidentalomas were screened.

Results: In the evaluation of cases; 180 (83%) of the masses were evaluated as non-functional and 37 (17%) as functional. Of the 37 patients evaluated as having functional adrenal mass; 10 (4.6%) pheochromocytoma, 5 (2.3%) Cushing's syndrome, 9 (4.1%) subclinical Cushing’s syndrome and 13 (6%) primary hyperaldesteronism were detected. In 180 patients who were evaluated as having non-functional adrenal mass; metastatic disease in 7 (3 non-small cell lung cancer, 1 breast cancer, 1 prostate carcinoma and 2 unknown primary cancer), myelolipoma in 4, ganglioneuroma in 1, hydatid cyst in 1, adrenocortical carcinoma in 2 patients were detected.

Conclusion: According to the results of this study, it is not uncommon for adrenal incidentalomas to be functional. It may be malignant in some cases. For this reason, adrenal incidentaloma is a condition that should be examined both in terms of
functionality and malignancy potential.

\r\n Synesthesia is a phenomenon in which stimulation of one sensory system leads to a different experience in a second sensory system. There is more than sixty types of Synesthesia, like grapheme-color, sound-color (chromesthesia), sound-movement, sound-flavor, color- flavor etc. have been identified so far. Synesthesia is seen in 4% in general population. The grapheme-color and sound-color Synesthesia are the most common types. A case is discussed that has auditory-visual and smell-color types Synesthesia started at 6 yo but currently she has had fewer symptoms than before. An active psychiatric pathology is not found in clinical evaluation.  There is neither significant patient history nor family history for psychiatric disorders other than a younger sister who has similar symptoms. She has not experienced any seizures or trauma. Her MRI and EEG were within normal limits. Functional MR imaging showed greater activation in the cerebral hemisphere that indicate lateralization. Since there is a positive familial history, we might consider genetic predispositions.

Aim: Nearly 30% of the patients with cleft palate need another surgery for velopharyngeal insufficiency. While
preoperative radiologic evaluation is necessary for planning, postoperative evaluation is also so important. In
this study, we plan to share our experience about evaluation of the velopharynx with dynamic MRI at patients
who were operated oving for velopharyngeal insuf ficiency.
Patients and Methods: The study included seventeen patients who were presented with velopharyngeal
insufficieny and we applied dynamic MRI for postoperative evaluation between April 2014 and May 2020.
Pharyngeal flap was applied for 7, posterior augmentation was performed for 7 (2 costal cartilaginous, 5 fat
graft) and myomucosal repair was done for 3 patients with submucosal cleft. Dynamic MRI were obtained
preoperatively and postoperatively at 3rd month. Postoperative results were evaluated with dynamic MRI.
Results: The study included seventeen patients, with an age range of 9-29 (mean 13± 2.5), 11 women (65%),
and 6 men (35%). Posterior wall located grafts were found at the second cervical vertebra and viable. While
there was no nasal air escape in superior pharyngeal flap applied patients at sagittal plane, in axial dynamic
images, gap was detected which is all essential for airway and must be obtained. The levator muscle direction
was observe normal postoperatively at patients with submucous clef. Nasal air escape area was decreased
in both methods significantly comparing with preoperative measu rement (p<0.05)
Conclusion: Because of the three-dimensional and dynamic structure of the velopharynx, it must be evaluated
in both planes and dynamic. Although there are many techniques for this purpose, none of them is ideal or
objective. Dynamic MRI can be used for postoperative follow-up as it is used for preoperative planning.
Evaluation of the pharyngeal flap atrophy , grafts and also gap size are provided with qualitative values .

Aim: We aimed to evaluate the relationship between magnetic resonance (MR) enterography and diffusion magnetic resonance imaging (MRI) investigations in inflammatory bowel disease (IBD) patients during active inflammation and remission phases. 

Patients and Methods: We included patients diagnosed with IBD between 01.12.2015-31.08.2016 at our hospital. 47 patients were included; 30 were male (63.8%) and 17 were female (36.2%). Thirty two (68.1%) of them had ulcerative colitis and 15 (31.9%) had Crohn’s disease. Standard institutional sequences for upper and lower abdomen scan included: sagittal and axial T2 TRUFI, axial and coronal fat suppressed T2 TRUFI and coronal and axial T1 VIBE following intravenous (at 60 seconds) contrast medium administration. First group of patients (n=10) had MRI investigations both at active and remission phases, whereas in the second group of patients (n=37) apparent diffusion coefficient (ADC) values, bowel wall thickness and contrast enhancement grades were compared between actively inflamed and non-inflamed bowel segments.

Results: A statistically significant difference was found regarding ADC values and bowel wall thickness measurements in the first group of patients when compared between active and remission phase MRI investigations (p=0.005). Bowel wall contrast enhancement degree did not differ between active and remission phases in the first group (p=0.059). In the second group, there was a statistically significant difference between active and normal bowel segments regarding ADC values, bowel wall thickness and contrast enhancement (p<0.001).

Conclusion: MR enterography and diffusion MRI may be beneficial to determine the degree of inflammation and response to treatment in IBD patients.

ABSTRACT

Aim: Sternal dehiscence is one of the most troublesome complications following cardiac surgery. Although it can be corrected by simple methods if detected earlier, treatment failure or delay in sternal dehiscence may result in mediastinitis, which is highly lethal.  In this study, we aimed to investigate alternative sternal closure systems, mainly sternal talon (STalon) and titanium sternal plates (SPlate). Patients and Methods: In between April 2015 and January 2018, patients with sternal dehiscence after any kind of open cardiac surgery were included in this study. These patients were retrospectively evaluated according to the their demographic data, risk factors for sternal dehiscence, type of operations, techniques used for fixation of the sternum, mainly focusing on the STalon and titanium SPlate fixation. Results: A total of 45 patients were taken into surgical correction because of sternal dehiscence.  Thirty-four (75.6%) of the patients male, whereas 11 (24.4%) were female. Mean time interval after the first operation to sternal dehiscence was 68.5 days (1-780 days). Mean body-mass-index (BMI) was 31.52 kg/m² (22.03-43.69 kg/m²). Before the sternal fixation, mean CRP value was 68.34, whereas it was 75.55 before discharge. Confounding risk factors were internal mammarian artery (IMA) harvesting for coronary artery disease, diabetes mellitus, bronchial asthma, chronic pulmonary artery disease and advanced age. Mean post-operative intensive care unit (ICU) length-of-stay (LOS) was 5.02 days (1-29 days), whereas hospital LOS was 17.18 days (2-74 days). Early mortality was observed in 3 patients (6.67%). The first choice of operation was simple closure and/or Robicsek closure. Apart from simple and Robicsek closure techniques, sternal talon and/or titanium plates were used in 24 patients (53.3%). DM was found to be related to extanded total hospital LOS, ICU LOS, and postoperative time to discharge. DM also increased the risk of both superficial and deep sternal infection rates (p<0.05).  Conclusion: Ideal sternal closure should stabilize the sternum, be cost-effective and provide shortest hospital LOS with minimal post-operative complications. In patients with intact intercostal spaces, sternal talon may eliminate serious complications, such as cardiac rupture mainly caused by dense adhesions. Sternal plates are mainly effective in fragmented fractures without stable intercostal spaces. All patients should be individualized according to type of lesions and sternal fractures.

Objective: Mucormycosis is an infrequent opportunistic fungal infection which may cause an aggressive and invasive soft tissue necrosis. It is usually developed in patients with immune system deficiency, and rarely seen in immunocompetant patients.  We report prognosis and treatment of the immunocompetant patients that developed facial cutaneous mucormycosis after short term corticosteroid therapy.

Material and Method: The patients who were admitted to Manisa Celal Bayar University Hospital after multitrauma and given short term corticosteroids due to cranial and spinal injuries and became immuncompromised and diagnosed as facial cutaneous mucormycosis between 2016 and 2018 were included in the study. Prognosis, medical and surgical treatment outcomes of therapy is reported.

Results: One patient with malar and maxillary involvement was treated with medical therapy and serial debridements and infection was cured. Reconstruction with free flaps were done, acceptable functional and aesthetic results were achieved. Two patients had adequate therapy and reconstructed with local flaps.   One patient was not operated due to recurrent fungal osteomyelitis and intracranial inflammatory findings, and regression in MRI was seen.

Conclusion: Mucormycosis should be kept in mind in contaminated wound infections in patients who have been treated with corticosteroids even for a short time after multitrauma. Rapid, repetitive and aggressive debridemants should be performed and reconstruction should be planned after cure of the fungi.

Introduction: Our aim is to evaluate the cardiac involvement of Neurofibromatosis type 1  patients in our region and to compare them with other clinical findings. In this study, we wanted to show the frequency and variety of cardiac involvement.

Material and Methods: Patients diagnosed with Neurofibromatosis type 1  in Hatay Mustafa Kemal University Medical Faculty Pediatric Neurology Clinic between 01/09/2019 and 01/09/2020 were included in the study. The patients included in the study were examined by a Pediatric Cardiology Specialist, and echocardiography and electrocardiography were taken. Demographic information, examination findings, brain magnetic resonance images were collected from the files of the patients. Electrocardiography and echocardiography were examined and recorded by the Pediatric Cardiology Specialist.

Results: We accepted 17 patients from our center to the study. Six patients (35.3%) were diagnosed with sporadic Neurofibromatosis type 1, while 11 patients (64.7%) had familial Neurofibromatosis type 1. All of our patients had cafe au late spots on the skin. In addition, 10 (58.8%) patients also had axillary and / or inguinal freckles. We detected optic glioma in 3 of our patients with ocular involvement, and lish nodules in 3 of them with papillary edema. When we looked at central nervous system involvement, we encountered various involvements in brain MRIs of 8 (47%) patients. In our cardiac examination, we found QT length in 1 patient’s electrocardiography. In the echocardiography we performed for the detection of cardiac structural pathologies, we detected nodular appearance compatible with subendocardial neurofibroma in 3 patients, mitral insufficiency in 3 patients, patent foramen ovale in 1 patient, atrial septal defect in 1 patient, and bicuspid aorta in 1 patient.

Discussion: In our study, unlike the literature, subendocardial nodular hyperechogenic appearance was present in 3 patients. Although these findings are quite rare, subendocardial nodular hyperechogenic images in 3 of our 17 patients suggest that this pathology may be more common. In addition, one of our patients had a long QT. As far as we know, this is the first case of Neurofibromatosis type 1 and Long QT syndrome. In conclussion; Cardiac involvement in patients with Neurofibromatosis type 1 could more common than mentioned in the literature.

Aim: Investigate the role of Magnetic Resonance Imaging (MRI) in the evaluation of response of the locally
advanced rectal cancer to the chemoradiotheraphy (CR T).
Patients and Methods: T2-weighted and Diffusion Weighted Imaging (DWI) of 24 cases with locally advanced
rectal cancer who have undergone total mesorectal excision 6-8 weeks following the CRT between 2015 and
2020 were evaluated retrospectively. The evaluated radiological parameters were as follows; Tumor morphology,
localization, length, mrT/mrN stages, and extramural vascular invasion (EMVI). Post-CRT MRI residue scoring
was performed (0: No residual tumor, 1: No significant residual tumor, fibrotic wall thickening, 2: Residual tumor
present). Regression grading was as follows; 1: No tumor, 2: Good response, mostly fibrosis, 3: Fibrosis and
mucin more than 50%, 4: Slight response, 5: No response.
Results: There was a significant decrease in the craniocaudal length of tumor and a significant increase
in the mean ADC of tumor after CRT (p=0.001). A significant and high correlation was observed between
histopathological T (pT) and post-CRT mrT (r=0.54, p=0.006). There was a significant correlation between pre-
CRT EMVI and perineural invasion (PNI) (r=0.53, p=0.008). A significant correlation was found between residue
scoring and regression grading (r=0.6; p=0.001), pT (r=0.48; p=0.02), and tumor length (r:0.51; p=0.01). There
was a significant correlation between regression grading and EMVI (r=0.43, p=0.036), PNI (r=0.46, p=0.02), pT
(r=0.41; p=0.048), pN (r=0.55; p=0.006), and metastatic/total lymph node ratio (r=0.46; p=0.02).
Conclusion: Post-CRT MRI is highly correlated with postoperative pathological evaluation of the locally
advanced rectal cancer. MRI is highly successful in re-staging as well as primary staging. The evaluation of
treatment response by MRI regression grading may contribute to the surgical planning.

Aim: Although hepatitis C virus (HCV) is essentially hepatopathic, there are many extra-hepatic symptoms that may develop with associated HCV infection. Of these, dermatological findings constitute a significant proportion of extra-hepatic symptoms. The aim of this study was to evaluate dermatological diseases accompanying to chronic HCV infection in our region. 
Patients and Methods: From a total of 2050 patients diagnosed and followed up for chronic HCV infection in the Infectious Diseases and Clinical Microbiology Clinics in a 12-years period between 2008 and 2020, 394 determined with concurrent dermatological disease were included in the study. 
Results: Chronic HCV patients diagnosed with dermatological disease comprised 218 (%58.6) females and 176 (%41.4) males with a mean age of 56±17 years. In the patients with chronic HCV infection presenting at the dermatology outpatient clinic, pruritus was determined most (%18.5) and followed by contact dermatitis (%17.5). At univariate analyses female gender (p:0,005, OR:3,329, CI 95% [1,439-7,701]) and advanced age (p:0,013, OR:1,029, CI 95% [1,006-1,052]) were detected as significant variables of frequent dermatological diseases. The female gender ( p: 0,038, OR:2,682, CI 95% [1,054-6,826]) was detected as the predictor of most frequent dermatological diagnoses in chronic HCV infection at multivariate logistic regression analysis. 
Conclusion: The most common reasons for presentation of patients with HCV infection at the dermatology outpatient clinic were determined to be pruritus and contact dermatitis. The frequency and variability of the diagnoses seen in chronic hepatitis C patients after presentation at the dermatology outpatient clinic suggest the need for further studies in this area with more standardised patient groups using standard laboratory techniques.
 

Systemic Lupus Erythematous, autoimmune character, is a inflammative disease holding many systems. The disease can sometimes follow insidiously with symptoms of fever, asthenia and prostration for years. Central nervous system is common. It is the clinical variable and may be very mild or very severe. In most patients, the age of onset is between 16-55 years old and is found in cases diagnosed in advanced age. Here, it is presented an elderly patient developed dizziness and right side prostration when she was 80 and diagnosed lupus when she was 85. We thought as worth for presenting because of that both the patient is elder and that the lesions have similar features with demyelinating plaques. The lupus should not be forgotten in the central nervous system involvement in advanced age cases and separator diagnosis.