Anatolian Clinic Journal of Medical Science / Anadolu Kliniği Tıp Bilimleri Dergisi

137-142

Authors: Suleyman Bademler, Murat Sari

Aim: Cancer treatment is of special importance during pregnancy, concerning the health of both mother and baby. Treatment of pregnancy-associated breast cancer (PABC) has become even more important today because women tend to delay pregnancy to later ages and because of women who desire to conceive while under treatment for breast cancer. This retrospective study is aimed at investigating the clinical, radiological and histopathological characteristics and PABC treatment outcomes of patients who had long-term follow-up. Materials and Methods: Sixteen women diagnosed with PABC were included in this study. We evaluated the clinicopathological characteristics, gestational history, and survival outcomes of the patients who had been treated and followed up for breast cancer during pregnancy and the first postnatal year at Istanbul University Institute of Oncology in 2010–2017. Results: The median patient age was 32 (21–41) years. The median gestational week of diagnosis in pregnant patients was 26 (11–35) weeks while the mean time elapsed after delivery until diagnosis in postpartum patients was 9.3 (±3.6) months. The median follow-up time was 47.5 (5–99) months. The mean disease-free survival (DFS) and overall survival (OS) were calculated because the median DFS and OS could not be computed. The mean OS and DFS values were 87.8±7.3 and 77.6±8.5 months, respectively. Discussion and Conclusion: Breast cancer in pregnancy is a special health condition that should be treated and followed up by a multidisciplinary team. Primary surgical intervention should not be delayed. While chemotherapy could be administered safely in the first and second trimesters, radiotherapy and targeted and endocrine treatments should be postponed until after delivery. Reporting and long-term follow-up of cases of pregnancy and cancer concurrence is essential for increasing the relevant knowledge.

147-150

Authors: Elif Ertan, Mustafa Doğan, Anar Alızada

Aim: In this study, we aimed to evaluate the results of conjunctivolimbal autograft surgery in patients with primary and recurrent pterygium.  Materials and Methods: Patients who underwent conjunctivolimbal autograft surgery for primary and recurrent pterygium at Ophthalmology Department of Afyon Kocatepe University Hospital between January 2012 and December 2016 were evaluated retrospectively. Results: A total of 130 patients were included. The pterygium was recurrent in 19 eyes of 18 patients while primary in 131 eyes of 112 patients. Of the patients operated, 64 were male and 66 female. The mean patient age was 62.60±1.16 (25–89) years. During the postoperative follow-up, suture-related inflammation was observed in 5 eyes (3.3%), dellen in 1 eye (0.66%) and pterygium recurrence in 6 eyes (3.9%). No other complication was observed. Discussion and Conclusion: Conjunctivolimbal autograft transplantation is an effective and safe method with low recurrence rates in treatment of primary and recurrent pterygium.

157-162

Authors: Adem Akkuş, Emel Çalışkan, Özge Kılınçel, Görkem Dülger

Aim: This study aimed to investigate the antimicrobial activity of extracts from the Istranca oak (Quercus hartwissiana Steven) against bacterial and fungal pathogens. Materials and Methods: Extraction of the Istranca oak was carried out with ethanol, formaldehyde, acetone, ethyl acetate, and methanol solvents. After injecting 50 μl of these extracts into sterile discs, the discs were dried in a sterile environment for 24 hours in order for the results not to be affected by the solvents present in the extracts. Antimicrobial activity against the species Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Salmonella spp., methicillin-resistant Staphylococcus aureus, methicillin-susceptible Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus spp., Candida albicans, Candida glabrata and Candida tropicalis was investigated by disc diffusion method. Results: It was observed that the extract prepared with ethanol showed the widest zone diameter against Enterococcus spp. (8mm) and S. epidermidis (8mm), the extracts with formaldehyde and ethyl acetate against E. coli (16mm, 28mm), the extract with acetone against Enterococcus spp. (21mm), and the extract with methanol against methicillin-susceptible S. aureus (28mm). For the yeasts, the extract prepared with ethanol showed the widest zone diameter against C. glabrata (12mm), the extract with formaldehyde against C. albicans (28mm) and C. tropicalis (28mm), and the extracts prepared with acetone, ethyl acetate, and methanol against C. albicans (19mm, 30mm, 22mm). Discussion and Conclusion: It was determined that the extract prepared with ethyl acetate showed wider zone diameter against the strains studied, compared to extracts prepared with the other solvents. Given that the widest zone diameters were observed against the strains E. coli, S. aureus and C. albicans, we think that it is important to conduct in vivo antimicrobial studies on the inhibitory effects of the Istranca oak indigenous to our country.

173-176

Authors: Abdulhalim Şenyiğit

Aim: This study aims to compare type 2 diabetic patients with coronary artery disease and type 2 diabetic patients with nephropathy in terms of common carotid artery intima–media thickness. Materials and Methods: The study included type 2 diabetics with coronary artery disease (n=36) and type 2 diabetics without coronary artery disease but with complicating nephropathy (n=31). The right and left common carotid arteries were evaluated in terms of intima–media thickness by using B-mode ultrasonography. Other traditional risk factors for cardiovascular disease were also evaluated. Results: Both right and left common carotid artery intima–media thicknesses were found to be significantly greater for the diabetics with concomitant coronary artery disease than for the diabetics with concomitant nephropathy only (0.99 mm vs 0.82 mm for the right and 1.07 mm vs. 0.92 mm for the left common carotid artery; p<0.05 for both). Other atherosclerotic cardiovascular risk factors (LDL-cholesterol, HDL-cholesterol, systolic and diastolic blood pressure, diabetic age) were similar for both groups (p>0.05 for all). Discussion and Conclusion: Presence of coronary artery disease is an important indicator for concomitant cerebrovascular disease in type 2 diabetics.

183-185

Authors: Talya Akata Akıncıoğlu, Ülkü Küçük, Sümeyye Ekmekçi, Samir Abdullazade, Coşkun Yıldız

A 52-year-old female patient presented to our hospital with abdominal pain and fatigue. Endoscopy revealed a polypoid lesion in the stomach and gastric biopsy atypical cells in the lamina propria. The cells showed positive staining for melan-A and HMB-45 and negative staining for cytokeratin 7 and cytokeratin 20. The case was labelled as “consistent with malign melanoma (MM).” We reached the pathology report of the enucleation that the patient underwent two years ago, after which she was diagnosed with stage-pT1a “MM with epithelioid features,” localized in the right bulbus oculi. Systemic scanning also revealed metastatic masses in the liver. The possibility of MM that can mimic other pathologies clinically, endoscopically, and histopatholgically should always be considered in cases where the primary pathology is unknown.

189-194

Authors: H. Volkan Kara, Ezel Ersen, Mehlika Iscan, İsmail Sarbay, Merve Ekinci, Akif Turna

Pulmonary aspergilloma is one of the clinical conditions with high mortality and morbidity in immunosuppressed patients. Surgical resection has been the leading treatment option; however, surgical treatment involves some risk of local and systemic dissemination and there are also patients who are functionally inappropriate to be treated surgically. In this paper, we present two patients with bilateral PA who underwent surgical and antifungal treatment. Antifungal therapy with voriconazole that was successful for both of our patients might be a promising approach to a group of PA patients who are not appropriate for surgery.

68-72

Authors: Saniye Aydogan Arslan, Arzu Daskapan, Nihan Ozunlu Pekyavas, Elif Sakizli

Aim: In this study, we aimed to determine the short-term effects of diaphragmatic Kinesio taping (KT) on aerobic exercise capacity and pulmonary function in sedentary individuals. Materials and Methods: Sedentary volunteers were included in the study. Participants were randomly divided into two groups: KT group (n =17), and sham KT group (n=19). In order to evaluate submaximal functional capacity and aerobic performance, shuttle run and pulmonary function tests were performed for each participant both prior to and four days after KT. Chest circumference measurement was made for the flexibility of the rib cage. The KT muscle facilitation technique was applied to the diaphragm muscle. Results: Pulmonary function test values showed an increase in FEV1 four days after KT, compared to the values prior to KT (p=0.002). There was statistically significant difference between shuttle run test results (p=0.001) and axillar chest circumference measurements (p=0.045) before and 1 week after KT. Statistically significant difference was also observed concerning FEV1 (p=0.014), FEV1/FVC (p=0.035) results and shuttle run test distance (p=0.009). Discussion and Conclusion: KT applied to the diaphragm muscle improves aerobic performance and pulmonary functions in the short term and when compared to the sham KT group.

79-83

Authors: Ali Aslan, Havva Erdem, Mürüvvet Akçay Çelik, Arzu Şahin, Soner Çankaya

Aim: Although WT1 was first identified as a tumor suppressor gene affecting Wilms’ tumor development, it has also been reported that its expression increases in certain malignancies such as colon cancer, and that it therefore has oncogenic properties. In this study, we aimed to determine dependence of WT1 expression on patient age and sex, type of pathological diagnosis, and the sample-taking area. Materials and Methods: Paraffin-embedded blocks and pathology reports of 32 patients with colon polyps that had been sent to pathology department were histopathologically reviewed retrospectively. p<0.05 was considered statistically significant. Results: No statistically significant relationship was observed between WT1 expression and the parameters of mean patient age, sex, localization, diameter, and histopathological diagnosis (p=0.235, p=0.423, p=0.338, p=0.719, p=0.338, respectively). However, when OR (odds ratio) values were considered, it was thought that there were clinically significant differences. Positive staining was 4.308 times higher in adenomas (neoplastic group) than in polyps (nonneoplastic group) (OR=4.308), 4,308 times higher in the portion from the transverse colon to the anus than in the transverse colon (OR=4.308), and 2.333 times higher in women than in men (OR=2.333). Discussion and Conclusion: The study findings suggest that there is no statistically significant relationship between presence of WT1 expression in polyps and sex, diagnosis, and sample-taking area, but that there is clinically significant differences when OR values are considered. Detection of benign and precancerous polyps with WT1 expression through routine immunohistochemical examination could contribute to better understanding WT1 immunotherapy and vaccine efficacy in individuals at high risk of developing colonic tumors.

88-92

Authors: Suleyman Bademler, Muhammed Zubeyr Ucuncu

Aim: Granulomatous mastitis is a rare disease of the breast. Initial findings during admission can be mistaken for breast cancer. In this study, we aimed to present our experience with idiopathic granulomatous mastitis (IGM). Materials and Methods: Patients who had been treated and followed up after a diagnosis of GM at the surgical clinic of the Istanbul University Institute of Oncology between 2007 and 2017 were categorized into two groups: those who had received steroid treatment only (Group 1), and those who had received steroids in combination with surgical treatment (Group 2). The groups were compared in terms of clinical and demographic characteristics and recurrence rates. Findings: We included a total of seventy-nine patients in our study. The mean patient age was 36.41±6.93 years and the mean follow-up 57.34±20.39 months. There was no significant difference between the two groups in terms of mean age, age at menarche, maternal age at first delivery, and the side involved (right, left, bilateral). The disease had recurred in 19 patients in Group 1 while no recurrence had been observed in Group 2 (p=0.001). Discussion and Conclusion: IGM is a disease that is rare but easily mistakable for breast cancer. The diagnosis necessitates confirmation through a biopsy. Steroid therapy combined with surgery can be the first choice in the treatment of this disease, on which no consensus has yet been reached. Such combination is capable of reducing recurrence rates.

97-101

Authors: İsmail Davarcı, M. Esra Koçoğlu, Muhterem Duyu, Melike O. Taşçılar

In this paper, we report our isolation of Elizabethkingia meningoseptica as a rare pathogen from the tracheal aspirate culture of a pediatric patient diagnosed with biliary atresia type 2 whose general condition had been deteriorating while under follow-up in our intensive care unit. Following the isolation, her condition improved after her treatment was modified in accordance with the related antimicrobial susceptibility test results.

108-110

Authors: Ozan Dogan, Alper Basbug, Aski Ellibes Kaya, Derya Basbug, Cigdem Pulatoglu

Uterine prolapse during pregnancy is a rare condition with an estimated incidence of 1:10,000–15,000 pregnancies. Premature labor and delivery are the most prevalent complications in pregnancies with pelvic organ prolapse. Various treatment methods from conservative approaches to surgery are possible. In this paper we report a 27 year-old patient who was treated with Arabin pessary due to uterine prolapse in the first trimester.

121-128

Authors: Tugba Haliloglu Ozkan, Enes Ozkan , Selim Arici

The purpose of orthodontic treatment is to enhance patients’ life quality by improving their dentofacial functions and aesthetics. Minimal histological damage and pain, rapid tooth movement, short treatment duration, and stability of results are the major criteria for successful treatment. In recent years, the demand for orthodontic treatment has been increasing gradually. Prolonged duration of orthodontic treatment affects the psychological motivation of the patients and leads to several undesirable situations, such as caries, gingival recession, and root resorption. Thus, in recent years, related research has investigated the acceleration of orthodontic tooth movement. However, despite the various laboratory and clinical interventions designed to achieve faster tooth movement, uncertainties and unanswered questions about these techniques persist and warrant further investigation. Several surgical techniques as well as physical and chemical applications have been reported by previous studies to accelerate orthodontic tooth movement, most of which have been conducted on animals, with debatable applicability on humans. However, as tooth movement is a multifactorial phenomenon, further research is needed in the future. In this review, we describe the orthodontic tooth movement acceleration methods reported thus far.

6-11

Authors: Erkan Kilinc , Yasar Dagistan , Emine Dagistan , Zeliha Cosgun

Aim: Inflammatory mechanisms play a key role in the pathogenesis of back pain related to disc hernia. Mean platelet volume (MPV) and red cell distribution width (RDW) are novel and promising inflammatory markers in routine hemogram tests. In this study, we aimed to compare the MPV and RDW values of patients with lumbar disc herniation (LDH) to those of healthy subjects and symptomatic patients suffering from sciatica without radiological evidence of lumbar disc herniation. Materials and Methods: This retrospective cohort study was carried out in the Neurosurgery Department of the Abant Izzet Baysal University Education and Research Hospital. Three groups as the controls (n=57) and LDH (n=73) and sciatica (n=20) groups were designed. Hemogram parameters including white blood cell count (WBC), hemoglobin (Hb), hematocrit (Htc), mean corpuscular volume (MCV), RDW, platelet count (PLT) and MPV were evaluated for each group. Results: The mean MPVs of the LDH, sciatica, and control groups were 9.3±1.8 fL, 8.2±1.1 fL, and 8.4±1.0 fL, respectively. The mean MPV was significantly higher for the LDH group, compared to the sciatica and control groups (p=0.001). The mean RDWs of the LDH, sciatica, and control groups were 14.8±1.8, 13.8±1.0, and 13.7±1.2, respectively. The mean RDW was also significantly higher for the LDH group in comparison to the sciatica and control groups (p=0.001). Discussion and Conclusion: We think that elevated MPV and RDW values might be strong indicators of LDH in patients with sciatica and that such patients should be prioritized for imaging studies. However, further prospective studies are needed to support our results.

20-25

Authors: Ahmet Selim Özkan , Sedat Akbaş , Nihat Polat , Mehmet Rıdvan Yalın

Aim: In this study, we aimed to evaluate the mean changes in the corneal endothelial cells and pachymetry values of patients who underwent general anesthesia with sevoflurane with N2O or O2. Materials and Methods: Forty eyes of 40 patients who had extraocular surgery under general anesthesia were included in this prospective study. The patients were divided into two groups as the O2 and N2O groups, for which %50 O2 (total flow rate; 2 L/min in O2-air mixture) and %50 O2 (total flow rate; 2 L/min in O2–N2O mixture) were used, respectively. The duration of the surgery was recorded. The CD (cell density), CV (cell variation), Hex (hexagonality rate) and pachymetric specular microscopy results were evaluated before surgery, and at the first and fourth weeks after surgery. Results: The surgical duration and demographic data of the groups were similar, and there was no statistically significant difference between the two groups. The value of CV was 26±2 cell/mm2 for the O2 group and 30 cell/mm2 for the N2O group at the first week. There was a statistically significant increase in the N2O group values, compared to the preoperative values (p=0.008). The Hex value was 52±10% for the O2 group and 62±11% for the N2O group at the first postoperative week, and there was a statistically significant increase in the N2O group values in comparison to the preoperative values (p=0.007). There was no significant difference between the two groups in terms of CD, CV, Hex, and pachymetry at other times. Discussion and Conclusion: Statistically significant change was observed at the first postoperative week in the corneal variation and hexagonality rate values of the pediatric patients who underwent general anesthesia with nitrous oxide. More studies need to be done for further assessments.

34-41

Authors: Kayahan Karaytuğ , Eren Yıldız , Sefa Giray Batıbay

Aim: Hallux rigidus is a disease characterized by degeneration of the first metatarsophalangeal(MTF-1) joint. The choice of arthroplasty instead of arthrodesis in the surgical treatment of advanced hallux rigidus is still controversial. In this study, we aimed to report the early treatment results of a number of patients who had advanced hallux rigidus and underwent newgeneration three-component press-fit total joint arthroplasty. Materials and Methods: The patients were evaluated in terms of degrees of MTF-1 joint dorsiflexion, plantar flexion, and total joint range of motion (ROM), scores of AOFAS, VAS, SF-12 PCS, and satisfaction survey results. The preoperative and postoperative values were analyzed statistically. Radiologically, anteroposterior (AP) and lateral radiographs were taken and examined for loosening, wear, and alignment. Results: Nineteen joints (14 female, 5 male) of 17 patients were included in the study. The mean age was 59 (49–67) years. The mean patient follow-up was 15 (12–22) months. The mean dorsiflexion degree was 12.7° (range 2.1°–22.1°) preoperatively and 30.1° (11.6°–47.3°) postoperatively. The mean plantar flexion degree was 16° (7.8°–24.2°) preoperatively and 9.2° (2.3°–16.5°) postoperatively. The total range of motion (ROM) of the MTF-1 joint improved from a preoperative 28.4° to a postoperative 39.4°. The mean postoperative AOFAS, VAS, and SF-12 PCS scores were calculated as 85.3 (57–96), 1.3 (0–5), and 57.7 (53.7–59.9), respectively. The increase in the patients’ AOFAS and SF-12 PCS scores and the decrease in the VAS scores were found to be statistically significant. Discussion and Conclusion: Advanced MTF-1 joint osteoarthritis is a disease that causes severe pain and loss of motion. The method for a standard surgical treatment is still controversial. It has been reported in the literature that satisfactory results have been achieved in applications of three-component cementless press-fit total prostheses, in contrast to older prosthetic applications that cause serious complications. The pain relief and the increase in AOFAS scores are considered the most successful aspects of the treatment. Based on the information obtained from this study, we think that application of new-generation three-component press-fit total prostheses is an effective method in the treatment of advanced hallux rigidus, and that the early results are satisfactory when it has been applied to appropriate patients

48-50

Authors: Aysun Çaglar Torun

The most severe complications developed in patients with dyskeratosis congenita (DKC) are bone marrow failure (BMF), difficult airway, and pulmonary fibrosis. Accordingly, in DKC patients to be operated, the clinical and laboratory data should be evaluated for presence of BMF-related pancytopenia, difficult airway and opportunistic infections, and the systemic examination prior to the administration of general anesthesia should be made carefully. The preoperative preparation should include thorough examination of the lungs as well as assessment for postoperative respiratory distress. The operation should be attempted when the patient’s clinical and laboratory values are optimal. Supportive equipment should be prepared in advance for patients expected to suffer difficult airway. This paper will discuss the preoperative preparation and anesthetic management in a pediatric case of DKC complicated with bone marrow failure where the patient was scheduled for dental treatment under general anesthesia.

55-58

Authors: Mehmet Sargın, Mehmet Selçuk Uluer

Peripheral nerve blockade is a good alternative technique in cases where general anesthesia is not required or there are high risks. When regional anesthesia is required in more than one region in the body, the risk of toxicity will proportionally increase as the dose of the local anesthetics used is increased. In recent years, increased diversity of anesthetic applications and easier access in clinics to medical tools such as ultrasonography equipment have provided a significant decrease in the required doses of local anesthetics. Discussing in the light of the current literature, this paper reports a bilateral infraclavicular block performed on a patient with bilateral distal radius fracture by using low doses of local anesthetic agents.