Risk factors for recurrence and morbidity in reoperative thyroid surgery: a different point of view
Kalin Nicolaev Vidinov, Georgi Petrov Georgiev
J Clin Exp Invest 2013;4(4):417-421.
https://doi.org/10.5799/ahinjs.01.2013.04.0317
Research Article
[Abstract]
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ABSTRACT
Objective: Recurrent goiter is a common problem following subtotal thyroid gland resection for multinodular goiter disease. The aim of the present study is to evaluate risk factors for recurrence, ultrastructural particularities of the thyroid and morbidity rate in relation to the side of initial and redo surgery for recurrent disease.
Methods: From January 2003 to December 2010 a total of 4,395 patients underwent consecutive thyroid gland surgery for nodular goiter at Department of Endocrine Surgery USBALE “Akad. Iv. Penchev” Hospital. Five hundred fifty one (12.5%) patients underwent redo-surgery for recurrent disease after subtotal resection. All of them with complete follow-up were included in the present study.
Results: Recurrent disease was found in 279 (50.7%) patients in the ipsilateral lobe and 272 (49.3%) patients in the contralateral lobe. The incidence of permanent recurrent laryngeal nerve palsy was significantly higher in patients with ipsilateral redo surgery compared to patients undergoing initial operation (3.9% vs. 1.2%; p<0.05) whereas no difference was found in patients with contralateral redo surgery compared to patients undergoing initial operation. Independent risk factors for contralateral recurrent disease were age at primary operation <30 years and familial history.
Conclusion: Our study showed that reoperation on the ipsilateral lobe is associated with a significantly higher morbidity rate compared to initial surgery. Reoperation on the contralateral lobe carries no additional morbidity. Further studies are necessary in order to evaluate whether lobectomy is sufficient for patients with familial history and unilateral goiter.
Keywords: Goiter, recurrence, nodular goiter, thyroid gland, recurrent laryngeal nerve palsy, hypoparathyroidism
Expression of voltage-gated sodium channel in primary tumors and corresponding metastases in the Copenhagen rat model of prostate cancer
Senay Yıldırım
J Clin Exp Invest 2013;4(4):422-428.
https://doi.org/10.5799/ahinjs.01.2013.04.0318
Research Article
[Abstract]
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ABSTRACT
Objective: Increasing evidence indicates that prostate cancer (PCa) cells possess voltage-gated sodium channels (VGSCs) and these channels contribute to the metastatic progression of the disease. In the present study, it was aimed to investigate the heterotopic expression of VGSCs in carcinogenesis and metastasis. It was evaluated whether the expression of VGSC in strongly metastatic rat Mat-LyLu PCa cells observed in vitro is also conserved when these cells form primary tumors and metastasize to the lungs upon their subcutaneous injection in rats.
Methods: PCa model was induced in male Copenhagen rats by subcutaneous implantation of strongly metastatic Mat-LyLu cells. The expression of VGSCs was studied in the model utilizing molecular biological and immunochemical techniques.
Results: Reverse transcription PCR and immunohistochemistry showed that the expression of VGSC is conserved in the primary prostate tumors of Mat-LyLu and not eliminated in the corresponding lung metastases at both the mRNA and protein level.
Conclusion: The results are consistent with the predominant role of VGSC in the metastatic progression of PCa and consistently support the VGSC hypothesis of cancer progression.
Keywords: Prostate cancer, voltage-gated sodium channel, primary tumor, metastasis
Long-term changes in sexual functions following complicated pregnancies and deliveries
Ali Özler, Mehmet Sıddık Evsen, Pınar Em, Abdulkadir Turgut, Serdar Başaranoğlu, Yasin Bez, Ahmet Yalınkaya, Talip Gül
J Clin Exp Invest 2013;4(4):429-435.
https://doi.org/10.5799/ahinjs.01.2013.04.0319
Research Article
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ABSTRACT
Objective: The aim of this study is to evaluate the effects of complicated pregnancy and delivery (P/D) on sexual functions and to determine possible risk factors that affect sexual functions.
Methods: Women, who have the history of severe preeclampsia, placenta previa totalis, abruption placentae or postpartum uterine atonia, comprised the study group. The control group was comprised the women matched for age, parity, mode of delivery, vocation, the level of income and education status. Their fear of getting pregnant again and fear of death in the most recent delivery were measured by questionnaires. The Arizona Sexual Experience Scale was used to assess the sexual functions. We compared sexual functions of the women with and without suffering from complicated P/D.
Results: Fear of death during the last delivery and fear of getting pregnant again were significantly more intense in the study group (p=0.002 and p<0.001, respectively). The rates of volunteers detected sexual dysfunction in the study and control groups were 55.1% and 38.7%, respectively (p=0.081). Fear of death during the last delivery was found to be significant risk factors for sexual dysfunction (odds ratio [OR] = 1.653; 95% CI = 1.131-2.415; p=0.009).
Conclusion: In conclusion, sexual dysfunction rate of women with a history of complicated pregnancy and delivery, was almost equal that of women with a history of health pregnancy and delivery. Fear of death during the last delivery was found to be most important risk factor for sexual dysfunction.
Keywords: Fear of death, fear of getting pregnant again, complicated pregnancy, complicated delivery, sexual dysfunction
Incidence of pterygium in patients admitted to a university hospital
Fethiye Gülden Turgut, Fırat Helvacıoğlu
J Clin Exp Invest 2013;4(4):436-442.
https://doi.org/10.5799/ahinjs.01.2013.04.0320
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ABSTRACT
Objectives: This study aimed to investigate the incidence of pterygium in a particular district of Istanbul, its association with age, and gender, and the severity of the disease.
Methods: All patients aged ≥ 30 years referred to our outpatient clinics between January 2009 and December 2009 were included in this retrospective study. Age, gender, anterior segment photos, and findings of biomicroscopic eye examination were evaluated.
Results: The incidence of pterygium for all age groups was 2.91% (male 1.75%, female 3.67%) with an increasing incidence with age. A significant difference was detected in its incidence favoring female patients in 40-49, and 70-79, and male patients in ≥ 80 age groups, respectively. In addition, pterygium was seen in one (75.4%) or both eyes (24.6%) preferring right or left eye in 50.7%, and 49.3% of the patients, respectively. Pterygium was in nasal or temporal region in 98%, and 2% of the patients, respectively. The disease state in 59.9% of the patients was consistent with Stage 2 pterygium. The distance of pterygium from limbus was observed greatest in 60-69, and at a minimum in 40-49 age groups. No relationship was found between eye colour and development of pterygium.
Conclusion: The incidence of pterygium increases with age. Incidence of pterygium differs between genders but without any significant difference. Its occurrence in one or both eyes and in right and left eyes was not influenced by gender of the patients. A statistically significant impact of eye colour of the patient on the development of pterygium was not disclosed.
Keywords: Pterygium, incidence, İstanbul
Orthopedic approach to foreign body injuries
Celil Alemdar, Abdullah Demirtaş, İbrahim Azboy, Mehmet Gem, Emin Özkul, Mehmet Bulut, Cahit Ancar
J Clin Exp Invest 2013;4(4):443-448.
https://doi.org/10.5799/ahinjs.01.2013.04.0321
Research Article
[Abstract]
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ABSTRACT
Objective: Although foreign body injuries are quite common, there are an insufficient number of publications on this matter. The aim of this study was to evaluate patients with foreign body injuries, and to determine the treatment algorithm.
Methods: A total of 97 patients were evaluated, including 53 men and 44 women. Ninety-one patients underwent surgery, and six patients were treated conservatively. Surgery was performed in the operating room in all cases. To ensure that the foreign body was removed, fluoroscopic control was completed during and after the procedure. Antibiotics were administered routinely to all patients, and the need for tetanus prophylaxis was evaluated in each patient.
Results: The mean age of the patients was 16.5 (range: 2-58) years. Regarding the type of foreign body, there was injury due to: a needle in 65 patients, glass in 14, wood in 7, iron spit in 1, iron bar in 1, pieces of metal in 3, and other foreign bodies were found in 6 patients. There were 25 injuries of the upper extremity, and 72 of the lower extremity. The time of admission to the hospital after the injury ranged from 1 day to 3 years. Obvious signs of infection were detected in 10 patients. There were no complications after the follow-up of patients who were treated conservatively.
Conclusion: Foreign body penetration is a severe injury that may cause significant problems when ignored. Treatment algorithms prepared according to the type of injury would guide the most appropriate approach to these injuries.
Keywords: Foreign body, extremity, localization, injury
Seropositivity of HBsAg, anti-HCV and anti-HIV in preoperative patients
Berfin Karaayak Uzun, Hakan Er, Serdar Güngör, Bayram Pektaş, Mustafa Demirci
J Clin Exp Invest 2013;4(4):449-452.
https://doi.org/10.5799/ahinjs.01.2013.04.0322
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[Abstract]
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ABSTRACT
Objective: The infections caused by human immunodeficiency virus (HIV), hepatitis B (HBV) and C (HCV) viruses pose a serious occupational risk for the healthcare workers especially those in emergency services, laboratories and surgery wards. Vaccination and establishment of the strict biosafety procedures are the main principles to prevent blood-borne infections in healthcare workers. Additionally, serological screening of the preoperative patients could decrease the risk for exposure. In this study, we aimed to determine the seroprevalence of HBsAg, anti-HCV, anti-HIV 1/2 in preoperative patients.
Methods: Hospital automation records were evaluated retrospectively for 4.367 patients who were scheduled for surgery and scanned for anti-HIV 1/2, HBsAg and anti-HCV as preoperative procedures in the preparation period of operation between January 2012 and December 2012.
Results: HBsAg positivity rate was found in 7.7% (n=336), anti-HCV positivity rate was found in 2.3% (n=101). A two (0.05%) of five patients were positive for anti-HIV 1/2 was found positive verification test and the other three samples were accepted as false positive test results.
Conclusion: All healthcare workers must be trained about occupational diseases and vaccinated against Hepatitis B. Universal precautions must be strictly followed particularly in the operating room. In addition, all patients should be considered as potential carriers regarded as a carrier of the potential for infection.
Keywords: Anti-HCV, anti-HIV, HBsAg, preoperative procedures, seroprevalence
The prognostic impact of the detection of metastatic inferior mediastinal lymph node in non-small cell lung cancer at preoperative term
Hakan Keskin, Abdullah Erdoğan, Arife Zeybek, Levent Dertsiz, Alpay Sarper, Abid Demircan
J Clin Exp Invest 2013;4(4):453-456.
https://doi.org/10.5799/ahinjs.01.2013.04.0323
Research Article
[Abstract]
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ABSTRACT
Objective: In our study, we reviewed the survival of patients operated for non-small cell lung cancer (NSCLC) and had positive inferior mediastinal lymph nodes that couldn't be staged with mediastinoscopy prior to surgery in comparison to other mediastinal lymph node involvement, the localization of tumors that metastasize to inferior mediastinal lymph nodes.
Methods: 487 cases operated for NSCLC were reviewed retrospectively. The predominant localization of the tumors with inferior mediastinal lymph node involvement was investigated.
Results: Among the cases that were completely resected, 56 cases were reported to be pathologically mediastinal lymph node involvement. Among these patients, there were 36 patients with inferior mediastinal lymph node involvement, the survival of which were compared to the survival of patients with involvement in other mediastinal lymph node stations involvement. The patients with inferior mediastinal lymph node involvement had a mean survival time of 41.72 months, 5 years survival rate of 36.1%. When compared to other patients N2 involvement, survival was better in inferior mediastinal lymph node involvement, although the difference was not statistically significant. The tumor localization that metastasizes most frequently to the inferior mediastinal lymph nodes are the lower lobes. Compared to the upper lobes the difference is statistically significant.
Conclusion: In tumors of the lower lobes, there are benefits to invasive and non-invasive staging of inferior mediastinal lymph nodes in terms of patient survival. Further studies with large case series are needed.
Keywords: NSCLC, inferior mediastinal lymph nodes, survival, prognosis
Effects of postoperative early motion on the results of osteosynthesis with miniplates in metacarpal fractures
İbrahim Azboy, Celil Alemdar, Abdullah Demirtaş, Emin Özkul, Mehmet Gem, Mehmet Bulut
J Clin Exp Invest 2013;4(4):457-462.
https://doi.org/10.5799/ahinjs.01.2013.04.0324
Research Article
[Abstract]
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ABSTRACT
Objectives: In our study, we aimed to evaluate the radiological and functional results of rigid internal fixation with mini plate osteosynthesis in the management of metacarpal fractures.
Methods: In this study, 11 patients (10 males, 1 female) which were treated with mini plate osteosynthesis for metacarpal fracture (n=13) were evaluated retrospectively. The average age of patients was 35 years (range 25-46 years) with a mean follow-up of 1.4 years (range 1.1 to 2.2-years). Rehabilitation program was started on the postoperative second day. Range of motion was assessed according to the total active range of motion (TAROM) scale.
Results: Eight patients (10 metacarpal) had excellent scores, two patients had good scores and one patient had moderate score at final follow-up. Time to union was found an average of 6 weeks (range 4-7 weeks). Complications did not observed such as loss of reduction, infection, circulatory disorders, neurological symptoms, osteonecrosis, sudeck atrophy.
Conclusion: Rigid internal fixation with mini plate osteosynthesis could be performed in patients with metacarpal fractures with satisfactory radiological and functional results along with rehabilitation program contains passive and active joint movements initiated at early post-operative period.
Keywords: Metacarpal fracture, plate-screw, early rehabilitation
Carotid intima-media thickness and neutrophils/lymphocytes ratio in patients with overt and subclinical hypothyroidism
Fahri Güneş, Mehmet Asik, Burak Altun, Hacer Sen, Emine Binnetoglu, Erdem Akbal, Sengul Ozcelik, Kubilay Ukinc
J Clin Exp Invest 2013;4(4):463-467.
https://doi.org/10.5799/ahinjs.01.2013.04.0325
Research Article
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ABSTRACT
Objective: Hypothyroidism, whether overt or subclinical, has multiple effects on the cardiovascular system. Neutrophil-lymphocyte (N/L) rate is closely related to cardiovascular disorders and atherosclerosis. Our study aimed to assess N/L rate and carotid artery intima-media thickness (CIMT) in patients with overt and subclinical hypothyroidism (SCH).
Methods: The study included 36 patients with SCH and 28 patients with overt hypothyroidism (OH) as well as 30 healthy controls. CIMT, thyroid hormone levels, complete blood count and lipid parameters were measured in all subjects. Correlation analysis and linear regression analysis were performed for N/L rate.
Results: Mean CIMT was 0.51 ± 0.15, 0.58 ± 0.16, 0.67 ± 0.24 mm in control, SCH, and OH groups, respectively. CIMT of OH patients was high compared with control subjects (P < 0.05). CIMT of SCH patients were not different compared with control subjects and OH patients (P > 0.05). It was no correlation that CIMT between N/L ratio (p > 0.05).
Conclusion: Neutrophil-lymphocyte rate was not found to be useful indicator of early atherosclerosis in SCH and OH patients.
Keywords: Hypothyroidism, carotid artery, intima media thickness, neutrophil lymphocyte ratio
Isolated secondary fungal infections of pleural cavity
Makbule Ergin, Ali Yeğinsu, Arife Zeybek, Kürşat Gürlek
J Clin Exp Invest 2013;4(4):468-471.
https://doi.org/10.5799/ahinjs.01.2013.04.0326
Research Article
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ABSTRACT
Objectives: Pleural fungal infections are rare, but the incidence has been increasing with immunosuppressant diseases and use of immunosuppressive medications. In this report, we present 6 patients with pleural effusions that have been determined fungal infection.
Methods: The medical records of patients with followed and treated due to fungal infection of the pleural were retrospectively reviewed.
Result: The 6 cases whom was 58 of the value median for age were treated as surgical and medical due to fungal infection of the pleural cavity. Dyspnea, cough and chest pain were the most common symptoms. Fever, night sweats and expectoration are relatively rare. In 4 patients, the infections of pleural cavity developed on the bases of rheumatoid arthritis, tuberculosis, pleural mesothelioma and esophagopleural fistula. In two patients had isolated fungal infections. Cultural positivity was seen in 5 patients. Fungal hyphae were determined by cytopathology in all of the patients.
As a surgical procedure, all of the patients underwent decortication or pleural biopsy and pleural irrigation. In all patients, antifungal agents were added to surgical procedures. Full recovery of infection was seen in 5 patients. One patient died.
Conclusion: In immunosuppressive patients, the incidence of pleural effusions due to or associated with fungal infections are more common. Addition to culture of pleural fluid, histopathological evaluation of pleura will aid diagnosis.
Keywords: Lung, fungal infection, pleural effusion
Effects of spermiogram parameters in patients who attempt intrauterine insemination
Erhan Demirel, Osman Şevket, Seda Ateş, Funda Demirel, Serdar Koç, Süha Sönmez
J Clin Exp Invest 2013;4(4):472-476.
https://doi.org/10.5799/ahinjs.01.2013.04.0327
Research Article
[Abstract]
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ABSTRACT
Objective: The aim of this study is detection of optimal sperm parameters by evaluating the effects of motile sperm count and morphology on clinical pregnancy rates in patients who applied for intrauterine insemination.
Methods: This study comprised 279 intrauterine insemination cycles, which has applied to 172 infertile patients between January 2003 and June 2005, in Süleymaniye Obstetrics-Gynecology Hospital, Infertility Unit. We, firstly compared the clinical pregnancy rates according to processed total progressive motile sperm count, by classifying IUI cycles into two groups as <1million and ≥1million according to TPMS. Then, we compared the clinical pregnancy rates according to morphology, by classifying IUI cycles into two groups as with normal morphology < 4% and ≥ 4% according to Kruger’s strict criteria. To compare the clinical pregnancy rates by dividing cycles into four subgroups evaluated with two parameters together.
Results: Statistically significant difference was not found between patients’ ages (women), duration of infertility and day 3 FSH levels between groups and subgroups. There was no statistical significant difference in the clinical pregnancy rates in group, which was classified as <1million and ≥1million according to TPMSS neither in group which was classified as normal morphology <4% and ≥4%. Optimal clinical pregnancy rates were achieved in subgroup with ‘TPMS ≥1million and normal morphology ≥4% when two parameters evaluated together. The difference of pregnancy rate in this group compared to the other sub-groups was statistically significant.
Conclusion: Optimal clinical pregnancy rates increases when two parameters ‘TPMS ≥1million and normal morphology ≥4% were together.
Keywords: intrauterine insemination, spermiogram, pregnancy
Bonesetter choice of Turkish society in musculoskeletal injuries and the affecting factors
Serdar Sargın, Ahmet Aslan, Mehmet Nuri Konya, Aziz Atik, Gökhan Meriç
J Clin Exp Invest 2013;4(4):477-482.
https://doi.org/10.5799/ahinjs.01.2013.04.0328
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ABSTRACT
Objective: In this study, it was aimed to investigate the demographic features, administration reasons and educational status of the patients who were presented to the bonesetters for orthopedic complaints.
Methods: 96 (26 males, 70 females) patients were included in this study, who filled a questionnaire out of 1926 patients went to bonesetters between June and December 2012. All the patients were recorded regarding demographic features, first application places, educational status, administration reasons, and complication rates.
Results: 87 patients (90.6%) preferred bonesetters as the first application place. The mean age of the patients was 31±16.1 years. The most common reason was advices of the family members or relatives (40.6%). The educational status was not significant in administration rate, but low educational status has significant correlation with more complication rates. Sixteen patients developed sequels (16.6%). The effect of bonesetters’ treatment was mostly found to be placebo.
Conclusion: Bonesetter is a country reality when prevalence was taken in notice. However, the similarity of their results to placebo ones, having no education, having no legal rights, paying no tax make this issue a great problem. The solution of this problem is depended to increase health programs to inform public and to increase government superintension.
Keywords: Fracture, Bonesetter, Traditional Medicine, Complication
Assessment of mean platelet volume in chronic obstructive pulmonary disease during stable period and acute exacerbation
Ersin Şükrü Erden, Recep Dokuyucu, Mesut Demirköse, Erhan Yengil, Fatih Sefil, Hatice Kayım Bilgiç, Sibel Doğru, Sedat Motor
J Clin Exp Invest 2013;4(4):483-487.
https://doi.org/10.5799/ahinjs.01.2013.04.0329
Research Article
[Abstract]
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ABSTRACT
Objective: Chronic obstructive pulmonary disease (COPD) is an important public health problem and it is associated with systemic inflammation. Mean platelet volume (MPV) is one of the markers indicating platelet activation, and it was found to be high in many diseases related to inflammation. In previous studies reported different results evaluating of MPV in COPD. In this study, we aimed to evaluate of C-reactive protein (CRP), white blood cell (WBC), and MPV in acute exacerbation of COPD and stable COPD patients.
Methods: In this retrospective study, data of 40 patients with acute exacerbation of COPD, 43 stable COPD patients and 40 healthy subjects were evaluated.
Results: The mean MPV, CRP and WBC were found in control, stable COPD and acute exacerbation of COPD groups, 7.9±1.1; 8.2±1.3 and 8.7±1.6 fL; 3.4±1.2; 5.2±3.5 and 27.5±23.6 mg/L; 7.8±1.6; 8.1±2.1 and 11.4±4.5 x103/ ϻL, respectively. The mean WBC and CRP in the acute exacerbation of COPD group were significantly higher than the other groups (for both values p ˂0.001). The mean MPV in the acute exacerbation of COPD group was found higher than in the other groups. The mean MPV values were significantly higher in patients of acute exacerbation than control subjects (p=0.030).
Conclusion: The results of this study suggest that the increased MPV may be a marker for the evaluation acute exacerbation of COPD as well as the classic acute phase reactant CRP.
Keywords: Chronic obstructive pulmonary disease, complete blood count, C-reactive protein, mean platelet volume
Prevalence and risk factors of vitamin D deficiency in patients with widespread musculoskeletal pain
Muharrem Çidem, Seher Kara, Hakan Sarı, Murat Özkaya, İlhan Karaca
J Clin Exp Invest 2013;4(4):488-491.
https://doi.org/10.5799/ahinjs.01.2013.04.0330
Research Article
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ABSTRACT
Objective: Vitamin D deficiency is a worldwide common health problems. Vitamin D deficiency in adults has been associated with proximal muscle weakness, skeletal mineralization defect, and an increased risk of falling. Patients with vitamin D deficiency commonly complain of widespread pain in the body. The aim of this study was to examine the prevalence and risk factors of 25-hydroxyvitamin D deficiency in patients complaining of widespread musculoskeletal pain.
Methods: In this cross-sectional study, 8457 patients with widespread musculoskeletal pain (7772 females, 685 males), aged 46.7 (range 20-100) years were included. Serum 25-hydroxyvitamin D was measured with ELISA method. Patients were classified into two groups: 1) Patients with vitamin D deficiency (<20 ng/ml) and 2). Patients without vitamin D deficiency ( >20 ng/ml).
Results: Prevalence of vitamin D deficiency was found to be 71.7%. A binary logistic regression model showed that low 25(OH)Vit D level was associated with gender, age and month in which 25(OH) hypovitaminosis was determined. The risk of low 25(OH) Vit D was found to be 2.15 times higher in female patients and 1.52 times higher on March and 1.55 times higher on April.
Conclusion: This study indicates that Vitamin D deficiency should be taken into consideration in patients with widespread musculoskeletal pain, and some precautions such as sunbathe during summer should be recommended patients having risk of vitamin D deficiency.
Keywords: Osteomalacia, vitamin D, widespread body pain
Investigation of the relationship between mean platelet volume and obstructive sleep apnea syndrome
Ersin Şükrü Erden, Erhan Yengil, Ertan Tuncel, Hatice Kayım Bilgiç, Mesut Demirköse, Sedat Motor, Sebahat Genç
J Clin Exp Invest 2013;4(4):492-496.
https://doi.org/10.5799/ahinjs.01.2013.04.0331
Research Article
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ABSTRACT
Objective: Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent upper airway obstruction and intermittent hypoxia during sleep. Intermittent hypoxia and increased inflammatory activity plays a role in increased risk of cardiovascular disease in the OSAS. OSAS is an important cause of morbidity and mortality and cardiovascular disorders are the most important complications of OSAS. Mean platelet volume (MPV) is a marker of platelet activation and function, and increased platelet volume is associated with increased platelet activity. Different diseases related with inflammation, hypoxia, vascular injury, thrombosis and atherosclerosis were found to be associated with MPV. In this study, we aimed to investigate the relationship between OSAS and MPV.
Methods: In this retrospective study, data of sex and age matched 33 patients with moderate OSAS, 34 patients with severe OSAS and 30 healthy subjects were evaluated.
Results: The mean MPV was found in control, moderate OSAS and severe OSAS groups as 7.83±1.00, 8.26±1.40 and 8.94±1.20 (fL) respectively. The mean MPV value was significantly higher in severe OSAS group than control subjects (p=0.001). In correlation analysis, there were positive correlation between MPV with apnea-hypopnea index and total sleep time, and negative correlation between MPV with platelet count and minimum oxygen saturation (Respectively, p=0.003 / R=0.295, p=0.030 / R=0.221, p=0.011 / R= -0.257, p=0.019 / R= -0.238).
Conclusion: In this study, the increased MPV was associated with severe OSAS and the results of this study suggest that the platelet activation is increased in OSAS. Hypoxia caused by OSAS, due to the activated platelets, may play a role in the development of cardiovascular diseases which is an important cause of morbidity and mortality in OSAS.
Keywords: Complete Blood Count, Hypoxia, Mean Platelet Volume, Obstructive Sleep Apnea Syndrome
Thrombophilia in complicated pregnancies
Ayşe Şahin, Mahmut Nedim Çiçek
J Clin Exp Invest 2013;4(4):497-502.
https://doi.org/10.5799/ahinjs.01.2013.04.0332
Research Article
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ABSTRACT
Objective: To investigate the incidence and etiology of pregnancy complications associated with thrombophilic factors.
Methods: Fifty-four patients with complicated pregnancy and 40 healthy pregnant subjects were included the study. Factor V Leiden (FVL) mutation, protein S, protein C, anti-thrombin deficiency levels were investigated.
Results: Of the 54 patients with complicated pregnancy, 29 had preeclampsia, 18 had intra uterine growth retardation, and 7 had intrauterine fetal loss. The most common defect was FVL mutation. FVL mutations in patient group and the control group were 27.2% and 10%, respectively, which were statistically significant. The protein S, protein C, and anti-thrombin deficiencies were found higher in the patient group compared to control (p>0.05 for each).
Conclusion: FVL mutation was found higher in patient group compared to the control group, Protein C deficiency and anti-thrombin deficiency were related to preeclampsia but not other pregnancy complications. Clinicians should take into account the thrombophilia in complicated pregnancy, especially preeclampsia.
Keywords: Factor V Leiden, protein C, protein S, anti-thrombin, complicated pregnancy
Successful management of a patient with toxic epidermal necrolysis by high dose intravenous immunoglobulin
Ali Güneş, İlyas Yolbaş, Selvi Kelekçi, Servet Yel, Cahit Şahin, Aydın Ece
J Clin Exp Invest 2013;4(4):503-505.
https://doi.org/10.5799/ahinjs.01.2013.04.0333
Case Report
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ABSTRACT
Toxic epidermal necrolysis (TEN) is a disease that mostly caused by drug use and characterized by acute onset and rapidly progressive necrosis of the epidermis. In severe cases, mortality rate change between 20% and 60%. Although there is no definite treatment, some authors have reported the effectiveness of intravenous immunoglobulin (IVIG). Here, we presented a 9-year-old male patient with TEN. Skin rashes of patient began after three days of using ibuprofen, metronidazole, clarithromycin, and procaine penicillin. Skin lesions resembling second-degree burns covered 50% of the patient’s body surface area. After giving high-dose IVIG, the patient’s lesions improved. This case is an example of effect of high dose IVIG in the treatment of TEN.
Keywords: Toxic epidermal necrolysis, intravenous immunoglobulins, child
Solitary rectal diverticulum: A case report
Kemal Peker, İsmail Demiryılmaz, Mehmet Seyhan Kalkan, İsmayil Yılmaz
J Clin Exp Invest 2013;4(4):506-508.
https://doi.org/10.5799/ahinjs.01.2013.04.0334
Case Report
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ABSTRACT
Rectal diverticulas are very rare and most of patients with rectal diverticula are diagnosed incidentally. Inflammatory processes may have developed at the time of the diagnosis. Here we report a case of rectal diverticulum which was developed after stapled transanal rectal resection procedure. Abdominal magnetic resonance imaging revealed a giant diverticulum of the rectum. A fecaloma is removed from rectum endoscopically.
Keywords: Magnetic resonance imaging, rectal diverticulum, stapled hemorrhoidopexy
Trigeminal nerve involvement in congenital insensitivity of pain with anhidrosis
Abdullah Kürşat Cingü, Alparslan Şahin, Muhammed Şahin, Yasin Çınar, Seyhmus Arı, İhsan Çaça
J Clin Exp Invest 2013;4(4):509-511.
https://doi.org/10.5799/ahinjs.01.2013.04.0335
Case Report
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ABSTRACT
Congenital insensitivity to pain with anhidrosis (CIPA) is a rare cause of corneal anesthesia. Here, we report a case of CIPA with clinically prominent features of severe dry eye symptoms with painless corneal epithelial defect, early loss of primary teeth and a painless fissure on her upper lip in association with trigeminal anesthesia, and painless wounds on extremities.
Keywords: Congenital pain insensitivity, trigeminal involvement, painless corneal epithelial defect
Giant cell tumor of the distal tibia: Report of a rare case
Georgi Petrov Georgiev, Svetoslav Antonov Slavchev
J Clin Exp Invest 2013;4(4):512-516.
https://doi.org/10.5799/ahinjs.01.2013.04.0336
Case Report
[Abstract]
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ABSTRACT
Giant cell tumor of bone is an aggressive lesion, although benign. Foot and ankle involvement is rare. Herein, we presented a case of a 26-year-old woman complaining of increasing pain and swelling of the left ankle followed by limitation of joint motion. Imaging was consistent with the diagnosis of giant cell tumor of bone, which was confirmed by open biopsy. The lesion was treated with segmental en-bloc resection and ankle arthrodesis with good functional outcome. We also discuss clinical, radiological, and therapeutic characteristics of this pathology with the light of the literature.
Keywords: giant cell tumor of bone; tibia; ankle; arthrodesis;
bone transplantation
Acute kidney injury due to rhabdomyolysis after status epilepticus: Two pediatric case reports
Ahmet Midhat Elmacı, Fatih Akın, Erhan Aksoy
J Clin Exp Invest 2013;4(4):517-520.
https://doi.org/10.5799/ahinjs.01.2013.04.0337
Case Report
[Abstract]
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ABSTRACT
Rhabdomyolysis is defined as degeneration of skeletal muscle due to traumatic or non-traumatic causes. With the injury of sarcolemma, myocyte contents (myoglobin, enzymes and electrolytes) leakage into the plasma and urine occurs. If rhabdomyolysis is not recognized and untreated, severe even fatal complications such as acute kidney injury (AKI), hypocalcemia, hyperkalemia, hypovolemia, muscle necrosis, cardiac arrythmias and compartment syndrome may occur. Status epilepticus is an uncommon cause of rhabdomyolysis and myoglobinuria. We report here two pediatric patients, who developed myoglobinuria and AKI due to status epilepticus.
Keywords: Epilepsy, child, rhabdomyolysis, kidney injury
Primary cutaneous follicle center lymphoma in a 77-year-old woman
Göknur Kalkan, Zennure Takçı, Gülfer Akbay, Emel Güngör, Ayşegül Üner, Hatice Meral Ekşioğlu
J Clin Exp Invest 2013;4(4):521-524.
https://doi.org/10.5799/ahinjs.01.2013.04.0338
Case Report
[Abstract]
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ABSTRACT
Cutaneous B-cell lymphoma is characterized by monoclonal proliferation of the B-lymphocytes and usually limited to the skin. Primary cutaneous follicle center lymphoma is the most common cutaneous B-cell lymphoma, which is formed by clonal proliferation of centrocytes and centroblasts in follicular or diffuse pattern. Here we present a case of 77-year-old woman patient who had acomplaint of pruritic swellings on her scalp and diagnosed as primary cutaneous follicle center lymphoma. In this manner, we would like to remind this disease which we do not frequently meet in daily practice and emphasize to consider lymphoma in the differential diagnosis of these kind of lesions.
Keywords: B-cell lymphoma, primary cutaneous, B-lymphocytes
A case of isolated inferior ST segment elevation myocardial infarction due to occlusion of the left anterior descending coronary artery and review of the literature
Faruk Ertaş, Ferhat Özyurtlu, Halit Acet, Mehmet Zihni Bilik
J Clin Exp Invest 2013;4(4):525-528.
https://doi.org/10.5799/ahinjs.01.2013.04.0339
Case Report
[Abstract]
[PDF]
ABSTRACT
ST elevation myocardial infarction is a clinic situation usually presents with total occlusion in the coronary artery. The electrocardiography (ECG) at the presentation helps us to diagnose, to guess the occluded coronary artery and to assess the treatment. However, sometimes the ECG could not be enough to guess the occluded coronary artery. Left anterior descending (LAD) coronary artery occlusion resulting in inferior ST-segment elevation without anterior ST-segment elevation is an extremely rare finding. In this study, we presented a case who admitted to the emergency department with a typically chest pain and inferior ST-segment elevation without anterior ST-segment elevation ECG pattern but a total occlusion in LAD in the coronary angiography.
Keywords: Myocardial infarction, electrocardiography, coronary angiography
A case of linear lichen planus: Using the accurate nomenclature
Göknur Kalkan, Zennure Takcı, Gülçin Güler Şimşek
J Clin Exp Invest 2013;4(4):529-531.
https://doi.org/10.5799/ahinjs.01.2013.04.0340
Case Report
[Abstract]
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ABSTRACT
Linear lichen planus (LLP) is a rare variant of lichen planus that is characterized by lichenoid, pruritic, violaceous papules, arranging in a linear pattern. When lichen planus is localized in a dermatomal pattern or Blaschcoid lines, incorrect nomenclature has been used and mistakes have been made in terminology. It should be known that there is not a dermatomal arrangement; however, Blaschko lines have been followed in the definition of linear lichen planus. We should avoid the zosteriform term when there is not a previous story of herpes zoster infection. Here we present a case of 40-year-old man that has lesions in two different Blaschko lines and investigate this complexity in terminology.
Keywords: Lichen planus, linear, terminology
Radiologic findings of olfactory neuroblastoma (Esthesioblastoma)
Alpaslan Yavuz, Cemil Göya, Aydın Bora, Mehmet Beyazal, Çağatay Andiç
J Clin Exp Invest 2013;4(4):532-534.
https://doi.org/10.5799/ahinjs.01.2013.04.0341
Case Report
[Abstract]
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ABSTRACT
Olfactory neuroblastoma (ONB) also known as esthesioblastoma is a rare malignant neoplasm originating from olfactive epitelium, usually locate in the olfactory region of the nasal cavity and anterior skull base. Few cases have been published in the literature yet. Detailed radiologic and histopathological examination is necessary for diagnosis and staging ONB. Prognosis is favorable especially for locally advanced tumors; regional and distant metastasis has been accepted as indicators of poor prognosis. Surgery and radiotherapy are the main therapeutic modalities in use today. We reported the x-ray graphic, B Mod-Doppler Ultrasound (US) and Computed Tomography (CT) findings of 64 years-old male with ONB in this presentation.
Keywords: Olfactory neuroblastoma, esthesioblastoma, cribriform plate
The asymptomatic giant renal mass diagnosed due to its metastasis: Case report
Ramazan Altıntaş, Fatih Oğuz, Cemal Taşdemir, Ali Beytur, Serhan Çimen, Ali Güneş
J Clin Exp Invest 2013;4(4):535-537.
https://doi.org/10.5799/ahinjs.01.2013.04.0342
Case Report
[Abstract]
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ABSTRACT
Renal cell carcinoma (RCC) is one of the most frequent malignancies of the genitourinary tract and has high mortality rates. Ten to fifteen percent of the patients are asymptomatic and it is incidentally detected by the imaging methods done for the investigation of other diseases. Metastasis is most frequently to the lungs, bone or liver. In this article, we presented to 64 year-old male patient, who had a retroperitoneal cystic mass reaching up to 18 cm in size according to imaging techniques.
Keywords: Metastasis, asymptomatic, giant, renal mass
Central serous chorioretinopathy case with ooze sign
Mehmet Murat, Fatih Mehmet Türkcü, Harun Yüksel, Alparslan Şahin, İhsan Çaça
J Clin Exp Invest 2013;4(4):538-541.
https://doi.org/10.5799/ahinjs.01.2013.04.0343
Case Report
[Abstract]
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ABSTRACT
Forty two-year old, male patient was presented to our clinics with complaint of blurred vision and metamorphosis in the right eye for 1 year and in the left eye for last 3 days. In his fundoscopic examination, diffuse retinal pigment epithelial atrophy in the right eye and serous detachment at macular region in the left eye were observed. In fundus fluorescent angiography and optic coherence tomography, active CSCR in the left eye and ooze sign which is compatible with atypical form of previous CSCR in the right eye were detected.
Keywords: Central serous chorioretinopathy, Ooze sign
A life-threatening abdominal abscess secondary to forgotten placental tissue during cesarean section: A case report
Elif Ağaçayak, Ali Özler, Senem Yaman Tunç, Abdulkadir Turgut, Fatma Bozkurt, Mehmet Fatih Fındık
J Clin Exp Invest 2013;4(4):542-545.
https://doi.org/10.5799/ahinjs.01.2013.04.0344
Case Report
[Abstract]
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ABSTRACT
Techniques for cesarean delivery, reliable anesthesia, blood products and antibiotics has led to the expansion of indications for cesarean birth. Nowadays, to be comfortable in anesthesia, medicine and materials used in, severe sterilization techniques, advances in surgery and postoperative care were reduced mortality and morbidity. However; caesarean section still include infection, bleeding, need for transfusion, thromboembolic risks of a longer stay in the hospital, later to be healing, but rather risks, such as the withdrawal of the pain continues. Postpartum hemorrhage inside the remaining placentas compared to normal primary complaint is that too much. At the same time ultrasonographic examination of the uterine involution does not occur, the uterus larger than normally. The aim of this case report, and the absence of postoperative bleeding, complete involution of the uterus that have not been diagnosed, and threatened her life was to present a case which is characterized by abdominal abscess.
Keywords: Cesarean operation, the placenta, intra-abdominal abscess
Lumbar intraspinal synovial cyst with urine incontinence: A case report and review of the literature
Yahya Turan, Tevfik Yılmaz, Cüneyt Göçmez, Kağan Kamaşak, Salih Hattapoğlu, Adnan Ceviz
J Clin Exp Invest 2013;4(4):546-549.
https://doi.org/10.5799/ahinjs.01.2013.04.0345
Case Report
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ABSTRACT
Synovial cysts are rarely observed in cases with epidural compressive syndromes. They are intraspinal lesions that may mimic disc hernias by causing radicular symptoms. A 28-year-old female patient presented with radicular complaints such as back pain for 6 months, urinary incontinence for 1 month, and progressive right leg pain and numbness for the last 2 weeks. Physical examination revealed weakness (4/5) in gastrocnemius muscle, right L5-S1 hypoesthesia, and urinary incontinence. On magnetic resonance imaging, an intraspinal cyst was seen at the level of L5-S1. The patient was operated with bilateral L5 hemipartial laminectomy, foraminotomy, and cyst excision. Her symptoms, especially urinary incontinence, regressed at the early postoperative period and completely disappeared together with normal motor and sensory examination findings at the control visit at 1 year.
Keywords: Synovial cyst, lumbar spine, intraspinal steroids, spinal surgery, urine incontinence
Induced pluripotent stem cells and cell therapy
Banu - İskender, Halit Canatan
J Clin Exp Invest 2013;4(4):550-561.
https://doi.org/10.5799/ahinjs.01.2013.04.0346
Review
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ABSTRACT
Human embryonic stem cells are derived from the inner cell mass of a blastocyst-stage embryo. They hold a huge promise for cell therapy with their self-renewing ability and pluripotency, which is known as the potential to differentiate into all cell types originating from three embryonic germ layers. However, their unique pluripotent feature could not be utilised for therapeutic purposes due to the ethical and legal problems during derivation. Recently, it was shown that the cells from adult tissues could be reverted into embryonic state, thereby restoring their pluripotent feature. This has strenghtened the possiblity of directed differentition of the reprogrammed somatic cells into the desired cell types in vitro and their use in regenerative medicine. Although these cells were termed as induced pluripotent cells, the mechanism of pluripotency has yet to be understood. Still, induced pluripotent stem cell technology is considered to be significant by proposing novel approaches in disease modelling, drug screening and cell therapy. Besides their self-renewing ability and their potential to differentiate into all cell types in a human body, they arouse a great interest in scientific world by being far from the ethical concerns regarding their embryonic counterparts and their unique feature of being patient-specific in prospective cell therapies. In this review, induced pluripotent stem cell technology and its role in cell-based therapies from past to present will be discussed.
Keywords: Induced pluripotent stem cells, pluripotent stem cells, embryonic stem cells, regenerative medicine
Diabetes mellitus and primary healthcare
Mehmet Halis Tanrıverdi, Tahsin Çelepkolu, Hamza Aslanhan
J Clin Exp Invest 2013;4(4):562-567.
https://doi.org/10.5799/ahinjs.01.2013.04.0347
Review
[Abstract]
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ABSTRACT
Diabetes mellitus is a metabolic disease characterized by hyperglycemia. It stems from defects, which are formed in insulin secretion, insulin effect or both caused by interactions of genetics, environmental factors and life style changes. As well as being a very serious and progressive disease, we face it as a major health problem for both individuals and society for it adversely affects the mortality and morbidity by causing chronic and acute complications in case of lack of control.
Maximum effort should be made in order to prevent diabetes in all sections of society. Family medicine doctors have the greatest part in this regard for their unique roles in primary care. Therefore, primary care health personnel should evaluate the patients in terms of diabetes risk factors, take the preventive measures against development of diabetes and do diabetes screening for required individuals. They should follow up the treatments and controls of the patients having diabetes in order to avoid complications. Since prevention and treatment requires a multi-disciplinary approach, they should to refer patients to nephrology, ophthalmology, cardiology etc. departments. To this end, diabetes and approach to diabetic patients have been examined in this article.
Keywords: Diabetes mellitus, primary care, approach to the patient
A rare cause of non-atherosclerotic myocardial infarction: Rheumatoid arthritis
Ziya Şimşek, M. Hakan Taş, Emrah İpek
J Clin Exp Invest 2013;4(4):568-569.
https://doi.org/10.5799/ahinjs.01.2013.04.0348
Letter to Editor
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ABSTRACT
Cardiovascular involvement is common in rheumatoid arthritis [1]. Pericarditis, cardiomyopathy, myocarditis, cardiac amyloidosis, coronary vasculitis, arrhythmias, valvular heart disease and congestive heart failure due to ischemia can be seen in addition to the classical extra-articular involvement [2]. Patients with rheumatoid arthritis are under risk of accelerated atherosclerosis and myocardial infarction due to increased inflammation. Endothelial dysfunction is an important mechanism for thrombosis in these patients [3]. Pro-inflammatory cytokines (interleukin-1 beta and tumor necrosis factor alpha, C-reactive protein), activated coagulation factors (tissue factor, von Willebrand factor and plasminogen activator inhibitor-1), increased activity of cell adhesion molecules (selectins, vascular adhesion molecule-1, intercellular adhesion molecule-1) and matrix metalloproteinases are responsible for this endothelial dysfunction leading thrombosis [3]. The risk is especially higher in patients who have used or are using glucocorticoids [4]. In patients with Cushing’s syndrome due to chronic steroid use, accumulation of cardio-metabolic risk factors like visceral obesity, hypertension, hyperglycemia and hyperlipidemia results in acceleration of cardiovascular disease [4]. Additionally, a hypercoagulability state was also detected in patients with endogenous Cushing’s syndrome [5]. Herein we present a patient with rheumatoid arthritis who had extensive coronary thrombosis and was given steroid therapy for a long time.
Keywords: amyloidosis, vasculitis, tissue factor