ABSTRACT

Objective: To investigate the effects of intra articular tramadol injection on articular cartilage and synovium in rat knee joint.
Methods: After Animal Ethical Committee approval, a total of 20 Sprague-Dawley rats were used and divided into 4 groups. Each group was composed of 5 rats. 0.2 ml of tramadol HCl was injected into the right knee joints and left knee joints of all the rats were considered as control. Control side joints received saline injection. Rats were sacrificed with ketamin on 1st, 7th, 14th and 21st days and knee joints were removed. Obtained tissue samples were decalcified and were dyed with Hematoxylin-eosin and Masson’s trichrome stain and examined by light microscopy for the presence of inflammation in periarticular area and synovia.
Results: Congestion of synovial veins and perivascular cell infiltration were observed in tramadol group on days 1 and 7 (P < 0.05). The inflammation process was replaced by fibrosis on day 14 and fibrosis was significantly decreased on day 21.
Conclusion: Intra articular tramadol should be used cautiously, keeping in mind that it may cause synovial inflammation in early phases and fibrosis in late phases.

Keywords: Analgesics, opioid, tramadol, rat, hyaline cartilage, arthroscopy

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Objective: To evaluate the changes in corneal parameters (keratometry, corneal thickness, topography indices) after corneal collagen cross-linking in keratoconus.
Methods: The medical records of 6 patients who underwent corneal collagen cross-linking treatment for keratoconus and have been followed-up for a minimum of 24 months were recruited. Best corrected visual acuity (BCVA), maximum keratometry (Kmax), central corneal thickness (CCT) values and corneal topography indices: index of surface variance (ISV), index of vertical asymmetry (IVA), keratoconus index (KI), central keratoconus index (CKI), minimum radius of curvature (Rmin), index of height asymmetry (IHA), and index of height decentralisation (IHD) were recorded.
Results: The mean preoperative Kmax value was 46.67±4.15 (43.30-57.10) D and the mean Kmax value at the final postoperative visit was 45.41±2.95 (43.00-53.20) D. Mean preoperative CCT was 494.70±33.69 (438-537) µm and final postoperative mean CCT was 495.60±34.99 (433-539) µm. The deterioration in corneal topography indices stopped during the follow-up period of each case.
Conclusion: Stopping the deterioration of corneal parameters in keratoconus is the desired outcome after cross-linking treatment. Our results found an improvement or at least stabilization in all topography indices in keratoconus patients.

Keywords: Keratoconus, corneal collagen cross-linking, corneal topography

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Objective: To evaluate the efficacy of combined treatment of intravitreal bevacizumab injection followed by grid laser photocoagulation in patients with diabetic macular edema
Methods: Patients with diabetic macular edema received single dose intravitreal bevacizumab injection and followed by grid laser photocoagulation treatment four weeks later in the retrospectively conducted study. All eyes had underwent a complete ophthalmic examination including optical coherence tomography at baseline and at first and third month after laser treatment. The changes between outcome and baseline measurements in central macular thickness, macular cube volume and best-corrected visual acuity were observed. The changes in intraocular pressure and any reported complication were also evaluated.
Results: After the combined therapy the reduction in the mean of central macular thickness was 96.91 μm (24.94%) with a corresponding improvement in best-corrected visual acuity. The reduction in the mean of central macular thickness and the improvement in the mean of best-corrected visual acuity were statistically significant (p ˂ 0.05). There was no significant changes in the mean of IOP (p = 0.95). No complication related to the intravitreal injection or laser photocoagulation was reported in the treated eyes.
Conclusion: Combined therapy with intravitreal bevacizumab injection and sequential grid laser photocoagulation appeared to be effective in reducing central macular thickness and cube volume and improving visual acuity. A combination of intravitreal bevacizumab injection and sequential grid laser photocoagulation could be used as an initial treatment of diabetic macular edema.

Keywords: Bevacizumab, diabetic macular edema, grid laser photocoagulation

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Objective: Endometrium, which plays a very important role in reproductive biology and one of the pathologies connected with it as are the problems in the implantation. One of the most important processes for the female fertility are experienced in implantation failure and one of the developed methods for the solution are endometrial coculture application. In this study, to provide knowledge of the types of cells in in vitro monolayer endometrial coculture.
Methods: In our study, consisting of 8 fertile and 16 infertile women suffering from recurrent implantation failure were included in two groups. Performing aspiration with negative pressure pipeline endometrial tissue samples were obtained. Intended to carry embryo to the blastocyst stage, Endometrial Epithelial-gland cells (EG) and Epithelial stromal (ES) cells are obtained, after concluding of the culture was provided to do light microscopic tissue follow of these tissues. Cocultured cells were grouped stained with toluidine blue. Working with the numerical values of the cell types was performed using the Chi-square statistical analysis method.
Results: In cocultured, both fertile and cell types derived from the TIB group, with light microscopic examination, were distinguished by morphological characteristics. Each of the two groups, called cells called vacuoles, microvilli and cytoplasmic extension was defined.
Conclusion: Both groups, coculture derived from endometrial tissue were examined by light microscope. Thus, the identification of differences between groups was provided classification of cell structures in the coculture and endometrial cocultured practices, was concluded to be beneficial in the embryo's development.

Keywords: infertility, endometrium, coculture applications, implantation failure

ABSTRACT

Objective: Investigation of unpredictable risks due to abnormal uterine pathology after the choice of uterus-preserving reconstructive surgical procedure for women who have uterine prolapse and no other complaints was aimed.
Methods: The data of 121 women (105 postmenopausal and 16 premenopausal) who underwent vaginal hysterectomy due to pelvic organ prolapse was examined and the post-hysterectomy histopathology results were evaluated.
Results: Senile cystic atrophy was the most common endometrial pathology result among postmenopausal women (63.5%). However, proliferative and secretory endometrium was the most common endometrial pathology finding among premenopausal women (81.3%). There were statistically significant differences between postmenopausal and perimenopausal women in terms of these pathology results (p<0.001). While, there was no difference between groups in terms of endometrial polyps, hyperplasia and adenomyosis (p>0.05), myoma uteri was significantly more common in patients with perimenopause (p=0.01).
Conclusion: The uterus must be evaluated in terms of endometrial pathologies in asymptomatic women with pelvic organ prolapse before uterus-preserving reconstructive surgical procedure, especially in postmenopausal period.

Keywords: Pelvic organ prolapse, vaginal hysterectomy, endometrium

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Objective: The aim of this study is to obtain the thoughts, knowledge levels and training needs’ of the family medicine residents in Ankara about ophthalmology. Also with this study, we aimed to raise awareness on this issue and guide the studies that aimed to promote standard care for ophthalmology patients.
Methods: Between 01/04/2015-01/05/2015, we applied a questionnaire, developed by researchers to the family medicine residents who were working at a training and research/ university hospital in Ankara. We reached to the 200 family medicine residents to join to the survey but 196 of them completed the questionnaire. Data analysis was performed with SPSS 21.0 for Windows application.
Results: Only 12.8% of the residents think that the ophthalmology training given in the medicine faculty is enough, but 54.1% of them disagree and 33.2% of them partially agree. It was found that the most common cause of inadequate training in medical faculty is lack of practice. 9.5% of the family medicine residents agree that the ophthalmology training given during the family medicine specialization training is enough but 67.5% of them disagree and 20.5% of them partially agree. Residents think that ophthalmology education in family medicine training is not sufficient because Ophthalmology rotation is optional in the curriculum.
Conclusion: The curriculum of family medicine specialization training should include both practical and theorical trainings for the primary health care. In this context, compulsory and elective clinical rotations are an important part of specialization training. Only 9.5% of the participants agree that the ophthalmology training given during the family medicine specialization training is enough. It was thought that the results of the study will raise awareness on this issue and help the new studies about developing the approaches to the patients with eye diseases in primary care.

Keywords: Family medicine, training requirements, ophthalmology

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Objective: This survey aims to elucidate patient and health system related factors leading to delayed diagnosis and treatment of breast cancer in Southeastern Anatolia.
Methods: Hundred patients admitted to Department of General Surgery at Dicle University between December 2012 and July 2014, and diagnosed with breast cancer in preceding 6 months were included in the survey after their consent. The survey has 4 chapters (patient and health system related factors, demographic data, and assessment of cancer stage) and 25 questions.
Results: Fifty-eight percent of patients visited a physician with a 3 months delay after realization of breast cancer symptoms. Only 8% of patients had regular check-ups. Nine percent of patients were suspicious of breast cancer due to the lesion in the breast. 86% of patients did not consider it to be a serious matter. Lack of female physicians cited by 2% as the reason for avoiding doctor’s visit. Seven percent cited lack of knowledge and 23% being scared. Seventy-seven percent were able to get a doctor’s appointment, 82% to get mammography, 78% underwent biopsy in a week. Women between the ages of 30-50 had higher concern about cancer (p<0.05). Women who were illiterate or housewives regarded doctor’s visitation as not a good experience (p<0.05).
Conclusion: Patients’ age and literacy, and efficiency of health system may be contributing factors on the delay of diagnosis and treatment of breast cancer. Cancer awareness should be increased and fear being diagnosed with cancer should be overcome in women between the ages of 30-50 to decrease the delay of diagnoses.

Keywords: Breast cancer, delay on diagnosis and treatment, a survey

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Objective: Acromegaly is a syndrome characterized by growth hormone (GH) and insulin like growth factor-1 (IGF-1) over secretion. It was aimed to sharing detected metabolic disorders of the patients with acromegaly who have been under follow-up at our clinic.
Methods: One hundred five patients, who were diagnosed as acromegaly in our clinic between 2010 and 2015, were enrolled to the study. The age, gender, involvement feature additional systemic and metabolic diseases were recorded and laboratory findings.
Results: A total of 105 patients included in the study, 56 women (53.3%) and 49 men (46.7%), respectively. Patient’s’ ages ranged 23-78 (mean 42.1±16.7). 34 patients (32.3%), hypertension in 20 (19.04%), diabetes mellitus, and is 11 (10.4%) had impaired glucose tolerance.
Conclusion: Somatic disfigurement (hand and foot enlargement etc.) is the major characteristic of the disease but the prognosis is determined by cardiovascular, respiratory and metabolic complications. In acromegaly, hypertension and diabetes are common, cardiovascular disease is the principal cause of death. We believe that our study will contribute to the determination of our country’s data.

Keywords: Acromegaly, hypertension, diabetes

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Objective: In the present study, we aimed to determine the Fetuin-A levels in different regions of the brain in absence epileptic Wistar Albino Glaxo/Rijswijk (WAG/Rij) rats in order to contribute the identification of new potential biomarkers of the diagnosis, prognosis and follow up the epilepsy treatment.
Methods: 1, 3 and 6 months old male WAG/Rij rats (n=21) with absence epilepsy were used in this study. All of the rats were decapitated under anesthesia and their cortex and thalamus tissues were isolated. Fetuin-A levels of the groups were determined by Western Blot method by using standard techniques and differences between densities of the groups were compared.
Results: According to data obtained, there was no Fetuin-A expression in brain cortex and thalamus tissues of WAG/Rij rats with absence epilepsy.
Conclusion: In this study, it was shown that Fetuin-A is not expressed in brain cortex and thalamus tissues of WAG/Rij rats with absence epilepsy throughout the age-related development. By evaluating the findings obtained, extensive researches that contain molecular and histological methods must be planned, Fetuin-A findings that are obtained experimentally must be confirmed.

Keywords: Absence epilepsy, Fetuin-A, WAG/Rij rat

ABSTRACT

Paraneoplastic vascular pathologies are rare in daily practice. There is limited data about this phenomenon. Patient with a diagnosis of metastatic rectum carcinoma presented with digital necrosis. The work up for vascular and rheumatological pathology was inconclusive. Lesions progressively improved with steroid therapy. Paraneoplastic vascular lesions are rare in oncology practice. Our case points out important parts of a rare clinical entity.

Keywords: Rectum cancer, digital necrosis, paraneoplastic

ABSTRACT

Anorexia nervosa (AN) is an eating disorder, which is characterized by the avoidance of eating in a way that threatens the physical integrity of an individual, and trying to lose weight. It is known that the risk of mortality is high in AN. Death occurs as a results of medical complications and/or suicide. On the other hand, the exact time point of mortality becoming a risk during the progression of the disease progression is not defined. Certain predictors have been defined for mortality in AN. In this study, our aim was to present a case of a 15-year old female patient, who had died due to medical complications related to AN.

Keywords: Anorexia nervosa, mortality, death, predictors

ABSTRACT

Metastasis to the thyroid is extremely rare. In recent years, there is an increase in metastasis to the thyroid. This may be related with common use of the fine-needle aspiration biopsy. Synchronized occurrence of the oncocytic variant of papillary carcinoma of the thyroid and metastasis into thyroid, especially of esophageal origin, is very rarely seen. We present a rare case of a 56-year-old female in whom a primary esophageal squamous cell carcinoma gave rise to a metastatic palpable mass in the left lobe of thyroid gland and oncocytic variant of papillary carcinoma of the thyroid in the right lobe of thyroid gland.

Keywords: Metastasis, papillary carcinoma, squamous cell carcinoma, thyroid

ABSTRACT

Hanging is usually fatal and it is one of the most preferred method of suicide due to can be applied easily at any environment. In hanging particularly serious injuries is seen on the neck structures. Vascular injuries, cervical spine injury, laryngeal, tracheal injury can be seen or cerebral edema, intracranial hemorrhage can be occurred secondary to neck injury. In survivors of hanging, epilepsy, pulmonary complications such as acute respiratory distress syndrome, pulmonary edema, and bronchopneumonia are frequently observed. Hanging is a serious health problem that requires urgent intervention and post-professional care. Hanging has a high mortality despite early and accurate intervention. However the relief of neck structures and the treatment of accompanying complications can increase survival. In this study, we aimed that once again attract attention one of the most preferred way of suicide hanging cases, raise awareness of community on this issue and emphasize the importance of the early interventions in patients with near hanging.

Keywords: Hanging, medico/legal, complication

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Prenatal diagnosis of invasive and noninvasive tests can be done in a way (NIPT), but because of the invasive methods have risks of infection and abortion, diagnosing non-invasive procedure increasing day by day. One of the widespread cell free fetal DNA in maternal blood test (cffDNA) that is increasing in clinical use has been drawing attention. The incidence of aneuploidy chromosomal anomaly of the kind in which all live births; Trisomy 21 (Down Syndrome) 1/800, trisomy 13 (Patau syndrome) 1 /10,000, trisomy 18 (Edwards syndrome) is a form of 1/6000. Because of the high mortality and morbidity, it is vital that congenital anomalies should be diagnosed in prenatal period. Aneuploidy testing for high-risk pregnant women after the 10th week of pregnancy in terms of the blood sample is taken and free fetal DNA in maternal plasma is based on the measurement of the relative amount. Knowledge of the current criteria for use by healthcare professionals in the field test will allow the exclusion of maternal and fetal risks. In this study, it is aimed to demonstrate current international approaches related to the positive and negative sides of non-invasive that is one of the prenatal diagnostic methods of cffDNA test.

Keywords: Prenatal diagnosis, non-invasive prenatal test, cffDNA test