Contribution of ethical approach and effective communication to the correct diagnosis of acute appendicitis - a single center experience from a pragmatic perspective.

OBJECTIVE: In this study, we reviewed the data of patients who presented to the Emergency Department with abdominal pain, underwent ultrasonography (USG) and computed tomography (CT), and were pathologically diagnosed with acute appendicitis and non-appendicitis. We aimed to emphasize the ethical importance of specifying a clinical diagnosis with its effect on radiologically correct diagnosis and patient management method. PATIENTS AND METHODS: A total of 1047 patients, 971 patients with acute appendicitis due to pathology, and 76 patients with non-acute appendicitis, who applied to the Emergency Department with acute abdominal pain, underwent ultrasound and/or CT of the whole abdomen were evaluated. According to their clinical diagnoses, both patient groups were divided into acute appendicitis (Group I) and other diagnoses (Group II). After the patients were screened retrospectively, pathology and imaging results were compared with clinical diagnoses. RESULTS: According to their clinical diagnosis, the pathology result of 654 patients in Group I and 317 patients in Group II was acute appendicitis. Appendicitis was diagnosed in 569 patients in Group I and 240 patients in Group II by performing at least one of the radiological imaging methods. In 162 patients, the diagnosis of appendicitis could not be made by imaging. CONCLUSIONS: Considering the low negative predictive values in USG and CT examinations for the diagnosis of appendicitis is important. An indication of the clinical diagnosis in accordance with deontology and effective communication between the clinician and the radiologist is important for making a rapid and accurate diagnosis by determining the effective imaging method.

Determination of radioactivity levels in feldspathic dental ceramics.

Activity concentrations of 42 different feldspathic dental ceramic powders were determined using a gamma spectrometer with an HPGe detector. The average 238U, 232Th and 226Ra activity concentrations of the specimens were 126 ± 8 Bq kg-1, 5.6 ± 0.5 Bq kg-1 and 12.7 ± 1.2 Bq kg-1, respectively. The average 40K activity was found as 2855 ± 89 Bq kg-1 ranging from 2252 ± 70 Bq kg-1 to 3522 ± 110 Bq kg-1 due to high potassium content in dental ceramics. None of the activity concentration measurements exceeded the limits by EC and ISO.

Postoperative complications following colonic resection for cancer are associated with impaired long-term survival.

AIM: Surgery for colorectal cancer is associated with a high incidence of postoperative complications. The aim of this study was to analyse whether postoperative complications following radical resection for colorectal cancer are associated with increased recurrence rate and impaired survival. METHOD: Patients operated for colon cancer between 2007 and 2009 with curative intent were identified through the Swedish Colorectal Cancer Registry. The cohort was divided into three subgroups: patients who developed severe postoperative complications, patients who developed non-severe complications and patients who did not develop any complication (controls). RESULTS: Of 6779 patients included in the study, 640 (9%) developed severe complications, 994 (15%) non-severe complications and 5145 (76%) had no complications. The 5-year overall survival rate was 60.3% in the severe complication group, 64.2% in the non-severe complication group and 72.8% in the control group (P < 0.01). The 3-year disease-free survival rate was 66.8%, 70.9% and 77.8% respectively (P < 0.01). The recurrence rate did not differ between the three groups. In multivariate analysis, both severe and non-severe complications were found to be risk factors for decreased overall survival at 5 years [hazard ratio (HR) 1.38, 95% CI 1.47-1.92, and HR 1.18, 95% CI 1.27-1.60 respectively; P < 0.05) as well as for decreased 3-year disease-free survival (HR 1.37, 95% CI 1.14-1.65, and HR 1.26, 95% CI 1.08-1.48 respectively; P < 0.05). CONCLUSION: Complications after colonic resection for cancer are associated with impaired 5-year overall survival and 3-year disease-free survival and exhibit more severe postoperative complications, mainly via mechanisms other than cancer recurrence.

Type D personality, anxiety, depression and personality traits in patients with isolated itching of the external auditory canal.

OBJECTIVE: This study evaluated type D personality, anxiety, depression and personality traits in patients with isolated itching of the external auditory canal. METHOD: A hundred consecutive out-patients with isolated itching of the external auditory canal and 100 controls were enrolled in the study. The Type D Scale, the abbreviated form of the Eysenck Personality Questionnaire Revised and the Hospital Anxiety and Depression Scale were used for data collection. Patients were also evaluated using the Modified Itch Severity Scale. RESULTS: In all, 43 per cent of patients and 15 per cent of controls met the criteria for a type D personality. Patients with a type D personality had higher anxiety and itching severity but lower extraversion compared with those without a type D personality. Multiple linear regression analysis showed that extraversion and type D personality were independently associated with itch severity. CONCLUSION: These data suggest that clinicians should consider psychological and personality features when evaluating and treating patients with isolated itching of the external auditory canal.

Plasma homocysteine, folate and vitamin B12 levels in patients with lung cancer.

AIM: Disorders in the metabolism of homocysteine and B vitamins, which are involved in a one-carbon transfer reaction and important for DNA synthesis and methylation, have been hypothesized to be associated with carcinogenesis. The purpose of this study is to evalu-ate the levels of homocysteine, vitamin B12 and folic acid in patients with newly diagnosed lung cancer and determines whether they might be used as an accurate tumor marker for monitoring the patients if they are found to be elevated in lung cancer. MATERIALS AND METHODS: Forty male patients with lung cancer were included in this study. Age-matched forty healthy males who had not malignant disease or had not received any drug affecting plasma homocysteine levels were selected as control group. Homocysteine, vitamin B12 and folate levels were measured in the samples obtained from the patients and controls. RESULTS: Mean age of the patients with lung cancer was 58.7 ± 9.9 years. All the patients were cigarettes smokers. Mean daily consumption of cigarettes was 2.0±0.7 packs and mean duration of smoking was 30 ± 11 years. Histologic type of carcinoma was found to be squamous cell carcinoma in 55%, adenocarcinoma - in 35%, and small cell carcinoma - in 10% of the cases. Clinical stage was stage IA in 20%, stage IB - in 20%, stage IIA - in 2.5%, stage IIB - in 10%, stage IIIA - in 12.5%, stage IIIB - in 20%, and stage IV - in 15% of the cases. Mean homocysteine level was 15.3 ± 7.3 µmol/l in the patients with lung cancer while 9.8 ± 2.6 µmol/l in controls. Homocysteine level was significantly higher in the patients with lung cancer compared to control group (p < 0.001). Mean folate level was 4.3 ± 1.8 pg/ml in cancer cases while 6.1 ± 2.3 pg/ml in controls. That is to say, plasma folate levels were significantly lower in cases of lung cancer compared to controls (p < 0.001). There was no significantly difference between groups with regard to B12 levels (mean B12 level was 234 ± 99 and 240 ± 104 ng/ml in the patients with lung cancer and controls, respectively, p = 0.78). Plasma homocysteine, vitamin B12 and folate levels did not show significant difference with respect to histologic type of carcinoma. No significant correlation was found between plasma homocysteine, vitamin B12, folate levels and number of cigarettes smoked per day, duration of smoking, age of the patient, and clinical stage of carcinoma. There was also no correlation between number of cigarettes smoked per day, duration of smoking, age of the patient and clinical stage of carcinoma. A possible inverse correlation between plasma homocysteine, vitamin B12 and folate levels was not observed. CONCLUSION: In conclusion, high plasma homocysteine and low folate levels could be associated with lung cancer. However, further studies performed on large patient population are needed.

The prevalence of usage of herbal medicines among cancer patients.

PURPOSE: To study the prevalence of the usage of herbal medicines among cancer patients. METHODS: This study was carried out between October 1, 2009 and May 31, 2011, by using face-to-face interviews with cancer patients attending oncology departments (clinics and outpatient clinics, chemotherapy units). A special questionnaire was filled in during the interviews. RESULTS: Of the patients 68.2% reported usage of herbal medicines, 66% stated that their usage of herbal medicines was based on the media and the Internet as a source and 64% stated that they received information about herbal medicines from relatives and friends. Only 24% of herbal medicines users had consulted or discussed their use with a physician. CONCLUSION: In Turkey, especially among cancer patients, there is a high prevalence of complementary and alternative medicine (CAM) usage and the most commonly used form of CAM is herbal medicines. This prevalence has also been found to be high in our research as well. Due to the probable side effects and potential drug interactions of herbal agents, all cancer patients should be asked about their use of herbal medicines.

Calculation of pediatric femoral fracture rotation from direct roentgenograms.

BACKGROUND: Radiologic determination of pediatric femoral fracture rotation has been debated. Measuring the antetorsion angle of the fractured femur by computed tomography and comparing it with the opposite side has been the method of choice for this purpose. However, no simple method for direct measurement of femoral fracture rotation exists in the literature. In this study, our aim was to test a mathematical method of measuring the axial plane malrotation from direct roentgenograms. MATERIALS AND METHODS: A pediatric femoral shaft fracture model was produced. The bone was secured to a wooden frame that allowed the distal part of the fracture to rotate around an axis. Radiographs were taken at known intervals of rotation ranging from the neutral position to 60° external rotation and to 60° internal rotation in 5° increments of rotation. Five independent, blinded observers measured the radiographs and calculated the fracture rotation according to a standard formula. Calculated rotation values were compared with known rotation values. RESULTS: Calculated rotation values were close to actual rotation values throughout the arc of rotation. The mean absolute error of five observers for all measurements of external and internal rotation was 3.97° (±0.83). The correlation coefficient between calculated and actual rotation values was 0.9927. The interobserver intraclass correlation coefficient for calculated rotation was 0.997. CONCLUSIONS: Absolute error and correlation coefficient values indicate that this method is accurate and reliable in determining the fracture rotation.

Prognostic significance of the metastatic lymph node ratio for survival in colon cancer.

PURPOSE: The metastatic lymph node ratio (LNR) is defined as the number of metastatic lymph nodes divided by the total number of lymph nodes removed. The aim of this study was to investigate the prognostic significance of the metastatic LNR in patients with colon cancer. METHODS: One-hundred twenty-five patients with stage III colon cancer admitted to the Istanbul University Oncology Institute between 1995 and 2005 were retrospectively evaluated. The median LNR was 0.2, and this figure was accepted as cut-off value in the present study. Overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method. Log-rank test was used for intergroup comparisons. The significance level was put at p<0.05. RESULTS: Of the 125 patients, 58 (46.4%) were males and 67 (53.6%) females with median age 57 years. The mean OS in patients with a LNR <0.2 was 120.5±7.3 months, with a LNR ≥0.2 was 92.8±9.0 months Although clinically significant, the difference between the groups was statistically insignificant (p=0.074). The mean duration of DFS in patients with a LNR <0.2 was 100.6±8.6 months and for those with a LNR ≥0.2 it was 71.7±8.3 months (p=0.017). The 5-year DFS rate in patients with a LNR ≥0.2 was 42.3%; it was 64.1% in those with LNR<0.2. The difference between the groups was statistically significant (p=0.017). CONCLUSION: The determination of the optimal cut-off value for the LNR in future prospective studies will help defining prognosis with better accuracy in colon cancer patients.

Treatment and clinicopathologic predictors for adenoid cystic carcinomas of the head and neck.

PURPOSE: To retrospectively evaluate the management and clinicopathologic predictors of outcome of adenoid cystic carcinoma (ACC) patients treated and followed at our Department. METHODS: Data on 41 patients treated between 2000 and 2006 at the University of Istanbul, Institute of Oncology, were reviewed. Factors affecting recurrence, distant metastasis and survival were evaluated. RESULTS: There were 22 (53.6%) major salivary and 19 (46.3%) minor salivary gland tumors. Eighteen patients (43.9%) had solid histologic type tumor. Twenty-one (51%) patients had perineural invasion and 28 (68.2%) high grade tumors. Sixteen (39%) patients had stage I disease, 12 (29.1%) stage II and 13 (31.5%) stage III. Thirty-two patients (78.4%) had radical and 9 (21.9%) partial resection. Thirty-one patients (75.6%) received adjuvant postoperative radiotherapy (RT). Eight patients (19.5%) suffered locoregional relapse and 9 (21%) distant metastases. Two patients (4.8%) died from ACC and 7 (17%) from other causes. The median follow-up was 48 months (range 24-60). Disease free survival (DFS) at 2 and 3 years were 78% and 58%, respectively. Overall survival (OS) at 2 years and 3 years were 87% and 80%, respectively. Median time to locoregional relapse and distant metastasis was 28 and 32 months, respectively. Seven of 9 patients with distant metastasis had solid tumor subtype. Distant metastasis occurred more frequently in patients with tumors of major salivary glands (66%). Sites of distant metastasis were lung alone (n=5), bone alone (n=2) and 2 patients had both lung and bone metastasis. There was no statistically significant relationship between clinical T stage and solid histology with locoregional relapse (p <0.05). Surgical resection type and perineural invasion were significant prognostic factors for locoregional relapse (p=0.03). T stage (p=0.001), grade (p=0.02) and solid histology (p=0.003) were prognostic factors associated with DFS. Prognostic factors associated with OS were grade (p= 0.001), clinical T stage (p=0.02), solid histology (p=0.01), radical excision (p=0.04) and perineural invasion (p=0.001). CONCLUSION: ACC is a neoplasm in which early diagnosis is important because it is a slow-growing tumor producing diffuse invasion. Distant metastasis and locoregional relapse can be predicted by solid histologic subtype, high grade, type of surgery, perineural invasion and tumor stage. The most frequent sites of metastasis are lung and bone.

Extraoral prostheses using extraoral implants.

The aim of this study was to evaluate extraoral prostheses and the use of extraoral implants in patients with facial defects. 10 cases were treated utilizing maxillofacial prostheses employing extraoral implants in five cases. 16 extraoral implants were installed. Seven implants were placed in irradiated sites in the orbital regions. Six implants were placed in mastoid regions and three in a zygoma region that was irradiated. Two implants failed before initial integration was achieved in irradiated areas. Using 14 extraoral implants as anchors, five extraoral prostheses were set. The other five cases were treated with extraoral prostheses without using extraoral implants due to cost and patient-related factors. The data included age, sex, primary disease, implant length, implant failure, prosthetic attachment, radiation therapy, and peri-implant skin reactions. The use of extraoral implants for the retention of extraoral prostheses has simplified the placement, removal, and cleaning of the prosthesis by the patient. The stability of the prostheses was improved by anchors. Clinical and technical problems are presented with the techniques used for their resolution. Using extraoral implants resulted in a high rate of success in retaining facial prostheses and gave good stability and aesthetic satisfaction.

Rehabilitation of an edentulous cleft lip and palate patient with a soft palate defect using a bar-retained, implant-supported speech-aid prosthesis: a clinical report.

Prosthetic rehabilitation of an edentulous cleft lip and palate patient with a combined hard and soft palate defect is a great challenge, due to the lack of retention of the obturator prosthesis as a result of its weight and the inability to obtain a border seal. Dental implants improve the retention, stability, and occlusal function of prostheses when used in carefully selected cleft lip and palate cases. This clinical report presents an edentulous unilateral cleft lip and palate patient who has hard and soft palate defects and an atrophied maxilla, treated with an implant-supported speech-aid prosthesis.

Programa de apoyo y asesoramiento para familias con enfermo crónico y su repercusión en la gestión del proceso de hemodiálisis / No disponible

No disponible

Prevalence of Behçet's disease in rural western Turkey: a preliminary report.

OBJECTIVES: To study the prevalence of Behçet's disease (BD) in a rural area of Western Turkey. METHODS: This study was conducted in seven villages in the rural Havsa region which has a total population of 5727. The physicians and medical students visited every household and distributed a questionnaire on the symptoms of rheumatic disorders. One of the questions was whether they had ever suffered from mouth ulcers. If the response was affirmative the proband was examined by a rheumatologist and a dermatologist for other symptoms. The individuals with true aphthous ulcerations had pathergy tests and were invited to the hospital for ophtalmic examinations. RESULTS: Of the 5203 individuals who participated in this survey, 4861 were 10 years or older. 124 out of 190 individuals who responded positively to the question regarding the presence of mouth ulcers had true aphthous ulcerations. 115/124 underwent a pathergy test and 4 showed positive reactions without any other stigmata of BD, except for folliculitis in one. Among the individuals with a negative pathergy test, 2 had acneiform skin lesions and 1 a genital ulcer. No individual exhibited any ocular symptoms or findings characteristic for BD. Only 1 person with aphthous ulceration, folliculitis and a positive pathergy test was considered to have BD. CONCLUSION: In this survey, the prevalence of BD was found to be 2: 10,000 (95% confidence interval 0 to 4.3: 10,000). This figure is lower than what has been reported in four previous studies from different regions in Turkey. This finding might be due to ethnic distribution and geographical differences.

Response to nimodipine in caffeine-induced neurotoxicity in cerebellar granular cell culture of rat pups.

Methylxanthines (theophylline, theobromine and caffeine) are widely used as central nervous system stimulants and caffeine is used in the treatment of apnea in newborns. Plasma therapeutic concentration of caffeine is around 110 microM. Caffeine diffuses the blood brain barrier easily, increasing oxygen consumption in neurones and leading to cell death. In the present study, 4-7-day-old rats were used to obtain cerebellar granular cell cultures. Caffeine was used 50, 150, 250 and 350 microM concentrations and the most toxic dose for it was found to be 350 microM. Death cell scores were 0.9+/-0.63 for control, 1.1+/-0.63 for 50 microM, 0.89+/-0.47 for 150 microM (P>0.05 for both), 3.84+/-0.8 for 250 microM (P=0.024) and 6.2+/-0. 86 for 350 microM (P=0.001) caffeine concentrations. The role of voltage-dependent calcium channels in caffeine-induced neurotoxicity was tested with the doses of 100 and 200 microM nimodipine 45 min before or after the 350 microM caffeine. Both doses of nimodipine after caffeine administration were found to be ineffective in blocking neurotoxicity. Doses administered 45 min prior to caffeine, reduced death cell score to 0.89+/-0.23 (P=0.000) for 100 microM nimodipine and 2.35+/-0.96 (P=0.000) for 200 microM nimodipine administration into the cultures. A dose-dependent manner of nimodipine in ischemic states is well-known. In the light of these results, nimodipine may be used in the treatment of newborn apneas together with caffeine to prevent neurotoxic side effects of high or repeated doses of it.