Pediatric Primary Raynaud's Phenomenon: A Comprehensive Cardiovascular Analysis.

Our aim in this study is to evaluate the cardiovascular findings of pediatric patients with primary Raynaud's phenomenon (RP) and to determine if there are any pathological findings. Our study included 42 pediatric patients aged between 7 and 18 who were diagnosed with primary RP and did not have any additional underlying structural vascular disease or secondary rheumatological conditions. The control group consisted of 30 healthy volunteers aged 7-18 years, matched by age and sex, without any additional diseases. We evaluated demographic, clinical, and laboratory findings, echocardiographic and capillaroscopic features, as well as carotid intima-media thickness. Compared to the control group, pediatric patients with primary RP showed increased A wave velocity and E/E' ratio parameters in the left ventricle, indicating diastolic dysfunction of the heart. The isovolumetric relaxation time (IVRT) was prolonged in both the left and right ventricles, and the E/A ratio decreased in the left ventricle. The myocardial performance index (MPI), indicating both systolic and diastolic dysfunction, increased in both ventricles. Additionally, the aortic stiffness index, aortic elastic modulus (Ep), and left carotid intima-media thickness (CIMT) significantly increased, while distensibility decreased in pediatric patients with primary RP compared to the control group. The cardiovascular evaluation of pediatric patients with primary RP revealed that diastolic dysfunction is likely present in both the left and right heart. Additionally, based on the aorta and carotid intima measurements, it is suggested that pediatric patients with primary RP are at risk for developing atherosclerosis.

Posterior fixation of gastric tube with fibrin sealant in laparoscopic sleeve gastrectomy: a promising method to prevent revision surgeries.

BACKGROUND: We aim to assess the effects of gastric posterior fixation with fibrin sealant in laparoscopic sleeve gastrectomy in aspects of 12th-month body mass index and gastric volume. METHODS: The patients who underwent laparoscopic sleeve gastrectomy between January 2019 and February 2021 were divided into two groups preoperatively. The first 75 patients were appointed to the posterior fixation group, and the second 75 were to the control group. Changes in gastric volume and body mass index were assessed in the postoperative 12th month. RESULTS: There were 110 patients in the final analysis. Fifty-four patients had posterior fixation, and 56 had only laparoscopic sleeve gastrectomy. The posterior fixation group was superior in terms of total weight loss rate (39.1% vs. 34.5%, p<0.001) and less gastric volume increase rate (39.8% vs. 164.7%, p<0.001) in the postoperative 12th month. CONCLUSION: Our study suggests that posterior fixation with fibrin sealant in laparoscopic sleeve gastrectomy is a promising method for preventing weight regain and creating a need for revision surgery.

A comparison of the 2 thermal ablation procedures for the management of benign thyroid nodules.

INTRODUCTION: In recent years, ultrasound (US)-guided thermal ablation techniques have come to the fore as minimally invasive alternatives to surgery. The purpose of this study was to assess the effectiveness and safety of radiofrequency ablation or microwave ablation procedures in patients with benign thyroid nodules. MATERIAL AND METHODS: This retrospective and single-centre study consisted of 55 patients and 62 benign thyroid nodules that were treated either with radiofrequency ablation (RFA) or microwave ablation (MWA) in our hospital between January 2020 and March 2022. All the patients were at high risk for surgery or with symptomatic TNs and who refused surgery. The TNs diagnosed as benign from the fine-needle aspiration biopsy were evaluated in terms of volume reduction, symptom, and cosmetic scores. In addition, these 2 treatment modalities were compared to each other. RESULTS: Out of 55 patients, 44 (80%) were female and were aged between 24 and 97 years with a median age of 50 years. RFA was applied to 54.5% (n = 30) of the participants, and MWA was applied to 46.5% (n = 25). The volume reduction rate (VRR) after RFA and MWA at the first month was 63.4 ± 14.2 and 65.7 ± 13, respectively. No significant difference was detected between the 2 groups in terms of VRR (p = 0.51). In addition, the mean symptom and cosmetic scores decreased significantly in both procedures, and there was a significant difference due to the symptom score change in the RFA group compared to the MWA group. Of all the patients, one patient experienced haematoma in the RFA, and one patient had transient voice change in the MWA group. No life-threatening complications were noted. CONCLUSION: In the treatment of benign symptomatic thyroid nodules, both RFA and MWA are options worthy of consideration in terms of efficacy and safety.

Comparison of percutaneous gallbladder aspiration with percutaneous cholecystostomy in acute cholecystostomy patients. Can gall bladder aspiration alone be sufficient?

BACKGROUND: The aim of this study is to compare the efficacy and complication rates of percutaneous gallbladder aspiration (PA) and percutaneous cholecystostomy (PC) in the management of AC and present the experiences of a single third-line center. METHODS: The results of 159 patients with AC who admitted to our hospital between 2015 and 2020, that underwent PA and PC procedures, because they did not respond to conservative treatment and LC could not be performed, were retrospectively analyzed. Clinical and laboratory data before and 3 days after PC and PA procedure, technical success, complications, response to treatment, duration of hospital stay, and reverse transcriptase-polymerase chain reaction (RT-PCR) test results were recorded. RESULTS: Out of 159 patients, 22 (8 men 14 women) underwent PA procedure and 137 (57 men 80 women) underwent PC. No significant difference was detected between the PA and PC groups in terms of clinical recovery (P: 0.532) and duration of hospital stay (P: 0.138) in 72 h. The technical success of both procedures was 100%. While 20 out of 22 patients with PA were having a noticable recovery, only one was treated with twice PA procedures and a complete recovery was observed (4.5%). Complication rates were low in both groups and were statistically insignificant (P: 1.00). CONCLUSION: In this pandemic period, PA and PC procedures are effective, reliable, and successful treatment method that can be applied at the bedside for critical patients with AC who are not compatible with surgery, which are safe for health workers and low-risk minimal invasive procedures for patients. In uncomplicated AC patients, PA should be performed, and if there is no response to treatment, PC should be reserved as a salvage procedure. The PC procedure should be performed in patients with AC who have developed complications and are not suitable for surgery.

Comparison of the cystocholedochal angle in patients with choledocholithiasis and only cholelithiasis.

This study aims to evaluate the relation between the cystocholedochal angle (SCA) and choledocholithiasis. The data of 3.350 patients were reviewed retrospectively and a total of 628 patients who met the criteria were included in the study. The patients included in the study were divided into three groups as patients with choledocholithiasis (Group I), patients with only cholelithiasis (Group II), and patients without gallstones as control group (Group III). Measurements of SCA, cystic, bile, and common hepatic ducts (CHDs) were made on magnetic resonance cholangiopancreatography (MRCP) images. Laboratory findings and demographic characteristics of the patients were also recorded. Of the patients included in the study 64.2% were female, 35.8% were male, and their age ranged from 18 to 93 (mean 53.37 ± 18.87 years). While the mean SCA values of all patient groups were 35.44° ± 10.44°, the mean length of cystic, bile and CHDs were 28.91 ± 9.30, 40.28 ± 12.91, 27.09 ± 9.68 mm respectively. All measurements were higher in Group I in comparison to other groups, whereas all measurements of Group II were higher than those of Group III (p < 0.001). Statistical analysis suggests that a SCA of 33.5° and above is an important criterion for diagnosis of choledocholithiasis. Increase of SCA raises the likelihood of choledocholithiasis, as it facilitates the passage of stones from gallbladder into the bile ducts. This is the first study to compare SCA in patients with choledocholithiasis and those with only cholelithiasis. Therefore, we think that this study is important and will be a guide for clinical evaluation.

The extent of agreement between frozen and paraffin block data from axillary samples in patients with early-stage breast cancer.

INTRODUCTION: Patients with early-stage breast cancer currently undergo sentinel lymph node dissection to evaluate the axillary region. Frozen tissue blocks are evaluated intra operatively and paraffin-embedded samples are studied postoperatively. We explored whether sentinel lymph node dissection adequately reflected axillary involvement (as revealed by the paraffin blocks) in patients with early-stage breast cancer; we sought to avoid axillary dissection. METHODS: The agreement/non-agreement rates between the results of axillary ultrasonography and biopsy, sentinel lymph node and axillary dissections, and frozen and paraffin block results, were retrospectively analyzed for 200 patients with early-stage breast cancer. The positive predictive values and accuracies were recorded in those who were positive on both ultrasonography and biopsy. The negative predictive values were calculated for doubly negative cases. RESULTS: The frozen and paraffin block results disagreed in 19 (9.5 %) cases and agreed in 181 (90.5 %). The frozen block and dissection results differed in five of 38 patients who underwent axillary dissection (AD) (one patient did not undergo AD); the results were in agreement in 32. Of the 19 block-disagreement cases, 16 were in the non-neoadjuvant chemotherapy (NAC) group and three in the NAC treatment group. Clinically, the negative predictive values of the frozen and paraffin block data were 80 % in patients lacking axillary involvement. CONCLUSION: Paraffin block evaluations only (thus, without frozen block examinations) of early-stage breast cancer lymph nodes seem to be sufficient to guide treatment. Also, a thorough clinical examination (with ultrasonography and axillary biopsy) reduces the dissection rate and the associated functional impairments.

Evaluation of treatment responses among subgroups of breast cancer patients receiving neoadjuvant chemotherapy.

BACKGROUND: Breast MRIs are helpful for determining treatment plans, responses, and prospective survival analyses. In this retrospective cross-sectional study, we compared the preoperative MRI treatment response to neoadjuvant chemotherapy (NAC) administration with the postoperative pathological response in breast cancer patients. MATERIALS AND METHODS: We analyzed data from 108 hospitalized patients receiving NAC between 2020 and 2022. We used MRI to evaluate the treatment response to NAC in patients with locally advanced breast cancers who had not received any prior treatment. We recorded the longest diameter of the primary tumor and the numbers of secondary tumors and axillary lymph nodes. In addition, we examined the correlation between the MRI response rate and pathological specimen results. RESULTS: In our subgroup analyses, we found the best pathological response in patients with luminal B (Ki-67 index >14%) breast cancer and positivity for both hormone receptor and HER-2 markers. After comparing the pathological and radiological treatment responses in tumors and lymph nodes, the sensitivities were 90.3% for the pathological assessment and 42.8% for the radiological assessment, while the accuracies were 84.2% for the pathological assessment and 61.1% for the radiological assessment. CONCLUSION: Using MRI techniques and sequence intervals and examining the histopathological characteristics of tumors may help increase the accuracy of the pathological complete response.

Extrahepatic Biliary Tract Variations is an Effect for Acute Calculous Cholecystitis.

OBJECTIVE: To evaluate the anatomy of the extrahepatic bile duct and to reveal its importance in the formation of acute calculous cholecystitis (ACC). STUDY DESIGN: Case-control study. PLACE AND DURATION OF STUDY: Department of General Surgery and Radiology, Kanuni Sultan Suleyman Training and Research Hospital of the University of Health Sciences, Turkey, between January 2016 and December 2021. METHODOLOGY: The data of the patients treated with ACC were analysed on MRCP by an experienced radiologist. The patients were divided into two groups; asymptomatic gallstones (AsGS, control group) and ACC. The cystic duct, common hepatic duct, and common bile duct lengths and variations in cystic duct opening were measured. Receiver operating characteristics (ROC) analysis was conducted to define a cut-off value and compared categorical results of the two groups by Mann-Whitney U test. RESULTS: One-hundred and seventy-three patients were analysed, one-hundred and seven were females, and 66 were males. The median age was 46 years in the AsGS group and 53 years in the ACC group. It was statistically significant that ACC had a higher median age value than AsGS (p=0.014). In the analysis of extrahepatic variations, cystic duct, common hepatic duct, and common bile duct length, were statistically longer in the calculous cholecystitis group (p<0.001, p=0.022, and p=0.019 respectively). ROC analysis was performed for cystic, common hepatic, and common bile duct length, respectively. Cut-off values ​​were 30.5 mm, 36.5 mm, and 42.5 mm. CONCLUSION: Extrahepatic bile duct variations are of critical importance in ACC surgery. In the data, as the cystic duct and common bile duct lengthens, the possibility of ACC increases. There is need for studies with larger samples. KEY WORDS: Acute calculous cholecystitis, Extrahepatic biliary tract, Anatomical variations, Cholelithiasis.

A Rare Cause of Colonic Obstruction: Inflammatory Fibroid Polyp.

Only 5% of all cases of intussusceptions occur in adults. Although it is known to occur frequently due to inflammatory bowel disease, postoperative adhesions, or neoplastic masses, inflammatory fibroid polyps (IFP), which are rare lesions of the gastrointestinal tract, may present this clinical picture. In rare cases of intussusception due to IFP, clinical suspicion should be kept in the foreground and mind in the differential diagnosis. In this article, the purpose was to present the clinical, radiological, and pathological findings and the treatment of obstruction caused by this rare lesion.

Incidentally Detected Gastrointestinal Wall Thickness on Abdominal Computed Tomography; What Does it Mean for Endoscopy?

BACKGROUND: The clinical significance of gastrointestinal wall thickening (GWT) on abdominal computed tomography (CT) is not certain, yet. Despite the need for clinical guidelines describing the importance and evaluation of GWT on a CT scan, there have been few studies evaluating these incidental imaging abnormalities. The aim of this study is to endoscopically evaluate certain etiologies that cause incidental GWT found on CT. METHODS: This retrospective cohort study was carried out with patients who had incidentally detected GWT on a CT scan at the Kanuni Sultan Süleyman Training and Research Hospital between February 2016 and December 2018. RESULTS: A total of 129 patients (62 males and 67 females; mean age 57.5 years, range: 26-87 years) were included in the study. Abnormalities observed during endoscopy at the exact site of the GWT noted on a CT image were found in 114 patients (99%): upper endoscopy revealed malignancy in 33 (29%), gastritis in 63 (52%), hiatal hernia in 19 (16%), a gastric ulcer in 7 (6%), and alkaline gastritis in 3 (2%). Colonoscopy revealed malignancy in 4 (33%), benign polyps in 5 (35%), colonic ulcer in 2 (16%), and 2 patients (16%) had normal findings. Malignancy was detected more frequently in the cardioesophageal region compared with the antrum (P=0.020). CONCLUSION: In this study, detection of GWT on CT often indicated pathologies which were subsequently confirmed endoscopically. Pathological findings were detected in 83% of these patients, with approximately 30% determined to be malignant. Endoscopic evaluation is recommended when GWT is reported on a CT scan.

Spleen infarct secondary to thrombus in COVID-19-related splenic vein: A case report.

Splanchnic venous thrombosis is a rare type of venous thromboembolism, and its actual incidence is still unknown. Splenic infarction develops due to splenic vein (SV) thrombosis. Patients with COVID-19 may be exposed to a risk of thrombotic events, and the system affected at the highest level by coagulopathy is the respiratory system. The case presented here is splenic infarction that developed because of SV thrombosis, which is a rare form of venous thromboembolism.

The effect of transarterial chemoembolization therapy on survival in patients with non-resectable hepatocellular carcinoma: Single-center study results.

Background and Aim: This study was designed to investigate the tumor response and effect of drug-eluting transarterial chemoembolization (DEB-TACE) treatment on survival in patients diagnosed with hepatocellular carcinoma (HCC). Materials and Methods: The records of 40 patients who underwent DEB-TACE between March 2018 and November 2020 were retrospectively analyzed. Follow-up included abdominal computed tomography and measurement of serum albumin, bilirubin, prothrombin time, and alpha-fetoprotein values. The treatment response was evaluated using the European Association for the Study of the Liver criteria. Results: A total of 70 TACE sessions were performed in the 40 study patients with HCC. The etiology was chronic hepatitis B virus (n=32), secondary biliary cirrhosis (n=2), cryptogenic (n=2), or chronic hepatitis C virus (n=4). Based on the TACE response, complete response was observed in 22 patients, a partial response in 8 patients, and progression in 10 patients. Liver transplantation was performed for 4 patients who had a complete response. The formation of new nodules was observed in 8 patients during the follow-up period. In all, 29 patients survived and 11 died. Conclusion: The findings of this study suggest that DEB-TACE had a positive effect on the survival of patients diagnosed with HCC who could not be treated surgically.

A novel survival algorithm in COVID-19 intensive care patients: the classification and regression tree (CRT) method.

BACKGROUND/AIM: The present study aimed to create a decision tree for the identification of clinical, laboratory and radiological data of individuals with COVID-19 diagnosis or suspicion of Covid-19 in the Intensive Care Units of a Training and Research Hospital of the Ministry of Health on the European side of the city of Istanbul. MATERIALS AND METHODS: The present study, which had a retrospective and sectional design, covered all the 97 patients treated with Covid-19 diagnosis or suspicion of COVID-19 in the intensive care unit between 12 March and 30 April 2020. In all cases who had symptoms admitted to the COVID-19 clinic, nasal swab samples were taken and thoracic CT was performed when considered necessary by the physician, radiological findings were interpreted, clinical and laboratory data were included to create the decision tree. RESULTS: A total of 61 (21 women, 40 men) of the cases included in the study died, and 36 were discharged with a cure from the intensive care process. By using the decision tree algorithm created in this study, dead cases will be predicted at a rate of 95%, and those who survive will be predicted at a rate of 81%. The overall accuracy rate of the model was found at 90%. CONCLUSIONS: There were no differences in terms of gender between dead and live patients. Those who died were older, had lower MON, MPV, and had higher D-Dimer values than those who survived.

The role of elastography in the assessment of chronic liver disease in children.

BACKGROUND: Conventional ultrasonography is a method preferred for the investigation of chronic liver diseases in pediatric groups, as it is non-invasive, cheap, feasible and available. The purpose of this study is to present the role of Share-wave Elastography (SWE) in terms of diagnostic value in children diagnosed with "chronic liver disease." METHODS: We studied patients who had been diagnosed with chronic liver disease between March 2012-September 2015, and who had undergone liver biopsy and had their pathology results, compared with 26 healthy subjects. Statistical analysis was performed with IBM SPSS Statistics for Windows, Version 20.0. "Pearson Correlation Analysis" was performed in order to measure the relationship between elastography values and Brunt level. RESULTS: This study had 107 subjects in total, consisting of 81 patients between 0-204 months of age Pearson correlation coefficient level was determined as r = 0.644. Since the correlation coefficient is positive, there is a same-directional relationship between Elastography level and Brunt degree. This means that while one of the variables is increasing, the other one will also increase. CONCLUSION: Since it is known that development of hepatic fibrosis is a dynamic process, and that many hepatic fibrosis etiologies are known to continue throughout the course of life, the application of Real time SWE method instead of repeated liver biopsies on patients is a much simpler and smart method. Increasing the clinical use of Real Time SWE method with future studies might provide an opportunity for preventing unnecessary liver biopsies since the patients are evaluated in a shorter time and in a cost-effective manner.

Impacts of anthropogenic factors on land degradation during the anthropocene in Turkey.

The aim of the present study was to determine the factors that effected the beginning of the Anthropogenic Era (human age) in Turkey and formation of biomes. Destruction of vegetation, soil erosion and land degradation are the most important factors in the formation of anthropogenic biomes in Turkey. For this reason, first of all, a literature review about land degradation, which has been going on for past 300 years in Turkey, and about its causes was made. Changes that have occurred over the last 70 years were studied with the help of aerial photos and satellite images. In addition, studies we have conducted in the last 35 years have contributed substantially to the determination of the extent of the destruction of vegetation and land degradation in Turkey. As a result of research based on literature reviews and fieldwork, the impact of humans on the natural habitat were identified, and the current situation was studied. The findings about the current situation that emerged due to human impact were then transferred to an electronic environment, and a map of anthropogenic biomes was produced with the help of ArcGIS Desktop software. Based on the results obtained, one can say that the natural habitat has considerably changed over the last 200 years; vegetation has been damaged, and land degradation has become faster because of human activities. These results indicate that 97% of natural biomes have become anthropogenic biomes, and this change has become more obvious during 20h century in Turkey. The results also show that the change has been more influential after 1950.

Land use and land cover change detection in Karinca river catchment (NW Turkey) using GIS and RS techniques.

The basin of Karinca river, in the north-west of Turkey, covers an area of 29,840 ha. Pronounced changes in land use emerged as a result of the development of activities in the tourism sector in Turkey in the 1970's. The basin has been significantly affected in the course of this process. This study was conducted in order to determine the land use changes (as well as the type of changes and their direction) occurring in the use of land in the Karinca river catchment for the period 1979-2007. The geographical data were gathered by using 1:25000 scale topographical maps as a basis. Thus, the existing soil and land use data from 1979 were processed on these bases and the the main materials rendering the land use were produced. Geometric verification was made by putting the previously prepared bases onto landsat ETM+ and satellite images of 2007. In the final stage, results pertaining to the changes in land use were obtained by overlapping the two sets of data. All processes were done using the ArcGIS Desktop v9.x program. According to the data of the year 1979, the catchment area consisted of 43.4% forest, 26.5% grassland, 18.3% olive groves, 10.6% agriculture and 1.2% built-up lands. Comparing these coverage with the data of 2007, show a clear shift among residential areas, olive groves and forest terrain. It was found that the agricultural areas, particularly along the shoreline, were converted into resort houses and that the olive groves (the dominant land use) shifted from lower regions to its upper sectors. All these changes caused loss of natural habitats leading to degradation.