ISSN 1301 - 0883 / E-ISSN 1339 - 3886


Eastern J Med: 23 (4)
Volume: 23  Issue: 4 - 2018
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1.Determination of most frequent opportunistic intestinal parasites in children
Sahime İşler, Yunus Emre Beyhan
doi: 10.5505/ejm.2018.70883  Pages 232 - 236
INTRODUCTION: The aim of this study is to determine the most frequent opportunistic intestinal parasites in children and demonstrate its importance. Study was conducted on patients between the ages 0 and 16 between. The study consisted of a total of 150 children, 66 girls and 84 boys. 44 of the girls and 56 of the boys (100 in total) had diarrhea.
METHODS: Evaluation was done by native-Lugol, flotation in saturated zinc sulfate, and modified acid-fast staining.
RESULTS: Intestinal parasites were detected 38% of 150 examnined stool samples, 41% of those with diarrhea and 32% of those without diarrhea were positive. The highest parasite was detected as Blastocystis hominis (14,7%); and the lowest wereare Ascaris lumbricoides and Hymenolepis nana (0,7%).
DISCUSSION AND CONCLUSION: It was concluded that all children with gastro-intestinal complaints should be evaluated for intestinal parasites, mainly opportunistics, without preliminary screening whether the patient is diarrhea or not.

2.CD8 Expression on Clonal B-CLL cells and CD8+ Lymphocytes in the Microenvironment, Relations with Prognosis and Survival
Elif Gulsum Umit
doi: 10.5505/ejm.2018.97759  Pages 237 - 241
INTRODUCTION: In lymphoproliferative neoplasms including chronic lymphocytic leukemia (CLL), hairy cell leukemia and even multiple myeloma, the biology of the monoclonal cells as well as the surrounding cells which are called microenvironment of the bone marrow are known to be in an interplay.
METHODS: Data of 275 patients diagnosed with B-CLL were collected in a retrospective manner. Demographic features, laboratory including flow cytometry, immunoglobulins, genetic evaluations and clinical follow up were recorded from files.
RESULTS: 111 patients were female (40.4%) while 164 were male (59.6%). Mean age was 70.46 years (21-92). CD8 positivity on CLL cells was observed in 12 patients. No significance was observed regarding complications and survival. 71 patients demonstrated a dense surrounding CD8 positive lymphocytes. Of these patients, none had 17p deletion while 28 patients demonstrated 13q deletion (39.4% of CD8+ Treg group while 82.3% of all patients with 13q del) and 6 patients had 11q deletion. ITP, lowIgG levels, development of secondary malignancies, high percentage of bone marrow infiltration, Richter’s transformation were significantly corelated. CD8+ T lymphocyte richness in the microenvironment was significantly related with survival.
DISCUSSION AND CONCLUSION: Cancer is related with immunodefiency. With the evolution of tumors, they find ways to elude immune recognition. CD8 expression on B-CLL cells may not be explained with clinical features or prognosis. But The density of CD8 within the infiltrated bone marrow may explain the long term immune escape of CLL cells, with the effort to balance immune regulation by disease control, though resulting with increased autoimmunity.

3.Effect of intermittent fasting during acrylamide exposure on blood copper, zinc and lead levels in rats
Zübeyir Huyut, Okan Arihan
doi: 10.5505/ejm.2018.20082  Pages 242 - 246
INTRODUCTION: Zinc and copper are responsible for certain physiological functions in the body. On the other hand lead is a toxic trace element. In this study, effect of intermittent fasting on blood zinc, copper and lead levels during acrylamide exposure was studied.
METHODS: Forty female adult Wistar albino rats were divided into 4 groups (n=10 in each group). First group: control group without any administration, second group: acrylamide group in which 20 mg/kg/day acrylamide was administered for 30 days, third group: intermittent fasting group in which 12 hours of fasting were administered overnight for 30 days, fourth group: intermittent fasting and acrylamide group in which 20 mg/kg/day acrylamide and 12 hours of intermittent fasting was administered for 30 days. At the last day of experimental procedure blood was withdrawn under anesthesia. Zinc as well as copper levels were measured from plasma samples in flame unit and lead was measured from erythrocyte packages in combustion unit of Atomic Absorption Spectrophotometer.
RESULTS: In acrylamide group, zinc was lower (p<0.05) whereas copper (p>0.05) and lead levels (p<0.05) were increased. In intermittent fasting group zinc level was higher whereas copper and lead levels were lower compared to acrylamide group (p<0.05). In acrylamide+intermittent fasting group lead level was significantly lower (p<0.05).
DISCUSSION AND CONCLUSION: Results indicate an augmentation of toxic copper and lead elements due to acrylamide administration whereas a decrease in zinc which is an important element for growth and immune system. On the contrary, intermittent fasting decreased such untoward effect of acrylamide and increased potential detoxification of toxic chemicals.

4.Determination of The Knowledge and Skills of Physicians Working In Emergency Services Against Judicial Incidents
Mustafa Moralıgıl, Mehmet Nuri Bozdemır, Mehmet Iz, Mehmet Emin Layık, Fatma Betul Ay İz, Kıvanç Karaman
doi: 10.5505/ejm.2018.96977  Pages 247 - 253
INTRODUCTION: In our study, we aimed to determine the approach of physician working in emergency services to forensic cases and to provide data for training on this subject.
METHODS: Our study was carried out between 10.06.2016-15.08.2016 with the physicians working in the emergency services in the country. In order to measure the level of knowledge of physicians in judicial cases, qualitative evaluation including questionnaires and cases were conducted.

RESULTS: 496 physicians were participated in the study.The average age of physicians was 36.7 ± 5.8 years, 65.9% were male. While 39.9% of physicians participated in seminar about forensic medicine, 298 (60.1%) of them did not attend to any seminars regarding forensics. The correct answer rates average of 74 questions asked to doctors about simple medical intervention was 85.6 ± 11.1%. Average of correct responding to questions about life-threatening was 70.3 ± 9.3% and the average of correct responding to all questions was 78.0 ± 7.7%. Among simple medical intervention, life-threatening and total, a positive correlation was found between the level of knowledge and age (p <0.05). The total and simple medical intervention knowledge of the men was found to be better than women (p <0.05). As a result, specialist doctors’ knowledge level was lower, general practitioners had the best knowledge level (p<0.05). Life-threatening and the total level of knowledge was higher in physicians who attended the seminar (p<0.05).
DISCUSSION AND CONCLUSION: As a result, the knowledge level of physicians is inadequate on forensic medicine and should be increased with in-service training.

5.Comparison of the Horizontal Condyle Angle of the Dentulous and Edentulous Patients Using Cone Beam Computed Tomography
Alaettin Koç
doi: 10.5505/ejm.2018.51422  Pages 254 - 257
INTRODUCTION: To compare horizontal condyle angle (HCA) between fully edentulous and dentulous patients and consider relationship of age and gender to HCA.
METHODS: In this study, fifty patients between the ages of 25 and 76 were included and their HCA were measured on cone beam computed tomography (CBCT) images by software, then relationship of measured HCA to age, gender and dental condition were analyzed.
RESULTS: It was understood that gender had no significant effect on HCA (p= 0.850), also dental conditon had no significant effect on HCA (p= 0.772). There was no significant relationship between age and HCA, and a negative correlation was found between them (r= -0.25, p= 0.865).
DISCUSSION AND CONCLUSION: In the literature, ıt was emphasized that higher HCA may cause temporomandibular joint (TMJ) internal derangement. To our study, as age increases, HCA decreases. In other words, increase of HCA was not seen in older population of patients which may cause TMJ internal derangement.

6.Clinical and radiological impact markers in evaluation characteristic unilateral paranasal sinus diseases
Farah Dayana Zahedi, Mohd Hazmi Mohamed, Salina Husain, Thean Yean Kew, Balwant Singh Gendeh
doi: 10.5505/ejm.2018.81300  Pages 258 - 263
INTRODUCTION: The aim of this study is to analyze the clinical and radiological features, which characterized specific unilateral sinus diseases.
METHODS: Retrospective review of patients’ medical records with unilateral sinus opacification detected from computed tomography (CT) scan for 10 years duration in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The clinical presentation, mean age, presence of calcification and bony destruction and Lund Mackay score between groups were compared.
RESULTS: A total of 151 (23.5%) patients had unilateral paranasal sinus opacification on CT scan from 640 scan reviewed with 99 (65.6%) had inflammatory diseases, 38 (25.2%) had benign neoplastic condition and 14 (9.3%) with malignant neoplastic condition. Epistaxis was found to be significantly higher in malignant group (n=12/14) while rhinorrhea was higher in inflammatory condition (n=65/99). Bone erosion and mean Lund Mackay score were higher in malignant neoplasms group
DISCUSSION AND CONCLUSION: Computed tomography imaging combined with clinical presentation can be used as a tool to suspect malignant sinonasal disease. One should highly suspicious of malignancy if the Lund-Mackay score of the CT paranasal sinus is high. However,
tissue biopsy is still needed for confirmation

7.A Retrospective Analysis of Haemotologic Parameters in Patients with Bilateral Tinnitus
Ufuk Düzenli, Nazım Bozan, Mehmet Aslan, Hüseyin Özkan, Mahfuz Turan, Ahmet Faruk Kıroğlu
doi: 10.5505/ejm.2018.02703  Pages 264 - 268
INTRODUCTION: Tinnitus is a perception disorder of sound. Beside otologic diseases; mood disorders, inflammatory diseases, thromboembolic pathologies may lead to tinnitus. Mean platelet volume (MPV), Platelet Distribution Width (PDW) and Neutrophil-to-Lymphocyte Ratio (NLR) were investigated as biomarkers in tinnitus patients. In this study, we aimed to find whether there is any association between these biomarkers and bilateral tinnitus patients.
METHODS: Fifty eight with tinnitus and 58 healthy subjects were included to study. Distribution of age and sex in each group were equal. Hearing thresholds of tinnitus patients were obtained with pure-tone audiometry. Haemotologic values was evaluated in each group and correlation between these values and audiometric data were investigated in tinnitus patients.
RESULTS: PDW values of tinnitus group were found statictically significant higher than control group values (p=0.041). NLR was found lower in tinnitus patients and it was statistically significant (p=.001). MPV values were found similar in each group. In tinnitus group there were no correlation between haemotologic values and audiometric data.
DISCUSSION AND CONCLUSION: In this study we found blood marker value alterations in bilateral tinnitus patients but there were no correlation with audiologic data. And so we need larger studies to reach more significant results.

8.Retroperitoneal Abscesses: Origin, Ethiology And Percutaneous Treatment
Rahmi Aslan, Mesut Özgokce, Recep Eryılmaz, Mehmet Arif Duran, Murat Yıldızhan, Kerem Taken
doi: 10.5505/ejm.2018.69875  Pages 269 - 274
INTRODUCTION: Purpose: Retroperitoneal abscess is a rare clinical condition that can cause mortality if not properly treated. In our study, we aimed to report the data of retroperitoneal abscess cases which performed percutaneous drainage in the first step treatment
METHODS: A retrospective study was made of 81 patients with retroperitoneal abscesses treated at our hospital from June 2010 to December 2017 for the purpose of analyzing the diagnosis and treatment of these rare infections. In each case, we analyzed patient characteristics, abscess location and origin, predisposing factors, clinical presentation, microbiology, radiographic findings, treatment, and outcome
RESULTS: 81 cases were identified as 11 (14%) primary and 70 (86%) as secondary. The majority (63%) of these abscesses were originated from Urinary System, while others were found to be originated from psoas, vertebral and Gastrointestinal system (GIS). Urolithiasis, previous surgery, and other Urinary system anomalies were determined to be the most common predisposing factors. Escherichia coli (E. coli) was the most commonly seen pathogen in abscess culture. In all patients, percutaneous drainage catheter was successfully placed in the abscess lodge. No serious complications occurred in patients during and after the procedure. 78/81 (96%) clinical success was achieved. In 12 months follow-ups, recurrence was seen in only 5 patients
DISCUSSION AND CONCLUSION: Percutaneous abscess drainage should be preferred in the treatment of retroperitoneal abscesses as easy to perform, cost effective, low complication risk and high success rate

9.Surgical results of 23-gauge pars plana vitrectomy in adult traumatic retinal detachment
Dilek Yaşa, Zeynep Alkın
doi: 10.5505/ejm.2018.81994  Pages 275 - 279
INTRODUCTION: To evaluate the anatomic and functional results of 23gauge pars plana vitrectomy (PPV) in eyes with traumatic retinal detachment (RD).
METHODS: Medical records of patients who had each undergone PPV surgery after traumatic RD diagnoses were retrospectively reviewed. Patients who had at least 6 months of follow-up were included in the study. Patients' clinical characteristics, preoperative and postoperative distance corrected visual acuities, anatomical success rates, and complications were analyzed.
RESULTS: Twenty-seven eyes from 27patients were included in the study. Mean patient age was 48±17 years, and 96% of the cases were male. Mean follow-up period was 8±3 months. Seventeen (63%) patients had closed and 10 (37%) patients had open globe trauma. Five (19%) patients had an intraocular foreign body. Mean time from trauma to PPV was 34±33 days. Anatomical success was achieved in 19 (70%) eyes. Functional success was achieved in 13 (48%) eyes. Preoperative (baseline) visual acuity was the only factor associated with functional success.
DISCUSSION AND CONCLUSION: Traumatic RD may result in severe visual loss in the majority of cases despite the advancements in PPV techniques. Functional success is rate is higher in patients presenting better preoperative (baseline) visual acuity.

10.Post-Void Residual Urine Volume: Potential Recurrence Risk Factor for Bladder Cancer among the Male Smoker Patients
Abdullah Gul, Mehmet Gokhan Culha, Omer Onur Cakir
doi: 10.5505/ejm.2018.71601  Pages 280 - 283
INTRODUCTION: Aromatic amines and polycyclic aromatic hydrocarbons are chemical carcinogens that stimulate urothelial cell dysplasia and result in bladder cancer. Bladder outlet obstruction due to BPH may increase the contact time of any potential carcinogens in the urine to the bladder urothelium. We aimed to compare the post-void residual (PVR) urine volume between recurrent and nonrecurrent non-muscle invasive bladder cancer (NMIBC) patients with concomitant lower urinary tract symptoms (LUTS).
METHODS: A total of 480 patients with NMIBC were operated at our institution between May 2014 and May 2018. Of these patients, 93 men with concomitant LUTS were identified. After excluding 40 men who quitted smoking, 53 smoker men were included in study. Patient age, smoking habits, grade and stage of tumor, risk group of the tumor were recorded along with presence of recurrence. PVR urine volume was compared between patients with recurrent and nonrecurrent NMIBC.
RESULTS: The mean age was similar between patients with recurrent (n=17) and nonrecurrent (n=36) NMIBC (p = 0.475). The amount of smoking (pack year) was not different between the two groups (p = 0.407). The grade and stage of tumors were also statistically insignificant in both groups. Mean PVR urine volume was higher in patients with recurrent (88 mL) compared to nonrecurrent(62 mL) group. However, these results were not statistically significant (p = 0.548).
DISCUSSION AND CONCLUSION: We believe that the lower PVR urine volume, the lower risk for bladder cancer recurrence, although we couldn't prove this hypothesis statistically. Further clinical studies are needed to confirm the relationship between those.

11.The Effects of Serum CRP Level on Postoperative Atrial Fibrilation Occurrence in Patients who had Coronary Bypass Surgery
Ali Kemal Gür, Mehmet Coskun Aykac, Emrah Sisli
doi: 10.5505/ejm.2018.92053  Pages 284 - 288
INTRODUCTION: Coronary bypass operations are the most common cardiac surgery operations. Our aim in this article was to explain the relation between post operative serum C Reactive Protein (CRP) level and AF.
METHODS: A total of 198 patients who had isolated coronary artery bypass graft (CABG) operation between January 2016 and February 2018 in our cardiovascular surgery clinic were included in our study. Patients included in the study were examined after separating those with serum CRP levels below 8.0 mg/L in Group 1 and those with serum CRP levels above 8.0 mg/L in Group 2. There were 82 patients in Group 1 (31 F, 51 M) and 116 patients (48 F, 68 M) in Group 2.
RESULTS: Average age of all patients was 61.2 ± 8.1 years and it was 59.8 ± 9.4 years in Group I and 61.5 ± 7.4 years in Group II. AF was observed in a total of 65 patients (32.8%) including 13 patients in Group 1 (15.8%) and 52 patients (44.8%) in Group 2. AF occurrence in Group 2 with high CRP was statistically significant (p<0.05). Patients with a mortal course in 30 days following the operation were not included in the study.
DISCUSSION AND CONCLUSION: Coronary artery disease constitutes a mortality and morbidity cause itself. Post operative serum CRP level can be used as an indicator before AF occurs. We can't state high CRP as the primary cause of AF due to the study we made but we detected that AF prevalence increased in high CRP levels.

12.The Alteration of Life Quality Between Hormone Treatment-Receiving and Non-Receiving Early-Stage Prostate Cancer Patients Who Underwent Radiotherapy
Feryal Karaca
doi: 10.5505/ejm.2018.66933  Pages 289 - 297
INTRODUCTION: Curative surgery or radiotherapy is the treatment of choice in localized prostate cancer. Androgen deprivation therapy, which is performed according to the risk groups, is effective in the downsizing of the prostate. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire EORT-QLQ C30 is an effective means of evaluating the quality of life on the basis of the individual’s physical and functional scales
METHODS: 35 prostate cancer patients who had not undergone surgery and who received curative radiotherapy were included in the study. The study was performed prospectively.The life qualities and weights of prostate cancer patients were evaluated before, at the end of, and 3 months after, the radiotherapy sessions, by means of the EORTC-QLQ30 Test
RESULTS: The alterations encountered in hormone-receiving patients on the basis of physical, emotional, perceptional, and social scores, in addition to fatigue, nausea, vomiting and pain evaluations, done on the basis of the EORTC-QLQ30 measurements performed prior to, at the and of and 3 months after, the radiotherapy sessions, were found to be statistically significant (p<0.001). Patients who did not receive hormone therapy in the emotional and pain scores demonstrated statistically significant changes during the same evaluations p=0.006, and p=0.019, respectively
DISCUSSION AND CONCLUSION: It was concluded at the end of the study, that radiotherapy, in general, does not impose a negative effect on the quality of life in prostate cancer patients but it does lead to changes in the general and emotional functional scores, as well as the complaints of pain, insomnia, constipation, and diarrhea

13.Anthropometric measurement of the hand
Nuriye Kübra Bayraktar, Esin Tokmak Özşahin
doi: 10.5505/ejm.2018.03164  Pages 298 - 301
INTRODUCTION: This study aims to get various anthropometric measurements of dominant hands of students from vocational high school of health and classify them according to Krogman Hand Index to form a database
METHODS: 141 students (49 male, 92 female) who were healthy anatomically and had no other known disease attending to vocational high school of health of Baskent University were recruited. Right hand was dominant for all of the students. The length and width of the right hand of the students were taken after their height and weight were measured. The results were recorded as mm. The findings were classified according to Krogman index with the formula hand width / hand lengt X 100.
RESULTS: For males right hand length and width was 183,9±0,88mm; and 87,54±0,70mm; respectively, with hand index being 47,58 and classified as brachyeri according to Krogman hand index. For females right hand length and width was 169,75±2,01 and 77,63±1,21mm respectively with hand index being 45,72 and classified as mesocheri according to Krogman hand index.
DISCUSSION AND CONCLUSION: Measurements of body and body parts display variability due to age, gender, genetic and environmental factors across populations. Therefore; such data used in gender discrimination, identification and special ergonomic structures need to be population spesific.

14.A new alternative flap in the closure of meningomyelocele defects: modified S flaps
Ömer Faruk Koçak, Canser Yılmaz Demir, Muhammet Eren Ersöz, Yavuz Özsular, Yılmaz Sultanoğlu, Abdurrahman Aycan, Mehmet Edip Akyol
doi: 10.5505/ejm.2018.37450  Pages 302 - 307
INTRODUCTION: Back defects may occur after several factors such as cancer,trauma,pressure sores.These conditions are more frequent in adults group,whereas the etiological factor in newborn infants is usually meningomyelocele defects. The aim of this study is to define more reliable and easily applicable surgical technique for the closure of meningomyelocele defects.
METHODS: This study included a total of 15 infants who underwent operation with the diagnosis of meningomyelocele and were treated with a modified S flap at our clinic between January 2016 and January 2017.During surgery,two flaps with a random pattern planned from the healthy skin on the right and left side of the meningomyelocele defect were transposed to close the defect.The flap donor sites were primarily sutured by elevating the surrounding skin.The left-sided flap was designed with superior pedicle and the right one with inferior pedicle.
RESULTS: Of the participants,13 were females and two were males with a mean age of 3.2 (min-max: 1 to 16) days.The mean follow-up was 11.5 (min-max: 5 to 17) months.The mean defect size was 6.5x5 (min-max: 5x4 to 7x6) cm. The mean flap size was 6.5x2.9 cm for the flap planned from the left side and right side of the defect.Complication was observed only in one patients including partial necrosis.
DISCUSSION AND CONCLUSION: Our study results suggest that modified S flap is an easily applicable flap. The greatest advantage of this flap is the shortening of the operation time. However, the major disadvantage of this flap is the random pattern flap (absence of a known blood wessel).

15.Erythema Multiforme; Sixty Six Case Series with Review of Literature
İbrahim Halil Yavuz, Göknur Özaydın Yavuz, Serap Güneş Biligili, İrfan Bayram, Hülya Savaş
doi: 10.5505/ejm.2018.70893  Pages 308 - 312
INTRODUCTION: Erythema multiforme (EM) is an acute, self-limited, and sometimes recurrent skin disease considered to be a hypersensitivity reaction associated with certain medications and infections. EM has recently been recognized as a distinct disease differentiated from the Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The aim of this study was to evaluate the clinical and histopathological characteristics of patients with EM.
METHODS: The retrospective study included 66 patients who received outpatient or inpatient treatment at the Dermatology department due to a diagnosis of EM between 2005 and 2017. Age, gender, etiological factor, recurrence, significant histopathological findings, presence of target lesions, mucosal involvement, and treatment methods were recorded.
RESULTS: The 66 patients included 22 (33.3%) men and 44 (66.7%) women with a mean age of 36.7±13.9 years. The etiological factor was Herpes labialis in 36.4%, medication in 31.8%, Orf infection in 13.6%, and no etiological factor was detected in 18.2% of the patients.
DISCUSSION AND CONCLUSION: Although EM is a common entity in dermatology practice, there are a limited number of studies reporting on EM. The results indicated that that EM can occur secondary to Orf infection.

16.Presentation of a rare case: Ig A deposit disease in pregnancy
Onur Karaaslan, Erkan Şimşek
doi: 10.5505/ejm.2018.42713  Pages 313 - 315
Linear IgA dermatosis is a rare autoimmune bullous skin disease characterized by accumulation of linear IgA along the basal membrane zone and formation of subepidermal bullous. A 27 year-old female case who developed blister on the scalp (hairy skin) in 11th gestational week used dapsone and prednisolone during her pregnancy. In this case the fetal and maternal results of Ig A deposit disease and used medications are presented.

17.Conjunctival Lymphangiectasis
Erbil Seven, Muhammed Batur, Serek Tekin, Gülay Bulut, Tekin Yaşar
doi: 10.5505/ejm.2018.29494  Pages 316 - 318
In this article, a 51-year-old man with conjunctival lymphangiectasia who applied to the hospital with conjunctival swelling on left eye examination was presented. Conjunctival resection was performed and no recurrence was found in the follow-up examination at 9 months. This is an uncommon clinical condition in which conjunctival swelling occurs as a consequence of enlarged lymphatics of the bulbar conjunctiva.

18.A Rare Complication Of Abdominal War Surgery: Gossypiboma In A Child Refugee
Burhan Beger, Ebuzer Düz, Hüseyin Akdeniz
doi: 10.5505/ejm.2018.60783  Pages 319 - 321
BACKGROUND: Gossypiboma is a term used for a forgotten cotton sponge or gauze in the body. Gossypiomas may be fistulae from the peritoneal cavity to the gastrointestinal tract or may extructed to the urinary bladder, intestines and skin. İntestinal obstruction and perforation may ocur.
CASE REPORT: In this case we present a four years old war victim boy complicated with a huge gossypiboma. He applied to our clinic with intestinal obstruction. Clinic investigations showed that 11x4 cm sized mass presented on the left upper side of the abdomen. While surgical operation, a gastro-ileo-colic fistula was detected due to a foreign body. After all approaches he survived with no complication.
CONCLUSİON: Forgeting a foreign object in human body by surgical operations is a very worrying situation for surgeons, although it is very rare. Gossypiboma should be kept in mind especially in the cases of refugees and war victims who went under surgery with increased stress due to war conditions.

19.Niemann-Pick Disease Type B Diagnosed in the Adulthood
Sinan Demircioğlu, Celalettin Korkmaz, Hilal Akay Çizmecioğlu, Necdet Poyraz
doi: 10.5505/ejm.2018.19484  Pages 322 - 324
Niemann-Pick disease (NPD) type B is an autosomal recessive liposomal storage disorder. NPD type B can present later in life with predominantly visceral symptoms, and has a more favorable prognosis. The natural history of NPD-B is one of progressive hypersplenism and gradual deterioration of pulmonary function. In this paper, we are presented NPD type B patient who were diagnosed at 41 years old while being followed for years with the diagnosis of interstitial lung disease.

20.Acute abdominal pain due to wandering spleen torsion: A case report
Adem Yokuş, İbrahim Akbudak
doi: 10.5505/ejm.2018.63634  Pages 325 - 327
Wandering spleen is a rare condition. This condition is due to absence, laxity or underdevelopment of splenorenal, gastrosplenic and splenocolic ligaments that hold the spleen in its normal localisation. Clinic presentation may be asymptomatic or may be painful abdominal mass, intermittent abdominal pain or acute abdomen. In this report, a thirty-five year old female patient with torsion of a wandering spleen was presented with clinical and radiological findings.

21.Coexistence of deletion, ring, and monosomy of chromosome 7 in a patient with MDS-RAEB-2
Cigdem Aydin, Orhan Kemal Yucel, Ozan Salim, Levent Undar, Bahar Akkaya, Sibel Berker Karauzum
doi: 10.5505/ejm.2018.65487  Pages 328 - 331
Monosomy 7 or partial deletion of chromosome 7 is a frequent cytogenetic finding in myelodysplastic syndrome (MDS). However, only a few cases of MDS with a ring chromosome 7 have been reported. We report a first case of MDS with 46,XX, der(7)del(7)(p22)del(q22)[7]/46,XX,r(7)(p22q22)[7]/46,XX[23] karyotype in a 30 year old female patient at diagnosis. The patient was diagnosed as MDS-refractory anemia excess blast type 2 (RAEB-2) (IPSS): 3, high risk). Acute myeloid leukemia (AML) induction type- chemotherapy was initiated. After second allogeneic hematopoietic stem cell transplantation, 46,XX [15] karyotype were detected in patient. She died due the acute graft versus host disease of the liver at the second month of the transplantation. Herein, we report a first case of MDS having the three abnormalities; ring 7, derivative 7; due to p and q arm deletion on the chromosome 7 and monosomy 7.

22.Thiopenthal for Propofol Related Extrapyramidal Movements: Case Report
Hilmi Demirkıran, Bilgin Dalkılınç, Cevdet Yardımcı, Celaleddin Soyalp, Nureddin Yuzkat, Mehmet Kılıç
doi: 10.5505/ejm.2018.53244  Pages 332 - 333
Many drugs are used in outpatient anesthesia procedures. One of them, propofol, is used frequently because of its advantages like fast effect and short duration. Involuntary tonic-clonic movements similar to epilepsy are rarely seen when using propofol. One 41-year old male patient weighing 80 kg and admitted with acute appendicitis presented hemiballismus-like severe extrapyramidal movements in all his extremities when propofol was administered. In this article, we discuss how we treated these undesired propofol side effects.

23.Hearing Loss Due to Cavernous Hemangioma of Inferior Concha
Yaser Said Çetin, Muzaffer Arı, Nazım Bozan
doi: 10.5505/ejm.2018.46320  Pages 334 - 337
Location of cavernous hemangioma in nasal cavity is a very rare condition. Herein we will report an adult male diagnosed with cavernous hemangioma located in inferior concha and causing otitis media with effusion that was treated with the minimally invasive trans-nasal endoscopic technique. Although there are many options in treatment of lesions in nasal cavity, we recommend the trans-nasal endoscopic approach since it is minimally invasive and it is sufficient in both bleeding control and complete removal of the cavernous hemangioma.

24.Evaluation of Giant Galactocele With Ultrasound and Shearwave Elastography Findings
Nurşen Toprak, Ali Mahir Gündüz, Sebahattin Çelik
doi: 10.5505/ejm.2018.59480  Pages 338 - 340
Giant galactocele is a rare bening cystic form of milk products of the breast. Giant galactocele’s sonographic features are described in many report, but shear wave elastography (SWE) findings are not fully known. Galactocele ultrasound findings have been described, but some lesions are confusing. SWE may show a hard tissue-like finding in the galactocele and may be confused with malignancy especially in the chronic lesions. In the present case report, we aimed to present routine sonographic and SWE findings of a giant galactocele in a 29 year old woman.

25.Cuteneus Sarcoidosis, Mimicking Acne In A Patient and The Importance Of Dermoscopy In Differential Diagnosis
Zeynep Gizem Kaya İslamoğlu, Abdullah demirbaş
doi: 10.5505/ejm.2018.46693  Pages 341 - 343
Sarcoidosis is a multi-systemic granulomatous disease of unknown aetiology. After the lungs, the skin is the second most common organ involved. Cutaneous involvement occurs in up to 30% of patients and skin findings are often the initial presenting symptom. Plaques and papules are the most commonly observed cutaneous lesions. Sarcoidosis can be mimicing other diseases. Dermoscopy is a non-invasive method that allows skin lesions to be visualized. In recent years, it is used for increasing diagnostic accurarcy in many skin diseases. Sarcoidosis is one of these diseases. We present a case of 50 year old man, with erythematous maculopapules over the front of chest for about two years. He treated like acne but had no benefit from therapies. Cutaneus sarcoidosis was diagnosed at the end of the dermoscopic, clinical and histopatological examination of patient. Here, we emphasized that, sarcoidosis can interfere many skin diseases and dermoscopy is a non-invasive method that can be used before biopsy in the differential diagnosis

26.A rare case of pelvic Castleman's Disease mimicking an adnexal tumor
Erbil Karaman, Çağrı Ateş, Ali Kolusarı, İsmet Alkış, Hanım Güler Şahin, Abdulaziz Gül, Feyza Demir
doi: 10.5505/ejm.2018.61580  Pages 344 - 346
Castleman’s disease(CD) is described as benign lymho node angiofollicular hyperplasia and mostly seen in thoracic cavity. The occurrence in pelvic cavity is very rare. It is usually mimicking the pelvic adnexal solid-heterogenous tumoral mass. So the preoperative diagnosis is mostly difficult. We now report a case of pelvic CD in a patient with pelvic pain. The patient underwent laparotomy with suspicious of adnexal tumor. However, the diagnosis was made at histopathologic examination postoperatively. The surgery was curative in this case and no reccurence was observed in the patient.

27.Primary vulvovaginal choriocarcinoma patient who underwent autologous hematopoetic stem cell transplantation: A case report of unusual presentation
Ramazan Esen, Nurlan Mammadzada, Birol Yildiz, Nuri Karadurmus
doi: 10.5505/ejm.2018.95866  Pages 347 - 349
Ovarian germ cell tumors (GCT) are derived from primordial germ cells of the ovary. Choriocarcinomas are more commonly of placental than ovarian origin in a woman. Vaginal choriocarcinoma is seen very rare in the literature. If the germ cell tumors are relapsed or refractory to the salvage chemotherapy, autologous hematopoietic stem cell transplantation (AHSCT) can be used for the treatment. Our aim is to present a rare vaginal choriocarcinoma patient who underwent AHSCT due to the relapsed disease.
Case report:
A 46-year-old woman who had two vaginal deliveries 18 years ago, presented with a vaginal mass. The diagnosis was made as choriocarcinoma after abscess drainage. Due to the elevated levels of β-HCG, she had undergone chemotherapy. After the four lines chemotherapy serum tumor markers remained high. Because of that reason, AHSCT was performed and after the transplantation, the β-HCG level has decreased. The patient was observed with a very good partial response.
According to current literature, AHSCT is a reasonable treatment option for relapsed or resistant cases. In conclusion, our case is the first and unique who has undergone AHSCT. AHSCT is an effective and tolerable treatment for ectopic relapsed and refractory choriocarcinoma cases.

28.Five-Year Follow-Up of a Delayed Reimplanted Avulsed Tooth: Case Report
Esin Özlek, Burak Ak, Elif Akkol
doi: 10.5505/ejm.2018.86158  Pages 350 - 354
This case involves the reimplantation of an avulsed mandibular central tooth that occurred two hours after an accident. A nine-year old girl had visited nearest dental health care center complaining of an avulsed mandibular central tooth two hours after her bicycle accident. The avulsed tooth had been kept in milk in for those two hours. It was reimplanted and referred to a dentistry faculty with a composite splint. The patient presented to our clinic three days later. The non-hygienic composite splint was removed and gingivoplasty procedure was performed by a periodontologist. The new splint was applied using polythene fiber post (Ribbond) Ribbond Inc., Seattle, WA, USA). Clinically normal periodontal tissues were detected after two weeks, and endodontic treatment was begun. Root filling of the clinically asymptomatic tooth was performed after 30 days, and coronal restoration finished using composites. The tooth is still functional now after five years. The long-term prognosis for the replanted tooth is unclear. During this growth period, however, the height of the alveolar bone has been preserved and is aesthetically satisfying.

29.A case of rectal villous adenoma in a 28 year old female patient presenting with Depletion syndrome
Sheref A. Elseidy, Haitham H. Alzamli, Ahmed A. Abd Alkader, Esraa Mamdouh, Marina S. Ghaly
doi: 10.5505/ejm.2018.96168  Pages 355 - 357
Secretory villous adenoma is one of the rare causes of severe secretory diarrhea,acute kidney injury and refractory electrolyte imbalance.A classic triad named McKittrick-Wheelock syndrome.aggressive hydroelectrolyte rebalancing is often needed, and curative treatment is obtained only with complete removal of the lesion, by endoscopic resection or surgery. High clinical suspicion in patients with severe dehydration due secretory diarrhea and concomitant electrolyte imbalance is both mandatory and essential for early diagnosis and treatment before complications arise.
case presentation: In this case we describe a 28 year old female patient suffering from 6 months of secretory diarrhea, presented to our emergency department with severe dehydration, acute renal failure, hyponatremia and hypokalemia After re hydration and electrolyte replacement confirmation of the diagnosis was done by colonoscopy and biopsy showing 3 sessile colonic polyps (2 at distal end of Transverse colon, largest one at descending colon) the biopsy confirmed the presence of villous adenoma with high grade dysplasia. Normalization of the electrolyte imbalance and the kidney functions was done and she was successfully treated with surgical resection that lead to complete resolution of symptoms.
conclusion: McKittrick-Wheelock syndrome is a rare life threatening depletion syndrome that can lead to acute kidney injury and electrolyte imbalance with concomitant organ damage. Early management by vigorous repletion therapy and curative surgical resection will mostly resolve the symptoms and complications.

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