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Eastern J Med: 24 (4)
Volume: 24  Issue: 4 - 2019
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ORIGINAL ARTICLE
1.Correlation between change in respiratory muscle strength and cough ability in patients submitted to open-heart surgery
Karan Pongpanit, chitima kulchanarat, Sasipa Buranapuntalug, Kornanong Yuenyongchaiwat
doi: 10.5505/ejm.2019.02486  Pages 401 - 404
INTRODUCTION: The purpose of this study was to determine the correlation between change in respiratory muscle strength and change in cough ability in patients submitted to open-heart surgery.
METHODS: An observational cross-sectional study was conducted among 52 participants. Respiratory muscle strength was assessed by maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) using a respiratory pressure meter. Cough ability was evaluated by voluntary expiratory peak flow (PEF) using a digital spirometer. Evaluations were performed on the day of admission and discharge.
RESULTS: Post-operative MIP, MEP, and PEF were significantly lower than those evaluated preoperatively (all p < 0.001). The difference of MIP and MEP was substantial positively correlated with the change in PEF in both absolute and predicted values (all p < 0.001) with the changes in MIP was highly relation.
DISCUSSION AND CONCLUSION: This study demonstrated that weakness of respiratory muscles, especially inspiratory muscle, was correlated to declining in cough ability in patients who had undergone open-heart surgery.

2.Is there a mortality effect of emipiric colistin in the treatment of acinetobacter baumanni?
İlhan Bahar, Gülseren Elay
doi: 10.5505/ejm.2019.25743  Pages 405 - 411
INTRODUCTION: To investigate the effect of empirical or culture based colistin therapy on the mortality of intensive care medicine (ICU) patients with severe sepsis and septic shock
METHODS: Patients with severe sepsis and septic shock treated in three Intensive Care Units of medical faculty of Erciyes University were included in this retrospective, descriptive study. Sixty-nine patients were included in this study. The empirical group (Group 1) consisted of 33 (47%) patients; Group 2 consisted of 36 (53%) patients.
RESULTS: Results: The baseline Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were significantly higher in the empirical group (p = 0.01). However, the groups did not differ regarding the pre-treatment Sepsis-related Organ Failure Assessment (SOFA) scores (p=0.92). The groups did not differ regarding the mean duration of intensive care stay (15 days vs. 20 days, p = 0.20) or in terms of the intensive care mortality (58.3% vs. 72.7%, p = 0.31). There was also no difference between the groups in 30-day in hospital mortality (61.1% vs. 78.8%, p = 0.12).
DISCUSSION AND CONCLUSION: In patients with severe sepsis/septic shock, there were no differences between the groups in which the colistin therapy was initiated empirically or based on sensitivity test results.


3.Syrian migrants with brain metastasis patients: quality of life and anxiety before radiotherapy, depression before and after radiotherapy and the effect on familial relatives
Feryal Karaca, Gökhan Çavuş, Çiğdem Usul Afşar, Selahattin Menteş, Yaşar Sertdemir, Yurdal Gezercan
doi: 10.5505/ejm.2019.52724  Pages 412 - 421
INTRODUCTION: In this study, our aim is to evaluate the quality of life, depression and anxiety of the Syrian patients who have brain metastasis and their relatives before starting radiotherapy and to correlate their depression and anxiety after radiotherapy. Brain metastases are frequently considered the last stage in many cancers.
METHODS: The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, Beck Depression Inventory, and State-Trait Anxiety Inventory I-II test questionnaires were administered upon the arrival of 51 Syrian immigrant patients with brain metastases and their relatives to a radiotherapy clinic.
RESULTS: Beck Depression Inventory, and State-Trait Anxiety Inventory questionnaires II were administered after radiotherapy. Beck Depression Inventory performed before and after radiotherapy in patients and their relatives and Beck Depression Inventory analysis was significant (p < 0.001). State-Trait Anxiety Inventory II analysis performed before and after RT in patients and their relatives was significant (p < 0.001).
DISCUSSION AND CONCLUSION: According to the State-Trait Anxiety Inventory II, high-anxiety situations occurred before radiotherapy, which we considered a continuum anxiety state, and increased in patients and their relatives after radiotherapy. According to the Beck Depression Inventory, depression decreased in patients’ relatives after radiotherapy and increased in patients. The State-Trait Anxiety Inventory II scores after radiotherapy were high in patients and their relatives. This study was the first to evaluate the quality of life, socioeconomic status, depression, anxiety state and continuity of Syrian patients with brain metastases and their relatives. Therefore, we conclude that Syrian immigrants with brain metastases experience continued anxiety.

4.The comparison of Crystallized phenol with Lateral Flap method in treatment of sinus pilonidalis
feyzi kurt
doi: 10.5505/ejm.2019.92485  Pages 422 - 426
INTRODUCTION: We aimed to evaluate our experience with crystallized phenol for the treatment of pilonidal sinus disease and to compare it with Kardiyakis method.
METHODS: Patients who undergone surgery for the pilonidal sinus disease between January 2016 and September 2018 in our clinic have been evaluated prospectively. Patients’ data including age, sex, follow-up time, complications and recurrence rates were recorded
RESULTS: Patients’ mean age were 21.5±7.9 and 24.4±7.4 in phenol and kardiyakis groups, respectively. Sex distribution were 35 males to 10 females in phenol group and 107 males to 19 females in kardiyakis group. No recurrences were observed in phenol group, while recurrences in 8 patients were noted in kardiyakis group. This difference was not statistically significant (p=0.11).
DISCUSSION AND CONCLUSION: Crystilized phenol technique is easy applicable and comfortable method for pilonidal sinus disease treatment. It may have less recurrence rate when compared to kardiyakis method, but more studies are needed to definitely establish this.
Key words: Pilonidal sinus, phenol, surgical flap, crystallized phenol, Kardiyakis method


5.Evaluation of accuracy and reliability of electrocardiographs interpreted by emergency medicine assistants
Mehmet Reşit Öncü, Fatma Özdemir, Şule Akköse Aydın
doi: 10.5505/ejm.2019.09327  Pages 427 - 433
INTRODUCTION: The purpose of this study is to evaluate accuracy and reliability of the electrocardiographs interpreted by the Emergency Medicine assistants and to determine compatibility between the interpretations of the electrocardiographs read by the emergency medicine assistants and cardiologist.
METHODS: This study was performed in the prospective and sectional manner on 252 patients who applied to Emergency Department and whose triage categories were 1 and 2. The ECGs were evaluated by the Emergency Medicine assistants and cardiologist independently of each other. The interpretations made by the cardiologist accepted as the gold standard.
RESULTS: 252 patients were included in the study. 60.% of them was male and 39.7% of them was female, and the mean age was found as 59,4 (± 13,6). 23% (n: 58) of 73 ECGs interpreted by the cardiologist was seen that they normally interpreted by the Emergency Medicine assistants. 179 electrocardiograms evaluated by the cardiologist were determined that they contained the pathologies as the major for 39, as the potential clinical importance for 78 and as the minor for 62. 187 electrocardiograms evaluated by the Emergency Medicine assistants were determined that they contained the pathologies as the major for 25, as the potential clinical importance for 89 and as the minor for 73
DISCUSSION AND CONCLUSION: In our study, we detected that there was significantly compatibility between the interpretation skills of electrocardiograms for the cardiologist and Emergency Medicine assistants. We also distinguished that there were important deficiencies. The electrocardiogram interpretation skills can be further improved by the trainings that will be given bedside

6.Nurses as a new stakeholder in genetics and the place of genetics in educational processes: A Study from Turkey
Ayşe Yacan Kök, Çiğdem Aydın Acar
doi: 10.5505/ejm.2019.48378  Pages 434 - 436
INTRODUCTION: Nurses having post graduate degree are ready to assume clinical and leadership roles in health care systems and should also be prepared to undertake similar roles in genetic / genomic health care services.The purpose of this study was to assess the undergraduate students’ awareness, perception and understanding of various human genetic topics, tests and disorders.
METHODS: This is a descriptive and cross-sectional study. A self-report questionare which was designed to evaluate undergraduate nursing students’ theorotically knowledge of genetic concepts, disease and the perception of students about medical biology and genetic lesson. Two hundred and twenty two pre-licencured nursing students compromised the sample. A 54-item questionnaire prepared by literature-based researchers was used as a data collection tool. Descriptive statistics and Fisher's Exact Test or Pearson Chi-square test were used to analyze the relations between categorical variables.
RESULTS: The majority of nursing students in this study (%70,1) took Medical Biology and Genetic lesson. But, more than half of nursing students (58,1%) reported “No” to adequate level of knowledge about genetic. Competence about genetic were not changed level of class. However, students who taking medical biology and genetic lesson had more genetic disease knowledge than no taking group. The evaluation of responses to the section on basic genetic information showed that the lowest levels of description were prenatal diagnosis (31,5%) and locus (36,9%). Also, 82,4% of the nursing students agreed that nurses’ role in genetic diseases diagnosis.
DISCUSSION AND CONCLUSION: With the advances in the field of genetics, there was a need for nursing students to integrate genetic information into nursing practice. It is thought that the results of this study may help to reform and improve the educational strategy related to medical biology and genetics in nursing education.

7.Retrospective Evaluation of Patients with Hairy Cell Leukemia: A Decade Experience at a Single Center
Mehmet Baysal, volkan bas, sedanur karaman gülsaran, ALİ CANER OZDOVER, Elif Umit, Hakki Onur Kirkizlar, Fulya Oz Puyan, Ahmet Muzaffer Demir
doi: 10.5505/ejm.2019.67944  Pages 437 - 440
INTRODUCTION: In this study, we aimed to investigate the demographic characteristics, treatment modalities and response rates in patients with Hairy Cell Leukemia (HCL) which have been diagnosed and followed up in our center.
METHODS: Data of the 27 patients diagnosed with HCL at our center between 2007 and 2018 were retrospectively evaluated. Patients diagnosed with HCL according to WHO 2016 classification of lymphoid neoplasms by bone marrow biopsy. Flow cytometry, clinical and demographic data of the patients were evaluated. BRAFV600E mutational status evaluated in selected cases. All patients were given cladribine as first line treatment
RESULTS: Eight of our patients (29.6%) were female and 19 (70.3%) were male. In 20 patients (74%), complete remission was detected with first-line cladribine treatment, while in 3 patients (11.1%) partial remission was achieved, and 4 patients (14.8%) were unresponsive. Rituximab was administered to 3 refractory patients while one patient received pentostatine. Two patients who could not achieve remission died due to severe and critical infection, while one patient died due to cerebrovascular disease. 24 of our patients are still alive.
DISCUSSION AND CONCLUSION: Cladribine confers a safe and effective treatment modality. Although purine analogs have improved response rates and progression-free survival, progress has yet to be made for resistant and relapsing patients

8.The Effect of Hypertension and/or Diabetes on Blood Pressure and Heart Rate Changes in Patients Undergoing Oral Surgeries
Levent Cigerim, Volkan Kaplan
doi: 10.5505/ejm.2019.64872  Pages 441 - 450
INTRODUCTION: The aim of this study was to evaluate the effect of hypertension and/or diabetes on systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) changes of individuals during oral surgeries.
METHODS: This randomized observational study was conducted on patients undergone oral surgical procedures. The individuals were divided into 3 systemic disease groups. The group 1 consisted of only individuals with hypertension, the group 2 included individuals with hypertension and diabetes, and the group 3 consisted of only individuals with diabetes. Initial and final SBP, DBP and HR measurements according to age, gender and body mass index (BMI) between groups were analysed statistically. The statistical significance level was set at p<0.05.
RESULTS: Of the 414 patients aged 18-82 years included in the study, 38.2% were male and 61.8% were female. Outcomes of 271 patients undergone surgical procedures; the DBP change of the patients in the group 3 were significantly lower than that of those in the group 1 (p<0.01). The HR change of the patients in the group 1 was significantly higher than that of the patients in the groups 2 and 3 (p<0.05). The increase in the SBP of the patients in the group 2 was higher than that of the patients in the group 3 in patients under the age of 50 years (p<0.05).
DISCUSSION AND CONCLUSION: In the literature, there was no study that evaluated the change in blood pressure and heart rate during surgery in diabetic patients.
Hypertension, diabetes, individual factors like BMI and age were effective in SBP, DBP and HR changes.

9.Investigation Of The Severity Of Depressive Symptoms In Cancer Patients Receiving Chemotherapy
Tülay Eren, gökşen inanç İmamoğlu, Cengiz Karaçin, Sema Türker, Ebru Cilbir, hayriye Şahinli, mustafa Altınbaş, ramazan esen, hasan Karadağ, doğan yazılıtaş
doi: 10.5505/ejm.2019.02419  Pages 451 - 456
INTRODUCTION: The prevalance of depression is high in cancer patients. In the process of initiation, maintenance and completion of treatment, the detection of depression is closely associated with treatment outcomes. Therefore, awareness of this issue is of great significance at present. In view of the aforementioned information, The aim of the present study is to investigate the severity of depressive symptoms and factors that can lead to depression in cancer patients receiving outpatient chemotherapy.
METHODS: Patients receiving chemotherapy in Diskapi Training and Research Hospital and volunteering to participate in the study, were administered Beck Depression Inventory and asked to fill sociodemographic data form.
RESULTS: The present study was carried out with 100 patients (55 female, 45 male) receiving treatment in outpatient chemotherapy unit. High depression score was detected in 21 (%) patients. In the evaluation of the factors influencing high depression score, the rate of high depression score was found to be higher in female patients (p: 0.03). Similarly the rate of high depression score was higher in patients at metastatic stage (p: 0.01). Apart from these, no other factor was found to be associated with high depression score.
DISCUSSION AND CONCLUSION: Depression is one of the factors that affect treatment compliance and prognosis of the disease. Therefore, awareness of this issue is quite important. Cancer treatment requires a multidisciplinary approach and in this patient groups, those with depressive characteristics should be especially supported.

10.Time-related comparison of scolicidal activity of the different substances used in hydatid cyst
Ersin Borazan, Mehmet Avni Gökalp, Yasemin Zer, Nurullah Aksoy, Alper Aytekin, Latif Yılmaz
doi: 10.5505/ejm.2019.04706  Pages 457 - 462
INTRODUCTION: Inactivation of protoscoleces is one of the main principles of treatment in hydatid cysts. The aim of the present study is to evaluate the scolicidal efficacies of some frequently used scolicidal substances in hydatid cyst fluid.
METHODS: Hydatid cyst fluids were aspirated from ten patients during surgical treatments and the interventional radiology procedures. The suitable cyst fluids were examined for interactions with 0.9% NaCl, 15% NaCl, 10% povidone-iodine, savlon, crystalline, and 0.4% chlorhexidine gluconate (Chx-Glu), respectively. Scoleces in the mixtures were counted at minutes 2, 5, 10 and 20. The ratio of the number of living scoleces / total scoleces was calculated. Normal distribution of numerical data was analyzed using the Shapiro - Wilk test. ANOVA and LSD tests were used in the comparison of variables.
RESULTS: There were significant differences between each scolicidal substances and time in terms of the ratio of living scoleces (p<0.05). But all scolicidal substances failed to kill all of the scoleces in the second and fifth minutes. There were significant differences between Chx-Glu and other scolicidal substances in the second minute apart from povidone-iodine, and 99% of the scolexes died at 5 minutes with Chx-Glu. Chx-Glu, savlon, and 10% povidone-iodine showed full efficacy in minute 10. Crystalline and 15% NaCl were able to reach full efficacy in minute 20.
DISCUSSION AND CONCLUSION: The efficacy of all substances was increasing with the waiting period. As soon as possible, the fastest active substance Chx-Glu seems to be used in conservative surgical interventions.

11.The Knowledge Level of Families Living in Van About Dental Trauma And Its Treatment
Beyza Ünalan Değirmenci, Alperen Değirmenci
doi: 10.5505/ejm.2019.07830  Pages 463 - 471
INTRODUCTION: The aim of this study was to assess the awareness of Turkish family members living in Van about TDI management and treatment.
METHODS: The questionnaires designed for our study consist of the answers of 762 random individuals who applied to Van Yuzuncu Yil University Faculty of Dentistry between February 2018 and November 2018. The questionnaire consists of 21 questions about TDI awareness and management.
RESULTS: All statistical analyses were performed using SAS version 9.4. Descriptive statistics for demographic data are illustrated using the mean. The Chi-Square test was used to assess the statistical significance between demographic data and TDI questions. Our study revealed that 48.5% of the participants were never informed about TDI before. 64.8% think that they are not competent enough to intervene in case of a TDI situation. The majority of Turkish family members knows little about the optimal storage medium. It was determined that the participants were not as well-informed about TDI management as they presumed to be.
DISCUSSION AND CONCLUSION: Educational activities should be organized in order to raise the awareness of TDI among Turkish family members.

12.Association Between Endothelial Nitric Oxide Synthase Polymorphisms T786C and G894T and Ischaemic Stroke
VEDAT CILINGIR, AHMET DONDER, Aysel Milanlıoğlu, Abdullah Yılgör, Temel Tombul
doi: 10.5505/ejm.2019.36036  Pages 472 - 477
INTRODUCTION: Endothelial nitric oxide synthase (eNOS) gene polymorphisms are suspected to increase the risk of ischaemic stroke (IS). eNOS-synthesized NO regulates vascular tone and inhibits the progression of atherosclerosis. The present study aimed to determine the association between eNOS polymorphisms G894T and T786C and IS.
METHODS: Sixty acute IS patients (32 male, 28 female) were included and classified in accordance with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Genotypes of patients with eNOS G894T and eNOS T786C polymorphisms were determined through polymerase chain reaction.
RESULTS: Significant differences were observed in the distribution of eNOS T786C polymorphism among IS subgroups. The eNOS T786C polymorphism heterozygote (TC) and homozygote (CC) genotypes more frequent in patients in the large artery atherosclerosis (LAA) subgroup. Considering a dominant model of inheritance for eNOS T786C polymorphism, the risk of IS was higher for the LAA subgroup than for other IS subgroups. Among potential haplotypes, the eNOS 786C+ eNOS 894G haplotype was associated with an increased risk of LAA; however, this finding was not statistically significant.
DISCUSSION AND CONCLUSION: eNOS gene polymorphisms are suspected to increase the risk of ischaemic stroke. Our results suggest that the eNOS T786C gene polymorphism is associated with LAA in IS patients.

13.Extraintestinal Manifestations Associated with Celiac Disease
Yusuf Kayar, Ramazan Dertli, Neslihan Surmeli, Mehmet Ali Bilgili
doi: 10.5505/ejm.2019.26122  Pages 478 - 483
INTRODUCTION: Celiac disease (CD) can be affected almost all organs of the body, including the nervous system, liver, skin, reproductive and musculoskeletal systems. In this study, it is aimed to determine the prevalence of extra-intestinal manifestations (EIMs) in adult celiac patients and to investigate the factors affecting the development of EIMs.
METHODS: The study included 230 celiac patients who were diagnosed and followed-up in our clinics between 2015-2019. The demographic and anthropometric characteristics, initial admission complaints, disease duration and dietary compliance of the patients were documented. All EIMs that accompanied the celiac disease were recorded, and their relationship with risk factors was analyzed.
RESULTS: The age range of the patients was 18-72 years, and the mean age was 33,4±10,6 years. One hundred seventy two (74.8%) patients were female and disease follow-up was 4,8±3,5 years. The number of patients with accompanying EIMs was 202 (87.8%). Osteoporosis/osteopenia was found in 146(63,5%) patients, oral involvement in 116(50,4%) patients, arthritis/arthralgia in 96(41,7%) patients as the most common comorbidities. It was determined that, there was a significant relationship between EIM and body mass index. Although the EIMs development was less in patients who had strict diet; however, this was not statistically significant.
DISCUSSION AND CONCLUSION: The majority of adult celiac patients were found to be accompanied by EIMs. The diagnosis is delayed due to various clinical presentations. Lack of delay in diagnosis of celiac disease and consequently reduced gluten exposure seem to be the only factor in preventing some EIMs.

14.Approaches in the treatment of urethral strictures
Murat Demir, kerem taken
doi: 10.5505/ejm.2019.71473  Pages 484 - 489
Urethral strictures are defined as the narrowing of the anterior urethral lumen or as corpus spongiosum fibrosis. Anterior urethral strictures can be divided as iatrogenic, inflammatory, idiopathic, and traumatic based on their etiology. Lower urinary tract septomas develop as a result of this disease. Many complications may occur in untreated patients.Cystoscopy, retrograde urethrography and ultrasonography can be used to diagnose the disease.Treatment methods are endoscopic and open surgery.Endoscopic treatment methods include dilatation, cold knife and laser internal uretrotomy. Recurrent bulbar urethral strictures; ”End-to-end anastomosis urethroplasty“ technique for short stenosis shorter than 2 cm. The technique of like ogmented anastomosis urethroplasty an with buccal graft is used for longer or complicated stenosis.

15.Relationship Between Calcium Metabolism Parameters
Saliha YILDIZ, Mustafa Öztürk
doi: 10.5505/ejm.2019.46873  Pages 490 - 496
INTRODUCTION: Blood calcium is under very tight control in a narrow range of 8.5-10.5 mg / dl. We aimed to investigate the factors that contributed to this control.
METHODS: 464 females and 254 males aged 16-96 years were examined retrospectively. PTH, 25OH vitamin D, Ca, Mg, P and spot urine calcium, creatinine levels were examined.
RESULTS: The rates were as follow; hypercalcemia 5.6%, primary hyperparathyroidism 10.4%, secondary hyperparathyroidism 40.8%, tertiary hyperparathyroidism 17.5%, normal PTH hypercalcemia 1.25%, hypocalcemia 13.5%, hypoparathyroidism 3.7%, hypovitaminosis D 77.6%, hypophosphatemia 6.4%, hyperphosphatemia 17.5%, hypomagnesemia 17.5%, hypermagnesemia 10.4%.
Severe vitamin D deficiency was 37% (n: 172) in females and 20% (n: 53) in males (p <0.01). Urinary Ca and urine creatinine 25 OH vitamin D cut-off value was 10 ng / ml and it was 13ng / ml for PTH. While vitamin D was 10-20 ng / ml, urine Ca / creatinine ratio was lowest and it increased after 20 ng / ml in females and 30 ng / ml in males. There was a negative correlation with PTH as Ca decreased from 8.3 mg / dl and a positive correlation when it increased above 9.2 mg / dl. Mg correlated positively with PTH, Ca and P (p: 0.00 r: 0.23, p: 0.007 r: 0.13, p: 0.00 r: 0.21, respectively).

DISCUSSION AND CONCLUSION: Mg was found to be significantly correlated with all parameters and 25 OH vitamin D was not correlated with any parameters. On the other hand, we have determined the threshold values where the parameters interact with each other.

16.Relationship between red cell distribution width and serum C reactive protein levels in maintenance hemodialysis patients
Ali Veysel Kara
doi: 10.5505/ejm.2019.26213  Pages 497 - 502
INTRODUCTION: We aimed to investigate the relationship between RDW and serum CRP levels in maintenance hemodialysis patients.
METHODS: We enrolled 112 eligible maintenance hemodialysis patients in this retrospective study. Two groups were identified according to red cell distribution width (RDW) values: patients with normal RDW (RDW < 14.5%) and patients with elevated RDW (RDW ≥ 14.5%). Spearman correlation analysis and linear regression analysis were used to investigate the relationship between the study parameters.
RESULTS: The only statistically significant difference between two groups was serum CRP levels (p: 0.007). Serum albumin levels had significant but weak inverse correlation with serum CRP levels (r: -0.257, p: 0.006). RDW values had significant but weak positive correlation with serum CRP levels (r: 0.289, p: 0.002). We did not found a significant correlation between hemoglobin levels and serum CRP levels and serum ferritin levels and serum CRP levels (p: 0.090 and p: 0.664, respectively). We made multivariate linear regression analysis and RDW was detected as the only independently associated factor for serum CRP levels (p: 0.028).
DISCUSSION AND CONCLUSION: We found that there is a statistically significant positive correlation between CRP and RDW in maintenance hemodialysis patients. We also showed a significant relationship between RDW and serum CRP levels. We concluded that RDW can be used as an inflammatory marker for hemodialysis patients.

17.Perforated Gastrıc Cancer: A Dıffıcult Challenge For The Surgeon.
özkan yılmaz, Necat Almalı
doi: 10.5505/ejm.2019.92259  Pages 503 - 509
INTRODUCTION: Perforated gastric cancer (PGC) is a rare complication of gastric cancer that is associated with high in-hospital mortality. Most patients with PGC undergo emergency surgery with a prediagnosis of acute abdomen. The challenges faced in the preoperative diagnosis persist during surgery due to lack of an optimum surgical approach, meaning that the surgical treatment of patients with PGC is often based on the experience and prejudices of the surgeon. The aim in the present study is to evaluate the clinicopathological characteristics of patients with PGC and to discuss the currently available surgical treatment options.
METHODS: The present study investigated retrospectively the demographic characteristics of 30 patients who underwent surgery for pgc in our clinic, and in whom a pathological examination revealed adenocarcinoma. The study further evaluated the relationship between the employed treatment methods and survival.
RESULTS: The study included 30 patients, 23 of which were male and seven who were female. The mean age was 62.4±10.5 years. In terms of disease progression, 23 patients had stage IV, six had stage III and one had stage II. Of the total, 19 patients underwent a gastrectomy and 11 underwent local repair. In-hospital mortality occurred in 10 patients (four of which underwent a gastrectomy and six who underwent a local repair). The difference between the gastrectomy and local repair groups was significant in terms of mortality (p<0.017). Overall survival was 286±516.7 days across the entire study group, 421.2±614.8 days in the gastrectomy group and 68±105.7 days in the local repair group. There was a significant difference between the two groups in terms of mean survival (p<0.13). A positive correlation was identified between perioperative sepsis parameters and in-hospital mortality. The mean survival time was significantly higher in the non-septic group (886±729.5 days) than in the septic group (67.8±65.5 days) (p<0.01).
DISCUSSION AND CONCLUSION: Patients with PGC represent a challenge for surgeons due to difficulties in treatment and the poor prognosis of the patients. Although PGC occurs in only very rare occasions, it must be kept in mind that the selection of an appropriate surgical therapy and the successful treatment of sepsis are of vital importance.

18.Evaluation Of Intraocular Pressure and Central Corneal Thickness Changes After Hemodıalysis in Patıents With Chronic Renal Failure
Seyfettin Erdem, Müslüm Güneş
doi: 10.5505/ejm.2019.15986  Pages 510 - 514
INTRODUCTION: This study evaluated short-term changes in intraocular pressure (IOP) and corneal thickness (CCT) following haemodialysis (HD) in chronic renal failure (CRF) patients.
METHODS: We studied 34 eyes of 34 patients with CRF undergoing HD. Patients included in the study were classified into two subgroups: group 1 (with DM) and group 2 (non DM). All patients underwent a detailed ophthalmological examination including CCT and IOP before and after the HD session. Total body weight and body volume loss after haemodialysis were also measured.
RESULTS: The sex distribution of patients were 22 female (64.7%) and 12 male (35.3%). The DM group was comprised of 15 patients (44.1%), and the non-DM group had 19 patients (55.9%). The mean age was 60.3 ± 17.2 (range 21–88) years, and the dialysis time was 51.4 ± 38.5 (range 5–132) months. The mean IOP change after HD decreased from 15.88±2.37 to 14.11±2.02 mmHg (95% CI, 1.40–2.11; p < 0.001). The mean CCT decreased from 554.88±14.27 to 550.52±13.67 μm. (95% CI, 1.97–4.08; P = p < 0.001). The loss in body volume was positively correlated with a decrease in IOP (r = 0.737, p < 0.001) and CCT (r = 0.784, p < 0.001).
DISCUSSION AND CONCLUSION: In patients with CRF who have glaucoma, visual acuity may be adversely affected by IOP and CCT changes following HD. Therefore, a detailed ophthalmologic examination should be performed to take preventive measures for at-risk patients before and after HD.

19.Determination of post-transplant diseases in kidney donors and investigation of risk factors
murat alay, Taner Kara
doi: 10.5505/ejm.2019.43760  Pages 515 - 519
INTRODUCTION: Kidney donors are followed up periodically for health problems such as chronic renal failure (CRF), hypertension (HT), diabetes mellitus (DM) that may develop after transplantation. The aim of this study was to determine the disease and to investigate the risk factors in renal donors followed in the outpatient clinic of the Nephrology.


METHODS: In this study, 40 patients with renal donors aged between 18-75 years who were admitted to the nephrology clinic were included. From all donors; anamnesis was taken to determine if there was any disease after kidney transplantation and physical examinations were performed.
Donors have previously looked at; 24-hour urinary glomerular filtration rate (GFR) and proteinuria measurement, creatinine, alanine aminotransferase (ALT), fasting glucose, hemoglobulin A1c (HgbA1c) values were recorded. According to the physical examination and laboratory results of the donors, systemic disease after transplantation and risk factors were evaluated

RESULTS: Of the 40 donors included in the study, 29 (72%) were female and 11 (18%) were male. In the post-transplant background; 3 (7.5%) had DM, 6 (15%) had HT and 1 (2.5%) had both DM and HT. The mean GFR was 81.62 ± 21.31 ml / min. The viral markers of the donors were negative for anti-HCV, anti-HIV and HbsAg
DISCUSSION AND CONCLUSION: As a result of the study, the incidence of diseases such as DM, HT, CRF in the follow-up of kidney donors admitted to our clinic was found to be the same as in the community.The fact that the incidence of donor diseases after transplantation is the same as the incidence in the community leads to a better option in the treatment of end-stage renal disease

20.Evaluation of Asterion Morphometry in Terms of Clinical Anatomy
Sinem Akkaşoğlu, Mine Farimaz, Hilal Akdemir Aktaş, Hakan Ocak, Ömür Dilek Erdal, Mustafa Fevzi Sargon, selma çalışkan
doi: 10.5505/ejm.2019.504523  Pages 520 - 523
INTRODUCTION: Asterion is the junction of lambdoid, parietomastoid and occipitomastoid sutures and it corresponds to the location of the posterolateral fontanelle. It is close related to the location of junction of transverse and sigmoid sinuses.
Mastoid process, posterior end of zygomatic arch, external occipital protuberance and lambda are bony features in close proximity of asterion. In the present study we measured the distance between asterion and each of aforementioned bony points.

METHODS: Twenty human dry skulls were included in this study.
RESULTS: Distance between asterion and mastoid process was 43.65 ± 6.75 mm on the left side and 45.01± 6.04mm on the right side. Distance between asterion and posterior end of zygomatic arch was 43.97 ± 7.37 mm on the left side and 43.95± 7.02 mm on the right side. Distance between asterion and external occipital protuberance was 62.59 ± 8.83 mm on the left side and 54.75 ±5.57mm on the right side. Distance between asterion and lambda was 81.40 ± 7.36 mm on the left side and 82 ± 4.96 mm on the right side.
In 84 % of the cases asterion was at the junction of transverse and sigmoid sinuses. In 12% of the cases asterion was below the junction of transverse and sigmoid sinuses. In 4 % of the cases asterion was above the junction of transverse and sigmoid sinuses.

DISCUSSION AND CONCLUSION: Asterion is the essential point to indicate safety zone for surgical approach and to determine sex and age. It is great interest of anatomists, anthropologists, forensic experts, radiologists and neurosurgeons.

21.Treatment of Osteochondral Lesions of the Talus with Transmalleolar Open Mosaicplasty
Cihan Adanaş, SEZAİ ÖZKAN
doi: 10.5505/ejm.2019.86729  Pages 524 - 529
INTRODUCTION: To evaluate middle-term outcomes of patients that underwent open mosaicplasty due to osteochondral lesions of the talus causing chronic complaints.
METHODS: The retrospective study included 23 patients that were diagnosed with a Grade III, IV, and V osteochondral lesion of the talus according to the Bristol classification system between January 2014 and December 2017. Pain assessment was performed using Visual Analog scale (VAS 1-10) and functional outcomes were assessed using the AOFAS (American Orthopedic Foot & Ankle Society) Ankle-Hindfoot Rating System. Additionally, a questionnaire was filled out by each patient both preoperatively and at 1 year postoperatively.
RESULTS: Mean AOFAS score was 55.652 preoperatively and was 88.913 postoperatively and a significant difference was found between the two scores (p<0.001). Similarly, mean VAS score was 7.39 preoperatively and was 2.04 postoperatively and a significant difference was found between the two scores (p<0.001).
DISCUSSION AND CONCLUSION: Open mosaicplasty appears to be a useful technique for the treatment of cystic osteochondral lesions of the talar dome larger than 10 mm in diameter. The technique is also safe and effective and allows successful closure of the cartilaginous loss with hyaline cartilage.

22.Training Healthcare Staff on Ventilator-Associated Pneumonia (VAP) Prevention Bundle and Its Effects on VAP Bundle on VAP
Mehmet Zeki Çakan, Hilmi Demirkıran, Cevdet Yardımcı
doi: 10.5505/ejm.2019.63626  Pages 530 - 535
INTRODUCTION: Ventilator-associated pneumonia (VAP) is a nosocomial infection that can develop in patients receiving mechanical ventilator (MV) support. In this study, we aim to investigate how increased compliance with VAP prevention bundle training for health personnel affects the incidence of VAP, the onset day of VAP, the duration of mechanical ventilation, and mortality rates.
METHODS: In this study, the study group (VAP prevention bundle group after healthcare staff training) included 68 patients who received MV support. The control group consisted of 100 patients who received the VAP prevention bundle between January 2016 and June 2017 in the anaesthesia ICU.The Centers for Disease Control and Prevention (CDC) criteria were used for the diagnosis of VAP. In both groups, compliance with the Prevention Bundle, the incidence of VAP, the onset day of VAP, the duration of mechanical ventilation, the day of tracheostomy operation and mortality rates were recorded.Patient groups were compared statistically.
RESULTS: ETT cuff pressure of 20–25 cm H2O was maintained at 97.96% in the VAP Prevention Bundle group and at 93.13% in the control group (p = 0.01). In our study, VAP was detected in 12 patients (17.6%) in the study group and 9 patients (9%) in the control group.The carrying out the VAP prevention bundle to the patients with mechanical ventilatory support reduced the mortality rates.
DISCUSSION AND CONCLUSION: Implementation of the VAP prevention bundle group did not decrease the incidence of VAP in our clinic.We think that the present VAP prevention bundle should be revised in the way of use of stress ulcer prophylaxis.

23.Relationship between Vitamin D deficiency and Chronic Tension-type Headache
Aydın Çağaç
doi: 10.5505/ejm.2019.53315  Pages 536 - 538
INTRODUCTION: Vitamin D deficiency is a possible factor involved in the etiology of chronic tension-type headache (CTTH). Vitamin D is directly associated with lifestyle and eating habits and affects a large proportion of the general population. The aim of this study was to investigate the role of vitamin D deficiency in CTTH.
METHODS: Patients aged 18 years or older that presented to our Neurology polyclinic with CTTH between December 1, 2017 and March 31, 2018 were reviewed retrospectively. Patients were assigned into three groups based on their Vitamin D levels: (I) deficiency state: <10 ng/mL, (II) insufficiency state: 10-25 ng/mL, and (III) optimal state: 25-70 ng/mL. The groups were compared with regard to age, gender, and Vitamin D levels.
RESULTS: The study included a total of 782 patients comprising 32% men and 68% women with a mean age of 34 years. Based on their serum Vitamin D levels, 482 (61.6%) patients were classified into Group I (<10 ng/mL), 211 (27.0%) patients into Group II (10-25 ng/mL), and 89 (11.4%) patients into Group III (>25 ng/mL) and a significant difference was found among the three groups with regard to serum Vitamin D levels (p<0.01).
DISCUSSION AND CONCLUSION: Vitamin D deficiency is an increasingly major health problem due to modern lifestyle. Accordingly, Vitamin D deficiency should be considered in patients presenting with CTTH.

24.Perioperative Results of Patients Undergoing Laparoscopic Cornual Resection and Cornuotomy in Cornual Pregnancy; Three Years Experiences of a Tertiary Referral Center
Pınar Kadiroğulları, Huseyin Kiyak, Kerem Doğa Seçkin
doi: 10.5505/ejm.2019.07108  Pages 539 - 544
INTRODUCTION: Cornual pregnancy is a rare form of ectopic pregnancy that accounts for 2 to 4% of ectopic pregnancies, with a mortality rate of 2.0 to 2.5%. Traditionally, interstitial pregnancies were treated by medical treatment (methotrexate) or by laparotomy, cornual resection or hysterectomy. We aimed to report perioperative outcomes in these series of patients treated with laparoscopic surgery for cornual ectopic pregnancy.
METHODS: The data of the patients who underwent laparoscopic surgery for interstitial pregnancy (n=10) were retrospectively reviewed. Demographic characteristics of the patients such as age, gravida, parity, predisposing factors were examined. Complaints of admission, operation and duration, preoperative and postoperative hemoglobin levels, size of pregnancy materials, length of hospital stay and complications were evaluated.
RESULTS: Eight patients underwent laparoscopic cornual resection and two patients underwent laparoscopic cornuotomy. The mean age of the patients included in the study was 29.5±4.0 years, gravida 2.2±1.1, parity 0.7±0.82, delta hemoglobin 1.19±0.57 g/dl. Abnormal bleeding and inguinal pain were the most common symptoms in symptomatic patients. The mean operation time was 64.5±22.6 (40-120) minutes. The mean hospital stay of the operated patients was 2.7±0.67 days.
DISCUSSION AND CONCLUSION: Laparoscopic treatment of cornual ectopic pregnancies is an appropriate and safe treatment option. In our experience, the laparoscopic approach minimizes overall blood loss without causing trauma and allows a bloodless area for anatomic restoration. We believe that laparoscopic cornual resection and cornuotomy can be performed successfully in the hands of experienced surgeons and the future fertility chances of the patients can be preserved.

25.Coronary Artery Anomalies and Variations Detected in Computed Tomography Angiography
Ali Mahir Gündüz
doi: 10.5505/ejm.2019.33043  Pages 545 - 550
INTRODUCTION: There are many methods in the diagnosis of coronary artery diseases, and the reference method is catheter angiography. Coronary computed tomography angiography (c-CTA) is more valuable in the diagnosis of coronary artery and cardiac anomalies, plaques in the coronary artery wall, aortic dissection, myocardial bridges, osteal pathologies and coronary fistulas. In this study, we investigated the diversity and frequency of coronary artery anomalies and variations in c-CTA examinations performed in our unit.
METHODS: We included 700 patients who underwent c-CTA in the study. The c-CTA images and reports of the patients were retrospectively evaluated, and the diversity and frequency of coronary artery anomalies and variations were investigated. The axial images, multiplanar reconstruction, maximum intensity projection and 3D volume rendering images were examined together and coronary artery stenosis, anomalies and variations were evaluated.
RESULTS: We detected intermediate artery in 126 patients (18%) myocardial bridging in 87 patients (12.43%). LMCA was not observed in 11 (1.6%). Single coronary artery was observed in 3 (0.43%). RCA showed an interarterial course between aorta and pulmonary artery in 1 patient (0.14%).
DISCUSSION AND CONCLUSION: C-CTA is an effective method in detecting coronary artery diseases, variations and anomalies. There are studies indicating that c-CTA is superior to catheter angiography in the diagnosis of coronary artery anomalies. Coronary artery anomalies are the uncommon category of cardiac diseases. Their incidence in the community is 1-2%. Our study supports that c-CTA is an imaging method that is used in the diagnosis of coronary artery anomalies and variations and provides detailed information.

CASE REPORT
26.Management of Incidental Amyand Hernia With A Case Report.
TOLGA KALAYCI, ÜMİT HALUK İLİKLERDEN
doi: 10.5505/ejm.2019.82787  Pages 551 - 553
Introduction

The presence of appendix vermiformis in inguinal hernia is known as Amyand hernia. Amyand hernia is a rare condition estimated to account for approximately 1% of all inguinal hernias. In our case we want to show our approach to incidental Amyand hernia.

Case Report

An 80-year-old male patient was received at urology service because of prostatic symptoms. There were comorbid factors like hypertension,chronic obstructive lung disease and geriatric age. On surgery with spinal anesthesia, surgeons invited us to evaluate his left inguinal hernia. We evaluated hernia and saw distal ileal segments, proximal right colonic segments and inflamme appendix at hernia defect. Because of appendix inflammation we performed appendectomy. Hernia was repaired with mesh. We put a drain at surgery area. At postoperative first day, the patient discharged with drain. The fifth day of post-surgery, the drain was pulled out. At the time of 1st and 3rd month check of the patient, there was no problem about surgery.

Discussion

Amyand hernia is one of the rare conditions encountered by the surgeon during hernia surgery. The surgeon must know the Rosanoff and Bassoon Classification of Amyand Hernia to successfully manage Amyand hernia surgery. The surgeon also must know the situation in which case an appendectomy should be performed and in which case the mesh should be used.

27.Coexistence of Autism and Ring Chromosome 22
Esra Sizer, Tuğba Yüksel, Diclehan Oral
doi: 10.5505/ejm.2019.52714  Pages 554 - 557
The incidence of ring chromosome 22, which was first described by Weber et al. in 1968, is not known yet. Phenotypic features such as craniofacial anomalies, growth and developmental retardation, hypotonia, mental retardation, delay in motor skills, and syndactyly in the 2nd and 3rd toes are observed in cases with ring chromosome 22. Ring chromosome 22 abnormality has rarely been reported in children diagnosed with autism spectrum disorder. Herein, we will discussed a six-year old boy having a karyotype of 46, XY, r (22) (p11.2q13), ish del (22qter) (MS607-) on cytogenetic examination who was diagnosis with autism spectrum disorder.

28.Isolated pneumopericardium after penetrating chest injury
Hasan Ekim, Meral Ekim
doi: 10.5505/ejm.2019.25582  Pages 558 - 559
Pneumopericardium is defined as the presence of air or gas in the pericardial sac. Its course is stable unless tension pneumopericardium develops. However, even patients with asymptomatic pneumopericardium should be carefully monitored due to risk of tension pneumopericardium. We presented a 24-year-old male victim with stab wound complicated with isolated pneumopericardium. Pneumopericardium was accidentally encountered by plain chest radiograph. It was spontaneously resolved without pericardiocentesis or pericardial window.



 
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