ISSN 1301 - 0883 / E-ISSN 1309 - 3886
 
 








  Eastern J Med: 22 (4)
Volume: 22  Issue: 4 - 2017
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ORIGINAL ARTICLE
1.The Presence of Paroxysmal Nocturnal Hemoglobinuria in Patients with Idiopathic Chronic Renal Failure
Omer Ekinci, Ali Dogan, Cengiz Demir
doi: 10.5505/ejm.2017.30301  Pages 133 - 136
INTRODUCTION: Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal stem cell disease. Chronic renal failure (CRF) is defined as progressive deterioration in the regulation of fluid and electrolyte balance of the affected kidney due to a decrease in glomerular filtration rate resulting from various diseases. We also investigated the presence of PNH in follow-up patients diagnosed with end-stage renal failure (ESRD) of unknown etiology in this study.
METHODS: This study was carried out at the Yüzüncü Yıl University in Van, Turkey. Sixteen patients with end-stage renal failure who had unknown etiology from a total of 143 patients were included in the study. The patients’ age, gender, hemogram, biochemical parameters, and percentage of PNH clone were examined. PNH clone was analyzed by the Fluorescein Aerolysin method.
RESULTS: Of the patients, 10 (62%) were female, 6 (38%) were male. Hemodialysis was performed in 15 patients (94%) as renal replacement therapy. Fourteen of the patients (88%) had anemia. LDH was elevated in 6 patients (38%), and those with high LDH also suffered from anemia. PNH clone was negative for all patients as determined by FLAER analysis.
DISCUSSION AND CONCLUSION: A survey of the literature did not result in any study on the presence of paroxysmal nocturnal hemoglobinuria in idiopathic chronic renal failure. This is the first such study with this focus. Based on review of the cases described in the literature, PNH should be considered in the differential diagnosis of renal failure cases which are unexplained and especially those accompanied by hemolysis findings.

2.Evaluation of the hand anthropometric measurement in ADHD children and the possible clinical significance of the 2D: 4D ratio
Ece Buru, Rabet Gözil, Meltem Bahçelioğlu, Seçil Özkan, Elvan İşeri
doi: 10.5505/ejm.2017.73792  Pages 137 - 142
INTRODUCTION: Objectives. Attention deficit/hyperactivity disorder (ADHD) is characterized with decreased storage time of the information related to the lack of attention and behavioral changes such as hyperactivity and anxiety with hand features. Our purpose was to investigate the possibility to use the 2D: 4D ratio in clinics as an easy prediagnostic parameter.
METHODS: Methods: A total of 540 people (104 ADHD, 436 controls) between 7 – 17 years old were included in our study.
RESULTS: Results. Our study group revealed a statistically meaningful difference between the ADHD and their controls in 2D: 4D ratio of their right hand and the 2D: 4D and 4D: 5D ratios of their left hand. The male ADHD subjects and controls also demonstrated significant difference in their 2D: 4D, 2D: 5D, 3D: 4D, and 3D: 5D ratios of the right hand and the 2D: 4D and 2D: 5D ratios of the left hand. Especially, ADHD boys had a more feminize 2D: 4D left hand ratio than the controls. While, there was a significant difference in all finger ratios of the right hand and the 2D: 4D and 4D: 5D ratios of the left hand between the ADHD girls and their controls. Thus, the more masculine 2D: 4D right hand ratio was observed in ADHD girls.
DISCUSSION AND CONCLUSION: Conclusion. Our results pointed out that the ADHD and some other child psychiatric disorders could be early diagnosed related to the anthropologic parameters. So, the treatment of these individuals could be assigned in early period.



3.The role of paroxysmal nocturnal hemoglobinuria in idiopathic habitual abortion
Yaren Dirik, Omer Ekinci, Osman Kara, Deniz Dirik, Ali Dogan, Cengiz Demir
doi: 10.5505/ejm.2017.30085  Pages 143 - 146
INTRODUCTION: Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal hematopoietic stem cell disease presenting with intravascular hemolysis, bone marrow failure, and thrombosis. Hereditary and acquired thrombophilia are known to play an important role in the etiology of patients with habitual abortion (HA). PNH, which is a cause of acquired thrombophilia, may have a role in the etiology of HA. In this study, we investigated the presence of PNH in the etiology of patients with a history of HA.
METHODS: The study group consisted of 150 patients diagnosed with habitual abortus of unknown etiology and 150 healthy women with no history of habitual abortus as a control group. The age range for both groups was 18 – 55 years. The PNH clone was screened by the FLAER (fluorescein-labeled proaerolysin) method.
RESULTS: The PNH clone was positive in five (3.3%) patients in the study group. Four of the PNH clone positive patients were found to have a very low clone positivity level (0.05%, 0.24%, 0.12%, 0.21%), while one had a high level (30%).
DISCUSSION AND CONCLUSION: PNH clone positivity results in the study group indicate that PNH should be investigated in cases of idiopathic HA, as one patient required treatment.

4.Survivin Expression May Affect The Neoadjuvant Chemotherapy Response in Breast Cancer Patients
Sinan Demircioğlu, Mehmet Artaç, Levent Korkmaz, Şeyda Gündüz, Mustafa Karaağaç, Hasan Esen, Gülgün Erdoğan, Zehra Er, Elif Peştereli, Lema Tavlı, Hakan Bozcuk
doi: 10.5505/ejm.2017.92486  Pages 147 - 154
INTRODUCTION: To investigate whether there is a predictive effect of NF-kappaB, survivin, and Ki-67 expressions on pathological response and disease relapse in breast cancer (BC) patients
METHODS: Ki-67, survivin and NF-kappaB expressions were analyzed in the pathology specimens of breast biopsy before and after neoadjuvant chemotherapy (NeoCT) in BC patients (n=52). Event-free survival (EFS) (defined as recurrence or metastasis free) analyze was performed.
RESULTS: The median overall survival was 43.5 months and the median EFS was 51 months (95% CI: 33.3-68.9) in all patients. The expression percentages of NF-kappaB, survivin, and Ki-67 significantly decreased after NeoCT (p<0.001). Survivin expression level before NeoCT was significantly higher in patients who did not respond to NeoCT than both partial-responders and complete-responders (p=0.038, p=0.010, respectively). Type of NeoCT was the only independent factor on pathological response status (p=0.007). Addition of taxanes to NeoCT improved pathological complete response rates about six times. However, no predictor was found to be a prognostic factor for EFS in multivariate analyze.
DISCUSSION AND CONCLUSION: Higher survivin expression level before NeoCT may be associated with poor pathological response to NeoCT. These findings must be tested with prospective clinical trials.

5.The comparison of dentin adaptation and sealing ability of gutta-percha/AH Plus, Resilon/Epiphany SE, EndoREZ: an in-vitro study
Mert Gökay Eroğlu, Gündüz Şekip Bayırlı
doi: 10.5505/ejm.2017.86580  Pages 155 - 161
INTRODUCTION: The aim of this study was to compare three different root canal filling systems (gutta-percha/AH Plus, Resilon+Epiphany SE, EndoREZ) regarding their adaptation to dentine and their sealing ability at different horizontal sections.
METHODS: Hundred single-rooted upper incisors were divided into 3 groups and filled gutta-percha/AH Plus, Resilon+Epiphany SE or EndoREZ root canal filling system. All teeth were sectioned at the depths of apical 1 mm, 3 mm, and 5 mm. The cut sections were examined with stereomicroscope. The ratios of the areas containing core material, sealer and/or space to the total area were calculated and analyzed statistically.
RESULTS: EndoREZ had significantly more core ratio at 1 mm compared to the other systems. At 3 mm, Gutta-percha/AH Plus had the lowest core ratio (p<0.05). At 1 mm cut section, EndoREZ had significantly lower sealer+debris+space ratio than other groups, while Gutta-percha/AH Plus had the highest sealer+debris+space ratio at 3 mm (p<0.05). When core, sealer, and space areas were examined within groups, significant differences were found in the ratios of Gutta-percha/AH Plus and Resilon+Epiphany SE groups at different cut sections.
DISCUSSION AND CONCLUSION: Results of the present study are mostly consistent with the previous findings. However, there are some contradictory results as well. Conflicting findings might result from the differences in the methods of measurement. Moreover, filling materials that are away from the biological cycle may limit in vitro studies.

6.Effect of Postmenopausal Strontium Ranelate Treatment on Oxidative Stress in Rat Skin Tissue
Mehmet Berköz, Özgün Sağır, Serap Yalın, Ülkü Çömelekoğlu, Fatma Söğüt, Pelin Eroğlu
doi: 10.5505/ejm.2017.76588  Pages 162 - 166
INTRODUCTION: The effects of strontium ranelate in the treatment of post-menopausal osteoporosis on the free radical-antioxidant balance of the skin have not been fully elucidated. In this study, we investigated the effects of strontium ranelate treatment on oxidative stress parameters in the skin tissue of rats with the experimental osteoporosis model.
METHODS: Total 35 Wistar-Albino rats were divided to 5 groups as control group (Group I), oophorectomy group (Group II), strontium ranelate group (Group III), oophorectomy + strontium ranelate group (immediately after the overectomy) (Group IV) and overtectomy + strontium ranelat group (after three months of overectomy) (Group V). In Group III, IV and V, 500 mg/kg doses of strontium were given to rats by orally. At the end of the study, malondialdehyde (MDA) and glutathione (GSH) levels, superoxide dismutase (SOD) and catalase activities of the rats’ skin tissues were determined.
RESULTS: Catalase and SOD activities and GSH levels of all groups were found to be significantly lower than Group I (p<0.05). MDA levels of all groups were significantly higher than Group I (p<0.05). Catalase and SOD activities and GSH levels of Group IV and V were found to be significantly lower than Group II (p<0.05). MDA levels of Group IV and V were found to be significantly higher than Group II (p<0.05).
DISCUSSION AND CONCLUSION: In conclusion, strontium ranelate treatment in oophorectomized rats has resulted in an increase in oxidative stress in skin tissue and can cause to several skin disorders.

7.Pre-operative mean corpuscular volume, red cell distribution width and neutrophil-to-lymphocyte ratio in patients with enchondroma
Sezai Özkan, Cihan Adanaş, Ferhat Danışman
doi: 10.5505/ejm.2017.40427  Pages 167 - 171
INTRODUCTION: Enchondromas are benign, solitary bone tumors originating from hyaline cartilage, that are usually located in the upper and lower extremities. They are equally distributed in both genders and in all age groups. Approximately 40-65% of the cases are located in the small tubular bones of the hand, and the proximal phalanx, metacarpal bones, middle phalanx are frequently involved; involvement of the distal phalanx is quite rare. The aim of this study was to investigate the pre-operative white blood cell count, neutrophil count, red cell distribution width, mean corpuscular volume, platelet count, hemoglobin, hematocrit and NLR values, and make a comparison with a control group. The most commonly involved sites are also investigated in the patient group.
METHODS: This retrospective study investigated the preoperative WBC, neutrophil, lymphocyte, RDW, MCV and NLR values in 20 patients and 20 controls, and compared the frequency of the involved sites among patients with enchondroma.
RESULTS: No statistically significant difference was determined between the groups with regard to WBC, neutrophil count, MCV, RDW. While the NLR values were different between the groups, there was no statistically significant difference. Involvement of the proximal phalanx was statistically significantly higher (p<0.05).
DISCUSSION AND CONCLUSION: This is the first study investigating the pre-operative RDW, MCV, NLR, PLT, Hgb, Hct and WBC in patients with enchondroma. While no statistically significant difference was determined between the groups with regard to these parameters, we suggest that they should be studied in larger groups and in clinical tests, so that the malignancy potential may be predicted.

8.Retrospective Analysis of Patients Followed at Van Training and Research Hospital Palliative Care Unit
Havva Yeşil Çınkır, Abdullah Kahraman
doi: 10.5505/ejm.2017.92005  Pages 172 - 175
INTRODUCTION: Palliative care has taken place in the health system in the world over the last 30 years as a care system that includes medical and supportive treatments to alleviate the suffering of persons with difficult or impossible treatment. In this study, we aimed to evaluate retrospectively the patients treated and followed-up in our hospital palliative care service.
METHODS: The data of 327 patients who were followed-up and treated in the palliative care unit of Van Training and Research Hospital between May 2015 and February 2017 were reviewed retrospectively.
RESULTS: Of the 327 patients, 137 (41.9%) were female and 190 (58.1%) were male. The median age was 63 and the age range was between 12 and 96 years. 87.8% of the patients were followed up due to cancer and cancer related complications. The most common cancer was stomach (32.7%) and esophagus (11.3%). Among the reasons for admission, oral intake disorder was 34.6%; pain palliation 24.5%; oral intake impairment / pain palliation 16,2%. Total parenteral nutrition was applied to 57.2% of the patients, jejunostomy was performed in 2 patients, and percutaneous enterogastrostomy was performed in 1 patient. 67% of patients underwent pharmacologic and invasive treatment for pain palliation. In follow-up, 77 patients (23.5%) died.
DISCUSSION AND CONCLUSION: With the increase in the number of elderly population, chronic diseases and bed dependent patients, palliative care needs and awareness are increasing in non-cancer patients. Increasing the number of palliative care centers will improve the quality of life of end-cancer patients and other patient groups and their families.



9.Effect of exercise on erythrocyte osmotic fragility in high fat diet fed rats during intermittent fasting
Semih Yaşar, Nizamettin Günbatar, Sevgi Yüksek, Okan Arıhan, Gökhan Oto
doi: 10.5505/ejm.2017.39200  Pages 176 - 179
INTRODUCTION: Exercise is an important component of a healthy lifestyle. High fat diets are blamed for various health problems such as cardiovascular diseases. Intermittent fasting is a way of increasing longevity and decreasing certain adverse health conditions. In this study effect of exercise, intermittent fasting and high fat diet on erythrocyte osmotic fragility which is an important marker of erythrocyte integrity.
METHODS: 42 Wistar albino male rats were used in this study. Rats were divided into 7 groups in which each were composed of 6 animals. Exercise was administered 3 times a week. Intermittent fasting was administered 2 times a week (24 without any food in those two days). High fat was given in a high fat diet. Combination of applications was also administered in different groups.
RESULTS: Results state an increase in erythrocyte osmotic fragility due to exercise. High fat or intermittent fasting did not cause in increase in fragility however they did not alleviate increased fragility due to exercise where they are concomitantly administered with exercise.
DISCUSSION AND CONCLUSION: Intermittent fasting administered solely or with high fat did not change erythrocyte osmotic fragility therefore stating no negative impact of intermittent fasting on this studied parameter. However no protective effect was observed in IF+Exe group. This result can also be interpreted with high impact of Exe in this study on the rats. Studies including molecular mechanism focusing on erythrocyte membrane lipid alterations should be performed to clarify current findings.

10.Is Reassessment of Radiographs Taken from Pediatric Patients Useful for Detecting Unrecognised Hip Dysplasia?
Reşit Sevimli, Mehmet Fethi Ceylan, Emrah Yıldırım, Mehmet Aslan, Gökay Görmeli
doi: 10.5505/ejm.2017.78941  Pages 180 - 183
INTRODUCTION: Developmental Dysplasia of the Hip (DDH) is an entity that may be congenital as well as develop during infancy or childhood and include anatomic disorders of the hips. Moreover,DDH is of great importance with the possibility of being diagnosed late and the disabilities it causes inpatients.Despite the fact thatthere was not a patient with complaints of hip dislocation in this study, the unrecognized cases that admitted to the clinics due to other complaints were tried to present.
METHODS: Hip and pelvic radiographs taken from10000 children who were referred to emergency and pediatric outpatient clinics of our department with other complaints between 2009-2016were evaluated.Six patients who had high acetabular index according to the measurements calculated from 4000radiographs thatwere appropriate for evaluation and who were thought to have unrecognized were recalled and their hip radiographs were evaluated
RESULTS: Six patients with suspected hip dysplasia detected from 4000 radiographs, which were suitable for themeasurement techniques,were called to the control examination.In the physical examinations and radiographs,abnormal radiographic views of a patient with complete dislocation and two patients with dysplastic hip according to their first radiographs were completely resolved
DISCUSSION AND CONCLUSION: When treatment of DDH can be performed with simple instrumentation or limited surgical interventions in the early infancy, complicated surgical interventions are required during age of walking and after this period,whichreduce the success rate. Therefore, we think that every child under one year old who has referred to the clinics for other reasons and those with hip or pelvis graphs are required to be examined in terms ofDDH

11.Contribution of Sonoelastography in the Differentiation of Benign and Malignant Breast Masses: A Comparative Analysis on Sonographic BIRADS Classification
Harun Arslan, Zülküf Akdemir, Alpaslan Yavuz, Necat İslamoglu, Sebahhatin Çelik, Mesut Özgökçe, Abdussamet Batur, Hüseyin Akdeniz, Harun Egemen Tolunay
doi: 10.5505/ejm.2017.58070  Pages 184 - 190
INTRODUCTION: In this study, we aimed to investigate the effectivity of ultrasonographic elastography in the differentiation of benign and malignant lesions detected on B-mode ultrasonography.
METHODS: The lesions were scored by using B-mode USG with breast imaging-report and data systems (BIRADS) and then sonoelastographic color-coded maps were obtained by elastography in a single session. Sonoelastographic scoring was achieved with a 5-point scoring system. Elasticity scores and strain ratio (SR) values were compared with histopathological findings.
RESULTS: The 133 patients included 132 (99.2%) women and 1 (0.8%) man. Mean age was 40.45±14.8 years.Depending on the pathological findings, 94 (71.2%) lesions were classified as benign and 39 (28.8%) as malignant. Mean SR value was 4.419±1.43, with 5.5 in malignant lesions and 4.3 in benign lesions. At the cut-off value of 4.95 for SR, the sensitivity and specificity of USG in elastographic examination were 81.6% and 78.7%, respectively. A significant correlation was found between the SR value and the BIRADS score calculated on USG (rho=0.86; two-tailed; p<0.001).
DISCUSSION AND CONCLUSION: In conclusion, the use of sonoelastographic examination following the USG examination with B-mode ultrasonography can be a complementary diagnostic method that increases the specificity of USG

12.Trends and causes of maternal mortality in Eastern province of Turkey
Numan Cim, Erkan Elci, Sena Sayan, Gulhan Gunes Elci, Serif Aksin, Recep Yildizhan
doi: 10.5505/ejm.2017.22932  Pages 191 - 201
INTRODUCTION: We aimed to analyse causes of maternal mortality cases in Eastern province of Turkey.
METHODS: The cases were evaluated for age, gravida, age at first birth, gestational week, postpartum death time, educational status, medical history, high risk pregnancies, pregnancy termination type, delivery methods and death causes. The distribution of these cases by type of death and years is examined. In addition, the causes of death were compared among groups according to their death pattern and years.
RESULTS: A total of 69 maternal deaths were detected. Maternal mortality rate was... The mean age of the cases was 30.4±7.6 and they had their first births when they were 20.9±5.1 years old. Mean number of gravida was 3.9±2.8. These cases were 32.3±7.4 in the week of gestation when mortality occurred. The mean number of pregnancy follow-ups was 4,24±4,0, postpartum direct maternal mortality time was 13,7±25,5 days. The number of maternal mortality according to the years respectively;6,12,15,16,7,13.
When the causes of maternal mortality are examined respectively; preeclamptic diseases(26,1%), hemorrhage(15.9%), committed suicide(10.1%), pulmonary embolism(8.7%), cerebrovascular disease(7.2%), heart disease(5.8%), amnion fluid embolism(5.8%), sepsis(4.3%), traffic accidents(4.3%), firearm injuries(4.3%), malignancy(2.9%), pneumonia(1.4%), multiple organ failure(1.4%), and electric shock(1.4%). Among the direct causes of death; preeclamptic diseases, hemorrhage and pulmonary embolism were the most common and among the causes of indirect death; cerebrovascular diseases, heart diseases and sepsis were the most common.
DISCUSSION AND CONCLUSION: Maternal mortality is an important obstetric complication that needs to be paid attention to. Preeclamptic diseases and hemorrhage continue to be the most common cause of maternal mortality.

CASE REPORT
13.Anesthesia management in a patient with Carney Syndrome: Case report
Abdullah Kahraman, Cahide Kahraman
doi: 10.5505/ejm.2017.38358  Pages 202 - 203
Carney Syndrome is a complex of symptoms which can demonstrate autosomal dominant or sporadic transition that are followed by cardiac and cutaneous myxomas and endocrine abnormal activity. Myxomas demonstrate familial transition due to autosomal dominant inheritance at a rate approximately of %5. In anesthesia management, some of the most significant things to be paid attention to are; the localization, size and mobility of the myxoma. Recurrence rate of familial myxoma after surgical resection is reported to be about 21-67%. In this article, anesthesia practice in a Carney Syndrome case with cerebral aneurysms that is scheduled for operation due to surrenalectomy, has been presented.

14.Management of gastric cancer with liver metastasis in a pregnant woman
Numan Cim, Erbil Karaman, Osman Toktas, Gulhan Gunes, Esra Andıc, Serhat Ege, Recep Yildizhan
doi: 10.5505/ejm.2017.21931  Pages 204 - 207
Gastric cancer during pregnancy is very rarely seen. The complaints and symptoms of gastric cancer are non-specific and many of these symptoms are frequently masked by factors related to normal pregnancy. Also abdominal examination cannot be done easily and in an optimal manner due to the gravid uterus. Here we report the treatment and follow up management of metastatic gastric cancer in a 38 year-old multiparous woman with 31 weeks of pregnancy.
A 38 year-old woman with G10P8A1 and 31 weeks of pregnancy was admitted to maternity outpatient clinic with the complaints of nausea, vomiting and constipation since 4 days. On palpation a solid lesion with 1.5 cm size was palpable in the subxiphoid region. The abdominal examination could not be performed due to the gravid uterus however, a solid nodule with largest diameter of 5 cm was observed on the liver suspected as metastasis. On the explorative laparotomy, a tumoral mass with multiple peripheral lymphadenopathies were observed in the posterior gastric antrum, pancreas and colon median entry-invasive artery. Multiple metastases in the omentum and liver with large amount of acid in the abdomen were present.
Early diagnosis and treatment is important for the prognosis of the gastric cancer. The complaints and symptoms of gastric cancer are non-specific and many of these symptoms can be seen similarly during normal pregnancy period. If the same symptoms recur during pregnancy or failure to respond to therapy, gastrointestinal system should be evaluated endoscopically.

15.Congenital Hypothyroidism in Axenfeld-Rieger Syndrome
Çağatay Çağlar, Muhammed Batur, Erbil Seven, Serek Tekin, Tekin Yaşar
doi: 10.5505/ejm.2017.07269  Pages 208 - 210
Axenfeld-Rieger syndrome (ARS) manifests varying degrees of anterior segment dysgenesis and carries a risk of resistant glaucoma. It can affect ocular and extraocular structures derived from the neural crest. A small part of the thyroid gland originates from the neural crest, and defects in thyroid origination can result in thyroid agenesis. Thyroid agenesis is a cause of congenital hypothyroidism. To the best of our knowledge, no information exists about ARS associated with congenital hypothyroidism caused by congenital agenesis. We have presented clinical features the first case of ARS associated with congenital hypothyroidism.

16.A Case: Abscess Formation in the Sub-Tenon’s Space After Strabismus Surgery
Muhammed Batur, Erbil Seven, Adem Gül, Cagatay Caglar, Tekin Yaşar
doi: 10.5505/ejm.2017.02996  Pages 211 - 213
A five-year-old boy was examined in follow-up in our strabismus department due to exotropia and amblyopia in the right eye. Recession to both lateral recti muscles was performed. When the patient was examined one week, postoperatively, he complained of pain in the right eye. Upon physical examination, hyperemia and minimal swelling of the surgical area were observed. The situation was diagnosed as an abscess. The abscess was drained and the eye was irrigated with cefazolin and gentamycin solutions. All signs and symptoms were determined to be resolved in subsequent postoperative visits.

17.A young woman with multiple intra cardiac mass, systemic symptoms and stroke
Mohamed Faisal
doi: 10.5505/ejm.2017.20592  Pages 214 - 217
A 32 year old lady was admitted to hospital following generalised tonic seizure, and recurrent stroke. She had history of young stroke with left hemiparesis at the age of 27, subsequently defaulted follow up. Evaluation during that time included connective tissue disease and antiphospholipid syndrome screening which were negative and a transthoracic echocardiogram which revealed pericardial effusion of unknown aetiology. A repeat transthoracic and a cardiac computed tomography (CT) scan during this admission revealed multiple intracardiac mass at left and right atrium while CT Brain showed extensive multifocal infarct. Patient also had constitutional symptoms of fever, loss of appetite and loss of weight. A diagnosis of cardiac myxoma was made.
The diverse presentation of cardiac myxoma indicates the complexity of the disease. This case illustrates that early diagnosis and treatment of cardiac myxoma is of utmost importance in preventing further sequelae.

18.Emergency Cesarean ın a Patıent Wıth Atrıal Septal Defect
Erol Karaaslan
doi: 10.5505/ejm.2017.25238  Pages 218 - 220
It is a common fact that thousands of mothers die because of pregnancy around the world each year. Acomprehensive antepartum screening is of prime importance for the reduction of maternal mortality. Heart diseases are a major cause of maternal mortality. Atrial Septal Defect (ASD) is the most common acyanotic congenital heart disease.
A 22-year-old primiparous woman at 38 weeks of gestation applied to the gynecology department with palpitations and excessive fatigue. ASD was detected in the cardiology outpatient clinic. Due to fetal distress, emergency cesarean section (C-section) was performed under spinal anesthesia. The patient developed acute-onset hypotension and respiratory distress. In this report, we present a case with ASD that underwent emergency C-section due to fetal distress.

19.Unusual complication of stent placement in the treatment of coarctation
Serhat Koca, Feyza Ayşenur Pac, Vedat Kavurt, Ajda Mutlu Mıhcıoglu, Denizhan Bagrul
doi: 10.5505/ejm.2017.72691  Pages 221 - 223
Stent placement is the first line treatment for coarctation of aorta in adolescent and adult patient population. Complications during this procedure due to aortic wall and the technique were reported previously. Here we present a pediatric patient who developed a complete AV (atrio-ventricular) block during stent implantation which required temporary cardiac pacemaker and anti-inflammatory therapy.

20.A Case of Allergic Contact Dermatitis Due to Application of Synthetic Casting Which Mimics the Manifestation of Cellulitis
Tülin Türközü, Necip Güven
doi: 10.5505/ejm.2017.43531  Pages 224 - 226
Casting application is one of the essential aspects with respect to conservative treatment of fractures in Orthopaedics and it may be applied after surgical treatment when needed. In the recent years, common use of synthetic cast (45% polyurethane resin and 55% fiberglass) and also undercast cotton padding (synthetic fiber) caused an increased incidence of allergic contact dermatitis. It may develop an allergic reaction progressing accompanied by eruptions and itching as commonly experienced in our daily orthopaedic practice. We have presented a case of allergic contact dermatitis which mimics an unusual manifestation of cellulitis in routine clinical practice.

21.An Unusual Bladder Mass: Dermoid Cyst And Review Of The Literature
Abdullah Gul, Ahmet Sahan, Canan Firat, Yiloren Tanidir
doi: 10.5505/ejm.2017.83997  Pages 227 - 229
Dermoid cysts are developmental benign anomalies and comprise at least two germ layer tissue. Dermoid cyst is usually known to be of primordial germ cell origin; however, there are some rare cases in which they have been noticed in other midline and paraxial organs. Although they generally settle in ovaries, they might be found in other tissues such as urinary bladder. Dermoid cyst should be kept in mind as a differential diagnosis for unusual presentation and histopathological appearances in bladder mass and should also be known that there is no need for further following up. We report a case of a 47-year-old woman with bladder dermoid cyst being the first case report from Turkey as a bladder mass resected endoscopically.

REVIEW ARTICLE
22.The Significance of 4D Ultrasonography in Fetal Anomaly Screening
Demet Aydogan Kırmızı
doi: 10.5505/ejm.2017.25733  Pages 230 - 232
Ultrasonography has been a reliable diagnostic tool used for years in fetal anomaly screening. Along with technological improvements, the image quality of ultrasound devices has also increased. Four-dimensional (4D) ultrasound with real time imaging capability is the latest technological tool in this area. Today, its use in perinatologic screening of fetal anomalies is becoming widespread This situation has opened the debate on the diagnostic value of 4D ultrasound in fetal evaluation. 4D ultrasound when performed in experienced hands provides more detailed information on organ functions, fetal anomalies, and understanding of movement and behavioral characteristics. In contrast, conventional 2D ultrasound maintains an indispensable position in the evaluation of fetuses. In the literature, the superiority of 4D to 2D has not been shown. However, diagnostic accuracy is expected to increase when the techniques are used together. A general evaluation was made in our article and the significance of the two ultrasound technologies in detecting fetal anomalies were compared.

23.Postmenopause and Metabolic Syndrome
Sena Sayan, Recep Yildizhan
doi: 10.5505/ejm.2017.88598  Pages 233 - 236
In this review, the causes and results of the metabolic syndrome and the relationship between vasomotor symptoms such as hot flashes, night sweats, which started with the termination of ovarian activity in the postmenopausal period, were compared.
The pathophysiology of the postmenopausal and metabolic syndrome has been examined in parallel. Vasomotor symptoms have been shown to be more severe in postmenopausal women with metabolic syndrome.

LETTER TO EDITOR
24.Meningioma of the cavernous sinus
Nitin K Sethi, Tomoko Ikuine, Nicolle Steiner
doi: 10.5505/ejm.2017.21043  Page 237
Key Words: Meningioma, cavernous sinus



 
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