ISSN 1301 - 0883 / E-ISSN 1309 - 3886

  Eastern J Med: 25 (2)
Volume: 25  Issue: 2 - 2020
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1.Hemodynamic monitoring using a pulse counter Vigileo Flotrac cardiac output system in transapical off-pump minimally invasive mitral valve repair
Havva Sayhan Kaplan, Ümit Karadeniz, Burak Kaya, Ibrahım KARA, Ali Fuat Erdem
doi: 10.5505/ejm.2020.04557  Pages 177 - 183
INTRODUCTION: The aim of this study was to present our anesthetic management and early hemodynamic recovery after transapical off-pump neochords implantation
METHODS: This study was enrolled at Sakarya University Educational Research Hospital between September 2016 and June 2017. The perioperative records of 13 patients who underwent mitral valve repair using the Neochord DS1000 system were analyzed. Hemodynamic measurements recorded with the Vigileo Flotrac invasive arterial cardiac output system were evaluated.
RESULTS: Thirteen patients were included in the study. Transfusions of a total of 2 U of erythrocytes and 11 U of plasma were performed. After Neochord implantation, the mean cardiac output increased at a statistically significant level according to the values measured after induction p = 0.003.
DISCUSSION AND CONCLUSION: Increased cardiac output measurement after placement of the neochordaes and elimination of insufficiency have emerged as indications of early hemodynamic recovery.

2.The relationship between placental elasticity and prenatal serum screening markers and Doppler indices
Murat Akbaş, Faik Mümtaz Koyuncu, Hakan Erenel, Burcu Artunc Ulkumen, Tülay Oludağ Mete
doi: 10.5505/ejm.2020.29981  Pages 184 - 190
INTRODUCTION: It has been shown that placental elasticity values were higher in pregnant women with preeclampsia and intrauterine growth restriction. The studies have been reported that prenatal serum screening markers and uterine artery Doppler parameters could be useful in the prediction of preeclampsia and intrauterine growth restriction. In this study, we aimed to investigate the relationship between placental elasticity values and these serum markers and Doppler indices in the first and second-trimester.
METHODS: 108 cases between 11-14 gestational weeks were enrolled for this study. Placental elasticity measurements were performed after the first-trimester combined test and Doppler assessment. The same procedures were repeated with the second-trimester triple test for 71 pregnant women who were followed-up. Correlation analysis of demographic characteristics, biochemical parameters and Doppler findings with placental elasticity values were performed.
RESULTS: In the first-trimester, we found a statistically significant and positive correlation between placental elasticity values and bilateral uterine artery notching (r =0.193, p = 0.045) and mean arterial pressure ( r =0.398, p < 0.001). Likewise, positive correlation was found between placental elasticity values and bilateral uterine artery notching (r =0.303, p = 0.023) and mean arterial pressure ( r = 0.274, p = 0.041) in the second-trimester.
DISCUSSION AND CONCLUSION: Our study showed that placental elasticity values were positively correlated with mean arterial pressure and bilateral uterine artery notching in the first and second-trimesters. In light of these findings, the utility of placental elasticity measurment in early gestation to predict pathologies due to insufficient placentation has to be proven with comprehensive studies.

3.The Evaluation of Intensive Care Units Quality in Turkey: a Multicenter Study
İlhan Bahar
doi: 10.5505/ejm.2020.32704  Pages 191 - 201
INTRODUCTION: The intensive care beds are limited in number and costly. The problem might be solved by using these beds more efficiently. We were the first in conducting intensive care-related quality research in our country.
METHODS: Our study was a survey study. We screened a total of 134 tertiary level intensive care units.
RESULTS: Specialists working in intensive care units of 134 hospitals, of which 54 were university hospitals, were interviewed. The ratio of hospitals without any negative-pressure chamber was 55.6%. No medical technical manager was present in intensive care units. No physical therapy coordinator was determined to be present in intensive care units, presenting only when a consultation was requested. No joint meeting with a multi-professional team was being held. We also determined that no joint meeting was being held with the infection control committee regarding handwashing either. Additionally, we discovered that the growing microorganisms and their antibiotic sensitivities were not being evaluated together with the infection control committee.
DISCUSSION AND CONCLUSION: We determined that inadequacies were present regarding the infrastructure, procedures, and outcomes related to quality assessment in Turkey, which is a developing country.

4.Effectiveness of self-adjusted phosphate binder dose according to dietary phosphate content method in improving hyperphosphatemia among hemodialysis patients
Su Mee Khor, Chee Ping Chong
doi: 10.5505/ejm.2020.98598  Pages 202 - 210
INTRODUCTION: Serum phosphate level control is a major goal in the management of hyperphosphatemia among end stage kidney disease patients. This study aimed to evaluate the effectiveness of self-adjusted phosphate binder dose according to dietary phosphate content method (SPB method) in optimizing the phosphate level among hemodialysis patients.
METHODS: This was a randomized controlled study conducted from September 2015 to October 2016 which involved eight hemodialysis centers in Penang, Malaysia. Ninety-eight hemodialysis patients who had serum phosphate level more than 1.8 mmol/L were recruited and randomly assigned to intervention and standard group. All patients underwent a standard low phosphate counseling. The 49 patients in intervention group underwent an additional counseling on how to adjust the calcium carbonate tablet dose based on their food intake with the help of a booklet. Meanwhile, the calcium carbonate dose was fixed to the meals among the patients in standard group. The change in serum phosphate levels in both groups at baseline, month-3, month-6 and month-9 were recorded.
RESULTS: The phosphate level at baseline for intervention (2.15±0.22 mmol/L) and standard (2.22±0.27 mmol/L) group were not differed significantly (p = 0.19). The intervention group showed significant lower phosphate level compared to standard group (month-3: 1.68±0.43 mmol/L versus 2.10±0.39 mmol/L; month-6: 1.58±0.34 mmol/L versus 2.07±0.38 mmol/L; month-9: 1.54±0.36 mmol/L versus 1.96±0.33 mmol/L; P < 0.001).
DISCUSSION AND CONCLUSION: The SPB method demonstrated significant greater serum phosphate level reduction than the fixed-dose method. This new method in consuming phosphate binder dose should be introduced among the hemodialysis patients.

5.Clinical and Pathological Predictors of Prolonged Lymphorrhoea After Pelvic Lymph Dissection in Radical Cystectomy
Orkunt Özkaptan, Muhsin Balaban, Alkan Çubuk, Ahmet Şahan, Kasım Ertaş, Cuneyd Sevinc, Tahir Karadeniz
doi: 10.5505/ejm.2020.12244  Pages 211 - 217
INTRODUCTION: The aim of the study was to determine different variables that may be predictive for prolonged lymporrhoea and total days of drainage of lymph.
METHODS: Two hundreds and three patients who underwent radical cystectomy and retroperitoneal lymph node dissection were enrolled in this study. Lymphorrhoea was defined as the total amount of lymph drained by the drains until their removal. Total days of drainage were defined as the days until the removal of the last drains. Parameters that might be related to lymphorrhoea and total days of drainage including age, body mass index (BMI), removed lymph nodes, hemoglobin level (gr/dl), estimated blood loss (EBL), platelet count (PLN), hospital stay (HS) and lymph node status were reviewed, retrospectively. Statistical analyses were performed to determine the association between lymphorrhoea with probable predictors for these variables.
RESULTS: The mean number of removed lymph nodes was 28.52 (16-58). The mean amount of lymphorrhoea and total days of drainage was 1504 ml (300-5850) and 10.10 days (2-27), respectively. Multivariate analyses revealed that the mean amount of lymphorrhoea gradually rises as EBL, patients age, negative lymph nodes and lymphadenectomy extension increases (P<0.05). According to total days of drainage, multivariate analyses showed that BMI, number of removed lymph nodes were statistically significant predictors of prolonged drainage (p=0.016, p=0.046; respectively).
DISCUSSION AND CONCLUSION: Predictors for lymphorrhoea may help us mainly to foresee hospital duration and eventual complications that may be induced by lymphorrhoea. In patients with a higher risk for lymphorrhoea, preoperative maneuvers could be applied to decrease lymphorrhoea.

6.The association of Visfatin levels with metabolic parameters and inflammation in diabetic nephropathy
Ayşegül Sakin, Suleyman Sahin, Ahmet Behlul, Abdullah Sumnu, Meltem Gursu, Abdullah SAKİN, Savas Ozturk
doi: 10.5505/ejm.2020.27122  Pages 218 - 224
INTRODUCTION: To investigate the visfatin levels at different stages of diabetic nephropathy(DNP), changes in visfatin levels according to stages of DNP, and the association of visfatin levels with other anti-inflammatory parameters including high sensitivity C-reactive protein(hsCRP), interleukin-6(IL-6), and tumor necrosis factor alpha(TNFα).
METHODS: Patients were stratified into 4 groups based on the glomerular filtration rate(GFR) and albuminuria as follows; Group I: albuminuria<30 mg/day and GFR>60ml/min, Group II: albuminuria 30 to 300 mg/day and GFR>60ml/min, Group III: albuminuria>300mg/day and GFR>60ml/min, and Group IV: albuminuria>300 mg/day and GFR<60 ml/min.
RESULTS: Of the 141 patients included in the study, 83(58.8%) were female. The mean age of patients was 55.3±8.2 years. Microalbuminuria was found to be 10.1±9.8 mg/day in group I, 89.4±68.2 mg/day in group II, 525.1±280.7 mg/day in group III, and 1034±1893 mg/day in group IV, showing a statistically significant difference between the groups(p<0.001). When the correlation analysis was repeated separately in each group, there was a positive correlation between Visfatin and IL-6 levels in only group III (r=0.926; p<0.001). When the patients in group III and IV were combined in a single group and considered as macro-albuminuric, multivariate analysis showed that visfatin had a positive correlation with IL-6 (r=0.380, p=0.006)
DISCUSSION AND CONCLUSION: In this study, we could not determine any association between visfatin levels and other anti-inflammatory markers(IL-6, TNFα, and hsCRP). However, we found a close relationship between visfatin levels and IL-6 which is one of the most important markers of inflammation in diabetic patients with overt nephropathy, namely macro-albuminuric patients.

7.How do the diet, oral hygiene habits and body mass index affect tooth caries in the students of the faculty of dentistry?
Alperen Değirmenci, Beyza Ünalan Değirmenci
doi: 10.5505/ejm.2020.15046  Pages 225 - 233
INTRODUCTION: The purpose of this study is to examine the effects of oral hygiene and dietary habits on body mass index (BMI) and decayed, missing and filled teeth (DMFT) index of dentistry faculty students.
METHODS: A total of 166 students studying at XXXXXXX University Faculty of Dentistry were included in the study. Participants were asked to complete a questionnaire containing 16 questions related to diet and oral hygiene habits. The number of teeth in the mouth and DMFT indexes were recorded according to WHO criteria. During the general health examination, the length and weight of the participants were measured and recorded. Body mass index (BMI) was calculated as kilograms per meter squared.
RESULTS: Calculated BMI of the male and the female participants was found as 23.23 and 21.48 respectively. Statistically, no significant relationship was found between the diet and oral hygiene habits in the survey and BMI and DMFT(p>0.05). When ZINB regression results were examined, it was observed that there is a significant difference statistically between the classes in terms of DMFT (p<0.0001), however there is no difference in terms of BMI and gender (p>0.05).
DISCUSSION AND CONCLUSION: Considering the future roles of the students in the faculty of dentistry, it is very important to find out their information level about both oral hygiene habits and diet habits and if necessary to plan future trainings about this and aim to increase the information levels.

8.Investigation of The Effect of Different Eye Exercises on Hypermetropia in School-Aged Children: A Randomized Single-Blind Trial
Gülay Aras Bayram, Işıl Kutlutürk Karagöz, Zeliha Candan Algun
doi: 10.5505/ejm.2020.80774  Pages 234 - 240
INTRODUCTION: The aim of this study was to investigate the effect of different eye exercises on hypermetropia in school-aged children and to determine whether exercise protocols have superiority to each other.

METHODS: 60 hypermetropia school-aged children were randomly assigned to three groups: Bates Exercise Group (BEG), Convergence Exercise Group (CEG) and Oculo-Motor Exercise Group (OMEG). Outcome measures included sciascopy, Snellen chart and The Pediatric Quality of Life Inventory Version 4.0(PedsQI4.0). All three groups were given home exercises which warranted eye exercises twice a day, repeated 10 times daily for 6 weeks.
RESULTS: CEG showed a statistically significant effect on visual acuity for the right and left eye (p=0.004, p=0.014, respectively) and Pediatric Quality of Life Inventory (p<0.05). In the OMEG, there was a statistically significant effect on visual acuity for the left eye (p=0.011) and Pediatric Quality of Life Inventory (p<0.05).

DISCUSSION AND CONCLUSION: Eye exercises, especially those such as convergence and oculomotor exercises could be reliably performed for the treatment of hypermetropia in school-aged children.

9.Radiotherapy in a patient with rectal cancer and pelvic kidney: a dosimetric study
Alparslan Serarslan, Yalçın Daştan, Nilgun Ozbek Okumus, SÜKRIYE BILGE GÜRSEL, Ahmet Deniz Meydan
doi: 10.5505/ejm.2020.03789  Pages 241 - 249
INTRODUCTION: Pelvic kidney is an important treatment challenge in pelvic malignancies. This study investigated the most appropriate treatment in the presence of simultaneous pelvic kidney in patients with rectal cancer.
METHODS: This study used computed tomography images of postoperative radiotherapy planning in a male patient with rectal cancer. Coplanar intensity-modulated, non-coplanar intensity-modulated, and volumetric-modulated arc radiotherapy rectal cancer planning was performed with six different scenarios based on tumor location and lymph node status; a dosimetric comparison was then performed.
RESULTS: In a patient with rectal cancer and pelvic kidney, where the external iliac lymph nodes were not included in the radiation field, it was determined that, regardless of rectal tumor localization, optimal ≤45 Gy radiotherapy planning could only be performed with the volumetric-modulated arc therapy technique. In the same scenario, optimal ≤50.4 Gy radiotherapy planning could only be performed in a distally localized rectal tumor and with the volumetric-modulated arc therapy technique. In contrast, when the external iliac lymph nodes were included in the radiation field for the same patient, regardless of rectal tumor localization, no radiotherapy technique ≤45 Gy could protect the pelvic kidney.
DISCUSSION AND CONCLUSION: In patients with locally advanced rectal cancer and pelvic kidney, oncologic treatment (either radiotherapy first or surgery first) should be decided based on the available radiotherapy technique, lymph node status of rectal cancer, and tumor localization.

10.Acute Change of Left Ventricular End-diastolic Pressure during Primary Percutaneous Coronary Intervention and Its Relationship with Early Reperfusion Parameters
Murat Cap, Emrah ERDOĞAN, Ali Karagöz, Cem Doğan, Rezzan Deniz Acar, Tuba Unkun, Çetin Geçmen, Flora Özkalaycı, Büşra Güvendi Şengör, Zübeyde Bayram, Cihangir Kaymaz, NIHAL OZDEMIR
doi: 10.5505/ejm.2020.60252  Pages 250 - 255
INTRODUCTION: Elevated left ventricular end-diastolic pressure (LVEDP) is associated with adverse outcomes among those patients with ST-elevation myocardial infarction (STEMI).We aim to investigate the acute change of LVEDP in patients with STEMI and the relationship between LVEDP and early reperfusion parameters, such as ST-segment resolution (STR%) and myocardial blush grade (MBG).
METHODS: A total of 51 consecutive patients with STEMI who had undergone successful primary percutaneous coronary intervention (pPCI) with TIMI flow grade 3 were included in the study. LVEDP measurements were performed at the beginning (pre-pPCI LVEDP) and end of (post-pPCI LVEDP) the pPCI. MBG was defined after a successful pPCI; STR% was calculated 60 minutes after pPCI.
RESULTS: The mean pre-pPCI LVEDP was 22.1 ± 4.8 mmHg and the post-pPCI LVEDP was 19.4 ± 4.8 mmHg. There was a mean 2.7±1.8 mmHg decrease in LVEDP values after pPCI which was statistically significant (95% CI -3.2, -2.2, p value<0.001). Post-pPCI LVEDP median value was 19 mmHg. The patients were divided into two groups according to median value: there were 26 (51%) patients with post-pPCI LVEDP≤ 19 mmHg and 25 (49%) patients with post-pPCI LVEDP> 19 mmHg. STR% and MBG were significantly different between the two groups (p= 0.03 and p= 0.01). Post-pPCI LVEDP had a moderate negative correlation with MBG (r= -0.438) and STR% (r= -0.501).
DISCUSSION AND CONCLUSION: In this study, we demonstrated that primary PCI might substantially reduce the LVEDP level. Moreover, the LVEDP levels achieved after PCI might be associated with myocardial reperfusion, assessed by STR% on ECG and MBG during angiography.

11.Is Laparoscopic Cholecystectomy a safe method for elderly patients? A retrospective clinical study
Feyzi kurt
doi: 10.5505/ejm.2020.57855  Pages 256 - 259
INTRODUCTION: As in developed countries, the elderly population is gradually growing in our country. Therefore, the approach to diseases of these individuals may be different from adults and young individuals. Acute cholecystitis is common in elderly patients and may sometimes pose a high risk. In this clinical study, we aimed to compare our surgical treatment outcomes for acute cholecystitis in elderly and adult patients.
METHODS: The study included 225 patients who were operated with the diagnosis of acute cholecystitis in the General Surgery Clinic of Seyhan State Hospital between 2013 and 2019. The patients were divided into 2 groups according to their ages. The group 1 consisted of patients aged 75 years and older, while the group 2 included patients younger than 75 years of age. The patient data were obtained by scanning the database. The preoperative and postoperative data of the patients were recorded. The patients' age, morbidity, mortality and length of hospital stay were compared.
RESULTS: When the patients in the elderly group were compared with the patients in the adult group, there was no statistically significant difference between the groups in terms of conversion from laparoscopic to open surgery, bleeding, bile leak, abscess and peritoneal collection. Our mortality and morbidity rates were similar in both groups and were consistent with the literature.
DISCUSSION AND CONCLUSION: Elderly patients with acute cholecystitis can be operated laparoscopically, as in other adult patients. Treatment approaches do not vary for elderly and young patients.

12.Preoperative Factors Associated with the Need for the Morcellation in Total Laparoscopic Hysterectomy
Huseyin Kiyak, ONUR KARAASLAN, Kerem Doga Seckin, Tolga Karacan, Eser Sefik Ozyurek, Gulseren Yilmaz, berk bulut
doi: 10.5505/ejm.2020.47135  Pages 260 - 266
INTRODUCTION: Removal of uterus during laparoscopic hysterectomy (LH) is occasionally challenging and therefore sometimes requires morcellation. Morcellation techniques for hysterectomy can spread the cancer cells which were presumed benign preoperatively in to the abdomen or pelvis. The present study aimed to identify the demographic and the clinical factors associated with the need for morcellation in patients undergoing LH.
METHODS: A total of 153 patients who underwent LH for presumed benign causes were enrolled in this retrospective study. Subjects were divided into two groups according to the need for the morcellation during the LH: Morcellation group and intact vaginal removal (IVR) group (it delivered total of uterine specimen). The two groups were compared with respect to demographic and clinical characteristics.
RESULTS: The frequency of the postmenopausal women was significantly higher in the morcellation group than the IVR group(p = 0.005). Preoperative uterus width(p < 0.001) and postoperative Uterus weight(p < 0.001) were significantly higher in the morcellation group compared to that of the IVR group. Uterine weight(OR: 1.020, 95 % CI: 1.008-1.031, p = 0.001) and menopause (OR: 2.571,95 % CI: 1.328-4.980, p < 0.001) were predictive for the need of morcellation. A cut-off value of 287.5 gram was able to predict the need for morcellation with 87% sensitivity and 71 % specificity.
DISCUSSION AND CONCLUSION: The present study demonstrates that uterine weight and presence of the menopause are predictive for the need of morcellation at the time of the total LH. These factors should be considered in preoperative planning and used to further guide surgeons in providing LH.

13.Our results on cancellous screw fixation of femoral neck fractures in adults
Tolgahan Kuru
doi: 10.5505/ejm.2020.98852  Pages 267 - 272
INTRODUCTION: Femoral neck fractures are among the common types of hip fractures. There is no ideal treatment option with consensus for the treatment of these fractures. There are various surgical treatment methods depending on patients’ age, general status etc. Studies have reported advantages and disadvantages for each treatment method. In this study, we aimed to evaluate treatment outcomes and complications in patients who were treated with cancellous screw fixation method.
METHODS: A total of 17 patients treated in the orthopedics and traumatology clinic of our hospital between January 2016 and December 2018 were included in the study. Patients’ age, gender, fracture side, mechanism of fracture, duration of hospitalization, postoperative Harris hip score, union status and postoperative complications were recorded.
RESULTS: According to the Garden’s classification, 6 patients had garden Type I and II displaced fractures, and 11 patients Garden Type III and IV nondisplaced fractures. Postoperative Harris hip score was found as ‘excellent’ in 47.1%, ‘good’ in 35.3%, ‘moderate’ in 11.8% and ‘poor’ in 5.9% of the patients. Postoperatively 5.8% of the patients developed wound site infection, 5.8% nonunion, 11.7% implant failure and 5.8% avascular necrosis.
DISCUSSION AND CONCLUSION: Cancellous screw fixation of femoral neck fractures, which can be inserted with minimal invasive techniques with relatively low complications, seems a safe and beneficial method.

14.Selecting the arterial cannulation site in acute type A aortic dissection: axillary artery or femoral artery?
Şahin Şahinalp, Ali Kemal Gür
doi: 10.5505/ejm.2020.68442  Pages 273 - 277
INTRODUCTION: The aim of this study was to investigate the effects of cannulation site (either the right axillary artery or the right/left main femoral artery) on the mortality and morbidity of postoperative acute type A aortic dissection (ATAAD) patients.
METHODS: A total of 41 ATAAD patients (male: female = 29: 12), of whom 15 underwent cannulations of the right axillary and 26 of the main femoral artery, were retrospectively evaluated. Post-operative mortality and morbidity were assessed and statistically analyzed.
RESULTS: Of the participants, 34 (82.9%) were type I and 7 (17.0%) were type II according to the DeBakey classification. Cerebral protection was achieved using deep hypothermia in 14 patients, and by antegrade cerebral perfusion in addition to deep hypothermia in 9 patients. Early postoperative mortality was 17.0% (n = 7). There were no significant differences between the axillary artery and femoral artery cannulation groups in terms of postoperative mortality and morbidity. However, a greater number of arcus aortic interventions was performed in the group undergoing axillary artery cannulation (Group II). In this group, the rate of antegrade cerebral perfusion was also high.
DISCUSSION AND CONCLUSION: Although the cannulation site in patients with ATAAD was not determined to affect mortality and morbidity, both options present advantages and disadvantages. We believe that all relevant factors pertaining to the patient as well as the surgical procedure to be employed should be evaluated in tandem in selecting the optimal cannulation site.

15.Human chorionic gonadotropin levels 0/1-4 days after methotrexate administration for predicting ectopic pregnancy treatment success
Gültekin Adanaş Aydın, Gülten Özgen
doi: 10.5505/ejm.2020.85520  Pages 278 - 284
INTRODUCTION: Ectopic pregnancy is one of the major causes of morbidity and mortality, accounting for 1 to 2% of all pregnancies. With the introduction of recent developments in diagnostic tools, the success rate of medical treatment has increased. The treatment is considered successful, if there is a 15% decline in serum human chorionic gonadotropin (hCG) levels between Days 4 and 7 of follow up in patients receiving single-dose methotrexate (MTX) treatment. In the present study, we aimed to determine whether the change in hCG levels between Days 0 and 4 is useful in predicting treatment success in patients receiving single-dose MTX protocol.
METHODS: A total of 93 patients who were diagnosed with ectopic pregnancy in our clinic between September 2016 and September 2018 and treated with MTX were retrospectively analyzed. The hCG levels of the patients on Days 0/1-4-7 were measured and recorded. Changes in hCG levels between Days 0/1-4 and 4-7 were calculated.
RESULTS: The overall success rate of single-dose MTX treatment was found to be 71.6%. A total of 50 patients of the success group had decreased hCG levels on Day 4, while only 18 patients of the success group had increased hCG levels on Day 4. Using the cut-off value for hCG change between Days 1 and 4, an increase of 16.1% in hCG levels was found to be the strongest predictor of treatment success. The sensitivity, specificity, and positive predictive value of this cut-off value were 89.7%, 64%, and 87.1%, respectively.
DISCUSSION AND CONCLUSION: In conclusion, early changes in hCG levels may be useful in the follow-up of the treatment success.

16.The Effects of Corneal Edema on the Intraocular Pressure Measurements
Erbil Seven, Serek Tekin, Muhammed Batur, Beyza Yavuzer, Tekin Yaşar
doi: 10.5505/ejm.2020.16023  Pages 285 - 292
INTRODUCTION: To evaluate the possible effects of corneal edema on intraocular pressure (IOP) measurements obtained with three different tonometers on the first day after cataract surgery.
METHODS: Sixty-four eyes of the 64 patients underwent phacoemulsification and IOP measurements using Goldmann applanation tonometer (GAT), Tono-Pen applanation tonometer (TAT), and Pascal digital contour tonometer (DCT) the first day after surgery. Central corneal thickness (CCT) measurements were used to quantify the postoperative corneal edema. Intraclass correlation coefficient and Bland-Altman plot were used to assess the compatibility of IOP measurements among three method pairs.
RESULTS: TAT and DCT IOP measurements were found to be compatible with each other (p=0.141) in the corneal edema group. The GAT and TAT IOP measurements in the eyes with corneal edema were inversely proportional to the CCT values (p=0.011 and p=0.033, respectively), but the DCT relationship was not statistically significant (p=0.44).
DISCUSSION AND CONCLUSION: The lack of a significant relationship between DCT and CCT in edematous corneas may suggest that DCT, as in normal corneas, can perform CCT-independent measurements. However, there is still no gold standard method for IOP measurement in edematous corneas.

17.Spinal anesthesia is associated with postoperative urinary retention in women undergoing urogynecologic surgery
Gulseren Yilmaz, Aysu Akça, Huseyin Kiyak, ONUR KARAASLAN, ZİYA SALİHOĞLU
doi: 10.5505/ejm.2020.63625  Pages 293 - 298
INTRODUCTION: Objective: We hypothesized that spinal anesthesia could lead to impairment in bladder function and consequently to postoperative urinary retention(POUR), particularly in patients undergoing urogynecologic surgery. This study aimed to compare the rate of the POUR between the subjects receiving spinal and general anesthesia who underwent urogynecologic surgery.
METHODS: One hundred and eighty subjects who underwent urogynecologic surgery in a between June 2016 and May 2019 were retrospectively analyzed to evaluate the risk of POUR after general versus spinal anesthesia. All subjects underwent a standardized voiding trial subsequent to surgery, which was performed by backfilling the bladder with 300 ml of saline. Presence of > 100 ml volume in post-void bladder scan was defined as POUR. The primary outcome was to compare rates of POUR between spinal and general anesthesia. Identifying the risk factors for POUR was the secondary outcome of this study.
RESULTS: Spinal anesthesia group included 80, and the general anesthesia group consisted of 100 patients. The overall rate of the POUR was %22.8. The proportion of the patients with POUR was significantly higher in the spinal anesthesia group compared to that of the subjects in the general anesthesia group (%33.8vs. %14,P=0.002). Multivariate logistic regression analysis revealed that adoption of spinal anesthesia (Odds ratio: 3.172, 95%CI: 1.383-7.275, P=0.006) and presence of diabetes (Odds ratio: 5.840, 95% CI: 2.325-14.666, P< 0.001) were independent predictors for the development of POUR.
DISCUSSION AND CONCLUSION: The rate of the POUR is significantly higher in patients receiving spinal anesthesia than those receiving general anesthesia among women undergoing urogynecologic surgery.

18.Comparison of Pap-smear and Colposcopy in the Absence of HPV Test for the Diagnosis of Premalignant and Malignant Cervical Lesions
Süleyman Cemil Oğlak, Mehmet Obut
doi: 10.5505/ejm.2020.21548  Pages 299 - 304
INTRODUCTION: In this study, we aimed to evaluate the Pap-smear results and colposcopic findings of 163 patients admitted to the colposcopy unit of our hospital with the histopathological examination results of cervical sampling for abnormal Pap-smear and/or colposcopy findings in the absence of HPV test.
METHODS: All patients underwent gynecological examination, and Pap-smear test was performed. Subsequently, the cervix was examined by colposcopy. Local medical treatment, Pap-smear follow up, cervical sampling or surgery was recommended according to Pap-smear, colposcopic examination results and other clinical examination findings.
RESULTS: Negative predictive value (NPV), positive predictive value (PPV), sensitivity and specificity of Pap-smear were 88.1%, 13.3%, 28.5% and 74%, respectively. NPV, PPV, sensitivity and specificity of colposcopy were 93.3%, 14.3%, 85.7 and 76.2%, respectively.
DISCUSSION AND CONCLUSION: The combined use of Pap-smear and colposcopy in the detection of premalignant and malignant lesions of the cervix increases the success and enables early diagnosis and appropriate treatment in the absence of HPV test.

19.Correlation of Cervical Smear Cytology and Histopathology Findings from Van Yüzüncü Yıl University Dursun Odabaş Medical Center in Turkey
Feyza Demir, Remzi Erten, ibrahim Aras, İrfan Bayram
doi: 10.5505/ejm.2020.01886  Pages 305 - 311
INTRODUCTION: Papanicolaou cytology (Pap smear) is a screening technique recommended by World Health Organization (WHO), commonly used in the detection of precancerous lesions. This study aimed to compare the Pap smear results and the subsequent biopsy results in 258 patients diagnosed in our clinic to analyse their false-positive and false-negative rates and to discuss the outcomes in light of literature.
METHODS: The study included Pap smear specimens archived for four years that had undergone histopatholojical diagnoses of cervical biopsy, conization, curettage, and/or histerectomy within the three months. In the retrospective analysis, cytological diagnosis and the histological diagnosis which had been established within the subsequent three months were compared and then the false-negative and false-positive rates were calculated.
RESULTS: In the cyto-histological comparison, the false-negative and false-positive rates independent of class ratio were 4,3% and 19%, respectively. The sensitivity, selectivity, positive and negative predictive values were 69%, 98%, 89% and 93%, respectively, excluding atypical classes of the cytologic diagnoses.
DISCUSSION AND CONCLUSION: As can be seen in our results, the correlation between Pap smear and biopsy results in our patients displayed an unignorable inconsistency although it was not remarkably different from those reported in the literature. Such discrepancies, which are likely to be detected in the cyto-histopathological studies around the world and do not attenuate the value of cervical cytology despite being unignorable, indicate the necessity of screening schemes involving the combined and effective use of different techniques such as Human papillomavirus (HPV) tests, repeated smear examinations, colposcopic examination, and biopsy in patients diagnosed by cervical cytology.

20.Incidentally Detection of the Swyer-James Syndrome With Opposite Side Pneumonia
GÜNER DEMİR, Mehmet Aslan
doi: 10.5505/ejm.2020.61687  Pages 312 - 314
Swyer-James Syndrome (SJS) is ana rare disease that is also known as unilateral hyperlucent of the lung. This disease may lead to atelectasis and pulmonary hypoplasia. The viral and bacterial respiratory system infections in the childhood are considered as predisposing factors of the chronical bronchial inflammation that leads to SJS. It is characterized by obliteration of the bronchias, air-trapping and lung hypoperfusion. In this report, we describe the case of a 50-year-old male with pneumonia and incidentally detected SJS in the other side of the thorax.

21.A Case of Lung Adenocarcinoma Presenting as Miliary Appearance
Buket Mermi&775;t Çi&775;li&775;ngi&775;r, Aysel Sunnetcioglu, MESUT ÖZGÖKÇE, IRFAN BAYRAM
doi: 10.5505/ejm.2020.97769  Pages 315 - 317
Multiple benign conditions may be the cause of miliary nodules, but the most common cause is metastatic disease. Even so miliary metastasis of lung cancer is rarely seen. The most common lung cancer with a miliary distribution is adenocarcinoma. It is often difficult to diagnose adenocarcinomas with a progressive course. Anamnesis, physical examination, imaging methods can give an idea but diagnosis should be confirmed histopathologically. As in our case, tissue biopsy should be performed for diagnosis. We aimed to present this case because we performed a tru cut biopsy which is rarely used for histopatologic diagnosis and the milier nodules in the lung of adenocarcinoma is a rare condition.

22.THORACOPAGUS: A Case of Conjoined Twins
Gökçe Naz Küçükbaş, gurcan turkyilmaz, güler şahin
doi: 10.5505/ejm.2020.24861  Pages 318 - 320
Conjoined twins originates from abnormal divergence of the embryonic plaque after 12th day of fertilization causing shared organ systems. The prevalence varies between 1/50.000 and 1/200.000 and diagnosis is possible by advanced ultrasonographic imaging techniques. Despite limited number of successful cases in the literature, conjoined twins have poor prognosis and management usually requires termination. In this study we present a 22 year-old, nulliparous woman in 14th gestational week without specific obstetric history diagnosed with thoracopagus.

23.Orthodontic Camouflage Treatment Without Tooth Extraction of Skeletal Class III Malocclusion with Mandibular Bite Turbo Application
Saadet Çınarsoy Ciğerim
doi: 10.5505/ejm.2020.57060  Pages 321 - 326
Treatment of Class III malocclusions is difficult malocclusions. The treatment of skeletal Class III anomalies varies according to the jaw and the growth period of the anomalies. Adult individuals whose growth is over are treated with fixed orthodontic mechanics or orthognathic surgical approaches. If skeletal class III anomaly is not severe and does not constitute a problem aesthetically, camouflage treatment can be done with fixed orthodontic mechanics. This case report presents the results of orthodontic camouflage treatment and treatment applied to a skeletal Class III malocclusion female patient with chronological age of 17 years and 9 months and skeletally in the Ru period. The molar relationship of the patient with a slightly concave profile is Angle Class III. In cephalometric examination, skeletal class III problem was detected (ANBº = -6). At the end of treatment, a dental class I relationship and a smooth soft tissue profile were obtained.

24.Does the Coronavirus a Global Threat?
Hüseyin Güdücüoğlu, Duygu Korkmaz
doi: 10.5505/ejm.2020.67934  Pages 327 - 329
At the end of December, 2019; patients presenting with viral pneumonia due to an unidentified microbial agent were reported in Wuhan, China. A novel coronavirus was subsequently identified as the causative pathogen, provisionally named 2019 novel coronavirus (2019-nCoV). The new name of this disease is coronavirus disease 2019, abbreviated as COVID-19. The virus has spread to several countries and cities. According to the World Health Organization (Feb 16, 2020). Considering the number of cases reported between 21 January and 16 February, the number of cases expected to be possible between 17 February and 19 April has been tried to be estimated. Depending on time, expected number of cases in a one month has been tried to be estimated by linear and quadratic models for China and other countries separately. The determination coefficients for the Quadratic model were found to be 98% for both China and other countries.

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