ISSN: 2149-2247 | E-ISSN: 2149-2549
ERCİYES MEDICAL JOURNAL - Erciyes Med J: 41 (4)
Volume: 41  Issue: 4 - 2019
EDITORIAL COMMENTS
1.A Potential Method to Help Predict Genetic Diseases and Arrange Healthcare: Copy Number Variation Analysis
Munis Dündar, Saide Betül Arslan
doi: 10.14744/etd.2019.36604  Pages 355 - 356
Abstract | Full Text PDF

INVITED REVIEW
2.Neuroendocrine Consequences of Traumatic Brain Injury and Strategies for its Management
Aysa Hacioglu, Fahrettin Kelestemur
doi: 10.14744/etd.2019.65983  Pages 357 - 363
Traumatic brain injury (TBI) is a common problem that generally affects the young population. Hypothalamo-pituitary damage may occur as a result of direct damage during trauma or due to secondary insults, such as hypotension or hypoxia that may occur thereafter. The incidence of pituitary dysfunction post-TBI has been reported to range from 5–76.4%. Growth hormone deficiency and central hypogonadism are among the most common hormone deficiencies that occur post-TBI. Patients who develop pituitary dysfunction post-TBI may present with life-threatening hypotension, hyponatremia during the acute phase, or subtle and nonspecific complaints such as fatigue, depression, or cognitive impairments during follow-up. Pituitary dysfunction may recover but new-onset deficiencies may develop over time, mandating routine screening of TBI patients. Several risk factors have been investigated and various screening algorithms have been proposed in recent studies. We aimed to review the recent literature in terms of epidemiology, screening modalities, and clinical perspectives of pituitary dysfunction post-TBI.

ORIGINAL ARTICLE
3.In Vitro Susceptibility Testing of Rifampin Against Acinetobacter Baumannii: Comparison of Disk Diffusion, Agar Dilution, and E-test
Mojtaba Varshochi, Alka Hasani, Seyed Jalaledin Derakhshanfar, Zhinous Bayatmakoo, Fatemeh Ravanbakhsh Ghavghani, Parinaz Poorshahverdi, Masoud Nouri-Vaskeh
doi: 10.14744/etd.2019.90018  Pages 364 - 368
Objective: Resistance against a wide variety of antibiotics is one of the prominent characteristics of Acinetobacter baumannii. The purpose of this study was to investigate the in vitro susceptibility testing of A. baumannii isolates to rifampin and the examination of the value of routine antibiogram with disk diffusion, E-test, and agar dilution methods on collected isolates from a tertiary hospital in north-west Iran.
Materials and Methods: Susceptibility of 68 clinically isolated A. baumannii against rifampin using three in vitro methods was investigated. For the E-test method, the Pachon–Ibanez’s and Saballs’s study criteria were used. The Pachon–Ibamez criteria were used for agar dilution method. For disk diffusion, the standard Kirby–Bauer diffusion method was used. The area under curve (AUC) was used to determine the appropriate methods. The methods were interpreted using sensitivity, specificity, and negative and positive predictive values.
Results: A. baumannii susceptibility to the rifampin according to the E-test was 41.2% (Panchon–Ibanez criteria) and 32.4% (Saballs’s criteria). The susceptibility was 29.4% according to the agar dilution method for the Panchon–Ibanez criteria, 2.9% according to the agar dilution method for the Saballs’s criteria and, and 1.5% according to the disk diffusion methods. The results of the E-test method according to Pachon–Ibanez’s and Saballs’s criteria in comparison with the result of the agar dilution method according to Pachon–Ibanez’s criteria had the highest AUC.
Conclusion: According to the susceptibility testing of rifampin against A. baumannii, the E-test method has a higher diagnostic value than the agar dilution and disk diffusion methods.

4.Women’s Birth Choice Request Changes in Ten Years: A Single Primary Care Center Experience
Arda Borlu, Fevziye Çetinkaya
doi: 10.14744/etd.2019.95815  Pages 369 - 374
Objective: Normal birth is the most cost-effective and healthiest form of birth for mother and baby, but it has become less preferable in recent years. This study has two goals: first, to examine the change in the rate of women’s normal birth requests, and second, to examine the changes in factors that may affect this request within a ten-year time period.
Materials and Methods: The results of two descriptive cross-sectional researches done in the same primary health care center region in 2007–2008 and 2017–2018 were presented. Data were collected by questionnaire form with face-to-face interviews with women who gave birth in the last year. The chi-square test and t-test were used for statistical comparison.
Results: It was observed that women’s normal birth request rate decreased. The normal birth request rates of women who were under 25 years, high school graduates, unemployed, and in the middle economic level decreased more than of the others. The rate of women who think that “women who give birth normally get more pain” increased.
Conclusion: In a period in which cesarean rates have increased instead of the desired decrease, the rate of women wishing normal birth has decreased. In the ten-year comparison, it was found that women who did not have sociodemographic characteristics associated with cesarean delivery request (high economic status, employed, higher age, university graduate) in previous studies were also shying away from normal birth. Studies should be conducted on women overcoming their concerns about pain during normal birth.

5.The Fusion of T2 Weighted MRI and Diffusion-Weighted Imaging in Evaluating the Depth of Myometrial Invasion in Endometrial Cancer
Ola Magdy Mohamed Shatat, Sherihan Fakhry, Maha Hussein Helal
doi: 10.14744/etd.2019.43815  Pages 375 - 380
Objective: To investigate the performance of fused T2WI-diffusion-weighted imaging (DWI) in the preoperative evaluation of the depth of myometrial invasion in endometrial cancer.
Materials and Methods: Twenty-nine patients with histologically proven endometrial carcinoma were enrolled in this study. All of them underwent a full magnetic resonance imaging exam including T2-weighted images and DWI with b values of 0, 500, and 1000 s/mm2. The ADC value in endometrial cancer and normal endometrium of control cases was calculated. The myometrial invasion depth was judged in each sequence separately as well as by fused images, and was correlated with the surgical pathology results.
Results: In the evaluation of superficial myometrial invading lesions using the fused T2WI-DWI, the sensitivity was found to be 94.7%, specificity was 90%, and accuracy was 94.7%, while the values of about 90% sensitivity, 94.9% specificity, and 90% accuracy of fused T2WI-DWI in the evaluation of deep myometrial invading lesions were obtained. On the ADC maps, the mean ADC value of endometrial cancer was 0.9±0.17×10−3 mm2/s and the mean ADC value of normal endometrium of control cases was 1±0.11×10−3 mm2/s.
Conclusion: The fusion of T2WI and DWI showed a good noninvasive diagnostic method of staging of invasion and preoperative depth. It can be used as an alternative diagnostic tool for endometrial carcinoma staging with reduced cost and injection of a contrast agent.

6.Usefulness of Dermoscopic Findings in the Clinical Evaluation of Beard Alopecia Areata
Özlem Karadağ Köse
doi: 10.14744/etd.2019.54815  Pages 381 - 384
Objective: The aim of this study is to investigate the usefulness of dermoscopic findings in the clinical evaluation of beard alopecia areata (BAA).
Materials and Methods: A total of 38 patients who presented with BAA diagnosed via clinical evaluation and 38 adults who did not have BAA (control group) were included. Their age, skin phototype, localization, severity, scalp involvement, duration of the disease, laboratory findings, and concomitant disorders were noted. Clinical and dermoscopic photos were taken by videodermoscope and recorded. Dermoscopic findings were analyzed according to the checklist described in previous articles for scalp alopecia.
Results: Clinical severity of alopecia areata was observed as 13 (34.2%) solitary lesions, 22 (57.9%) multiple lesions, and 3 (11.1%) cases of total beard loss. According to the follicular features, white vellus and tapering hairs were detected 26 (68.4%) and 8 (21.1%) in the patient group, respectively. The difference between white vellus (p=0.001) and tapering hairs (p=0.003) was significant between the patient and the control groups. Other follicular findings, such as yellow dots, black dots, black vellus hairs, broken hairs, hair diameter diversity, and gray–white dots, did not show a significant difference between the patient and control groups. None of the interfollicular findings were significantly different between the two groups.
Conclusion: According to our study, a dermoscopic evaluation is useful in the clinical evaluation of BAA. Detection of the white vellus and tapering hairs may guide diagnosing of BAA.

7.Are Red Blood Cell Distribution Width and RDW/Hemoglobin Ratio Predictable in Mortality Among Patients with Chronic Obstructive Pulmonary Disease?
Nalan Ogan, Ersin Günay, Ayşe Demir Baha, Esen Sayın Gülensoy, Evrim Eylem Akpınar
doi: 10.14744/etd.2019.10270  Pages 385 - 389
Objective: Chronic obstructive pulmonary disease (COPD), the third most common cause of death in the world, is a multi-component disease with pulmonary and extrapulmonary manifestations. The red blood cell distribution width (RDW) conveys important information for short- and long-term prognosis through a variety of medical conditions. Anemia can be seen in patients with COPD due to systemic inflammation and malnutrition. The aim of this study was to evaluate the role of RDW and RDW/Hgb in the prediction of mortality in patients with exacerbated COPD.
Materials and Methods: Between December 2015 and December 2017, 97 patients admitted to the Department of Chest Diseases at the Ufuk University Medical Faculty, with a diagnosis of COPD exacerbation were evaluated retrospectively. The demographic, clinical, laboratory characteristics, pulmonary functional tests, and arterial blood gases were noted. The RDW values and RDW/Hgb ratios were compared between patients who had died and those who were still alive.
Results: About 79.4% of the patients (n=77) were male and the rest of them 20 (20.6%) were female. The mean age was 73.01±9.54 years. The RDW values of patients with mortality were higher than the living COPD patients (p<0.001). The RDW/Hgb ratio was found to be higher in patients who had died than those who were living (p<0.001). The levels of C-Reactive protein were significantly higher in patients with COPD with mortality (p=0.034).
Conclusion: The elevated RDW levels and the RDW/Hgb ratio were associated with an increased annual number of attacks, comorbidities, and an increased PO2 and PCO2 mortality risk in patients with COPD.

8.Predictors of Perinatal Mortality Associated With Placental Abruption: A Single Center Experience With 200 subjects
Gülseren Yılmaz, Aysu Akça, Hüseyin Kıyak, Ziya Salihoğlu
doi: 10.14744/etd.2019.81084  Pages 390 - 393
Objective: Despite recent advances in prenatal diagnostic techniques, placental abruption (PA) remains one of the most significant causes of maternal morbidity and perinatal mortality. The purpose of the present study is to summarize the current knowledge concerning PA and to present maternal and fetal outcomes of the patients admitted to our clinic who underwent cesarean delivery for PA.
Materials and Methods: All the consecutive patients enrolled in our clinic and diagnosed with PA between January 2015 and December 2018 were enrolled in this retrospective study. Data regarding demographics, operation details, and the postoperative course included blood transfusions, development of maternal and fetal complications, and laboratory measurements were collected from the electronic institutional database.
Results: A total of 200 patients were recruited in this retrospective study. No maternal death was observed during the in-hospital course. Uterine rupture developed in 6 (3%) subjects, severe hemorrhage occurred in 28 subjects (14%), and fetal and neonatal mortality was observed in 10 (5%) subjects. Logistic regression analyses indicated that fibrinogen levels prior to delivery (p=0.039), gestational age (p=0.005), smoking (p=0.044), and maternal systolic blood pressure (p=0.013) were independent predictors for fetal and neonatal mortality.
Conclusion: The maternal and perinatal mortality observed in our study population is favorable as compared to previous results. Fibrinogen levels prior to delivery, gestational age, smoking, and maternal systolic blood pressure were independently predictive for fetal and neonatal mortality in subjects with PA.

9.Post-necrotizing Enterocolitis Stricture: Misdiagnosis of this Complication Results in Greater Infant Mortality
Emine İnce, Semire Serin Ezer, Abdülkerim Temiz, Hasan Özkan Gezer, Akgün Hiçsönmez
doi: 10.14744/etd.2019.98470  Pages 394 - 397
Objective: Intestinal stricture following necrotizing enterocolitis (NEC) is often misdiagnosed as recurrent functional constipation, enteritis, and malnutrition, and it increases the rates of morbidity and mortality in infants. Although a number of studies have focused on the potential etiologic factors leading to NEC, the information regarding the occurrence and diagnosis of post-NEC strictures is limited. The aim of this study was to evaluate the clinical presentation and diagnostic and surgical methods to treat NEC.
Materials and Methods: The medical records of infants who had undergone surgery for post-NEC strictures between January 2005 and September 2018 were evaluated retrospectively in a single institution.
Results: This study included 38 infants (20 males, 18 females) with post-NEC stricture. Their histories revealed that they had been treated medically (20 of 38) or surgically (18 of 38) for NEC. Symptoms typical of intestinal obstruction (vomiting, abdominal distension, constipation, growth retardation, etc.) were present in the medically treated patients. The average time of onset of symptoms after the acute episode of NEC was 1.64±0.78 months. Contrast studies revealed strictures in the small intestine in 13 (65%) medically treated patients, while 13 (72.2%) surgically treated patients had strictures in the colon. Additionally, 2 of surgically treated patients presented with ileocolic fistulae. In 11 of 38 (28.9%) patients, the contrast studies were false-negative.
Conclusion: Post-NEC strictures may present with vague nutritional problems, causing the diagnosis to often be missed, which leads to high rates of morbidity and mortality in infants. Colon enemas, distal loopograms, and small bowel passage radiograms are useful in making a diagnosis, but a careful examination of the intestines for the presence of any other strictures should be done during the surgery.

10.An Exploration of Factors That Cause the Spontaneous Migration of Double-J Stents After Retrograde Intrarenal Surgery
Furkan Şendoğan, Turgay Turan, Özgür Efiloğlu, Gokhan Atış, Turhan Çaşkurlu, Asıf Yıldırım
doi: 10.14744/etd.2019.24540  Pages 398 - 401
Objective: Retrograde intrarenal surgery (RIRS) is a minimally invasive and relatively new method of treatment for kidney stones. We aimed to identify the factors that cause stent migration in patients who have undergone RIRS to treat kidney stones.
Materials and Methods: Four hundred and twenty-eight patients who underwent RIRS to treat kidney stones that were less than 2 cm in size and had JJ stents inserted intraoperatively between December 2013 and December 2017 were included in this study. For each patient, demographic data and, if present, JJ stent migration direction and postoperative complications were recorded. Twenty-eight patients who experienced JJ stent migration (group 1) and 400 patients who did not experience the migration (group 2) were compared.
Results: Postoperative complications developed in a total of 39 (9.1%) patients. Seventeen complications were evaluated as minor (Clavien 1–2) and 22 (5.1%) were evaluated as major. Almost all of the major complications (n=21) were found to be associated with JJ stent migration. Urosepsis was detected in only one patient (Clavien 4). The mean ages in groups 1 and 2 were 45.4±17.3 years and 44.3±15.1 years, respectively. The mean stone size in group 1 was 16.9±3.0 mm, whereas it was 14.2±5.3 mm in group 2 (p=0.031). A comparison of both the groups showed that the likelihood of an occurrence of JJ stent migration increased significantly with the degree of hydronephrosis (p<0.001).
Conclusion: JJ stent migration after RIRS increases the rate of major complications. An association was detected between JJ stent migration and an increase in stone size and the degree of hydronephrosis.

11.Analysis of Genital Hygiene Behaviors of Women Who Applied to Women’s Illnesses and Birth Policlinic
Hilal Karadeniz, Ruşen Öztürk, Gül Ertem
doi: 10.14744/etd.2019.37132  Pages 402 - 408
Objective: This research report is a descriptive and cross-sectional study to investigate and compare the genital hygiene behaviors of pregnant, nonpregnant, and puerperal women.
Materials and Methods: The study included 304 pregnant, nonpregnant, and postpartum women in the 15–49-year age group, who presented at the Ege University Medical Faculty Hospital Obstetrics and Gynecology Clinic, between December 2015 and May 2016 and were accepted to participate in the study. The socio-demographic characteristics and gynecological characteristics of the subjects were collected by face-to-face interviews using the “Individual Presentation Form” and “Genital Hygiene Behavior Inventory.”
Results: Within the sample, 30.3% were nonpregnant women, 39.8% were pregnant women, and 29.9% were postpartum women. The mean age of the sample was found to be 30.0±7.59 years. When the inventory data of genital hygiene behaviors were examined, the mean of the total scaled score was 80.5±11.1; 78.5±11.9 for nonpregnant women; 80.4±10.6 for pregnant women; and 82.5±10.8 for postpartum women. No other statistically significant difference between the groups in terms of the scale total point average was evident (p>0.05).
Conclusion: No statistically significant difference between the groups in terms of genital hygiene behaviors was evident, as the results of the study showed that the average of genital hygiene behavior scores of pregnant, nonpregnant, and postpartum women was not too high. However, only one-third of women had received education in genital hygiene in their life, therefore, some women tend to practice incorrect genital hygiene behavior. It is believed that an increase in the education can increase the usage of correct genital hygiene practices.

12.Role of Cytology in Pleural Effusion: A Single-Center Experience
Canan Sadullahoğlu, Ruşen Uzun
doi: 10.14744/etd.2019.88557  Pages 409 - 413
Objective: As a fast and effective method, cytopathological examination of the pleural fluid is the diagnostic tool of choice in determining the etiology of a spectrum of inflammatory to neoplastic conditions. The aim of the present study was to investigate the role of pleural cytology samples examined within a certain time period in determining the presence of malignant cells.
Materials and Methods: Cytological materials of 433 patients with pleural effusion (PE) were retrospectively analyzed. Clinical parameters and cytological diagnosis were recorded in consecutive patients with PE.
Results: Of the 433 cases enrolled in the study, 264 (61%) were male, and 169 (39%) were female. 15.6% (67/433) of the cases were reported as malignant, and 85% were aged >50 years. It was found that the contribution of repeated cytological examination of a material to diagnosis was approximately 3%. The sensitivity and specificity of the cytological method were calculated as 34% and 99%, respectively. Immunocytochemistry was performed in 50 patients who received cell-block techniques, and 42.4% of those were diagnosed as malignant. Molecular tests were also performed in 5 patients.
Conclusion: Although the sensitivity is low, cytological examination of the pleura can be considered a diagnostic tool of vital importance, especially in patients with an advanced-stage disease and poor performance, who can benefit from rapidly evolving and changing treatment options.

13.Frailty and Quality of Life in the Elderly Living in Nursing Home
Betül Özen, Özlem Ceyhan, Nuray Şimsek, Tülay Bülbül
doi: 10.14744/etd.2019.52814  Pages 414 - 419
Objective: This work was designed to determine the association between the level of frailty and quality of life in nursing home residents.
Materials and Methods: This descriptive and correlational study was conducted in a nursing home in Turkey that is affiliated with the Ministry of Family and Social Policy. Between May 2016 and August 2016, we included 126 elderly individuals who satisfied the inclusion criteria and who agreed to participate in the study.
Results: The mean age of the participants was 78.2±10.7 years. The scores achieved in the Edmonton Frail Scale showed moderate and severe frailty in 33.4% of the elderly individuals. There was a linear correlation between frailty and life quality scores (r=–0.323, p<0.001). In the regression analysis, it was determined that as the age increased, the frailty total score increased significantly (F=9.567, p<0.05, R=0.60, R2=0.36). It was observed that as the number of chronic diseases increased, the frailty total score increased.
Conclusion: According to the results of the study, it was determined that fragility affected the quality of life in elderly individuals. It is recommended for healthcare personnel in the nursing home to evaluate the elderly in terms of frailty and to know risk factors for the frail elders.

14.Causes of Blindness and Moderate to Severe Visual Impairment in Niğde, Central Anatolia, Turkey
Erkut Küçük, Kürşad Zor, Uğur Yılmaz
doi: 10.14744/etd.2019.66199  Pages 420 - 424
Objective: We investigated the causes of blindness and moderate to severe visual impairment (MSVI) in the Niğde province of Turkey using the disability health board records of the Niğde State Hospital.
Materials and Methods: The disability health board reports of Niğde State Hospital recorded between 2011 and 2015 were retrospectively evaluated. The causes of blindness and MSVI were determined using the cause in the better-seeing eye, based on World Health Organization (WHO) criteria. The overall, age-related, and gender specific causes of blindness and MSVI were identified.
Results: During the study period, 335 subjects were recorded as blind and 381 subjects were recorded as having MSVI. The main causes of blindness were retinitis pigmentosa (14.6%), age-related macular degeneration (AMD) (12.2%), and diabetic retinopathy (12.2%). In the MSVI group, the main causes were cataract (18.4%), AMD (16.5%), and diabetic retinopathy (13.9%).
Conclusion: Retinitis pigmentosa, AMD, and diabetic retinopathy were the leading causes of blindness, and, in addition to these, cataract was a prominent cause of MSVI. The prevalence of retinitis pigmentosa was unexpectedly high in this region of Turkey, which may be due to the high frequency of consanguineous marriages that are commonly seen in Middle Eastern countries. This information is important for planning public health policies and raising public awareness of the visual impairment, given that several leading causes of visual impairment are reversible or preventable.

15.Clinical Significance of Incidental 18-FDG Uptake in Nasopharynx on PET/CT Scanning
İmdat Yüce, Kerem Kökoğlu, Ümmühan Abdulrezzak, Samet Aydemir, Turan Arlı, Sedat Çağlı
doi: 10.14744/etd.2019.73626  Pages 425 - 428
Objective: The necessity of biopsy in cases of incidental nasopharyngeal 18 fluorodeoxyglucose (18-FDG) uptake was investigated in this study.
Materials and Methods: A total of 27 patients, who suffered incidental 18-FDG uptake in their nasopharynx, were enrolled in the study. Their primary malignant diseases, physical examination findings, standardized uptake values (SUV), uptake sides, and nasopharynx biopsy results were evaluated.
Results: There were 23 benign and 4 malignant tumors found on the biopsy results. A total of 10 patients had visible lesions in their physical examinations. When the data were evaluated statistically, the relationship between the visible lesion and the nasopharyngeal biopsy results was found to be significant (p<0.05). All the patients who had a malignant biopsy result also had a history of lymphoma and an asymmetrical nasopharyngeal uptake. There was no significant difference between the SUVmax value and the biopsy result.
Conclusion: Biopsy can be considered in patients who have a visible lesion in the nasopharynx examination, a history of lymphoma, and asymmetrical nasopharyngeal uptake according to the PET scan.

16.Disease-Modifying Antirheumatic Drugs and Remote Ischemic Postconditioning Ameliorate for Myocardial Injury in Rats Under Cerebral Stroke
Duygun Altıntaş Aykan, Muhammed Seyithanoğlu, Ülkü Kazancı
doi: 10.14744/etd.2019.02703  Pages 429 - 434
Objective: Currently, there is uncertainty about the increased risk of myocardial infarction following ischemic stroke or transient ischemic attack and the method of risk management after the stroke. In this experimental study, we aimed to evaluate myocardial injury after inducing global cerebral ischemia in rats and assess their responses to the treatments with disease-modifying antirheumatic drugs (DMARDs) and ischemic postconditioning (PC).
Materials and Methods: Global cerebral ischemia was induced by occluding the bilateral common carotid arteries for 20 minutes and subsequently reperfusing them. Thirty-two Wistar rats were divided into 4 treatment groups (n=8 for each group). Group I received 7 mg/kg/day infliximab immediately and at 6 hours after the stroke and group II received 10 mg/kg/day leflunomide immediately and at 6 hours after the stroke. In group III, the skeletal muscle in the limbs was clamped for 180 minutes immediately after the stroke and was reperfused for 120 minutes. Group IV was sham-operated and received saline immediately and at 6 hours after the stroke. Myocardium tissue samples were collected for histopathologic assays and to create hypoxia-induced tissue oxidative markers.
Results: We found that apoptosis and nucleus loss in the myocardium were significantly decreased after the administration of infliximab, leflunomide, and remote ischemic PC. Necrosis in the myocardium and cardiac malondialdehyde (MDA) level were also significantly decreased after treatment with remote skeletal muscle PC.
Conclusion: Our findings demonstrated that remote ischemic PC and DMARDs were protective against cerebral ischemia/reperfusion injury. They acted by mobilizing the endogenous adaptive mechanisms in the myocardium and inhibited oxidative stress by increasing the activity of antioxidant enzymes.

17.Most Frequent Esophageal Foreign Bodies Ingested by Children
Derya Altay, Duran Arslan
doi: 10.14744/etd.2019.10693  Pages 434 - 439
Objective: The presence of a foreign body in the esophagus represents one of the gastroenterological emergencies. In this study, we aimed to evaluate retrospectively foreign bodies attached to the esophagus.
Materials and Methods: The files of pediatric patients admitted to the university hospital due to ingestion of foreign bodies between January 2018 and January 2019 were examined retrospectively, and those attached to the esophagus were evaluated.
Results: A total of 215 pediatric patients were admitted with the complaint of foreign bodies ingestion, and 63 (29.3%) of them had foreign bodies impacted in the esophagus. The mean age of the 63 patients (55.6% males) was 4.8±3.9 years. The mean age of 152 cases (58% males) was 5.3±3.8 years. Of the cases with foreign bodies impacted in the esophagus, 10% were Syrian refugees. Most of the foreign bodies removed from the esophagus endoscopically were coins, which were frequently attached to the upper esophageal sphincter. In the remaining patients, the foreign bodies (mostly coins) pass through the gastrointestinal tract without any problems.
Conclusion: Endoscopy is an important method in the treatment of esophageal foreign bodies. An early intervention is important in patients who ingested a button battery. However, adolescents who have food impacted in the esophagus should be evaluated earlier in terms of eosinophilic esophagitis.

18.Percutaneous Retrieval of Internal Double-J Ureteral Stents Using a Snare
Güven Kahriman, Nevzat Özcan, Aytaç Doğan
doi: 10.14744/etd.2019.24654  Pages 440 - 443
Objective: In this paper, we aim to report our experience in percutaneous ureteral stent retrieval using a loop snare under fluoroscopic guidance and to assess the efficacy and safety of the method.
Materials and Methods: Between February 2009 and December 2016, electronic records of the patients who underwent percutaneous ureteral stent retrieval were reviewed. A total of 12 patients (8 males, 4 females; age range, 6 months–75 years; mean age, 39.71±32.3 [standard deviation] years) were included in the study. A loop snare was used to retrieve the ureteral stent from the calyx, renal pelvis, and upper or distal ureters via the vascular sheath. The stent retrieval was performed for endoscopic failure (n=5), proximal stent migration (n=3), early occlusion of the stent (n=2), and stent fragmentation (n=2). A complete percutaneous removal of the ureteral stent with the snare was considered a technical success.
Results: Our technical success rate was 100%. There were no major complications. One patient (8.3%) had minor hematuria that resolved spontaneously.
Conclusion: Percutaneous ureteral stent retrieval using a loop snare under fluoroscopic guidance is a safe and effective procedure, especially when the cystoscopic removal has failed and stent-related complications occurred.

19.Radioprotection in Prenatal Care Using a Nonwoven Fabric with Electromagnetic Shielding Property
Ayşe Gizem Şahmelikoğlu, Sacide Karakaş, Ayfer Metin Tellioğlu, Niyazi Acer, Mehmet Bilgen
doi: 10.14744/etd.2019.55798  Pages 444 - 449
Objective: Electromagnetic shielding fabrics (EMSFs) have been marketed by several manufacturers within the past few years. However, their efficacies in protecting living organisms against the harmful effects of EM noise have yet to be established. The aim of the present study was to accomplish this task with novel in vivo experiments where fetal development and the pathological consequences of wearing protective fabric against EM radiation during pregnancy were investigated.
Materials and Methods: Nine pregnant rats were equally divided into three groups. Sham controls were kept unexposed, but the remaining six were subjected to EM radiation at 900 MHz for 1 h daily throughout the pregnancy. However, three of the rats were protected by a nonwoven fabric manufactured locally and characterized previously. After birth, the kidneys of newborns were extracted and evaluated by histopathology. Histometry data were analyzed statistically.
Results: EM exposure affected the kidney structure and morphology as revealed by the disruption of glomerular basement membrane continuity, increased Bowman capsule and proximal tubule sizes (from 15.01±2.56 µm to 29.94±4.42 µm), and thickened cortex and medulla (from 261.13±4.10 µm to 284.57±10.93 µm for cortex and from 594.25±23.48 µm to 732.61±20.46 µm for medulla). However, the effects were significantly attenuated in those kidneys placed behind the fabric.
Conclusion: EMSF effectively protects the fetal kidney against EM radiation at 900 MHz during the developmental phase and possibly at other frequencies and for other organs. It is advisable to wear such fabrics during pregnancy when EM pollution is of significant concern.

CASE REPORT
20.Gallstone Ileus Due to a Cholecystoduodenal Fistula
Daniel Kostov, Vasil Kostov
doi: 10.14744/etd.2019.54926  Pages 450 - 452
Gallstone ileus is an infrequent complication of cholelithiasis, which manifests as small distended intestinal loops containing the characteristic radiographic patters of “air-fluid levels.” Cholelithiasis is associated with high rates of morbidity and mortality. A 64-year-old woman was admitted to the hospital with a history of abdominal pain, nausea, multiple episodes of bilious vomiting, distention, and constipation that had been occurring continuously since the past 7 days. Clinical examination revealed bloating and diffused tenderness in the abdomen. There was no rebound and no defense. Computed Tomography (CT) of the abdomen showed air-fluid levels in small bowel segments, a 50×35 mm calcified gallstone that was obstructing the terminal ileum, air in the gallbladder, and a large impacted ileal gallstone. The patient underwent laparoscopic repair of a cholecystoduodenal fistula, cholecystectomy, and removal of a gallstone by enterotomy with subsequent reconstruction of the terminal ileum. The patient was discharged on the 5th postoperative day with a full resolution of symptoms and no complications. CT of the abdomen is a useful aid in the diagnosis of cholecystoduodenal fistula and gallstone ileus. If the patient’s medical condition is stable and suitable, a one-stage laparoscopic approach with concurring enterotomy, cholecystectomy, and fistula resection is a worthwhile endeavor.

21.The Importance of Preoperative Dermoscopy in Basal Cell Carcinoma Due to a Case of Nodular Cystic BCC
Selami Aykut Temiz, İlkay Özer, Arzu Ataseven, Recep Dursun, Sıddıka Fındık
doi: 10.14744/etd.2019.48992  Pages 453 - 455
Basal cell carcinoma (BCC) is the most widespread malignancy among all malignancies. It constitutes 65%–80% of non-melanoma skin malignancies. Although there is no universally accepted classification for BCC, there are at least 26 different defined subtypes, which can all be very difficult to recognize. The best-known variants of BCC are nodular, superficial, morpheaform, and infiltrative types. In this report, we describe a patient who was referred for surgery with the diagnosis of cystic BCC by preoperative dermoscopy. Herein, we present a rare form of nodular cystic BCC due to its importance in improving the knowledge of dermoscopy and surgery.

22.Wernicke’s Encephalopathy: A Forgotten Disease
Sevda Onuk, Hasan Dirik, Ramazan Aktaş, Şahin Temel, Nevzat Herdem, Nurhayat Tuğra Özer, Gülşah Güneş Şahin, Murat Sungur, Kürşat Gündoğan
doi: 10.14744/etd.2019.32391  Pages 456 - 458
Wernicke’s encephalopathy (WE) is an acute neurological condition characterized by ataxia, confusion, ocular findings, and impairment of consciousness due to thiamine deficiency. Although alcoholism is the most common reason, WE cases resulting from prolonged total parenteral nutrition (TPN) without multivitamin complex have been reported. Here we present a dramatic improvement in symptoms with high-dose thiamine in a patient who developed WE due to TPN after gastrointestinal surgery.

IMAGE
23.Bleeding Polyp of the Nasal Septum
Satvinder Singh Bakshi
doi: 10.14744/etd.2019.32858  Page 459
Abstract | Full Text PDF

24.Is it Just Simple Dermatitis or Eczema?
Öner Özdemir
doi: 10.14744/etd.2019.53533  Pages 460 - 461
Abstract | Full Text PDF

HISTORY OF MEDICINE
25.Humoral Pathology Theory in the Kutadgu Bilig (Wisdom of Royal Glory): A Karakhanid Turkic Work From the 11th Century
H. Volkan Acar, Eyüp Sarıtaş, Nüket Örnek Büken
doi: 10.14744/etd.2019.44452  Pages 462 - 466
The Turkic people in Central Asia started to convert to Islam in the mid-8th century. Islam, just like other religions in other cultures, had an impact on various aspects of Turkish life, including literacy, language, and culture. It seems that the concept of four humors has been adopted by Turkic people along with the conversion to Islam. The humoral pathology theory based on the idea that human bodies contain basic four humors, or fluids (i.e., blood, yellow bile, black bile, and phlegm), was the mainstream medical system for hundreds of years. After a paradigm shift in medicine in the mid-19th century, this theory was replaced with the modern germ theory. However, the reflections of the four humors theory can be observed in the Kutadgu Bilig, an 11th century Central Asian Turkic “mirror for princes,” which contains pieces of advice on ideals of statecraft. It is also possible to find the traces of medical understanding of Turkic people from that period in this work. The evaluation of the manuscript shows that it contains valuable information related to humoral pathology theory. Some of the examples are that it emphasizes that the harmony of the humors is essential for a healthy life; the relationship between temperament and age, season, food, and four qualities (hot–cold and wet–dry) is expressed. In conclusion, the Kutadgu Bilig is a good sample of work containing information on the humoral pathology theory in Central Asian Turkish medicine from the 11th century.

SUBJECT INDEX
26.Subject Index

Pages 467 - 468
Abstract | Full Text PDF

REVIEWER LIST
27.Reviewer List

Pages 469 - 470
Abstract | Full Text PDF

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