The 33-year Retrospective Analysis of Esophageal Carcinomas: Cerrahpaşa Experience

Aim:Esophageal cancer is a fatal disease where the majority of patients are diagnosed at an advanced stage. In this study, we aimed to present the demographic and clinicopathological characteristics of patients who were operated for esophageal cancer.Materials and Methods:A total of 847 patients who underwent surgery, chemoradiotherapy, or palliative procedures for esophageal pathology between the years of 1985 and 2018 were retrospectively analyzed. Age, gender, tumor location, histopathology, surgical technique, and chemoradiotherapy history of patients were analyzed.Results:In the study, 488 patients were male (60.5%) and 319 were female (39.5%). The ratio of males and females was 1.52. The average age was 58.6 years, and 80.1% were older than 50 years. The most common pathological material obtained was squamous cell carcinoma (67.5%), followed by adenocarcinoma (27.7%). Total esophagectomy was performed in 435 patients; distal esophagectomy was performed in 38 patients. Transhiatal esophagectomy (n=271, 62.2%) was the most common procedure that was performed.Conclusion:Esophagectomy is the primary treatment modality for esophageal cancers. When determining the optimal treatment, appropriate patient selection, staging, and risk assessment should be made. Patient-specific treatment should be planned with a multidisciplinary approach

Magnetic resonance imaging based kidney volume assessment for risk stratification in pediatric autosomal dominant polycystic kidney disease

IntroductionIn the pediatric context, most children with autosomal dominant polycystic kidney disease (ADPKD) maintain a normal glomerular filtration rate (GFR) despite underlying structural kidney damage, highlighting the critical need for early intervention and predictive markers. Due to the inverse relationship between kidney volume and kidney function, risk assessments have been presented on the basis of kidney volume. The aim of this study was to use magnetic resonance imaging (MRI)-based kidney volume assessment for risk stratification in pediatric ADPKD and to investigate clinical and genetic differences among risk groups.MethodsThis multicenter, cross-sectional, and case-control study included 75 genetically confirmed pediatric ADPKD patients (5–18 years) and 27 controls. Kidney function was assessed by eGFR calculated from serum creatinine and cystatin C using the CKiD-U25 equation. Blood pressure was assessed by both office and 24-hour ambulatory measurements. Kidney volume was calculated from MRI using the stereological method. Total kidney volume was adjusted for the height (htTKV). Patients were stratified from A to E classes according to the Leuven Imaging Classification (LIC) using MRI-derived htTKV.ResultsMedian (Q1-Q3) age of the patients was 6.0 (2.0–10.0) years, 56% were male. There were no differences in sex, age, height-SDS, or GFR between the patient and control groups. Of the patients, 89% had PKD1 and 11% had PKD2 mutations. Non-missense mutations were 73% in PKD1 and 75% in PKD2. Twenty patients (27%) had hypertension based on ABPM. Median htTKV of the patients was significantly higher than controls (141 vs. 117 ml/m, p = 0.0003). LIC stratification revealed Classes A (38.7%), B (28%), C (24%), and D + E (9.3%). All children in class D + E and 94% in class C had PKD1 variants. Class D + E patients had significantly higher blood pressure values and hypertension compared to other classes (p > 0.05 for all).DiscussionThis study distinguishes itself by using MRI-based measurements of kidney volume to stratify pediatric ADPKD patients into specific risk groups. It is important to note that PKD1 mutation and elevated blood pressure were higher in the high-risk groups stratified by age and kidney volume. Our results need to be confirmed in further studies

Volume CXIV, Number 4, November 7, 1996

Objective: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population.Methods: Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014.Results: The most common karyotype was 45,X (50.7%), followed by 45,X/46,XX (10.8%), 46,X,i(Xq) (10.1%) and 45,X/46,X,i(Xq) (9.5%). Mean age at diagnosis was 10.2±4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45,X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosis) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto's thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%.Conclusion: This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespa

The effects of ultra-early clipping on survival and neurological outcome in poor-grade aneurysmal subarachnoid haemorrhage = Az ultrakorai klipelés hatása a túlélésre és a neurológiai kimenetekre súlyos stádiumú, aneurysmaruptura okozta subarachnoidealis vérzés esetén

Background and purpose – European Stroke Organisation guidelines advise treating aneurysmal subarachnoid haemorrhage (aSAH) as early as possible. However, the optimum timing along with its beneficial effects is controversial. Therefore, we aimed to investigate the effects of ultra-early clipping on neurological outcomes and survival in poor-grade aneurysmal subarachnoid haemorrhages. Methods – This retrospective study included all poorgrade aneurysmal subarachnoid haemorrhage patients treated by ultra-early surgical clipping at Trakya University Hospital between January 1, 2001, and December 31, 2020. We analysed the outcome and mortality data of these patients. Specifically, we evaluated the effects of ultra-early clipping on outcomes, defined as within six hours of the onset of symptoms. Results – From 813 records, 212 met our inclusion criteria. Of these, 117 (55.2%) were female and 95 (44.8%) male. The mean age was 58.3 ± 13.7 years. Glasgow Outcome Scale scores differed significantly between age groups, subarachnoid haemorrhage grades, those who did and did not rebleed, and those who did or did not suffer from vasospasms. A beneficiary relationship was found between ultra-early clipping and mortality among patients. Furthermore, favourable outcomes were significantly more frequent in the ultra-early clipping group. Conclusion – The aSAH patients treated at our hospital who received ultra-early clipping had significantly lower mortality rates and more favourable outcomes. The difference was significant among those treated during the last decade and among patients younger than 50. = Háttér és cél – A European Stroke Organisation irányelvei szerint az aneurysmaruptura okozta subarachnoidealis vérzést (aSAH) a lehető leghamarabb kezelni kell. Mindazonáltal, a beavatkozás optimális ideje, és az általa elérhető előnyök egyelőre még nem tisztázottak. Célunk ezért az volt, hogy megvizsgáljuk az ultrakorai klipelés hatását a túlélésre és a neurológiai kimenetekre súlyos stádiumú, aneurysmaruptura okozta subarachnoidealis vérzések esetén. Módszerek – Retrospektív vizsgálatunkba bevontuk mind - azokat a súlyos stádiumú, aneurysmaruptura okozta subarachnoidealis vérzésben szenvedő betegeket, akiket 2001. január 1. és 2020. december 31. között a Trakya Egyetemi Kórházban ultrakorai klipeléssel kezeltek. Elemeztük a bevont betegek neurológiai kimeneteit és mortalitási adatait. Értékeltük az ultrakorai klipelés (definíció szerint a tünetek jelentkezése utáni 6 órán belüli beavatkozás) kimenetekre gyakorolt hatását. Eredmények – 813 beteg közül 212 felelt meg a bevonási kritériumoknak. A bevont betegek 55,2%-a nő (n=117), 44,8%-a férfi (n=95) volt. Az átlagos életkor 58,3 ± 13,7 volt. A Glasgow Kimeneti Skála pontszámai szignifikánsan különböztek az életkori csoportok, a subarachnoidealis vérzés súlyossága, az ismételt vérzés, illetve a vasospasmus előfordulása szerint. Az ultrakorai klipelés hatására csökkent a mortalitás, és a többi kedvezô kimenet is szignifikánsan gyakoribb volt ebben a csoportban. Következtetés – Azon aSAH-betegek körében, akiket kórházunkban ultrakorai klipeléssel kezeltünk, szignifikánsan alacsonyabb mortalitás alakult ki, és egyéb kimeneteik is szignifikánsan jobbak lettek. A különbség szignifikáns volt a legutóbbi évtizedben (2010–2020) kezeltek és az 50 évesnél fiatalabbak esetén

Urban Seismic Risk Reduction and Mitigation Strategies in Turkey

Since the early ages of humankind, safety and security has been a critical issue against the forces of nature. However, history has always proven the power of nature over humankind in certain regions on Earth for centuries. Indeed, this is a never-ending war between Earth and its inhabitants, namely us, human beings. Humankind’s organization (cities, roads, lifelines etc.) in the nature has never been perfect within the view of environmental pollution and excessive consumption of the resources. Particularly, the quality of civil engineering design and practice is strongly affected from the social and economic background of the country. The societies in rapid development claim excessive demands in terms of housing and transportation. Such demands may create vulnerable urban areas if the economic and social conditions are not in balance or harmony. Thus, nature should not be blamed as the scapegoat in the regions where disasters claim human and economic losses. In fact, the reason for the losses is nothing else than humankind itself. A rational question arises then about how to overcome human and economic loss due to natural disasters. The idea of determining the most vulnerable items in urban areas and reconstructing with the most reliable equivalents may seem very challenging. Even though the macroeconomic implications are very complex, reconstructing the items in densely populated areas is the most effective mitigation action against disasters in the short term. Having learnt lessons from the major earthquake disasters in the heart of the industry and mostly dense urban areas, Turkish government has drawn a long strategic road map in the risk perception and the disaster mitigation strategy for almost all the community services and the infrastructure. The development of awareness against disasters has become part of formal education at all ages. The National Disaster Management system was reorganized from scratch and the capabilities improved by providing additional financial and human resources. All school and hospital buildings in İstanbul were assessed in terms of seismic safety. Those found inadequate were demolished and then reconstructed. In addition, a law on urban renewal of the seismic risk areas was enacted in 2012 allowing the licensed engineering offices to assess the seismic risk of residential buildings at the request of the house owners. If the assessment report is approved by the local municipality, the building is set to demolish within 60 days following the legal notice to the property owners. Disagreeing owners have the right to get the assessment re-evaluated by the independent peer reviewers. In the case of demolition, the house owners are eligible to receive 12 months of rental support from the government. During the time period 2012 to 2019, more than 120 000 buildings were assessed and 74% of them were demolished, the majority of the latter were in İstanbul area where a major earthquake is expected within the following decades. This chapter is intended to explain one of the most comprehensive and challenging disaster mitigation strategies being applied in Turkey based on experience since the 1999 earthquakes.Published19-426T. Studi di pericolosità sismica e da maremot