Solid pseudopapillary tumor of the pancreas: A Case Report

Pankreasın nadir görülen solid psödopapiller tümörü olgusunu sunmayı amaçladık. Nonspesifik gastrointestinal yakınma ile başvuran 15 yaşında kadın hastada, fizik muayenede epigastrik bölgede dolgunluk tespit ettik. Görüntüleme tetkiklerinde distal pankreasta solid psödopapiller tümörü düşündüren lezyonu distal pankreatektomi ile tedavi ettik. Çoğunlukla genç kadınlarda saptanan, cerrahi rezeksiyonla iyi prognoz elde edilmesi nedeniyle pankreasın solid psödopapiller tümörünün diğer pankreas malignitelerinden ayrıldığı akılda tutulmalıdır.We aimed to present a rare case of solid pseudopapillary tumor of the pancreas. In the physical examination, we diagnosed fullness in the epigastriatic area of a young female patien who applied to the hospital with a non-spesific gastrointestinal complaint. We amployed distal pancreatectomy on the lesion which brought to mind solid pseudo papillary tumor in distal pancreas in the imaging studies. It should be born in mind that solid pseudo papillary tumor, which is generally diagnosed in young women, differs from other pancreatic malignities in that a good prognosis is obtained through surgical resectio

Pankeasın Solid Psödopapiller Tümörü: Olgu Sunumu

Pankreasın nadir görülen solid psödopapiller tümörü olgusunu sunmayı amaçladık. Nonspesifik gastrointestinal yakınma ile başvuran 15 yaşında kadın hastada, fizik muayenede epigastrik bölgede dolgunluk tespit ettik. Görüntüleme tetkiklerinde distal pankreasta solid psödopapiller tümörü düşündüren lezyonu distal pankreatektomi ile tedavi ettik. Çoğunlukla genç kadınlarda saptanan, cerrahi rezeksiyonla iyi prognoz elde edilmesi nedeniyle pankreasın solid psödopapiller tümörünün diğer pankreas malignitelerinden ayrıldığı akılda tutulmalıdır

Donma Hasarı ve Malüliyet Bir Olgu Sunumu

İş kazaları ve malüliyetler, zaman zaman yargıya yansımaktadır. Mahkeme durumun belirlenmesi için Adli Tıptan rapor talep etmektedir. Olgunun, 1987 yılında görev sırasında soğukta uzun süre kalmış olması nedeniyle ayakları donmuştur. Çeşitli sağlık merkezlerince görülen olgu, bu merkezlerde “burger”, “öpere sempatektomi, burger” gibi tanılar almış, ayrıca bir üniversite hastanesi tarafından da görülen olgu hakkında “ alt ekstremitede donuk sonucu periferik arter yetersizliği yoktur” raporu verilmiştir. Olgu, 1997 yılında ayağında meydana gelen hasar nedeniyle “Burger” tanısıyla emekli edilmiş. Kendisine daha once verilen tıbbi raporlar dikkate alınarak Emekli Sandığı tarafından vazife malülii olarak değerlendirilmemiştir. Olgu durumunun Burger’den kaynaklanmadığını ileri sürerek dava açmıştır. 2001 yılında mahkeme olgunun yeniden değerlendirilmesini istemiş, Kocaeli Üniversitesi Tıp Fakültesi Adli Tıp Anabi-lim Dalında yapılan incelemeler sonucunda öykü ile patolojik bulguların uyumlu olmadığı saptanmıştır. Ayırıcı tanı için olguda ayrıntılı fiziksel muayene ve radyolojik incelemeler yapılmış, “Burger” hastalığında kalıcı olan damar lezyonları ve kol-lateral gelişimin olguda gözlenmediği görülmüştür. Yapılan doppler ve anjiyografik incelemeler sonucunda sağ bacakta gözlenen patolojinin daha çok donma soması oluşan mirovasküler hastalıkla uyumlu olduğu kanaatini bildirir rapor düzenlenmiştir. Mahkeme düzenlenen bu rapor doğrultusunda hastanm vazife malülii olduğuna karar vermiştir. Anahtar Kelimeler: Maluliyet, Burger, Donma hasarı, Adli tıp

Renal hücreli karsinom ile birlikte midede gastrointestinal stromal tümör

Gastrointestinal stromal tümörler (GİST), gastrointestinal sistem (GİS)in en sık mezenkimal tümörleridir. Renal hücreli kanserler (RCC) ile birlikte bulunabilirler. İkili vakalar literatürde rapor edilmekle beraber, bunlar olgu raporları biçimindedir. Bu olgu raporunda midede GIST olan ve aynı anda RCC tespit edilen bir hasta sunulmaktadır. Tedavi kapsamında, midede kama rezeksiyonu ve parsiyel nefrektomi uygulandı. Ameliyat sonrası komplikasyonu olmayan hasta, post-op 7. günde taburcu edildi.Gastrointestinal stromal tumours (GIST) are the most common mesenchymal tumours of the gastrointestinal system (GIS). They may co-exist with renal cell cancers (RCC). While a couple of cases have been reported in literature, these are in the form of case reports. This case report presents the case of a patient with GIST in the stomach and simultaneously detected RCC. Within the scope of the treatment, wedge resection to the stomach and partial nephrectomy were performed. The patient, who had no post-op complications, was discharged on post-op day 7. Gastrointestinal stromal tumours (GIST) are the most common mes- enchymal tumours of the gastrointestinal system (GIS). They may co-exist with renal cell cancers (RCC). While a couple of cases have been reported in literature, these are in the form of case reports. This case report presents the case of a patient with GIST in the stomach and simultaneously detected RCC. Within the scope of the treatment, wedge resection to the stomach and partial nephrectomy were performed. The patient, who had no post-op complications, was discharged on post-op day 7

Longitudinal Strain and Strain Rate for Estimating Left Ventricular Filling Pressure in Heart Transplant Recipients

Traditional parameters have limited value to estimate left ventricular filling pressure (LVFP) in orthotropic heart transplant (OHT) recipients. We hypothesized that global longitudinal strain (GLS), diastolic, and systolic strain rate (SR) would be depressed in OHT recipients with elevated LVFP and could overcome the limitations of traditional parameters. We studied consecutively OHT patients at the time of endomyocardial biopsies and retrospectively pretransplantation studies conforming to the same protocol. Comprehensive echocardiography with strain measurements was performed. Results were compared with pulmonary capillary wedge pressure (PCWP) obtained from right heart catheterization that was performed just after the echocardiography study. In all, 74 studies were performed in 50 OHT recipients. Mean PWCP was 11.8 +/- 4.3 mm Hg (range: 4 to 25 mm Hg). Several parameters, but not left atrial volume index, mitral inflow velocities, annular velocities, and their ratio (E/e'), were different between studies with normal (n = 47) and elevated PCWP (n = 27). Area Under Curve for GLS (0.932*), E/e'SR (0.849*), and systolic SR (0.848*) (*p 0.0001) were more accurate than traditional parameters for predicting PCWP 12 mm Hg. GLS, systolic SR and E/e'SR remained accurate regardless of LV ejection fraction and allograft vasculopathy. Meanwhile, E/e' was accurate to predict PWCP in native failing hearts before transplantation. Changes in GLS and E/e'SR tracked accurately changes in PCWP. In conclusion, traditional indices of diastolic function perform poorly in OHT recipients, whereas GLS and E/e'SR provide reliable means of LVFP, irrespective of ejection fraction and allograft vasculopathy. These parameters also track reasonably well the changes in LVFP. (c) 2020 Elsevier Inc. All rights reserved

Multiparametric assessment of right ventricular function in heart transplant recipients by echocardiography and relations with pulmonary hemodynamics

Objective: Right ventricular (RV) dilatation and dysfunction are usually present in heart transplant (HTx) patients and worsened with residual pulmonary hypertension (PH). We aimed to determine the ability of different echocardiographic modalities to evaluate RV function in comparison with cardiac magnetic resonance (CMR) and their relations with pulmonary hemodynamics in HTx patients. Methods: A total of 62 data sets [echocardiographic, hemodynamic, and CMR] were acquired from 35 HTx patients. Comprehensive echocardiography, including two-dimensional (2D) transthoracic echocardiography, speckle tracking echocardiography, and three-dimensional (3D) echocardiography, was performed. Mean pulmonary artery pressure (mPAP) was obtained invasively from right heart catheterization. The correlations between all echocardiographic parameters and CMR imaging data and the differences between patients with and without residual PH were evaluated. Results: Diastolic and systolic RV volumes and RV ejection fraction (RVEF) by 3D echocardiography correlated strongly with CMR-derived volumes and RVEF (r =.91, r =.79, r =.64; p <.0001 for each, respectively). Among other parameters, RV fractional area change (r =.439; p <.001) and RV free wall longitudinal strain (RVFW-LS) (r = −.34; p <.05) correlated moderately with CMR-RVEF, whereas tricuspid annulus S’ velocity (r =.29; p <.05) and tricuspid annular systolic plane excursion (r =.27; p <.05) correlated weakly with CMR-RVEF. Additionally, 3D-RVEF and RVFW-LS were significantly decreased in studies with mPAP ≥ 20 mm Hg in comparison to those with mPAP < 20 mm Hg (47.7 ± 3.7 vs. 50.9 ± 5.3, p =.04 and −15.5 ± 3.1 vs. −17.5 ± 3, p =.03, respectively). Conclusion: The best method for the evaluation of RV function in HTx recipients is 3D echocardiography. Besides, the subclinical impact of residual PH on RV function can be best determined by RVFW-LS and 3D-RVEF in these patients

Pregnancy and its outcomes in hemodialysis patients in Turkey

Background/aim: This study aimed to investigate pregnancy frequency and evaluate the factors affecting live births in hemodialysis (HD) patients. Materials and methods: Female HD patients whose pregnancy was retrospectively reported between January 1, 2014, and December 31, 2019. The duration of HD, primary disease, and the information on whether the pregnancy resulted in abortion, stillbirth, or live birth, whether the HD duration was prolonged after diagnosing the pregnancy and whether it accompanied preeclampsia were recorded. Results: In this study, we reached 9038 HD female patients' data in the study. A total of 235 pregnancies were detected in 145 patients. The mean age was 35.42 (35 +/- 7.4) years. The mean age at first gestation was 30.8 +/- 6.5 years. The average birth week was 32 (28 -36) weeks. A total of 53.8% (no = 78) of the patients had live birth, 51.7% (no = 70) had at least one abortion in the first 20 weeks, and 13.1% (no = 19) had at least one stillbirth after 20 weeks. The rate of patients' increased numbers of dialysis sessions during pregnancy was 71.7%. The abortion rate was 22.4% in those with increased HD sessions, whereas 79.3% in those not increased HD sessions (p < 0.001). Live birth frequency was 67.2% in the increased HD sessions group and 3.4% in those who did not differ in HD sessions (p < 0.001). Conclusion: For the first time, we reported pregnancy outcomes in HD female patients, covering all regions of Turkey. It has been observed that; increasing the number of HD sessions in dialysis patients will decrease fetal and maternal complications and increase live birth rates