The Adrenal Gland Volume Measurements in Manifestation of the Metabolic Status in Type-2 Diabetes Mellitus Patients

Objectives. The aim of our study was to investigate the differences in adrenal gland volume between nondiabetic controls and Type-2 diabetic patients and to examine the influence of glycemic control in diabetes mellitus on adrenal gland volume. Methods. From March 2 to November 25, 2015, 62 consecutive patients with Type-2 DM along with 62 nondiabetics matched by age, gender, and BMI were enrolled in this prospective study. Our diabetes patients were categorized into two groups, well-controlled and poorly controlled diabetes groups. Adrenal volumetric measurements were performed by two radiologists, prospectively and independently, with semiautomatic software. Interobserver reliability was studied using the interobserver correlation coefficient (ICC). Results. The total adrenal volume (TAV) was significantly higher in Type-2 diabetic patients when compared with nondiabetic patients (p<0.05). When we investigated diabetic patients according to glycemic controls, the TAVs in controlled diabetic patients were significantly higher than in those of the poorly controlled or uncontrolled diabetic patients (p<0.05). Nondiabetic control patients have significantly smaller TAVs when compared to controlled and poorly or noncontrolled diabetic patients (p<0.05). Conclusion. Our study suggests that adrenal gland volume measurement may be used as an indirect marker of glycemic control in patients with diabetes

First Diagonal Coronary Artery: Left Ventricular Fistula Presenting as Unstable Angina

Coronary artery fistulae are characterized by communications between a coronary artery and a cardiac chamber or another vascular structure. They are usually congenital, but acquired forms may occur. Most patients are usually asymptomatic. However, some studies have emphasized that the incidence of symptoms and complications increases with age, particularly after the age of 20 (Liberthson et al. 1979, Hong et al. 2004). We aimed to present a very rare form of fistula originating from the first diagonal artery and connecting into the left ventricle

A case report with catheter caused Bacillus cereus bacteremia and investigating the clonal relatedness between the isolates by PFGE

Bacillus cereus, hareketli, endospor oluşturabilen Gram pozitif fakültatif aerop basil olup, besin zehirlenmesi, endokardit, bakteriyemi ve sepsis gibi enfeksiyonlara neden olmaktadır. Olgumuzda, 57 yaşında akut myeloid lösemi tanılı, kemik iliği nakli olmuş, kemoterapi almakta olan bayan hasta yüksek ateş şikayetiyle başvurduğu dahiliye kliniğinde nötropenik ateş ve pnömoni öntanılarıyla yatırıldı. Periferik kan kültürlerinde Bacillus cereus üremesi üzerine kateterle eş zamanlı kan kültürleri yapıldı. Kültürlerde B.cereus üremesi tekrar eden hastada kateter kaynaklı bakteriyemi tanısı konularak antibiyotik tedavisi genişletildi. Tedavi sonrasında kateter kan kültürleri dışında üremesi görülmeyen hastanın genel durumunun düzeldiği ve ateşinin düştüğü gözlendi. Üç ayrı zamanda alınan kültürlerde üreyen B.cereus izolatları arasında klonal ilişkinin araştırılması amacıyla Pulsed- field jel elektroforezi yapıldı ve izolatların aynı klon olduğu görüldü. Kan kültürlerinde Bacillus türlerinin üremesi genellikle kontaminasyon olasılığını düşündürmekte olduğundan bazı klinik laboratuvarlar tür düzeyinde identifikasyon yapmamaktadır. Fakat izole edilen tür enfeksiyon etkeni olabileceğinden, bu yaklaşım hasta için zaman kaybına ve gerekli tedavinin gecikmesine neden olabilir. Bu durumlarda kan kültürü tekrarının istenmesi, hastanın immün sistem durumu ve klinik tablosu göz önünde bulundurularak tür tayininin yapılıp yapılmamasına karar vermek gerekmektedir.Bacillus cereus is a motile and spore-forming Gram positive rod and is a microorganism species which cause infections such as food poisoning, endocarditis, bacteremia sepsis. In our case; 57 years old, acute myeloid leukemia diagnosed female patient who had bone narrow transplantation and getting chemotherapy was interned with prediagnosis of neutropenic fever and pneumonia in internal medicine clinics which she admitted with high fever. Since B.cereus growth in peripheral vein blood cultures, catheter blood cultures was performed simultaneously. B.cereus growth repeated in the cultures so catheter caused bacteremia was considered as the diagnosis and antibiotherapy was expanded. After treatment, no growth was observed except catheter blood cultures, general condition of the patient improved and her fever disappeared. Pulsed-field gel electrophoresis was performed in order to investigate the clonal relatedness between B.cereus isolates which were grown in three cultures of separate times and isolates were observed as the same clone. Blood cultures yielded B.cereus are usually considered the possibility of contamination so some clinical laboratories do not perform identification at species level. But the species which is isolated may be the cause of infection, so this approach may be time-consuming for the patient and cause a delay in necessary treatment. In such cases; repeat blood culture should be requested and a decision should be done whether to perform species identification according to the patient&amp;#8217;s immune system condition and clinical presentation

A case report with catheter caused Bacillus cereus bacteriemia and investigating the clonal relatedness between the isolates by PFGE

Bacillus cereus is a motile and spore-forming Gram positive rod and is a microorganism species which cause infections such as food poisoning, endocarditis, bacteremia sepsis.In our case; 57 years old, acute myeloid leukemia diagnosed female patient who had bone narrow transplantation and getting chemotherapy was interned with prediagnosis of neutropenic fever and pneumonia in internal medicine clinics which she admitted with high fever. Since B.cereus growth in peripheral vein blood cultures, catheter blood cultures was performed simultaneously. B.cereus growth repeated in the cultures so catheter caused bacteremia was considered as the diagnosis and antibiotherapy was expanded. After treatment, no growth was observed except catheter blood cultures, general condition of the patient improved and her fever disappeared.Pulsed-field gel electrophoresis was performed in order to investigate the clonal relatedness between B.cereus isolates which were grown in three cultures of separate times and isolates were observed as the same clone.Blood cultures yielded B.cereus are usually considered the possibility of contamination so some clinical laboratories do not perform identification at species level. But the species which is isolated may be the cause of infection, so this approach may be time-consuming for the patient and cause a delay in necessary treatment. In such cases; repeat blood culture should be requested and a decision should be done whether to perform species identification according to the patient’s immune system condition and clinical presentation

Acute Kidney Injury Related to Intravenous Immunoglobulin Therapy: A Case Report

İntravenöz immünglobulin hipogamaglobinemi tedavisinde kullanılmak üzere geliştirilmiş ve sonrasında birçok otoimmün, inflamatuvar sistemik hastalıkta kullanım alanı bulmuştur. Akut böbrek hasarı, intravenöz immünglobulin tedavisinin nadir bir komplikasyonu olup sıklıkla formülasyondaki stabilizatör maddeye bağlı gelişir ve günler içinde böbrek fonksiyonları geri kazanılır. Bu yazıda bir haftadır bacaklarında güçsüzlük ve his kaybı şikayeti ile akut inflamatuvar demyelinizan polinöropati (Guillaine Barre Sendromu) tanısı konulan; beş günlük intravenöz immünglobulin tedavisi sonrası akut böbrek hasarı gelişen ve bir ay sonra böbrek fonksiyonları tam olarak düzelen 81 yaşında kadın bir olgu sunulmuştur. İntravenöz immünglobulin kullanımı sonrası akut böbrek hasarı açısından hastalar mutlaka yakından izlenmelidir.Intravenous immunoglobulin (IVIG) has been developed for the treatment of hypogammaglobulinemia and is also used for many systemic inflammatory and autoimmune disorders. Acute kidney injury is a rare complication of the use of IVIG, and is mainly caused by stabilizing agents in the protein formulation. A complete recovery of renal function is seen within days. We present the case of an 81-year old woman, treated for acute inflammatory demyelinating polyneuropathy (Guillain-Barr&eacute; syndrome) that caused loss of sensation and muscle weakness in the leg. She was treated with IVIG for five days. Renal failure developed during treatment. The patient's acute kidney injury resolved a month later. The patients should be monitored closely after IVIG therapy for renal injury

Disseminated tuberculosis in a non immun compromised patient with a complicated diagnosis

Tuberculosis (TB) has become a global emergency worldwide. The long time period between the exposure to TB bacillus and the onset of symptoms cause a delay in diagnosis. Herein, we report a case of 64-year-old female patient suffering from dyspepsia, anorexia, weight loss and abdominal pain for the last 8 months. Physical examination, ascites fluid evaluation, chest radiography, ultrasonographic and tomographic scans, histopathological analysis of the lymphadenopathy (LAP) and endometrial tissue revealed TB. A fourfold antituberculous treatment with isoniazid, pyrazinamide, rifampicin and ethambutol was prescribed for two months and for four months maintenance therapy with isoniazid and rifampicin was given. On the fourth month of the medical treatment the patient clinically recovered. Since the diagnosis of TB is difficult, high grade suspicion, combination of the radiologic, microbiologic and histopathological examinations are needed to achieve a diagnosis

Clips migration to duodenum as a rare complication of laparoscopic cholecystectomy

Laparoskopik kolesistektomi sonrası, ameliyatta kullanılan metal kliplerin duedonum duvarına hareketle çıkıntı oluşturmaları nadir görülen bir komplikasyondur. Genellikle kanamalı ülsere neden olurlar. Kliniğimize karın ağrısı, hazımsızlık ve mide ekşimesi şikayetiyle başvuran 65 yaşında bayan hastaya yapılan üst gastrointestinal endoskopide duedonum bulbus tabanında yerleşik metal klip izlendi. Yapılan skopide üst üste binmiş iki klip olduğu görüldü. Metal klipler endoskopik olarak çıkarıldı. Olgunun öyküsünde 15 ay önce semptomatik kolelitiazis nedeniyle laparoskopik kolesistektomi yapıldığı öğrenildi. Bu olgu sunumunda laparoskopik kliplerlerin nadir olarak duedonum duvarına çıkıntı oluşturmasına yönelik yaklaşım ile ilgili bilgi verildiEndoclip migration into the duodenum is an extremely rare complication of laparoscopic cholecystectomy. The patients usually present with bleeding ulcer. Here we report a 65-year-old female patient with a complaint of abdominal pain and dyspepsia due to clip migration into the duodenum after laparoscopic cholecystectomy secondary to symptomatic cholelithiasis 15 months previously. Ultrasonography and liver function tests were normal. Endoscopy showed metal clips in the second part of duodenum. The clips were removed endoscopically. No active bleeding was noted. In this case report, we present diagnosis and management of clips migration into wall of duodenum as a complication of laparoscopic cholecystectom

Clips migration to duodenum as a rare complication of laparoscopic cholecystectomy

WOS: 000404541200016Endoclip migration into the duodenum is an extremely rare complication of laparoscopic cholecystectomy. The patients usually present with bleeding ulcer. Here we report a 65-year-old female patient with a complaint of abdominal pain and dyspepsia due to clip migration into the duodenum after laparoscopic cholecystectomy secondary to symptomatic cholelithiasis 15 months previously. Ultrasonography and liver function tests were normal. Endoscopy showed metal clips in the second part of duodenum. The clips were removed endoscopically. No active bleeding was noted. In this case report, we present diagnosis and management of clips migration into wall of duodenum as a complication of laparoscopic cholecystectomy

Bezoara Bağlı İleus: Endoskopik Parçalamaya İkincil

Bezoar, gıda veya yabancı cisimlerin gastrointestinal sistemde taş benze-ri kitle şeklinde sertledir ve nadiren obstrüksiyona ve ileusa neden olur. Midede olan bezoar, genellikle konservatif yöntemlerle tedavi edilebilir. Bezoarlar endoskopik tedavisi sırasında genellikle parçalanarak gastroin-testinal sistemden çıkartılır. Obstrüksiyonu endoskopik tedavinin nadir bir komplikasyonudur ve genellikle gastrointestinal sistemden çıkartılamayan bezoar parçalarına bağlı gelişir. Bu yazıda endoskopik bezoar tedavisi son-rası ileus gelişen 78 yaşında kadın hasta sunulmuştur.Bezoar is a hardened mass of food or foreign objects found in the gastro- intestinal system, which occasionally causes obstruction and ileus. Bezoar, if present in the stomach, should generally be treated with conservative methods. During endoscopic treatment, bezoar is usually fragmented and removed. An uncommon complication of endoscopic treatment is gas- trointestinal obstruction because of unremoved fragments. We report a 78-year-old female with ileus after endoscopic fragmentation of bezoar