BOYUNDA KİTLE NEDENİYLE KONSULTE EDİLEN SERVİKAL KOSTA VAKASI: OLGU SUNUMU

AMA&Ccedil;:Servikal kosta, KBB Hastalıkları kliniklerinde nadir g&ouml;r&uuml;l&uuml;r. Bu yazıda, boyunda kitle nedeniyle b&ouml;l&uuml;m&uuml;m&uuml;ze başvuran ve servikal kosta tanısı alan bir vaka sunularak meslektaşlarımız arasında farkındalık yaratmak ama&ccedil;lanmıştır.OLGU:&nbsp;27 yaşında kadın hasta boyun sol b&ouml;lgesinde şişlik nedeniyle KBB Hastalıkları b&ouml;l&uuml;m&uuml;ne başvurdu. Rutin fizik muayene sırasında saptanmış ve tarafımıza y&ouml;nlendirilmişti. Hasta asemptomatikti. Boyun sol b&ouml;lgesinde, supraklavikuler alanda, sternokleidomastoid kas altında, derin yerleşimli yaklaşık 4 cm &ccedil;apında kitle mevcuttu. Kitle, olduk&ccedil;a sert ve hareketsiz idi. Derin palpasyonla ağrı oluyordu. Bu fizik muayene bulguları ile kemik kaynaklı bir patoloji olabileceği d&uuml;ş&uuml;n&uuml;lerek direkt servikal grafi ile tetkik edildi. Grafisi incelendiğinde hastanın bilateral servikal kostasının olduğu, sağdakinin rudimenter, soldaki servikal kostanın ise daha belirgin olduğu g&ouml;zlendi. Hastanın tanısı daha ileri radyolojik tetkikler ile de doğrulandı.&nbsp;TEDAVİ VE PROGNOZ: Servikal kosta, torasik outlet sendromunun (TOS) nedenlerinden bir tanesidir. Asemptomatik olan hasta Fiziksel Tıp ve Rehabilitasyon b&ouml;l&uuml;m&uuml;ne y&ouml;nlendirildi.Servikal kosta toplumda % 0.5-2 oranında g&ouml;r&uuml;lebilen bir anomalidir. Supraklavikuler alanda bir şişlik ile başvuran vakalarda fizik muayenede olduk&ccedil;a sert, hareketsiz, derin palpasyonda ağrılı kitle saptanması durumunda akla getirilmelidir.</p

BOYUNDA KİTLE NEDENLİ BAŞVURAN SERVİKAL KOSTA VAKASI: OLGU SUNUMU

AMA&Ccedil;:&nbsp;Servikal kosta, KBB Hastalıkları polikliniklerinde nadir g&ouml;r&uuml;len bir hastalıktır. Bu yazıda, boyunda kitle nedeniyle b&ouml;l&uuml;m&uuml;m&uuml;ze başvuran ve servikal kosta tanısı alan bir vaka sunularak meslektaşlarımız arasında farkındalık yaratmak ama&ccedil;lanmıştır.OLGU:&nbsp;27 yaşında kadın hasta boyun sol b&ouml;lgesinde şişlik nedeniyle KBB Hastalıkları b&ouml;l&uuml;m&uuml;ne başvurdu. Rutin fizik muayene sırasında saptanmış ve tarafımıza y&ouml;nlendirilmişti. Hasta asemptomatikti. Boyun sol b&ouml;lgesinde, supraklavikuler alanda, sternokleidomastoid kas altında, derin yerleşimli yaklaşık 4 cm &ccedil;apında kitle mevcuttu. Kitle, olduk&ccedil;a sert ve hareketsiz idi. Derin palpasyonla ağrı oluyordu. Bu fizik muayene bulguları ile kemik kaynaklı bir patoloji olabileceği d&uuml;ş&uuml;n&uuml;lerek direkt servikal grafi ile tetkik edildi. Grafisi incelendiğinde hastanın bilateral servikal kostasının olduğu, sağdakinin rudimenter, soldaki servikal kostanın ise daha belirgin olduğu g&ouml;zlendi. Hastanın tanısı daha ileri radyolojik tetkikler ile de doğrulandı.&nbsp;TEDAVİ VE PROGNOZ: Servikal kosta, torasik outlet sendromunun (TOS) nedenlerinden bir tanesidir. Asemptomatik olan hasta Fiziksel Tıp ve Rehabilitasyon b&ouml;l&uuml;m&uuml;ne y&ouml;nlendirildi.YORUM:&nbsp;Servikal kosta toplumda % 0.5-2 oranında g&ouml;r&uuml;lebilen bir anomalidir. Supraklavikuler alanda bir şişlik ile başvuran vakalarda fizik muayenede olduk&ccedil;a sert, hareketsiz, derin palpasyonda ağrılı kitle saptanması durumunda akla getirilmelidir. Direkt grafi ile tanısı konmaktadır.</p

Comparison of a combination test (1 mu g ACTH test plus glucagon test) versus 1 mu g ACTH test and glucagon test in the evaluation of the hypothalamic-pituitary-adrenal axis in patients with pituitary disorders

Objective:To investigate whether a combination of the low-dose (1 mu g) adrenocorticotropin (ACTH) stimulation test and glucagon stimulation test (GST) could overcome the problem of equivocal results with the GST or ACTH test alone in patients with pituitary disorders. Subjects and methods: The study included 41 adult patients with pituitary disorders and 20 healthy subjects who underwent evaluation of cortisol response to ACTH, GST, and a combination of both tests. Blood samples for cortisol measurement were obtained at baseline and 30, 60, 90, and 120 minutes after intravenous administration of ACTH 1 mu g and 90, 120, 150, 180, 210, and 240 minutes after subcutaneous injection of glucagon 1 mg. The combination test was performed by injecting ACTH 1 mu g at the 180-minute time point of the GST, with blood samples for cortisol measurement obtained at 210 and 240 minutes. Results: Overall, 28 patients with normal cortisol response to both tests also had a normal cortisol response to the combination test. Ten patients with adrenal insufficiency in both tests also had adrenal insufficiency in the combination test, including a patient who had a peak cortisol value of 12.4 mu g/dL (which is the cutoff value for the combination test).Two patients with adrenal insufficiency in the ACTH stimulation test and one patient with adrenal insufficiency in the GST had normal cortisol responses to the combination test. Conclusion: By using an appropriate cutoff value, the combination test may offer additional information in patients with equivocal results in the GST and ACTH stimulation test

Patient diagnosed with immunoglobulin G4-related autoimmune pancreatitis after total pancreatoduodenectomy, gastrectomy, and splenectomy: A case report

Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory condition involving the development of mass lesions of the affected organ, which can mimic many malignant disorders. IgG4-related autoimmune pancreatitis (AIP) is a common presentation form of IgG4-RD. Patients presenting with multiple mass lesions in the pancreas undergo aggressive surgeries with the misdiagnosis of pancreatic adenocarcinoma. A patient applied to the health center with back and stomach pain. She had two mass lesions involving the pancreatic head and tail; tumor markers were not significantly elevated. The patient underwent total pancreatoduodenectomy, total gastrectomy, and total splenectomy due to misdiagnosed pancreatic adenocarcinoma and developed severe morbidities afterward. She was diagnosed with IgG4-related AIP after surgery. On performing clinical suspicion the necessary diagnostic procedures for exclusion will protect patients from unnecessary surgeries that may lead to severe morbidities

Skeletal Muscle Mass, Muscle Strength, and Quality of Life in Adult Patients with Familial Mediterranean Fever: A Comparative Study with Healthy Controls

Aim: This study (1) compared skeletal muscle mass (SMM) and muscle strength in familial Mediterranean fever (FMF) patients with those of healthy controls (HCs) and (2) investigated the association of SMM and muscle strength with disease severity and quality of life (QOL). Materials and Methods: This study included 31 FMF patients and 30 matched HCs. Disease severity was evaluated using the International Severity Scoring System for FMF (ISSF). Body composition parameters were measured using a bioelectrical impedance analysis. Grip and pinch strengths were calculated for muscle strength. Health status was assessed with Short Form 36 (SF-36). Results: The all-body composition parameters of the FMF patients, including SMM, were similar to those of the HCs, with significantly lower grip and pinch strengths. All SF-36 scores of the FMF patients were significantly lower than those of the HCs. Positive correlations were observed between muscle-related indices and pinch strength for some SF-36 domains. Conclusion: Muscle- or fat-related indices were similar among adult patients with FMF and the HCs. In contrast, patients with FMF had a poorer health-related QOL and lower grip and pinch strengths than the HCs. Further studies are needed to determine the clinical significance of these correlations in patients with FMF