Aortocaval Fistula in a Behcet's Disease Patient

Behcet's disease (BD) is a chronic, recurrent, systemic disease that is characterized by oral and genital ulcers and oculocutaneous inflammatory lesions. Cardiovascular involvement especially large artery involvement is a serious and vital complication of BD. Pseudoaneurysms in the major arteries may be the cause of sudden death in BD. In our case a pulsatile abdominal mass was determined to be an aortic pseudoaneurysm associated with BD and an aortocaval fistula. Here we report this case and a short review of literature because this is the first reported aortocaval fistula in a BD patient in English literature

Attitudes and approaches towards COVID-19 management among the public and pharmacists in Northern Cyprus

Purpose: To study the attitudes and approaches towards COVID-19 management among the public and pharmacists in Northern Cyprus.Method: Questionnaire were administered face-to-face and online to volunteer pharmacists and othermembers of the public, after receiving approval from the Near East University Ethics Boards. Responses to the questionnaire were evaluated statistically.Results: The pharmacists who quickly learned and adopted the necessary protection measures againstCOVID-19 at the beginning of the pandemic were young professionals under the age of 30 years who had less than 5 years of professional experience (p < 0.05). Most pharmacists who prepared magistral disinfectants/antiseptic solutions and lotions for irritation caused by excessive hand washing were agedabove 60 years, with more than 30 years of professional experience (p < 0.05). The people who responded in the questionnaires asked for products derived from Echinacea, Sambucus nigra, propolis, ginger and Pelargonium sidoides to boost their immune system. Approximately 22.6 % of the respondents received COVID-19-related information from doctors, while 33.4 % got theirs from pharmacists. However, 6.7 % of the respondents got information from social media groups which they created (p < 0.05).Conclusion: Cooperation between pharmacists and health care organizations is increasingly crucial forpublic health, since there are still gaps in the successful control of COVID-19 pandemic. Therefore, it would be beneficial and even necessary to add a course on "management and solidarity in pandemics and other disasters" to the undergraduate education programs in pharmacy and all other healthcare disciplines.&nbsp

Midenin glomus tümörü

Altmış dört yaşında erkek hasta masif üst gastrointestinal sistem kanaması ile acil servise başvurdu. Distal gastrektomi uygulanan hastada ameliyat sırasında antral bölge küçük kurvaturda submukozal yerleşimli, 2.4 cm çapında, iyi sınırlı bir kitle palpe edildi. Kitlenin histopatolojik incelemesinde, düzensiz dallanan, ince duvarlı damarların arasında yuvalanmalar, kordonlar ve tabakalar oluşturan berrak sitoplazmalı uniform tümör hücreleri görüldü. İmmünohistokimyasal olarak vimentin ve SMA ile pozitif; sitokeratin, CD34, sinaptofizin, kromogranin A, NSE, CD117 (C-kit) ve S-100 protein ile negatif sonuç elde edildi. Elektron mikroskopik olarak berrak sitoplazmalı, kaba kromatinli yuvarlak nukleusa sahip hücrelerinin damar yapıları etrafı nda gruplar oluşturdukları görüldü. Klinik bulgular, makroskopik görünüm, tümör paterni, immünohistokimyasal ve elektron mikroskopik bulgular glomus tümörü ile uyumlu bulundu.A sixty-four-year old male patient presented to the emergency room with massive upper gastrointestinal tract bleeding. During distal gastrectomy, a submucosal, well demarcated mass with a diameter of 2.4 cm was palpable in the antral region of the lesser curvature. Histopathological examination of the mass revealed uniform tumor cells with clear cytoplasms and round nuclei, forming nests, strands and sheets between dense, irregularly branching, thin-walled vessels. Immunohistochemistry was positive for vimentin and SMA and negative for cytokeratin, CD34, synaptophysin, chromogranin A, NSE, CD117 (C-kit) and S-100 protein. Electron microscopy demonstrated tumor cells with clear cytoplasms and round nuclei with coarsely dispersed chromatin, forming groups around vascular structures. Clinical findings, gross appearance, tumor pattern, immunohistochemical findings and electronmicroscopic findings were all consistent with a glomus tumo

Adnexal Torsion: Difficulty in Diagnosis and Management

Aim:To investigate both the diagnostic value of Doppler-ultrasonography and factors influencing surgical intervention in patients with adnexal torsion (AT).Methods:We retrospectively examined medical records of 66 women with AT in a single center between January 2007 and December 2016.Results:Forty-three out of 66 patients (65.1%) with AT were correctly diagnosed preoperatively. On Doppler examination, reduced ovarian arterial blood velocity was observed in 39 patients (59.1%); and the sensitivity was 0.67. AT was diagnosed in 49 patients (74.2%) via laparotomy, and the number of patients who were subjected to radical treatment was higher than that of patients managed with conservative treatment (54.6% vs 45.4%). Although there was no difference in the surgical approaches (laparoscopy vs laparotomy) between the groups, age, gravidity, parity, body mass index, and ovarian cyst size were significantly lower in patients who were treated conservatively (p<0.05).Conclusion:The diagnostic value of Doppler examination for AT is limited and the decision for surgical management should not be delayed based on Doppler results. Early age, low gravidity, parity and body mass index, and small size of ovarian cyst on ultrasonography were indication for conservative treatment, whereas black-bluish macroscopic appearance had no influence on the preference towards the selection of treatment

Determination of snow water equivalent (SWE) according to elevation and its importance for water resources in semi-humid region of Turkey

The aim of this study was to determine the altitudinal distribution of snow water equivalent (SWE) in the north-east facing aspect of the basin of the Fabrika River in Artvin. Study sites were selected at four different altitudes, where a total of thirty snow samples were collected from each study site from the depth steps of 0–5 cm and 5–10 cm. As a result, the snow sample collected on February 21, 2008 at 1250 m altitude and from 5–10 cm depth was found to produce the highest SWE value while the snow sample collected on February 15, 2008 at 200 m altitude and from 0– 5 cm depth was found to produce the lowest SWE value. A strong relationship was detected between the SWE of the snow sample collected from 0–5 cm depth and the altitude of the sampling site. This relationship was formulated as: [R2= 0.94, SWE = 0.1328* (Altitude 0.687)], while this relationship was formulated as: R2= 0.928, SWE = 0.15 * (Altitude 0.6750)], in depth of 5–10 cm

Coronary arteriovenous fistulas in the adults: natural history and management strategies

<p>Abstract</p> <p>Objective</p> <p>To describe aspects of the natural history and pathophysiology of coronary arteriovenous fistula and to propose potential treatment strategies.</p> <p>Methods</p> <p>Eleven adult patients were treated surgically for coronary arteriovenous fistulas (8 male, 3 female) during the last three years. Mean age was 48,7 ± 9,5 years (range 32-65 years). Diagnosis was made by coronary angiography and transesophageal echocardiography</p> <p>Results</p> <p>All patients were symptomatic due to the associating cardiac disorder or fistula. Presenting symptoms were chest pain, exertional dyspnea and palpitation. All patients were diagnosed by selective angiography. Transthoracic and transoesophageal echocardiography was performed to identify the Qp/Qs ratio in one patient. One patient who had an LAD to pulmonary artery coronary arteriovenous fistula with a vascular malformation needed early reoperation due to recurrence of the fistula. Echocardiographic evaluation at the postoperative third month revealed no residual shunts in all patients.</p> <p>Conclusion</p> <p>Because of the severe complications that may develop due to coronary arteriovenous fistula, we believe that every coronary artery fistula should be treated invasively by surgery or transcatheter closure. But both treatment modalities still need to be evaluated with randomized multicenter studies for long term survival and effectiveness.</p

In situ thrombosis in pulmonary arterial aneurysms due to Behçet’s disease and efficacy of ımmunosuppressive therapy

BehçetDisease (BD) is a systemic vasculitis characterized by recurrent oral and genital ulcers and uveitis, arthritis, and involvement of the gastrointestinal tract, central nervous system and blood vessels. The aneurysms of the pulmonary arteries, with or without thrombosis, are typical manifestation of BD. We report a case with BD, pulmonary arterial aneurysms(PAA) and in situ thrombosis. We aimed to show the effectiveness of immunosuppressive treatment on in situ thrombosis in a case with PAA and BD

Pulmonary echinococcosis mimicking multipl lung metastasis of breast cancer: The role of fluoro-deoxy-glucose positron emission tomography

<p>Abstract</p> <p>Background</p> <p>Echinococcosis is still a serious problem particularly in endemic areas such as South and Central America, Mediterranean countries, and Russia. Furthermore, hydatid cysts of the lung are often indistinguishable from a variety of other pulmonary lesions such as lung tumors</p> <p>Case presentation</p> <p>We herein present a 56 year old woman with breast cancer who presented with bilateral pulmonary nodules due to echinococcosis granulosis that mimicked metastatic breast cancer to the lung.</p> <p>Conclusion</p> <p>During the evaluation of the malignancies which could metastasize to the lung, it must be kept in mind that the appearance of bilateral multiple pulmonary masses can also be the sign of a pulmonary echinococcosis especially in endemic areas. FDG-PET with its known high negative predictive value in characterizing indeterminate pulmonary nodules >1 cm is very helpful to characterize this kind of lesions.</p

Persistent High Postoperative Carcinoembryonic Antigen in Colorectal Cancer Patients- Is it Important?

INTRODUCTION: Evaluation of pre- and postoperative serum CEA levels together has seldom been assessed for the prognosis of colorectal cancer (CRC). OBJECTIVE: To concurrently evaluate pre- and postoperative CEA as factors of relapse and survival. METHODS: The study consisted of 114 patients who had undergone surgery from February 2002 to June 2006 for CRC. All patients were classified into four groups according to their pre- and postoperative CEA levels. Data obtained for clinicopathologic parameters, lymph node metastasis, stage, recurrence, and CEA levels were analyzed to determine their association with survival. Multivariate analysis by the Cox proportional hazard regression model was performed to identify the independent prognostic factors associated with survival. RESULTS: Postoperative serum CEA levels remained high in Group 3 (n = 32). Nineteen patients (59.3%) demonstrated a detectable cause for persistent high CEA levels, while the reasons for those in the other thirteen patients (40.6%) remained obscure. Abnormal preoperative CEA levels significantly correlated with the depth of tumor invasion, lymph node metastasis, TNM stage, and recurrence (p < 0.05). Abnormal postoperative CEA levels were significantly related to the depth of tumor invasion, TNM stage, and postoperative relapse (p<0.05). Patients in Group 3 demonstrated the worst survival rate. Abnormal postoperative CEA levels, lymph node metastasis, and location of the tumor were independent prognostic factors for survival. CONCLUSION: The survival of patients with high postoperative CEA levels due to unknown reasons may be extended if they are exhaustively tested with sensitive diagnostic methods and treated at an early stage

Bariatrik cerrahi sonrası viseral organ yağ infiltrasyon değişikliklerini izlemenin etkili yöntemi: İdeal IQ sekansı

Aim: The aim of this study is to demonstrate the efficiency of non-invasive imaging method-MR proton density fat fraction (PDFF); ideal IQ sequence- on detecting the effects of bariatric surgery on liver and pancreatic fatty infiltration. Materials and Methods: Thirty-nine patients (25 females, 14 males) who underwent bariatric surgery between May 2016 and April 2017 were analyzed retrospectively in this study. Body mass index (BMI) and body weight (BW) values of all patients were noted one week before and one month after bariatric surgery, and meanwhile an unenhanced upper abdominal MR imaging was performed. Liver fat fraction (LFF), pancreas fat fraction (PFF), liver volume (LV) and craniocaudal length of liver (LL) were measured with MR-PDFF and T2 weighted images. Changes in all parameters after the surgery were recorded and the correlation of these changes with the change in LFF was analyzed. Results: At the end of first month of bariatric surgery, a significant decrease on mean values of LFF and PFF has been observed along with a decrease of LV, LL, BW and BMI (p<0.0001). A moderate positive linear correlation was observed between LFF and PFF, LV, LL (r=0.69, 0.61, 0.49; respectively) while a weak positive linear correlation was noticed between LFF and BMI, BW (r=0.34, 0.21; respectively). Conclusion: Ideal IQ sequence enables quantitative analysis of fatty infiltration of the liver and pancreas and thus may be used as a non-invasive tool to monitor the positive effects of the bariatric surgery on fatty infiltration of these visceral organs in the postoperative period.Amaç: Bariatrik cerrahinin karaciğer ve pankreas yağ infiltrasyonu üzerindeki etkilerinin saptanmasında non-invaziv görüntüleme yönteminin-MR proton dansite yağ fraksiyonu (PDFF); ideal IQ sekansı-etkinliğini göstermeyi amaçladık. Gereç ve Yöntem: Bu çalışmada Mayıs 2016 ile Nisan 2017 tarihleri arasında obezite cerrahisi geçiren 39 hasta (25 kadın, 14 erkek) retrospektif olarak incelendi. Tüm hastaların vücut kitle indeksi (VKİ) ve vücut ağırlığı (VA) değerleri bariatrik cerrahiden bir hafta önce ve bir ay sonra kaydedildi ve bu esnada kontrastsız üst abdomen MR görüntülemesi yapıldı. MR-PDFF ve T2 ağırlıklı görüntülerle karaciğer yağ fraksiyonu (KYF), pankreas yağ fraksiyonu (PYF), karaciğer hacmi (KV) ve karaciğer kraniyokaudal uzunluğu (KKU) ölçüldü. Ameliyat sonrası tüm parametrelerdeki değişiklikler kaydedildi ve bu değişikliklerin KYF’deki değişiklik ile korelasyonu analiz edildi. Bulgular: Bariatrik cerrahinin 1. ayının sonunda KYF ve PYF ortalama değerlerinde anlamlı azalma ile birlikte KV, KKU, VA ve VKİ’de azalma gözlendi (p<0,0001). KYF ile PYF, KV, KKU arasında orta derecede pozitif bir doğrusal korelasyon gözlenirken (sırasıyla r=0,69, 0,61, 0,49), KYF ile VKİ, VA arasında (sırasıyla r=0,34, 0,21) zayıf bir pozitif doğrusal korelasyon fark edildi. Sonuç: İdeal IQ sekansı, karaciğer ve pankreasın yağ infiltrasyonunun kantitatif analizini sağlar ve bu nedenle postoperatif dönemde bariatrik cerrahinin bu viseral organların yağ infiltrasyonu üzerindeki olumlu etkilerini izlemek için non-invaziv bir araç olarak kullanılabilir