The frequency of phimosis in patients who underwent circumcision

Bu retrospektif çalışmada, sünnet uyguladığımız çocuklarda patolojik fimozisin sıklığını ve önemini ortaya konmak amaçlandı. Ocak 1994-Ağustos 2000 tarihleri arasında kliniğimizde sünnet uygulanan 490 çocuğun verileri incelendi. Olguların işlem öncesi muayenesinde saptanan fimozis sıklığı yaş gruplarına göre değerlendirildi. Sünnet öncesi yapılan genital muayenede toplam 34 (% 6.93) çocukta fimozis varlığı saptandı. 490 olgudan ayrıca 3' ünde (%0.6) unilateral hidrosel, 2' sinde (% 0.4) anterior hipospadias ve yine iki olguda (% 0.4) tek taraflı inmemiş testis saptandı. Yaş gruplarına göre değerlendirildiğinde, fimozis görülme sıklığının yaş ilerledikçe azaldığı belirlendi. Çalışmamızda 0-3 yaş gurubu çocuklarda fimozisin daha sık görüldüğünü belirledik. Yaşla birlikte görülme sıklığı azalmaktaydı. Bu nedenle ilk 3 yaş grubundaki fimozis'li olgularda topikal tedavi önerilebilir. Tıbbi tedaviye yanıt alınamayan ve enfeksiyon saptanan olgularda ise sünnet uygulaması düşünülmelidir.To establish the frequency and importance of pathological phimosis in children who underwent circumcision. A review of the frequency and importance of phimosis was performed in 490 children who underwent circumcision between January 1994 and August 2000 at our clinic. The frequency of phimosis according to age groups was evaluated. Overall 34 (% 6.93) children had typical phimosis before circumcision. Furthermore among the 490 patients, 3 (%0.6) had unilateral hydroceles, 2 (%0.4) had anterior hypospadias and 2 (%0.4) had unilateral cryptorchidism. The frequency of phimosis decreased gradually in older groups. In this study, we determined a higher frequency of phimosis in children between ages 0-3. The frequency decreased with age. For this reason, topical therapy should be administered before 3 years of age and circumcision should be reserved for patients who have infection or do not respond to medical therapy

Fetus in fetu : a case report

Fetus-in-fetu (FIF), gebelik esnasındaki anormal embriyogenezis sonrası gelişen nadir bir anomalidir. Malforme fetüs ikiz eşinin vücudu içinde büyümekte ve sıklıkla abdominal bir kitle olarak tespit edilmektedir. Klinikte FIF ve fetiform teratom (FT) tanıları arasında kesin bir sınır yoktur. Kliniğimize karında kitle nedeniyle başvuran yedi yaşındaki erkek hasta değerlendirildi. Bu nadir görülen olgu nedeniyle, FIF ile FT ayırıcı tanısındaki gerekli kriterleri tartıştık.Fetus in fetu (FIF) is a rare anomaly due to an abnormal embriogenesis of fetus during pregnancy. Malformed fetus grows in the body of co-twin and its frequently detected as an abdominal mass. There is no clear distinction between the term of FIF and fetiform teratoma (FT). A seven years old boy who admitted to our clinic with an abdominal mass was examined. In the light of this case, we discussed the criteria's of differential diagnosis between FIF and FT

How high is the inter-observer reproducibility in the LIRADS reporting system?

Purpose: To investigate the reproducibility of LIRADS v2014 and contribute to its widespread use in clinical practice. Material and methods: This retrospective, single-centre study was conducted between January 2010 and October 2015. A total of 132 patients who had dynamic magnetic resonance imaging (MRI)/computed tomography (CT) images in the Picture Archiving and Communication Systems (PACS) with liver nodule were included in the study, 37 of whom had histopathology results. Five radiologists who participated in the study, interpreted liver nodules independently on different PACS stations according to the LIRADS reporting system and its main parameters. Results: We determined that level of inter-observer agreement in the LR-1, LR-5, and LR-5V categories was higher than in the LR-2, LR-3, and LR-4 categories (κ = 0.522, 0.442, and 0.600 in the LR-1, LR-5, and LR-5V categories, respectively; κ = 0.082, 0.298, and 0.143 in the LR-2, LR-3, and LR-4 categories, respectively). The parameter that we observed to have the highest level of inter-observer agreement was venous thrombus (κ = 0.600). Conclusions: Our study showed that LIRADS achieves an acceptable inter-observer reproducibility in terms of clinical practice although it is insufficient at intermediate risk levels. We think that the prevalence of its use will be further increased with training related to the subject and the assignment of numerical values that express the probability of malignancy for each category and including the ancillary features in the algorithm according to clearer rules

Comparison of TNM 1987 and TNM 1997 classifýcations in staging of renal adenocarcinoma

Amaç: Böbrek adenokarsinomunun klinik olarak doğru evrelenmesi prognoza yönelik bilgiler ve doğru tedavi seçimi sağlama açısından önem taþımaktadır. Bu çalıþmada bilgisayarlı tomografi (BT) ile klinik evrelemede, hemTNM87 hem de 97 sınıflamasının patolojik evreleme ile korelasyonunu incelemeyi amaçladık. Yöntem: Ocak 1995-Kasım 2000 tarihleri arasında böbrek adenokarsinomu tanısı ile radikal nefrektomi uygulanan 66 olgununBTve patoloji bulgularına göre yeniden evrelemesi yapıldı. Bulgular: TNM 97 evreleme sistemi uygulandığında, TNM 87'ye göre T2 evre olan 23 olgunun T1 evreye geçtiği belirlendi. T3 olgularında ise evrelemede bir değiþim olmadı. BT ile klinik evrelemenin patolojik evrelemeye korelasyonu, hem TNM 87 hem TNM 97 sınıflamasına göre istatiksel olarak anlamlı bulundu (p<0.001). Sonuç: Böbrek adenokarsinomlarının klinik evrelemesinde BT etkin ve güvenilir bir tanı yöntemidir. TNM 97 evreleme sisteminin patolojik evre ile olan uyumu, TNM 87 sistemine göre istatistiksel olarak daha yüksek bulunmuþtur (p<0.01). Yeni sınıflama ile saptanan evre II'den evre I'e belirgin kaymanın olgulardaki takip maliyetlerini azaltabileceği sonucuna vardık.Objective: Accurate clinical staging of renal adenocarcinomas is important in determining prognosis and correct mode of therapy. In the present study, we aimed to examine the correlation of clinical staging with computerized tomography (CT)accordingtobothTNM 1987 and 1997 classifications withpathological staging. Material and Methods: Sixty-six patients with a diagnosis of renal adenocarcinoma who underwent radical nephrectomy between January 1995-November 2000 were re-staged according to CT and histopathological findings. Results: Using the TNM 1997 classification resulted in a redistribution of 23 patients from stage pT2 to stage pT1. There was no change in classification of patients with pT3 disease. Clinical staging with CT and pathological correlation was found to be statistically significant in both TNM 1987 and TNM 1997 staging classifications (p<0.001). Conclusion: Clinical staging of renal adenocarcinomas with CT is an effective and reliable method. TNM 1997 staging has a statistically higher correlation with pathological staging compared to TNM 1987. It is concluded that the apparent shift of cases from stage II to stage I with the new classification will help decrease of follow-up costs

Increased level of resistin predicts development of atrial fibrillation

AbstractBackgroundResistin is a peptide hormone that is secreted from lipid cells and is linked to type-2 diabetes, obesity, and inflammation. Being an important adipocytokine, resistin was proven to play an important role in cardiovascular disease. We compared resistin levels in patients with and without atrial fibrillation (AF) to demonstrate the relationship between plasma resistin levels and AF.MethodOne hundred patients with AF and 58 control patients who were matched in terms of age, gender, and risk factors were included in the trial. Their clinical risk factors, biometric measurements, echocardiographic work up, biochemical parameters including resistin and high-sensitivity C-reactive protein (hs-CRP) levels were compared.ResultsIn patients with AF, plasma resistin levels (7.34±1.63ng/mL vs 6.67±1.14ng/mL; p=0.003) and hs-CRP levels (3.01±1.54mg/L vs 2.16±1.28mg/L; p=0.001) were higher than control group. In subgroup analysis, resistin levels were significantly higher in patients with paroxysmal (7.59±1.57ng/mL; p=0.032) and persistent AF (7.73±1.60ng/mL; p=0.006), but not in patients with permanent AF subgroups (6.86±1.61ng/mL; p=0.92) compared to controls. However, hs-CRP levels were significantly higher only in permanent AF patients compared to control group (3.26±1.46mg/L vs 2.16±1.28mg/L; p=0.02). In multivariate regression analysis using model adjusted for age, gender, body mas index, hypertension, diabetes mellitus, and creatinine levels, plasma resistin levels [odds ratio (OR): 1.30; 95% confidence interval (CI): 1.01–1.70; p=0.04] and hs-CRP levels (OR: 1.44; 95% CI: 1.12–1.86; p=0.004) were the only independent predictors of AF.ConclusionThe elevated levels of plasma resistin were related to paroxysmal AF group and persistent AF group, but not to permanent AF group

Quantitative investigation for the dielectrophoretic effect of fluorescent dyes at single-cell resolution

Most of the microscopy-based, quantitative assays rely on fluorescent dyes. In this study, we investigated the impact of fluorescent dyes on the dielectrophoretic response of the mammalian cells. The dielectrophoretic measurements were performed to quantify whether the fluorescent dyes alter the dielectrophoretic properties of the cells at single-cell resolution. Our results present that when 10 V-pp electric field is applied, the fluorescent-labeled cells experienced the crossover frequency at 8-10 kHz, whereas the label-free cells exhibited at 16-18 kHz

Current barriers and recommendations on the diagnosis of transthyretin amyloid cardiomyopathy: a Delphi study

ObjectivesThis study has been conducted to investigate the non-invasive diagnostic journey of patients with a transthyretin amyloid cardiomyopathy (aTTR-CM) in Turkey, identify the challenges and uncertainties encountered on the path to diagnosis from the perspectives of expert physicians, and develop recommendations that can be applied in such cases.MethodsThis study employed a three-round modified Delphi method and included 10 cardiologists and five nuclear medicine specialists. Two hematologists also shared their expert opinions on the survey results related to hematological tests during a final face-to-face discussion. A consensus was reached when 80% or more of the panel members marked the “agree/strongly agree” or “disagree/strongly disagree” option.ResultsThe panelists unanimously agreed that the aTTR-CM diagnosis could be established through scintigraphy (using either 99mTc-PYP, 99mTc-DPD, or 99mTc-HMPD) in a patient with suspected cardiac amyloidosis (CA) without a further investigation if AL amyloidosis is ruled out (by sFLC, SPIE and UPIE). In addition, scintigraphy imaging performed by SPECT or SPECT-CT should reveal a myocardial uptake of Grade ≥2 with a heart-to-contralateral (H/CL) ratio of ≥1.5. The cardiology panelists recommended using cardiovascular magnetic resonance (CMR) and a detailed echocardiographic scoring as a last resort before considering an endomyocardial biopsy in patients with suspected CA whose scintigraphy results were discordant/inconclusive or negative but still carried a high clinical suspicion of aTTR-CM.ConclusionThe diagnostic approach for aTTR-CM should be customized based on the availability of diagnostic tools/methods in each expert clinic to achieve a timely and definitive diagnosis

Türkiye Romatizma Araştırma ve Savaş Derneği ankilozan spondilit ulusal tedavi önerileri

Objectives: To develop Turkish League Against Rheumatism (TLAR) National Recommendations for the management of ankylosing spondylitis (AS). Materials and methods: A scientific committee of 25 experts consisting of six rheumatologists and 19 physical medicine and rehabilitation specialists was formed by TLAR. Recommendations were based on the 2006 ASsessment in Ankylosing Spondylitis International Working Group(ASAS)/European League Against Rheumatism (EULAR) recommendations and a systematic review of associated publications between January 2005 and September 2010. A Delphi process was used to develop the recommendations. Twelve major recommendations were constructed for the management of AS. Voting using a numerical rating scale assessed the strength of each recommendation. Results: The 12 recommendations include patient assessment, patient follow-up along with pharmacological and non-pharmacological methods. Some minor additions and changes have been made to the ASAS/EULAR recommendations. All of the recommendations had sufficient strength. Conclusion: National recommendations for the management of AS were developed based on scientific evidence and consensus expert opinion. These recommendations will be updated regularly in accordance with recent developments.Türkiye Romatizma Araştırma ve Savaş Derneği᾽nin (TRASD) Ankilozan Spondilit (AS) için ulusal tedavi önerilerinin oluşturulmasıdır. Gereç ve yöntemler: TRASD tarafından altı Romatoloji ve 19 Fiziksel Tıp ve Rehabilitasyon uzmanı olmak üzere toplam 25 kişiden oluşan bir bilimsel kurul oluşturuldu. Önerilerde 2006 yılında yayınlanan Ankilozan Spondilit Değerlendirme Uluslararası Çalışma Grubu (ASAS)/Romatizmaya karşı Avrupa Ligi (EULAR) önerileri ve Ocak 2005 - Eylül 2010 arasında yayınlanmış olan ilişkili yayınlar konusundaki sistematik bir inceleme temel alındı. Öneriler oluşturulurken Delphi süreci kullanıldı. Ankilozan spondilit tedavisi ile ilgili 12 ana öneri oluşturuldu. Oylama yapılarak önerilerin güçlülük düzeyi bir nümerik derecelendirme skalası ile belirlendi. Bulgular: On iki öneri hasta değerlendirilmesini, hasta takibini ve farmakolojik ve non-farmakolojik yöntemleri içermektedir. ASAS/EULAR önerilerine bazı ilaveler ve önerilerde bazı küçük değişiklikler yapılmıştır. Tüm öneriler yeterli kuvvete sahipti. Sonuç: Bilimsel kanıtlar ve uzmanların görüş birliği ile AS tedavisine yönelik ulusal öneriler oluşturulmuştur. Bu öneriler, yeni gelişmeler doğrultusunda düzenli olarak güncellenmelidi

The frequency of Duchenne muscular dystrophy/Becker muscular dystrophy and Pompe disease in children with isolated transaminase elevation: results from the observational VICTORIA study

IntroductionElevated transaminases and/or creatine phosphokinase can indicate underlying muscle disease. Therefore, this study aims to determine the frequency of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD) in male children and Pompe disease (PD) in male and female children with isolated hypertransaminasemia.MethodsThis multi-center, prospective study enrolled patients aged 3–216 months with serum alanine transaminase (ALT) and/or aspartate transaminase (AST) levels &gt;2× the upper limit of normal (ULN) for ≥3 months. Patients with a known history of liver or muscle disease or physical examination findings suggestive of liver disease were excluded. Patients were screened for creatinine phosphokinase (CPK) levels, and molecular genetic tests for DMD/BMD in male patients and enzyme analysis for PD in male and female patients with elevated CPK levels were performed. Genetic analyses confirmed PD. Demographic, clinical, and laboratory characteristics of the patients were analyzed.ResultsOverall, 589 patients [66.8% male, mean age of 63.4 months (standard deviation: 60.5)] were included. In total, 251 patients (188 male and 63 female) had CPK levels above the ULN. Of the patients assessed, 47% (85/182) of male patients were diagnosed with DMD/BMD and 1% (3/228) of male and female patients were diagnosed with PD. The median ALT, AST, and CPK levels were statistically significantly higher, and the questioned neurological symptoms and previously unnoticed examination findings were more common in DMD/BMD patients than those without DMD/BMD or PD (p &lt; 0.001).DiscussionQuestioning neurological symptoms, conducting a complete physical examination, and testing for CPK levels in patients with isolated hypertransaminasemia will prevent costly and time-consuming investigations for liver diseases and will lead to the diagnosis of occult neuromuscular diseases. Trial RegistrationClinicaltrials.gov NCT04120168