20191203131938 20191203131938 Selçuk Tıp Dergisi sinandemircioglumd@gmail.com Prof. Dr. Sinan DEMİRCİOĞLU Selçuk Tıp Dergisi Selcuk Med J 2149-8059 1017-6616 12 3 2019 35 4 Selami Aykut TEMİZ 0000-0003-4878-0045 İBRAHİM ERAYMAN Pembe OLTULU MUNİSE DAYE \r\n    Skin tuberculosis (tbc) is a chronic granulomatous infection of the skin. This can occur in different clinical forms depending on the route of entry, the immune response of the host, the number of the bacilli and the virulence. Mycobacterium tuberculosis, mycobacterium bovis, and, rarely, Bacille Calmette-Guerin (BCG) can be the cause of the disease. Skin tbc count is less than 2% of all tuberculosis cases. The majority of cases of cutaneous tuberculosis are endogenous (lupus vulgaris, scrofuloderma, metastatic tuberculosis abscess, acute miliary tuberculosis, orifice tuberculosis), and a few are exogenous tbc primer complex (tuberculosis), tuberculosis cutis verrucosa, forms in which the bacillus comes from the outside. \r\n\r\n    Primer inoculation tuberculosis (tuberculosis chancre) occurs in people with  that have not previously been contacted with the bacilli. Here we present a case of primary inoculation tuberculosis, a rare variant of cutaneous tuberculosis. \r\n\r\n  \r\n 12 3 2019 278 281 10.30733/std.2019.01075 https://selcukmedj.org/en-us/primer-skin-tuberculosis-as-a-sporotricoid-in-the-right-arm-en-5171/ https://app.selcukmedj.org/uploads/makale-pdf/1075-4-219659342.pdf OSMAN BALCI CEMRE ALAN 0000-0002-6276-1345 MEHMET COLAKOĞLU FEDİ ERCAN  Heterotopic pregnancy is a condition in which intra- and extrauterine pregnancies occur at the same time. However in the last decades there has been a significant increase of heterotopic pregnancy as high as %1-3 , this raised frequency has been attributed to the extended use of assisted reproductive technologies. Because it is a rare condition,there is no standart management or treatment method for heterotopic pregnancy. Usually methotrexate, RU 486 (Mifepristone) and prostaglandins aren’t used if intrauterine pregnancy wanted to persist, because of their potantial teratogenic effects on embryo. Here we present a case with heterotopic pregnancy who were treated by surgery for ectopic pregnancy and intrauterine pregnancy ended with labour of a healthy infant in term.\r\n 12 3 2019 271 273 10.30733/std.2019.00810 https://selcukmedj.org/en-us/heterotopic-pregnancy-resulting-in-a-live-birth-after-ivf-case-report-en-5006/ https://app.selcukmedj.org/uploads/makale-pdf/810-2-257162267.pdf GÖNÜL ÇİÇEK ŞENTÜRK MERVE SAYAR Fatma Altay ASLI HAYKIR SOLAY HALİME LÜLLECİ Brucellosis is one of the most frequent zoonotic diseases in our country. Brucellosis, a systemic infection, can arise with various clinical involvements. Genitourinary involvement is seen at varying rates between 4-20%.Seven examinedepididymo-orchitis cases were diagnosed through anamnesis, physical examination and ultrasonography.All of our patients are provincials, in their anamnesis, there are histories regarding eating infected milk and dairy products and         miscarriages in animals. Only in two of seven cases, diagnosis was made through coombs tube agglutination; in the other five of seven cases, standard tube agglutination test was sufficient for diagnosis. Blood culture positiveness was determined in three patients. Patients were healed by taking brucella treatment for six weeks.      Combined modality therapy was administered to all patients. Treatment deficiency was not determined in any patients. In this article, we aim to provide taking into consideration also brucellosis in histories of patients having epididymo-orchitis treatment.\r\n  12 3 2019 259 263 10.30733/std.2019.00858 https://selcukmedj.org/en-us/evaluation-of-seven-cases-with-brucella-epididymo-orchitis-en-5031/ https://app.selcukmedj.org/uploads/makale-pdf/858-2-202489038.pdf FATMA DOĞANAY NURSEN ŞEN CENGİZ KADIYORAN 0000-0002-7173-3530 ZEYNEP DADACI \r\n Parkinson’s disease (PD) is a progressive neurodegenerative disorder that leads to a selective loss of dopaminergic neurons in the basal ganglia of the brain. The main characteristics of the disease are tremor, bradykinesia and rigidity. There are also several non-motor manifestations of PD, one of which is visual system involvement. There is a decrease in retinal nerve fiber layer thickness in PD. In our study, we described bilateral optic atrophy along with a decrease in macular and retinal nerve fiber layer thickness in a patient with PD. \r\n 12 3 2019 264 266 10.30733/std.2019.01058 https://selcukmedj.org/en-us/optic-atrophy-in-a-patient-with-parkinson-s-disease-en-5159/ https://app.selcukmedj.org/uploads/makale-pdf/1058-2-451233988.pdf AHMET ŞEN 0000-0001-7628-7640 ZEYNEP AYDIN BUĞRA KAYA ÖZLEM DÜNDAR ŞAHİN \r\n Brown tumors are benign, but locally aggressive tumors that may emerge as a rare complication of prolonged hyperparathyroidism. They may be clinically and radiologically confused with bone metastases. Browns tumors show increased metabolic activity on F-18 FDG-PET/CT just as metastatic bone lesions. In this study, we present a patient who underwent PET/CT to seek a primary focus with the presumed diagnosis of  multiple bone metastasis, and Brown tumor was suspected because no primary focus was detected on imaging and increased FDG enhancement was seen in parathyroid locations, and the diagnosis was confirmed with further investigations. Herein, we aimed to underline that Brown tumors should be kept in mind in the differential diagnosis in patients who are clinically and radiologically considered to have bone metastasis. \r\n 12 3 2019 267 270 10.30733/std.2019.01081 https://selcukmedj.org/en-us/a-benign-pathology-mimicking-multiple-bone-metastasis-on-f-18-fdg-petct-brown-tumor-en-5172/ https://app.selcukmedj.org/uploads/makale-pdf/1081-2-846544330.pdf BÜŞRA ÇAVDARTEPE FAHRETTİN DUYMUŞ NADİR KOÇAK TÜLİN ÇORA NAFİZ YAŞA Neurofibromatosis type I (NF1) is a complex disorder caused by mutations of the neurofibromin protein-encoding gene on the chromosome 17. NF1 is an autosomal dominant disorder. The prevalence of NF1 is approximately 1:2500 to 1:3500. Both genders are equally affected. Herein, we report a 27-year-old female patient who had multiple hyperpigmented skin macules, multiple café-au-lait spots, axillary freckling, optic glioma, hundreds of soft cutaneous neurofibromas and lisch’s nodules on the iris of both eyes. According to the clinical features, we suspect from NF1 and-then sequence analysis of NF1 gene was performed. A heterozygous c.980 T> G (p.L327R) mutation was detected in the NF1 gene. This mutation has not been reported previously. 12 3 2019 274 277 10.30733/std.2019.01144 https://selcukmedj.org/en-us/a-case-report-of-neurofibromatosis-type-1-diagnosed-with-a-noval-mutation-detection-in-nf1-gene-en-5391/ https://app.selcukmedj.org/uploads/makale-pdf/1144-5-429312587.pdf ŞULE ARICAN 0000-0002-8634-1150 SEMA TUNCER AYBARS TAVLAN 0000-0002-6064-0179 GÜLÇİN BÜYÜKBEZİRCİ 0000-0002-9438-3414 Aim: In this study, we aimed to discuss our experience and results of non-operating room anesthesia. Materials and Methods: Anesthesia records of patients older than 18 years who underwent sedo-analgesia outside the operating room for diagnosis and treatment between May 2017 and December 2017 were retrospectively screened. The records were examined in terms of demographic data, applied procedure, duration of the procedure, sedation grade, medications used, developing minor and major complications, chronic obstructive pulmonary disease story and intensive care need. Relationships between complications with demographic data and categorical variables were analyzed. Results: Totally 2562 patients underwent sedo-analgesia. 1428 (55.7%) of these cases were female and 1134 (44.3%) of them were male. The average age of patients was 53.08±16.55. 268 (10.5%) of the cases were ASA I, 1683 (65.7%) were ASA II, 598 (23.3%) were ASA III and 13 (0.5%) were ASA IV. 519 (20.3%) patients were minimally sedated, 1541 (60.1%) were moderate sedated and 502 (19.6%) deep sedated. The longest procedure time in endoscopic retrograde cholangiopancreatography was 28.7 ± 16.3 min, and the shortest procedure time in endoscopy was 10.3 ± 3.1 min. The most commonly performed procedure was colonoscopy with 31%. The most commonly used drug combination was midazolam + propofol + fentanyl applied to 1231 patients (48%). 148 (5.76%) patients had minor complication, and 10 (0.37%) patients had major complication. A total of 15 (0.58%) patients underwent intensive care after the procedure. Desaturation was statistically significantly higher in patients with ASA III and above, in procedures take longer than 15 minutes, in patients older than 65 years, and in the presence of chronic obstructive pulmonary disease. The intensive care need after the procedure was also significantly higher in these patient groups. Conclusion: The incidence of non-operating room anesthesia is increasing steadily. The risks associated with these practices are similar to the anesthesia in the operating room. In order to increase patient safety and reduce complications, it is important to carry out a thorough evaluation before the procedure, to provide proper monitored anesthesia care in appropriate physical conditions, and to establish healthy communication between the teams. 12 3 2019 217 224 10.30733/std.2019.01121 https://selcukmedj.org/en-us/our-non-operating-room-anesthesia-experiences-en-5228/ https://app.selcukmedj.org/uploads/makale-pdf/1121-4-6515985.pdf HALİL ERDOĞAN BAHADIR FEYZİOĞLU MEHMET TOKAÇ İLKNUR CAN AHMET SERTDEMİR Introduction: Circulating stem cells (CSCs) are released from bone marrow in to the circulation after myocardial injury to improve tissue repair. Radiofrequency ablation (RFA) of cardiac arrhythmias, particularly for atrial fibrillation, has been shown to trigger the release of CSCs through inflammatory mediators. We aimed to investigate whether CSCs are increased in the circulation following non-extensive ablation procedures such as slow pathway or accessory pathway ablations. Methods: Twenty-six patients [13 females, 54 (18-74) years old] who underwent slow pathway ablation for atrioventricular nodal reentrant tachycardia (n=18) and accessory pathway ablation for atrioventricular reentrant tachycardia (n=8) were included. Peripheral blood CD34+ cell count and multiple serologic markers [troponin I (Tn-I), C-reactive protein (CRP), interleukin-6 (IL-6), stromal cell derived factor (SDF) 1 alpha] were evaluated before the ablation procedure and 7 and 30 days after the procedure. Results: The CD34+ cell count was significantly increased on the 7th day after the procedure when compared to baseline [33 (15-133) vs. 22,5 (5-79) cells per microliter respectively, P<0.001]. The CD34+ cell count was similar to baseline on the 30th day following the procedure. Levels of Tn-I, CRP, IL-6 and SDF1-α did not change significantly following ablation. The amount of energy applied during RFA (watts) was significantly correlated with the 30th day CD34+ cell count (r: 0.460; p= 0.018). Conclusions: Peripheral blood CSCs are increased after slow pathway or accessory pathway ablations which are less extensive ablations compared to atrial fibrillation ablation. The levels return to baseline by the 30th day following the procedure. The increase in CSCs was positively correlated with the amount of energy delivered during the procedure. 12 3 2019 225 229 10.30733/std.2019.01135 https://selcukmedj.org/en-us/the-effect-of-radiofrequency-ablation-on-stem-cells-and-systemic-inflammation-in-patients-with-supraventricular-tachycardia-en-5238/ https://app.selcukmedj.org/uploads/makale-pdf/1135-2-770480796.pdf MEHMET YILDIRIM MUSTAFA ŞENTÜRK MEHMET METİN BELVİRANLI Kemal Ercan 0 Abstract INTRODUCTION Acute mesenteric ischemia (AMI) is an acute abdominal disease which is age-related with possible bad prognosis; and while its morbidity and mortality rate is 10% in early diagnosis and treatment it may progress with 100% mortality when diagnosis and treatment are delayed.The aim of this study was to unearth the efficiency of neutrophil-to-lymphocyte ratio (NLR) which has recently been started to be utilized in the prediction of AMI prognosis and used as a prognostic factor in many diseases. MATERIALS and METHODS: The data of a total of 111 patients, who had undergone surgical procedures and diagnosed with mesenteric ischemia intraoperatively at Necmettin Erbakan University Meram Medical School’s General Surgery Clinic between 2005 and 2013 and whose diagnoses had later on been confirmed pathologically, were retrospectively evaluated within the scope of the study. The demographic data of all patients (age, sex) were recorded. The hemogram results of the patients, analyzed with peripheral blood, were reviewed for preoperative evaluation. The surgical procedure performed, the part and length of the resected bowel based on pathology results, the duration of hospitalization, survey, presence of comorbidity, white blood cell count, creatinine values, and NLR of the patients were determined. The data were statistically analyzed. RESULTS: The patients who did not survive had a mean NLR of 24.77 ±10.38, while the same ratio was found to be 17.6±10.65 for survivors. The NLO value was found to be high in cases with mortality.   CONCLUSION: AMI still proves to have high mortality in spite of the developments in imaging techniques and laboratory analyses. There is no specific laboratory analysis for early diagnosis. High preoperative NLR in patients suspected to have AMI may indicate bad prognosis. 12 3 2019 230 234 10.30733/std.2019.01148 https://selcukmedj.org/en-us/prognostic-value-of-the-efficiency-of-preoperative-neutrophil-to-lymphocyte-ratio-in-acute-mesenteric-ischemia-prognosis-en-5358/ https://app.selcukmedj.org/uploads/makale-pdf/1148-2-223808495.pdf Recai Dağlı 0 Mehmet Cantürk 0 FATMA ÇELİK 0000-0003-0192-0151 12 3 2019 235 241 10.30733/std.2019.01145 https://selcukmedj.org/en-us/emergency-operations-and-anesthesia-distribution-analysis-retrospective-study-en-5363/ https://app.selcukmedj.org/uploads/makale-pdf/1145-2-761692789.pdf FUNDA GÖDE GÜLİN OKAY AHMET IŞIK ALİ SAMİ GÜRBÜZ 0000-0001-7747-3074   Abstract   Background and Aim: Hysterosalpingography is usually preferred for evaluation of tubal patency however it is also a helpful technique for detection of uterine pathologies. There is very limited data about the sensitivity of hysterosalpingography for evaluation of uterine cavity diseases. Therefore the aim of our study is to evaluate the sensitivity of hsyterosalpingography for uterine pathologies. Materials and Methods: The records of infertile patients who applied to Izmir Medicalpark hospital between November 2017 and September 2018 were retrospectively evaluated. Data of patients who had hysterosalpingography and hysteroscopy on the same day were investigated. The clinical characteristics (age, duration of infertility, cause of infertility, type of infertility) of these patients were evaluated. The results of hysterosalpingography and hysteroscopy were compared for uterine pathologies. Results: A total of 114 patients were included in the study. When the correlation between HSG and hysteroscopy was evaluated, there were similar results in 71 (62.3%) and different results in 43 (37.7%) patients. Extra uterine pathology was detected in 32 patients whose HSG was evaluated as normal. Negative predictive value of HSG was 44% (32/72) for uterine pathologies. Endometrial polyp was detected in 36 patients during hysteroscopy however the number of patients with initial diagnosis of endometrial polyp was 12. The sensitivity of hysteroscopy for endometrial polyps was 37.5% (12/36). Conclusion: The sensitivity of HSG which was applied concurrently with hysteroscopy is low for uterine pathologies. However it might be beneficial in daily clinical practice for evaluating and treating tubal and uterine pathologies at the same time   12 3 2019 255 258 10.30733/std.2019.01245 https://selcukmedj.org/en-us/are-the-results-of-concurrent-hysterosalpingography-and-hysteroscopy-similar-for-detecting-uterine-pathologies-en-5382/ https://app.selcukmedj.org/uploads/makale-pdf/1245-3-63090663.pdf IŞIL YURDAIŞIK Objective: Brain death is defined as the complete and irreversible loss of all brain functions including the brain stem. Three major findings used for the diagnosis of brain death are coma, absence of the brain stem reflexes and apnea. The diagnosis of brain death has become more important with the increasing number of patients waiting for transplantation. The objective of this study was to determine the efficacy of computed tomography angiography in confirming brain death. Material & Methods: Clinical brain death was reported in total 21 patients hospitalized in critical care unit of our hospital between October 2015 and June 2018. One of these patients was excluded since he underwent magnetic resonance angiography. CTA findings of the remaining patients were retrospectively evaluated. Patients were aged between 25 and 75 years with a mean age of 45 ± 1 years. CTA evaluations were performed using a 64 detector device. 100 mL contrast agent was delivered with a double head automated pump at a rate of 3.5 – 4 cc/sec as 350-375 mg/mL. When the region of interest reached to 90-100 HU cut off value, the images were acquired at 15-20 sec intervals on the axial plan. CTA findings were interpreted using 10- point scale. Results: Causes of death were reported as intracranial hemorrhage in eight patients, ischemic cerebrovascular events in four patients, hemorrhage after craniotomy in three patients, cardiac arrest in two patients, post-traumatic contusio cerebri in one patient, and metabolic reasons in two patients. Contrast filling was “0” in the ACA, PCA, MCA distal, and ICA supraclinoid branches of all 20 patients. Suspected contrast filling was found in MCA proximal in eight patients and unilateral ACA proximal in two patients. Each loss of opacification in the intracranial brancges was scored as 1 point. Accordingly, all patients were scored as 10 points. Conclusion: According to our results, CTA is an effective and sensitive method for the diagnosis of brain death which is obligated by regulations.   12 3 2019 242 248 10.30733/std.2019.01158 https://selcukmedj.org/en-us/evaluation-of-the-efficacy-of-computed-tomography-angiography-in-brain-death-en-5383/ https://app.selcukmedj.org/uploads/makale-pdf/1158-4-363349827.pdf MEHMET GÜNDÜZ MEHMET ADAM MEYDAN TURAN Abstract Aim: We aimed to assess the changes in retinal nerve fiber layer (RNFL) and optic nerve head (ONH) in patients with chronic obstructive pulmonary disease (COPD). Patients and Methods: Thirty patients having severe COPD and 29 age and sex-matched healthy subjects were enrolled in the study. After a detailed ophthalmic examination, the ONH and RNFL thickness measurements were taken by an optical coherence tomography (OCT) (Stratus OCT-3). Arterial blood gases (pO2 and PCO2) were measured and respiratory functional tests were performed for the staging of COPD patients. The OCT parameters were compared difference between the 2 groups using independent t test, while Pearson correlation analysis was performed to assess the correlations between respiratory functional tests, arterial blood gases and RNFL thickness parameters. A p value less than 0.05 was accepted as statistically significant. Results: There were no significant differences in optic disc area, cup area and rim area between COPD and healthy subjects (p>0.05). Parameters of mean and superior quadrant RNFL thickness were found to be significantly thicker in COPD subjects (114.52±7.7 µm and 141.07 ±18.2 µm, respectively) compared to the control subjects (107.9±5.4 µm and 131.31±13.6 µm, respectively) (p<0.05). No correlation was found between pO2 and RNFL thickness (r=-0.22, p=0.33). There was a moderate correlation between pCO2 and superior quadrant RNFL (r= 0.53 and p=0.017), and a high negative correlation between FEV1/FVC and superior quadrant RNFL (r=-0.76, p=0.003). Conclusions: The increase in pCO2 and the decrease in FEV1 / FVC indicate increased hypoxia. Peripapillary RNFL loss associated with RGC death can be masked by hypoxia / ischemia-induced retinal and optic disc edema. Increased mean RNFL thickness in COPD patients was thought to be due to retinal edema associated with increased hypoxia. 12 3 2019 249 254 10.30733/std.2019.01237 https://selcukmedj.org/en-us/the-evaluation-of-retinal-nerve-fiber-layer-thickness-by-optical-coherence-tomography-in-patients-with-chronic-obstructive-pulmona-en-5387/ https://app.selcukmedj.org/uploads/makale-pdf/1237-3-416513163.pdf KEVSER NALBANT SEMİH ERDEN \r\n Autism spectrum disorder is a neuro-developmental disorder characterized by social interaction and communication, and restricted and repetitive behaviors. Autism is seen in nearly one of 68 children. The incidence is reported to increase, and the increase is suggested to arise from increased information, awareness and alterations in diagnostic criteria. However, environmental factors and their relationships to several unknown genetic factors are also considered to contribute to the increase. The assessment of whether environmental factors lead to risks for autism spectrum disorder in perinatal period, especially when children are exposed to these factors in a neurodevelopmentally important and fragile stage, is so important. It is reported that in pregnancy, there is an association between autism spectrum disorder, and exposure to such drugs as valporic acid, terbutaline and Selective Seratonin Reuptake Inhibitors.Exposure to heavy metals and pesticides increases the risk of autism spectrum disorder.Intense smoking, and alcohol consumption and drugsdisrupt neurodevelopmental process, Also, gestational diabetes may elavate the risk of autism spectrum disorder due to autoimmunal disorders, infections and inflammatory pocesse of prolonged fever. Migration, seasons and air pollution exposed in pregnancy are also reported to affect autism spectrum disorder risk. The awareness level between environmental factors and autism spectrum disorder should be increased among prospective mothers, and these mothers should be trained as to the risk factors. Because prospective mothers avoid these factors, or the elimination of these factors should be beneficial for reducing autism spectrum disorder risk, analyzing related studies and enlightening risk factors are especially important. Here, we aimed at revising recent studies related to prenatal factors from a holistic perspective.\r\n 12 3 2019 282 290 10.30733/std.2019.00942 https://selcukmedj.org/en-us/autism-spectrum-disorder-and-prenatal-risk-factors-en-5092/ https://app.selcukmedj.org/uploads/makale-pdf/942-3-156200259.pdf