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The Medical Journal Of Haydarpaşa Numune Training and Research Hospital - : 59 (4)
Volume: 59  Issue: 4 - 2019
1.Comparison of Adenosine Deaminase (ADA) and Cancer Antigen 125 (CA 125) Levels in Epithelial Ovarian Tumors
Mustafa Taş, Zeynep Ece Utkan Korun, Alper Koçak, Adem Yavuz, Bülent Özçelik, Mete Güngör, Gökalp Öner
doi: 10.14744/hnhj.2018.60362  Pages 309 - 314
INTRODUCTION: In this study, we aimed to determine serum adenosine deaminase (ADA) and cancer antigen 125 (CA 125) levels in patients with epithelial ovarian tumors.
METHODS: A total of 75 patients with 47 malignant and 28 benign epithelial ovarian tumors were included in this case-control study. On the morning of the operation, serum CA 125 and ADA levels were determined. Postoperative epithelial ovarian tumor patients were divided into two subgroups as benign and malignant histopathologically. We evaluated whether there was a correlation between tumor levels and serum CA-125 and ADA levels of subgroups and malignant patients.
RESULTS: Of 47 patients with malignant epithelial ovarian cancer, 20 of them had an early-stage (stage 1-2) and 27 of them had advanced-stage (stage 3-4) tumors. Serum CA-125 (26.38 vs 44.93, p<0.001) and ADA levels (29.91 vs 42. 82, p≤0.05) were significantly higher in malignant epithelial ovarian tumors than in benign epithelial ovarian tumors. There was no significant correlation between ADA levels.
DISCUSSION AND CONCLUSION: This study showed that serum ADA levels in patients with epithelial ovarian cancer could be used as a biomarker in combination with other parameters for predicting malignancy in ovarian cancer. To validate these clinical data, large-scale studies of epithelial ovarian tumors are needed.

2.The Treatment of Lymphangiomas with Bleomycin in Childhood: A Retrospective Observational Study
Salim Bilici, Veli Avci, Tülin Öztaş, Muhammet Asena, Kıymet Çelik
doi: 10.14744/hnhj.2019.22590  Pages 315 - 319
INTRODUCTION: Lymphangioma is defined as the congenital malformation of the lymphatic system. According to morphological classifications, there are macrocystic, microcystic and mix types. Treatments vary from one clinic to another given that there are no commonly accepted guidelines. This study aims to present the results of ultrasonography-guided intralesional bleomycin treatment of lymphangioma.
METHODS: Retrospective evaluation was conducted on 20 patients with lymphangioma who were treated with intralesional bleomycin. Under local anesthetic and aseptic conditions, 0.4-0.6 mg per kg bodyweight of bleomycin was injected under ultrasonography guidance. The response was graded as “excellent response” (>90% reduction), “good response” (>50% reduction in size) and “poor response” (<50% reduction or no change in size).
RESULTS: The 20 cases comprised eleven female and nine male patients with a mean age of 3.1 years. The lymphangioma was located on the neck in eight cases, on the trunk in seven cases, on the axillary region in two cases, the mass extended from the neck to the mediastinum and retropharynx in one case. Also, it was on the anterior surface of the thigh in one case and on the anterior surface of the leg in one patient. Excellent response was seen in 50% of the patients, a good response in 40% and a poor response in one patient.
DISCUSSION AND CONCLUSION: Bleomycin injection is very effective for the treatment for macrocystic and mixed type lymphangioma of the neck and on any other surface area of the body. It is an appropriate treatment choice for cases that have previously undergone surgery and then show recurrence or incomplete resection.

3.Evaluation of Paranasal Sinus Variations with Computed Tomography
Gülay Güngör, Nazan Okur
doi: 10.14744/hnhj.2019.48243  Pages 320 - 327
INTRODUCTION: Paranasal sinuses are one of the most common anatomical variations in humans. Computed tomography (CT) is an imaging modality used as the gold standard in the evaluation of patients before endoscopic sinus surgery (ESS). This study aims to evaluate the anatomic variations that should be considered before and during the surgical procedure by CT examination and to determine their frequency.
METHODS: In this study, the images of patients who were referred to the otorhinolaryngology (ENT) outpatient clinic, considering that they had had sinus pathology and underwent paranasal sinus CT imaging were retrospectively analyzed. A total of 320 patients aged between 15-90 years were evaluated. Non-contrast images obtained by multislice CT were examined. The breakdown of anatomic variations evaluated in CT sections obtained according to these protocols is presented in Table 1.
RESULTS: Of the 300 patients, 151 were male (47.2%) and 169 were female (52.8%). The mean age was 39.8±15.8 years. The most common anatomic variation was agger nasi cell with 86.3% (n=276). The least detected anatomical variations were pneumatized inferior turbinate and bifid inferior turbinate as 0% (n=0), inferior turbinate hypoplasia as 0.3% (n=1), and bifid uncinate process variations as 0.6% (n=2).
DISCUSSION AND CONCLUSION: Considering that a significant portion of the variations identified in this study (such as ICA protrusion and dehiscence, ethmoid roof asymmetry, Onodi cell, atelectatic UP) may lead to significant complications during surgery, it is important to know and describe the appearance of these variations on CT. In our study, significant variation was observed in the sinonasal region, and it was once again emphasized that paranasal sinus CT was very valuable in determining these variations.

4.Diagnostic Distribution of Cervicovaginal Smear in Bursa and Its Surrounding
Taşkın Erkinüresin, Esra Kartal, Yasin Altekin, Muzaffer Temur, Hakan Demirci, Emin Üstünyurt
doi: 10.14744/hnhj.2019.71602  Pages 328 - 332
INTRODUCTION: In this study, our aim was to analyze Pap smear cervical cancer screening results at our hospital. We also sought to compare our ASC/SIL rate with the relevant studies in the literature, which is one of the quality standard criteria for the pathology laboratory.
METHODS: In our study, digital reports of 6902 cases diagnosed according to the Bethesda Reporting System for Pap cervical cancer screening and other medical indications in the pathology department of our hospital between 1st January 2018 and 31st December 2018 were reviewed retrospectively.
RESULTS: When 6902 cervicovaginal smear cases were analyzed concerning epithelial abnormality, 6528 cases (94.6%) were reported as NILM, and seven cases (0.1%) were reported as an inadequate smear. Epithelial abnormality was detected in the remaining 367 (5.3%) cases. Out of 367 cases,279 (4.0%) of them were reported as ASC-US;42 cases (0.6%) as AGC-NOS;24 cases (0.3%) as LSIL;12 cases (0.2%) as ASC-H, seven cases (0.1%) as HSIL; one case (0.0%) as LSIL and AGC-NOS; one case (0.0%) as ASC-H and AGC-NOS and one case (0.0%) as squamous cell carcinoma (SCC). The ASC/SIL rate of our laboratory for the year 2018 was 9.125.
DISCUSSION AND CONCLUSION: Our SCC rate was 0.02%, which was the second-lowest rate in the relevant literature. The reason for this may be the success of the cervicovaginal Pap smear screening program performed in our region. Our inadequate cervicovaginal smear rate concerning assessment was the lowest rate in the literature. Our ASC/SIL rate was 9.125, and this was the third highest ASC/SIL rate in the literature. The reason for our laboratory’s 2018 ASC/SIL rate of 9.125 may be the concern of some of our pathologists of false-negative reports. We detected various differences between epithelial abnormality and infection prevalence in the cervicovaginal smears in our region and epithelial abnormality and infection prevalence in different regions of the world. Intra-departmental case presentations and in-service training could be organized to keep the ASC/SIL rate in the pathology laboratory under three. At the same time, pathologists’ quarterly ASC/SIL rates could be calculated and reported to the pathologists.

5.Evaluation of Palliative Care Patients Admitted to the Emergency Department
Davut Tekyol, İbrahim Altundağ, Nihat Müjdat Hökenek, Gürkan Akman
doi: 10.14744/hnhj.2018.29494  Pages 333 - 336
INTRODUCTION: Palliative care is a multidisciplinary approach that should be applied to relieve the remaining physical, social, psychological and mental problems of the patients who have a progressive and untreatable disease to live the remaining time comfortably. Our aim is to examine the patients, who are in need of palliative care and admitted to the emergency department, to determine the diagnosis of the patients, the reasons of applications to the emergency services and to show how the emergency services can contribute to the solution of the complaints of palliative care patients.
METHODS: In accordance with this purpose, 184 patients who were admitted to Haydarpasa Numune Training and Research Hospital Emergency Medicine Clinic between January 2017 and March 2018 and who needed palliative care as a result of the evaluations were included in the study. The aim of this retrospective study was to provide a more effective and accurate approach to palliative care patients who applied to the emergency department.
RESULTS: Palliative care patients, many of whom are dependent on another person, when they are considered to be in need of urgent care and symptomatic treatment, should be treated with care and attention in small palliative care units of the emergency services.
DISCUSSION AND CONCLUSION: To provide better palliative care, we can determine palliative care as a new side of the emergency department. In addition, opening a palliative care policlinic in the emergency department and increasing the quotas of palliative care services can be evaluated for this purpose.

6.Evaluation of Generic Antibiotic Usage from the Perspective of Drug Cost
Güldem Mercanoglu
doi: 10.14744/hnhj.2018.50023  Pages 337 - 341
INTRODUCTION: The drug costs are the biggest expense item among health expenditures. Increasing the use of generic drugs is the most important solution for decreasing costs. Antibiotics, with an 18.1% rate of prescription, are the most used pharmacological group worldwide. This study aims to calculate the original/generic drug costs of antibacterial agents prescribed to hospitalized patients in a university hospital.
METHODS: During 13 month-period prescribed drugs to hospitalized patients were recorded with the product names and amount, and drug costs were determined for the three active agents most commonly prescribed in the antibacterial group.
RESULTS: The total number of prescriptions was 337.462 during the 13-month-period and 46.3% of them were antibiotics. Among them, 94.4% were antibacterial agents. In the subgroup analysis, cephalosporin group of antibacterial agents was the most frequently prescribed. On the contrary, amoxicillin+sulbactam was found to be the most frequently prescribed active substances within the top 100 prescription drugs. When prescription details were evaluated, generic forms of active substances were more frequently prescribe than the original drugs. From the point of drug costs with the use of generic drugs for 13 month-period, the total saving was about 31%.
DISCUSSION AND CONCLUSION: It is projected for 2023 that the proportion of drug costs in health expenditures will reach 25% in our country. When this data is taken into consideration, the usage and prescription of generic drugs should be encouraged. Establishing generic drug promotion policies, accelerating the regulatory processes of generic drugs, including generic drugs in reimbursement lists, without delay will increase the demand for generic drugs and contribute to the reduction of drug costs, which constitutes the most important part of health expenditures.

7.Is the Emergency Cesarean Section associated with Hypotension? Retrospective Analysis of 80 Patients Undergoing Elective or Emergency Cesarean Section under Spinal Anesthesia
Esra Adıyeke
doi: 10.14744/hnhj.2019.80958  Pages 342 - 346
INTRODUCTION: While CS is associated with several intraoperative and postoperative complications, the risk of the hemodynamic changes in case of an emergency CS is usually underestimated. The lack of adequate patient preparation before anesthesia and insufficient time to correct the volume depletion before anesthesia are common issues in emergency CS. The present study aimed to compare the hemodynamic changes in patients undergoing elective or emergency CS.
METHODS: All consecutive patients undergoing CS with spinal anesthesia in a tertiary stage hospital were enrolled in this retrospective study. Patients were divided into two groups according to the emergency of the CS as Elective CS group and emergency CS groups. Elective CS patients received routine volume replacement before surgery, whereas emergency CS patients received volume replacement according to the operator’s decision. The difference in the hemodynamic parameters throughout the surgery between the elective and emergency CS groups was the primary outcome measure of this study.
RESULTS: The amount of the intravenous fluid administered before surgery was significantly lower in the emergency CS group compared to the elective CS group (650±280 ml vs. 1430±460 ml, p<0.01). A significant drop occurred in systolic, diastolic, and mean arterial pressure early at the 5th minute of anesthesia in patients undergoing emergency CS. However, no significant change was observed in the elective CS group concerning the systolic, diastolic, and mean arterial pressure and heart rate.
DISCUSSION AND CONCLUSION: In contrast to the women undergoing elective CS, a significant drop occurs in systolic, diastolic and mean arterial blood pressure following the implementation of the spinal anesthesia in patients undergoing emergency CS. Rapid evaluation of the volume status and intravenous volume replacement may prevent the reduction of the arterial pressure in patients undergoing emergency CS.

8.Evaluation of Intensive Care Patient Bed Cleanliness by ATP Bioluminescence
Arzu Yıldırım Ar, Servet Öztürk, Sevgi Alagöz, Ahmet Emre Akın, Canan Ağalar, Güldem Turan
doi: 10.14744/hnhj.2019.02360  Pages 347 - 350
INTRODUCTION: One of the most important causes of intensive care infections is cross-contamination, and priority is given to hand hygiene and environmental cleanliness in preventing it. Adenosine 5 triphospatebioluminescence (ATP) can measure the content of invisible contamination by measuring microorganism organic content. ATP produces results fast. In this study, we aim to evaluate the ATP measurement results retrospectively to observe environmental contamination at a time when infection rates have increased in our clinic.
METHODS: We retrospectively evaluated the results of measurements performed on three different days in December 2017. The measurements were made when all 20 beds in our clinic were occupied. Measurements were made in a region of 5x20 cm on the side of each bed before and after cleaning using ATP Clean Trace (3M Company-USA) device, and the results were recorded in the relative light unit (RLU). Although there are studies that have adopted a surface cleanliness threshold of 100-500 RLU, in our clinic, we consider the most commonly used 250 RLU for similar surface cleanliness as a threshold value. The threshold value for surface cleaning is accepted to be 250 RLU. If the value is above 250 RLU after cleaning, the cleaning is repeated, and the measurements are made again.
RESULTS: During the first measurement, three beds had to be cleaned a second time and during the third measurement, eight beds had to be cleaned a second time. Post-cleaning values were significantly lower than the pre-cleaning days (p<0.05).
DISCUSSION AND CONCLUSION: Consistent with the literature, we found that satisfactory cleanliness of the sides of the bed, which we think have been cleaned visually, cannot be sometimes achieved and they required to be cleaned again. We believe that it is important to quantify cleanliness inspection in intermittent periods in the prevention of contamination in intensive care.

9.The Evaluation of the Patients with Methemoglobinemia Due to Prilocaine
Aytekin Kaymakcı, Sirin Guven, Mehmet Arpacık, Ceyhan Şahin, Hayrünisa Kahraman Esen, Turan Yıldız
doi: 10.14744/hnhj.2019.38247  Pages 351 - 354
INTRODUCTION: This study aims to present the results and treatment of prilocaine-induced methemoglobinemia at three different hospital pediatric surgical clinics.
METHODS: The data were obtained from hospital information systems at the University of Health Sciences Umraniye Training and Research Hospital, Prof. Dr. İlhan Varank Training and Research Hospital and Inonu University Medical Faculty Pediatric Surgery clinics between 2009 and 2019. The patients with prilocaine-induced methemoglobinemia in pediatric surgery clinics were evaluated retrospectively.
RESULTS: A total of 11 cases were identified (10 male and 1 female). The mean age was 4.60 months (max/min: 1-12) and the mean weight was 5.570 g (max/min: 3600-11000). Local prilocaine (Citanest®), at doses 1-3 mg/kg, was injected to eight cases of circumcision, two cases of bilateral inguinal hernia and one case of undescended testicle + circumcision. In all cases, cyanosis in the skin and mucous membranes and methemoglobin in the blood gases were high (10-30%). 300 mg/kg ascorbic acid was applied to the patients for treatment, and 24 hours of methemoglobin levels were normal (1-3%).
DISCUSSION AND CONCLUSION: Methemoglobinemia should be suspected in cases where prilocaine is used as a local anesthetic, especially prilocaine should not be used in infants younger than six months of age, and alternative local anesthetics for prilocaine should be considered.

10.Relationship of Epidemiologic Features and Risk Factors in Impaired Glucose Tolerance and Gestational Diabetes Mellitus
Güldeniz Toklucu, Mehmet Nizamoğlu, Alper Kızıltepe
doi: 10.14744/hnhj.2018.77699  Pages 355 - 362
INTRODUCTION: To examine the relation of weight and parity with glucose intolerance during pregnancy.

METHODS: This study was a prospective cohort survey of 365 women at 24-38 weeks of gestation who were attending the antenatal clinic in Istanbul Bakırköy region, between 1st January 2009 and 31st December 2009. Risk factors were determined using a questionnaire, and two steps oral glucose tolerance test (OGTT) were routinely performed. The statistical analysis was performed using Kruskal Wallis test, Mann-Whitney U test, Chi-square test and Oneway Anova test, Tukey HSD test. P<0.05 value was statistically significant.

RESULTS: Pregestational weight, gestational weight gain and parity of the women with GDM were significantly higher, and educational status was significantly lower than other groups (p<0.01).

DISCUSSION AND CONCLUSION: Pregestational obese women and women who had higher gestational weight gain higher risk of GDM. Patient education is important for preventive medicine practice.

11.Is there any Relationship between Proximal Femur Fracture Site and Hip Anatomy?
Sefa Giray Batıbay, Savaş Çamur
doi: 10.14744/hnhj.2018.92259  Pages 363 - 366
INTRODUCTION: There are few studies reporting the relationship between hip fracture site and hip geometry and bone mineral density in the literature. The forces affecting the hip joint, the arm of the force and the angle of the load are the basis of hip biomechanical studies. The angle of the proximal femur and the morphological parameters are important for stress distribution due to the response to the burden. We think that the morphological differences of the proximal femur are related to the fracture type.
METHODS: Between 2015-2018, patients who applied to the hospital with femur fracture were listed. One thousand twenty-four femur fractures were detected. Pertrochanteric, femoral neck and subtrochanteric fractures were selected on the list. Patients with appropriate pelvis X-rays were identified. Intertrochanteric distance, femoral neck length, femoral neck width, lateral offset length, neck- shaft angle and acetabulum center-edge angle were measured by one orthopedic surgeon.

RESULTS: Significant statistical results were found between collum femoris fractures and collodiafizer angles of subtrochanteric fractures (p=0.0117). Significant statistical results were also observed between pertrochanteric fractures and subtrochanteric fractures (p=0.0439). Comparing with the subtrochanteric group and the femoral neck group’ CE angles, a significant difference was found (p=0.0490). There was no statistically significant difference between pertrocanteric group and subtrochanteric group (p=0.2614).
DISCUSSION AND CONCLUSION: To our knowledge, this is the first morphological femur fracture study that was conducted for Turkish society in the literature. An advantage of our work is that this study can be used to design an implant.

12.Our Experiences about Cubital Tunnel Syndrome
Ayşe İrem İskenderoğlu, Nesibe Sinem Çiloğlu, Barış Çin
doi: 10.14744/hnhj.2018.06977  Pages 367 - 369
INTRODUCTION: Cubital tunnel syndrome is the second frequent compression syndrome of the upper extremities after carpal tunnel syndrome. Numbness of the ulnar nerve distribution is the most experienced symptom in the patients. Surgery is necessary for patients whose symptoms persist with nonoperative treatments. We use fascial flap and subcutaneous anterior transposition of the ulnar nerve to treat cubital tunnel syndrome in our clinic. In this study, our aim is to examine and report long-time results of these patients.
METHODS: We retrospectively examined 30 patients who had been operated because of the cubital tunnel syndrome between November 2009 and April 2013 in our clinic.

RESULTS: There were 18 female (60%), and 12 male (40%) patients between the age of 35-67. In 10% of the patients, electrophysiological findings became normal after the postoperative six months. In 60% of the patients, electrophysiological findings became normal after the postoperative 18 months. In 10% of the patients, there were no differences after postoperative 18 months, and in 20% of the patients, electrophysiologic findings reduced from high level to middle level and from middle level to low level after postoperative 18 months.

DISCUSSION AND CONCLUSION: Fascial flap and subcutaneous anterior transposition of the ulnar nerve is a very effective and reliable surgical procedure. It is widely accepted and it has low complication rates.

13.The Role of Cardiovascular and Inflammatory Markers in Elucidating the Etiology of Respiratory Distress in the Newborn
Funda Yavanoğlu Atay, H. Gözde Kanmaz Kutman, Duygu Bidev, Şerife Suna Oğuz
doi: 10.14744/hnhj.2018.04880  Pages 370 - 374
INTRODUCTION: Respiratory distress is at the top of the reasons for admission to the neonatal intensive care unit. This study aims to investigate the role of cardiovascular markers, such as N-terminal pro-brain natriuretic peptide (NT-proBNP), asymmetric dimethylarginine (ADMA) and an inflammatory marker interleukin-6 (IL-6) in elucidating the etiology of respiratory distress, severity of disease and early morbidity.
METHODS: Infants born at ≥32 gestational weeks in our hospital with Downes scores >5 between January 2014-June 2014 and admitted to the neonatal intensive care unit because respiratory distress were enrolled. Blood samples were obtained for this study, Pro-BNP, IL-6 and ADMA levels and Downes scores were calculated at the hospital admission and also 48-72 hours later. Gestational age-matched newborns without respiratory distress and congenital heart disease constituted the control group. Demographic data, medical treatments, type and duration of respiratory support and duration of admission were recorded.
RESULTS: A total of 95 infants were enrolled in this study. Fifty- three (75.7%) of them had transient tachypnea, 9 (12.8%) of them had respiratory distress syndrome and 8 (11.4%) of the patients diagnosed as neonatal pneumonia. The control group consisted of 25 healthy infants. There was no statistically significant difference between ADMA, proBNP, IL-6 levels on days 1 and 3. ADMA levels were found to be positively correlated with Downes scores, duration of mechanical ventilation and inotrope requirement.

DISCUSSION AND CONCLUSION: There is no single reliable marker that can be used in the differential diagnosis of conditions that arise as the cause of respiratory distress in newborns. Especially on Day 3, ADMA levels may be a guide in determining the severity of the disease since it is associated with inotrope need and prolonged respiratory support requirements.

14.Retrospective Evaluation of the Cesarean Rates of a Training and Research Hospital in Istanbul Sancaktepe District
Güldeniz Toklucu, Kemal Sandal, Arzu Bilge Tekin, Bilge Doğan Taymur, Niyazi Tuğ
doi: 10.14744/hnhj.2018.07769  Pages 375 - 378
INTRODUCTION: Cesarean rates have been rising steadily in recent years. This study aims to evaluate cesarean section rates performed in the first year in İstanbul Sancaktepe Şehit Profesör İlhan Varank Research and Training Hospital Department of Obstetrics and Gynecology due to the 10-Group Classification System (Robson classification).
METHODS: Information about the cases was retrieved retrospectively from our hospital records of the Robson classification.

RESULTS: The total cesarean ratios in our clinic were 31.9% in 1 year period. Our Robson Group 1 ratio was 21.5%. When we examined distribution according to the Robson groups, we noticed that the highest contribution to cesarean rates was achieved with 99.1% of Group 5, 100% of Group 6, 92.8% of Group 7, 80% of Group 8 and 100% of Group 9.

DISCUSSION AND CONCLUSION: The Robson On-Group Classification System is an easy-to-use and convenient method of analysis that can be used freely for all healthcare facilities. In the first year of our clinic, total cesarean rate was determined lower than the 2016 Turkey research data. The major factor in our cesarean rate was established as Robson Group 5. This group is the largest contributor to all cesarean rates in most obstetric populations.

15.Hospital-acquired Hyponatremia: Risk Factors and Outcomes
Zeynep Ece Demirbaş, Gülizar Şahin, Kadir Kayataş, Mehmet Tepe, Yasemin Özgür, Seher Tanrıkulu, Refik Demirtunç
doi: 10.14744/hnhj.2018.94899  Pages 379 - 385
INTRODUCTION: Hyponatremia is the most common electrolyte disorder. This study aims to specify the clinical and demographical features of the patients who have a hospital- acquired hyponatremia, to identify the risk factors and to analyze the effects of these factors on clinical outcomes.
METHODS: This study was conducted retrospectively over a one-year period between 2012-2013 at Haydarpasa Numune Research and Education Hospital on 133 patients who developed hyponatremia during the hospitalization for any kind of reasons. The clinical features of the patients, comorbid diseases, symptoms related to hyponatremia, pathophysiological causes of hyponatremia and treatments that could be related to hyponatremia were also identified and the relationship between all above and plasma sodium concentrations, hospital length of stay, also mortality was investigated.
RESULTS: Among the 133 patients (median age 69.0 years) included to this study whose length of stay was between 2 -150 days, according to minimum plasma sodium concentrations (median 125.0 mEq/L), the overall incidence of mild hyponatremia was 8.3%; moderate hyponatremia 46.6% and severe hyponatremia was 45.1%. It was observed that 33.8% of the patients developed symptoms related to hyponatremia and also 100% of the patients who developed coma were classified as severe hyponatremia. The ratio of normalized hyponatremia was 27.1% and the overall mortality was 28.6%. Mortality was 83.3% among the patients who developed coma (p=0.007) and 71.4% who had dementia (p=0.020).

DISCUSSION AND CONCLUSION: The findings showed that mortality rates were higher among the patients who developed coma, and who had dementia as a comorbid disease. We believe that this study will be a guide for further case-controlled, prospective studies that can explain the relationship between hospital-related hyponatremia and comorbid diseases.

16.Management of Acute Subdural Hematoma: Single-centre Experience with 20 Subjects
Mustafa Efendioglu, Esra Adıyeke
doi: 10.14744/hnhj.2019.08831  Pages 386 - 389
INTRODUCTION: Given the high morbidity and the mortality that arise from the acute subdural hematoma (ASDH), factors affecting the clinical and neurological outcomes need to be clarified. This retrospective study purposes of demonstrating a single-center experience of the surgical treatment of subjects with ASDH and aims to find out to the contributors to the in-hospital mortality in subjects with ASDH.
METHODS: This retrospective study analyzed data of 20 subjects who underwent surgical evacuation of an acute subdural hematoma. Data concerning demographic features and pre-and postoperative hemodynamic parameters were retrieved from electronic medical records.
RESULTS: The median length of the intensive care unit (ICU) stay was seven (2-28) days. In-hospital mortality occurred in four (20%) subjects. Correlation analyses revealed that intraoperative mean arterial pressure was significantly correlated with in-hospital mortality (r=-0.565, p=0.009).
DISCUSSION AND CONCLUSION: In our study population, the mortality from surgical management of the ASDH was 20%, which is quite lower than the reported mortality rate in previous studies. Intraoperative mean arterial pressure was a significant contributor to in-hospital mortality. Rapid and vigorous management of the intraoperative hypotension may improve the surgical outcomes in subjects with ASDH.

17.Tolvaptan for Heart Failure with Volume Overload not Responding to Conventional Treatment: A Retrospective Analysis
Melike Betül Öğütmen
doi: 10.14744/hnhj.2018.16056  Pages 390 - 395
INTRODUCTION: To study outcomes in patients with heart failure (HF) resistant to conventional diuretic therapy receiving add-on tolvaptan (vasopressin 2 receptor antagonist) or ultrafiltration.
METHODS: In this study, a retrospective analysis was performed on the patients with HF who had significant volume overload, ischemic dilated cardiomyopathy, and hyponatremia (serum sodium: 125-135 mEq/L) resistant to conventional treatment who received add-on oral tolvaptan 15 mg/day or ultrafiltration.
RESULTS: Outcomes included a change from baseline in serum sodium, blood urea nitrogen (BUN), serum creatinine and body weight after three days. Changes in baseline hepatic enzymes and fasting blood glucose were analyzed in the tolvaptan arm 24 hours after stopping treatment. The analysis included 26 patients (tolvaptan: n=13; ultrafiltration: n=13). The overall baseline median (min, max) values were as follows: serum sodium 131 (122, 140) mEq/L, BUN 60.5 (21, 120) mg/dL, serum creatinine 1.6 (0.8, 3.7) mg/dL, body weight 76 (51, 92) kg. After three days, baseline serum sodium increased significantly in both arms with a significantly greater median % change in the tolvaptan arm (5 [-7, 12]) versus ultrafiltration (1 [-1, 8], p=0.037). No significant change in baseline BUN in the tolvaptan arm while it decreased in ultrafiltration arm (p=0.001). In both arms, there was significant weight loss and no significant change in serum creatinine versus baseline. No significant change was observed in baseline fasting glucose or hepatic enzyme levels in the tolvaptan arm. There were not any serious adverse events.

DISCUSSION AND CONCLUSION: The outcomes of patients with HF whose volume overload resistant to conventional treatment receiving add-on tolvaptan or ultrafiltration were not different concerning improving hyponatremia and inducing weight loss, without worsening of renal function.

18.Sporadic Hemiplegic Migraine: A Case Report
Davut Tekyol, İbrahim Altundağ, Nihat Müjdat Hökenek
doi: 10.14744/hnhj.2018.36854  Pages 396 - 398
The complaint of headaches is a frequent application to the emergency department. Most of the patients have a benign primary headache. Thus, fast and effective treatment is sufficient. A 24-year-old patient was admitted to the emergency department with symptoms of headache, slowing down in speech, numbness and weakness on the left side. After the examinations, the patient was diagnosed with a hemiplegic migraine attack. During follow-up, the patient's muscular weakness and symptoms totally improved, and migraine prophylaxis was started. Hemiplegic migraine, a rare subtype of migraine that characterized by recurrent focal weakness and headache episodes, was reviewed on this case.

19.Congenital Brucellosis in a Premature Infant
Erkan Yetmis, Sevinç Çelik, Çiğdem Sağ, Narin Akıcı, Cagatay Nuhoglu
doi: 10.14744/hnhj.2018.78055  Pages 399 - 401
Brucellosis is a worldwide infectious disease that arises from Brucella type bacteria. The infection is transmitted to humans through the consumption of unpasteurized milk, direct contact with infected animals. Congenital brucellosis occurs using trans-placental transmission due to maternal infection during pregnancy or ingestion of the contaminated maternal secretions during birth and breastfeeding. The diagnosis of brucellosis is made by culture or serology. In this article, the case of a premature infant with congenital brucellosis presumed to be acquired trans-placental transmission is reported because of the rarity of such cases. We should note that preventive procedures should be taken to protect pregnant women living in high-risk areas where brucellosis is endemic.

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