ISSN: 2630-5720 | E-ISSN: 2687-346X
HAYDARPAŞA NUMUNE MEDICAL JOURNAL - Haydarpasa Numune Med J: 62 (4)
Volume: 62  Issue: 4 - 2022
OTHER
1.Frontmatters

Pages I - X

RESEARCH ARTICLE
2.The Evaluation of Long-Term Outcomes of Outside-in Transobturator Tape Procedure in the Treatment of Stress Urinary Incontinence
Alim Gökhan Kuşgöz, Ertuğrul Can Tüfekçi, Fisun Vural, Ayşe Deniz Ertürk Coşkun
doi: 10.14744/hnhj.2021.26937  Pages 369 - 373
INTRODUCTION: The objective of the study was to investigate the objective-subjective success rates and complications of outside-in transobturator tape (TOT) surgery with urinary distress inventory (UDI)-6 questionnaire and subjective assessment after 5 years follow-up.
METHODS: We analyzed 60 women with stress urinary incontinence who underwent outside-in TOT procedure by the same surgeon and mesh, and were followed up after 5 years. All patients’ gynecological examination findings, stress test, Q-tip test, pad test, residual urinary volume, UDI-6 questionnaire, and duration of operation and complications were recorded. 3 years and 5 years after surgery, all patients were evaluated for anatomic-functional outcomes and subjective patient satisfaction.
RESULTS: The mean age of the population was 51.92±7.31 years, and 50% of the women were postmenopausal. Two patients (3.3%) had intraoperative bladder injury. Among long-term complications, one patient had (1.6%) de novo urge incontinence. There was no mesh erosion in the 5 years follow-up. When we compared the pre-operative and 5-years post-operative Q-tip test angles, a significant decrease was observed (63.92±14.17; 25.08±9.68) (p=0.001). UDI-6 question 3,4 survey scores were also significantly lower in the 5th year follow-up (p=0.001) At the end of 5 years, we observed an objective success in 82.9% of the patients. The patients also reported a subjective improvement of 82.9%.
DISCUSSION AND CONCLUSION: If proper surgical technique is used, outside-in TOT procedure is an efficient and safe method with high objective and subjective cure rates and low complication rates after a 5 year follow-up.

3.The Oxidative Stress Level in Children with Inguinal Hernia
Semih Lütfi Mirapoğlu, Aytekin Kaymakcı, Kübra Bozali, Eray Metin Güler
doi: 10.14744/hnhj.2022.72246  Pages 374 - 376
INTRODUCTION: Inguinal hernias (IH) are among the problems frequently encountered by surgeons, and they have the risk of developing significant complications. This study determines the levels of oxidative stress in pediatric patients with IH as a case–control study.
METHODS: Inguinal hernia patients who applied to the Bezmialem Vakif University and Health Sciences University Umraniye Health Application and Research Center Pediatric Surgery Outpatient Clinic and healthy control group were studied with the inert blood. Oxidative stress biomarkers total oxidant status (TOS), total antioxidant status (TAS), total thiol (TT), native thiol (NT), and myeloperoxidase (MPO) levels measured by photometric methods. Oxidative stress index (OSI) and disulfide (DIS) were calculated.
RESULTS: Oxidative damage biomarker levels increased statistically in the IH group, TOS, OSI, DIS, and MPO levels (p<0.001). TAS, TT, and NT levels were statistically significantly decreased in the IH group (p <0.001).
DISCUSSION AND CONCLUSION: As a result of our study, while oxidative stress is induced in an IH, antioxidant defense is decreased. Our results can guide the determination of the factors that cause IH and the development of current treatment.

4.Reducing Neointimal Hyperplasia in Experimental Carotid Balloon Damage Model with Oral Administration of Cilostazol
Hasan Murat Arslan, Perçin Karakol, Ali Vefa Özcan
doi: 10.14744/hnhj.2020.26122  Pages 377 - 382
INTRODUCTION: Percutaneous revascularization is one of the interventions through which results are obtained quite quickly among the current treatment of blockage artery diseases. In fact, the success achieved is lower than expected due to stenosis formation and spontaneous thrombosis. Vascular endothelial damage after endovascular interventions causes it to become a sticky surface for leukocytes and platelets, the distortion of the normally smooth surface through which the blood moves nonstop causes an increase in adhesion and procoagulant activities and permeability. While many cytokines, vasoactive molecules, and growth factors are released intermittently, if the inflammatory response is not suppressed in some way, the accumulation of extracellular matrix occurs with smooth muscle cell migration and proliferation in the vascular wall. This process, known as neointimal hyperplasia, has become a nightmare for many surgeons. As the known physiopathological mechanism of restenosis began to be understood, many pharmacological agents, mechanical agents were developed to prevent this process and tested with animal and human clinical trials. In our study, we aimed to show the inhibitive effect of cilostazol on neointimal hyperplasia by giving the experimental animal model an oral way.
METHODS: Intimal damage was created in the control and experiment group using the rat carotid artery balloon damage model. A group of animals was reserved as a Sham group. Preparations obtained from rat common carotid after oral cilostazol treatment for 2 weeks were evaluated histopathologically. Their statistical significance was observed.
RESULTS: In within-group analyses, while no difference was observed among themselves, in cross-group analyses, in terms of intimal thickening, a significant difference was found between Group 1 (Sham) and Group 2 (Control), Group 2 and Group 3 (Experiment), however, between Group 1 and Group 3, no statistically significant difference was detected. In light of these results, we reached the conclusion that cilostazol has an inhibitive effect on intimal hyperplasia when taken through the oral path. On the other hand, when comparing intimal and medial thickness rates, that the low artery intima/media ratio was found only in the experimental group, shows that the endothelial damage created in the intima was limited by cilostazol and decreased neointimal hyperplasia unrelated to the media layer.
DISCUSSION AND CONCLUSION: This drug whose systemic and topical effectiveness has been detected previously, would yield positive results not only in patients with peripheral artery disease, but also in peripheral artery patients with symptoms of claudicatio intermittence because of the fact that it shows the most effective and direct impact when administered orally, it is easy to use and its absorption is quite high.

5.Comparison of Prophylactic Methods to Prevent Clinical Infection After Trans-Rectal Prostate Needle Biopsy
Mehmet Akif Ramazanoglu, Tuncay Toprak, Mehmet Yılmaz
doi: 10.14744/hnhj.2021.48657  Pages 383 - 387
INTRODUCTION: Studies have shown that infectious complications after trans-rectal prostate biopsy (TRUS-Bx) are increasing and various prophylactic methods have been developed to reduce these complications. This study aimed to compare the effectiveness of oral antibiotic and rectal Povidone-iodine usage for infection prophylaxis before TRUS-Bx.
METHODS: Data of 280 patients who underwent prostate biopsy between July 2016 and October 2019 were reviewed retrospectively. Prophylaxis was achieved with 3 days of oral antibiotic therapy before biopsy in 147 patients and with 10% Povidone-iodine rectal application during biopsy in 133 patients. The groups were compared in terms of demographic data, PSA levels, prostate volumes, cancer detection rates, number of biopsy cores, and infectious complications such as urinary tract infection and fever within 1–2 weeks after TRUS-Bx.
RESULTS: The mean age of patients receiving antibiotic prophylaxis was 62.2±8.8, while the mean age of patients receiving prophylaxis with rectal Povidone-iodine was 63.2±9.1 years (p=0.38). There was no significant difference in terms of prostate specific antigen level, cancer detection rates and age in both groups. About 15.6% had diabetes in the antibiotic prophylaxis group and 16.5% had diabetes in the Povidone-iodine group. In the group receiving antibiotic prophylaxis, acute prostatitis was seen in 7 (4.8%) patients, 2 of whom were sepsis and in the group receiving rectal Povidone–iodine prophylaxis, acute prostatitis was seen in 4 (3%) patients, 1 of whom was sepsis. The groups were not statistically different in terms of infective complications (p=0.45).
DISCUSSION AND CONCLUSION: The groups were not statistically different in terms of infective complications after prostate biopsy. Therefore, prophylaxis which was achieved with rectal Povidone-iodine application may be more appropriate in terms of both antibiotic resistance and cost.

6.Validity and Reliability of the Turkish Version of the Glaucoma Quality of Life-15 Scale
Yücel Öztürk, Alev Özçelik Köse, Sevcan Balcı, Özgül Öztürk
doi: 10.14744/hnhj.2021.83702  Pages 388 - 394
INTRODUCTION: Our aim was to translate the Glaucoma Quality of Life-15 Scale (GLQ-15) into Turkish and assess the reliability and validity of the adapted scale.
METHODS: This was a cross-sectional study. One hundred and twenty-two with the primary open-angle glaucoma were evaluated using the Turkish version of the Glaucoma Quality of Life-15 and National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25). Internal consistency and test-retest reliability at a 2-week interval were evaluated. Floor and ceiling effects and factor analysis was performed to test the validity.
RESULTS: Cronbach’s alpha values were ranged from 0.65 to 0.95 which indicates that the internal consistency values are moderate to excellent and intraclass correlation coefficients were ranged from 0.85 to 0.95 between test and retest assessments. The Turkish version of the Glaucoma Quality of Life-15 is negatively and moderate to strongly correlated with the scale and the NEI-VFQ-25, as expected.
DISCUSSION AND CONCLUSION: The Turkish version of the GLQ-15 is a valid and reliable instrument to evaluate the level of quality of life in patients with glaucoma. Our results support the potential usefulness of this questionnaire in clinical practice.

7.Cancer Surgery Experience in a Tertiary Pandemic Hospital During the COVID-19 Pandemic
Mehmet Gülmez, Can Saraçoğlu, Selahattin Vural, İsmail Aydın, Tuğrul Kesicioğlu, Ali Aktekin
doi: 10.14744/hnhj.2021.73645  Pages 395 - 399
INTRODUCTION: One of the major challenges that the healthcare system was facing during the pandemic was how to manage patients requiring specific treatment, such as cancer surgery while managing the treatment of patients with COVID-19. Especially in pandemic hospitals, arrangements were made for the follow-up and treatment of other non COVID-19 patients in order to prevent transmission within the hospital. The aim of the study was to evaluate patients undergoing cancer surgery during the pandemic in the General Surgery Department of our hospital, which serves as a pandemic hospital.
METHODS: Cancer surgeries performed under emergency and elective conditions in the General Surgery Department of a tertiary pandemic hospital between March 11th, 2020, and July 31st, 2020, were retrospectively evaluated.
RESULTS: A total of 46 patients were included in the study. Two patients who underwent cancer surgery died of non-COVID-19 causes. No findings suggestive of COVID-19 were found in any patients in the preoperative or postoperative periods. During this period, no contamination was detected in the operating room team or in the healthcare personnel who followed the patients in the ward.
DISCUSSION AND CONCLUSION: In a hospital that has been declared as a pandemic hospital and the majority of its capacity has been reserved for the follow-up and treatment of patients with COVID-19, isolated areas can be created and special surgeries such as cancer surgery can be successfully performed in addition to emergency surgeries.

8.Surgical Treatment of Cerebral Hydatid Cysts
Ali Erhan Kayalar, Ersin Hacıyakupoğlu, Mustafa Efendioğlu, Derviş Mansuri Yılmaz
doi: 10.14744/hnhj.2021.18942  Pages 400 - 404
INTRODUCTION: Cerebral hydatid cysts are caused by the cranial intraparenchymal settlement and growth of tenia echinococcus embrio. CT reveals well-circumscribed, non-contrast enhanced, intraparenchymal homogenous cystic mass. Cyst fluid is isointense like cerebrospinal fluid (CSF). Operation is the most preferred therapeutic approach in cerebral hydatid cyst. We presented four cases that underwent operation at the past 5 years to attract attention to cerebral hydatid cyst which became evident in our country recently.
METHODS: We had four cases with cerebral hydatid cyst that underwent operation between 2015 and 2020.
RESULTS: We had three male one female patient. Their age was between 9 and 16 and mean age was 13. Three of them had solitary; one patient had multiple hydatid cyst. Common complaint of our cases was headache. The patients had seizure, diplopia, homonim hemianopia, and strabismus due to bilateral 6th nerve palsy.
DISCUSSION AND CONCLUSION: Cerebral hydatid cyst is most commonly seen in childhood (70%). All of our cases had headache and papillary stasis. In addition, our 2nd case had epilepsy, 3rd case had right homonim hemianopsia, and 4th case had diplopia. Recently, due to the situations in the middle east, lots of immigrants left their countries and live abroad, some of those were already contaminated. We can state that we have to refresh our knowledge about hydatid cysts and be aware that new cases may arise due to immigration patterns.

9.Risk of Hepatocellular Carcinoma Development in Chronic Hepatitis C Patients Who Achieved a Sustained Virological Response With Interferon-Based Treatments
Özgür Bahadır, Ayça Saltürk, Mevlüt Kıyak, Halil Şahin, Emine Kanatsız, Nurgül Ceran, Serpil Erol, Fatih Güzelbulut
doi: 10.14744/hnhj.2021.90532  Pages 405 - 410
INTRODUCTION: We aimed to evaluate hepatocellular carcinoma (HCC) risk in patients who achieved an sustained virological response (SVR) with interferon (IFN)-based treatments at long-term follow-up.
METHODS: In this retrospective study, we reviewed the data of patients with Chronic hepatitis C who received IFN-based treatments between January 2004 and July 2015 and had achieved SVR. Eighty-two patients who met the inclusion criteria were included in the study. Laboratory test results, liver biopsy results, and imaging findings at the start of treatment were recorded. Serum HCV RNA results at the start, the end and the 24th week after completion of treatment, and HCV genotype were also recorded. Follow-up was the time interval between the end of therapy and HCC diagnosis or the date of last available imaging in the absence of HCC. When any new lesion has appeared on USG, then patients underwent triphasic computed tomography or dynamic magnetic resonance imaging. HCC was diagnosis according to guidelines.
RESULTS: In our cohort, 10 (12%) patients had advanced fibrosis or cirrhosis. After 88 months of mean follow-up duration, 3 of 82 (3.7%) patients developed HCC. The mean time between the end of treatment and HCC development was 91 months. Two patients who developed HCC had cirrhosis, while 1 had F1 fibrosis at the start of treatment. However, the noncirrhotic patient had concomitant nonalcoholic liver disease and developed cirrhosis during follow-up, and had cirrhosis at the time of HCC diagnosis. One patient had genotype 1 and one had genotype 2 HCV, while genotype was not determined in 1 patient. Two of these patients had diabetes mellitus.
DISCUSSION AND CONCLUSION: HCC can be developed even in patients who achieved an SVR after years of IFN-based treatments. Particularly, patients with advanced fibrosis or cirrhosis must be under surveillance for HCC indefinitely. Patients with no-mild fibrosis should also be under surveillance for HCC if they had another risk factors for cirrhosis.

10.Monocyte High-Density Lipoprotein Cholesterol Ratio and Coronary Collateral Circulation Development in Patients with Stable Coronary Artery Disease and no History of Revascularization
Sinan Varol, Fahrettin Katkat, Serkan Karahan, Irfan Şahin, Ertuğrul Okuyan
doi: 10.14744/hnhj.2021.58224  Pages 411 - 416
INTRODUCTION: In patients with chronic total occlusion (CTO), various degrees of coronary collateral circulation (CCC) can be seen. No clinical study was conducted for the relationship between monocyte/high-density lipoprotein cholesterol ratio (MHR) and the development of CCC.
METHODS: Among 17,391 patients, the angiographic procedures were analyzed. Patients who had a history of acute coronary syndrome, myocardial infarction, percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG) procedure were excluded from the study. A total of 217 patients with CTO were retrospectively analyzed. The Cohen-Rentrop classification was used for retrograde CCC score.
RESULTS: Both patient groups were male dominant. The prevalence of hypertension and diabetes was similar. MHR values did not differ between poor CCC versus good CCC groups (13.90±6.34 vs. 14.33±7.57, respectively, p=0.948). About 15.5% of patients in the poor CCC group and 19.9% of patients in the good CCC group have multiple CTOs.
DISCUSSION AND CONCLUSION: MHR as a novel marker of inflammation and atherosclerotic index is not related to CCC development in patients with CTO and stable coronary artery disease.

11.Comparison of the Effects of Fentanyl and Dexmedetomidine Administered in Different Doses on Hemodynamic Responses During Intubation
Elvan Tekir Yılmaz, Nihal Kadıoğulları, Saadet Menteş
doi: 10.14744/hnhj.2020.60948  Pages 417 - 423
INTRODUCTION: The present study is intended to compare the effects of dexmedetomidine administered in two different doses and of fentanyl before induction to prevent hemodynamic response caused by laryngoscopy and endotracheal intubation in ASA I-II group patients.
METHODS: On obtaining the approval from the hospital ethics board and patient approvals, 60 general surgical patients between the age of 20 and 65 years who were in ASA I-II risk group were included in the study. In addition to routine monitoring, Bispectral index (BIS) monitoring was performed. Group F was injected 2 µg/kg fentanyl, Group D1 was injected 0.5 µg/kg dexmedetomidine, and Group D2 1 µg /kg dexmedetomidine as iv bolus for 1 min. After the injection, SBP, DBP, HR, and BIS values were recorded at definite intervals of 1, 3, 5, and 10 min after intubation.
RESULTS: We have found that administration of 0.5 and 1 µg/kg IV dexmedetomidine and 2 µg/kg fentanyl before anesthesia administration suppressed the increase in heart rate and blood pressure in response to laryngoscopy and intubation. There was no significant predominance of high and low doses of dexmedetomidine over each other and fentanyl. In addition, there was no significant difference between thiopental consumption, while sedation scores and BIS values were significantly different.
DISCUSSION AND CONCLUSION: Dexmedetomidine is as effective as fentanyl in suppressing hemodynamic responses to laryngoscopy and intubation and can be used as an alternative to fentanyl.

12.The Screening Effectivity of Fecal Occult Blood Test
Ümit Sekmen, Ozan Şen, Hamit Karayağız, Tolga Katmer, Resül Altınayak, Didem Altay Gazi, Merve Mehveş Çelebi, Melih Paksoy
doi: 10.14744/hnhj.2021.14880  Pages 424 - 427
INTRODUCTION: Fecal occult blood (FOB) test is accepted as an effective screening tool for decreasing colorectal cancer mortality especially after age 50. We aimed to understand its effectiveness among younger age groups, by analyzing the results of control colonoscopy of the patients with FOB test positivity detected during check-up.
METHODS: Six thousand six hundred and sixty-five individuals administered to check-up center in Acibadem Fulya Hospital between 2010 and 2020. We retrospectively analyzed the results of those who accepted the FOB test (1432 individuals). We advised colonoscopic examination for patients with FOB test positivity (344 individuals). T understand the predictive role of FOB test, we compared the results according to age, gender, body mass index, and hemoglobin level.
RESULTS: Three hundred and forty-four FOB tests were positive out of all 1432 tests. Out of these, only 126 asymptomatic patients accepted the control colonoscopy. There were 21 adenomatous polyps detected in colonoscopic examinations. Statistically higher number of polyps was found after age 50, but two of the patients had adenomatous polyps at age of 45.
DISCUSSION AND CONCLUSION: FOB test is a crucial screening test after age of 45. In case of positive result, colonoscopy should be advised.

13.The Predictive Role of Second and Third Fluid Cytology in the Diagnosis of Malign Plevral Fluids in Patients with Negative First Fluid Cytology
Şeyma Özden, Işıl Gökdemir, Ayşin Durmaz, Murat Kıyık, Yasin Özden
doi: 10.14744/hnhj.2021.50465  Pages 428 - 433
INTRODUCTION: In this study, we wanted to investigate the role of pleural fluid cytology, which is examined for the second and third times in malignant pleural fluid cases that cannot be diagnosed by first pleural fluid cytology.
METHODS: A total of 116 patients were evaluated in this retrospective study. 2nd samplings of pleural effusions were evaluated via thoracentesis in 105 patients (90.51%)with negative cytology results on the first thoracentesis attempt, and 3rd samplings were evaluated for 34 patients (29.31%). Pleural biopsy using a cope needle was performed on patients who could not be diagnosed upon pleural fluid cytology. If pleural biopsy did not yield any diagnosis, VATS (video assisted thoracoscopy) was performed, and pleural decortication was performed in some patients who could not be diagnosed with VATS. Pleural fluid cytology results suspected to be malignant were considered to be negative and the same procedure was performed as above.
RESULTS: 7 out of the 116 cases (6.03%) were found to be cytologically positive on the first thoracentesis. Out of the cases found to be negative on first attempt, 29 (26.6%) were diagnosed positive upon second attempt. 34 cases which were not diagnosed at first and second attempt underwent a third thoracentesis attempt and were evaluated cytologically. Out of the 34 cases, 11 (32%) were diagnosed in the 3rd attempt. A total of 47 cases (40.5%) were diagnosed with pleural fluid cytology. In the presence of primary lung cancer, the rate of diagnosis by 2nd fluid cytology was statistically significant compared to other types of malignancy (p<0.05).
DISCUSSION AND CONCLUSION: In cases with negative pleural fluid cytology at the first examination, examination of fluid cytology for the second and third times should be considered with a high contribution to the diagnosis, especially in patients who are unable to apply more invasive diagnostic methods.

14.The Effect of 25-OH Vitamin D on Biochemical and IL-12 Parameters in Patients with Metabolic Syndrome
Ali Ihsan Oluk, Sülayman Baş, Pınar Eker, Berna Yücel Aybal, Gülbu Işıtmangil, Funda Türkmen
doi: 10.14744/hnhj.2021.10846  Pages 434 - 439
INTRODUCTION: The present study investigates the effect of 25-OH vitamin D replacement on blood pressure, as well as biochemical and IL-12 parameters in patients with metabolic syndrome (MetS), and whether a threshold for vitamin D exists in such effect.
METHODS: This prospective study included 44 metabolic syndrome patients who presented to the Internal Medicine Clinic of Haydarpaşa Numune Training and Research Hospital. The patients had a mean age of 44.68±11.49 years; 65.9% (n=29) were female and 34.1% (n=15) were male. Biochemical tests were made for 25-OH vitamin D, glucose, HbA1c, triglycerides, HDL-K, LDL-K, BUN, creatinine, uric acid, calcium, albumin, leukocytes, neutrophils, lymphocytes, hemoglobin, C-reactive protein, and spot urine albumin/creatinine ratio, and blood pressure measurements were made before and after vitamin D replacement. In addition, IL-12 levels were measured twice using the ELISA method. A statistical analysis of the data was made using IBM the SPSS Statistics 22 (IBM SPSS, Türkiye) software package.
RESULTS: A statistically significant decrease was noted in systolic and diastolic blood pressure and IL-12 levels after vitamin D re-placement when compared to the pre-replacement levels (p<0.001, p=0.008, p<0.001). When the patients were divided into two groups based on 25-OH vitamin D levels (Group-1, 25-OH vitamin D ≥32 ng/mL; Group-2, 25-OH vitamin D <32 ng/mL) after vitamin D replacement, the mean IL-12 level was found to be significantly lower in the Group-1 patients than in the Group-2 patients (p<0.033). In addition, a positive correlation was identified between vitamin D replacement and serum levels of magnesium.
DISCUSSION AND CONCLUSION: These findings suggested that vitamin D replacement had blood pressure-lowering and anti-inflammatory effects in MetS patients. The threshold for the anti-inflammatory effect was found to be ≥32 ng/mL.

15.Synchronous Endometrial and Ovarian Carcinomas; Correlation of Clinicopathological Parameters with Recurrence and Survival
Nermin Koç, Sevcan Arzu Arınkan, Davut Şahin, Osman Temizkan
doi: 10.14744/hnhj.2021.76476  Pages 440 - 446
INTRODUCTION: We aimed to determine the possible clinicopathological factors that might affect recurrence and survival in synchronous malignancy of the endometrium and ovary without discriminating the presence of two independent primary tumors or metastasis.
METHODS: Patients who were admitted with the diagnosis of synchronous endometrial and ovarian cancer between 2000 and 2015 were reviewed retrospectively.
RESULTS: Recurrence occurred in 12 (48%) patients. The mean duration of recurrence was 23.7 months. There is a significant relationship between presence of lenfovascular invasion), involvement of lymph node, spread to non-ovarian, and non-endometrial pelvic organs or beyond and the increase recurrence risk in the synchronous endometrial and ovarian cancer. The conditions involving the increased diameter of tumor in the endometrium and bilateral ovarian involvement are related with decreased survival. Besides, presence of endometrioid type ovarian tumor and absence of endometrial myometrial invasion are related with increased survival.
DISCUSSION AND CONCLUSION: Variables such as endometrial tumor diameter, myometrial invasion, endo/non endo type of ovarian tumor and presence of bilateral tumor were found to be effective on survival, variables such as lymphovascular invasion, lymph node involvement, and pelvic spread were effective on recurrence.

16.Dosimetric Phantom Consistency of TMR-10 Protocol in Homogeneous and Inhomogeneous Regions in Gamma Knife Radiosurgery Planning
Mehmet Tönge, Ömer Yazıcı, Veyselkarani İpek, Hilal Acar Demir
doi: 10.14744/hnhj.2022.04372  Pages 447 - 453
INTRODUCTION: The algorithms used in the GammaPlan treatment planning system are “Tissue Maximum Ratio (TMR) classical,” “TMR 10,” and “convolution” algorithms, respectively. In this study, the consistency of dosimetric measurements with the TMR 10 protocol used in SRC (stereotactic radiosurgery) planning in lesions located in homogeneous and inhomogeneous regions in different intracranial location scenarios was investigated.
METHODS: n this study, the accuracy of administration of multiple metastasis treatment on the Gamma Knife Perfexion device was investigated. Computed tomography was performed with 1 mm cross-section intervals of CIRS brand Atom randofantoma. Critical organs and three different brain metastases located in homogeneous and heterogeneous regions, which are not on the same plane with each other, were drawn on the phantom. Planned target volume (PTV) volumes were created without margining the drawn gross tumor volumes, and three separate plans were made for three different PTV volumes. All plans were calculated using the TMR 10 algorithm. Critical organ doses were kept below the brain-SRC criteria for all calculated plans. Gafchromic EBT-3 film was placed on the sections with the target volume drawn on the phantoms and irradiated (1600 cGy, 50% isodose area). Measurements were made three times. The measured film results and the doses calculated from the planning were compared with gamma index analysis for different tolerance values.
RESULTS: In our study, for three different lesions planned and irradiated with different gradient index values, a difference of 2.11–9.58% was observed between the values calculated with the TMR-10 protocol and the values obtained in the dosimetric measurement. A decrease in consistency was observed, especially in inhomogeneous region placements.
DISCUSSION AND CONCLUSION: There may be inconsistency between the TMR-10 protocol and actual dosimetric measurements, especially around inhomogeneous intracranial structures. We hope that this inconsistency will decrease in the future with the developing dose calculation protocols.

CASE REPORT
17.Markedly Elevated hCG Levels in a Patient with Partial Hydatidiform Mole: An Extremely Rare Presentation
Esra Keleş, Serkan Akış, Burak Giray, Canan Kabaca, Murat Api, Handan Çetiner, Uğur Kemal Öztürk, Eser Şefik Özyürek
doi: 10.14744/hnhj.2021.23865  Pages 454 - 457
In a partial molar pregnancy, the level of β-Human chorionic gonadotropin (β-HCG) is often within a large spectrum. An extremely high level of β-HCG levels (>1.000.000) is only 2-3% of partial moles. Partial molar pregnancy commonly presented with mildly elevated HCG (<100,000), vaginal bleeding, abortion and rarely complicated with medical complications and theca lutein cysts. We present a case with extremely high HCG levels (1.861.011 IU / L) in the early second trimester and complicated by maternal anemia, hyperthyroidism, proteinuric hypertension, hirsutism, and enlarged bilateral theca lutein cysts. During follow-up, the patient's HCG level returned to normal after 27 weeks. Clinicians should keep in mind that partial mole hydatidiform may be presented with very high HCG levels. They should be aware of the medical conditions that may complicate this disease and adopt a multidisciplinary approach.

18.A Case of Psoriatic Arthritis with Elbow Involvement Misdiagnosed as Osteomyelitis
Özge Gülsüm Illeez, Feyza Ünlü Özkan, Kübra Neslihan Kurt Oktay, Fatma Nur Soylu Boy, Pınar Akpınar, Ilknur Aktaş
doi: 10.14744/hnhj.2021.26576  Pages 458 - 461
Psoriatic arthritis is a chronic systemic inflammatory disease characterized by joint inflammation associated with psoriasis and may present with a variety of clinical manifestations related to bone structures and soft tissues around the joints. Psoriatic arthritis may show radiological findings similar to osteomyelitis (OM). A 69-year-old patient who had been diagnosed with psoriatic arthritis for 5 years was referred to our clinic with a preliminary diagnosis of OM due to severe pain in the right elbow. The patient had polyarthralgia and extensive skin involvement. Disease activation was considered as a result of detailed investigations. Both the joint and skin involvement of the patient was controlled with biological agent treatment. Differential diagnosis should be done carefully in patients with arthralgia and/or arthritis. Advanced radiological imaging should be performed.

19.Laparoscopic Partial Nephrectomy Revealed a Collision Tumor Composed of Renal Papillary Cell Cancer and Oncocytoma: A Case Report
Yavuz Baştuğ, Emrah Özsoy, Emre Pehlevan, Gülistan Gümrükçü, Serdar Aykan
doi: 10.14744/hnhj.2021.69782  Pages 462 - 465
Diagnosing symptomatic or incidental renal masses increased with the advances in technology. Renal cell carcinoma (RCC) is the most common type of kidney cancer. Papillary RCC is the second most subtype of RCC. Renal oncocytoma is a benign epithelial tumor of kidney and is the second most common benign tumor after angiomyolipoma. Hybrid tumors of oncocytoma and chromophobe RCC are known in the literature. However, primary renal collision tumors are rare neoplasms those composed of two different cell lineages. We present a rare entity as a case report which is oncocytoma with renal papillary cell cancer Type 1.

20.A Case of Necrotizan Fasiitis After Pnomokok Septic Arthritis
Bekir Karagöz, Levent Adıyeke, Murat Bakır
doi: 10.14744/hnhj.2020.56823  Pages 466 - 469
Septic arthritis is the inflammation of the synovial membrane and synovial fluid in the joints with bacterial, viral, or fungal agents. It is most commonly spread by hematogenous way. In cases that are not treated, it can cause permanent and serious disabilities. The most common factor in all age groups was “Staphylococcus aureus”. We report a case of necrotizing fasciitis after septic arthritis due to Streptococcus pneumoniae, resulting in hip disarticulation.

21.COVID-19 in Kidney Transplant Recipients, Single Center Study From Turkey
Başak Boynueğri, Bülent Demirelli, Burcu Boztepe, Seniha Şenbayrak, Melike Betül Öğütmen
doi: 10.14744/hnhj.2021.73626  Pages 470 - 475
In December 2019, an outbreak of COVID-19, caused by a novel SARS-CoV-2, occurred in Wuhan. Currently, COVID-19 has spread widely around the World. Although immunosuppression is associated with a severe course of covid infection, information on the first presentation, clinical findings and outcomes of COVID-19 disease in patients with kidney transplantation is limited. This study included kidney transplant recipients who were radiological and/or serological diagnosed COVID-19 in University of Health Sciences, Haydarpasa Numune Education and Research Hospital. Data from 5 patients were reviewed retrospectively. Four patients were female and the median age was 46. Four recipients had hypertension, 1 had diabetes mellitus. All the patients were taking tacrolimus except one at the time of COVID-19 diagnosis, and all of them were also taking either mycophenolate mofetil or mycophenolic acid. One patient was taking mTOR inhibitor.The most common presenting symptom was cough. All of the patients had multifocal bilateral ground-glass opacity which was compatible with viral infection with Thorax CT scans. Three patients were lymphopenic. The primary change in immunosuppression in the majority of patients was complete cessation of either mycophenolate mofetil or mycophenolic acid while reducing the tacrolimus. The mTor inhibitor dose of the patient receiving antimetabolite with mTor inhibitor was maintained. All of the patients received hydroxychloroquine (HCQ), azithromycin and ceftriaxone as treatment. Two patients recieved oseltamivir treatment. One patient was treated with azithromycin, hydroxychloroquine, ceftriaxone, favipiravir and vitamin C combination. During the follow-up, none of them had acute kidney injury and needed for intensive care. In our study, among 5 kidney transplant recipients with COVID-19, overall presentation was similar to that reported from other countries. All of our patients experienced a favorable outcome with our current treatment strategy but the small group cohort makes it difficult to say any conclusions about safety and tolerability of our protocol.

22.Highly Differentiated Follicular Carcinoma Arising from Struma Ovarii (Strumosis) Presenting as Pseudo-Meigs Syndrome with Elevated CA125 Level: A Case Report
Olcay Kurtulan, Anıl Ertürk, Nejat Özgül, Alp Usubütün
doi: 10.14744/hnhj.2021.00236  Pages 476 - 479
A 75-year-old woman presented with the left ovarian mass, ascites, unilateral pleural effusion, and elevated CA125 levels. Clinical and radiological findings were highly suspicious for a malignancy. The patient underwent surgical excision of the uterus and infracolic omentum, and an intraoperative consultation was performed. Ovarian mass was diagnosed as “struma ovarii” and no other surgical procedure was performed. Histopatologic examination showed struma ovarii on the left ovary and bland-looking thyroid tissue implants on omentum and hernia sac. The patient diagnosed as “highly differentiated follicular carcinoma arising from struma ovarii” (HDFCO). No additional therapy was recommended to the patient and after a 53 months of follow-up, no recurrence was identified. HDFCO previously named strumosis is characterized by the presence of thyroid tissue in the peritoneal cavity with a bland morphology. Pseudo-Meigs syndrome with elevated serum CA125 levels in a 75-year-old lady is highly suspicious for malignancy, but HDFCO is an entity with a benign clinical course that shows the importance of intraoperative consultation. We describe the first case of HDFCO (strumosis) presenting as Pseudo-Meigs syndrome with elevated serum CA125 levels.

OTHER
23.Erratum: Author’s name correction
Toluy Özgümüş, Müjdat Kahraman, Tolga Gümüşkemer, Mustafa M. Güldü, Ozan Durmaz, Alper Bayrak, Pınar Ata Eren, Funda Türkmen
doi: 10.14744/hnhj.2022.74317  Page 480
Abstract | Full Text PDF

24.Reviewers Index

Page 481
Abstract | Full Text PDF

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