ISSN: 2630-5720 | E-ISSN: 2687-346X
Cilt: 63  Sayı: 1 - 2023

Sayfalar I - X

OX40 Gene Expression Level on Pathology Sections Obtained from Pituitary Adenomas Tissues
Buruç Erkan, Ozan Barut, Barış Çolluoğlu, Mustafa Kılıç, Utku Adılay, Metehan Eseoğlu, Doğan Güçlühan Güçlü, Ozan Haşimoğlu, Osman Tanrıverdi, Ömür Günaldı
doi: 10.14744/hnhj.2022.99076  Sayfalar 1 - 7
INTRODUCTION: In this study, it was aimed to determine OX40 gene expression level on pathology sections obtained from PA tissues, and the level of circulating OX40L in peripheral blood samples of patients. Furthermore, it was aimed to evaluate the findings depending on the type, histopathological, and immunohistochemical features of the tumor.
METHODS: The study was conducted with two groups (Study/Control). The study group (Group 1) consisted of patients (n=49) operated with the diagnosis of PA. The control group (Group 2) is the brain tissue samples obtained from patients (n=10) who underwent temporal lobectomy for the and treatment of epilepsy due to mesial temporal sclerosis.
RESULTS: We found out that the tissue OX-40 gene expression levels of patients with PA did not differ from the gene expression levels of the control group. There was no statistically significant difference was found as a result of the comparison of pituitary ox40-tissue parameter measurement value with patient finding characteristics.
DISCUSSION AND CONCLUSION: PAs have altered cell behavior and epigenetic modifications that lead to various prognostic patterns and responses to treatment. As the disease progresses, up-and down-regulation of immune factors promotes the interaction between the immune system and tumor cells. Thus, it serves as a potential target for new diagnostic and therapeutic strategies.

Comparison of Various Measures for Anticipating Difficult Laryngoscopy in Turkish Population: An Observational Study
Derya Özden Omaygenç, Oylum Selçuk
doi: 10.14744/hnhj.2021.04379  Sayfalar 8 - 15
INTRODUCTION: Difficult laryngoscopy (DL) was established as the most accurate determinant of difficult intubation. Here, we sought to assess the diagnostic value of various bedside tests for predicting DL. We also aimed to create a regression model in this context.
METHODS: 137 patients were included in the study. Demographic features and eight diagnostic variables were evaluated for DL predictivity. These were retrognathia, presence of buck teeth, modified Mallampati test (MMT), upper lip bite test (ULBT), sternomental distance, interincisor distance (IID), thyromental distance, and neck circumference. DL was identified by Grade III-IV view during laryngoscopy according to the Cormack-Lehane classification.
RESULTS: The frequency of DL was 27% (n=37) in our sample population. Among predictive tests, IID was lower in patients with DL, while mean MMT score, frequency of retrognathia, and that of Grade 3 in ULBT were significantly higher. According to the results of logistic regression analyses IID (Odds Ratio [OR]: 0.504, Confidence intervals [CI] 95% [0.260–0.978], p=0.043), MMT score (OR: 2.001, CI 95% [1.159–3.454], p=0.013), and presence of retrognathia (OR: 0.108, CI 95% [0.019–0.613], p=0.012) were determined as independent predictors of DL. Our predictive model (two out of three factors: IID ≤4 cm, MMT score≥3, and retrognathia) anticipated DL with a sensitivity of 35.1%, a specificity of 91%, a negative predictive value of 79.1%, and an accuracy of 75.9%.
DISCUSSION AND CONCLUSION: None of the bedside tests or their dual combinations had considerable success for predicting DL in our study. Considering this fact and variation of the predictive performance of bedside tests for DL among different ethnicities, we composed a distinctive regression model. This model anticipated DL with reasonable specificity and accuracy rates.

Is There any Effect of Online Platform Overuse on Headaches During the Pandemic?
Buse Rahime Hasırcı Bayır, Berfin Parmak, Büşra Aslan, Ömer Karbuş, Melik Şah Çelik, Şehmus Caner Uymak
doi: 10.14744/hnhj.2021.24650  Sayfalar 16 - 20
INTRODUCTION: Social constraints experienced during the pandemic have increased the use of online systems in both education and business life. Our aim is to evaluate the effect of overuse of online platforms on headache.
METHODS: This study was conducted with 1627 participants with online data collection form which includes sociodemographic data and 25 questions related to the use of online platforms during the pandemic.
RESULTS: One thousand four hundred and ninety-five participants with a mean age of 20.76±2.21 years were university students or graduates. While the average daily screen time exposure was 2–4 h (743/1627), this time has increased to 8 h and above (966/1627) in the pandemic. While 68.6% of the participants reported an increase in headaches during the pandemic, 62.4% of the participants believed in parallel that this was related to the increase in the use of online systems. When comparing the pre- and post-pandemic periods, the headache duration (p<0.001), frequency (p<0.001), severity (p<0.001), and use of analgesics (p<0.001) increased significantly in both genders.
DISCUSSION AND CONCLUSION: In addition to COVID-19, the unfavorable role of changes in social life should also be considered in the increase of headache. Questioning the active use of online platforms during the pandemic in people with headache complaints may guide the regulation of treatment.

Comparison of the Results of Plication and Resection Techniques in Horizontal Strabismus Surgery
Gizem Yel, Zeynep Acar, Ece Turan Vural, Uğur Yılmaz Mumcu, Rüveyde Bolaç Unculu, Ahmet Nohutçu
doi: 10.14744/hnhj.2021.54926  Sayfalar 21 - 26
INTRODUCTION: The aim of this study is to compare the results of plication and resection techniques in patients who underwent horizontal strabismus surgery.
METHODS: The records of patients who were operated due to horizontal strabismus in the Department of Ophthalmology of Health Sciences University Haydarpaşa Numune Training and Research Hospital between 2011 and 2017, were reviewed retrospectively. Those who underwent resection and those who underwent plication were divided into two groups. The amount of deviation at postoperative 1st day, 1st month and at the last control visit, were compared. Postoperative ≤ 8 PD deviation was considered successful.
RESULTS: Twenty-two patients underwent horizontal rectus plication combined with antagonist muscle recession surgery. Eight of the patients were operated for esotropia and 14 for exotropia, and their mean age was 14.59±10.27 years. Twenty-four patients underwent horizontal rectus resection combined with antagonist muscle recession surgery. Nine of the patients were operated for esotropia and 15 for exotropia, and their mean age was 19.67±13.38 years. The mean amount of preoperative deviation was 30.79±7.29 PD in the plication group, and 39.89 ±10.72 PD in the resection group. Mean follow-up time was 12.82±7.47 months in the plication group and 9.75±8.63 months in the resection group. There was no statistically significant difference between the success rates of the two groups according to their final control follow-up (p>0.05).
DISCUSSION AND CONCLUSION: Plication surgery, which is a fast, easy-to-apply and safe muscle strengthening technique, is as effective as resection surgery in the treatment of horizontal strabismus.

Diffusion-Weighted MR Imaging of Normal Pancreas in Children and Adults; Relation of Apparent Diffusion Coefficient Values with Age and Gender
Osman Dere, Abdurrahim Dusak, Halil Kazanasmaz
doi: 10.14744/hnhj.2021.34366  Sayfalar 27 - 32
INTRODUCTION: The objective of this study was to evaluate the healthy pancreas with diffusion-weighted imaging (DWI) in children and adults and demonstrate the changes of apparent diffusion coefficient (ADC) values related to age and gender.
METHODS: Eighty-five patients, who did not have pancreas disease, were included in the study. The patients were divided into four groups according to their ages (0–20 years; 21–40 years; 41–60 years; ≥61 years). Diffusion-weighted images were obtained in the axial plane, with three different b-values (b=0; b=50 and b=400 s/mm2) and ADC maps were calculated automatically. On the ADC maps, three separate ADC values were calculated for each region (head, body, and tail) with the free-hand technique using the “region of interest”. Then, the mean values were calculated. The mean ADC values of the pancreatic head, body, and tail were used for the calculation of the total ADC value. The effect of age and gender on ADC values was determined by one-way ANOVA analysis and independent sample t-test, respectively.
RESULTS: The mean pancreatic total ADC value was higher in 0–20 years and ≥61 age groups compared to other age groups. In addition, the ADC values of the pancreatic head in the 0–20 age group were found to be statistically significantly higher compared to those of 21–40 and 41–60 age groups. There was no correlation between mean pancreatic total, head, corpus, and tail ADC values and gender.
DISCUSSION AND CONCLUSION: The results of this study demonstrate that age has an effect on pancreatic ADC values, nevertheless gender has no effect on ADC values. The mean ADC values by age and gender may be useful in diagnosing diseases and can be used as a reference for the future studies.

Activity Preferences of School-Age Children with Cerebral Palsy: Comparison with Healthy Peers
Gönül Koyuncu, Mine Uyanık
doi: 10.14744/hnhj.2020.55822  Sayfalar 33 - 39
INTRODUCTION: The aim of the study was to evaluate physically disabled children of 6–10 years of age with cerebral palsy (CP) with regard to functional independence levels and preferences of activity; and to compare these characteristics with those of their healthy peers, and also to highlight the relationship of the mothers’ depression level with the preferences of activity.
METHODS: Eighty children with CP and 80 healthy ones were enrolled to the study together with their mothers. The main research group (Group A) consists of equal numbers of boys and girls in 6–8 and 9–10 years of age, a total of 80 children with CP, while Group C (control) is composed of equal numbers of age-and sex-matched healthy children. Sociodemographic data and Preferences for Activities of Children measures were collected from all children, whereas Pediatric Functional Independence Measurement were applied to children with CP, and their mothers were evaluated through Beck Depression Inventory.
RESULTS: Among the children with CP, 47 were diplegic, 12 triplegic, 15 quadriplegic, one had total, and five had mixed type CP. Healthy children had higher levels of functional independence, and higher frequency of participation in the activities. Both groups of children mostly preferred to participate individual developmental activities and least in social-based activities. Mothers of children with CP had higher depression scores when compared to those of healthy children and depression scores of the mothers are inversely proportional to the total preference of participation in the activities in children with CP (p<0.05).
DISCUSSION AND CONCLUSION: Functional independence level and depression status of mothers of children with CP had a significant repressive effect on preferences of participation in activities.

Evaluation of the Results of the Use of two Different Anticoagulants in COVID-19 Patients who Were Followed-Up and Treated in the Intensive Care Unit
Seyfi Kartal, Esra Kongur, Abdullah Özdemir, Çağatay Erman Öztürk, Mustafa Arslan
doi: 10.14744/hnhj.2021.60024  Sayfalar 40 - 45
INTRODUCTION: The risk of thromboembolism increases due to tendency to coagulopathy, excessive inflammation, hypoxia, and immobility in patients who are treated of COVID-19 in Intensive Care Units (ICU). Therefore, thromboembolism prophylaxis (anticoagulant therapy) is recommended. There is no clear recommendation in the literature regarding the dose and duration of anticoagulant therapy. In this study, we evaluate of two different anticoagulant administrations in terms of prognosis and mortality in COVID-19 patients who were followed up and treated in the ICU.
METHODS: After the approval of the Ethics Committee, the study was carried out by retrospectively in ICU affiliated to three different centers. The patients were divided into two groups as those using anticoagulant at a prophylactic dose (Group 1) and treatment dose (Group 2). Various parameters of the patients were evaluated.
RESULTS: Of the 91 patients included in the study, 61.5% received prophylactic and 38.5% therapeutic anticoagulants. The rate of male patients 73.9% was found to be significantly higher in the mortal group (p=0.014). About 75.9% of the patients who received mechanical ventilation treatment and 13.59% of the patients who were not applied died (p<0.001). Mortality was higher in the group using prophylactic anticoagulants (58.39% vs. 37.1% p;0.043). Patients using prophylactic doses of anticoagulants had 2.42 times more mortality (Odds Ratio=2.42). Hb levels were found to be lower (p=0.017) and pro-thrombin time and partial prothrombine time values were long (p=0.048 and 0.038, respectively) in patients who received anticoagulants at the treatment dose.
DISCUSSION AND CONCLUSION: Despite the increased tendency for thrombosis in COVID-19, there is no clear preventive or protective treatment. Hence, if there is no contraindicated situation, we believe that anticoagulants can be used safely at the treatment dose to avoid possible thromboembolic complications and reduce the risk of mortality. There is a need for largescale studies on dose selection in terms of prophylaxis.

Evaluation of the Effectiveness of Electromyographic Biofeedback Training in Patients with Patellofemoral Pain Syndrome
Merve Çalkın Korkmaz, Mehmet Ağırman, Sena Tolu, Arzu Dinç, Ahmet Salim Göktepe
doi: 10.14744/hnhj.2021.90912  Sayfalar 46 - 52
INTRODUCTION: This study aimed to evaluate the effects of adding electromyographic (EMG) biofeedback to an exercise program on pain, function, and electrical activity in the isometric contraction of the vastus medialis obliquus (VMO) and vastus lateralis (VL) muscles in patients with patellofemoral pain syndrome (PFPS).
METHODS: The study included 30 patients with PFPS. The biofeedback group received physiotherapy and an EMG biofeedback-guided exercise program, and the control group received only physiotherapy with a home exercise program. The Visual Analog Scale (VAS) and PFPS Severity Scale (PSS) were used to evaluate pain severity. The Kujala Patellofemoral Scale (KPS) and the Functional Index Questionnaire (FIQ) were used to evaluate the effect of knee pain on daily living activities and lower extremity function.
RESULTS: Compared to baseline, the VAS-current and severe pain, PSS, KPS, and FIQ scores and the mean and maximum isometric contraction values of the VMO and VL muscles were significantly improved in both groups. However, the maximum VMO and VL isometric contraction differential values were significantly increased only in the biofeedback group.
DISCUSSION AND CONCLUSION: Our findings suggest that the EMG biofeedback adjunct to a physiotherapy program for PFPS produces additional benefits for pain relief, improvement of daily life activities, and increasing muscle strength.

Evaluation of Magnetic Resonance Venography Techniques on the Detection of Dural Sinus Variations, Flow Gaps, and Thrombosis
Ayşe Özlem Balık, Turgay Öner
doi: 10.14744/hnhj.2022.15483  Sayfalar 53 - 57
INTRODUCTION: The aim of the study was to examine the role of the contrast-enhanced gadolinium-enhanced three-dimensional magnetic resonance venography (GE 3D MRV) technique in the detection of dural sinus pathologies by comparing the two-dimensional (2D TOF MRV).
METHODS: One hundred and eighty patients who underwent MRV due to dural sinus pathology in the radiology department of Haydarpaşa Numune Training and Research Hospital between January 2019 and July 2019 were included in the study. Images of 21 patients in the study group who had both 2D TOF MRV or GE 3D MRV were evaluated retrospectively.
RESULTS: About 33.3% of cases were male and 66.7% (n=14) were female. The mean age of the patients was 29.7±4.64 years (18–64 years). In 2D TOF MRV series, complete signal loss was observed in the unilateral transverse sinus (TS) of four patients (2.2%/180–1.6%) and in the sinus rectus of 1 patient (1/180–0.55%). Of these, 2 (1.1%) located in the TS and GE (2.1%) located in the sinus rectus were confirmed in the 3D MRV. Two patients’ imaging showed a jugular vein and ipsilateral sigmoid sinus flow defect on 2D TOF MRV, but no findings on GE 3D MRV. There were four arachnoid granulations observed in the transverse sinuses in 4% of cases on two-dimensional venography, all of them confirmed on contrast-enhanced examinations. Six of the flow gaps observed in the transverse sinuses of 12 patients in 2D TOF MRV, disappeared completely in GE 3D MRV. When the diameters of the transverse sinuses were determined using the two techniques, the ratio of inconsistencies in Grade 0 and Grade 3 was higher than the others.
DISCUSSION AND CONCLUSION: GE 3D MRV, a contrast imaging method, can be used effectively when there is a diagnostic challenge to exclude sinus thrombosis on 2D TOF imaging.

Demographic Properties of Patients who Underwent Lateral Lymph Node Neck Dissection Because of Thyroid Cancers
Ali Aktekin, Günay Gürleyik, Umut Kına, Zuhal Özcan, Meryem Doğan
doi: 10.14744/hnhj.2021.44452  Sayfalar 58 - 61
INTRODUCTION: Lymph node dissections due to thyroid cancers from neck are difficult and many anatomic structures are in danger to be injured. We present our some lateral lymph node neck dissection experiences in thyroid cancers.
METHODS: Demographic, clinical, and pathologic data of the patients who underwent lateral lymph node dissection between January 1, 2017, and December 31, 2019. Routine dissections of IIA, III, IV, and VB were performed. In addition, we added IIB and VA in cases when metastasis confirmed in papillary thyroid cancers (PTC). We completely dissected compartment II to V in the cases of medullary thyroid cancers. Post-operative concerned hemorrhage, nerve injury, chyle leakage, and whether received RIA treatment, the presence of loco-regional relapse and mortality was documented.
RESULTS: We performed neck dissection in 14 women and 14 men, with an average age of 45.7 (20–78). Histopathological examination revealed that 25 patients had papillary, two medullary thyroid, and one patient had mixed medullary and PTCs. Bilateral neck dissection was performed in five patients. Tumor stages were T1 in 13, T2 in two, T3 in 12, and T4 in one patient. An average of 26.8 (8–72) lymph nodes was dissected from the lateral compartments and metastatic ones were 4.6 (0–20). We had three thoracic duct leakages and three local edemas. All three leakages were dissolved end resolved spontaneously with long lasting drains without negative pressure aspiration and employing slight compression locally. Only 22 patients could receive RIA. The recurrence in the thyroid location and/or lateral lymph node compartment was seen in five patients. Mortality was seen in two patients due to other reasons.
DISCUSSION AND CONCLUSION: Management of patients with papillary thyroid carcinoma should involve a balance in the risk from treatment and disease so decisions to perform neck dissection should be made individually. An oncological complete surgical resection is to remove all gross metastatic disease and preserving vital neurovascular structures. A thyroid surgeon should know the indications, the anatomic structures at lateral neck region and also techniques to decrease the rates of locoregional recurrences, to improve survival, and to prevent the occurrence of some serious complications.

Retrospective Evaluation of the Effect of Surgery and CyberKnife on Recurrence and Neurological Deficits in Cases Diagnosed as Vestibular Schwannoma
Mehmet Alpay Çal, Haydar Gök
doi: 10.14744/hnhj.2022.45712  Sayfalar 62 - 67
INTRODUCTION: We aimed to investigate the effects of treatment with microsurgical resection and CyberKnife, on local control and functional neurological loss in patients diagnosed as vestibular schwannoma and to choose the best treatment method for the benefit of the patient.
METHODS: Thirty-one patients were included in the study. Microsurgical resection was performed in 15 (Group 1) patients, and CyberKnife treatment was performed in 16 (Group 2) patients. Microsurgical resection with retrosigmoid approach was performed as a surgical method for Group 1 patients, accompanied by electrophysiological studies. Stereotaxic radiosurgery was performed with CyberKnife in Group 2 patients whom with tumors smaller than 3 cm and risk of additional morbidity. All patients were followed up clinically and radiologically.
RESULTS: The mean tumor diameter was 32.7±8.02 mm in Group 1 patients and 17.6±6.1 mm in Group 2 patients. The mean follow-up period was 33.8±16.3 months in Group 1 and 16.4±7.5 months in Group 2. The local control success of microsurgical resection in vestibular schwannomas was 100%, and the CyberKnife treatment was 93.75%. Good to moderate facial nerve function was preserved in 80% of Group 1 patients. In Group 2, the rate of complete preservation of facial nerve functions is 100%. While the rate of complete loss of hearing function was 6.67% in Group 1, no deterioration in hearing function was observed in Group 2.
DISCUSSION AND CONCLUSION: Microsurgical resection is inevitable in large-sized vestibular schwannomas due to the mass effect. The application of surgery accompanied by electrophysiological studies reduces neurological deficits. Functional losses may occur even in the presence of electrophysiological studies. In large and giant tumors, applying microsurgical resection with electrophysiological studies and providing local control with CyberKnife as an adjuvant treatment in the presence of residual tumor are seen as the ideal treatment method.

Evaluation of Osteoporosis After Total Thyroidectomy in Euthyroid Post-Menopausal Women
Örgün Güneş, Yusuf Murat Bağ
doi: 10.14744/hnhj.2021.82542  Sayfalar 68 - 71
INTRODUCTION: Exogenous thyroid hormone usage for thyroid-stimulating hormone (TSH) suppression was found to be risky of bone loss for post-menopausal women (PW) after total thyroidectomy (TT). However, osteoporosis in euthyroid PW was not examined. We aimed to evaluate the frequency and severity of osteoporosis after TT in euthyroid PW.
METHODS: One hundred PW were included and were divided into two groups as the TT group (n=50) and the control group (n=50). The patients were in the post-menopausal period for at least 5 years, were euthyroid, and did not receive any drugs effective on bone metabolism. Age, length of post-menopausal period, and laboratory findings including TSH, triiodothyronine, thyroxine, serum calcium, serum phosphorus, serum magnesium, serum intact parathormone, serum alkaline phosphatase, 24-h urine calcium, and bone mineral density (BMD) of vertebra, femoral neck, trochanteric region, and Ward’s triangle were analyzed and compared between two groups. BMD was expressed as T-score.
RESULTS: No significant difference was found between the two groups in terms of age, length of postmenopausal period, laboratory findings, and T-scores of L1, L2, and L4 vertebra. The T-scores of the L3 vertebra, femoral neck, trochanteric region, and Ward’s triangle significantly differed between the groups (p=0.029, p=0.001, p=0.005, and p=0.000, respectively). Osteoporosis was observed in 50% of patients in the TT group, but this rate was only 16% in the control group and this difference was significant (p=0.001).
DISCUSSION AND CONCLUSION: After TT, BMD decreases and the rate of osteoporosis increases in PW, even under replacement dose of exogenous thyroid hormone.

Is There any Relation between the Presence of Helicobacter Pylori Infection and Duodenogastric Reflux in Children?
Burcu Volkan, Nevzat Aykut Bayrak
doi: 10.14744/hnhj.2021.94914  Sayfalar 72 - 75
INTRODUCTION: Although it is a bile-sensitive microorganism in vitro, Helicobacter pylori (Hp) has been detected in human bile and gallbladder tissue. Recently, it is reported that bile acids eliminate Hp after gastric surgery. However, the data about the relationship between Hp and bile acids in subjects without surgery are limited. We aimed to evaluate the clinical features and Hp gastritis rate among patients with and without reflux of gastric bile acid.
METHODS: Patient data were collected through reviewing medical records of 1–18-years old children who underwent gastroscopy during the study period. The rapid urease test (RUT) result, the presence of gastric or bulbar erosion/ulcer, and duodenogastric reflux (DGR) were obtained from gastroscopy reports. Histologic changes of alkaline gastritis and other types of gastritis were noted. Hp infection was accepted as “present” if both RUT and histopathological findings confirm the Hp presence.
RESULTS: Among 754 diagnostic esophago-gastro-duodenoscopy (EGD), 521 subjects were eligible. Bile was visible at the stomach in 114 children (mean age: 11.29±3.90 years, 76.3% girls). The remaining 407 children without bile in the stomach were served as controls (mean age: 9.09±4.53 years, 52.1% girls). Girl gender was a risk factor for bile in the stomach during EGD (aOdds Ratio [aOR]: 1.33, 95% confidence interval [CI]: 1.09–1.77, p<0.05). Hp was present in 35 (30.7%) subjects in the study group and 210 (51.6%) controls (OR: 1.68, 95% CI: 1.25–2.24, p<0.05). Foveolar hyperplasia was present in 98 (86.0%) cases in the study group and 2 (0.5%) controls. Alkaline gastritis was correlated with bile in the stomach (r2: 0.89, p<0.01), older age (r2: 0.18, p<0.01), and girl gender (r2: 0.21, p<0.01).
DISCUSSION AND CONCLUSION: The rate of Hp infection was lower in patients with DGR compared to controls. Furthermore, DGR was significantly more frequent in girls and grown-up children. A high percentage of patients with bile reflux had alkaline gastritis.

Treatment of Choroid Plexus Tumours
Ersin Hacıyakupoğlu, Ali Erhan Kayalar, Mustafa Efendioğlu, Serik Akshulakov, Aydin Sav, Sebahattin Hacıyakupoğlu
doi: 10.14744/hnhj.2021.81598  Sayfalar 76 - 84
INTRODUCTION: Choroid plexus tumors (CPT) develop from the neuroepithelial lining which is well fused with ependymal cells in the 6th week of pregnancy. There is a broad spectrum of histological and biological characteristics. These tumors 70% are seen in children. The most important symptom is findings of increased intracranial pressure. Computed tomography and magnetic resonance imaging are essential in diagnosis. The aim of this study was to evaluate the surgical results of patients with a diagnosis of choroid plexus papilloma who were operated in our clinic.
METHODS: In this article, demographic characteristics, surgical approach, and results of 11 pediatric and three adult patients who underwent tumor excision between 2000 and 2020 were evaluated retrospectively.
RESULTS: We evaluated the findings, the treatment approaches, and surgical outcomes of 11 pediatric and three adult cases who underwent grosstotal excision between 2000 and 2020.The pediatric cases comprised of eight choroid plexus papilloma, two atypical choroid plexus papilloma, and one diffuse villous hyperplasia filling supratentorial ventricles (left, right lateral ventricles, and third ventricle). In one of our adult cases (12th case), choroid plexus papilloma was located at the right lateral ventricle and we suspected of parenchymal infiltration but pathologic diagnosis was pilocytic astrocytoma. These two tumors together constructed collesion tumor. The other tumor located in the right pontocerebellar angle (Case 13) had undergone stereotactic radiosurgery 10 years previously as it had been considered to be meningioma, and as there had been no follow-up, growth had continued.
DISCUSSION AND CONCLUSION: CPTs show anaplastic transformation, may have an effect of irritation on the parenchyma, and may cause secondary tumors with the effect of parenchyma infiltration. Gamma knife treatment is not highly effective and the basic treatment should be considered to be grosstotal resection.

Is Taking Routine Biopsy from Incisura Angularis During Gastroscopy Necessary?
Ayça Saltürk, Özgür Bahadır, Emine Kanatsız, Halil Şahin, Mevlut Kıyak, Fatih Güzelbulut
doi: 10.14744/hnhj.2021.33602  Sayfalar 85 - 88
INTRODUCTION: The updated Sydney system recommends sites and numbers of stomach biopsies (mapping) for evaluation of Helicobacter pylorii colonization, glandular atrophy, intestinal metaplasia (IM), gastrit ulcer, and cancer. The incisura angularis is considered to be a typical site for early detection of premalingnant lesions. Our study aimed to clarify whether it is necessary to take biopsy from the incisura angularis routinely during gastrocopy in addition to corpus and antrum biopsies.
METHODS: Nine hundred ninety-eight patients, with a mean age±SD of 51.13±15.2 were enrolled. Two biopsies had been taken from antrum, two from corpus, and one from incisura angularis during routine gastroscopy. Biopsy samples were taken from the stomach mucosa with non-visible detectable lesions. Histologic specimens were graded using the updated Sdyney classification.
RESULTS: H. Pylori was identified in 464 (46%) of the 998 patients. Two hundred and fifty-four (25%) patients of the 998 showed IM and 73 (7%) patients of the 998 showed atrophic gastritis. Of the 998 patients 15 (1.5%) showed H. pylorii positive in the angulus biopsy only. Similary, IM in 24 patients (2.4%) and atrophy in 15 patients (1.5%) were showed in the incisura angularis. Severe glandular atrophy score in the incisura was higher than the antrum and corpus.
DISCUSSION AND CONCLUSION: Based on our study, taking routine biopsies from incisura angularis provides little additional information; however, angulus biopsies are significant to detect severe premalignant lesion especially in high-risk patients.

Is There a Relationship Between Omalizumab Treatment and the Development of Thromboembolic Events in Asthmatics?
Şeyma Başlılar
doi: 10.14744/hnhj.2022.99810  Sayfalar 89 - 93
INTRODUCTION: Omalizumab is indicated for the treatment of uncontrolled moderate and severe allergic asthma. The long-term real-life studies showed that it may result in an increase in thromboembolic events (TEs). This single-center study was planned to evaluate whether the use of omalizumab was related to the development of thromboembolism and change in peripheral blood thrombocyte counts.
METHODS: Adult patients with moderate and severe asthma treated with (study group) and without omalizumab (control group) for at least 12 months were evaluated retrospectively. Data for demographic and clinical characteristics, duration of omalizumab treatment, number of thrombocytes before and after omalizumab, and development of TE were examined and compared between the two groups.
RESULTS: A total of 168 patients, 73 were treated with omalizumab (13/73 male (17.8%), the mean age was 56.63±12.41 years), and 95 were treated without omalizumab (30/95 male (31.6%), the mean age was 50.71±16.34 years) were included in the study. The median (25–75th percentile) omalizumab treatment duration was 52 (36–78.5) months. None of the controls but two (2.7%) of the cases in the study group developed thromboembolism (p=0.187). The mean number of thrombocytes was similar before and after the treatment (276575.34±47869.59 vs. 294356.16±72351.26, p=0.087).
DISCUSSION AND CONCLUSION: Although there were sporadic cases with TE following omalizumab treatment in the study, it was not related to a significantly increased thromboembolism risk.

Causes of Complications and Unplanned Early Readmissions in Endoscopic Pituitary Adenoma Surgery; Early Results of a Single-Center Study
Serdar Onur Aydın, Mustafa Umut Etli
doi: 10.14744/hnhj.2022.49260  Sayfalar 94 - 98
INTRODUCTION: We aimed to reveal the complications, the early results of surgery and the reasons for early readmissions that may occur in a neurosurgery team that has just started endoscopic pituitary surgery.
METHODS: A retrospective analysis of patients with pituitary adenoma who were operated on in our clinic was performed. The patients were examined in terms of age, gender, and pathological diagnosis, whether there was a disorder in pre-operative hormone levels, post-operative complications, surgical and endocrine complications developed in the post-operative period, complaints, and findings during the planned and unplanned readmissions within the first 30 days.
RESULTS: Of the 23 patients included in the study, 13 were male and 10 were female. The ages of the patients ranged from 22 to 68 (mean 49.3). Intraoperatively cerebrospinal fluid leakage was observed during surgery in 4.3% of the patients, and sixth cranial nerve paralysis was observed in 4.3% of the patients as an additional surgical complication. As an endocrine disorder, diabetes insipidus developed in 13% of the patients in the post-operative period; however, the findings were temporary in 66.6% of these patients. In the first routine follow-up examination after discharge, no complaints were observed in 82.6% of the patients, anosmia was observed in 4.3%, cacosmia in 4.3%, and runny nose in 4.3% of patients. Unrelated to the routine control examination, 26% of the patients admitted to the hospital unplanned in the first 30 days postoperatively, and the complaints were neck pain, rhinorrhea, headache, nausea-vomiting, double vision, and epistaxis.
DISCUSSION AND CONCLUSION: The results of this study showed that during the follow-up period, neurosurgeons should pay emphasis to transient diabetes insipidus, rhinorrhea, hormonal failure, and sixth cranial nerve paralysis. Complication rates in clinics new to the procedure are similar to the existing literature due to the widespread use of endoscopic pituitary surgery, the ease of learning the surgical procedure, and the fact that challenging cases are not selected in the first stage of surgery.

Anticancer Effects of Punicalagin
A. Cansu Kilit, Esra Aydemir
doi: 10.14744/hnhj.2021.77044  Sayfalar 99 - 104
Side effects of treatments such as chemotherapy, radiotherapy, and immunotherapy, which are widely used today, negatively affect the cancer treatment process. In particular, the need for new treatments with less side effects but with higher therapeutic power is increasing day by day due to the resistance developing in patients against antineoplastic drugs and radiation therapy. From this point of view, natural compounds of plant origin attract attention because of their bioavailability, less side effects, and most importantly, because they can be either an auxiliary or an alternative treatment to traditional cancer treatments due to their low cost.
Pomegranate (Punica granatum) is a fruit that is abundant in our country, has anticancer bioactive components such as phenolic compounds, and has medicinal value. The pomegranate fruit peel that constitutes approximately 30% of the weight of pomegranate fruit, which is unfortunately discarded, is actually particularly rich in phenolic compounds such as Punicalagin (PN) and Ellagic acid (EA) and various minerals. There are studies revealing that PN has direct or indirect anti-oxidant, anti-tumor, anti-atherosclerosis, anti-inflammatory, anti-viral, anti-fungal, and anti-bacterial effects. Its positive effects on health and its non-toxic structure enable the multifunctional use of PN compound. In this review, the therapeutic use of PN phenolic compound as an anti-cancer agent is discussed.

The First Multisystem Inflammatory Syndrome in Children (MIS-C) Diagnosis in Our Clinic in the Late Period of the Pandemic: Case Report
Elif Küçük, Çağatay Nuhoğlu
doi: 10.14744/hnhj.2021.76148  Sayfalar 105 - 108
COVID-19, which started in China in December 2019 and affected the globe, is seen less frequently in children compared to adults and progresses with milder symptoms. However, some of the children who had COVID-19 infection in Europe in April 2020 were critically ill cases in need of intensive care with shock and multi-organ failure, while others had characteristics similar to Kawasaki Disease. Studies show that SARS-CoV-2 causes multisystem inflammatory syndrome (MIS-C) in children. In this article, a case diagnosed with MIS-C in the early period is presented, which can be frequently confused with Kawasaki Disease and should be considered primarily in the differential diagnosis.

Gossypiboma, Mimicking a Renal Neoplasm: A Case Report
Levent Verim, Ömer Yüksel, Çağatay Tosun
doi: 10.14744/hnhj.2021.67209  Sayfalar 109 - 111
Retained surgical sponges, so called gossypiboma (or textilomas), are very rare complications after surgical procedures. The estimated incidence is approximately 1/1000–1500 surgical operations but the actual incidence rate is unknown because of its medicolegal aspects. Clinical manifestations may occur early or late after surgery, depending on the type of inflammatory reaction. Ultrasound and computed tomography (CT) imaging and magnetic resonance imaging are valuable tools in diagnosing gossypibomas. Gossypiboma may appear like low density, high density or complex masses with CT. Sometimes high density capsule may be seen. Internal calcification is a rare finding. Gossypibomas may look like abscess, hematoma, pseudocyst, or tumors. Here in, we presented a rare renal gossypiboma case mimicking a renal tumor. Gossypiboma should be kept in mind at differential diagnosis of renal masses who had undergone renal surgery before.

Intestinal Spirochetosis in an Immunocompetent Host: A Case Report and Review of Literature
Ayşe Özbek, Zarife Melda Bulut
doi: 10.14744/hnhj.2021.87059  Sayfalar 112 - 114
Intestinal spirochetosis is a very rare condition and is often known to be associated with immunodeficiency. Although its colonoscopic findings are not specific, its histopathological appearance is quite remarkable. In this case, intestinal spirochetosis with colonic polyp, unrelated to immunodeficiency, was presented.

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