Diskapi Yildirim Beyazit Training Research Articles

Association Between Keratoconus and Familial Mediterranean Fever in Turkey.

To evaluate the association between familial Mediterranean fever (FMF) and keratoconus (KC). This retrospective case-control study was performed to compare the prevalence of KC in patients with FMF with the corresponding prevalence in control patients without FMF referred to Genetic Diagnostic Center at Diskapi Yildirim Beyazit Training and Research Hospital from June 2012 to June 2015. We included all 100 patients with FMF. Each FMF-affected patient was matched to 3 controls. None of the patients in the control group (0%, 0/300) had KC, whereas 4 of 100 patients with FMF (4%) had KC (P < 0.004). Three of 33 patients with a homozygous mutation (9.1%) (M694V/M694V in 2 cases and M680I/M680I in 1 case) and 1 of the 46 patients with a compound heterozygous mutation (2.2%) (M694V/M680I) had KC, whereas none of the 21 patients with a heterozygous mutation (0%) had KC. All patients with KC were women, and mean age was 40.8 years (range, 30-51). Although 1 of the 4 patients with KC had hypertension and type 2 diabetes mellitus, the other 3 patients did not have any systemic illness except FMF. When we compared the prevalence of KC in patients with FMF (4%) with the highest prevalence of KC reported in the literature (0.2%), FMF was a predisposing factor to develop KC [odds ratio: 18.1 (95% CI: 11.9-27.5)] especially in patients with a homozygous mutation [odds ratio: 43.4 (95% CI: 28.6-65.7)]. Mediterranean fever (MEFV) gene mutations, particularly in homozygous mutations of the MEFV gene, may be a predisposing factor in the development of KC.

OP-067 Effects of Calcific and Inflamatory Mechanisms on Different Aortic Cusps in Etiopathogenesis of Degenerative Aortis Stenosis

A B S T Association Between Platelet to Lymphocyte Ratio and Saphenous Vein Graft Disease. Ca gri Yayla, U gur Canpolat, Ahmet Akyel, Kadriye Gayretli Yayla, Samet Yilmaz, Sadik Kadri Acikgoz, Firat Ozcan, Osman Turak, Mehmet Do gan, Ekrem Yeter, Sinan Aydo gdu. Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey; Diskapi Yildirim Beyazit Training and Research Hospital, Cardiology Clinic, Ankara, Turkey. R A C T S Background: Atherosclerosis plays an important role in the formation of saphenous vein graft disease. Previous trials showed that inflammatory blood cells has an active role in this process. The platelet to lymphocyte ratio (PLR) has been researched as a novel predictor for cardiovascular risk and indicator of atherosclerosis. The aim of this study was to assess the relationship between saphenous vein graft disease (SVGD) and PLR. Methods: A total of 220 patients with SVG were enrolled. The study population was subdivided into two groups according to the presence of SVGD (n1⁄487 with SVGD and n1⁄4133 with patent SVG). At least 50% stenosis within the SVG was defined as clinically significant. Results: The PLR [136.9 (70.8-335.5) vs. 76.8 (29.6-212.4); p<0.001] and mean platelet volume (8.6 1.1 vs 8.3 1.1; p1⁄40.043) were significantly higher in patients with SVGD. Also, PLR showed significantly positive correlation with age of SVG (p<0.05). Median age of SVGs were also higher in SVGD group (p1⁄40.025). In multivariate logistic regression analyses, the PLR and mean platelet volume were found as independent predictors of SVGD. Using a cut-off level of 106.3, the PLR level predicted SVGD with a sensitivity of 87.4% and a specificity of 80.3%.

PP-045 DEVELOPMENT OF CHRONIC LYMPHOCYTIC LEUKEMIA IN A PATIENT WITH JAK2V617F POSITIVE ESSENTIALTHROMBOCYTHEMIA

According to the cognitive model, the common mechanism underlying all psychological disorders is distorted or dysfunctional thoughts that affect mood and behaviors. Dysfunctional thoughts predispose an individual to depression and are among the processes that form the basis of personality traits. Elucidating the personality beliefs associated with depression and dysfunctional thoughts is important to understanding and treating depression. The aim of the present study is to determine whether depressed patients exhibited pathological personality beliefs compared with healthy controls. Furthermore, we investigated which personality beliefs were more common among such depressed patients.A total of 70 patients who were admitted to the Department of Psychiatry at Ankara Diskapi Yildirim Beyazit Training and Research Hospital (Ankara, Turkey) and diagnosed with major depressive disorder according to The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnostic criteria were included in the study. Additionally, 70 healthy controls matched for age, marital status, and education were included in the study. The Sociodemographic Data Form and Personality Belief Questionnaire-Short form (PBQ-SF) were administered to the participants.A comparison of the depression group with the healthy controls revealed higher scores in dependent, passive–aggressive, obsessive–compulsive, antisocial, histrionic, paranoid, borderline, and avoidant personality subscales in the depressive group.These results suggest that personality beliefs at the pathological level are more common in depressive patients and that the detection of these beliefs would be useful for predicting the prognosis of the disease and determining appropriate treatment methods.

Comparison of personality beliefs between depressed patients and healthy controls

IntroductionAccording to the cognitive model, the common mechanism underlying all psychological disorders is distorted or dysfunctional thoughts that affect mood and behaviors. Dysfunctional thoughts predispose an individual to depression and are among the processes that form the basis of personality traits. Elucidating the personality beliefs associated with depression and dysfunctional thoughts is important to understanding and treating depression. The aim of the present study is to determine whether depressed patients exhibited pathological personality beliefs compared with healthy controls. Furthermore, we investigated which personality beliefs were more common among such depressed patients. MethodsA total of 70 patients who were admitted to the Department of Psychiatry at Ankara Diskapi Yildirim Beyazit Training and Research Hospital (Ankara, Turkey) and diagnosed with major depressive disorder according to The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnostic criteria were included in the study. Additionally, 70 healthy controls matched for age, marital status, and education were included in the study. The Sociodemographic Data Form and Personality Belief Questionnaire-Short form (PBQ-SF) were administered to the participants. ResultsA comparison of the depression group with the healthy controls revealed higher scores in dependent, passive–aggressive, obsessive–compulsive, antisocial, histrionic, paranoid, borderline, and avoidant personality subscales in the depressive group. ConclusionsThese results suggest that personality beliefs at the pathological level are more common in depressive patients and that the detection of these beliefs would be useful for predicting the prognosis of the disease and determining appropriate treatment methods.

Metastatic Papillary Thyroid Carcinoma Masked by Diffuse Parenchymal Calcification

Diskapi Yildirim Beyazit Training and Research Hospital, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey *Ankara University Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey Metastatic Papillary Thyroid Carcinoma Masked by Diffuse Parenchymal Calcification Yaygin Parankimal Kalsifikasyon ile Maskelenmis Metastatik Papiller Tiroid Karsinomu DOI: 10.4274/tjem.2102

MRI volumetry of the temporal lobe in Sudan: Validated protocol and preliminary normative data

MRI volumetry of the temporal lobe in Sudan: Validated protocol and preliminary normative data

Ultrasound-guided pulsed radiofrequency treatment of the intercostal nerve: three cases

To the Editor: Radiofrequency thermocoagulation (RFTC) can be effectively used to treat chronic pain [1]. However, it may lead to thermal destruction of tissue surrounding the nerve [2]. Thus, correct identification of the targeted tissue is of great importance. For this purpose, imaging methods such as fluoroscopy, magnetic resonance imaging (MRI), computed tomography (CT) scan, and—more recently—ultrasound (US), are utilized [3]. RFTC has been successfully applied in treating intercostal neuralgia [2]. Three patients (a 33-year-old woman, a 66-year-old man, and a 73-year-old man) who had been diagnosed with various diseases (intercostals neuralgia, postthoracotomy pain syndrome, and postherpetic neuralgia) were examined in a pain unit. Numerical Rating Scale (NRS) scores were 7, 6, and 7, respectively. All three patients had been treated previously with anti-inflammatory drugs, gabapentin, paracetamol, and tramadol. Diagnostic intercostal nerve blocks (ICNB) were applied to the concerned segments with US guidance. The patients underwent US-guided pulsed radiofrequency (PRF) therapy (42 C, 120 s) after having given informed consent. They reported pain relief within 30 min and remained at the lower limit (NRS scores 2, 0, 1 respectively) throughout the 6-month follow-up period. The targeted ribs were marked at 8 cm lateral to the spinous processes. A SonoSite M-turbo ultrasound machine (Bothell, WA, USA) with a linear transducer probe (HFL 38X/13-6 MHz) was used to perform the intercostal nerve RFTC. The US probe was placed on the marked area in the longitudinal plane, and using an appropriate tilt, the ribs and the pleura became visible (Fig. 1). The RFTC needle (100 cm insulated with a 10-mm straight tip, NeuroTherm , USA) was viewed with the in-plane technique and was then directed toward the caudal edge of the ribs. When the edge of the needle was observed to be in the intercostal groove, the location of the concerned intercostal nerve was verified both by motor nerve stimulation (2 Hz, 1 ms, 2 V) and by confirming that the impedance value was 300–350 X. Local muscle spasms only were identified. While maintaining visualization of the needle at the caudal edge of rib, PRF was applied at 42 C for 120 s with an RFTC generator (NT1100, NeuroTherm . After two PRF cycles, 3 ml 0.25 % bupivacaine was injected by real-time observation of the local anesthetic spread under US guidance, and the RF needle was removed. The patients tolerated the procedures well and were monitored for 1 h postprocedure. All three patients were discharged on the same day. Although an intercostal nerve block is an effective and well-known technique for pain relief, its application, especially through the conventional method, is avoided because of the risk of pneumothorax, hemothorax, intravascular injection, and intrathecal injection [4]. Pleura can be viewed clearly using the US-guided intercostal nerveblock method, allowing an intercostal nerve block to be applied more safely [5]. US offers the advantage of portability, real-time imaging, cost savings, and a lack of radiation. In conclusion, US-guided PRF of intercostal nerves may be effective and safe. T. Akkaya D. Ozkan Anesthesiology Department and Pain Unit, Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

Differences between rural and urban primary care units in Turkey: Implications on residents′ training

Context:Family practice training takes place at primary care based training centers linked to Education and Research State Hospitals in Turkey. There is a discussion if these units are adequate to train primary care staff and if the patients of these units reflect the applicants of primary care.Aims:The aim of our study is to investigate the demographic characteristics, the effect of distance on primary care utilization, and most common diagnosis of the patients who applied to two different outpatient clinics: One urban and one rural.Settings and Design:Study was conducted from the electronic health records of the patients applied to outpatient clinics of Ankara Diskapi Yildirim Beyazit Training and Research Hospital Department of Family Medicine between 1 January and 31 December 2009.Results:Total number of patients applied to both of the outpatient clinics was 34,632 [urban clinic: 16.506 (47.7%), rural clinic: 18.126 (52.3%)]. Leading three diagnoses were upper respiratory tract infection (URTI), general medical examination (GME), and hypertension (HT) in the most common 10 diagnosis.Conclusion:In our study, the rural outpatient clinic is regarded as a primary care unit in the neighborhood of living area and the urban clinic as close to working environment. We found statistically meaningful differences in most common diagnosis, gender, age, and consultation time between the rural and urban clinics. According to our results, family practitioners’ field training should take place at different primary care units according to sociodemographic characteristics of each country.

Unusual cause of primary amenorrhea due to kissing internal carotid arteries

Disorders of anterior pituitary like tumors may cause amenorrhea. Non neoplastic sella lesions like infiltrative or infectious diseases may compress pituitary and may lead to secondary amenorrhea by hypogonadotropic hypogonadism. Congenital isolated gonadotropin deficiency such as Kallman’s syndrome may cause primary amenorrhea [1]. Uncommon vascular origin situations may also effect pituitary. Around sella aneurysm like internal carotid artery may lead to amenorrhea. Aneurysms of carotid arteries rarely simulate pituitary adenoma by expanding mass within sella. Carotid aneurysms may compress pituitary. These aneurysms may cause hypopituitarism. Generally these aneurysm cause more than one pituitary hormonal deficiencies [2–4]. The most common initial deficiencies are the gonadotropins [2]. Several congenital anomalies of internal carotid artery especially agenesis and congential hypopituitarism have been reported [5, 6]. A 23-year-old lady presented with primary amenorrhea to our department. She stated that when she was 16 years old, she was admitted to another hospital for primary amenorrhea. At that time, telarche did not occurred and she had little pubic hair. Her bone age was 15 and chromosomal analysis had been revealed normal XX karyotype. Her pelvic ultrasonography had revealed hypoplasia of her genital organs. She had been started oral conraceptives. She had been told that she had delayed puberty. In 2004 thyroxine replacement had been started for hypothyroidism due to hashimoto thyroiditis in public hospital. In physical examination axillary and pubic hairs and external genitalia were normal. Secondary sexual characters were normal. Her weight was 178 cm, weight was 89.2 kg and BMI was 28.2. Pituitary function testing demonstrated isolated hypogonadotropic hypogonadism. Prolactin and other pituitary hormone levels were in normal range. Magnetic resonance Imaging (MRI) was performed and uncover bilateral close dilated internal carotid arteries (ICAs) approaching to the midline where causing pituitary gland compression. Distance between ICAs was shortened in MRI angiography (Fig. 1). Vascular causes are very rare cause of pituitary hormonal deficiencies. These are generally because of ICA aneurysm or thrombosis/occlusion [1]. Isolated hormonal deficiency due to or conjunction with vascular anomaly did not reported before. Here we report probable congenital hypogonodotropic hypogonadism that cause primary amenorrhea due to ICAs position anomaly (medial proximity). MRI angiography may be helpful to identify vascular etiologies. In the future, development in imaging techniques could identify some of the rare etiologies of pituitary hormonal deficiencies. M. Sahin B. Karbek I. O. Unsal A. Gungunes N. Colak B. Ucan E. Cakal M. Ozbek T. Delibasi Department of Endocrinology and Metabolic Diseases, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

Stem Cell Studies in Plastic Surgery

Sir:FigureTo date, the most promising innovation in medicine is stem cells. Over the past decade, a remarkable number of articles have been published regarding stem cells.1–5 Novel research and innovation are essential for the improvement of plastic surgery. We think that stem cell research is exceedingly important for improvement of plastic surgery. Therefore, in this study, we evaluated stem cell publications in plastic surgery–related journals between 2001 and 2009. We downloaded records from PubMed over the Internet. The search strategy used the phrase “stem cell” in articles between 2001 and 2009. The analysis was limited to articles that were already published. Articles in press were excluded. All types of articles were included, such as original articles, editorial materials, letters, case reports, and others. Articles in all languages were included. The total number of stem cell studies per year was identified. After downloading, the articles related to plastic surgery were extracted. Of these articles affiliated with plastic surgery, we extracted articles published in the journals most commonly regarding plastic surgery, to evaluate the interest of plastic surgery related journals into stem cell studies. Plastic and Reconstructive Surgery, Annals of Plastic Surgery, Aesthetic Plastic Surgery, Burns, Clinics in Plastic Surgery, Journal of Craniofacial Surgery, Journal of Oral and Maxillofacial Surgery, and Wound Repair and Regeneration were selected as data sources. The number of articles in these journals was compared with the total number of the publications per each year, between 2001 and 2009. The analysis of publications was stratified by publication year, journal, and countries of the authors' affiliations. The countries of the authors' affiliations were identified from the addresses in their affiliations and correspondences. There were 20,072 articles published in the literature between 2001 and 2009. The number of the publications increased annually, reaching a peak of 4037 in 2009 (Fig. 1). The affiliation of these articles to plastic surgery was 212. One hundred forty-nine of these 212 articles (70 percent) affiliated with plastic surgery were published in the journals most commonly regarding plastic surgery. Most of these articles were published in Plastic and Reconstructive Surgery (43 percent), Wound Repair and Regeneration (17 percent), and Journal of Craniofacial Surgery (13 percent) (Table 1). Authors from 20 countries contributed to publications in the journals most commonly regarding plastic surgery. The top five countries are the United States (50.3 percent), Japan (16.7 percent), China (11.4 percent), Italy (4.6 percent), and South Korea (3.3 percent). The top five centers are the University of California (11 articles), Harvard Medical School (seven articles), Stanford University School of Medicine (seven articles), the University of Pittsburgh (seven articles), and the University of Tokyo School of Medicine (five articles). Disregarding the possibility of authors having the same name, 668 authors contributed to publications. Most authors were presented in only one article, and 129 authors were present in two or more articles.Fig. 1: The annual number of stem cell studies in the literature between 2001 and 2009.Table 1: Annual Number of Stem Cell Studies in Plastic Surgery JournalsIn conclusion, this article provides an overview of the stem cell studies published in the journals most commonly regarding plastic surgery. The background of the articles was analyzed, and an overview of the stem cell studies in plastic surgery was emphasized. Tolga Eryilmaz, M.D. Fatih Oktem, M.D. Mustafa Durgun, M.D. Rifat Ozakpinar, M.D. Ali Teoman Tellioglu, M.D. Diskapi Yildirim Beyazit Training and Research Hospital, Second Department of Plastic and Reconstructive Surgery, Ankara, Turkey DISCLOSURE The authors have no commercial associations or financial relationships to disclose.