Last Issue JCAM

An evaluation of the 10-year major osteoporotic and hip facture risk using the frax score in Erzurum

Aim: The aim of this prospective study was to provide an estimation of the 10-year probability of the four major osteoporotic fractures using fracture risk
evaluation scale (FRAX) and to review the risk factors for osteoporosis in males and females aged over 50 years in Erzurum, Turkey. Material and Method:
An evaluation was made 1254 patients who presented at the Outpatient Clinics of State Hospital in 2013. Taking the risk factors and bone mineral density
(BMD) values into consideration, and using the FRAX risk evaluation scale, the 10-year major osteoporotic (MO) and hip fracture risks were evaluated for all
the participants. Results: While a significant difference was seen between the genders in respect of measurements of the osteoporosis (OP) major risk fracture
with BMD determined as mean 7.4% in females and 5.77% in males, and without BMD, as 8.27% in females and 4.59% in males and without BMD, the hip
fracture risk was 2.92% in females and 1.91% in males (p=0.016, p<0.001, p<0.001, respectively), no significant difference was determined in the hip fracture
risk with BMD at 2.62% in females and 3.05% in males (p=0.517). With an increase in body mass index (BMI), there was a decrease in the OP risk (p<0.001).
With BMD, the MO fracture risk groups were formed of 84.5% low risk, 10.5% moderate risk and 5% high risk. Discussion: If BMD values were taken as the
basis for medical treatment in Turkey, the use of scanning tests and fracture risk evaluation scales such as FRAX would be useful. However, to be able to better
determine the extent of OP and the fracture risk in the general population and maybe to be able to determine threshold values which may be different in our
population, there is a need for further multi-center studies including greater numbers of patients.

Diagnostic value of serum apelin-13 in patients with pulmonary thromboembolism

Aim: We aimed to investigate whether serum apelin-13 value could be a novel biomarker in the diagnosis of pulmonary thromboembolism (PTE). Material and

Method: The study included 142 patients, 82 of which were diagnosed with PTE and 60 were control cases. Serum apelin-13 level was measured using venous

blood samples with the ELISA kit. Results: The serum apelin level was 2219.4 ± 65.2 ng/mL in the PTE group and 1234.7 ± 35.5 ng/mL in the control group

(p<0.05). Serum apelin-13 was 2495.8 ± 738.0 ng/mL in the DVT (+) group and 2118.0 ± 496.8 ng/mL in the DVT (-) group (p=0.009). The best cut-off value for

apelin-13 in the control and PTE groups was determined as 1579 ng/mL. Sensitivity was 92.7% and specificity was 96.7% (95% confidence interval: 0.939 to

0.995, area under ROC curve: 0.979, p<0.001). Discussion: This study showed that serum apelin-13 value can be used as new diagnostic biomarker in patients

with PTE. Apelin-13 value also elevates in patients with DVT (+). These results suggest that apelin-13 value may be used as a novel biomarker in the patients

with acute PTE and DVT (+) in future practice.

Biological variation components of glycated hemoglobin HbA1c on tosoh G7 HPLC

Aim: Biological variation (BV) of the HbA1c test can be affected by analysis method, sampling period, and disease activity. The aim of the present study was to

examine the impact of CVI, CVA, and II for Tosoh G7 system. Material and Method: 96 samples from 12 healthy volunteers were collected for every two weeks

during a two-month period. HbA1c levels of all samples were measured by G7 HPLC (non-porous ion-exchange) Analyser. Biological variation parameters CVI,

CVA, CVG, RCV, and II were calculated. Results: The mean of HbA1c was 5.10% (32.3 mmol/mol). CVA was calculated as 2.81%. The CVI and CVG for HbA1c

were 1.69% and 7.56%, respectively. RCV and II values were 9.08% and 0.22. Discussion: According to our results, the sampling period and study method were

fundamental to determining biological variation parameters. When using the Tosoh G7 system, we observed similar results to other methods, e.g. boronate

affinity or immunoturbidimetry. Low individuality index of HbA1c presented that the analyte had marked individuality and that the population-based reference

values had low utility for disease monitoring. Thus, estimation and inclusion of RCV in laboratory reports for HbA1c will guide the clinicians in evaluating the

importance of difference between serial results and glycemic status of the patients.

Influence of pulsed electromagnetic field on dermatological symptoms of hyperandrogen in obese women with polycystic ovarian syndrome

Aim: Polycystic ovarian syndrome (PCOS) is common endocrinal problem that leading to irregularity of menstruation, acne, hirsutism, and finally infertility. Low

level pulsed electromagnetic field (PEMF) have strong anti-inflammatory effect through restoration of plasma membrane calcium ATPase activity. The purpose

of this study was to investigate the effect of PEMF on hyperandrogen symptoms (Acne & Hirsutism) in obese PCOS women. Material and Method: Thirty volunteer

obese PCOS women were participated in this study, their ages ranged from 20 to 30 years and BMI ranged from 30 to 34.9 kg/m2, they randomly divided

into two equal groups; group A, which received PEMF three times per week with diet control therapy, group B, which received diet control therapy only. Both

groups were evaluated before and after therapy (12weeks) through measuring their weight, C-reactive protein, luteinizing hormone (LH) / follicular stimulating

hormone (FSH) ratio, androgen excess symptoms (modified Ferryman–Gallwey (mFG) scoring system & global acne grading system (GAGS). Results: The

results of this study showed that there was a statistically significant difference (P>0.05) between both groups (A&B) after therapy (12 weeks) in LH/FSH ratio,

CRP, mFG and GAGS, in favor to group (A). Conclusion the present study revealed that pulsed electromagnetic field are effective in decreasing hyperandrogen

symptoms and improve fertility by improving hormonal variables.

The results of tectonic keratoplasty

Aim: In this study, we aimed to evaluate the results of tectonic penetrating keratoplasty (PK) in the treatment of the non-traumatic corneal perforations. Material and Method: Thirty-five eyes of 35 patients who underwent tectonic PK between January 2000 and January 2017 were included in this study retrospectively. The cases were evaluated in terms of age, sex, etiology, follow-up period, anatomical stability, graft clarity, best corrected visual acuity and complications. Results: Twenty-one of the 35 patients were male. The mean age was 49.4. The mean follow-up period after keratoplasty was 43.2 ± 8.4 months. Predisposing factors leading to perforation were microbial keratitis in 17 eyes (48.5%), corneal melting associated with ocular surface disease in 13 eyes(37.1%) and perforated descemetocele in 5 eyes (14.4%). Anatomical stability was achieved in 94% of the eyes. The graft clarity rate was 62% at the end of the follow-up period. Approximately half of the cases obtained a final visual acuity of 0.2 and better postoperatively. The most common complication was glaucoma. Discussion: Emergency PK is required to maintain anatomical integrity in corneal perforations. Success rate is evaluated with anatomical integrity; graft clarity and visual acuity are not satisfactory. However, prognosis can be improved by the control of the underlying pathology, inflammation and intraocular pressure.

Subacute subdural hematomas: Comparison of surgical methods and clinical outcomes

Aim: Although subacute subdural hematoma (SSDH) patients are considered to be similar to chronic subdural hematoma (CSDH) patients, it was aimed to set
forth the clinical follow-up and treatment differences between these groups and to compare and discuss the results of different surgical treatments that can
be applied. Material and Method: Sixty-seven patients diagnosed with SSDH were retrospectively reviewed, and 57 of them treated surgically. Clinical findings
and signs of progress were recorded. The patients were divided and evaluated in two groups; those who underwent surgery with burr-hole trepanation method
(Group 1) and those who underwent membranectomy with craniotomy (Group 2). Outcomes were compared in 2 groups. The way how the membranectomy with
the craniotomy procedure is applied has been explained. Results: In Group 1 subdural space and pneumocephalus were wider in the early postoperative period
(average width: 13,2 mm; 24,6 mm). In Group 2, subdural space and pneumocephalus widths and lengths were an average of 4,6 mm and 11 mm. In Group 1,
the late period re-operation rate was 17,1%, whereas, in Group 2, those rates were determined to be 9,1%. Discussion: SSDH patients show different clinical
course than CSDH patients. Burr-hole trepanation method is not as efficient as the craniotomy method in surgical patients. In patients undergoing craniotomy
and membranectomy, the likelihood of the remnant and pneumocephalus is lower in the postoperative period. Parenchymal expansion can be achieved in the
early period with positive-end-expiration-pressure for a few seconds in the intraoperative period.

Outcomes of N-butyl cyanoacrylate use in cases where incidental durotomy developed in lumbar disc herniation surgery

Aim: Incidental durotomy (ID) occurred during lumbar disc herniation surgery is one of the most frequently encountered surgical complications. Different
methods have been defined related to the repair of durotomy during the perioperative period. The author explains the use and results of n-butyl cyanoacrylate
(NBCA) which is one of the agents used for repair of ID. Material and Method: The records of cases that ID developed and that were operated due to lumbar
disc herniation were retrospectively reviewed and their results were discussed. Totally 29 cases were operated using the described method. All durotomy
defects were less than 1cm. None of ID’s were repaired with primary suturation. NBCA (Glubran 2®) was conveyed to regions by the method of instillation and
covered as a thin layer. Results: All cases were mobilized next morning after the surgery. The average time elapsed until the discharge is 2,8 days. Postoperative
subcutaneous cerebrospinal fluid (CSF) collection development was detected in 1 case and treated with the conservative method. In 2 cases paresthesia
which started in the early postoperative period and treated with pregabaline 50 mg for one month period. Discussion: NBCA is a fast and effective preventive
preparation for cases where ID developed in lumbar disc herniation surgeries. It strongly sticks to the dura and doesn’t break away or meltdown. NBCA allows
early mobilization in the postoperative period and does not have any compressive effect on root if it covers the dural defect as a thin layer. If it is used appropriately,
the results are very satisfactory.

Can MELD score be a predictor of liver metastasis in colorectal cancer?

Aim: A significant number of patients with colorectal cancer (CRC) present with liver metastasis at initial diagnosis. The Model for End-Stage Liver Disease
(MELD) score consists of three parameters including bilirubin, creatinine and International Normalized Ratio (INR), and is primarily used to rank the priority
of patients awaiting liver transplantation. The aim of the study is to investigate the predictive value of MELD score for liver metastasis in patients with CRC.
Material and Method: A total of 436 patients diagnosed as CRC were included in the study. The patients were divided into two groups: patients without liver
metastasis and those with liver metastasis. The association between MELD score and presence of liver metastasis was investigated. Results: There were 256
(57.9%) males and 183 (41.1%) females, with an overall mean age of 64 years. Liver metastasis was found in 58 (13.2%) patients. Mean MELD score was
found to be 8.88 in patients with hepatic metastasis whereas the patients without metastatic liver disease had a mean MELD score of 8.61 (p=0.015). Discussion:
MELD score is significantly higher in patients with liver metastasis than in those without liver metastasis. Further studies may help to confirm this result
and to determine a possible cut-off value of MELD score.

Efficacy and safety of holmium laser lithotripsy in the treatment of posterior urethral stones

Aim: Urethral stones constitute less than 1% of the stones observed in the urinary system. Due to their rare occurrence, there is a limited number of studies on
the treatment of urethral stones. In this study, the efficacy and reliability of holmium laser lithotripsy applied to male patients with posterior urethral calculi
were analyzed retrospectively. Material and Method: Forty-one cases of male patients who received holmium laser lithotripsy due to posterior urethral stones
between January 2011 and December 2017 were retrospectively reviewed. The complications of the patients were evaluated according to age, application
complaints, stone dimensions, etiologic factors, operation time, and modified Clavien classification. Results: The mean age of the patients was 38.4 ± 16.7
years. Acute urinary retention was recorded in 26 (63.4%) patients, hematuria in 4 (9.8%), difficulty in urinating in 5 (12.1%), perineal pain in 4 (9.8%), and
dysuria in 2 (4.9%) as the main admission finding. The smallest stone size was 9 mm and the largest stone size was 24 mm. Twenty-four of the 41 patients
(58.5%) were found to have a stone in another localization of the urinary system along with the urethra stone. A total of 11 (26.8%) patients had a history
of previous urological surgery. Discussion: In the present retrospective study, 41 male patients with posterior urethral stones were successfully treated using
endoscopic holmium laser lithotripsy with low complication rates.
Conclusion: According to the results obtained in our study, holmium laser lithotripsy was an effective and reliable method for the treatment of posterior urethral
stones.

Evaluation of complete blood count parameters in patient with acute myocardial infarction over 80 years of age and under 40 years of age

Aim: In our study, we compared the values of whole blood count (CBC) parameters, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR)
parameters of patients over 80 years and under 40 years of age with acute myocardial infarction (AMI). Material and Method: We performed a retrospective
study between 2011 and 2016 by screening the files of AMI patients who underwent primary percutaneous coronary intervention. A total of 259 patients under
40 years of age (Group 1) and over 80 years of age (Group 2) were included in the study. Results: When the hematological parameters were examined, white
blood cell (WBC), neutrophil, lymphocyte, thrombocyte, hemoglobin, hematocrit numbers were found to be significantly higher in Group 1 patients. When PLR
and NLR were examined (105.8 ± 67.6 & 149.2 ± 94; p <0.001, 3.2 ± 3.2 & 4.2 ± 4.4, p < 0.074 respectively), PLR was significantly higher in group 1. When
the age was correlated with hematological and biochemical parameters, there was a significant negative correlation with WBC, neutrophil, lymphocyte, and
platelet, was and a positive correlation with PLR, NLR, red blood cell distribution width (RDW), Gensini score and creatinine. Discussion: In elderly patients over
80 years, the hematological response of cells to acute events such as AMI was reduced due to the decreased bone marrow function.

Predictive and prognostic value of preoperative complete blood count in prostate cancer

Aim: The predictive and prognostic value of complete blood count (CBC) in different types of cancer has been frequently demonstrated in recent years. Prostate
cancer is the second most common cancer in men worldwide and is one of the most leading causes of death. In our study, we sought to find out whether CBC
parameters could distinguish patients with prostate cancer from patients with benign prostatic hyperplasia. Material and Method: Laboratory findings and
histopathological findings of totally 93 patients were retrospectively re-evaluated. The absolute neutrophil count (ANC), the absolute lymphocyte count (ALC),
platelet count, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and mean platelet volume (MPV) values were noted. In patients with
prostate cancer, pathological parameters such as prostate weight, tumor percentage, Gleason score perineural invasion, seminal vesicle involvement, apical
and radial margin involvement, extra-prostatic extension were determined. Results: In our study, we found that ANC, NLR, PLR, and MPV were significantly
different between patients with benign prostatic hyperplasia and with prostate cancer (p < 0.05). We found that ANC and MPV were much more successful
in discriminating these patients (p < 0.001). We have shown that ANC has higher specificity and MPV value has higher sensitivity. However, we didn’t find any
correlation between blood parameters and pathological parameters in patients with prostate cancer. Discussion: Our study has shown that ANC, NLR, PLR,
and MPV have the ability to discriminate malignant lesions from benign lesions. Although no correlation with pathologic parameters can be determined, we
think that CBC might be evaluated as an auxiliary tool for prostate cancer diagnosis.

The efficiency of prolotherapy in lateral epicondylitis

Aim: Lateral epicondylitis, is an overuse syndrome of the forearm extensor muscles. In this study, we aimed to investigate the effect of prolotherapy in patients

with lateral epicondylitis in terms of pain, and function. Material and Method: This retrospective study comprised 23 consecutive patients above 18 years of

age, who were diagnosed as lateral epicondylitis. Demographic data, VAS and DASH score were derived from chart review. Results: Our findings revealed that

prolotherapy treatment lead to statistically significant improvement in pain and function. Discussion: Prolotherapy has been proposed as a potential therapy

for chronic tendinitis and believed to produce a controlled inflammatory response and to stimulate an adequate fibroblastic proliferation and connective tissue

repair Pain reduction is also hypothesized to be related to the elimination of nerve fibers that are associated with neovessels or collagen fibril disruption and

subsequent healing response. Discussion: Prolotherapy is a safe and effective alternative option for patients with refractory lateral epicondylitis.

Video-assisted thoracoscopic treatment of benign mediastinal masses: analysis of 44 cases

Aim: Compared with the conventional surgical procedures, video-assisted thoracoscopic surgery (VATS) is an alternative method for the management of

thoracic pathologies. Along with recent advances, this method has become a standard approach to benign mediastinal lesions. In this study, it’s aimed to

emphasize the usefulness of VATS for the treatment of benign mediastinal masses. Material and Method: In this study, 44 cases that were diagnosed with

benign mediastinal mass operated by VATS in a single thoracic surgery department between January 2009 and January 2015 were evaluated retrospectively

and compared to literature data. The cases were analyzed according to age, sex, symptoms, signs, diagnostic procedures, pathological findings and postoperative

complications in the early period. Results: Forty-four benign mediastinal lesions approached with VATS were included in the study. The average age of the

cases was 49, and 28 of them were female while 16 were male, 27.3 % of cases were asymptomatic. The most frequent symptoms were: shortness of breath,

chest pain, and cough. In all cases, complete resection was performed by using VATS technique. Postoperative complication rate was 9.1% and 4.5% of those

was prolonged air leak. During the follow-up period recurrence has been developed in only 2 cases. Discussion: The localization and pathologic diagnosis of the

lesions are determinant for the treatment of benign mediastinal masses. Surgical approach with VATS plays an important role in diagnosis and treatment of

mediastinal lesions. VATS should be preferred priority in surgical treatment of mediastinal masses and cysts, due to postoperative advantages.

Elastofibroma dorsi: clinical experiences of 13 cases and review of the literature

Aim: Elastofibroma dorsi (ELD) is a rare soft tissue benign tumor of the chest wall. We aimed to investigate the epidemiological, clinical, paraclinical, and treatment

aspects of ELD. In the period between January 2009 and March 2018, 13 patients who underwent surgery for ELD were retrospectively analyzed in our

study. Material and Method: Data of 13 ELD patients who underwent surgery were obtained retrospectively from medical records. Clinical findings were evaluated

in terms of radiological, pathological and long-term results and compared with literature data. Results: During the study period 13 cases were operated

for elastofibroma dorsi. Mean age was 52,4 (36-68) and there were 12 females and 1 male patient. The tumor was located on the right side in 8 patients (61,5

%), on the left in 4 patients (30,7 %) and bilaterally in 1 patient (7,6 %). All patients had complaints of swelling and back pain developed during the shoulder

movements. All patients underwent complete resections. The tumor size ranged from 5 to 12 cm. The mean length of hospital stay was 3,6 days (1-6 days) with

a morbidity of 15,3 % (seroma observed in 2 patients). The mean follow-up was 29,3 months (4-76 months). In the follow-up period, clinical symptoms of all

cases were declined and no recurrence was observed. Discussion: Elastofibroma dorsi is a rare pseudotumoral lesion of soft tissue. In symptomatic cases, surgical

excision should be preferred. When encountering painful masses in the periscapular area in elderly female patients, ELD should be considered on diagnosis.

Mean platelet volume and nuclear red blood cells in patients with septal deviation

Aim: Nasal septal deviation is a frequent cause of nasal obstruction and is defined as the displacement of the nasal septum to one side. Mean platelet volume

(MPV) is a complete blood count parameter that provides information about the platelet size. Nuclear red blood cells (NRBCs) are the precursor cells of

erythrocytes. We aimed to investigate the MPV and NRBCs, which are complete blood count parameters showing changes in hypoxic conditions in the septal

deviation patients and people without nasal obstruction. Material and Method: Patients who underwent an operation due to septal deviation and patients who

had a septal deviation, but did not have symptoms were examined retrospectively between January 1st, 2017 and October 30 th, 2017. Our study population

was divided into 3 groups: Patients operated for septal deviation, with Septal Deviation but without symptom, without nasal obstruction, Patients who had

blood tests for tinnitus, etc., patients without respiratory complaints during the same period were also included in the study. Results: There was no significant

difference in the MPV parameters between the group with operation due to septal deviation and the group with nonsymptomatic septal deviation (p = 0,999).

There was no significant difference between MPV parameters between patients with no nasal obstruction and patients with septal deviation. (p = 0,595 and

0,520). In all groups, the NRBCs% parameter was no different from zero except 9 patients. Discussion: It is thought that the MPV and NRBCs parameters in

the operation and symptom evaluation of septal deviation patients will not provide any extra findings.

The cost analysis of varicose vein treatment techniques in Turkey: a benefit or profit problem?

Aim: Varicose veins are common healthcare problem in Turkey and worldwide. In this study, we compared the economic parameters of commonly used varicose

treatment techniques, particularly classical surgical techniques, endovenous radiofrequency ablation (RFA) and glue (cyanoacrylate) techniques’ costs, hospital

bills, and profits. Material and Method: A total of 100 patients who had varicose vein operations, were evaluated retrospectively between April 2017 and November

2017. These patients were divided into subgroups depending on the methods used such as classical surgical treatment or catheter-based techniques.

Demographic data including age, gender, hospitalization period, cost of the patient, amounts billed to SGK, and the patient-based profit/loss was analyzed for

groups of varicose vein treatments described above. Results: Twenty-nine patients (29%) were treated by surgery and 71 patients (71%) received catheterbased

treatments. Thirty-four patients (34%) were treated by glue injection, and 37 patients (37%) were treated by RFA. There was no difference between the

groups for the length of hospital stay (p > 0.05). The glue group had the highest cost (2093.8 ± 148.9 TL) while the surgery group had the lowest cost (618.2

± 365.4 TL), with the RF group in between (1453.1 ± 130.3) (p < 0.001). The RF group had the highest profit for the hospital (209.9 ± 261.3 TL), while the glue

group had the lowest profit (-66.3 ± 126.2 TL) (p<0.001). Discussion: The most suitable strategy seems to be RFA when profit is a concern. But the patient’s

wishes, anatomical properties, activity/working conditions and the physician’s choice for the welfare of the patient should be determinative.

Comparison of inflammatory level and symptom level in cases having chronic rhinosinusitis

Aim: The aim of this study was to investigate whether the endoscopic findings, coronal computed tomography data and the level of histopathological changes

observed in tissue samples had any effects on the quality of life in chronic rhinosinusitis cases. Material and Method: In this prospective study, 34 patients

diagnosed with chronic rhinosinusitis (Group 1) and 34 volunteer individuals having no chronic rhinosinusitis (Group 2) were included. Detailed anamnesis,

endoscopic examination findings, quality of life in patients with chronic rhinosinusitis questionnaire scores and coronal paranasal computed tomography

scores were recorded in the files of all the cases. Endoscopic evaluation findings were evaluated using the Lund-Kennedy scoring system, all the cases were

given a chronic rhinosinusitis evaluation questionnaire, coronal paranasal computed tomography findings were scored using the Lund-MacKay system. Results:

The average quality-of-life score, the average radiological score, the average endoscopic examination score, the histopathological evaluation of the surgical

specimens, the average inflammatory score, the average fibrosis scores and the average osteoblastic-osteoclastic score was statistically different between

two groups. When a correlation analysis was performed, the quality-of-life scores were found to have a negative correlation with the radiological scores,

endoscopic scores, fibrosis scores and osteoblastic-osteoclastic activity scores in Group 1. And also radiological scores were positively correlated both with

the endoscopic scores and the osteoblastic-osteoclastic activity scores and a positive correlation was found between the endoscopic scoring and the mucosal

inflammation in Group 1. Discussion: The results of our study showed that the histopathological changes affected the quality of life negatively.

Brucellosis and inflammatory markers: data from south-east province of Turkey

Aim: Brucellosis is the most common zoonosis in the world. It is commonly seen in developing countries and causes economic loss. Brucellosis is a major public

health problem. Therefore, early diagnosis of brucellosis is very important. The current study aims to investigate WBC, CRP, ESR, NLR, PLR and MPV levels,

when brucellosis was first diagnosed. Material and Method: The study included a total of 394 patients who were enrolled at our hospital between the dates

of January 2007 and June 2017. Among these patients 197 were cases of brucellosis and 197 were healthy controls. Results: WBC values were statistically

significantly lower in the patients with brucellosis, compared to the control group (p < 0.001). Otherwise, NLR, CRP, ESR and MPV values were statistically

significantly higher in the patients with brucellosis, compared to the control group (<0.001, 0.005, 0.001, 0.042, p values respectively). PLR values did not differ

statistically significantly between the groups (p = 0.468). Discussion: NLR is obtained from a whole blood count. NLR increases in inflammatory conditions

and this increase are regarded as a marker of systemic inflammation. In a study, it was determined that NLR values were significantly higher in the brucellosis

group than the control group (p = 0.032). Mean platelet volume indicates platelet size and activity. It is also used as a marker of platelet dysfunction.

Increased MPV level is associated with thrombotic disorders and endothelial dysfunction. In the study by Aktar et al. MPV values were significantly higher in

the brucellosis group than in the control group (p=0.026). Conclusion: NLR and MPV have been shown to be important markers that can be used in the first

diagnosis of brucellosis.

Application of vac in type III open fractures

Aim: Functional results of patients with Type III open long bone fractures treated with vacuum-assisted closure (VAC) and approximating sutures were evaluated.

Material and Method: A total of 21 patients (4 female, 17 male with a mean age of 27 years, range: 3–64 years) with Gustilo-Andersen Type 3 open

fracture were included in the study. The mean follow-up period was 25.67 months (range, 9–52 months). Thirteen patients had Type IIIB and eight patients

had Type IIIC open fractures. Following a large debridement and irrigation in an operating room setting, wound dimensions were measured. Subsequently, VAC

was applied. During the application, skin traction sutures were applied over the vacuum sponge. During the last dressing change in which a clean granulation

tissue was obtained, the wound was closed following the measurement of its dimensions. Wound dimensions measured during the large debridement in the

operating room were compared with the wound dimensions measured after the final VAC application. Results: Mean duration between trauma and operation

was 7.57 hours (range, 2–23 hours). The wound was closed with delayed primary suturing in seven patients. In the remaining 14 patients, wound dimensions

measured following the last VAC application were found to be decreased with a mean of 40.02% (range, 20-60%). Seven patients underwent a skin graft, two

had a free flap application, four had a fasciocutaneous flap, and one had a fasciocutaneous flap + graft application. Two patients underwent revision operations

for graft failure. Five patients (23.8%) developed a deep wound infection. The infections resulted in osteomyelitis in two patients (9.5%). Discussion: VAC

application together with skin traction sutures in Type IIIB and C open fractures decreases wound size dimension of a graft or flap to be applied. Also it may

reduce the requirement for secondary interventions.

Level of evidence: Level IV.

The importance of otoscopic examination in the hearing screening of neonates

Aim: Permanent hearing loss in children is congenital in more than 80% of cases. Hearing screenings of newborns are important in the early determination of

hearing loss. The aim of this study was to draw attention to the importance of a careful otoscopic examination before hearing screening in newborns. Material

and Method: In this retrospective study, the records of patients who underwent a hearing test according to the hearing screening program in our clinic between

January 2015 and January 2017 were examined. Evaluation was made of patient data with findings such as vernix caseosa, impacted cerumen, serous otitis

media, external otitis, and ear canal anomalies in the notes from the otoscopic examination conducted prior to the evoked otoacoustic emission (EOAE) test.

Results: The EOAE test was applied to 1417 patients immediately following otoscopic examination. The EOAE was normal in 1266 patients, while no response

could be obtained from the ears bilaterally in 91 patients and unilaterally in 60 patients. After follow-up and treatment of patients with serous otitis, ear debris,

or vernix caseosa determined in the otoscopic examination, hearing loss was determined with a repeated EOAE test as bilateral very advanced in 2 patients,

unilateral very advanced in 1 patient, moderately advanced in 2 patients, at 30 dB in 5 patients, and hearing neuropathy was considered in 1 patient. Discussion:

The significant improvement in hearing loss after treatment of vernix caseosa, cerumen, and serous otitis media has shown how important the otoscopic

examination as part of the initial hearing screening of newborns.

Research into the protective effect of syringic acid in rats with induced experimental pancreatitis

Aim: The aim of this study was to evaluate the protective effects of dietary syringic acid (SA) on the development and severity of cerulein-induced acute

pancreatitis (AP) in rats in terms of biochemical and histopathologic changes. Material and Method: 24 rats were divided into 3 equal groups. Three groups

were compared in terms of the levels of oxidative stress, antioxidant markers, pancreatic enzymes, and histopathological changes. This study was approved

by the ethics committee of our university and the project was supported by the scientific research unit (project number 2016 / 3-43 D). Results: In the pancreatitis

group, the amylase and lipase values were significantly higher and oxidative stress markers were significantly elevated; the Glutathione peroxidase

(GSH-Px) level was found to be significantly decreased in the pancreatitis group compared to the control and treatment groups. Apoptosis and cellular damage

level results were significantly higher in the pancreatitis group, while cellular damage in the treatment group was significantly lower (P < 0.05) than in the

pancreatitis group. Discussion: Although a syringic acid diet does not totally prevent AP, it has been shown to decrease the severity of AP on both enzymatic

and histopathological levels.

A case of Fahr s disease presenting with seizures

Fahr’s disease is a rare idiopathic bilateral and symmetrical calcification of the basal ganglia, thalami, subcortical hemispheric white matter and deep cerebellar nuclei.
We report an unusual case of Fahr’s disease in a 53-year-old man who presented with generalized seizure in our emergency department. Based on clinical, radiological
and endocrinological appearance, the patient was diagnosed with Fahr’s disease associated with hypoparathyroidism. Parenteral calcium and calcitriol supplementation
were given in the emergency department. The clinical outcome was favorable after the treatment. Our case illustrates that Fahr’s disease, though rarely seen, has to be
considered in a patient with convulsive state associated with calcifications of the basal ganglia.

A case of brainstem encephalitis treated with plasmapheresis

Brain stem encephalitis is a rare disease, which can be triggered by infection, with
an unclear etiology, in which infectious and autoimmune mechanisms are thought
to play a role in the pathogenesis. Major clinical symptoms are ataxia, muscle
weakness and ocular and bulbar dysfunction. Its etiology can vary from infection
to autoimmune reasons. Listeria, enterovirus type 71 and Herpes simplex
virus are the most common infectious causes. It may also be caused by neurobehcets,
Bickerstaff’s encephalitis, autoimmune diseases such as multiple sclerosis
and paraneoplastic reasons. With those in mind, the underlying etiology is
unclear in most cases. Treatment is based on etiology. Immunosuppressive
treatment can be tried in brain stem encephalitis patients whose etiology can
not be made clear. In this case report, we present a case of brainstem encephalitis
which did not respond to the present treatment and was treated with
plasmapheresis.

A rare cause in the differential diagnosis of abdominal pain: stercoral colitis

Stercoral colitis is a rare and often fatal complication of constipation.
Diagnosis of stercoral colitis is made in only 10% of patients before surgery.
A 45-year-old female presented to the emergency department with abdominal
pain and constipation. Computerized abdominal tomography was suitable with
the diagnosis of stercoral colitis. Stercoral colitis complications are related to
high mortality and morbidity. Early diagnosis and treatment should be started. We
have presented a rare case of “stercoral colitis” and have observed the diagnosis
and treatment methods in the light of literature information.

Could red cell distribution width in the first trimester be used to predict preeclampsia?

Aim: It has been reported that red cell distribution width (RDW) and hypertension are somehow related, but there is no well-established evidence about the

probable relationship between RDW and preeclampsia. The present study aimed to determine whether RDW in the first trimester can be used to predict the

presence and severity of preeclampsia. Material and Method: This is a retrospective review of 57 healthy pregnant women, 42 women with mild preeclampsia,

and 18 women with severe preeclampsia who delivered at the study center. These three groups were compared with respect to complete blood count parameters

obtained during the first trimester. Results: When compared with the control group, systolic blood pressure, diastolic blood pressure, leukocyte count, RDW,

blood urea nitrogen, and proteinuria were significantly higher in the severe preeclampsia group (respectively p<0.001, p<0.001, p=0.036, p<0.001, p<0.001,

and p<0.001). The median RDW values of control, mild, and severe preeclampsia groups were 12.51% (range: 10.6-15.02%), 13.2% (range: 10.45-15.5%), and

13.7% (range: 11.9%-14.7%). RDW was significantly higher in the severe preeclampsia group than in the control group (p<0.001) and mild preeclampsia group

(p=0.001). However, mild preeclampsia and control groups had statistically similar RDW values (p>0.05). Discussion: Increased RDW in the first trimester can

be utilized to predict severe preeclampsia, but RDW values do not seem to correlate with the severity of preeclampsia.