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.

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.

+45T>G single nucleotide polymorphism of adiponectin gene: Is it a factor in childhood obesity?

Aim: Childhood obesity is increasing in incidence and is strongly associated with obesity in adulthood. Several studies to explain the role of genetics in the pathogenesis of obesity have been performed. The aim of this study was to investigate the relation between +45T>G single nucleotide polymorphism (SNP) and childhood obesity. Material and Method: 268 obese and 185 healthy (control) children and adolescents aged 6-17 years were enrolled. Laboratory tests including fasting glucose, insulin level, and lipid profile were drawn only from the obese participants. The +45T>G SNP in adiponectin gene was analyzed from the members of both groups by a polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP) method. Results: The genotype frequencies of the adiponectin gene for +45 locus in exon 2 were 77.9%, 19.1%, and 3% in obese subjects and 72.1%, 23.5%, and 4.4% in the control group for TT, TG, and GG respectively (p=0.357), with the allelic frequency of the G allele 12.5% in obese subjects and 16.1% in controls (p=0.129). When we compared different adiponectin genotypes, there wasn’t any significant difference in frequencies of TT genotype (wild type) and non-TT (TG+GG) genotypes between the obese and control groups (p=0.162). Also, comparing GG genotype and non-GG (TG+TT) genotypes revealed no significant difference between the obese and control groups (p=0.439). Among obese subjects there were no significant relationships between different genotypes and clinical characteristics such as presence of hypertriglyceridemia, low high-density lipoprotein (HDL-C), hypertension, and insulin resistance. Discussion: In conclusion, in the present study, in a well-described obese and a control group of pediatric patients, we observed a lack of association between the +45T>G SNP and childhood obesity and its traits

Healthcare staff’s attitude on hand hygiene and exposure to contaminated materials

Aim: Healthcare staff may be exposed to many risks as part of their profession. Infection control and prevention measures aim to reduce risks to the hospital and healthcare staff. This study evaluated knowledge and attitudes of healthcare staff for hand hygiene and exposure to contaminated materials. Material and Method: The descriptive study was conducted among healthcare staff who volunteered to participate. Data were obtained using survey forms covering subject-related knowledge and attitudes of the healthcare staff. The study was conducted with 85 participants. Results: In this study, the numbers of times health care workers applied hand hygiene were grouped as “50 and below” and “over 50,” to indicate fewer or more than 50 times each day, and the rates were detected as 49% and 51% respectively. When asked which occupation group complied with hand hygiene most often in the work unit, the answers were as follows: nurses 81%, physicians 11%, and cleaning staff 8%. The most common answer to the question about the primary purpose of washing hands was to protect oneself (66%), followed by prevent transporting microorganisms (34%). Discussion: It is not easy to systematically measure belief and compliance; however, it is important and useful to evaluate the training needs of healthcare staff with questionnaires and observations at certain intervals and to organize in-service training programs continuously. This study has shown that there are still details to be corrected in terms of practices and attitudes despite training provided, that it is necessary to cover these details in training, and that the continuity of these studies should be ensure

Prognostic value of soluble factors of angiogenesis and adhesion processes in head and neck squamous cell carcinomas

Aim: In this study, we aimed to define the prognostic value of two factors related to angiogenesis and adhesion processes of head and neck squamous cell carcinomas. The prominent angiogenesis molecule is vascular endothelial growth factor (VEGF). The vascular cell adhesion molecule (VCAM) first attracted attention more than two decades ago as endothelial adhesion receptor with key function for leukocyte recruitment in term of cellular immune response. Material and Method: 35 patients with head and neck squamous cell carcinomas were enrolled in this study. The control group consisted of 20 people who had no sign of regional or systemic diseases. 33 patients were male and 2 patients were female. Mean age was 59.7 years (28-76). Results: We showed that VEGF levels in the patient group were significantly higher than in the control group (p=0.001). However, when comparing the VEGF levels of different stages, there was no statistical significant difference between the stages. Discussion: Serum VEGF levels can provide sufficient information for the early diagnosis of the disease but prognosis may not be evaluated according to the results of our study. VCAM levels were not specific and sensitive to use as a tumor marker but VCAM may be a valuable factor to determine the prognosis and tumor aggression in cancer patients.

Assessment of auditory brainstem responses in hypothyroidism and hyperthyroidism

Aim: This study aimed to determine the effect of thyroid hormone changes on hearing pathways by assessing audiometry and auditory brainstem responses of hypothyroid and hyperthyroid patients and to determine whether hypothyroidism and hyperthyroidism patients are at risk for hearing loss. Material and Method: Between June 2008-July 2009, 25 hyperthyroidism (Graves, Multinodular Goitre) and 25 hypothyroidism (Hashimato hypothyroidism) patients who were newly diagnosed in the endocrinology clinic of Düzce University Medical Faculty between the ages of 20-50 were taken into study. Audiometry and Auditory brainstem response (ABR) measurements were performed for each patient. Results: In audiometry findings of hyperthyroid patients, a sensorineural hearing loss was detected especially at high frequency when compared to normal control group. There was no significant difference in the ABR results when compared with the control group. When audiometric findings were interpreted in hypothyroid patients, a sensorineural hearing loss was detected especially at high frequencies when compared to the control group. When the ABR measurements of the control group were compared with the hypothyroid group, the wave latencies I., III., V. and I-III, I-V interpeak latencies were higher in the hypothyroid group, but the difference between the first wave latency and III-V and I-V interpeak latencies was not statistically significant (p> 0,05), but the difference between III., V. wave lattices and I-III interpeak latency was statistically significant (p <0.05). These changes in ABR waves suggest that there are retrocochlear problems in hypothyroid patients. Discussion: The results of our study suggest that both hyperthyroidism and hypothyroidism may have an impact on the hearing pathways.

The impact of liver transplantation on quality of life and the psychiatric consequences in one year

Aim: Liver transplantation (LT) is a challenging operation with a burden affecting patients, families, and donors. The aim of the study was to compare the prevalence of psychiatric disorders and symptoms, and the quality of life of patients waiting for LT, with patients one year after transplantation. Material and Method: The patients in the LT waiting list (n: 68), and the outpatients evaluated for routine controls twelve months after LT (n: 53) were included in the study. Thus, patients were evaluated cross-sectionally in two groups: the pretransplantation group (PrTG) and the post-transplantation group (PsTG). The patients were administered the Receiver Sociodemographic Data Form, Short Form-36 Health Survey (SF-36), Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-1), and the Hospital Anxiety and Depression Scale (HADS). Results: There was no difference by means of the sociodemographic and clinical variables between the two groups. The PrTG showed significantly lower levels in all of the SF-36 scores except the mental health subscale when compared to the PsTG. Current psychiatric disorder was found in 29.4% of the PrTG while in 20.8% of the PsTG. There was no significant difference in the prevalences of psychiatric disorders between the groups. Discussion: Liver transplantation provides improvement in most of the domains of the quality of life of patients except the mental health domain. After LT, patients continue to be under risk of psychiatric disorders even later in the follow-up.

Procalcitonin, c-reactive protein, leukocyte, mean platelet volume levels in bloodstream infections

Aim: Levels of Serum Procalcitonin (PCT), C-Reactive Protein (CRP), Leukocyte (WBC) and Mean Platelet Volume (MPV) were evaluated in sepsis patients. We evaluated the diagnostic accuracy of different inflammatory markers to discriminate sepsis caused by different pathogens. Material and Method: In this study we included 126 episodes of bacteremia from 126 patients with sepsis. Medical records of patients who had bacteremia caused by Gram-negative bacteria (GN), Gram-positive bacteria (GP) or yeast were reviewed, and information about PCT and other inflammatory markers was recorded. Mann-Whitney U test and Spearman’s correlation analysis were used for statistical analysis. Results: 60.4% of the cases (n=76) were GN, 31.7% (n=40) were GP and 7.9% (n=10) were yeast. There was a statistically significant difference between PCT, CRP, and MPV levels according to the microorganism (p=0.001, p<0.01). There was no statistically significant difference between WBC measurements according to the microorganism (p>0.05). Discussion: According to the microorganism, gram positivity cutoff points were determined for PCT as (≤12.17), CRP as (≤9.70) and MPV as (≤9.32). In bilateral comparisons, there was a significant increase in GN and yeast sepsis, while a significantly low level was found in GP sepsis. There was no significant difference between GN and yeast. When the measurements of PCT according to bacterial species are examined, the highest measurement was 44.6 ng/ml with Escherichia coli bacteria,  followed by Candida bacteria with 12.6 ng/ml. 

Relationship Between Neutrophil to Lymphocyte Ratio with Scoring Systems of Pneumonia Severity

Aim: Today, community-acquired pneumonia remains one of the causes of high mortality and morbidity. In this study, we aimed to demonstrate the relationship between NLR, which was found to be a marker related to the systemic inflammation in the recent studies, and PSI, CURB-65, and PIRO, which were developed to predict hospitalization, being taken to an intensive care unit, and prognosis in patients with community-acquired pneumonia, and mortality. Material and Method: 100 patients admitted to the department and intensive care unit with the diagnosis of community-acquired pneumonia were included in the study. The patients underwent physical examinations and their medical histories were taken when admitted to the hospital. The biochemistry, hemogram, arterial blood gas examinations were analyzed. Their Pneumonia Severity Index (PSI), CURB-65 (Confusion, Blood Urea Nitrogen, Respiratory Rate, Blood Pressure, Age ≥65), and PIRO (Predisposition, Infection, Response, Organ dysfunction) scores were calculated. NLR was defined as absolute neutrophil count divided by absolute lymphocyte count. Results: 67 of the patients in the department and another 33 in the intensive care unit were followed. The average age of patients followed in the intensive care unit was 75.3±10.3 and the average age of patients followed in the department was 66.8±12.5. A positive correlation was found between NLR and CURB-65, PIRO, and PSI scores (respectively: r: 0.354 p<0.001, r: 0.290 p: 0.003, r: 0.302 p: 0.002). In the ROC curve analysis, for the estimation of CURB-65 > 2 score, NLR had a 6.26 predictive value (AUC:0.762, 95% CI:0.662-0.863, p<0,001), 76% sensitivity and 60% specificity; for the estimation of PIRO 4-5-6 score, NLR had a 6.67 predictive value (AUC:0.687, 95% CI:0.569-0.806, p=0.013), 67% sensitivity and 60% specificity; for the estimation of PSI score, NLR had a 5.55 predictive value (AUC:0.637, 95% CI:0.523-0.750, p<0,001), 62% sensitivity and %58 specificity. Patients who died had significantly higher NLR levels in proportion to the survivors (13.5+9 vs 7.9+6.8, p=0.010). However, in the ROC curve analysis for the estimation of death, NLR was not superior to CURB, PIRO, and PSI scores. Discussion: NLR, a non-specific inflammatory marker that can be calculated quickly and easily in the routine hemogram examination, and is closely related to the scores regarding the severity of patients with CAP. Although it is not superior to the score systems in the estimation of death, it can be used for the same purpose as the score systems

Impact of resistive exercise versus aerobic exercise on bone mineral density in postmenopausal women

Aim: Osteoporosis is a major public health problem and the most common skeletal disorder. It has been described as a silent disease affecting millions worldwide. This study was aimed to determine the impact of resistive exercise versus aerobic exercises on bone mineral density in post-menopausal women. Material and Method: Forty post-menopausal women participated in this study, ranging in age from 50 to 60 years. They were divided into two groups equal in number, Group (A) who performed combined upper and lower body resistive exercise for 30 minutes, three times per week, for 12 weeks in addition to their usual daily calcium intake and group (B) who performed aerobic exercise for 30 minutes, three times per week, for 12 weeks in addition to their usual daily calcium intake. All subjects in both groups (A and B) were assessed pre- and post-treatment through measuring bone mineral density (BMD) of hip and lumbar regions by DEXA. Results: The results of the present study revealed that there was a highly statistically significant increase in BMD of hip and lumbar regions after treatment, with p<0.005 in both groups (A&B). However, there was a non-statistically significant difference between groups after treatment in BMD of hip and lumbar regions, p > 0.05. Discussion: It can be concluded that there is no preference of resistive exercise or aerobic exercise in their effect on improving bone mineral density in post-menopausal women.

Comparison of liquid based cytology cervical smears with histopathological findings

Aim: Cervical cancer is still a health problem in countries where cervical cancer screening is not routinely performed. A significant decrease in the rate of mortality from cervical cancer has been observed since the Pap test was introduced. Within the last decade liquid-based cytology (LBC) has replaced the Pap test. Our aim is to compare cervical smears prepared with the liquid-based cytology method with histopathological findings. Material and Method: Cervical smears and corresponding cervical biopsy reports of 300 patients diagnosed with epithelial cell abnormality between 2014-2016 were reevaluated retrospectively. Smears were prepared with the LBC test SurePath. Biopsy materials were stained with  hematoxylin eosin. Slides were reported according to Bethesda 2014 classification. Biopsy materials were classified into 4 categories according to the WHO 2014 classification. Results: Cytology results of 273 patients (91%) were abnormal. Biopsy results showed lesions such as low grade cervical intraepithelial lesion, high grade cervical intraepithelial lesion, and squamous cell carcinoma in 178 patients (59.3%). The calculated sensitivity and specificity for LBC were 89.89% and 7.38% respectively, indicating low accuracy of specificity for LBC. Discussion: The management of treatment in diagnosis of epithelial cell abnormality in cervical cytology should be according to the sets of specified protocols. Because we may encounter high grade squamous intraepithelial lesions in biopsy with the diagnosis of atypical squamous cells of undetermined significance (ASCUS) in cytology, the necessity of colposcopy can be disputed for the management of this group of lesions. 

Elimination of clinical biochemistry laboratory tests through artificial intelligence programs to increase cost-effectiveness

Aim: The aim of the study was to evaluate the efficacy of software programs such as ALIN IQ, to prevent the regular practice of unnecessary testing in the preanalytical phase, which could save millions of dollars. Material and Method:  This study was conducted using data obtained from certain tests using the ALIN IQ software developed by Abbott Core Laboratory. The software implements algorithms defined by the information management system of the hospital to manage laboratory test ordering by clinicians. In the study, three tests—AST, direct bilirubin, and free PSA—were blocked by the software. Instead, the software suggested ALT, total bilirubin, and total PSA tests as preferences when ordered along with other tests sent to the c16000 biochemistry analyzer. Results: In this study, data on numbers of tests (ALT, AST, PSA) run over a one-month period were acquired from ALIN IQ software in a laboratory that runs 2,444,024 tests per year. Findings showed that 11,137 AST, 6,856 direct bilirubin, and 1,340 free PSA tests were ordered unnecessarily over the course of the month, and that avoiding these three tests (AST, direct bilirubin, and free PSA) provided savings of 77.96% from AST, 77.22% from direct bilirubin, and 72.45% from free PSA, corresponding to a projected 231,996 unnecessary tests per year. Discussion: Given the rise of global healthcare costs, reducing laboratory expenditures costing billions of dollars has been discussed in many articles, and different suggestions have been put forward. The present study showed that in addition to the measures set in place in the preanalytical phase, the costs of medical tests could also be reduced through the use of intelligent software programs in the analytical phase.

Association of inflammation markers with epicardial adipose tissue in drug naïve metabolic syndrome

The metabolic syndrome (MetS) or syndrome X is a serious health problem effecting an increasing number of person worldwide. In the present study, the aim
was to investigate whether there is an association among epicardial adipose tissue thickness, insulin resistance, lymphocyte to monocyte ratio (LMR) and
monocyte count-to-high density lipoprotein cholesterol ratio (MHR) levels in drug naïve patient with metabolic syndrome. Twenty-two consecutive drug-naïve
women diagnosed with MetS and 30 age matched consecutive healthy women (as the control group) were recruited into the study. MHR was significantly
higher [12.1 (10.5–16.4) vs 10.3 (7.0–13.8); p <0.01], whereas LMR was significantly lower in patients with MetS [ 3.6 (2.5–4.1) vs [4.1 (3.3–5.9) p = 0.02]. The
present study shows that both LMR and MHR may be novel and useful indicators of MetS.

Deep vein thrombosis after sodium hyaluronate injection to knee joint: a case report

Hyaluronic acid is widely used in medical procedures such as intra-articular injections. In addition to some risks of this procedure such as sepsis and injury to neighboring

structures, deep vein thrombosis and pulmonary embolism should be kept in mind as rare complications. For this reason it is recommended that intra-articular injection

of hyaluronic acid be performed by the ultrasound guidance (usg) method. In this report we present a 67-year-old man with lower extremity deep vein thrombosis following

a sodium hyaluronate injection to the right knee joint due to lower extremity pain. The patient was treated with warfarin sodium and low molecular weight heparine

and recanalized flow was achieved in common, superficial, and deep femoral veins and in the popliteal vein within the six-month follow-up period.

The evaluation of thyroid function tests in patients presenting to the family medicine clinics

Aim: Publications concerning the effects in society of recommendations regarding iodine supplementation over the last approximately 30 years are inconsistent.

In addition to studies suggesting that iodine supplementation is insufficient, others report that it can lead to hyperthyroidism. We planned this study in

order to investigate the results of iodine supplementation in our region through the retrospective screening of records of patients presenting to the family

medicine clinics. Material and Method: This was a retrospective, cross-sectional study. Five hundred seventy-two patients undergoing TSH and free T3 and

free T4 measurement were included. All numerical data were categorized and expressed as number and percentage and then subjected to chi square analysis.

Results: Free T3 and free T4 values were within reference ranges at a level of almost 100%. However, only 85% of TSH values were within references ranges,

and 12.9% were low. Discussion: The suppression of TSH values in this study shows an increased predisposition to subclinical hyperthyroidism. In the light of

these findings, hyperthyroidism must be carefully monitored in addition to hypothyroidism in the approach to thyroid diseases.

Rapid and sensitive determination of carnitine profiling by tandem mass spectrometry can be a diagnostic marker of paroxysmal atrial fibrillation

Aim: Paroxysmal atrial fibrillation (PAF), which is in the sub-group of atrial fibrillation that spontaneously resolves within 48 hours and does not last more than

7 days, is one of the most important causes of cryptogenic stroke. Other than ECG findings, there are no biochemical diagnostic criteria for PAF. Early diagnosis

of PAF reduces the risk of morbidity and mortality. Therefore, it is important to identify new diagnostic markers. Metabolomics methods have recently started

to be used for this purpose. Carnitine profiling with LC-MS/MS is a fast, inexpensive metabolomics screening method with high sensitivity and has started to

be used for the determination of new diagnostic markers. The aim of this study was to investigate the viability of the carnitine profile as a new biochemical

marker supporting diagnosis in PAF patients. Material and Method: A total of 27 carnitine ester profiles were examined with the LC-MS/MS method using

serum samples taken from 41 patients diagnosed with PAF from ECG findings and 42 healthy individuals with sinus rhythm. Results: The C14, C16:1, and C18:1

serum carnitine ester levels of the PAF patients were determined to be statistically significantly higher than those of the healthy control group (p<0.05) and

C6DC levels were found to be significantly lower (p<0.05). Discussion: The results of the study strengthened the view that with measurements made with LCMS/

MS, the carnitine profile, which is an inexpensive, sensitive reference method, can be used as an objective biochemical test to support diagnosis.

Linear fractures of the cranium: follow-up and management results of 442 cases

Aim: We aimed to evaluate the clinical and radiological follow-up of cases with isolated linear fractures detected in the cranium in the post-traumatic period, to determine on which cases and when to perform control radiological examinations and to suggest follow-up protocol. Material and Method: 442 cases with isolated linear cranium fracture were evaluated in the study. Imaging examinations and clinical findings of the cases at the time of admission were compared with radiological examinations and clinical findings at follow-up. Fracture localizations and trauma types were compared. Accompanying maxillofacial fractures depending on the localization of fractures detected in the cranium were determined. Results: In the follow-up CT examinations of 18 out of 442 cases, cerebral contusion in 12 cases and epidural hematoma in 1 case, not detected during initial admission were found. Post-traumatic epilepsy was observed in 4 cases without radiologic findings. In cases receiving follow-up radiological examinations, no significant difference was found between radiological examinations performed during 4-6 hours versus 12-24 hours after trauma. Discussion: Isolated linear fracture cases do not require neurosurgical intervention. The treatment protocol may change depending on findings during the follow-up period. Performing routine follow-up radiological examinations is not cost-effective in cases in which no additional finding is present, and symptoms do not persist.

Which site is least painful during intravenous cannulation?

Aim: The aim was to determine the least painful cannulation site in patients via the Visual Analogue Scale. Material and Method: Of 104 patients (53 women) admitted to the Emergency Department of Meram Medical School of Necmettin Erbakan University, 45 were cannulated through antecubital site, 33 by wrists and 26 via dorsal. No difference was detected between groups as to age and gender. All cases were cannulated by the same nurse using pink cannulas. The patients were asked to mark the severity of pain during procedure on the Visual Analogue Scale where scores range from 0 to 10. Results: When a significant difference was found between the groups via the Kruskal-Wallis test as to the Visual Analogue Scale scores, the Mann-Whitney-U test with Boferroni correction was performed. Therefore, while the pain on antecubital site was found to be significantly lower during cannulation compared to that found on wrist and dorsal, no difference was found between the pain scores detected on wrist and dorsal. Discussion: The antecubital site, a commonly used area for cannulation, was determined to be the least painful area when compared to other sites. It provides easy access to the vein, which may why it is commonly used, and may also be one of the reasons. It is the least painful area during cannulation. In the present study performed in 104 patients, the antecubital area was significantly the least painful cannulation site compared to wrist and dorsal. In patients required to be cannulated, the antecubital site is considered preferable due to painlessness unless specific complications are present.

Are gastrointestinal stromal tumours really asymptomatic?

Aim: Gastrointestinal stromal tumours (GISTs) detected incidentally during abdominal surgical interventions or imaging may cause serious morbidity and mortality.

We retrospectively investigated the histopathological diagnoses of GISTs made in our clinic and possible symptoms caused by the tumours prior to diagnosis.

Material and Method: We retrospectively reviewed the files of patients who underwent surgery in the general surgery clinic of Kahramanmaras Sutcu

Imam University between April 2012 and January 2017 and who were histopathologically diagnosed with GISTs; all were included in the study. Demographic

data including age and sex, and data on preoperative complaints at the time of admission, tumour location, metastasis, local recurrence, and death were obtained.

Results: The mean male and female patient ages were 57.1 ± 15.2 and 51.3 ± 15.3 years, respectively. Abdominal pain was the most common symptom

(46.2%); other symptoms included weight loss, a palpable abdominal mass, constipation, incontinence, and lower gastrointestinal tract bleeding. The ileum was

the most frequently involved region of the gastrointestinal tract (30.8%); other affected areas included the jejunum, lower intestinal tract, omentum, rectum,

peritoneum, stomach, and pancreas. The CD117 positivity rate was 92.3%, the CD34 positivity rate was 50%, the actin positivity rate was 69.2%, and the

desmin positivity rate was 15.4%. Discussion: GISTs are generally found incidentally, but they are accompanied by some symptoms in most of patients. However,

as the symptoms are shared by many diseases, they are often overlooked by doctors and patients; these tumours are not diagnosed in a timely manner.

A tomographic evaluation of the tuffier line in patients with hip fracture

Aim: The aim of this study was to compare the vertebral level of the Tuffier line in patients with hip fracture with the level in a control group using computed

tomography (CT) examination, and to determine whether or not the Tuffier line changed location according to age and gender. Material and Method: CT images

were examined of 55 patients aged >18 years with hip fracture who presented at the Orthopaedics Clinic and of 55 patients as a control group who had

lumbar CT taken for any other reason. Results: A total of 110 patients were included in the study, comprising 46 males and 64 females. The Tuffier line was

determined at higher levels in the patients with hip fracture compared to the control group (p=0.006). While there was no significant relationship between

gender and level in the hip fracture group (p=0.579), the Tuffier line was determined to be at lower levels in the females of the non-fracture group (p=0.000).

Discussion: The results of this study showed that in hip fracture patients there could be a change according to age and gender. In particular, as the Tuffier line

in hip fracture patients crosses a higher vertebral level compared to the normal population, to reduce the complication rate in the application of neuroaxial

anaesthesia, it would be more appropriate to use auxiliary methods additional to the Tuffier line when determining the entry point.

Surgical management of thyroid follicular neoplasms: A retrospective analysis of 128 patients

Aim: The most appropriate surgical management of follicular neoplasm/suspicious for follicular neoplasm (FN) lesions is still controversial. The aim of the

study is to analyze the outcomes of surgical procedures in the treatment of FN patients. Material and Method: We retrospectively evaluated 128 patients,

surgically treated after an FN diagnosis. Total thyroidectomy (TT) or hemithyroidectomy (HT) was performed according to the clinical signs of the patients.

The main criteria for HT were a single nodule, nodule size, younger age, and the absence of thyroiditis or clinical/intraoperative suspicion of malignancy. Age,

gender, associated thyroiditis, and nodule size were compared along with definitive pathology. Complication rates were also evaluated. Results: TT was performed

in 87/128 (68%) and HT in 41/128 (32%) patients. Completion thyroidectomy was required in only 6/41 HT patients. The overall malignancy rate was

37/128 (28.9%); 32.4% (12/37 patients) following HT, and 67.6% (25/37 patients) following TT, respectively. No complications were reported in the HT group.

Discussion: Considering the low risk of FN lesions, HT is an appropriate method for treatment in selected patients with minimal morbidity. However, in cases

of multinodular disease, associating chronic thyroiditis, or a higher risk of cancer, TT should be recommended.

Effectiveness of the mulligan mobilization technique in mechanical neck pain

Aim: The aim of this study was to investigate the effectiveness of Mulligan Mobilization technique in participants with mechanical neck pain. Material and

Method: A total of 40 participants (35 female, 5 male) aged between 25 to 50 years were included the study. Participants were randomly divided into two

groups as Mulligan Mobilization group and control group. The participants in both groups received home exercise program. The participants were treated

10 times for two weeks. Pain (Visual Analog Scale), muscle strength (stabilizer pressure biofeedback, Hand Held Dynamometer), range of motion (universal

goniometer) pain threshold (algometer), disability level (Neck Disability Index), quality of life (Nottingham Health Profile), depressive symptoms (Beck Depression

Inventory), cervical performance level (cervical performance tests) were measured at baseline, after the treatment program and repeated 1 month and

3 months after the end of the treatment. Results: In both groups’ pain intensity, pain threshold, muscle strength, performance level, the range of motion,

disability, depression, and quality of life improved after the treatment program (p<0.05). Discussion: The results of this study showed Mulligan Mobilization

treatment program has positive effects on pain, the range of motion, muscle strength, performance level, disability, depressive symptoms, and quality of life

in participants with mechanical neck pain.