Objective: The alpha atrial natriuretic hormone (α-ANH) is released in response to atrial distension and excessive fluid volume in the body. The aim of the present study was to evaluate α-ANH levels before and after pneumonectomy and to investigate the effects of normal and increased volume of crystalloid–colloid fluids on α-ANH following pneumonectomy in a rabbit model.
Methods: A total of 20 New Zealand rabbits were used in the study. The mean weight of the rabbits was 1.831 g. The subjects were divided into four groups with five in each group. The first group was given 3 mL/kg/h of crystalloid; the second group was given 10 mL/kg/h of crystalloid; the third group was given 3 mL/kg/h of colloid; the fourth group was given 10 mL/kg/h of colloid. Blood samples were preoperatively collected from the jugular vein. Posterolateral thoracotomy was applied to all subjects. The hilus was tied and cut en bloc with 2/0 silk, and pneumonectomy was performed. All groups received infusion for 3 h. Following infusion, blood samples from the contralateral jugular vein were collected at postoperative 3 h. Pre- and postoperative α-ANH levels were compared.
Results: There was no significant difference in the mean weight of the groups (χ2=1.417, p=0.478). There was no significant difference in the pre- and postoperative α-ANH levels among all groups (Z=0.674, p=0.5 in the first; Z=0.405, p=0.686 in the second; Z=1.753, p=0.08 in the third; Z=0.944, p=0.345 in the fourth).
Conclusion: Our study results suggest that pneumonectomy alone appears not to change the α-ANH levels, and hypoxia, increased atrial pressure, and some neurohormonal factors may enhance α-ANH release.

INTRODUCTION: Vitamin D deficiency may play a role in the pathogenesis of preeclampsia by causing abnormal placental implantation and by affecting the inflammatory response. The aim of this study was to compare the cord blood vitamin D level in neonates born to preeclamptic mothers with that of a control group of newborns whose mothers were not preeclamptic.
METHODS: The preeclamptic group was made up of newborns of mothers classified as having moderate to severe preeclampsia. Neonates of a similar gestational age and birth weight born to normotensive mothers comprised the control group. The cord blood vitamin D level of both groups of newborns was measured and the results were statistically compared.
RESULTS: Sixty neonates born to preeclamptic mothers and 47 born to normotensive mothers were included in the study. The mean serum vitamin D level of the study group was 12.62±5.43 ng/mL and 12.85±5.56 ng/mL in the control group. The percentage of those determined to have a serum vitamin D level <20 ng/mL in the study and the control groups was 89.5% and 88.9%, respectively. The serum magnesium level in the study group was statistically greater than that observed in the control group (p<0.001).
DISCUSSION AND CONCLUSION: The cord blood vitamin D level of those born to preeclamptic mothers was not found to be statistically different when compared with the vitamin D level of neonates of normotensive mothers.

INTRODUCTION: Malignant pleural effusions (MPEs) cause a decrease in the quality of life and are the most important cause of anxiety in this group of patients. Currently, it is aimed not only to eliminate the diseases but also to increase the quality of life of individuals. The aim of the present study was to determine the effect of pleurodesis on the quality of life of patients with MPE.
METHODS: Twenty-four patients who underwent pleurodesis were prospectively included in the study. Talc pleurodesis was performed to the patients by tube thoracostomy. The 36-Item Short Form Survey (SF-36) quality of life scale was applied to the patients during their hospitalization and on day 11 of discharge. Data were analyzed statistically.
RESULTS: Female patients comprised 70.8% (n=17) of the cases. The mean age of the patients was 54.29±13.84 years. Fifty percent (n=12) of the cases were applied pleurodesis due to pleura metastasis of breast cancer, whereas 29.2% (n=7) due to lung cancer and the rest (20.8%, n=5) due to ovarian carcinomas, respectively. As a result of the comparison of the responses of the patients to the SF-36 quality of life results before and after the procedure, pleurodesis provided significantly positive results on all parameters (p<0.05) except for only mental health (p=0.20).
DISCUSSION AND CONCLUSION: The main reason for impairment in mental health is that patients have advanced cancers. We believe that the explanation of that is if pleurodesis does not change the stage of cancer. However, the presence of significant contribution of the treatment on all of the other parameters is an indication of how important pleurodesis is. Our study also provided hints that young patients can benefit more from pleurodesis. We think that the patient’s cachexia status due to primary disease has no effect on the quality of life that pleurodesis provided. We believe that pleurodesis should be performed in all patients with MPE, if possible.

INTRODUCTION: Generalized joint hypermobility (GJH) is a condition of the connective tissue, which has movement ability beyond the normal limit of synovial joints. Its effects on disc degeneration and neck pain are not fully known. The aim of the present study was to determine the relationship between GJH and cervical disc degeneration that is detected in magnetic resonance imaging (MRI) and also neck pain.
METHODS: Cases aged between 20 and 50 years who were admitted to outpatient clinics with neck and arm pain were included in the study. Their cervical MRIs were evaluated. Beighton score was used to evaluate these cases for GJH, and they were also evaluated prospectively using the Visual Analog Scale (VAS) for pain and Neck Disability Index (NDI) for disability.
RESULTS: Of the 75 cases, 59 (78.7%) were female, 16 (21.3%) were male, and GJH was found in 15 (20%). There was no statistically significant difference in the values of Miyazaki grade parameters in all cervical disc levels and VAS and NDI values between the patients with and without GJH (p>0.05).
DISCUSSION AND CONCLUSION: This result suggests that GJH may not be a single risk factor for cervical disc degeneration, and VAS and NDI values increase in patients aged between 20 and 50 years.

INTRODUCTION: Restless legs syndrome (RLS) is a common sleep disorder. In addition to disturbing sleep, however, RLS also affects quality of life and may lead to significant fatigue or psychiatric symptoms. This study was an examination of the effects of RLS on quality of life and symptoms of anxiety and depression.
METHODS: In this study, 55 patients (7 males and 48 females) who met the diagnostic criteria of idiopathic RLS and 35 healthy individuals (8 males, 27 females) were evaluated using validated Turkish versions of the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), the International Restless Legs Syndrome Study Group (IRLSSG) rating scale for the severity of RLS, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), the Fatigue Severity Scale (FSS), and the Short Form Health Survey (SF-36), which measures quality of life.
RESULTS: Fifty-two patients who met the diagnostic criteria for idiopathic RLS were evaluated in Group I and 35 healthy controls were included in Group II. A statistically significant difference was observed in the PSQI, ESS, ISI, BDI, BAI, FSS, and SF-36 questionnaire results in the RLS group compared with the control group. The mean score of the SF-36 Physical Component Summary (PCS) scale was significantly lower among RLS patients than that of the healthy subjects. There was a negative correlation between the PCS score and RLS severity, fatigue, insomnia, daytime sleepiness, sleep quality, anxiety, and the level of depressive symptoms. Multivariate linear regression analysis indicated that the FSS and BDI values were influential variables on the PCS score.
DISCUSSION AND CONCLUSION: The results of the present study demonstrated that patients with idiopathic RLS experienced significantly impaired quality of life and the psychiatric symptoms of anxiety and depression.

INTRODUCTION: The aim of the present study was to evaluate the treatment modalities and recurrence status of patients diagnosed with phyllodes tumor in light of a literature search.
METHODS: All female patients who received treatment for phyllodes tumor between January 2015 and January 2017 were included in our study. All data were collected through retrospective analysis. Histopathological results, type of surgery, application of chemoradiotherapy, tumor size, recurrence rate, and demographic data were analyzed.
RESULTS: Twenty-five cases were evaluated. Of the 25 cases, 8 were diagnosed as malignant. The rest were 3 borderline and 14 benign and fibroadenomas. Three of 8 malignancies were treated with mastectomy, and the other 5 were treated with wide local excision. Recurrence occurred in two cases; one of them received chemotherapy, and the other had chemoradiotherapy. All 17 remaining patients underwent wide local excision. A single case was treated with mastectomy due to large tumor size.
DISCUSSION AND CONCLUSION: There is still an ongoing debate for the treatment of phyllodes tumors. Negative margins for malignant cases play a major role for successful treatment. There is no consensus for the application of chemo- and radiotherapy.

INTRODUCTION: Establishing a safe pneumoperitoneum in laparoscopic surgery is the beginning of the surgery. This study aimed to compare Veress needle insertion (VNI) and direct trocar insertion (DTI) methods.

METHODS: A total of 122 patients who underwent laparoscopic intervention mainly laparoscopic cholecystectomy, between August 2017 and February 2018, in the general surgery clinic were randomized. Among all patients, 62 were insufflated and operated using VNI and 60 with DTI method. The number of laparoscopic entrances, time of entry, complications, and postoperative pain were compared between the groups.

RESULTS: The two groups were similar in terms of demographic characteristics. A statistically significant difference was observed between the DTI and VNI groups regarding the entry time, pneumoperitoneum formation time, and gas leakage variables. A statistically significant difference was also observed between the DTI and VNI groups in the number of insertions. For the other variables, no statistically significant difference was observed between the DTI and VNI groups.

DISCUSSION AND CONCLUSION: In DTI, the duration of the generation of the pneumoperitoneum was significantly shorter. However, gas leakage was higher in the DTI group. No significant difference was observed in other variables. The DTI may be preferable to VNI according to time.

INTRODUCTION: Thyroglossal duct cysts (TGDCs) are one of the most common midline neck masses in children. They may be found in adults as well. The aim of this study was to evaluate the demographics of patients diagnosed with TGDCs and to discuss the diagnosis, treatment plans, and follow-up details.
METHODS: The data of 91 patients diagnosed with TGDCs in our clinic between January 2010 and February 2017 were obtained. They included demographics, medical records, a postoperative follow-up, and complications. The pathology confirmed TGDCs in all 91 cases.

RESULTS: Of 91 patients, 49 (53%) were males, and 42 (46%) were females. The mean age of patients was 20.29. Patients complained of a cystic midline mass in 47 (52%) of cases, and fistulas in the midline neck area in 43 of (47%) cases. All patients underwent the Sistrunk procedure. Fourteen (15%) patients relapsed.

DISCUSSION AND CONCLUSION: TGDCs should be considered in differential diagnosis of midline neck masses in all ages. A physical examination and ultrasonography are the easiest and the most accurate methods in diagnosis. The Sistrunk procedure with its low recurrence rates is the gold standard method in the treatment.

INTRODUCTION: Hepatitis B virus (HBV) affects over 400 million people in the world and is a major threat despite all measures taken for its prevention. It is one of the most important causes of liver cirrhosis. Liver cirrhosis causes malnutrition as a result of decreased oral intake, both because of the disease itself and multiple other reasons. Studies showed an inverse correlation between muscle mass and insulin resistance. We aimed to evaluate the relationship between insulin resistance, muscle mass, and muscle strength in patients with HBV-related cirrhosis.

METHODS: We included 65 patients with HBV-related cirrhosis in Child-Pugh class A and B groups and 65 healthy control individuals in this monocentric study. Muscle mass indices were calculated with bioimpedance analysis for both groups to determine muscle strength and muscle mass. Handgrip strength, arm, and calf circumferences were measured. In both groups, HOMA-IR values were calculated to determine insulin resistance. Correlations of fasting glucose, fasting insulin, HbA1C, LDL, HDL, triglyceride, and cholesterol levels with calf and waist circumference measurements were detected. The relationship between muscle mass and insulin resistance, laboratory results, and waist and calf circumference was evaluated.

RESULTS: The mean value of muscle mass index was 10.98±11.40 kg/m2 in cirrhotic patients and 9.88±1.12 kg/m2 in healthy control individuals. HOMA-IR values were detected as 3.47±3.80 in the study group and 1.83±1.20 in the control group. The correlation coefficient between muscle mass and insulin resistance was statistically insignificant, especially in the study group.

DISCUSSION AND CONCLUSION: In our study, there was no relationship between muscle mass and insulin resistance in cirrhotic patients with hepatitis B.

INTRODUCTION: The association of lymphopenia detected in patients with sarcoidosis with disease activity was investigated in the present study.
METHODS: Patients who were diagnosed as having sarcoidosis and healthy volunteers/individuals with no diagnosis of active disease between July 2016 and June 2017 were included in this study. Patients who were detected to have an absolute lymphocyte count (ALC) of <1.3 × 10³/mm³ were accepted as lymphopenic patients. The detection rates of lymphopenia were compared between two groups. The respiratory function testing-diffusing capacity of the lungs for carbon monoxide (RFT-DLCO) levels and the high-resolution computed tomography (HRCT) results of patients with and without lymphopenia in the sarcoidosis group were compared.

RESULTS: In the sarcoidosis group, 77 patients were included, and in the control group, 41 patients were included. The number of lymphopenic patients in the sarcoidosis group was 21 (27.2%), and that in the control group was 1 (2.4%) (p=0.001). The percentaged DLCO value of 33 patients (28%) was below 80%; however, the percentaged DLCO value of 44 patients was higher than 80% in the sarcoidosis group. The mean ALC of patients in the sarcoidosis group who had a DLCO value of <80% was 1.6±0.7; however, the mean ALC of patients who had a DLCO value of >80% was 2±0.7 (p=0.016). A positive correlation was detected between ALC and DLCO% (p=0.044, r=0.230). Although lymphopenia was detected in 42% of patients whose DLCO value was <80%, lymphopenia was detected in 15% of patients whose DLCO value was >80% (p=0.01). No significant association was detected among the sarcoidosis stage, symptom, and radiologic findings of the patients with the absolute lymphocyte count (p>0.05).

DISCUSSION AND CONCLUSION: Lymphopenia is frequently detected in patients with sarcoidosis. Lower DLCO values may be detected in patients with lymphopenic sarcoidosis.

INTRODUCTION: Seasonal and weather changes may affect the development of pulmonary embolism. The effects of seasonal and meteorological factors on mortality are controversial. We aimed to investigate the effects of seasons and meteorological data on patients with a low and high pulmonary embolism severity index and those with 30-day mortality.

METHODS: Pulmonary embolism cases were included in our study. Daily pressure, humidity, temperature, and wind values were taken from the general online information by the Directorate of Meteorology. All cases were divided into the low-risk and high-risk group, using a simplified pulmonary embolism severity index.

RESULTS: Eighty-six patients diagnosed with pulmonary thromboembolism were included in the study. Comparison between the two groups revealed that the disease was detected during winter in the high-risk group (31.3%) and during summer in the low-risk group (59.1%) (p=0.011). No statistically significant results were found on the day of diagnosis and pressure, humidity, temperature, and wind averages on the 7th day based on the severity index (p>0.05). There were no statistically significant results detected when comparing the average air pressure, humidity, air temperature, season, and wind for mortality in 30 days (p>0.05).

DISCUSSION AND CONCLUSION: In the light of these data, it was determined that seasonal and meteorological factors had no effect on mortality in pulmonary embolism.

INTRODUCTION: The aim of the present study was to discuss the effects of antagonism of neuromuscular blockade with sugammadex on extubation success and residual curarization in neonates with retrospective data.
METHODS: The present study was conducted as a retrospective analysis of the data of 27 neonates aged ≤40 days who underwent abdominal surgery between January 2012 and December 2013. Rocuronium was used for anesthesia induction, and patients whose neuromuscular blockade was antagonized by sugammadex and who were monitored with train-of-four (TOF) were included in the study. The dose of rocuronium administered, the dose of sugammadex, the duration of the operation and anesthesia, elapsed time from the last dose of rocuronium to sugammadex administration and elapsed time from sugammadex administration to extubation, and TOF values during extubation were recorded from the anesthesia records.

RESULTS: The mean age of the patients was 10.29±11.80 days. The mean weight was 3.04±1.92 kg. The mean sugammadex dose was 3.6 mg/kg. The elapsed time from the last rocuronium to sugammadex administration was 27.3±7.7 min, the elapsed time from sugammadex administration to extubation was 1.05±0.6 min, and the TOF value during extubation was 93.5±7.3. The time to reach TOF 0.9 was 88.11±21.06 s.

DISCUSSION AND CONCLUSION: Sugammadex, which is used for the reversal of neuromuscular blockade in neonates, showed a similar efficacy as in adult and pediatric patient studies. Safe extubation can be performed in neonates in a short period with sugammadex.

INTRODUCTION: Obstructive sleep apnea (OSA) affects mortality and morbidity due to persistent hypoxemia attacks during the night. The use of portable sleep monitors (PMs) has been investigated in recent years because the use of polysomnography (PSG) in the OSA diagnosing is a rare and expensive method. In our study, we aimed to investigate the compliance of Turkish population to PMs and PSG.
METHODS: Demographic records of 62 patients referred with OSA symptoms were collected from the database. An ear, nose, and throat (ENT) physician was examination was pweformed for all patients. Afterwards, sleep records were taken with PM, followed by PSG.
RESULTS: There was no difference between the PM and PSG parameters in terms of the apnea–hypopnea index and the oxygen desaturation index. The sensitivity of the PMs was 89%, and the specificity was 100%.


DISCUSSION AND CONCLUSION: This study showed that the PM and PSG parameters were compatible with each other. We concluded that portable monitors that are cheaper, simpler, and capable of shooting at home can be used in the diagnosis of OSA, where obesity and OSA are very common.

INTRODUCTION: In this study, we aimed to present our treatment results of patients with intracranial Cavernoma who treated with Stereotactic Radiosurgery (SRS) by using CyberKnife
METHODS: Between April 2010 and December 2017, the data of 19 patients treated with SRS in our clinic with the diagnosis of Cavernoma were evaluated retrospectively.
RESULTS: The median follow-up time was 82 (range; 9-100 months) months. SRS was performed in median one fraction (range, 1-3) and according to the size of the lesion the prescription dose was ranged from 12 to 21 Gy (median, 15 Gy). During the post-SRS follow-up period, 6 of the 10 patients with headache had a complete response, 3 patients had a partial response and 1 patient had no response. 3 of the 4 patients with seizure had a partial response and 1 patient had a stable response in seizure frequency. 1 of the 2 patients with vision problem had a complete response and 1 had no change. 1 of the 3 patients with hemi paresthesia had a complete response and 2 had no change. Radiological evaluations in post-SRS follow-up revealed complete response in 4 patients, partial response in 3 patients, stable disease in 9 patients, and progression in 3 patients. Rebleeding was detected in 1 (5.3%) of 3 progressive patients at 17th months and radiation-induced radionecrosis was detected in other 2 patients at 9th and 11th months. There were no procedure-related complications resulting in mortality.
DISCUSSION AND CONCLUSION: In cavernoma patients with high risk for surgical intervention and/or especially in patients with high risk for bleeding, SRS is an effective and alternative treatment to surgery.

Thrombotic thrombocytopenic purpura (TTP) is characterized by the pentad of microangiopathic hemolytic anemia, uremia, thrombocytopenia, neurological symptoms, and fever. It can be a fatal emergency if early diagnosis and appropriate evaluation are not performed. TTP is associated with an acquired or congenital deficiency of the von Willebrand factor-cleaving metalloprotease, ADAMTS13. It can be triggered by many diseases or drugs. Plasma exchange, which is an urgent treatment modality, can be effective in cases of TTP. Presently described is the case of a 35-year-old man with a diagnosis of TTP that developed after a burn injury. The underlying mechanism of TTP development after a burn is still unknown. Clinicians should pay attention to neurological symptoms and thrombocytopenia after burn accidents and must be alert to this life-threatening situation.

The ultrasound-guided erector spinae plane (ESP) block has been recently described for postoperative analgesia after various thoracic and abdominal surgeries, mostly laparoscopic. Some authors suggest that the ESP block has an effect on both visceral and somatic pain. We describe the successful use of continuous ESP block using intermittent boluses via catheter in open cholecystectomy (OC). Our patient was scheduled for laparoscopic cholecystectomy, which unexpectedly led to open procedure. Continuous ESP block provided good analgesia for 96 h after surgery. To our knowledge, this is the first case report of the use of continuous ESP block using intermittent boluses for OC.

Hughes–Stovin syndrome is an extremely rare autoimmune clinical disorder that is characterized by deep vein thrombosis with multiple pulmonary and/or bronchial arterial aneurysms. This syndrome is an important cardiovascular status that may manifest Behçet’s disease with systemic aneurysms. Here, we present the case of a 16-year-old female patient who suffered from recurrent life-threatening hemoptysis episodes due to right lower lobe pulmonary artery aneurysms and was finally treated with pulmonary resection.

Neuroblastomas are the second most common type of neonatal tumor originating from embryonic nerve cells. It constitutes 20% of all fetal tumors and is incidentally detected on routine ultrasonography (US). Magnetic resonance imaging (MRI) plays a complementary role to US when diagnosis is difficult. In the absence of poor prognostic factors, treatment is not recommended during the prenatal and neonatal periods, and follow-up imaging is considered sufficient. In this case report, we present the US and MRI findings of a fetal neuroblastoma detected in the 25th week of pregnancy in the left fetal adrenal gland.

A periorbital subcutaneous emphysema that developed after a successful external dacryocystorhinostomy (DSR) has been presented. The patient gave a history of sudden swelling of bilateral eyelids after a forceful sneeze and blowing of the nose. Physical examination showed periorbital edema and hyperemia; palpation of the swollen region revealed crepitation. These signs and symptoms suggested subcutaneous emphysema. Subcutaneous or orbital emphysema occurring after DSR is a rare complication. Pure subcutaneuos emphysema recovers spontaneously in a short period.