INTRODUCTION: Renal artery lesions frequently occur and may require intervention. The aim of the present study was to describe technical considerations of endovascular treatment of aneurysms, pseudoaneurysms, arteriovenous malformation, and arteriovenous fistula of the renal artery.
METHODS: From August 2009 to April 2012, the cases of 13 patients (7 women and 6 men) with 15 renal artery lesions were retrospectively analyzed. All patients underwent endovascular treatment. Preprocedure computed tomography (CT) and postembolization control angiography were performed. Seven true renal artery aneurysms, 6 renal artery pseudoaneurysms, 1 arteriovenous malformation, and 1 arteriovenous fistula were defined using CT and angiography.
RESULTS: Successful endovascular treatment was performed in all patients. N-butyl 2-cyanoacrylate embolization was performed in the case of the arteriovenous malformation, Guglielmi detachable coil (GDC) embolization was performed in the case of the arteriovenous fistula, and all pseudoaneurysm patients were treated with N-butyl 2-cyanoacrylate embolization, with the exception of 1, who was treated with GDC embolization. GDC embolization was likewise performed in all aneurysm patients. In 1 aneurysm patient, stent-assisted coil embolization was performed. No complications or periprocedural mortality occurred. On follow-up imaging, partial infarct was detected in 5 patients with no clinical evidence of organ insufficiency.
DISCUSSION AND CONCLUSION: Endovascular treatment of renal artery lesions is a safe and highly successful procedure with minor complications, compared to surgery. Thus, endovascular approach should be considered the first choice of treatment in cases of renal artery lesions.

INTRODUCTION: The aim of the present study was to retrospectively evaluate geriatric type 2 diabetic patients admitted to emergency services as a result of diabetes.
METHODS: All files of geriatric patients admitted to emergency services between January and August 2013 were analyzed. Patients admitted as a result of diabetes and related acute complications were included in the study.
RESULTS: Hypoglycemia was diagnosed in 28.2% (n=42) of patients, and hyperglycemic hyperosmolar state was found in 26.9% (n=40). Hyperglycemia, diabetic ketoacidosis, diabetic foot infection, and lactic acidosis were diagnosed in 20.1% (n=30), 16.1% (n=24), 6.7% (n=10), and 2% (n=3) of patients, respectively.
DISCUSSION AND CONCLUSION: Difficulties can occur in follow-up and treatment of diabetes mellitus in geriatric patients. Further comprehensive studies are needed on the topic.

INTRODUCTION: The aim of the present study is to investigate the impact on male erectile function of extracorporeal shock wave lithotripsy (ESWL) performed on kidney stones.
METHODS: A total of 114 patients who had ESWL therapy between May-August 2012 evaluated were divided into 3 groups at the end of first month. Patients without kidney stones were in Group 1, patients who had residual fragments were in Group 2, and patients who required additional intervention were in Group 3. Patients’ initial scores on the International Index of Erectile Function (IIEF)-5 questionnaire were compared with results after completing the questionnaire again at the end of first and third months.
RESULTS: Mean age of 114 patients included in the study was 41.7 (range: 20–63) years of age, mean stone size was 16.5 (range: 10–25) mm. Differences in IIEF scores before and after treatment were evaluated and there was a statistically significant reduction in erectile function after the first month in all groups. IIEF scores of patients in Group 1 and Group 2 returned to initial values at the end of 3 months, and Group 3 saw additional reduction (p=0.039).
DISCUSSION AND CONCLUSION: We have to consider the increasing of sexual disfunction which depends on performing ESWL and additonal surgical interventions after ESWL.

INTRODUCTION: The aim of the present study was to analyze the gradually increasing number of patients who admit during emergency room admittance to having used a synthetic cannabinoid derivative, “bonsai.”
METHODS: Patients who admitted to having used “bonsai” and with symptoms of respiratory/cardiovascular complications were included. Electrocardiogram findings, vital signs, and blood gas values were recorded in a database and pooled for analysis. Data were analyzed using frequencies and chi-square tests.
RESULTS: Of the 24 patients with complications that matched the inclusion criteria, the data of 20 patients were examined. While 3 (15%) patients had Glasgow Coma Scores (GCSs) >13, 12 (60%) had GCSs of 9–13, and 5 (25%) had GCSs <9. One patient with a GCS of 3 experienced cardiopulmonary arrest and was hospitalized in the ICU following successful cardiopulmonary resuscitation. Respiratory acidosis was determined in 17 (85%) patients with pCO2 >45 mmHg.
DISCUSSION AND CONCLUSION: Synthetic cannabinoid derivatives such as “bonsai” are easy to obtain. It should be remembered that the components change continuously and may cause different side effects. Use of products such as “bonsai” may cause death by respiratory depression.

INTRODUCTION: The aim of the present study was to evaluate cases of classified atypical squamous cells of undetermined significance (ASCUS) by correlating histological diagnosis to provide management guidelines.
METHODS: A total of 452 patients were evaluated by colposcopy and colposcopically directed biopsies and/or endocervical curettage, as indicated. Patients were followed by control smears every 3 to 4 months.
RESULTS: Colposcopic biopsy was performed in 136 patients (33%). Of these patients, 96/452 (70%) had cervical intraepithelial neoplasia (CIN) grade 1, 8/452 (5.9%) had CIN grade 2, and 4/452 (2.9%) had invasive cervical carcinoma. During 12-month follow-up, persistence of ASCUS occurred in 32/452 (7.8%) patients, and progression to high-grade dysplasia was observed in 12/452 (2.7%) patients. Regression to normal smear occurred in 408/452 (89.5%) ASCUS patients.
DISCUSSION AND CONCLUSION: A high rate of improvement was observed during follow-up of low-grade abnormal cytologies. However, 10–15% false negative rates in Papanicolaou smears, and irregularity and omission of follow-up may lead to missed incidences of high-grade lesion or invasive cervical cancer. Colposcopy and follow-up smears are the optimum means of observation.

INTRODUCTION: Determining rates of cancer distribution, mortality, and survival is important. Existing cancer registration centers include more than 50% of the Turkish population. Descriptive epidemiological studies, therefore, are still valuable in determining cancer data.
METHODS: Data from 12,603 cases of cancer diagnosed by the Kartal Dr. Lütfi Kýrdar Training and Research Hospital Department of Pathology between 2008 and 2012 were included. Topographical, histological, and behavioral codes were expressed according to the International Classification of Diseases for Oncology (ICD-O). Rates of cancer, according to location, age, and gender distribution were determined.
RESULTS: A total of 6,682 cases were male, 5,921 were female. Mean age was 59.9 in males, 55.6 in females. The most common cancer sites for males were the bladder, prostate, colorectal area, skin, and stomach. The most common sites for females were the breast, skin, colorectal area, thyroid, and cervix uteri. The most common histological types for males were adenocarcinoma NOS, transitional carcinoma NOS, squamous cell carcinoma, carcinoma NOS, basal cell carcinoma, and malignant lymphoma. The most common histological types for females were infiltrating ductal carcinoma NOS, adenocarcinoma NOS, carcinoma NOS, papillary carcinoma NOS, squamous cell carcinoma, and basal cell carcinoma.
DISCUSSION AND CONCLUSION: These data are representative of Ýstanbul. Histological cancer typing aids in advances in targeted therapies.

INTRODUCTION: At this study, the effect of oral glutamine usage in the prevention of acute esphagitis and weight loss in lung cancer patients receiving radiotherapy (RT) was evaluated.
METHODS: The study included 88 patients. Results were evaluated retrospectively. Glutamine dose was 30 g daily (10 g/8 hours) during thoracic RT and for 2 weeks after RT. Once-daily 1.8–2Gy RT with one fraction was used, and 60–64 Gy RT was performed with 5 fractions of weekly treatment. Patients’ weight, body mass index (BMI) and esophagitis levels were evaluated weekly.
RESULTS: Glutamine was well tolerated by all the patients. Mean esophagus RT doses were 15.56 (12–26) Gy. No dysphagia was observed in 35 patients (39.8%), but 53 (60.2%) were found to have dysphagia. Grade 3 and Grade 4 dysphagia was not observed. Weight loss was not observed in 17 (19.3%) patients. Weight loss was observed in 20 (22.7%) patients, while weight gain was observed in 51 (58%) patients. In 19 (95%) of 20 patients with weight loss, dysphagia was present. In 34 of 68 patients who didn’t have weight loss, dysphagia was present (p=0.001). Esophagitis was detected less in the patient groups that received no more than esophagus dose of 20 Gy, with peripheral localized tumors, and patient groups that received 4 or fewer chemotherapy treatments (p=0.002).
DISCUSSION AND CONCLUSION: Oral glutamine usage is decreasing the severity and frequency of esophagitis in patients receiving RT for lung cancer and is helpful for the prevention of weight loss.

INTRODUCTION: The aim of the present study was to retrospectively evaluate geriatric oncology cases hospitalized in the clinic.
METHODS: Files of oncology patients hospitalized between May 2012 and March 2013 were analyzed. Demographic data was recorded, including the 5 most common types of cancer according to gender, duration of hospitalization, and prognosis of patients diagnosed at 65 years of age or older.
RESULTS: The 5 most common types of cancer in male patients (28.3%, n=17) were hematological malignancies (21.7%, n=13), lung cancer (13.3%, n=8), colon cancer (10%, n=6), bladder cancer (8.3%, n=12) and prostate cancer. The 5 most common types of cancer in female patients (26.7%, n=12), were hematological malignancies, colon cancer (24.4%, n=11), breast cancer (13.3%, n=6), lung cancer (11.1%, n=5), and bladder cancer (4.4%, n=2).
DISCUSSION AND CONCLUSION: In cases of geriatric oncology, incidence of cancer types may also vary. The most common cancer type in both men and women in the present study was hematologic malignancy.

INTRODUCTION: The aim of the present study was to evaluate the effect of uncomplicated cataract surgery on macular thickness in diabetic and nondiabetic patients.
METHODS: The cases of patients who underwent phacoemulsification surgery between March and June 2013 were retrospectively evaluated. Patients with over 6% HbA1c, uncontrolled diabetes mellitus, systemic disease, concurrent ocular disease, use of drugs that may affect macular thickness, and complicated surgeries were excluded. Preoperative and postoperative 3rd-month visual acuity and intraocular pressure were measured, and biomicroscopy and fundus examinations were performed. Cirrus HD-OCT model 4000 optic coherence tomography (Carl Zeiss Inc., Oberkochen, Germany) was used for macular thickness analysis. All data was statistically analyzed.
RESULTS: Twenty-four eyes were included in the diabetic patient group; 34 eyes were included in the control group. Corrected visual acuity at final visit had increased in both groups (p<0.05). By the end of the 3rd month, mean change in central foveal thickness was 16.03±4.5 μm in the diabetic group (p<0.05), and 7.31±3.3 μm in the control group (p<0.05). Postoperatively, perifoveal thicknesses of 3 and 6 mm increased significantly in both groups. By follow-up, clinically significant macular edema (CME) had developed in 1 eye of a diabetic patient, while no CME had developed in the control group. When data was compared between groups, foveal and perifoveal mean thickness changes were significantly higher in the diabetic group (p<0.05).
DISCUSSION AND CONCLUSION: While significant macular thickness increase was postoperatively observed in both groups, it was found that this increase was higher in diabetic patients. Ophtalmalogic surgeons should be careful when planning cataract sugery in diabetic patients without rethinopathy although HbA1c levels are normal.

INTRODUCTION: The aim of the present prospective study was to assess changes in macular thickness by means of spectral optical coherence tomography after neodymium-doped yttrium aluminum garnet (Nd: YAG) laser posterior capsulotomy for posterior capsule opacification.
METHODS: 69 eyes (37 right, 32 left) of 53 patients (18 male, 35 female) who underwent Nd: YAG laser posterior capsulotomy between May 2012 and June 2013 were included to this study. Pre-capsulotomy central macular thickness was compared with post-capsulotomy measurements at 1 week and 1, 3, and 6 months.
RESULTS: Mean patient age was 66 (35–83) years. While mean central macular thickness was 209.8±28.2 μ prior to Nd: YAG laser capsulotomy, post-laser values at 1 week, 1 month, 3 months, and 6 months were 213.3±27.5 μ, 214±26.8 μ, 213±26.3 μ, and 212.9±26.5 μ, respectively. No statistically significant differences in mean central macular thickness measured pre- and post-capsulotomy were determined (p>0.05).
DISCUSSION AND CONCLUSION: Nd: YAG laser capsulotomy for the treatment of posterior capsular opacification is a safe and effective procedure that does not cause significant increase in macular thickness.

INTRODUCTION: The aim of the present study was to evaluate code blue implementation and results in a teaching and research hospital.
METHODS: Code blue implementation between January 2011 and April 2013 was retrospectively reviewed. Patient age and gender, location, date, and time of call, team unit and time of arrival, and activities performed were recorded. Additionally recorded were duration and results of cardiopulmonary resuscitation (CPR), and medications administered.
RESULTS: A total of 237 incidences of code blue assistance were included. The majority of calls (82) were made from the internal medicine, chest diseases (62), and infectious diseases (29) clinics. However, there is no code blue in some clinics. Of blue code patients, 142 were male (59.9%), 95 (40.1%) were female. Mean patient age was 66.9 years. While 48 (20.4%) patients did not require CPR, cardiac and/or pulmonary arrest occurred in 187 (79.6%) patients. As a result of CPR, spontaneous circulation was restored in 38 (20.3%) patients, though 149 (79.7%) did not respond. Average time of team arrival was 3.45±1.92 minutes. CPR was administered in 32.26±13.47 minutes per patient.
DISCUSSION AND CONCLUSION: Early recognition of cardiopulmonary arrest is essential, and CPR must be performed quickly and accurately by first response staff, particularly in cases of acute deterioration.

Chest wall infections may be spontaneously developped primary problems or secondary infections due to effects of previous procedures and current diseases. Rapid drainage and proper antibiotic therapy usually provide successful resolution, regardless of the etiology. A 49-year-old male patient who was diagnosed with diabetes mellitus was referred due to swelling on the lateral of the left hemithorax that had begun 10 days prior. Computed tomography of the chest and magnetic resonance imaging of the upper abdomen revealed a collection originating from the anterolateral of the left hemithorax, with lobulation toward the intraabdominal region from abdominal muscles in the left upper quadrant and the rectus muscle. Following surgical debridement and drainage, and 6 months of follow-up, no recurrence has been observed.

Orbital infections are serious diseases. Clinical manifestation may present as preseptal cellulitis, though serious complications can quickly occur. Described in the present report is a patient diagnosed with preseptal cellulitis during hospitalization who developed nearly every complication associated with orbital infection in a short period of time. A 12-year-old boy with signs of preseptal cellulitis was admitted to the ophthalmology clinic. He was hospitalized, and antibiotic treatment was initiated. Due to headache, fever, and signs of meningeal irritation, on the third day lumbar puncture was performed, and meningitis was detected. Radiological investigations showed retroorbital abscess, inflammation of the rectus muscles, severe narrowing and arteritis in the carotid cavernous sinus segment, and subdural effusion. Surgical drainage was immediately performed, and subsequent improvement was remarkable; the patient recovered without occurrence of sequela. Evaluation of patients who present with signs of preseptal cellulitis on physical examination alone may lead to delay in proper treatment. Early radiographic imaging and surgical intervention (if necessary) can be lifesaving.

Hajdu-Cheney is a syndrome characterized by acro-osteolysis of distal phalanges and digital anomalies, specific craniofacial and skull changes, orofacial anomalies, flexibility in the joints, connective tissue disorder, and proportionate short stature. Patients with Hajdu-Cheney syndrome often require general anesthesia due to orthopedic disorders. Presently described is airway management in a female patient with Hajdu-Cheney syndrome while under general anesthesia. Literature related to the syndrome is also reviewed.

Nocardia typically causes opportunistic infections in immunocompromised patients. It usually causes lesions with cavities, though mass-like lesions are also common. Despite being curable, pulmonary nocardiosis is a highly mortal disease due to difficulties in diagnosis. Presently described is a case of pulmonary nocardiosis with a mass lesion and no known immunocompromisation or history of corticosteroid use. The patient was also diagnosed with small-cell lung cancer after thorough investigation. The importance of differential diagnosis is emphasized.

A 33-year-old primiparous, eclamptic patient who had been diagnosed with epilepsy 10 years prior, but who discontinued medical treatment 7 years ago and who used levothyroxine (levotiron 100 mg/day) regularly for hypothyroidism, was found comatose at her home and admitted to the hospital after a 3-hour delay. Required examinations and emergency caesarean section were performed due to prediagnosis of eclampsia (proteinuria: +++; hematuria: +++). An emergency hysterectomy was performed because of continued bleeding. Due to worsening clinical picture and development of disseminated intravascular coagulation, fibrinogen (haemocomplettan 4x1/day) was replaced. Exploratory laparotomy was performed for hemorrhage control. In spite of high-level supportive therapy, the patient died from multiple organ failure in the 48th hour of admission. It was concluded that presently high rates of mortality and morbidity can be reduced through collaboration of obstetricians, anesthetists, and intensive care specialists in the treatment of postpartum bleeding, particularly in high-risk pregnancies. As all required treatments recommended in recent literature were performed in the present case utilizing the available facilities, it was also concluded that new treatment strategies and methods should be developed in order to reduce rates of morbidity and mortality.

Systemic lupus erythematosus (SLE) is a severe condition that occurs rarely in pediatric age group. Etiology is unclear. Diagnosis may be made based on clinical presentation and laboratory findings. Described in the present report is the diagnosis of SLE in an 11-year-old girl with leg pain and growth retardation. As a result, SLE should be always kept in mind in children who present to primary care with leg pain, a frequent condition.

Microscopic polyangiitis (MPA) is a necrotizing vasculitis involving the small vessels without granulomatous inflammation. Most MPA presents with renal and pulmonary involvement. The present case was an occurrence of elevated anti-myeloperoxidase anti-neutrophilic cytoplasmic antibodies (p-ANCA) microscopic polyangiitis with renopulmonary syndrome in a patient who presented with progressive cough, dyspnea, and renal failure.

Seckel syndrome is an autosomal recessive disorder, characterized by intrauterine growth retardation, microcephaly, atypical appearance with hypoplastic face and mental retardation. This syndrome may be accompanied by renal, cardiac, hematological, skeletal and central nervous system abnormalities. Presently reported is a case of Seckel syndrome diagnosed with symmetric intrauterine growth retardation and clinical symptoms.

Fibrous dysplasia is a rare, benign, but locally invasive, developmental anomaly of the bone tissue. In the present review,etiopathogenesis, clinical findings, differential diagnosis, and treatment of craniofacial fibrous dysplasia are outlined.