INTRODUCTION: The lungs are the second most common site of metastasis, and for selected patients, pulmonary metastasectomy can be a curative option. The surgical goal is complete resection with minimal parenchymal loss in order to prolong life. In well-selected cases, minimally invasive approaches can increase quality of life and offer equivalent oncological outcomes.
METHODS: Patients diagnosed with pulmonary metastasis who underwent a metastasectomy in a single hospital between January 2012 and December 2017 were evaluated retrospectively. A total of 92 patients (55 male and 37 female) underwent thoracotomy or thoracoscopy procedures with the goal of complete resection.
RESULTS: Among the patients included in the study, 8 were symptomatic: cough was reported in 3, chest pain (pneumothorax) was experienced in 3, and hemoptysis occurred in 2 cases. The longest disease-free survival (DFS) period was seen in cases of epithelial tumor (40.1 months) and sarcoma (28.2 months); the shortest survival was seen in those with germ cell tumor (8.3 months) and melanoma (8.1 months).
DISCUSSION AND CONCLUSION: Patients with pulmonary metastasis require a multidisciplinary approach for treatment. When the primary disease is under control and there is no other distant metastasis, metastasectomy with complete surgical resection can provide an extended period of DFS, particularly for patients with epithelial or sarcomatous tumors.

INTRODUCTION: The aim of this study was to investigate the relationship between health literacy, diabetic control, and diabetic complications in patients with type1 diabetes mellitus (DM).
METHODS: This was a descriptive study. A total of 106 patients with type 1 DM who were between 18 and 65 years of age and who could speak and understand Turkish and had no cognitive disease were included in the study. The Turkish version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) was used to assess health literacy. The retinopathy status and levels of hemoglobin A1c, fasting blood sugar, and urine albumin of the patients were obtained from the hospital files.
RESULTS: Overall health literacy was inadequate in 10.4%, problematic in 54.7%, adequate in 20.8%, and excellent in 14.2% of the participants. Retinopathy was found to be statistically significantly higher in the problematic+inadequate group than in the adequate+excellent group in the overall health literacy evaluation (24.6% and 5.4%, respectively). There was no significant difference in the frequency of neuropathy, nephropathy, or cardiovascular disease in the health literacy groups.
DISCUSSION AND CONCLUSION: The present study demonstrated that low health literacy in patients with type 1 DM was associated with increased retinopathy. Physicians should keep the positive effects of education in mind in order to better control the disease and prevent complications.

INTRODUCTION: The aim of this study was to modify the Alvarado scoring system to increase its sensitivity and specificity in predicting acute appendicitis in elderly patients.
METHODS: The data of 81 patients older than 70 years of age who were admitted for acute abdominal pain between January 2015 and December 2017 were randomized into 2 groups and evaluated retrospectively. In Group 1 patients, acute appendicitis was not histopathologically established postoperatively, while Group 2 patients had pathological results consistent with acute appendicitis. The sensitivity and specificity of computed tomography (CT) scans and Alvarado scores were evaluated in the 2 groups.
RESULTS: The specificity and sensitivity of the modified Alvarado score was 86% and 81%, respectively, whereas the specificity and sensitivity of a CT scan was 93% and 92.1%, respectively, in diagnosing acute appendicitis.
DISCUSSION AND CONCLUSION: There are a limited number of studies related to acute appendicitis in elderly patients and the current strategy for treatment is not clear. Due to the decreased sensitivity of the Alvarado score in the diagnosis of acute appendicitis in elderly patients, the goal of this research was to adjust the scoring system. Scores >7 are more reliable in predicting appendicitis. We believe that patients can be more accurately diagnosed in a short period of time using this modified Alvarado scoring system. In combination with a CT scan evaluation, the success rate of diagnosis may be improved and delayed diagnosis prevented.

INTRODUCTION: The aim of this study was to compare the early postoperative recovery effects between patients who were given sevoflurane or desflurane before having lower abdominal surgery under general anesthesia.
METHODS: Eighty patients aged between 18 and 75 years with an American Society of Anesthesiologists physical status classification of I or II who were scheduled for elective lower abdominal surgery were divided into 2 groups. Before the induction of anesthesia, heart rate (HR), blood pressure, and peripheral oxygen saturation (SpO2) were measured, and neuromuscular monitoring was performed. Following the intravenous (IV) administration of 5 to 7 mg/kg thiopental and 1 mcg/kg fentanyl, 0.6 mg/kg rocuronium was used to facilitate endotracheal intubation. Maintenance of anesthesia was provided using 4% desflurane in Group I and 1.3% sevoflurane in Group II in a 50% oxygen-air mixture. During surgery, additional doses of 1 mcg/kg fentanyl were administered and the concentration of volatile anesthetics was adapted according to hemodynamic conditions. At the end of the operation, volatile agents were discontinued and 100% oxygen was administered to all patients. When the train-of-four stimulation value exceeded 85%, the patients were extubated and oxygen was provided via facemask. Perioperative axillary temperature, SpO2, hemoglobin (Hb), arterial pressure, HR, and total opioid consumption were recorded. SpO2 level, airway control value and modified Aldrete score were recorded at the 1st, 5th, 10th, 15th, 20th, 30th, 45th, and 60th minutes during the postoperative period. Pain evaluation was performed using a visual analog scale (VAS) of 1 to 10 at the same intervals.
RESULTS: There were no significant differences between the 2 groups in terms of the duration of anesthesia and surgery, extubation time, change in axillary temperature, perioperative hemodynamic changes, airway control, or VAS scores. In Group I, the total opioid dose was significantly higher and the preoperative and postoperative Hb values were significantly lower (p<0.01). The modified Aldrete scores of Group I were significantly higher than those of Group II at 10 minutes and at later intervals (p<0.002). In Group I, the postoperative SpO2 values were significantly higher than those seen in Group II (p<0.05 and above) at the 5th, 10th, 20th, 30th, and 45th minutes.
DISCUSSION AND CONCLUSION: It was concluded that desflurane may be a better choice of anesthesia during lower abdominal surgery than sevoflurane for patients with the potential for respiratory complications.

INTRODUCTION: This study was an evaluation of differences in the inflammatory markers of C-reactive protein (CRP) level, the neutrophil-to-lymphocyte ratio (NLR), the platelet count-to-mean platelet volume ratio (PLT/MPV), and the platelet-to-lymphocyte ratio (PLR) in patients with pulmonary candidiasis and pulmonary aspergillosis.
METHODS: A retrospective, cross-sectional study was performed with the data of patients who were diagnosed with pulmonary candidiasis and pulmonary aspergillosis between 2016 and 2017 according to the records of the hospital information system. The results and date of hemograms, the biochemistry values, and C-reactive protein (CRP) levels were recorded. The NLR, PLT/MPV, and PLR were calculated. The documented parameters of the study groups were compared and analyzed.
RESULTS: There were 44 patients (29 men) (candidiasis, n=19; aspergillosis, n=25), with a median age of 65 years. In both groups, the incidence of chronic obstructive pulmonary disease, level of CRP, and the NLR, PLR, MPV, and PLT/MPV were statistically similar. At discharge, the CRP, PLR, NLR, and PLT values were still similar in the 2 groups; however, the MPV was significantly lower in the pulmonary aspergillosis group when compared with the pulmonary candidiasis group (7.3 vs 8.4; p=0029).
DISCUSSION AND CONCLUSION: Most biomarkers were similar in the pulmonary aspergillosis and the candidiasis groups; however, a PLT elevation and an MPV decrease were significant in the diagnosis of aspergillus. Similar findings in prospective, multicenter studies performed with patients who are suspected of having a fungal lung infection will add to the ultimate determination of the value to be given to PLT and MPV biomarkers in the initiation of empirical treatment.

INTRODUCTION: Voiding cystourethrography (VCUG) is widely performed in the pretransplant evaluation of patients with a history of urological disorders to detect vesicoureteral reflux (VUR). The aim of this study was to evaluate the relationship between the primary etiology of end-stage renal disease (ESRD) and the prevalence of VUR, thereby determining the necessity for VCUG in pretransplant patients.
METHODS: A total of 319 pretransplant cases that underwent VCUG were retrospectively reviewed.
RESULTS: VCUG revealed VUR in 53 (16.6%) cases. VUR was left-sided in 21 (41.2%), right-sided in 18 (35.3%), and bilateral in 12 (3.8%), and grade 1 in 10 (19.6%), grade 2 in 19 (37.3%), grade 3 in 20 (39.2%), and grade 4 in 2 (3.9%). The etiology of ESRD was hypertension in 125 (39.2%), diabetes mellitus (DM) in 46 (14.4%), polycystic kidney disease (PKD) in 21 (6.6%), amyloidosis in 16 (5%), VUR in 11 (3.4%), and glomerulonephritis (GN) in 11 (3.4%). The incidence of VUR was significantly higher in female patients. Hypertension, DM, PKD, amyloidosis, and GN were not found to predict VUR. The rate of abnormal VCUG findings was similar in cases with secondary and idiopathic ESRD.
DISCUSSION AND CONCLUSION: The findings demonstrate that only sex was a predictor of VUR in pretransplant cases. The presence of VUR was not related to any cause of ESRD; therefore, VCUG is not needed in all cases as a part of pretransplant evaluation.

INTRODUCTION: A blood transfusion, defined as a procedure to replace lost blood, is actually a tissue transplantation, performed with consideration given to the impact profile, the potential development of complications, and the risk of anaphylaxis and rejection, which may lead to death. This study is an analysis of emergency blood transfusions in terms of symptoms and indications.

METHODS: Hospital records of blood transfusions administered in the emergency service were retrospectively reviewed. The patients were categorized into 2 groups: emergency patients and non-emergency patients, based on the presentation.
RESULTS: Over the course of 3 months, 1156 transfusions (2.18 per person) were performed in 528 patients (61.4% male). It was determined that the most commonly seen patient complaints were weakness (19%) and melena (14%), followed by cases in which the patient was asymptomatic, but there was laboratory pathology (12.9%). In all, 47% of all cases of blood transfusion were considered urgent.
DISCUSSION AND CONCLUSION: No correlation was determined between urgency requirement and hemoglobin level. Aside from those administered for active bleeding, most blood transfusions were not performed due to an urgent indication. The establishment of separate, ambulatory parenteral treatment units in could reduce the burden on emergency services to some extent and protect the priority status real emergency patients need.

INTRODUCTION: Nowadays, surgical procedures become more reliable as urinary system stone disease begins to be treated with minimally invasive methods. Percutaneous nephrolithotomy (PNL) is the first treatment option for kidney stones >2 cm. An increase in postoperative stone-free (SF) rates due to improvements in technology and experience, operation, and hospital stay is reduced. Over time, complications of PNL have been reduced and more standardized with classifications similar to the developed Clavien grading system. The aim of the present study was to comparatively investigate the factors that are considered to affect success and complications in PNL operation.
METHODS: The present study included 928 patients (1011 renal units) who underwent PNL operation between November 2004 and January 2013 in our clinic. These patients had preoperative (sex, age, body mass index (BMI), operation side, previous stone operations, hydronephrosis and grade, stone localization, stone area, and volume), operative (operation time, fluoroscopy time, number of access, and calyces of access), and postoperative (hemoglobin, hematocrit, complication, transfusion, stone removal, nephrostomy withdrawal time, length of hospital stay, and need for additional intervention). The complications that occurred during and after the operation were classified according to the modified Clavien system. Subsequently, patients were divided into two groups: patients with complications (Group 1) and those with no complications (Group 2). The groups were analyzed comparatively.
RESULTS: Overall, 628 male and 383 female (M/F: 8/5) patients were included in the study. The mean age of the patients was 41.9 years. Of the evaluated operations, 185 had minor or major complications, and 826 had no complications. Complications in PNL operation are classified according to the modified Clavien grading: 23 (2.27%) complications in grade 1, 143 (14.14%) complications in grade 2, 11 (1.08%) complications in grade 3A, 6 (0.59%) complications in grade 3B, 4 (0.39%) complications in grade 4A, and 15 (4.48%) complications in grade 4B. No complication according to grade 5 was observed. Statistically, stone size, preoperative hydronephrosis grade, time of operation and fluoroscopy, length of stay in the hospital, and SF rates were found to be effective parameters on complication development in both groups (p<0.05). Age, gender, BMI, number of access to the kidney, and postoperative complications were not found to be effective parameters in terms of complication development (p>0.05).
DISCUSSION AND CONCLUSION: PNL is an effective and reliable method for the treatment of urinary stone disease. Most of the complications are minor. Stone size, presence of preoperative hydronephrosis, long operation times, and excessive access to the kidney collecting system increase the complication rates. Another important result obtained in the present study is that the complication rates are higher in patients with high SF rates than in other patients.

INTRODUCTION: Even after successful kidney transplantation, 10% to 50% of kidney transplant recipients have persistent hyperparathyroidism. Parathyroidectomy (PTX) has been reported to be associated with deterioration of renal function and reduced graft survival. The aim of this single-center, retrospective study was to analyze the long-term effect of PTX on calcium, phosphorus, and parathyroid hormone (PTH) levels, as well as the estimated glomerular filtration rate (eGFR), in renal transplantation patients who underwent PTX.
METHODS: The study population consisted of 154 patients followed between January 2014 and December 2017, 9 of whom underwent PTX. The median PTH, calcium, phosphorus, and eGFR values were recorded before and after PTX.
RESULTS: The median preparathyroidectomy PTH, calcium, phosphorus, and eGFR values were 311.57 pg/mL, 11.02 mg/dL, 2.35 mg/dL, and 90.88 mL/minute, respectively. When compared with the baseline figures, there was a decrease in PTH (311.5 vs. 147.5 pg/mL; p=0.015), calcium (11.02 vs. 9.01 mg/dL; p=0.017), and eGFR (90.88 vs. 75.44 mL/minute; p=0.008), and an increase in the phosphorus level (2.35 vs. 3.4 mg/dL; p=0.06) 1 month after surgery. The eGFR returned to the baseline rate 1 year after surgery (90.88 vs. 79.39 mL/minute; p=0.11).
DISCUSSION AND CONCLUSION: PTX in renal transplant recipients appears to be a safe procedure. Although renal function deteriorates in the acute period following PTX, long-term stabilization occurs.

Orbital inflammatory syndrome (OIS) or orbital pseudotumor is the most frequent cause of an orbital mass. Most cases are steroid responsive, but treatment of patients with refractory OIS may also include radiotherapy. Presently described are 3 cases of orbital pseudotumor that had a partial steroid response or recurrence and were treated successfully with CyberKnife (Accuray Inc., Sunnyvale, CA, USA).

Glioblastoma multiforme (GBM), comprised of astrocytes, is the most common brain tumor of the central nervous system. Although extracranial metastasis of GBM is very rare (<2%), when it occurs, the lungs are the most common site. Presently described are the cases of 2 male patients, aged 55 and 69 years, who were ultimately diagnosed with pulmonary metastasis of GBM. A lesion that appears to be a primary malignancy on lung imaging may, in fact, be a metastasis. Treatment of the primary malignancy can lead to regression. A detailed anamnesis, evaluation of accompanying diseases, and a pathological diagnosis are of vital importance.

Marjolin’s ulcer is an aggressive ulcerating malignancy that arises in a chronic wound and most often takes the form of squamous cell carcinoma (SCC). It often occurs in old burn scars, but it may also develop in post-traumatic lesions or chronic wounds. The prognosis is often poor as a result of delayed diagnosis. Presently described are cases in which chronic hidradenitis suppurativa and pilonidal sinus developed into SCC.

Methemoglobinemia occurs when the hemoglobin molecule is oxidized from the normal ferrous state to the ferric state. Rarely, it may be a congenital condition (methemoglobin-reductase deficiency), but more frequently it is a result of oxidant exposure. Among the large number of agents that can cause acquired methemoglobinemia is prilocaine, commonly used for local anesthesia during circumcision. Methylene blue is known to be the best treatment option; however it is not always available, and there is no universally accepted alternative. Vitamin C has been reported as an alternative treatment in recent years, but there is no definitive information about efficacy, dose, and renal side effects at high doses. Presently described is the case of an infant who developed cyanosis after a local application of prilocaine during circumcision who was successfully treated with the intravenous administration of vitamin C.

Plasmablastic lymphoma (PBL) is a rarely seen diffuse large B cell lymphoma variant associated with acquired immunodeficiency syndrome, oral mucosa localization, and a poor prognosis. There is not yet a standard protocol for the treatment of PBL; the treatment of a small number of human immunodeficiency virus (HIV)-negative cases has been reported in case reports and series and shared on a case-by-case basis. Presently described is the case of a 60-year-old man with PBL that originated in the sinus and spread to the orbit. The patient was HIV-negative and immunocompetent. The treatment and follow-up are presented in the context of the available literature.

Calcific bursitis most commonly affects the subacromial and trochanteric bursae. Patients most often present at the hospital because of increased pain at night and when performing overhead activities. A physical examination of the shoulder typically reveals restriction in abduction and internal rotation. Pain is usually observed during the resorption phase of the deposit. Chronic pain is also related to the inflammatory process caused by calcification. Calcified lesions in a bursa or tendon are not always visible on an X-ray, and may not be apparent among physical examination findings. Small and scattered deposits can often be detected on an X-ray; however, a calcific slurry mass in the subacromial-subdeltoid bursa can be found more reliably with ultrasonography (US) than with plain film. Pain is often resistant to steroid injections. In symptomatic patients, US-guided fragmentation of the lesion with a needle, using a local anesthetic, saline lavage, and a steroid injection, can often achieve complete healing in a very short period of time. Presently described is successful treatment of a calcified lesion located in the subdeltoid bursa achieved by performing lavage, splitting the calcified lesion, and administering a steroid injection.