Taydas, Ogun; Yalcin, Ahmet; Goktepeli, Mehmet; Aydinli, Onur

Objective: The aim of the study was to evaluate the hypoechoic halo sign, a finding that can be used in the ultrasonographic diagnosis of antral gastritis, and its relationship with clinical symptoms. Design: Retrospective analysis of prospectively collected data Setting: Erzincan Binali Yildirim University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey Subjects: The study included 39 patients with endoscopically proven antral gastritis and 39 age- and sexmatched controls with an endoscopically normal antrum. Intervention: The hypoechoic halo sign was defined as a hypoechoic band surrounding the echogenic middle part of the antrum in axial ultrasonographic images. Main outcome measures: The presence of heartburn, dyspepsia, reflux and nausea and the visual pain scale (VAS) scores of the patients were recorded. Results: The hypoechoic halo sign was observed at a rate of 84.6% in the antral gastritis group, while this rate was 15.4% in the control group (P<0.001). The receiver operating characteristic curve analysis showed that the thickness of the hypoechoic halo being larger than 6.7 mm was associated with antral gastritis at a sensitivity of 87.9 and specificity of 100. The univariate analysis showed that age, steatosis, heartburn, dyspepsia, VAS score, reflux and nausea were associated with the thickness of the halo sign. Conclusion: The hypoechoic halo sign can be used with high specificity and sensitivity in the diagnosis of antral gastritis.

Somuncu, Erkan; Akyol, Fethi

Hypercalcemic crisis is a rare but fatal condition. This condition may occur primarily due to primary hyperparathyroidism caused by parathyroid adenoma or rarely parathyroid carcinoma. In surgical treatment, parathyroidectomy and additional procedures are often performed with general, local and regional anesthesia. We present a case of a 71-year-old white woman with a hypercalcemic crisis associated with a possible preoperative parathyroid carcinoma. Serum calcium and parathyroid hormone levels were 18.8 mg/dl and >1900 pg/ml, respectively. Emergency left lower parathyroidectomy was performed only under locoregional anesthesia because of existing comorbidities. There was a rapid decrease in parathyroid hormone levels immediately after surgery. Histology revealed a 3 cm parathyroid carcinoma in our patient. Definitive surgery was planned and the patient was discharged. Excision in hypercalcemic crisis due to parathyroid adenoma, ipsilateral thyroid lobectomy and removal of abnormal lymph nodes in case of carcinoma is recommended. In our patient, emergency parathyroidectomy was preferred instead of definitive surgery in the first stage because of comorbidities. This case raises awareness of the life-threatening hypercalcemic crisis and emphasizes the importance and benefit of emergency parathyroidectomy and alternative anesthesia techniques in hypercalcemic crisis.

Bedel, Cihan; Koc, Ural

Objective: To determine the predictive value of the optic nerve sheath diameter (ONSD) at distances 3 mm and 10 mm behind the posterior limit of the eyeball and of the initial Rotterdam CT Scoring (RCTS) scores in determining the severity and mortality in traumatic brain injury (TBI). Design: Retrospective study Setting: Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital, Antalya, Turkey Subjects: One hundred and eighty-two patients were included from January to December, 2017 Intervention: None Main outcome measure: Demographic and clinical data and computed tomography (CT) scans of the brain were record-ed. ONSD for each eye was measured on the initial CT scans. Bilateral ONSD was measured at distances 3 and 10 mm behind the posterior limit of the eyeball and RCTS scores were assessed on the same CT images. Results: The study included 182 patients [age: 43.68±19.65 years; 79.1% males; mean RCTS: 2.53±1.35; mortality: 14.3% (n=27)]. The median RCTS score was 4(1-6) mm in non-survi-vors vs. 2(1-6) mm in surviving patients (P<.001). The mortality rate for RCTS score of ≥4 was 40% (18/45). The mean ONSD values measured both at 3 mm and 10 mm distances were higher for lower Glasgow Coma Scale (GCS) scores (P=.001, P=.003, respectively). The mean ONSD values were higher for higher RCTS scores (P<.001). The receiver operat-ing curve analysis calculated the best ONSD cut off value to predict mortality as 5.0 mm (sensitivity: 80%; specificity: 78.46%) with an area under curve of 0.856 (95% CI: 79-92.1%). Conclusion: ONSD values along with RCTS and GCS scores enhance the prognostic performance and improve sensitivity while maintaining high specificity in predicting severe TBI and mortality.

Teke, Turgut; Feyzioglu, Bahadir; Tosun, Mustafa; Dogan, Metin; Yesildag, Kerim; Ozdemir, Mehmet

Objective: To investigate a possible role of torque teno virus (TTV) in the etiology of sarcoidosis Design: Controlled prospective study Setting: Faculty of Meram Medicine, Necmettin Erbakan University, Konya, Turkey Subjects: This cross-sectional, clinical study included 37 sarcoidosis patients and 9 healthy control patients. Intervention: TTV DNA quantification was performed by real-time PCR by the hybridization probe system, and viral load was interpreted by means of the crossing point (CP) value in sera of subjects. Main outcome measures: The prevalence and viral load of TTV Results: TTV DNA was detected in the majority of both patients and healthy controls. The prevalence was 59.5% in patients and 55.6% in controls. This difference was not statistically significant. However, CP values were statistically different in the patient group from the control group (p <0.001); namely, the viral load of TTV was higher in the patient group than in the healthy control group. Conclusions: Overall, these findings demonstrate for the first time that TTV plays a role in the etiology of sarcoidosis. It is likely that the role of TTV in the pathogenesis of sarcoidosis is an aberrant immune response, driven by viral antigens.

Akin, Yigit; Ucar, Murat; Yucel, Selcuk

Although the prevalence of urolithiasis is nearly 2-3% in childhood, the risk of recurrence may range between 6.5-54%. There has been an increase in stone disease in the pediatric age groups. The stone disease in children has multifactorial etiology. After the diagnosis, detailed metabolic evaluation is required. High recurrence rates, therapeutic irregularities and deficiency in diagnosis may lead to co-morbidities such as loss of kidney. After the exact diagnosis, surgical options such as stone extraction and correction of the anatomical anomalies come into question. Besides these, medical and supportive treatments are needed for preventing recurrence, urinary infection and, preserving renal function. Supportive care includes increased fluid intake and dietary modifications. Medical treatment depends on the cause of urinary stone disease. Morbidities of pediatric urolithiasis can be prevented by early diagnosis, detailed metabolic analysis, regular follow-up and medical treatment protocols.

Arslan, Murat; Akin, Yigit; Ates, Mutlu; Gozen, Ali Serdar; Tunc, Lutfi; Guven, Selcuk

Objective: To compare the effectiveness of different electrosurgical devices used during laparoscopic surgery in Turkey Design: Retrospective study Setting: Gulhane Military Medical Academy, Experimental laboratory, Turkey Subject and Methods: Six large White-Landrace-Pietrain pigs, with a mean weight of 63 ± 3.61 kg, were used in 2011. Interventions: Laparoscopic Vessel Sealing Devices Main Outcome Measures: Sealing time, demarcation, destruction, sticking, and burning effects of laparoscopic electrosurgical devices were investigated in blood vessels and ureters Results: Sealing process was significantly shorter with Liga Sure Atlas (LS-10 mm and LS-5 mm), Plasma Trissector Gyrus (PTG) and Harmonic Scalpel (HS) in gonadal vessels. The shortest superficiald emarcation was provided with HS. The sticking effects of the LS-5 mm and PTG were lower in ureters. The superficial demarcation was shorter with PT Gthan LS-5 mm, LS-10 mm and HS in ureters. Conclusions: HS stands out a bit more among devices with electrosurgical effects and fewer side effects to surrounding tissues than other devices in our study. Electrosurgical device should be selected according to necessity of the kind of dissection.