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Background and Design: This study aims to investigate the prognostic factors in BRAF wild-type metastatic cutaneous melanoma and the prognostic role of inflammation indices. Materials and Methods: Metastatic BRAF wild-type cutaneous melanoma patients who presented to our clinic between 2011 and 2021 were enrolled. To investigate their prognostic roles, age, gender, performance status, first immunotherapy regimen received by the patient, metastatic sites, and seven inflammation indices [C-reactive protein (CRP)/albumin ratio (CAR), neutrophil lymphocyte ratio (NLR), prognostic nutritional index (PNI), platelet lymphocyte ratio (PLR), systemic immune-inflammation index (SII) and advanced lung cancer inflammation index (ALI) and hemoglobin, albumin levels, lymphocyte and platelet counts (HALP)] were studied. Results: Fourty-seven patients, consisting of 22 (46.8%) females and 25 (53.2%) males, were included in this study. Mean patient age was 54 (18-88) years. In our study, there were 16 (34%) patients with liver metastasis, 17 (36.2%) patients with lung metastasis, and 9 (19.1%) patients with brain metastasis. As immunotherapy, 34 (72.3%) patients had received Nivolumab, while 13 (27.7%) patients had received Ipilimumab therapy. When the relationships of the prognostic variables with overall survival were inspected in univariate and multivariate analyses, brain metastasis was found to be an independent prognostic factor (p=0.02). Lung metastasis approached the threshold of statistical significance in univariate analysis (p=0.09) and liver metastasis in multivariate analysis (p=0.07). The seven inflammation indices examined in the analyses [CAR, NLR, PNI, PLR, SII ALI and HALP] were found to have no prognostic role in both univariate and multivariate analyses. Conclusion: Our study determined that brain metastasis is an independent poor prognostic factor in BRAF wild-type metastatic melanoma. Prognostic roles of the CAR, NLR, PNI, PLR, SII ALI and HALP indices could not be demonstrated.

PURPOSEThe increase in volume and pressure in the right atrium (RA) and right ventricle (RV) has been shown to increase the liver stiffness (LS). In the literature, there is no information about the changes in LS value in patients with atrial septal defect (ASD). The aim of our study was to investigate the change of LS values obtained by point shear-wave elastography (pSWE) in patients with ASD and the clinical utility of pSWE for this disease.METHODSThis cross-sectional study included 66 patients with ostium secundum ASD: 21 patients with no indication for ASD closure (Group I), 38 patients who underwent ASD closure (Group II), and 7 patients who had ASD with Eisenmenger syndrome (Group III). All patients underwent echocardiography and pSWE. Increased LS was accepted as ≥7 kPa.RESULTSLS values as well as transaminases, clinical signs of heart failure and functional and structural heart abnormalities (increase of RA and RV diastolic dimensions, tricuspid regurgitation pressure gradient [TRPG], ASD size and decrease of ejection fraction, tricuspid annular plane systolic excursion) significantly increased from Group I to Group III (P < 0.001 for all comparisons). Mean LS values for Group I, Group II, and Group III were 5.16±1.55 kPa, 7.48±1.99 kPa, and 13.9±2.58 kPa, respectively. In multivariate linear regression analysis, ASD size and TRPG were significantly associated with LS increase. Only ASD size independently predicted abnormal LS increase ≥7 kPa according to multivariate logistic regression. Clinical value of LS increase was comparable to TRPG for detection of Eisenmenger syndrome; in the receiver operating curve analysis, area under the curve was 0.995 for LS (P < 0.001) and 0.990 for TRPG (P < 0.001). At 10 kPa threshold, LS determined the Eisenmenger syndrome with 100% sensitivity and 91.5% specificity.CONCLUSIONLS value assessed by pSWE was significantly increased in ASD patients with closure indication and Eisenmenger syndrome compared to patients without ASD closure indication and was comparable with TRPG in regards to Eisenmenger syndrome identification. ASD size significantly associated with LS and independently predicted abnormal LS increase ≥7 kPa.

Background: The relationship between elastic properties of the aorta and presence of coronary artery disease (CAD) has been investigated in previous studies. However, the relationship of aortic stiffness (AS) with extent and complexity of CAD in patients with non-ST-segment elevation myocardial infarction (NSTMI) have not been evaluated in previous studies. Aims and Objectives: The aim of this study is to determine the relationship of AS with extent and complexity of CAD in patients with NSTMI. Materials and Methods: Study population includes 400 patients (265 men, 135 women, mean age 61,8 ± 10.4 years) who had coronary angiography (CAG) in our clinic between February 2013 and October 2013 with the diagnosis of NSTMI. Patients were divided into two groups according to the median SYNTAX score as SYNTAX score < 16,5 SYNTAXlow group; and SYNTAX score ≥ 16,5 SYNTAX high group. AS parameters containing pulse wave velocity (PWV) and augmentation index (AIx) were calculated using applanation tonometry. Results: PWV and AIx parameters were found to be significantly higher (P < 0.001 for each) in SYNTAX high group compared to SYNTAX low group. Also age, the frequency of HT (hypertension), HPL (hyperlipidemia) and DM (diabetes mellitus) were significantly higher (P < 0.05 for all) in SYNTAX high group. HT (β = 0.083, P = 0.048), DM (β = 0.160, P < 0.001), PWV (β = 0.520, P < 0.001), and AIx (β = 0.230, P < 0.001) were found to be independently associated with SYNTAX score in multivariate regression analysis. On the other hand, age (β = 0.255, P < 0.001), HT (β = 0.212, P < 0.001), NT-proBNP (β = 0.086, P = 0.012) and SYNTAX score (β = 0.494, P

INTRODUCTION: Pulmonary valve stenosis is the most common of the right ventricular outflow tract obstruction, BVP has been the treatment of choice in these subgroup of patients. In this study, we aimed to evaluate right ventricular functions of patients undergone BVP for PS using two-dimensional, pulse wave (PW) Doppler and tissue Doppler echocardiography. METHODS: 33 patients undergone BVP for PS (11 female, 22 male; mean age 7.7 +- 5.6 years) and age and gender-matched healthy 50 children were evaluated. RESULTS: In our study, the two-dimensional echocardiography derived TAPSE, RVED and RVFAC values; PW Doppler echocardiography derived tricuspid E and A waves, E/A ratio, and ET; tricuspid S and E wave, E/A ratio and ET obtained from tissue Doppler echocardiography were found to be lower in the patient group. IVRT and IVCT values obtained from both tissue Doppler and PW Doppler echocardiography, and the Tei index, were found to be increased in the patient group. Pulmonary insufficiency after BVP was present in 21.2% of the patient group DISCUSSION AND CONCLUSION: BVP appears to be a safe and effective option in treatment of congenital pulmonary valve stenosis. Presence of residual stenosis after BVP is found to be associated with right ventricular failure. Increased Tei index showed the presence of impaired right ventricular functions in patients undergone BVP for PS.

Systemic lupus erythematosus (SLE) is a systemic, chronic, inflammatory, autoimmune disease characterized by multi-organ and -system involvement such as the kidneys and hematologic and central nervous systems. The clinical presentation of the disease is extremely variable. Systemic findings, nephritis, neuropsychiatric disease, and cytopenia are more common in children than in adults at presentation. Chorea typically manifests with jerky, involuntary, and purposeless movements, involving the face, four limbs, and neck. In addition, patients suffer from dysarthria, gait disturbance, and neuropsychiatric symptoms. Chorea can be the first finding of SLE during childhood. Herein we reported a 13-year female patient who presented with movement and speech disorders and who was diagnosed chorea-related SLE.

Trichobezoar is a mass found trapped in the gastrointestinal system formed from the ingestion of hair. They are mostly localized inside the stomach, and they can occasionally extend from the pylorus into the duodenum and small intestines. At the same time, they are almost always associated with trichotillomania, trichophagia, and other psychiatric diseases. Trichobezoar can be easily confused with other diseases characterized by abdominal pain and vomiting. Removal of the mass with laparotomic, laparoscopic, and endoscopic interventions is an available treatment approach. Among them, the laparotomic approach is the most effective treatment modality. Herein, we present a case and reviewed the literature from a general outlook in order to emphasize current, updated approaches to the pediatric cases with trichobezoar.

Breast cancer usually metastasizes to bone, lungs, liver and central nervous system. Rarely, atypical metastases may occur. Isolated peritoneal metastasis of breast cancer is very uncommon. On systemic examination of a 50-yearold woman who presented to our outpatients’ clinic with the complaints of abdominal pain and distention, abdominal ascites and a breast mass were found. Biopsy from the breast mass revealed invasive ductal carcinoma and laparoscopic peritoneal biopsy showed peritoneal metastasis of the breast cancer. Palliative chemotherapy was planned. The patient rejected the treatment and has been under follow-up for 6 months does not have any other metastasis now.