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Studies on cranial gunshot injuries in the Syrian war are present in the literature. However, the effect of surgical timing on the clinical outcomes of patients undergoing surgical treatment has not been discussed extensively. In this study, the time from injury to surgery is called "time to surgery." Kilis, a city close to Aleppo, Afrin, and Azez, where the conflicts in Syria are intense, is one of the cities where the first emergency treatments were administered. This study aimed to evaluate patients who underwent surgery in Kilis State Hospital due to cranial gunshot injury in the Syrian war and to investigate the effect of surgical timing on mortality and Glasgow Outcome Score.Surgical treatment was applied to 42 (32.8%) patients in the first 4 hours, 64 (50%) patients within 4 to 24 hours, and 22 (17.2%) patients between 24 hours and 3 days. As the time to surgery decreased, the good Glasgow Outcome Score (GOS) (4-5) outcome rates increased. The differences in surgical timing and GOS results of patients with Glasgow Coma Score (GCS) 8 were found to be significant for good GOS results. As the time to surgery decreased for patients with a GCS 8, mortality rates decreased equally. This result was statistically significant.Our study showed that surgical timing is as important as early intubation, aggressive resuscitation, and admission GCS for both survey and GOS.

Objectives Obesity is often the result of a high-calorie and unbalanced diet for a long time and can sometimes be associated with hyperphagia and eating disorders. Neurotensin (NT) is an anorexigenic peptide, which is secreted from the central nervous system and intestines, and increases intestinal fat absorption. In the literature, conflicting results regarding serum NT level in obesity and the relation of NT with metabolic parameters were reported. Besides, there is no data regarding the relation of NT with eating disorders or food preference in obese individuals. We aimed to evaluate the relation of serum NT level with metabolic parameters, hyperphagia, binge eating disorder (BED) and food preference in obese adolescents. Methods The study included 65 obese adolescents and 65 healthy controls. Anthropometric measurements, biochemical analyzes and body fat analyzes were performed in all cases. Hyperphagia score, presence of BED and three-day food intake records were also evaluated. Results NT level was significantly higher in obese adolescents than in controls and it was not associated with metabolic parameters, hyperphagia or food preference. In the obese group, NT level was not significantly different according to the presence of BED. Conclusions Serum NT level is high in obese adolescents; however, it is not associated with metabolic parameters, hyperphagia, BED or food preference.

Background: Peritumoral edema of primary brain tumors is an important cause of morbidity and mortality. The number of studies currently available on the prognostic role of peritumoral brain edema in the posterior fossa is extremely limited. Objective: Based on the known importance of magnetic resonance imaging in diagnosing supratentorial metastases, this study aimed to investigate the effects of peritumoral edema on survival of patients with posterior fossa metastases and the preoperative diagnostic value of MRI. Methods: Edema and mass volumes of 49 patients with posterior fossa metastasis, who underwent surgery during 2012–2016, were measured using magnetic resonance imaging. The edema/mass indices were retrospectively calculated and interpreted by evaluating the demographic, clinical, and survival data. Results: The study consisted of 32 (65.3%) male and 17 (34.7%) female participants, with the mean age ± standard deviation of 47.25±29.25 (17–81) years. Among the 49 patients with posterior fossa metastases, 34 (69.4%) had carcinoma, while 15 (30.6%) had non-carcinoma metastases. The edema/mass indices of patients with carcinoma and non-carcinoma metastases were found to be 14.55±9.64 and 1.34±1.08, respectively, and the difference was statistically significant (p Conclusion: The edema/mass ratio was found to be a significant diagnostic factor for the prediction of posterior fossa metastases. Further detailed studies are warranted to investigate the effect of edema/mass ratio on survival rate.

Brain arteriovenous malformations (AVMs) are congenital anomalies that present as intracranial hemorrhage or epilepsy. AVMs often remain clinically silent for extended periods. Although AVM treatment methods are controversial, three treatment strategies are usually combined or applied alone: surgical removal, embolization and stereotactic radiosurgery. We compared clinical and radiological outcomes in intracranial AVM patients treatedPatients who did (30 patients) and did not (30 patients) undergo endovascular embolization before surgical resection at the İzmir Katip Çelebi University Atatürk Training and Research Hospital Neurosurgery Clinic from 2011 to 2019 were included in this retrospective, cohort study. Symptoms at diagnosis, comorbidities and clinical (AVM and Spetzler-Martin grade) and morphological characteristics were assessed.A mean one-year follow-up assessed outcomes using the modified Rankin score, and imaging studies assessed AVM obliteration post-procedure. Mean operation times for surgical resection with and without embolization were 166.50 ± 32.02 and 204.47 ± 26.66 min, respectively. Mean patient hospitalization periods for surgical resection with and without embolization were 8.43 ± 3.60 and 12.00 ± 5.51 days, respectively.Among patients who underwent surgical resection, significant operation time and hospitalization time differences were observed in favor of patients who underwent embolization, indicating that preoperative embolization is a safe and beneficial method for treating ruptured and non-ruptured AVMs.

Introduction and Objectives: We aimed at evaluating retrospectively effects of surgery on the clinical symptoms and signs and imaging parameters in the patients with Chiari's malformation undergoing surgical treatment. Materials and Methods: Medical charts and radiological images of the patients with Chiari's Malformation type I who had surgical treatment between January 2008 and July 2014 were reviewed retrospectively. The patients were classified as those having good (in whom the symptoms disappeared or reduced), stabilized (with preoperative symptoms persisting without any progression), or poor (with preoperative symptoms progressing in the postoperative period) outcomes. Findings: All patients underwent FMD, Cl laminectomy and duraplasty. Seventeen subjects underwent removal of arachnoid adhesions, 10 subjects underwent opening of the fourth ventricle, and one subject underwent subpial resection. Of the patients, 28 were female and 11 were male with ratio of females to males being 25:1. The youngest patient was 5 years old and the eldest one was 51 years old, and mean age of the patients was 3231 ± 3131 years. The subjects were divided in two groups based on presence or absence of associated syringomyelia: those with syringamyelia (Group 1, n = 15) and those without syringomyelia (Group 2, n = 24). Postoperatively, in the Group 1 (SM 1- CM) 10 (66.7%) patients had good, 3 (20%) had stabilized and 2 (133%) patients had poor surgical outcomes. In the Group 2, 23 (918%) subjects had good and 1 (4.2%) subject had stabilized outcomes. For the Group 2, rate of recovery was higher than in the Group 1 (918% and 66.7%, respectively; Pearson's chi-square test, P = 0.014). Rate of recovery in 21 subjects with degree of tonsillar herniation being more than 11 mm (95.2%) was statistically significantly higher than 18 subjects with degree of tonsillar herniation being less than 11 mm (72.2%) (Pearson's chi-square test, P = 0.047). Results: FMD is a safe and efficient surgical method for the Chiari malformations with or without associated syringomyelia. The subjects without associated syringomyelia benefited more from the surgery. Complications related to CSF may be reduced using additional tissue glues. Studies with greater number of cases should be conducted on the effect of degree of tonsillar herniation on surgical outcomes.

Objective: To investigate mortality in patients undergoing surgical treatment for spontaneous intracranial hemorrhage (sICH) and to identify the predictive factors. Materials and Methods: The medical records of 164 patients with sICH who underwent surgery at two institutions between 2010 and 2017 were retrospectively examined and analyzed. Results: Among 164 patients who received surgical treatment, 83 (50.6%) were women and 81 (49.4%) were men. The mean patient age was 56±14.54 years. Of all patients, 109 (66.4%) had hypertension. Hematoma was intraparenchymal in 69 (42.1%) patients, thalamic in 33 (20.1%), intraventricular in 33 (20.1%), and cerebellar in 29 (17.7%) patients. The mortality rate among patients who underwent surgery within the first 8 h of hematoma occurrence was 55.4%; this rate was 73% among those who underwent surgery 8-24 h after diagnosis, and 72.7% among those who underwent surgery 24-48 h after diagnosis. Conclusion: Prognosis and mortality associated with sICH are usually affected by patient age, hematoma location and volume, intraventricular hemorrhage, and patient’s initial neurologic status. We found no significant relationship between surgical treatment 8 h after hemorrhage and mortality. There are still discussions about the indications of surgical treatment in intracranial hematomas.

OBJECTIVE: In this study, it was aimed to evaluate the relationship between parental personality characteristics and psychiatric symptoms with childhood obesity. METHODS: This cross-sectional study was conducted in third-level clinical care institution. Thirty obese adolescents and 29 age- and sex-matched healthy controls were included in the study. Both mothers and fathers were accepted to participate in the study in the obese and control group. The Temperament and Character Inventory (TCI) was used to determine the personality features of the parents, and the Brief Symptom Inventory (BSI) was used to evaluate their psychiatric symptoms. RESULTS: According to the TCI scores, fathers of the obese group had lower scores in self-directedness and persistence subscales than the controls’ fathers, and mothers of the obese group had higher scores in the harm avoidance subscale and lower scores in the cooperativeness subscale than mothers of the controls. In the BSI scores, mothers of the obese group had higher scores in anxiety and somatization subscales than mothers of the controls; however, there were no differences in paternal subscales between the parents of the obese and control groups. CONCLUSIONS: Parental personality profiles and psychiatric symptoms may affect parenting and family functions. Thus, they may contribute to susceptibility to childhood obesity, and may be an additional area to consider when addressing the psychological environment of adolescents with obesity.

Background This study aims to compare the clinical results of patients with upper thoracic vertebral fractures treated with pedicle screw and posterior spinal fusion with preoperative surgical planning and 3-dimensional (3D) modeling and patients treated with freehand screws. Methods Fifty patients who underwent pedicle screw placement with a diagnosis of upper thoracic fracture between June 2018 and October 2020 were included in our study. Pedicle screws were used in 25 patients (group 1) after the planning was completed with the help of 3D preoperative printing and modeling. Pedicle screws were applied in 25 patients in the control group (group 2) using the freehand technique. Intraoperative bleeding amount, operation time, and correct screw placement data in both groups were recorded. Results The operation time was 134 ± 22 minutes for group 1 and 152 ± 38 minutes for group 2. The difference in operation times was found to be statistically significant (p < 0.05). Based on axial and sagittal reconstruction images, the accuracy rate of pedicle screw placement (grades 0 and 1) in group I was 96.6% compared to 83.6% in group II. The minor perforation rate (grade 1, 4 mm) was 2.3% in group II; however, misplaced screws were not associated with neurological deficits. The difference in overall accuracy rates between the two groups was significant (p < 0.05). Conclusions For 3D models of upper thoracic pedicle screw insertion, guide plates can be produced inexpensively and individually. It provides a new method for the accurate placement of upper thoracic pedicle screws with high accuracy and secure use in screw insertion.

Objectives The present study aimed to compare patients in whom an operation plan was prepared before surgery using the three-dimensional (3D) modeling technology with the application of freehand screws using magnetic resonance imaging (MRI) and computed tomography (CT) scan images. Methods The printings and modelings were established in the Training and Research Center. Of 40 patients, 20 underwent surgery with 3D printing (Group 1) and 20 with the freehand technique (Group 2). The surgeries were performed by the same surgeons. Moreover, 5-mm pedicle screws were located in 122 vertebrae in 20 patients in whom 3D modeling was used and in 124 vertebrae in 20 patients in whom this modeling technique was not used. Results The mean time of screw insertion was 2.9 ± 1.2 minutes in the experimental group and 4.7 ± 2.3 minutes in the control group. While the mean amount of bleeding was 7.4 ± 4.1 ml in the experimental group, it was found to be 39.6 ± 14.2 ml in the control group. When the locations of the screws in the experimental group were evaluated, it was seen that 106 (86.9%) screws were 'excellent' and 16 (13.1%) screws were 'good.' When the placement of 124 pedicle screws in the control group was evaluated, it was found that 100 (80.6%) screws were 'excellent,' 20 (17.8%) screws were 'good,' and two (1.6%) screws were 'poor.' Conclusion The use of the improved 3D technology in the neurosurgery field is advantageous for surgeons, as it decreases the preoperative preparation phase, length of operation, and risk of complications.

Background: This study aims to compare the clinical results of patients with upper thoracic vertebral fractures treated with pedicle screw and posterior spinal fusion with preoperative surgical planning and 3-dimensional (3D) modeling and patients treated with freehand screws.Methods: Thirty patients who underwent pedicle screw placement with a diagnosis of upper thoracic fracture between June 2018 and October 2020 were included in our study. Pedicle screws were used in 15 patients (group 1) after the planning was completed with the help of 3D preoperative printing and modeling. Pedicle screws were applied in 15 patients in the control group (group 2) using the freehand technique. Intraoperative bleeding amount, pedicle screw insertion time, and correct screw placement data in both groups were recorded. The time of insertion of each pedicle screw was recorded.Results: The operation time was 134 ± 22 minutes for group 1 and 152 ± 38 minutes for group 2. The difference in operation times was found to be statistically significant (p 4 mm) was 1.7% in group II. The difference in overall accuracy rates between the two groups was significant (pConclusions: For 3D models of upper thoracic pedicle screw insertion, guide plates can be produced inexpensively and individually. It provides a new method for the accurate placement of upper thoracic pedicle screws with high accuracy and secure use in screw insertion.

Background/Objectives In recent years, oxytocin (OXT) and polymorphisms in the oxytocin receptor (OXTR) gene have been reported to play roles in obesity pathogenesis. However, there was no study evaluating OXTR gene variants in childhood obesity. The aim of the study was to investigate the relation of OXTR gene polymorphisms and serum OXT levels with metabolic and anthropometric parameters in obese and healthy adolescents. Subjects/Methods The study was a multi-centered case-control study, which was conducted on obese and healthy adolescents aged between 12 and 17 years. Serum OXT and leptin levels were measured, and OXTR gene variants were studied by qPCR (rs53576) and RFLP (rs2254298) methods. Results A total of 250 obese and 250 healthy adolescents were included in this study. In the obese group, serum OXT level was lower and leptin level was higher than the control group. In the obese group, frequencies of homozygous mutant (G/G) and heterozygous (A/G) genotypes for rs53576 polymorphism were higher than the control group. Homozygous mutant(G/G) and heterozygous (A/G) genotypes for rs53576 polymorphism were found to increase the risk of obesity compared to the wild type (A/A) genotype [OR = 6.05 and OR = 3.06; p < 0.001, respectively]. In patients with homozygous mutant (G/G) and heterozygous (A/G) genotype for rs53576 polymorphism, serum OXT levels were lower than the wild type (A/A) genotype. In the obese group, hyperphagia score was higher than the control group and correlated negatively with serum OXT level. Conclusions This study revealed that low serum OXT level, which is associated with hyperphagia may be an underlying cause for obesity in adolescents. For rs53576 polymorphism of the OXTR gene, obesity risk is higher in patients with homozygous mutant(G/G) and heterozygous(A/G)genotypes.

Background and Aims Hyperuricemia has been associated with the development of hypertension, cardiovascular, and renal disease. However, there is no data about the effect of lowering uric acid level on hypertension, renal function, and proteinuria in renal transplant patients. We therefore conducted a prospective study to investigate the benefits of allopurinol treatment in renal transplant patients and to investigate indirectly its effect on graft survival. Method A total of 105 Renal transplant recipients(RTRs) were included in this study. Patients were randomized to receive either placebo (n=51) or 300 mg/day allopurinol (n=54). We have examined uric acide, urinary albümin/Cr ratio, eGFR, CRP and blood pressure before and 24 weeks later after treatment in both group. Results In the allopurinol group, the mean serum uric acid levels, eGFR, creatinine urinary albümin/Cr ratio significantly improved(P < 0.001). However, blood pressure, CRP not statistically significant (P > 0.05). No correlation was observed between changes in uric acide and changes in CRP, or blood pressure in the allopurinol group. No significant changes were observed in the control group (P > 0.05). Multivariable regression analysis showed that uric acide was positively correlated with UACR (r= 0,473, β = 0.021, P = 0.002) and negatively correlated with eGFR ( r= -0554 β = 0.016, P = 0.001) in RTRs. Conclusion We bring indirect evidence that hyperuricemia increases urinary albümin/Cr ratio, and decreases eGFR. Hence, management of hyperuricemia may prevent the progression of renal disease, even in patients with normal renal function, suggesting that early treatment with allopurinol should be an important part of the management of renal transplant recipients. Long-term follow-up studies are warranted to identify the benefits of uric acid management on renal function and proteinuria.

The aim of this study was to evaluate the olfactory function of patients who had undergone endoscopic transsphenoidal pituitary surgery. In this prospective study, the "Sniffin' Sticks" test was performed between June 2016 and April 2017 at Izmir Katip Celebi University Ataturk Training and Research Hospital. Thirty patients who were scheduled to undergo endoscopic transsphenoidal pituitary surgery were evaluated preoperatively and 8 weeks postoperatively using the Sniffin' Sticks test battery for olfactory function, odor threshold, smell discrimination, and odor identification. The patients were evaluated preoperatively by an otolaryngologist. The patients' demographic data and olfactory functions were analyzed with a t test and Wilcoxon-labeled sequential test. The study group comprised 14 women (46.7%) and 16 men (53.3%) patients. The mean age of the patients was 37.50 +/- 9.43 years (range: 16-53 years). We found a significant difference in the preoperative and postoperative values of the odor recognition test (P = 0.017); however, there was no significant difference between the preoperative and postoperative odor threshold values (P = 0.172) and odor discrimination values (P = 0.624). The threshold discrimination identification test scores were not significant (P = 0.110). The olfactory function of patients who were normosmic preoperatively was not affected postoperatively. This study shows that the endoscopic transsphenoidal technique for pituitary surgery without nasal flap has no negative effect on the olfactory function.

Psoriasis is a common chronic inflammatory disease. Having more information about psoriasis and comorbid diseases means that patients have more involvement in treatment.Evaluate the knowledge levels of psoriasis patients about the disease and comorbidities and also to determine participation in treatment decisions.Totally 103 patients over the age of 18 with diagnosed psoriasis were included into the study. A questionnaire including items on knowledge about disease and treatment options, comorbid diseases were filled out by the patients. Total knowledge score (TKS) was found by giving 1 point to the questions that the patients knew correctly.Patients were well informed about their risk of depression (64.1%), but were less well informed about their risk of atherothrombotic disease (14.6%). About 50.4% of the patients thought that psoriasis may be due to an internal organ disease. There was a negative correlation between the patient's age, the age of diagnosis and TKS. About 42.7% wanted to leave the decision entirely to the physician.The results of this study showed that majority of patients with psoriasis are not aware of the increased risk of comorbid diseases and do not have enough knowledge about psoriasis.

In recent years, drug use has come to the forefront as one of the most important problems of public health. Tianeptine is an antidepressant that is structurally similar to tricyclic antidepressants and is used for the treatment of depression but is also abused because its pleasing feature has been recognized by drug users. Two forensic cases were autopsied with an interval of 25 days. One case had unilateral unusual inguinal lesions. The other case bilateral unusual inguinal lesions. It was understood that these lesions were preformed, improved surgical catheter incisions in order to facilitate intravenous injections for drug abuse. This application, which was detected in the inguinal region, was found to be interesting. It is aimed to raise the awareness of this application, which is not found in the literature. As a result of the intense human transit, substance abuse habits and methods have also been transferred to citizens...

Aim: In the treatment of vertebral compression fractures, kyphoplasty stands out as an effective treatment method that has been performed more frequently in recent years. The etiology of compression fractures varies from patient to patient. Biopsy results taken from the patients during the procedure reflect these differences. We wanted to emphasize the importance of the biopsy procedure performed during kyphoplasty by evaluating the biopsy results. Materials and Methods: The patient files, radiological images and biopsy results of the patients, who were treated with kyphoplasty due to vertebral compression fracture and who had a biopsy performed during this procedure between 2017 and 2019. Results: The total number of operated patients was found to be 201, and the number of vertebrae biopsies was 269. Eighty-three of our patients were male and 118 were female. Of the 269 biopsy results in total, 18 (6.7%) had pathological findings; 3 of them were compatible with osteomyelitis, while the remaining 15 were malignant. Conclusion: Since the biopsy procedure performed during the treatment of vertebral compression fractures with kyphoplasty could be performed safely and provides an opportunity for early diagnosis and treatment, a biopsy requirement for the benefit of patients would be inevitable in all kyphoplasty procedures.

Aim: The present study aimed to report the peri- and postoperative complications in patients undergoing third ventricular colloid cyst resection using a microsurgical approach.Materials and Methods: A total of 29 patients with symptomatic third ventricular colloid cysts were operated upon via the microsurgery method at two different neurosurgery clinics, and their data were analyzed retrospectively.Results: Among them, 12 (41.4%) were men, and 17 (58.6%) were women. The mean age was 34.24 ±16.43 years, and the age range was 1–70 years. Headache was the most common symptom at reference and occurred in 21 (72.4%) patients. Also, ataxia was the presenting symptom in 7 (24.1%) of our patients, vomiting in 6 (20.7%), visual loss in 6 (20.7%), epileptic seizures in 4 (13.8%), incontinence in 4 (13.8%), and loss of consciousness in 1 (3.4%). Moreover, 19 (65.5%) had hydrocephalus, and two of them with weak consciousness were operated after the application of a preoperative external ventricular drainage systemConclusion: The interhemispheric transcallosal approach is the most commonly used method in colloid cyst microsurgery, and the most frequent surgical complication is venous infarction secondary to this approach. Thus, the significant results of infarct that occurred in patients with preoperative hydrocephalus suggest that this complication could be controlled more easily if the hydrocephalus and intracranial pressure are followed up more carefully in the pre- and perioperative periods.

Şahin, Nilay (Balikesir Author), Objective: The aim of this study was to determine functional status and QoL of children with spina bifida (SB) by using the Functional Independence Measure for Children (WeeFIM) and the Child Health Questionnaire PF-50 (CHQPF-50) and to compare the functional status data of pediatric SB patients with those of healthy children. Material and Methods: Forty children with SB and 40 healthy children aged between 36 and 143 months were enrolled in the study. Both pediatric SB patients and healthy children were divided into three age groups: Group 1: 36-71 months, Group 2: 72-107 months, and Group 3: 108-143 months. The WeeFIM and CHQPF-50 were completed for children with SB, whereas the WeeFIM was completed only for healthy children. Results: In both assessments, the total score and subscale scores were lower than normal values in children with SB. However, improvement was found in self-care; communication; social, emotional, and mental status; and family factors with increasing age. On the other hand, there was no improvement in physical score, transfer, mobility, and sphincter control with increasing age. Functional status of children with SB was significantly lower compared to healthy children. Conclusion: There was progress in self-care, communication, family factors, and social, emotional and mental status in children with SB with increasing age., Amaç: Bu çalışmanın amacı, spina bifidalı (SB) çocuklarda fonksiyonel bağımsızlık indeksi (WeeFIM) ile çocukluk çağı sağlık değerlendirme sorgu formu PF-50 (CHQPF-50) kullanılarak fonksiyonel durumu ve yaşam kalitesini belirlemek ve fonksiyonel durum açısından elde edilen sonuçları sağlıklı çocuklarla karşılaştırmaktır. Gereç ve Yöntemler: Yaşları 36-143 ay arasındaki, 40 SB’li ve 40 sağlıklı çocuk çalışmaya alındı. Pediatrik SB hastaları ve sağlıklı çocuklar yaşlarına göre 3 gruba ayrıldı: Grup 1: 36-71 ay, Grup 2: 72-107 ay, Grup 3: 108-143 ay idi. Spina bifidalı çocuklarda WeeFIM ve CHQPF-50; sağlıklı çocuklarda ise WeeFIM dolduruldu. Bulgular: Her iki değerlendirmede toplam skor ve alt grupların skorları SB’li çocuklarda normal değerlerden daha düşüktü. Ancak kendine bakım, iletişim, sosyal, ruhsal ve mental durum ve ailesel faktörlerin yaşla birlikte iyileştiği tespit edildi. Öte yandan fiziksel skor, transfer, mobilite ve sfinkter kontrolünde yaş artışıyla birlikte iyileşme saptanmadı. Sağlıklı çocuklara göre, SB’li çocukların fonksiyonel durumunda anlamlı bir düşüklük elde edildi. Sonuç: Sonuçta SB’li çocuklarda kendine bakım, iletişim, ailesel faktörler ile sosyal, ruhsal ve mental durumlarda yaş arttıkça ilerleme olmaktadır.

Ischial bursitis or ischiogluteal bursitis is the inflammation of the ischiogluteal bursa due to excessive or inappropriate physical exercise, prolonged sitting, running, repetitive jumping, and kicking. Since ischial bursitis is a rare, infrequently recognized pathology and is difficult to differentiate from the soft tissue disease and tumors (both malignant and benign), herein exemplified is a case with ischiogluteal bursitis whereby the role of magnetic resonance imaging (MRI) in the prompt diagnosis has been highlighted.

Deep vein thrombosis (DVT) is a common complication following spinal cord injury (SCI). Although DVT of the upper extremity is much less common than DVT of the lower extremities, the risk of pulmonary embolism following upper-extremity DVT should not be disregarded.MethodCase report.FindingsA bilateral upper-extremity DVT developed in a 51-year-old woman with SCI (central cord syndrome) being followed in our rehabilitation clinic. Medical treatment resulted in improvement in the clinical status of the patient as well as the regression in the thrombus.ConclusionIn patients with SCI, DVT should be kept in mind in the presence of pain and edema in the upper extremities, and prophylactic DVT treatment should be considered.

The objective of this study was to assess the prevalence of fibromyalgia (FM) in patients with episodic migraine and to evaluate the relationship between migraine characteristics and FM. One hundred and eighteen consecutive patients (mean age = 38 years, 75 % women) fulfilling the International Classification of Headache Disorders-II criteria for migraine with (n = 22) and without (n = 96) aura from an outpatient headache clinic of a university hospital were evaluated. The diagnosis of FM was made based on the 1990 American College of Rheumatology classification criteria. Participants completed some self-administered questionnaires ascertaining sociodemographics, headache severity, frequency and duration, headache-related disability (Headache Impact Test [HIT-6]) and Migraine Disability Assessment Scale, widespread musculoskeletal pain (visual analog scale), depression (Beck depression inventory), anxiety (Beck anxiety inventory), sleep quality (Pittsburgh Sleep Quality Index), fatigue (Multidimensional Assessment of Fatigue), and quality of life (Short Form-36 Health Survey [SF-36]). In patients with FM, the tender point count and the Fibromyalgia Impact Questionnaire were employed. FM was diagnosed in 37 (31.4 %) of the patients. FM comorbidity was equally distributed across patients with and without aura. Severity of migraine headache, HIT-6, and anxiety were especially associated with FM comorbidity. Patients suffering from migraine plus FM reported lower scores on all items of the SF-36. This study indicates that the assessment and management of coexisting FM should be taken into account in the assessment and management of migraine, particularly when headache is severe or patients suffer from widespread musculoskeletal pain.

WOS: 000398230800006, PubMed: 27860257, Aim: The objective of this study is the evaluation of the effect of vitamin D replacement treatment on musculoskeletal symptoms and quality of life in patients with chronic widespread musculoskeletal pain (CWP) including fibromyalgia (FM) and vitamin D deficiency. Method: Patients with nonspecific CWP and vitamin D deficiency (25-OH D3

Background: Transplant centers commonly evaluate split renal function (SRF) with MAG3-scintigraphy (MAG3) in living kidney donation. Alternatively, the kidney volume can be measured based on pre-donation CT-scans. The aim of this study was to identify the most accurate CT-volumetry technique for SRF[for full text, please go to the a.m. URL], 133. Kongress der Deutschen Gesellschaft für Chirurgie

Numerous hormonal factors contribute to the lifetime risk of breast cancer development. These include inherited genetic mutations, age of menarche, age of menopause, and parity. Inexplicably, there is evidence indicating that ovariectomy prevents the formation of both estrogen receptor (ER)–positive and ER-negative breast cancers, suggesting that ER-negative breast cancers are dependent on ovarian hormones for their formation. To examine the mechanism(s) by which this may be occurring, we investigated the hypothesis that steroid hormones promote the outgrowth of ER-negative cancers by influencing host cell types distinct from the mammary epithelial cells. We used a novel xenograft mouse model of parturition-induced breast carcinoma formation, in which the tumors that arise following pregnancy lack the expression of nuclear hormone receptors, thereby recapitulating many clinical cases of this disease. Despite lacking ER expression, the tumors arising following pregnancy in this model require circulating estrogens for their formation. Moreover, increasing the levels of circulating estrogens sufficed to promote the formation and progression of ER-negative cancers, which was accompanied by a systemic increase in host angiogenesis and was attendant with the recruitment of bone marrow–derived stromal cells. Furthermore, bone marrow cells from estrogen-treated mice were sufficient to promote tumor growth. These results reveal a novel mechanism by which estrogens promote the growth of ER-negative cancers. [Cancer Res 2007;67(5):2062–71]

Polyomavirus BK (BKPyV) is ubiquitous among humans. Following primary infection, the virus remains latent predominantly in the hosts' uroepithelial cells. Up to 10 % of renal transplant recipients show a viral reactivation that can lead to polyomavirus-associated nephropathy (PyVAN). In the absence of early treatments, the risk of graft loss is up to 80 %. Monitoring viral load in urine and plasma by real-time PCR after transplantation is the most common diagnostic tool to detect viral reactivation. In the present retrospective study, BKPyV-DNA loads in urine and plasma by quantitative real-time PCR were associated with clinical data, including HLA haplotype, blood parameters and viral genotype, of 40 renal transplant recipients at the University Clinics of Cologne. Seventeen out of 329 patients screened for BKPyV from January 2009 to October 2013 were detected BKPyV positive in urine only, whereas in 23 patients the virus became additionally detectable in plasma. Among these, ten patients progressed to PyVAN. Overall, the present study showed that the detection from the third month onwards after transplantation of a first viruric episode with a median viral load of 1 × 10(8) copies/mL, followed after few days by a first viremic episode with a median viral load of >1 × 10(4) copies/mL, was strongly associated with the development of PyVAN. In conclusion, the viral load and the temporal profile of the first viruric and viremic episode post-transplantation, in combination with specific features of the host immune response, should be considered as relevant clinical determinants of the risk of renal transplant recipients to progress to PyVAN.

Plantar fasciitis often leads to disability. Optimal treatment for this clinical condition is still unknown.To compare the effectiveness of wearing a full-length silicone insole with ultrasound-guided corticosteroid injection in the management of plantar fasciitis.Randomized clinical trial.Forty-two patients with chronic unilateral plantar fasciitis were allocated randomly to have an ultrasound-guided corticosteroid injection or wear a full-length silicone insole. Data were collected before the procedure and 1 month after. The primary outcome measures included first-step heel pain via Visual Analogue Scale and Heel Tenderness Index. Other outcome measures were the Foot and Ankle Outcome Score and ultrasonographic thickness of the plantar fascia.After 1 month, a significant improvement was shown in Visual Analogue Scale, Heel Tenderness Index, Foot and Ankle Outcome Score, and ultrasonographic thickness of plantar fascia in both groups. Visual Analogue Scale scores, Foot and Ankle Outcome Score pain, Foot and Ankle Outcome Score for activities of daily living, Foot and Ankle Outcome Score for sport and recreation function, and plantar fascia thickness were better in injection group than in insole group (p0.05).Although both ultrasound-guided corticosteroid injection and wearing a full-length silicone insole were effective in the conservative treatment of plantar fasciitis, we recommend the use of silicone insoles as a first line of treatment for persons with plantar fasciitis.

BACKGROUND: In this study, we discuss traumatic lesions as assessed in decomposed bodies. METHODS: From 1390 autopsies, which were performed by Adnan Menderes University, Faculty of Medicine, Department of Forensic Medicine staff during the period 2004-2008, reports of 62 decomposed bodies were searched, and traumatic lesions were found in 19 of them. Features like gender, living conditions, crime scene, identity witness, season, postmortem interval, cause and origin of deaths, and existence of traumatic lesions were investigated. RESULTS: From the 1390 forensic autopsies, 4.5% were decomposed bodies. Male cases accounted for 91.9%, and the male/female ratio was 11.4/1. From reports, 38.7% lived alone, and the crime scene was the home in 57.9%. Traumatic lesions were found in 30.6%. The leading causes of death were cardiac diseases in natural deaths, hanging in suicide cases, stab wounds in homicide cases, and carbon monoxide poisoning in accidents. It was statistically significant that traumatic lesions were common in outdoor cases and indoor bodies were common among single cases. CONCLUSION: As it is necessary to distinguish traumatic lesions carefully in decomposed bodies, a full examination and autopsy should be performed. Language: tr

Although disseminated intravascular coagulation (DIC) has been a well-known disorder for many years, there is lack of sufficient number of clinical trials about incidence, frequency of underlying disorders, and prognosis of DIC in children. The aim of this study was to evaluate the frequency, etiologic factors, and clinical and laboratory findings of DIC and to determine the prognostic factors influencing the mortality in hospitalized pediatric patients. Medical records of 5535 children who were hospitalized were investigated. Sixty-two patients who were diagnosed as acute DIC were enrolled. The frequency of DIC was 1.12%. The underlying etiologic factors were infection in 59 patients (95.2%) and major trauma in 3 patients (4.8%). The frequency of bleeding and thrombosis was 48.8 and 4.8%. Respiratory, cardiovascular, hepatic, renal, neurologic, and gastrointestinal dysfunction was present in 71, 67.7, 35.5, 16.1, 16.1 and 11.3% of patients, respectively. Respiratory and cardiovascular dysfunctions were significantly associated with mortality. Multiorgan dysfunction syndrome ( MODS) was present in 85.5% of the patients, and 54.8% of the patients had developed acute respiratory distress syndrome ( ARDS). Mortality rate was significantly high in patients with MODS and ARDS. In multivariete logistic regression analysis, only ARDS and cardiovascular dysfunction had predictive and prognostic value on mortality. None of the diagnostic laboratory tests had predictive or prognostic value and the degree of abnormality of these tests did not show any correlation with mortality. In conclusion, DIC is not a rare disorder in hospitalized children, especially in patients with sepsis, and MODS, ARDS, and respiratory and cardiovascular system dysfunctions are poor prognostic factors.

BACKGROUND: Breast cancer is a remarkably heterogeneous disease. Luminal, basal-like, "normal-like", and ERBB2+ subgroups were identified and were shown to have different prognoses. The mechanisms underlying this heterogeneity are poorly understood. In our study, we explored the role of cellular differentiation and senescence as a potential cause of heterogeneity. METHODOLOGY/PRINCIPAL FINDINGS: A panel of breast cancer cell lines, isogenic clones, and breast tumors were used. Based on their ability to generate senescent progeny under low-density clonogenic conditions, we classified breast cancer cell lines as senescent cell progenitor (SCP) and immortal cell progenitor (ICP) subtypes. All SCP cell lines expressed estrogen receptor (ER). Loss of ER expression combined with the accumulation of p21(Cip1) correlated with senescence in these cell lines. p21(Cip1) knockdown, estrogen-mediated ER activation or ectopic ER overexpression protected cells against senescence. In contrast, tamoxifen triggered a robust senescence response. As ER expression has been linked to luminal differentiation, we compared the differentiation status of SCP and ICP cell lines using stem/progenitor, luminal, and myoepithelial markers. The SCP cells produced CD24+ or ER+ luminal-like and ASMA+ myoepithelial-like progeny, in addition to CD44+ stem/progenitor-like cells. In contrast, ICP cell lines acted as differentiation-defective stem/progenitor cells. Some ICP cell lines generated only CD44+/CD24-/ER-/ASMA- progenitor/stem-like cells, and others also produced CD24+/ER- luminal-like, but not ASMA+ myoepithelial-like cells. Furthermore, gene expression profiles clustered SCP cell lines with luminal A and "normal-like" tumors, and ICP cell lines with luminal B and basal-like tumors. The ICP cells displayed higher tumorigenicity in immunodeficient mice. CONCLUSIONS/SIGNIFICANCE: Luminal A and "normal-like" breast cancer cell lines were able to generate luminal-like and myoepithelial-like progeny undergoing senescence arrest. In contrast, luminal B/basal-like cell lines acted as stem/progenitor cells with defective differentiation capacities. Our findings suggest that the malignancy of breast tumors is directly correlated with stem/progenitor phenotypes and poor differentiation potential.