Mevlana Tıp Bilimleri Archive

ABSTRACT

Paragangliomas are rarely seen neural crest-derived tumors. They mostly present in carotid bifurcation. %10 of cases are familial. Familial paragangliomas generally occur at a younger age and bilaterally. Paragangliomas are often slow-growing, asymptomatic cases. In patients with symptoms, swelling of the neck, dysphagia, odynophagia are most common. Physical examination of patients with carotid-based paraganglioma reveals an insensitive mass in front of SCM (fountain sign). Although they are mostly benign, they can become malignant if they make metastasize. Multidisciplinary approach is important in these patients. While the main treatment is surgery, radiotherapy can be applied in metastatic disease, inoperable patients or patients who have positive surgical margins. In this article, 2 different paranganglioma cases with lymph node metastasis are discussed. In both cases, regional radiotherapy was administered after the surgery.

Key words: Paraganglioma, carotid body tumor, lymphatic metastasis, radiotherapy

ABSTRACT

Neurofibromatosis-Noonan syndrome is a rare disorder which shows the features of both neurofibromatosis type 1 and Noonan syndrome. Mutations in the NF1 gene were identified in majority of  Neurofibromatosis-Noonan Syndrome cases. The co-occurrence of NF1 and PTPN11 mutations has been shown in very few studies and has been attributed  to a denova mutation either in NF1 or PTPN11. We didn’t see PTPN11 gene mutations without NF1 mutations in Neurofibromatosis-Noonan Syndrome patients in the literature. Here, we report a 7-year-old boy who had clinical features of Neurofibromatosis-Noonan Syndrome with a mutation in the PTPN11 gene. He has 3 homozygous missense mutation in PTPN11 gene (g.584G>T, g.794C>T, g.28145G>C). These mutations are shown that the cause of disorder at database but it was not found  any manuscript in the literature.

Key words: Neurofibromatosis type 1, Noonan Syndrome, café-au-lait macules, short stature, children

ABSTRACT

Aim: Identfying at which rate the catheter settled into urinary system causes infection due to duration in spite of prophylactic antibiotic treatment in the patients underwent surgery because of urinary system pathology.

Material and Methods: The study population consisted of 16 patients who had urinary system pathology,underwent surgery and selected randomly in Pediatric Surgery Clinic were included the study. Urinary system catheters were applied to all patients after operation. Sefuroxim was begun to 10 of these patients, sefaperazon+sulbaktam to 1, ampicillin + sulbactam to 1, penicilin crystalyse to 1, amicasin to 1 and triemthoprim+sulphametoxasole to 2.Urine cultures were taken from the patients on 3rd, 7th and 10th days after operation and the rates of system infection identified were compared. When reproduction was identified in culture antibigram, the antibiotic treatment was changed due to the result of culture antibiogram. The catheters of all patients were extracted out on postoperative 10th day. The patients were delivered with the supression of triemthoprim+sulphametoxasole except ones who had reproduction in their urine cultures.       

Results: The study population consisted of 16 patients are composed of  11 (66 %) female and 5 (34%) male [mean age, 7.21±1.47 years (±SD); range, 0 to 14 years], Reproduction wasn’t observed at the urine cultures taken on 3rd day. Reproduction was observed at one of urine cultures taken on 7th day (enterococ). Reproduction was identified at three of the urine cultures taken on 10th day. (One of them was pseudomonas, two of them were candidas). The rate of reproduction was 6.25 % on 7th day and 23.08 % on 10th day. Although the ratio of reproduction on 10th day was higher than the ratio of reproduction on the 7th day, there was no significant difference between these two days (p= 0.625). 

Conclusion: We think that it is useful to investigate the antibiotic used when catheter is kept more than one week.

Key words: Pathology of urinary system, catheter of urinary system, risk of infection, culture-antibiogram. 

ABSTRACT
Aim: Myroides type bacteria are gram negative, aerobic, non-fermentative, catalase, oxiadase, urease and gelatinase positive, yellow pigmented, immobile, opportunistic pathogenic rare bacteria not found in human flora. In this study, the main purpose is to examine the antibiotic susceptibility of the Myroides species isolated from urine, wound, blood culture samples over six years period.

Material and Methods: Myroides species isolated from the urine, wound, blood culture samples during January 2015 to February 2021 were included in this study. VITEK 2 Compact automated system was used to identify bacteria determine their antibiotic susceptibility.

Results: Myroides spp. was isolated in different culture samples of 16 patients with clinical findings. It was seen %57,1 of the Myroides species included in our study were resistant to all antibiotics. Although Myroides species were most grown in urine culture samples(%87,5), they were also observed to grow in wound culture samples(%6,25) and blood culture samples(%6,25). Among the patients included in our study, the rate of Myroides isolation in intensive care and service patients was determined as %81,25.

Conclusion: Myroides species are microorganisms with epidemic potential, which are mostly detected in intensive care and ward patients who are hospitalized for a long time. Clinicians should be aware of this microorganism which has an epidemic potential, resistant to multiple drugs and encountered frequently in recent years.

Key words: Myroides, resistance, epidemic, opportunistic

ABSTRACT
Aim: The aim of this study is to evaluate the effects of normal sponge vacuum assisted closure, silver sponge vacuum assisted closure and conventional dressing methods on hospitalization time, wound healing and infection in patients with  infected cavity wounds.

Patients and Method: Between February 2013 and February 2020, 153 patients with infected cavity wounds were included in the study. The patients were divided into three groups; Patients treated with conventional wound care were included in group A, patients treated with normal sponge negative pressure wound therapy (NPWT) were included in group B, and patients managed with silver sponge NPWT were included in group C. Demographic data of the patients (age, gender), the time from hospitalization to surgery, the number of positive cultures and hospital stay were recorded. Wound dimensions were compared over wound photographs uploaded to Digimizer Image Analysis Software.

Results: The number of reproduction was the lowest in the patients who underwent silver sponge NPWT (p< 0.05). In the patient group who underwent wound care with silver sponge NPWT (group C), the hospitalization period was the least (p< 0.05). The effects of sponge type on the wound diameter were not statistically significant between group B and group C (p>0.05).

Conclusion: In patients for whom negative pressure wound treatment is appropriate, silver sponge closure can be preferred, allowing patients to get rid of the bacterial load in a shorter time and return to their normal lives sooner.

Key words: Infected cavity wound, negative pressure wound therapy, vacuum assisted closure with silver sponge.

ABSTRACT
Aim: With the developments in radiotherapy techniques, a significant increase has been observed in the local-regional control rates in patients with head and neck cancer. In the current study we aimed to evaluate the usability of 18F-FDG PET/CT in radiotherapy planning of head and neck cancer.

Materials and Method: In this study, patients with locally advanced stage head and neck cancer whose radiotherapy planning was designed over 18F-FDG PET/CT and whose curative radio (-chemotherapy) decision was made in our clinic were evaluated.

Results: A total of 19 patients whose treatment planning was done over 18F-FDG PET/CT were included in this study. Treatment volumes and critical organ volumes were determined in accordance with the protocols after combining 18F-FDG PET/CT axial sections with planning CT axial sections. Concomitant chemotherapy was applied to patients with an indication. Gross tumor volume (GTV), clinical tumor volume (CTV), planning tumor volume (PTV) and critical organ doses were evaluated using dose-volume histograms. It was observed that critical organ doses were not exceeded in all patients who were planned to be treated by fusion with 18F-FDG PET/CT, the doses planned to be applied to the target volumes were administered as planned, and no dose reduction was made in any patient.

Conclusion: This study confirms that in patients with locally advanced head and neck cancer, 18F-FDG PET/CT can be used reliably in determining the localization of primary tumors and lymph nodes, as well as in the administration of planned radiotherapy doses. It is thought that determining the treatment plans reliably will have a positive effect on long-term side effects and survival outcomes.

Key words: 18F-FDG PET/BT, Radiotherapy, Locally Advanced Head and Neck Cancer

ABSTRACT
Aim: Liver cancer is an increasingly common malignancy associated with high mortality. It is the sixth most common cancer and the fourth the leading cause of cancer-releated death worldwide. In histopathological type determination, besides morphological features, immunohistochemical profile is also important. HepPar-1, AFP and Glypican-3 (GPC-3) are the main immunohistochemical markers used in the diagnosis of hepatocellular carcinoma (HCC) and differantiation from metastatic tumors.

Materials and Method: Hematoxylin/Eosin and immunohistochemical properties of resection and biopsy materials of 101 cases diagnosed with HCC between January 2019 and October 2021 were evaluated. HepPar-1, GPC-3 and AFP results are listed. The rates of positivity and negativity were determined for these three markers.

Results: HepPar-1 was positive in 85 (84.2%) of 101 cases, GPC-3 was positive in 76 (75.2%) cases and AFP was positive in 28 (27.7%) cases. There were 17 (16.83%) cases in which all 3 parameters were positive and 4 (3.96%) cases in which they were negative.When the positivity was evaluated in terms of 2 parameters, HepPar-1 and GPC-3 were positive in 49 (48.51%) cases, HepPar-1 ve AFP 5 (4.95%) cases,  AFP ve GPC-3 4 (3.96%) cases. The co-positivity of HepPar-1 and GPC-3 was found to be significantly higher.

Conclusion: We think that the inclusion of immunohistochemical markers such as HepPar-1, GPC-3 and AFP, which have been associated with hepatoid differentiation in the literature and have been reported to be valuable in terms of malignancy, in the diagnosis and differentiation of HCC from metastatic tumors, will be important in achieving an effective result.

Key words: AFP, Glypican-3, hepatocellular carcinoma, HepPar-1, liver cancer

ABSTRACT

Radiotherapy is a component of standard care in cancer treatment. It was conventionaly known that radiation kills cancer cells through direct interaction with DNA or via the production of free radicals. Currently, we know that radiotherapy enhances anti-tumor immune responses by increasing tumor antigen release and inducing T cell infiltration. Thus, RT can create a systemic effect defined as 'abscopal effect' with the immune response it creates against tumor cells. Similarly, immune check point inhibitors provide the induction of more effective anti-tumor immunity. Combining radiation and immunotherapy has been shown to be promising in improving treatment outcomes and reducing relapses by overcoming tumor immune tolerance. However, optimal use of combined therapy in terms of RT dose and fractionation, and immunotherapy-radiotherapy sequence is still unclear. In this review, the synergistic effect of RT and immunotherapy and the abscopal effect of combination therapy are described with review of various publications. Besides this, the optimum sequencing, effective RT dose and fractionation in the combination of RT with immune therapy were summarized.

Key words: Immunotherapy, radiotherapy, check point inhibition, abscobal effect.