There are numerous occupational pollutants originating from a wide variety of industrial areas and working environments. These pollutants can be brought inadvertently from workplace to home in various ways and may negatively affect the health of household. In the literature, this situation was known as para-occupational exposures in the past but today it is referred as take-home exposures. In this review article; transport pathway, the diversity of take-home exposures, the population at risk and occupational security deficits were examined and precautions in reducing the take-home exposures were
discussed. At the same time, take-home exposures were considered as an important public health problem and the contribution of social inequalities to the extent of the problem was also evaluated. It is aimed to help researchers to have a comprehensive view of take-home exposures and to support preventive efforts.
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Introduction: In this retrospective study, the indications and success, complication and mortality rates of local and regional flaps used in head and neck reconstruction were investigated. Methods: Patients operated for head and neck reconstruction
between the years 2014 and 2019 were included in this retrospective study. Results: A total of 41 patients were included in the study. The mean patient age was 60.3±20.6 (range: 8-89). In 39.0% (n=16) of patients, the pectoralis major muscle flap was used for reconstruction. In 17.1% (n=7) of patients, the local advancement flap was used. In all, 29% (n=12) of patients had squamous cell carcinoma, 19.5% (n=8) had basal cell
carcinoma, and 14.6% (n=6) of patients had tracheoesophageal fistula. The overall complication rate was 29.2%. The mortality rate was 2.4% (n=1). Conclusion: In this retrospective study, it was objectively demonstrated that local regional pedicle flaps can be used safely in the repair of head and neck defects with correct patient analysis, wound site and defect evaluation, and flap planning
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Introduction: The purpose of this study was to compare
prostate-specific antigen (PSA), PSA density (PSAd), the prostate
imaging-reporting and data system (PI-RADS) score, and lesion
dimension (four parameters) in clinically significant prostate
cancer (PCa) detection.
Methods: This study included 154 patients who underwent
multi-parametric prostate magnetic resonance imaging
(mpMRI) and 12 quadrant systematic prostate biopsy between
01/2018 and 03/2019. Two radiologists used the PI-RADS
version 2.1 to describe the MRI findings by consensus. A Gleason
score ≥3+4 was assessed as clinically significant PCa. Areas
under the curve (AUC) were calculated using receiver operating
characteristics. Youden’s index was used to determine ideal
cutoffs. DeLong’s test was used to evaluate statistically
significant differences between the four parameters.
Results: The median age was 66 (±6.9) in this cohort. The
median PSA level was 7.8 ng/dL (±18.4, 1.6-109.3), the median
PSAd was 0.146 ng/mL/cm3
, and the median lesion dimension
was 12 mm. In MRI, the number of cases with the PI-RADS
scores from 1 to 5 were 34, 6, 11, 38, and 65, respectively. In
terms of pathology, there was no tumor in 44 patients’ samples,
while insignificant cancer and clinically significant PCa were
seen in 33 and 77, respectively. The AUC values of PSA, PSAd,
PI-RADS score, and lesion dimension were 0.684, 0.731, 0.856,
and 0.858, respectively. The optimal cutoffs were ≥10 ng/mL for
PSA, ≥0.22 ng/mL/cm3
for PSAd, ≥4 for the PI-RADS score and
≥10 mm for lesion dimension. DeLong’s tests showed that the
PI-RADS score and lesion dimension were significantly superior
to PSA and PSAd. There was no significant difference between
the PI-RADS score and lesion dimension. Conclusion: The PI-RADS score and lesion dimension had
higher accuracy than PSA and PSAd in clinically significant
PCa detection. Lesions ≥10 mm were associated with the risk
of clinically significant PCa, and this should be considered in
reporting.
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Introduction: Acute non-variceal upper gastrointestinal
bleeding (ANVUGIB) is an important public health problem
with high rates of morbidity and mortality. ANVUGIB results
in hypovolemia, hypotension, and shock, increasing cardiac
oxygen use and may cause elevated serum levels of cardiac
troponin (cTn). In this study, we aimed to evaluate whether
elevated cTnI has clinical significance in patients with ANVUGIB.
Methods: A total of 62 patients diagnosed with ANVUGIB
whose serum cTnI levels were studied at the time of admission
and follow-up in our clinic from January 2015 to January 2016
were included in the study. Patients with acute cardiac diseases
that may cause elevated cTn were excluded from the study.
Results: Forty-three of the patients were male (69.4%), and the
mean age of all patients was 71.52±13.30 years. The mean
cTnI level was 0.042±0.097 in all patients, with cTnI levels
higher than the reference value in nine (14.5%) patients. In
logistic regression analysis, the factors found to contribute to
cTnI were tachycardia, chronic kidney disease, and coronary
artery disease. In receiver operating characteristic analysis, cutoff values of 0.025 and 6.5 were found for cTnI and the Rockall
score, respectively. In addition, cTnI and the Rockall score were
shown to affect survival [log-rank (Mantel-Cox) test: p=0.011;
log-rank (Mantel-Cox) test: p=0.014; respectively].
Conclusion: We believe that serum cTnI levels studied during
the first admission will be found useful as a biomarker in
addition to the other existing risk determination systems,
in order to identify patients at risk, even if findings of acute
coronary syndrome are not observed in patients presenting
with ANVUGIB
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Introduction: This study is an experimental setup to examine
the effects of splenectomy, applied to multi-trauma patients
who are commonly seen in emergency traumatology
practices and on fracture healing processes with respect to
histopathological, biomechanical, and radiological aspects.
Methods: Further, 32 male Sprague Dawley rats (10 months
old; average weight 394.5±28.3 g) are included in the study.
In a dark environment, rats are fed at 22 °C for 12 hours
with standard rodent food ad libitum. They are divided into
two groups: splenectomy (total splenectomy and long bone
fracture healing) and control (only long bone fracture healing
n=16). Four months after surgery, rats are killed, and callus
tissues in fractured femurs were examined histopathologically,
radiologically, and biomechanically.
Results: In the radiological analysis of the femur materials
in relation to the case and control groups, there was no
substantial difference in the Goldberg classification score
(p˃0.05). Similarly, no substantial difference was observed
(p˃0.05) in histopathological examinations and biomechanical
analysis conducted in femur samples.
Conclusion: When all of the results obtained in our study
are evaluated together, it was concluded in the rats to which
splenectomy is applied that this did not affect fracture healing
histopathologically, biomechanically, and radiologically,
despite the modification of immune modulators.
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Introduction: Insulinoma is the most common functional
neuroendocrine tumor of the pancreas. There are different
methods for the preoperative localization of insulinoma, such
as Computed Tomography (CT) scan, Magnetic Resonance
Imaging and Endoscopic Ultra Sonography (EUS). In this study,
we report on the clinicopathological features of insulinoma in
43 patients.
Methods: The hospital records of 43 patients with suspicion of
insulinoma based on biochemical diagnostic criteria, referred
to İmam Khomeini Complex Hospital, Tehran, Iran between
2006 and 2016, were reviewed retrospectively.
Results: Of the 43 studied patients, 28 were female. The mean
age of the patients was 45.4±13.3 years. The most frequent
clinical presentation of insulinoma was neurogenic and
neuroglycopenic symptoms (81.4%). Mean glucose, insulin,
and C-peptide in patients with hypoglycemic crisis were
39.13±13.15 mg/dL, 32.15±32.53 μUI/mL, and 4.77±2.88
ng/mL, respectively. Mean tumor size was 2.13±1.22 cm. The
most common site of insulinoma was the tail of the pancreas.
Surgery was the treatment of choice and performed in 31
patients. Of 21 tumors studied microscopically, 7 were invasive.
Conclusion: In non-diabetic patients with manifestations
of hypoglycemia, a diagnosis of insulinoma should be
considered. During the past decade, the diagnostic delay for
insulinoma has been reduced in our country by improving
imaging technologies. EUS and CT scan are the best modalities
for localization and size measurement of insulinoma. Tumor
size has decreased compared with pre
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Patients with traumatic intracranial subarachnoid hemorrhage
(SAH) rarely develop spinal subarachnoid hemorrhage (SSAH)
without direct spinal injury. We present the case of a 76-yearold male patient with traumatic intracranial SAH and subdural
hematoma, back pain and weakness in the both lower
limbs radiating to the legs three days after the trauma. After
worsening of pain and numbness, the patient underwent a
lumbar magnetic resonance imaging 7 days after the trauma,
in which blood was seen in the spinal canal in the lumbosacral
region. The bleeding was considered SSAH because of the
liquid level. The patient underwent conservative treatment
because the patient was found to be at high cardiac risk and
the neurological deficit was mild. In patients with traumatic
intracranial hemorrhage and delayed pain or neurological
deficits, SSAH should be suspected in the first period of trauma
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Introduction: The aim of this study was to reveal the factors that affect the clinical outcomes of patients undergoing surgery in our university hospital for intestinal atresia (IA) and to share our experience. Methods: We analyzed data from 74 newborns with IA who underwent surgical treatment between January 1997 and December 2016.
Results: The study population consisted of 40 female and 34 male newborns with a mean age at diagnosis of 6.4±8.3 days. The mean birth weight was 2.3±0.6 kg, the mean gestational age was 35.6±2.8 weeks, the mean maternal age was 28.9±6.1 years, and the mean hospitalization time was 24.5±25.3 days. Duodenal atresia was the most common diagnosis (n=31, 42%) and colonic atresia the least common (n=2, 3%). The longest and shortest mean hospital stays occurred in patients with jejunal (32.8±41.6 days) and those with colonic (8±0 days) atresia, respectively. Although the survival rates were low in newborns with either intestinal or duodenal atresia (80% or 81%, respectively), all patients with pyloric or colonic atresia survived. Of the patients who died, 82% (9/11) had additional congenital abnormalities (X2 =8.461, p=0.004), which included
major cardiac defects (n=3), Down syndrome (n=2), biliary atresia (n=1), esophageal atresia + tracheoesophageal fistula + anal atresia + tracheal atresia (n=1), esophageal atresia + tracheoesophageal fistula (n=1), and microcephaly (n=1).
The mean hospital stay of patients with or without additional abnormalities was 26.4±21.4 or 23.04±28.04 days, respectively (p=0.207). Conclusion: Among newborns with IA, duodenal atresia was the most common diagnosis and colonic atresia the least common. Additional congenital abnormalities negatively affect the hospital stay and mortality rate of newborns with IA.
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Introduction: We aimed to investigate the factors affecting
survival in non-small-cell lung cancer (NSCLC) patients with
multiple brain metastases.
Methods: One hundred thirty patients who were diagnosed
with NSCLC at the time of presentation or during disease followup were evaluated at University of Health Sciences Turkey,
İstanbul Training and Research Hospital, Clinic of Radiation
Oncology between 2012 and 2017.
Results: In univariate analysis, significant effects of age >60
(p=0.006), stage 4 at the time of diagnosis (p<0.001), Karnofsky
Performance score (KPS) <70 (p<0.001), extracranial metastasis
presentation (p=0.014), uncontrolled primary tumor (p=0.002),
headache (p=0.037), and recursive partitioning analysis (RPA)
Class III (p<0.001) were observed in predicting early mortality.
In multivariate Cox regression analysis, stage 3 at the time of
diagnosis [hazard ratio (HR): 0.419, 95% confidence interval
(CI): 0.217-0.809, p=0.010], KPS ≥70 (HR: 14.515, 95% CI: 5.470-
38.519, p<0.001), and RPA Class I-II (HR: 0.192, 95% CI: 0.102-
0.362, p<0.001) had a positive effect on overall survival.
Conclusion: Predicting prognostic factors when making
whole- brain radiotherapy decisions in NSCLC patients with
multiple brain metastases will help in treating such patients
appropriately. In multiple brain metastases with NSCLC
patients, stage 3 at the time of diagnosis, KPS ≥70, and RPA
Class I-II have a positive effect on overall survival.
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Introduction: Multiple myeloma (MM) constitutes
approximately 10% of hematological malignan-cies with
abnormal proliferation of plasma cells, which causes an
abnormal increase of monoclonal immunoglobulin light
chains. We aim to examine our young myeloma cases’ data
and compare light chain disease with other subtypes, which
are known to have a worse prognosis in all age groups.
Methods: Fifty-five MM patients diagnosed and treated between
January 2010 and 2020 under 60 years old, were analyzed
retrospectively. Their demographic data, laboratory, treatment
subtypes, MM subtypes, CRAB findings (hypercalcemia, renal
failure, anemia, and presence of lytic bone lesions), treatment,
and responses to the first-line treatment were analyzed. The
patients were divided into two groups, the light chain and
other myeloma subgroups, and compared statistically.
Results: Seventeen patients were female (30.9%), and 38 were
male (69.1%). The median age was 54 (range: 34-59) years. The
median duration of follow-up was 30 (range: 3-108) months.
The MM sub-types examined were: immunoglobulin G (IgG)/
Kappa 13 (23.6%), kappa light chain 10 (18.2%), lambda light
chain 10 (18.2%), IgG/Lambda 9 (16.4%), IgA/Lambda 8 (14.5%),
and IgA/Kappa 5 (9.1%). There was no significant difference
between the two groups except for albumin and calcium
values. In the other myeloma subtype group, albumin and
calcium values were significantly lower (p<0.05) than the light
chain group.
Conclusion: The myeloma distribution under the age of 60
was different from that in the general my-eloma population.
The light chain was more at the forefront, which appears to
be related to lytic le-sions, kidney failure, and amyloidosis.
Moreover, albumin, an independent prognostic indicator for
myeloma, decreased in the other myeloma subgroup compared
with the light chain subgroup. They are first mentioned in the
literature in patients under 60 years old
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