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Ultrasonography and Fluoroscopy Guided Percutaneous Placement of Hickman Catheters in Children
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2020-01-01) Çevik, Muazez; Deniz, Sinan; Çalışkan, Can
ABSTRACT Purpose: Hickman catheters (HCs) are commonly used in children who need bone marrow transplantation. Although several methods of implantation have been described, the aim of the present study was to evaluate the results of ultrasonography-and fluoroscopy-guided percutaneous insertion of HCs into a central vein in children. Materials and Methods: Data from patients who were hospitalized for ultrasonography-and fluoroscopy-guided percutaneous placement of HCs from August 2014 to January 2017 were retrospectively evaluated. The data were evaluated with respect to patient characteristics, complications, HC features, and outcomes. Results: Three hundred and six times HC positioned in 206 patients were evaluated. One hundred and twenty-six patients were male, and the remaining 80 were female. The age of the patients ranged from 2 months to 19 (range, 7.31±4.85) years. HC implantation was technically successful in all patients. The right jugular vein was the preferred access vein in 87.4% of HCs. The length of time between HC placement and removal was 147±108.9 days (range, 7–795 days). Three (0.01%) of the recorded complications were classified as early postoperative. Two of those three patients developed bleeding, and one had cardiac tamponade. No mortality was related to HC insertion during the perioperative or postoperative period. Conclusion: Ultrasonography-and fluoroscopy-guided percutaneous HC insertion in a central vein is safe and applicable to all children regardless of size, age, or diagnosis.
Pathology of Hepatocellular Adenoma: Subtypes and Rare Morphologic Features
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2020-01-01) Hayırlıoğlu, Ecem Çağla; Fotioğlu, Hristina; Kırımlıoğlu, Hale
ABSTRACT Background: The molecular classification has been divided HCA into four main subgroups: hepatocyte-nuclear-factor-1a mutated (H-HCA), B-catenin type (HA-B), inflammatory type (HA-I) and unclassified type. Those subgroups were linked with risk factors, clinical behavior, histological features, imaging and malignant transformation. Subtyping is useful to predict HA’s behavior and also to detect morphology which may have the potential to affect the prognosis. We aimed to review subtype features of our hepatocellular adenoma cases and discuss the importance of the rare morphologic features. Methods: Fifteen Hepatocellular adenoma cases (10 resections, 3 explants and 2 biopsies) were included in this study. Hematoxylin and eosin (H&E) stained slides, Reticulin and Masson’s trichrome stains, as well as immunohistochemical studies (IHC), were used to evaluate general morphologic and immunophenotypic features performed with B-catenin, SAA amyloid and Glutamine Synthetase(GS) using standard laboratory techniques in the Ventana Benchmark Ultra platform. CD34 immunohistochemical stains were performed on atypical cases to evaluate the presence of vascularization. Results: By morphologic features and Immunohistochemistry, 3 HA-B (%20), 4 HA-I (%26.6), 4 HA-H (%26.6) and 4 HA-U (%26.6) cases were classified. Two HA cases had Dubin-Johnson pigment and Two of the beta-catenin mutated HAs had bone marrow metaplasia. In one of the cases, malignant transformation in the HA was present. The microscopic findings included hemorrhage, pigment formation, granuloma formation, presence of inflammation, presence and degree of steatosis, preserved or non-preserved reticulin network. Conclusions: Besides the classic morphologic features; granuloma formation, pigmentation, bone marrow metaplasia can be seen in HAs. Although the prognostic significance of those is not known, they are considered to have a role in the development and progression of HA.
Management of Cough-İnduced Rib Fracture at Term Pregnancy: A Case Report
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2020-01-01) Bodur Öztürk, Harika; Balcı, Veysel; Bağış, Veysel
ABSTRACT Spontaneous rib fracture in pregnant women is a rare entity. It is generally occurs after a coughing episode. The main symptom is acute developed persistent pain. Chest radiography is generally sufficient for precise diagnosis. In this article,
Endometrial Polyp in Early Pregnancy Ending with Term Labor
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2020-01-01) Selam, Belgin; Danışman, Nuri; Ekmen, Süheyla; Bircan, Ceyda
ABSTRACT Endometrial polyps may be detected by transvaginal ultrasonography (TVS) in early pregnancy. These pregnancies may end with fetal demise. There are not enough data in literature defining term labor in pregnancy with endometrial polyp. The current case describes in detail, the progress of a pregnancy with endometrial polyp including fetal growth, regression of polyp, assessment of placental pathology and postpartum follow-up. Giant endometrial polyp protruding into the uterine cavity adjacent to the gestational sac was detected by TVS in a 31 year-old-primigravida. She delivered a healthy baby and the polyp regressed completely by the end of the pregnancy. Polyps detected in early pregnancy may regress without any effect on the fetal demise or placental insufficiency. Close antenatal follow-up is advised for the prognosis of these pregnancies.
Lenfödem Tanı ve Tedavisine Güncel Bakış
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2020-01-01) Turna, Işıl Fazilet Turna
ÖZET Lenfödem, cilt ve cilt altı dokuda proteinden zengin interstisyel sıvının birikmesi ile oluşan kompleks bir durum dur. Ekstremitedeki hacimsel ve cilt dokusundaki kozmetik değişiklikler hastanın günlük yaşamını ve psikososyal durumunu olumsuz etkilemektedir ve tedavi edilmez ise ilerlemeye devam etmektedir. Lenfödem, primer ya da sekonder nedenlere bağlı olabilir. Primer lenfödemde en sık görülen anomali tipi, hipoplazik tip lenf damarlarıdır. Sekonder lenfödemin en sık tipi, gelişmiş ülkelerde meme kanseri cerrahisi sonrası görülürken gelişmekte olan ülkelerde, parazitlerdir (filaryazis). Lenfödemin tanısı, evrelendirilmesi ve şiddetinin ölçülmesinde henüz altın standart bulunmamaktadır. Öykü ve muayeneden sonra, klinik pratikte en sık kullanılan teknik ultrasonografidir. Lenfödem tedavisinin ilk basamağı ekstremiteyi normal ya da normale yakın boyuta ulaştırmak ve komplikasyon ları önlemektir, çünkü tedavide kür yoktur. Komplet dekonjestif terapi, lenfödem ve ilişkili durumlarda kullanılan, manuel lenf drenajı, kompresyon tedavisi, remedeal egzersizler, cilt bakımından oluşan 4 bileşenli bir tedavidir. Bu tedavi 2 fazlı olarak yapılmaktadır. Faz 1 yoğun veya dekonjestif tedavidir. Faz 2 de ise bası giysileri ve gece bandajı ile faz 1 deki kazanımları sürdürebilmesi amaçlanır. Bu dönem ömür boyu devam eder. Sonuç olarak lenfödem, izole bir tablo veya hayatı tehdit eden sistemik bir sendrom olabilir. Tanı, tedavi ve takip aşamasında multidisipliner yaklaşılmalıdır.