Orbital decompression surgery for the treatment of Graves＇ ophthalmopathy：comparison of different techniques and long-term results

AIM： To evaluate the long-term results of different orbital decompression techniques performed in patients with Graves＇ ophthalmopathy（GO）.METHODS： Totally 170 cases with GO underwent orbital decompression between 1994 and 2014. Patients were divided into 4 groups as medial-inferior, mediallateral（balanced）, medial-lateral-inferior, and lateral only according to the applied surgical technique. Surgical indications, regression degrees on Hertel exophthalmometer, new-onset diplopia in the primary gaze and new-onset gaze-evoked diplopia after surgery and visual acuity in cases with dysthyroid optic neuropathy（DON） were compared between different surgical techniques.RESULTS： The study included 248 eyes of 149 patients. The mean age for surgery was 42.3±13.2 y. DON was the surgical indication in 36.6% of cases, and three-wall decompression was the most preferred technique in these cases. All types of surgery significantly decrease the Hertel values（P〈0.005）. Balanced medial-lateral, and only lateral wall decompression caused the lowest rate of postoperative new-onset diplopia in primary gaze. The improvement of visual acuity in patients with DON did not significantly differ between the groups（P=0.181）. CONCLUSION： The study show that orbital decompression surgery has safe and effective long term results for functional and cosmetic rehabilitation of GO. It significantly reduces Hertel measurements in disfiguring proptosis and improves visual functions especially in DON cases.

sTRAIL Serum Levels and TRAIL 1595 Genotypes: Associations with Progress and Prognosis of Colorectal Carcinoma

Programmed cell death called apoptosis, plays an important role in the development and maintenance of tissue homeostasis and abnormalities in apoptotic function have been known as important events in the pathogenesis of many cancer types, such as colorectal cancer. It has been shown that both the membrane-bound TRAIL and sTRAIL can induce apoptosis in several tumor types by activating death receptors. Our study was to investigate the existence of TRAIL 1595 C/T SNP in colorectal cancer patients and possible effects of this substitution on serum levels of sTRAIL. In the present study, TRAIL 1595 C/T polymorphism was genotyped in 76 patients with colorectal cancer and 98 healthy subjects using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. There were no significant differences in the distribution of TRAIL 1595 C/T genotypes and frequencies of the alleles between colorectal cancer patients and controls. The increased frequency of TRAIL 1595 homozygotes genotypes in patients who had advanced tumour stage was statistically significant (p = 0.0082). Serum sTRAIL levels in the colorectal patients with CT genotype were lower than those of patients with early tumor stage (p = 0.028). The decreased sTRAIL levels were observed in the patients with distant metastasis and CT genotype (p = 0.023). Our findings have suggested that TRAIL 1595 C/T genotypes and sTRAIL levels might be associated with the progression of colorectal cancer in Turkish population.

Prevention of Helicobacter pylori infection in childhood

Helicobacter pylori(H.pylori)infection is one of the most common infections worldwide.Although infection rates are falling in the developed and developing countries,H.pylori is still widespread in the world.This article has reviewed the important publications on H.pylori in childhood with a focus on its evolving transmission route and the source of infection and preventive strategies in childhood,PubMed was searched up to identify eligible studies.Relevant publications were searched using the following.

Effect of early preoperative 5-fluorouracil on the integrity of colonic anastomoses in rats

AIM:To determine the effect of chemotherapy on wound healing by giving early preoperative 5-fluorouracil (5-FU)to rats with colonic anastomoses. METHODS:Sixty Albino-Wistar male rats(median weight,235 g)were used in this study.The rats were fed with standard laboratory food and given tap water ad libitum.The animals were divided into three groups: Group 1:Control group(chemotherapy was not administered),Group 2:Intraperitoneally(IP)administered 5-FU group(chemotherapy was administered IP to animals at a dose of 20 mg/kg daily during the 5 d preceeding surgery),Group 3:Intravenously(IV)administered 5-FU group.Chemotherapy was administered via the penil vein,using the same dosing scheme and duration as the second group.After a 3-d rest to minimize the side effects of chemotherapy,both groups underwent surgery.One centimeter of colon was resected 2 cm proximally from the peritoneal reflection,thensutured intermittently and subsequently end-to-end anastomosed.In each group,half the animals were given anaesthesia on the 3rd postoperative(PO)day and the other half on the 7th PO day,for in vivo analytic procedures.The abdominal incisions in the rats were dissected,all the new and old anastomotic segments were clearly seen and bursting pressures of each anastomotic segment,tissue hydroxyproline levels and DNA content were determined to assess the histologic tissue repair process. RESULTS:When the IV group was compared with the IP group,bursting pressures of the anastomotic segments on the 3rd and 7th PO days,were found to be significantly decreased,hydroxyproline levels at the anastomotic segment on the 7th PO day were significantly decreased(P<0.01). CONCLUSION:In this study,we conclude that early preoperative 5-FU,administered IV,negatively affects wound healing.However,IP administered 5-FU does not negatively affect wound healing.

Ultrasound biomicroscopy in patients with unilateral pseudoexfoliation

·AIM: To compare the anterior segment morphology evaluated using ultrasound biomicroscopy(UBM) in patients with clinical pseudoexfoliation syndrome(XFS)in one eye and no clinical XFS in the fellow eye.·METHODS: Thirty patients with unilateral XFS were included in the study. All patients underwent evaluation of their anterior segment using UBM with and without dilatation with 1% cyclopentolate. The anterior chamber depth(ACD), lens thickness(LT), anterior chamber angle(ACA), ciliary body thickness(CBT), scleral thickness(ST), trabeculae-ciliary processes distance(T-CPD), and iris-ciliary processes distance(I-CPD) were measured using UBM scans. All results between the eyes with clinical XFS and their fellow eyes without clinical XFS were then compared.·RESULTS: Before dilatation the eyes with XFS(4.350±0.531 mm) were found to have a significantly thicker lens(P =0.002) than the eyes without XFS(4.238 ±0.540 mm).In addition after dilatation, the eyes with XFS(4.310 ±0.500 mm) were found to have a significantly thicker lens than the eyes without XFS(4.160±0.480 mm)(P=0.019).The average ACD, for the group with XFS, comparing pre-dilatation(2.616 ±0.349 mm) and post-dilatation measurements(2.714±0.413) was found to be statistically increased(P =0.014). The average ACD, comparing pre-dilatation to post-dilatation measurements in patients without XFS(2.680±0.360),(2.720±0.500) was found to be statistically unchanged(P =0.450).·CONCLUSION: Crystalline lenses tended to be thicker in the eyes with clinical pseudoexfoliation than their fellow eyes without pseudoexfoliation.

Gastric pneumatosis intestinalis associated with malignancy:An unusual case report

Pneumatosis intestinalis(PI)is an uncommon disease defined as gas-filled cysts that are found in the wall of the gastrointestinal(GI)tract.The exact causes of PI are still unclear,but it may associated with coexisting diseases,such as some GI disorders,connective tissue disease,some medication and drugs,and rarely malignancy.The most common localization is the small intestine.Gastric PI secondary to malignancy has been rarely documented.We report on a 94-year- old man with gastric PI associated with inoperable adenocarcinoma localized in the duodenum.Following the gastrojejunostomy and choledochojejunostomy bypass,his general condition improved and PI disappeared,but he died due to poor performance status and malignancy 6 mo later.We suggest that in patients presenting with PI,malignancy should be considered in the differential diagnosis.

Chest X-rays in detecting injuries caused by blunt trauma

BACKGROUND:The appropriate sequence of different imagings and indications of thoracic computed tomography(TCT)in evaluating chest trauma have not yet been clarified at present.The current study was undertaken to determine the value of chest X-ray(CXR)in detecting chest injuries in patients with blunt trauma.METHODS:A total of 447 patients with blunt thoracic trauma who had been admitted to the emergency department(ED)in the period of 2009–2013 were retrospectively reviewed.The patients met inclusion criteria(age>8 years,blunt injury to the chest,hemodynamically stable,and neurologically intact)and underwent both TCT and upright CXR in the ED.Radiological imagings were re-interpreted after they were collected from the hospital database by two skilled radiologists.RESULTS:Of the 447 patients,309(69.1%)were male.The mean age of the 447 patients was 39.5±19.2(range 9 and 87 years).158(35.3%)patients were injured in motor vehicle accidents(MVA).CXR showed the highest sensitivity in detecting clavicle fractures[95%CI 78.3(63.6–89)]but the lowest in pneuomediastinum[95%CI 11.8(1.5–36.4)].The specificity of CXR was close to 100%in detecting a wide array of entities.CONCLUSION:CXR remains to be the first choice in hemodynamically unstable patients with blunt chest trauma.Moreover,stable patients with normal CXR are candidates who should undergo TCT if significant injury has not been ruled out.

Development of a Six Sigma Infrastructure for Trabeculectomy Process

The aim of this article is to show how an eye clinic of a Turkish public hospital initiated Six Sigma principles to reduce the number of complications encountered during and after trabeculectomy surgeries. Data were collected for ten years. To analyse the process, main tools of Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC) improvement cycle such as SIPOC Table, Failure, Mode and Effect Analysis were implemented. Sources and root causes of ten types of complications were identified and reported. Patient’s eye anatomy, experience of ophthalmic surgeon, quality of surgical equipment, quality and type of suture, and experience of staff were identified to be Critical-to-Quality (CTQ) factors for a successful surgery. The most frequently occurring complication was found to be hypotony. The process sigma level of the process was measured to be 3.1391. The surgical team concluded that ten complications (out of twelve) should be significantly reduced by taking the necessary preventative measures.

Association of complementary and integrative therapy use and symptoms among Turkish patients with familial Mediterranean fever

Objective: This study explored the correlations between the use of complementary and integrative therapies(CITs) and symptoms among Turkish patients with familial Mediterranean fever(FMF).Methods: This is a cross-sectional and descriptive study. The study was conducted with 1119 FMF patients who were registered to the social networking site for Behcet’s and the FMF Patients Association(Befemder) in Turkey, between January 2018 and February 2019. Data were collected using an online survey, for which a three-part questionnaire was created using a Google form. Descriptive statistics, chi-square test and logistic regression analysis were used to analyze the data.Results: It was determined that 53.2% of the individuals who participated in the research used various forms of CITs and that 32.8% used vitamin and mineral supplements(calcium, iron, and vitamin B12, C and D), 25.0% used nutritional supplements(fish oil and honey), and 24.6% used oral herbs(ginger, turmeric, green tea and rosemary) and mind–body methods(relaxation, respiration exercise and meditation). It was determined that the percentage of participants that used CITs was higher among women(odds ratio [OR] = 1.825;95% confidence interval [CI] 1.421–2.344), those with joint pain(OR = 1.385;95% CI 1.047–1.832), those with difficulty breathing(OR = 1.323;95% CI 1.031–1.697), those with gastrointestinal symptoms(OR = 1.405;95% CI 1.089–1.814) and those who had a family member with FMF(OR = 1.437;95% CI 1.115–1.851).Conclusion: More than half of the individuals used at least one type of CIT for symptom control.