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Volume: 1  Issue: 2 - 2023
1.Front Matter

Pages I - IV

2.A New Oncoplastic Surgical Technique in Breast Lower Inner Quadrant Tumors; Banana Incision Mammoplasty
Mahmut Onur Kültüroğlu, Ferit Aydın, Fatih Aslan, Kazım Çağlar Özçelik, Lütfi Doğan
doi: 10.14744/ajh.2023.35220  Pages 33 - 36
INTRODUCTION: Oncoplastic breast surgery provides breast cancer patients with the opportunity to remove more breast tissue while maintaining aesthetic outcomes. The choice of surgical method depends on the tumor’s location in the breast quadrant, breast size, tumor-to-breast ratio, and the extent of breast sagging. The lower inner quadrant tumors, having less breast tissue, pose greater cosmetic challenges, making oncoplastic breast surgery increasingly significant. This article introduces the ‘banana incision mammoplasty’ technique, specifically designed for lower inner quadrant tumors.
METHODS: The technique involves a concave, banana-shaped incision extending from the areola to the medial aspect of the breast fold and then superiorly. The incision’s lower end terminates 2-3 cm above the inferior breast fold.
RESULTS: The banana incision mammoplasty, tailored for lower inner quadrant breast tumors, is versatile, suitable for all breast sizes. This technique, as we described for these specific tumors, shows a complication rate (including wound infection, seroma, hematoma) comparable to other mammoplasty methods. Notably, the banana incision mammoplasty involves a smaller incision and avoids skin tension by preparing only the glandular flap.
DISCUSSION AND CONCLUSION: The banana incision mammoplasty is poised to be recognized in medical literature as a reliable oncoplastic surgery technique. It allows for extensive surgical resection while ensuring favorable cosmetic results.

3.The significance of Systemic Immune Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI) in fetuses with fetal growth restriction
Recep Taha Ağaoğlu, Izzet Özgürlük, Özge Öztürk, Dilara Dilara Sarıkaya Kurt, Burak Hızlı, Zehra Yılmaz Vural, Kadriye Yakut Yücel
doi: 10.14744/ajh.2023.36844  Pages 37 - 41
INTRODUCTION: Our aim was to investigate the significance of parameters such as neutrophil-to-lympho-cyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune inflammatory index (SII), and systemic inflammatory response index (SIRI) in late fetal growth restriction (FGR) cases.
METHODS: After applying the exclusion criteria, 70 late FGR cases and 70 healthy pregnant cases matched by maternal age and week of gestation were included in the study. In addition to demographic characteristics, neonatal outcomes, and peripheral blood parameters, we examined whether there were differences between groups in NLR, PLR, MLR, SII, and SIRI scores. We also investigated the association between systemic inflammatory markers and neonatal intensive care unit (NICU) admis-sion. P-values < 0.05 were interpreted as statistically significant.
RESULTS: The FGR group had higher leukocyte, neutrophil, NLR, and SII values than the control group (p=0.019; p=0.007; p=0.011; p=0.005, respectively). For the diagnosis of FGR, an optimal cut-off value of ≥4.7946 was found for NLR (with 54.7% sensitivity and 85.7% specificity) and a value of ≥918.15 for SII (with 67.1% sensitivity and 60% specificity). PLR and SII were higher in the FGR group with NICU admission than in the FGR group without NICU admission (p=0.024; p=0.012, respectively).
DISCUSSION AND CONCLUSION: SII, in addition to other clinical data, may contribute to both the diagnosis of FGR and the prediction of NICU admission in FGR cases. This finding is supported by randomized controlled trials with large series of prospective subgroup analyses.

4.Protective Effect of Oxytocin on Ovarian Histopathology at Septic Rat Model
Belma Gözde Özdemir, Metin Özsoy, Halis Özdemir, Songül Yerlikaya Kavak, Salih Salar
doi: 10.14744/ajh.2023.99608  Pages 42 - 46
INTRODUCTION: Sepsis is the body’s response to infections, and it is associated with high morbidity and mortality rates. This study aimed to examine the histopathological changes in rats with an intra-ab-dominal abscess model after oxytocin administration and to investigate oxytocin’s potential protective effects.
METHODS: A total of 21 Wistar Albino rats were randomly divided into three groups, with seven in each group. The sepsis group was created after cecal-ligation-perforation. The first group consisted of normal healthy rats, the second group of septic rats, and the third group of septic rats administered oxytocin. The ovaries of the rats were then surgically removed and examined histopathologically.
RESULTS: The study evaluated normal ovarian tissue (Group 1), ovarian tissue with sepsis (Group 2), and ovarian tissue treated with oxytocin (Group 3) for endothelial damage (wall thickening, fibrin deposition, and swelling), vacuolization, cellular debris, proteinous material deposition, and neutro-phil infiltration. Statistically significant differences were observed in endothelial damage (p=0.001), vacuolization (p=0.005), cellular debris (p=0.030), proteinous material deposition (p=0.030), neutrophil infiltration (p=0.001), and the total score (p=0.001). Comparing Group 2 and Group 3, no statistically significant differences were found in endothelial damage (p=0.063), vacuolization (p=0.059), cellular debris (p=.102), and proteinous material deposition (p=0.102). However, significant differences were noted in neutrophil infiltration (p=0.020) and the total score (p=0.028).
DISCUSSION AND CONCLUSION: The study observed that in oxytocin-administered sepsis models, the cellular changes caused by the septic condition improved in the histopathological examination of the ovarian tissue, favoring the oxytocin group.

5.A Case Report: Pyoderma Gangrenosum, Acne and Hidradenitis Suppurativa (PASH) Syndrome
Tuğba Atak, Selda Pelin Kartal
doi: 10.14744/ajh.2023.18209  Pages 47 - 49
PASH syndrome, consisting of the triad of pyoderma gangrenosum (PG), acne, and hidradenitis suppurativa (HS), is a rare chronic autoinflammatory disease. The etiology and pathogenesis of the syndrome are not yet clearly understood. However, certain genes, such as PSTPIP1, have been associated with this syndrome. In treating PASH syndrome, various options are available depending on the disease’s severity, including recommendations for weight loss and smoking cessation. Furthermore, there is a rare possibility of cutaneous malignancy developing in HS, a component of PASH syndrome, which tends to worsen the prognosis for these patients. In HS patients, distinguishing between malignant transformation in chronic lesions and classical lesions is challenging, potentially leading to diagnostic delays. Therefore, in high-risk patients with long-standing atypical ulcerative lesions, malignancy should be suspected. This case report presents a 46-year-old male patient diagnosed with PASH syndrome.

6.Situs Inversus Totalis: A Mirror Woman
Emine Ayten Aksoy Keleş, Sümeyya Duran Kaymak, Berna Turhan, Izzet Özgürlük, Gülin Feykan Yeğin, Nezih Kavak, Rasime Pelin Kavak
doi: 10.14744/ajh.2023.28291  Pages 50 - 52
Situs inversus totalis (SIT) is a rare anatomical anomaly where the internal organs are oriented in a mirror-image fashion compared to typical human anatomy. Radiographic techniques play a crucial role in identifying and elucidating these anatomical variations. It is essential for medical practitioners to be vigilant for this anomaly during preoperative evaluations.

7.Life-Threatening Anticoagulation in Hughes-Stovin Syndrome with Pulmonary Arterial Thrombosis: A Case Report
Serap Duru, Merve Özdoğan Algın, Busra Oral, Fatma Yıldırım, Ertuğrul Çağrı Bölek, Alper Sarı, Ebru Revan, Saadet Demirtas Inci, Bahadir Gultekin, Koray Hekimoglu, Umit Kervan
doi: 10.14744/ajh.2023.92486  Pages 53 - 57
Hughes-Stovin syndrome (HSS) is a rare variant of Behçet’s disease characterized by the presence of pulmonary vascular aneurysms and venous thrombosis. In this case report, our aim is to emphasize the response to medical treatment in a patient currently under our follow-up, whose general condition is progressing well. A 35-year-old male patient with a diagnosis of HSS presented to the emergency department with complaints of chest pain, dyspnea, and hemoptysis. Clinical, laboratory, and radiological findings were consistent with a diagnosis of massive pulmonary arterial thromboembolism. Pulmonary artery pressure (PAP) was measured at 95 mmHg during right heart catheterization. Chronic thrombi were observed in bilateral lower extremity Doppler ultrasonography. Despite the dilemma of anticoagulant treatment due to the presence of aneurysms in the pulmonary artery and the risk of bleeding associated with HSS, intensive care unit administration of heparin infusion was initiated due to the patient’s life-threatening massive pulmonary thromboembolism. With the improvement of vital signs, the patient was transferred to the chest diseases service, and treatment with low molecular weight heparin (enoxaparin sodium) was initiated. Furthermore, based on a multidisciplinary council decision, infliximab (intravenous, 5 mg/kg) and riociguat (oral, 2.5 mg three times a day) treatments were planned due to chronic thromboembolic pulmonary hypertension. At the 1-month follow-up after discharge, a decrease in PAP to 65 mmHg was observed, along with improvements in exercise capacity, functional class, and hemodynamics. HSS is a clinical condition with a poor prognostic course and high mortality rates, which can manifest with thrombosis and cardiovascular problems. Treatment consensus remains elusive in this context. Anticoagulants, antithrombotics, and immunosuppressive drugs are recommended. In cases where surgical treatment is not feasible, medical treatment can be a suitable option for clinicians. Particularly, for HSS cases unresponsive to corticosteroids, biological agents should be considered.

8.Time-Saving and Successful Palliative Treatment for Scimitar Syndrome
Akif Kavgacı, Sultan Göncü, Berna Uçan, Fatma Zehra Öztek Çelebi, Utku Arman Örün
doi: 10.14744/ajh.2023.46220  Pages 58 - 59
Abstract |Full Text PDF

9.Isolated Omentum Herniation: A Rare Morgagni-Larrey Herniation
Sıtkı Safa Taflan, Ülfet Nihal Irdem Köse, Özgür Çağlar, Çiğdem Üner
doi: 10.14744/ajh.2023.69885  Pages 60 - 62
Abstract |Full Text PDF