BK Virus Infections and Hemorrhagic Cystitis in Allogeneic Hematopoietic Stem Cell Transplant Recipients.

BK virus (BKV) associated with hemorrhagic cystitis (HC) is the most important complication that develops after hematopoietic stem cell transplantation (HSCT) in patients with hematological malignancies. This study aims to investigate BKV infections and HC in pediatric patients after allogeneic hematopoietic stem cell transplantation. Between November 2018 and November 2019, a total of 51 patients between the ages of 11 months and 17 years were included in the study. BKV Bosphore ® v1 quantification kit (Geneworks Anatolia, Turkey) was used for the detection of BKV DNA in urine and blood samples. Among the total of 51 patients, the incidence of BKV infection was found to be 86.3%. Allogeneic HSCT was performed in 40 patients and autologous HSCT in 11 patients. BK viruria and/or viremia were detected in 85% (44) of patients who underwent allogeneic HSCT and in 90% in the autologous group. High-level BK viruria (>107 copies/mL) was found in 41% (9) of 22 patients who were BKV positive before transplantation, while in 27.5% (8) of 29 patients who were BKV negative before transplantation; thus, BKV positivity before transplantation was considered a risk factor for high-level BK viruria. Acute GVHD developed in 6 of 40 patients in the allogeneic group. HC was prevented in 12 (67%) of 18 patients who received preemptive treatment, while HC developed in 6 (33%). HC occurred at a median of 35 days (17-49 days) post-transplant. Despite preemptive treatment, 6 (15%) patients who developed HC associated with BKV were in the allogeneic group but not in the autologous group. Of these patients with HC, 5 received a myeloablative treatment regimen, and 1 patient was given a reduced-intensity treatment regimen. The viral load in urine was found to be 107-9 copies/mL within 2 weeks before the development of HC and has been identified as a prognostic indicator. In conclusion, early diagnosis of viral infections by monitoring BKV viral load in HSCT patients will be effective in preventing the progression of complications such as BKV-associated HC by providing timely initiation of preemptive treatment.

Pericardial rupture of mediastinal mature cystic teratoma: An unusual cause of pediatric acute chest pain.

A previously healthy 12-year-old girl presented to the emergency department with severe chest pain and dyspnea that woke her from sleep. She had short-term syncope just before the emergency admission. On physical examination, respiratory rate was 26 breaths per minute while resting, and blood pressure was 92/56 mmHg. Other physical examination findings were insignificant. She had no past medical history, and her family history was unremarkable. Laboratory test results showed elevated C-reactive protein (27 mg/L; reference range: <5 mg/L) and white blood cell count (13.7 K/µL; reference range: 4-12 K/µL). Other laboratory test results were within normal limits, including troponin T value (3 ng/L; reference range: 3-14 ng/L). An electrocardiogram showed 1 mm ST-segment elevation in bipolar (D1 and D2) limb leads, and augmented vector foot leads, and echocardiography revealed a complicated pericardial effusion and a suspicious mass adjacent to the left ventricle.

In Vitro efficacy of cyclosporine a and various antiseptics and antiviral drugs on adenovirus genotype 8, a common cause of epidemic keratoconjunctivitis.

PURPOSE: To evaluate the in vitro efficacy of cidofovir, ganciclovir, povidone-iodine, chlorhexidine, and cyclosporine A on adenovirus genotype 8. METHODS: Conjunctival samples were collected from patients with adenoviral conjunctivitis and cultured in A549 cells. Adenovirus diagnosis was confirmed by RT-PCR. For each drug, the 50% cytotoxic concentration (CC 50 ) was determined. Subsequently, the antiviral activity was tested at concentrations below CC 50, and the 50% inhibitor concentration (IC 50 ) of drugs was determined RESULTS: While the IC 50 of cidofovir against adenovirus genotype 8 was 3.07 ± 0.8 µM, ganciclovir, povidone-iodine, chlorhexidine, and cyclosporine A were not found to be effective against adenovirus genotype 8 at concentrations below the CC 50 value. CONCLUSIONS: Cidofovir was found effective and the IC 50 value was within the ranges in the literature. Ganciclovir and cyclosporine A were found to be ineffective at doses below the cytotoxic dose, povidone-iodine and chlorhexidine was found to be highly cytotoxic.

The Relationship between Clinical Findings and Viral Load in Adenoviral Keratoconjunctivitis.

The aim of this study was to evaluate the relationship between clinical findings and viral load in adenoviral keratoconjunctivitis (Ad-Kc). In this cross-sectional study, 30 eyes of 30 patients with Ad-Kc were assessed. Real-time polymerase chain reaction was performed to detect and quantify adenovirus in all samples. Patients were divided into three subgroups according to baseline viral load (<107, 107-108, >108 human adenovirus [HAdV] copies/mL). The duration of follow-up, HAdV DNA copy number, treatment regimen, and detailed clinical findings, including uncorrected visual acuity, eyelid edema, conjunctival hyperemia, chemosis, follicular reaction, corneal involvement, conjunctival pseudomembrane, and subepithelial infiltrates (SEIs) were recorded. This study showed that a high initial viral load was associated with the development of SEIs and pseudomembrane formation (P < 0.05). The clinical findings and ocular complications of Ad-Kc were similar in the treatment groups at the final examination (P > 0.05). Our results show that a high initial viral load in Ad-Kc may be predictive of inflammatory sequelae. Determining the initial viral load in Ad-Kc may help understand the clinical course of the disease better and prevent complications.

An Experimental Study on Timing in Tracheal Stenosis Surgery.

BACKGROUND: TNF-α, IL-6, and TGF-ß are important bio mediators of the inflammatory process. This experimental study has investigated inflammatory biomarkers' efficacy to determine the appropriate period for anastomosis surgery in tracheal stenosis cases. METHODS: First, a pilot study was performed to determine the mean stenosis ratio (SR) after the surgical anastomosis. The trial was planned on 44 rats in four groups based on the pilot study's data. Tracheal inflammation and stenosis were created in each rat by using micro scissors. In rats of groups I, II, III, and IV, respectively, tracheal resection and anastomosis surgery were applied on the 2nd, 4th, 6th, 8th weeks after the damage. The animals were euthanized 8 weeks later, followed by histopathological assessment and analysis of TNF-α, IL-6, and TGF-ß as biochemical markers. RESULTS: Mean SR of the trachea were measured as 21.9 ± 6.0%, 24.1 ± 10.4%, 25.8 ± 9.1%, and 19.6 ± 9.2% for Groups I to IV, respectively. While Group III had the worst SR, Group IV had the best ratio (p = 0.03). Group II had the highest values for the biochemical markers tested. We observed a statistically significant correlation between only histopathological changes and TNF-α from among the biochemical markers tested (p = 0.02). It was found that high TNF-α levels were in a relationship with higher SR (p = 0.01). CONCLUSION: Tracheal anastomosis for post-traumatic stenosis is likely to be less successful during the 4th and 6th weeks after injury. High TNF-α levels are potentially predictive of lower surgical success. These results need to be confirmed by human studies.

The effect of the anticoagulant on the cellular composition and growth factor content of platelet-rich plasma.

BACKGROUND: The cellular and biochemical composition of the platelet rich plasma (PRP) may impact its regenerative capacity. PRP composition have been shown to vary substantially among different separation systems and protocols. The type and the dose of anticoagulant might affect the content of PRP. OBJECTIVE: The objective of this study was to evaluate the effect of anticoagulant use, on cellular composition and the amount of growth factors in fresh PRP. METHODS: Three different methods were used to prepare PRP from 12 healthy participants. The protocol 1 included standart dose sodium citrate (SC) (0.9 ml, 3.8%), protocol 2 included 0.5 ml SC and no anticoagulant was used in protocol 3. The PRP's were compared in regards to cellular content, capture efficiency of platelets (CE), concentrations and total doses of fresh studied vascular endothelial growth factor (VEGF), platelet derived growth factor -BB, (PDGF-BB), transforming growth factor ß1 (TGF-ß1) levels. RESULTS: The CE and total platelet count were highest in protocol 1. The white blood cells (WBC) and VEGF were highest in protocol 3. The highest total TGF-ß1 and total PDGF levels were obtained with protocol 1, while the highest total VEGF levels were obtained with protocol 3. CONCLUSION: The results of this study revealed that the use and the dose of SC affects the cellular content of PRP and GFs measured in fresh PRP. The CE and platelet dose increases while the WBC and VEGF decreases with the use of SC.

Superior Strategy in Benign Tracheal Stenosis Treatment: Surgery or Endoscopy?

INTRODUCTION: Due to the variations in (laryngeal) tracheal stenosis (TS) patient groups, there is still no consensus on which patient should be treated with endoscopy or surgery. The aim of the present study was to generate an algorithm in the light of the related literature and the data obtained from a clinic where both endoscopic and surgical treatments are conducted. METHOD: A retrospective analysis was performed on the data of a total of 56 patients during 2013 to 2019. A total of 38 patients were subject to surgery with 31 as a first treatment option and 7 due to the unsatisfactory results of endoscopic treatments. Endoscopic approaches were tried on a total of 29 patients with 25 as initial treatment and 4 due to postsurgical recurrence. RESULTS: Symptomatic full control ratio was determined as 69% with endoscopic treatments, 89.5% in subglottic stenosis (SGS) surgery (n = 19), and 89.5% in trachea surgery (n = 19). However, success rates with no recurrence were determined, respectively, as 40.0, 36.4, and 36.4% for patients subject to dilatation, stent, or T tube treatment. Dilatation was observed to be successful in patients with stenotic segment lengths of less than 1.5 cm (p = 0.02). Failure rates increased in SGS (p = 0.03) and TS (p = 0.12) in the surgical group with increasing stenotic segment length. The presence of comorbidities was not effective on treatment success. CONCLUSION: Endoscopic methods are preferred in cases of web-like stenosis. Surgical methods should first be considered for other patients and endoscopic methods should be used on patients who are not suited for surgery or in cases of postsurgical recurrence.

Atypical herpes simplex keratitis: frequency, clinical presentations and treatment results.

AIMS: To determine herpes simplex virus (HSV) DNA positivity in corneal scraping samples obtained from patients with microbial keratitis whose findings were not specific for HSV keratitis and to evaluate these particular cases with respect to clinical features and antiviral treatment results. METHODS: Records of patients with microbial keratitis treated in a tertiary eye care hospital within the 3-year period were evaluated retrospectively. Real-time polymerase chain reaction (PCR) was used to identify HSV DNA. Smear slides were evaluated by light microscopy. Patients with typical presentations and histories of HSV keratitis were excluded. RESULTS: Two hundred and seventy-six eyes of 276 patients were included in the study. HSV-1 DNA was detected in 25 eyes (9%). In these 25 eyes, the initial diagnosis was fungal or bacterial keratitis. The mean symptom duration was 20 ± 14 days (2-60 days). The risk factors were ocular surgery (20%), blepharitis (16%), trauma (8%) and contact lens wear (4%); however, the majority of patients did not have any specific cause for keratitis (52%). Clinical features were variable and not typical for any particular etiology. Culture and microscopic examinations revealed bacteria and/or fungi in 6 patients in addition to herpes infection. Antiviral treatment was successful in 72% of patients. CONCLUSION: Herpetic corneal infections can present without typical dendritic or geographic ulcers and may be masked by other infections. Real-time PCR is a useful method for rapid and definitive diagnosis. HSV infection should be considered for microbial keratitis without specific risk factors, with negative culture results and poor response to antimicrobial agents.

Fibromyalgia and nondipper circadian blood pressure variability.

BACKGROUND AND OBJECTIVES: Aberrant circadian rhythm with persistent nocturnal sympathetic hyperactivity has pointed out malfunctioning autonomic nervous system in fibromyalgia (FM) patients. This is a common pathogenesis shared also by patients with nondipping blood pressure (BP) pattern. Therefore, we aimed to investigate the frequency of nondipping BP pattern in normotensive women with newly diagnosed FM compared with healthy women. METHODS: Sixty-seven normotensive women with new diagnosis of FM and 38 age-matched healthy volunteer women were recruited into the study. All subjects underwent 24-hour ambulatory BP monitoring on a usual working day. Individuals were defined as "dippers" if their nocturnal BP values decreased by more than 10% compared with daytime values; defined as "nondippers" in case of a decline less than 10%. Serum creatinine, fasting blood glucose, cholesterol levels, albumin, and thyroid-stimulating hormone levels were assessed. RESULTS: Ambulatory measurements showed significantly higher diastolic BP values in patients with FM for both average of 24-hour recordings. Patients with FM had significantly lower systolic (9.1 ± 3.9 vs 11.5 ± 4.9, P = 0.010) and diastolic dipping ratios (12.3 ± 6.1 vs 16.1 ± 6.4, P = 0.004). The number of nondippers in the FM group was significantly higher than that of controls for both systolic (66% vs 34%, P = 0.002) and diastolic BP measurements (42% vs 21%, P=0.031). Patients with FM were 3.68 times more likely to be systolic nondipper and 2.69 times more likely to be diastolic nondipper. CONCLUSIONS: We have demonstrated a significant relationship between FM and nondipping BP pattern, and we suggest that nondipping profile, which has been closely associated with cardiovascular morbidity, may appear as an additional risk factor in patients with FM.

The choice of invasive diagnostic techniques in advanced lung cancer.

BACKGROUND: We retrospectively evaluated the invasive diagnostic techniques that were not suitable for transthoracic biopsy or bronchoscopy and the results of these techniques for advanced lung cancer cases. METHODS: The files of patients operated at the Department of Thoracic Surgery, Faculty of Medicine, Pamukkale University for advanced lung cancer (stages III and IV) between 2006 and 2010 were retrospectively reviewed for the analysis of definite diagnostic methods. RESULTS: The mean age of 59 patients who underwent invasive diagnostic techniques was 56.55 ± 9.42 years (32 to 75) and the female to male ratio was 1:4 (11 female:48 male). Mediastinoscopy was the most commonly used invasive technique with 20 patients (34%) while the second most common technique was video-assisted thoracoscopic surgery with 10 patients (17%). Thoracotomy was the most invasive diagnostic technique with four patients (6.5%). CONCLUSIONS: Although it would be desirable to use noninvasive and minimally invasive diagnostic techniques in the diagnosis of lung cancers, we should not try to avoid using invasive diagnostic techniques in surgical practice in advanced lung cancers where other techniques may be inadequate.

Comparison of only T3 and T3-T4 sympathectomy for axillary hyperhidrosis regarding treatment effect and compensatory sweating.

OBJECTIVES: Patients diagnosed with axillary hyperhidrosis can face psychosocial issues that can ultimately hinder their quality of life both privately and socially. The routine treatment for axillary hyperhidrosis is T3-T4 sympathectomy, but compensatory sweating is a serious side effect that is commonly seen with this approach. This study was designed to evaluate whether a T3 sympathectomy was effective for the treatment of axillary hyperhidrosis and whether this treatment led to less compensatory sweating than T3-T4 sympathectomies among our 60-patient population. METHODS: One hundred and twenty endoscopic thoracic sympathectomies were performed on 60 patients who had axillary hyperhidrosis. The sympathectomies were accomplished by means of a single-lumen endotracheal tube and a single port. The axillary hyperhidrosis patients were randomly divided into two groups with 17 patients in Group 1 undergoing T3-T4 sympathectomies and 43 in Group 2 undergoing only T3 sympathectomies. We analysed the data associated with the resolution of axillary hyperhidrosis, the degree of patient satisfaction with the surgical outcome and the quality of life in parallel with compensatory sweating after the procedure as reported by the patient and confirmed by the examiner. Moreover, the results were compared statistically. RESULTS: No statistically significant difference was observed between the groups based on age (P=0.56), gender (P=0.81), duration of the surgery (P=0.35) or postoperative satisfaction levels (P=0.45). However, the incidence and degree of compensatory sweating were lower in the T3 group than the T3-T4 group at the 1-year follow-up (P=0.008). CONCLUSIONS: T3 sympathectomy was as effective as T3-T4 sympathectomy for the treatment of axillary hyperhidrosis based on the patients' reported postoperative satisfaction, and the T3 group demonstrated lower compensatory sweating at the 1-year follow-up.

Total situs inversus found coincidentally following a firearm injury.

Situs inversus totalis is very rare and usually diagnosed coincidentally as it does not affect the patient's life. Being unaware of the patient's condition can lead to undesirable results from the surgeon and patient's point of view when an emergency and forensic surgical intervention is required. We present a case who was operated on urgently for a firearm injury after receiving a preoperative diagnosis of situs inversus totalis. In conclusion, situs inversus totalis can cause difficulties for surgeons in case of emergency surgery and is usually diagnosed coincidentally. There are a few cases of situs inversus with lung cancer in the literature but this is the first time a case with a firearm injury has been reported.

Squamotous-type sarcomatoid carcinoma of the lung with rhabdomyosarcomatous components.

Lung carcinosarcoma is an infrequently biphasic tumor composed of carcinomatous and sarcomatous components. It is divided into endobronchial (squamous-type) and peripheral (glandular type) categories. The carcinomatous component is usually a squamous carcinoma, and the sarcomatous component usually resembles a fibrosarcoma or a malignant fibrous histiocytoma. The presence of rhabdomyoblastic differentiation in such neoplasms is exceedingly rare. There are strong associations with smoking and asbestosis. In this study, we describe a unique case of a 43-year-old man with a 75 packet/year smoking history in whom a rare mixed malignant tumor of the lung was diagnosed and treated by left pneumonectomy. Histological examination of the resected specimen showed squamous cell carcinoma and rhabdomyosarcoma components. Although rare, the association of a sarcomatoid carcinoma of the lung with squamous cell carcinoma and rhabdomyosarcomatous component is possible and should be kept in mind when dealing with these unusual tumors.

Hydatid cyst, an unusual cause of spontaneous hemothorax and diagnostic thoracoscopy: case report.

Hydatid disease is a common parasitic disease in areas where sheep and cattle are raised and is currently endemic in the eastern and southwestern parts of Turkey. Patients with hydatid cysts typically present with cough, chest pain, dyspnea, hemoptysis, or allergic reactions. When ruptured, these cysts may cause hemoptysis, dyspnea, and hydatid thorax. Previously published series of cyst hydatid have reported cyst hydatid rupture and hemothorax secondary to trauma, but nontraumatic hemothorax due to spontaneous rupture of hydatid cyst has not been defined. We discuss the clinical features of a patient with no history of trauma who presented to the emergency department with hemoptysis and dyspnea and was found to have hemothorax due to spontaneous rupture of the hydatid cyst on videothoracoscopic investigation and underwent thoracotomy for hydatid disease treatment.

Intraoperative neurophysiological monitoring during surgery for tethered cord syndrome.

AIM: The tethered cord syndrome refers to a variety of lesions that can cause the conus medullaris to be low-lying or incapable of movement within the spinal canal. Permanent or temporary neurological complications were reported following surgical release. In this report, peri- and postoperative results in cases with tethered cord syndrome that were followed by multimodal intraoperative neurophysiological monitoring (MIONM) methods are presented. MATERIAL AND METHODS: An IONM system (Nicolet CR Endeavor) was used for monitoring during tethered cord surgery. Somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs), direct nerve root/rootlet stimulation, free-run electromyography (EMG) and F-waves were used during tethered cord surgery of 10 cases to prevent possible nerve injuries. RESULTS: MEP and SEP recordings did not change in any of the cases during surgery. The nervous tissue was identified and differentiated from connective tissue in three cases when motor responses were elicited with direct stimulation of nerve roots. None of the cases had neurological deficits following the operation. CONCLUSION: Direct nerve root/rootlet stimulation should be one of the components of MIONM during surgery for tethered cord syndrome to prevent postoperative neurological deficits.