The Prevalence of Minimal Hepatic Encephalopathy in an Outpatient Hepatology Clinic.

BACKGROUND: Minimal hepatic encephalopathy can only be detected by specific psychometric or neuropsychological tests. We aimed to determine the prevalence of minimal hepatic encephalopathy in a hepatology outpatient clinic of a tertiary center. METHODS: A total of 82 patients with chronic liver disease were involved prospectively in this study. Control groups consisted of healthy volunteers (n = 123) and chronic renal failure patients (n = 28). We used 2 different methods to detect minimal hepatic encephalopathy. First method was a battery of 5 psychometric tests (number connection tests A and B, digit symbol test, serial dot test, line tracing test) which was filled by all patients. The second method was critical flicker frequency test. Both methods were used in the whole group (n = 233). We applied linear regression analysis to the results of psychometric tests of healthy volunteers to establish equations to calculate the expected values of each test. Test results of the patients were evaluated according to the expected results obtained from these equations. RESULTS: The prevalence of minimal hepatic encephalopathy detected by psychometric tests and critical flicker frequency test was 13% and 14%, respectively. When the positivity of both tests was deemed necessary to diagnose minimal hepatic encephalopathy, the rate of minimal hepatic encephalopathy was 3.6% (n = 3) in a chronic liver disease patient group. CONCLUSION: Minimal hepatic encephalopathy is a difficult clinical condition to diagnose, and it is more appropriate to use psychometric tests and critical flicker frequency test together.

Temporary Implant Irradiation: Survey of Turkish Society of Radiation Oncology Breast Cancer Study Group.

OBJECTIVE: To understand the clinical approach of radiation oncologists during the treatment of patients with breast reconstruction. MATERIALS AND METHODS: A questionnaire survey was emailed to 105 active members of the Turkish Radiation Oncology Society, the Breast Cancer Study Group. The factors associated with radiation oncologists and their current practice was identified. RESULTS: Fifty radiation oncologists (47.6%) responded, and most of the responders (83%) were physicians who treated >50 new breast cancer patients annually. The majority of the physicians worked in academic hospitals and had more than 15 years of work experience. The early reconstruction rate was noted to be low among patients with mastectomy (<10% of the mastectomy patients) (p<0.05). Early implant irradiation with temporary tissue expander was noted to be a more common procedure. The majority of the respondents (68%) preferred to irradiate an inflated implant (20% total, 80% partial). In addition, 22% of the physicians declared that they routinely used bolus and that 60% of them used it only for patients at a high risk of local recurrence factors. CONCLUSION: It can thus be concluded that variations exist between experienced radiation oncologists and others. Hypofractionation is not yet commonly practiced for patients with reconstruction in Turkey. A concrete consensus can be helpful to create a homogeneity in treatment decisions and practical applications.

Erectile dysfunction in prostate cancer patients treated with intensity-modulated radiation therapy.

BACKGROUND: Sexual dysfunction is an important side-effect after radiotherapy (RT) for prostate cancer (PCa). The aim of this study was to compare sexual functions of PCa patients before and after intensity-modulated RT and to analyze their correlation with penile bulb (PB) doses and patient characteristics. MATERIALS AND METHODS: Forty-two patients who underwent RT ± hormone therapy for PCa between 2010 and 2013 were analyzed. Sexual functions assessed by patient-reported questionnaire and physician reported scale before and 3 years after treatment. The effect of patients' age, prostate volume, testosterone levels, comorbidity, smoking status, tumor stage, RT technique, hormone therapy, and PB doses to sexual functions were investigated. RESULTS: After 3 years of RT, 64.3% of all patients had a lower erectile score; and 75% of patients who were previously potent (n = 24) had become impotent after treatment. However sexual desire still remained in 75.8% of patients who had desire before treatment (n = 33). Statistical analysis showed that two parameters were correlated with postradiotherapy impotency outcome; PB mean radiation dose (P = 0.033) and testosterone levels (P = 0.032). CONCLUSIONS: RT, despite modern techniques, affects the sexual function of PCa patients in varying degrees. Reducing radiation doses to penile structures may play a role in preventing erectile dysfunction.

Comparison of changes in renal function with dosimetric parameters in gastric cancer patients treated with adjuvant chemoradiotherapy.

PURPOSE: Our objective was to analyze kidney damage using glomerular filtration rate (GFR) and dynamic renal scintigraphy (DRS) compared with dose volume histogram (DVH) parameters in gastric cancer patients. MATERIALS AND METHODS: Twenty-two gastric cancer patients treated with postoperative chemoradiotherapy were retrospectively evaluated. Student's t test was used to compare pre- and posttreatment GFR and creatinine values. The relative contribution of the left and right kidney in DRS results was expressed as left-to-right ratio (L/R), and the percentage of initial and control participation ratio difference was calculated. Spearman's correlation analysis was used to compare the percentage difference of L/R ratio with DVH parameters of each kidney. RESULTS: In DRS analysis, decrease in left kidney cortical function was observed in one patient. V5-V10 of the left and bilateral kidneys were significantly associated with GFR decline. None of the DVH parameter was significantly associated with L/R ratio. However, the V15 and Dmean of the bilateral kidney were significantly correlated with greater decrease in L/R ratio in seven patients whose posttreatment DRS period was > 12 months. CONCLUSIONS: Decline in renal function, even with current renal constraints, was observed. Minimization of V5, V10, and V15 and mean dose (Dmean) to the kidney should be considered.

The Reliability and Validation of the Turkish Version of the Asthma Self-Management Knowledge Questionnaire.

OBJECTIVES: There is no validated questionnaire in Turkish to assess asthma knowledge. In this study, we aimed to evaluate the reliability and validity of the Turkish version of the Asthma Self-Management Knowledge Questionnaire (AKQ) among asthmatic adults. MATERIAL AND METHODS: The AKQ was translated into Turkish by two medical-text translators, followed by back translation and final review by two clinicians with experience in asthma management. The Turkish Asthma Self-Management Questionnaire was then applied to 202 adult asthma patients, and additional demographic and clinical features of the patients were collected for analysis. RESULTS: The internal reliability of the 24-item AKQ was not high (Cronbach's alpha=0.55). Tukey's test of additivity was significant (p<0.001). This result revealed that all questions are consistent and measure the same concepts. Factor analysis demonstrated a probable structure of 10 factors that together explained 63.7% of total variance in results. Intra-class reliability of the AKQ was quite high. CONCLUSION: This study shows that AKQ seems to be a suitable instrument to evaluate the effect of different components of asthma knowledge - such as triggers, medications, asthma exacerbations, and avoidance measures - in adult asthmatics.