ISSN :2822-5872
Volume: 3  Issue: 2 - 2024
1.Full Issue

Pages I - II

2.Septo-columellar reconstruction with radial forearm free flap
Emrah Kagan Yasar, Ceyhun Uzun, Yusuf Alper Aytaç, Zeynep Banu Arıcı, Murat Sahin Alagoz
doi: 10.5505/achmedj.2024.25743  Pages 49 - 57
INTRODUCTION: Columellar subunit reconstruction is described as one the most challenging area in the literature. Radial forearm free flap (RFFF) can easily provide the reconstruction of columella and neighbouring regions with different styles of designs and different types of tissues included if needed.
METHODS: Patients who have large composite defects in the septocolumellar region and have been reconstructed with RFFF between 2018-2021 were included in the study. Patients' age, gender, etiology of septocolumellar defect, anatomical deficiencies on nose, flap sizes and designs, cartilage donor site, recipient vessels, flap donor site repair methods, time of hospital stay, and complications were investigated.
RESULTS: Six patients, comprising five males and one female with an average age of 50.8 years, were evaluated. The etiologies were congenital agenesis in one patient, trauma in two patients, and tumors in three patients. Adipofascial radial forearm free flaps (RFFF) were utilized in two patients, with primary closure of the donor sites. To prevent excessive skin thickness in septal mucosal reconstruction, only adipofascial flaps were employed. The facial artery and vein served as the recipient vessels in all cases, with the pedicle tunneled from the nasal region to the submandibular region. The average flap size was 5.08 x 4.66 cm. Septal cartilage was used to create the cartilage framework in two cases, while costal cartilage was used in the remaining cases. The mean operation time was 6.6 hours, the average ICU stay was 16.3 hours, and the mean hospitalization duration was 6.5 days. Complications included scar spread and synechia at the flap donor site in two different patients.
DISCUSSION AND CONCLUSION: Using the facial artery and vein for recipient vessels makes the new skin scarring away from midface area. RFFF provides an excellent option for optimal septocolumellar reconstruction deriving from a variety of etiologies with the disadvantage of sacrificing a main artery in upper extremity.

3.The effect of maternal asthma on serum PAPP-A levels and first trimester aneuploidy screening test running
Bergen Laleli Koc, Gonca Türker Ergün, Ozgur Kara, Atakan Tanacan, Deniz Oluklu, Betül Akgün Aktaş, Ecem Kaya, Dilek Sahin
doi: 10.5505/achmedj.2024.72691  Pages 58 - 64
INTRODUCTION: PAPP-A (Pregnancy-associated plasma protein-A) is considered a pro-inflammatory marker and its serum levels are elevated in non-pregnant patients with asthma. In the current research, we aimed to investigate whether maternal serum PAPP-A levels, a biomarker for first-trimester aneuploidy screening, differ in pregnant women with asthma compared to healthy pregnant women.
METHODS: In the first step, maternal serum PAPP-A MoM values, used as the first-trimester fetal aneuploidy screening marker, were compared between pregnant women with asthma and a healthy pregnant group. In the second step, the groups compared whether PAPP-A and fβ-HCG ( free β human chorionic gonadotropin) levels were below or above the cut-off values for Trisomy 21 and compared them according to maternal age (<35; ≥35).
RESULTS: The median PAPP-A level was found to be 2.15 IU/L (0.41-9.91) in the asthma group and 2.54 IU/L (0.56-11.40) in the control group, and there was no difference between the groups (P=0.363). The median PAPP-A MoM value was 0.99 (0.15-3.28) in the asthma group and 1.07 (0.33-3.37) in the control group. This result did not show a statistically significant difference (P = 0.694). No statistically significant difference was shown between the groups below and above 35 age (P=0.456).
DISCUSSION AND CONCLUSION: Maternal serum PAPP-A levels in pregnant women with asthma do not vary compared to the healthy pregnant group without asthma. Based on the results of our study, the first-trimester fetal aneuploidy screening test is a reliable screening method for pregnant women with asthma.

4.Cervical Cerclage: An Obstetrical Dilemma
Atakan Tanacan, Mehmet Sinan Beksac
doi: 10.5505/achmedj.2024.33042  Pages 65 - 71
INTRODUCTION: This retrospective study evaluated women in whom transvaginal cervical cerclage (TCC) was performed in a previous pregnancy but delivered without cervical intervention in the most recent pregnancy. The primary aim was to underline the importance of etiology based management protocols on favorable pregnancy outcomes in patients with a history of TCC.
METHODS: We retrospectively evaluated 34 patients with at least one failed TCC for the treatment of cervical insufficiency (CI) but who gave birth without TCC in their most recent pregnancies.
RESULTS: All patients were evaluated preconceptionally and examined for maternal risk factors. At least one risk factor was present in all cases. The autoimmune antibody positivity rate was 41.2%. Twelve patients had Hashimoto thyroiditis, two had systemic lupus erythematosus, two had pernicious anemia, and two had anti-phospholipid antibody syndrome. 32 had homozygous or heterozygous methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms, while 11 were homozygous or heterozygous for factor 5 Leiden or prothrombin-20210A gene mutations.
DISCUSSION AND CONCLUSION: The elimination and management of risk factors for cervical ripening and dilatation are important for preventing unnecessary cervical interventions.

5.Evaluation Of Humeral Cortical Index In Patients Over 65 Years With Proximal Humerus Fractures
Enver Kılıç, Atahan Durğal
doi: 10.5505/achmedj.2024.63835  Pages 72 - 76
INTRODUCTION: The aim of our study is to evaluate the effect of humeral cortical index (CI) on proximal humerus fracture (PHF) risk in patients over 65 years.
METHODS: Patients over 65 years who had PHF due to injury being a fall from less than standing height and were treated surgically between January 2019 and December 2023 were included in group 1. Patients over 65 years who applied to the hospital and had a shoulder anterior-posterior radiography were included in group 2. Neer classification was used to classify PHF. CI measurements were performed for all patients.
RESULTS: In group 1, 54 male and 36 female patient were evaluated. In group 1, 42 right and 48 left humeral CI measurements were performed. The average age of group 1 was 72.87±6.65. In group 2, 49 male and 37 female patient were evaluated. The average age of group 2 was 70.9 ±4.79. No significant difference was determined between group 1 and group 2 for gender, age and side. (p=0.684, p=0.236, p=0.128 respectively). For group 1, the mean humeral CI was 0.304±0.06 and 0.380 ±0.07 for group 2. A significant difference was determined between group1 and group 2 for humeral CI. (p>0,001) No significant difference was determined between Neer type 2 patients and Neer type 3-4 patients for age, gender and humeral CI. (p=0.373, p=0.15, p=0.451 respectively) The risk of PHF increased 3.2 times in patients with humeral CI lower than 0.3267.
DISCUSSION AND CONCLUSION: Humeral CI is a good parameter in determining the risk of PHF in the population over 65 years. However, humeral CI does not affect the severity of PHF.

6.Perinatal outcomes of choroid plexus cysts in a high-risk pregnant population: A tertiary center experience
Murat Haksever, Atakan Tanacan, Esra Karataş, Osman Onur Özkavak, Refaettin Sahin, Hakkı Şerbetçi, Ezgi Başaran, Ekin Ersoy, Dilek Şahin
doi: 10.5505/achmedj.2024.99608  Pages 77 - 81
INTRODUCTION: The objective of this study was to present the results of fetuses followed up for choroid plexus cysts(CPC) in our clinic and to provide an additional benefit to the existing literature.
METHODS: This is a retrospective cohort study conducted in Ankara Bilkent City Hospital perinatology clinic. All pregnant women who were followed up with a antenatally diagnosed choroid plexus cyst between 2021 and 2023 were included in the study. Demographic characteristics, prenatal ultrasound findings, non-invasive screening test results, invasive diagnostic test results, clinical management and postnatal outcomes were evaluated and compared between unilateral CPC group and bilateral CPC group.
RESULTS: A comparison between unilateral and bilateral groups revealed no significant differences in maternal age, gravidity, parity, or number of abortions. However, the week of diagnosis was found to be smaller in the group with bilateral choroid plexus cysts (p=0.004). Patients undergoing invasive testing were higher in the bilateral CPC group, although these differences were not statistically significant. There was no statistically significant difference between the groups in terms of pregnancy termination rate, gestational week at delivery, neonatal weight, NICU admission, and APGAR scores. The group with additional anomalies exhibited a higher rate of high-risk screening tests, a higher rate of anomaly detection in invasive tests, and a higher rate of pregnancy termination. Nevertheless, these differences were not statistically significant
DISCUSSION AND CONCLUSION: In conclusion, fetal choroid plexus cysts represent a risk factor for aneuploidy when associated anomalies are present.

7.Abdominoscrotal hydrocele: A case report of a young adult treated with laparoscopy
Turgay Kaçan
doi: 10.5505/achmedj.2024.40469  Pages 82 - 85
Abdominoscrotal hydrocele (ASH) is a rare condition characterized by interconnected abdominal and scrotal components, resembling the appearance of an hourglass, which can occur in both pediatric and adult populations. Although its pathophysiology remains incompletely elucidated, it involves an increase in fluid pressure within the tunica vaginalis, resulting in the progression of fluid along the inguinal canal towards the abdomen and the formation of an abdominal sac. Due to the potential for various complications such as hydronephrosis and lymphedema in the leg secondary to compression effects, early surgical intervention is generally recommended. The presentation aims to demonstrate a case of ASH successfully managed through laparoscopic excision.

8.Add-on Erythromycin and Tacrolimus Treatment for Primary Sjogren’s Syndrome-Related Immune Thrombocytopenia: A Case Report
Masashi Ohe
doi: 10.5505/achmedj.2024.52244  Pages 86 - 89
A 64-year-old woman with primary Sjogren’s syndrome (SjS) was admitted to our hospital for nasal bleeding, oral bleeding, and purpura on her entire body. On this admission, laboratory findings were as follows: white blood cell counts, 8,910 /μL; hemoglobin, 9.9 g/dL; and platelet (PLT) counts, 0.1×104/μL. Although the anti-PLT antibodies were positive, other autoimmune antibodies including anti-deoxyribonucleic acid antibodies were negative. No immunoglobulin (Ig)M antibodies for cytomegalovirus and Parvovirus B19, and no IgG antibodies for Helicobacter pylori, were detected. No abnormal findings suggestive of infection were identified in the systemic examination. A bone marrow aspiration smear revealed normal bone marrow. Based on these findings, the patient was diagnosed with primary SjS-related immune thrombocytopenia (ITP). The patient initially received intravenous immunoglobulin, methyl prednisolone (PSL) pulse therapy, and subsequent high dose PSL without significant improvement. Therefore, eltrombopag was added. Subsequently, erythromycin (EM) was also added, considering its immunomodulatory effects. After initiating the EM treatment, the PLT counts increased. Therefore, the PSL dosage was reduced. However, the PLT counts gradually decreased. Instead of increasing the PSL dosage again, tacrolimus (TAC) was successfully added. Consequently, the PSL dosage could be successfully reduced. This case suggests that EM and TAC can be effective alternatives when conventional immunosuppressants fail to improve primary SjS-related ITP."