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Item Postprandial Hypoglycemia: An Unusual Presentation for Insulinoma(2016) Haydardedeoglu, Filiz Eksi; Torun, Ayse Nur Izol; Andic, Cagatay; Bakiner, Okan; Bozkirli, Emre; kayaselcuk, Fazilet; Ertorer, Melek EdaInsulinoma is the most common type of islet cell tumor of the pancreas and its incidence is estimated at four per one million persons per year. Although fasting hypoglycemia is the typical presentation, cases with postprandial hypoglycemia have rarely been reported. A 48-year-old woman was admitted to our department for evaluation of hypoglycemia. Laboratory data suggested a state of postprandial endogenous hyperinsulinemic hypoglycemia. Abdominal computed tomography revealed a mass lesion measuring 20 mm at the distal pancreas. A decision was made to perform an arterial calcium-stimulated venous sampling for excluding nesidioblastosis coexisting with a pancreatic incidental mass. After that the patient was referred to surgery. Pathological examination revealed a low-grade well-differentiated neuroendocrine tumor with regional lymph node metastasis. Herein, we report a case of malignant insulinoma presenting with postprandial hypoglycemia and discuss the differential diagnosis and possible mechanisms of postprandial hypoglycemia in insulinoma cases.Item The Evaluation of Clinical Signs in Patients with Suspected Renovascular Hypertension(2018) Tekkarismaz, Nihan; Torun, Dilek; Ozkan, Ugur; Zumrutdal, Aysegul; Acar, Fatma Nurhan Ozdemir; 0000-0001-7631-7395; 0000-0002-5682-0943; 0000-0002-6267-3695; AAD-9088-2021; AAK-1697-2021; AAD-9111-2021OBJECTIVE: Renovascular hypertension (RVH) is the most common yet correctable cause of secondary hypertension if diagnosed early. There are many clinical signs that can suggest RVH. The aim of this study was to find which clinical or laboratory signs are more indicative in diagnosing RVH and in determining which patients should go through renal angiography. MATERIAL and METHODS: The study included 184 patients who presented to our clinic due to hypertension and were under risk of RVH. All patients underwent three-dimensional time-of-flight Magnetic Resonance Angiography with phase-contrast. The patients were divided into two groups as with and without renal artery stenosis, supported by MRA. RESULTS: Advanced age, low body mass index, high serum creatinine level, presence of proteinuria, and patients with diabetes mellitus and coronary artery disease were found to be significant risk factors for RVH. Only the presence of renal asymmetry and the history of coronary artery disease were found to be independent risk factors. CONCLUSION: In conclusion, detailed patient history and the evaluation of renal size are very important for patients with hypertension. Coronary artery disease and a difference in renal size of more than 1.5 cm could be strong indicators of RVH.Item The effect of extracorporeal shock wave lithotripsy on distribution of interstitial cells of Cajal in rabbit renal pelvis and proximal ureter(2015) Boybeyi, Ozlem; Fedakar Senyucel, Mine; Ayva, Ebru Sebnem; Soyer, Tutku; Aslan, Mustafa Kemal; Basar, Mehmet Murad; Cakmak, Ahmet Murat; 25790556Background/aim: An experimental study was performed to evaluate the effect of extracorporeal shock wave lithotripsy (ESWL) on the distribution of interstitial cells of Cajal (ICC) in rabbit renal pelvis and proximal ureter. Materials and methods: Six New Zealand rabbits were included. Right kidneys were exposed to a total of 3000 shock waves (14 kV) by using an electrohydraulic-type ESWL device. Right sides were allocated as the ESWL group (EG, n = 6) and left sides as the control group (CG, n = 6). Tissues were harvested on day 7. Tissues were examined histopathologically for the presence of edema, inflammation, congestion, hemorrhage, fibrosis, and vascularization. Mast cell tryptase and CD117 (c-kit) staining was performed for ICC distribution. Results: Although increased tissue edema in renal pelvises and increased inflammation in ureters were observed in EG, no statistical difference was detected between groups (P > 0.05). In CG, positive CD117 staining was detected in 2 renal pelvises and ureters. None of the EG samples showed CD117 staining and no statistical difference was detected between groups (P > 0.05). Conclusion: Rabbit does not appear to be a good model for investigating ICCs. ESWL may cause histopathological alterations in the renal pelvis and ureter. Since it has not been statistically proven, reduced contractility of the ureter after ESWL may not be attributed to altered distribution of ICCs in the renal pelvis and ureter.Item A. Lazer ve Isik Sistemleri(2020) Ozcan, HamdiLaser and light systems are being used and demanded by patients more and more everyday in the treatment of acne and scars. Various devices are used in active acne and scar treatment. The effects of light systems on acne and scar tissue have been reported in different magnitudes. Since there are differences in practice and methodology, no judgement can be made on the success of treatment methods. The effectiveness of light systems increases with combined therapies. Their use in combination with medical therapies may increase the rate of success.Item Could radial extracorporeal shock wave therapy have an effect on wound healing in clinical practice by creating genotoxic damage? An in-vitro study in mouse fibroblasts(2021) Simsek, Ekin Kaya; Haberal, Bahtiyar; Kasap, Yesim Korkmaz; Yurtcu, Erkan; 0000-0003-3438-1633; 0000-0002-1668-6997; 34842098; AAV-8821-2021; W-9080-2019Objectives: This study aims to evaluate wound healing effects of in vitro radial extracorporeal shock wave (rESW) application on mouse fibroblasts and whether the cytotoxic effect of extracorporeal shock wave (ESW) was due to a possible genotoxic effect. Patients and methods: After creating an in vitro wound healing model in L929 mouse fibroblast culture, fibroblasts were stimulated with a frequency of 3 Hz, and 100, 250, 500, 1,000 and 1,500 pulses shock waves were applied. Energy flux densities ranging from 0.01 to 0.23 mJ/mm2 (14.3 MPa) at a constant pressure level of 0.5 and 1 bar were applied. Wound healing, cell viability, and genotoxicity were evaluated at 24 and 48 h. Results: All shot numbers for both pressures significantly reduced cell viability (p<0.05). For both 0.5 and 1 bar pressures, in both intervals, the rate of wound healing decreased, regardless of the number of shots (p<0.05). In vitro genotoxic damage was detected at both 0.5 and 1 bar pressures, in both time intervals, regardless of the number of shots. The genotoxic damage increased from 24 h to 48 h. Conclusion: The study results suggest that, when ESWT is applied in this in vitro experimental setup, cell viability decreases and wound healing is delayed under all conditions. Furthermore, genotoxic damage can be prevented by using shots below 1,000 pulses. Therefore, while investigating the therapeutic effect of ESW therapy in vitro, the upper limit for the number of shots should be 1,000 pulses.Item A rare hematological complication of visceral leishmaniasis: hemophagocytic syndrome(2016) Solmaz, Soner; Boga, Can; Kozanoglu, Ilknur; Asma, Suheyl; Turunc, Tuba; Demiroglu, Yusuf ZiyaThe term "hemophagocytosis" describes the pathologic finding of activated macrophages, engulfing erythrocytes, leukocytes, platelets and their precursor cells. This phenomenon is an important finding in patients with hemophagocytic syndrome. It is a distinct clinical entity characterized by fever, pancytopenia, splenomegaly and hemophagocytosis in bone marrow, liver and lymph nodes. Hemophagocytic syndrome can be classified according to the underlying etiology into either primary (genetic) or secondary (acquired). Severe infections, malignancies, rheumatologic disorders and some metabolic diseases can lead to secondary hemophagocytic syndrome. Infection-associated hemophagocytic syndrome implicating Leishmania is very rare and often difficult to diagnose. Therefore, we aimed to report a young boy with Visceral Leishmaniasis associated hemophagocytic syndrome.Item Retroperitoneal Schwannoma: A Case Report(2017) Ozer, Cevahir; Goren, Mehmet Resit; Hasbay, Bermal; Erbay, Gurcan; 0000-0002-7850-6912; 0000-0002-2001-1386; 0000-0002-1706-8680; AAM-2222-2020; Y-6143-2019; AAK-5370-2021Schwannomas are benign tumors originating from Schwann cells of the neural sheaths. Only 0.3% to 3% of the schwannomas are located the retroperitoneal space. Most schwannomas are asymptomatic and often found incidentally. The ideal treatment is complete surgical excision. Here, we report a case of a 49-year-old woman with retroperitoneal schwannoma.Item Improving the rapid office strain assessment method with an integrated multi-criteria decision making approach(2020) Delice, Elif Kilic; Can, Gulin Feryal; Kahya, EminNowadays, work-related musculoskeletal disorders (WMDs) are gradually increasing. This not only reduces work efficiency but also negatively affects workers' health. For this reason, it is important to design the working environment based on ergonomic principles in order to prevent WMDs before they occur. In addition, before starting ergonomic design improvement activities in the enterprises, it is necessary to identify the departments with high strain levels and evaluate the design of the office components in these departments. In this study, an integrated multi-criteria decision making (MCDM) approach was proposed based on the Rapid Office Strain Assessment (ROSA) method to determine the strain level caused by office components and to identify the departments to be ergonomically improved according to these levels. In the proposed approach, the strain level related to office components was evaluated by ROSA method. To determine the importance weights of office components on strain levels, Step-by-Step Weight Assessment Ratio Analysis (SWARA) was used. Weighted Aggregated Sum Product Assessment (WASPAS) method was applied to order the departments according to the strain levels. The proposed approach was implemented in a company operating in the aviation industry. As a result, the most important office component that increases the strain level was determined as the chair, while the Manufacturing Engineering and R & D departments were determined as the units with the highest strain levels. Additionally, by performing sensitivity and comparative analysis, changes in the departments' rankings were evaluated.Item Are Bone Turnover Markers Related with Fracture Risk in Initial Diagnose Postmenopausal Osteoporosis? A Cross-Sectional Clinical Study(2015) Yalbuzdag, Seniz Akcay; Sarifakioglu, Banu; Sengul, Ilker; Cetin, NuriObjective: In this study, we investigated the relationships between 10 year fracture risk calculated with FRAX assessment tool and bone turnover markers (BTM) in women with diagnosed as postmenopausal osteoporosis for the first time. Materials and Methods: After exclusion of the causes of secondary osteoporosis 61 postmenopausal women diagnosed with osteoporosis for the first time were enrolled. Height and weight measurements, comorbid diseases, menopause age, and laboratory investigations were recorded. Lumbar and femur neck and femur total T scores were measured by dual-energy x-ray absorptiometry (DXA). As BTM, serum osteocalcin (OC) and urine deoxypridinoline levels were measured. 10-year fracture risk of hip and major osteoporotic fracture was calculated with FRAX assessment tool. Results: The mean age of patients was 61 +/- 39 years. Median value of menopause year was 15.13 years (min: 2, max: 40). The median 10-year hip fracture and major osteoporotic fracture risks were calculated as 1.10% (min: 0, max: 23), 6.9% (min: 3, max: 34) respectively. There was no significant relationship between BTM and fracture risk. Positive significant correlation was found between menopause year and hip fracture risk, and between menopause year and major osteoporotic fracture risks (p=0.031, 0.276; p=0.025, r=0.287). Negative significant correlation was detected between body mass index and hip fracture risk (p=0.002, r=-0.392). Conclusion: In our study, we couldn't find relationship between BTM and fracture risks assessed by using FRAX tool in patients with initially diagnosed of postmenopausal osteoporosis. Further studies are needed to investigate the relationship between BTM and fracture risk in different patient groups.Item Herpes Zoster Brachial Plexopathy: Direct Steroid Injection(2017) Araz, Coskun; Askin, Suna; Yilmaz, Cem; 0000-0002-2353-8044; 0000-0002-4927-6660; 27560523; AAK-2948-2021; AAJ-4576-2021Herpes zoster (shingles) is a viral disease, characterized by painful skin eruptions and neuropathic sensory symptoms. Motor involvement and brachial plexus involvement in herpes zoster are rare conditions. Together with antiviral medication and pain therapy, palliative and supportive modalities take an important role in the treatment of herpes zoster. It is well documented in previous reports that oral or intravenous steroid administrations may be additive in management. In this case report, positive effects of direct steroid injection onto the brachial plexus via ultrasonography guidance in a patient with motor weakness due to herpes zoster involvement of brachial plexus is presented.