Gallbladder sludge and acute pancreatitis induced by acute hepatitis A.

In this case report, a young woman with gallbladder sludge and acute pancreatitis due to acute hepatitis A (HAV) is presented. She was admitted to our hospital with abnormal hepatic enzymes. Five days prior to her admission, an initial abdominal ultrasound was performed at another hospital and revealed no abnormality, while her serum aspartate aminotransferase (AST) level was at the upper limit of normal (ULN) x 8. A second ultrasound was performed at our hospital and revealed a gallbladder wall thickness (9.3 mm), gallbladder sludge in the gallbladder lumen, pancreatic edema, ascites, and hepatomegaly while AST was at the ULN x 50. Magnetic resonance imaging and magnetic resonance cholangiopancreatography revealed imaging features of an acute stage of pancreatitis and gallbladder wall thickness with coexisting sludge in the gallbladder lumen. HAV infection was diagnosed by the detection of immunoglobulin M against HAV in the serum. The patient underwent two repeated abdominal ultrasound examinations on the 5th (AST was at the ULN x 3) and the 20th days (AST was at the normal) after her discharge, and both revealed normal findings. In our case, we observed reversible changes in the hepatobiliary and pancreatic system which was related to the severity of hepatic necro-inflammation. HAV-associated pancreatitis may be due to the formation of biliary sludge during the acute phase of the viral illness, but this association needs further investigation.     

The Factors Contributing to Death Anxiety in Cancer Patients

Suffering comes in many ways for patients confronting cancer. One of these is an unspecifiable fear about death, which is an existential issue. The aim of this study was to investigate the relationship between death anxiety and its correlates in cancer patients. Seventy cancer patients were assessed using SCID-I, Templer's Death Anxiety Scale, the Hospital Anxiety (A) and Depression (D) Scale, the Distress Thermometer, the Visual Analogue Scale for pain (VAS), the Global Assessment of Functioning, and Glock and Stark's Dimensions of Religious Commitment scales, and these assessments were compared between cancer patients with and without death anxiety. Multiple regression analysis was conducted after correlation analysis between death anxiety and sociodemographic and clinical variables. Axis I psychiatric diagnosis, pain scores, and negative believes about what will happen after death were found to be higher in patients having death anxiety than patients not having death anxiety. Also life expectancy was perceived as shortened in patients with death anxiety. Death anxiety was associated with anxiety, depressive symptoms, and beliefs about what will happen after death. In conclusion, death anxiety could not be regarded as a natural consequence of having cancer; it is associated with the unresolved psychological and physical distress.     

Can possible toxic effect of ultraviolet-A after corneal cross-linking be prevented? In vitro transmittance study of contact lenses at 370 nm wavelength

Context: Corneal collagen cross linking (CCL) with ultraviolet A (UVA) has been proposed as a treatment for the progression of corneal ectasia associated with keratoconus and post-laser-assisted in situ keratomileusis (LASIK) ectasia. Despite the reports about safety of procedure, we consider that UVA of sunlight can effect riboflavin saturated and de-epitelizated cornea early after CCL.

Objectives: To evaluate the UVA blockage capability of 11 different silicone hydrogel contact lenses which are widely used after CCL treatment.

Methods: Eleven different silicone hydrogel and daily disposable contact lenses were evaluated. The UVA light at 365?nm wavelength for UVA source and UV light meter to measure UVA radiation were used. 3, 9 and 18?mW/cm² power of UV radiance was applied centrally to the each type of contact lenses. The power of UVA transmittance for each radiance and percentage of blockage were evaluated for each brand. Also, protection factor (PF) was calculated.

Results: The senofilcon A and narafilcon A had the highest blockage and lowest transmittance (p?=?0.02). PF was significantly higher in the senofilcon A and narafilcon A at 3, 9 and 18?mW/cm² (p?=?0.0001). And also, the hilafilcon B, filcon IV, nelfilcon A, enfilcon A, lotrafilcon A and lotrafilcon B had the highest UVA transmittance.

Conclusion: The narafilcon A and the senofilcon A may be a good options for epithelial healing after CCL procedure to protect the cornea from UVA of sunlight. And also, the hilafilcon B, filcon IV, nelfilcon A, enfilcon A, lotrafilcon A and lotrafilcon B contact lenses that have high-UVA transmittance feature can be a treatment choice for contact lens-assisted CCL technique in thin corneas.     

A rare cause of hydrops fetalis in two Gaucher disease type 2 patients with a novel mutation

Metabolic Brain Disease - Gaucher disease type 2 is the most progressive and the rarest form of Gaucher disease, defined as the acute neuronopathic type. We presented two GD2 patients who died...     

Discrimination between non-functioning pituitary adenomas and hypophysitis using machine learning methods based on magnetic resonance imaging‑derived texture features

Purpose

Hypophysitis is a heterogeneous condition that includes inflammation of the pituitary gland and infundibulum, and it can cause symptoms related to mass effects and hormonal deficiencies. We aimed to evaluate the potential role of machine learning methods in differentiating hypophysitis from non-functioning pituitary adenomas.

Methods

The radiomic parameters obtained from T1A-C images were used. Among the radiomic parameters, parameters capable of distinguishing between hypophysitis and non-functioning pituitary adenomas were selected. In order to avoid the effects of confounding factors and to improve the performance of the classifiers, parameters with high correlation with each other were eliminated. Machine learning algorithms were performed with the combination of gray-level run-length matrix-low gray level run emphasis, gray-level co-occurrence matrix-correlation, and gray-level co-occurrence entropy.

Results

A total of 34 patients were included, 17 of whom had hypophysitis and 17 had non-functioning pituitary adenomas. Among the 38 radiomics parameters obtained from post-contrast T1-weighted images, 10 tissue features that could differentiate the lesions were selected. Machine learning algorithms were performed using three selected parameters; gray level run length matrix-low gray level run emphasis, gray-level co-occurrence matrix-correlation, and gray level co-occurrence entropy. Error matrices were calculated by using the machine learning algorithm and it was seen that support vector machines showed the best performance in distinguishing the two lesion types.

Conclusions

Our analysis reported that support vector machines showed the best performance in distinguishing hypophysitis from non-functioning pituitary adenomas, emphasizing the importance of machine learning in differentiating the two lesions.

     

Indications for eye removal surgeries: A 15-year experience at a tertiary military hospital

Objectives:

To analyze the indications and types of eye removals at a military tertiary care hospital in Turkey.

Methods:

The medical records (age, gender, affected eye, type of surgical procedure, indications of surgery) of 123 patients who underwent evisceration and enucleation in the course of a 15-year period (January 2000 to December 2014) at Gulhane Military Medical Academy, Ankara, Turkey were reviewed retrospectively.

Results:

The mean age was 35.61±18.52 (range 3-80 years). The number of male in the patient group was 92 (74.8%) and female was 31 (25.2%). Patients who underwent evisceration were 95 (77.2%), whereas 28 (22.8%) of them underwent enucleation. The mean age of the eviscerated patients was 30.63±13.08, whereas the mean age of the enucleated patients was 52.50±23.92 (p<0.001). The leading indications for eye amputations were trauma (n=62, 50.4%), malignancy (n=20, 16.3%), painful blind eye and absolute glaucoma (n=20, 16.3%), endophthalmitis (n=12, 9.7%), and phthisis bulbi, and cosmetic reasons (n=9, 7.3%).

Conclusion:

Trauma was the most common etiology for evisceration, and malignancy was the most common etiology for enucleation. Using protective eyewear and early detection of intraocular malignancy and glaucoma through routine ophthalmic examinations are essential for providing non-invasive treatment modalities instead of eye removal.Eye removals are performed in cases of severe trauma, eye malignancy, endophthalmitis unresponsive to medical treatment, painful blind eye, and absolute glaucoma, as well as phthisic eyes with severe cosmetic defects.1-4 Evisceration is the removal of intraocular structures other than the sclera, whereas enucleation is the removal of the entire eyeball including the sclera leaving behind only the orbital structures.5 Evisceration surgery is usually preferred in extremely severe trauma cases, while enucleation is used in advanced cases of intraocular malignancy.1,3,6 The aim in such surgeries is to remove the damaged eye, provide sufficient comfort, replace the lost volume, and renew functional and cosmetic appearance.7 Removal is a difficult decision for both patients and physicians, and is considered as the last resort. In addition to clinical indications, the potential sight of the eye and patient’s psychological aspects should also be taken into consideration.1 In developed countries, the most common reasons for eye amputations are malignancy3 and trauma,6 whereas in developing countries, infections are the dominating factors.1,8 In this study, the etiology and surgery methods of 123 eye amputations performed in the Gulhane Military Medical Academy (GATA) between January 2000 and December 2014 were analyzed, and possible public health and preventive programs regarding this matter were evaluated.