Bruselloz gelişmekte olan ülkelerde halen sık rastlanan bir hastalıktır. Bruselloz'da santral sinir sistemi tutulumu yaklaşık %3-13 arasında görülmektedir. Akut, subakut veya kronik menenjit, ...meningoensefalit, poliradikülonevrit, myelit ve vaskülit en sık görülen nörobruselloz tablolarıdır. Bu yazıda derin serebral penetran damarların vaskülitik tutulumu neticesinde inme (sol hemiparezi) gelişen ve bazal meningeal tutuluma bağlı sol 6. kraniyal sinir tutulumu olan 20 yaşında erkek bir nörobruselloz olgusunun sunulması amaçlanmıştır. Olgumuzda beyin omurilik sıvısında (BOS) lenfositer pleositoz ve protein artışı ile birlikte kan ve BOS'ta brusellaya karşı antikor pozitifliği saptanmıştır. Brusella'nın endemik olarak görüldüğü ülkemizde, inme ve benzeri klinik tabloların ayırıcı tanısında nörobruselloz da akla gelmelidir.
Brucellosis is still common in developing countries. Central nervous system involvement in brucellosis has been reported to be 3-13%. Acute, subacute or chronic meningitis, meningoencephalitis, polyradiculoneuritis, myelitis and vasculitis are the most common features of neurobrucellosis. The aim of this report is to present a case of neurobrucellosis. A 20-year-old male had a stroke (left-sided hemiparesis) due to vasculitic involvement of penetrating cerebral vessels and left abducens palsy related to basal meningeal involvement. Examination of cerebrospinal fluid (CSF) revealed lymphocytic pleocytosis and increased protein as well as raised antibody titers for brucella were detected in the blood and CSF. Neurobrucellosis should be considered in the differential diagnosis of stroke and related disorders because of its endemic nature in our country.
Akut dissemine ensefalomiyelit (ADEM) ve Guillain-Barré sendromu (GBS) sinir sisteminin immun aracılı enflamatuvar, demiyelinizan, hastalıklarıdır. Santral ve periferik sinir sisteminin birlikte ...tutulduğu kombine demiyelinizan süreçlere nadir rastlanmaktadır. Bu durum santral ve periferik sinir sisteminde bulunan miyelin tarafından paylaşılan ortak bir epitop ile açıklanabilir. Bu yazıda üst solunum yolu enfeksiyonunu takiben 14. günde ekstremitelerinde uyuşukluk ve hafif güçsüzlük gelişen 49 yaşında bir erkek hasta sunulmuştur. Artmış BOS protein düzeyi ve kayıp F dalgaları bulguları, Guillan-Barré sendromu (GBS) kriterlerini karşılıyordu. Hastada, günler içinde sinirlilik ve davranış değişikliği ortaya çıkması üzerine yapılan, kranyal MRG tetkikinde periventriküler ve sol hipokampal T2 hiperintens ovoid lezyonlar, torakal MRG incelemesinde; T3-4, T10-11 seviyelerinde fusiform, kontrast tutan demiyelinizan lezyonlar görüldü. Bu bulgular, ADEM tanısı ile uyumluydu. Uygulanan kortikosteroid tedavi sonrası duysal semptomları ve üriner retansiyon düzeldi. Üç yıllık takibinde ise klinik atak ve radyoloji bulgu gözlenmedi. Tanı, GBS'na eşlik eden ADEM olgusuydu
Acute disseminated encephalomyelitis (ADEM) and Guillain-Barré syndrome (GBS) are both immunologically mediated two inflammatory demyelinating diseases. The combined demyelinating process in the CNS and PNS is a rare occurrence. This may be explained by a shared epitope between peripheral and central nervous system myelin. We report a 49- year- old male patient who developed numbness and mild weakness in all his extremities two weeks after an upper respiratory infection. The elevated CSF protein levels and delayed F waves fulfilled the criteria of GBS. In a few days irritability and behavioral disturbances appeared. Cranial MRI revealed bilateral periventricular white matter and left hippocampus T2-weighted hyperintense ovoid lesions. Thoracal MRI revealed T1-weighted hypointense and T2-weighted hyperintense fusiform lesions at T3-4 and T10-11 levels with contrast enhancement. A diagnosis of acute disseminated encephalomyelitis (ADEM) was considered. After corticosteroid administration sensorial symptoms and urinary retention were improved. No clinical and radiological findings of a new attack were observed during the three year follow-up. The diagnosis was Guillain-Barré syndrome associated with ADEM.
Background: In a previous study, we had evaluated short-term effects of interferon beta-1a (IFNB-1a) 44 μg s.c. three times per week treatment on serum levels of IFN-gamma (IFNG), IL-23, IL-17, ...IL-10, IL-9, IL-4 and TGF-beta (TGFB) and found a reduction only in IL-17 and IL-23 levels after 2 months of treatment. Methods: Using the same multiple sclerosis (MS) cohort, we assessed the predictive value of early cytokine level changes (difference between 2nd month and baseline levels as measured by ELISA) on the efficacy of long-term IFNB-1a treatment. Results: The alteration in IFNG levels of patients without any relapse was statistically lower than that of patients having one or more relapses (p = 0.019, Student's t-test). When patients with or without expanded disability severity scale (EDSS) progression were compared, none of the cytokine level changes showed a significant difference between groups. IL-17 and IL-23 level changes did not predict relapse and EDSS progression in IFNB-1a-treated MS patients. Conclusion: Our results show that the predictive power of early IFNG measurement on relapse occurrence may potentially extend a time span of several years.
Lung cancer is the leading cause of cancer-related deaths worldwide. Before beginning lung cancer treatment, it is necessary to complete procedures such as suspecting lung cancer, obtaining a ...pathologic diagnosis, and staging. This study aimed to investigate the processes from suspicion of lung cancer to diagnosis, staging, and treatment initiation.
The study was designed as a multicenter and cross-sectional study. Patients with lung cancer from various health institutions located in all geographic regions of Turkey were included in the study. The sociodemographic and clinical characteristics of the patients, the characteristics of the health institutions and geographic regions, and other variables of the lung cancer process were recorded. The time from suspicion of lung cancer to pathologic diagnosis, radiologic staging, and treatment initiation, as well as influencing factors, were investigated.
The study included 1410 patients from 29 different medical centers. The mean time from the initial suspicion of lung cancer to the pathologic diagnosis was 48.0 ± 52.6 days, 39.0 ± 52.7 days for radiologic staging, and 74.9 ± 65.5 days for treatment initiation. The residential areas with the most suspected lung cancer cases were highly developed socioeconomic zones. Primary healthcare services accounted for only 0.4% of patients with suspected lung cancer. The time to pathologic diagnosis was longer in the Marmara region, and the wait time for staging and treatment initiation was longer in Eastern and Southeastern Anatolia. Patients who presented to chest disease referral hospitals with peripheral lesions, those with early-stage disease, and those who were diagnosed surgically had significantly longer wait times.
The time between pathologic diagnosis, staging, and treatment initiation in lung cancer was longer than expected. Increasing the role of primary healthcare services and distributing socioeconomic resources more equally will contribute to shortening the time to diagnosis and improve treatment processes for lung cancer.
•Primary healthcare services play little role in the suspicion of lung cancer.•Patients with lung cancer are frequently diagnosed in areas of high socioeconomic development.•The time between suspicion of lung cancer and pathologic diagnosis, staging, and initial treatment is longer than expected.•The Eastern and Southeastern Anatolia regions have a longer time to staging and treatment initiation.•Patients with peripheral lesions, in the early stages of their disease, and diagnosed surgically have longer wait times.
