Acta Medica

Thoracic vertebral metastasis and spinal cord injury secondary to multiple myeloma: a case report

Öznur Uzun — Wed, 24 Dec 2025 00:00:00 +0300

Axillary arch as a rare variant of the latissimus dorsi: cadaveric case report and literature review

Christos Lyrtzis, Georgios Paraskevas, Nikolaos Anastasopoulos, Paissios Greige — Wed, 24 Dec 2025 00:00:00 +0300

This case report explores the axillary arch, a rare anatomical variation of the latissimus dorsi muscle, which can compress vital neurovascular structures in the axilla. We present a detailed examination of a 75-year-old male cadaver, where the axillary arch was identified extending from the latissimus dorsi to the pectoralis major. The arch measured 6.0 cm in length and 0.6 cm in width, passing over the intercostobrachial nerve, median nerve, and medial brachial vein. The potential for this anatomical variant to cause neurovascular compression and contribute to conditions such as thoracic outlet syndrome is discussed. This study emphasizes the importance of recognizing the axillary arch in surgical practice to avoid complications during procedures involving the axillary region. Insights gained from cadaveric dissections are vital for enhancing our understanding of anatomical variations and their clinical implications.

The clinical frailty scale for the assessment of frailty in octogenarians in the intensive care unit

Ayşe Müge Karcıoğlu, Pelin Ünsal — Wed, 24 Dec 2025 00:00:00 +0300

Objective: Increased frailty is shown to be related to vulnerability to adverse health outcomes. The objective of the study was to assess the usability of frailty identified using the Clinical Frailty Scale (CFS) in patients aged 80 years and older admitted to the intensive care unit (ICU).

Materials and Methods: We conducted a retrospective screening of the octogenarian patients admitted to the ICU between January 1 and October 31, 2023. After excluding the postoperative patients, we recorded the demographic characteristics and comorbidities, APACHE II scores, Charlson Comorbidity Index, CFS scores, general admission reasons, and discharge patterns from ICU.

Results: The median age of the 156 patients in the study was 85, with 51.9% being female. The median APACHE II score was 18 (12–28), and the median CFS score was 5 (1–9). The CFS score categorized 37 patients as non-frail, 37 as pre-frail, and 82 as frail. The frail group exhibited statistically significant elevations in age, albumin levels, APACHE II scores, and comorbidities, including dementia, cerebrovascular disease, and cancer. The CFS score, age of 90 years or older, presence of pressure ulcers, APACHE II score, and acute kidney injury were associated with an increased risk of mortality. However, analysis of survival rates across frailty categories revealed no significant differences among the groups (p: 0.348).

Conclusion: Although the survival analysis revealed no major differences among non-frail, pre-frail, and frail groups, frailty was associated with risk of death in patients aged 80 and older, making it a potentially simple tool for doctors to predict outcomes.

Testicular prostheses: effects on sensual confidence

Neslihan Çelik, Mehmet Emin Şenocak, Saniye Ekinci — Wed, 24 Dec 2025 00:00:00 +0300

Objective: Testicular implants were presented to improve impaired physical self-confidence of the patients due to lack of testicles. The evaluation of the pediatric population who underwent gonadectomies with or without testicular prostheses placement has not been sufficient so far regarding body image perception, psycho-social interactions with their peers, male friends, and intimate partners through distinctive functional stages in their lifespans. With this study, we aimed to reveal and analyze the experiences of our patients with testicular implants in terms of self-esteem, concerns and complaints during their social and sexual interactions across the passage from childhood to adulthood.

Materials and Methods: The medical records of the pediatric patients who underwent testicular prostheses insertion were examined retrospectively. The questionnaire titled “The Physical and Emotional Evaluation of Testicular Prosthesis Implanted Patients” was sent to each patient and completed surveys were received by post.

Results: Eleven pediatric patients received 18 testicular prostheses. The median age of the patients at time of the procedures was 17 years old. Eight of the patients accepted to participate the study and completed the questionnaire. All patients agreed that chance of providing the normal appearance of scrotum was important. Four patients found their prostheses improper compared to normal ones. Two patients expressed discomfort during their sexual experiences which resulted in shame in one and no effect in the other patient.

Conclusions: Emotional status of the children with testicular prostheses needs to be studied separately and in a more detailed way according to their different developmental stages. The necessary support that would be given by child and adolescent psychiatrists before and after the implantation may improve the psycho-social status of the patients. The patients and their families should be informed properly about the advantages and probable early and late psycho-social consequences of the implants.

Age, fracture severity, injury mechanisms and concomitant injuries predict surgical intervention in pediatric proximal humerus fractures

Wed, 24 Dec 2025 00:00:00 +0300

Objective: Proximal humerus fractures (PHFs) in children often heal well with conservative treatment due to the region’s high remodeling potential. However, the decision to operate becomes more nuanced in older children or those with severe fracture displacement or high-energy trauma. This study aimed to identify factors associated with operative management of pediatric PHFs.

Materials and Methods: We retrospectively reviewed 41 pediatric patients (aged 6–16 years) with PHFs treated between 2014 and 2024. Patient demographics, Neer-Horowitz classification, injury mechanisms, and presence of concomitant injuries were analyzed. Injury mechanisms were categorized as low-energy or high-energy. Outcomes were assessed using the Pediatric/Adolescent Shoulder Survey (PASS) at final follow-up. Multivariate logistic regression was used to identify independent predictors of surgical treatment.

Results: Of the 41 patients, 19 (46.3%) underwent surgical fixation, while 22 (53.7%) were treated nonoperatively. Patients in the operative group were older (mean 13.2 vs. 10.7 years, p < 0.001) and more likely to have Neer-Horowitz Grade III or IV fractures (89.5% vs. 40.0%, p < 0.001). High-energy trauma (94.7% vs. 59.1%, p = 0.003) and concomitant injuries (52.6% vs. 27.3%, p = 0.001) were significantly more frequent in the surgical group. On multivariate analysis, independent predictors of surgery included older age (OR 1.49, p = 0.018), Grade III/IV fractures (OR 5.41, p = 0.015), high-energy trauma (OR 4.57, p = 0.040), and concomitant fractures (OR 5.13, p = 0.042). At final follow-up, there was no significant difference in PASS scores between groups (operative: 87.8, nonoperative: 88.9; p = 0.68).

Conclusion: Age, fracture severity, high-energy trauma, and concomitant injuries are significant predictors of surgical intervention in pediatric PHFs. However, both surgical and nonoperative treatments yielded excellent functional outcomes, highlighting the importance of individualized treatment strategy.

Omentopexy as a novel adjunct to detorsion in ovarian torsion: experimental evidence

Gül Şalcı, Zuhal Akçören, Saniye Ekinci — Wed, 24 Dec 2025 00:00:00 +0300

Objective: In the treatment of ovarian torsion, the primary goal is to preserve the ovary through detorsion, even when it appears blue-black. However, no routinely applied method currently exists to prevent ischemia-reperfusion (I/R ) injury that occurs after detorsion. The aim of this study is to evaluate the effect of wrapping the detorsioned ovary with omentum in preventing I/R associated tissue damage

Materials and Methods: Fifteen Sprague–Dawley rats were randomly assigned to three groups (n = 5 each). In the sham group, laparotomy was performed, and the abdomen was closed without further intervention. In the control group, the left ovary was rotated 720° clockwise and fixed to the anterior abdominal wall, followed by omentectomy. After 24 hours, laparotomy was repeated and the ovary was detorsioned. In the experiment group, the left ovary was rotated 720° clockwise and fixed to the anterior abdominal wall. After 24 hours, laparotomy was repeated, the ovary was detorsioned, and then wrapped in omentum. Twenty-one days after the first surgery, oophorectomy was performed in all groups. Ovarian tissues were histopathologically examined for congestion, interstitial edema, neutrophilic infiltration, and necrosis, and overall tissue damage scores were calculated.

Results: There was no significant difference between the sham and experiment groups regarding overall tissue damage (p = 0.171). However, the control group had significantly higher tissue damage compared to the sham group (p = 0.001). Necrosis was observed in two ovaries of the control group, whereas no necrosis was seen in the sham or experimental groups. Viable follicles were detected in only two rats in the control group, while all rats had viable follicles in the sham and experiment groups.

Conclusion: Omentopexy was found to be effective in tissue healing. Wrapping the ovary with omentum after detorsion may help preserve ovarian function and maintain follicular viability.

Presentation and clinical outcome of adolescents with Graves’ disease

Yağmur Ünsal, Nalan Özaltın, Ayşe Derya Buluş — Wed, 24 Dec 2025 00:00:00 +0300

Background: Only a limited number of studies have investigated the characteristics of pediatric Graves’ disease (GD). These studies include limited number of participants with varying treatment protocols, definition of remission, and follow-up duration.

Objective: This study aimed to determine the clinical characteristics, remission and relapse rates of adolescents with GD, focusing on potential predictors of remission at diagnosis in adolescents receiving antithyroid drugs (ATD).

Methods: Clinical, laboratory, and radiologic features of 19 patients (F/M:13/6) under 18 years of age, who were followed for GD from 2013 to 2025 at our hospital were retrospectively assessed. Remission was defined as sustained euthyroid state without relapse for at least 12 months after discontinuing ATD.

Results: Patients were diagnosed with GD at a median age of 15 years (IQR: 11.6-15.9). 7 (36.8%) presented with palpitation while 3 (15.8%) presented with weight loss. Tachycardia was observed in 9 (47.4%) and hypertension in 1 (5.3%). Goiter was detected in 13 (68.4%) and ophthalmopathy in 8 (42.1%). Thyroid ultrasonography revealed goiter (6.6 SDS, IQR: 3.6-10.3). 18 (94.7%) of patients had findings consistent with thyroiditis and 4 (21.1%) had thyroid nodules.

Five patients were solely treated with methimazole (MMI) while 14 received both MMI and a β-blocker. Median initial MMI dose was 0.3 mg/kg/day (0.2–0.4). Median follow-up time was 13.0 months (4.5–96.0). MMI was discontinued after a median of 38 months (20–96) at a median dose of 0.02 mg/kg/day (range, 0.02–0.03) in 8 (42.1%) of patients. GD (or thyrotoxicosis) was relapsed in 5 (62.5%) of pateints after a median of 4 months (3–22). Remission was achieved in 3 (15.7%). It was observed that patients with higher thyroid volume SDS at diagnosis tended to have a higher relapse rate. Definitive treatment methods, including radioiodine ablation (n=2) and total thyroidectomy (n=3), were performed in 26.3%, and papillary thyroid carcinoma was detected in one.

Conclusion: ATD is an effective treatment option in adolescents with GD. Thyroid volume at diagnosis may serve as a potential predictor of remission hence further studies are needed to confirm this observation. It should also be noted that thyroid nodules in children with GD may be associated with papillary thyroid carcinoma and therefore thyroid nodules warrant careful evaluation.

Predictors of myeloproliferative neoplasm in non-cirrhotic portal vein thrombosis: a comparative analysis with hereditary thrombophilia-related cases

Yusuf Samir Hasanlı, Yusuf Bayraktar — Wed, 24 Dec 2025 00:00:00 +0300

Objective: Non-cirrhotic portal vein thrombosis (PVT) is rare in patients without cirrhosis or intra-abdominal malignancy, commonly associated with thrombophilia or myeloproliferative neoplasms (MPNs). Comparative studies on clinical and laboratory features of MPN- versus thrombophilia-related PVT are limited. This study aimed to examine etiological differences and identify parameters that may aid differential diagnosis.

Materials and Methods: In this retrospective cross-sectional study, 73 adult patients with non-cirrhotic PVT due to MPNs or hereditary thrombophilia were included. Clinical, laboratory, imaging, and endoscopic data were collected from records. Continuous variables were analyzed using t-test or Mann-Whitney U test, and categorical variables using chi-square or Fisher’s exact test. Multivariable logistic regression and ROC analysis identified predictors of MPN-associated PVT.

Results: Platelet counts were significantly higher in the MPN group than in the thrombophilia group (p<0.001). Hepatomegaly and portal double ductopathy (PDD) were more frequent in MPN, with the difference for PDD being significant (p=0.032). Splenic/superior mesenteric vein involvement occurred in 41.7% versus 26.5%, and portal vein cavernous transformation (PVCT) in 79.2% versus 57.1%; these differences were not statistically significant. In multivariable analysis, platelet count was the only independent predictor of MPN (p=0.003). ROC analysis showed an AUC of 0.79, with a cutoff ≥161×10³/µL yielding 85% sensitivity and 61% specificity.

Conclusion: Platelet count is a strong, independent marker for distinguishing MPN-related non-cirrhotic PVT. Although PDD and PVCT are more frequent in MPN, platelet level offers a rapid, practical parameter for differential diagnosis. These findings provide valuable guidance for clinical practice and patient selection for advanced genetic testing.

Challenging cervical spondylodiscitis: Is interventional treatment superior to conservative management?

Çiğdem Yalçın, Ali Kutta Çelik, Oğuz Kağan Demirtaş — Wed, 24 Dec 2025 00:00:00 +0300

Objective: Cervical spondylodiscitis is a rare spinal infection with limited literature on its management. While antibiotic therapy is critical for infection control, addressing residual pain and functional deficits remains challenging. This retrospective observational study evaluated the efficacy and safety of interventional management in patients with spontaneous cervical spondylodiscitis.

Materials and Methods: Patients were treated with either medical therapy or interventional pain management after completing antibiotic therapy and physical rehabilitation. The outcomes of interventional pain management (Group 1, n=9 ) and medical therapy (Group 2, n= 12) in improving pain, functional capacity, and quality of life in patients with cervical spondylodiscitis were compared. Treatment responses were assessed using Numerical Rating Scale (NRS), Neck Disability Index (NDI), and SF-12 scores before and after therapy. Changes in cervical lordosis angles were also monitored.

Results: Of the 35 screened patients, 21 met the inclusion criteria, with 12 opting for medical therapy and 9 for interventional treatment. Both groups demonstrated significant improvements in NRS, NDI, and SF-12 scores after treatment (p<0.05). Interventional therapy resulted in superior NRS and NDI outcomes compared to medical therapy (NRS: 1.11 vs. 2.33, p=0.017; NDI improvement: 76% vs. 56.66%, p=0.0009). No significant changes in cervical lordosis angles were observed in either group.

Conclusion: Interventional pain management provides superior pain relief and functional improvement compared to medical therapy alone in patients with cervical spondylodiscitis. Conservative management is effective in appropriately selected cases, offering an alternative to surgery for those without instability or neurological deficits.