Behçet’s Syndrome (BS) is a multisystem vasculitis with various clinical manifestations. Pathogenesis is unclear, but studies have shown genetic factors, innate immunity and autoinflammation to have an important role in the disease course. Diversity in the microbial community of gut microbiota may significantly contribute to the activation of the innate immune system. The clinical features of BS present themselves in clusters and each cluster may be a consequence of different disease mechanisms. For this reason we aimed to investigate the gut microbiota of BS patients with uveitis. In addition to healthy controls, we have aimed to compare the gut microbiota of BS with that of Familial Mediterranean Fever (FMF) and Crohn’s Disease (CD) as both diseases have innate and autoinflammatory features in their pathogenesis. Seven patients with BS, 12 patients with FMF, 9 patients with CD and 16 healthy controls (HC) were included in the study. Total genomic DNAs were isolated from fecal samples of the patients. Partial 16S rRNA gene was sequenced using the PGM Ion Torrent (Thermo Fisher Scientific, Waltham, MA, USA) for microbiota analysis. Statistical analysis showed that significant differences were detected on the microbial community of four groups. Succinivibrionaceae is dominant and the signature family, whereas Bacteroides was absent in BS patients.

Dieulafoy lesion should be considered in massive gastrointestinal bleeding that may be difficult to localize. If the endoscopic and angiographic approaches fail, surgery must be considered according to the patient's clinical condition within an appropriate time. Although mostly seen in the stomach of old male patients with co-morbidities, here we presented a Dieulafoy lesion in the jejunum of a 21-year-old female patient without any significant comorbidity. After endoscopic and angiographic attempts, surgical resection with the help of intraoperative endoscopy was performed. It was shown that perioperative endoscopy may reveal the localization of jejunal bleedings and may guide the definitive treatment.

The Medical Bulletin of Sisli Etfal Hospital

Background: Prophylactic central lymph node dissection (CLND) in papillary thyroid carcinoma (PTC) is still controversial. This study aimed to analyze the factors related to the patient and tumor characteristics affecting central lymph node metastasis (CLNM) in PTC patients and to evaluate the contribution of the results to shaping the surgical treatment algorithm. Methods: Two hundred and fifty-five PTC patients who underwent total thyroidectomy and CLND were evaluated retrospectively. Histopathology reports were examined to reveal tumor characteristics. The CLNM ratio and the relationship between CLNM with clinicopathological and demographic characteristics were analyzed. Results: The incidence of CLNM was 54.9% (95 CI%: 49−60.8). Male gender (P=0.027), age<45 years (P=0.016), tumor size≥9.5 mm (P<0.001), lymphovascular invasion (P<0001) and extracapsular invasion (P=0.007) were factors that increased the risk of metastasis. The follicular variant decreased the risk (P=0.010). There was no relationship between CLNM and focality (P=0.054). A low-to-moderate correlation was found between tumor diameter and the metastatic lymph node (MLN) number/total lymph node number ratio (r=0.396, P<0.001). Conclusion: A selective prophylactic CLND strategy can be applied in cN0 patients. As the tumor diameter increases in PTC, both the risk of CLNM and the number of MLN increase. Lymphovascular and extracapsular invasion are other factors that increase the risk. The follicular variant is associated with a lower risk of CLNM. Male patients who are under the age of 45 and have a tumor diameter of 9.5 mm or more are definite candidates for prophylactic CLND.

Idiopathic granulomatous mastitis (IGM) is a benign, chronic inflammatory lesion of the breast. Immunoglobulin G4 (IgG4) associated disease is rare in the breast. In our study, we aimed to evaluate the efficacy of steroid treatment on IgG4 levels in tissue in patients diagnosed with IGM. Between 2008 and 2017, 55 patients diagnosed with IGM in our clinic were included in the study. Demographic, clinical, microbiologic and histopathologic characteristics, treatment modality and recovery time were evaluated retrospectively. Patients were divided into 3 groups according to tissue IgG4 levels: negative (Group I), infrequently and slightly positive (Group II), and highly positive (Group III). Group I patients had a complete response rate of 77.8%. In the rest of the patients (22.2%), insufficient response was detected from the beginning of the treatment. In Group II, the response rate was 91.3% and the permanent success rate after treatment was 87.0%. Although group III patients had a complete response at the beginning (95.65%), they relapsed in a short period of time (26.1%) after discontinuation of steroid treatment. At least one steroid-related side effect was observed in 47 (85.8%) patients in all groups. There is no consensus on the dose and duration of immunosuppressive treatment in IGM. In this study, responses to steroid treatment according to IgG4 concentration in pathologic breast tissue and recurrences after the end of treatment were determined. We think that high IgG4 concentration in the tissue is associated with recurrence and other immunosuppressive drugs should be added as maintenance after steroid treatment.