Acute interstitial nephritis is characterized by inflammatory infiltration and edema in renal insterstitium and is associated with acute failure in renal functions. The most frequent cause of AIN is drug use which is responsible approximately 60-70% of AIN cases and antibiotics are the leading among almost all kinds of medication classes. Hypersensitiviy reactions to a certain drug or any metabolites of a drug play a major role in AIN pathogenesis. Regardless from etiologic factor, most of AIN patients refer to hospital with non-specific symptoms (nausea, vomiting, fatique etc.) or acute failure findings of renal functions. Renal biopsy is the gold standard in diagnosis of AIN, revealing classical pathologic sign of inflammatory infiltration in renal interstitium. When diagnosis of AIN is certain, suspected drug must be discontinued instantly and oral or intravenous steroid therapy must be started immediately. Steroid therapy has a positive correlation with rapid and complete remission, but total recovery may not be achieved in all cases. In this review, we tried to look over this illness which needs more attention in clinical practice.

Secondary hyperparathyroidism (SHPT) is a secondary adaptive response to maintain calcium homeostasis and caused by any condition associated with chronically reduced serum calcium (Ca) levels, and low serum Ca levels lead to compensatory overactivity of the parathyroid gland. It is a common complication of chronic kidney disease (CKD) and is part of the CKD-mineral bone disorder (CKD-MBD). SHPT is associated with increased risk of morbidity and mortality; thus, SHPT control is recommended. SHPT develops in patients with CKD due to a variety of mechanisms including increased phosphorus and fibroblast growth factor 23 (FGF23), and decreased calcium and 1.25 dihydroxyvitamin D levels. Patients present with various bone disorders, cardiovascular disease, and certain patterns of biochemical abnormalities. The diagnosis of patients with SHPT require a combination of clinical investigation and laboratory findings. Many patients with this disease are asymptomatic and only have abnormalities detectable by laboratory and radiologic studies. Laboratory tests may reveal hypocalcemia, normocalcemia or hypercalcemia and hyperphosphatemia. In addition, patients wirh SHPT have extremely elevated parathyroid hormone (PTH) levels, elevated or normal alkaline phosphatase (ALP) levels and decereased vitamin D (vit D) levels. Patients also can become symptomatic. Untreated SHPT leads to progressive bone disease, osteitis fibrosa cystic, and soft tissue calcifications. Patients may experience intractable bone pain, fractures, pruritis, soft tissue or vascular calcifications, calciphylaxis, erythropoietin resistant anemia, and mental status changes. Medical treatment consists of controlling hyperphosphatemia, vit D analogs and Ca administration, and calcimimetic agents. The majority of patients with SHPT can be managed by medical treatment. Despite improvements in medical therapy, it does not always provide control of the SHPT. Some patients require surgical treatment. The surgical indications include PTH levels >500-800 pg/ml associated with hypercalcemia and/or hyperphosphatemia despite medical therapy. Other indications include calciphylaxis, fractures, bone pain or pruritis. Pre-operative imaging is only occasionally helpful except in re-operative parathyroidectomy (PTX). Operative approaches include subtotal PTX, total PTX (TPTX) with or without autotransplantation, and possible thymectomy. Each approach has its own proponents, advantages and disadvantages which are discussed. Hypocalcemia is the most common postoperative complication requiring aggressive calcium administration. Benefits of surgical treatment may include improved survival, bone mineral density and alleviation of symptoms.

Objective: The purpose of the study is to define the skin findings of gastroenterology inpatient clinic patients.
Material and Method: Patients who were under treatment in the Gastroenterology Department of our hospital between November 2012-April 2013were included in the study. Patients’ age, gender and disease information were recorded. All patients were examined by the same dermatologist.
Results: A total of 89 patients (37 (41.5%) female, 52 (58.4%) male) were included in the study. The mean age of the patients was 52.79 (20-85) years. The patients were followed up with the diagnosis of different gastrointestinal diseases, including inflammatory bowel diseases (33.7%), liver cirrhosis (33.7%), other hepatobiliary diseases (12.3%), malignancies (10.1%) and pancreatitis (8.9%). Dermatologic examination revealed that 36 patients (40.4%) had pigmentation disorders, 32 patients (35.9%) had xerosis cutis, 31 patients (34.8%) had bacterial and fungal infections and 21 (23.5%) had various nail changes. As spesific skin findings; 1 (1.1%) patient with ulcerative colitis had psoriasis vulgaris, 1 (1.1%) patient with Crohn’s disease had vitiligo, 1 (1.1%) patient with Kaposi’s sarcoma had the nodules of the Kaposi’s sarcoma in oral mucosa, 1 (1.1%) patient with liver cirrhosis had palmar erythema and 1 (1.1%) tuberculous peritonitis had erythema nodosum.
Conclusion: In our study we defined a small number of spesific skin findings of gastrointestinal diseases.

Objective: We aimed to evaluate the patients of which were diagnosed with digital subtraction angiography (DSA) and were treated with endovasular emolisation by using different agents of arterial bleeding originating from upper gastrointestinal sytem (GIS), lower GIS, pulmonary system or trauma.
Material and Method: Patients who have been sent to our interventional radiology department under emergency conditions for embolization between July 2012 and April 2016 were retrospectively evaluated. For this purpose, cases in which contrast media extravasation and/or pseudo aneurysm was diagnosed with DSA as the focus of bleeding on upper GIS, lower GIS, pulmonary system or trauma were included. Success of the treatment was assessed by the absence of contrast media extravasation and/or pseudoaneurysm after the procedure.
Results: Eleven upper GIS, 5 lower GIS, 6 pulmonary and 7 traumatic (totally 29) bleeding foci were embolized successfully. Coil was used in all of 11 patients with upper GIS, 3 patients with lower GIS, 3 patients with pulmonary and 5 patients with traumatic bleeding. Coil and glue was used in 1 and acrylic microparticles in 1 patient with lower GIS bleeding. Polyvinyl alcohol (PVA) was used in 1, coil and PVA in 1 and acrylic microparticles in 1 patient with pulmonary bleeding. Glue was used in 2 patients with traumatic bleeding. No contrast media extravasation and/or pseudoaneurysm were observed after the procedure.
Conclusion: Technical success rates of arterial embolization which is performed by experienced interventional radiologists increase with advances in microcatheter technology and choosing different embolic agents.

Objective: The treatment of femoral diaphyseal fractures in children 6 to 12 years of age has changed substantially over the last two decades and continues to evolve. Although external fixation and sub muscular plating have been extensively used in the management of paediatric femur fractures, there are few studies which have compared the results of external fixation and submuscular bridge plating in paediatric closed unstable spiral femoral diaphyseal fractures.
Patients and Method: Two groups of patients treated by external fixator or submuscular plating due to femoral diaphyseal spiral and comminuted fractures were included in our study. Twenty patients comprised the external fixation group and 26 patients the submuscular bridge plating group. The patients were evaluated for mechanism of injury, knee ROM, length of hospital stay, clinical and radiological findings and complications. The average follow-up period was 2 (range: 1.5 to 4) years.
Results: Age of the patients ranged from 6 to 11 (average: 7.45) years in the external fixator group and from 7 to 12 (average: 9.08) years in the submuscular plating group. In the external fixator group, the fixator was removed at an average of 12.2 weeks. In the submuscular plating group, radiographic union was detected at an average time of 10 weeks. Pin site infection was common in the external fixator group. Patients were given knee ROM rehabilitation for knee contracture. No refracture was observed in the external fixator and submuscular plating groups.
Conclusion: The main point to consider in external fixator use in pediatric femur fractures is refractor after fixator removal, which is mostly seen in transverse and open fractures. Use of the external fixator in spiral fractures and removing the fixator following bone healing in four cortices may prevent refractor complication. It is the surgeon’s choice to decide between the two treatment modalities to operate on the femur fracture. Although we found similar results between external fixator and plate in pediatric femur shaft fractures; we think large population based studies are needed in order to comparison.

Objective: Non-union accompanied by infection requires both the treatment of infection and stabilisation of the fracture. This study examined the efficacy of a fixation technique using antibiotic impregnated polymethylmethacrylate (PMMA) cement-coated intramedullary nail in patients with infected pseudarthrosis of the femur or tibia.
Material and Methods: Fourteen patients with Cierny-Mader stage 4 infected non-union of the femur or tibia were included. Patients were treated with local debridement, antibiotic containing PMMA cement-coated intramedullary nail application and systemic antibiotics. They were followed-up for union and recovery of infection.
Results: Femoral and tibial pseudarthrosis were present in 3 and 11 patients, respectively. Eleven patients had hypertrophic and three patients had atrophic infected non-union. The mean duration of follow-up was 24.7 months (range: 8-37 months). During follow-up, infection improved in 85.7% of the cases (12 patients). Union was achieved in 10 (71.4%) patients during follow-up. Ten over 11 patients (90.9%) with hypertrophic pseudarthrosis achieved union. On the other hand, none of the patients with atrophic pseudarthrosis achieved union.
Conclusion: Considering the high-dose local antibiotic effect and the advantage of stabilisation with intramedullary nail, antibiotic impregnated PMMA cement-coated locked intramedullary nail application may be recommended in the treatment of hypertrophic pseudarthrosis. However, regarding the treatment of atrophic pseudarthrosis, it seems to be effective for the treatment of infection but ineffective for bone
union. Larger trials are warranted.

Objective: To identify the factors associated with pulmonary metastasis, such as lymph node positivity, tumour location and histological differentiation in patients with laryngeal squamous cell carcinoma (scc).
Material and Methods: This study is designed as retrospective cohort study. Data from 263 patients diagnosed with laryngeal scc were reviewed retrospectively. Pulmonary metastasis was observed in 39 of these patients.
Results: The transglottic tumors had the highest pulmonary metastasis rate (%50). The pulmonary metastasis rate was significantly lower in patients with glottic tumors than those with tumors in other regions (p= 0.003) The pulmonary metastasis rate was higher in lymph node-positive patients than in lymph node-negative patients. Pulmonary metastasis rate was significantly higher among patients with N2-N3 stage lymph nodes compared to those with N1 stage lymph nodes. Pulmonary metastasis rate is also increased significantly among patients with histologically poorly differentiated tumours (p= 0.001).
Conclusion: The laryngeal cancer patients with positive lymph node, with transglottic tumour and with poorly/moderately differentiated tumour should be monitored carefully and followed up closely for possible pulmonary metastasis.

Objective: In this study, we aimed to examine the prevalence and relationship of celiac disease (CD) in children with cerebral calcifications (CC).
Material and Methods: Children with cerebral calcifications were screened for celiac disease using the anti-tissue transglutaminase IgA antibody.
Results: A total of 129 children with CC (75 boys, 54 girls; age: 6 months to 16 years) were evaluated. Control group consisted of 223 healthy children. The prevalence of CD was significantly higher in patients with CC than control subjects (p=0.01). In three patients pathological examination of duodenal biopsy resulted as total villous atrophy. All three patients had both iron deficiency anemia and short stature problem. Although, no calcification in occipital lobe was detected in computed tomography of these three patients, there were nonspecific calcifications in choroid plexus and pineal gland localizations.
Conclusion: According to results from our study, prevalence of celiac disease being low in patients with intracerebral calcifications suggested that there is not a strong correlation between development of calcification and celiac disease. It suggested that occurrence of calcification in choroid plexus and/ or pineal gland might be related to celiac disease.

Objective: Amyand’s hernia is described as the presence of vemiform appendix in the inguinal hernia sac and this condition is mostly incidental. The aim of this retrospective analysis was to evaluate the role of appendectomy and the mesh repair in the patients with Amyand’s hernia.
Material and Methods: The clinical and laboratory findings, and treatment modalities of 12 patients with Amyand’s hernia among 6630 inguinal hernia patients who underwent surgery between January 2000 and May 2015, were retrospectively recorded. Moloney darn repair was performed in the patients who had inflamed appendix whereas Lichtenstein repair was performed in the patients who had non-inflamed appendix.
Results: All of the patients were male with a mean age of 48.9 years (range 28-67 years). The most common symptoms and pain in the patients were swelling of the right inguinal area and pain. Three patients underwent emergency surgery due to incarcerated right inguinal hernia while remaining nine patients underwent elective surgical repair. The diagnosis of Amyand’s hernia was made during hernia surgery and routine appendectomy was performed in all patients. The only complication was the wound infection which was observed in the patient with perforated appendicitis (8.3%). The mean follow-up period was 80.4 months (range: 8-180 months) and there were no recurrent cases.
Conclusion: The appendectomy can be performed safely in the patients with Amnyand’s hernia. The repair for inguinal hernia may provide satisfactory results in the absence of inflammation.

Objective: This study was performed to evaluate the demographical features, risk factors, responsible microorganisms, antibiotic resistance of newborns with sepsis in a neonatal intensive care unit (NICU).
Material and Method: A total of 121 patients who were diagnosed with sepsis between May 2014 and May 2015 in our NICU were evaluated retrospectively. The cases were investigated in terms of gender, birth weight, gestational age, risk factors, clinical and laboratory findings, cerebrospinal fluid (CSF) analysis and biochemistry, cultures of blood, urine and CSF, distribution of microorganisms, and antibiotic resistance.
Results: A total of 431 patients were admitted to NICU during the study period. Of these, 121 (28%) patients were diagnosed as neonatal sepsis. Early and late-onset sepsis were diagnosed in 85 (70.3%) and 36 (29.7%) cases respectively, and 24 (19.8%) cases were premature. At least one risk factor was identified in 60% of patients with sepsis. Bacterial growth was detected in 39 (32%) of total cultures. The most isolated microorganisms were S.aureus (30.2%), K.pneumoniae (25.5%) and S.epidermidis (16.2%).
Conclusions: The changing spectrum of etiology and increasing drug resistance in neonatal sepsis may pose a serious problem. Therefore, the risk factors, responsible microorganisms, and antibiotic resistance in neonatal sepsis must be determined for every NICU to start appropriate empirical antimicrobial therapy.

Objective: Abdominal wall endometriosis is a rare subtype of extra-pelvic endometriosis; and the patients present with a painful abdominal mass that is particularly aggravated by menstruation. Ultrasound and MRI are the recommended diagnostic tools for the evaluation of the mass lesions. Biopsy is performed when calcifications in the granulation tissue cannot be differentiated from chronic blood products. Susceptibility weighted imaging (SWI) is a relatively new MR technique where the image contrast is mainly based on magnetic susceptibility differences. SWI has higher sensitivity to blood products compared to conventional MRI sequences. Although it has been mostly used in neuroimaging studies, recent studies have shown that it provides additional diagnostic information abdominal imaging. In this article, we aim to demonstrate the diagnostic utility of SWI for lesions of abdominal wall endometriosis.
Case: A 29-year-old woman with a history of Caesarean-section delivery five years ago presented with a cyclic pain and slowly growing abdominal mass located superior to the Caesarean incision scar on the left side of the midline. A heterogeneous hypoechoic solid mass was detected ultrasonographically underneath the fascia of rectus muscle. On MRI, a solid heterogeneous enhancing lesion located anterior to the rectus muscle was seen in which blood products and calcifications could not be differentiated by their signal intensities. On SWI sequence, signal voids within the lesion on magnitude images were hyper intense on phase images and this excluded calcifications endorsing endometriosis as diagnosis.
Conclusion: SWI imaging with its high sensitivity to blood products, contributes to the diagnosis of abdominal wall endometriosis by depicting different phases of hemorrhage during menstruation and non-menstruating days. Another advantage of SWI is the ability to differentiate between blood products and calcification which provides additional value to improve diagnostic ability of pelvic MRI.

Objective: Inflammatory myofibroblastic tumor (IMT) is a rare tumor. The etiology and biological behaviour is controversial. It could be seen in many different anatomical sites, however it is commonly seen in the lungs, mesentery, genitourinary tract and retroperitoneum. Uterine round ligament is a very rare location for IMT.
Case: We report the morphological, immunohistochemical and clinical features of an IMT which is located in the retroperitoneum / uterine round ligament of a young woman in this paper.
Conclusion: It is essential to differentiate IMT from benign and malignant mimickers for providing an appropriate therapy and follow-up.

Ovarian pregnancy is a rare form of ectopic pregnancy but it is the most common type of nontubal ectopic pregnancy. Many times it is operated with a misdiagnosis of ruptured tubal ectopic pregnancy or hemorrhagic corpus luteum. The high-resolution transvaginal ultrasonography is a valuable tool for diagnosis of ectopic pregnancy but ovarian pregnancy still remains a diagnostic problem and a continuous challenge to the gynecologist. The correct diagnosis is made at the time of surgery and confirmation is by histopathological report. The case here presented was managed laparoscopically, and the diagnosis was based on surgical and histopathological findings.

Objective: Food allergy is the most common cause of anaphylaxis in children and recent studies suggest that the prevalence of food allergies has increased. Among foods, fruits are rarely the cause of anaphylaxis. Although banana allergy has been identified among the causes anaphylaxis in adults, the incidence of banana anaphylaxis reported in children is very rare. In this case report a patient who developed anaphylaxis after banana ingestion was discussed.
Case: A 4-year-old boy male patient admitted with widespread itching, swelling of the eyelids, urticarial rash in body following exposure to banana. In oral provocation test performed in order to confirm the diagnosis made with banana, urticarial papules were detected. Urticaria, swelling of the eyelids and wheezing complaints occured in the body in 10 minutes after banana was given. Bilateral rhonchus was presented in auscultation and the blood pressure of the patient measured was normal. The patient was diagnosed with anaphylaxis and 0.01 mg / kg IM epinephrine nebuliser with short-acting beta 2 agonists and antihistaminic treatment were given. The patient who recovered during follow-up was discharged with antihistaminics and 3-day oral methylprednisolone therapy. Recommendations were made to patient and adrenaline auto-injector was prescribed and its use was described.
Conclusion: Although rare, children may develop anaphylaxis with bananas. Therefore, oral provocations for diagnostic purposes should be performed by experienced centers and necessary precautions should be taken against the reactions that may occur.