Makale Arama

To evaluate the five year survival outcomes of breast cancer patients treated at our department and to assess the prognostic factors that affect survival parameters. All patients underwent our department’s routine procedure for breast cancer. All patients received RT to the breast or chest wall using 3D conformal technique with 2 Gy fraction doses, five days a week with two opposite tangential fields. If necessary, ipsilateral supraclavicular fossa field was added to the treatment field. Anthracycline-based chemotherapy was primarily used, patients with estrogen receptor- positive disease received hormonal therapy and patients with Her-2 receptor-positive disease received trastuzumab. The primary end points of this study were to evaluate the overall survival (OS) and the disease-free survival (DFS) of the patients. The secondary end points of this study were to assess the prognostic factors that affect the survival outcomes. Statistical analysis were carried out using SPSS Statistic program version 13. Between 11.02.2010 and 01.05.2016, 559 patients with breast cancer who had been irradiated postoperatively were included in this retrospective study. 2 and 5 year OS rates were 97% and 84%; 2 and 5 year DFS rates were 97% and 71%, respectively. According to multivariate analysis, ≥70 year, to have triple (-) hormonal status, to have T3-4 disease, to have N2-3 nodal stage and to have locoregional recurrence or distant metastasis were the independent prognostic factors that affect OS. Also, to have N2-3 nodal stage and to have triple (-) hormonal status were independent prognostic factors that affect DFS. Breast cancer is the most common cancer among women. Its incidence has been increasing but mortality has been decreasing in the last 10-15 years. In the light of current treatment modalities, to know the prognostic factors that affect survival outcomes is very important for both choosing the most appropriate treatment modality and the prediciton of treatment response.

The aim of this study is to evaluate our experience of patients with their clinical presentations and treatment approaches followed and underwent atrial septal defect surgery in Cardiovascular Surgery Department. Between 2010-2013, 28 patients (20 females, 8 males) mean age 58 months (range 5 month to 14 year-old) who underwent atrial septal defect surgery were included in the study retrospectively. In two patients, there were sinus venosus atrial septal defects with partially abnormal pulmonary venous drainage. In one patient, there was primum atrial septal defect. 25 patients had secundum atrial septal defects. Mean pulmonary artery pressure was 18.6 mmHg(8- 39 mmHg) and mean Qp/Qs ratio was 2.2 (1.4-4.5) in patients who underwent cardiac catheterization. Atrial septal defects were closed with synthetical patch in all of the patients. The mean of intensive care unit hospitalization was 3.2 (1-12) days. The mean of cardiovascular surgery clinical hospitalization was 4.1 (1-17) days. The mean discharge time was 7.4 (4-29) days. No mortality was observed and no hemodinamically significant residual was observed. The average postoperative follow-up period of patients was 24 months (1 month-3.5 years). Surgically closure of atrial septal defect, one of the most common forms of congenital heart disease, is performed safely in many medical center with low mortality and complication rates. If atrial septal defect remains untreated, significant complications such as cardiac failure, pulmonary vascular obstructive disease and atrial arrhythmias may occur.

Abstract:

Objective: Our objective in this study was to present our four years of experience in laparoscopic surgery for urinary system accompanied by literature.

Material and Methods: Between January 2014 and October 2018, laparoscopic surgical intervention was made on urinary system for 97 patients in our clinic. 54 patients had right and 42 patients had left laparoscopic surgical intervention and 1 patient had radical prostatectomy. Patients were retrospectively examined for operation duration, average blood loss, intraoperative and postoperative complications, hospitalization duration and drain installation time after separating into two groups as right and left.

Results.

Average age of the patients was 44(16-67). Male/Female rate was 54/43. Apart from radical prostatectomy, 54 patients had right and 42 patients had left kidney laparoscopic surgical intervention. Average operation duration was 145 (40-210) minutes, average drain removal time was 3.1 (1-10) days, hospitalization duration was 3.4 (1-14) days and bleeding amount was 150(20-500) cc in all interventions. Lengthened urinary drainage was observed from the drain in one patient who had pyelolithotomy and one patient who had radical prostatectomy. When all interventions were considered, the average complication ratio was found 5.1%. No differences were observed in the parameters compared among right and left laparoscopic surgery interventions.

 

Conclusion: For a surgeon in the first learning phase of laparoscopy, choosing relatively simpler procedures in the beginning but passing to more complex operations without much delay may quickly shorten the learning phase. Through the selection of suitable patients and adequate equipment, laparoscopic surgery can also be applied safely in peripheral centers.

Nowadays, interventional treatment is one of the indispensable methods of treatment for pediatric cardiology centers. The results of interventional treatment of our center were presented within two years. The results of 40 patients who underwent interventional procedure in our center between February 2011-November 2012 were retrospectively reviewed. Interventional therapy was applied to 40 patients. Fifty-five percent (n:22) of these patients were female, 45% (n:18) were male. Their age is from 10 days to 15 years, their weight is between 3.7 and 60 kg. Pulmonary balloon valvuloplasty was performed to nine patients with valvular pulmonary stenosis. Angioplasty was performed to 10 patients with the coarctation of aorta. Transcatheter ASD closure was performed to 12 patients with atrial septal defect. The five patients’ ductus with a wide range closed by transcatheter. Mitral balloon valvuloplasty was performed to 14-year-old patient with mitral stenosis. In our hospital,angiography was performed since June 2010 until November 2012, with total of 155 patients with angio process and interventional procedure was applied to 40 of these patients (25.8%). At first,diagnostic angiography is performed in our angiography unit. Subsequently, interventional procedures were performed such as balloon angioplasty to the coarctation of the aorta and pulmonary balloon valvuloplasty, respectively. Recently, processes that are complicated and requires experience such as transcatheter closure of ASD and PDA, and aortic stent implantation transactions began to be performed in our clinic. Considering the last 6 months, the rate of invasive procedures increased to 50% compared with diagnostic procedures.

Thrombotic thrombocytopenic purpura (TTP) is a rare and fatal disorder characterized with microangiopathic hemolytic anemia, thrombocytopenia, neurological symptoms, fever, and kidney failure. The reason of TTP and optimal treatment method of TTP is still unknown. However, today, therapeutic plasma exchange (plasmapheresis) and / or plasma infusion is considered as the standard treatment method for these patients. In this study, the clinical characteristics and outcome of 18 patients with TTP treated with plasma exchange at the Department of Hematology, Meram Faculty of Medicine, Necmettin Erbakan University, between 2008 and 2011 years were evaluated retrospectively. Among the patients, 6 were male, 12 were females, median age was 39 (21-66), 8 were idiopathic, 7 were postpartum, 1 was post operative periods of prosthetic operation, 1 was pesticide exposure and 1 was NSAII induced TTP. The first admission of patients were evaluated for symptoms and complete blood counts, coagulation tests, BUN (blood urea nitrogen), creatinine, LDH (lactic dehydrogenase) levels were performed. All patients were initially treated with a daily plasma exchange plus steroids, which was continued until the normalization of platelet count and the level of LDH. In this study, a total of 165 plasmapheresis procedures were performed to total 18 cases. Fresh frozen plasma (FFP) was used as fluid of replacement. Of the 18 patients, 15 were discharged with complete remission (n:12) and partial remission (n:3), and 3 had no response and died of progressive neurological fingings and acute renal failure. Untreated TTP has a high mortality that may be as great as 90%. However, the rate of this mortality is dramitacally changed with plasma exchange treatment. As a result, today, plasma exchange is the most effective treatment available for treatment of TTP.

The vascular access path is important in cancer patients who need long-term intravenous treatment. With this partial application port named, long-term intravenous application could be performed, and changes were made in the structure and application of these catheters with the over the years. Between January 2006-August 2010, 235 cancer patients underwent permanent venous port were retrospectively reviewed in our clinic. Patients’ age were ranged from 28-82 (mean 45±3). 132 patients were female, 103 were male. All attempts to port catheter performed under local anesthesia in the operating room, monitoring. The total number of days that remained attached to the port for 235 patients ranged from 11-1997 days (mean 603 days). The clinical use of intravenous port catheters has increased, and the importance of them every day to increase. Especially, in patients’ vascular access inappropriate, these catheters used safely. Installing the port by experts, be careful in Huber needle use, than more 10 cc of injector volume, and the port has been inserted after the evaluation of imaging methods, detection of skin under the best of use of the sterile period, and the use of heparin made by persons experienced with the washing process also will extend the life of the catheter and will improve patient comfort.

Purpose: The aim of this study is the documentation of characteristics of cases diagnosed and followed as cholelithiasis which is quite rare in childhood period. Material and method: Data of 23 cases diagnosed as cholelithiasis in ourclinic between June 1998 and June 2005 were evaluated. Result: Fifteen of cases were female (65.2%) and eight were male (mean age: 8.3±4.7 year). The most important reason of stone formation was hemolytic diseases (43.5%). No underlying reason could be found in 30.4% of cases. About 39% of all cases and 80% of cases with hemolytic diseases (43.5%). No underlying reason could be found in 30.4% of cases. About 39% of all cases and 80% of cases with hemolytic diseases were asymptomatic. Cholecystectomy was performed in nine of 23 cases (39.1%). Multiple stones were detected in 78% of all cases while all patients with hemolytic disease had multiple stones. Stone analysis was not performed in any of patients. Conclusion: Knowledge about cholelithiasis which rarely detected in children is insufficient. Most of cases with hemolytic disease are asymptomatic and gall bladder Stones were detected accidentally. Periodic follow up of these patients is very important. Laparoscopic cholecystectomy must be performed in all symptomatic patients and in patients having Stones larger than 2 cm diameter. Needed significance to stone analysis must be given in our country.

The purpose of this study was to evaluate the fear, vvorry and axieties of patients about anesthesia and surgery preoperatively by using a questionaire, and to measure their anxiety by using visual analogue scale (VAS). Five hundred and thirty six patients (>19 yr of age) were questioned about their worries, fears and request of Infor­ mation by means of a questionaire. The ansvvers were analysed with chi-square and correlation tests and p<0.05 was considered as significant. Fear from surgery was higher in the less educated patients (p<0.05). VVomen feared from anesthesia and surgery more than men (p=0.0001). Men prefered local anesthesia more than vvomen (p=0.00165). Fear and request of Information increased with increased income (p=0.01). VAS scores vvere high­ er in vvomen, illeterate and primary school graduates, and patients vvithout previous surgical or anesthesia expe- rience (p<0.05). No correlation was present betvveen VAS scores and income or increase or decrease of Informa­ tion requests (p>0.05). İt was concluded that not ali but some patients feared of surgery or anesthesia or vvanted Information. Informing these patients on the consequences of anesthesia and surgery may be usefull in alleviating their fears or vvorries. Positive correlation betvveen the results of the questionaire and VAS scores, leads us to con- sider that VAS scores may be usefull for measuring preoperative anxiety.

This study was aimed to evaluate our clinical experience and results of transcatheter closure of patent ductus arteriosus patients in our clinic between June 2011 and November 2013. Atotal of 21 patients (16 female, 5 male) undergoing transcatheter patent ductus arteriosus closure procedure with mean age 5.4 (9 months and-17 years-old) were included in this study retrospectively. Transcatheter patent ductus arteriosus closure procedure was successfully performed in 21 patients (100%) without any complication like device erosion, arrythmia, thrombosis or residual shunt during follow-up. Amplatzer ductal occluder 1 device was used in 11 patients, Amplatzer ductal occluder 2 device was used in 9 patients and MemoPart PDA Occluder device was used in one patient. Percutaneous closure of patent ductus arteriosus defects with occlusive devices is safe and effective procedure with a high success rate and less complications.

The aim of the study was to evaluate the problems and progresses of esophageal atresia (EA) treated in our department for 20 years at a single tertiary center for pediatric surgery. The study used a retrospective chart review of infants diagnosed with EA between 1991 and 2010. Patients were divided into 2 groups as Group I (1991-1998) and Group II (1999-2010) according to the years of diagnosis. All patients were also assessed regarding the prenatal history, delivery method and time, time of admission, diagnostic procedures, time of surgery, surgical techniques, associated anomaly, complications, and mortality rates. Mean weight of the cases was 1960±5.35 gr when they were admitted, 75% of deliveries was performed in hospital and 25% was at home. 85% of the babies was in term and 15% was preterm. Prenatal polyhydramnios story was detected in 55% of babies. Mean admittion time of the cases was 5.9±1.42 days. Almost all the patients admitted to our department had prediagnosis. The associated anomaly rate was 39%. Patients in Group I were operated immediately, and the ones in Group II were operated in elective conditions after being stabilized. As surgical technique, primary repair and end-to-end anastomosis were carried out in most of the cases. Most common intraoperative complication was iatrogenic pleural opening. The most common early period postoperative complications were pneumonia and atelectesia; late complication was gastroesophageal reflux. Overall mortality was 56% and this rate was 76% for Group 1 and 45% for Group 2. Respiratory insufficiency, pneumonia, and anastomotic leakage were the most common causes of mortality. This retrospective study performed in our department showed that corrected intensive care conditions and the developments in surgical techniques decreased preoperative and postoperative complications and mortality rates in esophageal atresia, which was one of the most anomalies seen in newborns.

Aim: Small cell lung cancer (SCLC) is associated with an aggressive course and short survival. Conventional chemotherapy (CT) is the mainstay of SCLC treatment. However, the majority of information on chemotherapy (CT), as well as information on demographic data of patients, is based on studies from several decades ago. In this study, we aimed to determine the current demographic and clinical characteristics of patients with SCLC and to determine their responses to the treatments.

Patients and methods: This was a retrospective, cross-sectional, cohort study. Definitions of survival were overall survival (TOS) and survival after metastasis (MOS). TOS was calculated as the time from the diagnosis to the date of death or last visit. MOS was calculated as the time from the diagnosis of metastasis to the date of death or last visit.

Results: The data of 161 patients were analyzed. Response rates obtained with 1st line CT, 2nd line CT, and 3rd line CT were 72.2%, 43.3%, and 40.4%, respectively. The median TOS and median MOS were calculated as 15.7 months (0.03-106.97) and 13.79 months (0.03-79.54), respectively. Although they were metastatic, ten patients had never received first-line CT, and the median MOS was 1.88 months and 14.62 months, respectively, in those who did not receive CT and received CT. Twenty-one (18.9%) of the 111 patients who needed second-line treatment did not receive CT, and the median MOS was 8.39 months and 18.45 months, respectively, in those who did not receive CT and received CT. Eighteen of the 65 patients (27.7%) who required the third-line treatment did not receive CT, and the median MOS was found to be 15.36 months and 23.86 months, respectively, in those who did not receive CT and received CT. The presence of metastatic disease at the time of diagnosis and refusal of treatment were statistically significant parameters affecting the median TOS. And, poor performance status and refusal of treatment were statistically significant parameters parameters affecting the median MOS.

Conclusions: In this study, it was confirmed that early diagnosis of SCLC was associated with a survival advantage. It was shown that the patients who received and were able to tolerate the treatment had obtained a survival advantage, regardless of the disease phase.

Gastrointestinal procedures are the most frequent ones in outpatient anesthesia applications which increase day by day. However pediatric cases are rare. Out patient anesthesia applications, especially in pediatrik patients, are more difficult and so it is important to use guidelines in this manner. In this article our anesthetic experience in a endoscopic retrograde cholangiopancreatography applied on a pediatric patient is reported with literature review.

A single dose spinal analgesia (SDSA) has been defined as an alternative method for the cases which are late for epidural labour analgesia. This study was undertaken to present our experiences on SDSA for multiparous parturients who attended to the obstetrical ward during the advanced stages of labour and requested analgesia. The files of 48 multiparous parturients who applied for SDSA method for labor analgesia between 1 January and 30 July 2009 were retrospectively analyzed. SDSA was performed with 2.5mg levobupivacaine combined with 15µg fentanyl, and 1.2 ml normal saline, using a 27 G pencil point needle in the sitting position. Initiation time of analgesic effect, duration of the second stage of labour lasting after application of SDSA, the number of parturients who needed rescue analgesic and side effects were recorded. SDSA was successfully performed in all parturients. The mean initiation time of analgesic effect and the second stage of labour lasting after application of SDSA were 2.6±0.7/min and 62.2±20 / min, respectively. Six parturients (12.5%) needed rescue analgesic. No side effects were observed except pruritus which occurred in 15 (31%) parturients. The method of SDSA was sufficient in 87.5% of multiparous parturient who requested labour analgesia at the advanced stages of labour. Further studies that include alternative combination of easy and effective methods are needed to increase the success rate of this method.

Despite advanced diagnostic methods, diagnosis of small intestinal tumors is hard and they are generally detected at an advanced stage. These cancers may form emergency cases that need to be addressed surgically like bleeding, obstruction, and perforation or insidious abdominal pain and weight loss. We present our clinical experiences and the short term results of 29 patients with primary small intestinal tumors who had undergone emergency surgical procedures. The data of these 29 patients treated at our clinic between 2005 and 2011 were retrospectively evaluated. Study parameters included the patients’ demographic, clinical, radiological, and pathological characteristics. All the cases underwent emergency surgery. 16 of the patients were male, while 13 were female, and their mean age was 62 (35-80). Intestinal obstruction was detected in 19 of the cases, while perforation in 6, and mesenteric ischemia in 4. Tumors were located in the ileum in 14 patients, in the jejunum in 10, and in the duodenum in 5. The most frequent pathological diagnoses were GIST with 8 cases and adenocarcinoma with 8 cases. The most frequently performed surgical procedures were small intestinal resection and anastomosis. Four patients developed surgical site infection and three had anastomotic leaks in the post-op period. Mortality was seen in five patients in the early post-op period. Tumors of the small intestine are very rare. The findings are non-specific and advanced diagnostic methods are needed during the diagnostic process. They generally cause clinical conditions that necessitate emergency surgery. The timing of the treatment is a significant factor determining survival.

Multiple myelom (MM) is a plasma cell malignancy and is characterized by anemia, recurrent infections, serum and/or urine monoclonal protein, osteolytic bone lesions, hypercalcemia and renal failure. The prevalence of nephropathy varies between 20 and 50% in MM. In this study, the prevalence of nephropathy and related factors were aimed to investigate in MM patients who admitted to the Hematology and Nephrology clinics of Meram Faculty of Medicine, Necmettin Erbakan University. A total of 104 MM patients (F/M: 55/49) were retrospectively examined who were administered in the last five years. The mean follow up duration was 29 months. The mean age was 64±10.6 years. During the follow-up period, 30.8% of our patients died and 58% were still alive. The fate of the 10.6% of the patients could not be learned. Patients with serum creatinine ≥2 mg/dL were considered as patients with nephropathy. The vincristine-adriamycindexamethasone or melfelan-methylprednisolone (for patients >65 years) were administered as initial therapy. Statistical analysis was performed with SPSS 15.0. Renal involvements were observed in 33 patients (31.7%). Hyperuricemia (p=0.002), hypercalcemia (p=0.037), hypovolemia (p<0.001) and oliguria (p<0.001) were found to be higher in patients with creatinine ≥2 mg/dL. In 31 patients (29.8%), hemodialysis (HD) treatment was required, 19 of these (61.2% of HD patients, 18.2% of all patients) were treated with HD permanently. Mortality rates were found as %42 in patients with nephropathy and %25.3 without nephropathy (p=0.034). Renal failure is a poor prognostic marker in multiple myeloma. In this study one-third of MM patients had nephropathy requiring HD. Although renal insufficiency is mainly due to monoclonal light chain nephropathy, reversible causes such as hypovolaemia should be carefully evaluated. We think that particular attention should be paid to this group because of the increased risk of mortality.

The presence of cardiac disease in pregnancy is still one of the most important reason of maternal mortality. The possibility of acute coronary syndrome increases in pregnancy. Birth with caesarean section provides proper hemodynamic monitoring and management in parturients with cardiac disease. However the ideal anesthetic to be applied to parturient with cardiac disease is controversial. Although regional anesthesia is usually preferred method, general anesthesia may be applied in some special cases. Invasive monitoring reduces mortality and morbidity in cardiac patients undergoing general anesthesia. Opioid use reduces the stress response to surgery and intubation. If the use of opioid is required before birth, remifentanil is the ideal agent because of its rapid onset of action and metabolism. In this case, we aimed to present our general anesthesia experience on a parturient with high cardiac risk where regional anesthesia is contraindicated because of the use of anticoagulation.

\r\n Synesthesia is a phenomenon in which stimulation of one sensory system leads to a different experience in a second sensory system. There is more than sixty types of Synesthesia, like grapheme-color, sound-color (chromesthesia), sound-movement, sound-flavor, color- flavor etc. have been identified so far. Synesthesia is seen in 4% in general population. The grapheme-color and sound-color Synesthesia are the most common types. A case is discussed that has auditory-visual and smell-color types Synesthesia started at 6 yo but currently she has had fewer symptoms than before. An active psychiatric pathology is not found in clinical evaluation.  There is neither significant patient history nor family history for psychiatric disorders other than a younger sister who has similar symptoms. She has not experienced any seizures or trauma. Her MRI and EEG were within normal limits. Functional MR imaging showed greater activation in the cerebral hemisphere that indicate lateralization. Since there is a positive familial history, we might consider genetic predispositions.

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Single incision laparoscopic surgery is a rapidly evolving laparoscopic surgical approach. We report a comparison of single incision laparoscopic appendectomy (SILA) and standard laparoscopic appendectomy (SLA). Thirty-one patients who applied to a city hospital, and underwent laparoscopic appendectomy were included in this study. Twelve patients received SILA and 19 patients received SLA. Operation time, hospital stay, postoperative pain, diet, and postoperative complication were reviewed. There were no statistically significant differences in patients demographics and no differences between SILA, and SLA patients respectively, in operation time (65.8-58.9 minutes p>0.05), duration of hospitalization (1.8-1.3 days p>0.05), mean visual analogue scale score (2.8-2.6 p>0.05), and return to diet (12-14 hours p>0.05). Single incision laparoscopic appendectomy in experienced centers, can be a serious alternative to conventional laparoscopic appendectomy. Laparoscopy can be applied in each center, because it does not require special tools.

Abstract

 

Objective

There is still no consensus on nonoperative management (NOM) for the treatment of patients with liver injury due to multiple trauma. In this study, we aimed to present our experience in patients who underwent NOM in our hospital due to liver injury resulting from blunt trauma.

Material & Methods

In this study, a total of 104 patients who presented to our hospital with liver injury due to multiple trauma were retrospectively evaluated. Patients with successful NOM and those who underwent laparotomy due to failure of NOM were grouped.

Results

All of the 104 patients had solid organ injury due to blunt abdominal trauma, and 58 of these had thorax trauma. NOM was successfully performed in 94 patients with liver injury due to blunt abdominal trauma. The treatment was converted to surgery in 10 patients during conservative follow-up. According to injury grades; 35 patients were graded as Grade 1, 23 patients as Grade 2, 24 patients as Grade 3, and 12 patients as Grade 4. Data of 10 patients with liver trauma and NOM failed were compared with those of the NOM group.

Conclusion

The development of complications increases in patients with high-grade injury or those accompanied by thorax trauma. The rate of complications is high in patients who receive NOM in Grade 4 injury.

Erector spinae plane block (ESPB), one of the popular regional anesthesia techniques in recent years, has first been used for upper thoracic neuropathic pain. Later, it has been used in many different indications for both acute and chronic pain treatment at different lower thoracic and lumbar levels. Our limited experience demonstrates that bilevel bilateral sacral ESPB is an easy and effective method in the treatment of perianal chronic intermittent pain. However, many issues, such as the application site, the volume of local anesthetics and the sensory blockade, still remain being investigated. Due to the lack of clinical research, our review is currently unable to support the evidence and routine use of sacral ESPB. We consider that anatomical radiological and  clinical studies are needed to elucidate the efficacy and mechanism of action of sacral ESPB

Percutaneous endoscopic gastrostomy (PEG) is a minimal invasive method of enteral nutrition for the patients that the oral intake is not possible. The aim of this study is to determine the results of our PEG insertion procedure performed. We analysed the medical records of 112 patients who had an initial PEG insertion retrospectively in January 2011 and December 2012 at Selçuk University Faculty of Medicine. We inserted 20 F Abboth Flexiflo endoscopic gastrostomy tubes by the “Pull Tecnique” in all cases. No general anesthesia was needed. The records were reviewed with regard to age, gender, indications, interventional complications, the port-site leakage, periportal infection and mortality were examined. PEG was performed to 112 patients comprising 37 females (33%) and 75 (67%) males, ages ranged from 28 to 77 years with a mean age of 53±16,57 years. All patients had neurological defects that impair feeding. Average time of feeding through PEG 180±74,84 (min 10- max 295) days. After PEG, subcutaneous infection was occured at 4 (3.5%) patients, gastrointesinal intolerance was occured at 5 (4.4%) patients, leakage from gastrostomy site was occured at 6 (5.3%) patients. PEG is a simple,safe and effective feeding method for enteral nutritional deficiency in patients.

The aim at this study is to evaluate women’s experience, opinion about mode of delivery, satisfaction with hospital care after cesarean section. This descriptive, cross-sectional study was carried out at 140 women who had cesarean section. The proposed cut off score for SMMSCB was 146.5 and 48.6% of the women had high level of satisfaction. The mean SMMSCB scale score was 144.9±18.7 (min=90, max=105). When subgroups of the scale was examined, ‘perception of health professionals’ was 20.1±3.4 (min=5, max=25); preparation for caesarean 7.9±1.9 (min=2 max=10); ‘comforting’ score was 7.8±2.9 ( min=3 max=15); ‘information and involvement in decision making’ score was 28.2±6.9 (min=8 max=40), meeting the baby 7.4±3.9 (min=3 max=15), postpartum care 7.5±5.1 (min=7 max=30), hospital room 10.5±3.1 (min=3 max=15), hospital facilities 9.9±2.9 (min=3 max =15), respect for privacy 15.1±3.7 (min=8 max=20), meeting expectations 14.6±2.9 (min=8 max =20). The level of satisfaction was found high in women who had given birth with epidural anesthesia and who were in the age group of 26-30 (p

The malignant tumors of bone are more common than benign tumors. The bone tumors is the smallest group in all tumors. For this reason, knowledge and experience required for the diagnostic approach. Osteochondroma is the most common benign bone tumor. The lesion can be single, multiple forms are rarely seen. This condition is known as osteochondromatosis or diaphyseal aklazi. Diaphyseal aklazi (DA) is a rare hereditary disorder of cartilage differentiation and inherited as an autosomal dominant. Chondrosarcoma that especially for the development of new lesions occurring after termination of puberty should be evaluated. In this case report presented the two brothers who are diagnosed with DA come in with the complaint of short stature. One of the patients was 15-year-old girl and the other was a 14-year-old male. A common complaint of both short stature and non-painful swelling of bones. The patients were diagnosed with diyafizyal aklazi according to typical family history, physical examination findings, and radiographic findings.

One of the ways for the child to get familiar with its surrounding environment and to build up relations with the same is bringing any possible object to the mouth for tasting. Thus, the children happen to swallow foreign bodies of sorts and sizes unimaginable. A great portion of the grown up children swallowing foreign bodies demonstrate mental deficiencies or psychological problems. The clinic symptoms may be coughing, dyspnoea, hoarseness, breathing difficulty, weakened respiratory sounds and hyper saliva in the mouth. The foreign bodies are usually coins. We want to share an alternative treatment in foreign body aspirations. In this article is demonstrated an alternative approach for foreign body aspiration in four years old patients with down syndrome. The patient developed no complications during the medical intervention and discharged under recommendations. Foreign body aspiration is common in childhood. The majority of foreign bodies are coins. Approach to foreign body aspiration in a patient’s clinical presentation, type of foreign bodies, inserted in the aspiration time and the response shall be decided to treatment according to the conditions. Approaching treatment is endoscopy, observation or operation. In emergency alternative methods can be used such as balloon extraction with foley catheter by experienced surgeons.

It is not possible to determine dysrhythmias at any time, because those may occur briefly and unpredictably throughout the day. Transtelephonic electrocardiography (TTE) allows arrival to the hospital by the phone line dysrhythmia at the time. The aim of this study was to evaluate the value of TTE in the diagnosis and treatment of dysrhythmias, especially seen intermittently, in pediatric patients. We retrospectively evaluated records of 121 children, followed-up in Pediatric Cardiology Unit between May 2003 and May 2006. The patients were age of between 4 months to 18 years (median age 12 ± 4.4 years). The most common presenting symptoms were palpitation (42.1%), chest pain (15.7%), palpitation together with chest pain (6.6%), syncope (5%), easy fatigability (5%) and also the research of drug efficiency (3.3%). The dysrhythmia findings were determined on TTE in 21 of 110 cases whose standard electrocardiographies were normal. On TTE, supraventricular tachycardia was observed in three of 25 patients with normal HM. The dysrhythmia was detected in 24% of TTE records (supraventricular extrasystoles, ventricular extrasystoles, sinusal tachycardia, supraventricular tachycardia, sinus bradycardia, sinus tachycardia, sinus pause, Mobitz type I atrioventricular block were detected in 11, 7, 4, 3, 2, 1 and 1 cases, respectively). Four patients were using drugs (verapamil in 3 and propranolol in 1) before TTE recordings. According to the TTE records, medical treatments were started in 10 patients with previously untreated (verapamil in 5, propranolol in 3, digoxin in 1 and also amiodarone in 1). Eventually, we suggest that HM is a usefull, reliable and non-invasive diagnostic method for the detection of dysrhythmias in patients with dysrhythmia suggestive symptoms and normal ECG. Additionally, TTE should be used in follow-up and treatment of the patients with some dysrhythmias, even undetectable with HM.

Aim: In this study, we aimed to present our 10-year experience regarding clinicopathology characteristics and
overall survival of 69 patients with adenocarcinomas of esophag ogastric junction (AEJs).
Patients and Methods: A total of 69 consecutive patients diagnosed with AEJ and operated in our clinics
were included in the study. Patients’ demographic characteristics; laboratory parameters, surgical resection
approach; TNM stages; resection extent; total number of removed lymph nodes; tumor localization; presence
of lymphatic, vascular and perineural invasion and overall survival (OS) status were recorded. The patients
were divided into two groups as Siewert Type II and Siewert Type III.
Results: There was no statistically significant difference between the groups in terms of age (p=0.696)
and gender (p=0.140). Distribution of T stage was statistically significantly different between the groups
(p=0.026). OS was found to be significantly higher in patients at R0 level compared to those at R1 level. OS
was statistically significantly higher in patients without lymphatic, vascular and perineural invasion. 1-year OS
was determined as 83.50%, 3-year OS as 49.10% and 5-year OS as 43.60%. The risk of mortality increased
by 8.63 folds in the presence of perigastric fat infiltration, 12.60 folds in the case of vascular invasion and
13.45 folds in the case of perineural invasion. The survival rate was found as 51% and 41% in the Siewert
Type II and Type 3 patients at median 10-year follow-up.
Conclusion: This study had successfully evaluated the clinicopathological characteristics and overall
survival, and demonstrated that Siewert II tumors and Siewert III tumors had similar survival outcomes.
Further comprehensive multicenter studies with larger series and long-term studies are needed to provide
contribution to the existing evidence on outcomes of patients w ith AEJs.

Palliation of esophageal obstruction due to benign or malignant causes, esophageal stents effectively implemented. Strictures of the upper cervical esophagus stent placement, foreign body sensation in his neck due to constant worry and discomfort that the patient has particular challenges. Additionally, the endoscopist needs to have great skill to properly adjust the proximal stent end. We present the experience of stenting high cervical esophageal strictures with a selfexpanding metalic stent, in postoperative benign stenosis. Dysphagia disappeared and the endoprosthesis was well tolerated.

Intrauterine devices (IUDs), which use a reversible and highly efficient method, significantly lower mortality and morbidity compared to the medical and social risks of unwanted pregnancies. Mortality is less in IUDs compared to birth control pills, which is one of the most effective methods. On the other hand, morbidity is higher due to bleeding, inflammatory diseases of the pelvis and uterine perforation. Failure to properly place the IUDs in the uterus is the main cause of all major complications such as pregnancy, evacuation of the vehicle, bleeding, mesh, perforation and infection.

Objective: Direct immunofluorescence examination contributes to the correct and differential diagnosis and treatment management of immune-mediated dermatological diseases that can also affect the mucous membranes.

In this study, it was aimed to compare skin/mucosa biopsies performed using direct immunofluorescence and histopathological examination, compliance with the preliminary diagnosis and to evaluate the diagnostic value of immunofluorescence examination.

Patients and Methods: A total of 207 patients’ biopsies sent to the pathology laboratory between January 01, 2019 and December 31, 2019 were evaluated. Groups were formed according to the preliminary diagnosis (intraepithelial/subepithelial separation conditions, lupus erythematosus, lichen planus, vasculitis), and histological (intraepithelial/subepithelial separation, clasia, dermal mucin deposition) and direct immunofluorescence (immunoglobulin G, M, A, and C3 depositions, patterns) findings were recorded. SPSS 23.0 package software with Kappa statistics and the McNemar test were performed. P<0.05 was considered statistically significant.

Results: Direct immunofluorescence results were negative in 115 patients, positive in 91 patients and could not be evaluated in one patient. Histological agreement was found in 19 of 44 (43.2%) patients with bullous pemphigoid, 10 of 18 (55.6%) with pemphigus, 26/51 (50.9%) with lupus erythematosus, 10/15 (66.7%) with lichen planus, 6/6 (100%) with Henoch Shönlein purpuras and 37/62 (59.7%) with other vasculitides. Direct immunofluorescence positivity was found as 19/19 for bullous pemphigoid, 10/10 for pemphigus, 11/26 for lupus erythematosus, 2/10 for lichen planus, 6/6 for Henoch Shönlein purpura, and 28/37 for other vasculitides (κ = 0.021).

Conclusion: Direct immunofluorescence examination significantly supports clinical and histopathological findings in the diagnosis of immune mediated dermatologic diseases and in the differential diagnosis of vesiculobullous diseases.

Vesicovaginal fistula cases treated in our clinic betvveen 1983-1998 has been evaluated retrospectively. Etiologic causes and approaches to treatment have been discussed. 70.6 % of the cases were caused by gynecologic re- asons vvhereas the remaining 29.4 % were due to obstetric reasons. Three cases treated by electrocoagulation, eleven cases by transabdominal-transvesical approach and another three by transvaginal approach. After eva- luation of the results, 66.6% (2/3) success rate has been reached with electrocoagulation while this rate was 100% (3/3) at transvaginal methods and 72.7% (8/11) with transabdominal-transvesical approach. Three cases which failed at the first application of transabdominal-transvesical method ended up with recovery after the se- cond treatment with the same method. Although the number of cases are not enough to give a solid decision, we concluded that the transvaginal approach may be preferred as a first method in vesicovaginal fistula by con- sidering the lesser amount of morbidity, minimum blood loss, easiness of operation and control över the operated area, shorter hospital stay and simultaneous treatment of stress incontinance.

Endoscopic retrograde cholangiopancreatography (ERCP) has an important role in the diagnosis and treatment of hepatobiliary and pancreatic diseases. This study was discussed the three years’ experience of general surgery of endoscopy unit. The records of 242 ERCPs of 200 patients, performed between February 2010 and March 2013, were retrospectively evaluated. The age range 19-84 years (mean; 47.3 years) and 116 patients (58%) were female. The most common indication was the presence of obstructive jaundice and/or a high serum bilirubin level (159 patients, 79.5%). The average ERCP duration was 16.5 min (5-55 min.). A repeat ERCP was needed in 38 patients (19%) and cannulation was successful 185 patients (92.5%). Endoscopic sphincterotomy was performed in 177 patients (88.5%), biliary balloon application in 156 (78.3%), and stone extraction in 144 (72%). Complication occurred in 8 patients (4%) and the most common complication was acute pancreatitis (4 patients, 2%). There was no mortality in any patient in this series. Although the relationship between the risk of mortality and morbidity of ERCP, a reliable method of diagnosis and treatment of hepatobiliary and pancreatic diseases.

The aim of this study was to determine the experiences of emergency critical intensive care unit patients. This descriptive study was conducted at an emergency critical intensive unit in a Teaching and Research Hospital located in Konya. One hundred twenty one intensive care patients were included in the study. A questionnaire and “Intensive Care Experience Scale” were used as data collection tools. Of the patient,50.4%of them were female, 19% of them had elementary school graduates or lower degree education and 66.1% of them were married. Patients’score of intensive care experiences scale was 60.09±6.53. At the end of the study, it was determined that the patients inthe intensive care units lived negative experiences partly.

The aim of the study is to evaluate the fetal echocardiography results of high and low risk pregnancies for congenital heart diseases in our clinic between June 2011-January 2012. A total of 351 pregnant who underwent a full fetal echocardiographic examination were included in the study. Pregnant women were classified as high and low risk groups according to their admission reasons. The two groups were evaluated for the type of congenital heart disease and its prevalence.The prevalence of congenital heart disease in high and low risk pregnancies were found as 16.7% and 5.7%, respectively. The most frequently detected congenital heart disease was ventricular septal defect. Self-admission (36.1%) was the most frequent reason in low risk pregnancy group, while maternal diabetes (8.9%) was the most common among maternal factors, polihydramnios/oligohydramnios in fetal factors (1.9%) and fetal anomalies in previous pregnancies (1.2%) in hereditary factors were common in high risk group. Fetal echocardiography is a useful technique for early diagnosis of congenital heart diseases, providing consuling for families and to prepare for the required interventions after the birth. Fetal echocardiography should be performed on high risk pregnancies. However, in low risk pregnancies fetal echocardiography may also be performed on selected cases.

Aim: It was aimed to investigate podcast awareness and frequency of use among otorhinolaryngologists
on a national scale.
Patients and Methods: This study was conducted via the open web address of 'Google forms'
(Mountain View, CA) between 2021-2022. On a national scale, the intended audience consisted of
otorhinolaryngologists of all ages and levels of experience. Ou r survey consisted of twenty questions.
Results: In our study, the number of people who answered our questions was 112 (92 men (82.1%),
20 women (17.9%). When asked if they had listened to podcasts about otorhinolaryngology, 23 people
(20.5%) answered that they had listened and 89 people (79.5%) had not. When people want to learn
about a topic in the field of Otorhinolaryngology before pandemic, the most frequently used literature
resources are 40.2% (n=45) books and 31.3% (n=35) e-books. It was observed that the most frequently
used literature sources in the pandemic were 30.4% (n=34) online meetings and 27.7% (n=31) e-books.
There was a statistically significant difference between the frequency distribution of resources consulted
before and during the pandemic (p<0.001).
Conclusion: Although the ongoing pandemic has affected the frequency of consulted to literature
resource, it has not caused a significant change in podcast usage. The authors hope that this article will
create an awareness for producing Turkish podcasts in the field of otolaryngology .

Admitted to our clinic with stab wounds treatment of cervical tracheal injuries conservatively. Our clinic between the ages of 25-40 due to penetrating injury to the cervical trachea under 2 cm and 6 cases were evaluated retrospectively. Generally, in patients presenting with cervical subcutaneous emphysema, respiratory distress and tracheal input-output occured . broad-spectrum antibiotic were taken and cervical anteseptikli spançlarla tightly closing, and continuous nasal oxygen, There were not accompanied organ injuries like esophagus and other organ .1 weeks after the spontaneous tracheal incisions were closed, and decreased subcutaneous emphysema were discharged. Tracheobronchial injuries due to stab injury to the cervical trachea is almost always, while the bullet wounds of firearms in any area that fits.Our cases injuries at around 80% of cervical trachea was noted in the literature. Cervical tracheal injury in patients with stridor, subcutaneous emphysema, severe respiratory distress, hemoptysis, hoarseness is the most common findings. if it is less than 2 cm and the tracheal anterior cervical injuries, if any organ injury, such as closing trakeastomi thought were more appropriate to remain conservative

The aim of this prospective study is to evaluate the results of our total laparoscopic hysterectomy (TLH) cases. Forty one patients underwent TLH due to benign or malign disorders were reviewed prospectively between January 2013 and April 2014. Rigid instruments 10 mm telescope, and advanced bipolar energy modalities were used during the procedure. A primary 10-mm trocar was inserted directly through a 1-cm sub umbilical incision. The laparoscope was inserted through this trocar after insufflation of the abdominal cavity with 3–4 L of CO2. The second and third incisions were performed in the avascular right and left lower quadrant of the abdomen and two ancillary 5-mm trocars were inserted through these incisions. Uterine manipulation was performed by using RUMI® II. During the removal of the specimen, if necessary, intracorporeal myomectomy and morcellation were performed before the uterus and ovaries were delivered intact through the vagina. A 0-Vicryl suture was used for close the vaginal cuff. The sutures were passed through the left and right uterosacral and cardinal ligaments in all patients. All procedures were performed by the same surgeon. The mean age of the cases, body mass indexes (BMI), duration of operations, the amounts of blood loss, rates of complications and post operative hospital stay were assessed. The indications of for hysterectomies were, 16 myoma uteri, 6 medical treatment-resistant abnornal uerine bleeding, 5 benign ovarian cyst, 4 adenomyozis, 3 myoma uteri+ovarian cyst, 2 endometrial polyp, 2 endometrioma, 2 endometrial hyperplasia and 1 early stage cervical cancer. The mean age of patients were 47.5 (30-68 years), mean BMI of patients were 30.2 (24-44), mean specimen weight was 215.9 (90-650 gr), mean operation duration was 107.9 (60-210 min), mean blood loss was 81.1 (30-300 ml), mean preoperative hemoglobin (Hb) was 12.5±0.9 gr/ dl, mean postoperative Hb was 11.5±0.8, and the mean hospital stay was 2.5 (2-4 days). There were no intraoperative complications. Late postoperative complication was vaginal vault infection in 2 cases. Total laparoscopic hysterectomy is safe and feasible method for gynecological diseases. Careful selection of patients is critical for obtaining the best results.

The aim of this study was to evaluatie of adnexal masses cases that were diagnosed and laparoscopically treated during pregnancy in our clinic. This retrospective study included 18 cases that were diagnosed to have adnexal masses during pregnancy or referred from other clinics to our clinic and treated by laparoscopy between January 2005 and December 2009. Patient’s characteristics such as age, gravidity, parity, symptoms, gestational age at the time of diagnosis, sonographic findings, and type of laparoscopic surgery, operation time and hospitalization time were recorded. Eighteen women with adnexal masses during pregnancy who underwent laparoscopic surgery were included in this study. The average age of the patients was 28.5±4.3 (range 20–37) years and the average gestational age was 13.1±3.3 (range 8–20) weeks. The patients presented usually with pelvic pain. Adnexal cyst was mostly seen by ultrasonographic evaluation. Adnexal torsion was detected in 8 patients. Nine patients were in first trimester, other 9 patients were in second trimester. We performed laparoscopic cystectomy in 10 patients, detorsion and cystectomy in 6 patients and salpingoooferectomy in 2 patient’s. Mean adnexal mass size was 7.8±2.3 (range 5–15) cm. Mean operation time was 37.2±7.1 (25–50) minutes and mean hospitalization time was 1.8±0.6 (1–3) days. Abortion was not detected in our cases. According to these findings, laparoscopic surgery is the most appropriate treatment for patients with adnexal masses during pregnancy in the presence of expert surgeons. Laparoscopic surgery if performed by experienced surgeons seems to be safe and better management method for maternal-fetal health.

The only and main source in blood donation is human. It is imperative to evaluate the factors related to blood donors well to obtain the blood continuously and freshly. In this study conducted in Konya, the desire of one person to donate blood to another person was found to be significantly higher in youth and men. In addition, the education levels of the individuals affected voluntary blood donation. The behavior of participating in this social event was higher in experienced people (p <0.01).

Aim: The aim of the present study was to evaluate the general characteristics, survival time and prognostic factors affecting the high grade glial tumor after radiotherapy and chemotherapy. Patients and Methods: Data of 166 patients were retrospectively analyzed. Included histopathologically confirmed cases were grade 3 anaplastic astrocytoma and grade 4 glioblastoma multiforme. Patients were treated with curative radiotherapy and simultaneous ± adjuvant Temozolamide. Results: 73% of the patients were male, 27% were female and the median age was 57 years. 21% were anaplastic astrocytomas, 79% were glioblastom multiforme. 40% of the patients were total, 49% of the patients were subtotally operated and 11% of the patients had only biopsy for diagnostic purposes. The median Karnofski performance score of the patients before radiotherapy was 90. 3-dimensional conformal radiotherapy was applied to 37% of the patients, 63% of the patients were treated with intensity-adjusted radiotherapy technique. Simultaneous Temozolamide was administered with 92% of patients’ radiotherapy. The median follow-up time was 15 months. Overall survival rates were 82 months for anaplastic astrocytoma and 15.5 months for glioblastome multiforme (p <0.001). Overall survival rates at 1, 2, and 5 years were 77%, 59%, and 55% for anaplastic astrocytoma and 59%, 33%, and 4% for glioblastome multiforme, respectively. Median overall survival in patients aged <50 years was 39.3 months, while age ≥50 years was 12.4 months (p <0.001). Overall survival according to operation pattern was 33.2 months in total exposures, 13.8 months in subtotal resections, and 4.9 months in biopsies (p = 0.00). Overall survival was 8.1 months with a performance of <70, while overall survival was 22.3 22.3 months with ≥70 (p = 0.00). Overall survival was 12.9 months in patients who underwent three-dimensional conformal radiotherapy and 21.5 months in patients undergoing intensity-adjusted radiotherapy (p = 0.005). Overall survival was 7.8 months when applied to radiotherapy dose <60 Gy and 21.7 months when given 60 Gy (p = 0.00). Median survival was 18.4 months and 7.2 months, respectively, using concurrent Temozolamide (p = 0.03). Conclusion: In conclusion, the patient’s diagnosis, age, operative form, performance, radiotherapy dose, chemotherapy usage and survival were positive and our results are compatible with the literature.

The objective of this study was to evaluate renal arteries in living kidney candidate donors through DSA as well as compare and contrast the findings with surgical findings. 180 kidney donor candidates were evaluated through retrospective analysis and findings were compared and contrasted with surgical operation notes. DSA images of kidney donor candidates collected from the back-up service were randomly and independently from patient credentials examined in laboratory stations through retrospective analysis by two experienced radiologists. According to DSA findings of 180 kidney donor candidates, 158 donors (87,8%) were diagnosed with single renal artery and 22 donors (12,2%) were diagnosed with multiple renal artery while 156 donors (86,6%) were diagnosed with single renal artery and 24 donors (13,3%) were diagnosed with multiple renal artery according to surgical operation notes. Comparing and contrasting DSA findings with those of surgical operation notes, it was marked that 154 donors owned the same findings while 6 donors were diagnosed with different findings. In accordance with these findings, our accuracy rate was 96% and our sensitivity and specificity ratios in multiple renal artery diagnosis were measured as 83% and 98% respectively based on operation notes. It is of great significance to evaluate left side renal arteries accurately as well as to identify their variations in living kidney donors. DSA is regarded as golden standard in imaging vascular structure of kidney and it proves the pace, normal anatomy as well as variations of renal arteries accurately and in great detail.

Aim: In this study, we discuss the efficacy and safety of autologous hematopoietic stem cell transplantation
(AHSCT) for high-risk pediatric solid-tumor patients based on 1 2 years of experience.
Patients and Methods: The data of patients aged < 18 years with pediatric malignancies who underwent
AHSCT between January 2009 and July 2021 at the Pediatric Bone Marrow Transplant Unit were evaluated
retrospectively.
Results: Fifty-one patients (24 girls and 27 boys; median age, 7.8 years; range: 0.5–18 years) were
enrolled in the study; 20, 15, 8, 4, 2, and 2 patients had diagnoses of neuroblastoma, Ewing’s sarcoma,
Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, germ cell tumor, and soft tissue sarcoma, respectively.
The median neutrophil and platelet engraftment times were 11 (8–45) and 16 (4–62) days, respectively,
and the median hospital stay was 38 (17–67) days. The median follow-up time was 2.83 (0.12–10.81)
years and the overall survival (OS) rate was 51.3 ± 10.3% for all patients; the median follow-up times
and survival rates for the Ewing’s sarcoma and neuroblastoma cases were 2.63 (0.12–10.55) years and
64.2 ± 14.9%, and 2.81 (0.31–7.91) years and 42.8 ± 12%, respectively. All four patients who received
the conditioning regimen of carboplatin, etoposide, and melphalan (CEM) died; 6 of 16 neuroblastoma
patients who received the busulfan and melphalan (Bu/Mel) regimen as a conditioning regimen died: the
median follow-up period of the Bu/Mel neuroblastoma patients was 3.08 (0.32–7.91) years and the OS
rate was 55.1 ± 13.8%.
Conclusion: Although the number of patients in this study was limited, AHSCT resulted in better survival
for Ewing’s sarcoma and neuroblastoma cases than reported for those who did not undergo AHSCT in
our clinic.

Objective: Conjunctiva is a region where various neoplastic or non-neoplastic lesions may develop.  In this study, we aimed to perform a histopathological analysis of conjunctival lesions and to determine their prevalence.

Material & Methods: Conjunctival biopsies of 401 patients who presented to the pathology laboratory between 2009 and 2019 were retrospectively examined. The cases were histopathologically divided into two groups as non-neoplastic and neoplastic lesions. Neoplastic lesions were further divided into subgroups as benign, premalignant, and malignant lesions. The prevalence of lesions and distribution of age and gender among the groups were analyzed.

Results: In our series of 401 patients, the mean age was 49.89±21.75 years. Of all patients, 209 (52.1%) were male and 192 (47.9%) were female. Non-neoplastic lesions were found in 296 (73.8%) and neoplastic lesions in 105 (26.2%) patients. The mean age was found as 50.79±19.34 years in patients with non-neoplastic lesions, and 47.34±27.39 years in patients with neoplastic lesions. Of neoplastic lesions, 64 (60.2%) were benign, 17 (16.2%) premalignant, and 24 (22.6%) malignant. The most commonly found non-neoplastic lesion was pterygium (n:220; 54.78%) while the most common benign lesions were nevus and other pigmented lesions (n:38; 9.5%), and the most common malignant lesion was squamous cell carcinoma (n:14; 3.5%). The prevalence of neoplastic lesions significantly increased over 45 years old (p<0.05).

Conclusion: In the current study, conjunctival lesions diagnosed in our laboratory over 10 years were reviewed and histopathologically analyzed. Recognition of conjunctival lesions and being aware of the rates of non-neoplastic and neoplastic lesions are crucial for treatment planning and protection of visual functions.

İn this article early and late results of PTFE vascular access grafts in patients with chronic renal failuer who have unsuccessfull arteriovenous fistula was discussed.

The aim of this study is exploring the effects of childbirth education, physiotherapy and psychotherapy-based interventions on fears and worries about childbirth and labour. Expectant mothers in the last trimester of gestation those did not have a delivery before were taken to the study. At first the participants were examined by a psychiatrist than sociodemographic data form Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), Beck Depression and Beck Anxiety Inventories (BDI, BAI) were applied. Then 3 sessions each taking 60 minutes on possible physical and mental problems before birth were done, an exercise plan and recommendations for facilitating delivery were given to participants, information about possible physical and psychological problems after childbirth were given and their questions on these issue were answered. In results mean age of the group was found as 27.2±3.6. The mean gestational age was 35.7±2.3. Socio-demographic characteristics (age, education level, income level, etc.) was not found significantly correlated with the W-DEQ scores. W-DEQ 1 scores were positively correlated with BAI scores. In Wilcoxon test analyses W-DEQ 1 and W-DEQ 2 scores including all the subscales were significantly different p<0.001. As a conclusion on expectant mothers having their third trimester of pregnancy, education before childbirth was found helpful in reducing fears and negative thoughts related to childbirth.

Aim: Bites are an essential cause of injury since the world. Treatment of bites is made according to specific guides and principles. The study's purpose is to examine the demographic characteristics of patients hospitalized due to bite wounds and to be a guide for new studies and treatments by sharing surgical treatment experiences.

Material and Method: Patients who were bitten and required surgical treatment were included in the study. Demographic characteristics, tetanus, and rabies prophylaxis applications, infection agents isolated from the wound site, antibiotherapies applied, and surgical treatments were recorded.

Results: Of the patients, 43 were male and mean age (±SD) of 34.5±23.8years (range, 3-85 years). Bites were in the head and neck region in 13(65%) of patients under 15 years old and in 12(27.3%) of the patients over 15 years old. In extremities, the injury was present in 7(35%) patients under 15 and in 28(63.6%) patients over 15 years old. Of the injuries, 50(78.1%) were caused by dogs, 8(12.5%) by wild animals (7 pigs, one wolf), 4(6.3%) by other pet species (horse, donkey, cow), and 2(3.1%) by humans. The intervention was made to all the patients according to guide of rabies prophylaxis specified by the Ministry of Health, General Directorate of Public Health. Irrigation was applied to the wound site with plenty of pressurized and soapy water. Forty patients received tetanus prophylaxis, 62 patients received rabies prophylaxis, and rabies immunoglobulin was applied to patients considered as suitable. Prophylactic amoxicillin clavulanate treatment was started in 38 of the patients, crystalline penicillin-G in 12, sultamicillin in 6, the combination of sultamicillin and aminoglycoside in 6, and cefazolin treatment in 2. 12(18.8%) patient underwent an urgent operation for repair process without any microbiological examination on the date of arrival. Among the patients to whom repair was applied on the first day, 7 had primary saturation, 3 had a local flap, 1 underwent ear, and 1 underwent nasal replantation, one patient had femoral artery repair, and one patient had peroneal nerve repair. Among 52 patients who underwent late repair, primary suturation was applied to 35, skin graft to 4, local flap to 17, and paramedian forehead flap to 2. No complication was seen in any of the patients who underwent early and late repairs.

Conclusion: Bacterial burden of the wound can be reduced enough to allow urgent repair owing to the irrigation of the wound with plenty of pressurized and soapy water in bites. 

Scientific experiments are needed to see the natural course of the disease in living (human or animal) individuals and to develop treatment for this. For centuries, human beings have been studying human-like organisms and have been using an animal experiments in order to advance in science and health. Researchers who work in in the field of physiotherapy that is the main philosophy of which is to plan and apply the appropriate program by the teamwork into each patient under the clinical and experimental knowledge, must have knowledge of the design, methodology, analysis and interpretation of the study in order to be able to effectively evaluate the results of research on animal experiments. This paper aims to introduce the basic principles of experimental animal studies used in the field of physiotherapy and to give the necessary information to choose the appropriate experimental model.

İn this study; lumbar and thoracic epidural applications under sedation in school age children were presented. Thoracic epidural catheters were inserted before elective thoracotomies and were combined with general anes­ thesia. Lumbar epidural catheters were inserted in the emergency orthopedic cases that had contraindication for general anesthesia and were combined with sedation.

 

Aim: The aim of this study was to primarily investigate the effects of selected anesthesia method on anxiety, patient satisfaction and pain level in elective caesarean section, and secondarily obtain information about quality of service.

Materials and Methods: The study was carried out as a prospective questionnaire in the Department of Anaesthesiology and Reanimation the Meram Medical Faculty Hospital of Necmettin Erbakan University between June 2017 and August 2017, on 160 volunteers aged between 18 and 45 years for whom elective cesarean section under General Anesthesia (GA) or Spinal Anesthesia (SA) was planned. Demographic data of the patients such as age, place of residence, education level, number of children, and cesarean experiences were recorded. In the preoperative and postoperative period, anxiety levels were measured by State-Trait Anxiety Inventory (STAI-D), pain levels were measured by Visual Analog Scale (VAS) scores and satisfaction levels were evaluated at postoperative 6th and 24th hours by (Quality of Recovery: QoR 40 T) questionnaire.

Results: There was no statistically significant difference between the patients' preoperative and postoperative anxiety scores and demographic data (p> 0.05). Patients with previous cesarean experience had lower preoperative anxiety levels (p <0.05). The STAI-D scores and the numbers of patients with anxiety in the GA and SA groups were similar (p> 0.05).Postoperative anxiety levels were significantly lower in both groups than in the preoperative period (p <0.05). VAS values of the SA group at the 6th and 24th hours were significantly higher than the group treated with GA.(p<0.05). The 24th hour VAS values of the SA group were higher than the VAS values at the 6th hour (p <0.05). In the GA group, VAS values at 24th hour were lower than the VAS values at 6th hour (p <0.05). The satisfaction levels of general anesthesia and spinal anesthesia were similar in the postoperative period (p> 0.05). Complaint of headache was high in SA group while complaint of sore throat was high in GA group(p<0.05). While there was no correlation between anxiety level, VAS values and satisfaction level (p> 0.05), there was a negative correlation between VAS values and pain parameters, which are the subgroup of satisfaction questionnaire, in both groups (p <0.05).

Conclusion: It is concluded that the preferred anesthesia method in elective cesarean section has no effect on anxiety and satisfaction, and the patient satisfaction level and service quality will be improved by providing effective analgesia by reviewing our postoperative pain algorithm.

 

Aim: Convalescent plasma (CP) therapy has been used for treatment, although it has not been Corona
Virus 2019 Disease (COVID-19) specific antiviral agent so far. However, the effectiveness of CP treatment
on prognosis and mortality is still a matter of debate. In this study, we aimed to share our experiences
about the ef fectiveness of CP treatment in COVID-19.
Materials and Methods: The study was conducted in 126 patients diagnosed with COVID-19 who received
CP treatment in addition to standard treatment between May 2020 and February 2021. 126 patients were
divided into two groups as those who underwent SP within the first five days (Group A) and after five days
(Group B). The patients in these two groups were evaluated in terms of laboratory parameters, clinical
and mortality.
Results: A total of 126 patients were identified (86 patients in Group A and 40 patients in Group B). 119
(94.4%) patients were discharged with recovery, 7 (5.5%) patients died. The mean days of hospitalization
were found to be 11.4±0.7 in Group A and 18.4±1.7 in Group B (p<0.001). Treatment-related lymphocyte,
PLT, fibrinogen and CRP main effect of change was significant (p<0.001). However, the results were
marginally significant when the two groups were compared in terms of D-dimer. When the simple effect is
evaluated; Group A as not significant, while group B was significant. Starting CP treatment 5 days before
or 5 days later did not change the laboratory parameters. However, D-dimer was marginally significant
(p=0.058).
Conclusion: In our study, it was shown that early initiation of CP treatment reduced the hospitalization,
but had no ef fect on mortality and laboratory parameters.

Aim: The aim of this study was to determine pressure ulcer prevention knowledge and attitudes among nurses who cared for surgical patients that were exposed to pressure ulcer risk factors such as immobilization and nutritional problems.

Materials and Method: This descriptive study was carried out with 150 nurses who were working in the surgical clinics and surgical intensive care units of a medical faculty hospital in XXXX and who had at least one year’s professional experience. Necessary permissions were obtained from the ethics committee and the institution prior to the research. Data were collected with a patient information form, the Pressure Ulcer Prevention Knowledge Assessment Instrument (PUPKAI) and the Attitude towards Pressure ulcer Prevention instrument (APuP) between October 1, 2018 and February 1, 2019.  Data were analyzed with the independent-samples t-test, the Mann-Whitney U test, the Kruskal-Wallis test, the correlation analysis and the multiple regression analysis.

Results: The mean age of the nurses was 29.91±6.48 years, 65.3% were female and half of them had undergraduate degrees. According to the PUPKAI total mean score (<60%), the pressure ulcer prevention knowledge of the nurses was inadequate and only 24% had a knowledge score ≥60%. Regression analysis results showed that, nurses' professional experience duration, working style, number of patients per shift and the experiences of giving care to patients with pressure ulcers were found to have a significant effect on the PUPKAI total mean score (p<0.05). According to the APuP total mean score (≥75%), the nurses had positive attitudes towards pressure ulcer prevention. It was also determined that the descriptive characteristics of the nurses did not significantly affect the APuP total mean score (p>0.05). There was no significant relationship between the total mean scores of the PUPKAI and APuP (p>0.05).

Conclusion: This study revealed that the surgical nurses had positive attitudes towards pressure ulcer prevention but they had inadequate knowledge about it. These findings highlight the need for institutional arrangements to ensure that nurses have access to evidence-based knowledge about pressure ulcer prevention.

Aim: In this study, we aimed to discuss our experience and results of non-operating room anesthesia.

Materials and Methods: Anesthesia records of patients older than 18 years who underwent sedo-analgesia outside the operating room for diagnosis and treatment between May 2017 and December 2017 were retrospectively screened. The records were examined in terms of demographic data, applied procedure, duration of the procedure, sedation grade, medications used, developing minor and major complications, chronic obstructive pulmonary disease story and intensive care need. Relationships between complications with demographic data and categorical variables were analyzed.

Results: Totally 2562 patients underwent sedo-analgesia. 1428 (55.7%) of these cases were female and 1134 (44.3%) of them were male. The average age of patients was 53.08±16.55. 268 (10.5%) of the cases were ASA I, 1683 (65.7%) were ASA II, 598 (23.3%) were ASA III and 13 (0.5%) were ASA IV. 519 (20.3%) patients were minimally sedated, 1541 (60.1%) were moderate sedated and 502 (19.6%) deep sedated. The longest procedure time in endoscopic retrograde cholangiopancreatography was 28.7 ± 16.3 min, and the shortest procedure time in endoscopy was 10.3 ± 3.1 min. The most commonly performed procedure was colonoscopy with 31%. The most commonly used drug combination was midazolam + propofol + fentanyl applied to 1231 patients (48%). 148 (5.76%) patients had minor complication, and 10 (0.37%) patients had major complication. A total of 15 (0.58%) patients underwent intensive care after the procedure. Desaturation was statistically significantly higher in patients with ASA III and above, in procedures take longer than 15 minutes, in patients older than 65 years, and in the presence of chronic obstructive pulmonary disease. The intensive care need after the procedure was also significantly higher in these patient groups.

Conclusion: The incidence of non-operating room anesthesia is increasing steadily. The risks associated with these practices are similar to the anesthesia in the operating room. In order to increase patient safety and reduce complications, it is important to carry out a thorough evaluation before the procedure, to provide proper monitored anesthesia care in appropriate physical conditions, and to establish healthy communication between the teams.

Aim: In this study, it was aimed to investigate the kidney function, hypertension development and
proteinuria in individuals with only one kidney .
Patients and Methods: The study included 96 patients who had previously undergone nephrectomy with
the causes of nephrolithiasis and chronic pyelonephritis-induced nonfunctional kidney, RCC (Renal Cell
carcinoma), trauma, and donor nephrectomy among 17800 patients who applied to the Siirt State Hospital
Nephrology and Urology outpatient clinics between January 2016 and December 2019. The data of the
patients were obtained from patient files database retrospectiv ely.
Results: A total of 96 patients, 45 female and 51 male, were included in the study. 23 (24%) of the
patients had donor nephrectomy (DN), and 73 (76%) had nephrectomy (DE) due to nephrolithiasis, chronic
pyelonephritis, trauma, and renal cell cancer (RCC). The patients were divided into two groups as those
who underwent DN and DE due to other etiologies. Between DN and DE group, there was no statistically
significant difference in terms of mean age, distribution of gender, presence of HT before nephrectomy,
DM, presence of hematuria and new onset proteinuria (P> 0.05). Compared to the DN group, the frequency
of new onset in CKD and HT development was significantly higher DE group.
Conclusion: Nephrectomy is a risk factor for the development of CKD, proteinuria and hypertension.
Therefore, preventive measures should be taken in a timely manner to reduce the prevalence of
nephrectomies due to benign diseases.

Retinopathy of prematurity (ROP) is a potentially blinding disease. ROP continues to be a leading cause of blindness of newborn in areas of the world that provide neonatal intensive care services to premature newborns. The aim of this review is to evaluate the new technical improvements and treatment modalities under current data. Increased number of Newborn Intensive Care Units leads to survive of incerased number of immature babies which in turn leads to increased number of premature infants to be screened and eyes to be treated. Although the current gold standart of screening method is examination by an experienced opthalmolog with binocular indirect ophthalmoscopy, a new debate arose that claims digital retinal photographs may be taken and evaluated in the remote reading centers by experienced ophthalmologists. On the other hand intravitreal injection of single dose of anti-VEGF may replace the more destructive cryotherapy and laser at the treatment aspect. Recent technical and medical improvements may induce major changes at the screening and treatment protocols of PR.

Aim: Post-myocardial infarction ventricular septal defects (PMIVSD) are rare but have extremely high
mortality and morbidity. Mortality rates and risk factors vary in many studies. We aimed to evaluate
the mortality rates and risk factors of ventricular septal defects (PMIVSD) after myocardial infarction
performed in our center .
Patients and Methods: We retrospectively enrolled the patients who underwent surgery for PMIVSD in
our clinic from January 2006 to April 2020 with the age ≥ 18.
Results: A total of 9451 patients admitted to our center with acute myocardial infarction between 2006
and 2020 were examined. Twenty-eight patients operated for PMIVSD were included in the study. Our
PMIVSD rate was 0.296%. When we compare those survivors and non-survivors the only thing which
statistically significant was length of stay in hospital. In survivors it was 13 days when it 2 days in nonsurvivors
group (p<0.001). One patient in survivor group was st ayed in hospital for 107 days.
Conclusion: Timing of the surgery for PMIVSD patients is still challenging. Further strategies like
implanting LVAD or percutaneous devices and waiting for a while before the surgery will be the better
approach for PMIVSD patients.

Aim: We aimed to report our experience of a digital artery perforator flap use in fingertip and pulp defects reconstruction

 Materials and Methods: 8 patients underwent reconstruction with digital artery perforator flap for their finger defects were enrolled in the study. The patients were evaluated in terms of etiology, sex, age, comorbidities and outcomes.  The size of the flaps ranged from 20 x10 mm to 25 x20 mm.

 Results: The average age of the patients was 43,6 (range:19-66) years. 6 of 8 flaps survived completely and healed uneventfully.1 flap was totally lost where as 1 flap had partial skin necrosis.  No patients complained of cold intolerance or residual joint contracture. Mild hooked nail deformity occurred in one of the patients.

 Conclusions:  The DAPF is a reliable and versatile flap for fingertip defect reconstructions in non smoker patients without comorbidities. Single-stage operating procedure, ease of harvest, rapid recovery and preservation of digital arteries are the most important advantages.