Makale Arama

Diagnostic and therapeutic cardiac catheterization attempts have recently been increasing. Numerous complications may develop after cardiac catheterization, including local complications, such as thrombosis, pseudoaneurysm, arteriovenous fistula, bleeding, infection, and distal embolization at the catheter insertion site, as well as complications associated with the anesthetic agents, such as respiratory depression, tachycardia and bradycardia. A total of 120 patients, who underwent cardiac catheterization between June 2010 and June 2012 were retrospectively evaluated. The patients were aged from 9 days to 15 years (mean 3.5±4.2 years) and 58 (48%) were female and 62 (52%) were male. Of the 120 patients, 102 (85%) underwent a diagnostic cardiac catheterization procedure, whereas in 18 (15%) patients an interventional procedure was performed. Complications were encountered in 7 (5.8%) patients, aged from 9 days to 15 years (3.5±4.2 years). There were femoral hematoma in two patients, femoral bleeding in one patient, femoral thrombosis in two patients, bradycardia in one patient, and a patient developed respiratory arrest during sedation (with midazolam). Femoral venous thrombosis, which was seen in two patients, was treated with low molecular weight heparin in one case and with low molecular weight heparin and pentoxifylline in the other. Two patients who developed femoral hematoma underwent local treatment. One patient developed resistant bradycardia, for which a temporary pacemaker was inserted. A patient with femoral hemorrhage was treated with protamine sulfate. One patient, who developed respiratory arrest due to midazolam, was treated with respiratory support. All patients were discharged in a good condition after the treatment. The complications in patients who underwent cardiac catheterization in our clinic, and the risk factors for these complications were analyzed retrospectively. Patients undergoing cardiac catheterization should be closely monitored in terms of possible local and general complications. The incidence of the complications can be reduced by taking appropriate measures. The morbidity and the mortality can be reduced by early diagnosis and treatment of the complications.

Stenoses of the left main coronary artery are considered as significant lesions that cause left ventricular dysfunction and increase mortality and morbidity rates. It has been demonstrrated that surgical treatment is better than medical treatment in these lesions. The early and mid-term results of patients to whom urgent coronary artery bypass surgery performed because of significant stenosis of left main coronary artery were investigated retrospectively. Between 2003 and 2004, 21 patients were operated urgently in our department. The mortality and morbidity rates in these patients were found in acceptable ratios. Urgent surgical revascularization in left main coronary artery stenosis is a safe method and can be preferred as a life saving treatment in such cases.

Cerebral Venous Thrombosis occurs less frequently in comparison to the arterial diseases of the brain. The diagnosis can only be made through imaging techniques and its mortality and morbidity is relatively high. Cerebral Venous Thrombosis can occur due to primary or secondary hipercoagulopathies. İt is known to have a varied clinical spectrum. We evaluated the patients with CVT etiological, topographical, presentational, clinical features and prognosis of the patients whom have been followed by our inpatient clinic years between 2009 and 2013 retrospectively. We examined the demographical features, signs and symptoms, ethiological factors, neuroradiological findings and treatments of 33 patients with CVT. Thirty three patients with CVT (24 female, 9 male) were identified. The average age was 33.4 (range:24-58). The most common symptoms were headache (81.8%) and nausea (48.4%). Focal neurological deficits were observed in 36.3% of patients and impaired consciousness was observed in 6.06% of cases. In cerebral venography examinations single sinus involvement was recorded in 16 patients and multiple sinus involvement was reported in 17 cases. Genetic and acquired coagulopathies, vasculitis and hormonal changes were the most common detected etiologic causes. All patients were treated with anticoagulants. Mortality was observed two patient. The patients with CVT have quite different etiological causes and the risk of mortality and severe disability could be reduced by early diagnosis and treatment.

Because the technique of enucleation and incomplete excisions, 50 years ago recurrence rates after surgical re- moval of tumors, especially pleomorfic adenomas ranged betvveen 21% and 70% . Today, surgery for bening pa­ rotid tumors has evolved into a procedure that is both effective and safe. The advent of facial nerve Identification and preservation with tumor removal with a adequate amount of surrounding healthy parotid tissue, occurred in the early 1940s as a true change in philosophy. The operation, termed superficial parotidectomy, is no w accepted by the majority of otolaryngologists. İn this article 23 patient that had benign parotis tumors was presented. Sur­ gical therapy and techniques discussed vvith literatüre, l/Ve shovv that superficial parotidectomy is the better tec- nique for benign parotis tumors.

Stenoses of the left main coronary artery are considered as significant lesions that cause left ventricular dysfunction and increase mortality and morbidity rates. It has been demonstrrated that surgical treatment is better than medical treatment in these lesions. The early and mid-term results of patients to whom urgent coronary artery bypass surgery performed because of significant stenosis of left main coronary artery were investigated retrospectively. Between 2003 and 2004, 21 patients were operated urgently in our department. The mortality and morbidity rates in these patients were found in acceptable ratios. Urgent surgical revascularization in left main coronary artery stenosis is a safe method and can be preferred as a life saving treatment in such cases.

Hellp Syndrome (Hemolysis-Elevated Liver enzymes-Low Platelets)is characterized by hemolysis, elevated liver enzymes and low platelet count, and related with an increased with an increased foetal and maternal mortality. We aimed in this study to evaluate the morbidity and mortality of 15 Hellp syndrome patients who have been admitted to our intensive care unit, between 2005 and 2009 years retrospectively. Patients ICU admission indications, demographic, clinical and obstetric data was noted down; hemoglobin, serum albumin level, prothrombine time ve active partial thromboplastin time, fibrinogen level, thrombocyte number, total bilirubine ve creatinine levels, AST, ALT, lactate dehidroginase (LDH) levels were analysed. Intensive care unit(ICU)admission of Hellp sydrome patients were convulsion, loss of consciousness, airway control, invasive hemodinamic monitorisation, ARDS, intracerebral hemorrhage and respiration insufficiency During 4 day intensive care unit following of our patients, thrombocyte numbers began to increase from third day of admission. But this increament was statistically significant between admission day to ICU and fourth day. Again similarly AST, ALT, LDH, ürea ve creatinine levels began to decreased at third day and decreament was statistically significant as from fourth day(P

Objective: Feeding gastrostomy is generally needed in the cases of oropharnyngeal dysphagia. The objective of this study is to analyze the use of surgical gastrostomy with mini laparatomy under local anaesthesia in situations where endoscopic procedure is not possible.

Methods: Stamm gastrostomy was performed in 62 patients in whom oral and nasogastric tube feeding could not be given and percutaneous endoscopic gastrostomy could not be performed.

Results: A mean age of 63.7 years and 83.9% of them were ASA IV. The indications for gastrostomy were tumour obstruction, neuromuscular diseases, paralysis and cerebrovascular bleeding, oesophageal injury, metastatic tumours and hypoxic encephalopathy in 51.6, 17.7, and 16.6, 1.6 and 12.9% respectively. The mean operation duration was 34 ± 12.8 minutes. Procedure-dependent hospital morbidity and mortality were low (% 16.2- % 14.5, respectively).

Conclusion: Stamm gastrostomy with mini laparatomy under local anaesthesia is an effective alternative in situations where percutaneous or endoscopic procedures cannot be done. It can be performed in high-risk patients safely due to its short operation time, low morbidity and mortality.

Obesity surgery is a highly effective method on ensuring a maintained weight loss. Following the obesity surgeries, while there are complications specific to type of the surgery, early or late complications also can be seen. In our study, we aim to present the determined complications during or post surgery on patients who were conducted bariatric surgery due to morbid obesity.Bariatric surgery was conducted on a total of 361 patients. Of these patients, 207 (57.3%) laparoscopic sleeve gastrectomy (LSG), 38 (10.5%) laparoscopic Roux-n-Y gastric bypass (LRYGB), 32 (8.8%) Rouxn-Y gastric bypass (RYGB), 32 (8.8%) mini gastric bypass (MGB), 28 (7.7%) laparoscopic mini gastric bypass (LMGB), 21 (5.8%) sleeve gastrectomy (SG), 2 (0.5%) vertical banded gastroplasty (VBG) and 1 (0.2%) intragastric balloon placement procedures were applied. Anastomotic leak was determined on 2 patients (0.5%) with Roux-n-Y gastric bypass. On 1 patient with SG conducted, a leak through stapler route has occurred. On 1 patient evisceration, on 1 patient a spleen injury during the surgery, on 44 patient (12.1%) surgical site infection were detected. 91% of these patients with surgical site infection had diabetes mellitus. While on patients with laparoscopic bariatric surgery the ratio of surgical site infection was 6.8%, in open surgery this ratio was increased up to 29.4%. Ileus, pulmonary embolism and DVT were developed in 9 (2.4%), 3, (0.8%) pulmonary and 8 (2.2%) patients, respectively. On super obese 2 patients mortality was occurred due to postoperative lung insufficiency. With bariatric surgery, regardless of the surgery technic used there is a possibility of morbidity. Consequently, it must be careful for selecting a morbid obese patient and during the treatment in terms of complications.

The aim of this study is to analyse the results of diagnosis and treatment of esophageal foreign bodies which may cause mortality and morbidity. 27 patients who had rigid esophagoscopy with the diagnosis of esophageal foreign bodies in our clinic between May 2011 and September 2012 were evaluated according to age, gender, the complaint at the arrival, the type and the localization of the foreign bodies, additional treatments and time of hospital stay retrospectively. Of 27 patients included in this study; 12 (44,4%) were male and 15 (55,6%) were female. Mean age was 16,1. The complaints at arrival were sore throat in 10 (37,1%), dysphagia in 9 (33,3%), hypersalivation in 5 (18,5%) and dyspnea in 1 (7,4%) whereas 2 (7,4%) patients had no complaints. Esophagoscopy didn’t show any foreign bodies in 4 (14,8) cases and most of the foreign bodies detected in esophagus were bones (n=11) and metal coins (n=7). Mean time of hospital stay was calculated as 1,55 days and there was no mortality. Early diagnosis and treatment of esophageal foreign bodies is essential to avoid from serious and fatal complications which may ocur. An early performed esophagoscopy is the reliable and effective treatment method for this purpose.

The part of population over 80 years old has increased in the last decades. Older population constitiutes major part of patients with cardiovascular diseases. The mortality, the morbidity and the frequency of acute coronary syndromes rise as the age of patients increases. The data related with the benefit of primary coronary intervention for old aged population is limited.Here we present 97 year old patient who applied with inferior myocardial infarction at the second hour of his chest pain and underwent to primary percutaneous intervention successfully. We wanted to discuss the current literature pertinent with our case.

Diarrhea goes on to be an important reason of morbidity and mortality in childhood. Rotavirus infections are among the most common casues of severe gastroenteritis in infants and small children. Secondary bacteremia cases after rotavirus have been rarely reported. An eight month of boy was hospitalized due to rotavirus gastroenteritis and moderate dehydration. After his symptoms resolved with intrevenous hydration and probiotic sachet, fever and deteriotation in general condition were realized on the third day and sepsis was diagnosed. He was monitorized in Intensive Care Unit and started ceftriaxone, amikacine, and vancomycine empirically. His blood culture grew Klebsiella oxytoca which was sensitive to ceftriaxone and amikacine. Vancomycine was stopped and other antibiotics were given for totally 14 days. He was discharged when recovered completely. Bacterial sepsis secondary to rotavirus is an important clinical situation. Fever lasting more than 48 hours or fever rising after remission should be alarming. The importance of rotavirus vaccination should be emphasized because of its probable protective effects on disease complications.

Aim: To highlight the neurovascular complications of hemodialysis and discuss the therapeutic approaches with the relevant literature. Case Report: A 19- year old man on maintenance hemodialysis who admitted to our clinic with intracerebral hematoma is discussed. Conclusion: Neurovascular complications are being recognised as the major causes of mortality and morbidity in hemodialysis patients. Prevention of neurovascular complications of uremia and accelerated hypertension requires the cooperation of both the neurologists and nephrologists.

Trauma is stili an important mortality and morbidity cause among the young population in the world. Therefore, trauma should be seriously considered in view of medical and social factors. İn this study, it was aimed to inves- tigate the types of trauma in respect to reasons, and to provide data to epidemiologic Information of our country. Between January 1999 and December 1999, totally 2850 cases with trauma [(2051 male (72%) and 799 female (28%)] applied to Emergency Department of Selçuk University, Meram Medical Faculty, were analyzed retro- spectively. AH cases were evaluated according to their sex, age, type of trauma, time of trauma, the duration betvveen the onset of trauma and application time to the Emergency Service, and type of transportation. 2332 (82%) of cases were aged betvveen 0 and 40 years. 1593 (55.9%>) of the cases had trauma due to car-crush. Only 885 cases (31.1 %) were transferred to Emergency Service vvithin 1 hour. Most of the trauma occurred on Sundays (n=467, 16.4%), and in June (n=342, 12%>). The most frequent reason of the trauma was found to be fail (50.5%). İt was concluded that, in the organisation of trauma, the vvounded subject should be transferred to the nearest trau­ ma çenter, according to the degree of his/her trauma.

The cavernous sinus thrombosis is a very rare and life-threatening condition. The mortality rate remains high, and significant morbidity includes residual cranial nerve palsies and blindness. The causes of cavernous sinus thrombosis are infectious or aseptic. We report well-progressed a rare case of aseptic thrombosis of the cavernous sinus in an older patient.

Endoscopic retrograde cholangiopancreotography (ERCP) is commonly used for diagnosis and treatment in pancreatic and biliary diseases. Although it is a commonly used and safe procedure, it can also be related with several complications. These complications are generally mild, but few of of them may cause severe morbidity and mortality. We present a rare complication of ERCP with bilateral pneumothorax, extraluminal abdominal air, retroperitoneal and wide subcutaneous emphysema. The patient was transferred to intensive care unit (ICU). As a result; because of these rare but mortal complications, ERCP must be performed in departments which can be supported by intensive care units.

Invasive candidiasis is responsible for about 10% of nosocomial sepsis and it continues to be significant cause of serious morbidity and mortality in very low birth weight infants. Alhough the informations about the antifungal drugs which used for Candida species are increasing, studies and conclusions about the efficacy and safety are still insufficient. Most of the studies have focused on the pharmacokinetic and pharmacodynamic evaluations and obtained from adult patients. However, efectiveness of the therapy can not be same in newborns due to the different pathophysiology of neonatal candidiasis in newborn, the inferences can not be considered from adult studies. Until now, amphotericin B deoxycholate, fluconazole and micafungin seems to be effectivev therapy for the treatment of neonatal invasive candidiasis. Herein, the medical literature has been scanned and compiled with the latest information about the use of antifungal agents in newborn.

Premature rupture of membranes (PROM) is frequently encountered problems in obstetric practice and PROM is effecting perinatal outcomes. Premature rupture of membranes is associated with 20% to 30% of all preterm births. The prognosis is related primarily to gestational age at presentation and delivery. Appropriate treatment must be applied after patients were evaluated carefully, especially about gestational age and presence of infection. Preterm premature rupture of membranes (PPROM) is a major cause of perinatal morbidity and mortality and the most difficult problem for obstetricians. This reason, diagnosis, treatment and management of PPROM is very important. Diagnosis, treatment and management of PPROM is often discussed, but stil no consensus. In this review, we aimed to discuss how to approach with the support of current literature to problems we faced on PROM management.

Obesity hypoventilation syndrome (OHS) is a reason of hypercapnic respiratory failure (HRF) and early death. In this study, the laboratory and clinical characteristics of 29 female patients who did not have obstructive pulmonary disease and admitted to pulmonary medicine intensive care unit due to HRF were evaluated. The mean age of the patients was 63.6±17.3 and polysomnography was applied to all of them. The mean body mass index (BMI) of the cases was 41.7±9.4. According o all night polysomnography the mean apnea-hypopnea index was 38.8±29.1, arousal index was 34.6±26.1 and the mean night saturation was 66.5±8.8. BIPAP/CPAP was given to 23 of 29 cases to use at home. The BIPAP titration of the patients demonstrated a mean IPAP of 15.1±1.3 cmH2 O and a mean EPAP pressure of 8.25±1.6 cmH2 O. In conclusion, it was observed that NIV is a therapy that decreases the morbidity and mortality in cases with OSH.

Aim: The aim of this study was to evaluate the demographic characteristics, emergency care needs and prognosis of patients aged 65 years and older who presented to our Emergency Medicine Clinic with abdominal pain for a period of one year.

Patients and Methods: In this single-center, retrospective, observational study included patients aged 65 years and older who presented to the emergency department with abdominal pain between June 15, 2015 and June 14, 2016. The related variables were recorded from the patients' electronic and written files. The general patient population and the differences of variables in the 65-74 age group, 75-84 age group and ≥85 age group were investigated.

Results: A total of 1330 patients were included in the study. The mean age of the patients was 75.2 ± 7.2 years and 582 (43.8%) were male. While 58.8% of the patients were discharged from the emergency department, the most common hospitalization wards were General Surgery (14.1%) and Gastroenterology (11.4%). The ICU admission rate increased with age (p<0.001; 3.3% - 5.8% - 11.6%). The mean length of stay in hospital was 5.9 ± 7.1 days and the in-hospital mortality rate was 3.4%. While 50.1% of the patients in the 65-74 age group were discharged from the emergency department without consultation, this rate decreased to 36.6% in the ≥85 age group and the difference was statistically significant (p<0.001). Abdominal ultrasound was performed in 34.1%, abdominal tomography in 20.0% and both of them in 7.5% of the patients.

Conclusion: The patients aged 85 years and older with abdominal pain are more likely to be characterized by more examination needs, more consultation needs, more hospitalization rates and higher mortality rates. Taking these differences into consideration during the management of the elderly patients with abdominal pain in emergency department will help to reduce morbidity and mortality rates while improving patient care quality.

Burns pose a major problem for the community because of mortality and morbidity they cause. Nursing management of burn patients includes medical care and psychological support of burn patients and their families. Optimal care of burn patients requires a multidisciplinary team approach. Nurses are the coordinator of all the patient care activities. This compilation includes published articles about the importance of nursing process in burn patients and nursing diagnosis samples.

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.

Aim: Atherosclerotic heart disease is the most causes of morbidity and mortality in chronic renal failure patients. We compared CAPD and HD patients for cardiovasculer disease (CVD) risk factors and increased mean carotid artery intima media tickness (MCIMT) that results early atherosclerosis. Method: 25 HD patients (12 M, 13 F, mean age 42.3 11.4 year, dialysis time 32.6 19.5 month) and 28 CAPD patients (10 M, 18 F, mean age 41.8 9.5 year, dialysis time 25.5 22.1 month) in our clinic were included to the study. All patients bilateral carotid arteries examined by B mode ultrasonography and measured MCIMT. Patients with diabetes mellitus and more than 10 years undergo dialysis excluded. Results: In HD patients homocystein level and MCIMT are higher when compaired with CAPD patients. (in order p=0.012 and p=0.011). But in CAPD patients plasma total cholesterol and triglycerid levels are higher than HD patients. (in order p=0.001 and p=0.008) There is a positive correlation between MCIMT and homocystein level in HD patients (p=0.001, r=0.677) but not yet in CAPD patients. Conclusion: In CAPD patients MCIMT; early sign of atherosclerosis and homocystein level are lower. CAPD may be more advantageous and defender for atherosclerosis with renal replacement therapy patients.

In this study, we evaluated the first open heart operations performed in our clinic. Between August 2005 and June 2011, a total of 550 patients (318 male, 232 female; mean age 58,35 years) underwent open heart surgery in our clinic. Preoperative mean ejection fraction was 36,8% (20 to 65). Diagnosis of patients were as follows: 397 cases had coronary aryery disease, 114 cases had valvular heart disease, 19 cases had congenital heart disease, 17 cases had aortic pathology and 3 cases had left atrial myxoma. Major comorbidities were hypertension, diabetes mellitus and chronic obstructive lung disease. Mean intensive care unit stay was 2,1 days (1-17), whereas mean hospital stay was 6,7 days (4- 23). Total complication rate was 28,54% with 157 cases. The most common postoperative complication was atrial fibrilation with 57 (10,36%) cases. Low cardiac output in 23 (4,18%) patients, wound infections in 16 (2,9%) patients, temporary neurologic disorder in 13 (2,36%) patients, renal failure in 10 (1,81%) patients and mechanical ventilation requirement in 6 (1,09%) patients were observed in hospitalization period. Reoperation was used in totally 45 (8,18%) cases due to hemorrhage (n=41) and sternal dehiscence (n=4). Total mortality rate was 5,63% with 31 cases. The most common cause of mortality was low cardiac output. This study demonstrated that open heart surgery has been performed successfully in a state hospital despite the all difficulties. We think that our mortality and morbidity rates are acceptable and similar to current literature.

In the course of infectious diseases in children, hematopoiesis and coagulation systems may be effected as a result of several pathological mechanisms. Some hematological problems may occur especially in infection term or in post infection term as a complication. Selection of an appropriate approach to hematological problems as well as infection treatment may be useful to reduce mortality and morbidity related to infectious diseases in children. In this review, hematologic manifestations of infectious diseases in children were evaluated in detail.

Postpartum hemorrhage (PH) is responsible for 25-30 percent of maternal deaths worldwide. PH is the most important reason of maternal mortality and morbidity in developing countries. The most frequently reason of primary PH is uterine atony (UA). Approach for uterine atony starts with large intravenous and urinary catheterization. For the patients who don’t respond medical treatment, uterine tamponade, compression sutures, if necessary uterine artery ligation-embolization or hypogastric artery ligation is applied. The last and the most unwanted procedure is hysterectomy. Urgent peripartum hysterectomy rate is about %0.020-%0.509. We observed that Christopher B Lynch used sutures for uterus for not to perform hysterectomy and this technique is sited as B-Lynch technique in literature. After this procedure, by using different sutures for uterus to avoid hysterectomy, various suture techniques are tried to be defined. In this case series, we shared data of uterine atony hemorrhage control which was provided by use of fundal serosal plasental field suturation for 5 uterine atony cases ,who don’t respond classical modalities.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. For many patients, maximal therapy for COPD produces only modest or incomplete relief of disabling symptoms and these symptoms result in a significantly reduced quality of life. Despite the high morbidity and mortality associated with severe COPD, many patients receive inadequate palliative care. There are several reasons for this. First, patient– physician communication about palliative and end-of-life care is infrequent and often of poor quality. Secondly, the uncertainty in predicting prognosis for patients with COPD makes communication about end-of life care more difficult. Consequently, patients and their families frequently do not understand that severe COPD is often a progressive and terminal illness. The purpose of the present review is to give knowledge regarding palliative and end-of-life care for patients with COPD. Recent studies provide insight and guidance into ways to improve communication about end-of-life care and thereby improve the quality of palliative and end-of-life care the patients receive. Two areas that may influence the quality of care are also highlighted: 1) the role of anxiety and depression, common problems for patients with COPD; and 2) the importance of advance care planning. Improving communication represents an important opportunity for the improvement of the quality of palliative and endof-life care received by these patients.

We aim to evaluate the new cavity appropriate suture application in 7 patienst with uterin atony (UA) in our clinic. We applied the new cavity appropriate suture in 7 patienst with uterin atony via 1 no vicryl suture in Meram Medical School Hospital Department of Obs&Gyn. In 3 patients with normal vaginal delivery with postpartum hemorrhage and in 4 patients delivered by cesarian section atony occured. In 3 patients of 7 the plasenta was fundus -lying ,in 4 of them it was plasenta previa. Bleeding control was done in all of them. There was no complications in any of them. Patients discharged on an average 3.95 days. Menstruation syclus restored on an average 18 -24 months in theese patients. Uterin atony has a serious morbidity and mortality. In this pathology the risk of mortality, morbidity and hysterectomy is high. İn 7 patients with uterin atony we observed the bleeding stopped with our new tecnique. We observed no serious complication. No patient underwent hysterectomy

In this article, we researched 87 patients in our clinic with primary bronch carcinoma for diagnosis and treatment methods. Seventy-five of the cases were men (86.2 %) and 12 of them (13.7 %) were women. 72 of thern smokers of different numbers and times. 15 of the cases were passive smokers. Most of the patients were applied often 5 or more months that the symptoms began because of the patients' uneducation and the physicians uncare. In our research, the best diagnostic technic is the endoscopy and biopsy together in 69 cases (79.3 %). Thoracotomy were applied in 25 cases. We couldn't know about the 5 years survey because the patients never come to control. The mortality rate was 4 % with 1 death.

Abstract

Aim: Respiratory infections caused by PIV are related to major morbidity and hospitalization rates in infants and young children. The aim of the present retrospective study is to investigate the rate and seasonal distribution of PIV infections in pediatric patients with lower respiratory tract infections.

Patients and Methods: Nasopharyngeal swab specimens of pediatric in- and outpatients with the diagnosis of lower respiratory infection were collected from various pediatric clinics between January 2014 and December 2016. PIV types 1, 2, 3 and 4 were identified by multiplex real time PCR method.

Results: One of the four PIV types was identified in 224 of 1983 nasopharyngeal swab specimens of patients aged less than 18 years (11.3%). PIV-3 was the most common agent among the subtypes (75%) followed by PIV- 4 (15.2%). The rate of PIV-1 and PIV-2 were 5.8% and 4%, respectively. Of all pediatric patients, 75.9% were under 5 years of age. When the seasonal distribution was examined, it was determined that PIV-3 was frequently observed in summer (53.6%), whereas PIV-1 and PIV-2 were observed in autumn and winter months.

Conclusion: PIV-3 was the most common subtype. Prompt identification of PIV by multiplex real time PCR method would be very helpful for clinicians in the treatment and prevention of the respiratory infections caused by viral pathogens.

This study was undertaken ta determine the safety af prognostic inflammatory and nutritional index (PINI) as an indicator of metabolic response to surgical stress, and whether there is a relationship between PINI and post-operative morbidity in children. Thirty-two patients who were performed appendectomy were enrolled in the study. Of the pafients 17 had acute appendicitis (Group 1) and 15 had gangrenous or perforated appendicitis (Group 2). Serum albumin (AL), prealbumin (PA), c-reactive protein (CRP) ve alpha-1 acid glicoprotein (AGP) values were measured pre-operatively (-1), on postoperative day 1 (+1), and postoperative day 3 (+3) in all patients. Mean PIN1-1, PINI+1, and PIN1+3 values were calculated by using these parameters. In grup 1, mean PINI-1, PINI+1, and PIN1+3 values were fonud 5.6±3.9, 15.6±7.8, and 5.8±3.6, respectively (p< 0.0001). In group 2, the same values were 25.2±16.4, 47.2±-28.1, and 43.9±24.2, respectively. The difference between PIN1-1 and PINI+1 was found statistically significant (p<0.0001) while there was no significant difference between PIN1+1 and PIN1+3 (p>0.02) in group 2. Mean PINI values were fonud higher in group 2 compared with group 1, and the difference between two groups was statistically significant (p<0.001). These results suggest that PINI is a cafe and valuable index for determination of metabolic response to sur-gical stress in children, and postoperative follow-up of surgical patients.

Nt. N (native nephrectomy) is not a frequently performed procedure following transplantation because the kidneys have important endocrinal functions in the organism. Therefore, native kidneys should not be displaced following transplantation. A 48-year-old female patient presented to the ER (emergency room) with complaints of abdominal pain, nausea, vomiting and fever. The patient’s history revealed that she had undergone cadaveric renal transplant about 30 months ago. Examination showed that there was comprehensive sensitivity and rebound all about the abdomen. Her urinary sediment contained an ample amount of leucocytes and erythrocytes. The patient who did not show any improvement regarding the sepsis indications in spite of liquid replacement and appropriate antibiotheraphy was taken into surgery. The patient received bilateral Nt. N from the midline incision. Bilateral Nt. N is a rare procedure. Sepsis and acute abdomen problems brought about by recurrent native renal infections of the patient were successfully treated by bilateral Nt. N . We think that for this case native nephrectomy should have been performed under better conditions before development of sepsis and acute abdomen conditions due to recurrent renal infections.

Patients with cavitary lung lesions have a high ris of morbidity and mortality with prolonged hospitalization. In this study 204 patients who were treated in Selcuk University, Chest Diseases and Thoracic Surgery departments between 1995-2003, are examined retrospectively. There were 142 (70%) men and 62 (30%) women aged from 6 to 77. Definite diagnosis was established by the presence of cavitary lung lesion in chest x ray or CT. Variable of age, sex, etiology and type of treatment, were analyzed. The most common cause of cavitary lesion was tuberculosis (36%). There were 114 (56%) right caviation, 74 (%36) left and 16 (8%) bilateral cavitation 59 (29%) cases were treated by a surgery, while 145 (%71) were treated by medical treatment and observation. Six cases were died due to respiratory failure

Aim: Radiotherapy plays a significant role in the management of head and neck cancers. However, mucositis and xerostomia are the most common side effects in curative treatment. The aim of this prospective, randomized study is to compare the efficacy of zinc sulphate and amifostine in preventation of radiation induced salivary gland damage in head and neck cancer (HNC) patients using quantitative salivary gland scintigraphy (QSGS). Patients and Methods: Thirty patients with HNC who had received radio±chemotherapy were randomly assigned to receive either zinc sulfate or amifostine. All the patients were once a week during RT for oral mucositis using the Radiation Therapy Oncology Group (RTOG) Acute Radiation Morbidity Scoring criteria, and measurement of body weight. Before and 2 months after treatment, salivary gland scintigraphy was performed. Using the time–activity curves, changes in the maximum uptake (UR) and relative saliva excretion rate (ER) between pre- and post- treatment were calculated. The measurements were statistically compared using paired Mann-Whitney U test. Statistical significance was defined as p < 0.05. Results: The protective effect of zinc sulphate on the salivary glands was similar to amifostine and there were no statistically significant difference in UR, ER results at QSGS, oral mucositis or weight loss between the two groups. Conclusion: The effectiveness of both support therapy was compared and there was no significant difference in efficacy. However, because of the cost difference, the use of the zinc sulphate can be an alternative to amifostine for prevention of xerostomia, oral mucositis and other toxic effects. Further studies with more patients and follow-up are suggested in this regard.

Pressure ulcers, a major problem worldwide, cause morbidity and lead to mortality. We aimed to conduct a prospective study which includes incidence of pressure ulcer and risk factors for pressure ulcers in intensive care unit of neurology. Forty-six patients were evaluated according to National Pressure Ulcer Advisory Panel during the ICU period strictly. Age, hospitalization period, mean arterial pressure, pressure ulcer degree, hemoglobin and albumin levels, and comorbidities were evaluated. The incidence of pressure ulcer in neurologic intensive care unit was 15%, and hypoalbuminemia, low muscular strength, and prolonged stay in intensive care unit are significantly high in pressure ulcer group than the control group. Primer prevention of pressure ulcers is one of the major issues in intensive care unit, especially to prevent protein malnutrition.

Sydenham’s Chorea (SC) is a neurological movement disorder that results from antistreptocpccal antibodies cross-reacting with brain tissues, especially basal ganglia and causing to an inflamatory reaction. According to the 1992 modified Jones criteria, acute rheumatic fever is a major criterion and is sufficient evidence on which to base a diagnosis. SC is frequently seen in the 5-15 years of age. It appears approximately 6 months later from the attack of ARF. SC usually continues 4-6 weeks, it may be permanent. Carditis accompanies SC much more frequently than the other signs of ARF. SC is a neuropsychiatric disorder that may present with anxiety, emotional lability, obsessive compulsive symptoms, attention deficit and hyperactivity symptoms or tics. Most of the cases improve spontanously and many treatment are available. Recurence is common. Penisilin prophylaxis should continued to avoid carditis and recurrence. SC is considered to be the most common cause of acquired chorea in devoloping countries. Even though it has been recognized for centuries, it has kept up its importance by periodic exacerbations. SC and ARF are still declining in recent years in our country, together with which is a significant cause of morbidity as a public health problem.

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.

Identification of patients who will deliver prematurely is extremely important to decrease neonatal and maternal morbidity and mortality. The aim of this study was to evaluate the value of cervical length (CL) measurement in predicting preterm birth (PTB) in asymptomatic low risk women. A total of 200 consecutive asymptomatic patients between 16-22 gestational age who had no history of PTB previously were included in this prospective study. CL was measured by transvaginal ultrasonography and the predictive value of CL for PTB was evaluated in this low risk population. The incidence of PTB was 4.5% (9/200). The mean age (±S.D.) of the preterm and term groups was 27.7±6.98 and 24.9±4.47 years, respectively (p=0.222). The CLs at 16-22 weeks were not statistically different between the term group (35.0±4.57 mm) and the preterm group (36.5±6.93 mm) (p=0.887). Cesarean delivery rate was significantly higher in preterm group (p=0.04). Ultrasonographic CL measurement alone has limited value in prediction of preterm delivery in a low risk asymptomatic population. Also there is insufficient evidence to recommend routine CL screening in this subpopulation. Further larger prospective studies are needed to identify patients that may benefit most from such screening.

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.

Pulmonary edema following the obstruction of an upper airway is an uncomman and unpredictable clinical situation. In this case report, it was aimed to discuss the ethiology, pathophsiology, diagnosis and treatment methods of negative pressure pulmonary edema (NPPE) that developed just after the resolution of laringopasm in the patient who underwent to gynecologic operation. Early diagnosis and treatment can affect the mortality and morbidity in NPPE.

Unicornuate uterus with rudimentary horn is the rarest congenital anatomic anomaly of women genital system and usually develops following insufficient development of Mullerian ducts causing many life threatening obstetrical and gynecologic complications unless diagnosed and managed properly. We present a 31 years old patient applied to our clinic with a his-tory of 4 months amenorrhea and progressively incerasing low abdominal pelvic pain. Abdominal sonographic examination revealed a nonviable fetus at 16 weeks of gestation, lying in a rudimentary horn. Elective laparotomy was performed and the unrupture rudimentary horn with a nonviable fetus was totally excised by laparatomy. Post-operative recovery was uneventful. The need for a high index of suspicion and the role of ultrasonography in the accurate diagnosis is highlighted.

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.

Despite advances in nephrology, morbidity and mortality of ESRD patients remain high on hemodialysis (HD). Pre-dialysis nephrologic care (PDNC) might be expected to result in decreased morbidity and better clinical outcome for the first year on HD. In study, CRF patients referred to nephrology clinic (PDNC group, n=28) and those urgently underwent HD (UHD group, n=27) were evaluated for the progress of clinical and biochemical parameters in the first year. At the enrollment, observed differences between groups were: lower Htc ratios (p

AIM: Our aim is to evaluate the rates, indications and complications of cesarean section, to discuss how to reduce rates, indications and complications in Selçuk University Facult of Medicine. MATERIAL-METHODS: VVomen who gave birth in Selçuk University Facult of Medicine Obstetrics and Gynecology Department between 1992-1999 were examined retrospectively. Cesaren rates, indications, complications, mortality and morbidity were evaluated. FINDINGS: Total cesarean rate was % 23.8. 1/3 of this was composed of previous cesarean. Primary cesarean rate was % 25,5. We found an increasing cesarean rate because of previous cesareans with resultant increase in total cesarean rate every year. CONCLUSION: Cesarean rates were increasing every year. Determination of primary cesarean indication more carefully, planning of vaginal birth for previous low seğmeni transverse incisions would decrease cesarean rate.

AIM: Our aim is to evaluate the rates, indications and complications of cesarean section, to discuss how to reduce rates, indications and complications in Selçuk University Facult of Medicine. MATERIAL-METHODS: VVomen who gave birth in Selçuk University Facult of Medicine Obstetrics and Gynecology Department between 1992-1999 were examined retrospectively. Cesaren rates, indications, complications, mortality and morbidity were evaluated. FINDINGS: Total cesarean rate was % 23.8. 1/3 of this was composed of previous cesarean. Primary cesarean rate was % 25,5. We found an increasing cesarean rate because of previous cesareans with resultant increase in total cesarean rate every year. CONCLUSION: Cesarean rates were increasing every year. Determination of primary cesarean indication more carefully, planning of vaginal birth for previous low seğmeni transverse incisions would decrease cesarean rate.

Foreign body aspirations (FBA), which have high mortality and morbidity rate, are common pediatric emergency issues occured in childhood. FBA is seen more frequently among children under 3 years old. If there is no history of sudden-onset choking and cough, it can be ignored and the patient may come with recurrent pulmonary infections and its related complications. In this report, 10-monthold boy patient who was brought with complaints of sudden-onset of cough, vomiting and wheezing after eating a kind of broad bean ( termiye) was presented. Diagnosis was established on the history, physical examination, the chest X-ray and bronchoscopy. The foreign body (termiye) was located in the right inferior bronchus and removed. This case emphasizes that the presence of a foreign body aspiration must be kept in mind in childhood. Because foreign body aspiration is a serious problem that may lead to complications or even to death.

As preterm labor is one of the leading causes of neonatal mortality and morbidity, it is important to determine the pregnant women who are at high risk of preterm labor. In our study, we investigated the importance of maternal serum progesterone levels to predict preterm pregnancy. Two hundred eighty patients with singleton, alive pregnancy between 10-12 weeks were included in our study. We also evaluated serum maternal progesterone levels at 16-20 weeks and presence of vajinal bleeding was investigated. The gestational age was calutated according to the first day of the last menstrual period. Deliveries between 24-366/7 weeks were accepted as preterm delivery, deliveries after 37 weeks were recorded as term delivery. Of all pregnancies %10,4 (n=29) were preterm and % 89,6 (n=251) were term delivery. We did not find any correlation between preterm labor and maternal age, abortion history, smoking history and VKİ. We found correlation between history of vaginal bleeding and preterm labor. The mean of maternal serum progesterone levels between 10-12 weeks was 26.58 ng/ml in patients who had term delivery and 23.9ng/ml in patients who had preterm delivery. Twenty three ng/ml was accepted as the cut-off level, %15 of pregnancies with progesterone below this level were resulted with preterm delivery and above this level only %8 of pregnancies were resulted with preterm delivery. Progesterone level above 23 ng/ml %92 of pregnancies resulted with term delivery ,below this level %85 pregnancies resulted with term delivery. When we use cut off level 23 ng/ml to predict term birth it had 55% sensitivity, 62% specificity, negative predictive value was 92%. Pregnants whose progesterone levels were above 23 ng/ml preterm birth fail from 10,4% to 7%. As a result; if progesterone values between 12 and 14 weeks was above 23 ng/ml we found that pregnancies were resulted as term in 92% of patients. We need wide studies for maternal serum progesterone levels in early pregnancy to predict preterm labor.

Aim: Respiratory muscle weakness is the inevitable consequence of many neuromuscular disorders. Deterioration in respiratory function contributes to significant morbidity and is responsible for high mortality rates with these diseases. The aim of this review to summarize diagnostic and therapeutic approaches for respiratory problems in patients with neuromuscular disorders. Main Findings: Usually, chronic respiratory failure develops slowly over a period of several years. Initially, it presents with disordered breathing that is apparent only during sleep, followed by continuous progression to severe hypoventilation, cor pulmonale and eventually frank respiratory failure in end-stage disease. Early detection of respiratory compromise and preventive care are likely to improve outcome and quality of life for many patients. This has led to the development of proactive monitoring and treatment programmes that include regular assessment of pulmonary functions, respiratory strength and sleep studies, home mechanical ventilation, chest physiotherapy, early antibiotic treatment and nutritional intervention. In particular, noninvasive positive pressure ventilation is effective in resolving respiratory failure and has dramatically changed the management of these patients. Conclusion: Pulmonary functions and sleep related respiratory problems should be followed up regularly in patients with neuromuscular disorders. Noninvasive mechanical ventilation is the most important therapeutic option for the management of respiratory failure in these patients group.

Preoperative evaluation of patients who will undergo surgical intervention is based on the principle of doing harm first (1). The most important factors affecting morbidity and mortality in gypsum surgery are put-. It is the physiological and functional status of the moner and cardiac systems (2). Preoperative examinations are directed towards separating the patients into high or low risk groups, since they cause purple-bidite to determine inoperability from the direction of mortar and thalite.

Aim: Diabetes, which has turned into a pandemic in the twenty-first century, concerns all branches of medicine. This study aims to investigate the prevalence of diabetes unawareness by checking HbA1c in patients hospitalized in clinics other than internal medicine and evaluate the factors associated with them.

Patients and Methods: The study included 630 patients hospitalized outside internal medicine services at or over the age of 18 whose anthropometric measurements could be made. The sociodemographic properties and comorbidities of the patients were recorded. Their anthropometric measurements, fasting blood glucose and HbA1c measurements were made. Those without a known diabetes diagnosis but with an HbA1c value of ≥6.5% were grouped as diabetes unaware. The differences among known diabetes, diabetes unaware and no diabetes  groups  were examined.

Results: The study was conducted between 01.03.2017 and 31.12.2017. The mean age of the patients was 58.04±18.56, while 54.6% (n=344) were male. The number of the patients with known diabetes was 190 (30.2%), 396 (62.9%) did not have diabetes, and unknown diabetes was detected in 44 (7%). Among the 234 patients with diabetes, 18.8% (n:44) had diabetes unawareness. The rate of those under the age of 45 in the diabetes unaware group (11.4%) was higher than that in the known diabetes group (3.7%) (p<0.01). Again, the rate of the male sex was also higher among the same individuals (68% vs 47.9%, p:0.15). The rate of overweight in the diabetes unaware group (56.8%) was higher than those in the known diabetes (37.9%) and no diabetes (39.1%) groups (respectively, p:0.36, p<0.01). There was no significant difference among the three groups in terms of educational levels. The rate of comorbidity presence was higher in the known diabetics (89.5%) than the diabetes unaware group (75%) (p:0.01). All patients with diabetes were evaluated by logistic regression analysis. The male sex, age<45 years, being overweight and absence of a comorbidity were associated with diabetes unawareness.

Conclusion: Undiagnosed diabetes was detected in 7% of the patients. Among all diabetic patients, 18.8% had diabetes unawareness. Conducting diabetes screening with HbA1c in inpatients and paying special attention to those under 45, males, overweight patients and those without comorbidities may help detect unknown diabetes.

This study was retrospectively registered at the Protocol Registration and Results System (Clinicaltrials.gov PRS)  with the registration number NCT04694326.

in this study, the risks of emergency surgical procedures in elderly patients and the effect of surgery on the morbidity and mortality were investigated. The records of 884 patients, those who were 65 years old or elder, and who were operated on in the Department of Surgery, University of Selçuk beetwen May 1991 and April 1997 were analyzed, retrospectively. One hundred eighty three patients (20.7%) were operated on urgently and 701 patients (79.3%) were elective. The ratio of male ifemale was 1.9 (120M/63F) and the mean age was 72.3 (range 65-95) in the emergency operations. Most frequent reason for the emergency operations were intestinal obstruction (49 cases), acute mesenteric ischemia (24 cases) and pepic ulcer perforation (23 cases). Mean hospital stay was 10.8 days (3-51 days) in the emergency and 7.2 days (1-41 days) in the elective operation (p<0.0001). The mor-tality was 18.6% in the emergency and 3.4% in the elective operations (p<0.0001). There was no correlation bet-ween mortality rates in different age groups (p>0.05). The highest mortality was observed in intraabdominal abs-cess and in perforated gallbladder disease. Intestinal resection and anastomosis was performed in 55.9% of expired cases. The majority of the patients (70.6%), who had died, had coexisting cardiopulmonary diseases. The main causes of death in alt patients were sepsis and cordio-pulmonary diseases. The main causes of death in all patients were sepsis and cardio-pulmonary failure. In conclusion, age is not a contraindication for an emergency operation and does not affect mortality which appears to be directly related to the severity and nature of the di-sease and to the coexisting cordio-pulmonary diseases. For this reason, timing is very important in the operations of elderly patients, and it is wise to perform the most conservative operation in some severe surgical conditions.

Incisional hernia is a frequently encountered complication after abdominal surgery and require repeat surgical repair. We were retrospectively evaluated the patients underwent open and laparoscopic ventral incisional hernia repair (LVHR) with Dual Mesh. Between December 2008 and February 2015, age, gender, body mass index, the location and size of the hernia, surgical procedure (open/ laparoscopic), accompanied which other surgical pathology, length of hospital stay, mortality and morbidity rates were obtained and evaluated of the patients who were admitted to our clinic and repaired open and or laparoscopic surgery with Dual Mesh. A total of 28 patients, 15 were female and 13 were male. The mean age was 57.78± 12:39 (38-78) years. 12 patients were operated laparoscopically, remaining 16 with open psurgery. Hernia size was 12.0±2.6 (5-32) cm. The average length of hospital stay was 5.75±5.25 (1-21) days. Except the two surgical site infection and one seroma in both groups, no other complications or recurrences were seen. Ventral incisional hernia repair with Dual mesh at LVHR compared to open surgery was effective and safe treatment option with its short hospital stay and less morbidity.

Fungal bloodstream infections are a leading cause of morbidity and mortalite in the immunosuppressed patients. While Candida albicans remains the predominant pathogen, the proportion of invasive candidiasis caused by other species of Candida continues to increase. In this study the identification of the Candida species isolated from blood cultures and investigation of their susceptibilities against amphotericin B and fluconazole was aimed. Candida strains isolated from 97 patients blood cultures within the time period of July 2009-2011 were included in the study. Identification of the strains, germ tube test, morphological appearance of corn meal-Tween 80 agar medium and API 20C AUX (Biomeriux, France) were used. The most common Candida form was C. albicans (68 %) followed by C. parapsilosis (14.5 %) and C. glabrata (9.3 %). Amphotericin B, fluconazole susceptibilities and Minimum Inhibitory Concentrations (MIC) values were measured with E-test method. All Candida strains were susceptible to amphotericin B. Except the flukonazole resistant one and dose-dependent susceptible six C.glabrata isolates, non of Candida isolates were resistant to fluconazole.

Meningococcal infections sometimes leads to meningococceınia and meningiiis which cause high rnortality and morbidity. in recent years, as observed elsewhcre iıt ihe world, in our region the number of patients with meningococcal disease are seriou.sly being increased. in this study, 63 patients with meningococcal disease were evaluaied at the Selçuk University Research and Training Hospital.

Aim: Pulse wave velocity (PWV) and augmentation index (AI) are indicators of arterial stiffness and non invasive methods of detecting the severity of vascular injury. This study included large sample size and evaluated PWV and AI in chronic hemodialysis (HD) patients to detect the related risk factors. Method: 881 patients on chronic HD program (44% females) were included in this study. PWV and AI of the patients measured by single operator using pulse wave analysis device (Sphygmocor). Pulse wave was measured from carotid-radial distance. Aortic AI was obtained from aortic pulse wave forms derived from radial artery .for all patients, left ventricular geometry was evaluated by echocardiography and volume status was evaluated by bioimpedence device. Results: The average PWV in patient group was 10.0± 2.5 m/s, average AI was 27±11%. AI -HR75, the heart rate corrected form at 75 beat/minute of AI was found to be 29±11%. PWV and AI were found above limit value in 29% and 67% of the patients respectively. A positive relation was found between PWV and AI. when patients with high and normal AI were compared, albumin values were lower while average blood pressure values, cardiothoracic ratio(CTR) were higher and ejection time longer in patients with high AI. AI had a negative relation with height and weight. AI 75 was also negatively related to height and weight. In patients with high AI75 Araştırma Yazısı 151 more patients had left ventricular hypertrofy (LVH). Male patients percentage and average blood pressure was higher in patients with high PWV. In the analysis of PWV of the subgroup (n:408 patients), evident interdialytic weight increase was present in the group with PWV of ≥ 11.5 m/ sc compared to the group of < 8.5 m/sc. Conclusion: measures that can be used to evaluate vascular stiffness like PWV and AI are related to average arterial blood pressure, cardiothoracic ratio, hypoalbuminemia, interdialytic weight increase. We think that the relation between these parameters and cardiovascular morbidity and mortality will become clear in the follow up of our hemodialysis patients.

Mediastinoscopy is a widely used technique in the diagnosis of staging of lung cancer and primary and secondary mediastinal disease. İt was reported that mediastinoscopy was greater than sensitivity of %75 and specificity of % 90. We retrospectively revievved 24 mediastinoscopy performed in our clinic betvveen January 1999 and December 2002. There were 17 men and 7 women aged from 24 to 77 (mean age 57 years ) and the duration of operation was 30- 60 minutes. Eight patients had mediastinoscopy for the staging of lung cancer and sixteen patients for diagnosis of mediastinal mass. İn 3 of 8 patients N2 and N3 disease was identified. İt was suggested that these patients were inoperable. İn six- teen patients with mediastinal disease, sarcoidosis was diagnosed in 5 patients, non small celi lung cancer in 4 patients, tuberculosis in 4 patients, lymphoma in one patient, lung fibrosis and reactive lymph nodes in two patients. There were no complications and mortality in our cases. We conclude that mediastinoscopy is highly effective and safe procedure in the diagnosis of mediastinal diseases and staging of the lung cancers.

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The main aim of the study was to evaluate differences in conventional and tissue doppler echocardiographic parameters in patient with acute pulmonary embolism (PE). Our descriptive and cross-sectional study population included 29 healthy voluntary controls and 54 patients with diagnosis of acute PE who were admitted to Selcuk University, Meram School of Medicine Hospital between January 2010 to July 2010. Two-dimensional and doppler echocardiaographic parameters, tissue doppler parameters were recorded and these parameters were compared between patient and control groups. There was not statistically significant difference between two groups with regard to demographic features and comorbidities. Right ventricular (RV) ejection fraction (EF) was detected to be significantly lower (46.2 vs. 60.5; P<0.001), whereas systolic pulmonary artery pressure was found to be significantly higher (45 mmHg vs. 24.7 mmHg; P<0.001) and inferior vena cava (IVC) collaps index was also found to be significantly lower (0.36 vs. 0.62; P<0.001) in patient group. RV myocardial performance index (MPI) values were evaluated by pulsed wave tissue doppler technique and significantly increased in acute PE group compared to control group (0.53 vs. 0.43; P<0.001). Furthermore, RV E/Em was found significantly higher (6.5 versus 5,0; P=0.04) and RV isovolumetric relaxation time (IVRT) was significantly prolonged in acute PE group compared to control group (67 msec vs.57 msec; P<0.001). Especially RV EF, IVC collaps index, Sm, MPI, E/Em can be used as different echocardiograhic parameters for the diagnosis of acute PE.

Idiopathic pulmonary arterial hypertension (IPAH) with an incidence of 1-2/million per-year. IPAH is a term used to define a variety of progressive conditions that have in common, increased pulmonary vascular resistance leading to right heart failure and death. Pulmonary arterial hypertension is presented with cyanosis, polyctemia and right heart failure. Increased prevelance of mortality is due to progression and late diagnosis of the disease. We present this case to alert physicians to keep in mind rare but serious disease IPAH in the differential diagnosis of polyctemia.

German measles (rubella) is a viral disease characterized by rash, fever and lymphadenopathy in children and adults. This disease is passed with mild symptoms in childhood, if the virus passes to the fetus during pregnancy, it leads to congenital rubella syndrome and can lead to many anomalies. The purpose of this study was to determine the seroprevalence of rubella IgG antibodies in women of marriage-age. In this study, Rubella IgG antibodies were investigated in the serum of marriage-age women who had attended to step one health care provider for premarital tests, prospectively. Tests were performed by Electrochemiluminescence immunoassay (Cobas, Roche, Almanya) according to the manufacturer’s recommendations. 963 women who were between18-25 years old in marriage age were included in this study. Rubella IgG antibodies were positive in 929 (96.5%) and were negative in 34(3.5%) of them.The seroprevalence of rubella have been found to be high in Konya. Immunity continues during lifetime in individuals who suffered from infection but women in marriage age who had not been infected and unvaccinated are at risk. Vaccination of women attended for premarital tests may reduce morbidity and mortality associated with congenital rubella syndrome.

Aim: The aim of this study is to evaluate the versatility of the use of FDMA flaps in soft tissue defects in
the fingers.
Patients and methods: Patients who underwent reconstruction due to soft tissue defect in the upper
extremity between May 2018 and May 2021 were scanned over the file. Among these patients, patients
who had a finger defect and were reconstructed with the first dorsal metacarpal artery flap were included
in the study .
Results: 12 patients were included in the study. The etiology of the defect was trauma in all patients.
Tunneling technique was used in 5 patients for flap adaptation. No patient experienced total flap or graft
loss. Age, gender, comorbidity, defect localization, defect size and operation time were examined in terms
of complications. No statistically significant difference was detected. Smokers and non-smokers were
examined, no statistically significant difference was found. The use of tunnel for flap adaptation did not
make a statistically significant dif ference in terms of complications.
Conclusion: First dorsal metacarpal artery flap is a very reliable option for defects in the 1st and 3rd
fingers. If the tunnel technique is used, it should be ensured that the tunnel width is suf ficient.

\r\n Prognostic importance of thrombocyte indices in children with carbon monoxide poisoning

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\r\n Objective: Carbon monoxide (CO) poisoning is still being a major cause of morbidity and mortality all over the world. Although the role of platelet functions in CO poisoning is not clear, increased platelet activation and aggregation had been reported previously. Increased thrombotic tendency due to endothelial damage, increased platelet stickiness, and alterations in the fibrinolytic pathway occurs in CO poisoning. The aim of our study was to determine whether platelet indices provide clinical benefit or not in children with CO poisoning.

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\r\n Materials and Methods: We retrospectively reviwed the records of children with the diagnosis of CO poisoning who admitted to the pediatric emergency departments of Konya Beyhekim State Hospital and Necmettin Erbakan University Meram Medical Faculty. A total of 92 children with CO poisoning and 62 age- and gender-matched healthy controls were included in the study.

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\r\n Results: While mean platelet volume (MPV) and platelet distribution width (PDW) levels were significantly higher (9,34±0,55 vs 9,78±0,97fL, p=0.001 ; 11,46±2,64 vs 10,57±1,41, retrospectively, p=0.007), platelet count and plateletcrit (PCT) (324,05±82,07 vs 357,27±89,70 x10⁹ p=0.015 ; 0,31±0,06 vs 0,33±0,07, retrospectively, p=0.039) were significantly lower in patients with CO poisoning. MPV levels were also significantly higher in patients with a carboxy hemoglobin (COHb) level higher than 20, when compared with COHb levels between 10-20 (9,40±0,84 vs 10,08±1,22 fL, p=0.003).

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\r\n Conclusion: Our results showed that platelet indices MPV and PDW are markedly elevated in patients with CO poisoning while platelet count and PCT were decreased. MPV and PDW levels, which reflect the changes in platelet activation and function, may predict the development of especially thromboembolic complications in the course of CO poisoning.  MPV and PDW levels may be useful in prognostic estimation of CO poisoning.

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\r\n Keywords: carbon monoxide; children; platelet indices; poisoning

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Most pancreatic injuries are minor and can be treated by external drainage. CT represents the best noninvasive diagnostic method for the detection of pancreatic injury, with sensitivity and accuracy of at least 80%. Morbidity and mortality rates for isolated pancreatic trauma are directly related to the presence of damage at the pancreatic duct. This article is based on 4 patients who have applied to our Department of General Surgery in Ümraniye Training and Research Hospital between April 2009 and December 2011. Three of the patients were men, and one of them was woman. The average age of the patients was 22 (17-28). Two of them have undergone surgery and drainage. Two patients have been treated with conservative treatment. Pancreatic fistula was seen in two patients. External drainage and conservative treatment are effective treatments for the low grade pancreatic injuries.

Aim: We aimed to report the long-term results of the patients undergone posterior preperitoneal tension-free mesh hernioplasty operation for inguinal hernia. Patients and Methods: IVe icnluded in this study 624 patients undergone posterior preperitoneal tension-free mesh hernioplasty operation for inguinal hernia betvveen October 1992 and June 2000. The patients were invited for control in the first and third postoperative months and yearly. The patients who did not come to control were asked by telephone and letter if they had any recurrences and problem with their operation. The patients lost their communication with us after the operation were excluded from this study. The patients were examined and evaluated for urinary retention, bleeding, spermatic cord edeme, wound infection, neuralgia and recurrence in the early and late postoperative periods. Results: 584 of the patients were men and 40 were women. The patients were follovved 37.4 months (range: 6-108 months) after the operation. We found 1.8% recurrence, 0.3%> bleeding, 2.7%> infection, 4.2% spermatic cord edeme, 0.6% neuralgia and 0%> urinary retention ratio. Conclusion: We concluded that, posterior preperitoneal tension-free mesh hernioplasty operation is a safe method with low morbidity and recurrence rate in inguinal hernia repair.

The aim of this study is to report our surgical results in ventricular septal defects. Between 2001 and 2009, 92 patients with ventricular septal defect underwent surgical correction in our center were included in this study. Additional cardiac defects were pulmonary hypertension in 27 (29.3 %) patients, patent ductus arteriozus in 10 (10.8 %) patients, Down Syndrom in 7 (7.6 %) patients, and aortic regurtation 5 (5.4 %) patients. Defects were closed with Dacron patch using separately sutures. Early mortality was developed in 5 (5.4 %) patients. 65 patients were followed for 6.1 years. Residual VSD was detected in 3 patients and one of them underwent secondary operation. There was no complet atrioventriculary block. 1˚- 2˚ degree aortic and tricuspit regurtation were not operated and included in our follow up programme. We hope to perform surgery for ventricular septal defect with low mortality and morbidity as a new Middle Anatolian center.

Tracheobronchial foreign body aspiration is a common and lifethreatening problem in childhood and adulthood and an important cause of childhood morbidity and mortality. Recurrent respiratory tract infections may be due to foreign body aspiration. Aspirates includes frequently; toys, coins, beans, nuts, peanut, kernel, dried legumes, and sugars in children and; food, awn, turban pins, metallic objects and dental prosthesis in the adults, respectively. If foreign body aspiration may caused to complete or nearly total occlusion, in this time the object have to be removed urgently. Although flexible bronchoscopy can be used to remove of foreign bodies in children and adults, rigid bronchoscopy remains the gold standard all the time.

Aim: We used Ligasure vessel sealing system in order to lessen the bleeding while cutting the parenchyma or to have a non-bleeding resection at 15 patients with mass at the liver. We aimed to present the data of the 15 patients where we applied hepatectomy and pericystectomy by the help of Ligasure, as a preliminary study. Material and Method: The records of 15 liver patients for whom we applied hepatectomy and pericystectomy by the help of Ligasure at Selcuk University Meram Medical Faculty of General Surgery Department during 2005-2007, were examined retrospectively. 10 of the patients were liver tumors (4 of them were hemangiomas, 2 were an adenoma and 4 were hepatocellular carsinoma), 3 of them were liver cyst hydatid, one of them was gall bladder Ca and the other was hepatolithiazis. Ligasure vessel sealing system (Ligasure Valleylab®) was used for all cases. Hepatectomy and pericystectomy by the help of Ligasure were applied to the patients. During parenchyma transection, sutures were used for great vessels a one patient. Result: The mean age of the patients was 53.7(32-65) and male/female ratio was 15/17. Mean blood loss was 217(30-700)cc and blood transfusion was not needed accept one case. Mean transection time was 48.93(25-85) minutes. There were no significant increases at biochemical parameters at the postoperative period. There was no morbidity at the late postoperative period. Conclusion: Ligasure application seems to be the precursor of a non-bleeding period at liver transection at them treatment of benign and malignant diseases of the liver

The current study aimed to determine the in our country patients diagnosed peripheral arterial disease (PAD), the relationship with the atherosclerotic risk factors. A better understanding of the risk factors will make it possible to take precautions against the modifiable risk factors, and will facilitate the early diagnosis and implementation of effective therapy. The patients who had been diagnosed with PAD either clinically or by using ultrasonography underwent peripheral angiography for the arteries of the lower extremities. The patients were evaluated in terms of age, gender, and atherosclerotic risk factors. Of the 408 patients, 78.4% were males, and the mean age was 61.5±9.5 years. The patients had the following risk factors: hypertension (HT), 58.3%; diabetes mellitus (DM), 26.7%; a family history of CAD (Coronary artery disease), 15.9%; smokers, 48.2%; hypercholesterolemia, 49.7%. The extent of PAD observed during peripheral lower extremity angiography was associated with atherosclerotic risk factors. Particular attention should be focused on the co-morbidities of PAD. Non-invasive, as well as invasive tests, should be performed when indicated to decrease morbidity and mortality in patients at risk for PAD.

Abstract

INTRODUCTION

Acute mesenteric ischemia (AMI) is an acute abdominal disease which is age-related with possible bad prognosis; and while its morbidity and mortality rate is 10% in early diagnosis and treatment it may progress with 100% mortality when diagnosis and treatment are delayed.The aim of this study was to unearth the efficiency of neutrophil-to-lymphocyte ratio (NLR) which has recently been started to be utilized in the prediction of AMI prognosis and used as a prognostic factor in many diseases.

MATERIALS and METHODS:

The data of a total of 111 patients, who had undergone surgical procedures and diagnosed with mesenteric ischemia intraoperatively at Necmettin Erbakan University Meram Medical School’s General Surgery Clinic between 2005 and 2013 and whose diagnoses had later on been confirmed pathologically, were retrospectively evaluated within the scope of the study.

The demographic data of all patients (age, sex) were recorded. The hemogram results of the patients, analyzed with peripheral blood, were reviewed for preoperative evaluation. The surgical procedure performed, the part and length of the resected bowel based on pathology results, the duration of hospitalization, survey, presence of comorbidity, white blood cell count, creatinine values, and NLR of the patients were determined. The data were statistically analyzed.

RESULTS:

The patients who did not survive had a mean NLR of 24.77 ±10.38, while the same ratio was found to be 17.6±10.65 for survivors. The NLO value was found to be high in cases with mortality.

 

CONCLUSION:

AMI still proves to have high mortality in spite of the developments in imaging techniques and laboratory analyses. There is no specific laboratory analysis for early diagnosis. High preoperative NLR in patients suspected to have AMI may indicate bad prognosis.

Context: Alcohol dependence syndrome is a major problem affecting both individuals and their family. Children of alcohol dependent parents are vulnerable to a host of behavioural problems. Studies in the west have shown both internalizing and externalizing symptoms in these children.

Aims: To assess the psychological functioning in offspring of alcohol dependent parents and its association with severity of alcohol dependence.

Settings and Design: This study was conducted at the Department of Psychiatry of a Tertiary hospital in Bangalore spanning a period of one year. Eighty children aged 11 years - 18 years, along with their alcohol dependent fathers were included.

Methods and Material: Socio demographic details of the parent and the child were collected by a semi structured Performa along with informed consent. Alcohol dependence was diagnosed based on ICD 10 criteria. Severity of Alcohol dependence was assessed using Severity of Alcohol Dependence Questionnaire (SADQ). Psychological functioning of the children was assessed using Youth Self Report Scale (YSR).

Statistical analysis used: descriptive statistics, and Chi-square test

Results: Among 80 children assessed 41 were males and 39 were females. 47.5% of them showed significant internalizing symptoms and 48.7% significant externalizing symptoms. Internalizing scores had higher correlation with girls (P – 0.004) and externalizing symptoms in boys (P – 0.008). However no correlation was found with severity of dependence in the father.

Conclusions: It was found that there was high prevalence of psychiatric morbidity in terms of externalizing and internalizing behaviours in children of alcohol dependent fathers. Thus early detection of these problems and intervention would ensure improved functioning in this group.

Aim: Venous thromboembolism (VTE) events covering deep vein thrombosis (DVT) and pulmonary
embolism (PE) constitute the most important morbidity-mortality cause in obesity surgery. The objective
of this study was to assessment of thromboembolism results in patients who underwent bariatric surgery
with standard dose prophylaxis.
Patients and Methods: The patients who were operated for morbid obesity in our clinic between 2015 and
2019 were retrospectively examined. Cases that had laparoscopic sleeve gastrectomy and were applied
standard dose Enoxaparin prophylaxis were included in the study. Demographic data, preoperative
preparation and postoperative antiembolic treatment conditions of the patients were registered.
Results: Eighty-seven patients who had laparoscopic sleeve gastrectomy were included in the study. 66
(%75,8) of the patients were female and 21 (%24,1) were male. The mean age was 38.7 (18-55). Mean
hospitalization duration was 6.6 (3-69) days. Four patients (% 4,5) had postoperative complication. PE
developed in two patients while leak-related mediastinitis and incisional hernia (%1,1) developed in one
case each.
Conclusion: Despite available prophylaxis methods, VTE constitutes an important morbidity and mortality
cause in patients who had bariatric surgery. While high-dose low-molecular weight heparin (LMWH) use
may cause bleeding, the possibility of VTE increases with using low-dose LMWH. This situation appears
as a limitation of LMWHs. New studies are needed for increased dose at early period and standard dose
application after discharge.

183 cases with supratentorial aneurysm were operated on in Neurosurgery Department, Selçuk University Meram Medical School betvveen March 1987 and September 2002. İn the present study we aimed to discuss 183 intracra- nial supratentorial aneurysm cases, according to their location, clinical features, treatment modalities, mortality and morbidity rates. The series were evaluated through the review of literatüre and presented.

It is a know that morbidity of cardiovascular disorders is high in diabetic patients. Besides obesity and hypertension, increased levels of triglycerides and very low density lipoprotein cholesterol were identıfied among high risk factors in the development of coronary arter disease in patients with abnormal oral glucose tolerance test. In this study, i1 is compared with risk factors and coronary heart disease among the patients with 60 abnormal glucose tolerance test and 60 type-II diabetes mellitus and 60 normal cases. Body muss index is found high in patients with' aıabetes melliıbıç and abnormal glucose tolerance les( It was higı- levels of systolic and diastolic blood pressuı e in patients with diabetes mellitus and abnormal glucose rolerance test. The level of triglycerids and totaı s holesterol and fasting blood sugaı were high in patıenıs with diabetes mellitus and abnormal glucose tolerance test, but it was low level of high density liport.teın cholesterol in both groups. It is identıfied mort ınactivelife standart regarding life style in both Finally these results suggested that the risk tactors of coronary artery disease increased in patients with abnormal glucose tolerance test lıke diabetes mellitus

In pregnant women, trauma is responsible for nonobstetrik maternal-fetal mortality and morbidity. Approach to trauma in pregnancy is similar to non-pregnant women. Approach to patient with considering physiological changes during pregnancy and timely prevention of possible obstetrical complications is significant keeping in mind that these complications may affect maternal mortality and morbidity.

Inguinal hernia operations are frequently performed at general surgery clinics. These procedures can be performed not only under general anesthesia but also with methods like spinal anesthesia, epidural anesthesia, and local anesthesia. Inguinal reparations can be successfully performed with local anesthesia especially on older patients, those with comorbidity and significant risk of anesthesia. An ample amount of studies in literature underline the fact that the results of hernia reparations performed under local anesthesia are no different than the results of hernia reparations done under general anesthesia. This report discusses the case of an 87-yearold male patient with comordid diseases like hypertension, diabetes mellitus, congestive heart failure, and chronic kidney failure as well as irreducible inguinal hernia who had to undergo emergency hernia reparation under local anesthesia. Although inguinal hernia reparation under local anesthesia has been comprehensively evaluated in literature, there is very limited information on the reparation of incarcerated inguinal hernias under local anesthesia. Consequently, we think that it is possible to use local anesthesia successfully to surgically treat incarcerated hernias with low risk of strangulation especially on senior and comorbid patients. However, we also believe that it would be of utmost significance to conduct a comparative study between emergency hernia operations performed under local anesthesia and general anesthesia in order to be able to recommend a safer solution on the subject.

It was been presented 6 massive intestinal resection cases due to acute mesenteric vasculary occlusion in 3 cases strangulated small bowel obstruction in one case, perforated Mediterranean lymphoma in one case and ascariasis in one case between 1983-1987 in Selçuk University Medicine Faculty Alt of them developed short bowel syndrome. Total parenteral nutrition (TPN) was applied up to adaptation for new condi-tion and prevention of and treat the early complications. Five cases were successful, one case died after two months postoperation. The highy early mortality and morbidity rate can be decreased by TPN in short bowel syndrome cases.

Many different aproaches were reported for the reconstruction of columella defects that local flaps through microvascular tissue transfer. There was a columella defects in 22 years old male patient because of the explo- sion of bomb and the reconstruction was not thought by a local flap owing to large scar tissues next to the defect. After the dissectlon of wide adhesion of the septum nasi spongostan tampons were put into new plane. Then 2x1,5 cm diameter skin island flap with angular artery pedicul was prepared on the right nasolabial skin and transferred to the defect in order to the reconstruction of columella. The flap was folded and sutured. İt was made the flap thin by defatting 3 weeks later. The result was acceptable aesthetically. The results and short operative time for this flap were thought us that it is an alternatlve to the microvascular reconstruction and morbidity of the donor area was acceptable.

Psychiatric disorders and psychological stress has been implicated as a potential trigger in onset and exacerbation of dermatological diseases. Additionally, skin diseases have often been found to be associated with anxiety, depression and impaired quality of life. Therefore, it may be considered that there are a reciprocal influence between psychiatric status and skin diseases. Although significant majority of the cases begin before adulthood, limited data are available about relationship between skin disease and psychiatric morbidity in childhood and adolescence. In this article, psychodermatologic disorders in these age groups and our current scientific knowledge on these disorders will be discussed.

Although foreign body embolization is a rare complication of percutaneous coronary intervention, the increase in the number of procedures results in this problem being more frequently encountered by interventional cardiologists. Contemporary case studies have reported the rate of stent stripping to be below 1%. Interventional cardiologists attend to a considerable number of cases in everyday practice and witness a diverse spectrum of complications. Stent stripping can result in severe complications such as emergency coronary bypass surgery, coronary thrombosis, myocardial infarction, cerebrovascular event and death. Thus, the proper management of stent stripping is important for reducing the risk of mortality and morbidity. In this article, we present a case of left main coronary artery stent stripping; we discuss the removal procedure and the complications that arose.

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.

The best known adverse effect of smoking on the unborn baby is the decrease in birth weight (1,2). Ahlsten et al. (3) who conducted research on this subject, mean birth weight of babies whose mothers smoked. found that the average birth weight of newborn babies whose mothers did not smoke was 400 Gni lower than the average. In addition, it has been reported that there is an increase in ablatio placenta, placenta previa, premature birth, perinatal morbidity and mortality incidence among babies of mothers who smoke during pregnancy (1).

167 vascular reconstructive operations have been performed in our clinic using a prosthetic vas-cular graft (Dacron or PTFE) and/or autogenous vein graft between the dates of January 1988 -March 1996. During their follow up in this period 6 graft infection (%3.56) have been developed. Our major treatment protocol in graft infections was to remove the infected graft totally and to use app-ropriate antibiotics according to culture results. Our morbidity was I amputation . In different series incidence of graft infections is reported to he between 1.3 - 6%.

Pelvic fractures associated with blunt trauma contributed significantly to morbidity and mortality.We reviewed 271 patients with pelvic fractures which were treated between March 1985 and Sep-tember 1994 in this study. Tint average age of pa-tients was 26.7 (between 3-70) years. The majority of the patients (%41.3) had one or more associated injuries: 43 with blunt abdominal trauma, 27 with - genitourinary tract injuries, 23 with thoracic in-juries, 22 with head trauma, 4 with neurologic in-juries and 3 with vascular injuries. There were Jive open pelvic fractures. Altough the overall mortality was %5.5 the mortality rate in. unstable pelvic "'Fac-tures was %9.6. The major causes of death in our patients were closed head injury, intra-abdontinal and intro-pelvic hemorrhage. The pelvic .fractures with associated injuries are serious trauma and re-quire more prompt and effective treatment methods.

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.

Although an effective anti-microbial therapy is applied, the infective endocardit, an infection o endocardium, stili keep its mortality and morbidity. Since it progresses with a general infecsion table. the detay of its diagnos plays an inıportant role in the terapy of it. C ardiac failıa-e tachicardia, valves vegetation and embolic phenemens were effective in the prognosis. Observing vegetation at aorta valve on echocardiography was significiant for diagnose and alt the cases had ı'egatation. lklicroorganism wasn't able ro be cultivated in hemoculture. Only in one case, Brucella bakteria was cultivated from vegetation. There cases who were diagnosed injective endocardit and had aorta valve vegetation were examined and compared ith the literature.