Celiac disease is the only life-long continuing food intolerance. This intolerance, caused by gluten, endamages the structure of small intestine and prevents the absorption of nutritional elements. Celiac disease is usually related with other auto-immune diseases. Rate of this disease in our country is increasing in time. It can be seen in people of different ages and different clinical findings. In our day, the most efficient way of treatment is removal of gluten from daily diet. Gluten-free diet that step in treatment phase, affects the living of individual in a period in which growth and development is most rapid. By applying the gluten-free diet strictly, the risk of complications like low bone mineral density and intestine malignite related with the disease, can be decreased. However, it is not always easy to apply and keep track of gluten-free diet by family or child. Moreover, gluten-free diet can cause excess of some nutritional elements (saturated fat), gaining high calorie, and poorness of some nutritional elements (fiber, folic acid, vitamin B ₁₂, iron, zinc, magnesium). Particularly, gluten-free products, when compared with their gluten-including equivalents, have less magnesium, fiber, and folic acid, as well as they are far more expensive. It is determined that a lot of patient considered "resistant" to diet treatment are also eating gluten-including food. Therefore, gluten-free diet should be planned and followed well, and family and child should be educated. This editted article is about, celiac disease, diet treatment for celiac disease, principles of the diet treatment, concordance to the diet, and the factors that effects this concordance.

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Familial Mediterranean Fever (FMF) is characterized by attacks and inflammation of serous membranes. After discovery of MEVF mutations, several studies have been carried out about the effect of genotype to phenotype, a number of them showed relationship between genotype and phenotype, but some of them not. The aim of our study was to investigate the relationship between genotype and clinical features in children with FMF. This study was performed with 131 patients who have FMF diagnosis. The demographic data, clinical findings, mutations were investigated retrospectively. 52.7% of our patients were boys, 47.3% were girls. Distribution of the age of diagnosed was different from age of onset of symptoms (p=0.00). The most frequent symptom was abdominal pain (94.7%) and it is followed by fever (91.6%), arthralgia (65.6%) and chest pain (27.5%). Infection, stress, menstruation and physical training triggered the attack in some patients. Respectively, the most common mutations were M694V (50.4%), M680I (26.7%) and 148Q (11.5%). No mutation was detected in 14.5% of our patients. Nausea and vomiting were less in M694V homozygous patients, and arthralgia was higher in E148Q heterozygous patients (p<0.05). We had 3 patients with colchicine-resistant who were siblings. In our study, a significant relationship between phenotype and genotype was not observed. It is difficult to recognize the disease in infancy period, FMF should be considered in patients with frequently admitted to hospital in order to avoid complications.

The prevelans of prediabetes is increasing over the world. It is estimated that more than 470 million people will have prediabetes by 2030. Prediabetes is defined as intermediate state between normal and diabetic glycaemic values and high risk categories for DM development. Insulin resistance and beta cell dysfuction start with prediabet before marked glucose changes. In observational studies it has been reported that the relationship was found between prediabetes and chronic renal disease, small fiber neuropathy, retinopathy, serebrovascular and cardiovascular disesase. In this review, it was evaluated that the definition of prediabetes and its microvascular and macrovascular complications.

In the Human Skin The efficacy of antimicrobial agents applied to-pically to the skin surface in eradicating coagulase-negative staphylococci (ENS) residing in the skin surface. Five antiseptic solutions (10 % povidone iodine, 2 % iodine, 2 % tincture of iodine, 70 % ethanol, and 0.5 % Chlorhexidine) were applied for 15s with a gauze sponge. The antimicrobial ointments (po-vidone-iodine. silver sulfadiazine, mupirocin, so-dium fucidate, and a double-antibiotic ointment con-taining neomycine, and bacitracin) were applied and covered for 6 th with gauze. After treatment. the surface was sampled. All agents were effective in eradicating ENS from the surface. The antiseptic solutions povidone-iodine. chlor-hexidine and tincture of iodine eradicated surface bacteria in every trial (10 of 10 each), and 2 % io-dine and 70 % ethanol eradicated bacteria from the surface in 9 and 7 of 10 trials, respectively. Four of the five antimicrobial ointments were also effective in the sterilization of the skin sur-face: 1 % silver sulfadiazine was the exception.

In this article, results of 750 cases who underwent choledochus exploration with cholecystectomy or cholecystectomy in our clinic are presented. In 549 (73.2%) of our cases, chronic cholecystitis, 150 (O 20) acute cholecystitis, 34 (4.5%) had gallbladder injury, 9 (1.2%) were due to gallbladder cancer and 8 (1%) , 1) cholecystectomy was performed for other reasons. Common bile duct exploration was performed in 150 cases (20%) for various reasons. Various postoperative complications were detected in 80 (11.1%) of 720 surviving patients who recovered with medical or surgical treatment. 30 of 750 patients died in the postoperative period, with a mortality rate of 4%. 7 (1.2%) of 556 patients who underwent cholecystectomy for chronic cholecystitis with and without stones died.

The purpose of that study is comparing reusuable and disposable dropes’ medical waste and washing expenditures. Sample of definer type study generates 304 case who fallowed at a training and research hospital.Parameters were collected with using “the inspection form of surgial dropes”.The work order of operating room was not interfereted and all cases were choosen randomly.Both drope groups were used in all surgeries which is in group of sample and it was watched by researchers.For practicable study;written written authority was gotten from Ethical Committee of The Selçuk University and Educational Planning and Coordination Committee of Konya Training and Research Hospital.Datas were summerized with number,percent,average and standart deviation. T and ANOVA tests were used on analysis.Findings: The cost of buying medical waste and materials generates the cost of disposable dropes. In case reusuable dropes,washing and sterilization costs on used dropes generate main costs .Resusuable dropes has a cot overrun was determined. Disposable dropes are more cost-effective than the disposable dropes.

Early stage cervical cancers involve stage I and stage IIA. The treatment is radical hysterectomy and pelvic lymph node dissection. Besides the operation can be performed by laparotomy, with the development of laparoscopic technology, the treatment has been started with laparoscopic radical hysterectomy and laparoscopic lymph node dissection. The advantages of laparoscopic approach are less analgesic requirement, minimal postoperative discomfort, shorter hospital stay and faster return to normal daily activities. In this article, a patient was presented having early stage cervical cancer at 30 years old; therefore, applied laparoscopic radical hysterectomy (type III), laparoscopic bilateral pelvic para-aortic lymph node dissection. Also, despite possibility receive radiotherapy, laparoscopic bilateral ovarian transposition was applied due to remove ovaries from radiation area. This operation can not be performed at any center, because it requires advanced experience.

Saccadic eye movernents in reading of a teıt iır Turkish were electrooculographicaily recorded, nd the arnplitudes of the saccades were Tneasured on the electrooculograrns. The relationship between ithe amplitudes of regression saccades and those of the next ()nes was investigated. The results suggested thLıt visual information proces.sing alsa occurs during reading.

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

With the rapid technological advances, ultrasonography (US) has become an important breast imaging procedure in the last decade. In addition to the complementary role to mammography and magnetic resonance imaging, today it has an important place in interventional situations such as guiding needle aspiration, core needle biopsy and presurgery needle localization. American College of Radiology has developed “The Breast Imaging Reporting and Data System” (BIRADS) lexicon to standardize the terminology in the US reports. This lexicon includes the descriptors from several feature categories, the assessment of findings and the recommendation of the action to be taken. Six morphologic features were described for solid breast masses: shape, orientation, margin, lesion boundary, internal echo pattern and posterior acoustic features. Despite the known overlap between benign and malignant features, typical signs of benignity were oval shape, gently lobulation, homogenous hyperechogenity, parallel orientation; typical signs of malignity were irregular shape, antiparallel orientation, noncircumscribed margin, echogenic halo, decreased sound transmission. The purpose of this article was to discuss reliability of these BIRADS US lexicon descriptors in the differentiation of benign from malignant solid masses of the breast.

Lung cancer is the most common among cause of cancer deaths in worldwide. NSCLC represent between 80% to 85% of all the diagnosed lung cancers cases. Systemic chemotherapy for patients with NSCLC has limited impact on overall survival. Patients eligible for chemotherapy should be selected carefully. The aim of this study analyzed prognostic factors for survival in NSCLC patients. We retrospectively reviewed 741 NSCLC patients between 2000 and 2012. Ten potential prognostic variables were chosen for analysis in this study. Univariate and multivariate analyses were conducted to identify prognostic factors associated with survival. Univariate and multivariate statistical methods were used to determine prognostic factors. Among the 10 variables of univariate analysis, three variables were identified to have prognostic significance: performans status (PS), diabetes mellitus (DM) and stage. Multivariate analysis included the 3 prognostic significance factors in univariate analysis. Multivariate analysis by Cox proportional hazard model showed that PS was considered independent prognostic factors for survival, as were DM and stage. In conclusion, PS, DM and stage were identified as important prognostic factors in NSCLC patients. These findings may also facilitate pretreatment prediction of survival and can be used for selecting patients for treatment.

This study has been planned for investigating the effects of TİVA, vvhich is formed by the combination of midazolam-fentanyl and VİMA with inhalation of sevoflurane on the induction and maintenance of anesthesia, recovery period and cognitive functions of anesthesia in geriatric age. Patients undergoing to transurethral prostatectomy ( TUR-P ) were randomly divided two groups as Group M and S. İnduction vvas performed with midazolam and fentanyl in group M and inhalation ın Group S. Mask tolerance, induction time, reflexes of respiration, extubation, eye-opening time and time for telling his/her name, and advers effects were examined in both groups. The mean arterial blood pressure and heart rate vvere also recorded during the operation. The hemoglobin and 02 saturation values vvere recorded before the operation, 2 and 24 hours after the operation. The mental status test vvas applied. The induction time of Group M vvas found to be longer and eye-opening time and time for telling name vvere significantly shorter than Group S ( p<0.05). Heart rate vvas significantly lovver in group M 2 minutes after operation starts and at 30th minute of the operation ( p<0.05 ). The mental status test shovved no difference betvveen two groups in every mental status examining period ( p>0.05 ). There vvas no difference betvveen the preoperative values and postoperative 24 hours’ values.İn conclusion, each of the anesthesia methods can be a choice for this group of age by providing a heamodynamically stable anesthesia, fast and comfortable recovery. İn addition, the effects of these methods on early cognitive functions did not differ from each other.

A prospective study was conducted to analyze the rate of perinatal mortality and the perinatal mortality causes in 2395 infants who vvere born in 1997, at Selçuk University Hospital. Among whom were 77 of the perinatal deaths vvere stillbirths and 2318 live births. Preterm infants totaled341 (14.7%) vvhile 251(10.48%) had low birth vveights and 90 (3.75%) had very low birth vveights. The stillbirth rate was 32.1 per 1000. 73 of the 2318 live birth infants died during the first seven days of life. The perinatal mortality rate (PNMR) was 62.6 per 1000 and early neonatal mortality rate 31.4 per 1000. According to Wigglesworth classification of perinatal deaths (n-150), macerated still­ birth, asfixial conditions, lethal congenital abnormalities and immatürity groups vvere, 15%, 51%, 13% and 13% respectively. The analyses of PNMR implies that more than half (57.33%) of the deaths could be prevented. The main cause of high PNMR in this hospital is attributable to be a referral çenter in this region for high risk preg- nancies. PNMR could reduced vvith a large scale fetal-maternal assesment program and technological de- velopment covering the vvhole region vvith the ultimate goal of reducing the perinatal mortality rate.

Neonatal jaundice is usually a self-limiting benign clinical condition. International treatment guidelines to outline the borders of treatment of neonatal jaundice exist. The aim of our study is to evaluate the rationale of treatment guidelines for newborns admitted to the hospital for jaundice. In this retrospective study, the records of the cases admitted to the Newborn Intensive Care Unit between January 1, 2009 and December 31, 2010 for neonatal jaundice were reviewed. Status of jaundice on admission were evaluated on the basis of hyperbilirubinemia treatment guideline. The newborns who had any clinical risk factor or additional problem for severe hyperbilirubinemia, and higher serum bilirubin level on admission requiring treatment were designated as “Babies Need to Treatment”, whereas the remaining as “Babies Need Not to Treatment”. Of overall 518 cases, 267 were boys (51.5%) and mean gestational age was 37.2±2.2 weeks, and birth weight 2988.3±617 gram. The number of patients admitted in consistent with current treatment guideline of neonatal jaundice was 391 (75.4%). The group of “Babies Need to Treatment” showed significant relationship with the male gender (p=0.03), whereas other parameters including gestational age, birth weight, delivery type, multiple gestation and consanguineous marriage were nonsignificant. We think that newborns with jaundice should be on close follow-up in order to prevent development of bilirubin encephalopathy, however unnecessary investigations and treatment should be avoided as well.

To investigate the correlation of body mass index (BMI) with clinical parameters in women with fibromyalgia syndrome (FMS). Under the criteria of 1990 American Council of Rheumatology, 162 women diagnosed with FMS were included. In each patient, duration of complaints, level of education, pain severity via Visual Analogue Scale (VAS), tender point counts (TPC), Beck Depression Inventory (BDI) score, Fibromyalgia Impact Questionnaire (FIQ) and BMI (kg/ m²) were measured. Patients were grouped as normal (BMI<25), overweight (BMI=25-29.9) and obese (BMI≥30), and clinical parameters of FMS were compared between groups. Via Spearman’s ranked correlation coefficient, the association between BMI and FMS was investigated. Fifty-two patients (34.4%) was present in group with BMI<25, 70 (44.8%) in group with BMI=25-29.9 and 40 (%24.7) in group with BMI≥30. While a statistically significant difference was present as to TPC and FIQ between groups, no significant association was found as to age, duration of complaints, VAS and BDI scores. In the analysis, a positive correlation between BMI, and TPC, FIQ scores, duration of complaints and age, and a negative correlation between BMI and level of education were determined. Our findings indicate FIQ and TPC are strongly correlated with BMI, and higher rate of BMI seems to increase the severity of FMS. So, it is considered that weight control may positively impact physical functions and course of the condition.

Regionally to determine cigarette smoking level and affecting factors in a population is an important part of fighting with cigarette smoking. In this study we aimed to evaluate the smoking rates, the factors effecting on smoking and to learn the knowledges about quiting in patients who applied Iğdır Government Hospital Chest Diseaes Department. 721 patient , 426 male ( 59,1 %) and 295 female ( 40,9 %) were enrolled in the study who applied to our hospital between 1 December 2008- 2 February 2009. All patients filled the questionnaire by acting face to face. Demographic characteristics and smoking condition were asked in questionnaire forms. 102 (% 14.1) of the patients were never smoking, 514 (%71.3) of them were still smoking and 105 ( % 14.6) of them were quited. Smoking rates were increasing with education level in females (p

Primary ovarian leiomyosarcomas, which are often encountered in post-menopausal women, are rare, their origin, etiology, histological and clinical features and optimal treatment plan have not been fully explained tumors. They constitute less than 3% of all ovarian tumors. Due to rarely observation and the lack of specific symptoms, ovarian leiomyosarcomas are often difficult to be recognized. In this article, a 66-year-old patient who was operated for ovarian mass and pathology resulted with ovarian leiomyosarcoma, was presented. Although ovarian tumors are rare, leiomyosarcomas ovarian gonadal stromal tumors should be kept in mind in the differential diagnosis.

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

Aim: Geraniol, a monoterpene, is a plant-derived natural antioxidant. Hydrogen peroxide (H2O2) is a member of reactive oxygen species (ROS). The objective of this study is to de-termine the effect of geraniol on brain cholesterol and lipophilic vitamins such as vitamin A (retinol) and vitamin E (alpha (α)- tocopherol and α-tocopherol acetate) in H2O2-administrated male rats. Materials and Methods: Adult male Wistar rats were randomly divided into four groups (n=7). Geraniol (50 mg/kg) and H2O2 (16 mg/kg) were administered by an intraperitoneal injection for 30 days with a 1-day interval. Brain samples were homogenized and cholesterol, α-tocopherol, α-tocopherol acetate, and retinol levels analyzed from lipid extracts by HPLC. Results: Brain cholesterol level was found to be significantly higher in the H2O2 group than the control group. Brain α-tocopherol acetate levels were found to be significantly higher in the H2O2 and the geraniol+H2O2 groups than the control group. There was no difference in retinol levels between any groups. Conclusion: In conclusion, our results indicate that brain cholesterol and α-tocopherol acetate levels are affected by H2O2-induced oxidative stress. Moreover, we suggest that geraniol has the potential to reduce the effect of H2O2 in male rats.

Schizencephaly is a slit covered with gray matter, that lies from the ependimal surface to the piadressing a long the hemisphere. If the walls of the slitscovered with gray matter of are close to each other it is named as Type 1 (closedlip), if they are further from each other, it is called astype 2 (openlip). Clinics in children has a large range of spectrum from mental motor retardation, seizure to focal neurological disorders. Most of the patients have epilepsy which are usually characterized by focalseizures. There are only a few cases where schizencephaly causes status epilepticus. Here in, we report a schizencephaly case of a 7 year old boy who was accepted with a status epilepticus clinics that started locally and progressed generally. We emphasize the important role of schizencephaly in epilepsy and status epilepticus.

Objectives:

Customer satisfaction surveys are a routine device used to assess performance. Surveys are used in hospitals to check physician and patient satisfaction. Hamad Medical corporation’s (HMC) histopathology laboratory is College of American pathologists (CAP) accredited with highly trained pathologists and technical staff that routinely undertake various educational courses and are involved in research related activities. The lab has state of the art staining and immunohistochemistry service as well. However, it was felt that not all clinicians are very comfortable approaching pathologists and some many times experience problems either contacting lab staff or updating histopathology orders. Hence to narrow down the problems encountered by the clinicians and improve the specimen flow through the lab along with the communication between clinician and pathologist, that we deem vital, we designed this pilot survey.

Methods:

The survey questionnaire was made online with 15 questions in total and the link was electronically mailed to all Consultant and Specialist physicians in Hamad medical corporation (HMC). Around 3500 emails were sent out but only 105 surveys were filled in two months’ time. The survey included questions pertaining to multiple facets of quality of histopathology services and information regarding the participant.

Results:

The overall satisfaction was highest for Multidisciplinary presentations (96%) and lowest (77%) for timeliness of reporting. The satisfaction was above 90% for clarity and format, Diagnostic accuracy and pathologists’ responsiveness to problems. Thirty six percent of the people rated MDT presentations as excellent while 46% of the people thought overall quality of professional interaction was good. The areas of improvement, as per this survey, was timeliness of reporting and notifications of significant abnormal results (overall satisfaction 79%). Majority of the people who took the survey (36%) were from internal medicine and half were members of multidisciplinary meetings (49%). Seventy-one of percent of the participants were from Hamad General hospital (HGH), while rest were from the other hospitals under HMC.

Conclusion:

The response rate for the survey was low, hence another survey with a wider reach, preferably by paper, is required to get more representative data. In general, the clinicians at HGH are satisfied with the services provided by the histopathology laboratory. Areas of improvement include Turnaround time (TAT), avoidance of descriptive reports and better communication with the ordering clinician.

Keywords:

Quality control, quality improvement, survey, histopathology, Laboratory

Present study was performed to determine the methods for early diagnosis of necrotizing fasciitis (NF), to indicate the importance of the early surgery and its repetition when necessary, and to predict the prognosis using laboratory tests. Study was performed with 34 patients who were diagnosed NF between 2005 and 2010. Prognosis were retrospectively inspected in terms of the age, gender, etiology, predisposing factors, laboratory findings, the application period, the number of surgical debridement, infection location and culture result of the patients. The most important etiological factors were found to be surgical intervention and local soft tissue infection. Among the predisposing factors of obesity and diabetes were found to be the most common. All patients had laboratory risk indicator for necrotizing fasciitis (LRINEC) score of 7 or above. The mean LRINEC score was found to be 9.1. Abdominal, groin and perineum were the common infection locations. Only 11 patients admitted to the hospital, diagnosed and received treatment for NF within the first 48 hours after the first symptoms. The wound cultures were positive in 26 patients. Most commonly grown microorganisms were E. coli and K. pneumoniae. Four patients who died during treatment were advanced age (mean 74.7), admitted late (5-10 days), had high LRINEC scores (mean, 12) and chronic diseases (diabetes, obesity, chronic lymphocytic leukemia). The patients who have high LRINEC score, over the age of 65 and admitted in 5 days or more after the first symptoms, were observed to have poor prognosis. Whenever a patient is suspected to have NF, physical examination, laboratory tests and invasive diagnostic procedures should be performed immediately in order to have an early diagnosis.

In ihis study, 200 serum samples whiclı were taken from suspectd patients with toxoplasmosis lwere applied ta Indirect liaernagglutination and ELISA IgG and IgM tesis, Positive results were rrecorded ıriihixt 104 samples (52%) for Indirect Ilaemaglülination, 1164 and more titers. 88 positive volumes (44%) were found in ELISA I8G test, as for IgM test 40 (20%) were found ln agreetnent of 171% was established between ELISA 18G and Indireet Haemaglütination tesis. Concequently icompairing the discovered values and data, specivity, sensitivity and ağreetnent both tesis were discused.

Aim: The clinical course of COVID-19 cases and the severity of symptoms vary according to the case.
However, it has been seen in the cases examined that it poses a greater risk for those with chronic
diseases and elderly individuals. In order to protect elderly individuals from COVID-19, governments
have introduced some restrictions. It is thought that the wrong evaluation of these restrictions may lead
to attitudes of ageism. This study aimed to determine the relationship between society's fear of COVID-19
and attitudes towards ageism.
Patients and Methods: This work is designed in descriptive type. This study was conducted with
volunteers between the ages of 18-65 683 people. The data of the study were collected using the Fraboni
Scale of Ageism and COVID-19 Fear Scale. Data were collected on 1-20 Jun e 2020.
Results: The mean Fraboni Scale of Ageism and COVID-19 Fear Scale scores were 67.87±6.15 and
18.81±6.16, respectively. The results showed a weak and negative correlation between COVID19 fear
and ageism.
Conclusion: In general, individuals had a positive attitude towards the elderly and had low levels of
COVID-19 fear.

Aim: We aimed to determine types and locations of deep-seated soft tissue foreign bodies (FB) and to evaluate the differences between gender and age groups.

Materials and Methods: A total of 310 patients operated due to deep-seated FB penetration between January 2011 and January 2018 were included in the study. Patients were divided into three groups as under 18 years, 18-45 years, and over 45 years. FB were divided into five groups. Locations of the FB were divided into five region in the upper extremities and into six region in the lower extremities. FB type and location were analyzed according to the gender and age groups.

Results: The most common FB was metal piece in men by 48.4%, and needle in women by 77.3% (P<.0001). Needle was the most common FB by 67.4% in men and 94.2% in women who aged under 18 years (P=.12), whereas the most common FB was metal piece by 54.7% in men and needle by 71.4% in women in the aged 18-45 years age group (P=.0007) and metal piece by 61.3% in men and needle by 70.0% in women in the over 45 years age group (P=.0023). The most common location of FB was hand in men by 35.2% and foot in women by 61% (P<.0001). The most common location of FB was foot by 65.1% in men, and foot by 62.9% in women who aged under 18 years (P=.04), whereas the most common location of FB was hand by 38.9% in men aged 18-45 years and foot by 60.3% in women in the same age group (P=<.0001). The most common location of FB was hand by 65.5% in men and foot by 60% in women who aged over 45 years (P<.0001).

Conclusion: Our study is the first in the literature to evaluate the type and location of the deep-seated FB according to the gender and age groups. The most common location and type of FB were found as foot and needle in women of all age groups and in men under 18 years. This result may be related to the reason that needles, which is used for sewing, are often dropped to the floor due to inattention or neglect of persons, and these persons spend more time at home. Whereas, the most common location and type of FB were hand and metal piece in men over 18 years, respectively. This result may be associated with the labor class doing heavy work which is under risk for hand injury and consists of men over 18 years.

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.

Macroglossia, prenatal or postnatal overgrowth, macrosomia, macroglossia, and abdominal wall defects (omphalocele, umbilical hernia, or diastasis recti) permit early recognition of BeckwithWiedemann syndrome. Complications include neonatal hypoglycemia and an increased risk for Wilms tumor, adrenal cortical carcinoma, hepatoblastoma, rhabdomyosarcoma, and neuroblastoma, among others. The frequency of hypoglycemia in this population is between 30% and 50%. The cause of hypoglycemia is unclear but supports a hyperinsulinemia as the major factor. The majority of infants with hypoglycemia will be asymptomatic and have resolution of the hypoglycemia within the first 3 days of life. Less than 5% will have hypoglycemia beyond the neonatal period. As conclusion, in patients with BWS levels of insulin and blood glucose must be monitorized beginning from first hours of life. Hypoglycemia may be prolonged in presence of hyperinsulinemia as like this present case.

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

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

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

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

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

Necrotizing fasciitis (NF) is an infectious disease with a possible fulminant course that it is characterized by necrosis of the skin, soft tissues, fascia or muscle. Treatment involves extensive debridement and antibiotherapy. Although, debridement may not always be possible due to limitations in the administration of general and/or block anesthesia in some patients based on such reasons as overall health, bleeding diathesis or medications being used by the patient. There is limited information or studies exploring possible options in such patients, although those that are available support the lifesaving advantages of early fasciotomies performed under local anesthesia. A 76-year-old male patient was admitted with generalized edema to the right forearm and arm, erythema, and a lesion with a bulla and purulent discharge. An NF diagnosis was confirmed with a positive finger test and emergency surgery was planned; however, general anesthesia could not be administered due to the impaired overall health status of the patient, who was using aspirin, preventing blockage. Accordingly, the abscess was drained through arm and forearm fasciotomies that were performed under local anesthesia, and samples were obtained for culture.In conclusion, NF can be fatal when left untreated, while successful results can be achieved with early diagnosis, sufficient debridement and treatment with appropriate antibiotics. That said, drainage of the abscess through multiple fasciotomies can improve the laboratory findings and support treatment in NF patients who cannot undergo rapid debridement or can not tolerate general anesthesia. A fasciotomy may be performed as a supportive treatment prior to debridement in such patients.

Benign cysts of Mullerian type present as pelvic mass in perimenopausal and postmenopausal women mimicking ovarian malignancy. Herein, a case of benign uterine mullerien cyst detected in a woman with postmenopausal uterine bleeding resistant to medical treatment and operated with a preoperative diagnosis of right ovarian simple cyst is presented. Differential diagnosis is also discussed. Sixty two years old postmenopausal woman presented with complaint of abdominal pain and vaginal bleeding. A cystic mass of 4x3 cms thougth to be originated from right ovary was determined on pelvic ultrasound. The patient with postmenopausal uterine bleeding resistant to medical treatment of 6 months given before went to surgery with a preoperative diagnosis of right ovarian simple cyst. After pathologic examination, the cyst was diagnosed as benign uterine mullerien cyst.

The metastatic ovarian tumors constitute 3 to 8% of all and 10 to 30% of malignant ovarian tumors. The common primary sites for metastatic disease to the ovaries include the colon stomach, breast and the genitoürinary tract. Hematolojic malignancies, including lymhoma and leukemia, also involve the ovaries. Clinical history, tumor markers, tumor morphological-histological features and imaging features are useful to distinguish secondary ovarian tumors from primary ovarian tumors. Magnetic Resonance imaging (MRI) provides useful information for characterization of various ovarian benign or malign masses. The use of MRI for diagnosis of ovarian masses includes consideration of morphologic characteristics and signal intensity characteristics on T1 and T2-weighted images. It is important to determine the ovarian metastasis due to change the method of treatment. İn this case we present MRI an ultrasound findings of bilateral ovarian metastasis of lobular breast cancer.

The study compares the recovery charecteristics of desflurane and isoflurane in children undergoing tonsillectomy and/or adenoidectomy. Forty children 4-12 year of age were studied and thirty minutes prior to the induction of anesthesia, ali patients received 0.5 mg/kg midazolam orally. They were randomly assigned to receive 1-1.5 % isoflurane (group I) and 6-7 % desflurane (group II) for maintenance of anesthesia afterpatients given 2-2.5 mg/kg propofol and 10 pg/kg alfentanyl for anesthesia induction. Before surgery, patients received 20 mg/kg paracetamol rectally for postoperative analgesia. Dexamethasone 150 pg/kg was given to reduce the incidence of postoperative nausea and vomiting. Administration of anesthetic agents was terminated at the end surgery. At the end of operation extubation and recovery time determined. Extubation time was defined as the time from discontinuation of anesthetics to extubation. Recovery time was measured from the time the anesthetics were discontinued until the patients achieved a score of 8 on the Aldrete score. Agitation was evaluated by using the three-point score. Extubation and recovery time were significantly faster in the desflurane group than isoflurane group (p<0.05). İncidence of agitation was similar for both groups. As a result, desflurane provides a faster recovery than isoflurane in short-term surgery on children.

Idiopathic thrombocytopenic purpura (İTP) is the most common seen acquired bleeding disorder of childhood. İt has a benign course. Nevertheless, it has a great importance because of an organ bleeding risk and possibility of an existance of underlying serious disease and chronicity. İn our study we investigated retrospectively 86 patients diagnosed as İTP. Peak ages of the cases vvere 5 and 13 years. Except the intracranial bleeding, almost every type of bleeding vvere seen. We prefered corticosteroids for the first choice of treatment. 73 patients received high dose methylprednisolone for the treatment. 41 ofthem (47.6%) recovered totally. Immediate increase in the thrombocyte count after the corticosteroid therapy was observed in 79% of the patients. Chronicity rate was as high as 41.8% and the ages of this group vvere similar to that of the peek incidence ages. None of the patients died. Four patients, resistant to medical treatment went to splenectomy. Hovvever, the increase of thrombocyte count was permanent in only one case. One of the patients diagnosed as İTP was accepted as systemic lupus erythematosus three months later and one as Hodgkin lymphoma three years later. Patients with İTP should be monitered closely because of the bleeding risk and should be detected seriously because of an underlying disease risk and should be alert against the malignity or autoimmune disease at the chronic stage or after the remission phase.

/Ve observed patients with Herpes Zoster for the malignant diseases who came to dermatology elinle in the last five years. Of the 213 patients, in 12 ( % 5.68) we found malignant diseases such as pulmonary, hepatic, ovary, bladder cancers, squamous celi carcinoma, chronic lymphositic leukemia and non- hodgkin lymphoma. We suggest that, patients with Herpes Zoster must be searehed for malignant diseases, but it doesn ’ t mean that Herpes Zoster is a cancer marker.

Aim: Another issue that is as important as breast milk and breastfeeding today is the mental health of
postpartum mothers. The aim of the study is to evaluate the effect of postpartum depression and anxiety
levels of puerperant women aged 18-49 on breastfeeding attitude s.
Patients and Methods: This study was conducted with 243 participants over the age of 18, who did
not have any psychiatric disease before or during pregnancy, who applied for puerperal and newborn
vaccination between February 1, 2021 and August 1, 2021, registered to the central family health centers.
Results: It was observed that women's education, necessity of breast milk, breastfeeding knowledge
level and breastfeeding duration affected their breastfeeding attitude levels. When we examined the
breastfeeding attitudes according to the weeks of birth, it was seen that the breastfeeding attitudes of
the participants who gave birth before 32 weeks were at a higher level than those who gave birth at 36
weeks or more (p=0.001).
Conclusion: It is evaluated in terms of the state of the optimizable how it affects the views according to
the results. In the field of education, which receives support in state anxiety and postpartum appearance,
it can be played that the body will affect the mother and baby positively, regarding the communication in
this regard, for better general appearance.

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.

Endometriosis is a condition where the functional and morphological endometrial gland and stromal structure are found outside the uterus. It occurs most often in pelvis, peritoneum, ovaries, posterior cul-desac and uterosacral ligaments. Retrograd menstruation, metaplasia, lymphatic and hematogenous outspread, mechanical transplantations in insicional scars during the operations and some else theories are introduced for pathogenesis. Subcutaneous mass, swelling, cyclic pains associated with menstruation, tenderness are likely clinical symptom and signs. Magnetic resonance imaging, computed tomography, ultrasound, fine needle aspiration biopsy are used in diagnosis. Total excision is the considered management of the scar endometriosis. Recurrens is rarely occurs after total excision. Here we present the case of 33 years old woman who had a cyclic painful mass on her p

Since it has first observed in April 2009, the swine origin Influenza A virus infection, spreaded worldwide and cases of dead increased. Untill now the number papers in literature about the radiological signs caused by the desease is extremely low. In this review we aimed to overview the H1N1 and collect the data in literature about radiological signs of the desease.

In the literature. results of VEP studies in epi-lepsy appear tü be controversial. This picture is li-kely due tü the technique diverselv used and the re-latively small numbeı- of the patients groups. Pattern-reversal VEP are recorded in 24 patients with photosensitive (FS) discharges in EEG, and other 21 patients with epilepsy. VE? amplitudes show no dUlerences from those of normal control groups. P100 mean latency of non-fotosensitive group is not prolonged in the patients who are un-derınedication, nor is. it in the ones who have not been administered the drugs (valproic acide and carbamazepine) yet. The latency is founded to be normal in FS gı-o-ups. The impression that the effects of the drugs on VEP reflect dğyerently in this group is eliceted. it is considered that the results may indıcate dğferent pathogenetical mechanisirn in FS group.

Selection of primary mode of therapy for lower ureteral stones is stili controversial, should it be ESVVL (Extracorporeal shock wave lithotripsy) or ureteroscopic approach? ESVVL therapies were applied to 321 patients. Ultrasonographic targetings were used when stones could be localised by ultrasound in 131 patients (Group I), fluoroscopic targetings were used in 186 patients (Group II) during ESVVL treatment. Uretroscopic approach was selected in 121 patients as a primary treatment of lower ureteral stones. (Group III) Total success rates were 85% for ESVVL treatment and 94.4% for ureteroscopic approach. (P=0.015) Success rates were 91.1% and 80.6% in Group 1 and 2 subsequently. (P=0.015) Retreatment rate was clearly lower in group I (11.8%)than the group II (26.3%). (P=0.001) Success rate of ureteroscopic approach was compared to ESVVL groups, vvhile there was no d if ference with group I, (P=0.048) success rate of grup III was higher than group ll.(P=0.002) Complication rates showed significant difference between ESVVL and ureteroscopy groups.(13.2% versus 3.7%)(P=0.004) VVe concluded that ESVVL should be selected as a primary therapy of lower ureteral stones that can be seen by ultrasound due to its the higher success and lower complication rates than the ureteroscopic approach.

\r\nAim: Diabetes is a serious health problem which has increased rapidly in recent years and causes numerous complications. Vitamin D levels may be a contributing factor to the glycemic control. The aim of the study was to evaluate the relationship between vitamin D levels and glycemic control in diabetic patients.

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\r\nMethods: 330 patients with Diabetes Mellitus type 2, who were admitted to our outpatient clinic between September 2015 and June 2016, were included in the study. Patients were stratified into three groups according to the vitamin D levels; ≤20 ng / mL, between 20-30 ng / mL and ≥30 ng / mL. These groups were compared in terms of patients' socio-demographic characteristics, blood parameters, diabetes-related characteristics, and diabetes treatment. Patients were categorized into two groups according to the HbA1c levels;  ≤7% and  ≥7%. The same parameters and vitamin D values were compared between two groups. All data were recorded into the SPSS version 21. Participants' demographic datas, percentage and frequency values, were tabulated. A p value  of <0.05 was the limit for statistical significance. 

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\r\nResults: A total of 330 patients (51.2% females, mean age 53,79±10,2 years) with diabetes were interviewed. When evaluated in terms of body mass index, 13.9% (n = 46) were classified as normal, 34.5% (n = 114) were overweight and 51.5% (n = 170) were obese. When patients were divided into groups according to vitamin D levels, 286 (86.7%) patients with a vitamin D level below 20 ng / mL and 44 patients (13.3%) with a level above 20 ng / mL were detected. When patients were compared according to vitamin D levels, there was a negative correlation (-r = 0.357, p <0.001, -r = 0.344, p <0.001, respectively) between vitamin D levels and patients' fasting blood glucose level (FBG) and postprandial glucose level (PBG). There was a negative correlation (-r = 0.433, p <0.001) between vitamin D levels and HbA1c levels. Negative correlation (-r = 0.131, p <0.05) was found between vitamin D and triglyceride levels.

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\r\nConclusion: Vitamin D levels were significantly lower in patients with HbA1c> 7% (n = 191) when compared to those with HbA1c <7 (n = 95) (p <0.001). Vitamin D levels may be important in glycemic control of diabetic patients.

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Acrylamide (ACR) is an organic chemical which occurs in foods extensively consumed in diets worldwide. ACR promotes the generation of reactive oxygen species and the depletion of antioxidants. The aim of this study was to investigate liver, brain and kidney of tissue total antioxidant status (TAS), total oxidant status (TOS) and liver and brain of tissue oxidized LDL (ox-LDL) levels in long term ACR + standard diet and ACR + high-fat diet given rats, compared to control rats. Forty-eight male Wistar rats (5-6 weeks of aged) were segregated into two diet groups and fed with a high-fat diet (crude fat 20%) or standard diet (crude fat 2.7%) respectively; and animals in each diet groups were exposed to acrylamide at the dose of 0, 2, 10 and 20 mg/kg bw/day via drinking water for 28 days. At the end of the experiment tissue samples were analyzed for TAS, TOS and ox-LDL. ox-LDL and TOS levels were increased as doses of acrylamide were elevated in liver and brain tissue, no significant difference was present at levels of ox-LDL/protein (p=0.087) and TOS/protein (p=0.751) in liver tissue among eight groups. While no significant difference was observed at levels of ox-LDL/protein in brain tissue (p=0.808) among eight groups, TOS/protein levels in brain tissue (p<0.001) became significantly increased. No significant difference was present at levels of TOS/protein (p=0.052) in renal tissue among eight groups. As doses of acrylamide were increased, TAS/protein levels in brain, liver and renal tissue became decreased, and a significant difference was present at TAS/protein levels among the groups (p<0.001). Our findings showed that long term treatment with 2, 10 and 20 mg/kg doses of ACR + standard diet and ACR + high-fat diet treatment led to a significant depletion of tissue TAS levels and over production of tissue TOS and ox-LDL levels, consequently, to an increase in oxidative stress.

Gestational diabetes mellitus (GDM) was previously described as any degree of glucose intolerance with first recognition at pregnancy for many years. Currently, pregnant with DM at their initial prenatal visit has been diagnosed as overt diabetes, not gestational diabetes. The remaining pregnant who found not to have DM at initial visit and not known to have DM should undergo oral glucose tolerance screening at 24-28. weeks of gestation and diagnosed as GDM if any value exceeds the threshold values. The prevalence of GDM is reported 1-14% among the different populations. Its diagnose is increasing over the world with new GDM criteria. Recently, ADA has adopted the 2008 International Association of Diabetes and Pregnancy Study Groups (IADPSG) conference criteria based on the Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) study. IADPSG criteria for GDM is including; 75 gr glucose tolerance test has been recommended as diagnostic test for GDM and a single abnormal value has been considered to be sufficient for diagnosis in this conference. The threshold values for glucose tolerance test are as following; for fasting glucose; 92 mg/dl (5.1 mmol/L), for 1.hour; 180 mg/dl (10 mmol/L), for 2 hour; 153 mg/dl (8.5 mmol/L). In this review, the modifications on GDM definition and the current diagnostic criteria for GDM were evaluated.

Aim: Axillary defects mostly occur after burn contracture releases or hidradenitis suppurativa debridements. Reconstruction of this type of defect is a challenge since the ultimate aim is maintaining a pliable coverage with full mobility of the shoulder joint. Scapular flap is one of the reconstructive options in axillary defect coverage. This study is aiming to present reconstruction of axillary defects with scapular island flaps for different indications and to discuss the outcomes of the donor sites so as to suggest it as a workhorse flap in axillary reconstruction.
Patients and Methods: A total of 7 patients treated with 8 scapular island flaps between 2015 and 2019 were included retrospectively. Five patients were operated for hidradenitis suppurativa and 2 patients reconstructed for axillary contracture. All scapular flap pedicles were skeletonized and transferred to the axilla through the triangular space.
Results: Flap dimensions ranged from 84cm2 to 128 cm2 without exceeding 8cm of the width. Donor site scars widened between 3 months to 6 months post-operatively and independent of patient age. Donor site scars ranged from 1.5-2.6 cm after at least 3 months of follow-up. All flaps survived without any complication except one with a tip necrosis that healed with secondary intention.
Conclusion: Scapular island flaps can cover defects of the axilla created by various causes. Horizontal extension of the flap protects it from burn scar involvements of the posterior axillary line and the arm. Although widening of the scars seems to be a disadvantage, thin and pliable skin coverage with ease

Aim: To report an immature teratoma case that was differentiated from mature teratoma. Case report: A 29 year old woman consulted to Gynecology and Obsterics clinic vvith pelvic pain. İn the histoıy of the patient, it was un- derstood that she had left sided ooferectomy due to left ovarial cyst. At that time the ovarial pathologyhad been reported as normal. İn the pelvic examination of the patient a pelvic mass that can not be differentiated from ute- rus was detected. İn the pelvic ultrasonography of the patient, at the right ovarial area a smooth bordered hete- rogenous mass that had calcified areas vvith in the body, and that was measured as to be 11x11 cm and found to have solid and cystic components was detected.İn the laboratory finding AFP: 10,5 (0-7), CEA: 6,4 (0-4,1), CA 125: 32,9 (0-21), CA19.9: 322 (0-18,4), CA 15.3 :24,5 (7,5-53 ), HCG < 1 was found. The patient had been operated, the right ovarial mass extirpation and right ooferectomy had been done. The diagnosis vvith the histopathological examination of the mass was defined as immature teratoma grade-l. Conclusion: İt is needed to get several biop- sies of the pathological spesimen in order not to skip. The immature components of the teratomas and neural com­ ponents should be shown vvith immunohistochemical methods.

Congenital Leukemia is rare disease seen at birth or in the first 4 weeks of life . The incidence of Congenital Leukemia is 1 over 4.7 million live births. Most of the cases are myeloblastic leukemia. Usually symptoms like leukocytosis, petechia, echymosis, cutaneous nodules, hepatosplenomegaly and central nervous system involvement are seen. Two newborns with Down syndrome which were septic at application and diagnosed as congenital leukemia are presented in this article. The early recognition of such cases and finding opportunity to treat before the appearance of secondary complications such as sepsis play an essential role for saving life.

Hepatocellular carcinoma (HCC) generally develops as a consequence of underlying liver disease, most commonly viral hepatitis. The development of HCC follows an orderly progression from cirrhosis to dysplastic nodules to early cancer development, which can be reliably cured if discovered before the development of vascular invasion (typically occurring at a tumor diameter of approximately 2 cm). If resection is not possible because of poor liver function, vascular invasion and metastasis. To prevent tumor progression while waiting, nonsurgical treatments including percutaneous radiofrequency ablation, and transarterial chemoembolization are employed.

We aimed to present a rare case with giant ovarian tumor which causes intraabdominal mass in a 14-year-old girl. On examination, there were abdominal distension and a palpable solid mass in abdomen. On abdominal ultrasonography (US) and computed tomography (CT) examination, a giant mass, which covers all intraabdominal cavity, was identified in the abdomen. Laparatomy was carried out in elective conditions after all tests had been performed. The mass originated from left ovary was excised totally via left salpingoooferectomy, following both ovaries and both tuba uterinas. The operative diagnosis of dysgerminoma was confirmed with histopathologic examination. Chemotherapy was scheduled by Hematology-Oncology Department. Dysgerminoma should be considered in the differential diagnosis of the girls who are admitted with the intraabdominal giant masses.

We report a 38 year-old male patient vvith non-Hodgkin’s lymphoma who developed oliguric acute renal failure depending on tumor lysis syndrome, following chemotherapy. We treated, patient vvith diuretic, bicarbonate infusion, calcium gluconate, and 30% dextrose vvith insulin. We couldn’t give a response to these treatments. After chemotherapy, on 4th day we started to use hemodialysis. After hemodialysis, we supplied a recovering in this patient as clinic and laboratory.

Eye movernents during reading in 5 completely deaf-mute subjects were electrooculographically recorded. It was notable that electrooculographical patterns showed large saccads and fixations with long duration. As expected the deaf-mutes were considered ta read with non-phonological reading process. However the results motivated for further quantitative study.

Simple kidney cysts are common, benign and asymptomatic masses and usually unrequire any treatment. However, this simple cyst can grow over time, may become symptomatic and develop complications they may require treatment. In our study, we aim to present, the 63 -years-old male patient admitted to our clinic with dyspnea, abdominal pain and asymmetric abdominal distension. Abdominal ultrasonography (USG) showed that exophytic renal cyst reached 195x180 mm. We underwent sclerosing agents in the presence of continuous percutaneous catheter drainage and dyspnea decreased at the follow-up. Subsequent USG after six months revealed disparition of the cysts.

This study aimed to research dietary quality in adults and to compare using different parameters (body mass index, education statues, gender and age). The cross-sectional study was conducted on randomly selected 421 adults (275 females, 146 males) living in Ankara. Dietary intakes of individuals aging between 20 and 50 years (mean±SD, 32.7±9.096 years) were collected by using 24-hour recall method. Mean adequacy ratio scores calculated by using nutrient adequacy ratio were used for dietary quality assessment. According to mean adequacy ratio scores, 56% of individuals’ dietary nutrient content found to be inadequate. In the study, there was no significant difference in mean adequacy ratio scores according to education, age, body weight; whereas, male mean adequacy ratio scores were higher than female. There is a need for improving diets according to mean adequacy ratio scores assessment in Turkey. Dietary quality can be affected by different variables such as gender, body mass index, age and education statues. Improving dietary quality should be aimed using plan and policies, developed taking into consideration these variables by governments.

268 cases on which laparoscopic cho-lecystectomy was treated in General Surgical De-partment at the University of Selcuk, Faculty of Me-dical Science between 1994 th January-1995 th June were taken into consideration. 236 patients have de-veloped gallbladder stone which moves along with bilecholic, 32 patients have developed acute cho-lecystitis and 4 patients, because of having de-veloped splenic abcess, splenic eccinococcous cyst, simple cyst at left lobes of the liver, simple cyst at right over were taken into operation. Despite the successful application of la-paroscopic cholecystectomy at 252 patients, 16 pa-tient had necessarly been take into laparotomy. Mortality rate is nil. The operation approximately takes 50 minutes and patients are kept at our hos-pital for nearl 2 days and the patient's recoveries takes a week. Serious complications was observed at 6 patients. We come to the conclusion that the reason for the complications peeing high is that this kind of surgical attempts are very recently applied in our clinic.

Aim: Opopanax hispidus (Friv.) Griseb plant belongs to the Apiaceae family. It is traditionally used for the treatment of hemorrhoids, female infertility, and purification of blood. We aimed to examine the histological changes in the murine ovarian tissue following the administration of a methanolic extract of the aerial parts of the Opopanax hispidus (Friv.) Griseb plant.

Materials and methods: Twelve adult female Swiss-Albino mice were randomly allocated into 2 groups. Control group received no administration. In the Opopanax hispidus group the methanolic extract (200 mg/kg/day) was administered via oral gavage for 5 days. At the end of the experiment right ovarian tissue of each subject was excised. Routine histological processing of tissue samples fixed in 10% formalin were then sectioned at a thickness of 5 µm. The sections were stained with hematoxylin and eosin and examined with a light microscope. The modified method of Cavalieri principle was used in the stereological measurement. The total tissue volume ratio was measured with a point counting grid provided by the Shtereom version 1.5 software package. Mann-Whitney U test was used to compare the groups.The significance level was set at 5%. All statistical analyses were performed using SPSS (ver: 20) software package.

Results: A significant difference was observed with respect to the number of antral follicles (p<0.05). A comparison of ovarian volumes between the groups revealed a significant decrease in the Opopanax hispidus group (p<0.05).

Conclusion: We demonstrated that Opopanax hispidus exerted positive effects on the ovarian tissue and increased the number of antral follicles, probably due to its antioxidant effect.

During nine years (1976 - 1985) 80 patients with upper extremity arterial injuries after shotgun, cunt trauma etc. were treated surgically. Earliest admission was two his and latest was 18 his. 66 of patients had uneventful recovery and 14 were palliated with acceptable results. This article emphasises the importance of such injuries and early admission to a vascular surgical unit.

Single coronary artery is observed in approximately 2-4% of all coronary artery anomalies. In our case, 48 years old female patient had exercise-induced angina pectoris and fatigue. After her exercise electrocardiogram revealed ST depression during 9 mets, we demonstrated a single coronary artery as an extremely rare anomaly of coronary artery in which there was no original left main artery as well as right coronary artery, left anterior descending and circumflex arteries were originated from right sinus Valsalva. On medical treatment with beta blocker, her symptoms had recovered. This type of coronary anomalies is very infrequent and may be a reason of sudden death.

The Stylohyoid syndrome is a clinical o•cuı-ance which is resulted due to elongated styloid process and calcified stylohyoid ligament . The main complaints in the opeı-ated 43 patients with the diagnosis of stylohyoid syndrome were sore thı-oat, foreign body sensation. Evaluation of computerized tomographic findings revealed that elongated styloid process (70.3%) followed hy ligament calcıfication (29,6%) were the ıngior causes of styloid syndrome. Evaluation of the pos toperat ive specimens histopathologically showed the calsite crystal depositions in ligament Postoperative follow- up revealed complete recovery of the complaints in 95.3% of patients

It is claimed that the use of ultrasound-assisted liposuction in bodyshaping surgery produces less blood loss and more skin contraction than conventional liposuction. In the literature, however, we could not find any studies comparing the efficacy of conventional liposuction with ultrasonic liposuction in the treatment of arm contour deformities. In this study, therefore, it is aimed to compare the efficacy, complications and bleeding rates of conventional liposuction with ultrasonic liposuction in the treatment of arm contour deformities. Twenty patients with the complaints of arm contour deformity during the period of 2012-2016 were included in the study. All of the patients were treated with liposuction. The patients were divided into two groups; ultrasonic liposuction (Group 1; n: 10) and conventional liposuction (Group 2; n: 10). Necrosis was defined as a major complication. Seroma, hematoma, asymmetry and roughness in the skin were defined as minor complications. The location of the thickest part of both arms of patients in both groups were measured at the end of the surgery and at the end of the first postoperative year. A total of 5 ml lipoaspirate samples were taken from each patient intraoperatively. The specimens were stained with hematoxylin-eosin and the numbers of erythrocytes per unit area were determined. According to Triceps Skin Classification, 4 of the patients were Type 2, 3 were Type 3 and 3 were Type 4, in Group 1. In Group 2, 3 of the patients were Type 2, 3 were Type 3 and 4 were Type 4. The average arm circumference of the patients in Group 1 was 36 cm (minimum 32 cm - maximum 40 cm), while in Group 2 the average arm circumference was 35 cm (minimum 31 cm - maximum 39 cm). At the end of the operation, the average arm circumference of the patients in Group 1 was 31 cm (minimum 28 cm - maximum 32 cm) while in Group 2 the average arm circumference of the patients was 32 cm (minimum 28 cm - maximum 33 cm). At the end of the first postoperative year, the average arm circumference was decreased to 30 cm in Group 1 and 31.8 cm in Group 2. Moreover, the number of erythrocytes calculated in cm2 in Group 2 was 50-60 / 1HPF (HPF: high power field) at 40x magnification and this value was calculated as 20 / 1HPF in Group 1. The mean arm thickness before the surgery was similar in both groups. However, the mean postoperative arm thickness of the patients in Group 1 was significantly lower than Group 2 (p <0.05). Moreover, the number of erythrocytes seen in the lipoaspirate unit area was significantly lower in Group 1 than in Group 2 (p<0.05). In this study, we have demonstrated that ultrasonic liposuction could provide more skin contraction in the treatment of arm contour deformities with appropriate patient selection. In this indication, a better appearance can be obtained with less sagging compared with conventional liposuction.

Aim: The aim of this study was to evaluate the prognosis value of tumor size and preoperative albumin levels in gastric cancer patients treated with postoperative chemoradiotherapy. Patients and Methods: Patients records reviewed retrospectively. Clinicopathologic features were analyzed. 199 patients who applied to our clinic between 15.1.2010-31.12.2016 were included in this study. The primary end points of this study were to evaluate the overall survival (OS) and the disease free survival(DFS). Results: Mean follow up time was 20.43 months. Distant metastases devoloped in 50 patients and 102 patients were alive. In multivariate analyses , advanced T stage, history of smoking, preoperative albumin level less than 3.5 gr/dl and tumor size more than 8 cm were found to have poor prognostıc effect on OS. Lymphovascular invasion (LVI) and tumor size were showed negative effects on DFS. For statistical analyses SPSS( statistical package for social sciences) 21.0 statistical package was used. Conclusions: Despite recent treatment modalities the prognosis of gastric cancer is still poor and novel prognostic factors together with the current ones may be helpful to predict decision of proper treatment modalities and survival of the patients

Obesity incidence is rapidly increasing in Turkey like all over the world. Surgery has become a gold standard treatment for obesity due to the unsatisfactory results of diet and drug therapies. The number of clinics applying bariatric surgery is increasing every day. In this review, preoperative, perioperative and postoperative nursing care strategies were discussed.

Objective: The aim was to review the hormonal status, treatment and histopathological diagnosis of patients admitted to our endocrinology outpatient clinic with the diagnosis of adrenal incidentaloma.

Material and Methods:Between 2015-2018, 217 patients with adrenal incidentaloma who were admitted to the endocrinology outpatient clinic were included in the study. 1 mg overnight dexamethasone suppression test (DST), 24 hour urine free cortisol, 24-hour urine methanephrine and normetanephrine levels were evaluated in all patients.Patients who also have hypertension or hypokalemiawere screened for the plasma aldosterone/renin activity ratio. CT or MRI imaging properties of adrenal incidentalomas were screened.

Results: In the evaluation of cases; 180 (83%) of the masses were evaluated as non-functional and 37 (17%) as functional. Of the 37 patients evaluated as having functional adrenal mass; 10 (4.6%) pheochromocytoma, 5 (2.3%) Cushing's syndrome, 9 (4.1%) subclinical Cushing’s syndrome and 13 (6%) primary hyperaldesteronism were detected. In 180 patients who were evaluated as having non-functional adrenal mass; metastatic disease in 7 (3 non-small cell lung cancer, 1 breast cancer, 1 prostate carcinoma and 2 unknown primary cancer), myelolipoma in 4, ganglioneuroma in 1, hydatid cyst in 1, adrenocortical carcinoma in 2 patients were detected.

Conclusion: According to the results of this study, it is not uncommon for adrenal incidentalomas to be functional. It may be malignant in some cases. For this reason, adrenal incidentaloma is a condition that should be examined both in terms of
functionality and malignancy potential.

Organizing pneumonia (OP) is characterized histopathology cally by tufts of fibroblasts and immature collagen filling of respiratory bronchioles and alveoli. Symptoms are usually nonspecific and include cough and dyspnea. Radiograph cally, OP frequently manifests as patchy bilateral infiltrates that can be relapsing and migratory. Cryptogenic organizing pneumonia (COP) may be defined as having non-specific symptoms which can ultimately be described as a subset of the OP that cannot be attributed to any reason. Forty-nine-year-old female patient admitted with the complaints of 2 year exertional dyspnea and 20 day dry cough. The patient was diagnosed of pneumonia and prescribed with antibiotics; however, no improvement was observed in her complaints and lung graphics. The physical examination of the patient, routine laboratory analyses, collagen tissue markers and bronchoscopy were normal. In chest X-Ray, there were 4 nodular density approximately 1 cm in size, in the upper zone. In thorax CT, there were irregular contours multiple nodules, and the biggest one was approximately 35x7 mm in the upper lobes and in the superior of the left lower lobe of lungs. Acid fast bacteria was negative at bronchoalveolar lavage. The patient was diagnosed COP as clinically and radiologically. Then, systemic cortico steroid therapy was started. A complete clinical recovery was observed in the sixth month of the treatment and at the control thorax CT displayed that nodular lesions were disappeared completely. In the cases that were not respond to antibiotic therapy and patients having radiologically mobile and temporary infiltrations may be taken into consideration in the differential diagnosis.

The aim of this study is to investigate the effects of sevoflurane and propofol anesthesia on postoperative nausea vomiting and recovery in the middle ear surgery. The patients undergoing to middle ear surgery were randomly divided into two groups as Group S ( n=19) and Group P ( n=19). AH the patients are premedicated with 0.1 mg/kg İM midazolam and the induction was done with sevoflurane in Group S and 2.5 mg/kg İVpropofol in Group P. After the blockage with vecuronium 0.1 mg/kg, entübation was performed. Anesthesia maintenance was done with sevoflurane 1-3% in Group S and 8 mg/kg /h IV propofol infusion in Group P and 70% N2O/O2 inhalation in both. At the end of the operation, after quitting the anesthetics, the extubation times, spontaneous eye opening and recovery times were recorded. Postoperative nausea vomiting were evaluated in 2nd, 6th, 12th,18th and 24th hours. There were no significant differences found betvveen the groups according to spontaneous eye opening and recovery times ( p>0.05 ). Nausea-vomiting rate was found to be high in 0-2, 2-6, 12-18 hours in Group S ( p<0.05), but there was no difference in 6-12 hours ( p>0.05). Nausea-vomiting was not seen in any of the groups in 18-24 hours. İn conclusion no differences were found betvveen these anesthesia methods according to postoperative recovery, although nausea-vomiting rates appearently lovver in Group P. For this reason propofol anesthesia was decided to be an alternative for the middle ear surgery which has a high incidence ofpostoperative nausea and vomiting.

Ovarian cysts rarely reach enormous dimensions. The giant ones could be get mixed with mesenteric cysts, lymphangioma, local ascites or peritoneal inclusion cysts. We presented a case in which the preoperative evaluations revealed a lymphangioma eventhough the final hystopathological diagnosis was an endometriotic cyst (a type of benign ovarian cyst). Cystic lesions related to gonadal structures should be kept in mind when you’re dealing with giant cystic structures which are encountered rarely as a result of physical and laboratory examination at acute abdomen. The fertility situation and wish of patient should be considered when the treatment algoritm with an interdisciplinary approach are drawn .

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.

The excessive maternal alcohol drinking results in Fetal Alcohol Syndrome which is a pathology caused by the embryotoxic effects of ethanol in prenatal period. The mechanisms of ethanol action at the cellular or molecular levels are scarce. In this study it was aimed to investigate the effects of ethanol on growth and development of mammalian embryos as well as the morphological structure and the role of free radicals on these effects. Wistar rats were obtained from the Selcuk University Experimental Medicine Research Center and their 9.5 days embryos were explanted and cultured for 48 hours in rat serum. Whole rat serum used as a culture medium fort he control group while different concentrations of ethanol (250-500 mg%) were added tor at serum fort he experimental groups. Also, the lowest effective concentration of ethanol for all parameters was added to the culture media in the presence of an antioxidant superoxide dismutase (SOD). Ten embryos were used for each experimental condition. Dose-dependent effects of ethanol on embryonic developmental parameters such as; total morphological score, yolk sac diameter, crown-rump length, somite number, embryo and yolk sac protein contents were compared using morphological and biochemical methods. Each embryo was evaluated for the presence of any malformations. Compared to the control embryos, ethanol significantly decreased all developmental parameters döşe-dependently (p<0.05) with an increase in overall dismorphology. The haematoma in different regions, especially in the neural tube was most frequently observed. When the SOD was added to theculture media in the presence of ethanol, growth and developmental parameters were improved (p<0.05) and there was a decrease in the incidence of malformations (p<0.05). A döşe dependant developmental toxicity of ethanol on rat embryos during organogenesis wasdetermined, these effects might involve free oxygen radicals.

Novvadays, patients suffering from blunt abdominal trauma are examined by abdominal ultrasonography, routinly. Subcapsular bleeding of the spleen in these patients can be overlooked if there isn't free fluid in the abdominal cavity, ultrasonographic examination carried out in suboptimal contitions and after the trauma attention was in- tensified on the Central nervous system injury. İn 3 cases who have been examined by abdominal ult­ rasonography just after the trauma, any pathological finding was not been determined related with their spleen also examined by upper abdominal computed tomography because of their some complaints after the trauma (1 wk-1 yr) and splenic subcapsular hematomas were establised in these patients. İn patients with delayed de- velopment of splenic subcapsular hematoma following abdominal trauma can cause late rupture of the spleen, so we think that the patients suffering from blunt abdominal trauma must be examined by the control radiological methods after the trauma.

Duchenne muscular dystrophy is a progressive, hereditary neuromuscular disease with the cause of death usually occurring because of respiratory failure. The development of respiratory failure during wakefulness usually preceded by hypoventilation during sleep. The aim of this study were to assess the presence and severity of nocturnal desaturations and to determine the parameter of daytime lung function associated with nocturnal desaturations in patients with DMD. Material and method: The monitoring of overnight oxygen saturation is widely used for sleep apnoea-hypopnea screening. As our method we choosed aprospective comparison of wakeful respiratory function tests (spirometry, maximum voluntary ventilation, maximal mouth pressures, arterial blood gases) with outcomes of overnight oxymetry. Fourteen clinically stable patients with DMD, mean age (±SD) 13,83 ± 1,86 were studied. Results: The lowest oxygen saturation < 85% was present in 9 (64%) patients and oxygen desaturation index > 5 was found in 10 subjects (71%). Desaturation index was significantly related to maximum inspiratory pressure (r= -0,633, p<0,05), FVC (r= -0,730, p<0,01) and FEV1 (r= 0,664, p<0,05). However logistic regression analysis showed that overnight desaturations could not be reliably predicted from the daytime pulmonary function test results. Conclusion: Sleep-related desaturations are freguently present in clinically stable patients with DMD. Overnight desaturations can not be predicted from daytime respiratory function tests. Even in the absence of sleep-related symptomatology (headache, somnolence, etc.), sleep related respiratory disturbances should be suspected and searchhed in DMD patients.

Distruction of urethral anatomic continuation resulted from some complication like infections , rupture and fistula which arise from foreign body insertion . These foreign bodies are inserted for desire, erotic stimulation and infravesical obstruction. A 60 years old male patient presented with uretheral foreign body (90 cm electric cable) which thought to be inserted for overcoming the infravesical obstruction which resulted from BPH.

Background: Acute appendicitis is the mostcommon surgical problem in pregnancy after obstetric reasons. Pregnant patients operated with diagnosis of acute appendicitis were reviewed retrospectively in this study. Patients and Methods: 24 pregnant patients operated with diagnosis of acute appendicitis in Ankara Numune Training and Research Hospital between January and December 2003 were included in this study. Results: 19 out of 24 patients (%79.2) were pathologically diagnosed as acute appendicitis. Out of other 5 patients, 2 patients had ovarian cystrupture, 1 had ovarian cyst torsion and 2 had negative laparatomies. Distribution of patients was 2, 16 and 6 patients respectively, for 1st, 2nd and 3rd trimester. 2 patients had pretermlabour and 1 fetus resulted with exitus. Preoperative ultrasonography showed similarity to peroperative findings in 12 of 24 patients. Discussion: Diagnosis of acute appendicitis in pregnancy is quite difficult and physical examination and patient history are still most important diagnostic tools. Perforation risk in pregnant patients higher than normal population.

Between August 1969 and January 1982, D.Ü.T.F. The file notes of 186 patients with colon and rectal cancer hospitalized in the General Surgery Clinic were examined. Surgical intervention was performed in 156 of these, and surgical treatment was not performed in 30 of them. In our cases, 55.9% of the lesion was found in the rectum or rectosigmoid, 26.8% in the right colon and 17.3% in the left colon. Carcinoma was found to be non-curable in 98 and curable in 58 of 156 patients. Radical surgery was performed in 58 patients and palliative surgery in 98 patients. Overall mortality rate in 156 patients was 26.2%. Eighty-nine colon cancer patients applied to our clinic without an emergency, 60 of them cancer is non-curable and postoperative mortality was 23.3% and cancer was curable in 29 and 10.3%.

İn this study, the pregnant women live in Yenimahalle Training and Research Health Department (YMTRHD) region, at the 24-28 th pregnancy week were applied the Glucose Scanning Test in order to determine the abnor- mal glucose values. On June 2001 and in YMTRHD region, there has been 205 pregnant women at the midwives. 201 of them (98%) was accepted to fulfill the scanning test. The mean age of the pregnant vvomen was 26.9±5.5. İn the study we found the rate of positiveness in Glucose Scanning Test (GST) as 18.9%; and the rate of positive- ness in Oral Glucose Tolerance Test as 4.5%. İt is observed that GSTpositiveness has no relation with diabetes- existence, macrosomia story, obesity and parity (p>0.05). Consequently, Gst was determined positive in the 18.9% of the pregnant women who live in YMTRHD region. İt is observed that parity, aprevious history of overweight born baby, Body Mass lndex (BMI) and diabetes history in the family do not change the result of the test. For this rea- son, it has been determined that GST should be applied to ali the pregnant women who exceed 24th week of preg­ nancy.

In patients with rheumatoid arthritis (RA), concomitant fibromyalgia syndrome (FMS) has been reported in 14-17% of cases. Several methods are used to evaluate the outcomes in RA. Among them, disease activity score (DAS 28) is the most frequently used. The previous studies demonstrated that the presence of FMS is associated with a significant increase in the DAS 28 scores in patients with RA. Therefore if, the presence of FMS is ignored if more aggressive treatment approach can be applied to these patients. The aim of this study was to assess the frequency of FMS and evaluate the effect of FMS to disease severity and treatment approach in RA patients. A total of 74 female RA patients were enrolled to the study and they were separated in two groups with regards to presence of concomitant FMS (Group 1 only RA, and group 2 RA with FMS). The number of tender (TJ) and swollen joints (SJ), erythrocyte sedimentation rate (ESR) and for pain visual analog scale (VAS) levels were noted and DAS 28 scores were calculated for RA disease severity. Additionally, the patients were examined for the presence of pain in 18 FMS tender points. Group 1 included 44 patients, while there were 30 patients in group 2. The mean DAS 28 score (3.41 & 4.77, p:0,000), the median number of TJ (4 & 11) (p:0,000) and mean VAS (21,81 & 45,00) (p:0,000) were significantly higher in group 2. However, the difference in SJ (0 & 0) and ESR (24.93 ± 18 & 30.33 ± 25 mm/h) values were not significant. The type of medication used for treatment (DMARD or Anti-TNF drug) did not differ according to FMS existence in RA patients or not whether having FMS or not in RA patients. This study revealed that, the number of TJ, mean VAS and mean DAS 28 score are higher in in RA patients having concomitant FMS in RA patients. RA severity evaluated with DAS28 score may be overestimated due to concomitant FMS which may lead to inappropriate treatment approaches. There was no difference in terms of medical treatments because the presence of FMS considered in our clinic.

Abdominal actinomycosis is a rare infectious disease caused by an anaerobic bacterium actinomyces israeli. Pelvic actinomycosis is generally associated with the use of intrauterin devices (IUD). This chronic suppurative infection can mimic pelvic malignancy. The diagnosis of the disease is frequently miss preoperatively. The surgeons must be aware of this rare complication in order to avoid an extensive surgical procedure. Case: We present the case of a 31 year old premenoposal woman with an abdominal pain and a history of IUD us efor 6 years. On physical examination the patient had tenderness on right lower abdomen and a palpable cystic mass 8x10 cm in size on pelvic bimanual examination. A preoperative transvaginal USG showed a 9x9 cm cystic mass originated from right ovary. The patient was taken to the emergency operating suite with the diagnosis of torsion of the right cystic ovary by gynaecologist. During the exploratory laparotomy we observed an extensive diffusely infiltrating process involving right adnexa, sigmoid colon sacrum and right pelvic Wall. A loop of jejunum was adherent to this infiltrating process and a mass 5x6 cm in size was palpated in sigmoid colon. These findings were highly suggestive of a colonic carcinoma and the patient was consulted with a general surgeon intraoperatively. Right salpingo -ooferectomy + sigmoid resection + segmental jejunal resection was performed. Pathologic findings showed chronic inflammatory tissue with evidence of actinomycosis. Conclusion: The case described here underlines that surgeons must be aware of this unusual infectious disease in the differential diagnosis of pelvic mass.

Aim: To determine the course and the variations of radial nerve and its muscular branches in human fetuses. Material and Method: Radial nerve dissections were made on the 200 arms and forearms of 100 fetuses (50 males and 50 females). Length, thickness and distance measurements were taken by the same person using a 0.01 mm sensitive digital compass. Results: In all arms, primarily, the medial branch of muscular branch was separating from radial nerve. This branch was originating from posterior superior part of radial nerve in 153 arms (76.5%) and anterior superior part of radial nerve in 47 arms (23.5%). On forearms it was observed that the first branches of radial nerve reached to the brachioradialis muscle and extensor carpi radialis longus muscle. It was found that the motor branch which innervates extensor carpi radialis brevis muscle exit from deep branch in 48% of the arms, from radial nerve (separating location of the deep and superficial branches) in 42% of the arms, and from superficial branch in 10% of the arms. Also it was observed, in 26% of the cases, that a muscular branch originated from radial nerve and reached to the inferolateral segment of brachial muscle. It was found that there was no relationship between radial nerve and humerus body’s upper (superiorly 0.18) and lover (inferiorly 0.17) parts. Conclusion: The course, muscular branches, innervation patterns and variations of radial nerve should be well known by the specialists especially dealing with the local surgery of this region. In the fetuses, the knowledge of the spiral course of the radial nerve on the posterior face of humerus is crucial to determine the operation approach point, and this area is less safer than adults in the fetuses, according to our results.

Type 2 diabetes makes up more than 90 percent of diabetes mellitus (DM) being of a quite significant risk factor fort he development of coronary arter disease and most of these patients are required to take oral antidiabetic treatment. Upon considered that the main cause of the deaths in type 2 DM is cardiovascular diseases it is necessary that the effects of the drugs used for thesepatients on cardiovascular system be well-known to have various direct and indirect cardiovascular effects over these influences.

The present study investigated serum and placental tissue prolidase enzyme activities in the preeclampsia. Serum and placental tissue samples from 24 women with preeclampsia and 25 women with healthy pregnancy were collected. Prolidase enzyme activity was determined using a photometric method. Data such as maternal age, systolic and diastolic blood pressure, gestational age and fetal birth weight were assesed. Serum prolidase activities were found significantly lower and placenta prolidase activities were significantly higher in preeclamptic pregnancy than those in controls. Statistically significant correlations were found between placenta prolidase levels and gestational age, fetal birth weight. In conclusion, we conclude that collagen turnover rate is increased in preeclamptic placenta. However, further studies are needed how prolidase affect gestational age and fetal birth weight in preeclampsia.

Anthropometric measurements were perform ed to assess the physical growth and developmet of the prim ary school children. For this purpose; the body height and vveight, and head, thorax, ab­ domen, pelvis, upper and lover extrem ities related parts measurements of 356 prim ary school children were com plated and analysed statistically regarding sex and age. The results were also com pared with other studies from different part of the Turkey and possible factors vvhich might have contributed to the differences were discussed. We expect that our findings could be used a reference norm for grovvth and development in Konya and will be useful in the es- tablishm ent of the standart values of Turkish children body measurements.

Abstract

Aim: This study was designed to compare the effect of the classical bull horn excision pattern lip lift technique (group I) and the lip suspension technique (group II) which was performed using a dermal flap prepared on the upper lip with the same pattern incision, on patient satisfaction and scar appearance in lip lift surgeries.

Patients and Methods: Twenty-eight female patients aged 48-66 years, operated by the author between 2016 and 2023, were analyzed in two groups. The first group included 14 patients who were operated on with the classical bull horn excision pattern lip lift technique, and the second group included 14 patients who were operated with the lip suspension technique using a dermal flap prepared on the upper lip with the same pattern incision under local anesthesia. At the end of the 6th month, the patients in both groups, who were followed up for 6 months, were asked about their satisfaction with the overall aesthetic result using the global aesthetic improvement scale. In addition, an evaluator surgeon scored the postoperative scar using the Vancouver scar scale. All results were evaluated statistically.

Results: 9 of 14 patients (66%) stated very much improvement in the group 2 in which the dermal suspension flap was used, while 6 of 14 patients (%42.9) stated very much improvement with classical technique in Group 1, in the postoperative assessment at 6th month. Likewise, when the scar score performed by the evaluator surgeon was examined in 6th month. The scar scale was 14 in group 1 and 4 in group 2. In Group 1, the values of the patients ranged from 0 to 4, and the mean value was 1.0. In Group 2, the values ranged between 0-2 and the mean value was 0.3. Overall patient satisfaction was clinically significantly higher in group 2 when compared with group 1 and the scar was found to be clinically significantly less in group 2 when compared with group 1, even though there is no statistical significance (p>0.05) between 2 groups in overall patient satisfaction and scar score, probably due to limited number of patients in groups.

Conclusion:

It has been concluded that lip lift surgeries performed using the dermal suspension flap technique can contribute as a valuable alternative to the classical excision method, due to both higher overall aesthetic patient satisfaction and less scarring in our patients.

Aim: This cross-sectional study aims to determine job satisfaction of research assistants taking medical specialization education at Meram Medical School and factors that may be related to job satisfaction. Patients and Methods: A questionnaire consisting of Minnesota Job Satisfaction Scale and questions regarding demographic information is applied to 244 (80,2% ) physician assistants via face to face meeting. Results: 52.5% of participants were male, 55.3% of them were married and 29.1% had at least one child. Average of age was 28.42±3.02 years. Average number of night duties monthly was 6.53±4.10. 9.8% of research assistants had quitted a specialization education before. 60.6% of physicians were not content with their salaries. Overall satisfaction point average was 3.24±0.53, intrinsic satisfaction point average was 3.40±0.56, extrinsic satisfaction point average was found to be 2.97±0.62. Extrinsic satisfaction point averages of physicians working in basic sciences was found to be significantly higher than averages of physicians working in internal medicine and surgery branches. 33.2% of physicians were satisfied with working conditions, 44.3% with their chiefs’ behaviours towards employees, 84.4% with their colleagues. Overall satisfaction and extrinsic satisfaction points of participants who graduated from medical schools in Konya were meaningfully higher than points of those who graduated from medical schools outside Konya. Conclusions: Improving the working environments and conditions of physicians having busy schedule, enabling them to have a voice in institution policies, increasing the wages will not only increase the job satisfaction level of research assistant physicians, but also the quality of service provided to patients.

The effects of excess all-trans retinoic acid on liver tissue were investigated in this study. Tvvelve adult male VVistar rats were used. The animal were divided into three groups. I. group: 20 mg/kg/day all-trans retinoic acid was given to rats (n:4) by oral gavage, during 15 days II.group: 40 mg/kg/day all-trans retinoic acid was given to rats (n:4) by oral gavage, during 15 days III.group: Pats were used as control (n:4) End of experimental study, rats were killed under ether anesthesia. Liver tissues were taken and fixed with Boin’s solution for light microscobic observation. Paraffin blocks were prepared and 5 mm sections were stained diffrent methods. Later, sections were examined with ligth microscope. İn the experimental groups, the cytoplasms of hepatocytes in the peripheral zone of liver lobules were stainless. Excess celi infiltration which were considered activated Kupffer cells, observed at the peripheral zone. Moreover, hepatic lobule structure of experimental groups were destroyed This findings were more serious for intake 40 mg/kg/day all-trans retinoic acid rats.

Objective: The aim of this study is to determine the frequency of the patients with onychomycosis who have admitted to our clinic. Materials and method: 771 patients aged 18 years and over presented to Dermatology Clinic of Meram Medical Faculty of Selcuk University between October 2004 – January 2005 were included into the study. Age, sex and education level of the patients were noted. Nail samples were taken for diagnosis in our laboratory. Direct microscopic examinaiton and culture were performed. Chi-square test and student t test were used for statistical analysis. Results: Onychomycosis was detected in 67 cases (8.7%), of whom 43 (64.1%) were male and 24(35.9%) were female. The presence of onychomycosis was found to correlate significantly with increasing age (p<0.05), male gender (p<0.05) and low education level (p<0.05). Conclusion: We detected the frequency of onychomycosis as 8.6% in our patients. We consider that occurance rate of onychomycosis may decrease in our region when informative educational measures related to with protection are performed.

Drinking water is a significant source in mineral intake due to the fact that waterborne minerals are present in ionic form and are instantly absorbed by the gastrointestinal tract. However, up until now, no comprehensive research has been encountered about how levels of trace elements in drinking water are related with body compositions of the children. Thereupon, in this study, it was aimed to assess the relationship between clinically important trace element levels in public drinking water and body composition of the children in Batman. The universe of the study consisted of female children, at the age range of 13-18 (mean age 15.9±1.68), who were divided into overweight, obese and normal weight groups of 20 participants, according to body mass index (BMI) and percentile curves, and who applied to Batman Regional State Hospital Diet Policlinic. The levels of lithium (Li), nickel, lead (Pb), silicon, stannum, strontium (Sr), boron, aluminium (Al), barium and rubidium were measured in water samples obtained from municipality and individual wells by employing inductively coupled plasma spectrometry. Body composition measurements were performed by means of bioelectrical impedance analysis (Tanita BC 418). Li levels in drinking water showed significantly positive correlations with BMI, fat mass and fat percentage in all children. Similarly, Pb levels in drinking water showed significantly positive correlations with BMI, fat mass and fat percentage in children. Finally, Al and Sr levels in drinking water showed significantly positive correlations with body weight, BMI, fat percentage and several variables of body composition in children. According to the findings obtained, it may be suggested that there is a relationship between Li, Pb, Al and Sr contents in drinking water and body composition of children aged 13-18.

Noonan syndrome is an autosomal dominant disorder that is typically dysmorphic anamolies at birth. In many affected individuals, this syndrome is associated with cardiac defects and a distinctive facial appearance. We aimed to discuss a different variant of Noonan Syndrome progressing especially with gingival overgrowth and dental anomaly in our cases. A 15-year-old female patient presented to our family medicine outpatient clinic with the complaint of growth retardation. The patient was diagnosed with Noonan Syndrome with phenotypic symptoms. Noonan Syndrome is one of the syndromes without any chromosomal anomalies developing with Turner-like phenotypic features. Gingival overgrowth and dental anomaly coexistence in addition to the oral symptoms that are likely to be related to the Noonan Syndrome was present in our case.Specifically, if there are accompanying symptoms and findings in cases with gingival overgrowth and dental anomalies as seen in patients’ mouth and teeth examinations, Noonan Syndrome may be taken into consideration.

Pharmacogenetics deals with genetic variations and individual response differences of drugs. The discovery of enzymes responsible for drug metabolism and the research to DNA sequences encoding these enzymes enable the creation of individual treatment strategies. Cytochrome 2B6, cytochrome 2C9, cytochrome C19, cytochrome 2D6, cytochrome 3A4, N-acetyltransferase, dihydropyrimidine dehydrogenase, thiopurine methyltransferase, UDP-glucuronyl transferase and catechol-O-methyltransferase enzymes are mainlyresponsible from drug metabolism and polymorphisms in enzyme activities affect the pharmacokinetic properties of the drug which leads to differences in drug response between individuals. First examples that form of the basis of pharmacogenetic studies are N-acetyltransferase and cytochrome 2D6 polymorphisms. Consideration of enzyme polymorphisms that may result with pharmacokinetic differences during drug choice is important to increase the success of treatment and to prevent adverse/toxic reaction risk. The studies about pharmacogenetics, which was studied about 50 years ago, has become more important nowadays with the development of gene technology. Individual drug choice will be an important parameter by further development of pharmacogenetics in the second 50 years through pharmacogenetic studies that is accelerated due to technological developments.

With the understanding that adipose tissue is not only a passive energy store, but also an endocrine organ, interest in bioactive factors secreted from adipose tissue has increased. Adipose tissue, consisting of pre-adipocytes, macrophages, endothelial cells, fibroblasts and leukocytes, as well as adipocytes, has an important role in systemic metabolic regulation. Chemerin, called tazarotene-induced gene 2 (TIG2) or retinoic acid receptor responder 2 (RARRES2), was first discovered in 1997 in psoriatic skin lesions as a retinoic acid-sensitive gene. It was later determined that chemerin regulates adipogenesis and adipocyte metabolism, with data showing that it alters adipocyte differentiation, expression of important genes in glucose and lipid metabolism, and is classified as a new adipokine. The effects of chemerin in circulating and inflammatory fluids are mediated through receptor G protein-bound receptor chemokine-like receptor 1 (CMKLR1). The increase in the number of clinical trials associated with increased levels of local and / or circulating chemerin in various diseases, from obesity, metabolic syndrome (MetS), type 2 diabetes mellitus (T2DM), polycystic ovarian syndrome (PCOS) to inflammatory diseases, supports the important roles of chemerin in the pathogenesis of these diseases. Although it is clear that serum chemerin levels increase in these diseases, the mechanisms regulating the expression of the chemerin are not fully understood. More randomized controlled studies are needed to understand the mechanisms of action of chemerin.

The renin angiotensin system is thought to be modulated by gonadal steroids. After unilateral nephrectomy and unilateral nephrectomy + bilateral ovariectomy, occured changes were investigated in this study. Right nephrec- tomized and rigth nephrectomized + bilateral ovariectomized female rats left kidneys were examined histopatho- logically after four week. Severe inflammatory reaction was observed in only nephrectomized rats after four week. Moreover acut renal ischaemia was observed in the unilateral nephrectomized + total ovariectomized rats left kid- ney. Our results showed that gonadal steroids may have a role in modulating acut renal ischaemia.

Two cases of morphea which developed after hepatitis B vaccination at the sides of injection were presented. One of these two patients was a 25 years old female. She referred to our clinic with complaints of brownish spots and hardening on external side of her right arm. In her history she said that she was given hepatitis-B vaccination a year ago, on the thickened parts of her arm, twice with 4 weeks internal. Itching, discoloration and hardening started on these regions 3-4 months later, especially inceasing with exposure to sun. The other case was male and 23 years old. He referred to our clinic with complaints of discoloration, regional hardening, hair fall on the upper part of his right arm. He said that he was given two hepatitis B vaccination 8 months ago with 4 weeks interval. Two months after the innoculation he had the mentioned complaints over the innoculated regions of his arm. Incisional biopsy was taken from both of two cases. Histophathologic examinaton results were found accord with morphea. According to clinic prognosis, plaque and slowly progressive type morphea was found in the female patient and lineer and rapidly progressive type morphea was found in the male patient. Systemic involvement was not determined in both of the two patients. The local and/or systemic treatments were begun to both of the patients.

Isolated tubal torsion other than combination with ovarian torsion is reported in few articles in the literature. Especially in cases with normal appearing ovaries and having acute abdomen clinic as like usual torsion, this disease should be kept in mind. In this report a case of isolated tubal torsion is presented which is diagnosed preoperatively with ultrasonography and computed tomography and possible results of the delay in the treatment is discussed.

Purpose: Cross sectional imaging technigues more widely available in the recent years for evaluation of pelvic and tubo-ovarian lesions. We discussed the primary contribution of these methods in the diagnosis of uterine masses in the patients with tubo-ovarian lesions. Materials and Method: IVe present 41 tubo-ovarian lesion with pathologic correlation. Transabdominal sonography, enhanced and nonenhanced CT seans were performed in ali cases. Moreover sagittal and axial T1-weighted as well as T2- vveighted, and fat-saturated unenhanced and gadolinium- enhanced MR images of the pelvic region. kVe compared our radiologic findings with histopathological results. Results: Three of 41 cases had corpus luteum eyst, 10 had eystadenoma, 7 had ovarian carcinoma, 7 had dermoid eyst, 4 had endometrioma, 3 had abcess, 2 had eyst hydatid, and 1 had ovarian fibroma on histopathological examination. Correct diagnosis was established in 33 (80%) out of 41 lesions with US, in 29 (80%) out of 36 lesions with CT scan and in 33 (83%) out of 40 lesions with MRI. Correct diagnosis was established in 33 (83.3%) out of 36 lesions with US, in 29 (77.7%) out of 36 lesions with CT scan and in 33 (86.1%) out of 36 lesions with MRI. Conclusion: Because of ability to detect invasion and in defining the extent of disease, MRI is better than sonography, and CT, and appears to be the modality of choice for evaluated of the pelvic masses. Although US pas potantial advantages and limitations, it should be preferred as the first method of searching for pelvic pathologies.

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

Wilm’s tumor, the most common childhood renal cancer, is a heterogeneous renal tumor in which diffuse anaplastic or negative histology represents poor prognosis. In Wilm’s tumor pathogenesis, a large number of factors remain uncertain. For this reason, the disease continues to be the focus of further research. MicroRNAs are small, protein-encoding RNA molecules that regulate gene expression at post-transcriptional stage. The role of microRNAs in cancer onset and progression has been demonstrated in most solid cancers. MicroRNAs also have a diagnostic potential, and microRNA-targeted treatment is a candidate for an important role in cancer treatment. In Wilm’s tumor, dysregulation of certain key oncogenic or tumor suppressor microRNAs, such as miR-17 ~ 92 cluster, miR-185, miR-204, and miR-483 has been documented. In this study, we will summarize the current evidence about the role of dysregulated microRNAs in the development of the Wilm’s tumor. The possible effects of MicroRNAs on the clinical diagnosis and prognosis of the Wilm’s tumor will also be discussed. Thus, an overview of the future place of microRNAs in the implementation of new treatment options will be presented.

\r\n Purpose: Mesh erosions that necessitates excision can develop in Trans Obturator Tape (TOT) surgeries which are widely used in the treatment of stress urinary incontinence.

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\r\n In our study, we described a method of vaginal flap placed under suburethral sling to prevent urethral mesh erosion related with TOT surgery and evaluated the patients for postoperative complications.

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\r\n Materials and methods: In our study, 22 patients who had TOT and cystocele operations simultaneously and to whom flaps composed of vaginal tissue were placed in front of the urethra under the mesh between December 2014 and May 2018 were evaluated retrospectively. Patients were evaluated for urethral mesh erosion, vaginal mesh erosion, complaints of urgency and dyspareunia, urinary retention, and need for secondary surgery.

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\r\n Results: The mean postoperative follow-up of the patients were 8,95±8,45 months. 20 patients had simultaneous TOT and cystocele operations (%90,9), 2 patient had vaginal hysterectomy, TOT and cystocele operations simultaneously (%9,1). Urethral mesh erosion developed in none of the patients during the follow-up period. Vaginal mesh erosion and dyspareunia was observed in only one menopausal patient. Urinary retention and overflow incontinence developed in another patient. Vaginal hysterectomy, TOT and cystocele operations were made simultaneously in this patient. Mesh of this patient was cut later on.

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\r\n Coclusion: The surgical technique we used in our cases kept urgency and vaginal mesh erosion in a minimal level besides totally preventing urethral mesh erosion in a mean short-term follow-up period of 9 months.

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Aim: Many different methods have been used for detection of antiepielptic drug concentrations for many years in clinical chemistry laboratories. In our study we aimed to evaluate the performance of turbidimetry as a method for detection of serum antiepileptic drug concentrations by comparing it with HPLC technique. Material and Method: Measurements were performed in both methods teknion the blood samples of the epileptic patients who were in follow up in neurology and pediatrics clinics of Ministry of Health Ankara Education and Research Hospital. This study was carried on laboratory of biochemistry of the same hospital. 35 samples for carbamazepine, 31 for phenytoin and 30 for phenobarbital were taken into this study. Results: Within run CV values for HPLC technique in measurement of sera were as follows for each drug: Carbamazepine 1.57% and 3.62%; phenytoin 2.15% and 4.14%; and phenobarbital 1.53% and 4.34%. They were found in turbidimetric method as follows: Carbamazepine 2.66% and 7.03%; phenytoin 1.98% and 2.04% and phenobarbital 3.3%1 and 5.24%. There was a significant correlation between turbidimetric method and HPLC technique (for carbamazepine r= 0.95, phenytoin r= 0.97 and phenobarbital r= 0.86 ). The recovery rates for each drug in turbidimetry were satisfactory (carbamazepine R%= 80.4%, phenytoine 88% and phenobarbital 86.8%).They were as follows in HPLC technique: R%= 105%, 107%, 110%. Conclusion: HPLC technique is accepted as a reference method for detection of serum antiepileptic drug concentrations. The performance of turbidimetric method is weak when compared with HPLC technique. But because of the cost effectiveness and the short turn around time, turbidimetry was preferred in our country.

The aim of the study was to investigate the changes in fat and carbohydrate oxidation rates in the same and different activity speed during walking and running. Eleven healthy males participated in this study. The subjects’ individual preferred walk-to-run transition speeds (WRTS) were determined. Each subject covered 1.5 mile distance for four exercise tests; walking (WRTS-W) and running (WRTS-R) tests at WRTS, 2 km.h-1 slower walking than WRTS (WRTS-2) and 2 km.h-1 faster running than WRTS (WRTS+2). The expired air was measured and analyzed breath-by-breath using an automated online system and heart rate was monitored and recorded throughout walking and running tests. Maximal fat oxidation was observed at the WRTS-R activity. Fat oxidation rate was significantly higher in WRTS-R than WRTS-W. Also, carbohydrate oxidation rates were significantly higher in WRTS-W activity than WRTS-2 and WRTS-2 activities. Our results indicate that differences in fat oxidation during running and walking might have been resulted from activity intensity rather than activity mode.

We carried out a retrospective and prospective study of 47 patients who had sustained injuries over the last three years from the hand passing through or striking glass. The demographic data, severity of injury, history of psychiatric illness and outcomes of the patients were evaluated. The preoperative examination of these injuries significantly underestimated the amount of damage. A simple and small laceration has the potential to conceal an underlying deep injury. For this reason, if glass is implicated as a causative agent, careful preoperative evaluation and surgical management should be considered.

This study was constructed on 103 middle ear drainage of 90 suppurative chronic otitis media patients who app-lied to the outpatient clinics of the Selçuk University Faculty af Medicine. Aerobic bacteria and mycatic cultures of middle ear discharges were taken from patients. Standart therapeutic regime (daily care and topical drops with an-tibiotics) was applied ta MI of the patients according to their culture-antibiogram. Some of the patients who are re-sistant this medication were undertakerı to combirıed otomycotic therapy. The results showed that suppurative chro-nic otitis media was a risk factor for otomycosis. It was indicated that the addition of antifungal drugs ta the conventional treatment protocol increased the recovery chance of patients who resistant to conventional therapy.

in this report. a case of an endometriotic cyst of the right ovary in a pregnant women is presented and clinical and pathological findings were compared to those in the literature. The effects about infertility and pregnancy of endometriosis were discussed.

Aim: Pediatric age period has a dynamic structure for nevogenesis. In this paper, it was aimed to contribute to recognition of banal and atypical nevi through examining dermoscopic pattern and pigment network structures of acquired melanocytic nevi in pediatric age group. 
Patients and Methods: One hundred and fifty pediatric volunteers who were not predisposed to nevogenesis were included in the study. Children were divided into two groups as 7 and under, and 8 and over. 
Results: It was observed that the mean number of nevus was higher in the older age group (9.72) than in the younger age group (3.44). It was observed that the predominant pattern structure was globular pattern in both groups, and nevi with reticular patter in the age group of 8 and above were more than the age group 7 and below (p = 0.03). In both groups, nevi with globular pattern were found to be denser in the trunk and nevi with reticular patter in the extremities (p = 0.001). When the pigment network structures of nevi were examined, it was observed that the most frequently observed pigment network was uniform, but nevi with central pigmentation changes were observed more frequently in the age group of 8 years and older (p = 0.001).
Conclusion: Although acquired melanocytic nevi in the pediatric age group often have a globular pattern and uniform pigment network, the number of nevi with reticular pattern and central pigmentation changes increases with increasing age. 

Aim: Many options have been reported in reconstruction of the facial defects such as skin grafting, local flaps and free flaps. The extended V-Y flap, a modified V-Y advancement flap, is very useful in closing defects following excision of large facial lesions. Herein, we presented our 6 years experience for covering of the large facial defects with extended V-Y flaps. Material and Method: This procedure was applied to 27 patients with age ranging from 38 to 79 between 2001 and 2007. All operations were performed under local anaesthesia. The lesions were either squamous cell carcinomas, basal cell carcinomas, malignant melanoma, trichilemmoma, seborrheic keratosis or actinic keratosis and they were localized in the malar area, infraorbital area, lateral nasal aspect, the zygomatic area and the forehead. The size of the defects ranged from 3 x 3 cm to 6 x 5, 5 cm. Results: All of the flaps were achieved suitable closure of defects. The functional and aesthetic results were satisfactory for patients, and no tumor recurrence was observed during the 9 to 17 months follow-up period. Conclusion: Extended V-Y flap can be used reliably for the reconstruction of large facial tissue defects.

Aim: Multiple sclerosis (MS) is an immune- mediated disease of the central nervous system. We will emphasize in this article; very different mechanisms, and complex interactions have important role in immunopathology of multiple sclerosis. Main Findings: The pathogenesis of MS is best viewed as a complex interaction between genetically predetermined susceptibility markers and environmental stimuli. MS is charecterized by inflammation, demyelination, apoptosis in oligodendrocytes, remyelination, and axon loss. Immune reaction against different components of the central nervous system (particularly myelin structures) are thought to play an important role in the initiation of the destructive process. The inflammation in MS appears to be caused by an overactive pro-inflammatory TH1 profile in T cells. Demyelination can result as a consequence of direct damage to myelin by inflammatory cells or indirectly because of the enviroment produced by inflammation. Axon loss occurs in MS lesions starting early in the disease. Conclusion: MS occurs with different immünopathological mechanisms.

Aim: Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract. GISTs are thought to originate from the precursors of interstitial Cajal cells which regulate gastrointestinal peristaltism. GISTs include a group of heterogeneous tumors with different morphology and biologic behavior so their epidemiology, clinico-pathological features and prognosis is distinct in different countries. The aim of this study is to analyze the histopathological, immunohistochemical characteristics and risk groups of 100 patients with GIST in the last 10 years in our depertment. Patients and Methods: Between 2006-2016, 100 patients with GIST diagnosed in our Pathology laboratory were examined retrospectively. Risk groups were determined according to diameter and mitotic rates of the cases. Histopathologic and immunohistochemical features excluding diameter and mitosis were analyzed and the relationship between risk groups was analyzed. A Chi-care- Fischer was used for descriptive statistical analysis. Results: In our cases, there is no relationship between age, gender and risk groups. Colorectal, extra gastrointestinal system (peritoneum, mesentery and retroperitoneum), small intestine and stomach GISTs are in high risk group respectively. Small intestine, colorectal and extra gastrointestinal system tumors are larger diameter than stomach tumors. There is no relationship between immunohistochemical CD-34, S-100, SMA, desmin and risk groups. Tumors expressing over 10% of Ki-67 are in high-risk group. Stomach and extra gastrointestinal tumors represent more CD-34 expression. Tumors with necrosis, haemorrhage and high cellularity are at higher risk group. There is no relationship between risk groups and ulceration, growth pattern and atypia. Conclusions: GISTs are rare tumors of the gastrointestinal tract and may occur in different regions, in different variations. Detailed histopathologic and immunohistochemical examination of the GİSTs

Aim

This study aims to determine the prevalence of falls and associated risk factors among elderly living in Sinop, Turkey.

Materials and methods

The universe of this cross-sectional study consists of 32506 people older than 65 years old whom are registered to the family physicians’ information system and live in Sinop. After stratification for sex and age (65-74, 75 and over) a sample size of 2463 and 92.1% were reached. Data about some of the socio-demographic characteristics, falling status, daily living activity functionalities, depression status and awareness about falls of the participants were collected via a structuralized questionnaire. Relations between falls and associated risk factors were assessed by four different logistic regression models.

Results

The mean of falling prevalence after age 65 among elderly was 36.4%. Not being graduated from any school, having low scores for current health conditions, using more than one drug daily, not being able to walk without support and being positive for depression are found to be risk factors for falling among both sex and age groups. Having a chronic disease, living alone, having fear of falling, having low awareness about falls, being dependent in daily living activities and having inadequate knowledge about prevention from falls are found to be risk factors for at least two of the sex and age groups. There were no statistically significant relations between falling risk and previous or current employment status.

Conclusion

Falls are important public health concerns among elderly and the variability of risk factors depending on determinants such as age and sex should be considered while planning further implementations targeting fall prevention and control of risk factors for elderly.

onary Cryptococcosis is a rare entity in Turkey. Diagnosis of the presented rare case made microbiologically from the aspirated bronchia/ lavage and histologically taken from the bronchial biopsy. Excellent result was achieved with Misteklin (Tetracyclin+Mycos-tatin) with uneventful recovery.

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

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

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

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

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

Purpose: Cross sectional imaging technigues more widely available in the recent years for evaluation of uterine lesions. We discussed the primary contribution of US, CT, and MRI methods in the diferential diagnosis of uterine masses. Materials and methods: We evaluated the spectrum of US, CT, and MRI findings of the 15 uterine masses. Transabdominal sonography, enhanced and nonenhanced CT seans were performed in ali cases. Moreover, sagittal and axlal T1 weighted as well as T2 weighted, and fat-saturated unenhanced and gadolinium-enhanced MR images of the pelvic region. We compared our radiologic diferential diagnosis with pathologic diagnosis. Results: Seven of 15 cases had myoma, 3 had adenomyosis, 3 had endometrial carsinoma, and 2 had servix carcinoma. Correct diferential diagnosis was established in 11 (73%) out of 15 cases with US, in 12 (80%) with CT, and in 13 (87%) with MRI. Conclusion: MRI is the imaging method best suited for evaluation of uterine lesion than other imaging technigues. Since ultrasonography allows deiiation of the uterine masses in at least two scanning planes, this method should be preferred as the first method of searehing for uterine lesions.

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.

Multi-Slice Computed Tomography (MSCT) is a recently introduced non-invasive technique used for the diagnosis of coronary artery disease (CAD). Both MSCT and conventional coronary angiography (CAG) may provide direct visualization of the coronary arteries. To determine the diagnostic accuracy of 128-slice MSCT compared with the results of conventional CAG for the diagnosis of significant coronary artery stenosis. Forty-two eligible patients who underwent 128-slice MSCT with the suspicion of CAD and had any coronary lesion within the whole coronary tree were enrolled prospectively. Subsequently, CAG was performed to confirm the severity of coronary lesions. The records acquired by MSCT coronary angiography and conventional CAG were evaluated by 16-segment model of American Heart Association (AHA). Mean age of the patients was 56±12 years, and mean heart rate prior to the examination was 69±4 bpm (min-max: 54-78). Of 672 coronary segments, 669 were interpretable and evaluated in 42 patients. For all the interpretable segments, overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the diagnostic accuracy (DA) of 128-slice MSCT to detect significant stenosis were 91%, 98.5%, 93.8%, 97.8% and 97%, respectively. These values for evaluation of proximal segments were 97.8%, 96.4%, 95.7%, 98.1% and 97.1% and, for distal segments were 87.4%, 98.8%, 92.7%, 97.7% and 97%, respectively. Our results show that, the diagnostic performance of MSCT appear almost equivalent to CAG, current gold standard, with excellent, sensitivity, specificity, positive and negative predictive values. We think that, 128 slice-MSCT will be increasingly utilized in future, decreasing unnecessary coronary angiography procedures.

A 37 - year old woman was admitted to the co-ronary care unit (CCU) with the diagnosis of acute anteroseptal myocardial infarction. Three days post admission to the coronary care unit upon history of her menstrual status a pregnancy test was done and found to he positive. Her CCU care was continued and discharged without any complications. Her later phases of pregnancy was uneventful and underwent premature vaginal delivery at 8 months. This re-inforces the idea of close follow up of pregnant women with respect to possible angina pectoris if history reveals hypertension, diabetes. SMDking. overweight and other risk factors of myocardial in-farction.

Balanced reciprocal translocations are the largest group of chromosomal aberrations responsible for recurrent abortions in couples. A couple, aged 27 and 29 years referred for cytogenetic analysis and counseling for five first trimester spontaneous abortions which one of them was a twin. After the chromosomal analyses the women’s karyotype was determined normal and the man’s was 46,XY,t(18;20)(p11.3;q11.2). The main cause of the loss of reproduction was tought to be the reason of the unbalanced product of this translocation. The genes localized on the region of this balanced translocation was looked over based on the literatüre and the risk of unbalanced karyotyped pregnancies were discussed.

Aim: We aimed to evaluate surgical procedure carried out to an 8 years old child, clinically diagnosed as Henoch-Schönlein Purpura (HSP), undergoing intussusception repair, because of allergic vasculitis, erythamatose maculopapuler rashes, rectal bleeding, abdominal pain and intussusception, under the light of literature data. Case Report: An eight years old and a male child was consultated because of his biliary vomiting, nausea and diffuse maculopapuler rushes which were localised especially in lower extremites. The symptoms of HSP were observed at histopathologic examination of skin. On examination, the symptoms of acute abdomen, which were characterised with diffuse tenderness and distansion, hipoactive intestinal sounds and abondant biliary drainage from nasogastric tube, were identified. The pneumatic and hydrostatic reductions were not performed because of the risk of perforation due to severe peritonitis and his poor general condition. The patient was operated on after preoperative resuscitation. During the explorative laparatomy, edema and the symptoms of insufficient vascularisation in all intestinum were present. Also, it was observed that approximately 20 cm’s intestinal segment which begins from 10 cm proximal of ileocaecal valve, had been necrotic and ileostomy was carried out after resecting this segment. Meanwhile, it was observed that the whole intestine was edematous and localised blood circulation was distorted in some areas. The patient was operated on to make bridectomy when evisceration and brid ileus occurred on postoperative eleventh day, and the ileostomy was closed at the same session. The patient was delivered with complete recovery 16 days after closing of ileostomy. Conclusion: Although HSP is rarely seen as the cause of acute abdomen, too serious complications of this disease must be kept in mind.

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.

Tuberculosis remains to be a serious public health problem in our country and all over the world. Extrapulmonary tuberculosis causes major clinical problems because of difficulties encountered in the differential diagnosis. In this case report, we aimed to discuss a case of tuberculous lymphadenitis mimicking mediastinal tumor in chest CT and PET-CT examination. Eighty years old female patient with right paratracheal enlargement in the chest radiography was admitted to our hospital. Thorax CT and MR imaging was supporting this expansion as concordant with the mediastinal tumor. The PETCT showed increased FDG uptake in favor of malignant masses. However, mediastinoscopic biopsy was reported as tuberculous lymphadenitis and antituberculous therapy was started. It should be kept in mind that even in adults patients, tuberculous lymphadenitis should be thought in differential diagnosis of mediastinal masses suspecting malignancy with imaging techniques and also it should not be forgotten that tuberculous lymphadenitis may be presented with elevated FDG uptake at PET-BT.

Aim: This review sought to determine the relationship between cyanosis and hematological signs and findings. Main finding: Patients with cyanotic congenital heart disease are succeptible to develope hematological side effects. Several findings, including polycytemia, thrombocytopenia, factor deficiencies, iron-deficiency anemia and disseminated intravasculary coagulation have been reported. Decreased arterial oxygen saturation in cyanotic congenital heart disease causes compensatory kurise in hemoglobin and haematocrit levels. Erythrocytosis is an adaptive response to improve oxygen transport in cyanotic congenital heart disease. However, at highly increased haematocrit levels patients may experience hyperviscosity symptoms. Iron-deficiency in cyanotic congenital heart disease patients is often overlooked due to elevated hemoglobin concentrations. The detection of a hemostatic abnormality and its correction by appropriate therapy are likely to minimize the side effects. Results: Children with cyanotic congenital heart disease are prone to both thrombosis and hemorrhage. Hematological management of cyanotic congenital heart disease has received little attention. The lack of practical therapeutic guidelines forced us to consolidate our observations on patients with cyanotic congenital heart disease.

The number of patients admitted ta our department with spontaneous. pneumothoıar during the Last ten years is 150. Conservative and intercostal drainage methods used in 30 patients failed. Therefore, they are alt operated on. Superiority of lambolu parietal pleural method over the other methods used for this group of disorders have been discussed. No recurrence has been reported during the 4 - year follow - oup period.

İn this study the seropositivity of antiHA VlgM and IgG, HBsAg, HBeAg, antiHBe, antiHBs, antiHBdgM, antiHBc and antiHCV were investigated in the sera of 96 staff working at the kitchen of different goverment departments and 100 healthy people. İn the sera of staff vvorking in the kitchen antiHAVIgG was 93.7% (90/96) positive and in the control group 92% positive. AntiHAVIgM was found negative in ali of the staff and control group. The seropositivity of HBsAg, HBeAg, antiHBe, antiHBc and antiHBs were found as 5.2, 2.1, 3.1, 17.7, 14.6 % respectively in the control group these markers were found 7, 7, 0, 27, 34 % respedively. AntiHBdgM was negative in al! of the sera. Anti HCV was found positive at one kitchen staff and at the two person of the control group. For the staff who were negative for hepatitis A and B virüs markers a vaccination programme was planned.

A rare cause of acute abdomen; appendiceal neuroma. Case report

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ABSTRACT

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    Acute abdomen refers to nontraumatic pathologies of abdominal origin which are characterized by sudden-onset abdominal pain. In most cases the cause of pain is a pathological condition requiring urgent surgical intervention. Acute appendicitis is the most common indication for surgical intervention in patients presenting to emergency department with acute abdomen. Obstruction of appendiceal lumen has been widely accepted as the precipitating factor in the pathophysiology of acute appendicitis. It usually develops as a result of food or feces particles entering into and obstructing appendiceal lumen, leading to inflammation and swelling of regional lymph nodes. Luminal obstruction results in overproduction of bacteria, excessive mucus secretion, and increased intraluminal pressure. Some studies in recent years have suggested a neural component in the pathophysiology of this condition. Such cases may present with various diagnoses such as obliterated appendix, fibrous obliteration, appendiceal neuroma, and neurogenic appendicitis. In this paper we present a case operated with the initial diagnosis of appendicitis and histopathologically diagnosed with appendiceal neuroma, a rare cause of acute abdomen.

Marjolin’s ulcer is a term to describe a malignancy arising from scar tissue, especially burn scars. It appears on burn scar a long period after initial burn injury. The most common malignancy is squamous cell carcinoma (SCC) for these type of patients. Basal cell carcinoma, melanoma and sarcoma have less frequently been reported. Biopsy is the most important diagnostic procedure. The treatment is wide excision and regional lymph node dissection. A 12 year old child admitted to our clinic with unhealed wound in the axillary region for ten months. The patient had an ulcer axillary region through thorax. Incisional biopsy was performed. Histopathologic examination revealed that SCC. Wide surgical excision was done. The defect area was covered with flap. Axillar contracture was reconstructed with Z-platies. The case was presented due to early development of Marjolin’s ulcer as in ten years.

Aim: In this study, the aim is to determine the effects of BIPAP on alveolar gas exchange and haemodynamics over BIPAP + PSV mode in acute respiratory failure. Material and method: After sedation, 50 patients with acute respiratory failure were ventilated. BIPAP was preferred for first six hours and 10 cmH2O PSV was added on BIPAP for the second six hours. Mean arterial pressure (MAP), heart rate (HR), inspiratuar pressure (Pinsp), peak pressure (Ppeak), plato pressure (Pplato), mean pressure (Pmean), minimum pressure (Pmin),intrinsic PEEP (PEEPi,) total minute volume (MVtop), spontaneous minute volume (MVspo) and ratios, total frequencies (ftop), spontaneous frequency (fspo) and ventilatuar frequency (fmek), inspirium ve expirium tidal volumes (VTinsp, VTeksp), resistans, complians, arteriel blood gases values, FiO2 values and Horovitz ‹ndex (PaO2/FiO2) were recorded at, T1: initiation of ventilation, T2: end of the BIPAP ventilation, T3: end of BIPAP + PSV ventilation. Results: There was no statistically difference in haemodynamic data, Ppeak, MVtop, VTinsp, VTeksp, airway resistance, compliance, PaCO2, SaO2 ve PaO2 values. The increase in spontaneous respiratory rate and decrease in Pinsp with BIPAP + PSV mode was statistically significant (p<0.05). Arterial blood gas analysis with BIPAP + PSV ventilation, FiO2 levels were reduced while Horovitz index values were increased (p<0.05). Conclusion: BIPAP and adding 10 cmH2O PSV provide positive effects on oxygenation. We think that the effects of this kind of hybrid ventilation should investigate at homogenous subgroups and long term ventilation.

A retrospeetive study was done of the treatrnent of closed and open fractures of the tibia in 133 patients with 140 fractures. These patients vith shafi fractures of tibia were treated at the Department of Orthopaedics and Trawıatology of the Selçuk Oniversitiy Hospital, between 1983 and 1989 The mean oge al initiation of treatrnent was 32 years. Their ages ranged from 13 to 72 years old. ln all, 96 fractures were closed and 44 were opera. Traffic accidents were the most cause of the injury. In 96 patients, the tibial fracture was the only inju.ry, i,x 37 patients other injuries also were present. 7 patients had bilaterall tibial fractures. The patients were followed al least unlu/ to clinical and radiographical union of the fracture. Iri (his series, the overall succes rates in healing of the fractures with open and closed method_v were highly satisfactory

Introduction: Migraine is a neurovascular disease that is common worldwide. In a few studies, a relationship was found between vitamin D levels and headache severity and types. In this study, we primarily investigated whether there was a difference in vitamin D levels between migraine patients and healthy controls, and secondarily, whether there was a relationship between types and severity of migraine and vitamin D levels.

 

Patients and Methods: This case-control study was carried out between January 2021 - July 2022 at ***** University ***** Faculty of Medicine, Department of Neurology. 204 patients over the age of 18 who were diagnosed with migraine and 204 healthy volunteers without headache were included in our study. The diagnosis of migraine was made by a neurologist according to the International Headache Society 3 criteria.

 

Results: The mean vitamin D level was 15.30±9.93 ng/dl in the migraine group and 14.62±7.93 ng/dl in the control group. There was no statistically significant difference between the two groups (p=0.976). There was no difference between migraine patients and the control group in terms of vitamin D deficiency and insufficiency (p=0.365).

 

Conclusion: According to the results of our study, we did not find any difference in vitamin D levels between migraine patients and the normal population. There was no statistical difference in vitamin D levels among migraine subtypes. In addition, no relationship was found between severity and frequency of migraine attacks and vitamin D levels. According to the results of our study, the high prevalence of vitamin D deficiency appears to be a common problem in both migraine patients and the healthy population, and randomized clinical studies with large sample numbers are needed on this subject.

To identify the normals of ecch region and as it is necessary la use thern, in a group of 96 healty people fasting blood sugar levels total cholesterol, 11DL-cholesterol and triglyserid analysis were carried out. fasting blood sugar level in females were 87,06 ± 8.93 mgtell and 76,97 ± 9,1 mg1d1 tn rnales; total cholesterol 206,41 ± 28,43 rrıgidl in _females and 187,20 ± 41,34 mg1d1 in rnales; 11DL-eholesterol 54,45 ± 9,83 rngIdl in females and 41,63 ± 8,42 rngidl in rnales and triglyserids 101,38 ± 35,17 rngidl in females and 127,6 ± 5.1,94 rngidl in ırrzalex Also the people were arranged in three groups, according ta their ages ranging from 20-34.-35- 49, 50 and over; and the eheınges of value• related to age were inspected. The results which were obiained have been compaired with the results of the other investigators and it has been agreed that the results which were found would be a refe.rence for the laboratories stu-dying iıx that region.

The process of treating skin lesions by adding chemical burning to dermabrasion is called salabrazion. During this surgical procedure, after the superficial skin and bad formations are removed, epithelization developing from sweat glands, fat and hair follicles covers the open area. Antibiotic impregnated gases are covered to protect this new epithelium and to prevent infection. Instead of this cover, we applied the amnion membrane, which contains physiological and biological properties, in its fresh and dried form, which we achieved very good results in covering the areas where grafts were taken before. We suggested the use of this method because of the very good results we got.

Aim: Atrial fibrillation is a common disorder and is an important cause of thromboembolic events. Recently, direct oral anticoagulant drugs (DOACs) are being used to reduce the frequency of thromboembolic events among these patients. DOACs have several advantages over oral vitamin K antagonists, such as fixed dosage and fewer side effects. However, since the drugs and their affects cannot be monitored directly, difficulties are encountered in assessing drug efficacy and side effects. For this purpose, platelet indices and their relationship with DOACs may be utilized for the prediction of thromboembolic and hemorrhagic events.

Patients and Methods: 301 patients with atrial fibrillation who were using DOACs were included in the study. Platelet indices such as platelet count, platelet distribution volume, plateletcrit, platelet-large cell ratio were evaluated at the first and sixth months. The effect of DOACs on these indices and relationships with bleeding events were investigated.

Results: All groups were similar in regard to baseline platelet indices, except for lower P-LCR value among recipients of rivaroxaban. When post-treatment results were compared, all groups were found to have similar values in all parameters. However, time-bound comparisons revealed that apixaban and dabigatran significantly reduced P-LCR value after 6 months of use.

Conclusion: This study showed that apixaban, rivoraxaban and dabigatran had no effect on platelet count, MPV, PDW, PCT values in whole blood count of patients with non-valvular AF. All characteristics of those with and without hemorrhagic events were also similar of patients with non-valvular AF.

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

Simple renal cysts are asymptomatic incidental findings; however, for a small subset of benign renal cysts, patients may present with pain, hematuria, urinary infection, pyelocaliceal obstruction or hypertension. Laparoscopic cyst ablation is an effective minimally invasive modality for the treatment of benign renal cyst. Our aim was to show the ultrasonic energy safe and effective method during laparoscopic renal cyst excision. In our clinic 14 patients underwent operated laparoscopic renal cyst excision with transperitoneal approach between January 2006 and February 2010. Trocar port for camera was inserted to the peritoneum in order to open the told line, gerato fascia and fat over the cyst. Harmonic™ scissor with the cautery was used to incise the cyst wall. Mean age of the patients was 58,1 years. Mean operation and hospitalization times were 59,2 minutes and 1,57 days, respectively. We did not need the fourth trocar during operation and the operation was finished. There was no complication in this procedure. Mean follow-up time was years. In long-term follow-up period symptomatic recurrence was observed in one patient and someone else be observed radiologic recurrence. We believe that using ultrasonic device is safe and effective method in laparoscopic cyst decortication. However, prospective controlled trials are needed to evaluate the other energy sources.

Objective: Epistaxis is a common condition in the childhood age group. However, it is important to diagnose the underlying bleeding disorders in children presenting with this complaint. Simple methods to be used in primary health care are needed to determine whether patients have bleeding disorders.

This study aims to evaluate patients presenting with epistaxis with the bleeding questionnaire and determine the diagnostic value of patients with symptomatic but normal hemostatic tests.

Methods: Seventy-seven children with epistaxis were included in the study group and 20 healthy children in the control group. Pediatric Bleeding Questionnaire (PBQ) was used for evaluation.

Results: In our study, 19.4% (n = 15) of the patients were diagnosed with bleeding diathesis (vWh: 10, rare factor deficiency: 5). The mean age at presentation was 8.99 ± 3.42 (3-17) years. Thirty-seven (48%) were girls and 40 were boys. In terms of PBQ epistaxis score, there was no statistically significant difference between those with and without bleeding diathesis. However, the overall score was not statistically different; it was higher in the group with bleeding diathesis. The cutaneous bleeding score was higher in the group with bleeding diathesis and there was a statistically significant difference.

 Conclusions: This study showed that bleeding scores can be used in patients with epistaxis who apply to primary health care institutions and patients with high overall scores and cutaneous bleeding scores should be directed to the hematologist for further research.Keywords: Epistaxis, bleeding diathesis, bleeding score

Aim: Kluyvera sp., a Gram-negative bacterium in Enterobacteriaceae family, may give rise to such infections as urinary system infections, enteritis, soft tissue infections and sepsis in children. It is known that Kluyvera species is an opportunistic pathogen detected in immunosuppressed hosts as well as in immunocompetent ones. Considering that it may enlight future studies related to Kluyvera infections, studies in the literature have been scanned. Material and Method: The data about Kluyvera spp. isolates were obtained retrospectively from clinical microbiology records. Result: It was seen that, of the 3 Kluyvera isolates, 1 was a urine specimen, and the other 2 were from umbli cal area. In this study, antimicrobial susceptibility studies of the clinically significant Kluyvera isolates showed susceptibility patterns similar to those reported in the medical literature, namely trends of resistance to ampicillin and first- and second-generation cephalosporins. Moreover none of the clinically significant isolates were resistant to amikacin, ciprofloxacin, gentamycin, and trimethoprim+sulfametoxazole. Conclusion: It was concluded in the light of both the studies in the literatüre and this study that rare and opportunistic organisms, such as Kluyvera may be an infection cause in children.

We present a human chorionic gonadotropin producing testicular seminoma case which was discovered during infertility evaluation. Although sperm count and motility were normal, postwash sperm swim-up results were poor that returned to normal after orchiectomy.

Asymptomatic huge overial benign mucinous cystadenoma: A case report. Overial benign mucinous cystadenoma can grove huge sizes. Abdominal cysts are usually asymptomatic unless they have huge sizes. It is a rare condition asymptomatic clinical course of a huge abdominal cyst as like in our case. We aim to examine abdominal cysts by presenting a case of huge overial benign mucinous cystadenoma in this article. Abdominal ultrasound imaging is a useful exemination in diagnosis of abdominal cysts. For differential diagnosis abdominal tomography and magnetic resonance must perform as a advenced imaging method. Surgical treatment is usually open surgery performed by a median incision. Although open surgical tecniques are protecting importance as a convential prosedure laparoscopic surgical methods are increasingly having popularization.

Intravenous administration of rocuronium often leads to injection pain. We investigated the effect of diphenhydramine pretreatment, reducing the incidence of pain on rocuronium injection. This randomized study was carried out on ASA I-II, 60 adult patients for elective surgery under general anesthesia. Patients were divided into two groups, thirty patients in each. After tournique application on forearm and inflation to 70 mmHg, 2 ml saline, 2 ml (20 mg) diphenhydramine were given in Group S (n=30) and Group D (n=30) respectively. 30 seconds after the pretreatment, tournique was deflated and 10 mg rocuronium was injected over 10 seconds. The patients were asked immediately to assess pain with 4 point pain scale. No significant differences were noted in the number of patiens who had no pain and mild pain in group S and D (p>0.05). Number of patients who had moderate and severe pain was higher in Group S than Group D (p

ABSTRACT

Introduction: Most of the large defects in the hand are required vascularized skin coverage because they exposed tendons and bones. A pedicled groin flap has been offered as a standard flap for this indication. But immobilization of the upper extremity can be a disadvantage. Raising the groin flap is also possible as a free flap. The disadvantage of free flap is a time-consuming microsurgical procedure. We aimed to compare the pedicled and free groin flap reconstructions in patients with large hand defects based on patient-reported outcomes.

Materials and Methods: Sixteen patients who had groin flaps pedicled or free for the large defects of their hands were included in this study between 2013-2020. This study was performed retrospectively clinical survey work. Patients were divided into two groups: the pedicled groin flap group (n=8) and the free groin flap group (n=8). Patients were followed for 2 years. The patients were subjected to DASH and SF-36 tests after a postoperative period. Pre- and postoperative pain were evaluated with the Visual Analogue Scale. On which day they could walk and sit in the toilet without pain and not needed a second person for daily work, the patients were asked.

Results: Half of the patients with pedicled flaps had serious elbow and shoulder pain and required physical therapy. The wound healing was completed significantly earlier in the free groin flap group (p<0.05). The mean hospital stay in the pedicled group was longer than the free flap group (21 days and 13 days, respectively), which was statistically insignificant. The DASH scores were found to be 92 and 72 in the subacute and chronic stages in the pedicled flap group, whereas 52 and 24 were found in the free flap group, respectively (p = 0.012 and 0.002). According to SF-36 scores, physical functions were impaired significantly in the pedicled flap group (p < 0.001). The number of days needed by the second person for daily work was 79 in the pedicled group and 24 in the free flap group (p = 0.041). Sitting in the toilet without pain was started on the 63rd day in the pedicled group and on the 15th day in the free flap group (p = 0.036).

Conclusions: By transferring the groin flap as a free flap, the problems related to shoulder and elbow joints have disappeared, hand rehabilitation could be started earlier, and the time to return to daily work was shortened. So, if the groin flap is preferred, free style should be considered first.

Abstract

Aim: Since clinical and prognostic heterogeneity is observed in diffuse large B-cell lymphoma (‎DLBCL) patients, it is vital to determine its prognostic and predictive factors. The frequency of these factors varies geographically and ethnically. We aimed to reevaluate and discuss the prognostic and predictive ‎factors of DLBCL patients who have been treated with R-CHOP in our ‎center based on the WHO 2017 revised 4^th edition.‎ We also investigated the incidence of EBV in DLBCL-NOS.

Patients and Methods: Patients with DLBCL-NOS diagnosed previously in our hospital between 2007-2017 and treated with ‎R-CHOP were included in the study. We evaluated the expressions of CD10, CD5, CD30, BCL-2, BCL-6, MUM-1, MYC, LMP-1, EBNA-2, Ki-67, and p53, by immunohistochemistry, and EBV encoded RNA by in situ hybridization in 104 cases of DLBCL-NOS. The Revised International Prognostic Index (R-IPI) score and the overall survival time ‎was ‎calculated.

Results: The study included 56 men (53.8%) and 48 women (46.2%). The median age was 64.5 years. In 59.6% of the patients, the disease had a nodal beginning, whereas in 40.4% of the patients it had an ‎extranodal presentation. High ‎stage (III-IV) was present in 26.5% of the GCB subtype and 43.6% of non-GCB subtype (p=0.049). A high ‎R-IPI score was observed in 40% of GCB subtype and 54.5% of non-GCB subtype (p=0.028). Survival was significantly lower in the non-GCB subtype (log-rank test p=0.003).‎ The EBV frequency was about 3% as it is reported in Western populations. The frequency of DEL status was 8.7%, indicating that it was associated with inferior survival (p=0.045). De novo CD5⁺ DLBCL ratio as 13% and it was also associated with inferior survival (p=0.013).  We also found CD30⁺ DLBCL ratio as 11.5%, but we could not establish a significant relationship with prognosis.

Conclusion: DLBCL-NOS requires detailed subtyping and elaboration of prognostic factors. ‎The frequency of DEL status and De novo CD5⁺ DLBCL indicated that it was associated with inferior survival. However, we could not establish ‎a meaningful relationship of CD30⁺ DLBCL with prognosis.‎ Three EBV positive cases were identified and two of them were classified as ‘EBV positive large B cell lymphoma’ according to the WHO 2017 revised 4^th edition.

Keywords: Diffuse Large-Cell Lymphoma; Prognostic Factors; Survival

A total of 122 consecutive patients underwent valve replacement with a Sjörk-Shiley-Convexo-Concave (BSCC) and Sorin Allearhon (SA) prostheses from Au-gust 1, 1990 through. June 30, 19%. ,4 total of 102 pa-tients had a mitral valve replacement with SA, others had mitral valve replacement with BSCC at Selçuk Universty Hospital. AlI survivors were prospeetively lallowed hy regular clinical examinations every 3 months lbr 5 years. The mean follow-up time was 32 months_ Overall hospital mortality ?vere 5.8 % for pa-tients with SA and 15 % for patients with BSCC. Res-pectivel- lale mortality was due to thromhoemholic events (n=6), sudden death (n=3), noneardiae death (n=1 ). Khi square test eAplained that thromhotic events was a different hetween SA and BSCC (P=0.425, P<0.05). Khi square test explained that there was a significant difierent ahout late mortality rate hetween SA and BSCC (P=0.218, P<0.05). The er-hocardiographic study was carried out on 92 cases (17 BSCC. 75 SA). During the first months of ohservation no sık-nificant an actuarial differences hetween there rnec-hanical pı-ostheses could he ohserved however, afteı- 5 years of long - term follow-up the actuarial rates vere ınore favorahle for the BSCC pı-osthesis.

Between 1983 - 1985 years, 52 patients were adm.itted with deep rein thrombosis. 28 of these patients were female and 24 male. Ali patients were treated conservatively with anticoağulants, bed rest and antibiotic. 45 patients had uneventful recovery. 7 patients required close follow because of resisting oederna of the extremities.

Aim: We aimed to search the effects of erythropoietin on anastamoses recovery in the rats to which rchemotherapy was applied and intestine anastomos was made. Material and Method: The study was carried out at Selcuk University Experimental Research Center (SUDAM). The rats were divided into 4 groups including 10 subjects. The subjects in all groups were weighed before the surgical operation and laparotomy was made with middle line cutting. Nothing but standard feeding was made to the subjects in the 1st group after making sigmoid colon anastomoses. Subcutan erythropoietin injection was administered to the 2nd group after colon anastomoses. The 3rd group was injected intraperitoneal 5- fluorouracil after colon anastomoses was made. The 4th group was made intraperitoneal 5- fluorouracil after colon anastomoses, and subcutan erythropoietin injection was administered.On the 7th day following the anastomoses, the rats were weighed and they were sacrificed. Anastomoses bursting pressure among the groups, hydroxyproline level in the samples taken from anastomoses line and collagen and rich bind tissue formation from the fibroblast histopathologically, the rise angiogenesis, intensity in inflammation and the existence of necrosis were evaluated. Results: In the rats to which erythropoietin was applied, the bursting pressures and hydroxyproline levels were significantly higher than those of the control group statistically. During the histopathological examination, it was seen that rich bind tissue formation from angiogenesis and collagen in the erythropoietin group rose while there was a significant reduction in the formation of inflammation and necrosis. These positive effects of erythropoietin was also established in the rats to which 5- fluorouracil was applied. Conclusion: In the rats to which colo-colic anastomoses was made, it was considered that erythropoietin inflammation had positive effects on angiogenesis with its influences on proliferation and restructuring. The same positive effects were observed in the rats which used 5-fluorouracil. Thus, it can be expected that erythropoietin can reduce the risk of anastomoses escape after colo-colic anastomoses and in conditions such as chemoteraphy, which negatively affects the recovery of anastomoses.

To determine bacteriology and antibiotic sensitivity of chronic otitis media with effusion (COME). The study group consist of 40 children with COME who had undergone miringotomy between May 2003 and January 2006. In 38 children, both of ears demonstrated effusions, whereas in two children, only one ear had effusions. Total of 78 effusion samples were cultured for bacteria and antimicrobial testing was performed for antibiotic sesitivity. Although in the 21.8% (17) of effusion samples showed bacterial growth, in the 78.2% (61) of effusion samples no showed bacterial growth. Haemophilus influenzae (29.5%) was the most common causative pathogen, followed by Streptococcus pneumoniae (17.7%), Coagulase negative staphylococcus (11.8%), Moraxella catarhalis (11.8%), Staphylococcus aereus (11.8%), Corynobacterium Spp (5.8%), Enterococcus spp (5.8%) and Lactobasil (5.8%) were isolated. Penicilin resistance was found in %64.7 of Streptococcus pneumoniae. Most of effusion samples were sterile. Therefore, the treatment of patient with COME should be recovered predisposne foctors (allergy, Eustachian Tube Dysfunction, Adenoid Hyperplasia, Gastroesophageal reflux) rather than routine antibiotic use.

Glioblastoma multiforme (GBM) is the most malign glial tumor. It rarely causes skin metastasis. It is frequently misdiagnosed as a primary subcutaneous tumor. The number of cases related to skin metastasis of GBM reported in the literature is limited. We here presented a GBM case with scalp invasion and applied with cheloidlike formations on the old craniotomy scar. The patient applied to us with cutaneous, firm, infiltrated nodules in skin color in area concomitant with the incision scar on frontal region. Within 2 months, the nodules turned into a giant tumoral mass covering whole frontal region. The result of the biopsy conducted on nodular lesions were reported as undifferentiated tumor (malign tumor metastasis) scalp. The patient died 3 months after scalp invasion.

Background: Facelift surgery is a frequently preferred aesthetic surgery procedure to reduce the signs of aging and achieve a more youthful appearance. The incidence of complications such as hematoma is quite high among patients undergoing facelift surgery. This study aims to compare the efficacy of TXA and hemostatic net technique in terms of preventing hematoma formation in facelift surgery patients.

Patients and Method: The study included 65 patients (56 F, 9 M) who underwent deep plan facelift and face and neck lift between October 2019 and February 2023. Patients were evaluated in four different groups: TXA given, those applied hemostatic net, those applied both, and the control group applied neither. Demographic information, follow-up findings, any hematoma or other complications in the postoperative period were recorded. Differences between the groups were evaluated statistically.

Results: The mean age of the patients was 54 years. The patient group using only TXA consisted of 17 patients, the group hemostatic net applied consisted of 9 patients, the group applied both consisted of 21 patients, and the control group consisted of 18 patients. Hematoma was observed in 6 patients in total. Although a numerical decrease in the incidence of haematoma was observed in patients in whom only haemostatic net was used and in patients in whom only TXA was used, it was not statistically significant (p>0.05). The incidence of haematoma decreased that is statistically significant in patients in whom TXA and haemostatic net were used together (p<0.05).

Conclusion: Tranexamic Acid and hemostatic net both together showed to be effective in reducing the incidence of hematoma. It is thought that these measures may improve surgical outcomes and accelerate the recovery process of patients.

In this study we evaluated the efficiency and reliability of spinal anesthesia during extracorporeal shock wave lithotripsy (SWL) after the ineffective ureteroscopic lithotripsy (URL). In our clinic for 4 years, all of 17 patients who were applied SWL under spinal anesthesia (Group 1) were received to study. Also, 17 patients were administered sedo-analgesia with midazolam and fentanyl (Group 2) were included randomly into the study. Group 1 patients were transported to the SWL unit with monitoring and observance of anesthetist under spinal block after ineffective URL. The diameter of the stones, the level of the maximal energy, SWL, fluoroscopy and recovery times, the rate of stone free were recorded. The pain assessment was performed with verbal pain scale (VPS). Any patients showed hypotension, bradycardia, desaturation and nause-vomiting. There were no significant differences related to the diameter of the stones, SWL and flouroscopy times, the rate of stone free between groups. The maximal energy was 56.7 mjoule in Group 1, 47.6 mjoule in Group 2 (p

Laryngeal Mask Airway (LMA) is used widely in anesthesia practice especially in outpatient anesthesia. LMA has got some specific complications. These complication does not generally result in impairment of the patency of the LMA. In the case reported the patient bit the LMA during recovery and seperated it into two part. We were not able to open the patients mouth so therefore we administered propofol in order to open the mouth and take the part of the damaged LMA from the pharynx. The patient was easly ventilated with a face mask after placing an airway and the recovery was uneventful. We believe that it is important to place a small size airway near the LMA for preventing complications related LMA bite.

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.

Aim: The aim of this study is to examine whether the timing of surgery in our elderly patients with a
diagnosis of hip fracture changed before and after the pandemic, and whether this situation caused an
increase in mortality .
Patients and Methods: The patients who were operated with the diagnosis of hip fracture between March
2019 and March 2020 in our hospital database were accepted as in the pre-pandemic period, and the
patients who were operated with the diagnosis of hip fracture between April 2020 and April 2021 were
considered as in pandemic period. Both groups were statistically compared in terms of age, gender,
waiting time for surgery , length of hospital stay and one year mortality .
Results: When the factors af fecting mortality were examined, the time elapsed until surgery significantly
increased mortality. While the mean waiting time for surgery was 27.6±19.4 hours in all patients, it was
25.7±19.1 hours in Group 1 and 29.6±19.6 hours in Group 2 and there was a significant difference between
the two groups (p=0.043). The cut-off value of the waiting time for surgery, which caused mortality, was
determined as “23.35” hours. While no significant increase in mortality was found in Group 1 (p=0.340),
the increased delay for surgery in Group 2 affected mortality significantly (p=0.027).
Conclusion: In this study, it was found that the increase in the delay of admission for surgery over 23.35
hours in the elderly population after hip fractures was directly associated with one year of mortality
and also we think that the waiting time for surgery in the pandemic conditions is one of the factors that
negatively af fect mortality in these patients.

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.

Between 1983-1988 378 patients with thoracic trauma were admitted to the Department of Thoracic and Cardiovascu-lar Surgery, Selçuk University School of Medicine. In 74.3 percent of the cases cause was blunt injury and 25.7 percent due to penetrating trauma. In majority of the patients treatment was Conservative. Only 2.2 percent of the cases had emergency thorocotomy. Overall mortalıty rate was 5.3 percent.

A Brenner Tumor which is a rare condition, WaS " presemed and subject discussed.

Colorectal cancer remains a significant health problem today. In parallel to the developments in the field of surgery, improvements in adjuvant and neoadjuvant treatment modalities lead to increase in both local control and overall survival times. The main purpose of this review is to discuss the current treatment options of rectal cancer with literature data. Surgery is an essential treatment option for rectal cancer. Treatment success for rectal cancer has been increasing by the help of neoadjuvant (preoperative) or adjuvant (postoperative) modalities. According to the recent studies, preoperative (chemo) radiation therapy is superior to postoperative treatment in terms of local control and sphincter preservation. However, there is not enough data regarding to the difference between the efficacy of shortterm preoperative radiotherapy and long-term chemoradiotherapy. Today, for the treatment of rectum cancer, preoperative (chemo) radiotherapy is superior to postoperative (chemo) radiotherapy in terms of overall survival and local control. However, new prospective randomized trials should be designed to compare the short term and long term preoperative (chemo) radiotherapy.

Betvveen April 1990 and May 1997, 101 patients with unstable thoracolumbar vertebral fractures were treated operatively. The mean follow-up was 27 (3-66) months. There were 70 men and 31 women. The mean age was 35.9 (18-69) years. Etiology was falling from a height in most of them (56.4%). The delay from the original trauma to the presentation ranged from 2 hours to 7 days. First lumbar vertebra was affected mostly (35.5%). According to the Deniş classification, there were 94 burst fractures, 22 compression fractures, 4 fracture-dislocations and one seat-belt injury. Fiftynine patients had Frankel type E, and 14 had Frankel type A neurologic status. The me- dium angle of local kyphosis was 24° and the percentage of anterior compression was 40.7%. The percentage of average spinal canal involvement was 44.5%. The average time after the trauma till the operation was 4.5 days (6 hrs-20 days). The mean operative time was 135 minutes and 2.8 units of whole blood transfusion was used on the average, intraoperatively. Postoperative bracing was applied to ali of the patients. One CSF fistula, two su- perficial infections and one pressure sore were noted as early complications. Eighteen patients with neurologic deficits had partial, and two patients had full recovery. 394 transpedicular screvvs vvere used and there vvere 31 (7.8%) bent screvvs, 9 (2.2%) screvv breakages and 19 (4.8%) screvv migrations. Transpedicular fixation was found to be an effective method for thoracolumbar vertebral fracture surgery.

İn this study, investigation of the knovvledge and attitudes of the nurses about the characteristics of AIDS, spreading ways and prevention was aimed. Totally 236 nurses vvorking in Selçuk University Medical Faculty Hospital were included in this study and vvere intervievved in March 1999. The mean age of the nurses was 24.3 ± 4.3. Nearly 1/3 of the nurses declared that they had participated some educative programs about AIDS previously. 52.1 % of the nurses claimed that there was no difference betvveen having HIV or AIDS disease. 89.0 % of the nurses said that HIV transmission is possible with sexual course vvithout using condom and 56.8 % said that HIV transmission is possible vvith oral sex. The question of "How do you act to an AIDS patient" was ansvvered as "I take preventive measures" by 54.2 % of the nurses. 6.8 % of the nurses said that injectors must be discarded vvithout removing its needle and vvithout closing its cover, 68.6 % said that infected incising tools must be put into resistant boxes. 82.6 % evaluated herself as under the risk of HIV, 20.3 % said that they must have right to refuse medical applications to an AIDS patient. The mean knovvledge score of the nurses vvas 66.7 ± 9.7. The majority of the knovvledge deficiency vvas about the vvays of AIDS prevention. The nurses are generally vvorking very close to the patients. So, they should be educated periodlcally about transmission and prevention of AIDS disease to get correct, adequate and updated knovvledge about it.

Our case was pre-diagnosed with appendicitis but during the surgery it was seen that the patient had cecal diverticulum perforation. Further, as the dissection continued appendicitis with retrocecal subserous localization was identified. The goal of our study is to underline the possibility that appendicitis in a rare localization can be overlooked in patients diagnosed with simultaneous cecal diverticulum complications. Although cecal diverticulum is a rare lesion, there are some difficulties regarding its diagnosis and treatment since its symptoms are similar to acute appendicitis when there is a complication. It can hardly be differentiated from acute appendicitis through physical examination and radiological imagining methods are mostly insufficient. Therefore, patients are generally diagnosed intraoperatively. Acute appendicitis is one of the most frequent causes of acute abdomen. Appendectomy, too, is the most frequently performed surgery among intraabdominal emergency surgical procedures. A good anamnesis and a careful and sufficient physical examination are very significant in the diagnosis of acute appendicitis. Alongside these, various laboratory and imaging techniques can be utilized. Although the appendix can be seen in different localizations, the retrocecal site is one of the rare localizations among all. In patients presenting to the emergency departments with complaints of right lower quadrant pain, many diseases, led by appendicitis, based on the patient’s age and sex should be taken into consideration. The possibility that these diseases may co-exist should always be remembered and, therefore, intra-operational exploration should be performed thoroughly.

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

As all over the world, crimes commited with fi-rearms are widely spread in Turkey. Particulary in the rural areas, crimes commited by shotguns are common. To have accurate knowledge about a shot-gun and a shotgun shell is essential for judicial pro-ceedings. Correct investigation of wound will help the origin of case. In this study not only general in-formation about shotgun and shotgun shell but also fundamentals off ring distance which may help for-ming the criterias of case have been given.

Routine antibiotic prophylaxin was performed in 36 patients undergoing lower urinary tract ins-trumentation. A three day course of a once a day of 1 g of Cephalexin was compared with a three day co-urse of 100 mg. of Nitrofurantoin three times a day, in a blinded placebo contolled study. Both drugs were significantly more efeective in preventing pos-tinstrumentation urinary tract infections than pla-cebo (P>0.003). Differences in efficacy between the two drugs were not significant; however, side effects in the Nitrofurantoin group more frequent and im-portant than those in Cephalexin group. Cephalexin also offered the advantage of a once daily dosing schedule.

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

This descriptive and cross sectional study was conducted to assess the depression and the quality of life (QoL) in cancer patient. The sample of the study consisted of 102 the patients with cancer, treated at Medical Oncology Department of, between 1-30 March 2008. WHOQOL –Brief was used to evaluate the patients’ quality of life. Depression status was evaluated with Beck Depression Inventory (BDI). Of the interviewees, 57.8% were male (n=59), 42.2% were female (n=43), and the mean age was 49.7± 15.2. The mean value of Beck depresyon was found as 12.4±9.9 (min=0, max=48). According to the BDI, 47.1% (n=48) were normal, 21.6% (n=22) mild, 18.6% (n=19) moderate and 12.7% (n=13) were severely depressed respectively. The gender, occupation, education and marital status of the people with cancer had not effected the depression (p>0.05). When we compared the QoL scores and depression status, there was a significant difference in perception of overall health and the satisfaction from life (p=0.000), general health and quality of life (p=0.000), physical health (p=0.011), social relationships (p=0.000), psychological health (p=0.001)) and environmental (p=0.000) between the depressive people and non-depressive ones statistically. Assessing quality of life in cancer patient will provide better understanding of the disease and will improve the evaluation of the therapy response. Anxiety and depression are the major concerns in cancer patient and it is necessary to understand these problems in order to cope with them, and psychological aid is essential.

\r\n PURPOSE
\r\n             The aim of this study is to analyze if there were any factors that would indicate the diagnosis of dilating vesicoureteric reflux (VUR) (≥ grade 3) in the second voiding cystourethrogam (VCUG) of children with a normal first VCUG.

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\r\n MATERIAL AND METHODS
\r\n             Patients who underwent VCUG between 2012 and 2017 were retrospectively reviewed. Within the cohort, patients who required more than one VCUG were abstracted and those with an abnormal first VCUG (VUR, posterior urethral valve, etc.) were excluded. Factors such as; age, gender, lower urinary tract dysfunction (LUTD), renal scarring, recurrent urinary tract infection, abnormal ultrasonography findings (bladder abnormalities/variable degrees of hydronephrosis), and technical problems (absence of voiding phase) were noted. Mann-Whitney U test was used for continuous variables whereas Chi Square test was used for categorical values.

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\r\n RESULTS
\r\n             A total of 25 patients were found to have undergone more than 1 VCUG (19 girls, 6 boys; mean age 6 ± 3 years). Median time period between the two VCUGs were 12 months (range 1 – 72 months). VUR was detected in 11 patients, while dilating VUR was discovered in 7 patients. Among those, 6 patients were diagnosed with bilateral VUR. Recurrent UTI was found to be the only factor that would indicate dilating VUR in the second VCUG (p=0,049). Interestingly, no VUR was detected in cases that were performed after a first VCUG with inadequate technique. 

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\r\n CONCLUSION

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\r\n             Recurrent UTI was shown to be the sole factor that would indicate the diagnosis of dilating VUR in the second VCUG. In our study, 28% patients with a normal first VCUG were shown to have dilating VUR in the second study. Therefore, in recurrent febrile UTI, second VCUG should be considered in patients with a normal previous imaging.
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Purpose: Extensor digitorum longus (EDL) and extensor hallucis proprius (EHP) muscles were overloaded in Ischaemic and normal muscle in order to determine how muscle hypertrophy occurred under these conditions, and to vvhat extend fibres of different size in the same muscle responded to overload during different time courses. Methods: İn this experiment 87 male rats were used and divided into control (C), ischaemic (I) achieved by unilateral ligation of the common iliac artery, overloaded (O) achieved by unilateral ablation of the synergist tibialis anterior, and overloaded plus ischaemic (O+l) groups. Histological analysis was performed on cryostat sections. Results: İn EDL hypertrophy occurred at the same level during the first 4 vveeks (P<0.05 vs. O), while in the smaller EHP hypertrophy occurred progressively över this time (P<0.01). After 6 vveeks, hypertrophy of the EDL was clearly greater than at earlier time points. İn the EDL muscle the response to hypertrophy was greatest in the smaller muscle fibres (P<0.01). VVhile hypertrophy was not signlficant in the larger fibres, atrophy was significant during ischaemia (P<0.01). VVhen overloaded muscle was made ischaemic there was less hypertrophy compared to non-ischaemic muscle during the first 4 weeks but it reached the same level by 6 vveeks, possibly due to angiogenesis in this time. Conclusions: There was greater hypertrophy in the smaller muscle vvhen a synergist muscle was removed, and there was also greater hypertrophy in the smaller fibres vvithin same muscle. İt is postulated that in order to prevent atrophy and stimulate angiogenesis in the ischaemic muscle, as vvas shovvn in the O+l muscle, careful exercise is reçuired although possible pain during the initial period may limit the response.

In this article, we presented six ovarian Sertoli-Leydig cell turııors with histopatologic and clinical features. This cases classified in 3 grades as: well, intermediate and poorly dillerantiation. There was retiforrn dıfferentiation in only one case. We couldn't encounter heterolog elements in any case.

Endometriosis is theplacement of theendometrialtissue in anotherpart of the body. Most commonly involved in peritoneum, ovaries, douglas and rectovaginal septum. It can be placed in many parts of the body. Our case was evaluated at 26 years of age after failed perianal abscess and fistula surgery. The patient has pain, swelling and discharge in the perianal region. The stiffness in the perianal region was seen during surgery. The stiffness was totally excised. Histopathological examination revealed endometriosis. It should be kept in mind that endometriosis may occur in different regions from the usual localization.

This study was performed to determine relationships among relatives in Konya, by the Family Research Çenter of Selçuk University, in 1996. A questionnaire of twenty-seven questions applied to 539 married subjects. Significant differences were found betvveen male and female in frequency of contact, cooperation and support on overcoming problems in the family.

Syhilis, in the group of sexuallY transmitted di-seases, maintains its importance' over the world and in our countm Iiı recent years, a trend tv increase iıt. cases of syphilis has been observed. Among causes of this trend are social, ecoıtomic and moral factors. Two cases with Condylomata lata and other symptoms of secondarv svphilis vere presemed be-cause of the importance of the subject.

Aim: In the present study, the aim is to determine whether centromere protein H (CENPH) gene expression levels change in prostate carcinoma (PCa).
Materials and Methods: Prostate tissue sample of 40 patients with primary prostate cancer was used in the study. Hence, transcriptional analysis of the CENPH gene was conducted in the total paraffin embedded prostate tissues extracted from patients diagnosed with prostate cancer. The expression analyses were obtained from the comparison of the expressions within the tumoral and non-tumoral areas in the prostate tissue of the same patient.
Results: Separate RNA isolation was performed. Subsequent qRT-PCR analyzes were repeated three times and quality controls of the Ct values were performed on the obtained data. The Ct values of the expression of the housekeeping gene GAPDH and the target gene CENPH gene were compared in tissue (tumor and normal) and technical repeat groups. There was no statistically significant difference in CENPH gene expression between tumor and normal tissue specimens in prostate cancer. Moreover, on investigating the causes of death, in none of the patients PCa related death was determined. 
Conclusion: In our study, we could not find any relationship with prostate cancer tumorogenesis in CENPH gene expression anomalies. However, some cancers (non-small cell lung cancer, colon cancer, etc) with high CENPH gene expression are associated with tumor aggressiveness, poor prognosis and drugresistance. More studies are needed on CENPH gene expression and its effect on prostate cancer.

This study was aimed to compare the knowledge levels of health education teachers with others in basic health subjects. This crosssectional study was performed in all high schools in Konya city center in 2011. The sample consisted of teachers who taught health education or counseled in health related clubs and same number of teachers of other lessons. Data were obtained by a questionnaire filled by teachers themselves under the supervision of interviewer. First part of the questionnaire was about demographic information while the second consisted of 35 questions evaluating the knowledge about protection, improvement, vaccines, contagion, diet, healthy behavior, adolescent health, first approach to frequently encountered health problems, etc. Overall level of health knowledge was assessed by summing the points for each subject, 2 for known, 1 for partially known and 0 for unknown/blank, and converting them to percentage. T test and variation analysis were used for data analysis. The mean age of 314 teachers participated in the study was 39±8, 55% of them were males, 45% were females and 90% were married. 39% of the participants consisted of health education teachers and guide teachers of health related clubs, 61% were the teachers of other lessons. The average score was higher in health education group (56±16) than the other teachers (43±14). The knowledge score was also higher in female teachers and graduates of health related faculties (biology, physical education, child development). Teaching health education or counseling in a health related club increases the general knowledge level of teachers. In writers’ opinion, improving the knowledge level of teachers in health might help students to acquire positive behaviors about health as the current level is not adequate and significant number of wrong answers was present.

Bilirübin encephalopathy or kernicterus is a neurologic syndrome resulting from the deposition of uncongugated bilirübin in brain celis. Features of kernicterus may include cerebral palsy and deafness. The purpose of this research was to investigate the effects of kernicterus on grovvth and grovvth hormone. Our research included 22 patients with kernicterus, 18 patients vvho had exchange transfusions but having no features of kernicterus, 14 patients who had only phototherapy, and 15 patients vvho had no jaundice during neonatal period vvho vvere inves- tigated at 21 months old (mean age). Ali patients had complete blood count, urine analysis, glucose, and grovvth hormone. We observed overt neurologic abnormalities in 6 patients vvith kernicterus. There vvas grovvth retardation in 5 of 6 infants vvith neurologic abnormalities. There vvas no grovvth retardation in other patients. Our research has indi- cated that there may be grovvth retardation in patients vvith kernicterus and the reason for this may be nutritional disorders. More investigations must be done in order to understand the abnormalities in grovvth hormone in patients vvith kernicterus.

To evaluate symptoms and diagnosis of patients who presented to the child and adolescent psychiatric outpatient clinic. Medical records of patients admitted to the Child and Adolescent Psychiatry Outpatient Clinic at Selcuk University Meram Faculty of Medicine between 2002 and 2007 were studied retrospectively. When admisson complaints of cases were reevaluated the most frequent symptoms were nervousness, over-activity, ürine to miss, stuttering and feeling of distress. According to the DSM-IV diagnoses, 2082 (%86.8) cases had any psyciatric disorder. The most common diagnosis were anxiety disorders, attention deficit hyperactivity disorder, mood disorders, enuresis, relationship problems and mental retardation, respectively. Of the cases, 20.1 % were diagnosed with multiple conditions. The most frequent comorbid diagnoses were enüresis and depression. The most frequent comorbid diagnoses were mental retardation-enüresis and enüresis-attention deficit hyperactivity disorder and depression-anxiety disorders. Approximately one-third of subjects were prescribed psychotropic medications. Our findings may be helpful in improving treatmentservices in child and adolescent psychiatry

Myotonic dystrophy is the most common muscular dystrophy of adulthood. Neurological manifestation of the disease is typical, however diagnosis could be challenge in patients presentig with predominant cardiac or systemic symptoms. 46 year old male was suffering from presyncope attacks for 16 years, and first examined by a cardiologist. Because of the recent complaints including walking difficulty, he was referred to neurology department. Following a detailed neurological examination and electrodiagnostic workup, he was finally diagnosed myotonic dystrophy type 1. The case highlights the necessitiy of neurological consultation in patients who present with conduction defects, arythmias or cardiomyopathies of unknown origin, accompanied by overt or subtle neurological symptoms. In such patients, neuromuscular disorders should be considered in the differential diagnosis; and in order to provide thorough diagnostic evaluation, multidisciplinary approach is essential.

To investigate the level of 25(OH)D and association between 25(OH)D level and hormonal-biochemical parameters in Polycystic ovary syndrome (PCOS). Thirty three patients diagnosed with PCOS and 42 age- body mass index (BMI) matched control group admitted to Bolge Training and Research Hospital from May to October were included in the study. Serum total testosterone (TT), free testosterone (fT), 25(OH)D, dihydroepiandrostenodione sulphate, LH, FSH, thyroid stimulating hormone (TSH), cortisol, 17αOH-progesterone, fasting glucose, insulin levels were evaluated after 12 hour fasting. HOMA-IR (fasting glucose level x fasting insülin / 405) was calculated. Serum 17αOH progesterone and 25(OH)D levels were significantly lower in PCOS group (p<0.01). Serum LH, LH/ FSH TT, FT, insulin, ACTH, and DHEAS levels were significantly higher in PCOS group (p<0.01). There was statistically significant negative correlation of 25(OH)D levels with PCOS, LH/FSH, TT, fT, DHEAS ve FGS. There was no statistically significant correlation between 25(OH)D levels and age, body mass index and insulin resistance. The results of this study indicated that vitamin D deficiency is highly prevalent among women with PCOS independent of body mass index. We also demonstrated that vitamin D deficiency was correlated with hyperandrogenism in PCOS women. Low serum 25(OH)D levels might exacerbate PCOS symptoms. Large intervention trials are needed to evaluate the effect of vitamin D supplementation on hormonal and clinical parameters in PCOS women.

The most serious complication of Paget's disease is the sarcomataus degeneration. Two cases of bone sarcoma in Paget's disease were diagnosed and treated at the University Hospital, departrnent of orthopaedy and Traumatology between 1983 and 1988. Histologically, lesions were osteogenic sarcoma and it is radiographically found ta be osteolitic. Pain, pathologic fracture and tender swelling were constant features. Femur and humerus were the affected bones. Overall prognosis for !hese patients were poor.

While working on the serological diagnosis of tuberculosis over the last 20 years I developed a very simple test that can show in one minute whether a person has any of the serious infectious and suppurative dis-eases including tuberculosis, cancer, leukemia and lymphoma or not. This test basically consists of placing a drop of blood obtained from the fin-gertip on a slide, adding a drop of each of two different solutions into it and observing whether a small red presipitations occur in the mixture or not.

Since the identification of SARS-CoV-2, a multisystem inflammatory syndrome (MIS-C) that appears in
children after COVID-19 disease and mimics Kawasaki disease was reported in the UK in April 2020,
while it is associated with Covid-19 in adults. Multisystem inflammatory syndrome (MIS-A) was reported
in June 2020. MIS-A patients have been reported to be up to 50 years of age in the literature and are more
likely to have some underlying health condition and have recently had an identifiable respiratory disease
compared to MIS-C. On the other hand, MIS-A patients and MIS-C patients have many overlapping clinical
features, but the severity of cardiac dysfunction, incidence of thrombosis, and MIS-A mortality may be
higher in MIS-A. While it is clear that neutrophilia, lymphopenia, and thrombocytopenia are common in
MIS-C/A, these features, together with elevations in troponin and BNP/NT-proBNP, have been considered
measures of disease activity .

n this study, we aimed to compare the effects of cisatracurium besilat and rocuronium bromide on neuromuscular block. After Faculty Ethic Committee approval, 26 adult patients from ASA l-ll class were included to the study. Patients were randomly divided into two groups. Anaesthesia induction was realized by 2mg/kg alfentanil + 5 mg/kg thiopental. Patients in group I (n:13) received 0.1 mg/kg cisatracurium, patients in group II (n:13) 0.6 mg/kg rocuronium for intubation. The maintenance of anaesthesia was done by 1-1.5 % isoflurane + 50/50 %, N2O/O2. Patients were evaluated by "Mallampati scale" before operation and by " Goldberg and Cromach scale" during operation for assesment of intubation quality. The onset of action (T95), duration of action (T25) and recovery time (T25-75) of neuromuscular blockade were recorded. Unpaired student’s t test and Mann-Whitney U test were used for statistical analysis (px0,05). There were no differences betvveen the two groups with respect to hemodynamics parameters, recovery time, quality of intubation and demografic datas (p>0,05). The onset of action and the duration of action of neuromuscular blockade were shorter in group II (p<0,05). IVe conclude that althought both cisatracurium and rocuronium provide sufficient cardiovascular stability and intubation conditions, rocuronium may be choosen at situations which is required rapid intubation.

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

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

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

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

Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in the ICU, and it complicates illness course by increasing mortality rate, hospital length of stay, and costs for patients who acquire it. Therefore, the prevention of VAP is a major issue in ICU clinical practice since it may help improve clinical outcome and reduce costs.. There are numerous strategies discussed in literature in relation to the prevention of VAP The numbers of studies targeting many areas of preventative strategies have significantly increased since the turn of this century. On the other hand, these strategies for ventilator-assisted pneumonia remain highly controversial. Preventive measures of VAP are mainly aimed to reduce oropharyngeal or gastric colonization, and to avoid aspiration of contaminated aerodigestive tract secretions. This review aims to summarize the nonpharmacologic and pharmacologic measures for prevention of VAP. We belive that prevention is better than cure.

The place of surgical treatment, except for the treatment of complications, in peptic ulcer gradually decreases. Helicobacter pylori eradication with proton pump inhibitors (PPI) and H2 receptors that have been used frequently recently have played important role in this decrease. One of the most common complications of peptic ulcer, though protective medicines, is still perforations and they are very common among surgical emergencies. The files of 311 patients with peptic ulcer perforation accepted to the clinic between 2000-2010 were examined retrospectively. The patients applied to our clinic with peptic ulcer perforation were examined in terms of age, sex, seasonal relation, and applied surgical technique. 206 of the patients were male with 52.8 mean age and 105 of them were female with 65.2 mean age. 266 of the patients were fixed with primary suture, 35 of them had bilateral truncal vagotomy+pyloroplasty and 10 were fixed laparoscopically. Average hospitalization time was 7 days. While wound infection developed in 25 of the patients, evisceration was developed in 8 patients, 9 patients were exetus. Over the last ten years there has been a change from definitive attempts to primary fixation and from laparotomy to laparoscopic methods for treatment of peptic ulcer perforations our clinic.

Migraine is a frequent headache disorder in the population. The aim of this cross-sectional study was to document demografic and clinical features of subjects with migraine headache who admitted to the outpatient department of a university hospital in Konya. The study included 206 patients diagnosed as migraine according to the 2004 International Headache Society criteria and 218 healty controls of identical sex, age, marital status and education level who did not suffer from frequent headaches other than tension type with a frequency of not more than once a month. Using a questionnaire, we evaluated patient demographics, characteristics of migraine headache, family history and associated symptoms in 206 migraine pattients. 173 woman and 33 men were evaluated. The male:female ratios of migraine patients were 1:5. The mean age at consultation was 37.02±10.40 years. Of the 206 patients, 64.4% met criteria for migraine without aura, while 35.4% met criteria for migraine with aura. Most of the women were of lower educational level. Approximately half of the patients had severe and more than 3 attacks per month. Attack treatment was used frequently. Result of the study confirm that migraine is a more common disorder in women with lower educational level. In additon; this article emphasizes the need for informing patients of the hazards of drug overuse.

A twelve years old virgin patient who was menstruating regularly for one year presented with severe pelvic pain associating with her menstruation. She was diagnosed to have right renal agenesis before 4 months. In her physical examination she had annular hymen and normal external genital organs. Vaginal depth was 6 cm. In her pelvic ultrasonography, the endometrial thickness was 8 mm on left side uterus and 8x10 cm hematometra appearance was seen on right side. Laparotomy was planned for the patient. During the operation double uterus and double endometrial cavities were seen with fusion line in the middle. Double cervices were palpated by hand. Hematometra was seen on right side. Bilateral ovaries were normal. Uterus was incised from the middle the separating fibrous tissue was removed, hematoma was evacuated and the two cavities united. The patient was discharged on the 2nd postoperative day without complications. After two weeks she presented with severe vaginal bleeding for which laparotomy was done. The metroplasty line was opened. A bleeding arterial end was noticed on left lateral isthmic wall and it was not related to the incision line. The vessel was sutured and the patient was discharged on the 4th postoperative day without complication.

İn this study, experimental hypothyroidism in rats was induced using 6-propyl-2-tiouracyl (PTU) and its effects on kidney, glomerule and tubules structure were investigated at microscopic level. İn the experiments, 60 days old 12 female rats which weighted 200-250 gr were used. The rats were separeted into two groups. To one group, 10 mg/kg day PTU was introduced intraperitoneally for 15 days. To other group which was used as a control group %0.9 physiological solution (PS) was injected intraperitoneally for 15 days.. İn the renal structure investigated by light and electron microscope, it was observed that internal and external medulla were similar to those of the control group. Moreover, some expansion in glomerül capillaries of cortex, plumpness and expansion in capsule cavity were observed. Particularly, basal folding in proximal tubule was found to be evident. Likevvise, increase in intercelluler spaces and formation of a vacuolize view were found. İt was found that there was no any damage in glomerule filtration barrier at thin structure level. İt was also found that there not no any difference in basal lamina which was similar to the control group.

This study included 126 Down syndrome cases (81 males and 45 females) who had regular trisomy 21 in 120 cases, chromosome 21q trisomy in 5 and a mosaic karyotype in one case. The ratio of males to females was found to be 2:1 in regular trisomy 21 and 1:4 in chromosome 21q trisomy. The study implicated that trans-locations that were found were mostly matemal in origin. it is alsa noteworthy that the frequency of consanguinity among the parents having children with Down syndrome (21.6%) was not different from the population fre-quency in Konya (23.2%). Moreover, the mean age of ~her having children with Down syndrome was de-termined to be 30.7

Aim: Executive function deficits are very common in attention deficit hyperactivity disorders (ADHD).
Recent studies suggest that common mechanisms in the pathophysiology of obesity and ADHD may be
related to impulse control and executive functions. This study aimed to compare the executive functions
and self-esteem levels of children and adolescents with ADHD with and without overweight/obesity. The
study also aimed to examine the relationships between overweight/obesity, executive functions, ADHD
and self-esteem in children and adolescents.
Patients and Method: Participants included 71 children/adolescents (mean age = 16.12±1.71; age range=
12-18 years; 71.83% males) with ADHD who applied to Gazi University Child and Adolescent Psychiatry
outpatient clinics between March 2021 and April 2022 and did not use any medication. Participants
completed the Executive Functions Behavior Evaluation Inventory Scale (parent form), Conners Parent
Rating Scale-Revised Short Form and Rosenberg Self-Esteem Scale .
Results: Results showed that hyperactivity symptoms and working memory function were significant
predictors of self-esteem in adolescents with ADHD. In addition, when adolescents with ADHD were
compared according to their overweight/obesity level, significant differences were found between the
groups in working memory and planning/organization functions. However, no difference was found
between the groups in terms of self-esteem and ADHD severity.
Conclusion: The findings suggest that working memory and hyperactivity symptom severity may play an
important role in understanding the self-esteem of adolescents with ADHD. While no difference was found
in terms of self-esteem and ADHD clinic in adolescents diagnosed with ADHD according to overweight/
obesity status, differences in working memory and planning/organization skills suggest that executive
functions play a critical role in overweight/obesity in ADHD.

19 patients suspected of the diagnosis of acute appendicitis were examined with ulirasonography (US). Definitive diagnosis was not reported in one case. in 2 patients, postoperative °Yarkın torsion was reported. in 17 patients, the US diagnosis was provided with cilinical findings. The US diagnosis (%89) was correct. Appendix is seen in target configuration and greater !han normal in patients not having preappendicülar abscess. Target configuration is not seen in patients occurence periappendicüler abscess.

Fasciola hepatica (FH) is a parasitical disease mostly concerns the veterinary medicine but sometimes accidentally infests humans. It’s generally seen in some parts of the world especially in tropical and developing countries but the incidence is increasing day by day all over the world due to increased facility of intercontinental transportation and immigration. Liver and biliary tree is the final target site for the parasite. The clinical presentation varies from basic biliary colic to jaundice and even complicated cholangitis leading death. Low level of knowledge about the disease, especially in the non-endemic areas, leads delayed diagnosis and therapy. Prompt evaluation and therapy of the patient is the corner stone of the success. Herein, we discuss a case of biliary obstruction due to FH from presentation to therapy including ERCP and cholecystectomy in the guidance of the literature.

Brucellosis is a bacterial zoonotic disease with the major symptoms such as fever, joint and muscle pain generally caused by consumption of meat and milk of infected animals. Serological test methods such as Rose Bengal plate agglutination (RBPA) and standart tube agglutination test, are used in the diagnosis of brucellosis because of the lack of availability of blood culture in several laboratories, the low growth rate and ease to be effected by antimicrobials of the bacteria. Variations in biochemical parameters could be seen in the course of infection. In this study, seroprevalence of brucellosis in our region was determined by Rose Bengal and standart tube agglutination tests, and variations in biochemical parameters of the sera defined as positive for brucellosis were also evaluated. Rose Bengal test was found to be positive for 144 out of 4041 patient sera send to Microbiology Laboratory with the initial diagnosis of brucellosis. Among these sera, agglutination titer of 1/160 and over was detected in 121 samples. Seroprevalence for brucellosis was 3.56% for our study group. Among patient sera found to be positive in STA, 98 (81%) showed increase in C-reaktif protein (CRP) level, 66 (54.5%) in erytrocyte sedimantation rate (ESR), 29(24%) in alanin aminotransferase (ALT) and aspartat aminotransferase (AST). Additionally, leucocytosis was seen in 11 (9.1%), leucopenia in 12 (9.9%), anemia in 46 (36%) and thrombocytopenia in 53 (43.8%) patient sera. As STA titer increased CRP level had a paralel rise, but the platelet and leukocyte number decreased. In conclusion, especially serum CRP level could be a useful biochemical test parameter for the diagnosis and follow-up of brucellosis.

Objective: Pap smear test is a commonly used and effective screening method in detection of cervical cancer and its precursor lesions. There is a very limited number of studies on use of Pap smears in diagnosis of the endometrial carcinomas. We have aimed to investigate the incidence rate of atypical endometrial cells in Pap smears of the patients diagnosed with endometrial carcinoma and the correlation between these cells and clinicopathological parameters.

Material and methods: In this study, patients who were diagnosed with endometrial carcinoma and who had smear sampling between January 2015 and September 2017 were examined retrospectively. Histological type, nuclear grade and Pap smear results of endometrial carcinoma cases were evaluated.

Results: Pap smear sampling was concurrently performed in 59 of the 97 patients diagnosed with endometrial carcinoma. The ages of the patients who underwent smear sampling ranged between 42 and 82 years (mean 57.43±9.08 years). The menopausal status evaluation of the women revealed that 12 (20.3%) and 47 (79.7%) patients were premenopausal and postmenopausal, respectively. Endometrioid type carcinoma was encountered in 51 (86.4%) patients as the most commonly found histological type. Serous, clear cell and mucinous carcinomas were determined in 6 (10%), 1 (1.8%) and 1 (1.8%) patients, respectively. The results of Pap smear tests were atypical in 24 (40.7%) patients whereas normal results were obtained in 35 (59.3%) patients. Nuclear grade assessment of the carcinomas showed that grade 1, grade 2 and grade 3 carcinomas were discovered in 24 (40.7%), 25 (42.3%) and 10 (17%) patients, respectively. The rate of the atypical endometrial cells encountered by Pap smears has increased as grade of the tumors increased.

Conclusion: We have concluded that the detection rate of atypical cells by Pap smear in endometrial carcinomas is considerably high. The incidence of atypical cells is higher in nonendometrioid and high-grade carcinomas.

We investigated hypertension incidence among °at patients and the patients from the province in Konya. The first group included 1000 randomized out patients and the. second group included 2036 patients examined during health sereening studies in certain areas. We used World Health Organisation criterias for hypertension diagnosis. In first group hypertension incidence among patients under 45 years old was 22.5%, 46-60 years 44.5%, 61 years and over 60.3% and the mean 32.5%. In second group hypertension incidence among patients under 45 years oid was 14,2%, 46-60 years 42.2%, 61 years and over 44% and the mean 23,1%. The hypertension incidence increases gradually in older patients and most of them are mild cases, obesite and diabetes mellitus are important risk factors, cerebrovascular accident, cardiac and renal pathologies are the most common complications.

We studied P glycoprotein (Pgp) expression by testing fine needle aspiration specimens from lymp nodes with C- 494 antibody using an immunocytochemical assay in 30 cases of hlstologically proven non-Hodgkin’s lymphoma (NHL) at diagnosis and after three courses of chemotherapy. Pgp expression was detected İn two of eight patients with stage l-ll, 10 of 22 patients with stage lll-IV at diagnosis and in one of two patients with stage l-ll, three of eight patients with stage lll-IV after chemotherpy. The stage of disease, the presence of B symptoms, the rate of response to treatment and duration of overall survival showed no significant difference between the group of Pgp negative patients ad the group of Pgp positive patients. İn conclucion we suggest that Pgp expression alone can not explain the treatment of chemotherapy resistance in NHL probably due to multifuctorial mechanisms of drug resistance.

The ideal therapy for sacrococcygeal pilonidal disease (SPD) would be a prompt cure that allowed patients to return quickly to normal activity, with minimal morbidity and a low risk of complications. We report the case operated with excision and primer suture for SPD a month ago had infected and decomposed wound. A 23-year-old male patient was admitted to the emergency room with complaints of intergluteal discharge and pain that last for 10 days. Surgery which was excision and primer suture was applied him in other health center for SPD a month ago. There was infected and decomposed wound and a large cavity under sutured skin on intergluteal area. In the second operation, we excised decomposed wound including cavities and skin as modified equilateral quadrangle shape, a right flap was prepared and rotated to left side for primer suture. Patient was discharged on postoperative 3th day and drain was getting out on postoperative 5th day. Patient recovered completely without any complication on postoperative 20th day. Our case is no not only unique but also rare. However, we think that the most appropriate method for treatment of SPD should be known and applied by all surgeons in our country.

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

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

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

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

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.

Amyand hernia is described presence of appendices vermiformis in inguinal hernia sac. The incidence of Amyand hernia is approximately 1% of all hernias. There are many treatment procedures of Amyand’s hernia. Since Amyand hernia is extremely rare and there are many controversial surgical managements, we wanted to share our case. We have encountered a Amyand hernia case during right inguinal hernia repair surgery. Treatment method and outcome were evaluated. Twentyone-year-old male patient was suffering from right groin pain and swelling for almost one year. He was operated with the diagnosis of right inguinal hernia, electively. Intraoperative exploration revealed Amyand hernia, appendectomy and hernia repair were performed using polypropylene patch with same incision. The patient’s postoperative course remained without complication and after 3 days he was discharged. Amyand hernia which especially difficult to diagnose preoperatively, particularly in terms of therapeutic approach, the debate continues, is extremely rare entity. There is no current consensus about appendectomy and using patch. We think that; regardless of the appendix is inflamed or noninflamed, appendectomy should be done. If the appendix is inflamed or perforated, prosthetic materials shouldn’t be used and while repairing hernia, anatomic repair or biological materials resistant to infection should be used.

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

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\r\n Abstract

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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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Pneumomediastinum can develop spontaneously or in the setting of trauma. Spontaneous pneumomediastinum (SPM) is a rare condition and treatment of these patients is generally limited to observation. We discovered SPM in 15-year- old male patient, who had been wrestling, admitted to our emergency service with chest pain and shortness of breath. In this case report we discussed that in a patient without trauma, medical intervention for developing pneumomediastinum, the increased vagal maneuver may lead to SPM.

Aim: Coughing is a common symptom in childhood. The cough last for over 4 to 6 weeks and also which makes patients the family and the doctor feel discomfort is called chronic cough. If this cough last long and repeats, it has to be investigated. After a detailed history and physical examination, distinctive studies have to be made. The purpose of this study is to evaluate the patients, which have been made flexible bronchoscopy because of chronic cough, by their clinical, laboratory and bronchoscopic findings. Material and Method: In this study we evaluated 23 patients with chronic cough; which were examined between January 2002 and December 2006 in Pediatric Chest Unit of Hacettepe University. Patients have cough for over 4 to 6 weeks, without specific chest X Ray findings, gastroesophageal reflux and problem with their immunologic system were and because of all these reasons they have been made bronchoscopy. The patients files are analyzed retrospectively by their demographic, clinic and bronchoscopic findings. Results: The study consisted of 23 patients: (12 males/11 females). The age of the patients vary between 1 and 13,8 years (mean age: 5 years). All patient’s radiological findings were normal without one patient. This patient’s have bronchial abnormalities in sanal bronchoscopy. When it is observed with flexible bronchoscopy ten patients have abnormal findings. Two patients have foreing body aspiration in their left main bronchus, two patients have tracheomalasia, three patients have hyperemia and secretions infection and two have bronchial abnormalites.In six patients’ bronchoalveolar lavage microorganism grew. Three patients have lipid laden macrophage and two patients whose previous gastroesophageal reflux scintigraphie were negative then found in and started treatment Conclusion: Although flexible bronchoscopy is an invasive technique, it evaluates respiratory system’s functional, anatomic characteristics well and it is a valuable technique in finding the etiology of chronic cough.

Amaç: Çocukluk döneminde Epstein-Barr virüsüne (EBV) nedenli enfeksiyöz mononükleoz olguları yüksek sıklıkta görülmektedir. Akut EBV enfeksiyonu belirti ve bulguları farklı klinik tablolarla kendini gösterebilmektedir. Çalışmamızda çocuklar arasında yaş ve yüksek riskli yaş gruplarına göre akut EBV enfeksiyonlarının klinik sunumunun incelenmesi amaçlandı.

Aim: In childhood, infectious mononucleosis cases caused by Epstein-Barr virus (EBV) are seen with high frequency. The signs and symptoms of acute EBV infection can manifest with different clinical pictures. Care should be taken in differential diagnosis for correct treatment. In our study, it was aimed to examine the clinical presentation of acute EBV infections by age and high-risk age groups among children.

Patients and Methods: A total of 337 pediatric patients with infectious mononucleosis who applied to our tertiary hospital in 2013-2020 were included in the study. EBV VCA IgM and IgG antibodies were studied by ELISA method (quantitative microplate ELISA, Euroimmun®, Germany) in accordance with company recommendations. Patient information and results were evaluated retrospectively.

Results: The mean age of the patients was 5.1 ± 3.4 years. 22.8% of the patients were in the group of 0-2, 43.0% of them were 3-5, 29.7% of them were 6-12, and 4.5% of them were 12 years old and above. The most common signs or symptoms in children diagnosed with acute EBV infection were lymphadenopathy (59.6%), lymphocytosis (45.1%), fever (40.9%), swelling in the throat (39.2%) and pharyngitis (30.0%). Fever complaints were significantly higher between the ages of 3-5 compared to other age groups. The seasonal distribution of the cases was similar. It was determined that the cases increased over the years and the most cases were seen in 2019 (23.4%). It was observed that the time between the start of complaints and the application to the hospital increased directly proportional to age groups.

Conclusion: In our study, it was concluded that there was no difference in acute EBV infection in childhood age groups in terms of signs and symptoms, and the number of cases increased slightly over the years, especially in children with lymphadenopathy, splenomegaly and hepatomegaly.

Black hairy tongue, also named as lingua villosa nigra, is a painless, asymptomatic, benign condition characterized by an abnormal brownish–black discoloration of the dorsal surface of the tongue caused by variety of precipitating factors. It usually appears in people over age 40 years with a history of poor oral hygiene, smoking and antibiotic use. Here we report a case of 65-year-old diabetic woman patient presented to our outpatient clinic with black hairy tongue. By means of this case, data about this disorder will be able to reviewed and reminded to be aware of this rarely seen disease in daily practice and advise to pay more attention to oral hygiene and brushing techniques that will help treating this disorder.

The electrocardiography (EKG) is a usefid di-agnostic tool, extensiyely used in either cardiac pa-tient or normal infrequent that abnormal changes are obseryed. When EKG'_ç of the elderly people, not as.sociated with a cardiac disorder, are examined. The this study 400 subjects, having been exa-mined in the outpatient department were involved. The ECG's examined, revealed nn overall «ab-normality rate of % 32. A : 53 abnoı-mality was ob-served. in cardiac patient, whereas %12 of normal subjects clemostrated an abnormal ECG. Moreoyer, these changes in ECGs were not associated with a pathological coııdition.

The term of retrosternal goiter means that more than 50% of thyroid gland descends in the thorax. These commonly present as asymptomatic lesions, but less commonly may also cause airway and esophageal compression. Surgery remains the most effective treatment for retrosternal goiters. We report the case of a retrosternal goiter which compressed and dislocated the trachea and esophagus. It was excised using a transcervical approach. The patient recovered well and was discharged at postoperative 3 day.

Organ tuberculosis is an important problem for the public health in devoloping countries. Tuberculosis can be seen on any part of the gastrointestinal tract from mouth to anus. Esophageal tuberculosis is very rarely seen with 0.14% prevalance. It usually originates from mediastinal tuberculous lymphadenopathy. We report a 55-year-old woman who admitted to our hospital with complaints of dysphagia, weight loss, audinophagia and epigastric pain. The chest radiography revealed a linear opacity compatible with fibrotic tape was seen on chest x-ray. Thorax CT examination revealed milimetric calcified lymph nodes at subcarinal and the right hilar region, thickening of proximal part of esophageal wall through carinal leveland subsegmenter collapse on left lower lobe. Ulcerative lesion with dimension of 1×1 cm localized in the 19th cm of the esophagus was seen on upper gastrointestinal endoscopy, suggesting esophageal carcinoma. Biopsy revealed necrotizing granulomatous ulceration which resembled tuberculosis. After antituberculous chemotherapy, the endoscopy repeated in end of the 2nd month of antituberculous therapy and the recovery of ulcer lesion was seen and the biopsy showed no signs of tuberculosis. Conclusion; esophageal tuberculosis should be kept in mind at differential diagnosis in patients who have complaints of dysphagia and loss weight and radiological signs.

This study was carried oral retrospectively at Selçuk University Family Center covering the di-vorce cases lı-oın the law-court files 1993 in Konya. The inf'ormation on the divorce registers ►eı-e exa-nıined carefidly and Conflict Tactic Scale is revised for adapting the divorce cases due ta spousal agg-ression towards married women. There result ob-tained data vere analyzed according to minitab sta-tistical programe. Total 526 divorce cases accured in Konya 1993 and divorce due ta agression was found that verbal aggression represented the major cause of divorce (42.44%) followed by physical (33.09%) and verbal and physical aggression (24.46%). The age difference hetween the spouses, espe•ialy signıficant (p<0.05). That is most divorce due to aggresion was occurred between 21-32 yeaı-s of married women age. On the other hand the age of spouses at the time of marriage, the husbands age at the time of divorce, the duration of marriage, the number of either man ör woman did not show sta-significant influence on the divorce due to aggression. As a result, it can be concluded that aggression towards women in general is a major cause of divorce and physical and abusive agg-ression is the serious aspect of divorce due ta agg-r-ession.

 

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

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

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

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

 

Bone wax is a commonly used hemostatic agent derived from beeswax. It is used widely in neurosurgery, orthopaedic surgery, maxillofacial and orthognathic surgery.  Although few case reports have emerged regarding complication due to the bone wax, the use of it continues in various surgical sites.  We report an unusual case of a non-healing ulcer over the iliac crest appearing one year after bone harvest was done for alveolar bone grafting

Spinal epidural air associated with spontaneous pneumothorax is a rare condition. There was a pneumothorax in the patient had no history. Pneumothorax was demostrated chest X-ray and thorax CT. Moreover, CT showed also spinal air. This finding was discussed with literatüre

Aim: This study evaluated the antibacterial effect of gaseous ozone on multi-drug resistant (MDR)
pathogens with regard to time dependency. Controlling infections with MDR bacteria became a big
challenge for health care professionals. Therefore, the major corcern should be altered to alternative
therapies.
Materials and Methods: The study was performed in Necmettin Erbakan University Meram Medical
Faculty Hospital, Department of Medical Microbiology Laboratory between 21 March to 15 April 2021. Ten
MDR bacteria were evaluated in vitro using in the Petri dishes at seven bacterial concentrations (102-
108 bacteria/dish). The ozone showed its efficacy on these MDR bacteria under the following conditions
applied: 40 μg/ml at 10, 20 and 40 minutes and control (no gas was used). After 24 hours incubation of
plates, the average colony counts for each exposure time of ozone were figured out and transformed to
Log10.
Results: Taking acccount the mean bacterial reduction (log10), the bactericidal effect of ozone was
determined on only methicillin-resistant Staphylococcus aureus, VIM-1 producing Klebsiella pneumoniae
and Carbapenem resistant-Acinetobacter baumannii in 10 minutes exposure. The optimum effect was
generally observed within 20 minutes on tested isolates. However, the MDR-Pseudomonas aeruginosa
showed a relatively lower response to ozone. All bacteria was inactivated over the level at 99% at the end
of the 40 min exposure to ozone.
Conclusions: The gaseous ozone showed satisfactory bactericidal activity on MDR pathogens and its
effect depens on exposure time and type of bacteria. Taken into account, the need for new approaches
for the control of microbial infections in the pandemic world, the optimization of ozone therapy should be
undertaken high priority and more in vivo studies are needed to support in depth understanding of the
ozone ef fect on the inactivation of MDR bacteria.

Spinal epidural air associated with spontaneous pneumothorax is a rare condition. There was a pneumothorax in the patient had no history. Pneumothorax was demostrated chest X-ray and thorax CT. Moreover, CT showed also spinal air. This finding was discussed with literatüre

In this study, the number of mast cells vere investigated in smears from thirty Lippes loops and fifteen cupper loaded intrauterine contraceptive devices (IUD). Under the light microscope the presence of the mast cells and the increment of the cell number in one over seven cases which IUD reınained in uterus for less than 3 months have been cleared out. As a result of this, the effects of mast cells on IUD action mechanism and a correlation between the number of mast cells ıvith the remaining duration of Cu++ loaded IUD in uterus is considered.

Background: The aim of this study was to develop a fructose- and iron-mediated model of steatohepatitis, which is similar to the human phenotype.

Methods: We randomly divided ninety 1.5 months old female Wistar-Albino rats into three groups. All three groups contained 30 rats in each group and 5 subgroups per group. While the control group was fed ad libitum, the fructose group’s feed consisted of 60% fructose in drinking water and that of the fructose-iron group consisted of 60% fructose in drinking water along with intraperitoneal administration of iron every 2 weeks. We performed laparotomies at 2-week intervals (at 2, 4, 6, 8, and 10 weeks) in all subgroups.

Results: None of the groups had hepatosteatosis or fibrosis at the end of the 10th week. Hepatocellular ballooning scores were significantly higher in the fructose-fed groups than in the control group (p<0.001). At 10th week serum ferritin levels in the fructose-iron group were significantly higher than those in the control and fructose groups (p<0.001). Iron accumulation in the rat liver was observed in the fructose-iron group histopathologically by the 4th week.

Conclusion: Chemically and histopathologically, a model of steatohepatitis can not be developed in young and female rats with 60% concentrated fructose feeding and administration of iron for 10 weeks. To develop a model of steatohepatitis resembling the human phenotype, it is more advisable and feasible to use adult male rats fed meals combined with fructose in order to maintain adequate hydration and nutrition for at least 16 weeks.

A fifty two year old woman sustaining bilateral hand injurles after a traffic accident was admitted to our clinic. She had right thumb amputation from the carpometacarpal level, tendon and skin loss in the right hand secönd finger, loss of the 2-3 extensor tendons and the overlying dorsal skin in the left hand. Reconstruction in a single session was planned and palmaris longus tendons from both hands were taken and used as intercalary grafts for extensor tendon losses after which the skin loss was covered with a radial forearm flap. Afterwards, the second injured finger in the right hand was taken and pollicisized using the Buck Gramcko technique. At the last follow-up examination 8 months after the injury, she was able to pick up small objects and grip large and heavy objects using her right hand. The range of motion of the wrist and the fingers of the left hand was completely restored. The importance of treatment design tailored individually for each patient was stressed in this case.

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

Major malformation screening was made in 7868 mewborns at Konya Maternity and Children Care State Hospital, Turkey, January through October in 1988. Newborns, 28 weeks old and over were subjected to physical examination and the blood type determinations when needed. Blood type determinations were made for all mothers who gave birth. During 10 months period, of the 7868 babies born 3762 were female and the remaining 4106 babies were males. Among the 218 stillborn babies, 95 of them were female and 123 were males. 75 babies born with major malformations, and 66 (88%) of 75 had single and the remaining 9 (12%) had multiple malformations. The overall incidence is found ta be 0.9% and 0.11% for single and multiple malformations, respectively. About 51% of 66 newborns had musculo-skeletal system, 30% central nervous system, 14% digestive system, 1,5% circulatory systern, 1,5% urogenital system malformations, respectively. Also, musculo-skletal system malformations were found more often in males than female infants. Similarly, pes equino-varus was predorninant among the males whereas polydactylism among the females. In musculo-skeletal malformation system, stillbirth frequency is rather low (3 females and 1 male out of 33 malformed cases). The most stillbirths were seen in central nervous system (13 female and 3 male out of 20 cases). Anencephalus seemed to appear more often in female infants !han the male ones, and anencephalus and hydrocephalus females were stillborn infants. Multiple major malformations

Suprascapular notch located on the superior border of the scapula and just medial to the base of the coracoid process. This notch is covered by superior transverse scapular ligament and is turned into a foramen. Suprascapular nerve passes under this ligament and suprascapular vessels passes together over it. The images of the patients undergone MDCT examination between 2008 and 2009 were used in this study. Total 88 right and left MDCT scapula images obtained from 44 individuals (22 male, 22 female) were used. Suprascapular notch was divided into 5 types from these images. These types; Type 1: with deep and large notch, Type 2: with deep and narrow notch, Type 3: with shallow and large notch, Type 4: with shallow and narrow notch, Type 5: without a notch. In our study, the most common type was with (29,54%) deep, large notch and the least common type was the group (2,27%) without a notch. In addition, the relationship between suprascapular notch and supraglenoid tubercule, superior angle and inferior angle was evaluated.

The aim of the study was to determine the effects of alpha lipoic acid (ALA) on the lipid peroxidation and antioxidant status. Twelve rats were included in the control group. 48 rats were given a single dose of 50 mg/kg i.p. streptozocin. Blood glucose levels were measured after one week and the rats whose blood glucose levels were over 300 mg/dl were included in the study. After 3 weeks diabetic rats were divided into four groups; diabetic control group, ALA group, diabetic exercise group, ALA exercise group. ALA groups received 100 mg/kg i.p. ALA for two weeks. The rats in the exercise group were exposed to exercise at 15th day. Intracardiac blood was taken under anesthesia and malondialdehyde (MDA) and nitric oxide (NO) levels and superoxide dismutase (SOD) and xanthine oxidase (XO) activities were determined in the blood samples. It was observed that ALA exercise group had lower level of MDA than diabetic exercise group. NO levels in the exercise groups supplemented with ALA were lower than in the diabetic groups performed exercise but not received this supplementation. We concluded that exercise induced lipid peroxidation is decreased by ALA supplementation and NO increase is attenuated by ALA supplementation in diabetic rats.

This study was iınplemented on patients' parents or relatives who brought their children to the Polyc-clinic of Departmant of Pediatrics in Faculty of Me-dicine, Selçuk University between 18 and 22nd of November 1991. 1n this study it was observed that only 17 percent of patients had applied for tertiarv care wlüle 71 percent of diem had came for primarv care. Patients applying for tertiary care were usually brought to the hospital by their fathers and male pa-tients more in number and relatively higher in 0-6 age group (p<0.05). It was also observed that number of patients, e.specially of those referred, decreased to-wards weekend (p>0.05) and parents were utilizing less health service in each level of care for their third and more childs (p>0.05). We believe that it will be more usefid for both community and health organi-zations ta make primary health care services more effective and such regulations, in which university hospitals, vvithoıtt taking care of patients social insu-rance guarantees, just can be used for tertiary health care services a step-by-step referral system.

Aplastik anemia is a rare and severe comp-lication of viral hepatitis. It's mortality rate is al-most 85%. This coplication has been observed most often in association with non A, non-B viruses (es-pecially hepatitis C virus) and also the other he-patitis viruses can cause this complication. We presented a 17 years old male patient who had aplastir anemia associated with hepatitis C virus. Although full hematologic recovery occured in three months but aplastic anemia recurred after 26 months. The patient died of E. roll septicemia ca-used by harmful traditional application.

The reliability in the clinical follow - up of prog-ress and recovery from pneumonia of a practical slide test (ST) that is approximately parallel to the plasma fibrinogen level (PFL) has been investigated in a group of 18 patients with bacterial pneumonia and 18 healthy subjects considered as a control group. Test results were compared with white blood cell (WBC) count, WBC differential count, eryt-hrocyte sedimentation rate (ESR) and PFL. It was concluded that since at the end of the treatment (15. day) all five of these hematologic tests showed mar-ked declines compared to pre-treatment levels, they could be accepted as indicators of the cure of pne-umonia. However, no significant differences were observed between pre-treatment levels of WBC count and ESR and the corresponding levels me-asured at the end of the 5. and 10. days of the tre-atment period. In contrast. ST. WBC differential count and PFL values dropped consistently thro-ughout the treatment and returned either to normal or nearly normal levels upon recovery. We conclude that among these tests ST and WBC differential count were better suited to the treatment of bacterial pneumonia because of their low cost and ease in application.

İn this study, we analysed 101 cases operated by the microsurgical technique for lumbar disc herniation betvveen 1997 and 2000 in Selçuk University Medical School Department of Neurosurgery. We have concluded, patients operated with microsurgical technique, undergo a shorter operation, discharged the hospital earlier, recover more quickly, and return to work earlier.

Portal veins are the veins that carry the venous blood of the splacnic area in the abdomen to the liver (KC) sinusoids. Stomach, intestine, gallbladder, spleen, and pancreatic veins join the portal venous system. The largest vein of this system is the vena portal. It occurs by the union of the veria porta v.lialis (splenic vein) and the v. Mesenterica superior at the level of the L2 vertebra and the race of the pancreatic head. The v.porta, which has no valve inside, branches into the KC and opens to the sinusoids and central vein. Central hepatic veins unite and make v. Hepatic. Any reason that disrupts or prevents the blood flow in this system increases the blood pressure in the portal venous system and leads to portal hypertension (PH). To overcome the resistance of the sinusoidal system, the pressure in the portal system is normally 5-10 mm Hg higher than the venous pressure in other systems. With this increase in height, PH occurs. It is PH when the blood pressure in the portal venous system is higher than = 20 mm Hg (1) and, according to some authors, 10-12 mm Hg (17-20 cm water pressure) (2).

Hydatid cyst is a parasitic infestation caused by Echinococcus granülosus. In this study we present a pulmonary hydatid cyst case that has radiological and bronchoscopic view like a malign mass. A 17 year-old male patient. He has cough, sputum and hemoptysis complaints. He has 10 kg weight loss in last two mounths. Thorax computed tomography showed a consolide lesion in the the right upper lobe. Fiberoptic bronchoscopy was performed in this case. There was an endobronchial hump lesion covered with necrotic tissue, in the right upper lobe anterior segment. The result of bronchoscopic biopsy was reported as ‘hydatid cyst’. We found a cystic lesion at the left liver lobe in abdominal ultsonography. Patient transferred for operation at thoracic surgery department. Hydatid cyst was rejected by operation. Hydatid cyst is usually located in the lower lobes of the lungs. Although cyst has classic radiologic, bronchoscopic findings, we should think hydatid cyst in different radiological and bronchoscopic findings too.

Introduction: İn this study, we presented the results of smooth pinning which is a less aggressive surgical procedure with pelvipedal cast application in fractures of the neck of the femur in children. Materials and Methods: This study covers the results of surgically treated 48 hips of 49 children with fractured neck of femur who were admitted to our clinic betvveen 1986-1998. The mean age was 6.2 years (range 2-9 years). According to Colonna classification, four hips were type I, 27 hips were type II, 16 hips were type III, and two hips were type IV. İn ali patients, closed reduction with three or four percutaneus or öpen surgical smooth pins of two or three millimeters in diameter was applied using image intensifier and traction table. Pelvipedal cast was applied postoperatively. Results: Patients were follovved for 43 months (range 27-163 months) and the results were assessed using Ratliff’s criteria. Thirty-nine (79.6%) hips had good, nine (18.4%) hips had fair, one (2%) hip had poor results. Complications included avascular necrosis in 10 hips, prematüre closure of the epiphyseal plate in 3 hips, non-union in 3 hips, varus deformity in five hips, pin loosening in three hips. Conclusion: We realized that smooth pins were advantageous as their damages on epiphyseal plate were less, their percutaneus applications were easier and removing them by minör surgical procedures was possible. Unlike in adults, the femoral fractures in children are healed easily vvithout using compressive systems. İn relation to this, we observed that smooth pins had no negative effects in fracture union. The complication rates in this study were not higher than other studies reported in the literatüre.

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.

The indications, age and mortality rate in a re-cent 8-vear eıperience with 150 nephrectomies reveiwed. Chronic pyelonephritis is the most .frequent condition (38 per cent) requiring nephec-tom•. Renal tıonor is the thinl frequent cause (14 per cent). Of 150 cases 98 were mıde, 52 }vere fe-male. The over-all mortalite rate was 1.33 per cent but was almost nil in the absence of malignancy.

We report a patient with pancytopenia which is an unusual manifestation and a rare hematologic complication of acute brucellosis. A 29-year-old female patient was hospitalized with fever and pancytopenia. Brucella standard tube agglutination test was found to be positive and cultures from blood yielded growth of Brucella melitensis. The patient completely recovered by the sixth week following combined antibacterial treatment of doxycycline and streptomycine. Brucella should be considered as an uncommon cause of pancytopenia and should be treated immediately.

Purpose: After a few reports on end-to-side nerve repair at the beginning of this century, the technique was put aside until it has recently been reintroduced by Viterbo. VVe herein present the results of three cases treated by end-to-side median-to-ulnar neurorraphy. Methods: Three patients vvith median nerve defects betvveen 15 and 22cm were treated by end-to-side nerve repair, through an epineurial window. The follow-up times were betvveen 12 and 18 months. Sensory evaluation involved superficial touch, pin-prick, and two poi'nt discrimination tests. Motor evaluation was done by assessing the presence of opposition, and palpating the abductor pollicis brevis. Results: Sensory recovery was observed in ali the patients, in the median nerve dermatome. İn case-3 it was incomplete at the tips of his fingers. Motor recovery vvas absent, except in case-1, who could perform opposition before the operation, as well. Conclusions: End-to-side nerve repair is a viable alternative in cases vvith long gaps betvveen the ends of the injured nerve.

Diabetes mellitus (DM) absolute or relative deficiency of endogenous insulin or resulting from peripheral ineffectiveness of chronic hyperglycemia, carbohydrate, protein and fat metabolism disorder, capillary membrane changes, and accelerated atherosclerosis associated with chronic, progressive disease (1). The main cause of vision loss in patients with diabetic macular edema(4). In the treatment of macula edema, laser photocoagulation, VEGF inhibitors and vitrectomy is recommended. Choroid, neuroretina, photoreceptors preserving particularly selective RPE laser damage seems to be the appropriate treatment method (24). It was seen that Fundus was preserved µs pulse duration and consecutive irradiation damage, selective RPE with photoreceptors (26,27). Suffered damage to the planned study of selective RPE treatment in diabetic macular edema, Afyon Kocatepe University School of Medicine, Department of Ophthalmology, Retina Unit, between October 2005 and February 2007 were followed up with a diagnosis of DRP, and triggers as a result of the examination detected the presence of macular edema over the age of 18, 99 eyes of 84 patients separated into 2 groups and administered SRL and grid laser treatment followed 6 months. As a result, SRL, and grid laser photocoagulation was effective in the treatment of DMÖ. 84.9 % increase in SRL-treated patients and stabilization of visual acuities were determined. It was confirmed that in Grid laser group and 6-month follow-up and stabilization as a result of an increase in visual acuity was 89.9%.