Makale Arama

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.

Aim: Gastric cancer is one of the leading causes of cancer-related deaths. Tumor budding has been
shown to be a prognostic factor in many cancers. In this study, we aimed to evaluate the prognostic
significance of tumor budding in intestinal-type gastric adenoc arcinoma.
Patients and Methods: A total of 152 cases diagnosed as intestinal type gastric adenocarcinoma in
the Pathology Clinic between 2015 and 2021 were included in the study. Tumor budding was grouped
as low, medium and high. Hematoxylin and eosin-stained slides were re-evaluated in terms of tumor
differentiation, lymphovascular invasion (LVI), perineural invasion (PNI), lymph node involvement, depth
of invasion (pT) and tumor budding.
Results: Tumor budding was low in 30.9% (n=47) of the subjects included in the study, moderate in 37.5%
(n=57) and high in 31.4% (n=48). Statistically, as tumor budding increased, tumor size increased (p<0,05),
follow-up times were shortened, survival time (p<0,05), and tumor differentiation (p<0,05) decreased. A
statistically significant correlation was observed between tumor budding and LVI (p<0,05), PNI (p<0,05),
pT(p<0,05), lymph node involvement(p<0,05), and mortality of the cases (p<0,05). No statistically
significant correlation was observed between tumor budding and gender, age, tumor localization and
operation type (p>0.05).
Conclusions: Tumor budding is associated with poor prognostic factors. As it may be important to guide
the treatment modality and follow-up, tumor budding status may be mentioned in routine pathology reports.

Aim: Cardiovascular events, including ventricular arrhythmias and sudden cardiac death (SCD), are the primary source of death in hemodialysis (HD) patients. Checking ECG parameters such as QT interval, QT dispersion (QTd), TPe interval, TPe/QT ratio, and cardiac-electrophysiological balance (iCEB = QT/QRS) can be useful for classifying patients with high arrhythmia and SCD risk. Our study aimed to compare the change of electrocardiographic parameters before and after the HD session with the healthy control group.

Methods: A total of 49 HD patients and 50 healthy volunteers were included in the study. The groups were divided into two groups as hemodialysis and control group. ECGs of the hemodialysis group were evaluated before and after dialysis. ECG data were scanned and evaluated on a digital platform. QT, cQT, QTd, TPe, TPe/QT, TPe/cQT, QT/QRS, and cQT/QRS were measured.

Results: While QTd, cQTd, TPe, TPe / QTc, and QRS decreased significantly after hemodialysis compared to pre-HD(p <0.05 for each), HR, iCEB, and iCEBc showed a significant increase after dialysis treatment (p <0.05 for each). Comparing pre-dialysis ECG parameters with the control group, QT, cQT, QTd, cQTd, TPe and iCEBc were significantly higher in pre-HD (p <0.05 for each). Comparing the ECG parameters after dialysis, HR, cQT, QTd, cQTd, iCEB, and iCEBc values were significantly higher than the control group (p <0.05 for each).

Conclusion: By evaluating the electrocardiographic parameters showing ventricular repolarization and depolarization together, the risk of arrhythmia and sudden cardiac death can be predicted in HD patients.

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.

In this report, the relationship between biochemical, hormonal and radiological findings of renal osteodystrophy was investigated in twenty undergoing hemodialysis patients and in ten non - hemodiyalysed patients.

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.

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

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

Retrospectively evaluated patient with thoracic trauma who were hospitalized and treated at chest surgery clinic from january 2005-july 2009 A total of 255 patient(220 male-35 female mean age 38.2) with thoracic trauma were evaluated with respect to etiology¬ thoracic pathologies assosiated injuries and treatment methods. Blunt and penetrating thoracic injuries were found in 167 and 88 patients .Respectively the most common cause were traffic accidents (%78) and stab wounds, (%92) for blunt and penetrating thoracic injurıes.The most frequent thoracic pathologies were soft injurıes(%35) followed by pneumothorax(%24), multpl rib fractures ,(%21) hemopneumothorax(%20) and hemothorax(%17).Extrathoracic injurıes were seen in 60(%23.5) patients .The most common being cranial(%45) ,extremity injuries(%38) and abdominal (%18.3). Treatment was conservative 53 patient (%20.78) tube thoracostomy (n- 167 %67.49)diapragmatic repair or bleeding control with thoracotomy (n-35 %13.7). Mortality occured in 3 patients (%1.17) It is important that thoracic trauma patients with increased risk of mortality and morbidity should recieve immidiate and systematic treatment

Objective: The aim of our study is evaluate the association between serum vitB12 levels at time of diagnosis and clinical and laboratory signs in multiple myeloma patients.

Material and Methods: Patients were divided into two groups; those had low and normal levels of vitB12. Groups were analized by using independent simple T, Mann Whitney U and chi-square tests considering by distrubition characteristics of data.

Results: Two hundred-and-twelve patients' records were examined retrospectively. Forty-one (32%) patients had low vitB12 levels. In patients with low vit B12 levels, bone marrow plasma cell ratios were also significantly lower than those found normal vit B12 levels (median %30 vs %50, respectively) (p: 0,024). There was no statistically significant difference between the two groups in terms of age, lytic bone lesion numbers, and serum levels of total protein, lactate dehydrogenase, ß2-microglobulin, calcium, creatinin, albumin. However, 11 patients (%26,8) in low vitB12 group had anemia, while 44 (%50,5) patients in normal vitB12 group had. So, anemia was more often in vitamin B12 normal group patients (p: 0,019). No difference was found in terms of myeloma ISS and R-ISS stages in two patient groups.

Conclusions: Bone marrow median plasma cell ratio was also low in the group with low vit B12 levels. Our data could not show its clinical reflection. Further studies with larger groups are required to evaluate the response to treatment, survival and recurrence rate.

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

Sildenafil, a phosphodiesterase inhibitor, decreases pulmonary arterial pressure by providing vasodilation in the pulmonary vascular bed. In this study, the effect of sildenafil use was investigated for prevention of pulmonary hypertensive crisis attacks in the postoperative period in patients with congenital heart defects. In our clinic, 9 patients with pulmonary hypertension and congenital heart defects were operated in between November 2005 and May 2006. Mean age of the patients were 9.6±8.1 (3-12) months and the mean body weights were 5.5±0.9 (4-7) kg. All patients were operated following median sternotomy by using extracorporeal circulation after aortic and bicaval cannulation. Medium hypothermia with cold blood cardioplegia was used. Sildenafil treatment was started in the early postoperative period by 0.5 mg/kg/day through the nasogastric tube. The dose was gradually increased up to 2 mg/kg/day and the treatment was maintained for one week. The results of the patients were evaluated retrospectively. Mean pulmonary arterial pressure in the preoperative period was 52.7±7.9 mmHg. Mean intubation times of the patients were 58.4±34.0 (20-100) hours, whereas intensive care unit stay and hospitalization periods were 2-7 (mean 4.8±2.0) and 6-12 (mean 10.11±2.8) days, respectively. During the study, neither mortality, nor important hypotension caused by sildenafil, was detected. Only a pulmonary hypertensive crisis attack was detected in 1 patient. One patient had consistent heart block and permanent pacemaker was implanted. Sildenafil is an effective choice of treatment for prevention of postoperative pulmonary hypertensive crisis in patients with congenital heart defects accompanied by pulmonary hypertension.

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

Chickenpox is an infectious disease caused by varicella-zoster virus (VZV), characterized by egzentematous rash. The frequency of encephalitis in patients with chickenpox was determined as 0.1-0.2% and the incidence is higher in patients with depressed cell-mediated immune response. Mortality rates vary between 5% and 20%. Patients who survive have a high likely to develop of permanent neurological complications after encephalitis. In this study, we report a fivemonth old infant who was admitted with a seizure and diagnosed as encephalitis. Meningoencephalitis was detected by the cranial magnetic rezonans. Anticonvulsants and antiviral therapy were supplemented. Patient was taken to physical therapy program due to the development of the mental motor retardation and quadriparazi in the follow-up periods.Therefore, we aimed to emphasize with this case that the patients suffering from chickenpox in the first year of the life should closely be followed up for complications, and the encephalitis due to varicella can also be seen rarely.

Diabetic nephropathy is one of the important microvascular complications of diabetes mellitus. Diabetic nephropathy develops as major complication of both type 1 and type 2 diabetes mellitus. At the same time, it is currently the leading cause of end-stage renal disease. Two of the main risk factors for diabetic nephropathy are hyperglycemia and arterial hypertension, but the genetic susceptibility in both type 1 and type 2 diabetes is of great importance. Contribute to the development of diabetic nephropathy other risk factors such as hyperglycemia, hypertension, obesity, hereditary diseases, smoking, and advanced age. The progression from normal albuminuria to microalbuminuria is accepted as the initial step in diabetic nephropathy, and then distinctive proteinuria, decreased glomerular filtration rate, and end-stage renal failure develops.

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

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

Between August 1969 and August 1981 105 patients with breast car-cinoma were operated on at the General Surgery Department of Medical Faculty of Diyarbakır University. We studied the case noter of these pa-tients. There were 98 female and 7 male patients. Radical mastectomy was performed on 93 patients, and simple mastectomy on 12 cases. Dur-ing the postoperative period, there were 3 deaths in 105 patients with bre-ast carcinoma. The mortality rate was 2.8 percent.

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

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

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

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

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

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

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

The liver is the most frequently wounded organ in the abdominal traumas and the rate of mortality is still very high. We aimed to present a case that was treated with non-operative methods which led to hepatitis because of increase in intraparenchymal hematoma in the late period. Seventeen-year-old male patient who had liver laceration after blunt abdominal traumas was treated with embolectomy due to liver hematoma. In late period, liver parenchymal hematoma can be increased and patients can develop hepatitis because of increased hematoma pressure on intraparenchymal biliary tract and this situation can be effectively treated with non-surgical methods.

Our surgical results have been reported after repair of complete atrioventricular septal defects (CAVSD). Between 2001 and 2009, 29 patients with CAVSD underwent operation at our institution. Double patch repair of CAVSD were performed in all patients. All attempts to close the cleft of the left atrioventricular valve (LAVV) were conducted as completely as possible. Early mortality occurred in three cases (% 10.3) after repair. Twenty patients could be followed-up for a mean of 3.5 years. Reoperation wasn’t needed for LAVV insufficiency, residual atrial septal defect or ventricular septal defect. Repair for CAVSD can be performed in early infancy. The double - patch repair in a safe surgical method that can achieve low mortality and good midterm outcomes.

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.

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.

Video-assisted thorocotomy (VATS) was performed to 10 patients to whom diagnosis couldn’t done with closed pleura biopsy betvveen June of 1995 and december of 1997 at the clinic of chest Surgery of Medical Faculty of Selçuk Üniversity. 5 of the cases were female and 5 of them were male. The smallest case was 28 years old, the eldest case was 80 years old and average age of ali cases was 55.7. VATS was performed to 5 of ali cases from the right, and to 5 of them from the left side. At the 9 cases biopsy was taken with VATS, İt 1 case biopsy vvasn't effective, for this reason öpen biopsy was one with thoractomy. Ali of the cases in whom biopsy were done with VATS absolute diagnosis have been done. İn the 4 of these cases diagnosis was malign mesotelioma, in 3 of them diagnosis was tubercülosis, in 2 of them diagnosis was nonspesific pleuritis. İn the thorocotomy performed patient the diagnosis was metastasis of adenocarcinoma. Complications and mortality vvasn't seen in any of the cases.

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.

Antineutrophil cytoplasmic autoantibody (ANCA) associated small vessel vasculitis constitutes a group of life-threatening diseases and renal involvement is its most severe and common manifestation. Microscopic polyangiitis (MPA) is a rare form of such vasculitis in children characterized by pulmonary-renal syndrome with pauci-immune rapidly progressive glomerulonephritis. A 9-yearold boy was admitted to our hospital because of rash, arthralgia and dark urine. Urine analyses showed hematuria and proteinuria. Blood examination revealed anemia, renal failure and positive p-ANCA. A chest CT revealed diffuse infitration. The renal biopsy demonstrated crescentic glomerulonephritis, immunofluorescent examination was negative. He was diagnosed MPA. High-dose methylprednisolone and high-dose cyclophosphamide therapy improved all of the lung infltrates and renal function.

Pulmonary embolism(PE) is a serious disease which is one of the most important reason of cardiovascular mortality. In spite of the fact that electrocardography(ECG) has a limited effect on the diagnosis and determination of the prognosis of PE, it is an essential method for clinically differentiating PE from other diseases that might be confused with PE, such as myocardial infarction(MI) .The aim of this case report presentation is to discuss whether this stuation might be a marker on determination of the prognosis.and the fact that PE could mimic the ECG findings of ST elevation myocardial infarction even though it is rare. Fifty six years old patient with acute renal failure and disorder of liver dysfunction, who had been treating in intensive care unit of internal medicine department, complained about chest pain and shortness of breath occuring on second day of his admission to the hospital. The patient was taken from cardiology department with anteroseptal MI prediagnosis after evaulation of the ECG demonstrating about 4 mm ST elevation in V1-V4 precordial derivations. Coronary angiography was performed to the patient being thought to whom primary percutaneous coronary intervention might be neccessary and there was not any lesion determined in epicardial coronary arteries. The parameters obtained from transthoracic echocardiographic evaulation of the patient was corcordant with the diagnosis of PE. It was understood from the imaging reports performed previously that trombus in vena cava inferior had been detected. The patient had cardiac arrest and died while he was being prepared for the pulmonary embolectomy operation after diagnosing of PE. The aspect which made our case report more attractive is that there were only various case reports published about PE in literature, which indicateST elevationmimicing anterior myocardial infartion. It is thought that this situation might be observed in PE and might guide for determination of the prognosis as well when this case report is evaulated together with the other ones.

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

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

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

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

Although it remains relatively stable childhood cancer rates in the last two years, thanks to advances in early diagnosis and treatment there has been a serious decline in the mortality rate. Despite all these developments, it still experienced today that children diagnosed with cancer 75% more than they can not survive more than five years. Before cancer treatment, oral and dental health problems may impair during and after the child’s health and quality of life. Therefore, pediatric dentists, the provision of oral hygiene and dental treatment needs of these patients have a very important place.

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

Aim: The aim of this study is to evaluate the association between hematologic diseases and SARS-CoV-2
infection in patients who have been been diagnosed with a hemat ologic disease after COVID-19 infection.
Patients and Methods: The ones who had a previously history of COVID-19 infection among the patients
diagnosed with any malign or autoimmune hematologic disease were evaluated between April 1, 2020 – April
1, 2021, retrospectively. The Patients who had the COVID-19 infection and the patients who had not were
compared.
Results: Twenty-four (7.8%) patients of 305 newly diagnosed who had a previously history of COVID-19
infection were determined. The most common diagnosis was non-Hodgkin Lymphoma in both of the groups.
Although it was not statistically significant, frequency of NHL and aggressive NHL were most common in
the patients with history of COVID-19 (25.1% vs 23.1%; p=0.143 and 66.6% vs 56.9%, p=0.094). The basic
hematologic parameters were similar between the two groups. The median time between COVID-19 infection
and the hematologic diagnosis was 4.1 (0.6-11.8) month; the minimum duration was in the patient with
Immune Thrombocytopenic Purpura and the maximum was the one with Multiple Myeloma. The median time
up until the diagnosis was longer in the malign group (4.5 vs 2.5 months; p=0.070).
Conclusions: As a result of the study, it has been emphasized that COVID-19 may have an etiological factor
for malign and hematologic diseases with autoimmune pathogenesi s.

Between 1982-1987 seventy-one patients with pure mitral stenosis was operated at the Department of Thoracic and Cardio-Vascular surg. Selçuk Üniversitesi School of Medicine. There was no mortality. Early post operative and long term term results revealed that a good palliation was achieved in of the patients. Although open heart surg facilities were available at the department emphasis was made in the thought that closed mitral valvotomy stili has a place for the surgical treatment of pure mitral stenosis.

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.

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

A retrospective study was performed to investigate the mortality among the patients hospitalized in department of chest diseases Dicle University medical school clinic. The patients passed out in this clinic in the period from January 2004 to May 2009 were evaluated. It was determined that totally 4417 patients were hospitalized (8892 hospitalization) in this period and 384 (8.6%) of them resulted in death. The mean age of the patients was 66.8±15.3 and 92 (33%) were women and 187 (67%) were men. The principal causes of their mortality were pneumonia in 92 patients (33.1%), chronic obstructive pulmonary disease (COPD) in 87 (31.2%) patients, pulmonary cancer in 52 (18.6%) patients, tuberculosis (TB) in 18 (6.5%) patients, pulmonary thromboembolism (PE) in 18 (6.5%) patients and another diseases in 12 (4,2%). When the accompanying diseases were evaluated, no additional diseases were determined in 130 (46.6%) patients; 41 patients (14.7%) had cardiac disorders, 22 patients (7.9%) had cancers outside the lungs, 18 patients (6.5%) had cor pulmonale, 17 patients (6.1%) had neurologic disorders, 15 patients (5.4%) had renal diseases, 10 patients (3.6%) had diabetes mellitus (DM), 9 patients (3.1%) had TB and 17 patients (6.1) had unclassified disorders. In conclusion, we think that the knowledge about their mortality rates and the causes of mortality is useful for every clinic for their approach to the patients and considering the accompanying diseases is helpful to decrease the mortality

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

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

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

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

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

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

Cystic lesions of the parathyroid gland are uncommon. Although majority of patients with cystic parathyroid adenoma present with mild hypercalcemia, some may present with parathyroid crisis which can be a life-threatening clinical condition. In this article, we present a patient who applied to emergency service with symptoms of acute parathyroid crisis, was diagnosed parathyroid adenoma with cystic degeneration and treated. A 46 years old male patient was applied to emergency service with confusion. In blood analyses, calcium level was 16,6 mg/dl and akut kidney failure was determined. In radiological imagination, parathyroid adenoma with cystic degeneration was determined and patient was treated minimal invasive parathyroidectomy.After the operation, parathormon and calcium levels were returned the normal levels. Parathyroid cysts are uncommon, and they are classified as functional or nonfunctional so far as hypercalcemia. Functional cystic parathyroid adenomas are very rare. These patients can approach with symptoms of hyperparathyroidism or parathyroid crisis. Parathyroid adenomas with cystic degeneration and functional parathyroid cysts should be considered about causes of primary hyperparathyroidism and acute parathyroid crisis.

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

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

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

One hundred female patients alt of who had breast cancer were applied Madden's modified radical mastectomy technque. The cases were examined considering the age of the patient, the localisation and size of the tumor, axillary metastasis and classification. Complications and the rate of mortality and survival were studied. The results were as hopeful as radical mastectomy.

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

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%.

Uraemia is a syndrome of clinical and metabolic abnormalities that develop in parallel with deteriorating renal function. The neurological consequences of uraemia are similar in many ways to the central nervous system effects of other metabolic and toxic disorders. There are several recent case reports of acute movement disorders with bilateral basal ganglia involvement in diabetic uraemic patients. We studied MRI and DWI findings of a patient with diabetus mellitus and chronic renal failure who developed acute ensepholopathy. Patients with diabetes mellitus and chronic renal failure may be progress to acute ensepholopathy. After hemodialysis semptoms are regressed; MRI can be used succesfully at acute phase and after hemodialysis.

The aim of this study is to evulate our surgical results of Tetralogy of Fallot. Between 2001–2009, 35 patients with Tetralogy of Fallot underwent to total correction at our department. Five of them had Down syndrome (%14.2), 3 had patent ductus arteriousus (%8.5), 2 had pulmonary atresia (%5.7), 1 had hypothyroidism (%2.8) and 1 had coronary artery anomaly (%2.8). Five patients had Blalock-Tausing shunt in their medical history. Transannular approach was avoided because of causing pulmonary valve insufficiency in late period, but it was obliged to apply in 12 patients. Early mortality occured in 3 cases (%8.5) after repair. Twenty three patients were followed for mean 6.7 years. One patient with pulmonary gradient underwent reoperation at postoperative 15th month and died due to multiple organ failure. There were no complet atrioventricular block and disrhythm in long term. Second degree pulmonary insufficiency that was developed in 12 patients who underwent transannular patch closure was followed up to day. We think that ventricular septal defect and infundibular stenosis could be corrected via transatrial approach, if necessary via transpulmonar approach and in long term, pulmonary insufficiency and right ventricular disfunction could be prevented.

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

Despite all these advances in medical treatment, sinusitis is still one of the most important reasons for intracranial sepsis. Complications of sinusitis is not very common but; the rapid spread of the infection to orbital and the intracranial tissue can be raised very serious and high mortality complications such as subdural empyema, meningitis, brain abscess and cavernous sinus thrombosis. Therefore, it is important to know where sinus infections can spread. In this case report, a 26 year old female patient was presented with periorbital cellulitis, venous thrombosis and meningitis developed as a complication of sinusitis.

In Patients With Chronic Uraemia it is well known that uraemia is one of the re-asons for polyneuropathy. The subject of this study was to investigate if and how much the uraemia cases autonomic dysfunction. 38 patients with chronic renal failure have been included in the study. Right median nerve motor and sensory conduction. ulnar nerve sensory conduction, peroneal motor conduction and rural nerve sensory conduction have all been recorded from these pa-tients, R-R intervals have also been studied in both during resting and deep inspirium. In addition to that, the sympathetic skin responses evoked by res-piratioit and noise have also been simultaneously from both hands recorded. 56.75% of the patients showed nerve conduction values which indicate polineuropathy. The data re-levant to the R-R inten►ks (during resting %l = 5.58 ± 3.27, during deep inspirium %D = 11.3 ± 5.9, %D-%1= 5.47 ± 5.05. %Dl%1 = 2.19 ± 1.43) have been compared to the values obtained from the control group.1 .The established correlation between R-R intervals and the age of the control group does not exist in the patients with iiremia.2.11 has been found that the %D,%1 and %D-%1 values are sta-tistically different from the values of the control group.The sympathetic skin response could not have been obtained from nine patients(%23_68)_Longer latency values have been observed as compared to the control group. In conclusion it may he surmised that the pa-tients with chronic renal failure show to an im-portant degree an autonomic disfithction (probably due to the autonomic neuropathy) together with polvneuropathy.

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

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

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

Aim: Diarrhea is one of the most common causes of mortality and morbidity in childhood, especially in developing countries. Dehydration related to diarrhea can be mortal if it could not be prevented. Mothers play important role in preventing children from diarrhea and replacing fluid and elect rolytes before the dehydration. Material and Method: Information levels of the mothers about diarrhea and oral rehydration solution were extracted from an questionnaire form. The results of the questionnaire were investigated according to socioeconomic, educational levels of the mothers. Results: In the study, 250 mothers’ answers (ages varied 17 to 50-years-old, median; 32-years-old) were evaluated. Seventy-seven (30.8%) of the mothers were from upper-socioeconomic-class 98(39.2%) were from middle-socioeconomic-class, and 75 (30%)were from lower-socioeconomic-class. Approximately, half of the mothers were graduated from primary school. 190 (76%) of mothers pointed out that diarrhea is a mortal disease and the most common protection practice is to be aware of hygiene, whereas 26.8% of the participants remarked that they did not have any idea for protection from diarrhea. The most common method that the mothers choose when their children had diarrhea was juicy drinks (55.6%), and application to medical center (24.4%). 93.6% of the mothers remarked that they should increased intake of juicy drinks and 88.4% remarked that they did not stop breast feedings when their children had diarrhea. Oral rehydration solution was known by 76.4% of the participants, and this knowledge had been achieved from a medical center (42%) and broadcast media (18.8%). Seven of the mothers (2.8%) had a history of child death related to diarrhea. Conclusion: Since diarrhea still remains one of the most common causes of mortality in childhood in the twenty-first century, the mothers must be instructed, and much time must be allowed in primary medical center and media for education about diarrhea. Unlabored achievement to oral rehidration solution must be provided for the parents.

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

Hemodialysis patients have a tendency toward to thrombosis. AVF thrombosis is frequent in those patients. Study was aimed to evaluate patients by means of hemostatic state at our study, hemostatic parameters in haemodialysis patients with respect to healthy group were evaluated. Haemodialysis group (HDG) consisted of 45 patients (27 male, 18 female) and control group (CG) consisted of 15 healthy persons (8 male, 7 female). These parameters were evaluated whether contributing to thrombosis APC resistance is found to be higher in patient group. AT III and tPA antigen levels are low in patient group, while vWF antigen levels are high in patients with AVF problem compared to healthy subjects. Hypofibrinolysis and prethrombotic state were thought to play role in contributing vascular endothelial injury and AVF thrombosis. These findings reflect the pre-trhrombotic state and injured vascular endothelium in HDG with AVF problems. Thus, Hemodialysis patients must be screened and evaluated by means of pre-thrombotic events for better AVF survival and outcome.

The recent developments involving the molecular basis, diagnosis and treatment of Alport's syndrome was reviewed. The determination of the nature of type IV collağen and localisation of its genes have provided new insights in the understanding of the different sign and symptoms of Alport's syndorme and helped to reach new approaches in diagnosis and treatment. Immunohistochemical examinations may help to distinguish the X linked and autosomal forms of Alport's syndrome. The genomic investigations may be reçuired in suspected cases. İn this disease with no effective treatment the gene therapy is promising.

In this article, the results of 141 hepatic hydatid cyst cases operated in our clinic are presented. Surgical treatment was applied 180 times to 192 liver hydatid cysts detected in 141 patients. Marsupialization 83, partial cystectomy and closure of the remaining part without drainage 70, pericystectomy 11, partial cystectomy and tunneling 10, left lateral seg-mentectomy 5, drainage of the cyst and abdominal cavity was used once. Nine of 141 hepatic hydatid cyst cases were lost, postoperative mortality was 6.4%.

This study is performed in 57 renal transplant recipients and 57 hemodialysis patients with chronic renal failure in the Nephrology Division of the Department of Internal Mek-lif-...ine, University of Hacettepe School of Medicine and llemodialysis Unit (4- the Department of Internal Medicine, University of Selçuk School of Medicine_ Cytornegalovirus (CMV) IgM and 1gG antibodies were deterrnined in blood sarnples by enzyme-linked immunosorbent assay (ELISA) rnethod in the Microbiology Laboratory of Selçuk University. 1,Ve compared the results with control including 50 healty individuals. We fourıd CMV-IgM seropositivity 56.14%, CMV- IgG seropositivity 100% in the renal transplant recipients and CMV-IgM seropositivity 24.56%, CM11-IgG se.ropotisivity 91.23% in the hernoclialysis patients. In control group, CMV-IgM seropositivity was 2% and CMV-IgG seropositivity 50%. The rates of CMV-1gM and Ig G seropositivity in the renal transplant recipients and hemodialysis patients with chronic renal failure were high and significant according ta the control group (p<0.01).

Diabetic nephropithy is one of the major cause of early mortality among the diabetic patients. In order to reduce the mortality, the prevention of nephropathy and the meticulous control of diabetesz are necessary. Various trials are beige carried out with antihypertensive drugs to control diabetic nephropathy. Although, physiologic or protective role of these drugs is not to be verified in this study. For this, renal changes in streptozotocin induced diabetic rats were intesvigated morphologically at 4 weeks and 8 weeks intervals and the results were compared histologically with those of cilazapril treated strep-tozotocin induced diabetic rats. Cilazapril arrested the nephropathy at early hypey'unction and hyperthropy stage in streptozotocin induced diabetic rats. The ratio, of the left kidney weight to body weight of cilazapril treatment received diabetic rats was either similar to 4 weeks old diabetic rats or higher than that of 8 weeks old diabetic rats which was the farther support of nephropathic arrest by the cilazapril treatment. Histologic studies also revealed that glomerular basement membrane thickness, fatty degenerative of epithel cells of tubuli, tubular necrosis. pyelonephritis, and intenstitial fibrozis were conspicuously regressed by cilazapril treatment

Aim: Temporary hemodialysis catheters inserted into the internal juguler vein are commonly used in patients who need emergent hemodialysis. During this procedure, although it is very rare, the patient may have anatomicaldifferences. Therefore, before the procedure, it should be studied whether the patient has any cardiovascular abnormality or not. Case report: Dextrocardia was detected in control chest X-ray of a 55 year old patient, who was in routine hemodialysis programme and had a history of 10 arteriovenous fistula operations and multiple transient and permanent catheter insertions because of chronic renal failure. Conclusion: For this reason, we suggest posteroanterior chest x-ray as the routine technique since it is the simplest diagnostic method.

In This report, level of trigliserides has been studied in patients with renal failure. Hypertrigilseridemy encountered in this patients has been found to be releated with insufficiency of lipoprotein lipase activity and the the disfunction of carbonhydrate metabolism.

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

Vitamin D is a liposoluble prohormon and a secosteroid which is produced in the skin after exposure to sun-shine. It is turned to calsitriol which has an important role in the calcium and phosphate metabolism by different metabolic pathways. Deficiency of vitamin D is related to some factors such as less sunlight exposure, inadequately intake of vitamin D and absorbtion problems. Studies recently done have shown vitamin D deficiency exists in many people. The effects of vitamin D deficiency on numerous diseases and functional disorders such as chronic musculoskeletal pain, Type 1 and Type 2 Diabetes Mellitus (DM), obesity, multiple sclerosis, rheumatoid arthritis, cardiovascular diseases, osteoporosis, microalbuminuria, renal failure involving colon, prostat and breast cancers either are reported in literature.Vitamin D is one of the main structural elements playing an essential role in several metabolic pathways both directly and indirectly providing numerous functions carring vital importance for organism. In spite of causing a lot of functional disorders and diseases, vitamin D replacement therapy in case of deficiency is safe, economic and simple unless neglected. In this review, we aimed to demonstrate the metabolism, functions and effects of vitamin D, increased risks of chronic diseases likely to be encountered in vitamin D deficiency and the importance of vitamin D replacement therapy.

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.

The cardiovascular involvement is the majör cause of mortality in the scorpion envenomation. Cardiac enzymes should be measured if patients with scorpion envenoming have symptoms related to cardiovascular system accompanied with local pain. Serum level of troponin I is a highly specific fort he myocardial injury. It may be allow early establishing of the cardiac involvement and starting to treatment. The using of troponin I as a follow-up criterion in the scorpion envenoming with cardiac involvement may be prevent from events that will ocur later. We presented a 7-year-old boy with scorpion envenoming.

Tuberculosis (TBC) is an infection that rarely seen in the first year of maximum immunosuppression. Beacuase of its rarity we aimed to present a case of TBC that developed after renal transplantation in our newly established transplantation unit. A live donor renal transplantation was performed on a 45 years old man who was complaining of chronic renal failure for four years and on hemodialysis for two years. There was no signs of TBC in the physical examination, preoperative laboratory investigation and past medical history of the patient. Prednisolone, MMF, FK-506 combination and in the 1st and 4th day Basiliximab were performed as immunosuppressive protocol. In 1 st postoperative month, there was a cavernous lesion in the left upper zone on chest x-ray. Antituberculosis treatment was started according to a positive sputum culture for TBC bacili. After twelve months of antituberculosis treatment there was a clinical and laboratory improvement and the treatment was ceased accordingly. Because of its frequent past history in our country, TBC is aserious disease that should be kept in mind and dealt with carefully in patients undergoing renal transplantation.

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

236 (5.2%)nosocomial infections were detected in 4468 patients hospitalised in our newborn unit in Medical Fa- culty, Selçuk University between 1992 and 1996. 169 (71.6 %) of the infections detected were in prematüre ba- bies while 67 (28.4%) of them in mature babies and that numbers corresponded 11.5 percent and 2.2 res- pectively. The most common infection was sepsis (73.1%) and others such as menengitis (19.3%), pneumonia (3.4%) and others (4.2%) followed it. At least one microorganism growed in 32 (13.5%)specimens obtained from various body fluids. 9 (28.1%) of the miroorganisms were Klebsiella spp. and 8 (25.0%) of were E.coli Mortality rates of the infections were 87.5% for pneumonia, 61.5% for sepsis, 8.7% for menengitis and 60.0% for others, which corresponded an average mortality rate of 51.6 %.

Serum vitamin E, IIDL cholesterol and IIDL bound vitamin E levels were inverstigated in 20 patients with chronic renal failure and 24 healty subjects. Vitamin E, 11DL cholesterol and IIDL bound vitamin E levels of controls were fou.nd as 1.1063 ± 0.0079 mg/dl, 48 ± 4.81 mg/dl and 0.1095 ± 0.0094 mg/dl while those of patients were 1.0881 ± 0.0437 mg/dl, 26.55 ± 6.21 mg1d1 and 0.2657 .± 0.1209 mg/dl, respectively. IIDL-bound vitamin E levels of patients were higher (p<0.001) and 1113L cholesterol levels were lower (p<0.001) than those of controls.

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

\r\n Introduction: Multipl myeloma is a disease of unknown pathogenesis. Although there was a different

\r\n

\r\n hypotheses on the subject, recently mutations in the pathway of apoptosis come to the fore. PUMA may play a role in apoptosis, bound or

\r\n

\r\n unbound p53. The role is regulated by various signals of transcription factors. In this study; the expressions of p53 and PUMA in bone marrow hematopoetic cells of

\r\n

\r\n have been worked and the relationship between myeloma pathogenesis with p53- PUMA was

\r\n

\r\n searched.

\r\n

\r\n Method: The expression of p53 and PUMA was evaluated using immunohistochemistry. The

\r\n

\r\n procedure was carried out using specific antibodies against p53 and PUMA. Bone marrow

\r\n

\r\n biopsies of MM patients at the time of diagnosis (n=31) were included in the study group.

\r\n

\r\n Bone marrow biopsies from individuals who had normal hematopoiesis (n=12) were included

\r\n

\r\n as control. After staining, strength was calculated of each positively staining

\r\n

\r\n cells.

\r\n

\r\n Findings: The percentage of cells showing PUMA expression was significantly higher in

\r\n

\r\n bone marrows of MM patients as compared to normal bone marrow samples (p=0.000). We

\r\n

\r\n found a correlation between the percentage of plasma cells with staining prevalence of

\r\n

\r\n PUMA, but it was not statistically significant (p=0.385). There was no correlation between

\r\n

\r\n the stage of the disease with PUMA expression.

\r\n

\r\n Results: Our results showed that specially PUMA expression is significantly higher in bone

\r\n

\r\n marrow cells of MM patients compared to healthy controls. Higher positivity of PUMA

\r\n

\r\n suggested that, PUMA induced nongenotoxic reasons at the time of diagnosis. The lack of

\r\n

\r\n p53 and PUMA positivite suggests that, apoptosis play a role in myeloma pathogenes

\r\n

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

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

ABSTRACT

Aim: Sternal dehiscence is one of the most troublesome complications following cardiac surgery. Although it can be corrected by simple methods if detected earlier, treatment failure or delay in sternal dehiscence may result in mediastinitis, which is highly lethal.  In this study, we aimed to investigate alternative sternal closure systems, mainly sternal talon (STalon) and titanium sternal plates (SPlate). Patients and Methods: In between April 2015 and January 2018, patients with sternal dehiscence after any kind of open cardiac surgery were included in this study. These patients were retrospectively evaluated according to the their demographic data, risk factors for sternal dehiscence, type of operations, techniques used for fixation of the sternum, mainly focusing on the STalon and titanium SPlate fixation. Results: A total of 45 patients were taken into surgical correction because of sternal dehiscence.  Thirty-four (75.6%) of the patients male, whereas 11 (24.4%) were female. Mean time interval after the first operation to sternal dehiscence was 68.5 days (1-780 days). Mean body-mass-index (BMI) was 31.52 kg/m² (22.03-43.69 kg/m²). Before the sternal fixation, mean CRP value was 68.34, whereas it was 75.55 before discharge. Confounding risk factors were internal mammarian artery (IMA) harvesting for coronary artery disease, diabetes mellitus, bronchial asthma, chronic pulmonary artery disease and advanced age. Mean post-operative intensive care unit (ICU) length-of-stay (LOS) was 5.02 days (1-29 days), whereas hospital LOS was 17.18 days (2-74 days). Early mortality was observed in 3 patients (6.67%). The first choice of operation was simple closure and/or Robicsek closure. Apart from simple and Robicsek closure techniques, sternal talon and/or titanium plates were used in 24 patients (53.3%). DM was found to be related to extanded total hospital LOS, ICU LOS, and postoperative time to discharge. DM also increased the risk of both superficial and deep sternal infection rates (p<0.05).  Conclusion: Ideal sternal closure should stabilize the sternum, be cost-effective and provide shortest hospital LOS with minimal post-operative complications. In patients with intact intercostal spaces, sternal talon may eliminate serious complications, such as cardiac rupture mainly caused by dense adhesions. Sternal plates are mainly effective in fragmented fractures without stable intercostal spaces. All patients should be individualized according to type of lesions and sternal fractures.

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

Mesenteric cysts are rare intra-abdominal tumors. The goal of this study is to analyze the clinical symptoms and the pathological features of mesenteric cysts and the surgical approaches. The data of 17 patients who had surgeries because of mesenteric cysts between 2005 and 2012 at our clinic were evaluated retrospectively. Eleven (65%) of our patients were female, while six (35%) were male and the median age was 32 (17-70). The most frequently seen clinical presenting complaint of our patients was abdominal pain and abdominal mass. The mesenteric cysts were most frequently located in the small intestine mesentery (70.5%). The cyst sizes varied between 2 and 25 cm. The most frequently performed surgical procedure was enucleation (76%). While surgical site infection was seen in two patients, anastomosis leak was seen in one and this patient had loop ileostomy. The mean period of hospitalization was 8 (2-17) days. No mortality cases were seen in the post-op period. Mesenteric cysts are rare intra-abdominal masses. They can be seen in different localizations within the abdominal cavity. Patients are generally diagnosed by radiological methods. The rate of recurrence is low following total excision and it has a good prognosis. Although laparoscopic resection is a preferred method, physicians should secure total resection in malign cases and the cyst should not be perforated.

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

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

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

This is a group of Progressive renaldisorders that usualy have their onset in childhood. The common characteris- tic is the peresence of a variable number of cysts in the medulla associated with significant cortical tubular atro- phy and interstitial fibrosis. Although the presence of medullary cysts is important, the corticaltubulointerstitial dam- age is the causeof the eventual renal incufficiency. İt has four variants: 1- Sporodic, nonfamilial (% 20); 2- Familial juvenile nephronophytisis (% 50), inherited asa recessive disease; 3- Renal - retinal dysplasia (% 15), recessively inherited and associated with retinitis pigmentosa; and 4-Adult onset medullary cystic disease, dominantly inherited (%15). The case had shown the view of sporadic nonfamilial variant of UMCD and was presented because of the rarity in literatüre it.

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

Backround: Myocardial infarction with coronary artery disease (MICAD) is the leading cause of myocardial injury. Myocardial injury non-related to atherosclerotic plaque disruption (non-MICAD) is a rare and heterogeneous diagnosis. Although MICAD is well studied, non-MICAD was not thoroughly identified in young patient population. We aimed to investigate the frequency, main etiologies, and five-year mortality of patients with non-MICAD younger than 40 years.

Methods: We retrospectively enrolled 292 patients with acute myocardial injury younger than 40 years between January 2010 and December 2014. Clinical, demographic, laboratory, angiographic features, and five-year all-cause mortality were compared between patients with non-MICAD (n=78) and MICAD (n=214).

Results: Median age of patients was 36. Non-MICAD group was younger than MICAD group [32 (28-37) vs 37 (34-39)]. The frequency of female patients with non-MICAD was higher than those with MICAD (24.4% vs 10.3%). Most of the patients with MICAD presented with STEMI (77.1%), while most of the patients with non-MICAD presented with non-STEMI (89.7%). Most common etiologies of non-MICAD in were myocarditis (32%) and vasospasm (9%). Age, female sex, no smoking and, absence of dyslipidemia were independent predictors for non-MICAD. Five-year all-cause mortality in non-MICAD group was significantly lower than MICAD group (2.6% vs 10.3%) (log-rank test p=0.04).

Conclusion: Non-MICAD represents a heterogeneous group of patients who had varying etiologies at different ages. Despite the lower mortality rate of non-MICAD group, different diagnostic and treatment strategies are required for management of patients with non-MICAD.

We aimed to investigate the markers and possible risk factors of urinary infection in predialysıs patients with CRF and patients undergoing dialysis by comparing groups younger or older than 65 years of age. We evaluated 82 patients with chronic renal failure who have been followed by nephrology and infectous disease policlinic due to urinary infection during January 2012 and December 2012 in medical faculty of Kahramanmaras Sutcu Imam University. The patient in the predialysis period was accepted as group I, the patients ongoing dialysis and continuous ambulatory peritoneal dialysis (CAPD was accepted as group II. 58 (70,7%) of these patients were in dialysis program. 34 (29,3%) were in predialysis patients. The average age of the patients in predialysis group was 63, 62±15,482 and the average age of the patients in dialysis group were 50, 08±21,086. (45,1%) of these patients were ≥65 years old and compared with serum levels of the kolesterol, trigliserid ve albumin, levels in ≥65 years old cases were statistically significant than ≤65 years old cases. Escherichia coli was microorganism that the most commonly isolated in urinary cultures in both groups. (43.9%) of patients were diabetic. There was no statistical difference between the levels of serum CRP, ESR and leucocytosis between the groups (p>0.05). Fever, pyuria and nitrite positivity between the predialysis and dialysis groups was statistically no significant. Comorbidity in the group above 65 years of age may increase the tendency of infection.

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

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

Objective: Familial hypercholesterolemia (FH) is an autosomal dominant inherited genetic disorder that causes a significant increase in low-density lipoprotein (LDL) cholesterol levels and leads to early coronary heart disease and cardiac mortality. Although this disease has a heterozygous (HeFH) and homozygous (HoFH) form, the incidence of HeFH is reported to be 1: 500, while HoFH is reported to be 1: 1 000 000. This disease is often caused by LDL receptor (most common), apolipoprotein B (Apo B), Proprotein Convertase Subtilisin/Kexin 9 (PCSK9), and LDL receptor adaptor protein (LDLRAP) gene mutations. Patients with FH do not respond well to lipid-lowering therapies such as a statin, and so lipoprotein apheresis is the treatment of choice.

Material and Methods: We compared the results of lipoprotein apheresis in a 20-year-old female patient diagnosed with HoFH with two different methods [double-filtration plasmapheresis (DFPP) and dextran sulfate column (DSC) methods]. 40 lipoprotein apheresis procedures including 20 sessions of DFPP and 20 sessions of DSC were evaluated.

Results: When the two methods were compared the changes in high-density lipoprotein, white blood cells, platelets, potassium, calcium, prothrombin time (INR) and activated partial thromboplastin time values were statistically significant.

Conclusions: In conclusion, our study suggests that it would be more appropriate to choose the apheresis method according to the clinical and laboratory findings of the patient since it shows that two different methods have different effects on serum electrolyte values, hemostasis criteria and leukocyte and platelet counts.

Between 1989 and 1992 in University of Selçuk, Faculty of Medicine, Department of Surgery, 12 patients were diagnosed with portal hypertension. 14 surgical intervention (3 selective and 8 nonselective shunt, 1 eosophageal transsection and 2 Sugiura-Fwagawa procedure) were peıforıned ta these patients. Except 1 oesophageal transsection and 2 Sugiura-Futagawa operation, all operations were peıformed in elective conditions. Expect 2 cases underwent Sugiura-Futagawa operation, there were no operative mortality. Ir wasn't developed the recurrent hemorrhage in following 3 mounts to 2 years.

Agenesis of the gallbladder is a rare congenital anomaly occurring in 1 to 4 people of a population of 10000. It may present with biliary type symptoms such as upper abdominal pain requiring further investigation. Ultrasound is the first choice of imaging for biliary symptoms but is frequently misleading in the context of Gallbladder Agenesis. We report a case of congenital Gallbladder Agenesis and a biliary tract abnormality diagnosed by laparoscopy. As a result most patients are diagnosed following conversion of laparoscopic to open cholecystectomy and subsequent failure to identify the gallbladder. Failure to suspect Gallbladder Agenesis at laparoscopy can result in unnecessary open surgery and a high risk of bile duct damage with corresponding postoperative morbidity and mortality.

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.

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

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

Aim: To determine the primary success rate and follow up results of renal artery stenting or balloon angioplasty in controlling renovascular hypertension and renal failure in patients with renal artery stenosis. Method: Before balloon angioplasty and stenting; renal angiography and Doppler ultrasonography findings were evaluated and also findings of MRA were estimated if present.The clinical estimation of the cases were made upon to renal functions, hypertension values and the changes of the number of medicines used. Results: Balloon expandable stents were placed in 32 renal arteries of 37 patients. Balloon angioplasty were used in 7 renal arteries of 37 patients (22 men, 15 women; mean age 50.24). There were hypertension in all of the patients. In 12 patients; there were disturbed renal functions. In order to determine the activity of the cure of the disease, the patients are followed by measuring blood pressures and serum creatinin levels before and after the stenting and balloon angioplasty. Stenosis rate was 30-100% (mean 74.15%).The lesions were ostial in 15 patients, truncal in 24 patients. Mean follow up time was 21.2 months (3-84 months). Hypertension was cured in 9 (24.33%) patients, improved in 19 (51.35%).patients In 9 (24.33%) patients there was no respond. In 12 patients with disturbed renal function, 8 (22.22%) patients showed improvement, 4 (11.10%) patients showed deterioration and 4 (11.10%) patients were stable. Conclusion: Revascularization of renal artery stenosis with stenting and balloon angioplasty is a simple, efficient and safe procedure. In patients with uncontrolled hypertension and progressive renal failure; revascularization of renal ar tery stenosis with stenting and baloon angioplasty pointed out impor tant clinical benefit.

 Postpartum haemorrhage (PPH) which is the first cause of maternal mortality in our country is responsible for about 25% of maternal deaths in the world . While PPH is defined as loss of 500 ml or more of blood from the genital tract within 24 hours of thebirth of a baby, severe PPH is blood loss exceeding 1,000 mL. The most common causes are uterine atony, genital tract injuries and placental retention. Many methods are used such as effective implementation of the uterine fundus massage, the use of agents which myometrium contact, hypogastric and/or uterine artery ligation or embolization in its treatment. Despite this, PPH is the primer cause of maternal death in our country. To reduce maternal mortality rates caused by dependence of PPH,  evidence-based approaches are important in treatment and care. Pharmacological, surgical approaches and various applications for the third stage of labour in the prevention and treatment of PPH are used. But there are no evidence-based studies at adequate levels for all treatment. The clinical data in a large part of the PPH/therapeutic approach are limited. Therefore, it is intended in this article to determine the current approaches related to the prevention of postpartum haemorrhage and to inform health professionals about the adequacy of the initiatives implemented.

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It is the sudden occlusion of the pulmonary artery and its branches by an object such as thrombus air, fat, tumor parcast coming through the bloodstream (1). In the USA, about 630 thousand people are exposed to pulmonary embolism every year and about 200 thousand people are exposed to it. While the mortality rate is 8% in those who can be diagnosed and are treated, it approaches 30% in those who cannot be felt (2). Deep thrombosis was found in 33% of the cases (3,4). Pulmonary thromboembolism is a known complication from the beginning of the 19th pain. Previously, the thrombus was thought to be inside the artery, but later it was defined as embolic. In 1858, Wirchow first demonstrated that the so-called pulmonary thrombosis was an embolism, and he described a triad. Accordingly, local travnia at the wall of the vessel stays with the tendency of the blood to clot (5). These factors still maintain their validity in etiology. ETIOLOGY The reasons leading to pulmonary thromboembolism are mainly thrombi and lysis: fat, air, amnion tumor tissue, parasite eggs, foreign bodies such as catheters. Pulmonary artery embolism was found in 1 out of 3 cardiac autopsies on average, with mitral stenosis being in de-cornized cases. The right heart may be the source of thrombi in cases with atrial fibrillation or past myocardial infarction. In addition, factors that facilitate ventricular thrombosis are among the risk factors for pulmonary enriboli. Situations where the risk of pulmonary embolism is increased.

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

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

Aim: 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.

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

Primary immunoglobulin A (IgA) nephritis associated with dominantly IgA deposition in glomerular mezengium. Macroscopic or microscopic hematuria are seen and proteinuria may be associated with hematuria. Acute renal failure (ARF) rarely occurs in the course of IgA nephritis. In here, a male case 15 years old with IgA nephritis had been presented with ARF and rapidly resolving renal failure.

Between Januar). 1994 to Septemher 1996. 16 patients with mediastinal mass were surgically eAp-Iored. Among them 11 of them were males and 5 were .female. Their ages ranged 35 ta 68 vears (mean 53.8). For 13 patients right anterior me-diastinotomy were pe)formed (81.25%) and left an-terior mediastinotomy were perforıned for 3 pa-tients, respectiyely. 117 one case the right anterioı-mediastinotomy procedure failed and thoracotomy required. In 14 cases of 16 (87.50 %) pathologi• di-agnosis was made hy ınediastinal exploration. Par-hologic extıminations revealed that epidermoid can-cinonıa in 3 patients, sarcoidosis in 3 patients, oat cell carcinoma in 2 patients, lenfoğna in 2 patients. tuberculosis in 2 patients. adenocarcinoma in 1 pa-tient, and chronic nonspesıfic inflamation in 1 pa-tient refflectively. The patient who required tho-racotomy was diagnosed as sarcoidosis. Opeıyuive complication and moı-tality occured,

95 patients underwent coronary artery bypass grafting at the Selcuk University Medical School bet-ween January 1993- December 1994. During car-diopulmonary bypass, moderate hypothermia and cold potassium cardioplejia were used. Hospital mor-tality was found as 7.3 %, late mortality was 2.6 %.

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

It was reported that there is relationship between high brain natriuretic peptide (BNP) levels and mortality in chronic obstructive pulmonary disease (COPD). In this study, we investigated effect of NIV to the BNP and troponin. Fifty eight cases with COPD were enrolled to this study. The patients were divided into two groups as cases receiving NIV (n:41) and cases not receiving NIV (n:17). In both groups pretreatment and posttreatment pro BNP and troponin levels were measured. Initially, in NIV group both pro-BNP (2013.95 pg/ml) and troponin (0.17 ng/ml) levels were significantly higher than those of control group (328.9 pg/ml and 0.02 ng/ml, respectively) (p0.05). In conclusion, in severe COPD acute exacerbations that develop respiratory failure, both pro-BNP and troponin levels increase significantly. This increase suggests that in COPD exacerbations, depending on severity of exacerbation right ventricle load and pulmonary hypertension may be more prominent and myocardial injury may accompany this. In COPD exacerbations, NIV treatment could safely decrease the increased pro-BNP levels without increasing the myocardial injury.

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

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

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 .

Thrombotic thrombocytopenic purpura (TTP) is a clinical condition characterized by hemolytic anemia and thrombocytopenia. The condition is usually associated with fever, neurological findings and renal failure. When it occurs in pregnancy, it is a serious disease with high mortality rate. It may become confused with some diseases of pregnancy. Early diagnosis is very important for maternal and fetal health. In our article we present 23 years old patient with 23 weeks intrauterine dead fetus presented to our clinic for control. She had her first pregnancy before 2 years and it was terminated on the 19th week because of intrauterine death. She had the diagnosis of TTP in her both pregnancies.

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

A 44 years old woman who having hemodialysis for three years had a complaint of pain in the fistular area. Ultrasonographic examination was done to the fistular area. There was no flow by color doppler imagings. Transient dialysis catheter for hemodialysis was suggested to the patient. Catheter was advanced to the left jugular vein. When control telecardiography examination was done, catheter malposition was detected. Venous type blood was seen when negative pressure applied. Anjiography was applied to detect the catheter localisation. Caheter was seen in coronary sinus via the route of persistant left superior vena cava.

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.

An increase in serum gastrin levels is noted in patients with chronic renal failure. In our study, serum gastrin levels of 24 patients with chronic renal failure who were under 10 conservative treatment and 14 hemodialysis treatment were determined. Serum gastrin levels of both groups were significantly higher than the control group (p <0.05). There was no correlation between total gastrin levels and serum creatinine levels. In addition, we found that serum gastrin levels after hemodialysis did not show a significant decrease compared to pre-hemodialysis.

In this article, 692 patients in whom thyroid op-erations were made have been reported. Of these cas-es, 621 were female and 71 mal e. Enucleation was petformed in 19 patients, subtotal excision in 532 cases (157 unilateral, 375 bilateral) and total exci-sion in 141 patients (30 unilateral, 96 total on one side+subtotal on the other side, 15 bilateral). The postoperative mortality rate was %0.0. 508 nerve dissections were carried out in 292 of 692 pa-tients and the relations of the recurrent laryngeal nerves to the inferior thyroid arteries were found in 276 dissection. Only one transient hypoparatiroidism was found in one of 292 patients in whom nerve and artery dis-section were peıformed. Bilateral ligation of the trunk of the inferior thy-roid artery must not be carried out ıf it is not neces-sary, the branches of this vessel should be ligated be-yond the parathyroid glands. If the trunk of the artery is ligated on one side for hemorrhage atention is paid not to ligate it on the other side.

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

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

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

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

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

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

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

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

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Aim: This study was undertaken to evaluate the electromyograpy (emg) and laboratory findings of amyloidosis related with dialysis in the patients treated with high flux (HF) and standart (STD) hemodialysis (HD). Method: This study included a total of 16 standart HD and 16 HF HD patients who were treated with dialysis for at least 3 years. Median nevre (motor and sensory), Unlar nevre (motor and sensory), Fibular motor, Posterior Tibial motor and Sural sensorial nerves were evaluated. Blood β2 mikroglobulin levels in these patients were investigated. Results: There was statistical significant difference in regard to blood β2 mikroglobulin levels between both groups (p=0.00). EMG findings of Carpal tunel syndrome (CTS) was observed in 20% and 25% of the patients treated with ST HD and HF HD (respectively). There was no statistical significant difference in terms of EMG findings between two groups (p=0.539). Conclusion: EMG is a useful method in the detection of neurological findings such as CTS. The initiation of HF TD appears to be reasonable before the findings of amyloidosis related with dialysis was started in susceptible cases.

Risk factors and encountered problems during follow-up in babies with low birth weight (SGA) were investigated. 108 babies with SGA and who were follovved by our pediatrics department vvere evaluated. 52cases vvere male (48.2%) and 56 cases vvere female (51.8%) .40.7% of ali cases vvere prematüre and others (59.3%) vvere term babies. 53.7% of ali cases vvere applied from the city çenter. Low socioeconomic level, mother’s age lovver than 18 years, and preeclampsia vvere the most freguent risk factors. Infections (32.4%) , asphyxia (25.9%), hypoglysemia (21.3%) and polycythemia (19.4%) vvere the freguent problems. Important causes for mortality vvere infections, congenital abnormalities, and asphxy.

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

Aim: Despite its high prevalence, pain induced by uremic neuropathy is usually underrecognized during diagnostic process and undertreated. In most of the patients, traditional drugs are ineffective. In this study, we investigated the effect of gabapentin on neuropathic pain along with quality of life (QOL) and depression in hemodialysis (HD) patients. Methods: Twenty two patients with chronic renal failure who were on HD were included in our study (10 males and 12 females, mean age 62±3.53). We administered 300 mg/day gabapentin for 8 weeks to patients in whom neuropathic pain was detected. We administered SF-36 Evaluation Test (Physical Component Score and Mental Component Score) for QOL, Beck s Depression Inventory (BDI) for depression and Short Form of McGill s Pain Questionnaire (SF-MPQ: VAS; Visual Analogue Score, PPI; Present Pain Intensity, total SF-MPQ) before and after the treatment. Results: With gabapentin treatment, we found a statistically significant decrease in pain scale scores. Total SF-MPQ decreased from 21.32±8.74 to 7.5±5.72, VAS scale decreased from 6.4±2.15 to 2.45±1.81, PPI decreased from 3.18±1.1 to 1.3±0.88. We also determined significant improvements in SF-36 and BDI scales (p

Pregnancy habits of motIzers and their relation to child ınortality have been studied between March and May of 1991. Mothers between 15-24 years of age, consanquinity, the intervals less than 2 years betwe-en pregnancies, pregnancy less than 38 weeks, igno-rance of tetanus immunization, meals largely related cereal nutrition and lackiness of nutritive balance, weight gain less than 9 kg, lack of prenatal health care, multiple pregnancy increased infant and child monality rate and this increase was statistically me-aningffil (p<0.05). Unspecified illnesses during pregnancy and vomiting, increase in food intake pa-rallel pregnx2ncy, and undesirable pregnancy diri not affect infant and child monality significantly.

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

Inthisstudy,theoutcomes of subxiphoid pericardial tube drainage technique were eveluated in patients with pericardial effusion. 39 patients with pericardial effusion admitted toour clinic between January 2007 - December 2010 were treated with subxiphoid pericardial tube drainag etechnique. 16 of patients were femaleand 23 were male and their ages were between 17 to 83 years. The procedure was carried out with local anesthesia and sedation in all patients. There was no mortality in any patients. Average drainag evolume was 1050 ml. Recurrent pericardial effusion requiring repeated surgical in tervention was observed in 2 patients. Subxiphoid pericardial tube drainage is a effective and safetechnique for treatment of pericardial effusion.

Diagnosis of acute abdomen in pregnancy is still a difficult situation. Due to physiological and anatomical changes of a pregnant woman during pregnancy, the diagnosis and treatment can be difficult to decide. In addition, some of the procedures used for the diagnosis are avoided because of risk to the fetus. Delay in the diagnosis may cause maternal morbidity, mortality, risk of fetal loss and can cause premature birth. Surgical intervention may be required or surgical intervention may be harmful in some cases. The incidence of acute abdomen in pregnancy has been reported as 1 in 500-635. Among the causes of nonobstetric acute abdomen in pregnancy are: acute appendicitis, intestinal obstruction, acute cholecystitis, cholelithiasis, inflammatory bowel disease, peptic ulcer, acute pancreatitis, hepatic rupture, intestinal obstruction, acute fatty liver of pregnancy and severe preeclampsia. The life of the mother and fetus are important in the diagnosis and treatment. Early diagnosis and treatment are very important for the fetus and the mother.

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

Aim: 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.

Serum Alpha Toeopherol, Ascorbic Acid, Triglycerid, Tutal Cholesterol, IIDL-Cholesterol, LDL-Cholesterol, Urea and Creatinine Levels in Chronie Reno! Faliure Patiens Chronic renal fidlure patients sera were analyzed for alpha tocopherol, rucorbic acid, totrıl cholesterol, triglycerid, IDL-cholesterol, LDL-cholesterol, urea and creatinine. These values were compared with those of healthy subjects. The serum samples were obtained from 35 normal healthy and 30 patients with chronic renal failure. Nortnal healthy peopk serum kvels were: alpha tocopherol 1.10 ± 0.01 mgidl, ascorbic acid 1.02 ± 0.07 mgldl, total cholestcrol 168 ± 27.09 mgidl, triglycerid 92.2 ± 32.57 ingldl, HDL-cholesterol 47.4 ± 5.23 mgldl, LDL-cholesterol 104.2 ± 27,94 urea 34.6 ± 5.18 nıglıll,. .creatinine 0.48 ± 0.09 ?right/. The serum levels of patients with chronic renal failure were: alpha tocopherol 1,104 ± 0..009 mgldl, ascorbic acid 0.47 ± 0.17 mgidl, triglycerid 204,2 ± 39.62 in►Idl, cholesterol 199.3 ± 45.73 ingidl, 11DL-cholesterol 25.93 ± 7.01 mgldl, LDL-cholesterol 125.6 ± 34.8 nıgidl, urea 223.5 ± 79.18 creatinine 10.24 ± 4.79 ingldl. The follo•ing values of patients were higher than those nf healthy subjects: iriglycerid (p<0.00I ), choksterol (p<0.005), LDL-chole►terol (p<0.01), urea (p<0.001), ceratinine (p<0.001). On the other hand, ascorbic acid and 11D1.-rholesterol values were lower (p<0.001). Alpha levels of the patients were normal. A po►itıı-t' correlation was found betwcen cholesterol and LDL-choksterol = 0.719, t =5.,48).

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

İn this study a revievv of 9 arteriovenous malformation eases surgically treated between October 1991 and Oc- tober 1999 is presented. Of these cerebral AVM cases, 5 were presented with intracranial hemorrhages, 2 had Progressive neurologic deficit, 2 had headaches initially. Surgical mortality was 1/9 in the series. The clinical di- agnostic and therapeutic aspects of cerebral AVM' s ar e emphasized and the literatüre on this subject has been reviewed.

The purpose of this study is to assess the color doppler ultrasound findings in the hemodialysis patients with arteriovenous fistula dysfunction/afunction. In this retrospective study, we searched the dossier of forty- five patients underwent to color doppler ultrasound examination because of inadequate dialysis. This color doppler ultrasound findings were compared with the literature. Twenty-seven (60%) of this 45 hemodialysis (HD) patients were female, 18 (%40) were male and the mean age was 55.15±15.03 (16-87). Twenty-eight of 45 patients have radiocephalic, 17 patients have brachiocephalic and brachiobasilic native arteriovenous fistula. Stenosis were detected in 36 HD patients, two of them settled in supporter arteries, 5 stenosis were on the level of anastomosis, 19 stenosis localized in the first segment after anastomosis and 10 stenosis settled on distal part of the first segment. Central venous oclusion were found in 4 of patients, whereas aneurysms were found in 6 patients. Seven of 13 thrombosed arteriovenous fistula were nonfunctional and the thromboses occluded the lumen of fistula. The thromboses settled in the anevrysmatic dilatation in others cases. The doppler Ultrasound examination performed well skilled is very usefull methods for diagnosis of arteriovenous fistula dysfunction.

Abstract

INTRODUCTION

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

MATERIALS and METHODS:

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

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

RESULTS:

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

 

CONCLUSION:

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

Thrce cases of spinal hydatid cysts are reported. Ali the patients were admitted with symptoms of compression of the spinal cord. The patients were treated surgicall, recurrens was in only one patiant and no mortality.

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.

In 373 prematüre babies whose gestational ages were determined exactly, the incidence of fetal mal-nutrition chat is described as birth weight at or be-low 10th centile was found 25.4%. The rate of fetad malnutrition was increasing after 32nd week of ges-tational age. Maternal causes were determined in 66.3% of 95 patients with fetal malnutrition Feta! causes were found in 4.2% and no cause in 29.5% of cases. An obvious effect of fetal malnutrition on pre-mature mortality rates was observed.

İn this study, the prevalence of H.pylori-lgG antibody was investigated in 83 hemodialysis (HD) and 30 CAPD patients and compared with those of 45 healthy control group. İn determination of IgG antibody against H.pylori enzyme immunoassay ELİSA method was used. Mean ages were 46.2+17.4 and 44.6+15.7 years and dialysis durations were 35.4+ 36.9 months and 20.2+18 months in HD and CAPD patients respectively. Age of control group was 49.4+15.3 (18-80) years. H. Pylori-antibody was positive in 36 HD patients (43.4 %), in 9 CAPD patients (30 %) and in 19 healthy Controls (42.2 %). Hp-lgG antibody positivity in HD and CAPD patients was not statistically different from control subjects. İn conclusion, there is no assosiation between Hp-lgG antibody posi­ tivity and age, sex, dyspeptic symptoms two groups. İn this patients Hp IgG positivity should not be evaluated with- out endoscopic and.histopathologic findings.

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

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

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

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

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

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.

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

During 1996 and 1999, we applied MVAC in 27 patients whose final stage bladder tumor depends on pathological and radiological bases at urological department. 15.4 % had complete response, 34.6 % had partial clinical response, 34.8 % hadn’t any clinical response and 19.7% had progression. One of the patient died due to a wide spreed tumor metastasis and neutropenic sepsis during the treatment. The most common side-effects were nausea- vomiting, transient renal failure, leucopenia, and trombocytopenia. M-VAC therapy showed it’s beneficial effect by decreasing the stage so providing TUR possibility and other alternative surgical procedurs.

Aim: İn this study, the mechanichal resistance of the different kind of anastomoses made traditional suture materials and fibrin glue, and related celi infiltration in small intestine anastomoses performed after mechanical obstuction investigated. Material and Method: This study was performed on 30 rats which were divided into two groups (15 Each) After 24 hours of the mechanical obstructions was made and after 24 hours a traditional suture material anastomoses was performed in one group while fibrin glue anastomose was performed to other group. The bursting pressure of the anastomoses and perianastomose celi infiltration were invastigated in both groups three days later. Results: We observed that, the usage of fibrin glue did not affected the mortality while was found to be more reliable considering leake from the anastomoses . The bursting pressure of the anastomoses made by suture material was 25.7 mmHg which was found to be 23.7 mmHg when fibrin glue was used. Hovvever, there was no statistically significant difference betvveen those two results. Also the celi infiltration was observed to be more when fibrin glue was used compared to other group, but the differce was not statistically significant. İn conclusion, the present study shows that the usage of fibrin glue in accurate concentration and amount might be an effective method in preventing leakage after anastomoses.

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

Plevral involvemenı from multiple myeloma is reported infrequently. A Patient presented bere who was 66 years old man. lt was seve plevral involvement after 5 MOMIIS diagnosis of the disease.

Amaç: Bu çalışmada, kritik bakım hastalarında yoğun bakım ünitesi (YBÜ) yatışında ölçülen kan üre
azotu (BUN)/albümin oranının hastane içi mortaliteyi tahmin etme açısından prognostik değerinin
değerlendirilmesi amaçlandı.
Hastalar ve Yöntem: Bu retrospektif gözlemsel çalışma, bir üniversite hastanesinin acil servisinde (AS)
gerçekleştirildi. Altı ay (1 Temmuz 2019 - 31 Aralık 2019) boyunca acil AS-YBÜ’ye yatırılan hastalar
çalışmaya dahil edildi. BUN/albümin oranının hesaplanmasında YBÜ’ye kabul öncesi ölçülmüş olan BUN
ve albümin değerleri esas alındı. Çalışmanın birincil sonucu ha stane içi mortaliteydi.
Bulgular: Çalışmaya toplam 572 hasta dahil edildi. Dahil edilen hastaların ortanca yaşı 66 (54–77) yıldı
ve bunların 362'si (%63,3) erkekti. Genel hastane içi mortalite oranı 29.0% (166 hasta) idi. Vefat edenlerin
ortanca BUN seviyesi hayatta kalanlardan daha yüksekti (38,2 (21,4-59,7) ve 21,9 (14,9-36,9) mg/dL,
p<0,001). Vefat edenlerin ortanca albümin seviyesi hayatta kalanlardan daha düşüktü (2,9 (2,3-3,5) ve 3,7
(3,2-4,0) g/dL, p<0,001). Vefat edenlerin ortanca BUN/albümin oranı hayatta kalanlardan daha yüksekti
(13.33 (6.69–22.99) ve 6.21 (3.83–11.21), p<0.001). Eğri altında kalan alanların sıralaması albümin
(0,742), BUN/albümin oranı (0,720) ve BUN (0,678) idi. Hastane içi mortaliteyi tahmin etme açısından
hesaplanan kesim değerleri, albümin için 3,2 g/dL, BUN/albümin oranı için 10 ve BUN için 32 mg/dL idi.
Sonuç: Sonuç olarak, YBÜ’ye yatış sırasında saptanan hipoalbüminemi, kritik hastalarda hastane içi
mortalite ile ilişkilidir. Yüksek BUN ve BUN/albümin oranı da bu hastalarda hastane içi mortalitenin
öngörücüleridir; ancak BUN ve BUN/albümin oranı hipoalbüminemid en daha üstün değildir .

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

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

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

Acute appendicitis is a serious surgical emergency, in all age groups. Although mortality has been reduced in recent years, morbidity remains a problem. It is doup«ui whether individuals can take any action to avoid appendicitis. In this study, we searched the range of the age of 210 patients who were operated because of acute appendicitis in the Faculty of Medicine, Selçuk University from May 1987 to May 1991 and discussed the causes of acute appendicitis under the light of literature dala.

Mortality rate of 92 premature babies accepted to pediatrics department of Medical Faculty of Selçuk Oniversity between January and Decernber 1990 was investigated. Mortality rate was cletermined as 30.4 percent. The mortality rate was decreased with the duration of gestation and the weight of babies at term. Also, the mortality rate of babies born at ob-stetrics clinics of the faculty was less than those born at home or brought from other hospitals in or out of Konya. According to the clinical evaluation, the primary causes of death vere found to be respira-tory distress syndronw, anoxic birth and sepsis. Our finclings are discussed with those of literature.

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

Purpose: It was aimed to present the clinical and functional results of the patients who underwent tumor resection and endoprosthetic reconstruction due to malignant tumor around the elbow.

Methods: 14 patients who underwent tumor resection and endoprosthetic reconstruction due to malignant tumor in the elbow circumference between 2011-2018 in our clinic were included in the study. While 4 of the patients were primary tumors (1 fibromixoid sarcoma, 1 leimyosarcoma, 1 multiple myeloma and 1 ewing sarcoma), 10 were distant organ metastases (4 breast cancer, 3 lung cancer, 1 stomach cancer, 1 renal cell cancer and 1 thyroid cancer). Musculoskeletal Tumour Society (MSTS) score and Mayo elbow performance score (MEPS) and survival were evaluated.

Results: The minimum follow-up period of the patients was 7 months, and the maximum follow-up period was 55 months. The mean MEPS score of the patients was 67.5 ± 12.0 (range, 45-90), and the mean of the MSTS score was 19.4 ± 2.3 (range, 16-24). Recurrence occurred at follow-up in 3 patients and exitus at follow-up in 7 patients. In this study, the median survival time of the patients was 44 months. The 1-year survival rate was 70.1% while the 3-year survival rate was 54.5%.

Conclusion: Pain and functional results are satisfactory in patients who undergo tumor resection and endoprosthetic reconstruction due to malignant tumor around the elbow. In the future, studies with larger patient series are needed.

Between April 1987 and June 1993, 90 mitral valve replacements were performed in Selcuk University Faculty of Medicine, Thoracic and Cardiovascular Surgery Department. Early mortality is 8 (8.8%), late mortality is 5 (5.5%)

Acute suppurative clzolangitis is a severe form of cholangitis due to hacterial contamination in the bil-iary system and responsible from a high rate of mortality. in 'his article. 6 patients diagnosed and treated with acute suppurative cholangitis were presented and the importance of early surgical decompression was discussed.

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

In order tü prepare the patients who had developed chronic renal failure to hemodilaysis, latero-lateral arteriovenous fistula application was applied among the localized arteria. In 4 cases in which superficial venis weren't sujficient (arteria brachialis-venae brachialis) was reconstructed among the deep vessels in fossa an-tecubiti. It was observed that there were some en-largements which made the hemodialysis possible on the superficial veins by means of the venous connection between deep and superficial veins in 30 clays

In order tü prepare the patients who had developed chronic renal failure to hemodilaysis, latero-lateral arteriovenous fistula application was applied among the localized arteria. In 4 cases in which superficial venis weren't sujficient (arteria brachialis-venae brachialis) was reconstructed among the deep vessels in fossa an-tecubiti. It was observed that there were some en-largements which made the hemodialysis possible on the superficial veins by means of the venous connection between deep and superficial veins in 30 clays

Medical School between lune 1995 and Apı-il 199C. 28 of the ope-rations were for acquired heart disease and 3 were for congenital heart disease. During caı-- diopulrnonary bypass, moderate hypotermia and cold potassium cardioplegia were used. 7 patients who had coronarv artery disease were peıformed CABG. 18 ones with valve disease were peıformed valve replacemed or valvılloplasiy. One patient with myxonıa underwent tunıor excision, aortic dis-section underwend Bentall proceduı-e Septal defekt were repaired. Early moı-tality rate was found 12.9 % with a 4 patients.

Cardiogenic shock is an emergency clinical state which is usually due to delile myocardial infarction and clzaracterized by hipoperfusion of vital organs. If the management isn'i on time- and isn't enough, patients with cardiogenic shock commonly die. Fortunately: IABC, by alleviating coroner circulation and left ventricular functions, can give the the chance ,fo• interventional cardiac procedures such as cardiac catheterization and revasvcularization.While generally accepted mortality rate is at least 60-70% in car-diogenic shock, it can be decreased with optimal IABC and revascularizarion. On the other hand, emergency PTCA in patients with acute myocardial infarction decreased the incidence of hospital mortality and cardiogenic shock. The design of this review is to investigate the clinical landnuırks• IABC and the efficacy of IABC, alone ör together with newer intervetztional cardiac procedures, on disease states that could cause cardiogenic shock.