Makale Arama

\r\n Aim: The aim of this study is to determine the relationship between pregnancy outcomes and histopathology examination of the intended placenta and umbilical cord specimens.

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\r\n Patients and Methods: 112 placenta materials were scanned as retrospective in an archive of Usak University Education and Research Hospital of Pathology Department. Term placentas measurement were based on Kaufmann’s Pathology thus; 37-40 week, size 18 cm, weight 350-750 gr, thickness 2-2,5 cm. Umbilical cord's vessel number, membrane structure, chorioangioma, infarct, hematoma, hemorrhage were recorded. Infarct, chorioamnionitis, subchorionic fibrin deposit, congestion of chorionic vessel, subchorionic hemorrhage, corangiosis, chorioangioma, calcification, perivillous fibrin deposit, an effect of meconium, fibrinoid necrosis, villitis, ectasia of a chorionic vessel were detected as histopathologic findings. Gender, mode of delivery, maternal disease, birth weight, maternal age, parity, birth length, head circumference, APGAR between 0-9 were recorded.

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\r\n Results: 112 placentas; 4 of 29 (13,7%) placental infarct, 2 of 19 (10,5 %) placental corangiosis, one of 17 (5,8%) subchorionic haemorrhage, 2 of 29 (6,8%) chorioamnionitis, one of 12 (8,3%) umbilical cord congesione cases were detected with abnormal pregnancy outcomes. Statistically significant results were found between subchorionic haemorrhage and placenta size (P = 0, 004), maternal age and umbilical cord dimension (P = 0, 0001), birth weight and placenta and umbilical cord dimensions (p = 0.000). However, no association was found between these parameters and pregnancy outcomes. Relationship between baby weight and placenta and umbilical cord size was determined in diabetic, preterm, ablatio placenta, and stillbirths and pregnancies. No significant association was found between histopathologic findings and pregnancy outcomes.

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\r\n Conclusion: When placenta and umbilical cord specimens are evaluated, the location and size of the lesion should be indicated along with the presence of the lesion in order to explain regular clinical follow-up and adequate anamnesis as well as the effect on the pregnancy outcome.

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The aim of this study is to evaluate the indications, results and complications of amniocentesis that we performed in our clinic. Between January 2008 and January 2009 at the Department of Obstetrics and Gynecology Clinic of Selcuk University Meram Medicine Faculty, 617 amniocentesis procedure were performed for many indications in their 16-22nd weeks of gestations. The outcomes were analyzed. The mean age of mother was 32.43±6.66 (18-44) and the mean age of father was 35.79±7.42 (19-61). The mean gestational week was 17.68±2.82 and mean gravidity was 3.03±3.76 (1-12). The biggest amniocentesis indication group was high risk at prenatal screening test with 272 (44.1%) cases. Followed by the advanced maternal age with 203 (32.9%). Chromosomal abnormality was found in 30 (4.94%) cases after the result of karyotype analyses, 18 (60%) of these abnormalities were found in the group of >35 years old. In 15 patients Trisomy-21, in 3 cases Trisomy-18, in 2 cases Turner, in one case mosaicism (46XX/XY), in 4 cases translocation and in 5 cases inversion type chromosomal abnormality was detected. Of the 617 amniocenteses, 3 (0.48%) had fetal losses. The cause of abortion was early membrane rupture in two cases and cramps and vaginal bleeding in one case. Amniocentesis is the most commonly preferred and reliable invasive prenatal test for prenatal diagnosis of genetic disease with minimal complications. Amniocentesis is an important prenatal diagnostic method which must be used when there is accurate indication.

Bleeding can not be absolutely terminated in spite of conventional techniques of hemostasis. In order to investigate the effect of  Ankaferd Blood Stopper^® (ABS) on persisting bleeding after conventional hemostasis, we applied topical ABS spray or plasebo on orthognatic surgery (n=19). Substances were applied to the surgical field after  conventional methods of hemostasis. In orthognatic surgery group, the association of blood loss with the operation type, age, gender, ABS usage, duration of operation and blood pressure   was analyzed. The rates of Hb and Htc decline was % 25 in ABS group and % 19 (Hb), % 20 (Htc) in placebo group. The only significant association was with gender indicating a higher blood loss with being male (p=0,01). In conclusion, this study did not reveal any ABS effect on bleeding from the surgical site persisting after  conventional hemostasis.

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.

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.

To evaluate the hysterectomies carried out in our clinic for a period of two years. The study retrospectively evaluates the clinical and demographic characteristics of the 853 patients that had abdominal hysterectomy and vaginal hysterectomy procedures with various indications for the two years from January 2008 to December 2009 in Selcuk University, Faculty of Medicine, Gynecology and Obstetrics Department. In our clinic, the most common indication for hysterectomy was myoma uteri and the procedure was performed on 358 (41.9%) patients between the years 2008 and 2009. The second most common indication was gynecological malignancies and hysterectomy was performed on 161 (18.8%) patients. The ratio of abdominal hysterectomy (total and subtotal) was determined to be 93.6%, whereas the ratio of vaginal hysterectomy was 6.4%. As well as hysterectomy, bilateral salpingo ooforectomia (BSO) was also performed in 453 (53.1%) cases. We have seen 0.5% bladder injury, 0.37% ureter injury and 0.37% bowl injury in the abdominal hysterectomy group. In vaginal hysterectomy group, there was 1 case (1.85%) with bladder injury. With various indications such as myoma uteri, gynecological malignancy, uterovajinal prolapse, endometriosis and peripartum hemorrhage, hysterectomy is the most commonly performed operation by gynecologists. Although, the relative advantages and disadvantages of the abdominal, vaginal, and laparoscopic hysterectomy types are known, abdominal hysterectomy is still the most common procedure in our clinic.

Although many studies have been conducted on electrolytes in blood serum, we could not find a study with total ion concentration in the literature. In order to show that the total ion concentration in blood serum can be determined using radiofrequency electromagnetic field, we found the average of the total ion concentrations as 290 m mol / L from the 5 cc blood samples we obtained from 40 healthy people aged between 17 and 40 years. We determined the average of the total ion concentrations of 730 m mol / L and the average of the urine total ion concentration / blood serum total ion concentration ratio to be 2,537 from the urine of 35 of these 40 people simultaneously.

A series of 460 cases of hydatid cyst of the lung has been studied. Preoperative diagnosis has been made radiologically in 90<,-, of the cases. In 395 cases, cystotomy has been performed with subsequent capitonnage, while, wedge resection has been performed in 27 cases, with lobectomy in 15 cases and segment resection in 23 cases. Following a careful he-rnorrhage control, two drains have been placed in the thorax and the thoracic cavity has been closed. Recurrence occured in two cases (0.43 %), three cases resulted in exitus (0.65 %); no recurrence has been encountered in other cases as revealed by post-operative follow-up cheks within a period of theree years after operation.

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

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

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

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

Objective: To investigate the effects of difFerent volüme resuscitation regimens on organ functions in uncontrol­ led haemorrhagic shock before surgical control of bleeding. Material and methods: Total 37 New-Zeland type rabbits divided into fourgroups designated as S(sham, n=7), C(control, n=10), ECR(early controlled resuscitation, n=10) and EFRfeariy fast resuscitation, n=10). Rabbits were let bleeding until mean arterial pressure decreased to 30 mmHg then intracut was taken out to permet free bleeding. S group is sham-operated group. Group C did not receive any volüme replacement for an hour after the onset of shock. Volüme resuscitation with şalin begin- ned at rate 2 cc/kg/min to achive MAP 60 mmHg in group ECR while volüme resuscitation with şalin beginned at rate 4 cc/kg/min to achive MAP 80 mmHg in group EFR. Bleeding was controlled at first hour in study groups and resuscitation went on foran hour. Liverand renal function tests and haematocrit values were studied basally, first hour and 24th hour respectively. Results: Urea and creatinin levels increased at the first hour in group C. SGOT levels were found to be elevated at 24 hours in group O, ECR, and EFR. Haematocrit values were decreased at 24th hour in group C, ECR, and EFR. Most severe decrease in haematocrit values were observed in group EFR. Conclusion: it is concluded that early controlled resuscitation in haemorrhagic shock is effective in preventing the organ damage that can develop during haemorrhagic shock when compared to late oragressive resuscitation.

Congenital factor VII (FVII) deficiency is an uncommon bleeding disorder with an estimated incidence of 1/300.000-1/500.000. Congenital Factor VII deficiency is an otosomal recessively inherited and 0.5% of all congenital coagulation disorders. Factor 7 deficiency is the fourth of all congenital factor deficiencies in the Factor 8, Factor 9, and lack of the Von Willebrand Factor. It affects men and women in the same proportions. Although there is no correlation between FVII level and bleeding risk. An important part of the patients are asymptomatic until advanced age, often by chance, is investigating the bleeding parameters, only PT’s long, APTT is normal due to the received diagnosis. Fresh frozen plasma (FFP), FVII, prothrombin complex concentrates (PCC), plasma-derived factor VII (pdFVII); recombinant activated factor VII (rFVIIa) are used for prophylaxis or treatment of bleeding. In this case, a pregnant woman at term which her first pregnancy was resulting in vaginal childbirth without any problem, but factor 7 deficiency was detected in her second pregnancy and there was also no problem to term is presented to cesarean operation with recombinant activated factor FVII for the preparation and post-operative management.

Aim: Capsule endoscopy is a revolution at the diagnosis of digestive tract diseases by providing a new non-invasive way. In our manuscript we discuss the use of capsule endoscopy in the diagnosis of digestive tract disease. Main Findings: Capsule endoscopy is a new diagnostic tool especially used for the diagnosis digestive tract disease such as obscure gastrointestinal bleeding, small below tumours, coeliac disease, Crohn’s disease, etc. In these patients, the technique is also helpful for effective decision-making concerning subsequent treatments. Beside it is clearly more sensitive than conventional imaging modalities. Conclusion: The capsule endoscopy is a new tecnique consolidated and as its potential is known, its indications are extended. Larger studies are needed to assess the influence of capsule endoscopy on clinical outcoumes.

Pemphigus is a group of autoimmune mucocutaneous diseases characterized by intraepithelial separation. Herpes gestationis is one of the rarely seen types of pemphigus. Its incidence is about 1/ 50000 - 1/ 60000. In our article we present a 25 years old patient in her 10th week of pregnancy presented to our clinic because of vaginal bleeding. The patient complained of an itching lesion on the upper quadrant of her left breast for which she was consulted to Dermatology department. The patient was discharged with the antihistaminic treatment that was advised by the dermatologist. After 10 days the patient presented with generalized, itching, erythematous, pustular lesions. A biopsy was taken from the lesion and the result was herpes gestationis. After 4 weeks of steroid therapy the lesions regressed. The patient is still taking methyl prednesolone treatment and on routine pregnancy control. Herpes gestationis is usually seen in the 2nd-3rd trimester of pregnancy. When herpes gestationis is suspected from lesions appearing in the first trimester the diagnosis should be confirmed by biopsy.

Multiple intracerebral hemorrhage represents 2 % of ali intracranial hemorrhages. Multiple intracerebral hemor- rhages have been known to occur most frequently in patients with coagulation defects, neoplasms, angiopathies or sinüs thrombosis. The finding of recurrent intracerebral hemorrhages is not unusual in patients with systemic arterial hypertension, but simultaneous occurence of multiple hemorrhages is rare in these patients. However, multiple spontaneous intracerebral hemorrhages vvithout an identifiable etiology were also reported in the literatüre. Here, we describe a hypertensive patient who developed multiple intracerebral hematomas. The patient had bilateral thalamic hematoma that extended the lentiform nucleus. There was apathy, loss of emotional concern, upvvard gaze palsy, tetraparesis and hypertensive retinopathy in the neurologic examination. Conditions other than hypertension that might cause intracerebral hemorrhage were excluded by laboratuary investigations.

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

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.

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

Crimean-Congo Hemorrhagic Fever (CCHF) virus,which is classified in the family of Bunyaviridae and Nairovirus genus and grouped in arbovirus is RNA-containing helical type capsid and enveloped virus. This infection which is caused by these viruses has severe disease manifestations and a very high fatality. The aim of this study was to investigate the seroprevalence of CCHF in Konya and so it was planned to screen IgG-type antibody. For this purpose, 1000 healthy blood donors who referred to the Blood Center of Necmettin Erbakan University Meram Medical Faculty Hospital, were included in the study While 154 (15.4%) blood donors were living in rural areas, 846 (84.6%) of the donor were lived in the city center. Of these individuals, 947 (94.7%) were male and 53 (5.3%) were female. ELISA basedCCHF IgG commercial test kit (VectocrimeanCHF-IgG, Bectop, Russia) was used to determine the specific IgG antibody developed against CCHF. Eight of tested samples (0.8%) were positive for the presence of antibodies against CCHF and 992 (99.2%) were negative. The presence of IgG antibody prevalence of CCHF after research indicates the presence of a small number of illness in Konya. For the detection of regional prevalence of the disease similar studies will be useful in other provinces. In aspect the route of transmission of this virus infection, because of this infection is caused by tick

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.

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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.

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

In this study, we aimed the evaluation of the laparoscopically treated ectopic pregnancy cases in our clinic. This retrospective study included 56 cases that were diagnosed to have ectopic pregnancy and treated by laparoscopy between January 2007 and December 2009. Patients characteristics such as age, gravidity, parity, symptoms, gestational age at the time of diagnosis, sonographic findings, preoperative and post-operative serum ß-human chorionic gonadotropin (ß-hCG) and hemoglobin levels, type of laparoscopic surgery, blood transfusion and additional treatments were recorded. The average age of the patients was 30.4±4.2 years, the average gestational age was 6.6±1.4 weeks, and the average ß-hCG value at presentation was 2932.4±2276.8 IU/L. The patients presented usually with pelvic pain and abnormal vaginal bleeding. Adnexal mass and hemoperitoneum were mostly seen by sonographic evaluation. Ampuller pregnancy was the most common. Most of patients had conservative surgery; salpingectomy was applied to 10.7% of patients. Ten patients received blood transfusion and 2 patients underwent re-laparoscopy because of postoperative bleeding. Serum ß-hCG levels returned to normal at the end of the 1st month after surgery in all patients. According to these findings, laparoscopic surgery is the most appropriate treatment for young patients with ectopic pregnancy who are hemodynamically stable and wish to preserve their fertility

Amyloidoma is a tumoral deposition characterized by localized deposition of amyloid in the tissues. It is very rare in the head and neck region, especially in the maxillary sinus. A 64 years old female patient applied to our clinic with complaints of left-sided nasal obstruction and epistaxis. Endoscopic examination revealed a yellowish polypoid mass obstructing the left nasal passage. Paranasal sinus tomography revealed a tumoral mass filling the left maxillary sinus and repressing the medial wall. Biopsy was positive for amyloidosis. A complete resection of the mass was suggested for a definite diagnosis. The tumor was removed by endoscopic medial maxillectomy, which permitted total excision of the lesion. Pathology results showed amyloidosis. No other organ involvement was detected. Rectal biopsy and proteinuria were negative. Here, we present the extremely rare case having localized amyloidosis of the maxillary sinus.

Tonsillectomy (with or without adenoidectomy) continious to be a commonly peıformed operation in the practice of otorhinolaryngology. Although the incidance of postonsillectomy haemorrhage has been decreased it is serious problem for surgeons. Bizmut Subgallate is an effective agent in pre-venting hemorrhage after adenotonsillectomy. It is shortened the clotting time of whole blood an activation of coagulation in assays of the partial thromboplastin time. The action of Bizmut Subgallate was localized to an effect on Ilageman Factor. In this report; control of bleding using topical Bismut Subgalltıte in the operation of 39 patients was discussed.

In this study the toxic effects of formaldehyde to lungs and protective effects of omega-3 fatty acids against these toxic effects were investigated at histological and biochemical levels. For this purpose, 21 adult male Wistar rats were divided into three groups. Rats in group I were used as control. Rats in group II were injected with formaldehyde every other day. Rats in group III Daily received omega-3 fatty acids with injection of formaldehyde. At the end of 14 days experimental period all rats were killed by decapitation. The lung tissue specimens which were taken from the rats were examined under light microscope after performing the routine histological procedures. The activities of superoxide dismutase (SOD), catalase (CAT), xanthine oxidase (XO) and malondialdehyde (MDA) were determined in the lung specimens by using spectrophotometric methods. In our study in rats whom formaldehyde was given a statistically significant increase in the levels of SOD, XO and MDA was determined when compared to control group. A significant decrease in the level of CAT was also detected. In the light microscopic examination of this group, bleeding areas in interstitium, hemosiderin loaded macrophages and ephitelial spilths on terminal bronchiales was observed. It was determined that the histological variances which caused by formaldehyde exposure were decreased in ratswhom received omega-3 fatty acids along with formeldehyde. In addition a decrease in SOD, XO, MDA levels and an increase of CAT levels were determined. Asa result, it was determined that damage accured in lung tissue of rats exposured to formaldehyde and this damage was prevented by the application of omega-3 fatty acids.

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.

Transturethraltresection was carried ovt succesfully in the fifty-seven patient with benign prostatic hyperpiasie, bladder neck obstruction, cancer of the prostate and b7adcler betwen 1984 and 1987 spinal anesthesia wa2 giyen to eleyen patiens and general anesthesia forty-five patiens. T ype of anesthesia (spirıal and general), tissue size removed, operation time and irrigation fluid have been investigated cor;.e?ation with hemorraghie. There was correlation betwen operation time and hemor-raghie in both the spinal and general anesthesia. Correlation, between tissue size removed and hemorraghim was found ver} important in both. Correlati.on with hemorraghi.e of irrigation fluid was important in ()nin spinal anesthesie. The hemorraghie in the spinal anesthesia was much lessthan general anesthesia.

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

In this study in which feto-maternal transfusion was researched, the Tate of feto-maternal transfu-sion was 18.59%. Fetal and materna' blood group cornpatibility, prirnipar pregnancy and forceps or vacuum adminisiration were signıficanily enhanced feto-rnaternal transfusion. But, bleeding during pregnancy, preeclampsia, induction adrninistration, duration of pregnancy, duration of delivery onset, with bleeding. Fetal presentation form, placentae and cordon complications were not effective ta feto-maternal transfusion.

Percutaneous nephrostomy was performed in patients with various kidney pathology in our clinic between january 1985 and july 1987. This procedure was performed in 50 patients. Our hand made guide wire was used in 28 of thern. Imported J guide wire was used in the others. Both kinds of guide wires and results are compared. Our hand made guide wire is found feasible for this purpose.

Intraventricular hemorrhage (IVH) is a common complication associated with delivery in preterm neonates. Germinal matrix, subependymal layer of lateral ventricle is the most occurring site of intraventricular hemorrhage. IVH is imaged as a hyperechogenic area and ventriculomegaly on ultrasonography, but it is detected easily by fetal magnetic resonance imaging (MRI). The present case was referred to our clinic due to ventriculomegaly on ultrasonography. Germinal matrix was determined on the fetal cranium with ultrasonography and intrauterine MRI at 30th weeks of gestation. The pregnancy was terminated by cesarean section due to severe preclampsia. Fetal MRI should be performed to confirm the diagnosis on the cases with suspect ventriculomegaly.

In this study, the clinical and laboratory findings of 539 anemic patients who were hospitalized between 1996 and 2003 in Hematology inpatient clinics of Internal Medicine Department in Selçuk University Meram Medical Faculty, were evaluated. In our study the most common anemia was Fe deficiency anemia, there were 280 patients, it was seen three-fold more in women. In premenapausal period, menomethrorhagea was the most common cause (48%) in women. Among postmenapausal women and men, the most gastrointestinal hemorrhageas. In our patients, the rate of lesions which might bleed observed in colonoscopy. The second common cause of anemias was vit B12 deficiency causing megaloblastic anemias. In our study, cobalamine deficiency was detected in 115 patients.Thirty two patients had both Fe and vit B12 deficiencies. Twenty one patients had folic acid deficiency anemia. In our study, 28 patients had hemolytic. Twentysix patients had aplastic anemia. Twenty seven patients had chronic disease anemias. Four female patients had myelodysplastic syndrome with refractory anemia and 6 patients had anemia due to chronic kidney failure. Our study was carried out in inpatient clinics. Anemia, affecting all systems, makes many diseases worse. That’s why, it’s an important health problem.

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

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

Time management and making a correct diagnosis are very important for survival of patients with altered state of consciousness. In our study, we aimed to determine the value of the infrascanner device, which is a non-invasive and a fast method in detection of intracranial hemorrhage. A total of 38 patients who had been admitted to the emergency department of our hospital with the complaint of altered state of consciousness were included in the study. The patients underwent investigations with regard to hemorrhage immediately after admission using the infrascanner device by trained residents of emergency medicine. 20 (52.6%) of the patients were male. The mean age was 51.8 years and the Glasgow Coma Scale was 10.6 (15-3). While hemorrhage was detected on cerebral CT in 22 (57.9%) patients, it was not detected in 16 (42.1%). In the infrascanner device examination, negative results were detected in 24 (63.2%) patients and positive results were detected in 14 (36.8%) patients. The sensitivity of the infrascanner device was found to be 63.6%, specifity was found as 100%, the positive predictive value was found as 100%, and the negative predictive value was found as 66.7%. The results obtained from the study indicate that the infrascanner device provided beneficial clinical data in addition to symptoms and neurological examination in patients who required further imaging procedures. The high specificity puts forth that patients in whom hemorrhages are detected using the infrascanner device, should definitely be evaluated with further tests.

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

Stroke related monoparesia is rare clinical condition and predominantly arose from small bleeding or lacuner infarcts secondary to small vascular disease. In this case we present monoparesia characterized by isolated motor defesit without sensorial deficit due to infarction of left precentral gyrus.

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.

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

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

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

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

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

Eighty year old, male patient presented to our clinic with symptoms of difficult nose breathing, epistaxis and rarely hemoptysis. No abnormalities were seen during oral, anterior nasal and ear examination of the patient. A mass in the nasopharynx was observed during the fiberoptic nasopharyngoscopic examination. The patient was diagnosed as extramedullary plasmacytoma based on the deep biopsy from nasopharynx. Plasmacytomas are tumors of plasma cells, develop outside the bone marrow as solitary masses and they may be associated with multiple myeloma. Cases of extramedullary plasmacytoma (EMP) in the head-neck area develops rarely. Malignant tumors of the nasopharynx are treated surgically and/or via radiotherapy. Extramedullary plasmacytomas are known to be radiosensitive, however, many authors recommend a combined therapy of surgery and radiotherapy. All the treatment options were explained to the patient, however, the patient did not accept surgery. Therefore, the patient was started on radiotherapy and no recurrences were observed during the twenty-nine-month follow-up period. More caution should be exercised for elderly patients presenting with nasal obstruction, epistaxis, and their nasopharynx as well as nasal cavity should be endoscopically assessed in detail.

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

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

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

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

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

Breast cancer is the most frequently diagnosed cancer in women and second cancer leading death among cancer deaths in women (after lung cancer). Simultaneous bilateral breast cancer is seen 1-2% and metachronous 5-8%. Bilateral breast cancer has worse prognosis than unilateral breast cancer. Locoregional recurrences after mastectomy is often occure in bone, muscle, skin or subcutaneous tissue of the chest wall, and that was seen approximately until 2 years. In skin metastases; asymmetric nodules, eritematose rash, itching, bleeding, ulceration, symptoms and signs such as necrotic exuda can be seen. Breast cancer treatment should be made by a multidisciplinary team. Radiotherapy in these patients are curative or palliative. In this case, we aimed to show the effectiveness of the electron beam in modern radiotherapy.

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 of the recent study is to evaluate the relationship between endometrial sampling indications and histopathological results. Four hundred women who applied to Izmit Maternity and Child Health Hospital, and had endometrial sampling in 2011 were included in this retrospective study. Data was retrieved from patient’s files and pathology archives. Patients were grouped as menometrorrhagia, postmenopausal bleeding, pre-hysterectomy for myoma uteri and cervical polyp. Data was analyzed with a statistical processing program (SPSS). The mean age was 46.4±8.3 years. Indications of endometrial sampling were menometrorrhagia (62.3%), postmenopausal bleeding (22 %), pre-hysterectomy for myoma uteri (9.5%) and cervical polyp (6.2%), respectively. Of all the cases, 139 (55.8%) had menometrorrhagia with proliferative/secretory endometrium, 23 (9.2%) had endometrial hyperplasia and 1 (0.4%) had endometrial cancer for diagnosis. However, in postmenopausal bleeding group, 48 (54.5%) had atrophic endometrium, and 6 cases (6.8%) were diagnosed for endometrial adenocarcinoma. In prehsyterectomy for myoma uteri, 27 (71%) had proliferative/secretory endometrium, and no adenocancer was diagnosed. In cervical polyp group, 10 cases (40%) had endometrial polyps for diagnosis. General speaking, endometrial sampling should be applied in cases with postmenopausal bleeding and cervical polyps, but a more selective treat should be conducted in cases with menometrorrhagia and prehysterectomy for myoma uteri

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

Essantial Thrombocythemia (ET) is a disease characterized by an increased platelets count, megakaryocyte hyperplasia and increased thrombotic or hemorrhagic events. ET is frequent in women and 15-20% of patients with ET are diagnosed in childbearing age. Pregnancy loss is more in patients with ET than normal population. Early pregnancy loss occurs in 1/3 of patients with ET. We present a women, with ET complicated with portal vein thrombosis who had 3 early and 1 late pregnancy loss with hydroxyurea treatment. She had live birth after treatment with interferonalfa (IFN-α) and low molecular weight heparin (LMWH). Aims of treatment of pregnant women with ET prevent of maternal complications and pregnancy loss due to vasooclusive events. Thus, treatment with IFN-α, aspirin and LMWH are safe and improve pregnancy outcomes.

Electrical stimulation of the supraorbital nerve on one side evokes early reflex contraction of the orbicularis oculi muscle ipsilaterally (R1) and late reflexes bilaterally (direct-R2 and consensual-R2c). The Central pathway of the R1 may conduct through the pons but the exact Central pathvvay of the R2 is not entirely understood. İt has been presumed that the stimulus goes up to the opposite thalamus and/or cortex, than project down to bilateral facial nuclei. İn this study, the blink reflex was investigated in 13 patients with thalamic hemorrhage and in 12 normal subjects. R1 was normal on both side stimulation but R2 and R2c obtained by stimulation on the paretic side slo- wer in latency compared with responses of the non paretic side and the values of the normal subjects. İt is pre­ sumed that the thalamus may modulate the second component of the blink reflex.

İn this study, totally 203 patients with iron deficiency anemia who had been hospitalised and became therapy in our department between January 1996-June 2000 were examined. Of the patients143 were female and 60 were male, mean age was 45.09+17.11 year in females and 58.43+14.75 year in male. The mean values of erythrocyte were 3.673.007±677.929/mm3 İn females, 3.520.333±780.210/mm3 in males, haemoglobin was 8.49+2.2 g/dl in females, 7.42±2.3 g/dl in males, hematocrit was 27.1+6.3 % İn females, 23.9+6.3 % in males, mean corpusculer volüme was 70.2±9.3 fl in female, 66.9+10.4 fl in males, serum iron was 27.66±8.5 mcg/dl in females, 25.97+8 mcg/dl in males, serum iron binding capacity was 383.94±56.11 mcg/dl in females, 389.72±48.4 mcg/dl in males, serum ferritin was 4.73+3.3 ng/ml in females, 5.05±3.3 ng/ml in males. Chronic gastrointestinal bleeding and gynecologic bleeding were found to be the most commen causes of iron deficiency anemia in females vvhereas chronic gastrointestinal bleeding in males.

In 33 patients with peptic ulcer which were included by radiologic and clinic examination and history were evaluated for hematologic values. These patients should not have a history of gastrointestinal hemorrhage and occult blood and parasites in stool. These patients group were compared with 10 normal people who had not peptic ulcer and gastric compliants and no prominent anemia. At the end of the study; the patient group had a ligde dillerence from the normal group in 1lb, red blood cell count, PCV. There was important dillerence between the values of iron and total Iran binding capacity.

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

n determination the ethiology of subarachnoid haemorrhage some radiological diagnostic methods are used. Su- barachnoid haemorrhage, intracranial haemotoma and intravetricular bleeding can be correctly detected by com- puted tomography (CT), but in demostration of small aneurysm or trombosed aneurysm CT can be insufficient. Angiography which is an invasive examination also effective in the diagnosis of intracranial aneurysms and de­ termination of surgical strategy. 98 patients (45 M, 53 F) who have been admitted the hospital because of their acute neurological findings have intracranial aneurysms which were shown by angiography. Ali of these patients have been examined by CT also before angiography. 96 of 98 patients (97.9%) had subarachnoid haemorrhage and in 98 patients there were 103 aneurysms. Only 24 of 103 (23.3%) aneurysms were shown by CT exa- mination. We think that in patients with intracranial haemorrhage which are shown by CT examination, con- ventional angiography or digital substraction angiography remains the gold standart for detailed aneurysms de- tection and also for surgical planning.

ANTEGRAD URETERAL STENTING; INDICATIONS - METHODS - COMPLICATIONS AND RADIOLOGICAL APPROACH TO  COMPLICATIONS

 

Abstract:

Objectives

The aim of this study is to evaluate the indications, success rate, complications, technical success enhancing method, methods of antegrad ureteral stenting and the radiological management of complications due to retrograde and antegrade ureteral stenting in the treatment of ureteral obstructions and ureteral leaks caused by malignant and benign etiologies.

Materials and Methods

In this retrospective study, fluoroscopy and US-guided antegrade ureteral stenting procedures between January 2016 and December 2018 were examined. The study included 110 antegrade ureteral stenting and percutaneous nephrostomy in a total of 78 patients with 25 female patients (32.05 %), a mean age of 65.87 (20-90) and 53 male patients (67.94%) with a mean age of 68.73 (30-90).  Demographic data, antegrade ureteral stenting indications, procedure results and complications were evaluated for each patient.

Results

Antegrade ureteral stenting is a good alternative for patients with retrograde ureteral stent placement and already with percutaneous nephrostomy catheters. It has a high technical success rate and low complication risk. The use of the equipment used in other radiological procedures in antegrade ureteral stenting increases the technical success. Malposition,  perforation, hemorrhage, urinoma, abscess complications such as retrograde or antegrade ureteral stenting can be managed by radiological methods.

Key Words: Double J Ureteral stent, Ureteral obstruction, Percutaneous, Antegrade, Hydronephrosis,

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

This study was performed retrospectively by eva-luating the 51 patient's data who had chronic pa-ranchimal liver disease and who had ultrasonographic portal vein diameter from 1989 to 1994 in Internal Me-dicine Department of Selruk University School of Me-dicine. The cases were divided into three categories: the first who has easophagial varicess and varicess bleeding, the second who has easophagial varicess and not varicess bleeding. 17 cases was evaluated in each groubs. The finding of endoscopic and ult-rasonographic examinations was also consistent with other studies which performed in Turkey that implies the wider Vena porta diameter, the more common ea-sophagial varicess and varicess bleeding. Lack of such a strong correlation about this topic in France and Austria might be due to more earlier seeking medical advise of the patients in these countries.

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 was to present, through a retrospective case series, results of the patients who were treated arthroscopically for anterior glenohumeral instability. We evaluated 41 patients. Mean follow-up of the patients were 45 months (range 32-80). There were 4 (10%) female and 37 (90%) male with a mean age of 32 (range 24- 44). There were 27 (65%) right and 14 (35%) left shoulders. Dominant side was injured in 25 patients. All of the patients were suffered from a traumatic shoulder dislocation. Many etiological factors are responsible for these traumatic dislocations like swimming, falling on the side while playing soccer or volleyball or a direct trauma to the shoulder. MRI was performed before the surgery and it was found to be a Bankart lesion for all the patients. Also, all patients were evaluated according to Rowe and Constant scores. Postoperatively, mean Rowe score was 87 (range 15-100) and mean Constant score was 95 (range 88-100). Excellent resuls were obtained in 33 (80.5) patients. There were 8 (19.5) patients of recurrences and 2 of them had arthroscopic revision surgery and Laterjet procedure was performed for the latter 2 patients. Arthroscopic shoulder surgery is a long learning curve, requiring the training process but also has the advantages of less bleeding, easy rehabilitation and wound healing. As a result, this effective method can be performed for recurrent shoulder instability patients with less complication rates.

Traurnatic diaphragmatic rupture is a condition which the diagnosis is difficıdt. in Mis article 4 cases with traumatic diaphragmatic rupture which presented intestinal obstruction, volvulus of the dyspepsia and intraabdominal haemorhagea were evaluated retrospectively. Two cases were diagnosed prooperatively and the athers during operation. Unless probabilitiy is thought the diagnosis could easily be ınissed. Chest X-rays and other routine diagnostic ınethods were our diagnostic criteria in Mese cases. ff ultrasonographic exarnination is available diagnosing of such cases becomes accurate and easy.

Introduction: Circulating stem cells (CSCs) are released from bone marrow in to the circulation after myocardial injury to improve tissue repair. Radiofrequency ablation (RFA) of cardiac arrhythmias, particularly for atrial fibrillation, has been shown to trigger the release of CSCs through inflammatory mediators. We aimed to investigate whether CSCs are increased in the circulation following non-extensive ablation procedures such as slow pathway or accessory pathway ablations.

Methods: Twenty-six patients [13 females, 54 (18-74) years old] who underwent slow pathway ablation for atrioventricular nodal reentrant tachycardia (n=18) and accessory pathway ablation for atrioventricular reentrant tachycardia (n=8) were included. Peripheral blood CD34+ cell count and multiple serologic markers [troponin I (Tn-I), C-reactive protein (CRP), interleukin-6 (IL-6), stromal cell derived factor (SDF) 1 alpha] were evaluated before the ablation procedure and 7 and 30 days after the procedure.

Results: The CD34+ cell count was significantly increased on the 7^th day after the procedure when compared to baseline [33 (15-133) vs. 22,5 (5-79) cells per microliter respectively, P<0.001]. The CD34+ cell count was similar to baseline on the 30^th day following the procedure. Levels of Tn-I, CRP, IL-6 and SDF1-α did not change significantly following ablation. The amount of energy applied during RFA (watts) was significantly correlated with the 30^th day CD34+ cell count (r: 0.460; p= 0.018).

Conclusions: Peripheral blood CSCs are increased after slow pathway or accessory pathway ablations which are less extensive ablations compared to atrial fibrillation ablation. The levels return to baseline by the 30^th day following the procedure. The increase in CSCs was positively correlated with the amount of energy delivered during the procedure.

40 patients who underwent decortication surgery in Selçuk University Faculty of Medicine, Thoracic and Cardiovascular Surgery Clinic were evaluated per pair and postoperatively, aprotinin was applied to 20 patients and the amount of bleeding from the postoperative drains was compared. The average amount of drainage in the aprotinin group was 210 + 142 cc. And 562.5 + 230 cc in the control group. It was emphasized that the results were statistically significant and the use of aprotinin reduced homologous blood transfusion and protected from complications.

We reviewed 137 patients (91 men and 46 wo-men) with intracranial hemorrhages. We classified intracranial hemorrizage; intracerebral, subarachnoid-al. subdural and epidural hemorrhages. There was he-tnarrhage of 85 (%62) cases tn the intracerebral, 27 (%19.7) in the subarachnoidal, 14 (%10.3) in the subdural, and 11 (%8) in the epidural localizalion. The mean age of the patients was 56 in the intracerebral hemorrhages, and 34-42 in the others locali-zations.

The objective of the study was to evaluate the effect of ketoprofen on after tonsillectomy in patıents. All charts of patıents, who underwent tonsillectomy with or without adenoidectomy, were reviewed. The age at the time of surgery ranged between 3 and 27 years (mean age = 10.0±3.02 years). Patıents were divided into two groups based on the drugs used for postoperative pain relief.Group I received paracetamol after surgery. Group II received Ketoprofen after surgery. A total of 40 patients received ketoprofen and 50 patients were given paracetamol. Posttonsillectomy hemorrhage occurred in one (2.5%) patıent,primary hemorrhage was noted in one patient and secondary hemorrhage occurred in zero patients. While 1 of 40 patıents (2.5%) who were given ketoprofen had postoperative hemorrhage,1 of 50 patients (2.0%) who were given paracetamol had hemorrhage There was no significant difference in hemorrhage rates between these two groups (p[0.05). Hemorrhage following tonsillectomy is rare and frequently occurs in the early postoperative period. There is no significant increased risk of hemorrhage after ketoprofen administration and it can be used safely for posttonsillectomy pain relief.

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.

Bleedin in newborn infants is an important problem, among these, caused by disseminated intravascular coagulopathy has the most serious prognosis. In this report we discussed disseminated intravascular coagulopathy which is one of the most serious problem in newborn period in pediatrics.

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.

Epidural hematomae are one of the most seen emergency neurosurgical pathologies. Acute epidural hematomae generally depends on the bleeding of the arteria meningia media and its branches and collection of the hematoma at the epidural space. Epidural hematomae rarely depend on the venous sinusal bleedings. The management is generally surgical decompression of the hematoma. In this report, we present a case which is not operated after the detection of epidural hematoma and managed conservatively.

In this retrospective investigation, 106 children diagnosed as anaphylactoid purpura between 1983-1990 were evaluated. The disease was mostly encountered 5-14 years old. There was no sex predilection. 38% of the patients had predisposan factors and most of them were respiratory tract in-fections. The important symptorns were cutaneous manifestations, abdornirzal pain, limp pain consec-utively. Skin (100%), gastrointestinal system (65%), kidneys and musculoskeletal system (42%) were mainly allected. The leading cutaneous manifestations were purpuras and petechias. 38% of the pa-tients with gastrointestinal manifestations had hemorrhage. One patient was diagnosed as pancreaii-tis. The percent of the recurrences was 15%. The noticable laboratory abnormalities were the increas-ing of erythrocyte sedimentation rate, the elongation of prothrombin time, CRP and ASO positivity. [Jetirn perforation was developed during corticosteroid therapy in a case.

Epidermoid cyst refers to the implantation of epidermal elements into the dermal and deeper tissues. In head and neck, incidence ranges from 1.6 to 7%. In the tonsillar area it is extremely rare i.e less than 0.01%. They occur in fetal period  as congenital lesion or as an acquired lesion  either due to a trauma or  as post surgery implant. In this case report, we will discuss the epidermoid cyst, in a 46-year-old male who presented with history of pain in the throat with previous history of bilateral tonsillectomy. 

Aim: Mesenchymal tumors of the gastrointestinal tract other than gastrointestinal stromal tumors are rare and most of them are benign. The aim of this study to reveal the clinical and pathological features of non-gastrointestinal stromal tumor mesenchymal tumors of the gastrointestinal tract.

Materials and Methods: All gastrointestinal endoscopic and surgical resection materials, between 2008-2018, were retrospectively reviewed. Cases diagnosed with mesenchymal tumor other than gastrointestinal stromal tumors were included.

Results: Twenty four lipomas, 14 inflammatory fibroid polyps, six leiomyomas, four lymphangiomas, four hemangiomas, four schwannomas, two neuromas, two malignant melanomas, one leiomyosarcoma, one granular cell tumor and one Kaposi sarcoma were detected. The median ages of the cases were 61 years (29-87), the median tumor size was 1.5 cm (0.2-14). Thirty seven (58.7%) cases were female and 26 (41.3%) were male. They caused nonspecific symptoms. No recurrence or metastasis was detected after excision in benign tumors regardless of the pathological diagnosis.

Conclusion: Non-gastrointestinal stromal tumor mesenchymal tumors of the gastrointestinal tract are mostly small and benign tumors that can be seen at any age and are frequently seen in women. The most common ones are lipomas and inflammatory fibroid polyps. Most gastric tumors cause dyspeptic complaints and intestinal tumors cause abdominal pain, nausea or vomiting, as well as some of the intestinal tumors lead to serious, even fatal clinical situations such as acute and chronic bleeding, obstruction, perforation, volvulus or intussusception. For benign tumors’ treatment, excision is sufficient, they do not exhibit recurrence or metastasis.

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.

Anterior and posterior nasal packings were applied ta stop bleeding in 50 patients suffering epistaxis. 40 of the cases were anterior epistaxis and 10 posterior. Arterial blood samples were obtained from femoral artery on the 2nd day of the cases with packing and 24 hours follawing the removal of packing. p02 and pCO2 values were determined in blood samples. 11 was observed that arterial p02 was increased and pCO2 was decreased after the removal of packings. The decrease in pCO2 was statis-tically significant. It was concluded that it was more suitahle to avoid the packing tf there wasn't cer-tain indications.

This study was performed retrospectively by eı'a-luating the 200 cases. Of cases 130 was male ( 65%, mean ages 50), of them 70 was female (35%, mean ages 55 ). The ratio male/female was 1,8 (p<0,005). In the Ethiologic distribution; HBV(36%) was the striking cause where as HCV (33%) was second and alcohol consumption was the third causal factor. Alt-hough there are some differences in ı-atio, this dist-ribıttion was consistent with the results of other studies in Turkey. On the other hand, while the leading cause of chronic paranchimal liver disease is alcohol con-sumption in Europe and USA, it is HBV, an infectious agent, in developping countries. Weakness and fa-inting, abdominal swelling and loss of appetite and body weight at-e the most prominent svrnptoms. The connnonest abnormality and phvsical exa-mination was hepatomegaly which was followed bı-ascites and splenomegaly. The distribution of symptorns and physical findings were consistent with those in the literature published in Turkeı•. In over study easophagial bleeding to varies was the leading conıplication while hepatic en-cephaloapthy was reported as the comınonest one of chronic liver disease in Istanbul.

Between 1987-1995, seven patients with pe-netrating cardiac ınjury were presented and the iın-portance of urgent surgeıy and pericardiocentesis were emphasized. In cardiac injuıy, pericardiocentesis is in-sufficient. thoracotomy should be prinıarly per-formed in order to relieve tomponade and control bleeding.

Deep neck infection (DNI) used to manifest itself with a lethal compliactions when early diagnosis and treatment was ignored. Although, the advent of antibiotics has reduced considerably the incidence of overall number of deep neck infections. However, insufficient cure of infection of concerned tissue or the USC of inappropriate antibiotic treatment can mask the DNI related symptoms and findings. In this report, we are presenting a case tha was admitted to our clinic with a gastrointestinal hemorrhage and Iater her deep neck infection was diagnosed. The pus was drained out and treated with appropriate antibiotic regiment.