Makale Arama

According to the fundamental nature of penile erection, insufficiency of the arteriel blood supply to the corpora cavernosa caused by an organic arteriel disease is found in a large fraction of case. Our experience in the treatmen of stenoses or obstruction of the common iliac arteries with PTA, rotacs and intra-arteriel stents in 27 patients, between 38-63 years of ages, are reported. Clinical finding were lower limb claudicatio in all patients and impotence in 12 patients. The underlying disease was atherosclerosis in all 27 patients. Restitution of potency was recorded 4-12 months after the PTA or intravasccular stent application. After the intervention of procedures in 9 (%75) of the 12 patients, potency was succesliilly restored. As a results we think that radiological interventional procedures are succesfull in treatment of impotency which has arteriel etiology.

In this article, 191 cases were presented who operated in The Thoracic and Cardiovascular Sur-gery Clinic, University of Selcuk between 1987 and 1994. 52.87% of them were male and 47.12% of were female. Most of the patients were 11-20 years of age. 99 of cystes (51.83%) were in right lung, 84 (43.97%) were in left lung and 8(04.17%) of them were in both lungs. Median sternotomy was per-formed in 5 cases, segmentectomy in 6 cases, wedge resection in 7 cases, lohectomy in 9 cases, cystotomy and capitonage in 159 cases, decortication in 10 cases and cystectomy in 4 cases. 13 liver cystes and one spleen cyste were excised via trans-diaphragmatic approach. Empyerna was seen in 4 cases and succesfully treated. Only one case died on respiratory failure. Relapse was not seen in any case.

Objective: Purpose of this study was to use imaging methods which is cheaper and offering less radiation dousage for determination of alveol clefts. Fort his purpose, perapical and oclussal plane X-rays are used in this study, which are widely used by dentists for diagnosis of dental pathologies. Patients and methods: Elevenpatients with unilateral alveol clets was operated with seconder otogen iliac and allogenic cansellous bone grafts between 1998 and 2004. Bone defects was measured by NetCAD program with periapical and oclussal graphies pre operatively. Bone wax was used for per operative measurement and real size has been obtained. Late period control graphies was obtained with the same rontgenograms between post operative 6 months and 1 year. Lost bone volume and ossification were determined. Result: We think that periapical and oclussal graphies are easier procedures and may be used instead of CT for follow up in alveol clefts. Additional advantages are exposure to lower doses of radiation and low prices.

Patients with acute rheumatic fever, who were admitted to Pediatric Cardiology Unit of Selçuk University Meram Faculty of Medicine, were studied ret- rospectively to verify the clinical and laboratory profile of the disease. 395 cases were identified among patients admitted to the present institution. Age on admission was 5-18 years (mean 11.3±2.8), they were 213 (53.9%) boys, and 182 (46.1%) giriş. Manifestations included carditis 70.3°%, arthritis 66.5°%, Sydenham’s chorea 22.2%, eritema marginatum 1 °%,subcutaneous nodules 0.7%. Pericardial effusion was occurred in 3.5°%. Mitral insuffi- ciency and aortic insufficiency and aortic insufficiency were occurred in 95.3°% and 46.4°%, respectively. The regur- gitation disappeared in 23.6°% and 33°% of patients with mitral and aortic regurgitation, during follow-up. The caus- ing recurrence was the non-compliance with penicillin prophylaxis.

Various materials and techniques have been used to obtain an ideal graft ta replaced within the venous system in experimental "and ainica/ researches. In this study autogenous vein, spiral composite autogenous yein and knitted Dacron have been replaced segmentaly in canine femoral veins and the potantiality of these grafts has been investigated. Continuous patency was determined by venogram then by exploring on the fifteenth day. From the patency point of view autogenous vein was found to be significantly better than knitted Dacron (p< 0.01). And the spiral compsite ven was found to give better result than Dacron. Since long term observation was not avalible, recanalization could not be deminstrated.

Aim: Mutations in the DCLRE1C gene result in functional impairment of the Artemis protein and T/B cell development is adversely affected. As a result of this mutation, a clinic of severe combined and combined immunodeficiency (CID) generally occurs. In our region where consanguineous marriage is common, CID cases due to this mutation are frequently encountered. Therefore, suspected patients should be evaluated promptly for the relevant gene mutation. It is clear that more complicated and costly methods are used in the detection of mutations and there is a need for cheaper and faster methods. Therefore, in this study, it was aimed to determine the mutations of DCLRE1C gene exon 3 (c.194C>T; p.T65I) and exon 14 (c.1669_1670insA; p.T577Nfs*21) by using Polymerase Chain Reaction-Restriction Fragment Length
Polymorphism (PCR-RFLP) method.
Patients and Methods: The study was carried out between 2017 and 2020 and study included 14 patients followed up with DCLRE1C mutation in our clinic, 2 parents and 10 healthy controls. PCR-RFLP analysis was performed with primers containing mutation sites and approp riate restriction enzymes.
Results: As a result of the analysis, 12 patients were homozygous mutant for DCLRE1C gene exon 3, 2 parents were heterozygous for exon 3, and 2 patients were heterozygous for exon 3 and exon 14 and were found to be compound heterozygous genotype. Mutations were confirmed by Sanger DNA sequencing. Mutations in the relevant region were determined quickly and re liably by the PCR-RFLP method.
Conclusion: The study showed that the PCR-RFLP method is a cheap, safe and fast method that can be used in cases such as family screening, especially for the detection of known mutations in primary immunodeficiencies.

A case of very large condyloma acuminatum lo-cated in inguinal region in a 62 years old male 40 years history was treated by surgical excision and split thickness skin graft. Altough it had very Tong his-tory there was no malign transformation in histo-pathological examination. We presented it because of its unusual size and tong history without malign transformation.

This prospective study was carried out on 63 cases operated for the lumbar disc herniation, at the Medical Faculty of Selçuk University in 1996 in the first 9 months. All cases were divided into three equal groups :21 cases who had only disc operation was taken as first group, second group of cases re-ceived topical meperidine at the and of the ope-ration while third group of cases were applied me-peridine injected autolog fat graft. The patients were referred postoperatively 1, 3. 5 and 7 th days _according to "Mc Gill Pain S•ala". In this study we wanted to see the effects of the application method of meperidine on pos-toperative pain and comfortable mohilization.

Coronary ectasia is localized or diffuse dilation of coronary arteries. There are limited data about the percutaneous coronary intervention (PCI) of ectatic coronary arteries with stenosis. Different stent systems such as carotid, bilier and venous graft have been used in these lesions. Post-dilation has been performed by peripheric balloon catheter, if necessary. In this case, we reported a patient with acute inferior myocardial infarction and ectatic right coronary artery who was treated with primary PCI using a renal stent.

Lipodermatosclerosis is a progressive dermatosis, which is closely related with chronic venous insufficiency. Lipodermatosclerosis has been clinically classified into acute, subacute and chronic stages. Acute phase, which also represents a sequelae of chronic venous insufficiency, is commonly misdiagnosed as cellulitis, since typical clinical presentation closely resembles cellulitis with extremely painful, indurated plaques with intense erythema and edema affecting distal parts of the lower extremities. Chronic lipodermatosclerosis is much more common than acute lipodermatosclerosis and this form is easily recognized with clinical examination. Chronic lipodermatosclerosis is more common in women, indeed up to 90% of the reported cases are women in their middle ages. Here, we report a young male patient with chronic lipodermatosclerosis on right lower extremity, which had been developed in the presence of chronic venous insufficiency. We point out and highlight the clinical characteristics of this patient as chronic lipodermatosclerosis is less frequently observed in young males.

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.

All employees (N=498) of Seydişehir Public Hospital’s (SDH) were included, who were working in the period of 2013 and 2015, in the study in order to assess their seroprevalence of Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Human Immunodeficiency Virus (HIV). After getting the official permission, data on employees’ personnel follow-up forms (health information forms) kept by the Hospital’s Infection Control Unit and records of Hospital Information Management System (HIMS) were retrospectively analyzed. Results showed that employees were HBsAg (+), anti-HBs (+) and anti-HCV (+) as in 0.8%, 86.7% and 0.2% levels, respectively. A statistically significant relationship between occupational status (doctor, nurse/ medical staff, health technician, cleaning personnel and other group) and anti-HBs was found (p<0.001). In the further analysis, the proportion of anti-HBs (+) was lower in the other group (including medical secretary, biologist, psychologist, dietician, pharmacist, security, kitchen worker, driver, information processing, technical service, tailor, social worker, and researcher) than the groups of doctor, nurse / health officer, health technician, cleaning staff. There was no difference in terms of anti-HBs between doctor, nurse / health officer, health technician and cleaning staff group (p=0.442). Also, a statistically significant relationship was observed between the employed units (internal services, surgical services, operating room, intensive care unit, emergency services, dialysis, laboratory and other units). An important difference for anti-HBs seropositivity was found (p=0.011). In the further analysis, the ratio of anti-HBs positivity was lower in the other units including kitchen, security, data entry and technical service than internal services, surgical services, operating room, intensive care, emergency service, dialysis and laboratory groups. There was no difference in terms of anti-HBs positivity among the internal services, surgical services, operating room, intensive care, emergency service, dialysis, and laboratory groups (p=0.717). There were no statistically significant relations of the HBsAg seropositivity with the employed unit (p=0.96) and the professional status of the employees (p=0.566). Consequently, HBV, HCV and HIV seroprevalence levels of SDH employees were in parallel with the other studies.

Diabetic muscle infarct is a rare complication of type 1 insulin dependent diabetic patient, resenting with focal thigh pain, tenderness, swelling and erythema. These pathologic findings were observed in 72 years old male patient, 5 days after he was accepted to our clinic because of diabetic foot ulcer. The mass was thought that on abscess at first but unixue extensor hallucis muscle infarct was observed by surgical exploration.Necrosed muscle was excised and defect area was reconstructed with split thickness skin graft. V/e have presented a case of extensor hallucis longus muscle infarction in a diabetic patient first in the literatüre.

We present a case of Jessner's lymphocytic in-filtrate of the skin in a 40-year-old man. The patient had non healing ch•onic inflarnmatory erit-hemapustulous lesions on the face and uppeı- pan of the auı•icles. bilaterally. First histopathologic di-agnosis of the patient was "Discoid lupus ery-thematosus". The lesions appeared on the ,face and made a deformity on the nose. In o•der to achieve exact diagnosis and treatment, all the lesions on the face excised and reconstructed hy a split skin grafit. Auricular lesions that were not treated such a this way, heakd spontaneously. Histopathologic exa-mination of the specimen that was excised from the lesion and healthv skin. revealed that the diagnosis is Jessner's lymphocvti• infiltrate. The reason of spontaneous healing of the auricular lesions exp-lained with no exposure of the auricles to sunshine.

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.

It is well known that malignancies especially of lymphoreticular and gastrointestinal origin are more common in patients with common variable immune deficiency (CVID). Incidence of malignancy among relatives of patiens with CVID was reported in a limited number of studies. In this study incidence of malignancy among patients with CVID, IgA deficiency and their relatives were investigated. We evaluated 25 CVID and 68 IgA deficiency patients, and their 727 and 1802 respective relatives for the presence of malignancy. In addition, all the first degree relatives of patients with CVID were screened for the presence of IgA deficiency and autoantibodies in terms of positive anti nuclear antibody (ANA) and anti double stranded DNA antibody (dsDNA). Incidence of malignancy in patients with CVID and their relatives were 12% and 1.9%, respectively. A history of malignancy was positive in none of the patients with IgA deficiency but in 2.3% of their relatives. None of the patients with CVID had positive ANA or anti dsDNA. Our results confirm the notion that incidence of malignancy is increased in patients with CVID. However, relatives of neither CVID nor IgA deficiency patients , displayed any increase in the incidence of malignancy. Screening of patients with CVID for malignancy and their relatives for IgA deficiency might provide early diagnosis of these conditions.

Acute rheumatic fever (ARF) is an acquired cardiac disease, that may develop as a non-supurative, late-onset complication of an infection with group A β-hemolytic Streptococcus, such as pharyngitis or tonsillitis, continues to maintain its importance in developing countries, despite it is relatively rare in developed countries. The aim of this study was to review patients, diagnosed with acute rheumatic fever at our center, and to discuss this disease, which is a major health problem in our country, in the light of recent literature data. Files of patients, who referred to Selçuk University Medical Faculty Hospital, and diagnosed with ARF between January 2010 and February 2014, were assessed, retrospectively, and patient demographic data, clinical and echocardiographic (ECHO) features, treatment responses were identified. A total of 65 patients, including 26 (40%) girls and 39 (60%) boys, diagnosed with ARF, with an average age of 11,6 years (5-17 years) at the time of diagnosis, 16 (24.6%), 11 (16.9%), 5 (7.7%) and 33 (50.8%) of 65 patients has also been diagnosed with carditis, arthritis, carditis and (+) arthritis, and silent carditis, respectively. The most frequently referred symptoms are arthritis and arthralgia, with a 59% rate. Although pathological murmurs and innocent murmurs were identified during physical examination in 25 (38.4%) and 21 (32.3%) patients, respectively; 19 (29.2%) patients had no evidence of heart murmur. The most common findings in echocardiographic assessment are mitral insufficiency (MI), aortic insufficiency (AI), and mitral and aortic valve involvement in 14 (21.5%), 10 (15.4%) and 22 (33.9%) patients, respectively. Acute rheumatic fever continues to be a health-threatining condition in our country. Even if there are no pathological murmur in patients referred with arthritis or arthralgia, with an increased level of acute phase reactants; echocardiographic assessment should be taken.

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.

Lagophthalmus is the inability to close the eyelids completely leading to exposed cornea (scleral show) which can result in corneal scar formation and vision loss. The skin of upper eyelid is soft and flexible, so this makes winking easier. To return the upper eyelid its soft and flexible structure, Z-plasty, VY advancement flaps, full-thickness skin grafts, and pedicle flaps are defined as treatment options. The aim of this study was to demostrate the usage of bipedicle flap and midface lift as an alternative treatment option for lagophthalmus that is related to the vertical shortness of upper eyelid developed after blepharoplasty.

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.

Suture material in surgery to place septorhinoplasty graft and cartilage often are used to shape the nasal tip. Foreign body reaction to suture material is visible. In cartilage graft processes and suture techniques, polypropylene is frequently used suture material in septorhinoplasty. One of the most important feature of suture material is that it should not cause reaction in tissue. severity of the inflammatory reaction is not only related to personal factors but also type of suture material. Polypropylene suture material related to the reactions were shown rare. In this study, reaction developing a case based on polypropylene suture material was presented and subjects were discussed in the light of literature information.

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.

Extensive surgical excision, free skin graft and regio•al lymphadeno-idectomy for therapeutic or prophylactic reasons were performed in fifteen malign skin melanoma cases. They were kept under postoperative chemotherapy, radiotherapy, immunotherayp afterwards and various aspects of melanomas were examined.

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

The aim of this study was to evaluate aerobic bacterial infections which were ocurred in febrile neutropenic patients, infectious agents and their antibiotic susceptibilies. Eighty-two febrile neutropenic attacks in 67 patients (42 male, 25 female) betvveen age 2-82 years were evaluated in this study. Two hundred and forty-nine samples were evaluated and 45 pathogen agents (21 from urine, 16 from blood, 3 from wound, 2 from throat, 2 from abcess and 1 from palate sputum) were isolated. 33.3% of these pathogens were gram-positive and 66.7% of them were gram-negative microorganisms. Escherichia coli is the most commonly isolated pathogen and than Staphylococcus aureus, Enterobacter cloaca, Klebsiella pneumoniae are isolated. Staphylococcus aureus was the most common organism isolated from blood. As there are differences in infectious agents and infection sites from one to another centereach çenter must define its own infectious agents, infection sites and antibiotic suscepti­ bilies.

Most of the coagulation factors and their proteins are synthesized in the liver. Therefore many kind of coagulation disorders occur during chronic liver diseases. Prothrombin time (PT) is one of the most important coagulation tests which can be used in chronic liver diseases as the first line measurement of the severity of hepatic tissue insuffi- ciency. On the other hand the level of thyroid hormone can often change during chronic liver diseases. İn our study we measured PT and free T3 values of the patients with chronic liver diseases diagnosed by clinical findings and confirmed histopathologically and we also compared them with the same parameters obtained from the healh con- trol group with chronic liver diseases. İn the patient group we have detected significant decrease in free T3 and an increase in PT and a negative correlation between free T3 and PT. V/e think that, the decreased level of free T3 , is a manifestation of decreased liver tissue capacity and tike PT it can be used as a hepatic failure index.

Tendon transfers enable wrist and finger extension, and stabilize the thumb vvoints in permanent radial palsy. Different technigues of transfer and their modifications have been used so far. İn 14 out of 17 patients with a mean age of 26 years, we restored finger extension using pronator teres. Terun of function was expected in the other 3 patients, and the so called internal splinting operation was performed using only the pronator teres for vvrist extension. Immobilization in a plaster splint for three weeks was used postoperatively, and it was continued as a night splint foranother three weeks. A rehabilitation programme was started at the end of three weeks postoperatively for ali the patients. The man follow-up was 17 months on the average. Functional scoring was done according to the Zachary model and we obtained 11 very good, 3 good, 2 fair and, 1 bad results. Tvvelve patients returned to their former occupations. Fifteen patients were satisfied with the results. We did not encounter any infection postoperatively. The transfer for wrist extension failed in one patient. We obtained good results comprable with the ones in the literatüre using our technique of transfer, meticulous surgery and good rehabilitation. Although not so important, inability to provide radial abduction was the lacking port of the transfer.

Aim: Vertebrobasillar insufficiency (VBI) is a common problem of elderly patients. However, diagnosis of VBI is generally difficult. The aim of this study was to determine the findings and efficiencies of MRA and CDUS in the diagnosis of VBI. Material and Method: We examined 40 patients (20 men, 20 women, mean age: 54.83±14.36 years) having signs and symptoms of VBI and 20 controls of the same age and sex. All of the patients, underwent cervical MRA, CDUS, cranial MRI. The diameter measurements and systolic and diastolic flow velocities of the vertebral arteries were compared between study and control group. Posterior circulation was also evaluated by cranial MRI in patients with VBI. Results: By CDUS, 9 patients with oclusion, 5 patients with kink or stenosis and 6 patients with only hypoplasia, and 2 patients with insufficient flow were diagnosed. MRA showed occlusion in 14 patients, stenosis in 4 patients, kink in 6 patients, tortuosity in 6 patients, and fenestration in one patient. MRA of the remaining 5 patients were normal. Cranial MRI of 7 patients was abnormal. On MRA, there was distal oclusion in five out of 14 patients having oclusion. CDUS showed low velocity and high resistance in the extracranial segment of these vessels. Conclusion: When only the extracranial pathologies of vertebral arteries were in concern, CDUS specifity was 81,5% and sensitivity was 84,6% according to MRA. If all the vertebrobasillary system pathologies were in concern CDUS sensitivity and specifity according to MRA were 57,1% and 60%, respectively.

Thirty patients scheduled for elective coronary aı-tery hypass grafting (CABG) were randoınly al-located tü two groups foı- myocaı-dial preservation: crystalloid cardioplegia (group 1), blood car-dioplegia (group 2). In group 1 ,2.4±0.6 distal anas-tomoses for each patient were performed. In the next group (group 2), the numher of distal anastomoses was 2.4±0.7. The demographic pı-ofiles were iden-tical. Crystalloid and hlood cardioplegia were de-livered thı-ought the aortic root intermittently. The patient temperature was kept at 30°C. The study pto-tocol compı-ised recording of the following pa-rameteı-s: 1. Postoperatively positive inotropic and IABP suppoı-t 2. Postoperatively CK-MB, LDH, SGOT and CK enzyme studies 3. ECG changes (rhythm disturbances) 4. Spontaneous sinus rhythm (after removing cross-clamp). The low enzyme values in concerning injury was taken in the blood cardioplegia gı-oub. The results in this study suggest that betteı- myo-cardial pr-otection may be thought to occur hy hlood cardiopegia. We can say that blood cardiopegia is a safi. alternative way of myocaı-dial protection 1,vith good clinical r-esults and lower enzyme levels.

Adult respiratory distress syndrome is an advanced degree of distressing respiratory failure in adults. Various factors play a role in this clinical picture. Although respiratory failure associated with trauma and shock has been reported since the beginning of the twentieth century, the definition of respiratory distress seen in adults is very recent. In 1967, Asbaugh et al. Described this entity with its clinical and physiopathological features.

Introduction: Our aim is to evaluate the cardiac involvement of Neurofibromatosis type 1  patients in our region and to compare them with other clinical findings. In this study, we wanted to show the frequency and variety of cardiac involvement.

Material and Methods: Patients diagnosed with Neurofibromatosis type 1  in Hatay Mustafa Kemal University Medical Faculty Pediatric Neurology Clinic between 01/09/2019 and 01/09/2020 were included in the study. The patients included in the study were examined by a Pediatric Cardiology Specialist, and echocardiography and electrocardiography were taken. Demographic information, examination findings, brain magnetic resonance images were collected from the files of the patients. Electrocardiography and echocardiography were examined and recorded by the Pediatric Cardiology Specialist.

Results: We accepted 17 patients from our center to the study. Six patients (35.3%) were diagnosed with sporadic Neurofibromatosis type 1, while 11 patients (64.7%) had familial Neurofibromatosis type 1. All of our patients had cafe au late spots on the skin. In addition, 10 (58.8%) patients also had axillary and / or inguinal freckles. We detected optic glioma in 3 of our patients with ocular involvement, and lish nodules in 3 of them with papillary edema. When we looked at central nervous system involvement, we encountered various involvements in brain MRIs of 8 (47%) patients. In our cardiac examination, we found QT length in 1 patient’s electrocardiography. In the echocardiography we performed for the detection of cardiac structural pathologies, we detected nodular appearance compatible with subendocardial neurofibroma in 3 patients, mitral insufficiency in 3 patients, patent foramen ovale in 1 patient, atrial septal defect in 1 patient, and bicuspid aorta in 1 patient.

Discussion: In our study, unlike the literature, subendocardial nodular hyperechogenic appearance was present in 3 patients. Although these findings are quite rare, subendocardial nodular hyperechogenic images in 3 of our 17 patients suggest that this pathology may be more common. In addition, one of our patients had a long QT. As far as we know, this is the first case of Neurofibromatosis type 1 and Long QT syndrome. In conclussion; Cardiac involvement in patients with Neurofibromatosis type 1 could more common than mentioned in the literature.

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.

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

Aim: 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.

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.

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 %.

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.

Nearly all of the reports about pneumomediastinum associated with pneumonia have been conducted in adults as pneumomediastinum was uncommon in pediatric age group. This case report is described an infant with pneumonia complicated with pneumomediastinum and epidural emphysema. Her original disease is a severe combine immunedeficiency (SCID). Another reason to provide this case report is that epidural emphysema or pneumorachis associated with pneumonia and pneumomediastinum is a rare condition.

Nonmicrovascular replantation of an avulsed auricula as a composite graft is an unreliable solution. The use of retroauricular pocket to enhance survival of the composite ear graft is a multistage procedure and aesthetic results are poor. In this case report the vascularity of the composite graft is attempted to be increased by transposing fascial flap. Fifty-four year old man had an amputation of his ear due to a human bite. The amputated ear was reattached to its original position as a composite graft. Afterwards a temporoparietal fascia flap has been transposed between the posterior skin and the cartilage of the amputated ear. Amputated ear had been revascularised completely without any distorsion at the cartilages. Acceptable aesthetic result was obtained. An ear amputation can succesfully be replanted as a composite graft by using the described technique in a single stage.

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

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Many studies have been conducted to prevent tetany crises due to hypocalcemia occurring after parathyroidectomy. These can be listed as, from the simplest to the most complicated, intravenous calcitherapy, use of parathyroid hormone extracts, application of parathyroid grafts. The fact that graft implantations, which are considered to be the most advanced method, are lifeless and cause allergic reactions have led researchers to turn to the portacaval anastomosis method to drain immune antigens. Meanwhile, it has been observed that the porta-caval anastomosis has a positive effect on the blood calcium level in animals with parathyroidectomy and at the same time, the hypocalcemia is eliminated with a calcium-rich diet.

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

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

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

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

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

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

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.

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

This study was performed in the deparment of general surgery of Ankara Universitiy Medical Faculty, betvveen September 1992-December 1992. Thirty patients were diagnosed chronic venous insufficiency and 15 healty per- son were evaluated by colour doppler ultrasonography and the results were compared with venography findings. İn the diagnosis of chronic venous insufficiency, colour doppler shovved 87 % sensitivity, 80 % spesifity, 85 % ac- curacy, % 80 pozitive predictive value, % 87 negatif predictive value, As a conclusion in the diagnosis of chronic venous insufficiency coloured doopler USG can be considered as the primary diagnostic method. İt is also a cheep and non in vasi ve scanning method.

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

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).

Wound healing is a physiological process consisting of hemostasis, inflammation, proliferation, and
maturation phases. The disruption that occurs at any stage of these intertwined phases is presented to the
clinician as a chronic wound. The stromal vascular fraction, isolated as a part of the aqueous fraction after
enzymatic or mechanical digestion of lipoaspirate, is an important mesenchymal stem cell reserve, as
well as. It is considered a heterogeneous tissue cocktail due to the preadipocytes, endothelial precursors,
immune cells, hematopoietic cells, fibroblasts and pericytes it contains. Because of its proangiogenic,
antiapoptotic, antifibrotic, immunomodulatory, and anti-inflammatory activities, as well as its advantages
in isolation, stromal vascular fraction has lately acquired prominence in current wound therapy. Although
SVF alone is not effective for wound healing, it is a new and effective technology that provides adequate
cell count and viability for proper wound care and wound bed preparation prior to reconstruction and to
minimize surgical failure.

The acquired immune deficiency syndrome (AIDS) was first described in the ntedical literature in June 1981. Since that time there has been exp-losion in the number of reports of AIDS. AIDS has been reported in patients with ha-emophilic patients who were receiving commercially prepared factor VIII concentrate more than from blood- bank produced cryoprecipitate. This is pro-bably due to the fact that each unit of factor VIII concentrate is made from blood obtained from 2000-5000 blood donors. The prevalence of HIV infection amog adult ha-emophilic men in most studies is reported to range from %50-90 percent. About % 1 of these patients developed AIDS. The heamophilic patients and their heterosexually partner and their children are risk for AIDS We would like to present the first one case of AIDS in hemophilic patients and his wife in our cli-nic.

Neonatal hemochromatosis is a rare disease clinically defined as severe neonatal liver disease in association with extrahepatic siderozis. The etiology of neonatal hemochromatosis is not understood exactly. However, according to a theory neonatal hemochromatosis is accepted to be an alloimmune disorder causing liver injury in fetus. After an effected one in the pregnancy the recurrence rate of neonatal hemochromatosis is ~80%. Hepatocellular failure which occurs in the first days of life with coagulopathy, hypoglycemia, hypoalbuminemia, hypofibrinogenemia, thrombocytopenia, anemia, and direct and indirect hyperbilirubinemia characterizes neonatal hemochromatosis. In order to diagnose neonatal hemochromatosis there are some certain criteria that sould be taken into account such as a positive family history, high serum ferritin levels, high serum alpha-fetoprotein levels and siderozis demonstrated with histology or with magnetic resonance. Since an affective medical treatment has not been found yet, liver transplantation is almost always required. The prognosis of neonatal hemochromatosis is generally poor. This review will discuss neonatal hemochromatosis that leads to liver failure in the fetus or newborn.

Aim: Autologous bone harvesting is the gold standard for grafting in a variety of orthopaedic procedures.
The aims of this study were to introduce an alternative technique of K-wire guided, multidirectional
percutaneous bone graft harvesting with Jamshidi from the anterior iliac crest, and to put forward the early
comparative clinical results of this technique.
Patients and Methods: 38 patients, who underwent a variety of hand surgeries in which bone grafting was
required between January and November 2013, were included in this retrospective, comparative study.
The included diagnoses of the patients were; non-unions of hand and wrist bone fractures, and benign
bone tumors. The prospectively collected data of patients were retrospectively evaluated in two groups.
Iliac crest autograft harvesting were performed with a standardized open technique, and with a novel
percutaneous technique -which will be described in the subsequent section- in group I, and II, respectively.
The mean age of the patients was 29.6 +/- 6.4, and 28.6 +/- 8.2 in group I, and II, respectively. The patients’
postoperative pain related with the perception of the pain and surgical scar, were evaluated according to the
graded Visual Analogue Scale; at postoperative 6th months. Statistically , Mann-Whitney U test was used.
Results: There were no major postoperative complications in the percutaneous group. Regarding pain,
mid-term at postoperative 6th months, VAS scores were found to be lower in group II than in group I,
significantly (p< 0.05).
Conclusion: The novel K-wire guided bone graft harvesting with Jamshidi from the iliac crest is a safe and
patient-friendly method in terms of postoperative pain reduction. This technique is useful in small joint and
bone surgeries, requiring bone grafting. The results of this study should be further supported with higher
level of evidence studies.

A successful partial left ventriculectomy and mitral valve replacement (Batista) operation with 31 No Sorin prosthetic valve performed to a 45 year old female patient for end-stage heart failure and dilated cardiomyopathy (class IV NYHA) which occured secondary to mitral valve disease and was resistant to ali medications. Postoperative control echocardiography revealed a 15-20% increase in the ejection fraction (with simps method) in comparison with preoperative echocardiography. The severe heart failure symptoms of the patient recovered and she is discharged in the 1&h d ay.

Towards the end of 2019, new coronavirus causing acute respiratory distress syndrome in patients was detected in Wuhan Province, China . This virus was called serious acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the International Virus Taxonomy Committee. The disease caused by this new coronavirus was called coronavirus disease-2019 (COVID-19) by the World Health Organization. This virus was found to be in the subclass of Betakoronavirus caused by bats. The role of viral proteins such as envelopes, membranes, nucleocapsids and spike proteins responsible for viral infectivity in immunopathogenesis is being investigated in studies. It has been emphasized in studies in which multiple organ failure develops due to the development of cytokine storm, especially in the advanced stages of the disease. An effective host immune response, including natural and adaptive immunity to SARS-Cov-2, is essential for controlling and treating viral infection. Although there is no effective treatment for the disease today, the benefits of various immunosuppressive and immunomodulatory drugs have been shown in studies. In this article, the immunopathogenesis of SARS-CoV-2 and the treatment models that can be effective on immunopathogenesis are reviewed in the light of current literature.

The most important problem with taze reconstruc-don of mandibular defect is the rejection of the mate-rial used. Up to date, various methods such as alloplastk reconstruction, free vascularizedfiaps, osteotrziyocu-tanöz flap and partide osseos greft have been de-scribed. in Iliis article we presented a patient who had multiple trıaxillofacial fractures and osseos tissue loss in mandible due to an accident that we have used reconstruction with free costal graft for the defect of mandibular fractures and other techniques have been revieved in literature.

The most important problem with taze reconstrucdon of mandibular defect is the rejection of the material used. Up to date, various methods such as alloplastk reconstruction, free vascularizedfiaps, osteotrziyocutanoz flap and partide osseos greft have been de-scribed. in Iliis article we presented a patient who had multiple trıaxillofacial fractures and osseos tissue loss in mandible due to an accident that we have used reconstruction with free costal graft for the defect of mandibular fractures and other techniques have been revieved in literature.

Abdominal aortic aneurysms have been to life the-ratening a pathologic process. Early aternpts to pre-vent rupture of aneurysm included ligation, wram-ping sac in an attend to induced trombosis. In 1951 Dubost introduced graft replacement of aortic ane-urysm that a reliable method of aneursym repair be-come available. Since then graft interposition for ab-dominal aortic aneursym has been become prefer therapy. Between 1990 and 995, 10 patients underwent operations for abdominal aortic aneurysms at the Sel-cuk University Medical Faculty clinic of car-diovascular surgery patients had elective procedure and 1 patient had urgent procedure. One patient had been died during the operation and in the other pa-tients haden't been seriously a postoperatif cop-lication.

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%.

Treatment and Follow up Traumatic arteriovenous fistulas are mostly occur as a result of penetrating injuries and so-metimes iatrojenic causes. Surgical treatment was performed on 8 tra-umatic arteriovenous fistula cases between the dates September 1989 and February 1996. Two patients were female and six patients were male ages ranged between 1.5 to 44. Etiology was gun shut wound in 5, stuhing and penetrating wound in 2 and as a re-sult of puncture to vein in I. Time interval after tra-uma was ranged between I day and 10 years. Ar-teriovenous fistulas were ntnd in the localization of right femoral artery - femoral vein in 3, left popliteal artery - vein in 1, left posterior tibial artery - vein in 1, right carotis artery - internal juguler vein and left brachial artery - basilic vein in I. Arterial end to end anastomosis in 5, primary arterial repair in 1. ar-terial prosthetic graft intopozitions in 1 and otojen yen patch angioplasty in I were used for the closure of the arteriovenous fistulas. Venous primary repair in 5, otogen safenous vein graft interposition in I. ve-nous ligation in 2 were used for the closure of the ar-teriovenous fistulas which venous repair.

In. the repairing of tibial defects which were oc-curred by different causes, using of ipsilateral vas-tidal-Led graft of fibula which has the pellicle ofpe-roneal arter, improves rapid healing and reduces the risk of infection, avascular necrosis and hos-pitalisation. On suitable cases, we have preferred and advised this method performed on six cases in our clinic.

Aim: This study aimed to evaluate vitamin D levels, which were determined over a year in the pediatric
clinic of a training and research hospital in Central Anatolia, according to age groups, gender, and
seasonal characteristics.
Patients and Methods: This retrospective study was conducted using the data of children aged 0–18
years who applied to the children’s clinic of a hospital between January 2019 and December 2019 and
whose vitamin D levels were determined. Children were divided into five different age groups, 28 days–12
months, 13 months–2 years, 2–5 years, 6–11 years, and 12–18 years, in accordance with Standard 6
recommendations. Vitamin D levels were evaluated in terms of age group, gender, and admission season.
Results: A total of 9496 children, 5360 (56.4%) females and 4136 (43.6%) males, were included in the
study. A 25(OH)D level below 20 ng/mL (representing a deficiency) was found in 6472 (68.2%) of the
participants, while 2085 (21.9%) participants had a 25(OH)D level between 21–29 ng/mL (representing an
insufficiency) and 939 (9.9%) participants had a 25(OH)D level over 30 ng/mL (representing sufficiency).
It was determined that vitamin D levels are lower in girls than in boys, vitamin D levels are inversely
proportional to age, and vitamin D levels reach their lowest values in winter and highest values in summer.
The effects of age group, gender, and season of admission on vitamin D levels were statistically significant
(P < 0.001).
Conclusion: The mean vitamin D levels for all age groups were either insufficient or deficient. Vitamin D
levels in children aged 0–18 is related to age, gender, and season. Necessary measures should be taken,
especially for at-risk groups, to prevent vitamin D deficiency or insuf ficiency.

The clinical presentation and management of 20 popliteal artery injuries following penetrating and blunt trauına were rewiewed during the period 1990 to 1996 of at the Cardiovascular Surgery De-partment of the Medical Faculty of Karadeniz Tech-nical University. Clinical and Doppler evaluation identified arterial injury in 16 (%80 per cent) pa-tients. In four (%20 per cent) patients with arterio-venous fistula or false aneurysms pedal pulses were palpable during initial assesnıent. Autogenous vein grafting was used in 8 patient, PTFE prosthesis was used in 2 patients, a direct end-to- end anastomosis was succesful in 8 patients, trombectomy was done in 1 patient and lateral repair was done in 1 patient. As a routine repair of associated venous injuries, early fasciotomy were used. External, internal fi-xation, skeletal traction was done for compoutıd and comminuted fractures. The significant functional orthopedic disability following blunt arterial trauma at the knee is emphasized

22 cases with traumatic peripheı-al aneurysm were treated at the Clinic of Cardiovasculer Suı-gery of Selçuk Univeı-sity Medical Faculty hetween 1989 - 1995 years. In eleyen of the cases were etiology due to injuı-ies of gun wounds, eight of them were penetrating instruments, rwo cases were after A.V. Fistüla anastomatic operation and one case was after invasiye vasculer procedure. Vein replacement was petformed in six cases and 9. Cases end ta end anastomosis was done and synthetic greft rep-lacement ta four case (PTFE) and in 3 cases were done arterial ligation. Twenty cases were resulted with healing. Postoperative compiications developed in two cases. In one of them was transposed the graft saphenous yemi!, and forearm amputation was applied to other patient..

We present case a who developed multiple phe ripheral aneurysms despite the treatment in Beket's disease. Two of the aneurysms were located in the left femoral artery and one in the right femoral ar-tery and another one in the left axillary artery.At dif-ferent times (in two years) these aneurysms which developed independently were resented and the ar-terial continuation was obtained using saphen vein and syntihetic grafts.