Makale Arama

Saddle block is an ideal procedure that can provide sufficient anesthesia by protecting hemodynamic stability especially in elder patients with high cardiac risk. A 52 years old male patient with bladder tumor who was scheduled for transurethral bladder resection (TUR-B) had history of hypertension, diabetes mellitus and congestive heart failure. Echocardiography showed that LVEF was 20%; RVEF was 28% and there were insufficiency (MVI) of third degree, insufficiency (TVI) of second degree, biventricular global hypokinesia and remarkable dilatation on the right and left structures of the heart. The patient was considered as having ASA class IV. He had TUR-B under saddle block. In conclusion, we considered that saddle blockade was a more safe and efficient anesthetic procedure rather than neuroaxial blockade or general anesthesia for the highrisk patient who had bladder tumor.

Aim: Distal femoral fractures are common seen both elderly and young population. These fractures are % 7 of all femoral fractures. Providing of alingment after distal femoral diaphyseal fractures is important for the development of deformity and shortness. In this study, it was aimed to determine whether the effect of intramedullary nail method applied in the treatment of distal femoral diaphyseal fractures that do not extend into the joint to the femoral alignment. Patients and Methods : 62 patients were evaluated who were treated with intramedullary nail with the diagnosis of distal femoral diaphyseal fracture between 2010 and 2016. Patients has at least 1 year of follow-up. Patients were divided into 3 groups according to fracture joint distance (<100 mm, 100-130 mm, >130 mm). Nail-joint distance (NJD), fracture line-joint distance (FJD), fracture-nail distance (FND), and the translation and alignment of the fracture line were evaluated for each group. Results: In group 1; NJD 17,1±6,8 mm, FJD 78,4±17,6 mm, FND 60,8±15,9 mm, translation 4±1,3 mm, and the malalignment was 2,9±1,7°. In Group 2; NJD 19±6,8 mm, FJD 119,5±8 mm, FND 100,6±8 mm, translation 3,9±1,7 mm, and malalignment 3±1,7°. In group 3; NJD 25,2±8,7 mm, FJD 143,3±7,8 mm, FND 118,1±11,7 mm, translation 3,5±1,8 mm, and malalignment was 2,5±1,4°. Conclusion: In our study, we found that as the distance between the fracture and the joint decreased, the degree of malalignment and translation increased, and when the distance between the nail and the joint was kept below 20 mm, the amount of malalignment and translation decreased. If distal femur fractures near the joint line will be treated with intramedullary nailing attention must be taken for the malalignment and translation. Especially when the fracture-joint distance is less than 100 mm, keeping the distance between the nail and the joint below 20 mm will keep the translation and malalingment at a minimum level.

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

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

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

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

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

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

The Zenker’s diverticulum (pharyngeal pouch) is a rare pulsion diverticulum of the mucosa of the pharynx just above the cricopharyngeal muscle. It occurs at the left side and was commonly seen in elderly patients. Maintypical symptoms include dysphagia, regurgitation, chronic cough, aspiration and weight loss. Symptomatic patients with large diverticulum should be treated surgically. Although in recent years successful results with endoscopic therapy has been reported, diverticulectomy and myotomy are still seems to be the best treatment. In this study, a case of 36 years old woman with rightsided Zenker’s diverticulum, clinical presentation, and management are reviewed.

Melanoacanthoma or pigmented seborrhoeic keratosis is a rare variant of seborrhoeic keratosis which commonly occurs as deeply pigmented lesion in the head and neck or trunk of elderly patients. Melanoacanthomas shows proliferation of dendritic melanocytes and basaloid keratinocytes on histology. The lesion can clinically mimic malignant melanoma and variants a histopathological examination for the right diagnosis and proper management.

Frequency of osteoporosis in postmenopausal women is rising depending on various factors. This study is aimed at to analyse the risk factors that cause osteoporosis for women living in Kütahya. The assessment of bone mineral density (BMD) of Lumbar vertebral bone (L1-L4) via dual energy X-ray absorptiometry (DEXA) machine in a-p position was carried out on 103 women, aged between 40- 82 who had already been in menopause and applied to Kütahya Devlet Hastanesi (Kütahya State Hospital) department of DEXA for assessment of bone mineral density. Study data were achieved from survey results. Experimental group was evaluated according to World Health Organisation (WHO)’s Osteoporosis Classifications via DEXA assessments as T score -1,0 SD> normal, T score -1,0 SD and -2,5 SD is osteopeni and T score <-2,5 SD is osteoporosis. It was observed that all the respondents are housewifes, primary school educated and have a low activity level. It was observed again that the responders who are osteoporosis and osteopenia are older,shorter; particularly, osteoporosis group is 3 cm shorter and have less weight than normal group of people. The group of people who are osteoporosis and osteopenia have a lower age of first and last menstruation than normal people. Yet, they have a higher breast-feeding duration. It was detected that the patients have a lower T scores who had used cortisone for a long time and had bone fracture than who didn’t have any. It was detected again that the scores fell down depending on tested people’s decreasing in come, however, they rose depending on tested people’s rising education status. It was detected that the T scores of people who are leading a rural life was lower than who are leading a urban life. As a result of our study it was noticed that risk of osteoporosis rises depending on age, life style, characteristics of sociodemographic are effective on falling of bone mineral density.

Between May 1984-April 1988 7 cases with destroyed lung were treated at S. Ü. Faculty of Medicine Thoracic and Cardiovascular Surgical Department. The youngest and oldest patients were 5 and 47 years old. Patients presented themselves with coughing, purulant sputum, dyspnea, pleural pain and hemoptysis. Clubbing of fingers was common in all cases. We obtained no perfusion in the destroyed lung side whom we could research. Surgical treatment with 5 pneumonectomy and 2 pleuropneumonectomy were corned out. There were 2 empyema as post operative complication with broncho-pleural fistula in one patient. This patient died following thoracoplasty. The other patient is still alive with open drainage.

Aim

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

Materials and methods

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

Results

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

Conclusion

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

Aim

The decision to start treatment in sarcoidosis is made based on clinical and radiological findings and changes in pulmonary function test findings during follow-up, and more useful tools are needed in treatment management. F-18 fluorodeoxyglucose (18F-FDG) positron required important tomography / computed tomography (PET/CT) contains important information about the extent of sarcoidosis. On the other hand, the neutrophil/lymphocyte ratio (NLR) opens as a good prognostic marker for tissue-related inflammation. This study evaluated the relationship between the 18F-FDG PET/CT findings of sarcoidosis and NLR and other clinical findings.

Material and methods

The data of the patient who was diagnosed with sarcoidosis after 18F-FDG PET/CT examination in our clinic were retrospectively reviewed. Patients' age, gender, NLR values, smoking status, extrathoracic involvement and symptoms, and 18F-FDG PET/CT findings were compared.

Results

This study consisted of 41 patients. There was a strong correlation between NLR and whole body total lesion glycolysis (TLG), and moderate correlation between  MAIA and NLR (r values: 0.852, 0.660, both of them p value: <0.001, respectively). There was a significant difference between the groups showing only thoracic involvement and additional extrathoracic involvement with MAIA, TLG and NLR values (p values,: 0.002, 0.001 and, 0.003, respectively). In the classification made according to the symptoms of the patients, there was no significant difference between the groups with SUVmax, MAIA, TLG and NLR values. Median values were found to be significantly higher in the elderly group (p values: 0.037 and 0.040, respectively). In the classification made according to gender; there was no significant difference in both PET/CT parameters and NLR values.

Conclusion

The close relationship between the NLR value, which is accepted as a prognostic indicator in sarcoidosis, and the 18F-FDG PET / CT findings which show the involvement of the disease in the whole body, may provide the clinician with significant benefits in treatment management.

Decubitus ulcers can develop in immobilized patient. Patients with spinal cord injury and elderly patients are at high risk. We presented 36 patient with pressure sore that we operated between May 1994 and January 2000 and our reconstructive procedures. Sacral, trochanteric and ischial pressure sores we are included the study, other sites were excepted. As 3 patient with ischial ulcer were accepted because of recurrence, there were no recur- rence for sacral and trochanteric ulcers. This recurrences were not depend on surgical techniçues perhaps due to pressure. Selecting the proper surgical technique for decubitus ulcer, is important eitherpreventing recurrence and funtional loss. We revievved our experience with reconstruction of decubit ulcers betvveen 1994 and 2000 years.

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.

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

Bronchial carcinoid tumors constitute approximately 5 percent of all lung tumors. They occur with about equal frequency in both sexes. Most patients are young or middle aged adults. These tumors are not related to cigarette smoking or other known pulmonary carcinogenic factors. Dependent upon the location of the tumor within the lung clinical presentation and morphologic appearance, these tumors are four variants. These variants are the central carcinoid, the peripheral carcinoid, atypical carcinoid, tumorlet type bronchial carcinoid. In this study, two cases diagnosed as bronchial carcinoid turner in Pathology Depart-ment of Medical School of Selçuk University between May 1987 -April 1988 were presented and discusseJ.

Bronchial carcinoid tumors constitute approximately 5 percent of all lung tumors. They occur with about equal frequency in both sexes. Most patients are young or middle aged adults. These tumors are not related to cigarette smoking or other known pulmonary carcinogenic factors. Dependent upon the location of the tumor within the lung clinical presentation and morphologic appearance, these tumors are four variants. These variants are the central carcinoid, the peripheral carcinoid, atypical carcinoid, tumorlet type bronchial carcinoid. In this study, two cases diagnosed as bronchial carcinoid turner in Pathology Depart-ment of Medical School of Selçuk University between May 1987 -April 1988 were presented and discusseJ.

Aim: This study was aimed to determine the demography of family caregiver of dependent older adults and their attitude related to care and relationship between attitude and short time education. Material and Method: The study carried out as quasi-experimental design. Forty-eight family caregivers of dependent older adults were included from a randomly selected health center area in Karaman city center. The family caregiving questionnaire was applied by interviewing. The family caregivers were educated by co-researcher about care of elderly. The questionnaire was applied again after eight weeks of education. Results: The mean age of the family caregivers was 49±16, 71% of them were married and 35% were uneducated. Almost all of them were women and were not working elsewhere. In 26 items the average of positive attitude score of the family caregivers was 59±27 on 100 points. The attitude scores was not significantly different according to demographic features. The scores were higher in post-training compared to pre-training. Conclusion: It is concluded that education of family caregivers by public health nurses positively affect the quality of care of dependent older adults.

MEO was described by Chandler in 1968. it is a progressive exiernal otitis that usually occuring elderly diabetic patients caused by Pseudomonas Aeruginosa. Leads ta death by paratysis of multipl cranial nerves and other iniracranial complications when attaching ternporal bone and skull base. in this article, we present a patient who was diagnosed as MEO at arar clinic and üs etiopathogenesis, clinical features, diagnosis and Ireatment have been cliscused.

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

Aim: Acute or chronic diseases, malnutrition, and the biological changes reagarding to aging can disrupt protective barriers, impair clearance mechanisms, and contribute to the expected age-related diminution in cellular immune responses to microorganisms such as Mycobacterium tuberculosis. Case Report: A 90 year old patient with the diagnosis of testicular tuberculosis after an operation because of a mass in testis was treated with isoniazide, rifampicin, ethambutol and morphozinamide. Conclusion: The extrapulmonary tuberculosis risk may increase in the elderly together with the increase in tuberculosis because aging may reduce the effectiveness of the body's immune system.

This study was carried out to find out the clinical affect, tolerance, side affect and metabolic affects of nitrendipine on 43 hypertensive patients. The pa-tients were divided tn to 3 groups as light, rnild and severe. In study group 11 patients had atherosciehot-ic heart disease, 3 had congestive heart failure and 13 had diabetes mellitus. Nitrendipine was giyen ta all patients 20 mg one dese daily in the morning. The patients were examined upon his application, in the firsth, the third and the sixth weeks. At the end of the six week treatment, the affect and the side affect of nitrendipine were evaluated. The success rate of nitrendipine in light hypertension was 86.66%, in mild hypertension was 81.81%, 64.70% in severe hypertension and considering the total 43 patients, the success was 76.74% in our study. While meaningful decrease in blood pressure in all hypertensive groups was observed at the end of six week treat►ent, meaningful increase in pulse rate was noticed in all except diabetic and the old pa-tients. The side affects such as particularly palpita-tion, headache and flushing, dizziness, feel of vomit-ing and exhoustion were noticed 44.18% of all groups. In conclusion, nitrendipine was proved to be ef-fectiw and reliable drug in all hypertensive patients.

Cartilaginous tumors of larynx are rare, but should be suspected in elderly patients with persistent hoarseness, dyspnea, or dysphagia after malign epithelial tumors has been disproved. 250 cases have been reported in the literatüre. These tumors were investigated by revievved of the literatüre.

Aim: Aging is a major process that results in changes in cardiovascular structure and function in elderly people. The aim of this review to summarize the effect of aging on some aspects of cardiovascular structure and function. Result: Increased arterial stiffness alters afterload and left ventricular shape. Age related deteriorations in left ventricular structure and functions are impaired ejection reserve, increase in diastolic volume and an altered diastolic filling pattern. Reduction in the number of myocytes and deterioration of subcellular structure are also remarkable with advanced age. Significant alterations in cardiovascular function during exercise are also demonstrated in elderly people. Conclusion: Significant changes have been noted in the structure and function of the cardiovascular system in older people that are considered to be the result of aging. These changes can be regarded as either adaptive or early preclinical disease, but they occur in the absence of clinically manifest dysfunction.

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

Purpose:

Primary and metastatic digestive system malignant melanomas are extremely rare. In our study, we aimed to compare lymph node metastasis with clinical and pathological parameters in gallbladder, stomach, small intestine and anorectal region malignant melanomas.

Materials and methods:

This retrospective study included 20 cases diagnosed with malignant melanoma in the gastrointestinal tract organs between January 2010 and January 2020 at XXXXXXXXXXXX. In our study, we wanted to evaluate the relationship between regional lymph node metastasis and age, gender, tumor localization, tumor size, extraintestinal melanoma history, melanin pigment, neutrophil-lymphocyte ratio and post-diagnosis life span in primary and metastatic malignant melanoma cases. We also reviewed the origin and literature of the cells from which melanoma originates in the digestive system.

Results:

There was a statistical relationship between tumor diameter and regional lymph node metastasis (p =0.000). As the tumor diameter increased, the lymph node metastasis rate increased. There was a relationship between survival and gender, tumor localization, distant metastasis, primary and metastatic digestive system melanoma (all p <0.05). Most of the men and those who did not metastasize away from the digestive system were alive. All patients with melanoma metastases to the digestive system and all patients with gallbladder and small intestine localization were alive. Our 70 year old patient with gallbladder primary malignant melanoma was the oldest patient we could identify in the literature.

Conclusions:

Regardless of cutaneous or origin, all melanomas originate from melanocytes, cells derived from embryological nerve crest. Malignant melanoma can be primary in every region, more frequently in the anorectal region in the gastrointestinal tract. The most common metastasis is to the small intestine. Accurate diagnosis is vital in places where it is rarely seen, such as the digestive system. Recently, in metastatic melanoma, immuno-oncological agents are used in adjuvant therapy to help prevent metastatic spread of the disease. Thanks to these treatments, it is reported that more than half of patients with melanoma who have the risk of metastasis after surgical resection provide recurrence-free survival. Although it is very rare, it should be kept in mind that there may be primary or metastatic malignant melanoma in the evaluation of digestive system biopsies.