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Introduction: Brucellosis is a zoonotic disease distributed worldwide and very important public health problem especially in the developing countries. In this study, we aimed to evaluate the clinical/laboratory findings of brucellosis patients and contribute of coombs testing to diagnosis at Iğdır State Hospital infection diseases and clinical microbiology department. Materials and Methods: One hundred and forty-five brucellosis patients followed up in our clinic between September 2012 and February 2013 were evaluated retrospectively. Demographic characteristics, laboratory findings, diagnostic methods of the patients were presented. Results: The mean age of the patients were 39±15 (18-80) and 59% (n=86) of the patients were female, 41% (n=59) were male. Most frequent risk factors were animal breeding (n=115, 79%) and using underdone milk and milk products (n=98, 69%). Most reported complaints were weakness (92%), arthralgia (89%), sweating (74%), lack of appetite (70%) and fever (68%). Fifty-seven of the brucellosis patients could not diagnosed with standard tube agglutination. Therefore, Coombs test was used for these undiagnosed patients (39%, n=57). Eighty patients were evaluated as acute (55%), 53 as subacute (37%) and 12 as chronic (8%) brucellosis. Conclusions: Brucellosis can affect all organ systems and cause different clinical manifestations. Therefore, difficulties are encountered in the diagnosis of the disease. Brucellosis should be kept in mind in the differential diagnosis especially in the endemic regions. When the clinical suspicion exists detailed laboratory evaluation must be performed.

Amaç: Endoskopik minimal invaziv yöntemle ven çıkarılması kullanılmasına rağmen kalp merkezlerinin çoğunda halen konvansiyonel açık yöntemle ven çıkarılması standart bir uygulamadır. Yara yeri enfeksiyonları nadir olmakla birlikte sıklıkla sistemik hastalığa sahip obez ve yaşlı kadınlarda görülmektedir. Enfekte ve nekrotik dokuların debridmanı gerekli olmasına rağmen yaranın primer mi yoksa Vakum Yardımlı Kapama (VYK) tekniğiyle mi kapatılması tartışma konusudur. Gereç ve yöntem: Retrospektif olarak iki farklı merkezden 43 hastada toplam 54 bacak insizyon yarasını değerlendirdik. Dizüstü, diz ve dizin altında olmak üzere sırasıyla 20, 29 ve 5 bacak yarası incelenmiştir. 20 yaranın 12 si (dizüstündeki), 29 yaranın 18’i (dizaltındaki) ve diz bölgesi üzerindeki bütün yaralar 7,2±0,8 günlük vakum yardımlı kapama tedavisi kullanıldıktan sonra dikiş atılarak kapatılmıştır. Diğer yaralar ise debridman sonrasında primer olarak kapatılmıştır. Bütün hastalara yara yerinden alınan kültür sonucuna göre duyarlı antibiyotik tedavisi başlanmıştır. Bulgular: Bütün hastalar kullanılan tekniklerle tamamen iyileşmiştir. Primer yara kapama yapılan 2 hastada tekrar debridman ve sonrasında vakum yardımlı kapama cihazı kullanma gereksinimi olmuştur. Pürülan akıntı sadece dizaltı yarası olan 3 hastada görülmüştür. Sonuç: Safen ven koroner arter bypass cerrahisinde en sık kullanılan otolog greft olmakla beraber bacak yaraları cerrahi sonrasında görülen can sıkıcı komplikasyonlardır. Bu yaraların tedavisinde her iki metot da etkili olmalarına rağmen vakum yardımlı kapama cihazı tekniğinin diz altındaki yaralar için daha başarılı olduğu görülmektedir. Bu bulgular diz altında daha az cilt altı doku olmasına veya eşlik eden mikroanjiopatilere bağlı olabilmekle birlikte daha ileri çalışmalar için adres teşkil etmektedir.

Türk lehçeleri hakkında verdiği bilgilerle Dîvânu Lugâti’t-Türk, Türk dilinin en önemli eserlerindendir. Kâşgarlı Mahmud, eserinde Oğuzlarla ilgili de ayrıntılı kayıtlara yer vermiştir. Oğuzların dil özellikleriyle ilgili düştüğü kayıtlardan biri de diğer Türk boylarının kullandığı ikilemeli ifadeler yerine onların ikilemelerin yalnızca bir ögesini kullandıklarıdır. Bu konuda verdiği bir örnek, diğer lehçelerdeki kattı kardı ifadesi yerine Oğuzların sadece kardı dedikleri şeklindedir. Bugün Türkiye Türkçesi ve ağızlarında kat- ve kar- fiillerinin ikisi de yaşamakta; bu sözcükler bazen eş anlamlı olarak da kullanılabilmektedir. Anadolu ağızlarında kat- fiilinin; Dîvânu Lugâti’t-Türk’teki “kattı kardı” ikilemesi ve aynı zamanda hem tarihsel hem çağdaş olarak kar- fiilinin anlamıyla örtüşen bir kullanımı olduğu görülmektedir. Bu durumu, ağızlarımızda kullanılan hamur katmak ifadesi açık bir şekilde yansıtmaktadır. Aynı kullanım, Azerbaycan Türkçesi ve ağızlarında da tanıklanmıştır. Bu incelemede, bu ifadedeki kat- fiilinin, kat- kar- (“katı kardı”) ikilemesinden eksiltmeli bir kullanımla ortaya çıktığı gösterilmeye çalışılmıştır. Ayrıca, Derleme Sözlüğü’nde yer almayan bu kullanımla Derleme Sözlüğü’ne katkıda bulunmak amaçlanmıştır.

The use of a left ventricular assist device (LVAD) as a bridge to heart transplantation (HTx) or as a destination therapy in patients with a contraindication for HTx is increasing. However, nearly half of the patients with LVAD support experience a ventricular arrhythmia (VA) in the first year. The history of a pre-LVAD VA is one of the most powerful predictors of VA after LVAD implantation. The clinical experience and data about ablation of a VA in patients with an LVAD are limited. There are important issues to be considered before and during the procedure in LVAD patients compared to other VA ablation patients. This is a report of ablation of intractable ventricular tachycardia in a patient with a LVAD.

Bu çalışmada Demirci halı dokumacılığında kullanılan bazı terimler üzerinde durulmuş ve bunların Türk Dil Kurumu tarafından yayınlanmış olan on iki ciltlik Derleme Sözlüğü’nde yer alıp almadığı araştırılmıştır. Veri toplamada, ilgili çalışmalar da gözden geçirilerek, Demirci’de halı dokuyan kaynak kişilerden yararlanılmıştır. Üç yüz yıllık dokumacılık tarihinde Demirci halıları gündelik kullanımda önemli bir yer tutmaktadır. Bu durum son yıllarda makine halıcılığının gelişmesiyle gerilemiş, Demirci’de halı dokuyanların sayısı azalmaya başlamıştır. Bu sebeple özellikle ilçeye özgü terimlerin en kısa zamanda tespit edilmesi ve halk ağzından derlemeler sözlüğüne kazandırılması gerekmektedir. Bu çalışmayla bir nebze de olsa ağız çalışmalarına katkı koymak amaçlanmıştır. Yapılan çalışma sonucunda argaç, arış, kirkit gibi bazı terimlerin Derleme Sözlüğünde yer almasına rağmen tespit edilen bölge adlarında Demirci’ye rastlanmaması dikkatimizi çekmiştir. Bazıları da sözlükte başka anlamlarla verilmiştir. Tespit ettiğimiz terimlerden ara urganı, e'lik/eklik, gıyı örneği, iç örneği, ters ilme gibi bazılarının da Derleme Sözlüğü'nde yer almadığı görülmüştür.

The term “herd immunity” is an immunization concept that refers to a means of protecting a whole population from an infectious disease by immunizing a certain percent of a population. Measles is a highly contagious infectious disease. Measles vaccine failure may lead to outbreaks. In this article, basic herd immunity concepts and measles immunization practices are reviewed.

Bu makale, iç basınçlara maruz ince bir aliminyum diskte oluşan elastik- plastik gerilmelerin hesaplanması ile ilgilidir. Bu çalışmada, küçük plastik deformasyonlar için sınır şartlarını, elastik-plastik gerilmeri ve şekil değiştirmeleri sağlayan analitik bir çözüm öngörüldü. Von-Mises kriteri akma kriteri olarak kullanıldı ve malzeme plastik deformasyonda ideal plastik olarak kabul edildi. İç çaptan dış çapa kadar olan bölgede elastikplastik ve artık gerilmeler hesaplandı. Sonuçlar tablolar ve grafikler halinde verildi. Bütün radial gerilme bileşenleri, ?r, bası gerilmesidir ve bu gerilmeler disk'in iç çapında maksimum değerdedir. Bütün teğetsel gerilme bileşenleri, ??, çeki gerilmesidir ve bu gerilmeler plastik deformasyonun başladığı yerde maksimum değerdedir. Teğetsel artık gerilmeler radial artık gerilmelerinkinden çok çok büyüktür.

Bu makale, iç basınçlara maruz ince bir aliminyum diskte oluşan elastik- plastik gerilmelerin hesaplanması ile ilgilidir. Bu çalışmada, küçük plastik deformasyonlar için sınır şartlarını, elastik-plastik gerilmeri ve şekil değiştirmeleri sağlayan analitik bir çözüm öngörüldü. Von-Mises kriteri akma kriteri olarak kullanıldı ve malzeme plastik deformasyonda ideal plastik olarak kabul edildi. İç çaptan dış çapa kadar olan bölgede elastikplastik ve artık gerilmeler hesaplandı. Sonuçlar tablolar ve grafikler halinde verildi. Bütün radial gerilme bileşenleri, ?r, bası gerilmesidir ve bu gerilmeler disk'in iç çapında maksimum değerdedir. Bütün teğetsel gerilme bileşenleri, ??, çeki gerilmesidir ve bu gerilmeler plastik deformasyonun başladığı yerde maksimum değerdedir. Teğetsel artık gerilmeler radial artık gerilmelerinkinden çok çok büyüktür.

This paper deals with elastic-plastic stress analysis of a thin aluminum disc under internal pressures. An analytical solution is performed for satisfying elastic-plastic stress-strain relations and boundary conditions for small plastic deformations. The Von-Mises Criterion is used as a yield criterion, and elastic perfectly plastic material is assumed. Elastic-plastic and residual stress distributions are obtained from inner radius to outer radius, and they are presented in tables and figures. All radial stress components, ?r, are compressive, and they are highest at the inner radius. All tangential stress components, ??, are tensile, and they are highest where the plastic deformation begins. Magnitude of the tangential residual stresses is higher than those the radial residual stresses.

Introduction: Throughout history, influenza virus pandemics have led to the death of millions of people. The virus sometimes causes pathological changes that can lead to severe illness and death. Inflammatory cytokines and chemokines have been shown to be involved in the pathogenesis of tissue damage in the lungs of animals and humans infected with influenza viruses. Materials and Methods: The serum concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β) and interleukin- 6 (IL-6) were determined with enzyme immunoassay (EIA) in 57 patients who were hospitalized with confirmed influenza and a control group. Results: Fifty-seven patients with confirmed influenza A (H1N1) 2009 and 62 healthy subjects as the control group were included in this study. Of these patients with influenza, 51 (89.4%) were discharged, and 6 (10.5%) died of influenza-related illness. TNF-α levels were found to be 43.0 pg/mL in fatal patients, 20.9 pg/mL in non-fatal patients, and 4.1 pg/mL in the control group. IL-6 levels were found to be 1074.12 pg/mL in fatal patients, 191.0 pg/mL in non-fatal patients, and 36.1 pg/mL in the control group. The differences between groups were statistically significant (p= 0.003 and p< 0.001, respectively). IL-1β levels were found to be 2.1 pg/mL in fatal patients, 7.1 pg/mL in non-fatal patients, and 7.5 pg/mL in the control group, and the difference was not statistically significant (p= 0.657). Conclusion: We found that TNF-α and IL-6 levels were significantly higher in patients who died. We suggest that higher levels of pro-inflammatory cytokines may be used as an important marker of mortality.

The red-mud obtained during the production of aluminium from bauxite as a by-product contains valuable materials such as Fe, Al, Na,V, Ti etc. In this study, red-mud was dissolved with H2 SO4 and converted to FeSO4.7H2 O by 86 % efficiency. The optimum converting conditions were found as heating for three hours at 170o C. The red-mud is not suitable for the production of pig iron because, it hasn't got enough iron contents(38.57 per cent Fe2 O3). We concluded that, the red-mud can be used in production of FeSO4.7H2 O.

Boksitten alüminyum üretiminde atık madde olarak ele geçen kırmızı çamur bünyesinde Fe, Al, Na, V ve Ti gibi kıymetli maddeler bulundurur. Bu çalışmada, sülfürik asit kullanılarak 170 o C 'de 3 saat süreyle çözünürleştirilen kırmızı çamur içindeki demir, uygulanan analitik işlemler sonucu % 86 verimle FeSO4.7H2 O şeklinde ayrıldı. Demir oranı düşük (%38,57 Fe2 O3) olması sebebiyle pik demir üretimi için uygun olmayan kırmızı çamurun FeSO4.7H2 O üretiminde kullanılabileceği sonucuna ulaşıldı.

Boksitten alüminyum üretiminde atık madde olarak ele geçen kırmızı çamur bünyesinde Fe, Al, Na, V ve Ti gibi kıymetli maddeler bulundurur. Bu çalışmada, sülfürik asit kullanılarak 170 o C 'de 3 saat süreyle çözünürleştirilen kırmızı çamur içindeki demir, uygulanan analitik işlemler sonucu % 86 verimle FeSO4.7H2 O şeklinde ayrıldı. Demir oranı düşük (%38,57 Fe2 O3) olması sebebiyle pik demir üretimi için uygun olmayan kırmızı çamurun FeSO4.7H2 O üretiminde kullanılabileceği sonucuna ulaşıldı.

Plasmodium falciparum malaria causes about 450.000 deaths every year, mostly in children around the world. The infection is seen in cases coming from abroad and may lead to deaths in Turkey. Many native P.falciparum malaria cases and deaths due to this infection were observed in Turkey during mid 1900's when malaria was epidemic. But only two native cases were reported in the last 50 years, both from Manisa. First case was a one-year old baby who has come to Manisa from Urfa with his family and has never been abroad. He has diagnosed with Plasmodium vivax malaria and treated with chloroquine and primaquine. A previously obtained thin blood film was examined and characteristic P.falciparum rings in red blood cells were observed and the case was published together with photographs as probable P.falciparum and P.vivax mixed infection. After this case, microscopists working in Malaria Control Unit of Manisa were informed about the differentiation of malaria species in thin blood samples. Soon afterward, another case who have never been abroad before were also diagnosed with P.falciparum and P.vivax mixed infection and this case was also published with photographs taken from thin blood samples. As molecular diagnostic methods were not improved and widespread in those years, it could not be applied in both cases. A Giemsa stained thin blood sample of the baby case was incidentally found 22 years afterwards and with the aim of molecular diagnosis, the blood sample on the slide previously processed for DNA isolation, then analysed with "FTD Malaria Differentiation (Fast Track Diagnostics, Luxembourg)" multiplex kit with real-time polymerase chain reaction by using probes special for P.falciparum, P.ovale, P.malariae, P.vivax species. DNA's belonging to P.falciparum and P.vivax were found to be positive, the case is molecularly proved to have P.falciparum and P.vivax mixed infection. This case indicated that Turkey is convenient for the expansion of P.falciparum malaria in terms of the climate and vectors and suggested that the potential danger may increase with the effects of global warming, wars and migrations and may jump to Europe over Turkey. The case which molecularly proved the existence of native P.falciparum malaria in the near future in Turkey, was presented to draw attention to the danger of this infection for Turkey and Europe.

In this case, catheter-related bacteremia due to Globicatella sanguinis in a 43 years old female patient undergoing hemodialysis with the diagnosis of diabetic nephropathy was presented and the methods in the laboratory diagnosis of the rare opportunistic pathogen, Globicatella cins, were nvestigated. A set of peripheral blood cultures and simultaneous catheter culture was obtained from the patient in third of May 2016. Biochemical tests, Phoenix (Becton Dickinson, USA) and MicroScan (Beckman Coulter, USA) automated systems and matrix assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF MS) based Microflex MS (Bruker, Daltonics, Germany) and VITEK MS (database v2.0) (bioMérieux, France) systems were used for the identification of the cultured bacteria. Partial 16S rDNA sequencing was done by using specific p8FPL 5'-AGT TTG ATC ATG GCT CAG-3' and p806R 5'-GGA CTA CCA GGG TAT CTA AT-3' primers. Minimal inhibitory concentrations (MICs) for vancomycin, erythromycin, imipenem, cefotaxime and benzypenicillin were determined by agar gradient method. The blood and catheter cultures yielded the same type of bacterial colonies. Alfa-hemolytic, catalase negative colonies observed on blood agar plates after an over night incubation yielded gram-positive cocci on Gram staining. In Şişli Hamidiye Etfal Hospital, the isolate was identifed as G.sulfidifaciens (score value > 2) by Bruker MS system and as G.sanguinis by Phoenix automated system. In Inönü University, the isolate could not be identified by Microscan automated system while VITEK MS named the isolate as 99.9% G.sanguinis and 98.3% G.sulfidifaciens. The 16S rDNA sequencing identifed the isolate as 100% G.sanguinis (GenBank accessionno. KJ680157.1). The MIC values were 0.38 µg/ml, 1.5 µg/ml, 0.38 µg/ml, > 32 µg/ml and 64 µg/ml for vancomycin, eryrthromycin, imipenem, cefotaxime and benzylpenicillin, respectively. The patient was diagnosed as catheter-related bacteremia and vancomycin (1 x 1 g IV/72 h) was used for up to 10 days. No fever and bacterial growth in cultures were present in her control visits. As G.sanguinis is not among the commonly encountered pathogens and due to difficulties in laboratory diagnosis, it may be missedor mis-identified in clinical laboratories. BD Phoenix and Bruker MS data bases lack G.sulfidifaciens and G.sanguinis, respectively, while the Globicatella genus is not present in MicroScan database. The increased number of medical implementations and the increasing number of immunosuppressed patient populations in recenty ears will lead to the emergence of rare bacteria. Increasing the diagnostic power of clinical microbiology laboratories by conventional and molecular methods and renewal of the databases of commercial identification systems by expanding the pathogen spectrum are significantly important for the prevention and control of infections caused by these agents.

Leriche syndrome is a disease characterized by thrombotic occlusion in the aorta, frequently in the distal renal artery. Classic symptoms of this syndrome include pain in the lower extremities emerging during activity (claudication), impalpability of femoral pulses, and impotency in male patients. Definitive diagnosis of claudication due to insufficient circulation as well as claudication that is neurogenic in origin, is difficult. Medical history, physical examination, and monitoring methods are important for definitive diagnosis. Impalpability of bilateral femoral pulses in physical examination may be sign of Leriche syndrome. Color Doppler ultrasonography can be used to demonstrate that there is no circulation in the iliac arteries in cases of Leriche syndrome. In these patients, thrombotic occlusion of the aorta is confirmed by computed tomography angiography. Presently described is a case of Leriche syndrome in which the patient presented at hospital with complaint of claudication and was diagnosed with lumbar disc herniation. Since vascular pathologies were not considered in differential diagnosis, treatment was delayed and it resulted in mortality; for this reason it is important. When patients come to hospital with complaints of leg pain, clinicians should consider vascular pathologies before reaching definitive diagnosis, using detailed patient history and comprehensive physical examination.

Objective: The aim of this study is to determine the effects of continuous positive airway pressure (CPAP) treatment on depression, anxiety, and perceived stress levels and to identify factors predictive of treatment efficacy in patients with obstructive sleep apnea syndrome (OSAS)., Method: This study included 51 patients admitted to the Adiyaman University Medical School Otorhinolaryngology Department or Eskisehir Yunus Emre State Hospital between January and September 2014 with one or more complaints including snoring, excessive daytime sleepiness, or apnea witnessed by the partner. Diagnosis of OSAS was made by polysomnography and CPAP treatment was initiated. Depression levels were assessed in all study subjects using the Hospital Anxiety and Depression Scale (HADS) at the start of treatment and at 3 months. Anxiety levels were assessed using both the HADS and the State and Trait Anxiety Inventory (STAI), and perceived stress level was assessed using the Perceived Stress Questionnaire (PSQ)., Results: After CPAP treatment, we observed significant decreases in both the Depression and Anxiety Subscales of the HADS, in the Trait Anxiety subscale of the STAI, and in the PSQ. An evaluation of the initial parameters that predict improvements in these scales revealed that snoring time predicted decreases in all scale scores., Conclusion: In OSAS patients CPAP treatment has positive effects on psychological parameters like depression, anxiety, and perceived stress. We suggest that possible psychogenic benefits should be considered when deciding to start CPAP treatment, particularly in patients with pronounced and extended snoring who may also have social problems.

Background: The aim of this study was to evaluate the outcomes of the children with absent distal pulses following supracondylar humerus fractures., Methods: Forty-two pulseless hand patients who were treated due to supracondylar humerus fractures were evaluated retrospectively. The evaluation included symptoms presented at preoperative and postoperative neurological examinations, mechanism of injury, time from injury to presentation, time from injury to surgery, length of hospital stay, and postoperative complications., Results: In 27 patients, radial pulse was palpated following reduction. A stream was identified in ten patients with Doppler, and no stream was identified in two patients. These two patients had no ischemia and they presented with a stream on Doppler one day after the surgery. Immediate vascular exploration was applied in three patients (7%) who retained ischemia after the reduction and was unable to present a stream on Doppler. One patient underwent primary suture, and the other two were managed with saphenous vein graft and primary repair., Discussion: It is vital to re-evaluate patients presenting with a pulseless hand following supracondylar humerus fracture; the ones with no ischemia or ischemic sign should be closely followed, and the ones retaining ischemic signs should be managed with primary vascular repair.

Objective: This study aimed to assess the impact of chronic sinusitis (CS) on carotid-intima-media thickness (CIMT), a marker of early atherosclerotic changes in the arterial bed., Methods: The study included 50 patients with CS (25 male, 25 female, mean age 26.6 ± 5.34 years), and 50 healthy subjects (25 male, 25 female, mean age 25.8 ± 4.76 years), aged 18 to 35 years without atherosclerotic risk factors, normal body mass index and normal metabolic parameters. CIMT was measured in all patients by ultrasonography. CS was confirmed by medical history and computed tomography scan of the paranasal cavities., Results: No significant difference existed between the groups in terms of age, sex, body mass index (BMI), waist circumference, plasma creatinine, glucose, low-density lipoprotein (LDL), high-density lipoprotein (HDL) cholesterol values (p>0.05). However, mean values of CIMT (mm) were significantly greater in CS patients than in healthy subjects (0.51 ± 0.09 vs. 0.40 ± 0.07, p<0.001). Duration of CS disease was 6.0 (3.0-13.0) years. Significant correlation was found between CIMT mean values and age, BMI, waist circumference, HDL and LDL-cholesterol values and duration of CS (r=0.413; p<0.001, r=0.353; p<0.001, r=0.355; p<0.001, r=-0.266; p=0.007, r=0.327; p<0.001 and r=0.425; p=0.002 respectively). Multiple linear regression analysis revealed that waist circumference, HDL and LDL-cholesterol and duration disease of CS were independent predictors of CIMT (ß=0.523; p=0.001, ß=-0.176; p=0.045, ß=0.297; p=0.002, and ß=0.436; p<0.001, respectively)., Conclusion: Our cross-sectional study revealed the presence of a negative effect of CS on the atherosclerotic process. Therefore, it is believed that effective treatment of CS may be beneficial in slowing the process of atherosclerosis.

Objectives: The aim of the study is to evaluate hypertensive patients who are supposedly under control according to office blood pressure measurements with 24 hour ambulatuar blood pressure monitoring for determining their actual controlled hypertension rate. In addition, we investigate the adherence ratio of blood pressure measurements to current guidelines., Study Design: Nine hundred-forty hypertensive patients supposedly under control according to office blood pressure measurements were enrolled in the study. Twenty-four hour ambulatuar blood pressure monitoring was performed on all of them., Results: Actual controlled hypertension was determined in 617 (65.6%) patients whereas 323 (34.4%) patients had uncontrolled hypertension. The blood pressure measurements that were over threshold values were seen mostly at night and in the early morning during ambulatuar blood pressure monitoring. Nocturnal and early morning hypertension was determined in most of the patients who were supposedly under control according to office blood pressure measurements. This was especially true in patients with high cardiovascular risk such as diabetes mellitus, chronic kidney failure, and metabolic syndrome., Conclusion: Efficacy of antihypertensive therapy during 24 hour and the early morning period is essential for optimal risk modification.

The aims of this study were to determine anti-HBs positivity in children who had received three doses of hepatitis B vaccine during infancy and to evaluate the factors that may affect the serological status. Local ethics committee approval was obtained at the beginning of the study. The study was carried out between December 2005 and October 2007 among children attending the outpatient clinics of medical school hospital. The study encompassed 912 children (393 female, 519 male; aged 1-5 years old) who had been immunized with three doses of intramuscular recombinant hepatitis B vaccine during infancy. All of the children were born to HBsAg negative mothers and did not have any known immune system problems. Sociodemographic characteristics and passive smoking status were gathered by a questionnaire. Anthropometric measurements were taken, and a detailed physical examination was carried out for each child. Blood samples were obtained to check serum HBsAg, anti-HBs and anti-HBc levels by commercial micro-ELISA (Sanofi Diagnostics Pasteur, Sydney) method. Levels of anti-HBs ≥ 10 mIU/ml were defined as seropositivity. In seronegative children, anti-HBs levels were re-checked 4 weeks after receiving one booster dose of hepatitis B vaccine. Of the children 877 (96.2%) were found anti-HBs positive, while all of them were negative for anti-HBc or HBsAg. Of children 34.8% were 12-23 months; 28.7% were 24-36 months; and 36.5% were 37-60 months-old, and anti-HBs negativity rate was higher in the older age group with a statistically significant difference (1.4%, 3.9% and 4.2%, respectively; p= 0.003). Anti-HBs antibodies were found negative in 2.8% of children who were born by vaginal route and in 5.8% of children who were born by cesarean section, the difference being statistically significant (p= 0.016). There were no significant differences between anti-HBs seropositivity and gender, working/ educational status of the mothers and the presence of smoking parents in the family (p> 0.05). Logistic regression analysis indicated that the factors that affect antibody levels in vaccinated children were the duration of breastfeeding only (4.77 ± 1.53 months in anti-HBs positives and 3.69 ± 2.13 months in negatives; p= 0.008), birth weight (3328.18 ± 318 g in anti-HBs positives and 3135.27 ± 488 g in negatives; p= 0.037) and pregnancy parity (anti-HBs was negative in 3.4% of children born from mothers who had < 2 parities, and 8.2% of children born from mothers who had < 3 parities; p= 0.037). The remaining 35 (3.8%) children with undetectable antibody levels became seropositive after one dose of hepatitis B vaccination, with the antibody levels of ≥ 100 mIU/ml. This response underlined the presence of immune memory in vaccinated children. The results of this study indicated that almost all 1-5 years old children who had received three doses of hepatitis B vaccine during infancy were protected from hepatitis B virus infection. It was concluded that similar studies should be carried out in different settings.

Objectives: This study aims to compare the functional results of dynamic compression plates (DCP) and interlocked retrograde intramedullary nails (IRIN) used for the treatment of humeral shaft nonunions., Patients and Methods: Twenty-six patients (12 males, 14 females; mean age, 42.8 years; range 21 to 61 years) who underwent surgical treatment of humeral shaft nonunion either with DCP (n=13) or IRIN (n=13) between October 1999 and January 2008, were retrospectively analyzed. Treatment consisted of removing previous implants and DCP or IRIN fixation with additional autogenous bone grafts for atrophic nonunions. Union time, range of motion, radiographic length difference, Constant-Murley Scale (CMS), Disabilities of the Arm, Shoulder and Hand (DASH-T) and Mayo Elbow Performance Score (MEPS) were evaluated at a mean follow-up time of 59.5 months (range; 17 to 125 months)., Results: There was a statistically significant correlation among the functional scores of DASH-T, MEPS and CMS. No statistically significant difference was observed in the functional outcome between the groups (DCP and IRIN). Range of motion of the elbow joint was significantly impaired in three patients who were plated for distal shaft nonunions., Conclusion: Both DCP and IRIN provide satisfactory functional outcomes in the treatment of humeral shaft nonunions. Distal shaft nonunions may demonstrate a decrement in elbow motion associated with distal placement of plates.

Background: Mortality and morbidity in burn cases can be reduced with early diagnosis. Many markers are used for early diagnosis of burn complications like sepsis. In this current study, the relationship between numerical/morphologic granulocyte abnormalities and complications was investigated in pediatric burns. It was aimed to introduce histopathologic marker(s) for burn-related complications., Methods: Thirty-two pediatric burn cases hospitalized between December 2006 and December 2009 were included in the study. A total of 192 complete blood count and peripheral blood smear results were analyzed comparatively. Findings were used to identify any correlation among white blood cell count and peripheral blood smear changes (the appearance of immature granular cells, toxic granulation, purple granules and Döhle bodies) and complications such as bacteriemia, sepsis, wound infections, severe anemia, and graft failure., Results: White blood cell count changes and the appearance of immature granular cells were not suitable for use as a diagnostic marker for complications. Nevertheless, there was a statistically significant correlation between the appearance of toxic granulation, purple granules and Döhle bodies and subsequent complications (p: <0.0001, 0.041, 0.001, respectively)., Conclusion: Toxic granulation, purple granules and Döhle bodies appear to be helpful in predicting burn-related complications. Therefore, peripheral blood smear is a suitable test for predicting future complications.

Van der Woude syndrome is a congenital abnormality characterized by labial cysts, accessory salivary glands, pits, fistulas and paramedian sinuses of the lower lips, and is frequently associated with cleft lip and palate. This disease is the most common syndromic cleft abnormality. The disease is characterized by a single gene abnormality where craniofacial morphogenesis is affected. It has an autosomal dominant inheritance with involvement of 1q32-41 chromosomal locus. However, the gene expression profile is variable and the disease may present in some individuals with sinuses of the lower lips only. We present results of analysis of genetic penetrance in the pedigree of five cases with Van der Woude syndrome together with a review of the literature.

For the patient admitted with right lower quadrant abdominal pain, acute appendicitis is the most frequently considered diagnosis. Appendectomy is the most common of all emergency operations. However, there may be several reasons for left lower quadrant abdominal pain. Situs inversus totalis is an anomaly that occurs during embryonic development when intraabdominal and intrathoracic organs have reverse localization. In this case report, we present a patient who was admitted with left lower quadrant abdominal pain and was diagnosed as situs inversus totalis and acute appendicitis. In view of the legal repercussions for doctors as a result of erroneous diagnosis and treatment, we think that adequate evaluation of the studies in the emergency service is important and that the radiological investigations have to be used appropriately and sufficiently.

Widespread production of CTX-M type extended-spectrum beta-lactamases (ESBL) in Enterobacteriaceae strains which are resistant to extended-spectrum cephalosporins is the most remarkable example for rapid and global spread of plasmid mediated antimicrobial resistance in bacteria. Consecutive 200 ESBL producing Enterobacteriaceae strains out of 1640 isolates that were obtained from clinical samples (167 urine, 11 wound, 7 bronchoalveolar lavage, 3 peritoneal fluid, 2 cerebrospinal fluid, 2 biopsy, 2 tracheal aspirate, 2 conjunctiva, 1 abscess, 1 catheter) between February to July 2009 in our laboratory were included to this study. Among the 200 ESBL positive isolates 141 (70.5%) were Escherichia coli, 51 (26%) were Klebsiella pneumoniae, 5 (2.5%) were Enterobacter spp. and one of each (0.5%) Citrobacter freundii, Klebsiella oxytoca and Proteus mirabilis. ESBL positivity was 11% among the 123 community-acquired strains and 13% among the 77 hospital acquired strains, the statistical difference being insignificant (p > 0.05). The prevalence of bla(CTX-M) beta-lactamase genes were detected by multiplex polymerase chain reaction with the use of two general primer sets: CTX-MA1 and CTX-MA2 primers for the amplification of CTX-M-1, CTX-M-2 and CTX-M-9 enzymes group, and CTX825-F and CTX825-R primers for the amplification of CTX-M-8 and CTX-M-25 enzymes group. bla(CTX-M) genes were detected in 167 out of 200 strains (83.5%). CTX-M production rates in community and hospital acquired strains were found as 86.2% and 79.2%, respectively and no statistically significant difference was detected (p > 0.05). CTX-M producing strains were either E. coli (n = 132) or Klebsiella spp. (n = 35) and were expressing one of the enzymes from CTX-M-1, CTX-M-2 or CTX-M-9 groups. No strains carrying CTX-M-8 or CTX-M-25 group enzymes were detected. CTX-M production rates in ESBL producing E. coli strains in community and hospital were found as 92.5% and 95.7%, respectively, whereas the same rates for ESBL producing Klebsiella spp. strains were 67.8% and 66.7%. The difference between the CTX-M production rates of community and hospital acquired strains was not statistically significant (p > 0.05). In conclusion, CTX-M prevalence was found high in ESBL producing strains of both E. coli and Klebsiella spp. Since bla(CTX-M) gene acquisition usually results in the emergence of multiple drug-resistant Enterobacteriaceae strains, screening for CTX-M type ESBL production in the laboratory has an important impact on monitoring the resistant strains which have endemic potential.

In this study, the epidemiological, clinical, laboratory and therapeutic features of forty adult malaria patients referred our clinic between February 1996-September 2009, were assessed retrospectively. Diagnosis was established by Giemsa-stained thick and/or thin blood smears in all cases. Thirty-four patients were male and 6 patients were female and mean age was 31.1 years. All patients had a history of travel to endemic areas (24 cases to Africa, Afghanistan, Azerbaijan, Arabian Peninsula, 16 cases to Southestern Anatolia Region), and none of them had chemoprophylaxis. Plasmodium vivax was detected in 20 patients, and P.falciparum in 18 and mixed (P. vivax and P. falciparum) in two. Parasitemia ranged from 0.5%- 25%. Fever (100%), periodic fever (62.5%), splenomegaly (72.5%), hepatomegaly (45.0%), anemia (67.5%), leukopenia (32.5%), thrombocytopenia (75.0%), a rise in erytrocyte sedimentation rate (65.0%), abnormalities in hepatic enzymes (62.5%), hyponatremia (32.5%), hypoglisemia (25%) and an elevated serum creatinine level (27.5%) were determined in the patients. Two patients with P. falciparum developed acute renal failure and cerebral involvement died soon after admission. Acute renal failure, acute respiratory distress syndrome, cerebral involvement and dissemine intravasculer coagulation were observed in one patient with falciparum malaria who recovered completely. In conclusion, every febril patients with a history of travel to the endemic regions should raise the suspicion of malaria. Effective pre-exposure chemoprophylaxis and personal protection measures should be provided to travellers visiting endemic regions.

Objectives: Paraoxonase (PON1) is a high-density lipoprotein (HDL)-associated esterase that hydrolyses lipoperoxides. PON1 serves as a protective factor against oxidative modification of LDL, suggesting that it may play an important role in the prevention of atherosclerotic process. Research has focused on two polymorphisms: leucine (L allele) to methionine (M allele) substitution at codon 55, and glutamine (A allele) to arginine (B allele) substitution at codon 192., Study Design: We examined amino acid changes at codon 55 and 192 in the PON1 gene by polymerase chain reaction and using restriction enzymes in 120 patients (92 men, 28 women; mean age 48.2+/-4.3 years) with premature coronary artery disease (CAD) and in 102 healthy subjects (80 men, 22 women; mean age 46.8+/-5.2 years) with no history of CAD and a normal electrocardiogram., Results: Distribution of genotypes in the patient and control groups at codon 55 were 6.7% and 4.9% for MM, 46.7% and 29.4% for LM, 46.7% and 65.7% for LL, respectively. The frequency of genotypes at codon 192 were as follows: 4.2% and 2% for RR, 40% and 35.3% for QR, and 55.8% and 62.8% for QQ, respectively. While the frequency of PON1 55M allele was higher in the CAD group (0.3 vs. 0.2), PON1 192R allele frequency did not differ (p>0.05). There was a significant relationship between the PON1 M/L55 polymorphism and CAD (p=0.017), whereas the R/Q192 polymorphism was not associated with CAD (p=0.445)., Conclusion: These data suggest that the PON1 M/L55 polymorphism shows a significant relationship with CAD and the Q/R192 polymorphism is not a major risk factor causing susceptibility to CAD in our population.

Objectives: We evaluated late-term results of surgical repair and physical rehabilitation of isolated zone 3 extensor tendon injuries., Methods: Sixteen patients (13 males, 3 females; mean age 28 years; range 11 to 57 years) underwent surgical repair for isolated simple central slip injuries of zone 3 extensor tendon. Injuries involved the second, third, fourth, and fifth fingers in seven, three, two, and four patients, respectively. Primary tendon repair was performed in 14 patients. Two patients were treated after one week and two months following primary injury, respectively. Tendons were repaired by modified Kessler and epitendinous sutures in four patients, and by locking running suture in 12 patients. Following surgical repair, three patients underwent K-wire fixation in extension for two weeks, while 13 patients received the short arc motion protocol. The patients were assessed with respect to proximal interphalangeal (PIP) joint motion and extension loss. Functional results were assessed using the Strickland formula. The mean follow-up was 58 months (range 8 to 120 months)., Results: Full range of motion of the PIP joint was achieved in 15 patients (93.8%). The mean PIP joint motion was 98 degrees. One patient (6.3%) had an extension loss of 10 degrees in the range of motion of the PIP joint. There were no losses in the range of motion in three patients treated with K-wire fixation. The mean of the Strickland formula was 94.8% (range 74% to 100%), showing an excellent result in 15 patients (98.3%) and a good result in one patient (6.3%). All the patients returned to their pre-injury work status. None had buttonhole deformity or soft tissue complication., Conclusion: A proper suture technique combined with the short arc motion protocol provides good results in the treatment of isolated zone 3 extensor tendon injuries.

Objectives: We evaluated the indications and disadvantages of percutaneous technique for proximal humerus fractures in relation to complications encountered in osteoporotic elderly patients and the importance of patient selection., Methods: The study included 18 patients (10 men, 8 women; mean age 48 years; range 14 to 89 years) who underwent percutaneous fixation (closed reduction and pin fixation with K-wires or Schanz screws) for proximal humerus fractures. Eight patients were beyond 60 years of age. According to the Neer classification, five patients had two-part, 13 patients had three-part neck fractures. The patients were evaluated with range of motion of the shoulder, radiographs, and the Disability of Arm Shoulder and Hand questionnaire (DASH). The mean follow-up was 23 months (range 8 to 60 months)., Results: The mean shoulder abduction was 134 degrees (range 30 degrees to 160 degrees) and the mean elevation was 118 degrees (range 30 degrees to 140 degrees). Full range of motion of the shoulder was achieved in 11 patients (61.1%), including all with two-part fractures. Abduction losses of 60 degrees to 130 degrees and less than 30 degrees were seen in four patients and three patients, respectively, all of whom were older than 60 years. The mean DASH score was 18 (range 0 to 77). Fourteen patients having a score of less than 10 had no pain or functional complaints. Four patients with a score of more than 10 were older than 70 years. Pin migration was observed in seven patients (38.9%), all of whom were over 60 years of age. One patient required revision with partial prosthesis. Nonunion was seen in one patient (5.6%) and malunion with a varus/valgus deformity occurred in four patients (22.2%). None of the patients developed avascular necrosis., Conclusion: Percutaneous fixation may be preferred in the treatment of two-part and carefully-selected three-part proximal humerus fractures. Due to high complication rate, patient selection is of primary importance among elderly patients.

Objectives: We evaluated long-term results of treatment including creation of a gutter and muscle transposition in patients with chronic sclerosing osteomyelitis (CSO)., Methods: Between 1980 and 1996, 11 patients (5 women, 6 men; mean age 36 years; range 17 to 69 years) with CSO were treated with creation of a gutter and muscle transposition. Seven patients had femoral, and four patients had tibial involvement. The main complaint was pain. The patients were evaluated with respect to complaints and radiologically (X-ray, computed tomography, and magnetic resonance imaging) after a mean follow-up of 12.4 years (range 6 to 24 years)., Results: During the follow up period, all the patients remained symptom-free without the need for antibiotic treatment except for one patient with tibial involvement, whose pain recurred after five years. The patient's complaint disappeared following reoperation with the same technique. Histologic examination of surgical biopsies showed nonspecific changes consistent with low-grade chronic osteomyelitis. Cultures were negative in all cases. Control radiographies showed no progression of sclerosis. Computed tomography showed cortical bone formation surrounding the transposed muscle, and magnetic resonance imaging showed fatty degeneration in the transposed muscle, without any signs of active osteomyelitis., Conclusion: The aim of gutter creation and muscle transposition is to increase blood supply to the diseased bone segment, without the need for microsurgical interventions and secondary reconstructive procedures. Our long-term results show that this technique is efficacious in patients with femoral and tibial involvement.

Objectives: Patients who underwent surgery for thyroid masses were evaluated with regard to clinical symptoms, diagnostic and treatment methods, and the results of treatment., Patients and Methods: The study included 92 patients (72 women, 20 men; mean age 45 years; range 16 to 71 years). Clinical diagnoses were based on findings of ultrasonography, thyroid function tests, thyroid scintigraphy, and fine-needle aspiration biopsy. Operations performed were near-total thyroidectomy (n=40), hemithyroidectomy (n=25), bilateral subtotal thyroidectomy (n=16), and total thyroidectomy (n=11). Patients with carcinoma associated with neck lymph node metastasis also underwent lateral, anterolateral, modified radical, or radical neck dissections., Results: Postoperative histopathologic diagnoses were benign colloid nodule (n=70), papillary carcinoma (n=16), medullary carcinoma (n=2), anaplastic carcinoma (n=2), and Basedow-Graves disease (n=2). Unilateral vocal cord paralysis developed in 11 patients (11.9%), five of which persisted beyond one year follow-up. Two patients (2.2%) had transient hypocalcemia and one patient (1.1%) had postoperative hematoma., Conclusion: Preoperative determination of the structure and confines of thyroid masses increases success rates of surgical procedures and minimizes complication rates.

Objectives: We compared two mini skin incision techniques utilized in the treatment of carpal tunnel syndrome (CTS)., Methods: Twenty-seven patients who underwent surgery for CTS were evaluated in two groups according to the site of the mini incision performed for surgical release. A single mini skin incision was performed over the transverse carpal ligament in 12 patients (group 1; 17 hands; 1 man, 11 women; mean age 55 years; range 38 to 66 years), and on the distal side of the ligament in 15 patients (group 2; 17 hands; all women; mean age 54 years; range 34 to 71 years). The two groups were compared with regard to improvement in pain and numbness, rigidity and sensitivity of the scar tissue, time to use the hands, and palmar pinch and grip strengths. The mean follow-up was 26.6 months in group 1, and 23.7 months in group 2., Results: Complete disappearance of symptoms was obtained in 14 wrists (82.4%) in group 1, and in 15 wrists (88.2%) in group 2, with no significant difference between the two groups (p>0.05). Rigidity and sensitivity of the scar tissue were seen in nine wrists (52.9%) in group 1, and in two wrists (11.8%) in group 2 (p<0.05), which lasted 3.5 months and 1.5 months, respectively. In group 2, time to use the affected hand for basic needs (9 days) and normal function (21 days) was significantly shorter, compared to 18 days and 35 days in group 1, respectively (p<0.05). The mean differences of grip and pinch strengths of the two hands were -2.78 kg and -0.60 kg in group 1, and -0.77 and -0.46 kg in group 2, respectively (p>0.05)., Conclusion: Although both methods of release yield satisfactory results in the mid- and long-term, mini skin incision performed on the distal side of the transverse carpal ligament is associated with less incision-related morbidity.

Objectives: The purpose of this study was to evaluate early postoperative biomechanical changes in plicated joint capsules and to determine the effect of debridement to create a bleeding inner capsular surface on the healing process., Methods: Fifty-four mature New Zealand white rabbits were used. Plication was performed in unilateral medial knee joint capsules of 48 rabbits either alone (n=24) or following debridement (n=24) to create a bleeding inner capsular surface. Six rabbits remained untreated for the control group. The operated knee joints were immobilized in flexion postoperatively. The rabbits from the two study groups were sacrificed in groups of six immediately after operation, in the first, second, and third weeks, of which five were evaluated in tensile tests and one was evaluated histologically., Results: Compared to the controls, tensile strengths were significantly higher in both study groups until the third week (p<0.01), after which the difference became insignificant (p>0.05). The strength of the plicated capsules was significantly higher in the first week in both study groups than those measured in subsequent weeks (p<0.01), whereas similar tensile strengths were recorded in the second and third weeks (p>0.05). Compared to its absence, the use of debridement was associated with a significantly lower strength in the first week (p<0.01), but this difference was not observed afterwards (p>0.05). Histological findings were similar in the two study groups and were characterized by healing with increased fibrosis starting from the first week., Conclusion: A plicated capsule would not be weaker than an intact one. Our findings do not favor debridement for a more rapid and better healing process. Rather, it might have adverse effects on the biomechanical properties of the capsule.

Objectives: In external fixation, the type and configuration of K-wires have a considerable effect on fixation stability. Indications for external fixation have recently increased in the treatment of various musculoskeletal pathologies in osteoporotic patients. This biomechanical study was designed to determine the effect of surgical washers used with olive wires on surface kinetics of the cortical bone., Methods: The study included 32 tibiae obtained from one-year-old sheep. Samples were prepared from the proximal parts of the tibiae which were then divided into four groups equal in number. A 1.8-mm olive K-wire was inserted into the proximal metaphyseal regions of the tibiae. Except for the control group, surgical washers were used with olive K-wires in the three study groups, with diameters of 5 mm, 7 mm, and 10 mm, respectively. The samples were then placed in a specially designed servo-hydraulic universal testing machine for static tensile test at 10 mm/min., Results: The mean failure load was 806.9 N in the control group, compared to 1285.9 N, 1317.9 N, and 1345.9 N in the three groups in which 5-mm, 7-mm, and 10-mm surgical washers were used, respectively. While there were significant differences between the control and study groups (p<0.0001), failure loads did not differ significantly between the three study groups (p=0.574)., Conclusion: The use of surgical washers in combination with olive K-wires offers a significant advantage to increase stability and to decrease surface pressure. We recommend utilization of washers for external fixation surgery in osteoporotic patients and osteoporotic bone segments.

Objectives: The purpose of this study was to evaluate the effect of dorsal cortical comminution on radiographic outcome of unstable distal radius fractures after treatment with closed reduction and K-wire fixation., Methods: Forty-two patients were treated with closed reduction and K-wire fixation for unstable, extra-articular distal radius fractures with dorsal angulation. The patients were evaluated in two groups depending on the presence or absence of dorsal metaphyseal cortical comminution observed as a radiopacity on lateral radiographs. Thus, 30 patients (13 males, 17 females; mean age 56 years; range 22 to 77 years) did not have dorsal cortical comminution, whereas 12 patients (8 males, 4 females; mean age 48 years; range 18 to 76 years) did. The mean follow-up period was 8.8 months (range 3 to 106 months) in the former, and 5.5 months (range 3 to 131 months) in the latter groups. Radiographic parameters were compared including palmar tilt measured on lateral, radial inclination and radial length on posteroanterior radiographs obtained before treatment and after union., Results: Radial inclination, palmar tilt, and radial length showed significant improvements in both groups (p<0.05). The results were acceptable in all the patients with achievement of standard reference values. The presence of dorsal cortical comminution did not have any significant effect on radiographic parameters (p>0.05). No significant complications were encountered during the follow-up period., Conclusion: Dorsal cortical metaphyseal comminution does not have an adverse effect on radiographic results. Treatment with closed reduction and K-wire fixation is safe and effective even in the presence of dorsal cortical comminution.

Objectives: The aim of this study was to evaluate the accuracy of diagnostic tools in comparison with surgical results of occult ganglion cyst of the wrist, which is one of the causes of chronic wrist pain., Methods: Twenty-five patients (4 males, 21 females; mean age 29 years; range 16 to 46 years) underwent surgery with an initial diagnosis of occult ganglion following unsuccessful conservative treatment. The mean symptom duration was 29 months (range 3 months to 10 years). Diagnosis was based on finger extension test performed in 24 patients. Six patients and 13 patients were assessed by ultrasonography and magnetic resonance imaging (MRI), respectively. Interosseous neurectomy was performed in three patients. The mean follow-up was 31 months (range 6 to 72 months)., Results: Occult dorsal ganglion was resected from the scapholunate interval in 22 patients (88%). No ganglion was found in three patients, who had only degeneration of the scapholunate ligament. Finger extension test was positive in 23 patients. One patient with a negative test result was found to have degeneration of the scapholunate ligament. The test yielded two false positive results, one of which was negative by MRI. Surgical confirmation was achieved in 11 patients evaluated by MRI and in four patients evaluated by ultrasonography. Diagnostic accuracy rates for MRI, ultrasonography, and finger extension test were 92%, 66%, and 92%, respectively. Two patients (8%) underwent reoperation for recurrence. None of the patients complained of instability in the late period. Except for one patient, all patients (96%) were asymptomatic at final evaluations., Conclusion: Finger extension test is an important diagnostic tool for occult ganglion with 92% accuracy. Both diagnosis and treatment of occult ganglion cysts have become easier by evolving diagnostic tools.

The surface of diarthrodial joints is covered by hyaline cartilage whose regeneration capacity is extremely limited. Conventional surgical techniques enable repair of full-thickness articular cartilage defects only by fibrous cartilage having poor mechanical properties. Recently, new techniques have been developed to provide hyaline or hyaline-like repair tissue in the treatment of full-thickness cartilage defects. Autologous osteochondral transplantation involves press-fit implantation of both bone and cartilage obtained from healthy articular surface. The principal indication for this technique is unifocal full-thickness chondral or osteochondral defects measuring 1 to 4 square centimeters. This surgical procedure can be performed openly or arthroscopically. The graft should be placed vertically and evenly to the joint surface. Although short-term and mid-term results are satisfactory, several problems have been reported including donor site morbidity, damage to cartilage, and incongruity and incorporation of the graft. Autologous osteochondral transplantation provides viable osteochondral units at a single stage and eliminates the need for culturing chondrocytes which is quite expensive. Currently, no surgical technique or medical treatment provide complete healing of articular cartilage defects. Autologous osteochondral transplantation is an important stage worthy of improvement in this respect.

Pleural effusion is a relatively infrequent finding in multiple myeloma (MM) and malign effusions due to myelomatous effusion is seen very rarely. In this article we reported a case with bilateral myelomatous effusion. Myelomatous etiology was detected by demonstrating gammopathy in pleural fluid protein electrophoresis and demonstrating abundant number of atypical plasma cells in pleural fluid cytology. Pleural fluids due to MM are usually seen in IgA type of MM's, IgG on the surface of CD-138 positive cell was demonstrated in flow cytometric study of the pleural fluid of the reported case. In conclusion we mentioned that a patient who does not have diagnosis of MM before may present with pleural involvement, the involvement may be bilateral and flow cytometry can be used in diagnosis.

A 47-year-old male patient had undergone endoscopic balloon dilatation six times due to pyloric stenosis however the result was not satisfying. Surgical treatment was considered. Chest X-ray revealed free sub-diaphragmatic air but there were no acute abdomen signs clinically. In abdominal computerized tomography, there were small intestinal loops anterior to the liver and there was gas collection, which can not be differentiated exactly between an extraluminal free air and the one in the bowel wall of adjacent small bowel segments. In the emergency surgery cysts filled with gas in the wall of distal ileal segments were seen. Pneumatosis intestinalis should be kept in mind in the differential diagnosis of free intraabdominal air.

Objectives: We evaluated vascular problems in patients who were planned to receive posterior interosseous artery (PIA) flap for soft tissue defects in the dorsal hand, thumb, and the first web., Methods: The study included 25 male patients (mean age 27 years; range 12 to 54 years) in whom reconstruction was planned with the use of the reverse PIA flap. The defects were in the following localizations: the dorsal hand (n=15), the first web (n=5), hypothenar region (n=3), and the palmar aspect of the wrist (n=2). The frequency of anatomic variations and complications were evaluated., Results: The use of the PIA flap was cancelled in one patient (4%) due to an anatomic variation of the PIA in the forearm. The vascular pedicle of the flap was removed because of insufficient arterial perfusion due to the absence of distal carpal anastomosis and the donor tissue was used as a free flap in two patients (8.3%). The remaining 22 patients who received pedicled flaps were followed-up for a mean of 3.2 months (range 1.5 to 6.5 months), during which six patients (27.3%) developed venous insufficiency. A superficial vein anastomosis was performed in five patients within the first 24 hours, which resulted in complete improvement. One patient was not available for venous anastomosis and developed flap necrosis. The occurrence of venous insufficiency was not correlated with the timing of flap surgery, the size of the flap, and the placement of the flap pedicle (p>0.05)., Conclusion: The use of the reverse PIA flap is appropriate for soft tissue defects in the dorsal hand, thumb, and the first web. However, the frequency of anatomic variations and vascular complications is higher compared to other reverse pedicled flaps.

Background: To investigate the effects of postoperative early enteral and glutamine enriched enteral feeding on the healing of experimental colonic anastomosis., Methods: Forty Wistar-albino rats were equally divided into 4 groups. Colonic transsection and anastomosis situated at the distal left colon was performed on all animals. Animals in groups 1 and 2 received late total enteral nutrition (TEN) and in groups 3 and 4 early TEN. Glutamine was added to TEN protocol in groups 2 and 4. The colonic segment including the anastomosis was excised at the end of the 7th day postoperatively. Bursting pressure of the anastomosis and tissue hydroxyproline levels were determined., Results: Bursting pressure levels were 111.6 and 95.8 centimeters of water (cmH(2)O) in early and late nutrition groups, respectively (p=0.022). Comparison of late TEN groups showed a significant difference in favor of group with glutamine (95.8 vs 138.5 cmH(2)O; p<0.0001). Highest bursting pressures (139 and 138.5 cmH(2)O) were measured in both early and late TEN groups with glutamine. Tissue hydroxyproline level in early TEN group (2440.3 microg) was significantly higher than late TEN group (1509.6 microg; p=0.024). Comparison of late TEN groups showed a considerable but not statistically significant difference (p=0.276) in favor of group with glutamine (1509.6 vs 1981.6 microg)., Conclusion: Postoperative early TEN significantly ameliorates the resistance of the anastomosis and collagen synthesis. Glutamine enrichment in nutritional protocol decreases and reverses the disadvantages of late TEN regarding the resistance of anastomosis. A similarly positive, albeit weaker, effect of glutamine supplementation is also seen on collagen synthesis.

Tracheobronchial foreign body aspiration is uncommon in adults and one etiologic factor is laryngeal surgery. A 50-year-old male patient presented with cough, high fever, and severe dyspnea three months after partial laryngectomy for squamous cell carcinoma of the larynx. A computed tomography scan of the thorax showed a hyperdense mass lesion in the right main bronchus, suggesting a foreign body. Diagnostic bronchoscopy was performed under general anesthesia and a small bone fragment, 2 x 1.3 cm in size, was removed from the right bronchial lumen. The patient showed slow improvement due to prolonged atelectasis until complete clinical and radiologic recovery.

Objectives: We compared the electrophysiologic and histopathologic results of grafting and distraction methods in the treatment of defective peripheral neural injuries., Methods: Thirty male white rabbits (age 6 months) were divided into three groups and a circular external fixator (CEF) was applied to the right tibias. In group I (primary repair), the right deep peroneal nerve was cut without inducing any defect and a tibial osteotomy was performed. The remaining groups underwent bone and nerve excision of about 1 cm in the middle third of the tibia. In group II, the defect area was closed acutely with the CEF and the continuity of the nerve was restored. In group III, a nerve graft obtained from the left side was placed in the defect area and an epiperineural repair was made. Group II underwent distraction 21 days after surgery for 10 days with a rate of 0.25 mm four times a day. Electrophysiological studies were performed in the 12th and 24th weeks and nerve biopsies were obtained in the 32nd week for histopathologic examination., Results: Electrophysiological studies in the 12th week did not show any significant differences in nerve conduction between the three groups; however, in the 24th week, amplitude and latency values of the graft group were 50% lower than those of the primary repair and distraction groups (p<0.05). On histological examination, the results were good in group I and II, but poor in group III with respect to nerve fiber density, thickness of the myelin sheath, degenerative changes in the myelin sheath, and average axon number., Conclusion: Our data demonstrate that treatment of neural defects by the distraction method results in much better results than the grafting method.

Objectives: Postoperative nausea and vomiting prolong the time spent in postanesthesia recovery units. In this study, we investigated the effect of neostigmine and atropine combination, used to avoid residual curarization, on nausea and vomiting., Methods: The study included 40 ASA I-II patients who were planned to have a short-term arthroscopic operation. The patients were administered a single dose of 0.4 mg/kg atracurium besylate for muscle relaxation, and then, were randomly divided into two groups. In group I, neuromuscular blockade was eliminated with 1.5 mg neostigmine and 0.5 mg atropine, whereas group II patients underwent spontaneous resolution. The patients were evaluated for nausea and vomiting and the need for antiemetic drugs in the recovery unit, patient room, and on the postoperative second day., Results: There were no significant differences between the two groups with respect to hemodynamic parameters and peripheral oxygen saturation. The mean operation time did not differ significantly (p>0.05), but the mean extubation time was significantly shorter in group I (p<0.05). No significant differences were observed for the occurrence of nausea and vomiting and the need for antiemetic drugs in the recovery unit, patient room, and on the postoperative second day (p>0.05)., Conclusion: In patients undergoing arthroscopic surgery, it is safe to use neostigmine and atropine combination before extubation to avoid residual neuromuscular blockade associated with the use of non-depolarizing myorelaxants.

Objectives: This study was designed to compare the biomechanical characteristics of non-anatomic (far from joint) and anatomic (close to joint) levels of tibial tunnel fixation with soft tissue graft using a soft tissue interference screw in anterior cruciate ligament (ACL) reconstruction., Methods: Twelve bovine tibiae and digital extensor tendons were divided into two homogeneously equal groups after removing soft tissues. Tibial tunnels were prepared with a 7-mm drill with the use of an ACL guide adjusted to 45 degrees . Each tunnel was then dilated to 9 mm in 0.5 mm increments. Digital extensor tendons were fixed at non-anatomic (group I) or anatomic (group II) tibial tunnel levels with a soft tissue metal interference screw, 9 x 30 mm in size. All the specimens were cycled 500 times from 50 to 250 N with 1 Hz frequency in a servo-hydraulic testing machine followed by ultimate load at-failure testing at a rate of 20 mm/min. Statistical analyses were made using the Mann-Whitney U-test., Results: The mean screw insertion torque values were 8.2+/-2.4 Nm and 7.8+/-2.3 Nm in groups I and II, respectively (p=0.88). The mean values of graft displacement (1.9+/-0.75 mm versus 2.2+/-1.2 mm, p=0.63) and stiffness (132.72+/-10.93 N/mm versus 125.14+/-15.93 N/mm, p=0.63) did not differ significantly., Conclusion: The biomechanical properties of ACL reconstruction with soft tissue graft fixation using a soft tissue interference screw are not influenced by the level of tibial tunnel fixation.

Objectives: We investigated the biomechanical characteristics of anterior or posterior tibial tunnel placement of the soft tissue graft with a soft tissue interference screw in anterior cruciate ligament (ACL) reconstruction., Methods: Twelve bovine tibiae and digital extensor tendons were divided into two homogeneously equal groups after they were stripped of all soft tissues. Tibial tunnels were prepared and digital extensor tendons were fixed at nonanatomic (apart from the joint) anterior (n=6, group I) or posterior (n=6, group II) tibial tunnel positions with a soft tissue metal interference screw, 9x30 mm in size. All the specimens were cycled 500 times from 50 to 250 N at 1 Hz frequency in a servo hydraulic test device, after which ultimate load-at-failure testing was performed at a rate of 20 mm/min., Results: The mean screw insertion torque values were 8.2+/-2.4 Nm and 8.4+/-2.8 Nm in groups I and II, respectively (p=0.88). No significant differences were found between the two groups with respect to graft displacement (1.9+/-0.8 mm vs 2.3+/-0.4 mm; p=0.38) and stiffness (132.7+/-10.9 N/mm vs 126.4+/-8.5 N/mm, p=0.98) at the end of cyclic loading., Conclusion: Our results show that the site of nonanatomic soft tissue graft fixation in the tibial tunnel (anterior or posterior) with a soft tissue interference screw do not affect the biomechanical parameters in ACL reconstruction.

Growing participation of children in sports has resulted in an increased incidence of sports injuries. Although methodological differences in epidemiologic studies largely prevent precise comparisons, it appears that young athletes participating in combat and contact sports seem to be more prone to injuries. Knee and ankle injuries are the most commonly encountered problems and chronic events are more prevalent than acute ones. The occurrence of athletic injuries is multifactorial and may present differences with respect to sex and the sports branch involved. An analytical approach of all relevant groups (parents, coaches, physical education teachers, health personnel) is necessary to understand, treat, and prevent athletic injuries in children.

Anterior cruciate ligament (ACL) reconstructions in skeletally immature patients present unique difficulties, one major concern being reconstruction-induced growth disturbances. Another issue is the failure of adolescent patients to comply with the treatment programs. Initially, activity limitations and bracing can be recommended for isolated ACL tears in young skeletally immature adolescents who are at stages I, II, and III according to the modified Tanner classification, and for whom reconstruction can be delayed until completion of skeletal maturity provided that any joint instability or meniscal injury do not develop. For symptomatic patients, partial or complete transphyseal techniques or complete transphyseal reconstruction with doubled or quadrupled hamstring tendon grafts can be applied, with special care being afforded to keep clear distance between fixation materials and the physeal plates. In patients who are at pubertal stages of IV or V or with skeletal ages above 13 (F) or 14 (M) years, a transphyseal reconstruction with hamstring autografts seems to be the best solution. It should be kept in mind that functional outcomes of ACL reconstructions in skeletally immature patients are inferior to those obtained in adults even after a prudent surgical approach without associated growth disturbances.