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Bu çalışmanın amacı, çevreci bir teknoloji olan ORC sistemlerinin örnek olarak ele alınan bir kruvaziyer ve Ro-Ro gemisinde kullanımının liman sahaları üzerindeki potansiyel çevresel etkilerini ortaya koymaktır. Bu kapsamda 2017 yılı içerisinde Çeşme Limanı’na giriş-çıkış yapan bir yolcu gemisi ile bir Ro-Ro gemisinin ayrılma ve yanaşma sırasındaki manevra süreleri ile limanda kaldıkları süreler ele alınarak, gemilerin liman içerisindeki bir yıllık toplam yakıt tüketimleri hesaplanmıştır. Literatürde yer alan, termal verim değeri valide edilmiş bir gemi ORC sistemi ele alınarak, atık ısı geri kazanımı ile kazanılabilecek potansiyel yakıt tasarrufu ve egzoz salımlarındaki azalma miktarları hesaplanmıştır. Buna göre, manevra sürecine kıyasla, CO2 salımının kruvaziyer gemisi için %73,56’sı, Ro-Ro gemisi için %84,60’ı liman sürecinde gerçekleşmiştir. ORC sistemlerinin kurulumu ile liman sahası içerisindeki operasyonlardan kaynaklı yakıt tüketiminden iki gemi için toplamda bir yılda 107,77 MT ve buna bağlı olarak tüm salımlardan yıllık olarak %12,33 oranında tasarruf elde edilebileceği sonucu ortaya çıkmıştır., The aim of this study is to reveal the potential environmental effects of the utilization of ORC systems on a reference cruise and Ro-Ro ships on port areas. In this context, the one-year total fuel consumption of the ships in the port was calculated by considering the time spent on manoeuvrings during departure and berthing and the time they stayed in the port while entering and leaving Çeşme Port in 2017. A marine ORC system with a validated thermal efficiency value in the literature is taken into consideration for calculating the potential fuel savings and reduction in exhaust gas emissions that can be gained by waste heat recovery. Accordingly, 73.56% of the CO2 emissions for the cruise ship and 84.60% for the Ro-Ro ship occurred during the port stays when compared to the maneuvering periods. It is concluded that a total of 107.77 MT of fuel consumption and accordingly 12.33% of all emissions caused by the operations of the two ships in the port area can be saved annually with the installation of ORC systems onboard.

Bu çalışmanın amacı, IC Çeşme Marina içerisindeki yatların yanaşma ve kalkış manevraları sırasında ortaya çıkan karbon salım miktarlarını hesaplamayı amaçlamaktadır. Bu çalışmayı gerçekleştirmek için Çeşme marinadan yatların bir yıllık giriş-çıkış verileri, boyut ve makine bilgileri alınmıştır. Marinada yatların 3 knot hızla giriş çıkış kuralına uydukları varsayılmış, buna göre yakıt tüketimleri, makine yükü ve salım hesaplamaları yapılmıştır. Liman sahasından çıktıktan sonra da MCR’de gittikleri kabulü yapılmıştır. Ayrıca teorik hesaplar Çeşme marinadaki 3 millik alanı kapsayacak şekilde gerçekleştirilmiştir. 2017 yılı içerisinde yatların Çeşme marinada yaptıkları CO2 gazı salım miktarı hesaplanmış ve sonuç bölümünde bu miktarı azaltmak için yapılabilecek çalışmalara değinilmiştir. Hesaplar yapılırken 1,2 km’lik alan marina sahası olarak alınmış, geri kalan 4,3 km ise açık deniz bölgesi olarak adlandırılmıştır. Marina sahasında 6423,69 kg, açık denizde 10352,24 kg olmak üzere toplam 16775,94 kg ortalama karbon salımı gerçekleştiği hesaplanmıştır. Bu çalışma, Çeşme marina sahası içerisindeki yatlardan kaynaklanan egzoz salım envanterini ortaya koymaktadır. Salım değerlerinin düşürülebilmesi için yatlarda yenilenebilir enerji kullanımının yaygınlaşması gerekliliği gösterilmiştir.

AIM: To find out the anatomical changes in spine and pelvis, and the impact of various breast size-4-x display--inline-block" style="background: var(--highlight-yellow); color: inherit;">sizes of women on the quality of life. MATERIAL and METHODS: Sixty women with back pain volunteered to participate in this study. Their body mass index (BMI) was calculated. Clinical evaluation of the pain was assessed using the Oswestry Disability Index and visual analogue scale. Breast volumes were measured using the Grossman Rounder device. Scoliosis radiograms were obtained, and the cervical lordosis, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic incidence and pelvic tilt angles were measured in patients. The relationship between the increasing breast size and BMI was investigated through all these parameters. RESULTS: Increase in breast size positively changes the sagittal balance (r=0.356, p=0.005) and increases cervical lordosis (r=0.300, p=0.020). Increase in BMI leads to a positive sagittal balance (r=0.329, p=0.010) and increases the pelvic tilt (r=0.460, p=0.000). In patients with a positive sagittal balance, the sacral slope (r=-0.350, p=0.006) and the lumbar lordosis angle decrease (r=-0.552, p=0.000), whereas the pelvic tilt increases (r=0.298, p=0.021). CONCLUSION: Macromastia has an impact on cervical lordosis and sagittal balance, while indirectly impacting the pelvic tilt rather than the thoracic kyphosis and lumbar lordosis.

AIM Schwannomas are the most common benign tumors of the peripheral nerve. Surgery is indicated in patients with progressively increasing tumor volume, pain, paresthesia, and progressively worsening neurological deficits. CASE DESCRIPTION This article presents the case of a 32-year-old female patient with schwannoma. The patient had swelling on the anterior aspect of her right foot for a year. Her pain increased over the past 2 months, and a positive Tinel sign was present over the swelling. Magnetic resonance imaging revealed a large schwannoma mass in the deep peroneal nerve. The patient's large schwannoma was completely excised along with its capsule. CONCLUSION Schwannomas are benign tumors of the peripheral nerves that rarely exhibit malignant transformation. Treatment is considered to be curative if complete resection is achieved.

Bir örgütün toplum ve paydaĢları tarafından nasıl görüldüğünü yansıtan kurumsal imaj, toplumun ve paydaĢların örgüte iliĢkin davranıĢları, tutumları ve kararları ile iliĢki halindedir. Bireylerin hatta devletlerin bile çok önemsediği sağlık konusunda da tüketicilerin birçok davranıĢı, tutumu ve kararı kurumsal imaj algısı ile iliĢki halindedir. Bu çalıĢma ile sağlık tüketicilerinin kurumsal imaj algısı ile hastane bağlılığı arasındaki iliĢkinin özel hastaneler açısından ortaya konulması amaçlanmıĢtır. AraĢtırma, Eylül 2018’de Ġstanbul’da gerçekleĢtirilmiĢtir. AraĢtırma verileri Ġstanbul’da ikamet eden ve 18 yaĢını doldurmuĢ bireylerden toplanmıĢtır. AraĢtırmada veri toplamak için anket yöntemi kullanılmıĢ ve geçerli olan 386 adet anket formu değerlendirilmeye alınmıĢtır. Yapılan analizlerde tanımlayıcı istatistikler hesaplanmıĢ ve Spearman's korelasyon analizi yapılmıĢtır. AraĢtırma sonuçlarına göre, kurumsal imaj algısı ile hastane bağlılığı arasında istatistiksel olarak anlamlı, pozitif yönlü ve yüksek düzeyde iliĢki olduğu belirlenmiĢtir. Yine araĢtırma sonuçlarına göre, katılımcıların kurumsal imaj algısının olumlu olduğu, hastane bağlılığı düzeyinin ise, orta düzeyde olduğu belirlenmiĢtir. Kurumsal imaj algısının sağlık tüketicilerinin hastane bağlılığı ile olan iliĢkisi ve olumlu kurumsal imaj algısının hastanelere sağladığı faydalar dikkate alındığında, kurumsal imaj algısının olumlu olabilmesi için hastane yönetimlerinin, hastanenin fiziki koĢullarda ve görünümünde iyileĢtirmeler yapmak, çalıĢanların kurumu en iyi Ģekilde temsil etmesini sağlamak, kaliteli hizmet sunmak, sosyal sorumluluk faaliyetlerini yerine getirmek, sosyal medya platformlardaki paylaĢımları ve basını takip etmek, paydaĢları ve kamuoyunu bilgilendirmek, yaĢanan mağduriyetlere hızlı bir Ģekilde müdahale etmek gibi çalıĢmalarda bulunması önerilmektedir.

Objective: We aimed to investigate the effectiveness of the amount of polymethylmethacrylate used in pain control and maintenance of long-term vertebra corpus height in patients undergoing percutaneous vertebroplasty due to osteoporotic compression fracture of the lumbar vertebra. Method: A total of 60 patients who underwent unilateral percutaneous vertebroplasty between 2014 and 2019 due to osteoporotic compression fracture of the lumbar vertebrae were included in the study. Patients who received 5 ml and 3 ml cement injection were retrospectively analyzed. Of patients, postoperative visual analogue scale (VAS) score and anterior vertebral height of the patients at 1st-year control were evaluated. Results: In the postoperative period, the mean visual analogue scale score was 2.3±0.46 in the 5 ml injected group and 2.2±0.4 in the 3 ml injected group (p5 ml=0.001, p3 ml= 0.001). There was a statistically significant decline in pain control in both groups. The mean anterior vertebral height loss (AVHL) in the 5 ml injected group was 31.5±0.40%, and 32.6±0.47% in the 3 ml injected group (p5 ml=0.820, p3ml= 0.870). There was no statistically significant alteration in both groups. Conclusion: Our results indicate that the 3 ml polymethylmethacrylate injection during the percutaneous vertebroplasty procedure provides adequate pain control and stabilization in patients with lumbar vertebral osteoporotic fracture. Therefore we think that small amount of polymethylmethacrylate (3 ml) is sufficient to avoid undesirable complications in this patient group.

Aim To evaluate the relationship between the time from termination of anticoagulant/antiplatelet medication to surgery and the risk of acute postoperative hemorrhage in CSDH patients. Material and methods A retrospective study of patients who underwent bur hole craniotomy for CSDH between December 2014 and December 2019 was performed. Demographic and clinical data of age, gender, medication (antithrombotic therapy), smoking, daily alcohol consumption, history of head trauma, presenting symptoms and neurological examination were collected from medical records. Patients were divided into 3 groups according to the time of surgery from referral; 1st group: within 24 hours; 2nd group: between 24 to 72 hours; 3rd group: after 72 hours. Results In the 5-year period, 117 patients underwent CSDH surgery. 72 of 117 patients were male (61.5%) and 45 of 117 patients were female (38.5%). The mean age was 70.5 ± 7.2 years. Postoperative ASDH was observed in 2 of 32 patients (6.3%) without any antithrombotic medication history and 6 of 85 patients (7.1%) with previous antithrombotic medication history. Preoperative antithrombotic drug usage was not statistically significant in terms of acute complication development (p = 0.797). Conclusion In this study, we found that the risk of acute hemorrhage due to antithrombotic medication did not differ from those who were not under the medication. Although it is reported in the literature that antiaggregant and anticoagulant drugs should be discontinued between 5 and 7 days before the surgical procedure, our results showed that acute hemorrhage was not detected in any of the patients operated 72 hours after referral.

Katar, Salim (Balikesir Author), Introduction and Aim: Chiari malformation is a congenital anomaly formed as the result of the herniation of posterior fossa structures through the foramen magnum toward the spinal canal. In this study, we aimed to present the improvement rate regarding the herniation in cerebellar tonsils following shunting procedures in patients with Chiari malformation and associated hydrocephalus. Method: We measured in mm the improvement rate regarding the herniation in cerebellar tonsils in postoperative cervical MRI images obtained following ventriculoperitoneal shunting procedures for hydrocephalus in adult patients with symptoms of Chiari malformation such as balance disorder, dizziness, numbness and loss of muscular strength at the hands who were diagnosed with Chiari malformation and hydrocephalus following cranial and cervical magnetic resonance imaging (MRI). Results: A total of fifteen adult patients in whom the cerebellar tonsillar herniation was over 5 mm and accompanied by hydrocephalus were included in our study. The measure of herniation in the patients involved in the study was between 1.11 cm and 8 mm. The amount of improvement in herniation following the shunting procedure was between 7.76 mm and 2.2 mm. Conclusion: In patients with Chiari malformation associated with hydrocephalus, cerebellar tonsillar herniation can regress to 5 mm, which is considered as physiological, and the symptoms related to Chiari malformation can disappear. When Chiari malformation is associated with hydrocephalus, the tonsillar herniation may improve, and symptoms may disappear following the ventriculoperitoneal shunting procedure for hydrocephalus without necessitating posterior decompression for Chiari-related herniation.

Amaç: Bu çalışmanın amacı, düşük ayak gelişiminden sinir dekompresyonuna kadar geçen sürenin düşük ayak kliniğinde iyileşme oranı ve derecesi üzerine olan etkilerini değerlendirmektir.Gereç ve Yöntemler: Nisan 2014 ve Şubat 2019 arasında düşük ayak kliniği (ayak bileği dorsifleksiyonu 0/5 parazik) nedeniyle mikrodiskektomi geçirmiş olan ardışık 30 hasta retrospektif olarak incelendi. Hastalar düşük ayak gelişiminden ameliyata kadar geçen süreye göre 1 hafta olmak üzere göre 3 gruba ayrıldı. Gruplar arasında ameliyat sonrası ayak bileği dorsifleksiyon kas kuvvetlerinin iyileşme oranlarını ve derecesini değerlendirmek için Kruskal-Wallis ve Bonferroni düzeltmeli Mann Whitney U testi kullanıldı.Bulgular: Bu çalışmada, düşük ayak nedeniyle ameliyat edilen 30 hasta (18 kadın ve 12 erkek) değerlendirilmiştir. Hastaların ameliyat sırasındaki ortalama yaşı 46,5±13,5 (aralık 18-72) idi. Ameliyat sonrası ayak bileği dorsifleksiyonu kas gücü 1 hafta grubunda 1,0±1,3 (aralık, 0-3) idi. 1 hafta grubundan (p=0,002) anlamlı şekilde farklılık göstermekteydi. 72 saat - 1 hafta grubu ve >1 hafta grubu arasında istatistiksel olarak anlamlı bir farklılık görülmedi (p=0,427).Sonuç: Düşük ayak kliniğinde semptomların başlangıcından cerrahi dekompresyona kadar geçen sürenin, ameliyat sonrası iyileşme oranlarında istatistiksel olarak anlamlı bir prediktör olduğu görüldü., Aim: The aim of this study was to evaluate the effect of the duration from foot drop development to nerve decompression on the rate and degree of recovery in foot drop clinic.Material and Methods: We retrospectively reviewed 30 consecutive patients who had undergone microdiscectomy for foot drop clinic (ankle dorsiflexion 0/5 paresis) between April 2014 and February 2019. Patients were divided into three groups according to the time from foot drop development to surgery, as 1 week. Kruskal-Wallis and Bonferroni corrected Mann Whitney U test were used to evaluate the rate and degree of recovery of ankle dorsiflexion muscle strength between groups.Results: In this study, 30 patients (18 females and 12 males) who underwent surgery for foot drop were evaluated. Mean age at the time of surgery was 46.5±13.5 (range, 18-72) years. Postoperative ankle dorsiflexion strength was 4.2±1.6 (range, 0-5) in 1 week group. Postoperative muscle strength improvement level of 1 week group (p=0.002). There was no statistically significant difference between 72 hours - 1 week group and >1 week group (p=0.427).Conclusion: In foot drop clinic, the duration from onset of symptoms to surgical decompression was a statistically significant predictor of postoperative recovery rates.

Background: Subdural empyema is a rare form of intracranial infection. It is described as accumulation of purulent infective material between the inner layer of dura mater and outer layer of arachnoid membrane. Case Description: A 17-year-old girl was admitted to the emergency department with acute left hemiplegia and was diagnosed with interhemispheric subdural empyema that showed a three-fold increase in size within 12 hours. Complete recovery was achieved with emergency surgical evacuation and additional 3 weeks of antibiotic treatment. Conclusion: Subdural empyema should be diagnosed and managed early in time since it may progress very rapidly and can cause high morbidity and mortality. Complete recovery can be achieved if it is diagnosed early and treated in time.

Aim To determine whether the timing of shunt placement affects shunt infection rate in hydrocephalus associated with myelomeningocele (MMC). Material and methods The cases of 67 consecutive patients who underwent MMC repair and ventriculoperitoneal (VP) shunt placement between 2010 and 2017 were analyzed, retrospectively. Shunt infection rates were compared for three different approaches: simultaneous shunting (MMC repair and shunting in the same session; n=22), early shunting (shunting in the first week after MMC repair; n=21), and delayed shunting (shunting in the second week after MMC repair; n=24). Results Three patients in the simultaneous shunting group (13.6%) and two patients in the early shunting group (9.5%) developed shunt infection, whereas no such infections occurred in the delayed shunting group (p > 0.05). Conclusion While the shunt infection rates for the simultaneous, early and delayed shunting groups were not significant, it is of interest that no shunt infections occurred in the delayed shunting group. Investigation with a larger number of patients is warranted to assess whether delayed shunting might reduce the risk of shunt infection.

Aim: The aim of this study was to evaluate the effect of the duration from foot drop development to nerve decompression on the rate and degree of recovery in foot drop clinic. Material and Methods: We retrospectively reviewed 30 consecutive patients who had undergone microdiscectomy for foot drop clinic (ankle dorsiflexion 0/5 paresis) between April 2014 and February 2019. Patients were divided into three groups according to the time from foot drop development to surgery, as 1 week. Kruskal-Wallis and Bonferroni corrected Mann Whitney U test were used to evaluate the rate and degree of recovery of ankle dorsiflexion muscle strength between groups. Results: In this study, 30 patients (18 females and 12 males) who underwent surgery for foot drop were evaluated. Mean age at the time of surgery was 46.5±13.5 (range, 18-72) years. Postoperative ankle dorsiflexion strength was 4.2±1.6 (range, 0-5) in 1 week group. Postoperative muscle strength improvement level of 1 week group (p=0.002). There was no statistically significant difference between 72 hours-1 week group and >1 week group (p=0.427). Conclusion: In foot drop clinic, the duration from onset of symptoms to surgical decompression was a statistically significant predictor of postoperative recovery rates. © 2019, Duzce University Medical School. All rights reserved. Medical Research Council, MRC: Table1 A total of consecutive thirty patients, who had undergone microdiscectomy due to foot drop clinic (ADF 0/5 paresis) by the same surgical team in two different state hospitals between April 2014 and February 2019, were retrospectively reviewed. Clinical records, radiological imaging reports and surgical reports were reviewed. Data on patient demographics and clinical features, the time elapsed between the development of foot drop and surgery, duration of surgery, and muscle strength of ADF in the early post-operative period were reached. The evaluation of muscle strength of the ADF was carried out by the assessment of the tibialis anterior muscle in accordance with the muscle strength scale of Medical Research Council (Table1). Comorbidities, including diabetes mellitus (DM), smokers, coronary artery disease, chronic obstructive pulmonary disease (COPD) and hypertension were ascertained from the medical records. All procedures carried out in studies including human participants were conducted in compliance with the ethical standards of institutional and/or national research committee, the Helsinki Declaration and its amendments or comparable ethical standards. Ethical approval for the study was obtained from the institutional review board of Namık Kemal University (01.08.2019, 2019/21). Informed and written consent was obtained from all patients. The patients were divided into three groups as regards the time elapsed from the development of foot drop to surgery, as 1 week. Statistical Analysis Normality assumption for continuous data were examined by Shapiro-Wilk test. The differences between the groups were analyzed by Kruskal-Wallis test followed by Mann Whitney U test with Bonferroni correction, since variables not showing normal distribution. Descriptive statistics given as mean±standard deviation and median (minimum-maximum). Categorical data were analyzed with Fisher-Freeman-Halton test and summarized as frequency and percentage. All statistical analyses were performed using MedCalc v.12.7.7 (MedCalc Software, Ostend, Belgium), and p

Lipomatous meningiomas are extremely rare subtypes of benign meningiomas and are classified as metaplastic meningioma in the World Health Organization classification. We present a 77-year-old man presented with the history of a gradually intensifying headache for the last 3 months. A right frontoparietal mass was detected on his cranial magnetic resonance imaging. The patient was operated on via a right frontoparietal craniotomy, and histopathological diagnosis was lipomatous meningioma. Distinctive characteristics of lipomatous meningiomas were discussed with special emphasis to importance of immunohistochemical examinations, particularly for its differentiation from the tumors showing similar histology though having more aggressive character.

Aim: Our aim was to determine whether a combination of sagittal index (SI), canal compromise (CC), and loss of vertebral body height (LVBH) is associated with the severity of neurological injury in patients with thoracolumbar burst fractures. Materials and Methods: Seventy-four patients with thoracolumbar burst fracture undergoing instrumentation between 2010 and 2015 were analyzed retrospectively. The degree of neurological injury was determined using the American Spinal Injury Association (ASIA) scoring system. The association between the morphology of the fracture and the severity of neurological injury was analyzed. Results: There was a strong association between fracture morphology and the severity of neurological injury. Of the patients, 77.5% with SI ≥20°, 81.6% with CC ≥40%, and 100% with LVBH ≥50% had lesion according to ASIA. All of 7 patients with ASIA A had SI ≥20°, CC ≥40%, and LVBH ≥50%. On the other hand, 79% of the patients with ASIA E had SI 25°, the patients with CC >40%, and the patients with LVBH >50% are likely to have a more severe neurological injury.

Kanat, Ayhan/0000-0002-8189-2877 WOS: 000376130600006 PubMed: 27217655 Objective: the most common used technique for posterolateral cervical disc herniations is anterior approach. However, posterior cervical laminotoforaminomy can provide excellent results in appropriately selected patients with foraminal stenosis in either soft disc prolapse or cervical spondylosis. the purpose of this study was to present the clinical outcomes following posterior laminoforaminotomy in patients with radiculopathy. Materials and Methods: We retrospectively evaluated 35 patients diagnosed with posterolateral cervical disc herniation and cervical spondylosis with foraminal stenosis causing radiculopathy operated by the posterior cervical keyhole laminoforaminotomy between the years 2010 and 2015. Results: the file records and the radiographic images of the 35 patients were assessed retrospectively. the mean age was 46.4 years (range: 34-66 years). of the patients, 19 were males and 16 were females. in all of the patients, the neurologic deficit observed was radiculopathy. the posterolaterally localized disc herniations and the osteophytic structures were on the left side in 18 cases and on the right in 17 cases. in 10 of the patients, the disc level was at C5-6, in 18 at C6-7, in 2 at C3-4, in 2 at C4-5, in 1 at C7-T1, in 1 patient at both C5-6 and C6-7, and in 1 at both C4-5 and C5-6. in 14 of these 35 patients, both osteophytic structures and protruded disc herniation were present. Intervertebral foramen stenosis was present in all of the patients with osteophytes. Postoperatively, in 31 patients the complaints were relieved completely and four patients had complaints of neck pain and paresthesia radiating to the arm (the success of operation was 88.5%). on control examinations, there was no finding of instability or cervical kyphosis. Conclusion: Posterior cervical laminoforaminotomy is an alternative appropriate choice in both cervical soft disc herniations and cervical stenosis.

Lumbar spinal arachnoiditis occurring after diagnostic lumbar puncture is a very rare condition. Arachnoiditis may also present with fever and elevated infection markers and may mimic epidural abscess, which is one of the well known infectious complications of lumbar puncture. We report the case of a 56-year-old man with lumbar spinal arachnoiditis occurring after diagnostic lumbar puncture who was operated on under a misdiagnosis of epidural abscess. In the intraoperative and postoperative microbiological and histopathological examination, no epidural abscess was detected. To our knowledge, this is the first case of a patient with postlumbar puncture arachnoiditis operated on under a misdiagnosis of epidural abscess reported in the literature. The authors suggest that arachnoiditis may mimic epidural abscess due to its clinical and radiological features and should be considered in the differential diagnosis of complications of lumbar puncture.