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Background: Optic neuritis, myelitis, and neuromyelitis optica spectrum disorder (NMOSD) have been associated with antibodies against myelin oligodendrocyte glycoprotein-immunoglobulin G (anti-MOG-IgG). Furthermore, patients with radiological and demographic features atypical for multiple sclerosis (MS) with optic neuritis and myelitis also demonstrate antibodies against aquaporin-4 and anti-MOG-IgG. However, data on the diagnosis, treatment, follow-up, and prognosis in patients with anti-MOG-IgG are limited. Aims: To evaluate the clinical, radiological, and demographic characteristics of patients with anti-MOG-IgG. Study Design: Multicenter, retrospective, observational study. Methods: Patients with blood samples demonstrating anti-MOG-IgG that had been evaluated at the Neuroimmunology laboratory at Ondokuz Mayıs University’s Faculty of Medicine were included in the study. Results: Of the 104 patients with anti-MOG-IgG, 56.7% were women and 43.3% were men. Approximately 2.4% of the patients were diagnosed with MS, 15.8% with acute disseminated encephalomyelitis (ADEM), 39.4% with NMOSD, 31.3% with isolated optic neuritis, and 11.1% with isolated myelitis. Approximately 53.1% of patients with spinal involvement at clinical onset demonstrated a clinical course of NMOSD. Thereafter, 8.8% of these patients demonstrated a clinical course similar to MS and ADEM, and 28.1% demonstrated a clinical course of isolated myelitis. The response to acute attack treatment was lower and the disability was higher in patients aged > 40 years than patients aged < 40 years at clinical onset. Oligoclonal band was detected in 15.5% of the patients. Conclusion: For patients with NMOSD and without anti-NMO antibodies, the diagnosis is supported by the presence of anti-MOG-IgG. Furthermore, advanced age at clinical onset, Expanded Disability Status Scale (EDSS) score at clinical onset, spinal cord involvement, and number of attacks may be negative prognostic factors in patients with anti-MOG-IgG.

Aim: The clinical picture of acute stoneless cholecystitis can be seen in a wide range from mild lesions to the size that threatens the patient’s life. In this study, we aimed to contribute to the literature by investigating the relationship between patients with acute stone-free cholecystitis and diabetes mellitus (DM). Materials and Methods: Patients were analyzed for age, sex, and blood tests. Descriptive statistics for numerical variables are presented as mean, standard deviation, min-max values. Non-parametric test procedures were performed on non-normally distributed data. In this context, dependent and independent sample t-test and Mann-Whitney U test were used to determine the relationships between the parameters. Spearman’s correlation analysis was used, and chi-square analysis was performed to evaluate the relationship between categorical data. Results: The parameters measured by complete blood count and biochemistry were as follows: neutrophil: 56.72±23.17, C-reactive protein (CRP): 38.31±7.70, aspartate aminotransferase (AST): 78.86±25.80, alanine aminotransferase (ALT): 73.59±159.90, gamma glutamyl transferase (GGT): 142.99±236.08, urea: 37.14±24.41, creatinine: 0.90±0.50, glucose: 115.42±53.70, white blood cell: 8.49±6.66, percentage of neutrophils: 63.80±14.10, platelet: 245.63±84.62. There was a positive correlation between CRP and AST, CRP and ALT, CRP and GGT, and ALT and GGT in DM+ patients. Conclusion: It can be said that advanced age and the presence of DM increase the risk of stoneless cholecystitis, and blood parameters are used to show the presence of infection. In addition, deterioration in liver function tests increases more in patients with DM.

Obesity, which develops especially in childhood and adolescence, is an important health problem at all ages. Hormones that stimulate the hypothalamus about the body's energy stores prevent eating and keep body weight within certain physiological limits. Investigating obesity and the hormones associated with obesity is very important in this context. We believe that the functions of obesity-associated hormones that have been identified to date can guide further studies. In this review, obesity-related hormones and their mechanisms of action are discussed.

The most common neurological disease in the world and one of the leading reasons for mortality is stroke. In addition to its effect on many systems of the body, COVID-19 infection also affects the central nervous system and causes neurological involvement. In our study, we examined the effects of the COVID-19 pandemic on stroke by comparing the pre-pandemic and pandemic times. Patients who presented to the emergency department with a stroke during the same time in two different years were included in the study. Patients with clinical conditions mimicking stroke in the differential diagnosis, those with a positive polymerase chain reaction test for COVID-19, and those with COVID-19 pneumonia were excluded from the sample. Patients diagnosed with stroke were examined using clinical, laboratory, and radiological imaging methods. Length of stay in hospital (service or intensive care unit) and mortality rates were recorded. There was no significant difference between the pre-pandemic and pandemic times in relation to the incidence of ischemic and hemorrhagic stroke, sex, and age. Although the number of patients presenting with an ischemic stroke increased during the pandemic time, the rate of acute ischemic stroke patients decreased. In addition, there was a decrease in the rates of patients who underwent intravenous thrombolytic and mechanical thrombectomy. Stroke cases increased during the pandemic time, but the rate of admission for acute ischemic stroke decreased. Because of this reason patients delaying their hospital visits because of pandemics lost their chance of acute treatment. [Med-Science 2022; 11(2.000): 836-40]

Aim: Our aim in this study is to consider the relationship between arterial blood gas (ABG) parameters and prognosis in severe head trauma in children. Material and Methods: Patients younger than 17 years of age with a Glasgow Coma Scale (GCS) of 8 and below with a history of head trauma were retrospectively analyzed. The relation of ABG parameters taken at the time of admission with mortality was examined. Independent sample T-test was used for pH, PCO2 and base extract (BE) parameters in ABG, and Mann Whitney U test was used for PO2 and lactate parameters. Results: 48 patients were included in the study. Gender, age, admission blood pressure arterial values, GCS and Abbreviated Injury Scale (AIS) scores, length of stay in intensive care, and the surgical application did not differ statistically between the patient groups who died and survived (p> 0.05). Ph and PO2 values were lower, PCO2, lactate and BE values were found to be higher in the deceased patient group compared to the living patient group (p˂0.05). The presence of acidosis, hypercapnia, or hyperlactatemia according to ABG values in the patient group who died was statistically significantly higher (p˂0.05). Conclusion: In our study, we found that the presence of acidosis, hypercapnia, and hyperlactatemia in patients according to ABG values increased mortality. In addition, according to the results of ROC analysis, we found that high PCO2 and lactate values could be specific indicators indicating poor prognosis. We think that PCO2 and lactate measured in arterial blood may be biomarkers that can determine the prognosis.

In December 2019, a novel coronavirus outbreak spread rapidly all over the world. The virus is known to be neuroinvasive, but much is still unknown. In this study, we aimed to present the main neurologic symptoms in patients who were diagnosed with coronavirus disease 2019 (COVID-19). The study was conducted retrospectively by phoning 156 patients in Turkey diagnosed with COVID-19 through real-time polymerase chain reaction; only 100 patients could be reached. Data about their demographics, initial symptoms, neurological symptoms, and sleeping habits were collected. During the disease process, 66% had at least one neurological symptom, 55% had central nervous system symptoms, 42% had peripheral nervous system symptoms, and 64% had sleep disturbances and myalgia. Impaired consciousness, smell and taste impairments, and sleep disturbances were significantly higher in patients with positive chest computed tomography imaging (p < 0.05). Neurological symptoms were observed in COVID-19, as in other coronaviruses. Headache in particular was the most common symptom in our population. In patients with respiratory system findings, the detection of certain neurological symptoms such as smell-taste impairments, impaired consciousness, and sleep disorders were more common. We concluded that COVID-19 patients should be approached in a more holistic way, taking the nervous system into account.

Aim: The aim of this study is to evaluate the relationship between infection-induced PV and inflammatory parameters levels, WBC, NLR, PLR and CRP in elderly patients. Material and Method: In our study, 122 patients with peripheral vertigo complaints were retrospectively evaluated. Their gender, age, the type of admission, emergency room discharge and hospitalization, hospital admission time, complaints, and physical examination findings rates were examined. Results: The mean age was 73.4 years.. 115 patients (94.3%) were discharged after follow-up in the emergency department, while 7 patients (5.7%) were hospitalized. Complaints were 75.4% dizziness, 18% nausea-vomiting and 6.4% headache, respectively. There was no statistically significant difference in PLT, NEU, LYM, NEU / LYM and PLT / LYM values. Conclusion: In our study, WBC and CRP were significantly higher in patients. The results of our study showed that it can be used actively in the diagnosis of inflammatory causes in the pathogenesis of elderly patients with peripheral vertigo.

INTRODUCTION: In this study, it was aimed to investigate the physical, psychological and familial problems of the healthcare provider working in emergency health care services that develop due to their work and working conditions. METHODS: 297 people working in emergency health services in three different cities were included in the study. The study was carried out between November 15 and December 15, 2020 by conducting an online questionnaire. The participants in the study were asked questions about their physiological and psychological health conditions through the questionnaire. The answers received were evaluated statistically. RESULTS: In this study conducted with 297 people working in emergency health services (EHS), 189 (63.6%) people had health problems, 249 (83.8%) people worked even though they were ill, 186 (62.6%) people did not go to regular check-ups about their diseases, 282 (94.9%) were found to be under occupational stress and 141 (47.5%) of them needed psychological support. It has been determined that women have more health problems than men, are constantly using medication and need psychological support more (p=0.002, p=0.001, p=0.001). The health status of EHS employees who worked on duty was worse than those working overtime. This situation was statistically significant (p=0.002). DISCUSSION AND CONCLUSION: It is observed that emergency health care workers have some physical and mental problems. All stressful situations on healthcare provider should be identified and working conditions should be improved.

Abstract We experimentally demonstrate the operation of a Rowland-type concave grating for spin waves, with potential application as a microwave spectrometer. In this device geometry, spin waves are coherently excited on a diffraction grating and form an interference pattern that focuses spin waves to a point corresponding to their frequency. The diffraction grating was created by focused-ion-beam irradiation, which was found to locally eliminate the ferrimagnetic properties of YIG, without removing the material. We found that in our experiments spin waves were created by an indirect excitation mechanism, by exploiting nonlinear resonance between the grating and the coplanar waveguide. Although our demonstration does not include separation of multiple frequency components, since this is not possible if the nonlinear excitation mechanism is used, we believe that using linear excitation the same device geometry could be used as a spectrometer. Our work paves the way for complex spin-wave optic devices—chips that replicate the functionality of integrated optical devices on a chip-scale.

Synaptic vesicles are primed into a state that is ready for fast neurotransmitter release upon Ca2+-binding to Synaptotagmin-1. This state likely includes trans-SNARE complexes between the vesicle and plasma membranes that are bound to Synaptotagmin-1 and complexins. However, the nature of this state and the steps leading to membrane fusion are unclear, in part because of the difficulty of studying this dynamic process experimentally. To shed light into these questions, we performed all-atom molecular dynamics simulations of systems containing trans-SNARE complexes between two flat bilayers or a vesicle and a flat bilayer with or without fragments of Synaptotagmin-1 and/or complexin-1. Our results need to be interpreted with caution because of the limited simulation times and the absence of key components, but suggest mechanistic features that may control release and help visualize potential states of the primed Synaptotagmin-1-SNARE-complexin-1 complex. The simulations suggest that SNAREs alone induce formation of extended membrane-membrane contact interfaces that may fuse slowly, and that the primed state contains macromolecular assemblies of trans-SNARE complexes bound to the Synaptotagmin-1 C2B domain and complexin-1 in a spring-loaded configuration that prevents premature membrane merger and formation of extended interfaces, but keeps the system ready for fast fusion upon Ca2+ influx.

The anti-inflammatory and anti-apoptotic effects of molecular hydrogen, delivered as hydrogen-rich saline (HRS), on spinal cord injury was investigated. Four-month-old male Sprague Dawley rats (n = 24) were classified into four groups: (1) control—laminectomy only at T7-T10; (2) spinal injury—dura left intact, Tator and Rivlin clip compression model applied to the spinal cord for 1 min, no treatment given; (3) HRS group—applied intraperitoneally (i.p.) for seven days; and (4) spinal injury—HRS administered i.p. for seven days after laminectomy at T7–T10 level, leaving the dura intact and applying the Tator and Rivlin clip compression model to the spinal cord for 1 min. Levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were measured in blood taken at day seven from all groups, and hematoxylin–eosin (H & E) and terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) were used to stain the tissue samples. IL-6 and TNF-α levels were significantly lower in the group treated with HRS following the spinal cord injury compared to the group whose spinal cord was damaged. A decrease in apoptosis was also observed. The anti-inflammatory and anti-apoptotic effect of IL-6 may be a clinically useful adjuvant therapy after spinal cord injury.

Amaç: Hipospadias, üretral meanın daha proksimalde lokalize olduğu bir anomalidir. Cerrahi olarak tedavi edilir. Hipospadias cerrahisi geçiren çocuklar, duygusal bozukluklara diğer cerrahi yöntemlere göre daha fazla yatkın olmaktadırlar. Bu çalışmada normal sünnet yapılan ve hipospadias cerrahisi geçiren çocukların ebeveynlerinin duygusal ve karakteristik mizaçlarının değerlendirilmesi amaçlanmıştır.Gereç ve Yöntemler: Bu çalışmaya hipospadias cerrahisi geçiren çocukların ve normal sünnet yapılan çocukların ebeveynlerinden gönüllü olanların tümü dahil edilmiştir. Ebeveynlerden veri toplamak için yarı yapılandırılmış sosyodemografik veri formu, Memphis, Pisa, Paris ve San Diego Mizaç Değerlendirme Anketi (The Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire, TEMPS-A), Durumluluk-Süreklilik Kaygı Envanteri (State-Trait Anxiety Inventory, STAI) I-II ve Beck Depresyon Ölçeği (BDÖ) kullanılmıştır.Bulgular: Ebeveynler arasında klinik ve sosyodemografik özellikler açısından anlamlı bir fark yoktu. Hipospadiaslı olan ve normal sünnet olan çocukların ebeveynleri TEMPS-A mizaç ölçeği puanları, STAI toplam ve I-II alt ölçek puanları ve BDÖ puanları açısından karşılaştırıldığında da istatistiksel olarak anlamlı bir fark bulunmadı.Sonuç: Hipospadias karmaşık bir biyolojik gelişme defektidir. Hipospadias ameliyatı geçiren erkeklerde, ileriki dönemde gelişen cinsel işlev bozuklukları genellikle psikolojik nedenlerle gelişir. Ebeveynlerin kaygı düzeyleri dikkate alınmalı ve operasyonu erken dönemde planlanan ve gelecekte birçok etkisi olabilecek olan hipospadias tedavi sürecinde herkes birlikte hareket etmelidir. Bu alanda ebeveynlerle yaptığımız bu çalışmanın diğer çalışmalara rehberlik edebileceğini düşünüyoruz.

Munc13-1 plays a central role in neurotransmitter release through its conserved C-terminal region, which includes a diacyglycerol (DAG)-binding C1 domain, a Ca2+/PIP2-binding C2B domain, a MUN domain and a C2C domain. Munc13-1 was proposed to bridge synaptic vesicles to the plasma membrane through distinct interactions of the C1C2B region with the plasma membrane: (i) one involving a polybasic face that is expected to yield a perpendicular orientation of Munc13-1 and hinder release; and (ii) another involving the DAG-Ca2+-PIP2-binding face that is predicted to result in a slanted orientation and facilitate release. Here, we have tested this model and investigated the role of the C1C2B region in neurotransmitter release. We find that K603E or R769E point mutations in the polybasic face severely impair Ca2+-independent liposome bridging and fusion in in vitro reconstitution assays, and synaptic vesicle priming in primary murine hippocampal cultures. A K720E mutation in the polybasic face and a K706E mutation in the C2B domain Ca2+-binding loops have milder effects in reconstitution assays and do not affect vesicle priming, but enhance or impair Ca2+-evoked release, respectively. The phenotypes caused by combining these mutations are dominated by the K603E and R769E mutations. Our results show that the C1-C2B region of Munc13-1 plays a central role in vesicle priming and support the notion that two distinct faces of this region control neurotransmitter release and short-term presynaptic plasticity.

Objective: Cardiac resynchronization therapy (CRT) induces structural and electrical reverse remodeling of the failing heart. However, the association between native QRS narrowing and cardiac fibrosis markers has not been investigated in patients with an implanted CRT device. Methods: A total of 41 symptomatic patients diagnosed with systolic heart failure who underwent CRT implantation were included in this study. Electrocardiogram findings and cardiac fibrosis marker levels [galectin-3, growth-differentiation factor-15 (GDF-15) and procollagen III N-terminal propeptide (P3TD)] were collected before and 12 months after initiation of biventricular pacing. Reverse electrical remodeling was defined as a decrease in 12-month intrinsic QRS (iQRS) duration by ≥20 milliseconds after CRT implantation. Results: The median QRS duration decreased from 155 milliseconds (interquartile range [IQR]: 142–178 milliseconds) before CRT to 142 milliseconds (IQR: 130–161 milliseconds) (p=0.001) after 12 months of CRT. According to the predefined criteria, electrical remodeling was detected in 16 (39.0%) patients. The median galectin-3, GDF-15, and P3TD levels were significantly decreased after CRT implantation in patients with electrical remodeling [27.65 ng/mL (IQR: 24.4–35.2 ng/mL) vs 23.00 ng/mL (IQR: 16.0-36.7 ng/mL), p=0.017; 3104 pg/mL (IQR: 2923–4825 pg/mL) vs 2276 pg/mL (IQR: 1294–3209 pg/mL), p=0.002; 0.43 ng/mL (IQR: 0.23–0.64) vs 0.15 ng/mL (IQR: 0.04–0.29 ng/mL), p=0.034, respectively]. The galectin-3, GDF-15, and P3TD levels were not significantly changed in patients without electrical remodeling [26.80 ng/mL (IQR: 23.9–31.5 ng/mL) vs 28.80 ng/mL (IQR: 23.0–34.8 ng/mL), p=0.211; 4221 pg/mL (IQR: 2709–4995 pg/mL) vs 3035 pg/mL (IQR: 2038–4872 pg/mL), p=0.143; and 0.34 ng/mL (IQR: 0.11–0.68 ng/mL) vs 0.21 ng/mL (IQR: 0.09–0.37 ng/mL), p=0.112, respectively]. Conclusion: The results from the small sample used in this study indicated that electrical reverse remodeling after CRT was associated with a decrease in cardiac fibrosis.

Pulmonary valvular stenosis is a rare valvular disease; it accounts for 7% to 12% of all patients with congenital heart disease. Patients with mild or moderate pulmonary stenosis (PS) are usually asymptomatic and the stenosis is often detected incidentally with echocardiography performed for another reason. Severe PS typically presents with symptoms related to increased right ventricular pressure and right heart failure. Valvular heart diseases are associated with increased morbidity and mortality in pregnancy due to cardiovascular alterations that occur during the gestational period, such as increased extracellular volume, a faster heart rate, and decreased venous return due to compression of the vena cava inferior by the enlarged uterus. While mild or moderate PS can be well tolerated in pregnancy, severe PS can lead to maternal and fetal perinatal complications. Presently described is the case of a pregnant patient with severe PS who successfully underwent balloon valvuloplasty in the third trimester.

Morphologically congenital sensorineural hearing loss can be investigated under two categories. Majority of the congenital hearing loss (80%) are membranous malformations. Here the pathology involves inner ear hair cells. There is no gross bony abnormality and therefore, in these cases, high resolution computerized tomography and MRI of the temporal bone reveal normal findings. Remaining 20% have various malformations involving the bony labyrinth and therefore, can be radiologically demonstrated by CT and MRI. The latter group involves surgical challenges as well as problems in decision making. Some cases may be managed by hearing aid, some need cochlear implantation while some cases are candidates for an auditory brainstem implantation. During cochlear implantation, there may be facial nerve abnormalities, cerebrospinal fluid leakage, electrode misplacement or difficulty in finding the cochlea itself. During the surgery for inner ear malformations, surgeon must be ready to modify the surgical approach or choose special electrodes for surgery. In the present review article inner ear malformations are classified according to the differences observed in the cochlea. Hearing and language outcome after various implantation methods is closely related to the status of cochlear nerve and a practical classification of the cochlear nerve deficiency is also provided

It is thought that abnormal invasive implantation of the placenta occur as a result of the defect came decidua basalis only in women who have a history of cesarean section previously. Massive obstetric hemorrhage has increased in placenta accreta. Despite the ultrasound, doopler ultrasound and magnetic resonance, in early pregnancy weeks the diagnosis of plecenta accreta is reduced. Therefore, the presence of life-threatening vaginal bleeding in early pregnancy we have to suspect from placenta accreta. We will publish here, the second trimester uterine placenta accreta cases showing the placement of the rear well. [Med-Science 2016; 5(4.000): 1033-6]

Background: Neurobrucellosis is a disease consisting of a wide spectrum of complications such as peripheral neuropathy, cranial nerve involvement, ataxia, meningeal irritation, paraplegia, seizures, coma, and even death. The vestibulocochlear nerve seems to be the most commonly affected cranial nerve (10%). We present a patient with neurobrucellosis whose auditory perception and speech intelligibility skill performances improved after cochlear implantation. Case Report: A 35 year-old woman was admitted to another hospital 2 years ago with the symptoms of headache, nausea, and altered consciousness, who was finally diagnosed with neurobrucellosis. She developed bilateral profound sensorineural hearing loss during the following 6 months. There was no benefit of using hearing aids. After successful treatment of her illness, she was found to be suitable for cochlear implantation. After the operation, her auditory perception skills improved significantly with a Categories of Auditory Performance (CAP) score of 5. According to clinical observations and her family members’ statements, her Speech Intelligibility Rating (SIR) score was 3. Her speech intelligibility skills are still improving. Conclusion: Our case report represents the second case of hearing rehabilitation with cochlear implantation after neurobrucellosis. Cochlear implantation is a cost-effective and time-proven successful intervention in post-lingual adult patients with sensorineural hearing loss. Early timing of the surgery after appropriate treatment of meningitis helps the patient to achieve better postoperative results.

Background: Sudden sensorineural hearing loss (SSNHL) is still a complex and challenging process which requires clinical evidence regarding its etiology, treatment and prognostic factors. Therefore, determination of prognostic factors might aid in the selection of proper treatment modality. Aims: The aim of this study is to analyze whether there is correlation between SSNHL outcomes and (1) systemic steroid therapy, (2) time gap between onset of symptoms and initiation of therapy and (3) audiological pattern of hearing loss. Study Design: Retrospective chart review. Methods: Patients diagnosed at our clinic with SSNHL between May 2005 and December 2011were reviewed. A detailed history of demographic features, side of hearing loss, previous SSNHL and/or ear surgery, recent upper respiratory tract infection, season of admission, duration of symptoms before admission and the presence of co-morbid diseases was obtained. Radiological and audiological evaluations were recorded and treatment protocol was assessed to determine whether systemic steroids were administered or not. Treatment started ≤5 days was regarded as “early” and >5 days as “delayed”. Initial audiological configurations were grouped as “upward sloping”, “downward sloping”, “flat” and “profound” hearing loss. Significant recovery was defined as thresholds improved to the same level with the unaffected ear or improved ≥30 dB on average. Slight recovery was hearing improvement between 10-30dB on average. Hearing recovery less than 10 dB was accepted as unchanged. Results: Among the 181 patients who met the inclusion criteria, systemic steroid was administered to 122 patients (67.4%), whereas 59 (32.6%) patients did not have steroids. It was found that steroid administration did not have any statistically significant effect in either recovered or unchanged hearing groups. Early treatment was achieved in 105 patients (58%) and 76 patients (42%) had delayed treatment. Recovery rates were no different in these two groups; however, when unchanged hearing rates were compared, it was statistically significantly lower in the early treatment group (p

Transvenous pacemaker or implantable cardioverter defibrillator (ICD) implantation procedures are usually performed under local anesthetic, and prilocaine is the most common agent to be used. The data regarding methemoglobinemia after cardiac device implantation are scarce. Thus, presently described is the case of a 47-year-old female patient with arrhythmogenic right ventricular cardiomyopathy/dysplasia who underwent ICD implantation for secondary prophylaxis and developed cyanosis as a result of prilocaine-associated methemoglobinemia. Prilocaine was administered during the procedure. To our knowledge, this is the second case in the literature presenting methemoglobinemia due to local anesthetic after transvenous cardiac device implantation.

Aim: The aim of this study is to detect the adequacy and quality of cervico-vaginal sampling in different age groups. Method: As a screening test, cervico-vaginal smears were obtained from 1179 women was admitted to Obstetrics and Gynecology Clinic of Bozok University Hospital between September 2012 and April 2013. Patients were grouped according to their ages. Patients under 20 years were designated as adolescents, patients between 20 and 44 years represented fertile period and patients 45 years and over were defined as menopausal patients. All the smears were evaluated by the same pathologist. Transformation Zone detection is required for sufficient and appropiate smear sampling. Kruskal Wallis H Tests were used for statistical analysis. Values under 0.05 were accepted as significant. Mann Whitney U test was performed for detecting the origin of significance. Results: Among 1179 patients, 14 of them were adolescents (1.18%), 752 of them belonged to fertile period group (63.78%) and 413 of them were menopausal patients (35.02%). In these groups smear sampling sufficiency and quality detected as; 64.20% in adolescents, 72.90% in fertile period and 59.95% in menopausal patients. Among smears with inflammation, 7 of them were adolescents (50%), 470 of them were in fertile period group (62,50%) and 158 cases were in menopause group (38,25%). Only 1 patient diagnosed as ASC-US (0,08%) and no other premalignant lesion was detected. There was a statistical difference between groups (p

Objective: Atrial fibrosis is one of the main components of atrial fibrillation (AF) pathophysiology and culminates in structural, electrical and contractile remodelling. Fibronectin is one of the well-known mediators of fibrogenesis. However, the association of plasma fibronectin with atrial remodelling has not been studied previously. Therefore, the aim of this study was to assess the relationship between plasma fibronectin level and atrial electrical and structural remodelling in patients with lone paroxysmal AF. Methods: A total of 51 lone paroxysmal AF patients and 40 age-, gender- and body mass index-matched healthy control subjects were enrolled. Plasma levels of fibronectin and high sensitive C-reactive protein (hs-CRP) were measured and transthoracic echocardiography for assessment of total atrial conduction time (TACT) and left atrial (LA) volume index was performed on all study participants. Results: Plasma fibronectin, hs-CRP, TACT, LA diameter and LA volume index were significantly higher in lone paroxysmal AF group compared to healthy controls (p

Objectives: In this study, we aimed to evaluate the effect of percutaneous closure of patent foramen ovale (PFO) on the recurrence of stroke and new cardiac arrhythmia using magnetic resonance imaging (MRI) and Holter monitoring. Study design: Patients with PFO had >1 previous stroke or transient ischemic attack documented with MRI in the first event. PFO with right to left shunt was detected by transesophageal echocardiography (TEE) and transcranial Doppler ultrasound. MRI examinations were performed on patients before and one year after PFO closure was applied. A twenty-four hour Holter monitoring was performed in all patients within 1 month before and 6 months after the procedure. Results: Percutaneous PFO closure was performed on 47 patients (25 female, mean age: 38.7 years) who had cerebral ischemic events detected by MRI. A year after the procedure, TEE showed that there was no residual interatrial right-to-left shunting. After a 14 month follow-up, no new cerebrovascular event and no new lesion on MRI were recorded. The incidence of arrhythmia did not increase significantly after the procedure on Holter monitoring (p=0.917). Conclusion: One-year clinical and MRI follow-up study of patients with cerebral ischemic events and percutaneous closure of PFO showed no recurrent event and no significant complication associated with the procedure. In addition, Holter monitorization demonstrated that the procedure did not increase the incidence of arrhythmias compared with pre-procedural monitoring.

Objectives: Pulmonary vein (PV) isolation with cryothermal energy is a recently introduced technique in patients with atrial fibrillation (AF). It may reduce procedural times and serious complications associated with radiofrequency (RF) ablation. We aimed to present the baseline characteristics and followup data of our study population undergoing cryoballoon AF ablation. Study design: A total of 236 patients (126 male, 110 female; mean age 54.6+-10.45; range 16 to 78 years) underwent PV isolation with 28 mm cryoballoon due to symptomatic AF. These patients failed with at least one previous antiarrhythmic drug. The postprocedure in the first 3 months was defined as blanking period. Median follow-up time was 14 (3-24) months. Procedural success, complicaitons, and follow-up results were defined according to Heart Rhythm Society guidelines. Results: Acute procedural success rate (≥3 PV isolation) was 99.5%. Mean procedural and fluoroscopy times were 72.5+-5.3 (50-90) min and 14+-3.5 (12-24) min. Major complications were observed in 3 patients (1.2%). At the median 14 month follow-up, 80.6% of paroxysmal AF patients and 49.2% of persistant AF patients were free from AF recurrence. RF ablation was performed in 10 patients with recurrence. Smoking, body mass index, non-paroxysmal AF type, AF duration (years), left atrial size, and early recurrence were the predictors of recurrence in multivariate regression analysis. Conclusion: This study represents the first experience with cryoballoon ablation for AF in Turkey. The efficacy and safety of cryoballoon AF ablation technique was shown due to the acceptable success and low complication rates in paroxysmal AF patients. Particularly, patients with early recurrence should be closely followed-up.

A 44-year-old male patient with a diagnosis of Miller Fisher syndrome, Graves disease and central nervous system demyelination is presented. Clinical and laboratory findings supported the diagnosis of Miller Fisher syndrome. On T2-weighted sections of cranial magnetic resonance imaging, many ovoid-shaped, hyperintense lesions in bilateral deep white matter were detected. Magnetic resonance imaging spectroscopy demonstrated low N-acetylaspartate to creatine (NAA/Cr) ratio consistent with demyelination. Combined peripheral nervous system and central nervous system demyelinating processes are rare. In this Miller Fisher syndrome case, an immunological mechanism affecting both the peripheral nervous system and central nervous system with association of Graves disease is discussed in light of the relevant literature. A positive response to intravenous immunoglobulin G treatment was obtained

A 44-year-old male patient with a diagnosis of Miller Fisher syndrome, Graves disease and central nervous system demyelination is presented. Clinical and laboratory findings supported the diagnosis of Miller Fisher syndrome. On T2-weighted sections of cranial magnetic resonance imaging, many ovoid-shaped, hyperintense lesions in bilateral deep white matter were detected. Magnetic resonance imaging spectroscopy demonstrated low N-acetylaspartate to creatine (NAA/Cr) ratio consistent with demyelination. Combined peripheral nervous system and central nervous system demyelinating processes are rare. In this Miller Fisher syndrome case, an immunological mechanism affecting both the peripheral nervous system and central nervous system with association of Graves disease is discussed in light of the relevant literature. A positive response to intravenous immunoglobulin G treatment was obtained.

We compared three different chemotherapy regimens containing epirubicin in hormonerefractory prostate cancer (HRPC) patients. Sixty-nine patients with HRPC were randomized into three groups. The first group (22 patients) received 30 mg/m2/week i.v. epirubicin for 8 weeks. The second group (24 patients) received 30 mg/m2/week i.v. epirubicin for 8 weeks followed by monthly maintenance therapy for 4–6 months. The third group (23 patients) received oral estramustine phosphate (EMP) at a dose of 840 mg/day together with weekly and monthly maintenance epirubicin. The response rates, mean survival times, and toxicity were determined. Within the first 3 months, pain and performance scores were improved by at least one degree in all the groups. One patient in group two and three patients in group three had complete response. Partial response rates were 23% in group 1, 25% in group 2, and 17% in group 3. Stable disease rates were 41% in group 1, 33% in group 2, and 26% in group 3. The progression rates within the first 3 months were 36% in group 1, 38% in group 2, and 44% in group 3. None of the patients developed complications that were significant enough to terminate the treatment. Two patients in group 3 died of cardiotoxicity. The mean survival times were 10.1, 15.8, and 16.1 months in groups 1, 2, and 3, respectively. It was determined that weekly and maintenance epirubicin treatment protocol, and estramustine treatment protocol in addition to this treatment, was only meaningfully more effective against weekly epirubicin treatment in the statistical sense (0.01 < p < 0.05). However, due to the complications of EMP, which influence the quality of life, we believe that this was usable only when measures were adopted against these effects.