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Aim: The aim of this study was to evaluate the accompanied cervical injuries of the patients presenting to the emergency department (ED) because of penetrating, perforating or tangential cranial gunshot injuries (CGI). Material and Methods: The retrospective study included 137 patients that presented to the EDs at Mustafa Kemal and Ataturk University due to penetrating, perforating or tangential CGI between 2014 and 2018. Patients younger than 12 years old and had insufficient radiological records were excluded from the study and thus 115 patients were included in the study. Results: 115 patients included 105 (91%) men and 10 (9%) women with a mean age of 27 (range, 12-65) years. Of the 115 injuries, 84 (73%) were high-velocity and 31 (27%) were low-velocity gunshot injuries. The injuries included 92 (80%) penetrating or perforating and 23 (20%) tangential injuries. No cervical dislocation injury was accompanied by CGI in any patient. Unilateral lamina fracture of the cervical vertebra was observed in one patient. Conclusion: Our results support the opinion that isolated penetrating, perforating or tangential CGI did not cause to cervical spinal injuries, the intubation or tracheostomy procedures should not be postponed after radiological evaluation of cervical spinal stability.

Eğitimli insan gücü yetiştirilmesinde etkin rol oynayan üniversitelerde mesleki ve teknik eğitim, dört yıllıkmesleki-teknik eğitim fakülteleri ve iki yıllık meslek yüksekokulları ile gerçekleştirilmektedir. Bunlardan meslekyüksekokulları (MYO), iş piyasasının ihtiyaç duyduğu ara elemanların yetiştirilmesi amacıyla kurulmuşken,anılan fakültelerin amacı mesleki orta öğretim kurumlarının öğretmen ihtiyaçlarını karşılamaktır. Ancak istenilennitelikteki ara insan gücünü yetiştirecek eğitimcilerin, verilmek istenilen bu eğitim sürecinde karşılaşılan bazısıkıntılar, mesleki eğitimi de olumsuz yönde etkileyebilmektedir. Bu derlemenin amacı, insan sağlığınaodaklanan mesleklerde çalışacak ara insan gücünü yetiştiren Sağlık Hizmetleri Meslek Yüksekokullarındakiakademik personelin durumu ve karşılaştıkları sorunlar ile çözüm yollarını irdelemektir. Genel birdeğerlendirmeyle ele alındığında Sağlık Hizmetleri Meslek Yüksekokullarında eğitici/öğrenci oranının diğermeslek yüksekokullarına göre yüksek olduğu, akademik personelin bireysel ve mesleki gelişimi destekleyecekmekanizmaların bulunmadığı, alan dışı görevlendirmelerin yapıldığı ve bazı yönetsel sorunların yaşandığıgörülmüştür. At universities, which constitute the most important source of qualified labor, vocational and technical training iscarried out through four-year vocational and technical education faculties and two-years vocational schools.Vocational schools (VS) are intended to meet the intermediate staff needed by the labor market while vocationalfaculties are aimed at training teachers needed by vocational secondary schools. However, trainers who will trainthe intermediate human power in the desired quality experience some difficulties in this process andconsequently vocational education can be affected negatively. This review explores the current status andproblems, as well as solutions, of academic staff of Vocational Schools of Health Services, which provide theintermediate human power to work in the occupations focused on human health. In general, it was observed thatthe trainer/student ratio in Vocational Schools of Health Services was higher than other vocational schools, therewere no mechanisms to support individual and professional development of academic staff, and there wereirrelevant assignments and some administrative problems.

Amaç: İntertrokanterik femur kırıkları tedavisinde osteosentez kabul gören bir tedavi yöntemidir. İleri yaş grubunda görülen instabil intertrokanterik femur kırıkları tedavisinde osteosentez ve artroplasti uygulanmakta olan tedavi seçenekleridir. Çalışmamızda bu iki tedavi yöntemini karşılaştırarak sonuçlarını ortaya koymayı planladık. Gereç ve yöntem: Kliniğimizde yapmış olduğumuz geriye dönük çalışmada ortalama yaşı 77 olan 53 hastaya uygulanan iki farklı cerrahi yöntemin sonuçlarını karşılaştırdık. 26 hastaya proksimal femur çivisi, 27 hastaya hemiartroplasti uygulandı. Bulgular:Hastaların preoperatif değerlendirmesinde gruplar arasındahasta sayısı, yaş ortalaması ve cinsiyet dağılımı yönünden anlamlı bir farklılık görülmedi. Ameliyat sonrası yapılan değerlendirmede proksimal femur çivisi ile tedavi edilen grupta Harris kalça skoru anlamlı olarak daha yüksekti. Hemiartroplasti uygulanan grupta eritrosit süspansiyonu ihtiyacı, yoğun bakım gereksinimi ile mortalite oranı proksimal femur çivisi uygulanan hastalara oranla anlamlı olarak daha yüksek gözlemlendi. Sonuç:Yaşlı, instabil intertrokanterik femur kırıklı hastalarda proksimal femur çivisi uygulaması sonuçlarının hemiartroplastiye oranla daha iyi olduğu görüldü., Purpose: Osteosynthesis is an accepted treatment modality in the treatment of intertrochanteric femur fractures. Osteosynthesis and arthroplasty are the treatment options for treatment of unstable intertrochanteric femur fractures in advanced age group. We planned to compare the results of these two treatment modalities in our study. Materials and methods: We retrospectively compared the results of two different surgical procedures on 53 patients with an average age of 77 years. Proximal femoral nailing performed in 26 patients and hemiarthroplasty in 27 patients. Results:Preoperative evaluation of the patients did not show any significant difference between the groups in terms of number of patients, age average and gender distribution. Harris hip score was significantly higher in the group treated with proximal femoral nails after the operation. In hemiarthroplasty group, the need for erythrocyte suspension, intensive care need and mortality rate were significantly higher than the patients treated with proximal femoral nails. Conclusion: In elderly, unstable intertrochanteric femur fracture patients, proximal femoral nailing surgery results were found to be better than hemiarthroplasty

Aim: Patient education is important for patients with predialysis chronic renal disease (CKD)because it can delay the progression of the disease to end-stage renal failure.Anxiety and depression may also contribute to the progression of the disease in patients with CKD. We evaluated the influences of education on progression ofCKD, the Short Form 36 Health Survey (SF36), and the Beck Depression Inventory (BDI) in predialysis CKD patients. Material and Methods: 121 patients with nondialysis stage 2-5 CKD were involved in this study. At the start of the study, the SF36 and BDI scoring were performed in all patients and their creatinine clearances were calculated. 31 patients were given education on CKD by the dialysis specialist nurse once a month. At the end of the sixth month, SF36 and BDI were rescored, and their creatinine clearances were recalculated. Results: There were no significant differences between the two groups regarding age, gender, creatinine clearance, and duration of chronic kidney disease. At the end of the sixth month, when the educated and uneducated patients were compared, while the increase of the creatinine level was significant in the two groups, the SF36 and BDI scores were found to be improved significantly in the study group. Conclusion: The results of this study suggested that patient education may improve the SF36 and BDI scores, but it does not affect the progression of the disease for at least six months in duration.

Near-infrared ışığın dokulara penetre olabilmesi, oksihemoglobin ve deoksihemoglobin tarafındanabsorbe edilebilmesi rejyonel serebral oksijen satürasyon ölçümünün temel prensibinioluşturur. Bu yöntemle, serebral dokunun oksijen arz-talep dengesi devamlı ve gerçek zamanlıolarak değerlendirilebilmektedir. Ölçümlerde, beyinde venöz, kapiller ve arteriyel kompartmanlardabulunan kan volümünün sabit bir değer olduğu varsayılır. Bu sebeple serebral oksimetrelerbu kompartmanlara ait oksijenizasyonla ilgili ortalama bir değer sunmaktadırlar.Düşük rejyonel serebral oksijen satürasyon değerleri serebral hipoksi ve/veya iskemi ile ilişkilendirilmiştir.Ancak serebral oksimetrelerin postoperatif nörolojik komplikasyonları azalttığıyönündeki veriler çelişkilidir. Bu yüzden genel anestezi uygulamalarında rutin bir monitörizasyonyöntemi olarak kullanılması önerilmemiştir. Yine de özellikle kardiyak cerrahi ve karotisendarterektomi cerrahisinde kullanımı faydalı olabilir. Penetration of near-infrared light into the tissue and its absorption by oxyhemoglobin anddeoxyhemoglobin constitute the basic principle of regional cerebral oxygen saturationmeasurement. With this method, oxygen supply-demand balance of the cerebral tissue canbe evaluated continuously and real-timely. Blood volume present in venous, arterial andcapillary compartments of the brain is assumed to be a constant volume in the measurements.Therefore, cerebral oximeters provide an average value related to the oxygenation of thesecompartments. Low regional cerebral oxygen saturation values were associated with cerebralhypoxia and/or ischemia. However, the data showing that cerebral oximeters decreasepostoperative neurological complications are conflicting. Therefore, it has not been suggestedas a routine monitoring method in general anaesthesia applications. İts use may be helpfulespecially in cardiac surgery and carotid endarterectomy surgery.

Amaç: Yapısal olmayan bir amino asit olan antioksidan etkili taurinin kırık iyileşmesi üzerine etkilerinin araştırılması Gereç ve Yöntem: Kontrol grubunda dokuz, taurin grubunda yedi tane Yeni Zelanda tipi tavşana açık tibial osteotomi uygulandı. Radyolojik kırık iyileşmesi, 21. günde çekilen direk grafi ve bilgisayarlı tomografi (BT) kesitleri üzerinde Goldberg skoru ile değerlendirildi. Histoloik olarak iyileşme Huo skoruna göre derecelendirildi. Sıfırıncı, yedinci, 14. ve 21. günlerde serumda malondialdehit (MDA) ve alkalen fosfataz (ALP) düzeyleri ölçüldü. Bulgular: Direk grafi ve BT kesitlerine göre kırık iyileşmesinin ortanca evresi taurin grubunda radyolojik kaynamayken kontrol grubunda olası kaynama olarak bulundu. Histolojik olarak, kallus taurin grubunda esas olarak kemik dokusundan oluşurken (ortanca Huo skoru 8), kontrol grubunda baskın doku kıkırdaktı (ortanca Huo skoru 6). MDA düzeyindeki değişimler oksidatif stresin kırık iyileşmesinin enflamatuvar fazında en yüksek olduğunu göstermekteydi. Her iki grupta da ALP düzeyleri önce azalmış, 21. Günde yeni kemik oluşumuyla yeniden yükselmiş olarak bulundu. Sonuç: Bu çalışmanın sonuçları deneysel osteotomi modelinde taurinin erken evre kırık iyileşmesi üzerinde olumlu etkileri olduğunu desteklemektedir. Bu etki tarunin antioksidan özelliği ile ilişkilendirilebilir., Objective: To evaluate the influence of taurine, a non-structural amino acid with antioxidant effects, on fracture healing. Materials and Methods: Open tibial osteotomy was performed on nine New Zealand rabbits in the control group and seven in the taurine group. Radiologic fracture healing was assesed using the Goldberg score on x-rays and computed tomography (CT) sections on the 21st day. Healing was graded histologically using the Huo score. Serum malondialdehyde (MDA) and alkaline phosphatase (ALP) levels were measured, at days zero, seven, 14 and 21. Results: Upon completion of the study, in the taurine group, the median stage of healing was recorded as “radiologic union”, whereas it was “probable union” in the control group with respect to x-ray and CT sections. In the taurine group, callus was mainly composed of osteoid tissue (median Huo score 8); in the control group the predominant tissue was chondroid (median Huo score 6). Changes in MDA levels revealed that oxidative stress was greatest in the inflammatory phase. In both groups, the ALP levels first decreased, and then increased ,with new bone formation on the 21st day. Conclusion: Taurine improved early bone healing in an experimental animal osteotomy model. This influence might be related to its antioxidant properties.

Vatansever, Alper (Balikesir Author), Çalışmamız, tıp fakültesi öğrencilerinin, anatomi pratik eğitimi sırasında karşılaştıkları zorlukların belirlenebilmesi ve çözümlenmesi ile birlikte anatomi pratik derslerinin daha etkili bir yönteme dönüştürülmesini amaçlamaktadır. Bu noktadan yola çıkılarak, anatomi eğitimine yeni başlamış ve anatomi eğitimini bitirmek üzere olan toplam 226 öğrenci çalışmamıza dahil edilmiştir. Bu öğrencilere, açık uçlu ve çoktan seçmeli sorulardan oluşan 30 soruluk anket uygulaması yapılmıştır. Anket uygulaması tamamlandıktan sonra elde edilen yanıtlar, SPSS 21 paket programı ile değerlendirilmiştir. Çalışmamıza katılan öğrencilerden 225’i (%99,6), anatomi dersinin işlenişi hakkında kendilerinin de fikirlerinin alınması gerektiğini belirtmişlerdir. Bunun yanında, anatomi eğitimi için vazgeçilmez olan kadavra gösteriminin yanı sıra, radyo-lojik görüntülerin de yardımcı eğitim aracı olarak kullanılması gerektiğini düşünmektedirler (%72,6). Elde edilen bulgular, anatomi pratik eğitiminin daha etkili bir yöntemle ilerleyebilmesi için tıp fakültesi öğrencilerinin fikirlerinin alınmasının gerekliliğini ortaya koymaktadır., Aim of our study was detection of medical students’ difficulties during anatomy practical education and creating more effective anatomy practical education by resolving their problems. For this purpose, a total of 226 medical students who had just started and were about to complete anatomy lectures were included. A questionnaire consisting of 30 questions including of open-ended and multiple choice questions was given to these students. After the questionnaire was completed, the responses were evaluated using the SPSS 21 software. 225 (99.6%) of the students participating in this study stated that it was necessary to ask their ideas about the anatomy courses. Furthermore, besides the cadaver demonstration which is indispensable for anatomy education, radiological images should be used as an auxiliary educational tool (72.6%). Our results revealed that it was necessary to ask the medical students’ ideas for proceeding the anatomy practical courses with a more effective method.

Amaç: Mortalite ve morbidite oranı oldukça yüksek olan intraserebral hemorajinin(İSH) prognozunda inflamatuar süreç oldukça önemli bir yer tutar. İnflamatuar bir gösterge olarak kabul edilen platelet/lenfosit oranının(PLO); son yapılan çalışmalarla özellikle akut koroner sendrom, kalp kapak hastalıkları, çeşitli onkolojik hastalıklar ve serebral infarktüste prognozla ilişkili olduğu ortaya konmuştur. Ancak akut dönem İSH’li hastaların prognozunu göstermedeki yeri henüz bilinmemektedir. Gereç ve Yöntemler: Çalışmamıza retrospekif olarak Ocak 2008- Haziran 2016 tarihleri arasında kliniğimize şikayetlerinin başladığı ilk 24 saat içinde başvuran, İSH tanısı kesinleşmiş 296 hasta ile benzer yaş ve cinsiyete sahip 180 kontrol dahil edildi. 296 hastanın 120 tanesi 30 günlük hastane yatışı sırasında hayatını kaybetmişti. Hastalarla kontrollerin ve ölenlerle sağ kalan hastaların nötrofil/lenfosit oranları(NLO) ile PLO değerleri karşılaştırılarak 30 günlük mortaliteyi saptamada NLO ve PLO’nun rolü değerlendirildi. Bulgular: Hasta grubu kontrollerle, ölen hastalar sağ kalan hastalarla kıyaslandığında nötrofil ve platelet sayıları ile NLO ve PLO değerleri hasta grubunda ve özellikle de ölen hastalarda daha yüksekti. Yapılan tek ve çok değişkenli lojistik regresyon analizlerinde, NLO ve PLO değerlerindeki yüksekliğin akut dönem İSH’li hastalardaki kısa dönem mortaliteyi saptamada anlamlı bağımsız değişkenler olduğu saptandı(p= 0.014,p=0.024).Ek olarak yapılan ROC analizi ile PLO için 261.7, NLO için ise 9.5 üzerindeki değerlerin İSH’ye bağlı 30 günlük mortaliteyi saptamada kullanılabileceği gösterildi. Sonuç: Bu sonuçlarla akut dönem İSH’lı hastalarda NLO ve PLO değerlerinin arttığı ve mekanizması tam olarak bilinmese de NLO ve PLO değerlerindeki yüksekliğin İSH’li hastalarda kısa dönem mortalite ile yakından ilişkili olduğu söylenebilir., Aim: Inflammation plays an important role in the prognosis of intracerebral hemorrhage(ICH), which has high mortality and morbidity rates. Platelet to lymphocyte ratio(PLR), which was accepted as an indicator of inflammation, have been increasingly demonstrated a prognostic factor, particularly in acute coronary syndrome, various oncological diseases, and in cerebral infarction in recent studies. Nonetheless, its significance regarding the determination of prognosis in patients with ICH has not yet been clarified. Materials and Methods: This is a retrospective study including 296 patients who presented to our clinic within 24 hours of the onset of symptoms and who were diagnosed with ICH between January 2008 and June 2016, along with 180 age and sex-matched controls. During their 30 day-hospitalization, 120 of these 296 patients died. Patients and controls were compared in terms of neutrophil to lymphocyte ratio(NLR) and PLR values; these were also compared between died and surviving patients. The significance of NLR and PLR in predicting mortality was also evaluated. Results: Patients had significantly higher neutrophil and platelet counts and NLR and PLR values than controls; these results were similar between died and surviving patients. Univariate and multivariate logistic regression analyses indicated that NLR and PLR were independent predictors of short term mortality in ICH (p= 0.014, p=0.024). In addition, ROC analysis showed that cut-off values of 261.7 for PLR and 9.5 for NLR may be used to determine 30-day mortality due to ICH. Conclusion: These results indicate that NLR and PLR can increase in patients with ICH, and that although the mechanism is unclear, the increase of NLR and PLR is closely associated with short term mortality in patients with ICH.

Objective: Complementary and alternative treatment methods (CAM) are used frequently for patient have primary headache patients and many studies investigate why it is used. Our aim is to determine reason of using CAM and application locations of CAM in our country. Methods: Two hundred patients who were diagnosed primary headache and accepted to participate in our study were enrolled. We investigate sociodemographic data, CAM usage frequency, preferred CAM, satisfaction rates, thought on CAM use, recommendation sources, whether medical treatment continues or not and reason of CAM usage. Results: The 26% of patients were using CAM and 55,7% of those using CAM were satisfied with the treatment. Patients using CAM were younger than those who did not use (p=0,033). Unemployed, students and all-day employees; single people and well-educated people were using CAM more often (p=0,042; p=0,026; p=0,009, respectively). The most frequent reason of CAM usage was 'effective treatment of headache of this treatment methods'. 85% of CAM users had also continued medical treatment. Conclusion: We found single and well-educated patients more likely candidate for CAM. High rates of CAM and medical treatment usage indicates that CAM only treatments are not generally accepted in our country., Giriş: Dünyada baş ağrısında tamamlayıcı ve alternatif tedavi (TAT) yöntemleri kullanımına yönelik çalışmalar artan sıklıkta yapılmakta ve hastaların bu tedaviye başvurma nedenleri araştırılmaktadır. Çalışmamızın amacı ülkemizdeki baş ağrısı hastalarında TAT yöntemlerinin yerini ve nedenlerini belirlemektir. Yöntem: Çalışmamıza nöroloji polikliniğinde primer baş ağrısı tanısı konulmuş çalışmaya katılmayı kabul eden 200 hasta dâhil edildi. Hastaların sosyodemografik verileri, TAT kullanım sıklığı, tercih edilen TAT yöntemi, memnuniyet oranları, TAT’a bakış açısı, tavsiye kaynakları, tıbbi tedaviye devam edip etmedikleri ve TAT’a başvuru sebepleri sorgulandı. Bulgular: Hastaların % 26’sı TAT kullanırken, TAT kullananlarda tedaviden memnuniyet oranı % 55,7 bulundu. TAT kullananlar kullanmayanlara göre daha gençti (p= 0,033). TAT kullanımı işsiz, öğrenci, tam gün çalışan gruplarında diğer meslek gruplarına göre (p= 0,042), bekârlarda evlilere oranla (p= 0,026) ve eğitim düzeyi yüksek olanlar da düşük olanlara göre (p= 0,009) daha fazlaydı. En sık TAT’a başvuru sebebinin ‘Bu tedavinin baş ağrısını etkili şekilde tedavi ettiğine inanma’ olduğu bulundu. TAT kullanan hastaların % 85’i önerilen tıbbi tedaviye de devam etmişti. Sonuç: Bekâr ve eğitim düzeyi yüksek bir hastanın TAT kullanımı için daha yüksek oranda aday olduğunu saptadık. Hastalarımızın önemli oranda TAT ile birlikte medikal tedaviye devam etmesi ülkemizde TAT’lerin tek başına kullanımının halen genel kabul görmediğini göstermektedir.

Amaç: Bu araştırma, Ahi Evran Üniversitesi, Sağlık Yüksekokulu, hemşirelik öğrencilerinin HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome) hakkındaki bilgi ve tutumlarını belirlemek amacıyla yapılmıştır. Gereç ve Yöntem: Tanımlayıcı tipte olan bu araştırma, Mart-Nisan 2015 tarihleri arasında yapılmıştır. Anket uygulaması sırasında sınıfta bulunan ve araştırmaya katılmayı kabul eden 351 öğrenci (%80.1) araştırmanın evrenini oluşturmuştur. Araştırmanın verileri literatür taranarak hazırlanan anket formu aracılığı ile toplanmıştır. Anket formu öğrencilerin sosyo-demografik özellikleri ile 23 maddeden oluşan HIV/AIDS bilgi düzeyi soruları ve 9 maddeden oluşan AIDS’e karşı tutum ifadelerini içermektedir. Tanımlayıcı verilerde yüzde ve sayı, istatistiki analizlerde Mann-whitney U ve Kruskal Wallis testleri kullanılmıştır. Bulgular: Katılımcıların yaş ortalaması 21.17±2.24 olup, %71.8’ikız öğrenciydi. Öğrencilerin %18.5’i 1. sınıf öğrencisidir. Öğrencilerin %65’i AIDS’li olduğunu bildiği kişilerden uzak duracağını ve %17.9’u AIDS’li hastaların toplumdan uzak tutulması gerektiğini bildirmişlerdir. Ayrıca öğrencilerin %83.2’si mesleki olarak AIDS konusunda riskli olduklarını düşünmektedirler. Öğrencilerin yaş grubu, bulundukları sınıf ile HIV/AIDS bilgi düzeyi puan ortalamaları arasında istatistiksel olarak anlamlı fark saptanmıştır (p

Objective: The aim of the study was to investigate the prophylactic effects of acetyl L-carnitine against to uterus induced by cisplatin. Methods: Twenty-four female Wistar albino rats were divided into four groups: group I (control) was administered with saline; group II was administered with acetyl L-carnitine; group III was administered with cisplatin; group IV was pretreated with acetyl L-carnitine before cisplatin intraperitoneal injection. After 72h of cisplatin injection uterine tissue was removed. Histological and immunohistochemical investigations were performed, respectively. Results: We found that the number of TUNEL and caspases positive cells were increased in the endometrial epithelium, subepithelial connective tissue, endometrial glands and stroma in group III compare to the other groups. Furthermore inflammation and edema were observed in uterus of rats in group III. Conclusion: We can concluded that pretreatment of acetyl L-carnitine administration has protective effect on histological alteration of uterus caused by cisplatin. Amaç: Bu çalışmanın amacı, asetil L-karnitinin, sisplatinin neden olduğu uterus hasarına karşı profilaktik etkilerini araştırmaktır. Yöntem: Yirmi dört adet Wistar albino cinsi dişi sıçanlar dört gruba ayrıldı: 1. gruba (kontrol) salin uygulaması yapıldı; 2. gruba asetil L-karnitin uygulaması yapıldı; 3. gruba sisplatin uygulaması yapıldı; 4. grup ise sisplatinin intraperitoneal enjeksiyonu öncesinde asetil L-karnitin ile ön tedaviye tabi tutuldu. Sisplatin enjeksiyonundan 72 saat sonra uterus dokusu çıkarıldı. Histolojik ve immünohistokimyasal incelemeler yapıldı. Bulgular: TUNEL ve kaspaz pozitif hücre sayılarının, diğer gruplara göre 3. grupta endometriyal epitelde, subepitelyal bağ dokusunda, endometriyal bezlerde ve stromada arttığını bulduk. Ayrıca 3. Gruptaki ratların uterusunda inflamasyon ve ödem gözlenmiştir. Sonuç: Asetil L-karnitin ön tedavi uygulamasının, sisplatin kaynaklı uterus histolojisinin değişikliği üzerinde koruyucu etkisi olduğu sonucuna vardık.

Aim: Spondylodiscitis, if not diagnosed on time, can cause morbidity or mortality at high rates. This study was carried out with the aim of testing the hypothesis that “neutrophil-to-lymphocyte ratio can be used” especially in cases where it is difficult to diagnose spondylodiscitis. Material and Methods: This study involved 24 patients admitted to the State Hospital of Ministry of Health and Namik Kemal University for spondylodiscitis between January2014 and June2017. After excluding the cases that did not meet the inclusion criteria (n=6), the remaining cases (n=24) were referred to as the study group. A control group was created from healthy volunteers (n=24) who applied for routine physical checkups at the clinic between the same dates and who were similar in terms of age, sex, and body mass index to the study group. Hemogram parameters of the cases in both groups; white blood cell, C-reactive protein, erythrocyte sedimentation rate, and neutrophil-to-lymphocyte ratio were statistically compared. Results: Patients in the spondylodiscitis group, compared to healthy volunteers had statistically significant neutrophil-to-lymphocyte ratio value. Conclusion: Especially in cases where the diagnosis of spondylodiscitis is not assured, the neutrophil-to-lymphocyte ratio parameter, which is less costly than other diagnostic methods and the analysis results of which can be obtained in a shorter time, may be used to support clinical diagnosis.

GİRİŞ ve AMAÇ: Rinoplasti öncesi bir değerlendirme aracıolarak paranazal BT kesitleri kullanılarak doğu Karadenizbölgesinde yaşayan insanlara ait nazal antropometrikdeğerlendirilmesi.YÖNTEM ve GEREÇLER: Çalışmaya Ocak 2013 ve Mayıs2014 tarihleri arasında başvuran 400 yetişkin hastanınparanazal BT kesitleri dâhil edildi. Nazofrontal açı, nazalkemiğin üst sınırı, orta seviyesi ve alt sınırındaki nazal kemikkalınlığı, nazal kemik uzunluğu, nazal piramit açıları ve burunkökündeki cilt kalınlığı ölçülerek kaydedildi. Nazal ölçümlererkek ve kadınlar arasında istatistiksel olarak karşılaştırıldı veyaş ile korele edildi.BULGULAR: Ortalama nazofrontal açı 125.2213.44 oluperkeklerde 118.3912.27 ve kadınlarda 132.0410.86olarak bulundu. Ortalama nazal kemik kalınlığı üst sınırda6.92 1.92 mm, orta seviyede 2.52 0.91 mm, alt sınırda 1.090.56 mm olarak bulundu. Ortalama nazal kemik uzunluğu26.28 mm 6.27 mm, nazal kemik orta seviyesindeki nazalpiramit açısı ortalaması 51.616.94 olarak, burun kökü ciltkalınlığı ortalaması ise 6.76 cm 1.81 cm olarak bulunduTARTIŞMA ve SONUÇ: Çalışmamızdaki nazal antropometrikveriler, doğu Karadeniz bölgesi insanlarında rinoplasti öncesiplanlama açısından yararlı olacaktır.TARTIŞMA ve SONUÇ: Çocukluk döneminde örselenmeyemaruz kalan annelerin kendi çocuklarına daha fazla örselenmedavranışlarında bulundukları saptandı. INTRODUCTION: To evaluate the anthropomorphic featuresof nasal bony structures of Eastern Black Sea region peopleusing paranasal CT, as a preoperative assessment tool forrhinoplasty.METHODS: Totally 400 patients with CT scan of paranasalsinuses between January 2013 and May 2014 were included inthis study. Nasofrontal angle, upper, intermediate and inferiorthicknesses of nasal bone, nasal bone length, nasal pyramidalangle and skin thickness at nasal radix were measured. Nasalmeasures were compared between females and males, andstatistically correlated with age.RESULTS: The median nasofrontal angle of all patients was125.2213.44, 118.3912.27 in male patients and132.0410.86 in female patients. The mean nasal bonethickness was 6.92 mm 1.92 mm at the upper border of thenasal bone, 2.52 mm 0.91 mm at the intermediate level, and1.09 mm 0.56 mm at the lower border. The mean nasal bonelength was 26.28 mm 6.27 mm and the mean nasal pyramidalangle was 51.616.94 at the intermediate level of the nasalbone. The mean skin thickness at nasal radix was 6.76 cm 1.81 cm.DISCUSSION and CONCLUSION: Our study may be helpfulfor pre-operative evaluation of Eastern Black Sea Regionpeople undergoing rhinoplasty.

The aim of the present study was to compare the performance of positron emission tomography (PET) component of PET/computed tomography (CT) with new emerging PET/magnetic resonance (MR) of the same vendor.According to National Electrical Manufacturers Association NU2-07, five separate experimental tests were performed to evaluate the performance of PET scanner of General Electric GE company; SIGNATM model PET/MR and GE Discovery 710 model PET/CT. The main investigated aspects were spatial resolution, sensitivity, scatter fraction, count rate performance, image quality, count loss and random events correction accuracy.The findings of this study demonstrated superior sensitivity (~ 4 folds) of PET scanner in PET/MR compared to PET/CT system. Image quality test exhibited higher contrast in PET/MR (~ 9%) compared with PET/CT. The scatter fraction of PET/MR was 43.4% at noise equivalent count rate (NECR) peak of 218 kcps and the corresponding activity concentration was 17.7 kBq/cc. Whereas the scatter fraction of PET/CT was found as 39.2% at NECR peak of 72 kcps and activity concentration of 24.3 kBq/cc. The percentage error of the random event correction accuracy was 3.4% and 3.1% in PET/MR and PET/CT, respectively.It was concluded that PET/MR system is about 4 times more sensitive than PET/CT, and the contrast of hot lesions in PET/MR was ~ 9% higher than PET/CT. These outcomes also emphasize the possibility to achieve excellent clinical PET images with low administered dose and/or a short acquisition time in PET/MR.Amaç: Bu çalışmada son yıllarda nükleer tıpta rutin uygulamaya giren pozitron emisyon tomografisi/manyetik rezonans (PET/MR) görüntüleme sistemi ile PET/bilgisayarlı tomografi (BT) görüntüleme sistemlerinde ‘National Electrical Manufacturers Association’ (NEMA) testlerinin yapılması ve sonuçların karşılaştırılması amaçlandı. Yöntem: NEMA NU2-07 testlerinden uzaysal ayırma gücü, hassasiyet, saçılma fraksiyonu kayıp sayımlar ve rastgele olay ölçümleri, görüntü kalitesi, sayım kayıpları rastgele olay düzeltme doğruluğu olmak üzere beş ayrı deneysel çalışma yapıldı. Bulgular: Sensitivite testi sonuçları değerlendirildiğinde PET/MR sisteminin PET/BT sistemine göre yaklaşık 4 kat daha üstün olduğu bulundu. Görüntü kalitesi test sonuçlarından sıcak lezyon kontrastının PET/MR’da %9 daha yüksek olduğu bulundu. PET/MR scatter oranı gürültü eşdeğeri sayım hızı (NECR) 218 kcts ve aktivite konsantrasyonunun 17,7 kcts/cc olduğu durumda %43,4 bulundu. Buna karşılık PET/BT scatter oranı NECR 72 kcts ve aktivite konsantrasyonunun 24,3 kcts/cc olduğu durumda %39,2 bulundu. Tesadüfi hataları düzeltme doğruluğu PET/MR’da 3,4 ve PET/BT’de 3,1 bulundu. Sonuç: PET/MR’da sensitivite değerinin PET/BT’ye göre yaklaşık 4 kat daha yüksek olduğu, PET/MR’da sıcak lezyon kontrastının PET/BT’ye göre %9 daha yüksek olduğu ayrıca PET/MR’da PET görüntülerinin daha az aktivite miktarı/veya daha kısa çekim süresinde elde edilebileceği sonucuna varıldı. Anahtar kelimeler: PET/MR, PET/BT, NEMA testleri, kalite kontrol.

Amaç: Bu çalışmanın amacı, inme sonrası hemipleji hastalarında glenohumeral subluksasyonun klinik değişkenlerle ilişkisinin değerlendirilmesidir. “Hemiplejik hastalardaki omuz subluksasyonu; spastisite, motor iyileşme ve ambulatuvar durum ile ilişkilidir” hipotezinin değerlendirilmesi amaçlanmaktadır. Yöntemler: İnme sonrası hemipleji tanılı hastalardan, omuz ağrısı nedeniyle anteroposterior omuz radyografisi çekilmiş olanlar çalışmaya dahil edildi. Retrospektif olarak dizayn edilen bu çalışmada, hastaların elektronik veri tabanındaki ve dosyalarındaki verilerinden demografik özellikleri (yaş, cinsiyet), hastalık süreleri, fonksiyonel ambulasyon skalaları (FAS), üst ekstremite için Brunnstrom motor iyileşme seviyeleri ve Modifiye Ashworth Skalası'na (MAS) göre spastisite evreleri kaydedildi. Muayene verilerinden klinik GHS tanısı alıp almadıkları not edildi. GHS saptanan hastalarda, muayeneleri ile eş zamanlı çekilmiş olan anteroposterior omuz radyografilerinde vertikal ve horizontal mesafeler ölçüldü. Klinik değişkenler ile GHS arasındaki ilişki değerlendirildi. Bulgular: Omuz ağrısı nedeniyle anteroposterior omuz grafisi çekilmiş olan, toplam 47 hemipleji hastasının sistem verisine ulaşıldı. Dışlama kriterlerinden sonra, yaş ortalaması 66,2±12,1 yıl olan 41 hasta istatistiksel analize dahil edildi. Hastaların 22’sinde (%53,7) GHS mevcuttu. Subluksasyon oranı Brunnstrom kategori I’de (Brunnstrom 1-3), kategori II’deki (Brunnstrom 4-6) hastalara göre anlamlı olarak daha fazlaydı (p0,05). Non-fonksiyonel (FAS 0-2) ve fonksiyonel (FAS 3-5) ambulasyona sahip hastalarda subluksasyon oranları benzerdi (p>0,05). GHS'li hastalarda, vertikal ve horizontal mesafeler, FAS ve MAS kategorisine göre değişim göstermezken (p>0,05), Brunnstrom kategori II’de, istatistiksel analiz için yeterli hasta sayısına ulaşılamadığından karşılaştırmalı analiz yapılamadı. Sonuç: İnme sonrası hemipleji hastalarında, GHS varlığı, motor iyileşme seviyesiyle ilişkili olmakla birlikte, ambulasyon ve spastisite düzeyinden bağımsızdır. Subluksasyon olan hastalarda, ambulasyon ve spastisite düzeyinin subluksasyonun kantitatif ölçümleri üzerine etkisi olduğu gösterilememiştir. Objective: The objective of the present study was to evaluate the relationship between glenohumeral subluxation (GHS) and the clinical variables in patients with post-stroke hemiplegia. The hypothesis, “Spasticity, motor recovery and ambulatory status are associated with GHS in hemiplegic patients” was tested. Methods: Post-stroke hemiplegic patients who had undergone anteroposterior shoulder radiography with a complaint of shoulder pain were included in the study. In this retrospectively designed study, demographic features (age, sex), disease duration, Functional Ambulation Scale (FAC) score, upper extremity Brunnstrom’s motor recovery stage, spasticity grade of the affected upper limb according to the Modified Ashworth Scale (MAS) were recorded from the electronic medical database. It was also noted whether the patients were diagnosed with GHS or not. In patients with GHS, vertical and horizontal distances were measured on anteroposterior shoulder radiographs, which were taken at the time of physical examination. Results: Data of 47 hemiplegic patients underwent anteroposterior shoulder radiographs due to shoulder pain was obtained. Following the application of exclusion criteria, 41 patients with a mean age of 66.2±12.1 were analysed. Of them, 22 (53.7%) had GHS. Subluxation rate was significantly higher among patients in Brunnstrom category I (Brunnstrom 1-3) than those in category II (Brunnstrom 4-6) (p0.05). Subluxation frequency was also similar between patients with non-functional (FAC 0-2) and functional ambulation (FAC 3-5) (p>0.05). In patients with GHS, vertical and horizontal distances did not differ by FAC and MAS category (p>0.05). Since Brunnstrom category II did not have enough number of patients for statistical tests, comparative analysis could not be applied. Conclusion: Among patients with post-stroke hemiplegia, presence of GHS is related to the motor recovery stage, but is regardless of ambulation and spasticity level. In patients with GHS, level of ambulation and spasticity had no impact on the quantitative measures of subluxation.

Aim: The aim of this study is to examined the effect of the oral administration of puerarin on wound healing in diabetic rat.Material and methods: Twenty-four rats were divided into three groups: Group 1 (n:8) non diabetic control (NDC), group 2 (n:8) diabetic control (DC), group 3 (n:8) diabetic puerarine (DP). Rats Group DC and DP were injected a single dose 200 mg/kg streptozin solution for diabet model. A full thickness linear incision was made in the paravertebral region of the rats and the wound edges were covered with a sterile plaster. In Group NDC and DC, rats were given saline solution for 7 days. In Group DP, rats were given 200 mg/kg puerarin with oral gavage for 7 days. All animals were euthanized at 7 days postoperative. Connective tissue volumes and new vessel formation were measured with stereological analysisResults: Stereologic analysis showed that Group NDC and DP had significantly more connective tissue volume at 7 days compared with group DC. New vessel formation volumes were also significantly lesser in group DC. Connective tissue and new vessel volumes difference were not statistically significant between group NDC and DP.Conclusion: Orally administered puerarin enhances new vessel formation and support wound healing in diabetic rats.

Introduction: Amyand’s hernia is the rare presentation of the vermiform appendix in an inguinal hernia sac. This study is anevaluation of perioperative diagnoses of Amyand’s hernia.Methods: This retrospective study was carried out using the data of patients who were admitted to the Selcuk UniversityFaculty of Medicine Department of Pediatric Surgery between November 2011 and December 2017. The clinical data of ageand sex of the patient, side of the hernia location, admission complaints, and the treatment were assessed.Results: During the study period, 1668 patients, 1279 males and 309 females, underwent an inguinal herniorrhaphy at thiscenter. Amyand’s hernia was diagnosed in 14 (0.83%) cases. All were male and had a right-sided Amyand’s hernia. The medianage was 7.5 months. Swelling was observed in 12 patients, postoperative recurrent swelling was seen in 1, and incarcerationin 1. An appendectomy was performed with the herniorrhaphy in 1 case; in the remainder the appendix vermiformis wasreduced.Discussion and Conclusion: Amyand’s hernia is a rare condition in children, and the diagnosis is generally made duringsurgery. When diagnosed, the appendix should be examined carefully. In the presence of an inflamed appendix, an appendectomyshould be performed.

Aim: Though metacarpophalangeal joint collateral ligament injuries are commonly observed, the presence of accompanying avulsed osteochondral fragment or aponeurosis injury in adult patients is a situation that may require definite surgical treatment. Our study investigated patients attending our clinic after acute hand trauma with radial or ulnar collateral ligament injury who underwent arthroscopy-aided surgical treatment and who regularly attended check-ups to examine the efficacy and results of arthroscopy-aided treatment for collateral ligament injury of the metacarpophalangeal joint. Material and Methods: The study assessed fracture healing, joint movement angles and complications of 11 patients who attended our hand surgery department from December 2015 to April 2018 who had ulnar or radial collateral ligament injury of the metacarpophalangeal joint with accompanying osteochondral avulsion fracture repaired with the aid of arthroscopy with at least 1 year of continuous attendance at check-ups. Results: Four patients had 1st proximal finger avulsion fracture accompanying ulnar collateral ligament injury, four patients had 2nd proximal finger avulsion fracture accompanying ulnar collateral ligament injury, 1 patient had 4th finger and 2 patients had 5th finger proximal phalanx fractures accompanying radial collateral ligament injury. The patients’ avulsion fractures and ligament injuries healed without problem, 2 patients had limited joint movement angles and 1 patient developed complex regional pain syndrome. Conclusion: It is considered that the results of arthroscopy-aided collateral ligament injury repair and avulsed fragment fixation are good and perfect healing.

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Amaç: Bu çalışmada, koroner arter hastalığı olan tip 2 diyabetik hastalar ile nefropatisi olan tip 2 diyabetik hastaları ana karotis intima–media kalınlığı açısından karşılaştırmak amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya koroner arter hastalığı olan tip 2 diyabetik hastalar (n=36) ve koroner arter hastalığı olmayan, nefropati ile komplike tip 2 diyabetik hastalar (n=31) alındı. Sağ ve sol ana karotis arter intima–media kalınlığı B-mod ultrasonografi ile değerlendirildi. Hastalarda kardiyovasküler hastalık açısından diğer geleneksel risk faktörleri de değerlendirildi. Bulgular: Koroner arter hastalığının eşlik ettiği diyabet hastalarında hem sağ hem de sol ana karotis arter intima–media kalınlığı, sadece nefropatinin eşlik ettiği diyabet hastalarına göre anlamlı derecede fazla bulundu (sağ ana karotis için 0,99 mm’ye 0,82 mm, sol ana karotis için 1,07 mm’ye 0,92 mm; her ikisi için de p0,05). Tartışma ve Sonuç: Koroner arter hastalığı varlığı tip 2 diyabette eşlik eden serebrovasküler hastalık için önemli bir göstergedir., Aim: This study aims to compare type 2 diabetic patients with coronary artery disease and type 2 diabetic patients with nephropathy in terms of common carotid artery intima–media thickness. Materials and Methods: The study included type 2 diabetics with coronary artery disease (n=36) and type 2 diabetics without coronary artery disease but with complicating nephropathy (n=31). The right and left common carotid arteries were evaluated in terms of intima–media thickness by using B-mode ultrasonography. Other traditional risk factors for cardiovascular disease were also evaluated. Results: Both right and left common carotid artery intima–media thicknesses were found to be significantly greater for the diabetics with concomitant coronary artery disease than for the diabetics with concomitant nephropathy only (0.99 mm vs 0.82 mm for the right and 1.07 mm vs. 0.92 mm for the left common carotid artery; p0.05 for all). Discussion and Conclusion: Presence of coronary artery disease is an important indicator for concomitant cerebrovascular disease in type 2 diabetics.

Objectives. The aim of this retrospective study was to report the treatment results obtained with the ankle- spanning Ilizarov fixator technique in the treatment of complex OTA/AO type 43C3 open tibial pilon fractures. Methods. A total of 14 patients with open OTA/AO type 43C3 tibial pilon fractures were evaluated. The demographics and fracture characteristics, preoperative and postoperative radiological evaluations, duration of follow-up (months), time to union (months) and complications were recorded. After collection of operative data, patients were invited for functional and radiological outcome evaluation. American Orthopaedic Foot and Ankle Society (AOFAS) scores and range of movement (ROM) of the ankle joint were investigated. Also radiologically the ankle osteoarthritis level according to the Bargon et al. criteria was noted. Results. The mean age of the patients was 48.7 years (range, 26-72 years). The mean follow-up period was 32 months (range, 25- 46 months). The clinical and radiological time to union was mean 6.5 months (range, 5-11 months). On the postoperative ankle CT images, the separation within the ankle was measured as < 2mm in all patients and in 3 patients, stepping was measured as > 2mm. Following removal of the external fixator, dorsiflexion was measured as mean 15.5° (range, 0°-23°) and plantar flexion as mean 26.14° (range, 13°-36°). The mean AOFAS was 80.35 (range, 56-92). Conclusion. Satisfactory results can be obtained with the Ilizarov external fixator passing the ankle in the permanent treatment of AO-43C3 type open tibial pilon fractures.

Aim: Papillary thyroid carcinoma (PTC) is the most common primary thyroid malignancy. It is called papillary thyroid microcarcinoma (PTMC) if the nodule is less than 10 mm in diameter. It has been shown that platelets may play an essential role during chronic inflammation, cancer progression, and metastasis. The aim of this study was to examine the value of platelet indices including platelet count, mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) in PTC. Material and Methods: 26 patients (19 female, 7 male) with PTC diagnosis were included in the study. The patients were divided into two groups: papillary thyroid microcarcinoma (PTMC) and PTC. All patients who were included in the study were examined for complete blood count parameters. Results: There was no significant difference between the groups in terms of age and gender. Leukocyte count, neutrophil count and percentage, lymphocyte count and percentage, platelet count, plateletcrit, and MPV were not statistically different between groups. PDW were significantly higher in patients with PTC than in those with PTMC. Conclusion: Our results show that patients with PTC have higher PDW levels compared to patients with PTMC. Elevated PDW in PTC may be useful in diagnosis of the disease and for better understanding of its pathogenesis.

Aim: The objective of this study is to investigate effects of vitamin D levels in intensive care patients on length of stay in intensive care unit and duration of hospitalization, and the need for mechanical ventilation. Material and Methods: This study was conducted as a retrospective study between February 2015 and January 2016. Length of stay in the intensive care unit and duration of hospitalization, and the need for mechanical ventilation were compared among all patients who were admitted to the intensive care unit and whose 25 (OH) D levels were examined. We further investigated whether vitamin D levels have an effect on 30-day mortality. Results: A total of 155 patients were included in the study. Vitamin D deficiency was found in 123 (79%) patients, and vitamin D insufficiency in 21 (13%) patients, while vitamin D levels were evaluated as normal in the remaining 11 (7%) patients. The effects of 25(OH)D levels of the patients on the length of stay in the intensive care unit (P=0.302), duration of hospitalization (P=0.363), and the need for mechanical ventilation (P=0.150) were not statistically significant. No statistically significant difference was observed between the mortality rates according to vitamin D levels (P0.377). Conclusion: We found that 25 (OH) D vitamin levels were significantly low in intensive care patients. Although it is difficult to achieve a clear result because of a wide range of comorbidities in intensive care unit patients, we believe that further prospective randomized studies are warranted to clarify this issue.

Objective: Elevated levels of serum IgE and eosinophilia are the indicators of atopy and intestinal parasitic infections. We evaluated the effect of Enterobius vermicularis infection (enterobiasis) on blood eosinophil count and IgE levels in allergic rhinitis. Methods: A total of 110 patients diagnosed with allergic rhinitis (with symptoms of rhinorrhea, itchy nose and nasal congestion) consisting of 41 (37.27%) males and 69 (62.73%) females were examined. Forty-one (37.27%) patients with enterobiasis were selected as the study group. The remaining 69 (62.73%) patients accepted as the control group. Results: In the study group the mean serum total IgE level and mean serum eosinophil count were 393.10 ± 159.83 IU/mL and 0.56 ± 0.04 103/mL, respectively. In the control group the mean serum total IgE level and mean serum eosinophil count were 236.91 ± 63.55 IU/mL and 0.37 ± 0.12 103/mL, respectively. The difference between the two groups was statistically significant for serum total IgE levels (p < 0.05) but not for serum eosinophil count (p > 0.05). The correlation coefficients between serum total IgE level and eosinophil count were statistically insignificant (p > 0.05). Conclusions: More comprehensive and long-term placebo-controlled studies should be performed in order to find the answer to the question of whether helminth infections play a role in allergic disease.

Aim: To evaluate and compare the mRNA expression of antioxidant genes between the cervical and lumbar degenerated disc tissues. Material and Methods: Obtained degenerated Nucleus Pulposus (DNP) materials were divided into two groups, which were cervical DNP (Group I) (n=20) and lumbar DNP (Group II) (n=20). There are 6 men and 14 women in group I with a mean age of 43.8 years and 13 men and 7 women in group II with the mean age of 40.3 years (28 to 54). All cervical DNP materials were obtained between C5 and C6 and all lumbar DNP materials were obtained between L4 and L5 levels. The TGF?1, bFGF, IGF-1, NGF and Matrix metalloprotease III (MMP III) gene expressions of DNP materials were determined by polymerase chain reaction, Real-time polymerase chain reaction and western blotting techniques.Results: When the results of the two groups were compared by polymerase chain reaction, the expressions of TGF?1, bFGF, IGF-1, NGF and MMP III was found lower in lumbar DNP group. Also the TGF?1, bFGF, IGF-1, NGF, and Matrix metalloprotease III genes showed a decrease in gene expression levels when they were analyzed by Real-time polymerase chain reaction. Conclusion: These data showed that; decrease of the TGF?1, bFGF, IGF-1, NGF and MMP III genes in the degenerated lumbar disc tissues, may related with the possibility of molecular background of the disease pathogenesis.

research Amaç: Çocukluk çağında solunum sistemi hastalıklarına ve anomalilerine sık rastlanılmaktadır. Solunum yolu problemlerinde fleksibl fiberoptik bronkoskopi (FOB) kullanımın, tanı ve tedavideki etkinliğini ve çocukluk çağında güvenle kullanımını göstermek amaçlanmıştır. Gereç ve Yöntem: Şubat 2011- Haziran 2012 tarihleri arasında, Dr. Lütfü Kırdar Kartal Eğitim ve Araştırma Hastanesi Çocuk Göğüs Hastalıkları bronkoskopi ünitesinde yapılan 116 FOB işlemi retrospektif olarak değerlendirildi. Bulgular: Fleksibl fiberoptik bronkoskopi yapılan 77’si erkek, 39‘u kız toplam 116 hasta değerlendirmeye alındı. Bronkoskopi endikasyonlarının dağılımı; olgularda görülen stridor, kronik öksürük, persistan wheezing, tekrarlayan krup, hemoptizi, postero anterior akciğer (PAAC) grafisinde persistan infiltrasyon, lokalize bronşektazi, lokalize havalanma artışı, yabancı cisim şüphesi, atelektazi ve akciğer tüberkülozunun tanı ve değerlendirilmesi idi. Sonuç: Bronkoskopi tekrarlayan, persiste eden ve tanısında zorlanılan üst ve alt havayolu semptomları olan hastalarda güvenle yapılan, önemli bir tanı ve tedavi aracıdır. Objective: Respiratory system disorders and anomalies are common in the childhood. In this study, our objective was to demonstrate the effective use of the flexible fiberoptic bronchoscopy (FOB) in the respiratory system disorders and its safety in the childhood. Materials and Methods: 116 FOB interventions, which were carried out in the bronchoscopy unit of the Dr. Lütfü Kırdar Kartal Training and Research Hospital Pediatric Pneumology Department, were retrospectively evaluated. Results: 77 of the 116 evaluated FOB patients were boys and 39 were girls. The most common indication for bronchoscopy was stridor (33.6%) and the most common diagnosis after the bronchoscopy was laryngomalacia (27.59%). Bronchoscopy was completed successfully in 112 patients (96.55%) and it was discontinued in 4 patients (3.5%). Conclusion: Bronchoscopy is an important diagnosis and treatment tool, which can be safely carried out in the recurrent, persistent and hard-to-diagnose upper and lower respiratory disorders in the childhood.

Aim: Nimodipine is used to prevent cerebrovascular-originated ischemic neurological deficits, yet its effects on nucleus pulposus (NP) cells or annulus fibrosus (AF) cells weren’t studied. This study aimed to examine nimodipine’s effects on vitality and proliferation of chondroadherin (CHAD), type II collagen (COL2A1), and hypoxia-inducible factor 1 alpha (HIF 1α) gene expression in human primary NP/AF cells. Material and Methods: NP/AF cell cultures obtained from 6 patients who underwent microdiscectomy were treated with 100 µMolar nimodipine and analyzed at 0, 24, and 48 h. Data were evaluated using one-way ANOVA and post-hoc Tukey HSD with 95% confidence interval. Results: We observed suppressed cell proliferation and increased necrosis in nimodipine-treated NP/AF cell cultures, especially degenerated tissue. COL2A1 gene expression wasn’t detected in any experimental groups. CHAD and HIF 1α expression had time-dependent decreases in control. CHAD and HIF 1α expression were found to decrease at 24h, but increased at 48h in degenerated tissue. In nimodipine-applied intact tissues, CHAD expression was stable at 24h but 1.62 times higher than control at 48h. HIF 1α levels were lower than control. Conclusion: In nimodipine-treated degenerated AF/NP cultures, CHAD and HIF 1α expressions had time-dependent decreases. However, after complete RT-PCR data evaluation, no correlation between nimodipine application and gene expression occurred.

Aim: Acute bronchiolitis is the most common lower respiratory tract infection of children younger than 2 years of age. There aren't any standardized diagnostic criteria and severity assessment classifications for acute bronchiolitis available in literature. Mean platelet volume (MPV) has shown to be effected in inflammatory conditions and to our knowledge there's only one recent study in children with acute bronchiolitis that demonstrated an association between MPV change and acute brınchiolitis. Materials and Methods: In this retrospective study we enrolled 555 children diagnosed with Acute bronchiolitis and 516 healthy infants with a matching age and sex. Results: MPV levels were found significantly higher in patient group (8,2 ± 0,8 fL) than the control group (7,9 ± 0,8 fL). In terms of hospitalization need, no significant difference was detected between the MPV values of the hospitalized group and the outpatients (8,3±0,8 fL; 8,2±0.7 fL, respectively). Conclusions: In conclusion, our data show that MPV values are significantly elevated in acute bronchiolitis compared to healthy infants. However, MPV can't be used as a guidance in attack severity nor can it predict hospitalization and systemic steroid need. Amaç: Akut bronşiolit, 2 yaşından küçük çocuklarda en sık görülen alt solunum yolu enfeksiyonudur. Literatürde akut bronşiolit için standart tanı kriterleri ve şiddet değerlendirme sınıflamaları mevcut değildir. Ortalama platelet hacminin (MPV) lokal inflamasyondan etkilendiği gösterilmiştir ve akut bronşiolit ile MPV ilişkisini gösteren tek bir çalışma bulunmaktadır. Materyal ve Metot: Bu çalışmada MPV ile akut bronşiyolit arasındaki ilişkiyi belirlemeyi amaçladık, ayrıca hastalığın şiddetini değerlendirmede yararlı bir belirteç olup olmadığını araştırdık. Bu retrospektif çalışmada akut bronşiolitis tanısı alan 555 çocuğa ve eşleştirilmiş yaş ve cinsiyete sahip 516 sağlıklı bebek çalışma grubuna dahil edilmiştir. Bulgular: MPV düzeyleri hasta grubunda (8,2 ± 0,8 fL) kontrol grubuna (7,9 ± 0,8 fL) göre anlamlı olarak yüksek bulundu. Hastaneye yatış açısından hastaneye yatırılan grup ve poliklinik hastalarının MPV değerleri arasında anlamlı bir fark saptanmamıştır (sırası ile, 8,3 ± 0,8 fL; 8,2 ± 0,7 fL) Sonuç: Sonuç olarak, verilerimiz, akut bronşiolit varlığında MPV değerlerinin sağlıklı bebeklere göre anlamlı derecede yükseldiğini göstermektedir. Bununla birlikte, MPV atak şiddetinde bir rehber olarak kullanılamaz ve hastaneye yatışı ve sistemik steroid ihtiyacını tahmin edemez.

Aim: The aim was to compare and contrast the lumbal area DEXA measurements made in lateral and front-back positions in theclinically diagnosed female patients with osteoporosis. Material and methods: From the female patients that were referred to our clinic due to low energy fractures that occurred in areasother than the vertabrae, whom were thought to have osteoporotic fractures, were postmenaposal with no known history of diseases, and medication that can lead to osteoporosis and fracture, with no known previous diagnosis of osteoporosis, 39 patients have been included in the study. Anteroposterior and lateral standart lumbar DEXA measurements were performed on all patients. Results: The results of our study revealed that the the laterally performed lumbar Dual Energy X-ray Absorbsiometer (DEXA) measurements have diagnostic advantage in osteoporosis over anteroposteriorly performed measurements. The antiosteoporotic treatment would have beeen prescribed to 82% of the patients if the anteroposteriorly performed lumbar region Dual Energy X-ray Absorbsiometer (DEXA) measurements were taken into account, while when laterally performed measurements were taken into account the percentage was 97.5%. Conclusion: If lateral lumbar area Dual Energy X-ray Absorbsiometer (DEXA) measurements are used in diagnosing osteoporosis more patients would receive the required treatment and the risk of the osteoporotic low energy fractures could be lowered.

research Amaç: Akciğer kanseri kötü prognozlu ve tedavi yanıtı sınırlı olan bir kanser türüdür. Galektin akciğer kanseri patogenezinde rol alabildiği düşünülen fakat akciğer kanseri ile ilişkisinin yeterli düzeyde gösterilemediği potansiyel bir belirteçtir. Amacımız serumda basit bir yöntem olan galektin 1 ve 3 ölçümünün, akciğer kanseri tanısal ya da prognostik belirteci olup olamayacağını araştırmaktır. Yöntem: Çalışmaya 49 akciğer kanseri ve 30 sağlıklı kontrol hastası alındı. Serumlarında galektin 1 ve 3 düzeyleri galektin ölçüm kiti ile çalışıldı. Akciğer kanserli olgular ve sağlıklı kontrol hastaları galektin 1 ve 3’ün tanısal ve prognostik belirteç olup olmayacağı ile ilgili parametreler istatistiksel olarak incelendi. Bulgular: Akciğer kanserli hastada galektin 1 ve 3 değeri, kontrol grubuna göre daha düşüktü. Galektin 1 ve 3 düzeyleri ile sağ kalım, evre ve tümör çapı arasında ilişki saptanmazken, metastaz ve tümör tipi ile negatif ilişkisi saptandı. Sonuç: Galektin 1 ve 3 değeri akciğer kanseri hastalarında sağlıklı olgulara göre daha düşüktür fakat sensitivite ve spesifitesi kısıtlıdır. Literatürde yüksek galektin düzeyi ile akciğer kanseri arasında pozitif saptanan ilişkinin daha geniş hasta gruplarında çalışılmasının uygun olacağı görüşündeyiz. Basit bir tanısal belirteç olarak serum düzeyinin kullanımı umut vaat etmektedir. Objective: Lung cancer is a cancer type with poor prognosis and limited treatment response. Galectin is a potential marker of lung cancer, which is suggested to be involved in the pathogenesis of lung cancer although its association with lung cancer was not accurately demonstrated. Our aim was to investigate whether the simple method of serum galectin 1 and 3 measurements could be diagnostic or prognostic markers of lung cancer. Methods: Forty-nine lung cancer patients and 30 healthy controls were included in the study. The serum galectin 1 and 3 levels were measured using a Galectin assay kit, provided by contribution of the Hitit University Scientific Research Project (SRP). Lung cancer patients and healthy controls were categorized by galectin 1 and 3 levels, either as high or low, and were evaluated statistically for parameters related to diagnostic and prognostic markers. Results: Galectin 1 and 3 values were lower in lung cancer patients compared to the control group (p= 0.015, p= 0.001, respectively). No significant difference was detected for survival and size of tumor between Galectin 1 and 3 groups. Significant difference was detected for metastasis and type of tumor between Galectin 1 and 3 groups. Conclusion: Galectin 1 and 3 values were lower in lung cancer patients compared to healthy subjects but sensitivity and spesifity were not satisfactory. We believe that, the positive relationship between high galectin levels and lung cancer reported in the literature should be assessed further in larger patient populations. Galectin 1 and 3 were not found associated with survival. Measurement of serum galectin-1 and galectin-3 levels as a diagnostic marker is a simple but promising method.

Amaç: Çalışmamızda non-alkolik yağlı karaciğer (NAYK) hastalığında ilgili biyokimyasal belirteçleri ve bunlar arasındaki ilişkileri incelemeyi amaçladık. Gereç ve Yöntemler: Herhangi bir yakınması olmayıp hastanemize kontrol amacıyla başvurmuş olan bireylerin dosyaları retrospektif olarak incelendi. Ultrasonografide (USG) karaciğerde değişik derecelerde NAYK tespit edilen 148 (94 kadın, 54 erkek) birey vaka grubu olarak, USG’de NAYK tespit edilmeyen 149 (76 kadın, 73 erkek) birey ise sağlıklı kontrol grubu olarak çalışmaya dahil edildi. Toplamda 297 hastanın açlık kan glukozu, insülin, HOMA-IR, ürik asit, C-reaktif protein (CRP), trigliserit, LDL, HDL, TSH, D vitamini, AST, ALT, GGT, ALP değerleri ve USG ile belirlenmiş olan NAYK dereceleri incelendi. Bulgular: Cinsiyet karşılaştırılmasında erkeklerde, NAYK prevalansı vaka grubunda sağlıklı gruptakine göre anlamlı biçimde daha yüksek bulundu (p=0,029). Benzer şekilde serum açlık kan glukozu, insülin, HOMA-IR, ürik asit, trigliserit, HDL, ALT, AST, GGT, CRP değerleri de vaka grubunda anlamlı biçimde daha yüksekti. HDL, D vitamini düşüklüklerinin NAYK derecesine etkisi saptanmadı. Vaka grubunda NAYK derecesine göre yapılan analizler açlık kan şekeri (AKŞ), HOMA-IR, ALT, AST ve GGT ortalamaları açısından NAYK dereceleri arasında istatistiksel olarak anlamlı fark olduğunu gösterdi. NAYK derecesi 2 ve 3 olan gruplar birleştirilerek analizler tekrarlandığında NAYK derecesi 1 ve 2 olan iki yeni grup arasında AKŞ, insülin, HOMA-IR, ALT, GGT ortalamaları açısından istatistiksel olarak anlamlı bir fark bulundu. Bu kez AST’deki farklılık azalırken, insülin değeri ortalaması açısından da istatistiksel olarak anlamlı fark olduğu gözlendi. Tartışma ve Sonuç: Çalışmamız görünürde sağlıklı olan bireylerde de NAYK’nin araştırılması gerektiğini, erken tanı ve uygun yönetim ile siroz ve hepatoselüler karsinom gibi komplikasyonların önüne geçilebileceğini düşündürmektedir., Aim: In this study, we aimed to investigate the related biochemical markers and their correlations in non-alcoholic fatty liver (NAFL) disease. Materials and Methods: Patient files of individuals who came to our hospital for routine controls without any complaints were reviewed retrospectively. One hundred and forty-eight individuals (94 females; 54 males) whose ultrasonographic examination revealed varying degrees of NAFL disease constituted the patients group and 149 individuals (76 females; 73 males) whose results were clear the healthy controls group. We reviewed the ultrasonographically determined NAFL disease grades and fasting blood glucose, insulin, HOMA-IR, uric acid, C-reactive protein (CRP), triglyceride, LDL, HDL, TSH, vitamin D, AST, ALT, GGT and ALP values of a total of 297 patients. Results: With respect to sex, NAFL prevalence was significantly higher in the patients group than in the healthy controls for males (p=0.029). Similarly, fasting blood glucose, insulin, HOMA-IR, uric acid, triglyceride, HDL, ALT, AST, GGT and CRP levels were also significantly higher in the patients group. No effect of low HDL and vitamin D levels on NAFL disease grade was observed. Analyses based on NAFL disease grade showed statistically significant difference between the subgroups of disease grade of the patients group in terms of fasting blood glucose, HOMA-IR, ALT, AST and GGT mean values. When the analyses were repeated after the grade 2 and 3 subgroups were combined, there was statistically significant difference between the new grade 1 and 2 subgroups in terms of fasting blood glucose, insulin, HOMA-IR, ALT and GGT mean values. This time there was statistically significant difference in terms of mean insulin levels also, while the difference between the AST levels decreased. Discussion and Conclusion: Our study suggests that apparently healthy individuals also be examined for presence of NAFL disease because timely diagnosis and appropriate management could significantly help prevent complications such as cirrhosis and hepatocellular carcinoma.

Jejunal divertikülozis nadir görülen bir hastalıktır. Prevalansı yaşla doğru orantılı olarak artmakta, 6. ve 7. dekadlarda en üst düzeye ulaşmaktadır. Jejunal divertiküller genellikle asemptomatik seyirlidir ancak, perforasyon geliştiğinde ciddi morbidite ve hatta mortaliteye neden olabilir. Acil servise karın ağrısı ile başvuran, ilk muayenede ve görüntülemede anormal bulgu saptanmayan, yatışının 48. Saatinde akut karın nedeniyle ameliyata alınan ve jejunal divertikül perforasyonu saptanan, intraoperatif arrest nedeniyle exitus gelişen hasta ile ilgili deneyimimizi paylaşmak istedik. Jejunal diverticulosis is a rare disease. The prevalence increases with age, reaching the highest level in the 6th and 7th decades. Jejunal diverticulum is usually asymptomatic but may cause serious morbidity and even mortality when perforation develops. We wanted to share our experience with the patient who presented with an emergency department abdominal pain, who had no abnormal findings on the first examination and imaging, who was operated on due to acute abdomen at the 48th hour of hospitalization and who developed jejunal diverticulum perforation and developed exitus due to intraoperative arrest. © Copyright 2018 by Gazi University Medical Faculty

Aim: Music’s rehabilitative effects are clear in the literature, but the effect of the music type on the post-stroke patients is not clear. The aim of the present study was to investigate the effects of listening different types of music on depression, sleep quality, mental state and anxiety in post-stroke patients. Material and Methods: The study was conducted prospectively. Thirty post-stroke pateints admitted to Department of Neurology, Faculty of Medicine at Mustafa Kemal University, were considered for the study. The patients’ depression level, sleep quality, anxiety and cognitive status were evaluated. Subjects were listening music during the rehabilitation program. Subjects were separated as the Eastern Music group (n=10), western music group (n=10) and control group (n=10). Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Standardized Mini Mental Test (SMMS), and Pittsburgh Sleep Quality Index (PSQI) tests were performed for all subjects twice pre and post- treatment. Results: There was a significant difference in SMMT and BDI within the eastern and Western Music groups (p

Brain death is defined as the irreversible loss of brain function following various pathophysiological changes. In many countries, the brain death diagnosis is carried out in conjunction with organ transplant programs. In Turkey, at third level health institutions in particular, healthcare units established entities that follow similar procedures. The increased number of patients waiting for organs and donor discovery studies have enhanced the public’s interest in this topic. Since the emergency department is usually the first line in admitting patients, its staff must have the firsthand knowledge of managing brain death and organ donation process. In this article, we present three clinical cases that we followed and diagnosed with brain death in our emergency department. Due to the lack of studies addressing brain death procedures in the emergency service, we believe that this report will greatly contribute to our awareness and handling of brain death treatment.

Amaç: Prematür bebeklerde sık görülen, soldan sağa şant ve mortalite ilemorbiditenin önemli bir nedeni olan patent duktus arteriozusun, mekanikventilatörde uzun süre takipli, bronkopulmoner displazi veya respiratuardistres sendromu gibi respiratuar problemleri olan veya medikal tedaviyerağmen patent duktus arteriozusları kapanmayan hastalarda cerrahi ile erkendönemde kapatılmasının, doğum sonrası dönemde gelişebilecekkomplikasyonların önlenmesi açısından güvenilir bir yöntem olduğunuliteratür destekli sunmaktır.Gereçve Yöntem: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi KalpDamar Cerrahisi bölümünde 2006-2015 yılları arasında yapılan, prematürdoğum öyküsü olan ve ek kardiyak patolojisi olmayan 32 patent duktusarteriozus vakası çalışmaya dahil edildi.Bulgular: Çalışmaya dahil edilen 32 hastanın 14’ü (%43,7) kız, 18 ‘i (%56,3)erkekti. Operasyon öncesi en sık görülen rahatsızlık respiratuar distressendromu idi (n20). Hastaların 22 tanesi(%68,7) pediatrik yoğun bakımdaentübe takip edilmekteydi. Cerrahi prosedür; medikal tedavi ile duktuslarıkapanmayan veya intrakranial kanama, böbrek yetmezliği veyatrombositopeni gibi medikal tedavinin kontrendike olduğu vakalarauygulandı.Serimizde eksitus oranı %15,6 idi (n5). Mekanik ventilatördenayrılma süreleri ortalama 6,2 gündü. Postoperatif ekokardiyografikontrollerinde erken dönemde yineleyen patent duktus arteriozus görülmedi.Sonuç:Prematür bebeklerde patent duktus arteriozusa bağlı doğum sonrasıgelişebilecek mortal ve morbid tabloları engellemek için patent duktusarteriozus, medikal tedavinin başarısız olduğu veya genel durumu kritikmekanik ventilatör bağımlı infantlardaşanta bağlı ikincil organ yetmezliğigelişmeden önce postnatal erken dönemde güvenli bir şekilde kapatılabilir., Objective:Our aim is to evaluate the closure of patent ductus arteriosusthrough surgery at an early stage, commonly seen in premature infants and aleading cause of left-to-right shunt and mortality/morbidity, as a safe modalityto prevent complications that may develop in postnatal preiod in patients withbronchopulmonary displasia or respiratory distress syndrome followed up inmechanical ventilation, and whose ductus arteriosus can not be closed despitemedical treatment.Material and Methods:Thirty two cases of patent ductus arteriosus withpremature birth history and no additional cardiac pathology, performed in theDepartment of Cardiovascular Medical School, Necmettin Erbakan Universitybetween 2006-2015 were included into the study.Results:Of the 32 patients, 14 (43,7%) were females and 18 (56,3%) weremales. The most frequently seen preoperative disorder was respiratorydistress syndrome(n20). Twenty-two (68%) of the patients were following asintubated in newborn intensive care unit. Surgical procedure was performedin patients whose ductus were not closed via medical treatmentorin whommedical treatment was contraindicated for problems such as intracranialhemorrhage, renal failure or thrombocytopenia. Excitus rate was 15,6% (n5)in our series. Removal time of mechanical ventilation was average 6,2 days.Postoperative echocardiography showed no recurrence of patent ductusarteriosus.Conclusion:Prevention of postnatal mortality and morbidity due to patentductus arteriosus in premature infants can be achieved by early surgicalclosure during postnatal early period before secondary organ failure due toshunting develops and infants with critical general status-dependent onmechanical vantilation-,and for whom medical treatment is unsuccessful.

Objective: Carpal tunnel syndrome (CTS) is the most common peripheral trap neuropathy resulting from compression of the median nerve in the carpal tunnel of the wrist. Open release of the transverse carpal ligament is now the most commonly used method. New techniques are being developed to avoid complications of standard long curvilinear incision. Methods: Between March 2010 and January 2016, carpal tunnel release was performed by the same surgeon with 110 minimally invasive techniques in 96 patients due to CTS. Complaints and physical examination findings were compatible with CTS and mid- to severe-severity CTS cases supported by EMG were included in the study. Results: Complaints and examination findings were recorded at the post- operative 1 st year outpatient clinics of the patients. Of the110 carpal tunnel release, in 50 patients (%45,5) total, in 45 patients (%40.9) significant, in 13 patients (%11,8) slight improvement were recorded, while no improvement was recorded in 2 patients (%1,8). They stated that 88% of the patients were satisfied with the operation and 12% were not satisfied. Visual Analog Scale (VAS) was used to evaluate pain complaints. The mean VAS score was 7,5 pre- operatively and 3,2 at post-operatively 1 year follow-up. Conclusion: In patients with CTS, median nerve decompression with minimal wrist incision is an effective and reliable surgical procedure., Amaç: Karpal tünel sendromu (KTS), median sinirin el bileğindeki karpal tünelde sıkışması sonucu ortaya çıkan en sık periferik tuzak nöropatidir. Transvers karpal ligamanın açık serbestleştirilmesi günümüzde en yaygın kullanılan yöntemdir. Standart uzun kurvilinear insizyonun komplikasyonlarından sakınmak için yeni teknikler geliştirilmektedir. Yöntem: Mart 2010- Ocak 2016 yılları arasında KTS nedeniyle 96 hastaya 110 minimal invazif teknik ile aynı cerrah tarafından karpal tünel serbestleştirilmesi yapıldı. Şikayet ve fizik muayene bulguları KTS ile uyumlu olup EMG ile ön tanısı desteklenmiş orta ve ağır derece KTS olguları çalışmaya alındı. Bulgular: Hastaların post-operatif 1. yıl poliklinik kontrollerindeki şikayet ve muayene bulguları kaydedildi. 110 karpal tünel serbestleştirilmesi sonrası 1. yılda, 50’sinde (%45,5) tam, 45’ inde (%40.9) belirgin, 13’ ünde (%11,8) hafif düzelme kaydedilirken 2 (%1,8) hastada düzelme olmadı. Hastaların %88’ i olduklarını ameliyattan memnun olduklarını, %12’ si memnun olmadıklarını belirtti. Hastaların ağrı değerlendirmeleri için Görsel Analog Ağrı Skalası kullanıldı. Bu değer ameliyat öncesi 7,5 iken ameliyat sonrası 1. yılda 3,2 olarak kaydedildi. Sonuç: KTS hastalarında, minimal el bileği insizyonu ile median sinirin dekompresyonu, etkin ve güvenilir bir cerrahi prosedürdür.

Aim: Human body has an unmatched capacity to keep the correct posture against gravity. Balance is the most important factor for the stability of ankle joint. Ramadan is a special religious month of Muslim calendar (The Hegira calendar) which includes an integrated life style change in dietary habits, sleep pattern, daily life and social activities. The objective of this study was to examine the effect of fasting on ankle proprioception sense.Material and Methods: This study was attended by 30 of the first year students of the Faculty of Medicine of Inonu University. Ankle proprioception sense was measured at 10º dorsiflexion (DF), 11º plantarflexion (PF) and 25º PF angles in eyes open position (EOP) and eyes closed position (ECP) by using active reproduction test. Deviations from these angles were recorded as proprioception score. The measurements were made two weeks before Ramadan started and 2 weeks after Ramadan started when the students were fasting. Ankle proprioception measurement was conducted separately for right and left foot with digital inclinometer.Results: According to the results of Wilcoxon paired samples test, statistically significant difference was found between pre-fasting and fasting period in ECP 10º DF and 11º PF angles of the right foot and ECP 11º PF angle of the left foot (p0.05).Conclusion: As a conclusion, we believe that fasting has an effect on proprioceptive sense, even though partly. Considering the difficulty of finding out the angles measured, associating the results with only fasting period is open to dispute.

AMAÇ: Bu çalışmada Selçuk Üniversitesi Tıp Fakültesi2011-2013 tarihleri arasında Çocuk Onkoloji AnabilimDalı’nda takipli ve Çocuk Cerrahisi Kliniğince opere edilentoplam 22 retroperitoneal tümörlü hastanın kayıtlarıretrospektif olarak değerlendirildi.GEREÇ VE YÖNTEM: Retroperitoneal tümör nedeniyle2011-2013 arasında cerrahi girişim yapılan olgulargeriye dönük olarak incelendi. Primer retroperitonealtümörü kontrol altına alınan, başka uzak organ metastazıolmayan cerrahi tedavi uygulanan olgular çalışmayadahil edildi. Yaş, cinsiyet, primer tanı anında tümör evresi,cerrahi tedavi yöntemi, patolojik tanı ve takip açısındanolguların dosyaları retrospektif olarak değerlendirildi.BULGULAR: Olgularımızın 9’u (%40) erkek, 13’ü (%60)kadındı. Ortalama yaş erkeklerde 71 ay (3-132), kadınlarda37 ay (6-204) idi. Histopatolojik olarak olguların 15(%68)’i nöroblastom, 4’ü (%18.5) Wilms tümörü, 1’i(%4.5) embriyonal rabdomyosarkom, 1’i (%4.5) berrakhücreli sarkom, 1’i (%4.5) malign sinir kılıfı tümörü olarakdeğerlendirildi. Tanı anında olguların 8’i (%36) evre I, 7’si(%32) Evre III, 7’si (%32) evre IV safhasındaydı.SONUÇ: Olgularımızın %68’i nöroblastom olup,tanı anında hastaların %64’ü evre III ve evre IV idi.Anatomik lokalizasyonları nedeniyle ileri evrelere kadarsessiz tümörler olan retroperitoneal tümörlerin çoğunöroblastomdur ve genellikle ileri evrelerde tanı alırlar., OBJECTIVE: In this study, Selcuk University Facultyof Medicine between 2011 - 2013 follow-up at theDepartment of Pediatric Oncology and Pediatric Surgeryclinic was operated by a total of 22 patients withretroperitoneal tumors were evaluated retrospectively.MATERIAL AND METHODS: Retroperitoneal tumorswere evaluated retrospectively during 2011-2013. Thecases treated with primary retroperitoneal tumor, surgicaltreatment without other distant organ metastasis wereincluded in the study. The files of the cases were primarydiagnosis in terms of age, sex, tumor stage at the timeof diagnosis, surgical treatment method, pathologicaldiagnosis and follow-up reviewed retrospectively.RESULTS: Nine out of 22 cases (40%) male and 13 (60%)were female. Male mean age of 71 months ( 3-132 ) inthe girls 37 months ( 6-204 ). The histological results, 15(68%) of neuroblastoma, 4 (18.5%) Wilms, 1 (4.5% ) EmbryonalRhabdomyosarcoma, 1 (4.5% ) Clear cell sarcoma ,1 (4.5% ) malignant nerve sheath tumors were evaluated.Eight of the cases (36%) were stage I, 7 (32%) were stageIII, 7 (32%) stage IV.CONCLUSIONS: In conclusion, 68% of our cases wereneuroblastoma and 64% of the patients were stage IIIand stage IV at the time of diagnosis. Retroperitonealtumors are generally diagnosed in advanced stages. Wethink that this is due to the anatomical localizations andthe silent as far as the clinically advanced stage.Tamer SEKMENLİ1, İlhan ÇİFTÇİ1, Doğan KÖSE2, Yavuz KÖKSAL2, Nevin SEKMENLİ3

Aim: We aimed to assess the incidence, mean size, patterns, and types of accessory and sesamoid bones of the foot using computed tomography. Material and Methods: A total of 814 non-contrast-enhanced computed tomography images of the foot obtained from 717 patients between October 2015 and January 2018 were investigated retrospectively. Images acquired in the original axial plane were used to perform multiplanar reconstruction in the coronal or sagittal planes. Incidence, mean size, patterns, and types of accessory and sesamoid bones were evaluated in all images. Results: Accessory bones were detected in 387 (47.5%) non-contrast-enhanced computed tomography scans from 326 patients (45.4%). Sixty-seven patients (9.3%) showed accessory bones on both sides; 133 patients (18.5%), only on the right side; and 126 patients (17.5%), only on the left side. The most common accessory bones of the foot were the os naviculare accessorium (24.8%), os trigonum, (20.3%), os peroneum (14.6%), os intermetatarseum (10.6%), os supranaviculare (3.1%), os supratalare (1.9%), and os vesalianum (1.5%). The hallucal sesamoid bone was observed in all patients, while the interphalangeal sesamoid bone was observed in 34.6% of the patients. Conclusions: The computed tomography scans provided a detailed overview of the characteristics of accessory and sesamoid bones, and the incidence of these bones in our patients was higher than those reported in previous radiographic studies. Our findings can facilitate the diagnosis and management of disorders involving these bones.

Yorgunluk, multiple sklerozlu bireylerde en sık rastlanan semptomlardan biridir. Multiple skleroz ile ilişkili yorgunluğun değerlendirildiği çalışmalarda; çoğu yorgunluk vakasının çevresel ve vücut içi sıcaklığının yükselmesi ile arttığı belirlenmiştir. Multiple sklerozlu bireylerde vücut sıcaklığı düşürülerek sinir iletisinin hızlandırılması ve semptomların giderilmesi amacıyla çeşitli soğutma tedavisi yöntemleri kullanılmakta ve yorgunluk düzeyinde azalmalar olduğu bildirilmektedir. MS hastalarında soğutma tedavisi; soğuk su içme, soğuk duş alma, deriye soğuk ped uygulama veya soğutucu giysi gibi yapay soğutma sistemlerinin kullanımı ile sağlanmaktadır. Bu derleme, MS hastalarında yorgunluk yönetiminde soğutucu giysi uygulaması ile ilgili literatür bilgisini paylaşmak amacıyla yazılmıştır., Fatigue is one of the most common symptoms in individuals with multiple sclerosis. In the studies evaluating the fatigue associated with multiple sclerosis, it was determined that fatigue increased with the elevation of body and environmental temperature in most of the cases. Various cooling methods are being used to accelerate nerve conduction and eliminate symptoms by reducing body temperature in the individuals with multiple sclerosis and it is reported that level of fatigue decreased with cooling therapies. In MS patients cooling treatment is provided by use of artificial cooling systems, such as drinking cold water, taking a cold shower, applying cold pad or cooling suits. This review aims to share knowledge about the application of cooling clothing in fatigue management in MS patients.

Aim: In this study, it was firstly aimed to investigate the effect of Daptomycin (DAP) on the proliferation in Vancomycin (VCM)-administered primary chondrocyte cultures and non-drug-administered primary chondrocyte cultures. Our second objective was to investigate the effects of DAP and VCM on the NP-specific marker protein chondroadherin (CHAD), which is associated with spinal cord and dorsal column growth, on the transcription factor-1 alpha (HIF-1?), which is induced by hypoxia, and on a type II collagen (COL2A1), which is also known to play a significant role in the development of extracellular matrix, at the pharmaco-molecular level.Material and Methods: Standard human primary chondrocyte cultures were established. DAP and VCM were added to the samples. In all groups, molecular analysis was performed at 0th, 24th and 48th hours. In addition, the surface morphology of the cells was evaluated.Results: Changes in cell morphology and cell death in cultures were observed 24 hours after administration of antibiotics to cell cultures. It was observed that drug administration was associated with the cell viability and that cell viability rate for two antibiotics was similar at the 0th and 48th hours. The expression of three genes decreased at the 24th hour in the experimental group where DAP was administered.Conclusion: Thanks to this molecular-based research, it should not be forgotten that DAP and VCM active pharmacological agents, especially used in the treatment of Methicillin-resistant Staphylococcus aureus induced surgical infections, have a negative effect on human chondrocyte and ECM components.

Cardiac myxoma associated with coronary artery disease is a rare pathology in an elderly patient. Herein we present an 81-year-old woman undergoing simultaneous surgical treatment for left atrial myxoma combined with coronary artery disease. The postoperative course of the patient was uneventful. The initial removal of mass should be performed to prevent systemic embolization of tumor fragments.

GİRİŞ ve AMAÇ: Bu çalışmada bölgemizde 0-16 yaş grubu çocuk hastalarda üriner sistem infeksiyonuna neden olan bakteriler ve antibiyotik direnç oranlarının belirlenmesi, çeşitli idrar analiz testlerinin kültür sonuçları ile birlikte tanısal uyumunun değerlendirilmesi amaçlanmıştır.YÖNTEM ve GEREÇLER: Mart 2015- Şubat 2016 tarihleri arasında üriner sistem infeksiyonu ön tanısı alan 0-16 yaş grubu çocuk hastalara ait hem kültür hem de idrar analizi istemi olan toplam 982 idrar örneğinin sonuçları retrospektif olarak incelenmiştir. Hastalara ait idrar kültürü sonuçları ile birlikte tam otomatik idrar analizatöründe incelenen lökosit (≥10/mL) ve nitrit pozitifliği değerlendirilmiştir.BULGULAR: İdrar kültürlerinde üreme tespit edilen 196 hastada rastlanan bakteriler sıklık sırasına göre Escherichia coli (%72), Klebsiella pneumoniae (%8.6), Proteus mirabilis (%7.6), Enterococcus spp (%7) ve diğer bakteriler (%4.8) türleri olmuştur. E.coli ve K. pneumoniae izolatlarında amikasin, fosfomisin, nitrafurontain ve imipeneme karşı direnç gözlenmemiştir ve en etkili antibiyotikler olarak tespit edilmiştir. Kültür sonuçları referans kabul edilerek idrar analiz testlerinden lökosit ve nitrit pozitifliğinin tanısal sensitivite, spesifite, pozitif prediktif değer, negatif prediktif değer ve doğruluk oranları hesaplanmıştır. Bu değerler lökosit için sırasıyla %64.3, %95, %76.4, %91, %88.4 ve nitrit için %17.1, %99, %86, %83.5, %69.8 olarak hesaplanmıştır.TARTIŞMA ve SONUÇ: Bölgemizde, çocuk hastalarda antibiyotik direnç oranları diğer çalışmalara göre düşük bulunmuştur. Yaptığımız karşılaştırmaya göre idrar analiz sonuçlarının tek başına tanı koydurucu olmadığını, direnç gelişiminin önlenmesi amacı ile antibiyogramların yapılması ve takibi, hızlı tanı amacıyla kullanılan idrar analiz testlerinin kültürün daha verimli değerlendirilmesinde yararlı olacağını düşünmekteyiz., INTRODUCTION: : The present study aimed to determine the bacteria causing urinary tract infection and their antibiotic resistance rates, and to assess the diagnostic compliance along with the culture results of several urine analysis tests in pediatric patients aged 0–16 years in the present region.METHODS: A retrospective analysis was performed to examine the results of a total of 982 urine samples received for both urine culture and analysis. These samples were of pediatric patients aged 0–16 years prediagnosed with urinary tract infection between March 2015 and February 2016. Along with the urine culture results of the patients, leukocyte (≥10/mL) and nitrite positivity reviewed in the full automated urine analyzer was also evaluated.RESULTS: The most common bacteria identified in 196 patients in whom growth was detected in urine cultures were Escherichia coli (72%), Klebsiella pneumoniae (8.6%), Proteus mirabilis (7.6%), Enterococcus spp. (7%), and other species (4.8%), as per the order of frequency. In E. coli and K. pneumoniae isolates, no resistance was observed to amikacin, phosphomycine, nitrofurantoin, and imipenem, which were also found to be the most effective antibiotics. Diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates of leukocyte and nitrite positivity were calculated from the urinalysis tests by taking the culture results as reference. These values were found to be 64.3%, 95%, 76.4%, 91%, 88.4% for leukocytes and 17.1%, 99%, 86%, 83.5%, 69.8% for nitrites, respectively.DISCUSSION AND CONCLUSION: We can say that the antibiotic resistance rates in pediatric patients in our region are found to be lower compared to other studies. According to comparisons we have made, urinary analysis results are not diagnostic alone due to the low correspondence of culture results. The urinalysis tests used for rapid diagnosis will be useful for assessing the culture more efficiently by performing and following antibiograms to prevent the development of resistance.

Uterine prolapse during pregnancy is a rare condition with an estimated incidence of 1:10,000–15,000 pregnancies. Premature labor and delivery are the most prevalent complications in pregnancies with pelvic organ prolapse. Various treatment methods from conservative approaches to surgery are possible. In this paper we report a 27 year-old patient who was treated with Arabin pessary due to uterine prolapse in the first trimester., Gebelikte uterin prolapsus nadir görülen bir durumdur, tahminen 10–15 bin gebelikte 1 görülür. Pelvik organ prolapsusu gelişen gebeliklerde en yaygın komplikasyon erken doğumdur. Konservatif yaklaşımdan cerrahiye kadar, çeşitli tedaviler mümkündür. Bu çalışmada, ilk trimesterde uterin prolapsus nedeniyle Arabin pesser ile tedavi edilen 27 yaşındaki bir hasta sunulmuştur.

INTRODUCTION: Microtia is a congenital anomaly, manifested by a small anddisfigured auricle. Interleukin (IL) 1 is an important mediator of inflammationand cartilage destruction, This study is aimed at investigating association ofIL-1A (-889) and IL-1B (-511) variants in a Turkish patient population withmicrotia.METHODS: Nineteen patients diagnosed with microtia and 40 healthy controls wereenrolled to the study. The IL-1A (-889) and IL-1B (-511) variants were evaluatedusing the polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) method. For statistical analysis, SPSS version 22.0 was used.RESULTS: The genotype distribution of the IL-1A (-889) variant wasstatistically different between the cases and the control group. IL-1A -889 CCgenotype was lower in microtia cases while TT genotype was more prevalent inmicrotia cases, respectively (p=0.008, p=0.008). High difference was alsoobserved when the patient group and the control group were compared accordingto IL-1 (-889) CT+TT (p=0.003). IL-1A (-889) C allele was lower in microtiapatients and T allele was higher in patients (p=0.005). The allele frequencyand genotype distribution of IL-1B (-511) CT variant did not show any statisticallydifference between patients and controls (p>0.05). DISCUSSION AND CONCLUSION: To our knowledge, for the first time in theliterature we have demonstrated a significant association of the IL-1A (-889)functional variant with microtia in a Turkish cohort.İngilizce Kısa Başlık: IL-1 gene variants in microtia, GİRİŞ ve AMAÇ: Mikrotia küçük ve şekil bozukluğu olan kulak kepçesi ilegörülen kongenital bir anomalidir. İnterlökin (IL) 1 enflamasyon ve kıkırdakharabiyeti için önemli bir düzenleyicidir. Bu çalışma Türk mikrotiahastalarında IL-1A (-889) ve IL-1B (-511) varyantlarının ilişkisinideğerlendirmeyi amaçlamıştır.YÖNTEM ve GEREÇLER: Çalışmaya mikrotia tanılı 19 hasta ve 40 sağlıklı kontroldahil edilmiştir. IL-1A (-889) ve IL-1B (-511) varyantları polimeraz zincirreaksiyonu (PZR)- sınırlayıcı parça uzunluk polimorfizm (RFLP) yöntemi ileincelenmiştir. İstatistik analiz için, SPSS 22.0 versiyonu kullanılmıştır.BULGULAR: IL-1A (-889) varyant genotip dağılımı hastalar ve kontrol grubuarasında istatistiksel olarak farklıydı. IL-1A -889 TT genotipi mikrotiahastalarında daha yaygınken, CC genotipi mikrotia hastalarında daha azdı,sırasıyla (p=0.008, p=0.008). Hasta ve kontrol grupları IL-1 (-889) CT+TTdurumuna göre karşılaştırıldığında büyük fark saptandı (p=0.003). IL-1A (-889)C alleli mikrotia hastalarında azdı ve T alleli hastalarda çoktu (p=0.005).IL-1B (-511) CT varyant genotip ve allel dağılımı hastalar ve kontrol arasındaherhangi istatistiksel fark göstermedi (p>0.05). TARTIŞMA ve SONUÇ: Bildiğimiz kadarıyla literatürde ilk olarak, IL-1A (-889)fonksiyonel varyantın Türk topluluğunda mikrotia ile önemli ilişkisi olduğunugösterdik.Türkçe Kısa Başlık: Mikrotiada IL-1 gen varyantları

Amaç:Bu çalışma, adölesan doğumların anne ve yenidoğana yönelik sonuçlarını incelemek amacıyla yürütülmüştür. Gereç veYöntem: Tanımlayıcı tipte yapılan çalışmada, Türkiye’nin batısında bir üniversite hastanesinde 01.01.2012-31.12.2014 tarihleri arasında doğum yapmış olan 19 yaş ve altı 282 adölesanın dosyaları retrospektif olarak incelenmiştir. Veriler, araştırmacılar tarafından oluşturulan, 38 sorudan oluşan anket formu ile toplanmıştır. Verilerin değerlendirilmesinde sayı, yüzde, ortalama, standart sapma kullanılmıştır. Bulgular: Çalışmada adölesan gebelik oranı %6.08, katılımcıların yaş ortalaması 18.29±0.99 olup %93.3’ü 17- 19, %6.7’si 14-16 yaş grubundadır. Adölesan gebelerin %78’i daha önce hiç gebelik geçirmemiştir. Annelerin %39.4’ünün doğumu sezaryen ile gerçekleşmiş, %10.6’sının preterm eylem öyküsü mevcuttur. Ortalama doğum haftası 38.58±2.50’dir ve yenidoğanların doğum ağırlığı ortalaması 3.140±604.36 gram, %9.2’sinin doğum kilosu 2.500 gramdan azdır. Kadınların %44’ünün hemoglobin değeri 11 gr/dl’nin altında ve hemoglobin değeri ortalaması 10.10±1.48’dir. En sık sezaryen endikasyonları, ilerlemeyen eylem (%18.9) ve fetal distres (%18) olarak saptanırken, adölesan gebelerin %18.8’inde obstetrik komplikasyon belirlenmiştir. Sonuç:Adölesan gebelikler anne ve çocuk sağlığı üzerine olumsuz etkilerinden dolayı sağlıklı toplumların oluşmasında önemli bir sorundur. Bu nedenle adölesan gebeliklerin önlenmesinde adölesanlara, ailelerine, adölesan gruplara hizmet veren kurum ve kuruluşlara ve tüm topluma bilgilendirme eğitimleri yapılmalıdır., Purpose: This study was conducted to analyse adolescent deliveries results on the mother and the new-born. Materials and methods: In this descriptive study, retrospective analyses were conducted in a university hospital in the western part of the Turkey. 282 files of adolescent (younger than 19) deliveries, between 01.01.2012 and 31.12.2014, were analysed retrospectively. Data were collected through a survey with 38 questions generated by the researchers. Average mean, percentage and standard deviation were used for the analyses of the gathered data. Results: The adolescent pregnancy ratio was 6.08% in the study and average of their age was 18.29±0.99. 93.3% of them were aged between 17-19 and 6.7% of them were aged between 14-16. 78% of adolescent pregnant had not had a pregnancy before. 39.4% of them had a caesarean section and 10.6% of them had a preterm labour history. The average of the pregnancy week was 38.58±2.50, average weight of the new-born was 3.140±604.36 gr and 9.2% of them were less than 2.500 gr. Women’s haemoglobin value average was 10.10±1.48 and 44% of them was less than 11 gr/dl. The most common caesarean section indications were abnormal labour progress (18.9%) and fetal distress (18%). Also, obstetric complication was determined in 18.8% of the adolescent pregnants. Conclusion: Because of its negative effects on the health of the mother and child, adolescent pregnancy is an important problem in generation of healthy society. Because of this, informative training should be given to adolescents, their family, the foundations and institutions giving service to them and all society.

Amaç: Obezitede gastrointestinal fonksiyon değişiklikleri sıklıkla meydana gelmektedir. Bu çalışmada obez olgularda gastroözefageal reflü (GÖR) sıklığını araştırmak, mide boşalım ve özefagus transit zamanlarındaki değişiklikleri sintigrafik yöntemlerle değerlendirmek amaçlandı. Yöntem: Kilo kontrolüne yönelik tedavi almayan, diyabetik olmayan 50 kadın obez olguya ait veriler retrospektif olarak incelendi. Ortalama Vücut Kitle İndeksi (BMI) 34.96±3.04 kg/m2 idi (değer aralığı: 32-39 kg/m2). Tüm olgularda özefagus transit ve mide boşalım zamanları, gastroözefageal reflü varlığı sintigrafik yöntemlerle değerlendirildi. Elde edilen veriler klinik arşivimizde bulunan yaşları uyumlu obez olmayan 30 kadın olguya ait sonuçlar ile karşılaştırıldı. Bulgular: Obez grupta 17 olguda (34%) sintigrafik olarak gastroözefageal reflü saptandı. Ortalama mide boşalım yarı zamanı (t1?2) 59,18±30,8 dk, ortalama özefagus transit zamanı ise 8,9±7,2 saniye idi. GÖR sıklığı ve ortalama özefagus transit zamanı obez grupta kontrol grubuna gore anlamlı yüksek bulundu. Mide boşalım ve özefagus transit zamanları GÖR saptanan obez olgularda, GÖR saptanmayanlardan anlamlı yüksekti. Obez ve obez olmayan olgular arasında C14 üre nefes testi pozitifliği açısından anlamlı fark bulunmadı. Vücut kitle indeksi ile GÖR, özefagus transit ve mide boşalım zamanları arasında anlamlı korelasyon saptanmadı. Sonuç: Bu çalışmaya dahil edilen 50 obez olgunun 42’sinde mide-özefagus motilite değişiklikleri mevcuttu. Obezitede bu değişikliklerin neden-sonuç ilişkisi henüz tam anlaşılamamakla birlikte obezitenin oluşumu, korunması ya da beslenme alışkanlıklarında potansiyel etkileri olabileceği düşünülmüştür, Objective: Altered gastrointestinal function has frequently been observed in obese patients. The aim of this study was to investigate the frequency of gastro-esophageal reflux (GER) and to determine the alterations of gastric emptying and esophageal transit by scintigraphic methods in obese patients. Methods: Scintigraphic studies of 50 obese female non-diabetic patients who had not received any treatment for weight control were retrospectively reviewed. Mean Body Mass Index (BMI) was 34.96±3.04 kg/m2 (range:32-39 kg/m2). All subjects were submitted to scintigraphic evaluation of esophageal transit, gastro-esophageal reflux, gastric emptying and presence of Helicobacter pylori infection. The data of obese patients were compared with those of sex-age matched 30 non-obese cases who were selected from our clinical archive. Results: In obese group, seventeen (34%) patients were found to be GER positive scintigraphically; mean gastric emptying time (t1⁄2) was 59.18±30.8 min and the mean esophageal transit time was 8.9±7.2 s. Frequency of positive GER scintigraphy and the mean value of esophageal transit time were significantly higher in obese patients than non-obese control subjects. Gastric emptying time and esophageal transit time values were significantly longer in GER positive obese patients than GER negative ones. There was no statistically significant difference in the frequency of positive C14 urea breath test between obese and non-obese subjects and there were also no statistically significant correlations between BMI, GER, esophageal transit time and gastric emptying time. Conclusion: In our study, 42 of the 50 obese patients had esophago-gastric motility alterations. The significance of these alterations in obesity is not fully understood, but it is believed that these changes could be because of potential contributing factors in the development or maintenance of obesity or changes in eating habits.