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Background: Glecaprevir/pibrentasvir (G/P) is a pangenotypic direct-acting antiviral (DAA) drug with a high resistance barrier. It has been used in patients with chronic hepatitis C in Turkey since March 2019. This drug's efficacy and safety data in Turkey are very limited, and there are not enough studies on real-life data. Objectives: In this study, we aim to present real-life data, efficacy, and safety for our patients. Methods: In this retrospective, observational, single-center study, 116 patients who were started on G/P (100mg/40mg) oral therapy at the infectious diseases clinic between March 2019 and December 2021 due to HCV were included. Of the 116 patients included in the study, 92 were analyzed. Demographic data of the patients, previous treatment experience, drug use, viral load (HCV RNA levels at the 4th week of treatment and 12th week after treatment), and viral genotype data were obtained retrospectively from the automation system. Statistical analysis IBM SPSS version 21.0 statistical package program was used. Results: Seventy-one (77.2%) of the patients were male, and 21 (22.8%) were female, with a mean age of 47.4 (18 - 89). Genotype distribution of patients 8.7% (n = 8) type 1a, 31.5% (n = 29) type 1b, 26.1% (n = 24) type 2, 22.9% (n = 21) type 3, 10.9% (n = 10) were type 4, 8.7% (n = 8) of the patients were treatment-experienced. In our study, there were no patients with cirrhosis. SVR-12 could not be obtained from a patient infected with only genotype 1a. In addition, this patient was co-infected with Hepatitis B. No side effects were observed in any of the patients that required treatment discontinuation. The SVR-12 rate was 98.6% with patients per protocol analysis (PP), but the SVR-12 rate was 77.2% with intention to treat analysis (ITT). Conclusions: In conclusion, this study suggested that G/P therapy in Turkey is used in real life with very high efficacy and tolerability. In addition, a significant change was observed in the genotype distribution previously reported in Turkey in the patient group we treated.

Existing reinforced concrete (RC) buildings designed according to outdated codes may lack sufficient strength, stiffness or ductility to meet the seismic performance criteria of current codes. To enhance the system stiffness and re-centering capability, an elastically designed supplementary steel frame (SF) is installed in parallel with the BRBs. Near full-scale cyclic tests are conducted on such retrofit schemes for performance evaluation. The retrofitted specimens showed stable hysteretic behavior up to the retrofit target story drift of 1/150 as proposed in the Japanese seismic regulations. Tests demonstrate that the proposed system is feasible and increases both strength, ductility, and damping to an adequate seismic performance level while the elastic steel frame is effective in providing post-yield stiffness and re-centering capability even when the RC frame is subjected to moderate inelasticity. Special emphasis is placed on the composite behavior of RC members and SF. A simplified composite interaction model is proposed and results from the developed model show good agreement with the experimental data. Ductility demands are shown to concentrate in the BRBs as per the design intent.

Introduction: Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis, which can affect any organ. The incidence of TB has increased due to the increase in the number of diseases and drugs that cause immunosuppression. The diagnosis of extrapulmonary TB (EPTB) is mostly clinical, histopathologic, radiologic, less frequent microbiological diagnosis. In our study, it was aimed to reveal the data helpful in the diagnosis by retrospectively examining the demographic and clinical data of the patients with EPTB. Materials and Methods: The patients who had a diagnosis of EPTB and were followed up between January 2012 and March 2017 in Fırat University Hospital, Department of Infectious Diseases and Clinical Microbiology were included in the study. Data were analyzed using Statistical Packages for the Social Science 22 statistical program. Results: The study included 125 patients, 28.8% were male and 71.2% were female. The mean age was 46.3±17 years. Of the patients with EPTB diagnosed; 49% had lymphadenitis, 14% musculoskeletal system involvement, 3% miliary involvement, 10% genitourinary system involvement, 4% central nervous system involvement, 5% gastrointestinal system involvement, 5% mastitis, and 9% had other organ involvements. Patients most frequently presented with complaints of swelling, sweating and fever. Tuberculin skin test (TST) was positive in 61.1% of the patients and quantiferon test was positive in 71% of the patients. Growth in mycobacterial culture was found in 12.8% of our patients, polymerase chain reaction positivity in 6.4%, and acid-resistant staining positivity in 16.8%. Granuloma structures were seen in 81.9% of the patients who underwent histopathological examination, and caseification necrosis was detected in 64.7% of the granuloma structures. Conclusion: Tuberculosis must be considered in the differential diagnosis of infectious diseases in which no etiology is detected in areas where TB is common, such as our country. It is thought that none of the EPTB diagnostic methods have the sensitivity and specificity that can be used alone, and that the evaluation of TST or quantiferon can still be used for diagnosis. There is a need for new tests that have high sensitivity and specificity for the diagnosis of EPTB.

Objective: The aim of this study is to determine antibacterial susceptibilities of Gram-negative bacteria isolated from diabetic and non-diabetic patients as infectious agents of community-acquired urinary tract infections (UTI) and to compare their rates of resistance to the antibiotics frequently used in empirical treatment. Methods: Ninety-six diabetic and sixty-eight non-diabetic (total n=164) patients’ data were evaluated retrospectively who diagnosed as community-acquired urinary system infection and consulted to outpatient clinics of Department of Endocrinology and Infectious Diseases of Firat University School of Medicine between January 1st , 2014 and December 31st, 2014 whose urine cultures demonstrated Gram-negative bacteria were included in the study. Antibiotic susceptibilities of the isolated bacteria were determined using Vitek 2 automated system and the results were evaluated as sensitive and resistant. Results: In both diabetic and non-diabetic patient groups, most frequently Escherichia coli (88.5% in diabetic and 85.3% in non-diabetic groups) were isolated. In the diabetic group, microorganisms mostly demonstrated the highest rates of resistance against ampicillin, cephalosporins, ciprofloxacin, amoxicillin-clavulanic acid and in the non-diabetic group ampicillin, amoxicillin-clavulanic acid, cefuroxime and trimethoprim-sulfamethoxazole. Conclusion: Resistance to ciprofloxacin was at a significantly higher rate in the diabetic group. In diabetic patients, it will be more appropriate to give antibiotherapy in urinary system infections based on the antibacterial susceptibility test results.

Aim: Gastric disorders present in a wide range, including malignant and benign diseases of the upper gastrointestinal system. Increased MPV levels are associated with inflammation. The goal of this study was to determine the diagnostic importance of MPV in gastric disorders and evaluate level of MPV in patients that underwent upper gastrointestinal endoscopy. Materials and Methods: Patients who had undergone endoscopy and shown to have a gastric disorder with blood count performed were included in the study. Only one surgeon performed all of the endoscopies. MPV value, platelet count, hemoglobin and white blood cell count levels were analyzed. Results: 116 patients were included in the study. Mean age of all patients was 47,8+/-16,4. Mean value of MPV was determined to be 7,79+/-1,21, within the range of 5,85 to 12,5 fL. There was no significant correlation between diagnoses and MPV levels (P>0,05). Additionally, there was no significant difference in MPV levels in histopathological diagnoses groups (p>0,05). There was a highly negative correlation between platelet count and MPV levels in a Scatter Plot correlation graph (r=0,083). Conclusions: MPV is a frequently used hematological parameter that indicates platelet function and activity affected by inflammation. It was hypothesized that changes in MPV levels could be associated with gastric disorders. Statistical analysis of the data revealed there was no association between MPV and gastric disorders. It is suggested that MPV is not a suitable marker to determine gastric disorders, however further larger studies can be useful to determine the importance of MPV such a context. [Arch Clin Exp Surg 2016; 5(4.000): 216-221]

Background The goal of the present study was to evaluate the antioxidant effects of melatonin on pulmonary contusion (PC) caused by isolated blunt thoracic trauma (BTT) in an experimental rat model. Materials and methods A total of 49 rats were divided into three groups: control group (CG), trauma group (TG), and melatonin group (MG). PC was induced by isolated BTT for all the groups except the control group. Intraperitoneal melatonin was administered to the MG after trauma. Blood and tissue samples were collected from the groups. Malondialdehyde (MDA), total oxidant capacity and total antioxidant capacity (TAOC), arterial blood gas, and other biochemical parameters such as urea, creatinine, alanine aminotransferase (ALT), and aspartate aminotransferase were measured. Lung tissue samples were collected for histopathology. Results On day 2, blood MDA and total oxidant capacity levels were lower, and TAOC levels were higher in the MG compared with the TG ( P 2 , and PCO 2 of the MG significantly improved on day 2 compared with the TG ( P ≤ 0.001). Compared with the TG, histologic damage scores of the MG decreased on day 2 ( P = 0.013). Urea, creatinine, ALT, and aspartate aminotransferase levels of the MG on day 2 were lower than TG parameters ( P = 0.01, P = 0.02, P = 0.05, and P Conclusions Our findings demonstrate that melatonin can improve the histopathology of PC and distant organs such as liver and kidney by diminishing oxidative stress. All these findings suggest that melatonin may be an effective new therapeutic agent for PC caused by BTT.

Summary The aim of this study was to investigate whether enoxaparin (ENX) administration would increase seroma risk and worsen mesh tissue recovery in an experimental rat hernia repair model. Fifty-six adult male Wistar–Albino rats were included in the study. Rats were equally and randomly separated into seven groups: Group 1, Control, only subcutaneous dissection was performed; group 2, Sham, Hernia defect was primary sutured; Group 3, Prolene mesh; Group 4, Dual mesh; Group 5, ENX + Sham; Group 6, ENX + Prolene mesh; Group 7, ENX + Dual mesh. ENX was subcutaneously injected at a dose of 180 U/kg per day for 7 days. Rats were killed after the amount of subcutaneous seroma was determined by ultrasound on day 7 following the surgical procedure. Mesh-tissue healing was evaluated using histopathological and immunohistochemical (CD31) staining methods. The mean seroma amount significantly increased in Groups 5–7 compared to Groups 2–4. CD31 immunostaining showed a reduction in neovascularization in Groups 6 and 7, compared to Groups 3 and 4. Neovascularization decreased and hemorrhage, necrosis and oedema findings remarkably increased in Groups 6 and 7, when compared to Groups 3 and 4. Fibroblastic activity and inflammation were more prominent in Groups 3 and 4. It should be kept in mind that ENX interferes with inflammation, which is desired in the early period of healing and leads to an increase in overall seroma amount with anti-coagulant effects, which in turn may disrupt wound healing and mesh-tissue adhesions, as was indicated in our study.

Background The aim of this study was to investigate the possible protective effect of interleukin 18-binding protein (IL-18BP) on ischemia-reperfusion (I/R)-induced liver injury in experimental rat models. Liver is one of the most affected organs from I/R process. IL-18 is an important proinflammatory cytokine, which may induce some events such as production of reactive oxygen substances and release of various cytokines. IL-18BP acts as an inhibitor of IL-18. The relationship between IL-18 and IL-18BP has an important place in inflammatory process. Materials and methods Rats were equally divided into three groups as follows: sham: Hepatic pedicle dissection was done, but hepatic pedicle clamping was not used. I/R: Sixty minutes of ischemia and 2 h of reperfusion were applied. IR + IL-18BP: Recombinant human IL-18BP (100 µg/kg) was administered 30 min before the surgery. Hepatic pedicle was clamped during 60 min of ischemia and 2 h of reperfusion was achieved. Results Liver enzyme levels were significantly lower in the IR + IL-18BP group, when compared with the I/R group. Serum and tissue levels of tumor necrosis factor-?, IL-6, and IL-18 were considerably lower in the IR + IL-18BP group, when compared with the I/R group, but hepatic interferon-? and IL1ß levels were not significant. Serum oxidative stress index level was significantly higher in the I/R group, when compared with the IR + IL-18BP group. In immunostaining, it was observed that pathologic changes were lower in IR + IL-18BP group than the I/R group. Conclusions IL-18BP exhibited anti-inflammatory, antioxidant, and protective effects in I/R-mediated hepatic injury via regulating some liver enzyme activities and cytokine levels. Additionally, these effects have been verified by histomorphologic examination and oxidative stress markers. © 2016 Elsevier Inc., Firat University Scientific Research Projects Management Unit: TIP.12, Afyon Kocatepe University Scientific Research Projects Unit supported the present study (project no: 12.TIP.12). Authors' contributions: A.B. and Y.G. contributed to the writing of the article, analysis of biochemical parameters, and statistical analyses. S.Y. and S.K. contributed by carrying out experimental and surgical studies on assay animals. O.H., F.B., and A.K. did the biochemistry, histopathologic, and immunohistochemical examinations. O.O. and K.D. contributed to the conception and design of the study.

The lack of in-depth understanding of the seismic behavior and ductility of precast concrete structures makes it difficult to reach to ductility demand which could be exhibited during an earthquake. The limitations are mainly related to the beam-to-column connections as the main load transfer paths. Two distinct exterior beam–column connections made of normal-strength concrete are investigated experimentally. Both dry and wet type installment techniques are used in the industrial type joints while the residential type joints are wet connections. The specimens are subjected cyclic displacement reversals in order to obtain information on strength, stiffness and ductility characteristics of the connection details. The preliminary design of the joints has been updated during the tests based on the damages observed, thus a set of improved specimens have also been built and tested, and a relatively better performance is obtained expectedly. The industrial and residential types of connections showed stable load–displacement cycles with high energy dissipation up to structural drift of 2%, though a significant level of pinching and deterioration of the critical section have occurred at around 3% drift level. The tested specimens have been numerically modeled to calibrate the analytical tools, and a satisfactory approximation has been obtained between experimental and numerical results.

Objective: The aim of the study is to determine the effect of fibromyalgia (FM) on disease activity and quality of life in rheumatoid arthritis (RA) patients. Methods: This was a randomized and prospective study conducted in 96 RA patients admitted to our rheumatic diseases outpatient clinic, diagnosed according to the American College of Rheumatology (ACR) 1987 criteria at least for 2 years. Data composed of demographical properties, painful and swollen joints, duration of morning stiffness, level of pain by Visual Analog Scale (VAS), number of used disease-modifying antirheumatismal drugs (DMARD), and disease duration of all patients. In addition C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and anticyclic citrullinated peptide (anti-CCP) levels were measured. Disease Activity Score 28 (DAS28) was used to assess disease activity and Health Assessment Questionnaire (HAQ) and short form (SF-36) were used to assess the quality of life. FM diagnosis was primarily made on the basis of the ACR 1990 FM criteria. After then, two groups were generated as FM-positive and FM-negative patients. Disease activity (DAS28), quality of life (HAQ and SF-36), morning stiffness durations, numbers of painful and swollen joints, pain levels by VAS, number of DMARDs used, duration of disease, and laboratory diagnosis as well as activity parameters (CRP,ESR,RF, and anti-CCP) were compared between the two groups. Results: There was no significant difference in the duration of morning stiffness, duration of disease, number of used DMARDs, CRP,ESR, RF, and anti-CCP (p>0.05) between the two groups. RA patients with FM showed significantly higher scores of VAS, HAQ, and DAS28 and more painful joints than RA patients without FM; SF 36 scores were significantly lower in FM patents (p

Highlights • Developmental abnormalities of liver including ectopic liver are rare conditions. • Although it does not usually produce any symptom clinically, it can rarely result in serious complications such as bleeding, pyloric and portal vein obstruction. • Ectopic liver has the capacity of malignant transformation to hepatocellular carcinoma that makes it essential to be removed. • The vascular anatomy of ectopic liver should be identified before the dissection of gallbladder in order to prevent hemorrhage from the liver parenchyma., Introduction Developmental abnormalities of liver including ectopic liver tissue (ELT) are rare conditions. Few cases presenting ELT have been reported in literature till now. Even though the most common area seen is gallbladder, it is detected both abdominal and thoracic sites. There is a relationship between HCC and ectopic liver that necessitates the removal. Presentation of case A 51-year-old female was hospitalized because of abdominal pain. Gallstone and bile duct dilatation were determined during ultrasonographic (USG) evaluation. The patient was operated for cholecystectomy following a successful endoscopic retrograde cholangiopancreatography (ERCP). During operation, a mass located on gallbladder with its unique vascular support was identified and resected together with gallbladder. The mass had a separate vascular stalk arising from liver parenchyma substance and it was clipped with laparoscopic staples. The histopathological examination revealed that the mass adherent to gallbladder was ectopic liver confirming the intraoperative observation. The postoperative course of patient was uneventfull and she was discharged at the second day after the operation. Discussion Ectopic liver tissue is incidentally found both in abdominal and thoracic cavity. ELT can rarely be diagnosed before surgical procedures or autopsies. It can be overlooked easily by radiological techniques. Although it does not usually produce any symptom clinically, it can rarely result in serious complications such as bleeding, pyloric and portal vein obstruction. ELT also has the capacity of malignant transformation to hepatocellular carcinoma that makes it essential to be removed. Conclusion Although ELT is rarely seen, it should be removed when recognized in order to prevent the complications and malignant transformation.

Objective: The aim of this study was to investigate the daily energy expenditure; resting metabolic rate (RMR); healthrelated physical fitness parameters such as maximal aerobic capacity, muscle strength, and flexibility; pulmonary function tests (PFTs); and body composition and body fat distribution changes in patients with cholelithiasis, and to compare them with healthy controls. Materials and methods: Thirty female patients with cholelithiasis and 30 controls were included in this study. Daily physical activity was monitored using a metabolic Holter and the maximal aerobic capacity was estimated using the Astrand submaximal exercise protocol. The body composition was established with a bioelectrical impedance analyzer. RMR, PFTs, strength, flexibility, circumference, and skinfold measurements were also carried out. Results: Maximal aerobic capacity, trunk flexibility, daily moderate activity duration, daily vigorous activity duration, total energy expenditure, RMR, PFT, lean body mass, adiposity, and body fat distribution values were not significantly different between the patients and the controls. The cholelithiasis patients had lower daily step numbers, handgrip strength, and back-leg strength values, whereas their higher daily sleep duration values were comparable with those of the controls. Conclusion: Our results suggest that daily physical activity and muscle strength were impaired in female cholelithiasis patients when compared with the healthy controls. We suggest that using daily exercises, including not only aerobic but also strength training as lifestyle modifications in cholelithiasis patients, might be helpful for the development of more beneficial illness management strategies. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Hydatid cyst (HC) disease is a zoonotic disease caused by the larvae of Echinococcus granulosus. We report our experience of treating HC manifesting aggressive characteristics. Between January, 2010 and December, 2013, 40 patients underwent surgery for HC disease in our department. The subjects of this study were six patients whose disease followed an aggressive and invasive clinical course. The HC disease in these patients involved the vertebrae, chest wall, mediastinum, diaphragm, and lung, with destruction of the lung. There were four men and two women, with a mean age of 47 years (range 12–81 years). Treatment consisted of cystectomy and additional procedures, such as corpectomy and resection of the chest wall, approaching the liver and spleen with phrenotomy and lobectomy. One patient suffered prolonged biliary drainage, and another had a bronchopleural fistula and atelectasis. One patient died of empyema 1 month postoperatively. The mean hospital stay was 9 days. In some patients, HCs can act as an aggressive tumor, involving the surrounding tissues, organs, and even bony structures. Aggressive HCs may cause various sequelae and require extended surgical interventions in addition to cystectomy.

Background Use of transversus abdominis plane (TAP) block for postoperative analgesia is continuously increasing. However, few studies have investigated intraoperative effects of TAP block. We aimed to study the effects of TAP block in terms of cost-effectiveness and consumption of inhalation agents. Material and methods Forty patients undergoing laparoscopic cholecystectomy were enrolled in this study. Patients were randomly divided into 2 groups: Group 1 (n=20) patients received TAP block and Group 2 (n=20) patients did not receive TAP block. Standard anesthesia induction was used in all patients. For the maintenance of anesthesia, fractional inspired oxygen (FIO2) of 50% in air with desflurane was used with a fresh gas flow of 4 L/min. All patients were monitored with electrocardiography and for peripheral oxygen saturation (SpO2), end-tidal carbon dioxide (ET), heart rate (HR), noninvasive mean blood pressure (MBP), and bispectral index (BIS). Bilateral TAP blocks were performed under ultrasound guidance to Group 1 patients. The BIS value was maintained at between 40 and 50 during the surgery. The Dion formula was used to calculate consumption of desflurane for each patient. Results There was no difference between the groups with respect to demographic characteristics of the patients. Duration of anesthesia, surgery time, and dosage of fentanyl were similar in the 2 groups. However, the cost and consumption of desflurane was significantly lower in Group 1. Conclusions Total anesthesia consumption was lower and the cost-effectiveness of anesthesia was better in TAP block patients with general anesthesia than in non-TAP block patients undergoing laparoscopic cholecystectomy.

INTRODUCTIONCases of retained foreign bodies during surgery are more frequently seen in developing countries. Following surgical procedures, unintentionally retained foreign bodies can cause serious complications, in addition to medico-legal issues.PRESENTATION OF CASEA 60-year-old man presented with abdominal cramps. He had previously undergone a laparoscopic radical right nephrectomy due to renal cell carcinoma. Abdominal tomography revealed a mass surrounding the main vascular structures with malignant features in the location of previously performed nephrectomy. Further evaluation of the mass was undertaken by PET/CT. Increased FDG uptake on the PET/CT scan suggested disease recurrence. Retroperitoneal lymph node dissection was performed. The dissection specimen was opened to determine the nature of the mass. Retained plastic foreign bodies were found. There were no malignant cells in the histopathological examination of the surgical specimen.DISCUSSIONA granulomatous reaction which is mainly responsible for morbidity occurs around the foreign bodies due to the inflammatory response. These granulomas may cause confusion during patient follow-up, especially in those who have undergone major abdominal surgery due to cancer.CONCLUSIONFollowing surgical resection for malignancy, unintentionally retained foreign bodies can produce a moderate increase in FDG uptake mimicking disease recurrence.

Objective: Surgical site infections (SSIs) are a major problem after surgery. They cause to impairment of patient comfort, increase morbidity, mortality, in hospital stay and costs. The aim of this study is to investigate the risk factors affecting SSIs. Material and Methods: One thousand forty patients underwent general surgery procedures at a single state

Ischemia-reperfusion (IR) injury of the liver is an unresolved problem that occurs during certain surgical approaches, including hepatic, cardiac and aortic operations. In this study we aimed to investigate whether crocin and safranal had protective effects on liver IR injury induced in an infrarenal aortic clamping (IRAC) model. Male Wistar-Albino rats (n=32) were divided into four groups with 8 animals each as follows: Sham, IR, IR+crocin, and IR+safranal. The infrarenal aorta (IRA) was clamped for 60min for the ischemic period and allowed to reperfuse for 120min. Blood and tissue samples were collected for biochemical, histological and immunohistological analysis. Plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were found to be significantly higher in the IR group than the sham group (respectively; p=0.015, p

The most common disease required emergency surgical operation is acute appendicitis. Appendectomy is the most common surgical procedure in the world and remains important due to be an efficient treatment method. We aimed to determine seasonal variations of acute appendicitis in our regions and identify the demographical and regional differences.We analyzed retrospectively data of the patients who were admitted to the Afyon Kocatepe University hospital and Sivrihisar State hospital between 2003 and 2012. 839 patients' data were analyzed.Mean age of the all patients was 33 ± 14.7 year. Acute appendicitis was seen more frequent in autumn and spring (P0.05). There was no significant difference between seasons in Afyon Kocatepe university hospital, while appendicitis was seen more common in autumn than winter in Sivrihisar state hospital (P0.05). There was not any relationship with the monthly average temperature, humidity, total precipitation amount and frequency of appendicitis (P0.05).Although appendicitis has a seasonal variation, other environmental factors and impact of nutritional habit should not be ignored. Etiology of appendicitis is still multifactorial. In the future multiparameter nationwide studies can present country-specific etiology of appendicitis.Appendectomy, Appendicitis, Seasonal variations.L’appendicite è la patologia che più comunemente richiede un intervento chirurgico in emergenza, e l’appendicectomia è il procedimento chirurgico più commune in tutto il mondo, importante in quanto rappresenta un trattamento efficace. Il nostro scopo è stato quello di determinare le variazioni stagionali dell’appendicite nella nostra regione e di indentificare le differenze demografiche e regionali, e per questo abbiamo analizzato retrospettivamente I dati dei pazienti ricoverati nell’ospedale universitario Afyon Kocatepe e nell’ospedale statale Sivrihisar State tra il 2003 ed il 2012, cioè 839 pazienti. L’età media di tutti i pazienti era di 33 ± 14.7 anni, e la maggior frequenza dell’appendicite acuta è risultata in autunno e nella primavera (P0.05). Non si sono osservate differenze sigfnificative stagionali nell’ospedale universitario Afyon Kocatepe, mentre l’appendicite si è manifestata più frequentemente in autunno che non in inverno nell’ospedale statale Sivrihisar (P0.05). non c’è stata nessuna relazione con la temperatura media mensile, l’umidità, l’entità delle precipitazioni e la frequenza dell’appendicite (P0.05). In conclusion, sebbene l’appendicite presenta una variazione stagionale, altri fattori embientali e l’impatto delle abitudini alimentari non vanno ignorate. L’etiologia dell’appendicite è comunque.multifattoriale, e nei futuri studi multiparametrici nell’intero territorio nazionale potrebbero evidenziarsi delle etiologie territorio-specifiche di questa patologia.

Halil Kunt,1,* Ä°hsan Şentürk,2,* Yücel Gönül,3,* Mehmet Korkmaz,4 Ahmet Ahsen,5 Ömer Hazman,6 Ahmet Bal,7 Abdurrahman Genç,8 Ahmet Songur3 1Department of Science Education, Faculty of Education, Dumlupinar University, Kütahya, 2Department of Orthopedics and Traumatology, 3Department of Anatomy, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, 4Department of Radiology, Faculty of Medicine, Dumlupinar University, Kütahya, 5Department of Nephrology, Faculty of Medicine, 6Department of Biochemistry, Faculty of Science and Arts, 7Department of General Surgery, 8Department of Physiology, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey *These authors contributed equally to this work Background: In the literature, some articles report that the incidence of numerous diseases increases among the individuals who live around high-voltage electric transmission lines (HVETL) or are exposed vocationally. However, it was not investigated whether HVETL affect bone metabolism, oxidative stress, and the prevalence of thyroid nodule.Methods: Dual-energy X-ray absorptiometry (DEXA) bone density measurements, serum free triiodothyronine (FT3), free thyroxine (FT4), RANK, RANKL, osteoprotegerin (OPG), alkaline phosphatase (ALP), phosphor, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels were analyzed to investigate this effect.Results: Bone mineral density levels of L1–L4 vertebrae and femur were observed significantly lower in the electrical workers. ALP, phosphor, RANK, RANKL, TOS, OSI, and anteroposterior diameter of the left thyroid lobe levels were significantly higher, and OPG, TAS, and FT4 levels were detected significantly lower in the study group when compared with the control group.Conclusion: Consequently, it was observed that the balance between construction and destruction in the bone metabolism of the electrical workers who were employed in HVETL replaced toward destruction and led to a decrease in OPG levels and an increase in RANK and RANKL levels. In line with the previous studies, long-term exposure to an electromagnetic field causes disorders in many organs and systems. Thus, it is considered that long-term exposure to an electromagnetic field affects bone and thyroid metabolism and also increases OSI by increasing the TOS and decreasing the antioxidant status. Keywords: bone mineral density, electromagnetic radiation, electrical workers, thyroid, RANK, RANKL

Objective Acute kidney injury (AKI) is a serious condition that can be induced by liver transplantation, major hepatic resection or prolonged portal vein occlusion. AKI can increase the frequency of postoperative complications. In the current study, we aimed to investigate whether interleukin-18 binding protein (IL-18BP) pretreatment has a protective effect against possible kidney injury following liver ischemia-reperfusion (IR) achieved by Pringle maneuver in an experimental rat model. Materials and Methods A total of 24 male Wistar albino rats were included in this study. Animals were equally and randomly separated into 3 groups as follows: I, Sham group, II, IR group (1-hour ischemia and 4-hour reperfusion) and III, IR + IL-18BP group (50 µg/kg IL-18BP was intraperitoneally administered 30 minutes before surgery). Blood, liver and kidney samples were collected for histopathological and biochemical (hepatic and renal function, nitric oxide, malondialdehyde and glutathione levels) analysis. In addition, proinflammatory cytokines including tumor necrosis factor ?, IL-1ß and IL-6 levels were measured in kidney tissues. Results IL-18BP has improved kidney functions in acute kidney damage, restored structural changes, exhibited anti-inflammatory effects by decreasing proinflammatory cytokines and regulated the oxidative stress parameters by antioxidant effect. Conclusions Current study would be the first to evaluate the protective, antioxidant and anti-inflammatory effects of IL-18BP on renal damage induced by liver ischemia (1 hour) and reperfusion (4 hours). As a result, we have demonstrated that AKI may develop after hepatic IR with Pringle maneuver and IL-18BP pretreatment can attenuate this damage. By this way, complications related to liver IR could be minimized and also postoperative hospitalization durations, treatment costs and healing periods could be decreased. © 2016 Southern Society for Clinical Investigation

Strength and stiffness of panel and joint in non-diaphragm CHS-column to H-beam connection were experimentally investigated Herein, the panel means the cylindrical stub circumscribed by outer planes of the beam and the column, and the joint means the butt seam between the column wall and the beam end. Two types of specimen were tested: one is an X-shaped frame whose panel is subjected to shear, and the other is a 3-point bending specimen whose panel is free from shear. In result, the joint strength and stiffness are well predicted by the previously proposed formulae irrespective of the existence of shear in the panel, and the panel strength and stiffness are also well predicted by the well known formulae given for diaphragm connections. This suggests that the interaction between panel and joint of the non-diaphragm connection can be ignored in structural design. Japan Society for the Promotion of Science, JSPS: 15J10631

Renal injury is an important complication of infrarenal aortic occlusion (IAO), which is mainly encountered during the postoperative period. Aortic clamping procedure may lead to turbulent blood flow and eventually vasoconstriction at renal arterial level of the abdominal aorta. IL-18BP has well-known antioxidant and anti-inflammatory properties. In this study, we aimed to determine whether IL-18BP has anti-inflammatory, antiapoptotic, antioxidant, and protective effects on acute kidney damage induced by IAO rat model.A total of 30 adult male Wistar-Albino rats were equally and randomly separated to three groups as follows: SHAM laparotomy, ischemia-reperfusion (IR), and IR + IL-18BP. We applied 30-min IAO and 2-h reperfusion. Inflammatory cytokine levels (TNF-α, IL-1β, IL-18, IL-6, and IFN-γ) and oxidative stress parameters (TAS, TOS, and OSI) were measured. In addition to this, urea and creatinine levels, histopathology of kidney, mRNA expression levels of inflammatory cytokines, and apoptotic genes were investigated.Urea and creatinine, tissue and serum levels of TNF-α, IL-6, IL-18, IFN-γ, and TOS, and oxidative stress index (OSI) were found significantly lower in IR + IL-18BP group, when compared to the IR group. Moreover, mRNA expression levels of inflammatory cytokines and apoptotic genes were prominently depressed in IR + IL-18BP pre-treatment group in histopathologic examination, there was a significant difference between the IR and other three groups (P0.001). These improvements were demonstrated with a total score of histopathologic damage. In our previous studies, we have demonstrated that IL-18BP has antioxidant, inflammatory, and protective effects on liver and spinal cord IR injury. Data established from the present study suggest that IL-18BP may exert anti-inflammatory, antiapoptotic, antioxidant, and protective effects on IAO-induced acute kidney injury in rats, and this would be the first study to be conducted in this field.Data established from the present study suggest that IL-18BP may exert anti-inflammatory, antiapoptotic, antioxidant, and protective effects on IAO-induced acute kidney injury in rats.

Fournier gangreni, agirlikli olarak erkeklerde gorulen, hizli ilerleyen, mortalite orani yuksek bir nekrotizan fasiittir. Yumusak doku enfeksiyonlari ile benzer etiyoloji gosterme- sine karsin ozellikle immunsupressif ve diabetli hastalarda hastalik cok daha hizli seyir gostererek mortal seyreder. Hastaligin tedavisinde ana unsurlar erken tani, erken cerra- hi debritman ve uygun antibiyoterapidir. Bu calisma predis- pozan faktor olarak insan immun yetmezlik virusu (HIV) pozitifligi olan bir hastada iskiorektal apse drenaji sonrasin- da Fournier gangreni gelisimini aktarmak ve bu hastalarda erken cerrahi debritmanin gerekliligini vurgulamak amac- lanmistir. Fournier's gangrene mainly seen in men is rapidly progressi- ve necrotizing fasciitis and has a high mortality rate. Altho- ugh the etiology of Fournier's gangrene is similar to the show soft tissue infections, the disease especially could be morta- lity in patients with immunosuppressive and diabetes. The main factors in treatment of the disease are early diagnosis, surgical debridement and appropriate antibiotics. In this article we aimed to present developing Fournier's gangrene in a patient with human immunedeficiency virus (HIV) positi- ve after iskiorectal abscess drainage and intended to high- light the need for early surgical debridement.

Mycotic aneurysms represent a diagnostic and therapeutic challenge still lacking general recommendations for optimal therapy. So far, Listeria monocytogenes (L. monocytogenes) is very rarely reported to be the causative organism of mycotic aortic aneurysms. We report 2 cases of mycotic abdominal aortic aneurysms due to L. monocytogenes infection being treated by radical debridement, open in situ reconstruction with aorto-bi-iliac Dacron grafts, and long-term antibiotic therapy. Both patients recovered well from surgery. Interestingly, the long-time follow-up for the first patient 9 years after surgery was entirely uneventful. Open debridement in an in situ reconstruction with Dacron grafts followed by antibiotic therapy seems to be a suitable therapeutic regime for mycotic aneurysms due to L. monocytogenes.

Gastrointestinal sistemin en sik rastlanan konjenital anomalisi Meckel divertikuludur. Cogunlukla asemptomatiktir. Genellikle komplikasyonlarin gelistigi durumlarda tani alirlar. Klinik yasa bagli degisiklik gostermektedir. Eriskin yas grubunda en sik rastlanan komplikasyon obstruksiyon tablosu iken ikinci sirayi divertikulit almaktadir. Bu makale ile obstruksiyon ve divertikulit tablosunu es seansli barindiran bir olguyu literatur bilgileri isiginda sunmayi amacladik

Irritable bowel syndrome (IBS) is a common gastrointestinal disease which leads to a reduction in the quality of life. Restless legs syndrome (RLS) and the incidence of poor sleep quality (PSQ) are known to increase in IBS. In this study, we aimed to investigate the prevalence and association of RLS and PSQ in a young population. A total of 112 IBS patients (46 constipation predominant IBS, 17 diarrhea predominant IBS, 23 mixed IBS and 26 unsubtyped IBS) and 106 healthy controls were included in the study. The Pittsburgh Sleep Quality Index (PSQI) and the 2012 revised diagnostic criteria of the International Restless Legs Syndrome Study Group were used in the groups. In the patients with IBS and the control group, the respective results obtained were as follows: presence of PSQ 16 (13.4 %) and 5 (4.7 %) and presence of RLS 10 (8.9 %) and 4 (3.7 %), respectively. There were significant differences between the two groups in terms of these values. According to the PSQI, the mean global PSQI scores of patients with IBS and control group were 7.61±3.9 and 4.5±3.7, respectively (P = 0.01). While PSQ was detected in 21 out of 218 participants, RLS was detected in 14. PSQ and RLS coexisted in nine of the participants and all of them were IBS patients. Previous studies and our study reveal that the frequency of RLS and PSQ increases in IBS. However, this result is a lower rate compared to previous studies. The controlled and prospective studies with larger numbers of cases which demonstrate the real frequency.

WOS: 000348695900006, PubMed: 25692120, Purpose: Severe Local and systemic tissue damage called ischemia/reperfusion (IR) injury occurs during the period of reperfusion. Free oxygen radicals and proinflammatory cytokines are responsible for reperfusion injury. IL-18 binding protein (IL-18BP) is a natural inhibitor of IL-18. The balance between IL-18 and IL-18BP has an important role in the inflammatory setting. The present study aimed to investigate whether IL-18BP had a protective role in remote organ hepatic IR injury. Methods: Wistar-Albino rats were divided into three groups that contained seven rats. Group I (sham): Laparotomy and infrarenal abdominal aorta (AA) dissection were done but no clamping was done. Group II (I/R): The infrarenal AA was clamped by atraumatic microvascular clamp for 30 rninutes and then was exposed to 90 minutes of reperfusion. Group III (IR + IL-18BP): 75 mu g/kg of IL-18BP in 0.9% saline (1 mL) was administered 30 minutes before infrarenal AA dissection and clamping; 30 minutes of ischemia was applied and then was exposed to 90 minutes of reperfusion. Results: Serum AST, ALT, and LDH levels were remarkably higher in IR group and returned to normal levels in treatment group. The proinflammatory cytokine levels had decreased in treatment group, and was statistically significant compared with the IR group. Serum levels of total oxidant status and oxidative stress index decreased and levels of total antioxidant status increased by IL-18BP. Conclusion: This study suggested that IL-18BP has antioxidant, anti-inflammatory and hepatoprotective effects in cases of IR with infrarenal AA induced liver oxidative damage.

Kist hidatik hastaligi hayvanciligin yaygin olarak yapildigi yerlerde halen ciddi bir saglik sorunudur. En sik karacigerde yerlesim gosterir. Hastalar cogunlukla asemptomatik olmakla birlikte karin agrisi gibi nonspesifik sikâyetleri de bulunabilmektedir. Tani cogunlukla rastlantisal olarak konmaktadir. Tedavi edilmeyen kist hidatik hastaligi safra yoluna acilma, obstruksiyon, ruptur ve buna bagli anaflaktik sok gibi olumcul komplikasyonlara neden olabilmektedir. Tedavisi icin farkli yontemler olmakla birlikte hastaligin primer tedavisi cerrahidir. Cerrahi icin klasik yaklasim sekli abdominal yolla olmaktadir. Ancak karindan ulasimin guc oldugu karaciger kubbe yerlesimli kist hidatikleri icin torakotomi ile transdiyafragmatik yaklasim da alternatif bir tedavi yontemi olabilir. Bu yazi ile transtorasik yaklasimla tedavi edilen karaciger kubbe yerlesimli uc kist hidatik olgusunu sunmayi amacladik.

The falciform ligament is one of the anatomical structures which attach the liver to the diaphragm and anterior abdominal wall. Primary falciform ligament is very rare. In this article, we present a case of an isolated falciform ligament necrosis, a rare primary pathology of the falciform ligament, who was admitted with acute abdomen. Case presentation: A 64-year-old female patient was admitted with the complaints of pain. Laboratory test results showed a leukocyte count of 17,000/mm3. Imaging studies demonstrated intra-abdominal reactionary fluid along with a heterogeneous mass localized in the falciform ligament. Exploratory laparotomy revealed a necrotic mass of the falciform ligament. No other pathology responsible for falciform ligament necrosis was found. We believe that falciform ligament necrosis should be considered a preliminary diagnosis, if any ligament abnormality, tumor, intraligament air density, or the presence of reactionary fluid surrounding the ligament is detected through abdominal imaging studies.

Background Pneumoperitoneum (PNP) and patient positions required for laparoscopy can induce pathophysiological changes that complicate anesthetic management during laparoscopic procedures. This study investigated whether low tidal volume and positive end-expiratory pressure (PEEP) application can improve ventilatory and oxygenation parameters during laparoscopic surgery. Methods A total of 60 patients undergoing laparoscopic surgery were randomized to either the conventional group ( n = 30, tidal volume = 10 mL/kg, rate = 12/minute, PEEP = 0 cm H 2 O) or the low tidal group with PEEP group ( n = 30, tidal volume = 6 mL/kg, rate = 18/minute, PEEP = 5 cm H 2 O) at maintenance of anesthesia. Hemodynamic parameters, peak plateau pressure (Pplat) and arterial blood gases results were recorded before and after PNP. Results There was a significant increase in the partial pressure of arterial carbon dioxide (PaCO 2 ) values after PNP in the conventional group in the reverse Trendelenburg (41.28 mmHg) and Trendelenburg positions (44.80 mmHg; p = 0.001), but there was no difference in the low tidal group at any of the positions (36.46 and 38.56, respectively). We saw that PaO 2 values recorded before PNP were significantly higher than the values recorded 1 hour after PNP in the two groups at all positions. No significant difference was seen in peak inspiratory pressure (Ppeak) at the reverse Trendelenburg position before and after PNP between the groups, but there was a significant increase at the Trendelenburg position in both groups (conventional; 21.67 cm H 2 O, p = 0.041, low tidal; 23.67 cm H 2 O, p = 0.004). However, Pplat values did not change before and after PNP in the two groups at all positions. Conclusion The application of low tidal volume + PEEP + high respiratory rate during laparoscopic surgeries may be considered to improve good results of arterial blood gases.

Objective: Although radiological imaging modalities like barium enema and computed tomography provide some clues, endoscopic methods still maintain superiority in assessment and differential diagnosis of large intestinal symptoms and complaints that require biopsy. We aimed to present the results of colonoscopic procedures performed in our general surgery clinic in detail. Material and Methods: Seven hundred patients who presented to Afyon Kocatepe University, Faculty of Medicine, Department of General Surgery Endoscopy Unit between January 2011 and July 2012 with an indication for colonoscopy were retrospectively evaluated. Results: Out of the 700 patients enrolled in the study 356 (50.8%) were male while 344 patients (49.2%) were female. The mean age of the patients was found to be 49 years. Within the group of 700 patients who underwent colonoscopic examinations, the terminal ileum and cecum have been reached on the first attempt in 432 patients (61.7%) and colonoscopic success has been achieved. Results of colonoscopies performed on 700 patients in our clinic revealed malignancy in 42 (6%) patients, and all of these patients were treated surgically in our clinic. Mortality was not observed in this series. Procedure-related bleeding and perforation developed in 6 patients. One patient developed respiratory arrest due to sedation and patient was responsive to resuscitation. The complication rate in our series was 1%. Conclusion: In the study where we revised our own clinical experience, we found that our success rate was lower than the literature, and our complication rate was higher. The main reasons are accepted as our colonoscopy unit’s being young and the low patient volume.

The aim of this study is to evaluate the changes between the initial and late cranial CT scans in patients with mild-to-moderate head trauma. MATERIAL andOf the two thousand six hundred and forty-four patients hospitalized for head trauma within a two-year period, 112 (4.24%) patients scored 8 or above in the Glasgow coma scale and there were changes between initial and late head CT.Of these, 103 had worsening CT findings. Neurological status deteriorated in 30% of these cases. Forty-six patients required surgery based on findings seen on the delayed scans. Neurological status was stable in 50% of the cases. All the eight patients who expired had abnormal CT scans initially and had progression in their late scans.In patients with mild-to-moderate head trauma, serial CT scanning may independently modify treatment decisions in a subgroup of patients. Judgment for delayed scans should be made on an individual basis by taking the risk factors into account.

İkinci basamak sağlık kurumunda ameliyat edilen penetran karın yaralanmalarını epidemiyolojik olarak irdelemek. Eylül 2004 - Aralık 2008 tarihleri arasında Kars Devlet Hastanesine penatran karın yaralanması nedeni ile ameliyat edilen olgular retrospektif olarak incelendi. Hastalar yaş, cinsiyet, yaralanma nedeni; ateşli silah veya delici kesici alet, ameliyat bulguları ve komplikasyonlar açısından değerlendirildi. Penetran yaralanma nedeni ile ameliyat edilen 80 hastada yaş ortalaması:30,81+2 (8-83), kadın/erkek oranı:12/68(%15/-%85) idi. Hastalar yaş gruplarına göre incelendiğinde 15 yaş ve altı; 6 olgu (% 7,3) 16-64 yaş grubunda;71 olgu (%86,6), 65 yaş ve üstü; üç olgu (%3,1) saptanmıştır. Yaralanma nedeni olarak 56 (%70) olguda kesici delici alet, 24 (%30) olguda ateşli silah yaralanması tespit edildi. Opere edilen olgulardan 16 hastada ( %20) negatif laparatomi yapılmıştır. Negatif laparatomi yapılan olgulardan 13’ü (%23,5) kesici delici alet yaralanması, üç (%12,5) olgu ise ateşli silah yaralanması nedeniyle ameliyat edilmişlerdi. Yaralanan organ sayısı olarak 21 olguda (% 32,8) tek organ yaralanması görülürken 43 olguda (% 67,2) birden fazla organ yaralanması görülmüştür. Organ yaralanması, en sık 18 olguda (% 28,1) İnce barsak, 12 olguda (%18,8) kolon, 12 olguda (% 18,8) mide, 8 olguda (% 12,5) karaciğer, 8 olguda (% 12,5) diafragma, 6 olguda (%9,4) dalak, 3 olguda (%4,7) böbrek, 2 olguda (% 3,1) pankreas yaralanması olarak tespit edilmiştir. Hastanede ortalama kalış süresi:5,9+2 (4-11) gündür. Dört olgu (% 5) opere edildikten sonra hastaların yoğun bakım ihtiyaçları olması nedeniyle ileri bir merkeze sevk edilmiştir.Tarafımızdan tedavisi tamamlanan olguların 8’inde (% 10,5) komplikasyonlar görülmüştür. İkinci basamak sağlık kurumumuzda penetran karın yaralanmalarının daha çok genç erkeklerde ve delici-kesici alet ile oluştuğu, organ yaralanmasının çoğunlukla birden fazla olduğu, en sık yaralanan organın ise ince barsak olduğu görüldü. Penetran yaralanmaların büyük çoğunluğu ikinci basamak sağlık kurumlarında tedavi edilebilir. Ancak gerektiğinde ilk müdahalenin ardından ileri bir merkeze sevk edilmelidir.