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OBJECTIVE: In this study, we aimed to rate Hepatitis B Virus (HBV) reactivation, risk factors for reactivation and compare the efficacy of prophylactic antiviral therapy in patients who initiated immunosuppressive therapy. PATIENTS AND METHODS: A total of 177 patients with Chronic Hepatitis B or resolved HBV infection who had received immunosuppressive treatment were analyzed in this retrospective study. Demographic features, relevant liver tests, prophylactic treatment type, duration of treatment, transaminase levels and HBV serology and clinical conditions were recorded from all patients who received prophylactic treatment. RESULTS: Eleven reactivation occurred in all groups. The mean age of patients who developed reactivation was statistically significantly lower (p=0.049). Three (27.3%) of the patients were male and 8 (72.7%) were female (p=0.66). Eight (36.36%) of 22 HB surface antigen (HBsAg) positive patients developed reactivation, 3 (155%) of 155 HBsAg negative patients developed reactivation. HBsAg positivity was determined as a risk factor for reactivation (p<0.001). There was no significant difference neither in reactivation, nor in the type of antiviral treatment (p=0.2) according to anti-HBs serology (p=0.366). CONCLUSIONS: As a result, early age, baseline HBsAg positivity, moderate risk group, baseline HBV DNA positivity were associated with reactivation. Gender, immunosuppressive therapy type, preemptive antiviral therapy type, and anti-HBs titers were not associated with reactivation. [ABSTRACT FROM AUTHOR]

INTRODUCTION: We aim to determine the fetal nasal bone length (NBL) percentile values that can be used in the prediction of the fetal anomaly at 11-14 weeks of gestation in a low-risk population. METHODS: Our prospective and cross-sectional study included four hundred and eighty-six singleton pregnancies who applied for the first-trimester aneuploidy screening test at 11-14 weeks of gestation. We excluded pregnant women with fetal structural or chromosomal anomaly, nuchal translucency >3mm, an absent nasal bone, and in utero fetal death. Reference and percentile values of the NBL were calculated separately for 11,12,13,and 14. gestational weeks. RESULTS: Standard NBL measurements were performed in 486 pregnancies according to inclusion and exclusion criteria. Median NBL values were computed for each gestational age (GA), for 11,12,13 and 14. weeks of gestation was found 1.6mm (range=1.1-2.5), 1.8mm (range=1.1-3.0), 2.0mm (range=1.4-3.1), and 2.2mm (range=1.7-2.8), respectively. A positive significant correlation was found between NBL and the crown-rump length (CRL) (NBL (mm) = [0.02xCRL(mm)] + 0.73, r=.483; p

Introduction: The Barthel Index of Activities of Daily Life (ADL) is a scale used to evaluate performance in daily life activities and investigate the reason and resulting relationships in a comprehensive, non-biased manner.Aim: The aim of this study was to compare the daily life activities of patients who underwent proximal femoral tumor resection prosthesis assessed by the Barthel Index with the activities of daily living of patients with a total hip prosthesis performed for non-tumor reasons.Materials and methods: Twenty-eight patients were included in the study. Sixteen patients underwent hip prosthesis for reasons other than tumor (femur proximal avascular necrosis, coxarthrosis, etc.) and 12 underwent wide resection and femur proximal tumor resection prosthesis due to primary malignant bone tumor or metastasis in the proximal femur. The Barthel Index was used to evaluate their life quality at 3 months.Results: A total of 28 patients (mean age 60.9±1.4 yrs, range 19.0-84.0, 17 female and 11 male patients) were included into the study. Mean ADL score was 84.5±20.6 (5–100.0). While only one patient was totally dependent in terms of daily life activities, 8 other patients were totally independent. When the patient groups were categorized by degree of dependency according to the ADL scores, it was found that dependency states of the two surgery groups were similar in distribution (p=0.212, p=0.703, and p=1.000 respectively).Conclusion: Functional recovering levels were good in the patients who underwent a surgery for proximal femoral tumor resection prosthesis; there was no significant difference when we compared the functional level after total hip prosthesis applied for non-tumor reasons.

Objective:Alveolar soft part sarcoma (ASPS) is a rare soft tissue tumor that usually affects young patients. Because of the rarity of the disease, most reports relating to ASPS are in the form of case reports or small series.Methods:We performed a retrospective study to evaluate the clinic features, treatment and outcome in a consecutive series of patients with localized or metastatic ASPS between 2004 and 2014. Demographics, tumor sizes, sites of tumor and extent of disease, treatments provided, progression, and overall survival were evaluated.Results:Total of 8 patients were identified. The clinical assumptive diagnosis of the doctor making first medical examination was benign soft tissue tumor like hemangioma in 3 cases (37.5%), delaying treatment. The most common loca¬tion of primary tumor was the thigh. The median diameter of the mass was 136.8±76.0 mm (range=4-572 mm). Median overall follow-up was 64 months.Conclusion:It was found that age greater than 28 years at the time of diagnosis, and the non-thigh placement of the tumor on the limb were found to increase the risk of lung metastasis. It was found that 37.5% of the patients underwent inadequate operation with the pre-diagnosis of vascular-related benign tumors. So, a comprehensive preoperative evaluation for the differential diagnosis of ASPS is needed when interfering with hemangioma-like vascular associated tumors.

Introduction: Primary malignant tumours of the clavicle are exceptionally uncommon. In the literature the number of publications reporting long-term oncologic outcomes after claviculectomy is quite low. Aim: To analyse clinicopathological presentation of functional results of 15 patients with primary malignant clavicular tumour after claviculectomy and also to evaluate relationship of resection amount and the postoperative complication state with functional results. Materials and Methods: Fifteen patients (9 males, 6 females; mean age 44.8 years; range 2-87 years) with primary malignant tumours of clavicle who were performed claviculectomy between 2002 and 2017 were included the study. Patient’s mean follow-up duration was 41 months (range 14 to 68 months). Twelve patients underwent partial and 1 patient underwent total clavicle resection without reconstruction. Two patients underwent reconstruction with allograft fibula after partial clavicle resection. The functional result was assessed with the Constant-Murley scores, International Society of Limb SalvageMusculoskeletal Tumour Society (MSTS) evaluation system and The University of California-Los Angeles (UCLA) shoulder rating scale. Mann Whitney u test was used for comparison of data sets. Spearman correlation was used to test the association between resection amount and patient’s scale scores. Linear regression analyses were carried out to evaluate the association of resection amount with patient’s scale scores. Results: The mean postoperative MSTS score was 63.1±14.1 (range, 33-80), the mean Constant-Murley score was 57.8±13.7 (range, 30-74) and the mean UCLA score was 20.8±6.8 (range, 8-31). A statistically significant and perfect negative corelation was found between resection amount and MSTS score (r=-0.907 p

Amaç: Histerektomi sonrası vajinal kuff prolapsusu için risk faktörlerini belirlemek ve histerektomi sonrası kuff prolapsusu sıklığını tahmin etmek Materyal ve Metod: Bu çalışma, Ocak 2010 ve Aralık 2012 yılları arasında benign sebeplerden dolayı histerektomi yapılan kadınlardan oluşan retrospektif bir çalışmadır. Medikal kayıtlar iki grup hastadan toplanmıştır. Vaka grubu, vajinal kuff prolapsusu için cerrahi uygulanan kadınlar iken kontrol grubu çalışma süresince yapılan histerektomi sonrasında vajinal kuff prolapsusu tesbit edilmeyen kadınlar idi. Çoklu regresyon modeli uygulanarak histerektomi sonrası risk faktörleri tanımlandı. Bulgular: 1758 histerektominin 56 (3.19%) tanesi vaka grubu idi. Çoklu regresyon analizi histerektomi sırasında yaşın ≥60 olmasını, astım, eski pelvik organ prolapsusu cerrahisi varlığını, vajinal yoldan histerektomi yapılmasını, genital prolapsus nedeni ile histerektomi yapılmasını, vücut kitle indeksinin ≥27 kg/m2 ve vajinal doğum sayısının ≥2 olmasını histerektomi sonrası vajinal kuff prolapsusu gelişimi için risk faktörleri olduğunu gözterdi. Araştırma Makalesi / Research Article 63 Kokanalı et al. Cukurova Medical Journal Sonuç: Histerektomi sonrası kuff prolapsusu nadir bir komplikasyondur. İleri yaş, obesite, kronik akciğer hastalığı, önceki genital prolapse cerrahisi, vajinal histerektomi, 2 ve üstü vajinal doğum varlığı kuff prolapsusu riskini arttırmaktadır. Bu risk faktörleri tanımlamak bu komplikasyonu önlemede önemlidir.

Purpose: To identify risk factors for vaginal vault prolapse after hysterectomy and also estimate incidence of post-hysterectomy vault prolapse. Material and Methods: This is a retrospective study of women who underwent hysterectomy for benign indications between January 2010 and December 2012. Medical records were reviewed from two groups of women. Case group was women who had undergone surgery for vault prolapse after hysterectomy; control group was women who were not identified with vault prolapse after hysterectomy by the time of the study. Multivariate regression model identified odds of post-hysterectomy vault prolapse. Results: Of 1758 hysterctomies, 56 (3.19%) were cases. Multivariate regression analysis demonstrated that age at hysterectomy and #8805;60 years, presence of asthma, previous pelvic organ prolapse surgery, vaginal route of hysterectomy, genital prolapse as indication of hysterectomy, body mass index and #8805;27 kg/m2 and number of vaginal delivery and #8805;2 are independent risk factors for development of post-hysterectomy vault prolapse. Conclusions: Vault prolapse after hysterectomy is a relatively rare complication. Elderly age, obesity, chronic obstructive lung diseases, prior genital prolapse sugery, vaginal hysterectomy, genital prolapse as indication of hysterectomy and the number of vaginal delivery and #8805;2 increase vault prolapse risk. Identification of these risk factors is important to prevent this complication. [Cukurova Med J 2015; 40(1.000): 63-71]

Unilateral tubal absence is a rare clinical condition with unknown etiology and probable causes are adnexal torsion, ischemia, birth defects and infection. In the literature there is limited data and only few case reports about this disease. Therefore we aimed to evaluate the clinical characteristics of an incidental unilateral tubal atrophy case during caesarean section that can be considered for publication.

Endometriosis is an ectopic occurrence of tissue morphologically and functionally resembling endometrial tissue outside the uterine cavity. Vulva is one of the rarest location of extrapelvic endometriozis. We report a case of a 44-year-old multiparous woman, referred to our clinic with the complaints of having a vulvar mass and cyclic swelling of the mass during menstruation. She had a history of 2 previous cesarean delivery and no history of previous vulvar or vaginal surgery. The mass was 3-4cm in diameter and localized on the upper-portion of the right labium minus. Complete surgical excision was performed with the suspicion of endometriosis. Final histopathology report confirmed the diagnosis of endometriosis. Three weeks after surgery there was no evidence of endometriosis. In conclusion whether or not having a history of a previous vulvar surgery, vulvar endometriosis should be considered as a part of differential diagnosis in evaluation of vulvar masses.

Endometriosis is the presence of functional endometrial tissue outside the uterus. Abdominal wall endometriosis is the one of the rarest site of extra pelvic endometriosis (AWE). We herein report the clinical characteristics of a 29 year’s old (G2P2) woman with abdominal wall endometriosis, 21 months after the last cesarean section. A total excision of the mass was performed and final histopathology of the mass was reported as endometriosis. We recommend taking into consideration this rare condition especially in women presenting painful mass near the scar with previous caesarean section.

We investigated the effect of doxazosin on cholinergic and adrenergic agonists responses in detrusor smooth muscle preparations from sham-operated and 2-week partially obstructed rat bladders. Male Wistar albino rats, 200 – 250 g, were randomly allocated to 4 experimental groups consisting of 12 animals each: sham-operated bladder, sham-operated bladder treated with doxazosin, partially obstructed bladder, and partially obstructed bladder treated with doxazosin. Partial outlet obstruction of the rat was surgically induced. The response to carbachol (10−7 – 10−4), isoproterenol (10−6 – 10−3 M) and 80 mM KCl were recorded. Carbachol caused concentration-dependent contractile responses in the detrusor smooth muscles from sham-operated and partially obstructed bladder. Isoproterenol produced concentration-dependent relaxation responses in the detrusor strips from all groups. Dose-response curves for carbachol and isoproterenol showed a shift to the left in rat detrusor smooth muscles from partially obstructed bladder when compared with the results obtained in detrusor muscles from sham-operated bladder. These responses were reversed to normal by doxazosin treatment in rat detrusor smooth muscles from partially obstructed bladder. KCl produced contractile responses in rat detrusor smooth muscles from all groups. The contractile responses to KCl were not significantly changed in all groups. We have shown that carbachol and isoproterenol responses were shifted to the left in rat detrusor smooth muscles from partially obstructed bladder and these responses were reversed by doxazosin treatment.

Abstract Background Since cardiovascular diseases are associated with high mortality and generally undiagnosed before the onset of clinical findings, there is a need for a reliable tool for early diagnosis. Carotid intima-media thickness (CIMT) is a non-invasive marker of coronary artery disease (CAD) and is widely used in practice as an inexpensive, reliable, and reproducible method. In the current study, we aimed to investigate prospectively the relationship of CIMT with the presence and extent of significant coronary artery narrowing in patients evaluated by coronary angiography for stable angina pectoris. Methods One hundred consecutive patients with stable angina pectoris and documented ischemia on a stress test were included in the study. The patients were divided into two groups according to the result of the coronary angiography: group 1 (39 patients) without a noncritical coronary lesion, and group 2 (61 patients) having at least one lesion more than 50% within the main branches of the coronary arteries. All of the patients underwent carotid Doppler ultrasound examination for measurement of the CIMT by a radiologist blinded to the angiographic data. Results The mean CIMT was 0.78 ± 0.21 mm in Group 1, while it was 1.48 ± 0.28 mm in Group 2 (p = 0.001). The mean CIMT in patients with single vessel disease, multi-vessel disease, and left main coronary artery disease were significantly higher compared to Group 1 (1.2 ± 0.34 mm, p = 0.02; 1.6 ± 0.32 mm, p = 0.001; and 1.8 ± 0.31 mm, p = 0.0001, respectively). Logistic regression analysis identified CIMT (OR 4.3, p < 0.001) and hypertension (OR 2.4, p = 0.04) as the most important factors for predicting CAD. Conclusions The findings of this study show that increase in CIMT is associated with the presence and extent of CAD. In conclusion, we demonstrated the usefulness of carotid intima-media thickness in predicting coronary artery disease but large-scale studies are required to define its role in clinical practice.

Abstract Background Statins improve the endothelial function in patients with coronary artery disease (CAD). However, they contribute to the substantial decrease in coronary heart disease by reducing plasma cholesterol levels. They also, reduce oxidative stress, stabilize the atherosclerotic plaque and inhibit inflammatory response. These functions of statins have been briefly described as pleiotropic effects. The aim of our study was to evaluate the effect of atorvastatin therapy on endothelial functions in patients with CAD. Methods Fourty-nine patients (40 men, 9 women, mean age 59 +/- 11 years) with diagnosed CAD were selected as the study group. The patients were given 10 mg/day atorvastatin for 12 weeks. If the target cholesterol levels has not been achieved 6 weeks after the treatment, then the daily atorvastatin dosage has been increased. The endothelial function was evaluated by flow mediated dilatation (FMD) of the brachial artery. Results It has been figured out that 12 weeks later, atorvastatin caused a statistically significant decrease in the plasma levels of LDL-cholesterol and total cholesterol (p < 0,0001). Meanwhile, it was determined that the FMD got statistically significant improved 12 weeks after the atorvastatin therapy (8,1%–4,2%, p < 0,001). However there was no statistically significant change in non-endothelium dependent dilatation (NID). Conclusion Endothelium derived vasodilatation (EBD), which was non-invasively detected via brachial artery ultrasonography, had statistically significant improvment within 12 weeks of atorvastatin therapy whereas non-endothelium dependent dilatation (NID) had no change.

Bugünkü konuşmanın konusu olarak hukuk devriminin nedenlerini seçmiş bulunuyorum. Aslında cumhuriyetten sonra Atatürk devrimleri dediğimiz devrimleri bir tek devrime indirgemek bence olanak içinde. O da lâikliğin kabulü. Zaten hukuk devrimine baktığımız zaman da aynı şeyi görüyoruz: Hukukta laikleşme. Hepimiz biliyoruz, 1926 yılında ceza Kanununu İtalya'dan, Ticaret Kanununu Almanya'dan, Medeni Kanunu ve Borçlar Kanununu İsviçre'den ve Hukuk Yargılama Usulü Kanununu da yine İsviçre'nin bir kantonu olan Nöşatel'den aldık. Ancak, bunların içinde yeni olan, devrim niteliği taşıyan yalnız Medeni Kanundur. Çünkü daha önce diğer saydığım alanlarda, Osmanlı İmparatorluğu zamanında da, yabancı hukuk, resepsiyon yoluyla alınmış bulunuyordu.

Tarihsel bir kişinin, bir olayın, belli bir düşünün veya olgunun damgasını taşıyan belli zaman sürelerine genel olarak çağ adı verilmektedir. Böylece bir Kutsal Bağlaşma çağından, Napoleon çağından, Fatih Mehmet çağından, Meiji çağından, Aydınlanma çağından sözedilmektedir. Tarihsel çağlara bölme yolundaki çalışmalar çok eskidir. Eskiden bilinenler içinde en yaygın olanı Hıristiyan tarihçilerin çağ ayrımı idi: 1. Putperestlik çağı; 2. Hıristiyanlık çağı. XVIII. yüzyılın başlarına doğru, popüler tarih kitaplarının yazarı Alman tarihçisi Christoph Cellarius (1638-1707) tarihi İlkçağ, Ortaçağ ve Yeniçağ olarak üçe ayırdı. Sonradan Fransız İhtilali ile başlayan dördüncü bir çağı Yakınçağ adıyla bunlara eklediler. Bu ayrım hiçbir biçimde Avrupa dışı, giderek Batı Avrupa dışı ülkelerin ve ulusların tarihlerine uymaz. Çünkü bu çağların başlangıcı olarak kabul edilen, daha doğrusu öyle gösterilen tarihsel olayların, örneğin Batı - Roma İmparatorluğu’nun yıkılması (476), Rönesans (XIV-XV. yüzyıllar) ve Reform (XVI. Yüzyıl), Keşifler (örneğin yeni deniz yollarının ve Amerika’nın bulunması gibi) buluşlar (Basım tekniğinin Batı'da bulunuşu gibi), Batı Avrupa dışı ülkelerin tarihinde hiçbir rolü, hiçbir önemi yoktur. Rönesans Batı Avrupa'nın sınırlarını aşamadığı gibi, Reform Hıristiyan dünyasının, daha doğru bir deyimle Katolik dünyasının bir sorunu idi; çünkü Rum - Ortodoks Kilisesi Reform'dan hiçbir biçimde etkilenmiş değildir. Rönesans ve Reform'un Çin'de veya Japonya'da giderek doğrudan doğruya Batı Avrupa’nın sınırında bulunan Osmanlı İmparatorluğu'nda etkilerini saptamak olanaksızdır. Fransız İhtilalinin Osmanlı İmparatorluğu'nda, İran'da, Hind'de, Afganistan'da, Etiyopya'da ne gibi dolaysız izlerine rastlanabilir?

Background: Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract that affects people across the age spectrum but often starts in childhood or early adulthood. Despite this, almost all published research examining the symptomatic and health-related quality of life (HRQL) experiences of CD has been conducted in an adult population. Studies providing a comprehensive overview of the lived experience of pediatric and adolescent CD are virtually non-existent. The experiences of younger children aged 2-7 years are especially unknown., Results: A total of 49 participants (31 children and 18 parents) were interviewed. This included 11 dyads (i.e., parents and children from the same family). Analyses were conducted based on reporter-type (patient self-report vs parent observer-report) and age subgroups (ages 2-4 vs 5-7 vs 8-11 vs 12-17). Key symptoms were identified across the age subgroups and reporter types. Abdominal/stomach pain, passing gas/feeling gassy, diarrhea/liquid stools, fatigue/tiredness, bowel urgency, blood in stools, stomach cramping, constipation, and incomplete evacuation were discussed most frequently. The most common HRQL impacts included impact on physical activity, school, social life, and mood (i.e., feeling sad/low), and were mostly consistent between reporter type and across age spectrum. Concept agreement between parents and children in the dyad analysis was > 60% for most symptoms and impacts., Conclusions: Qualitative interviews revealed the substantial symptom and HRQL burden of pediatric CD from the child and parent perspectives and that disease experiences were largely consistent across the age range and based on both reporter perspectives. This is an important first step towards implementing a robust measurement strategy for the assessment of symptoms and HRQL impacts in pediatric CD.

Background: This study was conducted to evaluate content validity of the IntraVenous and SubCutaneous Treatment Administration Satisfaction Questionnaires (TASQ-IV and TASQ-SC), for use in a clinical trial population of participants with paroxysmal nocturnal hemoglobinuria (PNH) undergoing eculizumab treatment., Methods: Participants underwent semi-structured combined brief introduction to disease history and full cognitive debriefing interviews to establish symptoms and key impacts of PNH and to explore the clarity and relevance of both sets of instructions (TASQ-IV and TASQ-SC). The clarity, relevance, response options, and recall period of the TASQ-IV items were also explored., Results: Ten participants with PNH were recruited. Fatigue was the most commonly reported symptom (n = 7); the most commonly reported impact of PNH was on physical activity (n = 4). Nine participants indicated understanding and relevance of the TASQ-IV instructions; three participants suggested changes. Of the 20 TASQ-IV items, ≥ 15 were considered understandable, relevant and to have suitable response options (n ≥ 8). The TASQ-SC instructions were understood by all participants; seven participants indicated relevance. While a few participants suggested minor changes for the items, these reflected the one-off completion of the measure in an interview setting and were thus not considered sufficient to justify modification of the measure for clinical trial completion., Conclusions: Most participants understood the TASQ-IV and TASQ-SC instructions (n = 9 and 10, respectively) and the TASQ-IV items were considered clear, relevant and to have suitable response options, demonstrating face and content validity of the instruments for the clinical trial setting.