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Amac: Alt ekstremitenin kaybi bireylerin ayakta durma, transfer yeteneklerini ve ambulasyonunu etkiler. Bu calismanin amaci; alt ekstremite amputasyonu olan ve hastanemize basvuran hastalarin klinik ve demografik karakteristiklerini belirlemektir. Gerec ve Yontem: Calismamiz retrospektif bir kohort calismasidir. Calismaya Ocak 2012- Mayis 2013 aylari arasinda hastanemize basvuran ve alt ekstremite amputasyonu olan hastalar dahil edildi. Hastalarin dosyalari gozden gecirildi, demografik ve klinik karakteristikleri kaydedildi. Tanimlayici degiskenler ortalama ve standart sapma (min-max), kategorik degiskenler n (%) olarak verildi. Veriler SPSS 15.0 kullanilarak analiz edildi. Bulgular: Toplam 836 alt ekstremite amputasyonu olan hastaya ait ortalama yas 36.12±11.69(9-78)’ idi. Hastalarin 770(%92.3)’u unilateral ampute, 59(%7.1)’i bilateral ampute idi. Amputasyon seviyesine gore degerlendirildiginde hastalarin 456(%54.5)’si unilateral diz ustu amputasyonu, 236(% 28.3)’u unilateral diz alti amputasyonu idi. Etiyoloji acisindan degerlendirdigimizde; 373(%44.6) hastada trafik kazasi, 103(%12.5) hastada is kazasi amputasyon nedenini olusturuyordu. Hastalarin cogunlugu 456(%54.5) mikroislemci kontrollu dizustu protezi ile, takiben 224(%26.7) ise aktif vakum sistemli dizalti protezi ile ambule idi. Sonuc: Calismamizda amputasyonla basvuran hastalar arasinda en yaygin sebebi travma olarak saptamamiza ragmen, bu amputelerin ulkemizdeki genel profilini yansitmadigini dusunuyoruz. Ancak calismamiz ampute hastalarin demografik ve klinik ozelliklerini belirlemek acisindan yol gosterici olmustur. Bu veriler ampute hastalarin toplumsal rehabilitasyonu ve yeni protezlerin gelistirilmesi acisindan onem arzetmektedir.

Diagnosis of papillary lesions of the breast by fine needle aspiration cytology (FNAC) is problematic. For this reason, it is situated in the indeterminate zone in classification systems.To ascertain the accuracy of cytological diagnosis of papillary lesions in distinguishing papillary lesions from non-papillary lesions and to determine whether papillomas can be reliably distinguished from malignant papillary lesions by FNAC.A total of 346 cases with the diagnoses of breast papillary lesions were selected among 5112 breast FNAC procedures performed in our center. One hundred and thirty-nine cases with excised lesions were included in this study, and their corresponding histology was reviewed.Papillary lesion diagnosis was confirmed by histopathology in 103 (74.1%) of 139 patients. Cytology and histopathology results were not found to be compatible in 35 (25.2%) cases. The diagnostic accuracy of distinguishing papillary breast lesions as malignant or benign was assessed statistically. According to the cytology-histology comparison, one case was evaluated as false negative (FN) and twelve cases as false positive (FP). Overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FNAC in distinguishing papillary lesions as benign or malignant were calculated as 87%, 97%, 83%, 72%, and 98%, respectively.The diagnostic accuracy of papillary breast lesions classified by FNAC might be improved by careful evaluation together with cytological, radiological, and clinical findings (triple test). Cell block may allow more accurate evaluation of the papillary lesion and can be applied to immunohistochemical examination. It may also facilitate the differentiation of benign/malignant papillary lesions.

OBJECTIVES: The aim of this study was to investigate the effect of virtual reality (VR) therapy on motor and functional development in children with cerebral palsy (CP). PATIENTS AND METHODS: In this single-blind, prospective, randomized-controlled study, a total of 41 patients (28 males, 13 females; mean age 8.49 years; range, 5 to 15 years) receiving inpatient treatment for CP were included between April 2009 and September 2009. The patients were randomly divided into two groups as the study group (n=21) and control group (n=20). Neurophysiological and conventional treatment methods, and occupational therapy were applied to all patients. In addition, a total of 12 VR therapy sessions for one hour were administered three days a week for four weeks to the study group. Before and after treatment, the Bimanual Fine Motor Function (BFMF) test was performed to measure hand functioning, Gross Motor Function Classification System (GMFCS) for functional levels, and Functional Mobility Scale (FMS) for mobility. RESULTS: There was a significant increase in the BFMF, GMFCS, and FMS scores after treatment, compared to baseline values in the study group (p

Objective: In this study, an immunohistochemical investigation was carried out into CDX2 expression in intestinal metaplasia (IM) that accompanies chronic gastritis in endoscopic biopsies and gastric cancers in resection materials.We aimed to assess differences in the intensity of CDX2 staining between groups and identify the role of CDX2 in determining the risk of cancer. Material and Methods: The endoscopic biopsies taken from 70 stomachs dia gnosed with chronic gastritis and materials resected from 54 stomachs diagnosed with adenocarcinoma have been ex - amined in our laboratory. Results: The mean CDX2 score for the tumors in the resection group was found to be statistically significantly lower compared to that for the complete and incom - plete subgroups in the endoscopic biopsy group (p

To the editor, A 39-year-old female achondroplastic patient was admitted to our outpatient clinic for her back and lower extremity pain. Her height and weight were 125 cm and 38 kg, respectively (Fig. 1). She had a body mass index of 24.3 kg/m. She had undergone leg lengthening on bilateral tibias when she was 12. On physical examination, she had bilateral paravertebral muscle spasm at her back. She also had painful hip internal rotation and knee flexion on both sides with bilateral positive Clarke’s sign. Her physical examination was otherwise noncontributory. X-ray examination revealed early degenerative changes, especially at the hip joints and strikingly osteopenia. On detailed questioning, it was understood that she had been advised to receive 300,000 IU vitamin D3 (the form of vitamin D available in our country) once a year and to exercise regularly for low bone density 2 years ago. The past two bone mineral density (BMD) measurements, performed by a single technician using dual-energy X-ray absorptiometry (DEXA) on a Lunar DPX-IQ scanner in our center, were analyzed, and a new BMD measurement was performed under similar conditions with the ones referred above (Table 1, Fig. 2). The laboratory tests was as follows: serum total calcium, 9.3 mg/dl (8.2–10.6); inorganic phosphate, 3.2 mg/dl (2.5–4.5); alkaline phosphatase (ALP), 47 U/l (30–126); type 1 collagen C terminal telopeptide (CTX), 0.253 (25–573); osteocalcin, 3.46 ng/ml (3.1–13.7); parathormone, 34.23 pg/ml (15–65), and vitamin D3, 20.1 ng/ml (>30). Risk factor examination for low bone density yielded no results. Low bone density was considered as a consequence of altered bone metabolism due to achondroplasia. She was prescribed 300,000 IU oral vitamin D3 and recommended to continue on her exercises. She was also included in a physical therapy program for her symptoms due to degenerative changes. Achondroplasia is the most common form of skeletal dysplasias. A spontan or inherited mutation in the fibroblast growth factor receptor 3 (FGFR3) gene on the fourth chromosome brings out the disease [1]. The primary defect is abnormal endochondral ossification [2]. It has a number of wellknown neuromusculoskeletal manifestations [3]. Recently, Arita et al. reported low bone density, diagnosed with spinal BMD analysis and panoramic radiographic measurements, in 5 of 11 achondroplastic patients for the first time in the literature [4]. To the best of our knowledge, our report is the second one referring the relationship between

Primary heart tumors are extremely rare and their frequency ranges from approximately 0.01-0.3% in autopsy series. Nearly one quarter of all primary cardiac tumors are malignant tumors such as sarcoma. Rhabdomyosarcoma is the second most common malignant primary tumor of the heart following angiosarcoma.Primary cardiac tumors present with one or more of the symptoms of the classic triad: cardiac symptoms and signs resulting from intracardiac obstruction; signs of systemic embolization; and systemic or constitutional symptoms. The prognosis after surgery is usually excellent in case of benign tumors, but is unfortunately still limited in localized malignant diseases [Butany 2005].In this case report we present a 45-year-old female patient operated three times in 9 years because of left atrial tumor.

Background: Lymphadenopathy (LAP) may be the first symptom of many diseases. We aimed to investigate peripheral LAP results taken by excisional biopsy. Methods: Histopathological examination of 185 lymph node biopsy specimens were evaluated between January 2009 and April 2015 in Istanbul Private Ekin Pathology Laboratory, retrospectively. Results: The average age of patients ranged from 1 to 86 was 41.01 ± 20.62 years. 87 of were female, 98 of male. 62 (33.5%) of excisional biopsy materials were benign lesions and 123 (66.5%) of malignant. Benign lesions were consisted of reactive hyperplasia, cat-scratch disease, toxoplasmosis, necrotizing/non-necrotizing granulomatous. Of these patients, 40 had nodes with reactive hyperplasia (15 female/25 male, mean age: 27.35 y), 14 had necrotizing granulomatous disease (9 female/5 male, mean age: 39.86 y), 2 non-necrotizing granulomatous disease (1 female/1 male mean age: 43 y), 4 had cat-scratch disease (1 female/3 male mean age: 54.25 y), 1 toxoplasmosis (26 y, female), 1 Kikuchi disease (25 y, female). In the evaluation of malign lesions; 38 were Hodgkin lymphoma (HL) (20.5%, 17 female/21 male, mean age: 34.89 y) 77 had non-Hodgkin lymphoma (NHL) (41.6%, 37 female/40 male, mean age: 52.26 y), 8 metastasis (4.3%, 5 female/3 male, mean age: 53.5 y). Reactive LAP observed most common in cervical region, NHL in axillary-abdomen-inguinal-mediastinum and HL in the supraclavicular region. Conclusion: Excisional biopsy can be applied safely with minimal morbidity and mortality and a gold standard diagnostic method for LAP. Although LAP is mostly related with benign lesions, malignancy should be kept in mind in differential diagnosis.

Aim: We aimed to investigate the diagnostic value of fine needle aspiration biopsy (FNAB) and compared our FNAB results of non-thyroidal head and neck lesions with excisional biopsy results. Materials and methods: A total of 866 aspiration material taken from different parts of head and neck region out of thyroid were evaluated at Haydarpasa Numune Training and Research Hospital Pathology Laboratory, between January 2002 and May 2013 and 248 of which has histopathologic response were included in the study. Patients depending on origin of the masses were divided into three categories as; salivary gland, lymph nodes and soft tissue/cystic lesions. The sensitivity, specificity, diagnostic accuracy values of fine needle aspiration biopsies have been investigated for all the series and individually for each category. Findings: Diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive values of non-thyroidal head and neck masses were respectively; For all of the series; 94.6%, 97.9%, 96.7%, 95.9%, 97.2%, Salivary gland: 88.9%, 100%, 98.8%, 100%, 98.7%, Lymph nodes: 94.7%, 89.3%, 92.9%, 94.7%, 89.2%, Soft tissue/cystic lesions: 100%, 100%, 100%, 100%, 100%. For all of the series; there were 4 false negative (FN) cases; and 3 false positive (FP) cases. Conclusion: FNAB in the diagnosis of head and neck masses; it is an easy, cheap and usefull procedure.

This study aimed to investigate the efficiency of FES application on the abdomen-posterior back muscles in children with CP that were enrolled into physical therapy and rehabilitation (PTR) program.The study included 55 spastic diplegic children that were hospitalized for rehabilitation. Those with deformities that could disrupt the balance in sitting and cause problems in evaluations were excluded. The patients were randomly divided into two equal groups according to their time of presentation. Thirty-two children completed the study. The control group received PTR program only for 4 weeks. The children in the FES group received PTR in addition to electrical stimulation. Electrical stimulation was applied 5 days a week for 4 weeks to abdomen-posterior back muscles in 30-minute-long sessions. To evaluate the balance in sitting, sitting score of gross motor function measurement (GMFM) and to evaluate the trunk asymmetry in sitting, radiographic measurements were used. Thus, kyphosis, Cobb and sacral angles were measured.The comparisons of the measurements of the two groups before and after the treatment showed that the GMFM sitting score and the sacral angle were statistically significantly increased, and the kyphotic and Cobb angles were statistically significantly decreased. After the treatment, both groups demonstrated an increase in the GMFM score, but the increase in the FES group was statistically significantly higher than that in the control group. With respect to radiological measurements, the changes observed in both the kyphotic and Cobb angles after the treatment were statistically significantly higher in the FES group than in the control group. The rates of the changes in the sacral angle did not differ among the groups.We believe to provide balance in sitting for children with CP, FES applied on abdomen-back muscles along with conventional therapy to maintain trunk control is more effective than conventional therapy alone.

We describe an extremely rare case of a complete fistula, a combination of the first 2 branchial arches as a component of branchiootorenal syndrome. A 13-year-old girl presented with the complaint of intermittent drainage from bilateral preauricular and right lower neck external openings. A contrast fistulogram revealed a complete fistula. Diagnostic features and surgical techniques are discussed in detail.

Merkel cell carcinoma (MCC) is uncommon cutaneous malignant neuroendocrine tumour of the elderly people with rapidly growing skin nodules found frequently on sun-exposed areas of the body. MCC is often an aggressive tumour with high tendency for local recurrence, lymph node involvement and distant metastases. This paper reports a case of metastatic MCC diagnosed by fine needle aspiration cytology (FNAC), flow cytometric deoxiribonucleated acid (DNA) analysis, pathohistology and electron microscopy. The cytological features in aspirate (stained with Papenheim and Papanicolaou staining) included increased cellularity, discohesive groups of small-to-medium size malignant cells with uniform, round-to-oval nuclei with moulding effect, fine chromatin, multiple micronucleoli and scanty cytoplasm. DNA flow cytometric analysis of the aspirate showed unexpected results for clinically aggressive behaviour of this tumour (the patient died after 21 months), and revealed that tumour contained diploid peak with DNA index of 1.1. The proliferation was high with elevated S-phase fraction (21%). The cytological diagnosis of possible metastatic MCC was confirmed by histological one as well as by electron microscopy presented the pathognomonic features for this tumour: dense-core neurosecretory granules with diameter of 100–250 nm surrounded by whorls of intermediate filaments. MCC provides an enormous challenge for the morphologist because of a wide range of differential diagnosis and for the clinician because this tumour has a highly malignant potential for local recurrence, nodal and distant spread and very often is combined with other tumours. Therefore it is important to perform FNAC of different lesions in the same patient because it can distinguish MCC from the other tumours.