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İnsanlığın peygamberlere olan ihtiyacı ve Allah’ın insanlara peygamber göndermesinin gerekli olup olmaması hususları, İslam düşüncesinde üzerinde en çok durulan konulardan biridir. Nübüvvetin gerekliliği konusu, birey ya da toplumun vahiy ve peygambere ihtiyaç duyup duymadığı, ihtiyaç duyuyorsa bunun hangi alanlarda olduğu tartışmasını içermektedir. “Allah tasavvuruna ulaşmak için peygamber gerekli midir, Allah’ın insanoğluna peygamber gönderme zorunluluğu var mıdır, Akıl peygamberlerin getirdiği dinî ve ahlâkî ilkelere ulaşabilme potansiyeline sahip midir, İyi ve kötünün bilinmesinde peygamberin bildirimi gerekli midir ve Kendilerine peygamberin daveti ulaşmayan toplumların ibadet sorumlulukları ne düzeydedir?” gibi sorular nübüvvete duyulan ihtiyaç kapsamında ele alınmaktadır. Çalışmamızda, Kemâleddîn İbnü’l-Hümâm’ın (öl. 861/1457) peygamberliğin gerekliliğine dair görüşleri, el-Müsâyere fi’l-ʿaḳāʾidi’l-münciye fi’l-âḫire’ isimli eserinden hareketle tespite çalışıldı. İbnü’l-Hümâm’ın görüşleri Hanefî/Mâtürîdî ekole mensup bir mütekellim olması açısından dikkat çekmektedir. Çalışmamızda insanların peygamberlere ihtiyacı, Allah’ın peygamber göndermesinin gerekli olup olmadığı, salt akıl ile peygamberlerin getirdiği esasların tespitinin mümkün olup olmadığı ve iyilik-kötülüğün bilinmesinde peygamberlerin rolü konuları İbnü’l-Hümâm özelinde incelendi. Ayrıca “Peygamberlik neden gereklidir?” sorusuna İbnü’l-Hümâm’ın verdiği cevapların, günümüz açısından taşıdığı anlam da sorgulandı. Böylece bu çalışmada, İbnü’l-Hümâm’ın peygamberliğin gerekliliği meselesine dair görüşleri, bütüncül bir bakış açısı ile yansıtmaya çalışıldı.

In vitro literature studies have suggested that atherosclerotic oxidized low density lipoprotein (OxLDL) inhibits trophoblast invasion. The objective of this study was to determine the levels of OxLDL and to examine the relationship between antioxidative estradiol, estriol, and prooxidative progestin in normal and preeclamptic placental tissues and measure the serum activity of antioxidative paraoxonase (PON1). The study included 30 preeclamptic and 32 normal pregnant women. OxLDL was determined with ELISA, estradiol, unconjugated estriol, and progesterone that were determined with chemiluminescence method in placental tissues. Serum PON1 activity was determined with spectrophotometric method. Levels of OxLDL (), estriol (), estradiol (), and progesterone () were lower in the placental tissues of preeclamptic group compared to the normal pregnant women. Serum PON1 activity was higher in preeclamptic group () and preeclamptic group without intrauterine growth restriction () compared to normal pregnant women. Tissue estriol of preeclamptic group without/with IUGR (, ) was lower than the normal group. Results of our study suggest that the events leading to fetoplacental insufficiency lead to a reduction in the levels of estriol limit deposition of OxLDL in placental tissues. The serum PON1 activity is probably important in the inhibition of OxLDL in preeclampsia.

Aim: In cancer patients, the overall risk of venous thromboembolism (VTE) is increased 7-fold, and in cases of certain malignancies, this risk increases to 28-fold. The main objectives of this study are to describe patterns of use of anticoagulants for the treatment of cancer-related VTE in Turkiye and to assess patient characteristics. Material and Methods: This was a multicenter, retrospective, descriptive study utilizing data from 17 centers across Turkiye. We included 2936 patients with a diagnosis of any cancer and a diagnosis of proximal lower-limb deep vein thrombosis (DVT) and/or pulmonary embolism (PE) between January 1, 2016, and December 31, 2019. These patients were only included if the cancer diagnosis was made at least 6 months before the diagnosis of VTE or within 30 days following the diagnosis of VTE. Patients were followed from the day after the index date until the earliest date among the dates of death, the end of the study, or the end of the 6-month treatment period. Results: The study included 2796 patients with VTE between 2016 and 2019. While 41.4% of the participants were female, 58.6% were male, and 66.1% of the patients had DVT while 45.2% had PE. Furthermore, 52.7% had a history of smoking and only three patients had known hereditary thrombophilia. Lung cancer was the most common type of cancer, diagnosed in 872 patients (29.3%), followed by colon cancer diagnosed in 255 patients (8.6%) and breast cancer diagnosed in 202 patients (6.8%). Among these patients, 70.3% were in an advanced stage of the disease. Chemotherapy was administered to 469 (65.7%) patients at the time of disease onset. Among the patients with VTE, 99.5% were treated, and low-molecular-weight heparin was used in 97.5% of these cases while 3% of the patients were treated with direct oral anticoagulants. Bleeding was observed in 1.6% of the patients who participated in this study, and 39.1% of the bleeding events whose type was specified were categorized as major bleeding. Bleeding was most intense in the gastrointestinal tract (56.7%). Recurrence was observed in 1.5% of the patients and improvement was observed in 42.1%. In the first 6 months after diagnosis, 14.3% of the patients died. Causes of mortality could not be obtained from the patients' records. Conclusion: VTE is common in patients with active cancer and associated with high recurrence and mortality rates. Efforts are needed to prevent VTE, diagnose it in time, and reduce the recurrence rates, especially in the first year after VTE diagnosis. [Turk J Vasc Surg 2023; 32(3.000): 158-65]

Aim: Venous thromboembolism (VTE) is a relatively common public health problem. In addition to increasing mortality due to complications, it also causes an increase in the cost of the country's economy and loss of labor due to the morbidity it creates. Considering that the recurrence of VTE is a common condition, the importance of this disease for the society increases even more. Although we have come a long way in treatment and follow-up, we see that VTE and its related complications maintain their place as a significant risk factor in the society at increasing rates. Material and Methods: This is an additional analysis of a multicentral, retrospective descriptive study, CAT-TR (Assessment of Patient Characteristic in Cancer Associated Venous Thrombosis in Turkey). The aim of the CAT-TR study was to evaluate patient characteristic and treatment patterns of cancer-induced VTE in Turkey. This article aims to evaluate the incidence and prevalence of cancer-induced VTE in two regions of Turkey between January 01, 2016 and December 31, 2019. Results: In our study, the 4-year prevalence of Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE) in Central Anatolia and Marmara was 86.43, 103.56 and 105.68, 98.04 per 100.000 people, respectively. The cumulative incidence of cancer-related VTE in the Central Anatolian and Marmara populations is 17.22 and 6.71 per 100.000 people, respectively. Conclusion: The values we found in the prevalence and incidence study of VTE will be very valuable in terms of being a reference for us in the treatment and prevention of the disease. We believe that this study will shed light on new studies for diseases that may cause VTE in larger populations and strategies to be followed in prevention. [Turk J Vasc Surg 2023; 32(2.000): 66-70]

Background: In this study, the effects of pulsatile and non-pulsatile on-pump Coronary Artery Bypass Graft surgery (CABG) and off-pump CABG techniques on the intraocular pressure were investigated. Methods: Forty-five patients who planned to elective coronary artery bypass surgery with on-pump pulsatile (n = 15), non-pulsatile (n = 15), or off-pump (n = 15) were included. Intraocular Pressure (IOP) measurements were performed on both eyes at nine time-points: 1) Before the operation, 2) After anesthesia induction, 3) 3 minutes after heparin administration Left Internal Mammary Artery (LIMA) harvesting, 4) End of the first anastomosis, 5) End of LIMA anastomosis, 6) 3 minutes after protamine administration, 7) End of the operation, and 8) Second hour in Intensive Care Unit (ICU), 9) Fifth hour in ICU. Mean Arterial Pressure (MAP) and Central Venous Pressure (CVP) were also recorded at the same time points as IOP. Results: In Cardiopulmonary Bypass (CPB) groups (pulsatile or non-pulsatile CPB) with the beginning of CPB, there were significant decreases in IOP values when compared to baseline (p = 0.012). This decrease was more prominent in the non-pulsatile group when compared to the pulsatile group (T4 IOP values: pulsatile, 9.7 ± 2.6; non-pulsatile, 6.8 ± 1.9; p = 0.002; T5 IOP values: pulsatile, 9.5 ± 1.9; non-pulsatile, 6.7 ± 2.1; p = 0.004). At the end of the surgery (T7), IOP values returned to the baseline and stayed stable at the remaining time-points. In-off pump group, IOP values significantly increased with a head-down position (T4 IOP values: off-pump surgery, 19.7 ± 5.2; p = 0.015). IOP values remained high until the normalization of head-down position (T6) and stayed stable through the rest of all remaining time-points. Conclusion: During cardiac surgery regardless of the technique (on-pump CABG, off-pump CABG), intraocular pressures remain in the normal ranges. It should be kept in mind that patients should be avoided from long and extreme Trendelenburg position, low CVP, and MAP levels during cardiac surgery to prevent eye-related complications.

Chronic pelvic pain (CPP) is often diagnosed by gynecologists. In recent years, the realization that venous insufficiency in the pelvic or retroperitoneal area can also cause CPP has led to the involvement of vascular physicians in the diagnosis and treatment. Differentiating pelvic venous disease (PeVD) from gynecological, internal or even orthopedic complaints poses a challenge. A comprehensive study of the patient's medical history and a detailed description of symptoms are of paramount importance. The symptoms of PeVD depend on the veins involved. Whereas pelvic pain is mainly an expression of an insufficiency of the ovarian vein and/or the internal iliac vein, left flank pain and hematuria are caused by an obstruction of the renal vein. Symptoms may also be associated with atypical varicose veins in the vulva, perineum, or legs. Anatomical gaps, pelvic escape points, allow them to communicate with the branches of the insufficient internal iliac veins and with the ovarian. As an effective tool for reporting PeVD patient populations the symptoms-varicespathophysiology (SVP) classification was published in 2021. It is thought to be the initial point of both the treatment standard and identifying homogenous patient populations for clinical trials. [Turk J Vasc Surg 2021; 30(1.100): 1-7]

Pelvic venous disease (PeVD) is an overlooked condition that can affect daily life of patients. Although medical history and physical examination may lead to suspicion of PeVD, accurate imaging is important for establishing the diagnosis with high certainty. Despite the increasing popularity of magnetic resonance imaging and Duplex ultrasound as non-invasive imaging methods, selective venography remains the gold-standard imaging method to establish the diagnosis of PeVD. In addition, venography provides an opportunity for treatment in a single procedure. In this chapter, we define the techniques for selective ovarian venography and discuss its clinical importance in diagnosis of PeVD. [Turk J Vasc Surg 2021; 30(1.100): 17-21]

Objectives: This study aims to compare embolectomy results for acute lower limb ischemia (ALLI) between patients aged ≥80 years and [Turk J Vasc Surg 2020; 29(2.000): 84-9]

The two main mechanisms for pelvic venous disease (PeVD) are reflux of ovarian vein and obstruction of left common iliac or left renal vein. Some patients have a combination of the two. Adequate assessment of the location and degree of stenosis and delineation of venous anatomy are the key elements in the success of interventions to treat chronic obstructions causing PeVD. While venography is more accessible and less expensive to perform than intravascular ultrasound (IVUS), an increasing number of studies have demonstrated that IVUS is significantly more sensitive than venography in identifying stenotic lesions and real-time anatomical alterations of the affected venous segments. In this paper, we discuss the derived information and the clinical applications of IVUS during such interventions. The definitive diagnosis of PeVD can be achieved with venography combined with IVUS to evaluate for obstructive lesions in the iliac veins and compression of the left renal vein. Venography has poor sensitivity and specificity in the detection of venous stenosis. However, IVUS can detect fine intraluminal trabeculae and outside compression that can be missed with standard multiplanar venography. The IVUS can confidently confirm the persistent venous stenosis regardless of the hemodynamical alterations of venous pressure, as well. Moreover, it is possible to precisely measure the diameter of ovarian vein with IVUS. This may be helpful to decide about the diameter of the coils or the plugs needed to avoid migration. In conclusion, IVUS enables us to accurately evaluate the underlying cause of PeVD and apply a patient's tailored treatment on table. [Turk J Vasc Surg 2021; 30(1.100): 14-6]

Pelvic venous disease (PeVD) are a not rare cause of venous insufficiency in the leg that is frequently underestimated and poorly managed. Graduated compression stockings (GCSs) represents a pillar in lower limb chronic venous disease (CVD). Despite these first two considerations, clear GCS indications in PeVD are still missing due to the lack of literature data on this topic. In the present short report, we offer an insight on the topic and the potential rationale for GCS use in PeVD. [Turk J Vasc Surg 2021; 30(1.100): 27-9]

Objectives: This study aims to present the clinical results of patients administered rivaroxaban for the treatment of deep vein thrombosis (DVT) in terms of efficacy and safety. Patients and methods: A total of 78 patients (44 males, 34 females; mean age 60.9±20.6 years; range, 26 to 88 years) diagnosed with DVT had received rivaroxaban treatment at the Gulhane Education and Research Hospital's Cardiovascular Surgery Clinic between August 15, 2014 and November 3, 2017 were included in the study. Deep vein thrombosis diagnoses of the patients were confirmed by Doppler ultrasonography. The patients' epidemiological and biochemical values were evaluated. Major-minor bleeding and recurrence that occurred during rivaroxaban treatment was investigated. Results: The mean follow-up period was 12.2±9.4 (range, 6-48) months. When anticoagulant treatments of the patients were examined, 21 patients (27%) were treated with rivaroxaban as initial treatment and 57 patients (73%) had transitioned from warfarin to rivaroxaban treatment. In patients using rivaroxaban, one patient had hypermenorrhea and two patients had epistaxis. Major bleeding was not detected. While three patients had alanine aminotransferase levels up to two times higher than the normal limit, none of the patients had clinically significant liver or kidney failure. Recurrent DVT or pulmonary embolism was not detected in the patients. Conclusion: According to the current guidelines and literature findings novel oral anticoagulants could be used safely and efficiently as a first line drug theraphy in DVT patients due to their noninferior effectiveness to warfarin and lower side effect profile. [Turk J Vasc Surg 2019; 29(1.000): 9-14]

Pelvic venous disease (PeVD) as a terminology incorporates many different pathologies in pelvis in both men and women. There are still many question marks in this area that need to be answered. In this article, we attempt to highlight the areas of where we should focus on for future research topics. [Turk J Vasc Surg 2021; 30(1.100): 35-6]

Background. Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) are being used for preoperative management of critical coronary artery disease. However, preoperative UFH therapy may cause a reduction in antithrombin concentrations, leading to various degrees of heparin resistance (HR). The main purpose of this study is to investigate the effects of preoperative LMWH on HR during cardiopulmonary bypass (CPB). Methods. Data were retrospectively reviewed from adult patients that underwent on-pump coronary artery bypass graft (CABG) surgery. Four hundred fifty-seven patients underwent CABG, and 139 of them, who had isolated on-pump CABG, were included in the study. The heparin sensitivity index was calculated if activated clotting time levels were discovered below 400 seconds. Values less than 1.3 were accepted as HR. Results. Of 139 patients who underwent on-pump CABG, preoperative LMWH was administered in 59 patients (56.8%). Intraoperative HR occurred in 29 patients (20.9%). Patients who received preoperative LMWH had an increased risk of developing HR compared with patients who did not receive LMWH (odds ratio 4.8 and 95% confidence interval 1.7–13.5). CPB duration and aortic clamp duration were significantly longer in patients who developed intraoperative HR when compared to those in patients who did not develop HR. Conclusion. Preoperative treatment with LMWH may cause intraoperative HR. Corrective and preventive arrangements with close follow-up should be performed in this group of patients.

Introduction. Digital ischemia is a rare complication of several chemotherapeutic medications. We aimed to present a patient with digital ischemia, secondary to a new generation chemotherapeutic drug, oxaliplatin. Case Report. 62-year-old woman presented to our department with severe pain, paresthesia, and distal acrocyanosis on her right hand fingertips. Her complaints started five days after the third cycle of a chemotherapy protocol consisting of 5-fluorourasil (5-FU), folinic acid, and oxaliplatin due to advanced colon carcinoma. On physical examination, hemorrhagic and partly ulcerative lesions were detected at her right hand fingertips. Radial and ulnar pulses were absent at affected side. Digital subtraction angiography revealed severe vascular resistance in the affected extremity. Iloprost trometamol treatment was started with the dosage of 1 ng/kg/min. In addition, low-molecule-weight heparin was used for preventing possible microemboli. Symptomatic relief was provided after five days, and patient was discharged on 7th day of treatment. Discussion. The pathogenesis of oxaliplatin induced vascular toxicity remains unclear. Endothelial damage, increased adherence of platelets, deposition of immune complexes as an immunologic effect of oxaliplatin, and hypercoagulable state may be the reason for arterial thrombosis, digital microemboli, possible digital ischemia, and their several consequences.

Intravenous leiomyomatosis (IVL) is a rare neoplasm characterized by histologically benign-looking smooth muscle cell tumor mass, which is growing within the intrauterine and extrauterine venous system. In this report we aimed to present an unusual case of IVL, which is originating from iliac vein and extended throughout to right cardiac chambers. A 49-year-old female patient, who was treated with warfarin sodium due to right iliac vein thrombosis, was admitted to our department with intermittent dyspnea, palpitation, and dizziness. Physical examination was almost normal except bilateral pretibial edema. On magnetic resonance venography, there was an intravenous mass, which is originated from right internal iliac vein and extended into the inferior vena cava. Transthoracic echocardiography and transesophageal echocardiography revealed a huge mass extending from the inferior vena cava through the right atrium, with obvious venous occlusion. Thoracic, abdominal, and pelvic MR showed an intravascular mass, which is concordant with leiomyomatosis. Surgery was performed through median sternotomy. A huge mass with 25-cm length and 186-gr weight was excised through right atrial oblique incision, on beating heart with cardiopulmonary bypass. Histopathologic assessment was compatible with IVL. Exact strategy for the surgical treatment of IVL is still controversial. We used one-stage approach, with complete resection of a huge IVL extending from right atrium to right iliac vein. In such cases, high recurrence rate is a significant problem; therefore it should be kept in mind.

Pelvic venous disorder represents an as common as challenging clinical scenario because of the blurred borders between pelvic region and lower limb treatment target, because of the subtle and aspecific signs and symptoms, because of the lack of large randomized comparative trials providing clarity on the best practice and strong recommendations. Herein we present pathophysiology and clinical considerations on the lower limb varicosities of pelvic origin, suggesting possible management strategies based on clinical manifestation, ultrasound detection and targeted sclerotherapy. Large studies are needed to identify the best diagnostic parameters guiding the best strategy and highlighting the most reliable reported outcomes from such heterogeneous patients. [Turk J Vasc Surg 2023; 32(0.000): 24-7]

Pathological shear and stretch stress acting on the endothelium lining following venous reflux has been associated with an increased risk not only of thrombosis, but also of pan-endothelial inflammation. Indeed, varicose veins patients demonstrate an increased risk not only of deep venous thrombosis, but also of pulmonary embolism and peripheral arterial disease. Ex-vivo studies, including the ones on vascular endothelial cells, highlight the correlation between the physical forces and the biochemical related messaging triggering these clinical scenarios. Herein we report insights on the biosignaling following this mechano-transduction involving surface and cytoskeleton structures such as the glycocalyx, involved in endothelial permeability, protection, as well as in vessel tone and coagulation balance in a parallelism between lower limb and pelvic venous district venous thrombo-inflammation. [Turk J Vasc Surg 2023; 32(0.000): 28-30]

The creation of a virtual European network and reference centers, targeted at Pelvic venous disease, holds promising potential for the medical and research communities. Nevertheless, effective implementation of the initiative necessitates prudent planning, funding, and support. The establishment of such networks and reference centers requires certain considerations. We will elaborate on these considerations and are there best practices? The development from reference centers into (virtual) networks and even thinktanks is a precarious process of which is making its way from infancy to adulthood. [Turk J Vasc Surg 2023; 32(0.000): 20-1]