GÝRÝÞ ve AMAÇ: Tüm dünyayý etkileyen COVID-19 hastalýðý saðlýk kurumlarýnýn bu konuda önemli tedbirler almasýný gerekli kýlmaktadýr. Saðlýk Bakanlýðý düzeyinden aile saðlýðý merkezlerine kadar alýnan çeþitli tedbirlerle koronavirüs hastalýðýnýn hem toplum hem de saðlýk sistemi üzerindeki etkilerinin en aza indirgenmesi hedeflenmiþtir. Pandemiden aðýr etkilenen ülkelerin ortak özellikleri saðlýk sisteminin ve hastane organizasyonunun yetersiz kalmasýdýr. Servis veya yoðun bakým gerekliliði olan hastalarýn tedavilerinin etkin bir þekilde yapýlmasý amacýyla böyle büyük pandemik krizler için hastaneyi hýzlýca uygun hale getirmek önemli rol oynar. Süratli bir þekilde harekete geçip, aciliyeti olmayan hastalarýn tedavilerini erteleyip, pandemiden etkilenen hastalara yer açýlmasý gerekmektedir. Ayrýca oluþturulan taný ve tedavi algoritmalarýnýn tüm ülkede ayný hastalýk grubunda ayný algoritmayý izlemesi geri dönüþ açýsýndan da önemlidir. Bu çalýþmada 11 Mart – 07 Mayýs 2020 arasýnda COVID-19 salgýnýnýn baþarýlý bir þekilde yönetilmesinde deneyimlerimizi aktardýk ve hastane organizasyonunun tedavinin baþarýlý olmasýndaki rolünü araþtýrdýk.
YÖNTEM ve GEREÇLER: 11 Mart 2020 tarihinde Kartal Dr. Lütfi Kýrdar Eðitim ve Araþtýrma Hastanesi, Saðlýk Bakanlýðý tarafýndan pandemi hastanesi olarak ilan edilmiþtir. COVID-19 tanýsý konulan hastalarýn yatýrýlmasý için hastanemizde hýzlýca 31 klinikte 500 pandemi hasta yataðý oluþturuldu.
BULGULAR: Bu tarihe kadar COVID-19 nedeni ile toplam 37350 poliklinik muayenesi yapýldý. 20 Nisan 2020’de 1656 ile en yüksek poliklinik muayene sayýsýna eriþildi. Mart ayýnýn sonlarýna doðru hem COVID-19 polikliniklerimize baþvuran hasta sayýsýnda hem de pandemi kliniklerinde yatan hasta sayýsýnda gözle görülür bir artýþ meydana geldi. Bu süreçte 2536 hasta yatarak tedavi edildi. Bu hastalarýn 163’ü çocuktu. Yatan hastalarýmýzýn 2087’si (%82) þifa ile taburcu edildi, 255 (%10) hastanýn ise pandemi kliniklerinde ve pandemi yoðun bakým ünitelerinde tedavilerine devam edilmektedir.
TARTIÞMA ve SONUÇ: Sonuç olarak COVID-19 saptanan hastalarýn taný ve tedavisi konusunda fiziki mekan ve saðlýk ekibi olarak yeterli bir konumda olmak ve iyi bir organizasyon þemasý ile tedavi sürecini yürütmek hastalarýn kýsa sürede tedavi olmasýna neden olduðu gibi, morbidite ve mortalitenin azalmasýna katký saðlayacaðý kanaatindeyiz.

INTRODUCTION: During the pandemic, various measures have been taken from the Ministry of Health to family health centers to minimize the effects of COVID-19 on both society and the healthcare system. It is crucial to quickly revise the hospital for such a large pandemic crisis to effectively treat patients that require hospitalization or intensive care. It is vital to act quickly, postpone the treatment of elective patients, and make room for patients affected by the pandemic. It is also important that the same diagnostic and treatment algorithms are followed all over the country to get reliable feedback. In this study, we share our experience in the successful management of the COVID-19 outbreak between March 11 and May 7, 2020, and investigate the role of the hospital organization in the success of the treatment.
METHODS: Kartal Dr. Lütfi Kýrdar Training and Research Hospital has been declared as a pandemic hospital by the Ministry of Health on March 11, 2020. To hospitalize patients diagnosed with COVID-19, 500 pandemic patient beds were arranged in 31 clinics.
RESULTS: Until this date, 37350 polyclinic examinations have been performed for COVID-19. The highest number of outpatient examinations was reached by 1656 on April 20, 2020. By the end of March, there was a noticeable increase in both the number of inpatient and outpatient clinics. Through pandemics, a total of 2536 patients was hospitalized, 163 of them were children. While 2087 (82%) of our inpatients were discharged, 255 (10%) of the patients are still being treated in our institution.
DISCUSSION AND CONCLUSION: In conclusion, we think that in the diagnosis and treatment of COVID-19, having adequate physical space and sufficient workforce, and carrying out the treatment process with a good organizational chart will help us treat patients in a shorter time and will contribute to the reduction of morbidity and mortality.

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Amaç: Ön karýn duvarý fýtýklarý (ventral herniler) karýn cerrahisi sonrasýnda sýk karþýlaþýlan problemlerdendir. Bu tip fýtýklar çoðunlukla orta hat ve transvers kesilerden sonra görülmesine raðmen her tip karýn operasyonundan sonra görülebilirler. Sýklýðý %20 olmasýna raðmen son verilere göre insizyonel fýtýk sýklýðý %2–11’dir. Sadece Amerika Birleþik Devletleri’nde yýlda 190.000 insizyonel herni operasyonu yapýlmaktadýr. Karýn operasyonlarýndan sonra oluþan insizyonel fýtýklar ciddi iþ gücü kaybýna, morbiditeye ve kötü yaþam kalitesine neden olmaktadýr. Yüksek insidansý ve morbiditesi nedeniyle önemli bir cerrahi sorundur. Ýnsizyonel fýtýklar karýnýn kapatýlmasýndaki yetersiz iyileþmeden kaynaklanmaktadýr. Obezite, yara kenarlarýnýn sýký kapatýlmasý, yara yerinde enfeksiyon, hematom, seroma, karýn kapama tekniði, steroid kullanýmý, malnutrisyon (hipoproteinemi…), sigara kullanýmý, kronik obstrüktif akciðer hastalýðý (KOAH), diyabet gibi.
Gereç ve Yöntem: Bu çalýþmada, sýçanlarda farklý karýn kapama tekniklerinin hücresel düzeyde yara iyileþmesi üzerine patolojik ve biyokimyasal etkilerinin deneysel olarak gösterilesi amaçlanmýþtýr.
Bulgular: Bu çalýþmada, ortalama aðrýlýðý 200–250 gr olan Wistar Albino cinsi diþi sýçan kullanýldý. Denekler her grupta 8 sýçandan oluþan beþ gruba ayrýldý. Önceden yapýlan orta hat kesisinden patolojik (enflamasyon, anjiyogenez ve kollojen aktivitesi) ve biyokimyasal [MDA (malondialdehit), NO (nitrik oksit), kaspaz 3 aktivitesi, MMP 2-9 (metalloproteinaz 2 ve 9), TNF alfa (tumör nekrosis faktor alfa), IL6 (interlökin 6)] inceleme için ‘U’ þeklinde örnekler alýndý, tüm bu iþlemlerden sonra sýçanlar sakrifiye edildi.
Sonuç: Bu çalýþmanýn sonucuna göre, eðer batýn fasyasý optimal (vaskülariteyi bozmayacak derecede sýký kapatýlmamalý ve uç-uca kapatýlmalý) kapatýlýrsa, tek tek veya sürekli karýn kapama tekniði arasýnda insizyonel fýtýk geliþimi açýsýndan istatistiksel olarak anlamlý fark yoktur.

Objective: Incisional hernias that are the type of anterior abdominal wall hernia (ventral hernia) are common surgical problems after abdominal procedures. Although these types of hernias are seen after every abdominal operation, they are mostly seen after the midline and transverse incisions. However, the incidence of incisional hernia is 20%, according to the latest data, the incidence of incisional hernia is 2-11%. Only in the U.S.A., 190 000 incisional hernia operations are carried out per year. Incisional hernias that are seen after abdominal surgical procedures cause important loss of labour, morbidity and adversely affect the quality of life. Because of the high incidence and morbidity rate, it is one of the important problems of surgery. Incisional hernias originated from previous insufficient healing of abdominal closure. Factors that cause incisional hernias are obesity, tight closure of wound edges, wound infection, hematoma, seroma, type of incision, the technique of abdominal closure, steroid use, malnutrition (hypoproteinemia), smoking, COPD, diabetes and mellitus.
Methods: In this study, experimentally, we aimed to show the pathologic and biochemical effects of different closure techniques on wound healing into the cellular level of rats.
Results: In this study, we used 40 female rats that were Wistar Albino types and their mean-weight was 200–250 gr. Rats were divided into five groups. Each group included eight rats. U-shaped samples were taken from mid-line incision, previously made, for pathologic (inflammation, angiogenesis and collagen activity) and biochemical [MDA (malondialdehyde), NO (nitric oxide), caspase 3 activity, MMP 2-9 (Metalloproteinases 2 and 9), TNF alfa (tumor necrosis factor alfa), IL6 (interleukin 6)] study, and after these procedures, rats were sacrificed.
Conclusion: The findings obtained in this study show that there was no statistically significant difference between abdominal closure techniques one by one or continue suturing concerning incisional hernia if the fascia was closed optimally (not very tight, not to deteriorate the vascularity and end to end closing).

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GÝRÝÞ ve AMAÇ: Primer membranöz nefropatide (PMN), podosit membranlarýndaki fosfolipaz A2 reseptörüne (PLA2R) karþý geliþen antikorlar, immün komplekslerin oluþumuna neden olarak glomerular bazal membranda fonksiyon kaybýna sebep olurlar. Ayrýca PMN’de glomerüllerde kompleman 4d (C4d) birikimi de gösterilmiþtir. Bu çalýþmanýn amacý, PMN olgularýnda PLA2R ve C4d ekspresyonlarýný deðerlendirmek ve klinik parametrelerle baðlantýlarýný araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Elli bir hastaya ait klinikopatolojik bilgiler ve parafine gömülmüþ örnekleri toplandý. Formalin fikse ve parafine gömülmüþ dokular rutin hematoksilen-eozin, periyodik asit schiff ve gümüþ methenamin boyalarýyla ve anti-PLA2R (CL0474; Atlas Antikorlarý) ve C4d (Poliklonal; CellMarque) immün boyalarýyla boyandý. On adet normal böbrek dokusu ve 10 adet fokal segmental glomeruloskleroz (FSGS) olgusu PLA2R ve C4d ekspresyonu için kontrol olarak seçildi.
BULGULAR: PMN olgularýnýn hepsi (n=51) (%100) PLA2R ile pozitifti, 15’i (%29) 2+, 36’sý (%71) 3+ olarak skorlandý. Olgularýn 40’ý (%78) C4d pozitifti. C4d boyanma oranlarý: 31 olguda zayýf pozitif (1+) (%61), dokuz olguda orta þiddette pozitif (2+) (%18) olarak gözlendi. Kuvvetli boyanma gözlenmedi. Tüm kontrol olgularý PLA2R ve C4d ile negatifti. PLA2R ve C4d boyanma yoðunluðu ile proteinüri seviyeleri, kreatinin seviyeleri ve kompleman 3 (C3) pozitifliði arasýnda istatistiksel olarak anlamlý bir fark saptanmadý. Benzer olarak C4d boyanma yoðunluðu ile proteinüri seviyeleri, kreatinin seviyeleri ve C3 pozitifliði arasýnda istatistiksel anlamlý bir fark saptanmadý.
TARTIÞMA ve SONUÇ: PMN tanýsýnda PLA2R ve C4d’nin immünohistokimyasal olarak saptanmasý güvenli ve kolay bir metoddur. Ýmmünfloresan yöntemiyle IgG ve C3 saptanmasýný saðlayacak yeterli dokunun olmadýðý durumlarda, immünhistokimyasal olarak PLA2R ve C4d pozitifliði PMN tanýsýnda faydalý olabilir.

INTRODUCTION: Antibodies against the phospholipase A2 receptor (PLA2R) on podocyte membranes result in the formation of immune complexes that cause loss of function of the glomerular basement membrane in primary membranous nephropathy (PMN). It has also been demonstrated that there is a deposition of complement 4d (C4d) in the glomeruli in PMN. The present study aims to evaluate PLA2R and C4d immunoexpressions in PMN cases and search the correlation with the clinical parameters.
METHODS: In this study, clinicopathological data and paraffin-embedded specimens were collected from 51 patients. The formalin-fixed paraffin-embedded tissues were stained using routine hematoxylin-eosin, periodic acid-Schiff, and silver methenamine stains and immunostained for anti-PLA2R and C4d. Ten normal kidney tissues and 10 focal segmental glomerulosclerosis (FSGS) cases were selected as controls for PLA2R and C4d immunoexpression.
RESULTS: Of the PMN cases, 51 (100%) cases were positive for PLA2R, including 15 (29%) cases that scored 2+, and 36 (71%) cases that scored 3+. Forty of the 51 cases (78%) were positive for C4d. The percentages of cases staining positively for C4d, per scoring group, were as follows: 31 (61%) cases faintly (1+) positive and 9 (18%) cases moderately (2+) positive. No strong positivity was observed. All of the control cases (100%) were negative for PLA2R and C4d. There was no statistically significant difference between the intensity of the staining of PLA2R and the staining of C4d, proteinuria levels, creatinine levels, and complement 3 (C3) positivity. Similarly, there was no statistically significant difference between the intensity of the staining of C4d and proteinuria levels, creatinine levels, and C3 positivity.

DISCUSSION AND CONCLUSION: Immunohistochemical detection of PLA2R and C4d is a safe and easy method for the diagnosis of PMN. In cases where fresh tissue is not available for the detection of IgG and C3 using the immunofluorescence method, positivity for PLA2R and C4d with immunohistochemistry may be beneficial for the diagnosis of PMN.

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GÝRÝÞ ve AMAÇ: Prokalsitonin (PCT) enfeksiyon hastalýklarýnýn tayininde kullanýlan özgüllüðü oldukça yüksek bir belirteçtir. Plevral sývýsý olan hastalarda son yýllarda bu belirteç ile ilgili çalýþmalar yürütülmüþtür. Bu çalýþmada amacýmýz, plevral sývý PCT düzeyinin parapnömonik plevral efüzyon (PPE) tanýsýndaki rolünü, diðer eksudatif plevral efüzyon nedenlerinden ayrýmýnda kullanýlabilirliðini ve toraks ultrasonografi (USG) görüntüsü ile iliþkisini araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Çalýþmaya toplam 128 eksudatif plevral sývýlý hasta dahil edildi. Hastalar PPE (n=71) ve PPE dýþý (n=57) olmak üzere iki gruba ayrýldý. Hastalarýn demografik bilgileri, ek hastalýklarý, akciðer grafisindeki ve toraks USG’deki radyolojik bulgularý, hemogram ve C-reaktif protein (CRP) bulgularý, plevral sývýda albümin, protein, laktat dehidrogenaz (LDH) ve glukoz seviyeleri, plevral sývý hücre sayýmý kaydedildi. PPE ve PPE dýþý gruplarýn plevral sývý PCT düzeyleri, serum PCT düzeyleri ile toraks USG bulgularý istatistiksel olarak birbirleri ile karþýlaþtýrýldý. Ýstatistiksel analizler için SPSS 17.0 programý kullanýldý. P deðerinin <0.05 olmasý istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Yüz yirmi sekiz hastanýn 71’i (%55) PPE ve 57’si (%45) PPE dýþý nedenlere baðlý taný aldý. Plevra sývýsýnda PCT düzeyi ve serum PCT düzeyi bakýmýndan PPE ve PPE dýþý gruplar arasýnda anlamlý fark yoktu (sývý PCT için p=0.31 ve serum PCT için p=0.21). Toraks USG görüntülerine göre dört gruba ayrýlan hastalarda PPE ve PPE dýþý gruplarda anekoik sývýlar ile kompleks septasýz sývýlarda gruplar arasýnda istatistiksel olarak anlamlý bir fark saptanmadý (sýrasýyla, p=0.079 ve p=0.147). Ancak kompleks septalý sývýlar PPE grubunda daha fazla bulundu ve aralarýndaki bu fark istatistiksel olarak anlamlýydý (p=0.003).
TARTIÞMA ve SONUÇ: Sonuç olarak, çalýþmamýzda PPE’lerde, plevral sývý PCT ve serum PCT ölçümünün tanýsal deðeri olmadýðý saptandý. Her iki grupta plevra sývý PCT düzeyinin, serum PCT düzeyine oraný da tanýsal önem taþýmýyordu. Ayrýca toraks USG görüntüleri ile PCT düzeyleri arasýnda korelasyon saptanmadý.

INTRODUCTION: Procalcitonin (PCT) is a highly specific marker for the detection of infectious diseases. In recent years, studies on this marker have been conducted in patients with pleural fluid. Our aim in this study is to investigate the role of pleural fluid procalcitonin level in distinguishing parapneumonic pleural effusion (PPE) from other causes of exudative pleural effusion and its relationship with thorax ultrasonography (USG).
METHODS: A total of 128 exudative pleural effusion patients were included in this study. The patients were divided into two groups as PPE and non-PPE. Demographic findings, comorbidities, radiographic images in chest radiography and thorax USG, hemogram and CRP results, albumin, protein, lactate dehydrogenase (LDH) and glucose levels in pleural fluid and pleural fluid cell count were recorded. Pleural fluid PCT levels, serum PCT levels and thoracic USG images of PPE and non-PPE groups were compared statistically with each other. P-value <0.05 was considered statistically significant.
RESULTS: Of the 128 patients, 71 (55%) were diagnosed with PPE and 57 (45%) were diagnosed with non-PPE causes. There was no significant difference in the level of pleural fluid PCT and serum PCT levels between the PPE and non-PPE groups (p=0.31 and p=0.21, respectively). No statistically significant difference was found between the anechoic fluids and the complex pleural effusion without septum in the PPE and non-PPE groups (p=0.079 and p=0.147, respectively). However, complex septated fluids were higher in PPE group and this difference was statistically significant (p=0.003).
DISCUSSION AND CONCLUSION: It was found that the pleural fluid PCT and serum PCT measurements in the PPE did not have a diagnostic value. Pleural fluid PCT/serum PCT ratio were not significantly different between the two groups. In addition, there was no correlation between thoracic USG images and PCT levels.

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GÝRÝÞ ve AMAÇ: Kliniðimizde oral kavite kanseri nedeni ile cerrahi yapýlan ve rekonstrüksiyonda bukkal miyomukozal flep kullanýlan hastalarýn dosya kayýtlarý incelenerek flebin fonksiyonel sonuçlarý incelendi.
YÖNTEM ve GEREÇLER: Kliniðimizde 2016 Temmuz–2020 Þubat dönemi içerisinde oral kavite skuamöz hücreli kanseri nedeni ile ameliyat edilen ve bukkal miyomukozal flep rekonstrüksiyonu yapýlan 15 hastanýn dosya kayýtlarý incelendi. Hastalarýn demografik özellikleri, tümörün yerleþim yeri ve evresi, flebin hazýrlanma süresi, flebe baðlý intraoperatif kanama miktarý ameliyat sonrasý yaþanýlan komplikasyonlar, varsa dekanülasyon süreleri, nazogastrik sonda ile yardým olmaksýzýn oral beslenme süreleri kayýtlarda araþtýrýldý.
BULGULAR: Hastalarýmýzýn yaþ ortalamasý 66 idi (daðýlým, 52–78 yýl). On beþ hastanýn 13’ü erkek ikisi kadýn idi. Oral kavite tümörlerinin 11’i dil, ikisi aðýz tabaný ve ikisi de sert damak kaynaklý idi. Ortalama flep uzunluðu 7x3.2 cm idi. Üç hastaya trakeostomi açýldý ve hepsi ameliyat sonrasý üçüncü günde dekanüle edildi. Tüm hastalara ameliyat sonrasý ikinci günde yumuþak diyet baþlandý. Ameliyat sonrasý ortalama beþinci günde hastalar nazogastrik sonda yardýmý olmaksýzýn beslenmeye baþlandý. Flep kaldýrma süresi ortalama 35 dakika (25–49 dakika) idi. Ortalama kanama miktarý 25 ml (20–40 ml) idi. Ýki hastada flepte parsiyel yara yeri açýlmasý ve bir hastada parsiyel kýsmý flep kaybý gözlendi.
TARTIÞMA ve SONUÇ: Bu bulgular ýþýðýnda bukkal miyomukozal flep özellikle oral kavite kanser defektlerinin rekonstrüksiyonunda baþ boyun cerrahlarýnýn akýlda tutmasý gereken seçeneklerden birisidir. Flebin primer cerrahi sahada olmasý, teknik olarak hýzlý ve basit hazýrlanabilmesi avantajlarý pediküllü bir flep olmasý nedeni ile yaklaþýk iki hafta sonra pedikülünün kesilmesinin gerekliliði dezavantajlarý içerisinde sayýlabilir.

INTRODUCTION: We aimed to review our data about the functional outcomes of the buccinator myomucosal flap used for head and neck reconstruction after oncologic ablative surgery.
METHODS: Retrospective chart analysis was performed of 15 patients between the ages 52 and 78 years (mean age 66 years) who had buccinator myomucosal flaps for oral cavity reconstruction after tumor ablation. All the resections and reconstructions were performed by the first author (BK) at two tertiary referral centers. The demographic feature of the patients, anatomical subsites of the cancer, operation type, flap raising time, total operation time, blood loss during flap harvesting, wound problems and other postoperative complications, decannulation time and postoperative oral feeding time were collected from the patients` medical charts.
RESULTS: One patient had minimal distal flap loss. There was no need for additional surgery for this patient. Two patients had partial wound dehiscence, which was resutured in the operating theatre. The donor sites were closed primarily in all cases. One of the patients had wound dehiscence in donor site which healed by secondary intention. Mean flap size was 7x3.2 cm. All flaps needed a second operation for pedicle separation due to the pedicled flap nature. All separations of pedicles were performed using sedation and adequate analgesia in operating theatre without general anesthesia. Mean separation time was 12 days after the first surgery. Three patients had tracheostomy and the mean decannulation time was three days for those. Soft diet was started in the postoperative 2nd day in all patients. However, mean postoperative oral feeding time without any nasogastric tube assistance was five (3–9 days) days. Mean flap harvesting time was 35 minutes (25–49 minutes). Mean intraoperative blood loss during flap harvesting was 25 ml (20–40 ml).
DISCUSSION AND CONCLUSION: Buccinator myomucosal flap should be in the armamentarium of every head and neck surgeon for oral cavity reconstruction.

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GÝRÝÞ ve AMAÇ: Kardiyak implante edilebilir elektronik cihaz enfeksiyonlarýnýn görülme oraný yýllar geçtikçe artmakta ve bu durum ciddi komplikasyonlar ve maliyet artýþý ile iliþkili olabilmektedir. Bu çalýþmada, bizim üçüncü basamak saðlýk merkezi deneyim sonuçlarýný deðerlendirdik.
YÖNTEM ve GEREÇLER: 2012–2018 yýllarý arasýnda, prosedürel ve izlem verileri mevcut olan, tüm kardiyak implante edilebilir elektronik cihaz implantasyonu uygulanan hastalar çalýþmaya alýndý.
BULGULAR: Beþ yüz on iki hasta içerisinden, yaþlarý 29–78 yaþ arasý deðiþen altý hastada cihaz enfeksiyonu saptandý. Ortalama takip süresi 2.8±1.7 yýl idi. Hepsi yeni implant olgulardý ve beþ olgu için tüm sistemin çýkarýlmasý (jeneratör ve tüm transvenöz lead’ler dahil) iþlemi yapýldý. Lokal enfeksiyon belirtileri olmayan izole cep erozyonu olan bir olguda, jeneratör çýkarýlmasý ve debridman iþlemleri yapýldý ve yara antibiyotik solüsyonu ile yýkandý. Tüm hastalara taburculuk sonrasý iki haftalýk oral antibiyotik tedavisi verildi. Üç hastada reimplantasyon sonrasý, 13±6.1 ay takip döneminde enfeksiyon tekrarý oluþmadý. Ýmplante edilmiþ cihaz tipleri hariç, enfekte olan ve enfekte olmayan hastalar arasýnda bazal özellikler açýsýndan farklýlýk saptanmadý. Cihaz enfeksiyonu olan hastalarda hematom ve pnömotoraks görülmedi.
TARTIÞMA ve SONUÇ: Cihaz enfeksiyonlarý için bilinen geleneksel risk faktörleri enfekte hastalarýmýzla iliþkili olarak saptanmadý. Cihaz enfeksiyon oranýmýz (%1.17) düþüktü ve hem cihaz enfeksiyonu hem de tedavisi nedeniyle ciddi bir komplikasyon görülmedi.

INTRODUCTION: The rate of cardiac implantable electronic device (CIED) infections has become prevalent in recent years, and they are related to severe complications, as well as a cost burden. In the present study, we assessed the results of our single tertiary care center experience.
METHODS: All patients who underwent CIEDs implantation between 2012 and 2018 with procedural and follow-up data available were included in this study.
RESULTS: Device infection was defined in six of 512 patients aged from 29 to 78 years old. The mean follow-up period was 2.8±1.7 years. They were new implants and system, removal which included a generator, and all transvenous leads were carried out for five cases. Removal of the generator and debridement of the pocket was performed in one case with isolated pocket erosion without local signs of infection and the wound was irrigated with antibiotic solution. A 2-week oral antibiotic therapy was administered to all patients following discharge. After reimplantation, there was no infection recurrence in three patients during 13±6.1 months follow-up period. Baseline characteristics, with the exception of implanted device types, were similar between infected and non-infected patients. Hematoma or pneumothorax was not observed in patients with device infection.
DISCUSSION AND CONCLUSION: Prevalent risk factors for device infections were not relevant to our patients. Our device infection rates (1.17%) were slightly lower, and there was no serious complication due to the device infection itself or its management.

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GÝRÝÞ ve AMAÇ: Yenidoðan sepsisi taný ve tedavisindeki geliþmelere raðmen, bebeklerde önemli bir morbidite ve mortalite nedeni olmaya devam etmektedir. Bu çalýþmada, yenidoðan ünitesinde kan kültüründe etken izole edilip sepsis tanýsý konulan hastalarýn demografik verilerini, sepsis nedeni olan mikroorganizmalar ve taný aldýklarý andaki akut faz reaktanlarýný deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Hastanemiz yenidoðan yoðun bakým ünitesinde üç yýllýk süre boyunca, klinik ve laboratuvar bulgularýyla birlikte, kan kültürü pozitif sepsis tanýsý almýþ olan 131 olgu geriye dönük olarak deðerlendirildi.
BULGULAR: Sepsisli olgularýn taný aldýðý zaman alýnan kan kültüründe üretilen mikroorganizmalara bakýldýðýnda 36 hastada ile en yüksek oranda (%27.5) Staf. aureus izole edildiði görüldü. Bu olgularýn 19’u metisilin dirençli S. aureus idi. Yirmi altý hastada (%19.8) Klebsiella spp. saptandý. 13 olguda Klebsiella pneumonia, iki olguda Klebsiella oxytoca izole edilirken, 11 olguda ESBL pozitifliði tespit edildi. Sepsisli olgularýmýzda kültür alýmýnýn birinci gününde trombosit deðerlerinin beþinci gün trombosit deðerlerine göre anlamlý düþük; kültür alýnan birinci gün CRP ve ortalama trombosit volümü (MPV) deðerlerinin beþinci gün CRP ve MPV deðerlerine göre anlamlý yüksek olduðu saptandý (p<0.05). Çalýþmamýzda kan kültüründe gram pozitif etken izole edilen grubun kan kültürü alýndýðý birinci gün CRP ve maksimum CRP deðerlerinin ortalamasý kan kültüründe gram negatif mikroorganizma izole edilen gruptan istatistiksel olarak anlamlý derecede düþük bulundu (p<0.05).
TARTIÞMA ve SONUÇ: Bu çalýþma ile ünitemizde yenidoðanlarda sepsise en sýk neden olan mikroorganizmalarý; etkene yönelik olarak (gram pozitif veya gram negatif) ve hastane kökenli olup olmamasýna göre sepsis tablolarýnda, sepsis belirteçlerinde farklýlýk olduðunu belirledik.

INTRODUCTION: Neonatal sepsis continues to be an important cause of morbidity and mortality in infants despite improvements in diagnosis and treatment. This study was planned to evaluate the demographic data, causative microorganisms and acute phase reactants at the time of diagnosis of blood culture positive sepsis in our neonatal intensive care unit.
METHODS: We evaluated our patients diagnosed with blood culture positive sepsis in the neonatal intensive care unit during three years retrospectively. In this study, 131 patients whose clinical and laboratory findings were consistent with sepsis were included.
RESULTS: The most common microorganism isolated from blood cultures that were taken at the time of diagnosis was S. aureus (n=36, 27.5%). Nineteen of them were methicillin-resistant S. aureus. Klebsiella species were isolated in 26 cases (19.8%) (K. pneumoniae, K. oxytoca and ESBL positive Klebsiella species in 13, 2 and 11 cases, respectively). Thrombocyte counts of our patients were statistically significantly lower on the first day of culture sampling compared to the fifth-day values (p<0.05), in contrast, CRP and mean platelet volume (MPV) values were significantly higher (p<0.05). According to our findings, on the first day of culture sampling, the CRP and mean of maximum CRP values of our patients with gram-positive sepsis were significantly lower than the values of our patients with gram-negative sepsis (p<0.05).
DISCUSSION AND CONCLUSION: In this study, the most common microorganisms which cause sepsis in our neonatal intensive care unit were determined. We detected that the clinical findings and markers of sepsis differ depending on the type of the organism, whether gram-positive or gram-negative and the type of infection, whether it is nosocomial or not.

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GÝRÝÞ ve AMAÇ: Akciðer rezeksiyonu uygulanan hastalarda preoperatif pulmoner ve kardiyak fonksiyon testleri ve hastaya ve cerrahiye ait özellikler operasyon sonrasý sonuçlarý etkileyebilmektedir. Biz bu çalýþmada bu parametrelerin ameliyat sonrasý kýsa döneme etkilerini deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Bu çalýþmada, Ocak 2018–Eylül 2018 tarihleri arasýnda akciðer kanseri ve karsinoid tümör sebebiyle kliniðimizde rezeksiyon uygulanan 117 hasta geriye dönük olarak deðerlendirildi. Vücut kitle indeksi, 1. saniyedeki zorlu ekspiratuvar volüm, karbonmonoksit difüzyon testi, ejeksiyon fraksiyonu, ortalama pulmoner arter basýncý ve neoadjuvan tedavi bilgileri deðerlendirilip gruplara ayrýldý. Lojistik regresyon ve Kruskal-Wallis analiz hastanede kalýþ ve ameliyat sonrasý komplikasyonlar üzerine etkileri saptamada kullanýldý. Majör göðüs duvarý rezeksiyonu yapýlan hastalar çalýþmadan dýþlandý.
BULGULAR: Çalýþmaya ortalama yaþý 63.8±9.8 olan 72 erkek ve 45 kadýn alýndý. Hastalara sýklýkla lobektomi ameliyatý uygulandý (n=87; %61.5). Ýncelenen parametreler hastanede yatýþ süresi ve genel komplikasyon oranlarýný etkilemedi. Ancak neoadjuvan tedavi, düþük FEV1 deðeri, ameliyat sonrasý pnömoni sýklýðý ile iliþkili bulundu.
TARTIÞMA ve SONUÇ: Güvenli sýnýrlar içinde ameliyat öncesi akciðer ve kalp deðerlendirme testleri hastanede yatýþ süresini öngörememiþtir. Pnömoni geliþimi neoadjuvan tedavi ve düþük FEV1 deðeri ile iliþkili çýkmýþtýr. Hastanede yatýþ süresini ise etkilen tek parametre açýk cerrahi olmuþtur.

INTRODUCTION: Preoperative pulmonary and cardiac function tests and some characteristics of the patients and surgery may predict operative outcomes after resection for lung cancer. In this study, we aimed to analyze the effects of these parameters on short-term outcomes.
METHODS: This is a retrospective study, including 117 patients who underwent surgical anatomical resection due to lung cancer and carcinoid tumor at a single center between January 2018 and September 2018. In this study, body mass index, forced expiratory volume in 1 sec (FEV1), transfer coefficient of the lung for carbon monoxide (KCO), ejection fraction, mean pulmonary artery pressure, and neoadjuvant treatment were evaluated and categorized into groups. Logistic regression and Kruskal–Wallis analysis were used to determine the predicted effects of the parameters on the duration of hospitalization and general complication rates. The patients who underwent major chest-wall reconstructions were excluded from this study.
RESULTS: The series comprised of 72 males and 45 females, with a mean age of 63.8±9.8 years. Most patients underwent a lobectomy (n=87; 61.5%). The evaluated parameters were not related to the duration of hospitalization and general complication rates. However, neoadjuvant treatment and preoperative low FEV1 were significantly related to occurring postoperative pneumonia.
DISCUSSION AND CONCLUSION: Over the limits of safety, which have been well known, preoperative pulmonary and cardiac functions did not predict the duration of hospitalization in patients who underwent resections for lung cancer. Postoperative pneumonia was related to the neoadjuvant treatment and relatively lower preoperative FEV1. The longer duration of hospital stay was the only parameter related to open surgery.

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GÝRÝÞ ve AMAÇ: Ýnmeli hastalarda üst ekstremite motor fonksiyonlarýnýn deðerlendirilmesinde kullanýlan Kol Hareket Araþtýrma Testi (ARAT) skorlarýnýn fonksiyonel baðýmsýzlýðý ön görebilme kapasitesini araþtýrmak.
YÖNTEM ve GEREÇLER: Bu çalýþmaya yaþ ortalamasý 61.10±9.12 olan toplam 59 inmeli hasta alýndý. Hastalarýn 41’i (%69.5) erkek 18’i (%30.5) kadýndý. Ýnme sonrasý inme polikliniðinde takip edilen hastalarýn demografik bilgileri alýndýktan sonra üst ekstremite fonksiyonlarý ARAT testi ve fonksiyonel baðýmsýzlýklarý Kendine Bakým Becerilerin Performans Deðerlendirmesi (PASS) ve Fonksiyonel Baðýmsýzlýk Ölçeði (FIM) testleri ile deðerlendirildi.
BULGULAR: Hastalarýn ortalama inme geçirme süreleri 15.38±7.16 ay olarak bulundu. Spearman korrelasyon testi sonuçlarýna göre ARAT ve PASS arasýnda (p=0.902), PASS-BADL (temel günlük yaþam aktiviteleri) (p=0.480), PASS-IADL (enstrümental günlük yaþam aktiviteleri) (p=0.524) ARAT ve FIM (p=0.451), FIM Motor (p=0.393) ve FIM Cognitive (p=0.553). arasýnda korelasyon görülmedi). FIM ve PASS skorlarý arasýnda zayýf bir korelasyon vardý (r=0.275, p=0.033).
TARTIÞMA ve SONUÇ: Üst ekstremite motor fonksiyonlarýnýn deðerlendirilmesinde rutin olarak kullanýlan ARAT skorlarý fonksiyonel baðýmsýzlýk ile korele olmadýðý saptandý. Üst ekstremite motor fonskiyonlarýnýn deðerlendirilmesinde ARAT testine ek olarak fonksiyonel baðýmsýzlýk ölçeklerinin kullanýlmasý uygun olabilir.

INTRODUCTION: To investigate the ability of the Action Research Arm Test (ARAT) scores to predict functional independence in the evaluation of upper extremity motor functions in stroke patients.
METHODS: A total of 59 patients with stroke with a mean age of 61.10±9.12 were included in this study. Forty-one (69.5%) of the patients were male, and 18 (30.5%) were female. After obtaining the demographic data of the patients who were followed up in the stroke outpatient clinic after the stroke, upper extremity functions were evaluated using ARAT test, and functional independence was evaluated with Performance Assessment of Self Care Skills (PASS) and Functional Independence Scale (FIM) tests. The data were retrospectively evaluated and recorded.
RESULTS: The mean stroke duration was 15.38±7.16 months. According to Spearman correlation test results, there was no correlation between ARAT and PASS (p=0.902), PASS-BADL (Basic activities of daily living) (p=0.480), PASS-IADL (Instrumental activities of daily living) (p=0.524) and between ARAT and FIM (p=0.451), FIM Motor (p=0.393), and FIM Cognitive (p=0.553). There was a weak correlation between the FIM and the PASS scores (r=0.278, p=0.033).
DISCUSSION AND CONCLUSION: ARAT scores routinely used in the evaluation of upper extremity motor functions were not correlated with functional independence. In addition to the ARAT test, functional independence scales may be appropriate for the evaluation of upper extremity motor functions.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada, idiyopatik Parkinson hastalýðýna (ÝPH) baðlý siyaloresi olan bir grup hasatada botulinum toksin A (BONT-A) enjeksiyon tedavisinin etkinliði ve güvenilirliðinin deðerlendirilmesi ayný zamanda daha baþka yararlarýnýn olup olmadýðýnýn belirlenmesi amaçlandý.
YÖNTEM ve GEREÇLER: Nöroloji polikliniðimizde BoNT-A ile tedavi edilen siyalore ve IPH’lý 21 hastanýn geriye dönük analizi Haziran 2017–Aralýk 2018 tarihleri ​​arasýnda yapýldý. BoNT-A, ultrason rehberliði olmadan parotis bezlerine enjekte edildi. Tedavi öncesi siyalore þiddeti, Düþme Sýklýðý ve Ciddiyet Ölçeði (DFSS) ve Unified Parkinson Hastalýk Deðerlendirme Ölçeði (UPDRS) bölüm 2 madde 6’ya göre ölçüldü. Tüm hastalarýn demografik özellikleri kaydedildi. Hastalar enjeksiyondan önce, enjeksiyondan bir hafta sonra, enjeksiyondan bir ay sonra ve enjeksiyondan üç ay sonra çaðrýldý ve hastalar üzerindeki týbbi etkiler ile iliþkili olumsuz etkiler deðerlendirildi.
BULGULAR: Bu çalýþmada ÝPH olan hastalarda siyalore tedavisinde parotis bezlerine BONT-A uygulamasý sonucunda iþlem öncesi UPDRS ve DSFS skorlarý ile iþlem sonrasý birinci hafta birinci ay ve üçüncü ay deðerlendirildiðinde anlamlý derecede azalma saptandý. Bununla birlikte DSFS ve UPDRS skorlarý enjeksiyon sonrasý birinci haftada enjeksiyon sonrasý üçüncü aya göre anlamlý olarak düþüktü. Enjeksiyon sonrasý birinci hafta ve birinci ay etkisi arasýnda anlamlý fark saptanmadý. Hastalarda ciddi bir yan etki gözlenmedi.
TARTIÞMA ve SONUÇ: Sonuç olarak, bu çalýþmada ÝPH olan hastalarda. siyalore tedavisinde tükrük bezlerine BoNT-A enjeksiyonunun kolay, güvenli, tolere edilebilir ve etkili olduðu gösterilmiþtir. Bununla birlikte, daha uzun süreli takip edilmiþ ve daha büyük sayýda hasta içeren ileriye yönelik klinik çalýþmalar sonuçlarýmýzý onaylamak ve uzatmak için gereklidir.

INTRODUCTION: The present study aims to evaluate the efficacy and safety of botulinum toxin A (BONT-A) injection therapy on a group of patients with Idiopathic Parkinson’s disease (IPD)-associated sialorrhea.
METHODS: A retrospective analysis of 21 patients with sialorrhea and IPD treated with BoNT-A at our neurology outpatient clinic was conducted between June 2017- December 2018. BoNT-A was injected into the parotid glands without ultrasound guidance. Pre-treatment sialorrhea severity was quantified according to the Drooling Frequency and Severity Scale (DFSS) and Unified Parkinson’s Disease Rating Scale (UPDRS) part 2 item 6 Demographic characteristics of all the patients were recorded. Patients were summoned before the injection, one week after the injection, one month after the injection and three months after the injection and adverse effects on patients associated with the medical treatment were evaluated.
RESULTS: A significant decrease in the UPDRS and DSFS scores was observed when the 1st week, 1st month and 3rd months after the procedure are evaluated. However, the DSFS and UPDRS scores were significantly lower in the 1st month after the injection with regards to the 3rd month after the injection. No serious side effects were observed in the patients.
DISCUSSION AND CONCLUSION: In this study, it is demonstrated that BoNT-A injection is simple, safe, tolerable and effective in sialorrhea treatment of patients with IPD. However, further clinical studies involving longer-term follow-up and a larger number of patients are required to confirm and extend our results.

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GÝRÝÞ ve AMAÇ: Alt karýn cerrahisi sýrasýnda bisektral indeks (BIS) rehberliðinde hedef kontollü infüzyon (HKÝ) kullanýlarak iki anestezik rejimin, propofol-remifentanil veya desfluran-remifentanilin klinik özelliklerini incelemektir.
YÖNTEM ve GEREÇLER: Alt karýn cerrahisi geçirecek 60 hasta randomize olarak iki gruba ayrýldý: Propofol-remifentanil grup (Grup P) ve desfluran-remifentanil grup (Grup D). Tüm hastalara anestezi indüksiyonu 2 mg kg-1 propofol, 1 µg kg-1 remifentanil ve 0.6 mg kg-1 rokuronyum iv ile saðlandý. Her iki grupta da entübasyon sonrasý remifentanil infüzyonu Minto farmokinetik modeline göre HKI cihazýyla uygulandý. Grup D’deki hastalara %50–50 oksijen hava karýþýmý ve %6 desflurane uygulandý. Grup P’de propofol %1(10 mg/mL) için farmakokinetik model Schnider modeli seçildi ve HKÝ ile 4 µ/mL-1 olacak þekilde uygulandý. BIS deðeri 40–60 arasýnda tutulacak þekilde dozlar artýrýldý ya da azaltýldý. Tüm hastalarýn hemodinamik parametreleri, spontan solunumun geri dönme süresi, göz açma süresi, trakeal ekstübasyon süresi, verbal komutlara uyma süresi, anestezi ve cerrahi süresi, ameliyat sonrasý Modifiye Aldrete skoru kaydedildi.
BULGULAR: Operasyon süresince yapýlan incelemede kalp atým hýzý (p=0.006), diyastolik arter basýncýnýn (p=0.003) ve ortalama arter basýncýnýn (p<0.0001) Grup P’de anlamlý düzeyde Grup D’den daha yüksek seyrettiði görüldü. Ekstübasyon süresi Grup P’de (p=0.02) daha kýsa iken, diðer derlenme bulgularý açýsýndan iki grup arasýnda fark yoktu.
TARTIÞMA ve SONUÇ: Hedef kontollü infüzyon ile hem propofol-remifentanilin hem de desfluran-remifentanilin bispektral indeks kýlavuzlu kombinasyonlarý alt karýn cerrahisi geçiren hastalar için uygundur. Desfluran ve HKÝ ile remifentanil deki düþük kan basýncý önemli bir avantaj olabilir.

INTRODUCTION: Our objective was to examine the clinical properties of two anesthetic regimens, propofol-remifentanil target-controlled infusion (TCI) or desflurane-remifentanil TCI under bispectral index (BIS) guidance during lower abdominal surgery procedures.
METHODS: Sixty consenting patients who scheduled for lower abdominal surgery were prospectively studied and were included in one of the two groups: propofol-remifentanil group (Group P) or desflurane-remifentanil group (Group D). General anaesthesia was induced with 2 mg kg-1 propofol, 1 µ kg-1 remifentanil and 0.6 mg kg-1 rocuronium injection. After intubation, remifentanil was administered using the TCI device in both groups. The pharmacokinetic model of Minto was used. Group D patients received a 50%–50% oxygen-air mixture and 6% desflurane. The Schnider model was selected for the administration of propofol 1% (10 mg/mL) in Group P, and the TCI dose was adjusted to 4/mL-1. The propofol infusion and inspired fraction of desflurane were adjusted to keep BIS value between 40–60. Hemodynamic parameters, time until recovery of spontaneous respiration, eye-opening and tracheal extubation, compliance with verbal commands, duration of anesthesia and surgery and postoperative modified Aldrete scores were recorded for all patients.
RESULTS: The heart rate (p=0.006), diastolic arterial pressure (p=0.003) and mean arterial pressure (p<0.0001) for the Group P was significantly higher than Group D. The extubation time was shorter in Group P (p=0.02), but there was no significant difference between the groups concerning other recovery findings.
DISCUSSION AND CONCLUSION: BIS-guided combinations of propofol-remifentanil and desflurane-remifentanil delivered using TCI are both suitable for patients undergoing lower abdominal surgery. The low blood pressure achieved with target-controlled infusions of remifentanil and desflurane may confer important advantages.

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GÝRÝÞ ve AMAÇ: Bu çalýþmadaki amacýmýz hipotiroidi tanýsý almýþ hastalarda ve saðlýklý kontrol grubunda Epworth uykululuk ölçeðini kullanarak gündüz aþýrý uykululuðunu araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Yetmiþ beþi hipotiroidi, 52’si kontrol grubu olmak üzere 127 kiþi ile çalýþma tamamlandý. Tüm katýlýmcýlarýn yaþ, boy, kilo, vücut kitle indeksi, bel çevresi, sistolik ve diyastolik kan basýncý kaydedildi. Tiroit hormon testleri ve biyokimyasal parametrelere sabah aç olarak bakýldý. Gündüz aþýrý uykululuðu ölçmek için Epworth Uykululuk Ölçeði kullanýldý.
BULGULAR: Epworth Uykululuk Ölçeði puanlarý hipotiroidili grupta 7.3±0.7 kontrol grubunda ise 6.4±0.4 olarak bulundu, gruplar arasýnda anlamlý farklýlýk yoktu (p=0.703). Hipotiroidi olan grupta kontrol grubuna göre kilo (p<0.001), vücut kitle indeksi (p<0.001), bel çevresi (p=0.001), trigliserit düzeyleri (p=0.001) daha yüksek, yüksek yoðunluklu lipoprotein düzeyi daha düþük bulundu (p=0.001). Hipotiroidi olup gündüz aþýrý uykululuðu da olanlarda, gündüz aþýrý uykululuðu olmayanlara göre total kolesterol, düþük yoðunluklu lipoprotein düzeyi daha yüksek, yüksek yoðunluklu lipoprotein düzeyi daha düþük bulundu. Tiroit fonksiyonlarý normal olup gündüz aþýrý uykululuðu olan grupta da yüksek yoðunluklu lipoprotein düzeyi daha düþük bulundu. Epworth Uykululuk Ölçeði puanlarý ile yaþ, kilo, boy, vücut kitle indeksi, bel çevresi, boyun çevresi, tiroit stimülan hormon, sistolik ve diyastolik kan basýncý ve kan lipit seviyeleri arasýnda iliþki tespit edilmedi (p>0.05).
TARTIÞMA ve SONUÇ: Hipotiroidi ve kontrol grubu gündüz aþýrý uykululuðu yönünden benzer bulundu. Ancak gündüz aþýrý uykuluðu olan grupta, olmayan gruba göre metabolik parametrelerde bozulma tespit edildi. Hipotiroidi hastalarýnda gündüz aþýrý uykululuðunun daha geniþ katýlýmlý benzer çalýþmalarla deðerlendirilmesi gerektiði sonucuna varýldý.

INTRODUCTION: The present study aims to investigate the excessive daytime sleepiness in patients with hypothyroidism and in the healthy control group using the Epworth sleepiness scale.
METHODS: This study was completed with 127 people, 75 of whom were hypothyroidism and 52 were control group. Age, height, weight, body mass index, waist circumference, systolic and diastolic blood pressure of the all participants were recorded. Thyroid hormone tests and biochemical parameters were examined in the morning. Epworth Sleepiness Scale was used to measure daytime sleepiness.
RESULTS: Epworth Sleepiness Scale scores were 7.3±0.7 in the hypothyroid group and 6.4±0.4 in the control group, and there was no significant difference between the groups (p=0.703). Weight (p<0.001), body mass index (p<0.001), waist circumference (p=0.001) and triglyceride levels (p=0.001) were higher and high density lipoprotein levels were lower (p=0.001) in the hypothyroid group than the control group. Total cholesterol, low density lipoprotein level and high density lipoprotein level were lower in patients with hypothyroidism and excessive daytime sleepiness than those without hypothyroidism. High density lipoprotein levels were also lower in the group with normal thyroid function and excessive daytime sleepiness. There was no correlation between Epworth Sleepiness Scale scores and age, weight, height, body mass index, waist circumference, neck circumference, thyroid-stimulating hormone, systolic and diastolic blood pressure and blood lipid levels (p>0.05).
DISCUSSION AND CONCLUSION: Hypothyroidism and control group were similar concerning excessive daytime sleepiness. However, metabolic parameters deteriorated in daytime sleepy group compared to non-daytime sleepy group. It was concluded that similar studies with broader participation should be conducted.

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GÝRÝÞ ve AMAÇ: Laparoskopik adrenalektomi adrenal tümörlerin rezeksiyonunda altýn standarttýr. Genel cerrahi pratiðinde nadir karþýlaþýlmasý ve öðrenme eðrisinin yüksek olmasýndan dolayý bazý teknik zorluklarý vardýr. Bu çalýþmanýn amacý tek merkezde yapýlan laparoskopik transperitonealinin adrenalektominin perioperatif ve postoperatif sonuçlarýnýn deðerlendirmektir.
YÖNTEM ve GEREÇLER: Aralýk 2008 ile haziran 2018 tarihleri arasýnda 65 hastaya laparoskopik transperitoneal adrenalektomi yapýldý. Hastalarýn verileri, perioperatif ve postoperatif sonuçlar hastanenin medikal kayýtlarýndan geriye dönük olarak analiz edildi.
BULGULAR: Altmýþ beþ hastaya laparoskopik transperitoneal adrenalektomi yapýldý. Bu çalýþmada 44 kadýn hasta ve 21 erkek hasta vardý. Tümör tipine göre; 47 fonksiyonel adrenal tümör, 13 insidental tümör ve üç hastada akciðer kanserine baðlý izole adrenal metastaz mevcuttu. Otuz bir hastanýn sað adrenal bezinde ve 34 hastanýn ise sol adrenal bezinde tümör vardý. Beþ hastada açýk cerrahiye dönüldü.
TARTIÞMA ve SONUÇ: Laparoskopik transperitoneal adrenalektomi adrenal tümörlerde güvenli ve uygulanabilir bir tekniktir. Postoperatif komplikasyonlarý azaltmak için hastalar erken mobilize edilmeli ve solunum egzersizi yaptýrýlmalýdýr. Buna ek olarak, açýða dönüþ oranýný azaltmak için cerrah laparoskopi konusunda tecrübeli olmalýdýr.

INTRODUCTION: Laparoscopic adrenalectomy is the gold standard for the resection of adrenal tumors. There are some technical difficulties due to the rarity in general surgical practice and the long learning curve. The present study aims to evaluate perioperative and postoperative results of laparoscopic transperitoneal adrenalectomy in a single center.
METHODS: Between December 2008 and June 2018, 65 patients underwent laparoscopic transperitoneal adrenalectomy. Patients’ demographic data, peroperative and postoperative results were retrospectively analyzed from hospital medical records.
RESULTS: Sixty-five patients underwent laparoscopic transperitoneal adrenalectomy. In this study, there were 44 female and 21 male patients. According to the tumor types, there were forty-seven functional adrenal tumors, thirteen incidental adrenal tumors and three isolated adrenal metastasis from lung cancer. Thirty-one patients had right-sided and thirty-four patients had left-sided adrenal tumors. Conversion to open surgery was seen in five patients.
DISCUSSION AND CONCLUSION: Laparoscopic transperitoneal adrenalectomy is a feasible and safe operative technique in adrenal tumors. Patients should be mobilized early and enforced to respiratory exercise to decrease postoperative complications. In addition to them, the surgeon should be experienced in laparoscopy to decrease the rate of conversion.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý kliniðimizde primer hiperparatiroidizm nedeni ile paratiroidektomi uygulanan hastalar da yüksek paratiroid hormon (PTH) seviyelerini geriye dönük olarak literatür eþliðinde irdelemek.
YÖNTEM ve GEREÇLER: Eylül 2015, Aralýk 2017 arasýnda kliniðimizde primer hiperparatiroidizm nedeni ile ameliyat edilen ve takip edilen 121 hasta yaþ cinsiyet, ameliyat öncesi kalsiyum (Ca) ve PTH seviyeleri, ameliyat sonrasý Ca ve PTH seviyeleri, taný, patoloji sonuçlarý, yapýlan ameliyat, takip süresi, nüks açýsýndan geriye dönük olarak deðerlendirildi. Kendilerine ulaþýlamayan hastalar çalýþmaya alýnmadý.
BULGULAR: Primer hiperparatiroidizm nedeni ile ameliyat edilen hastalarýn en küçüðü 26 yaþýnda, en büyüðü 82 yaþýnda olup yaþ ortalamasý 54.83±12.56 idi. Bunlarýn 103’ü (%85.1) kadýn hasta idi. Klinik tanýlarýna göre hastalarýn 119’u (%98.4) adenom, ikisi (%1.6) hiperplazi idi. Patolojik sonuçlarýna göre ise 103 hasta (%85.1) adenom, dört hasta (%3.3) karsinom, dört hasta (%3,3) hiperplazi, 10 hasta (%8.2) adenom ve troid papiller karsinoma tanýsý aldý. Ameliyat öncesi ortalama PTH seviyeleri 301.9±470 pg/ml (en düþük 79 pg/ml, en yüksek 3674 pg/ml), ortalama Ca seviyesi ise 11.42±0.7 mg/dl (en düþük 10.10 mg/dl, en yüksek 13.07 mg/dl) idi. Ameliyat sonrasý ortalama PTH seviyesi 77.2±11.1 pg/ml (en düþük 6.0 pg/ml, en yüksek 907 pg/ml), ortalama Ca seviyesi ise 9.38±0.7 mg/dl (en düþük 6.3 mg/dl, en yüksek 11.4 mg/dl) idi. Takip süresi minimum sekiz ay, maksimum 28 ay olup ortalama 18.75±5.4 ay idi. Ameliyat sonrasý PTH yüksekliði 17 (%14.8) hastada devam etti. Dokuz (%7.4) hastada böbrek yetersizliði (bu hastalarda ameliyat sonrasý PTH seviyesi normal olup üç-dört ay sonra yükselme tespit edildi), üç (%2.4) hastada vitamin D eksikliði ve beþ (%4.1) hastada da nüks tespit edildi.
TARTIÞMA ve SONUÇ: Pirimer hiperparatiroidizm nadir görülen bir hastalýktýr. Ameliyat sonrasý PTH seviyesi yüksek olan hastalarda nüks yanýnda normokalsemik PTH elevasyonu (NPE) ve buna sebep olan renal fonksiyon bozukluðu, kemik açlýðý ve vitamin D eksikliði de göz önünde bulundurulmalýdýr.

INTRODUCTION: In this study, we tried to evaluate retrospectively high levels of parathyroid hormone in patients who received parathyroidectomy due to primary hyperparathyroidism in the light of the literature search.
METHODS: In this study, 121 patients who underwent surgery for primary hyperparathyroidism between September 2015 and December 2017 were retrospectively evaluated, according to gender, preoperative calcium and PTH levels, postoperative calcium and PTH levels, diagnosis, histopathological results, type of surgery, follow-up time and recurrence. We excluded patients who were unreachable.
RESULTS: Mean age was 54.83±12.56 (26–82). One hundred three patients were female (85.1%). One hundred nineteen patients were diagnosed (98.4%) as adenoma, whereas two patients were diagnosed as (1.6%) hyperplasia. According to histopathological results, 103 (85.1%) adenoma, four (3.3%) carcinoma, four (3.3%) hyperplasia and 10 (8.2%) adenoma and papillary carcinoma of the thyroid were found. Preoperative mean PTH value was 301.9±470 pg/ml (79-3674 pg/ml). Preoperative mean calcium level was 10.10 mg/dl (10.10 - 13.07 mg/dl). Postoperative mean PTH value was 77.2±11.1 pg/ml (6.0- 907 pg/ml). Postperative mean calcium level was 9.38±0.7 mg/dl (6.3- 11.4 mg/dl). Mean value was 9.38±0.7 mg/dl. Mean follow-up time was 18.75±5.4 (8–28) months. Post-operative PTH elevation persisted in 17 (14.8%) patients. Nine (7.4%) of them had chronic kidney failure, three (2.4%) patients suffered from vitamin D deficiency, and five (4.1%) cases had a recurrence.
DISCUSSION AND CONCLUSION: Primary hyperparathyroidism is a rare disease. In the absence of postoperative PTH decrease and normocalcemic PTH elevation should be considered as well as recurrence. Renal diseases, bone hunger and Vitamin D deficiency should be evaluated.

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GÝRÝÞ ve AMAÇ: Dünya genelinde olduðu gibi ülkemizde de yaþlý nüfusun artýþýna paralel olarak acil servis baþvuru oraný da artýþ göstermektedir. Çalýþmamýzda acil dahiliye ünitemizde takip ettiðimiz 65 yaþ ve üzeri hastalarýn baþvuru nedenlerinin tespiti, mevcut hastalýklarýnýn kontrolü, yeni geliþen akut problemlerin tedavisi ve takiplerinin deðerlendirilmesi amaçlandý.
YÖNTEM ve GEREÇLER: Saðlýk Bilimleri Üniversitesi Kartal Dr. Lütfi Kýrdar Eðitim ve Araþtýrma Hastanesi Acil Dahiliye Ünitesi’ne Ekim 2017–Aralýk 2017 tarihleri arasýnda baþvuran tüm 65 yaþ ve üzeri hastalar geriye dönük olarak deðerlendirmeye alýndý. Hastalarýn dosyalarýndan cinsiyetleri, mevcut hastalýklarý, baþvuru nedenleri, tanýlarý (ICD 10 kodlarý alýnmýþtýr) kaydedildi. Baþvurular geriye dönük olarak hastane bilgi iþlem sistemi üzerinden incelendi, tüm veriler bilgisayar ortamýnda SPSS ver. 20.00 programýnda deðerlendirildi.
BULGULAR: Çalýþmaya alýnan 65 yaþ ve üzeri 310 geriatrik hastanýn yaþ ortalamasý 76.6; en küçüðü 65, en büyüðü 103 yaþýnda idi. Hastalarýn 149’u (%47.9) erkek; 161’i (%51.8) kadýn ve yaþ aralýðý; 65–74 yaþ 129 (%41.5) kiþi, 75–84 yaþ 133 (%42.8) kiþi, 85 yaþ üzeri 48 (%15.4) kiþi olarak izlendi. En sýk tespit edilen hastalýklar kardiyovasküler sistem, gastrointestinal sistem ve üriner sistem hastalýklarý idi.
TARTIÞMA ve SONUÇ: Günümüzde acil servislere yaþlý nüfus baþvuru oraný artmaktadýr. En sýk görülen hastalýklar kardiyovasküler sistem, gastrointestinal sistem ve üriner sistem hastalýklarý olarak bulunmuþtur. Hastanelerde hastalarýn ilk deðerlendirilmesinde; baþvuru þikayetleri, kronik hastalýklarý, kullandýklarý týbbi tedavi ile öykü ve fizik muayene bulgularýnýn da eklenerek hastalýklarýnýn yönetiminin planlanmasý yaþam kalitesi ve saðkalýmlarý açýsýndan faydalý olacaktýr.

INTRODUCTION: In parallel with the increase in the elderly population in our country as in the world, the rate of the patients applied to the emergency services has shown an increase. The present study aims to investigate the application reasons of the patients aged 65 and over who were followed up in our emergency internal medicine unit, to examine their current diseases, to treat their newly-emerging acute problems, and to evaluate their follow-up processes.
METHODS: All patients aged 65 and over, who applied to the Emergency Internal Medicine Unit a tour hospital between October 2017 and December 2017, were retrospectively evaluated in this study. Gender, current disease, application reason and diagnosis (including ICD 10 codes) of the patients were recorded through their files. Applications were examined retrospectively through the hospital information system, and all data were entered into the program called SPSS 20.00 in the computer environment.
RESULTS: The mean age of 310 geriatric patients aged 65 and over who were examined in this study was 76.6.The youngest age was 65 and the oldest age was 103. Furthermore, it was found that 149 (47.9%) of the patients were men, 161 (51.8%) of them were women, 129 (41.5%) of them were between the ages of 65 and 74, 133 (42.8%) of them were between the ages of 75 and 84, 48 (15.4%) of them were in the age of >85. The most common diseases were cardiovascular system diseases, gastrointestinal system diseases and urinary system diseases.
DISCUSSION AND CONCLUSION: In our day, the rate of the elderly population applied to emergency services has increased. It has been found that the most common diseases are cardiovascular system diseases, gastrointestinal system diseases and urinary system diseases. In the first examination of the patients at hospitals, determination of the methods on diseases in accordance with their physical examination findings, anamnesis and medical treatment will be beneficial in terms of their life quality and survival.

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GÝRÝÞ ve AMAÇ: Bu çalýþma, Türkiye’nin klinik çalýþmalarýn yürütülmesi konusunda uyguladýðý uluslararasý yönetmeliðin etkilerini 24 yýllýk bir dönem içinde göstermektedir.
YÖNTEM ve GEREÇLER: ClinicalTrial.gov sitesi ve içerisinde sunulan filtreler kullanýlarak klinik çalýþma sayýlarý kategorize edilmiþtir. Bu araþtýrmalar altý yýllýk dört farklý zaman aralýðý kullanýlarak yapýldý. Çalýþmalarýn çeþitleri, faz daðýlýmlarý, yaþ aralýklarý, sponsor çeþitleri ve cerrahi klinik çalýþmalarýn tüm çalýþmalara oraný incelendi.
BULGULAR: Türkiye’nin konusu geçen 24 yýllýk dönemine bakýldýðýnda yürütülen klinik çalýþmalarýn sayýsýnýn katlanarak arttýðý gözlemlendi. 01.01.1994 ile 01.01.2000 tarihleri arasýnda kayýtlý 23 klinik çalýþma, 01.01.2012 ile 01.01.2018 tarihleri arasýnda 1930’a yükselmiþtir. Buna ek olarak, Türkiye’de geç fazlý çalýþmalara, erken fazlý çalýþmalara kýyasla daha büyük bir eðilim olduðu görüldü.
TARTIÞMA ve SONUÇ: Türkiye’nin klinik ilaç araþtýrma yönetmeliðindeki reformu, inovatif týp için uyumlu bir alan yaratmýþtýr. Türkiye’nin benzersiz coðrafi konumu, teknolojik geliþmeleri ve hedef hasta kitlesinin uygunluðu göz önünde bulundurulduðunda bu ivmeli artýþ beklenmedik deðildir. Türkiye’deki geç fazlý çalýþmalarýn sayýsýnýn erken fazlý çalýþmalara kýyasla az oluþu, geliþmekte olan ülkelerde olasý düþük maliyet ve tedavi edilmemiþ hasta grubunun varlýðý nedeniyle oluþan çekiciliði yansýtmaktadýr.

INTRODUCTION: This study aims to investigate the effects of Turkey’s adoption of clinical trial (CT) regulations and international guidelines on CTs conducted in Turkey over the course of the 24 years.

METHODS: The ClinicalTrials.gov website and its advanced filtering were used to identify registered CTs performed in Turkey during four six-year intervals. Various characteristics of the CTs, such as design, phase distribution, participant age, and type of funding, and the percentage of surgery-related CTs, were analyzed.
RESULTS: The number of CTs conducted in Turkey increased exponentially during the 24-year study period, from 23 studies between 01/01/1994 and 01/01/2000 to 1930 studies between 01/01/2012 and 01/01/2018. Phase distribution analysis showed that there were more late-phase CTs than early-phase CTs in Turkey during the study period.
DISCUSSION AND CONCLUSION: Modernization of Turkey’s regulations for CTs facilitated the relevant growth of CTs in Turkey. Considering Turkey’s unique geographic location, technological advancements, and ease of patient recruitment, the observed exponential increase in the number of CTs performed is not surprising. The higher number of late-phase CTs, as compared to early-phase CTs in Turkey, indicates that late-phase CTs may be more common in developing countries because they are less expensive to conduct that early-phase CTs and the pool of potential participants are naive.

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Bir hemitoraksýn en az üçte birini kaplayan dev amfizematöz bül (DAB) varlýðýnda cerrahi bir tedavi seçimidir. Bu yazýda, ilerleyen nefes darlýðý, balgam, günlük aktivitelerini yerine getirememe þikayetleriyle müracaat eden, radyolojik incelemeler sonrasý iki taraflý DAB tanýsý alan, 53 yaþýnda erkek bir olgu sunuldu, ameliyat sonrasý yaþanan sorunlar tartýþýldý. Sað taraftaki DAB ameliyat edildi. Ameliyat sonrasý dönemde hava kaçaðý (HK) oldu ve akciðerin geniþlemesi yetersizdi. Solunum sýkýntýsý ve pürülan sekresyon oluþtuðu anda otolog kan uygulamasýyla bu önemli sorun çözüldü. DAB varlýðýnda, ameliyat öncesi dönemdeki kalan akciðer hakkýndaki cerrahi sonucu tahmin etmek zordur. Ameliyat sonrasý dönemde çok ciddi sorunlarla karþýlaþýlabilinir. Ameliyat sonrasý dönemde HK’nýn uzamasý ve akciðerin geniþleyememesi çok ciddi bir sorundur. Otolog kan uygulamasý; bu sorunlarýn çözülmesinde güvenli, kolay ve etkilidir.

Surgery is a treatment choice in the presence of a giant emphysematous bulla (GBE) that covers at least one third of a hemithorax. In this article, a 53-year-old male patient who presented with complaints of progressive shortness of breath, sputum, and inability to perform his daily activities, diagnosed as bilateral GBE after radiological examinations, and post-operative problems were discussed. The right side GBE was operated on. In the postoperative period, there was an air leakage (AL), and the expansion of the lung was insufficient. As soon as respiratory distress and purulent secretion occurred, this important problem was resolved with autologous blood administration. In the presence of GBE, it is difficult to predict the surgical outcome about the lung tissue in the preoperative period. Very serious problems can be encountered in the postoperative period. In the postoperative period, the prolongation of HK and the inability of the lung to expand are very serious problems. Autologous blood application is safe, easy and effective in solving these problems.

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Lyme hastalýðý, ixodes türü kenelerle bulaþan, Spirochaetales ailesi içinde yer alan Borrelia burgdorferi cinsi bakterinin neden olduðu zoonozdur. Hastalýðýn seyrinde kalp, deri, sinir ve kas-iskelet sistemi etkilenebilir. Nöroborelyoz olarak tanýmlanan santral sinir sistemi tutulumu, immün iliþkili akut nöropati olan Guillain Barre sendromu (GBS) ile benzerlik gösterebilir. Bu yazýda fasial paralizi, kas güçsüzlüðü ve yaygýn kas aðrýsý nedeniyle GBS düþünülerek nöroloji kliniðinde takip edilen bir olgu paylaþýldý. Klinik takibinde bulgularýnda düzelme olmayan hastanýn öyküsünde kene temasýnýn olmasý nedeni ile ayýrýcý tanýda nöroborelyoz düþünülmüþ, klinik ve laboratuvar bulgularý ile taný doðrulanmýþtýr. Bu olguda GBS’nin ayýrýcý tanýsýnda nöroborelyozun akýlda tutulmasý gerektiði vurgulanmýþtýr.

Lyme disease is a zoonosis that arises from Borrelia burgdorferi spp belonging to the Spirochaetales family, transmitted by Ixodes-type ticks. In the course of the disease, the heart, skin, nervous and musculoskeletal system may be affected. Central nervous system involvement, defined as neuroborreliosis, may be similar to Guillain- Barré syndrome (GBS), an immune-mediated acute neuropathy. In this article, a case that was followed up in the neurology clinic with GBS due to facial paralysis, muscle weakness and widespread muscle pain was shared. Neuroborreliosis was considered in the differential diagnosis of the patient whose clinical findings did not improve due to the presence of tick contact in history, and the diagnosis was confirmed by clinical and laboratory findings. In this case, it was emphasized that neuroborreliosis should be kept in mind in the differential diagnosis of the GBS.

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Güdük apandisit inkomplet apendektomi sonrasý geriye kalan apendiksin enflamasyonu sonrasý görülen nadir bir komplikasyondur. Apendektomi öyküsü olan ve akut karýn tablosu ile baþvuran olgularda güdük apandisit tanýsý sýklýkla gözden kaçmaktadýr. Görüntüleme yöntemleri tanýda büyük önem taþýmaktadýr. Biz bu olgu sunumumuzda iki gündür devam eden sað alt kadran aðrýsý ile acil servise baþvuran ve üç ay önce laparoskopik apendektomi öyküsü olan güdük apandisit olgusunun görüntüleme ve operasyon bulgularýný sunmayý amaçladýk. Hasta, yapýlan güdük apendektomi sonrasýnda sorunsuz taburcu edilmiþtir.

Stump appendicitis is a rare complication of an appendiceal inflammation after an incomplete appendectomy. Diagnosis of stump appendicitis in patients who have a history of appendectomy and presenting with acute abdomen is frequently overlooked. Imaging methods are of great importance in diagnosis. In this case report, we aimed to present the imaging and operation findings of stump appendicitis with a history of right lower quadrant pain for two days and a history of laparoscopic appendectomy three months ago. The patient was discharged uneventfully following a stump appendectomy.

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