GÝRÝÞ ve AMAÇ: Akciðer, tüm vücut kanserleri için ikinci en sýk metastaz organý olup seçilmiþ hastalarda pulmoner metastazektomi küratif seçenektir. Operatif yaklaþýmda temel amaç en az parankim kaybý ile komplet rezeksiyon yapmak ve doðru hasta seçimi ile sað kalým süresini uzatmaktýr. Ýyi seçilmiþ hastalarda minimal invaziv giriþimler hastanýn ameliyat sonrasý yaþam kalitesini, eþit onkolojik sonuçlarla artýrabilmektedir.
YÖNTEM ve GEREÇLER: Ocak 2012–Aralýk 2017 tarihleri arasýnda pulmoner metastaz tanýsý ile kliniðimizde metastazektomi yapýlan hastalar incelendi. Klinik deðerlendirme sonrasýnda pulmoner rezeksiyona uygun olan 92 hasta (55 erkek ve 37 kadýn) operasyona hazýrlandý. Torakotomi ve torakoskopi prosedürleri ile cerrahi uygulanan hastalarda komplet rezeksiyon amaçlandý.
BULGULAR: Çalýþmamýza alýnan hastalar baþvuru anýnda semptomlar açýsýndan deðerlendirildiðinde, 8 olgu semptomlu olarak saptandý ve bunlardan 3’ünde öksürük, 3’ünde göðüs aðrýsý (pnömotoraks nedeni ile) mevcuttu. Histopatolojik tip ile hastalýksýz yaþam süresi deðerlendirmesinde ise en yüksek yaþam süresi epiteltal tümörlerde (40.1 ay) ve sarkomlarda (28.2 ay) saptanýrken, germ hücreli tümörlerde (8.3 ay) ve melanomlarda (8.1) ise en düþük olarak izlendi.
TARTIÞMA ve SONUÇ: Multidisipliner bir tedavi yaklaþýmý gerektiren pulmoner metastazlý hastalarýn; primer hastalýðý kontrol altýnda, uzak metastazý olmayýp ve komplet cerrahi rezeksiyon uygulanabiliyor ise özellikle epitelyal tip ve sarkom tipi tümörlerde metastazektominin hastalýksýz yaþam süresine ve ortalama saðkalýma ciddi katkýsý olduðu kanaatindeyiz.

INTRODUCTION: The lungs are the second most common site of metastasis, and for selected patients, pulmonary metastasectomy can be a curative option. The surgical goal is complete resection with minimal parenchymal loss in order to prolong life. In well-selected cases, minimally invasive approaches can increase quality of life and offer equivalent oncological outcomes.
METHODS: Patients diagnosed with pulmonary metastasis who underwent a metastasectomy in a single hospital between January 2012 and December 2017 were evaluated retrospectively. A total of 92 patients (55 male and 37 female) underwent thoracotomy or thoracoscopy procedures with the goal of complete resection.
RESULTS: Among the patients included in the study, 8 were symptomatic: cough was reported in 3, chest pain (pneumothorax) was experienced in 3, and hemoptysis occurred in 2 cases. The longest disease-free survival (DFS) period was seen in cases of epithelial tumor (40.1 months) and sarcoma (28.2 months); the shortest survival was seen in those with germ cell tumor (8.3 months) and melanoma (8.1 months).
DISCUSSION AND CONCLUSION: Patients with pulmonary metastasis require a multidisciplinary approach for treatment. When the primary disease is under control and there is no other distant metastasis, metastasectomy with complete surgical resection can provide an extended period of DFS, particularly for patients with epithelial or sarcomatous tumors.

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GÝRÝÞ ve AMAÇ: Tip 1 diyabetes mellitus hastalarýnda saðlýk okuryazarlýðýnýn diyabet kontrolü ve hastalýða özgü komplikasyonlarla iliþkisini araþtýrmak amaçlandý.
YÖNTEM ve GEREÇLER: Bu araþtýrma tanýmlayýcý bir çalýþmadýr. On sekiz–altmýþ beþ yaþ aralýðýnda olan Türkçe konuþan ve herhangi bir biliþsel rahatsýzlýðý olmayan 106 tip 1diyabetes mellitus hastasý araþtýrmaya dahil edildi. Avrupa Saðlýk Okuryazarlýðý Araþtýrmasý Anket sorularý kiþilerin saðlýk okuryazarlýðý düzeylerini ölçmede kullanýldý. Katýlýmcýlarýn retinopati muayeneleri, HbA1c sonuçlarý, açlýk kan þekeri sonuçlarý ve albuminüri seviyeleri hasta dosyalarýndan elde edildi.
BULGULAR: Toplamda saðlýk okuryazarlýðý %10.4 katýlýmcýda yetersiz, %54.7 katýlýmcýda problemli, %20.8 katýlýmcýda yeterli ve %14.2 katýlýmcýda mükemmeldi. Retinopati sýklýðý, saðlýk okuryazarlýðý problemli ve yetersiz olan grupta yeterli ve mükemmel olan gruba oranla daha sýktý (%24.6 ve %5.4). Saðlýk okuryazarlýðý gruplarýnda nöropati ve nefropati ve kardiyovasküler hastalýklar arasýnda fark yoktu.
TARTIÞMA ve SONUÇ: Çalýþma sonucunda tip 1 diyabetes mellitus hastalarýnda saðlýk okuryazarlýðýnýn artmýþ retinopati riski ile iliþkili olduðu görüldü. Hekimler hastalýk kontrolü ve korunmasýnda eðitimin önemini akýlda tutmalýdýrlar.

INTRODUCTION: The aim of this study was to investigate the relationship between health literacy, diabetic control, and diabetic complications in patients with type1 diabetes mellitus (DM).
METHODS: This was a descriptive study. A total of 106 patients with type 1 DM who were between 18 and 65 years of age and who could speak and understand Turkish and had no cognitive disease were included in the study. The Turkish version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) was used to assess health literacy. The retinopathy status and levels of hemoglobin A1c, fasting blood sugar, and urine albumin of the patients were obtained from the hospital files.
RESULTS: Overall health literacy was inadequate in 10.4%, problematic in 54.7%, adequate in 20.8%, and excellent in 14.2% of the participants. Retinopathy was found to be statistically significantly higher in the problematic+inadequate group than in the adequate+excellent group in the overall health literacy evaluation (24.6% and 5.4%, respectively). There was no significant difference in the frequency of neuropathy, nephropathy, or cardiovascular disease in the health literacy groups.
DISCUSSION AND CONCLUSION: The present study demonstrated that low health literacy in patients with type 1 DM was associated with increased retinopathy. Physicians should keep the positive effects of education in mind in order to better control the disease and prevent complications.

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GÝRÝÞ ve AMAÇ: Yaþlý hastalarda akut apandisitin tahmininde Alvarado skorlama sistemini modifiye ederek, skorlamanýn sensivite ve spesifitesini arttýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Ocak 2015–Aralýk 2017 tarihleri arasýnda kliniðimizde akut karýn aðrýsý ile baþvuran yetmiþ yaþ üstü 81 hastanýn dahil edildiði geriye dönük bir çalýþma yürüttük. Týbbi takiple taburcu edilen ve ameliyat sonrasý patolojik tanýsý apandisit ile uyumlu olmayan hastalar Grup 1, ameliyat sonrasý histopatolojik olarak apandisit olduðu gösterilmiþ hastalar Grup 2 olarak tanýmlandý. Bilgisayarlý tomografi (BT) ve Alvarado skorunun yetmiþ yaþ üstü hastalarda sensivitesi ve spesifitesi deðerlendirildi.
BULGULAR: Çalýþmamýzda, modifiye Alvarado skorunun akut apandisit tanýsýný koymada spesifitesi %81, sensitivitesi %86 iken BT’nin spesifitesi %93, sensitivitesi %92.1 olarak bulunmuþtur.
TARTIÞMA ve SONUÇ: Yaþlýlarda akut apandisite yönelik stratejisi hala belirsizdir ve bu konuda az sayýda çalýþma vardýr. Alvarado skorlama sisteminin yaþlý hastalarda tanýda duyarlýlýðýnýn düþük olduðundan dolayý, Alvarado skorlama sistemini modifiye ederek 7 ve üzerinde skor alan yaþlý hastalarda akut apandisit tanýsýnýn daha yüksek doðrululuk oranýyla, zamanýnda teþhis edilebileceðini düþünmekteyiz. Akut apandisit tanýsýnda Alvarado skorlama sistemi ile BT kombine edildiðinde tanýdaki baþarýnýn artýp teþhisteki gecikmenin azalacaðý kanaatindeyiz.

INTRODUCTION: The aim of this study was to modify the Alvarado scoring system to increase its sensitivity and specificity in predicting acute appendicitis in elderly patients.
METHODS: The data of 81 patients older than 70 years of age who were admitted for acute abdominal pain between January 2015 and December 2017 were randomized into 2 groups and evaluated retrospectively. In Group 1 patients, acute appendicitis was not histopathologically established postoperatively, while Group 2 patients had pathological results consistent with acute appendicitis. The sensitivity and specificity of computed tomography (CT) scans and Alvarado scores were evaluated in the 2 groups.
RESULTS: The specificity and sensitivity of the modified Alvarado score was 86% and 81%, respectively, whereas the specificity and sensitivity of a CT scan was 93% and 92.1%, respectively, in diagnosing acute appendicitis.
DISCUSSION AND CONCLUSION: There are a limited number of studies related to acute appendicitis in elderly patients and the current strategy for treatment is not clear. Due to the decreased sensitivity of the Alvarado score in the diagnosis of acute appendicitis in elderly patients, the goal of this research was to adjust the scoring system. Scores >7 are more reliable in predicting appendicitis. We believe that patients can be more accurately diagnosed in a short period of time using this modified Alvarado scoring system. In combination with a CT scan evaluation, the success rate of diagnosis may be improved and delayed diagnosis prevented.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, genel anestezi altýnda alt karýn cerrahisi geçirecek olan hastalarda sevofluran ve desfluran kullanýmýnýn ameliyat sonrasý erken dönem etkilerinin karþýlaþtýrýlmasýdýr.
YÖNTEM ve GEREÇLER: Elektif alt batýn cerrahisi geçirecek 18-75 yaþ arasý ASA fizik durumu I ya da II olan 80 hasta seçilerek iki gruba ayrýldý. Anestezi indüksiyonundan önce kalp hýzý, kan basýncý, periferik oksijen satürasyonu ölçüldü ve nöromusküler monitörizasyon uygulandý.Tiyopental 5-7 mgr/kg ve fentanil 1 µgr/kg iv uygulanmasýnýn ardýndan rokuronyum 0.6 mg/kg iv uygulanarak endotrakeal entübasyon gerçekleþtirildi. Anestezi idamesi Grup I’de %4 desfluran Grup II’de %3 sevofluran %50 oksijen-hava karýþýmý ile saðlandý. Cerrahi sýrasýnda hemodinamik deðiþikliklere göre fentanil 1 µgr ve volatil anesteziklerin konsantrasyonlarý deðiþtirilerek uygulandý. Cerrahinin sonunda volatil anestezikler kesilerek bütün hastalara %100 oksijen solutuldu. TOF %85 deðerine ulaþýnca hastalar ekstübe edildi ve yüz maskesi ile oksijen verildi. Peroperatif aksiller ýsý, SpO2,hemoglobin (Hb), arteriyel basýnç, kalp hýzý ve total opioid tüketimi kaydedildi. Postoperatif dönemde 1., 5., 10., 15., 20., 30., 45., 60. dakikalarda SpO2 deðerleri, havayolu kontrol ve modifiye Aldrete derlenme skorlarý kaydedildi. Aðrý deðerlendirilmesi vizüel analog skala (VAS) ile 1-10 arasý olacak þekilde ayný zaman aralýklarýnda deðerlendirildi.
BULGULAR: Gruplar arasýnda tanýmlayýcý deðerler, anestezi süreleri, cerrahi süreleri, ekstübasyon süreleri, aksiller ýsý, ameliyat öncesi SpO2, ameliyat öncesi ve sonrasý hemodinamik deðerler havayolu kontrol skoru ve VAS deðerleri arasýnda anlamlý fark tespit edilmedi. Grup I’de toplam opioid dozunun anlamlý olarak daha yüksek, ameliyat öncesi Hb ve ameliyat sonrasý Hb deðerlerinin ise anlamlý olarak daha düþük olduðu gözlendi (p<0.01).
TARTIÞMA ve SONUÇ: Genel anestezi uygulamalarýnda desfluranýn özellikle ameliyat sonrasý komplikasyon riski yüksek olan hastalarda sevoflurana tercih edilebilir.

INTRODUCTION: The aim of this study was to compare the early postoperative recovery effects between patients who were given sevoflurane or desflurane before having lower abdominal surgery under general anesthesia.
METHODS: Eighty patients aged between 18 and 75 years with an American Society of Anesthesiologists physical status classification of I or II who were scheduled for elective lower abdominal surgery were divided into 2 groups. Before the induction of anesthesia, heart rate (HR), blood pressure, and peripheral oxygen saturation (SpO2) were measured, and neuromuscular monitoring was performed. Following the intravenous (IV) administration of 5 to 7 mg/kg thiopental and 1 mcg/kg fentanyl, 0.6 mg/kg rocuronium was used to facilitate endotracheal intubation. Maintenance of anesthesia was provided using 4% desflurane in Group I and 1.3% sevoflurane in Group II in a 50% oxygen-air mixture. During surgery, additional doses of 1 mcg/kg fentanyl were administered and the concentration of volatile anesthetics was adapted according to hemodynamic conditions. At the end of the operation, volatile agents were discontinued and 100% oxygen was administered to all patients. When the train-of-four stimulation value exceeded 85%, the patients were extubated and oxygen was provided via facemask. Perioperative axillary temperature, SpO2, hemoglobin (Hb), arterial pressure, HR, and total opioid consumption were recorded. SpO2 level, airway control value and modified Aldrete score were recorded at the 1st, 5th, 10th, 15th, 20th, 30th, 45th, and 60th minutes during the postoperative period. Pain evaluation was performed using a visual analog scale (VAS) of 1 to 10 at the same intervals.
RESULTS: There were no significant differences between the 2 groups in terms of the duration of anesthesia and surgery, extubation time, change in axillary temperature, perioperative hemodynamic changes, airway control, or VAS scores. In Group I, the total opioid dose was significantly higher and the preoperative and postoperative Hb values were significantly lower (p<0.01). The modified Aldrete scores of Group I were significantly higher than those of Group II at 10 minutes and at later intervals (p<0.002). In Group I, the postoperative SpO2 values were significantly higher than those seen in Group II (p<0.05 and above) at the 5th, 10th, 20th, 30th, and 45th minutes.
DISCUSSION AND CONCLUSION: It was concluded that desflurane may be a better choice of anesthesia during lower abdominal surgery than sevoflurane for patients with the potential for respiratory complications.

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GÝRÝÞ ve AMAÇ: Çalýþmada pulmoner kandidiaziz ve aspergilloziz enfeksiyonunda enflamatuvar belirteçlerden C-reaktif protein (CRP), nötrofil lenfosit oraný (NLO), platelet ve ortalama platelet hacmi (PLT/MPV), platelet lenfosit oraný (PLO) farklý olup olmadýðý araþtýrýldý.
YÖNTEM ve GEREÇLER: Çalýþma 2016–2017 yýllarýnda geriye dönük kesitsel olarak yapýldý. Hastalar hastane bilgi yönetim sisteminden (HBYS) pulmoner kandidiaziz (ICD taný kodu B 37), pulmoner aspergilloziz (ICD taný kodu B44) kodu ile tarandý. Yatýþ, çýkýþ hemogramlarý, ek hastalýklarý, yatýþ günü, hastane mortaliteleri kaydedildi. CRP, NLO, PLT/MPV, PLO hesaplandý. Gruplarýn kayýt edilen deðerleri, enflamatuvar biyobelirteçleri karþýlaþtýrýldý.
BULGULAR: Çalýþmaya 44 (kandida n=19, aspergillus n=25) hasta alýndý. Ortanca yaþlarý 65 ve 29 erkekdi (%66). Pulmoner kandidiazis ve aspergilloziz hastalarýnda KOAH, hastalarýn yatýþ CRP, NLO, PLO, MPV, PLT/MPV deðerleri benzer idi; taburculuk sýrasýnda CRP, PLO, NLO, PLT benzer iken taburculukta MPV pulmoner aspergillozizde, pulmoner kandidiaziz hastalarýndan anlamlý düþük (7.3 ve 8.4, p=0.029) idi.
TARTIÞMA ve SONUÇ: Pulmoner aspergilloziz ve kandidiaziz enfeksiyonlarýnda çoðu biyobelirteç benzerdi. Aspergillus tanýsýnda PLT yüksekliði ve MPV düþüklüðü anlamlýdýr. Fungal akciðer enfeksiyonu düþünülen hastalarda yapýlacak olan ileriye yönelik, çok merkezli çalýþmalarda benzer bulgular olmasý amprik tedavi baþlanmasýnda platelet ve MPV biyobelirteçlerinin önemini artýracaktýr.

INTRODUCTION: This study was an evaluation of differences in the inflammatory markers of C-reactive protein (CRP) level, the neutrophil-to-lymphocyte ratio (NLR), the platelet count-to-mean platelet volume ratio (PLT/MPV), and the platelet-to-lymphocyte ratio (PLR) in patients with pulmonary candidiasis and pulmonary aspergillosis.
METHODS: A retrospective, cross-sectional study was performed with the data of patients who were diagnosed with pulmonary candidiasis and pulmonary aspergillosis between 2016 and 2017 according to the records of the hospital information system. The results and date of hemograms, the biochemistry values, and C-reactive protein (CRP) levels were recorded. The NLR, PLT/MPV, and PLR were calculated. The documented parameters of the study groups were compared and analyzed.
RESULTS: There were 44 patients (29 men) (candidiasis, n=19; aspergillosis, n=25), with a median age of 65 years. In both groups, the incidence of chronic obstructive pulmonary disease, level of CRP, and the NLR, PLR, MPV, and PLT/MPV were statistically similar. At discharge, the CRP, PLR, NLR, and PLT values were still similar in the 2 groups; however, the MPV was significantly lower in the pulmonary aspergillosis group when compared with the pulmonary candidiasis group (7.3 vs 8.4; p=0029).
DISCUSSION AND CONCLUSION: Most biomarkers were similar in the pulmonary aspergillosis and the candidiasis groups; however, a PLT elevation and an MPV decrease were significant in the diagnosis of aspergillus. Similar findings in prospective, multicenter studies performed with patients who are suspected of having a fungal lung infection will add to the ultimate determination of the value to be given to PLT and MPV biomarkers in the initiation of empirical treatment.

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GÝRÝÞ ve AMAÇ: Voiding sistoüretrografi (VSUG) ürolojik hastalýk öyküsü olan olgularýn transplantasyon öncesi vezikoüretral reflü (VUR) açýsýndan deðerlendirilmesinde sýklýkla kullanýlýr.
YÖNTEM ve GEREÇLER: Son dönem böbrek hastalýðýnýn (SDBH) etiyolojisi ile VUR prevalansý iliþkisini ve VSUG gerekliliðini deðerlendirmeyi amaçladýk. Transplantasyon öncesi VSUG uygulanan 319 hasta geriye dönük olarak deðerlendirildi.
BULGULAR: Voiding sistoüretrografi ile 53 (%16.6) olguda VUR saptandý; 21 (%41.2) sol taraflý, 18 (%35.3) sað taraflý, 12 (%3.8)iki taraflý; 10 (%19.6) grade 1, 19 (%37.3) grade 2, 20 (%39.2) grade 3 ve 2 (%3.9) grade 4 idi. SDBH sebebi 125 (%39.2) olguda hipertansiyon, 46 (%14.4) olguda, polya DM, 21 (%6.6) kistik böbrek hastalýðý, 16 (%5) olguda amiloidoz, 11 (%3.4) olguda VUR ve 11 (%3.4) olguda glomerulonefrit idi. VUR sýklýðý kadýnlarda anlamlý olarak daha fazla bulundu. Hipertansiyon, DM, polikistik böbrek hastalýðý, amiloidoz ve glomerulonefrit VUR belirteci olarak bulunmadý. Anormal VSUG bulgusu sýklýðý sekonder ve idyopatik SDBH olgularýnda benzer bulundu.
TARTIÞMA ve SONUÇ: Çalýþmamýz, cinsiyetin VUR için anlamlý bir belirteç olduðu sonucunu ortaya koymuþtur. VUR varlýðý ile SDBH etiyolojisi arasýnda iliþki bulunmadý. Bu nedenle transplantasyon öncesi deðerlendirmede VSUG yapýlmasýnýn gerekli olmadýðý kanaatindeyiz.

INTRODUCTION: Voiding cystourethrography (VCUG) is widely performed in the pretransplant evaluation of patients with a history of urological disorders to detect vesicoureteral reflux (VUR). The aim of this study was to evaluate the relationship between the primary etiology of end-stage renal disease (ESRD) and the prevalence of VUR, thereby determining the necessity for VCUG in pretransplant patients.
METHODS: A total of 319 pretransplant cases that underwent VCUG were retrospectively reviewed.
RESULTS: VCUG revealed VUR in 53 (16.6%) cases. VUR was left-sided in 21 (41.2%), right-sided in 18 (35.3%), and bilateral in 12 (3.8%), and grade 1 in 10 (19.6%), grade 2 in 19 (37.3%), grade 3 in 20 (39.2%), and grade 4 in 2 (3.9%). The etiology of ESRD was hypertension in 125 (39.2%), diabetes mellitus (DM) in 46 (14.4%), polycystic kidney disease (PKD) in 21 (6.6%), amyloidosis in 16 (5%), VUR in 11 (3.4%), and glomerulonephritis (GN) in 11 (3.4%). The incidence of VUR was significantly higher in female patients. Hypertension, DM, PKD, amyloidosis, and GN were not found to predict VUR. The rate of abnormal VCUG findings was similar in cases with secondary and idiopathic ESRD.
DISCUSSION AND CONCLUSION: The findings demonstrate that only sex was a predictor of VUR in pretransplant cases. The presence of VUR was not related to any cause of ESRD; therefore, VCUG is not needed in all cases as a part of pretransplant evaluation.

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GÝRÝÞ ve AMAÇ: Kan transfüzyonu eksik olanýn yerine konulmasýdýr; etki profili, komplikasyon geliþimi, anaflaksi riski, ölüme kadar gidebilen rejeksiyon epizotlarý ile beraber düþünüldüðünde aslýnda bir doku transplantasyonudur. Klinik pratiðimizi dahiliye gözüyle semptom ve endikasyon açýsýndan gözden geçirmek amacýyla acil dahiliye servisinde yapýlan kan transfüzyonlarýný derlemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Hastanemiz acil dahiliye servisinde yapýlan kan transfüzyonlarý geriye dönük olarak hastane bilgi sistemi üzerinden tarandý. Hastalar baþvuru þikayetlerine göre aciliyet gerektirenler ve aciliyet gerektirmeyenler diye iki gruba kategorize edildi.
BULGULAR: Üç ayda dahiliye acil servisinde %61.4’ü erkek toplamda 528 hastaya 1156 adet transfüzyon gerçekleþtirildi (kiþibaþý ortalama 2.18 adet). Baþvuru þikayetlerinde ilk üç sýrada halsizlik (%19), melena (%14), yakýnmasýz (sadece laboratuvar patolojisi) (%12.9) yer alýyordu.Aktif kanamayla gelen gastrointestinal sistem kanamalarý hariç tutulduðunda ne onkoloji ne hematolojik onkoloji ne de diðer hasta gruplarýnýn temel baþvuru þikayetlerine bakýldýðýnda aciliyet gerektiren þikayet oranlarý %50 dahi deðildi. Tüm hastalarýn %47’sini ancak acil hastalar oluþturmaktaydý.
TARTIÞMA ve SONUÇ: Ýstanbul Anadolu yakasýnýn en kalabalýk hastanelerinden biri olan hastanemiz yoðun bir transfüzyon deneyimine sahiptir. Sonuç olarak aciliyet gereksinimi ile hastalarýn geliþ hemoglobin düzeyleri arasýnda bir korelasyon olmadýðý gibi; aktif kanama haricinde acilde yapýlan kan ürünleri transfüzyonlarýnýn çoðunun acil endikasyonla yapýlmadýðý görüldü. Acil servislerin yükünü bir nebze azaltýlmasý ve gerçek acil hastalarýn önceliðinin korunmasý adýna hastanelerde ayaktan parenteral tedavi ünitelerinin kurulmasý düþünülebilir.

INTRODUCTION: A blood transfusion, defined as a procedure to replace lost blood, is actually a tissue transplantation, performed with consideration given to the impact profile, the potential development of complications, and the risk of anaphylaxis and rejection, which may lead to death. This study is an analysis of emergency blood transfusions in terms of symptoms and indications.

METHODS: Hospital records of blood transfusions administered in the emergency service were retrospectively reviewed. The patients were categorized into 2 groups: emergency patients and non-emergency patients, based on the presentation.
RESULTS: Over the course of 3 months, 1156 transfusions (2.18 per person) were performed in 528 patients (61.4% male). It was determined that the most commonly seen patient complaints were weakness (19%) and melena (14%), followed by cases in which the patient was asymptomatic, but there was laboratory pathology (12.9%). In all, 47% of all cases of blood transfusion were considered urgent.
DISCUSSION AND CONCLUSION: No correlation was determined between urgency requirement and hemoglobin level. Aside from those administered for active bleeding, most blood transfusions were not performed due to an urgent indication. The establishment of separate, ambulatory parenteral treatment units in could reduce the burden on emergency services to some extent and protect the priority status real emergency patients need.

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GÝRÝÞ ve AMAÇ: Günümüzde üriner sistem taþ hastalýðýnýn minimal invaziv yöntemlerle tedavi edilmeye baþlamasýyla cerrahi prosedürler güvenilir hale gelmeye baþlamýþtýr. Perkütan nefrolitotomi (PNL) operasyonu, 2 cm’den büyük böbrek taþlarýnda ilk tedavi seçeneði haline gelmiþtir. Teknolojideki geliþmeler ve tecrübenin artmasýyla operasyon sonrasý taþsýzlýk oranlarýnda artýþ; operasyon ve hastanede yatýþ sürelerinde azalma olmuþtur. Zaman içinde PNL komplikasyonlarý azalmýþ ve geliþtirilen Clavien derecelendirme sistem benzeri sýnýflandýrýlmalarla daha standart hale getirilmiþtir. Bu çalýþmada, PNL operasyonunda baþarýyý ve komplikasyonlarý etkilediði düþünülen faktörlerin karþýlaþtýrmalý olarak araþtýrýlmasý amaçlandý.
YÖNTEM ve GEREÇLER: Çalýþmamýzda Kasým 2004 ile Ocak 2013 arasýnda kliniðimizde PNL operasyonu uygulanmýþ 928 hasta (1011 renal ünite) dahil edildi. Bu hastalarýn ameliyat öncesi [cinsiyet, yaþ, vücut kitle indeksi (VKÝ), operasyon tarafý, daha önce taþ nedeniyle yapýlan iþlemler, hidronefroz ve derecesi, taþ lokalizasyonu, taþ alaný ve hacmi], operatif (operasyon süresi, skopi süresi, giriþ yeri sayýsý, giriþ yapýlan kaliks) ve ameliyat sonrasý (hemoglobin, hemotokrit, komplikasyon, transfüzyon yapýlmasý, taþsýzlýk, nefrostomi çekilme süresi, hastanede kalýþ süresi, ek giriþim ihtiyacý) verileri geriye dönük olarak dosya kayýtlarýndan incelendi. Operasyon esnasýnda ve operasyon sonrasýnda meydana gelen komplikasyonlar modifiye Clavien sistemine göre sýnýflandýrýldý. Daha sonra olgular, komplikasyon geliþen hastalar (Grup 1) ve geliþmeyenler (Grup 2) olarak ikiye ayrýldý. Gruplar karþýlaþtýrmalý olarak analiz edildi.
BULGULAR: Çalýþmaya alýnan hastalarýn 628 erkek, 383 kadýn (E/K: 8/5), yaþ ortalamasý ise 41.9 idi. Deðerlendirilen operasyonlarýn 185’inde minör veya majör bir adet komplikasyon geliþirken, 826’sýnda komplikasyon geliþmediði görüldü. PNL operasyonunda görülen komplikasyonlar modifiye Clavien derecelendirilmesine göre sýnýflandýrýldýðýnda derece 1’de 23 (%2.27) komplikasyon, derece 2’de 143 (%14.14) komplikasyon, derece 3A’da 11 (%1.08) komplikasyon, derece 3B’de 6 (%0.59) komplikasyon, derece 4A’da 4 (%0.39) komplikasyon, derece 4B’de 15 (%1.48) komplikasyon görülürken, derece 5’e uygun komplikasyon görülmedi. Her iki grup arasýnda yapýlan karþýlaþtýrmada taþýn büyüklüðü, preoperatif hidronefroz derecesi, operasyon ve floroskopi süreleri, hastanede kalýþ süreleri ve taþsýzlýk oranlarýnýn komplikasyon geliþimi üzerine etkili parametreler olduðu istatistiksel olarak gösterildi (p<0.05). Hastanýn yaþý, cinsiyeti, VKÝ, böbreðe giriþ sayýsý, operasyon sonrasý ek giriþimlerin ise komplikasyon geliþimi açýsýndan etkili parametreler olmadýðý saptandý (p>0.05).
TARTIÞMA ve SONUÇ: Perkütan nefrolitotomi, üriner sistem taþ hastalýðý tedavisinde etkin ve güvenilir bir yöntemdir. Meydana gelen komplikasyonlarýn çoðu minör komplikasyonlardýr. Taþ büyüklüðü, ameliyat öncesi hidronefroz varlýðý, uzun operasyon süreleri, böbrek toplayýcý sistemine fazla giriþ yapýlmasý komplikasyon oranlarýný artýrmaktadýr. Bu çalýþmada elde ettiðimiz baþka önemli bir sonuç ise taþsýzlýk oranlarýnýn yüksek olduðu hastalarda komplikasyon oranlarýnýn da diðer hastalara göre yüksek olmasýdýr.

INTRODUCTION: Nowadays, surgical procedures become more reliable as urinary system stone disease begins to be treated with minimally invasive methods. Percutaneous nephrolithotomy (PNL) is the first treatment option for kidney stones >2 cm. An increase in postoperative stone-free (SF) rates due to improvements in technology and experience, operation, and hospital stay is reduced. Over time, complications of PNL have been reduced and more standardized with classifications similar to the developed Clavien grading system. The aim of the present study was to comparatively investigate the factors that are considered to affect success and complications in PNL operation.
METHODS: The present study included 928 patients (1011 renal units) who underwent PNL operation between November 2004 and January 2013 in our clinic. These patients had preoperative (sex, age, body mass index (BMI), operation side, previous stone operations, hydronephrosis and grade, stone localization, stone area, and volume), operative (operation time, fluoroscopy time, number of access, and calyces of access), and postoperative (hemoglobin, hematocrit, complication, transfusion, stone removal, nephrostomy withdrawal time, length of hospital stay, and need for additional intervention). The complications that occurred during and after the operation were classified according to the modified Clavien system. Subsequently, patients were divided into two groups: patients with complications (Group 1) and those with no complications (Group 2). The groups were analyzed comparatively.
RESULTS: Overall, 628 male and 383 female (M/F: 8/5) patients were included in the study. The mean age of the patients was 41.9 years. Of the evaluated operations, 185 had minor or major complications, and 826 had no complications. Complications in PNL operation are classified according to the modified Clavien grading: 23 (2.27%) complications in grade 1, 143 (14.14%) complications in grade 2, 11 (1.08%) complications in grade 3A, 6 (0.59%) complications in grade 3B, 4 (0.39%) complications in grade 4A, and 15 (4.48%) complications in grade 4B. No complication according to grade 5 was observed. Statistically, stone size, preoperative hydronephrosis grade, time of operation and fluoroscopy, length of stay in the hospital, and SF rates were found to be effective parameters on complication development in both groups (p<0.05). Age, gender, BMI, number of access to the kidney, and postoperative complications were not found to be effective parameters in terms of complication development (p>0.05).
DISCUSSION AND CONCLUSION: PNL is an effective and reliable method for the treatment of urinary stone disease. Most of the complications are minor. Stone size, presence of preoperative hydronephrosis, long operation times, and excessive access to the kidney collecting system increase the complication rates. Another important result obtained in the present study is that the complication rates are higher in patients with high SF rates than in other patients.

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GÝRÝÞ ve AMAÇ: Baþarýlý böbrek transplantasyonundan sonra bile, alýcýlarýn %10–50’sinde kalýcý hiperparatiroidi görülebilir. Paratiroidektominin (PTX) böbrek fonksiyonlarýnda ve graft saðkalýmýnda bozulma ile iliþkili olduðu bildirilmiþtir. Çalýþmamýzda, merkemizde takip edilen ve PTX uygulanan böbrek nakli hastalarýnda PTX’in kalsiyum, fosfor, parathormon (PTH), tahmini glomerüler filtrasyon hýzýna (eGFR) uzun dönem etkilerini geriye dönük olarak deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Ocak 2014–Aralýk 2017 tarihleri arasýnda takip edilen 154 olgudan dokuzuna PTX uygulanmýþtý. PTX öncesi ve sonrasý medyan PTH, kalsiyum, fosfor ve eGFR deðerleri kaydedildi.
BULGULAR: Paratiroidektomi öncesi medyan PTH, kalsiyum, fosfor ve eGFR deðerleri sýrasýyla 311.57 pg/mL, 11.02 mg/dL, 2.35 mg/dL ve 90.88 mL/dk idi. Bazal deðerler ile bir aylýk kontrol deðerleri karþýlaþtýrýldýðýnda PTH (311.5 pg/mL vs. 147.5 pg/mL, p=0.015), kalsiyum (11.02 mg/dL vs. 9.01 mg/dL, p=0.017) ve eGFR (90.88 mL/dk vs.75.44 mL/dk, p=0.008) deðerlerinde azalma, fosfor seviyerinde artma (2.35 vs 3.4 mg/dL, p=0.06) görüldü. Bir yýllýk konrolde eGFR bazal seviyelerine döndü (90.88 mL/dk vs. 79.39 mL/dk, p=0.11).
TARTIÞMA ve SONUÇ: Böbrek nakli sonrasý PTX uygulanmasý güvenilir bir metoddur. Her ne kadar PTX sonrasý böbrek fonksiyonlarýnda erken dönemde bozulma görülse de, uzun dönemde stabilizasyon saðlanýr.

INTRODUCTION: Even after successful kidney transplantation, 10% to 50% of kidney transplant recipients have persistent hyperparathyroidism. Parathyroidectomy (PTX) has been reported to be associated with deterioration of renal function and reduced graft survival. The aim of this single-center, retrospective study was to analyze the long-term effect of PTX on calcium, phosphorus, and parathyroid hormone (PTH) levels, as well as the estimated glomerular filtration rate (eGFR), in renal transplantation patients who underwent PTX.
METHODS: The study population consisted of 154 patients followed between January 2014 and December 2017, 9 of whom underwent PTX. The median PTH, calcium, phosphorus, and eGFR values were recorded before and after PTX.
RESULTS: The median preparathyroidectomy PTH, calcium, phosphorus, and eGFR values were 311.57 pg/mL, 11.02 mg/dL, 2.35 mg/dL, and 90.88 mL/minute, respectively. When compared with the baseline figures, there was a decrease in PTH (311.5 vs. 147.5 pg/mL; p=0.015), calcium (11.02 vs. 9.01 mg/dL; p=0.017), and eGFR (90.88 vs. 75.44 mL/minute; p=0.008), and an increase in the phosphorus level (2.35 vs. 3.4 mg/dL; p=0.06) 1 month after surgery. The eGFR returned to the baseline rate 1 year after surgery (90.88 vs. 79.39 mL/minute; p=0.11).
DISCUSSION AND CONCLUSION: PTX in renal transplant recipients appears to be a safe procedure. Although renal function deteriorates in the acute period following PTX, long-term stabilization occurs.

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Orbital enflamatuvar sendrom veya orbital psödotümör orbital kitlelerin en sýk nedenidir. Olgularýn çoðu steroid yanýtlýdýr ancak tedaviye dirençli hastalar radyoterapi seçeneðine sahip olabilirler. Burada baþarýlý bir CyberKnife tedavisi yaklaþýmý ile kýsmi steroid cevabý veya nüks gösteren üç orbital psödotümör olgusu sunduk.

Orbital inflammatory syndrome (OIS) or orbital pseudotumor is the most frequent cause of an orbital mass. Most cases are steroid responsive, but treatment of patients with refractory OIS may also include radiotherapy. Presently described are 3 cases of orbital pseudotumor that had a partial steroid response or recurrence and were treated successfully with CyberKnife (Accuray Inc., Sunnyvale, CA, USA).

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Glioblastoma multiforme (GBM) astrositlerden köken alan ve merkezi sinir sisteminin en sýk görülen beyin tümörüdür. GBM’nin ekstrakraniyal metastazlarý oldukça nadir görülmekle birlikte (<%2) metastaz yaptýðý yerlerin baþýnda akciðer gelir. Bu olgularda akciðerde primer akciðer karsinomu düþündürür. Bu yazýda kitle saptanan ve GBM’nin akciðer metastazý olarak taný alan 55 ve 69 yaþýnda iki erkek hasta sunuldu. Akciðer görüntülemesinde primer maligniteyi düþündüren lezyonlar metastaz tanýsý alabilmekte ve primer malignitenin tedavisi ile regrese olabilmektedir. Bu nedenle ayrýntýlý anamnez, eþlik eden hastalýklarýn deðerlendirilmesi ve patolojik taný hayati önem arz etmektedir.

Glioblastoma multiforme (GBM), comprised of astrocytes, is the most common brain tumor of the central nervous system. Although extracranial metastasis of GBM is very rare (<2%), when it occurs, the lungs are the most common site. Presently described are the cases of 2 male patients, aged 55 and 69 years, who were ultimately diagnosed with pulmonary metastasis of GBM. A lesion that appears to be a primary malignancy on lung imaging may, in fact, be a metastasis. Treatment of the primary malignancy can lead to regression. A detailed anamnesis, evaluation of accompanying diseases, and a pathological diagnosis are of vital importance.

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Marjolin ülseri (MU) yanýk ve kronik yara zemininde geliþen, agresif seyreden ve skuamöz hücreli karsinom (SHK) dönüþümü gösteren malign cilt tümörüdür. Daha sýklýkla uzun dönem yanýk zemininde görülmekle birlikte travma sonrasý ya da kronik diðer yaralarda da karþýmýza çýkmaktadýr. Genellikle ön tanýlarda düþünülmeyip tanýsý geç konmakta ve bu yüzden prognozu kötü seyretmektedir. Bu çalýþmada, iki olguda uzun dönem takip edilen hidradenitis suppurativa ve pilonidal sinüs lezyonlarýnýn MU zemininde SHK’ya dönüþümü sunuldu.

Marjolin’s ulcer is an aggressive ulcerating malignancy that arises in a chronic wound and most often takes the form of squamous cell carcinoma (SCC). It often occurs in old burn scars, but it may also develop in post-traumatic lesions or chronic wounds. The prognosis is often poor as a result of delayed diagnosis. Presently described are cases in which chronic hidradenitis suppurativa and pilonidal sinus developed into SCC.

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Methemoglobinemi hemoglobin molekülünün normal ferroz durumdan ferik duruma okside olmasý ile oluþur. Nadiren doðumsal (methemoglobin redüktaz eksikliði) veya daha sýklýkla oksidanlarla karþýlaþma sonucu edinsel olarak görülebilmektedir. Edinsel methemoglobinemi yapan çok sayýda ajan bildirilmekte olup, nedenlerinden biri de sünnet pratiðinde lokal anestezi için sýk kullanýlan prilocain uygulamasýdýr. Tedavide kullanýlan metilen mavisine ihtiyaç olduðu bilinmekle birlikte genel olarak kabül edilmiþ alternatif tedavi yoktur. Bu tedaviler içinde son yýllarda bildirilen C vitaminin; etkinliði, dozu ve yüksek dozda renal yan etkileri konusunda net bilgi bulunmamaktadýr. Sünnet sýrasýnda lokal prilocain uygulamasý sonrasý siyanoz geliþen yenidoðan olgusu metilen mavisi bulunamadýðý için intravenöz vitamin C ile baþarý tedavi edilmesi nedeniyle sunulmuþtur.

Methemoglobinemia occurs when the hemoglobin molecule is oxidized from the normal ferrous state to the ferric state. Rarely, it may be a congenital condition (methemoglobin-reductase deficiency), but more frequently it is a result of oxidant exposure. Among the large number of agents that can cause acquired methemoglobinemia is prilocaine, commonly used for local anesthesia during circumcision. Methylene blue is known to be the best treatment option; however it is not always available, and there is no universally accepted alternative. Vitamin C has been reported as an alternative treatment in recent years, but there is no definitive information about efficacy, dose, and renal side effects at high doses. Presently described is the case of an infant who developed cyanosis after a local application of prilocaine during circumcision who was successfully treated with the intravenous administration of vitamin C.

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Nadir görülen plazmablastik lenfoma (PBL) AIDS ile iliþkili, oral mukoza yerleþimli, kötü prognozlu, diffüz büyük B hücreli lenfoma varyantý olarak kabul edilmektedir. Plazmablastik lenfomanýn henüz tedavisinde standart bir protokol olmamasý, olgu bildirimi ve çalýþmalar halinde yapýlan az sayýda HIV negatif olgularýn tedavisi olgu bazlý olarak yapýlmakta ve paylaþýlmaktadýr. Bu yazýda maksiller sinüs kaynaklý ve orbitaya yayýlmýþ olan PBL’li 60 yaþýnda erkek, HIV negatif ve immün kompetan hastamýza uyguladýðýmýz tedavi ve takip süreci literatür bilgileri eþliðinde sunulmuþtur.

Plasmablastic lymphoma (PBL) is a rarely seen diffuse large B cell lymphoma variant associated with acquired immunodeficiency syndrome, oral mucosa localization, and a poor prognosis. There is not yet a standard protocol for the treatment of PBL; the treatment of a small number of human immunodeficiency virus (HIV)-negative cases has been reported in case reports and series and shared on a case-by-case basis. Presently described is the case of a 60-year-old man with PBL that originated in the sinus and spread to the orbit. The patient was HIV-negative and immunocompetent. The treatment and follow-up are presented in the context of the available literature.

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Kalsifik bursit, sýklýkla subakromial ve trokanterik bursada izlenmektedir. Omuzda gözlendiðinde hastalar genellikle istirahat, hareketlerle ve gece artan aðrý nedeniyle baþvurmakta, fizik muayenede omuz hareketleri kýsýtlanmaktadýr. Aðrý genellikle depozitin rezolüsyon fazýnda izlenmektedir. Kronik aðrý ayný zamanda kalsifikasyon nedeniyle oluþan enflamasyon sonucu oluþmaktadýr. Bursa, tendon gibi yapýlarda kalsifik lezyonlar her zaman MRG ve direkt grafilerde bulgu vermez, fizik muayene bulgularý da ayýrt edici olmamaktadýr. Büyük çamursu kalsifikasyonlar ve bursal kalsifikasyonlar ultrasonografi ile çok daha iyi saptanýr, küçük ve daðýnýk depozitlerin ise direkt grafide görülme oraný daha yüksektir. Birçok olguda aðrý birçok durumda steroid enjeksiyonlarýna dirençli olmaktadýr. Semptomlu hastalarda lezyonun iðne ile parçalanmasý, lavajý ve steroid enjeksiyonu ile çok kýsa sürede komplet iyileþme saðlanabilmektedir. Bu yazýda, subdeltoid bursa içinde kalsifik lezyonu ve bursiti olan hastanýn ultrason eþliðinde yapýlan giriþimle kalsifik lezyonun parçalanarak bursa içine lavaj yapýlmasý ve sonrasýnda steroid enjeksiyonu yapýlarak baþarýlý bir þekilde tedavisi sunuldu.

Calcific bursitis most commonly affects the subacromial and trochanteric bursae. Patients most often present at the hospital because of increased pain at night and when performing overhead activities. A physical examination of the shoulder typically reveals restriction in abduction and internal rotation. Pain is usually observed during the resorption phase of the deposit. Chronic pain is also related to the inflammatory process caused by calcification. Calcified lesions in a bursa or tendon are not always visible on an X-ray, and may not be apparent among physical examination findings. Small and scattered deposits can often be detected on an X-ray; however, a calcific slurry mass in the subacromial-subdeltoid bursa can be found more reliably with ultrasonography (US) than with plain film. Pain is often resistant to steroid injections. In symptomatic patients, US-guided fragmentation of the lesion with a needle, using a local anesthetic, saline lavage, and a steroid injection, can often achieve complete healing in a very short period of time. Presently described is successful treatment of a calcified lesion located in the subdeltoid bursa achieved by performing lavage, splitting the calcified lesion, and administering a steroid injection.

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