GÝRÝÞ ve AMAÇ: Bu prospektif klinik çalýþmanýn amacý septal deviasyon ameliyatý geçirecek hastalardaki zor havayolu insidansýný timpanoplasti operasyonu geçirecek hastalardaki zor havayolu insidansý ile karþýlaþtýrmak ve zor havayolu insidansýna etki eden faktörlerin belirlenmesidir. Septal deviasyon ameliyatý geçirecek hastalardaki zor havayolu için predispozisyon yaratan faktörlerin araþtýrýlmasý ikincil çýktý olarak deðerlendirilmiþtir.
YÖNTEM ve GEREÇLER: Çalýþmaya septoplasti (çalýþma grubu-Grup S) uygulanan 130 hasta ve timpanoplasti (kontrol grubu-Grup T) uygulanan 125 hasta olmak üzere toplam 255 katýlýmcý dahil edildi. Operasyon öncesi havayolu deðerlendirilmesi LEMON protokolü kullanýlarak yapýldý. Bütün hastalara uyku apne sendromu (UAS) risk tanýsý için STOP-BANG soru testi uygulandý. Laringoskopi sýrasýnda Cormack-Lehane laringeal görüntü dereceleri not edildi. Cormack-Lehane skalasýna göre zor havayolu tanýmlamasý yapýldý (I–II=kolay, III–IV=zor). Ek olarak kullanýlan entübasyon yöntemi, entübasyon deneme sayýsý, stile kullanýmý, krikoid basý ve airway kullanýmý kaydedildi.
BULGULAR: Bu çalýþma popülasyonunda entübe edilemeyen hasta olmadý. Cormack-Lehane skoru ve zor havayolu insidansý Grup S’de Grup T’ye göre anlamlý olarak daha yüksek bulundu (p<0.001). Mikrognati (p<0.001, OR: 9.38, 95% CI: 2.71– 45.93) ve UAS (p<0.001, OR: 58.013, 95% CI: 14.025–239.98) varlýðý septoplasti geçirecek hastalarda zor havayolu açýsýndan risk faktörü olarak bulundu.
TARTIÞMA ve SONUÇ: Havayolu operasyon öncesi zor entübasyon açýsýndan deðerlendirilmeli ve minör cerrahi bile olsa zor havayolu için risk faktörleri belirlenmelidir.

INTRODUCTION: The aim of this prospective clinical study was to compare the incidence of difficult airway in patients undergoing septal deviation with the incidence of difficult airway in patients undergoing tympanoplasty and to determine the factors associated with the incidence of the difficult airway. Investigation of predisposing factors for difficult airway in patients undergoing septal deviation surgery was evaluated as a secondary outcome.


METHODS: A total of 255 participants, 130 patients undergoing septoplasty (study group-Group S) and 125 patients undergoing tympanoplasty (control group-Group T) were included in this study. Preoperative airway evaluation was performed using the LEMON protocol. For all patients, the STOP-BANG questionnaire was performed to identify the risk of Obstructive Sleep Apnea Syndrome (OSAS). Cormack-Lehane laryngeal view grades were noted during laryngoscopy. The definition of difficult intubation was identified according to the Cormack-Lehane scale (I–II=easy, III–IV=difficult). Additionally, the intubation method used, number of intubation attempts, use of stylet, cricoid pressure, and usage of airway were recorded.
RESULTS: There were no unintubated patients in this study population. Cormack-Lehane score and incidence of difficult airway were significantly higher in the Group S than the Group T (p<0.001). Micrognathia (p<0.001, OR: 9.38, 95% CI: 2.71–45.93) and OSAS (p<0.001, OR: 58.013, 95% CI: 14.025–239.98) were found to be risk factors for difficult airway in patients undergoing septoplasty.
DISCUSSION AND CONCLUSION: The airway should be evaluated for difficult intubation before surgery and risk factors for difficult airway should be determined even in minor surgery.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Bu çalýþmadaki amaç, uterin sarkom tanýsý alan hastalarýn sosyodemografik özelliklerini ve bu hastalara klinik yaklaþýmý deðerlendirmektir.
YÖNTEM ve GEREÇLER: Bu çalýþmada Kadýn Hastalýklarý ve Doðum Kliniðimizde 1 Ocak 2004–1 Ocak 2014 tarihleri arasýnda uterin sarkom tanýsý alan 55 hasta geriye dönük olarak irdelendi. Hastalarýn týbbi dosyalarýna ulaþýlarak sosyodemografik veriler, hastalýðýn taný ve tedavi süreçlerinde uygulanan yöntemler araþtýrýldý. Hastalar telefonla aranarak hastalýðýn progresyonu ve rekürrens ile ilgili bilgilerine ulaþýldý. Saðlýk bakanlýðý hasta ölüm bildirim raporlarýna ulaþýlarak hasta ölüm tarihleri belirlendi ve bulgular istatiksel olarak analiz edildi.

BULGULAR: Otuz bir karsinosarkom (%56.4), 15 leiomyosarkom (%27.3), altý endometrial stromal sarkom (%11), üç adenosarkom (%5.5) olmak üzere toplam 55 uterin sarkom tanýlý hasta deðerlendirmeye alýndý. Ortalama yaþ 60.75±12.74 (yaþ aralýðý 33–86) idi. Kýrk üç hasta (%78.2) postmenopozal dönemde idi. Yirmi altý hasta (%47.3) endometrial örnekleme, 17 hasta (%31) frozen patolojik inceleme, 11 hasta abdominal histerektomi (%20) ve bir hasta abdominal miyomektomi (%1.8) tanýsý aldý. Taný anýnda üç hastada uzak metastaz saptandý. FIGO 2009’a göre evrelenen hastalarýn %65.5’inin evre-1 olduðu saptandý. Cerrahi operasyona giden hastalarýn %58.5’i jinekolog-onkolog tarafýndan ameliyat edildi. Elli iki hasta (%94.5) total abdominal histerektomi ve iki taraflý salpingooferektomi oldu. Yirmi sekiz hastaya (%51) pelvik lenf nodu disseksiyonu yapýldý. Ortalama saðkalým süresi karsinosarkomda 47 ay, leiomyosarkomda 49.6 ay, endometrial stromal sarkomda 84.8 ay, adenosarkomda 68.7 ay olarak hesaplandý. Verilerin toplandýðý ocak 2019 tarihine kadar 37 hasta (%67.3) hayatýný kaybetti.

TARTIÞMA ve SONUÇ: Uterus sarkomlarý nadir izlenen, erken evrede bile prognozu kötü olan tümörlerdir. Her bir histolojik tip ayrý ayrý deðerlendirilmelidir. Uterus sarkomlarýnda temel tedavi cerrahi olarak kabul görmüþtür. Adjuvan tedavilerin rolü tartýþmalýdýr.

INTRODUCTION: The present study aims to evaluate the sociodemographic characteristics and clinical management of patients with uterine sarcoma.
METHODS: Retrospective analysis of 55 patients, who were diagnosed with uterine sarcomas between January 1, 2004–January 1, 2014, was performed. Sociodemographic characteristics, methods used in diagnosis and treatment processes were investigated by accessing the medical files of the patients. All patients were contacted by telephone to obtain information about disease progression and recurrence. Patients’ death reports were obtained from the national database of the Ministry of Health and the findings were analyzed statistically.

RESULTS: In this study, 55 cases of uterine sarcoma, of whom 31 carcinosarcomas (56.4%), 15 leiomyosarcomas (27.3%), six endometrial stromal sarcomas (10.9%) and three adenosarcomas (5.5%) were analyzed. The median age was 60.75±12.74 (min-max: 33–86). Forty-three (78.2%) patients were in postmenopausal period. Twenty-seven (47.3%) of these patients were diagnosed by endometrial sampling, 17 (30.9%) patients were diagnosed by frozen section, 11 (20%) patients were diagnosed by hysterectomy and one (1.81%) patient was diagnosed by myomectomy. Three patients had distant metastases at the time of diagnosis. According to FIGO (International Federation of Gynecology and Obstetrics) 2009, 65.5% of the patients were diagnosed at stage 1. 58.5% of the patients who underwent surgery were operated by gynecologist-oncologist. Total abdominal hysterectomy with bilateral salping-oopherectomy was performed in 52 patients (94.5%). Pelvic lymph node dissection was performed in 28 patients (51%). The mean survival time was 47 months in carcinosarcoma, 49.6 months in leiomyosarcoma, 84.8 months in endometrial stromal sarcoma and 68.7 months in adenosarcoma. Until the last date of collecting data, January 2019, 37 patients (67.3%) died.

DISCUSSION AND CONCLUSION: Uterine sarcomas are rare tumors with poor prognosis even in the early stages. Each histological type should be evaluated separately. Surgery is the main treatment method in uterine sarcoma. The role of adjuvant therapy is controversial.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Doðum sonrasý kanama tüm dünyada önemli bir sorundur ve maternal ölüm oranýný azaltmak için çözülmesi gerekmektedir. Amacýmýz doðum sonrasý kanamayý jinekolojik anamnez yoluyla tahmin etmekti.
YÖNTEM ve GEREÇLER: Kasým 2017-Temmuz 2018 tarihleri arasýnda prospektif gözlemsel bir kesit çalýþmasý yapýldý. Doðum için baþvuran tüm hastalar deðerlendirildi ve gruplandý. Grup 1 (n=240), düzenli adetleri olduðunu ve kanama bozukluðu öyküsü olmadýðýný iddia eden hastalardan oluþturuldu. Grup 2 (n=60), anormal uterin kanamasý olan (menstrüasyonda >80 mL kanama ve/veya 8 günden daha uzun süreli adet dönemi ve/veya 24 günden daha kýsa süreli siklus ve/veya adetler arasý kanama) hastalardan oluþuyordu ve baþka bir kanama bozukluðu öyküsü yoktu. Hastalar kanama diatezi açýsýndan araþtýrýldý.
BULGULAR: Ortalama yaþ 28.77±5.88 yýl ve ortalama doðum öncesi hemoglobin deðeri 11.76±1.36 mg/dl idi. Hastalarýn 118'i (%39.3) vajinal doðum, 182'si (%60.7) sezaryen ile doðum yaptý. Ortalama doðum sonrasý hemoglobin deðeri 10.71±1.49 mg/dl idi. Grup 1'de doðum öncesi ve doðum sonrasý hemoglobin deðerleri Grup 2'ye göre daha yüksekti (sýrasýyla, p=0.001 ve p=0.003). Anormal uterin kanama (AUK), prepartum (r=0.222, p=0.000) ve postpartum hemoglobin deðerleri ile koreleydi (r=0.171, p=0.030). Grup 1'de postpartum ve postpartum hematokrit deðerleri Grup 2'den yüksek bulundu (sýrasýyla, p=0.001 ve p=0.021). AUK, doðum sonrasý kanama ile iliþkili bulunmadý. Fetal sonuçlarla alakalý olarak (1. dakika ve 5. dakika APGAR skoru, yenidoðan YBÜ giriþ ve doðum aðýrlýðý), sadece yenidoðan YBÜ kabulü, anormal uterin kanamaya sahip olmakla anlamlý þekilde iliþkiliydi (p=0.03).
TARTIÞMA ve SONUÇ: Doðum sonrasý kanama her zaman öngörülebilir bir durum deðildir ve doðum öncesi anormal uterin kanama anamnezi olan hastalarýn hemoglobin düzeylerinin doðum öncesi ve doðum sonrasýnda daha düþük olmasý beklenebilir.

INTRODUCTION: Postpartum bleeding is a life-threatening obstetric problem all over the world, which needs to be well managed to reduce maternal mortality. In this study, we aim to predict postpartum bleeding by menstrual cycles of the patients.
METHODS: A prospective, observational, cross-sectional study was conducted between November 2017 and July 2018. All the patients that gave labour in our clinic were evaluated and grouped. Group 1 (n=240) consisted of the patients with regular menstrual cycles, and they had no history of bleeding disorders, Group 2 (n=60) consisted of the patients with abnormal uterine bleeding as >80 mL bleeding in a period, having period before 24 days, >8 days of bleeding in a period or intermenstrual bleeding. However, they had no other history of bleeding disorder. All the patients were screened for bleeding diathesis.
RESULTS: The mean age was 28.77±5.88 years and the mean prepartum hemoglobin was 11.76±1.36 mg/dl. 118 (39.3%) of the patients had a vaginal delivery and 182 (60.7%) had a cesarean delivery. The mean postpartum hemoglobin was 10.71±1.49 mg/dl. Group 1 had higher prepartum and postpartum hemoglobin than Group 2 (p=0.001 and p=0.003, respectively). Abnormal uterine bleeding (AUB) was correlated with prepartum (r=0.222, p=0.000) and postpartum hemoglobin (r=0.171, p=0.030). AUB was not significantly related to postpartum bleeding. Regarding fetal outcome, only neonatal intensive care unit admission was significantly related to abnormal uterine bleeding history (p=0.03).
DISCUSSION AND CONCLUSION: Postpartum bleeding is not always a predictable status, and patients with abnormal uterine bleeding history should be expected to have lower hemoglobin levels prepartum and postpartum.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Perkütan nefrolitotomi operasyonlarýnda, amplatz dilatatörlerle yapýlan one shot dilatasyon tekniði ile konvansiyonel ardýþýk dilatasyon tekniði uygulanan hastalarýn sonuçlarýný karþýlaþtýrmayý amaçladýk
YÖNTEM ve GEREÇLER: Ocak 2016 ile Haziran 2018 tarihleri arasýnda perkütan nefrolitotomi operasyonu yapýlan 213 hastanýn verileri retrospektif olarak deðerlendirildi. Ardýþýk dilatasyon yapýlan olgular Grup 1, one shot dilatasyon yapýlan olgular ise Grup 2 olarak ayrýldý. Tüm hastalar operasyondan önce kontrastsýz bilgisayarlý tomografi ile deðerlendirildi. Perkütan nefrolitotomi iþlemi deneyimli endourologlar tarafýndan gerçekleþtirildi. Hastalara postoperatif 3. ayda bilgisayarlý tomografi ile kontrol yapýldý. Bilgisayarlý tomografide 4 mm’den büyük taþ kalan hastalarýn perkütan nefrolitotomi iþlemi baþarýsýz kabul edildi. Bilgisayarlý tomografi de hiç rezidü olmamasý veya 4 mm’den küçük taþ varlýðý taþsýzlýk olarak kabul edildi. Gruplar demografik özellikleri, operasyon süresi, skopi süresi hemoglobin deðiþim miktarý, komplikasyonlarý (modifiye clavien sýnýflamasý ile), hastanede kalma süresi ve operasyon baþarýsý yönünden karþýlaþtýrýldý.

BULGULAR: Gruplar arasýnda operasyon verileri, taþsýzlýk oranlarý ve komplikasyonlar açýsýndan istatistiksel olarak anlamlý farklýlýk yoktu. One shot dilatasyon grubunda ortalama hastanede kalýþ süresi daha kýsa olarak tespit edildi (p<0.001).
TARTIÞMA ve SONUÇ: Konvansiyonel ardýþýk dilatasyon tekniði, toplam floroskopi zamaný, komplikasyon oranlarý ve cerrahi baþarý oraný açýsýndan amplatz dilatörlü one shot dilatasyon tekniðiyle benzerdir.

INTRODUCTION: In this study, we aimed to compare the results in patients undergoing the one-shot dilatation (OD) technique and the conventional serial dilatation (SD) technique with amplatz dilators in percutaneous nephrolithotomy (PNL) operations.
METHODS: We retrospectively evaluated the data of 213 patients who had undergone PNL between January 2016 and June 2018. The patients who had undergone SD were classified as Group 1 and the patients undergoing OD as Group 2. All of the patients had undergone contrast-free computed tomography (CT) before the operation. The PNL procedure was performed by experienced endo-urologists. Follow-up CT was performed in the 3rd postoperative month. The PNL procedure was considered unsuccessful in patients who had a stone larger than 4 mm on the CT scan. The patients were accepted as 'stone free' when there was no residual stone or there was a stone less than 4 mm in diameter on the CT scan. The groups were compared concerning demographic characteristics, operation duration, fluoroscopy duration, amount of hemoglobin change, complication rate (according to the modified Clavien classification), length of hospital stay and the operation success rate.
RESULTS: There was no statistically significant difference between the groups concerning operation data, rate of stone-free patients and complication rates. The mean length of hospital stay was shorter in the OD group (p<0.001).
DISCUSSION AND CONCLUSION: The conventional SD procedure is similar to the OD procedure with amplatz dilators concerning the total fluoroscopy time, complication rates and the surgical success rate.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: 2008 yýlýnda Amerikan Anestezistler Biriliði (ASA) tarafýndan hasta güvenliðini artýrmak amacýyla bir ameliyat öncesi kontrol listesi kýlavuzu yayýmlandý. Çalýmamýzda bu kýlavuzu kullanarak bilginin klinik pratiðe aktarýlmasý için, eðitim sürecinde kullanýlan video bazlý geri bildiriminin etkinliðini ve uygulanabilirliðini belirlemeyi amaçladýk.
YÖNTEM ve GEREÇLER: On anestezi asistaný, kýdemlerine göre iki yýl altý ve iki yýl üstü olmak üzere iki gruba ayrýldý. Hazýrlýk, anestezi indüksiyonu ve hava yolu yönetimi tamamlandýðýnda, ASA kontrol listesine göre video bazlý geri bildirim verildi. Asistanlarýn bilgi ve beceri düzeyleri deðerlendirildi. Video bazlý geri bildirimden iki ay sonra bir baþka hastada tüm basamaklar tekrar edildi. Sonuçlar kontrol listesi skoru ile karþýlaþtýrýldý, her bir kýlavuz maddesi analiz edildi.

BULGULAR: Katýlýmcýlarýn yaþlarý 27–34 aralýðýnda (28.9±2.28 yaþ) beþi kadýn beþi erkekti. Kýdemli ve kýdemsiz asistanlarýn video bazlý geri bildirim öncesi ve sonrasý deðerlendirme sonuçlarý benzerdi. Her iki grupta da geribildirim sonrasý baþarý puaný, geribildirim öncesi baþarý puanýndan anlamlý derecede yüksekti (p<0.05).
TARTIÞMA ve SONUÇ: Genel anestezi indüksiyonu sýrasýnda, hava yolu yönetimi öncesindeki ASA kontrol listesi prosedürünün video aracýlý geri bildirim ile klinik pratiðe baþarýyla kazandýrýlabileceði gösterildi. Bu metodun rutin anestezi asistan eðitim programýna katýlmasýyla hasta güvenliðinin artýrýlabilceði sonucuna varýldý.

INTRODUCTION: A preoperative checklists guide was issued in 2008 by the American Society of Anesthesiologists (ASA) to improve patient safety. We aimed to determine the applicability and effectiveness of video-based feedback for the transfer of knowledge into clinical practice by using this guide.
METHODS: Ten anesthesia residents were divided into two groups according to their seniority, under two years and over two years. Once the preparation, anesthesia induction and airway management steps were completed, video-based feedback was given according to the ASA checklist. The knowledge level and skills of the residents were evaluated. Two months after the video-based feedback, all steps were repeated in another patient. The results were compared with a checklist score. Each guideline item was analyzed.
RESULTS: The ages of participants varied between 27–34 years (28.9±2.28 years), five were female, and five were male. Results of the pre and post video-based feedback evaluations of the residents were statistically similar in the senior and junior groups. The post-feedback achievement score in both groups was significantly higher than the pre-feedback achievement score (p<0.05).
DISCUSSION AND CONCLUSION: It has been shown that the ASA Checklist Procedure before airway management during general anesthesia induction can be successfully put into clinical practice with video-based feedback. We concluded that patient safety could be increased by the integration of this method into the routine anesthesia resident training program.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Açýk radikal sistoprostatektomi (RS) sonrasý 90 günlük komplikasyon oranýný ve üç aylýk mortalite oranýný standart bir metodoloji kullanarak bildirmek.
YÖNTEM ve GEREÇLER: Ayný ameliyat ekibi tarafýndan Mart 2008–Aralýk 2017 tarihleri arasýnda ameliyat edilen 209 RS erkek hastanýn verileri geriye dönük olarak incelendi. Hastalarýn özellikleri, klinik sonuçlarý, patolojik parametreleri ve cerrahi güçlük reflektörleri geriye dönük olarak hastane saðlýk kayýtlarýndan toplandý. Ameliyat sonrasý komplikasyonlar Clavien-Dindo sýnýflamasýna göre derecelendirilirken, Martin kriterleri komplikasyonlarý bildirmek için kullanýldý. Ýstatistiksel analizler için SPSS 22.0 sürümü kullanýldý.
BULGULAR: Yüz doksan sekiz hastanýn 143’ünde (%72.2) toplam 239 komplikasyon geliþti. Bu komplikasyonlarýn otuz dokuzu (%19.7) ameliyat
sonrasý otuzuncu günden sonra meydana geldi. Ortalama ameliyat süresi 412.6± (300–485) idi. Ortalama EBL 1107±617.3 mL (400–3600) idi. Genel ortalama hastanede kalýþ süresi 19.2±7.3 gündü (7–30). Perioperatif transfüzyon hastalarýn %78.8’ine verildi (n=156). Kýrk bir hastada (%20.7) majör komplikasyonlar (Clavien 3–5) gözlendi. En sýk görülen komplikasyon kategorileri gastrointestinaldi (%28.8). En sýk görülen komplikasyon ileus idi, hastalarýn %21.2’sinde meydana geldi.
TARTIÞMA ve SONUÇ: Radikal sistoprostatektominin morbiditesini tanýmlamak için daha uzun bir takip süresinin deðerlendirilmesini desteklemektedir. Raporlama kriterlerinin standartlaþtýrýlmasý, çalýþmalar arasýnda doðrudan karþýlaþtýrma yapýlmasýna olanak saðlayacaktýr. Standart bir raporlama metodolojisi kullandýktan sonra komplikasyon oranlarý, bu metodolojileri kullanmayan çalýþmalara kýyasla daha yüksekti.

INTRODUCTION: This study aims to evaluate the 90-day complication rate and 3-month mortality after open radical cystoprostatectomy using a standardized method to report complications.
METHODS: We retrospectively reviewed the data of 209 RC male patients operated by the same surgical team between March 2008 and December 2017 in our institution. Patients’ characteristics, clinical outcome, pathological parameters and reflectors of surgical difficulty were retrospectively collected from the hospital medical record. Postoperative complications were graded according to the Clavien-Dindo classification, whereas Martin criteria were used to report complications. SPSS version 22.0 was used for the statistical analyses.
RESULTS: A total of 239 complications developed in 143 of the 198 patients (72.2%). Thirtynine (19.7%) of these complications occurred after thirty days postoperatively. The mean operation time was 412.6± minutes (300–485). Mean EBL was 1107±617.3 ml (400–3600). Overall mean hospitalization time was 19.2±7.3 days (7–30). Perioperative transfusion was given in 78.8% of the patients (n=156). Major complications (Clavien 3-5) were observed in 41 (20.7%) patients. The most common complication categories were gastrointestinal (28.8%). Ileus was the most common complication, occurring in 21.2% of the patients.
DISCUSSION AND CONCLUSION: Our results support the consideration of a more extended follow-up period to define the morbidity of RC. The standardization of the reporting criteria for complications will allow direct comparisons between studies. The complication rates after utilizing a standard reporting methodology were higher compared to studies that do not employ such methodologies.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Kan kültürlerinin yaklaþýk %5 kadarýnda üreme gösterilebilen selülit olgularýnda olasý baktereminin tedavi öncesi akut faz reaktanlarýnýn düzeyi ile iliþkisinin araþtýrýlmasý ve kan kültürü ile doku/yara/apse kültürlerinin karþýlaþtýrýlarak etken mikroorganizmayý göstermedeki yerinin deðerlendirilmesi amaçlandý.
YÖNTEM ve GEREÇLER: 1 Ocak 2015 ve 31 Aralýk 2016 tarihleri arasýnda enfeksiyon hastalýklarý ve klinik mikrobiyoloji kliniðinde selülit tanýsý ile yatan 18 yaþ ve üzeri hastalarýn medikal kayýtlarý hastane otomasyon sistemi üzerinden geriye dönük olarak incelendi. Diyabetik ayak enfeksiyonlarý, dekübit enfeksiyonlarý, zonaya eþlik eden selülitler ve eþlik eden baþka sistem enfeksiyonlarý olan hastalar çalýþmaya dahil edilmedi. Hastalarýn tedavi öncesi vücut ýsýsý, lökosit sayýsý, C-reaktif protein ve eritrosit sedimantasyon hýzý, kültür sonuçlarý, yatýþ öncesi aldýklarý
antibiyotikler, yatýþlarýnda baþlanan empirik tedaviler, tedavi süreleri, komorbid hastalýklarý ve klinik yanýtlarý kaydedildi.
BULGULAR: Çalýþmaya 194 hasta dahil edildi. Yüz kýrk üç hastadan tedavi öncesi kan kültürü alýndýðý ve bunlardan sadece dokuzunda (%6.30) üreme olduðu saptandý. Buna karþýlýk doku/ yara kültürü alýnan 35 olgunun 17’sinde (%48.6) üreme olduðu görüldü. Ýlk baþvurudaki ortalama beyaz küre sayýsý bakteremik olmayan hastalarda 13.9x103/mm3 iken, bakteremik hastalarda 15.2x103/mm3 idi. Ýlk baþvurudaki ortalama C-reaktif protein deðeri ise bakteremik olmayan grupta 148 mg/L iken, bakteremik grupta 164 mg/L saptandý. Ancak her iki parametre için de fark istatistiksel olarak anlamlý bulunmadý. Bununla birlikte ilk baþvuruda ortalama eritrosit sedimantasyon hýzý kanda üreme olmayan ve olan grupta sýrasýyla 56.5 mm/h ve 92 mm/h olarak bulundu (p=0.03).
TARTIÞMA ve SONUÇ: Selülit olgularýnda baþvuruda ateþ olsa bile kan kültürünün etiyolojiye yönelik yeterli klinik fayda saðlamadýðý; bunun yerine apse, yara,
bül sývýsý, doku kültürü gibi enfeksiyon bölgesinden kültür örneði alýnmasýnýn etiyolojik ajaný göstermede daha yararlý olacaðý kanýsýna varýldý. Laboratuvar göstergelerden eritrosit sedimantasyon hýzý yüksekliðinin özellikle 67.5 mm/h ve üzeri deðerlerin bakteremiyi iþaret etmesi açýsýndan daha anlamlý olduðu saptandý.

INTRODUCTION: This study aims to investigate the relationship between bacteremia and the level of acute phase reactants in cellulite cases and to evaluate the value of blood culture and tissue/wound/abscess cultures in determining causal microorganism.
METHODS: The adult patients were included in this study, who were hospitalized with a diagnosis of cellulitis between January 1, 2015, and December 31, 2016. Patients’ medical records revealed from computer based hospital system, retrospectively. Patients with diabetic foot
infections, decubitus infections, cellulite accompanying shingles and other concomitant system infections were excluded from this study. Before antibiotic treatment, patient’s body temperature, leukocyte count, c reactive protein level, erythrocyte sedimentation rate, culture
results, antibiotic treatment before hospitalization, empirical antibiotic treatment in hospital, treatment duration, comorbidities and clinical response data were collected.
RESULTS: There were 194 patients in this study. Blood cultures collected from 143 patients before antibiotic treatment. Nine of 143 (6.3%) patient’s blood cultures were positive. On the other hand, results of the tissue/wound cultures were positive in 17 of the 35 cases (48.6%). Mean white blood cell count at the first admission was 13.9x103/mm3 in non-bacteremic group and 15.2x103/mm3 in bacteremic group. Mean C-reactive protein level at the first admission was 148 mg/L in non-bacteremic group and 164 mg/L in bacteremic group. There was no statistical significance between these two acute phase marker and bacteremia in cellulitis cases. However, mean erythrocyte sedimentation rate was 92 vs 56.5 mm/h respectively in bacteremic and non-bacteremic patient (p=0.03).
DISCUSSION AND CONCLUSION: In the cases of cellulitis, blood culture did not provide sufficient clinical benefit for the etiology even the presence of fever. It was concluded that taking culture samples from infection site, such as abscess, wound and tissue culture, would be more useful for identification of the etiologic agent.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Çeþitli çalýþmalarda, kronik kalp yetersizliðinde görülen morbidite ve mortalitenin artýþýnýn kortizol düzeyleri ile ilgili olduðu göserilmiþtir. Bu çalýþmada kronik kalp yetersizliði olan hastalarda hastanede yatýþ sýrasýnda ve bundan 48 saat sonra alýnan kortizol ölçümlerinin takip sürelerinde erken ve geç mortaliteyle iliþkisinin bakýlmasý amaçlandý.
YÖNTEM ve GEREÇLER: Çalýþmaya kalp yetersizliði tanýsý bulunan 66 hasta dahil edildi (36 kadýn, 30 erkek). Ýlk kortizol ölçümü hasta yatýþ için baþvurduðunda, ikinci kortizol ölçümü ilk ölçümden 48 saat sonra yapýlmýþtýr. Ýlk altmýþ gün içinde ölen hastalar erken mortalite ve 60-180 gün içinde ölenler geç mortalite olarak kabul edildiler
BULGULAR: Altý aylýk takip sonrasýnda 66 hastanýn 18’i hayatýný kaybetti. Ýlk kortizol ölçümleri mortalite grubunda sað kalan hastalara göre yüksek bulundu (18.84±5.39 ve 15.47±4.95; p=0.028). ölüm oraný NYHA sýnýf III-IV (p=0.033), erkek cinsiyet (p=0.045), vücut kitle indeksi yüksek (VKI) (p=0.036), olan gruplarda yüksek iken hipertansiyonu bulunan hasta grubunda daha düþük bulundu. Cinsiyet, VKI, NYHA sýnýfý, hipertansiyon ve Cox regresyon analizinde, yüksek NYHA sýnýfý 2.614 [1.017-6.717] (p=0.046), hipertansiyonun olmamasý 0.358 [0.139–0.921] (p=0.033) ve kortizol düzeyleri 5.091 [1.757-14.774] (p=0.003) mortaliteyi öngören faktörler olarak bulundu.
TARTIÞMA ve SONUÇ: Sonuç olarak, yüksek serum kortizol düzeyleri kronik kalp yetersizliði olan hastalarda erken ölüm riskinin baðýmsýz bir belirleyicisidir. Sýnýf III-IV NYHA olmasý yanýnda hipertansiyon varlýðýnýn bulunmamasýda diðer belirlenmiþ risk faktörleri olarak gösterilmiþtir.

INTRODUCTION: In several studies, chronic heart failure has shown to be associated with cortisol levels as increasing morbidity and mortality. The present study aims to evaluate the relationship between serum cortisol levels measured at hospitalization and 48 hours after the first sample with the early and late mortality rate at follow up period in patients with chronic heart failure.
METHODS: Overall, 66 patients (36 female, 30 male) admitted with the diagnosis of heart failure were included in this study. First cortisol level measurement at the admission, and the second after 48 hours were made. Patients who died within the first sixty days were considered as early mortality and patients who died within 60–180 days as late mortality.
RESULTS: After six months of follow up, overall, 18 out of 66 patients died. First, cortisol levels were established to be higher in the mortality group than the patients survived (18.84±5.39 vs 15.47±4.95; p=0.028). The mortality rate was also found to be higher in the groups with NYHA class III-IV (p=0.033), in male sex (p=0.045), in the group with higher BMI (p=0.036), while it was found to be lower in the patients with hypertension group. In cox regression analysis with a model of gender, BMI, NYHA stage, Hypertension and cortisol levels, it was established that high NYHA stage 2.614 [1.017–6.717] (p=0.046), lack of HT 0.358 [0.139–0.921] (p=0.033) and high cortisol levels 5.091 [1.757–14.774] (p=0.003) were factors predicting mortality.
DISCUSSION AND CONCLUSION: In conclusion, a high level of serum cortisol is an independent predictor of early cause mortality risk in patients with chronic heart failure. Class III-IV NYHA and lack of HT were found to be other established factors influencing mortality rate of these patients.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý retinal ven dal týkanýklýðýnda makula ödemi tedavisinde kullanýlan intravitreal deksametazon implantýn (Ozurdex ®, Allergan, Irvine, CA) multifokal elektroretinogram (mfERG) deki etkinliðini gözlemleyerek Ozurdex’in retinanýn fonksiyonel yapýsýndaki etkinliðini incelemektir.
YÖNTEM ve GEREÇLER: Çalýþmamýza Kasým 2013–Kasým 2014 tarihleri arasýnda retinal ven dal týkanýklýðý (RVDT) nedeniyle Ozurdex implant uyguladýðýmýz 17’si erkek toplam 42 hasta dahil edildi. Bütün hastalara Ozurdex uygulamasý öncesinde snellen eþeline göre düzeltilmiþ en iyi görme keskinliði, biomikroskopik muayene, optik koherent tomografi ile makuler kalýnlýk ve mfERG ölçümleri yapýldý. Hastalar deksametazon implant öncesi ve sonrasý altýncý ayda mf ERG testi uygulandý.
BULGULAR: Etkilenen kadranlarda ve ringlerde mfERG deðiþiklikleri istatsitiksel olarak anlamlý bulunmadý (p>0.05). RVDT nedeniyle etkilenen kadranda implisit zamaný implantasyon öncesi 38.74±3.76 ms iken implantasyon sonrasý 38.08±2.66 ms, olarak ölçüldü. Tüm ringlerde ve etkilenen kadranlarda p dalgasýnýn implisit zamaný kýsalmýþ olsa da bu durum istatistiksel olarak anlamlý bulunmadý.
TARTIÞMA ve SONUÇ: Daha önce yapýlan çalýþmalarda Ozurdex sonrasý birinci ve üçünvü aylarda mfERG de anlamlý fonksiyonel etki görülmediði raporlanmýþtýr. Bu çalýþmada RVDT hastalarýnda Ozurdex sonrasý altýncý ayda görme keskinliðinde anlamlý artýþ, santral makula kalýnlýðýnda anlamlý azalma görülmesine raðmen mfERG de anlamlý fonskiyonel deðiþiklik görülmediði sonucuna varýldý.

INTRODUCTION: This study aims to investigate functional changes in the macula by multifocal electroretinography (mfERG) following intravitreal dexamethasone implant for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO).
METHODS: Forty-two patients treated with intravitreal dexamethasone implant (Ozurdex®, Allergan, Irvine, CA) for macular edema secondary to branch retinal vein occlusion (17 male, 25 female, mean age: 58.4±10.3 years) were included this study. All patients had a detailed ophthalmological examination, including determination of best-corrected visual acuity, slitlamp examination, dilated fundus examination, optical coherence imaging of the macula and multifocal electroretinography. These examinations were performed in all cases before the intravitreal injection of dexamethasone implant, and the patients were followed with these modalities until six months after implantation.

RESULTS: The mfERG changes in rings and effected quadrants were not statistically significant (p>0.05). Implicit times in affected quadrants were 38.74±3.76 ms and 39.88±3.63 ms in preimplantation period and were measured as 38.08±2.66 ms, 38.57 ms in the post-implantation
period. Although p wave implicit times in all rings and effected quadrants were relatively shorter, the difference was not statistically significant (p>0.05).
DISCUSSION AND CONCLUSION: Previous reports with first and third month results showed no significant change in mfERG findings in patients with BRVO in the short term. In this study, although a significant increase in visual acuity and a significant decrease in central macular thickness were observed in six months after Ozurdex in BRVO patients, no significant functional change was observed in mfERG.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Diyabetik maküla ödemi (DMÖ) nedeniyle intravitreal bevacizumab tedavisi uygulanan hastalarda baþlangýç retina hacminin son görme keskinliði (GK) ve harf kazanýmý (HK) ile iliþkisini araþtýrmak.
YÖNTEM ve GEREÇLER: Klinik olarak anlamlý DMÖ nedeniyle intravitreal bevacizumab enjeksiyonu yapýlan 19 hastanýn 28 gözü geriye dönük olarak incelendi. Spektral-domain optik koherens tomografi (SD-OKT) ile ölçülen baþlangýç retina hacmi (RH) ve santral retinal kalýnlýðýnýn (SRK) bir yýl sonundaki GK ve harf kazanýmý ile iliþkisi incelendi.
BULGULAR: Baþlangýç GK 58.9±11.9 harf, SRK 564.2±125.1 µm ve baþlangýç RH 12.4±2.3 mm3 iken final GK 67.4±11.6 harf, SRK 410.2±124.2 µm ve final RH 10.6±2.2 mm3 idi (sýrasýyala, p=0.001, p<0.001, p<0.001). Ortalama 9.7±2.3 enjeksiyon sonrasýnda birinci yýlda ortalama +8.5 harf kazanýmý saðlandý. Final GK ile baþlangýç RH ve baþlangýç GK korale bulundu (sýrasýyla; r=-0.542 p=0.003 ve r=0.485 p=0.009). Harf kazanýmý ise sadece baþlangýç GK ile korale bulundu (r=-0.528, p=0.004). Çoklu regresyon analizi sonrasýnda harf kazanýmý ve final GK’ye etki eden faktörlerin baþlangýç GK ve baþlangýç RH olduðunu bulundu (p<0.001).
TARTIÞMA ve SONUÇ: Diyabetik maküla ödeminde baþlangýç RH’nin intravitreal anti-VEGF tedavisi yanýtýnýn belirlenmesinde SRK’dan daha anlamlý bir faktör olduðunu görülmüþtür. Objektif ve kantitatif bilgi saðlayan bu gibi veriler görsel prognoz tayini, tedavi ve takip stratejisinin planlanmasý açýsýndan yol gösterici olabilir. Tedavi yanýtýný etkileyebilen, olasý prognostik faktörler: maküla iskemisi ve vitreoretinal arayüz patolojileri, kistoid dejenerasyon, sert eksuda varlýðý gibi morfolojik özellikler de göz önünde bulundurulmalýdýr.

INTRODUCTION: To assess the effects of initial retinal volume (RV) on visual acuity (VA) after intravitreal bevacizumab treatment for diabetic macular edema (DME).
METHODS: The data of 28 eyes of 19 patients treated with bevacizumab for clinically significant diabetic macular edema were retrospectively evaluated in this study. The association of visual acuity and letter gain with initial retinal volüme (RV) and central retinal thickness (CRT) after one year of treatment were evaluated.
RESULTS: Baseline VA was 58.9±11.9 letters; CRT was 564.2±125.1 µm and baseline RV was 12.4±2.3 mm3. At 12 months; VA was 67.4±11.6 letter; CRT was 410.2±124.2 µm and RV was 10.6±2.2 mm3 (p=0.001, p<0.001 and p<0.001, respectively). Following 9.7±2.3 injections, the mean VA gain at month 12 was +8.5 letters. Visual acuity after one year of treatment was correlated with baseline RV and baseline VA (r=-0.542 p=0.003 and r=0.485 p=0.009, respectively). The letters gain was correlated only with the baseline VA (r=-0.528, p=0.004). A multiple regression analysis was performed to investigate the relationship between the baseline VA, RV, CRT, serous macular detachment, age, the number of the injections, and letter gain and final VA. The factors significantly affecting the letters gain and final VA were baseline VA and baseline RV (p<0.001).
DISCUSSION AND CONCLUSION: Baseline retinal volume seems to be an important factor predicting the response to anti-VEGF treatment in DME. Such objective and quantitative data would allow us to be more certain when discussing prognosis, treatment and monitoring strategies. Presumed prognostic factors as: macular ischemia, vitreoretinal interface abnormalities, cystoid degeneration and hard exudates should also be considered.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Son yýllarda artan karbapenem direnci ile birlikte Klebsiella pneumoniae enfeksiyonlarý ülkemizde ve tüm dünyada önemli bir saðlýk problemi haline gelmiþtir. Bu çalýþmada, Klebsiella pneumoniae bakteriyemilerinde karbapenem direnci için risk faktörlerini belirlemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Aralýk 2016–Mayýs 2018 tarihleri arasýnda kan kültüründe Klebsiella pneumoniae üremesi olan hastalar ileriye yönelik olarak çalýþmaya dahil edildi. Olgular karbapenem direnç durumuna göre gruplara ayrýlarak; tek ve çok deðiþkenli regresyon modeli ile karbapenem direnci için risk faktörleri analiz edildi.
BULGULAR: Çalýþmaya dahil edilen 53 olgunun; 27’si karbapenem dirençli, 26’sý ise karbapenem duyarlý Klebsiella pneumoniae izolatý ile enfekte idi. Yapýlan tek deðiþken analiz sonuçlarýna göre; hastaneye yatýþ öyküsü [p=0.043; Odds ratio (OR)=3.20; %95 güven aralýðý (%95 GA): 1.04–9.85], yoðun bakým ünitesinde (YBÜ) yatýyor olmak (p=0.001; OR=10.91; %95 GA 2.61–45.6), beta-laktam/beta-laktam inhibitörü kombinasyonu kullanýmý (p<0.001; OR=41.67; %95 GA 7.57–229.2), glikopeptid kullanýmý (p=0.001; OR=7.92; %95 GA 2.31–27.1) Klebsiella pneumoniae bakteriyemilerinde karbapenem direnci için istatistiksel olarak anlamlý bulundu. Çok deðiþkenli analiz sonucunda ise; hastaneye yatýþ öyküsü (p=0.016; OR=9.64; %95 GA: 1.54–60.46), beta-laktam/beta-laktam inhibitörü kombinasyonu kullanýmý (p<0.001; OR=38.45; %95 GA 6.04–244.85) karbapenem direnci açýsýndan anlamlý baðýmsýz risk faktörü olarak saptandý.
TARTIÞMA ve SONUÇ: Yaptýðýmýz çalýþmada, hastanede yatýþ öyküsü, beta-laktam/beta-laktamaz inhibitörü kombinasyonu kullanýmý Klebsiella pneumoniae bakteriyemilerinde karbapenem direnci için en önemli risk faktörü olarak bulunmuþtur.

INTRODUCTION: In recent years, carbapenem-resistant Klebsiella pneumoniae infections have become an important health problem in our country and all over the world. In this study, we aimed to identify the risk factors of carbapenem-resistant K. pneumoniae bacteremia.
METHODS: Patients who suffered from Klebsiella pneumoniae bacteremia between December 2016 and May 2018 were included prospectively in this study. Patients were divided into groups according to carbapenem resistance and risk factors were analyzed under variable and multivariable logistic regression model.
RESULTS: Of the fifty-three patients were included in this study, 27 patients infected with carbapenem-resistant K. pneumoniae and 26 patients infected with carbapenem-suspectible K. pneumoniae. Risk factors for carbapenem-resistant K. pneumoniae bacteremia according to univariate analysis were listed prior hospitalization (p=0.043; OR=3.20; 95% CI: 1.04–9.85), admission to intensive care unit (p=0.001; OR=10.91; 955 CI: 2.61–45.6), use of beta-lactams/beta-lactamase inhibitor combination (p<0.001; OR=41.67; 95% CI: 7.57–229.2) and use of glycopeptides (p=0.001; OR=7.92; 95% CI: 2.31–27.1). Before hospitalization (p=0.016; OR=9.64; 95% CI: 1.54–60.46) and use of beta-lactams/beta-lactamase, inhibitor combination (p<0.001; OR=38.45; 95% CI: 6.04–244.85) were identified as independent risk factors for carbapenem resistance in multivariate analysis.
DISCUSSION AND CONCLUSION: According to our study, before hospitalization, the use of beta-lactams/beta-lactamase inhibitor combination was the major risk factor for carbapenem-resistant Klebsiella pneumoniae bacteremia.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Polio geçiren hastalarda azalmýþ kas tonusu, sýnýrlý ambulasyon, asimetrik tutulum, gecikmiþ büyüme ve kullanmama osteoporozu ile karakterize alt ekstremite paralizisinin genel sekelleri vardýr. Kullanmama osteoporozu riski taþýyan bu hastalar ayný zamanda osteoporotik kýrýk geçirme riski altýndadýrlar. Bu çalýþmanýn amacý, ekstramedüller internal fiksasyon cihazlarýnýn polio iliþkili osteoporotik femoral kýrýklarda daha iyi sonuçlar elde etmedeki etkinliðini deðerlendirmektir.
YÖNTEM ve GEREÇLER: Toplam 13 yetiþkin polio hastasý geriye dönük olarak deðerlendirildi. Tek taraflý proksimal ve diyafizer femur kýrýðý için ekstra medüller internal fiksasyon cihazlarý ile tedavi edildi. Tüm hastalarýn fonksiyonel durumlarý Vignos sakatlýk derecesi ile deðerlendirildi.
BULGULAR: Tüm hastalar (ort. yaþ 62; daðýlým 47–88) ekstra-medüller iç fiksasyon cihazlarý ile tedavi edildi. Sekiz diyafizer kýrýða kilitli plak uygulandý. Proksimal femur kýrýklarýnýn üçü kayan kondil vidasý ile ve ikisi kayan kalça vidasý ile tedavi edildi. Ortalama takip süresi 48.6 aydý (daðýlým 26–62 ay). Kemik kaynama süresi tüm hastalarda ortalama 3.7 ayda (daðýlým, 3–5 ay) tespit edildi. Bir hastada masif pulmoner emboli görüldü. Kaynamama, materyal yetmezliði veya baþka herhangi bir komplikasyon görülmedi.
TARTIÞMA ve SONUÇ: Polio geçirmiþ olan hastalar yüksek kýrýk riski taþýr. Ekstra medüller internal fiksasyon cihazlarý, polio ile iliþkili femur kýrýklarý için uygun stabiliteyi ve iyi fonksiyonel sonuçlarý saðlar.

INTRODUCTION: Polio survivors have common sequelae of lower extremity paralysis characterized by flaccid muscle tone, limited ambulation, asymmetric involvement, retarded growth, and disuse osteoporosis. Such patients at risk of disuse osteoporosis are also at risk of sustaining osteoporotic fractures. This study aims to evaluate the effectiveness of extramedullary internal fixation devices in achieving better results in osteoporotic polio-related femoral fractures.
METHODS: Retrospective evaluation was made of a total of 13 adult polio patients treated with extramedullary internal fixation devices for unilateral proximal and diaphyseal femoral fractures. The functional status of all patients was evaluated with the Vignos grade of disability.
RESULTS: All patients (mean age 62 years; range 47–88 years) were treated with extramedullary internal fixation devices (locked plate in eight diaphyseal fractures; dynamic condylar screw (DCS) and plate in three, and dynamic hip screw (DHS) and plate in two proximal femoral fractures). The mean follow-up period was 48.6 months (range 26–62 months). Bony union was confirmed at a mean of 3.7 months (range, 3–5 months) in all patients. Massive pulmonary embolism was seen in one patient. No cases of non-union, implant cutout or any other complications developed.
DISCUSSION AND CONCLUSION: Post-polio patients are at high risk of fractures. Extramedullary internal fixation devices provide effective stability for bony union and good functional results in polio-related femoral fractures.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Astým hastalýðýnýn tedavisinde, hastalýðýn tedavi ile kontrol altýnda tutulmasý hedeflenmektedir. Astým kontrol testi (AKT) günümüzde en çok kullanýlan, hastalar ve aileleri tarafýndan da kolayca anlaþýlan ve astýmýn iyi veya kötü seyirde olduðunu gösteren önemli bir testtir. Bu test klinik pratikte hasta tarafýndan doldurulmaktadýr. Çalýþmanýn amacý AKT’nin hekim tarafýndan doldurulmasýnýn sonucu nasýl etkileyeceðinin ve sonuçlarýn klinik ve fonksiyonel parametreler ile uyumunun deðerlendirilmesidir.
YÖNTEM ve GEREÇLER: Çalýþmaya hastanemiz göðüs hastalýklarý polikliniðine Haziran–Aðustos 2016 tarihleri arasýnda baþvuran ve en az bir yýldýr astým tanýsý olan hastalar dahil edildi. Hastalarýn demografik özellikleri, fizik muayene bulgularý, solunum fonksiyon testi deðerleri, almakta olduklarý astým tedavisi, eðitim durumlarý, aylýk gelirleri ve çalýþma durumlarý kayýt edildi. Hastalar poliklinik muayenesi öncesi kendileri AKT cevapladýlar. Ayný test muayene sýrasýnda hastaya doktor tarafýndan tekrar soruldu. Ýki testin sonuçlarýnýn birbirleri ile uyumu, bunu etkileyen faktörler ve AKT sonuçlarýnýn klinik ve fonksiyonel parametreler ile olan iliþkisi SPSS 17.0 ile istatistiksel olarak deðerlendirildi.
BULGULAR: Çalýþmaya yaþ ortalamalarý 38.8±13.6 (14–76) yýl olan, 58 (%55) kadýn 47 (%44.8) erkek toplam 105 astým hastasý alýndý. Olgularýn AKT ortalama puaný 14.5±5.8, hekim tarafýndan yapýlan testte ise 13.9±4.4 idi. Olgularýn 33.3’ü üniversite, %23.8’i lise, %38.1’i ilkokul, %4.8’i ise ortaokul mezunu idi. Astým kontrol testinin hekim tarafýndan doldurulmasý ile hasta tarafýndan doldurulmasý arasýnda sonuçlarda istatistiksel olarak anlamlý bir fark olduðu görüldü (p=0.02). Hastanýn eðitim durumunun bunu etkileyen en önemli faktör olduðu saptandý. Hekim tarafýndan yapýlan AKT’nin sonuçlarýnýn klinik ve fonksiyonel parametreler ile daha uyumlu olduðu saptandý.
TARTIÞMA ve SONUÇ: Çalýþmamýz bize eðitim düzeyi düþük olan toplumlarda AKT’nin hekim tarafýndan yapýlmasýnýn astým kontrolü ile daha uyumlu sonuçlar verebileceðini gösterdi. Bu amaçla astým çalýþma gruplarýnýn çok merkezli ve daha geniþ hasta sayýsý ile çalýþmalar yapmasýnýn yol gösterici olacaðýný düþünüyoruz.

INTRODUCTION: In the management of asthma disease, the aim is to keep the disease under control with treatment. Asthma control test (ACT) is the most widely used and important test that is easily figured out by the patients. This test is filled by the patient during the clinical practice. The present study aims to evaluate how the filling of ACT by the physician will affect the outcome and the concordance of results with clinical and functional parameters.
METHODS: Patients who applied to the Outpatient Clinic of Chest Diseases in our Hospital between dates of June–August 2016 and who had at least one year of asthma diagnosis were included in this study. The patients filled their own answers to the ACT before the outpatient clinic examination. The same test was given to the patients by the doctor during physical examination.
RESULTS: A total of 105 asthma patients were included in this study whose mean age was 38.8±13.6 (14–76) years, 58 (55%) of them were female and 47 (44.8%) of them were male. Mean ACT score of the cases was 14.5±5.8, while it was 13.9±4.4 in the tests filled by the doctor. 33.3% of the cases were college graduates, 23.8% of them were high school graduates, 38.1% of them were primary school graduates, and 4.8% of them were middle school graduates. A statistically significant difference was detected (p=0.02) between the results of asthma control tests filled by the doctor and that of those filled by the patients. It was detected that the status of education of the patient was the factor with the highest impact on the situation. It was found that ACT results filled by doctors were in higher concordance with clinical and functional parameters.
DISCUSSION AND CONCLUSION: Our study demonstrated that ACT being filled by the doctor in societies with lower levels of educational status would yield results that were in higher concordance with asthma control.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Hasta güvenliði sorunu çok faktörlüdür. Günümüzde konu ile iliþkili çalýþmalar kurumlar ve saðlýk profesyonelleri tarafýndan yapýlan hatalar üzerine odaklanmýþtýr. Çalýþmamýz, genellikle göz ardý edilen hastalarýn kendileriyle iliþkili tutum ve davranýþlarýnýn sebep olduðu güvenlik sorunlarýný ortaya koyabilmek amacýyla tasarlanmýþtýr.
YÖNTEM ve GEREÇLER: Hasta güvenliðinde hasta tutum ve davranýþlarýnýn deðerlendirilmesine yönelik 300 hasta ve yakýnýna anket uygulanmýþ ve sonuçlar analiz edilmiþtir.
BULGULAR: Çalýþma sonuçlarý deðerlendirildiðinde, katýlýmcýlarýn dörtte üçü saðlýk sorunu yaþadýklarýnda hastaneye baþvurduklarýný beyan etmiþlerdir. Buna karþýlýk katýlýmcýlarýn yarýsýndan fazlasý saðlýk profesyonelleri tarafýndan tedavi ve bakýmlarý konusunda bilgilendirilmediklerini bildirmiþlerdir.
TARTIÞMA ve SONUÇ: Hasta güvenliði ile iliþkili sorunlarla baþ etmenin önemli bir unsuru da hastalarýn tutum ve davranýþlarýnýn dikkate alýnmasýdýr. Sonuç olarak, saðlýk profesyonellerinin tedavi ve bakým süreçlerinde hasta ile ilgili olasý güvenlik endiþelerine yönelik çözüm önerileri geliþtirmeleri önemlidir.

INTRODUCTION: Patient safety is a multi-factorial issue although the literature focused on the errors of health professionals. This study aims to disclose the safety problems that arise from patients’ attitudes and behaviors.
METHODS: To evaluate the patient attitudes and behaviors in patient safety practices, 300 patients or patient relatives were interviewed, and data were analyzed in this study.
RESULTS: Approximately 3/4 of the participants declared that they applied to a hospital in case of a health problem. More than half of the participants expressed that they were not informed about their treatment and care.
DISCUSSION AND CONCLUSION: An important component of coping with problems related to patient safety is to notice about patient attitudes and behaviors. Consequently, it is important for health care professionals to develop suggestions on patient-related safety concerns during treatment and care processes.

Abstract | Full Text PDF

Þilotoraks çeþitli nedenlerle oluþabilir. Non-Hodgkin lenfoma ve intratorasik cerrahi travma en sýk nedenlerdir, olgularýn yaklaþýk %15’i idiyopatiktir. Ýdiyopatik þilotoraksýn minimal travma ile iliþkili olduðu düþünülmektedir ve beþinci torasik vertebra seviyesinin üstündeki hasarlarda sol hemitoraksta efüzyona yol açtýðý bilinmektedir. Olgumuzda, hastanýn geçmiþ týbbi öyküsünün derinlemesine sorgulanmasýyla tanýmlanan bir etiyolojiye sahip bir sol tarafta þilotoraks tespit ettik. Hastanýn öyküsünde; birkaç gün önce, sol koluyla aðýrlýk çalýþýrken, anteriyor skalen kas bölgesinde ciddi bir aðrý yaþadýðýný öðrendik. Subklavius ve anteriyor skalen kasýnýn aþýrý gerilmesinin sol lenfatik kanalýn rüptürüne yol açabileceðini düþündük. Aðýrlýk kaldýrma sonrasý travmatik þilotoraks nadir görülen bir durumdur. Sýradýþý plevral efüzyon olgularýnda taný için farkýndalýk ve þüphe önemlidir.

Chylothorax cases are associated with several etiologies. Non-Hodgkin lymphoma and intrathoracic surgical trauma are the most frequent reasons, but approximately 15% of the cases are idiopathic. Idiopathic chylothorax is thought to be related to minor trauma, and damage above the fifth thoracic vertebra is known to lead to left-sided effusion. In this report, we describe a left-sided chylothorax with an etiology that was finally identified by an in-depth interrogation of the patient’s past medical history. Several days previously, while he was weight training with his left arm, he experienced serious pain in his scalenus anterior muscle area. We thought that overstretching of the subclavious and anterior scalenus muscle might have led to the rupture of the left lymphatic duct. Traumatic chylothorax after weight lifting is a rare entity. Awareness and a high degree of suspicion are important in cases of unusual pleural effusion.

Abstract | Full Text PDF

Miyokart infarktüsü (MI) birçok komplikasyona sebep olabilir. Spinal infarkt MI’nin nadir komplikasyonlarýndan olmasýna raðmen nörolojik semptomlarla gelen hastalarda özellikle akýlda tutulmasý gerekir.

Myocardial infarctions (MI) has many complications and spinal infarction is one of them. Although spinal infarction is rare, we should keep in mind that spinal infarction is a possible complication after MI.

Abstract | Full Text PDF

Okronozis homogentisik asit ve metabolitlerinin eklem kýkýrdaðý, deri ve sklera gibi konnektif dokularda birikimiyle karakterize bir tablodur. Taný genellikle dejeneratif artrit, okronotik pigmentasyon ve idrar renginin alkalizasyonu sonucu siyahlaþmasýndan oluþan klinik triad ile konur. Okronozisde en önemli morbidite nedenlerinden biri okronotik artropati olduðu için, taný alan iki olguyu sunmayý amaçladýk. Olgulardan birinin kalça ve diz, diðerinin diz eklemlerinde ileri derecede dejeneratif deðiþiklikler mevcuttu. Operasyon materyallerinin makroskopik incelemesinde eklem yüzeylerinde siyah renk deðiþikliði dikkati çekti. Histopatolojik incelemede; kahverenkli pigment içeren kýkýrdak lakünleri, yumuþak dokuda inflamatuar infiltrat ile birlikte kahverenkli pigment birikimi gözlendi. Klinik öyküleri sorgulandýðýnda; küçüklüklerinden beri idrarlarýnýn koyu renkli olduðu ve iç çamaþýrlarýna idrar temasý sonucunda siyah renkte leke oluþtuðu ifade edildi. Tüm bulgular birlikte deðerlendirildiðinde okronotik artropati tanýsý alan iki olgu nadir görülmeleri nedeniyle literatür verileri eþliðinde gözden geçirildi.

Ochronosis is an entity characterized by deposition of homogentisic acid and metabolites in connective tissues, such as joint cartilage, skin and sclera. Ochronosis is generally diagnosed by a clinical triad of degenerative arthritis, ochronotic pigmentation and urine color turning black upon alkalization. Since ochronotic arthropathy is one of the most important morbidity causes in ochronosis, in this study, we aimed to present two cases diagnosed. One of two cases we present had advanced degenerative alterations in both hip and knee, and the other case had advanced degenerative alterations in knee joints. Macroscopical examination of the resection materials revealed black pigmentation on joint surfaces. Histopathologically, cartilage lacunes filled with brown pigment and inflammatory infiltration, as well as brown pigmentation in soft tissue, were observed. Clinical history revealed that the patients had dark urine since childhood and they detected dark spotting at their underwear. As all findings evaluated together, these two rare cases, which are diagnosed as ochronotic arthropathy, reviewed in the light of the literature.

Abstract | Full Text PDF

Ektima, impetigonun ülseratif formu olup, lezyon epidermis ve dermisin derin kýsmýna doðru ilerlemiþtir. Lezyonlarýn üzerinde çoðu zaman krutlar bulunur ve krut kaldýrýldýðýnda altta pürülan ülsere zemin ortaya çýkar. Bu yazýmýzda, çocuk polikliniðine bacaklarýnda ektima lezyonlarý ile baþvuran ve ayýrýcý taný açýsýndan þarbon bildirimi de yapýlan bir hastayý sunmaktayýz. On yaþ altý aylýk erkek hasta bacak bölgesinde topikal tedaviye cevap vermeyen ciltten kabarýk kimi sulu sarý renkli, kimi siyah renkli kabuklu, etraflarý belirgin hiperemik beþ adet lezyon ile baþvurdu. Hastanýn fizik muayenesinde cilt lezyonlarý dýþýnda patolojik bulgu yoktu. Laboratuvar incelemelerinde Lökosit: 9900/mm3, Hb: 13.6 g/dL, trombosit: 478000/mm3, C-reaktif protein: 8.6 mg/L (0–3.5 mg/L) olarak saptandý. Biyokimyasal deðerleri normal sýnýrlarda bulundu. Ayný gün dermatolojiye de konsülte edilen hastada ön planda ektima düþünüldü. Ayýrýcý taný açýsýndan yarasýndan alýnan yara kültürü, hem piyojen kültüre, hem de þarbon açýsýndan hastanemiz sürveyans birimi aracýlýðýyla Halk Saðlýðý Müdürlüðü’ne hem Polimeraz Zincir Reaksiyonu (PZR) hem de kültür çalýþýlmak üzere gönderildi. Hastanýn önceden bilinen penisilin alerjisi olduðu öðrenildiði için tedavisi klindamisin intravenöz ve siprofloksasin oral olarak düzenlendi. Yara kültüründe Streptococcus pyogenes üremesi olduðu öðrenildi. Þarbon bildirim sonucu negatif gelen hastanýn siprofloksasin tedavisi kesilerek, tedavisine klindamisin intravenöz olarak devam edildi. Yatýþýnýn 10. gününde genel durumu iyi olan, lezyonlarý tamamen kabuklanýp, çevresinde eritem kalmayan hastanýn tedavisinin 10 güne tamamlanarak kesilmesi planlandý. S. pyogenes halen penisilin direnci geliþtirmeyen antibiyotiklere duyarlý bir mikroorganizma olmakla birlikte komplikasyonlarý nedeniyle hýzlý bir þekilde tedavisi edilmesi gerekmektedir.

Ecthyma is a form of ulcerative impetigo which erodes through epidermidis and dermis. Mostly, the crusts are found on the lesions, and when the crust is removed, there is a purulent ulcer at the bottom. Herein, we report a patient who presented with ecthyma lesions on his legs to the outpatient clinic and had cutaneous anthrax reporting for differential diagnosis. A 10-year, 6-month old boy admitted to the hospital with five lesions with some of them are wet yellowish-colored, and some of them crusted in black color, surrounded with the hyperemic area on the leg which did not respond to topical treatment. In physical examination, he had no other pathological sign. The laboratory results showed a white blood cell (WBC) count of 9900/mm3, a hemoglobin level of 13.6 g/dL, platelet count of 478000/mm3 and C-reactive protein of 8.6 mg/L (0–3.5 mg/L. Biochemical values were normal. The patient was consulted the Department Dermatology and ecthyma was the primary diagnosis. However, cutaneous anthrax was in a differential diagnosis. Thus, we sent two swabs, one swab for PCR and one swab for culture. Because of penicillin allergy of the patient, clindamycin and ciprofloxacin were started. Streptococcus pyogenes yielded in culture and tests for anthrax were negative. Thus, we stopped ciprofloxacin and clindamycin therapy continued. On the day of 10th, the patient was discharged because of the crusted lesions with no hyperemic area. S. pyogenes is still susceptible to penicillin; however, it may cause severe complications. Thus, it should be treated promptly.

Abstract | Full Text PDF

Abstract | Full Text PDF