GÝRÝÞ ve AMAÇ: Rinit medikamentoza (RM), çoðunlukla topikal dekonjestanlarýn uzun süreli, aþýrý ve yanlýþ kullanýmý ile iliþkili, alerjik olmayan bir rinit þeklidir. Günümüzde bilinen tek etkin tedavi yöntemi nazal steroidlerdir. Çalýþmamýzda, RM’de ortaya çýkan mukozal deðiþikliklerin sürfaktan tatbiki ile geri dönüþümünü saðlamayý amaçladýk. Ayrýca, sürfaktanýn etkinliðini karþýlaþtýrmak amacýyla farklý gruplara farklý moleküller de uygulandý.
YÖNTEM ve GEREÇLER: Otuz sýçan beþ gruba ayrýldý. Tüm gruplar 30 gün boyunca %0.05 topikal oksimetazolin ile tedavi edildi. Silya kaybý, konjesyon, ödem, goblet hücre artýþý ve mukus bezlerindeki artýþ, skuamöz metaplazi ve kronik enflamatuvar hücre infiltrasyonu ana parametreler olarak belirlendi. Beþinci gruptaki sýçanlar RM ile uyumlu mukozal deðiþikliklerin varlýðýný kanýtlamak amacýyla sakrifiye edildi. Histopatolojik inceleme döneminde (15 gün), kalan gruplara oksimetazolin uygulanmaya devam edildi. Tedavi yöntemleri Grup 1’de salin yýkamasý (%0.09 NaCl), Grup 2’de mometazon furoat monohidrat 50 μg %0.05, Grup 3’te sürfaktan yýkama çözeltisi 1 damla/100 cc ve Grup 4’te mometazon furoat monohidrat ile intranazal sürfaktan birlikte 15 gün boyunca uygulandý. Altmýþýncý günün sonunda tüm sýçanlar dekapite edilerek histopatolojik deðerlendirme için patolojiye gönderildi.
BULGULAR: Salin ve mometazon furoat ile tedavi edilen gruplarda nazal mukozal konjesyonda anlamlý gerileme izlendi (p=0.005). Silya kaybý regresyonu deðerlendirilmesinde, gruplar arasýnda anlamlý bir fark görülmedi; ancak beklenmedik þekilde salin grubunda %83 oranýnda gerileme görüldü. Ödemin tedavisi için sürfaktan/mometazon furoat kombinasyon tedavisinin anlamlý derecede etkisiz olduðu bulundu (p=0.013). Kronik enflamatuvar hücre infiltrasyonu açýsýndan gruplar arasýnda istatistiksel fark bulunmadý (p=0.115). Tüm tedavi gruplarýnda rastlantýsal olarak skuamöz metaplazi saptandý ancak gruplar arasýnda istatistiksel olarak anlamlý bir fark izlenmedi (p=0.076).
TARTIÞMA ve SONUÇ: Sürfaktan veya sürfaktanýn nazal steroid ile kombinasyonu, RM tedavisinde anlamlý etkinliðe sahip deðildir.

INTRODUCTION: Rhinitis medicamentosa (RM) is a nonallergic form of rhinitis, mostly associated with prolonged, excessive, and improper use of topical decongestants. The only effective treatment for this is nasal steroids. This study aimed to reverse the mucosal changes in RM by the use of surfactant. Different molecules were applied to each group to compare surfactant’s effectiveness.
METHODS: Thirty rats were divided into five groups. All groups were treated with topical oxymetazoline 0.05% for 30 days. Loss of cilia, congestion, edema, goblet cell growth, and increase in mucous glands, squamous metaplasia, and chronic inflammatory cell infiltration were set as the main parameters. Rats in group 5 were sacrificed; all proved the presence of mucosal changes in compliance with RM. All groups were continued to be treated with oxymetazoline even during the histopathological examination period of 15 days. Treatment modalities of each group for 15 days were as follows: saline wash (0.09% NaCl) in group 1, mometasone furoate monohydrate 50 μg 0.05% in group 2, surfactant wash solution 1 drop/100 cc in group 3, and intranasal surfactant solution with mometasone furoate monohydrate 0.05% in group 4. All rats were decapitated and sent for histopathological evaluation at the end of day 60.
RESULTS: A significant regression in the nasal mucosal congestion was found in groups treated with saline and mometasone furoate (p=0.005). No significant difference was found between groups when evaluating for regression of loss of cilia but unpredictably was seen in saline group by 83%. Surfactant/mometasone furoate combination therapy was found to be significantly ineffective for treatment of edema (p=0.013). No statistical difference was found between the groups in terms of chronic inflammatory cell infiltration (p=0.115). Squamous metaplasia was observed in all treatment groups, and there was no statistically significant difference between the groups (p=0.076).
DISCUSSION AND CONCLUSION: Surfactant or its combination with nasal steroid is not significantly effective in the treatment of RM.

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Amaç: Random paternli cilt flepleri sýklýkla plastik cerrahi pratiðinde ilk tercih edilen fleplerdir, ancak flebin angiogenezi sýrasýnda distal kýsmýnda meydana gelen nekroz ek cerrahilere ihtiyaç duyulmasýna sebep olur. Tedavinin uzamasý iþ gücü, zaman ve moral açýsýndan maliyetlidir. Random paternli cilt fleplerinin yaþayabilirliðinin arttýrýlmasý için birçok ilaç araþtýrýlmýþtýr ve bunlarýn etkileri ile ilgili her ne kadar tatmin edici sonuçlar elde edilmiþ olsa da; bu ilaçlarýn sistemik kullanýmýna ve yüksek maliyetine baðlý potansiyel yan etkiler klinik kullanýmlarýný kýsýtlamýþtýr. Bu çalýþmada, random paternli cilt fleplerinin yaþayabilirliðinin arttýrýlmasý için kapsaisinin etkisi çalýþýlmýþtýr.

Gereç ve Yöntem: 60 adet, 180-230 gr aðýrlýðýndaki erkek Wistar Albino sýçan sýrtýnda (deney grubu: n=30; kontrol grubu: n=30) random paternli McFarlane cilt flepleri oluþturuldu ve ardýndan yerine iade edildi. Deney grubundaki fleplere 7 gün süreyle postoperatif dönemden baþlayarak ve topikal olarak günde 2 kez kapsaisin %0,1 krem uygulandý. Fleplerdeki nekroz oraný Sasaki’nin ‘papertemplate’ yöntemi ile deðerlendirildi.

Bulgular: Deney grubundaki fleplerin nekrotik kýsmýnýn total flebe oraný %22.9 ± %8.94 iken kontrol grubunda %36.8 ± %10.05 olarak tespit edildi. Polimorfonükleer lökosit infiltrasyonu, kapiller proliferasyon, lenfosit oraný ve diðer parametrelerin analizi; deney grubunda kapsaisin krem uygulanmasýnýn flep yaþayabilirliðine pozitif etkisi olduðunu göstermiþtir.

Sonuç: Deney grubunda flep distalinde önemli ölçüde daha az nekroz gözlendi. Elde edilen sonuçlara göre %0.1’lik kapsaisin kremin topikal uygulanmasý ile random paternli cilt fleplerinde flep yaþayabilirliðinin arttýðý tespit edildi. Ancak bireyler arasýnda, türler arasýnda ve ayný bireyde uygulanan bölgeler arasý oluþan farklýlýklar, klinik kullaným için daha geniþ çalýþmalarýn yapýlmasý gerekliliðini ortaya koymaktadýr.

Objective: Random flaps are often the first choice of technique in plastic surgery, however, necrosis developing in the distal portion of the flap during angiogenesis may necessitate additional surgery. Prolonged treatment is expensive in terms of labor, time, and morale. Several drugs have been investigated as a means of improving the viability of random flaps, and while satisfactory results have been reported, potential side effects due to systemic use and high costs have prevented widespread clinical use. This study examined capsaicin as a resource for improved viability and angiogenesis in random flaps.

Methods: Random-pattern, dorsal, McFarlane skin flaps were created in 60 male Wistar albino rats weighing 180–230 g (experimental group: n=30; control group: n=30) and sutured back into place. Capsaicin 0.1% cream was applied on the flap postoperatively and topically twice daily for 7 days in the experimental group. The necrosis rate was calculated using Sasaki’s paper template method.

Results: The ratio of the necrotic portion of the flap to the total flap was 22.9±8.94% in the experimental group and 36.8±10.05% in the control group. Analysis of polymorphonuclear leukocyte infiltration, lymphocyte ratio, capillary proliferation, and other parameters indicated that the application of capsaicin cream had a positive effect on flap viability in some zones in the experimental group.

Conclusion: Significantly less necrosis was seen in the experimental group. The results suggest that capsaicin 0.1% cream may increase the viability of random pattern skin flaps. However, differences in transdermal application characteristics between species, between individuals, and even between regions in a single individual demonstrate the need for additional studies.

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Amaç: Alfa lipoik asidin serebral vazospazm üzerindeki koruyucu etkilerini subaraknoid kanama ile deneysel bir sýçan modeli oluþturarak ve bu veriler üzerinde biyokimyasal, patolojik ve histomorfometrik analiz yaparak inceledik.

Gereç ve Yöntem: Toplam 28 Albino Wistar sýçaný rastgele dört gruba (her biri n=7) aþaðýdaki þekilde gruplandýrýldý: Grup (G) 1, deneysel müdahale yok; Subaraknoid kanamaya maruz kalan G2; Subaraknoid kanamaya maruz kalan ve fizyolojik salin (100 mg/kg) uygulanan G3; ve G4, subaraknoid kanamaya tabi tutulmuþ ve alfa lipoik asit (100 mg/kg) ile uygulanan.

Bulgular: Ýlaç gruplarý (G3 ve G4) arasýnda lipit peroksidasyonunun son ürünü olan malondialdehit seviyelerinde istatistiksel olarak anlamlý bir azalma gözlenmedi. Ayrýca, ilaç gruplarý (G3 ve G4) arasýnda endojen bir antioksidan enzim olan paraoksonaz düzeylerinde istatistiksel bir artýþ olmamýþtýr. Baziler arter ince kesitlerinin morfolojik incelemesinde, subaraknoid kanama gruplarýnda (G2 ve G3) þiddetli luminal daralma ve damar duvarý kalýnlaþmasý gözlendi. Alfa lipoik asit uygulanan grupta (G4) damar duvarý kalýnlýðý ölçümleri, diðer subaraknoid kanama gruplarýna (G2 ve G3) kýyasla istatistiksel olarak anlamlý bir fark göstermemiþtir; bununla birlikte G4, G3’ten daha büyük lümen çaplarýna sahipti.

Sonuç: Bu bulgular alfa lipoik asidin malondialdehitle iliþkili lipit peroksidasyonu ve paraoksonaz aktivitesi üzerinde bir etkisi olmadýðýný; ancak subaraknoid kanamayý takiben serebral vazospazm tedavisinde baziler arter lümen çaplarý üzerinde olumlu etkileri olduðunu göstermektedir.

Objective: This study is an examination of the protective effects of alpha-lipoic acid (ALA) on cerebral vasospasm in an experimental rat model with subarachnoid hemorrhage (SAH) using biochemical, pathological, and histomorphometric analyses.

Methods: A total of 28 albino Wistar rats were randomly categorized into 4 groups (n=7 each): Group (G)1, no experimental intervention; G2, subjected to SAH; G3, subjected to SAH and given physiological saline (100 mg/kg); and G4, subjected to SAH and treated with ALA (100mg/kg).

Results: No statistically significant decrease in malondialdehyde level, the end product of lipid peroxidation, was observed among the drug groups (G3 and G4). Furthermore, there was no statistical increase in paraoxonase level, an endogenous antioxidant enzyme, among the drug groups (G3 and G4). Thin sections of the basilar artery were morphologically examined, and severe luminal narrowing and vessel wall thickening were observed in the SAH groups (G2 and G3). In the ALA group (G4), vessel wall thickness measurements revealed no statistically significant difference compared with the other SAH groups (G2 and G3); however, G4 rats were found to have larger luminal diameters than those in G3.

Conclusion: These findings suggest that ALA had no effect on malondialdehyde-associated lipid peroxidation and paraoxonase activity; however, it had a favorable effect on basilar artery luminal diameter in the treatment of cerebral vasospasm following SAH.

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GÝRÝÞ ve AMAÇ: COVID-19 pandemisi Çin’den baþlayarak hýzla tüm dünyaya yayýlmýþ ve asemptomatik formdan solunum yetersizliði ve mortaliteye kadar giden geniþ bir yelpazede klinik seyir göstererek pek çok ülkede saðlýk sisteminde önemli derecede zorlanmalara neden olmuþtur. COVID-19 dýþý enfeksiyonlara benzer olarak, yaþ ve komorbiditeler gibi obezite de hastalýðýn klinik seyrini etkileyebilir. Çalýþmamýzda COVID-19 pnömonisi ile takip edilen hastalarýmýzda kilolu olmanýn ve obezitenin, hastalýðýn klinik seyri ve mortalite üzerine etkisinin araþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: 11 Mart–30 Nisan 2020 tarihleri arasýnda COVID-19 enfeksiyonlu hastalar geriye dönük olarak incelendi. Hastalarýn elektronik ve yazýlý dosyalarýndan yaþ, cinsiyet, ek hastalýklarý, vücut kitle indeksleri (VKÝ), noninvaziv mekanik ventilasyon (NIMV) ve invaziv mekanik ventilasyon (ÝMV) ihtiyaçlarý ve mortalite durumlarý kaydedildi. O2 ihtiyaçlarý, NIMV, IMV ihtiyaçlarýna göre aðýr ve hafif klinik seyirli iki gruba ayrýldý. Hastalar BMI ≥25 kg/m2 ve ≥30 kg/m2 olarak iki gruba ayrýlarak hastalýðýn seyri deðerlendirilmiþtir.
BULGULAR: Çalýþmaya dahil edilen 125 olgunun 82’si (%65.6) erkek ve yaþ ortalamasý 51.77±4.99 idi. VKÝ ortalamasý 27.76±4.76 kg/m2 idi. Aðýr ve hafif seyirli hastalarýn VKÝ ortalamasý arasýndaki fark istatistiksel olarak anlamlýydý (sýrasýyla, 28.8±5.36 ve 26.9±4.10) (p=0.028). Aðýr seyirli olgularýn %43.4’ünün VKÝ ≥30 kg/m2 iken hafif klinik seyirli olgularýn %20.8’i VKÝ ≥30 kg/m2 idi ve istatistiksel olarak anlamlýydý (p=0.007). Altmýþ beþ yaþýnýn üzerinde ve VKÝ ≥25 kg/m2 olan 17 hastanýn %70.6’sý aðýr klinik seyir göstermiþti (p=0.021). NIMV ihtiyacý olan hastalarýn %59.1’inin VKÝ ≥25 kg/m2, %31.8’inin VKÝ ≥30 kg/m2 dir. ÝMV ihtiyacý olan hastalarýn %66.7’inin VKÝ ≥25 kg/m2, %37.5’inin VKÝ ≥30 kg/m2 dir. VKÝ ile NIMV ve ÝMV ihtiyacý arasýnda istatistiksel olarak anlamlý fark bulunamadý. Hastalarýn %14.8’i hayatýný kaybetti. Hayatýný kaybeden ve yaþayan olgularýn VKÝ’leri arasýnda istatistiksel olarak anlamlý fark yoktu (p=0.768).
TARTIÞMA ve SONUÇ: Bu kohort çalýþmasý, aþýrý kilo ve obezitenin hastalýk þiddetini deðerlendirmede ve tahminde önemli bir faktör olduðunu ve özellikle VKI ≥30 kg/m2 olan hastalarýn takiplerinde dikkatli olunmasý gerektiðini göstermiþtir

INTRODUCTION: Coronavirus disease 2019 (COVID-19)-related infections emerging from China that spread worldwide show a wide range of clinical courses from asymptomatic presentation to respiratory failure and even death. Similar to non-COVID-19 infections, obesity, age, and comorbidities can also affect the clinical course of the disease. This study aimed to investigate the effect of obesity on the clinical course and mortality of patients hospitalized with COVID-19 pneumonia.
METHODS: Between March 11 and April 30, 2020, patients hospitalized with COVID-19 pneumonia were retrospectively analyzed. Patients were classified as having severe and mild disease based on oxygen, non-invasive mechanical ventilation (NIMV), and invasive (IMV) mechanical ventilation requirements. Two groups were evaluated based on body mass index (BMI) of ≥25 and ≥30 kg/m2.
RESULTS: Of the 125 patients, 82 (65.6%) were men, and their mean age was 51.77±4.99 years. Their mean BMI was 27.76±4.76 kg/m2. The difference of the mean BMI between the patients with severe and mild disease was statistically significant (28.8±5.36 and 26.9±4.10, respectively) (p=0.028). BMI of ≥25 and ≥30 kg/m2 were noted in 43.4% and 20.8% of patients with severe and mild disease, respectively, which was statistically significant (p=0.007). Moreover, 70.6% of 17 patients older than 65 years with BMI of ≥25 kg/m2 had a severe clinical course (p=0.021). Among patients requiring NIMV, 59.1% and 31.8% had a BMI of ≥25 and 30 kg/m2, respectively. Among patients requiring IMV, 66.7% and 37.5% had a BMI of ≥25 and 30 kg/m2, respectively. No statistically significant difference was found between BMI and NIMV and IMV need. Death occurred in 14.8% of the patients. No statistically significant difference was found between the BMI of those who died and survived (p=0.768).
DISCUSSION AND CONCLUSION: Bu kohort çalýþmasý, aþýrý kilo ve obezitenin hastalýk þiddetini deðerlendirmede ve tahminde önemli bir faktör olduðunu ve özellikle VKÝ ≥30 kg/m2 olan hastalarýn takiplerinde dikkatli olunmasý gerektiðini göstermiþtir.

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INTRODUCTION: Diabetes Mellitus Type 2 (DM2) is characterized by varying degrees of insulin resistance, impaired insulin secretion, and increased glucose production. Some people with DM2 have more complications such as nephropathy, retinopathy, and neuropathy. The earliest stage of renal impairment occurs with prolonged microalbuminuria. This study aimed to determine the incidence of the most common microvascular complications in DM2 patients.
METHODS: We retrospectively evaluated the data of 126 patients who had undergone treatment in 2014. It includes anamnesis, laboratory, and physical examination data from the patient histories. All patients with early stage DM2 were separated into two groups based on the presence of albuminuria: Group I - macroalbuminuria and Group II - microalbuminuria (<300 mg). Analysis and statistical processing of the collected data were performed to evaluate microvascular complications and determine the incidence of albuminuria in the studied population.
RESULTS: The prevalence of macroalbuminuria was 60.3% (76 patients). In both groups, as in the total sample, the frequency of women was higher (57.9%). The prevalence of macroalbuminuria was strongly influenced by age (≥65 years) of the patients (72.4%, average age = 69.8±11.1 years). Microalbuminuria has been proven to be an extremely significant marker for development of microvascular complications in DM2 (retinopathy 39.5%, neuropathy 52.6%, and nephropathy 54%).
DISCUSSION AND CONCLUSION: Early diagnosis of microvascular complications and an adequate therapeutic approach is needed to prevent disability. Therefore, it is important to introduce the screening for the presence of microalbuminuria in practice, which will identify patients at increased risk of developing microvascular complications.

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GÝRÝÞ ve AMAÇ: Post-dural ponksiyon baþ aðrýsý (PDPH) aðrý kontrolü zorlayýcý olabilir. PDPH tedavisinde epidural kan yamasý (EBP) önerilir. EBP kanama, enfeksiyon ve norolojik istenmeyen etkileri olan giriþimsel bir prosedürdür. Bu çalýþmada destekleyici PDPH tedavisine eklenen transnazal sfenopalatin gangliyon bloðunun (SPGB) etkisini deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Spinal anestezi altýnda sezaryen operasyonu geçiren ve PDPH geliþen gebe kadýnlar ileriye yönelik randomize olarak çalýþmaya dahil edildi. Hastalar rastgele, destekleyici tedavi alan (n=10) ve destekleyici tedaviye SPGB eklenenler (n=10) olarak iki gruba ayrýldý. Hastalarýn PDPH þiddeti Visual analog scale (VAS) ile deðerlendirildi. VAS deðerleri baþvuru sýrasýnda (T1), tedaviden sonraki dördüncü (T2), on ikinci (T3) ve yirmi dördüncü saatte (T4) kayýt altýna alýndý.
BULGULAR: Ýki grup arasýnda yaþ, boy, kilo ve vücut kitle indeksi açýsýndan istatistiksel olarak anlamlý fark yoktu. Ayrýca baþvuru sýrasýndaki, 12. ve 24. saatteki VAS deðerleri iki grup arasýnda benzer bulundu. Ancak destek tedavisine SPGB eklenen grupta dördüncü saatteki VAS deðeri anlamlý olarak düþük bulundu (p=0.002).
TARTIÞMA ve SONUÇ: Sonuç olarak tek taraflý SPGB, PDPH akut tedavisinde hýzlý, etkili ve güvenli bir yöntem olarak kullanýlmýþtýr. Ýleri çalýþmalara gereksinim olmakla beraber PDPH tedavisinde ilk tedavi seçeneði olarak kullanýlabileceði kanýsýna varýlmýþtýr.

INTRODUCTION: Pain control for a post-dural puncture headache (PDPH) can be challenging. Epidural blood patching (EBP) is recommended; however, EBP is an interventional procedure with the risk of bleeding, infection, and adverse neurological effects. The aim of this study was to evaluate the effects of a transnasal sphenopalatine ganglion block (SPGB) as supportive PDPH treatment.
METHODS: Pregnant women undergoing a cesarean section under spinal anesthesia who developed PDPH were included in this prospective randomized study. The enrolled subjects were randomly assigned to 2 groups: a medical treatment group (n=10) and a group that would receive medical treatment with the addition of SPGB (n=10). Visual analog scale (VAS) scores were recorded at the time of admission, and at 4, 12, and 24 hours after treatment.
RESULTS: There was no statistically significant difference between the 2 groups in terms of age, height, weight, or body mass index. The mean VAS values at the baseline, 12th hour, and 24th hour were similar between the groups. However, the mean VAS score at the fourth hour was significantly lower in the block group (p=0.002).
DISCUSSION AND CONCLUSION: A unilateral SPGB is a rapid and effective method to treat PDPH. However, the safety of this technique requires further research due to complications encountered, including a seizure.

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GÝRÝÞ ve AMAÇ: Formalin fiksasyonu, farklý dokularda rezeksiyon materyallerinin boyutunda %57’ye kadar azalmaya neden olur. Bu çalýþmanýn amacý, sigmoid kolon tümörü nedeniyle anterior rezeksiyon yapýlan hastalarda formalin fiksasyonunun rezeke edilen kolon dokusunun boyuna, cerrahi sýnýr uzaklýðýna ve tümör boyutuna olan etkilerini belirlemektir.
YÖNTEM ve GEREÇLER: Bu ileriye yönelik çalýþma, Ocak ve Aralýk 2016 tarihleri arasýnda elektif rezeksiyon uygulanan 40 ardýþýk sigmoid kolon tümörü spesmeni ile yapýldý. Çalýþmayý yürüten cerrah tarafýndan çýkarýlan spesmen üzerinde ilk 15 dakikada kolonun toplam uzunluðu, tümörün boyutu ve proksimal ve distal cerrahi sýnýr mesafeleri ölçüldü. Daha sonra spesmen %10’luk formalin ile fikse edildi ve ayný ölçümler fiksasyon soonrasýnda araþtýrmayý yürüten patolog tarafýndan yapýldý.
BULGULAR: Yeni rezeke edilen materyaldeki ortalama toplam uzunluk, proksimal cerrahi sýnýr mesafesi, distal cerrahi sýnýr mesafesi ve tümörün boyutu sýrasýyla 32.9 cm, 16.7 cm, 12.1 cm ve 4.8 cm idi. Postformalin fiksasyon deðerleri sýrasýyla 22.0 cm, 10.6 cm, 7.4 cm ve 4.2 cm idi (tüm deðerler için p=0.00).
TARTIÞMA ve SONUÇ: Bu çalýþmanýn sonuçlarý, fiksasyonu takiben kolon materyalinin toplam boyutunda ortalama %34 küçülme olduðunu ortaya koymuþtur. Final patoloji sonuçlarýnda cerrahi sýnýrlara beklenmedik yakýnlýðýn olduðu durumlarda formalin fiksasyonunun küçülme üzerindeki etkisi dikkate alýnmalýdýr.

INTRODUCTION: Formalin fixation results in decrease in the size of resection materials up to 57% in different tissues. The objective of this study was to determine the effects of formalin fixation on the longitudinal size and tumor size of resected colon tissue because of a sigmoid colon tumor.
METHODS: This prospective study was conducted with 40 consecutive sigmoid colon tumor patients who underwent elective resection between January and December 2016. The surgeon conducting the study opened up the specimens within 15 minutes of resection, and the total length of the resected colon, size of the tumor, and proximal and distal surgical margin distances were then measured. The pathologist then recorded the measurements, without applying any stretch.
RESULTS: The mean total length, proximal surgical margin distance, distal surgical margin distance, and size of the tumor in the resected material were 32.9 cm, 16.7 cm, 12.1 cm, and 4.8 cm, respectively. Postformalin fixation values were 22.0 cm, 10.6 cm, 7.4 cm, and 4.2 cm, respectively, in the same order (p=0.00 for all).
DISCUSSION AND CONCLUSION: The results of the present study revealed 34% shrinkage in the total size of colon material following fixation. The effect of formalin fixation on shrinkage should be considered in cases where there is an unexpected proximity to surgical margins, as shown by the pathology results.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý aort, iliak ve femoral arter açýlarýnýn diabetik ayaklý ve diabetik ayaðý olmayan diabetik hastalarda farklý olup olmadýðýný ve bu açý farklýlýklarý ile diabetik ayak geliþiminin öngörülüp görülemeyeceðini bilgisayarlý tomografi anjiografi (BTA) kýlavuzluðunda belirlemekti.
YÖNTEM ve GEREÇLER: Çalýþmaya 61 diabetik ayaklý, 50 diabetik ayaðý olmayan toplam 111 diabetes mellitus (DM) hastasý dahil edildi. Bu hastalarýn çekilmiþ BTA’larýnda ölçülen aort, sað ve sol iliak ve sað ve sol femoral bifurkasyon açýlarý ayrý ayrý olarak PACS sistemi üzerinden geriye dönük olarak deðerlendirildi.
BULGULAR: Kontrol grubu ile olgu gruplarý arasýndaki deðerler karþýlaþtýrýldýðýnda, aort bifurkasyon açýsý (p=0.438); sað (p=0.223) ve sol (p=0.459) iliak bifurkasyon açýlarý; sað (p=0.080) ve sol (p=0.064) femur bifurkasyon açýlarý arasýnda istatistiksel olarak anlamlý bir fark bulunmadý.
TARTIÞMA ve SONUÇ: Çalýþmamýz Aort ve alt ekstremite bifurkasyon açýlarý diabetik ayaðý olan ve olmayan diabetik hastalarda farklýlýk olmadýðýný göstermiþ olup diabetik ayak geliþiminde DM’nin (DM) neden olduðu vasküler geometrideki bozulmanýn majör bir etken olmadýðýný göstermiþtir.

INTRODUCTION: The aim of this study was to determine whether aortic, iliac, and femoral artery bifurcation angles were different in diabetic patients with and without diabetic foot, and whether angle differences assessed based on computed tomography angiography (CTA) imaging could predict the development of diabetic foot.
METHODS: A total of 111 patients with diabetes mellitus (DM) were included in the study: 61 with diabetic foot and 50 without diabetic foot. The aortic, right and left iliac, and right and left femoral bifurcation angles were measured using CTA images and evaluated retrospectively with the Sectra PACS system (Sectra Medical Systems GmbH, Koln, Germany).
RESULTS: When the values of the control and diabetic foot groups were compared, there was no statistically significant difference between the aortic bifurcation angle (p=0.438), right (p=0.223) and left (p=0.459) iliac bifurcation angles, or the right (p=0.080) and left (p=0.064) femur bifurcation angles.
DISCUSSION AND CONCLUSION: The results revealed no significant difference in the bifurcation angles of the aorta and lower extremity arteries in diabetic patients with and without diabetic foot, and suggested that the changes in vascular geometry caused by DM may not be a major factor in the development of diabetic foot.

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GÝRÝÞ ve AMAÇ: Amacýmýz tedaviye dirençli glokom olgularýnda Ahmed glokom valv (AGV) implantasyonu kýsa dönem sonuçlarýný deðerlendirmektir.
YÖNTEM ve GEREÇLER: Ocak 2018–Mart 2019 tarihlerinde dirençli glokom tanýsýyla AGV implantasyonu uygulanan 31 olgu geriye dönük incelendi. Görme keskinliði en az ýþýk hissi düzeyinde olan ve en az 6 aylýk ameliyat sonrasý takibi bulunan hastalar çalýþmaya alýndý. Olgularýn ameliyat öncesi ve sonrasý en iyi düzeltilmiþ görme keskinlikleri (EÝDGK), göz içi basýncý (GÝB) düzeyleri, topikal antiglokomatöz ilaç sayýlarý, santral kornea kalýnlýðý (SKK) deðerleri kaydedildi. Ameliyat sonrasý tüm komplikasyonlar ayrýntýlý olarak not edildi.
BULGULAR: Ameliyat sonrasý GÝB’in ilaçsýz 5–22 mmHg arasýnda olmasý tam baþarý, ilaçla 5–22 mmHg arasýnda olmasý kýsmi baþarý, ilaca raðmen >22 mmHg olmasý ise baþarýsýzlýk olarak kabul edildi. Tam baþarý ve kýsmi baþarýnýn toplamý toplam cerrahi baþarý olarak tanýmlandý. Ortalama takip süresi 12.94±4.98 aydý. Ameliyat öncesi 40.84±8.27 mmHg olan ortalama GÝB düzeyleri ameliyat sonrasý son muayenede 13.84±2.95 mmHg’ya; ameliyat öncesi ortalama 3.68±0.54 olan antiglokomatöz ilaç sayýsý ameliyat sonrasý son muayenede 1.10±1.35’e düþtü. Ameliyat öncesi ve sonrasý SKK ve EÝDGK’de anlamlý deðiþme saptanmadý (p>0.05). Olgularýn %22.6’sýnda (n=7) komplikasyon görüldü. En sýk (n=3) rastlanýlan komplikasyon AGV plate bölgesinde enkapsüle kist geliþimi oldu. Olgularýn %45.2’sinde (n=14) tam, %54.8’inde (n=17) kýsmi olmak üzere toplam %100 (n=31) cerrahi baþarý elde edildi.
TARTIÞMA ve SONUÇ: Dirençli glokom olgularýnda ameliyat öncesi ortalama GÝB düzeyleri oldukça yüksek olsa da, kýsa dönemde, AGV implantasyonu GÝB’yi düþürmede etkili bir cerrahidir. Uzun süreli takiplerle, AGV implantasyonunun GÝB’yi düþürmedeki sürdürülebilir etkisini göstermek mümkün olacaktýr.

INTRODUCTION: To evaluate the short term outcomes of Ahmed glaucoma valve (AGV) implantation in refractory glaucoma.
METHODS: A total of 31 cases who had undergone AGV implantation between January 2018 and March 2019 for refractory glaucoma were retrospectively evaluated. The patients, with a visual acuity of at least light perception, had postoperative follow-up records of at least 6 months were included in the study. Preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), number of topical antiglaucoma medications and central corneal thickness (CCT) were recorded. Any postoperative complications were noted.
RESULTS: The surgical outcome was graded as complete success for IOP between 5-22 mmHg without antiglaucomatous medication; qualified success for IOP between 5-22 mmHg with antiglaucomatous medication; and failure for IOP >22 mmHg despite medication. The sum of the complete success and qualified success groups was defined as total success. The mean follow-up time was 12.94±4.98 months. The preoperative mean IOP levels and topical antiglaucoma medication numbers decreased from 40.84±8.27 mmHg to 13.84±2.95 mmHg and 3.68±0.54 to 1.10±1.35 respectively at the final postoperative examination. There were no significant differences between preoperative and postoperative CCT and BCVA levels (p>0.05). The most common (n=3) complication was encapsulated cyst formation in the AGV plate region. The complete, qualified and total success rates were 45.2% (n=14), 54.8% (n=17) and 100% (n=31), respectively.
DISCUSSION AND CONCLUSION: Although the mean preoperative IOP levels are quite high in refractory glaucoma cases, in short term, AGV implantation is an effective surgery for lowering IOP. With longer follow-ups, it will be possible to show the sustainable impact of AGV implantation on lowering IOP.

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GÝRÝÞ ve AMAÇ: Ýnme, zamana baðlý tedavisi ile morbidite ve mortalitenin en sýk nedenlerinden biridir. Tedavinin önündeki en büyük engel, hastane öncesi ulaþým gecikmeleri, doku plazminojen aktivatörü (IV-tPA) ve mekanik trombektomi (MT) ile tedavide tereddüt etmektir. Ýstanbul’da bu sorunlarý ve inme tedavisinin önündeki engelleri ortadan kaldýrmak için farklý eðitim faaliyetleri gerçekleþtirilmiþtir. Çalýþmamýzda bu aktivitelerin tedavi sürecine yansýmalarýný göstermeyi amaçladýk.
YÖNTEM ve GEREÇLER: Bu çalýþma, Ýstanbul’daki 2645 saðlýk personeline inme tedavisi organize etmek amacýyla verilen eðitim programlarýnýn etkinliðini görmek için geriye dönük olarak tasarlanmýþtýr. Çalýþmamýzda, eðitimlerin sonunda 2017–2018 yýllarý içindeki bir aylýk periyotta nakil süreleri, inme tanýsý için doðruluk oranlarý ve tedavi parametreleri arasýndaki deðiþikliði inceledik
BULGULAR: Bu çalýþmada, 1–31 Ekim 2017 (n=796) ve 1–31 Ekim 2018 (n=832) tarihleri arasýnda inmeden þüphelenilen ve ambulansla hastaneye nakledilen 1628 hastayý deðerlendirdik. Hastane öncesi ulaþým sürelerinde minimal fakat anlamlý düþüþler vardý (p<0.05). Ýnme þüphesi ile hastaneye sevk edilen hastalarýn 2017 yýlýnda %27’sinde akut inme tanýsý konmasýna raðmen, 2018’de bu rakam %36 idi (p<0.05). Akut inme hastalarýna iv-tPA ve MT uygulamalarý da 2018’de 2017’ye göre önemli ölçüde artmýþtýr (IV-tPA için %14’e karþý %26 p=0.003 ve MT için %6’ya karþý %13, p=0.034).
TARTIÞMA ve SONUÇ: Analizlerimiz, inme tanýsý konmasýnda, tPA kullanýmýnda ve mekanik trombektomideki belirgin artýþlar ile eðitim programlarýnýn hedeflerine baþarýyla ulaþtýklarýný göstermiþtir.

INTRODUCTION: Stroke is one of the most common causes of morbidity and mortality in the world and therapy is time-sensitive. The biggest obstacles to optimal treatment are pre-hospital transport delays and hesitation to administer intravenous tissue plasminogen activator (iv-tPA) and perform a mechanical thrombectomy (MT). A number of educational sessions were held in Istanbul to address these problems. This study examined the effects of this training.
METHODS: This retrospective study was designed to analyze the effectiveness of stroke treatment training programs provided to 2645 medical personnel in Istanbul, Turkey. The transport time, accuracy rate of stroke diagnosis, and treatment parameters of a 1-month period in 2017 and the same month in 2018 after the training were evaluated.
RESULTS: In all, 1628 suspected stroke patients who were transported to a hospital by ambulance in October 2017 (n=796) and October 2018 (n=832) were included. There was a minimal but meaningful decrease in pre-hospital transportation time (p<0.05). In 2017, 27% of the patients who were transported to the hospital with the suspicion of stroke were ultimately diagnosed with acute stroke, while 36% were diagnosed with acute stroke in 2018 (p<0.05). Applications of iv-tPA and MT to acute stroke patients also significantly increased in 2018 (tPA: 14% vs 26%, p=0.003; MT: 6% vs 13%, p=0.034).
DISCUSSION AND CONCLUSION: The analysis indicated that the educational programs targets were successful based on an increase in the diagnosis of stroke and use of iv-tPA and MT.

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GÝRÝÞ ve AMAÇ: Sigara isteði ile baþa çýkmada davranýþsal stratejiler arzu seviyesini bastýrýr ve sigarasýz süreyi uzatýr. Davranýþsal stratejilerinden yeme içme tercihleri ve egzersiz aktivitelerinin baþaçýkabilme ve sigara býrakma tedavisi baþarýsýndaki rolü dikkat çekmektedir. Çalýþmamýzda sigara býrakma programý kapsamýnda tedavi alan hastalarda sigara içme isteði ile baþa çýkabilmek için uygulanan davranýþlarýn hedonik gýda ve egzersiz özelliklerine göre deðerlendirilmesi ve tedavi baþarýsýna etkilerinin incelenmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Geriye dönük kohort çalýþmamýzda merkezimiz sigara býraktýrma programý kapsamýnda takip edilmiþ 119 hastanýn demografileri, sigara býraktýrma tedavi özellikleri, baðýmlýlýk düzeyleri, tedavi sonuçlarý, takip sürecinde sigara isteði halinde tercih edilen gýda ve aktiviteleri kaydedildi. Tedavi baþarýlý olan ve olmayan gruplarýn verileri karþýlaþtýrýlarak incelendi.
BULGULAR: Tedavi sürecinde ilk bir ay içerisinde sigarayý býrakanlar ve kilo artýþý olanlar tedavi baþarýlý grupta daha fazlaydý (sýrasýyla, p<0.001 ve p<0.001). Tedavi baþarýsýz grupta yüksek baðýmlýlýk ve tedavi sürecinde relapse daha fazla saptandý (sýrasýyla, p=0.04, p=0.001). Farmakolojik tedavilerden vareniklin ve nikotin sakýzý kullanýmý gruplara göre farklýlýk göstermemekteydi. Ancak nikotin bant kullanýmý tedavi baþarýsýz grupta daha fazla idi (p=0.046). Sigara içme isteði halinde uygulanan davranýþsal stratejiler arasýnda hedonik diyet tercih edenlerin tedavi baþarýlý grupta fazla olduðu görülürken (p=0.04), non-hedonik diyet, egzersiz aktivite ve egzersiz yapmama aktivite tercih edenler her iki grupta da benzerdi.
TARTIÞMA ve SONUÇ: Sigara býrakma tedavisi alan bireylerin sigara içme isteði halinde hedonik gýda tercih etmesi ve çoklu strateji uygulanmasý tedavi baþarýsý ile iliþkilidir. Egzersiz aktivite tedavi baþarýsý ile iliþkisizdi. Çalýþma sonuçlarý, bireye uygun diyet stratejileri belirleme ve çoklu strateji planlamasý ile sigara býrakmada tedavi baþarý þansýný arttýracaðýna dair ön kanýt saðlamaktadýr.

INTRODUCTION: Food and beverage preferences and exercise activities suppress the desire to smoke and extend the cessation period. The aim of the present study was to investigate effects of food consumption and physical activities on the success of a smoking cessation program.
METHODS: In our retrospective cohort study, demographics, smoking cessation therapy features, levels of addiction, treatment results, food preferred in case of desire to smoke during follow-up, and physical activities of 119 patients monitored within the scope of smoking cessation program in our site were recorded. The data of the groups with successful and unsuccessful smoking cessation were analyzed by comparison.
RESULTS: The successful group had more patients who quit smoking within the first one month in the treatment process and gained weight than the unsuccessful group (p<0.001 and p<0.001, respectively). Compared to the successful group, the unsuccessful group recorded a higher level of addiction and relapse (p=0.04, p=0.001, respectively). The use of varenicline and nicotine gum among pharmacological treatments did not differ between groups, nicotine patch was more frequently used higher in the unsuccessful group (p=0.046). The successful group also had more patients who consumed hedonic diet among the behavioral strategies in case of urge to smoke (p=0.04).
DISCUSSION AND CONCLUSION: The preference for hedonic foods in case of urge to smoke in patients who underwent smoking cessation treatment and implementing multiple strategies are associated with the success of the treatment, unlike exercise activity. This study may provide preliminary support for an eating strategy using a dietary plan and multi-strategy for the success of smoking cessation programs.

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GÝRÝÞ ve AMAÇ: Literatürde hepatit C enfeksiyonu, metabolik sendrom ve non-alkolik karaciðer yaðlanmasý arasýnda iliþki olduðu görülmüþtür. Çalýþmamýzda Hepatit C antikoru saptanan kiþilerde metabolik sendrom parametreleri incelendi.
YÖNTEM ve GEREÇLER: Çalýþmaya, hastanemize baþvuran ve anti HCV pozitifliði saptanan 52’si erkek ve 52’si kadýn olmak üzere 104 hasta alýndý. Hasta grubunda ATP III ve IDF’nin belirlediði metabolik sendrom kriterlerine göre ayrý ayrý inceleme yapýldý.
BULGULAR: ATP kriterlerine göre metabolik sendrom oraný %36.5 (n=38) saptandý. Kadýnlarda ATP kriterlerine göre metabolik sendromlu oraný %55.8 (n=29), erkeklerde bu oran %17.3 (n=9) bulundu. IDF kriterlerine göre ise tüm hastalar içinde metabolik sendromlu oraný %48.1 (n=50) olarak saptandý. Kadýnlarda IDF kriterlerine göre metabolik sendromlu hasta oraný %65.4 (n=34) iken; erkeklerde bu oran %30.8 (n=16) bulundu.
TARTIÞMA ve SONUÇ: Çalýþmamýzda HCV antikoru saptanan kadýn hastalarda metabolik sendrom oraný erkek hastalara göre belirgin olarak yüksek saptanmýþtýr.

INTRODUCTION: Research has shown that hepatitis C infection, metabolic syndrome (MS), and non-alcoholic fatty liver syndrome are associated. This study was designed to assess the parameters of MS in people with hepatitis C antibodies.
METHODS: We enrolled 104 patients, including 52 men and 52 women who visited our hospital and had anti-hepatitis C virus (HCV) positivity. In the patient group, different examinations were performed as per the MS criteria in the Adult Treatment Panel (ATP) III and International Diabetes Federation (IDF) guidelines.
RESULTS: As per the ATP III criteria, the prevalence of MS was 36.5% (n=38) in the total population, 55.8% (n=29) in women, and 17.3% (n=9) in men in our study. When the IDF criteria were applied, the MS prevalence was 48.1% (n=50) in the total population, 65.4% (n=34) in women, and 30.8% (n=16) in men.
DISCUSSION AND CONCLUSION: In our study, the prevalence of MS was significantly higher in female patients with HCV antibodies than in male patients.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada alt ekstremite cerrahisinde ultrasonografi eþliðinde yapýlan kombine siyatik-femoral sinir bloðu ile spinal anestezinin klinik özellikler, postoperatif analjezi ve yan etkiler açýsýndan karþýlaþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Ýleriye yönelik randomize olan bu çalýþma yaþlarý 18–65 arasýnda deðiþen ve ASA fizik durumu I-III arasýnda alt ekstremite cerrahisi geçirecek 60 hastayý kapsamaktadýr. Hastalar rastlantýsal olarak iki gruba ayrýlarak bir gruba spinal anestezi (n=30) diðerine ultrason eþliðinde kombine siyatik-femoral sinir bloðu (n=30) uygulandý. Ýþlem süresi, cerrahi anestezi derinliðinin saðlanmasýna kadar geçen süre, analjezi süresi, intraoperatif hemodinamik parametreler, hasta memnuniyeti, postoperatif analjezi kalitesi ve istenmeyen sonuçlar kaydedildi.
BULGULAR: Ýþlem süresi, duyusal ve motor blok baþlama süresi, cerrahiye baþlama süresi, motor blok geri dönüþ zamaný ve ilk analjezik ihtiyacýna kadar geçen süre siyatik-femoral blok uygulanan grupta anlamlý olarak uzundu (p<0.001). Postoperatif 24 saat içerisinde kurtarýcý analjezik ihtiyacý olan hasta sayýsý anlamlý olarak düþük bulundu (p<0.001). Ýntraoperatif hemodinamik parametreler ve olumsuz sonuçlar açýsýndan her iki grubun sonuçlarý benzer güvenlikte idi.
TARTIÞMA ve SONUÇ: Siyatik-femoral sinir bloðu, alt ekstremite cerrahisinde özellikle spinal anestezinin riskli olacaðý hasta grubunda güvenli ve etkin bir bölgesel anestezi alternatifidir. Postoperatif aðrý yönetiminde, uzamýþ postoperatif analjezi etkisi ve analjezik tüketimini azaltmasý açýsýndan spinal anesteziye klinik üstünlük saðlamaktadýr.

INTRODUCTION: The aim of this study was to compare the clinical efficacy and safety of an ultrasound-guided combined sciatic-femoral nerve block (SFNB) with spinal anesthesia (SA) in lower limb surgical procedures in terms of clinical properties, postoperative analgesia, and adverse outcomes.
METHODS: This prospective, randomized study comprised 60 patients aged 18–65 years with an American Society of Anesthesiologists physical status of I-III scheduled for a lower limb surgical procedure. The patients were randomly divided into 2 groups to receive either SA (n=30) or an ultrasound-guided combined SFNB (n=30). The duration of the intervention, time to achieve surgical anesthesia, analgesia duration, intraoperative hemodynamic parameters, patient satisfaction, quality of the postoperative analgesia, and adverse outcomes were recorded and analyzed.
RESULTS: The duration of the intervention, time to onset of sensorial and motor block, time to start of surgery, motor block reversal time, and time to first postoperative analgesic were significantly longer in the SFNB group (p<0.001). Significantly fewer patients required rescue analgesia in the first postoperative 24 hours compared with the SA group (p<0.001). The intraoperative hemodynamic parameters and adverse outcomes were similar in both groups.
DISCUSSION AND CONCLUSION: SFNB is a safe and efficient alternative regional anesthesia technique to SA in lower limb surgical interventions, and particularly for high risk cases where SA is contraindicated. The prolonged duration of postoperative analgesia and reduced need for postoperative analgesic drug consumption were superior to SA in terms of postoperative pain management.

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GÝRÝÞ ve AMAÇ: Transrektal ultrasonografi (TRUS) eþliðinde alýnan prostat biyopsilerinde atipik küçük asiner proliferasyon (ASAP) tanýsý alan olgular invaziv bir iþlem olan biyopsi tekrarý ile takip edilmektedir. ASAP sýklýðýnýn azaltýlmasý rebiyopsi gereksinimi ve yeni tanýsal giriþimlere baðlý yükleri azaltabilir. Bu çalýþmada, ilk prostat biyopsisi örneklerinde ASAP tanýsý verilen ve sonraki biyopsilerinde benign ya da malign olduðu saptanan olgularýn baþlangýçtaki hasta demografik özellikleri ve serum PSA deðerleri yaný sýra çeþitli histopatolojik özellikleri yönünden tartýþýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Bu geriye dönük çalýþmaya, ASAP tanýsý almýþ 187 olgu ve 257 kor biyopsi dahil edildi. Olgularýn, baþlangýçtaki yaþ ve PSA düzeyleri kaydedildi. Histopatolojik incelemede, ayrý ayrý deðerlendirilen her kor için þüpheli asinüslerin sayýsý, nükleer büyüme, nükleol belirginliði, sitoplazmik amfofili, luminal amorf aselüler sekresyon, kristaloid varlýðý, infiltratif görünüm, atrofi ve enflamasyon bulgularý kaydedildi. Adenokarsinom varlýðýnda Gleason skoru saptandý.
BULGULAR: Orta-yüksek dereceli malign grubun yaþ ortalamasý benign gruba göre anlamlý düzeyde yüksektir. Serum PSA düzeyi de ortayüksek malignite grubunda diðer gruplardan anlamlý yüksek bulundu. Nükleusta ≥2 kat büyüme oraný, malign taný alan grupta benign gruptan anlamlý düzeyde fazlaydý. Nükleol belirginliði de malign grupta anlamlý olarak daha sýk görüldü. Amfofilik sitoplazma, lümende aselüler amorf eozinofilik sekresyon varlýðý malign olgularda anlamlý düzeyde daha sýk iken enflamasyon, benign grupta daha fazlaydý.
TARTIÞMA ve SONUÇ: Bu çalýþmada, nükleuslarda ≥2 kat büyüme, nükleol belirginliði, amfofilik sitoplazma, lüminal amorf aselüler sekresyon ve enflamasyonun yokluðu malignite ile iliþkili bulunmuþtur. Ortalama yaþ ve serum PSA düzeylerinin yüksek olmasý orta/yüksek dereceli malignite lehine kriterlerdir. Ýlk TRUS biyopsinin bu kriterler eþliðinde deðerlendirilmesi ASAP tanýsýný ve sonraki gereksiz invaziv giriþimleri önleyebilir.

INTRODUCTION: Cases diagnosed as atypical small acinar proliferation (ASAP) in prostate transrectal ultrasound (TRUS) biopsies typically require rebiopsies, which are invasiveand associated with increased risk of complications. Therefore, reduction in the rates of ASAP diagnoses during initial biopsy interpretation will decrease the need forrebiopsy and limit the burden of new diagnostic procedures. The current study aimed to investigate patient demographics, serum PSA levels, and histopathological features of cases identified as “ASAP” during initial prostate biopsies and as “benign” or “malignant” in the rebiopsies.
METHODS: This retrospective study included 187 cases and 257 core biopsies with a diagnosis of ASAP. Initial age and serum PSA levels were recorded, and the cores were analyzed histopathologically. The presence of nuclear enlargement, prominence of nucleoli, cytoplasmic amphophilia, luminal acellular secretions, cristalloids, infiltrative growth pattern, atrophy, inflammation, and number of the suspicious acini were recorded. Adenocarcinomas were identified using the Gleason score.
RESULTS: The mean age and serum PSA levels were significantly higher in the intermediate-high grade malignant group compared to the other groups, while nuclear enlargement (>2 times) and prominent nucleoli were more frequently observed in the malignant group compared to the benign group. Amphophilic cytoplasm and luminal acellular amorphous eosinophilic secretions were more frequently observed in malignant groups, while the benign group exhibited higher rates of inflammation.
DISCUSSION AND CONCLUSION: The findings of the current study showed enlargement of the nuclei (≥2 times), nucleolar prominence, amphophilic cytoplasm, luminal amorphous acellular secretion, and absence of inflammation were associated with malignancy. Moreover, higher mean age and serum PSA level were related with intermediate-high grade malignancy, and consideration of these factors during evaluation of initial TRUS biopsies may decrease the prevalence of ASAP diagnoses and prevent unnecessary interventions.

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GÝRÝÞ ve AMAÇ: Cerrahýn tecrübe ve volümü ile tiroid cerrahisinin ameliyat sonrasý sonuçlarý arasýndaki iliþki son yýllarda literatürde yaygýn olarak tartýþýlan güncel bir konudur. Bu çalýþmamýzda, kliniðimizde branþlaþma öncesi ve sonrasý dönemlerde gerçekleþtirilmiþ olan tiroidektomi ameliyatlarýnýn komplikasyon oranlarýný karþýlaþtýrmayý ve branþlaþmanýn tiroid cerrahisi sonuçlarý üzerine etkisini deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþma, Nisan 2013–Mart 2017 tarihleri arasýnda tek bir üçüncü basamak referans hastanede benign ve malign tiroid hastalýklarý nedeniyle boyun diseksiyonu olan veya olmayan tiroidektomi yapýlmýþ hastalarý içermektedir. Hastalar kliniðimizde branþlaþma öncesi (BÖ grubu) ve branþlaþma sonrasý (BS grubu) olmak üzere iki gruba ayrýldý. Gruplar yaþ, cinsiyet, operasyon türü, ameliyat sonrasý hipokalsemi, insidental paratiroidektomi, rekürren larengeal sinir yaralanmasý ve ameliyat sonrasý kanama/hematom açýsýndan karþýlaþtýrýldý.
BULGULAR: Branþlaþmaya gidilmeden önceki (BÖ) yýllarda 367 (%47), branþlaþma sonrasý (BS) iki yýlda 409 (%53) olmak üzere toplam 776 tiroid hastasý ameliyat edildi. Gruplar arasýnda Ca2+ açýsýndan anlamlý fark olmadýðý, PTH seviyesinin ise Grup BÖ’de anlamlý ölçüde daha düþük olduðu gözlendi (sýrasýyla, p=0.2 ve p=0.02). Grup BS’de anlamlý ölçüde daha az ameliyat sonrasý geçici hipokalsemi geliþtiði görüldü (p<0.001). Ýnsidental paratiroidektomi oraný BÖ grubunda anlamlý ölçüde daha yüksekti (p<0.01). Grup BÖ’de 15 (%4), Grup BS’de 2 (%0.5) hastada ameliyat sonrasý geçici ses kýsýklýðý geliþtiði görüldü. Çalýþmamýzda toplam 12 hastada tek taraflý vokal kord paralizisi geliþtiði ve bu olgularýn tamamýnýn Grup BÖ’de olduðu görüldü (p<0.01). Gruplar arasýnda kanama açýsýndan istatistiksel anlamlý bir fark yoktu (p=0.5).
TARTIÞMA ve SONUÇ: Bu çalýþmadan elde ettiðimiz veriler tiroid cerrahisinde branþlaþmanýn hipokalsemi, insidental paratiroidektomi ve rekürren larengeal sinir yaralanmasý komplikasyonlarýný anlamlý ölçüde azalttýðýný göstermektedir.

INTRODUCTION: The relationship between the surgeon’s experience/volume of performed operations and postoperative results of thyroid surgery is a pressing issue that has been widely discussed in recent publications. This study aimed to compare the complication rates in thyroidectomy operations performed before and after specialization and evaluate the effect of specialization on the outcomes of thyroid surgeries.
METHODS: The study included patients who had undergone thyroidectomy with or withoutneck dissection due to benign or malign thyroid diseases in a single tertiary reference hospital between April 2013 and March 2017. The patients were divided into two groups: those who were operated on before specialization (BS) and after specialization (AS). Age, gender, operation type, postoperative hypocalcemia, incidental parathyroidectomy, recurrent laryngeal nerve (RLN) injury, and postoperative bleeding or hematoma were compared between the groups.
RESULTS: Of the thyroid patients, 776 were operated on (367 (47%) and 409 (53%) of the BS and AS groups, respectively). No significant difference was found between the two groups regarding the postoperative Ca2+ level, while the parathormone was significantly lower in the BS group (p=0.2 and p=0.02, respectively). In addition, postoperative transient hypocalcemia was significantly less common in the AS group (p<0.001). The incidental parathyroidectomy rate was significantly higher in the BS group (p<0.01). Postoperative transient hoarseness developed in 15 (4%) patients in the BS group and in 2 (0.5%) patients in the AS group. Twelve patients had unilateral vocal cord paralysis, all of whom were in the BS group (p<0.01). No significant difference exists between the groups regarding bleeding (p=0.5).
DISCUSSION AND CONCLUSION: This study indicated that specialization in thyroid surgery significantly reduced complications (e.g., hypocalcemia, incidental parathyroidectomy, and RLN injury).

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SARS-CoV-2 veya “görünmez katil” sadece hayatýmýzý deðiþtirmedi, ayný zamanda günlük uygulamalarýmýz ve anesteziye yaklaþýmýmýzý da deðiþtirdi. Önlükler, tulumlar ve 2–3 çift eldiven dahil olmak üzere koruyucu ekipman ve kýyafetler giymeye baþladýk. Yüzlerimiz, bulutlanmýþ farklý tür maskeler ve gözlüklerle kaplý bir þekilde çalýþmaya baþladýk. Sonuç olarak, zorlukla hareket ediyor ve sýnýrlý görüþ kabiliyetine sahip bir þekilde çalýþýyoruz. Hastalarla iletiþimimiz sýnýrlanmýþtýr; yüz ifadelerimizi, gülümsemeleri veya endiþelerimizi göremedikleri için sadece seslerimizi duyabiliyorlar. Biz onlara daha çok yakýnlýk, sevgi ya da kaygý göstermekten çok robot gibiyiz. Enfekte hastalarýmýza yabancýyýz. Hamile COVID-19 pozitif hastalar için anestezi türü düþünülürken, önemine göre sýraladýðýmýz üç faktör göz önünde bulundurulmaktadýr: bizim için en güvenli yöntem olmasý, kolayca uygulanabilmesi, zor ve sýnýrlý hareket ve görüþ kabiliyetinin ve hastanýn da arzularýnýn dikkate alýnmasý. Öncelikler deðiþti mi?

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), sometimes referred to as an invisible killer, has changed all of our lives, including the daily practices of medical personnel and the approach to anesthesia. We must wear protective equipment and special suits, aprons, and 2 or 3 pairs of gloves. Our faces are obscured by masks and goggles and shields. We move with difficulty and have limited vision. Communication with patients is limited; they cannot see our facial expressions of smiles or concern. They only hear our voice, which may also be muffled. We look more like robots than someone demonstrating assistance, love, or compassion. We are strangers to our infected patients. When thinking about the type of anesthesia for pregnant patients who have the disease caused by SARS-CoV-2, coronavirus2019 (COVID-19), 3 factors taken into consideration ranked according to importance are the safest method for healthcare providers, ease of application, and difficulties associated with movement and vision. The patient’s wishes are secondary. Have priorities changed?

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Kanda ferröz deðerliðinde bulunan hemoglobinin okside olup ferrik duruma geçmesine methemoglobinemi denir. Doðuþtan yapýsal hemoglobin defektleri veya lokal anestezik ilaçlar, kimyasal madde ve gýda alýmý gibi edinsel sebeplerden ötürü geliþebilir. Methemoglobinemi seviyesi %10’u geçtiði durumlarda siyanoz ile karakterize iken, daha yüksek durumlarda doku hipoksemisi, koma, kardiyovasküler kollaps ve hatta ölüme bile neden olabilir. Bu seviyeyi vücutta düþüren ana mekanizma nikotinamid adenin dinükleotid (NADH)-sitokrom b5 redüktaz yolaðýdýr. Bu olgu sunumuzda, çocuk acil servisimize farklý zamanlarda baþvuran iki bebeðin sünnet iþleminde prilokaine baðlý geliþen methemoglobineminin taný ve tedavisi anlatýlmaktadýr.

Methemoglobinemia is a complication that develops when ferrous hemoglobin is oxidized to a ferric state. It may be congenital due to structural hemoglobin defects or acquired through causes such as exposure to local anesthetic drugs or intake of toxins. Methemoglobinemia is characterized by cyanosis when the blood level exceeds 10%, and at higher levels it may cause tissue hypoxemia, coma, cardiovascular collapse, or even death. The primary mechanism used to reduce the methemoglobin level in the body is the nicotinamide adenine dinucleotide phosphate-cytochrome b5 reductase pathway. This case report is a presentation of the diagnosis and treatment of prilocaine-induced methemoglobinemia in 2 recently circumcised infants admitted to the pediatric emergency department.

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Üretrada kýl varlýðý çeþitli operasyonlardan sonra ortaya çýkabilir ve tekrarlayan rahatsýz edici komplikasyonlara yol açabilir. Ýþeme zorluðu ile baþvuran 76 yaþýnda erkek hastaya kýllý üretra için internal üretrotomi ve lazer ablasyon tedavisi uygulandý. Olgu ilgili literatür eþliðinde sunulmuþ ve tartýþýlmýþtýr.

The presence of hair in the urethra can lead to recurrent, uncomfortable complications following various operations. A 76 years old male patient who admitted with voiding difficulty underwent internal urethrotomy and laser ablation treatment for hairy urethra. The case is presented and discussed with the relevant literature.

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