GÝRÝÞ ve AMAÇ: Nonsteroid antiinflamatuvar ilaçlar, alkol tüketimi ve Helicobacter pylori, dünya çapýnda yüksek insidansla mide ülserinin en yaygýn nedenleri arasýndadýr. Aþýrý alkol tüketimi sonucu mide mukozasýnda hasar oluþumu artar. Alkol kaynaklý mide ülseri oluþumunu incelemek ve ülser tedavisi ile ilgili bileþikleri araþtýrmak için sýçanlarda etanol bazlý mide ülseri modeli kullanýlmaktadýr.
YÖNTEM ve GEREÇLER: Persimmon (Diospyros kaki L), Spraque Dawley sýçanlarýnda 5 ml/kg etanol ile oluþturulan mide ülseri modelinde uygulandý. Hurmanýn mide ülseri üzerindeki olasý gastroprotektif etkileri histopatolojik ve biyokimyasal yöntemlerle deðerlendirildi.
BULGULAR: Persimmon özü, IL-10, IL-6, TNF-α ve IL-1β gibi sitokin düzeylerini önemli ölçüde azalttý. Ayrýca kaspaz-3 ve NF-κB oluþumunu önemli ölçüde düþürdü.
TARTIÞMA ve SONUÇ: Bu deneysel çalýþmanýn bir sonucu olarak persimmon, etanol ile oluþturulan mide ülseri modelinde mide koruyucu etki göstermiþtir.

INTRODUCTION: The worldwide incidence of a gastric ulcer is high, most often as a result of use of nonsteroidal anti-inflammatory drugs, excessive alcohol consumption, or Helicobacter pylori infection. An ethanol-based gastric ulcer model in rats was used to examine the effect of persimmon (Diospyros kaki L.) extract as a potential form of treatment.
METHODS: Two dosages of persimmon extract were applied in a gastric ulcer model created with 5 mL/kg ethanol in Wistar albino rats. Histopathological and biochemical methods were used to assess any gastroprotective effects.
RESULTS: Persimmon extract significantly decreased the level of the cytokines interleukin (IL)-10, IL-6, tumor necrosis factor alpha (TNF-α) and IL-1 beta. Caspase-3 and nuclear factor kappa B expression was also significantly reduced.
DISCUSSION AND CONCLUSION: Persimmon fruit extract demonstrated a gastroprotective effect in an ethanol-based gastric ulcer model in rats.

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GÝRÝÞ ve AMAÇ: Rektal kanser nedeniyle sfinkter koruyucu rezeksiyon yapýlan hastalarda açýk ile laparoskopik yaklaþýmýn yaþam kalitesi sonuçlarýný karþýlaþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Ocak 2017–Aralýk 2018 tarihleri arasýnda kliniðimizde rektum kanseri nedeniyle ameliyat edilen 122 hasta çalýþmaya alýndý. Hastalar cerrahi tekniðe göre iki gruba ayrýldý; açýk (n=85) ve laparoskopi (n=37). Yaþam kalitesi anketi, European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30) ve European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Colorectal Cancer 29 (EORTC QLQ-CR29) formlarýný içermektedir.
BULGULAR: EORTC QLQ-C30 anketinde, genel durum (p=0.008), fiziksel aktivite (p=0.003) ve bulantý/kusma (p=0.005) öðelerinde laparoskopik grupta istatistiksel olarak anlamlý daha iyi sonuçlar elde edildi. EORTC QLQ-CR29 anketinde, sadece þiþkinlik deðerlendirmesinde laparoskopik grupta istatistiksel olarak anlamlý daha yüksek deðerler saptandý (p=0.02).
TARTIÞMA ve SONUÇ: Rektal kanser cerrahisinde laparoskopik yaklaþým, erken dönemde yaþam kalitesi açýsýndan açýk yaklaþýmdan üstündür. Bununla birlikte uzun dönem sonuçlarda cerrahi tekniðin yaþam kalitesini deðiþtirmediði saptandý.

INTRODUCTION: The aim of this study was to compare the health-related quality of life (HRQoL) results of the open and laparoscopic approaches in patients who underwent a sphincter-preserving resection for rectal cancer.
METHODS: A total of 122 patients who underwent surgery for rectal cancer at a single center between January 2017 and December 2018 were included in this prospective study. The patients were divided into 2 groups according to the type of surgical procedure: open (n=85) or laparoscopy (n=37). The HRQoL questionnaires employed were the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Colorectal Cancer 29 (EORTC QLQ-CR29).
RESULTS: The EORTC QLQ-C30 questionnaire revealed statistically significant differences with better results in the laparoscopic group for the following items: global status (p=0.008), role functioning (p=0.003), and nausea/vomiting (p=0.005). A significant difference was seen on the EORTC QLQ-CR29 questionnaire only for the flatulence item, with a better score recorded in the laparoscopic group (p=0.02).
DISCUSSION AND CONCLUSION: The laparoscopic approach in rectal cancer surgery was superior to the open approach in terms of HRQoL in the early period. However, long-term results indicated that HRQoL was independent of surgical approach.

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GÝRÝÞ ve AMAÇ: Hemodiyaliz, hastalar için fiziksel ve psikolojik stres faktörlerinin bir arada olduðu bir tedavi modalitesidir. Tedavinin getirdiði yoðun kaygý ve stres aleksitimik duygular için oldukça elveriþlidir. Aleksitimik bireyler duygu ve düþünceleri ifade etmekte zorlanma, kendisi ve çevresindeki fizyolojik deðiþimleri deðerlendirememe ile karþý karþýyadýr. Hemodiyaliz hastalarý hemodinamik olarak sürekli biyokimyasal deðiþimlere uðrar. Çalýþmadaki amacýmýz sürekli hemodiyaliz tedavisi altýndaki hastalarda takipte kullandýðýmýz biyokimyasal parametreler ile aleksitimik duygular ve stres faktörleri arasýndaki iliþkiyi araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmaya 2019 yýlýnda Bilecik ilinde son dönem böbrek yetersizliði ile hemodiyaliz tedavisi alan 51 gönüllü hasta alýndý. Araþtýrmada hastalarýn rutin hemodiyaliz biyokimyasal takip verileri, hemodiyaliz stresör ölçeði ve Toronto alexitimi ölçeði kullanýldý. Rutin takip edilen hemodiyaliz parametreleri ve ölçekler arasýnda istatistiksel anlamlýlýk düzeyi (p<0.05) olarak belirlendi.
BULGULAR: Çalýþmaya alýnan bireylerin stres düzeylerinin oldukça yüksek olduðu görüldü. Hastalarýn %58.8’nin aleksitimik olduðu anlaþýldý. Hastalarýn hemodiyaliz stresörü ortalamasý 86.6, Toronto aleksitimi ölçeði ortalamasý 62.76 olarak bulundu. Hemodiyaliz hastalarýnda stres ve aleksitimik duygu ölçeklerinin yüksekliði dikkat çekmiþtir. Hemodiyaliz stresör ölçeði ve Toronto aleksitimi ölçek alt gruplarý arasýnda diyaliz giriþ kreatinin, URR (üre azalma oraný), Kt/V, kuru aðýrlýk, albümin, diyaliz çýkýþ üre ve kalsiyum arasýnda anlamlý iliþki saptanmýþtýr.
TARTIÞMA ve SONUÇ: Hemodiyaliz hastalarýnýn takibinde psikiyatrik deðerlendirmenin rutin olmasý gerektiði, son yönetmelik deðiþikliði ile kaldýrýlan aylýk psikolog/psikiyatri muayenesinin tekrar baþlatýlmasý gerektiði aþikardýr. Diyaliz ünitesinde çalýþan saðlýk personelinin stresle baþa çýkma ve stresli hasta yönetimi konularýnda farkýndalýðýnýn arttýrýlmasý ayrýca önemlidir.

INTRODUCTION: Hemodialysis is a treatment modality for patients, in which physical and psychological stress factors are together. Intense anxiety and stress caused by treatment are very favorable for alexithymic feelings. Hemodialysis patients undergo continuous biochemical changes hemodynamically. Our aim in this study was to investigate the relationship between biochemical parameters; we use in hemodialysis patients’ follow-up and alexithymic emotions and stress factors.
METHODS: Fifty-one patients who received hemodialysis treatment due to end-stage renal failure in Bilecik Province in 2019 were included in the study. Routine biochemical follow-up data of patients, hemodialysis stressor scale, and Toronto alexithymia scale (TAS) were used in the study. The statistical significance level was determined as p<0.05 between routinely monitored hemodialysis parameters and scales.
RESULTS: It was observed that 58.8% of the patients included in the study were alexithymic. The mean hemodialysis stressor was 86.6, and the mean TAS was 62.76. The high levels of stress and alexithymic emotion scales in hemodialysis patients were noted. A significant relationship was found between inlet creatinine, urea reduction ratio, Kt/V, dry weight, albumin, output urea, and calcium between the hemodialysis stress scale and TAS subgroups.
DISCUSSION AND CONCLUSION: Psychiatric evaluation should be routine in the follow-up of hemodialysis patients, and the monthly psychologist/psychiatric examination, which was abolished with the last regulation change, should be restarted. It is also essential to increase the awareness of health-care professionals working in the dialysis unit about coping with stress and stressful patient management.

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GÝRÝÞ ve AMAÇ: Biyolojik ajanlar, kronik enflamatuvar hastalýðý (KEH) olan hastalarda hastalýk aktivitesinin etkili kontrolünü saðlar. Bununla birlikte, ciddi enfeksiyon riski artýþý ile iliþkilidirler. Bu çalýþmanýn amacý, biyolojik ajan kullanan hastalarda ciddi enfeksiyonlarýn daðýlýmý ve riskini, bu hastalardaki önerilen tarama testleri ve aþýlama oranlarýný araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Biyolojik ajan alan KEH’li hastalarý geriye dönük olarak deðerlendirdik; hepatit ve tüberküloz (TB) tarama testlerini ve önerilen aþýlarý, ciddi enfeksiyon oranlarýný ve risk faktörlerini gözden geçirdik.
BULGULAR: Çalýþmaya dahil edilen 320 hastanýn %58’i erkek ve ortalama yaþ 44.5 (±12.2) idi. Hastalarýn kullandýðý biyolojik ajanlarýn daðýlýmý; Infliksimab 108 (%33.8), Adalimumab 115 (%35.9), Etanercept 61 (%19.1), Ustekinumab 19 (%5.9), Sertolizumab 9 (%2.8), Golimumab 5 (%1.6) ve Sekukinumab 3 (%0.9). KEH’li hastalarda hepatit B, pnömokok, influenza ve hepatit A aþýlama oranlarý sýrasýyla %82.9, %12.5, %11.6 ve %4 bulundu. TB tarama testi olarak hastalarýn %33.4’ünde tüberküloz cilt testi, %79’unda QuantiFERON-TB Gold testi tercih edildi. Toplam 25 (%7.8) ciddi enfeksiyon olgusu meydana geldi ve en sýk görülen enfeksiyon bölgesi solunum yolu (%28) ve idrar yolu (%28) olarak bulundu. Ýkili lojistik regresyon analizi, kronik obstrüktif akciðer hastalýðý (KOAH) olan ve azatiyoprin kullanan hastalarda enfeksiyon riskinin anlamlý derecede daha yüksek olduðunu gösterdi.
TARTIÞMA ve SONUÇ: En sýk görülen enfeksiyon bölgeleri solunum yolu ve idrar yolu idi ve KOAH olan ve azatiyoprin kullanan hastalarda enfeksiyon riski anlamlý derecede yüksekti. KEH hastalarý için aþýlama oranlarý önerilenden düþüktü. Biyolojik ajan kullanan hastalarda hepatit B ve TB reaktivasyon riski farkýndalýðý, diðer enfeksiyonlara göre daha yüksek olduðu sonucuna varýldý.

INTRODUCTION: Biologic agents can provide effective control of disease activity in patients with chronic inflammatory disease (CID), however, they are associated with an increased risk of serious infection. The aim of this study was to investigate the risk and distribution of serious infection, the rate of vaccination, and the screening tests recommended in patients treated with biologic agents.
METHODS: Patients with CID who were given biologic agent therapy were retrospectively evaluated. Hepatitis and tuberculosis (TB) screening tests, the vaccinations administered, risk factors for and the rate of serious infection were reviewed.
RESULTS: Of the 320 patients included in the study, 58% were male and the mean age was 44.5 years (±12.2 years). The biologic agent used was infliximab in 108 patients (33.8%), adalimumab in 115 (35.9%), etanercept in 61 (19.1%), ustekinumab in 19 (5.9%), certolizumab in 9 (2.8%), golimumab in 5 (1.6%), and secukinumab in 3 (0.9%). The hepatitis B, pneumococcal, influenza, and hepatitis A vaccination rate in patients with CID was 82.9%, 12.5%, 11.6%, and 4%, respectively. The tuberculin skin test was preferred for 33.4% of the patients for TB screening, while the QuantiFERON-TB Gold test (Qiagen NV, Hilden, Germany) was used in 79%. A total of 25 (7.8%) cases of serious infection occurred, and the most common sites were the respiratory tract (28%) and the urinary tract (28%). Binary logistic regression analysis showed that the risk of infection was significantly higher in patients who had chronic obstructive pulmonary disease (COPD) and those who used azathioprine.
DISCUSSION AND CONCLUSION: The most common sites of infection were the respiratory tract and the urinary tract, and the risk of infection was significantly higher in patients who had COPD and those who used azathioprine. The rate of vaccination was lower than has been recommended. Awareness of hepatitis B and TB reactivation risk in patients treated with biologic agents was greater than awareness of the risk of other infections.

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GÝRÝÞ ve AMAÇ: Sýçanlarda oluþturulan iki taraflý over torsiyon distorsiyon modelinin neden olduðu over ve akciðer hasarý üzerine mirisetin’in olasý yararlý etkilerinin araþtýrýlmasý planlandý.
YÖNTEM ve GEREÇLER: Otuz iki adet Wistar-Albino diþi sýçan rastgele dört gruba ayrýldý. Bu araþtýrmanýn gruplarý, sham, over torsiyon detorsiyon, Myr/25 (25 mg/kg dozda mirisetin+torsiyon detorsiyon) ve Myr/50 (50 mg/kg dozda mirisetin+torsiyon detorsiyon) olarak tasarlandý.
BULGULAR: TOS, MDA, OSI seviyeleri ve MPO aktivitesi, hem over hem de akciðer dokularý için, over torsiyon detorsiyon grubunda sham grubuna göre anlamlý olarak arttý. Bununla birlikte, over torsiyon detorsiyon grubunda SOD aktivitesi ve TAS deðeri azaldý. Bunun aksine, Myr/25 ve Myr/50 gruplarýnda mirisetin tedavisi nedeniyle MPO aktivitesi, TOS, OSI ve MDA seviyeleri azalýrken SOD aktivitesinin anlamlý olarak artmýþtýr.
TARTIÞMA ve SONUÇ: Sonuç olarak, sýçanlarda over torsiyon detorsiyonunun neden olduðu over ve akciðer dokusu hasarýna karþý korumada mirisetin uygulamasýnýn etkili olduðu belirlendi.

INTRODUCTION: This study was designed to examine the effects of myricetin (Myr) on ovarian and lung tissue in rats with induced torsion-detorsion (TD) of bilateral ovaries to determine the potential to reduce oxidative damage.
METHODS: The study group comprised 32 female Wistar albino rats randomly allocated to 4 groups: sham, ovarian TD, Myr/25 (25 mg/kg dose of Myr+TD), and Myr/50 (50 mg/kg dose of Myr+TD).
RESULTS: The total oxidant status (TOS), malondialdehyde (MDA) level, oxidative stress index (OSI), and myeloperoxidase (MPO) activity in both ovarian and lung tissues increased significantly in the ovarian TD group compared with the sham group, while the superoxide dismutase (SOD) and total antioxidant status (TAS) values decreased in the same group. In contrast, the SOD level increased, while MPO activity, the TOS, the OSI, and the MDA level decreased significantly in the Myr/25 and Myr/50 groups.
DISCUSSION AND CONCLUSION: Myr demonstrated protection against lung and ovarian tissue injury in induced-TD experimental rats.

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GÝRÝÞ ve AMAÇ: Açýk kalp cerrahisinde uygulanan median sternotomi sonrasýnda sternal kemik iyileþmesi ve enfeksiyon problemleri önemli morbidite ve mortalite ile sonuçlanabilmektedir. Bu çalýþma ile sternal dehisens için uygulanan termoreaktif nitinol klipslerin (TRNK) etkinliðini, güvenilirliðini, avantajlarýný, dezavantajlarýný ve tekniklerini deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Temmuz 2010’dan Þubat 2019’a kadar; kliniðimizde primer kalp cerrahisi sonrasý sternal dehisens geliþen 40 hastaya (26 erkek,14 kadýn; ortalama yaþ 60±4; 45–76 arasý) sternumu kapatmak için TRNK uygulandý. Sternum revizyonu postoperatif 72±4 günde (9–255 gün) uygulandý. Hastalarýn %55’inde (n=22) yüzeyel yara enfeksiyonu geliþmesi nedeniyle vakum yardýmlý kapama (VAK) tedavisi sonrasý cerrahi müdahale uygulandý.
BULGULAR: Revizyon sonrasý bir hastada plörezi, bir hastada pnömoni geliþti. Hastane mortalitesi gözlenmedi. Ýkinci revizyon cerrahisinde, nükseden yara yeri enfeksiyonundan dolayý; nitinol plaklar dokuz hastada çýkartýldý, üç hastaya pektoral flap uygulandý, bir hastaya rektus flap uygulandý; beþ hastada da yara primer kapatýldý. Ameliyat sonrasý dönemde bir hastada mortalite gözlendi. Altý aylýk takipte nükseden sternal dehisens, mediastinit, sternal apse ya da sekonder osteomyelit gibi sternotomi komplikasyonlarý izlenmedi.
TARTIÞMA ve SONUÇ: Sternal dehisens olgularýnda enfeksiyona sekonder dehisens geliþimi ve buna baðlý mediastinit riskini azaltmak için erken dönemde cerrahi müdahaleler uygulanmalýdýr. TRNK’nin sternal dehisensli hastalarýn tedavisi için hastanede kalma süresini ve ameliyat sonrasý komplikasyon riskini azaltmada ve hasta konforunu artýrmada kullanýlmasýný öneriyoruz.

INTRODUCTION: Difficulties with sternal bone healing or infection after a median sternotomy performed for open cardiac surgery can result in significant morbidity and mortality. This study evaluates the efficacy, safety, advantages, disadvantages, and techniques related to the use of thermoreactive nitinol clips (TRNCs) to treat sternal dehiscence.
METHODS: TRNCs were used to close the sternum in 40 patients (26 male, 14 female; mean age: 60±4 years, range: 45–76 years) with sternal dehiscence that developed following primary cardiac surgery between July 2010 and February 2019. Sternum revision was performed at a mean of 72±4 days postoperative (range: 9–255 days). Vacuum-assisted closure (VAC) was applied before the surgical intervention in 55% (n=22) of the patients due to superficial wound infection.
RESULTS: Pleurisy was observed in 1 patient, and pneumonia developed in 1 patient after the revision. Mortality did not occur during hospitalization. The nitinol plates were removed in a second revision surgery in 9 patients: a pectoralis flap was created for 3, a reconstructive rectus flap was used in 1, and primary wound closure was implemented in 5 cases due to recurrent wound infection. Mortality was recorded in 1 patient in the postoperative period. Sternotomy complications of recurrent sternal dehiscence, mediastinitis, sternal abscess, or secondary osteomyelitis were not observed in 6 months of follow-up.
DISCUSSION AND CONCLUSION: Surgical interventions for sternal dehiscence should optimally be performed in the early period to decrease the risk of dehiscence secondary to infection and mediastinitis. The use of TRNCs for patients with sternal dehiscence was successful and decreased the duration of hospital stay and the risk of postoperative complications, as well as providing greater patient comfort.

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GÝRÝÞ ve AMAÇ: Çoðunlukla non-neoplastik lezyonlar olan safra kesesi poliplerinin malignite potansiyeli taþýmasý, safra kesesi polibi olan hastanýn takip ve tedavi kararýnda önemli bir unsurdur. Bu çalýþmada safra kesesi polibi ön tanýsý ile ameliyat edilen hastalarýn ameliyat endikasyonlarýnýn deðerlendirilmesi, radyolojik ve patolojik bulgularýnýn karþýlaþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Kliniðimizde Ocak 2015–Haziran 2020 tarihleri arasýnda safra kesesi polibi tanýsý ile tedavisi yapýlan hastalarýn demografik ve klinik verileri, histopatolojik özellikler, yapýlan giriþimler ve komplikasyonlarý geriye dönük olarak deðerlendirildi.
BULGULAR: Safra kesesi polibi tanýsý ile toplam 93 hastaya kolesistektomi yapýldý. Radyolojik görüntülemede 44 (%47.3) hastada multipl safra kesesi polibi saptandý ve poliplerin ortalama çapý 6 mm idi. Histopatolojik incelemede 93 hastanýn 33’ünde (%35.5) polip saptandý. Hastalarýn 29’unda (%31.2) kolesterolozis, 22’sinde (%23.6) kolelityazis saptandý ve 16 (%17.2) hastada anormali saptanmadý. Kolesterolozis ve kolelityazis 11 (%11.8) hastada birlikte görülürken bir hastada kolelityazis ve safra kesesi polibi saptandý.
TARTIÞMA ve SONUÇ: Klinik muayene ile poliplerin boyutu, görünümü ve sayýsý gibi radyolojik bulgular safra kesesi poliplerinin ameliyat endikasyonunda belirleyici rol oynamaktadýr. Hastanýn risk faktörleri ve klinik bulgular dikkatli deðerlendirilerek ameliyat için doðru karar verilmelidir.

INTRODUCTION: The gallbladder polyp (GBP)s are mostly known as non-neoplastic lesions and have malignancy potential, which is an essential factor in the follow-up and treatment of the patient. This study aimed to evaluate the indications for surgery and compare the radiological and pathological findings of patients who were operated with the pre-diagnosis of GBP.
METHODS: The demographic and clinical data, histopathological features, interventions and complication rate of the patients who underwent surgery for GBP between January 2015 and June 2020 in our clinic were retrospectively evaluated in this study.
RESULTS: Cholecystectomy was performed in 93 patients with a diagnosis of GBP. Multiple GBPs were observed in 44 (47.3%) patients on radiological imaging, and the mean diameter of the polyps was 6 mm. Polyps were found in 33 (35.5%) of the 93 patients in histopathological examination. Cholesterolosis was detected in 29 (31.2%) of the patients, cholelithiasis in 22 (23.6%) patients, and no abnormality was found in 16 (17.2%) patients. While cholesterolosis and cholelithiasis were seen together in 11 (11.8%) patients, cholelithiasis and GBP were detected in only one patient.
DISCUSSION AND CONCLUSION: Clinical examination and imaging findings, such as the size, appearance and the number of polyps, have a critical role in the indication of surgery for patients with GBPs. The risk factors and the clinical findings of the patients should be considered together for an accurate surgery decision.

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GÝRÝÞ ve AMAÇ: Fraktalkine, bazý kanser tiplerinde hem tümörojenik hem de anti-tümoörojenik aktivite gösteren bir kemotaktik ajandýr. Bu çalýþmada, fraktalkinenin primer kas invaziv olmayan mesane kanserinde taný, nüks ve progresyondaki rolünü araþtýrdýk.
YÖNTEM ve GEREÇLER: Çalýþmaya primer kas invaziv olmayan mesane kanseri tanýsý konulan 44 hasta ve saðlýklý kontrol grubu olan 40 kiþi olmak üzere toplam 84 kiþi alýndý. Kan ve idrar örnekleri toplandý ve fraktalkine düzeyi ELISA yöntemi ile deðerlendirildi. Ýdrar kreatinin düzeyleri hesaplanýp idrar fractalkine düzeyi optimize edildi. Demografik veriler, tümör evresi (Ta, T1), derecesi (düþük, yüksek), sayýsý, boyutu ve rekürrens, progresyon durumu kaydedildi. Fraktalkine düzeyleri ve alt grup analizleri her iki grup arasýnda karþýlaþtýrýldý. Hasta grubuna NMP22 test yapýldý ve hastalardan idrar sitolojisi gönderildi.
BULGULAR: Hasta grubun ortalama yaþý, 63.9±11.1, kontrol grubunda ise 62.3±9.6 idi. Ortalama idrar fraktalkine düzeyi hastalarda 7.8±0.9 ng/ml ve kontrol grubunda 7.7±0.6 ng/ml olup iki grup arasýnda istatistiksel anlamlý fark izlenmedi (p=0.426). Ortalama idrar fraktalkine/kreatinin deðeri iki grup arasýnda benzerdi (sýrasýyla, 16.0±32.2 ng/mgCr ve 11.1±7.0 ng/mgCr, p=0.781). Ortalama serum fraktalkine düzeyi hasta grubunda 2.9±1.2 ng/ml ve saðlýklý kontrol grubunda 2.9±0.7 ng/ml olup, iki grup arasýnda istatistiksel anlamlý fark izlenmedi (p=0.183). Ayný zamanda, fraktalkine düzeyi ile tümör boyutu, sayýsý, nüks ve progresyon durumu arasýnda iliþki tespit edilmedi. Fraktalkine düzeyi NMP22 test pozitif hastalarda negatif olanlara göre istatiksel anlamlý olarak daha yüksekti. Sitoloji hastalarýn %45.5’inde pozitifti fakat fraktalkine deðerleriyle istatiksel anlamlý bir iliþki görülmedi.
TARTIÞMA ve SONUÇ: Bu çalýþmada, her iki grup arasýnda serum ve idrar fraktalkine düzeyi benzer bulunmuþ olup, fraktalkinenin primer mesane kanserli hastalarda biomarker olarak kullanýlamayacaðý gösterilmiþtir.

INTRODUCTION: Fractalkine is a chemotactic agent that shows both tumorogenic and anti-tumorogenic activity in some cancer types. In this study, we investigated the role of fractalkine in the diagnosis, progression and recurrence of primer non-muscle-invasive bladder cancer (NMIBC) and compared it with the healthy population.
METHODS: Overall, 84 people that consisted of 44 cases with primary NMIBC and 40 healthy controls enrolled for this study. Blood and urine samples were collected and fractalkine levels were measured by the ELISA method. Urinary creatinine levels were calculated and urinary fractalkine levels were optimized. Demographic data, tumor stage (Ta, T1), grade (low and high), number of tumors, tumor size, recurrence and progression status of patients were recorded. NMP22 test was performed on the patient group and urine cytology was sent from the patients. Fractalkine levels and subgroup analyses were compared between two groups.
RESULTS: The mean age of patients was 63.9±11.1 and 62.3±9.6 in the control group. The mean urinary fractalkine level was7.8±0.9 ng/ml in the study group and 7.7±0.6 ng/ml in the control group; there was no statistically significant difference between the two groups (p=0.426). Mean urinary fractalkine/creatinine level was similar between the study group and control group (16.0±32.2 ng/mgCr and 11.1±7.0 ng/mgCr, respectively, p=0.781). Mean serum fractalkine level was 2.9±1.2 ng/ml in the study group and 2.9±0.7 ng/ml in the control group; there was not a statistically significant difference (p=0.183). Also, we could not find any relation of fractalkine levels with tumor size, number, recurrence and progression. NMP 22 test was positive in half of the study group and Fractalkine levels were higher in the patients that NMP22 tests were negative that was statistically significantly. Cytology was positive for 45.5% of patients, but there was not any statistical correlation between fractalkine levels and cytology.
DISCUSSION AND CONCLUSION: In this study, we did not find a significant difference concerning serum and urinary fractalkine level between the two groups. These findings do not support the use of fractalkine as a biomarker for bladder cancer diagnosis and follow-up.

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GÝRÝÞ ve AMAÇ: Fonksiyonel endoskopik sinüs cerrahisi (FESS) sýk kullanýlan bir tedavi yöntemidir ve ameliyat sýrasýnda paranazal sinüslerin, olfaktör fossa ve komþu anatomik yapýlarýn anatomisinin bilinmesi önemlidir. Paranazal sinüs bilgisayarlý tomografi (BT), paranazal sinüslerin, nazal kavite ve nazofarenksin deðerlendirilmesinde sýklýkla kullanýlan bir görüntüleme yöntemidir. Bu çalýþmamýz, paranazal sinüs BT görüntülerinde Keros sýnýflamasýna göre popülasyonumuzdaki olfaktör fossa derinliðini geriye dönük olarak deðerlendirerek Keros tiplerini ve görülme sýklýðýný belirlemeyi amaçlamaktadýr.
YÖNTEM ve GEREÇLER: Bu çalýþmada, Aralýk 2018–Haziran 2019 tarihleri arasýnda kulak burun boðaz kliniði tarafýndan yönlendirilen ve Radyoloji kliniðinde kontrastsýz paranazal sinüs BT incelemesi yapýlan hastalarýn görüntüleri geriye dönük olarak deðerlendirildi. Sonuç olarak 18–87 yaþlarý arasýnda 522 hasta çalýþmamýza dahil edildi.
BULGULAR: Ýncelenen toplam 1044 koku fossasýnýn (OF) ortalama derinliði 4,89 mm ve standart sapma (SD) ±2.79 olarak hesaplandý. Ortalama OF derinliði açýsýndan erkekler ve kadýnlar arasýnda istatistiksel olarak anlamlý fark bulundu (p<0.001). Toplam 1044 olfaktör fossada Keros sýnýflandýrmasýna göre, 322 tarafta (%30.85) tip 1, 697 tarafta (%66.75) tip 2 ve 25 tarafta (%2.4) ise tip 3 mevcuttu. Bu çalýþma, ülkemizdeki en büyük olfaktör fossa olgu çalýþmasýna sahiptir ve verileri üçüncü basamak bir saðlýk merkezinde elde edilmiþtir.
TARTIÞMA ve SONUÇ: Paranazal sinüs BT raporlamasýnda sol ve sað taraf için Keros sýnýflandýrmasýnýn rutin olarak yapýlmasý, bu bölgenin anatomisi ile ilgili cerrahi branþlara deðerli katkýlar saðlayarak, cerrahi komplikasyonlarý en aza indirmeye yardýmcý olacaktýr.

INTRODUCTION: Functional endoscopic sinus surgery (FESS) is a frequently used treatment method, and it is important to know the anatomy of the paranasal sinuses, olfactory fossa and adjacent anatomical structures during surgery. Paranasal sinus computed tomography (CT) is a frequently used imaging method in the evaluation of the paranasal sinuses, nasal cavity and nasopharynx. Our study aims to determine Keros types and their incidence by retrospectively evaluating the depth of the olfactory fossa in our population according to the Keros classification on paranasal sinus CT images.
METHODS: In this study, the images of the patients who were directed by the otorhinolaryngology clinic and who underwent non-contrast paranasal sinus CT examination in the Radiology clinic between December 2018 and June 2019 were evaluated retrospectively. As a result, 522 patients between the ages of 18 and 87 were included in our study
RESULTS: The average depth of the total 1044 olfactory fossa (OF) examined was 4.89 mm with a standard deviation (SD) calculated of ±2.79. Statistically, a significant difference was found between males and females in mean OF depth (p<0.001). According to Keros classification, 322 sides (30.85%) had type 1, 697 sides (66.75%), type 2 and 25 sides (2.4%) had type 3 in 1044 olfactory fossa. To our knowledge, this study has the largest case series for the olfactory fossa in our country, and the data were obtained in a tertiary health center.
DISCUSSION AND CONCLUSION: The routine use of Keros classification for the left and right side in paranasal sinus CT reporting will help minimize surgical complications by providing valuable contributions to the surgical branches related to the anatomy of this region.

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GÝRÝÞ ve AMAÇ: Ameliyat sonrasý adezyona baðlý akut mekanik baðýrsak obstrüksiyonunda (MBO) laparoskopik adezyolizis klinik tecrübemizi literatür ýþýðý altýnda tartýþmaktýr
YÖNTEM ve GEREÇLER: Ocak 2014–Aralýk 2019 tarihleri arasýnda adezyona baðlý akut MBO nedeniyle laparoskopik adezyolizis uygulanan hastalar çalýþmaya dahil edildi. Akut MBO tanýsý, hastanýn öyküsü, klinik muayene bulgusu, ayakta direkt batýn grafisi (ADBG) ve bilgisayarlý tomografi (BT) ile konuldu. Hastalardan 24–48 saat sonunda konservatif tedaviye yanýt alýnamayanlara laparoskopik adezyolizis uygulandý.
BULGULAR: Laparoskopik adezyolizis planlanan 24 hasta çalýþmaya dahil edidi. Hastalarýn 16’sý kadýn 8’i erkek idi. Ortalama yaþ 52 (27–74) idi. Hastalarýn 14’ünde distal ileumda, 10’unda proksimal jejunumda ameliyat sonrasý adezyona baðlý MBO ve adezyonun proksimalinde dilatasyon izlendi. Hastalarýn dördünde (%16.7) teknik zorluklardan dolayý açýk cerrahiye geçildi. Hastalarýn yedisinde olasý bir kanama ve intestinal perforasyon riskini takip etmek amacýyla douglasa dren konuldu. Ameliyat sonrasý birinci günde karýn aðrýsý ve bulantý þikayetleri gerileyen hastalarda oral alým baþlandý. Hastalar ortalama ameliyat sonrasý 4.2 (2–8) gün sonra taburcu edildi. Bir hastada ameliyat sonrasý üçüncü günde dreninden intestinal içerik gelmesiüzerine operasyona alýnarak loop ileostomi yapýldý. Hiçbir hastamýzda ameliyat sonrasý mortalite gözlenmedi.
TARTIÞMA ve SONUÇ: Laparoskopik cerrahinin son yýllarda artan kullanýmý ýþýðýnda, ameliyat sonrasý adezyona baðlý akut MBO’da konvansiyonel cerrahi yöntemin dezavantajlarýndan dolayý, laparoskopik yaklaþýmýn güvenle yaygýnlaþacaðý kanaatindeyiz.

INTRODUCTION: The aim of the study was to discuss our clinical experience of laparoscopic adhesiolysis in acute mechanical bowel obstruction (MBO) due to post-operative adhesion in the light of the literature.
METHODS: Patients who underwent laparoscopic adhesiolysis due to acute MBO due to adhesion between January 2014 and December 2019 were included in the study. Diagnosis of acute MIO was put with patient’s history, clinical examination findings, standing direct abdominal radiography, and computed tomography. Laparoscopic adhesyolysis was applied to those who did not respond to conservative treatment at the end of 24–48 h.
RESULTS: Twenty-four patients with laparoscopic adhesiolysis were included in the study. Sixteen of the patients were women and eight were men. The average age was 52 years (27–74). Post-operative MBO due to adhesion and dilatation in the proximal of the adhesion was observed in the distal ileum in 14 patients, in the proximal jejunum in ten patients. For 4 (16.7%) patients, it was switched to open surgery due to technical difficulties. Douglas drain was placed in seven of the patients to monitor the risk of possible bleeding and intestinal perforation. Oral intake was started in patients whose abdominal pain and nausea complaints regressed on the 1st post operative day. Patients were discharged after an average post-operative 4.2 (2–8) days. Loop ileostomy was performed in one patient, when intestinal contents came from the drain on the post-operative on the 3rd day. Post-operative mortality was not observed in any of our patients.
DISCUSSION AND CONCLUSION: In light of the increasing use of laparoscopic surgery in recent years, due to the disadvantages of the conventional surgical method in acute MBO due to post-operative adhesion, we believe that the laparoscopic approach will safely become widespread.

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GÝRÝÞ ve AMAÇ: Son zamanlarda serum endotrofin seviyesi ile tip 2 Diyabetes Mellitus (DM) arasýndaki iliþkiyi araþtýran çalýþmalar, yaðlý karaciðer ile metabolik sendrom arasýndaki iliþkiye odaklanmýþtýr. Bu çalýþmada, metabolik sendromlu hastalarda metabolik disregülasyonun bir belirteci olarak tanýmlanan serum endotrofin düzeyi ile non-alkolik yaðlý karaciðer arasýndaki iliþkinin artan prevalansla araþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Ýleriye yönelik çalýþmamýza dahiliye kliniðine baþvuran metabolik sendromlu 40 hasta (24 kadýn ve 16 erkek) ve 20 saðlýklý gönüllü (10 kadýn ve 10 erkek) dahil edildi. Hastalarýn karaciðer steatozu açýsýndan deðerlendirilmesi, geçici elastografi yöntemi ile 10 MHz konveks problu Toshiba 500 Aplio marka model ultrason cihazý ile transabdominal ultrasonografi kullanýldý. FLI ve HSI temel numune analizlerine göre hesaplanmýþtýr. Endotrofin seviyeleri bir Sunred ELISA kiti ile çalýþýldý.
BULGULAR: Endotrofin düzeyleri, metabolik sendromlu grupta saðlýklý gruba göre daha düþük bulundu ve sonuçlar istatistiksel olarak anlamlý farklýlýk gösterdi (p<0.001). Gruplar için ortalama elastografi sonuçlarý (m/s ve kPa cinsinden) karþýlaþtýrýldýðýnda istatistiksel olarak anlamlý farklýlýklar bulundu (p=0.001, p<0.001). HSI skoru ile serum insülin seviyeleri ve HOMA sonuçlarý arasýnda istatistiksel olarak anlamlý farklýlýklar saptandý.
TARTIÞMA ve SONUÇ: Çalýþmamýzda endotrofin seviyeleri ile yaðlý karaciðer arasýnda bir iliþki bulunmadý. Endotrofin, yeni keþfedilen etkilere sahip bir parametredir; klinik uygulamada uygulanabilirlik ve güvenilirlik açýsýndan araþtýrýlmaktadýr.

INTRODUCTION: Studies in recent times researching the correlation between serum endotrophin level and Type 2 DM have focused on the association of fatty liver with metabolic syndrome. This study aims to research the correlation between serum endotrophin levels, defined as a marker of metabolic dysregulation, with nonalcoholic fatty liver in metabolic syndrome patients, with increasing prevalence.
METHODS: Our prospective study included 40 patients (24 females and 16 males) with metabolic syndrome attending the internal medicine clinic and 20 healthy volunteers (ten females and ten males). Evaluation of patients in terms of liver steatosis used transabdominal ultrasonography with a Toshiba 500 Aplio brand model ultrasound device with 10 MHz convex probe with transient elastography method. Fatty Liver Index and Hepatic Steatosis Index (HSI) were calculated on the basis sample analyses. The endotrophin levels were studied with a Sunred enzyme-linked ýmmunosorbent assay kit.
RESULTS: Endotrophin levels were found to be lower in the group with metabolic syndrome compared to the healthy group and results were statistically significant different (p<0.001). When the mean elastography results for the groups (in m/s and kPa) are compared, there were statistically significant differences found (p=0.001, p<0.001). There were statistically significant differences between HSI score with serum insulin levels and homeostasis model assessment results.
DISCUSSION AND CONCLUSION: In our study, a correlation was not found between endotrophin levels and fatty liver. Endotrophin is a parameter with newly discovered effects and is being researched for applicability and reliability in clinical practice.

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GÝRÝÞ ve AMAÇ: Literatürde, postmastektomi aðrý sendromuna (PMPS) yol açan birçok faktör araþtýrýlsa da, tümörün patolojik tipi ve ek hastalýk varlýðý ile iliþkisi hakkýnda bir çalýþma bulunmamaktadýr. Amacýmýz, meme kanseri nedeniyle mastektomi uygulanmýþ hastalarda, PMPS sýklýðýný ve patolojik tip ve ek hastalýk varlýðýnýn risk faktörü olma olasýlýðýný deðerlendirmektir.
YÖNTEM ve GEREÇLER: Meme kanseri nedeniyle 2008–2016 yýllarý arasýnda mastektomi uygulanmýþ 392 hastanýn verileri geriye dönük olarak incelendi. Demografik verileri, cerrahi tipi, radyoterapi, kemoterapi, ek hastalýk varlýðý, tümörün patolojik tipi, aksiller diseksiyon, toplam ve metastatik lenf nodu sayýsý, hastalarýn algoloji kliniðine baþvuru durumu, Vizüel Analog Skala deðeri, gabapentin ve/veya pregabalin kullanýmý araþtýrýldý. Gabapentin ve/veya pregabalin kullanýmý, PMPS varlýðý açýsýndan anlamlý kabul edildi.
BULGULAR: Çalýþmamýzda, PMPS insidansý %24.4 idi. Ýleri yaþ (>50; %72.6) ve hipertansiyon (%33.3) ile PMPS araýnda istatistiksel olarak anlamlý iliþki saptandý. Cerrahi tipi, aksiller diseksiyon, total ve metastatik lenf nodu sayýsý, radyoterapi, kemoterapi ve tümörün patolojik tanýsý risk faktörü olarak deðerlendirilmedi.
TARTIÞMA ve SONUÇ: Hipertansiyonun ileri yaþ ile birlikte risk faktörü olmasý, bu konularla ilgili ileriye yönelik çalýþmalara ihtiyaç olduðunu düþündürmektedir. Ayrýca, geriye dönük çalýþma olmasý nedeniyle, tüm patolojik tipler için eþit subgrup sayýlarý düzenlenememiþtir. Sonuç olarak, her patolojik tanýnýn eþit olarak gruplandýrýlýðý ileriye yönelik çalýþmalarla bu iliþkinin daha net ortaya çýkarýlabileceðini düþünüyoruz.

INTRODUCTION: Although many risk factors that cause postmastectomy pain syndrome (PMPS) have been searched, in literature, no study was found on the pathological type and the presence of additional diseases. Its aimed to evaluate the frequency of PMPS and probability of being a risk factor of pathological type and the presence of additional diseases in whom underwent mastectomy for breast cancer.
METHODS: The data of 392 patients who underwent mastectomy for breast cancer between the years 2008 and 2016 were analyzed retrospectively. Demographic data, surgery type, radiotherapy, chemotherapy, presence of additional diseases, the pathologic diagnosis of the tumor, axillary dissection, number of total and metastatic lymph nodes, application status of the patients to Algology Clinic, VAS, Gabapentin, and/or Pregabalin usage were investigated. Gabapentin and/or Pregabalin usage was accepted as the presence of PMPS.
RESULTS: In our study, PMPS incidence was 24.4%. Statistically significant difference was detected between older age (>50; 72.6%) and hypertension (33.3%) with PMPS. The type of surgery, axillary dissection, number of total and metastatic lymph nodes, radiotherapy, chemotherapy, and the pathological diagnosis of tumor were not determined as risk factors.
DISCUSSION AND CONCLUSION: Our determination of hypertension as a risk factor for PMPS with advanced age suggests that there is a need for prospective studies that address advanced age and hypertension. In addition, due to the retrospective study feature, an equal number of subgroups could not be made for all pathological types. Therefore, we think that this relationship can be revealed more clearly with prospective studies in which every pathological diagnosis is grouped equally.

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GÝRÝÞ ve AMAÇ: Katarakt ile birlikte kornea endotel disfonksiyonu olan olgularda fakoemülsifikasyon ve göz içi lensi uygulamasý ile kombine yapýlan descemet membran endotelyal keratoplasti cerrahisinin (Triple DMEK) görsel anatomik sonuçlarýnýn ve komplikasyonlarýn deðerlendirilmesi.

YÖNTEM ve GEREÇLER: Ocak 2014–Temmuz 2018 tarihleri arasýnda Kartal Dr. Lütfi Kýrdar Eðitim ve Araþtýrma Hastanesi Göz Hastalýklarý Kliniði’nde Triple DMEK cerrahisi yapýlan 32 hastanýn 39 gözü geriye dönük olarak deðerlendirmeye alýndý. Olgularýn ameliyat öncesi ve sonrasý 1., 3., 6. ve 12. aydaki düzeltilmiþ en iyi görme keskinlikleri (DEÝGK), endotel hücre sayýsý (EHS), santral korneal kalýnlýðý (SKK), ortalama refraktif sferik eþdeðerleri (SE), tekrar hava verilme (THV) sýklýðý ve komplikasyonlarý deðerlendirildi.
BULGULAR: DEÝGK ameliyat öncesi 1.22±0.32 logMAR iken (n=39), ameliyat sonrasý 6. ayda 0.19±0.18 (n=33), 12. ay sonunda 0.11±0.09 (n=27) logMAR’a yükselmiþtir (p<0.05; Wilcoxon test). EHS donör korneada 2771±284 hücre/mm2 (n=39) iken, ameliyat sonrasý 6. ayda 1401±270 hücre/mm2 (n=32), 12. ay sonunda 1373±217 hücre/mm2’ye (n=24) düþmüþtür (p<0.05). SKK ameliyat öncesi 696±99 µm’dan, ameliyat sonrasý altýncý ayda 518±42 µm, 12. ay sonunda 517±35 µm’a düþmüþtür (p<0.05). Ortalama refraktif SE ameliyat öncesi -0.57±0.69 D iken (n=21), altýncý ayda +0.47±0.65 D (n=31), 12. ay sonunda 0.48±0.67 D (n=27) olarak ölçüldü. On ikinci ayda hastalarýn %82’sinde ortalama sferik eþdeðer 1 D veya altýnda saptandý. Çalýþmamýzda 7 göze 1 kez (%17.9), 2 göze ise 2 kez (%5.12) THV iþlemi yapýldý. Greft yetmezliði geliþen 7 gözün 6’sýna tekrar DMEK, 1 göze ise penetran keratoplasti yapýldý.
TARTIÞMA ve SONUÇ: Triple DMEK cerrahisinin, düþük red reaksiyonu riski, öngörülebilir refraktif sonuçlarý, kapalý sistem cerrahisinin avantajlarý ve korneal sütür komplikasyonlarýnýn ihmal edilebilir düzeyde düþük olmasý, düþük doz steroid tedavisinin yeterli olmasý nedeniyle kornea endotel disfonksiyonu ile birlikte kataraktý olan olgularda tedavi seçenekleri arasýnda ilk sýralarda olduðunu düþünüyoruz.

INTRODUCTION: This study aims to assess visual anatomic outcomes and complications of Descemet Membrane Endothelial Keratoplasty (DMEK) combined with phacoemulsification and intraocular lens implantation in patients with coexisting endothelial dysfunction and cataract.
METHODS: Triple DMEK (DMEK with simultaneous cataract surgery) was performed in 39 eyes of the 32 patients. Best-corrected Visual Acuity (BCVA), Endothelial Cell Density (ECD), Central Corneal Thickness (CCT), Refractive Spherical Equivalent (RSE), air injections (Re-bubbling) frequency and complications were assessed preoperatively and postoperative months 1, 3, 6 and 12.
RESULTS: BCVA increased from 1.22±0.32 logMAR preoperatively to 0.19±0.18 (n=33) and 0.11±0.09 (n=27) at six months and 12 months after surgery, respectively (p<0.05; Wilcoxon test). The mean ECD of donor corneas decreased from 2771±284 cell/mm2 (n=39) to 1401±270 cell/mm2 (n=32) after six months and to 1373±217 cell/mm2 (n=24) after 12 months (p<0.05). Preoperative CCT decreased from 696±99 µm and to 518±42 µm and 517±35 µm 6 and 12 months after surgery, respectively (p<0.05). The mean RSE was -0.57±0.69 D (n=21) preoperatively and +0.47±0.65 D (n=31) and 0.48±0.67 D (n=27) 6 and 12 months after surgery. The mean RSE was detected ≤1D in 82% of the patients at 12th month. Re-bubbling was performed once in seven eyes (17.9%) and twice in two eyes (5.12%). Re-DMEK was performed in six of seven eyes of which graft failure developed, whereas penetrating keratoplasty was performed in one eye.
DISCUSSION AND CONCLUSION: Triple DMEK may consistently give predictable refractive results without adverse endothelial function. Hence, triple DMEK can be considered as the primary treatment approach in cases with endothelial dysfunction and cataract.

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GÝRÝÞ ve AMAÇ: Çalýþmamýzýn amacý Graves oftalmopatili (GO) hastalarda ön ve arka segment oküler parametreleri deðerlendirmek ve saðlýklý kontrol grubuyla karþýlaþtýrmak.
YÖNTEM ve GEREÇLER: Çalýþmaya 68 GO hastasý ve 40 saðlýklý kontrol grubu dahil edildi. GO hastalarý klinik aktivite skorlarýna (KAD) göre iki gruba ayrýldý. KAD puaný ≥3/7 olan hastalar aktif GO, 3/7’den az KAD puanlarý inaktif GO olarak adlandýrýldý. Sferik kýrýlma kusuru (SKK), astigmatik kýrýlma kusuru (AKK), merkezi kornea kalýnlýðý, göz içi basýncý ve aksiyel uzunluk (AU) kaydedildi. Subfoveal koroidal kalýnlýk (SFKT) ve global ve sektörel peripapiller retina sinir lifi tabakasý kalýnlýðý (pRSLTK) spektral alan-optik koherens tomografi ile ölçüldü.
BULGULAR: Aktif GO hastalarý, inaktif GO hastalarý ve saðlýklý kontrollere kýyasla anlamlý derecede daha yüksek miyopik SKK ve AKK’ye sahipti (sýrasýyla, p=0.040 ve 0.030). Ortalama AU deðeri her iki GO grubunda kontrole göre istatistiksel olarak anlamlý derecede daha uzundu (p=0.048) ancak aktif GO ve inaktif GO olan hastalar arasýnda AU açýsýndan anlamlý fark yoktu. Aktif GO ve inaktif GO olan hastalar, kontrollere göre anlamlý derecede daha yüksek SFKK’ye sahipti (p=<0.001). Ayrýca, aktif GO’lu hastalar, inaktif GO ve aktif GO hastalarýna göre önemli ölçüde daha ince global pRSLTK, superio pRSLTK, inferior pRSLTK ve temporal pRSLTK’ye sahipti. Ýnaktif GO hastalarýnda saðlýklý kontrollere kýyasla sadece daha ince inferiyor pRSLTK vardý.
TARTIÞMA ve SONUÇ: GO hastalarýnda, özellikle aktif GO olan hastalarda refraktif durumda, SFKK ve pRSLKT’de önemli deðiþiklikler saptandý. Bu parametreler GO hastalarýnýn deðerlendirilmesinde ve ciddi oküler komplikasyonlarýn önlenmesinde potansiyel yardýmcýlar olabilir.

INTRODUCTION: The aim of our study was to evaluate the anterior and posterior ocular parameters in patients with Graves’ ophthalmopathy (GO) compared to control.
METHODS: Sixty-eight patients with GO and 40 healthy controls were included in the study. The patients with GO were divided into two groups according to their clinical activity score (CAS). Patients with ≥3/7 CAS points were entitled as active GO and CAS points less than 3/7 were entitled as inactive GO. Spherical refractive error (SRE), astigmatic refractive error (ARE), central corneal thickness, intraocular pressure, and axial length (AL) were recorded. The subfoveal choroidal thickness (SFCT) and global and sectorial peripapillary retinal nerve fiber layer thickness (pRNFLT) were measured by spectral domain- optical coherence tomography.
RESULTS: The patients with active GO had significantly higher myopic SRE and ARE compared to patients with inactive GO and healthy controls (p=0.040 and 0.030, respectively). The mean AL was statistically significant taller in both GO groups than control (p=0.048) but there were no significant differences in AL between the patients with active GO and inactive GO. Patients with active GO and inactive GO had significantly higher SFCT than controls (p≤0.001). Furthermore, patients with active GO had significantly thinner global pRNFLT, superior pRNFLT, inferior pRNFLT, and temporal pRNFLT than patients with inactive GO and active GO. The patients with inactive GO had only thinner inferior pRNFLT compared to healthy controls.
DISCUSSION AND CONCLUSION: The patients with GO had significant alterations in refractive status, SFCT, and pRNFLT, especially patients with active GO. These parameters might be potential adjuncts in the evaluation of GO patients and preventing ocular serious complications.

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GÝRÝÞ ve AMAÇ: Bisiklete baðlý yaralanmalar nedeniyle acil servise baþvuran olgularýn karakteristik özelliklerini belirlemek amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Epidemiyolojik, geriye dönük ve tanýmlayýcý bir çalýþma olarak planlandý. Çalýþmada 2014–2019 yýllarýnda S.B.Ü. Ýstanbul Kartal Dr. Lütfi Kýrdar Eðitim ve Araþtýrma Hastanesinin Acil Servis’ine bisiklete baðlý yaralanmalar nedeniyle Adalar bölgesinden baþvuran olgular geriye dönük olarak incelendi. Veriler hastanenin bilgisayar ortamýnda kayýtlý olan hasta dosyasý kayýtlarý incelenerek kaydedildi. Son beþ yýla ait hasta kayýtlarý incelenerek bisiklet kazasý olgularýna ait veriler; sosyodemografik özellikler, kaza ile ilgili özellikler, travma özellikleri ve mortalite özellikleri açýsýndan deðerlendirildi.
BULGULAR: Çalýþmaya 1582 hasta dahil edildi. Hastalarýn %58.1’i (n=919) erkek, yaþ ortalamasý 24.14±11.95’dir. Hastalarýn hiçbirinde kiþisel korucu önlem (kask, dizlik vb) yoktu. En çok travmaya maruz kalan bölgeler, alt/üst ekstremite %63.2 (n=993), baþ/boyun %21 (n=333) bölgeleriydi. Mortalite oraný ise %0.8 (n=12) olarak bulundu.

TARTIÞMA ve SONUÇ: Bisiklet kazalarýnda genç yaþ grubundakiler etkilenmiþtir. Baþ/boyun travmasý ve intraparankimal kanamanýn mortalite nedeni olduðu görülmüþtür. Kazazedelerin kask gibi güvenlik önlemlerini kullanmadýðý saptanmýþtýr.

INTRODUCTION: This study aims to identify the characteristics of applicants arriving at the emergency department due to bicycle-related injuries.
METHODS: This study was designed as an epidemiological, retrospective and descriptive analysis study. The cases between 2014 and 2019 presented in this study with bicycle-related injuries to the Department of Emergency of S.B.U. Istanbul Kartal Dr. Lutfi Kýrdar Training and Research Hospital from Princess Island were analyzed retrospectively. The relevant data were recorded by examining patient files available in the electronic data of the hospital. Patient records from the last five years were examined and the data regarding bicycle accidents were evaluated concerning sociodemographic attributes, accident properties, trauma characteristics and mortality characteristics.
RESULTS: In this study, 1582 patients were included. 58.1% of the patients (n=919) were male, and the average age was 24.14±11.95. None of the patients had personal protective measures (e.g., helmets and knee pads). The major areas exposed to trauma were the lower/upper extremity with 63.2% (n=993) and the head/neck with 21% (n=333). The mortality rate was 0.8% (n=12).
DISCUSSION AND CONCLUSION: In the bicycle accidents, the individuals classified under the young age group were affected. Head/neck trauma and intraparenchymal bleeding were the main cause of mortality. It was observed that the victims were not taking security measures such as helmets.

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Siyatik sinir, alt ekstremitenin bir siniridir. Spinal sinirlerden; dördüncü Lomber’den (L4) üçüncü Sakral’a (S3) kadar olan sinir köklerinin birleþmesi ile oluþur. Siyatik sinir, arka uyluk kaslarýný innerve eder ve ek olarak duyusal fonksiyonu vardýr. Siyatalji, siyatik sinirin irritasyonundan kaynaklanan aðrýya verilen isimdir. Siyatalji en yaygýn olarak alt lomber sinir köklerinin (L4, L5 veya S1) sýkýþmasý ile indüklenir. Jinekolojik, vasküler, travmatik, enflamatuvar ve tümöral bozukluklar gibi çeþitli intrapelvik patolojiler siyataljiye neden olabilir. Disk herniasyonunu taklit eden intrapelvik patolojiler çoðunlukla göz ardý edilir. Cerrahi yaklaþým ve laparoskopi veya robotik cerrahi ile fonksiyonel keþif, siyataljiye neden olabilen intrapelvik patolojilerin farkýndalýðýný önemli ölçüde arttýrmýþtýr. Hastanýn intrapelvik patolojilere açýsýndan detaylý incelenmesinin ardýndan cerrahi veya medikal tedavi gerekliliðine karar verilir; siyatik aðrý remisyonunda kayda deðer sonuçlar alýnabilir.

The sciatic nerve is the nerve of the lower limb. It is derived from spinal nerves, fourth Lumbar (L4) to third Sacral (S3). The sciatic nerve innervates the muscles of the posterior thigh and additionally has sensory functions. Sciatica is the given name to the pain sourced by irritation of the sciatic nerve. Sciatica is most commonly induced by compression of a lower lumbar nerve root (L4, L5, or S1). Various intrapelvic pathologies include gynecological, vascular, traumatic, inflammatory, and tumoral disorders that may cause sciatica. Intrapelvic pathologies that mimic disc herniation are quite always ignored. Surgical approach and a functional exploration by laparoscopy or robotic surgery have significantly increased the intrapelvic pathology’s awareness, resulting in sciatica. After a detailed assessment of the patient, which causes intrapelvic pathologies, deciding whether surgical or medical therapy is needed, notable results in sciatic pain remission can be done.

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Candida türleri normal florada bulunmaktadýrlar ancak, baðýþýklýk sisteminin baskýlanmasý, kateter kullanýmý ve yoðun bakým ünitesinde yatmak gibi altta yatan hazýrlayýcý faktörler sonucunda hastalýk geliþimine neden olabilmektedirler. Candida glabrata çocuklarda hayatý tehdit eden ve nadir görülen mantar enfeksiyonudur. Bu yazýda, yanýk ünitesinde yatan Candida glabrata kandidemisi geliþen 14 aylýk hasta sunulmuþtur. On dört aylýk erkek çocuk yanýk servisinde %9.5 oranýnda ikinci derece kaynar su ile haþlanma yanýðý nedeniyle yatýrýldý. Hastanýn yatýþýnýn üç gününde ateþ olmasý üzerine ampirik piperasillin-tazobaktam intravenöz tedavisi baþlandý. Kan kültüründe üreme saptanmadý. Tedavinin beþinci gününde tekrar ateþi olmasý nedeniyle alýnan kan kültüründe maya ön üreme bildirilmesi üzerine tedaviye intravenöz flukonazol eklendi. Üremenin Candida glabrata olmasý üzerine tedavi caspofungine olarak deðiþtirildi. Kontrol kan kültürde üreme saptanmadý. Candida glabrata nadir görülen ciddi enfeksiyon tablosuna sebep olabilen ve azollere dirençli olan, bir mantar türüdür. Bu olgumuzda bilinen bir immün yetersizlik tanýsý, yoðun bakým yatýþý ya da santral kateter kullanýmý yoktu. Ancak yanýk hastalarýnýn da sekonder immünsüprese olduklarý ve ciddi ve nadir enfeksiyonlara yatkýn olduklarý unutulmamalýdýr.

Candida species are found in the normal human flora; however, predisposing factors, such as immunosuppression, intensive care unit stay, and catheter use, may cause progression to disease. Candida glabrata is a rare, but potentially life-threatening, fungal infection. This report describes the case of a 14-month-old male patient who developed Candida glabrata candidemia during hospitalization in the burn ward. The patient was admitted to the hospital with second-degree scald burns comprising 9.5% of the total body surface area. A fever was observed on the third day of hospitalization and empiric intravenous piperacillin-tazobactam therapy was initiated. A blood culture revealed no microorganism. Fluconazole was added to the patient’s therapy on the fifth day of treatment due to yeast reported on a blood culture taken after a recurrence of fever. Laboratory results indicated that the yeast was Candida glabrata and treatment with caspofungin was implemented. A control blood culture was sterile. Candida glabrata is a rare fungal pathogen, however, it can cause severe infection and is resistant to azoles. The classic risk factors of immunosuppression, intensive care unit admission, or catheter administration were not present in this case, yet it should be kept in mind that burn patients are secondarily immunosuppressed and prone to severe infections.

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Orbital selülit ve abseleri çoðunlukla maksiller, etmoid ve frontal sinus enfeksiyonlarýna sekonder geliþmektedir. Orbital travma sonrasýnda nadir olsada görülebilmektedir. Yabancý cisim ile meydana gelen penetran orbitafasial travma olgularýnda orbita içi dokularda yabancý cisim varlýðý radyolojik görüntüleme yöntemleri yardýmýyla dýþlanmalýdýr. Görüntülenemeyen yabancý cisimler için þüpheli muayene bulgularý varsa yakýn takip ve cerrahi eksplorasyonu gerekmektedir. Orbital abseler sýklýkla bakteriyel kaynaklý olsada deðiþkenlik göstebilir. Olasý enfeksiyon durumunda kültür alýnarak etken saptanmalý ve uygun tedavisi ivedilikle yapýlmalýdýr. Tedavi edilmeyen orbital enfeksiyonlar sonrasý %10 olguda görme kaybý görülür. Kavernöz sinus trombozu, beyin absesi ve menenjit gibi ölümcül olabilen durumlarla sonuçlanabileceðinden erken tanýnmasý ve zamanýnda tedavi edilmesi önemlidir. Bu olgu sunumuyla, aðaç dalý ile orbital yaralanma sonrasý geç dönemde meydana gelen orbital abse olgusunu ve klinik yaklaþýmýmýzý literatür bilgileri ýþýðýnda sunmayý amaçladýk.

Orbital cellulitis and abscesses are typically secondary to a maxillary, ethmoid, or frontal sinus infection. Rarely, it may also be seen after orbital trauma. In cases of penetrating orbitofacial trauma caused by a foreign body, the presence of any foreign body in the intraorbital tissues should be investigated with radiological imaging, however, an initial examination may be insufficient. Suspicious examination findings require close follow-up and surgical exploration for non-visualized foreign bodies. Though orbital abscesses are often bacterial in origin, the causative agent varies depending on the etiology, and in cases of a possible infection, the culture should be studied and treated appropriately. Vision loss of some 10% can occur in an untreated orbital infection. Early recognition and timely treatment of an orbital infection is important in order to avoid potentially deadly conditions, such as cavernous sinus thrombosis, brain abscess, or meningitis. In this case report, a case of orbital abscess occurring after a tree branch-related orbital injury and the clinical approach applied for a 76-year-old patient are reviewed in the context of the relevant literature.

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Akut ürtiker þikâyeti ile baþvuran ve bronþiolit geliþtikten sonra alýnan nazofaringeal sürüntüsünden parainfluenza virüs tip 3 (PÝV-3) elde edilen 11 aylýk kýz hasta klinikte akut ürtikerde nadir saptanan bir etiyolojik ajan dolayýsýyla sunulmuþtur. Bir haftadýr süren tüm vücutta makülo-papüler döküntüye benzer kýzarýklýk, nezle, ateþ yüksekliði ve öksürük þikayeti ile dýþ merkeze götürülen hasta orada baþlanan tedaviye raðmen döküntü þikâyetlerinin bir hafta içinde geçmeyip artýþ göstermesi nedeni ile çocuk allerji ve immünoloji polikliniðine getirildi. Hastanýn yapýlan fizik muayenesinde vücutta yaygýn ve tedaviye cevap vermeyen ürtikeryal döküntüsü ve ileri inceleme tedavi amacý ile çocuk allerji ve immünoloji servisine yatýþý yapýldý. Yatýþýnýn ikinci gününde ve bronþiolit geliþtikten sonra yapýlan deðerlendirmede akciðerlerde iki taraflý subkrepitan ral ve hýrýltý olmasý nedeni ile hastaya salbutamol 6x0.15 mg/kg/doz nebül verildi. Hastaya ürtiker için feniramin 1.4 mg/kg/gün (iki dozda), ranitidin 2 mg/kg/gün (iki dozda) tedavisi baþlandý. Alýnan nazofarenks sürüntüsünde PÝV-3 izole edildi. Çocukluk çaðý akut ürtiker etiyolojisinde viral enfeksiyonlarýn önemli bir yer tuttuðu unutulmamalýdýr. Ürtikerle giden hastalýklarýn ayýrýcý tanýsýnda etiyolojik faktörler açýsýndan ayrýntýlý bir öykü ve enfeksiyona yönelik incelemelerin alýnmasý gerekebilir.

Presently described is the case of an 11-month-old-girl diagnosed with acute urticaria due to parainfluenza virus type 3 (PIV-3). This rare etiological agent of urticaria was isolated from a nasopharyngeal swab after the development of bronchiolitis. The patient had received treatment at another clinic for a maculopapular skin eruption, rhinorrhea, fever, and a cough; however, after a lack of response and a progression of symptoms, she was brought to our pediatric allergy and immunology polyclinic. A physical examination revealed diffuse and resistant urticarial plaques on the body and she was admitted for further evaluation and therapy. Bronchiolitis developed and auscultation on the second day of admission revealed bilateral subcrepitant rales and wheezing. Treatment with salbutamol 6x0.15 mg/kg/dose was initiated, and pheniramine 1.4 mg/kg/day (in 2 doses) and ranitidine 2 mg/kg/day (in 2 doses) were added for the urticaria. PIV-3 was isolated from a nasopharyngeal swab. It is important to remember that viral infections can have a significant role in the etiology of acute urticaria in childhood. A detailed medical history and laboratory evaluations for infection may be needed for a thorough differential diagnosis and evaluation of etiological factors in urticarial disease.

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Sphingomonas paucimobilis aerop, non-fermantatif, spor oluþturmayan, sarý pigmentli, çok yavaþ hareketli gram negatif bir basildir. Bakteriyemi, pnömoni, kateter iliþkili kan dolaþýmý enfeksiyonlarý, menenjit, peritonit, osteomiyelit, septik artrit, ameliyat sonrasý endoftalmit, akciðer ve dalak apseleri, üriner ve biliyer sistem enfeksiyonlarýna neden olabilmektedir. Saðlýklý ve immün sistemi baskýlanmýþ kiþilerde enfeksiyonlara yol açabilmektedir. Hastane su sistemine kolonizasyonu nedeni ile bildirilen salgýnlar mevcuttur. Ayrýca hastanelerde hemodiyaliz ve steril ilaç solüsyonlarýnda bulunabilmektedir. Bu olgu, literatürde immünsuprese olmayan yaþlý hastalarda Sphingomonas paucimobilis’e baðlý geliþen ürosepsis olgularýna nadir rastlandýðý için sunulmuþtur.

Sphingomonas paucimobilis is an aerobic, non-fermentative, non-spore-forming, yellow-pigmented, very slow-moving, Gram-negative bacillus. Sphingomonas paucimobilis can cause bacteremia, pneumonia, catheter-related bloodstream infections, meningitis, peritonitis, osteomyelitis, septic arthritis, postoperative endophthalmitis, lung and spleen abscesses, and urinary and biliary system infections. It can lead to infections in healthy and immunocompromised individuals through a variety of mechanisms. This report describes a rare case of urosepsis due to Sphingomonas paucimobilis.

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