GÝRÝÞ ve AMAÇ: Tüm dünyayý etkisi altýna alan COVID-19 salgýný þiddetlendikçe, hastalýðýn seyrini tahmin etmede laboratuvar öngörücülerinin tanýmlanmasýna daha fazla ihtiyaç duyulmaktadýr. Bu öngörücüler ciddi hastalýk geliþtirme riski yüksek olan hastalarý belirlemeyi ve böylece devam eden pandemide sýnýrlý olan insan ve teknik kaynaklarýn tahsisini optimize edecektir. Çalýþmamýzda sýk kullanýlan mutlak lenfosit, nötrofil lenfosit oraný (NLR) ve C-reaktif protein (CRP) parametrelerinin dýþýnda systemic-immune-inflammation index (SII), lenfosit CRP oraný (LCR), trombosit lenfosit oraný (PLR), ortalama trombosit volümünün trombosit miktarýna oraný (MPV/PLT)’nin, COVID 19 pnömonisinde prediktör olarak kullanýlabilirliðini saptamayý amaçladýk.
YÖNTEM ve GEREÇLER: Mart 2020–Mayýs 2020 arasýnda COVID-19 nedeniyle hastaneye yatýrýlan hastalarýn verileri geriye dönük deðerlendirilerek demografik verileri, týbbi geçmiþi, laboratuvar bulgularý kaydedildi. Laboratuvar parametrelerinden NLR, PLR, LCR, SII, MPV/PLT oranlarý hesaplandý. Oksijen inhalasyon tedavisi, noninvaziv mekanik ventilasyon ihtiyacý (NIMV), yoðun bakým ihtiyacý ve mortalite durumlarý kaydedildi. Aðýr ve aðýr olmayan hastalýk olarak iki gruba ayrýlan hastalardan solunum hýzý >30 kez/dak veya oksijen satürasyonu <%90 olanlar aðýr olarak tanýmlandý.
BULGULAR: Çalýþmaya 62’si erkek (%73.8) 84 hasta dahil edildi, 37’sinin en az bir komorbiditesi mevcuttu. Yaþ ortalamasý 54.07±15.70 yýldý. Yirmi sekiz hastada (%33.3) hastalýk aðýr seyretmiþ, 13’ünde (%15.5) NIMV ihtiyacý, 13’ünde (%15.5) yoðun bakým ihtiyacý gerekmiþti. On bir hasta hayatýný kaybetti. Hastalýk aðýrlýðý, yoðun bakým ihtiyacý ve mortaliteyi öngörmede CRP ve NLR istatistiksel olarak anlamlý yüksek iken, mutlak lenfosit sayýsý ise düþüktü. SII ve PLR hastalýk aðýrlýðýný, yoðun bakým ihtiyacýný öngörmede anlamlý farklýlýk gösterirken, LCR her üç durumda da anlamlý farklýlýk gösterdi. MPV/PLT oraný sadece mortaliteyi öngörmede anlamlý bulunmuþtur.
TARTIÞMA ve SONUÇ: Enflamutuvar indeksler COVID-19 pnömonisinde prognostik belirteçler olarak kullanýlabilir. Kostefektif ve kolay eriþilebilir olan bu indeksler aðýr olgularýn erken tanýnmasýný öngörerek tedavi yönetiminin zamanýnda baþlatýlmasýný saðlayabilirler.

INTRODUCTION: The magnitude of the coronavirus 2019 (COVID-19) pandemic has produced a
great need to determine laboratory parameters of prognostic significance. This information will help identify patients at risk of severe disease and assist in the optimal allocation of limited medical resources. The aim of this study was to determine the usefulness of systemic-immune-inflammation index (SII), lymphocyte-to-CRP ratio (LCR), platelet-to-lymphocyte ratio (PLR) and mean thrombocyte volume-to-platelet count ratio (MPV/PLT) values compared with the commonly used laboratory parameters of absolute lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP), as prognostic biomarkers of COVID-19.
METHODS: The medical records of patients hospitalized with COVID-19 pneumonia between March 2020 and May 2020 were retrospectively evaluated. The NLR, PLR, LCR, SII, and MPV/PLT values were calculated based on laboratory parameters. The need for oxygen support, non-invasive mechanical ventilation (NIMV), and intensive care treatment were documented, as well as mortal outcomes. The patients were divided into a non-severe group and a severe disease group, which was defined by a respiratory rate of >30/minute or an oxygen saturation <90%.
RESULTS: A total of 84 patients were enrolled, including 62 (73.8%) males. The mean age of the study group was 54.07±15.70 years. Thirty-seven had at least 1 comorbidity. Twenty-eight patients (33.3%) had severe disease, with 13 (15.5%) requiring NIMV and 13 (15.5%) needing intensive care. Eleven patients died during the study period. Elevated CRP and NLR and decreased absolute lymphocyte counts were statistically significant in predicting disease severity, need for intensive case treatment, and mortality. The SII and PLR findings also reached statistical significance in the prediction of disease severity and the need for intensive care, and the LCR value was a significant predictor of all 3 outcomes. The MPV/PLT ratio was significant only in forecasting mortality.
DISCUSSION AND CONCLUSION: Our results indicate that inflammatory indexes can be used as prognostic predictors in COVID-19 pneumonia. These index measurements are cost-effective and readily available, and therefore can aid in the early identification and timely medical management of severe cases.

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GÝRÝÞ ve AMAÇ: Bu çalýþmadaki amacýmýz 112 acil saðlýk hizmetlerine baðlý ambulanslar ile taþýnan olasý ve kesin tanýlý koronavirüs hastalýðý 2019 (COVID-19) hastalarýnýn demografik özelliklerinin incelenmesidir.
YÖNTEM ve GEREÇLER: Bu çalýþma geriye dönük olarak COVID-19 tanýsý veya þüphesi olup ambulans ile nakli saðlanmýþ hastalarýn verileri kullanýlarak oluþturuldu. 11 Mart 2020–11 Mayýs 2020 tarihleri arasýnda Ankara 112 acil çaðrý merkezine ulaþan tüm çaðrýlar incelendi,18 yaþ üstü, ambulans ile taþýnan tüm olgular çalýþmaya alýndý.
BULGULAR: Acil çaðrý merkezinde saðlýk ekibi tarafýndan yapýlan deðerlendirme sonucu 107.173 olguya ambulans görevlendirmesi yapýlmýþtý. 11.345 tane olasý COVID-19 ön tanýlý olgunun hastanelere transferi saðlandý. Bu hastalarýn 856’sý (%7.5) PCR sonucuna göre COVID-19 kesin tanýsý aldý. COVID-19 tanýsý alan hastalarýn %50.6’sý kadýndý ve yaþ ortalamasý 50.6±18.7 idi. COVID-19 pozitif hastalarýn triaj kodlarý %57.1 sarý, %37.1 yeþil ve %5.7 kýrmýzý olarak deðerlendirildi. COVID-19 pozitif hastalarýn %95.7’si kentsel olguydu.
TARTIÞMA ve SONUÇ: COVID-19’a baðlý enfeksiyonlar dünyaya hýzla yayýlarak pandemiye yol açmýþtýr. Hýzla artan olgu sayýlarý ve virüsün yüksek morbidite oraný toplumda yaygýn kaygý durumuna neden olmuþtur. Olgularýn yaþ ve cinsiyet daðýlýmlarý, sosyokültürel durumlarý ve semptomlarý gibi tanýmlayýcý veriler hastalýðýn hangi popülasyonlarda daha sýk görüldüðü ve risk gruplarýný belirlemede faydalý olacaktýr.

INTRODUCTION: The aim of this study was to examine the demographic characteristics of possible and definitively diagnosed coronavirus disease 2019 (COVID-19) patients transported by ambulance through the national 112 emergency health services telephone number.
METHODS: This study was conducted retrospectively using data from patients diagnosed with or suspected of having COVID-19 who were transported to hospital in Ankara by ambulance. Calls to the 112 emergency services call center between March 11, 2020 and May 11, 2020 were examined, and all of the relevant patients over the age of 18 transported by ambulance were included in the study.
RESULTS: Ambulances were dispatched to 107,173 cases during the study period. In all, 11,345 possible COVID-19 cases were transferred to hospitals and 856 (7.5%) of these patients were subsequently diagnosed with COVID-19 based on a polymerase chain reaction test. Of the patients diagnosed with COVID-19, 50.6% were women. The mean age of the entire group was 50.6±18.7 years. The triage code of the COVID-19-positive patients was 57.1% yellow, 37.1% green, and 5.7% red. Urban residents constituted 95.7% of the patients with a positive COVID-19 diagnosis.
DISCUSSION AND CONCLUSION: Infection with severe acute respiratory syndrome 2 virus, which causes COVID-19, spread quickly and was declared a pandemic in early 2020. The rapidly increasing case numbers and the high morbidity rate caused widespread anxiety. Descriptive data, such as age and gender distribution, sociocultural characteristics, and symptoms, of patients attended to by emergency medical service units will help to determine prevalence and risk, and provide important information for public health management.

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GÝRÝÞ ve AMAÇ: Seboreik dermatit, toplumda oldukça sýk görülen, sebase bezlerden zengin saçlý deri, yüz ve intertrijinöz bölgeler gibi alanlarý etkileyebilen, eritemli papüloskuamöz lezyonlarla kendini gösteren kronik enflamatuvar deri hastalýðýdýr. Deri hastalaýklarýnda mevsimsel ataklar çeþitli hastalýklarda vurgulanmakla birlikte çeliþkili sonuçlar bildirilmiþtir. Bu çalýþmada, seboreik dermatit tanýlý eriþkin ve çocuk hastalarýmýzýn demografik verilerini taramak ve mevsimsel farkýlýklarý karþýlaþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Bu geriye dönük, kesitsel, tek merkezli, hastane bazlý çalýþmaya 01.06.2015–01.06.2020 tarihleri arasýnda hastanemiz deri ve zührevi hastalýklarý polikliniðine baþvuran ve klinik muayene sonucunda seboreik dermatit tanýsý alan hastalar alýndý. Bu tanýyý alan hem çocuk hem eriþkin hastalar deðerlendirildi.
BULGULAR: Belirtilen tarihler arasýnda polikliniðimizde 2656 hasta seboreik dermatit tanýsý almýþtýr. Hastalarýn ortalama yaþý 31.99±15.88 (0–87) idi. Bu hastalarýn 1.540 (%58) erkek iken, 1116’sý (%42) kadýndý. Yaþ gruplarýna göre daðýlýma bakýldýðýnda seboreik dermatit en sýk 20–30 yaþ grubunda (%29.9) görülmekteydi. Kadýn hastalarda yaþ ortalamasý 29.51±15.43 iken erkek hastalarda 33.80±15.96 idi. Mevsimsel aktivite karþýlaþtýrýldýðýnda 817 (%31) hastanýn kýþ mevsiminde, 615 hastanýn (%23) ilkbaharda, 452 hastanýn (%17) yaz mevsiminde, 772 (%29) hastanýn ise sonbaharda baþvurduðu görüldü.
TARTIÞMA ve SONUÇ: Seboreik dermatit toplumda sýk görülen, multifaktöryel bir deri hastalýðýdýr. Çalýþmamýzda oldukça geniþ hasta profili deðerlendirilmiþ ve seboreik dermatitin orta yaþ eriþkinleri ve erkekleri daha fazla etkilediði görülmüþtür. Çalýþmamýzda hastalarýn sýklýkla soðuk mevsimlerde baþvurduðu gözlenmiþtir. Bu çalýþmadan elde edilen veriler literatürle benzerlik göstermekle birlikte bu bulgularýn ülkemiz adýna epidemiyolojik verilere katkýda bulunacaðýný umuyoruz. Hastalarda izlenen mevsimsel ataklarý daha net açýklayabilmek için diðer tetikleyici faktörlerin de deðerlendirildiði, ileriye yönelik tasarlanmýþ, popülasyon bazlý çalýþmalarýn daha faydalý olacaðýný düþünüyoruz.

INTRODUCTION: Seborrheic dermatitis is a common, chronic inflammatory skin disorder, characterized by erythematous papulosquamous lesions in body regions that are rich in sebaceous glands, particularly the scalp, face, and intertriginous areas. Seasonal variation has been reported in different skin diseases with conflicting results. We aimed to analyze the demographic characteristics of the patients with seborrheic dermatitis and to determine the impact of seasonality on seborrheic dermatitis.
METHODS: In this retrospective, cross-sectional, single-center, hospital-based study, the patients, who visited for the diagnosis of seborrheic dermatitis to our outpatient dermatology clinic between 01.06.2015-01.06.2020, were included. We reviewed the outpatient dermatology service database retrospectively. Both pediatric and adult dermatology outpatient administrations were evaluated.
RESULTS: A total of 2.656 patients with seborrheic dermatitis were admitted to our outpatient clinic between the study period. The mean age of the patients was 31,99±15,88 (0-87) years. Among these patients, 1.540 (58%) were males and 1116 (42%) were females. Seborrheic dermatitis was most common in 20-30 years (29,9%). The mean age of the females was 29,51±15,43, and 33,80±15,96 in males. As we compare according to the seasonal activity, 817 (31%) patients admitted in winter, 615 patients in spring (23%), 452 patients in summer (17%), and 772 (29%) patients in autumn.
DISCUSSION AND CONCLUSION: Seborrheic dermatitis is a multifactorial skin disease that is common in the population.In our study,a wide patient profile was evaluated and it was observed that seborrheic dermatitis more often affects the middle-aged adults and men more.In our study, it was observed that patients frequently applied during the cold season.Although the data obtained from this study are similar to the literature,we hope that these findings will contribute to epidemiological data on behalf of our country.We think that prospectively designed population-based studies that evaluate other triggering factors will be more useful in order to explain the seasonal attacks observed in patients more clearly.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý spinal anestezi sýrasýnda perfüzyon indeksi, cilt sýcaklýðý ve ortalama arter basýncý deðiþikliklerini deðerlendirmek ve perfüzyon indeksi deðerlerini kullanarak spinal anestezinin baþarýsýný belirlemektir.
YÖNTEM ve GEREÇLER: Çalýþmaya torakal 10 (T10) seviyesinde spinal anestezi altýnda elektif cerrahi geçiren, American Society of Anesthesiologists (ASA) fiziksel durumu I–II olan toplam 128 hasta dahil edildi. Ortalama arter basýncý, kalp atým hýzý, vücut sýcaklýðý, perfüzyon indeksi ve pinprick testi ile belirlenen spinal anestezi seviyesi; anestezi indüksiyonunu takiben 30 dakika boyunca kaydedildi. Spinal blok sonrasý deðiþiklikleri deðerlendirmek için tekrarlý ölçümler ANOVA testi kullanýldý ve doðrusal karma modeller oluþturuldu. Anestezi sonrasý 2. dakikadaki perfüzyon indeksi ölçümleri için zamana baðlý ROC eðrileri oluþturularak T10 spinal anestezi seviyesine ulaþmayý öngörecek kesim noktalarý belirlendi. Ek olarak, perfüzyon indeksi oranlarý için standart ROC eðrileri oluþturuldu.
BULGULAR: Perfüzyon indeksi deðerlerinde anlamlý bir doðrusal artýþ vardý (β=0.14, standart hata = 0.01, p<0.001). Ýstatistiksel olarak anlamlý zamana baðlý ROC eðrileri, anestezi sonrasý 6. dakika ve sonrasý için elde edildi. Onbeþinci dakikadan sonra spesifisite %100 idi. Anestezi sonrasý 15. dakikadaki T10 spinal blokaj oluþumu için, 2. dakikadaki perfüzyon indeksi ölçümlerinin kesim noktasý 2.40 idi (Eðri altýnda kalan alan-EAA: 0.71, %95 güven aralýðý-GA: 0.59–0.83, sensitivite: %47, spesifisite: %100) idi. Standart ROC analizinde ise yalnýzca 2. dakikadaki perfüzyon indeksi oranlarý için eðri altýnda kalan alan istatistiksel olarak anlamlýydý.
TARTIÞMA ve SONUÇ: Anestezi indüksiyonu sonrasý 2. dakikadaki perfuzyon indeksi ölçümü 2.4’ün üzerinde olan hastalarýn hepsi, indüksiyon sonrasý 15. dakikada T10 spinal blok seviyesine ulaþmýþtý. Bu bulgunun tekrarlayan perfüzyon indeksi ölçümlerindeki artýþ eðilimi ile desteklenmesi gerekmektedir. Pinprick testine uyumu kýsýtlý hastalar için, çalýþmanýn bulgularýnýn ameliyathane pratiðine adaptasyonu düþünülebilir.

INTRODUCTION: The aim of this study was to evaluate the changes in perfusion index (PI), skin temperature, and mean arterial pressure (MAP) during spinal anesthesia and to determine the success of spinal anesthesia using the PI values.
METHODS: A total of 128 patients belonging to American Society of Anesthesiologists’ physical status I-II undergoing elective surgery under spinal anesthesia at the T10 level were included in this study. MAP, heart rate, body temperature, PI, and spinal anesthesia level, determined with the pinprick test, were recorded from baseline to 30 min following anesthesia induction. Repeated measures ANOVA test was used to evaluate changes after spinal block and linear mixed models were created. Time-dependent receiver operating characteristics (ROC) curves, using post-anesthetic 2nd min PI measurements and time to T10 spinal anesthesia level, were estimated to predict further successful spinal blockade. In addition, standard ROC curve analysis was performed for the PI ratios.
RESULTS: There was a significant linear increase in PI values (β=0.14, standard error = 0.01, p<0.001). Time-dependent ROC curves became significant for the post-anesthetic 6th min and after. Specificity was 100% after the 15th min. The cutoff value of post-anesthetic 2nd min PI was 2.4 (Area under the ROC curve-AUC: 0.71, 95% confidence interval: 0.59–0.83, sensitivity: 47%, specificity: 100%) to predict successful spinal blockage for the 15th min. In standard ROC curve analysis, only the 2nd min ROC curve revealed a significant AUC.
DISCUSSION AND CONCLUSION: All of the patients whose PI measurement at the 2nd min after the induction of anesthesia was above 2.4, reached the T10 spinal block level at the 15th min after induction. This finding must be supported by the increasing trend in PI individually. Adaptation of the study findings to the operation room practice may be considered for the patients with limited compliance to the pinprick test.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý su geçirmez duraplasti yapýlmayan dekompresif kraniektomi (DK) olgularýnda komplikasyon oranlarýný tespit etmektir.
YÖNTEM ve GEREÇLER: Kliniðimizde ameliyat edilen, 42 tane, su geçirmez duraplasti yapýlmayan dekompresif kraniektomi olgusu geriye dönük olarak incelendi.
BULGULAR: Çalýþmaya alýnan 42 hastanýn ortalama yaþý 62.7 (34–90), 32’si erkekti. Hastalarýn baþvuru anýndaki Glasgow Koma Skalasý (GKS) skoru ortalama 7, ortalama orta hat þiftleri 12.1 mm ve DK yapýlana kadar geçen süre ortalama 1.9 gün olarak tespit edildi. DK cerrahisi yapýldýktan en az 20 gün sonra hastalarýn 23 tanesi hayattaydý. Tüm hasta grubunda, toplam üç hastada (%7.1) yüzeysel yara yeri enfeksiyonu tespit edildi. Ýkisi erkek olan bu üç hastanýn ortalama yaþý 65.3 idi. Komplike olan üç olgunun baþvuru anýndaki GKS skoru ortalama 7, ortalama orta hat þiftleri ve DK yapýlana kadar geçen süre ortalama 3.3 gün olarak tespit edildi. Olgularýn hiçbirinde beyin apsesi, menenjit, beyin omurilik sývýsý (BOS) fistülü ve/veya yara iyileþme problem görülmedi.
TARTIÞMA ve SONUÇ: Sonuç olarak, su geçirmez duraplasti yapýlmayan DK tekniði, yara yeri enfeksiyonlarý ve BOS fistülü geliþmesi açýsýndan kabul edilebilir komplikasyon oranlarýna sahiptir. Su geçirmez duraplasti yapýlmayan DK tekniði, malign orta serebral arter enfartký ve intraserebral hematom nedeniyle ameliyata alýnan hastalarda çok hayati olan cerrahi süreyi kýsaltmaktadýr.

INTRODUCTION: This study was designed to determine the incidence of complications occurring after a decompressive craniectomy (DC) without duraplasty.
METHODS: The data of 42 consecutive patients who underwent DC without watertight duraplasty were evaluated retrospectively and analyzed.
RESULTS: The average age of the study group patients was 62.7 years (range: 34–90 years) and 32 of the 42 patients of them were male. The mean Glasgow Coma Scale (GCS) score was 7, the mean midline shift was 12.1 mm, and the mean length of time from injury until DC was 1.9 days. Twenty-three patients were alive at least 20 days after DC. Antibiotherapy was used to treat a wound infection in 3 (7.1%) patients. Two of these 3 patients were male and the mean age was 65.3 years. The mean GCS score before surgery in this subset of complicated cases was 7, the mean midline shift was 15 mm, and the mean length of time until DC was 3.3 days. No other complications, such as brain abscess, meningitis, cerebrospinal fluid (CSF) fistula, or wound healing abnormalities were observed.
DISCUSSION AND CONCLUSION: DC without watertight duraplasty had an acceptable incidence of postoperative complications. This technique reduces the surgical time of surgery, which can be vital in critical patients with malignant middle cerebral artery infarction or intracerebral hematoma.

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GÝRÝÞ ve AMAÇ: Vajinismus, kadýnlarýn yaþam kalitesinde önemli rahatsýzlýða ve bozulmaya neden olabilecek en yaygýn kadýn psikoseksüel iþlev bozukluklarýndan biridir. Çalýþmanýn amacý gebelikte vajinismusun özelliklerini deðerlendirmekti.
YÖNTEM ve GEREÇLER: Bu çalýþmaya riskliði gebeliði olmayan ancak vajinismusu olan 17 gebe ve gebe olamayan (kontrol) 34 vajinismus hastasý dahil edildi. Her iki gruptaki tüm hastalar biliþsel cinsel terapiler ve davranýþsal tedavilerle tedavi edildi. Vajinismus tedavisi nedeniyle gebelik komplikasyonu görülmedi.
BULGULAR: Gebe olan vajinismus grubunda seans sayýsý ve seanslara toplam katýlým gün sayýsý kontrol grubundan anlamlý olarak daha azdý. Vajinismusu olan gebelerin on ikisinde sezaryen, beþinde vajinal doðum mevcuttu. Sezaryen doðumlardan yedisinin endikasyonu elektifti ve beþinin farklý týbbi endikasyonlarý vardý. Tedaviden sonra 16 çift (%94.1), tam penetrasyonlu cinsel iliþkiye çok rahat bir þekilde kavuþtu, ancak bir çift tam penetrasyona sahip olduklarýný ancak aðrýlý olduðunu belirtti.
TARTIÞMA ve SONUÇ: Yaptýðýmýz bu çalýþma gebelik sýrasýnda vajinismus tedavisi ile ilgili ilk çalýþmadýr. Cinsel iliþki olmadan zaman zaman gebe kalan vajinismus hastalarýnýn hamilelik sýrasýnda güvenli bir þekilde cinsel terapi alabileceðini ve sonuçlarýn gebe olmayan vajinismus hastalarýndan daha iyi olduðunu gözlemledik.

INTRODUCTION: Vaginismus is a common female psychosexual dysfunction that can cause a significant deterioration in quality of life. The aim of this study was to evaluate the characteristics of vaginismus during pregnancy and treatment outcomes.
METHODS: A total of 17 pregnant women with a normal-risk pregnancy and vaginismus, and 34 vaginismus patients who were not pregnant (control group) and their partners were included in the study. All of the patients were treated with cognitive therapy and behavioral therapy. Treatment did not result in any pregnancy complications.
RESULTS: The control group required significantly more therapy sessions and a greater total number of treatment days than the pregnant vaginismus group. Twelve of the pregnant women with vaginismus had a cesarean section, and 5 had a vaginal delivery. Seven of the cesarean deliveries were elective, and 5 were due to medical indications. After treatment, 16 couples (94.1%) from the pregnant group reported that they had very comfortable, full penetrative sexual intercourse, while 1 couple said that they had achieved full penetration, but it was painful.
DISCUSSION AND CONCLUSION: This is believed to be the first study to examine vaginismus treatment during pregnancy. The findings indicated that vaginismus patients can undergo sexual therapy during pregnancy safely, and that results may be achieved sooner than with non-pregnant vaginismus patients with valuable benefits. Treatment can reduce the preference for a caesarean section, lessen anxiety related to gynecological exams and delivery.

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GÝRÝÞ ve AMAÇ: Multipl skleroz (MS) ilerleyici, enflamatuvar, kronik ve nörodejeneratif bir hastalýktýr. MS hastalarýnýn en yaygýn semptomlarýndan biri, %90’a varan yüksek oranlarla idrar kaçýrmadýr. Önceki çalýþmalar, idrar kaçýrmanýn MS hastalarýnýn yaþam kalitesini düþürdüðünü göstermiþtir. Ancak MS’ in fiziksel özür düzeyini belirleyen Geniþletilmiþ Özürlülük Durum Ölçeði (EDSS) skoru ile üriner sistem sorunlarýndan kaynaklanan yaþam kalitesi puanlarý arasýnda bir iliþki olup olmadýðý bilinmemektedir. Bu nedenle çalýþmamýz, üriner inkontinansa özgü yaþam kalitesi anketlerinden biri olan King Saðlýk Anketi (KHQ) puaný ile EDSS skoru arasýndaki iliþkiye odaklanmaktadýr.
YÖNTEM ve GEREÇLER: Çalýþmaya Cerrahpaþa Týp Fakültesi Hastanesi Nöroloji Kliniði’nde MS tanýsý almýþ ve ayakta tedavi gören 18–65 yaþ arasý 32 kadýn hasta dahil edildi. Hastalarýn EDSS skorlarý arasýnda herhangi bir sýnýflama yoktu. Ýdrar kaçýrma ile iliþkili yaþam kalitesi deðerlendirmesi için KHQ kullanýldý. Ýstatistiksel analiz için SPSS sürüm 22 kullanýldý. Normal daðýlým Kolmogorov Smirnov testi ile deðerlendirildi, parametrik olmayan korelasyon Spearman’ýn rho katsayýsý ile hesaplandý.
BULGULAR: Üriner inkontinansa özgü yaþam kalitesi ile özürlülük durumu arasýnda istatistiksel olarak anlamlý negatif bir iliþki bulundu (r=0.392, p<0.05).
TARTIÞMA ve SONUÇ: Çalýþmamýzda EDSS skoru yüksek MS hastalarýnýn üriner inkontinansa özgü yaþam kalitesi skorlarýnýn düþük olduðu ortaya konmuþtur.

INTRODUCTION: Multiple sclerosis (MS) is a progressive, inflammatory, chronic, and neurodegenerative disease. One of the most common symptoms of MS patients is urinary incontinence with high rates of up to 90%. The previous studies have shown that urinary incontinence reduces the quality of life of MS patients. However, it is not known whether there is a relationship between the Expanded Disability Status Scale (EDSS) scores, which determine the physical disability level of MS, and the quality of life scores caused by urinary problems. For this reason, our study focuses on the relationship between EDSS scores and King’s Health Questionnaire (KHQ) scores, which is one of the quality of life questionnaires specific to urinary incontinence.
METHODS: The study included 32 female patients aged 18–65 years, diagnosed with MS, and received outpatient treatment at the Neurology Clinic of Cerrahpaþa School of Medicine Hospital. There was no categorization among the patients’ EDSS scores. Quality of life associated with urinary incontinence was measured with the KHQ. Normal distribution was assessed by Kolmogorov–Smirnov test and non-parametric correlation was calculated by Spearman’s rho coefficients using SPSS version 22.
RESULTS: It was found a statistically significant negative correlation between urinary incontinence-related quality of life and disability status (r=0.392, p<0.05).
DISCUSSION AND CONCLUSION: In our study, we found that MS patients with high EDSS scores have low urinary continence-related quality of life scores.

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GÝRÝÞ ve AMAÇ: Endometriyozis, üreme çaðýndaki kadýnlarýn %10’unu etkileyen kronik bir hastalýktýr. Belirsiz patofizyoloji nedeniyle, küratif bir tedavi seçeneði mevcut deðildir. Bu nedenle hastalýkla ilgili klinik deneyim ve artan bilgi birikimi büyük önem taþýmaktadýr. Bu çalýþmanýn amacý, uzun dönem klinik stratejileri deðerlendirmek için üçüncü basamak bir jinekoloji kliniðinde endometriyozis hastalarýnýn demografik özelliklerini, semptomlarýný, týbbi alýmýný, analjezik ihtiyacýný ve tedavi yöntemlerini araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Bu geriye dönük tanýmlayýcý olgu çalýþmasý, üçüncü basamak bir jinekoloji kliniðinde gerçekleþtirildi. Kasým 2012 ile Temmuz 2020 arasýnda bir veri tabaný araþtýrmasý yapýldý ve toplam 1098 hasta çalýþmaya dahil edildi. Hastalarýn yaþ, gravite, parite, ameliyat öyküsü ve demografik özellikleri kaydedildi. Taný yöntemleri, týbbi ve cerrahi tedavi stratejileri, hastanede kalýþ süresi ve analjezik ilaç ihtiyacý için medikal dosyalar tarandý.
BULGULAR: Sekiz yüz yetmiþ üç hasta evre 3 hastalýða sahipken, sadece altý hastaya evre 4 hastalýk teþhisi konmuþtur. Hastalarýn %47’si ultrason ile, %53’ü cerrahi olarak teþhis edildi. Hastalar cerrahi tekniklere göre deðerlendirildiðinde 144 hastaya laparoskopik, 235 hastaya laparotomi yapýldý. Laparoskopi sonrasý ortalama hastanede kalýþ süresi 2.68±1.02, laparotomi sonrasý ortalama süre 3.45±1.69 olarak hesaplandý. Týbbi tedavi stratejileri açýsýndan kayýtlarýn incelenmesi, 110 hastanýn kombine oral kontraseptif (KOK), 36’sýnýn progesteron ve 525’inin dienogest aldýðýný ortaya koydu.
TARTIÞMA ve SONUÇ: Endometriyozisin iyileþtirici tedavisi için büyük bir arayýþ bir süredir devam etse de, tedavi seçenekleri yýllar içinde büyük ölçüde deðiþmedi. Cerrahlarýn tecrübesi arttýkça, endometriyozis cerrahisinde laparotominin yerini laparoskopik cerrahi almýþtýr. Ayrýca týbbi tedavi seçenekleri olarak progestinler daha fazla önem kazanmýþtýr. Bununla birlikte, tedavi stratejilerine bakýlmaksýzýn, endometriyozis hastalarýnýn hala uzun süreli tedavilere ve takiplere ihtiyacý vardýr.

INTRODUCTION: Endometriosis is a chronic disease that affects 10% of women of reproductive age. No curative treatment is currently available due to the as yet unclear pathophysiology. Therefore, clinical experience and additional knowledge of the disease has great value. This study was an investigation of the demographic characteristics, symptoms, medication use, analgesic need, and treatment methods of endometriosis patients at a tertiary gynecological clinic in order to evaluate long-term clinical strategies.
METHODS: This retrospective, descriptive case study was conducted at a tertiary gynecological clinic. A database search of records from November 2012 to July 2020 yielded a total of 1098 patients for initial inclusion in the study. Age, gravidity, parity, surgical history, and demographic characteristics were recorded, as well as the diagnostic methods, medical and surgical treatment strategies, hospitalization duration, and need for analgesic medication.
RESULTS: In all, 873 patients had stage 3 disease and 6 patients were diagnosed with stage 4 disease. Of the study group, 47% of the patients were diagnosed using ultrasound and 53% were diagnosed surgically. An assessment of the surgical techniques used revealed that 144 patients underwent laparoscopic surgery while 235 underwent a laparotomy. The mean duration of hospitalization following a laparoscopy was 2.68±1.02 days, whereas the mean length of stay following a laparotomy was 3.45±1.69 days. Analysis of the medical treatment strategies applied indicated that 110 patients were given a combined oral contraceptive (COC), 36 received progesterone, and 525 were treated with dienogest.
DISCUSSION AND CONCLUSION: Although there has been an ongoing search for a curative treatment for endometriosis for some time, the treatment options have not changed dramatically over the years. Laparoscopic surgery has largely taken the place of a laparotomy as surgeons became more experienced and progestins have gained more importance as a medical treatment option. However, at present, regardless of treatment strategy, endometriosis still requires a long period of treatment and follow-up.

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GÝRÝÞ ve AMAÇ: Gerilimsiz sentetik mesh kullanýlarak yapýlan Lichtenstein ve total ekstraperitoneal (TEP) onarým uygulanmýþ hastalarda her iki tekniðin testis volümü ve spermatik kord kan akýmý üzerine olan etkilerini karþýlaþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Ocak 2018-Haziran 2019 tarihleri arasýnda genel cerrahi polikliniðine baþvuran ve poliklinikte kasýk fýtýðý tanýsý alan tetkik ve konsültasyonlarý tamamlanarak, anestezi onayý olan 20-40 yaþ arasý, cinsel aktif 96 erkek hastalar çalýþmaya alýndý. Hastalar iki gruba randomize edildi. Hastlarýn 48’ine Lichtenstein herniorafi (Grup 1) 48’ine ise TEP onarýmý (Grup 2) yapýldý. Hastalar ameliyat sonrasý 1 yýl sonra kontrole çaðrýlarak inguinal ve skrotal Doppler ultrason yapýldý. Ultrasonografik deðerlendirmede ameliyat edilmiþ taraf ve saðlam taraf testis volümleri ve spermatik kord arteriel kan akým deðerleri ölçüldü. Arteriyel kan akýmý ölçümünde, sistolik tepe akým hýzý (Vmax), diastolik sonu akýmhýzý (Vmin), rezistivite indeksi (RI) ve pulsalite indeksi (PI) ölçüldü.
BULGULAR: Lichtenstein herniorafi (Grup 1) yapýlan tarafýn ameliyat edilmemiþ taraf ile karþýlaþtýrýlmasýnda Vmin, RI, PI ve TV deðerleri açýsýndan istatistiksel olarak anlamlý fark bulundu (sýrasýyla, p=0.03, 0.01, 0.01, 0.01). TEP onarýmý (Grup 2) yapýlan tarafýn ameliyat edilmemiþ taraf ile karþýlaþtýrmasýnda ise testis volümleri ve spermatik kord arteriyel kan akým deðerleri arasýnda istatistiksel olarak anlamlý bir fark bulunmadý. Lichtenstein ve TEP gruplarý arasýnda Vmax, Vmin ve TV deðerleri arasýnda anlamlý bir fark bulunmazken RI ve PI deðerleri açýsýndan aralarýnda istatistiksel olarak anlamlý fark bulundu (sýrasýyla, p=0.02, 0.01).
TARTIÞMA ve SONUÇ: Sentetik mesh kullanýlarak yapýlan kasýk fýtýðýnýn cerrahi tedavisinde TEP onarýmýnýn, Lichtenstein tekniðine göre testis fonksiyonlarýnýn daha iyi korunmasý açýsýndan elveriþli olduðunu göstermiþtir.

INTRODUCTION: The aim of this study was to compare the effects on testicular volume (TV) and spermatic cord blood flow of Lichtenstein hernia repair using tension-free synthetic mesh and laparoscopic totally extraperitoneal (TEP) repair.

METHODS: A total of 96 sexually active male patients aged 20–40 years who presented at a general surgery outpatient clinic between January 2018 and June 2019 and were diagnosed with inguinal hernia were included in the study. The patients were randomized into 2 groups. Of the group, 48 patients underwent Lichtenstein hernioplasty (Group I) and 48 patients had TEP repair (Group II). Inguinal Doppler ultrasound was performed 1 year after surgery to evaluate the operated side and to assess the intact testicular volume and spermatic cord arterial blood flow. The peak systolic velocity (Vmax), end diastolic velocity (Vmin), resistive index (RI), and pulsatility index (PI) were measured.
RESULTS: A statistically significant difference was found in the Vmin, RI, PI, and TV values in the Lichtenstein repair side (Group I) in comparison with the non-operated side (p=0.03, 0.01, 0.01, 0.01, respectively). In the comparison of the TEP repair side (Group II) with the non-operated side, no statistically significant difference was observed in the TV or spermatic cord arterial blood flow values. While there was no significant difference between Vmax, Vmin, and TV values between the Lichtenstein and TEP groups, a statistically significant difference was seen in the RI and PI values (p=0.02, 0.01, respectively).
DISCUSSION AND CONCLUSION: In this evaluation of the effects of surgical treatment of inguinal hernia, TEP repair provided better preservation of testicular function compared with the Lichtenstein technique.

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GÝRÝÞ ve AMAÇ: Tanýmlayýcý ve kesitsel tipteki bu çalýþmanýn amacý, irritable baðýrsak sendromu (IBS) hastalarýnda D tipi kiþilik ile gastrointestinal semptomlar arasýndaki iliþkiyi ortaya koymaktýr.
YÖNTEM ve GEREÇLER: Bu çalýþma, bir üniversite hastanesinin gastroenteroloji polikliniðinde IBS tanýsý alan hastalarla yapýldý. Çalýþmanýn evrenini, 15 Þubat 2019 ve 15 Mayýs 2019 tarihleri arasýnda poliklinikte IBS tanýsý konan 192 hasta, örneklemini 168 hasta oluþturdu. Veriler bir Hasta Tanýtým Formu, Gastrointestinal Semptom Derecelendirme Ölçeði (GSRS) ve D-14 Kiþilik Tipi Ölçeði (DS-14) kullanýlarak toplandý.
BULGULAR: Ýrritable baðýrsak sendromu hastalarýnýn %70.8’inde tip D kiþiliði vardýr. D Tipi kiþiliðe sahip olan hastalarýn GSRS toplam puaný (p<0.0001) ve alt boyutlarýndan reflü (p<0.0001), diyare (p=0.01), karýn aðrýsý (p=0.001), konstipasyon (p=0.001), hazýmsýzlýk (p=0.004) puanlarý D tipi kiþiliðe sahip olmayan hastalara göre anlamlý derecede yüksekti. Çoklu regresyon analizi yapýldýðýnda; reflü hariç tüm alt boyut ve GSDÖ toplam puanýnýn %20 oranýnda (R2=0.203, p=0.000) belirleyicilik rolü olduðu bulunmuþtur.
TARTIÞMA ve SONUÇ: Bu çalýþmada IBS tanýsý alan bireylerde D tipi kiþilik oranýnýn %70.8 olduðu, gastrointestinal semptomlardan karýn aðrýsý, reflü, diyare, hazýmsýzlýk ve konstipasyonun D tipi kiþiliði olan bireylerde olmayanlara göre daha fazla görüldüðü saptandý.

INTRODUCTION: The aim of this descriptive and cross-sectional study was to examine the relationship between type D personality and gastrointestinal symptoms in patients with irritable bowel syndrome (IBS).
METHODS: A total of 168 of 192 patients who presented at the gastroenterology polyclinic of a university hospital between February 15 and May 15, 2019 and were diagnosed with IBS were enrolled. The data were collected using a patient identification form, the Gastrointestinal Symptom Rating Scale (GSRS), and the Type D Scale-14 (DS-14) personality assessment.
RESULTS: Of the IBS patients studied, 70.8% had type D personality. The GSRS total score of the patients with type D personality (p=0.001), as well as their reflux (p=0.001), diarrhea (p=0.01), abdominal pain (p=0.001), constipation (p=0.001), and indigestion (p=0.004) subdimension scores were statistically significantly higher than those without type D personality. Multiple regression analysis indicated that the GSRS total score and all subdimension scores except reflux had a predictive value of 20% (R2=0.203; p<0.0001).
DISCUSSION AND CONCLUSION: In all, 70.8% of individuals diagnosed with IBS were classified as type D personality. The gastrointestinal symptoms of abdominal pain, reflux, diarrhea, indigestion, and constipation were more prevalent among individuals with type D personality compared with other personality types.

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GÝRÝÞ ve AMAÇ: Hafif akut pankreatiti (AP) orta düzey AP’den ayýran kesin parametreler hala belirsizdir. Bu çalýþmanýn birincil amacý, hafif ila orta-aðýr AP hastalarýnda enflamatuvar belirteçlerinin ayýrt ettirici gücünü deðerlendirmektir.
YÖNTEM ve GEREÇLER: AP tanýsý alan hastalarýn klinik bilgileri ve hastalýk baþý ile remisyon anýndaki enflamatuvar belirteç düzeyleri geriye dönük tek merkezli olarak toplandý. Enflamatuvar parametreler – Ortalama trombosit hacmi (MPV), nötrofil-lenfosit oraný (NLR), nötrofil-monosit ürünü (NMP), trombosit-lenfosit oraný (PLR) – elektronik veritabanýndan elde edildi. Acil servise baþvuru günü belirti baþlangýcý olarak kabul edildi ve hastanýn aðrýsýz olduðu ve oral beslenmeye baþladýðý gün remisyon tarihi olarak kabul edildi. Hasta gruplarýnýn klinik deðerlik ölçütleri (duyarlýlýk, özgüllük, pozitif ve negatif olabilirlik olasýlýklarý) hesaplandý.
BULGULAR: Toplam 217 AP hastasý belirlendi, 34’ü (%15.7) veri eksiði nedeniyle dýþlandý ve çalýþma popülasyonu 183 AP hastasýndan (%84.3) oluþtu. Gözden geçirilmiþ Atlanta Sýnýflamasýna göre, 142 (%77.6) hasta hafif AP (MAP) ve 39 (%21.3) hasta orta-aðýr AP (MSAP) idi. MAP grubunda ortanca nötrofil ve lenfosit sayýlarý, PLR, NLR, NMP, anlamlý olarak yüksek, LMR ise istatistiksel olarak anlamlý düzeyde düþük olarak belirlendi. Remisyon anýnda, ortanca MPV düzeyi anlamlý olarak daha yüksek iken (p=0.0062) ortanca beyaz küre sayýsý (WBC) anlamlý derecede daha düþüktü (p<0.0001). Ayný eðilim, MPV ve WBC için de MAP grubunda gözlendi, ancak MSAP-SAP grubunda MPV için mevcut deðildi.
TARTIÞMA ve SONUÇ: Tüm enflamatuvar belirteçlerin ve oranlarýn hafif ve orta-þiddetli AP gruplarý arasýnda anlamlý derecede farklý olduðunu bulduk. NLR gruplar arasýnda ayrým yapma yönünden en güçlü belirteçti. Baþlangýçtan remisyona kadar, MPV deðiþimi anlamlý deðilken, WBC’de deðiþimi, AP ciddiyetine bakýlmaksýzýn, anlamlý ve önemliydi.

INTRODUCTION: The exact parameters that differentiate mild Acute pancreatitis (AP) from moderate AP are still unclear. The primary aim of this study was to evaluate the prognostic utility of recently used inflammatory parameters in AP patients.
METHODS: We retrospectively collected the level of inflammatory parameters of patients who were diagnosed with acute pancreatitis at the onset and remission of the disease. The inflammatory parameters – Mean platelet volume (MPV), neutrophile-lymphocyte ratio (NLR), neutrophil-monocyte product (NMP), platelet-lymphocyte ratio (PLR) - were derived from the electronic patient database. The day of the presentation to the Emergency Department (ED) was accepted as the day of the symptom onset, and the day when the patient declared to be pain-free and started to take oral nutrition was accepted as the date of remission. We also calculated the clinical utility metrics such as positive and negative likelihood ratios at this threshold.
RESULTS: A total of 217 AP patients were retrieved from the system, and the final study population consisted of 183 AP (84.3%). According to revised Atlanta Classification, 142 (77.6%) patients were Mild AP (MAP) and 41 (22.4%) were Moderate and Severe AP (MSAP-SAP). Median neutrophil and lymphocyte counts, PLR, NLR, NMP were all significantly higher, and LMR was significantly lower in MAP group. At remission, the median MPV level was significantly higher (p=0.0062), and median WBC level was significantly lower (p<0.0001). The same trend was observed in MAP group for both MPV and WBC, but not present for MPV in MSAP-SAP group.
DISCUSSION AND CONCLUSION: We found that all inflammatory markers and ratios were significantly different between MAP and MSAP groups. Among those markers, NLR was the most powerful to discriminate between those groups. During AP from onset to remission, the changes in MPV had no benefit but the change in WBC was significant regardless of AP severity.

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GÝRÝÞ ve AMAÇ: Esnek bronkoskopi (EB) yenidoðan yoðun bakým ünitesinde (YYBÜ) yatan ve solunum problemleri olan hastalarýn yararýna kullanýlan bir araçtýr.
YÖNTEM ve GEREÇLER: Temmuz 2014–Temmuz 2020 tarihleri arasýnda YYBÜ’de yatan ve EB yapýlan tüm hastalar çalýþmaya alýndý. Demografik ve klinik özelikler, EB indikasyonlarý, EB prosedürüne ait veriler, EB bulgularý, EB komplikasyonlarý ve EB’nin hastanýn yönetimine saðladýðý katký deðerlendirildi.
BULGULAR: Kýrk sekiz hastaya EB yapýldý. Bunlarýn 22’si (%45.8) erkekti. Medyan yaþ 44 gündü (26.2–59.7). EB için en yaygýn endikasyonlar; %50 hastada ekstübasyon baþarýsýzlýðý ve %33 hastada havayolu hastalýðý idi. Bronkoskopik deðerlendirmeler ile 46 hastada (%95.8) en az bir anormallik saptandý. Kýrk bir (%85.4) hastaya bronkoalveolar lavaj yapýldý. EB, hastalarýn 46’sýnda (%93.8) hastanýn yönetimine katký saðladý. Kýrk sekiz hastanýn 16’sýna (%33.3) bronkoskopi ile taný kondu, 23 (%48) hastada ise týbbi tedaviler revize edildi. Hastalarýn yedisinde (%14.6) baþarýlý bir terapötik lavaj yapýldý. Hastalarýn 28’ine (%58.3) ise cerrahi giriþim uygulandý.
TARTIÞMA ve SONUÇ: Esnek bronkoskopi, YYBB’de solunum bozukluklarýnýn taný ve tedavisinde önemli bir deðere sahiptir. Hava yollarýnýn doðrudan görüntülenmesi, BAL’nin mikrobiyolojik deðerlendirmesi ve mukus týkaçlarýnýn uzaklaþtýrýlmasý, klinisyenlerin daha doðru taný koymasýna ve havayolu cerrahi prosedürleri dahil olmak üzere uygun tedavi seçeneklerini sunmasýna olanak tanýr.

INTRODUCTION: Flexible bronchoscopy (FB) is a safe and valuable tool for the assessment and treatment of patients in neonatal intensive care units (NICUs) with respiratory diseases.
METHODS: All neonates who underwent FB in the NICU between July 2014 and July 2020 were included in the study. All demographic and clinical data including FB indications, the FB procedure performed and FB findings, FB complications, and the contribution of FB to the management were examined.
RESULTS: Forty-eight patients underwent FB. Twenty-two (45.8%) of them were male. The median age was 44 days (26.2–59.7). The most common indication for FB was extubation failure at 50%, followed by suspected airway disease at 33%. Bronchoscopic assessments revealed at least one abnormality in 46 (95.8%) infants. Bronchoalveolar lavage (BAL) was performed in 41 (85.4%) patients. FB contributed to the management in 46 (93.8%) of the patients. Based on FB results, 16 of 48 (33.3%) patients received a diagnosis by bronchoscopy, and medical treatments were revised in 23 (48%) patients. A successful therapeutic lavage was made in 7 (14.6%) of patients. Surgical interventions were performed in 28 (58.3%) of the patients.

DISCUSSION AND CONCLUSION: FB has an important value in the diagnosis and management of respiratory disorders in NICU. Direct visualization of the airways, microbiological assessment of BAL, and removal of mucus plugs allow the clinicians to make an accurate diagnosis and provide appropriate treatment options, including airway surgical procedures.

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GÝRÝÞ ve AMAÇ: Hiperbarik oksijen tedavisinin (HBO2) antienflamatuvar ve antifibrotik etkisi bulunmaktadýr. Sistemik sklerozda (SS) dijital ülserler gibi kronik yara tedavisinde etkisi olduðu gösterilmiþtir. HBO2 tedavisinin, ek olarak SS’a baðlý fibrotik deðiþikliklere de etkisi olabileceði düþünülmektedir. Bu çalýþmada, medikal tedaviye dirençli dijital ülseri bulunan hastalarda, HBO2 tedavisinin SS baðlý deri kalýnlýðýna olan etkisi araþtýrýlmýþtýr.
YÖNTEM ve GEREÇLER: Bu çalýþma gözlemsel ve retrospektif bir çalýþmadýr. Altmýþ sekiz hastadan olan SS kohortumuzdaki hastalarýn 25’inde dijital ülser tespit edilmiþtir. Bu hastalarýn dördünde medikal tedaviye dirençli dijital ülser gözlenmiþtir. Öncelikle hastalara medikal olarak kalsiyum kanal blokerleri, asetil salisilik asit, iloprost ve bosentan tedavilerinden en az üçü uygulanmýþtýr. Bu tedaviye dirençli hastalar, romatolog ve sualtý ve hiperbarik uzmanlarý tarafýndan HBO2 açýsýndan deðerlendirilmiþtir. Takiben uygun hastalara HBO2 tedavisi verilmiþtir. Hastalarýn tedavi öncesi ve sonrasý modifiye Rodnan skorlarý (mRSS), saðlýk deðerlendirme anketi hastalýða baðlý kýsýtlýlýk ve kýsa form 36 testi ile hayat kalitesi ölçülmüþtür. Ayrýca hastalarýn deri kalýnlýðýna yönelik görsel analog skalasý deðerlendirilmiþtir.
BULGULAR: mRss skorunda tüm hastalarda tedavi sonrasý düzelme gözlenmiþtir. Ancak, sadece bir hastanýn dijital ülserinde anlamlý düzelme gözlenmiþtir. Ayrýca, hastalýða baðlý kýsýtlýlýk ve hayat kalitesi deðerlendirmelerinde anlamlý deðiþim tespit edilmemiþtir.
TARTIÞMA ve SONUÇ: HBO2 tedavisi, SS baðlý deri kalýnlýðýna antienflamatuvar ve antifibrotik etkileri ile olumlu deðiþim saðlayabilir. Hayat kalitesi ve hastalýða baðlý kýsýtlýlýkta düzelme için hastalýkla ilgili tüm alanlara yönelik tedaviler gerekmektedir.

INTRODUCTION: Hyperbaric oxygen (HBO2) therapy has well-known anti-inflammatory and antifibrotic effects. It may be an option for the treatment of chronic wounds including digital ulcers related with systemic sclerosis (SS). The therapy may also have an impact on the fibrotic complications of SS, including skin thickness. The aim of the study was evaluating the effect of HBO2 on skin thickness in SS patients with medical therapy resistant digital ulcers.
METHODS: This was an observational study.Twenty-five of 68 patients in our SS cohort had digital ulcers. Four of those had medical therapy resistant digital ulcers. Firstly, we administered at least three of the drugs: Calcium channel blockers, acetylsalicylic acid, iloprost and bosentan as combination therapy. Then, unresponsive patients were evaluated together by rheumatologist and underwater and hyperbaric medicine physician for HBO2 indication. Lastly, we applied HBO2 to eligible patients for their refractory and active digital ulcers. We evaluated the pre- and post-therapy values of modified Rodnan skin score (mRSS) for skin thickness, health assessment questionnaire for disease related disability, short-form 36 test for quality of life and visual analog scores related to skin thickness.
RESULTS: Modified Rodnan skin scores of all patients improved after the therapy. Nevertheless, we observed that only one patient’s digital ulcers got better with the therapy. Furthermore, disease-related disability and quality of life indices were not improved consistently according to the favourable changes in skin scores.
DISCUSSION AND CONCLUSION: HBO2 may have a positive effect on skin thickness owing to its anti-inflammatory and antifibrotic effects. Disease-related disability and quality of life parameters may improve further with addressing all aspects of the disease.

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GÝRÝÞ ve AMAÇ: Laparoskopik histerektomi (LH) sýrasýnda mesane yaralanmasý, üreter yaralanmasýndan yaklaþýk olarak üç kat daha fazla görülmektedir ve jinekologlar için hala önemli bir problem oluþturmaktadýr. Çalýþmamýzýn amacý, laparoskopik histerektomi sýrasýnda oluþan mesane yaralanmalarýnýn laparoskopik olarak onarýlmasýnýn sonuçlarýný sunmaktýr.
YÖNTEM ve GEREÇLER: Kasým 2018 ile Ocak 2020 arasýnda benign jinekolojik nedenlerle LH yapýlan hastalar geriye dönük olarak incelendi. Mesane yaralanmasý izlenen tüm hastalarýn týbbi kayýtlarý incelendi, yaralanma nedenleri, insidansý, tedavi ve takipleri deðerlendirildi.
BULGULAR: Laparoskopik histerektomi sýrasýnda mesane yaralanmasý olan sekiz hasta saptandý. Mesane yaralanmalarýn hepsi operasyon sýrasýnda farkedildi. Yedi hastada utero–vezikal alanýn laparoskopik olarak keskin ve künt diseksiyonu sýrasýnda, bir hastada da suprapubik trokar giriþi sýrasýnda mesane hasarý oluþtuðu izlendi. Mesane hasarlarýnýn tümü laparaskopik olarak onarýldý. Cerrahi sýrasýnda ve sonrasýnda hiçbir hastada majör bir komplikasyon izlenmedi. Mesane katateri cerrahiden 7–10 gün sonra çýkarýldý.
TARTIÞMA ve SONUÇ: Laparoskopik histerektominin korkulan bir komplikasyonu olan mesane yaralanmalarýnýn laparoskopik onarýmý, endoskopik cerrahide deneyimli bir jinekologlar tarafýndan da baþarý ile yapýlabileceði gösterilmiþtir.

INTRODUCTION: The rate of bladder injury during laparoscopic hysterectomy (LH) is three-fold higher than that of ureter injury and is an important problem for gynecologists. The aim of the present study was to present the results of laparoscopic repair of bladder injuries produced during LH procedure.
METHODS: Patients who underwent LH for benign indications between November 2018 and January 2020 were evaluated retrospectively. Medical records of all patients with bladder injury were reviewed and their causes of injury, incidence, treatment and follow-up were evaluated.
RESULTS: Eight patients were established to have bladder injury while undergoing LH. All bladder injuries were recognized during operation. Bladder injury occurred during laparoscopic sharp and blunt dissection of uterovesical area in seven patients and during suprapubic trochar insertion in one patient. All bladder injuries were repaired laparoscopically. No major complications were encountered during or after operation. Bladder catheters were removed 7–10 days after surgery.
DISCUSSION AND CONCLUSION: It was demonstrated that laparoscopic repair of bladder injury, which is a feared complication of LH, can be carried out successfully be gynecologists experienced in endoscopic surgery.

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GÝRÝÞ ve AMAÇ: Adenotonsillektomi ve tonsillektomi en yaygýn cerrahi prosedürlerdir. Nötrofil/lenfosit oraný, trombosit/lenfosit oraný ve ortalama trombosit hacmi enflamasyon belirteçleri olarak kullanýlabilir. Çalýþmanýn amacý, adenotonsillektomi ve tonsillektomi hastalarýnda bu enflamatuvar belirteçlerin deðerlerinin takipte etkili olup olmayacaðýný veya cerrahi karar için gösterge faktör olup olmadýðýný belirlemektir.
YÖNTEM ve GEREÇLER: Kronik tonsillit ve tonsil hipertrofisi nedeniyle ameliyat edilen 194 hastanýn týbbi kayýtlarý ve ameliyat öncesi kan deðerleri geriye dönük olarak incelendi. Ameliyat sonrasý birinçi ayda tam kan hücresi sayýsý (CBC) deðerleri deðerlendirildi. Kontrol grubu olarak pediatri kliniði tarafýndan takip edilen normal deðerlere sahip 83 hastanýn CBC kayýtlarý alýndý.
BULGULAR: Çalýþma grubundaki 194 hastanýn ameliyat öncesi nötrofil/lenfosit oraný deðerleri ameliyat sonrasý deðerlere göre anlamlý olarak yüksekti. Trombosit/lenfosit oraný deðerleri önemli ölçüde farklý deðildi. Ortalama trombosit hacmi açýsýndan ameliyat öncesi, sonrasý ve kontrol gruplarý 3 grupta istatistiksel olarak birbirinden farklýydý. Parametreler enfeksiyon sayýlarý açýsýndan incelendiðinde nötrofil/lenfosit oraný, trombosit/lenfosit oraný ve ortalama trombosit hacmi deðerleri açýsýndan gruplar arasýnda anlamlý farklýlýk gözlenmedi.
TARTIÞMA ve SONUÇ: Adenotonsillektomi ve tonsillektomi hastalarýnda tekrarlayan enfeksiyon sayýsý, nötrofil/lenfosit oraný, trombosit/lenfosit oraný ve ortalama trombosit hacmi açýsýndan ameliyat öncesi ve sonrasý deðerler açýsýndan anlamlý farklýlýk yaratmadý. Ancak cerrahi iþlem uygulanan hastalarda nötrofil/lenfosit oraný normal popülasyonda ve ameliyat sonrasý dönemde ameliyat öncesi döneme göre anlamlý olarak daha yüksekti. Bu nedenle nötrofil/lenfosit oraný’nýn tonsillit hastalarýnda enflamatuvar bir belirteç olarak kullanýlabileceðine inanýyoruz.

INTRODUCTION: Adenotonsillectomy/tonsillectomy are among the most widely used surgical procedures in ENT. The aim of the study is to compare the pre- and post-operative values of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and mean platelet volume (MPV) according to the number of recurrent infections and to determine its relation to the normal population.
METHODS: Complete blood cell values of 194 patients who underwent surgery for chronic tonsillitis and tonsillar hypertrophy as a study group, 83 patients with normal values as control group were analyzed for NLR, PLR, and mean platelet volume. Annual number of infections and blood parameters were compared before and after surgery.
RESULTS: Pre-operative NLR values of 194 patients in the study group were significantly higher than the post-operative values. In terms of MPV, pre-operative, post-operative, and control groups were statistically different from each other in 3 groups. When the parameters were examined in terms of number of infections, no significant difference was observed between groups in terms of NLR, PLR, and MPV values.
DISCUSSION AND CONCLUSION: We did not found any relationship between the annual number of infections and inflammatory blood parameters. Therefore, in terms of the number of infections per year, these parameters are not significantly valuable. However, in patients who underwent surgical procedures, NLR was significantly higher in the normal population and postoperatively than in the pre-operative period. Therefore, we believe the NLR may be used as an inflammatory marker in tonsillitis patients.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada acil servis (AS) veri tabanýnýn oluþturulmasýna zemin hazýrlayacak bazý bilgilere ulaþýlmasý hedeflenmiþtir. Acil servisin olasý yoðun saatlerinin belirlenmesi, insan gücünün planlanmasý için baþvurularýn aciliyet ve uygunluðu deðerlendirilmiþ; uygun olmayan baþvurularýn nedenleri ve zamanlarý saptanmýþ, önlenmesi konusunda alýnabilecek önlemler tartýþýlmýþtýr.
YÖNTEM ve GEREÇLER: Bu çalýþma 02.09.2015–31.10.2015 tarihleri arasýnda ileriye yönelik olarak yapýldý. Hastalarýn acil servis (yeþil alan) baþvurularýný deðerlendirmek amacýyla demografik veri (7 soru) ve AS baþvuru nedeninin tespiti için (15 soru) toplam 22 adet kapalý uçlu soru soruldu.
BULGULAR: Hastalarýn yaþ ortancasý 37 yýldý ve %51.2’si erkekti. Hastalar çoðunlukla ilköðretim (%34.3) mezunuydu. Hastalarýn çoðunun her hangi bir iþte çalýþtýklarý (%53.8) ve daha çok iþçi/hizmetli (%32.0) sýnýfýnda çalýþtýklarý belirlendi. Hastalarýn %88.1’inin sosyal güvencesi vardý. Hastalarýn sýklýkla 17: 00–08: 00 saatleri arasýnda AS’ye baþvurduðu görüldü (%52.4). Hastalarýn %74.7’si aile hekimini tanýyordu, %74.4’ü aile hekimine muayene amaçlý baþvurmuþ ve %48.2’si de daha önce 112’yi arayýp ambulans ile hastaneye nakli saðlanmýþtý. Hastalarýn %70.2’si mesai saatleri içinde aile hekimine baþvurmama nedenini baþta kendilerini acil hissetmeleri ve daha detaylý muayene olmak isteði (%36.3) olarak ifade etmektedirler. Hastalarýn AS’yi tercih etme nedeninin baþýnda yakýnlýk (%36.5) gelmekteydi. Son bir yýl içinde hastalarýn tamamýnýn AS’ye bundan önce en az bir kez baþvurduðu; %83’ünün en az bir polikliniðe baþvurduðu saptandý. Hastalarýn çoðu (%31.0) sýra bitene kadar bekleyeceðini belirtti. Hastalarýn %74.5’i triaj sistemine, %50.6’sý acil hastanýn öncelikli olduðu düþüncesine, %67.5’i ise genel sýra kurallarýna uyulmasý gerektiðini savundu. Mesai sonrasý gelen hastalar AS’yi en sýk tercih etme sebeplerinin yeni hastalanma (%61.6) olduðunu belirtti. Hastalarýn poliklinikler açýk iken AS’ye gelmelerinin en sýk sebebi ise hastanýn kendisinin acil olduðunu düþünmesi (%46.6) olarak saptandý.
TARTIÞMA ve SONUÇ: Sonuç olarak, kiþilere verilecek eðitim, acil servislerden acil olmayan iþlemlerin kaldýrýlmasý (enjeksiyon, pansuman vs), aile saðlýðý merkezlerinin uygun yerlere yerleþtirilmesi ve bu merkezlerdeki hekime olan güveninin artýrýlmasý, yeþil alan hastalarýndan alýnan muayene katký payý ücretlerinin yükseltilmesi ile acil servis’e (yeþil alan) olan baþvurunun azaltýlabileceði kanýsýndayýz.

INTRODUCTION: In this study, it is aimed to reach some information that will prepare the ground for the establishment of emergency service database. The urgency and appropriateness of the applications were evaluated for determining the possible rush hours of the emergency department (ED) and planning the workforce; the reasons and times of the inappropriate applications were determined and the measures to be taken to prevent them were discussed.
METHODS: This study was prospectively conducted in Ankara Training and Research Hospital, ED. Seven closed-ended questions were asked for the analysis of patients’ demographics and 15 closed-ended questions to determine the reasons of ED (green tag) applicant. Data were analyzed using SPSS for Windows v18 software and p<0.05 was considered statistically significant.
RESULTS: Of the patients, 88.1% had social security. Patients often presented to the ED between 5 PM and 08 AM (52.4%). Of the patients, 70.2% stated the reason for not referring to their family physicians within working hours as feeling themselves urgent and willing to have more detailed examination (36.3%). The leading reason for preferring the ED was its closeness (36.5%). It has been determined that all of the patients have referred to the ED at least once in the past year. Patients who came after working hours stated that the reason of their preference for ED because of acute illness (61.6%). It was determined that patients preferred ED over family health centers and outpatient clinics for drip-feed (50.6%) and/or injections (25.4%).
DISCUSSION AND CONCLUSION: As a result,we believe that the number of applications can be reduced with the education to be given to individuals, removal of non-urgent procedures from emergency services (injection, dressing, etc.), placement of family health centers in appropriate places, and increasing the trust of the physicians in these centers, increasing the costs of examination contribution from green field patients.

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GÝRÝÞ ve AMAÇ: Anorektal bölge ameliyatlarýnda farklý bölgesel anestezi teknikleri kullanýlmaktadýr. Ýdeal anestezi yöntemi yeterli analjezi saðlamalý, hasta konforu ve güvenliðini artýrmalý, erken mobilizasyona imkan vermelidir. Bu çalýþmanýn amacý, kaudal blok ve saddle blok tekniklerinin ameliyat sonrasý analjezik tüketimi, analjezik ajan ihtiyacý olan hasta sayýsý ve baþlangýç analjezik gereksinim zamaný üzerine olan etkilerini karþýlaþtýrmaktýr.
YÖNTEM ve GEREÇLER: Çalýþmaya elektif anorektal cerrahi geçiren 71 hasta alýndý. Saddle blok grubunda; ultrasonografi eþliðinde, L4-L5 seviyesinde intratekal boþluða, 25 G Quincke spinal iðne ile 7.0 mg hiperbarik bupivakain uygulandý. Kaudal blok grubunda; ultrasonografi eþliðinde, S4-S5 seviyesinde epidural boþluða, 20 G kaudal iðne ile %0.5 konsantrasyonda 25 ml bupivakain uygulandý.
BULGULAR: Grup kaudal’de; ameliyat sonrasý analjezik tüketimi ve analjezik ajan ihtiyacý olan hasta sayýsý, grup saddle’a göre anlamlý olarak düþüktü (p<0.05). Grup saddle’da ilk analjezik gereksinim zamaný grup kaudal’e göre anlamlý olarak daha düþüktü (p<0.05).
TARTIÞMA ve SONUÇ: Bu çalýþmada, grup kaudalde ameliyat sonrasý analjezik tüketimi, analjezik ajan ihtiyacý olan hasta sayýsý, baþlangýç analjezik gereksinim zamaný açýsýndan grup saddle’a göre anlamlý derecede daha iyi sonuçlar elde edildi. Kaudal bloðun klinik pratikte anorektal cerrahi için daha etkili olabileceði sonucuna varýldý.

INTRODUCTION: Different regional anesthesia techniques are used in anorectal surgeries. The ideal anesthetic method should provide adequate analgesia, patient comfort and safety, and enable early mobilization. The aim of this study was to compare the effects of caudal block and saddle block techniques on post-operative analgesic consumption, number of patients requiring analgesic agent, and initial analgesic requirement.
METHODS: The current study included 71 patients undergoing elective anorectal surgery. In the saddle block group, we inserted 25 G Quincke spinal needle by the ultrasonography guidance into the intrathecal space at L4-L5 level and administered 7.0 mg hyperbaric bupivacaine. In the caudal block group, we inserted 20 G caudal needle by ultrasound guidance into the epidural space at S4-S5 level and administered 25 ml bupivacaine at a concentration of 0.5%.
RESULTS: In group caudal, post-operative analgesic consumption and number of patients requiring analgesic agent were significantly lower than group saddle (p<0.05). In group saddle, first analgesic requirement time was significantly lower than group caudal (p<0.05).
DISCUSSION AND CONCLUSION: In this study, significantly better results were obtained in group caudal regarding post-operative analgesic consumption, number of patients requiring analgesic agent, and initial analgesic requirements time. We concluded that caudal block can be more efficient for anorectal surgery in clinical practice.

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GÝRÝÞ ve AMAÇ: Diyabetik retinopati yetiþkin çaðda görülen önlenebilir ve tedavi edilebilen körlük nedenlerinin baþýnda gelmektedir. Düzenli göz muayenesi ile sistemik tarama, diyabetik retinopatiye baðlý görme kaybýný ve körlüðü önleyebilir. Çalýþmamýzda fundus fotoðrafýnýn teletýp uyarlanmasýnýn diyabetik retinopati tanýsýnda etkinliðinin gösterilmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Ocak 2018–Ocak 2019 tarihleri arasýnda iki farklý diyabet merkezindeki hastalarýn diyabetik retinopati için takip durumlarýný geriye dönük olarak karþýlaþtýrdýk. Çalýþmaya 3539 diyabetik hasta dahil edildi. Bu hastalardan 1883’ü hastanenin ana kampüsünde yer alan ilk diyabet merkezinden göz doktoruna sevk edilmiþtir ve hastaneden uzakta bulunan ikinci merkezdeki 1656 hastanýn ise dijital fundus fotoðrafý çekilmiþtir. Bu görüntüler, bir teletýp sistemi aracýlýðýyla deðerlendirmek üzere uzman bir göz doktoruna iletilmiþtir.
BULGULAR: Çalýþma sonucunda 1883 hastadan sadece 933’ünün (%49.5) retinopati kontrolü için göz doktoruna baþvurduðunu gördük. Diðer yandan, teletýp yöntemi ile dijital fotoðrafla taranan hastalarýn tamamýna yakýný deðerlendirildi (1656’nýn 1589’u) ve sadece 67’si (%4) görüntüleme sorunlarý nedeniyle deðerlendirilemedi. Açýkca görüldüðü üzere, ikinci merkezde birinci merkeze göre çok daha fazla kiþi deðerlendirilmiþtir (933 [%49.5] 1589 [%96]; p<0.05).
TARTIÞMA ve SONUÇ: Sonuç olarak çalýþmamýz, teletýp sistemine uyarlanmýþ retina fotoðraflama yönteminin diyabetik retinopatinin düzenli taramasýný saðlamak için daha yaygýn kullanýlmasý gerektiðini ortaya koymaktadýr.

INTRODUCTION: Diabetic retinopathy is one of the most common causes of preventable and treatable blindness in adulthood. Systemic screening with regular eye examination can prevent vision loss and blindness related to diabetic retinopathy. Our study aimed to see the efficiency of telemedicine application of fundus photograph for the diagnosis of diabetic retinopathy.
METHODS: We retrospectively compared the patients’ follow-up situation for diabetic retinopathy screening from two different diabetic centers between January 2018 and January 2019. We recruited 3539 diabetic patients. Among these patients, 1883 of them were referred to ophthalmologist from the first diabetes center, which is located on the main campus of hospital and in the second center which is located away from the hospital, 1656 patients’ digital photographs were taken. These images were transmitted through a telemedicine system to an expert ophthalmologist for evaluation.
RESULTS: As a result of the study, we saw that only 933 of 1883 (49.5%) patients had admitted to the ophthalmologist for retinopathy control. On the other hand, among the patients who were screened by a digital photograph with telemedicine method, almost all of the patients were evaluated (1589 of 1656) and only 67 (4%) of them could not be evaluated due to imaging problems. It is obviously seen that in the second center much more people had been evaluated when compared to the first center (933 [49.5%] vs. 1589 [96%]; p<0.05).
DISCUSSION AND CONCLUSION: Our study confirmed that the use of the retinal photographing intertwined with the telemedicine system should be used more widely into provide regular screening of diabetic retinopathy.

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GÝRÝÞ ve AMAÇ: Amputasyonlar, günlük yaþam ve fonksiyonellik açýlarýndan kiþinin hayatýnda büyük deðiþikliklere yol açar. Amputasyondan dolayý meydana gelen vücut yapýlarýndaki ve vücut fonksiyonlarýndaki sýnýrlýlýk, aktivite seviyesini ve kiþinin toplumsal katýlýmýný etkiler. Bu çalýþmada Trinity Amputasyon ve Deneyim Ölçeði (TAPES) anketinin Türkçe versiyonu kullanýlarak amputasyondan sonra normal yaþama yeniden katýlým sürecinin yaþam kalitesi ve fonksiyonel düzey ile iliþkisinin incelenmesi amaçlandý.
YÖNTEM ve GEREÇLER: Çalýþmaya yaþ ve cinsiyet farkýna bakýlmaksýzýn üçüncü basmak hastanemiz Ortopedi ve Travmatoloji kliniðine baþvuran ve diyabetik ayak nedeniyle alt ekstremite amputasyonu yapýlan toplam 48 hasta dahil edildi. Tüm hastalara ait Trinity Amputasyon ve Deneyim Ölçeði (TAPES) anketleri doldurularak kaydedildi.
BULGULAR: Ankete dahil edilen 48 hastanýn 36’sý (%75.0) erkek, 12’si (%25.0) kadýndý. Toplam sekiz (%16.7) hastanýn ampütasyonu diz üstü düzeyinden, 40 (%83.3) hastanýnki ise diz altýndan yapýlmýþtý. Protezi günlük 12 saatin üzerinde kullanan 14 (%29.2) hasta varken, daha az süreyle kullananlar 34 (%70.8) kiþiydi. Hastalarýn ortalama yaþý 54.4±19.4 yýl (yaþ aralýðý: 11-86 yýl) idi. Protezden toplam memnuniyet skoru oraný %63.1±20.5 (aralýk: %20-92) idi.
TARTIÞMA ve SONUÇ: Çalýþmamýz ampüte hastalarda protezlere ve diðer bazý uyum kriterlerine karþý duyulan memnuniyet ile ilgili ülkemizde yapýlmýþ nadir çalýþmalardandýr. Çalýþmamýz verileri özellikle güdük ve fantom aðrýlarýnýn hem protezin günlük kullaným süresiyle, hem uyum skorlarýyla hem de proteze karþý duyulan memnuniyet skorlarý ile anlamlý iliþkili olduðunu ve bu aðrýlarýn ampüte hastalarýn psikolojik durumunu etkilediðini göstermiþtir.

INTRODUCTION: Amputations lead to major changes in one’s life in terms of daily life and functionality. Limitations in body structures and bodily functions due to amputation affect the level of activity and social participation of the individual. In this study, the Turkish version of the Trinity Amputation and Experience Scale (TAPES) questionnaire was aimed to investigate the relationship between the quality of life and functional level of re-participation after normal amputation.
METHODS: A total of 48 patients who were admitted to the Orthopedics and Traumatology Clinic of our tertiary care hospital, regardless of age and sex, underwent lower extremity amputation due to diabetic foot were included in the study. Trinity Amputation and Experience Scale (TAPES) questionnaires of all patients were recorded and filled out.
RESULTS: Of the 48 patients included in the questionnaire, 36 (75.0%) were male and 12 (25.0%) were female. A total of eight (16.7%) patients were amputated above the knee level and 40 (83.3%) patients under the knee. There were 14 (29.2%) patients who used the prosthesis for more than 12 hours a day, and 34 (70.8%) patients who used the prosthesis for less. The mean age of the patients was 54.4±19.4 years (range: 11–86 years). The total satisfaction score rate was 63.1±20.5% (range: 20–92%).
DISCUSSION AND CONCLUSION: Our study is one of the rare studies in Turkey about the satisfaction of prosthesis and some other compliance criteria in amputated patients. Our study data showed that especially stump and phantom pain were significantly related to both daily utilization of the prosthesis, compliance scores, and satisfaction scores for the prosthesis, and these pains affect the psychological state of the amputees.

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Situs inversus totalis, torasik ve abdominal organlarýn ayna hayali þeklinde yer deðitirmesi ile karakterize nadir doðumsal bir anomalidir. Situs inversus totalisli hastalarda safra kanalý ekseninin deðiþimi nedeniyle endoskopik retrograd kolanjiyopankreatografi yapmak normal olguya göre çok daha zor olmaktadýr. Bu yazýda, situs inversus totalisli bir hastada endoskopik retrogradkolanjiyopankreatografi iþlemi ile olaðan poziyonunda baþarýlý endoskopik retrogradkolanjiyopankreatografi yapýlacaðý ve maling darlýklý hastanýn koledoðuna stent yerleþtirilen olgumuzun nadir olmasý nedeniyle sunuyoruz.

Situs inversus totalis (SIT) is a rare congenital anomaly characterized by the transposition of thoracic and abdominal organs in a mirror image. Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients with SIT is much more difficult than in patients with normal anatomy due to the different orientation of the bile duct axis. This article describes the first known description of successful ERCP and the placement of a choledocal stent in a patient with SIT and malignant choledocal stenosis using an adjusted technique to accommodate the circumstances.

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Akciðerin kistik müsinöz tümörleri histolojik olarak çoðu akciðer adenokarsinomundan farklý olarak tanýmlanmýþtýr ve yakýn zamanda tanýmlanmýþ bir malign potansiyel spektrumuna sahiptir. Literatür çok nadir olduðu için genellikle olgu sunumu gibi çalýþmalar vardýr. Bu çalýþmada, nadir görülen bir primer müsinöz kistik tümör olgusu literatüre bir katký olarak sunulmuþtur.

Cystic mucinous tumors of the lung have been described as histologically different from most lung adenocarcinomas and have a recently identified malignant potential spectrum. Since the literature is very rare, there are often studies such as case reports. In this study, a rare case of primary mucinous cystic tumor of the lung was presented as a contribution to the literature.

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