GÝRÝÞ ve AMAÇ: SARS-CoV-2, hem çocuklarda hem de yetiþkinlerde ciddi hastalýðýn olasý bir etkenidir. Bu çalýþmada, hastanede yatan aðýr çocuk COVID-19 hastalarýnýn yönetimini deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Mart 2020 ile Mayýs 2020 tarihleri arasýnda 18 yaþ altý aðýr COVID-19'lu hastanede yatan 21 çocuðun yönetimine iliþkin veriler bu çalýþmaya dahil edildi
BULGULAR: Bu çalýþmada 888 ayaktan ve 221 yatan hasta olmak üzere toplam 1109 hasta toplandý. Hastanede yatan 221 çocuðun 91'i (%41.1)
SARS-CoV-2 için PCR pozitifti. Doksan bir COVID-19 hastasýnýn 21'i (%23) þiddetli COVID-19 olarak kabul edildi. Onu (%47.6) kýz, 11'i (%52.4) erkek olup, yaþlarý ortalama±standart sapma (SS) 14.4±2.7 yýl (aralýk; 9 yýl–17.6 yýl) olarak saptandý. En sýk baþvuru semptomlarý ateþ (%80.9), öksürük (%76.1), nefes darlýðý (%23.8) ve miyalji (%23.8) idi. Yirmi bir hastanýn dördünde (%19) altta yatan hastalýk vardý. On dokuz (%90.4) hasta ailede doðrulanmýþ olgularla yakýn temas halindeydi. Tüm hastalarda tipik olarak akciðer bilgisayarlý tomografi (BT) bulgularý vardý ve baþlýca gözlenen BT anormallikleri buzlu cam opasiteleriydi. Solunum desteðine ihtiyaç duyan iki hasta favipiravir tedavisi aldý. Ortalama hastanede kalýþ süresi 7.34±2.65 (5–16) gündü. Tüm hastalarda klinik iyileþme saðlandý.
TARTIÞMA ve SONUÇ: Çocuklarda COVID-19'un yetiþkinlere göre klinik seyri daha hafiftir ve daha iyi prognozu vardýr ancak çocuk hasta grubunda ciddi olgular tanýmlandýðý ve bu hastalarýn yakýndan takip edilmesi gerektiði akýlda tutulmalýdýr.

INTRODUCTION: SARS-CoV-2 is a probable causative agent of severe disease both in children and adults. In this study, we aimed to evaluate the management of hospitalized severe pediatric COVID-19 patients.
METHODS: Data on the management of 21 children under the age of 18 who were hospitalized with severe COVID-19 between March 2020 and May 2020 were included in this study.
RESULTS: A total of 1109 patients, including 888 outpatients and 221 inpatients, were included in this study. 91 (41.1%) of the 221 hospitalized children were PCR positive for SARS-CoV-2. 21 (23%) of 91 COVID-19 patients were considered severe COVID-19. 10 (47.6%) were females and 11 (52.4%) were males, with a mean±standard deviation (SD) age of 14.4±2.7 years (range; 9 years–17.6 years). The most prevalent symptoms at admission were fever (80.9%), cough (76.1%), shortness of breath (23.8%) and myalgia (23.8%). 4 (19%) of 21 patients had underlying diseases. 19 (90.4%) patients were in close contact with confirmed cases in the family. All patients had typical findings on lung computed tomography (CT) and the major CT abnormalities observed were ground-glass opacities. Two patients who needed respiratory support received favipiravir treatment. The mean hospital stay was 7.34±2.65 (5–16) days. Clinical improvement was achieved in all patients.
DISCUSSION AND CONCLUSION: The clinical course of COVID-19 in children is milder and has a better prognosis than adults, but it should be kept in mind that severe cases are defined in the pediatric patient group and these patients should be followed closely.

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GÝRÝÞ ve AMAÇ: Önceki çalýþmalarda ABO kan grubu ile gastrointestinal sistem kanserleri arasýnda bir iliþki olduðu gözlemlenmiþtir. Ancak farklý
merkezlerde yapýlan çalýþmalarda kan grubu kanser iliþkisi ayný sonucu vermemiþtir. Biz de tek merkezli yapýlan bu çalýþmada kan grubunun kolorektal kanser ile iliþkisini ve prognoza etkisini araþtýrdýk.
YÖNTEM ve GEREÇLER: Çalýþmaya Ocak 2013 ile Aralýk 2019 yýllarý arasýnda kolorektal kanser nedeniyle küratif cerrahi yapýlan toplam 313 hasta dahil edildi. Veriler geriye dönük olarak analiz edildi. Acil ameliyat olan, palyatif rezeksiyon yapýlan, kayýtlarýna ulaþýlamayan ve uzak metastazý olan hastalar çalýþma dýþý býrakýldý.
BULGULAR: A kan grubu kadýnlarda daha sýk görülürken diðer kan gruplarý erkeklerde daha fazla idi. AB kan grubundaki hastalarda ortalama
yaþam süresi 53.776±7.655 ay idi. Ve diðer gruplara oranla anlamlý olarak daha kötü idi. Multivaryant Cox regresyon analizinde incelendiðinde ise kan grubunun prognoza etkili olduðu görülmüþtür.
TARTIÞMA ve SONUÇ: ABO kan grubunun kolorektal kanser hastalarýnda prognoza etkili olduðu görüldü.

INTRODUCTION: It has been observed in previous studies that there is a relationship between ABO blood type and gastrointestinal system cancers. However, in studies conducted in different centers, the relationship between the blood type and cancer did not yield the same result. In this single-center study, we investigated the relationship of blood type with colorectal cancer and its effect on prognosis.
METHODS: A total of 313 patients who underwent curative surgery for colorectal cancer between January 2013 and December 2019 were included in the study. Data were analyzed retrospectively. Patients with emergency surgery, palliative resection, unavailable records, and distant metastases were excluded from the study.
RESULTS: While A blood type was more common in women, other blood types were more common in men. The overall survival for patients with AB blood type was 53.776±7.655 months. And it was significantly worse than the other groups. When examined in the multivariate Cox regression analysis, it was seen that the blood type was effective on the prognosis.
DISCUSSION AND CONCLUSION: It was observed that the ABO blood type had an effect on prognosis in colorectal cancer patients.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada cinsiyet, yaþ ve semptom kombinasyonlarýyla kolonoskopide belirlenen tanýlar arasýndaki iliþkiler analiz edilmiþtir.
YÖNTEM ve GEREÇLER: Çalýþmada 2018 yýlýnda hastanemiz endoskopi ünitesinde kolonoskopi uygulanan tüm hastalara ait demografik veriler, semptomlar ve kolonoskopi sonuçlarý hastane otomasyon sistemi kayýtlarýndan elde edildi ve incelendi.
BULGULAR: Ortalama yaþý 54.5±14.6 (aralýk: 6–94) olan hastalarýn 1692’si (%54) erkek, 1440’ý (%46) kadýndý. Hastalarýn %66.3’ü 50 yaþ üzerinde,
%5.9’u 30 yaþ altýndaydý. Kolonoskopi iþlemlerinin %7.3’ü tamamlanamamýþtý. Hastalarýn 168’inde (%5.4) gaitada gizli kan (GGK) pozitifliði, 1900’ünde (%60.7) rektal kanama, 1893’ünde (%60.4) konstipasyon, 1975’inde (%63.1) karýn aðrýsý mevcuttu. En sýk semptom birliktelikleri kanama + konstipasyon + karýn aðrýsý (1625 hasta; %51.9) ve konstipasyon + karýn aðrýsý (169 hasta; %5.4) idi. Kolonoskopi sonucunda hastalarýn 1616’sýnda (%51.6) anormal bulgu saptanmadý, 699’unda (%22.3) polip, 43’ünde (%1.4) kanser olduðu düþünülen kitle, 230’unda (%7.3) divertikülöz lezyon, 544’ünde (%17.4) diðer ön tanýlar konuldu. Polip saptanma oraný tek baþýna GGK pozitifliði olanlarda (p=0.003) veya GGK pozitifliði ile birlikte rektal kanama ve/veya konstipasyonu (p=0.001) olan hastalarda anlamlý yüksek, konstipasyonu olanlarda (p=0.034) anlamlý düþüktü. Yaþa göre yapýlan analizde 50 yaþ üstü hastalarda GGK pozitiflik oraný diðer gruplara göre anlamlý yüksek (p<0.001), rektal kanama oraný ise anlamlý düþük (p<0.001) bulundu, 30–50 yaþ grubunda aðrý oraný diðer gruplara göre anlamlý yüksekti (p=0.007). Polip (p<0.001), kanser görünümlü kitle (p=0.008) ve divertikülöz lezyon (p<0.001) oranlarý 50 yaþ üzeri grupta diðer gruplara göre anlamlý yüksek bulundu. GGK pozitif olanlarda polip (p<0.001) ve divertikülöz lezyon (p<0.001) saptanma oranlarý anlamlý yüksek, anormal bulgu saptanmayan hasta oraný (p=0.03) ise anlamlý düþüktü.
TARTIÞMA ve SONUÇ: Çalýþmamýz verileri GGK pozitifliði ya da rektal kanamasý olan hastalarýn kolonoskopik incelemelerinde önemli patolojiler saptandýðýný, özellikle 50 yaþ üzerinde kolorektal polip ya da kanser görünümlü kitle oranlarýnda artýþ olduðunu, konstipasyonu olan hastalarda ise anormal bulgu ya da malignite olasýlýðýnýn azaldýðýný göstermiþtir.

INTRODUCTION: It was aimed to analyze the relationships between gender, age, and symptom combinations, and the diagnoses determined in colonoscopy.
METHODS: Demographic data, symptoms, and colonoscopy results of all patients who underwent colonoscopy in our hospital’s endoscopy unit in 2018 were obtained from the hospital records and analyzed.
RESULTS: The mean age was 54.5±14.6 years. A total of 66.3% of the patients were over 50 years old. A total of 7.3% of colonoscopy procedures could not be completed. In 168 patients (5.4%) there was fecal occult blood (FOB) positivity, 1900 (60.7%) had rectal macroscopical bleeding, 1893 (60.4%) had constipation, and 1975 (63.1%) had abdominal pain. No abnormal findings were found in 1616 (51.6%) of the patients as a result of colonoscopy, 699 (22.3%) had polyps, 43 (1.4%) had cancer-like masses. The polyp detection rate was significantly higher in patients with positive FOB alone (p=0.003) or patients with rectal bleeding and/or constipation (p=0.001) and significantly lower in patients with constipation (p=0.034). The rates of FOB positivity (p<0.001), polyp (p<0.001), cancer-like mass (p=0.008), and diverticular lesions (p<0.001) were significantly higher in the patients over 50 years of age. The rates of polyps (p<0.001) and diverticular lesions (p<0.001) were significantly higher in FOB-positive patients.
DISCUSSION AND CONCLUSION: Findings of the present study showed that patients with FOB positivity or rectal bleeding showed significant pathologies in their colonoscopic examinations, especially over the age of 50, an increase in the rate of the colorectal polyps or cancer-like masses, and a reduced possibility of abnormal findings or malignancies in patients with constipation.

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GÝRÝÞ ve AMAÇ: Helicobacter pylori (Hp) gastrik kanser için bir risk faktörü iken intestinal metaplazi de gastrik kanserin prekürsör lezyonlarýndan bir tanesidir. Bu çalýþmada Hp ile intestinal metaplazi arasýndaki iliþkiyi deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Ekim 2018–Kasým 2019 tarihleri arasýnda üst gastrointestinal endoskopisi yapýlan toplam 550 hasta çalýþmaya dahil edildi. Hastalar yaþ, cinsiyet, endoskopik tani, Hp pozitifliði, intestinal metaplazi, gastrik atrofi ve gastrik kanser açýsýndan geriye dönük olarak deðerlendirildi.
BULGULAR: Çalýþmadaki 550 hastanýn 228’i erkek (%41.5), 322’si kadýndý (%59.5) ve ortanca yaþ 37.0 idi (18.0–79.0). Hastalarýn %62.7’sinde Hp, %17.1’inde intestinal metaplazi, %9.1’inde gastrik atrofi ve %2.9’unda gastrik kanser görüldü. Ýntestinal metaplazi pozitif hastalarýn 80’inde Hp pozitif, 14’ünde ise Hp negatif saptandý. Hp pozitif hastalarda intestinal metaplazi görülme oraný, Hp negatif hastalara göre anlamlý derecede daha yüksekti (p<0.001). Ayrýca Hp - intestinal metaplazi birlikteliðinin 50 yaþ üstü olgularda 50 yaþ altý olgulara göre anlamlý derecede daha fazla olduðu görüldü (p=0.002).
TARTIÞMA ve SONUÇ: Helicobacter pylori ile intestinal metaplazi arasýnda kuvvetli bir iliþki mevcuttur ve bu iliþki yaþ ile koreledir. Ýntestinal tip gastrik kanserin prekürsör lezyonu olan intestinal metaplazinin geliþimini önlemede Hp eradikasyonu kritik öneme sahiptir.

INTRODUCTION: Helicobacter pylori (Hp) is a risk factor for gastric cancer, and intestinal metaplasia (IM) is one of the precursor lesions of gastric cancer. The aim of this study was to examine the relationship between Hp and IM.
METHODS: A total of 550 patients who underwent upper gastrointestinal endoscopy between October 2018 and December 2019 were included in the study. The patient data of age, sex, endoscopic diagnosis, Hp positivity, IM, atrophic gastritis, and neoplasia were evaluated retrospectively.
RESULTS: There were 550 patients enrolled in the study: 228 males (41.5%) and 322 females (59.5%), with a median age of 37.0 years (interquartile range: 18.0–79.0 years). Hp was detected in 62.7% of the patients, IM in 17.1%, gastric atrophy in 9.1%, and gastric cancer in 2.9%. Among the patients with positive IM, 80 were Hp-positive and 14 were Hp-negative. The rate of IM was significantly higher in Hp positive patients than in Hp-negative patients (p<0.001). In addition, the incidence of Hp-IM coexistence was significantly higher in patients over 50 years of age (p=0.002).
DISCUSSION AND CONCLUSION: There was a strong relationship between Hp and IM, and the relationship was correlated with age. Hp eradication is critical to prevent the development of IM, a precursor lesion of intestinal-type gastric cancer.

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Amaç: Ýnmemiþ testis tanýsý ile transparankimal sütür fiksasyonu yapýlmaksýzýn orþiopeksi uygulanan çocuklarda operasyon sonuçlarýný
deðerlendirmek.

Gereç ve Yöntem: Bu çalýþmada geriye dönük olarak Ekim 2013–Ocak 2020 tarihleri arasýnda inmemiþ testis nedeniyle ameliyat edilen 347 olgu ele alýnmýþtýr. Bir–on beþ yaþ arasý inmemiþ testis tanýsý ile ameliyata alýnan hastalarda testis dartos poþuna yerleþtirildi ve poþ her iki yanlardan daraltýldý. Testis parankim dokusuna zarar vermemek ve spermatogenezi olumsuz etkilememek amacýyla transparankimal sütür
fiksasyonu uygulanmadý. Hastalar ameliyat sonrasý komplikasyonlar, ameliyatýn baþarý oraný ve nüks açýsýndan deðerlendirildi.

Bulgular: Transparankimal sütür fiksasyonu uygulanmaksýzýn dartos poþ daraltýlarak orþiopeksi uygulanan 347 hasta deðerlendirildi. 338
hastanýn takibinde testislerin fizik muayene ile skrotumda olduðu, ameliyat sonrasý altýncý ayda ve birinci yýlýnda çekilen skrotal ultrasonografide testis boyutlarýnýn normal olduðu görüldü. Yedi hastaya nüks nedeniyle reoperasyon, iki hastaya atrofi nedeniyle orþiektomi uygulandý.

Sonuç: Yapýlan bazý deneysel çalýþmalarda testis parankiminden geçilen sütürün testis parankim dokusunu zedelediði ve germ hücre geliþimini etkilediði saptamýþtýr. Bu nedenlerden dolayý testis skrotuma gergin olmayacak þekilde iniyorsa ve dartos poþu testis skrotuma indirildikten sonra her iki yanlardan nüks olmayacak þekilde daraltýlýyorsa, testis parankiminden geçilecek sütür bu dokuya histolojik düzeyde zarar verebileceðinden testis parankimal fiksasyon uygulanmayabilir. Bu çalýþmada %97.4 gibi baþarý oraný göz önünde bulundurulduðunda spermatogenezi olumsuz etkilememek için, uygun hastalarda testis parankiminden geçmeden baþarýlý bir orþiopeksi yapýlabileceði görüldü.

Objective: To evaluate the operation results in children with the diagnosis of undescended testis who underwent orchiopexy without fixation of transparanchymal sutures.

Methods: In this study, 347 patients who were operated on for undescended testis between October 2013–January 2020 were retrospectively reviewed. The testis was placed in the dartos pouch and the pouch was narrowed on both sides in patients. Those who underwent surgery with the diagnosis of undescended testis were between the ages of 1 and 15. Transparenchymal suture fixation was not applied in order not to damage testicular parenchymal tissue and adversely affect spermatogenesis. The patients were evaluated in terms of postoperative complications, operation success rate, and recurrence.

Results: 347 patients who underwent orchiopexy by narrowing the dartos pouch without transparenchymal suture fixation were evaluated. In the physcial examination performed in the follow-up of 338 patients, it was observed that the testicles were in the scrotum, and the testicular dimensions were normal in the scrotal ultrasonography performed at the 6th month and 1st year postoperatively. 7 patients underwent reoperation due to recurrence, 2 patients underwent orchiectomy for atrophy.

Conclusion: In some experimental studies, it was found that the suture passing through the testicular parenchyma damage the testicular parenchyma tissue and affect the germ cell development. For this reason, if the testicle descends into the scrotum without tension, and the dartos pouch is narrowed on both sides without recurrence, testicular parenchymal fixation may not be applied because the suture to be passed through the testicular parenchyma may damage this tissue histologivally. Considering the 97.4% success rate in this study, it was seen that successful orchiopexy could be performed without passing through the testicular parenchyma in suitable patients in order not to adversely affect the spermategenesis.

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GÝRÝÞ ve AMAÇ: Trakeostomi iþlemi, çocuklarda yetiþkinlerdekinin aksine morbidite ve mortalitesi daha yüksek bir uygulamadýr. Çalýþmamýzdaki amacýmýz, pediatrik cerrahi trakeostomi olgularýnda anestezi deneyimlerimizi geriye dönük olarak deðerlendirmektir.
YÖNTEM ve GEREÇLER: 2018–2020 yýllarý arasýnda cerrahi trakeostomi uygulanan 0–18 yaþ arasý 66 çocuk hasta çalýþmaya dahil edildi. Hastalarýn demografik özellikleri, entübe kaldýklarý süre, trakeostomi endikasyonlarý, kullanýlan anestezik ajanlar, intraoperatif ve postoperatif geliþen komplikasyonlar deðerlendirildi.
BULGULAR: Tüm hastalar arasýndan 39’u (%59.1) 1–12 ay aralýðýnda, 37’si (%56.1) kýzdý ve hastalarýn 43’ünün (%66.7) altta yatan nöromusküler
bir hastalýðý vardý. Hastalarýn 55’i (%84.8) çocuk yoðun bakýmda yatmakta idi. Hastalarýn trakeostomi öncesi entübe kaldýklarý süre
44.16±32.45 gün ve trakeostomi sonrasý yoðun bakýmda yatýþ süresi 34.60±26.76 gün idi. Genel ölüm oraný %3.03’dü (n=2). Hastalardan biri intraoperatif diðeri de postoperatif dönemde öldü. En sýk görülen komplikasyonlar, intraoperatif dönemde desatürasyon, erken postoperatif dönemde kanama ve geç postoperatif dönemde stoma granülasyonu’ydu. Hastalarýn %63.6’sý hastaneden taburcu oldu.
TARTIÞMA ve SONUÇ: Pediyatrik hastalarda nörolojik hastalýklara baðlý uzamýþ entübasyonun trakeostominin en sýk görülen endikasyonu olduðunu ve trakeostomi açma süresindeki uzamanýn mortalite ve morbiditeyi arttýrmadýðýný bulduk.

INTRODUCTION: Unlike adult practices, the tracheostomy procedure has higher morbidity and mortality in children. In this study, we aimed to retrospectively investigate our experience of anesthesia in cases who underwent tracheostomy with pediatric surgery.
METHODS: Sixty-six children aged 0–18 years who underwent surgical tracheostomy between 2018-2020 were included. Data included patient demographics, intubation time, tracheostomy indications, anesthetic agents used, and intraoperative and postoperative complications.
RESULTS: Of all patients, Thirty-nine (59.1%) were 1–12 months, 37 (56.1%) were female, and 43 (66.7%) had an underlying neuromuscular disease. Fifty-five patients (84.8%) were hospitalized in the pediatric intensive care unit. The intubation time was 44.16±32.45 days before tracheostomy and the duration of ICU stay was 34.60±26.76 days after tracheostomy. The overall mortality rate was 3.03% (n=2). One of the deaths occurred intraoperatively and the other during the early postoperative period. The most common complications were desaturation in the intraoperative period, bleeding in the early postoperative period, and stoma granulation in the late postoperative period. 63.6% of the patients were discharged.
DISCUSSION AND CONCLUSION: We found that prolonged intubation related to neurological disease was the most common indication for tracheostomy in pediatric patients and prolonged tracheostomy opening time did not increase mortality or morbidity.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, Türkiye’nin en yoðun nüfuslu ve sanayileþmiþ coðrafi bölgesi olan Marmara bölgesinde yer alan bir yanýk merkezinde takip edilen yanýk hastalarýnýn demografik özelliklerini, etiyolojisini, bulgularýný ve yanýk ile iliþkili faktörleri deðerlendirerek yanýk epidemiyolojisini belirlemektir
YÖNTEM ve GEREÇLER: Yanýk tedavi merkezinde takip edilen 630 hastanýn týbbi kayýtlarý incelendi. Hastalarýn demografik özellikleri, yanýk etiyolojisi, yanýk toplam vücut yüzey alaný yüzdesi, yanýk derecesi, yanýk yeri, yanýk ajaný, yanýk yeri vb. ile ilgili veriler deðerlendirildi.
BULGULAR: Yatarak tedavi gören 630 hastanýn ortalama yaþý 27.5±2.18 yýl idi. Hastalarýn %29.8’i kadýn, %70.2’si erkekti. En sýk görülen yanýk nedenleri sýrasýyla; haþlanma (sýcak su, çay, süt) (%37.2), alev (%31.9), elektrik (%18.4) ve haþlanma + alev + kimyasal (%11.7) idi. Hastalarda ortalama yanýk alaný yüzdesi %23.3 olarak bulundu. Elli dört olguda (%8.9) inhalasyon yanýðý ve 31 olguda eþlik eden çoklu travma tespit edildi.
TARTIÞMA ve SONUÇ: Yanýk, ciddi fiziksel ve psikolojik sonuçlarý olan bir travmadýr. Yanýk tedavisinde önemli ilerlemeler kaydedilmesine raðmen, yanýk oluþumunun önlenmesi ve bireylerin bilinçlendirilmesine odaklanmak daha etkili ve daha verimli görünmektedir.

INTRODUCTION: The aim of the present study is to determine the epidemiology of burns by assessing demographic features, etiology, findings and burn related factors in burn-injured patients followed-up in a burn center located in the Marmara Region, the most densely populated and industrialized geographical area of Turkey.
METHODS: Medical records of 630 in-patients were examined in the burn treatment center. The data relating to the demographic characteristics of patients, burn etiology, percentage of the burned total body surface area, burn degree, burn site, burn agent, place of occurrence, etc. were evaluated.
RESULTS: The mean age of 630 in-patients was 27.5±2.18 years. 29.8% of the patients were female, 70.2% were male. The most common causes of burns were respectively; scald (hot water, tea, milk) (37.2%), flame (31.9%), electrical (18.4%) and scald + flame + chemical (11.7%). The average percentage of burned area in the patients was found to be 23.3%.. Inhalation burn was reported in 54 cases (8.9%) and co morbid multiple trauma was reported in 31 cases.
DISCUSSION AND CONCLUSION: Burn is a trauma with serious physical and psychological consequences. Although considerable progress has been achieved in burn therapy, attempts for preventing burns and focusing on raising awareness of individuals seem to be more efficient and cheaper.

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GÝRÝÞ ve AMAÇ: Lisfrank kompleksi çoklu tarsal metatarsal kemik, eklem ve baðlardan oluþan osseo-ligamentöz bir yapýdýr. Lisfrank yaralanmasý olan
hastalarda en sýk tercih edilen tespit yöntemi transartiküler vida yöntemidir. Ancak bu yöntem ile tespit edilen hastalarda azýmsanmayacak sýklýkta vida kýrýlmasý komplikasyonu görülmektedir. Literatürde vida kýrýlma riskini kullanýlan vidanýn çapý ya da yapýsý ile iliþkilendiren çalýþmalar bulunmasýna raðmen yine de tam bir fikir birliði oluþmamýþtýr. Bu çalýþmanýn amacý, vida kýrýlma riskini çok sayýda parametreyi inceleyerek önceden öngörebilmeyi saðlamaktýr.
YÖNTEM ve GEREÇLER: Bu çalýþmada farklý çapta ve özellikte vidalar ile transartiküler tespit yapýlmýþ 61 lisfrank yaralanmalý hastayý geriye dönük deðerlendirdik. Hastalarýn dokuzunda (%14.7) vida kýrýlma komplikasyonunu saptadýk. Bu hastalarda vida kýrýlmasýný öngörebilmek için bazý demografik ve radyolojik parametreler incelendi. Yaþ, cinsiyet, aðýrlýk, kullanýlan vidanýn çapý ve yapýsý, eþlik eden küneiform, kuboid ya da metatars bazisi kýrýðýnýn bulunmasý, yaralanmanýn kaç tarsometatarsal eklemi ilgilendirdiði ve redüksiyonun anatomik olarak saðlanýp saðlanamamasýydý. Ayrýca iki yýllýk takiplerde post-travmatik artrozun geliþip geliþmediði, klinik deðerlendirmelerde Amerikan Ortopedik Ayak ve Ayak Bileði Derneði (AOFAS) -Orta Ayak Skoru ile Görsel Analog Skala (VAS) skorlarý da karþýlaþtýrýldý.
BULGULAR: Sonuç olarak, küçük çaplý ya da kanüllü vidalarda daha fazla vida kýrýlmasý komplikasyonunu beklerken, vida kýrýlmasýný öngörebilecek
anlamlý bir parametreyi bulamadýk. Vida kýrýlmasý olan hastalarda post-travmatik artrozu daha sýk tespit ettik. Ayrýca AOFAS-orta ayak
ve VAS skorlarýnda, vida kýrýlmasý yaþamayan hastalara kýyasla anlamlý bir fark olmadýðýný da gördük.
TARTIÞMA ve SONUÇ: Lisfrank yaralanmasýnýn transartiküler vida fiksasyonunda; vida çapý, vidanýn kanüllü veya solid yapýsý, eþlik eden tarsal veya metatarsal
yaralanmalarýn varlýðý ve yaralanan anatomik yapýlarýn redüksiyon kalitesi, vida kýrýlmasý komplikasyonu için herhangi bir risk faktörü oluþturmamaktadýr.

INTRODUCTION: The Lisfranc complex is an osseo-ligamentous structure consisting of multiple tarsal and metatarsal bones, joints, and ligaments. The transarticular screw method is the most commonly preferred fixation technique in patients with Lisfranc injury. However, screw breakage complications can be seen with a considerable frequency. Although there are studies in the literature that associate the risk of screw breakage with the diameter or structure of the screw used, there is still no consensus. The aim of this study is to predict the risk of screw breakage by examining many parameters.
METHODS: We retrospectively evaluated 61 patients with lisfranc injuries who underwent transarticular fixation with screws of different diameters and properties. We found screw breakage complications in 9 (14.7%) of the patients. Some demographic and radiological parameters were examined to predict screw breakage in these patients. Age, gender, weight, diameter and structure of the screw used, presence of accompanying cuneiform, cuboid or metatarsal base fracture, how many tarsometatarsal joints were involved and whether anatomical reduction was achieved. In addition, the development of post-traumatic arthrosis during the 2-year follow-up, and the American Orthopedic Foot and Ankle Association (AOFAS) -Middle Foot Score and Visual Analogue Scale (VAS) scores were also compared in clinical evaluations.
RESULTS: We could not find any radiological or demographic parameter that could predict the screw breakage complication in the results. We found only that post-traumatic arthritis was significantly more common in patients with screw breakages. We also found that there was no significant difference in AOFAS-midfoot and VAS scores in patients with or without screw breakage complications.
DISCUSSION AND CONCLUSION: In the transarticular screw fixation of Lisfranc injury; screw’s diameter, cannulated or solid structure, the presence of accompanying tarsal or metatarsal injuries and the reduction quality of the injured anatomic structures do not pose any risk factors for the screw breakage complication.

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GÝRÝÞ ve AMAÇ: Persistan human papillomavirus (HPV) enfeksiyonlarý serviks kanserinin baþta gelen sebebidir. Günümüzde HPV DNA çalýþmalarýnýn da dahil edildiði tarama programlarý sayesinde serviks kanseri insidansýnda ciddi azalmalar görülmektedir. Ancak tarama programlarýnýn daha da geliþtirilmesi için çalýþmalar devam etmektedir. Bu çalýþmada minor servikal sitolojik anormallikler ile nihai servikal biyopsi sonuçlarýnýn HPV alt tiplerine göre incelenmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: 2011–2019 yýllarý arasýnda üçüncü basamak bir merkezde HPV DNA pozitifliði veya minor servikal bozukluklar nedeniyle servikal biyopsi alýnan hastalar geriye dönük olarak incelenmiþtir. Hastalar saptanan HPV alttiplerine göre üç gruba ayrýlmýþtýr. Birinci grupta HPV16/18 ile enfekte olan hastalar, ikinci grupta HPV16/18 dýþýnda tek bir yüksek riskli HPV alttipi ile enfekte olan hastalar, üçüncü grupta HPV16/18 dýþýnda birden fazla sayýda yüksek riskli HPV alttipi ile enfekte olunan hastalar alýnmýþ ve sonuçlar karþýlaþtýrýlmýþtýr.
BULGULAR: Seçilen çalýþma döneminde çalýþma kriterlerini karþýlayan 430 hasta olduðu saptanarak çalýþmaya dahil edilmiþtir. Çalýþma grubunun ortalama yaþý 33.4±6.6, ortalama paritesi 2.1±1.1 olarak saptanmýþtýr. Birinci ve 3. gruplarda ≥CIN 2 servikal lezyon görülme oranlarýnýn benzer olduðu ancak HPV16/18 dýþýnda tek yüksek riskli HPV tipi ile enfekte olan hastalarda ≥CIN 2 lezyon görülme oranlarýnýn anlamlý ölçüde daha düþük olduðu görülmüþtür

TARTIÞMA ve SONUÇ: Servikal sitolojisinde minor deðiþiklikler olan hastalarda HPV16/18 dýþýnda kalan yüksek riskli HPV tiplerinin eþ zamanlý çoklu enfeksiyonu dikkatli inceleme gerektiren bir durum gibi görünmektedir.

INTRODUCTION: Human papillomavirus (HPV) infection is the leading cause of cervical cancer. Although screening programs involving cervical cytology and HPV DNA have greatly reduced the incidence of cervical cancer in the last decades, attempts to increase the accuracy of these programs are still ongoing. The objective of this study is to evaluate the association of cervical colposcopic biopsy pathology results in women with minor smear abnormalities in an HPV type-specific manner.
METHODS: Women who underwent a colposcopic cervical biopsy due to HPV DNA positivity or minor cervical cytological anomalies and tested positive for HPV DNA in a single tertiary center between 2011 and 2019 were retrospectively evaluated. Three groups were formed according to the detected HPV types. The first group consists of women infected with HPV 16 or 18, the second group consists of women infected with only one type of highrisk HPV other than HPV 16/18, and the third group includes patients infected with multiple types of high-risk HPV other than HPV 16/18.
RESULTS: Four hundred thirty patients met inclusion criteria within the selected period and were included in the study. The mean age of the population was 33.4±6.6 and the mean parity was 2.1±1.1. The prevalence of ≥CIN 2 lesions in the first and third group of patients were similar, however infection with a single type of high-risk HPV, except for HPV 16/18, was significantly lower in ≥CIN 2 lesions compared to the other two groups.
DISCUSSION AND CONCLUSION: Multiple type HPV infections in low grade cytology results even in the absence of HPV 16/18 seems to warrant a cautious approach.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, geriatrik diyabetik hastalarda vitamin D düzeyi ile QRISK2, BNF, ASSING, SCORE ve Framingham gibi çeþitli kardiyovasküler risk skorlama sistemleri arasýndaki iliþkiyi deðerlendirmektir.
YÖNTEM ve GEREÇLER: Çalýþmaya D vitamini yetersizliði olan 60 diyabetik geriatrik hasta (10–30 ng/mL) ve D vitamini eksikliði olan 40 geriatrik hasta (<10 ng/mL) dahil edildi. Hastalarýn QRISK2, BNF, ASSIGN, SCORE ve Framingham gibi kardiyovasküler hastalýk riskini gösteren skorlarý hesaplandý. Tüm deðerler bu iki grup arasýnda karþýlaþtýrýldý.
BULGULAR: D vitamini eksikliði olan hastalarda Framingham risk skoru (p<0.001), BNF (p=0.001) ve SCORE (p<0.001) anlamlý olarak yüksek iken diðer skorlarda gruplar arasý anlamlý farklýlýk yoktu. D vitamini düzeyi ile Framingham risk skoru (p<0.001 r=-0.384), BNF skoru (p=0.003
r=-0.299) ve SCORE skoru (p=<0.001 r=-0.407) arasýnda zayýf fakat istatistiksel olarak anlamlý negatif bir korelasyon vardý.
TARTIÞMA ve SONUÇ: Bu çalýþmada, diyabetik geriatrik hastalarda Framingham, BNF ve ASSIGN gibi kardiyovasküler risk skoru ile serum D vitamini konsantrasyonu arasýnda yakýn bir iliþki bulduk.

INTRODUCTION: The aim of this study is to evaluate the relationship between vitamin D levels and various cardiovascular risk scoring systems such as QRISK2, BNF, ASSING, SCORE and Framingham in geriatric diabetic patients.
METHODS: 60 diabetic geriatric patients with vitamin D deficiency (10–30 ng/mL) and 40 geriatric patients with vitamin D deficiency (<10 ng/mL) were included in the study. The scores of the patients indicating cardiovascular disease risks such as QRISK2, BNF, ASSIGN, SCORE and Framingham were calculated. All values were compared between these two groups.
RESULTS: While the Framingham risk score (p<0.001), BNF (p=0.001) and SCORE (p<0.001) were found to be significantly higher in patients with vitamin D deficiency, other scores did not significantly differ between the groups. There was a weak but statistically significant negative correlation between 25[OH] D levels with Framingham risk score (p<0.001 r=-0.384), BNF score (p=0.003 r=-0.299), and Score score (p <0.001 r=-0.407).
DISCUSSION AND CONCLUSION: In the present study, we found a close relationship between the Framingham, BNF and ASSIGN cardiovascular risk score and serum vitamin D concentrations in diabetic geriatric patients.

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GÝRÝÞ ve AMAÇ: Ýnsülin direnci, non-alkolik yaðlý karaciðer hastalýðý (NAYKH) için önemli risk faktörlerinden biridir ve Homeostazis Model Assesment-
Ýnsulin Resistance (HOMA-IR) insülin direncini göstermede kullandýðýmýz bir belirteçtir. Trigliserid/Glukoz indeksi (TgG indeksi) ise NAYKH’ý öngördürmede HOMA-IR kadar önemli, basit, kullanýlabilir bir parametredir. Bu çalýþmamýzda HOMA-IR ve TgG indeksinin
NAYKH öngördürmedeki deðerini belirlemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmaya Saðlýk Bilimleri Üniversitesi Haseki Eðitim ve Araþtýrma Hastanesi Ýç Hastalýklarý Kliniði’ne 2017–2018 yýllarý arasýnda baþvuran ve herhangi bir nedenle Batýn Ultrasonografisi (USG) çektirilmiþ 986 hasta geriye dönük incelenerek alýndý. Tüm vakalar
NAYKH tanýsý konulmadan önce diðer olasý karaciðer hastalýklarýný dýþlamak amacýyla klinik ve laboratuvar yönünden deðerlendirildi. Hastalara iki farklý gruplandýrma yapýldý. Birincisi NAYKH olan ve olmayan grup; ikincisi kontrol, prediyabetik ve Tip 2 diyabetik grup olarak belirlendi. Gruplarý karþýlaþtýrmak için normal daðýlýma göre sayýsal veriler Student t test veya Mann Withney u testi kullanýlarak deðerlendirildi. Univariate analizlerde sonlaným noktasýna göre fark saptanan deðiþkenlerin (TgG indeksi, HOMA-IR, yaþ, ürik asit, ALT, HDL, LDL, diyabet varlýðý) NAYKH geliþimi üzerine etkisini belirlemek için lojistik regresyon yapýldý. P<0.05 veya %95 güven aralýðý istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Çalýþmamýz NAYKH olan 470 hasta ve NAYKH olmayan 516 hasta olmak üzere toplam 986 hastadan oluþmaktadýr. TgG indeksi
hesaplanmýþ; 8.4 ve üzeri deðerlerde p<0.001 istatistiksel açýdan anlamlý düzeyde NAYKH sýklýðýnda artýþ görülmüþtür. Yapýlan korelasyon analizinde TgG indeksi ile HOMA-IR arasýnda pozitif korelasyon (r=0.438) bulunmuþtur. Univariate analizlerde sonlaným noktasýna göre fark saptanan deðiþkenlerden oluþturulan regresyon modelinin [TgG indeksi, HOMA-IR, yaþ, ürik asit, ALT, HDL, LDL, diyabet varlýðý] NAYKH geliþimi üzerine etkisi incelendiðinde; Backward Stepwise metodunda TgG indeksi (p<0.001, OR=3.702), HOMA-IR (p=0.003, OR=1.143), ALT yüksekliði (p=0.001, OR=1.020) en etkili risk faktörleri olarak saptandý.
TARTIÞMA ve SONUÇ: Sonuç olarak TgG indeksi NAYKH açýsýndan önemli öngördürücü bir parametre olarak deðerlendirilmiþtir. HOMA-IR NAYKH riskini 1.1 kat arttýrýrken, TgG indeksi 3.7 kat arttýrmaktadýr. Çalýþmamýzda TgG indeksinin HOMA-IR’dan baðýmsýz olarak da NAYKH riskini arttýrdýðý görülmüþtür.

INTRODUCTION: Insulin resistance is one of the most important risk factors for nonalcoholic fatty liver disease (NAFLD). Homeostasis Model Assessment Insulin Resistance (HOMA-IR) is a marker used to show insulin resistance. Triglyceride/Glucose index (TgG index) is a parameter that can be used to predict NAFLD and is as important as HOMA-IR. In this study, we aimed to determine the value of the HOMA-IR score and TgG index in predicting NAFLD.
METHODS: 986 patients who applied to University of Health Sciences Haseki Training and Research Hospital Internal Medicine Clinic between 2017–2018 and underwent an abdominal ultrasonography scan for any reason were included in the study retrospectively. All medical cases here were investigated in terms of all clinic and laboratory aspects in order to exclude other possible liver-related diseases before they were diagnosed with NAFLD. The patients were categorized and grouped in two different ways. The first is the group with or without NAFLD; the second group was categorized as the control group, prediabetic group and type 2 diabetic group.
RESULTS: Our study was conducted with a total of 986 patients, including 470 patients with NAFLD and 516 patients without NAFLD. When the TgG index is calculated; a statistically significant increase was observed in the incidence of NAFLD at levels above 8.4 (p<0.001). The correlation analysis revealed a positive correlation between the TgG index and HOMA-IR (r=0.438). TgG index (p<0.001 OR=3.702), HOMA-IR (p=0.003, OR=1.143), ALT elevation (p=0.001, OR=1.020) were found to be the most effective risk factors when the Backward Stepwise method was used.
DISCUSSION AND CONCLUSION: The TgG index was found to be a remarkable predictor-parameter for NAFLD. While HOMA-IR increases the risk of NAFLD by 1.1 times, the the TgG index increases it 3.7 times. In our study, it was also observed that the TgG index increased the risk of NAFLD, independent of HOMA-IR.

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GÝRÝÞ ve AMAÇ: Multipl skleroz (MS) hastalarýnda yorgunluk etyopatogenezi tam aydýnlatýlamamýþ sýk görülen bir bulgudur. Bu çalýþmada yorgunluðun
biyokimyasal veriler ve beyin manyetik rezonans (MR) görüntülemede korpus kallosum indeksi (CCI) ile iliþkisinin deðerlendirilmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Kesitsel özellikte olan bu çalýþmaya 58 MS hastasý, 42 kontrol olmak üzere 100 kiþi dahil edildi. Hastalarýn özürlülüðü geniþletilmiþ özürlülük durum ölçeði (EDSS) ile belirlendi ve yorgunluklarý Fatigue Severity Scale (FSS) ile deðerlendirildi. Biyokimyasal veriler analiz edildi. Beyin MR’da CCI deðerleri hesaplandý.
BULGULAR: Gruplar arasýnda yaþ, cinsiyet, vücut kitle indeksi açýsýndan farklýlýk tespit edilmedi (p>0.05). MS hastalarýnda kontrol grubuna göre folat düzeyi ve CCI deðeri istatistiksel olarak anlamlý derecede düþük saptandý (sýrasýyla p=0.029 ve p<0.001). MS grubunda trigliserit
deðerinin anlamlý derecede yüksek olduðu gözlendi, gruplar arasýnda diðer biyokimyasal veriler açýsýndan anlamlý farklýlýk yoktu. MS grubunda yorgunluk ile EDSS arasýnda pozitif korelasyon, korpus kallosum indeks ve folat deðeri arasýnda ise negatif korelasyon olduðu belirlendi. Yorgunluk ile diðer veriler arasýnda anlamlý korelasyon saptanmadý. Yorgunluðu olan ve olmayan MS hastalarý ve kontrol grubu karþýlaþtýrýldýðýnda ise gruplar arasýnda sadece folat açýsýndan farklýlýk olduðu tespit edildi (p=0.011).
TARTIÞMA ve SONUÇ: Sonuçlarýmýz MS hastalarýnda yorgunluðun; daha belirgin korpus kallosum atrofisi, daha ileri özürlülük seviyesi ve daha düþük folat düzeyi ile iliþkili olduðunu göstermektedir. MS hastalarýnda belirlenmiþ alt sýnýrýn üstünde bile olsa folat replasmaný yorgunluðu azaltabilir. Bu bulgularýn daha geniþ hasta serileri ile doðrulanmasý MS hastalýðýndaki yorgunluðun ve yorgunluk ile folat iliþkisinin daha iyi anlaþýlmasýna katký saðlayacaktýr.

INTRODUCTION: Fatigue is a common finding in patients with multiple sclerosis (MS) and its etiopathogenesis has not been fully elucidated. The aim of this study was to evaluate the relationship between fatigue and biochemical data and corpus callosum index (CCI) in brain magnetic resonance imaging (MRI).
METHODS: In this cross-sectional study, 100 individuals (58 MS patients and 42 control subjects) were included. The disability of the patients was determined with the extended disability status scale (EDSS), and their fatigue was evaluated with the Fatigue Severity Scale (FSS). Biochemical data were analyzed. CCI values were calculated on brain MRI scans.
RESULTS: There was no difference between the groups in terms of age, gender, and BMI (p>0.05). In MS patients, folate level and CCI values were found to be statistically significantly lower compared to the control group (p=0.029 and p<0.001, respectively). It was seen that the triglyceride value was significantly higher in the MS group, and there was no significant difference between the groups in terms of other biochemical data. It was found that there was a positive correlation between fatigue and EDSS, and a negative correlation between the CCI and folate value in the MS group. When MS patients with and without fatigue and the control group were compared,only folate levels were found to differ between the groups (p=0.011).
DISCUSSION AND CONCLUSION: Our results suggest that fatigue in MS patients is associated with corpus callosum atrophy, a higher level of disability, and lower folate levels. Folate replacement therapy may reduce fatigue, even if folate levels are above the lower limit. Confirming these findings with larger patient series will contribute to a better understanding of fatigue in MS disease and the relationship between fatigue and folate.

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GÝRÝÞ ve AMAÇ: Parkinson hastalarýnda en sýk görülen nonmotor semptomlardan biri aðrýdýr ve bazen dirençli aðrý yakýnmasý yaþam kalitesini olumsuz
etkilemektedir. Özellikle kas iskelet sistemi ile ilgili aðrýlar olmak üzere pek çok aðrý tipi ile D vitamini arasýnda iliþki olduðu farklý çalýþmalarda vurgulanmýþtýr.
YÖNTEM ve GEREÇLER: Hoehn-Yahr skalasýna göre evre 3’ün üstünde olan, mini mental durum testi (MMSE) 25 ve üstünde olup demans tanýsý olmayan, D vitamini düzeyini etkileyecek hastalýðý ve ilaç kullanýmý olmayan 43 idiyopatik Parkinson hastasýnýn demografik verileri, Bileþik Parkinson Hastalýðý Deðerlendirme Ölçeði (BPHDÖ) (UPDRS) motor alt skalasý, nonmotor semptom skalasý ve kýsaltýlmýþ geriyatrik depresyon ölçeði (GDÖ) kaydedilerek D vitamini düzeyi ile aðrý yakýnmasý arasýndaki iliþki deðerlendirilmiþtir.
BULGULAR: Çalýþmaya katýlan hastalarýn 24’ü erkek 19’u kadýndýr. Hastalarýn yaþ ortalamasý 61.9 (±9.84) olarak belirlenmiþtir. Ortalama hastalýk süresi 3.9 yýl; UPDRS motor skor ortalamasý 18.3 (±7.6) bulunmuþtur. Nonmotor semptom skalasýna göre yapýlan deðerlendirmede hastalar 30 üzerinden 10.2 (±5.3) puan almýþlardýr. Hastalarýn %60.5’inde aðrý yakýnmasý olduðu görülmüþtür. Aðrý varlýðý ile D vitamini düzeyi, yaþ, hastalýk süresi, UPDRS, ilaç dozu, nonmotor semptom skoru, GDÖ, arasýnda anlamlý iliþki (p>0.05) bulunamamýþtýr. Ýlaç dozu açýsýndan 60 yaþ ve altýndaki hasta grubunda aðrýsý olan ve olmayan hastalarýn levodopa dozlarý arasýnda anlamlý fark bulunmuþtur (p=0.04). Aðrýsý olanlarýn levodopa dozlarý olmayanlara göre yüksek bulunmuþtur. Altmýþ yaþ üstündeki hastalarda aðrý varlýðý ile UPDRS arasýnda anlamlý pozitif iliþki bulunmuþtur (p=0.035).
TARTIÞMA ve SONUÇ: Çalýþmanýn sonucunda aðrý ile D vitamini düzeyleri arasýnda iliþki tespit edilmedi. Daha büyük hasta gruplarýnda aðrý alt tiplerini belirleyerek aðrý ile D vitamini düzeyleri arasýndaki iliþkinin incelenmesinin önemli olduðu düþünülmüþtür.

INTRODUCTION: Pain is one of the most common nonmotor symptoms in patients with Parkinson's disease, and sometimes the complaint of refractory pain adversely affects quality of life. The relationship between vitamin D and many types of pain, especially musculoskeletal pain, has been emphasized in different studies.
METHODS: The demographic data of 43 idiopathic Parkinson's patients who are above stage 3 according to the Hoehn and Yahr scale, with MMSE 25 and above, and who had not received a diagnosis of dementia, and who had no disease and drug use affecting the vitamin D level, the UPDRS motor subscale, the nonmotor symptom scale and the shortened geriatric depression scale, were recorded. The relationship between vitamin D level and pain was evaluated.
RESULTS: Of the patients included in the study, 24 were male and 19 were female. The mean age of the patients was 61.9 (± 9.84) years. The mean disease duration was 3.9 years; the mean UPDRS motor score was 18.3 (± 7.6). According to the nonmotor symptom scale, the patients scored 10.2 (± 5.3) out of 30. 60.5% of the patients had pain complaints. No significant relationship was found between pain and vitamin D level, age, disease duration, UPDRS, drug dose, nonmotor symptom score, GDS, (p>0.05). A significant difference was found between levodopa doses of patients with and without pain in the 60-year-old and younger patients (p = 0.04). Levodopa doses of patients with pain were higher than those without pain. A significant positive correlation was found between the presence of pain and UPDRS in patients over 60 years (p = 0.035).
DISCUSSION AND CONCLUSION: As a result of the study, no relation was found between pain and vitamin D levels. In larger patient populations, it was thought to be important to examine the relationship between pain and Vitamin D levels by identifying pain subtypes.

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GÝRÝÞ ve AMAÇ: Amacýmýz bilinen keratokonus (KK) tanýsý olmayan olgularda, görme keskinliði, refraktif ve pakimetrik parametreler ile topografik keratokonus tarama sýnýflamasýnýn (KKTS) iliþkisini deðerlendirmektir.
YÖNTEM ve GEREÇLER: Bu geriye dönük çalýþmada klinisyenlerin, KK’tan þüphelenerek, topografi tetkiki istediði 183 hastanýn 366 gözüne ait görme keskinliði, refraktif ve pakimetrik parametreler ile Sirius topografi (CSO, Frenze, Ýtalya) ile elde edilen KKTS sonuçlarý normal, þüpheli KK ve KK olarak geriye dönük not edilmiþtir. Gözlere ait astigmatik deðerler; < -1 D, -1 / -2 D, -2 / -4 D, and > -4 D olmak üzere dört gruba ayrýlmýþ ve KKTS ile bu gruplar arasýndaki iliþki deðerlendirilmiþtir.
BULGULAR: EÝDGK þüpheli KK grubunda normal gruba göre yüksek (p=0.008), KK grubunda normal ve þüpheli KK grubuna göre düþük (sýrasýyla
p=0.015, p<0.001) bulunmuþtur. SKK deðerleri þüpheli KK ve KK gruplarýnda normal gruba göre düþük (p<0.001), KK grubunda ise
þüpheli KK grubuna göre düþük (p<0.001) bulunmuþtur. Þüpheli KK ve KK gruplarýnda sferik refraktif deðerler normal grubuna göre yüksek (sýrasýyla p=0.03, p<0.001), KK grubunda þüpheli KK grubuna göre yüksek (p<0.001) bulunmuþtur. Astigmatik refraktif deðerler ve sferik eþdeðer (SE), KK grubunda normal ve þüpheli KK grubuna göre yüksek (p<0.001) bulunmuþtur. KK sýnýfýnda astigmatik deðeri 0/-1 D arasý ve -1/-2D arasý olan göz bulunma oraný düþük (p<0.05), > -4 D olan göz bulunma oraný yüksek saptanmýþtýr (p<0.05).
TARTIÞMA ve SONUÇ: Vizyonu refraksiyonla artmayan ve/veya SKK ince olan ve/veya yüksek astigmatizmasý olan hastalarda KK açýsýndan topografik deðerlendirme istenmelidir. Astigmatik refraktif deðeri -1 D’nin altýnda olan gözlerde de KKTS’nda þüpheli KK ve KK bulunma ihtimali mevcuttur, -4 D’den büyük olanlarda ise KK olarak iþaretlenme ihtimali artmaktadýr.

INTRODUCTION: To evaluate the relationship between visual acuity, refractive and pachymetric parameters, and topographic keratoconus screening classification (KCSC) in patients without a known diagnosis of keratoconus (KC).
METHODS: This retrospective study included 366 eyes of 183 patients for whom topography examination was performed due to clinical suspicion of KC. Visual acuity, refractive and pachymetry parameters, and KCSC result (normal, suspect KC, or KC compatible) according to Sirius topography (CSO, Firenze, Italy) were noted retrospectively. The eyes were divided into 4 groups based on the magnitude of astigmatism (< -1 D, -1 to -2 D, -2 to -4 D, and > -4 D) and the relationship between these groups and topographic KCSC was evaluated.
RESULTS: BCVA was higher in the suspect KC group than in the normal group (p=0.008) and lower in the KC compatible group compared to the normal and suspect KC groups (p=0.015, p<0.001, respectively). CCT values were lower in the suspect KC and KC compatible groups
than in the normal group (p<0.001) and in the KC compatible group compared to the suspect KC group (p<0.001). Cylindrical values and spherical equivalent were higher in the KC compatible group than the normal and suspect KC groups (p<0.001). In the KC compatible group, fewer eyes had astigmatism of < -1 D or between -1 and -2 D (p<0.05), while significantly more eyes had astigmatism higher than -4 D (p<0.05).
DISCUSSION AND CONCLUSION: Patients whose vision did not improve with refraction, who had thin CCT, and/or high astigmatism should undergo topographic examination for KC. Eyes with cylindrical values less than -1 D may be classified as suspect KC or KC compatible, by topography while eyes with astigmatism higher than -4 D are more likely to be classified as KC compatible.

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GÝRÝÞ ve AMAÇ: Derin anterior lameller keratoplasti (DALK) ve penetran keratoplasti (PK) sonrasý geliþen glokom insidansýný ve anti-glokomatöz tedavisiye yanýtý karþýlaþtýrmalý olarak deðerlendirmek.
YÖNTEM ve GEREÇLER: Bu geriye dönük çalýþmada 146 DALK’li ve 156 PK’li hasta deðerlendirildi. Tüm hastalar keratoplasti iþleminden sonra 1., 3., 6., 12. ve 24. aylardada takip edildi. Glokom ve glokom tedavilerinin risk faktörleri ve insidansý hem DALK hem de PK gruplarýnda deðerlendirildi.
BULGULAR: Çalýþmaya DALK prosedürü olan 156 göz ve PK prosedürü olan 163 göz dahil edildi. DALK grubundaki 11 göze (%7.05) ve PK grubundaki 16 göze (%9.81) glokom tanýsý kondu (p=0.42). Ortanca anti-glokom ilacý sayýsý DALK gruplarýnda 1.0 ve PK gruplarýnda 1.5
idi (p=0.01). PK sonrasý glokomlu 16 gözün 4’üne (%25) mitomisin C ile trabekülektomi yapýldý (p=0.01). DALK grubunda hastalar cerrahi
müdahale olmaksýzýn tek anti-glokomatöz tedavi ile takip edildi.
TARTIÞMA ve SONUÇ: Çalýþma grubumuzda glokom insidansý DALK’li gözlerde %7, PK’li gözlerde %9.8 idi. Ancak, glokom ilacý sayýsý PK iþlemi olan gözlerde
DALK iþlemi olan gözlere göre anlamlý olarak daha yüksekti (p=0.01). Dahasý, DALK’li gözlerde, PK’li gözlere kýyasla mitomisin C ile trabekülektomi cerrahisine daha az gereksinim duyulmuþtur. Bu nedenle; sonuçlarýmýz, DALK prosedürünün glokom geliþimi açýsýndan PK’den daha uygun ve daha güvenli olabileceðini düþündürdü.

INTRODUCTION: To evaluate the incidence of glaucoma and the response rates to anti-glaucoma treatment after deep anterior lamellar keratoplasty (DALK) in comparison with penetrating keratoplasty (PK).
METHODS: In this retrospective study, 146 patients with DALK and 156 patients with PK were evaluated. All patients were followed up on the 1st, 3rd, 6th, 12th and 24th days after the keratoplasty procedure. The risk factors and incidence of glaucoma and glaucoma treatments were assessed in both the DALK and the PK groups.
RESULTS: A total of 156 eyes with DALK procedure and 163 eyes with PK procedure were included. Eleven eyes in the DALK group (7.05%) and 16 eyes in the PK group (9.81%) were diagnosed with glaucoma (p=0. 42). The median number of anti-glaucoma drugs was 1.0 in DALK groups and 1.5 in PK groups (p=0.01). Trabeculectomy with mitomycin C was performed in 4 of the 16 eyes (25%) with glaucoma after the PK (p=0.01). In the DALK group, patients were followed up with mono anti-glaucoma treatment therapy without surgical intervention.
DISCUSSION AND CONCLUSION: In our study group, the incidence of glaucoma was 7% in eyes with DALK and 9.8% in eyes with PK. However, the number of glaucoma drugs was significantly higher in eyes with PK procedure than eyes with DALK procedure (p=0.01). Moreover, eyes with DALK have needed less trabeculectomy with mitomycin C compared to eyes with PK. Therefore; our results suggested that the DALK procedure might be more appropriate and safer than PK concerning glaucoma development.

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GÝRÝÞ ve AMAÇ: Çalýþmanýn amacý tekrarlayan ayak bileði burkulmalarýnda lateral kollateral ligaman (LKL) hasarýný ultrason (US) ve ultrason elastografi
(USE) ile deðerlendirerek, bulgularý saðlýklý bireylerle karþýlaþtýrmaktýr.
YÖNTEM ve GEREÇLER: Sporla uðraþan 54 kiþi (toplamda 108 ayak bileði), saðlýklý 30 kiþi (toplamda 60 ayak bileði) çalýþmaya dahil edildi. LKL’yi oluþturan anterior talofibular ligaman (ATFL), kalkaneofibular ligaman (KFL) ve posterior talofibular ligamanlarýn (PTFL) proksimal, orta ve distal parçalarý deðerlendirildi. Ligamanlarýn US ve USE deðerlendirilmesi longitudinal planda yapýldý. Ligamanlarýn uzunluðu ve kalýnlýðý ölçüldü; hasarlanmasý dört derecede deðerlendirildi. USE paternleri de dört derecede deðerlendirildi ve gerinim oranlarý hesaplandý.
BULGULAR: ATFL uzunluðu hasta grubunda kontrol grubundan daha kýsaydý (p=0.028). Ligamanlarýn kalýnlýðýnda her iki grup arasýnda farklýlýk saptanmadý. ATFL, KFL ve PTFL’nin ultrasondaki hasarlanma dereceleri hasta grubunda daha yüksek tespit edidi (p<0.001).
TARTIÞMA ve SONUÇ: Sporcularda ayak bileði LKL hasarýnýn gösterilmesinde US non-invaziv taný yöntemi olarak kullanýlabilir. USE kronik LKL yaralanmalarýnýn
deðerlendirimesin US’ ye tanýsal katký saðlar.

INTRODUCTION: The aim of this study is to assess the sonography and elastography findings in the lateral collateral ligament (LCL) injury due to recurrent ankle sprains and to compare them to those of healthy individuals.
METHODS: A total of 108 ankles in 54 athletes and 60 ankles in 30 healthy volunteers were included. The LCL, consisting of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL), was evaluated for images in the following three sections: proximal, middle and distal. Longitudinal images of each tendon were obtained using ultrasound (US) and real-time sonoelastography. Degeneration of each tendon was evaluated in four grades and the length and thickness were measured in sonographic images. Real-time sonoelastography images were evaluated in four grades for elasticity pattern and strain ratios.
RESULTS: The length of ATFL was shorter in the patient group than in the control group (p=0.028). There was no difference between the patient and control group for ligament thickness. Sonographic grades in the patient group were statistically increased compared to the control group for ATFL, CFL and PTFL ligaments (p<0.001).
DISCUSSION AND CONCLUSION: US can be used as a non-invasive diagnostic method to demonstrate ankle LCL injuries in athletes. Real-time sonoelastography provides useful additional information for the evaluation of patients with chronic sprains of the ankle LCL.

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GÝRÝÞ ve AMAÇ: Meme kanseri kadýnlarda görülen en sýk kanserdir. Meme kanserlerinde REG1A ek-spresyonuna iliþkin literatürler sýnýrlý sayýdadýr. Bizim çalýþmamýz meme kanserlerinde klinik davranýþ ve hastalýksýz saðkalýmý etkileyebilecek prognostik faktörler ile KÝ67 ve REG1A ekspresyonunun iliþkisini belirlemeyi amaçlamýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmamýza 2007–2011 yýllarý arasýnda Kartal Eðitim ve Araþtýrma Hastanesi patoloji bölümünde meme kanseri tanýsý almýþ ve onkoloji kliniðinde takip edilen hastalar dahil edilmiþtir. Hasta kayýtlarý, onkoloji dosyalarý, patoloji lamlarý ve parafin bloklar gözden geçirilmiþ ve deðerlendirilmiþtir. Daha sonra en uygun bloklar immünhistokimyasal çalýþma için seçilmiþtir.
BULGULAR: Çalýþmamýzda 104 primer meme kanseri içemektedir. Hastalarýn yasý 24–95 arasýnda deðiþmekte olup ortalama yaþ 53.9±14.8 saptanmýþtýr. Tüm hastalar kadýndýr. Meme kanserinde REG1A ekspresyonu ile; vasküler invazyon, histolojik grede, metastaz, ER, PR, c-erbB2 arasýnda anlamlý bir iliþiki vardý. Ayný zamanda; meme kanserinde Ki67 ekspresyonu ile; tümör boyutu, vasküler invazyon, metastaz, ER, PR, c-erbB2 arasýnda anlamlý bir iliþki vardý.
TARTIÞMA ve SONUÇ: Sonuç olarak yeni prognostik parametrelere karar verilirken REG1A ekspresyonu prognozu belirlemede yeni tedavi stratejilerinin geliþtirilmesinde rol oynayabilir.

INTRODUCTION: Invasive breast carcinoma is the most common cancer in women. Literature data on REG1A expression in breast carcinoma was limited. Our study aimed to investigate the relationship between REG1A and Ki67 expressions with prognostic factors that might affect clinical behaviour and disease-free survival in invasive breast carcinomas.
METHODS: Patients diagnosed with invasive breast carcinoma at the Dr. Lütfi Kirdar Kartal Training and Research Hospital Pathology Clinic and followed up in the Oncology Clinic between 2007–2011 were included in our study. Patient records, oncology files, all pathological slides, paraffin blocks were examined are and evaluated. The most appropriate blocks were then selected for immunohistochemical analysis.
RESULTS: Our study included 104 cases of primary invasive breast carcinoma. The age of patients ranged between 24–95, and the mean age was 53.9±14.8. All cases were female. There was a statistically significant correlation between vascular invasion, histological grade, metastasis, ER, PR, c-erbB2 and REG1A exspression in breast carcinoma. In addition, there was a statistically significant correlation between tumor size, vascular invasion, metastasis, ER, PR, c-erbB2 and Ki67 exspression in breast carcinoma.
DISCUSSION AND CONCLUSION: In conclusion, identifying new prognostic parameters, one of which is REG1A, might have a role in the prediction of prognosis and development of new treatment strategies.

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GÝRÝÞ ve AMAÇ: Skrotal kalsinozis (SK) nadir görülen, genellikle asemptomatik, skrotum derisinde kalsiyum fosfat depolanmasýna baðlý nodüllerle karakterize benign bir durumdur. Bu çalýþmada amaç, skrotal kalsinozis tanýlý hastalarýn klinik bulgularýnýn araþtýrýlmasý, immünhistokimyasal yöntemle olasý epitelyal kökeni varlýðýnýn analiz edilmesidir.
YÖNTEM ve GEREÇLER: Çalýþmaya 2011–2020 yýllarý arasýnda, iki farklý merkezde, eksizyonel biyopsi ile skrotal kalsinozis tanýsý alan 15 hasta dâhil edildi. Hastalara ait demografik, klinik ve laboratuvar verileri geriye dönük olarak elektronik arþivden elde edildi. Tüm olgulardan hazýrlanan
Hematoksilen & Eozin (H&E) kesitler iki patolog tarafýndan yeniden deðerlendirildi. On üç olguya kist epiteli için sitokeratin AE1-AE3 immünhistokimyasal boyasý uygulandý.
BULGULAR: Hastalarýn ortanca yaþ deðeri 32 (4–68) idi. Hastalarda, skrotumun çoðunlukla ventral bölümünde non-ülsere, boyutlarý 0.5–2 cm
arasýnda deðiþen beyaz-sarý renkte, aðrýsýz nodüller ve üçünde kaþýntý þikâyeti mevcut idi. Sekiz hastada incelenen serum kalsiyum deðerlerinin normal idi. Histopatolojik incelemede skrotal dermiste psödokapsüllü, çoðunda kist duvarý ya da epitelizasyon izlenmeyen amorf ve dens, H&E ile bazofilik kalsiyum depozisyonlarý görüldü. Bu alanlar çevresinde yer yer makrofaj infiltrasyonu ya da hiyalinizasyon izlenirken bir olguda ossifikasyon mevcut idi. Beþ olguda çevrede epidermal kistler izlenirken, ikisinde kalsifikasyon, keratinizasyon ve epitel geçiþi birlikte izlendi. Bu alanlarda immünhistokimyasal olarak sitokeratin AE1-AE3 ile kist epiteli pozitif idi. Kist epiteli ve kalsifikasyon birlikte izlenen kistler, sadece kalsifikasyon izlenen kistlere göre daha küçük idi.
TARTIÞMA ve SONUÇ: Ýdiyopatik skrotal kalsinoziste patogenez ile ilgili durum netlik kazanmamýþ olsa da kýl folikülünün dilatasyonu sonrasý aðzýnýn týkanarak ilerleyen süreçte kistik deðiþim ve kist epitelinde kalsifikasyon ile epitelin yerini kalsiyumun almasý en olasý mekanizma gibi görünmektedir.

INTRODUCTION: Scrotal calcinosis (SC) is a rare, usually asymptomatic, benign condition characterized by calcium phosphate deposition in the skin of the scrotum. The aim of this study is to investigate the clinical findings of patients diagnosed with scrotal calcinosis and to analyze the presence of possible epithelial origin by immunohistochemistry.
METHODS: Fifteen patients diagnosed with scrotal calcinosis by excisional biopsy in two different centers between 2011 and 2020 were included in the study. Demographic, clinical, and laboratory data of the patients were obtained retrospectively from the electronic archive. Hematoxylin & Eosin (H&E) sections prepared from all cases were re-evaluated by two pathologists. Cytokeratin AE1-AE3 immunohistochemical stain was applied to 13 cases for the epithelium of the cyst.
RESULTS: The median age of the patients was 32 (4–68). Patients had ulcer-free, white-yellow, painless nodules measuring 0.5 to 2 cm, mostly in the ventral part of the scrotum, and three had pruritus. Serum calcium levels were normal in eight patients. Histopathological examination showed amorphous and dense, H&E and basophilic calcium deposits with pseudocapsules in the scrotal dermis, most of which had no cyst walls or epithelization. While macrophage infiltration or hyalinization was observed around these areas, ossification was present in one case. While epidermal cysts were observed in the periphery in five cases, calcification, keratinization, and epithelial passage were observed together in two of them. In these areas, the cyst epithelium was positive with cytokeratin AE1-AE3 immunohistochemically.
Cysts with cyst epithelium and calcification were smaller than those with only
calcification.
DISCUSSION AND CONCLUSION: Although the pathogenesis of idiopathic scrotal calcinosis is not clear, the cystic change and calcification in the cyst epithelium and the replacement of the epithelium by calcium appear to be the most likely mechanism after dilatation of the hair follicle.

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