OBJECTIVE: Interstitial cystitis/bladder pain syndrome (IC/BPS) refers to diseases that are challenging to identify, diagnose and treat. Thus, there is a need to study the clinical and cystoscopic picture of IC/BPS. The present research aims to study the clinical manifestations and results of cystoscopy with hydrodistension in women with IC/BPS.
METHODS: One hundred twenty-six women with clinically diagnosed IC/BPS were examined – their mean age was 46.7±14.0 years. Patients were surveyed on pelvic pain and urgency/frequency patient symptom score (PUF), visual analogue scale (VAS) and urgency severity scale (USS). All patients underwent a potassium test (PST) and cystoscopy with hydrodistension. Statistical analysis was performed using SPSS software version 15.0 (SPSS Inc., Chicago, Illinois, USA).
RESULTS: The average PUF score was 8.14±1.76 points, VAS – 5.45±0.93 points and USS – 2.63±0.91 points. A positive potassium test was detected in 91.3% of cases. The maximum average anatomical capacity of the bladder was 308.0±77.5 ml. The maximal cystometric capacity in women with mild pain was higher than among women with moderate and severe pain by 30.9% (p<0.05) and 53.0% (p<0.01), respectively. In most cases, mucosal changes were diffuse (n=57) or located in two parts of the bladder. One of the most common symptoms was the diffuse bleeding of the bladder mucosa (III degree). A statistically significant inverse correlation (r=-0.57, p<0.01) was found between the maximal cystometric bladder volume and the severity of the bladder mucosa changes. At the same time, a positive correlation was found between the severity of the bladder mucosa changes and the sum of points on the PUF questionnaire (r=+0.61, p=0.0003), the sum of points on the VAS questionnaire (r=+0.59, p=0.0008) and the USS questionnaire (r=+0.66, p=0.005).
CONCLUSION: A relationship has been established between the clinical manifestations of IC/BPS among examined women and changes in the wall of the bladder. The data obtained from our investigation can help increase IC/BPS diagnostics and improve IC/BPS treatment results.

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Amaç: Renin anjiyotensinojen sistemi (RAS) inhibitörlerinden ramipril ve sakubitril/valsartan, kardiyovasküler hastalýklarýn tedavisinde sýklýkla kullanýlmaktadýr. Hipertansif kadýnlarda gebelik sýrasýnda kontrendike olduklarý bilinmesine raðmen, ramipril veya sakubitril/valsartanýn paternal maruziyet sonrasý erkek fertilitesinde ilaç güvenilirliðine dair yeterli veri yoktur. Bu çalýþmada, ramipril ve sakubitril/valsartanýn normotensif ve hipertansif erkek ratlarda fertilite parametreleri üzerindeki etkilerini deðerlendirmeyi amaçladýk.
Yöntem: Yetiþkin erkek normotansif ve deksametazonla indüklenmiþ hipertansif ratlara 18 gün boyunca sakubitril/valsartan, ramipril veya salin verildi. Arteriyel kan basýncý karotis arter kanülasyonu ile verifiye edildi. Deney sonunda ratlarýn testis aðýrlýklarý, testis histopatolojik skorlamasý, sperm sayýsý, sperm motilitesi, sperm morfolojisi ve serum testosteron düzeylerini içeren erkek fertilite parametreleri analiz edildi.
Bulgular: Sakubitril/valsartan veya ramipril tedavileri, sperm üretimi, testis morfolojisi ve serum testosteron düzeylerinin radyoimmünoassay incelemesinde kontrol grubuna göre anlamlý bir farklýlýk göstermedi. Bununla birlikte, sperm motilitesi, RAS inhibisyonu altýndaki ratlarda anlamlý olarak azaldý.
Sonuç: Bu bulguya rat sperm kuyruklarýndaki anjiyotensin reseptörleri varlýðýnýn sebep olmasý muhtemeldir, çünkü anjiyotensin reseptörleri sperm motilitesinin modülasyonunda rol oynayabilmektedir. Sperm motilitesinde rol oynayan RAS ile iliþkili proteinlerin tanýmlanmasý, motilitedeki rollerini açýklamaya yardýmcý olabilir. Verilerimiz, paternal sakubitril / valsartan ve ramipril maruziyetinin erkeklerde fertilizasyonda genel olarak güvenli olduðunu kanýtlamaktadýr. (NCI-2019-0233.R1)

OBJECTIVE: Renin angiotensinogen system (RAS) inhibitors, ramipril and sacubitril/valsartan are frequently used in the treatment of cardiovascular diseases. Although they are known as contraindicated during pregnancy in hypertensive women, there is not any outcome of their safety in male fertility after exposure to ramipril or sacubitril/valsartan. In this study, we aimed to evaluate the effects of ramipril and sacubitril/valsartan to highlight their safety in the male fertility in normotensive and hypertensive rats.
METHODS: Adult male normotensive and dexamethasone-induced hypertensive rats were treated with sacubitril/valsartan, ramipril and saline for 18 days. Arterial blood pressures were verified using carotid artery cannulation. Male fertility parameters, including the testis weights, histopathologic scoring of the testis, sperm count, sperm motility, morphology, and serum testosterone levels, were analyzed in treated and nontreated normotensive/hypertensive rats.
RESULTS: Sacubitril/valsartan or ramipril treatments did not reveal a significant difference in sperm production, testicular morphology, and radioimmunoassay of serum testosterone levels compared to the control group. However, sperm motility was significantly reduced in rats under RAS inhibition.
CONCLUSION: This finding was likely mediated by the identification of Ang receptors in the tails of rat sperm given that Ang receptors may play a role in the modulation of sperm motility. Identification of RAS-related proteins involved in sperm motility may help to explain their roles in motility. Our data provide general safety evidence for the male fertilization ability after paternal sacubitril/valsartan and ramipril exposure.

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GÝRÝÞ VE AMAÇ: Ortaya çýkan kanýtlar, fermente edilebilen oligosakkarit, disakkarit, monosakkarit ve polyollerin (FODMAP) tüketiminin irritabl barsak sendromu olan bazý hastalarda semptomlara neden olduðu göstermektedir. Bu çalýþmada irritabl barsak sendromu (ÝBS) olan çocuklarda düþük FODMAP içerikli diyet etkinliðini, standart diyet ile karþýlaþtýrarak deðerlendirmek amaçlanmýþtýr.
YÖNTEM VE GEREÇLER: “Rome IV” kriterlerine göre ÝBS tanýsý alan, 6-18 yaþ arasýndaki 60 çocuk çalýþmaya alýndý. Randomize olarak seçilen hastalar düþük FODMAP içerikli diyeti baþlanan 30 hasta ve genel gastrointestinal sistem için koruyucu satandart diyetin verildiði 30 hasta olarak iki grupa ayrýldý. Hastalar araþtýrmanýn baþlangýcýnda, ikinci ayda ve dördüncü ayda deðerlendirildi. Hastalarýn bilgileri demografik veri formuna kaydedildi. Görsel analog skala (GAS) kullanýlarak hastalarýn karýn aðrýlarýný puanlamalarý istendi. Klinik Global Ýzlenim- Ýyileþtirme ölçeði (KGI-I) kullanýlarak hastanýn klinik durumuna doktoru tarafýndan puan verildi.
BULGULAR: Ýki grup arasýnda yaþ, cinsiyet ve semptoma süreleri açýsýndan anlamlý fark yoktu. Baþlangýçtaki, diyet öncesi GAS puanlarý kýyaslandýðýnda iki grubun puanlarý benzer saptandý. Ýki aylýk diyet sonrasý GAS puanýnda azalma ortalamasý düþük FODMAP içerikli grupta 3.80±1.10 iken, standart grupta 2.03±1.03 idi ve istatistiksel olarak anlamlýydý(p=0.0001). Hastalarýn 2. aydaki diyet sonrasý KGI-I ölçeði sonucu iki grup arasýnda istatistiksel olarak anlamlý saptandý (p=0.0001). Dördüncü aydaki GAS puanlarýnda artýþ düþük FODMAP içerikli grupta 2.97±1.10 puan iken, standart grupta 1.63±0.71 idi ve istatistiksel olarak anlamlýydý (p=0.0001). 4. aydaki diyet sonrasý KGI-I ölçeði deðerlendirmesi de iki grup arasýnda istatistiksel olarak anlamlý saptandý (p=0.0001).
TARTIÞMA VE SONUÇ: Düþük FODMAP içerikli diyetin standart diyete göre IBS'de semptom kontrolünde daha etkili olduðu görülmektedir. Diyetin ne kadar uzun süre yapýlacaðý, hangi fonksiyonel GÝS hastalýðýnda ne derece etkili olacaðý gibi klinik pratikte kullanacaðýmýz bilinmeyenler için de yeni çalýþmalara ihtiyaç vardýr. (NCI-2019-0316.R1)

OBJECTIVE: There is growing evidence that suggests that consumption of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) may result in some symptoms in certain patients with irritable bowel syndrome (IBS). This study aims to evaluate the efficacy of a low FODMAP diet in children with IBS by comparing it with the standard diet.
METHODS: Sixty children between the ages of 6 and 18 who were diagnosed with IBS according to Rome IV criteria were included in this study. Randomly selected patients were divided into two groups as 30 patients on a low FODMAP diet and 30 patients on a general protective standard diet for the gastrointestinal tract. Patients were evaluated at the beginning, second and fourth months of the study. The data of the patients were recorded in the demographic data form. Patients were asked to score abdominal pain using the Visual Analogue Scale (VAS). The clinical status of the patient was scored by the doctor using the Clinical Global Impression Improvement (CGI-I) scale.
RESULTS: There were no significant differences between groups about age, sex and symptom duration. When the pre-diet VAS scores were compared, the two groups were similar. The mean decrease in VAS score after two months of diet was 3.80±1.10 in the low FODMAP group and 2.03±1.03 in the standard group and was statistically significant. Post-dietary CGI-I score evaluation was determined to be statistically significant between the two groups. The increase in VAS scores in the fourth month was 2.97±1.10 points in the Low FODMAP group and 1.63±0.71 in the standard group, and was statistically significant. CGI-I score after the diet at the 4th month was also statistically significant between the two groups.
CONCLUSION: A low FODMAP diet seems to be more effective for symptom control in IBS when compared to standard dietary advice. Further studies are needed for the unknowns that will be used in clinical practice, such as how long the diet will be continued and how effective it will be in which GIS diseases.

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Amaç. Ailesel Akdeniz ateþi (AAA), kendi kendini sýnýrlayan ateþ ve serözit ataklarý ile seyirli, monogenik kalýtýmlý bir periyodik ateþ sendromudur. Taný ölçütlerinde yer alan bulgularýn yaný sýra, AAA hastalarýnýn ataklarýnda kas-iskelet sistemi bulgularý da eþlik edebilir. Bu çalýþmada, AAA’lý çocuklardaki kas-iskelet sistemi bulgularýnýn sýklýðý ve genotip iliþkisini ortaya koymayý amaçladýk.
Metot. 1 Ocak 2017 ile 1 Haziran 2019 tarihleri arasýnda çocuk romatoloji kliniðimizde AAA tanýsý alan ve en az 6 ay boyunca tarafýmýzdan takip edilen hastalar çalýþmaya alýndý. Hastalarýn kas-iskelet sistemi bulgularý kaydedildi. Hastalar “Mediterranean Fever” (MEFV) genindeki varyantlarýna göre gruplandýrýldý. Kas-iskelet sistemi bulgularý ve genotipik verilere göre hastalar gruplandýrýlarak, birbirleri ile karþýlaþtýrýldý.
Sonuçlar. Çalýþmaya 634 AAA tanýlý çocuk (336 kýz ve 298 erkek, K/E: 1,13/1) dahil edildi. Atak dönemindeki hastalarýn; %99'unda ateþ, %87,3'ünde karýn aðrýsý, %20,7'sinde göðüs aðrýsý, %11,3'ünde kusma, %10,7’sinde erizipel benzeri kýzarýklýk ve %9,3'ünde baþ aðrýsý vardý. Hastalarýn %58,5'ine (n: 370) kas-iskelet sistemi semptomlarý eþlik etmekteydi. En sýk görülen kas-iskelet sistemi bulgusu artralji (%32,6, n: 206) idi. Diðer kas-iskelet sistemi semptomlarý; artrit %23,7, myalji %20,5, egzersizle tetiklenen bacak aðrýsý %6,5, uzamýþ febril myalji %1 sýklýðýnda bulundu. MEFV geninin 10. ekzonunda M694V varyantýný homozigot taþýyan hastalarda, kas-iskelet sistemi belirtilerinin daha yüksek oranda ortaya çýktýðý görüldü (p=0,017). Bunun yanýnda, en az bir alelinde M694V varyantýný taþýyan hastalarýn da, atak dönemlerinde kas-iskelet sistemi bulgularýnýn daha sýk görüldüðü belirlendi (p=0,019).
Sonuç. Ailesel Akdeniz ateþi hastalarýnýn yarýsýndan fazlasýnda kas-iskelet bulgularýnýn geliþtiðini belirledik. Çalýþma sonucunda M694V varyant varlýðýnýn, kas-iskelet sistemi belirtilerinin ortaya çýkmasý için bir risk faktörü olabileceði düþünüldü. (NCI-2020-0075.R1)

OBJECTIVE: Familial Mediterranean fever (FMF) is a monogenic inherited periodic fever syndrome presenting with episodes of self-limiting fever and inflammation of serosal membranes. Besides the findings in the diagnostic criteria, musculoskeletal findings can also be seen in FMF patients attacks. In this study, we aim to reveal the frequency and genotype association of musculoskeletal manifestations in children with FMF.
METHODS: The patients diagnosed with FMF between January 1, 2017 and June 1, 2019, and followed for at least six months in our pediatric rheumatology clinic were included in this study. Musculoskeletal manifestations of patients were enrolled. The patients were grouped according to the “Mediterranean Fever” (MEFV) gene variants. Musculoskeletal manifestations of the patients were compared between the groups.
RESULTS: The study group included 634 children with FMF (336 female and 298 male, F/M: 1.13/1). The clinical manifestations of patients in the attack period were as follows: 99% of the patients had a fever, 87.3% had abdominal pain, 20.7% had chest pain, 11.3% had vomiting, 10.7% had erysipelas like erythema, and 9.3% had a headache. The musculoskeletal symptoms were accompanied by 58.6% (n=372) of the patients during the attack period. The most common musculoskeletal manifestation was found as arthralgia (32.6%, n=206). Also, the other musculoskeletal manifestations were as follows during attacks: arthritis in 23.7% (n=150), myalgia in 20.5% (n=130), exertional leg pain in 6.5% (n=41), and protracted febrile myalgia in 1% (n=7) of the patients. It was observed that the musculoskeletal manifestations were significantly higher in patients with homozygous M694V variants in exon-10 (p=0.017). The musculoskeletal manifestations were more common in the attack periods of patients carrying the M694V variant in at least one allele (p=0.019).
CONCLUSION: We found that the musculoskeletal manifestations were accompanied in more than half of patients with FMF. M694V variant was found as a risk factor for emerging musculoskeletal manifestations.

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Giriþ: COVID-19 Pandemisi dünyada hýzla yayýlarak küresel mortalitenin artmasýna neden olmuþtur. Bu çalýþmada Türkiye’nin COVID-19 ile mücadelesinde hangi eylemlerin daha etkili olduðu ile ilgili olarak pandemi ülkeleri ile Türkiye karþýlaþtýrmasý yapýlmasý amaçlandý.
Yöntem: Çalýþma retrospektif, gözlemsel, kesitsel olarak planlandý. Türkiye Cumhuriyeti Saðlýk Bakanlýðý resmi internet sayfasýnda 11 Mart - 26 Nisan tarihleri arasýnda günlük olarak bildirilen verileri elde edildi. Küresel COVID-19 verileri https: //www.worldometers.info/coronavirus/country/ adresinden günlük olarak kaydedildi. Yoðun Bakým Ünitesine (YBÜ) yatýþ, entübasyon ve ölüm oranlarýna verilerine iliþkin 31 günlük süreç analize dahil edildi. Parçalý regresyon analizi kullanýldý. COVID-19'dan etkilenen ülkelerden alýnan sonuçlar, ilk 65 gün için Türkiye'den alýnan sonuçlarla karþýlaþtýrýldý.
Bulgular: Toplamda 889.742 test yapýldý (pozitif = 110.130 [% 12.37]). Ölüm oraný 27 Nisan 2020'de% 2,55 (n = 2805) idi. Vakalarýn yýllýk yüzde deðiþim (APC) deðerleri 5 parçalý kýrýlma gösterdi ([23.1], [14.7] [11.4], [3.7], [0.7]; her p = 0.001). YBÜ yatýþý 4 parçalý kýrýlma gösterdi (APC: [3.1, p = 0.001], [-2.2, p = 0.10], [-7.6, p = 0.001], [-4.5, p = 0.001]). Entübasyon oranlarý için APC'nin düþüþü 5 parçalý kýrýlma gösterdi (APC: [1.1, p = 0.10], [-1.1, p = 0.001], [-2.0, p = 0.001], [-0.4, p = 0.40], [- 2,7, p = 0,001]). Ölüm oranlarý; 4 parçalý kýrýlma gösterdi (APC: [-6.3, p = 0.001], [8.4, p = 0.001], [0.2, p = 0.30], [1.4, p = 0.001]). Ýlk 65 günde 1 milyon kiþide ölüm oranlarý; Ýspanya% 11,6, Ýtalya% 11,4, Ýngiltere% 11,3, Fransa% 11,1, ABD% 10,3, Almanya% 8,4, Ýran% 8,2, Türkiye% 7,5, Güney Kore% 4,1 ve Çin% 2.4 idi.
Sonuç: COVID-19 ile mücadele için halk saðlýðý politikalarý ve COVID-19 rehberleri, Türkiye'de salgýnýn büyümesini kontrol ederek PCR pozitif vaka ve ölüm oranlarýnýn düþmesine yardýmcý olmuþtur. Türkiye, COVID-19'u Ýspanya, Ýtalya, Ýngiltere, Fransa ve ABD'den daha iyi yönetirken; Almanya ve Ýran'a benzer baþarý saðlamýþtýr. Çin ve Güney Kore, Mart-Mayýs 2020 döneminde COVID-19’u en iyi yöneten ülkeler olmuþtur. (NCI-2020-0328)

OBJECTIVE: COVID-19 has spread worldwide and leads to an increased risk of mortality. We aimed to analyze what actions have been effective in fighting COVID-19 in Turkey with a comparison to pandemic-affected countries.
METHODS: This was a retrospective observational cross-sectional study. The Republic of Turkey Ministry of Health official web page includes data reported daily from 11 March to 26 April. Global COVID-19 data were recorded daily from https: //www.worldometers.info/coronavirus/country/. Data were analyzed for 31 days according to Intensive Care Unit (ICU) admission, intubation and mortality rates. Segmented regression analysis was used. The results from COVID-19-affected countries were compared with the results from Turkey for the first 65 days.
RESULTS: In total, 889.742 tests were performed (positive=110.130 [12.37%]). The mortality rate was 2.55% (n=2805) on 27 April 2020. The annual percent change (APC) values of the cases showed 5 segments ([23.1], [14.7] [11.4], [3.7], [0.7]; each p=0.001). ICU admission showed 4 segments (APC: [3.1, p=0.001], [-2.2, p=0.10], [-7.6, p=0.001], [-4.5, p=0.001]). The decline of APC for intubation rates showed 5 segments (APC: [1.1, p=0.10], [-1.1,p=0.001], [-2.0, p=0.001], [-0.4, p=0.40], [-2.7, p=0.001]). The mortality rates showed 4 segments (APC: [-6.3, p=0.001], [8.4, p=0.001], [0.2, p=0.30], [1.4, p=0.001]). Deaths were reported per 1 million individuals for the first 65 days: Spain 11.6%, Italy 11.4%, UK 11.3%, France 11.1%, USA 10.3%, Germany 8.4%, Iran 8.2%, Turkey 7.5%, South Korea 4.1% and China 2.4%.
CONCLUSION: Public health policies and protocols to combat COVID-19 helped control the spread and decrease positive cases and mortality rates in Turkey. Turkey managed COVID-19 better than Spain, Italy, UK, France, USA and Turkey managed COVID-19 similarly to Germany and Iran. China and South Korea were best at managing COVID-19.

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Amaç: Miyastenia Gravis nöromusküler kavþak ileti bozukluðu ile seyreden otoimmun bir hastalýktýr. Hastalýk Asetil Kolin Reseptörlerine karþý geliþen antikorlar ile oluþur. Timus bu antikorlarýn oluþtuðu baþlýca organ olup Miyastenia Gravisli hastalarda büyük oranda anormaldir. Bu nedenle timektomi hastalýðýn tedavisinde yaygýn olarak kullanýlan bir tedavi yöntemidir. Hastalýðýn doðasý gereði prospektif kontrollü çalýþmalarýn yapýlmasý güç olmaktadýr. Bundan dolayý klinisyenlerin fikir birliði içinde olduðu bir algoritma yoktur, Tedavi yaklaþýmlarý daha çok konunun uzmaný olan kiþilerin gözlemleri ve deneyimlerine dayanmaktadýr. Literatüre katkýlar büyük oranda tedaviye yaklaþým ve timektominin prognoza etkilerini inceleyen retrospektif çalýþmalar ile saðlanmaktadýr. Bu retrospektif çalýþmada miyastenia gravisli Türk hasta grubu deðerlendirilmiþ, timektominin önemi ve prognoza etkileri vurgulanmýþtýr.
Metod: Nöromüsküler Hastalýklar Polikliniðinde 1998-2018 yýllarý arasýnda izlenen 93 Miyastenia Gravisli hasta retrospektif olarak incelenmiþtir. Hastalýk tipi, antikor durumlarý, tedavi, timektomi, timus patolojisi ve prognoz deðerlendirilmiþtir.
Bulgular: Timektomi hastalýk süresi ve timik patolojiden baðýmsýz olarak hastalýk prognozu üzerine pozitif etkiye sahiptir. En iyi sonuçlara kýsa hastalýk süresi, genç yaþ ve timik hiperplazili hastalara erken timektomi ile ulaþýlmýþtýr. Timoma varlýðý tedavi baþarýsýný kýsýtlamaktadýr. Yaþ ilerledikçe timektomi ihtiyacý azalmaktadýr.
Sonuç: Bu çalýþmada 93 Miyastenia Gravisli hasta retrospektif olarak deðerlendirilmiþ ve timektominin özellikle genç hastalarda mümkün olduðu kadar erken uygulandýðýnda prognoz üzerine olumlu etkisinin olduðu sonucuna varýlmýþtýr. En baþarýlý sonuçlar timik hiperplazili hastalarda alýnmýþtýr. (NCI-2019-0034)

OBJECTIVE: Myasthenia gravis (MG) is an autoimmune disease that may cause a disorder in transmission at the neuromuscular junction. Antibodies directed against acetylcholine receptors are responsible. The thymus is the place that that production of these antibodies mainly occurs. The thymus gland abnormalities and abnormal production of these antibodies are associated with MG. Consequently, thymectomy is a common treatment for MG. The nature of the disease makes it difficult to plan prospective, controlled trials; therefore, there is no current consensus among clinicians on a single algorithm of treatment, and the approach is frequently based on the observations and experiences of experts. The contributions to the literature largely consist of retrospective studies examining an approach to treatment and the effects of thymectomy on prognosis. In this retrospective study, evaluation of Turkish patients with myasthenia gravis was carried out for the importance of thymectomy and effects on prognosis.
METHODS: In this study, 93 patients with myasthenia gravis whose followed up at Neuromuscular outpatient clinic between 1998–2018 were evaluated retrospectively. Type of disease, antibody status, treatment, thymectomy, thymus pathology and prognosis were assessed.
RESULTS: Thymectomy had been a positive effect on the prognosis of the disease independent of the duration of disease and thymic pathology. The best results had been obtained with early thymectomy with short disease duration, younger age and patients with thymic hyperplasia. Success of therapy was limited with thymoma. With advanced age need for thymectomy was decreased.
CONCLUSION: In the present study, evaluation of 93 patients with myasthenia gravis was done retrospectively and it was concluded that thymectomy had a positive effect on prognosis, especially in young patients when performed as early as possible. The most successful results were obtained in cases with thymic hyperplasia.

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Amaç: Bu çalýþmanýn amacý çocuk kemik kýrýklarýyla ilgili risk faktörü olan verileri toplamaktýr.
Yöntem: Çalýþma grubunu kemik kýrýðý tanýsý almýþ toplam 1020 çocuk ( 282=%28 kýz, 738=%72 erkek, ortalama yaþ 8.3 ) oluþturmaktadýr. Yaþ, cinsiyet, kemik kýrýðýnýn gerçekleþtiði zaman, yaralanma mekanizmasý, kýrýðýn özelliði, eþlik eden ek yaralanmalar ve tedavi þekli kaydedilmiþtir.
Bulgular: Erkeklerin kýzlardan yaklaþýk üç kat fazla kemik kýrýðý vardý. Kýrýklarýn üst ekstremitede (% 76.6) ve sol tarafýnda (% 56.0) daha yaygýn olduðu görüldü ve en sýk kýrýlan kemiklerin izole radius (n=304; % 32.1); sýklýkla distal radius), sonra humerus olduðu izlendi (n=219; % 23.1); en sýklýkla suprakondiler). En sýk görülen alt ekstremite kemik kýrýklarý femur (n=92; % 31.7), sonra tibia idi (n=84; % 29.0). 194 hasta (% 19.0) çoklu kemik kýrýðý tanýsý aldý. Kýrýklarýn en sýk 3 ve 6 yaþlarý arasýnda (% 23.6) oluþtuðu, erkeklerde kýrýklarýn en sýk 13-15 yaþ arasý hastalarda (n=216; % 23.9) olduðu, kýzlarda ise 3-6 yaþ arasý hastalarda olduðu görüldü (n= 103; % 30.8). Kýrýklar ilkbaharda (n=384; % 31.0) ve yaz mevsiminde (n=365; % 29.5) daha sýktý ( en sýk Mayýs (n=156; %12.6) ve Aðustos (n=150; % 12.1). Kemik kýrýklarýnýn en fazla olduðu saat dilimi 12: 00 ila 17: 00 (n=824; % 66.6) idi. Kýrýklarýn en sýk nedenleri ev dýþý düþme (n=705; % 57.0) ve ev içi düþme idi (n=239; % 19.3). Kemik kýrýðýna eþlik eden en sýk yaralanma kafa travmasý idi (n=30; % 42.3). 59 hastada (% 5.8) epifiz kýrýðý tespit edildi. 51 hastada (% 5.0) açýk kýrýk gözlenirken, 592 hastaya (% 58.0) ayaktan tedavi uygulandý.
Sonuç: Çocuk kýrýklarý en sýk 10-15 yaþ arasý erkeklerde, sol üst ekstremitede, bahar ve yaz aylarýnda öðleden sonra ev dýþýnda olmaktadýr. Elbilek, el ve dirsek bölgesi kýrýklarýn en sýk görüldüðü alanlardý. Kýrýklarýn çoðu konservatif yöntemlerle tedavi edildi. Çocuklar için güvenli bir çevre oluþturulmasý yaralanma kontrolünde en etkin yöntemdir. Çocuklarýn yaþadýðý çevrelerde ve evde güvenlik için gerekli düzenlemeler yapýlmalýdýr. Sürekli eðitim, yasal düzenlemeler yaralanma kontrolünde etkin rol oynar. (NCI-2018-0183.R2)

OBJECTIVE: This study aims to collect data, which is a risk factor on bone fractures in children.
METHODS: The study group consisted of 1020 children (n=282; 28% girls and n=738; 72% boys, with a mean age of 8.3 years) with a bone fracture. The age, gender, the month and the time of the day the fracture was sustained, mechanism of injury, feature of the fracture, the presence of coexisting injuries, and the method of treatment were recorded.
RESULTS: Boys had approximately three times more fractures than girls. The fractures were found to be more prevalent in upper extremities (76.6%) and on its left side (56.0%), and the most commonly fractured bone was isolated radius (n=304; 32.1%); most frequently distal radius). The most prevalent lower-extremity fractures were to the femur (n=92; 31.7%). It was found that fractures occurred most frequently between the ages 3 and 6 (23.6%), and fractures in boys were most common among 13 to 15-year-old patients (n=216; 23.9%), whereas girls aged 3–6 years suffered the most fractures (n=103; 30.8%). The fractures were more common in spring (n=384; 31.0%) and summer (n=365; 29.5%). The time slot bone fractures occurred the most was from 12: 00 pm to 5: 00 pm (n=824; 66.6%). The most common reasons for fractures were outdoor falls (n=705; 57.0%), and indoor falls (n=239; 19.3%), respectively. Bone fractures co-occurred with head trauma the most (n=30; 42.3%). Fifty-nine patients (5.8%) had epiphysis fracture. 51 patients (5.0%) had open fractures. Five hundred ninety-two patients (58.0%) were given outpatient treatment.
CONCLUSION: Child bone fractures are most frequently seen in the left upper extremity in 10–15-year-old boys, occurring as a result of outdoor falls in the afternoon in the spring and summer months. Bones located in the wrist, hand, and elbow have been found to be much more vulnerable to fractures. Many of the fractures were treated by conservative methods. Creating a safe environment for children is the most effective method of injury control. Necessary arrangements should be made for the safety of children in the environment and at home. Continuing education and legal regulations play an active role in injury control.

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Giriþ: Bu çalýþmada, çok sayýda kolesistektomi yapýlan merkezde histopatolojik incelemede ksantogranulomatoz kolesistit saptanan hastalar ile saptanmayan hastalarda komplikasyon geliþimi, malignite ile ön tanýda karýþtýrýlma oranlarýnýn deðerlendirilmesi amaçlandý.
Materyal-metod: Ocak 2010 - Aralýk 2016 tarihleri arasýnda 2803 kolesistektomi yapýlan hasta retrospektif olarak deðerlendirildi. Histopatolojik incelemede, ksantogranulomatoz kolesistit saptanan hastalar Grup 1 ve kolelithiazis, kolesistit ve malignite saptanan hastalar Grup 2 olarak deðerlendirildi.
Bulgular: Histopatolojik incelemede, ksantogranulomatoz kolesistit saptanan 45 hasta Grup 1 ve 2758 hasta Grup 2 olarak deðerlendirildi. Grup 1’in 18’i erkek (40%) ve Grup 2’de 2758 hastanýn 707’si erkek (%26) idi (p=0,04). Ultrasonografi incelemede duvar kalýnlýðý Grup 1’deki hastalarýn 40’ýnda ve Grup 2’deki hastalarýn 662’sinde artmýþtý (p<0,0001). Grup 1’deki hastalarýn 24’ünde ve Grup 2’deki hastalarýn 61’inde açýða geçildi (p<0,0001). Postoperatif dönemde Grup 1’de 5 hastada ve Grup 2’de 32 hastada komplikasyon geliþti (p<0,0001).
Sonuç: Bu hastalarda ksantogranulomatoz kolesistit ayýrýcý tanýda düþünülmelidir ve bu olgularda özellikle anatomi daha dikkatli þekilde ortaya konularak cerrahi uygulanmalýdýr. (NCI-2019-0231.R1)

OBJECTIVE: In this study, we aimed to compare development of complications, malignancy and confusion rates in the preliminary diagnosis in patients with xanthogranulomatous cholecystitis identified.
METHODS: In this study, 2803 patients undergone cholecystectomy between January 2010 and December 2016 were retrospectively evaluated. Patients with xanthogranulomatous cholecystitis identified in the histopathological examination were classified as Group 1 and patients with cholelithiasis, cholecystitis, and malignancy detected were classified as Group 2.
RESULTS: Forty-five patients with xanthogranulomatous cholecystitis were classified as group 1 and 2758 patients as group 2. of group 1, 18 were male and group 2 consisted of 2758 patients with 707 (26%) being male (p=0.04). In the ultrasonographic examination, the wall thickness was increased in 40 patients in Group 1 and 662 patients in Group 2 (p<0.0001). The operation was converted to the open type in 24 patients in Group 1 and 61 patients in Group 2 (p<0.0001). Five patients in Group 1 and 32 patients in Group 2 developed complications in the postoperative period (p<0.0001).
CONCLUSION: Xanthogranulomatous cholecystitis should be considered for the differential diagnosis and the operation should be performed, especially by carefully exposing the anatomy in these patients.

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Amaç: Kardiyak sendrom X (KSX)’te altta yatan mekanizma tam olarak bilinmediði mikrovasküler disfonksiyon olarak tanýmlanmaktadýr. Prolidaz, kollajen sentezinde rol oynar. Artan serum prolidaz aktivitesinin (SPA) kollajen döngüsüyle körele olduðu gösterilmiþtir. Artan kollajen döngüsü vasküler fibrozis ve mikrovasküler disfonksiyonla iliþkili olabilir. Bu çalýþmada, KSX ile prolidaz aktivitesi arasýnda korelasyon olup olmadýðý deðerlendirildi.
Metot: Vaka-kontrol olarak tasarlanan çalýþmamýza ardýþýk 45 CSX hastasý (yaþ ortalamasý 50,7 ± 6,5 yýl, 27 kadýn) ve 40 saðlýklý kontrol (yaþ ortalamasý 51,2±6,5 yýl, 25 kadýn) dahil edildi. Prolidaz aktivitesi, Human Xaa-Pro Dipeptidase/Prolidase Enzyme-Linked Immunosorbent Assay Kit (Cusabio Biotech Co. Ltd, China) ile belirlendi.
Sonuç: Ortalama prolidaz aktivitesi KSX grubunda 898.8±639.1 mU/mL ve kontrol grubunda 434.1±289.8 mU/mL idi (p<0.001). ROC analizinde SPA deðerinin 350 mU/mL üstünde olmasýnýn, KSX tanýsýný desteklediði bulundu.
Tartýþma: KSX hastalarýnda artmýþ SPA, artmýþ oksidatif stres ve vasküler fibrosiz, endotelyal disfonksiyon ve artmýþ mikrovasküler rezistansa sebep olarak KSX patofizyolojisinde önemli bir rol oynayabilir. (NCI-2019-0333.R1)

OBJECTIVE: Although the underlying mechanism is not yet fully understood, Cardiac Syndrome X (CSX) is defined as microvascular dysfunction. Prolidase plays a role in collagen synthesis. Increased serum prolidase activity (SPA) has been shown to correlate with collagen turnover. Augmented collagen turn-over may be associated with vascular fibrosis and microvascular dysfunction. In this study, we assessed whether there was a correlation between CXS and prolidase activity.
METHODS: This case-control study included 45 consecutive CSX patients (mean age 50.7±6.5 years, 27 women) and 40 healthy controls (mean age 51.2±6.5 years, 25 women). Prolidase activity was determined with the Human Xaa-Pro Dipeptidase/Prolidase enzyme-linked immunosorbent assay kit (Cusabio Biotech Co. Ltd, China).
RESULTS: Mean prolidase activity was 898.8±639.1 mU/mL in the CSX group and 434.1±289.8 mU/mL in the control group (p<0.001). In ROC analysis, it was found that the SPA value above 350 mU/mL sympathizes with the diagnosis of CSX.
CONCLUSION: Increased SPA in CXS patients may play an essential role in the pathophysiology of CSX, leading to augmented oxidative stress and vascular fibrosis, endothelial dysfunction, and increased microvascular resistance.

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Amaç: Bu çalýþmanýn amacý, kronik bel aðrýsý olan ve cerrahi geçiren hastalarda, Manyetik Rezonans Görüntüleme (MRG) ile lomber kaslarýn boyutlarýndaki deðiþikliði deðerlendirmek ve ameliyat öncesi / sonrasý etkilerini belirlemekti.
Metod: Cerrahiyi takiben 6-12 aylarda 28 hastanýn (13K / 15E; yaþ: 45.39±11.56 yýl) L2 – S1 seviyelerinde kas ölçümleri MR görüntüleri üzerinden ölçüldü. Kontrol grubu lomber patolojisi olmayan ancak retrospektif arþiv görüntüleri mevcut olan 37 bireyden (18K /19E; yaþ: 34.41±10.72 yýl) oluþturuldu. Aksial MRG analizinde, her iki tarafýn m.multifidus, mm.erector spinae ve m.psoas major kesitleri cerrahi öncesi ve sonrasýnda 'kapalý poligon' metodu ile ölçüldü.
Bulgular: Cerrahi grubunun operasyon öncesi ölçümleri kontrol grubu ile karþýlaþtýrýldýðýnda; sað tarafta L2–3 ve L4–5 seviyelerindeki m.multifidus, sol tarafta ise L2–3, L4–5 ve L5–S1 seviyeleri m.multifidus ve L5–S1 seviyesi mm. erector spinae kesit alanlarý anlamlý olarak düþüktü (P <0,05). Cerrahi sonrasý sað taraf m.multifidus ve sol taraf mm.erector spinae kesit alanlarý L5–S1 düzeylerinde cerrahi öncesi deðerlerden anlamlý derecede düþüktü (P <0,05). Ayrýca hastalardan 8‘inin fizik tedavi programýna alýndýðý, bunlardan 2 sinin ünitede kalanýnýn ise ev egzersiz programý ile takip edildiði kaydedildi.
Sonuç: Bu çalýþma, kronik bel aðrýsý yaþayan bireylerde bel kaslarýnýn saðlýklýlarla kýyasandýðýnda atrofik olduðunu göstermektedir. Ayrýca lomber cerrahi sonrasý bu atrofinin süreklilik gösterdiði saptanmýþtýr. (NCI-2020-0004.R2)

OBJECTIVE: This study aims to assess the change in the dimensions of the lumbar muscles in patients with chronic lower back pain using Magnetic Resonance Imaging (MRI) and to determine pre/post effects of surgery.
METHODS: We enrolled 28 individuals (13F/15M; age: 45.39±11.56 years) whose L2–S1 muscle measurements were obtained using MRI, before and at follow-up 6–12 months after surgery. The control group comprising 37 individuals (18F/19M; age: 34.41±10.72 years) who had no lumbar pathology but for whom retrospective archive images were available. In the axial MRI analysis, the cross-sections of m.multifidus, mm.erector spinae and m.psoas major on both sides were measured with the ‘closed polygon’ technique.
RESULTS: The L2–3 and L4–5 levels of the m.multifidus on the right side, the L2–3, L4–5 and L5–S1 levels of the m.multifidus and the L5–S1 levels of the mm. erector spinae on the left side cross-sectional areas were significantly lower than the control group (p<0.05). The right-side m.multifidus and the left-side mm.erector spinae sectional areas were significantly lower than the pre-surgery values at the L5–S1 levels (p<0.05).
CONCLUSION: This study demonstrated that chronic lower back pain causes atrophy in the lumbar muscles and established the existence and continuity of atrophy after surgery.

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Giriþ: Bu çalýþmada amacýmýz, opere pankreas duktal adenokarsinomunda (PDAK) saðkalýmý etkileyen faktörleri ve primer tümör yerinin tedavi sonuçlarý üzerindeki olasý prognostik etkilerini araþtýrmaktýr.
Materyal ve metod: 2008 - 2018 yýllarý arasýnda takip ve tedavi edilen opere PDAK'lu toplam 98 hasta çalýþmaya dahil edildi. Metastatik veya lokal ileri evreler ve 18 yaþ altý hastalar çalýþma dýþý býrakýldý. Hastalar primer tümör yerleþimine göre *baþ veya *korpus/kuyruk olarak 2 gruba ayrýldý.
Bulgular: Çalýþmaya, 66'sý (% 68,3) erkek ve 31'i (% 31,7) kadýn olmak üzere toplam 98 hasta alýndý. Ortanca yaþ 62 yýl (35-82) idi. Primer tümör yerleþimi olarak, 74 (% 75,4) hasta *baþ ve 24 (% 24,6) hasta *Korpus/kuyruk lokalize idi. Primer tümör yerleþimine göre *baþ lokalize hastalarda ortanca hastalýksýz saðkalým, 16,0 ay iken *Korpus/kuyruk lokalize hastalarda 13 aydý (p = 0.972). Ortanca Genel saðkalým ise, *baþ lokalize hastalarda 25 ay iken *Korpus/kuyruk lokalize hastalarda 33 aydý (p = 0,698). Çok deðikenli analizde taný sýrasýndaki karsinoembriyonik antijen(CEA) düzeyi [Tehlike oraný (TO)=1,09 %95 güven aralýðý (GA)=1,01-1,18], evre III hastalýk (TO=2,09 95% GA=1,16-4,35) ve adjuvan tedavi (TO= 0,20 %95 GA=0,09- 4,34) saðkalýmý etkileyen faktörler olarak saptandý.
Tartýþma ve sonuç: Çalýþmamýzda, Opere PDAK tanýlý hastalarda, taný anýndaki yüksek CEA düzeyi ve evre III hastalýk saðkalýmý olumsuz yönde etkilerken, adjuvan tedavi verilmesi saðkalýmý arttýrdýðý gözlendi. Primer tümör yerleþiminin saðkalýmý etkilemediði saptandý. (NCI-2019-0345.R1)

OBJECTIVE: This study aims to investigate the factors affecting survival in operated pancreatic ductal adenocarcinoma (PDAC) and the possible prognostic effect of primary tumor localization on treatment outcomes.
METHODS: In this study, 98 patients with curatively-operated PDAC, who were followed up and treated for the years 2008 through 2018, were enrolled. Metastatic and locally advanced stages and patients under 18 years of age were excluded from this study. Patients were divided into two groups based on the primary tumor localization as *head or *body/tail.
RESULTS: Sixty-seven (68.3%) patients were male and 31 (31.7%) were female, with a median age of 62 years (range, 35–82 years). The numbers of patients with a primary tumor located in *head vs.*body/tail were 74 (75.4%) vs. 24 (24.6%), respectively. Patients with a primary tumor located in *head vs.*body/tail; median disease-free survival was 16.0 months vs. 13 months (p=0.972), respectively, with corresponding median overall survival was 25 months vs. 33 months (p=0.698). The level of carcinoembryonic antigen(CEA) at diagnosis (Hazard ratio[HR], 1.09 95%CI, 1.01–1.18), stage III disease (HR, 2.09 95%CI, 1.16–4.35), and receiving adjuvant treatment (HR, 0.20 95%CI, 0.09–4.34) were the independent predictors of survival.
CONCLUSION: Our study revealed that high levels of CEA at diagnosis and stage III disease adversely affected the survival in non-metastatic PDAC patients, while receiving adjuvant therapy had a positive effect on survival. The findings suggest that primary tumor localization did not affect survival in operated PC patients. The results on this issue are still inconsistent and under debate in the literature.

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Giriþ: Gökkuþaðý paterni, bir çok farklý rengin gökkuþaðýna benzer þekilde bir araya gelerek oluþturduðu dermoskopik bir patern olarak tanýmlanmaktadýr. Gökkuþaðý paterni, Kaposi sarkomunun karakteristik bir dermoskopik bulgusu olarak bilinmektedir. Biz bu çalýþmada, dermoskopik gökkuþaðý paterni gösteren Kaposi sarkomu dýþýndaki lezyonlarý inceleyerek, bu paternin tanýsal önemini tartýþmayý amaçladýk.
Yöntem: Bu çok merkezli çalýþmada, Kaposi sarkomu dýþýnda histopatolojik tanýsý olan 840 lezyon, dermoskopik gökkuþaðý paterninin varlýðý açýsýndan deðerlendirildi. Dermoskopik görüntüleme 10 büyütmeli polarize el dermoskopu ile yapýldý.
Bulgular: Bu çalýþmada toplamda 840 lezyon dermoskopik bulgular açýsýndan deðerlendirildi ve 21 non Kaposi sarkoma lezyonunda gökkuþaðý paterni saptandý. Pyojenic granuloma (n=4, %19), hipertrofik skar (n=4, %19), bazal hücreli karcinoma (n=2, %)10, dermatofibroma (n=2, %10), anjiokeratoma (n=2, %10), mavi, nevus (n=1, %65), granuloma annulare (n=1, %65), anjioma (n=1, %65), epidermal kist (n=1, %65), malign melanoma (n=1, %65), dissekan sellülit (n=1, %65) ve subungual hematoma (n=1, %65). En sýk izlenen lokalizasyonlar ekstemiteler (n=14, %67) ve yüzdü (n=3, %14).
Sonuç: Biz, vasküler ve vasküler olmayan lezyonlarda izlenebilen dermoskopik gökkuþaðý paterninin kompleks ve spesifik olmayan bir optik fenomen olduðunu düþünüyoruz. Bulgunun tanýsal deðeri, diðer eþlik eden dermoskopik bulgularla birlikte deðerlendirilmelidir. Bilgilerimize göre, bu çalýþma konuya odaklanan en geniþ vaka serisini içermektedir. Ayrýca, çalýþmamýz, daha önce gökkuþaðý paterninin tanýmlanmadýðý dissekan selülit, granüloma annulare ve subungual hematoma olgularýný da içermektedir. (NCI-2019-0204.R1)

OBJECTIVE: Rainbow pattern is a dermoscopic finding composed of multiple colors simulating a rainbow. It is known as a characteristic feature of Kaposi’s sarcoma. Here, we reported different non-Kaposi’s sarcoma conditions with a rainbow pattern aiming to discuss the diagnostic significance of the finding.
METHODS: In this multicenter study, dermoscopic images of the non-Kaposi’s sarcoma lesions having a histopathological diagnosis were reviewed for the presence of a rainbow pattern. Dermoscopic examination was performed by a polarized handheld dermoscope with x10 magnification.
RESULTS: A total of 840 lesions were reviewed and 21 (2%) non-Kaposi sarcoma lesions having dermoscopic rainbow pattern were detected. These lesions were as follows; pyogenic granuloma (n=4, 19%), hypertrophic scar (n=4, 19%), basal cell carcinoma (n=2, 10%), dermatofibroma (n=2, 10%), angiokeratoma (n=2, 10%), blue nevus (n=1, 5%), granuloma annulare (n=1, 5%), strawberry angioma (n=1, 5%), epidermal cyst (n=1, 5%), malignant melanoma (n=1, 5%), dissecting cellulitis (n=1, 5%) and subungual hematoma (n=1, 5%). The most common localization was limb (n=14, 67%) followed by face (n=3, 14%).
CONCLUSION: We suggest that the rainbow pattern is a complex and quite unspecific optic phenomenon which can be seen both in vascular and non-vascular lesions. Its diagnostic significance should be considered in the context of the other structural dermoscopic finding. To the best of our knowledge, to our knowledge, this is the most comprehensive study focusing on rainbow pattern in non-Kaposi’s sarcoma lesions. Here, we also reported rainbow pattern in dissecting cellulitis, granuloma annulare and subungual hematoma which has not been shown to have rainbow pattern previously.

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GÝRÝÞ ve AMAÇ: Helikobakter pylori (H.pylori) gram negatif bir bakteridir ve gastritin, peptik ve duodenal ülserin sebeplerinden biridir. Baþta geliþmekte olan ülkelerde olmak üzere, hem çocuklarda hem yetiþkinlerde önemli bir saðlýk problemidir. Bizim çalýþmamýzýn amacý, çocuklarda H. pylori pozitifliðinin prevalansýný tespit etmek ve güncel Sidney sýnýflandýrma kriterleri ile karþýlaþtýrmasýný yapmak idi.
YÖNTEM ve GEREÇLER: Bu çalýþma Ocak 2015’ten Haziran 2017’ye kadarki süreci kapsamaktadýr. Çalýþma 0-17 yaþ arasý 885 çocuðu içermektedir. H.pylori enfeksiyonunun tanýsý endoskopik biyopsilerin deðerlendirilmesi ile konulmuþtur.
BULGULAR: 885 çocuðun 418’inde (%47.2) H.pylori pozitif saptanmýþtýr ve bu pozitivitenin kronik inflamasyon, nötrofilik aktivite, lenfoid agregat ve folikül varlýðý ile korele olduðu görülmüþtür. Endoskopik görüntülemede eritematöz pangastrit ve antral nodularite varlýðý H.pylori pozitifliði ile iliþkili bulunmuþtur.
TARTIÞMA ve SONUÇ: Hastane temelli bu çalýþmamýzda saptadýðýmýz bulgular, H.pylori enfeksiyonunun çocuklar açýsýndan da problem teþkil ettiðini ve bu konuda daha geniþ çalýþmalara ihtiyaç duyulduðunu göstermektedir. (NCI-2018-0212.R3)

OBJECTIVE: Helicobacter pylori (H. pylori) is a gram-negative bacterium and one of the reasons for gastritis, peptic and duodenal ulcers. It is a crucial public health problem for both children and adults, especially in developing countries. This study aims to investigate the prevalence of Helicobacter pylori positivity in children and to compare with updated Sydney classification criteria.
METHODS: This study was conducted from January 2015 to June 2017. This study included 885 children aged 0-17 year(s). Endoscopic biopsies were evaluated for the diagnosis of infection due to H. pylori.
RESULTS: The findings showed that 418 (47.2%) of 885 children were positive for H. pylori, and this positivity had a significantly increasing correlation with the presence of chronic inflammation, neutrophilic activity, lymphoid aggregates, and follicles. Erythematous pangastritis and antral nodularity on endoscopic findings had a correlation with H. pylori positivity.
CONCLUSION: In this hospital-based study, the findings suggest that H. pylori infection is a problem for children and more extensive studies are needed to determine the prevalence of H. pylori positivity among children.

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NCI-2020-0012

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The Cerebro-Facial Venous Metameric Syndrome is characterized by ipsilateral venous/lymphatic anomalies involving simultaneously the brain and the face with a metameric distribution. This case report to describe a case of Cerebro-Facial Venous Metameric Syndrome presenting with a lump of the medial canthus. This was a case report a 24-year-old woman with a history of a mild headache, complained of a sporadic (at least once a month) serous leakage from the left eye and a small cutaneous protuberance in the left medial canthus, without focal neurological symptoms. The patient underwent brain Magnetic Resonance Imaging and findings were suggestive of a Cerebro-Facial Venous Metameric Syndrome 1-2. When multiple and ipsilateral vascular anomalies are observed, it should be considered the presence of Cerebro-Facial Metameric Syndrome, even without neurological symptoms and port-wine stains. Follow-up is mandatory, especially if there are cavernomas or facial arterio-venous malformations due to the risk of bleeding. (NCI-2020-0062.R1)

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Lipoma arborescens (LA) yavaþ ilerleyen ve villöz lipomatöz sinovyal proliferasyon ile seyir gösteren nadir görülen bir eklem içi lezyondur. Vakalarýn çoðu ileri yaþlarda dejeneratif ve/veya travma sonrasý eklem hastalýðý nedeni ile geliþebilmekte iken, inflamatuar eklem hastalýðý ile iliþkili bazý yayýnlar bulunmaktadýr. Bu vakada; 5 yýldýr her iki dizde devam eden þiþlik ve kontrol altýnda olmayan juvenil idiopatik artrit nedeni ile yaygýn lipoma arborescens geliþen 17 yaþýnda kýz hasta sunulmaktadýr. (NCI-2018-0093.R1)

Lipoma arborescens (LA) is a chronic, slowly progressive intra-articular lesion characterized by villous lipomatous proliferation of the synovium. Most cases have been described in elderly patients with degenerative or post-traumatic joint disease, but in several case reports, it has been considered to be related to inflammatory joint diseases. Here, we report a case of 17 years old female firstly presenting with bilateral swelling in both knees of five years duration, followed by the development of wide spread lipoma arborescens associated with the uncontrolled treatment of juvenile idiopathic arthritis.

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Amaç: Depresyon tedavisinde kullanýlan aripiprazole baðlý geçici miyopi geliþen bir olgu sunmak.
Olgu: 21 yaþýnda bayan hasta depresyon tanýsý ile 2 ay boyunca 15 mg/gün aripiprazol baþlanan hasta, normalde her iki gözüne -3.75 D gözlük kullanýyor. Yaklaþýk 3 gündür, gözlüðe raðmen görmede ani azalma ile kliniðimize baþvurdu. Anamnezinde aripiprazol kullanýmý hikayesi tespit edilen hastanýn muayenesinde her iki gözde de görme 6/10 düzeyinde ve otorefraktometre ölçümü her iki gözde -6.0 D idi. Hastanýn diðer göz muayene bulgularý normaldi. Hastanýn ilacý kesildi ve takibe alýndý. 1 aylýk takip sonunda hastanýn kendi gözlüðü ile görmesi her iki gözde de 10/10'a çýktý. Takibin ilk günü ölçülen Alx deðeri, 1 ay sonraki ölçümden 0.3 mm daha uzun iken, diðer ön segment bulgularý arasýnda minimal farklar kaydedildi.
Tartýþma: Akut miyopiye sebep olan spesifik mekanizma tam olarak ortaya konulamamýþ olmakla beraber, sýrasýyla silier spazm, silier cisimcik efüzyonu, periferal üveal efüzyon ve okuler seratonerjik intranöral liflerin etkisine baðlý olabileceði öne sürülmektedir.
Sonuç: Klinisyenlerin aripipirazol reçete ederken bu koþullarý göz önünde bulundurmasý ve göz ile ilgili yan etkiler konusunda hastayý bilgilendirmesinin önemli olacaðý görüþündeyiz. (NCI-2018-0228.R1)

This study aims to present a case of transient myopia due to aripiprazole used in the treatment of depression. A 21-year-old female who was being treated for depression with 15 mg/day Aripiprazole during two months. She normally used -3.75 D glasses. She was admitted to our outpatient clinic with sudden onset blurring of vision in both eyes despite using glasses for about three days. Using of aripiprazole was observed in the patient’s history. She was found to have myopia of -6.0 diopters in both eyes with measurement of otorefractometer; her visual acuity was 6/10 in both eyes with her glasses. The other eye examination findings of the patient were normal. The drug was discontinued, and the patient was followed. One mount later on examination, the patient’s visual acuity increased to 10/10 in both eyes. Following the first day of the Alx values measured were 0.3 mm longer than one month after the measurement; the minimal difference between the other anterior segment findings were recorded. Although the specific mechanisms that cause acute myopia has not been fully revealed, it can be ciliary spasm, ciliary bodies effusion, peripheral uveal effusion and effects of ocular serotonergic intraneural fibers. We believe that it would be important for clinicians. They should keep in mind these conditions when prescribing aripiprazole and need to inform patients about the side effects related to the eye.

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Ýskemik inme, koroner anjiyografi ve perkütan koroner giriþimlerin yüksek morbidite ve mortaliteye sahip nadir ve ciddi bir komplikasyonudur. Kateter iliþkili iskemik inmenin tedavisine yönelik büyük ölçekli bir çalýþma bulunmamaktadýr. Koroner anjiyografi sýrasýnda geliþen iskemik inmesi olan 46 yaþýnda, erkek hastayý sunmaktayýz. KAG iþlemi inme sonrasý sonlandýrýldý ve sol carotis arteri selektif olarak kanüle edildi ve dijital substraksiyon anjiyografi (DSA) sol orta serebral arterin (OSA) M1 segmentinin total oklüde (Modified Thrombolysis In Cerebral Infarction, mTICI, 0) olduðunu gösterdi. Stent-aracýlý trombektomi uygulandý ve DSA sol OSA'nýn distal dallarýnda mTICI 3 akýmýn saðlandýðýný gösterdi. Bir sonraki gün, nörolojik muayenede sensörel ve motor hasar izlenmedi. Kateter iliþkili inmelerde, mekanik trombektomi az zaman kaybettiren ve efektif bir yaklaþým oarak görünmektedir. (NCI-2018-0214.R1)

Ischemic stroke is a rare and serious complication of coronary angiography and percutaneous coronary intervention, which has high morbidity and mortality. To our knowledge, there is no large-scale randomized controlled trial for the management of catheter-related ischemic stroke. In this case study, we presented a 46-year-old male with peri-procedural ischemic stroke during the coronary angiography (CAG). The CAG was terminated after the stroke and the left carotid artery was selectively cannulated, and digital subtraction angiography (DSA) revealed total occlusion (Modified Thrombolysis in Cerebral Infarction, mTICI, 0) of the M1 part of the left middle cerebral artery (MCA). A stent-assisted thrombectomy was performed and the DSA revealed restoration of flow to the left MCA with mTICI 3 flow in the distal branches. The next day, the neurological exam showed no sensory, motor deficits. The patient was discharged four days later. In the setting of catheter-related stroke, mechanical thrombectomy seems to be the least time-consuming and effective approach.

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Koroner arter hastalýðý (KAH), günümüzde topluma ciddi manevi ve finansal yük getiren ciddi hastalýklardan biridir. Literatürde psikiyatrik bozukluklarýn koroner arter hastalýðýna yol açýp açmadýðý veya KAH sonrasý prevalansýn arttýðý konusunda birçok çalýþma vardýr. Birçok çalýþmada KAH hastalarýnda erken taný ve depresyon tedavisinin önemini vurgulamýþ olmasýna raðmen, klinisyenler günlük pratikte depresyona fazla dikkat etmemektedir. KAH hastalarýnda anksiyete ve depresyonu tanýmlamak için kullanýmý rahat olan birkaç ölçek geliþtirilmiþtir. KAH tedavisini takiben psikolojik belirti ölçekleri tarafýndan öngörülen yüksek depresyon ve anksiyete skorlarý, tedavi baþarýsý ve KAH hastalýðýnýn prognozu ile yakýndan iliþkilidir. Depresyon ve anksiyete bozukluklarý tanýsýnda KAH'li hastalarýn dikkatle izlenmesi gerektiðine inanýyoruz; çünkü bunlarýn tedavisi KAH prognozunu iyileþtirebilir. (NCI-2019-0227.R2)

Coronary artery disease (CAD) is one of the severe diseases that may cause significant moral and financial burden on society today. There are many studies in the literature on whether psychiatric disorders may cause CAD or an increase in prevalence after CAD. Although many studies have emphasized the importance of early diagnosis and treatment of depression in CAD patients, clinicians do not attach much attention to depression in daily practice. Several scales have been developed that are comfortable to use to describe anxiety and depression in CAD patients. High depression and anxiety scores predicted by psychological symptom scales following CAD treatment are closely related to treatment success and prognosis of the CAD. We believe that patients with CAD should be followed carefully for the diagnosis of depression and anxiety disorders; since the treatment of them may improve the prognosis of CAD.

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