GÝRÝÞ ve AMAÇ: Migren patogenezinde trigeminovasküler sistem aktivasyonunun önemli bir rol oynadýðý düþünülmektedir. Göz kýrpma refleksi (GKR) tetkiki trigeminal sistemin fonksiyonun incelenmesinde kullanýlan kolay bir yöntemdir. Çalýþmamýzda GKR tetkikinde kayýtlanan latanslarý deðerlendirerek migrenli hastalarda oluþan nörofizyolojik deðiþiklikleri incelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Uluslararasý Baþaðrýsý Derneði 2004 kriterlerine göre migren tanýsý alan 40 hasta (9’unda auralý migren, 31’inde aurasýz migren) ile 30 saðlýklý kontrol GKR tetkiki ile incelendi. Tüm olgularda supraorbital sinir sýrayla her iki taraftan uyarýlarak unilateral R1 ve bilateral R2 latanslarý ayrý ayrý deðerlendirildi.
BULGULAR: Migren grubunda hem sað hem sol taraftan kayýtlanan R1 (RR1 ve LR1) latans deðerleri ile sol taraftan kayýtlanan ipsilateral ve kontrlateral R2 (LR2i ve LR2k) latans deðerleri kontrol grubu ile karþýlaþtýrýldýðýnda istatistiksel anlamlý olarak uzun bulundu. Atak sýrasýnda inceleme yapýlan migren hastalarýnda RR1 ve LR1 latanslarý daha uzun bulundu (p<0.01). Ýnteriktal dönemde incelenen hastalarda aðrýnýn olduðu taraf ile latans deðerleri arasýnda anlamlý istatistiksel iliþki saptanmadý (p>0.05). Ýktal dönemde incelenen migren hastalarýnda aðrýnýn olduðu tarafta R1 ve R2i latans deðerleri daha uzun bulundu (sýrasýyla p=0.037 ve p= 0.028 ). Cinsiyet, atak süresi,atak sýklýðý, migren tipi ile kayýtlanan latans deðerleri arasýnda anlamlý iliþki saptanmadý (p>0.05).
TARTIÞMA ve SONUÇ: Sonuç olarak, çalýþmamýzda GKR tetkikinde elde edilen sonuçlar migren baþ aðrýsý olan hastalarda beyin sapý ve trigeminovasküler baðlantýlarda bir disfonksiyon olduðunu göstermekte ve migrendeki trigeminovasküler hipotezi desteklemektedir.

INTRODUCTION: Activation of trigeminovascular system is thought to play an important role in migraine pathogenesis. Blink reflex (BR) test is an easy method to study the trigeminal system. Latencies recorded in BR test were evaluated to examine neurophysiological changes that occur in migraine patients.
METHODS: A total of 40 patients diagnosed with migraine (9 with aura and 31 without aura) according to the International Headache Society (IHS) International Classification of Headache Disorders, 2nd edition, and 30 healthy control subjects were assessed using BR test. Supraorbital nerve was stimulated on each side, and unilateral early component (R1), and bilateral late component (R2) latencies were evaluated.
RESULTS: Significantly longer latency values were recorded on both right and left sides (RR1 and LR1) as well as bot h ipsilateral and contralateral R2 on the left side (LR2i and LR2c) in the migraine group compared to thecontrol group. Longer RR1 and LR1 latencies were found in patients with migraine who had an attack at the timeof study (p<0.01). There was no statistically significant correlation between the location of pain and latencies in the interictal period (p>0.05). But significantly longer R1 and R2i latencies were found at the symptomatic side of patients examined during the headache attack (p=0.037 and p=0.028 respectively). There was no statistically significant correlation between the recorded latencies and gender, attack duration, attack frequency and migraine type (p>0.05).
DISCUSSION AND CONCLUSION: Results of BR test in the present study are thought to point to a dysfunction in brainstem and trigeminovascular connections of patients with migraine headache and support the trigeminovascular theory of migraine.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada tiroidektomi sonrasý oluþabilen kalýcý veya geçici hipokalsemi geliþiminde, tesadüfi paratiroidektominin, uygulanan cerrahi yöntemin, tiroidit veya hipertiroidi varlýðýnýn etkilerini incelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: 2013–2015 yýllarý arasýnda Ýstanbul Medeniyet Üniversitesi genel cerrahi kliniðinde tiroidektomi uygulanmýþ olan hastalar çalýþmaya dahil edildi. Retrospektif olarak hasta dosyalarý, postoperatif kalsiyum deðerleri ve patoloji raporlarý incelendi. Postoperatif kalsiyum deðerlerine göre hipokalsemi (kalsiyum ≤8.5 mg/dl) saptanan hastalar Grup-1, normokalsemi saptanan hastalar ise Grup-2 olarak sýnýflandýrýldý. Gruplar insidental paratiroidektomi oranlarý, uygulanan cerrahi yöntemler ve tiroidit varlýðý açýsýndan istatistiksel olarak kýyaslandý.
BULGULAR: Çalýþmaya yaþ ortalamasý 49.8±12.8 (yaþ aralýðý: 20–88) olan, 74’ü (%17.7) erkek, 343’ü (%82.3) kadýn olmak üzere 417 hasta dahil edildi. Postoperatif tetkiklerde hipokalsemi saptanan 205 (%49.2) hasta Grup-1, normokalsemi saptanan 212 (%50.8) hasta Grup-2’yi oluþturdu. Grup-1’de 38 (%18.5) hastada insidental paratiroidektomi saptanýrken, Grup-2’de 18 (%8.5) hastada insidental paratiroidektomi mevcuttu. Ýnsidental paratiroidektomi varlýðý ile hipokalsemi arasýnda istatistiksel anlamlý iliþki saptandý (p: 0.003). Hastalara tiroidit veya hipertiroidi eþlik etmesi ile postoperatif hipokalsemi görülmesi arasýnda istatistiksel anlamlý iliþki saptanmadý. Uygulanan cerrahi yöntemlere göre deðerlendirdiðimizde, postoperatif hipokalsemi lobektomi uygulanan hastalarda bilateral total tiroidektomi veya santral disseksiyon yapýlan hastalara oranla istatistiksel açýdan anlamlý olacak þekilde daha az saptandý (p<0.01).
TARTIÞMA ve SONUÇ: Uygun vakalarda tek taraflý cerrahi tercih edilmesi ve hasssas bir disseksiyonla paratiroid bezlerin korunmasýna önem gösterilmesi postoperatif hipokalsemi geliþimini azaltacaktýr

INTRODUCTION: The present study evaluated effects of incidental parathyroidectomy, surgical technique, and presence of thyroiditis or hyperthyroidism on occurrence of postoperative persistent or transient hypocalcemia.
METHODS: Patients who underwent thyroidectomy at Ýstanbul Medeniyet University between 2013 and 2015 were included in the study. Patient information, postoperative serum calcium levels, and pathology reports were investigated retrospectively. Group 1 was made up of patients who were found to have hypocalcemia (calcium ≤8.5 mg/dL) according to postoperative serum level and normocalcemic patients were placed in Group 2. Groups were compared statistically in terms of rate of incidental parathyroidectomy, surgical technique, and presence of thyroiditis or hyperthyroidism.
RESULTS: Mean age was 49.8±12.8 years (range: 20-88). A total of 417 patients were included in the study, 74 (17.7%) were male and 343 (82.3%) were female. Group 1 consisted of 205 (49.2%) patients who had hypocalcemia according to postoperative serum level, and remaining 212 (50.8%) patients were placed in Group 2. In Group 1, 38 (18.5%) patients had incidental parathyroidectomy, and with only 18 (8.5%) patients in Group 2, a statistically significant relationship was found between incidental parathyroidectomy and hypocalcemia (p=0.003). There was no statistically significant difference in terms of presence of thyroiditis or hyperthyroidism between groups. There was statistically significant decrease in postoperative hypocalcemia rate in patients with lobectomy compared to patients with bilateral total thyroidectomy or central neck dissection (p<0.01).
DISCUSSION AND CONCLUSION: Risk of postoperative hypocalcemia may be reduced with lobectomy for selected patients. In addition, delicate dissection during thyroidectomy is important in order to protect parathyroid glands and prevent hypocalcemia.

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GÝRÝÞ ve AMAÇ: Son yýllarda yapýlan çalýþmalarda gebelikte ve erken bebeklik dönemindeki D vitamini eksikliðinin iskelet sistemi dýþýnda birçok kronik hastalýðýn ortaya çýkmasýna zemin hazýrladýðý bildirilmiþtir. Bu çalýþmada; saðlýklý yenidoðanlarda görülen kraniyotabesin fizyolojik olup olmadýðý, annedeki D vitamini eksikliði ile iliþkisini ve kraniyotabesi olan yenidoðanlarda tedavi gerekip gerekmediði araþtýrýlmýþtýr.
YÖNTEM ve GEREÇLER: Bu çalýþmaya saðlýklý, term ve >2000gr olan 150 yenidoðan dahil edildi. Yenidoðanlar postnatal taburculuklarý sýrasýnda (1-3. Gün) kraniyotabesi olanlar ve olmayanlar diye iki gruba ayrýldý. Ayrýca annelerinin 25(OH) vitamin D düzeylerine bakýldý. Yenidoðanlarýn tümü 1 aylýk olunca poliklinik kontrolüne çaðrýlarak kraniyotabes açýsýndan tekrar deðerlendirildi ve hepsinden serum Ca, P, ALP, PTH, 25(OH) vitamin D, idrar Ca/ kreatinin düzeyi gönderilerek deðerledirildi.
BULGULAR: Çalýþmaya alýnan yenidoðanlarýn 45’inde (%30) kraniotabes tesbit edildi. Kraniotabes kýþ aylarýnda doðan yenidoðanlarda anlamlý olarak yüksek saptandý (p<0.001). Ayrýca kraniotabesi olan gruptaki bebeklerin doðum aðýrlýklarý normal gruba göre daha düþüktü (p=0,002). Bir aylýkken kraniotabesi olan yenidoðanlarda olmayanlara göre PTH yüksek saptanýrken iki grup arasýnda anne ve bebeklerin 25(OH) vitamin D düzeyleri açýsýndan iliþki saptanmadý. Annelerin %96’sýnda D vitamini eksikliði ya da yetersizliði gözlenirken, yenidoðanlarýn %90’ýnda D vitamini düzeyleri normal idi. Kraniotabes ile beslenme þekli arasýnda iliþki gözlenmezken sadece anne sütü alan bebeklerde D vitamini istatistiksel olarak daha düþük saptandý (p<0.0001). Kraniotabes ile D vitamini alan ve almayan yenidoðanlar arasýnda istatistiksel anlamlý bir fark saptanmadý.
TARTIÞMA ve SONUÇ: Yenidoðan kraniotabesinin maternal D vitamini eksikliði ile iliþkisi net olmamakla birlikte daha fazla çalýþmaya ihtiyaç vardýr. Çalýþmamýzýn sonuçlarý maternal vitamin D eksikliðinin ülkemizde hâlâ önemli bir sorun olduðunu göstermektedir. Bu nedenle maternal vitamin D eksikliðini önlemeye yönelik tedbirlerin güçlendirilerek yaygýnlaþtýrýlmasý gerekmektedir.

INTRODUCTION: In recent studies, vitamin D deficiency during pregnancy and early infancy has been reported to predispose children to many chronic diseases, except those of the skeletal system. The aim of this study was to investigate whether craniotabes in otherwise healthy newborns is physiological, its relationship to vitamin D deficiency and whether or not it requires treatment.
METHODS: A total of 150 healthy newborns with a weight of over 2000 g were included. Newborns were divided into two groups during postnatal discharge (1-3.’s day): those with and without craniotabes. The 25-hydroxy (OH) vitamin D levels of the newborns’ mothers were measured, and all infants were re-evaluated for craniotabes, as well as tested to determine levels of serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), parathyroid hormone (PTH) and 25(OH) vitamin D, urine calcium and creatinine.
RESULTS: Craniotabes was present in 45 (30%) of newborns enrolled in the study. Craniotabes of the newborns born during the winter months was significantly higher. PTH level was significantly higher in 1-month-old newborns with craniotabes than those without craniotabes. No relationship was observed between diet and craniotabes, but in exclusively breastfed infants, vitamin D level was statistically significantly lower. No statistically significant difference was found in the occurrence of craniotabes in newborns with or without vitamin D support.
DISCUSSION AND CONCLUSION: The relationship between newborn craniotabes and maternal vitamin D deficiency is not clear. However, the present study illustrates that maternal vitamin D deficiency is still a major problem. Therefore, measuresto prevent maternal vitamin D deficiency should be strengthened.

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GÝRÝÞ ve AMAÇ: Parmak replantasyonu uygulanmýþ olan hastalarýn rehabilitasyon sonuçlarýný deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmaya kliniðimizde 2000 ile 2013 yýllarý arasýnda deðiþik seviyelerde parmak ampütasyonu uygulanmýþ olan hastalar dahil edildi. Hastalarýn ortalama yaþý 29.4 yýldý. Ortalama takip süresi 23 aydý. Parmaklarýn rehabilitasyonu ameliyat sonrasý 4. ila 8. haftadan baþlanarak 24. haftaya kadar devam ettirildi. Etkilenen elin eklem hareket açýklýklarý, günlük aktiviteye dönüþ süresi, kozmetik görünümü ve hastalarýn memnuniyeti Tamai kriterlerine göre deðerlendirildi.
BULGULAR: Tamai kriterlerine göre fonksiyonel sonuçlar 36 hastada mükemmel, 54 hastada iyi, 27 hastada orta ve 18 hastada kötüydü.
TARTIÞMA ve SONUÇ: Replantasyon uygulanan parmaklarýn ameliyat sonrasý rehabilitasyonu mümkün olduðunca en kýsa sürede baþlanýlmalýdýr. Rehabilitasyon süresince fizyoterapist, cerrah ve hasta yakýn iliþki içinde bulunmalýdýr. Rehabilitasyon programýna, ev egzersizlerine ve atel uygulamalarýna uyumlu hastalarda sonuçlar daha iyidir.

INTRODUCTION: The aim of the present study was to assess results of rehabilitation of patients after finger replantation.
METHODS: The study examined 160 fingers amputated and replanted at various levels between 2000 and 2013 at the clinic. Mean patient age was 29.4 years. Mean follow-up time was 23 months. Rehabilitation of fingers began between postoperative fourth and eighth week and continued until the 24th week. Range of motion of affected hand, return to daily activities, aesthetic appearance, and patient satisfaction were assessed according to Tamai criteria.
RESULTS: Functional results according to Tamai criteria were perfect in 36 patients, good in 54 patients, average in 27 patients, and poor in 18 patients.
DISCUSSION AND CONCLUSION: Post-operative rehabilitation of replanted fingers should begin as soon as possible. During the rehabilitation period, physiotherapist, surgeon, and patient must work in close cooperation. Functional results of patients who adjust to the rehabilitation program, home practice, and splint usage are better.

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GÝRÝÞ ve AMAÇ: Aorta koroner bypas (AKBG) veya peruktan koroner giriþimlerin (PKG) ardýndan taburcu sonrasý ilk 30 gün tekrar hastaneye baþvurma oranlarý yüksek olmasýna raðmen, bununla ilgili yeteri kadar veri yoktur ve risk faktörleri yeteri kadar araþtýrýlmamýþtýr. Bu çalýþmanýn amacý cerrahi ya da perkütan giriþimlerin ardýndan taburcu sonrasý ilk 30 günde tekrar hastaneye baþvurma oranlarýný araþtýrmak ve ardýndan her iki revaskülarizasyon metodunu karþýlaþtýrmaktýr.
YÖNTEM ve GEREÇLER: Çalýþmaya AKBG veya PKG yoluyla revaskülarizasyon yapýlmýþ 2664 ardýþýk hasta dahil edildi ve verileri retrospektif olarak tarandý. Demografik, postoperatif veriler ve PCI sonrasý veriler taramaya dahil edildi.
BULGULAR: Çalýþmaya AKBG grubunda 1103, PCI grubunda 1561 dahil edilen hasta vardý. Bunlardan AKBG grubunun %18,3’ü, PCI grubunun %15,2’si ilk 30 gün içinde tekrar hastaneye baþvurmuþtu. Multivariyat analizde yaþ, cinsiyet, düþük EF, KOAH, DM, hastanede kalýþ süresi (>10 gün), BMI, kreatinin düzeyleri AKBG grubu için, yaþ, cinsiyet, düþük EF,DM ve hastanede kalýþ süresi (>10 gün) ve kreatinin düzeyleri PCI gurubu için risk faktörü olarak bulundu.
TARTIÞMA ve SONUÇ: Her iki revaskülarizasyon metodu karþýlaþtýrýldýðýnda baþvuru oranlarý ve baþvuru için risk faktörleri benzer bulundu. Her iki revaskülarizasyon grubu arasýnda bir üstünlük saptanmadý. Bahsedilen risk faktörlerine sahip hastalarýn taburcusunda daha seçici olunmasý erken baþvuru oranlarýný azaltabilir.

INTRODUCTION: Though 30-day rates of readmission for coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) remain high, readmission rates and associated risk factors have not been well examined. The purpose of the present study was to determine the risk factors for and rates of readmission and to compare two revascularization methods on that basis.
METHODS: The study included 2664 consecutive patients who underwent coronary revascularization either with CABG surgery or PCI. The study was performed retrospectively and a wide variety of risk factors related to readmission were selected for analysis, including demographic data, preoperative risk factors and postoperative complications.
RESULTS: From the CABG group (Group 1, n=1103), 18.3% were readmitted, as were 15.2% of the PCI group (Group 2, n=1561). In multivariate analysis, age, gender, left ventricular ejection fraction (LVEF), chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), length of stay (>10 days), body mass index (BMI), and creatinine level on admission were associated with early readmission for group 1 (Table 3). In group 2, age, gender, LVEF, DM, length of stay (>10 days), and creatinine level on admission were associated with early readmission.
DISCUSSION AND CONCLUSION: When two methods of revascularization were compared, rates of readmission were found to be similar. Patients with cited risk factors are prone to readmission in the first 30 days, so extra precautions should be taken at discharge. Neither method can be concluded to be superior with regard to readmission rates.

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GÝRÝÞ ve AMAÇ: Diyabetes Mellitus tüm dünyada artan sýklýðýyla ve oluþturduðu komplikasyonlarla gün geçtikçe büyüyen bir saðlýk problemidir. Hastalýðýn kronik ve ilerleyici doðasý, hastalarý medikal tedavinin yanýnda alternatif týp kullanýmýna yöneltebilmektedir. Bu çalýþmada diyabetli hastalarda alternatif týp tedavi yöntemlerinin kullaným sýklýðý ve kullanýlan ürünlerin çeþitliliðinin araþtýrýlmasý hedeflenmiþtir.
YÖNTEM ve GEREÇLER: Eylül 2014-Mayýs 2015 tarihleri arasýnda Bezmialem Týp Fakültesi Hastanesi Endokrinoloji ve Metabolizma Hastalýklarý Bilim Dalý, Diyabet Polikliniði’nde takipli 301 diyabet hastasýna alternatif týp kullanýmý ile ilgili sorular yöneltilmiþtir.
BULGULAR: Çalýþmaya dahil edilen hastalarýn 81 (%26,9)’i alternatif týp yöntemlerini denemiþ olup, bunlarýn 50’si (%16,6) anket sýrasýnda halen bu tedavileri kullanmaktaydý. Alternatif týp ürünlerini her gün düzenli kullanan 43(%14,3) kiþi ve 6 aya kadar kullanan ise 24 (%8) kiþi olduðu görülmüþtür. HbA1c düzeyi, alternatif tedavi tercih edenlerde, tercih etmeyenlere göre anlamlý derecede düþük saptanmýþtýr (p=0,017). Çalýþtýðýmýz hasta grubunda, alternatif týp ürünleri kullanýmý ve diðer parametreler arasýnda istatiksel anlamlý bir fark bulunamamýþtýr. Alternatif týp kullanan gruptan sadece 10 (%12) hastanýn kullandýðý ek maddeden doktoruna bahsettiði ortaya çýkmýþtýr.
TARTIÞMA ve SONUÇ: Diyabetli hastalarda alternatif týp ürünlerine yönelim oldukça sýktýr. Bu ürünlerin glukoz regülasyonu üzerine detaylý çalýþmalar yapýlmalý, hem hekim hem hasta grubu bu açýdan bilinçlendirilmelidir.

INTRODUCTION: Diabetes mellitus (DM) is a growing health problem with serious complications. The chronic and progressive nature of the disease often leads patients to use complementary and integrative medicine. The presentstudy aimed to investigate the frequency of use of alternative medicine by patients with DM and the products used.
METHODS: Between September 2014 and May 2015, 301 patients with DM were selected from Bezmialem Foundation University Hospital Diabetes Clinic to participate in the study.
RESULTS: The results of the study indicate that 81 (26.9%) patients had tried alternative medicine, and 50 (16.6%) patients continued to use some form of alternative medicine product. A total of 43 (14.3%) patients used such products every day and 24 (8%) patients had used alternative medicine products for up to 6 months. Glycated hemoglobin (HbA1c) levels were significantly decreased in patients using alternative medicine products compared to the remainder of patients in the study (p=0.017). No other significant difference was found between the two groups. It was observed that among patients using alternative medicine products, only 10 (12%) had informed their physicians.
DISCUSSION AND CONCLUSION: This study indicated that patients with diabetes are very likely to use alternative medicine products. Additional studies are needed to further determine the efficacy of these products. Patients as well as health providers must be educated about complementary medicine and alternative products.

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GÝRÝÞ ve AMAÇ: Kronik inflamatuvar hastalýk (KÝH) terimi Ankilozan spondilit (AS) ve Ailevi Akdeniz Ateþini (AAA) de içine alan bir grup hastalýðý tanýmlamak için kullanýlýr. Geleneksel ateroskleroz risk faktörlerini taþýmadýklarý halde kardiyovasküler olay insidansý bu grup hastalarda artmýþtýr. Endotel disfonksiyonu, arterlerdeki aterosklerotik deðiþikliklerin oluþumunu tetikleyen temel mekanizmalardandýr ve brakiyal arterde akým aracýlý dilatasyon (AAD) endotel disfonksiyonunu belirleyen non-invaziv yöntemlerden biridir. Yapýlan son çalýþmalar trigliserid (TG) ile yüksek yoðunluklu lipoprotein (YYL) oranýnýn koroner ateroskleroz ile ilþkili olduðunu bildirmiþlerdir. Pek çok çalýþma KÝH’ li hastalarýn endotel disfonksiyonunu gösteren düþük AAD deðerlerine sahip olduklarýný göstermiþtir. Ancak TG/YYL oranlarý ve bu oranýn AAD ile iliþkisi bu grup hastalarda henüz araþtýrýlmamýþtýr. Bu çalýþmada KÝH' li hastalarda TG/YYL oranlarýnýn normal populasyona göre farklý olup olmadýðýnýn ve AAD ile iliþkisinin araþtýrýlmasý amaçlandý.
YÖNTEM ve GEREÇLER: 58 KÝH' li hasta ile bir grup saðlýklý gönüllü çalýþmaya dahil edildi. Çalýþma populasyonunun AAD ölçümleri yüksek çözünürlüklü bir ultrason kullanýlarak yapýldý ve TG/YYL oranlarý tüm çalýþma populasyonu için hesaplandý.
BULGULAR: KÝH' li hastalarda TG/YYL oranýnýn normal populasyona göre anlamlý derecede yüksek olduðu (2.5 (2.2-2.8) vs. 2.3 (2.1-2.5), p= 0.03) ve AAD deðerlerinin ise saðlýklý gönüllülere göre anlamlý derecede düþük olduðu ( 5.2 (4.2-6.3) vs. 6.7 (6.3-9.7), p< 0.001) saptandý. Ayrýca çalýþma populasyonunun TG/YYL oranlarý ile AAD deðerleri arasýnda negatif bir korelasyon tespit edildi.
TARTIÞMA ve SONUÇ: KÝH' li hastalar normal populasyona göre yüksek TG/YYL oraný ve düþük AAD deðerlerine sahip idi. Bu bulgu KÝH’ li hastalarda normal populasyona göre artmýþ aterosklerotik risk ile iliþkili olabilir.

INTRODUCTION: The term chronic inflammatory disease (CID) refers to a category of inflammatory diseases that includes Ankylosing spondylitis (AS) and familial Mediterranean fever (FMF). The incidence of adverse cardiovascular events is greater among patients with CID, though they may not have conventional atherosclerotic risk factors. Endothelial dysfunction is one of the underlying fundamental mechanisms that trigger development of atherosclerotic alterations in arteries, and flow-mediated dilatation (FMD) is a noninvasive method to determine endothelial dysfunction. Recent studies have shown a relationship between high triglyceride high-density lipoprotein cholesterol (TG/HDL-C) ratio and coronary atherosclerosis. Many studies have demonstrated that patients with CID have lower FMD values compared to healthy population, indicating endothelial dysfunction. However TG/HDL ratio and its relationship to FMD in patients with CID has not been investigated. The present study investigated whether TG/ HDL ratio in CID patients differs from that of healthy population, and its relationship to FMD in patients with CID.
METHODS: A total of 58 patients with CID and a group of 58 healthy volunteer individuals were enrolled in the study. FMD measurements were taken with high resolution ultrasound (US), and TG/HDL ratios were calculated.
RESULTS: Patients with CID had significantly higher TG/HDL-C ratio (2.5 [2.2–2.8] vs 2.3 [2.1–2.5]; p=0.03) and lower FMD values (5.2 [4.2–6.3] vs 6.7 [6.3–9.7]; p<0.001), compared to healthy group, and a negative correlation was found between FMD levels and TG/HDL ratio of the study population.
DISCUSSION AND CONCLUSION: Higher TG/HDL ratio and lower FMD values found in CID patients may reflect increased atherosclerotic risk.

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GÝRÝÞ ve AMAÇ: Biz bu çalýþmada varisli sirotik hastalarýmýzdaki varis büyüklüðünün trombosit sayýsý / dalak çapý oranýyla iliþkisini araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmaya siroz tanýsýyla takipli olan ve üst gastrointestinal endoskopisinde varis saptanan 186 hasta dahil edildi. Hastalarýn klinik, laboratuvar deðerleri, üst gastrointestinal sistem endoskopileri ve batýn ultrasonografisinin inceleme verileri retrospektif olarak deðerlendirildi. Hastalarýn tam kan sayýmýnda saptanan trombosit sayýsý en geniþ dalak uzunluðuna bölünerek Trombosit sayýsý / Dalak çapý oraný hesaplandý. Varisler büyüklüðüne göre küçük, orta ve büyük olarak sýnýflandý. Orta ve büyük varisli hastalar büyük varisliler olarak ayný grupta deðerlendirildi.
BULGULAR: Olgularýn %66.7 si (n=124) erkek, %33.3’ü (n=62) kadýn hastalardan oluþmuþtu. Hastalarýn %82.7 (n: 154)’ inde özofagial varis, %17.3 (n: 32)’ inde gastrik varis mevcuttu.
Özofagial varisli hastalarda; büyük varisi (orta + büyük varisliler) olanlarýn Trombosit sayýsý/ Dalak çapý oranlarý, küçük varisi olanlara göre anlamlý þekilde düþük bulunmuþtur (P: 0.04). Buna göre yapýlan ROC curve analizde Trombosit sayýsý / Dalak Çapý oranýnýn büyük varisleri %82 duyarlýlýkla ve %79 pozitif prediktif deðeri ile saptayabildiði bulunmuþtur. Gastrik varislilerde ise anlamlý bir farklýlýk saptanmamýþtýr ( P: 0.78).

TARTIÞMA ve SONUÇ: Sonuç olarak bu çalýþmada Trombosit sayýsý / Dalak Çapý oranýnýn özofagial varisli hastalarda büyük varisleri %82 duyarlýlýkla saptayabildiði gösterildi. Ancak gastrik varislilerde büyük varisleri predikte edemediði saptandý. Bulgularýmýzýn desteklenmesi için geniþ katýlýmlý prospektif çalýþmalara ihtiyaç vardýr.

INTRODUCTION: This study investigated the relationship between size of gastroesophageal varices and platelet count/spleen diameter ratio in cirrhotic patients.
METHODS: The present study included 186 cirrhotic patients in whom gastroesophageal varices were seen during upper gastrointestinal system endoscopy. Clinical features, laboratory parameters, upper gastrointestinal system endoscopy, and abdominal ultrasonographic findings of patients were evaluated retrospectively. Plateletcount/spleen diameter ratio (P/S) was calculated by dividing number of platelets in complete blood count (CBC) to largest diameter of spleen. Varices were classified as small, medium, or large, and patients were separated into two groups for comparison: those with small varices and those with medium or large varices. Of the total, 66.7 % of the patients were men (n=124) and 33.3% were women (n=62). Esophageal varices were found in 82.7% and gastric varices were found in 17.3%.
RESULTS: Patients with large esophageal varices were found to have significantly lower P/S compared to patients with small esophageal varices (p=0.04). In receiver operating characteristic (ROC) curve analysis, P/S and large varices correlated with 82% sensitivity and 79% positive predictive value. However, no statistically significant correlation between size of varices and P/S was found in patients with gastric varices (p=0.78).
DISCUSSION AND CONCLUSION: In patients with esophageal varices, P/S was found to be correlated with large varices with 82% sensitivity. However, this ratio did not predict large varices in patients with gastric varices. Prospective and randomized clinical researches are needed to clarify our findings.

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GÝRÝÞ ve AMAÇ: Ýntratekal morfinin sebep olduðu kaþýntýnýn patogenezinde santral inhibitör nörotransmiter (GABA) antagonizmasý veya serotonerjik sistemin aktivasyonu önemli faktörlerdir.Bu nedenle, biz, preoperatif ondansetron, gabapentin ve mirtazapinin morfinin sebep olduðu kaþýntýyý azaltacaðý hipotezini test ettik.
YÖNTEM ve GEREÇLER: Tek taraflý inguinal herni onarýmý veya pilonidal sinüs eksizyonu yapýlacak ASA I-II 80 hasta rasgele 4 eþit gruba ayrýldý ve preoperatif 2 saat önce mirtazapin 30 mg, 10 dakika önce ondansetron 8 mg, 1 saat önce gabapentin 1200 mg tablet ve 10 dakika önce plasebo olarak draje þeker verildi.Tüm hastalara 15 mg % 0,5 hiperbarik bupivakain ve 0,2 mg morfin ile intratekal enjeksiyon uygulandý.Uygulama sonrasý 0.-3.-6.-9.-12.-24. Saatlerde hastalarda kaþýntýnýn varlýðý, ortaya çýkýþ zamaný, devam süresi, lokalizasyonu ve þiddeti sorgulandý.
BULGULAR: Kaþýntý plasebo grubunda, ondansetron, gabapentin ve mirtazapin gruplarýyla karþýlaþtýrýldýðýnda daha sýk görüldü (sýrasýyla %70 vs %55, %35, %35). Kaþýntýnýn genellikle 2. ve 6. saatlerde ortaya çýktýðý gözlenirken gabapentin grubunda kaþýntý daha uzun sürede ortaya çýktý ( ort. SD; 4,75±2,7 sa. p=0,019 ). Ondansetron ve plasebo grubunda kaþýntýnýn daha uzun süre devam ettiði gözlendi (ort SD; sýrasýyla 6±3,08, 5,82±2,96 sa. p=0,047). Kaþýntýnýn sýk görüldüðü bir lokalizasyon istatistiksel açýdan tespit edilmedi. Kaþýntý þiddetinin plasebo grubunda diðer gruplara göre daha fazla olduðu gözlendi (p=0,0001). Yine de kaþýntý tedavisi gerekliliði açýsýndan gruplar arasýnda anlamlý fark yoktu.
TARTIÞMA ve SONUÇ: Her üç ilacýn da plaseboya göre intratekal morfinin sebep olduðu kaþýntýnýn insidansýný ve þiddetini azalttýðýný gözlemledik.

INTRODUCTION: Antagonism of the central nervous system inhibitor neurotransmitter gamma-Aminobutyric acid (GABA) or serotonergic system activation is an important factor in the pathogenesis of intrathecal morphine-induced pruritus. This study tested the hypothesis that preoperative use of ondansetron, gabapentin or mirtazapine can prevent morphine-induced pruritus.
METHODS: We randomly allocated 80 patients of American Society of Anesthesiology (ASA) classification I and II physical status who were to undergo unilateral inguinal hernia or pilonidal sinus operations under spinal anesthesia into 4 equal groups. The first 3 groups received oral doses of 30 mg mirtazapine, 8 mg ondansetron, and 1200 mg gabapentin at 2 hours, 10 minutes, and 1 hour before surgery, respectively, and the fourth group was given a placebo. All patients received intrathecal injection of 15 mg of 0.5% hyperbaric bupivacaine a nd 0.2 mgmorphine. Pruritus was evaluated at 0, 3, 6, 9, 12, and 24 hours after intrathec al morphine administration, anddetails of presence, onset time, duration, localization, and severity of pruritus were recorded.
RESULTS: Incidence of pruritus was significantly more frequent in the placebo group compared to ondansetron, gabapentin, and mirtazapine groups (70%, 55%, 35%, and 35%, respectively). In general, onset of pruritus was between 2 and 6 hours after intrathecal morphine injection; however, onset in the gabapentin group (mean±SD: 4.75±2.7 hours; p=0.019) was delayed compared to other groups. It was observed that pruritus persisted relatively longer in the ondansetron and placebo groups (mean±SD: 6±3.08; 5.82±2.96 hours, respectively; p=0.047). No statistical determination was made regarding location of pruritus. Sev erity of pruritus was greater in the placebo group (p=0.0001). Necessity for antipruritic treatment was not statistically significantlydifferent between groups.
DISCUSSION AND CONCLUSION: Incidence and severity of intrathecal morphine-induced pruritus decreased with use of each of all 3 drugs compared to placebo.

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Amaç: Akut apandisit en sýk karþýlaþtýðýmýz acil cerrahi patoloji olup; bu çalýþmada gebe olgularda akut apandisit taný ve tedavisinin literatür eþliðinde deðerlendirilmesi amaçlanmýþtýr.
Gereç ve Yöntem: Ýstanbul Medeniyet Üniversitesi Gernel Cerrahi Kliniðinde Ocak 2012-Aralýk 2014 yýllarý arasýnda gebeliði döneminde akut apandisit ön tanýsý ile appendektomi yapýlan yirmi bir olgu retrospektif olarak incelendi. Hastalarýn yaþlarý, gebelik haftalarý, þikayetleri, fizik muayene bulgularý, lökosit deðerleri, kan biokimyasý, tam idrar tahlillleri, ultrasonografi bulgularý, uygulanan cerrahi teknik, cerrahi insizyon þekli, ameliyat sonrasý komplikasyonlarý ve hastanede yatýþ süreleri kaydedildi.
Bulgular: Olgularýmýzýn on ikisi (%57.1) 2. trimester, beþi (%23.8) 3.trimesterde ve dördü (%19.0) 1. trimesterde idi. Ortalama yaþ 23.904 idi. Hastalarýn tümünde baþvuru þikayeti karýn aðrýsý idi. Lökosit sayýsý ortalama 13.297/mm³ idi. Karýn ultrasonografisinde 12 hastada (%57.1) akut apandisit ile uyumlu bulgular saptandý. Olgularýn on dördüne Mc Burney insizyon (%66.6), altýsýna sað paramedian insizyon (%28.6) ve birine laparoskopik appendektomi (%4.8) yapýldý. 19 olguda (% 90.5) akut apandisit, 2 olguda (%9.5) perforasyon saptandý. Ortalama yatýþ süresi 3.8 gün idi. Perfore olgularda cerrahi alan enfeksiyonu geliþip medikal tedavi edildi. Fetomaternal mortalite gözlenmedi.
Sonuçlar: Gebelikteki fizyolojik, anatomik ve biyokimyasal deðiþiklikler nedeniyle akut apandisit tanýsýnda gecikme hem anne ve hem de fetüs hayatýný tehdit edebilmektedir. Bu nedenle hýzlý taný ve uygun tedaviler önemli olmaktadýr.

OBJECTIVE: Acute appendicitis is one of the most common acute surgical pathology we encountered. In this study we investigated our pregnant cases of appendicitis, and reviewed literature.
METHODS: A total of 21 pregnant women who underwent appendectomy with the initial diagnosis of acute appendicitis in Istanbul Medeniyet University Clinics of General Surgery between January 2012, and December 2014 were retrospectively analyzed. The patients’s ages, trimesters, complaints, abdominal examination, laboratory, and ultrasonographic findings, surgical techniques, complications and hospital stay were noted.
RESULTS: The patients were in their first (n=12; 57.1%), second (n=5; 23.8%), and third trimesters (n=4; 19.0%) of their pregnancies Median age was 23.9 years. All of the patients had abdominal pain. Median value of WBC count was 13.297/mm³. Ultrasound was positive in 12 patients (57.1%). In 14 (66.6%) patients McBurney incision, and in 6 (28.6%) cases right paramedian incision were used. One patient (4.8%) underwent laparoscopic appendectomy. Nineteen cases were acute appendicitis (90.5%), and two cases were perforated appendicitis (9.5%). Average hospital stay was 3.8 days. Two cases with perforated acute appendicitis developed wound infection and treated conservatively. There were no fetomaternal mortality.
CONCLUSION: Physiologically anatomic and biochemical changes occurring during pregnancy can delay the diagnosis of acute appendicitis threaten the lives of both the mother and the fetus Therefore, rapid diagnosis and appropriate treatment convey importance.

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Acil servis ve kardiyoloji baþvurularýnda akut dispne temel þikayetlerdendir. Akut dispne genellikle hayatý tehdit eden bir durum olup astým, pulmoner emboli, akut kalp yetmezliði ve miyokard enfarktüsünde görülür. Burada acilimize ortopne ve ajitasyon ile kabul edilen 32 yaþýnda bir erkek hasta olgu sunumu olarak anlatýldý. Bu olguda fiziki muayene, elektrokardiyogram, ekokardiografi, kontrastlý tomografi ve koroner anjiyografi akciðer patolojilerinden pnomotoraks, pulmoner emboli ve koroner arter hastalýðýný dýþlamamýza yetti ancak uygun taný için yeterli olmadý. Aort diseksiyonu þüpesi devam ettiði için tranözefajial ekokardiyografi yapýldý. Hastada atýmdan atýma sol ana koronerin aðzýný kapatan flep imajý izlendi.

Acute dyspnea is a major complaint of patients admitted to cardiology and emergency departments (ED). Acute dyspnea can be life-threatening, and is seen in cases of asthma, pulmonary embolism, acute heart failure and myocardial infarction. The present case is that of a 32-year-old man admitted to the ED with orthopnea position and agitation. Physical examination, electrocardiogram (ECG), transthoracic echocardiogram (TTE), contrastenhanced computed tomography (CECT) of thorax and coronary angiography (CAG) helped to rule out chest disease pathologies such as pneuomo-thorax, pulmonary embolism and coronary artery disease, but were not enough to make an appropriate diagnosis in this case. Because of high pretest probability of aortic dissection, transesophageal echocardiography (TEE) was performed and a diagnosis of Stanford type A dissection closing left main coronary artery (LMCA) ostia from beat to beat was made.

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Pleomorfik adenomlar (PA) tükrük bezinin en sýk benign neoplazisidir. Genellikle parotis ve submandibular bez gibi major tükrük bezlerinde görülür. Ancak larinkste oldukça nadirdir. Bu lezyonlar genellikle yavaþ büyüyen, aðrýsýz kitleler þeklinde prezente olur. Malign transformasyon oldukça nadirdir, fakat zamanla bu risk artar. Biz ses kýsýklýðý ile baþvuran 59 yaþýnda erkek hastayý sunduk. Sað vertikal parsiyel hemilarinjektomi materyalinin deðerlendirilmesinde mukoza intakt olup larinksin supragottik bölgesinde yerleþimli 2×1.5×1 cm ölçülerinde kabarýk kitle izlendi. Lezyon PA’nýn karakteristik histolojik özelliklerine sahip idi ve taný sitokeratin, S-100 protein, GFAP ve vimentin ile immunohistokimyasal olarak konfirme edildi. Ancak histopatolojik olarak tanýmlanmasý her zaman kolay deðildir; tam tanýnýn konmasýnda ve uygun takibin gerçekleþmesinde immunohistokimya oldukça faydalýdýr.

Pleomorphic adenoma (PA) is the most common benign neoplasm of the salivary glands. It usually occurs in major salivary glands, such as the parotid and submandibular glands. Occasionally, however, it occurs in the larynx. These lesions generally present as a slow-growing, painless mass. Malignant transformation is very rare, but it increases with time. The present report is the case of a 59-year-old male who presented with a complaint of hoarseness. Right vertical partial hemilaryngectomy revealed an intact, mucosa-covered, fleshy 2×1.5×1 cm mass in the supraglottic area of the larynx. Lesion had histological characteristics of a PA, and this was confirmed byimmunohistochemical expression of cytokeratin, S100 protein, Glial fibrillary acidic protein (GFAP) and vimentin. Their histopathological identification is, however, not always straightforward; immunohistochemistry can contribute significantly to formulation of a definitive diagnosis and to the realization of appropriate follow-up.

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Fahr Sendromu, kalsiyum ve fosfor metabolizmasý bozukluðu ile iliþkili olarak bazal ganglialarda simetrik ve iki yanlý kalsifikasyonla karakterize nöropsikiyatrik bir sendromdur. Klinik bulgular, farklý yaþlarda baþlayýp çok çeþitli olabilmektedir. Bu yazýda Fahr Sendromu' nda nadir bir durum olan, epileptik nöbet ile baþvuran iki olgu tartýþýlmýþtýr. Bu olgular, bilgilerimize göre, jeneralize tonik klonik nöbetle baþvuran literatürdeki ilk olgular olmalarý açýsýndan önemlidir.

Fahr’s syndrome is a neuropsychiatric syndrome characterized by symmetrical and bilateral intracerebral calcifications located in the basal ganglia and usually associated with a phosphorus and calcium metabolism disorder. Clinical manifestations of Fahr’s syndrome vary; it may start at different ages and have a variety of presentations. This article discusses rare presentation of Fahr’s syndrome with epileptic seizure. These cases are important because they appear to be the first cases in the literature of Fahr’s syndrome presenting with generalized tonic clonic seizure.

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Amaç: Yenidoðan döneminde intestinal obstrüksiyon nedeni ile opere edilen ve konjenital bant basýsý saptanan bir olguyu sunmak.
Olgu: Prenatal dönemde yapýlan takiplerinde intestinal obstrüksiyon þüphesi olan ve post natal dönemde kusma ve batýn distansiyonu ile baþvuran olgunun yapýlan tetkiklerinde intestinal obstrüksiyon saptanmasý üzerinde cerrahi kararý alýndý. Yapýlan eksplorasyonda ileal anslar seviyesinde basý yapan ve geçiþe izin vermeyen bant tespit edildi. Bant kesildi ve pasajýn devamlýlýðý teyit edildi. Olgu post operatif dönemde sorunsuz olarak takip edilmektedir.
Sonuç: Prenatal veya postnatal dönemde saptanan intestinal obstrüksiyon olgularýnda nadir de olsa konjenital bant basýsý sendromu akýlda tutulmalýdýr.

Congenital band compression syndrome should be considered in cases diagnosed prenatally or postnatally as intestinal obstruction. Presently described is a report of newborn admitted to hospital with abdominal distension and bilious vomiting. A suspected intestinal obstruction had been diagnosed in prenatal examination. Surgery revealed congenital band compressing ileal segments and preventing transmission of intestinal content. Band was successfully removed and intestinal integrity is intact.

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Psöriazis T lenfosit aracýlý immün yanýt sonucu ortaya çýktýðý düþünülen kronik inflamatuar bir dermatozdur. Hastalýk klinik özellikler ve þiddet açýsýndan farklý þekillerle kendini gösterebilir. Psöriazisin klinik tipi tedavi rejiminin belirlenmesinde önemli bir antitedir. Bu makalede psöriazisin klinik tipleri gözden geçirilmiþtir.

Psoriasis is a chronic inflammatory dermatosis that is thought to onset as a result of T lymphocyte-mediated immunological response. Disease may manifest itself in different modalities with regard to clinical features and severity. Clinical type of psoriasis is an important element in determining the therapy regimen. This article reviews clinical types of psoriasis.

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