GÝRÝÞ ve AMAÇ: Ökse otu olarak bilinen ve halk arasýnda diyabet baþta olmak üzere birçok hastalýkta tedavi edici olarak kullanýlan Viscum album Avrupa’da ve Türkiye’de yaygýn bir yetiþme alanýna sahiptir. Projemiz Viscum album’un bu kullanýmýnda, streptozotosin (STZ) ile diyabet oluþturulmuþ sýçanlarda, lipit peroksidasyonu, antioksidan sistem ve plazma glikoz düzeyi üzerine etkilerini incelemeyi amaçlamaktadýr.
YÖNTEM ve GEREÇLER: 32 adet Sprague-Dawley yetiþkin erkek sýçan, her grupta 8’er adet olmak üzere 4 gruba ayrýlmýþtýr. Gruplar: Kontrol (K), streptozotocin (STZ), Viscum album (VA), ve Viscum album+ streptozotocin (VA + STZ) verilecek þekilde ayarlanmýþtýr. STZ sitratlý tampon (0.1 M, pH 4,5) içerinde 55 mg/kg olacak þekilde hazýrlandýktan sonra sýçanlara tek doz ve intraperitoneal uygulanmýþtýr. Hazýrlanan ekstre hayvanlara gruplarýna göre 10 gün boyunca hergün gavaj olarak verilmiþtir (100 mg/kg). 11. Gün hayvan gruplarýna göre streptozotocin ile diyabet oluþturulmuþtur (55 mg/kg). STZ uygulamasýndan 1 gün sonra çalýþma gruplarýnýn açlýk kan þekeri ölçüldü. Açlýk kan þekeri ölçüldükten sonra ayný gün içinde hayvanlar sakrifiye edilerek alýnan karaciðer ve böbrek dokularýnýn süpernatantlarýnda Katalaz (CAT), malondialdehid (MDA) ve protein tayini yapýldý. Veriler tek yönlü varyans analizi (ANOVA) ile deðerlendirildi, gruplar arasý ikili karþýlaþtýrmalar, post-hoc (Dunnet, Duncan, LSD) testler ile yapýldý. p<0,05 olasýlýk deðeri anlamlý kabul edildi.
BULGULAR: Sýçanlarda diyabet oluþturulmasýnýn oksidatif stresi arttýrdýðý saptandý.
TARTIÞMA ve SONUÇ: Diyabetik sýçanlara Viscum album verilmesi oksidatif stresi azalmakta ve bu durum sýçanýn genel durumunu iyileþtirmektedir. Viscum album’un antidiyabetik ve antioksidan etkilerinin daha net belirlenmesi için daha çok çalýþmaya ihtiyaç duyulmaktadýr.

INTRODUCTION: Viscum album (VA) is a species of mistletoe in the family Santalaceae that is thought to have therapeutic properties for several diseases, including diabetes. In the present study, conventional experimental rat model was used with diabetes induced with streptozotocin (STZ) to evaluate effect of VA on lipid peroxidation and antioxidant system.
METHODS: Total of 32 adult, male Sprague-Dawley rats were divided into 4 groups of 8 rats: Control group, STZ group, VA group, and group administered VA+STZ. VA extract was 100 mg/kg preparation delivered once a day by oral gavage for 10 days. Single dose of 55 mg/kg STZ citrate buffer (0.1 M, pH 4.5) was administered intraperitoneally to induce diabetes. Fasting blood glucose level was measured and recorded. Animals were sacrificed, and catalase (CAT), malondialdehyde (MDA), and protein present in liver and kidney tissue samples were measured. Activity of CAT, an antioxidant enzyme, was studied according to the Aebi method. MDA, a product of lipid peroxidation, was analyzed using Draper and Hadley spectrophotometric procedure. Protein level was determined using supernatant and extract of tissue homogenates according to Lowry method. Data were assessed using one-way analysis of variance and pairwise comparisons between groups. Post-hoc analysis included Dunnet test, Duncan test, and least significant difference test. P<0.05 was considered significant probability value.
RESULTS: Oxidative stress is associated with diabetic complications. VA administered to diabetic rats reduced oxidative stress and improved their general condition.
DISCUSSION AND CONCLUSION: Further studies are needed to enhance understanding of potential antidiabetic and antioxidant effects of VA.

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GÝRÝÞ ve AMAÇ: Amaç: Ýn vitro tedavisi uygulanmasýnda serum ve folliküler sývýdaki anti- müllerian hormon düzeyinin, elde edilen oosit, fertilizayon ve klinik gebelikle iliþkisinin deðerlendirilmesi çalýþmada amaçlandý.

YÖNTEM ve GEREÇLER: Yöntem ve gereçler: Multiagonist protokolü ile IVF uygulanan 44 infertil hasta çalýþmaya dahi edildi. Serum ve folliküler sývýsýnýn AMH düzeyleri oosit toplandýðý günkü seviyeleri deðerlendirildi. Bazal serum follikül hormon düzeyi adetin 3. günü ölçüldü. Ýstatistik analizinde, Pearson korelasyonu ve binari regresyon testleri kullanýldý. Ýstatistiksel olarak anlamlýlýðýn cut- off deðeri tip 1 hatta için % 5 kabul edildi.


BULGULAR: Bulgular: Serum AMH düzeyi, elde edilen oosit sayýsý, fertilizasyon ve klinik gebelik oranlarý ile doðru orantýlý olduðu bulundu (r=0,397, p=0,008; r=0,401, p=0,007; and r=0,382, p=0,011; surasýyla). Serum FSH düzeyi ile fertilizasyon ve kilinik gebelik oranlarý arasýnda ters orantýlý iliþki mevcuttur (r =-0,320, p=0,034 ve r =-0,308, p=0,042 sýrasýyla). Folliküler sývýnýn AMH düzeyinin IVF tedavisinin hiçbir sonucu ile iliþkisi yoktur.

TARTIÞMA ve SONUÇ: Sonuç: Serum AMH düzeyi elde edilecek oosit sayýsýný belirlemede, fertilizasyon ve klinik gebelik oranlarýný tespit etmede folliküler sývýnýn AMH düzeyinden daha güvenilebilir olabilir.

INTRODUCTION: The objective of this study was to evaluate the relationship between oocyte yield, fertilization, and clinical pregnancy (CP), and anti-Mullerian hormone (AMH) level in serum and follicular fluid during in vitro fertilization treatment.

METHODS: Forty-four infertile women who underwent IVF treatment using multiagonist protocol were included in this study. Baseline level of AMH in serum and follicular fluid was measured on third day of menstrual cycle. AMH level in serum and follicular fluid was then measured again on day of oocyte pick-up. Pearson correlation and binary regression tests were used for statistical analysis. For Type 1 error, p=5% was selected as cut-off value for statistical significance.
RESULTS: Serum AMH level was positively correlated with total number of oocytes retrieved and rate of fertilization and CP (r=0.397, p=0.008; r=0.401, p=0.007; and r=0.382, p=0.011, respectively). There was significantly negative correlation between serum level of follicle-stimulating hormone (FSH) and fertilization rate (r=-0.320; p=0.034), as well as serum FSH level and CP rate (r=-0.308; p=0.042). There were no significant correlations between AMH level in follicular fluid and IVF treatment outcomes.
DISCUSSION AND CONCLUSION: Serum AMH levels may be more reliable for prediction of total number of oocytes retrieved and rate of fertilization and CP than AMH levels in follicular fluid.

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GÝRÝÞ ve AMAÇ: Karotis cisim tümörleri nöral non-kromafin hücrelerden köken alan genellikle benign yapýda tümörlerdir. Tümörün cerrahi olarak çýkarýlmasý en uygun tedavi yaklaþýmýdýr. Bu tümörlerin cerrahi tedavisinde en sýk tercih edilen anestezi yöntemi genel anestezidir. Anestezi yönetiminin temel unsurlarýný hemodinamik stabilitenin korunmasý ve serebral perfüzyonun devamlýlýðýnýn saðlanmasý oluþturmaktadýr.
Bu çalýþmanýn amacý karotis cisim tümörleri cerrahisinde anestezik yaklaþýmý deðerlendirmek ve literatür bilgilerini ortaya koymaktýr.
YÖNTEM ve GEREÇLER: Çalýþmaya 2013-2016 yýllarý arasýnda Antalya Eðitim ve Araþtýrma Hastanesi’nde karotis cisim tümörü tanýsýyla opere edilen 10 hastanýn verileri dahil edildi. Hastalarýn demografik verileri, komorbiditeleri, operasyon taraflarý, ameliyat, yoðun bakým ve hastanede kalýþ süreleri, intraoperatif kan basýncý deðiþiklikleri, inotrop ajan kullanýmlarý, kan ve kan ürünü kullanýmlarý, postoperatif dönemde analjezik tüketimi, VAS skorlarý ve komplikasyonlar kaydedildi.
BULGULAR: Shamblin sýnýflamasýna göre 3 hasta Tip 1 ve 7 hasta Tip 2 olarak deðerlendirildi. Hastalarýn 6’sýnda tümör sað ve 4’ünde sol tarafta yer alýyordu. 1 hastada operasyon sýrasýnda transfüzyon gerektirecek miktarda kan kaybý gözlendi ve primer sütur ile kontrol altýna alýndý. Ortalama intraoperatif kan kaybý miktarý 287 ± 68 ml olarak bulundu. Tümör eksizyonu sýrasýnda 1 hastada taþikardi ve hipertansiyon geliþirken 4 hastada bradikardi ve hipotansiyon gözlendi. 1 hastaya hipotansiyonun devam etmesi üzerine inotrop destek infüzyonu baþlandý. Ortalama cerrahi süresi 109 ± 20 dk olarak tespit edildi. Postoperatif tramadol tüketimi 80 ± 25 mg’dý. Postoperatif VAS skorlarý ortalamasý 4±1 olarak bulundu. Yoðun bakýmda kalýþ süresi 2.4 ± 1.1 saat ve hastanede kalýþ süresi 3.8 ± 0.7 gün olarak bulundu. Olgularýn hiçbirinde postoperatif dönemde kalýcý nörolojik hasar ve mortalite görülmedi.
TARTIÞMA ve SONUÇ: Karotis cisim tümör cerrahisi yakýn ve kompleks bir anestezi yönetimi gerektirir. Ani hemodinamik deðiþikliklere karþý hemodinamik stabilitenin korunmasý ve serebral perfüzyonun monitorizasyonu ve devamlýlýðýnýn saðlanmasý anestezi yönetiminin en önemli unsurlarýný oluþturmaktadýr.

INTRODUCTION: Carotid body tumors (CBT) are benign tumors that originate from neural non-chromaffin cells that are typically localized near carotid bifurcation. Surgical removal of the tumor is the most appropriate treatment. General anesthesia is preferred anesthetic technique for CBT surgery. Basic elements of anesthetic management are protection of hemodynamic stability and maintaining cerebral perfusion pressure (CPP). The aim of this study was to evaluate anesthetic management of CBT surgery and present the literature knowledge.
METHODS: The study included 10 consecutive patients with diagnosis of CBT who underwent surgery at Antalya Training and Research Hospital, in Antalya, Turkey, between 2013 and 2016. Preoperative demographic details; comorbidities; side of surgical site; duration of operation; length of intensive care unit (ICU) and hospital stay; change of intraoperative blood pressure; use of inotropic drugs, blood products, and analgesics; postoperative visual analogue scale (VAS) pain score; and complications were recorded.
RESULTS: According to Shamblin classification, 3 tumors were type I and the remaining 7 were type II. Tumors were located on right side in 6 patients, and on left in 4. Blood loss sufficient to require transfusion was observed in 1 patient. Average intraoperative blood loss was 287±68 mL. Tachycardia and hypertension were observed in 1 patient; bradycardia and hypotension were seen in 4 patients. Infusion for inotropic support was administered to 1 patient. Mean duration of operation was 109±20 minutes. Mean VAS score was 4±1, mean ICU tramadol consumption was 80±25 mg. Duration of stay in ICU and hospital were 2.4±1.1 hours and 3.8±0.7 days, respectively. Mortality and neurological complications were not seen in postoperative period.
DISCUSSION AND CONCLUSION: CBT surgery requires close and complex anesthesia management. Protection of hemodynamic stability against sudden hemodynamic changes, monitoring, and maintaining CPP are the most important aspects of anesthetic management.

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GÝRÝÞ ve AMAÇ: Safra kaçaðý en sýk kolesistektomi sonrasý görülen nadir bir komplikasyondur. Ayrýca karaciðer, diðer biliyer prosedürler sonrasýnda altta yatan patoloji veya komplikasyona baðlý geliþir. ERCP safra kaçaklarýnýn taný ve tedavisinde majör rol oynar.
YÖNTEM ve GEREÇLER: 2008-2012 yýllarý arasýnda cerrahi sonrasý geliþen safra kaçaðý nedeni ile ERCP yapýlarak tedavi edilen olgular çalýþmaya dahil edildi. Etiyoloji, klinik, radyolojik özellikler ve endoskopik tedavi sonuçlarý kaydedildi.
BULGULAR: Çalýþmaya toplam 31 hasta (10 erkek,21 kadýn) dahil edildi. Hastalardan 20 tanesi kolesistektomi sonrasý, 10 tanesi karaciðer kisthidatiði,1 tanesi ise hepatik rezeksiyon cerrahisi sonrasý safra kaçaðý geliþen olgulardý. Bu olgularda en sýk semptom ve bulgular karýn aðrýsý, sarýlýk, perkütan drenden safra geleni olmasý, peritonit ve bilioma idi. 20 hasta (%60) endoskopik sfikterotomi (ES) ve nazobiliyer dren (NBD) ile 7 hasta (%35) ES ve biliyer stent (BS) ile bir hasta ES ile tedavi edildi. Kolesistektomi sonrasý safra kaçaðý geliþen olgularda tedavi baþarýsý %100 idi. 10 (%32) hastada kisthidatik cerrahisi sonrasý kistobiliyer fistül mevcuttu. Bu hastalarýn 7 tanesi ES ve NBD, 2 tanesi ES ve BS ile 1 hasta ise ES ile tedavi edildi.Kistobiliyer fistül olan olgularda tedavi baþarýsý %90 idi.
TARTIÞMA ve SONUÇ: ERCP safra kaçaklarýnýn teþhis ve tedavisinde kullanýlan etkili bir yöntemdir.Postoperatif safra kaçaklarýnýn endoskopik tedavisi etyolojik neden ve fistüle eþlik eden diðer faktörlere göre bireyselleþtirilmelidir.

INTRODUCTION: Bile leakage, while rare, can be a complication seen after cholecystectomy. It may also occur after hepatic or biliary surgical procedures. Etiology may be underlying pathology or surgical complication. Endoscopic retrograde cholangiopancreatography (ERCP) can play major role in diagnosis and treatment of bile leakage. Present study was a retrospective analysis of outcomes of ERCP procedure in patients with bile leakage.
METHODS: Patients who underwent ERCP for bile leakage after surgery between 2008 and 2012 were included in the study. Etiology, clinical and radiological characteristics, and endoscopic treatment outcomes were recorded and analyzed.
RESULTS: Total of 31 patients (10 male, 21 female) were included in the study. ERCP was performed for bile leakage after cholecystectomy in 20 patients, after hydatid cyst operation in 10 patients, and after hepatic resection in 1 patient. Clinical signs and symptoms of bile leakage included abdominal pain, bile drainage from percutaneous drain, peritonitis, jaundice, and bilioma. Twelve (60%) patients were treated with endoscopic sphincterotomy (ES) and nasobiliary drainage (NBD) catheter, 7 patients (35%) were treated with ES and biliary stent (BS), and 1 patient (5%) was treated with ES alone. Treatment efficiency was 100% in bile leakage cases after cholecystectomy. Ten (32%) cases of hydatid cyst surgery had subsequent cystobiliary fistula. Of these patients, 7 were treated with ES and NBD, 2 were treated with ES and BS, and 1 patient (8%) with ES alone. Treatment was successful in 90% of these cases.
DISCUSSION AND CONCLUSION: ERCP is an effective method to diagnose and treat bile leakage. Endoscopic treatment of postoperative bile leakage should be individualized based on etiological and other factors, such as accompanying fistula.

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GÝRÝÞ ve AMAÇ: Bu araþtýrmada yýllýk kontroller için baþvuran genç saðlýklý kiþilerde alkolik olmayan yaðlý karaciðer hastalýðýnýn (AOYKH) sýklýðýný belirlemek amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Bu retrospektif çalýþma bir asker hastanesinde gerçekleþtirilmiþtir. Toplam 254 saðlýklý erkek çalýþmaya dahil edilmiþtir, AOYKH’nýn varlýðý ve derecesine göre iki gruba ayrýlmýþtýr. Tüm bireylerin demografik verileri, biyokimyasal test sonuçlarý ve ultrasonografi bulgularý kaydedilmiþtir.Ýstatistiksel analizler IBM SPSS 22.0 kullanýlarak yapýlmýþtýr.
BULGULAR: AOYKH sýklýðý %10,6 bulunmuþ ve AOYKH varlýðý ile yaþ, aspartat transaminaz, alanin transaminaz, γ-glutamil transferaz, alkalen fosfataz, vücut kitle indeksi arasýnda önemli fark saptanmýþtýr (sýrasýyla p=0.014, p=0.022, p=0.003, p≤0.001, p=0.004 ve p≤0.001). Evre 2 AOYKH’de alanin transaminaz, açlýk kan þekeri, γ-glutamil transferaz, trigliserid, total kolesterol ve yaþ düzeyleri evre 1 AOYKH’ye göre daha yüksek bulunmuþtur. Ancak AOYKH evreleri karþýlaþtýrýldýðýnda istatistiksel önemli fark saptanmamýþtýr.
TARTIÞMA ve SONUÇ: Saðlýklý genç erkek bireylerde vücut kitle indeksi ve laboratuvar testleri normal olsa bile AOYKH sýklýðý nadir bir durum deðildi. Normal sýnýrlarda olmasýna raðmen, AOYKH varlýðý ve derecesine göre karaciðer enzim düzeylerinde hafif düzeyde artýþ saptanmýþtýr.

INTRODUCTION: This aim of the present study was to determine prevalence of non-alcoholic fatty liver disease (NAFLD) in healthy young persons admitted for annual medical check-ups.
METHODS: A retrospective study was conducted in a military hospital. Total of 254 healthy males were included and participants were divided into 2 groups according to presence and grade of NAFLD. Demographic data, biochemical test results, and ultrasonography findings were collected from all patients. Statistical analyses were performed using SPSS software, version 22.0 (SPSS, Inc., Chicago, IL, USA).
RESULTS: Prevalence of NAFLD was 10.6%. Significant differences were found with regard to age; levels aspartate transaminase, alanine transaminase, gamma-glutamyl transferase, and alkaline phosphatase; body mass index (BMI); and presence of NAFLD (p=0.014, p=0.022, p=0.003, p≤0.001, p=0.004, and p≤0.001, respectively). When compared to those with grade 1 NAFLD, levels of alanine transaminase, fasting blood glucose, gammaglutamyl transferase, triglycerides, total cholesterol and age variables were higher in those with grade 2 NAFLD. However, no statistically significant difference was noted when comparing grades of NAFLD.
DISCUSSION AND CONCLUSION: Though this study included patients with normal BMI and normal laboratory test results, presence of NAFLD was not rare in these otherwise healthy young men. Liver enzyme levels were within normal limits; however, there was slight tendency to be high consistent with presence and grade of NAFLD.

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GÝRÝÞ ve AMAÇ: Yaþam süresinin uzamasýna baðlý olarak geliþen yaþlý nüfusun ve kronik hastalýklarýn artýþý, evde bakým ihtiyacýný ve bakýcýlarýn sorunlarýný önemsememizi gerektirmektedir. Bu çalýþma evde saðlýk hizmeti alan hastalara bakým verenlerin depresyon düzeylerini belirlemek amacýyla yapýlmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþma 15.05.2013-01.07.2013 tarihleri arasýnda Kartal Dr. Lütfi Kýrdar Eðitim Ve Araþtýrma Hastanesi Aile hekimliði polikliniði tarafýndan evde saðlýk hizmeti sunulan 63 hastanýn bakýcýsý ile gerçekleþtirildi. Araþtýrmada sosyo-demografik özellikler soru formu ve Beck Depresyon Ölçeði kullanýldý. Verilerin deðerlendirilmesinde Kolmogorov Smirnov daðýlým testi, Mann-Whitney U test, Student-t-testi ve Ki-kare testleri kullanýldý.
BULGULAR: Katýlýmcýlarýn yaþ ortalamasý 52,4 yýl olup; %87,3’ü kadýn, %73’ü evli, aylýk geliri %50,8’inin 1000-3000 TL arasý, %46’sýnýn 1000 TL ve altý, %3,2’sinin ise 3000 TL ve üstüydü. Bakým alan hastalarýn %77,8’i tam, %22,2’si yarý baðýmlýydý. Bakýcýlýðý üstlenen hasta yakýnlarýnýn %61,1’inde depresyon görülürken, ücretli bakýcýlarýn %22,2’sinden depresyon görüldü (p: 0,052). Hasta bakým süresi 1 yýl ve altý olanlarýn %37’sinde, 1-5 yýl olanlarýn %63’ünde, 5 yýl ve üzeri olanlarýn ise %65’inde depresyon saptandý. Tüm katýlýmcýlarýn %55,6’sýnda depresyon tespit edildi.
TARTIÞMA ve SONUÇ: Hastanýn baðýmlýlýk durumu, yakýnlýðý ve bakým süresi gibi etkenlere baðlý olarak deðiþkenlik göstermesine karþýn tüm bakýcýlarda, normal popülasyondan yüksek oranlarda depresyon saptandý.

INTRODUCTION: Due to increase in elderly population as result of longer life expectancy and the incidence of chronic disease, greater importance should be given to elderly care and the needs of primary caregivers. The purpose of this study was to determine depression status of caregivers who were providing in-home healthcare services.
METHODS: This study was conducted with caregivers for 63 home-dependent patients who benefited from the services provided by Kartal Dr. Lutfi Kirdar Training and Research Hospital Family Practice Clinic between May 15, 2013 and July 1, 2013 using a socio-demographic variables questionnaire and the Beck Depression Inventory. Data were analyzed using Kolmogorov-Smirnov test, Mann-Whitney U test, Student’s-t test and chisquare test.
RESULTS: Of the total, 87.3% of survey participants were women. Average age was 52.47 years; 73% were married, 17.5% were single, and 9.5% were widows. Monthly income of 50.8% of participants was between TL 1000 and 3000. Of all the patients, 77.8% were totally, and 22.2% were semi-dependent. Depression was detected in 61.1% of patient relatives who were responsible for patient healthcare and in 22.2% of paid professional caregivers (p=0.052). Depression was detected at rate of 37% in caregivers who had been providing nursing care for less than 1 year, 63% for those who had been caregivers for 1 to 5 years, and for those providing care for more than 5 years, rate was 63 %. Rate of depression in study participants overall was 55.6%.
DISCUSSION AND CONCLUSION: Duration of providing care, dependency level of patient, and level of intimacy affect caregivers. They need psychological support.

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GÝRÝÞ ve AMAÇ: Hemodiyaliz hastalarýnda malnütrisyon sýk görülür ve yüksek morbidite ve mortalite oranlarý ile iliþkilidir.Bu çalýþmanýn amacý yaþlý hemodiyaliz hastalarýnda beslenme durumunun deðerlendirilmesidir.
YÖNTEM ve GEREÇLER: 163 hemodiyaliz hastasý tarandý ve herhangi bir dýþlanma kriteri olmayan 55 hasta (28 erkek ve 27 kadýn) çalýþmaya dahil edildi. Modifiye kantitatif subjektif global deðerlendirme skorlarýna göre hastalar üç gruba ayrýldý: grup I (n=22) normal beslenme, grup II (n=20) hafif-orta malnutrisyon, grup III (n=13) aðýr malnutrisyon.
BULGULAR: Sadece malnütre olan hastalarýn (n=33) verileri ile Modifiye kantitatif subjektif global deðerlendirme skorlarý arasýndaki iliþkiyi incelediðimizde, yaþ, C- reaktif protein, Malnütrisyon Ýnflamasyon Skoru arasýnda pozitif bir korelasyon, vücut kitle indeksi, biseps cilt kalýnlýðý, triseps cilt kalýnlýðý, orta kol çevresi, orta kol kas çevresi, fosfat ve albumin arasýnda negatif korelasyon bulduk.
TARTIÞMA ve SONUÇ: Malnutrisyon yaþlý hemodiyaliz hastalarýnda son derece yaygýndýr ve ilerleyen yaþla birlikte de sýklýðý artmaktadýr. Antropometrik ölçümler ve MQSGA yaþlý hemodiyaliz hastalarýnda beslenme durumunun deðerlendirilmesinde faydalý olabilir.

INTRODUCTION: Malnutrition is common among hemodialysis patients and is associated with higher rates of morbidity and mortality. The aim of this study was to evaluate nutritional status of geriatric hemodialysis patients.
METHODS: Total of 163 hemodialysis patients were initially screened, and 55 patients (28 males, 27 females; mean age: 72.9±8.4 years) met the criteria for inclusion. Patients were divided into 3 groups according to modified quantitative subjective global assessment (MQSGA) scores: Group I (n=22) normal nutrition, Group II (n=20) mild-to-moderate malnutrition, and Group III (n=13) severe malnutrition.
RESULTS: When we assessed the correlation between MQSGA nutrition score and data of malnourished patients (n=33), positive significant correlation was found between age, C-reactive protein level, and malnutrition-inflammation score. Negative significant correlation was found between body mass index, bicep skinfold, tricep skinfold, mid-arm circumference, mid-arm muscle circumference, and phosphate and albumin levels.
DISCUSSION AND CONCLUSION: Malnutrition is very common and increasing with aging in geriatric hemodialysis patients. MQSGA score and anthropometric measurements can be used to assess nutritional status in geriatric hemodialysis patients.

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Çocukluk çaðýnda görülen eklem þikayetleri sýk karþýlaþýlan ve ayýrýcý tanýsýnýn zor olduðu bir durumdur. Juvenil Idiopatik Artrit (JIA), çocukluk çaðýnýn en sýk görülen romatizmal hastalýðýdýr. Aðýrlýklý olarak periferik eklemleri tutan, kronik sinovit ve eklem dýþý bulgularla seyreden bir hastalýktýr. JIA kesin tanýsýnýn konulabilmesi bazen uzun zaman alabilir. Bu nedenle hastalar baþlangýçta farklý tanýlar ile izlenebilir. Artritler, travma ile tetiklenebilir ve travmanýn etiyolojide rol oynadýðý KBAS gibi diðer hastalýklarla karýþabilir. Bu olguda ayak bileði aðrýsý ile baþvurup kompleks bölgesel aðrý sendromu (KBAS) tanýsý ile takip ettiðimiz 8 yaþýnda bir kýz çocuk hasta sunulmuþtur.

Joint complaints in childhood are seen frequently and differential diagnosis can be difficult. Juvenile idiopathic arthritis (JIA) is the most common rheumatological disease of childhood. It involves peripheral joint arthritis, chronic synovitis, and extra-articular manifestations. Accurate diagnosis can take a long time and sometimes multiple diagnoses are used while following the patient until a final diagnosis can be reached. Arthritis may be triggered by trauma and confused with other diseases like complex regional pain syndrome (CRPS), in which trauma plays a role in the etiology. In the present case, ankle pain in an 8-year-old girl was misdiagnosed as CRPS.

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Apert sendromu kraniyosinostozis, el ve ayaklarda ciddi sindaktili ve dismorfik fasial özellikler ile karakterize nadir bir tip 1 akrosefalosindaktili sendromudur. Fibroblast growth faktör reseptör geninde mutasyon ile belirlenen otozomal dominant geçiþ özelliði gösterir.
Burada fizik incelemede akrosefali, belirgin alýn, oküler hipertelorizm, propitozis, kýsa ve geniþ burun, psödoprognatizm, diþlerde kalabalýklaþma ve ektopi, maksillar hipoplazi, kýsa saç çizgisi, yele boyun, pektus ekscavatum, el ve ayaklarda ciddi sindaktili bulgularýna sahip, 19 yaþýnda Apert sendromu tanýsý koyduðumuz kýz hastayý sunuyoruz.
Apert sendromunda çok sayýda fenotipik bulgular olmasý nedeniyle sendromun baþarýlý kontrolünde; diþ hekimleri, nörocerrah, plastik cerrah, fiziyatrist, oftalmotalog, perinatolog ve genetik uzmanýný içeren multidisipliner bir ekip esastýr.

Apert syndrome is the rare acrocephalosyndactyly syndrome type 1, characterized by craniosynostosis, severe syndactyly of hands and feet, and dysmorphic facial features. It demonstrates autosomal dominant inheritance assigned to mutations in the fibroblast growth factor receptor gene. Presently described is case of a 19-year-old female patient diagnosed on physical examination with Apert syndrome based on acrocephaly, prominent forehead, ocular hypertelorism, proptosis, short and broad nose, pseudoprognathism, dental crowding and ectopia, maxillar hypoplasia, low hairline, webbed neck, pectus excavatum, and severe, bilateral syndactyly of hands and feet. The multiple phenotypic signs of Apert syndrome make multidisciplinary team, including dentist, neurosurgeon, plastic surgeon, physiatrist, ophthalmologist, perinatalogist and geneticist, essential for successful management.

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Adenovirüs; solunum yolu enfeksiyonlarý, konjonktivit, gastroenterit gibi farklý klinik bulgularla ortaya çýkan viral enfeksiyon etkenidir. Ýmmun yetmezlikli hastalarda adenovirüse baðlý miyokardit, hepatit, ensefalit, pankreatit, dissemine hastalýk görülebilmektedir. Adenovirüs nadir olarak boðmaca benzeri sendromla prezente olabilir. Bu yazýda hiperlökositozla baþvuran adenovirüse baðlý boðmaca benzeri sendrom olgusu sunulmuþtur.

Adenovirus is an infectious viral agent that causes variety of clinical presentations such as respiratory disease, conjunctivitis, and gastroenteritis. Hepatitis, pancreatitis, myocarditis, encephalitis, and disseminated infection are primarily seen in immunocompromised patients. Rarely, adenovirus infection can present with pertussis-like syndrome. Described here is case of pertussis-like syndrome associated with adenovirus presenting with hyperleukocytosis.

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Duodenum sindirim sisteminde divertikülün kolondan sonra ikinci en sýk yerleþtiði lokalizasyondur. Perforasyon duodenum divertikülünün en nadir görülen fakat en ciddi komplikasyonudur. Biz olgumuzda acil servise karýn aðrýsý ve kusma þikayeti ile baþvuran, operasyon öncesinde çekilen bilgisayarlý tomografi ile “duodenum divertikülü perforasyonu” ön tanýsý konularak opere edilen 22 yaþýndaki erkek hastayý sunuyoruz.

Duodenum is the second most frequent location for diverticulum in the digestive tract, surpassed only by the colon. Perforation is rare, but it is the most serious complication of duodenum diverticula. Presently described is case of 22-year-old male patient who presented at emergency department with abdominal pain and vomiting. Surgery was performed with prediagnosis of perforated duodenum diverticula based on results of computed tomography.

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Kolelithiasis tanýsýyla elektif laparoskopik kolesistektomi yaptýðýmýz hastada intraoperatif olarak görülen sað diafragma agenezisinin dokümante edilerek literatür eþliðinde tartýþýlmasý.
Sað üst karýn bölgesinde son birkaç aydýr aðrý þikayetiyle polikliniðimize baþvuran normal mental kapasitede, iki normal çocuk annesi olan 36 yaþýnda kadýn hastada yapýlan radyolojik deðerlendirmeler sonucunda kolelithiasis mevcudiyeti, safra kesesi ve ekstrahepatik safra yollarýnýn karaciðer anteriorunda yerleþmiþ olduðu ve bununla beraber sað diafragma parezisinin de eþlik ettiði düþünüldü. Çocukluðundan beri sýk sýk solunum rahatsýzlýðý çektiðini ve hep yüksek yastýkta yattýðýný bildiren, sað kol ve ön kolun normalden kýsa ve sað elin hipoplazik ve malforme olduðu hastanýn kliniðimiz genel cerrahi konseyinde deðerlendirilmesi sonrasýnda elektif kolesistektomiye alýnmasýna karar verildi. Laparoskopik giriþimde karaciðer ve sað akciðer arasýnda diafragmanýn olmadýðý farkedildi. Safra kesesi ve ekstrahepatik safra yollarýnýn karaciðerin antero-superioruna deplase olduðu, kolonun kýsmen toraksta olduðu görüldü. Sað akciðerin hipoplazik olduðu, sol tarafta diafragmanýn normal olduðu görülerek video kaydý yapýldý. Kolesistektomi sorunsuz tamamlandý. Operasyon normal þartlarda sonlandýrýldý. Hastanýn rutin takiplerinde sorunsuz olduðu gözlendi.
Tek taraflý diafragma agenezisi yetiþkinlerde çok nadir görülen bir durum olup bu olgularda baþarýlý laparoskopik kolesistektomi literatürde henüz belgelenmemiþtir. Diafragma agenezisi durumunda karaciðer ve ekstrahepatik safra yollarý da toraksa doðru yer deðiþtireceðinden laparoskopik kolesistektomi iþlemi sýrasýnda maksimum tedbir alýnmalýdýr.

The importance of the complete absence of a hemidiaphragm or unilateral diaphragmatic agenesis in adulthood in relation to performing laparoscopic procedures has not been well documented. This article reports for the first time in literature a case of successful laparoscopic cholecystectomy in an adult with previously undiagnosed unilateral diaphragmatic agenesis. A 36-year-old female complaining of stubborn right upper abdominal pain radiating to her upper back was diagnosed as having cholelithiasis and was scheduled for laparoscopic cholecystectomy. There were also bilateral upper extremity malformations to a certain level. Routine diagnostic tests demonstrated that her entire liver and some bowel loops were in the right hemithorax, suggesting right-sided diaphragmatic hernia. Laparoscopic procedure was performed with the insertion of four trocars. Exploration of abdomen revealed total absence of the right hemidiaphragm. Cholecystectomy was completed laparoscopically in about 45 minutes without need for additional trocars. Patient had an uneventful recovery and was discharged on the second postoperative day without any complaint. Laparoscopic cholecystectomy in adults with diaphragmatic agenesis and intrathoracic abdominal viscera can be performed successfully. Nevertheless, any bile duct aberrations must be documented prior to surgery, and the surgeon should be able to convert to open procedure if necessary.

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Günümüzde tüberküloz yeniden çoðalma eðilimi gösteren ciddi bir hastalýktýr. Tüberkülozun en sýk akciðer dýþý görülme þekli lenf nodu tüberkülozudur. Boyunda kronik, aðrýsýz lenfadenopatinin ayýrýcý tanýsýnda servikal tüberküloz lenfadenopatisi mutlaka akýlda tutulmalýdýr. Birçok farklý patolojiyi taklit edebilen bu durumun tanýsýnda öncelikle kuþku çok önemlidir. Boyun tüberküloz lenfadenopatisi ayýrýcý taný açýsýndan önemli zorluklar göstermektedir. Çalýþmanýn amacý epidemiolojik ve klinik özellikleri ile taný için gerekli olan teknikleri gözden geçirmektir.

Tuberculosis is a very serious disease and incidence is once again on the rise. Lymph node tuberculosis is one of the most common extrapulmonary manifestations of tuberculosis. In differential diagnosis of chronic, painless cervical lymphadenopathy, cervical tuberculous lymphadenitis should be kept in mind. A high index of suspicion is needed for diagnosis of tuberculous lymphadenitis, which is known to mimic a number of pathological conditions. This article reviews epidemiology, clinical manifestations, and diagnostic techniques for cervical tuberculous lymphadenitis.

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Kromatografi bir karýþýmda bulunan bileþenlerin birbirinden ayrýlmasý, belirlenmesi ve saflaþtýrýlmasýný saðlayan önemli moleküler biyofizik yöntemlerden biridir. Bu yöntemle nitel ve nicel analizleri yapýlabilmektedir. Bu yöntemle moleküller büyüklük ve þekil, toplam yük, yüzeyde bulunan hidrofobik gruplar, kullanýlan duraðan faz ile baðlanma kapasitesi gibi farklý karakteristik özelliklerinden biri temel alýnarak moleküller saflaþtýrýlabilirler. Bu moleküler özellikler ve etkileþim tiplerine göre ayýrma dört temel sýnýfa ayrýlabilir. Bunlar iyon deðiþtirme, yüzeyde tutma (adsorpsiyon), bölme (partitisyon) ve moleküler dýþarýda býrakma kromotografileridir. Bu teknikler ayrýca kullanýlan ayýrma ve destek þekline göre kolon, ince tabaka, kaðýt kromotografileri olarak da ayrýlýr. Kolon kromatografisi en yaygýn protein saflaþtýrma yöntemlerinden biridir.

Chromatography is an important biophysical technique that enables the separation, identification, and purification of the components of a mixture for qualitative and quantitative analysis. Proteins can be purified based on characteristics such as size and shape, total charge, hydrophobic groups present on the surface, and binding capacity with the stationary phase. Four separation techniques based on molecular characteristics and interaction type use mechanisms of ion exchange, surface adsorption, partition, and size exclusion. Other chromatography techniques are based on the stationary bed, including column, thin layer, and paper chromatography. Column chromatography is one of the most common methods of protein purification.

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