GÝRÝÞ ve AMAÇ: Nerium oleander (Apocynacea, Zakkum) ve Aloe vera (Liliaceae) sahip olduklarý antibakteriyel, antiviral, antifungal ve antioksidan özellikleri nedeniyle deri hastalýklarýnýn tedavisinde yaygýn olarak kullanýlmaktadýr. Bu çalýþmanýn amacý Aloe vera bazlý Nerium oleander ekstraktýnýn (NAE-8®) yara iyileþtirici özelliðini antioksidan, antiinflamatuvar ve DNA onarým kapasitesi özellikleri açýsýndan incelemek ve yara tedavisinde sýk kullanýlan bir ajan olan gümüþ sülfadiazin (SSD) ile etkililiðini deðerlendirmektir.
YÖNTEM ve GEREÇLER: 24 adet Wistar albino sýçan randomize olarak 4 gruba ayrýlmýþtýr: Kontrol (K), Yanýk (Y), Yanýk+NAE8®, Yanýk+SSD. Ýlgili tedaviler tüm gruplara 14 gün boyunca, günde iki kez olmak üzere topikal olarak uygulanmýþtýr. Kan örnekleri tümör nekroz faktörü alfa (TNF-α), interlökin-1β (IL-1)β ve kuyruktaki DNA yüzdesi (%DNAT)’nin belirlenmesi için kullanýlýrken; deri doku örneklerinde malondialdehit (MDA) düzeyi, glutatyon (GSH) düzeyi, myeloperoksidaz (MPO) aktivitesi ölçülmüþtür. Ayrýca Hematoksilen & Eozin ve Gomori’nin tek aþamalý trikrom boyama yöntemleri ile rutin histolojik incelemeler gerçekleþtirilmiþtir.
BULGULAR: MDA, GSH, MPO, TNF-,α IL-1β ve %DNAT deðerlerinde oluþan termal travma kaynaklý deðiþikliklerin NAE-8® uygulamasý ile istatistiksel olarak anlamlý bir þekilde iyileþme gösterdiði tespit edilmiþtir. Yapýlan histolojik incelemelerin sonuçlarý da yanýk yarasýnda NAE-8® tedavisinin neden olduðu pozitif deðiþimleri desteklemiþtir.
TARTIÞMA ve SONUÇ: Bu çalýþmadan elde edilen sonuçlar, NAE-8®’in deri yanýklarýnýn tedavisinde umut verici bir ajan olduðunu düþündürmektedir.

INTRODUCTION: Nerium oleander (Apocynaceae) and Aloe vera (Liliaceae) are among the widely used herbal remedies for treating skin diseases and possess numerous activities such as antibacterial, antiviral, antifungal, and antioxidant. The aim of this study was to investigate the possible wound healing effect of Aloev era-based extract of the N. oleander leaf (NAE-8®) based on its antioxidant, anti-inflammatory, and DNA repair capacity along with histological changes and to compare them with the traditional silver sulfadiazine treatment (SSD).
METHODS: Twenty-four Wistar albino rats were randomly grouped as follows: i) control, ii) burn alone (burn), iii) burn with topical NAE-8® (burn+NAE-8®) treatment, and iv) burn with topical 1% silver sulfadiazine (burn+SSD) treatment. All groups received their related topical application twice a day for 14 consecutive days. Upon completion of the experimental protocol, trunk blood and skin tissues were collected for measuring malondialdehyde (MDA), glutathione (GSH), myeloperoxidase (MPO), tumor necrosis factor alpha (TNF-α), interleukin-1β (IL-1β), %DNA in the tail (%DNAT) levels along with histological examinations.
RESULTS: Thermal injury-induced alterations in MDA, GSH, MPO, TNF-α, IL-1β, and %DNAT levels were significantly reversed by NAE-8® treatment. These ameliorative effects were also supported by histological findings.
DISCUSSION AND CONCLUSION: Findings of the present study suggest that NAE-8® is a promising remedy for treating skin burn injury.

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GÝRÝÞ ve AMAÇ: Merkezi sinir sistemi (MSS) tümörlü kadavralardan çýkartýlarak gerçekleþtirilen karaciðer naklinde, düþük de olsa, alýcýda donör kaynaklý malignite geliþme riski olduðu için, bu tür donörler marjinal kabul edilmektedir. Marjinal greft kullanýmý organ baðýþýnýn az olduðu ülkelerde donör havuzunu geniþletmek için tercih edilen bir uygulamadýr. MSS tümörlü donörlerden gerçekleþtirdiðimiz karaciðer nakli sonuçlarýný sunmayý amaçladýk.
YÖNTEM ve GEREÇLER: Mart 2002 – Temmuz 2017 tarihleri arasýnda merkezimizde 1990 (n=399, % 20 kadavradan, n=1591, % 80 canlý vericiden) karaciðer nakli gerçekleþtirildi. Bu 399 kadaverik karaciðer naklinin 17’si (% 4,2) MSS tümörlü donörlerden gerçekleþtirildi. MSS tümörlü donörlerin ve bu greftlerin takýldýðý ve bir aydan uzun süre yaþayan 11 alýcýnýn verileri geriye dönük olarak incelendi. Demografik verileri, MSS tümör evreleri, alýcýlarda tümör geçiþi, sað kalým analizleri yapýldý.
BULGULAR: Tablo 1 ve 2 de sýrasýyla alýcý ve MSS tümörlü donörlerin demografik özellikleri sunulmaktadýr. Bu greftlerin sadece 2’si (% 18) kendi bölgemizden sunulmaktayken, 6’sý (% 54) ulusal hiçbir merkez tarafýndan kullanýlmadýðý için son sýradan merkezimize sunulmuþ, 3’ü (% 27) ise merkezimizdeki acil bildirimi olan hastalar için ulusal koordinasyon merkezi tarafýndan merkezimize sunulmuþ ve transplantasyon gerçekleþtirilmiþtir. Yüksek derece (grade III – IV) beyin tümörü 7 (% 64), düþük derece (grade I – II) ise 2 donörde saptanýrken, 2 donörün tanýsý radyolojik olarak konulduðu için patolojik olarak evrelendirilemedi. Genel ve tümörsüz saðkalým 1-3-5 yýllýk sýrasýyla, %100-70-45 saptandý.
TARTIÞMA ve SONUÇ: MSS tümörlü greftler kullanarak gerçekleþtirdiðimiz karaciðer nakli alýcýlarýnda medyan 40 ay (13-62) saðkalým elde edilmiþ ve hiçbir hastada donör kaynaklý malign transformasyon izlenmemiþtir.

INTRODUCTION: Liver transplantation from deceased donors with a central nervous system (CNS) malignancy has some risk of tumor transmission to the recipient. Though the risk is small, this group of donors is regarded as marginal. The use of marginal grafts may be an acceptable alternative practice in order to expand the donor pool in countries where there is a shortage of donated organs. The aim of this study was to examine and present the outcomes of liver transplantations performed using donors with a CNS tumor.
METHODS: Between March 2002 and July 2017, 1990 (deceased donor: n=399, 20%; living donor: n=1591, 80%) liver transplantations were performed at the center. Of the 399 deceased donors, 17 (4.2%) had a CNS tumor. The data of donors with a CNS tumor and of recipients who survived for more than 1 month (n=11) were retrospectively reviewed. Demographic data, the grade of the CNS tumor, tumor transmission to recipient data, and survival rates were analyzed.
RESULTS: Only 2 (18%) grafts were provided locally, 6 (54%) were offered to the transplantation center after all of the national centers had declined them, and 3 (37%) were made available to us by the national coordination center for patients with a documented notification of urgency. High-grade (grade III-IV) brain tumors were detected in 7 (64%) donors, while low-grade (grade I-II) tumors were found in 2 patients. The remaining 2 donors were not pathologically graded because the diagnosis was made radiologically. The 1-, 3-, and 5-year overall and tumor-free survival of the patients was estimated at 100%, 70%, and 45%, respectively.
DISCUSSION AND CONCLUSION: A median survival of 40 months (range: 13-62 months) was achieved in recipients of grafts from a donor with a CNS tumor and no donor-related malignant transformation was observed.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada, vücut kitle indeksinin (VKÝ) ve Ýnsulin direncinin (ÝR) Polikistik over sendromu (PKOS) ile iliþkili üreme parametrelerine etkisinin araþtýrýlmasý hedeflenmiþtir.
YÖNTEM ve GEREÇLER: PKOS tanýlý 106 hastanýn oosit toplama günü (OPU) kilo ve boy ölçüldü. VKÝ`ne göre hastalar üç alt gruba ayrýldý; grup I <25 kg/m2 (n=51), (normal), grup II ≤25-29.9 kg/m2 (n=27) (kilolu) ve grup III ≥30 kg/m2 (n=28)(obez). Ýkinci olarak hastalar HOMA-IR indekslerine göre iki gruba ayrýldý (IR: HOMA-IR >2.5).
BULGULAR: FSH, LH, LH/FSH, E2, testosterone, DHEAS, AMH and antral follikul sayýlarý gruplar arasý benzerdi. MII oosit, embryo sayýsý, fertilizasyon ve gebelik oranlarý insulin direnci olan ve olmayan PKOS tanýlý zayýf, kilolu ve obez grubunda anlamlý farklýlýk saptanmadý. Siklus baþýna gebelik ve doðum oraný zayýf grupta; kilolu ve obez grubuna göre daha yüksek çýkmasýna raðmen anlamlý düzeyde saptanmadý.
TARTIÞMA ve SONUÇ: VKÝ ile ÝR etkisine bakýldýðýnda PKOS' lu kadýnlarda reproduktif sonuçlar benzer iken, PKOS tanýlý kadýnlarda VKÝ ve ÝR`nin over cevabý ve IVF baþarýsý üzerine baðýmsýz bir etkisi vardýr.

INTRODUCTION: To examine effects of body mass index (BMI) and insulin resistance (IR) on the in vitro fertilization (IVF) outcomes in women with polycystic ovary syndrome (PCOS).
METHODS: A total of 106 women with PCOS who underwent intracytoplasmic sperm injection were investigated. The patients were stratified into groups according to their BMI [healthy weight: BMI <25 kg/m2 (n=51), overweight: ≤25–29.9 kg/m2 (n=27), and obese: ≥30 kg/m2 (n=28)]. Secondly, the patients were classified based on the presence of IR (IR was considered to be present if homeostatic model assessment-IR was >2.5). The main outcome measures were reproductive and IVF outcomes with respect to BMI and IR.
RESULTS: The basal hormonal evaluations, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH, estradiol, testosterone, DHEAS, AMH, and antral follicle counts, were similar between the groups of BMI and IR. The number of retrieved oocytes, MII oocytes, embryo counts, and fertilization and pregnancy rates were similar between lean and overweight/obese PCOS with and without IR. Even though pregnancy and delivery rates per started cycle and embryo transfer were higher in healthy-weight women with PCOS than in overweight/obese patients, it did not reach statistical significance.
DISCUSSION AND CONCLUSION: Reproductive outcomes in women with PCOS according to BMI and IR were similar. Neither BMI nor IR had an independent effect on ovarian response and IVF success in young women with PCOS.

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GÝRÝÞ ve AMAÇ: Pediatrik boyun kitleleri otolaringoloji pratiðinde sýk karþýlaþýlan problemlerdendir. Bu kitlelere yaklaþým, eriþkin hastalardan farklýdýr. Hekimler ya da klinikler arasý yaklaþým farklýlýklarý olabilmesi nedeniyle bu konudaki klinik çalýþmalarýn literatüre kazandýrýlmasý önemlidir. Bu amaçla, boyun kitlesi nedeniyle kliniðimize baþvurmuþ ve cerrahi biyopsi (insizyonel/eksizyonel) ile tanýlarý konmuþ 98 pediatrik hasta retrospektif olarak incelendi.
YÖNTEM ve GEREÇLER: Boyun kitlesi nedeniyle, son 8 yýl içinde kliniðimizde histopatolojik tanýlarý konmuþ, 8,5 ay-16 yaþ aralýðýndaki 98 (34 kýz, 64 erkek) hastanýn hastane kayýtlarý incelendi. Hastalarýn anamnez, fizik muayene bulgularý, kan tetkikleri, medikal tedavileri, görüntüleme, patoloji ve/veya mikrobiyoloji raporlarý deðerlendirildi. Boyun kitleleri, etyolojilerine, boyutlarýna, görüntüleme özelliklerine ve yerleþimlerine göre histopatolojik tanýlar eþliðinde kategorize edildi.
BULGULAR: 2-6 hafta arasýnda deðiþen antibiyoterapi sonrasýnda kitle boyutlarýnýn 20 mm’nin altýna inmemesi, tipik klinik presentasyon nedeniyle konjenital etyoloji düþünülmesi, malignite þüphesi nedeniyle cerrahi biyopsiyi planlanmýþ ve bu amaçla en çok eksizyonel biyopsi (%91.8) tercih edilmiþti. Etyolojilerine göre sýrasýyla en sýk enfeksiyöz boyun kitleleri görülürken, bunu konjenital ve neoplastik kitleler takip etmiþti (%49, %27.6, %23.4). En sýk görülen malignite %39.1 oranla Hodgkin lenfomaydý. Tiroglossal ve brankial kistler ise tüm konjenital kitlelelerin % 74.1’ ini oluþturmaktaydý. Kitlelerin %67.3’ü solid karakterdeydi. %44.9’u ise lateral boyunda lokalizeydi.
TARTIÞMA ve SONUÇ: Detaylý anamnez ve fizik muayene ile hastalarýn çoðunda taný konulabilirken, nonspesifik bulgularýn varlýðýnda görüntüleme, kan tetkikleri ve histopatolojik örnekleme tanýya ulaþmada gereklidir. Ultrasonografi görüntülemede ilk tercih olmalý, histopatolojik örnekleme için ise eksizyonel biyopsi, iðne biyopsisine tercih edilmelidir.

INTRODUCTION: Pediatric neck masses (PNMs) are a frequently encountered problem in otorhinolaryngology practice. The clinical approach to cervical masses in childhood varies from that of adults. Due to differences among clinicians in the assessment of a PNM, studies investigating this subject are significant contributions to the literature. For this reason, a review was conducted of pediatric PNM cases with an open biopsy (incisional/excisional) and a histopathological diagnosis.
METHODS: The hospital records of 98 (34 girls, 64 boys) pediatric patients aged between 8.5 months and 16 years were reviewed. The history, physical examination findings, blood tests, medical treatments, imaging reports, and the pathology and/or microbiology results of the patients were recorded and evaluated. The cervical masses were categorized according to the etiology, imaging features, size, and location.
RESULTS: Surgical biopsy was planned due to the suspicion of malignancy, typical clinical presentation or location, or size greater than 20 mm despite antibiotherapy for 2 to 6 weeks. Excisional biopsy (91.8%) was the first choice for histopathological sampling. Infectious masses were observed most commonly, followed by congenital and neoplastic masses, at a rate of 49%, 27.6%, and 23.4%, respectively. Hodgkin lymphoma was the most frequent type of malignancy (39.1%). Thyroglossal and branchial cysts constituted 74.1% of congenital masses. Sixty-seven percent of all masses were solid, and the lateral levels of the neck were the most affected locations (44.9%).
DISCUSSION AND CONCLUSION: In most cases, the diagnosis can be made with a detailed history and physical examination. In the presence of nonspecific findings, blood tests, imaging, and histopathological sampling are required. Ultrasound should be the first preference for imaging, and excisional biopsy is suggested rather than fine needle aspiration biopsy for histopathological sampling in pediatric neck masses.

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GÝRÝÞ ve AMAÇ: Vitamin B12 eksikliði ile periferal nöropati arasýndaki iliþki daha önce yapýlan çok sayýda çalýþmada gösterilmiþtir. Metformin Tip 2 Diyabetes Mellitus (DM) tedavisinde vazgeçilmez birinci basamak tedavi olarak tüm dünyada kullanýlmaktadýr. Metformin kullanýmýnýn vitamin B12 eksikliðine yol açtýðý bilinmektedir. Çalýþmamýzda Adýyaman ilimizde metformin kullanýmýna baðlý olarak geliþen vitamin B12 eksikliði ve periferal nöropati ile iliþkisini inceledik.
YÖNTEM ve GEREÇLER: Hastalarýn laboratuar ve Elektromiyografi (EMG) verileri retrospektif olarak incelendi. EMG raporu olmayan ve diðer bilgileri eksik olan hastalar çalýþma dýþý býrakýldý.
BULGULAR: Çalýþmaya metformin kullanan 86 Tip 2 DM hastasý alýndý. Hastalarýn 26’si erkek 60’ý bayandý. Hastalarýn yaþ ortalamasý 55,1±7,7 idi. Hastalarýn ortalama Vücut kitle indeksleri 29,1±9,01 idi. Hastalarýn ortalama HbA1c deðerleri 8,6±2,1 idi. Ortalama Diyabet süreleri 8,02±5,4 idi. Hastalarda vitamin B12 eksikliði sýklýðý %38,4 olarak saptandý. Hastalarýn %33,7’ünde periferal nöropati saptandý. Periferal nöropatisi olan hastalar ile olmayanlar vitamin B12 düzeyleri açýsýndan karþýlaþtýrýldýðýnda her iki grup arasýnda istatistiksel olarak anlamlý bir fark saptanmadý (P deðeri =0,64).
TARTIÞMA ve SONUÇ: Sonuç olarak ilimizde metformin kullanýmýna sekonder geliþen vitamin B12 eksikliðinin periferal nöropati sýklýðýný anlamlý bir þekilde arttýrmadýðý söylenebilir.

INTRODUCTION: The relationship between vitamin B12 deficiency and peripheral neuropathy has been shown in a number of previous studies. Metformin is the indispensable first-line treatment for type 2 diabetes mellitus (DM) worldwide. One of the adverse effects of the use of metformin is vitamin B12 deficiency. In the present study, we investigated the relationship between vitamin B12 deficiency and peripheral neuropathy due to the use of metformin.
METHODS: Patient’s laboratory and electromyography (EMG) data were retrospectively reviewed. Patients with no EMG report and other necessary information were excluded from the study.
RESULTS: Eighty-six patients with type 2 DM using metformin were included in the study. Of these patients, 26 were males and 60 were females. The mean age of the patients was 55.1±7.7 years. The mean body mass index of the patients was 29.1±9.01 kg/m2. The mean HbA1c level of the patients was 8.6%±2.1%. The mean duration of diabetes was 8.02±5.4 years. The incidence of vitamin B12 deficiency was 38.4%. Peripheral neuropathy was detected in 33.7% patients. There was no statistically significant difference in vitamin B12 levels between patients with peripheral neuropathy and those without peripheral neuropathy (p=0.64).
DISCUSSION AND CONCLUSION: Therefore, it can be concluded that the lack of vitamin B12 secondary to the use of metformin did not significantly increase the frequency of peripheral neuropathy.

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GÝRÝÞ ve AMAÇ: Postmenopozal dönemdeki kadýnlarda lipid profili ve plazma aterojenik indeksi (PAÝ) ile osteoporoz arasýndaki iliþkinin incelenmesi
YÖNTEM ve GEREÇLER: Kartal Dr. Lütfi Kýrdar Eðitim ve Araþtýrma Hastanesi’nde kadýn hastalýklarý ve doðum polikliniðine baþvuran, 12 ay ve üzeri adet görmeyen, yaþ aralýklarý 45-80 olan 407 postmenopozal dönemdeki kadýn hastanýn yaþ, menopoz süresi, boy, kilo, lipid profili, kemik mineral dansitesi (KMD) deðerleri ve oral kontraseptif kullanýmlarý retrospektif olarak incelendi. Hastalar osteoporoz varlýðýna göre iki gruba ayrýldý ve veriler karþýlaþtýrýldý. p<0.05 istatistiksel olarak anlamlý kabul edildi.
BULGULAR: 144 postmenopozal osteoporozu olan hasta çalýþmaya dahil edildi. Yaþ ortalamasý 61.7 ± 6.9 yýl olarak saptandý. Osteoporozu olmayan kontrol grubunda ise 263 postmenopozal kadýn bulunup, grubun yaþ ortalamasý 58.3 ± 4.5 yýl olarak saptandý. Trigliserid deðerleri açýsýndan istatistiksel olarak farklýlýk saptanmazken osteoporoz grubunda total kolesterol ve düþük dansiteli lipoprotein (LDL) deðerleri daha düþük, yüksek dansiteli lipoprotein (HDL) deðerleri ise daha yüksek saptanmýþtýr (p=0.762, p=0.002, p=0.01, p<0.001, sýrasýyla).

TARTIÞMA ve SONUÇ: Kardiyovasküler hastalýklarý önleme açýsýndan önemli olan yüksek HDL, düþük LDL ve düþük PAÝ deðerlerinin KMD açýsýndan olumsuz olduðu saptanmýþtýr.

INTRODUCTION: The goal of this study was to investigate the relationship between the lipid profile, plasma atherogenic index (PAI), and osteoporosis in postmenopausal women.
METHODS: The data of age, duration of menopause, height, weight, lipid profile, bone mineral density (BMD) value, and history of oral contraceptive use of 407 postmenopausal women who had not been menstruating for at least 12 months, were between the ages 45 and 80, and presented at the obstetrics and gynecology polyclinic of Kartal Dr. Lutfi Kirdar Training and Research Hospital were reviewed. The patients were divided into 2 groups according to the presence of osteoporosis, and the data compared. The level of significance was accepted as p<0.05.
RESULTS: A total of 142 postmenopausal patients with osteoporosis were included in the study. The mean age was 61.7±6.9 years. In the control group, there were 263 postmenopausal women without osteoporosis, with a mean age of 58.3±4.5 years. There was no statistically significant difference with respect to triglyceride level; however, in the osteoporosis group, the level of total cholesterol and low-density lipoprotein (LDL) were lower, and the level of high-density lipoprotein (HDL) was higher (p=0.762, p=0.002, p=0.01, p<0.001, respectively).
DISCUSSION AND CONCLUSION: A high level of HDL, and low LDL and PAI values, which are important for the prevention of cardiovascular disease, were found to be negative factors for BMD.

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GÝRÝÞ ve AMAÇ: Diz eklemini oluþturan kemik yapýdaki dizilim bozukluðunun diz osteoartriti (OA) ile iliþkili önemli biyomekanik faktörler arasýnda yer aldýðý bilinmesine raðmen, bu dengesizliðin menisküs yaralanmasýna neden olup olmadýðý konusunda yeterli bilgi bulunmamaktadýr. Bu çalýþmanýn amacý diz ekleminde meniskal yaralanma varlýðý ile femoro-tibial açý arasýndaki iliþkiyi deðerlendirmektir.
YÖNTEM ve GEREÇLER: Çalýþmaya Ocak 2015 - Mart 2015 tarihleri arasýnda kliniðimizde diz Manyetik Rezonans (MR)’ý çekilen hastalar dahil edildi. Bu hastalarýn diz MR görüntüleri meniskal yaralanma açýsýndan retrospektif olarak tekrar deðerlendirildi. Hastalarýn anatomik femoro-tibial açý ölçümleri ayný dönem çekilen AP diz radyografilerinden femur ve tibianýn anatomik eksenleri kullanýlarak hesaplandý. Femoro-tibial açý deðerleri ile meniskal yaralanma varlýðý arasýndaki iliþki analiz edildi.
BULGULAR: Çalýþmaya 101 hastaya ait (Erkek/Kadýn=53/48) 114 diz eklemi (57 sað -57 sol) dahil edildi. Yaþ ortalamasý 40,6 ±13,4 idi. Yaralanma bulunan medial menisküs sayýsý 92, bu dizlerdeki ortalama femoro-tibial açý deðeri 5,6±1,88; yaralanma bulunmayan medial menisküs sayýsý 22, bu dizlerdeki ortalama femoro-tibial açý deðeri 5,8±1,92 (P=0.82); yaralanma bulunan lateral menisküs sayýsý 22, bu dizlerdeki ortalama femoro-tibial açý deðeri 6,1±1,50; yaralanma bulunmayan lateral menisküs sayýsý 92, bu dizlerdeki ortalama femoro-tibial açý deðeri 5,6±1,96 (P=0.20) bulundu.
TARTIÞMA ve SONUÇ: Çalýþmamýzda dizin frontal plan kemik dizilimini gösteren femoro-tibial açý deðerleri ile medial ve lateral menisküslerde yaralanma varlýðý arasýnda istatistiksel olarak anlamlý iliþki bulunmamýþtýr. Femorotibial açýnýn meniskal yaralanma geliþiminde etkili olmadýðýný düþünmekteyiz.

INTRODUCTION: The purpose of this study was to assess the relationship between the presence of meniscal injury and the femorotibial angle in the knee joint.
METHODS: Patients who underwent knee magnetic resonance imaging (MRI) at our department between January 2015 and March 2015 were included in this study. Knee MR images of these patients were retrospectively re-evaluated for meniscal injury. The anatomic femorotibial angle measurements of the patients were calculated using AP knee radiograms. The relationship between femorotibial angle values and the presence of meniscal injury was analyzed.
RESULTS: One hundred and fourteen knee joints of 101 patients were included. The mean age of the patients was 40.6±13.4 years. The number of injured medial menisci was 92 and the average femorotibial angle in these knees was 5.6±1.88; the number of non-injured medial menisci was 22 and the average femorotibial angle value in these knees was 5.8±1.92 (p=0.82); The number of lateral meniscus with injury was 22 and the mean femorotibial angle value in these knees was 6.1±1.50; the number of lateral meniscus without injury was 92 and the average femorotibial angle value in these knees was 5.6±1.96 (p=0.20).
DISCUSSION AND CONCLUSION: In our study, there was no statistically significant correlation between femorotibial angle values and the presence of injury in medial and lateral meniscuses. We believe that frontal plane bone alignment disorder of the knee does not have a predisposition to meniscal injury.

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GÝRÝÞ ve AMAÇ: Doðum, birçok kadýnýn yaþadýðý doðal bir fizyolojik olay olup sýklýkla kadýnlar için korku kaynaðýdýr. Türkiye'de sezaryen oranlarý kentsel alanlarda kýrsal alanlardan daha yüksektir. Çalýþmada, Türkiye'deki sezaryen oraný en düþük olan yerleþim yerinde doðum korkusun da düþük oranda görüleceði hipotez edildi. Bu çalýþma, birisi kýrsal diðeri kentsel iki yerleþik popülasyondaki kadýnlarýn doðum korku düzeyinin karþýlaþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Bu çalýþma, büyük bir kent olan Ýstanbul'da ve kýrsal kesimde bulunan Siirt illerinde toplam 253 gebede yürütülmüþtür. Tanýmlayýcý bilgi formu ve WÝJMA Doðum Beklentisi/Deneyimi Ölçeði (W-DEQ) A versiyonu kullanýlmýþtýr.
BULGULAR: Siirt örnekleminde yer alan kadýnlarda þiddetli doðum korkusu olduðu belirlendi, ancak Siirt örneklemindeki kadýnlarýn doðum korkusu Ýstanbul örneklemindeki kadýnlardan daha düþüktü. Ýstanbul örneklemindeki kadýnlar daha yüksek doðum korkusuna ve daha çok vaginal doðum tercihine sahipti. Bu, sezaryen oraný yüksek olan yerleþim yerinde kadýnlarýn yüksek doðum korkularýna raðmen vaginal doðumu tercih edebildiklerini göstermektedir. Kadýnlarýn yaþadýðý yer (kýrsal alanlara karþý kentsel alanlar) doðum algýlarýný ve dolayýsýyla onlarýn doðum korkularýný etkilemektedir.
TARTIÞMA ve SONUÇ: Bu çalýþmanýn sonuçlarý, doðum korkusunun her kültürel ortamda artmýþ olmasý ile iliþkili faktörleri daha iyi anlamak için kültürler arasý ve bölgesel araþtýrmalara ihtiyaç duyulduðunu göstermektedir.

INTRODUCTION: Childbirth is a natural physiological event experienced by many women; however, it is frequently also a source of fear in women. Rates of cesarean sections in Turkey are higher in the urban areas than in the rural areas. We hypothesized that lower fear of childbirth (FOC) rates would be observed in the city having the lowest cesarean section rates in Turkey. This study aimed to compare FOC in women in two resident populations: one in a rural area and the other in an urban area.
METHODS: This study was conducted on 253 pregnant women in Istanbul, a large urban municipality, and Siirt, a city in rural Turkey. A descriptive information form and the A version of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) were used.
RESULTS: Severe FOC levels were recorded in women in the Istanbul sample; moreover, these levels were higher than those recorded in women in the Siirt sample. In addition, women in the Istanbul sample preferred vaginal birth to cesarean section and had greater FOC, a finding which demonstrates that women prefer vaginal birth even though they have a higher FOC level and live in a city with high cesarean section rates. Where women live (rural versus urban areas) affects their perception of birth and consequently, their FOC levels.
DISCUSSION AND CONCLUSION: The results of this study suggest that further cross-cultural and regional research is needed for better understanding FOC and factors associated with elevated FOC levels within each cultural setting.

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GÝRÝÞ ve AMAÇ: Rabdomiyoliz, iskelet kasý harabiyetine baðlý klinik ve biyokimyasal bir sendromdur. Bu çalýþmada amacýmýz üçüncü basamak bir hastanenin acil servisine baþvuran rabdomiyoliz olgularýnýn etiyolojik, demografik ve klinik özelliklerini inceleyerek ülkemiz rabdomiyoliz verilerine katkýda bulunmaktýr.
YÖNTEM ve GEREÇLER: Çalýþmamýz Ocak 2015 ile Ocak 2016 tarihleri arasýnda üçüncü basamak bir hastanenin acil servisine baþvuran hastalarýn verilerinin retrospektif olarak deðerlendirilmesi ile yapýlmýþtýr. Çalýþma evrenini hastanemiz acil servisine baþvuran ve baþvuru sýrasýnda kreatin kinaz deðerleri 5000 U/L üzerinde olan hastalar oluþturmuþtur. Çalýþmaya dâhil edilecek tüm olgularýn verileri araþtýrmacýlar tarafýndan hastanenin bilgisayar tabanlý veri kayýt sistemi kullanýlarak taranmýþtýr. Olgularýn yaþ ve cinsiyetleri, kreatin kinaz deðerleri, baþvuru þikâyetleri, etyolojileri, akut böbrek yetmezliði geliþip geliþmediði, hastalarýn yatýþ ve taburculuk durumlarý, yatýþ yapýlan hastalarýn yatýþ yapýlan klinikler taranmýþtýr
BULGULAR: Acil servisine baþvuru sýrasýnda kreatin kinaz deðerleri 5000 U/L üzerinde olan 51 hasta çalýþmamýza dâhil edilmiþtir. Hastalarýn baþvurudaki kreatin kinaz deðerleri 5052 ile 59140 U/L arasýnda deðiþmekte olup ortanca 7882 U/L (ÝQR: 7840) olarak bulunmuþtur. En sýk (%23,5) baþvuru sebebi ekstremite aðrýsý idi. Etyolojide en sýk (%19,6) yer alan sebep egzersiz idi. 21 hastanýn (%41,1) kliniklere yatýþýnýn yapýldýðý, 1 hastanýn (%1,9) ise öldüðü tespit edilmiþtir. Hastalarýn 4’ünde (%8,8) akut böbrek yetmezliði geliþtiði gözlenmiþtir.
TARTIÞMA ve SONUÇ: Rabdomiyoliz kas harabiyetine baðlý yaþamý tehdit edebilen klinik bir sendromdur. Her ne kadar travmatik yaralanma sonrasý akla gelse de diðer potansiyel nedenler söz konusu olduðunda da akla getirilmelidir. Bütün klinisyenler ortak nedenlerin, taný ve tedavi seçeneklerinin farkýnda olmalýdýr.

INTRODUCTION: Rhabdomyolysis is a clinical and biochemical syndrome caused by skeletal muscle injury. Our aim was to contribute to the existing data on rhabdomyolysis in our country by evaluating the etiologic, demographic, and clinical features of rhabdomyolysis patients who applied to a tertiary hospital emergency department.
METHODS: We retrospectively evaluated the data of patients who applied to the tertiary hospital emergency department from January 2015 to January 2016. The study population comprised patients admitted to the emergency department of our hospital with creatinine kinase levels above 5000 U/L at admission. The data of all cases that were included in the study were scanned by the researchers using the hospital’s computer-based data recording system. Age, sex, creatine kinase levels, complaints, etiology, whether or not acute renal failure developed, hospitalization and discharge status, and clinic of hospitalization were screened for all patients.
RESULTS: The creatine kinase levels of the patients at admission ranged from 5052 to 59140 U/L [median 7882 U/L (IQR: 7840)]. The most frequent (23.5%) cause of admission was extremity pain. The most common reason (19.6%) in the etiology was exercise. Twenty-one patients (41.1%) were admitted to clinics, and 1 patient (1.9%) died. Acute renal failure was observed in 4 patients (8.8%).
DISCUSSION AND CONCLUSION: Rhabdomyolysis is a clinical syndrome that can be life-threatening owing to muscle destruction. Although it is suspected after a traumatic injury, it should also be considered when other potential symptoms are observed. All clinicians should be aware of its common causes, diagnosis, and treatment options.

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GÝRÝÞ ve AMAÇ: Karaciðer nakli sonrasýnda akut apandisit görülme sýklýðý % 0,09-0,49 ile oldukça nadirdir ve bu hasta gurubunda Alvarado skorunun etkinliði günümüze kadar çalýþýlmamýþtýr. Çalýþmamýzda karaciðer nakli sonrasý akut apandisit geliþen hastalarýmýzýn klinik yönetimi ve Alvarado skorunun taný koymadaki etkinliði araþtýrdýk.
YÖNTEM ve GEREÇLER: Mart 2002 – Temmuz 2017 tarihleri arasýnda karaciðer nakli gerçekleþtirilen 1990 hastanýn prospektif olarak verilerinin kayýt edildiði veri bankasýndan, akut apandisit tanýsýyla tedavi edilmiþ olan 7 hastanýn dosyasý geriye dönük olarak incelendi. Hastalarýn Alvarado skorlarý hesaplandý ve güvenilirliði analiz edildi.
BULGULAR: Çalýþmamýzda karaciðer nakli hastalarýnda akut apandisit insidansý % 0,35 idi. Hastalarýn tümü eriþkin yaþ gurubunda ve %86’sý erkek cinsiyet aðýrlýktaydý. Ortalama yaþ 46,4 ± 10,7 yýl idi ve karaciðer naklinden sonra apandisit geliþimi, medyan 12 ay (4-101) olarak belirlendi. Alvarado skoru medyan 7 (5-9) idi. Hastalarýn hepsinin Alvarado skoru 5’in üzerinde iken, %71’inde skor 7 ve üzerindeydi.
TARTIÞMA ve SONUÇ: Karaciðer nakli hastalarýnda akut apandisit oldukça nadir görülür. Nakil dýþý hastalarda olduðu gibi Alvarado skorlamasý karaciðer nakli hastalarýnda da güvenle uygulanabilir.

INTRODUCTION: The incidence of acute appendicitis after liver transplantation (LT) is extremely low, reported to be 0.09% to 0.49%, but the efficacy of the Alvarado score in this patient group has not been studied. This study was an investigation of the clinical management of patients who developed acute appendicitis after LT and the usefulness of the Alvarado score in the diagnosis.
METHODS: The study was performed using the data of 7 patients treated for acute appendicitis who were among 1990 patients who underwent LT between March 2002 and July 2017. The Alvarado score of the patients was calculated and reliability was analyzed.
RESULTS: In this study, the incidence of acute appendicitis in LT patients was 0.35%. All of the patients were in the adult age group; 86% were male. The mean age was 46.4±10.7 years and the timeframe for the development of appendicitis after transplantation was a median of 12 months (range: 4-101 months). The median Alvarado score was 7 (range: 5-9). All of the patients had an Alvarado score above 5 and 71% had a score of 7 or more.
DISCUSSION AND CONCLUSION: Acute appendicitis is very rare in LT patients. As with non-transplant patients, Alvarado scoring can be safely performed in LT patients.

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Levetirasetam, yeni antiepileptik ilaçlardan birisidir. Epilepsi dýþýnda anksiyete bozukluklarý, distoni, levodopa ve nöroleptik ilaçlara baðlý olarak geliþen tardive diskinezinin tedavisinde de kullanýlmaktadýr. Konvülziyon nedeniyle IV fenitoin tedavisi baþlanan 10 yaþýnda erkek hastada kardiyak ritm bozukluðu olmasý üzerine fenitoin tedavisi kesilerek levetirasetam tedavisi baþlandý. Ancak levetirasetam tedavisinin ikinci gününde hastada görsel ve iþitsel halüsinasyonlar gözlendi. Levetirasetam kesilerek yerine sodyum valproat tedavisi baþlandý ve halüsinasyonlarýn kaybolduðu görüldü. Bu olgu ile halüsinasyonun, levetirasetamýn nadir komplikasyonlarýndan biri olduðunu hatýrlatmak istedik.

Levetiracetam is a new antiepileptic drug. In addition to epilepsy, it is also used for treating anxiety disorders and dystonia as well as tardive dyskinesia associated with the use of levodopa and neuroleptic drugs. Phenytoin therapy in a 10-year-old boy with convulsions was discontinued following cardiac rhythm impairment. The patient was then started on levetiracetam. However, visual and auditory hallucinations were observed on the 1st day of levetiracetam therapy. Levetiracetam was discontinued and replaced with sodium valproate, and the hallucinations resolved. The purpose of this report was to remind physicians that hallucinations are one of the rare complications of levetiracetam.

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Chiari network, sinus venosus’un sað kapaðýnýn embriyolojik kalýntýsý olarak nitelenen Eustachian valfe baðlý fibröz að olarak tanýmlanýr. Patofizyolojik olarak önemli bir sonucu olmayan, rastlantýsal olarak saptanan bir yapýdýr. Bununla birlikte, sað atriumda Chiari Network bulunmasý, klinisyeni diðer sað atriyal patolojilerden ayýrmaya zorlar. 76 yaþýnda, koroner arter bypass operasyonu olacak bir hastada, rastlantýsal olarak saptanan, sað atrial trombüse benzeyen geniþ bir Chiari network vakasý sunuyoruz.

The Chiari network is described as a reticulated network of fibers connected to the Eustachian valve identified as the embryological remnant of the right valve of the sinus venosus. It is an incidental finding without any significant pathophysiological consequences. However, the presence of the Chiari network in the right atrium obliges the physician to differentiate from other right atrial pathologies. We present a case of a large Chiari network mimicking a right atrial thrombus with incidental finding in a 76-year-old man undergoing coronary artery bypass surgery.

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Vakamýz 4 yaþýnda kýz hasta ani baþlayan ateþ, nefes darlýðý, ellerde ayakta atma þeklinde hareketler ve aðýzda kayma þikayeti ile acil servise baþvurmuþ, durumu kötüleþince yoðun bakým ünitesinde 6 gün gözetim altýnda tutulmuþtur. Hastanýn çocuklarda Glasgow Koma Skoru 1 idi. LP de hücre olmayýp BOS HSV -1/-2 pozitif olan hasta 14 gün antiviral tedavi almýþtýr. Hastanýn 1 ay önce geçirdiði herpes labialis enfeksiyonu, HSE düþündürmüþ, çekilen son kranial MRG sonuçlarýnda bilateral cerebral iskemik deðiþikliklerin HSE açýsýndan anlamlý olduðu tespit edilmiþtir. Antiviral tedavisi tamamlanan hasta FTR Anabilim Dalýna sevk edilmiþtir. Hastanýn Fonksiyonel seviyesi WeeFIM kullanýlarak deðerlendirildi. Hastaya 30 seans rehabilitasyon programýnda Bobath ilkelerine dayalý nöro-geliþimsel tedavi yaklaþýmlarý uygulandý. Hastanýn WeeFIM sokuru tedavi öncesi 20, sonrasý 88 olarak belirlendi. Kýsýtlama olmaksýzýn yürümeye baþlayan hastanýn sol taraftaki koreo-atetoid hareketleri ve üst ekstremitedeki ihmal fenomeni tama yakýn düzeldi. Hasta medikal tedavi ve ev egzersiz programý eðitimi verilerek taburcu edildi.

In this case, a 4-year-old girl was admitted to the emergency service with the complaints of a sudden onset of fever, shortness of breath, jerking motions of the hands and feet and a sliding mouth. Her condition deteriorated, and she was kept under observation in the intensive care unit for 6 days. The Glasgow Coma Score of the patient was 1. Lumbar puncture revealed a white blood cell count of 0 and cerebrospinal fluid was positive for herpes simplex virus 1 and 2. Antiviral therapy was administered for 14 days. One month earlier, the patient had experienced a herpes labialis infection, which suggested herpes simplex encephalitis (HSE). Cranial magnetic resonance imaging indicated significant bilateral cerebral ischemic changes, which also supported suspicion of HSE. After antiviral treatment, the patient was referred to the department of physical therapy and rehabilitation. The Functional Independence Measure for Children (WeeFIM) scale was used to evaluate the patient. A 30-session rehabilitation program based on the Bobath concept of neurodevelopmental therapy was implemented. Before the treatment, the WeeFIM score was 20 points, and at its conclusion, the score was 88 points. The patient began to walk without limitation and the choreoathetosis was almost completely corrected. The patient was discharged with medical treatment and a home-based exercise training program.

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Yirminci yüzyýlýn ikinci yarýsýnda insidans ve mortalite oranýndaki keskin düþüþe raðmen, mide kanseri halen dünya genelinde kansere baðlý ölümlerin en sýk ikinci nedenidir. Gastrik kanser varyantlarý bütün mide karsinomlarýnýn yaklaþýk %5´ ni oluþturur. Bu yazýda serum alfa-fetoprotein düzeyi yüksek, midesinde germ hücreli tümör ve adenokarsinom birlikteliði tespit edilen 68 yaþýnda nadir bir olgu, klinik ve patolojik bulgularý ile birlikte sunuldu.

Despite a sharp worldwide decline in the incidence and mortality due to gastric cancer during the second half of the 20th century, gastric cancer remains the world’s second leading cause of cancer-related deaths. Variants of gastric cancer account for approximately 5% of all stomach carcinomas. Herein, we report on a rare case of combined germ cell tumor and adenocarcinoma that arose in the stomach of a 68-year-old woman with a high level of alpha-fetoprotein in the serum. Clinical and pathological findings are presented.

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Subdural hematom insidansý yýlda yaklaþýk 100000'de 13,1'dir. Subdural hematom nadiren kafatasý ve dura metastazýna baðlý geliþebilir. Bu çalýþmada, kafatasý ve dura metastazýna baðlý subdural hematom geliþen prostat adenokarsinomu olan 71 yaþýnda bir olgu sunulmuþtur.

The incidence of subdural hematoma is approximately 13.1/100.000 per year. Subdural hematoma due to skull and dura mater metastases is rare. In this study, a 71-year-old patient with prostate adenocarcinoma who presented with chronic subdural hematoma due to skull bone and dura mater metastasis is presented.

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Sepsis ve septik þok kritik çocuk hastalarda morbidite ve mortalitenin önemli nedenlerinden birisidir. Tedavide hedef, yeterli organ perfüzyonunu devam ettirecek ortalama arteriel basýncýnýn saðlanmasýdýr. Katekolaminlere geliþen vasküler hiporeaktivite, alternatif vazopresör arayýþýný zorunlu kýlmýþtýr. Dopamin, dobutamin, adrenalin ve noradrenalin infüzyonuna raðmen pulse counter analizi ile kardiak indeksi yüksek, sistemik vasküler rezistans indeksi düþük ölçülen 14 yaþýnda septik þoklu erkek hastaya 10 μg/kg terlipresin IV puþe uygulandý, ardýndan 1 μg/kg/dk devamlý infüzyona devam edildi. Terlipresin tedavisine yanýt pulse counter analizi ile deðerlendirildi. Terlipresin puþesinden 10 dk. sonra ortalama arter basýncý ve sistemik vasküler rezistan indeksi yükseldi, kardiak indeks ve kalp hýzý düþtü. Noradrenalin infüzyonu dozu azaltýlarak 5. saatte 0,7 μg/kg/dk ‘a düþülebildi. Bu olguyu sunmaktaki amacýmýz; septik þokta, uzun etkili vazopresin analoðu olan terlipresinin vazokonstrüktör etkisini deðerlendirmekti.

Sepsis and septic shock are important causes of morbidity and mortality in critically ill children. The goal of treatment is to ensure adequate mean arterial pressure to maintain organ perfusion. The growing number of instances of peripheral vascular hyporeactivity to catecholamines has necessitated the search for alternative vasopressors. A 14-year-old boy had septic shock, with a high cardiac index and low systemic vascular resistance index (SVRI) measurements according to pulse contour analysis, despite treatment with dopamine, dobutamine, adrenaline, and noradrenaline infusions. A terlipressin (TP) 10 μg/kg intravenous bolus was administered, followed by a 1 μg/kg/minute continuous infusion. The response to TP treatment was assessed using pulse contour analysis. The mean arterial pressure and SVRI increased, and the cardiac index and heart rate decreased within 10 minutes after bolus administration of TP. Noradrenaline infusion could be reduced to 0.7 μg/kg/minute within 5 hours. The goal in presenting this case was to evaluate the vasoconstrictor effects of TP, a long-acting vasopressin analogue, in septic shock.

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