GÝRÝÞ ve AMAÇ: Bu çalýþmada,deneysel peritonitte mesalazin ile yapýlan batýn yýkamanýn TNF alfa,IL- 1beta, IL 6,CRP ve rat akciðerindeki inflamasyona etkileri araþtýrýlmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmada 24 adet 250-280 gr aðýrlýðýnda Sprague Dawley rat kullanýldý.Ratlar izotonik solusyonu veya mesalazin ile batýn yýkamaya göre 3 gruba ayrýldý.Sekonder peritonit çekumun perforasyonu ile oluþturuldu.Grup 1: Peritonit sonrasý herhangi bir iþlem yapýlmayan ratlar Grup 2: Perforasyon sonrasý 24.saatte izotonik ile batýn yýkama yapýlan ratlar Grup 3: Perforasyon sonrasý 24.saatte mesalazin ile batýn yýkama yapýlan ratlar.Kan örnekleri 48.saatte TNF alfa,IL 1 beta, IL 6, CRP ölçümleri için alýndý.Mesalazinin sistemik etkinliðini araþtýrmak için akciðer dokusu örneklendi.
BULGULAR: Gruplar incelendiðinde TNF alpha, IL-1 beta, ve CRP seviyeleri Grup 3'te anlamlý oranda düþüktü (p<0.05).Akciðer dokusunda lökosit infiltrasyonu diðer gruplarla karþýlaþtýrýldýðýnda Grup 3'te daha az oranda tespit edildi.
TARTIÞMA ve SONUÇ: Sekonder peritonitte mesalazin ile batýn yýkama sonrasý TNF alfa,IL 1 beta ve CRP seviyelerinde düþüþ tespit edildi.Sekonder peritonitli hastalarda mesalazin ile batýn yýkama faydalý olabilr.

INTRODUCTION: In this study,the effect of mesalazine was studied on TNF alpha IL-1 beta, IL-6, and C-reactive protein (CRP) levels and inflammatory changes in rat lungs with experimental peritonitis.
METHODS: In total, 24 male Sprague–Dawley rats weighing 250–280 g were used in the study.The rats were divided into three groups based on no irrigation or irrigation with isotonic solution or mesalazine. Secondary peritonitis was generated by cecum penetrations. Group I, no irrigation was given after the development of peritonitis; Group II, irrigation was performed using isotonic solution 24 h after the development of peritonitis; Group III: irrigation was performed using mesalazine 24 h after the development of peritonitis. Blood samples were taken in the 48th hour for measuring TNF alpha, IL-1 beta, IL-6, and CRP levels. Lung tissue samples were taken for examining the effect of mesalazine in the development of systemic sepsis.
RESULTS: TNF alpha, IL-1 beta, and CRP levels were significantly low in Group III than in the other groups (p<0.005). In the histologic examination, leucocyte infiltration in the lung was found low in Group III.
DISCUSSION AND CONCLUSION: TNF alpha, IL-1 beta, and CRP levels and leucocyte infiltration in the lung were found to be low in rats that were administered peritoneal irrigation using mesalazine after the development of secondary peritonitis. Peritoneal irrigation using mesalazine may be useful in patients requiring surgery due to secondary peritonitis.

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INTRODUCTION: Sciatic nerve neuropathy can be observed following intramuscular gluteal injections. The histopathological examination of sciatic nerve damage following intramuscular injection in the gluteal region for acute pain treatment is not feasible in humans due to the inability to dissect and examine the nerve tissue. To overcome this issue, we used a rat model for demonstrating damage to the sciatic nerve tissue after the application of commonly used drug injections.
METHODS: We investigated possible damage following the intramuscular injection of diclofenac, lornoxicam, morphine, and pethidine in a rat model based on histopathological characteristics such as myelin degeneration, axon degeneration, epineurium degeneration, fibrosis, epineurium thickening, perineurium thickening, lymphocyte infiltration, vacuolization, and edema.
RESULTS: All the analgesic drugs used in our study induced histopathological changes in the sciatic nerve. Anti-S100 positivity, showing nerve damage, was found to be the lowest in the group treated with diclofenac. Neurotoxic effects of diclofenac on the sciatic nerve were greater than those of the other drugs used in the study. Lornoxicam induced the least histopathological changes in the nerve.
DISCUSSION AND CONCLUSION: Diclofenac induced severe nerve damage not only after direct injection in the sciatic nerve but also after injection in the area around the nerve. Thus, we recommend restricting the use of intramuscular gluteal injections of diclofenac. Intramuscular use of morphine and pethidine should also be overviewed.

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GÝRÝÞ ve AMAÇ: Daha önce yapýlan patoloji ve otopsi çalýþmalarýnda lokal inflamasyon ile özellikle de adventisyanýn eozinofilik infiltrasyonuyla Spontan Koroner Arter Diseksiyonu (SKAD) arasýnda iliþki olabileceði öne sürülmüþtür. Ancak, sistemik inflamasyonun SKAD’unun patogenezindeki rolü bilinmemektedir. Biz bu çalýþmada SKAD’una baðlý olarak geliþen akut koroner sendrom (AKS) hastalarýnda sistemik inflamatuar aktivasyonun derecesini araþtýrmak istedik.
YÖNTEM ve GEREÇLER: Hastanemizin elektronik medikal veritabaný geriye dönük olarak incelendi ve SKAD iliþkili AKS geliþen 22 hasta bulundu. SKAD-AKS grubuna benzer demografik ve klinik özellikleri olan ve geliþi-güzel seçilen 30 aterosklerotik koroner arter hastalýðýna (KAH) sekonder AKS hastasý ve 30 KAH veya AKS öyküsü olmayan hasta ayný veritabanýndan çalýþmaya dahil edildi.
BULGULAR: Hem SKAD-AKS hem de KAH-AKS grubundaki hastalar kontrol grubu ile kýyaslandýðýnda daha yüksek WBC ve nötrofilik lökosit sayýsýna sahipti. Nötrofil-lenfosit oraný (NLO) ve C-Reaktif Protein (CRP), SKAD grubunda (NLO için 2.01 (1.54-6.17) ve CRP için 0.70 (0.13-2.70)) kontrol grubuna (NLO için 1.55 (1.27-2.13), p=0.03 ve CRP için 0.15 (0.10-0.43), p=0.049) kýyasla sadece SKAD-AKS grubunda anlamlý olarak daha yüksek saptandý. Ancak, SKAD-AKS ve KAH-AKS (NLO için 1.91 (1.41-2.78) ve CRP için 0.41 (0.09-1.10), her iki karþýlaþtýrmada p>0.05) gruplarý arasýnda hiçbir test parametresi açýsýndan anlamlý bir fark bulunmamaktaydý.
TARTIÞMA ve SONUÇ: Sistemik inflamatuar aktivasyonun derecesinin SKAD-AKS hastalarýnda KAH-AKS grubuyla benzer hatta daha fazla saptanmasý dolayýsýyla SKAD-AKS patofizyolojisinde inflamasyonun rolünden söz edilebilir.

INTRODUCTION: Pathological studies have suggested that local inflammation, particularly eosinophilic infiltration of the adventitia, could be related to nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD). However, the role of systemic inflammation in the pathogenesis of NA-SCAD remains unknown. Our aim was to investigate systemic inflammatory activation in patients with an acute coronary syndrome (ACS) secondary to NA-SCAD.
METHODS: The institutional electronic medical database was reviewed, and 22 patients with NA-SCAD-ACS were identified after the review. Furthermore, 30 random patients with CAD-ACS and 30 random subjects without any history of CAD or ACS with demographic and clinical characteristics similar to those of NA-SCAD-ACS patients were identified from the institutional database to be included in the study.
RESULTS: Patients with NA-SCAD-ACS and those with CAD-ACS both had higher white blood cell and neutrophil counts than controls. Neutrophil–lymphocyte ratio (NLR) and C-reactive protein (CRP) levels were only significantly higher in the NA-SCAD-ACS group [2.01 (1.54–6.17) for NLR and 0.70 (0.13–2.70) for CRP] than in the controls [1.55 (1.27–2.13), p=0.03 for NLR and 0.15 (0.10–0.43), p=0.049 for CRP]; however, there were no differences between the NA-SCAD-ACS and CAD-ACS groups [1.91 (1.41–2.78) for NLR and 0.41 (0.09–1.10) for CRP, p>0.05 for both comparisons] regarding all tested parameters.
DISCUSSION AND CONCLUSION: The degree of inflammatory activation in NA-SCAD-ACS patients was similar to, or even greater than, that in CAD-ACS patients; thus, suggesting a role of inflammation in the pathophysiology of NA-SCAD-ACS.

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GÝRÝÞ ve AMAÇ: Safra kesesi kanseri nadir görülen ve çok kötü prognoza sahip bir klinik tablodur. Lenf nodu diseksiyonu ile yapýlan radikal rezeksiyon, tedavinin tek þansýdýr. Bu çalýþmanýn amacý postoperatif erken dönemde safra kesesi kanseri nedeniyle yapýlan radikal rezeksiyonunun klinikopatolojik korelasyonun deðerlendirilmesidir.
YÖNTEM ve GEREÇLER: 2015 ve 2017 yýllarý arasýnda safra kesesi kanseri için için lenf nodu diseksiyonu ile radikal rezeksiyon uygulanan hastalar (n = 24). Demografik veriler, tümörün histopatolojik tipi, preoperatif tümör belirteçleri, patolojik tümör boyutu evresi (invazyon derinliði), lenf nodu metastazý ve postoperatif erken mortalite deðerlendirildi. Hastalar, lenf nodu metastazlarýna göre iki gruba ayrýldý: Grup 1 (lenf nodu metastazý olmaksýzýn) ve Grup 2 (lenf nodu metastazý olan).
BULGULAR: Grup 1 ve grup 2'deki hastalarýn ortanca yaþý sýrasýyla 65 (42-89) ve 68 (48-87) idi (p> 0.05). Kadýn / erkek oraný Grup 1 ve Grup 2'de sýrasýyla 4/4 ve 13/3 (p> 0.05) idi. Grup 2'de artmýþ metastaz eðilimi Grup 1'e göre (% 31'e karþý% 0) (p> 0.05) daha yüksek idi. Grup 2'deki tümörlerin% 88'i ileri evredeyken, grup 1 de bu oran % 37 idi (p <0.05).
TARTIÞMA ve SONUÇ: Safra kesesi kanseri tanýsýnda lenf nodu metastazý ilerlemiþ tümör evresi anlamýna gelmektedir. Bu, daha karmaþýk bir cerrahi rezeksiyona ve erken postoperatif mortaliteye neden olmaktadýr.

INTRODUCTION: Gallbladder cancer (GBC) is a rare clinical entity that has a poor prognosis. Radical resection with meticulous lymph node dissection is the only treatment option. The aim of the present study is to evaluate the efficacy of radical resection for GBC in the early postoperative period with the viewpoint of clinicopathological correlation.
METHODS: Patients (n=24) who underwent radical resection with lymph node dissection for GBC between 2015 and 2017 were included. Demographic data, histopathologic tumor type, preoperative tumor markers, pathologic tumor size/stage (depth of invasion), lymph node metastasis and metastasis rates, and postoperative early mortality were evaluated. The patients were grouped in two groups according to lymph node metastases: Group 1 (without lymph node metastasis) and Group 2 (with lymph node metastasis).
RESULTS: The median age of the patients in Group 1 and Group 2 was 65 (range, 42–89) years and 68 (range, 48–87) years, respectively (p>0.05). The female/male ratio in Group 1 and Group 2 was 4/4 and 13/3, respectively (p>0.05). There was a tendency for increased metastasis in Group 2 compared with Group 1 (31% vs. 0%) (p>0.05). Also, 88% of the tumors in Group 2 were in the advanced stage, whereas the rate was 37% in Group 1 (p<0.05). There was early postoperative mortality in seven patients who underwent resection. Four of the seven patients (43%) were from Group 2 and three (37%) from Group 1 (p>0.05).
DISCUSSION AND CONCLUSION: Lymph node metastasis in GBC indicates advanced tumor stage. This causes a more complex surgical resection and therefore results in higher early postoperative mortality.

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GÝRÝÞ ve AMAÇ: Hekimlerin öncelik sýrasýna göre oluþturduklarý kiþisel (K)-ilaçlarý ayný endikasyon özelinde bile farklýlýklar gösterebilmektedir. Biz bu çalýþmada hekimlerin akýlcý ilaç kullanýmý doðrultusunda K-ilaç listesi hazýrlanmasýna iliþkin bilgi ve tutumlarýný deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: K-ilaç listesi hazýrlamaya iliþkin bilgi ve tutumun ölçüldüðü anket aracýlýðýyla toplam 1062 aile hekimi ve 562 uzman hekim ile görüþülmüþtür.
BULGULAR: K-ilaç listesi hazýrlayan hekim sayýsý uzman hekimlere göre (%64,9) aile hekimlerinde (%72,8) anlamlý olarak daha fazla bulunmuþtur. Her iki grupta da kadýn hekimlerde daha fazla olmak üzere, kadýn aile hekimlerinde (%75,9) K-ilaç listesi hazýrlama tutumu kadýn uzman hekimlere (%67,8) göre anlamlý olarak daha yüksek saptanmýþtýr (p=0,002). Uzman hekimlerde K-ilaç listesi hazýrlama tutumu artan yaþ ile birlikte azalma eðilimi göstermiþ (p=0,006) ve kýdemli uzman hekimler bu tutumu genç uzman hekimlere göre anlamlý olarak daha az sergilemiþtir (p=0,007). Aile hekimleri ve uzman hekimler K-ilaç listesi hazýrlýðý sýrasýnda en sýk yararlandýklarý kaynaðýn “ilaç firmasý faaliyetleri” olduðunu belirtmiþtir (sýrasýyla %78,9 ve %74,3). Hekimlerin %80’inden fazlasý (aile hekimlerinin %80.9’u ve uzman hekimlerin %83.6’sý) orijinal ve jenerik ilaçlar arasýnda farkýn “mevcut” veya “kýsmen mevcut” olduðunu belirtmiþtir. Her iki grupta her 10 hekimden yaklaþýk 1’i reçeteleme sýrasýnda hastalarýnýn “karaciðer/böbrek hastalýðý” bilgisinden “nadiren” yararlandýðýný veya “hiç” yararlanmadýðýný ifade etmiþtir.
TARTIÞMA ve SONUÇ: Erkekler ve kýdemli hekimlerde daha belirgin olmak üzere, K-ilaç listesi hazýrlama tutumu beklenenin altýnda kalmýþtýr. Ayrýca ilaç seçiminde en sýk yararlanýlan bilgi kaynaðýnýn ilaç firmasý tanýtýmlarý olmasý dikkat çekicidir. Bu bulgular, tüm hekim gruplarýnda K-ilaç listesinin daha etkin kullanýmýna odaklanan akýlcý ilaç kullanýmý yaygýnlaþtýrma giriþimlerine ihtiyaç duyulduðuna iþaret etmektedir.

INTRODUCTION: Physicians’ personal (P) drugs, which were ranked by priority, may show variations even for the same indication. We aimed to evaluate physicians’ knowledge and attitudes regarding P-drug list preparation with respect to the rational use of medicine context.
METHODS: A total of 1062 family physicians (FPs) and 562 specialist physicians (SPs) were interviewed and questioned about their knowledge and attitude regarding P-drug list preparation.
RESULTS: Compared with SPs (64.9%), significantly more number of FPs (72.8%) prepared a P-drug list. Women were more likely to prepare the P-drug list in both groups; gender comparison showed that significantly more number of female FPs (75.9%) exhibited this attitude than female SPs (67.8%) (p=0.002). Among SPs, the trend for P-drug list preparation attitude decreased with increasing age (p=0.006), and significantly less number of senior physicians showed this attitude compared with junior physicians (p=0.007). The most common source of information referred to by FPs (78.9%) and SPs (74.3%) during P-drug list preparation was “pharmaceutical company activities.” More than 80% of responders (80.9% of FPs and 83.6% of SPs) specified that a difference “exists” or “partially exists” between original and generic drugs. Approximately one in 10 physicians in both groups stated that they “rarely/never” consider their patients’ “liver/kidney disease” during prescribing.
DISCUSSION AND CONCLUSION: More prominently in male and senior physicians, the attitude of P-drug list preparation remained lower than expected. Moreover, it is remarkable that pharmaceutical company promotions are the most common source of information for drug selection. These findings disclose the need for the rational use of medicine dissemination interventions for all physicians focusing on more effective use of P-drug list.

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GÝRÝÞ ve AMAÇ: Pankreasýn solid psödopapiller tümörü (SPT) çocukluk yaþ gurubunda çok nadir görülen pankreasýn birincil tümörlerindendir. Düþük malign potansiyele sahiptir ve radikal rezeksiyon ile prognoz oldukça iyidir. Lokal rekürrens ve inkomplet rezeksiyon sonrasý uzak metastaz nadiren bildirilmiþtir
YÖNTEM ve GEREÇLER: 2010-2017 tarihleri arasýnda Erciyes Üniversitesi Týp Fakültesi Çocuk Hastanesi’nde patolojik inceleme ile SPT tanýsý alan altý hastanýn dosyasý retrospektif olarak incelendi. Hastalarýn demografik özellikleri, tümör yerleþimi ve boyutu, taný yöntemleri, uygulanan immünohistokimyasal boyama özellikleri, uygulanan medikal ve cerrahi tedavileri kaydedildi.
BULGULAR: SPT tanýsý alýp çalýþmaya dahil edilen dördü kýz ikisi erkek altý hastanýn ortalama yaþý 14 (nim-max; 13-16)’dü. En sýk baþvuru þikayeti karýn aðrýsýydý. Hastalarýn üçünde (%50) kitle pankreas baþýnda, üçünde (%50) pankreas kuyruk kesimindeydi. Üç hastaya whipple ameliyatý, bir hastaya distal pankreatektomi, bir hastaya distal pankreatektomi ve splenektomi, bir hastaya subtotal pankreatektomi iþlemi yapýldý. Ý mmunohistokimyasal boyamalarýnda tüm hastalarda beta katenin, keratin, CD56, vimentin CD 10 ile boyama pozitif olarak saptandý.
TARTIÞMA ve SONUÇ: Sonuç olarak SPT nadir görülen ve düþük malignite oranýna sahip pankreatik kitledir. Tanýmlayýcý belirtilere neden olmamasý ve çoðunlukla asemptomatik olmasý nedeni ile taný konulmasý gecikebilmektedir. Cerrahi olarak tam rezeksiyonla sað kalým oraný oldukça yüksektir

INTRODUCTION: Solid pseudopapillary tumor (SPT) of the pancreas is an extremely rare primary tumor in the pediatric age group. It has a low malignant potential and the prognosis is good if radical resection of the tumor is performed. Local recurrence and distant metastasis has only rarely been reported following incomplete resection.
METHODS: A retrospective review of the medical records of 6 patients diagnosed as SPT according to a histopathological examination at the Children’s Hospital of Erciyes University School of Medicine between 2010 and 2017 was performed. Demographic characteristics, tumor localization and size, diagnostic method, immunohistochemical staining features, and medical and surgical treatments employed were recorded.
RESULTS: There were 4 girls and 2 boys with the diagnosis of SPT included in this study. The mean age of the patients was 14 years (min-max: 13–16 years). The most common presenting complaint was abdominal pain. The mass lesion was at the head of the pancreas in 3 cases (50%) and the tail of the pancreas in the remaining 3 patients (50%). A Whipple procedure was performed in 3 cases, a distal pancreatectomy in 1, a distal pancreatectomy plus splenectomy in 1, and a subtotal pancreatectomy in 1patient. Immunohistochemistry revealed positive staining for beta-catenin, keratin, CD56, vimentin, and CD10 in all cases.
DISCUSSION AND CONCLUSION: SPT is a rarely seen pancreatic mass with low rate of malignancy. Diagnosis may be delayed due to its asymptomatic nature in most cases and a lack of descriptive symptoms. The survival rate is quite high after radical resection.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, yenidoðan döneminde semptomatik veya asemptomatik olup rastlantýsal olarak keþfedilen vitellin kanal patolojisi (VKP) olan olgularýn yönetimini ve sonuçlarýný gözden geçirmektir.
YÖNTEM ve GEREÇLER: 1985 - 2015 yýllarý arasýnda tesadüfen keþfedilen veya semptomatik olup VKP rezeksiyonu yapýlmýþ yenidoðanlar geriye dönük olarak yaþ, cinsiyet, klinik özellikler, tedavi, perioperatif bulgular, ektopik doku patolojisi ve ameliyat sonrasý izlem açýsýndan incelendi.
BULGULAR: Çalýþmaya 36 yenidoðan dahil edildi. Yirmi altý erkek, 10 kýz (2.6: 1) idi. Ortalama aðýrlýk 2.400 g (800 g - 3090 g) idi. Onaltý vakada; (14 erkek ve iki kýz, 7: 1) VKP'si cerrahi olarak çýkartýldý. Patolojik deðerlendirmede olgularýn% 43'ünde (n: 7) ektopik gastrik mukoza vardý. VKP 12 erkekte ve sekiz kýzda (1.5: 1) tesadüfen keþfedildi. Bu grupta VKP 10 olguda (% 50) çýkarýldý. Tesadüfen bulunmuþ diðer vakalarda, VKP yerinde býrakýldý. Çýkartýlan olgularýn% 10'unda ektopik mide mukozasý görüldü. Ektopik gastrik dokular semptomatik VKP vakalarýnda, tesadüfen bulunanlara ve VKP çýkarýlan olgulardan daha sýktý (p <0.05).

Cerrahi olarak çýkartýlan olgularda erkek baskýnlýðý, tesadüfen keþfedilen olgulardan daha yüksekti (p <0.05). VKP tesadüfen keþfedilen bir hasta üç yýl sonra MD nedeniyle intussusepsiyon ve týkanma ile baþvurdu ve bir hasta 11 yaþýndayken rektal kanama ile baþvurdu.
TARTIÞMA ve SONUÇ: Yenidoðanlarda semptomatik VKP'si belirgin cinsiyet farklýlýðý gösterir. Semptomatik olgularýn, semptomatik olmayan olgulara kýyasla ektopik gastrik doku içerme olasýlýðý daha yüksektir. Tesadüfen saptanan ve VKP çýkarýlmayan olgular ilerde karþýlaþabilecek komplikasyonlardan dolayý yakýn takip edilmelidir.

INTRODUCTION: The aim of this study was to review the management of pediatric cases of vitelline duct pathology (VDP) detected surgically or incidentally during the neonatal period and the outcomes.
METHODS: The data of newborns who were symptomatic and underwent VDP resection or who were incidentally diagnosed with VDP at a single institution between 1985 and 2015 were retrospectively analyzed in terms of age, sex, clinical features, treatment, perioperative findings, ectopic tissue pathology, and postoperative follow-up information.
RESULTS: Among the 36 newborns enrolled in this study, 26 were male and 10 were female (2.6: 1). The median weight was 2400 g (range: 800–3090 g). In 16 cases (14 males and 2 females; 7: 1) the VDP was surgically repaired. Pathological evaluation indicated that 43% (n=7) of the cases had ectopic gastric mucosa. VDP was incidentally discovered in 12 males and 8 females (1.5: 1). VDP was removed in 10 cases (50%) and left intact in others. Ectopic gastric mucosa was observed in 10% of the VDP removal cases. Ectopic gastric tissue was more prevalent in the surgical VDP cases than in the incidentally discovered and VDP removal cases (p<0.05). Male predominance was greater in the surgically repaired cases than in the incidentally discovered cases (p<0.05). One patient whose VDP was discovered incidentally was admitted 3 years later with obstruction due to intussusception caused by Meckel’s diverticulum, and 1 patient was admitted with rectal bleeding at 11 years of age.
DISCUSSION AND CONCLUSION: Symptomatic VDP in the newborn demonstrates a significant gender difference. Symptomatic cases are more likely to have ectopic gastric tissue than non-symptomatic cases. Incidentally detected cases without removal should be followed closely for future complications.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada Geriatrik Depresyon- 15 Scale (GDS-15)’in Türk yaþlý nüfusunda geçerlik ve güvenirliðinin deðerlendirilmesi ve DSM-5 depresyon kriterleri ile sonuçlarýn kýyaslanmasý amaçlanmaktadýr.
YÖNTEM ve GEREÇLER: Çalýþmaya toplam 329 ayaktan tedavi gören hasta dahil edilmiþtir. Ýlk aþamada hastalara Mini Mental Durum Deðerlendirme testi uygulanmýþtýr. Hastalarýn DSM-5 taný kriterleri baz alýnarak depresyon tanýsýný karþýlayýp karþýlamadýklarý incelendikten sonra, baþka bir uygulayýcý tarafýndan GDS uzun formu uygulanmýþtýr. Uzun formun içinden kýsa formun maddeleri ayrýþtýrýlarak iki ayrý ölçek puaný elde edilmiþtir. Oluþturulan GDS-30 ve GDS-15 puanlarý DSM-5 ile karþýlaþtýrýlmýþtýr.
BULGULAR: GDS-30 un GDS-15 ile korelasyonu r = 0.966 idi (P < 0.001). DSM - 5 kriterleri dikkate alýnarak yapýlan analizde, kesme noktasý 5 ve üzeri olarak alýndýðýnda, GDS-15'in depresyonu saptamasýndaki duyarlýlýk, özgüllük, pozitif prediktif deðer ve negatif prediktif deðerleri sýrasýyla % 92,% 91,% 76 ve% 97 olarak bulundu. GDS-15 için ROC eðrisi altýnda kalan alan 0,97 idi (%95 güven aralýðý) (p < 0.001). Toplam ölçek için Cronbach alfa katsayýsý 0.920 idi.
TARTIÞMA ve SONUÇ: GDS-15, týpký GDS-30 gibi yaþlýlarda depresyonu ortaya koymada yararlý bir ölçektir. Bu çalýþma, GDS-15’in Türk yaþlý nüfusunda ve birincil bakým merkezlerinde, geçerlilik ve güvenilirliðine kanýt saðlamaktadýr.

INTRODUCTION: The present study aimed to assess the validity and reliability of Geriatric Depression-15 Scale (GDS-15) in Turkish older adults and to compare the results with Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5) depression criteria.
METHODS: A total of 329 outpatients were enrolled. In the first step, the patients underwent the Mini-Mental State Examination. After assessing whether the patients meet the diagnosis of depression based on DSM-5 diagnostic criteria, another researcher applied the long form of GDS. After sorting the items of short form out of the long form, two separate scores were obtained. The scores of GDS-30 and GDS-15 scales were compared with the scores of DSM-5.
RESULTS: The correlation of GDS-30 with GDS-15 was r=0.966 (p<0.001). The analysis performed considering DSM-5 criteria revealed that the sensitivity, specificity, positive predictive value, and negative predictive value of GDS-15 in determining depression were 92%, 91%, 76%, and 97%, respectively, when the cutoff value was taken as ≥5. The area under the receiver operating characteristics curve [95% confidence interval (CI)] was 0.97 (95% CI=0.947–0.996) for GDS-15 (p<0.001). The Cronbach alpha coefficient for the total scale was 0.920.
DISCUSSION AND CONCLUSION: GDS-15, just as GDS-30, is a beneficial scale in determining depression in older adults. This study provides an evidence for the validity and reliability of GDS-15 in Turkish elderly population and primary care centers.

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GÝRÝÞ ve AMAÇ: Ýskemik kolit; abdominal aort anevrizmasýnýn (AAA) açýk ve endovasküler (EVAR) yöntemle onarýmý sonrasý oluþan, mortalitesi oldukça yüksek bir komplikasyondur. Rüptüre AAA vakalarý sýklýkla acil þartlarda cerrahiye alýnýr, bu durum iskemik kolit ve iliþkili mortalitenin artýþýna neden olarak prognoza olumsuz etki etmektedir. Bu çalýþmada amaç; infrarenal AAA cerrahisisonrasý iskemik kolit nedeniyle rezeksiyon uygulanan hastalarda rüptüre anevrizmanýn morbidite ve mortaliteye etkisini araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Ocak 2012 ile Aralýk 2016 tarihleri arasýnda kliniðimizde, aort anevrizma cerrahisinden sonra iskemik kolit inedeniyle rezeksiyon yapýlan hastalar retrospektif olarak incelendi. Hastalar rüptüre anevrizmasý olanlar ve olmayanlar olarak iki gruba ayrýlarak karþýlaþtýrýldý.
BULGULAR: Ocak 2012 ile Aralýk 2016 arasýnda kardiyovasküler cerrahi kliniðinde toplam 275 infrarenal AAA olgusu tedavi edildi. On dört hasta (% 5) rezeksiyon gerektiren iskemik kolit geliþti. EVAR'lý 4 (% 1.8), açýk cerrahi yapýlan 10 vaka (% 17.5) Ýskemik kolit nedeniyle ameliyat edildi. Her iki grup arasýnda demografik veriler ve cerrahi giriþimler açýsýndan istatistiksel olarak anlamlý fark yoktu. Rüptüre AAA grubunda ölçülen laktat deðeri 2.6 mmol / L (1.1- 10.7) iken rüptüre olmamýþ grupta 1.1 mmol / L (0.8-5.4) idi. Yapýlan karþýlaþtýrmada fark istatistiksel olarak anlamlýydý p = 0.038). Gruplar arasýnda yapýlan karþýlaþtýrmada, gastrointestinal semptomlar, cerrahiye alýnma süreleri, etkilenen kolon segmenti ve yapýlan intestinal cerrahi yönünden fark saptanmadý. Rüptüre AAA grubunda mortalite oraný% 83.3, rüptüre olmayan AAA grubunda ise% 62.5 idi. Rüptüre grupta mortalite oraný daha yüksek olmasýna raðmen, istatistiksel olarak anlamlý deðildi (p = 0.393).
TARTIÞMA ve SONUÇ: Ýskemik kolit, AAA cerrahisinin mortalitesi yüksek bir komplikasyonudur. AAA’ da iskemik kolit mortaliteyi artýrmaktadýr. Özellikle rüptüre olan ve açýk cerrahi yöntemle anevrizma onarýmýnýn yapýldýðý vakalarda iskemik kolit akýlda bulundurulmalý, þüpheli vakalarda laparotomi ve erken müdahalenin liberal kullanýmý mortalite oranlarýný azaltacaðý kanaatindeyiz.

INTRODUCTION: The aim of this study was to investigate the effects of ruptured aneurysm on morbidity and mortality in patients with ischemic colitis (IC) and resection following infrarenal abdominal aortic aneurysms (AAA) surgery.
METHODS: Between January 2012 and December 2016, patients who underwent resection for ischemic colitis in our clinic were retrospectively reviewed. Data on the ruptured condition of the aneurysm, the emergency or elective form of aneurysm surgery, treatment method for the aneurysm (EVAR-open) were obtained. The patients were compared and divided into two groups as those with ruptured aneurysm and those without.
RESULTS: A total of 275 infrarenal AAA cases were treated by the cardiovascular surgery clinic between January 2012 and December 2016. Fourteen patients (5%) developed ischemic colitis requiring resection. Four (1.8%) patients with EVAR and 10 (17.5%) patients with open surgery were operated because of IC. No statistically significant difference was observed between the two groups in terms of demographic data and surgical procedures. The intergroup comparison did not reveal any statistically significant difference among gastrointestinal (GIS) symptoms, the time period until surgery, the involved colon segment, and the surgical procedures performed. The mortality rate in ruptured AAA group was 83.3%, while it was 62.5% in the non-ruptured AAA group. In spite of the fact that the mortality rate was high in the ruptured group, it was not statistically significant (p=0.393).
DISCUSSION AND CONCLUSION: IC is a complication of AAA surgery with a high mortality rate. Rupture in abdominal aortic aneurysm increasing mortality in IC patients. This complication with a high mortality rate following open AAA surgery should be noted by surgeons and we believe that the liberal utilization of laparotomy and early intervention in suspected cases will decrease mortality rates.

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GÝRÝÞ ve AMAÇ: Giriþ: Ektopik gebelik tedavisinde medikal veya cerrahi tedavi seçeneklerinden hangisinin daha baþarýlý sonuçlara sahip olduðu tartýþmalýdýr. Tedavi öncesi yüksek serum hCG seviyesinin medikal tedavi baþarýsýzlýðýndaki en önemli belirleyici etken olduðu bilinmesine raðmen, tedavi öncesi spesifik serum hCG seviyesi aralýðýna göre hangi tedavi modalitesinin uygun olduðu halen açýklýða kavuþturulamamýþtýr. Hastalarý tek doz metotreksat tedavisine uygun olmayan aday yapan deðiþkenler de benzer þekilde belirsizdir.
Amaç: Bu çalýþmanýn amacý tubal ektopik gebeliði olan kadýnlarda tek doz metotreksat tedavisinin baþarýsý ile iliþkili prediktif faktörleri belirlemektir.
YÖNTEM ve GEREÇLER: Tek merkezli retrospektif çalýþmamýzda tek doz metotreksat uygulanan 101 tubal ektopik gebelik tanýlý hasta seçildi. Gebelik haftasý, tedavi öncesi hCG deðeri, ektopik odaðýn boyutu, batýndaki sývýnýn varlýðý metotreksat tedavisinin baþarýlý ve baþarýsýz olduðu iki grup arasýnda karþýlaþtýrýldý
BULGULAR: Hastalarýn yaþ ortalamasý 30.6±5.8(19-42) ve ilk metotreksat enjeksiyonu sýrasýndaki ortalama gebelik haftasý 7.0±2.13(2.3-13.6) idi. Metotreksat ile medikal tedavinin baþarý oraný 77.2%(n=79) olarak bulundu. Baþarýlý medikal tedavinin uygulandýðý gruptaki ortalama hastanedeki kalýþ süresi 4.21±1.89 gün olarak hesaplandý ve medikal tedavinin baþarýz olduðu grupta ise bu süre 6.92±2.13 gün bulundu(p<0.05). Ultrasonografide batýnda sývý bulunan hastalardaki medikal tedavinin baþarýsýzlýk oraný 37.8%, sývý bulunmayan grupta ise 12.7% idi(p =0.03). Medikal tedavinin baþarýsýz olduðu gruptaki 1, 4 ve 7. güne ait ortalama hCG deðerleri sýrasýyla 3887-2589mIU / mL, 2814-1287mIU / mL, and 1119-285 mIU / mL olarak bulundu ve bu deðerler istatistiksel olarak anlamlý olarak yüksek idi (p<0.05). Metotreksat tedavisinin baþarýsýz olduðunu belirleyen sýnýr hCG deðeri 1362mIU / mL olarak bulundu.
TARTIÞMA ve SONUÇ: Bu çalýþma ile hCG seviyesi 1362mIU/mL ‘nin altýnda olan hastalaýn metotreksat tedavisi için uygun aday olduklarý bulundu. Bu hCG eþik seviyesi kesin bir sýnýr olmasa da metotreksat ile tedavi baþarýsý veya baþarýsýzlýðý olasýlýðýný belirlemekiçin kullanýlabilir. Ultrasonografide abdominal sývýnýn varlýðý kötü prognostik faktör olarak deðerlendirilebilir ancak ektopik odaðýn boyutunun tedavi baþarýsý ile baðlantýsý bulunamamýþtýr

INTRODUCTION: It is controversial whether medical or surgical treatment options have more successful results in ectopic pregnancy treatment. Although high pretreatment serum hCG levels have been known to be the most important predictor, the appropriate treatment modality for a specific range of hCG level remains unclear. Furthermore, the variables that make a patient a bad candidate for single-dose methotrexate treatment is unclear.
The aim of this study was to identify predictive factors associated with the success of single-dose methotrexate treatment in women with ectopic pregnancy.
METHODS: In this retrospective study, 101 women with tubal ectopic pregnancies who had been treated with single-dose methotrexate were selected. The gestational ages, pretreatment hCG values, ectopic mass size, and fluid presence in the abdomen were compared between the groups.
RESULTS: The mean age of the patients was 30.6±5.8 (range, 19–42) years, and the gestational age at first injection was 7.0±2.13 (range, 2.3–13.6) weeks. The overall treatment success rate was 77.2% (n=79). The mean duration of hospital stay was 4.21±1.89 days in the successfully treated group and 6.92±2.13 days in the failure group (p<0.05). The rate of treatment failure in patients with abdominal fluid was 37.8%, and it was 12.7% in the non-fluid group (p=0.03). hCG values on days 1, 4, and 7 were significantly higher in the unsuccessful group (3887–2589 mIU/mL, 2814–1287 mIU/mL, and 1119–285 mIU/mL, respectively; p<0.05). The cutoff hCG value, which determined the failure of methotrexate treatment, was found to be 1362 mIU/mL.
DISCUSSION AND CONCLUSION: In present study, patients with hCG value <1362 mIU/mL were found to be good candidates for methotrexate treatment. Although not strictly decisional, this hCG threshold level can be used to decide on the likelihood of methotrexate success or failure. Detection of abdominal fluid on ultrasonography also can be assessed as a bad prognostic factor, but size of ectopic mass does not correlate with methotrexate treatment success.

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GÝRÝÞ ve AMAÇ: Eklem hipermobilitesi (EH), eklemlerin fizyolojik hareket sýnýrlarýnýn üzerinde hareket geniþliðine sahip olmasýyla karakterize klinik bir durumdur. EH birçok kas iskelet sistemi yakýnmalarý ile birlikte olabilmektedir. Toplumda yaygýn görülen kas-iskelet sistemi aðrýsý nedenlerinden biri omuz aðrýsýdýr. Çalýþmamýzda farklý patofizyolojik mekanizmalarla omuz aðrýsý etkeni olan subakromial sýkýþma sendromu (SSS) ve omuzun adeziv kapsülitinin (AK) eklem hipermobilitesi ile iliþkisini incelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmaya fiziksel týp ve rehabilitasyon polikliniðimize baþvuran, klinik ve muayene ile SSS ve AK tanýsý konulan 18-70 yaþ arasýndaki olgular dahil edildi. Kontrol grubu olarak ayný yaþ grubundaki kas ve iskelet sistemi aðrýsý olmayan olgular alýndý. Tüm olgular hipermobilite açýsýndan generalize eklem hipermobilitesi (GEH) için Beighton skoru, benign eklem hipermobilite sendromu (BEHS) için ise revize 1998 Brighton kriterleri ile deðerlendirildi.
BULGULAR: Çalýþmamýza dahil olan 124 olgunun 71’i (%57.3) kadýn, 53’ü (%42.7) erkek idi. AK grubunda GEH olan olgu yoktu. SSS grubunda 2 (%4,50) olguda, kontrol grubunda 3 (%7.5) olguda GEH vardý. AK grubunda 4 (%10), SSS grubunda 6 (%13.63), kontrol grubunda ise 2 (%5) olguda BEHS saptandý. Gruplar arasýnda hipermobilite varlýðý açýsýndan istatistiksel olarak anlamlý fark saptanmadý (p>0.05). Beighton skorlarý açýsýndan karþýlaþtýrdýðýmýzda AK grubunun Beighton skorlarý, kontrol grubuna kýyasla istatistiksel olarak anlamlý düzeyde düþük bulundu (p<0.05).
TARTIÞMA ve SONUÇ: Çalýþmamýz SSS, AK ve kontrol gruplarý arasýnda GEH ve BEHS açýsýndan farklýlýk olmadýðýný göstermektedir. AK grubunda Beighton skorlarýnýn kontrol grubuna göre daha düþük bulunmasý, eklem hipermobilitesi olanlarda AK geliþme ihtimalinin daha düþük olabileceðini düþündürmektedir.

INTRODUCTION: Joint hypermobility (JH) is a clinical condition in which the joints move beyond the expected physiological range of motion. JH can be accompanied by many musculoskeletal complaints. One of the common causes of musculoskeletal pain is shoulder pain. The aim of this study was to investigate the relationship between subacromial impingement syndrome (SAIS), shoulder adhesive capsulitis (AC), and JH in patients with shoulder pain.
METHODS: Patients aged between 18 and 70 years who presented at the physical medicine and rehabilitation outpatient clinic and who were diagnosed with SAIS or AC in a clinical and physical examination were included in the study. Patients in the same age group without musculoskeletal system pain were included in a control group. All of the cases were assessed for hypermobility using the Beighton score for generalized joint hypermobility (GJH), and the revised 1998 Brighton criteria for benign joint hypermobility syndrome (BJHS).
RESULTS: Of the 124 cases included in the study, 71 (57.3%) were female and 53 (42.7%) were male. There was no case of GJH in the AC group. There were 2 (4.50%) cases in the SAIS group and 3 (7.5%) in the control group. BJHS was found in 4 (10%) cases in the AC group, 6 (13.63%) in the SAIS group, and 2 (5%) cases in the control group. There was no statistically significant difference between groups in terms of JH (p>0.05). The Beighton scores of the AC group were statistically lower those of the control group (p<0.05).
DISCUSSION AND CONCLUSION: The results of this study indicated no significant difference between the SAIS group, the AC group, and the control group in terms of GJH and BJHS. The fact that Beighton scores were lower in the AC group than in the control group suggests that the probability of developing AC in those with JH may be lower.

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GÝRÝÞ ve AMAÇ: Kulak geliþiminde altta yatan moleküler olaylar birçok düzenleyici molekülü içermektedir ki, kulak atrezili hastalarda mikroRNAlarýn rolü henüz açýklanmamýþtýr. Burada, 20-22 nükleotid uzunluðunda kodlanmayan bu RNA’larýn ekspresyonlarýný araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmamýzda apoptoz, anjiyogenez ve kondrogenez gibi farklý yolaklarda transkripsiyon sonrasý gen ekspresyonunu kontrol eden 12 miRNA seçildi. Deðiþen miRNA ekspresyonlarý 7 kulak atrezili hasta ile 8 saðlýklý kontrolde gerçek zamanlý PCR metodu kullanýlarak analiz edildi.
BULGULAR: Kulak atrezili hastalarda apoptozisi düzenleyen miRNA ekspresyonlarýný anlamlý olarak düþük bulduk. Bunlarýn arasýnda kontrol grubuyla kýyaslandýðýnda; miR-126 (MIR126), miR-222 (MIR222) ve miR-21 (MIR21) ekspresyonlarý sýrasýyla 76,2 (p=0.041), 61,8 (p=0.000), 30,5 (p=0.009) 71.21 (p=0.042) kat azalmýþtýr.
TARTIÞMA ve SONUÇ: Kulak atrezisi hastalarýnda apoptozu düzenleyen miRNA'larýn ekspresyonlarýnýn azalmasý, anormal kulak geliþimine neden olabilir. Tümör proteini p53'ün (TP53), p53 upregüle apoptoz modülatörünün (PUMA), fas hücre yüzey ölüm reseptörünün (FAS), fas hücre yüzeyi ölü reseptör ligandýnýn (FasL) ve fosfataz ve tensin homoloðunun (PTEN) düzenlenmesindeki deðiþiklikler doðrudan veya apoptozla iliþkili yolaklar üzerinden özellikle de dýþ kulak geliþimi sýrasýnda önemli rol oynayabilir. Bu, apoptozu düzenleyen miRNA´lar ile kulak atrezisi / mikrotia arasýndaki olasý iliþkiyi gösteren ilk çalýþmadýr.

INTRODUCTION: The molecular events underlying ear development involve numerous regulatory molecules; however, the role of microRNAs (miRNAs) has not been explored in patients with ear atresia. Here, we aimed to investigate the expressions of 20–22 nucleotide noncoding RNAs.
METHODS: We selected 12 miRNAs that function to control post-transcriptional gene expression in different pathways, including apoptosis, angiogenesis, and chondrogenesis. The altered miRNA expressions were analyzed by real-time PCR from serum samples of 7 patients with ear atresia and 8 controls.
RESULTS: We found that the expression of apoptosis-regulating miRNAs was significantly downregulated in patients with ear atresia. TThe expressions of miR126, miR146a, miR222, and miR21 were significantly decreased by 76.2-(p=0.041), 61.8-(p=0.000), 30.5-(p=0.009), and 71.21-fold (p=0.042), respectively, compared with controls.
DISCUSSION AND CONCLUSION: Abnormal ear development in ear atresia patients, could possibly be due to the reduced expression of apoptosis regulating miRNAs. Changes in the regulation of tumor protein p53 (TP53), p53 upregulated modulator of apoptosis (PUMA), Fas cell surface death receptor (FAS), FAS ligand (FasL), and phosphatase and tensin homolog (PTEN) directly or within the apoptosis-related cascades may play important roles during development, particularly in the external ear. This is the first report to present the possible association between apoptosis-regulating miRNAs and ear atresia/microtia.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý varus gonartrozunun cerrahi tedavisinde uyguladýðýmýz proksimal tibia medial biplanar retrotüberkül açýk kama osteotomi tekniðinin erken dönem sonuçlarýný deðerlendirmek ve literatür ile kýyaslamaktýr.
YÖNTEM ve GEREÇLER: Bu amaç doðrultusunda varus dizilimine sahip medial gonartrozu bulunan 22 hastanýn 23 dizine uygulanan proksimal tibia medial biplanar retrotüberkül açýk kama osteotomi sonuçlarýný incelendi.
BULGULAR: Hastalarýn 20’ si kadýn 2’ si erkekti. Hastalarýn ameliyat esnasýndaki yaþ ortalamalarý 56.24 (44-66), beden kitle indeksleri ortalama 31.95 (23.4 - 44.9), ameliyat öncesi ortalama Hospital for Special Surgery (HSS) skoru 68.7 (48 - 83) idi. Ameliyat öncesi ortalama femorotibial anatomik aks açýsý 186.39°(173 - 194), ortalama Insall-Salvatti indeks deðeri 1.04 (0.94 -1.171) idi.
Hastalarýn ortalama takip süresi 30.19 (6 - 42) aydýr. Son takiplerinde HSS skoru ortalama 86.48 (74 - 100), femorotibial anatomik aks açýsý 175°(168 - 171), Insall-Salvatti indeks deðeri 1.06 (0.857 – 1.32) idi.
Hastalarýn ameliyat öncesi ve son kontrollerindeki HSS skoru ve femorotibial anatomik aks açýsýnda istatistiksel olarak anlamlý düzelme mevcutken, Insall-Salvatti indeks deðerleri arasýnda istatistiksel olarak anlamlý farklýlýk saptanmamýþtýr.
Bir hastada fatal olmayan pulmoner emboli, bir hastada cerrahiden bir yýl sonra geliþen derin ven trombüsü, iki hastada geçici duysal sinir hasarý, bir hastada rabdomyoliz ve bir hastada da düzeltme derecesinde kayýp (nüks) geliþti.

TARTIÞMA ve SONUÇ: Çalýþmamýza göre; proksimal tibia medial biplanar retrotüberkül osteotomisi ile varus gonartrozlu hastalarda, frontal plan ve sagittal plan deformiteleri düzeltilebildiði gibi patellar tendon boyu da sabit býrakýlarak patellofemoral sorunlarýn önüne geçilebilmekte ve iyi klinik sonuçlar elde edebilmektedir.

INTRODUCTION: The early-period results of our technique for performing a medial biplanar retrotubercle open-wedge proximal tibial osteotomy for the surgical treatment of varus gonarthrosis were evaluated and compared with those reported in the literature.
METHODS: The clinical and radiological results of a medial biplanar retrotubercle open-wedge proximal tibial osteotomy performed on 23 knees in 22 patients with medial gonarthrosis with varus alignment were analyzed.
RESULTS: Twenty patients were female and 2 were male. At the time of surgery, the mean age was 56.22 years (44–66 years), the mean body mass index was 31.95 kg/m2 (23.4–44.9 kg/m2), and the mean Hospital for Special Surgery (HSS) score was 68.7 (48–83). The mean preoperative femorotibial anatomical axis angle was 186.39° (173–194°), and the mean Insall-Salvati index value was 1.04 (0.94–1.171). The mean length of follow-up was 30.19 months (6–42 months). At the last follow-up examination, the mean HSS score was 86.48 (74–100), the mean femorotibial anatomical axis angle was 175° (168–171°), and the mean Insall-Salvati index value was 1.06 (0.857–1.32). Comparison of the final follow-up values with the preoperative values demonstrated significant improvement in the HSS score and femorotibial anatomical axis angle, but no significant difference in the Insall-Salvati index value.
DISCUSSION AND CONCLUSION: The results of this study indicated that frontal and sagittal plane deformities in patients with varus gonarthrosis can be treated with biplanar retrotubercle open-wedge proximal tibial osteotomy with good clinical results that achieve patellar tendon length stability and avoid patellofemoral problems.

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Biz bu vakamýzda, CRT-D implantasyonu esnasýnda subklaviyan ven ponksiyonuna baðlý olarak fokal parankim içi akciðer kanamasý ve masif hemoptizi geliþen nadir görülen ve ilginç bir vakayý sunmayý amaçladýk. Hastamýzda klinik seyir saniyeler içinde akciðer ödemine ilerledi. Kontrastsýz Multidedektör Bilgisayarlý Tomografi, bu vakada kalýcý pil cebinin hemen altýnda akciðer dokusunda fokal alveolar hemorajiyi gösterdi, fakat ilginç olarak vakamýzda pnömotoraks yoktu. Bu vaka bize öðretti ki, subklaviyan ven ponksiyonu esnasýnda aniden öksürük ve hemoptizi geliþirse, komþu akciðer dokusunda parankim ponksiyonuna baðlý olarak hasar geliþimi, komplikasyon olarak akýlda tutulmalýdýr.

We present a rare and interesting case of subclavian vein puncture-induced focal intraparenchymal lung hemorrhage and massive hemoptysis developed during CRT-D implantation. Clinical picture advanced to pulmonary edema in seconds. A noncontrast multiple-detector computed tomography scan revealed focal alveolar hemorrhage in the lung tissue right under the pacemaker pocket, but remarkably, there was no pneumothorax. This case shows that if cough and hemoptysis suddenly develop during subclavian puncture, injury of the adjoining lung because of parenchymal puncture should be considered as a complication.

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Clostridium difficile infection (CDI) is a major cause of morbidity and mortality in patients with inflammatory bowel disease (IBD), especially in ulcerative colitis (UC). The incidence and severity of CDI in IBD has shown an increasing trend in the last two decades. Patients with IBD are predisposed to CDI secondary to the recurrent use of antibiotics, corticosteroids, and immunosuppressants and secondary to dysbiosis. It is clinically challenging to distinguish the symptoms of CDI from an IBD flare. The worsening of IBD symptoms demands escalation of steroids or initiation of biologics. However, the management of CDI in IBD, not responding to antibiotics, is not well described beyond a few case reports. We report two cases of CDI with active UC flare. The patients did not respond to antibiotics or intravenous corticosteroids but had rapid resolution of CDI symptoms after receiving infliximab infusion. The optimal dosing and infusion frequency of infliximab in management of CDI in UC/IBD remains to be established.

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Endovasküler anevrizma tamiri (EVAR), abdominal aort anevrizmasý (AAA) için güvenli ve etkili bir tedavi yöntemi olarak kabul edilmiþtir. Endoleak, EVAR sonrasý geliþen en sýk komplikasyon olup bazen acil müdahele ve giriþim gerektirir. Çoðu zaman endoleak tamiri çeþitli endovasküler yöntemlerle yapýlabilmekte iken bazý hastalarda açýk cerrahi tamir gerekmektedir. Bu çalýþmada yedi yýl önce rüptüre AAA nedeniyle EVAR yapýlmýþ olan sonrasýnda ikinci defa endoleak komplikasyonu geliþmiþ ve cerrahi tamir yapýlan 67 yaþýnda erkek bir hasta sunulmaktadýr. Bu hastada takibinin birinci yýlýnda inferior mezenterik arterden kaynaklanan tip II endoleak saptanmýþ olup, koil embolizasyonla tedavisi yapýlmýþtýr. Acil servisimize karýn aðrýsý ile baþvuran bu hastada çekilen BT anjiografide greftin posterior kýsmýnda tip Ia endoleak ve 22,9 cm’e ulaþan rüptüre olmamýþ dev anevrizma kesesi saptandý. Hasta hemodinamik olarak stabil olmadýðý için sol anterolateral torakotomi ve laparotomi ile operasyona alýndý. Bu çalýþmada açýk cerrahi yöntemle re-operasyona alýnan bu hasta sunulmuþ olup tip Ia endoleak tedavileri literatür ýþýðýnda tartýþýlmýþtýr.

Endovascular aneurysm repair (EVAR) has been widely accepted as a safe and effective treatment for abdominal aortic aneurysm. Endoleaks are the most common complication after EVAR and require urgent interventions. Usually endoleaks can be treated with endovascular procedures using a variety of techniques. Despite these interventions, if the endoleak still persists, conventional open surgery should be evaluated. A 67-year-old man had been treated with EVAR after a ruptured abdominal aortic aneurysm 7 years ago. Later on, a type II endoleak was detected due to the inferior mesenteric artery and treated with coil embolization at the first follow-up year. The patient was admitted to our emergency department due to abdominal pain. Computed tomography angiography demonstrated a type Ia endoleak from the posterior side of the graft with a huge abdominal aortic aneurysm sac (22.9 cm) without rupture. The patient was hemodynamically unstable, and open surgical repair was performed via left anterolateral thoracotomy and laparotomy. Here we report a case where we performed open repair of a type Ia endoleak and discuss the repairing techniques for type Ia endoleak in the light of the literature.

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Hem koroner vazospazm hemde kronik beta bloker kullanýmý senkop'a neden olabilmektedir.Biz kronik beta bloker kulanýmýna baðlý sinuzal bradikardi'nin neden olduðu rekürren senkop ataklarý olduðu düþünülen ancak altta yatan mekanizmanýn koroner vazospama ikincil geliþen tam atrioventriküler blok ve ventriküler aritmilerin olduðu anlasýlan bir vakayý sunmayý amacladýk. Olgunun tedavisi yüksek doz non-dihidropridin grubu kalsiyum kanal blokeri, nitrat ve dual ICD implantasyonu ile baþarýlý olarak yönetildi. Vazospazmýn neden olduðu senkop durumunda, altta yatan mekanizma atriyoventriküler blok ve / veya ventriküler aritmiler gibi karmaþýk olabilir. Bu nedenle, dual ICD implantasyonu optimal týbbi tedavi ile birlikte düþünülmelidir.

Spontaneous and simultaneous multivessel coronary artery spasm may present with multisite myocardial ischemia, atrioventricular block, acute lung edema, cardiogenic shock, or ventricular fibrillation. In a case of syncope caused by vasospasm, the underlying mechanism may be complex, such as atrioventricular block and/or ventricular arrhythmia. Dual implantable cardioverter defibrillator (ICD) placement should be considered along with optimal medical treatment. This report is a description of a 57-year-old male patient who was admitted to the hospital with chest pain followed by loss of consciousness. As the patient had bradycardia, a diffuse spasm, and life-threatening ventricular arrhythmia during ischemic episodes, a dual ICD device was implanted. ICD treatment may be a good option in cases with a diffuse spasm that is hard to control with medical treatment due to the risk of life-threatening ventricular arrhythmia.

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Mýknatýslar, güçlü manyetik alan özellikleri nedeniyle modern teknolojiler, týp ve diþ hekimliðinde kullanýlmaktadýr. Neodymium mýknatýslar bu güçlü mýknatýslardan biridir ve üzerine daha fazla araþtýrmalar yapýlmýþtýr. Bu derlemede, nadir toprak mýknatýslarýnýn geçmiþi, tanýmlanmasý ve özellikleri kýsaca ele alýnmýþtýr. Buna ek olarak þimdiye kadar yapýlan araþtýrmalardan elde edilen sonuçlar ile kabaca incelenmiþ ve mýknatýslarýn, özellikle de neodim mýknatýslarýn vücut sistemleri, dokularý, organlarý, hastalýklarý ve tedavileri üzerindeki etkilerinin olduðu sonucuna vardýk. Saðlýk sektöründeki çeþitli teþhis cihazlarýnda ve terapötik araçlarda kullanýmlarý olmasýna raðmen, mýknatýslarýn vücut için bazý zararlý potansiyelleri ve kaza riski vardýr. Neodymium mýknatýslarýn etkileri üzerine yeterli bir araþtýrma bulunmamasýna raðmen, hem diagnostik hem de terapötik prosedürler için büyük bir potansiyele sahip görünmektedir.

The strong magnetic field properties of magnets have led to their use in many modern technologies, as well as in the fields of medicine and dentistry. Neodymium magnets are a powerful type of magnet that has been the subject of recent research. This review provides a brief explanation of the definition, history, and characteristics of rare earth magnets. In addition, a broad overview of results obtained in studies performed to date on the effects of magnets, and neodymium magnets in particular, on body systems, tissues, organs, diseases, and treatment is provided. Though they are used in the health sector in various diagnostic devices and as therapeutic tools, there is some potential for harmful effects, as well as the risk of accident. The research is still insufficient; however, neodymium magnets appear to hold great promise for both diagnostic and therapeutic purposes.

Abstract | Full Text PDF

Abstract | Full Text PDF

Abstract | Full Text PDF