GÝRÝÞ ve AMAÇ: Granülosit koloni stümüle edici faktör (G-CSF) rekombinant DNA teknolojisi ile hazýrlanan ve en yaygýn olarak kullanýlan hematopoetik büyüme faktörüdür. G-CSF osteoklast ve osteoblast fonksiyonunu modüle ederek kemik metabolizmasýný etkilemektedir. Bu çalýþma, lösemi ve sölid tümör nedeni ile takip edilen çocuklarda, kýsa süreli G-CSF kullanýmýnýn kemik metabolizmasý üzerine olan etkilerini incelemeyi amaçlamaktadýr.
YÖNTEM ve GEREÇLER: Çalýþmaya hematolojik malignansi veya solid tümör nedeniyle kemoterapi protokolleri gereði G-CSF tedavisi alan 36 hasta ile büyüme faktörü almayan 20 kontrol hastasý olmak üzere toplam 56 hasta alýndý. Çalýþma grubundaki hastalarýn serum osteokalsin ve idrar serbest deoksipridinolin düzeyleri, G-CSF tedavisi baþlamadan önce, tedavi baþladýktan sonraki 3. günde, G-CSF tedavisi kesildikten 7 gün sonra ölçüldü. Kontrol grubundaki ölçümler kortikosteroid ve metotreksat içermeyen kemoterapi tedavisi sýrasýnda yapýldý.
BULGULAR: Tedavi baþlangýcýndan önceki ortalama osteokalsin düzeyinin (8.6±2.3 ng/ml), G-CSF tedavisinin 3. gününde anlamlý þekilde azaldýðý (7.7±2.3 ng/ml), G-CSF tedavisi kesildikten 7 gün sonra anlamlý þekilde arttýðý (7.9±2.2 ng/ml) (sýrasýyla p<0.001, p<0.001), bununla birlikte G-CSF tedavisi öncesi deðerlere göre halen anlamlý þekilde düþük olduðu saptandý (p<0.001). Ýdrar serbest deoksipridinolin düzeyinin ise, G-CSF tedavisinin 3. gününde anlamlý þekilde arttýðý (25.6±6.5 nmol/mmolCr), G-CSF tedavisi kesildikten 7 gün sonra anlamlý þekilde azaldýðý (22.6±6.4 nmol/mmolCr) (sýrasýyla p<0.001, p<0.001), bununla birlikte G-CSF tedavisi öncesi deðerlere göre halen anlamlý þekilde yüksek olduðu saptandý (p<0.001).
TARTIÞMA ve SONUÇ: Bulgularýmýz, kanserli çocuk hastalarda kýsa süreli G-CSF kullanýmýnýn kemik metabolizmasýný etkileyebileceðini ve metabolik deðiþikliklerde rol oynayabileceðini göstermiþtir. Osteoblastik aktivitede azalma, osteoklastik aktivitede artma; bu hastalarda kemik aðrýsý ile iliþkili olabileceðini ve osteoporoza katkýda bulunabileceði düþündürmektedir. Bu nedenle kanserli çocuklarda daha dikkatli kullanýlmasý gerekmektedir.

INTRODUCTION: The granulocyte colony-stimulating factor (G-CSF) is the most commonly used hematopoietic growth factor recombinant DNA technology. It affects bone metabolism by modulating both osteoclast and osteoblast functions. The aim of the present study was to investigate the effects of short-term use of G-CSF on bone metabolism in children with leukemia and solid tumors.
METHODS: Thirty-six patients with a malignancy who received G-CSF therapy according to chemotherapy protocols and another 20 growth factor-free cancer patients who were enrolled as controls were included in the study. The serum osteocalcin and urinary free deoxypyridinoline levels were measured before the start of G-CSF therapy, on day 3 after treatment, and 7 days after G-CSF therapy was discontinued. In the control group, the measurements were made during corticosteroid and methotrexate-free chemotherapy.
RESULTS: The mean osteocalcin level (8.6±2.3 ng/mL) from before the onset of treatment decreased significantly (7.7±2.3 ng/mL) on day 3 of G-CSF therapy and significantly increased after 7 days of G-CSF therapy (7.9±2.2 ng/mL) (p<0.001 and p<0.001, respectively), which was still significantly lower than the pre-G-CSF values (p<0.001). The urinary free deoxypyridinoline level significantly increased on day 3 of G-CSF treatment (25.6±6.5 nmol/mmol Cr) and significantly decreased after 7 days of G-CSF therapy (22.6±6.4 nmol/mmol Cr) (p<0.001 and p<0.001, respectively), which was still significantly higher than the values recorded before G-CSF therapy (p<0.001).
DISCUSSION AND CONCLUSION: The findings show that the short-term use of G-CSF in children with cancer can affect bone metabolism and can play a role in metabolic changes. Decreased osteoblastic activity and increased osteoclastic activity suggest that osteoporosis may be associated with bone pain in these patients.

GÝRÝÞ ve AMAÇ: Kýsa zaman penceresi, akut iskemik inmede (AÝÝ) intravenöz doku plazminojen aktivatöründen (IV-tPA) yararlanmada büyük bir engeldir. Bu makalede, acil servis odasý toplantýlarýnýn kapý-iðne zamanlarýnýn (KÝZ) adým adým iyileþtirilmesi üzerindeki etkisini analiz ettik.
YÖNTEM ve GEREÇLER: Bu çalýþmada, Sakarya Üniversitesi Eðitim ve Araþtýrma Hastanesi'ne Ocak 2015 ile Aðustos 2017 tarihleri arasýnda baþvurup IV-tPA ile tedavi edilen AÝÝ hastalarýnýn prospektif kaydedilmiþ verileri kullanýldý. KÝZ ölçütleri tek tek vaka bazýnda kaydedildi. Toplantýlar, IV-tPA ile tedavi edilen ardýþýk AÝÝ hastalarýnýn KÝZ' inde % 25' den fazla bir artýþ olduðunda acil servis odasýnda yapýldý. Konular, güncel kýlavuzlar tarafýndan önerilen inme yönetimi ve önceki KÝZ verilerimizden gelen geribildirimleri içermekteydi. Amaç, akut iskemik inmeli hastalarýn en az % 50'sinde KÝZ' i 60 dakika içinde tutabilmekti.
BULGULAR: 20 hastanýn ortalama KÝZ' i 76.9 ± 32.4 dakikaydý. Dokuz hastada KÝZ ≤ 60 dakika iken, ikisinde 30 dakikanýn altýnda idi. Her birinde ikiþer tane olmak üzere 2015, 2016 ve 2017 yýllarýnda altý toplantý gerçekleþtirildi. Ýstisnasýz olarak, tüm toplantýlarýn ardýndan KÝZ' de bir azalma oldu. Altý toplantý aralýðý göz önüne alýndýðýnda, ≤ 60 dakikada tedavi edilen hastalarýn oranlarý sýrasýyla % 0, % 0, % 60, % 66.6 ve % 100 idi.
TARTIÞMA ve SONUÇ: Acil servisteki toplantýlar, belirli kurallara göre gerçekleþtirildiðinde KÝZ' in iyileþtirilmesinde etkili olabilir.

INTRODUCTION: One major limitation of the use of intravenous tissue plasminogen activator (IV-tPA) is the short treatment window of acute ischemic stroke (AIS). In this article, we analyze the impact of emergency room meetings on step-by-step improvement of door-to-needle times (DTN).
METHODS: This study used prospectively recorded data of AIS patients treated with IV-tPA admitted to the Sakarya University Education and Research Hospital between January 2015 and August 2017. Time benchmarks of DTN were recorded on a case-by-case basis. Meetings were held in the emergency room if there was an increase of more than 25% in DTN of subsequent AIS patients treated with IV-tPA. Guideline-recommended stroke management methods and feedback from our previous DTN data were both considered. The goal was to improve DTN within 60 minutes for at least 50% of AIS patients.
RESULTS: Mean DTN of 20 patients was 76.9±32.4 minutes. Nine patients experienced ≤60 minute DTN times, while two were under 30 minutes. Six meetings were conducted, with two each in 2015, 2016, and 2017. Without exception, there was a reduction in DTN after all meetings. Considering the intervals of the six meetings, the ratios of patients treated at ≤60 minutes were 0%, 0%, 60%, 66.6%, 40 and 100%, respectively.
DISCUSSION AND CONCLUSION: Meetings in the emergency room, when conducted according to certain rules, can be effective in improving DTN.

GÝRÝÞ ve AMAÇ: Bradiaritmi kalp cerrahisi sonrasý geliþebilen komplikasyonlardan biridir. Bu konuyla ilgili daha önce çok az sayýda çalýþma yapýlmýþ olup, biz de çalýþmamýzda kalp cerrahisi sonrasý atriyoventriküler blok veya sinüs nod disfonksiyonu geliþmesini etkileyen ve kalýcý kalp pili takýlmasýný gerektiren faktörleri inceledik.
YÖNTEM ve GEREÇLER: Kalp cerrahisi sonrasý atriyoventriküler blok veya sinüs nod disfonksiyonu geliþen ve kalýcý kalp pili takýlan 62 hasta çalýþmamýza dahil edilmiþtir. Bunlar arasýnda 31 hasta prospektif olarak deðerlendirilmiþ olup kalan 31 hasta hastane kayýtlarýna dayanarak retrospektif olarak incelenerek demografik ve klinik özellikleri ve ameliyat bilgileri kaydedilmiþtir. Hastalar geçirdikleri ameliyatlara göre koroner arter baypas greft, kalap kapak cerrahisi, konjenital kalp cerrahisi ve bunlarýn kombinasyonlarý olarak gruplandýrýlmýþtýr. Hastalar preoperatif olarak standart 12 derivasyon elektrokardiyogram ve transtorasik ekokardiyografi ile deðerlendirilmiþ olup postoperatif dönemde bradiaritmi geliþen ve kalýcý kalp pili takýlan hastalar incelenmiþtir.
BULGULAR: Operasyon öncesi ileti anormalliði ve QRS geniþliði görülen olgularýn görülmeyen olgulara göre yaþ ortalamasý istatistiksel olarak anlamlý düzede yüksekti. 70 yaþ üzeri olgularda operasyon öncesi ileti anormalliði görülme riski için odds oraný 4,429 (%95 CI: 1,40-13,93) olarak saptandý. Cinsiyet, sol ventrikül ejeksiyon fraksiyonu, sol ventrikül dilatasyonu, intraventriküler septum kalýnlýðý, operasyon ile blok geliþimi arasýnda geçen süre, eþlik eden hastalýklar ve komplikasyon oranlarý arasýnda istatistiksel olarak anlamlý farklýlýk bulunmadý.
TARTIÞMA ve SONUÇ: 70 yaþ üzeri hastalarda preoperatif ileti anormalliði ve QRS geniþliði risk faktörü olarak belirlendi.

INTRODUCTION: Bradyarrhythmia is one of the complications that may develop after cardiac surgery. Only a few studies have previously dealt with this concern, and in our study, we investigated the factors affecting the development of atrioventricular block or sinus node dysfunction and the requirement of permanent pacemaker following cardiac surgery.
METHODS: A total of 62 patients who developed the atrioventricular (AV) block or sinus node dysfunction and required a permanent pacemaker following cardiac surgery were included in the study. Among these, 31 patients were evaluated prospectively, and the information regarding 31 patients was evaluated retrospectively based on hospital records. Demographic, clinical, and surgical information was recorded. Patients were grouped according to the types of procedures, including the coronary artery bypass graft, valve surgery, congenital heart disease, and combinations of these. Patients were evaluated by standard 12-lead electrocardiogram and transthoracic echocardiography preoperatively. The postoperative development of bradyarrhythmia and requirement of permanent pacemaker were evaluated.
RESULTS: The mean age of patients with preoperative conduction abnormality and wide QRS was statistically significantly higher than those without these disorders. The odds ratio for preoperative conduction abnormality risk in patients over 70 years of age was found as 4.429 (95% confidence interval, 1.40–13.93). There was no gender-related statistically significant difference in terms of left ventricular ejection fraction, left ventricular dilatation, interventricular septum thickness, the time interval from operation to the development of AV block, concomitant diseases, and complication rates.
DISCUSSION AND CONCLUSION: Preoperative conduction abnormality and wide QRS in patients over 70 years of age was determined as a risk factor.

GÝRÝÞ ve AMAÇ: Stres, çeþitli etkenlerin sebep olduðu, vücut çalýþmasýnda dengesizlik, sinir sisteminde bozukluk ve gerilimle ortaya çýkan karakterize bir durumdur. Bu çalýþmada, saðlýklý genç bireylerde strese baðlý artýþ gösteren kortizol seviyesinin dinamik ve statik denge skorlarýna etkisinin incelenmesi ve yüksek stresin doðuracaðý sonuçlarýn ortaya konulmasý amaçlandý.
YÖNTEM ve GEREÇLER: Çalýþmaya yaþlarý 19-22 arasýnda deðiþen, saðlýklý ve ayný komite sýnavýna girecek gönüllü 107 týp fakültesi 2. sýnýf öðrencisi dâhil edildi. Ýlk denge ölçümleri ve tükürük numuneleri komite sýnavýndan 40 gün önce alýndý ve bu dönem relax dönem olarak kabul edildi. Ayný öðrenciler komite sýnavýnýn olduðu gün tekrar denge ölçümlerine alýndý ve tükürük numuneleri toplandý. Bu dönem ise stresli dönem olarak kabul edildi. Kiþilere, relax ve stresli dönemde The State-Trait Anxiety Inventory (STAI) uygulandý. Dinamik denge skorlarý Star Excursion Balance Test (SEBT) ile ölçüldü. Statik denge skorlarý ise One Leg Standing Balance Test ile belirlendi.
BULGULAR: Tükürük numunelerindeki kortizol seviyesinin ortalamasý stresli dönemde relax döneme göre yaklaþýk 9 kat arttýðý belirlendi. Durumluk kaygýyý ortaya koyan STAI ölçeði de bu artýþý destekler nitelikte bir artýþ gösterdi. Stresli dönemde tüm yönlerde dinamik denge skorlarý belirgin azalma gösterdi. Ayrýca, stresli dönemde statik denge skorlarý relax dönemle karþýlaþtýrýldýðýnda belirgin azalma olduðu ortaya çýktý.
TARTIÞMA ve SONUÇ: Bu çalýþma; saðlýklý genç bireylerde stresin kýsa süreli bile dinamik ve statik dengeyi olumsuz yönde etkilediðini ortaya koymuþtur. Yapýlacak uzun süreli stres ve denge ölçümleri ile korele edildiðinde çalýþmamýzýn olumlu yönde kaynak ve temel oluþturacaðýný düþünmekteyiz.

INTRODUCTION: Stress is a condition caused by various factors and characterized by imbalance in body functioning, impair in nervous system, and tension. The purpose of this study was to examine the effects of cortisol level, which increases in healthy young individuals due to stress, on dynamic and static balance scores as well as to present the results caused by high levels of stress.
METHODS: In this study, 107 healthy medicine faculty students in their second year (who will take the same committee exam) aged between 19 and 23 years were included. The first balance measurements and saliva samples were taken 40 days before the committee exam, and this period was acknowledged as the relaxed period. The same students were considered for balance measurements again on the day of committee exam; saliva samples were collected, and cortisol concentration was determined. This period was acknowledged as the stressful period. The State-Trait Anxiety Inventory (STAI) was given to the participants in their relaxed and stressful periods. Dynamic balance scores were measured with Star Excursion Balance Test (SEBT). Static balance scores were measured with One Leg Standing Balance Test (OLSBT).
RESULTS: The mean cortisol level was found to increase approximately 9 times in stressful periods compared with that in relaxed periods. STAI, which shows state anxiety, showed an increase supporting this increase. In stressful periods, dynamic balance scores showed obvious decrease in all directions. In addition, in stressful periods, an obvious decrease was observed in static balance scores compared with those in relaxed periods.
DISCUSSION AND CONCLUSION: This study showed that stress negatively affected dynamic and static balance, even for short periods of time. We believe that our study will form a positive source and basis when correlated with long terms stress and balance measurements.

GÝRÝÞ ve AMAÇ: Amaç: Bu çalýþmanýn amacý, klinik pratikte görülme sýklýðý artmakta olan internetin sorunlu kullanýmýnýn; DEHB, kiþisel risk etmenleri ve ailesel etmenler açýsýndan iliþkisini araþtýrmak, saðlýklý kontrol grubuyla karþýlaþtýrarak varsa riske etki eden etmenler hakkýnda bilgi sahibi olmaktýr.

YÖNTEM ve GEREÇLER: Çalýþma grubu, Ankara Üniversitesi Týp Fakültesi Çocuk ve Ergen Ruh Saðlýðý ve Hastalýklarý polikliniðine baþvuruda bulunan, DEHB tanýsýyla takip edilmekte olan, 12-16 yaþlarý arasýnda, 34 çocuk ve ailelerinden oluþmuþtur. sosyodemografik açýdan uygun bir kontrol grubu seçilmiþtir. Çalýþma ve kontrol grubundaki çocuklarýn, ÇGDÞ-ÞY uygulanarak DSM -IV taný ölçütlerine göre psikiyatrik tanýlarý belirlenmiþtir. Çocuklara, Çocuk ve Ergenlerde Ýnternet/Bilgisayar Kullanýmý Deðerlendirme Anketi (Çocuk formu), Güçler ve Güçlükler Anketi –Ergen formu (GGA) ve Ýnternette Biliþsel Durum Ölçeði (ÝBDÖ) uygulanmýþtýr. Anne ve babalara, Çocuk ve Ergenlerde Ýnternet/Bilgisayar Kullanýmý Deðerlendirme Anketi (Ebeveyn formu), GGA- Ebeveyn formu ve Aile Deðerlendirme Ölçeði (ADÖ) uygulanmýþtýr.
BULGULAR: DEHB grubunun haftalýk internet kullanma süresinin daha fazla olduðu saptanmýþtýr. ÝBDÖ toplam puanlarýn ve tüm alt ölçek puan ortalamalarýnýn DEHB grubunda anlamlý düzeyde yüksek olduðu saptanmýþtýr. Uygulanan GGA sonuçlarýna göre, DEHB’si olan çocuklarda hiperaktivite, davraným problemleri ve arkadaþ iliþkilerinde sorunlar daha çok saptanmýþtýr. ADÖ genel aile iþlevleri, iletiþim, roller ve davranýþ kontrolü alt ölçek puanlarý DEHB grubunda anlamlý düzeyde yüksek bulunmuþtur. Gruplar arasýnda internet kullanma, evde bilgisayar olmasý ve evlerinde internet eriþimi bulunmasý açýsýndan iki grup açýsýndan faklýlýk olmadýðý saptanmýþtýr. DEHB grubunda, eþlik eden psikiyatrik bozukluklar ile ÝBDÖ ve haftalýk internet kullaným süresi arasýndaki iliþki incelendiðinde; Karþýt Olma Karþý Gelme Bozukluðu ve Davraným Bozukluðu tanýlarý ile istatistiksel olarak anlamlý bir iliþki olduðu saptanmýþtýr. DEHB grubunda, ADÖ’nün duygusal tepki verebilme alt ölçeði ile ÝBDÖ puanlarý arasýndaki istatistiksel olarak anlamlý bir iliþki bulunmuþtur.
TARTIÞMA ve SONUÇ: Çalýþmamýzda DEHB’de sorunlu internet kullanýmýnýn daha sýk olduðu ortaya konmuþtur. DEHB tedavisinde sorunlu internet kullanýmý da bir tedavi hedefi olarak ele alýnmalýdýr. Sorunlu internet kullanýmýna yönelik müdahaleler aile içi duygu ifadesini de göz önünde bulundurmalýdýr.

INTRODUCTION: The aim of this study was to determine the association of problematic internet use with attention deficit hyperactivity disorder (ADHD), personal risk factors, and familial factors and compare with a healthy control group and investigate the risk factors.
METHODS: The study sample consisted of 34 children aged 12–16 years and their families who applied to Ankara University Faculty of Medicine Department of Child and Adolescent Psychiatry with the diagnosis of ADHD. The control group consisted of 36 junior high and high school children aged 12–16 years and their families. The control group was matched with the ADHD group for age and sex. The Kiddie Schedule for Affective Disorders and Schizophrenia Present and LifetimeVersion (K-SADS-PL) version was used according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria for patients with ADHD and the control group. Internet/Computer Use Assessment Questionnaire for Children/Adolescents, the Strengths and Difficulties Questionnaire adolescent form (SDQ), and Online Cognition Scale (OCS) were applied to children. Internet/Computer Use Assessment Questionnaire for Parents and SDQ-parent form and Family Assessment (FAS) were applied to the parents.
RESULTS: Weekly internet usage was higher in the ADHD group than the control group. The OCS total scores and subscale scores were significantly higher in the ADHD group. The subscales of SDQ hyperactivity, conduct problems, and peer problems were significantly higher in the ADHD group. FAS-general functions, communication, roles and behavior control subscale scores were higher in the ADHD group. There was no significant difference between groups regarding the internet usage in the daily life, with the availability of a computer and internet at home. In the ADHD group, there was a significant correlation between the OCS scores, weekly internet usage, and psychiatric comorbidities Oppositional Defiant Disorder and Conduct Disorder. Also, affective responsiveness subscale scores of FAS were significantly correlated with OCS scores in the ADHD group.
DISCUSSION AND CONCLUSION: In this study, it was noted that problematic internet use was more frequent in ADHD. During ADHD treatment, problematic internet use may interfere in the treatment goals. Interventions to problematic internet use should consider familial emotional expression studies.

GÝRÝÞ ve AMAÇ: Lateral epikondilit (LE) yaygýn bir dirsek problemidir. LE tedavisinde ESWT yaygýn olarak kullanýlmasýna raðmen etkinliði hala tartýþmalýdýr. Ayrýca literatürde prospektif, randomize, kontrollü çalýþmalarýn sayýsý yeterli deðildir. Biz bu çalýþmamýzda ESWT’ nin gerçekten etkin olup olmadýðýný araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Bu çalýþma randomize, plasebo kontrollü, çift kör ve prospektif olarak planlandý. Dahil edilme kriterlerini karþýlayan 40 hasta 2 gruba ayrýldý. Gerçek ESWT (Grup 1, n: 20) ve plasebo ESWT (Grup 2, n: 20) olmak üzere kapalý zarf yöntemiyle randomize edildi. Hastalarýn Patient Rated Tennis Elbow Evaluation Turkish Version (PRTEE – T), VAS aðrý skorlarý, kavrama ve çimdikleme güçlerine bakýldý. Deðerlendirmeler tedavi öncesinde, sonrasýnda ve 1. ay kontrolleri olmak üzere 3 kez yapýldý. Her iki gruba da el bileði splinti, buz tedavisi ve istirahat verildi.
BULGULAR: Her iki grupta da cinsiyet ve dominant el arasýnda istatistiksel fark görülmedi. Kavrama ve çimdikleme gücünde gruplarýn kendi içlerindeki ölçümleri arasýnda anlamlý bir fark bulunmadý (p>0.05). VAS skorlarý açýsýndan incelendiðinde de yalnýzca gerçek ESWT grubunda kendi içinde anlamlý deðiþiklik bulundu (p<0.05). PRTEE-T skorlarýna göre bakýldýðýnda her iki grubunda kendi içinde anlamlý deðiþiklikleri olduðu bulundu (p<0.05). Gruplar arasýnda kavrama ve çimdikleme gücünde, VAS ve PRTEE-T skorlarýnda tedavi öncesine göre tedavi sonrasý ve kontrol ölçümleri arasýnda anlamlý bir fark bulunmadý (p>0.05).
TARTIÞMA ve SONUÇ: ESWT tedavisi uygulanan hastalarýmýzda aðrý ve fonksiyonel düzelme plaseboya göre daha belirgin olmasýna karþýn aralarýnda istatistiksel olarak anlamlý bir sonuç bulunamadý.

INTRODUCTION: Lateral epicondylitis is a common elbow problem. Although extracorporeal shockwave therapy (ESWT) is widely used in the treatment of lateral epicondylitis, its efficacy is still controversial. Moreover, the number of prospective, randomized, controlled studies in the literature is not sufficient. Here, we intend to investigate the efficacy of ESWT.
METHODS: The study was randomized, placebo-controlled, double-blind, and prospectively planned. Forty patients who met the inclusion criteria were divided into two groups, real ESWT (Group 1, n=20) and placebo ESWT (Group 2, n=20), in a 1: 1 randomized closed envelope manner. Patients were evaluated for Patient-Rated Tennis Elbow Evaluation-Turkish Version (PRTEE-T), visual analog scale (VAS) pain scores, and grip and pinching strengths. The evaluation were performed thrice before, at the end of treatment and 1 month after treatment. Both groups were treated with wrist splinting, ice treatment, and rest.
RESULTS: There was no statistical difference between sex and dominant hand in both groups. There was no significant difference in the grasp and pinching strength between the measurements of the groups themselves (p>0.05). When examined in terms of VAS scores, only significant changes were found in the actual ESWT group (p<0.05). According to the PRTEE-T scores, both groups showed significant changes (p<0.05). No significant difference was found between post-treatment and control measures in the grip and pinching power between groups, VAS and PRTEE-T scores before treatment (p>0.05).
DISCUSSION AND CONCLUSION: Although pain and functional improvement were more prominent in our patients treated with ESWT than placebo, no statistically significant results were found.

GÝRÝÞ ve AMAÇ: Uzun süreli bilgisayar kullanýmýnýn göz yaþý yapýmý ve buharlaþmasý üzerine etkilerini incelemek.
YÖNTEM ve GEREÇLER: Çalýþmada meslekleri nedeniyle günde 8 saat bilgisayar kullanan 30 kiþinin 30 gözü çalýþma grubu, günlük bilgisayar kullanýmý bir saati geçmeyen 30 saðlýklý bireyin 30 gözü ise kontrol grubu olarak deðerlendirildi. Olgular saat 8’de iþe baþlamadan ve saat 17’de mesai bitiminde muayene edildiler. Bireylerin yapýlan muayenelerinde göz yaþý yapýmý göstergesi olarak anestezili schirmer testi, göz yaþý buharlaþmasý göstergesi olarak göz yaþý kýrýlma zamaný(GYKZ) belirlenerek kaydedildi. Tüm olgular oküler yüzey hastalýk indeksi(OSDI) anketini tamamladýlar.
BULGULAR: Yaþ ve cinsiyet açýsýndan iki grup arasýnda anlamlý fark yoktu. Çalýþma ve kontrol grubunun Schirmer deðer ortalamasý sabah ve akþam sýrasýyla 16,80±2,04, 15,50±2,06 mm ve 17,28±1,52 ve 17,16 ±2,53 olarak ölçüldü. Ýki gruptada sabah ve akþam schirmer deðerleri arasýnda istatistiksel olarak anlamlý fark yoktu. (p>0,05) Çalýþma grubunun GYKZ ölçümlerinin sabah ve akþam deðerleri sýrasýyla 9,15±2,93, 6,80±1,11 sn olarak deðerlendirildi. Akþam GKYZ’nin düþtüðü görüldü (p<0,05). Kontrol grubunda ise 15,80±3,15 ve 15,20±1,92 sn olarak kaydedildi. Kontrol grubunda istatistiksel olarak anlamlý fark yoktu.(p>0,05) Çalýþma grubunun OSDI skorlarý sýrayla 26,7±3,36 ve 28,3±1,19 olup, kontrol grubunda ise 25.0±4,48 ve 27,3±2,27 idi. Ýki grup arasýnda ve sabah akþam deðerleri arasýnda istatistiksel fark bulunmadý.
TARTIÞMA ve SONUÇ: Sonuç olarak uzun süreli bilgisayar kullanýmýnýn göz yaþý yapýmý parametresi olan Schirmer testinde anlamlý deðiþiklik yapmadýðý saptanýrken, evoparatif tip kuru göz bulgusu olan göz yaþý kýrýlma zamaný (GYKZ) sonuçlarýnda istatistiksel anlamlý deðiþiklik yaptýðý görüldü. Çalýþmamýzýn sonucuna göre uzun süreli bilgisayar kulanýmý evoparatif tip kuru göz hastalýðýna neden olabilir.

INTRODUCTION: To evaluate the effects of long-term computer use on tear production and evaporation.
METHODS: In this study, 30 eyes of 30 people using computer for 8 hours a day were taken as the study group. In the control group, 30 eyes of 30 healthy individuals who did not spend 1 hour using computer on a daily basis were evaluated. The cases were examined at 8 am and 5 pm. The Schirmer test, tear break-up time (TBUT), and ocular surface disease index (OSDI) were evaluated.
RESULTS: There was no significant difference between the groups in terms of age and gender. The Schirmer test results, which measure the parameters of tear production, were 16.80±2.04 and 15.50±2.06 mm (p>0.05) in the study group, and 17.28±1.52 and 17.16±2.53 in the control group. The TBUT measurements were 9.15±2.93 and 6.80±1.11 sec in the study group. It was observed that the evening TBUT decreased (p<0.05). The TBUT measurements were 15.80±3.15 sec and 15.20±1.92 sec (p>0.05) in the control group. The OSDI scores were 26.7±3.36 and 28.3±1.19 in the study group, and 25.0±4.48 and 27.3±2.27 in the control group.
DISCUSSION AND CONCLUSION: As a result, it was found that a long-term computer use did not change the Schirmer test results significantly, but there were statistically significant changes in the tear break-up time (TBUT) results of the evaporative type eye dryness. According the our study results, long-term computer usage may cause an evaporative-type dry eye disease.

GÝRÝÞ ve AMAÇ: Kontrolsüz inflamatuar yanýt insan morbidite ve mortalitesine etkili birçok etkenin patogenetik mekanizmasýna katkýda bulunmaktadýr. Aspirin aterosklerotik hastalýk ve komplikasyonlarýnýn primer ve sekonder korunmasýnda etkili antiinflamatuar ve antitrombotik bir ilaçtýr. Çalýþmamýzýn amacý aspirin direncinin koroner aterosklertotik hastalýk yaygýnlýðý ve þiddeti üzerine etkisini incelemektir.
YÖNTEM ve GEREÇLER: Çalýþmamýza aspirin kullanan ve bilinen veya þüphe edilen koroner arter hastalýðý olup koroner anjiyografisi uygulanan 100 hasta dahil edildi.

BULGULAR: 100 hastanýn 30’u (8 kadýn, 22 erkek) aspirin dirençli grup (ADG) ve 70’i (22 kadýn, 48 erkek) kontrol grubunu oluþturmaktadýr. Gensini skorlama sistemi (GSS) ADG’de daha yüksek saptanmýþtýr (80,5 (36-166) karþý 45 (2-209); p<0,001). Perkütan koroner giriþim (PKG) ADG’ de daha fazladýr [30 hastada 13 (%43,3) ADG’de, 70 hastada 13 (%18,6) kontrol grupta; p=0,01]. PKG yapýlan 16 hasta üzerinden stent restenozu ADG’de daha yüksek bulunmuþtur (16 hastada 11 (%68,75) ADG’da, 16 hastada 5 (%31,25) kontrol grupta; p=0,016). Çoklu deðiþkenli regresyon analizine göre GSS (p=0,038; %95 CI: 1,001-1,026) ve PKG öyküsü (p=0,017; %95 CI: 1,182-89,804) aspirin direnci için baðýmsýz risk faktörleridir.
TARTIÞMA ve SONUÇ: Çalýþmamýzda GSS ile hesaplanan aterosklerotik yükün aspirin direnci olan hastalarda daha yüksek olduðu saptanmýþtýr. Bu sonuca göre aspirin direnci olanlarda koroner olay varlýðýnda daha yüksek dozlarda aspirin tedavisi verilebileceðini önermekteyiz. Ayrýca GSS ve PKG öyküsü aspirin direnci için baðýmsýz risk faktörleridir.

INTRODUCTION: Uncontrolled inflammatory responses could contribute to the pathogenesis of many leading causes of human morbidity and mortality. Aspirin is an anti-inflammatory and antithrombotic drug that is used in the primary and secondary protection in atherothrombotic diseases and complications. The aim of the present study was to analyze the effect of aspirin resistance on the extent and severity of atherosclerosis.
METHODS: One hundred patients who underwent coronary angiography with suspected or known coronary artery disease and were using aspirin were enrolled in the study.
RESULTS: Of these 100 patients, 30 (8 female and 22 male) formed the aspirin-resistant group (ARG), and 70 (22 female and 48 male) formed the control group. Gensini scoring system (GSS) was significantly higher in the ARG than in the control group (80.5 (36–166) vs. 45 (2–209); p<0.001). The number of percutaneous coronary intervention (PCI) patients was significantly higher in the ARG (13 of 30 (43.3%) ARG vs. 13 of 70 (18.6%) control group; p=0.01). Furthermore, when we evaluate the 16 reintervention patients, stent restenosis was significantly higher in the ARG (11 of 16 (68.75%) ARG vs. 5 of 16 (31.25%) control group; p=0.016). Multivariate logistic regression analysis revealed that GSS (p=0.038; 95% CI: 1.001–1.026) and PCI history (p=0.017; 95% CI: 1.182–89.804) were independent risk factors for aspirin resistance.
DISCUSSION AND CONCLUSION: In conclusion, atherosclerotic burden as calculated by the GSS is significantly higher in aspirin-resistant patients. According to this result, we suggest that aspirin treatment can be prescribed in higher doses in aspirin resistance patients with coronary events. Furthermore, GSS and PCI history could be independent predictors of aspirin resistance.

GÝRÝÞ ve AMAÇ: Romatizmal kalp hastalýðý (RKH), geliþmekte olan ülkelerde halen önemli bir morbididite ve mortalite nedenidir. Bu çalýþmanýn amacý, daha önce akut romatizmal ateþ taný hikayesi bulunmayan, ekokardiyografi ile RKH tespit edilmiþ asemptomatik vakalarý irdelemek ve takip sonuçlarýný sunmaktýr.
YÖNTEM ve GEREÇLER: Çalýþmamýza, hastanemiz Çocuk Kardiyoloji Polikliniði’ne 2011-2017 tarihleri arasýnda, farklý klinik nedenlerle baþvurup (spora katýlým ve çarpýntý gibi), ekokardiyografi ile RKH tanýsý konularak takibe alýnan, daha önce geçirilmiþ akut romatizmal ateþ öyküsü bulunmayan ve ekokardiyografi bulgularýna eriþilebilen olgular dahil edildi. Ekokardiyografi bulgularý geriye yönelik olarak incelendi.
BULGULAR: Elli beþ kýz, 20 erkek olmak üzere toplam 75 hasta çalýþmaya dahil edildi. Olgularýn ortalama yaþý 13,6 yýldý ( minimum 5, maksimum 18 yýl). Ortalama takip süresi 19,2 ay iken, en uzun takip süresi 66 ay olarak tespit edildi. Altmýþ yedi olguda (%89.3) baþvuru anýnda yalnýzca mitral kapakta patolojik yetersizlik mevcut iken, 2 olguda (%2,7) yalnýzca aort yetersizliði, 6 olguda (%8) hem aort, hem mitral kapakta patolojik yetersizlik akýmý mevcut idi. Olgularýn 45’i (%60 ) baþvuru anýnda Dünya Kalp Federasyonu kriterlerine göre sýnýrda RKH iken, 30 olgu (%40 ) kesin RKH tanýsý aldý. Takip sonrasý olgularýn, %88 ‘i baþlangýç ve takip sonu sýnýrda RKH olarak kalýrken, 2 olgunun bulgularý kesin RKH’dan sýnýrda RKH’ya gerilemiþ, 4 sýnýrda RKH olgusu kesin RKH‘ya ilerlemiþ, 2 olgu ise tamamen normale dönmüþ idi. Takip süresince, hiçbir olgunun kapak deðiþimine ihtiyacý olmadý.
TARTIÞMA ve SONUÇ: RKH, ülkemizde halen ciddiyetini koruyan bir saðlýk sorunudur. Ekokardiyografinin subklinik hafif veya asemptomatik vakalarý belirlemede duyarlýlýðý iyi bilinmektedir. Bu nedenle henüz rutin olmamasýna raðmen, ülke çapýnda ekokardiyografik tarama programlarýnýn baþlatýlmasý önem teþkil etmektedir.

INTRODUCTION: Rheumatic heart disease (RHD) is still a major cause of morbidity and mortality in developing countries. The aim of the present study was to investigate asymptomatic RHD cases diagnosed by echocardiography without any acute rheumatic fever (ARF) history and to present the follow-up results.
METHODS: Children who had been admitted to the pediatric cardiology department between 2011 and 2017 for various reasons (e.g., sport participation and palpitation) and diagnosed with RHD by echocardiography without a history of ARF were included the study. Echocardiographic findings of the patients were evaluated retrospectively.
RESULTS: A total of 75 (55 girls and 20 boys) patients were included in the study. The median age of the cases was 13.6 (minimum 5 and maximum 18) years. The median follow-up period was 19.2 months, whereas the longest follow-up period was 66 months. At the time of admission, pathological valvular insufficiency was present only in the mitral valve in 69 (89.3%) cases, only in the aortic valve in 2 (2.7%) cases, and in both aortic and mitral valve in 6 (8%) cases. Of the cases, 40 (60%) were diagnosed as borderline RHD at the time of admission, and 30 (40%) as definite RHD according to the World Heart Federation criteria. Of these cases, 88% remained the same as borderline RHD, and the findings of two patients improved from definite to borderline RHD. RHD of four patients deteriorated from borderline to definite RHD, and in two patients, valvular insufficiency completely resolved during the follow-up period. None of the cases needed valvular replacement.
DISCUSSION AND CONCLUSION: RHD is still a serious health problem in Turkey. The sensitivity of echocardiography in detecting subclinical mild or asymptomatic cases is well known. For this reason, although it is not yet applied as a routine study, it is important to start the nationwide echocardiographic screening program.

GÝRÝÞ ve AMAÇ: Bu çalýþmada akromioklavikular (AK) eklem çýkýðýnda hook plaklama ile Bosworth tekniðinin klinik sonuçlarý karþýlaþtýrýldý.
YÖNTEM ve GEREÇLER: Ýki farklý klinikte tip III AK eklem çýkýðý tanýsý nedeniyle iki farklý cerrahi tedavi uygulanan 44 hasta retrospektif olarak deðerlendirildi. Yaþ ortalamasý 44 (daðýlým, 18-80) olan hastalarýn 30’u erkek ve 14’ü kadýn idi. Hastalar uygulanan cerrahi tekniðe göre 2 gruba ayrýldý. Grup I, Bosworth tekniði kullanýlarak korakoklavikular fiksasyon yapýlan 25 hastadan oluþuyordu. Grup II, hook plak kullanýlarak akromioklavikular tespit uygulanan 19 hastadan oluþuyordu. Tüm hastalar modifiye UCLA (The University of California at Los Angeles Shoulder Score) and DASH (The disabilities of the arm, shoulder and hand) skorlamasý kullanýlarak deðerlendirildi.
BULGULAR: Ortalama takip süresi 23 ay (daðýlým, 12-24) idi. Cerrahi gruplar arasýnda modifiye UCLA (p=0.012) ve DASH (p=0.008) skoru açýsýndan istatistiksel olarak anlamlý bir farklýlýk gözlendi. Hook plaklama grubunda hem modifiye UCLA hemde DASH skoru açýsýndan Bosworth tekniðine göre daha iyi klinik sonuçlar vardý. UCLA and DASH skorlarý (respectively, r=0.677, p=0.000) arasýnda istatistiksel olarak yüksek anlamlý negatif korelasyon belirlendi.
TARTIÞMA ve SONUÇ: Hook plak ile fiksasyonda Bosworth tekniðine göre daha iyi klinik sonuçlar olmasýna raðmen, iþe dönüþ zamaný açýsýndan gruplar arasýnda farklýlýk olmadýðý gözlendi. AC çýkýðýnýn tedavisinde iyi redüksiyon, az komplikasyon ve yüksek hasta memnuniyeti için erken rekonstrüksiyon uygulanmalýdýr.

INTRODUCTION: In this study, it was compared the clinical results of the Bosworth technique and hook plating in acromioclavicular (AC) dislocations.
METHODS: 44 patients are retrospectively evaluated in this study whom diagnosed as type III AC dislocations and treated by two different surgical methods in two different clinics. The patients were 30 males and 14 females with a mean age of 44 years (range, 18–80 years). The patients were divided into 2 groups according to the applied surgical technique. Group I comprised 25 patients to whom coracoclavicular fixation was applied by using the Bosworth technique. Group II comprised 19 patients to whom acromioclavicular fixation was applied by using hook plate. All patients are evaulated by The University of California at Los Angeles Shoulder Score (UCLA) and The disabilities of the arm, shoulder and hand (DASH) scoring system.
RESULTS: The mean follow-up period was 23 months (range, 12–42 months). A statistically significant diffference was determined between the surgical groups in respect of the modified UCLA scale (p=0.012) and Quick DASH score (p=0.008). Hook plating group had better clinical results according to Bosworth group in terms of both UCLA and DASH score. A statistically highly significant negative correlation was determined between the UCLA and DASH scores (r=0.677, p=0.000).
DISCUSSION AND CONCLUSION: Although hook plating had better clinic outcomes compared to Bosworth technique, there is not seen difference between two groups in terms of the time of return to work. Treatment of the AC dislocation should perform early reconstruction for better reduction, fewer complications and higher levels of patient satisfaction.

GÝRÝÞ ve AMAÇ: Serebral palsili (CP) çocuklarýn D vitamini düzeylerini araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Ekim 2013 ile Mart 2017 tarihleri arasýnda Fiziksel Týp ve Rehabilitasyon Pediatrik Rehabilitasyon Polikliniði'ne gelen, 1-19 yaþ arasý 274 CP’li çocuk (111 kýz ve 163 erkek) çalýþmaya alýndý. Demografik veriler, komorbiteler, Kaba Motor Fonksiyon Sýnýflama Sistemi (KMFSS) ve El Becerileri Sýnýflama Sistemi (MACS) skorlarý kaydedildi. Serum 25 hidroksi vitamin D [25 (OH) D], kalsiyum (Ca), fosfat (P) ve parathormon (PTH) düzeyleri kaydedildi.

BULGULAR: CP'li çocuklarýn yaþ ortalamasý 7.59 ± 6.09 yýl idi. CP tipine göre, % 24.8 spastik tek taraflý, % 59.8 spastik bilateral, % 1.4 diskinetik, % 0.7 ataksik, % 7.6 miks ve % 5.1 sýnýflandýrýlamayan þeklinde daðýlým mevcuttu. CP'li 235 çocuðun serum 25 (OH) D düzeyleri ölçülmüþtü. 25 (OH) D düzeyi ≤12 ng / ml, D vitamini eksikliði olan 79 çocuk, 25 (OH) D düzeyi 12-≤20 ng / ml, D vitamini yetersizliði olan 62 çocuk, 25 (OH) D düzeyi 20-≤30 ng / ml, Dvitamini yeterli olan 43 çocuk ve 25 (OH) D düzeyi >30 ng / ml olan 15 çocuk mecuttu. 36 çocuk zaten D vitamini takviyesi alýyordu. 25 (OH) D düzeyleri ile GMFCS, MACS düzeyleri ve eþlik eden bozukluklar (epilepsi öyküsü, entellektüel gerilik, diþ problemleri ve büyüme geriliði gibi) arasýnda anlamlý korelasyon vardý (p<0.05).
TARTIÞMA ve SONUÇ: Bulgularýmýz, ambulatuar olmayan (KMFSS seviye IV-V) ve eþlik eden bozukluklarý olan CP’li çocuklarýn D vitamini eksikliðine eðilimli olduklarýný ve dolayýsýyla D vitamini açýsýndan kontrol edilmeleri gerektiðini ortaya koymuþtur.

INTRODUCTION: We aimed to investigate the vitamin D status of children with cerebral palsy (CP).
METHODS: A total of 274 children (111 females and 163 males), aged between 1 and 19 years with CP, who came to the Physical Medicine and Rehabilitation, Pediatric Rehabilitation Outpatient Clinic between October 2013 and March 2017, were included in our study. Demographics, data concerning the details of each child’s comorbidity, the Gross Motor Function Classification System (GMFCS), and Manual Ability Classification System (MACS) scores were recorded. The serum 25 hydroxy vitamin D [25(OH)D], calcium (Ca), phosphate (P), and parathormone (PTH) levels were also recorded.
RESULTS: The mean age of children with CP was 7.59±6.09 years. The distribution by the CP type was 24.8% spastic unilateral, 59.8% spastic bilateral, 1.4% dyskinetic, 0.7% ataxic, 7.6% mixed, and 5.1% unclassified. The serum 25(OH)D levels of the 235 children with CP were measured. There were 79 children at the 25(OH)D level ≤12 ng/ml, regarded as vitamin D deficiency; 62 children at the 25(OH)D level 12-≤20 ng/ml, considered as vitamin D insufficiency, 43 children at the 25(OH)D level 20-≤30 ng/ml, considered as vitamin D sufficiency, and 15 children at the 25(OH)D level >30 ng/ml. A total of 36 children were already taking vitamin D supplements. There was a significant correlation between the 25(OH)D levels and GMFCS and MACS levels and associated impairments such as the epilepsy history, intellectual delay, teeth problems, and growth retardation (p<0.05).
DISCUSSION AND CONCLUSION: Our results revealed that the children with CP who are not ambulatory (GMFCS levels IV–V) and have associated impairments were prone to vitamin D deficiency, and thus should be checked for vitamin D.

GÝRÝÞ ve AMAÇ: Kronik boyun aðrýsý (KBA) ile algýlanan stres düzeyleri, gündüz uykululuk hali, semptom þiddeti iliþkilerini incelemek ve fiziksel týp ve rehabilitasyon (FTR) tedavilerinin bu durumlar üzerine olan etkilerini incelemek amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmaya 54 KBA’ sý olan hasta ve 20 saðlýklý kontrol dahil edilmiþtir. KBA’ sý olan hastalar, FTR tedavi grubu (n=34) ve kontrol KBA grubu (n=20) olarak ikiye ayrýlmýþtýr. FTR tedavi programlarý TENS, hot pack uygulama, terapötik ultrason ve egzersizleri içermekteydi. Boyun aðrýsý için hareket ve istirahat görsel aðrý skorlarý (GAS), Epworth uykuluk hali (EUH), algýlanan stres ölçeði (ASÖ), boyun özürlülük indeksi (BÖÝ), tragus-duvar mesafesi (TDM), çene-sternum mesafesi (ÇSM) deðerleri tedavi öncesi ve sonrasý incelenmiþtir.
BULGULAR: ASÖ, TDM, ÇSM deðerlerinde saðlýklý kontrol grubu ile KBA’ sý olan hastalar arasýnda istatistiksel olarak belirgin fark saptanmýþtýr. FTR grubu ile kontrol KBA grubu arasýnda son deðerlendirmede GAS hareket ve istirahat, ASÖ, BÖÝ deðerleri açýsýndan belirgin farklýlýk saptanmýþtýr.
TARTIÞMA ve SONUÇ: KBA’ na tek açýdan bakmak klinik olarak eksik noktalar býrakabilir. KBA’ sý olan hastalar stres düzeyleri, gündüz uykululuk hali, fonksiyonellik açýsýndan deðerlendirilmelidir ve FTR tedavileri erken dönem sonuçlarýnda boyun aðrýsýný azaltmakla beraber eþlik eden bu tür problemlerin giderilmesi içinde faydalý olabilir.

INTRODUCTION: To evaluate the relationship between symptom severity, daytime sleepiness, and perceived stress levels and the impact of physical medicine & rehabilitation (PMR) therapies on these situations in chronic neck pain (CNP) conditions.
METHODS: The study included 54 patients with CNP and 20 healthy control individuals. Patients with CNP were divided into two groups: the PMR therapy group (n=34) and the CNP control group (n=20). The PMR therapy programs of the patients included TENS, hot packs, therapeutic ultrasound, and exercises. Visual analog scale (VAS) at activity and resting for neck pain, Neck Disability Index (NDI), Perceived Stress Scale (PSS), Epworth Sleepiness Scale, chin-manubrium distances (CMD), and tragus-wall distances (TWD) values were evaluated before and after the treatment programs.
RESULTS: Significant differences were found between the CNP patients and healthy controls regarding PSS, TWD, and CMD values. Furthermore, significant differences were detected between the PMR group and the CNP control group in the final evaluation of the VASresting, VASactivity, PSS, and NDI levels.
DISCUSSION AND CONCLUSION: Evaluation of CNP from a single point of view can leave clinically missing points. Patients with CNP should be assessed for daytime sleepiness, stress levels, and functionality, and PMR therapies can be effective in relieving pain and psychological stress in patients with CNP.

Nötropeni, mutlak nötrofil sayýsýnýn (MNS) 1500/mm3’ ün altýna düþmesine denir. Nötropeninin aðýrlýðý MNS ile direk iliþkilidir. Konjenital nedenler primer, akkiz nedenler sekonder nötropeni nedenlerini oluþturur. Bu bildiride CMV pnomönisine baðlý solunum yetmezliði ve entübasyon ihtiyacý olan bir hastada Gansiklovir tedavisine sekonder geliþen aðýr nötropeni ve buna sekonder oluþan kranial abse olgusunu sunulmuþtur.
Olgumuz 32 yaþýndaki annenin ilk gebeliðinden C/S ile 3900 gr olarak doðmuþ, 4 aylýk olduðunda ilk olarak öksürük ve solunum sýkýntsý þikayeti ile yatýrýlarak bronkopnömoni tedavisi baþlanýlmýþ. Solunum yetmezliði ilerleyen hastanýn entübasyon ihtiyacý olmuþ. Solunum yolu etken panelinde CMV(+) gelmesi üzerine CMV PCR çalýþýlýp yüksek kopya pozitif olmasý üzerine tedavisine Gansiklovir eklenilmiþ. Ýlk yatýþ deðerleri ve önceki deðerlerinde nötropeni olmayan hastada gansiklovir tedavisinin 21.gününde derin nötropeni geliþmiþ. Mekanik ventilatörde izlemi esnasýnda konvülziyon geçiren hastanýn beyin tomografisin de apse ile uyumlu görünüm izlenilmiþ..
Laboratuvar tetkiklerinde; Hemogramda anemi ve nötropeni dýþýnda özellik yoktu, Ýmmunglobulinler ve Lenfosit Paneli yaþýna uygun deðerlerdeydi (Tablo 1). Fago test normaldi. Primer Nötropeni etyolojisini ekarte etmek amacýyla yapýlan kemik iliðÝ aspirasyon deðerlendirilmesinde matürasyon arresti izlenmedi. Konjenital nötropeni nedenlerine yönelik yapýlan genetik analiz normal olarak raporlanýldý. Altý haftalýk hemogram takibinde siklik patern izlenmedi. Nötropeni etyolojisine yönelik çalýþýlan B12 vitamini, Folik asit, ANA, Direkt Coombs ve metabolik tetkikleri normaldi.
Takiplerinde nötropeni kendiliðinden düzeldi ve bu durum gansiklovir kullanýmýna sekonder nötropeni ve entübasyon gibi ilave risk faktörlerinin varlýðýnda buna baðlý kraniyal abse olarak deðerlendirildi.
Sekonder nötropeni, primer nedenlere göre çok daha sýk karþýlaþtýðýmýz bir durum olup, ilave risk faktörleri olsun olmasýn hayati komplikasyonlara yol açabilir.

In this report, we examine severe neutropenia secondary to ganciclovir treatment and associated intracranial abscess in a patient with respiratory insufficiency who required intubation due to cytomegalovirus (CMV) pneumonitis. Secondary neutropenia is a condition encountered more frequently than primary neutropenia, and additional risk factors may lead to vital complications, independent of the presence of additional risk factors.

Transverse Testiküler Ektopi ek anomalilere göre üç gruba ayrýlýr. Persistan Müllerian Kanal Sendromu'nun eþlik ettiði Tip-2 Transvers Testiküler Ektopi, hastalarýn yaklaþýk % 20'sini oluþturur. Dikkatli fizik muayene, ultrasonografi ve genetik/endokrinolojik deðerlendirme sonrasý cerrahi tedavi planlanmalýdýr. Herni onarýmý, testis biyopsisi ile birlikte orþiopeksi ve müllerian yapýlarýn eksizyonu Persistan Müllerian Kanal Sendrom'lu Transvers Testiküler Ektopi olgularýnda en uygun cerrahi yaklaþýmdýr. Bu çalýþmada, Tip-2 Transvers Testiküler Ektopi'li bir hastanýn taný ve tedavisine yaklaþýmýn paylaþmasý amaçlandý. Bir tarafta inmemiþ testis, diðer tarafta ise inguinal herni bulunan çocuklarda Transvers Testiküler Ektopi olasýlýðý akýlda tutulmalýdýr.

According to additional anomalies, transverse testicular ectopia (TTE) is classified into three groups. Type-2 TTE, accompanied by persistent mullerian duct syndrome, constitutes approximately 20% of the patients. Surgical treatment should be planned after careful physical examination, ultrasonography, and genetic/endocrinologic evaluation. Herniorrhaphy, orchiopexy with testicular biopsy, and excision of the mullerian structures are the most appropriate surgical approaches in cases of TTE with persistent mullerian duct syndrome. We aimed to share our approach to the diagnosis and treatment of a patient with type-2 TTE. Possibility of TTE should be kept in mind in children with nonpalpable testis on one side and inguinal hernia on the other side.

Paratiroid bezler parathormon (PTH) salgýlayarak kalsiyum ve fosfor metabolizmasýný düzenleyen endokrin glandlardýr. PTH’nýn fazla salgýlanmasý hiperparatiroidi (HPT) olarak adlandýrýlmakta ve primer, sekonder ve tersiyer olarak sýnýflandýrýlmaktadýr. Primer HPT’nin (PHPT) en sýk nedeni paratiroid adenomudur (%80-85). Adölesan dönemde geliþen juvenil PHPT oldukça nadir görülmektedir. PHPT hastalarýnda tüm yaþ gruplarýnda kemik lezyonlarý sýklýðý %10-20 oranýnda, juvenil PHPT hastalarýnda ise %5 oranýnda bildirilmiþtir. Kemik lezyonu olan olgularda paratiroidektomi sonrasýnda lezyonlarda gerileme olduðu bilinmektedir. Biz bu olgu sunumuzda adölesan hastada paratiroid adenomunun nadir bir ortaya çýkýþ þekli olan ve paratiroidektomi sonrasý gerileyen uzun kemiklerde ve sol 5.metakarpta çok sayýda Brown tümörlerinin görüntüleme bulgularýný sunmayý amaçladýk.

Parathyroid glands are endocrine glands that secrete parathyroid hormone (PTH) and regulate calcium-phosphor metabolism. The overexpression of PTH is called hyperparathyroidism (HPT), and is classified as primary, secondary, and tertiary. Primer HPT (PHPT) is the most common cause of parathyroid adenomas (80%–85%). Development of juvenile PHPT during adolescence is rare. The incidence of bone lesions in all age groups is reported to be 10%–20% in the patients with PHPT, and 5% in patients with juvenile PHPT. In patients with bone lesions, regression occurs in lesions after parathyroidectomy. In this case report, we aimed to present the imaging findings of long bones and left fifth metacarpal bone multiple Brown tumors, which is a rare presentation of parathyroid adenoma in adolescent patient and regression after parathyroidectomy.

Metaplastik meme karsinomu (MMK) hem habis epitel hem de mezenþimal doku bileþenleri bulunan bifazik lezyonlarý içeren heterojen bir grubu tanýmlayan genel bir terimdir. Klinik bulgularý invaziv duktal karsinoma benzer olsa da, nadiren inflamatuvar meme karsinomu bulgularý mevcut olabilir. Genellikle beþinci dekant da görülür. Metaplastik meme karsinomu lenf ve kan dolaþýmý ile yayýlýr. En sýk akciðer ve kemiðe uzak metastaz yapar. Tedavi yaklaþýmý genel olarak invaziv duktal karsinomda ayný ilkelere dayanmasýna raðmen, lokal nüks oranlarýnýn yüksek olmasý nedeniyle risk altýndaki gruplarda daha agresif tedavi uygulanmalýdýr. Bu çalýþmada MMK tanýlý beþ kadýn hastanýn klinikopatolojik özelliklerini ve tedavi yaklaþýmýný tartýþmayý amaçladýk.

Metaplastic breast carcinoma (MBC) is a general term defining a heterogeneous group that includes biphasic lesions, with both malignant epithelial and mesenchymal tissue components. Although its clinical findings are similar to those present in invasive ductal carcinoma, it rarely presents with the findings of inflammatory breast cancer. It is generally seen in the fifth decade. MBC spreads via lymph and blood circulation. Most common distant metastasis areas include lungs and the bone. Although the treatment generally relies on the same principles applied in invasive ductal carcinoma, a more aggressive treatment should be employed in at-risk groups due to higher rates of local recurrence. In this study, we aimed to discuss clinicopathological features and treatment approach in 5 women with MBC.

Geçtiðimiz yýllarda atriyal ileti yollarýndaki anormallikler ve bunlarýn klinik önemi bir çok çalýþmaya konu olmuþtur. Interatriyal blok (IAB) ve supraventriküler aritmiler (sýklýkla atriyal fibrillasyon) arasýndaki iliþki ortaya çýkarýlmýþ ve üzerine birçok araþtýrma yapýlmýþtýr. Týp dünyasý bu iliþkinin birçok yönünü ortaya çýkaran bilim adamýna ithafen bu birlikteliði ‘Bayés’ Sendromu’ olarak tanýmýþtýr. Bu derlemede IAB ile atriyal fibrillasyon (AF) iliþkisi üzerinde durulacak ve standart 12-lead yüzey elektrokardiyografik (EKG) incelemenin AF öngördürmedeki deðeri tartýþýlacaktýr.

In the past few decades, extensive research has been conducted on atrial conduction disorders and their clinical relevance. An association between interatrial block (IAB) and supraventricular arrhythmias [most commonly atrial fibrillation (AF)] has been discovered and extensively investigated. We coined the term “Bayés Syndrome” to describe this association, and the medical community has accepted the eponym in recognition to the scientist who discovered most of the aspects associated with it. In this non-systematic review, we will focus on the association between IAB and AF, with special emphasis on the value of the surface 12-lead ECG as a valid tool to predict AF.

Klinik araþtýrmalarý yapabilmek için gerekli olan “etik kurul onayý” ný almak araþtýrmacýlara, zaman yönetiminde yaþadýklarý bazý sorunlar; klinik araþtýrmalarý yapmakta olduklarý iþin bir parçasý olarak rutin bir iþlem olarak deðerlendirmeleri; tedavi, giriþim, araþtýrma ve müdahale kavramlarýný karýþtýrmak ve bazen de bilgi eksikliðinden dolayý zor gelebilmektedir. Ülkemizde insan gönüllülerin dahil edildiði klinik araþtýrmalarla ilgili mevcut yasal düzenlemeler çerçevesinde klinik araþtýrma yapmak isteyen araþtýrmacýlara yönelik dikkat edilmesi gereken hususlarla ilgili bilgi verilerek etik kurul onay süreci tartýþýlmýþtýr.

The “ethics committee approval” required to conduct clinical trials can be difficult to obtain for researchers due to problems with their time management, evaluating clinical investigations as a routine process as a part of their work; confusions regarding the concepts of treatment, interference, research and intervention, and sometimes due to lack of knowledge. Ethics committee approval process in our country is discussed by informing the investigators who want to conduct clinical research, about the issues that should be considered in accordance with the current legal regulations related to the clinical trials involving human volunteers.