ISSN: 2630-5720 | E-ISSN: 2687-346X
The Medical Journal Of Haydarpaşa Numune Training and Research Hospital - : 60 (3)
Volume: 60  Issue: 3 - 2020
RESEARCH ARTICLE
1.Postural Orthostatic Tachycardia Syndrome in Pediatric Patients with Celiac Disease and Relationship with Tissue Transglutaminase Antibody Levels and HLA Tissue Group
Elif Erolu, Esra Polat
doi: 10.14744/hnhj.2020.04557  Pages 211 - 214
GİRİŞ ve AMAÇ: Çölyak hastalığı tahıllardaki glutenle tetiklenen otoimmün bir hastalıktır. İntestinal sistem dışında birçok sistemde etkilenme görülebilir. Bunlardan biri otonom sinir sistemidir. Postural ortastatik taşikardi sendromu etyolojisinde de otoimmunitenin yeri tartışılan bir konudur. Biz de yeni tanı almış ve glütensiz diyet henüz başlanmamış hastalarda POTS varlığını ve serum antikor düzeyleri ve HLA doku grubu ile ilişkisini araştırmayı amaçladık.
YÖNTEM ve GEREÇLER: Yeni tanı almış ve henüz glütensiz diyet başlanmamış olan hastaların doku grupları ve doku transglutaminaz IgA düzeyleri (Anti-Tg IgA) düzeyleri kayıt edildi. Ortostatik semptomları olan Çölyak hastalarına aktif ayakta testi uygulandı. Tüm hastalara ekokardiyografi, 12 derivasyon ekg ve anemi ve sistemik hastalık araştırması yapıldı. POTS tanısı, sistemik hastalık, anemisi olmayan, 6 aydır ortostatik şikayetler tanımlayan ve aktif ayakta testi pozitif saptananlara konuldu. Yatay pozisyondan dikey pozisyona geçildiğinde; ilk 10 dakikada kalp hızının 40/dakika artması veya kalp hızının 120/ dakikanın üzerine çıkması ve kan basıncında sistolik/diastolik 20/10 mmHg’dan fazla düşme olmaması durumunda test pozitif kabul edildi.
BULGULAR: Çalışmaya alınma kriterlerini sağlayan 47 hastadan POTS pozitifliği 16 hastada (%34) saptandı. POTS pozitif olanlarda kız cinsiyeti (%62.5) erkek cinsiyetinden (37.5) daha fazla idi (p=0.023). Anti-Tg IgA düzeyi 200 U/ml üzerinde olan 31 hastadan 13’ünde (%41) POTS pozitif iken Anti-Tg IgA düzeyi 200 U/ml’ nin altında olan 16 hastanın 3 tanesinde (%18) POTS pozitif saptandı (p=0.04). Yirmibir hastada HLADQ2, 4 hastada HLADQ8, 15 hastada HLADQ2 ve HLADQ8 pozitifliği mevcuttu. HLADQ2 ve HLADQ8 birlikte pozitif saptanan 15 hastadan POTS pozitif olan 9 hasta (%65) mevcut idi, sadece HLADQ2 pozitif saptanan 21 hasta arasında 7 hastada POTS pozitifliği (%33) mevcuttu ve bu oran artmış bulundu (p=0.04).
TARTIŞMA ve SONUÇ: Çalışmamızda, Anti-Tg IgA düzeyi ile ve HLADQ2 ve DQ8 birlikteliğiyle POTS sıklığının arttığını gösterdik. Bu durum, POTS’un otoimmun kökenli bir hastalık olduğunu desteklemektedir. Çölyak hastalığı olan çocuklarda ortostatik semptomlar varlığında POTS varlığı akılda bulundurulmalıdır.
INTRODUCTION: Celiac disease is an autoimmune disease triggered by gluten in cereals. Many other system involvements may occur in Celiac disease. One of them is the autonomic nervous system. The role of autoimmunity in the etiology of postural orthostatic tachycardia syndrome (POTS) is also discussed recently. In this study, we aimed to investigate the presence of POTS and its relationship with serum antibody levels and HLA tissue group in patients with newly diagnosed Celiac disease and gluten-free diet not yet started.
METHODS: Active standing test was applied to patients with the Celiac disease with orthostatic symptoms. POTS diagnosis was made for those who had orthostatic complaints for six months and who were found to be positive for the active standing test and who have not systemic disease and anemia.
RESULTS: POTS positivity was found in 16 patients (34%) out of 47 patients who met the inclusion criteria. In POTS positive patients, female gender (62.5%) was higher than male gender (37.5) (p=0.023). POTS was positive in 13 (41%) of 31 patients with anti-Tg IgA levels above 200 U/ml and POTS positive in three (18%) of 16 patients with anti-Tg IgA levels below 200 U/ml (p=0.04). Twenty-one patients had HLADQ2, four patients had HLADQ8, 15 patients had HLADQ2 and HLADQ8 positivity. Out of the15 patients who were found to be HLADQ2 and HLADQ8 positive, nine patients (65%) were POTS positive, out of the 21 patients who were found to be HLADQ2 positive, seven patients had POTS positivity (33%) (p=0.04).
DISCUSSION AND CONCLUSION: In our study, we showed that POTS frequency increased with an increase in the Anti-Tg IgA level and HLADQ2 and DQ8 association. This supports that POTS is an autoimmune disease. The presence of POTS should be kept in mind in the presence of orthostatic symptoms in pediatric celiac disease.

2.The Effects of Epiretinal Membrane on the Treatment of Diabetic Macular Edema with Intravitreal Ranibizumab
Yalçın Karaküçük, Süleyman Okudan
doi: 10.14744/hnhj.2019.09226  Pages 215 - 220
GİRİŞ ve AMAÇ: Bu çalışma daha önce tedavi almamış, epiretinal membranı (ERM) olan ve ERM' si olmayan diabetik makula ödemli (DME) hastalarda ranibizumab tedavisinin yanıtını karşılaştırmayı amaçlamaktadır.
YÖNTEM ve GEREÇLER: Diabetik makula ödemi olan 71 hastanın 71 gözü geriye dönük olarak değerlendirildi. Hastalar DME' si olup ERM' si olmayan [ERM(-)] grup (𝑛 = 34) ve DME' si ve ERM’ si olan [ERM(+)] grup (𝑛 = 34) şeklinde ayrıldı. En iyi düzeltilmiş görme keskinliği (BCVA), merkezi makula kalınlığı (CMT) ve foveaaltı koroid kalınlığı (SFCT) değerlendirildi.
BULGULAR: ERM (-) ve ERM (+) hastalar arasında yaş ve cinsiyet dağılımı açısından anlamlı fark yoktu (p=0.052, p=0.96, sırasıyla). Her iki grupta CMT birinci, ikinci ve üçüncü ayda anlamlı bir azalma gösterdi (her iki grupta herbiri için p<0.01). Aynı zamanda, her iki grupta BCVA ikinci aydan itibaren anlamlı artış gösterdi (ERM (-) grupta p= 0.044 ve ERM (+) grupta p=0.006). ERM (-) ve ERM (+) grupta CMT ve BCVA başlangıçta, birinci ayda, ikinci ayda ve üçüncü ayda anlamlı farklı değildi. ERM (-) grupta SFCT başlangıç değerleri ile karşılaştırıldığında birinci ayda, ikinci ayda ve üçüncü ayda anlamlı şekilde azaldı (p=0.001, p<0.001, p<0.001, sırasıyla). ERM (+) grupta SFCT başlangıç değerleri ile karşılaştırıldığında birinci ayda değişmedi (p=0.389) fakat ikinci ve üçüncü ayda anlamlı olarak azaldı (p<0.001, p=0.001, sırasıyla).
TARTIŞMA ve SONUÇ: Üç aylık çalışmaya dayanarak, aylık uygulanan üç ranibizumab enjeksiyonunun, ERM' si olan veya olmayan diabet hastalarında istatistiksel açıdan anlamlı olarak görsel aktivitede iyileşme ve CMT ve SFCT' de düşüş sağladığını saptadık.
INTRODUCTION: This study aimed to compare the response to ranibizumab therapy in naive diabetic macular edema (DME) patients with and without an epiretinal membrane (ERM).
METHODS: A retrospective chart review was performed on 71 eyes in 71 DME patients. The patients were divided into a DME without ERM [ERM (-)] group (n=34) and DME with ERM [ERM (+)] group (n=37). Best-corrected visual acuity (BCVA), central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) were evaluated.
RESULTS: There were no significant differences in age or gender distribution between the patients in the ERM (-) and ERM (+) groups (p=0.052, p=0.96, respectively). In both groups, CMT showed a significant decrease during the first, second and third months (p<0.01 for each in both groups). Therefore, BCVA increased in both groups and made significant gains from the second month (p=0.044 in the ERM (-) group and p=0.006 in the ERM (+) group). CMT and BCVA values did not differ significantly between the ERM (-) and ERM (+) groups in the baseline, first month, second month or third month. In the ERM (-) group, SFCT values decreased significantly as compared to baseline in the first month, second month and third month (p=0.001, p<0.001, p<0.001, respectively). In the ERM (+) group, the first month SFCT value did not change significantly (p=0.389), but it decreased significantly in the second month and third month as compared to baseline (p<0.001, p<0.001, respectively).
DISCUSSION AND CONCLUSION: Based on studying patients for three months, we determined that a series of three monthly injections of ranibizumab ensured a statistically significant improvement in visual acuity and a decrease in CMT and SFCT in diabetic patients with or without ERM.

3.Evaluation of Correlation between Clinical and Magnetic Resonance Findings of Patellar Chondromalacia
Deniz Özel, Mustafa Çağlar Kır, Mehmet Öncü
doi: 10.14744/hnhj.2020.82504  Pages 221 - 225
GİRİŞ ve AMAÇ: Dizde manyetik rezonans inceleme endikasyonunu belirleyebilen kondromalazinin klinik bulgu ve manyetik rezonans görüntüleme özellikleri arasındaki ilişkiyi değerlendirmek ve yeni bir kıkırdak doku durumu göstergesi tanımlamak.
YÖNTEM ve GEREÇLER: Bu çalışma Mayıs 2017 - Şubat 2019 tarihleri arasında yapıldı. Diz ağrısı klinik olarak kondromalazi varlığı için anlamlıysa, vizüel analog skor (VAS) ve Kujala ön diz ağrı skoru (ÖDAS) kaydedildi. MRG değerlendirmesinde, ortalama patellar kalınlık (OPK) ve MRG derecesini birlikte değerlendirmek için patellar kıkırdak skoru (PKS) tanımlandı.
BULGULAR: İleri kondromalazi kadınlarda daha yaygındı. (p <0.01) Yaş ile MRG derecesi arasında pozitif bir korelasyon vardı ve korelasyon katsayısı 0.56 olarak hesaplandı.
Klinik ilişki için PKS, OPK (ortalama kıkırdak kalınlığı) ve MRG derecelerinin karşılaştırılmasında PKS ile en yüksek korelasyon katsayısı elde edildi. VAS ve ÖDAS ile ileri kondromalaziyi tanımlamak için ROC analizinde kesme değerleri sırasıyla 3 ve 80 idi. ÖDAS, VAS ile karşılaştırıldığında ileri kondromalazi için üstün bir klinik gösterge idi. Yaş ve cinsiyet ilişkileri gibi diğer demografik bulgular literatürle uyumlu idi.

TARTIŞMA ve SONUÇ: Diz durumunu belirlemek için VAS'yi ÖDAS gibi fonksiyonel ölçümlerle birleştirmek için potansiyel olarak daha iyi bir yöntem tanımlanmış olup, MRG endikasyonu değerlendirmesinde belirleyici olabilir. Yeni bir bakış açısı olarak, PKS hem ortalama patellar kalınlık hem de manyetik rezonans derecelendirmesinden oluşan kondral klinik durumun en iyi göstergesi idi.
INTRODUCTION: To evaluate the correlation between clinical appearance and magnetic resonance imaging features of chondromalacia that can determine the knee magnetic resonance indication and to define a novel chondral status indicator.
METHODS: This study was performed between May 2017 and February 2019. If the knee pain was suggestive for the presence of chondromalacia clinically, then VAS and Kujala AKPS were noted. For MRI evaluation, a patellar cartilage score (PCS) was defined to evaluate the mean patellar thickness (MPT) and MRI grading together.
RESULTS: Advanced chondromalacia was more common among females (p<0.01). There was a positive correlation between age and MRI grading and the correlation coefficient was calculated to be 0.56. The highest correlation coefficient obtained with PCS in comparing PCS, MCT (mean cartilage thickness) and MRI grading for the clinical relationship. To define advanced chondromalacia with VAS and AKPS cut-off values calculated to be 3 and 80 in ROC analysis. AKPS was a superior clinical indicator for advanced chondromalacia compared with VAS. The other demographic findings, such as age and gender relations, were concordant with the literature.
DISCUSSION AND CONCLUSION: A potentially better method was defined to combine VAS with functional measurements, such as AKPS, to determine a knee status may be indicative of MRI evaluation. As a novel perspective, PCS was the best indicator of the chondral clinical status that consists of both the mean patellar thickness and magnetic resonance grading.

4.Our 10 years’ Experience in Testicular Tumors
Senad Kalkan, Selahattin Çalışkan
doi: 10.14744/hnhj.2020.68095  Pages 226 - 228
GİRİŞ ve AMAÇ: Testis tümörleri genç erkeklerde görülen, diğer ürolojik malignitelere oranla düşük insidanslı bir hastalıktır. Çalışmamızda son 10 yıllık testis tümörü olgularının sonuçlarını paylaşmak istedik.

YÖNTEM ve GEREÇLER: Ocak 2009 ile Ocak 2019 yılları arasında testis tümörü öntanısıyla kliniğimizde opere edilen hastalar retrospektif olarak incelendi. Hastaların yaşı, laboratuar sonuçları ve patoloji sonuçları kayıt edildi. Patoloji raporunda benign tümör, kronik inflamasyon rapor edilen hastalar çalışmaya alınmadı.

BULGULAR: Çalışmaya 131 hasta dahil edildi. Hastalar 21 ile 90 yaş aralığında olup ortalama yaş 37.16+12.18 yıl idi. Germ hücreli tümör 125 hastada, sex-kord stromal tümör 3 hastada rapor edildi. Kalan 3 hastanın ikisinde liposarkom, birinde lenfoma tespit edildi. Germ hücreli tümör (GHT) rapor edilen hastaların 39.2%’ sinde seminom, 60.8%’ inde seminom dışı germ hücreli tümör mevcuttu. Seminom dışı germ hücreli tümör tespit edilen 76 hastanın; 65’inde (85.52%) mikst GHT, 7 (9.21%) hasta embriyonel karsinom ve 4(5.26%) hastada teratom saptandı.

TARTIŞMA ve SONUÇ: Hastaların büyük çoğunluğu germ hücreli tümörlerden oluşmaktaydı. En sık görülen mikst germ hücreli tümörler olup 2. sıklıkta seminomlar gözlendi.

INTRODUCTION: Testicular cancer is usually seen among young men and has lower incidence when compared with other urologic malignancies. This study aims to share the results of testicular cancer during the last ten years.
METHODS: In this study, the patients who underwent orchiectomy in our unit between January 2009 and January 2019 were reviewed retrospectively. Age of the patients, the laboratory results and pathological reports were recorded. The patients who were diagnosed as benign tumor and inflammation were excluded from this study.
RESULTS: There were 131 patients in the present study. The patients’ age was between 21 and 90, with a mean age of 37.16+12.18 years. The germ cell tumor was reported in 125 patients. The remaining of the six patients had a sex-cord stromal tumor (n=3), liposarcoma (n=2) and lymphoma (n=1). Of these 125 patients, seminomas were seen in 39.2% and nonseminomatous germ cell tumor in 60.8% of the patients. Mixed germ cell tumor was reported in 65 (85.52%) patients; embryonal carcinoma was detected in seven (9.21%) patients. Four (5.26%) patients were diagnosed as a teratoma.

DISCUSSION AND CONCLUSION: Most of the patients had germ cell tumors. Mixed germ cell tumor was the commonest tumor and followed by seminoma.

5.Long Term Visual Outcomes of Uveitis Associated with Behcet’s Disease
Selim Bölükbaşı, Yılmaz Özyazgan
doi: 10.14744/hnhj.2020.94557  Pages 229 - 233
GİRİŞ ve AMAÇ: İlk başvuru tarihleri 1977-1987 ve 2000-2010 yılları arasında olan hastaların görsel prognozlarını kıyaslayarak buna etki eden faktörleri irdelemeyi amaçlamaktayız.
YÖNTEM ve GEREÇLER: Bu retrospektif, gözlemsel çalışmaya 200 hastanın (48 kadın, 152 erkek) 382 gözü dahil edildi. İlk başvuru tarihleri 1977-1987 yılları arasında olanlar Grup1, 2000-2010 tarihleri arasında olanlar ise Grup 2 olarak sınıflandırıldı. Grup 1’de 100 hastanın 194 gözü, Grup 2’de 100 hastanın 188 gözü bulunuyordu. Hastaların dosyaları üzerinden her vizitte, en iyi düzeltilmiş görme keskinliği, biomikroskopik ve indirekt oftalmoskopik muayene bulguları, yaşı, cinsiyeti, göz tutulumunun tek veya çift taraflı oluşu, geçirdiği atak sayısı ve atakların aralıkları, oküler bulgular ve komplikasyonları, kullandıkları antiinflamatuar ve immunsupresif ilaç tedavileri ayrıca izlem başlangıcı ve sonundaki hasarın derecelendirilmesi not edilerek değerlendirildi.
BULGULAR: Hastaların %76’sı erkek, % 24’ü kadındı. Hastaların üveitle ilk başvuru yaş ortalaması 29 idi. Oküler tutulum % 91 çift taraflıydı. Grup 1’de ortalama atak sayısı 4.21 iken Grup 2’de 3.25 idi. Kaplan-Meier survival analiz yöntemiyle iki grup kıyaslandığında Grup 1’de %64.50’sinde potansiyel görme keskinliği kritik görme derecesi olan 0.1’in altına düşerken Grup 2’de bu değer %48.81 idi. (Log Rank: 11.44, p<0.001). Ortalama takip sonu evresi 1. Grupta 3.24, 2. Grupta 2.47 idi (p<0.001). Ortalama takip sonu en iyi düzeltilmiş görme keskinlikleri ise 1. Grupta 0.41, 2. Grupta ise 0.65 olarak bulundu (p<0.001).

TARTIŞMA ve SONUÇ: 2000’li yıllarda Behçet hastalığına bağlı üveitlerin vizüel prognozu; oküler atakların daha sıkı takibi, ciddi posterior üveiti olan hastalara azatioprin, siklosporin gibi immunsupresanların yerinde ve zamanında kullanımı ve seçilmiş olgulara da uygulanan yeni tedavi ajanlarının etkisiyle 1980’li yıllara göre daha seviyededir.
INTRODUCTION: To compare the visual prognosis of patients with Behcet’s uveitis who presented after 1977-1987 and 2000-2010.
METHODS: In this observational, retrospective study, 382 eyes of the 200 patients (48 female and 152 male) were included. Patients who visited the clinic between 1977 and 1987 were classified into Group 1, and patients who visited between 2000 and 2010 into Group 2. Group 1 consisted of 194 eyes (100 patients), and Group 2 consisted of 188 eyes (100 patients). Best corrected visual acuity (BCVA) measurements, biomicroscopic and fundoscopic examinations, gender, age of onset of uveitis, numbers of ocular attacks per year from the onset of ocular disease, immunosuppressive drugs and ocular complications were noted by medical records. Grade of uveitis was noted at the first and last visit.

RESULTS: In this study, 76% of the patients were male and 24% of the patients were female. Bilateral ocular involvement was in 91%. The mean age of onset of uveitis was 29 years. Mean ocular attack number was 4.21 in Group 1 and 3.25 in Group 2. Kaplan Meier survival analysis estimated the risk of losing useful vision (BCVA>0.1) at the last visit for Group 1 and Group 2 as 64.50% and 48.81% (Log Rank: 11.44, p<0.001). Mean last visit grade was 3.24 in Group 1 and 2.47 in Group 2 (p<0.001). Mean last BCVA was 0.41 in Group 1 and 0.65 in Group 2 (p<0.001).
DISCUSSION AND CONCLUSION: There was a trend for a better visual prognosis in patients who presented after 2000 due to following-up ocular attacks closer and using azathioprine, cyclosporin A and new treatment agents for severe posterior uveitis.

6.Does the Surgical Technique Affect the Results of Partial Nephrectomy Performed for Renal Cell Carcinoma? Single-center 'MIC' Score and 'Trifecta' Results
Abdurrahman İnkaya, Ahmet Tahra, Resul Sobay, Eyüp Veli Küçük, Uğur Boylu
doi: 10.14744/hnhj.2018.32559  Pages 234 - 240
GİRİŞ ve AMAÇ: Amaç: Renal Hücreli Kanser (RHK) nedeniyle açık (APN), laparoskopik(LPN) ve robot yardımlı parsiyel nefrektomi (RPN) uyguladığımız hastalarınMIC (Marjin, İskemi, Komplikasyon) skoru veTrifecta sonuçlarını bildirmek.
YÖNTEM ve GEREÇLER: 2007 ile ağustos 2018 tarihleri arasında böbrek tümörü nedeniyle açık parsiyel nefrektomi (APN) n: 58, laparoskopik parsiyel nefrektomi (LPN) n: 32 ve robot yardımlı parsiyel nefektomi (RPN) n: 126 uyguladığımız vakaların demografik özellikleri, tümör özellikleri, perioperatif ve post operatif veriler ve komplikasyonlar, histopatolojik özellikleri retrospektif olarak değerlendirildi. Böbrek tümörleri için nefron koruyucu cerrahi sonuçlarını bildirmede cerrahi sınır negatifliği, iskemi süresinin 20 dakikanın altında olması ve komplikasyon olmaması oranlarını içeren MIC Skoru ile cerrahi sınır negatifliği, perioperatif komplikasyonlar ve glomerul filtrasyon oranının (GFR) >%90 korunması parametlerini içeren ‘trifecta’ oranları ile sonuçlarımızı bildirmeyi amaçladık.
BULGULAR: RPN hastanede kalış ve tahmini kanama miktarında APN tekniğine üstün bulundu. Transfüzyon oranı ve tüm komplikasyonlar üç teknikte de benzer bulundu. APN'de daha kısa operasyon süresi ve iskemi süresi olmasına rağmen daha yüksek miktarda kan kaybı ve hastanede kalış süresi mevcut idi. Cerrahi sınır pozitifliğinde ve GFR'nin>%90 korunmasında her üç teknik arasında anlamlı fark bulunmadı. Sıcak iskemi süresi ortalama 23.6 dk ile en uzun LPN'de, ardından ortalama 18.4 dk ile RPN ve ortalama 16.6 dk ile APN'de en kısa tespit edildi.(p=0.003) Açık ile robotik teknik arasındaki fark anlamlı değilken LPN tekniğinde sıcak iskemi süresi anlamlı olarak uzundu. MIC skoru oranımız APN'de %79, LPN'de %71 ve RPN'de %81.7 bulundu.(p=0.04) Trifectaoranlarımız APN'de % 87, LPN'de %87.5 ve RPN'de %93.6 olarak gerçekleşti. (p=0.128)
TARTIŞMA ve SONUÇ: RHK için uygulanan parsiyel nefrektomi sonuçlarını bildirmede hem ''MIC skoru sistemi'', hem ''Trifecta'' sistemi kullanımı kolay ve tekrar edilebilir sistemler olduğundan objektif bir standardizasyon sağlayabilir. RPN düşük komplikasyon oranları, daha kısa operasyon süresi, açık cerrahiye benzer sıcak iskemi oranları ve onkolojik sonuçlar ile açık parsiyel nefrektomiye en güçlü alternatif tekniktir.
INTRODUCTION: To report the MIC scores and trifecta rates in patients who underwent partial nephrectomy with open (OPN), laparoscopic (LPN) and robot-assisted techniques (RPN) due to kidney tumor.
METHODS: Demographic characteristics, tumor characteristics, peri-and post-operative data and complications of the patients who underwent OPN (n=58), LPN (n=32) and RPN (n=126) between 2007 and August 2018 due to kidney tumor and histopathological features were evaluated retrospectively in this study. To report oncological and functional outcomes of nephron-sparing surgery for renal tumors, MIC (surgical margin negativity, ischemia duration less than 20 minutes and lack of complication) and Trifecta (surgical margin negativity, perioperative complications and glomerular filtration rate (GFR) >90% protection rate) were used.
RESULTS: RPN was superior to OPN technique in hospitalization and estimated bleeding. Transfusion rate and all complications were similar in all three techniques. Although OPN had shorter operation time and ischemia time, there was a higher amount of blood loss and hospital stay. No significant difference was found between all three techniques for surgical margin positivity and >90% preservation of GFR. The mean duration of warm ischemia was 23.6 minutes with the longest LPN, followed by a mean of 18.4 minutes with an RPN and a mean of 16.6 minutes with OPN (p=0.003). It was significantly longer. Our MIC score was 79% in OPN, 71% in LPN and 81.7% in RPN (p=0.04). Our Trifectaoranes were 87% in OPN, 87.5% in LPN and 93.6% in RPN (p=0.128).
DISCUSSION AND CONCLUSION: Both the 'MIC score system 'and the 'Trifecta' system are easy to use and reproducible systems for reporting partial nephrectomy results for renal tumors. Robot-assisted partial nephrectomy is the most powerful alternative technique for open partial nephrectomy with low complication rates, shorter operation time, similar ischemia durations and oncologic outcomes.

7.Dermatological Findings in Female and Male Fibromyalgia Patients
Müge Kepekçi, Berna Ürkmez, Emre Araz, Özgür Taşpınar, Murat Erdugan, Ilteriş Ahmet Şentürk
doi: 10.14744/hnhj.2018.98705  Pages 241 - 245
GİRİŞ ve AMAÇ: Fibromiyalji sendromu (FMS), yaygın kas iskelet sistemi ağrısı ve vücudun bazı noktalarında aşırı hassasiyet ile karakterize kronik bir hastalıktır. Çalışmamızın amacı, kadın ve erkek FMS tanısı alan hastalar ile kadın ve erkek sağlıklı gönüllüler arasında dermatolojik bulgular açısından fark olup olmadığını araştırmaktır.
YÖNTEM ve GEREÇLER: FMS tanısı konmuş 60 gönüllü kadın hasta ve 60 gönüllü erkek hasta çalışma grubuna alınırken; sağlıklı gönüllülerden oluşan 60 kadın ve 60 erkek ise kontrol grubuna alındı. Tüm katılımcılara ilk başvurularında Fibromiyalji Etki Anketi (FIQ) ve Beck Depresyon Ölçeği (BDI) uygulandı. Tüm katılımcıların cilt kontrolleri dermatoloji uzmanı tarafından yapıldı ve dermatolojik tanıları kaydedildi. Her iki grupta yer alan hastaların sonuçları karşılaştırıldı ve istatistiksel olarak anlamlı farklılıkların olup olmadığına bakıldı.
BULGULAR: Dermatolojik tanılar incelendiğinde, Lichen Simplex Kronikus tanısı, FMS'li kadın hasta gurubunda, sağlıklı kadın katılımcılara göre istatistiksel olarak anlamlı daha yüksek olarak tespit edildi (p=0.006).
TARTIŞMA ve SONUÇ: Bu çalışma sonucu bize FMS'li hastalardaki dermatolojik muayeneye, bütünsel muayene yaklaşımında daha fazla önem verilmesi gerektiğini düşündürmektedir.
INTRODUCTION: Fibromyalgia syndrome (FMS) is a chronic disease characterized by widespread musculoskeletal pain and hypersensitivity at some points of the body. Our study aims to investigate whether there is a difference between male and female FMS patients and male and female healthy volunteers concerning dermatological findings.
METHODS: Sixty female and 60 male patients, who were diagnosed with FMS, were included in the study group; 60 female and 60 male healthy volunteers were included in the control group in this study. Fibromyalgia Impact Questionnaire and the Beck Depression Inventory were applied to all participants at the time of admission. All participants were examined by a dermatologist, and dermatological diagnoses were recorded. The results of the patients in both groups were compared and statistically analyzed.
RESULTS: In the examination of dermatological diagnoses, it was found that the incidence of lichen simplex chronicus was significantly higher in female FMS patients than in healthy female participants (p=0.006).
DISCUSSION AND CONCLUSION: Based on the results of this study, our findings suggest that dermatological examination in patients with FMS should be given more importance within a holistic examination approach.

8.The Effects of Anti-HBs Antibodies Passed through Transplacental Route on Immunization Induced by HBV Vaccine and Natural Course of Passively Transmitted HBs Antibodies
Enver Atay, Aysu Say
doi: 10.14744/hnhj.2020.69335  Pages 246 - 249
GİRİŞ ve AMAÇ: Hepatit B enfeksiyonu toplum sağlığını ilgilendiren önemli bir enfeksiyondur. Bu çalışmada doğal ya da aşı ile Hepatit B virüsüne karşı bağışık annelerden doğan ve transplasental olarak anneden bebeğe geçen Anti-Hbs antikorlarının, yenidoğan bebeklerde HBV aşısına bağlı oluşan bağışıklığı etkileyip etkilemediğini, bu pasif geçen Anti-HBs antikor titrelerinin aşılı ve aşısız yenidoğan bebeklerdeki doğal seyrini değerlendirmeyi amaçladık.
YÖNTEM ve GEREÇLER: Çalışmaya 68 sağlıklı term yenidoğan bebek alındı. Bu yenidoğan bebeklerin annelerinin bağışıklık durumu değerlendirildi. Bebekler 3 gruba ayrıldı. Grup 1, anneleri AntiHBs antikoru pozitif olan bebekler, bu bebeklere HBV aşısı uygulanmadan AntiHBS titreleri ardışık olarak 0, 1, 3, 6 ve 8.aylarda bakıldı. Grup 2, anneleri AntiHBs antikoru pozitif olan bebekler, bu bebekler 0,1 ve 6.ayda HBV aşısı ile aşılandı ve bu bebeklerin de 0,1, 3, 6 ve 8.aylarda Anti HBS titrelerine bakıldı. Grup 3, anneleri AntiHBs antikoru negatif olan bebekler, bu bebekler 0, 1 ve 6.ayda HBV aşısı ile aşılandı, bebeklerin 0,1, 3, 6 ve 8. aylarda AntiHBS titrelerine bakıldı.
BULGULAR: Grup1; 22 bebek, grup2; 24 bebek, grup3 ise yine 22 bebekten oluşmakta idi. Anneleri AntiHBs antikoru pozitif olan aşılanmayan bebeklerin AntiHBs titrelerinin sırasıyla 1, 3, 6 ve 8. aylarda <10 mIU/mL altına düşme yüzdeleri %40,9, %50, %59,09, %100 olarak bulundu.
TARTIŞMA ve SONUÇ: Pasif antikorlara sahip bebeklere uygulanan HBV aşısına karşı antikor cevabının, anneleri HBsAg(-), AntiHBs(-), AntiHBcIgM(-) ve aynı aşı takvimi ile aşılanmış bebeklerdeki antikor cevabına benzer olduğu saptandı yaklaşık antikor cevabını verdiğini saptadık. Böylece bu transplasentalntal yola geçen AntiHBs antikorların 0, 1 ve 6.aylarda uyguladığımız uygulanan HBV aşısının oluşturduğu antikor cevabını etkilemediği tespit edildi.
INTRODUCTION: Hepatitis B infection is an important infection that concerns public health. In this study, we aimed to evaluate whether anti-Hbs antibodies born from mothers who are immune to hepatitis B virus with natural or vaccination and passed from mother to baby transplacentally affect the natural course of these passive anti-HBs antibody titers.
METHODS: In this study, 68 healthy term newborn babies were included. The immune status of the mothers of these newborn babies was evaluated. Babies were divided into three groups. Group 1, babies whose mothers were positive for AntiHBs antibody, anti-HBS titers were evaluated consecutively at 0, 1, 3, 6 and 8 months without HBV vaccine. In Group 2, babies whose mothers were positive for anti-HBs antibody were vaccinated with HBV vaccine at 0.1 and 6 months, and these babies were examined for anti-HBS titers at 0.1, 3, 6 and 8 months. In Group 3, babies whose mothers were negative of anti-HBs antibody were vaccinated with HBV vaccine at 0, 1 and 6 months, and babies were examined at 0.1, 3, 6 and 8 months.
RESULTS: Group 1 consisted of 22 babies, Group 2 consisted of 24 babies and Group 3 consisted of 22 babies. Percentages of anti-HBs titers falling below <10 mIU/mL at 1, 3, 6 and 8 months were found to be 40.9%, 50%, 59.09%, and 100% of non-vaccinated babies whose mothers were positive for anti-HBs antibody.
DISCUSSION AND CONCLUSION: We found that the antibody response to HBV vaccine administered to infants with passive antibodies was similar to the antibody response in mothers vaccinated with their mothers HBsAg (-), anti-HBs (-), anti-HBcIgM (-) and the same vaccine calendar. Thus, it was found that anti-HBs antibodies that started this transplacentalntal pathway did not affect the antibody response produced by the HBV vaccine administered at 0, 1 and 6 months.

9.The Role of TNF-alpha and IL-10 Cytokines in Degenerative Lumbar Spinal Stenosis
Mustafa Efendioğlu, Emine Emel Koçman
doi: 10.14744/hnhj.2020.81488  Pages 250 - 253
GİRİŞ ve AMAÇ: Bu çalışmada dejeneratif Lombar Spinal Stenoz (LSS) tanısı konmuş hastalarda Tümör Nekroz Faktörü-α (TNF-α)/ Intelökin-10 (IL-10) (enflamatuvar / antienflamatuvar) sitokin dengesini araştırdık.

YÖNTEM ve GEREÇLER: Hasta ve kontrol kanları, Haydarpaşa Numune Eğitim ve Araştırma Hastanesi İmmünoloji Laboratuarında santrifüjlenerek -20°C’de saklandı. Enzyme-linked immunosorbant assay (ELISA) yöntemi ile Human TNF-alfa ve IL-10 sitokinleri, Boster marka 96 kuyucuklu ELISA Kitler kullanılarak manuel yöntemle çalışıldı.
BULGULAR: Hasta grubunun TNF alfa değerleri, kontrol grubundan istatistiksel olarak anlamlı düzeyde yüksek bulundu (p: 0.004; p<0.05) ve hasta grubunun IL-10 değerleri, kontrol grubundan istatistiksel olarak anlamlı düzeyde yüksek bulundu (p: 0.017; p<0.05).
TARTIŞMA ve SONUÇ: Kanatimize göre; dejeneratif LSS olgularında TNF-alfa ve IL-10 sitokin düzeylerinin birlikte yükselmesi sayesinde; hastalığın enflamatuvar süreci, anti-enflamatuvar cevapla dengelenmeye çalışmaktadır.
INTRODUCTION: In this study, we investigated Tumor Necrosis Factor-α (TNF-α)/Interleukin -10 (IL-10) (inflammatory/anti-inflammatory) cytokine balance in patients diagnosed with degenerative Lumbar Spinal Stenosis (LSS).
METHODS: Blood samples obtained from patients and control subjects were centrifuged at the Haydarpaşa Numune Training and Research Hospital Immunology Laboratory and stored at -20°C. Human TNF-alpha and IL-10 cytokines were studied manually with an Enzyme-linked immunosorbent assay (ELISA) method using Boster brand 96-well ELISA kits.
RESULTS: TNF -alpha values of the patient group were found to be statistically significantly higher than the control group (p=0.004; p<0.05) and IL-10 values of the patient group were statistically significantly higher than the control group (p=0.017; p<0.05).
DISCUSSION AND CONCLUSION: Our findings suggest that TNF-alpha and IL-10 cytokine levels increased together in degenerative LSS cases. The inflammatory process of the disease is trying to be balanced with an anti-inflammatory response

10.The Fabry Family Determined as a Result of the Screening of the Transplanted Patients: A Single-Center Screening
Özgür Can, Süleyman Baş, Melike Betül Öğütmen
doi: 10.14744/hnhj.2018.81904  Pages 254 - 258
GİRİŞ ve AMAÇ: Fabry hastalığı X geçişli lizozomal depo hastalığı olup, hastalığa α-galaktosidaz A enziminin azalmış aktivitesi neden olmaktadır. Bu çalışmayla böbrek nakilli hastaların taranması sonrası saptanan bir Fabry ailesi değerlendirildi.
YÖNTEM ve GEREÇLER: Sağlık Bilimleri Üniversitesi Haydarpaşa Numune Eğitim ve Araştırma Hastanesi’ nde nakil olmuş 200 hasta taranabildi. Erkekler için α-galaktosidaz A aktivitesi tarama için kullanıldı. Bütün kadın hastalarda gen analizi kullanıldı.
BULGULAR: Nakilli 200 hastadan 35 yaşında bir kadın hastada c.376A>G (p. S126G) heterozigot mutasyon tespit edildi. 2015 yılında ablasından renal nakil yapılmıştı. Ablasında da aynı mutasyon tespit edildi.
Bu indeks vakadan başlayarak tespit edilebilen 38 aile üyesi ile iletişime geçildi. Sadece 22 aile üyesine genetik analiz yapıldı. On bir aile üyesinde genetik analiz negatif, 11 aile üyesinde genetik analiz pozitifti. 12 aile üyesi ile iletişim sağlanamadı. Pozitif olan sadece bir erkek hasta vardı, o da indeks vakanın yeğeniydi.

TARTIŞMA ve SONUÇ: On iki hastanın genetik analiz pozitifti. Mutasyon pozitif olan 87 yaşında hala ele alındığında, bazı hastalarda hastalığının hafif ve komplikasyonsuz geçebileceğini görülmektedir. Mutasyon pozitif sadece bir erkek hasta tespit edildi.
INTRODUCTION: Fabry disease (FD) is an X-linked lysosomal storage disorder that arises from a decreased activity of α-galactosidase A. With this study, we evaluated an FD family, which was detected after the screen of transplanted patients.
METHODS: We were able to screen 200 transplanted patients at the University of Health Science, Haydarpasa Numune Training and Research Center. α-Gal A activity was used for screening of the male patients. Gene analysis was performed for all female transplanted patients.
RESULTS: Among 200 patients, one 35 years old female patient had a genetic mutation, which was c.376A>G (p=S126G) heterozygous. She received a renal kidney from her sister in 2015. Genetic analysis of this female donor also revealed the same genetic variation. Starting with this index patient, we communicate with available 38 family members. Among these family members, the genetic analysis was performed to 22 family members. Twelve and 10 family members had negative and positive results, respectively. We could not communicate with 12 family members. Only one male family member had positive result and was the nephew of the index case.
DISCUSSION AND CONCLUSION: Eleven family members had positive results for genetic analysis. An 87 years old aunt showed the asymptomatic nature of the disease. Again, the family had only one male member with the mutation.

11.The Neuroectodermal Subtypes of Chiari Malformation: Long-term Results
Ramazan Sarı, Fatih Han Bolukbaşı, Recep Başaran, Mustafa Efendioğlu, Nejat Işık
doi: 10.14744/hnhj.2020.05658  Pages 259 - 265
GİRİŞ ve AMAÇ: Chiari malformasyonları (CMs) beyincik, beyin sapı ve kraniovertebral bileşkenin (CVJ) anatomik anomalileri ile tanımlanan heterojen bir hastalık grubudur. Bu çalışmanın amaçları, CM-0'ın CM, Chiari 1 ve 1.5'in bir alt grubu olup olmadığını belirlemek için, büyük CM'larında demografik ve klinik özellikler, insidans, cerrahi prosedürler ve sonuçları farklı patolojiler olup olmadığını belirlemektir.

YÖNTEM ve GEREÇLER: Tüm hastalar 1985-2016 yılları arasında CM için değerlendirildi ve ameliyat edildi. Hastalar çeşitli alt tiplere ayrıldı. Demografik veriler, ek hastalıklar, klinik özellikler, cerrahi prosedürler, komplikasyonlar ve sonuçlar kaydedildi.

BULGULAR: Çeşitli cerrahi prosedürler uygulanan 55 hasta değerlendirildi. Yaş ortalamaları 0.72 ± 1.17 idi. 26 CM-2 vakası (% 47.3), 16 CM-3 vakası (% 29.1) ve 13 CM-4 vakası (% 23.6) tespit ettik. Chiari alt tipleri karşılaştırıldığında ek hastalıklar, semptom süresi, nörolojik muayene, komplikasyon oranı ve hastanede kalış süresi arasında istatistiksel olarak anlamlı farklılıklar vardı.

TARTIŞMA ve SONUÇ: Hastanede kalış süresi, SM varlığı ve kısa semptom süresi daha kötü sonuçlarla ilişkilidir. Dura onarımı cerrahinin en önemli etkisidir. Dura defekti (BOS fistülü) komplikasyon oranını ve ortalama hastanede kalış süresini arttırır ve daha kötü sonuçlara neden olur. Bu nedenle, cerrahlar daha fazla zamana ihtiyaç duyarlar.

INTRODUCTION: Chiari malformations (CMs) are a heterogeneous group of disorders defined by anatomic anomalies of the cerebellum, brainstem, and craniovertebral junction (CVJ). This study aims to establish the de-mographic and clinical features, incidence, surgical procedures, and outcomes in large series of CMs, to investi-gate whether CM-0 is a subgroup of CM, Chiari 1 and 1.5 are different pathologies.
METHODS: In this study, all of the patients were evaluated and operated on for CM between 1985 and 2016. The patients were grouped into various subtypes. Demographic data, additional diseases, clinical features, surgical procedures, complications and outcomes were recorded.
RESULTS: In this study, 55 patients who underwent various surgical procedures were evaluated. Their mean age was 0.72±1.17. We detected 26 cases of CM-2 (47.3%), 16 cases of CM-3 (29.1%) and 13 cases of CM-4 (23.6%). When Chiari subtypes were compared, there were statistically significant differences in additional dis-eases, symptom duration, neuro examination, complication rate and hospital stay.
DISCUSSION AND CONCLUSION: The findings obtained in this study suggest that the long hospital stay, the presence of SM and short symptom duration are associated with worse outcomes. The dura repair is the most important stage of surgery. Dural tear (CSF fistule) increases the complication rate and mean hospital stay and also causes the worse outcome. Therefore, the surgeon should spend more time on dura repair.

12.Combination or Alone? Which one is the Best in Premature Ejaculation Treatment?
Aykut Buğra Şentürk, Ali Haydar Yılmaz, Basri Çakıroğlu, Muhammet Yaytokgil, Cemil Aydın, Musa Ekici, Serdar Aykan, Mustafa Sungur
doi: 10.14744/hnhj.2018.87699  Pages 266 - 270
GİRİŞ ve AMAÇ: Prematüre ejakülasyonlu hastalarda tek başına tadalafil ve dapoksetinle olan kombinasyonunun etkinliğinin karşılaştırmak.
YÖNTEM ve GEREÇLER: Prematüre ejakülasyon için üroloji kliniğinde tedavi edilen 120 hasta prospektif olarak değerlendirildi. Hastaların IELT ve IIEF formları çalışmadan önce dolduruldu ve ürolojik muayeneleri yapıldı. Tedavi edilen hastalar 2 gruba ayrıldı. Grup 1'deki hastalar sadece 5 mg tadalafil aldı, grup 2'deki hastalar ise 30 mg dapoxetine ve 5 mg tadalafil kombinasyonunu aldı.
BULGULAR: Tedaviden sonra, grup 1 IEFF skorları 25.12 ± 2.49 ve ortalama IELT skorları 7.35 ± 4.37 saniye idi. Her iki parametrede de istatistiksel olarak anlamlı bir artış vardı (p <0.001). Tedaviden sonra, grup 2 IEFF skorları 27.37 ± 2.46 ve ortalama IELT skorları 9.07 ± 4.20 saniye idi. Her iki parametrede de istatistiksel olarak anlamlı bir artış vardı (p <0.001).
TARTIŞMA ve SONUÇ: Erken boşalmanın tedavisinde Tadalafilin tek başına kullanılması yerine dapoksetinle kombine kullanılması tedavi başarısını arttıracaktır.
INTRODUCTION: To compare the effectiveness of tadalafil alone and in combination with dapoxetine in patients with premature ejaculation.
METHODS: In this study, 120 patients treated at the urology clinic for premature ejaculation were evaluated prospectively. IELT and IIEF forms of patients were filled before this study, and their urological examinations were performed. Patients that were being treated were divided into two groups. Patients in group 1 received only 5 mg tadalafil, whereas patients in group 2 received a combination of dapoxetine 30 mg and tadalafil 5 mg.
RESULTS: After the treatment, group 1 mean IEFF scores were 25.12±2.49, and mean IELT scores were 7.35±4.37 seconds. There was a statistically significant increase in both parameters (p<0.001). After the treatment, group 2 mean IEFF scores were 27.37±2.46, and mean IELT scores were 9.07±4.20 seconds. There was a statistically significant increase in both parameters (p<0.001).
DISCUSSION AND CONCLUSION: Use of dapoxetine in combination with tadalafil instead of using tadalafil alone in the treatment of premature ejaculation will increase treatment success.

13.Transperitoneal Laparoscopic Repair of the Retrocaval Ureter: Our Single-Center Experience
Serdar Aykan, Ahmet Ürkmez, Musab Ali Kutluhan, Mustafa Zafer Temiz, Atilla Semerciöz, Ahmet Yaser Müslümanoğlu
doi: 10.14744/hnhj.2018.91259  Pages 271 - 278
GİRİŞ ve AMAÇ: Retrokaval üreterin (RCU) laparoskopik transperitoneal onarımındaki tecrübemizi tanımlamak.
YÖNTEM ve GEREÇLER: Şubat 2010 ve Şubat 2017 yılları arasında, kliniğimizde RCU tanısı ile laparoskopik onarım uygulanan beş hasta (1 kadın ve 4 erkek) çalışmaya alındı. Hastaların yaş ortalaması 27 (20–32) idi. Tüm hastalar ameliyat öncesi, ilk olarak ultrasonografi (US) ile sonrasında kontrastlı bilgisayarlı tomografi (BT) ve intravenöz pyelografi (IVP) ile değerlendirildi. RCU' nun BT tanısından sonra tüm hastalara 99mTc-DTPA ile diüretik renografi incelemesi yapıldı. Laparoskopik cerrahi, üç olguda iki boyutlu (2D) görüntüleme sistemi, iki olguda ise üç boyutlu (3D) görüntüleme sistemi kullanılarak transperitoneal yaklaşımla yapıldı.
BULGULAR: Tüm operasyonlar açık cerrahiye geçilmeden laparoskopik olarak tamamlandı. Ortalama operasyon süresi 168 ± 9 dakika idi. 3 boyutlu görüntüleme sisteminin kullanıldığı iki hastanın operasyon süresi, 2 boyutlu görüntü sisteminin kullanıldığı hastalara göre daha kısa (155 ve 165 dakika) idi. Tüm hastalarda peroperatif kan kaybı 50 mL' den azdı. Oblitere üreter segmenti 4 hastada çıkarıldı. Dört hasta cerrahi sonrası semptomsuzdu ve böbreklerindeki hidronefrozda gerileme vardı. Olgulardan birinde postoperatif dönemde hidronefroz rezolüsyonu görülmedi.
TARTIŞMA ve SONUÇ: Retrokaval üreterin laparoskopik onarımında başarının anahtarı, dokuya saygı, iyi hemostaz ile düzlem boyunca diseksiyonun sağlanmasıdır. RCU' nun saf laparoskopik tedavisi uygulanabilir ve teknik olarak güvenilir görünmektedir. Aynı zamanda 3D görme sistemi kullanılarak diseksiyon ve intrakorporeal dikiş atma avantajları nedeniyle tercih edilebilir.
INTRODUCTION: We aimed to describe our experience in transperitoneal laparoscopic repair of retrocaval ureter (RCU) in this study.
METHODS: Between February 2010 and February 2017, five patients (1 female and 4 males) who underwent laparoscopic repair with the diagnosis of RCU in our department were included in this study. Patients’ mean age was 27 (range 20–32 years). All patients were pre-operatively evaluated using ultrasonography (US) followed by contrast-enhanced computed tomography (CT) intravenous pyelography (IVP). After CT diagnosis of RCU, all patients underwent diuretic renography examination with 99mTc-DTPA. Laparoscopic surgery was performed by the transperitoneal approach using the three-dimensional (3D) vision system in two and two-dimensional vision system (2D) in three patients.
RESULTS: All operations were completed laparoscopically without conversion to open surgery. Mean operation time was 168.5±9.89 minutes. Operation time of two patients in whom 3D a vision system was used was shorter (155 and 165 minutes) comparing to others in whom 2D vision systems used. Blood loss was less than 50 mL in all patients. Obliterated ureteric segments were excised in four patients. Four patients were symptom-free after surgery and had regression of hydronephrosis in their kidneys. In one of the cases, there was no resolution of hydronephrosis postoperatively.
DISCUSSION AND CONCLUSION: Careful dissection along the planes with good tissue respect and good hemostasis during each step are the key to success for laparoscopic repair of RCU. Pure laparoscopic treatment of RCU seems feasible and technically reliable. At the same, time using a 3D vision system, if available would be preferable because of the dissection and intracorporeal suturing advantages.

14.Prophylactic Effects of Verapamil in Testicular Ischemia-reperfusion Damage in Rats
Zülfü Sertkaya, Metin Ishak Öztürk, Orhan Koca, Mehmet Akyüz, Gülistan Gümrükçü, Muhammet İhsan Karaman
doi: 10.14744/hnhj.2018.72324  Pages 279 - 283
GİRİŞ ve AMAÇ: Testiste oluşturulan torsiyon, iskemik bölgeye nötrofillerin göçü ve serbest oksijen radikallerinin oluşumu, testiste iskemi-reperfüzyon (I/R) hasarının oluşumunda etkin rol oynayan faktörlerdir. Verapamil HCl, fenilalkilamin türevi L-tipi voltaj bağımlı kalsiyum kanal blokeridir. Çalışmamızda Verapamil HCl’ün, I/R sonucu testiste oluşan reperfüzyon hasarında koruyucu etkilerini araştırmayı amaçladık.
YÖNTEM ve GEREÇLER: Sekiz haftalık, 21 adet erişkin erkek Wistar-Albino sıçan randomize edilerek 3 gruba ayrıldı; Sham, I/R, I/R + Verapamil HCl. Sham ve I/R gruplarında 2. saatte intraperitoneal SF; I/R+Verapamil HCl grubunda ise detorsiyon esnasında 2 mg/kg intraperitoneal olarak verildi. Spermatojenik fonksiyonlar Johnsen kriterlerine göre değerlendirilerek her testis için ortalama skorlar hesaplandı. P < 0,05 değeri istatistiksel olarak anlamlı kabul edildi.
BULGULAR: Tüm gruplardan elde edilen histopatolojik ve moleküler parametreler karşılaştırıldı. Venöz kan örneklerinden ölçülen inflamasyon medyatörlerinin (TNF-α ve IL1-β) ortalama düzeyleri hesaplandı. Herhangi bir tedavi verilmeyen I/R gruplarında, sham gruplarına kıyasla TNF-α düzeylerinin istatistiksel anlamlı olarak arttığı ve Verapamil tedavisinin bu artışı anlamlı şekilde önleyerek sham gruplarına benzer düzeye getirdiği tespit edildi. Dokuda antioksidan özellik gösteren glutatyon peroksidaz (GPx) düzeylerinin, Verapamil HCl verilmeyen I/R grubunda Sham gruplarına kıyasla anlamlı olarak düştüğü gözlenirken, Verapamil HCl tedavisinin bu durumu önlediği saptandı. GPx ekspresyon skorlarının, I/R grubunda sham gruplarına kıyasla anlamlı olarak arttığı izlenirken, Verapamil HCl tedavisinin bu değerleri sham gruplarına benzer düzeylere indirdiği belirlendi. Spermatogenez açısından Johnsen skorlama sistemi kullanılarak yapılan histolojik değerlendirmede gruplar arasında ortalama skorlar açısından istatistiksel anlamlı bir fark saptanmadı.
TARTIŞMA ve SONUÇ: Torsiyon detorsiyon sonucu ortaya çıkan I / R durumunda, erken dönemde kandaki inflamasyon belirteçlerinin artışına, GPx aktivitesinde artışa, dokuların anti oksidan kapasitesinde azalmaya neden olduğu ve dört saat içinde spermatogenez parametrelerine etkisi olmadığı sonucuna varılmıştır. Verapamil HCl testis I / R'deki hasarı azaltır.
INTRODUCTION: Testicular torsion, migration of neutrophils to the ischemic region and the formation of free oxygen radicals are important factors in the occurrence of ischemia-reperfusion damage in testes. Verapamil HCl is a phenylalkylamine derivative of the L-type voltage-dependent calcium channel blocker. In our study, we evaluated the prophylactic effects of the Verapamil in testicular ischemia-reperfusion damage.
METHODS: Twenty-one, eight weeks old adult, male Wistar-Albino rats were randomly divided into three groups as follows: Sham, I/R, I/R+Verapamil HCl. In Sham and I/R groups, saline was injected intraperitoneally at the second hour; in I/R+Verapamil HCl group, Verapamil was injected intraperitoneal at the second hour. Spermatogenic functions were evaluated according to Johnsen criteria, and then, average scores were calculated. P<0.05 was statistically significant.
RESULTS: We compared all histopathological and molecular parameters derived from all groups. Average levels of inflammation mediators (TNF-α and IL-1β) were calculated. In the early period, compared with the Sham group, TNF-α levels increased statistically significant in theI/R group, which did not receive any medical treatment. Also, we saw that Verapamil HCl treatment avoided an increase in TNF-α level and provided the same levels as the Sham group. Glutathione peroxidase (GPx), which is antioxidant in tissue levels, significantly decreased in theI/R group, which did not receive Verapamil HCl as compared with the Sham group. Verapamil HCl avoided this situation. Although GPx expression scores were higher in the I/R group than the Sham group, Verapamil HCl treatment takes these scores to the same levels as in the Sham group. For spermatogenesis, there was no statistically significant difference between groups according to Johnsen scoring system.
DISCUSSION AND CONCLUSION: I/R generated by T/D, in the early period, causes an increase of inflammation mediators in blood. It resulted in an increase in GPx activity, which decreased anti- oxidant capacity in tissue, and it has no effect to spermatogenesis parameters in four hours period. Verapamil HCl reduces damage in testicular I/R.

15.Evaluation of the patients with Congenital Rikets
Enver Atay
doi: 10.14744/hnhj.2020.79847  Pages 284 - 287
INTRODUCTION: The present study aims to evaluate the clinical findings and biochemical properties of the patients who were followed up in the neonatal intensive care unit due to congenital rickets.
METHODS: The data of patients who were followed up in our neonatal intensive care unit between March 2015 and March 2020 due to congenital rickets were analyzed retrospectively from the patient’s files and registration forms. The findings of physical examination and biochemical tests of the patients were recorded at the time of admission.
RESULTS: Six patients were included in this study. Four of the patients were girls. The mean age of application was 19±6 days. All patients were admitted with convulsion. The average calcium at the first application was 5.5±0.7 mg/dL; ionized calcium 0.7±0.02 mmol/L; phosphorus 6.9±1.2 mg/dL; alkaline phosphatase 747±148 U/L; parathyroid hormone 265±40 pg/mL and mean 25-OH vitamin D 3.4±0.4 ng/mL. All cases were hospitalized and treated and diagnosed with congenital rickets.
DISCUSSION AND CONCLUSION: Despite vitamin D prophylaxis, rickets can still be seen in our country. With this study, we aimed to draw attention to the significance of vitamin D prophylaxis.

16.The Management of Gallbladder and Extrahepatic Biliary Duct Injuries
Mikail Çakır, Okan Murat Aktürk
doi: 10.14744/hnhj.2020.45220  Pages 288 - 291
INTRODUCTION: Injury of the biliary system is rare. They can be divided into traumatic biliary injuries and iatrogenic biliary injuries. In this study, extrahepatic bile duct and gall bladder injuries and treatment methods and complications were reviewed in the general surgery clinic.
METHODS: The files of the patients who were operated in the general surgery service of our hospital for extra-hepatic bile ducts and gallbladder trauma were examined in a retrospective cohort study. In addition to iatrogenic and traumatic injuries of the gallbladder, traumatic and iatrogenic injuries due to ERCP, laparoscopic interventions, Bismuth Strasberg classifications, repairs and complications of these injuries were examined.
RESULTS: A total of 13 non-hepatic biliary injuries were detected, four of which were in the gallbladder. 75% (3/4) of gallbladder injuries arose from abdominal trauma. The leading cause of common hepatic canal and choledochal injuries was iatrogenic. These injuries may occur during ERCP or cholecystectomy. In iatrogenic biliary tract injuries, 80% primary repair and drain placement were performed without a major complication.
DISCUSSION AND CONCLUSION: The vast majority of gallbladder injuries are due to abdominal trauma. They are most commonly seen in piercing and firearm injuries. The most common cause of non-liver biliary tract injuries is iatrogenic injuries. Traumatic injuries of the common hepatic canal and the choledochus are rare and rarely represent in isolation.

17.Evaluation of Clinical and Demographical Characteristics of the Patients who Admitted to the Pediatric Emergency Department of a University Hospital
Esra Türe, Erdal Erarslan, Abdullah Yazar, Fatih Akın, Dursun Odabaş
doi: 10.14744/hnhj.2019.68552  Pages 292 - 299
INTRODUCTION: This study aims to evaluate the admissions to our pediatric emergency department, the diagnoses, the follow-ups and treatments, contributing to plannings to be organized for timely and appropriate interventions.
METHODS: In this study, 46756 patients who admitted to the pediatric emergency department of our hospital as an outpatient or via ambulance were included to be evaluated retrospectively by age range, gender, time of admission, frequency of admissions by months, the complaint of emergency department admission, the diagnosis made and whether they were hospitalized in an inpatient ward.
RESULTS: In this study, 54% of the patients were male and the rest of the patients were female. Evaluated by seasons, it was determined that the maximum number of admissions, in descending order, were in winter and spring months, and the minimum number of admissions, however, were in summer and autumn months. During the day, the busiest time of the pediatric emergency department was between 16: 00 - 00: 00. The most commonly made diagnosis in the pediatric emergency department in all months during the whole year was determined to be upper respiratory tract infection (34.9%, n: 16060), followed by lower respiratory tract infections with a rate of 19.5%. Among all patients, the number of cases for which a forensic report was issued, however, was determined to be 1.5%. The hospitalization rate of all patients was determined to be 10.7%. 3099 (61.8%) of a total of 5013 hospitalized patients were hospitalized in the pediatric emergency department observation unit, where their treatments were completed.
DISCUSSION AND CONCLUSION: Pediatric emergency departments, which will serve under appropriate conditions and opportunities, by which unnecessary admissions and hospitalizations will be reduced, and in which shorter observations will be made, would be able to provide services of better quality, reduce the number of unnecessary tests and allow effective intervention.

18.Evaluation of Relationship between Alzheimer's Disease and Red Cell Distribution Volume (RDW)
Mustafa Ülker, Buse Çağla Arı
doi: 10.14744/hnhj.2018.09821  Pages 300 - 302
INTRODUCTION: Alzheimer's disease (AD) is a chronic degenerative disease of the central nervous system (CNS) that occurs with neuronal and synapse loss, progressive progression and may lead to impaired cognitive functioning, self-care deficits, and behavioral disorders. Red blood cell distribution width (RDW) is a numerical measure of the variation of the sizes of circulating erythrocytes in the circulation. It has been shown in some studies that increased RDW may affect the cerebrovascular pathology and may have a predisposing role in the development of AD. In this study, we aimed to compare the RDW values of patients with AD and healthy controls. Patients and healthy volunteers followed up in our outpatient clinics of our hospital between 2014-2018 were included in our hospital.
METHODS: A total of 98 individuals, including 49 AD diagnosed as AD in Erenkoy Mental Neurologic Disease Hospital outpatient clinic and 49 healthy controls, applied between 2014-2018, were enrolled in this study. Patients who had coronary heart disease, congestive heart failure, diabetes, hypo or hyperthyroidism, malignancy, chronic renal failure, chronic liver disease and hematologic disease were excluded from this study. Venous blood samples were taken from the median cubital vein. RDW values were estimated by the hospital hemogram measurement devices. SD/MCVx100% equation was also used for checking the RDW measurements.
RESULTS: The mean age of AD patients was 77.3± 8.5 and 73.6±12.0 in the control group with a statistically significant intergroup difference (p=0.020). There was no significant intergroup difference concerning gender (Male/Female, 21/28 in an AD group and 22/27 in the control group (p=0.839). There was no statistical difference between groups concerning RDW values. RDW distribution rates were 14.5±1.5 in AD and 14.7±1.9 in the control groups (p=0.206). The average MMSE score was 16 (8-23) in the AD group.
DISCUSSION AND CONCLUSION: Although we could not find any significant relationship between AD and RDW, because of its potential effects on AD, and the presence of studies with contrasting results, these results should be confirmed by studies performed with a higher number of patients.

19.Evaluation of Geriatric Patients Hospitalized for Toxic Hepatitis in a University Hospital
Pınar Tosun Taşar, Ömer Karaşahin, Murat Furkan Vural, Hakan Dursun
doi: 10.14744/hnhj.2020.54765  Pages 303 - 307
INTRODUCTION: Toxic hepatitis is a common condition that causes impaired liver function. In the geriatric population, factors that further increase the existing risk of toxic hepatitis include an age-related physiological decline in liver function, polypharmacy and the use of herbal products as natural remedies for health problems. This study aims to investigate the causes of toxic hepatitis and comorbid clinical conditions in patients aged 65 years and over who were hospitalized for toxic hepatitis.
METHODS: Data were collected by retrospective analysis of the medical records of 15 patients aged 65 years and older who were treated for toxic hepatitis in the geriatric ward of a university hospital between January 2019 and December 2019.
RESULTS: The mean age of the patients was 69.53±7.22, and 73.3% (n=11) were women. The most common chronic comorbidity was hypertension (46.7%). The most common suspected etiological factor for toxic hepatitis was an edible plant from the genus Ferula that is cultivated in the wild in Erzurum and its vicinity (locally known as çaşır otu). None of the patients developed fulminant hepatic failure or acute tubular necrosis during follow-up. All 15 patients in this study recovered and were discharged.
DISCUSSION AND CONCLUSION: The geriatric population is at risk for toxic hepatitis due to age-related physiological changes, polypharmacy, higher rates of chronic disease, and more frequent use of herbal medicines.

20.Prevalence of Myocardial Bridge and Possible Associated Variables with Coexisting Coronary Atherosclerosis and Acute Coronary Syndrome
Alper Kepez, Ashok Paudel, Osman Yesildağ, Bülent Mutlu
doi: 10.14744/hnhj.2018.60590  Pages 308 - 313
INTRODUCTION: The present study aims to evaluate the prevalence of myocardial bridging (MB) and investigate patient and bridge-related factors that may be associated with an increased tendency for atherosclerosis and acute coronary syndrome.

METHODS: Consecutive coronary angiography recordings that were recorded between 01/01/2013 and 01/01/2016 were retrospectively evaluated in this study. Data of consecutive patients with MB were obtained from patient files. Patients with MB were grouped according to the presence of significant atherosclerosis in any coronary artery and the presence of significant atherosclerosis proximal to bridge. Patients with isolated MB were also sub-grouped according to their presentation with the acute coronary syndrome. Demographic, clinical and angiographic parameters were compared between groups.
RESULTS: There were a total of 75 patients with MB, with an overall prevalence rate of 1.07%. MB patients without coexisting significant atherosclerotic lesion had longer bridge length and more severe stenosis rate (21.4±9.9 mm vs. 17.2±7.6 mm, p=0.045; 73.0±12.5% vs. 65.6±13.0%, p=0.015, respectively). Diabetes mellitus was the only risk factor that was more prevalent in MB patients with significant coexisting atherosclerotic lesions. MB segment of patients with proximal significant atherosclerosis was significantly shorter compared with the length of patients without significant proximal atherosclerosis (16.0±7.4 mm vs 20.7±9.5 mm, p=0.05). The presentation as an acute coronary syndrome was more prevalent in patients with significant atherosclerosis compared to patients with isolated MB (68.8% vs. 46.5%, p=0.045). There was no significant discriminative variable for presentation as acute coronary syndrome in patients with isolated MB.
DISCUSSION AND CONCLUSION: The prevalence rate of MB in our study is in agreement with the previous angiographic studies reported from Turkey. Coexisting atherosclerotic lesions seem to be primarily involved in the pathogenesis of acute coronary syndrome and ischemic symptoms that had necessitated coronary angiography.

CASE REPORT
21.Extraperitoneal Laparoscopic Radical Prostatectomy with Handheld Articulating Laparoscopic Instruments Driven by Robotic Technology
Serdar Aykan, Ahmet Yaser Müslümanoğlu
doi: 10.14744/hnhj.2018.62207  Pages 314 - 316
Robotic-assisted radical prostatectomy (RARP) is a popular current minimally invasive surgical treatment option for organ-confined prostate cancer (PCa). The benefits of RARP concerning fully articulating robotic arms and three-dimension (3D) vision are widely accepted. However, the cost of the RARP is the main limitation. Laparoscopic radical prostatectomy (LRP) has been still in usage for its minimally invasive features, but it is a very complex procedure, has negative effects on surgeons’ ergonomics, and has a limited vision on 2D. At his point, LRP with articulating devices and 3D vision is logical. We here reported an extraperitoneal LRP case with articulating laparoscopic instruments (Kymerax®, Terumo, Hatagaya, Tokyo, Japan) with the 3D visualizing system (Viking Systems, La Jolla; CA). To our knowledge, this is the first extraperitoeneal LRP using this set, in the literature.

LookUs & Online Makale