INTRODUCTION: The aim of this study was to determine the functional and radiographic outcome of Weber B and C ankle fractures with syndesmotic injury and compare the syndesmotic screw and the ANK nail.
METHODS: Of thirty-one patients with syndesmosis injury, sixteen were treated with open reduction and internal fixation with an ANK nail, and fifteen patients with a plate and supplemental syndesmotic screw. A clinical, anatomical and arthritis grading ankle scoring system according to Phillips was used to study the outcomes of each group.
RESULTS: There was no statistically significant difference between the two groups with respect to clinical score and anatomical score (p>0.05) but in the mean arthritis grading scoring (p<0.005). The most frequent complication (four patients from the ANK group, two patients, in the plate and screw group) was fibular shortening.
DISCUSSION AND CONCLUSION: We conclude that syndesmotic screw might put some biomechanical stresses on the ankle joint. And also, if the fibular fracture is oblique and comminuted, which represents most of the ankle fractures, the ANK nail, which cannot prevent fibular shortening, does not seem an alternative technique to the syndesmotic screw and plate fixation in the ankle fractures with syndesmosis rupture.

INTRODUCTION: Brucellosis is primarily an animal disease, is transmitted to humans by meats, milk and milk products of infected animals, can be seen in very different clinical presentations. In this study, 16 patients who were followed up and treated with the diagnosis of Brucellosis in our clinic were evaluated retrospectively.
METHODS:
RESULTS: The most frequent complaint of the cases was joint pain by 75%. Other frequent complaints were fever by 63%, weakness by 56%, joint swelling by 38%, abdominal pain, sweating, vomiting, body pain by 32%. The most frequent physical examination finding of the cases was fever by 63%. Hepatomegaly and/or splenomegaly were determined in 50% of the cases and lymphadenopathy was
seen in 13% of them. All patients received treatment with two types of antibiotics, 13% of them (n=2) received three types of antibiotics. Three days after the initiation of treatment, the complaints of all patients were decreased. The treatments of all patients have been completed in six weeks. In two cases (13%), relapse was observed. One of these patients had been treated previously for a year in a different city. Other patient received dual therapy.
DISCUSSION AND CONCLUSION:

INTRODUCTION: To evaluate the efficacy of %00.5 topical Cyclosporin A in the treatment of dry eye disease.
METHODS: Sixty-two patients with dry eye disease were studied. Patients were divided into two groups: Sjögren and non-Sjögren dry eye. Dry eye severity was graded based on Delphi panel classification. At ocular examination Schirmer’s test with and without topical anesthesia, tear breakup time (TBUT) test with Fluorescein were applied. Lissamine green and Fluorescein staining were scored. Impression cytology samples were collected. To evaluate the subjective symptoms Ocular Surface Disease Index (OSDI) was performed. All tests were repeated at 3 and 6. months. The efficacy of %00.5 topical Cyclosporin A (Restasis®, Allergan, Waco, TX) was compared between Sjögren and non-Sjögren groups according as subjective and clinical symptoms. The effect of dry eye severity to efficacy of treatment was analyzed.
RESULTS: Schirmer’s test with and without topical anesthesia, tear breakup time (TBUT) test results, Lissamine green and Fluorescein staining scores, cytology findings showed improvement in both Sjögren and non-Sjögren groups. Reduction at OSDI scores and daily use of artificial tears were determined. The greatest symptomatic benefit occured in the grade 3 patients.
DISCUSSION AND CONCLUSION: In this study after the use of Cyclosporin A in the treatment of dry eyes for a period of six months; significant improvement in clinical findings and OSDI scores was observed suggesting that Cyclosporin A is effective in tratment of grade1.2 and especially grade 3 dry eye disease.

INTRODUCTION: Tension-band wiring has been accepted as the treatment of choice for displaced olecranon fractures. The aim of this study was to evaluate the results of the treatment.
METHODS: Between 2006 and 2010 years, 24 patients with displaced olecranon fractures underwent open reduction and internal fixation with tension band wiring methods. There were 15 males and 9 females with an average age of 45 years (range, 17-90 years). The injury mechanism included traffic accident, falling, and direct trauma. According to Schatzker classification, 17 fractures were rated as type A (Transverse), 6 as type C (Oblique), and 1 as type D (Comminuted).
RESULTS: All patients were followed up 12-58 months with an average of 45 months. At last follow-up, the average flexion of the elbow was 128 degrees (range, 95-130 degrees) and average extension deficiency of the elbow was 15 degrees (range, 10_40 degrees). According to elbow functional evaluation criteria by Murphy, the results were excellent in 16 cases, good in 6, fair in 1, and worse in 1; the excellent and good rate was 91%.
DISCUSSION AND CONCLUSION: In treatment of displaced olecranon fractures, open reduction and internal fixation can be performed with tension band wiring based on different fracture types and the effectiveness is satisfactory.

INTRODUCTION: Our aim is to compare anthropometric measurements of infants whom their mothers likely suffering vitamin D deficiency because the mothers had spend large part of pregnancy in winter.
METHODS: We compared retrospectively anthropometric measurements of infants who were born in April, May and June of 2010 and 2011 years to infants who were born in December, October and November of 2010 and 2011 years at Ardahan State of Hospital.
RESULTS: We achieved 1218 infant’s data about their anthropometric measurements. 632 of them were in study group and 586 of them were in control group. It is statistically significant that mean birth weight of study group was 2950±457,2gr and we detected mean birth weight of control group was 3080±407,0gr(p<0,05). Although not statistically significant, mean birth height of the study group was 46,5±2,8cm and control group’s mean birth height was 50,1±1,7cm(p>0,05).
DISCUSSION AND CONCLUSION: According to previous researches, there are different results whether vitamin d affects the development of infants during gestational period. Some results show that vitamin D has positive effects on birth weight and height of infants in utero and some results show that there are no effects of vitamin D on birth weight and height of infants. However, vitamin D has important role especially in bone mineralization, improvement of immune system, prevention from central nervous system diseases and cancer treatment and
prevention.

INTRODUCTION: Our aim is to evaluate effects of high altitude on hematological values and to demonstrate the prevalence of anemia on this rural area.
METHODS: We demonstrated differences of hematological values between children who admitted to pediatric department of Ardahan State Hospital (altitude ~2000meter) and Ankara Atatürk Univetsity Faculty of Medicine (altitude~750meter).
RESULTS: Totally 1600 children were investigated in this study. 923 of them were in study group and 677 of them were in control group. According to age and gender reference values, the prevalence of anemia in study group was 25, 4% and in control group the prevalence of anemia was 18, 3%. It is statistically significant that mean RBC value of study group was 5, 0±0,4x106/μL and mean RBC value of control group was 4,6±0,3 x106/μL. Additionally, there was no statistically significant differences on other hematological values between these groups.
DISCUSSION AND CONCLUSION: Although the prevalence of anemia has decreasing around the world, especially in rural areas of our country the prevalence of anemia has increasing up to 30% level due to low socioeconomic status, low level of education and lack of sufficient nutrition intake. Additionally, living at high altitude causes some hematological adaptations so that RBC and hemoglobulin values increase. Therefore, this increase may overshadow some patient who has actually low hemoglobulin level.

INTRODUCTION: To compare the efficacy and tolerability of a fixed-dose combination of 0.3% Tobramycin and 1% Dexamethasone formulation versus the same agents administered separately for prophylaxis in a laser-assisted in situ keratomileusis (LASIK) population.
METHODS: In a prospective, randomized, onemasked, parallel-group study, 97 patients were evaluated for signs and symptoms of ocular infection or inflammation after bilateral LASIK. Group A (28 patients, 56 eyes) received a combined formulation of 0.3% tobramicin + 1% dexamethasone (Tobradex). Group B (30 patients, 60 eyes) received conventional treatment with the same agents from separate vials. Baseline and postoperative assessments were made on surgery days -2, 1, 3, and 15 and consisted of visual acuity; intraocular pressure; severity of inflammation of eyelids, conjunctiva, and cornea;tearing; ocular discomfort (foreignbody sensation, itching, or photophobia); and ocular pain.
RESULTS: No ocular infection or persistent inflammation was detected in either group at any time. All objective and subjective criteria of efficacy were similar regardless of treatment, with no significant differences between the groups. More patients who were dosed with the combined agent complained of mild ocular discomfort on day 3, but this different has no signifigant statistical difference between two groups.
DISCUSSION AND CONCLUSION: Post-LASIK topical prophylaxis with combined tobramicin + dexametazon eye drops (Tobradex) was well tolerated. This formulation appears to be therapeutically equivalent to conventional dosing with tobramicin and dexametazon from individual bottles for topical prophylaxis after laser refractive surgery.

INTRODUCTION: Diabetes mellitus is an independent risk factor for cardiovascular disease. Incidence of coronary atherosclerosis is higher in diabetics than non-diabetics; it has a rapid course and shows more frequent vascular involvement and disease. This study aims to evaluate
laboratory and demographic data and to determine basal-bolus insulin dosages at discharge.
METHODS: The study included in 99 type 2 diabetics undergoing coronary artery bypass grafting (CABG). Overnight fasting blood samples (10-12 hours) were collected between 08: 00 and 08: 30 a.m for testing fasting blood glucose, BUN, creatinine, HbA1c (%), TSH, free T4, free T3.Arterial blood pressure, body weight, height, waist circumference were measured and recorded. Duration of diabetes, the age at its onset, oral antidiabetic medication, its dosages, duration of use, insulin use, dosage (U / kg) and duration were noted.. The statistical
analyses were performed using SPSS for Windows 16.0 software.
RESULTS: The study included 99 type 2 diabetics undergoing coronary artery bypass graft (CABG) at Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital. The mean age was 59.74 ± 8.51 years, 25.3% were females and 74,7% were males. The mean duration of diabetes was 7.9 ± 6.68 yrs and BMI 28.64 ± 4.11 (kg / m²), height 168.09 ± 8.26 (cm), weight 80.91 ± 12.69 (kg). In the preoperative period, 14.1% patients were on insulin therapy, 58,6% were on oral antidiabetic drugs; 4% were on the diabetic diet, 23.2% were without any treatment for diabetes. Patients were discharged on basal insulin dosage unit (U), 20.2 ± 5.81 U; basal insulin U / kg 0.25 ± 0.08; bolus insulin 22.11 ± 7.11 U; bolus insulin U / kg 0, 28 ± 0.1.As to the incidence of thyroid dysfunction, 20 patients had subclinical hyperthyroidism, 3 subclinical hypothyroidism and 2 overt hypothyroidism.
DISCUSSION AND CONCLUSION: Regulating of glycemia in type 2 diabetics undergoing CABG significantly reduces the major postoperative complications, mortality and risk of infection. As high insulin resistance in patients undergoing coronary artery bypass surgery continues for a week or two in the postoperative period, basal and bolus insulin need should be taken into account at discharge.

Coronary artery fistulas connecting epicardial coronary arteries to the ventricles can be found generally during coronary angiography which performed for any reason and can cause ischemia by leading coronary steal syndrome. Here we aimed to present a 65 year-old woman who presented with acute inferior myocardial infarction and performed coronary angiography for primary percutaneus coronary intervention showing persistent Thebesian sinusoids due to fistulas to left ventricle from circumflex and left anterior descending artery.

Appendix mucocele is a rare condition in which mucus is accumulates in the lumen. It has some potential risks. Definite diagnosis is difficult preoperatively. Depending on the operative findings and the pathological evaluation, the spectrum of surgery extends from appendectomy to right hemicolectomy. In this study; patients who admitted hospital with abdominal pain diagnosed with appendix mucocele and treated with laparoscopic appendectomy successfully, were presented.

Primary Hyperaldosteronism is considered as autonomous excessive secretion of aldosterone hormone via adrenal cortex, usually due to solitary adenoma or bilateral adrenal hyperplasia and suppression of Plasma Renin Activity (PRA) resulting in hypertension and hypokalemia. Typically, it is reported in women at the age of 30-50. Adrenal Venous Sampling (AVS) is recommended to patients whom are planned to have surgical treatment. AVS is known as the best procedure that helps distinguish unilateral disorder from bilateral disorder. Our study aims to present adrenal adenoma diagnosed via venous sampling which has been done for the first time ever at our clinic.

Introduction: The aim is to evaluate calcium channel blocker intoxication and treatment of two cases of verapamil intoxication with
suicidal intention. Case 1: The patient was brought to hospital 14 hours after oral intake of a total of 5.04 g verapamil and 56 mg trandolapril. General situation was bad, the patient was confused, arterial blood pressure was 60/30 mmHg, and heart rate was 65 min-1. Dopamine, dobutamine, adrenaline and calcium infusion, nasogastric lavage and activated carbon were begun. The case was given 3 mg glucagon. After pacemaker while administering plasmapheresis, heart rate fell to 45 min-1 and upon desaturation the patient was intubated. Cardiopulmonary resuscitation (CPR) was begun and in the 2nd hour of CPR extracorporeal circulation was applied through the femoral vein-femoral artery. Extracorporeal circulation lasted for 10 hours, while plasmapheresis and calcium replacement continued. The patient was removed from extracorporeal circulation with support of intraaortic balloon pump and maximum doses of inotropics and vasoconstrictors. Despite support with maximum dose inotropics arterial blood pressure values fell and a tableau of
thrombocytopenia, ARDS and renal failure developed. On the 5th day after admission the patient arrested, did not respond to CPR and
was declared dead. Case 2: Twelve hours after oral intake of a total of 3.6 g verapamil the patient was brought to hospital. General condition was moderate, aware with arterial blood pressure of 60/30 mmHg, and heart rate of 44 min-1. Nasogastric lavage, activated carbon and dopamine infusion were begun. Fifteen hours after medication intake arterial blood pressure was 50/30 mmHg, heart rate was 30 min-1, the patient lost consciousness and developed cardiac arrest and was intubated. CPR was begun and the patient responded. Calcium infusion continued while the patient was monitored with a mechanic ventilator. Cardiac arrest developed again and CPR was administered. Seventeen hours after medication intake urination began and arterial blood pressure values in the 24th hour rose to 120/50 mmHg. Hemoperfusion was administered for 5.5 hours. On the 2nd day in intensive care the patient’s vital signs stabilized, on the 15th day they were extubated and on the 50th day they were discharged. Conclusion: Calcium channel blocker poisoning may cause life-threatening complications and requires emergency, aggressive support and antidotal treatment. Aggressive resuscitation, plasmapheresis, intraaortic balloon pump and extracorporeal circulation all have a place in supportive treatment.