GÝRÝÞ ve AMAÇ: Bebeðin erken dönemde iþitme duyusunun geliþmiþ olmasý hem dil ve lisan geliþimini hem de duygusal, sosyal ve zihinsel geliþimini önemli biçimde etkiler. Ýþitme kaybý 1000 canlý doðumda 1-2 oranýnda insidansla görülür. Bu oran yüksek riskli yenidoðanlarda daha yüksektir.
Yenidoðan iþitme taramalarýnda uyarýlmýþ otoakustik emisyonlar (Evoked Otoacoustic Emissions, EOAE) ve iþitsel beyin sapý cevabý (Auditory Brainstem Response, ABR) yöntemleri kullanýlmaktadýr.Biz bu çalýþmamýzda risk faktörü taþýyan yenidoðanlarýn EOAE ve ABR sonuçlarýný ve iki testin karþýlaþtýrmasýný deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Ocak 2011- Temmuz 2011 arasýnda hastanemizde doðan ve risk faktörü bulunan 104 bebek retrospektif olarak deðerlendirildi.
BULGULAR: Ýþitme Kaybý (+) grubunda konjenital anomali, yoðun bakýmda kalma ve sarýlýk varlýðý risk faktörleri, Ýþitme Kaybý (-) grubundan istatistiksel olarak anlamlý derecede yüksek bulunmuþtur. Lojistik regresyon analizinde sarýlýðýn iþitme kaybý için anlamlý bir risk faktörü olduðu saptanmýþtýr.
TARTIÞMA ve SONUÇ: Çalýþmamýz sonucunda ulasal verilere katký saðlanmýþ ve yenidoðan sarýlýðýnýn iþitme kaybý riskini arttýrdýðý gösterilmiþtir.

INTRODUCTION: The early development of the sense of hearing in the baby affects both language and language development considerably, as well as emotional, social and mental development. Hearing loss, which higher in newborns with risk factors, is 1-2% incidence in 1000 live births. Evoked Otoacoustic Emissions (EOAE) and Auditory Brainstem Response (ABR) methods are used in neonatal hearing screenings. We aimed to evaluate the EOAE and ABR results of the newborns in this study and the comparison of the two tests.
METHODS: Between January 2011 and July 2011, 104 newborns with a high-risk factor in our hospital were evaluated retrospectively.
RESULTS: The risk factors for the congenital anomaly, be in intensive care and neonatal hyperbilirubinemia, were found to be statistically significantly higher in the Hearing Loss group (+) than in the Hearing Loss group (-). In logistic regression analysis, it was determined that neonatal hyperbilirubinemia was a significant risk factor for hearing loss.
DISCUSSION AND CONCLUSION: Our findings contributed to the national data and our findings suggest that neonatal hyperbilirubinemia increases the risk of hearing loss.

GÝRÝÞ ve AMAÇ: Helikobakter Pilori (HP) hastalýðý kötü hijyenle iliþkilidir. Benzer þekilde kötü saðlýk okuryazarlýðý (SOY) da hijyen þartlarýnýn bozukluðu ile beraberlik göstermektedir. Bu çalýþmada amaç, kötü hijyen ile iliþkili iki durum olan SOY ve HP hastalýðý arasýndaki iliþkiyi araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Genel cerrahi kliniðine dispepsi yakýnmasý ile baþvurmuþ olan ve gastroskopi uygulanan 326 hastanýn verileri kesitsel analitik desende deðerlendirildi. Gastroskopi uygulanan bu hastalarda özefagus, mide ve duodenum deðerlendirildi ve antrum mukozalarýndan biyopsi alýndý. Rapor sonuçlarýna göre hastalar HP (+) ve HP (-) olarak gruplara iki gruba ayrýldý. Hastalarýn SOY durumlarýný deðerlendirmede ‘Hayatýn Gerçekleri’ sorularýndan oluþan Halk Saðlýk Okuryazarlýðý Ölçeði uygulandý.
BULGULAR: Araþtýrma sonucunda SOY ile HP enfeksiyonu mevcudiyeti arasýnda bir iliþki olmadýðýný tespit edildi. Daha yüksek SOY olan kiþilerde temiz su tüketme çabalarý, pastörize süt kullanýmý ve tuvalet hijyeninde artýþ görülmekteydi. SOY puanlarýnda artýþ ile HP eradikasyon tedavi arayýþý arasýnda pozitif bir korelasyon tespit edildi.
TARTIÞMA ve SONUÇ: Daha iyi SOY, hijyenik davranýþlarla ve HP tedavi arayýþý davranýþý ile birliktedir. HP enfeksiyonu olan bireylerde SOY arttýrma çabalarý bu hastalarýn tedavi arayýþlarýný olumlu etkileyecektir.

INTRODUCTION: Helicobacter pylori (HP) disease is associated with poor hygiene. Similarly, poor health literacy (HL) is also associated with poor hygienic conditions. The present study aims to investigate the relationship between HL and HP disease, two conditions associated with poor hygiene.
METHODS: The data from 326 patients who applied to the general surgery clinic with dyspepsia and underwent gastroscopy were evaluated in cross-sectional analytical design. Esophagus, stomach and duodenum were evaluated, and biopsy of the antrummucosa was performed in these patients. According to report results, patients were divided into two groups as HP (+) and HP (-). Public Health Literacy Scale consisting of the questions of 'Facts of Life’ was applied to the patients to evaluate their HL.
RESULTS: The findings showed that there was no relationship between the presence of HP infection and HL. In individuals with higher HL, consumption of clean water, increased use of pasteurized milk and toilet hygiene were observed. A positive correlation was found between the increase in HL scores and the search for HP eradication therapy.
DISCUSSION AND CONCLUSION: Better HL is associated with hygienic behavior and help-seeking behavior for the treatment of HP. Efforts to increase HL in people with HP infection will positively affect the treatment of these patients.

GÝRÝÞ ve AMAÇ: Biz bu çalýþmada meteorolojik deðiþikliklerin acil servislere baþvuran renal kolik hasta sayýsýnda etkili olup olmadýðýný, ayrýca bu etkinin cinsiyet ve yaþ ile deðiþkenlik gösterip göstermediðini araþtýrdýk.
YÖNTEM ve GEREÇLER: Ocak 2017 ve Aralýk 2017 tarihleri arasýnda Fatih Sultan Mehmet Eðitim ve Araþtýrma Hastanesi acil týp kliniðine renal kolik þikayetiyle baþvuran 5661 hasta International Classification for Diseases- 10 (ICD 10) N23 (renal kolik) kodu ile retrospektif olarak tarandý. Renal kolik tanýsý acil týp hekimlerince konuldu ve tedavi edildi. Aylara göre ortalama sýcaklýk ve nem deðerleri T.C. Orman ve Su Ýþleri Bakanlýðý Meteoroloji Genel Müdürlüðünden alýnmýþtýr.
BULGULAR: Çalýþma, yaþlarý 2 ile 91 arasýnda deðiþmekte olan, 3344’ü (%59.1) erkek ve 2317’si (%40.9) kadýn olmak üzere toplam 5661 olgu ile yapýlmýþtýr. Olgularýn muayene yaþlarý ortalamasý 41.58±14.63’dür. Mevsimler arasýnda olgularýn muayene yaþlarý ortalamalarý açýsýndan istatistiksel olarak anlamlý farklýlýk bulunmaktadýr (p: 0.001; p<0.05). Farklýlýðýn tespiti için yapýlan ikili karþýlaþtýrmalar sonucunda; Yaz mevsimindeki olgularýn muayene yaþý ortalamalarý, Kýþ (p: 0.001), Ýlkbahar (p: 0.001) ve Sonbahar (p: 0.045) mevsimlerindeki olgularýn ortalamalarýndan istatistiksel olarak anlamlý düzeyde düþük bulunmuþtur (p<0.05).
TARTIÞMA ve SONUÇ: Çalýþmamýzda meteorolojik parametrelerin renal kolik geliþimi üzerine etkileri olduðunu ve bu etkinin hastanýn yaþýna ve cinsiyetine göre deðiþkenlik gösterdiðini saptadýk. Özellikle sýcak aylarda erkek hastalarýn kadýnlara göre muhtemel hormonal mekanizmalardan dolayý dehidratasyona daha duyarlý olduðunu ve dolayýsýyla bu hastalarda renal kolik insidansýnýn yüksek olmasý nedeniyle sývý alýmýnýn arttýrýlmasý dehidrate kalmamasý önerilir.

INTRODUCTION: In the present study, we researched whether meteorological changes affect the number of renal colic patients admitted to the hospital emergency department and whether this effect varies with gender and age.
METHODS: In this study, 5661 patients admitted to the emergency medicine clinic of Fatih Sultan Mehmet Training and Research Hospital between the dates of January 2017 and December 2017 with renal colic complaints were retrospectively scanned with International Classification for Diseases- 10 (ICD 10) N23 (renal colic) code. Renal colic was diagnosed and treated by emergency medicine physicians. Average temperature and humidity values according to months were acquired from the Republic of Turkey Ministry of Forestry and Water Affairs General Directorate of Meteorology.
RESULTS: This study was conducted with a total number of 5661 cases between the ages of 2 and 91. 3344 (59.1%) of the patients were male, and 2317 (40.9%) were female. The average examination age of the cases was 41.58±14.63. There was a statistically significant difference between the seasons in terms of the examination ages of the cases (p=0.001). As a result of the dual comparisons, the average examination age of the cases in the summer season was found to be lower at a statistically significant level than the averages of the cases in Winter (p=0.001), Spring (p=0.001) and Fall (p=0.045) seasons (p<0.05).
DISCUSSION AND CONCLUSION: In our study, we detected that meteorological parameters have an effect on renal colic development, and this effect varies according to the age and gender of the patient. Especially in the warmer months, male patients are more sensitive towards dehydration than female patients, probably due to the hormonal mechanisms, so the renal colic incidence is higher in these patients. Thus, the suggestion is to increase fluid intake and not to stay dehydrated.

GÝRÝÞ ve AMAÇ: Çalýþan saðlýðý ülkemizde 6 Nisan 2011 tarih/27897 sayýlý yönetmelikle güvence altýna alýnmýþtýr. Saðlýk çalýþanlarýnýn görevlerindeki riske göre düzenli periyotlarla muayene ve kontrolleri yapýlmaktadýr. Bu çalýþmada, bir eðitim araþtýrma hastanesinde görev yapmakta olan hekimlerin periyodik muayenelerinde, malign hastalýklar için risk oluþturabilecek bilgi ve bulgularýn analizi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþma kesitsel ve tek merkezli nitelikte olup 01.06.2018-31.12.2018 tarihleri arasýnda Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi’nde görev yapan ve periyodik saðlýk taramasýný (PST) yaptýran toplam 227 hekimin dosyalarý incelenmiþtir.
BULGULAR: Periyodik muayeneye onam veren toplam 227 hekimin dosyalarý incelenmiþ, verileri tam olan 221 hekimden 125’inin kadýn(%56.6), 96’sýnýn ise erkek (%43.4) olduðu görülmüþtür. Malignite etiyolojisinde yer alan sigara sorgulandýðýnda; sigara içen hekim sayýsý 32 (%14.1) olup cinsiyetler arasý istatistiksel olarak anlamlý fark tespit edilmemiþtir. Diðer risk faktörü obezite oranlarý incelendiðinde; %20.7 fazla kilolu (n: 47), %3.5 obez (n: 8) ve %0.4 oranýnda morbid obez (n: 1) olduðu görülmüþtür. Erkek hekimlerde fazla kilolu veya obez olma durumu daha yüksek olup, kadýnlara göre aradaki fark istatistiksel olarak anlamlý bulunmuþtur. Risk faktörü olabilecek diðer bulgularýn oranlarý çok daha düþük bulunmuþtur.
TARTIÞMA ve SONUÇ: Literatürde yer alan malignite etiyolojisinde yer alabilecek riskler açýsýndan PST dosyalarýnýn analizinde, hekimlerin dünya ve ülkemiz verilerine göre olumlu sonuçlara sahip olduðu görülmektedir.

INTRODUCTION: Employee health was assured by regulation no. 27897 on 6 April 2011, in our country, Turkey. Health workers are periodically examined and controlled according to the risk in their duties. In this study, we aimed to analyze periodic examinations of physicians working in an educational research hospital and determine the findings that may pose a risk for malignant diseases.
METHODS: Periodic health examination (PHE) files of 227 physicians working in Haydarpaþa Numune Training and Research Hospital between 01.06.2018-31.12.2018 were examined in this study.
RESULTS: The files of 227 physicians who gave consent for the periodic examination were studied. Of the 221 physicians whose data were complete, 125 were female (56.6%), and 96 were male (43.4%). When smoking was questioned regarding the etiology of malignancy, the number of physicians smoking was 32 (14.1%), and no statistically significant difference was found between the genders. When another risk factor obesity rates were examined, 20.7% were overweighed (n: 47), 3.5% were obese (n: 8), and 0.4% were morbidly obese (n: 1). Male physicians were more likely to be overweighed or obese, and the difference was statistically significant compared to women. The rates of other findings that may be risk factors were much lower.
DISCUSSION AND CONCLUSION: When PHE files are analyzed regarding risk factors that may be involved in the etiology of malignancy in the literature, it is concluded that physicians have positive results according to the data of the world and our country.

GÝRÝÞ ve AMAÇ: Çalýþmamýzýn amacý, okskarbazepinin hematolojik parametreler, böbrek, karaciðer, tiroid fonksiyonlarý, plazma elektrolit, lipit, lipoprotein (a), B12 vitamini ve folik asit düzeylerine etkisini araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Onbeþ idiyopatik parsiyel epilepsili hasta çaliþmaya alýndý. Üç hasta, biri düzensiz ilaç kullanýmý, ikisi dirençli epilepsi nedeni ile ek antiepileptik tedaviye baþlamak zorunda kaldýklarý için çalýþmadan çýkarýldýlar. Kan örnekleri sabah, 12 saatlik açlýðý takiben alýndý. Serum örneklerinden hematolojik parametreler, sodyum (Na), potasyum (K), kalsiyum (Ca), fosfor (P), glukoz, kan üre azotu (BUN), alkalen fosfataz (ALP), alanin amino transferaz (ALT), aspartat amino transferaz (AST), gama glutamil transferaz (GGT), total kolesterol, trigliserid, düþük dansiteli lipoprotein-kolesterol (LDL-K), yüksek dansiteli lipoprotein-kolesterol (HDL-K), apolipoprotein A (Apo-A), apolipoprotein B (Apo-B), Lipoprotein a (Lp a), serbest ve total triiyodotirozin (T3), tetraiyodotirozin (T4), Tiroid stimulan hormone (TSH), folik asit ve B12 vitamin düzeyleri tedavi baþlangýcýnda, 3.,6. ve 12. aylarda çalýþýldý.
BULGULAR: Hematolojik parametrelerde, Na, K, Ca, P, glukoz, BUN, AST, ALT, ALP, total kolesterol, trigliserid, LDL-K, HDL-K, Apo-A, Lp (a), fT3, TSH düzeyleri, folik asit ve B12 vitamin düzeylerinde tedavinin 3,6,12. aylarda anlamlý deðiþiklik saptanmadý. GGT düzeylerinde 3,6,12. aylarda istatistiksel anlamlý olmayan yükselme, fT4 düzeylerinde istatistiksel olmayan düþüklük saptandý. Apo-B seviyesinde tedavinin 3. ayýnda anlamlý yükselme tespit edildi. Lp (a) düzeylerinde 12. ayda baþlangýç ve 6. ay deðerlerine göre istatistiksel anlamlý yükselme saptandý (p<0.05).
TARTIÞMA ve SONUÇ: Okskarbazepin kullanan çocuklarda karaciðer enzimlerinin, tiroid fonksiyon testlerinin ve özellikle ateroskleroz için risk faktörü olan Lp (a) seviyelerinin izlenmesi gerektiðini önermekteyiz.

INTRODUCTION: This study aims to investigate the effects of oxcarbazepine on hematological parameters, renal, liver, thyroid functions, plasma electrolyte, lipid, lipoprotein (a), vitamin B12 and folic acid levels.
METHODS: Fifteen idiopathic partial epilepsy patients were included in this study. Three patients were excluded from this study because of irregular drug use (n=1) and the requirement of additional antiepileptic treatment due to resistant epilepsy (n=2). Blood samples were taken in the morning following a 12-hour fasting period. Serum samples were examined as for hematological parameters, sodium (Na), potassium (K), calcium (Ca), phosphorus (P), glucose, blood urea nitrogen (BUN), alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), total cholesterol, triglyceride, low density lipoprotein-cholesterol (LDL-K), high density lipoprotein-cholesterol (HDL-K), apolipoprotein A (Apo-A), apolipoprotein B (Apo) -B), lipoprotein a (Lp a), free and total triiodothyronine (T3), tetraiodotyrosine (T4), thyroid-stimulating hormone (TSH), folic acid and vitamin B12 levels at the beginning of treatment, at the 3rd, 6th. and 12th months.
RESULTS: Significant changes were not detected in hematologic parameters, Na, K, Ca, P, glucose, BUN, AST, ALT, ALP, total cholesterol, triglyceride, LDL-C, HDL-C, Apo-A, Lp (a), fT3, TSH, folic acid and vitamin B12 levels at the 3rd, 6th, and 12th months of treatment. A statistically insignificant increase in GGT and a statistically insignificant decrease in fT4 levels were detected at the 3rd, 6th,12th months. A significant increase was detected in Apo-B levels at the third month of treatment, which returned to normal limits at the 12th months. There was a statistically significant increase in Lp (a) levels at the 12th month compared to baseline and the 6th-month values (p<0.05).
DISCUSSION AND CONCLUSION: We suggest that liver enzymes, thyroid function tests and Lp (a) levels, which are risk factors for atherosclerosis, should be monitored in children using oxcarbazepine.

GÝRÝÞ ve AMAÇ: Bu çalýþmada koroner arter baypas uygulanan 35 yaþ altý genç hastalarda çeþitli preoperatif ve peroperatif faktörlerin morbidite, cerrahi ve sonuçlar üzerine etkisi araþtýrýldý.
YÖNTEM ve GEREÇLER: Koroner arter hastalýðý sebebiyle 2005-2016 yýllarý arasýnda merkezimizde CABG operasyonu uygulanan 35yaþ altý (17-35) 130 yetiþkin [118 (%90.8)’ i erkek; ort. yaþ 31.82±3.3 ve 12 (%9,2)’ si kadýn, yaþ ortalamasý 32.08 ± 2.3 ] hasta retrospektif olarak deðerlendirildi. Hastalar cinsiyetlerine göre gruplandýrýlarak risk faktörleri, demografik verileri, perioperatif ve postoperatif parametreleri ile deðerlendirildi.
BULGULAR: Hastalardan Kadýn olgularýn %33.3’ ünde diyabet, ve %25’ inde aile hikayesi ve hipertansiyon öyküsü mevcuttu. Erkekler de ise diyabet %50.8, aile öyküsü %21.2, hipertansiyon %31.4’ inde mevcuttu. Kadýnlarýn %25’ i erkeklerin ise %68.6’ ü sigara tiryakisiydi. Kadýn Olgularýn %16.7’ sýnda erkeklerin ise %6.8’ inde ana koroner lezyonu vardý. Olgularýn 44 (%33.8)’ünde ise daha önce geçirilmiþ myokard enfarktüsü hikayesi vardý. CRP deðeri olgularýn % 47.7 unda normal deðerlerden yüksek bulundu. Olgularda ortalama preoperatif EF %53 idi. 7 (%5.4) olguya acil, 123 (%94.6) olguya elektif CABG uygulandý. 12 (9.2%) olgu atan kalpte 118 hastada CPB eþliðinde bypass uygulandý.


TARTIÞMA ve SONUÇ: Diyabetes mellitus, Hipertansiyon varlýðýnýn ve sigara içiminin cinsiyet ayýrt etmeden genç hastalarda koroner arter hastalýk riskini önemli oranda artýrdýðýný, sigara ile mücadelenin erken yaþlarda koroner arter hastalýðýnýn önlenebilir en önemli faktörü olabileceðini göstermektedir.

INTRODUCTION: In this study, the effects of various known cardiac risk factors on morbidity and surgical results in a population of patients aged 35 and below were studied.
METHODS: In this study, 130 patients [118 (90.8%) male; mean age 31.8±3.4 and 12 (9.2%) female; mean age 32.1±2.3] aged 35 and below (17-35 years of age) who underwent CABG in our center between the years of 2005 and 2016 were assessed retrospectively. Patients grouped by gender were assessed concerning cardiovascular risk factors, demographic features, some preoperative and postoperative parameters.
RESULTS: Concerning female patients, 33.3% had diabetes mellitus, whereas 25% had hypertension and a family history of coronary artery disease. As for the male patients, 50.8% had diabetes mellitus, 31.4% had hypertension, and 21.2% had a family history of coronary artery disease. The ratio of smokers in the male and female patient groups was 68.6% and 33.3%, respectively. CRP values were found to be higher in 47.7% of the patients. 33.8% of all patients (44 out of 130) had a previous myocardial infarction. Preoperatively measured mean EF value was 53%. While 94.6% of all patients (123 out of 130) were operated on an elective basis, 5.4% (7 out of 130) underwent an emergent operation. 9.2% of all patients (12 out of 130) underwent off-pump coronary artery bypass surgery, whereas, in the rest, cardiopulmonary bypass was employed. Mean number of grafts used was 2.4±1.2.
DISCUSSION AND CONCLUSION: The findings suggest that the presence of such cardiac risk factors as hypertension, diabetes mellitus, and smoking history increase coronary artery disease risk and postoperative morbidity significantly and adversely affect life expectancy in the young patient population, irrespective of gender. Thus, it could be easily postulated that smoking is the most important preventable risk factor for early-onset of coronary artery disease.

GÝRÝÞ ve AMAÇ: Kafa travmalarý ve intrakranial kanamalar travmalarýn en aðýr formlarýndandýr ve ciddi hasarla sonlanma olasýlýklarý yüksektir.
Primer hasarý takip eden sekonder hasar geliþimi ve bunu etkileyen faktörler üzerine hastaya iliþkin risk faktörlerinin yaný sýra travma sonrasýndan baþlayarak transport, acil servisler, operasyon süreçleri ve yoðun bakým tedavileri etkin rol oynamaktadýr
Hastanemiz beyin cerrahisi ve yoðun bakým klinikleri olarak son iki yýl süresinde birlikte izlediðimiz travmatik intrakranial kanamalarýn retrospektif bir analizini yaparak yoðun bakým süreci baþlangýcý ve sonlanýmý sýrasýndaki Glaskow Koma Skalasý(GKS) skorlarýna göre hastalarýmýzý deðerlendirmeyi amaçladýk
YÖNTEM ve GEREÇLER: Hastane yönetiminin yazýlý onayý ile, hastane bilgi sistemi(HIS) kayýtlarý incelenerek Yoðun Bakým kliniðine travmatik intrakranial kanama tanýsý ile son iki yýl içinde kabul edilen, 18 yaþ üzeri hastalar retrospektif olarak analize edildi.Acil servis ve yoðun bakým hastalarýndan 56 hasta verisi deðerlendirildi..GKS geliþ ve çýkýþ skorlarý, <8 (kötü sonlaným beklentisi), ve ≥ 8 (iyi sonlaným beklentisi) olarak iki grupta deðerlendirildi.
BULGULAR: Analizi yapýlan 51 hastanýn geliþ GKS skoru 8 altý ve üzeri olmak üzere deðerlendirildiðinde, pupilla reflekslerinde istatistiksel olarak anlamlý, kan glukoz düzeylerinde ise klinik olarak yorumlanabilecek bir farklýlýk gözlenirken, çýkýþ deðerlendirmelerinde kötü sonlaným gösteren 17 hasta deðerlendirildiðinde, bu hastalarýn 8 tanesinin geliþ GKS skorlarýnýn da 8 in altýnda olduðu, bu hastalarýn aðýr kafa travmasýyla birlikte çoklu intrakranial patolojilerinin olup dekopressif cerrahi geçirdikleri, ve çoklu beden travmasýna maruz kaldýklarý belirlenmiþtir.
TARTIÞMA ve SONUÇ: Çalýþmamýzda politravma ve kontrol edilemeyen intrakranial basýnç artýþý ile dekompressif cerrahi uygulanan hastalarýn, ve baþvuru sýrasýnda yüksek kan þekeri görülen hasta gruplarýnýn prognostik açýdan daha kötü sonlandýðý görülmüþtür.
Kafa Travmalarýnda her hastanenin bir algoritmik yaklaþýmý olamasý, ve aralýklý olarak bu süreçlerin analizinin hastalarýn akut müdahaleler sýrasý ve sonrasýnda sekonder hasarlardan korunmasýnda etkili olabileceði görüþündeyiz

INTRODUCTION: Traumatic brain injuries and intracranial bleeding are the most severe forms of traumatic injuries with a high probability of devastating prognosis. Secondary injuries of the brain, following the primary injury, are preventable, and transportation to and in the hospital; the interventions in the emergency department, operational procedures and intensive care (ICU) stay are all crucial for the prevention of the secondary insult to the injured brain. In this retrospective cohort study, we analyzed the traumatic brain injuries that were followed by the neurosurgical and intensive care departments together in ICU for the last two years.
METHODS: With the written permission of the hospital administration, the data in the Hospital Information System were examined. Fifty-six patients admitted to the ICU with the diagnosis of traumatic intracranial bleeding over the age of 18 were analyzed. GCS scores on admission and discharge from ICU were regarded as ≥8 (Good outcome) and <8 (Bad outcome), and patients’ clinical measures were examined according to these groups.
RESULTS: Pupillary reflexes showed a statistically significant difference between the ≥8 and <8 patients on admission. Blood glucose levels were clinically higher in the GCS<8 group. On the analysis of the 17 patients whose GCS scores <8 (Bad outcome) on discharge, it was seen that 8 of them had GCS scores below 8 on admission. These patients had severe head trauma, multiple intracranial pathologies and underwent decompressive surgery besides the polytrauma of the whole body.
DISCUSSION AND CONCLUSION: We found that patients who had polytrauma with high intracranial pressure that could not be controlled with the first-line therapies and undergoing decompressive surgery, and also the patients who had high glucose levels on admission (>200mg/dl) showed worse prognosis. Hospitals should have an algorithmic approach and periodic analysis of the performances to prevent those delicate patients from having secondary insults to the brain during the emergency interventions and after.

GÝRÝÞ ve AMAÇ: Bronkopulmoner displazi (BPD) prematürelik ile iliþkili en önemli kronik pulmoner morbidite ve mortalite nedenlerinden biridir. Bu çalýþmada prematüre infantlarda eritrosit daðýlým geniþliðinin (RDW) BPD geliþimini öngörmede belirteç olarak kullanýllabilirliðinin araþtýrýlmasý hedeflendi.
YÖNTEM ve GEREÇLER: Retrospektif kohort seklinde düzenlenen çalýþmaya hastanemizin yenidoðan yoðun bakým ünitesinde (YYBÜ) yatarak tedavi görmüþ, ≤32 gestasyon hafta olan vakalar dahil edildi. Çalýþma kohortu izlemde BPD geliþen premature infantlar ve izlemde BPD geliþmeyen kontrol grubu olmak üzere 2 gruba ayrýldý. Hastalarýn demografik verileri ve postnatal ilk 3 saat içinde alýnan tam kan parametreleri kaydedildi ve bu deðerler ile BPD arasýndaki iliþki araþtýrýldý.
BULGULAR: Dýþlanma kriterleri sonrasýnda 78 hasta çalýþmaya dahil edildi. BPD grubunda kontrol grubu ile karþýlaþtýrýldýðýnda, doðum gestasyon haftasý ve doðum aðýrlýðý oranlarýnýn belirgin olarak daha düþük olduðu izlendi (sýrasýyla; p=0.001, p=0.002). BPD grubunda maternal preeklampsi izlenme oraný kontrol gruba göre anlamlý daha yüksek izlendi (p= 0.04). Çalýþma gruplarýnýn hemogram parametereleri deðerlendirildiðinde BPD grubundaki RDW deðerlerinin kontrol grubuna göre anlamlý olarak daha yüksek olduðu izlendi (p= 0.002). Multivariate lojistik regresyon analizi ile modele BPD geliþimi üzerine etkili diðer deðiþkenler dahil edildiðinde RDW düzeyinin (OR= 11.986, %95CI 2.494-57.602, p=0.002) ve invazif mekanik ventilasyon süresinin (OR=1.429, %95 CI 1.127-1.811, p=0.003) anlamlý BPD prediktörü olduðu izlendi. RDW deðeri için ROC analizi uygulandýðýnda “cut-off” deðeri %18 belirlendiðinde; bu deðer için duyarlýlýk %81.50, özgüllük %84.78 ve AUC deðeri 0.845 olarak saptandý (p < 0.001).
TARTIÞMA ve SONUÇ: Çalýþmamýzda prematüre infantlarda RDW deðerinin BPD yi öngörmede önemli bir parametre olduðu izlendi. RDW'nin basit ve kolay eriþilebilir bir parametre olarak, BPD yi öngörmede ve erken yaklaþýmda önemli rolü olabilir

INTRODUCTION: Bronchopulmonary dysplasia (BPD) is one of the most frequent respiratory morbidity and the main cause of mortality in premature infants. This study aims to explore the role of red cell distribution width (RDW) to predict BPD in preterm infants.
METHODS: Preterm infants of ≤32 gestational weeks who were admitted to the neonatal intensive care unit during six months were enrolled in this retrospective study. The study cohort was divided into two groups according to BPD presence or not. Details of the demographic data of the patients and the laboratory data within three hours after birth were recorded. The relationship between RDW levels and BPD were evaluated.
RESULTS: Seventy-eight infants were included in the final analysis. In the BPD group, gestational age and birth weight were significantly lower than the control group (p=0.001 and p=0.002, respectively). In the BPD group, maternal preeclampsia was higher than the control group (p=0.04). In the BPD group, RDW levels were significantly higher than the control group (p=0.002). After performing the multivariate model of logistic regression, significant predictors of BPD were RDW levels (OR= 11.986, 95% CI 2.494-57.602, p=0.002) and duration of invasive mechanical ventilation days (OR=1.429, 9%5 CI 1.127-1.811, p=0.003). The optimal RDW cut point for prediction of BPD by the ROC curve analysis was 18%, which yielded sensitivity 81.50% and specificity 84.78%, and the AUC of RDW was 0.845 (p<0.001).
DISCUSSION AND CONCLUSION: Our findings show that the RDW level is a significant parameter to predict BPD in preterm infants. RDW as a simple and accessible value may be of important role in the prediction and early approach of BPD in preterm infants.

GÝRÝÞ ve AMAÇ: El yaralanmalarý plastik cerrahide sýklýkla rekonstrüksiyon gerektiren yaralanmalarýdýr (1). Parmak ucu elde en sýk yaralanan bölgedir. Etiyolojisinde sýklýkla travmalar ön planda yer almaktadýr.
YÖNTEM ve GEREÇLER: 2013- 2017 yýllarý arasýnda kliniðimizde replantasyona uygun olmayan, tip amputasyonu nedeniyle opere edilen 625 hastanýn kayýtlarý geriye dönük olarak incelendi.
BULGULAR: Travmalarýn etiyolojisi incelendiðinde, en sýk iþ kazalarý olmakla beraber, pediatrik yaþ grubunda sert cisimlerin arasýna sýkýþma en sýk etyolojik neden olarak tespit edildi. Replante edilemeyecek düzeyde olan vakalarda kompozit greft (%60), kompozit greft amaçlý kullanýlabilecek amputat olmayan vakalarda ise lokorejiyonel flep veya serbest flepler uygulanmýþtýr.
TARTIÞMA ve SONUÇ: Tutma hissetme, dokunma, sýkýþtýrma hareketlerinde önemli olduðu için el yaralanmalarýnýn rekonstrüksiyonlarý özelliklidir. Tip amputasyonlarýnda mümkün olduðunca fonksiyonel rekonstrüksiyon yapýlmalýdýr.

INTRODUCTION: Hand injuries typically need reconstruction in plastic surgery practice. (1) Tip region is the most injured area. Hand injuries mostly arise from traumas.

METHODS: In this study, the retrospective analysis of the 625 patients, who were operated because of tip amputation in our clinic between the years of 2013-2017, was carried out. The patients were not eligible for replantation.

RESULTS: The cause of the traumas was mostly industrial injuries. Finger jam was the common cause in the pediatric population. Composite grafts were used in cases with torn fingers (60%). Locoregional flaps and free flaps were applied in cases which had no torn fingers.

DISCUSSION AND CONCLUSION: Reconstruction of hand injuries is very important because of the feeling, touching, grasping and holding functions of the hand. Functional reconstruction should be performed in such tip amputation injuries.

GÝRÝÞ ve AMAÇ: Non-timomatöz miyastenia gravis hastalarýnda ve kontrol grubunda kontrastsýz toraks bilgisayarlý tomografisi ile anteriyor mediastinal yað dokusu dansitesinin karþýlaþtýrýlmasý.
YÖNTEM ve GEREÇLER: Retrospektif çalýþmamýza klinik olarak miyastenia gravis tanýsý koyulan ve kontrastsýz toraks bilgisayarlý tomografi ile tetkik edilmiþ olan 65 hasta dahil edildi. Hasta grubu ile ayný cinsiyet ve benzer yaþ daðýlýmýnda olan, kontrastsýz toraks bilgisayarlý tomografisi ile tetkik edilmiþ 65 olgudan oluþan kontrol grubu oluþturuldu.
BULGULAR: 65 miyastenia gravis hastasýndan oluþan hasta grubunun anteriyor mediastinal yað dokusu Hounsfield unit deðer ortalamasý ve standart sapmasý -97 ± 37.3; kontrol grubunun ise -121± 37.3 olarak saptandý. Miyastenia gravis hastalarý ve kontrol grubu arasýnda Hounsfield unit deðerleri ve standart sapmalarý arasýnda istatistiksel olarak anlamlý fark izlendi (p=0.01).
TARTIÞMA ve SONUÇ: Miyastenia gravis hastalarýnda anteriyor mediastinal yað dokusu dansitesi kontrol grubuna göre yüksek bulunmuþtur.

INTRODUCTION: Comparison of anterior mediastinal fat tissue densities between non-thymomatous myasthenia gravis patients and control group with non-contrast thorax computerized tomography.

METHODS: In this retrospective study, 65 patients with myasthenia gravis, who were examined by non-contrast thorax computerized tomography, were included. A control group consisting of 65 patients with the same sex and similar age distribution as the patient group was composed.

RESULTS: Anterior mediastinal fat mass Hounsfield unit average and standard deviation were -97±37.3 for 65 patients with myasthenia gravis and were -121±37.3 for the control group, respectively. There was a statistically significant difference between Hounsfield unit values and standard deviations between myasthenia gravis patients and the control group (p=0.01).

DISCUSSION AND CONCLUSION: In myasthenia gravis patients, anterior mediastinal fat tissue density was found to be higher than the control group.

GÝRÝÞ ve AMAÇ: Günümüzde cerrahlarýn laparoskopik kolesistektomiden (LC) Açýk kolesistektomiye (OC) geçmeleri hala zor bir karardýr. Bu çalýþmada amacýmýz LC yapýlan hastalarýn verilerini karþýlaþtýrarak ameliyat öncesi OC'ye dönüþüm olasýlýðýný öngörmektir.
YÖNTEM ve GEREÇLER: Hastalar iki gruba ayrýldý. Ýlki OC grubuydu. Ýkincisi LC grubu iken. Her iki grubun verileri çeþitli parametrelerle karþýlaþtýrýldý.
BULGULAR: LC'den OC'ye dönüþüm oraný %7,2 idi. Erkek hastalarda dönüþüm oraný %12.8, kadýn hastalarda ise %5.2 idi. OC'li grubun ortalama yaþý (52.66 ± 13.77) istatistiksel olarak laparoskopi grubundan (47.22 ±13.04) daha yüksekti (p=0.019 < 0.05).
TARTIÞMA ve SONUÇ: Hastalarýn yaþý, cinsiyeti, artmýþ alkalen fosfataz, gama-glutamil transferaz ve direkt bilirubin deðerleri, safra kesesi duvar kalýnlýðý, safra çamuru varlýðý ve koledokolitiyazis varlýðý veya þüphesi, preoperatif endoskopik retrograd kolanjiyografi öykü parametreleri grup OC'de risk faktörü olarak istatistiksel olarak anlamlý bulundu.

INTRODUCTION: Today, it is still a difficult decision for surgeons to convert from laparoscopic cholecystectomy (LC) to Open cholecystectomy (OC). Our aim in this study is to predict the possibility of conversion to OC before the operation by comparing the data of the patients who underwent LC.
METHODS: Patients were divided into two groups. The first group was the OC group and the second group was the LC group. The data of both groups were compared with various parameters.
RESULTS: The conversion rate from LC to OC was 7.2%. The rate of conversion in male patients was 12.8%, and the rate of conversion in female patients was 5.2%. The mean age of the group with OC (52.66±13.77) was statistically higher (p=0.019 <0.05) than the laparoscopy group (47.22±13.04).

DISCUSSION AND CONCLUSION: Regarding patients’ age, gender, increased alkaline phosphatase, gamma-glutamyl transferase and direct bilirubin values, gallbladder wall thickness, presence of bile sludge and presence or suspicion of choledocholithiasis, preoperative endoscopic retrograde cholangiography history parameters as a risk factor in the group OC, there were statistically significant relation.

GÝRÝÞ ve AMAÇ: Prematüre retinopatisi (ROP), erken doðan bebeklerin retinalarýnýn anormal damarlanmasý ile karakterize bir hastalýktýr. Bu çalýþmada, tiroid hormonlarýnýn anjiogenez üzerinde bilinen etkilerinden yola çýkýlarak, ROP ile tiroid hormonlarý arasýndaki iliþkiyi araþtýrmak amaçlanmýþtýr.


YÖNTEM ve GEREÇLER: Bu retrospektif çalýþmaya Bahçeþehir Üniversitesi Týp Fakültesi Göztepe Medical Park Hastanesi Yenidoðan Yoðun Bakým Ünitesinde Ocak 2011 ve Ocak 2019 yýllarý arasýnda doðumdan itibaren bir aydan uzun süre yatmýþ ve ROP muayeneleri yapýlmýþ olan, 34 gestasyon haftasýndan (GH) erken doðmuþ bebekler dahil edilmiþtir. Hastalar ROP tanýsý almýþ ve almamýþ olarak 2 gruba ayrýlmýþtýr. ROP tanýsý almýþ olan hastalar da ROP tedavisi yapýlmýþ ve yapýlmamýþ olarak 2 alt gruba ayrýlmýþtýr. Cinsiyet, GH, doðum aðýrlýðý (DA), bronkopulmoner displazi (BPD), mekanik ventilasyon süresi, oksijen tedavisi süresi, nekrotizan enterokolit ve intraventriküler kanama (ÝVH) deðiþkenleriyle birlikte, postnatal 7. ve 28. günlerde bakýlan serum serbest T4 (sT4-1 ve sT4-2) ve TSH (TSH-1 ve TSH-2) düzeyleri incelenmiþtir.
BULGULAR: ROP hastalýðý olmayan 193 bebek (Grup 1) ve ROP hastalýðý olan 152 bebek (Grup 2) çalýþmaya alýnmýþtýr. ROP olan 152 hasta içinde 114 bebek ROP tedavisi olmamýþ (Grup 2a) 38 bebek ise ROP tedavisi olmuþtur (Grup 2b). Grup 2’de serbest T4-1 ve TSH-2, Grup 1’dekine göre anlamlý derecede düþük saptanmýþtýr (p<0.001). Grup 2b’nin sT4-1 ve sT4-2 düzeyleri Grup 2a’ya göre anlamlý derecede düþük saptanmýþtýr (sýrasýyla p=0.042 ve p=0.015). Risk faktörlerinin lojistik regresyon analizinde, tiroid hormon deðerleri baðýmsýz risk faktörü olarak saptanmamýþtýr.
TARTIÞMA ve SONUÇ: Bu çalýþmada tiroid hormonlarýnýn ROP geliþimi üzerinde etkisinin olmadýðý saptanmýþtýr. Daha büyük ölçekli ve prospektif çalýþmalar, tiroid hormonlarýnýn ROP geliþimi üzerindeki etkilerine ýþýk tutabilir.

INTRODUCTION: Retinopathy of prematurity (ROP) is a disease characterized by abnormal vascularization of the retina in preterm infants. The present study aims to investigate the relationship between ROP and serum thyroid hormones based on the known effects of thyroid hormones on angiogenesis.
METHODS: This retrospective study included infants born <34 weeks of gestation between January 2011 and January 2019 who were hospitalized from birth to at least the first month of life in the Neonatal Intensive Care Unit and who had regular ROP examinations. The patients were divided into two groups as having ROP and no ROP. Patients diagnosed as ROP were divided into two subgroups as follows: treated ROP and untreated ROP. Variables, such as gender, gestational age (GA), birth weight (BW), bronchopulmonary dysplasia (BPD), duration of mechanical ventilation, duration of oxygen therapy, necrotizing enterocolitis and intraventricular hemorrhage (IVH), together with serum-free T4 and TSH levels on postnatal 7th (sT4-1 and TSH-1) and 28th days (sT4-2 and TSH-2), were examined.

RESULTS: One hundred ninety-three infants without ROP (Group 1) and 152 infants with ROP (Group 2) enrolled in this study. Among 152 patients with ROP, 114 infants did not receive ROP treatment (Group 2a), and 38 infants received ROP treatment (Group 2b). In Group 2, free T4-1 and TSH-2 were significantly lower than in Group 1 (p<0.001). The sT4-1 and sT4-2 levels of Group 2b were significantly lower than those of Group 2a (p=0.042 and p=0.015, respectively). In the logistic regression analysis of risk factors, thyroid hormone levels were not found to be independently effective on the development of the ROP.

DISCUSSION AND CONCLUSION: In this study, the findings suggest that thyroid hormones had no effect on ROP development. Larger and prospective studies may shed light on the effects of thyroid hormones on ROP development.

GÝRÝÞ ve AMAÇ: Tiroid hastalýklarý enflamatuar süreçle yakýndan iliþkilidir. Kýrmýzý hücre daðýlým geniþliði (RDW), ortalama trombosit hacmi (MPV) ve nötrofil / lenfosit oraný (NLR) günümüzde inflamatuvar belirteç olarak kullanýlmaktadýr. Amacýmýz RDW, MPV ve NLR düzeyleri ile benign tiroid nodülleri arasýndaki iliþkiyi araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Ocak 2011 - Mayýs 2017 tarihleri arasýnda Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi dahiliye kliniðine baþvuran hastalar geriye dönük olarak incelendi. Çalýþmaya dahil edilme kriterlerini karþýlayan benign tiroid nodülü olan 160 hasta ve 30 tiroid nodülü olmayan hasta dahil edildi. Hastalarýn rutin hemogram testleri kaydedildi ve RDW, MPV ve NLR deðerleri iki grup arasýnda karþýlaþtýrýldý. 
BULGULAR: RDW, MPV ve NLR deðerleri, nodülü olan grup ile nodülü olmayan grup arasýnda karþýlaþtýrýldý. Gruplarýn MPV veya NLR deðerleri arasýnda fark gözlenmedi. RDW deðerleri nodülü olan grupta nodülü olmayan gruba göre anlamlý derecede yüksekti (p = 0,036).
TARTIÞMA ve SONUÇ: Çalýþmamýz tiroid nodülleri ile altta yatan inflamatuvar süreç arasýndaki iliþkiyi desteklemektedir. Bununla birlikte, inflamatuvar biyobelirteçler ve malignite arasýnda bir iliþki olduðunu öne süren bazý çalýþmalarýn aksine, maligniteyi benign nodüllerden ayýrmada, benign koþullarda da artabileceklerinden, bu tür belirteçlerin kullanýlmasýný önermiyoruz.

INTRODUCTION: Thyroid diseases are highly associated with the inflammatory process. Red cell distribution width (RDW), mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR) are recently used inflammatory markers. In this study, our aim is to investigate the relationship between RDW, MPV and NLR levels and benign thyroid nodules.

METHODS: Patients who referred to Haydarpaþa Numune Training and Research Hospital internal medicine clinic between January 2011 and May 2017 were retrospectively analyzed. One hundred-sixty patients with benign thyroid nodules and 30 patients without thyroid nodules fulfilling the inclusion criteria were included in this study. Patients’ routine hemogram tests were recorded and RDW, MPV and NLR values were compared between two groups.

RESULTS: The RDW, MPV and NLR values were compared between the group with nodules and the group without nodules. No difference was observed between the groups’ MPV or NLR values. RDW values were significantly higher in the group with nodules than the group without nodules (p=0.036).

DISCUSSION AND CONCLUSION: Our study supports the relationship between thyroid nodules and the underlying inflammatory process. However, unlike some studies suggesting an association between inflammatory biomarkers and malignancy, we do not recommend the use of such markers since they may increase in benign conditions, in distinguishing malignant from benign nodules.

GÝRÝÞ ve AMAÇ: Gastrostomi için günümüzde açýk cerrahi ve endoskopik yöntemler olmak üzere birçok cerrahi yöntem tanýmlanmýþtýr. Tek insizyon gastrostomi (TÝG) ile ilgili ise oldukça az sayýda yayýn mevcuttur. Diðer yöntemlere göre daha az bilinen tek insizyon cerrahi gastrostomi deneyimimizi diðer gastrostomi yöntemleri ile karþýlaþtýrarak paylaþmayý amaçladýk.
YÖNTEM ve GEREÇLER: Haziran 2016 ile Haziran 2019 tarihleri arasýnda Ümraniye E.A.H. de TÝG yapýlan 15 olgu, Stamm gastrostomi (SG) yapýlan 14 olgu ve perkütan endoskopik gastrostomi (PEG) yapýlan 11 olgu retrospektif olarak deðerlendirildi. Olgularýn yaþ, cinsiyet, ameliyat endikasyonu, ameliyat yöntemi, ameliyat süresi, postoperatif komplikasyonlar karþýlaþtýrýldý.
BULGULAR: PEG yapýlan olgulardan birinde mide perforasyonu ve diðerinde gastrostomi tüpünün yerinde olmadýðý izlendi. Her iki hastayada laparotomi ve SG yapýldý. TÝG yapýlan 2 olguda insizyon yerinde evantrasyon ve altý hastada tüp çevresinde granülasyon izlendi. Evantrasyon lokal sütürle tedavi edilirken granülasyon gümüþ nitrat ile tedavi edildi. Stam gastrostomi yapýlan 1 olguda brid ileus geliþmesi nedeniyle laparotomi yapýldý. TÝG yapýlan hiçbir olguda laparatomi gerektirecek majör komplikasyon görülmedi.
TARTIÞMA ve SONUÇ: TÝG kolay uygulanabilir, minimal invaziv ve komplikasyon oraný da diðer yöntemlere göre düþüktür.

INTRODUCTION: Many surgical methods have been defined for gastrostomy, including open surgery and endoscopic methods. There are very few reports on single-incision gastrostomy. In this study, we aimed to share our experience of single-incision surgical gastrostomy, which is less known than other methods, by comparing it with other gastrostomy methods.

METHODS: Between June 2016 and June 2019, in Ümraniye E.A.H. 15, patients undergoing SIG, 14 patients undergoing Stamm gastrostomy (SG) and 11 patients undergoing percutaneous endoscopic gastrostomy (PEG) were evaluated retrospectively in this study. Age, sex, indication for operation, operation method, operation time and postoperative complications were compared.

RESULTS: Gastric perforation was observed in one patient, and a gastrostomy tube was absent in another patient. Laparotomy and SG were performed in both patients. Two patients who underwent SIG had eventration at the incision site and granulation around the tube in six patients. Evolution was treated with local suture and granulation was treated with silver nitrate. In one patient who underwent Stamm gastrostomy, laparotomy was performed because of the development of brid ileus. No major complication requiring laparotomy was seen in any patient who underwent SIG.

DISCUSSION AND CONCLUSION: SIG is easy to perform, minimally invasive, and the complication rate is lower than other methods.

GÝRÝÞ ve AMAÇ: Introduction: Internal mammary artery (IMA) graft is a commonly used coronary artery bypass conduit due to its high long-term patency rates. Besides, IMA can have a perioperative arteriel spasm problem. Papaverine, an opium alkaloid, is commonly used in vasospasm, especially for IMA. Iloprost, a synthetic prostacyclin analogue, could be an alternative to papaverine. In this study, we compared the effect of topical iloprost and papaverine in terms of prevention of IMA vasospasm.

YÖNTEM ve GEREÇLER: Between May-August 2009, 40 consequtive patients who underwent coronary artery bypass grafting using IMA graft were included in the prospective study. Patients were divided into two groups in order to be treated with topical vasodilators as iloprost and papaverine groups. Free blood flow of IMA were measured before and after the topical vasodilators were applied. These results were evaluated together with concurrently measured mean arterial pressures. Histopathologic examination was performed with the distal part of IMA and scored according to the desquamation rate.
BULGULAR: Preoperative and haemodynamic parameters between the two groups were similar. With both vasodilator agents, the amount of IMA blood flow were increased in similar ratio as well. Analysis of this increase was assessed by dividing the blood flow by the mean arterial blood pressure value. Iloprost group had similar vasodilation response when compared with the response of papaverine group. Besides, there was more desquamation in the papaverine group at a significant level. There was no significant difference between the two groups in terms of postoperative mortality and complications.
TARTIÞMA ve SONUÇ: We concluded that iloprost could be an alternative for papaverine with similar vasodilation response and lower level of endothelial damage.

INTRODUCTION: Internal mammary artery (IMA) graft is a commonly used coronary artery bypass conduit due to its high long-term patency rates. IMA may have a perioperative arterial spasm problem. Papaverine, an opium alkaloid, is commonly used in vasospasm, especially for IMA. Iloprost, a synthetic prostacyclin analogue, could be an alternative to papaverine. In this study, we compared the effects of topical iloprost and papaverine concerning the prevention of IMA vasospasm.
METHODS: Between May-August 2009, 40 consecutive patients who underwent coronary artery bypass grafting using IMA graft were included in this prospective study. Patients were divided into two groups to be treated with topical vasodilators as iloprost and papaverine groups. The free blood flow of IMA was measured before and after the topical vasodilators were applied. These results were evaluated together with concurrently measured mean arterial pressures. Histopathologic examination was performed with the distal part of IMA and scored according to the desquamation rate.
RESULTS: Preoperative and haemodynamic parameters between the two groups were similar. With both vasodilator agents, the amount of IMA blood flow was increased in a similar ratio as well. Analysis of this increase was assessed by dividing the blood flow by the mean arterial blood pressure value. Iloprost group had similar vasodilation response when compared with the response of the papaverine group. There was more desquamation in the papaverine group at a significant level. There was no significant difference between the two groups in terms of postoperative mortality and complications.
DISCUSSION AND CONCLUSION: We concluded that iloprost could be an alternative for papaverine with similar vasodilation response and lower level of endothelial damage.

GÝRÝÞ ve AMAÇ: Bu çalýþmada amacýmýz, son beþ yýlda 20 mm'den küçük böbrek taþlarýnýn tedavisinde retrograd intrarenal cerrahi (RIRS) uygulanan 452 hastanýn sonuçlarýný sunmaktadýr.
YÖNTEM ve GEREÇLER: Kliniðimizde Ocak 2013 ile Þubat 2018 arasýnda böbrek taþý nedeniyle RIRS uygulanan 452 hastanýn dosyalarý geriye dönük olarak incelendi. Bütün vakalarda floroskopi kullanýldý. Hastalarýn demografik verileri,operasyon bilgileri, taþ yeri ve boyutu ve taþsýzlýk oranlarý incelendi. Hastalar operasyon sonrasý birinci gün direk üriner sistem grafisiyle, birinci ay ise kontrastsýz bilgisayarlý tomografi (BT) ile kontrol edildi. Taþsýzlýk durumu, operasyondan bir ay sonra BT'de taþýn hiç olmamasý veya 3 mm den daha küçük rezidüel fragmanlar kalmasý olarak tanýmlandý.
BULGULAR: Yaþ ortalamasý 47.9 (aralýk, 12-85) yýl olan 285 (% 63) erkek ve 167 (% 36.9) kadýn hasta vardý.Ortalama taþ boyutu 13,5 mm (aralýk, 7-20 mm) idi. Üreter giriþ kýlýfý 388 (% 85.8) hastada kullanýldý. Ortalama operasyon ve floroskopi süreleri sýrasýyla 70.6 dakika (aralýk,45-150) ve 17.6 saniye (daðýlým 3-55) idi. Ortalama hastanede kalýþ süresi 1.3 (aralýk, 1-5) gündü. Yirmi (% 4.4) hastada renal kolik, hematüri, enfeksiyon ve / veya ateþ gibi minör komplikasyonlar geliþti. Majör komplikasyon görülmedi ve kan transfüzyonu yapýlmadý. Ameliyat sonrasý birinci ayda 403 (% 89.1) hastada taþsýzlýk durumu elde edildi.
TARTIÞMA ve SONUÇ: 20 mm'den küçük böbrek taþlarýnýn tedavisinde RIRS'ýn etkili, uygulanabilir ve güvenli bir tedavi yöntemi olduðuna inanýyoruz. Prosedür düþük morbidite ve yüksek baþarý oranýna sahiptir.

INTRODUCTION: This study presents our outcomes of 452 patients who underwent retrograde intrarenal surgery (RIRS) for the treatment of renal stones smaller than 20 mm in the last five years.
METHODS: We retrospectively reviewed the file of 452 patients who were performed RIRS for renal stones in our clinic between January 2013 and February 2018. Fluoroscopy was always used in all cases. Patients were investigated regarding demographic and operation data, stone location and size and stone-free rates. Patients were controlled by direct urinary system graphy on the postoperative first day and by non-contrasted computed tomography (CT) in a month after the intervention. Stone-free status was documented on CT if there were no residual stones or presence of residual fragments smaller than 3 mm after a month.
RESULTS: There were 285 (63%) male and 167 (36.9%) female patients with a mean age of 47.9 (range 12-85) years. Mean stone size was 13.5 mm (range 7-20 mm). Ureteral access sheath was used in 388 (85.8%) of the patients. Mean operative and fluoroscopy screening times were 70.6 (range 45-150) minutes and 17.6 (range 3-55) second, respectively. The average hospital stay was 1.3 (range 1-5) days. Twenty (4.4%) patients had minor complications, including renal colic, hematuria, infection and/or fever. No major complications and blood transfusions were noted. Stone-free status was achieved in 403 (89.1%) of the patients in the first month postoperatively.
DISCUSSION AND CONCLUSION: We believe that RIRS is an effective, reliable and safe treatment modality for kidney stones smaller than 20 mm. The procedure has low morbidity and high success rate.

Saðlýk hizmetlerinde iyileþtirmeler için kalite ölçümüne odaklanmak çok önemlidir. Ayrýca kalite deðerlendirmelerinde geçerli bir model, yönetiþimi saðlamak ve kalite iyileþtirme açýsýndan gereklidir. Bununla birlikte artan ve deðiþen küresel ve ulusal saðlýk öncelikleri hem iyileþtirme hem de ölçüm mekanizmalarýnýn saðlýk sistemleri üzerindeki olumlu etkilerinde önemli bir rol oynamaktadýr. Bu çalýþmada, saðlýk hizmetlerinde akreditasyon faaliyetlerini yürüten ve ulusal bir kurum olan Türkiye Saðlýk Hizmetleri Kalite ve Akreditasyon Enstitüsü’nün (TÜSKA) kullandýðý akreditasyon denetim programýnýn, bir dýþ deðerlendirme aracý olarak deðerlendirilmesi amaçlanmýþtýr.

The focus on quality measurement in healthcare for improvements is crucial. Thus, a valid model for quality assessment is needed to achieve governance and quality improvement. The growing and changing global and national health priorities both the improvement and measurement mechanisms play an important role in the positive impact on health systems. This paper aims to evaluate the Turkish Health Care Quality and Accreditation Institute (TUSKA), which a national institute and carry out accreditation activities in health services, used to the accreditation survey program as an external evaluation tool.

Apendiks hastalýklarý akut batýnýn en sýk karþýlaþýlan nedenleridir. Bunlarýn arasýnda apendiks vermiformis torsiyonu nadiren görülür.Apendiks torsiyonunun klinik bulgularý akut apandisitten ayýrt edilemez ve genellikle tanýsý operasyon esnasýnda konulur. Apendiks torsiyonu, primer ve sekonder torsiyon olarak tanýmlanmýþtýr. Apendiks torsiyonu her yaþta görülebilir ancak literatürde çocuklarda daha az görülmektedir. Biz burada fekalite baðlý sekonder apendiks vermiformis torsiyonu olgusunu sunduk ve apendiks torsiyonu ile ilgili literatürü gözden geçirdik.

Diseases of the appendix are the most common causes of an acute abdomen. Among them, torsion of the vermiform appendix is a rare disorder. Clinical manifestations of torsioned appendix vermiformis are indistinguishable from acute appendicitis and it is usually diagnosed during the operation. Primary and secondary torsion are recognized in the appendiceal torsion. Torsion of the appendix may occur at any age, but it is less common in children in the literature. Here, we report a case of secondary torsion of the vermiform appendix with fecalith impaction and review the literature on appendiceal torsion.

Nutcraker sendromu (NCS) ilk kez 1944 yýlýnda Grand tarafýndan sol renal venin süperior arter (SMA) ile abdominal
aorta arasýnda sýkýþmasý olarak tanýmlanmýþtýr. NCS ile ilgili sýnýrlý sayýda klinik çalýþma olmakla birlikte en sýk karþýlaþýlan semptom ve bulgular sol böbreðin venöz hipertansiyonuna baðlý sol yan aðrýsý, hematüri ve proteinüridir. Disparoni, dizüri, dismenore, skrotal ve alt ektremitede variköz ven oluþumu, karýn aðrýsý diðer nadir görülen semptom ve bulgulardýr. Daha nadir olarak NCS’nin arteryel hipertansiyona da yol açabildiði bildirilmiþtir. Arteryel hipertansiyonun sekonder nedeni araþtýrýlan iki genç olgumuzda NCS saptadýk ve irdelemeyi uygun bulduk.

Nutcracker syndrome (NCS) was first described by Grand in 1944 as compression of the left renal vein with the superior artery (SMA) between the abdominal aorta. Although there are a limited number of clinical studies on NCS, the most common symptoms and signs are left side pain, hematuria and proteinuria due to venous hypertension of the left kidney. Dyspareunia, dysuria, dysmenorrhea, scrotal and varicose vein formation in the lower extremity, abdominal pain are other rare symptoms and signs. Rarely, NCS has been reported to cause arterial hypertension. We found NCS in two young patients who were investigated for secondary reasons of arterial hypertension, and we decided to present them in this study.

Künt göðüs travmalarý, göðüs duvarýnýn her iki tarafýnda ölümcül solunumsal ve respiratuar problemlere yol açabilen travmalar olup göðüs yaralanmalarýnýn sýk görülen formudur. Ölümcül sonuçlara yol açabildiðinden dolayý acil müdahale edilmesi gerekmektedir. Künt göðüs travmasýný zamanýnda ve gerektiðinde göðüs tüpü ile uygun þekilde tedavi etmek, çoðu hastada optimal aðrý kontrolünde ve göðüs fizyoterapisinde iyi sonuçlar elde edilmesini saðlar. Biz bu yazýmýzda, þiddetli künt göðüs travmasý sonucu meydana gelen, multipl kaburga kýrýklarý olan pnömotorakslý, politravmatik hastanýn bilateral tüp torakostomisi ile baþarýlý þekilde tedavi edildiði vakanýn sunumunu yapmayý amaçladýk.

Blunt thoracic trauma is a common form of chest injuries that can be mortal on both sides of the thorax leading to potentially fatal respiratory or cardiovascular compromise. As blunt thoracic trauma may lead to fatal outcomes, emergency interventions are needed. Proper management of blunt chest trauma with timely chest tube thoracostomy should be considered, whenever necessary, optimal pain control and chest physiotherapy result in a good outcome in the majority of patients. Here, we present a case report of a polytraumatic patient with bilateral pneumothoraces with multiple rib fractures after a severe blunt trauma successfully treated by bilateral tube thoracostomy.