INTRODUCTION: Critical leg ischemia represents the final stage of atherosclerotic peripheral arterial disease (PAD). Patients affected by critical leg ischemia are the most complex subset of PAD and typically have chronic pathological consequences of hypertension, hyperlipidemia, diabetes and renal failure.
METHODS: In this study, we evaluated the early and sixth-month outcomes of percutaneous transluminal angioplasty (PTA) in patients with stenosis or occlusion at the infrapopliteal level. Only one leg was treated in one session. None of the patients received infrapopliteal stents, and only balloon angioplasty was performed.
RESULTS: In our study, 41 vessels with a total of 48 lesions in 31 patients were treated. The primary patency rate of the vascular segments treated at follow-up was 72.9%.
DISCUSSION AND CONCLUSION: In PTA, failure in the procedure and loss of patency are the main therapeutic challenges to be solved. Large-scale, multicenter, prospective studies that systematically evaluate existing infrapopliteal treatment methods are needed to develop contemporary, proven treatment standards.

INTRODUCTION: Ectopic pancreatic tissue (EP) occurs in the gastrointestinal tract at a rate of 95%, usually detected incidentally. Pediatric cases have been reported rarely. Here, we present the patients who were detected during the endoscopic procedure.
METHODS: Between 2015-2018, 485 patients who underwent esophagogastroduodenoscopy in two different centers were evaluated retrospectively in this study.
RESULTS: During the procedure, the lesion was detected in 14 patients (eight boys and six girls), which could be macroscopically compatible with ectopic pancreatic tissue. The age range of the patients was 12.3±4.1 years. Eleven of the lesions were localized in the pre-pyloric antrum and one of them was located in the distal esophagus. Histopathological examination revealed ectopic pancreatic tissue in the esophagus biopsy specimen and in six of the antrum biopsy specimens.
DISCUSSION AND CONCLUSION: EP is usually asymptomatic, commonly detected in the gastrointestinal tract (esophagus, stomach, duodenum, jejunum, ileum, omentum, gallbladder, Meckel's diverticulum) and can be seen in all age groups. The gold standard for diagnosis is histopathological evaluation. There are few case reports in the pediatric age group. In our series, we found the incidence of EP to be 1%.

INTRODUCTION: To measure the medial and lateral posterior tibial slopes separately on conventional Magnetic Resonance Imaging (MRI) and to investigate whether this method can be used in the prediction of anterior cruciate ligament (ACL) rupture.
METHODS: This study included 31 consecutive patients with a definitive diagnosis of isolated ACL rupture and 31 healthy subjects. The medial and lateral posterior tibial slopes, intercondylar notch distance, notch width index (NWI), distal femur width, medial and lateral condylar width and depth were measured by MRI in both groups. The difference between patients with ACL rupture and controls were studied using the Student’s t-test.
RESULTS: The lateral posterior tibial slope and lateral condylar depth measurements were significantly higher, and the distal femur width was lower in the group with ACL rupture when compared to controls (p<0.005).
DISCUSSION AND CONCLUSION: MRI is the modality to measure lateral and medial tibial slopes separately. A combination of increased lateral posterior tibial slope, lateral condylar depth and decreased distal femur width could be a risk factor in ACL rupture.

INTRODUCTION: Metabolic syndrome (MetS) increases the risk of cardiovascular diseases. The value of red blood cell width (RDW) has been demonstrated in several studies in coronary artery disease. This study aims to investigate the significance of RDW in MetS patients with coronary artery disease (CAD).
METHODS: In this study, 120 of 89 patients undergoing coronary angiography were included. The whole group was divided into two groups according to coronary stenosis as noncritical and critical CAD. The study group was also divided into MetS and non-MetS. The cardiometabolic risk parameters were evaluated and RDW was calculated from complete blood count.
RESULTS: MetS prevalence was not significantly different between critic (71%) and noncritical CAD (59.5%) groups. RDW was significantly associated with MetS in whole study population (p=0.037) and was significantly higher in critic-CAD-MetS group (p=0.018).
DISCUSSION AND CONCLUSION: RDW is an inflammation marker that is associated with MetS patients in CAD. The higher value of RDW is associated with critic-CAD. Future studies are needed to demonstrate the role of RDW on MetS to predict long-term cardiovascular events.

INTRODUCTION: Most of the acute pancreatitis cases (AP) are mild; however, severe forms are risky for the patients, and those patients may benefit from early aggressive therapy. In this study, we investigated the predictivity of red cell distribution width (RDW) as a potential biomarker of severity.
METHODS: In this study, a total of 123 patients with AP were classified high risk (Ranson score ≥3 or more, HR) and low-risk patients (Ranson score ≤3, LR). The patients were then investigated about the relationship of RDW to the severity of the disease and factors that affect prolonged hospital stay.
RESULTS: The median age and stay were 56 (IQR 46-71) years and four (IQR 3-5) days. Elevated levels of RDW corresponded to HR patients compared with the LR patients, 13.90 (IQR 13.40-14.78) vs 13.40 (IQR 13.00-14.00), p=0.001, respectively. Prolonged hospital stay was related to higher Ranson scores and elevated lipase levels.
DISCUSSION AND CONCLUSION: High lipase levels at hospitalization may be associated with prolonged hospital stay. Elevated RDW levels may help in prediction of high risk in acute pancreatitis patients at hospital admission.

INTRODUCTION: Periodontitis (PD) and rheumatoid arthritis (RA) are chronic inflammatory diseases that share complex multifactorial pathologic processes, including genetics, environmental and inflammatory factors. This study aims to evaluate the periodontal status and its association with sociodemographic and clinical factors in patients with RA.
METHODS: This study included 51 patients with RA; the mean age was 49.75±9.79 years old and 10.59±6.37 years of disease duration. Sociodemographic data and the rheumatologic assessment included detailed profiling of the disease and serology were noted. A full mouth periodontal examination, including the Gingival index, Plaque index, Pocket probing depth and clinical attachment level, was carried out by a periodontist. The periodontal status was classified according to the Centers for Disease Control-American Academy of Periodontology clinical case definitions.
RESULTS: Forty-five patients (88.2%) were female. 37.3% of patients had DAS28>3.2. All patients had PD, in mild (54.9%) to moderate (45.1%) severity. Aging, impaired oral hygiene, smoking, secondary Sjögren’s syndrome and high disease activity were associated with moderate PD.
DISCUSSION AND CONCLUSION: This study results identified a serious need to pay particular attention to oral health in patients with RA and refer these patients for periodontal evaluation and treatment. Future studies are needed to better investigate whether if efforts to prevent periodontal disease may also help prevent RA.

INTRODUCTION: Thyroid nodules present serious problems, and mostly they do not carry neoplastic characteristics. Thus, they do not need to be surgically treated. Fine-needle aspiration biopsy (FNAB) is the most important diagnostic tool in the assessment of thyroid nodules and the prevention of unnecessary surgery. In this study, FNAB results of the patients operated for thyroid nodules were compared with postoperative histopathology results and the results of the frozen section were evaluated.
METHODS: In this study, 206 patients who underwent preoperative FNAB for solitary thyroid nodules and multinodular goiter in the 2nd General Surgery Department of Istanbul Haydarpaþa Numune Training and Research Hospital between 1999 and 2003 years were included. Thyroid Disease Form and pathology reports were used to evaluate the patient files retrospectively.
RESULTS: The study population (n=206) consisted of 170 (82.52%) female and 36 (17.48%) male patients and the median age of the population was 46,56. When FNAB and histopathological examination results of the nodules were compared, four of 179 cases evaluated as benign lesions in FNAB were reported as thyroid cancer (2.23%) as a result of histopathological examination of the surgical specimen. Nine (69.24 %) of 13 cases as evaluated as atypical/suspicious, and all of the seven cases (100%) reported to be malignant in FNAB were reported as thyroid cancer after histopathological examination. The relationship between FNAB and histopathological results was statistically significant in all groups (p<0.0002).
DISCUSSION AND CONCLUSION: It was concluded that FNAB is a useful method in the evaluation of thyroid nodules, and will prevent many unnecessary operations as a cheap and reliable diagnostic tool that can be used in the selection candidates for surgery and preoperative diagnosis of thyroid carcinomas. It was also evaluated that the frozen section may be useful in guiding the operation of patients in whom FNAB cytology is considered as atypical/suspicious.

INTRODUCTION: Cardiovascular involvement is one of the multisystemic manifestations of acute biliary pancreatitis. In this study, we aimed to examine, to our knowledge, for the first time, how the Tpeak-Tend (TpTe) interval, a highly predictive electrocardiographic marker, is affected in patients with acute biliary pancreatitis.
METHODS: A total of 68 subjects were recruited in this retrospective case-control study. To determine the Corrected QT Intervals (QTc) and TpTe intervals, the electrocardiographs of all subjects were manually examined using the precordial V5 lead.
RESULTS: We found that the TpTe and QTc intervals were longer in the cases compared to the controls, and this difference was statistically significant (p<0.05). With respect to acute biliary pancreatitis, the QTc had 68.4% sensitivity and 67% specificity (AUC=0.660, CI: 0.529-0.791; p=0.024) and the TpTe interval had 76.3% sensitivity and 63.3% specificity (AUC=0.647, CI: 0.508-0.787; p=0.038).
DISCUSSION AND CONCLUSION: The Tpeak-Tend interval was evaluated for the risk of arrhythmia in patients with acute biliary pancreatitis. Our study demonstrated how the Tpeak-Tend and OTc intervals were affected in patients with acute biliary pancreatitis and that acute pancreatitis might be one of the causes of prolonged QTc and Tpeak-Tend intervals.

INTRODUCTION: To describe the characteristics of the elderly patients admitted to the emergency department (ED) due to domestic falls concerning the causes and outcomes of the accident.
METHODS: This study included all consecutive elderly patients admitted to the ED within two months due to domestic falls. Descriptive analyses regarding demographics, history, and clinical findings were performed.
RESULTS: In this study, 159 elderly patients were admitted with falls in the study period, while 73 patients had exclusion criteria. Mean age was 76.7±7.1 and 68.4% (n=59) were female. 81.2% of the patients were diagnosed with soft tissue injuries. Sixteen patients with fractures were older than patients without fractures (p=0.016). “Trip and fall” was the most common mechanism (n=37, 43.5%).
DISCUSSION AND CONCLUSION: Although a majority of domestic falls in the elderly result in simple injuries, fractures occur in older patients, patients with smoking habits and/or alcohol use, or on routine use of medicines.

INTRODUCTION: This study aims to retrospectively analyze the features and treatment of pyogenic granuloma of the vermillion border of the lip.
METHODS: Information regarding 16 cases of pyogenic granuloma of the vermilion border of the lips that underwent biopsy was retrieved from the pathology records of patients seen at the Plastic Surgery Department of Sanliurfa Mehmet Akif Inan Training and Research Hospital and Dermatology Department of Sanlýurfa Balýklýgol State Hospital. Data were reviewed and analyzed for age, gender, lesion site and diameter, treatments, recurrence and clinical features.
RESULTS: Sixteen patients (12 female (75%) and four (25%) male patients) were included in this study. The ages of the patients ranged from 14 to 42 years (mean age: 26.25). In nine of the cases (56%), the bleeding was the most obvious complaint. Seven cases (43%) referred to our clinics for cosmetic reasons. There were three cases under 16 years of age (18%). Fourteen lesions (87.5%) were located on the lower lip, two lesions (12.5%) on the upper lip. The duration of complaints of the patients varies between two weeks and six months (mean: five weeks). The average follow-up period was 13 months (6-17 months). Complications and recurrences did not develop in any case after the operation.
DISCUSSION AND CONCLUSION: The advantages of surgical excision are allowing the removal of the lesion in one session and the low recurrence rate. We recommend surgical excision for the treatment of pyogenic granulomas located on vermilion because it permits complete histopathologic examination considering that ulcerous and hemorrhagic lesions may be associated with malignancy and various diseases.

INTRODUCTION: Rational pharmacotherapy training given to undergraduate medical students enables the doctors to treat their patients in accordance with the principles of rational drug use. The present descriptive analysis was carried out on fourth-year medical students to detect their perceptions on this training program using a questionnaire.
METHODS: During the academic year of 2018-19, a total of 100 fourth-year medical students attended the one-week clinical pharmacology course. Upon completion, of course, an unnamed questionnaire asking their opinion about the program was given to them.
RESULTS: A total of 100 students participated in course, and the percent response to the survey questions was 72%. The post-course questionnaire results revealed that 77.8% of the students found the course was useful for medical students, and the students were generally pleased with the components of the program. The highest satisfaction was with the environment being appropriate for expression of their opinions (88.9%) and discussions conducted in an interactive environment (79.2%). Most of them answered that they had covered the rationale for personal (P-) drug selection (88.9%). The lowest satisfaction was with the duration sessions (51.4%) and duration of education (58.3%) that the discussion sessions may be shorter in duration while the duration, of course, may be extended to two weeks.
DISCUSSION AND CONCLUSION: In conclusion, the present analysis shows the favorable perception of the students who attended the clinical pharmacology program during the fourth year of medical school. The students stated that education is useful, they actively participated in the discussions, learned P-drug selection, and these will contribute to their professional lives.

INTRODUCTION: In this study, we aimed to compare the social phobia, depression and quality of life in patients with major lower limb amputation to non-amputated.
METHODS: Patients who were underwent above or below the knee amputation in the past were evaluated retrospectively by examining the hospital records. All the participants were administered Liebowitz Social Anxiety Scale (LSAS), Hospital Anxiety and Depression Scale (HADS), and Short-Form 36 (SF-36).
RESULTS: The number of patients was 30 (21 males, nine females) in the amputated group and 30 (22 males, eight females) in the control group. The mean age was 41.8±14.09 years in the amputated group and 43.3±18.68 years in the control group. All LSAS and HADS scores were higher, and SF-36 scores were lower in the amputation group compared to the control group (p<0.05). The patients who were amputated more than five years ago had higher LSAS social fear scores, and lower HAD depression scores compared to patients less than five years (p=0.035, p=0.024, respectively). The employed patients had lower HAD depression and HAD total scores compared to unemployed patients (p=0.008, p=0,049, respectively). The patients amputated due to medical complications had higher scores in anxiety compared to the patients with traumatic amputation (p=0.005, p=0.016, respectively).
DISCUSSION AND CONCLUSION: Social phobia, depression and poor quality of life are common problems in patients with major lower limb amputation. After five years, it should not be forgotten that social phobia will increase; depression will decrease along with its seriousness. Therefore, amputated patients should be psychiatrically counseled and treated. It is important to provide permanent employment opportunities to improve the quality of life.

INTRODUCTION: Aortic stenosis is the most common and dangerous native valve disease and it affects 2-4% of the patients over 65 years of age. However, the surgical procedure leads the patients to undergo great risks, especially in the elderly population and in patients with concomitant disorders. In this retrospective study, we described and analyzed our experience on TAVI procedures performed in our hospital.
METHODS: After the approval of the Ethics Committee to conduct this study, patients’ files from June 2012 to December 2014 were reviewed retrospectively and first 100 patients’ demographic data, STS, EuroSCORE, aortic valve pressure gradients, the methods of anesthesia and monitoring and postoperative complications were collected. All of the data were expressed as mean±standard deviation.
RESULTS: Among 100 remaining patients, on whom data were collected, mean age was found as 78.6±6.7 years and 65 of the patients were female. The mean pulmonary artery pressure was 46.9±14.2 mmHg and mean pressure gradient (PG) was 48.8±10.7 mmHg, whereas the peak PG was 75.5±17.1 mmHg before the TAVI procedure; left ventricular ejection fraction before the TAVI procedure was calculated as 51.2±14.2%. Analysis of the patient charts revealed a mean value for STS as 7.8±4.7 and a mean value for EuroSCORE as 34.9±14.1%. In all patients, a probe for transesophageal echocardiography was inserted for real-time monitoring, together with a temporary pacemaker. Implanted valves were expandable CoreValve in 56%, and the Edwards Sapiens XT Valve in 43%. Following completion of the procedure, final femoral angiography was performed to verify that there were no vascular injuries. The patients were transferred coronary ICU after extubation. During postoperative period, minor complications were encountered in 11% of the patients.
DISCUSSION AND CONCLUSION: The findings showed that TAVI was a procedure with a low rate of complications in patients with severe aortic stenosis when the steps of the procedure had been followed meticulously, according to the results of our retrospective study. The anesthesiologist should be a key member of the staff prior, during, and following the intervention. The ongoing prospective trials and retrospective research together with the debate on indications, type of the anesthesia, location where the procedure is held will shed light on the evolvement of this relatively novel technique.

INTRODUCTION: To report long term results after foldable iris-claw phakic intraocular lens (pIOL) implantation for the treatment of high myopia.
METHODS: The medical records of patients who underwent Artiflex (Ophtec BV, Netherlands) or Veriflex (Abbott Medical Optics Inc., USA) pIOL were retrospectively analyzed. Patients with five years of follow-up were included in this study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and central endothelial cell density (ECD) were analyzed preoperatively and in five years after surgery. The complications observed during and after surgery were also recorded.

RESULTS: This study included 23 eyes of the 23 patients. Mean preoperative SE was -10.71D±2.84D and improved to -1.60D±0.80D at the postoperative 5-year visit. Mean preoperative and postoperative UDVA were 1.47±0.22 logMAR and 0.26±0.16 logMAR, respectively (p<0.05). Mean preoperative and postoperative CDVA were 0.26±0.15 logMAR and 0.17±0.12 logMAR, respectively (p<0.05). Mean ECD decreased from 2526±268 cells/mm2 to 2357±295 cells/mm2 in five years postoperatively. (p<0.05) In two eyes, a temporary, steroid-induced increase in intraocular pressure (IOP) was detected.

DISCUSSION AND CONCLUSION: Artiflex/Veriflex pIOL implantation was found safe and effective in five years after surgery. However, a 5-year follow-up is not sufficient to evaluate its long term endothelial safety profile.

INTRODUCTION: Promoter polymorphism -173G/C of macrophage migration inhibitory factor (MIF) is related to higher MIF levels. In this study, we have investigated the effects of this polymorphism with the occurrence and severity of acute pancreatitis (AP).


METHODS: Sixty-two AP patients and 83 healthy volunteers were included in our study. The demographical, clinical, laboratory and radiological findings were recorded, and peripheral blood samples were genetically analyzed.
RESULTS: In this study, 35 female and 27 male patients were included. The mean age was 51. The AP severity was mild at 37 patients, moderate at 21 and severe at four patients. Genotype and allelic distribution at patient and control groups were statistically different (p<0.001; p=0.03). Although no significant difference between mild, moderate and severe AP groups detected, there was a tendency of CC genotype and C allele frequency being higher at moderate and severe AP and GG genotype being higher at mild AP. Eight of nine SIRS developed patients had CC genotype and C allele frequency was 88.9%. The leucocyte count at CC genotype and at C allele increased.

DISCUSSION AND CONCLUSION: According to our results, CC genotype and C allele frequency were related with AP occurrence. However, considering the severity of AP, the statistical significance could not be proven.

INTRODUCTION: In this study, we present the short-term results of our brachytherapy series in patients with localized prostate cancer administered by a team led by urologists.

METHODS: Forty-one patients who underwent prostate brachytherapy between September 2003 and January 2007 were evaluated in this study. All patients had biopsy-proven adenocarcinoma. Low dose rate (LDR) Iodine-125 prostate brachytherapy was performed under general anesthesia according to intraoperative-interactive planning and peripheral loading technique. Preoperative and follow-up Prostate-Specific Antigen (PSA) levels, International Prostate Symptom Scores (IPSS) and International Index of Erectile Function-5 (IIEF-5) scores of all patients were determined.
RESULTS: Preoperative mean PSA, Gleason score and prostate volume of the patients were 7.7±5 ng/ml (4-22.5), 5.8±0.9 (4-8) and 36.8±12.6 ml (15-58 ml), respectively. The mean age of the patients was 62.3±6.3 (52-76) years. The mean follow-up period was 36.5 (7-60) months. Mean PSA value at the third (1.4±1.3 ng/ml) and sixth months (1.0±0.7 ng/ml) was significantly lower than preoperative mean PSA value (p<0.05). There was no significant difference between preoperative mean IPSS score (12.1±5.3) and mean IPSS scores at the third and sixth postoperative months (13.5±6.5 and 11.7±7.5, respectively, p>0.05). There was no significant difference between the mean preoperative IIEF score (14.2±2.6) and mean IIEF scores at the third and sixth postoperative months (11.3±6.5 and 10.8±7.5, respectively, p>0.05). TURP was performed in two patients after brachytherapy because of chronic urinary retention in one patient and because of increased lower urinary tract symptoms in other patient. One patient was referred to radiotherapy due to inadequate radioactivity in the dosimetric control tomography.
DISCUSSION AND CONCLUSION: Brachytherapy is an effective method in the treatment of localized prostate cancer and it is recommended in current guidelines despite the recent decline in its use.

INTRODUCTION: The etiology of lumbar spinal stenosis (LSS) is still unknown, but it is a multifactorial disease. Reduced blood flow due to atherosclerosis is thought to accelerate spinal degenerative changes, but it is not known whether there is a relationship between blood lipid profile and the development of spinal stenosis. In this study, we compared the LSS patients who underwent surgery and the patients without narrow canal findings., We aimed to evaluate the role of hyperlipidemia in the etiology of spinal stenosis.
METHODS: In our study, the blood lipid values (total cholesterol, triglyceride, LDL cholesterol, HDL cholesterol) of two different groups between the ages of 60 and 70, consisting of women and men, were analyzed and compared retrospectively. Group 1 (LSS group) with 40 LSS cases (20 females/20 males) operated in our clinic, Group 2 (control group)with the patients from patients who applied to the outpatient clinic for nonspecific reasons (such as headache).
RESULTS: There was no statistically significant difference in Group 1 and Group 2 concerning HDL and LDL levels. The VLDL level of Group 1 was statistically significantly higher than Group 2 (p=0.000; p<0.05). The triglyceride level of Group 1 was statistically significantly higher than Group 2 (p=0.000; p<0.05).
DISCUSSION AND CONCLUSION: It is thought that there is a relationship between VLDL and triglyceride levels and the development of spinal stenosis. However, there is no such relationship with HDL and LDL.

INTRODUCTION: To compare the results of Verion system with manual marking in the reduction of astigmatism in eyes with cataract and low to moderate astigmatism by forming limbal relaxing incisions (LRIs).
METHODS: Thirty-eight eyes of 22 patients who had undergone standard phacoemulsification surgery and limbal relaxing incision for astigmatic correction with the help of image-guided system (Verion) were compared retrospectively with 40 eyes of 24 patients, who had undergone standard phacoemulsification surgery and limbal relaxing incision for astigmatic correction with manual marking.
RESULTS: There was no significant difference between two groups concerning the mean 1st and 6th month postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical and cylindrical values (p-values, 0.054, 0.068, 0.946, 0.957, 0.971, 0.947, 0.254 and 0.195, respectively). Even though the mean postoperative 1st-month and 6th-month cylindrical values of the second group were higher than those of the first group, the difference was not significant statistically.
DISCUSSION AND CONCLUSION: LRIs performed during cataract surgery are efficient in reduction of low to moderate astigmatism. LRIs performed with Verion system seem to be not different significantly from LRIs performed with manual marking in the reduction of astigmatism during cataract surgery.

Plummer-Vinson syndrome (PVS) is a clinical condition accompanied by dysphagia, iron deficiency anemia and esophageal web. PVS has not been encountered in recent years since the factors related to nutritional have been improved and iron deficiency anemia has been diagnosed and treated early. A rare cause of PVS is Celiac disease. There are very few cases reported in the literature related to Celiac disease and PVS coexistence. We wanted to present this case both to emphasize this togetherness PVS is rarely seen and because PVS may still be seen today.

Guillain-Barre syndrome (GBS) is an acute-onset and immune-mediated disorder of the peripheral nervous system characterized by rapidly developing motor weakness. GBS patients often develop cranial nerve involvement, usually in the form of facial or pharyngeal weakness. Ocular involvement, and in particular, isolated ptosis without ophthalmoplegia are rare manifestations and may bring about considerable diagnostic challenges. Herein, we report a young man presenting with bilateral ptosis along with mild generalized weakness as initial manifestations of GBS.