GÝRÝÞ ve AMAÇ: Çölyak hastalýðý tahýllardaki glutenle tetiklenen otoimmün bir hastalýktýr. Ýntestinal sistem dýþýnda birçok sistemde etkilenme görülebilir. Bunlardan biri otonom sinir sistemidir. Postural ortastatik taþikardi sendromu etyolojisinde de otoimmunitenin yeri tartýþýlan bir konudur. Biz de yeni taný almýþ ve glütensiz diyet henüz baþlanmamýþ hastalarda POTS varlýðýný ve serum antikor düzeyleri ve HLA doku grubu ile iliþkisini araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Yeni taný almýþ ve henüz glütensiz diyet baþlanmamýþ olan hastalarýn doku gruplarý ve doku transglutaminaz IgA düzeyleri (Anti-Tg IgA) düzeyleri kayýt edildi. Ortostatik semptomlarý olan Çölyak hastalarýna aktif ayakta testi uygulandý. Tüm hastalara ekokardiyografi, 12 derivasyon ekg ve anemi ve sistemik hastalýk araþtýrmasý yapýldý. POTS tanýsý, sistemik hastalýk, anemisi olmayan, 6 aydýr ortostatik þikayetler tanýmlayan ve aktif ayakta testi pozitif saptananlara konuldu. Yatay pozisyondan dikey pozisyona geçildiðinde; ilk 10 dakikada kalp hýzýnýn 40/dakika artmasý veya kalp hýzýnýn 120/ dakikanýn üzerine çýkmasý ve kan basýncýnda sistolik/diastolik 20/10 mmHg’dan fazla düþme olmamasý durumunda test pozitif kabul edildi.
BULGULAR: Çalýþmaya alýnma kriterlerini saðlayan 47 hastadan POTS pozitifliði 16 hastada (%34) saptandý. POTS pozitif olanlarda kýz cinsiyeti (%62.5) erkek cinsiyetinden (37.5) daha fazla idi (p=0.023). Anti-Tg IgA düzeyi 200 U/ml üzerinde olan 31 hastadan 13’ünde (%41) POTS pozitif iken Anti-Tg IgA düzeyi 200 U/ml’ nin altýnda olan 16 hastanýn 3 tanesinde (%18) POTS pozitif saptandý (p=0.04). Yirmibir hastada HLADQ2, 4 hastada HLADQ8, 15 hastada HLADQ2 ve HLADQ8 pozitifliði mevcuttu. HLADQ2 ve HLADQ8 birlikte pozitif saptanan 15 hastadan POTS pozitif olan 9 hasta (%65) mevcut idi, sadece HLADQ2 pozitif saptanan 21 hasta arasýnda 7 hastada POTS pozitifliði (%33) mevcuttu ve bu oran artmýþ bulundu (p=0.04).
TARTIÞMA ve SONUÇ: Çalýþmamýzda, Anti-Tg IgA düzeyi ile ve HLADQ2 ve DQ8 birlikteliðiyle POTS sýklýðýnýn arttýðýný gösterdik. Bu durum, POTS’un otoimmun kökenli bir hastalýk olduðunu desteklemektedir. Çölyak hastalýðý olan çocuklarda ortostatik semptomlar varlýðýnda POTS varlýðý akýlda bulundurulmalýdýr.

INTRODUCTION: Celiac disease is an autoimmune disease triggered by gluten in cereals. Many other system involvements may occur in Celiac disease. One of them is the autonomic nervous system. The role of autoimmunity in the etiology of postural orthostatic tachycardia syndrome (POTS) is also discussed recently. In this study, we aimed to investigate the presence of POTS and its relationship with serum antibody levels and HLA tissue group in patients with newly diagnosed Celiac disease and gluten-free diet not yet started.
METHODS: Active standing test was applied to patients with the Celiac disease with orthostatic symptoms. POTS diagnosis was made for those who had orthostatic complaints for six months and who were found to be positive for the active standing test and who have not systemic disease and anemia.
RESULTS: POTS positivity was found in 16 patients (34%) out of 47 patients who met the inclusion criteria. In POTS positive patients, female gender (62.5%) was higher than male gender (37.5) (p=0.023). POTS was positive in 13 (41%) of 31 patients with anti-Tg IgA levels above 200 U/ml and POTS positive in three (18%) of 16 patients with anti-Tg IgA levels below 200 U/ml (p=0.04). Twenty-one patients had HLADQ2, four patients had HLADQ8, 15 patients had HLADQ2 and HLADQ8 positivity. Out of the15 patients who were found to be HLADQ2 and HLADQ8 positive, nine patients (65%) were POTS positive, out of the 21 patients who were found to be HLADQ2 positive, seven patients had POTS positivity (33%) (p=0.04).
DISCUSSION AND CONCLUSION: In our study, we showed that POTS frequency increased with an increase in the Anti-Tg IgA level and HLADQ2 and DQ8 association. This supports that POTS is an autoimmune disease. The presence of POTS should be kept in mind in the presence of orthostatic symptoms in pediatric celiac disease.

GÝRÝÞ ve AMAÇ: Bu çalýþma daha önce tedavi almamýþ, epiretinal membraný (ERM) olan ve ERM' si olmayan diabetik makula ödemli (DME) hastalarda ranibizumab tedavisinin yanýtýný karþýlaþtýrmayý amaçlamaktadýr.
YÖNTEM ve GEREÇLER: Diabetik makula ödemi olan 71 hastanýn 71 gözü geriye dönük olarak deðerlendirildi. Hastalar DME' si olup ERM' si olmayan [ERM(-)] grup (𝑛 = 34) ve DME' si ve ERM’ si olan [ERM(+)] grup (𝑛 = 34) þeklinde ayrýldý. En iyi düzeltilmiþ görme keskinliði (BCVA), merkezi makula kalýnlýðý (CMT) ve foveaaltý koroid kalýnlýðý (SFCT) deðerlendirildi.
BULGULAR: ERM (-) ve ERM (+) hastalar arasýnda yaþ ve cinsiyet daðýlýmý açýsýndan anlamlý fark yoktu (p=0.052, p=0.96, sýrasýyla). Her iki grupta CMT birinci, ikinci ve üçüncü ayda anlamlý bir azalma gösterdi (her iki grupta herbiri için p<0.01). Ayný zamanda, her iki grupta BCVA ikinci aydan itibaren anlamlý artýþ gösterdi (ERM (-) grupta p= 0.044 ve ERM (+) grupta p=0.006). ERM (-) ve ERM (+) grupta CMT ve BCVA baþlangýçta, birinci ayda, ikinci ayda ve üçüncü ayda anlamlý farklý deðildi. ERM (-) grupta SFCT baþlangýç deðerleri ile karþýlaþtýrýldýðýnda birinci ayda, ikinci ayda ve üçüncü ayda anlamlý þekilde azaldý (p=0.001, p<0.001, p<0.001, sýrasýyla). ERM (+) grupta SFCT baþlangýç deðerleri ile karþýlaþtýrýldýðýnda birinci ayda deðiþmedi (p=0.389) fakat ikinci ve üçüncü ayda anlamlý olarak azaldý (p<0.001, p=0.001, sýrasýyla).
TARTIÞMA ve SONUÇ: Üç aylýk çalýþmaya dayanarak, aylýk uygulanan üç ranibizumab enjeksiyonunun, ERM' si olan veya olmayan diabet hastalarýnda istatistiksel açýdan anlamlý olarak görsel aktivitede iyileþme ve CMT ve SFCT' de düþüþ saðladýðýný saptadýk.

INTRODUCTION: This study aimed to compare the response to ranibizumab therapy in naive diabetic macular edema (DME) patients with and without an epiretinal membrane (ERM).
METHODS: A retrospective chart review was performed on 71 eyes in 71 DME patients. The patients were divided into a DME without ERM [ERM (-)] group (n=34) and DME with ERM [ERM (+)] group (n=37). Best-corrected visual acuity (BCVA), central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) were evaluated.
RESULTS: There were no significant differences in age or gender distribution between the patients in the ERM (-) and ERM (+) groups (p=0.052, p=0.96, respectively). In both groups, CMT showed a significant decrease during the first, second and third months (p<0.01 for each in both groups). Therefore, BCVA increased in both groups and made significant gains from the second month (p=0.044 in the ERM (-) group and p=0.006 in the ERM (+) group). CMT and BCVA values did not differ significantly between the ERM (-) and ERM (+) groups in the baseline, first month, second month or third month. In the ERM (-) group, SFCT values decreased significantly as compared to baseline in the first month, second month and third month (p=0.001, p<0.001, p<0.001, respectively). In the ERM (+) group, the first month SFCT value did not change significantly (p=0.389), but it decreased significantly in the second month and third month as compared to baseline (p<0.001, p<0.001, respectively).
DISCUSSION AND CONCLUSION: Based on studying patients for three months, we determined that a series of three monthly injections of ranibizumab ensured a statistically significant improvement in visual acuity and a decrease in CMT and SFCT in diabetic patients with or without ERM.

GÝRÝÞ ve AMAÇ: Dizde manyetik rezonans inceleme endikasyonunu belirleyebilen kondromalazinin klinik bulgu ve manyetik rezonans görüntüleme özellikleri arasýndaki iliþkiyi deðerlendirmek ve yeni bir kýkýrdak doku durumu göstergesi tanýmlamak.
YÖNTEM ve GEREÇLER: Bu çalýþma Mayýs 2017 - Þubat 2019 tarihleri arasýnda yapýldý. Diz aðrýsý klinik olarak kondromalazi varlýðý için anlamlýysa, vizüel analog skor (VAS) ve Kujala ön diz aðrý skoru (ÖDAS) kaydedildi. MRG deðerlendirmesinde, ortalama patellar kalýnlýk (OPK) ve MRG derecesini birlikte deðerlendirmek için patellar kýkýrdak skoru (PKS) tanýmlandý.
BULGULAR: Ýleri kondromalazi kadýnlarda daha yaygýndý. (p <0.01) Yaþ ile MRG derecesi arasýnda pozitif bir korelasyon vardý ve korelasyon katsayýsý 0.56 olarak hesaplandý.
Klinik iliþki için PKS, OPK (ortalama kýkýrdak kalýnlýðý) ve MRG derecelerinin karþýlaþtýrýlmasýnda PKS ile en yüksek korelasyon katsayýsý elde edildi. VAS ve ÖDAS ile ileri kondromalaziyi tanýmlamak için ROC analizinde kesme deðerleri sýrasýyla 3 ve 80 idi. ÖDAS, VAS ile karþýlaþtýrýldýðýnda ileri kondromalazi için üstün bir klinik gösterge idi. Yaþ ve cinsiyet iliþkileri gibi diðer demografik bulgular literatürle uyumlu idi.

TARTIÞMA ve SONUÇ: Diz durumunu belirlemek için VAS'yi ÖDAS gibi fonksiyonel ölçümlerle birleþtirmek için potansiyel olarak daha iyi bir yöntem tanýmlanmýþ olup, MRG endikasyonu deðerlendirmesinde belirleyici olabilir. Yeni bir bakýþ açýsý olarak, PKS hem ortalama patellar kalýnlýk hem de manyetik rezonans derecelendirmesinden oluþan kondral klinik durumun en iyi göstergesi idi.

INTRODUCTION: To evaluate the correlation between clinical appearance and magnetic resonance imaging features of chondromalacia that can determine the knee magnetic resonance indication and to define a novel chondral status indicator.
METHODS: This study was performed between May 2017 and February 2019. If the knee pain was suggestive for the presence of chondromalacia clinically, then VAS and Kujala AKPS were noted. For MRI evaluation, a patellar cartilage score (PCS) was defined to evaluate the mean patellar thickness (MPT) and MRI grading together.
RESULTS: Advanced chondromalacia was more common among females (p<0.01). There was a positive correlation between age and MRI grading and the correlation coefficient was calculated to be 0.56. The highest correlation coefficient obtained with PCS in comparing PCS, MCT (mean cartilage thickness) and MRI grading for the clinical relationship. To define advanced chondromalacia with VAS and AKPS cut-off values calculated to be 3 and 80 in ROC analysis. AKPS was a superior clinical indicator for advanced chondromalacia compared with VAS. The other demographic findings, such as age and gender relations, were concordant with the literature.
DISCUSSION AND CONCLUSION: A potentially better method was defined to combine VAS with functional measurements, such as AKPS, to determine a knee status may be indicative of MRI evaluation. As a novel perspective, PCS was the best indicator of the chondral clinical status that consists of both the mean patellar thickness and magnetic resonance grading.

GÝRÝÞ ve AMAÇ: Testis tümörleri genç erkeklerde görülen, diðer ürolojik malignitelere oranla düþük insidanslý bir hastalýktýr. Çalýþmamýzda son 10 yýllýk testis tümörü olgularýnýn sonuçlarýný paylaþmak istedik.

YÖNTEM ve GEREÇLER: Ocak 2009 ile Ocak 2019 yýllarý arasýnda testis tümörü öntanýsýyla kliniðimizde opere edilen hastalar retrospektif olarak incelendi. Hastalarýn yaþý, laboratuar sonuçlarý ve patoloji sonuçlarý kayýt edildi. Patoloji raporunda benign tümör, kronik inflamasyon rapor edilen hastalar çalýþmaya alýnmadý.

BULGULAR: Çalýþmaya 131 hasta dahil edildi. Hastalar 21 ile 90 yaþ aralýðýnda olup ortalama yaþ 37.16+12.18 yýl idi. Germ hücreli tümör 125 hastada, sex-kord stromal tümör 3 hastada rapor edildi. Kalan 3 hastanýn ikisinde liposarkom, birinde lenfoma tespit edildi. Germ hücreli tümör (GHT) rapor edilen hastalarýn 39.2%’ sinde seminom, 60.8%’ inde seminom dýþý germ hücreli tümör mevcuttu. Seminom dýþý germ hücreli tümör tespit edilen 76 hastanýn; 65’inde (85.52%) mikst GHT, 7 (9.21%) hasta embriyonel karsinom ve 4(5.26%) hastada teratom saptandý.

TARTIÞMA ve SONUÇ: Hastalarýn büyük çoðunluðu germ hücreli tümörlerden oluþmaktaydý. En sýk görülen mikst germ hücreli tümörler olup 2. sýklýkta seminomlar gözlendi.

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

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

GÝRÝÞ ve AMAÇ: Ýlk baþvuru tarihleri 1977-1987 ve 2000-2010 yýllarý arasýnda olan hastalarýn görsel prognozlarýný kýyaslayarak buna etki eden faktörleri irdelemeyi amaçlamaktayýz.
YÖNTEM ve GEREÇLER: Bu retrospektif, gözlemsel çalýþmaya 200 hastanýn (48 kadýn, 152 erkek) 382 gözü dahil edildi. Ýlk baþvuru tarihleri 1977-1987 yýllarý arasýnda olanlar Grup1, 2000-2010 tarihleri arasýnda olanlar ise Grup 2 olarak sýnýflandýrýldý. Grup 1’de 100 hastanýn 194 gözü, Grup 2’de 100 hastanýn 188 gözü bulunuyordu. Hastalarýn dosyalarý üzerinden her vizitte, en iyi düzeltilmiþ görme keskinliði, biomikroskopik ve indirekt oftalmoskopik muayene bulgularý, yaþý, cinsiyeti, göz tutulumunun tek veya çift taraflý oluþu, geçirdiði atak sayýsý ve ataklarýn aralýklarý, oküler bulgular ve komplikasyonlarý, kullandýklarý antiinflamatuar ve immunsupresif ilaç tedavileri ayrýca izlem baþlangýcý ve sonundaki hasarýn derecelendirilmesi not edilerek deðerlendirildi.
BULGULAR: Hastalarýn %76’sý erkek, % 24’ü kadýndý. Hastalarýn üveitle ilk baþvuru yaþ ortalamasý 29 idi. Oküler tutulum % 91 çift taraflýydý. Grup 1’de ortalama atak sayýsý 4.21 iken Grup 2’de 3.25 idi. Kaplan-Meier survival analiz yöntemiyle iki grup kýyaslandýðýnda Grup 1’de %64.50’sinde potansiyel görme keskinliði kritik görme derecesi olan 0.1’in altýna düþerken Grup 2’de bu deðer %48.81 idi. (Log Rank: 11.44, p<0.001). Ortalama takip sonu evresi 1. Grupta 3.24, 2. Grupta 2.47 idi (p<0.001). Ortalama takip sonu en iyi düzeltilmiþ görme keskinlikleri ise 1. Grupta 0.41, 2. Grupta ise 0.65 olarak bulundu (p<0.001).

TARTIÞMA ve SONUÇ: 2000’li yýllarda Behçet hastalýðýna baðlý üveitlerin vizüel prognozu; oküler ataklarýn daha sýký takibi, ciddi posterior üveiti olan hastalara azatioprin, siklosporin gibi immunsupresanlarýn yerinde ve zamanýnda kullanýmý ve seçilmiþ olgulara da uygulanan yeni tedavi ajanlarýnýn etkisiyle 1980’li yýllara göre daha seviyededir.

INTRODUCTION: To compare the visual prognosis of patients with Behcet’s uveitis who presented after 1977-1987 and 2000-2010.
METHODS: In this observational, retrospective study, 382 eyes of the 200 patients (48 female and 152 male) were included. Patients who visited the clinic between 1977 and 1987 were classified into Group 1, and patients who visited between 2000 and 2010 into Group 2. Group 1 consisted of 194 eyes (100 patients), and Group 2 consisted of 188 eyes (100 patients). Best corrected visual acuity (BCVA) measurements, biomicroscopic and fundoscopic examinations, gender, age of onset of uveitis, numbers of ocular attacks per year from the onset of ocular disease, immunosuppressive drugs and ocular complications were noted by medical records. Grade of uveitis was noted at the first and last visit.

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

GÝRÝÞ ve AMAÇ: Amaç: Renal Hücreli Kanser (RHK) nedeniyle açýk (APN), laparoskopik(LPN) ve robot yardýmlý parsiyel nefrektomi (RPN) uyguladýðýmýz hastalarýnMIC (Marjin, Ýskemi, Komplikasyon) skoru veTrifecta sonuçlarýný bildirmek.
YÖNTEM ve GEREÇLER: 2007 ile aðustos 2018 tarihleri arasýnda böbrek tümörü nedeniyle açýk parsiyel nefrektomi (APN) n: 58, laparoskopik parsiyel nefrektomi (LPN) n: 32 ve robot yardýmlý parsiyel nefektomi (RPN) n: 126 uyguladýðýmýz vakalarýn demografik özellikleri, tümör özellikleri, perioperatif ve post operatif veriler ve komplikasyonlar, histopatolojik özellikleri retrospektif olarak deðerlendirildi. Böbrek tümörleri için nefron koruyucu cerrahi sonuçlarýný bildirmede cerrahi sýnýr negatifliði, iskemi süresinin 20 dakikanýn altýnda olmasý ve komplikasyon olmamasý oranlarýný içeren MIC Skoru ile cerrahi sýnýr negatifliði, perioperatif komplikasyonlar ve glomerul filtrasyon oranýnýn (GFR) >%90 korunmasý parametlerini içeren ‘trifecta’ oranlarý ile sonuçlarýmýzý bildirmeyi amaçladýk.
BULGULAR: RPN hastanede kalýþ ve tahmini kanama miktarýnda APN tekniðine üstün bulundu. Transfüzyon oraný ve tüm komplikasyonlar üç teknikte de benzer bulundu. APN'de daha kýsa operasyon süresi ve iskemi süresi olmasýna raðmen daha yüksek miktarda kan kaybý ve hastanede kalýþ süresi mevcut idi. Cerrahi sýnýr pozitifliðinde ve GFR'nin>%90 korunmasýnda her üç teknik arasýnda anlamlý fark bulunmadý. Sýcak iskemi süresi ortalama 23.6 dk ile en uzun LPN'de, ardýndan ortalama 18.4 dk ile RPN ve ortalama 16.6 dk ile APN'de en kýsa tespit edildi.(p=0.003) Açýk ile robotik teknik arasýndaki fark anlamlý deðilken LPN tekniðinde sýcak iskemi süresi anlamlý olarak uzundu. MIC skoru oranýmýz APN'de %79, LPN'de %71 ve RPN'de %81.7 bulundu.(p=0.04) Trifectaoranlarýmýz APN'de % 87, LPN'de %87.5 ve RPN'de %93.6 olarak gerçekleþti. (p=0.128)
TARTIÞMA ve SONUÇ: RHK için uygulanan parsiyel nefrektomi sonuçlarýný bildirmede hem ''MIC skoru sistemi'', hem ''Trifecta'' sistemi kullanýmý kolay ve tekrar edilebilir sistemler olduðundan objektif bir standardizasyon saðlayabilir. RPN düþük komplikasyon oranlarý, daha kýsa operasyon süresi, açýk cerrahiye benzer sýcak iskemi oranlarý ve onkolojik sonuçlar ile açýk parsiyel nefrektomiye en güçlü alternatif tekniktir.

INTRODUCTION: To report the MIC scores and trifecta rates in patients who underwent partial nephrectomy with open (OPN), laparoscopic (LPN) and robot-assisted techniques (RPN) due to kidney tumor.
METHODS: Demographic characteristics, tumor characteristics, peri-and post-operative data and complications of the patients who underwent OPN (n=58), LPN (n=32) and RPN (n=126) between 2007 and August 2018 due to kidney tumor and histopathological features were evaluated retrospectively in this study. To report oncological and functional outcomes of nephron-sparing surgery for renal tumors, MIC (surgical margin negativity, ischemia duration less than 20 minutes and lack of complication) and Trifecta (surgical margin negativity, perioperative complications and glomerular filtration rate (GFR) >90% protection rate) were used.
RESULTS: RPN was superior to OPN technique in hospitalization and estimated bleeding. Transfusion rate and all complications were similar in all three techniques. Although OPN had shorter operation time and ischemia time, there was a higher amount of blood loss and hospital stay. No significant difference was found between all three techniques for surgical margin positivity and >90% preservation of GFR. The mean duration of warm ischemia was 23.6 minutes with the longest LPN, followed by a mean of 18.4 minutes with an RPN and a mean of 16.6 minutes with OPN (p=0.003). It was significantly longer. Our MIC score was 79% in OPN, 71% in LPN and 81.7% in RPN (p=0.04). Our Trifectaoranes were 87% in OPN, 87.5% in LPN and 93.6% in RPN (p=0.128).
DISCUSSION AND CONCLUSION: Both the 'MIC score system 'and the 'Trifecta' system are easy to use and reproducible systems for reporting partial nephrectomy results for renal tumors. Robot-assisted partial nephrectomy is the most powerful alternative technique for open partial nephrectomy with low complication rates, shorter operation time, similar ischemia durations and oncologic outcomes.

GÝRÝÞ ve AMAÇ: Fibromiyalji sendromu (FMS), yaygýn kas iskelet sistemi aðrýsý ve vücudun bazý noktalarýnda aþýrý hassasiyet ile karakterize kronik bir hastalýktýr. Çalýþmamýzýn amacý, kadýn ve erkek FMS tanýsý alan hastalar ile kadýn ve erkek saðlýklý gönüllüler arasýnda dermatolojik bulgular açýsýndan fark olup olmadýðýný araþtýrmaktýr.
YÖNTEM ve GEREÇLER: FMS tanýsý konmuþ 60 gönüllü kadýn hasta ve 60 gönüllü erkek hasta çalýþma grubuna alýnýrken; saðlýklý gönüllülerden oluþan 60 kadýn ve 60 erkek ise kontrol grubuna alýndý. Tüm katýlýmcýlara ilk baþvurularýnda Fibromiyalji Etki Anketi (FIQ) ve Beck Depresyon Ölçeði (BDI) uygulandý. Tüm katýlýmcýlarýn cilt kontrolleri dermatoloji uzmaný tarafýndan yapýldý ve dermatolojik tanýlarý kaydedildi. Her iki grupta yer alan hastalarýn sonuçlarý karþýlaþtýrýldý ve istatistiksel olarak anlamlý farklýlýklarýn olup olmadýðýna bakýldý.
BULGULAR: Dermatolojik tanýlar incelendiðinde, Lichen Simplex Kronikus tanýsý, FMS'li kadýn hasta gurubunda, saðlýklý kadýn katýlýmcýlara göre istatistiksel olarak anlamlý daha yüksek olarak tespit edildi (p=0.006).
TARTIÞMA ve SONUÇ: Bu çalýþma sonucu bize FMS'li hastalardaki dermatolojik muayeneye, bütünsel muayene yaklaþýmýnda daha fazla önem verilmesi gerektiðini düþündürmektedir.

INTRODUCTION: Fibromyalgia syndrome (FMS) is a chronic disease characterized by widespread musculoskeletal pain and hypersensitivity at some points of the body. Our study aims to investigate whether there is a difference between male and female FMS patients and male and female healthy volunteers concerning dermatological findings.
METHODS: Sixty female and 60 male patients, who were diagnosed with FMS, were included in the study group; 60 female and 60 male healthy volunteers were included in the control group in this study. Fibromyalgia Impact Questionnaire and the Beck Depression Inventory were applied to all participants at the time of admission. All participants were examined by a dermatologist, and dermatological diagnoses were recorded. The results of the patients in both groups were compared and statistically analyzed.
RESULTS: In the examination of dermatological diagnoses, it was found that the incidence of lichen simplex chronicus was significantly higher in female FMS patients than in healthy female participants (p=0.006).
DISCUSSION AND CONCLUSION: Based on the results of this study, our findings suggest that dermatological examination in patients with FMS should be given more importance within a holistic examination approach.

GÝRÝÞ ve AMAÇ: Hepatit B enfeksiyonu toplum saðlýðýný ilgilendiren önemli bir enfeksiyondur. Bu çalýþmada doðal ya da aþý ile Hepatit B virüsüne karþý baðýþýk annelerden doðan ve transplasental olarak anneden bebeðe geçen Anti-Hbs antikorlarýnýn, yenidoðan bebeklerde HBV aþýsýna baðlý oluþan baðýþýklýðý etkileyip etkilemediðini, bu pasif geçen Anti-HBs antikor titrelerinin aþýlý ve aþýsýz yenidoðan bebeklerdeki doðal seyrini deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmaya 68 saðlýklý term yenidoðan bebek alýndý. Bu yenidoðan bebeklerin annelerinin baðýþýklýk durumu deðerlendirildi. Bebekler 3 gruba ayrýldý. Grup 1, anneleri AntiHBs antikoru pozitif olan bebekler, bu bebeklere HBV aþýsý uygulanmadan AntiHBS titreleri ardýþýk olarak 0, 1, 3, 6 ve 8.aylarda bakýldý. Grup 2, anneleri AntiHBs antikoru pozitif olan bebekler, bu bebekler 0,1 ve 6.ayda HBV aþýsý ile aþýlandý ve bu bebeklerin de 0,1, 3, 6 ve 8.aylarda Anti HBS titrelerine bakýldý. Grup 3, anneleri AntiHBs antikoru negatif olan bebekler, bu bebekler 0, 1 ve 6.ayda HBV aþýsý ile aþýlandý, bebeklerin 0,1, 3, 6 ve 8. aylarda AntiHBS titrelerine bakýldý.
BULGULAR: Grup1; 22 bebek, grup2; 24 bebek, grup3 ise yine 22 bebekten oluþmakta idi. Anneleri AntiHBs antikoru pozitif olan aþýlanmayan bebeklerin AntiHBs titrelerinin sýrasýyla 1, 3, 6 ve 8. aylarda <10 mIU/mL altýna düþme yüzdeleri %40,9, %50, %59,09, %100 olarak bulundu.
TARTIÞMA ve SONUÇ: Pasif antikorlara sahip bebeklere uygulanan HBV aþýsýna karþý antikor cevabýnýn, anneleri HBsAg(-), AntiHBs(-), AntiHBcIgM(-) ve ayný aþý takvimi ile aþýlanmýþ bebeklerdeki antikor cevabýna benzer olduðu saptandý yaklaþýk antikor cevabýný verdiðini saptadýk. Böylece bu transplasentalntal yola geçen AntiHBs antikorlarýn 0, 1 ve 6.aylarda uyguladýðýmýz uygulanan HBV aþýsýnýn oluþturduðu antikor cevabýný etkilemediði tespit edildi.

INTRODUCTION: Hepatitis B infection is an important infection that concerns public health. In this study, we aimed to evaluate whether anti-Hbs antibodies born from mothers who are immune to hepatitis B virus with natural or vaccination and passed from mother to baby transplacentally affect the natural course of these passive anti-HBs antibody titers.
METHODS: In this study, 68 healthy term newborn babies were included. The immune status of the mothers of these newborn babies was evaluated. Babies were divided into three groups. Group 1, babies whose mothers were positive for AntiHBs antibody, anti-HBS titers were evaluated consecutively at 0, 1, 3, 6 and 8 months without HBV vaccine. In Group 2, babies whose mothers were positive for anti-HBs antibody were vaccinated with HBV vaccine at 0.1 and 6 months, and these babies were examined for anti-HBS titers at 0.1, 3, 6 and 8 months. In Group 3, babies whose mothers were negative of anti-HBs antibody were vaccinated with HBV vaccine at 0, 1 and 6 months, and babies were examined at 0.1, 3, 6 and 8 months.
RESULTS: Group 1 consisted of 22 babies, Group 2 consisted of 24 babies and Group 3 consisted of 22 babies. Percentages of anti-HBs titers falling below <10 mIU/mL at 1, 3, 6 and 8 months were found to be 40.9%, 50%, 59.09%, and 100% of non-vaccinated babies whose mothers were positive for anti-HBs antibody.
DISCUSSION AND CONCLUSION: We found that the antibody response to HBV vaccine administered to infants with passive antibodies was similar to the antibody response in mothers vaccinated with their mothers HBsAg (-), anti-HBs (-), anti-HBcIgM (-) and the same vaccine calendar. Thus, it was found that anti-HBs antibodies that started this transplacentalntal pathway did not affect the antibody response produced by the HBV vaccine administered at 0, 1 and 6 months.

GÝRÝÞ ve AMAÇ: Bu çalýþmada dejeneratif Lombar Spinal Stenoz (LSS) tanýsý konmuþ hastalarda Tümör Nekroz Faktörü-α (TNF-α)/ Intelökin-10 (IL-10) (enflamatuvar / antienflamatuvar) sitokin dengesini araþtýrdýk.

YÖNTEM ve GEREÇLER: Hasta ve kontrol kanlarý, Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi Ýmmünoloji Laboratuarýnda santrifüjlenerek -20°C’de saklandý. Enzyme-linked immunosorbant assay (ELISA) yöntemi ile Human TNF-alfa ve IL-10 sitokinleri, Boster marka 96 kuyucuklu ELISA Kitler kullanýlarak manuel yöntemle çalýþýldý.
BULGULAR: Hasta grubunun TNF alfa deðerleri, kontrol grubundan istatistiksel olarak anlamlý düzeyde yüksek bulundu (p: 0.004; p<0.05) ve hasta grubunun IL-10 deðerleri, kontrol grubundan istatistiksel olarak anlamlý düzeyde yüksek bulundu (p: 0.017; p<0.05).
TARTIÞMA ve SONUÇ: Kanatimize göre; dejeneratif LSS olgularýnda TNF-alfa ve IL-10 sitokin düzeylerinin birlikte yükselmesi sayesinde; hastalýðýn enflamatuvar süreci, anti-enflamatuvar cevapla dengelenmeye çalýþmaktadýr.

INTRODUCTION: In this study, we investigated Tumor Necrosis Factor-α (TNF-α)/Interleukin -10 (IL-10) (inflammatory/anti-inflammatory) cytokine balance in patients diagnosed with degenerative Lumbar Spinal Stenosis (LSS).
METHODS: Blood samples obtained from patients and control subjects were centrifuged at the Haydarpaþa Numune Training and Research Hospital Immunology Laboratory and stored at -20°C. Human TNF-alpha and IL-10 cytokines were studied manually with an Enzyme-linked immunosorbent assay (ELISA) method using Boster brand 96-well ELISA kits.
RESULTS: TNF -alpha values of the patient group were found to be statistically significantly higher than the control group (p=0.004; p<0.05) and IL-10 values of the patient group were statistically significantly higher than the control group (p=0.017; p<0.05).
DISCUSSION AND CONCLUSION: Our findings suggest that TNF-alpha and IL-10 cytokine levels increased together in degenerative LSS cases. The inflammatory process of the disease is trying to be balanced with an anti-inflammatory response

GÝRÝÞ ve AMAÇ: Fabry hastalýðý X geçiþli lizozomal depo hastalýðý olup, hastalýða α-galaktosidaz A enziminin azalmýþ aktivitesi neden olmaktadýr. Bu çalýþmayla böbrek nakilli hastalarýn taranmasý sonrasý saptanan bir Fabry ailesi deðerlendirildi.
YÖNTEM ve GEREÇLER: Saðlýk Bilimleri Üniversitesi Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi’ nde nakil olmuþ 200 hasta taranabildi. Erkekler için α-galaktosidaz A aktivitesi tarama için kullanýldý. Bütün kadýn hastalarda gen analizi kullanýldý.
BULGULAR: Nakilli 200 hastadan 35 yaþýnda bir kadýn hastada c.376A>G (p. S126G) heterozigot mutasyon tespit edildi. 2015 yýlýnda ablasýndan renal nakil yapýlmýþtý. Ablasýnda da ayný mutasyon tespit edildi.
Bu indeks vakadan baþlayarak tespit edilebilen 38 aile üyesi ile iletiþime geçildi. Sadece 22 aile üyesine genetik analiz yapýldý. On bir aile üyesinde genetik analiz negatif, 11 aile üyesinde genetik analiz pozitifti. 12 aile üyesi ile iletiþim saðlanamadý. Pozitif olan sadece bir erkek hasta vardý, o da indeks vakanýn yeðeniydi.

TARTIÞMA ve SONUÇ: On iki hastanýn genetik analiz pozitifti. Mutasyon pozitif olan 87 yaþýnda hala ele alýndýðýnda, bazý hastalarda hastalýðýnýn hafif ve komplikasyonsuz geçebileceðini görülmektedir. Mutasyon pozitif sadece bir erkek hasta tespit edildi.

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

GÝRÝÞ ve AMAÇ: Chiari malformasyonlarý (CMs) beyincik, beyin sapý ve kraniovertebral bileþkenin (CVJ) anatomik anomalileri ile tanýmlanan heterojen bir hastalýk grubudur. Bu çalýþmanýn amaçlarý, CM-0'ýn CM, Chiari 1 ve 1.5'in bir alt grubu olup olmadýðýný belirlemek için, büyük CM'larýnda demografik ve klinik özellikler, insidans, cerrahi prosedürler ve sonuçlarý farklý patolojiler olup olmadýðýný belirlemektir.

YÖNTEM ve GEREÇLER: Tüm hastalar 1985-2016 yýllarý arasýnda CM için deðerlendirildi ve ameliyat edildi. Hastalar çeþitli alt tiplere ayrýldý. Demografik veriler, ek hastalýklar, klinik özellikler, cerrahi prosedürler, komplikasyonlar ve sonuçlar kaydedildi.

BULGULAR: Çeþitli cerrahi prosedürler uygulanan 55 hasta deðerlendirildi. Yaþ ortalamalarý 0.72 ± 1.17 idi. 26 CM-2 vakasý (% 47.3), 16 CM-3 vakasý (% 29.1) ve 13 CM-4 vakasý (% 23.6) tespit ettik. Chiari alt tipleri karþýlaþtýrýldýðýnda ek hastalýklar, semptom süresi, nörolojik muayene, komplikasyon oraný ve hastanede kalýþ süresi arasýnda istatistiksel olarak anlamlý farklýlýklar vardý.

TARTIÞMA ve SONUÇ: Hastanede kalýþ süresi, SM varlýðý ve kýsa semptom süresi daha kötü sonuçlarla iliþkilidir. Dura onarýmý cerrahinin en önemli etkisidir. Dura defekti (BOS fistülü) komplikasyon oranýný ve ortalama hastanede kalýþ süresini arttýrýr ve daha kötü sonuçlara neden olur. Bu nedenle, cerrahlar daha fazla zamana ihtiyaç duyarlar.

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

GÝRÝÞ ve AMAÇ: Prematüre ejakülasyonlu hastalarda tek baþýna tadalafil ve dapoksetinle olan kombinasyonunun etkinliðinin karþýlaþtýrmak.
YÖNTEM ve GEREÇLER: Prematüre ejakülasyon için üroloji kliniðinde tedavi edilen 120 hasta prospektif olarak deðerlendirildi. Hastalarýn IELT ve IIEF formlarý çalýþmadan önce dolduruldu ve ürolojik muayeneleri yapýldý. Tedavi edilen hastalar 2 gruba ayrýldý. Grup 1'deki hastalar sadece 5 mg tadalafil aldý, grup 2'deki hastalar ise 30 mg dapoxetine ve 5 mg tadalafil kombinasyonunu aldý.
BULGULAR: Tedaviden sonra, grup 1 IEFF skorlarý 25.12 ± 2.49 ve ortalama IELT skorlarý 7.35 ± 4.37 saniye idi. Her iki parametrede de istatistiksel olarak anlamlý bir artýþ vardý (p <0.001). Tedaviden sonra, grup 2 IEFF skorlarý 27.37 ± 2.46 ve ortalama IELT skorlarý 9.07 ± 4.20 saniye idi. Her iki parametrede de istatistiksel olarak anlamlý bir artýþ vardý (p <0.001).
TARTIÞMA ve SONUÇ: Erken boþalmanýn tedavisinde Tadalafilin tek baþýna kullanýlmasý yerine dapoksetinle kombine kullanýlmasý tedavi baþarýsýný arttýracaktýr.

INTRODUCTION: To compare the effectiveness of tadalafil alone and in combination with dapoxetine in patients with premature ejaculation.
METHODS: In this study, 120 patients treated at the urology clinic for premature ejaculation were evaluated prospectively. IELT and IIEF forms of patients were filled before this study, and their urological examinations were performed. Patients that were being treated were divided into two groups. Patients in group 1 received only 5 mg tadalafil, whereas patients in group 2 received a combination of dapoxetine 30 mg and tadalafil 5 mg.
RESULTS: After the treatment, group 1 mean IEFF scores were 25.12±2.49, and mean IELT scores were 7.35±4.37 seconds. There was a statistically significant increase in both parameters (p<0.001). After the treatment, group 2 mean IEFF scores were 27.37±2.46, and mean IELT scores were 9.07±4.20 seconds. There was a statistically significant increase in both parameters (p<0.001).
DISCUSSION AND CONCLUSION: Use of dapoxetine in combination with tadalafil instead of using tadalafil alone in the treatment of premature ejaculation will increase treatment success.

GÝRÝÞ ve AMAÇ: Retrokaval üreterin (RCU) laparoskopik transperitoneal onarýmýndaki tecrübemizi tanýmlamak.
YÖNTEM ve GEREÇLER: Þubat 2010 ve Þubat 2017 yýllarý arasýnda, kliniðimizde RCU tanýsý ile laparoskopik onarým uygulanan beþ hasta (1 kadýn ve 4 erkek) çalýþmaya alýndý. Hastalarýn yaþ ortalamasý 27 (20–32) idi. Tüm hastalar ameliyat öncesi, ilk olarak ultrasonografi (US) ile sonrasýnda kontrastlý bilgisayarlý tomografi (BT) ve intravenöz pyelografi (IVP) ile deðerlendirildi. RCU' nun BT tanýsýndan sonra tüm hastalara 99mTc-DTPA ile diüretik renografi incelemesi yapýldý. Laparoskopik cerrahi, üç olguda iki boyutlu (2D) görüntüleme sistemi, iki olguda ise üç boyutlu (3D) görüntüleme sistemi kullanýlarak transperitoneal yaklaþýmla yapýldý.
BULGULAR: Tüm operasyonlar açýk cerrahiye geçilmeden laparoskopik olarak tamamlandý. Ortalama operasyon süresi 168 ± 9 dakika idi. 3 boyutlu görüntüleme sisteminin kullanýldýðý iki hastanýn operasyon süresi, 2 boyutlu görüntü sisteminin kullanýldýðý hastalara göre daha kýsa (155 ve 165 dakika) idi. Tüm hastalarda peroperatif kan kaybý 50 mL' den azdý. Oblitere üreter segmenti 4 hastada çýkarýldý. Dört hasta cerrahi sonrasý semptomsuzdu ve böbreklerindeki hidronefrozda gerileme vardý. Olgulardan birinde postoperatif dönemde hidronefroz rezolüsyonu görülmedi.
TARTIÞMA ve SONUÇ: Retrokaval üreterin laparoskopik onarýmýnda baþarýnýn anahtarý, dokuya saygý, iyi hemostaz ile düzlem boyunca diseksiyonun saðlanmasýdýr. RCU' nun saf laparoskopik tedavisi uygulanabilir ve teknik olarak güvenilir görünmektedir. Ayný zamanda 3D görme sistemi kullanýlarak diseksiyon ve intrakorporeal dikiþ atma avantajlarý nedeniyle tercih edilebilir.

INTRODUCTION: We aimed to describe our experience in transperitoneal laparoscopic repair of retrocaval ureter (RCU) in this study.
METHODS: Between February 2010 and February 2017, five patients (1 female and 4 males) who underwent laparoscopic repair with the diagnosis of RCU in our department were included in this study. Patients’ mean age was 27 (range 20–32 years). All patients were pre-operatively evaluated using ultrasonography (US) followed by contrast-enhanced computed tomography (CT) intravenous pyelography (IVP). After CT diagnosis of RCU, all patients underwent diuretic renography examination with 99mTc-DTPA. Laparoscopic surgery was performed by the transperitoneal approach using the three-dimensional (3D) vision system in two and two-dimensional vision system (2D) in three patients.
RESULTS: All operations were completed laparoscopically without conversion to open surgery. Mean operation time was 168.5±9.89 minutes. Operation time of two patients in whom 3D a vision system was used was shorter (155 and 165 minutes) comparing to others in whom 2D vision systems used. Blood loss was less than 50 mL in all patients. Obliterated ureteric segments were excised in four patients. Four patients were symptom-free after surgery and had regression of hydronephrosis in their kidneys. In one of the cases, there was no resolution of hydronephrosis postoperatively.
DISCUSSION AND CONCLUSION: Careful dissection along the planes with good tissue respect and good hemostasis during each step are the key to success for laparoscopic repair of RCU. Pure laparoscopic treatment of RCU seems feasible and technically reliable. At the same, time using a 3D vision system, if available would be preferable because of the dissection and intracorporeal suturing advantages.

GÝRÝÞ ve AMAÇ: Testiste oluþturulan torsiyon, iskemik bölgeye nötrofillerin göçü ve serbest oksijen radikallerinin oluþumu, testiste iskemi-reperfüzyon (I/R) hasarýnýn oluþumunda etkin rol oynayan faktörlerdir. Verapamil HCl, fenilalkilamin türevi L-tipi voltaj baðýmlý kalsiyum kanal blokeridir. Çalýþmamýzda Verapamil HCl’ün, I/R sonucu testiste oluþan reperfüzyon hasarýnda koruyucu etkilerini araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Sekiz haftalýk, 21 adet eriþkin erkek Wistar-Albino sýçan randomize edilerek 3 gruba ayrýldý; Sham, I/R, I/R + Verapamil HCl. Sham ve I/R gruplarýnda 2. saatte intraperitoneal SF; I/R+Verapamil HCl grubunda ise detorsiyon esnasýnda 2 mg/kg intraperitoneal olarak verildi. Spermatojenik fonksiyonlar Johnsen kriterlerine göre deðerlendirilerek her testis için ortalama skorlar hesaplandý. P < 0,05 deðeri istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Tüm gruplardan elde edilen histopatolojik ve moleküler parametreler karþýlaþtýrýldý. Venöz kan örneklerinden ölçülen inflamasyon medyatörlerinin (TNF-α ve IL1-β) ortalama düzeyleri hesaplandý. Herhangi bir tedavi verilmeyen I/R gruplarýnda, sham gruplarýna kýyasla TNF-α düzeylerinin istatistiksel anlamlý olarak arttýðý ve Verapamil tedavisinin bu artýþý anlamlý þekilde önleyerek sham gruplarýna benzer düzeye getirdiði tespit edildi. Dokuda antioksidan özellik gösteren glutatyon peroksidaz (GPx) düzeylerinin, Verapamil HCl verilmeyen I/R grubunda Sham gruplarýna kýyasla anlamlý olarak düþtüðü gözlenirken, Verapamil HCl tedavisinin bu durumu önlediði saptandý. GPx ekspresyon skorlarýnýn, I/R grubunda sham gruplarýna kýyasla anlamlý olarak arttýðý izlenirken, Verapamil HCl tedavisinin bu deðerleri sham gruplarýna benzer düzeylere indirdiði belirlendi. Spermatogenez açýsýndan Johnsen skorlama sistemi kullanýlarak yapýlan histolojik deðerlendirmede gruplar arasýnda ortalama skorlar açýsýndan istatistiksel anlamlý bir fark saptanmadý.
TARTIÞMA ve SONUÇ: Torsiyon detorsiyon sonucu ortaya çýkan I / R durumunda, erken dönemde kandaki inflamasyon belirteçlerinin artýþýna, GPx aktivitesinde artýþa, dokularýn anti oksidan kapasitesinde azalmaya neden olduðu ve dört saat içinde spermatogenez parametrelerine etkisi olmadýðý sonucuna varýlmýþtýr. Verapamil HCl testis I / R'deki hasarý azaltýr.

INTRODUCTION: Testicular torsion, migration of neutrophils to the ischemic region and the formation of free oxygen radicals are important factors in the occurrence of ischemia-reperfusion damage in testes. Verapamil HCl is a phenylalkylamine derivative of the L-type voltage-dependent calcium channel blocker. In our study, we evaluated the prophylactic effects of the Verapamil in testicular ischemia-reperfusion damage.
METHODS: Twenty-one, eight weeks old adult, male Wistar-Albino rats were randomly divided into three groups as follows: Sham, I/R, I/R+Verapamil HCl. In Sham and I/R groups, saline was injected intraperitoneally at the second hour; in I/R+Verapamil HCl group, Verapamil was injected intraperitoneal at the second hour. Spermatogenic functions were evaluated according to Johnsen criteria, and then, average scores were calculated. P<0.05 was statistically significant.
RESULTS: We compared all histopathological and molecular parameters derived from all groups. Average levels of inflammation mediators (TNF-α and IL-1β) were calculated. In the early period, compared with the Sham group, TNF-α levels increased statistically significant in theI/R group, which did not receive any medical treatment. Also, we saw that Verapamil HCl treatment avoided an increase in TNF-α level and provided the same levels as the Sham group. Glutathione peroxidase (GPx), which is antioxidant in tissue levels, significantly decreased in theI/R group, which did not receive Verapamil HCl as compared with the Sham group. Verapamil HCl avoided this situation. Although GPx expression scores were higher in the I/R group than the Sham group, Verapamil HCl treatment takes these scores to the same levels as in the Sham group. For spermatogenesis, there was no statistically significant difference between groups according to Johnsen scoring system.
DISCUSSION AND CONCLUSION: I/R generated by T/D, in the early period, causes an increase of inflammation mediators in blood. It resulted in an increase in GPx activity, which decreased anti- oxidant capacity in tissue, and it has no effect to spermatogenesis parameters in four hours period. Verapamil HCl reduces damage in testicular I/R.

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

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

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

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

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

INTRODUCTION: The present study aims to evaluate the prevalence of myocardial bridging (MB) and investigate patient and bridge-related factors that may be associated with an increased tendency for atherosclerosis and acute coronary syndrome.

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

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