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Purpose: The purpose of this retrospective study was to evaluate the screw malpositions of patients who underwent transpedicular screw application in various elective and emergency conditions.Material and Methods: 100 patients who underwent transpedicular screw application with various spinal pathologies between January 2012 and September 2016 were included in this retrospective study. Anteroposterior and lateral X-rays and thin section spinal computed tomography scans were performed within 72 hours after the operation. The data including age, gender, operation levels, number of screws placed, preoperative and postoperative neurological conditions, complications, number of screw malpositions and revision surgeries of the patients were gathered.Results: A total of 692 transpedicular screws were applied to 100 cases. 610 (88.15%) of the 692 transpedicular screws placed were evaluated as normal. 82 screws (11.85%) were evaluated as malpositions and 5 of them were revised. According to Gertzbein classification; 20 screws were grade 1, 44 screws were grade 2 and 18 screws were grade 3. 4 patients had anterior perforation, 39 patients had medial perforation, 38 patients had lateral perforation and 1 patient had inferior perforation. There was a dominancy of thoracal levels in screw malpositions.Conclusion: Thin section CT scans taken postoperatively was found to be the gold standard for detecting screw malpositions. We identified that malpositions were most frequently seen as medial pedicle wall perforations in the thoracal region due to anatomical structure of the pedicles., Amaç: Çalışmamızda elektif ve acil şartlarda çeşitli tanılarla opere olarak transpediküler vida uygulanan hastaların, vida pozisyonlarının retrospektif olarak incelenerek vida malpozisyonlarının değerlendirilmesi amaçlandı.Gereç ve Yöntem: Ocak 2012 ile Eylül 2016 tarihleri arasında çeşitli spinal patolojilerle transpediküler vida uygulanan 100 hasta retrospektif olarak incelendi. Operasyon sonrası 72 saat içinde anteroposterior ve lateral direk grafi ve ince kesit spinal bilgisayarlı tomografi görüntülemeleri yapıldı. Hastaların yaş, cinsiyet, operasyon seviyeleri, yerleştirilen vida sayıları, preoperatif ve postoperatif nörolojik durumları, komplikasyonlar, vida malpozisyon sayıları ve revizyon ameliyatlarını içeren verileri toplandı.Bulgular: 100 olguya toplam 692 transpediküler vida uygulandı. Yerleştirilen 692 transpediküler vidanın 610'u (%88.15) normal olarak değerlendirildi. 82 vida (%11.85) malpozisyon olarak değerlendirildi ve 5'i revize edildi. Gertzbein sınıflamasına göre; 20 vida derece 1, 44 vida derece 2 ve 18 vida derece 3 olarak değerlendirildi. 4 hastada anterior perforasyon, 39 hastada medial perforasyon, 38 hastada lateral perforasyon, 1 hastada inferior perforasyon vardı. Vida malpozisyonlarının torakal seviyelerde daha çok görüldüğü saptandı.Sonuç: Ameliyat sonrası alınan ince kesitli bilgisayarlı tomografi taramaları vida malpozisyonlarının belirlenmesinde altın standart olarak kabul edilmektedir. Malpozisyonların pediküllerin anatomik yapısına bağlı olarak en sık torakal bölgede medial pedikül duvarı perforasyonları şeklinde olduğunu tespit ettik.

Amaç: Bu çalışmanın amacı spastik serebral palsili çocuklarda myotonometre ile gastrokinemius kasının biyomekanik özelliklerini (tonus, elastisite, sertlik) değerlendirmek ve elektrik stimulasyonun kas tonusu, elastisite ve sertlik üzerine etkinliğini göstermektir. Gereç ve Yöntem: Spastik serebral palsili 40 hasta (11 diplejik, 16 quadriplejik, 13 hemiplejik) ve yaş, cinsiyet, vücut kitle indeksi eşleşen 20 sağlıklı kontrol değerlendirildi. Diplejik/quadriplejik hastaların ve sağlıklı kontrollerin bilateral, hemiplejik hastaların ise paralitik taraflarının medial ve lateral gastrokinemius kasının tonusu, elastisitesi ve sertliği MyotonPro cihazı ile ölçüldü. Spastisite Ashworth skalası ile, fonksiyonel seviyeleri Kaba Motor Fonksiyon Sınıflama Sistemi ile değerlendirildi. Serebral palsili hasta grubunun 66 ekstremitesinden elde edilen ölçümler, sağlıklı grubun 40 ekstremitesinden elde edilen ölçümlerle karşılaştırıldı. Bulgular: Serebral palsili hasta grubundan 18 hastanın (31 ekstremite) gastrokinemius kasına 5 gün elektrik stimulasyon tedavisi uygulandı. Tedavi öncesi ve sonrası ölçümler tekrarlandı. Elektrik stımulasyonu sonrası medial ve lateral gastrokinemius kasında tonus ve sertlikte anlamlı azalma, elastisitede ise anlamlı artış görüldü. Ashworth skoru da anlamlı olarak azalmakla birlikte Ashworth skoru ile myotonometrik değerler arasında korelasyon yoktu. Sonuç: Çalışmamızın sonucunda, elektrik stimulasyonu uygulaması ile kas tonusu, elastisite ve sertlik değerlerinde iyileşme sağlandı. MyotonPro’nun serebral palsili çocuklarda spastisitenin değerlendirilmesinde ve tedavi etkinliğinin ölçülmesinde kullanılabileceği sonucuna varıldı. Purpose: The aim of this study was to evaluate the biomechenical properties (tone, elasticity, stifness) of gastrocnemius muscle (GCM) using myotonometry in children with spastic cerebral palsy (CP) and to demonstrate therapeutic effectiveness of electrical stimulation onmuscle tone, elasticity and stiffness. Materials and Methods: Forty patients with spastic CP (11 diplegic, 16 quadriplegic, 13 hemiplegic) and 20 age, gender and body mass index matched healthy controls were evaluated. MyotonPro was used to measure the medial and lateral GCM on bilateral sides of diplegic/quadriplegic patiens and healthy controls,and from the paretic side of the hemiplegic patients. Spasticity was evaluated by Ashworth Scale and functional level was assessed by Gross Motor Function Classification System.The measurements of 66 extremities of 40 patients were compared with 40 extremities of 20 controls. Results: Eighteen patients (31 extremities) with spastic CP were treated for 5 days of electrical stimulation which was applied on GCM. The muscle tone and stiffness of medial and lateral GCM decreased and the elasticity values increased significantly after the intervention. Although Ashworth scores were also decreased, no correlations between Ashworth scores and myotonometric values were detected. Conclusion: Our results suggest that electrical stimulation for the treatment of spasticity had improvements on muscle tone, elasticity and stiffness. MyotonPro can be used to measure the effects of treatment in spasticity.

Purpose: Vitamin B12 and folic acid have some basic functions in the synthesis, repair and expression of DNA of which susceptibility to damage is a major concern in carcinogenesis. We have examined the relationship between childhood cancers and vitamin B12 and folic acid levels in the present study. Materials and Methods: Between November 2013 and December 2015 newly diagnosed 125 patients with solid tumors and 113 patients with lymphoproliferative/ myeloproliferative malignant diseases and 63 controls were enrolled into the study. Vitamin B12, folic acid and homocysteine levels were measured as a part of diagnostic evaluation at the time of diagnosis. Results: Vitamin B12 and folic acid levels were found to be significantly lower in children with malignant diseases compared to the control group. Homocysteine levels however were statistically higher than those of the control group. Folic acid levels were significantly lower in lymphoproliferative/myeloproliferative malignant diseases group compared to the solid tumor group. Conclusion: Lower vitamin B12 and folic acid levels can be used as supportive markers at the time of diagnosis of cancer. This relationship needs to be proved in future studies with larger series. Amaç: Vitamin B12 ve folik asit DNA sentezi, tamiri ve ekspresyonunda önemli görevler alırlar. Bu çalışmada çocukluk çağı kanserleri ile vitamin B12 ve folik asit düzeyleri arasındaki ilişki araştırıldı. Gereç ve Yöntem: Kasım 2013 ve Aralık 2015 arasında yeni tanı alan solid tümörlü 125, lenfoproliferatif/miyeloproliferatif malign hastalığı olan 113 hasta ve 63 kontrol çalışmaya dahil edildi. Vitamin B12 ve folik asit düzeyleri tanısal çalışmaların bir parçası olarak tanı anında ölçüldü. Bulgular: Vitamin B12 ve folik asit düzeyleri malign hastalığı olan çocuklarda kontrol grubuna oranla anlamlı olarak düşük bulundu. Homosistein düzeyleri ise kontrol grubuna göre istatistiksel olarak daha yüksekti. Folik asit düzeyleri lenfoproliferatif/miyeloproliferatif malign hastalığı olanlarda solid tümör grubuna oranla daha düşüktü. Sonuç: Düşük vitamin B12 ve folik asit düzeyleri kanser tanısında destekleyici belirteçler olarak kullanılabilir. Bu ilişkinin gelecekte daha geniş serilerle ortaya konması gerekmektedir.

Amaç: Bu çalışma, Resim-İş Eğitimi özel yetenek sınavına giren adayların el anatomisinin (parmak uzunlukları, el bileği çap, çevre ve hareket genişliği ölçümleri) desen sınavında aldıkları puan ile ilişkisi olup olmadığını ortaya koymayı amaçlamaktadır. Gereç ve Yöntem: Türkiye’deki bir üniversitenin Eğitim Fakültesi Güzel Sanatlar Eğitimi Bölümü Resim-İş Eğitimi Anabilim Dalı Özel Yetenek Sınavı’na giren adaylar çalışmaya dahil edilmiştir. Öğrencilerin dijital kaliper, esnek olmayan mezura ve dijital inklinometre kullanılarak parmak uzunlukları, el bileği çapı, çevresi ve hareket genişlikleri ölçülmüştür. Bulgular: Çalışmamıza 18-25 yaş arası 161 öğrenci (60 erkek, 101 kız öğrenci) dahil edilmiştir. Desen sınavında elli ve üzerinde puan alan 49 kız, 35 erkek öğrenci, kırk dokuz ve altında puan alan 52 kız, 25 erkek öğrenci bulunmaktadır. Çizim başarısı puanı elli ve üzerinde olan ile kırk dokuz ve altında olanların antropometrik özellikleri karşılaştırıldığında anlamlı fark elde edilememiştir. Sonuç: Bu çalışma, çizim becerisine etki eden pek çok unsurun olduğu ve tek başına antropometrik standartlarla çizim başarısı arasındaki ilişkinin ifade edilmesinin zor olduğunu göstermiştir. Purpose: The research aims to determine whether there is a statistically significant relation between the drawing exam scores got by candidates entering the special aptitude exams in the Fine Arts Education and their hand anatomy (phalange lengths, carpus diameter, circumference and width of motion measurements) or not. Materials and Methods: This study includes the candidates who entered Special Aptitude Exams organized by Department of Fine Arts Education, Faculty of Education of a university in Turkey. Phalanges length, wrist diameter, circumference and motion width were measured using digital caliper, inflexible scales and digital inclinometer. Results: In our study, 161 students (60 boys, 101 girls) aged 18-25 years were included. There are 49 female and 35 male students who score fifty or more in the drawing examination and 52 female and 25 male students with scores of forty-nine and under in this study. A significant difference was not obtained when the anthropometric features of those who were fifty or more and those who were below forty-nine were below the drawing achievement score. Conclusion: This study has revealed that there are many factors that influence the drawing skill. Also reached the conclusion that it is difficult to say that the effect of drawing on the success of the single anthropometric standards.

Amaç: Çalışmamızda epilepsi ve anlıksal yetiyitimlerinde ilk basamak tanı testi olarak moleküler karyotipleme yapmayı ve bu hastalıklar ile ilişkisini ortaya koymayı amaçladık.Gereç ve Yöntem: Çukurova Üniversitesi Balcalı Hastanesi Tıbbi Genetik Polikliniği'ne başvuran ve geniş bir klinik problem yelpazesi sergileyen 580 hastaya Affymetrix CytoScan platform aracılı moleküler karyotipleme yapıldı.Bulgular: Moleküler karyotipleme sonucunda anlıksal yetiyitimi olan hastaların %41’inde mikrodelesyon, %32’sinde duplikasyon ve %50’sinde hem delesyon hem de duplikasyon tespit edildi. Epilepsi hastalarının %16’sında mikrodelesyon, %34’ünde duplikasyon ve %50’sinde delesyon ve duplikasyon; anlıksal yetiyitiminin eşlik ettiği epileptik hastalarda %33.3 mikrodelesyon, %44.4 duplikasyon ve %22.2 hem delesyonlar hem de duplikasyon bulundu. Ayrıca, bu çalışmada bir epileptik hastada uniparental dizomi ve 2 hastada marker kromozom saptandı. Sonuç: Elde edilen sonuçlar, moleküler karyotipleme tekniğinin klinik rutinde uygulanmasının ve elde edilen verilerin tıbbi genetik uzmanı tarafından yorumlanmasının kromozom düzeyindeki anomalilerin veya sendromların tanınmasında faydalı olduğunu göstermektedir. Özellikle epilepsi ve anlıksal yetiyitimi olan hastaların tanısında ilk basamak tanı testi olarak moleküler karyotipleme tercih edilebilir., Purpose: The aim of this study was to investigate molecular karyotyping of epilepsy and intellectual disabilites and to reveal its relationship with these diseases. Materials and Methods: A total of 580 patients with a wide range of clinical problems underwent molecular karyotyping by Affymetrix CytoScan platform included in the study that were presented to Medical Genetics Policlinics of Balcali Hospital and Clinics, Cukurova University Faculty of Medicine. Results: Molecular karyotyping identified 41% microdeletions, 32% duplications and 50% both deletions and duplications in mental retardation patients; 16% microdeletion, 34% duplications and 50% both deletions and duplications in epilepsy patients; and 33.3% microdeletions, 44.4% duplications and 22.2% both deletions and duplications in mental retardation with epilepsy group. In addition, one of epilepsy group with uniparental disomy and 2 marker chromosomes were detected in this study. Conclusion: Our results demonstrate that molecular karyotyping and clinical interpretation by a medical geneticist is efficient in diagnosing chromosomal diseases. Moreover, molecular karyotyping might be more effective as a first tier testing in epilepsy and psychomotor retardation patients.

Amaç: Clavicula üst ekstremite ve gövde arasındaki kemik bağlantıdır. Bu çalışma, clavicula’nın anatomik yapısı ve morfometrik ölçümlerini belirlemek amacı ile yapılmıştır. Gereç ve Yöntem: Bu çalışmada cinsiyeti belli olmayan yetişkin Anadolu insanına ait 66 adet clavicula (34 sol, 32 sağ) ölçülmüştür. Clavicula’nın; maksimum uzunluğu, orta noktasının çevresi, extremitas acromialis’in superior inferior ve anterior posterior kalınlığı, lateral sınırı ile linea trapezoidea orta noktası arası mesafe, impressio costoclavicularis maksimum uzunluğu, impressio costoclavicularis maksimum genişliği, fascies sternalis’in maksimum uzunluğu, fascies sternalis’in maksimum genişliği, fascies acromialis’in maksimum uzunluğu, fascies acromialis’in maksimum genişliği, konkav açı ölçülmüş ve ayrıca Robustness indeksi (dayanıklılık indeksi) hesaplanmıştır. Bulgular: Clavicula’nın; maksimum uzunluğu 136.19±13.41 mm; extremitas acromialis’in superior inferior kalınlığı 10.59±2.15 mm; extremitas acromialis’in anterior posterior kalınlığı 21.62±3.87 mm; lateral sınırı ile linea trapezoidea orta noktası arası mesafe 17.06±3.83 mm; impressio costoclavicularis maksimum uzunluğu 16.51±5.11 mm; impressio costoclavicularis maksimum genişliği 8.07±2.88 mm; fascies sternalis’in maksimum uzunluğu 16.58±3.22 mm; fascies sternalis’in maksimum genişliği 20.26±3.29 mm; fascies acromialis’in maksimum uzunluğu 9.10±2.55 mm; fascies acromialis’in maksimum genişliği 14.74±3.43 mm; konkav açı 139.43±8.25º; clavicula’nın orta noktasının çevresi 3.57±0.46 mm ölçülmüş ve ayrıca Robustness indeksi (dayanıklılık indeksi) 2.63±0.32 olarak hesaplanmıştır. Sonuç: Clavicula’nın anatomik yapısı ve morfometrik ölçümlerinin saptanması özellikle akut ayrışmış corpus clavicula kırıklarında ve claviculayı ilgilendiren diğer pek çok patolojilerde klinik açıdan önemlidir. Purpose: Clavicle is the bony link between upper extremity and the body. This study is undertaken to assess the anatomical structure of clavicle and to determine the morphometric measurements. Materials and Methods: Sixty-six clavicle of unknown gender of an Anatolian population (34 left- 32 right) are included. Maximum claviculer length, the perimeter of the midpoint, the superior inferior and anterior posterior thickness of extremitas acromialis, the distance between the lateral border of the clavicle and the midpoint of linea trapezoidea, maximum length and width of impressio costoclavicularis, maximum length and width of fascies sternalis, maximum lengt hand width of facies acromialis and concave angle are measured in addition the Robustness index (endurance index) is calculated. Results: Maximum claviculer length was 136.19±13.41 mm; superior inferior thickness of extremitas acromialis was 10.59±2.15 mm; and anterior posterior thickness of extremitas acromialis was 21.62±3.87 mm; the distance between the lateral border of the clavicle and the midpoint of linea trapezoidea was 17.06±3.83 mm; maximum length of impressio costoclavicularis was 16.51±5.11 mm; and maximum width of impressio costoclavicularis was 8.07±2.88 mm; maximum length of fascies sternalis was 16.58±3.22 mm; and maximum width of fascies sternalis was 20.26±3.29 mm maximum length of fascies acromialis was 9.10±2.55 mm; maximum width of fascies acromialis was 14.74±3.43 mm; concave angle was 139.43±8.25º; the perimeter of the midpoint of the clavicle was 3.57±0.46 mm and the Robustness index (endurance index) was calculated to be 2.63±0.32. Conclusion: Knowledge on the clavicular measurements may be essential for orthopaedic surgeons in acute displaced midshaft clavicle fractures and to choose a standart treatment modality in many other conditions.

Amaç: Juvenil idiyopatik inflamatuvar miyopatiler (JIIM) nadir görülen, kronik kas inflamasyonu ile seyreden, ciddi morbidite, mortalite ile sonuçlanan bir grup otoimmün hastalıktır. Çalışmamızda Çukurova Üniversitesi Tıp Fakültesi Çocuk Romatoloji Bilim Dalı tarafından JIIM tanısı ile izlenen hastaların klinik ve laboratuvar verilerinin, tedavi yanıtlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Eylül 2003 ile Haziran 2017 tarihleri arasında JIIM tanısı ile izlemde olan 15 hasta çalışmaya alındı. Demografik veriler, tanı ve takip laboratuvar verileri, EMG ve kas biyopsi sonuçları, uygulanan tedaviler, tedavi yanıtları ve hastalık komplikasyonları geriye dönük arşiv dosyalarından elde edildi. Bulgular: JIIM hastalarının kız erkek oranı 2.75:1 idi. Hastaların 13 tanesi (%80) Juvenil Dermatomiyozit (JDM), 2 tanesi (%13.3) Juvenil Polimiyozit (JPM) ve bir tanesi (%6.7) Overlap Miyozit (OM) tanısı ile izlemdeydi. Başlangıç bulguları heliotrop raş ve malar raş (%86.7), Gottron papülü (%73.3) ve proksimal kas güçsüzlüğü (%100) idi. Erken dönem kortikosteroid tedavisi tüm hastalara ve metotreksat tedavisi 13 hastaya (%86.7) başlandı. Ayrıca 3 hastaya (%20) siklosporin, bir hastaya (%6.7) siklofosfamid, bir hastaya (%6.7) mikofenolat mofetil ve 4 hastaya (%26.7) intravenöz immunglobulin (IVIg) kullanıldı. Sonuçta tüm hastalar remisyona ulaştı fakat hastalık komplikasyonu olarak 2 hastada kalsinozis, bir hastada lipodistrofi gelişti. Sonuç: JIIM’de erken tanı ve yoğun immünsupresif tedavi hastalık komplikasyonu gelişimini önlemede önemlidir. Bu nedenle uluslararası standart tedavi ve izlem programları hastalık süreci boyunca dikkate alınarak izlem yapılmalıdır., Purpose: Juvenile idiopathic inflammatory myopathies (JIIMs) are rare autoimmune diseases. Delay in treatment may cause serious morbidity and mortality. Aim of this study is to evaluate demographic and clinical features, laboratory data, treatment modalities and outcome of patients with JIIMs.Materials and Methods: 15 patients with JIIMs, followed between 2003 and 2017 at Pediatric Rheumatology Department were included this study. We retrospectively collected data from patients’ medical records and analyzed them. Results: Out of the 15 patients, 13 (80 %) had Juvenile Dermatomyositis (JDM), 2 (13.3%) Juvenile Polymyositis (JPM) and 1 (6.7 %) Overlap Myositis (OM, with scleroderma). Clinical symptoms at diagnosis were proximal muscle weakness (100%), heliotrope rash and malar rash (86.7%), Gottron papule (73.3%). Early aggressive treatment with corticosteroid (100%) and methotrexate (86.7%) were started. Intravenous immunoglobulin in 4 patients (26.7 %), cyclosporine in 3 patients (20 %), cyclophosphamide in one patient (6.7 %), and mycophenolate mofetil in one patient (6.7%) were among additional immunosuppressive treatments. Eventually all patients achieved remission but two had calcinosis and one had lipodystrophy.Conclusion: Early diagnosis and early aggressive treatment are the key points for JIIMs. For this reason, international standard treatment and follow-up programs should be taken into consideration during the disease process.

Amaç: Bu çalışmanın amacı; diyabetli ve sağlıklı bireylerin sosyal sorun çözme becerilerinin karşılaştırılması, diyabetli hastaların sosyal sorun çözme tarzlarının/yönelimlerinin yaşam kaliteleri ve HbA1c düzeyleri ile ilişkisinin incelenmesidir.Gereç ve Yöntem: Endokrinoloji Polikliniğine başvuran Tip 2 Diabetes Mellitus tanılı hastalardan dahil etme kriterlerini karşılayan 90 hasta ile benzer sosyodemografik özelliklerde 90 sağlıklı bireye sosyodemografik bilgi formu, Sosyal Sorun Çözme Envanteri Kısa Formu, Dünya Sağlık Örgütü Yaşam Kalitesi Anketi Kısa Formu uygulandı. Diyabet hastalarının son 3 ay içindeki HbA1c ölçüm değerleri kullanıldı. Glisemik kontrolde hedef değer HbA1c≤7 olarak belirlendi.Bulgular: Diyabet hastalarının işlevsel sorun çözme puanları sağlıklı bireylerden anlamlı olarak daha yüksek; yaşam kalitesinin bedensel ve çevresel alan puanları ise anlamlı olarak daha düşüktü. Kadın, çalışmayan, hastalığı ile ilgili eğitim almayan diyabet hastalarının işlevsel olmayan sorun çözme puanları anlamlı olarak daha yüksek bulundu. HbA1c değeri ≤7 olan diyabetlilerin soruna olumlu yaklaşım puanları daha yüksekti. Korelasyon analizlerinde diyabetlilerin işlevsel sorun çözme tarzları ile yaşam kalitesinin bedensel, ruhsal ve çevre alanı arasında pozitif yönde, HbA1c arasında ise negatif yönde ilişki saptandı.Sonuç: Diyabetli hastaların sosyal sorun çözme becerilerinin değerlendirilmesi, gereksinimleri doğrultusunda girişimlerde bulunulması yaşam kalitesinin ve klinik sonuçların iyileştirilmesine katkı sağlayabilir., Purpose: The aim of this study is to compare the social problem-solving skills of diabetic and healthy individuals and to investigate the correlation between the social problem-solving styles/orientations of diabetic patients with their quality of life and HbA1c levels.Materials and Methods: Social Problem-Solving Inventory Short Form and World Health Organization Quality of Life Survey Abbreviated Version were performed on ninety patients admitted to Endocrinology Outpatient Clinic diagnosed with Type 2 Diabetes Mellitus, who met the inclusion criteria, and on 90 healthy individuals with similar sociodemographic characteristics to the patients. HbA1c measurement values of the diabetic patients over the last 3 months were used. The target value in the glycemic control was determined as HbA1c≤7.Results: Functional problem-solving scores of diabetic patients were significantly higher than the healthy subjects; the physical and environmental domain scores of quality of life were significantly lower. The non-functional problem solving scores of the diabetic patients who were women, unemployed and uneducated about the disease were significantly higher. Diabetic patients with HbA1c value ≤7 had higher positive attitude scores. Correlation analyses revealed that the functional problem solving styles of diabetics have a positive correlation with the physical, mental and environmental domains of the quality of life, and a negative correlation with HbA1c.Conclusion: Evaluating social problem-solving skills of diabetic patients and initiating them according to their requirements may contribute to the improvement of the quality of life and clinical outcomes.

Amaç: Çalışmamızın amacı, EMG biofeedback’in hemiplejik omuzun yeniden eğitimi üzerindeki etkisinin değerlendirilmesidir. Gereç ve Yöntem: Çalışmaya toplam 30 hasta alındı. Hastaların tutulan tarafında yer alan üst trapezius kasına, omuz hareketleri sırasında, relaksasyon sağlamak amacıyla 10 seans EMG biofeedback eğitimi verildi. Hastaların, tedavi öncesi ve sonrasında; üst trapezius kasının myoelektrik aktivitesi ile tonusu, deltoideus kasının ise sadece tonusu ölçüldü. Omuzdaki fonksiyonel iyileşmeyi değerlendirmek için Manuel Fonksiyon Testi kullanıldı. Bulgular: Tedavi sonunda üst trapezius kasının tonusunda ve myoelektrik aktivitesinde azalma, deltoideus kasının tonusunda ise artma olduğu görüldü. MFT sonuçlarına göre, tedavi sonunda omuz fonksiyonelliğinde yüzdece anlamlı bir iyileşme olduğu tespit edildi. El fonksiyonlarında ise herhangi bir iyileşme olmadı. Sonuç: Çalışmamızda EMG biofeedback eğitiminin, hemiplejik hastalarda omuz fonksiyonlarının iyileştirilmesi üzerine etkili olduğu görüldü. Hemiplejik hastalarda, EMG biofeedback ile yapılan omuz egzersizlerinin kliniklerde kullanılmasıyla tedavide olumlu sonuçlar alınabileceği sonucuna varıldı. Purpose: The aim of our study was to evaluate the effect of EMG biofeedback on hemiplegic shoulder reeducation. Materials and Methods: A total of 30 patients were included in the study. 10 sessions of EMG biofeedback training was given to the upper trapezius muscle on the affected side of the patients during shoulder movements to provide relaxation. Patients were evaluated before and after treatment; the myoelectric activity and tone of the upper trapezius muscle, and only the tone of the deltoideus muscle. Manual Function Test was used to assess functional recovery of the shoulder. Results: At the end of the treatment, it was seen that there was a decrease in the tone of the upper trapezius muscle and myoelectric activity and an increase in the tone of the deltoideus muscle. According to MFT results, there was a significant improvement in the percentage of shoulder function at the end of treatment. There was no improvement in hand function. In our study, EMG biofeedback training was found to be effective in improving shoulder function in hemiplegic patients. Conclusion: Preliminary results in this study suggested that in hemiplegic patients, the use of EMG biofeedback with shoulder exercises in the clinic, resulted in favorable outcomes in the treatment.

Purpose: The aim of this study was to assess sleep characteristics and sleep disorders in bipolar euthymic patients who declared to have sleep problems when asked. Material and Methods: A total of 57 outpatients aged 18-65 who said “no” to “Are you generally satisfied with your sleep pattern? Have you been satisfied with your sleep pattern for last one year?” questions (at least one of them) and / or said “yes” to “Is there a problem with your sleep according to others’ observations” question and have been followed in Bipolar Disorder Unit of Department of Psychiatry, Cukurova University Medical School were included in the study. A data form for socio-demographic features and another form for clinical characteristics of bipolar disorder have been completed. The general features of sleep were investigated by General Sleep Questionnaire (GSQ). All patients completed Epworth Sleepiness Scale (ESS).Results: The patients had problems in initiation, maintenance and termination of sleep frequently and 43.9% of sample group reported to sleep more than 10 hours a day, 54.4% to snore and 1.8% to have sleep apnea. Sleep disturbances were seasonal in 36.8% of sample group and were commonly defined as secondary and psychogenic. Conclusion: Sleep disorders are frequently seen in euthymic bipolar patients, rarely result with hospital admissions and are frequently overlooked. Their negative effects on illness course, functionality and quality of life are well known. All patients with bipolar disorder should be examined in detail in terms of sleep habits, sleep structure and sleep disorders., Amaç: Bu çalışmada ötimik dönemde olup, sorulunca uyku sorunu bildiren hastalarda uykunun genel özellikleri ile görülen uyku bozukluklarının belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmaya Çukurova Üniversitesi Tıp Fakültesi Ruh Sağlığı ve Hastalıkları Anabilim Dalı Bipolar Bozukluk Birimi’ne ayaktan başvuran ve “Genel olarak uyku düzeninizden memnun musunuz? Son 1 yıldır uyku düzeninizden memnun muydunuz?” sorularından en az birine “hayır” ve / veya “Başkalarının gözlemine göre uykunuzda sorun var mı?” sorusuna “evet” yanıtı veren 18-65 yaş arası 57 hasta alındı.Sosyodemografik Veri Formu ve Bipolar Bozukluk Veri Formu dolduruldu. Genel Uyku Anketi (GUA) ile uykunun genel özellikleri ve uyku bozuklukları sorgulandı. Tüm hastalar Epworth Uykululuk Ölçeği (EUÖ)’ni doldurdu. Bulgular: Uykuyu başlatma, sürdürme ve sonlandırma evrelerinde sıklıkla sorun yaşadığı gözlenen hastaların %43.9’unun 10 saatten fazla uyuduğunu, %54.4’ünün horladığını, % 1.8’inin uyku apnesi yaşadığını bildirdiği gözlenmiştir. Hastaların %36.8’inin uyku sorunlarının mevsimsel özellik gösterdiği saptanmış, uyku sorunları çoğunlukla ikincil ve ruhsal kökenli olarak tanımlanmıştır. Sonuç: BPB’un ötimik dönemlerinde uyku bozuklukları oldukça sık görülen, tedavi için başvuru nedeni olmayan, gözden kaçan ve hastalık seyri, işlevsellik ve yaşam kalitesi üzerine etkileri iyi bilinen bozukluklar olup, BPB tanılı her hastanın uyku alışkanlıkları, yapısı ve bozuklukları açısından ayrıntılı olarak incelenmesi büyük önem taşımaktadır.

Dental implantların maksiller sinüs içine yer değiştirmesi nadir görülen bir komplikasyondur. İmplantların maksiller sinüse yer değiştirmesi genellikle hatalı cerrahi planlama veya yetersiz cerrahi teknik ile ilgilidir. Dental implantlar sıklıkla sinüslerde yabancı cisim reaksiyonlarına neden olur ve sinüs komplikasyonlarının gelişmesinden kaçınmak için çıkarılmalıdır. Bu komplikasyonları önleyebilmek için, preoperatif dikkatli klinik ve radyolojik değerlendirmeler ile anatomik oluşumlarla ilgili cerrahi öngörü doğru bir şekilde yapılmalı ve atravmatik çalışılmalıdır. Bu çalışmada, retrospektif vaka serisini sunarak, sinüste bulunan dental implantın biyouyumlu olmasına rağmen çıkarılma gerekliliği tartışıldı., Dental implant displacement into the maxillary sinus is a rare complication. Maxillary sinus displacement of the implants is often associated with incorrect surgical planning or inadequate surgical technique. Dental implants often result in foreign body reactions in the sinuses and should be removed in order to avoid the development of sinus complications. A careful preoperative clinical and radiological evaluations and surgical foresight regarding anatomical formations should be done correctly and atraumatic technique should be performed in order to prevent these complications. In this study, a retrospective case series was presented to discuss the necessity of removing the sinus dental implant even if it is biocompatible.

Amaç: Bu çalışmada çocuklarda hematolojik hastalıklar nedeniyle yapılan splenektominin faydasını ve endikasyonlarının araştırılması amaçlanmıştır. Gereç ve Yöntem: Hastanemizde 2009-2015 yılları arasında, 0-17 yaş aralığında, herhangi bir sebepten dolayı splenektomi yapılmış hastalar araştırıldı. Hastalarının yaşı, cinsiyeti, tanıları, postsplenektomi enfeksiyon olup olmadığı, portal venoz tromboz (PVT) olup olmadığı, ameliyat tipi, preoperatif ve postoperatif beyaz küre sayısı, hemotokrit ve trombosit sayısı, eşzamanlı kolesistektomi, dalak boyutu ve ameliyattan fayda görüp görmediği retrospektif olarak incelendi. Bulgular: Hastaların (n=58) yaş ortancası 8’di. %41’i kız, %59 ‘u erkekti. Dört hastada splenektomi sonrası PVT gelişti. Hastaların 8’ine laparoskopik splenektomi yapıldı. 2 hasta ise ameliyata laparoskopik başlanmış ancak kanama sebebiyle açığa dönülmüştür. On dört hastaya eş zamanlı kolesistektomi yapıldı. En çok orak hücreli anemi (n=20 %34.5) ,daha sonra talasemi major ( n=17 %29,3) ve immün trombositopenik purpura (n=6 %10,3) tanılarıyla splenektomi yapıldı. Dokuz (%15) hasta splenektomi sonrası enfeksiyon nedeniyle hastanemize yatışı yapıldı. Hastaların 17 ‘sinde splenektomiden fayda görüp görmediği veri yetersizliğinden dolayı değerlendirilemedi. Değerlendirilen hastaların %85’i (n=35) splenektomiden fayda gördü. 4 hasta eksitus olmuştur. Talasemi major ve immün trombositopenik purpura olan birer hasta splenektomiden fayda görmedi. Orak hücreli anemi olan hastaların hepsi splenektomiden fayda gördü. Sonuç: Splenektomi, hala birçok hematolojik hastalığın tedavisi için kullanılan etkili cerrahi bir işlemdir. Trombosit sayısını yükseltmek için yapılan ameliyatlarda hastanın yaşı, azda olsa önemlidir. Purpose:. We aimed to research benefits and indications of splenectomy operation due to hematological disease in children. Materials and Methods: The children who underwent to splenectomy due to hematological diseases between 2009-2015 were included in this study. Age of patients, sex, diagnosis, post splenectomy infection, portal vein thrombosis (PVT), operation types, pre and post operative thrombocyte, leucocyte and hematocrit counts, simultaneous cholecystectomy, spleen size, the efficacy of operation were noted retrospectively. Results: Median age of the patients (n=58) was 8. 41% of them were girl and 51% were boy. PVT occurred in 4 patients after splenectomy. 8 of them underwent splenectomy laparoscopically. 2 had conversion due to uncontrolled bleeding. 14 patients underwent cholecystectomy simultaneously. Diagnosis were sickle cell anemia (SCA) (n=20, 34.5%), thalassemia major (n=17, 29.3%) and immune thrombocytopenic purpura (ITP) (n=6, 10.3%). 9 (15%) patients were hospitalized because of post splenectomy infections. Efficacy of splenectomy was not evaluated in 17 patients due to data lack. Efficacy of splenectomy was 85% in evaluated patients. 4 patients were death. One each of thalassemia major and ITP patients had no benefit and all of SCA patients had benefited from splenectomy. Conclusion: Splenectomy is still efficient operation procedure for many hematologic diseases. Age of patients is also important in respect of increasing thrombocyte counts

Karaciğerde görülen en sık benign neoplazm hemanjiyomdur. Genellikle asemptomatik olup ender olarak komplikasyon oluşturabilir. Karaciğer ve senkron organ tutulumu görülebilir. Genellikle medikal takip edilir. Semptomatik, hızlı büyüme gösterir ve tanı kesin değilse cerrahi tedavi uygulanmalıdır. Bu yazıda karaciğer ve diaframda aynı dönemde görülen senkron hemanjiyomu olan bir olgu sunulmuştur. The most common benign neoplasm seen in the liver is haemangioma. It is usually asymptomatic and rarely causes complications. Liver and synchronous organ involvement can be seen. It is usually followed by medical. If symptomatic, rapid growth and diagnosis is uncertain, surgical treatment should be performed. In this article, a case who presented with synchronous haemangima on liver and diaphragma has been reported.

Pneumomediastinum is due to air penetration in to the mediastinum. In children it is mostly due to asthma, however in newborns pneumonia or meconium aspiration syndrome are the predisposing factors. Pneumomediastinum is recognised by chest radiography, in newborn babies -spinnaker sign- an upwards and outwards deviation of thymic lobes can be seen due to raising of thymus above the heart by pneumomediastinal air. Babies may be asymptomatic or they may have respiratory distress. Pneumomediastinum usually resorbs spontaneously over one or two weeks. Here we report two newborn babies with pneumomediastinum. Although pneumomediastinum was obvious in the chest X-rays, both babies had mild respiratory distress and mediastinal air resorbed spontaneously., Pnömomediastinum mediastene hava girişi ile oluşmaktadır. Çocuklarda genellikle astıma bağlıdır, ancak yenidoğanlarda pnömoni veya mekonyum aspirasyon sendromu predispozan faktörlerdir. Pnömomediastinum tanısı genellikle akciğer grafisi ile konur, yenidoğan bebeklerde pnömomediastinal hava ile kalbin üstündeki timik lopların yukarı ve dışa doğru sapmasıyla timusun yükseldiği yelken işareti görülür. Bebekler asemptomatik olabildiği gibi solunum sıkıntısına da neden olabilir. Pnömomediastinum genellikle bir veya iki haftada kendiliğinden resorbe olur. Burada pnömomediastinumlu iki yenidoğan bebek sunulmuştur. Her iki bebeğin göğüs filminde belirgin pnömomediastinum olmasına rağmen, solunum sıkıntısı orta düzeyde idi ve mediastinal hava spontan resorbe oldu.

Amaç: Bu prospektif ve randomize çalışma, elektif cerrahi geçirecek 65 yaş ve üzeri ASA II-III hastalarda, sevofluran ve desfluran anestezisinde tek doz uygulanacak esmololün hemodinamik değişiklikler, entübasyona bağlı Bispektral indeks (BIS) değişiklikleri ve derlenme üzerine etkilerini karşılaştırmayı amaçlamaktadır. Gereç ve Yöntem: 65 yaş üzeri ASA II-III elektif cerrahi geçirecek 80 hasta 4 gruba ayrıldı. Tüm hastalara standart monitörizasyon ve BIS monitörizasyonu uygulandıktan sonra Grup I deki hastalara sevofluran ve intravenöz(IV) salin, Grup II deki hastalara desfluran ve IV salin, Grup III deki hastalara sevofluran ve tek doz esmolol (1 mg kg- 1), Grup IV deki hastalara desfluran ve tek doz esmolol (1 mg kg-1) uygulandı. Hastaların indüksiyon ajan uygulanması sonrası, esmolol uygulanması sonrası, kas gevşetici uygulanması sonrası, entübasyon esnasında, entübasyon sonrası oksijen saturasyonu, sistolik kan basıncı, diyastolik kan basıncı, kalp atım hızı ve bispektral indeks değerleri kaydedildi. Bulgular: Tek doz esmolol uygulamasının sevofluran ve desfluran anestezisinde endotrakeal entübasyona bağlı BIS değerlerindeki artışı engellediği görüldü. Gruplar karşılaştırıldığında esmolol uygulanan gruplarda ekstübasyon, göz açma ve derlenme süreleri daha kısa bulundu. Sonuç: İleri yaş grubu hastalarda desfluran ve sevofluran anestezisinde tek doz uygulanan esmolol trakeal entübasyona yanıt olarak gelişen sempatik deşarjı ve BİS değerlerindeki artışı baskılamaktadır. Purpose: In this prospective, randomized study, we aimed to compare the effects of single dose of esmolol on haemodynamic, bispectral index (BIS) changes related to intubation and recovery at sevoflurane and desflurane anaesthesia in 65 years and older patients who scheduled for elective surgery Material and Methods: Eighty ASA II-III patients who undergo elective surgery were divided 4 groups. After standart and Bispectral monitoring to all patients, the first group received sevoflurane and salin,e second group received desflurane and salin. The patients in Group III received sevoflurane and single dose of esmolol(1 mg kg- 1) and group IV received desflurane and single dose of esmolol(1 mg kg-1). While given induction drugs, neuromuscular blockers, during intubation and at 30 second, first minute and 5. minutes of intubation, oxygen saturation, systolic and diastolic blood pressure, heart rate, BIS values were recorded. Results: Single dose of esmolol administration during sevoflurane and desflurane anaesthesia was found to inhibit the increase of BIS values due to endotracheal intubation. When the groups compared, extubation, eyeopening and recovery time were significantly shorter in the groups which applied esmolol. Conclusion: In elderly patients, single dose esmolol administration in desflurane and sevoflurane anesthesia significantly inhibits sympathetic decharge and BIS value increases due to tracheal intubation.

Purpose: We aimed to analyze the findings of our pediatric patients who underwent flexible fiberoptic bronchoscopy (FFB) due to respiratory problems retrospectively.Materials and Methods: The medical records of all children who underwent FFB procedure at Mersin Women and Children’s Hospital Pediatric Pulmonology Section between 2014-2016 were included in the study.Results: A total of 241 patients aged between 3 months and 16 years were evaluated. The patients were divided into two groups according to their age (, Amaç: Pediatrik yaş grubunda solunum problemleri nedeniyle fleksibl fiberoptik bronkoskopi (FFB) yapılan hastaların bulgularının geriye dönük analizi hedeflenmiştir.Gereç ve Yöntem: 2014-2016 tarihleri arasında, Mersin Kadın Doğum ve Çocuk Hastanesi Çocuk Göğüs Hastalıkları kliniğinde FFB uygulanan tüm çocuk hastalar çalışmaya dahil edilmiştir.Bulgular: Yaşları üç ay ile 16 yıl arasında değişen toplam 241 hastanın verileri değerlendirilmiştir. Hastalar

Amaç: Sağlık çalışanlarının 18 yaş altı evlilik-gebelik olgularını adli bildirim yükümlülüğü konusunda çeşitli kaygılar ve çelişkiler yaşanabilmektedir. Çalışmamızda sağlık çalışanlarının bu konudaki, farkındalık düzeylerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Aile hekimleri ve aile sağlığı elemanlarından oluşan bir gruba 18 yaş altı evlilik ve gebeliklerin yaygınlığı, nedenleri, sonuçları ve adli bildirim zorunluluğu hakkında bir sunum yapıldı. Tarafımızca hazırlanan anket katılımcılara dağıtıldı ve sunum öncesi ve sonrasında gönüllülerden doldurmaları istendi. Bulgular: On sekiz yaş altı gebelik tespit ettiğinde bildirmeyeceğini belirtenlerin oranı ön testte %75.9 (n=66) iken bu oran son testte %19.4’e (n=12) düşmüştü. On sekiz yaş altı hem evlilik hem de gebelik için tespit ettiğinde bildireceği yönünde görüş bildiren katılımcı sayısı ön testte 21 (%24.1) iken son testte bu sayı 50’ye (%80.6) yükselmişti. On sekiz yaş altı gebelik tespit ettiğinde adli bildirim yapmayacağı yönünde görüş bildiren katılımcıların tümü (n=68) 18 yaş altı evlilik izni verme yetkisi kendilerinde olsaydı buna izin vermeyecekleri yönünde görüş bildirdi. Ön testte 18 yaş altı evlilik tespit ettiğinde bildireceğini ifade eden katılımcıların %98.4’ü (n=60) son testte de aynı fikirde iken, ön testte bildirmeyeceğini belirten katılımcılardan 5’i (%50) son testte bildireceği yönünde görüş değiştirmişti. Sonuç: Katılımcılar arasında 18 yaş altı evlilik ve gebeliğin adli bildirimi konusunda bir çelişki olduğu açıktır. On sekiz yaş altında gebelik varlığı katılımcılarından bildirimden kaçınmasına neden oluyor gibi görünmektedir. Sağlık çalışanlarına yönelik çocuk yaşta evlilik/gebelik konusunda yapılan kısa bir sunumun dahi konuyla ilgili anlamlı düzeyde farkındalık yaratmasının yanı sıra, adli bildirim konusunda da hassasiyet oluşturması beklenmektedir. Purpose: There may be some worries and discrepancies about of notification obligation for child marriage, child pregnancy. In this study, we aimed to determine the level of awareness of health workers about child marriage, child pregnancy and obligation of judicial notification. Material and Methods: We performed training for family doctors and nurses about child marriage, child pregnancy and judicial notification. Participants completed a questionnaire, which was prepared by authors, before and after the training. Results: While proportion of participants indicating they would not make judicial notification for child pregnancy was 75.9% (n=66) in the pre-test, it was 19.4% (n=12) in the post-test. The number of participants indicating they would make notification for both child pregnancy and marriage was 21 (24.1%) in the pre-test, 50 (80.6%) in the post-test. All participants indicating they would not make judicial notification for pregnancy (n=68), declared that they would not give permission to marry under age 18 if they had authority. 98.4% (n=60) of participants declared that they would make judicial notification for child marriage in the pre- and post-tests, although 50% (n=5) participants indicating they would not make notification in the pre-test, changed their opinion to make notification in the post-test. Conclusion: There is a discrepancy about judicial notification of child marriage and child pregnancy among participants. It seems like the presence of pregnancy lead to avoidance of judicial notification. To make a brief presentation about child marriage/pregnancy for health workers, can raise great awareness about this topic and can create sensitivity about notification.

Jarcho-Levin sendromu vertebra deformitelerin olduğu ve sinir sistemi, kardiyak, üriner ve gastrointestinal sistemi ilgilendiren birçok anomalinin de eşlik edebildiği bir sendromdur. İnsidansı 2.5/100.000 olup meningomiyelosel ve hidrosefali bu olguların dörtte birine eşlik eder. Hastalar genellikle solunum yetmezliği ile kaybedilirler. Bu yazıda meningomiyelosel ve hidrosefalisi olan ve opere edilen iki spondilotorasik tip Jarcho-Levin olgusu sunulmuştur. Jarcho-Levin syndrome is associated with vertebra, central nervous system, cardiac, urinary and gastrointestinal system abnormalities. Incidence is 2.5/100000 and meningomyelocel and hydrocephalus is rare, in about 1/4 of the Jarcho-Levin cases. Patients die due to respiratory insufficiency. Here we present two cases of Jarcho-Levin syndrome operated for meningomyelocele and hydrocephalus.

Amaç: Bu çalışmanın amacı, farklı çözücü buharlaşma stratejilerinin fiber postların kök kanal dentinine bağlanma dayanımına etkisini değerlendirmektir. Gereç ve Yöntem: Otuz adet çekilmiş insan üst santral kesici dişlerin kök kanalları TF Adaptive eğe sistemi (SybronEndo, CA, ABD) kullanılarak genişletildi. Kök kanal dolgusu yapıldıktan sonra post boşlukları 8 mm derinliğinde hazırlandı. Adeziv sistemi (ED Primer A + ED Primer B; Kuraray, Tokyo, Japonya) uygulamasının ardından örnekler rastgele iki gruba ayrıldı. Grup 1 (APA Grubu): 10 sn hava ile kurutmayı takiben kâğıt kon ile kurutma yapıldı, sonrasında ek olarak 10 sn daha hava uygulandı. Grup 2 (EV Grubu): 10 sn hava kurutmayı takiben EndoVac (Discus Dental, CA, ABD) ile 40 sn apikal negatif basınç ile kurutma yapıldı ardından da ek olarak 10 sn daha hava uygulandı. Fiber postlar (E Hahnenkratt GmbH) rezin siman ile yapıştırıldıktan sonra 40 sn boyunca her yönden ışınlandı. Bütün örnekler 48 saat boyunca %95 nemlilikte 37 °C'de saklandı. Daha sonar Push-out testi uygulandı. Bulgular: Fiber postların kök kanal dentinine bağlanma dayanım değerleri koronal ve apikal kısımda istatistiksel olarak anlamlı bir farklılık göstermemiştir. Ancak, orta üçlüde APA grubu EV grubuna göre istatistiksel olarak daha yüksek bağlanma dayanımı göstermiştir. Sonuç: EndoVac uygulanarak yapılan çözücü buharlaştırma yönteminin fiber postların kök kanal dentinine bağlanma dayanımına olumlu bir etkisi olmamıştır. Purpose: The aim of this study was to evaluate the efficacy of different solvent removal strategies on the push-out bond strength of fiber posts to root canal dentin. Materials and Methods: Root canals of 30 extracted maxillary human central incisors were enlarged with TF Adaptive file system (SybronEndo, CA, USA). After root canal obturation, post spaces were prepared to a depth of 8 mm. T h e n , the adhesive system (ED Primer A + ED Primer B, Kuraray, Tokyo, Japan) application, specimens were randomly assigned into two solvent evaporation strategies as follows APA: 10 s air-blowing, followed by insertion of 60 size absorbent paper point, followed by 10 s additional airblowing, EV: 10 s air-blowing, followed by 40 sec apical negative pressure by Endo-Vac (Discus Dental, CA, USA) followed by 10 s additional air-blowing. Resin fiber posts (E Hahnenkratt GmbH) were luted with resin cement (Panavia F 2.0, Kuraray) and then light-cured for 40 s from all directions. All specimens were then stored at 95% humidity for 48-h at 37°C. Then push-out test has been conducted.. Results: In comparison of groups there were no statistically significant differences on the push-out bond strength values of fiber post to root canal dentine in the coronal and apical out bond strength values than EV group. Conclusion: Evaporation strategy of self-etch adesive with EndoVac had no positive effect on the bond strength of fiber post to root canal dentin.

omuz ağrısı bulunan inmeli hastalarda proloterapi uygulamasının ağrı ve omuz eklem hareket açıklığı üzerine etkisini araştırmak. Gereç ve Yöntem: En az 6 ay önce inme geçirmiş hemiplejik omuz ağrısına yönelik proloterapi uygulanan 10 hastanın (ortalama yaş, 64.2±11.6 yıl) verileri retrospektif olarak toplandı. Tedavide rotator manşon tendonuna yönelik 3 seans dekstroz proloterapi enjeksiyonu içermekteydi. Hastaların tedavi öncesi ve tedavi bitiminden iki hafta sonraki vizüel analog skala omuz ağrısı skorları ve omuz eklem hareket açıklıkları değerlendirildi. Bulgular: Hastaların proloterapi öncesi vizüel analog skala omuz ağrısı değerleri (8.2±1.1 cm) proloterapi sonrası kontrolde (4.8±1.9 cm) istatistiksel olarak anlamlı derecede azaldı. Omuz fleksiyonu ve abduksiyonu derecelerinde tedavi sonrası görülen artış istatistiksel olarak anlamlı bulundu.. Sonuç: Bu pilot çalışmada elde edilen ilk bulgular hemiplejik omuz ağrısı tedavisinde proloterapinin faydalı etkisi olduğunu önermektedir. Purpose: To investigate the effect of prolotherapy on pain and shoulder range of motion in stroke patients with hemiplegic shoulder pain due to rotator cuff tendinopathy. Material and Methods: The data of 10 patients (mean age, 64.2±11.6 years) who had a history stroke of more than six months and underwent prolotherapy treatment were collected retrospectively. The treatment included 3 sessions of dextrose prolotherapy injections applied to rotator cuff tendon. Visual analogue scale pain scores and shoulder range of motions measured at baseline and two weeks later after end of the treatment were assessed. Results: Visual analogue scale shoulder pain scores of the patients decreased from 8.2±1.1 at baseline to 4.8±1.9 after prolotherapy. The degrees of shoulder flexion and abduction increased significantly after the treatment . Conclusion: Preliminary results in this pilot study suggested the beneficial effect of proloterapi in the treatment of hemiplegic shoulder pain.

Mushroom poisoning has an important place in thepoisonings applied to emergency department (ED).Patients may present with different toxoids according tothe fungus and toxin fecalin. Pantherina syndrome is atablature that can interfere with cerebrovascular diseasesdue to clinical presentation. Three patients from thesame family were admitted to our ED with newlydeveloped symptoms of confusion, aphasia andmydriasis. When the first patient was evaluated, thediagnosis of hypertensive encephalopathy was firstconsidered with the current symptoms. However, afterthe application of the second and third patients withsimilar symptoms, the anamnesis was deepened and thestory of eating a mushroom was questioned. Patients aretreated in the emergency ICU. Two patients recoveredwithin 24 hours, and the symptoms of one patientcontinued for up to 72 hours. Pantherina syndrome is atoxicoma characterized by early onset, confusion,neurological symptoms such as aphasia and mydriasis.Treatment is generally supportive treatment. Stomachlavage and activated charcoal will be useful in the earlyperiod. Benzodiazepines can be used in extremeagitation. Pantherina syndrome is one of the diagnosesthat clinicians should actually have in patients presentingwith an acute confusional condition. Mantar zehirlenmeleri günlük acil servis pratikuygulamasında zehirlenmeler içinde önemli bir yeresahiptir. Hastalar mantara ve toksinin türüne göre farklıklinik tablolar ile hastaneye başvurabilirler. Pantherinasendromu, serebrovasküler hastalıklarla k arışabilen birklinik tablodur. Aynı aileden üç hasta, yeni gelişen bilinçbulanıklığı, afazi ve midriyazis belirtileri ile acil servisebaşvurdu. İlk hasta değerlendirildiğinde, mevcutsemptomlarla birlikte hipertansif ensefalopati tanısıkonuldu. Bununla birlikte, benzer semptomlara sahipikinci ve üçüncü hastada anamnezin derinleştirilmesi ilemantar yemekten kuşkulanıldı. Hastalar acil yoğun bakımünitesinde tedavi edildi. İki hasta 24 saat içinde düzeldive bir hastanın semptomları 72 saate kadar devam etti.Pantherina sendromu erken başlangıçlı, konfüzyon, afazive midriyaz gibi nörolojik semptomlarla karakterize birklinik durumdur. Tedavi genellikle destek tedavisidir.Mide yıkama ve aktif kömür erken dönemde faydalıolacaktır. Benzodiazepinler aşırı ajitasyon durumundakullanılabilir. Pantherina sendromu, akut konfüzyonel birdurumla başvuran hastalarda klinisyenlerin düşünmesigereken tanılardan biridir.

Aim: Thyroidal incidentalomas (Tis) detected by F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18FDG PET/CT) may be associated with three different causes that include metastasis of another malignancy, primary thyroid gland malignancies and lastly benign thyroidal nodules, all require different clinical approaches. For appropriate treatment, quick characterization of the Ti is important, preferably with a lesser invasive method. Our aim was to determine whether the characterization of TIs can be performed with FDG-PET/CT, due to contribute faster diagnosis, and initiation of the therapy.Material and Methods: Forty-four patients with detected TIs in FDG-PET/CT were included in the study. The relationship between metabolically/morphological parameters and pathology results were evaluated statistically. If two subsequent cytology were negative, nodule accepted as benign. If cytology result was suspected or malignant, histopathological confirmation was made. For these patients, histopathological results were accepted as definite diagnosis. Results: Malignant thyroidal pathologies were detected in 29.5% of patients. We could not find any significant relationship between age, nodule size and SUVmax value and pathology results. According to ROC analysis, there were not any cut-off value for nodule size and SUVmax. Similar results were also obtained for papillary carcinoma as a special subgroup.Conclusion: Characterisation of TIs could not be performed by using age, nodule size and SUVmax. Therefore, TIs which detected by FDG-PET/CT should be examined pathologically due to high risk of malignancy.Keywords: Thyroidal incidentalomas; FDG-PET/CT; malignant; characterization.

Aim: The aim was to analyze the outcome of pediatric Hodgkin lymphoma patients treated with doxorubicin, bleomycin, vinblastine,and dacarbazine (ABVD) chemotherapy adjuvant radiotherapy according to the risk groups and determine the adverse prognosticfactors affecting survival in Hodgkin lymphoma.Material and Methods: A retrospective study was performed on 52 pediatric patients with Hodgkin lymphoma who were treated withABVD between 1997 and 2018. Patients with early-stage favorable disease received 4 cycles of ABVD radiotherapy. Early-stageunfavorable and advanced-stage patients received 6 cycles of ABVD radiotherapy.Results: Thirty (57.7%) boys and 22 (42.3%) girls were included in the study. The median age of the patients was 9 years and 3months (1 year and 10 month – 17 years and 7 months). Overall survival rate was 94.2% and the mean survival time was 19.50.70(95% CI, 18.1 - 20.9) years. The mean event-free survival time was 9.56.5 years. Overall survival rate was 90%, and the meanevent-free survival time was 8.26.1 years in early-stage favorable disease. Overall survival rate was 100%, and the mean eventfreesurvival time was 1.97.0 years in early-stage unfavorable disease. Overall survival rate was 94.1 %, and the mean event-freesurvival time was 8.96.3 years in advanced-stage disease. Presence of bulky disease, nodular sclerosing histologic subtype andleukocytosis had a negative prognostic effect on relapse and bulky disease had adverse effect on overall survival (p0.05).Conclusion: Four courses of ABVD chemotherapy radiotherapy (IFRT or ISRT) in early-stage favorable patients and 6 courses ofABVD chemotherapy radiotherapy (IFRT or ISRT) in both early-stage unfavorable and advanced-stage Hodgkin lymphoma patientsbenefited from promising outcomes in terms of OS and FFS.Presence of bulky disease, nodular sclerosing histologic subtype and leukocytosis have adverse prognostic effects on relapse andpresence of bulky disease have adverse effect on OS.

Aim: Cutaneous lupus erythematosus (CLE) has a multifactorial pathogenesis involving genetic and environmental triggers and congenital and acquired immune response. The aim of this study was to investigate the effects of Glutathione S-Transferases (GST) isoenzymes including GSTT1, GSTM1, and GSTP1 in the CLE patients with an etiology of solar radiation exposure. Material and Methods: Paraffin-embedded skin biopsy sections from the patients were stained by immunohistochemical methods. The results were evaluated under a light microscope by a pathologist. The pattern, localization, and distribution of the immunohistochemical staining were recorded for each patient. Staining of the nucleus or cytoplasm was considered as positive staining. The accuracy of staining was determined based on the intensity and percentage of staining. Results: No significant difference was found between the patient and control groups regarding staining intensity. In terms of staining percentage, the prevalence of GSTP1-3 genotype was significantly lower in the patient group compared to the control group (25% vs. 63.33%) (p=0.002). Conclusion: No significant difference was observed in the staining intensity of GSTP1, GSTT1, and GSTM1 between the patient and control groups and the staining percentage in some genotypes was even higher in the control group compared to the patient group.

Aim: Endometrial polyps are frequently associated with abnormal uterine bleeding. The kispeptin family is one of the peptides that play a role in reproductive functions and whose expression varies in various uterine pathologies. The aim of the study was to determine the relationship between serum Kisspeptin levels and endometrial polyps in women with premenopausal status.Material and Methods: The blood was collected prior to endometrial sampling from women admitted to the hospital due to abnormal uterine bleeding. According to the pathology results, patients were identified as polyp group (n=38) (endometrial polyps) and control group (n=50) (normal endometrial findings). Kisspeptin-54 levels were determined by ELISA method from serum obtained from venous blood. Results: There were no difference was found between the patients’ age, body mass index, gravida, para, abortus and the number of living children were compared (p>0.05). There was no statistically significant difference between the groups in terms of follicle stimulating hormone, luteinizing hormone and thyroid stimulating hormone values (p>0.05). Plasma kisspeptin (1.84±0.93 ng/dL and 1.32±0.47 ng/dL, p= 0.008) and estradiol (90.34±13.02 pg/mL and 81.75±12.36 pg/mL, p=0.002) levels were significantly higher in the polyp group than in the control group. After the Receiver Operating Characteristic (ROC) analysis the area under the curve (AUC) was 1.26 (p= 0.08), (95% CI, 0.550-0.782). The sensitivity value was 0.684 (0.512-0.819), the specificity was 0.620 (0.471-0.750).Conclusion: The serum Kisspeptin-54 and estradiol levels were found higher in patients with endometrial polyps.Keywords: Abnormal uterine bleeding; endometrial polyps; kisspeptin.

Aim: Alopecia areata is an auto-immune skin disease characterized by non-scarring hair loss. Nail changes are strongly associatedwith prognosis. In patients with Alopecia areata, the nail examination should not be neglected for an optimal follow-up.Material and Methods: A retrospective study involving 207 patients with Alopecia areata was undertaken in a tertiary hospitalbetween April 2016 and May 2017. Patients whose nail changes were registered in the database were included in the study. Gender,age, disease severity, sites affected, and nail changes of those patients were noted.Results: 114 patients (55%) had nail involvement. The most common nail finding was leukonychia (n 84). Nail pitting was detectedin 29 patients.11 patients had both leukonychia and nail pitting. The mean age of the patients with leukonychia was 23.3, while themean age of nail pitting patients was 31.7 and the mean age of the patients without nail change was 34.1.Conclusion: Leukonychia is the most common nail change in this study, as a different finding from all previous studies

Aim: We aimed to determine whether Neutrophil-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), Platelet-to-Lymphocyte Ratio (PLR), D-dimer, and troponin values were correlated with the simplified Pulmonary Embolism Severity Index (sPESI) in patients diagnosed as having Pulmonary Embolism (PE) in the emergency room. Material and Methods: Forty-three patients diagnosed as having PE in the emergency departmentwere divided into low and high-risk groups according to the sPESI. We investigated whether NLR, MLR, and PLR, d-dimer, troponin-I, and Pulmonary Artery Pressure (PAP) had any effect in determining the severity of PE. Also, patients were divided into groups as those with PAP ≤20 or >20 mm Hg, Systolic Blood Pressure (SBP) ≤100 or >100 mm Hg, and those receiving or not receiving thrombolytic treatment, and compared. Results: There was a statistically significant difference between patients with low sPESI (n=10) and those with high sPESI (n=33) in terms of age (p=0.001), pulse (p=0.016), oxygen saturation (p=0.039), troponin-I (p=0.029) and PAP (p=0.032), but there was no difference between the groups in terms of NLR (p=0.796), MLR (p=0.656), PLR (p=0.863), and d-dimer (p=0.343). There was a statistically significant difference between patients who did (n=6) and did not (n=37) receive thrombolytic treatment in terms of troponin-I (p=0.012), but there was no difference between the groups in terms of NLR (p=0.861), MLR (p=0.335), and PLR (p=0.277). Conclusion: NLR, MLR, PLR and d-dimer levels were found not to be effective in determining the severity of PE. Troponin-I was associated with sPESI and was considered as an effective marker in determining the thrombolytic treatment.

Aim: This study was planned to determine cut-off values of the Tinetti Performance Oriented Mobility Assessment (POMA) and the Self-Assessment Fall Risk Questionnaire (FRQ) in older adults with mild cognitive impairment.Material and Methods: This study included a total of 213 individuals aged 65 years and over in the study. These individuals were divided into two groups according to Mini Mental Test (MMT) scores: 116 individuals with an MMT score of 18-23 (mild cognitive impairment) and 97 individuals with an MMT score of 24 or more (normal cognitive function). Balance and gait performance was assessed by the POMA, the fall risk self-assessment by older adult susing a FRQ.Results: In Older Adults with mild cognitive function, the clinical cut-off points for the POMA and FRQ were determined according to ROC curve analysis. The clinical cut-off point for the POMA was determined as 15.5 points; and 15.5 points or more in the POMA were considered normal with a 95% confidence level. The clinical cut-off point for the FRQ was determined as 4.5 points; and 4.5 points or less in the FRQ were considered normal with a 95% confidence level.Conclusions: We think that it is important to take the values obtained in the present study into account in interpreting the above-mentioned commonly used tests when cognitive status is considered related to falling. Therefore, it is suggested that these tests used in the clinic should be examined considering the risk of falling in older adults with mild cognitive function.

Aim: The aim of this study was to investigate the relationship and difference between balance, physical fitness and the quality of lifein retired people living in different geographical regions of Turkey.Material and Methods: For balance evaluation Berg Balance Scale, for physical fitness evaluation Senior Fitness Test (Chair StandTest, Arm Curl Test, 2-Minute Step Test, Chair Sit-and-Reach Test, Back Scratch Test and 8-foot Up-and-Go Test) for quality of lifeevaluation Short Form (36) Health Survey were administered to 155 retired individuals from seven geographical regions of Turkey(Antalya, Gaziantep, Elazığ, Eskişehir, İstanbul, İzmir, Samsun) For statistical analysis, one-way analysis of variance and Spearman’scorrelation analysis were used.Results: A total of 155 individuals aged between 55 and over were included in the study. The mean age of the individuals was64.235.86 years. The results of Berg Balance Scale showed statistically significant differences (p0.05) both between balancescore and 8-foot Up-and-Go Test scores in Eskişehir and between the balance score and the results of the Arm Curl Test in Antalya(p0.05). There were no significant differences between regions in the results of the SF-36 assessment of quality of life. A significantpositive correlation between Berg Balance Scale score and the scores of Chair Stand, Arm Curl and 2-Minute Step Tests was recorded.Furthermore, Berg Balance Score and 8-foot Up-and-Go score were found to present a negative correlation.Conclusion: Aging and differences between geographic regions in which individuals live cause deterioration in balance and thissituation effects physical fitness. Although participants had different lifestyles, the fact that our evaluation indicated a lack ofdifference in the quality of life assessment results was pleasing.

Aim: An increase in the elderly population owing to an extended average life expectancy leads to an increase in the geriatric patient admissions to the emergency departments (EDs). The aim of this study was to investigate the intensity of geriatric patients among all admissions to the emergency department and to determine the importance of these patients in hospitalizations from the EDs.Material and Methods: Geriatric patients aged over 65 years were retrospectively evaluated between 1 January 2017and 31 December 2018. The patients were divided into two groups by the age: 65–79 (group I) and ≥80 years (group II). The number of days of hospitalization and mortality in the intensive care units (ICUs) and clinics were examined.Results: Of 386.670 patients aged over 18 years who were admitted to the ED, 17% (n=65.907) were aged ≥65 years. 64.4% of the patients who were hospitalized in the ICU from the ED were aged ≥65 years. The sex distribution of the patients who were admitted to but died in the ED in both the groups was as follows: Of 62.1% (n=72) in Group II were females, and of 62.1% (n=82) in Group I were males.Conclusion: In parallel with the increase in the number of geriatric patients in ED, there is a crowding in both clinics and ICUs. This article highlights the importance of geriatric patients in emergency department admissions and their importance in hospitalizations. Hospitalization and mortality rates increase with age. Keywords: Emergency department; crowding; geriatric patients.

Aim: Congenital heart disease (CHD) is one of the most common congenital anomalies. It is known that early detection of the criticallesions without symtomatic improves the prognosis of patients in the long term. In our study, we aimed to evaluate the efficacy andcost of pulse oximetry screening for detection of CHD in Konya region.Material and Methods: In our study, we analyzed the results of pulse oximetry screening of infants born between 2016 and 2018in Selcuk University and Saglik Bilimleri University Konya Training and Research Hospital. Positive screening test results and theircosts was evaluated.Results: Pulse oximetry was performed on a total of 3440 infants for screening congenital heart disease at two different centers. 2003(58.2%) of the cases were female and 1437 (41.8%) were male. The mean timing of screening was 24.713.1 (4-100) hours (mean SD (min-max). 292 (8.48%) infants were tested positive. Echocardiographic examination was performed in the positive cases. Theprevalence of CHD was found to be 27.6 ‰. The prevalence of critical CHD was 1.16 per 1000 live births. The false-positive screenrate was found to be 197 (5.7%). Among the cases who were screened, the most common CHD was the secundum ASD. The totalcost of probes was 2622 (497.91). The cost of echocardiography for 292 babies was approximately 13181 (2503).Conclusion: Screening for heart disease can be used effectively in the early diagnosis of serious and life-threatening diseasesin newborn and the cost is unneglectable in the early screening of patients. This study, the total cost of each infant screening isapproximately 4.5 (0.85) which appears to be a quite cheap and effective screening compared to the other countries.

Aim: To invastigate the inflammatory process and hormone parameters as a result of underlying cause of unexplained infertility (UI)Metarial and Methods: In total 153 patients with UI who underwent to intracytoplasmic sperm injection (ICSI) were included in the study. The blood hormones levels were obtained on the 2nd or 3rd day of the menstruation. Other blood count examinations were taken on the day of HCG administration. Relationship regarding embryo grade was also investigated.Results: Of those 153 patients, only 42 of them got pregnant. Mean maternal age was 29.08±3.5 and mean duration of the infertility was 8.19±3.1 years, respectively. There was no statistically significant difference between pregnancy rate, embriyo grade, and FSH, progesterone, fT3, fT4, TSH levels (p>0.05). Also no significant difference was found between pregnancy rate, embriyo grade and hemoglobin, hemotocrit, platelet, mean platelet volume, neutrophil, lymphocyte counts, neutrophil lymphocyte ratio and platelet lymphocyte ratio (PLR) (p>0.05). However, a significant difference was found between embriyo grade and estradiol values (p0.05). There was a negative correlation between hematocrit values and the oosit number collected with the number of embryos (p0.05). PLR was found to be 110.9 (63.6 - 313.2) in pregnant women and 110.5 (51.8 - 390) in nonpregnant patients and the correlation between the PRL measured on HCG day and pregnancy rate.was significant (p=0.002). LH median values measured on HCG day were significantly lower in pregnant group (p0.001). Conclusion: We found that inflammation does not affect on IVF result and estradiol levels significantly effects on embriyo quality. Also there was an inverse correlation between hematocrit levels and the number of oocyte- and number of embryos.Keywords: Infertility; blood cell count; inflammation; estrogen.

Aim: Preoperative biliary drainage is suggested for patients with jaundice, considering that surgical operations may increase postoperative complications in the presence of jaundice. The aim of this study was to test the effect of biliary drainage on possible serious complications, deaths, or period of hospital stay.Material and Methods: Between January 2012 and June 2016, 160 patients with operable and resectable periampullary tumors who were diagnosed with periampullary tumors underwent pancreaticoduodenectomy (Whipple’s procedure) in Marmara University Pendik Training and Research Hospital, Department of General Surgery. The patients’ demographics, accompanying comorbid diseases, type of biliary drainage, drainage duration, pre- and post-drainage laboratory data, emerging complications and need for re-hospitalization were recorded retrospectively from the accessible files and records.Results: It was observed that out of 158 patients with periampullary tumors, 116 that were operated with drainage had a higher occurrence of surgical site infections and anastomotic leaks, compared to the 42 patients that were operated without drainage. Similarly, when patient results were classified according to the Clavien-Dindo complication classification, the ratio was again against the patients that were operated with drainage. Drainage patients stayed in the hospital for a longer period; however, in terms of pancreatic fistula, re-hospitalization, need for intensive care and relaparotomy ratios, and especially in terms of mortality ratios, a difference between two patient groups was not observed. Conclusion: Investigating the data collected from patients that were operated without drainage, and specifically considering the bilirubin values of the patients who had complications, there was no threshold identified that contributed to a higher likeliness of complications. Consequently, even though there were no results to motivate recommending drainage, it was concluded that applying drainage does not create any difference in short-term prognosis, but drainage increases infectious complications.Keywords: Periampullary cancer; obstructive jaundice; preoperative biliary drainage; postoperative complication; hyperbilirubinemia.

Aim: The frequency of placenta previa (PP) is increasingly rising due to the increase in caesarean ratio. The aim of this study is to investigate the role of the white blood cell (WBC) in the preoperatively taken complete blood specimen in foreseeing whether hysterectomy will be performed or not in patients with placenta previa totalis.Materials and Methods:Two hundred fifty-seven (257) patients who experienced caesarean due to placenta previa totalis (PPT) in Ondokuz Mayis University between 2010 and 2018 had been surveyed retrospectively. The results of the preoperative Complete Blood Count (CBC) of the Placenta PreviaTotalis (PPT) patients in which either hysterectomy was applied or not, demographic characteristics, other follow-up and treatment results were accessed via system records and file surveys. The primary outcome is the role of preoperative White Blood Cell (WBC) levels in predicting hysterectomy, Results: WBC median values in the pre-operative complete blood specimen of the patients with placenta previa totalis demonstrate difference between the patients with hysterectomy and those without hysterectomy. While the median value was as 9.7 109/L in the patients who could be recovered with treatments apart from hysterectomy, this was obtained as 11.3109/L in the patients in which hysterectomy was applied (p=0.007).Conclusion: Increase in WBC in the pre-operative blood specimen of the patients with diagnosis of Placenta Previa Totalis may be guiding whether hysterectomy will be applied or not.Keywords: Placenta previa; hysterectomy; leukocytosis; caesarean.

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Aim: In this prospective study, we aimed to compare the patients scheduled for in vitro fertilization (IVF) with poor ovarian reserve to patients with unexplained infertility in the same age group in terms of sexual dysfunction.Material and Methods: In this prospective study, a total of 146 patients admitted to the IVF center of Ondokuz Mayis University between June 2018 and December 2018 were included in the study. Fourty-eight of these patients had poor ovarian reserve and 98 were scheduled for IVF due to unexplained infertility. In these patients, the female sexual function index (FSFI) scores were calculated for the diagnosis of sexual dysfunction prior to treatment. In addition, ovarian reserve tests such as cyclic follicle stimulating hormone (FSH) and anti mullerian hormone (AMH) at the beginning of the menstrual cycle were recorded.Results: The mean age of the female patients in the study was 30.2+-5 years. The mean FSFI score was 22.36 +-3.31 and 22.44+-3.53 in the group with poor ovarian reserve and with unexplained infertility, respectively. The prevalence of sexual dysfunction (FSFI score 26.55) in the poor ovarian reserve group was 89.6% (n=48) compared to the unexplained infertility group, which was 93.9% (n=98). The analysis of domains revealed no statistically significant difference between the two groups (p=0,356).Conclusion: Sexual dysfunction is frequently observed in patients scheduled for IVF. Our study showed that there was no difference in sexual dysfunction between the two groups. Interestingly, it was revealed that there was a correlation between FSH levels and satisfaction and pain.It was also interesting that the rate of sexual dysfunction was extremely high in both groups.Keywords: Decreased ovarian reserve; sexual dysfunction; unexplained infertility; ovarian reserve.

Aim: The large number and different varieties of cysts and cyst-like lesions around the knee joints are commonly encountered on the magnetic resonance scanning. We aimed to evaluate type, frequency, and size of cystic lesions observed around the knee joints and to find out its relationship with osteoarthritis.Material and Methods: 620 knee joints belonging to 545 patients were enrolled in the study. We retrospectively examined magnetic resonance images of the knee joints which were divided into three groups as non-degenerative, mild degenerative, and severe degenerative. The cysts have been classified according to count, type and size and their relationship with knee osteoarthritis was assessed.Results: Out of 620 knees, 248 knees (40%) had no degenerative arthritis, 178 knees (28.7 %) had mild, and 194 knees had severe (31.3 %) degenerative arthritis. Cystic lesions were identified in 411 knees (66.3%). One cyst in 261 knees, two cysts in 102 knees, three cysts in 40 knees, and four cysts in 8 knees were encountered. Increased number and average diameter of the cysts showed statistically significant relation with the degree of osteoarthritis (p0.001 and p0.04, respectively). Moreover, some types of cysts such as synovial cysts, intraarticular ganglion cysts, and intraosseous cysts were significantly increased with osteoarthritis (p0.001).Conclusion: There was significant increase in frequency, number, and average size of knee joint cysts in patients with degenerative arthritis findings. In addition, almost all cyst types except intrameniscal and parameniscal cysts, were found more frequently in the knees with degenerative arthritis.

Aim: To screen the symptoms of attention deficit and hyperactivity disorder in adult migraine patients. Material and Methods: Our study included 102 migraine patients and 93 sex- and age-matched healthy volunteers. Gender, age, level of education and duration of disease were recorded. We used the adult attention deficit/hyperactivity disorder self-report scale to evaluate the symptoms of adult attention deficit / hyperactivity disorder. In addition, the short form-36 and the hospital anxiety and depression scale were applied to the patients and the healthy controls. Results: The mean scores of attention deficit hyperactivity disorder were significantly higher in migraine patients compared to the control group. There was no significant relationship between the Adult Attention Deficit and Hyperactivity Disorder Self-Report Scale scores and the duration of the disease. There was a negative correlation between the SF-36 health questionnaire scores and the Adult Attention Deficit and Hyperactivity Disorder Self-Report Scale scores. There was a positive correlation between the Migraine Disability Assessment scores, the number of migraine attacks and the Adult Attention Deficit and Hyperactivity Disorder Self-Report Scale scores. Conclusion: Attention-deficit and hyperactivity symptoms can develop in adult migraine patients and cause psychosocial morbidity and poor quality of life.

Aim: The aim of this retrospective study was to evaluate the possible complications and the complication management of cervical anterior discectomies and fusions in light of the literature.Materials and Methods: The study population consisted of patients who presented to the clinic with neck pain and/or arm pain, loss of strength, and sensory disturbances who were operated on after a lack of response to conservative/medical treatment. This study included 200 cervical discopathy and/or cervical spondylosis cases. The literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‑analyses guidelines without language or country restrictions.Results: The most common complication was dysphagia. The complications also included dural tears, cerebrospinal fluid leakage, graft extrusions, neurological deterioration, postoperative hematomas, and recurrent laryngeal nerve injuries. These were found to be consistent with the literature.Conclusion: In order to minimize the incidence of complications, the preoperative clinical examinations and radiological imaging of each patient should be examined carefully, and the appropriate surgical planning should be performed. It is also important to comply with the rules of asepsis and antisepsis, make sure the surgical time is as short as possible, and perform a dissection based on the patient’s anatomy with the appropriate surgical equipment. In addition, it is important to wash the surgical area frequently, drain the system at the end of the operation, close the tissues in accordance with anatomical integrity, and perform close clinical follow-ups.Keywords: Anterior cervical discectomy and fusion; cervical degenerative disc disease; complications; management of complications.

Aim: Although tumor grade has no impact on endometrial cancer stage, it carries prognostic and therapeutic importance. Surgical management and adjuvant treatment following surgery in certain patients depends on a number of factors including tumor grade. Although grade 3 tumors are included in the high-intermediate risk group, there are data demonstrating that there is a slight difference in survival between patients with grade 1 and 2 tumors in early-stage disease. In this study, we aimed to investigate the association of grade with clinicopathological characteristics, recurrence-free and disease-specific survival in patients treated at our clinic and diagnosed with endometrioid endometrial cancer. Material and Methods: 279 patients with early FIGO Stage endometrioid endometrial cancer treated between 2009-2018 in a University hospital were included in the study. The associations between tumor grade with stage, lymphovascular space invasion (LVSI), myometrial invasion, tumor size, and survival were analyzed. Results: LVSI, ≥50% myometrial invasion, advanced stage and > 2 cm tumor size were significantly higher in grade 3 tumors compared to patients with grade 1 tumors. Recurrence-free and disease-specific survival were significantly lower in patients with grade 2 and 3 tumors compared to patients with grade 1 tumors. In multivariate analysis of RFS and DSS, tumor grade, LVSI and stage were independent prognostic factors. Conclusion: According to this study, grade 2 tumors may not differ significantly from grade 3 tumors in terms of survival. Therefore, due to the potential adverse prognosis associated with grade 2 and 3 tumors, vigilance for recurrence is warranted.

Aim: The aim of this study was to investigate the relationship between tinnitus and the factors that cause the tendency to thrombosis in terms of gender.Material and Methods: Fifty-five consecutive patients who admitted to our clinic with the complaint of idiopathic subjective tinnitus were included in this study. Routine ENT (ear nose throat) examinations and pure tone audiometry test were performed. Prothrombin time (PT), partial thromboplastin time (PTT), total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, Triglycerides, antithrombin III (AT III), protein C, protein S, homocysteine, antiphospholipid and anticardiolipin antibodies were examined in blood samples of patients. Temporal bone magnetic resonance imaging (MRI) was performed all patients. The results of the patients were compared in terms of gender and age groups (40 age).Results: The study was completed with 47 patients. Twenty-four of the patients were female and 23 were male. Both genders groups were similar in terms of age and pure tone average. Antiphospholipid and anticardiyolipin antibodies (IgG and IgM) were found as negative in all patients. Homocysteine levels were found to be statistically significantly higher in males than females (p=0.015; respectively 13.38±5.98 µmol/L and 9.87±3.11 µmol/L). AT III and Protein S levels were lower in males than females although this difference was not statistically significant (respectively p=0.07 and p=0.08)Conclusion: In this study, an association was shown between hyperhomocysteinemia and tinnitus, especially in males. Keywords: Tinnitus; tinnitus of vascular origin; thrombosis; gender role.

Aim: The aim of this study was to compare the important parameters for life, such as sleep, fatigue and quality of life, between the asymptomatic and schizophrenic individuals.Material and Methods: The study included 38 individuals diagnosed with schizophrenia by the psychiatrist and 39 asymptomatic individuals.All participants of our study applied to the outpatient clinic of Kirikkale High Specialization Hospital, Community Mental Health Center. Sociodemographic information of the individuals was questioned by the evaluation form. Sleep qualities of the individuals were evaluated with Pittsburgh Sleep Quality Index (PSQI), fatigue scores were evaluated with Fatigue Severity Scale (FSS), and quality of life scores were evaluated with World Health Organization Quality of Life Scale Brief Turkish Version (WHOQOL-BREF-TR).Results: A total of 77 individuals aged between 20 and 71 were included in the study. The mean age of the individuals with schizophrenia was 40.07 12.14 years, whereas the mean age of the asymptomatic individuals was 43.61 12.19 years.When the quality of sleep and the sleeping medication use were examined between the two groups, it was found that there was a statistically significant difference (p0.05). When the total scores of the sleep quality questionnaires were evaluated between the two groups, it was detected that there was no statistical difference (p0.05).When the quality of life was evaluated between the two groups, it was seen that the physical and social sub-parameters of the patients with schizophrenia were worse (p0.05).It was detected that there was no statistically significant difference in evaluations of fatigue severity between the two groups (p0.05).Conclusion: It was found that individuals with schizophrenia had a lower quality of life than asymptomatic individuals.We think that the physiotherapy and rehabilitation approaches in addition to medical and psychotherapy should be applied to improve sleep quality and quality of life in individuals with schizophrenia.

Purpose: The present study was aimed to analyze morphometric measurements of lower extremity dimensions in healthy females wearing and non-wearing high heeled shoes with narrow toe box.Materials and Methods: Lower extremity length measurements were taken from 121 healthy adult females (64 females non-wearing high heel shoes with narrow toe box, 57 females wearing high heeled shoes with narrow toe box) aged 20 to 40 years using an anthropometer and caliper. Additionally, demographic data (age, height, weight and body mass index-BMI) were taken and tibia-femur ratio (the ratio between tibia length and femur length-T/F) were calculated. Results: The mean values of Tibia - femur length ratio were found as 0.9087±0.038 (right) and 0.9088±0.036 (left) in females wearing high heeled shoes with narrow toe box, whereas the same values were established as 0.9128±0.035 (right) and 0.9157±0.032 (left) in females non-wearing high heeled shoes with narrow toe box. Furthermore, 53.12% of females non-wearing high heeled shoes with narrow toe box suffer from foot, knee and back pain, whereas 78.94% of females wearing shoes with narrow toe box suffer from foot, knee and back pain. Conclusion: The observations presented in this report have defined anatomic parameters and morphometric changes that need to be taken into consideration when wearing narrow high heeled shoes and shoes having wide toe box in females., Amaç: Bu çalışma dar burunlu yüksek topuklu ayakkabı giyen ve giymeyen yetişkin sağlıklı kadınlarda alt ekstremite ile ilgili morfometrik ölçümleri analiz etmek için yapılmıştır. Gereç ve Yöntem: Alt ekstremite uzunluk ölçümleri yaşları 20 ile 40 arası 121 yetişkin sağlıklı (geniş burunlu ayakkabı giyen 64 kadın; dar yüksek topuklu ayakkabı giyen 57 kadın) kadından antropometre ve kaliper kullanılarak yapıldı. Ayrıca, demografik veriler (yaş, vücut ağırlığı, boy uzunluğu, vücut kitle indeksi-BKI) alındı ve tibia-femur oranı hesaplandı. Bulgular: Dar burunlu yüksek topuklu ayakkabı giyen kadınlarda tibia’nın femur uzunluğuna oranı 0.9087±0.038 (sağ) ve 0.9088±0.036 (sol) iken, dar burunlu yüksek topuklu ayakkabı giymeyen kadınlarda aynı ölçümler sırasıyla 0.9128±0.035 (sağ) ve 0.9157±0.032 (sol) olarak hesaplandı. Son olarak, dar burunlu yüksek topuklu ayakkabı giymeyen kadınların %53.12’i ayak, diz ve bel ağrısı çekerken, dar burunlu yüksek topuklu ayakkabı giyen kadınların %78.94’si ayak, diz ve bel ağrısı problemi yaşamaktadır.Sonuç: Çalışmada elde edilen değerler, kadın populasyonunda dar burunlu yüksek topuklu ayakkabı ve geniş burunlu ayakkabı giyildiğinde dikkat edilmesi gereken anatomik parametreleri ve morfometrik değişimleri içermektedir.

Purpose: The aim of this study is to investigate the test-retest reliability of muscles strength measurements performed with Nicholas Manual Muscle Tester (NMMT) in healthy ballet subjects.Materials and Methods: The study group consisted of 10 healthy ballet students aged between 10-11 years. Muscle strength evaluations of lower extremity were made to determine the physical performance level using NMMT. Moreover, every measurements were performed three times with NMMT. Results: NMMT measurements were found as reliable for lower extremity muscle strength in clinical measurements. These reliability of NMMT scores were found as between 0.634 and 0.991. Conclusion: In this paper, we think that NMMT measurements for lower extremity muscles can be used as reliable in clinical measurements and the identification of problems including lower extremity, evaluation of the training and treatment effectiveness of ballet students, Amaç: Bu çalışmanın amacı sağlıklı bale öğrencilerinde Nicholas Manual Muscle Test (NMMT) aleti ile yapılan kas kuvvet ölçümlerinin test-retest güvenilirliğini araştırmaktır.Gereç ve Yöntem: Çalışma grubu 10-11 yaş arası 10 sağlıklı bale öğrencilerinden oluşmaktadır. Alt ekstremitenin kas kuvvet değerlendirmeleri NMMT aleti kullanılarak fiziksel performans düzeyini belirlemek için yapıldı. Ayrıca, her ölçüm 3'er defa NMMT aleti ile yapıldı.Bulgular: NMMT alet ölçümleri alt ekstremite kas kuvvet ölçümleri için klinik ölçümlerde güvenilir bulundu. NMMT aletinin güven aralığı 0.634 ile 0.991 olarak bulundu.Sonuç: Bu çalışmada, alt ekstremite kasları için NMMT aletinin bale öğrencilerinin tedavi etkinliğinin ve eğitimin değerlendirilmesinde, alt ekstremiteyi içeren problemlerin belirlenmesinde ve klinik ölçümlerde güvenilir olarak kullanılabileceğini düşünmekteyiz.

Amaç: Bu çalışmanın amacı izole subskapularis yırtıklarında etiyolojik bir faktör olan subkorakoid sıkışmada korakoid taşmanın bir risk faktörü olarak geçerliliğini araştırmaktır.Gereç ve Yöntem: Omuz artroskopisi uygulanan hastalardan izole subskapularis ve izole tam kat supraspinatus yırtıklı hastalar randomize olarak seçilerek iki grup oluşturuldu. Manyetik rezonans görüntüleme ve ameliyat videoları retrospektif olarak tekrar incelenerek T1 aksiyel manyetik rezonans görüntüleme kesitlerinde korakoid taşma miktarı ve korakoid taşma/humerus başı çapı oranı hesaplandı ve ortalamaları karşılaştırıldı.Bulgular: Çalışmada her iki grupta 28’er hasta olmak üzere toplam 56 hasta vardı. Hastaların yaş ortalamaları Grup 1 ve 2’de sırasıyla 48.719.66 ve 64.856.1 olarak bulundu. Cinsiyet ve ameliyat olan taraf bakımından fark yoktu. Ortalama korakoid taşma değerleri Grup 1 ve 2’de sırasıyla 16.085.6 ve 14.655.92, korakoid taşma/humerus başı çapı oranı ise 0.330.11 ve 0.290.11 bulundu. Ortalama korakoid taşma ve korakoid taşma/humerus başı çapı değerleri bakımından iki grup arasında anlamlı fark saptanmadı.Sonuç: Korakoid taşma ile subkorakoid sıkışma arasında istatistiksel olarak gerçek anlamda bir ilişki yoktur. Subskapularis yırtıklarında varlığı hala tartışmalı olan subkorakoid sıkışmaya bu çalışma ile de kanıt bulunamamıştır., Purpose: The aim of this study was to investigate the validity of the coracoid overlap as a risk factor of the subcoracoid impingement which is an etiologic factor in isolated subscapularis tears.Materials and Methods: Two groups were constituted including isolated subscapularis and isolated full-thickness supraspinatus tears selected randomly from patients who underwent shoulder arthroscopy. The magnetic resonance imaging and surgery videos were reviewed retrospectively to calculate and compare the means of the coracoid overlap and coracoid overlap/humeral head diameter ratio measured on T1 transverse magnetic resonance imaging sections.Results: There were a total of 56 patients including 28 in each group. The mean age of the groups were found to be 48.719.66 and 64.856.1 in Group 1 and 2, respectively. There was no significant difference in terms of age and involved shoulder. The mean coracoid overlap values were found to be 16.085.6 and 14.655.92 and coracoid overlap/humeral head diameter ratios were found to be 0.330.11 and 0.290.11 in Groups 1 and 2, respectively. There was no significant difference in terms of coracoid overlap values and coracoid overlap/humeral head diameter ratiosConclusion: There is actually no statistically significant relationship between coracoid overlap and subcoracoid impingement. There could be found no evidence also with this study for subcoracoid impingement which is still controversial in subscapularis tears.

Amaç: Elektif sezaryen operasyonlarında, spinal anestezide intratekal morfin eklenen ve eklenmeyen farklı levobupivakain dozlarının, randomize, çift kör olarak karşılaştırılması amaçlandı.Gereç ve Yöntem: Bu çalışma, ASA I-II grubu 37-42 haftalık miadında sezaryen operasyonu için spinal anestezi uygulanan 60 gebe kadında prospektif, randomize, çift-kör olarak planlandı. Hastalar randomize edilerek iki gruba ayrıldı. Grup L’ye 12,5 mg (3 ml) levobupivakain, Grup LM’ye ise 10 mg levobupivakain + 0.1 mg morfin (3 ml) intratekal uygulandı. Sensoryal ve motor blok süresi, postoperatif ilk 24 saatteki VAS ağrı skoru, ilk analjezi ihtiyacı süresi, hemodinamik ve solunumsal parametreler, sedasyon düzeyleri, Apgar skorları, hasta memnuniyeti ve komplikasyonlar kaydedildi.Bulgular: Gruplar arasında motor blok başlama ve sonlanma süresi, sensoryal bloğun başlama ve iki segment gerileme süresi ile hasta memnuniyeti açısından istatistiksel anlamlı fark yoktu. Grup L’de ilk analjezik ihtiyacı, Grup LM’ye göre daha erken ortaya çıktı (sırası ile; 158.6 ± 31.8 dakika, 176.6 ± 37.16 dakika). Sonuç: Levobupivakain dozunun azaltılmasına rağmen levobupivakaine düşük doz morfin eklenmesi ile, yan etki ve komplikasyon sıklığında belirgin artış olmadan benzer anestezi ve analjezi düzeylerine ulaşıldığı, ayrıca daha uzun süreli spinal analjezi sağlandığı sonucuna varıldı., Purpose: The object of this randomized and double-blinded study was to compare the efficacy of intrathecally applied levobupivacaine at different doses with or without morphine added in elective Cesarean section operations with spinal anesthesia.Materials and Methods: The study was planned as prospective, randomized and double-blinded in ASA I-II group of sixty women who were 37-42 weeks pregnant and applied spinal anesthesia for cesarean section. Patients were randomized into two groups. 12.5 mg (3 ml) levobupivacaine to group L, 10 mg levobupivacaine + 0.1 mg morphine (3 ml) to group LM were applied intrathecally. Sensory and motor block durations, postoperative immediate 24 hour VAS pain scores, time to the first need for analgesia, hemodynamic and respiratory parameters, sedation levels, APGAR scores, patients’ satisfaction and complications were recorded.Results: No significant difference was found between groups in terms of time to motor block formation and termination, time to sensory block formation and its two segment decline, and patients’ satisfaction. Rescue analgesic need for the first time in group L was earlier compare to group LM (158.6 ± 31.8 minutes and 176.6 ± 37.16 minutes respectively). Conclusion: Despite levobupivacaine dose reduction, its combination with low-dose morphine was resulted in prolongation of spinal analgesia without significant increase in the frequency of side effects and complications with similar anesthesia and analgesia levels.

Leptospirosis is a zoonosis transmitted through the urine of infected animals. Leptospira can be associated with respiratory, renal, hepatic and hematological complications and most importantly carries a high mortality when untreated. We present a rare cause of acute renal failure, acute hepatitis, hyperbilirubinemia and cold agglutinin disease occurring simultaneously, with leptospirosis., Leptospirosis, enfeksiyonlu hayvanların idrar yoluyla bulaşan bir zoonozdur. Leptospiroz; solunum, renal, hepatik ve hematolojik komplikasyonlar ile ilişkili olabilir ve tedavi edilmediğinde yüksek mortalite riski taşır. Bu yazıda leptospirozise bağlı akut böbrek yetmezliği, akut hepatit, hiperbilirubinemi ve soğuk aglutinin hastalığı gelişen nadir bir vaka sunulmuştur. .

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