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Objective To determine the potential predictors of antegrade ureteral stenting (AUS) failure in patients with malignant and benign ureteral obstruction. Method We retrospectively evaluated 116 AUS procedures performed in 80 patients for ureteral obstruction due to malignant and benign causes. Variables such as etiology for obstruction, ureter shape, previous treatment regimen, history of ileal loop diversion, and presence of percutaneous nephrostomy were recorded. Univariate and multivariate logistic regression methods were used between these variables and stent failure. Results Antegrade ureteral stenting was performed as single stage in 24 procedures (n: 24/116, 21%) and performed as a two-step approach after percutaneous nephrostomy in 92 procedures (n: 92/116, 79%). Ureteral stent was successfully deployed in 112 AUS procedures (n: 112/116, 96.5%). In 35 of these successful procedures, the patients were referred to our department due to prior failed retrograde ureteral stenting (RUS). Subsequent stent failure occurred in 40 procedures after a median interval of 39 days. Pre-stenting percutaneous nephrostomy (PN) was a statistically significant risk factor for stent failure (p: 0.041), and age showed an inverse relationship with stent failure (p: 0.008). Complications in early (within the first 30 days after procedure) and late stage occurred in a total of 17 procedures. Early complications included urinary tract infection (n: 11), stent migration (n: 3), and malposition (n: 1). Late complications (after 30 days) were urinary tract infection (n: 1) and stent migration (n: 1). Conclusion This study suggests that AUS can be performed effectively in both benign and malignant ureteral obstructions including cases with prior failed RUS. Two-step AUS after percutaneous nephrostomy was found to be a significant risk factor for subsequent stent failure in our study cohort.

Bu çalışma, 2019 yılında Bodrum[Türkiye]'da düzenlenen TRS Kongresi'nde bildiri olarak sunulmuştur. Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well-established diagnostic tool for lung cancer, sarcoidosis, and suspected metastatic extra-thoracic malignancy (ETM). Patients with primary ETM often have hypermetabolic mediastinal/hilar lymph node enlargement in the PET-scan done for initial staging or post treatment follow-up. We aimed to determine the diagnostic performance of EBUS-TBNA and the relationship between PET-SUV values and diagnosis of malignancy metastasis in patients with ETM. Materials and Methods: Results of EBUS-TBNA in ETM patients with suspected MLN metastasis were retrospectively analysed (May 2016 to July 2019). Non-malign results were confirmed for surgery or clinical/radiological follow-up. Lymph nodes with a high FDG-uptake (SUV > 2.5, MLN) were reported as suspicious for metastasis. Results: Of the 588 EBUS procedures, 109 were included in the analysis. Patient' mean age was 62.5 +/- 10.1 years; there were 35 men and 74 women. Primary malignancies were breast cancer in 33, gastrointestinal in 23, female genital tract in 17, head and neck in 14, genitourinary cancer in 13, malignant melanoma in 6, sarcoma in 2 and kaposi sarcoma in 1. According to EBUS-TBNA smear and cell block histopathologic evaluations, 16 patients' results (14.7%) were malignant compatible with metastasis of ETM. Among the 93 patients with non-malignant diagnosis, EBUS-TBNA revealed a granulomatous lympadenitis compatible with sarcoid reaction in 7 and tuberculosis in 2. A total of 9 patients underwent surgical procedures after EBUS-TBNA, with a definitive histological diagnosis of granulomatous lymphadenitis in 2, malignancy in 5 and, reactive lymph node in 2. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of EBUS-TBNA were 76.19% (95% CI 52.83-91.78), 100% (95% CI 95.89-100.00), 100%, 94.62% (95% CI 89.12-97.12) and 95.4%, respectively. Conclusion: EBUS-TBNA sampling has high diagnostic performance. Histopathological confirmation requirement for MLN should be kept in mind in patients with ETM, even they have negative EBUS results. Giriş: Endobronşial ultrason-kılavuzluğunda transbronşial iğne aspirasyonu (EBUS-TBİA), akciğer kanseri, sarkoidoz ve metastatik ekstra-torasik malignitelerde (ETM) iyi tanımlanmış bir tanı yöntemidir. Primer ETM evrelemesi ve tedavi sonrası takipte, mediastinal/ hiler lenf nodu (MLN) genişlemesi sık görülmektedir. ETM tanısı olan hastalarda EBUS-TBİA tanı performansı, PET-SUV değerleri ile malign metastaz tanısı arasındaki ilişkiyi araştırmayı hedefledik. Materyal ve Metod: Şüpheli malign metastaz olan ETM hastalarında yapılan EBUS-TBİA sonuçları retrospektif olarak analiz edildi (Mayıs 2016-Temmuz 2019). Malign olmayan sonuçlar cerrahi veya klinik/radyolojik takip ile konfirme edildi. Yüksek FDG-uptake olan (SUV > 2.5, MLN) lenf nodları metastaz şüpheli olarak raporlandı. Bulgular: Toplam 588 EBUS işleminden 109'u analize dahil edildi. Hastaların ortalama yaşı 62.5 ± 10.1; 35'i erkek, 74'ü kadın idi. Primer malignitelerin, 33’ü meme kanseri, 23'ü gastrointestinal, 17'si kadın genital sistem, 14'ü baş-boyun, 13’ü genitoüriner kanser, 6'sı malign melanom, 2'si sarkom ve 1'i kaposi sarkomu idi. EBUS-TBİA yayma ve hücre bloğu histopatolojik sonuçlarına göre 16 hastada (%14.7) ETM metastazı ile uyumlu malignite saptandı. Malign olmayan 93 hastadan 7'sinde sarkoid reaksiyon ile uyumlu granülomatöz lenfadenit, 2'sinde tüberküloz, 5'inde malignite bulundu. EBUS-TBİA sonrası cerrahi ile toplam 9 hastanın 2'sinde granülomatöz lenfadenit, 5'inde malignite ve 2’sinde reaktif lenf nodu saptandı. EBUS-TBİA için toplam duyarlılık, özgüllük, pozitif prediktif değer, negatif prediktif değer ve tanı doğruluğu, sırasıyla %76.19 (%95 GA 52.83-91.78), %100 (%95 GA 95.89-100.00), %100, %94.62 (%95 GA 89.12-97.12) ve %95.4 olarak saptandı. Sonuç: EBUS-TBİA örneklemesi tanı performansı yüksek bir yöntemdir. Negatif EBUS sonuçları olsa da, MLN genişlemesi olan ETM tanılı olgularda histopatolojik doğrulama gerekliliği akılda tutulmalıdır.

Many new features have recently been incorporated to CEDD Cozum/Child Metrics, an online and freely accessible scientific toolset. Various auxological assessments can now be made with data of children with genetic diseases (Prader Willi syndrome, Noonan syndrome, Turner syndrome, Down syndrome, and Achondroplasia) and preterm and term newborns. More detailed reports for height, weight, and body mass index data of a given child are now available. Last but not least, office and 24-hour ambulatory blood pressure values can be analyzed according to normative data.

Objective In this study, quality of life and psychiatric comorbid disorders were investigated in patients with cervical dystonia and their spouses and we also investigated the effect of botulinum toxin (BTX) treatment on these parameters. Material and method Thirty patients with cervical dystonia (CD) on BTX treatment and their spouses (n=30) were included. Beck Depression Scale (BDS), State-Trait Anxiety Inventory I and II (STAI-I, STAI-II), Hospital Anxiety Scale (HAS), Hospital Depression Scale (HDS) for psychiatric comorbid disease assessment, Toronto Western Spasmodic Torticollis Scale (TWSTRS) for disease activity assessment, and Craniocervical Dystonia Questionnaire (CDQ-24), Cervical Dystonia Impact Profile (CDIP-58), and Short Form 36 (SF-36) questionnaires for quality of life assessment were used. BDS, STAI-I and STAI-II, HAS, HDS, and SF-36 scales were also obtained from the spouses. The same tests were applied both before and 8weeks after the BTX treatment. Conclusion In our study, an increase in psychiatric comorbid disorders such as depression and anxiety was observed and the quality of life was adversely affected in all areas in patients. In the spouses of the patients, the rates of psychiatric comorbid disorders such as depression and anxiety were found to be increased when compared to healthy subjects while vitality, mental health, and general health perception were found to be negatively affected. Patients showed improvements in anxiety level, disease activity, and overall quality of life scales after BTX treatment.

Subacromial impingement syndrome (SIS) is one of the most frequent shoulder pathologies. Initial treatment is conservative. Subacromial injection of drugs achieves a high concentration at the pathologic site with less drug use and fewer systemic side effects. Glucocorticoids are most frequently injected. One concern with steroid use is the wide array of potential systemic and local complications. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also peripherally acting and can be used locally. Although intraarticular (IA) use of NSAIDs is common in orthopedic practice, it is mostly restricted to the knee joint. Reports of local NSAID for joint pathologies are relatively rare. This study compared the efficacy of single-dose subacromial injections of betamethasone and lornoxicam for treatment of SIS. Subacromial injections of either 7.0 mg betamethasone or 8 mg lornoxicam were received by 70 patients with mean age 53 (46-68) years. Treatment outcome was assessed with Constant-Murley and UCLA questionnaires before injection and at 2aEuro, 4aEuro, and 6aEuroweek follow-ups. The change in outcome scores compared to pretreatment was higher in the steroid group at all follow-ups (p < 0.001). Patients in the steroid group showed a significant improvement at all follow-ups compared to pretreatment (p < 0.001) and previous follow-ups (p < 0.05) at all times. Patients in the lornoxicam group showed a significant functional improvement in week 2 (p < 0.001), which was not evident in the following weeks (p > 0.05). Although functional recovery halted after week 2, outcome scores remained significantly higher than the pretreatment values at all weeks (p < 0.001). Although a single subacromial lornoxicam injection provides rapid functional recovery, which partially extends into the intermediate term, its results are inferior to betamethasone and it may be an alternative only in patients where corticosteroids are contraindicated.

WOS: 000371800700003, PubMed: 26493821, The aim of this study was to investigate the effect of stent cell geometry on midterm results of carotid artery stenting (CAS). One hundred fifty-five patients underwent CAS between February 2010 and December 2012. Ninety-one open- and 84 closed-cell stents were used in this non-randomized, retrospective study. Periprocedural complications were defined as the ones happened during the procedure or within 30 days afterwards. Starting from the 6th month after the procedure, in-stent restenosis was detected with multidetector computed tomography angiography and classified into four groups from focal restenosis to occlusion. Eleven complications were encountered in the periprocedural period (four on the open- and seven on the closed-cell group). Total complication rate was 6.3 % (11/175). No significant difference was detected in terms of periprocedural complications between two groups (p = 0.643). There was statistically significant difference between stent design groups in regard to radiological findings (p = 0.002). Sixteen of open-cell stents and three of closed-cell stents had focal restenosis. One closed-cell stent had diffuse proliferative restenosis and one open-cell stent had total occlusion. In-stent restenosis was more common in open-cell stent group, which have larger free cell area than closed-cell stents. Although our radiologic findings promote us to use closed-cell design if 'possible', no difference was detected in terms of clinical outcomes.

BACKGROUND: The purpose of this study was to compare short-term radiographic and clinical results of pediatric both-bone diaphyseal forearm fractures treated with intramedullary nail fixation using titanium nails or K-wires. METHODS: This was a prospective comparative trial. In total, 43 patients with both-bone open or closed forearm fractures who underwent surgical treatment with intramedullary fixation were randomly classified into two groups. Three patients did not return for the follow-up and were excluded from the study. Twenty of the 40 patients were assigned to the elastic stable intramedullary nail group and 20 were assigned to the K-wire group. Demographic data suggested no difference between the two groups except for the side of injury. Perioperative data and radiological and clinical outcomes were evaluated. RESULTS: The cohort comprised 5 girls and 35 boys whose mean age was 11.60 +/- 2.69 years. Except the proportion of patients who were conservatively followed up preoperatively, all perioperative data were similar between the groups. Radiographic and functional results were similar. There were two delayed unions; one pin track infection and one re-fracture. CONCLUSION: Intramedullary fixation of forearm fractures in children with titanium nail or K-wire does not affect radiological and clinical results. Both elastic stable intramedullary nail and K-wire fixation were effective in stabilizing pediatric diaphyseal forearm fractures. AMAÇ: Bu çalışmanın amacı titanium çivi ya da K-telleri kullanılarak intramedüller çivileme ile tedavi edilen çocuk önkol kırıklarının kısa dönem radyolojik ve klinik sonuçlarının karşılaştırılmasıdır. GEREÇ VE YÖNTEM: Bu çalışma ileriye yönelik karşılaştırmalıdır. İntramedüller tespit ile cerrahi olarak tedavi edilen açık ya da kapalı önkol çift kırıklı 43 hasta randomize olarak iki gruba ayrıldı. Takibi yapılamayan üç hasta çalışmadan çıkarıldı. Kırk hastadan 20’si elastik stabil intramedüller çivi grubuna ve 20’si de K-teli grubuna dahil edildi. Demografik veriler yaralanmanın tarafı dışında iki grup arasında benzerdi. Perioperatif veriler, radyolojik ve klinik sonuçlar değerlendirildi. BULGULAR: Kohort yaş ortalaması 11.60 (±2.69) olan 5 kız ve 35 erkek çocuktan oluşuyordu. Ameliyattan önce konservatif olarak takip eilen hastaların oranı dışında tüm perioperatif veriler gruplar arasında benzerdi. Radyolojik ve klinik sonuçlar da benzer idi. Toplamda iki kaynama gecikmesi, bir tel dibi enfeksiyonu ve bir refraktür gözlendi. TARTIŞMA: Çocuklarda önkol kırıklarının titanyum çivi ya da K-teli ile intramedüller tespitinin radyolojik ve klinik sonuçları benzerdir. Hem elastik stabil intramedüller çivi hem de K-teli tespiti pediatrik diafizeal önkol kırıklarının tedavisinde etkindir.

Successful weight loss after bariatric surgery has been associated with a variety of factors. The aim of this study was to determine the effects of educational status on surgical weight loss for patients undergoing sleeve gastrectomy (SG). This retrospective cohort study was carried out on patients undergoing SG between September 2013 and July 2015. Six months after surgery, the patients were classified into two groups according to their success in the percentage of excess weight loss (%EWL). Group 1: =%50EWL (successful WL) in the sixth month. The independent predictors for insufficient weight loss six months after SG were analyzed. In the sixth post-operative month, their mean %EWL and percentage of excess body mass index loss (%EBMIL) were 50 +/- 15.4 and 58.2 +/- 19.3, respectively. In univariate analysis, group 1 patients were found to be significantly older when compared to group 2 patients while the education level of group 2 patients was significantly higher when compared to group 1. A tertiary educational level at a university or higher was associated with a nearly fourfold increased success in weight loss (AOR 3.772, p = 0.03) 6 months after SG. Multivariate analysis showed that patients with a history of childhood obesity were more likely to have insufficient weight loss (AOR 0.390, p = 0.045). Childhood obesity and a lower level of education are associated with insufficient weight loss 6 months after SG. However, prospective external validation is warranted, with a long-term follow-up of a large bariatric surgery population.

Multiple myeloma (MM) is a hematologic malignancy characterized by lytic bone lesions and is usually with vertebral involvement. At the time of diagnosis, vertebral involvement is present in approximately 60% of patients (1). Pathologic vertebral fractures can easily occur in MM. Spinal instability, back pain, neurologic dysfunction and physical symptoms can be observed in patients with MM due to vertebral fractures. As a result, the quality of life of patients is affected significantly. A variety of contemporary therapeutic approaches are available for vertebral involvement in MM. These approaches are chemotherapy, radiotherapy, radioisotope therapy, bisphosphonate therapy, algological treatment and palliative/stabilization surgery. Risks of spinal instability and neural compression can be high with conservative treatment options. While surgery can be suitable for patients with neural compression, its complication rates are high (2). Percutaneous vertebroplasty (PV) is a minimally invasive treatment method. PV is used to treat back pain caused by vertebral involvement due to osteoporotic vertebral compression fractures, metastasis, multiple myeloma, and aggressive hemangioma (3). PV increases spinal stability by preventing vertebral collapse (2). PV was originally used for treatment of painful vertebral hemangioma by Galibert et al. (4). In several studies, it was reported that PV prevented vertebral height loss and reduced patient pain and need of analgesia use in patients with vertebral involvement due to osteoporosis and metastasis (5–8). PV usage is gradually increasing for vertebral involvement due to MM. However, data on PV usage for MM is limited in the literature (8). PV is preferred because it is more easily performed than surgery, more effective, and has lower rates of serious complications. The aim of this study was to assess the effectiveness, benefits, and reliability of PV in patients with vertebral involvement of MM.

Aim: Nosocomial infections (NI) in a neonatal intensive care unit (NICU) and neonatal clinic were evaluated during a one-year-period. Material and Method: 314 newborns were investigated for nosocomial infections. Local ethics committee approval was given for this study. Nosocomial infections was defined using the CDC criteria. Results: Nosocomial infections developed in 53% of 127 patients (58% with culture positivity) in the NICU and in 2.6% of 187 patients (all with a negative culture) in the neonatal clinic. In total, (NICU plus neonatal clinic), NI developed in 23% of hosptalized patients. Nosocomial infections rate was 42.3% and in terms of patient days, NI rate was 14/1000 patient-day. When evaluated separately, NI developed in 53.5% of patients admitted in NICU and in 2.6% of neonatal clinic patients. Also, NI rates were 17.9/1000 patient-day in NICU and 1.6/1000 patient-day in the neonatal clinic. Patients with NI stayed at the hospital for 73.6 +/- 47.8 day in NICU and for 16.0 +/- 6.7 day in the neonatal clinic. Nosocomial infections developed on the 29.4 +/- 30.9(th) d in NICU and on the 7.6 +/- 2.9(th) day in the neonatal clinic. In NICU, in terms of 128 NI episodes, the NI related mortality was 8.5%. 16.1% (n: 11) of the patients with NI died. They died on the 56.7 +/- 50.2(nd) day of admission and on the 25.8 +/- 10.2(nd) day second after NI diagnosis. There was no mortality in neonatal clinic patients. Conclusions: Our NI rates were slightly higher than the developed countries and lower than the developing countries. Bir yılda, Yenidoğan Yoğun Bakım Birimi (YYBB) ve Yenidoğan Kliniği’ne yatan hastalarda gelişen hastane enfeksiyonları (HE) incelendi. Gereç ve Yöntem: Hastane enfeksiyonları Centers for Diseases Control and Prevention (CDC) ölçütlerine göre tanımlandı. Çalışma için Uludağ Üniversitesi Tıp Fakültesi Etik Kurul onayı alındı (04 Mart 2008 tarih ve 2008-5/12 sayılı etik kurul yazısı). Bulgular: Yenidoğan YBB’de yatan 127 hastanın %53’ünde (%58,5’i kültür pozitif), Yenidoğan Kliniği’nde yatan 187 hastanın %2,6’sında (hepsi kültür negatif) HE gelişti. Yenidoğan YBB ve Yenidoğan Kliniği’nde toplam %23 hastada HE gelişti, HE hızı %42,3, yatış gününe göre HE oranı ise 14/1000 hasta günü olarak bulundu. Hastane enfeksiyonları oranı YYBB’de 17,9, Yenidoğan Kliniği’nde 1,6/1000 hasta günü bulundu. Hastane enfeksiyonları olan hastalar, YYBB’de 73,6±47,8 gün, Yenidoğan Kliniği’nde 16,0±6,7 gün yattı. Hastane enfeksiyonları tanısı, YYBB’sinde hastaneye yatışlarının ortalama 29,4±30,9. gününde, Yenidoğan Kliniği’nde 7,6±2,9 gününde konuldu. Yenidoğan YBB’de 128 HE atağında atak ilişkili ölüm oranı %8,5 idi. Hastane enfeksiyonları saptanan 68 hastanın 11’i (%16,1) kaybedildi. Hastane enfeksiyonları tanısı alan hastalar, Yenidoğan YBB’de ortalama yatışının 56,7±50,2. gününde kaybedildi. Hastane enfeksiyonları tanısı konulduktan sonraki ortalama ölüm günü; YYBB’de 25,8±10,2 gün olarak saptandı. Yenidoğan Kliniği’nde HE gelişen hastalarda ölüm saptanmadı. Çıkarımlar: Kliniğimizde Yenidoğan YBB ve Yenidoğan Kliniği’ndeki HE’leri gelişmiş ülkelere göre biraz yüksek, gelişmekte olan ülkelere göre daha düşük saptandı.

WOS: 000301385000001, PubMed: 22319523, Aim. Colonic polyps and thyroid nodules are common diseases and their frequency increases with age. In the literature, there is no study investigating the coexistence of colonic polyps and thyroid nodules. Therefore, this study was designed to investigate thyroid nodule prevalence in patients with colonic polyps. Material and Methods. Sixty-six patients with colonic polyps and 146 patients without colonic polyps enrolled into the study. Age and sex matched control group was composed from patients without colonic polyps. Colonoscopic examinations, thyroid ultrasonographies were performed in all patients, and TSH were measured. Results. Male/female ratio in polyp and control groups were 40/26 versus 68/78, respectively (P = 0.058). Mean ages were similar in both groups (53.3 +/- 11.4 versus, 51.8 +/- 11.4, P = 0.373). Thyroid nodule was detected in 44 (66.7%) patients with polyps and in 61 (41.8%) controls (P = 0.001). Patients with adenomatous polyps had 5 or more thyroid nodules compared to patients with hyperplastic polyps (P = 0.03). Thyroid nodules were more prevalent among patients aged 50 or older compared to 50 years or less (P = 0.023). Conclusion. Thyroid nodules were detected more common in patients with colonic polyps. Further studies are needed to clarify this coexistence.

Background and Aim: There is a paucity of data regarding the impact of sphincterotome design on cannulation success. Methods: We aimed to compare the 5.5 F standard sphincterotomes of two different manufacturers (sphincterotome 1: Endo-flex 5.5F [ENDO-FLEX GmbH, Voerde, Dusseldorf, Germany] vs sphincterotome 2: Ultratome 5.5F [Boston Scientific, Spencer, IN, USA]). Adult patients undergoing their first endoscopic retrograde cholangiopancreatography were included in two study groups. The sphincterotome preloaded with a guidewire was used for selective common bile duct cannulation in each group. Precut methods were applied in failed cases without crossover. Successful biliary cannulation in 10 attempts was the primary outcome. Results: Baseline features and indications were similar between groups (n = 100, group I, sphincterotome 1, vs n = 100, group II, sphincterotome 2). A higher success in initial cannulation was obtained in group II compared to group I (92% vs 81%, P = 0.03). Moreover, number of cannulation attempts and time to cannulation differed. No statistical significance was noted in group I (8%) versus group II (3%) regarding pancreatitis rate. The overall cannulation success after precut in failed cases was 95% (group I) and 97% (group II). Conclusions: There was a significant difference in cannulation success between the two different sphincterotome. 5.5F Ultratome with guidewire was superior to 5.5F Endo-flex sphincterotome with guidewire in initial selective cannulation of common bile duct. The results may show the importance of sphincterotome features to overcome the obstacles during cannulation such as complex intrapapillary mucosal features.

This study aimed to evaluate the incidence and the time course of methotrexate (MTX)-associated gastric intolerance in patients with rheumatoid arthritis and psoriatic arthritis. Four hundred twenty subjects undergoing MTX treatment for rheumatoid arthritis (n = 346) and psoriatic arthritis (n = 74) were retrospectively assessed. The incidence and time course of gastric MTX intolerance resulting in treatment discontinuation were investigated. In addition, the relations between gastric intolerance and patient characteristics, including gender, age, diagnosis, and rheumatoid factor (RF) positivity, were examined. Overall, oral MTX discontinuation rate due to gastric intolerance was 28.6 %. The time to discontinuation for oral MTX was 8.1 +/- A 11.5 months on average, with more than half of the discontinuations occurring within the first three months of treatment. Discontinuation was not associated with gender, age, diagnosis, or RF positivity. More than half of the patients that switched to a parenteral treatment regimen (52.6 %, 20/38) could tolerate the agent. Gastric MTX intolerance usually develops within the first year of treatment and presents a major obstacle to long-term treatment retention in patients with rheumatologic disease. However, parenteral MTX appears to be a good alternative for patients intolerant of oral MTX.

Objective: To investigate the usefulness and diagnostic performance of glycogen phosphorylase BB (GPBB) to aid early diagnosis of acute coronary syndrome and to compare with cardiac-specific troponin I (cTnI), creatine kinase isoenzyme MB and myoglobin. Material and Method: Non-traumatized 72 patients arriving at the emergency department within 3 hours after the onset of chest pain suggestive of acute coronary syndrome were included. The patients were classified as having acute myocardial infarction (AMI) or unstable angina pectoris (UAP). Blood samples were obtained on arrival (0 hours), 6 hours, and 24 hours. To determine the diagnostic performances of GPBB and other cardiac markers for ACS, sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios and receiver operating characteristic (ROC) curves with areas under curves were calculated. Results: Seventy two non-traumatic chest pain patients and 45 controls were enrolled. GPBB was the most sensitive biochemical cardiac marker of all tested in AMI and UAP patients on admission, whereas its specificity was low In both AMI and UAP patients, the area under the GPBB ROC curve, was significantly greater than the areas under all other ROC curves on admission. Conclusion: GPBB is a promising enzyme for the early laboratory detection of ischemic myocardial damage. Because the diagnostic specificity of GPBB for myocardial damage is low, a positive GPBB result should subsequently be confirmed by cTnI measurement. However; further studies on specificity and development of a fast, automated assay are necessary before GPBB can be recommended as a routine diagnostic tool.

Objectives: To investigate the factors influencing progression and chronification of episodic migraine, we conducted a 12-month face to face follow-up study of episodic migraine patients. Methods: One hundred eighty patients with episodic migraine were enrolled. 120 parameters were analyzed including demographic factors, social and life-style features, comorbid medical illnesses and headache characteristics. After the first evaluation, all patients was scheduled to a structured face to face interview at 3-months interval for one-year. Results: Thirty-two (17,7%) patients developed chronic daily headache. Four out of 32 (2,2%) had definite chronic migraine. Low education level, obesity, greater tea consumption (>= 4 cups/daily), predominantly hot and spicy diet, high headache frequency, long duration of headache and presence of allodynia at baseline, and more days with symptomatic drug intake were significant risk factors for progression and chronification of migraine. Cox regression analysis revealed triptan and NSAID intake, hot and spicy eating habit and allodynia as risk factors for chronification. Conclusion: Higher amount of tea consumption, hot and spicy diet appeared to be new risk factors for chronification of migraine. Weight gain is one of the most important risk factors. Patients should be warned about the risk factors to prevent chronification. Epizodik migrenin kronikleşmesinde ve progresyonunda rolü olabilecek faktörleri araştırmak amacı ile epizodik migrenli hastaların 12 aylık yüz yüze takip çalışmasını gerçekleştirdik. Gereç ve yöntem: 180 epizodik migren hastası çalışmaya alındı. Demografik verileri, sosyal yaşam ve yaşam tarzı özellikleri, eşlik eden hastalıklar ve başağrısı özellikleri olmak üzere 120 parametre analiz edildi. İlk değerlendirmeyi takiben tüm hastalar bir yıl boyunca 3 ayda bir yüz yüze yapılandırılmış görüşmeye alındı. Bulgular: Otuz iki (17,7%) hastada kronik migren gelişti. Otuz iki hastanın dördüne (%2.2) kesin kronik migren tanısı kondu. Düşük eğitim seviyesi, obezite, yüksek miktarda çay tüketimi (≥4 bardak/gün), acılı ve baharatlı beslenme tarzı, yüksek başağrısı frekansı, uzun süreli başağrısı hikayesi, ilk değerlendirmede allodini varlığı ve fazla miktarda semptomatik ilaç alınması migrenin kronikleşmesi ve progresyonu için anlamlı risk faktörleri olarak J.Neurol.Sci.[Turk] 2 saptandı. Cox-regresyon analizinde fazla miktarda triptan ve NSAID alımı, acılı ve baharatlı beslenme tarzı ve allodini varlığı anlamlı risk faktörleri olarak bulundu. Sonuç: Fazla miktarda çay tüketimi, acılı ve baharatlı beslenme migrenin kronikleşmesi ve progresyonunda yeni risk faktörleri olarak ortaya kondu. Kilo alımı en önemli risk faktörlerinden biridir. Hastalar migrenin kronikleşmesinin ve progresyonunun önlenmesi için risk faktörleri konusunda uyarılmalıdırlar

The purpose of the present study was to determine whether the axes aligned with the sulcus between the tibial spines and the middle of the posterior cruciate ligament at the knee and with the tibialis anterior tendon at the ankle provide a neutral rotational and coronal alignment of the tibial component in total knee arthroplasty (TKA). In a cohort of 45 TKA patients, CT scans were taken to quantify coronal and rotational positioning of the components. All patients received a posterior stabilised total knee replacement with a fixed insert (PFC Sigma; DePuy Orthopaedics, Inc; Warsaw, IN, USA). The tibial guide was aligned with the sulcus between the tibial spines and the middle of the posterior cruciate ligament at the knee and with the tibialis anterior tendon at the ankle. The average post-operative coronal mechanical alignment was 1A degrees varus (range 4.5A degrees varus-1.5A degrees valgus; SD +/- 1.51). The average post-operative rotational deviation from the transepicondylar axes (TEA) was 0.78A degrees of internal rotation (1.50A degrees of internal rotation - 3.5A degrees of external rotation) for the tibial component. The whole-extremity mechanical axis deviation was outside the tolerance range of 3A degrees in 4 patients (8.9 %). Deviation of the tibial component rotational position relative to the TEA was 3A degrees or less in 94.5 % of the patients. When the tibial component is aligned using the axis drawn from the centre of the PCL to the sulcus between the tibial spines on the proximal tibia and to the tibialis anterior tendon at the ankle, good alignment will be achieved in both the coronal and axial planes.

Objectives: In this study, we investigated the rate of the clinical and radiographic findings of femoroacetabular impingement (FAI) in patients with chronic hip pain and compared the findings with those of a control group. Patients and methods: The clinical and radiographic findings of FAI in 38 patients (group 1) having hip pain for more than three months were analyzed and compared with 42 controls (group 2). Internal rotation degrees were measured while the hips were at 90 flexion and impingement test was performed by rotating the hips internally at 90 flexion and adduction. The FAI findings were investigated on anteroposterior pelvis radiographs and cross-tablelateral radiographs of the hip joint in both groups. The collum-diaphyseal angle, alpha angle and anterior offset ratio on the femoral side and the center-edge angle, acetabular index, extrusion index and crossover sign on the acetabular side were evaluated. Results: The internal rotation degree of the painful hips were less than 20 degrees degree in 18 (47.4%) patients in group 1 and in one (2.4%) patient in group 2 (p

Radiographic findings of femoroacetabular impingement in the contralateral asymptomatic hip of patients who had undergone total hip arthroplasty because of primary osteoarthritis (n = 44) were compared with controls (n = 40). The centre-edge angle and caput-collum-diaphyseal angle were measured and the presence of crossover sign and a prominent ischial spine noted on anteroposterior radiographs of the pelvis. The alpha-angle and offset ratio were measured on cross-table lateral radiographs of the hip. The centre-edge angle and offset ratio were significantly lower and the alpha-angle significantly higher in the study group compared with controls. While the number of cases with an abnormal centre-edge angle was similar in both groups, the numbers with an alpha-angle > 50 degrees and the number with an offset ratio

In this multi-centered study, we aimed to evaluate the distributional incidence of rotavirus acute gastroenteritis (RVAGE) according to age groups and epidemiological features of hospitalized and outpatient cases in the city center of Bursa, Turkey. This study was carried out in a multi-centered setting that included the four largest hospitals dealing with more than 90% of the pediatric population in Bursa. Children under 15 years old with acute gastroenteritis (AGE) were included in the study. During a period of one year, all of the hospitalized AGE cases and initially one out of 15 systematically determined outpatient cases with AGE were included in the study. RV diagnosis was made by using monoclonal RV antigen kits (BioMerieux, France) in fresh stool. Of 542,199 annual general hospital visits in those four hospitals, 5,988 were diagnosed with AGE (1.1%). The annual general AGE incidence in children under 15 years of age was found to be 1.7% per year. The annual incidence of RVAGE was 2.8%, 2.5%, 1.5%, and 0.14% in the cases aged

Background and Design: Pityriasis rosea (PR) is an acute onset, self-limiting papulosquamous skin disease. The etiology of the disease is totally unknown, however, many epidemiological and clinical studies have suggested that infectious agents may cause the disease. Seasonal changes in the incidence may be an epidemiologic evidence for potential infectious etiology. In this study, we aimed to analyze the demographic data of PR patients and to explore the role of climatic factors in the etiology of the disease. Material and Method: We retrospectively reviewed the patient files of PR cases that had been followed up in our clinic between 2000 and 2005. Demographic data of the patients as well as the date of applications were recorded. Temperature, raining, pressure and humidity data for the City of Bursa for years 2000-2005 were obtained from the General Directorate of Meteorology, Republic of Turkey. Any potential relationship between onset time of PR and meteorological parameters was investigated statistically by using cluster analysis. Results: We reviewed the medical records of 413 patients, of whom 271 were female and 142 were male. Herald plaque was seen in 88 patients (21.3%). Pityriasis rosea was observed predominantly in persons between 20 and 29 years of age (139 patients; 33.6%). Distribution of number of cases between 2000-2005 was 51, 57, 80, 75, 63, 87. The highest number of patients was seen in winter (n:122; 29.5%) followed by spring (n:101; 24.4%), autumn (n:101; 24.4%) and summer (n:89; 21.7%). No statistically significant difference was found between annual and seasonal changes in the incidence of PR (p>0.05). Conclusion: We conclude that although the relation between PR and seasonal factors was not statistically significant in our study, multi-centric studies on large series of patients are needed to further investigate this topic.

In this study, we aimed to (1) propose landmarks for the hippocampus in a rat brain using an experimental study and (2) investigate hippocampus shape changes in a rat brain with epilepsy using the statistical shape analysis method. We have used the statistical shape analysis method to illustrate hippocampal shape deformation due to epilepsy. Statistical shape analysis is of increasing interest to the neuroimaging community because of its potential for locating morphological changes. Nineteen rat brains (ten healthy and nine epileptic) with hematoxylin and eosin images of the hippocampus were used. The results strongly indicated that the normalized hippocampal shape of the epileptic group was different from the nonepileptic group; deformation was seen most significantly in the medial regions of the cornu ammonis (CA1 and CA3) of the hippocampus. In conclusion, our landmark-based methodology detected regional differences in the hippocampus in epilepsy. This study may serve as an initial reference for future studies on shape alteration of the hippocampus associated with certain medical conditions.

The aim of this study was to determine changes in the incidence of nosocomial candidaemia and to evaluate the risk factors, demographic features, treatment and clinical outcome associated with candidaemia in a Turkish tertiary care paediatric unit within a 9-year period. The data of children who were diagnosed as nosocomial candidaemia, were examined in this study. Between January 1997 and December 2005, a total of 102 nosocomial candidaemia episodes were identified in 102 patients. The rate of nosocomial candidaemia in our clinic increased from 3.2 cases per 1000 admissions in 1997-1999, to 5.5 per 1000 admissions in 2000-2002 and to 6.9 per 1000 admissions in 2003-2005 (P = 0.003). The species most frequently causing candidaemia were Candida albicans (39.2%), Candida parapsilosis (21.6%) and Candida tropicalis (15.7%). The mortality of C. albicans (37.5%), was significantly higher than the mortality of non-albicans species (17.7%) (P = 0.04). Independent risk factors associated with candidaemia-related deaths by logistic regression analysis were disseminated candidiasis (odds ratio, 5.7; P = 0.01), paediatric intensive care unit stay (odds ratio, 8.1; P = 0.001), prolonged antibiotics therapy (odds ratio, 5.2; P = 0.014), use of total parenteral nutrition (odds ratio, 4.4; P = 0.038) and mechanical ventilation (odds ratio, 4.9; P = 0.01). The rate of nosocomial candidaemia in our clinic increased >2-fold during the study period.

Patients with psychogenic nonepileptic seizures (PNESs) or pseudoseizures are known to have psychiatric comorbidities. In the present retrospective analysis, we examined the sociodemographics, clinical characteristics, and psychiatric diagnoses of patients with PNESs. Our aim is to demonstrate the contribution of the consulting psychiatrists to the presumed psychiatric diagnoses of the neurologists. We used data from long-term video EEG monitoring (LVEM) performed at a specialized epilepsy center in Turkey. The study group comprised 67 patients (mean age: 30years, 75% female) diagnosed with PNESs following LVEM of approximately 5 days’ duration. Two hundred thirty-three episodes were recorded. Most of the patients experienced a PNES on the first day. All of the patients were taking antiepileptic drugs (AEDs) at the time of admission; 56.7% were taking antidepressant (AD) drugs. All of the PNES patients were diagnosed with conversion disorder by both the neurologists and the psychiatrists. Most of the PNES patients were using multiple AEDs. Cooperation between neurologists and psychiatrists and ongoing education for both neurologists and psychiatrists about PNES are needed in appropriate diagnosing and management of patients with PNES.