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INTRODUCTION: The authors aimed to evaluate the outcomes of free flap reconstructions performed for intraoral region in a single center.METHODS: Eleven free flaps have been performed for defects of the head and neck over a 4-year period. The patients were evaluated in terms of defects, flaps performed, complications and hospital stays.RESULTS: Seven patients were reconstructed with radial forearm free flap, one patient was reconstructed with free transverse rectus abdominis musculocutaneous flap, two patients were reconstructed with free vertical rectus abdominis musculocutaneous flap and the remaining one was reconstructed with free fibula osteomusculocutaneos flap. None of the flaps required reexploration for anastomotic thrombosis or hematoma. No flap failure occurred. We did not encounter any mortality or major morbidity. The average hospital stay was 21.1 days with a range from 11 to 25 days. DISCUSSION AND CONCLUSION: Multidisciplinary approach should be encouraged for the reconstruction of intraoral defects. The versatility of free tissue transfers allows reconstruction of most complex defects; although it carries significant risks, including longer operative times, donor site morbidity, recipient site complications and microsurgical failure, and longer hospital stays.

Anterior septal height is an important determinant of nasal tip projection. Accordingly, the anterior septal extension technique has proven itself to be a powerful tool for achieving long-lasting nasal tip projection in rhinoplasty. However, anterior septal extension does not protect against postoperative loss of nasal tip rotation unless an additional suspension strategy is used. A tip-suspending transfixion suture is the authors’ strategy for supporting nasal tip rotation whenever an anterior septal extension technique is performed. Of 156 rhinoplasties performed by the authors between 2010 and 2012, a cohort of 22 droopy-tip rhinoplasties was extracted in which the described technique was used. The patients in this cohort were included in a retrospective nasal tip projection and rotation analysis. The nasolabial angle (NLA) and Goode ratio measurements were compared between preoperative, 3-week postoperative, and 1-year postoperative profile-view photographs. The NLA and the Goode ratio measurements were significantly higher in the 3-week postoperative group than in the preoperative group, indicating an effective gain in both tip projection and rotation. The NLA and the Goode ratio measurements did not differ statistically between the postoperative 3-week and postoperative 1-year groups, indicating long-term maintenance of nasal tip position. A tip-suspending transfixion suture is an easy method for securing nasal tip rotation when used in conjunction with an anterior septal extension. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

WOS: 000340684700009 PubMed: 24519672 The objective of the current study was to determine the prevalence and the degree of iodine deficiency after mandatory salt iodization in Yigilca's school-aged children. A total of 806 school children aged 6-19 years were evaluated. The prevalence of goiter in children aged 6-12 and 13-19 years was 20.3 and 23.8%, respectively. The prevalence of hypothyroidism in children aged 6-12 and 13-19 years was 10.4 and 18.9%, respectively. The median serum free tetraiodothyronine (fT4) levels in children aged 6-12 and 13-19-years were 1.16 ng/dL and 0.91 ng/dL, respectively. The median urinary iodine concentration levels in children aged 6-12 and 13-19 years were 83 mu g/l and 78 mu g/l, respectively. The frequency of autoimmune thyroid disease was 2.1% in Yigilca's SAC. Goiter and iodine deficiency problems remain in rural areas of the West Black Sea Region of Turkey.

Sentinel lymph node biopsy (SLNB) is a staging procedure used to determine the nodal status of patients with melanoma. It has a significantly lower complication rate compared with elective lymph node dissection. SLNB is not recommended for very thin lesions (Breslow thickness ≤ 0.75 mm). The combined lymphatic mapping technique of technetium sulfur colloid with vital blue dye would result in identification of the sentinel node in 99% of patients when performed correctly. SLNB is the single most important prognostic factor in melanoma patients without clinical evidence of nodal metastasis Currently, micrometastatic disease found on SLNB is an indication for completion lymph node dissection. In this review, both current literature and ongoing debates considering SLNB are discussed., Sentinel lenf nodu biyopsisi (SLNB), malign melanomalı hastaların lenf nodlarının durumunu belirlemek için kullanılan bir evreleme prosedürüdür. Elektif lenf nodu diseksiyonuna göre çok daha az komplikasyon riski bulunmaktadır. SLNB, Breslow kalınlığı

Background: The pigment density and texture of breast skin are not uniform. Especially in patients with massive breasts, lower pole skin can be significantly darker and coarser than the upper pole skin. Nipple areola reconstructing (NAR) reduction mammaplasty is a technical modification of the “free nipple” procedure in which the original nipple areola complex (NAC) is discarded and the new NAC is reconstructed from coarse pigmented lower pole skin using a modified skate flap purse-string technique. Objectives: The authors review their initial clinical experience with NAR reduction mammaplasty. Methods: Between 2010 and 2012, 16 patients (31 breasts) underwent the NAR procedure, and these cases were retrospectively reviewed for patient demographics, preoperative topographic breast measurements, amount of reduction per breast, and complications. The operative goal was to obtain the smallest breast size that can be achieved with tension-free wound closure. Patient satisfaction was also assessed. Results: Breast reductions varied from 1150 to 2850 g/breast (average, 1590 g/breast), and patients were followed up for a minimum of 1 year (average, 15.9 months). No major local or systemic complications were encountered. Two patients required touch-ups for the correction of minor periareolar irregularities resulting mainly from the inversion of wound closure. At 1 year, average score for general satisfaction was 4.6, and the average score for NAC satisfaction was 3.9, on a scale from 1 (not satisfied) to 5 (extremely satisfied). Conclusions: NAR reduction mammaplasty enables the surgeon to perform massive reductions, design different non–NAC-bearing glandular pedicles for breast shaping, and obtain tension-free closure without the fear of ischemic complications. Level of Evidence: 4 ![Graphic][1] [1]: /embed/inline-graphic-1.gif

Objective: In this study, it was hypothesized that sol-gel silver coated titanium implants showed a better antibacterial activity compared to standard titanium implants in contaminated surgical fields. Material and Methods: Twenty four New Zelland Albino rabbits were used in the experiment. Right knees of the rabbits were determined as the control group and left knees were determined as the experiment group. Total knee replacement arthroplasty was performed by using a custom made titanium implant the control group. In the experiment group the same procedure was performed by using sol-gel antibacterial silver coated titanium implants. Following implantation, both groups were inoculated with bacterial suspensions containing standardised bacterial loads of S. aureus and P. aeruginosa. Animals were observed for general condition, body temperature, weight and clinical signs of implant infection for 12 weeks. Clinical signs of infection were further evaluated with microbiological tests. Results: Total infection rates, S. aureus-specific infection rates and P. aeruginosa-specific infection rates were significantly lower in sol-gel silver coated titanium implants. No statistically significant difference was found between the groups in terms of subclinical infection rates. Conclusion: We concluded that sol-gel silver coating of the titanium implants was effective against two common agents causing implant infections.

birikimine, demokratik geleneklerin yerleşmesine ve hükümet uygulamalarının denetlenmesine yardımcı olan hükümet programları üzerinde bugüne değin ayrıntılı bir çalışma yapılmamıştır. Bu konuda yapılan çalışmalar cumhuriyet dönemiyle sınırlı kalmıştır. Biz bu çalışmamızda biraz daha gerilere giderek II. Meşrutiyetten Cumhuriyetin ilanına uzanan zaman dilimi içindeki “Hükümetleri ve Hükümet Programlarını” gün ışığına çıkarıp araştırmacıların bilgisine sunacağız.”İhsan Güneş, Meşrutiyet’ten Cumhuriyet’e Türkiye’de Hükümetler Programları ve Meclisteki Yankıları , Türkiye İş Bankası Kültür Yayınları, İstanbul, 2012, s.XIII

Osmanli Devleti Birinci Dunya Savasi’nda yenilmis ve Mondros Mutarekesi’ni imzalamasinin ardindan, topraklari Itilaf Devletleri tarafindan isgal edilmistir. Turk milletinin isgale karsi yuruttugu basarili mucadeleden sonra, Mudanya Mutarekesi imzalanmis ve Anadolu’daki sicak catisma sona ermistir. Sonrasinda ise bir baris antlasmasi yapilabilmesi icin Isvicre’nin Lozan sehrinde konferans toplanmasina karar verilmistir. Konferansa katilacak heyet, Turklerin bagimsizlik mucadelesinin hedefi olan Misak-i Milli ilkelerini Itilaf Devletleri’ne kabul ettirebilmek amaciyla Lozan’a dogru yola cikmistir. Turkiye’nin bu andan itibaren diplomatik faaliyetleri de baslamistir. 13 Kasim’da toplanmasi gereken konferans ertelenmesine karsin, Turk heyeti geri donmemis ve Lozan Konferansi’nin toplandigi 22 Kasim’a kadar bu durumdan lehine bir sonuc cikarmak icin calismistir. Heyet baskani Ismet Pasa resmi ya da gayri resmi her turlu diplomatik girisimleri ve demecleri sirasinda, Turklerin baristan yana oldugunu, baris masasindaki gorusmelerde Turkler icin Misak-i Milli belgesinin temel olusturacagini soylemistir. Lozan Konferansi oncesinde yurutulen bu tur diplomatik faaliyetler, taraflarin birbirlerini tanimalarini saglamistir. Turkiye asla taviz vermeyecegi konulari duyurabilmis ve sergiledigi baristan yana tutumuyla, lehine bir kamuoyu yaratmaya calismistir.

Prolonged mean life expectancy gives rise to a more populated and older patient group. With increasing number of cases during the past decades, older patients are regarded as candidates for microsurgical interventions. Whether advanced patient age is an independent risk factor for microsurgical reconstruction is still an ongoing matter of debate.The Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, CINAHL and EMBASE databases were screened for combination of the key words "elderly", "geriatric", "advanced age", "free flap", "microsurgery", free tissue transfer" by using time limits between 1989 and 2015.According to results of the meta-analysis, there was no significant difference in the flap success rates(P =.39, CI = 0.848 to 2.329) and surgical complication rates (P = .83, CI = 0.792 to 1.163) between the young and elderly patient groups. However, the systemic complication rates(P = .02, CI = 1.468 to 3.572), preoperative ASA scores(P .0001, CI = 0.342 to 1.078), and mortality rates (P = .03, CI = 2.636 to 9.055) were found to be significantly higher in the elderly patients.Although an increased rate of systemic complications and mortality has been associated with advanced age, our study results showed no significant difference between the flap success rates and surgical complications. A successful reduction in systemic complications would bring the risk level of reconstructive microsurgical interventions of the elderly patient group to the level of the young patient group. © 2017 Wiley Periodicals, Inc. Microsurgery 37:442-450, 2017.

A novel microvascular anastomosis technique is described. Forty-five male Sprague-Dawley rats were divided equally into three groups before undergoing femoral artery anastomosis. The first group received standard eight-suture anastomotic repair. Group 2 (muscle group) received three sutures plus autogenous muscle graft wrapped around the anastomosis. In group 3 (fascial surface group), a muscle graft was wrapped around the anastomosis with the fascial side of the graft facing the anastomosis. Significantly less time and suture usage were noted using both fascial surface and muscle groups compared with controls (p0.05). No significant difference regarding patency rates or aneurysm formation existed among the three groups (p0.05). Additionally, grade 2 anastomotic leakage was less frequent in the study groups compared with the control group (p0.05). This new microvascular anastomosis technique took less time and achieved better performance than standard anastomotic repair.

Background: Acute brucellosis is a zoonotic disease seen in childhood, with non-specific complaints and clinical findings that can affect the locomotor, gastrointestinal, genitourinary, hematologic, cardiovascular, respiratory, and central nervous systems. Particularly in endemic regions, it occurs as a result of consumption of unpasteurized milk and dairy products. In this study, clinical and laboratory findings of children with acute brucellosis are presented. Methods: Data for 147 patients, aged 2–16 years, were evaluated retrospectively. Results: The most frequent complaints and clinical findings were abdominal pain and fever. Other complaints and clinical findings included arthralgia, myalgia, loss of appetite, weakness, sweating, fatigue, headache, arthritis, hepatomegaly, and splenomegaly. Anemia was the most frequent hematological abnormality detected; other abnormalities included leukopenia, thrombocytopenia, and pancytopenia. Conclusion: Childhood brucellosis can cause non-specific complaints and particularly anemia and leukopenia as hematological abnormalities. It is easily treated, however, with appropriate antibiotics.

Sphingomonas paucimobilis is a gram negative, nonfermentative, oxidase positive, very slow acting bacillus. In species of Sphingomonas, S. paucimobilis, known as a pathogen, is a rare cause of nosocomial infection. S. paucimobilis is isolated from distilled water, labs, nebulizers, mechanical ventilators and dialysis liquids in hospital. S. paucimobilis is reported to have caused infection among the patients which have chronic disease or a weak immune system, and alcoholics and drug users. In this case we presented a three year old girl patient, diagnosed with nephrolithiasis, who had S. paucimobilis her blood culture which was taken because of fever, chills and right costovertebral angle sensitivity on the 11th day. (J Pediatr Inf 2013; 7: 000-000)

Background Craniofacial structures have an intimate relationship with the central nervous system in the embryologic development period and the developmental abnormalities of the face and skull that are frequently associated with malformations of the central nervous system. Additional intracranial and extracranial malformations in a patient with craniofacial deformity may negatively affect the outcome of the surgery and the quality of life. Patients and methods A retrospective analysis of a total of 123 patients with craniofacial anomalies was performed. Physical examination notes, ophthalmologic findings, computed tomography, and magnetic resonance imaging reports were retrospectively analyzed, and intracranial and extracranial malformations and ophthalmologic problems in each group were categorized. Results Of the patients with nonsyndromic craniosynostosis, 29% had intracranial and extracranial malformations. Of them, 17% had ophthalmologic problems. Of the patients with syndromic craniosynostosis, 34% had intracranial and 31% had extracranial malformations. In the patients with craniofacial cleft, 60% had intracranial and 30% had extracranial malformations. The most common intracranial malformations are hydrocephaly, Chiari type 1 malformation, and corpus callosum disorders. Conclusions A multidisciplinary approach is essential in the evaluation and follow-up of individuals with craniofacial abnormalities. Conventional radiography and three-dimensional computed tomography of the bony skeleton and axial scanning of the soft tissues is our first-step routine. Brain magnetic resonance imaging should be performed in patients with multiple-suture synostosis, syndromic synostosis, and craniofacial clefts to rule out central nervous system and soft tissue malformations. During the postoperative first year, conventional x-rays are sufficient to evaluate the craniofacial area. Central nervous system disorders may cause major headaches, muscle weakness, hearing problems, extreme fatigue, poor motor coordination, and cognitive and social disabilities even when their intelligence quotient is normal. Therefore, every effort should be performed to search and treat additional malformations. Prevention of additional morbidities improves surgical and social outcomes.

Postoperative changes following superior pedicle breast reduction are closely related to the pattern of skin resection. We have observed that the superior pedicle, short horizontal scar breast reduction technique provides a stable breast shape in the long term. We test the validity of our clinical observations through objective analysis of postoperative dimensional changes following superior pedicle, short horizontal scar breast reduction. Of 42 patients who underwent superior pedicle, short horizontal scar breast reductions between January 2011 and June 2012, 38 (75 breasts) were available for long-term follow-up. The midclavicular point-to-superior areolar border distance (A), the inferior areolar border-to-inframammary fold (IMF) distance (B), and the areolar diameter (C) were measured and recorded at the time of (1) preoperative markings, (2) first postoperative visit, and (3) 2-year postoperative follow-up visit. The specifications of the preoperative markings were recorded to analyze their correlation with actual breast dimensions. The superior border of the nipple–areola complex (NAC) was located, on average, 1.2 cm higher at the first postoperative visit when compared with the markings (P

Basal and squamous cell carcinomas are the most common malignant cutaneous lesions affecting the nose. With the rising incidence of skin cancers, plastic surgeons increasingly face nasal reconstruction challenges. Although multiple options exist, optimal results are obtained when "like is used to repair like". We aimed to introduce a simple algorithm for the reconstruction of nasal defects with local flaps, realizing that there is always more than one option for reconstruction.We retrospectively reviewed 163 patients who underwent nasal reconstruction after excision of non-melanoma skin cancer between March 2011 and April 2014. We analyzed the location of the defects and correlated them with the techniques used to reconstruct them.There were 66 males and 97 females (age, 21-98 years). Basal cell carcinoma was diagnosed in 121 patients and squamous cell carcinoma in 42. After tumor excision, all the defects were immediately closed by either primary closure or local flap options such as Limberg, Miter, glabellar, bilobed, nasolabial, V-Y advancement, and forehead flaps.Obtaining tumor-free borders and a pleasing aesthetic result are major concerns in nasal reconstruction. Defect reconstruction and cosmesis are as important as rapid recovery and quick return to normal daily activities, and these should be considered before performing any procedure, particularly in elderly patients.

The domestication of the Eurasian grape (Vitis vinifera ssp. sativa) from its wild ancestor (Vitis vinifera ssp. sylvestris) has long been claimed to have occurred in Transcaucasia where its greatest genetic diversity is found and where very early archaeological evidence, including grape pips and artefacts of a 'wine culture', have been excavated. Whether from Transcaucasia or the nearby Taurus or Zagros Mountains, it is hypothesized that this wine culture spread southwards and eventually westwards around the Mediterranean basin, together with the transplantation of cultivated grape cuttings. However, the existence of morphological differentiation between cultivars from eastern and western ends of the modern distribution of the Eurasian grape suggests the existence of different genetic contribution from local sylvestris populations or multilocal selection and domestication of sylvestris genotypes. To tackle this issue, we analysed chlorotype variation and distribution in 1201 samples of sylvestris and sativa genotypes from the whole area of the species' distribution and studied their genetic relationships. The results suggest the existence of at least two important origins for the cultivated germplasm, one in the Near East and another in the western Mediterranean region, the latter of which gave rise to many of the current Western European cultivars. Indeed, over 70% of the Iberian Peninsula cultivars display chlorotypes that are only compatible with their having derived from western sylvestris populations.

Lymphomatous involvement of the ileum is rare and vey rarer is its presentation as appendicitis. Non-Hodgkin lymphoma is a high grade neoplasm. Lymphoblastic lymphoma is a common subtype of non-Hodgkin's lymphoma in childhood, accounts for approximately 30% of cases and typically presents as abdominal mass in children. This rapidly growing tumor may cause symptoms due to mass effect or direct involvement of the intestine. Clinical presentations like acute abdomen can be secondary to intestinal obstruction, intussusceptions or even sometimes perforation. We describe, here a case of a boy with an unusual presentation of Non-Hodgkin lymphoma mimicking acute appendicitis. Especially in patients with recurrent abdominal pain, the opinion of abdominal tomography evaluation is very useful., İleumun lenfomatöz tutulumu nadirdir ve daha nadiri de apandisit olarak tanı konulmasıdır. Non-hodgkin lenfoma bir yüksek dereceli tümörlerdir. Lenfoblastik lenfoma, çocukluk dönemindeki non-Hodgkin lenfomaların en sık görülen alt tiplerinden biridir ve vakaların yaklaşık % 30 ünü kapsar. Genellikle çocuklarda karında kitle şeklinde ortaya çıkar. Bu hızla büyüyen tümör, kitle etkisi veya doğrudan bağırsak tutulumuna bağlı belirtilere neden olabilir. Kliniği akut karını taklit ederek bağırsak tıkanıklığı, invajinasyon veya bazen perforasyon şeklinde olabilir. Biz burada alışılmadık bir şekilde apandisiti taklit eden ileumun non-hodgkin lenfomalı bir erkek çocuk olgu sunmak istedik. Özellikle tekrarlayan karın ağrısı olan olgularda karın tomografisi ile değerlendirmenin çok faydalı olduğu kanısındayız.

OBJECTIVE: In this study, authors aimed to retrospectivcely analyse the surgeries performed for basal cell carcinoma (BCC) in Ankara Oncology Hospital and they also aimed to settle the principles for diagnosis and treatment of BCC through the experiences gained.METHODS: 7018 patients, excluding the trauma cases, were admitted to plastic, reconstructive and aesthetic surgery clinic between 2010 and 2012. 423 patients with the diagnosis of BCC were retrospectively reviewed by means of sex, age, symptom, location, type of surgery and recurrence.RESULTS: The patients who were operated for BCC constituted 6% of the patients who admitted to Plastic and Reconstructive surgery clinic. 63.1% of the patients was male and 39.6% was female. 491 malignant tumor excisions were performed from the patients. It was seen that the lesions were most commonly located on head and neck region (89,2%). 26.2% of the patients was treated with excision and primary closure. 64.3% of the patients was treated with excision and local flap. 9.5% of the patients was treated with excision and grafting. Of the patients who were operated, 1.9% had recurrence and 9 patients were reoperated due to residual tumor.CONCLUSION: Our study reflects the 2-year experience of our clinic. Early diagnosis and treatment are very important to prevent the spread of the lesions and to decrease the recurrence. We should always work in coordination with radiation oncology department. Executing these kind of studies provides standardization of the principles for the diagnosis and treatment., AMAÇ: Bu çalışma ile Ankara Onkoloji Hastanesi'nde gerçekleştirilen bazal hücreli karsinoma (BHK) ameliyatlarını retrospektif olarak değerlendirmek ve elde edilen deneyim sonucunda tanı ve tedavi prensiplerini oluşturmak amaçlandı.YÖNTEMLER: 2010-2012 yılları arasında plastik, rekonstrüktif ve estetik cerrahi polikliniğine, travma hastaları hariç, 7018 hasta başvurdu. BHK tanısı ile ameliyat edilen 423 hastanın dosyaları ve patoloji raporları retrospektif olarak ve cinsiyet, yaş, semptom, lokalizasyon, uygulanan cerrahi yöntem, rekürrens gibi değişkenler göz önüne alınarak tarandı.BULGULAR: BHK nedeniyle ameliyat edilen hastalar, plastik, rekonstrüktif ve estetik cerrahi polikliniğine başvuran hastaların %6’sını oluşturdular. Hastaların %63,1’i erkek, %36,9’u kadındı. Ameliyat edilen hastalardan toplam 491 malign lezyon eksizyonu yapıldı. Lezyonların en sık baş boyun bölgesinde yerleştiği görüldü (%89,2). Hastaların %26,2’si eksizyon ve primer onarım ile, %64,3’ü eksizyon ve lokal flep ile, %9,5’i eksizyon ve greftleme ile tedavi edildi. Ameliyat sonrası tüm hastaların %1,9’unda rekürrens saptandı ve 9 hasta rezidü tümör nedeniyle yeniden ameliyat edildi.SONUÇ: Çalışmamız kliniğimizin 2 yıllık tecrübesini yansıtmaktadır. Erken tanı ve tedavi lezyonların yayılımının engellenmesi ve rekürrensin azaltılması açısından çok önemlidir. Radyasyon onkolojisi bölümü ile koordinasyon halinde çalışılmalıdır. Buna benzer çalışmaların yapılması, tanı ve tedavi prensiplerinin standardize edilmesini sağlamaktadır.

Wild grapevine was investigated in the southwestern part of Turkey where 114 accessions were collected from forestsandbanks of the rivers. These grapes are called “Jackal grapes” by villagers. Wild grapes a small, black and nearly round berries. They had two or more seeds. Berry weight did not exceed lg. Cluster mean weight was 33.5 g and clusters were smaller in size than those of cultivated grapes with about 40 berries per cluster. Wild grapes had a broad range of leaf shape and size. Leaf width was greater than leaf length and leaves had 3 or 5 lobes. Length of petiole was smaller than midvein. All accessions were subjected to isozymic analysis. Acid phosphatase (ACP), Catechol oxidase(CO), Glutamate oxalacetate transaminase(GOT), Malate dehydrogenase(MDH), and peroxidase(PER) enzymes were extracted from mature leaves. Electrophoresis was performed in vertical Polyacrylamide slab gels (PAGE). Isoenzyme polymorphism was observed for all enzyme systems studied except GOT. This enzyme has only two...

Age-related changes in proliferative activity in human gingival epithelium are uncertain. Proliferating cell nuclear antigen (PCNA) is a nuclear protein associated with the cell cycle. Nuclear PCNA immunoreactivity is found in the proliferative compartment of normal tissues. The aims of this study were to investigate the localization of PCNA expression in oral gingival epithelium (OGE) and to define the age-related changes as to PCNA-proliferative index (PI) in inflamed as well as healthy gingiva. Mitotic index (MI) was also used as a conventional marker of cell proliferation. Additionally, the effect of aging upon the maximum epithelial thickness (MET) was determined.Twenty older (65 to 85 years) (study) and 20 middle-aged (35 to 45 years) (controls) subjects were included in the study. Biopsies were obtained both from healthy and inflamed gingiva. The expression of PCNA was evaluated in formalin-fixed, paraffin-embedded gingival samples using an immunoperoxidase technique and PC 10 monoclonal antibody to PCNA. Hematoxylin and eosin stained sections were used for the quantitative measurement of MI and MET.All the tissue sections contained positive staining cells for PCNA in the gingival epithelium. Although PCNA expression was observed both in the basal and suprabasal layers, it was more prominent in the suprabasal layers. PI in inflamed gingiva was significantly higher in the older group. However, no significant difference was observed between the study and control groups with respect to PI in healthy gingiva. When all the subjects taken into the study were analyzed as a single group, PI in the inflamed gingival samples were found to be increased with aging. Nevertheless, no age-related change was noted in MI and MET. In both the study and the control groups, PI, MI, and MET were found to be increased due to inflammation.Our data indicate that PCNA expression in inflamed gingiva is higher in older subjects. Furthermore, a significant correlation was noted between aging and PCNA expression in inflamed gingiva. As there is no increase in mucosal epithelial thickness despite increased proliferation, we speculate that the duration of the PCNA+ phase in cell cycle may be longer in older subjects. This study also implies that PCNA immunolocalization can be used as an index of the state of cell proliferation in both biological and pathological events of the gingiva and/or other mucosal tissues.

Ataturk’un olumu, Turkiye’de ve dunyada buyuk bir yanki uyandirmis, kendisine Ankara’da, 21 Kasim 1938’de bir cenaze toreni duzenlenmistir. Cenaze, Ankara’ya nakledilmeden once, Istanbullularin Ataturk’e saygisini sunabilmesi icin, Dolmabahce Sarayi’nda 3 gun sureyle kalmistir. Ayrica cenaze Ankara’ya goturulene kadar, yol boyunca gectigi yerlerde bulunan halk ve Ankaralilar tarafindan da derin bir uzuntu ve saygiyla karsilanmis, torene dunya capinda bir katilim olmustur. Bu durum, Ataturk’le halki arasindaki iliskiyi ve Turkiye’nin dunyadaki sayginligini gostermesi acisindan oldukca onemli ve anlamlidir

WOS: 000348316800043, PubMed: 25483487, Successful vaccination policies for protection from bacterial meningitis are dependent on determination of the etiology of bacterial meningitis. Cerebrospinal fluid (CSF) samples were obtained prospectively from children from 1 month to, Novartis Vaccines and Diagnostics; GlaxoSmithKlineGlaxoSmithKline, The study was supported by Novartis Vaccines and Diagnostics (for 5 years) and by GlaxoSmithKline (for 2 years). The authors declare that they have no other conflicts of interest.

Angiotensin-converting enzyme inhibitors are widely used in medicine because of their antihypertensive and antifibrogenic effects. Angiotensin-converting enzyme activates angiotensin I to angiotensin II, which plays an important regulatory role in wound healing and collagen production. The authors investigated whether systemic administration of angiotensin-converting enzyme inhibitors has any effect on formation of hypertrophic scars using the rabbit ear wound model.Sixteen New Zealand albino rabbits were divided into four groups, and four punch defects were created on each ear. The first group received oral enalapril immediately after the creation of punch defects. The second group received oral enalapril on day 28 after the formation of scars. The third group received intralesional steroid injections on days 28 and 35. The fourth group was the control group. The rabbits were killed on day 40. The harvested specimens were analyzed histomorphometrically and immunohistochemically.Early enalapril application decreased the scar elevation index and fibroblast and capillary counts significantly, compared with the values in the control group. Late enalapril application decreased fibroblast counts significantly; however, there was no difference in scar elevation index compared with the control group. There was no difference between early enalapril application and steroid therapy in terms of scar elevation index and capillary and fibroblast counts. However, early and late enalapril groups displayed lower collagen type III immunoreactivity compared with the steroid and control groups.Early application of enalapril following dermal injury reduces formation of hypertrophic scars, probably because of its down-regulatory effects on type III collagen production.

WOS: 000320857300004, PubMed ID: 23637041, Streptococcus pneumoniae is the most common etiological cause of complicated pneumonia, including empyema. In this study, we investigated the serotypes of S. pneumoniae that cause empyema in children. One hundred fifty-six children who were diagnosed with pneumonia complicated with empyema in 13 hospitals in seven geographic regions of Turkey between 2010 and 2012 were included in this study. Pleural fluid samples were collected by thoracentesis and tested for 14 serotypes/serogroups using a Bio-Plex multiplex antigen detection assay. The serotypes of S. pneumoniae were specified in 33 of 156 samples. The mean age +/- the standard deviation of the 33 patients was 6.17 +/- 3.54 years (range, 0.6 to 15 years). All of the children were unvaccinated according to the vaccination reports. Eighteen of the children were male, and 15 were female. The serotypes of the non-7-valent pneumococcal conjugated vaccine (non-PCV-7), serotype 1, serotype 5, and serotype 3, were detected in eight (14.5%), seven (12.7%), and five (9.1%) of the samples, respectively. Serotypes 1 and 5 were codetected in two samples. The remaining non-PCV- 7 serotypes were 8 (n = 3), 18 (n = 1), 19A (n = 1), and 7F/A (n = 1). PCV-7 serotypes 6B, 9V, 14, 19F, and 23F were detected in nine (16.3%) of the samples. The potential serotype coverages of PCV-7, PCV-10, and PCV-13 were 16.3%, 45.4%, and 60%, respectively. Pediatric parapneumonic empyema continues to be an important health problem despite the introduction of conjugated pneumococcal vaccines. Active surveillance studies are needed to monitor the change in S. pneumoniae serotypes that cause empyema in order to have a better selection of pneumococcal vaccines., GlaxoSmithKlineGlaxoSmithKline, The study was supported by GlaxoSmithKline.

There are several different causes of the deformities of the external auditory canal requiring reconstruction such as tumors, burns, trauma, and malformations. Many surgical approaches with varying success for the reconstruction of the external auditory canal (EAC) have been favored, including secondary healing, skin grafting, and a variety of local skin flaps. Unfortunately, the major drawback of the previously defined techniques is the resulting stenosis of the EAC. A 73-year-old white man was admitted to our clinic because of an unhealing ulcerated lesion at the superior and posterior one third of the left external auditory canal, involving the most internal part of the concha. Preserving the superior one third of the helix, left auricle and the EAC was surgically removed en bloc. To reconstruct the surgical defect, a snail flap was designed on the ipsilateral cervical region and based posteriorly on the left mastoid region. Twisting the flap on its main axis, as mentioned, created a final shape resembling a snail and a tube with epithelium-lined canal inside. At the postoperative first-year visit, the patient's endoscopic examination showed no sign of recurrence, tympanoplasty graft was intact, and the EAC was patent without signs of stenosis. Our experience with the laterocervical flap supports the fact that this flap does not cause stenosis, hearing loss, and therefore should be concerned as one of the first choices of treatment for the reconstruction of EAC.

WOS: 000307687000003 PubMed: 22976603 Purpose: This study was aimed to determine the effect of maximum voided volume (MVV) on the efficacy of desmopressin. which is commonly used to treat primary monosymptomatic nocturnal enuresis (PMNE) in children and adolescents. Materials and Methods: Bladder capacity was measured with different methods in 52 patients with PMNE, and the effect of bladder capacity on desmopressin therapy was investigated. Results: Patients with PMNE in whom MVV was 70% or less of estimated bladder capacity were found to be unresponsive to desmopressin therapy. Conclusion: The MVV can be measured before desmopressin therapy in patients with PMNE as a marker to predict treatment success. Our results suggest that desmopressin should not be used in patients with low MVV. (J Nippon Med Sch 2012; 79: 255-258)

Acute brucellosis is a zoonotic disease seen in childhood, with non-specific complaints and clinical findings that can affect the locomotor, gastrointestinal, genitourinary, hematologic, cardiovascular, respiratory, and central nervous systems. Particularly in endemic regions, it occurs as a result of consumption of unpasteurized milk and dairy products. In this study, clinical and laboratory findings of children with acute brucellosis are presented.Data for 147 patients, aged 2-16 years, were evaluated retrospectively.The most frequent complaints and clinical findings were abdominal pain and fever. Other complaints and clinical findings included arthralgia, myalgia, loss of appetite, weakness, sweating, fatigue, headache, arthritis, hepatomegaly, and splenomegaly. Anemia was the most frequent hematological abnormality detected; other abnormalities included leukopenia, thrombocytopenia, and pancytopenia.Childhood brucellosis can cause non-specific complaints and particularly anemia and leukopenia as hematological abnormalities. It is easily treated, however, with appropriate antibiotics.

Background Gastroesophageal reflux (GER) is a disorder that is common by seen in childhood and may lead to severe complications. In this study, we ascertained the incidence of GER among the children who had typical and atypical complaints of GER and whether there was a difference between two groups comparing the findings of 24-hour pH-meter. Methods 39 out of 70 patients with typical and atypical GER symptoms were diagnosed as GER by 24-hour pH-meter monitoring. The patients were divided into three groups, those having gastrointestinal complaints, those having respiratory complaints and those having both gastrointestinal and respiratory symptoms. Results Evaluated the GER prevalence in these groups, it was found to be 60% in the gastrointestinal group, 48.6% in the respiratory group and 75% in the mixed group. When pH-meter measurements of GER positive patients were compared within the clinical groups, the fraction of time that pH was lower than 4 was found to be significantly higher in the mixed group (p = 0.004). Conclusions The coexistence of gastrointestinal and respiratory symptoms in the patients with GER may be related to the severe reflux.

Hyperhomocysteinemia is an independent risk factor for atherothrombotic disease and venous thrombosis. The effects of hyperhomocysteinemia on the microcirculation were studied in vascular diseases. The authors aimed to investigate the effects of hyperhomocysteinemia on the microcirculation of random-pattern skin flaps.Twenty-two male Sprague-Dawley rats, divided into two groups, were used in this study. The rats in group 1 (control) were fed the TD.07112 diet, and the rats in group 2 (experimental group) were fed the TD.07114 diet, enriched in methionine for 30 days, to induce severe hyperhomocysteinemia. The plasma homocysteine, folic acid, vitamin B12, and vitamin B6 levels were evaluated on days 0 and 30. Distally based skin flaps were elevated on day 30 and evaluated by direct observation, microangiography, and light microscopy on day 37.Mean homocysteine blood levels were 211.76 ± 56.55 μM/liter in group 2 and 14.48 ± 2.00 μM/liter in group 1 on day 30. The rate of necrosis was significantly higher in group 2 (59.00 ± 4.38 percent) compared with group 1 (32.54 ± 6.13 percent; p0.01). Microangiographic findings were similar to direct observation results. Microvessel calibration was reduced in group 2. In group 1, structures of epidermis and dermis were normal; however, there was a slight mononuclear cell infiltration along with thick collagen fibers. A more prominent mononuclear cell infiltration with fields of loose epidermis, associated with inflammation and infiltration, were observed in group 2.The authors demonstrated, for the first time, that hyperhomocysteinemia severely suppressed the microvasculature of skin flaps, as shown by increased flap necrosis and reduced microvessel calibration in the experimental group.

WOS: 000277987300013, Objective: The aim of this study was to determine the distribution of uropathogens causing community-acquired urinary tract infections in Duzce, and their antimicrobial susceptibility patterns. Material and Methods: The study was conducted prospectively in the Duzce University Medical Faculty between July 2004-June 2006 and included outpatients. Identification of microbial growth and determination of antimicrobial susceptibility by the Kirby-Bauer disk diffusion technique were performed according to the Clinical and Laboratory Standards Institute. Results: In total, 702 bacterial isolates were examined in the study. E. coli (64.1%) was the most common urinary pathogen identified. Klebsiella spp. (9.0%), Proteus spp. (5.8%), Staphylococcus aureus (4.7%), Enterococcus spp. (4.3%), coagulase-negative Staphylococci (2.6%), S. agalactiae (2.1%) and P. aeruginosa (1.9%) were the next most common species isolated. Community acquired uropathogens isolated in our region were highly resistant to trimethoprim/sulfamethoxazole, amoxicillin and amoxicillin clavulanate. However, ciprofloxacin was active against pathogens examined in this study with susceptibilities between 64.7% and 88.8% for the most prevalent pathogens (E. coli, 81.0% susceptible). The susceptibility of gram-negative pathogens to the parenterall antibiotics seemed to be higher than the oral agents. Conclusion: Many oral antimicrobial agents do not seem to be appropriate for the empirical treatment of community-acquired urinary tract infections in our region due to very high rates of resistance. Some oral antibiotics such as ciprofloxacin and cefaclor should be used cautiously in adults.

dikici, bunyamin/0000-0001-7572-6525 WOS: 000268554900017 Malignant infantile osteopetrosis (MIOP) is a rare inherited bone disease characterized by reduced or dysregulated activity of osteoclasts, which results in generalized osteosclerosis. This leads to abnormal bone marrow cavity formation and to the clinical signs and symptoms of bone marrow failure and nerve compression. Symptoms related to early or late hypocalcemia may appear as the first presentation of MIOP in a newborn. We present a 14-day-old boy with neonatal hypocalcaemia due to MIOP.

WOS: 000270644400025 PubMed: 18824318 Objective: The aim of this study was to investigate the effect of fatty infiltration of the liver (FIL) on the Doppler waveform pattern in the hepatic veins of obese children. Methods: In this prospective study, 59 patients with diffuse FIL and 45 normal healthy children who served as control group underwent hepatic vein B-mod and duplex Doppler sonography. The Doppler sonography spectrum of the right hepatic vein was classified into three groups: triphasic waveform, biphasic waveform, and monophasic or flat waveform. Results: There was a statistically significant difference in the phasicity of hepatic venous flow between patients and control subjects (p < 0,001). The Doppler flow pattern in the right hepatic vein was triphasic in 28 (47.5%), biphasic in 28 (47.5%), and monophasic in 3 (5%) children with fatty liver, while it was triphasic in 43 (95.6%) and biphasic in 2 (4.4%) control subjects. There was an inverse correlation between the sonographic grade of fatty infiltration of the liver and the phasicity of hepatic venous flow (r = -0.479, p < 0.001). Conclusions: Abnormal right hepatic vein Doppler waveform, biphasic as well as monophasic, can be seen in healthy obese children with diffuse FIL. (C) 2008 Elsevier Ireland Ltd. All rights reserved.

Background Neonatal tetanus (NT) is still considered as one of the major causes of neonatal death in many developing countries. The aim of the present study was to assess the characteristics of sixty-seven infants with the diagnosis of neonatal tetanus followed-up in the Pediatric Infectious Diseases Ward of Dicle University Hospital, Diyarbakir, between 1991 and 2006, and to draw attention to factors that may contribute (or may have contributed) to the elimination of the disease in Diyarbakir. Methods The data of sixty-seven infants whose epidemiological and clinical findings were compatible with neonatal tetanus were reviewed. Patients were stratified into two groups according to whether they survived or not to assess the effect of certain factors in the prognosis. Factors having a contribution to the higher rate of tetanus among newborn infants were discussed. Results A total of 55 cases of NT had been hospitalized between 1991 and 1996 whereas only 12 patients admitted in the last decade. All of the infants had been delivered at home by untrained traditional birth attendants (TBA), and none of the mothers had been immunized with tetanus toxoid during her pregnancy. Twenty-eight (41.8%) of the infants died during their follow-up. Lower birth weight, younger age at onset of symptoms and at the time admission, the presence of opisthotonus, risus sardonicus and were associated with a higher mortality rate. Conclusion Although the number of neonatal tetanus cases admitted to our clinic in recent years is lower than in the last decade efforts including appropriate health education of the masses, ensurement of access to antenatal sevices and increasing the rate of tetanus immunization among mothers still should be made in our region to achieve the goal of neonatal tetanus elimination.

dikici, bunyamin/0000-0001-7572-6525 WOS: 000207602800035 PubMed: 18614441 Gianotti-Crosti syndrome (papular acrodermatitis of childhood), which was first described in 1955, is a nonspecific rash that usually consists of the abrupt onset of pink flesh coloring, smooth or lichenoid, flat-topped papules. It was first related to hepatitis B virus (HBV) infection; however, cases not associated with HBV infection were reported as well. Although a type of delayed hypersensitivity reaction is speculated as a cause, exact pathogenesis still remains unclear. The prognosis is favorable and successful management relies upon general supportive and symptomatic care. We report a seven-year-old boy diagnosed with Gianotti-Crosti syndrome with monomorphous papules on his cheeks, buttocks and extremities associated with hepatitis B virus infection.

WOS: 000249541400016 PubMed: 17374471 Objective: To determine the relationship between thyroid blood flow and anthropometric measurements, pubertal stage, and thyroid and gonadotropic hormones. Materials and methods: We examined 123 healthy school-aged children prospectively (69 boys (56.1%) and 54 girls (43.9%), 7-17 years old). Their sex, age, body weight, height, body mass index (BMI), and pubertal stage were determined. Serum thyrotropin, free thyroxine, luteinizing hormone, and follicle stimulating hormone were measured in both genders, along with testosterone in boys and estradiol in girls. The peak systolic velocity (PSV), resistance index (RI), and pulsatility index (PI) of the superior thyroid artery were determined. The correlations between the Doppler parameters and these factors were investigated. Results: There were no differences in age, weight, height, BMI, thyroid volume, PSV, RI, or PI between boys and girls (P>0.05). The PSV and PI showed strong correlations with age, height, weight, puberty stage, thyroid volume, and BMI. The RI showed a strong inverse correlation with age, height, weight, puberty stage, and thyroid volume and a weak inverse correlation with the BMI. Conclusion: Determination of the thyroid arterial flow in normal healthy children is important during a Doppler ultrasound (US) examination. Doppler US parameters and their percentiles should be described in healthy children from different age groups, and these percentiles will aid in interpreting Doppler US in children. (C) 2007 Elsevier Ireland Ltd. All rights reserved.

Defects in the central upper lip are difficult to close because of the unique anatomy and limited reconstructive options. Therefore, for every individual patient, reconstructive goals must be prioritized. Reconstructive priorities for an old patient with a large full-thickness oncologic defect are clearly different than those of a teenager with a residual deficiency after cleft repair. Authors aim to share their experience of 2 cases in which large central upper lip oncologic defects have been reconstructed in a single stage using subcutaneous pedicled nasolabial island flap, which provides a single-stage reconstruction by recruiting tissue from the cheek. It obsoletes the need for a lip adhesion. Lip adhesion-related feeding problems are eliminated, oral aperture circumference is maintained, and oral function is preserved. For the elderly male, a full beard is an advantage because it hides both the cheek and the lip scars.

Amitraz is an insecticide/acaricide of formamidine pesticides used worldwide to control ectoparasites in animals. Amitraz poisoning is a rare disorder characterized by central nervous system (CNS) and respiratory depression, bradycardia, hypotension, hypothermia, hyperglycemia,nausea and vomiting. Poisoning may occur either by oral inhalation and dermal route. In this study, we present seven pediatric patients with amitraz poisoning. The initial symptoms were unconsciousness, dizziness and vomiting; and emerged within 30-150 minutes. The length of stay in the intensive care unit (ICU) was between 18-62 hours.

Deli bal zehirlenmesi Turkiye rsquo;nin Karadeniz Bolgesi rsquo;nde gorulen bir durumdur Bu zehirlenmenin nedeni bolgedeki daglarda dogal olarak yetisen Rhododendron ponticum bitki turunun nektarindan elde edilen balda bulunan grayanotoksin diye bilinen toksinden kaynaklanir Burada bal yedikten sonra kan basinci dusuklugu ve bradikardi nedeniyle gelisen halsizlik ve bas donmesi yakinmalari ile acil servise getirilen 15 yasindaki bir erkek cocuk sunuldu Turk Ped Ars 2013; 48: 53 4

Hizla degisen ve gelisen dunya da isletmeler ayakta kalmakta zorlanmaktadir. Karma ekonomilerden serbest pazar ekonomilerine gectigimiz bu gunlerde kar amaci guden ve gutmeyen kamu kurumlari da bu degisimden nasiplerini almaktadir. Bu degisimi sirasiyla 5018, 5436 ve en son 2006 yilinda cikarilan 9972 sayili kanun ve yonetmeliklerde gormekteyiz. Universitelerde de kurulmasi zorunlu olan Strateji Gelistirme Daire Baskanliklari bu kanun ve yonetmeliklerden yola cikarak gorev yapmakta ve yetki kullanmaktadir. Arastirmanin amaci ise baskanliklarin Stratejik Planin hazirlanmasinda ve uygulanmasinda gorevlerini ne kadar yerine getirebildikleri ve etkinliginin ne derece oldugunun ortaya cikarilmasidir. Etkinligin olculmesi icin yeni bir olcek olusturulmus ve bu olcek toplam 95 universitenin Strateji Gelistirme Daire Baskanliklarina gonderilmistir. Mail adreslerinde sorun olanlar ve cevap vermeyenler cikarildigi zaman degerlendirilmeye alinacak 41 anket analiz edilmistir. Analiz icin SPSS 17 paket programi kullanilmistir. Sonuclar degerlendirildigi zaman Strateji Gelistirme Daire Baskanliklarinin Stratejik Planlarin hazirlanis asamasinda yari yariya etkin olmalarina ragmen uygulanis surecinde buyuk cogunlugun etkin olmadigi sonucuna ulasilmistir.

Cornelia de Lange syndrome (CdLS) is a rarely seen multisystem developmental disorder syndrome characterized by facial dysmorphia (arched eyebrows, synophrys, depressed nasal bridge, long philtrum, down-turned angles of the mouth), upper-extremity malformations, hirsutism, cardiac defects, growth and cognitive retardation, and gastrointestinal abnormalities. The features of this disorder vary widely among affected individuals and range from relatively mild to severe. Early in life, the distinctive craniofacial features in mild de Lange syndrome may be indistinguishable from the severe (classical) phenotype. We present here a case of newborn with CdLs.