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Aimː To evaluate data from our hospital system before and after the implementation of the Bethesda System for Reporting Thyroid Cytology (TBSRTC) and comparison of our data with the previously published studies. Methods: Seven hundred seventy-one patients with thyroid nodules who underwent fine needle aspiration biopsy (FNAB) and surgery at our institution were analyzed retrospectively. FNAB resultswere divided into two parts in terms of the period they related to: pre-TBSRTC (between 2005 and 2010) and TBSRTC (between 2011 and 2013). Results: 341 FNAB were appliedin the period of TBSRTC. Of the 341 FNAB, 53(16%) were non diagnostic, 82(24%) were benign, 62(18%) were atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 28(8%) were follicular neoplasms and/or suspicion of follicular neoplasms (FN/SFN), 95(28%) were suspicion for malignancy (SuspM), and 21(6%) were malignant. Rates of malignancy reported on follow-up histopathological examination were non diagnostic in 11%, benign in 4.9%, AUS/FLUS in 23%, FN/SFN in 32%, SuspM in 44%, and malignant in 95.3%. Conclusions: In this study, the distribution of cases in TBSRTC categories and malignancy rates, differed from, recommended by TBSRTC and some studies. Implementation of TBSRTC did significantly affect our institution’s reporting rates.

Objective The aim of this study was to evaluate the carotid intima-media thickness together with the thickness of the epicardial adipose tissue in patients receiving antiepileptic drug therapy and to investigate the presence of increased cardiovascular risk in these patients. Methods The study included a total of 52 patients comprising 32 males and 20 females who were diagnosed as having epilepsy and who were using one or more antiepileptic drugs. The control group consisted of 34 healthy individuals comprising 16 males and 18 females. The individuals selected for the study group were requested to go to the hospital after overnight fasting. After blood sampling for serum lipid value, the carotid intima-media thickness was measured with high resolution B-mode ultrasonography and epicardial adipose tissue thickness with echocardiography in the patients and the control group subjects. Results The carotid intima-media thickness was determined as 0.47 ± 0.05 mm in the patient group and 0.44 ± 0.04 mm in the control group (p = 0.028). The carotid intima-media thickness was measured as 0.45 ± 0.05 mm in patients with epilepsy taking monotherapy and 0.49 ± 0.04 mm in those taking polytherapy (p = 0.003). The epicardial adipose tissue thickness was determined as 3.42 ± 0.09 mm in the patient group and 1.72 ± 0.90 mm in the control group (p = 0.000). The epicardial adipose tissue thickness was measured as 3.16 ± 0.87 mm in patients with epilepsy taking monotherapy and 3.77 ± 0.83 mm in those taking polytherapy (p = 0.041). Conclusions It was determined that carotid intima-media thickness and epicardial adipose tissue thickness were significantly high in children with epilepsy taking long-term antiepileptic drugs. These results demonstrate that these patients could be at increased risk of the development of cardiovascular complications. There is a need for more extensive studies on this subject.

Objective Eisenmenger syndrome (ES) is a life-threatening disease characterized by pulmonary hypertension and cyanosis in patients with congenital heart diseases. The aim of this study was to determine the brain metabolite changes in Eisenmenger syndrome compared with a control group using MR proton spectroscopy. Methods and Materials The study included 10 children (3 male, 7 female) with congenital heart diseases and a diagnosis of Eisenmenger syndrome. The control group consisted of 10 healthy volunteer children. All were examined with a 1.5 T MRI scanner and single voxel spectroscopy was performed to obtain spectra from three different regions; left frontal subcortical white matter, left lentiform nucleus and left thalamus. Peak integral values obtained from the spectra were used as quantitative data. Results The ages of the children with ES were between 5 and 16 years, and between 5 and 15 years in the control group. Periventricular white matter hyperintensities were observed in 3 patients. On MR spectroscopy study, significantly lower levels of Choline metabolite (Cho) were detected in the frontal subcortical region and thalamus regions of the patients compared with the control group. There was no statistically significant difference between the levels of other metabolites (NAA, Cr, mI and Glx). In the lentiform nucleus, although the average value of Cho in ES patients was lower than that of the control group, it was not statistically significant. Conclusion Cho metabolite was determined to have an important role in brain metabolism in Eisenmenger syndrome patients. Oral Cho treatment may help to extend survival.

An insidious progression of cardiovascular (CV) involvement is generally associated with rheumatologic diseases and finally regarded as a major source of morbidity and mortality in Juvenile idiopathic arthritis (JIA) patients. JIA could involve all of the cardiac structures, including pericardium, myocardium, endocardium; coronary vessels; valves and conduction system. Development of pericarditis, myocarditis, endocarditis and ventricular dysfunction are not unexpected issues in the progress of JIA. It is essential to ensure a comprehensive follow-up with advanced and up-to-date diagnostic and therapeutic modalities for prevention of CV complications in JIA patients. Since these are all associated with an unfavorable prognosis, it is necessary to detect subclinical cardiac involvement in CV asymptomatic patients, in order to start adequate management and treatment. Furthermore, controlling chronic inflammatory state of JIA by new treatment modalities will also significantly reduce the overall morbidity and mortality related to CV diseases. In this review, we aimed to investigate CV involvement patterns in patients with JIA.

Amaç: Amacımız aksiller lenf nodu pozitif meme kanserinde nonsentinel lenf nodu (NSLN) pozitifliğine etki edenfaktörleri araştırmak ve hasta grubumuzda Memorial Sloan-Kettering Cancer Center (MSKCC) ve Stanfordnomogramlarının etkinliğini karşılaştırmaktır.Yöntemler: 01.01.2008 - 31.08.2011 tarihleri arasında Ondokuz Mayıs Üniversitesi Tıp Fakültesi Genel CerrahiKliniği’nde sentinel lenf nodu biyopsisi (SLNB) sonucunda sentinel lenf nodunda metastaz saptanan invaziv memekanseri olan 112 hasta çalışmaya alındı. Karşılaştırılacak değişkenler SPSS 15.0 versiyonu programındanyararlanılarak kaydedildi. Lojistik regresyon analizi ile NSLN pozitifliğine etki eden risk faktörleri araştırıldı. P 0.05anlamlılık düzeyi olarak kabul edildi. Her iki nomogram icin “Receiver Operating Characteristics (ROC)” eğrilerioluşturuldu ve eğriler altındaki alanlar(AUC) hesaplandı. AUC değeri 0.70 ve üzerinde hesaplanan yöntem etkin olarakkabul edildi.Bulgular: Tek değişkenli analizde tümör boyutu, multifokalite, lenfovasküler invazyon varlığı, SLN’daki metastazınmakrometastaz oluşu, SLN’da kapsül dışı invazyon varlığı ve metastatik SLN sayısının toplam SLN sayısına oranıanlamlı bulundu. Çok değişkenli analizde lenfovasküler invazyon, SLN’da kapsül dışı invazyon ve metastatik SLNsayısının toplam SLN sayısına oranı NSLN metastazı ile ilgili bağımsız prediktif faktörler olarak saptandı. MSKCC veStanford nomogramlarının ikisinin de hasta grubumuzda etkin olmakla birlikte MSKCC nomogramının daha etkinolduğu sonucuna vardık.Sonuç: Nomogramlar aksillada NSLN’unda metastataz olasılığı hakkında yol gösterici yöntemlerdir. Ancak henüzaksiller lenf nodu diseksiyonunun (ALND) yerini alacak kapasitede değildirler. NSLN pozitifliğine etki eden yeniprediktif faktörlerin ortaya konulması ile etkinlikleri artırılabilir. Her klinik kendisine en uygun nomogramıbelirlemeli ve kullanmalı veya kendi nomogramını oluşturmalıdır. Objective: Our aim is to investigate the factors that affect non-sentinel lymph node positivity in patients with axillarylymph node positive breast cancer and to evaluate the effectiveness of Memorial Sloan-Kettering Cancer Center(MSKCC) and Stanford nomograms in our patients group.Methods: One hundred and twelve invasive breast cancer patients with metastatic sentinel lymph node biopsy (SLNB)who underwent surgery, between January 2008 and August 2011, in Department of General Surgery at OndokuzMayıs University School of Medicine were included in the study. Variables that will be compared with were recordedby using SPSS 15.0 version. Risk factors which effect the non sentinel lymph node positivity were analysed by logisticregression analysis. P 0.05 was considered as significant. Receiver operating characteristics (ROC) curves fornomograms were created and area under curves (AUC) were computed. AUC values equal to or greater than 0.70 havebeen accepted as good discrimination for prediction of non-sentinel lymph node metastasis.Results: In univariate analysis, tumor size, presence of multifocality, lenfovascular invasion, metastatic sentinel lymphnode with macrometastasis and extracapsular invasion, the ratio of number of metastatic sentinel lymph node to totalnumber of sentinel lymph node were found to be significant. In multivariate analysis, presence of lenfovascularinvasion, extracapsul invasion and the ratio of number of metastatic sentinel lymph node to total number of sentinellymph node were found to be independent factors for metastatic non-sentinel lymph node. For our patients group weconluded that the both of MSKCC and Stanford nomograms were effective.Conclusion: Nomograms are methods to predict the possibility of non sentinel lymphnode metastasis. But they haveyet not the ability to replace axillary lymph node dissection. Their effectiveness can be increased by new predictivefactors for non-sentinel lymph node positivity. Each clinic should determine and use most suitable nomogram orshould create own nomogram.

Local-Axillary Recurrence Rate and Affecting Factors in Patients Undergoing Breast-Conserving Surgery and Sentinel Lymph Node Biopsy Objective: SLNB procedure is developed as an alternative to ALND in surgical therapy of breast cancer and is a safe staging method with low morbidity. Our objective in the present study is to determine relapse rates in long-term follow up and the affecting factors in patients who underwent

Epilepsy is the most common chronic neurological illness in childhood and adolescence. The aim of this study was to investigate paraoxonase and arylesterase activities along with oxidative status parameters in children with intractable epilepsy. The study comprised 42 subjects with intractable epilepsy and a control group of 35 healthy subjects. Serum paraoxonase and arylesterase activities, and lipid hydroperoxide levels were determined. All paraoxonase and arylesterase activities were significantly lower in the intractable epilepsy subjects than in the controls (P

This preliminary study aimed to evaluate whether there are changes in the apparent diffusion coefficient (ADC) values of the brain in patients presenting with Eisenmenger syndrome (ES).This cross-sectional study included 10 consecutively recruited patients with ES and 10 healthy control subjects. In the patients and controls, eight distinct neuroanatomical locations were selected for analysis. Quantitative measurements of ADC values of the frontal white matter (FWM), occipital white matter, lentiform nucleus (LN), thalamus, frontal cortex, anterior and posterior limbs of the internal capsule and caudate nucleus were measured. Statistical analysis was performed using SPSSThe ADC values of the FWM and LN were significantly higher in the ES group than that in the control group. The mean ADC levels of other brain regions were not significantly different between the groups.Chronic hypoxia in patients with ES may lead to diffusion changes in the brain tissue. There is a need for further studies to assess the clinical significance of cerebral ADC values in patients with ES. Advances in knowledge: The ratio of extracellular volume to intracellular volume in the FWM and LN can be considered to be increased in patients with ES.

Origin of the left coronary artery from the pulmonary trunk [Anomalous origin of the Left Coronary Artery from the Pulmonary Artery ALCAPA ] is a rare congenital heart defect ALCAPA is one of the common causes of myocardial ischemia or infarction in infants and children In this report we present an eleven years old patient presenting with murmur and accompanied by echocardiographic findings of dilated cardiomyopathy and angiocardiographic investigation that revealed left coronary artery originating from the pulmonary artery Turk Arch Ped 2012; 47: 298 301

AIMS Williams syndrome (WS) is a microdeletion syndrome affecting cardiovascular and connective tissue as well as the endocrine and central nervous systems in 1 in 10,000 live births. This study aims to identify and evaluate cardiovascular abnormalities (CVAs) in 45 WS patients. PATIENTS AND METHODS We retrospectively reviewed a cohort of WS patients who were followed at our institution from January 1, 1990 through December 31, 2010. WS was clinically diagnosed by an experienced medical geneticist and confimed by fluorescence in situ hybridization. CVAs were assessed using electrocardiography, echocardiography or cardiac catheterization. RESULTS Twenty-seven patients (60%) were male; 18 were female (40%).The mean age at presentation was 4.6 +/- 3.1 years (3 months-13 years); the follow-up period was 6.9 +/- 4.4 years (6 months-18 years). CVAs were found in 86% of patients, the most common one being supravalvar aortic stenosis (SVAS) in 73% (isolated in 48%), peripheral pulmonary artery stenosis (PAS) in 42%, and mitral valve prolapse (MVP) in 22%. Less common were aortic insufficiency (15%), ventricular septal defect (11%), valvular pulmonary stenosis (11%), and aortic arch hypoplasia (8%) and coarctation (2%). Hypertension was present in 22% of patients. Surgical or catheter-based interventions were performed in 22% of cases. Two patients were lost in the postoperative period. CONCLUSION CVAs were found in more than four out of five patients, the most common ones being SVAS and PAS. Although surgery was performed in more patients with SVAS than with PAS, SVAS was minimal or mild in most patients and improved in few cases.

Gerec ve Yontem: Bu calismaya 1989 1994 yillari arasinda Istanbul Universitesi Kardiyoloji Enstitusu

Mondor hastalığı göğüs duvarı yüzeyel venlerinin tromboflebiti ile karakterize nadir görülen benign bir hastalıktır. Mondor Hastalığı ilk kez 1939da Henry Mondor tarafından tanımlanmıştır. Bu kendi kendini sınırlayan benign hastalık sıklıkla travma ve meme cerrahisi ile ilgilidir. Bununla birlikte etiyolojisi net olarak ortaya konulamamıştır. Amacımız olgumuz eşliğinde Mondor hastalığının özelliklerini tartışmaktır. Mondors disease of the breast is a rare benign breast condition characterized by thrombophlebitis of the superficial veins of the chest wall. Mondors disease was described in 1939 by Henry Mondor. Its a benign self limited problem associated most commonly with trauma and breast surgery . However the etiology of this disease is not clear. Our aim is to discuss Mondors disease properties by manuscript.

Background: Burning fat and carbohydrates to provide energy in biological systems causes the formation of free oxygen species. Objectives: This study aimed to evaluate the oxidative status of serum and breast milk of mothers giving birth prematurely and at full-term. Materials and Methods: The study comprised 50 mothers who gave birth at full-term at more than 38 weeks and 43 mothers who gave birth pre-term at below 32 weeks. On the postnatal 5th day, samples of the mother’s milk and serum were taken and stored at -80°C until the study day. On the study day, the total oxidant and total antioxidant levels were measured using the Erel method and the oxidative stress index (OSI) was calculated. Results: While the total oxidant level and total antioxidant level values of the milk of the premature birth mothers were found to be significantly high compared to those of the full-term birth mothers (P = 0.001), no statistically significant difference was found in the oxidative stress index values (P > 0.05). No statistically significant difference was found in the total oxidant level and oxidative stress index values of the serum of the premature birth mothers compared to those of the full-term birth mothers, while the total antioxidant level was found to be significantly low (P = 0.04). Conclusions: The oxidants and antioxidants in the milk of mothers giving birth prematurely were found to be significantly higher than those of full-term birth mothers. This can be evaluated as the milk of the premature birth mothers providing increased antioxidant defense to protect the infant.

Tarim, ismail Alper/0000-0002-6203-2644 WOS: 000366649600009 PubMed: 25720571 We aimed to research the relation of transaminase levels in blunt liver trauma (BLT) with the intensity of the trauma and the use of transaminase levels for deciding on surgical or non-operative treatment. In all, 44 patients with BLT diagnosed by computerized tomography (CT) were involved in this retrospective study. By testing the correlation of the transaminase levels and the grade of liver injury with receiver operator characteristics (ROC), area under the curve (AUC) was calculated; besides, the sensitivity, specificity, and cut-off values of transaminases were calculated separately for the grades. Moreover, same method was repeated for the surgically and non-operatively treated patients. Cut-off value was assessed for surgical and non-operative treatments. The efficiency of transaminases in deciding non-operative treatment was compared with that of other methods using ROC test applied on focused abdominal sonography in trauma (FAST), hemodynamic instability, blood replacement rate, aspartate aminotransferase (AST), and alanine aminotransferase (ALT). It was observed that the AUC, sensitivity, and specificity increased correspondingly with the grade rise of transaminase levels in BLT. In the selection of non-operative treatment/surgery, following values have been confirmed: AUC for AST: 0.851 (sensitivity: 86 %, specificity: 73 %, cut-off value: 498 U/L), AUC for ALT: 0.880 (sensitivity: 86 %, specificity: 81 %, cut-off value: 498 U/L), AUC for replacement: 0.948 (sensitivity: 86 %, specificity: 94 %), AUC for hemodynamic instability: 0.902 (sensitivity: 86 %, specificity: 94 %), and AUC for FAST: 0.642 (sensitivity: 57 %, specificity: 75 %). It was found that in BLT, transaminases can predict the injury rating with higher accuracy as the grade rises, and they outrival FAST in terms of determining the need for laparotomy.

WOS: 000370846200005 PubMed: 26170753 Objective: The purpose of this study was to determine the factors affecting survival in patients who underwent pancreaticoduodenectomy for periampullary cancers and to discuss the outcomes of our findings. Material and Methods: This retrospective study included 79 patients who underwent pancreaticoduodenectomy for periampullary cancers between September 1987 and October 2011 in the Department of General Surgery at Ondokuz Mayis University School of Medicine. The factors of age, tumor localization, tumor size, lymphovascular invasion, status of lymph node metastasis, tumor differentiation, preoperative CA 19-9 levels, preoperative total bilirubin levels, preoperative albumin levels, and preoperative biliary drainage were investigated to determine their influence on survival. The survival periods were calculated using the Kaplan-Meier method. The log-rank test was used for comparison of the prognostic factors. The independent prognostic factors affecting survival were determined by Cox hazard regression analysis and hazard ratios (HR) and 95% confidence intervals (CI) were calculated. P= 2 cm (HR: 2.0, 95% CI: 0.27-0.90), lymphovascular invasion (HR: 2.9, 95% CI: 0.18-0.60), CA 19-9 levels >= 100 U/mL (HR: 2.0, 95% CI: 0.26-0.90), and albumin levels

WOS: 000364167600008 In colorectal cancer, subcutaneous metastasis is a very uncommon event. Generally, this metastasis is described after primary colon carcinoma and signifies widespread disease and poor prognosis. Skin metastasis without liver metastasis is very rare. Cutaneous and subcutaneous metastases in laparotomy or laparoscopy scar are reported but there are only a few reports about metastasis to old incision scar. In this article, we described a case of colon cancer presenting as a cutaneous metastasis in an old appendectomy scar and discussed possible pathophysiological mechanisms.

Generalised lymphangiomatosis is a rare disease that is characterized by widespread bony and soft tissue involvement of lymphangioma. Radiological evaluation is crucial because the site and extent of the lymphangioma are important prognostic factors. The computed tomography, ultrasonography and magnetic resonance images showed sharply defined, non-enhanced cystic lesions involving the mediastinum, bones, spleen, lung, and lower neck. We report here a case that was referred to us for investigation of marked cardiomegaly.

Kuru, Bekir/0000-0001-7774-6431; YURUKER, SAIM SAVAS/0000-0002-6371-337X WOS: 000371618600079 PubMed: 27011529 Percutaneous endoscopic gastrostomy (PEG) is an important technique for the provision of nutrition. The present study presents data from our analysis of the PEG procedure. Patients administered with PEG at the endoscopy unit of the 19 Mayis University General Surgery Department between 2007 and 2013 were analyzed retrospectively, and technical problems, indications, and complications related to the PEG procedure in 221 patients were evaluated. Of the patients, 60 % were male and the median age was 61 years (1892 years). The most frequent indication was admittance to the intensive care unit, accounting for 46 % of the total, followed by neurological disease, with 41 %. The success rate of the procedure was 98 %, and the overall rate of complications was 22 %. No mortalities were reported as resulting from the procedure. The most common complication was the development of granulomas around the tube (8 %). PEG is a safe method of long-term feeding but is associated with a high rate of morbidity that can be treated easily using conservative treatment methods.

Our aim is to determine the disease-free survival (DFS) rate, and to investigate the prognostic factors among patients with invasive breast cancer at age 35 or younger.The medical records of the 67 patients who underwent surgery for invasive breast cancer were retrospectively reviewed. Potential prognostic factors that affect the DFS were investigated. DFS curves were obtained using the Kaplan-Meier method. The comparisons were made by the long-rank test. The prognostic factors affecting the DFS were determined by stepwise Cox proportional hazard regression test. The P value0.05 was accepted as significant.The median age was 32 (range, 23-35). The median follow-up interval was 55 months (range, 10-108). The 5-year DFS rate was 69.3%. In univariate analysis the number of pathologic axillary lymph nodes (p=0.035), triplenegative status (p=0.014) and tumor size (p= 0.004) were found to be the prognostic factors affecting the DFS. The 5-year DFS rate was 81% in non-triple negative patients, whereas this was 35% in triple-negative patients. In the multivariate analysis, triple-negative status was the only independent prognostic factor which affected the DFS adversely (HR: 1.48, CI: 0.66-082, p=0.027).Triple-negative status was found to be the only independent and adverse prognostic factor which affects the DFS in patients with invasive breast cancer at age 35 or younger.Breast cancer, Disease-free survival, Triple negative breast cancer, Young age.

Juvenile idiopathic arthritis (JIA) is a systemic chronic inflammatory disease. Cardiac involvement as pericarditis, myocarditis and valvular disease is common in JIA. This study aims to assess left ventricular (LV) diastolic functions with tissue Doppler imaging (TDI) and to compare it with conventional Doppler echocardiography (pulse wave Doppler (PWD)) techniques in patients with active JIA. Forty-five patients with active JIA and 47 healthy age- and sex-matched controls were included in this study. Duration of disease ranged from 6 to 138 months (mean 49.59 ± 31.25 months). In addition to PWD echocardiographic methods, TDI was performed to assess LV functions in all participants. On PWD echocardiography analysis, the JIA group had lower peak E velocity (p < 0.001), higher peak A velocity (p < 0.001) and more prolonged isovolumic relaxation time (IVRT) (p = 0.02). E/A ratio was found to be lower in patients with JIA than that in the control group (p < 0.001). Patients with JIA had a much higher E velocity trace integral (VTI) and A VTI when compared to controls (respectively p = 0.03, p = 0.04). Mitral annular early diastolic velocity (Em), among TDI parameters, was found to be lower in patients with JIA than that in the control group (p < 0.001). Em/Am (mitral annular late diastolic velocity) ratio was found to be lower in JIA patients compared with that in the control group (p < 0.001). There was an increase in IVRT in JIA patients compared to control group (p = 0.04). Though Em VTI was similar in the two groups, patients with JIA had a much higher Am VTI when compared to controls (respectively p = 0.48, p < 0.001). E/Em ratio was higher in patients with JIA than in the control group (p < 0.05). LV diastolic functions were impaired in patients with active JIA, in the absence of clinical evidence of cardiac disease. We have concluded that TDI solo, or jointly with PWD echocardiography, is valuable for the evaluation of diastolic functions in active JIA patients.

Dilated cardiomyopathy is an important cause of heart failure in children. Medical therapy rarely results in complete improvement of the disease, treatment of which usually requires transplantation. Herein, we present a patient with cardiomyopathy and rickets. Case report: A 3-month-old boy was referred to Pediatric Endocrinology Clinic due to low calcium level. On his physical examination, enlarged wrists and large anterior fontanel were remarkable. Results of laboratory analyses revealed a calcium level of 6.8 mg/dL, phosphorus level of 4.9 mg/dL, alkaline phosphatase level of 1637 U/L, parathyroid hormone level of 191.2 pg/ mL, and 25-hydroxyvitamin D level of 5.7 ng/mL. Hand-wrist radiograph revealed signs consistent with rickets. Echocardiogram revealed dilated left ventricle, hypokinetic myocardium, an ejection fraction of 42%, and fractional shortening by 20%. Oral calcium lactate was started and then vitamin D treatment was added. At the 3rd month of the therapy, laboratory tests completely returned to normal and signs of rickets disappeared. Echocardiogram findings returned to normal. Since cardiac functions began to improve after the therapy, dilated cardiomyopathy associated with vitamin D deficiency was considered. Vitamin D deficiency should be considered while evaluating dilated cardiomyopathy in the regions that are endemic for nutritional rickets and it should be kept in mind that the therapy may provide dramatic improvement. Dilate kardiyomiyopati (KMP) çocuklarda kalp yetmezliğinin önemli bir nedenidir. Çoğunlukla transplantasyon ihtiyacı duyulan bu hastalıkta nadiren medikal tedavi ile tam iyileşme sağlanabilir. Burada KMP ve rikets tanılarıyla izlenen bir olgu sunulmuştur. Olgu Sunumu: Üç aylık olgu çocuk endokrin polikliniğine kalsiyum (Ca) düşüklüğü nedeniyle yönlendirilmişti. Fizik muayenede el bileklerinde genişleme, geniş ön fontanel dikkati çekiyordu. Laboratuvar değerlendirmede, Ca 6,8 mg/dl, fosfor 4,9 mg/dl, alkalin fosfataz 1637 U/L, paratiroid hormon 191,2 pg/ ml, 25 hidroksi vitamin D düzeyi 5,7 ng/ml saptandı. El bilek grafisinde raşitizmle uyumlu bulgular vardı. Ekokardiyogramda geniş sol ventrikül, hipokinetik kalp kası, ejeksiyon fraksiyonu %42, fraksiyonel kısalma %20 idi. Vitamin D eksikliği tanısıyla önce Ca laktat tedavisi ardından D vitamin tedavisi başlandı. Tedavinin 3. ayında radyolojik bulguların düzeldi ve rikets bulguları kayboldu. Ekokardiyogram bulguları normale döndü. Tedaviden sonra kardiyak fonksiyonların düzelmeye başlaması nedeniyle olguda vitamin D eksikliğine bağlı dilate KMP düşünüldü. Nutrisyonel riketsin endemik olduğu bölgelerde dilate KMP’nin etyolojik değerlendirmesinde vitamin D eksikliği tanısı düşünülmeli, tedavinin dramatik iyileşme sağlayabileceği akılda tutulmalıdır.

Kuru, Bekir/0000-0001-7774-6431 WOS: 000333669500068 PubMed: 24606487 Background: To avoid performing axillary lymph node dissection (ALND) for non-sentinel lymph node (SLN)-negative patients with-SLN positive axilla, nomograms for predicting the status have been developed in many centers. We created a new nomogram predicting non-SLN metastasis in SLN-positive patients with invasive breast cancer and evaluated 14 existing breast cancer models in our patient group. Materials and Methods: Two hundred and thirty seven invasive breast cancer patients with SLN metastases who underwent ALND were included in the study. Based on independent predictive factors for non-SLN metastasis identified by logistic regression analysis, we developed a new nomogram. Receiver operating characteristics (ROC) curves for the models were created and the areas under the curves (AUC) were computed. Results: In a multivariate analysis, tumor size, presence of lymphovascular invasion, extranodal extension of SLN, large size of metastatic SLN, the number of negative SLNs, and multifocality were found to be independent predictive factors for non-SLN metastasis. The AUC was found to be 0.87, and calibration was good for the present Ondokuz Mayis nomogram. Among the 14 validated models, the MSKCC, Stanford, Turkish, MD Anderson, MOU (Masaryk), Ljubljana, and DEU models yielded excellent AUC values of >0.80. Conclusions: We present a new model to predict the likelihood of non-SLN metastasis. Each clinic should determine and use the most suitable nomogram or should create their own nomograms for the prediction of non-SLN metastasis.

Amac: Safra kesesi, biliyer kanallar veya bu bolgenin vaskuler yapilarina ait anomaliler nadirdir. Bu anomalilerin preoperatif tanisi zordur, ameliyat esnasinda surpriz olarak cerrahin karsisina cikmaktadir. Anomali varligi, safra kesesi ve biliyer kanallarin cerrahisinde postoperatif komplikasyonlarin artmasina neden olmaktadir.Bu calismada amac safra yollarinda anomali varligi ile ilgili risk faktorlerini incelemektir. Hastalar ve Yontem : Safra kesesi hastaligi nedeniyle ameliyat edilen 695 hasta calismaya dahil edildi.Hastalar retrospektif olarak yas, cinsiyet, safra yollari anomalileri, ameliyat esnasinda ve ameliyat sonrasi gelisen komplikasyonlar acisindan degerlendirildi. Anomaliler ile demografik veriler ve komplikasyonlar arasindaki iliski istatistiksel olarak analiz edildi. Bulgular: Calismaya dahil edilen 695 olgunun 56’si (% 8.1) 30 yas ve alti(Grup I), 639 hasta(% 91.9) ise 30 yas ustu dur(Grup II). Kadin/erkek orani:488/207 idi. Yas ortalamasi; Grup I de 26±3.593 yil ,Grup II de 53.48±12.685 yil idi . Safra anomalisi saptanan 28 hastanin (% 4.02) %71.4’ u (n:20) kadin, % 28.6’si (n:8) erkek idi. Anomali saptanan hastalarin yas ortalamasi:39,21±14.376 yil olarak saptandi. Grup I de 9 hastada , Grup II de 19 hastada anomali tespit edilmistir. 14 hastada biliyer, 4 olguda biliyer + vaskuler, 8 olguda arteriyel anomali, iki olguda duodenal divertikul saptanmistir . Anomalili 5 hastada (% 17.85), anomalisiz 31 hastada (% 4.64) laparoskopiden acik ameliyata gecilmistir. Grup I’de 1 olguda (% 1.75), Grup II de 19 olguda ( % 2.97) komplikasyon gelismis, mortalite gorulmemistir. Sonuc:Kolesistektomi cerrahisinde vaskuler ve biliyer anomaliler 30 yas alti hastalarda istatistiksel olarak daha yuksek bulunmustur. Bu anomaliler kolesistektomi komplikasyonlarinin artisina neden olabilmektedir. Bu nedenle komplikasyonlardan kacinabilmek ve preoperatif tani amaciyla gerekli tetkikler yapilmalidir. Anomalies of gall bladder, biliary tract and their vascular anatomy are rare. They are usually diagnosed intraoperatively . Presence of anomaly increases rate of surgical complications. The risk factors related with these anomalies were examined .Six hundred ninty five patients were retrospectively analysed. The statistical analysis of the relation between anomalies of biliary tract and age, gender and complications was made. Fifty six patients (8.1 %) of the 695 were 30 years old(Group II). Male/female ratio was 488/207. The mean age of Group I is 26± 3.593, the mean age of Group II is 53.48± 12.685. 71.4 % (n=20) of the 28 patients (4.02 %) with anomaly were female, 28.6 % (n=8) were male. The mean age of patients with anomaly was 39.21±14.376 years. Nine patients in Group I, 19 patients in Group II had anomalies. Fourteen biliary, 4 biliary and vascular, 8 arterial anomalies, 2 duodenal diverticula were observed. In 5 patients (17.85 %) with anomaly and in 31 patients (4.64 %) without anomaly, conversion to open cholecystectomy was needed. Complications occured in 1 patient (1.75%) in Group I, in 19 patients (2.97 %) in Group II. No mortality was seen. The number of biliary and vascular anomalies detected during cholecystectomy was significantly higher in patients< 30 years of age. Their presence may increase complications of cholecystectomy. For the prevention of complications, preoperative diagnostic evaluation is necessary.

In this study, we aimed to assess the technique and results of spleen-preserving laparoscopic distal pancreatectomy (SPLDP) on the basis of two cases. The first case was a woman with a large cystic papillary lesion of the distal pancreas. The other patient was a woman with a pancreatic mass on the tail of the pancreas. Both patients were operated on using SPLDP. Five trocars were used in the first case and four trocars were used in the second case. Thirty degree telescope visualization and LigaSure dissection were used during the operation. The splenic vessels were dissected, but the short gastric vessels were preserved. The pancreas was transected by one Endo GIA stapler and the cut edge of the pancreas was reinforced with sutures to prevent a pancreatic fistula. We performed the same technique in both cases. However, in the first case, we aspirated the content of the cystic mass of the pancreas before removing it to avoid making a large incision. The duration of the operation was 190 and 135 minutes, respectively. There were no postoperative complications. SPLDP is a safe, effective modality for managing lesions of the distal pancreas. If the splenic vessels are transected, the short gastric vessels must be protected to ensure the viability of the spleen. © Copyright 2013 by Turkish Surgical Association.

Left atrium and/or left ventricle dilatation on echocardiography is considered to be an indication for closure of ventricular septal defects (VSD). No study has addressed the accuracy of using dilated left heart chambers when defining significant left-to-right shunting quantified by cardiac catheterization in isolated small or moderate VSDs. In this study, the relation between dilated left heart chambers, measured by echocardiography, and left-to-right ventricle shunting, quantified by cardiac catheterization, was evaluated in patients with isolated VSD. The medical records of all patients with isolated VSD who had undergone catheterization from 1996 to 2010 were examined retrospectively. Normative data for left heart chambers adjusted for body weight (BW) and body surface area (BSA) were used. The pulmonary-to-systemic flow ratio (Qp:Qs) was calculated by an oximetry technique. A total of 115 patients (mean age 7.3 ± 5 years) fulfilled the inclusion criteria. There was a statistically significant difference in terms of Qp:Qs between the patient groups with normal and dilated left heart chambers, when adjusted for BW and BSA (p = 0.001 and p = 0.002, respectively). But the relationships between Qp:Qs and left heart chamber sizes on echocardiography were not strong enough to be useful for making surgical decisions, as left heart chamber dilatation was not significantly associated with Qp:Qs ≥ 2 (p = 0.349 when adjusted for BW, p = 0.107 when adjusted for BSA). Left heart chamber dilatation was significantly associated with Qp:Qs ≥ 1.5 only when it was adjusted for BSA (for BW p = 0.022, for BSA p = 0.006). As a result, left heart chamber dilatation measured by echocardiography does not show significant left-to-right ventricle shunting, as quantified by catheterization. We still advocate that catheter angiography should be undertaken when left heart chambers are dilated in echocardiography in order to make decisions about closing small- to moderate-sized VSD.

Background: Assessment of right ventricular function is a key point in the follow-up of operated patients with tetralogy of Fallot. Cardiac magnetic resonance assessment of right ventricular function is considered the gold standard. However, this technique is expensive, has limited availability, and requires significant expertise to acquire and interpret the images. Myocardial performance index and isovolumic acceleration have recently been studied for the assessment of right ventricular function and are shown to be simple yet powerful tools for assessing patients with right ventricular dysfunction of various origins. Methods: In this study, the integrity of myocardial performance index and isovolumic acceleration obtained by tissue Doppler imaging echocardiography to quantify right ventricular function was assessed in 31 patients operated for tetralogy of Fallot. Myocardial performance index and isovolumic acceleration measurements were compared with the parameters derived by cardiac magnetic resonance imaging. Results: In this study, a significant correlation has not been detected between cardiac magnetic resonance-originated right ventricular ejection fraction, pulmonary regurgitation fraction and myocardial performance index, isovolumic acceleration obtained by tissue Doppler imaging echocardiography from the lateral tricuspid annulus of the right ventricle. Conclusion: We have concluded that when evaluated separately, myocardial performance index and isovolumic acceleration obtained from tissue Doppler imaging echocardiography can be used in the long-term follow-up of patients who have been operated for tetralogy of Fallot, but that they do not show correlation with cardiac magnetic resonance-originated right ventricle ejection fraction and pulmonary regurgitation fraction.

YURUKER, SAIM SAVAS/0000-0002-6371-337X; Kuru, Bekir/0000-0001-7774-6431 WOS: 000315760800003 PubMed: 23487000 Purpose: The aim of our study is to evaluate the factors affecting surgical margin positivity among patients with invasive ductal breast cancer who underwent breast-conserving surgery (BCS) after preoperative diagnostic core biopsy. Methods: Two hundred sixteen patients with stage I, II invasive ductal breast carcinoma who had histological diagnosis with preoperative tru-cut biopsy and underwent BCS were included in the present study. Potential factors that affect the positive surgical margin were analyzed. In univariate analysis, the comparisons of the factors affecting the surgical margin positivity were made by chi-square test. Logistic regression test was used to detect the independent factors affecting the surgical margin positivity. Results: Positive axillary lymph node (odds ratio [OR], 8.2; 95% confidence interval [CI], 3.01 to 22.12), lymphovascular invasion (LW; OR, 3.9; 95% CI, 1.62 to 9.24), extensive intraductal component (ETC; OR, 6.1; 95% CI, 2.30 to 16.00), presence of spiculation (OR, 5.1; 95% CI, 2.00 to 13.10) or presence of microcalcification in the mammography (OR, 13.7; 95% CI, 4.04 to 46.71) have been found to be the independent and adverse factors affecting surgical margin positivity. Conclusion: Considering decision making for the extent of the excision and for achieving negative surgical margin before BCS, positive axillary lymph node, LVI, EIC, spiculation or microcalcification in mammography are related as predictor factors for positive surgical margin.

Kliniğimizde tanı koyduğumuz ve tedavi ettiğimiz 25 yaşındaki erkek hastamız eşliğinde ektopik meme, meme başı ve areola kompleksinin özelliklerini, tanı ve tedavi yöntemleriyle birlikte klinik önemini tartışmayı amaçladık. (Haseki T›p Bülteni 2013; 51: 26-7) In this study, we describe a case report of a 25-year-old male who was diagnosed with ectopic breast tissue and was treated in our clinic. Subsequently, we to discuss clinical presentation, diagnosis, treatment, and clinical significance of ectopic breast and nipple- areola complex. (The Medical Bulletin of Haseki 2013; 51: 26-7)

Kuru, Bekir/0000-0001-7774-6431; YURUKER, SAIM SAVAS/0000-0002-6371-337X WOS: 000322097200010 PubMed: 23884676 BACKGROUND We aimed to investigate the results of a non-operative approach to blunt spleen injury to re-evaluate the importance of injury grade. METHODS Thirty-one blunt splenic trauma cases subjected to non-operative treatment were evaluated retrospectively. The patients were classified into two groups as isolated spleen trauma (ST) group and multi-trauma (MT) group. The hospitalization and blood replacement needs, success of non-operative follow-up, and post-traumatic complications were compared between the two groups. The patients were evaluated via follow-up abdominal ultrasonography (US) and computerized tomography (CT). The results were evaluated with regard to post-splenic trauma complications. RESULTS According to the organ injury scale of the American Association for the Surgery of Trauma, 25.8% were grade-1, 32.2% grade-2, 29% grade-3, and 12.9% grade-4 injuries. It was observed that the transfusion amount was directly proportional to the injury grade. All patients with grade-4 injury and 14 patients with MT were treated successfully with the non-operative method. Splenic pseudoaneurysm developed in one patient in the MT group. One patient was diagnosed with late splenic rupture. CONCLUSION Hemodynamic stability is the most important criterion for the indication of non-operative treatment. However, in well-selected cases, patients with grade 4 splenic traumas and those with extra-splenic injuries could also be treated successfully with the non-operative method.

Objective Heart rate variability (HRV) measures are altered in various cardiac and non-cardiac situations in children. The autonomic nervous system is assumed to have a role in the pathophysiology of atrial septal defect (ASD). In this study, we evaluated the autonomic system by measuring HRV in children with ASD. Methods Twenty-eight patients with ASD and 32 healthy children (mean ages: 6.6 ± 2.1 years and 6.4 ± 2.2 years, respectively) were enrolled in the study. Twenty-four-hour ambulatory electrocardiographic recordings were obtained and the seven time-domain (SDNN, SDANN, rMSSD, SD, SDNN index, PNN50, and mean RR) and four frequency-domain (VLF, LF, HF, and LF/HF ratio) indices of HRV were analyzed. Results A significant decrease in calculated HRV variables was observed in children with ASD as compared to controls. The HRV alteration was found in both time-domain and frequency-domain parameters. Conclusions Our results indicate that HRV is decreased in children with ASD, which implies parasympathetic withdrawal and sympathetic predominance.

Objective Cardiac involvement as pericarditis, myocarditis and valvular disease is common in juvenile idiopathic arthritis (JIA). However, there are few studies concerning systolic and diastolic functions of the left ventricle in children with JIA. P wave dispersion is a sign for the prediction of atrial fibrillation. A recent study found that rheumatoid arthritis patients had an abnormally high P wave duration and P wave dispersion, markers for supraventricular arrhythmogenicity. In this study, we aimed to evaluate P wave dispersion and its relation with diastolic dysfunction of the left ventricle in patients with JIA. Methods We performed electrocardiography and Doppler echocardiography on patients and controls. Maximum and minimum P wave duration were obtained from electrocardiographic measurements. P wave dispersion defined as the difference between maximum and minimum P wave duration was also calculated. Findings No statistically significant differences were found between the patients and controls in minimum, maximum P wave duration and P wave dispersion. Among the diastolic parameters in patients group, increased late flow velocity, decreased early flow velocity and prolonged isovolumic relaxation time reflected diastolic dysfunction. Conclusion During 12 months of follow-up, no supraventricular arrhythmias were documented in JIA with diastolic dysfunction. JIA with diastolic dysfunction has normal atrial conduction parameters and therefore seemingly do not have an increased risk of atrial fibrillation.

WOS: 000302841000026 PubMed: 22186354 …

WOS: 000338440700017 PubMed: 24814308 BACKGROUND: We aimed to compare the effectiveness of linezolid in preventing intraperitoneal adhesions with hyaluronic acid 1 carboxymethylcellulose (Seprafilm). METHODS: Thirty rats were divided randomly into 3 groups: Group I (control), untreated; Group II (Seprafilm); and Group III (linezolid). All rats were sacrificed on the 14th day after surgery. Macroscopic adhesion, inflammation, and fibrosis were evaluated. RESULTS: The multiple comparisons between groups showed a statistically significant difference for adhesion. There were statistically significant differences between Group I and II and I and III, but no statistically significant difference between Group II and III. The multiple comparisons between the groups showed a statistically significant difference for inflammation and fibrosis. For inflammation and fibrosis, there was a statistically significant difference between Group I and II and I and III, but no statistically significant difference between Group II and III. CONCLUSION: The efficiency of linezolid in reducing the formation of intraperitoneal adhesions was statistically significant compared with the control group. (C) 2014 Elsevier Inc. All rights reserved.

Address for Correspondence/Yaz›sma Adresi: Dr. Bulent Koca, Istanbul Universitesi Cerrahpasa Tip Fakultesi, Cocuk Sagligi ve Hastaliklari Anabilim Dali, Cocuk Kardiyoloji Bolumu, Istanbul-Turkiye Phone: +90 212 530 69 19 Fax: +90 212 632 86 33 E-mail: bkoca78@yahoo.com Accepted Date/Kabul Tarihi: 07.09.2011 Available Online Date/Cevrimici Yayin Tarihi: 03.12.2011 ©Telif Hakk› 2011 AVES Yay›nc›l›k Ltd. Sti. Makale metnine www.anakarder.com web sayfas›ndan ulas›labilir. ©Copyright 2011 by AVES Yay›nc›l›k Ltd. Available on-line at www.anakarder.com doi:10.5152/akd.2011.197 Bulent Koca, Ayse Guler Eroglu, Selman Gokalp, Levent Saltik, Funda Oztunc

Early recognition of congenital cardiac pathologies and their treatment by means of palliative or corrective surgery at birth or infancy has vital importance. Successful repair of congenital cardiac defects by surgical methods has gained importance especially during the last twenty years. As the scope of the surveillance increased so did the interest in the outcomes of these treatments when the patients had reached puberty and adulthood. The purpose of our research was to study the psychological framework of the adolescents who had experienced these surgeries by listening both the children and the parents talk about their feelings and experiences. Our data was accumulated through interviews with 17 adolescents and their families, using qualitative methods. The main theme at the end of the analysis was "to be strong and resistive". We reached the conclusion that this condition was not a pathological build up but an attitude of coping, as it did not cause loss of functionality. The defensive psychological mechanisms used by these adolescents consisted of repression, compensation and reaction formation. We believe that this information is important to understand the real meaning of the manners displayed when these adolescents and their families pursue their daily lives, communicate and make relationships with their environment and especially professionals in the health services.