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Sample rejection rate is an important parameter used in the quality monitoring of medical laboratories. We investigated the effect of the COVID-19 pandemic on the monthly rejected sample analysis used as a quality indicator in the preanalytical process in our study.Monthly rejected sample analyzes were divided into two groups as six months before the pandemic (September 2019-February 2020) and six months during the pandemic (April 2020-September 2020). Rejection rates were determined retrospectively by dividing the monthly number of rejected samples to the total number of accepted samples obtained retrospectively via the laboratory information system. Six sigma values and quality indicator error rates were calculated. Pre-pandemic and pandemic data were compared with the paired t-test. The reasons for rejection were evaluated according to the frequency with the Pareto chart. The distribution of rejected samples according to the laboratory department and the medical units where the specimens were sent was examined.Compared to the pre-pandemic period, the rate of insufficient volume of samples increased statistically significantly during the pandemic, while incorrect requests and the other reasons for rejection decreased significantly. A significant increase was observed in the rejected coagulation samples. The rate of rejected samples from intensive care units increased during the pandemic.The COVID-19 pandemic affected the rejected sample analysis. In order to reduce the preanalytical errors, corrective and preventive actions should be taken also during the pandemic., Numune red oranı, tıbbi laboratuvarların kalite izleminde kullanılan önemli bir parametredir. Çalışmamızda preanalitik süreçte kalite indikatörü olarak kullanılan ve aylık olarak yapılan reddedilen numune analizine COVID-19 pandemisinin etkisi araştırılmıştır.Aylık reddedilen numune analizleri pandemi öncesi altı aylık (Eylül 2019-Şubat 2020) ve pandemi sırasındaki altı aylık (Nisan 2020-Eylül 2020) dönem olmak üzere iki gruba ayrılmıştır. Aylık reddedilen numune sayısı ve toplam kabul edilen numune sayısı laboratuvar bilgi yönetim sistemi üzerinden retrospektif olarak elde edilmiş, birbirlerine oranlanarak ret oranları belirlenmiştir. Altı sigma değerleri ve kalite uygunsuzluk oranları hesaplanmıştır. Pandemi öncesi ve pandemi verileri eşleştirilmiş t test ile karşılaştırılmıştır. Ret nedenleri Pareto grafiği ile sıklığına göre değerlendirilmiştir. Laboratuvar birimlerine ve numunenin gönderildiği tıbbi birimlere göre reddedilen numune dağılımı incelenmiştir.Pandemi öncesine göre, pandemi sırasında yetersiz numune oranı istatistiksel olarak anlamlı düzeyde artış gösterirken; hatalı istem ve diğer ret nedenleri anlamlı olarak azalmıştır. Reddedilen koagülasyon numunelerinde anlamlı düzeyde artış gözlenmiştir. Pandemi sırasında yoğun bakımdan reddedilen numune oranı artmıştır.COVID-19 pandemisi reddedilen numune analizini etkilemiştir. Preanalitik hata sıklığını azaltmak için pandemide de gerekli düzeltici ve önleyici faaliyetler gerçekleştirilmelidir.

Objective In this study, we aimed to evaluate the serum creatinine (SCr) levels with the reference change value (RCV) in patients receiving colistin treatment. Methods We retrospectively recorded the SCr levels of 47 patients receiving colistin treatment before treatment and on days 3 and 7 after treatment. RCV was calculated with the asymmetrical RCV formula (Z = 1.64, P Results The RCV was calculated as 15.6% for SCr. Compared with pretreatment values, SCr value on day 3 was 32/47 and on day 7 it was 36/47; as these results exceeded RCV, they were considered statistically significant. Conclusion Use of RCV in the interpretation of results between serial measurements will provide a more rapid and sensitive method when making decisions.

It was aimed to induce a new experimental colitis model by using acetic acid and trinitrobenzene sulphonic acid together and to investigate the severity of inflammation biochemically and histopathologically in comparison with other models.Fifty-six Wistar albino male rats were randomly divided into 4 groups as control, acetic acid, trinitrobenzene sulphonic acid, and combined groups, and the animals were sacrificed following the induction of colitis on the third day and on the seventh day. The serum amyloid A and myeloperoxidase were tested in plasma samples, and the tumor necrosis factor-alpha, interleukin 33, and ST2 were assayed in colon tissue samples with enzyme-linked immunosorbent assay in addition to histopathological examination.There were statistically significant differences between the combined and the control groups both on the third day and on the seventh day in all parameters. There was no difference between the acetic acid group on the seventh day and the control groups in biochemical parameters.The acetic acid model forms acute colitis. The combined model is found to be more successful in forming inflammation when compared to other models.

Objective: Repair of lower limb congenital or acquired tissue defesct in proper shape and function is the main topic of plastic surgery. In this article, we investigated different treatment methods of this anatomical region which is difficult to reconstruction and alternative solution methods to reconstruction with free flap, and also reviewed the treatment algorithm depending on the localization and size of the defect. Material and Methods: In this study; between 2011 and 2017, 27 patients who were surgically treated with a soft tissue defect in the lower extremity were evaluated according to treatment alternative for defect location and advantages of perforator flap to free flap. There were lower extremity soft tissue defect located in the proximal 1/3 cruris in 7 patients, in the middle 1/3 cruris in 12 patients and in the distal 1/3 cruris in 8 patients. Result: Early venous congestion was observed in 3 cases and wound infection was observed in 1 case. Venous congestion resolved spontaneously, wound infection healed with appropriate wound care. In 3 cases, partial flap loss was observed distal to the flap, and was treated with wound care without the need for a second operation. Conclusion: Perforator flaps are a reliable and effective method for repairing soft tissue defects of the lower limbs and it can be applied successfully in the early period after trauma. We think that it can be applied safely cause of the surgical technique is relatively easy and does not require microsurgery.

Nasal filling has gained popularity in plastic surgery practice and strengthened the surgeon's hand. Mild deformities of the nose can be treated with nasal filling instead of rhinoplasty, or small contour irregularities following surgical rhinoplasty can be corrected by dermal filler injections. It is a significant advantage of hyaluronic acid (HA) fillers that they can be dissolved with hyaluronidase in case of the patient dislikes the appearance and desires a surgical rhinoplasty. However, there is no publication about when rhinoplasty surgery can be performed safely after hyaluronidase injection. In this case series, we shared our experiences with nasal filling in plastic surgery practice under three headings: primary nasal filling, nasal filling for post-rhinoplasty defects and rhinoplasty after hyaluronidase injection in dissatisfied filling patients. We presented our nasal filling technique, indications, result analysis and also our rhinoplasty experiences we performed at different times after hyaluronidase injection. Nasal filling patients from July 2015 to March 2020 were divided and analyzed in three groups: (a) Primary nasal filling was provided to 62 patients, (b) nasal filling for post-rhinoplasty defect was provided to 18 patients, and (c) rhinoplasty after hyaluronidase injection was performed in five patients who are not satisfied with results. The duration between hyaluronidase and rhinoplasty operation was, respectively, 6 months, 3 months, 3 months, 2 months and 1 week. (a) In primary nasal filling, 57 patients were fully satisfied, two patients were satisfied, and three patients were dissatisfied with results. Results were stable up to at least 6 months (Range 6–14 months). (b) In nasal filling for post-rhinoplasty defects, all patients were fully satisfied with results. Results were stable for at least 12 months (Range 12–36 months). (c) In rhinoplasty after hyaluronidase injection, any filling residue was not observed, and there were no complications. The postoperative results were satisfactory. Nasal filling with hyaluronic acid represents an excellent alternative for patients who do not wish to undergo a rhinoplasty or a revision rhinoplasty procedure. HA filler can be dissolved easily with hyaluronidase if the patient does not like the result, and we think that rhinoplasty can be performed safely at least one week later from hyaluronidase treatment. 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 .

Background The repair of extensive lower lip defects is difficult due to the presence of both functional and esthetic requirements. This report describes functional lip repair using the partial latissimus dorsi free flap without nerve coaptation. Methods Reconstruction of the lower lip due to subtotal and total tissue defects was performed using latissimus dorsi free flap on twelve patients, between 2013 and 2017. The etiology was squamous cell carcinoma in six patients, malignant melanoma in one, firearm injury in three and microstomia in two. Following exposure of the lip defect, the partial latissumus dorsi muscle flap was harvested and transfered into the lower lip defect. The microvascular anastomoses was done and no nerve coaptation was performed. The muscle was covered with a skin graft taken from the thigh for mucosal and skin lining. Functional outcomes were assessed using physical examination, electromyography (EMG), electroneuromyography, cold/warm and pain sensation, two point discrimination (TPD), and Semmes Weinstein (SMW) tests. Results Postoperative course was uneventful for all of the flaps. Patients were followed for between fifteen months and four years (mean 28.2 months).Color match between the flap and the face and functional outcome was satisfactory. Reinnervation was detected at EMG in eleven patients undergoing surgery six months postoperatively.After 1 year, the patients demonstrated quite normal results of the test with SMW and TDP results. None of patients perceived both hot and cold sensation. Conclusion The technique is an alternative option in lower lip reconstruction since it provides satisfactory functional and esthetic results despite absence of any neural coaptation.

Physiological changes of the thyroid gland encountered during pregnancy can cause previously diagnosed thyroid nodules to grow or new nodules to form. Surgery of the slowly growing, localized, non-metastatic, well-differentiated, thyroid cancers diagnosed during pregnancy can be delayed to after delivery, whereas rapidly growing and metastatic cancers with compressive symptoms may be a candidate for surgery during pregnancy. In this case report, we present a case of cervical metastatic papillary thyroid cancer diagnosed and treated by total thyroidectomy and right functional neck dissection during pregnancy in a 22-year-old pregnant woman at 23-week pregnancy. In this case report, the optimal treatment for papillary thyroid cancer diagnosed during pregnancy is discussed under the light of current endocrine guidelines and previous case reports and series.

This study describes the robotic harvesting of a free omental flap. The patient was a 58-year-old man who had undergone several previous operations due to osteomyelitis caused by trauma. There was a non-healing wound and purulent discharge in the distal pretibial region. The flap was harvested based on the right gastroepiploic artery using robotic facilities only. The flap was then transferred to the debrided defect in the pretibial region. Anastomoses were performed between the posterior tibial vessels and the pedicle of the flap. A split thickness skin graft was used to cover the omental flap. The operation lasted 2.5 h in total, including flap harvesting, microvascular anastomoses, inset and skin grafting. The postoperative period was uneventful and the patient was discharged on the 12th day postoperatively. The reliability of the technique is discussed in this report, together with a brief review of the use of robot surgery in reconstructive surgery in the literature.

Objective: The main objective of soft tissue reconstruction is covering exposed muscle, bone and neurovascular tissues via healthy skin cover rather than aesthetic results. some patients feel uncomfortable about bulky flep mass. Thus, we can use some corrective surgical procedures for better aesthetic and functional outcomes.Material and Methods: Between 2005 and 2015, 45 patients operated for aesthetic and functional outcomes after free flap reconstruction for soft tissue defects. 40 fasciocutaneous free flaps, 2 osteocutanous fibula free flaps, 3 free muscle flaps performed. liposuction and skin excision performed for 38 fasciocıtaneous free flaps, only skin excison made for 4 flaps which are used for oral cavity reconstruction and tangential excision and skin grafting preformed for free muscle flaps.Results: mean follow up period is 45 months 10-100 months . elastic bandage used 3 weeks for compression whom underwent liposuction. There is no complication on postperative period. results were compared with patient satisfaction during daily activities, aesthetic appearence and preoperative and postoperative photographies. 32 flaps were at distal third leg and ankle areas, so patients are able to wear shoes and socks much more easier. oral cavity flap thinnig results show that patients had improved nutrition and airway. 9 patients had satisfied about aesthetic results whom operated for only aesthetic problems.Conclusion: after free flap operations, patients were reported poor aesthetic results and functional outcomes due to bulky flaps. Better aesthetic results and funtional outcomes can achieve via surgical procedures, Amaç: Yumuşak doku defektlerinin rekonstrüksiyonunda ilk hedef açıkta olan damar, sinir, kas ve kemik gibi dokuların üzerini kapatmak olduğundan estetik görünüm ikinci plandadır. Bu nedenle bazen hastalar flep dokusunda oluşan bulky görüntüden rahatsız olmakta ve düzeltilmesini istemektedir. Bu amaçla ikincil cerrahi girişimlerle hem estetik hem de fonksiyonel olarak daha iyi bir sonuç elde edilebilmektedir.Gereç ve Yöntemler: 2005 ile 2015 yılları arasında serbest fleplerle rekonstrüksiyon yapılmış, estetik görünüm ve fonksiyonel bozukluk şikayetiyle başvuran 45 hastaya revizyon cerrahi uygulandı. 40 hastaya fasyokutan flep, 2 hastaya osteokutan fibula flebi ve 3 hastaya kas flebi uygulanmıştı. Fasyakutan flep uygulanan 38 hastaya cilt eksizyonu ile liposakşın uygulandı. oral kavitedeki 4 fasyakutan flepte sadece kısmi cilt eksizyonu uygulandı. Kas flebi yapılan 3 hastaya tanjansiyel eksizyon ve kısmi kalınlıkta deri grefti uygulandı.Bulgular: hastaların takip süresi ortalama 45 aydır. 10-100 ay liposakşın yapılan olgulara elastik bandajla 3 hafta baskı uygulandı. operasyon sonrası dönemde herhangi bir komplikasyon gözlenmedi. sonuçlar, hastaların fonksiyonel kazanımları, estetik görünüm açısından memnuniyet ve operasyon sonrası çekilen fotoğraflarla değerlendirildi. revizyon ameliyatlarının 32’si ayak-ayak bileği seviyesinde olup hastalar ayakkabı ve çorap giymekte rahatladıklarını belirttiler. ağız ve çene bölgesine revizyon uygulanan 4 hasta, operasyon öncesine göre beslenme, nefes alma fonksiyonlarının iyileştiğini tarifledi. estetik nedenlerle başvuran 9 hasta kozmetik sonuçlardan memnun olduklarını belirttiler.Sonuç: serbest flep operasyonlarından sonra hastaların, estetik ve çeşitli fonksiyonel şikayetleri olabilmektedir. serbest flep yapılan ve çeşitli sebeplerle şikayeti olan hastalarda revizyon cerrahisi, hem fonksiyonel açıdan hem de kozmetik görünümün açısından hastaları memnun etmektedir

INTRODUCTION: Using the reference interval based population may not be sufficient for the evaluation of biochemical parameters in followed-up patients. Particularly in patient individuals, since intra-individual variation may be more variable, using the reference change value RCV will provide more information about the variables in parameters in following the patients. In this study it was aimed reveal to whether usage of RCV estimated from healthy individuals’ datum for laboratory will be valid or not in undergone hemodialysis patients.METHODS: In our hospital, the biochemical parameters of 22 hemodialysis patients followed regularly were examined and intra-individual CVI , inter-individual coefficients CVG and RCV were calculated. 21/2 x Z x CVA2 + CVI2 1/2 formula was used for reference change value.RESULTS: By using the undergone hemodialysis patients and our laboratory healthy biological variation datum, bias values obtained were estimated as, 42.25% for glucose; 26.15% for alkaline phosphatase ALP ; 23.66% for alanine transaminase ALT ; 31.12%vfor inorganic phosphate and 103.6% for Creactive protein CRP . DISCUSSION AND CONCLUSION: Consequently, it was demonstrated that reference change values of patient groups are different from healthy groups., GİRİŞ ve AMAÇ: Düzenli takibi yapılan hastalarda biyokimyasal parametrelerin topluma dayalı referans aralığı kullanılarak incelenmesi yeterli olmamaktadır. Özellikle hastalarda bireyiçi varyasyon çok daha değişken olabileceğinden dolayı, hastaların takibinde referans değişim değerinin RDD kullanılması parametrelerdeki değişiklikler hakkında daha fazla bilgi sağlayacaktır. Bu çalışmada, hemodiyalize giren hastalarda laboratuvar için sağlıklı bireylerin verilerinden hesaplanan RDD’nin kullanılmasının geçerli olup olmayacağını ortaya koymak amaçlanmıştır. YÖNTEM ve GEREÇLER: Hastanemizde takibi yapılan 22 hemodiyaliz hastasının biyokimya parametreleri retrospektif olarak incelendi ve bireyiçi CVI , bireyler arası varyasyon katsayıları CVG ile RDD’leri hesaplandı. RDD için 21/2 x Z x CVA2 + CVI2 1/2 formülü kullanıldı.BULGULAR: Hemodiyalize giren hastalar ile sağlıklı bireylerin biyolojik varyasyon verileri kullanılarak elde edilen RDD’ler için hesaplanan bias değerleri glukoz için %42.25; alkalen fosfataz ALP için %26.15; alanin amino transaminaz ALT için %23.66; inorganik fosfat için %31.12 ve C-reaktif protein CRP için %103.6 olarak hesaplandı.TARTIŞMA ve SONUÇ: Sonuç olarak, hasta grupların RDD’lerinin sağlıklı gruplardan farklı olduğu ortaya konmuştur.

Objective: Smart phones have a wide usage. Through these devices, communication has gained a different dimension and access to information has become much easier through mobile internet and communication. Describing the case via a phone call is often inadequate. Picture or video sharing provides a faster and earlier patient consultation. In this study; we aimed to present our experience, advantages and disadvantages of consulting plastic surgery patients with smartphones.Material and Methods: A total of 191 patients were consulted to a specialist by the residents via smartphones between March 2015 and July 2015. The group consisted of 110 males and 81 female patients aged between 7 and 69 years mean 34.5 . 90 patients were consulted from the emergency room 48 maxillofacial traumas, 15 soft tissue defects, 27 burns , and 57 patients from other clinics while 44 patients 22 free fl aps, 22 pedicled fl aps were consulted for fl ap assesment after fl ap surgery.Results: Faster and earlier treatment decisions were made for all patients who were consulted via smartphones. The method prevented late assessment, reduced workload, and enabled earlier treatment plans. After fl ap surgery, early decisions were made by seniors via pictures or videos taken by the residents in charge.Conclusion: Smartphone usage is common by doctors during consultations. Smartphones provide easier patient follow-up and faster decisions when determining the treatment plan, Amaç: Akıllı telefonlar günümüzde çok yaygın olarak kullanılmaktadır. Bu telefonlar sayesinde iletişim farklı bir boyut kazanmış, mobil internet sayesinde bilgiye ulaşmak ve iletişim çok kolay hale gelmiştir. Telefonda hasta anlatımı çoğu zaman yetersiz olup görüntü ya da video paylaşımı sayesinde daha hızlı ve erken bir şekilde hasta konsültasyonu yapılabilmektedir. Çalışmada; plastik cerrahide akıllı telefonlar ile yapılan hasta konsültasyonu, avantaj ve dezavantajları ile tecrübelerimizi sunmayı amaçladık.Gereç ve Yöntemler: Mart 2015 ile Temmuz 2015 tarihleri arasında 191 hasta, araştırma görevlileri tarafından akıllı telefonlar aracılığıyla icapçı uzman doktora konsülte edilmiştir. Hastaların 110’u erkek, 81’i kadındı. Hastaların yaşları 7 ile 69 yaş ortalama 34,5 arasındaydı. Acil servisten 90 hasta 48 maksillofasiyal travma, 15 yumuşak doku defekti, 27 yanık , farklı kliniklerden 57 hasta, fl ep operasyonu sonrası fl ep takibi yapılan 44 hasta 22 serbest fl ep, 22 pediküllü fl ep konsülte edildi.Bulgular: Akıllı telefonlar aracılığıyla konsülte edilen hastalar için tedavi planlaması kararları daha hızlı alınmıştır. Bu sayede mevcut iş yoğunluğundan dolayı oluşabilecek geç değerlendirme, ek iş yükü azalmış olup daha erken tedavi kararları alınmıştır. Flep takiplerinde ise nöbetçi araştırma görevlileri ilgili ögretim görevlisi ile canlı bağlantı kurarak gerek fotoğraf gerek video ile fl ep canlılığı ortak değerlendirilmiştir.Sonuç: Sonuç olarak, akıllı telefonlar artık doktorlar arasında hasta konsülte etmede çok sık kullanılan araçlardır ve hem hasta takibini kolaylaştırmakta hem de tedavi planını hızlandırmaktadır

Objective Reconstruction of the lips is pivotal because the lips play an essential role in facial aesthetics and have unique functional properties. We presented our experience in reconstruction of total or subtotal lower lip defects with functional gracillis muscle flap covered split-thickness skin graft (STSG) in patients. Methods Between 2009 and 2011, seven patients underwent resection of lower lip squamous cell carcinoma and lip reconstruction. Gracillis muscle flap was performed for reconstruction. Recipient vessels were the facial artery and vein. Motor nerve of the gracillis muscle was coapted to the marginal branch of the facial nerve. Gracillis muscle was covered with STSG. Patients were evaluated about mouth opening, oral competence, word articulation, the color match of the graft, the contraction of the muscle by physical examination. Electromyographic studies and sensation tests were performed. Results Postoperative course was uneventful for all of the flaps. No microvascular revisions were needed. One patient was reoperated because of wound dehiscence under local anaesthesia. Mean follow up period was 15 months. After three months, movement of the reconstructed lip was observed. Color of the grafted skin was matched with the skin of the face. The patients had no problems with word articulation, oral continence, or mouth opening. The electromyographic study showed recovery of motor innervation. After 1 year, the patients demonstrated recovered sensitivity with the sensation test. Conclusion Considering functional results, superior aesthetic appearance, and minimal donor-site morbidity of the functional gracillis transfer covered skin graft, we think that this method may be an alternative for reconstruction of large full-thickness defects of the lower lip. © 2015 Wiley Periodicals, Inc. Microsurgery, 2015.

Tendon lacerations are most commonly managed with surgical repair. Postoperative complications such as adhesions and ruptures often occur with immobilization. Early postoperative mobilization is therefore advised to minimize complications and time required to return to daily life. The aim of this study was to evaluate whether botulinum neurotoxin type-A (BoNT-A) can be used to enhance healing and prevent rupture in mobilized animals with Achilles tenotomy.Twenty-seven rabbits were divided into 3 groups, namely, I, II, and III, after surgical 1-sided Achilles tenotomy and end-to-end repair. The control group for biomechanical comparisons consisted of randomly selected contralateral (unoperated) healthy Achilles tendons. Group I received BoNT-A (4 U/kg) injection into the calf muscles. One week later, electromyographical confirmation was performed to establish the effects of injection. Surgery was then performed. Animals in the second group (n = 9, group II) were immobilized with a cast postoperatively. The third group (n = 9, group III) was mobilized immediately with no cast or BoNT-A. Tendons were harvested and gap formation or ruptures as well as strength of the repaired tendon were assessed 6 weeks after surgery.Achilles tendons healed in all animals injected with BoNT-A, whereas all were ruptured in group III. All Achilles tendons of animals in groups I and II healed. However, group I repaired tendons were biomechanically equivalent to healthy tendons, whereas group II repaired tendons demonstrated significantly decreased tensile strength (P = 0.009).The present study suggests that local injection of BoNT-A can be used for treatment of tendon rupture and may replace the use of cast for immobilization. However, further studies are needed to determine whether BoNT-A injection can have a beneficial effect on the healing of tendon repairs in humans.

Soft tissue defects of the distal lower extremities are challenging. The purpose of this paper is to present our experiences with the free peroneal artery perforator flap for the reconstruction of soft tissue defects of the distal lower extremity. Nine free peroneal artery perforator flaps were used to reconstruct soft tissue defects of the lower extremities between April 2006 and October 2011. All flaps were used for distal leg and foot reconstruction. Peroneal artery perforator flaps ranged in size from 2 cm × 4 cm to 6 cm × 12 cm. The length of the vascular pedicle ranged from 2 to 6 cm. Recipient vessels were: medial plantar vessels in seven cases, the dorsalis pedis vessel in one, metatarsal vessel in one. All flaps survived completely, a success rate of 100%. Advantages of this flap are that there is no need to sacrifice any main artery in the lower leg, and minimal morbidity at the donor site. This free perforator flap may be useful for patients with small to medium soft tissue defects of the distal lower extremities and feet.