Ailevi Akdeniz ateþine (AAA) ikincil geliþen amiloidozda kardiyovasküler bulgularýn, amiloidoz geliþmeyen hasta ve saðlýklý kontrol gruplarýyla karþýlaþtýrýlmasý amaçlanmýþtýr. Çalýþmada 33 sekonder amiloid hastasý, 33 AAA hastasý ile 65 saðlýklý kontrol olmak üzere 130 kiþi yer aldý. Sol ventrikül fonksiyonlarýnýn deðerlendirilmesinde 2-boyutlu, M-mod, konvansiyonel ve doku doppler ekokardiyografi incelemeleri kullanýldý. Aortun elastik özelliklerinin incelenmesinde 2-boyutlu ve M-mod ekokardiyografi kullanýldý. Karotis intima-media kalýnlýðýnýn ölçülmesinde karotis arter B-Mode ultrasonografi kullanýldý. Hasta ve kontrol grubu yaþ, cinsiyet, serum lipid düzeyleri açýsýndan benzer özellikteydi (p>0.05). Aortik elastik fonksiyon parametreleri hasta ve kontrol guruplarý arasýnda benzerdi (p>0.05). Mitral annuler E/A oraný amiloid grubunda kontrollere göre anlamlý olarak daha düþüktü ( p=0.004). Mitral annuler lateral Em/Am oraný amiloid grubunda benzer þekilde daha düþük iken (p=0.001), karotis intima-media kalýnlýðý amiloid grubunda belirgin derecede daha yüksek saptandý (p<0.001). AAA hastalarýn karotis intima-media kalýnlýðý saðlýklý kontrol grubuna göre daha yüksekti (p=0.03). Ejeksiyon fraksiyonu ve sol ventrikül kitle indeksi gruplar arasýnda benzerdi (p>0.05, her biri için). Bu çalýþmadaki bulgular AAA’ya sekonder amiloid geliþen hastalarda subklinik bir miyokardiyal tutulumun olabileceðini düþündürmektedir. Sekonder amiloide baðlý karotis intima-media kalýnlýðýnýn artýþý dikkat çekmiþtir.

The aim of the study is to investigate cardiovascular findings among patients with familial Mediterranean fever (FMF), secondary amyloid patients and healthy control group. The study was performed on 32 secondary amyloid patients, 33 FMF patients and 65 healthy control group. Left ventricular functions were measured using echocardiography including two-dimensional, M-mode, conventional and tissue doppler imaging. Aortic elasticity was analyzed using M-mode tracing guided by the two-dimensional echocardiography. CIMT was measured using carotis artery B-mode ultrasonography. Age, sex and serum lipids were comparable among groups (p>0.05). Aortic wall properties were similar between groups (p>0.05). Mitral annuler E/A ratios were significantly lower in secondary amyloid patients rather than FMF patients and healthy controls in measurement of conventional and tissue doppler echocardiography (p=0.004 and p=0.001, respectively). Moreover, CIMT values were higher in secondary amyloid patients (p<0.001). In additon, CIMT values was higher in FMF patients than healthy controls (p=0.03). Ejection fraction and left ventricular mass index were similar among groups (p>0.05, for both). These findings suggested that subclinical myocardial involvement is present in secondary amyloid patients. It is noted that CIMT values were higher in amyloid and FMF patients.

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Frequent attenders to emergency departments are increasingly important worldwide major healthcare problem. In our study we aimed to define characteristics of this unique and frail population. Study was conducted in Ankara Numune Training and Research Hospital during a 1-year period between 01.01.2013 and 01.12.2013 and adult patients older than 18 years old whom made emergency visits more than 12 times a year were included in the study. Each patient’s demographic data (age, sex, marital status), medical insurance status, cause of death, residential address, chronic disorders were noted and analyzed further. A total of 169,066 emergency department visits done by 124,574 different patients.117 frequent attenders visited emergency department for a total of 2,162 times. 76 were men and 41 were women. The count of visits were ranging from 12 to 91 per year. Of them the uninsured were significantly older.Both the age and frequency of divorced/widowed were significantly higher compared to other groups (p<0.05). Pain was significantly the most common presenting symptom followed by psychiatric complaints. Frequent attenders had mostly psychiatric and pain related chronic diseases in general but hematological disorders had significantly more common emergency department visits compared to other patients.16 patients were deceased during the study period. The analysis of the deceased patients revealed that they had a significantly higher frequency of emergency department visits, significantly higher mean age, and significantly higher rates of chronic internal and oncological disorders. Frequent patients, a frail population, have complex problems, the solution of which should primarily lie in familiarizing with this patient population and defining their characteristics.

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Bu çalýþmada kliniðimizde deðerlendirilen ve H1N1 virüs enfeksiyonu tanýsý alan hastalarýn hematolojik bulgularý ve hastalýðýn gidiþatýna etkileri gözden geçirildi. H1N1 enfeksiyon tanýlý 21 çocuk çalýþmaya dahil edildi. Kan sayýmý sonuçlarý 1, 3 ve 7. günlerde incelendi. Hastalarýn 1. gün hematolojik bulgularýnýn sýklýðý, ayný yaþ ve ayný sayýda hastadaki 3 grup ile karþýlaþtýrýldý. Hastalarýn yedisi (%33,3) kýz, 14’ü (%66,7) erkekti. Ortalama yaþ 5,1 saptandý. Hastalarýn yedisinde (%33,3) lökopeni, üçünde (%14,3) lökositoz, dördünde (%19) anemi bulunmaktaydý. Dokuz hastada (%42,9) trombositopeni, bir hastada da (%4,8) trombositoz mevcuttu. Dokuz hastada (%42,9) lenfopeni saptanýrken, üç hastada (%14,3) nötropeni, sekiz hastada (%38,1) monositoz saptandý. Altta yatan kronik hastalýðý olan, izlemlerinde solunum sýkýntýsý ve çoklu organ yetersizliði geliþen üç hasta kaybedildi. Sonuç olarak H1N1 enfeksiyonlarýnda sitopenilerin daha sýk görülmesi ve aðýr olmasýnýn klinik tablonun daha aðýr seyretmesine sebep olabileceði düþünülmektedir.

In this study, the hematologic findings of patients who were diagnosed with H1N1 virus infection and the effects on the course of the disease were reviewed. 21 children with H1N1 infection diagnoses were included in the study. Blood count results on days 1, 3 and 7 were examined. The frequency of the 1st day hematologic findings of the patients was compared with the 3 groups in the same age and the same number of patients. Time of onset of hematologic findings and prognostic effects were evaluated. Seven of the 21 patients (33.3%) were female, and 14 (66.7%) were male. The mean age was 5.1 years. Seven patients (33.3%) had leukopenia, 3 (14.3%) had leukocytosis, and 4 (19%) had anemia. Nine patients (42.9%) had thrombocytopenia, and 1 patient (4.8%) had thrombocytosis. Lymphopenia was detected in 9 patients (42.9%), neutropenia in 3 patients (14.3%), and monocytosis in 8 patients (38.1%). Three patients who had underlying chronic disease or respiratory distress died during the follow-up period. In conclusion, more frequent and severe cytopenias in H1N1 infections are thought to cause the clinical presentation to be more severe.

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Yenidoðanlarda kalp anomalileri yaklaþýk % 1 oranýnda görülmekte olup en sýk rastlanan doðumsal anomali grubunu oluþtururlar. Doðumsal anomaliye baðlý erken neonatal ölümlerin de en sýk görülen nedeni doðumsal kalp hastalýklarýdýr (DKH). Doðumsal kalp hastalýklarýnýn erken tanýnmasý gerekli týbbi veya cerrahi tedavi yöntemlerinin önceden belirlenmesi açýsýndan büyük önem taþýmaktadýr. Mart 2014- Ocak 2016 tarihleri arasýnda Çocuk Kardiyoloji polikliniðine fetal ekokardiyografik deðerlendirme yapýlmak üzere yönlendirilen 152 gebeye ait veriler çocuk kardiyoloji poliklinik kayýtlarýndan retrospektif olarak incelendi. 16 gebede (% 10.52) kompleks doðumsal kalp hastalýðý tanýsý aldý. Kompleks doðumsal kalp hastalýðý tanýsý koyulan tüm fetüslerden giriþim ya da cerrahi müdahale ön görülen fetüsler için aile ile görüþülerek müdahale yapýlacak merkez ile prenatal dönemde görüþüldü ve doðumlarýn multidisipliner bir yaklaþýmla koordine olarak yapýlmasý saðlandý. 16 fetusdan 4 tanesi aort koarktasyonu (AK), 5 tanesi Fallot tetralojisi (TOF), 1 tanesi fallot pulmoner kapak yokluðu (TOF-APV), 2 tanesi hipoplastik sol kalp sendromu (HLHS), 2 tanesi büyük arter transpozisyonu (BAT), 2 tanesi çift giriþli sol ventrikül (DILV) tanýsý aldý. Çalýþmamýzda doðum sonrasý acil giriþimsel tedavi gerekecek hastalarýn tamamýnda planlama ve merkezin ayarlanmasý prenatal dönemde yapýlmýþ olup hastalar postnatal dönemde PGE1 baþlanarak sevk edilmiþtir. Doðum salonunda acil giriþim ihtiyacý olabilecek fetuslar bu giriþimin yapýlabileceði merkezlere anne karnýnda yönlendirilmiþtir. Doðum sýrasýnda ve sonrasýnda hastalarda hiçbir hemodinamik instabilite meydana gelmemiþtir. Sonuç olarak; doðumsal kalp hastalýklarýnýn prenatal dönemde taný almasý postnatal risk belirlenmesi, giriþimsel tedavi olacak merkezle koordine olunabilmesine olanak saðladýðýndan neoanatal mortaliteyi önemli ölçüde azaltmaktadýr.

Cardiac anomalies occur in about 1% of newborn infants and form the most common group of congenital anomalies. Congenital heart diseases are the most common cause of early neonatal deaths due to congenital anomalies. Early recognition of congenital heart diseases has great importance for the pre-determination of necessary medical or surgical treatment methods. A total of 152 pregnant women who underwent fetal echocardiographic evaluation between March 2014 and January 2016 were reviewed retrospectively from the pediatric cardiology outpatient clinic records. 16 pregnancies (10.52%) were diagnosed with complex CHD. All fetuses diagnosed with complex CHD were interviewed at the prenatal period with the congenital heart intervention center for fetuses whom intervention or surgical intervention was foreseen, and the delivery was coordinated with a multidisciplinary approach. Of the 16 fetuses, 4 had aortic coarctation, 5 had tetralogy of fallot, 1 had no fallot absent pulmonary valve, 2 had hypoplastic left heart syndrome, 2 had transposition of great arteries, 2 had double inlet left ventricle. In our study, all of the patients who needed postpartum emergency interventional treatment were planned in the prenatal period and the center was set up and the patients were referred by starting PGE1 in the postnatal period. The fetus, which may need urgent intervention in the delivery room, is directed to the center prenatally. No hemodynamic instability has occurred in patients during and after birth. As a result; the prenatal diagnosis of CHD and postnatal risk determination, can reduce the neoanatal mortality significantly because it allows the interventional treatment to be coordinated with the center.

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Amaç: Çalýþmanýn amacý normal iþitmeli ve sensörinöral iþitme kayýplý yetiþkinlerde iþitsel uyarýlmýþ geç potansiyeller (ÝUGP) ve klasik davranýþsal tekniklerle elde edilen iþitme eþiði sonuçlarýný karþýlaþtýrmak ve bu iki testin birbiri ile ne kadar uyumluluk gösterdiðini araþtýrmaktýr. Metot: Çalýþmaya 18 normal iþiten (33 kulak), 56 iþitme kayýplý (112 kulak) olmak üzere toplam 74 yetiþkin (145 kulak) alýnmýþ ve 500, 1000, 2000 ve 4000 Hz frekanslarýnda elde edilen ÝUGP ve davraným eþikleri karþýlaþtýrýlmýþtýr. Bulgular: Normal iþitenlerde ÝUGP ve davraným eþikleri arasýnda 500 Hz'de korelasyon olmadýðý, 1000 ve 2000 Hz’ de orta, 4000 Hz’ de zayýf bir korelasyon olduðu, iþitme kayýplýlarda ise tüm frekanslarda yüksek derecede bir korelasyon olduðu görülmüþtür. Her iki ölçüm ortalamalarý arasýndaki en büyük fark deðeri normal iþitenlerde 5 dB, iþitme kayýplýlarda ise 7.4 dB 'dir.
Sonuç: Sonuç olarak ÝUGP' nin 500, 1000, 2000 ve 4000 Hz frekanslarýnda saf ses davraným eþikleri ile normal ve iþitme kayýplý kiþilerde yüksek oranda uyumluluk gösterdiði görülmüþtür. Bu nedenle ÝUGP’ yi, davraným eþiklerine kooperasyonu olmayan çocuk ve yetiþkinlerde, adli vakalarda ve nonorganik iþitme kayýplarýnda eþik yordamak üzere kullanýlabilecek uygun ve güvenilir bir test olarak önermek mümkündür.

Aim: The aim of the study was to compare the hearing threshold levels obtained by cortical auditory evoked responses and classic behavioral audiometry in adults with normal hearing and sensorineural hearing loss and to study the compatibility of these two tests. Methods: In this study 74 adults consisting of 18 normal hearing and 56 hearing impaired people were evaluated and hearing threshold levels obtained with both tests at 500, 1000, 2000 and 4000 Hz frequencies were compared. Results: The correlation between ALR and behavioral thresholds was found to be moderate at 1000 and 2000 Hz, poor at 4000 Hz and there was no correlation at 500 Hz in adults with normal hearing.On the other side in adults with hearing loss good correlation was found to be high at all of the tested frequencies. The biggest mean differences between two tests values were 5 dB in normal hearing people and 7.4 dB in hearing disorders people.
Consequences: ALRs have showed good correlations with pure tone behavioral thresholds and it may be suggested as a reliable and accurate test to estimate pure tone thresholds in uncooperative adults and children, forensic cases and subjects with nonorganic hearing loss.

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Alt solunum yolu enfeksiyonlarý çok önemli bir hastalýk ve ölüm nedeni olarak týbbýn önemli sorunlarý arasýnda baþta gelmektedirler. Güncel taný yöntemlerini kullanarak elde edilen veriler bu enfeksiyonlarý kontrol ve tedavide çok hýzlý yol almamýza yol açmaktadýrlar. Hastalýk etkeni mikroorganizmalarýn çeþitliliði ve sýklýðýnýn doðru bir þekilde ortaya çýkarýlmasý, taný, tedavi ve kontrolde önceki yýllar ve uygulamalardan farklý bir yöne doðru gidebilmemizi saðlayacaklardýr. Hastalarýn nazofaringeal aspirasyon sývýlarýnda 2015-2017 yýllarýnda 283 örnekte 21 viral solunum patojeni, Fast Track FTD Respiratory pathogens 21(Fast Track Diagnosis, Luxembourg) ile araþtýrýlmýþtýr. Hastalarýn tamamý alt solunum yolu enfeksiyonu tanýsý ile takip edilenlerdir. Toplam 283 örneðin 236 tanesinde bir ya da daha fazla etken ortaya çýkmýþtýr (%83,45). En sýk etkenler, Rhinovirus, Adenovirus, Ýnfluenza A ve B, Respiratuvar sinsityal virüs A/B, Human metapneumovirus A/B ve Parainfluenza 1 olmuþtur. Hastalarýn doðru ve etkili tedavisi 16-24 saat arasýnda sonuçlanan testler ile saðlanmýþtýr. Gerek hastanede yatýþ sürelerinde “düzelme”, gerekse uygun antimikrobiyal tedavinin zamanýnda baþlamasý ve etkenin bilinmesi ile baðlantýlý kontrol önlemlerinin alýnmasý sayesinde ciddi ekonomik katkýnýn yanýnda, daha önemlisi, doðru klinik ve epidemiyolojik uygulama ile ilgili önemli yol alýnmýþtýr. Hýzlý ve doðru sonuç veren daha kapsamlý testlerin ortaya çýkmasý, uygun maliyetle saðlanmasý ve basitçe kullanýlabilir olmasý bir sonraki aþama olarak karþýmýzda durmaktadýr. Saðlýk sigortalarý ve sosyal güvenlik kurumlarýnýn bu testleri kapsamlarýna almalarý tamamlayýcý bir aþama olarak gündemde olmalý ve hastalarýn saðlýðýný üst düzeye taþýmada saðlýk profesyonellerinin iþini kolaylaþtýrmalýdýr.

Lower respiratory tract infections are very important for public health as an important cause of morbidity and mortality. Data gathered with modern diagnostic tools let us to rapidly understand and control these infections. Discovering the variety and frequency of the microorganisms causing the disease will make us head in a different direction from previous years and practices in diagnosis, treatment and control; 21 viral respiratory pathogens were identified from the 283 nasopharyngeal aspirates with Fast Track FTD Respiratory 21 kit (Fast Track Diagnosis, Luxembourg) in years 2015-2017. All of these patients were followed up with a diagnosis of lower respiratory tract infection. One or more pathogen were discovered in 236 of 283 specimens (83,45%). The most frequent pathogens were Rhinovirus, Adenovirus, Influenza A and B, Respiratory Syncytial Virus A/B, Human metapneumovirus A/B and Parainfluenza 1. Appropriate treatment of the patients were provided from the tests resulting between 16-24 hours. Besides significant contribution to economy, big advancement was made in correct clinical and epidemiological practice, which is more important, owing to both “improvement” in duration of hospitalization and starting an appropriate antimicrobial therapy in time and taking infection control measures in association with identified causative agent. More comprehensive tests giving rapid and correct results, provided with reasonable costs and their being easy-to-use is the next step ahead us. Incorporation of these tests by health insurances and social security institutions should be on the agenda as a complementary step and should facilitate health professionals’ work in improving patients’ health levels.

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D vitamini, kemik mineral metabolizmasý üzerine etkileri dýþýnda, nörolojik, immune sistem
Ve endokrin sÝstem üzerine etkileri olduðu saptanmýþtýr. Bu da D vitaminÝ üzerine olan ilgiyi artýrmýþtýr. Kronik böbrek hastalýðý (KBH) olan hastalarda genel populasyona benzer þekilde D vitamin eksikliðinin böbrek hastalýðýnýn ilerlemesi, kardiovasküler mortalite ve morbiditede artýþ ile iliþkili olduðu gösterilmiþtir. Biz de bu çalýþmamýzda takip ettiðimiz KBH’li hastalarda D vitamin düzeyine etki eden faktörleri saptamayý amaçladýk.
Hastanemiz nefroloji kliniðine baþvuran, KBH olan ve diyalize girmeyen 120 hasta çalýþmaya alýndý.
Hastalarýn 68 (%56.7)’inde D vitamin eksikliði, 47 (%39.2)’sinde D vitamin yetmezliði vardý. Altmýþ sekiz hastanýn D vitamin düzeyi < 15 pg/ml, 56 hastanýn ise >15 pg/ml üstünde idi.
Diabetes mellitusu (DM) olanlar ve olmayanlar karþýlaþtýrýldýðýnda, DM olanlarda D vitamin düzeyi; 12,9± 6,6pg/ml iken DM olmayanlarda bu düzey 16,0±8,1 idi. Aradaki fark istatistiksel olarak anlamlýydý (p<0,05).
Korelasyon analizi sonucunda D vitamini, fosfor (rs=-0,30, p<0,001), PTH(rs=-0,34, p<0,001), proteinüri (rs=-0,22, p<0,05), DM varlýðý (rs=-0,19, p<0,05) ile negatif korele iken, hemoglobin (rs=0,27, p<0,001) ile pozitif korele idi. Fakat 25-OH-D ile FGF 23 (rs=-0,122, p=0,183) ve eGFR (rs=0,135, p=0,41) arasýnda ise herhangi bir iliþki saptanamadý
Multivariate lineer regresyon analizinde ise sadece PTH (Beta= -0,24, p<0,01), eGFR (Beta=-0,215, p<0,05) D vitamini üzerine negatif etkili bulundu.
Son yýllarda D vitaminin klasik mineral metabolizmasý dýþýnda pleotropik rolü ve özellikle de prediyaliz KBH’lý hastalarda bunun klinik sonuçlarý daha iyi anlaþýlmýþtýr. Bu nedenle de bu hasta grubunda D vitamini düzeyine etki eden faktörleri bilmek ve hastanýn tedavisinde bunlarý gözönüne almak büyük önem taþýmaktadýr.

D vitamin was found to have effects on the neurological, immunological and endocrine systems except for the effects on bone mineral metabolism. In patients with chronic kidney disease (CKD), vitamin D deficiency has been shown to be associated with progression of renal disease, increased cardiovascular mortality and morbidity. In this study, we aimed to determine the factors affecting the vitamin D level in our CKD patients.
One hundred and twenty patients with CKD but not on dialysis who were admitted to our nephrology clinic were included in the study. Sixty eight of the patients (56.7%) had vitamin D level deficiency, 47(39.2 %) of them had vitamin D insufficiency.
Sixty-eight patients had vitamin D levels of <15 pg / ml and> 56 pg / ml in 56 patients.
Vitamin D level in patients with DM was 12, 9± 6,6pg/ml and without DM was 16±8,1, the difference was statistically significant (p<0,05).
In univariate correlation analysis, vitamin D was negatively correlated with phosphorus (rs = -0,30, p < 0,001), PTH (rs = -0,34, p < 0,001), proteinuria (rs = -0,22) and DM (rs=-0,19, p<0,05). However we did not find any correlation between 25-OH-D and FGF 23 and (rs=-0,122, p=0,183), eGFR(p=0,183,rs=0,135).
In multivariate lineer regression analysis, only PTH (Beta = -0, 24, p < 0,01) and glomerular filtration rate (Beta = -0,215, p <0,05) were found to have a negative effect on vitamin D.
In recent years, besides the classical mineral metabolism of vitamin D, pleotropic role and clinical consequences in predialysis CKD patients have been better understood.
For this reason it is of great importance to know the factors affecting the vitamin D level in this patient group and to consider that in the treatment of the patients.

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Bu çalýþmanýn amacý,ektopik gebelikte ortalama trombosit hacmi (MPV) ve trombosit daðýlým geniþliði (PDW) gibi trombosit indekslerinin serum düzeyindeki deðiþimleri deðerlendirmek ve MPV ve PDW'deki deðiþikliklerin ektopik gebelikte öngörü deðeri taþýyýp taþýmadýðýný araþtýrmaktýr. Retrospektif olarak 2013 yýlý ile 2016 yýllarý arasýnda kliniðimize baþvuran 113 tubal ektopik gebeliði olan hastalar (26 rüptür ve 87 rüptür olmamýþ) ve ilk trimesterde 74 saðlýklý gebeliði olan kadýnlar çalýþmaya alýndý.Toplam 187 gebenin hemoglobin, hematokrit, trombosit düzeyi, MPV, PDW ile ilgili laboratuvar verileri analiz edildi. Trombosit sayýlarý, rüptüre olmuþ ektopik gebelikte, rüptüre olmamýþ ektopik gebelikler ve kontrol gruplarýna göre anlamlý derecede düþük bulundu (p< 0,01). MPV düzeyleri, özellikle rüptüre olmuþ ektopik gebelikte kontrol grubuna göre daha düþük bulunmakla birlikte, gruplar arasýnda anlamlý bir fark bulunamadý (p = 0,616). PDW seviyeleri ise rüptüre olmuþ ektopik gebelikte kontrol grubuna göre daha yüksek bulunmakla birlikte üç grup arasýnda istatistiksel olarak önemli bir fark görülmedi (p = 0,451). Sonuç olarak trombosit sayýlarý, rüptüre olmuþ ektopik gebelikte daha düþük olma eðilimi gösterir ve enflamasyon alanýndaki trombosit tüketimini göstermektedir. MPV deðerleri ise, patolojide olasý yüksek dereceli inflamasyonu düþündüren rüptüre ektopik gebelikte daha düþük gözükmektedir. Ön sonuçlarýmýz, rüptüre ektopik gebelik olgularýnda MPV düzeylerinin düþebileceðini ayný zamanda, PDW seviyelerini artýrabileceðini göstermektedir. Bununla birlikte, ektopik gebeliðin taný ve klinik izleminde trombosit indekslerinin yararlýlýðýný tanýmlamak için ileri çalýþmalara ihtiyaç vardýr.

The aim of the study is to evaluate changes in serum levels of platelet indices such as mean platelet volume (MPV) and platelet distribution width (PDW) in ectopic pregnancy and to investigate whether changes in MPV and PDW have predictive value in ectopic pregnancy. Retrospective analysis of 113 tubal ectopic pregnancies (26 ruptured and 87 unruptured) and 74 healthy pregnant women in the first trimester were included in the study. The hemoglobin, hematocrit, thrombocyte level, MPV, PDW were analyzed. In the result, thrombocyte counts were significantly lower in ruptured ectopic pregnancy than in unruptured ectopic pregnancies and control groups (p< 0,01). MPV levels were lower in the ruptured ectopic pregnancy than in the control group, but there was no significant difference between the groups (p = 0,616). PDW levels were higher in ruptured ectopic pregnancy compared to the control group, but there was no statistically significant difference between the three groups (p = 0,451). The platelet counts tend to be lower in ruptured ectopic pregnancy and indicate platelet consumption in the inflamed area. MPV appears to be lower in ruptured ectopic pregnancy, suggesting possible high grade inflammation in the pathology. Our preliminary results suggest that MPV levels may decrease and PDW levels may increase in ruptured ectopic pregnancies. However, further work is needed to define the usefulness of platelet indices in the diagnosis and clinical follow-up of ectopic pregnancies.

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Transforaminal interbody füzyon(TLIF) tekniði omurga cerrahisinde füzyon saðlamak amacý ile kullanýlmaktadýr. Tekniðin kendisi teknik detaylara sahip olup dikkat edilmemesi halinde ciddi komplikasyonlara yol açabilir. Bu iþlemde kullanýlan TLIF kafesinin boyunu belirlemek de teknik detaylarýn içinde önemli bir yere sahiptir. Bu retrospektif çalýþmada TLIF cerrahisinde kullanýlan kafesin önceden tahmin edilebilirliðini deðerlendirmek istedik. Bu amaç ile TLIF cerrahisi uygulanmýþ 22 hastanýn disk yüksekliklerini ve kafes boylarýný inceledik. Hastalarýn 9’u erkek, 13’u kadýn idi ve yaþ ortalamasý 52.3(30-72)’ idi. Kullanýlan kafes boylarý ve disk yükseklikleri arasýnda istatsiksel olarak anlamlý bir birliktelik saptanmadý. Transforaminal Ýnterbody füzyon tekniðinde kullanýlan kafes boyunun cerrahi teknik detaylara dikkat ederek belirlemenin daha uygun olduðunu düþünmekteyiz.

Transforaminal interbody fusion (TLIF) technique is used to provide fusion in spine surgery. The technique itself has technical details and can lead to serious complications if not paid attention. Determining the length of the TLIF cage used in this process is also important in the technical details. In this retrospective study we wanted to evaluate the predictability of the cage size used in TLIF surgery. For this purpose, we examined the disc heights and cage sizes of 22 patients who underwent TLIF surgery. Nine of the patients were male, 13 were female and the mean age was 52.3y (30-72). There was no statistically significant correlation between the used cage size and disc heights. We think that taking care of technical details is appropriate for determination of the cage size used in TLIF procedure.

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Bu çalýþmada izole büyük safen ven (BSV) yetmezliðinin tedavisinde n-butil siyanoakrilat ablasyon (n-BSA) tedavi yönteminin erken dönemde etkinliðinin ve vizüel analog skala (VAS) kullanýlarak hasta memnuniyetinin deðerlendirilmesi amaçlandý.
Ocak 2016 ile Temmuz 2017 tarihleri arasýnda, izole BSV yetmezliði nedeniyle n-BSA ile perkütan endovenöz embolizasyon uygulanan kronik venöz bozukluklar için kapsamlý sýnýflandýrma sistemi (CEAP) evre C1-C4 arasý olan, BSV çapý 6-9 mm arasýnda ve venöz reflü süresi 0,5 sn üzerinde bulunan 72 hasta çalýþmaya dahil edildi. Hastalar preoperatif dönemde ve postoperatif 1. ay ve 6. ay da VAS ile deðerlendirildi. Tüm hastalara ayný zamanda venöz renkli dupleks ultrasonografi (RDUS) yapýldý. Tüm veriler hasta dosyalarý aracýlýðýyla toplanýp retrospektif olarak deðerlendirildi. Ýstatistik hesaplamalarda Friedman testi kullanýldý. Tüm analizlerde istatistiksel anlamlýlýk p<0.05 olarak kabul edildi. Hastalarýn preoperatif, 1.ay ve 6.ay ortalama VAS skala skorlarý sýrasýyla 6.05, 1.8, 1.66 olarak saptandý. Postoperatif 1.ay ile 6.ay takipleri arasýnda anlamlý bir farklýlýk görülmezken (p>0.05), preoperatif VAS ve postoperatif 1.ay VAS deðerleri arasýnda istatiksel olarak anlamlý fark tespit edildi (p<0.001). Ayrýca preoperatif VAS ve postoperatif 6.ay VAS deðerleri arasýnda da istatiksel olarak anlamlý fark tespit edildi (p<0.001). Hastalara postoperatif 1.ay ve 6.ayda yapýlan venöz RDUS’da BSV kapanma oraný sýrasýyla 97% ve 95% idi.Ýzole BSV yetmezliðinde uygulanan n-BSA embolizasyon tedavisinin erken dönem sonuçlarý hasta memnuniyeti açýsýndan VAS ile deðerlendirildiðinde preoperatif dönem ile postoperatif erken dönemde anlamlý derecede olumlu iliþki saptandý. Ýzole BSV yetmezliðinin tedavisinde n-butyl siyanoakrilat ablasyon tedavi yönteminin erken dönemde hasta memnuniyetinin deðerlendirilmesinde VAS efektif bir deðerlendirme metodu olarak kullanýlabilir.

In this study, we aimed to evaluate the early results of n-butyl cyanoacrylate ablation (n-BSA) treatment and patient satisfaction using visual analogue scale (VAS) in the treatment of isolated great saphenous vein (GSV) insufficiency. 72 patients, in clinical grades of C1-C4 according to the Comprehensive Classification System for Chronic Venous Disorders (CEAP), treated with n-BSA percutaneous endovenous embolization in January 2016 to July 2017 due to GSV incompetence, with GSV diameter between 6-9 mm and a reflux time of > 0.5 second, were enrolled in the study. Preoperative and postoperative 1. and 6. month evaluations were made using VAS and venous color duplex ultrasonography (CDUS). All data were evaluated retrospectively via patient files. Friedman test was used for statistical analysis. Statistical significance was set at p < 0.05 for all analyses. Preoperative, 1. and 6. months VAS scores were 6,05, 1,8 and 1,66 respectively. The difference between postoperative 1. and 6. months was not significant (p>0.05), but the differences between preoperative and postoperative both 1. and 6. month scores was statistically significant (p<0.001). 1. and 6. month venous CDUS showed 97% and 95% GSV closure ratio respectively. Evaluation of early period outcomes of n-BSA embolization treatment for isolated GSV incompetence with regard to patient satisfaction using VAS, shows significant positive relationship in preoperative and early period postoperative period. VAS can be used as an effective method to evaluate early period patient satisfaction with n-BSA method for isolated great saphenous vein treatment.

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Bu çalýþmada amaç, Lakozamid'in (LCM) merkezi sinir sistemindeki etkinliðini belirleyen en önemli parametre olan zar lipidleri ile baðlanma profili hakkýnda bilgi elde etmek için, biyolojik zarlarýn en iyi bilinen temsili lipidleri tarafýndan oluþturulmuþ model zarlarla LCM'nin moleküler etkileþimi incelemektir. Bu amaç doðrultusunda, farklý konsantrasyonlarda (1-10-20 mol%) LCM'nin dipalmitoilfosfatidilkolin çok tabakalý veziküllerin biyofiziksel parametreleri üzerindeki etkileri kolesterolün (CHO) yokluðunda ve varlýðýnda (% 10 mol) diferansiyel tarama kalorimetrisi ve fourier transform infrared spektroskopisi ile araþtýrýldý. Elde edilen verilere göre; tüm konsantrasyonlarda LCM'nin ana geçiþ sýcaklýðýný, ana geçiþ eðrisinde geniþleme ile birlikte entalpiyi azalttýðý, bununla birlikte% 1 mol oranýnda LCM'nin,% 10-20 mol konsantrasyonlarýna kýyasla bu deðerleri en fazla etkilediði tespit edildi. Öte yandan, CHO'ün % 20 mol'e eklenmesiyle, bu parametrelerde önemli ölçüde azalmaya neden olduðu bulundu. Ayrýca, yüksek konsantrasyondaki LCM, gliserol ve fosfat gruplarýnýn hidrojen baðý yapma kapasitelerini ve lipid düzenini arttýrmýþ, fakat akýþkanlýðý azaltmýþtýr. Ayrýca, CHO'nun lipit düzeni ve akýþkanlýk dýþýnda LCM'nin bu etkilerini tersine çevirme eðiliminde olduðu bulundu. Elde edilen bulgulara göre kimyasal yapýsýna uygun olarak LCM, beyin membranýnda bol miktarda bulunan fosfatidilkolin lipitlerinin termotrofik parametrelerinin, yapýlarýnýn ve iþlevlerinin deðiþmesine yol açmasý LCM'nin biyolojik membranlara nüfuz etme yeteneðini göstermektedir. Ancak, bu tür davranýþlarýn derecesi, uygulanan LCM konsantrasyonuna ve CHO'nun varlýðýna baðlý olabilir. Özetle, tüm veriler epilepsinin terapötik stratejilerinde kullanýmý ve yeni antiepileptiklerin geliþtirilmesi için bilgi saðlayabilir.

In the present study, in order to obtain information about binding profile of lacosamide (LCM) with membrane lipids, which affect its availability in central nervous system, molecular interaction of LCM with model membranes formed by well-known representative lipids of biological membranes were monitored. The effects of varied concentrations (1-10-20 mol %) of LCM on biophysical parameters of dipalmitoylphosphatidylcholine multilammelar vesicles in the absence and presence of cholesterol (10 mol %) were studied by differential scanning calorimetry and fourier transform infrared spectroscopy. The results revealed that at all concentrations LCM decreased main transition temperature and enthalpy with broaden transition curve however, LCM at 1 mol % affected such values the most in comparison with 10-20 mol% concentrations. With the addition of CHO to 20 mol % of LCM sample, these parameters were significantly lowered. Moreover, LCM at high concentrations prominently increased both order and hydrogen binding capacity of glycerol and phosphate groups of lipids but reduced fluidity. Also, CHO was found to tend to reverse these effects of LCM except for order and fluididy parameters. According to the corresponding findings as being correlated with its chemical structure, LCM leads to alteration of thermotrophic parameters, structures and functions of phosphatidylcholine lipids abundant in brain cell membrane, which also show the penetration ability of LCM into biological membranes. But, the degree of such behavior can be dependent on applied concentration of LCM and presence of CHO. In sum, all data may provide information for its use in therapeutic strategies of epilepsy and development of new antiepileptics.

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Amaç: Amiyotrofik Lateral Skleroz (ALS) motor nöronlarý etkileyen nörodejeneratif bir hastalýktýr. Als2, ALS’ye neden olan genlerden biri olup, mutasyonlarý alsin proteininde iþlev kaybýna yol açar. Alsin ile UXT proteininin etkileþtiði in vitro olarak gösterilmiþtir. UXT NF-κB yolaðýnda bir kofaktördür. Çalýþmadaki amacýmýz Als2 geninin susturulmasýnýn NF-κB yolaðý aktivitesine olan olasý etkisinin primer spinal motor nöronlarda araþtýrýlmasýdýr.
Yöntem: Yetiþkin BalbC fare spinal motor nöron kültüründe, nöronlar anti-ChAT ve anti-βIII tubulin primer antikorlarý ile immünositokimyasal olarak gösterilmiþ, Als2 geni RNAi yöntemi ile susturulmuþ ve qRT-PCR ile doðrulanmýþtýr. Als2’nin susturulduðu motor nöronlardaki UXT, A20 ve IL8 gen ekspresyonlarý qRT-PCR ile belirlenmiþtir. NF-κB aktivatörü olan TNF-α kullanýlarak A20 ve IL8 ekspresyonlarýndaki deðiþim qRT-PCR ile ölçülmüþtür. Verilerin istatistiksel anlamlýlýðý Student t-test ile deðerlendirilmiþtir.
Bulgular: Ýmmünositokimyasal olarak gösterilen spinal motor nöronlarda RNAi ile Als2 gen ekspresyonu %74,3 oranýnda azaltýldý (p<0,0001) ve UXT ekspresyonunun %40 düþtüðü belirlendi (p<0,0001). IL8 seviyesinin %84,4 azaldýðý, ancak A20 seviyesinin %65 arttýðý gözlendi (p<0,0001). Nöronlara TNF-α uygulandýðýnda IL8 ekspresyonunun 17 kat yükseldiði, ancak A20 ekspresyonunun sadece %29,5 arttýðý bulgulandý.
Sonuç: Bu bulgular ýþýðýnda Als2 ile UXT arasýndaki gen ekspresyonu seviyesindeki korelasyonun saðlamasý yapýlmýþtýr. Als2 ve UXT seviyesindeki düþüþ IL8 seviyesini azaltýrken A20’yi yükseltmektedir. Bu veriler Als2’nin susturulmasýnýn enflamatuar cevabý azaltýrken pro-apoptotik sinyalleri A20 üzerinden tetikleyebileceðini düþündürmektedir. TNF-α kullanýlarak NF-κB yolaðý aktive edildiðinde, IL8 artýþý üzerinden gerçekleþen enflamatuar bir cevap görülmektedir. Böylece Als2 ile NF-κB yolaðý arasýndaki iþlevsel baðlantýnýn UXT üzerinden gerçekleþtiði ilk kez primer spinal motor nöron kültüründe doðrulanmýþ olup, IL8 ve A20 gibi NF-κB yolaðýndaki kilit moleküllerin bu baðlamda rol oynadýðý gösterilmiþtir.

Aim: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disorder affecting motor neurons. The loss-of-function mutations seen in the Als2 gene lead to ALS. The interaction between alsin, Als2 encoded protein, and UXT has been documented in vitro. UXT is a cofactor in NF-κB pathway. Our aim is to investigate the effect of Als2 silencing in NF-κB in primary motor neurons.
Method: Spinal motor neurons isolated from adult BalbC mice were characterized immunocytochemically by anti-ChAT and anti-βIII tubulin primary antibodies. Als2 was silenced by RNAi and expressions of UXT, A20 and IL8 were determined by qRT-PCR. TNF-α, an NF-κB activator, was also applied and alterations in the expressions of A20 and IL8 were measured. Data were statistically evaluated by Student t-test.
Results: Als2 expression decreased 74.3% by RNAi in immunocytochemically characterized spinal motor neurons (p<0.0001). UXT expression reduced by 40% (p<0.0001), decrease in IL8 expression was 84.4% (p<0.0001), whereas A20 expression increased by 65% (p<0.0001). When TNF-α was applied, IL8 expression increased by 17-fold, but the increase in A20 was only 29.5%.
Conclusion: The gene expressional correlation between Als2 and UXT has been proven. The decreases in Als2 and UXT cause a reduction in IL8 expression, whereas expression of A20 increases. This indicates that Als2 silencing might reduce inflammatory response while activating pro-apoptotic signals. When NF-κB pathway has been activated by TNF-α, a considerable increase in IL8 has been observed. These data provide a confirmation and elaboration of a connection between Als2, UXT and NF-κB pathway in primary spinal motor neurons.

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Biyolojik cevabý modifiye eden ajanlarla yapýlan biyolojik tedavi (biyoterapi) bazen alerjik hastalýklarýn tedavisinde kullanýlýr. Burada, alerjik rinit gibi baskýn Th2 tip cevabýnýn olduðu hastalýklarý modifiye eden biyolojik ajanlar güncel literatür verileri ýþýðýnda tartýþýlacaktýr. Astým hastalarýnýn %70–88’ninde sinonazal semptomlar ve nazal polipli kronik rinosinuzit hastalarýnda eþzamanlý astým geliþtirme ihtimali vardýr. Allerjik astým ve sinonazal hastalýklardaki ortak patofizyolojiden dolayý, omalizumab kullaným sonrasý hastalarýn bu hastalýklarýn semptomlarýndan kurtulmasý beklenir. Omalizumab’ýn ek tedavi olarak kontrolsüz persistan astýmdaki yararý gibi, ragweed (kanarya otu) ve huþ aðacý (birch) ile indüklenen mevsimsel ve perennial allerjik rinitli hastalarda semptomlarý düzelttiði ve yaþam kalitesini artýrdýðý da gösterilmiþtir. Astým tedavisinde anti-IgE (omalizumab) kullanýmý IgE-aracýlý alerjik rinit gibi diðer bir allerjik hastalýðýn tedavisi, üstün güvenlik profili ve kolay uygulanabilir doz sýklýðý saðlamak gibi bazý avantajlarý da barýndýrýr. Nazal polip hastalarý anlamlý yüksek IgE antikor titresi ve artmýþ doku IL-5 ekspresyonundan dolayý mukozal eozinofiliye sahiptir. Yüksek IL-5 düzeyinin atopiden ziyade Stafilokok aureus enterotoksinlerine baðlý olduðunun gösterilmesi araþtýrýcýlarýn IL-5 bloke eden stratejilerin araþtýrýlmasýna yol açmýþtýr. Sonuçta, mepolizumab ve reslizumab kavram-kanýt ilaç çalýþmalarý dâhilinde nazal polipli hastalara denenmiþtir. Anti–IL-5 monoklonal antikorlar nazal polip skorlarýný düþürmüþ fakat nazal semptom skorlarýný önemli derecede düzeltmemiþtir. Teorik olarak IL-4 ve IL-13’ün eozinofilik nazal polipoz patogenezindeki öneminden dolayý, dupilumab potansiyel tedavi þekli olarak denenmiþtir.

Biological therapy (biotherapy) is infrequently utilized to manage allergic disorders through biological response modifiers. Here, biological agents modifying Th2 type response dominant diseases e.g. allergic rhinitis are discussed under the light of current literature. 70–88% of asthmatic patients have sinonasal symptoms and chronic rhinosinusitis patients with nasal polyposis are more likely to develop concomitant asthma. Having the shared pathophysiology of allergic asthma and sinonasal diseases, it is supposed that patients concurrently suffering from both diseases relieve from symptoms with omalizumab. Like the profits of omalizumab as add-on treatment in uncontrolled persistent asthma, it has been shown to improve symptoms and quality of life in ragweed- and birch-induced seasonal and perennial allergic rhinitis patients. The omalizumab tactic in asthma management has also some pluses, comprising simultaneous dealing of further IgE-mediated disorders such as allergic rhinitis or eczema, an advantageous safety profile and a suitable medicating rate. Nasal polyp patients have significantly increased level of IgE antibodies and mucosal eosinophilia with augmented IL-5 tissue expression. High IL-5 level was recently found to be associated with Staphylococcus aureus enterotoxins rather than atopy have provoked researchers to investigate the clinical role of IL-5–blocking strategies. Consequently, mepolizumab and reslizumab have been tried in nasal polyp patients for proof-of-concept studies. The anti–IL-5 monoclonal antibodies reduce nasal polyp scores, but did not considerably improve symptom scores. Due to the assumed role of IL-4 and IL-13 in the pathogenesis of eosinophilic nasal polyposis, dupilumab was tried as a possible therapeutic agent as well.

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Üretral leiomyom düz kastan köken alan nadir mezenþimal benign tümördür ve sýklýkla kadýnlarda saptanýr. Literatürde sadece 100 kadýn ve 7 erkek vaka bildirilmiþtir. Ýdrar yolu enfeksiyonu, palpabl kitle, dizüri, hematüri ve akut üriner retansiyon en çok bildirilen semptomlardýr. Tedavide birinci seçenek kitlenin cerrahi çýkarýlmasýdýr. Bu sunumunda 34 yaþýnda, postpartum dönemde uretral leiomyomu olan ve alt üriner sistem semptomlarýna neden olan olgu sunulacaktýr.

Urethral leiomyoma is rare mesenchymal benign tumor of smooth muscle origin that is mostly seen in females. Only one hundred women and seven male cases have been reported in the literature. Urinary tract infection, palpabl mass, dysuria, hematuria and acute urinary retention are the most commonly reported symptoms. Surgical removal is the first choice of treatment for these tumor. We report here a case of 34 years old, post- partum period woman with an urethral leiomyoma caused lower urinary system symptoms.

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Acile ani þuur kaybý ile gelen ve üçüncü ventrikül araknoid kisti tespit edilen 57 yaþýnda bir erkek hasta sunuyoruz. Hastaya acil ventrikülostomi sonrasý transkallozal kist rezeksiyonu uygulandý. Postoperatif görüntülemede kistin gros-total eksize edildiði ve hidrosefalide orta derecede azalma olduðu görüldü. Hastanýn durumunda ancak vetriküloperitoneal þant takýldýktan sonra düzelme görüldü. Ancak bu kez de kraniotominin altýnda subdural hematom oluþtu. Sonuçta; üçüncü ventrikül araknoid kistlerinin cerrahi tedavisinde tercih edilecek yaklaþým dikkatle seçilmelidir. Açýk kraniotomi ile kist eksizyonunda þant gereksinimi olabilir ve bu yaklaþým subdural hematom gibi ciddi komplikasyonlara neden olabilir.

We report a 57-year-old male admitted to emergency department with acute loss of consciousness and diagnosed with third ventricular arachnoid cyst. Transcallosal cyst resection was performed following an emergency ventriculostomy. Postoperative imaging revealed gross-total cyst excision and a moderate decrease in hydrocephalus. However, the patient improved only after a subsequent ventriculoperitoneal shunting. This time, however, a subdural hematoma occurred under the craniotomy after the shunting. In conclusion, surgical approach for the treatment of arachnoid cysts of the third ventricle should be selected carefully. Cyst excision via open craniotomy may require subsequent shunting and can cause serious complications such as subdural hematoma.

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Klippel Feil sendromu, Poland sendromu ve ayna hareketlerinin tek olguda bir arada bulunmasý daha önce literatürde bildirilmemiþtir. Çalýþmamýzda, bu antitelerin birlikte bulunduðu bir hastayý rapor edip; bu birlikteliðin genetik bir arka planý olup olmadýðýný inceledik. 19 yaþýndaki erkek hasta, dirsek deformitesi ve sað baþparmak aplazisi ile baþvurdu. Sað pektoral kas kitlesi sola göre belirgin þekilde küçüktü. Sað tarafta yüksek skapula görünümü vardý. Nörolojik deðerlendirmede ayna hareketleri gözlendi. Sað radius baþý disloke idi. Manyetik rezonans görüntülerinde, C6-C7 füzyonu ile birlikte bu seviyede syrinks gözlemlendi. Yüksek çözünürlüklü kromozom mikrodizisi (CMA) testi gerçekleþtirildi. Küçük segmental de novo kopya sayýsý varyasyonlarý tespit edildi. Deðiþikliði kapsayan en büyük gen 287 kb'yi aþmamaktaydý ve saptanan varyasyonlarýn hiçbirisi, Uluslararasý Standart Sitogenomik Array (ISCA) kriterlerine göre fenotipik özellikleri açýklamakta bilinen bir hastalýkla iliþkili deðildi. Bilgimize göre literatürde tek olan olgumuzda çok sayýda konjenital anomali mevcudiyeti nedeniyle yüksek çözünürlüklü kromozom mikroarray analizi uyguladýk ve fenotipik özellikler ile iliþkili olabilecek önemli bir delesyon veya duplikasyon bulamadýk.

Coexistence of Klippel Feil syndrome, Poland syndrome and mirror movements have not been reported before. We aimed to report a patient with such coexistence and examined whether there is a possible genetic background of this association. A 19-year-old male patient presented with the absence of right thumb and deformity at the elbow. Right pectoral muscle mass was markedly smaller than left. There was a high scapula on the right side. Mirror movement was observed in neurological evaluation. Right radial head was dislocated. On magnetic resonance images, a syrinx was observed at the level of C6-C7 fusion. A high-resolution chromosome microarray (CMA) testing was performed. Small segmental de novo variations were detected. The largest gene spanning variation did not exceed 287 kb and none of the detected variations was known to be disease-associated or candidate to explain the phenotypic features according to The International Standard Cytogenomic Array (ISCA) criteria. Since our case is sporadic with multiple congenital abnormalities, we performed high-resolution chromosome microarray analysis to rule out genomic imbalance and found no significant deletion or duplication that can be associated with phenotypic characteristics.

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