Amaç: Tiroid hormonlarýnýn lipid ve glukoz metabolizmasý üzerinde etkileri olduðundan, tiroid disfonksiyonu kardiyovasküler hastalýklar için bir risk faktörüdür. Metabolik sendrom (MS) artmýþ kardiyovasküler hastalýk ve tip 2 diabetes mellitus riski ile birlikte artmýþ tüm nedenlere baðlý ölümle iliþkilidir. Çalýþmalar tiroid disfonksiyonunun artmýþ MS prevalansý ile iliþkili olduðunu göstermiþtir. Bunun yanýnda, MS’lu hastalarda daha fazla hipotiroidi görülmektedir. Bu çalýþmada, levotiroksin tedavisi altýndaki hastalarýn hala dah yüksek metabolik sendrom prevalansýna sahip olup olmadýklarýný araþtýrdýk.

Materyal ve Method: Çalýþmaya levotiroksin tedavisi altýnda olan hipotiroid 186 hasta (175 kadýn, 11 erkek) alýndý. Demografik, antropometrik ve labaratuvar verileri dosyalarýndan kaydedildi. International Diabetes Federation (IDF) kriterleri metabolik sendrom tanýsýnda kullanýldý.

Bulgular: Hipotiroidi hastalarýnda metabolik sendrom sýklýðý %52 idi. Ortalama yaþ 48.44 ± 14.90 yýl idi. Ortalama TSH düzeyleri 1.94 ± 1.11 uIU/L iken ortalama serbest T4 1.06 ± 0.20 ng/dL idi. Ortalama haftalýk levotiroksin dozu 537.01 ± 239.53 mcg idi. Ortalama haftalýk levotiroksin dozu aðýrlýk (r2: 0.188, p: 0.010), vücut kitle indeksi (r2: 0.227, p: 0.026) ve bel çevresi (r2: 0.164, p: 0.026) ile pozitif korrele idi. Ortalama haftalýk levotiroksin dozu ayný zamanda LDL-kolesterol (r2: 0.167, p: 0.031) ve HbA1c (r2: 0.180, p: 0.034) düzeyleri ile de pozitif korrele idi. Ortalama haftalýk levotiroksin dozu diðer kardiyometabolik risk faktörleri ile iliþkili deðildi (p>0.05).

Sonuç: Levotiroksin tedavisi altýnda ötiroid olan hipotiroidi hastalarýnda hala artmýþ metabolic sendrom prevalansý mevcuttur. Buna raðmen, daha büyük hasta grubu içeren daha geniþ kapsamlý çalýþmalar yapýlmalýdýr.

Aim: Since thyroid hormones have an impact on lipid and glucose metabolism, thyroid dysfunction may lead to cardiovascular problems. Metabolic syndrome (MS) is related to higher risk of cardiovascular disease, diabetes mellitus, and all-cause mortality. Studies have demonstrated thyroid dysfunction corresponds to a higher prevalence of MS. Additionally, some studies showed patients with MS had a higher prevalence of hypothyroidism. We aimed to investigate whether hypothyroid patients being treated with levothyroxine still have a higher prevalence of metabolic syndrome or not.

Material and Methods: One hundred and eighty-six hypothyroid patients (175 female, 11 male) using levothyroxine treatment were included in the study. Demographic, anthropometric and laboratory measures were recorded. International Diabetes Federation (IDF) criteria were used for diagnosis of MS.

Results: The prevalence of MS was 52% in hypothyroid patients using levothyroxine. Mean age was 48.44 ± 14.90 years. Mean TSH was 1.94 ± 1.11 uIU/L and mean free T4 was 1.06 ± 0.20 (ng/dL). Mean weekly levothyroxine dose was 537.01 ± 239.53 mcg. Weekly levothyroxine dose was positively correlated with weight (r2: 0.188, p: 0.010), BMI (r2: 0.227, p: 0.026) and waist circumference (r2: 0.164, p: 0.026). Weekly levothyroxine dose was also positively correlated with LDL-cholesterol (r2: 0.167, p: 0.031) and HbA1c (r2: 0.180, p: 0.034) levels. Weekly levothyroxine dose was not correlated with other cardio-metabolic risk factors (p>0.05).

Conclusions: The prevalence of metabolic syndrome is still high in hypothyroid patients under levothyroxine treatment. However, more comprehensive studies conducted in a larger population should be performed to enlighten this association.

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Kemik iliði ödemi sendromu (KÝÖS), etiyolojisi bilinmeyen, ani baþlangýçlý ve kendini sýnýrlayýcý lokalize aðrýyla karakterize MR görüntülemede sýrasýyla T1 ve T2 sekanslarda hipointens ve hiperintens sinyal veren non-spesifik sekelsiz iyileþen kemik ödeminin gözlenmesidir. Bu çalýþmada ayakta KÝÖS tanýlý hastalarýn baþlangýç klinik ve radyolojik özellikleriyle klinik seyrinin deðerlendirilmesi amaçlandý. Kliniðimizde Ocak 2014 ve Aralýk 2016 arasýnda KÝÖS tanýsý alan 17 hasta çalýþmaya dahil edildi. Ayak aðrýsý þikayetiyle baþvuran klinik olarak KÝÖS'den þüphelenilen hastalarda direkt grafi ve sonrasýnda MR görüntüleme istendi. KÝÖS tanýsý alan hastalarýn baþlangýç D-vitamini, hemogram, sedimentasyon, C-reaktif protein(CRP), romatoid faktör(RF) ve Anti-CCP deðerlerine bakýldý. Hastalara tanýdan itibaren indometazin ve D-vitamini baþlandý, 6 hafta çift koltuk deðneðiyle yükten koruma uygulandý. Tüm hastalarýn hikayelerinde ani baþlangýçlý ayak ve ayak bilek aðrýsý olduðu görüldü. Semptomlarýn ortalama süresi 7,12(2-20) aydý. Ortalama serum D-vitamini düzeyi 14 IU olduðu, sedimentasyon deðerlerinin 7 hastada hafif yüksek, CRP, RF ve Anti-CCP deðerlerinin normal olduðu gözlendi. KÝÖS en fazla talusta görüldü. Hastalarýn taný aldýklarýndaki AOFAS skoru ortalama 63, son kontrol AOFAS skoru ortalama 92'ydi. Konservatif tedaviler KÝÖS tanýsý alan hastalarýn izlenmesinde ilk seçenek tedavi olarak deðerlendirilmelidir. D-vitamini eksikliðinin hastalýðýn etyolojisinde rol alabileceði bilinmeli ve bu yönde araþtýrýlmalýdýr.

Bone marrow edema syndrome (BMES) describes non-specific, ill-defined areas of hypointense and hyperintense signal on T1 and T2 sequences, respectively. BMES has unknown etiology and resolves without sequelae. In this study, we aimed to evaluate the initial clinical and radiological features and clinical course of patients with standing BMES. We evaluated 19 feet of 17 patients who applied to our clinic between January 2014 and December 2016. X-Ray and MRI were taken in patients with clinical suspicion of BMES. Initial vitamin-D levels, hemogram, sedimentation, C-reactive protein(CRP), rheumatoid factor(RF) and Anti-CCP values of patients were evaluated. After the diagnosis, indomethacin and vitamin-D therapy and weight-bearing protection with double cruches was given for 6 weeks. All patients mentioned that sudden onset of pain. The mean duration of symptoms was 7.12(2-20) months. Mean serum 25(OH)D level was 14 IU, sedimentation values were slightly higher in 7 patients, CRP, RF and Anti-CCP values were normal. BMES mostly detected in talus. The mean AOFAS score of the patients was 63 and the last control was 92. Conservative treatments should be considered as the first-line treatment option in BMES. The importance of laboratory tests in BMES should not be forgotten. Vitamin-D may play a role in the etiology of the disease. For that reason, patients need to be investigated in that way.

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Amaç: Astigmatizmasý olan katarakt cerrahisi olgularýnda torik göz içi lensleri, limbal gevþetici kesi ve karþýlýklý saydam korneal kesi uygulamalarýnýn etkinliðini ve görsel sonuçlarýný karþýlaþtýrmak.

Hastalar ve Yöntem: Bu retrospektif karþýlaþtýrmalý çalýþma görsel olarak anlamlý kataraktý ve eþlik eden astigmatizmasý olan 56 hastanýn 56 gözüne fakoemülsifikasyon uygulanýp, torik göz içi lensi veya monofokal göz içi lensi ile birlikte limbal gevþetici insizyon (LRI) veya monofokal göz içi lensi ile birlikte karþýlýklý saydam korneal insizyon (OCCI) uygulanan hastalarýn dosyalarý incelenerek yapýldý. Baþlýca sonuç kriterleri postoperatif 6 aylýk düzeltilmiþ görme keskinliði, silindirik ve keratometre deðer deðiþimleri idi.

Bulgular: 6.ayda düzeltilmiþ görme keskinlikleri baþlangýç ölçümlerine göre 3 grupta da istatistiksel olarak anlamlý derecede daha iyi idi. (p<0.0001, p<0.0001, p<0.0001) Ortalama astigmat deðerleri cerrahi öncesi LRI grubunda 2.92 ± 1.1, OCCI grubunda 2.46 ± 1.7, Torik grubunda 2.68 ± 0.90 iken; cerrahi sonrasý sýrasýyla 1.01 ± 0.61, 1.16 ± 1.12, 0.9 ± 0.8 D olmuþtur. ( p<0.0001, p<0.0001, p<0.0001) Tedavi sonrasý düzeltilen astigmat miktarý LRI grubu için 1.9 ± 1.1, OCCI grubu için 1.3 ± 1.2, torik grubu için 1.78 ± 0.90 dioptridir. 3 grup arasýndaki fark istatiksel olarak anlamlý deðildir.

Sonuç: Tüm gruplarda postoperatif dönemde BCVA deðerinde artýþ ve refraktif astigmatizmada azalma saptanmýþtýr. Refraktif astigmatizmada düzelme en çok LRI grubunda olmasýna raðmen gruplar arasýnda anlamlý fark yoktur.

Purpose: To compare the efficacy and visual outcomes of toric intraocular lenses, limbal relaxing incisions and opposite clear corneal incisions for management of coexisting astigmatism on cataract surgery.
Patients and Methods: In this retrospective comparative study revealed 56 eyes of 56 patients’ files with visually significant cataract and coexisting corneal astigmatism were undergone phacoemulsification with either Toric IOL or monofocal IOL with LRI or monofocal IOL with OCCI. The main outcome measures were postoperative 6-month best corrected visual acuity, cylindrical and keratometer value changes.
Results: Best corrected visual acuities at sixth months were better at a statistically significant level in three groups compared to the baseline measurements. (p<0.01, p<0.01, p<0.01) The mean refractive astigmatism values were preoperatively 2.92 ± 1.1 in the LRI group, 2.46 ± 1.7 in the OCCI group, 2.68 ± 0.90 in the toric group whereas they became 1.01 ± 0.61, 1.16 ± 1.12 and 0.9 ± 0.8 D postoperatively, respectively. (p<0.01, p<0.01, p<0.01) Corrected astigmatism amount was 1.9 ±1.1 for the LRI group, 1.3 ±1.2 for the OCCI group and 1.78 ±0.90 dioptry for the toric group. The difference among three groups was not statistically significant.
Conclusion: An increase in the BCVA value and a decrease in refractive astigmatism were detected postoperatively in all groups. Although the most prominent improvement in refractive astigmatism occurred in the LRI group, there was no significant difference among the groups.

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Amaç: Kronik inflamasyon ve platelet agregasyonu ile yakýndan iliþkili olan artmýþ kýrmýzý kan hücresi daðýlým geniþliði (RDW) ve ortalama trombosit hacminin (MPV) obezite ve kardiyovasküler hastalýklar açýsýndan birer baðýmsýz belirteç olduðu düþünülmektedir. Ancak obezite cerrahisi olup belirgin kilo veren hastalarda bu parametrelerdeki deðiþim tam olarak bilinmemektedir. Bu çalýþmada laparoskopik sleeve gastrektomi (LSG) yapýlan hastalarýn bir yýllýk takiplerinde RDW ve MPV deðerlerindeki deðiþimi incelemeyi amaçladýk.
Gereç ve Yöntem: Þubat 2015 ve Haziran 2017 tarihleri arasýnda LSG yapýlan 98 morbid obez hastanýn (73 kadýn, 25 erkek) medikal kayýtlarýný inceledik. Cerrahi endikasyonlar kýlavuzlara uygun þekilde belirlendi; vücut kitle indeksi (VKÝ) >40 kg/m2 veya VKÝ>35 kg/m2 ve birlikteliðinde obeziteyle iliþkili ek hastalýklarýn varlýðý. Bazal deðerler ile birinci yýldaki deðerler arasýndaki fark Delta (Δ) ile gösterildi.
Bulgular: Çalýþma grubunun ortalama yaþý 41,89 ± 11,99 olup, cerrahi sonrasý birinci yýldaki ortalama kilo kaybýný 45,41 ± 13,13 kg’dý (% 36,5). Ortalama VKI birinci yýlda 46,60 ± 7,11 ‘den 29,58 ± 4,63 kg/m2 (p<0,001) ‘e düþtü. Ortalama RDW (% 14,61 ± 1,69’e karþý % 13,71 ± 2,10; p<0,01) ve MPV (8,63 ± 1,45 fL’e karþý 7,92 ± 1,24 fL, p<0,001) seviyelerinde cerrahi sonrasý anlamlý düþüþ dikkati çekti. Ayrýca Δ VKI ile Δ RDW (r = 0,343, p <0,01) ve Δ MPV (r = 0,322, p < 0,01) arasýnda pozitif korelasyon vardý.
Sonuç: LSG ile belirgin kilo veren hastalarýn birinci yýl takiplerinde verdikleri kilo ile korele olarak RDW ve MPV seviyelerinde anlamlý azalma bulduk. Ancak bu parametrelerin birçok faktörden etkilendiði düþünülecek olursa bu konuda prospektif, geniþ ölçekli ileri çalýþmalara ihtiyaç vardýr.

Aim: Elevated red blood cell distribution width (RDW) and mean platelet volume (MPV) levels which are closely associated with chronic inflammation and platelet aggregation are suggested as independent predictors of obesity and cardiovascular diseases. However influence of significant weight loss following bariatric surgery on these parameters is unknown. Therefore we aimed to find out the effect of significant weight loss following laparoscopic sleeve gastrectomy (LSG) on RDW and MPV levels.
Material and Methods: The medical data of 98 morbid obese subjects (25 male, 73 female) who were operated according to bariatric surgical indications in current guidelines; ‘body mass index (BMI) >40 kg/m2 or BMI= 35-40 kg/m2 with additional co-morbidities’ between February 2015 and June 2017 were recorded. Deltas (Δ) were calculated as subtracting one-year values from the baselines.
Results: The mean age of our study population was 41.89±11.99 years and mean weight loss in one-year after LSG was 45.41±13.13 kg (36.5%). BMI was decreased from 46.60±7.11 kg/m2 to 29.58±4.63 kg/m2. Compared to the baseline, significant decreases in RDW (14.61±1.69 % vs. 13.71±2.10 %; p<0.01) and MPV (8.63±1.45 vs. 7.92±1.24 fL, p<0.001) levels were found in the postoperative one-year values. In addition; ΔVKI was significantly correlated with ΔRDW (r=0.343, p<0.01) and ΔMPV (r=0.322, p<0.01).
Conclusion: We found that morbid obese subjects have significantly decreased RDW and MPV levels which are correlated to their weight loss in one-year follow-up after LSG. Because several factors may affect these parameters further prospective studies with large scale are needed.

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Giriþ:
Peptik ülser midedeki asit ve pepsinin yýkýcý etkileri ile mukozanýn korunma faktörleri arasýndaki dengesizlikten kaynaklanýr. Toplumda prevalansý %5-10 civarýndadýr ancak bu hastalarýn %2-10 kadarý perfore olur.. Genellikle önerilen operasyondan sonra 6-8 hasta içinde takip üst gastrointestinal sistem endoskopisi yapýlmasýdýr. Bu çalýþmamýzda perfore pefore peptik ülser vakalarýnda takip endoskopisinde helikobakter pilori ve mide kanseri görülme sýklýðýný araþtýrdýk.
Materyal ve Metod:
Peptik ülser perforasyonu sebebiyle opere edilen hastalarýn takip endoskopileri deðerlendirildi. Hastalarýn demografik özellikleri, operasyon notlarý, takip gastroskopileri ve patoloji notlarý deðerlendirilerek hastalardaki helikobakter pilori ve gastointestinal malignansi insidansý araþtýrýldý.
Bulgular:
Haziran 2014 ve haziran 2017 arasýnda 132 hasta peptik ülser perforasyonu sebebiyle acilen operasyona alýndý. Bu hastalarýn yaþ ortalamasý 43,46±18,78 (15-93) idi. Çalýþmaya dahil edilen hastalarýn 36’sý (%73,5 (36/49) takip endoskopisinde Helikobakter pilori için yapýlan testte pozitif olarak bulundu. Takip endoskopisinde tanýsý kesinleþen kanser insidansý %5,6 (3/53) olarak tespit edildi.
Sonuç:
Perfore peptik ülser hastalarýnda helikobakter pilori etiyolojide önemli rol oynamakla birlikte mide kanseri de hastalarda etiyolojide rol oynamaktadýr. Duodenal yerleþimli olduðu düþünülen perforasyonlarda da malignite ihtimali gözönünde bulundurulmalýdýr.

Introduction

Peptic ulcer disease arises from the imbalance between the mucosal defense factors and the destructive properties of acid pepsin. The prevalance is around 5-10% of the population but only 2-10% of the patients with the disease are complicated with perforation. What is adviced is a follow up gastroscopy 6-8 weeks after the operation. We aimed to investigate gastric malignancy and helicobacter pylori prevalence in the follow-up gastroscopy.
Material and Methods
The follow-up gastroscopy notes of the patients who went under operation for perforated peptic ulcer were reviewed. The demographic properties, the operation notes, the followw-up gastroscopy notes and pathology reports were reviewed for the presence of helicobacter pylori and gastric malignancy.
Findings
Between June 2014 and June 2017 a total of 132 patients were operated for peptic ulcer perforation. The average age of the patients was 43,46±18,78 (15-93). In the study group 73,5%(36/49) were found to be positive for Helicobater pylori. The gastric cancer diagnosis was confirmed in 5,6% (3/53) patients in the follow-up gastroscopy.
Conclusion
Helicobater pylori is an important factor in ethiology as well but one must be alert about the potential presence of a gastric cancer. There is also a potential malignancy presence in the perforations which are thought to be duodenal.

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Amaç: Osteogenezis imperfekta hastalarýnda oküler bulgularý incelemek amaçlanmýþtýr.
Hastalar ve Yöntemler: Hastalar Osteogenezis Ýmperfekta (OI) tiplerine göre gruplandýrýldý.Yaþ ve cinsiyetleri not edildi. Refraksiyon, göz içi basýncý (GÝB) santral korneal kalýnlýk (SKK) deðerleri ölçüldü. Korneal topografi görüntüleri alýndý. Tüm hastalarýn fundus muayeneleri yapýldý. Sferik eþdeðerleri ve en iyi düzeltilmiþ görme keskinlikleri (EDGK) kaydedildi. Hastalarda skleral renk deðiþikliði olup olmadýðý not edildi.
Bulgular: Bu çalýþmada 15 hastanýn 30 gözü incelenmiþtir. 15 hastanýn 8 tanesi Tip 1 OI, 5 tanesi Tip 4 OI ve 2 tanesi de Sillence sýnýflandýrma sistemine göre sýnýflandýrýlamadý. Sýnýflandýrýlamayan hastalarýn birinde FKBP10 mutasyonu ve diðerinde WNT1 mutasyonu vardý. Santral korneal kalýnlýk minimum 397 µm iken maksimum 588 µm’di. Ortalama santral korneal kalýnlýk 492 ± 67.49 µm’di. Korneal apeks keratometri (K) ve korneal astigmatizma deðerleri Tip 4 OI grubunda Tip 1 OI grubuna göre daha yüksek bulunmuþtur (sýrasýyla p<0.01, p < 0.05).EDGK Tip 1 OI grubunda Tip 4 OI grubuna göre anlamlý olarak daha yüksek bulunmuþtur (p < 0.01). Çalýþmaya alýnan 30 gözden 8’inde mavi sklera saptanmýþtýr(%26.7). Mavi sklerasý olan hastalarýn tamamý Tip 1 OI hastasýdýr. Mavi sklerasý olan ve olmayan hastalar arasýnda SKK, posterior elevasyon veya korneal astigmatizma deðerleri açýsýndan anlamlý fark saptanmamýþtýr (p> 0.05). Korneal apex K deðerleri mavi sklerasý olan hastalarda istatistiksel anlamlý derecede düþüktü (p<0.05).
Sonuç: OI hastalarýnda bizim bulgularýmýz daha ince SKK, mavi sklera ve özellikle Tip 4 OI hastalarýnda dik K deðerleridir. Bu sebeple hastalar keratokonus açýsýndan düzenli takip edilmelidir. Ýnce SKK nedeniyle yalancý göz içi basýncý düþüklüðüne karþý dikkatli olunmalýdýr. Olasý bir travmaya karþý hasta ve hasta yakýnlarýna koruyucu gözlük kullanýmý önerilmelidir.

Purpose: To research ocular findings in patients with osteogenesis imperfecta (OI).
Patients and Methods: Patients were grouped according to the type of OI. Age and gender data were noted. Refraction, intraocular pressure (IOP), and central corneal thickness (CCT) values were measured. Corneal topography images were obtained. Fundus examinations were made in all patients. Best corrected visual acuity (BCVA) and spherical equivalent (SE) values were recorded. Data about patients’ scleral color changes were noted.
Results: In this study, 30 eyes from 15 patients were examined. Of the 15 patients, 8 had OI Type 1, 5 had OI Type 4, and 2 couldn’t be classified by Sillence’s classification. One of that patients had a FKBP10 mutation and another had a WNT1 mutation. The minimum CCT was 397 μm and maximum was 588 μm. Average CCT was 492 ± 67.49 μm. Corneal apex keratometry (K) and corneal astigmatism values were higher for the OI Type 4 group than Type 1 (p <0.01, p<0.05, respectively). BCVA values were significantly higher in the OI Type 1 group than the OI Type 4 (p = 0.002) Out of the 30 eyes, 8 had blue sclera (26.7%). All of the patients with blue sclera had OI Type 1. There was no significant difference in terms of CCT, posterior elevation values, or corneal astigmatism values between patients with and without blue sclera (p > 0.05). Corneal apex K value was statistically lower in the patients with blue sclera (p < 0.05).
Conclusion: Our findings in patients with OI were thinner CCT, blue sclera, steep K values especially in Type 4 group. So patients should be followed regularly for keratoconus. Because of corneal thinning, physicians must be aware of underestimation of IOP. Patients and their relatives be advised to use protective glasses for probable trauma.

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Amaç: D vitamini, secosteroid yapýsýndaki fosfor metabolizmasýnda rol oynayan baþlýca hormonlardan biridir. Çalýþmalar, düþük serum D vitamini düzeylerinin otoimmün hastalýklar, diyabetes mellitus, hipertansiyon ve kanser gibi kronik hastalýklarla iliþkili olduðunu göstermiþtir. Bu çalýþmanýn amacý, Bilecik ilinde yaþ ve cinsiyete göre yetiþkin popülasyonda (18-98) serum 25-hidroksivitamin D düzeylerinin mevsimsel deðiþkenliðini araþtýrmaktýr.
Yöntemler: Ocak 2016 ile Aralýk 2017 tarihleri arasýnda hastaneye baþvuran hastalarýn dosyalarý retrospektif olarak tarandý. Hasta ilaçlarý deðerlendirildi. 22205 hastanýn serum D vitamini düzeyleri yaþa, cinsiyete ve mevsimlere göre deðerlendirildi.
Bulgular: 17070 kadýn (% 76,9) ve 5135 erkek (% 23.1) hastanýn serumdan D vitamini analiz edildi. Katýlýmcýlarýn serum D vitamini düzeylerinin ortanca deðeri kadýnlarda 17.2 (4.2-137.9), erkeklerde 22.9 (4.3-144.0) idi. Mevsimsel sýnýflandýrmaya göre, erkekler ve kadýnlarda her mevsimde serum 25-OH D vitamini yetersizliði saptandý (p<0.001). Erkeklerden farklý olarak kadýnlarda bahar ayýnda vitamin D eksikliði saptandý (p<0.001). Tüm hastalar için medyan serum 25-OH D vitamini seviyeleri sonbahar, ilkbahar, kýþ, yaz için sýrasýyla 20.2 (4.33-127.2), 16.3 (4.23-144.0), 18.6 (4.20-129.0) ve 19.6 (4.30-137.9) ng / mL idi.
Sonuç: Bilecik'te yetiþkinler arasýnda yetersiz D vitamini yaygýndýr. Serum 25-Hidroksi-D vitamini seviyeleri erkeklerde her mevsimde kadýnlara göre daha yüksekti (p<0.001). 25 (OH) D seviyesinin kadýnlarda ve ilkbaharda anlamlý derecede düþük olmasý dikkat çekicidir (p<0.001). Yetiþkinler için güneþ ýþýðýna maruz kalmalarýna ek olarak D vitamini takviyesi önermekteyiz.

Aim: Vitamin D is one of the major hormones involved in phosphorus metabolism in the secosteroid structure. Studies have shown that low serum vitamin D levels are associated with chronic diseases such as autoimmune diseases, diabetes mellitus, hypertension and cancer. The aim of this study was to investigate the seasonal variability of serum 25- hydroxyvitamin D levels in the adult population (18-98) according to age and gender in Bilecik province, Turkey.
Methods: The medical records of the patients admitted to hospital between January 2016 and December 2017 were retrospectively screened. The patient medications were evaluated. Serum vitamin D levels of 22205 patients were evaluated according to age, gender and seasonal.
Results: According to the data, serum vitamin D were analyzed from the sera of 17070 females (76,9%) and 5135 males (23.1%). The median value of serum vitamin D levels of the participants was 17.2 (4.2-137.9) in females and 22.9 (4.3-144.0) in males. According to the seasonal classification, there was inadequate of serum 25-OH vitamin D in all seasons in females and in males (p<0.001). Unlike men, vitamin D deficiency was detected in women during the spring (p<0.001). For all subjects, median serum 25-OH vitamin D levels were 20.2 (4.33-127.2), 16.3 (4.23-144.0), 18.6 (4.20-129.0) and 19.6 (4.30-137.9) ng/mL for autumn, spring, winter, and summer, respectively
Conclusion: Vitamin D inadequate is prevalent among adults in Bilecik. The serum 25-Hydroxy-Vitamin D Levels were higher in the males than in the females for all seasons (p<0.001). It is noteworthy that 25(OH)D levels were significantly lower in women and during spring (p<0.001). We recommend vitamin D supplementation for adults with additional the sunlight exposure.

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Amaç/Giriþ
Kömür madeni iþçilerinde ölümün en sýk sebeplerinden biri kardiyovasküler hastalýklardýr. Ateroskleroz dünya çapýnda kardiyovasküler hastalýklarýn en sýk sebebidir. Subklinik ateroskleroz karotis arterlerin yerleþimi sayesinde doppler ultrasonografi aracýlýðýyla teþhis edilebilir. Bu çalýþmada amaç kömür madeni tozuna kronik maruziyetin aterosklerotik sürece katkýsý olup olmadýðýný araþtýrmaktý.
Yöntemler
Çalýþma tek merkezli ve retrospektif olup 25 genç kömür madeni iþçisi, 25 kömür madeni emeklisi, 25 genç ve 25 yaþlý saðlýklý ve kömür tozu maruziyeti olmayan kontrollerden oluþmaktaydý. Olgularýn dosyalarýndan karotis doppler ultrasonografisi, biyokimyasal testleri, ekokardiyografisi, solunum fonksiyon testi bulundu ve kaydedildi.
Bulgular
Genç maden iþçisi grubu ile saðlýklý genç kontroller arasýnda karotis intima mediya kalýnlýðý arasýnda anlamlý fark bunmazken(0,66±0,16 vs 0,65±0,16; p=0,994); kömür madeni emeklisi grup ile saðlýklý ve yaþlý kontroller arasýnda anlamlý fark oluþtuðu görüldü(0,99±0,09 vs. 0,81±0,13; p=0,01).
Sonuçlar
Bu çalýþmada aterosklerozun erken dönemde teþhisini saðlayan karotis intima mediya kalýnlýðýnýn kronik kömür tozu maruziyeti sonrasý arttýðý görüldü. Bu nedenle kiþilerin ateroskleroz açýsýndan risk faktörlerini belirlerken mesleki sorgulamýnýn faydalý olabileceði düþünülebilir.

Background and Objectives
The cardiovascular diseases are one of the most frequent causes of death in coal miners. The atherosclerosis is the most frequent cause of cardiovascular disease around the world..The subclinical atherosclerosis can be diagnosed thanks to the localization of carotid arteries by measuring carotid intima media thickness via doppler ultrasonography.In this study, the aim was to investigate whether the chronic exposure to coal mine dust contributes to atherosclerotic process.
Methods
The study was designed as single centre, retrospective, consisting of 25 young coal miners, 25 coal miner retirements, 25 young people and 25 healthy elderly people who have never worked in coal mine controls. The carotid doppler ultrasonography, biochemical tests, echocardiography, respiratory function test results were found and recorded from the files of the cases
Results
There was not any meaningful difference in point of carotid intima media thickness between coal miners and healty young group(0,66±0,16 vs 0,65±0,16; p=0,994), while there was a meaningful difference between coal miner retirements and healthy elderly group(0,99±0,09 vs. 0,81±0,13; p=0,01).
Conclusions
In this study, it was revealed that the carotid intima media thickness, which facilitates in early stage in order to diagnose atherosclerosis, increased after chronic exposure to coal mine dust. Therefore, it can be thought that professional questioning may be beneficial while determining the risk factors of individuals in terms of atherosclerosis.

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Giriþ: Çocuklarda supraventriküler taþikardi (SVT)’lerin tedavisinde kateter ablasyon baþarýlý olarak uygulanmakla birlikte, geleneksel yöntemle yapýlan ablasyon iþlemlerinde X-ýþýnlarý kullanýlmaktadýr. Son dönemlerde, elektroanatomik haritalama sistemlerinin geliþtirilmesi ile ablasyon iþlemlerindeki floroskopi maruziyeti azaltýlmýþ, hatta bazý iþlemlerde tamamen elimine edilmiþtir. Radyofrekans ablasyon (RFA) taþiaritmilerin tedavisinde yaygýn olarak kullanýlan bir yöntemdir. Ancak, atriyoventriküler (AV) tam blok riski taþýmaktadýr. Bu nedenle, son dönemlerde atriyoventriküler nodal reenteran taþikardi (AVNRT)’yi de içeren septal taþikardi substratlarýnda kriyoablasyon (KRA) tercih edilmektedir. Bu çalýþmada, elektroanatomik haritama kullanýlarak SVT ablasyonu yapýlan hastalarýmýz ve kriyoablasyon deneyimlerimiz sunulmuþtur.
Metodlar: SVT nedeniyle kliniðimizde elektrofizyolojik çalýþma yapýlan 48 çocuk retrospektif olarak deðerlendirildi. Tüm prosedürler Ensite NavX Sistem (St. Jude Medical, St. Paul, MN,USA) eþliðinde yapýldý.
Sonuçlar: 30 hastada AVNRT, bu hastalarýn birinde atriyal taþikardi (AT) vardý, diðer bir hastada tipik ve atipik AVNRT birlikteydi. 7 hastada gizli AP, 9’unda manifest AP, 2’sinde sað taraflý AT, bir hastada Mahaim AP vardý. 42 (%87.5) hastada hiç floroskopi kullanýlmadý. Geriye kalan 6 (%12.5) hastada ortalama floroskopi süresi 6.0±2.28 dk (medyan: 6.0; aralýk: 3 -10 dk) idi. 34 (% 70.8) hastada KRA, 14 (%29.2) hastada RFA uygulandý. Akut baþarý % 95.8 oranýndaydý. 16±10.02 aylýk izlem süresinde 3 (%6.2) hastada nüks görüldü. Bu hastalara 2. seansta baþarýlý ablasyon yapýldý. Uzun süreli izlemde baþarý oraný % 100 idi. Hiçbir hastada kalýcý AV tam blok geliþmedi. Bir hastada transseptal giriþim sýrasýnda perikardiyal boyanma ve minimal perikardiyal efüzyon dýþýnda komplikasyon olmadý.
Tartýþma: Çocuklarda SVT ablasyonu elektroanatomik haritama yöntemiyle ve sýnýrlý floroskopi ile baþarý ile uygulanabilir. AVNRT ve septal taþikardi substratlarýnda KRA tercih edilmelidir.

Introduction: Athough, catheter ablation has become established therapy for treatment of pediatric SVT, X-ray has been used during electrophysiological procedures. Recent advances in electroanatomic mapping technologies resulted in a decrease or elimination of fluoroscopy during catheter ablation. Although, radiofrequency ablation (RFA) is a common option for treatment of tachyarrhythmias, it has irreversible risk of AV block. Cryoablation is preferred for septal tachycardia substrates due its safety. In this study, we presented our results of children who underwent SVT ablation using electroanatomical system and experiences in cryoablation.
Methods: A total of 48 children underwent ablation of SVT. All procedures were performed using the EnSite System (St. Jude Medical, Inc., St. Paul, MN, USA).
Results: Thirty patients had AVNRT, one of these had an additional atrial tachycardia and the other one had atypical AVRNT, 7 had concealed AP, 9 had manifest AP, 2 had atrial tachycardia, and one had Mahaim AP. Fluoroscopy was not used in 42 patients (87.5%). The mean fluoroscopy time in the remaining 6 (12.5%) patients was 6.0±2.28 minutes.Cryoablation was used in 34 (70.8% ) and RFA in 14 (29.2%). Acute success was 9A5.8%. During follow-up of duration, SVT recurred in 3 patients (6.2%). These patients underwent second successful ablation procedures. Final success was 100 %. No permanent AV block was observed. An uneventful pericardial needle injury occured in one patient during transseptal puncture with minimal effusion.
Conclusions: Catheter ablation of SVT can be performed effectively with limited fluoroscopy approach. Cryoablation should be preferred for ablation of septal tachycardia substrates, including AVNRT.

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Amaç: Çalýþmamýzýn amacý Spor Fizyolojisi polikliniðine obezite nedeniyle baþvuran kadýnlarda Three-Factor Eating Questionnaire (TFEQ) kullanarak kontrollü yeme, kontrolsüz yeme ve emosyonel yeme davranýþýný ortaya koymak ve bu davranýþlarýn ABO kan gruplarý ve Rh faktörü ile iliþkisininin olup olmadýðýný araþtýrmaktýr.
Yöntem: 18-65 yaþ arasý obezite nedeniyle baþvuran kadýnlardan obezite grubu (n= 197), kan bankasýna kan dönorü olarak baþvuran obez olmayan kadýnlardan kontrol grubu oluþturuldu (n= 95). Düz zeminde, çýplak ayakla boy uzunluklarý ölçüldü. Daha sonra bioimpedans (Tanita-BC-418 MA III) cihazýnda kilo, beden kitle indeksi, yað yüzdesi, yað aðýrlýðý ve yaðsýz aðýrlýðý gösteren tüm vücut analizi yapýldý. Kontrollü yeme, kontrolsüz yeme ve emosyonel yeme davranýþýný ölçen uluslararasý düzeyde kullanýlan, ülkemizde uygunluðu gösterilmiþ çalýþmalarý olan üç faktörlü beslenme anketini (Three-Factor Eating Questionnaire (TFEQ)-18) doldurmalarý istendi. Kan gruplarý ve Rh faktörünün tayini kan bankasýnda gerçekleþtirildi. Çalýþma kapsamýnda toplanan hasta verileri IBM Statistical Package for the Social Sciences (SPSS) for Windows 20.0 paket programý ile analiz edildi.
Bulgular: Cognitive restraint (Biliþsel kýsýtlama) A kan grubunda O grubuna gore daha yüksek oranda tesbit edilirken, kontrolsüz yeme ve emosyonel yeme davranýþýnýn ABO kan gruplarýndan ve Rh faktöründen etkilenmediði tesbit edildi.
Sonuç: Bu çalýþmada sadece A kan grubunda kontrollü kýsýtlama açýsýndan anlamlý sonuç tesbit edilmesi ABO kan grubu antijenlerinin ve Rh faktörünün yeme davranýþý üzerine etkisini araþtýrmak açýsýndan daha yeni çalýþmalara yol gösterici olabilir.

Objective: The aim of the present study is to reveal controlled eating, uncontrolled eating and emotional eating behaviours and to search whether an association exists between ABO blood types as well as Rh factor and these behaviours through Three-Factor eating Questionnaire (TFEQ).
Method: The women between 18 and 65 years of age who referred because of obesity consisted the obesity group (n=197) whereas a control group (n=95) was created from non-obese women who referred to the blood bank as blood donor. Body lengths of the women were measured at standing position without shoes. A complete blood analysis was performed including body weight, body mass index, fat percentage, fat weight and lean body weight through bio-impedance (Tanita-BC-418 MA III). The participants were asked to reply the three-factor Eating Questionnaire (TFEQ)-18) which is an international questionnaire evaluating controlled eating, uncontrolled eating and emotional eating behaviour. Blood type and Rh factor analyses were performed in the Blood bank. The patient data collected within the scope of the study were analysed through IBM Statistical Package for the Social Sciences (SPSS) for Windows 20.0 package program.
Findings: Cognitive restraint was detected higher in the blood type A when compared with blood type O whereas uncontrolled eating and emotional eating behaviour was not affected by ABO blood types and Rh factor.
Conclusion: A significant result for controlled restriction only in blood type A may guide new studies that shall search the effect of ABO blood group antigens and Rh factors on eating behaviour.

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Amaç: Nötrofil/lenfosit oraný, hem akut inflamatuar cevabý gösteren nötrofil yüksekliði, hem de fizyolojik stresi yansýtan lenfosit düþüklüðünün olumsuz etkilerini gösteren bir parametre olarak kabul edilmektedir. Nötrofil yüksekliði direk olarak iskemiye baðlý olabileceði gibi, inme geliþmesinden sorumlu inflamasyonun bir yansýmasý da olabilir. Hemorajik inmeli hastalarda ise kanamaya baðlý inflamatuar cevapta bir artýþ söz konusudur ki bu beyin hasarýnýn artmasýna sebep olur. Bu çalýþma inme alt gruplarýnda nötrofil/lenfosit oranýnýn nasýl deðiþtiðini ve fonksiyonel iyileþmeyle iliþkisini araþtýrmak için planlandý.
Materyal ve Metot: Çalýþmamýza iskemik inmeli 294 hasta, geçici iskemik ataklý 35 hasta, 19 hemorajik inme vakasý ve 70 kontrol birey olmak üzere olmak üzere toplam 418 kiþi alýndý. Herbir vakanýn nötrofil/lenfosit oraný hesaplandý; hastalarýn taburculuk Rankin skoru kaydedildi.
Bulgular: Nötrofil/lenfosit oraný inmeli hastalarda kontrollere kýyasla anlamlý olarak daha yüksek bulundu (p<0.01). Alt gruplarýn kontrol grubuyla analizinde aterosklerotik, kardiyoembolik, laküner, geçici iskemik atak ve hemorajik inme grubunun nötrofil/lenfosit oranlarý kontrollere göre anlamlý olarak daha yüksekti (p<0.01). Ýnme subtipleri karþýlaþtýrýldýðýnda hemorajik inmeli grupta nötrofil/lenfosit oraný tüm iskemik inme alt gruplarýndan anlamlý olarak daha yüksekti (p<0.01). Nötrofil/lenfosit oraný aterosklerotik ve embolik iskemik inmeli hastalarda hem laküner inmeli hastalardan hem de geçici iskemik ataklý hastalardan anlamlý olarak daha yüksekti (p<0.01). Korelasyon analizleri Rankin skorlarýyla nötrofil/lenfosit oraný arasýnda istatistiksel olarak anlamlý pozitif korelasyonun varlýðýný ortaya koydu (p<0.001, r=0.237).
Sonuç: Nötrofil/lenfosit oraný sistemik inflamatuar statusu gösteren bir parametredir. Ýnmenin her tipinde artmýþ olmasý ve klinik özürlülük skorlarýyla korelasyonu, beyin hasarlarýnýn azaltýlmasýnda enflamasyonu azaltmaya ya da önlemeye yönelik tedbirlerin ve geliþtirilecek stratejilerin önemini ortaya koymaktadýr.

Purpose: Neutrophil/lymphocyte ratio (NLR) is considered to be a parameter that reflects the negative consequences of both neutrophil elevation as a marker of acute inflammatory response and lymphocyte depression as a marker of physiological stress. The present study aims to investigate the changes of NLR in stroke sub-groups and their relation to the functional recovery.
Material and Methods: A total number of 418 subjects participated in the present research: 294 patients diagnosed with ischemic stroke, 35 patients experiencing a transient ischemic attack (TIA), 19 patients with hemorrhagic stroke and 70 control subjects. NLR of all subjects was calculated and their Rankin scores on discharge were recorded.
Findings: NLR was significantly elevated in stroke patients compared to the control subjects (p<0.01). When the sub-groups were compared to the control subjects, the findings indicated significantly higher NLR in all sub-groups (p<0.01). Comparisons between stroke sub-groups showed that the NLR in the sub-group with hemorrhagic stroke was significantly higher than the ratio recorded in the all ischemic stroke subgroup. NLR was also significantly higher in patients with atherosclerotic and embolic ischemic stroke, compared to patients with lacunar stroke or TIA (p<0.01). Correlation analysis demonstrated a statistically significant positive correlation between Rankin scores and NLR (p<0.001, r=0.237).
Conclusion: The findings suggest that NLR elevated in all types of stroke and its correlation with clinical disability scores underline the significance of the measures and future strategies with an aim to decrease or even to prevent inflammation to reduce brain damage.

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Anafilaksi tipik olarak deðiþik semptomlarla deri, solunum, kardiyovasküler veya gastrointestinal gibi birden fazla sistemin tutulumuyla meydana gelen ve yaþamý tehdit edici bir hastalýktýr. Anafilaksi genelde bilinen veya bilinmeyen bir alerjene temas sonrasý aniden kendini gösterir. Bununla beraber bilinen bir tetikleyici, neden veya olay olmadan da meydana gelebilir ve bu iyi bilinen tipi idiopatik anafilaksi olarak adlandýrýlýr. Ýdiopatik anafilaksi uygun bir alerjik deðerlendirme sonucu ve provokatif tetikleyicinin dýþlanmasýyla teþhis edilir. Ýdiopatik anafilaksi günümüzde çocuk ve eriþkinlerde tanýmlanmýþ ve artan oranda vakalar tüm dünyada görülmektedir. Ýdiopatik anafilaksi uygun tedavi rejimleriyle kontrol edilebilmesine raðmen, potansiyel olarak ölümcül, majör saðlýk harcamasýnýn bir kaynaðýný temsil eder, hasta ve ailede anksiyeteye neden olur. Kortikosteroide cevaplý bir hastalýk olmasý hastalýðýn immünolojik bir patogenezi olabileceðini düþündürür. Profilaksi yönetiminde kullanýlan tedavi rejimlerinin etkin olduðu gösterilmiþtir. Ýdiopatik anafilaksi vakalarýnýn literatürdeki derlenmiþ verilerinde birkaç ölüm vakasý bildirilmiþtir.

Anaphylaxis is a life-threatening disorder that typically occurs as a result of involvement of a few systems (e.g. dermatologic, respiratory, cardiovascular or gastrointestinal) with different symptoms. It usually happens abruptly after contacting with a known or an unknown allergen. Anaphylaxis can, nevertheless, take place without any particular precipitant, reason or occasion, and this well-known type of disorder has been named as idiopathic anaphylaxis. The diagnosis of idiopathic anaphylaxis is made following an accurate allergic assessment and elimination of any offensive agent. Idiopathic anaphylaxis has been currently defined in children and adults, and growing reports of patients are being observed globally. Idiopathic anaphylaxis is potentially lethal; typifies an origin of main health care expenses, brings anxiety to the patient and family, although it is manageable by correct therapeutic maneuvers. Since it is a corticosteroid- responsive disorder, it may have an immunological pathogenesis. Certain therapeutic regimes have been proven to be helpful in prophylactic treatment of idiopathic anaphylaxis. In the gathered data of idiopathic anaphylaxis cases in the literature, there have been a few fatalities described.

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Papiller tiroid karsinomu (PTC) iyi bir prognoz taþýr ve düþük nüks oranýna sahiptir. Tekrarlayan hastalýk esas olarak boyun ve uzak metastazlarý içerir. Nüks riskini azaltmak için, ilk ameliyat sýrasýnda papiller tiroid karsinomasý için profilaktik boyun diseksiyonunu kullanmak mevcut trenddir. Biz infraklaviküler alanlara uzanan seviye V boyun nodunda tekrarlayan papiller tiroid karsinomasý olgusunu sunuyoruz. Daha geniþ bir cerrahi eriþim ve daha iyi bir onkolojik sýnýr elde etmek için bir klavikula osteotomisi yapýldý. Tekrarlayan boyun hastalýðýnýn çoðunluðu merkezi kompartmanda olur, bunu seviye III ve seviye IV boyun düðümleri izler. Boyun rekürrensinin tekrarlanmasý, özellikle tümör IJV'nin alt kýsmýnda yer alýrsa, düzey IV boyun düðümlerinde, þilöz sýzýntý ve venöz kanama gibi önemli morbiditeleri beraberinde getirir. Klavikula osteotomisi daha iyi cerrahi eriþim saðlar ve bu nedenle yukarýda belirtilen komplikasyonlarý önler. Bir klavikula bölünmesi, iyi bir tümörün boyun tabanýnda iyi bir onkolojik sýnýr ile tamamen çýkarýlmasý için etkili bir yaklaþýmdýr.

Papillary thyroid carcinoma (PTC) carries a good prognosis and has a low recurrence rate. The recurrent disease mainly involves the neck and distant metastases. The current trend is to incorporate prophylactic neck dissection for papillary thyroid carcinoma during the very first surgery in order to reduce the risk of recurrence. We highlight a case of recurrent papillary thyroid carcinoma at level V neck node that extends to the infraclavicular spaces. A clavicle osteotomy was performed for a wider surgical access and to attain a better oncological margin. The majority of recurrent neck disease occurs at central compartment followed by the level III and level IV neck nodes. The reoperation of neck recurrence poses several significant morbidities such as chylous leaks and venous bleeding especially if the tumour is located at the inferior part of IJV, at the level IV neck nodes. The clavicle osteotomy provides better surgical access and thus avoids the aforementioned complications. A clavicle split is an effective approach for complete removal of a recurrent tumour at the base of the neck with good oncological margin.

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Akut apandisit ve travma sýklýkla görülen cerrahi acillerdendir. Travmanýn apandisite neden olup olmadýðý uzun yýllardýr tartýþma konusu olmuþtur.
36 yaþýnda erkek olgu sað alt karýn bölgesinde aðrý, kusma ve baðýrsaklarýnýn çalýþmamasý þikâyetleri ile baþvurdu. Olgunun anamnezinde yaklaþýk olarak 13–14 saat önce bisikletten düþerek batýn sað alt kadranýný bisikletin gidonuna çarptýðý öðrenildi. Fizik muayenede batýn sað alt kadranda palpasyonla hassasiyet, defans ve rebaund mevcuttu. Laboratuvar tetkiklerinde hemoglobin 12.6 g/dL ve lökosit 21.600/mm3 olarak belirlendi. Batýn ultrasonografisinde apendiks çapý 10 mm olarak ölçüldü, apendiks mezenteri ve periapendisiyel yað dokusu içerisinde yoðunluk artýþý ve ödem tespit edildi. Abdominal tomografide ise apendiks çapý 11 mm idi. Olgu acil olarak operasyona alýndý. Eksplorasyonda ödemli apendiksin kök, duvar ve mezosunda yoðun hematom görüldü. Olguda apendektomi iþlemine hematomlu apendiks mezosunun rezeksiyonu da eklendi. Çýkarýlan spesmenin patolojik incelemesi akut gangrenöz apandisit olarak raporlandý. Olgu 6 aylýk takibin sonunda asemptomatiktir.
Nadir de olsa ciddi künt batýn travmalarý sonrasýnda akut apandisit geliþebilmektedir. Klinisyenler künt batýn travmasýný takiben özellikle sað alt kadran aðrýsý ve defans bulunan olgularda erken taný ve sorunsuz bir postoperatif dönem için akut apandisitten mutlaka þüphelenmelidirler.

Acute appendicitis and trauma are commonly seen surgical emergencies. Whether or not the trauma is a cause of appendicitis has been subject to discussions for many years.
A 36-year-old male patient presented to our clinic complaining about pain in his right lower abdomen, vomiting and lack of bowel movement. His anamnesis revealed that he fell off a bicycle and had a stroke on his right lower abdominal quadrant from the handlebar of the bicycle approximately 13-14 hours ago. In physical examination, there were tenderness to palpation, guarding and rebound tenderness in right lower abdominal quadrant. Laboratory tests showed that hemoglobin was 12.6 g/dL and leukocyte 21.600/mm3. In abdominal ultrasound, the diameter of appendix was measured to be 10 mm and an increased density and edema were found in appendiceal mesentery and periappendiceal adipose tissue. Abdominal tomography showed that the diameter of appendix was 11 mm. The patient was urgently operated. During the exploration, intense hematoma was seen in the root, wall and mesentery of the edematous appendix. A resection of the mesoappendix with hematoma was included in appendectomy. After the pathological examination of the removed specimen, the case was reported to be an acute gangrenous appendicitis. The patient was asymptomatic after his 6-month follow-up.
Although rarely, acute appendicitis may be develop after a serious blunt abdominal trauma. Clinicians should absolutely suspect acute appendicitis especially in cases with right lower quadrant pain and tenderness following a blunt abdominal trauma for early management and an uneventful postoperative course.

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Walker-Warburg Sendromu (WWS) otozomal resesif (OR) geçiþ gösteren, retinal ve serebral anomaliler ile karakterize bir konjenital muskuler distrofidir. Bu makalede öyküde akraba evliliði olan hipotoni, makrosefali, tipik MR bulgularý ve yüksek kreatinin kinaz düzeyi ile WWS tanýsý koyduðumuz iki olgu sunulacaktýr. Bu olgularýn sunulmasýndaki amaç WWS için karakteristik ve diagnostik olan MR bulgularýný vurgulamak, nadir görülen bu sendrom için pediatristlerin yaný sýra radyologlarýn da dikkatini çekmek, OR geçiþ göstermesi nedeniyle aileye verilecek danýþmanlýðýn önemini vurgulamaktýr.

Walker-Warburg Syndrome (WWS) is inherited in an autosomal recessive pattern, is characterized by eye and cerebral anomalies and high creatinine phosphokinase levels. In this report two cases who had history ofconsanguineous marriage diagnosed as WWS according to findings of hypotonia, typical MR images and high creatinine phosphokinase levels, were presented. The aim of presenting these cases was to emphasize the characteristic and diagnostic MR findings for WWS, to take attention of radiologists and pediatricians to this rarely seen syndrome and to emphasize the genetic counseling of families due to autosomal recessive inheritance.

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Atriyal miksoma pediatrik yaþ grubunda sýklýðý yaþla en çok artan benign kalp tümörüdür. Hastalarýn çoðunda klinik triad; sistemik embolizasyon, atriyoventriküler kapak obstrüksiyonu, sistemik hastalýk bulgularý þeklindedir. Erken taný almasý yaþamsal öneme sahiptir. Bu yazýda çabuk yorulma, göðüs aðrýsý ve çarpýntý þikayeti ile pediyatri polikliniðine baþvuran ve sol atriyal miksoma tanýsý alan bir olgu sunulmuþtur.

Atrial myxoma is the most common benign heart tumor increasing with age in the pediatrics. Clinical triad in the majority of patients; systemic embolization, atrioventricular valve obstruction, systemic disease findings. Early diagnosis is very important. In this article, we report a patient who was referred to our clinic with fatigue, chest pain and palpitation and was diagnosed with left atrial myxoma.

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