GÝRÝÞ: Çalýþmamýzda Disemine Ýntravasküler Koagülasyon (DÝK) geliþen Gram negatif sepsis hastalarýnda Antitrombin III (AT III) ve Pentoksifilin tedavilerinin etkinliðini karþýlaþtýrmayý amaçladýk.
METOD: DiK geliþen gram negative sepsis hastalarýnda AT III aktivitesinin % 80’in altýna düþtüðü günü takipeden 6 gün hastalarýn bir kýsmýna 90-20 IU/kg/gün 6 saat olacak þekilde AT III, diðer kýsmýna 1.5mg/kg/saat 6 saat olucak þekilde pentoksifilin tedavisi uygulandý. Fibrinojen, FDP, D-Dimer, tam kansayýmý, ATIII aktivitesive DÝK skorlarýna bakýldý.
BULGULAR: Koagülasyon testleri, AT III aktivitesi ve FDP her iki tedavi ile tedavinin 2. gününden itibaren iyileþmeye baþladý (p<0.05). D-Dimer Pentoksifilin tedavisiyle tedavinin 2. Gününden (p<0.001), AT III tedavisiyle 4. gününden itibaren (p<0.05) düþmeye baþladý. Fibrinojen düzeyleri Pentoksifilin tedavisinin 2. Günü (p<0.05), AT III tedavisinin son gününde (p<0.001) düþtü. DiK skorlarý Pentoksifilin tedavisiyle tedavinin 3. Gününde (p<0.05) AT III tedavisiyle tedavinin son gününde (p<0.001) düþtü.
SONUÇ: olarak DÝK geliþen gram negatif sepsis hastalarýnda AT III ve Pentoksifilin tedavilerinin her ikisininde koagülasyon testleri, Fibrinojen, FDP, D-Dimer, AT III aktivitesive ve DÝK skorlarý üzerine olumlu etkisi vardýr.
Anahtar Kelimeler: Gram negatif sepsis, Dissemine Ýntravasküler Koagulasyon, Antitrombin, Pentoksifilin.

INTRODUCTION: The aim of this study was to evaluate the effects of Antithrombin III (AT III) and Pentoxifylline treatments on the gram negative septic patients with DIC.
MATERIAL AND METHODS: When plasma AT III activity was lower than 80%, AT group of patients were treated with AT III 90-120 IU/kg/day in 6 hours for 6 days and PTX group of patients were treated with 1.5 mg/kg/h of Pentoxifylline in 6 hours in 6 days. Fibrinogen, FDP, D-dimer, complete blood count, AT III activity, coagulation tests of patients were recorded daily. DIC scores were calculated and recorded daily also.
RESULTS: The coagulation tests, AT III activity and FDP started coming normal value on the second day of treatment with both treatments (p<0.05). D-Dimer decreased on the second day of treatment with pentoxifylline (p<0.001) and fourth day of AT III treatment (p<0.05). Fibrinogen became decreasing on the second day of pentoxifylline treatment (p<0.05) and on the last day of AT III treatment (p<0.001). DIC scores started to decrease on the last day of treatment with AT III treatment (p<0.001) and on the third day of treatment with pentoxifylline (p<0.05).
CONCLUSIONS: Both ATIII and pentoxifylline treatments had similar positive effects on the patients with DIC developing gram negative sepsis and AT levels started to rise early and reached normal values with both treatments.
KEYWORDS: Gram negative sepsis, Disseminated Intravascular Coagulation, Antithrombin, Pentoxifylline.

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Amaç: Transnazal sfenopalatin ganglion bloðu, baþ aðrýsý hastalýklarýnýn tedavisi için yaygýn olarak kullanýlan bir tedavi yöntemidir. Ancak bu non-invaziv teknik için henüz standart bir teknik tanýmlanmamýþtýr. Bu çalýþmada amacýmýz, sfenopalatin foramenlerin morfometrik ve anatomik özelliklerini araþtýrmak ve transnazal sfenopalatin ganglion bloðu için daha etkili bir yaklaþým ortaya koymaktýr.
Yöntem: Bu çalýþma retrospektif olarak dizayn edilmiþtir. Çalýþmaya 10 adet yarým kadavra kafasý ve 18 eriþkin kuru kafatasý olmak üzere toplam 28 örnek dahil edildi. Sfenopalatin foramen ve palatum durum arasýndaki mesafe, sfenopalatin foramen ve spina nasalis anterior arasýndaki mesafe, palatin durumundan sfenopalatin foramenlerin yükselme açýsý ve sfenopalatin foramenlerin uzunluðu ve geniþliði ölçüldü.
Bulgular: Foramenlerin ortalama geniþliði ve uzunluðu sýrasýyla 3.79 ± 0.35 ve 6.44 ± 0.94 mm idi. Palatum durum ve sfenopalatin foramenler arasýndaki ortalama mesafe 15.58 ± 1.68, sfenopalatin foramenlerin palatum durumdan yükselme açýsý ortalama 26.10° ± 3.97, sfenopalatin foramenlerin anterior nazal spinadan ortalama uzaklýðý 52.90 ± 2.98 mm idi.
Sonuç: Transnazal sfenopalatin blok uygulamasýnda kullanýlan nazal aplikatörün süpero-lateral yönde ortalama 5.3 cm, burun tabanýndan ortalanma 26 ° açý yapacak þekilde ilerletilerek uygulanmasýný tavsiye ediyoruz.

Objectives: Transnasal sphenopalatine ganglion block is a commonly used approach for treatment of a variety of headache disorders but no standard technique has yet been defined for this less invasive approach. In this study, our aim was to investigate morphometric and anatomical features of the sphenopalatine foramen to describe a more efficient approach for transnasal sphenopalatine ganglion block.
Methods: The present study was designed retrospectively. Ten cadaveric semi heads and 18 adult dry skulls (28 samples totally) were included in the study. A variety of measurements including the distance between the sphenopalatine foramen and palatum durum, distance between the sphenopalatine foramen and the spina nasalis anterior, angle of elevation of the sphenopalatine foramen from palatum durum, and the length and width of the sphenopalatine foramen were performed.
Results: The mean width and length of the foramen were 3.79 ± 0.35 and 6.44 ± 0.94 mm, respectively. The mean distance between the palatum durum and the sphenopalatine foramen were 15.58 ± 1.68 mm. The mean angle of elevation of the sphenopalatine foramen from the palatum durum was 26.10 ± 3.97 degrees. The mean distance of the sphenopalatine foramen from the anterior nasal spine was 52.90 ± 2.98 mm.
Conclusions: We suggest using a rigid cotton swab as nasal applicator and describe an application technique as advancing the applicator supero-laterally and 5.3 cm posterior to the spina nasalis anterior with an elevation angle of 26° from the palatum durum.

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Amaç: Böbrek ve idrar yolu hastalýklarýnýn deðerlendirilmesinde idrar sedimentinin mikroskobik analizi gereklidir. Bu çalýþmada, DIRUI FUS-200'ün ve yeni bir görüntü tabanlý otomatik idrar sediment analizörü olan Urised 3'ün analitik ve diagnostik performanslarýný deðerlendirdik ve karþýlaþtýrdýk.

Yöntem: Laboratuvarýmýza gönderilen 440 idrar örneði her iki otomatik idrar sediment analiz cihazý ve standart manuel mikroskopi ile deðerlendirildi. Kesinlik, linearite ve yöntem karþýlaþtýrma çalýþmalarý CLSI kurallarýna göre yapýldý.

Bulgular: FUS-200 ile manuel mikroskopi arasýndaki eritrosit (RBC) ve lökosit (WBC) sayýmlarý arasýndaki korelasyon katsayýlarý sýrasýyla 0.993 ile 0.861; Urised 3 ve manuel mikroskopi arasýnda 0,962 ve 0,818; FUS200 ve Urised 3 arasýnda 0.961 ve 0.961 idi. Klinik uyumsuzluk tüm yöntemler arasýnda %7 ile %14.16 arasýnda deðiþmiþtir.

Sonuçlar: WBC için analizörler ve manuel mikroskopi arasýndaki uyum, RBC'den daha iyiydi. Analizörler arasýndaki uyum WBC’de ve RBC’de daha iyiydi. Her ne kadar UriSed 3, FUS-200 ve manuel mikroskopi sonuçlarý belli bir uyum içinde olsa da, otomatize yöntemlerin sonuçlarýnýn manuel mikroskopi ile onaylanmasý, özellikle de kesme deðerlerine yakýn patolojik örnekler için faydalýdýr.

Objective: Microscopic urine sediment examination is necessary for evaluation of renal and urinary tract diseases. In this study, we evaluated and compared analytic and diagnostic performances of the DIRUI FUS-200 and a new image-based automated urine sediment analyzer Urised 3.

Method: 440 urine samples submitted to our laboratory were evaluated by two automated urine sediment analyzers and standardized manual microscopy. Precision, linearity and method comparison studies were performed according to CLSI guidelines.

Results: The correlation coefficients for erythrocyte (RBC) and leukocyte (WBC) counts between the FUS-200 and manual microscopy were 0.993 and 0.861; the Urised 3 and manual microscopy were 0.962 and 0.818; the FUS200 and Urised 3 were 0.961 and 0.961, respectively. Clinical non-concordance ranged from % 7 to % 14.16 between all methods.

Conclusions: The concordance among the analyzers and manual microscopy for WBC was better than for RBC. The concordance between the analyzers was better for WBC and RBC. Although the UriSed 3, FUS-200 and manual microscopy counts were in agreement, confirmation of the automated methods’ results by manual microscopy is helpful, particularly for pathological samples near the cutoff values.

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Amaç: Tip 2 Diabetes Mellitus (T2DM) tedavisinde ve önlenmesinde egzersizin birçok faydalý etkisi vardýr. Bu çalýþmanýn amacý, deneysel T2DM modelinde haftalýk toplam süre ayný olmak þartýyla farklý sýklýklarla yapýlan fiziksel aktivitenin kalp ile böbrek dokularý ve vasküler endotelyal büyüme faktör ekspresyonu üzerindeki etkisini deðerlendirmektir
Yöntem: Sýçanlar (n: 30) sedenter kontrol (SK), sedenter T2DM (SD), T2DM ve devamlý egzersiz (DEd, 30 dak/gün, 5 gün/hafta), T2DM ve kýsa aralýklý egzersiz (DEka, 3x10 dak/gün, 5 gün/hafta), T2DM ve hafta sonu savaþçýlarý egzersiz (DEhs, 35+40 dak/gün, 2 gün/hafta) olarak gruplara ayrýldý. Sýçanlara intraperitoneal olarak streptozosin (65 mg/kg) ve nikotinamid (110 mg/kg) uygulanarak T2DM indüklendi. 6 haftalýk (toplam süre 150 dak/hafta) yüzme egzersizinden sonra oral glukoz tolerans testi, insülin duyarlýlýðý ve sitokinlerin ölçümü için biyokimyasal analizler yapýldý. Kalp ve böbrek dokularýnda histopatolojik ve immünohistokimyasal analizler [VEGF, kapiller yoðunluk, dönüþtürücü büyüme faktörü beta (TGF-β)] yapýldý.
Bulgular: Sedenter diyabet sýçanlarýna kýyasla, tüm egzersiz gruplarýnda kan þekeri seviyesi, insülin duyarlýlýðý, kalp dokusunda kýlcal yoðunluðu, dokulardaki VEGF ifadeleri, böbrek dokusunda TGF-β ifadeleri ve tüm histopatolojik analizlerde önemli iyileþmeler gözlendi (p<0.05).
Sonuç: Bu çalýþmada, toplam aerobik egzersiz süresinin ayný kalmasý þartýyla (150dk/hafta) farklý sýklýklarda yapýlan aerobik fiziksel aktivitenin, T2DM'nin kalp ve böbrek dokusu üzerinde zararlý etkilerini önemli ölçüde iyileþtirebileceðini göstermektedir
ANAHTAR KELÝMELER: Fiziksel aktivite, kýsa aralýklý egzersiz, tip 2 diabetes mellitus, vasküler endotel büyüme faktörü, haftasonu savaþçýsý.

Aim: There are many beneficial effects of exercise in the treatment and prevention of Type 2 Diabetes Mellitus (T2DM). The aim of this study was to evaluate the effect of physical activity with different frequencies but same total durations on the heart and kidney tissues and vascular endothelial growth factor (VEGF) expressions in experimental T2DM model. Methods: Rats (n: 30) were divided as sedentary control (SC), sedentary T2DM (SD), T2DM and continuous exercise (DEc, 30 min/day, 5 days/week), T2DM and short bouts exercise (DEsb, 3 x 10 min/day, 5 days/week), T2DM and weekend warrior exercise (DEww, 35 + 40 min/day, 2 days/week) groups. Rats were administered streptozotocin (65 mg/kg) and nicotinamide (110 mg/kg) intraperitoneally. After 6-week swimming exercise (total duration 150 min/week), biochemical tests were performed to measure oral glucose tolerance test, insulin sensitivity and cytokines. Histopathological and immunohistochemical analyses [VEGF, capillary density, Transforming growth factor beta (TGF-β)] were performed in heart and kidney tissues.
Results: Compared with sedentary T2DM rats, significant improvements were observed in all exercise groups in terms of blood glucose level, insulin sensitivity, capillary density in heart tissue, VEGF expressions in tissues, TGF-β expressions in kidney tissue and all histopathological analysis (p<0.05).
Conclusion: This study shows that physical activity at various frequencies may significantly ameliorate harmful effects of T2DM on heart and kidney tissue without significant differences between exercise frequencies, provided that the total duration of aerobic exercise remains the same (150 min/week).
KEY WORDS: Physical activity, short bouts of exercise, type 2 diabetes mellitus, vascular endothelial growth factor, weekend warrior.

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Amaç: Bu çalýþmada prostat kanseri tanýsý ile definitif radyoterapi (RT) veya radikal prostatektomi (RP) uygulanmýþ hastalarýn biyokimyasal nüks (BN), biyokimyasal nükssüz saðkalým (BNS) ve genel saðkalým (GS) oranlarý ile tedavi yöntemlerini karþýlaþtýrmayý amaçladýk.
Yöntem: RP (n=82) veya RT (n=46) uygulanmýþ, herhangi bir kurtarma tedavisi uygulanmayan, en az 2 yýl 3 ayda bir serum PSA seviyeleri ile takip edilen 128 hasta dosyasý retrospektif olarak tarandý. Hastalarýn hepsi D’Amico risk sýnýflamasýna göre düþük, orta ve yüksek risk grubu olarak sýnýflandýrýlmýþtý. Cerrahi kolunda radikal prostatektomi yapýlmýþken, RT koluna 3D konformal RT tekniðinde70-74 Gy RT uygulanmýþtý.
Bulgular: 10 yýllýk takipte; düþük risk grubu hastalarda BN tespit edilmedi. Orta risk grubu hastalarda BN açýsýndan tedavi kollarý arasýnda fark tespit edilmezken, yüksek risk grubu hastalarda RT kolunun istatistiki olarak anlamlý derecede iyi olduðu saptandý (p<0.05). Düþük, orta ve yüksek risk grubunda GS oraný sýrasýyla RP’de % 97.1, % 93.8, % 92.3 iken; RT’de % 81.8, % 92.9, % 90.5 idi (p>0,05). BNS oranlarý ise orta ve yüksek risk grubunda sýrasýyla RP’ de % 92.3, % 95.2 veRT’de % 79.6, % 81.6 idi (p>0,05).
Sonuç: Prostat kanseri tedavisinde her iki kolda BNS ve GS oranlarý arasýnda anlamlý fark olmayýp, BN oraný açýsýndan yüksek risk grubu hastalarda RT’nindaha iyi olduðu tespit edildi. Sonuç olarak; normal dokularý maksimum seviyede koruyarak uygulayabilen yüksek doz RT teknikleri ile yapýlan ve RT etkinliðini destekleyen daha uzun süreli çalýþmalara ihtiyaç vardýr.
Anahtar Kelimeler: prostatektomi,radyoterapi, prostat kanseri

Aim: This study compared biochemical recurrence (BR), biochemical recurrence-free survival (BRFS) and overall survival (OS) rates and therapeutic methods in patients undergoing definitive radiotherapy (RT) or radical prostatectomy (RP) due to prostate cancer.
Methods: Files for 128 patients undergoing RP (n=82) or RT (n=46), receiving no salvage therapy, and with serum PSA levels monitored three-monthly for at least two years were examined retrospectively. Patients were assigned into low, intermediate and high risk groups based on D’Amico risk classifications. RP was performed in the surgical arm and 70-74 Gy RT using 3D conformal RT in the RT arm.
Results: No BR was determined among low risk group patients over 10-year follow-up. No difference was determined between the treatment arms in BR in the intermediate risk patients, while the RT arm was statistically significantly better among the high risk patients (p=0.04). OS rates in the low, intermediate, and high risk groups were 97.1%, 93.8%, and 92.3%, respectively, in the RP, and 81.8%, 92.9%, and 90.5%, respectively, in RT (p>0.05). BRFS rates in the intermediate and high risk groups were 92.3%, and 95.2% in RP, and 79.6%, and 81.6% in RT (p>0.05).
Conclusion: There was no significant difference between BRFS and OS rates in the two arms in prostate cancer treatment, although RT was better in the high risk group patients in terms of BR. Longer-term studies involving high-dose RT techniques applied with maximum protection of normal tissue and supporting the effectiveness of RT are needed.
Key words: prostatectomy, radiotherapy, prostate cancer

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Arka plan: Nutrisyonel yetersizliklerin eþlik edebildiði baðýrsak mukoza katmanýnýn tekrarlayýcý inflamasyonu, inflamatuvar baðýrsak hastalýðý (ÝBH) olarak bilinmektedir. Ýnflamasyon ve koroner arter hastalýðýnýn iliþkisi ortaya konulmuþtur. Mikrovasküler ve epikardiyal akýmý kombine bir þekilde deðerlendirebilen koroner akým rezervi (KAR), transtorasik ekokardiyografi ile deðerlendirilebilir. Bu çalýþmanýn amacý, ÝBH hastalarýnda prognostik nutrisyonel indeks (PNI) ile KAR arasýndaki iliþkiyi deðerlendirmekti.
Yöntem: Bu çalýþma, prospektif olarak dahil edilen 101 ÝBH hastasýný içermektedir. Bu hastalar kontrol grubu (n=32) ile karþýlaþtýrýlmýþtýr. PNI, serum albümin düzeyi, lenfosit sayýsý kullanýlarak hesaplanmýþtýr. KAR, doppler ekokardiyografi ile deðerlendirilmiþtir.
Bulgular: Çok deðiþkenli regresyon analizi ÝBH varlýðý, yaþ (>40) ve azalmýþ PNI’nýn (<53.8) KAR’daki bozulmayý baðýmsýz bir þekilde predikte ettiðini ortaya çýkarmýþtýr. Eðri altýnda kalan alan (AUC) %75’di (95% CI: 0.664-0.838) ve PNI seviyesi düþük KAR için anlamlý bir prediktördü (p<0.001).
Sonuçlar: Bu çalýþma göstermiþtir ki serum albümin seviyesi, lenfosit sayýsý ile hesaplanan PNI, remisyondaki ÝBH hastalarýnda azalmýþ KAR için güçlü bir prediktördür. Çalýþmamýz PNI ile koroner arter hastalýðý iliþkisini gösteren önceki çalýþmalarý desteklemektedir. Bu immunonutrisyonel indeks sadece iki komponente sahiptir, kolayca hesaplanabilir ve ucuzdur.

Background: The recurring inflammation of mucosal layer of intestines is known as inflammatory bowel disease (IBD), which could be accompanied by nutritional deficiencies. The association of inflammation and coronary artery disease has been established. Coronary flow reserve (CFR), which is an established method to evaluate combined microvascular and epicardial flow of coronary arteries, can be assessed by using transthoracic echocardiography. The aim of this study was to evaluate the association of Prognostic Nutritional Index (PNI) with CFR in IBD patients.
Methods: This study included 101 patients with IBD who were prospectively enrolled. These patients were compared to control group (n=32). PNI was calculated by using serum albumin level and lymphocyte count. CFR was assessed by using Doppler echocardiography.
Results: Multivariate regression analysis indicated that the presence of IBD, age (>40 years) and decreased PNI (<53.8) independently predict impairment of the CFR. The area under the curve (AUC) was 75.1 % (95% CI: 0.664-0.838), and PNI levels were significant predictor of low CFR (p<0.001).
Conclusions: This study showed that PNI, which is calculated using the serum level of albumin and lymphocyte count, is a strong predictor of decreased CFR in IBD patients in remission. Our findings support previous studies showing the relationship between PNI and coronary artery disease. This immunonutritional index has only two components and is easy to calculate, and inexpensive.

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Amaç
Bu çalýþmada endoskopik giriþim yapýlan hastalarýn; ek hastalýk varlýðý, preoperatif anestezi yönetimi öngörüsü, intraoperatif-postoperatif komplikasyon ve yoðun bakým gereklilikleri açýsýndan analizi amaçlanmýþtýr.
Yöntem
Endoskopi ünitesinde anestezi altýnda iþlem uygulanan hastalarýn kayýtlarý geriye yönelik tarandý. Hastalarýn preoperatif anestezi açýsýndan deðerlendirmeleri, intraoperatif anestezi veriler, postoperatif derlenme verileri ve yoðun bakým takibi gerekliliði kayd edildi. Elde edilen veriler istatistiksel analize tabi tutuldu.
Bulgular
Hastalarýn preoperatif risk öngörüsünün intraoperatif ve postoperatif takipte istatistiki anlama sahip olduðu olduðu tespit edildi. Ek hastalýk ve yüksek yaþ mevcudiyetinin iþlem sonrasý yoðun bakým gerekliliðini artýrdýðý tespit edildi. Desatürasyon ve hipotansiyon gözlenen hastalarda nitelikli yatýþ gerekliliðinin arttýðý tespit edildi.
Sonuç
Güvenli anestezi uygulamanýn ön koþulu; hasta hakkýnda detaylý bilgi sahibi olmaktan ve olasý komplikasyonlara hazýrlýklý olmaktan geçmektedir. Bu açýdan bakýldýðýnda endoskopi ünitelerinde iþlem uygulanan hasta profilinin analizi önem arz etmektedir. Çalýþmamýzda bu ünitelerde iþlem uygulanan hasta grubunun yaþlý ve ek hastalýk mevcudiyetini tespit ettik. Bu tür iþlem uygulanacak hastalarda öncesinde ayrýntýlý bir deðerlendirme ve gerektiðinde iþlem sonrasý yoðun bakým takibi gerekliliði muhakkak göz önünde bulundurulmalýdýr.

Objective
This study aimed to analyze patients undergoing endoscopic interventions in terms of comorbid diseases, preoperative anesthesia management predictions, intraoperative-postoperative complications and requirements for intensive care.
Methods
Records of patients who underwent procedures with anesthesia in the endoscopy unit were retrospectively screened. The patients’ preoperative anesthesia evaluation, intraoperative anesthesia data, postoperative recovery data and intensive care monitoring requirements were recorded. The data obtained were analyzed statistically.
Results
It was identified that the preoperative risk prediction of patients was statistically significant for intraoperative and postoperative monitoring. Comorbid disease and high age were identified to increase the requirements for intensive care after the procedure. Patients with desaturation and hypotension observed were identified to have increased need for qualified admission.
Conclusion
A precondition for reliable anesthesia administration is having detailed information about the patient and being prepared for possible complications. When examined from this aspect, analysis of the patient profile undergoing procedures in the endoscopy unit is important. In our study, we identified the presence of elderly patients and comorbid disease in the patient group with procedures in this unit. The need for detailed preliminary evaluation of patients undergoing these types of procedure and requirements for intensive care after the procedure, if necessary, should definitely be considered.

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Amaç: Çalýþmamýzda servikovajinal smear sonrasý Atipik glandüler hücre tanýsý konan hastalarýn klinikopatolojik özelliklerini deðerlendirmeyi amaçladýk.
Hastalar ve Yöntemler: Kadýn hastalýklarý polikliniðinde 2010-2018 yýllarý arasýnda muayene edilen ve servikovajinal smear yapýlan 9375 hastanýn kayýtlarý retrospektif olarak incelendi. Yetmiþ üç (% 0,8) hastaya Atipic glanduler hücreler tanýsý kondu. Atipic glandüler hücreler tanýsý konulan hastalarda kolposkopik muayene, servikal biyopsi, endoservikal ve endometriyal küretaj yapýldý. Hastalarýn yaþ, gravida, parite, sistemik hastalýklar ve klinikopatolojik özellikleri incelendi ve kaydedildi
Bulgular: Atipic glandüler hücreli 73 hastanýn 26'sýnda (% 35.6) servikal ve endometrial anormal histolojik bulgular saptandý. Bu 26 hastanýn 14'ünde (% 19.1) servikal intraepitelyal lezyon, 3'ünde (% 4.1) endometrial hiperplazi, 9'unda (% 12.3) invaziv kanser mevcuttu. Ýnvaziv kanser tanýsý alan 9 hastanýn beþinde (% 6.8) adenokarsinom (endoservikal ve endometrial), 3'ünde (% 4.1) servikal skuamöz karsinom gözlendi. Bir hastada endoservikal lenfoma izlendi. Çalýþmamýzda tespit edilen kanserlerin büyük çoðunluðu 50 yaþ ve üstü yaþ grubundaydý.
Sonuç: Agc tanýsý konan hastalarýn %12.3 de invaziv kanser görülmektedir ve bu hastalarýn çoðunun yaþý 50 yaþ ve üzeridir. Bu nedenle servikovaginal smear nedeniyle Atipic glandüler hücre tanýsý konan hastalar tüm klinik özelliklerle dikkatlice deðerlendirilmelidir.

Abstract Aim: We aimed to evaluate the clinicopathologic features of patients diagnosed with Atyipcal glandular cell on cervical cytology.
Patients and Methods: The records of 9375 patients who were examined in the gynecology outpatient clinic between 2010 and 2018 and underwent cervicovaginal smear were retrospectively reviewed. Seventy three (0.8%) patients were diagnosed as AGC. Colposcopic examination, cervical biopsy, endocervical and endometrial curettage were performed in patients diagnosed with AGC. Age, gravida, parity, systemic diseases and clinicopathological features of the patients were examined and recorded
Results: Cervical and endometrial abnormal histological findings were detected in 26 (35.6%) of 73 patients with Atypical glandular cell. Of these 26 patients, 14 (19.1%) had cervical intraepithelial lesions, 3 (4.1%) had endometrial hyperplasia and 9 (12.3%) had invasive cancer. Five (6.8%) of the 9 patients with the diagnosis of invasive cancer were adenocarcinoma (endocervical and endometrial), 3 (4.1%) cervical squamous carcinoma was observed. Endocervical lymphoma was observed in one patient. The majority of cancers detected in our study were in the age group of 50 years and older.
Conclusion: Twelve point three percent (12.3%) of patients diagnosed with Agc have invasive cancer and most of these patients are 50 years or older. Therefore patients diagnosed with Atypical glandular cell in cervicovaginal smear should be carefully evaluated with all clinical features

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Amaç
Pankreatikobiliyer hastalýklarýn tedavisinde endoskopik retrograde kolanjio pankreatografi (ERCP) altýn standarttýr. Çalýþmamýzýn amacý son dört yýlda ERCP konusundaki deneyimimizi gözden geçirip, ERCP iþleminin güvenilirliðini deðerlendirmektir.
Materyal ve Metot
Çalýþmamýz, 2014-2018 yýllarýnda ERCP iþlemine alýnan 18-104 yaþ arasýndaki tüm hastalarýn kayýtlarýnýn retrospektif olarak incelenmesiyle gerçekleþtirilmiþtir. Gerekli veriye hastanemiz arþiv sisteminden ulaþýlmýþtýr.
Bulgular
Toplam 1337 hasta çalýþmaya dahil edildi. 775’i kadýn, 562’si erkek, ortalama yaþ 60.58 ± 17.96 idi. Hastalarýn 39’u 18-30 yaþ, 694’ü 30-65 yaþ, 274’ü 65–75 yaþ, 258’i 75–85 yaþ, 72’si ise 85 yaþ üstü idi. Hastalarýn 28.27%’si Amerikan Anestezistler Derneðine göre (ASA) III-IV’dü. Ýþleme alýnan hastalarýn 1303’de standart sfinkteretomi baþarýlý iken (97.45%), 34 hastada baþarýlý olunmadý (2.55%). Erken kesi papillotomi 34 hastanýn 27’sinde (79.41%) gerçekleþtirildi. Hastalarýn 1207’sinde (90.27%) hiçbir komplikasyon görülmezken, 96’sýnda (7.18%) anestezi ve iþlem ile iliþkili minor ve major komplikasyon görülmüþtür. Otuz günlük mortalite oraný 1.64% olarak bulunmuþtur (n=22).
Sonuçlar
Tümüyle terapötik amaçlarla uygulanan ERCP’nin yüksek klinik baþarýsýyla güvenilir ve hayat kurtarýcý olduðu kanaatindeyiz.

Aim
Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard treatment for pancreaticobiliary diseases. The aim of this study was to evaluate the safety and review the outcomes of ERCP over the past 4 years.
Materials and Methods
The clinical records of patients aged 18–104 years who underwent ERCP at our gastroenterology clinic between 2014 and 2018 were included in the study. Data were acquired from the hospital archive system.
Results
A total of 1337 patients underwent ERCP, of which 775 were female and 562 were male, and their mean age was 60.58 ± 17.96 years. Thirty-nine patients were aged 18–30 years, 694 were aged 30–65 years, 274 were aged 65–75 years, 258 were aged 75–85 years, and 72 were aged >85 years. Among them, 28.27% were rated III–IV on the American Society of Anesthesiologists scale. Although biliary cannulation with standard sphincterotomy was successful in 1303 patients (97.45%), it could not be performed in 34 patients (2.55%). Precut papillotomy was performed in 27 (79.41%) of 34 patients. Furthermore, no complication was observed in 1207 patients (90.27%), whereas 96 patients (7.18%) had minor and major procedure-related and anesthesia-related complications. The 30-day mortality rate was 1.64% (n=22).
Conclusion
We concluded that ERCP, which is currently performed entirely for therapeutic purposes, is safe and lifesaving, with high clinical success rates.

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Amaç Çakal eriði (Prunus spinosa), gülgiller (Rosaceae) familyasýndan bir aðaçcýk türüdür ve Türkiye’de meyvesi besin olarak tüketilmektedir. Bu çalýþma P. spinosa metanol ekstresinin antioksidan aktivitesini ve kanser hücre hatlarý üzerindeki sitotoksik etkilerini deðerlendirmeyi amaçlamýþtýr.
Yöntem P. spinosa meyvesi metanol ekstresi, glioblastoma multiform (GBM) beyin kanseri (LN-229, U-87 ve T98G) ve pankreas kanseri (PANC-1 ve AsPC-1) hücre hatlarý kullanýlarak in vitro sitotoksik aktivitesi araþtýrýlmýþtýr. Hücre canlýlýðý deneyleri, biyolüminesans sistemi kullanýlarak canlý hücrelerin yüzdesinin ve antioksidan aktivitelerinin, spektrofotometrik olarak ABTS ve DPPH radikalleri ile ölçülmesi yoluyla gerçekleþtirilmiþtir. Ýstatiksel anlamlýlýk, unpaired student t-test ile belirlenmiþtir (p*<0.001 and p**<0.0005)
Bulgular P. spinosa meyve metanol ekstresi, ABTS• ve DPPH• testlerinde toplam fenolik içeriðe karþýlýk gelen 2548 ± 17,74 mg GAE / 100 g ve orta düzeyde antioksidan aktivite (0,1896 ± 0,1143 ve 0,0729 ± 0,0348) göstermiþtir.
Sonuç Elde ettiðimiz bilgiler ýþýðýnda, beyin ve pankreas kanseri hücre hatlarýndaki sonuçlarýnýn deðerlendirilmesinden sonra, GBM beyin kanseri hücrelerinde % 50-63 arasýndaki hücre canlýlýðý ile önemli derecede sitotoksik aktivitesi belirlenmiþ ancak PANC-1 ve AsPC-1 pankreas kanseri hücre hatlarýnda sitotoksisite gözlenmemiþtir,. Sonuç olarak, P. spinosa meyvesi metanol ekstresinin önemli antioksidan kapasiteye sahip olduðu ve glioblastoma beyin kanseri hücrelerinin canýlýlýðýnda istatistiksel olarak anlamlý bir azalmaya yol açtýðý gösterilmiþtir.

Aim Prunus spinosa L. (Rosaceae) fruits are consumed as food in Turkey. This study was aimed to evaluate P. spinosa methanol extract antioxidant activity and cytotoxic effects on cancer cell lines.
Methods P. spinosa fruit methanol extract was evaluated for its in vitro cytotoxic activity by using glioblastoma multiform (GBM) brain cancer (LN229, U87 and T98G) and pancreas cancer (PANC-1 and AsPC-1) cell lines. Cell viability assays were performed through measuring the percentage of viable cells using a luminescence system, and the antioxidant activities by ABTS and DPPH radical scavenging spectrophotometrically. Differences were considered as statistically significant at p*<0.001 and p**<0.0005 according to unpaired student t-test.
Results P. spinosa fruit methanol extract showed 2548±17,74 mg GAE/100 g corresponding to the total phenolic content, and moderate antioxidant activity (0,1896 ± 0,1143 and 0,0729 ± 0,0348) by ABTS• and DPPH• assays. To the best of knowledge, after of evaluation the results of brain and pancreas cancer cell lines, significant cytotoxic activities with 50-63% cell viability of GBM brain cancer cells were determined while no cytotoxicity was observed on pancreas cancer cell lines, PANC-1; and AsPC-1.
Conclusion The results of this study showed that the P. spinosa fruit methanol extract has significant antioxidant capacity and leads to statistically significant decreased viability on glioblastoma brain cancer cells.

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Ölümü tanýmlamak için kullanýlan geleneksel kriterler bütün durumlara uymayabilir. Bu çalýþma nörolojik kriterlere dayanan ölüm ilanýnýn (DDNC) üç Ýbrahimi dini geleneðe göre (Ýslam, Yahudilik ve Katoliklik) ölüm tespiti için geçerli bir yöntem olarak uygun olup olmadýðýný tespit etmek için din hukukunu araþtýrmaktadýr. Ýslami kaynaklar arasýnda, ne Kur’an, ne Sünnet (Hadith), ne icmâ (Ýslam alimlerinin fikir birliði) ne de kýyas (benzer hükme göre fýkhi akýl yürütme) ölüm tespiti için bir kriter tanýmlamaktadýr. Bu çalýþmada tespit edilen, ictihad yoluyla oluþturulmuþ olan altý fetvadan (baðlayýcýlýðý bulunmayan) beþi DDNC’yi desteklemektedir. Ýncelenen ülkelerden DDNC’yi kabul eden 13 Müslüman çoðunluða sahip ülkenin 11’i dikkate alýndýðýnda, Ýnanç temelli Ýslami saðlýk örgütlerinin kararlarý da fikir ayrýlýklarý göstermektedir. Üç temel Yahudi hukuku kaynaðý (Halacha) içerisinde, Tevrat (hem yazýlý ve sözlü olarak) ölüm tespitini açýk olarak tanýmlamamaktadýr. Misnah Oholot 1: 6 ve Gamara Hullin 21a Talmudi yorumlarýnýn ölüm tespiti için nörolojik bir yöntemin bazý durumlarda kabul edilebilir olduðunu önermesine raðmen, mitzvot d'rabbanan (hamamlar tarafýndan düzenlenen dini esaslar) sadece kardiyorespiratuvar kriterleri kabul eder, dolayýsýyla DDNC’yi reddeder. Son olarak, Katolik kilisesinin Canon hukukunda, Kutsal Kitap, Ýncil’in Eski Ahit’inde (yazýlý Tevrat) ve Yeni Ahit’te (Ýncil) kaydedildiði haliyle, ölüm tespiti için bir kriter tanýmlamamaktadýr. Aziz Thomas’ýn entegrasyonun kaybý (loss of integration) görüþü Katolik Kilisesinde Viyana Konsili’nden (M.S. 1312) bu yana hakimiyetini korumuþtur. Papa John Paul II ve Benedict XVI’in ortaya koyduðu sonraki kararlar DDNC’nin dikkatli bir þekilde kullanýlmasýný kabul etmiþtir. Dolayýsýyla, her üç inançta da DDNC’yi reddeden fikirler olmasýna raðmen DDNC birçok Müslüman ve Katolik tarafýndan ölüm tespitinde geçerli bir kriter olarak kabul edilirken Yahudilik tarafýndan reddedilmiþtir.

Traditional criteria to identify death may not fit all circumstances. This manuscript explores religious jurisprudence to ascertain whether death declaration by neurological criteria (DDNC) is accepted as a valid by 3 Abrahamic faith traditions: Islam, Judaism, and Catholicism. Among Islamic sources (order of primacy), neither the Qur’an, Sunnah as reported in Ḥadīth, Ijmā’ (scholarly consensus), nor Qiyas (precedent-based analogy) clearly describe death determination criteria. Through Ijtihad (lowest level of Sharīʿah), 5 of 6 non-binding fatwā support DDNC. Faith-based medical organizations are divided. Eleven of 13 surveyed Muslim-majority countries have laws supporting DDNC. Concern exists that premature death declaration could violate the Sharīʿah concept of Hifz-An-nafs (saving life). As such, DDNC remains debated in Islamic circles. Among the 3 main sources of Jewish law (Halacha), the Torah (oral and written) does not clearly define death declaration criteria. Despite Talmudic interpretations of Misnah Oholot 1: 6 and Gamara Ḥullin 21a suggest a possible justification for death determination using neurologic criteria, the bulk of mitzvot d'rabbanan (Rabbinic Law) rejects DDNC and adheres to cardiorespiratory criteria. Lastly, Catholic Church Cannon Law and the Holy Scripture recorded in Bible does not define death determination criteria. Following the Council of Vienne, Saint Thomas’s loss of integration view has predominated. Subsequent declarations by Popes John Paul II and Benedict XVI have cautiously accepted DDNC. Despite dissenting opinions in each faith, DDNC is currently accepted as valid by many Muslims and Catholics, while rejected by Judaism.

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Gitelman sendromu nadir görülen, otozomal resesif kalýtýlan, hipomagnezemi ve hipokalsiüri ile birlikte hipokalemik metabolik alkalozla karakterize bir renal tübülopatidir. Gitelman sendromu tanýsý genellikle adolesan dönemde konulmakla birlikte çocukluk hatta eriþkin dönemde bile gözlenmektedir. Biz bu vaka raporunda kas güçsüzlüðü, kramp ve halsizlik semptomlarý ile hastaneye baþvuran ve Gitelman sendromu tanýsý konan 19 yaþýndaki erkek hastayý sunduk.

Gitelman syndrome is a rare renal tubulopathy characterized by inherited autosomal recessive, hypokalemic metabolic alkalosis with hypomagnesemia and hypocalciuria. The diagnosis of Gitelman syndrome is usually established during adolescence, but is also observed in childhood and even in the adulthood period. In this case report, we presented a 19-year-old male patient who was diagnosed as Gitelman Syndrome and admitted to the hospital with symptoms of muscle weakness, cramps and weakness.

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Ýþitsel Nöropati Spektrum Bozukluðu (ÝNSB) normal dýþ tüy hücre fonksiyonuna ragmen afferent iþitsel yollarda senkronizasyonun kesintiye uðramasýyla tanýmlanan bir iþitme problemidir. Birçok gen mutasyonu ÝNSB’ye neden olabilir ve bazý vakalarda ek patolojiler gözlenebilir. CAPOS (serebellar ataksi, arefleksi, pes kavus, optik atrofi ve sensorinöral iþitme kaybý) sendromunda sensorinöral iþitme kaybý ÝNSB ile kendini gösterir ve odyolojik rehabilitasyonla ilgili sonuçlar literatürde yeterince açýklanmamýþtýr. Bu çalýþmada CAPOS sendromu ve ÝNSB’si olan koklear implant kullanýcýsý bir hasta sunulmuþtur. 14 yaþýnda kýz hasta ÝNSB ve CAPOS sendromuyla tanýlanmýþtýr. Bir yýl süren takibin ardýndan unilateral koklear implant kullanmaya baþlamýþtýr. Koklear implant sonrasýnda hastanýn iþitme eþiklerinde ve konuþmayý algýlama performansýnda belirgin derecede iyileþme gözlenmiþtir. Ayrýca Müzik Algýsýnýn Klinik Deðerlendirmesi Testinin Türkçe versiyonunda müzik algýsý performasýnýn yüksek olduðu görülmüþtür. Detaylý odyolojik deðerlendirmeler sonrasýnda CAPOS sendromu ve ÝNSB’si olan hastalar için koklear implant iyi bir seçenek olabilir.

Auditory neuropathy spectrum disorder (ANSD) is a hearing disorder which characterized with normal outer hair cell function but disrupted neural synchrony in the afferent auditory pathway. CAPOS (cerebellar ataxia, areflexia, pes cavus, optic atrophy, and sensorineural hearing loss) syndrome can manifest itself with ANSD and this rare situation and audiological rehabilitation outcomes have not well documented in the literature. We aim to present a cochlear implant user subject with CAPOS syndrome and ANSD. A 14-year-old girl diagnosed with ANSD and CAPOS syndrome. She received unilateral cochlear implant (CI). Her hearing sensitivity and speech perception abilities have been improved with CI. Also, she has a good music perception ability measured with the Turkish version of Clinical Assessment of Music Perception Test. After detailed audiological evaluations, CI could be a good option for patients who have ANSD and CAPOS syndrome.

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Oropharynx glial heterotopia is a congenital anomaly, whereby ectopic mature glial tissue is found around oropharynx isolated from the brain and spinal cord. Herein we report a rare presentation of a mass at the base of tongue in a neonate. In addition to underscore the rarity of oropharynx glial heterotopia, we discuss the dilemma in approaching its diagnosis and management in a neonate.

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Çocuk popülasyonda trakeobronþial kýkýrdak kalsifikasyonu çok sýk görülmeyen bir bulgudur. Keutel sendromu (OMIM 245150) astým benzeri ataklar ve tekrarlayan alt solunum yolu enfeksiyonlarý ile birlikte diffüz kýkýrdak kalsifikasyonu, brakiotelofalanji, orta hat defektleri, iþitme kaybý ile karakterize nadir görülen bir sendromdur. Biz burada astým tanýsýyla takip edilen ancak astým tedavilerine yanýtsýz 14 yaþýnda bir olgu sunuyoruz. Bu hasta trakeobronþial aðaç ve aurikulada kalsifikasyon, atipik yüz görünümü, tekrarlayan otitis media, iþitme kaybý ve tekrarlayan astým benzeri ataklar ile Keutel sendromu tanýsý aldý.

Tracheobronchial cartilage calcification is a very uncommon finding in pediatric population. Keutel Syndrome (OMIM 245150) is a very rare syndrome characterized by diffuse calcification of the cartilages, brachitelephalangia, pulmonary stenosis, mid-line defects, stippled epiphysis in infancy and hearing loss accompanied by recurrent respiratory infections and asthma-like attacks. Here, we present a 14 year old patient previously diagnosed as asthma, didn't relieve with appropriate asthma treatment and diagnosed with Keutel Syndrome with cartilage calcification on tracheobranchial tree and auricula, atypical facial features, recurrent otitis, asthma-like symptoms and hearing loss.

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