Kolesistoduodenal, kolesistogastrik veya daha nadir olarak koledokoduodenal fistülden geçen safra taþýnýn mide distalinde veya proksimal duodenumda neden olduðu gastrik çýkýþ obstüksiyonu Bouveret sendromu olarak adlandýrýlýr. Bouveret sendromu safra taþý ileusu olan hastalarýn %1-3'ünde görülür. Her ne kadar elektrohidrolitotripsi, lazer, ekstrakorporeal þok dalgasý litotripsisi gibi yeni cihazlarla ve snare-forseps gibi klasik endoskopik cihazlarla safra taþlarýnýn çýkarýlmasý veya parçalanmasý gibi tedavi modaliteleri tanýmlanmýþsada, hastalarýn sadece %29'u cerrahi dýþý yöntemlerden yararlanmaktadýr. Taþýn gastrotomi veya enterotomi ile çýkarýlmasý ek olarak kolesistektomi yapýlmasý, ikinci bir operasyonla da fistül onarýmý yapýlmasý komorbid hastalýðý olan yaþlý hastalar için önerilen bir yaklaþýmdýr. Bu yazýda bir Bouveret sendromu vakasý sunulmuþtur. Yazarlar ayný zamanda bu nadir hastalýðýn taný ve tedavisini gözden geçirmeyi ve bu konu ile ilgili literatür bilgilerini derlemeyi amaçlamýþtýr. (SETB-2018-04-054)

Gastric outlet obstruction that arises from gallstones impacted in the distal stomach or proximal duodenum after passing through a cholecystoduodenal, cholecystogastric or rarely choledocoduodenal fistula is called as Bouveret's syndrome and it accounts for approximately 1-3% of all the patients with gallstone ileus. Although treatment modalities, including stone removal or fragmentation with classical endoscopic devices, such as snares, and forceps or fragmentation of gallstones with new devices, such as electrohydraulic lithotripsy, laser, extracorporeal shockwave lithotripsy have been described. However, only 29% of the patients benefit from nonsurgical methods. Removal of the stone through a gastrotomy or enterotomy and performing cholecystectomy and fistula repair with a second operation is an approach recommended for older patients with comorbid diseases. In this paper, a case of Bouveret’s syndrome was presented. The authors also aimed to review the diagnosis, management and treatment of this rare disease and to update the previous reviews.

Adrenalektomi endikasyonlarý; malinite þüphesi veya malign tümörler, malinite riski olan non-fonksiyonel tümörler ve fonksiyonel adrenal tümörlerdir. Fonksiyonel tümörlerin boyutu ne olursa olsun, bunlarda cerrahi endikasyon vardýr. Fonksiyonel adrenal korteks kaynaklý olan tümörler; Cushing sendromunda fasikülata tabakasýndan kaynaklanan ve fazla glukokortikoid üreten adenomlar, Conn Sendromunda glomeruloza tabakasýndan kaynaklanan fazla aldesteron salgýlayan adenomlar ve adrenal medulla kaynaklý fazla katekolamin salgýlanmasýna neden olan feokromositomada adrenalektomi endikasyonu vardýr. Bazen hipofizer veya ektopik ACTH salgýlanmasýna baðlý Cushing hastalýðýnda bilateral adrenalektomi uygulamak gerekebilir. Nadiren fazla adrenal androjen ve östrojen salgýlayan adrenal korteksin retikülaris tabakasýndan kaynaklanan adenomlar da geliþebilir ve bunlarda da adrenalektomi endikasyonu vardýr. Adrenal cerrahi laparaskopik veya açýk teknikle uygulanabilir. Günümüzde seçilmiþ hastalarda laparoskopik adrenalektomi altýn standart tedavidir. Laparoskopik adrenalektomi transperitoneal veya retroperitoneoskopik olarak uygulanabilir. Her iki yaklaþýmýn birbirine göre avantaj ve dezavantajlarý vardýr. Ameliyat tipi seçiminde hasta özellikleri ile birlikte cerrahýn deneyimi ve alýþkanlýklarý da önemlidir. Dünyada en yaygýn uygulanan ameliyat tipi çoðu cerrahýn da daha aþina olduðu laparoskopik transabdominal lateral adrenalektomidir. Laparoskopik anterior transperitoneal yaklaþým, adrenalektomide en az tercih edilen laparoskopik yöntemdir. Retroperitoneal laparoskopik adrenalektomi posterior veya lateral yaklaþýmla uygulanabilir. Laparaskopik cerrahi konvansiyonel laparoskopi yanýnda robot yardýmlý olarak; transperitoneal veya retroperitoneal yolla uygulanabilir. Ayrýca konvansiyonel veya robot yardýmlý laparoskopik adrenalektomi transabdominal veya retroperitoneal olarak tek port yöntemiyle de uygulanabilmektedir. Günümüzde bilateral adrenal kitlelerde, multipl adrenal tümörlerin geliþme riski olan herediter hastalýklard, adrenalde soliter kitlelerde özellikle laparoskopik tekniklerle parsiyel adrenalektomi uygulanabilmektedir. Malignite veya malignite þüphesinde, büyük tümörlerde, laparoskopik cerrahinin kontraendike olduðunda açýk cerrahi endikasyon vardýr. Ayrýca laparoskopik cerrahide yaklaþýk %5 oranýnda açýða dönme riski vardýr. Özellikle malign veya malignite þüphesi olan büyük tümörlerde açýk transperitoneal anterior yaklaþým en sýk uygulanan açýk giriþimdir. Bu giriþim orta hat insizyonu, bilateral veya unilateral subkostal insizyon, Makuuchi veya modifiye Makuuchi insizyon ile uygulanabilir. Özellikle büyük malign lezyonlarýn blok olarak çýkarýlmasýnda torakoabdominal insizyon yapýlmasý gerekebilir. Açýk retroperitoneal yaklaþým posterior veya lateral yolla uygulanabilir. (SETB-2019-12-157)

Indications for adrenalectomy are malignancy suspicion or malignant tumors, non-functional tumors with the risk of malignancy and functional adrenal tumors. Regardless of the size of functional tumors, they have surgical indications. The hormone-secreting adrenal tumors in which adrenalectomy is indicated are as follows: Cushing’s syndrome, arises from hypersecretion of glucocorticoids produced in fasciculata adrenal cortex, Conn’s syndrome, arises from an hypersecretion of aldosterone produced by glomerulosa adrenal cortex, and Pheochromocytomas that arise from adrenal medulla and produce catecholamines. Sometimes, bilateral adrenalectomy may be required in Cushing's disease due to pituitary or ectopic ACTH secretion. Adenomas arise from the reticularis layer of the adrenal cortex, which rarely releases too much adrenal androgen and estrogen, may also develop and have an indication for adrenalectomy. Adrenal surgery can be performed by laparoscopic or open technique. Today, laparoscopic adrenalectomy is the gold standard treatment in selected patients. Laparoscopic adrenalectomy can be performed transperitoneally or retroperitoneoscopically. Both approaches have their advantages and disadvantages. In the selection of the surgery type, the experience and habits of the surgeon are also important, along with the patient’s characteristics. The most common type of surgery performed in the world is laparoscopic transabdominal lateral adrenalectomy, which most surgeons are more familiar with. The laparoscopic anterior transperitoneal approach is the least preferred laparoscopic method in adrenalectomy. Retroperitoneal laparoscopic adrenalectomy can be performed with a posterior or lateral approach. In addition to conventional laparoscopy, laparoscopic surgery is robot-assisted, which can be administered by transperitoneal or retroperitoneal approach. In addition, conventional or robot-assisted laparoscopic adrenalectomy can be performed transabdominally or retroperitoneally using the single-port method. Today, partial adrenalectomy can be performed using laparoscopic techniques in bilateral adrenal masses, hereditary diseases with the risk of developing multiple adrenal tumors, and solitary masses of the adrenal gland. Open surgery is indicated in the case of malignancy or suspected malignancy and large tumors when laparoscopic surgery is contraindicated. The risk of conversion to open surgery is low (approximately 5%). The open transperitoneal anterior approach is the most common open intervention, especially in large tumors with malignancy or suspected malignancy. This procedure can be performed using a midline incision, bilateral or unilateral subcostal incision, Makuuchi or modified Makuuchi incision. Thoracoabdominal incision may be required, especially in the removal of large malignant lesions as a block. The open retroperitoneal approach can be applied posteriorly or laterally.

Amaç: Fýtýk geliþimini önlemek için insizyon tipinin seçimi, insizyonun kapatýlma þekli ve kullanýlan sütür materyali önemli faktörlerdir. Amacýmýz en az nükse yol açacak en iyi yöntemi, en iyi teknikle uygulamak olmalýdýr. Cerrahi seçenekler arasýnda, primer onarým ve mesh ile açýk veya laparoskopik onarým yer alýr. Meshli onarým meshin tespit edileceði alana göre onlay, sublay veya inlay olarak yapýlabilir.
Bu retrospektif çalýþmada, insizyonel herni nedeniyle onlay veya inlay teknik ile herni tamiri yapýlan hastalarda ki nüks oranýný karþýlaþtýrmayý amaçladýk.
Metod: Ocak 2012- Ekim 2017 tarihleri arasýnda, kliniðimizde insizyonel herni nedeni ile opere ettiðimiz 185 hastanýn çalýþmaya dahil edildiði retrospektif bir çalýþmadýr.
Hastalarý onlay herni tamiri yapýlanlar (Grup 1) ve inlay herni tamiri yapýlanlar (Grup 2) olmak üzere iki gruba ayýrdýk. Her iki grupta da ayný özellikte (prolen) mesh kullanýlmýþtýr.
Bulgular: Grup 1’de 121, Grup 2’de 64 hasta mevcut idi. Verilere göre, hastalarýn %64.3'ü kadýn, tüm hastalarýn yaþ ortalamasý 58.4 ± 16.4 yýldý.
Hastalarýn %29.2’sinde postoperatif komplikasyon (seroma-hematom, cerrahi alan enfeksiyonu, yama rejeksiyonu, postoperatif ileus gibi) geliþti. Hastanede yatýþ süresi Grup 1'de 4,2 ± 3 gün ve Grup 2'de 5,6 ± 5 gündü. Ortalama izlem süresi 48.6 ay (24-93 ay) olup, nüks oranlarý Grup 1'de %5.8 (n: 7) ve Grup 2'de %10.9 (n: 7) idi. Gruplar arasýnda komorbidite, postoperatif komplikasyon, yatýþ süresi ve nüks açýsýndan istatistiksel olarak anlamlý farklýlýk gözlendi.
Sonuç: Biz inanýyoruz ki, eðer sadece prolen mesh kullanýyorsak, onlay teknik inlay tekniðe göre daha uygun olacaktýr, çünkü inlay teknik de nüks oraný daha yüksektir. (SETB-2019-10-131)

Objectives: The selection of incision type, closure type of incision and the suture material are some of the important factors to prevent hernia development. We should aim to perform the best procedure with the best technique to reduce the risk of recurrence. Surgical options include primary repair and open or laparoscopic repair with mesh. Mesh repairs can be performed as onlay, sublay or inlay according to the area where the mesh is to be laid. In this retrospective study, our main goal was to compare the recurrence rates in patients who underwent incisional hernia repair with onlay and inlay mesh techniques.
Methods: This retrospective study included 185 patients who underwent surgery due to incisional hernia in our clinic between January 2012 and October 2017. Patients were divided into two groups according to the technique as Group 1 with onlay mesh repair and Group 2 with inlay mesh repair. The same type of mesh (prolen) was applied to all patients.
Results: There were 121 patients in Group 1 and 64 patients in Group 2. According to data we obtained, 64.3% of the patients were women and the mean age of all patients was 58.4±16.4 years. Postoperative complications (such as seroma-hematoma, surgical site infection, mesh rejection, postoperative ileus) developed in 29.2% (n=54) of the patients. The length of hospital stay was 4.2±3 days in Group 1 and 5.6±5 days in Group 2. The mean follow-up period was 48.6 months (24-93 months), with the recurrence rates of 5.8% (n=7) in Group 1 and 10.9% (n=7) in Group 2, respectively. There was a statistically significant difference between the groups concerning comorbidity, postoperative complications, the length of hospitalization stay and recurrence.
Conclusion: We believe that the onlay technique will be more appropriate than the inlay technique when only prolen mesh is preferred because the recurrence rates are higher in the inlay technique.

Amaç: Çalýþmamýzda ampirik lansoprozol tedavisinin laringofaringeal reflü (LFR) semptomlarý ve endoskopik larinks bulgularý ile gastroözofageal reflü (GÖR) semptomlarý üzerine etkinliði araþtýrýlmýþtýr.
Yöntem ve Gereçler: Çalýþmamýzda LFR ile iliþkili semptomlarý olan 67 olgu prospektif olarak incelenmiþtir. Hastalarýn þikayetleri boðaz aðrýsý, boðaz yanmasý, balgam çýkarma, postnazal akýntý, boðaz temizleme ihtiyacý, disfoni, vokal yorgunluk, öksürük, globus hissi, disfaji ve halitosis semptomlarýný içeren 11 soruluk LFR semptom skorlamasý anketi ile deðerlendirildi. GÖR yakýnmalarý ise 12 soruluk GSFS (Gastroözofageal reflü hastalýðý semptomlarýnýn frekans skalasý) anketi kullanýlarak sorgulandý. Larinks bulgularý 70° endoskop ile posterior larinks, interaritenoid bölge ve aritenoidler ayrý ayrý olarak ödem, eritem ve noduler görünüm açýsýndan deðerlendirildi. Bütün semptom ve bulgular en hafiften þiddetliye doðru derecelendirilip skorlandýrýlmýþtýr. Hastalara 1 aylýk günde tek doz 30 mg lansoprozol tedavisi uygulandýktan sonra LFR ve GÖR semptomlarý ile larinks bulgularý tekrar deðerlendirildi. Tedavi öncesi ve sonrasý veriler istatistiksel olarak karþýlaþtýrýldý.
Bulgular: LFR semptom skorlarýnýn tamamýnda ve GSFS skorlarýnýn toplamýnda tedavi sonrasý anlamlý azalma saptanmýþtýr. Endoskopik larinks bulgularýndan posterior larinks, interaritenoid bölge ve aritenoidler üzerindeki nodüler görünümde tedavi ile istatistiksel olarak anlamlý þekilde iyileþme görülmüþtür. Her üç bölgedeki eritemde tedavi ile düzelme saptanmamýþtýr.Posterior larinks ve interaritenoid bölge ödeminde istatistiksel olarak anlamlý gerileme saptanmýþtýr. Aritenoid ödeminde ise anlamlý iyileþme görülmemiþtir.
Sonuç: Kýsa süreli antireflü tedavisi LFR semptomlarýnýn tamamýnda, GÖR semptomlarýnýn büyük bir kýsmýnda düzelme saðlamasýna raðmen reflünün larinks bulgularý üzerinde tam iyileþme saðlayamamýþtýr. Bulgular üzerinde daha belirgin iyileþme için uzun süreli tedavi etkinliðinin araþtýrýlmasý gerekmektedir.

Objectives: This study aims to investigate the effects of empiric lansoprazol therapy on laryngopharyngeal (LPR) and gastroesophageal (GOR) reflux symptoms and laryngological findings.
Methods: Sixty-seven patients with suspected LPR related symptoms were prospectively analyzed in this study. Following eleven symptoms were asked to patients using LPR symptom questionnaire; sore throat, throat burning, throat clearing, globus sensation, cough, halitosis, dysphonia, dysphagia, postnasal dripping, vocal fatigue and sputum. GOR symptoms were evaluated with the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) questionnaire consist of twelve symptoms. Posterior larynx, arytenoids and interarytenoid area were evaluated with a 70° endoscope. Erythema, edema and nodularity were graded separately using 4 point severity scale to examine laryngeal signs. All patients were treated using 30 mg lansoprazole once daily for four weeks. After the end of medication, symptoms and laryngoscopic signs were evaluated again with the same method. The pretreatment and posttreatment values were compared with statistical analyses.
Results: There was a statistically significant decrease in LPR symptom scores and total scores of FSSG. The severity of nodularity in the posterior larynx, arytenoids and interarytenoid area was improved after treatment. There was no statistically significant difference in erythema on each area larynx. Edema in the posterior larynx and interarytenoid area was improved but there was no change on the edema of arytenoids.
Conclusion: A short period of empiric antireflux treatment has a significant improving effect on all LPR symptoms and most of GOR symptoms. However, it was insufficient on laryngeal signs. Further research is needed to investigate longer times of treatment for the complete resolution of symptoms and signs.

Amaç: Obezite sýklýðý ve buna baðlý yandaþ hastalýklar günümüzde hýzla ve yükselen oranda artmaktadýr. Laparoskopik sleeve gastrektomi günümüzde dünya genelinde en sýk uygulanan bariatrik cerrahi olarak yerini almýþtýr. Özellikle tip2 diyabet hastalarýnda tedavide en etkin tedavi yöntemlerinden biridir. Bu çalýþmanýn amacý laparoskopik sleeve gastrektomiyi takiben hastalarda glukoz metabolizmasý üzerindeki etkilerini incelemektir.
Gereç ve Yöntemler: Bu çalýþmada Mart 2013 ile Eylül 2019 tarihleri arasýnda vücut kitle indeksi 35kg/m2 den küçük olan ve laparoskopik sleeve gastrektomi uygulanan 174 hastanýn dosyalarý geriye dönük olarak incelendi. Hastalar ameliyat öncesi dönemde multidisipliner bir ekip tarafýndan deðerlendirildi. Laparoskopik sleeve gastrektomiye uygun kriterleri saðlayan hastalar Amerikan Metabolik ve Bariatrik Cerrahlar Birliði kriterlerine göre ameliyata alýndý. Demografik veriler, vücut kitle indeksi, insülin, glikozillenmiþ hemoglobin (HbA1c), glukoz, homeostaz modeli insülin direnci (HOMA-IR) deðerleri kaydedildi. Hastalar ameliyat sonrasý 1-3-6 ve 12. aylarda ve sonrasýnda yýllýk olarak planlanan poliklinik ziyaretleri ile takip edildi.
Bulgular: Laparoskopik sleeve gastrektomi uygulanan 174 hastanýn ortalama yaþý 39,57±9,40, ortalama vücut kitle indeksi 32,70±2,65 idi. 149 hasta (%85,6) kadýndý. Hastane yatýþý ortalama 3,1±0,7 gün idi. Hastalarýn glukoz, HbA1c, HOMAR-IR ve insülin deðerlerine bakýldýðýnda 12 aylýk izlemde düþüþün istatistiksel olarak anlamlý olduðu izlendi. Ameliyat öncesi dönemle karþýlaþtýrýldýðýnda vücut kitle indeksinde de anlamlý bir düþüþ izlendi.
Sonuçlar: Laparoskopik sleeve gastrektomi vücut kitle indeksi 30-35kg/m2 olan hastalarda glukoz metabolizmasý üzerine etkili bir ameliyattýr. (SETB-2019-10-127)

Objectives: The prevalence of obesity and its associated comorbidities are increasing all over the world. Laparoscopic sleeve gastrectomy has become the most common bariatric surgery in the world today, especially in the treatment of Type 2 diabetes mellitus, which is one of the effective surgical methods. The present study aims to investigate the effects on glucose metabolism in patients following laparoscopic sleeve gastrectomy.
Methods: In this study, the files of 174 patients who had laparoscopic sleeve gastrectomy with a body mass index between 30-35kg/m2 between March 2013 and September 2019 were analyzed retrospectively. Patients were evaluated by a multidisciplinary team in the preoperative period. Patients who met the criteria for laparoscopic sleeve gastrectomy were operated according to American Metabolic and Bariatric Surgeons criteria. Demographic data, body mass index, insulin, glycosylated hemoglobin (HbA1c), glucose, homeostasis model insulin resistance (HOMA-IR) values were recorded. The patients were followed up with visits to the outpatient clinic scheduled for 1-3-6 and 12 months postoperatively.
Results: The mean age of the 174 patients who underwent laparoscopic sleeve gastrectomy was 39.57±9.40, and the mean body mass index was 32.70±2.65. 149 patients (85.6%) were female. The mean hospital stay was 3.1±0.7 days. When glucose, HbA1c, HOMAR-IR and insulin values of the patients were examined, it was observed that the decrease was statistically significant at 12 months follow-up. There was a significant decrease in body mass index compared to the preoperative period.
Conclusion: Laparoscopic sleeve gastrectomy is an effective surgery on glucose metabolism in patients with a body mass index of 30-35kg/m2.

Amaç: Tip 2 Diabetes Mellitus (DM)’un hafif biliþsel bozukluk (HBB), Alzheimer hastalýðý ve vasküler demans için bir risk faktörü oluþturduðu bilinmektedir. Ancak Tip 2 DM’nin kognitif fonksiyonlarda bozulmaya öncelikle hangi patofizyolojik mekanizmalarla yol açmaya baþladýðý ve bu bozulmanýn DM’nin hangi döneminde baþladýðý henüz bilinmemektedir. Bu çalýþmanýn amacý diabetik polinöropatili hastalarýn biliþsel iþlevlerini, polinöropati saptanmayan kontroller ile, Standardize Mini Mental Test (SMMT) ve Montreal Biliþsel Deðerlendirme Ölçeði (MOBÝD) kullanarak karþýlaþtýrmak ve polinöropati varlýðýnýn biliþsel bozukluk geliþiminde öngörücü bir faktör olup olmayacaðýný deðerlendirmektir.
Gereç ve yöntem: Merkezimiz EMG laboratuvarýna polinöropati ön tanýsý ile Ocak 2014 ve Ocak 2015 tarihleri arasýnda yönlendirilen Tip 2 DM tanýlý hastalar çalýþmaya dahil edildi. Elektrofizyolojik incelemeleri yapýlan hastalar polinöropati varlýðý açýsýndan deðerlendirildi. Polinöropati bulgularý saptananlar hasta grubunu, polinöropati saptanmayanlar ise kontrol grubunu oluþturdu. Tüm olgulara SMMT ve MOBÝD uygulandý. Çalýþmaya alýnan hastalarýn demografik verileri, eðitim süreleri kaydedildi. Hipertansiyon, koroner arter hastalýðý varlýðý sorgulandý. Þikayetleri, hastalýk süreleri, almakta olduklarý tedaviler sorgulandý, son 3 ay içindeki glikozile hemoglobin (HBA1C) deðerleri ve muayene bulgularý kaydedildi. Hasta ve kontrol grubu istatistiksel yöntemlerle kýyaslandý.
Bulgular: Çalýþmamýza dahil olan 81 hastanýn 34’ünde(%42) elektrofizyolojik olarak polinöropati varlýðý gösterilmiþtir. Polinöropati saptanan grupta, polinöropati saptanmayan gruba kýyasla yaþ, hastalýk süresi, HBA1C ortalamalarý daha yüksekti (sýrasýyla; p=0,024, p=0,000, p=0,016). Ancak iki grubun SMMT ve MOBÝD puanlarý arasýnda istatistiksel anlamlý farklýlýk saptanmadý. Her iki grupta da SMMT kesme deðeri 24’ün altýnda puan alan hasta saptanmadý. Polinöropatili gruptaki 34 hastadan 17’sinin(%50), kontrol gruptaki 47 hastadan 19’unun(%40,4) MOBÝD kesme deðeri 21’in altýnda puanlar aldýðý görüldü. Ýki grup arasýnda istatistiksel anlamlý farklýlýk saptanmadý. Tüm DM hastalarýnýn ortalama MOBÝD deðeri MOBÝD kesme deðeri olan 21 olarak tespit edildi. Ayrýca tüm Tip 2 DM hastalarýnda biliþsel bozukluðu etkileyen faktörler lojistik regresyon analizi ile deðerlendirildiðinde eðitim süresinin biliþsel bozukluðu etkileyen baðýmsýz faktör olduðu saptandý (OR=8,167; p=0,001).
Sonuç: Çalýþmamýzda, polinöropatisi olan ve olmayan Tip 2 DM hastalarýnýn SMMT ve MOBÝD ile deðerlendirilen biliþsel test skorlarý arasýnda istatistiksel anlamlý fark saptanmamýþtýr. Ancak çalýþmamýzýn kesitsel olmasý bu konuda yorum yapmamýza engeldir. Polinöropati varlýðýnýn Tip 2 DM’de biliþsel bozukluk geliþiminde öngörücü faktör olup olmayacaðýný aydýnlatabilmek için daha geniþ örneklem grubuna sahip ve uzun erimli izlem çalýþmalarýna ihtiyaç vardýr. Ayrýca periferik nörolojik tutulum bulgularý izlenmese de, Tip 2 DM’li hastalarda MOBÝD kesme deðerine göre düþük skorlar saptanabileceði ve Tip 2 DM popülasyonunda MOBÝD’in eðitim düzeyinden etkilenebileceði gösterilmiþtir.

Objectives: Type 2 Diabetes Mellitus (DM) is a risk factor for mild cognitive impairment (MCI), Alzheimer's disease and vascular dementia. However, it is not known which pathophysiological mechanisms lead to impairment in cognitive functions in Type 2 DM. This study aims to compare the cognitive functions of diabetic patients with and without polyneuropathy using standardized Mini-Mental Test (MMSE) and the Montreal Cognitive Assessment Scale (MoCA) and to assess whether the presence of polyneuropathy is a predictive factor for the development of cognitive impairment.
Methods: Patients with DM who underwent our EMG laboratory for polyneuropathy between January 2014 and January 2015 were included in this study. Patients who underwent electrophysiological examinations were evaluated for polyneuropathy. Patients with polyneuropathy were classified as a patient group and other patients as a control group. In all cases, MMSE and MoCA were administered. The demographic data and educational status of the patients were recorded. Hypertension, coronary artery disease, smoking and alcohol use were questioned. Their complaints, duration of illness and the treatment they were receiving were questioned. Glycosylated hemoglobin (HBA1C) values in the last three months and physical examination findings of patients were recorded. Patients with and without polyneuropathy were compared with statistical methods.
Results: Polyneuropathy was detected in 34 (42%) of the 81 patients who participated in our study. The age, disease duration and HBA1C levels were statistically higher in the polyneuropathy group than in the control group (p=0.024, p=0.000, p=0.016). However, there was no statistically significant difference between MMSE and MoCA scores of these groups. In both groups, there were no patients scoring below the MMSE cut-off value of 24. Seventeen of the 34 patients (50%) in the polyneuropathic group and 19 (40,4%) of the 47 patients in the control group had scores below the MoCA cut-off value 21. However, there was no statistically significant difference between the two groups. We also found that the mean MoCA value of all DM patients was 21, which was the MoCA cut-off value. Also, factors affecting cognitive functions in all Type 2 DM patients were evaluated by logistic regression analysis, and it was found that duration of education was an independent factor affecting cognitive impairment (OR=8.167; p=0.001).
Conclusion: In our study, we did not observe significant differences between MMSE and MoCA scores of Type 2 DM patients with and without polyneuropathy. However, the cross-sectional nature of our study makes it impossible to comment on this issue. To clarify whether the presence of polyneuropathy is a predictive factor in the development of cognitive impairment in Type 2 DM, there is a need for a larger sample group and long-term follow-up studies. It has also been shown that patients with Type 2 DM may have low scores according to the MOBID cut-off value even though peripheral neurologic involvement findings are not observed. In the Type 2 DM population, it has also been shown that MoCA may be affected by education level.

Amaç: Bilgisayarlý Tomografi klavuzluðunda yapýlan kalýn iðne biyopsisinin akciðer kitlelerinin histopatolojik tanýsýnda önemli bir rolü vardýr. Bu çalýþmanýn amacý, kliniðimizde akciðer kitlelerine yönelik bilgisayarlý tomografi kýlavuzluðunda yaptýðýmýz perkütan kalýn iðne biyopsi sonuçlarýmýzý paylaþmaktýr.
Yöntem: Kurumumuzda toplam 117 hastanýn akciðer kitlelerine yönelik Bilgisayarlý Tomografi klavuzluðunda perkütan yolla kalýn iðne biyopsisi yapýldý. Ýþlem sonrasý komplikasyon ve tanýsal yeterlilik oranlarý ve radyolojik-patolojik tanýsal korelasyon retrospektif olarak deðerlendirildi.
Bulgular: Hastalarýn 23’inde (% 20) komplikasyon (20 (%17) pnömotoraks; 3 (%3) kanama) meydana geldi; 5'sinde (toplam hasta sayýsýnýn %4’sý) göðüs tüpü takýlmasý gerekti. Komplikasyon oranlarý ile hasta cinsiyeti / yaþý, tümör hacmi / lokalizasyonu veya iðne hattý uzunluðu arasýnda anlamlý fark bulunmadý (p> 0.05). Toplamda 85 primer akciðer kanseri vakasýnýn 77'sinde (% 91) radyo-patolojik taný sonuçlarý tutarlýydý.
Sonuç: Bilgisayarlý Tomografi klavuzluðunda yapýlan kalýn iðne biyopsisi akciðer kitlelerinin tanýsýnda kabul edilebilir komplikasyon oranlarý ile yüksek tanýsal deðere sahiptir. (SETB-2019-10-133)

Objectives: Computed tomography-guided core needle biopsy has an important role in the accurate histopathological diagnosis of lung masses. The present study aims to share our results of computed tomography-guided percutaneous core needle biopsy of lung masses.
Methods: A total of 117 patients had computed tomography-guided percutaneous core needle biopsy for lung masses between January 2017-September 2019 in our institution. In this study, these patients’ post-procedural complications, diagnostic-yield-rates and radiological-histopathological correlations were evaluated retrospectively.
Results: Complications occurred in 23 (20%) patients (20 (17%) of pneumothorax; 3 (3%) of hemorrhage). Chest-tube-drainage was needed in five (4%) of all patients. No significant difference was found between complication rates and patient gender/age, tumor volume/localization or needle-path-length (p>0.05). In 77 of the 85 (91%) primary-lung-cancer-cases radiological and pathological diagnostic results were correlated.
Conclusion: Computed tomography-guided core needle biopsy has a high diagnostic yield rate with acceptable complication rates in the diagnosis of lung masses.

Amaç: Günümüzde, laparoskopik adrenalektomi adrenal bezlerde kitlesi olan uygun hastalar için altýn standart tekniktir. Bu çalýþmada laparoskopik adrenalektomi uygulanmýþ hastalarýn postoperatif sonuçlarýný deðerlendirmeyi amaçladýk.
Metod: Ocak 2014 ile Ekim 2019 yýllarý arasýnda opere edilen 76 hasta retrospektif olarak deðerlendirildi. Bu hastalara laparoskopik transabdominal adrenalektomi uygulandý. Demografik bilgileri, preoperatif endikasyonlarý, intraoperatif ve postoperatif komplikasyonlarý, mortalite ve hastanede yatýþ süreleri deðerlendirildi.
Bulgular: Ortalama yaþlarý 47.2±11.7 (22-71 arasýnda) olan 76 hastaya (30 erkek, 46 kadýn) laparoskopik adrenalektomi uygulandý. Kitleler hastalarýn 39'unda saðda, 33'ünde solda idi. 3 hastada bilateral adrenal kortikal hiperplazi mevcuttu. 1 hasta ise paraganglioma nedeniyle opere edildi. Açýk operasyona dönüþ 4 hastada(%5,26) gerçekleþti. 9 hastada(%11,8) intraoperatif ve postoperatif komplikasyonlar görüldü. Operasyon esnasýnda ve sonrasýndaki komplikasyonlar dalaktan kanama(2 vaka), böbrek üst polden kanama(1 vaka), renal arter yaralanmasý(1 vaka), karaciðer parankiminden kanama (2 vaka), dalak ve pankreasta iskemi(1 vaka), ince baðýrsak yaralanmasý(1 vaka), insizyonel herni(1 vaka) þeklindeydi.Komplikasyon oranlarý, kabul edilebilir ve literatürdeki diðer çalýþmalarla uyumlu oranlarda izlendi.
Sonuç: Laparoskopik adrenalektomi düþük açýk operasyona dönüþ oranlarý ve kabul edilebilir komplikasyon oranlarý ile uygun hastalarda güvenli bir þekilde uygulanabilmektedir. (SETB-2019-12-148)

Objectives: Currently, laparoscopic adrenalectomy is the gold standard technique for suitable patients with adrenal masses. In this study, we aimed to assess the postoperative results of patients who underwent laparoscopic adrenalectomy.
Methods: Between January 2014 and October 2019, 76 cases were operated and retrospectively evaluated. Laparoscopic transabdominal adrenalectomy was applied to the patients. Demographic profiles, preoperative indications, intraoperative and postoperative complications, mortality and length of hospital stay were evaluated.
Results: Seventy-six patients (30 male, 46 female) with a mean age of 47.2±11.7 (range 22-71) years underwent laparoscopic adrenalectomy. Thirty-nine of the patients had right; 33 of the patients had left adrenal masses. Three patients had bilateral adrenal cortical hyperplasia. One patient was operated for paraganglioma. Conversion to open adrenalectomy was observed in four patients (5.26%). Nine patients (11.8%) experienced intraoperative and postoperative complications. Intraoperative and postoperative complications were bleeding from spleen (2 cases) and upper pole of kidney (1 case), renal artery injury (1 case), bleeding from liver parenchyma (2 cases), ischemia of spleen and pancreas (1 case), small intestinal injury (1 case) and incisional hernia (1 case). The complication rate is acceptable and comparable with other studies in the literature.
Conclusion: Laparoscopic adrenalectomy can be safely applied in suitable patients with acceptable complications and low conversion rates.

Amaç: Psoriasis, kronik, inflamatuar, immun aracýlý bir cilt hastalýðýdýr ve trombositler patofizyolojisinde rol oynadýðý bilinmektedir. Son yýllarda yapýlan çalýþmalarda MPV (ortalama trombosit hacmi), trombosit aktivasyonunun bir belirteci olarak kabul edilmektedir. Biz çalýþmamýzda psoriasis hastalarýnýn MPV ve trombosit düzeylerini, saðlýklý kontrol grubuyla karþýlaþtýrmayý ve bunu hastalýk þiddetiyle korele etmeyi amaçladýk.
Gereç ve Yöntem(ler): Yirmi sekiz psoriasis ve yaþ ve cinsiyet olarak eþlenmiþ 30 saðlýklý kontrol hastasýnýn dahil edildiði bir vaka-kontrol çalýþmasý dizayn ettik. Her iki grupta hematoloji parametreleri, sedimentasyon hýzýný ölçerek gruplarý arasýnda karþýlaþtýrdýk ve bu deðerleri ayrýca hasta grubunda PAÞÝ (Psoriasis Alan Þiddet Ýndeksi) skorlarýyla korelasyonunu deðerlendirdik. Ýstatistiksel analiz SPSS (Versiyon 15.0) kullanýlarak yapýldý. PAÞÝ ve diðer parametreler arasýndaki iliþki için Spearmen Korelasyon Analizi kullanýldý.
Bulgular: MPV ve trombosit sayýsý psoriasis grubunda saðlýklý kontrollere göre istatistiksel olarak anlamlý yüksekti (p=0,012, p=0,015). Ayrýca trombosit sayýsýyla PAÞÝ skorlarý arasýnda pozitif yönde istatistiksel olarak anlamlý iliþki saptandý(r=0,424, p=0,025). Sedimentasyon hýzý ise gruplar arasýnda farklý deðildi.
Sonuç(lar): Literatürde bildirilen psoriasis ile hematolojik parametrelerin iliþkisini ortaya koymaya yönelik çalýþmalarýn sonuçlarý, birbirleriyle çeliþkilidir. Biz MPV ve trombosit sayýsýný psoriasisli hastalarda yüksek saptadýk ve sonuçlarýmýz psoriasisin patogenezinde trombositlerin rol oynadýðýný destekler niteliktedir ve ileride tedavi sonuçlarýnýn takibinde kullanýlabilir.

Objectives: Psoriasis is a chronic inflammatory, immune-mediated disease, and platelets have an important role in the pathomechanisms of psoriasis. Recent studies showed that MPV (mean platelet volume) could be used as a marker of platelet activation. In this study, we aimed to investigate the MPV level and platelet count in psoriasis patients and its association with disease severity.
Methods: We designed a case-control study with 28 psoriasis patients and age and sex-matched 30 healthy controls. Haematologic parameters and sedimentation rates compared between groups. These parameters also correlated with PASI (Psoriasis Area and Severity Index) score.
Results: MPV and platelet count were significantly higher in patients with psoriasis than controls (p=0.012, p=0.015). Also, platelet count was showed positive correlation with PASI scores (r=0.424, p=0.025). The sedimentation rate was not statistically different between groups.
Conclusion: There are many conflicting results about the correlation of haematologic parameters and psoriasis. We found that MPV and platelet counts higher in the psoriasis group, which suggests that platelets play an important role in the pathomechanism of psoriasis and may be helpful in assessing treatment outcomes.

Amaç: Liken planus (LP) deri,mukoz membranlar,saçlý deri ve týrnaklarý etkileyen kronik inflamatuar bir hastalýktýr.Daha önce yapýlan çalýþmalarda diabetes mellitus ve dislipidemi prevelansý LP hastalarýnda daha yüksek saptanmýþtýr.Fakat bu çalýþmalarýn çoðu retrospektif ve geriye dönük lipid düþürücü ilaç kullanan hastalarýn dahil edildiði veritabaný taramasý þeklinde idi.Bu çalýþma LP ve dislipidemi iliþkisini incelemeyi hedefleyen prospektif bir vaka-kontrol çalýþmasýdýr.
Yöntem: Bu çalýþma 49 LP hastasý ve 99 saðlýklý kontrol üzerinde yapýlmýþtýr.Tüm hastalar klinik ve histopatolojik incelemeye,kontrol grubu ise klinik incelemeye tabi tutulmuþtur.Analiz edilen deðiþkenler yaþ,cinsiyet,sigara kullanýmý,hipertansiyon,lipid profilleri ve açlýk kan glikozudur.
Bulgular: Hasta grubunda serum trigliserit,total kolesterol ve LDL kolesterol düzeyleri daha yüksekti.Fakat,istatiksel olarak anlamlý fark saptanmadý.Hasta ve kontrol gruplarýnýn yaþ ortalamalarý,cinsiyet,sigara içiciliði ve hipertansiyon oranlarýnda anlamlý fark saptanmadý.
Sonuçlar: Bu prospektif vaka-kontrol çalýþmasý, ortalama lipit deðerlerinin LP hastalarýnda daha yüksek olduðunu ortaya koymuþtur.Ýstatiksel olarak anlamlý olmasa da; klinisyenler bu iliþkiden haberdar olmalý ve bu hastalarý dislipidemi için taramayý düþünmelidir.

Objectives: Lichen planus (LP) is a chronic inflammatory disease that affects the skin, mucous membranes, scalp and nails. It has been reported that diabetes mellitus and dyslipidemia prevalence were higher in patients with LP. However, most of these reports were retrospective, database search, which included patients who were on lipid-lowering drugs. This study aims to conduct a prospective case-control study to investigate the association between LP and dyslipidemia.
Methods: This study was conducted on 49 patients with LP (mucosal or cutaneous) and 99 healthy controls. All patients were subjected to clinical and histological examination, whereas controls were subjected to clinical examination. The variables analyzed were age, sex, tobacco consumption, hypertension, lipid profiles and fasting blood glucose.
Results: Serum levels of triglycerides, total cholesterol and LDL cholesterol were higher in patients with LP. However, there was no significant difference between patients with LP and controls. No significant differences between LP patients and controls were observed with the average age, sex, tobacco consumption and hypertension.
Conclusion: This prospective case-control study demonstrated that dyslipidemia was more common among patients with LP. Physicians should be aware of this association and consider screening them for dyslipidemia.

Amaç: Çalýþmada üst ekstremite yaralanmasý sebebiyle Plastik Rekonstrüktif ve Estetik Cerrahi Kliniðinde yatarak takip edilen hastalarýn demografik özellikleri, etiyolojik faktörleri, týbbi tanýlarý retrospektif olarak incelenerek bu hastalarýn ameliyat sonrasý ilk 24 saatte içinde yaþadýðý sorunlarýn belirlenmesi amaçlanmýþtýr.
Yöntem: Þiþli Hamidiye Etfal Eðitim Araþtýrma Hastanesi Plastik Rekonstrüktif ve Estetik Cerrahi Kliniðine üst ekstremite yaralanmasý nedeniyle baþvuran 82 hasta çalýþmaya alýnmýþtýr. Bu hastalar operasyon sonrasý ilk 24 saat içinde aðrý, bulantý, kusma, kanama, ajitasyon varlýðý, ödem, üst ekstremite immobilizasyonu gerekliliði, dolaþým problemleri þikayetleri açýsýndan retrospektif olarak incelenmiþtir.
Bulgular: Hastalarýn etiyolojik faktörleri incelendiðinde; 54 hastanýn kesici ve delici alet ile, 10 hastanýn cama yumruk atma nedeniyle, 15 hastanýn iþ kazasý sonucu, 2 hastanýn trafik kazasý sonucu ve 1 hastanýn da darp nedeniyle yaralandýðý tespit edilmiþtir.
Hastalarýn operasyon sonrasý yaþadýðý sorunlar arasýnda, hastada %45 oranda (n=36) aðrý, %7 oranýnda bulantý ve kusma(n=5), %14 oranýnda yara yerinden pansumaný kirletecek tarzda kanamalarýnýn olduðu (n=11) ve bütün hastalarýn üst ekstremitede immobilizasyonu saðlamak amacýyla alçý atel uygulandýðý, ödemi önlemek amacýyla kol elevasyonu yapýldýðý saptanmýþtýr. Ayrýca ilk 24 saatte %2 oranýnda ödem,%16 oranýnda aþýrý aðrýya baðlý ajitasyon, %8 oranýnda da ciltte ya da uzuvda dolaþým problemi yaþadýklarý saptanmýþtýr.
Sonuç olarak: Hastalarýn yaralanma tiplerini ve postoperatif yaþadýklarý sorunlarý kategorize etmek üst ekstremite yaralanmalarý sonrasý oluþabilecek postoperatif deðiþikliklerin kolay ve doðru yönetilmesini saðlayacaðýný düþünmekteyiz. (SETB-2018-03-042)

Objectives: In this study, we analyzed patients with upper extremity injuries concerning patient demographics, injury type and etiological factors, and the most common problems encountered during the first 24 hours that were noted in the retrospective analysis.
Methods: In this study, a total of 82 patients who presented to the emergency plastic surgery clinic in Þiþli Hamidiye Etfal Research and Training Hospital, postoperatively these patients were checked after surgery for first 24 hours concerning pain, nausea and vomiting, edema, agitation, arm immobilization arm and vascular patency.
Results: Among etiological factors, 54 patients were sharp-object trauma, 10 patients punched a hard object, 15 patients had work hazard, two patients had traffic accident, one patient from the fight. When these patients were postoperatively analyzed, in 45% patients pain, in 7% nausea and in 14 % bleeding were observed. Plaster was placed in 100% of the patients in order and their arms were elevated to reduce edema. During the first four hours, in 2% of the patients, edema was seen, 16% agitation, 8%vascular problems.
Conclusion: When the type of injury is subcategorized to injuries of several compartments (nerve, tendon, muscle, artery, vein), the early postoperative challanges are more easily and correctly handled.

Amaç: Guillain Barre sendromu (GBS) tanýlý hastalarýn epidemiyolojik, klinik ve elektrofizyolojik özelliklerini gözden geçirmek
Gereç ve Yöntem: Nöroloji Kliniðinde Mart 2013 ve Aðustos 2017 tarihleri arasýnda GBS tanýsýyla yatarak tedavi gören 30 hastanýn klinik ve demografik verileri retrospektif olarak incelendi. Hastalar yoðun bakým ünitesinde (YBÜ) yatýþ durumuna göre iki gruba ayrýldý.
Bulgular: Toplam 30 hastanýn 7’si (% 23.3) kadýn, 23’ü (% 76.7) erkek olup yaþ ortalamasý 46.9 ±19.61 idi. Erkek cinsiyeti YBÜ (-) grupta daha baskýndý (%81∼%62). Hastalarýn % 86.7’sinde GBS öncesi enfeksiyon öyküsü mevcuttu. YBÜ (+) grupta üst solunum yolu enfeksiyonu (ÜSYE), YBÜ (-) grupta alt solunum yolu enfeksiyonu (ASYE) ve akut gastroenterit (AGE) oranlarý fazla bulundu (p =0.007). YBÜ (+) grupta alt ekstremitelerden baþlayan güçsüzlük daha yaygýn idi (p =0.011). YBÜ (+) olanlarda diplopi ve dizartri görülmezken ataksi ve disfaji oraný görece daha yüksek bulundu (p =0.001). Elektrofizyolojik incelemede % 26.7 oranýnda demiyelinizan polinöropati, % 30.1 oranýnda akut aksonal polinöropati, % 13.3 oranýnda akut sensoriyal aksonal polinöropati saptandý. YBÜ’de yatanlarda akut motor ve sensorial nöropati (AMSAN) ön planda iken YBÜ(-) grupta demiyelinizan polinöropati daha sýktý (p =0.04). Olgularýn % 26.7’sine mekanik ventilasyon uygulandý. Ölüm oraný % 6.8 bulundu.
Sonuç: YBÜ(+) GBS hastalarýnda ÜSYE, YBÜ (-) olanlarda AGE ve ASYE ana tetikleyici faktör olarak görünebilir. Asendan güçsüzlük, disfaji ve ataksi oraný YBÜ (+) GBS hastalarýnda görece daha yaygýndýr. YBÜ (-) grupta demiyelinizan polinöropati, YBÜ (+)’de ise AMSAN ön plandadýr. Çok merkezli randomize çalýþmalar GBS epidemiyolojisi konusunda daha aydýnlatýcý olacaktýr. (SETB-2018-01-02)

Objectives: To investigate the clinical, electrophysiological and epidemiological features of the patients who were diagnosed as Guillain Barre Syndrome (GBS) in our clinic.
Methods: The clinical and demographical properties of 30 patients with GBS who were hospitalized in our neurology clinic between March 2013 and August 2017 were retrospectively examined in this study. Patients were divided into two groups according to the requirement of stay in the intensive care unit (ICU).
Results: Patients were between 18-71 years range with 46.9 and 19.61 mean age. Seven of 30 patients (23.3%) were female, and 23 of them (76.7%) were male. Males were more dominant in the ICU (-) group (81% and 62%). A recent infection was found in 86.7% of patients. Upper respiratory tract infection (URTI) was more common in ICU (+) group whereas lower respiratory tract infection (LRTI) and acute gastroenteritis (AGE) were more common in the ICU (-) patients (p=0.007). Lower limb weakness was more frequent in the ICU (+) group (p=0.011). ICU (+) patients were lack of diplopia and dysarthria. Ataxia and dysphagia were relatively frequent in the ICU (+) group. Electrophysiological examinations revealed demyelinating polyneuropathy (26.7%), acute axonal polyneuropathy (30.1%) and acute sensorial polyneuropathy (13.3%). Demyelinating polyneuropathy was more common in the ICU (-) group, whereas acute motor and sensorial polyneuropathy (AMSAN) was more frequent in the ICU (+) group. In this study, 26.7 % of study patients required mechanical ventilation, and mortality rate was 6.8 %.
Conclusion: URTI in ICU (+), LRTI and AGE in ICU (-) patients might be major trigger factors of GBS. Ascending weakness, dysphagia and ataxia was more frequent in ICU (+) GBS patients. Demyelinating PNP was predominant in the ICU (-) group, whereas AMSAN was more frequent in the ICU (+) patients. Multicenter randomized studies would be more useful for highlining the epidemiology of GBS.

Amaç: Mortalite ve morbiditenin önemli nedenlerinden olan hastane enfeksiyonlarý (HE) tedavisi zor, maliyeti yüksek ancak önlenebilir enfeksiyonlardýr. Bu çalýþma ile Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesinde hastane enfeksiyonlarý ve etkenlerinin saptanmasý ve yerel verilerimizin belirlenmesi amaçlandý. Ayrýca 1995 yýlý ve günümüz verileri karþýlaþtýrýlarak bu süreçte etken daðýlýmýndaki deðiþim irdelendi.
Gereç ve Yöntem: 1995 ve 2017 yýllarýnda 1 Haziran – 31 Aralýk arasý dönemde hastane enfeksiyonu etkenleri deðerlendirildi. Hastanemiz Mikrobiyoloji laboratuvarýna bu dönemlerde yatan hastalardan kültür için gönderilen çeþitli materyallerden elde edilen ve hastane enfeksiyonu etkeni olarak deðerlendirilen izolatlar çalýþmaya dahil edildi. Bakteri tanýmlamasý; 1995 yýlýnda geleneksel yöntemler ile, 2017 yýlýnda ise MALDÝ-TOF MS ile yapýldý.
Bulgular: 1995 yýlýnda pediatrik ve yetiþkin toplam 100 hastadan izole edilen etkenlerin 48’i Pseudomonas aeruginosa (48/100), 37’si Klebsiella spp (37/100); 2017 yýlýnda ise en sýk etkenler Acinetobacter baumannii (37/179) ve Klebsiella spp (41/179)) olarak belirlendi. 2017 yýlýna gelindiðinde bakteri çeþitliliðinin de arttýðý gözlendi.
Sonuç: Ýzole edilen etkenler incelendiðinde eskiden olduðu gibi, gram negatif bakteriler ön planda olduðu, 2017 yýlýnda Pseudomonas azalýrken önemli direnç sorunu oluþturan Acinetobacter baumannii oranýnýn arttýðý görülmektedir. (SETB-2018-12-168)

Objectives: Healthcare-associated infections (HCAI), which are important causes of mortality and morbidity, are high cost but preventable infections. This study aimed to determine hospital infections and isolates in Þiþli Hamidiye Etfal Training and Hospital and to determine our local data. The changes in the distribution of the isolates in this process were evaluated by comparing the data of 1995 and today.
Methods: Materials sent to the microbiology laboratory of our hospital in 1995 and 2017 from the patients hospitalized in the period between June 1-December 31 were evaluated concerning hospital infection. The standard manual methods were used in 1995, while in 2017, MALDI-TOF MS was used for identification and BD Phoenix automated system for antibiotic susceptibility.
Results: In 1995, in total, 100 bacteria were isolated from pediatric and adult patients, of which 48 Pseudomonas aeruginosa (48/100), 37 Klebsiella spp (37/100). In 2017, Acinetobacter baumannii causing an important resistance problem was found to be increased in number. The main hospital infection causes were Acinetobacter baumannii (37/179), Klebsiella spp (41/179). In 2017, bacterial diversity was also increased.
Conclusion: Isolated strains, as in the past, are gram-negative bacteria, Pseudomonas spp decreased in 2017, and Acinetobacter spp increased. The findings suggest that the automated systems used in microbiology laboratories may have a role in the detection of bacterial diversity.

Amaç: Geçici iskemik atak (GÝA); akut, fokal serebral veya monooküler disfonksiyona ait kýsa süreli semptomlarla karakterize olan genel olarak 24 saatten kýsa süren epizodlardýr.Ýskemik inme geçiren hastalarýn % 10-15’nin öyküsünde GÝA vardýr (3-6). Bu hastalarýn % 18’i ilk 3 ay içinde inme geçirirken ABCD2 skorlamasý ile hastalardaki yakýn dönem inme riski belirlenebilmektedir. Çalýþmamýzýn amacý GÝA hastalarýnda risk faktörlerini ortaya koymak, etyolojiyi ve lezyon varlýðýný belirlemek, hastalarýn 90 günlük takipleri boyunca geliþmiþ inme oranýný saptamaktýr.
Gereç ve Yöntem: Çalýþmaya Ocak 2012- Ocak 2018 tarihleri arasýnda, yaþlarý 29-93 arasýnda deðiþen 68’i (%54.8) erkek toplam 124 GÝA hastasý alýndý. Hastalarýn anamnezleri alýnarak, nörolojik ve sistemik muayeneleri yapýldý. Hastalarýn GÝA süresi, risk faktörleri kaydedildi, ABCD2 skorlarý hesaplandý. Tüm hastalarýn açlýk kan glukoz düzeyi, lipid deðerlerine bakýldý. BBT ve DWI Beyin MR çekildi. Tüm hastalara Elektrokardiyografi, transtorasik Ekokardiyografi, karotis ve vertebral arter dopler ultrasonografi ve/veya MR anjiografi çekildi.
Bulgular: Çalýþmaya 56’sý kadýn toplam 124 hasta alýndý, hastalarýn yaþ ortalamasý 63.04 ±16.77 ‘di. Hipertansiyon en fazla görülen risk faktörüydü (% 50.8). 91 hasta (%73.4) herhangi bir antiagregan tedavi almazken, 27 hasta antitrombotik tedavi, 6’sý antikoagülan tedavi almaktaydý. Antitrombotik tedavi alanlarýn ABCD2 skorlarý anlamlý olarak yüksek tespit edildi (p=0,019). 52 hastanýn ABCD2 skoru 4’ün altýnda, 72 hastanýn ≥4 bulundu. % 67.7 hastada etyoloji belirlenemedi. Hastalarýn % 16.9’unda akut iskemik lezyon tespit edildi. Hastalarýn % 58’i oral antikoagülan tedavi ile taburcu edildi. 5 hastanýn tekrarlayan iskemik inme geçirdiði gözlendi.
Sonuçlar: GÝA ta iskemik inme ile benzer risk faktörleri mevcuttur, çoðu hastada etyoloji belirlenememekte hastalar en sýk oral antikoagülan tedavi ile taburcu olmaktadýr. (SETB-2018-02-027)

Objectives: Transient Ischemic Attack (TIA) is due to a temporary lack of adequate blood and oxygen to the brain. TIAs typically last less than 24 hours. 10-15% of ischemic stroke patients have a history of TIA. 18% of them experience an ischemic stroke within 90 days, and the ABCD2 scoring system is used to estimate the risk. Our study aims to investigate the risk factors, the etiology, the lesion occurrence on MRI and the near-term risk of stroke of patients on whom TIA was diagnosed.
Methods: In this study, 124 patients were included between January 2012 and January 2018. Sixty-eight of the 124 patients were male. The history of patients was questioned; systemic and neurological examinations were made. The stroke risk factors and TIA duration were noted and ABCD2 scores were calculated. All the patients’ blood samples, including glucose and lipid profile, were studied. They received CT, DWI MRI, electrocardiography, transthoracic echocardiography, ultrasound and/or MR angiography of the cervical arteries.
Results: One hundred twenty-four patients were included in this study, and 56 patients were female. The mean age was 63.04±16.77. Hypertension was the most common risk factor (50.8%). Twenty-seven patients were on antithrombotic; six patients were on anticoagulant therapy, while 91 patients were not receiving any antiaggregan therapy. ABCD2 scores were significantly higher on the antithrombotic therapy group (p=0.019). In 52 patients ABCD2 score was below 4, and in 72 patients, the score was greater than 4. In 67.7% of patients, no etiology was found. An ischemic lesion was detected in 16.9% of the patients. 58 % of the patients were discharged on anticoagulant therapy. Five patients developed ischemic stroke.
Conclusion: The risk factors of ischemic stroke and TIAs are similar factors. The etiology of TIAs cannot be found out in most of the patients. Thus, the patients are discharged with oral anticoagulant treatment.

Amaç: Tükürük bezi tümörleri (TBT), tüm baþ boyun tümörlerinin %5’inden azýný oluþturur. Tümör tipleri arasýnda belirgin morfolojik benzerlikler yanýsýra ayný tümör içerisinde dikkat çekici morfolojik çeþitlilik görülebilir. Bu tümörler 4. Dünya Saðlýk Örgütü (DSÖ) baþ boyun tüm.rleri sýnýflamasýna göre onkositik lezyonlar; nodüler onkositik hiperplazi, onkositom ve onkositik karsinom olarak gruplanýr. Onkositik hücreler birçok primer tükürük bezi neoplazisinin komponenti olabileceði gibi metastatik maligniteleri akla getirmektedir. Ayýrýcý tanýda bir çok lezyonun yeraldýðý bu grupta taný aþamasýnda deneyimlerimizin paylaþýlmasý amaçlandý.
GereН ve YЪntem: Kliniðimizde 2016-2017 yýllarýnda taný alan tükürük bezi onkositik lezyonlarý 4. DSÖ baþ boyun tümörleri sýnýflamasý ýþýðýnda hematoksilen eozin kesitler yanýsýra periodik asit shift (PAS), diastaza dirençli periodik asit shift ( D-PAS) ve p63, DOG1, sitokeratin 7 (CK7), androjen reseptör (AR), PAX8, CD10 immünohistokimyasal belirleyiciler ile yeniden deðerlendirilmiþtir.
Bulgular: 21 olgunun 19’u benign, 2’si malign tanýsý almýþtýr. Benign lezyonlarýn 18’i Warthin tümörü (WT) iken 1 olgu nodüler onkositik hiperplazinin eþlik ettiði onkositom olarak deðerlendirilmiþtir ve nadir görülen bir vaka olmasý sebebiyle dikkat çekmektedir.
Malign tanýsý alan olgulardan biri onkositik hücrelerden baskýn asinik hücreli karsinom (AciCCA), diðer olgu yüksek dereceli tükürük bezi kanal karsinomu (SDCA) tanýsý almýþtýr.
Sonuç: Pratikte nadir görülmeleri ve heterojen olabilen morfolojik bulgularý sebebiyle taný güçlükleri yaþadýðýmýz bu grup lezyonlar histokimyasal ve immünohistokimyasal bulgularý ile literatür eþliðinde sunulmuþtur.

Objectives: Salivary gland neoplasms are less than 5% of all head and neck neoplasms (1). Although there are morphological similarities between different neoplasms, there may be catchy morphological differences in a single tumour. According to the World Health Organization (WHO), 4th Head and Neck Tumours Classification oncocytic salivary gland lesions are classified as nodular oncocytic hyperplasia, oncocytoma and oncocytic carcinoma. Oncocytic cells may be a component of other salivary gland neoplasms and metastatic malignities.
Methods: In this study, salivary gland oncocytic lesions diagnosed in 2016-2017 were evaluated with Haematoxylin and Eosin (H&E) sections and PAS, diastase resistance PAS, p63, DOG1, cytokeratin7 (CK7), androgen receptor (AR) and PAX8 stains.
Results: Nineteen cases were benign, two cases were malignant. Eighteen of the benign lesions were Warthin tumour (WT), one case was oncocytoma with nodular oncocytic hyperplasia. Acinic cell carcinoma (AciCCA) with oncocytic cells predominant was one of the malignant cases. The other case was high-grade salivary duct carcinoma (SDCA).
Conclusion: The rarity and heterogeneity of this group of lesions may cause difficulties in diagnosis. We present histochemical and immunohistochemical findings of these lesions in light of the literature.

Amaç: Torakoskopik rezeksiyonla tedavi edilen primer spontan pnömotorakslý (PSP) hastalarý retrospektif olarak deðerlendirmek.
Yöntem: 2010–2016 yýllarý arasýnda Video yardýmlý torakoskopik cerrahi (VATS) ile tedavi ettiðimiz PSP hastalarýmýzý geriye dönük olarak deðerlendirdik.
Bulgular: Çalýþma döneminde 10 hasta spontan pnömotoraks nedeni ile hastanemize baþvurdu. Yaþlarý ortalama 16.6 (16–17) olan 5 çocuk (3 erkek, 2 kýz) VATS ile opere edildi. Hastalarýn üçünde bleb, bir hastada Konjenital Kistik Adenomatoid Malformasyon (CCAM) tip 2, sonuncusunda ise patolojik incelemede kronik amfizemli doku vardý. Postoperatif takip süresi herhangi bir komplikasyon olmaksýzýn 2.2 (1–4) yýldý.
Tartýþma: Spontan pnömotoraks özellikle ergen yaþlarda görülen bir hastalýktýr. Baþlýca nedenler apikal segment bül formasyonu ve bleblerdir. VATS özellikle apikal segmentlere ulaþmak ve kolay rezeksiyon yapmak için avantajlýdýr. Blebler, CCAM ve amfizemli akciðer dokusu spontan pnömotoraksa neden olabilir.

Objectives: We retrospectively evaluated the patients with primer spontaneous pneumothorax (PSP) who were treated with thoracoscopic resection.
Methods: We retrospectively collected the data of the patients with a spontaneous pneumothorax who were operated with video-assisted thoracoscopic surgery (VATS) between 2010 and 2016.
Results: During the study period, 10 patients applied to our hospital with spontaneous pneumothorax. Five children (three boys, two girls) with a mean age of 16.6 (16-17) were selected with VATS. Three of the patients had bleb, one of the patients had Congenital Cystic Adenomatoid Malformation (CCAM) type 2, and the last one had chronic emphysematous tissue on pathological analyses. Post-operative follow-up time was 2.2 (1-4) years without any complication.
Conclusion: Spontaneous pneumothorax is a disease especially seen in puberty. The main reasons are apical segment bullae formation and blebs. VATS is especially advantageous to reach apical segments and for easy resections. Blebs, CCAM and emphysematous lung tissue may cause spontaneous pneumothorax.

Amaç: Bu çalýþmada mekanik olarak ekspoze olmuþ ileri yaþ hastalarda kalp pillerinin fasyakütan lokal flep yardýmý ile kurtarýlmasýnýn etkinliði araþtýrýldý.
Metod: Ocak 2014 - Ocak 2018 tarihleri arasýnda kalp pili ekspozisyonu nedeni ile tedavi edilen on hasta (altý kadýn, dört erkek; Ort. yaþ 66,2 yýl) geriye dönük olarak incelendi. Tedavi edilen hastalarýn tamamýnda cerrahi onarým pilin yerleþtirildiði saha debridmanýný takiben, rejyonel fasyakütan flebler ile yumuþak doku onarýmý gerçekleþtirildi.
Bulgular: Yalnýzca bir hastada erken dönemde hematom görüldü ve revizyon yapýldý. Hastalarýn tümü baþarýlý bir þekilde tedavi edildi. Takip döneminde herhangi bir komplikasyon gözlenmedi.
Sonuç: Mekanik ekspozisyon olan ileri yaþ hastalarda hastalarda kalp pilinin etrafýndaki kapsülün eksizyonu ve fasyakütan lokal flebler ile onarýmý, ekspoze olmuþ kalp pili olgularýnda kullanýlan etkin bir tedavi yöntemidir. (SETB-2018-04-057)

Objectives: This study aims to investigate the efficacy of salvage of the mechanically exposed cardiac pacemakers with fasciocutaneous local flaps in elderly patients.
Methods: Between January 2014 and January 2018, ten patients (six females, four males; mean age 66.2 years) who were treated due to pacemaker exposition were retrospectively analyzed in this study. Exposed pacemaker and the wires were dissected, and capsulectomy was performed. The expose pacemaker was covered with the fascioutaneous flap.
Results: Only one patient had hematoma formation at early stage and revision was performed. All patients were treated successfully. No complication was observed during the follow-up period.
Conclusion: Reconstruction with fasciocutaneous local flaps is an effective treatment modality in case of mechanically cardiac pacemaker expositions in elderly patients.

Amaç: Elastofibroma dorsi (ED) sýklýkla skapula alt polünü içeren bölgede ele gelen þiþlik þeklinde büyüyen kitle lezyon olarak ortaya çýkar. Nadir bir benign neoplazi olan ED’nin klinik prezentasyonu ve radyolojik karakterizasyonu ön-taný için yeterli olabilmektedir. Karakteristik özelliklerinin görüntüleme yöntemleri ile daha net ortaya konmasý özellikle riskli vakalarda biyopsi ve eksizyonel cerrahi uygulanmadan tanýya gidiþi kolaylaþtýracaktýr.
Metod: Asemptomatik ya da aðrýlý cilt altý lezyon ile klinikte görülen 10 hasta deðerlendirildi. Toraks Bilgisayarlý Tomografi (BT), Manyetik Rezonans (MR) Görüntüleme ve ayýrýcý tanýda yeni ve daha faydalý bir tetkik olabilecek Difüzyon - MR hastalarýn deðerlendirilmesinde kullanýldý.
Sonuçlar: Tüm hastalara cerrahi uygulandý. Peroperatif frozen-section biyopsi ile taný alýnarak total eksizyon gerçekleþtirildi. Kesin patoloji sonuçlarý da ‘benign’ olarak öðrenilen hastalarýn postoperatif dönem ve takipleri sorunsuz idi.
Tartýþma: Difüzyon-MR radyolojik olarak belirli kriterlere dikkat çekerek nadir ve benign bir tümör olan elastofibroma dorsi tanýsýnda daha aktif kullaným ile riskli hasta grubunda majör bir cerrahiden kurtarabilir. (SETB-2018-02-024)

Elastofibroma dorsi is a benign lesion commonly presents as a palpable enlarging mass at the inferior pole of the scapula. Clinical presentation and radiological characteristics are often enough to suggest an accurate diagnosis. Increased awareness of the characteristic appearance and location of these benign lesions will increase radiologic diagnosis and decrease the need for biopsy.
Ten patients were admitted with a complaint of asymptomatic or painful subcutaneous masses localized at subscapulary region. Thorax computed tomography, magnetic resonance imaging (MRI) and a new feasible technique in differential diagnosis with malignancy and probable diagnosis of elastofibroma dorsi and diffusion-weighted MRI were used for diagnosis.
Surgery was applied to all patients, frozen-section biopsies of the lesions at the preoperative period, and final pathologies were all benign. Totally resection of whole lesions as en-bloc excision without any rest was performed at all patients. Postoperative and follow-up periods were uneventful.
Diffusion MRI can play an important role in the future and save the patients, especially medically poor ones, from the potential risks of surgery. Necessary further examinations for probable bilaterally lesions will save the patient from the risk of a second operation.

Giriþ: Ýnfantil karaciðer hemanjiomu, cocuklarda en sýk görülen selim karaciðer tümörlerindendir. En sýk semptomlar; karýnda kitle, anemi ve kalp yetmezliðidir. Tedavisi, hastadaki bulgulara göre sadece klinik takipten baþlayarak karaciðer nakline kadar deðiþebilir. Çalýþmamýzda olguya yapýlan ameliyat tekniðinin detaylarý sunuldu.
Olgu: Doðum sonrasý solunum durmasýna neden olan dev karaciðer hemanjiomu tespit edilen, 11 günlük yenidoðan olgu sunuldu.
Sonuç: Farklý klinik davranýþlarýyla karþýmýza çýkabilen infantil karaciðer hemanjiomlarýnýn büyük ve semptomatik olanlarý ameliyat edilmektedir. Cerrahlar açýsýndan nadiren görülen bu olgular için cerrahi tekniðin paylaþýlmasý faydalý olacaktýr. (SETB-2018-04-058)

Infantile hepatic hemangioma is the most common liver tumor in children. The most common symptoms are mass in her stomach, anemia and heart failure. According to the findings of the patient, the treatment may vary from the clinical follow-up to liver transplantation. In our study, the details of the surgical technique were presented.
An 11-day-old newborn case with giant hepatic hemangioma causing postnatal respiratory arrest was presented in this study.
Large and symptomatic patients with infantile hepatic hemangiomas who face us with different clinical behaviors are operated. It will be useful to share the surgical technique for these rarely seen cases for surgeons.

Konjenital sifiliz, treponema pallidum'un vertikal geçiþinden kaynaklanan ciddi bir hastalýktýr. Klinik bulgular gebeliðin evresi, fetüsün gestasyonel haftasý, maternal tedavi ve fetusun immünolojik yanýtýna göre ortaya çýkmaktadýr. Semptomatik yenidoðanlarda; erken doðum, düþük doðum aðýrlýðý, nonimmün hidrops fetalis, nekrotizan enterokolit (NEK), hepatomegali, deri döküntüleri, trombositopeni, hemolitik anemi ve ateþ tespit edilebilir.
Ýkinci trimesterden itibaren barsak hiperekojenite nedeni ile takip edilen, gebeliðin 29. haftasýnda 1,160 gr olarak doðan kýz bebekte postnatal solunum yetmezliði, hepatomegali, anemi ve trombositopeni saptandý. Bebekte ve annesinde Venereal Disease Research Laboratory titreleri pozitif, doðrulama testi olan Treponema pallidum hemaglütinasyon tetkiki reaktifti. Penisilin 10 gün uygulandýktan sonra anemi ve trombositopeni düzeldi. Postnatal 15. günde aniden perfore nekrotizan NEK geliþtiði görüldü. 3 kez NEK nedeniyle cerrahi müdahale yapýlmasýna raðmen klinik ve laboratuvar bulgular düzelmeyen hasta yaþamýn 54. gününde kaybedildi. Konjenital sifilizin hem prenatal baðýrsak hiperekojenitesi hem de NEK nedeni olduðu kanýsýndayýz. (SETB-2018-08-113)

Congenital syphilis is a severe disease that arises from the vertical transmission of Treponema pallidum. Clinical findings are related to the pregnancy stage, fetal gestational week, maternal treatment and fetal immunologic response. Prematurity, low birth weight, nonimmune hydrops fetalis, necrotizing enterecolitis, hepatomegaly, skin eruptions, thrombocytopenia, hemolytic anemia and fever can be detected in the symptomatic newborn. Postnatal respiratory insufficiency, hepatomegaly, anemia and thrombocytopenia were detected in a baby who was born at the 29th week of gestation, weighing 1.160 g and followed due to intestinal hyperechogenicity from the second trimester. Her and her mother’s Venereal Disease Research Laboratory titers were positive, confirming test Treponema pallidum hemagglutination was reactive. After penicillin was administered for 10 days, anemia, and thrombocytopenia were regressed. In the 15th day of life, findings of perforated necrotising enterocolitis (NEC) suddenly appeared. The operation was performed due to NEC for three times but nonresponsive laboratory and clinical findings and died in the 54th day of life. We assumed that syphilis is the cause of both bowel hyperechogenicity and necrotising enterocolitis.