Feokromositoma (FK) ve paraganglioma (PG) adrenal medulla, sempatik veya parasempatik ganglionlardan kaynaklanan nadir nöroendokrin tümörlerdir. Günümüzde FK/PG (FPG) ’nin tek kuratif tedavi seçeneði cerrahi rezeksiyondur. Cerrahi hem hipersekresyon riskini hem de tümör büyümesini ortadan kaldýrmayý amaçlamaktadýr. Hipersekresyonun sonuçlarý cerrahiden önce ve cerrahi sýrasýnda medikal tedavi ile dikkatlice kotrol edilmelidir. Postopertaif major komplikasyonlar hipotansiyon, rebound hipoglisemi olup, hastalar bunun için 24-48 arasý yakýn takip edilmelidir.
Cerrahi yaklaþým tercihi germline genetik mutasyon sonuçlarý, tümör çapý, vücut kitle indeksi, cerrahýn deneyimi, malignite olasýlýðýný içeren multipl faktörler temelinde belirlenir. Primer tümör rezeksiyonu tümör persistan ve reküren riskini tam ortadan kaldýrmaz. Bundan dolayý, cerrahi tedavi edilen FPG’li bütün hastalar reküren hastalýk ve yeni tümör oluþumu için en az 10 yýl takip edilmelidirler. Cerrahi rezeksiyon PPGL'ler için tek küratif tedavi olmasýna raðmen, metastatik hastalýkta rezektabl lokorejyonel metastazlar veya izole uzak metastazlar dýþýnda cerrahi tedavi palyatiftir. Palyatif tedavide amaç hormon salgýlanmasýný azaltmak ve kritik bir anatomik lokalizasyondaki metastaz ile iliþkili komplikasyonlarý önlemektir.
PCC/PGL’li hastalarda genellikle kombine α- ve β- adrenerjik blokaj uygulanmaktadýr. Bazý hastalar, hayatý tehdit eden ve kadiyovasküler, pulmoner, nörolojik, gastrointestinal, renal, hepatik ve metabolik sistemleri tutabilen feokromositoma multisistem krizi ile baþvurabilir. Feokromositoma krizi spontan olabilir veya tümörün manipülasyonu, travma, kortikosteroidler, β blokerler, anestezik ilaçlar gibi deðiþik tedaviler, adrenal cerrahi dýþý cerrahi streslerin uyarýsý ile ortaya çýkabilir. Bu hastalar cerrahi acilden öte medical acil olarak düþünülmelidir.
Bu derlemede, FPG’li hastalarda preoperatif, peroperatif ve postoperatif tedavi, küratif ve palyatif cerrahi tedavi, postoperatif sonuçlar ve takibin deðerlendirilmesi amaçlandý. (SETB-2020-08-137)

Pheochromocytomas (PCC) and paragangliomas (PGL) are rare neuroendocrine tumors arising from chromaffin cells in the adrenal medulla, sympathetic or parasympathetic ganglia. Currently, the only curative treatment option of pheochromocytomas/paraganglioma (PPGL) is surgical resection. Surgery aims to eliminate both risks of hypersecretion and tumor growth. The consequences of hypersecretion should be carefully controlled with medical therapy before and during the surgery. Postoperative major complications are hypotension and rebound hypoglycemia, and patients should be followed closely for 24-48 hours. The choice of surgical approach is determined based on multiple factors, including germline genetic test results, the size of the tumor, body mass index, surgeon's experience, and the likelihood of malignancy. Primary tumor resection does not completely eliminate the risk of tumor persistence and recurrence. Therefore, all patients with PPGL who are surgically treated should be followed for at least 10 years for recurrent disease and new tumor formation. Although surgical resection is the only curative treatment for PPGLs, surgical treatment is palliative except for resectable locoregional metastases in metastatic disease or for isolated distant metastases. The purpose of palliative treatment is to reduce hormone secretion and prevent metastasis-related complications in a critical anatomical location Combined and alfa;- and beta- adrenergic blockade is usually applied in patients with PPGL preoperatively. Some patients may present with pheochromocytoma multisystem crisis, which is a life-threatening condition that can involve cardiovascular, pulmonary, neurological, gastrointestinal, renal, hepatic and metabolic systems. Pheochromocytoma crisis may be spontaneous or may present with the tumor manipulation, trauma, corticosteroids, beta-blockers, anesthetic drugs, and the stimulation of non-adrenal surgical stress. These patients should be considered as medical emergencies rather than surgical emergencies. In this review, it was aimed to evaluate the pre-, per and post-operative management, curative and palliative surgical management, and postoperative outcomes and follow-up of the patients with PPGLs.

Amaç: Hipertansiyon tanýsý olan COVID-19 hastalarýnýn kronik renin-anjiyotensin-aldosteron sistemi (RAAS) blokeri kullanýmýnýn hastane içi istenmeyen olaylar ve hastalýðýn ciddiyeti üzerine etkisi halen belirsizliðini korumaktadýr. Bu çalýþmada COVID-19 nedeni ile hastanede yatan hipertansif hastalarda RAAS inhibitörlerinin kronik kullanýmý ile hastane içi advers olaylar arasýndaki iliþkiyi belirlemeyi amaçladýk.
Yöntem: Bu tek merkezli ve retrospektif çalýþmaya COVID-19 tanýsý konmuþ 349 hipertansif hastayý dahil ettik. Bütün hastalar hastane yatýþý öncesinde kronik olarak anjiotensin dönüþtürücü enzim inhibitörü (ADEI)/anjiotensin II reseptör blokeri (ARB) veya diðer antihipertansif tedavileri alýyordu. Ýstenmeyen klinik olaylar; hastane içi ölüm, yoðun bakýma gidiþ,yüksek akým oksijen ihtiyacý ve entübasyon olarak belirlendi.
Bulgular: Hastalar antihipertansif tedavi tipine göre iki gruba ayrýldý. (ADEI/ARB kullananlar, n=201; ADEI/ARB kullanmayanlar n=148). ADEI/ARB kullananlarla kullanmayanlar arasýnda hastane içi ölüm (29(14.4%) vs 20(13.5%), p=0.81), yoðun bakýma gidiþ (45(22.4%) vs 27(18.2%), p=0.34), yüksek akým oksijen ihtiyacý (97(48.3%) vs 68 (45.9%), p=0.67) ve entübasyon (32(15.9%) vs 23(15.5%),p=0.92) gibi hastane içi istenmeyen olaylar açýsýndan istatistiksel olarak anlamlý farklýlýk yoktu. Ayrýca enfekfsiyon þiddeti de gruplar arasýnda benzerdi. Lojistik regresyon analizinde yaþ, nötrofil/lenfosit oraný, prokalsitonin ve ferritin düzeyleri hastane içi ölüm için baðýmsiz ön gördürücüler olarak saptandý.
Sonuç: Sonuçlarýmýz COVID-19 nedeniyle hastanede yatan hipertansif hastalarda kronik ADEI/ARB kullanýmýnýn hastane içi istenmeyen olay sýklýðýný artýrmadýðýný düþündürmektedir. Son dönemde yapýlan çalýþmalarýn sonuçlarý çeliþkili olsa da; hipertansiyonu olan COVID-19 hastalarýnýn hastane yatýþý boyunca kronik ADEI/ARB kullanýmýnýn kesilmesi önerilmemektedir. (SETB-2020-09-159)

Objectives: The effects of chronic renin–angiotensin–aldosterone system (RAAS) blockers usage on adverse outcomes and disease severity remain uncertain in COVID-19 patients with hypertension. In this study, we aimed to determine the relationship between chronic use of RAAS inhibitors and in-hospital adverse events among hypertensive patients hospitalized with COVID-19.
Methods: In this retrospective single-center study, we enrolled 349 consecutive hypertensive patients diagnosed with COVID-19 infection. All patients were chronically on angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin II receptor blockers (ARB) or other antihypertensive therapies before hospital admission. Adverse clinical events were defined as in-hospital mortality, admission to intensive care unit, need for high-flow oxygen and intubation.
Results: Patients were categorized into two groups according to the type of antihypertensive therapy. (ACEI/ARBs users, N=201; ACEI/ARB nonusers, N=148) There was no statistically significant difference between ACEI/ARBs users and ACEI/ARBs nonusers concerning adverse clinical events, such as in-hospital mortality (29 (14.4%) vs. 20 (13.5%), p=0.81), ICU admission (45(22.4%) vs. 27 (18.2%), p=0.34), need for high-flow oxygen (97 (48.3%) vs. 68 (45.9%), p=0.67) and need for intubation (32(15.9%) vs. 23(15.5%), p=0.92), respectively. Also, the severity of infection did not differ among groups. The logistic regression multivariate analysis showed that age, neutrophil-lymphocyte ratio, procalcitonin and ferritin levels were independent predictors of in-hospital mortality.
Conclusion: Our results suggest that chronic use of ACEI/ARBs did not increase in-hospital adverse outcomes of hypertensive patients hospitalized with COVID-19. Although the recent data are contradictory, chronic ACEI/ARB therapy is not recommended to be discontinued in hypertensive patients during their hospitalization for COVID-19.

Amaç: Literatürde D vitamininin alt üriner sistem semptomlarý (LUTS) üzerindeki etkisi ile ilgili çalýþmalar mevcuttur. Bu çalýþmalarda çeliþkili sonuçlar bildirilmiþtir. LUTS kadýnlarda daha yaygýndýr. Bu çalýþmada kadýn hastalarda D vitamini ve LUTS arasýndaki iliþkiyi, üroflovmetrik yöntemle deðerlendirmeyi amaçladýk.
Material/metod: Bu retrospektif kohort çalýþmaya LUTS ile baþvuran 186 kadýn hasta dahil edildi. Demografik özellikler, týbbi öykü, kalsiyum (Ca) ve D vitamini içeren laboratuvar verileri ve maksimum idrar akýþ hýzý (Qmax), ortalama idrar akýþ hýzý (Qav) ve geçersiz hacim (V) olarak üroflovmetri sonuçlarý kaydedildi. Hastalar yaþ (18-50 ve ≥51) ve D vitamini seviyelerine (<20 ve ≥20) göre iki gruba ayrýldý. Laboratuvar parametreleri, üroflovmetri sonuçlarý gruplar arasýnda karþýlaþtýrýldý.
Bulgular: Yaþ ortalamasý 56,85 ± 12,95 idi. Ortalama D vitamini seviyesi 21.19 ± 13.93 ng / mL (2.5-83.5) idi. Ortalama Qmax deðeri 35.41 ± 12.63 iken ortalama Qav 19.13 ± 9.89 ve ortalama V 446.60 ± 165.08 mL idi. D vitamini düzeyleri yaþ gruplarýna göre farklýlýk gösterdi (p = 0.044). Qmax, Qav ve V deðerlerine göre gruplar arasýnda anlamlý fark gözlenmedi (p> 0.05). D vitamini düzeyi ile Qmax, Qav ve V deðerleri arasýnda anlamlý bir iliþki saptanmadý. Bununla birlikte, düþük D vitamini grubunda serum Ca düzeyi ile V deðerleri (p = 0.042) arasýnda negatif korelasyon saptandý.
Sonuç: Üroflovmetrik açýdan D vitamini düzeyleri ile LUTS arasýnda direkt iliþki bulamadýk. Bununla birlikte, D vitamini düþük olan hastalarda Ca düzeylerinin üroflovmetri parametresini etkilediðini tespit ettik. LUTS hastalarda vitamin D düzeylerine ek olarak serum Ca düzeylerini vurgulayan çalýþmalara ihtiyaç olduðuna inanýyoruz. (SETB-2020-07-114)

Objectives: In the literature, the effects of vitamin D on lower urinary tract symptoms (LUTS) have been investigated. Conflicting results have been reported in these studies conducted. LUTS is more common in women. In this study, we aimed to evaluate the relationship between vitamin D and LUTS in female patients using the uroflowmetric method.
Methods: This retrospective cohort study included 186 female patients who were admitted with LUTS. Demographic characteristics, medical history, calcium (Ca) and vitamin D, including laboratory studies and uroflowmetry results, as maximum urine flow rate (Qmax), average urine flow rate (Qav) and voided volume (V) were recorded. Patients were divided into two groups according to age (18-50 and ≥51) and vitamin D levels (<20 and ≥20). Laboratory parameters and uroflowmetry results were compared between groups.
Results: Mean age was 56.85±12.95 years. Mean vitamin D level was 21.19±13.93 ng/mL (2.5-83.5). Mean Qmax value was 35.41±12.63, whereas the mean Qav was 19.13±9.89, and the mean V was 446.60±165.08 mL. Vitamin D levels differed according to age groups (p=0.044). No significant difference was observed between groups according to Qmax, Qav and V values (p>0.05). No significant correlation was detected between vitamin D level and Qmax, Qav and V values. However, a negative correlation was detected between serum Ca level and V values (p=0.042) in the low vitamin D group.
Conclusion: There was no direct relationship between vitamin D levels and LUTS in respect to uroflowmetry. However, we determined that Ca levels affect the uroflowmetry parameter in patients with low vitamin D levels. There is a need for further studies emphasizing serum Ca levels in addition to vitamin D levels in patients with LUTS.

Amaç: Non-alkolik yaðlý karaciðer hastalýðý (NAYKH), insülin direnci ile karakterize olan obezite, diyabetes mellitus, metabolik sendrom gibi hastalýklarla yakýndan iliþkilidir. Metabolik sendromun karaciðerdeki tezahürü olduðu düþünülmektedir. Karaciðer fibrozisinin non-alkolik steatohepatitte (NASH) prognostik önemi yüksektir. Bu çalýþmada biyopsi ile kanýtlanmýþ NAYKH olgularýnda insülin direnci ile karaciðerdeki histopatolojik deðiþiklikler arasýndaki iliþki incelenmiþtir.
Gereç ve Yöntem: Çalýþmaya 85 kiþilik biyopsi ile kanýtlanmýþ NAYKH hastasý (64’ü NASH, 21’I NASH olmayan) ve 40 kiþilik kontrol grubu alýndý. Ýnsülin direnci ‘homeostasis model assessment of insulin resistance’ (HOMA-IR) kullanýlarak hesaplandý.
Sonuçlar: NAYKH grubunda C reaktif protein, total kolesterol, düþük dansiteli lipoprotein, trigliserit, vücut kitle indeksi (VKÝ), HOMA-IR düzeyleri kontrol grubuna göre istatistiksel açýdan anlamlý þekilde yüksekti. NASH grubunda NASH olmayan gruba göre HOMA-IR düzeyi anlamlý düzeyde (p=0.026) yüksekti. Ýleri düzeyde fibrozisi olan (evre 3-4, n=27) ve olmayan (evre 0-2, n=58) NAYKH hastalarý karþýlaþtýrýldýðýnda, ileri fibrozis grubunda hafif fibrozis grubuna göre VKÝ (35.2±4.6 kg/m2 ve 32.7±4.1 kg/m2 sýrasýyla, p=0.031) ve HOMA-IR (6.3 [5.8-6.8] ve 3.4 [2.6-4.8] sýrasýyla, p=0.001) seviyelerinin yüksek olduðu gözlendi. Kovaryans analizinde, ileri fibrozis grubunda HOMA-IR yüksekliðinin; VKÝ, yaþ, cinsiyet gibi karýþtýrýcý faktörler düzeltildiðinde de istatistiksel olarak anlamlý biçimde devam ettiði görüldü.
Sonuç: Fibrozis düzeyi ileri derecede olan NAYKH hastalarýnda HOMA-IR deðerinin yüksek olduðu gözlenmiþtir. Günlük pratikte kolaylýkla ölçülebilen HOMA-IR’nin fibrozis için baðýmsýz bir prediktör deðer olduðu görülmüþtür. (SETB-2018-11-163)

Objectives: Non-alcoholic fatty liver disease (NAFLD) is closely associated with diseases, such as obesity, diabetes mellitus, metabolic syndrome, which are characterized by insulin resistance. NAFLD is thought to be a manifestation of metabolic syndrome in the liver. Liver fibrosis has a high prognostic significance in non-alcoholic steatohepatitis (NASH). In this study, the relationship between insulin resistance and the histopathological changes in the liver was investigated in biopsy-proven NAFLD patients.
Methods: In this study, 85 biopsy-proven NAFLD patients (64 NASH, 21 non-NASH) and 40 healthy control subjects were enrolled. Insulin resistance was calculated using the "homeostasis model assessment of insulin resistance" (HOMA-IR).
Results: C reactive protein, total cholesterol, low-density lipoprotein, triglyceride, body mass index (BMI), HOMA-IR levels were significantly higher in the NAFLD group compared to the control group. In the NASH group, the HOMA-IR level was significantly higher than the non-NASH group (p=0.026). When NAFLD patients with advanced fibrosis (stage 3-4, n=27) and without fibrosis (stage 0-2, n=58) are compared, in advanced fibrosis group BMI (35.2±4.6 kg/m2 and 32.7±4.1 kg/m2, respectively; p=0.031) and HOMA-IR (6.3 [5.8-6.8] and 3.4 [2.6-4.8], respectively, p=0.001) levels were higher significantly. In the covariance analysis, when confounding factors, such as BMI, age and gender, were corrected, it was observed that the elevation of HOMA-IR level in the advanced fibrosis group continued statistically significantly.
Conclusion: HOMA-IR levels were high in NAFLD patients with advanced fibrosis. HOMA-IR, which can be easily measured in daily practice, is an independent predictor for fibrosis.

GÝRÝÞ: Çalýþmamýzýn amacý sýk aralýklý insülin tedavisi almakta olan tip 2 diyabet hastalarýnda farklý insülin tiplerini günlük insülin doz ihtiyacý ve tedavi baþarýsý açýsýndan karþýlaþtýrmak, yüksek dozlara raðmen tedavi baþarýsýzlýðýnýn sebeplerini irdelemektir
YÖNTEM: Retrospektif olarak dizayn edilmiþ olan çalýþmamýza bazal bolus insülin tedavisi altýndaki 198 tip 2 diyabet hastasý dahil edildi. Hastalar aldýklarý insülin tiplerine göre 3 gruba ayrýldý (Grup 1: Kýsa ve uzun etkili analog insülin alanlar(n: 83), Grup 2: Kýsa ve uzun etkili regüler insülin alanlar(n: 58), Grup 3: Regüler insülin + uzun etkili analog insülin alanlar(n: 57)) Hasta takip dosyalarýndan demografik veriler ve günlük insülin doz bilgileri kaydedildi. Bu veriler ve hedef HbA1c düzeyine ulaþma oranlarý gruplar arasýnda karþýlaþtýrýldý. Ayrýca, glisemik hedeflere ulaþýlabilen ve ulaþýlamayan hastalarýn insülin dozlarý karþýlaþtýrýldý.
BULGULAR: 198 hastanýn 123’ü (%62,1) kadýn 65’i (%47,9) erkektir. Üç grubun yaþ ortalamasý sýrasýyla 55,81± 8,1, 58,3 ± 8,9, 58,3± 8,8 dir. HbA1c düzeyleri Grup 1 de 8,72± 1,65, Grup 2 de %9,02± 1,98, Grup 3 de ise %9,05 ± 2,24 saptanmýþtýr. Hedef A1c deðeri %7 nin altýna ulaþma oranlarý analog tedavi grubunda %27,7, regüler tedavi grubunda %25,9, regüler+analog tedavi grubunda ise %31,6 dýr (p >0,05). Üç grubun günlük bolus ve bazal insülin dozu, total ve kg baþýna insülin dozu ve bazal bolus oraný anlamlý farklýlýk göstermemiþtir(p > 0,05). Grup 1 ve Grup 2 de glisemik kontrol hedefine ulaþýlamayan hastalarda günlük total insülin dozlarý,Grup 3 de ise bazal insülin dozu hedefe ulaþýlanlardan anlamlý olarak daha yüksek saptandý.
SONUÇ: Analog ve regüler insülinler arasýnda doz analizlerinde belirgin farklýlýk saptamadýðýmýz çalýþmamýzda en önemli sonuç olarak yüksek insülin dozlarýna çýkmanýn glisemik kontrol için yeterli olmayabileceði ortaya konulmuþtur. Bu hastalarda altta yatan neden aranmalý, düzeltilebilecek nedenler ortadan kaldýrýlmalýdýr. (SETB-2018-10-140)

Objectives: The present study aims to compare different types of insulin concerning treatment success and insulin dose requirement in type 2 diabetes patients who were receiving basal-bolus insulin therapy and to evaluate the causes of treatment failure despite high doses of insulin.
Methods: In our retrospective study, 198 type 2 diabetes patients who were receiving basal-bolus insulin therapy included. Patients were divided into three groups according to the insulin types (Group 1: short and long-acting analogue insulin users (n=83), Group 2: short and long-acting human regular insulin users (n=58), Group 3: human regular insulin + long-acting analogue insulin users (57)). Demographic data and daily insulin doses were recorded from the patient follow-up files. These data and the rates of achievement of the target HbA1c levels were also compared between groups. In addition, insulin doses of the patients whose glycemic targets could and could not be achieved were compared.
Results: In this study, 123 (62.1%) of the 198 patients were female and 65 (47.9 %) were male. The mean age of the three groups was 55.81±8.1, 58.3±8.9, 58.3±8.8, respectively. HbA1C values were 8.72±1.65% in group 1, 9.0±1.98% in group 2 and 9.05±2.24% in group 3. The rates of achievement HbA1c value below 7% were 27.7% in analogue insulin group, 25.9% human regular insulin group and 31.6% in regular + analogue insulin group (p >0.05). There were no significant differences in daily basal and bolus insulin doses, total daily and per kg insulin doses and basal-bolus rates between groups. Higher total daily insulin doses were determined in patients who could not achieve target glycemic values than achieved it in group 1 and 2. Higher basal insulin doses were determined in patients who could not achieve target glycemic values than could achieved it in group 3.
Conclusion: In our study, in which we did not find any significant difference in the dose analysis between analogue and regular insulin, the findings showed that high insulin doses might not be sufficient for glycemic control. The underlying causes should be investigated and correctible reasons should be eliminated in these patients.

Giriþ: Kronik ürtiker(KÜ) 6 haftadan uzun süren deri lezyonlarý ve anjioödem ile karakterize sýk görülen bir deri hastalýðýdýr. Etiyolojide otoimmün hastalýklar, enfeksiyonlar, ilaçlar, maligniteler gibi birçok faktör suçlanmakla birlikte hastalarýn önemli bir bölümünde herhangi bir neden saptanamaz. Bu çalýþmada amacýmýz kronik ürtikerli hastalarda etiyolojide rol alan faktörleri araþtýrmaktýr.
Gereç ve yöntemler: Dermatoloji Kliniði Alerji Polikliniði’nde kronik ürtiker tanýsý ile izlenen 62 hasta retrospektif olarak deðerlendirildi. Hastalara ait klinik ve laboratuvar verileri hasta dosyalarý ve hastane otomasyon sisteminden elde edildi. Elde edilen veriler kategorik deðiþkenler için sayý ve yüzde, sayýsal deðiþkenler için ortalama, standart sapma, minumum, maksimum olarak verildi.
Bulgular: Çalýþma grubunu 33(%53.2)’ü kadýn, 29(%46.8)’u erkek toplam 62 hasta oluþturdu. Anjioödem sýklýðý %51.6, eþlik eden fiziksel ürtiker %40.3 olarak hesaplandý. On dört(%22.6) hastada otoimmün hastalýk, 15 (%24.2) hastada enfeksiyon eþlik etmekteydi. Hastalarýn % 24,5’inde tiroid otoantikorlarý, %69’unda helikobakter pylori (H.pylori) antijeni pozitif bulundu. Sonuç: Kronik ürtikerli hastalarda otoimmün tiroid hastalýklarý ve enfeksiyonlar sýklýkla eþlik eden hastalýklar olarak öne çýkmaktadýr. (SETB-2018-10-150)

Objectives: Chronic urticaria (CU) is a common skin disease characterised by skin lesions and angioedema lasting longer than six weeks. Although many factors, such as autoimmune diseases, infections, drugs and malignities, are blamed in the etiology, no reason can be found in a significant majority of the patients. The present study aims to investigate the factors which have a role in the etiology in patients diagnosed with CU.
Methods: Sixty-two patients who were followed-up with the diagnosis of CU in the Allergy Polyclinic of Dermatology Clinic were retrospectively evaluated in this study. The clinical and laboratory data of the patients were obtained from the patient files and the hospital automation system. The obtained data were given as a number and percentage for the categorical variables and as mean, standard deviation, minimum, and maximum for the numerical variables.
Results: The patient group consisted of 33 women (53.2%), and 29 men (46.8%), with 62 patients. The prevalence of angioedema was calculated as 51.6%, and the accompanying physical hives was calculated as 40.3%. Autoimmune disease was accompanying in 14 (22.6%) patients, and coexisting infection was detected in 15 (24.2%) patients. Thyroid autoantibodies were detected positive in 24.5% of the patients, and helicobacter pylori (H.pylori) antigen was found positive in 69% of the patients.
Conclusion: Autoimmune thyroid diseases and infections are frequently detected as the accompanying diseases in patients diagnosed with CU.

AMAÇ: Bu çalýþmamýzda demir eksikliði anemisi ile yatan hastalarýn etyolojik olarak deðerlendirilmesini amaçladýk.
MATERYAL-METOD: Çalýþmamýzda 2005-2010 tarihleri arasýnda Þiþli Etfal Hastanesi Ýç Hastalýklarý Kliniðinde demir eksikliði anemisi tanýsý ile yatan 60’ý erkek, 90’ý kadýn toplam 150 hasta retrospektif olarak deðerlendirildi. Anemi için hemoglobin deðeri kadýnlarda <12 g/dl, erkeklerde <13 g/dl, demir eksikliði için transferrin satürasyonu ≤ %15 anlamlý olarak kabul edildi.
BULGULAR: Çalýþmamýza 60 erkek, 90 kadýn dahil edildi. Hastalarda tespit edilen etyoloji incelendiðinde 150 hastanýn 35’inde ( %23,3 ) eroziv gastrit, 15’inde ( %10 ) mide karsinomu, 14’ünde ( %9,3 ) kolon polibi, 14’ünde ( %9,3 ) myom, 13’ünde ( %8,6 ) divertikülozis, 7’sinde ( %4,6 ) kolon karsinomu, 7’sinde( %4,6 ) menometroraji, 6’sýnda ( %4 ) hemoroid, 6’sýnda ( %4 ) malabsorbsiyon, 4’ünde ( %2,6 ) çölyak hastalýðý, 3’ünde ( %2 ) mesane karsinomu, 3’ünde ( %2 ) hematolojik malignite, 23’ünde (%15,3) diðer nedenler ( nedeni belirlenemeyen ) saptandý.
SONUÇ: Demir eksikliði anemisi saptandýðýnda altta yatan ciddi bir hastalýðýn habercisi de olabilir. Olgularýn çoðunda sebep üst ve alt gastrointestinal sistem kaynaklý hastalýklardýr. Endoskopik incelemeler taný açýsýndan önemlidir. Demir eksikliði anemisi tanýsý alan olgularda gastroskopi, kolonoskopi incelemesinin birlikte yapýlmasýný önermekteyiz. (SETB-2018-09-134)

Objectives: In this study, we aimed to evaluate in-patients with iron deficiency anemia concerning etiology.
Methods: In our study, we retrospectively evaluated 150 in-patients (60 male and 90 female) with iron deficiency anemia in Sisli Etfal Hospital, Department of Internal Diseases between 2005 and 2010. Anemia was defined as Hb <12 g/dl for women and <13 g/dl for men and transferrin saturation ≤15%.
Results: In our study, 60 male and 90 female patients were included. Analyzing the etiology of iron deficiency anemia in 150 patients, we identified erosive gastritis in 35 (23.3%) patients, gastric cancer in 15 (10%) patients, colon polyps in 14 (9.3%) patients, erosive gastritis in 14 (9.3%) patients, myoma in 14 (9.3%) patients, diverticulosis in 13 (8.6%) patients, colon cancer in seven (4.6%) patients, menometrorrhagia in seven (4.6%) patients, malabsorption in six (4%) patients, hemorrhoids in six (4%) patients, celiac disease in four (2.6%) patients, bladder cancer in three (2%) patients, hematologic malignancy in three (2%) and other diseases (unexplained etiology) in 23 (15.3%) patients.
Conclusion: When iron deficiency anemia is detected, it may be a warning of an underlying severe illness. Reasons for many cases arise from upper and lower gastrointestinal tract diseases. Endoscopic examinations are important for diagnosis. We suggest performing gastroscopy and colonoscopy together in patients with iron deficiency anemia.

Amaç: Antenatal steroid tedavisinin (AST) prematüre morbidite ve mortalitesi üzerine olumlu etkileri bilinmektedir ancak laboratuvar belirteçleri üzerine etkisi hakkýnda az sayýda çeliþkili veriler mevcuttur. Prematüre bebeklerde AST’nin erken dönem laboratuvar deðerleri üzerine etkisinin incelenmesi amaçlandý.
Yöntem: Hastanemizde 2008 - 2013 yýllarý arasýnda doðan, gebelik süresi ≤32 hafta olan, týbbi kayýtlarýna ulaþýlabilen bebeklerin dosyalarý geriye dönük olarak incelendi. Antenatal steroid tedavisi, betametazon tek (12 mg) veya iki doz (24 mg) uygulanmýþ bebekler ve hiç uygulanmadan doðmuþ bebekler iki gruba ayrýldý. Gruplar arasýnda demografik özellikler, erken dönem klinik ve laboratuvar bulgularý ve yatýþ sürecinde ortaya çýkan morbiditeler karþýlaþtýrýldý.
Bulgular: Çalýþma dönemi içerisinde doðmuþ 603 bebeðin týbbi kayýtlarý incelendi. Toplam 515 bebeðin verisi analiz edildi. Antenatal steroid alan grupta (n=304), almayanlara göre (n=211), preeklampsi ve oligohidramniyoz sýklýðý daha fazla, APGAR 5. dakika skorlarý daha yüksek ve doðum salonunda entübe olma oraný daha düþük saptandý. Yatýþ sonrasý ilk laboratuvar deðerlendirmelerine göre AST grubunda beyaz küre (BK) sayýlarýnýn düþük ancak trombosit sayýlarýnýn ise daha yüksek olduðu belirlendi. Ýnterlökin-6 (IL-6) ve C reaktif protein (CRP) seviyeleri iki grup arasýnda benzer bulundu.
Sonuç: Bu retrospektif kohortta AST’nin preterm bebeklerin inflamatuvar belirteçleri üzerine anlamlý etkisi gösterilememiþtir. (SETB-2018-12-181)

Objectives: We assessed the effects of antenatal steroid treatment on preterm laboratory analysis conducted in the first 24 hours of life.
Methods: Medical records of inborn preterm infants whose gestational age was ≤32 weeks were retrospectively reviewed in this study. Preterm infants whose mothers received antenatal betamethasone treatment of either 12 mg or 24 mg and who did not were divided into two groups. Maternal and neonatal demographic characteristics, all preterm morbidities and mortality rates, early laboratory examinations were compared between the two groups.
Results: Medical records of 603 infants between 2008 and 2013 were retrospectively reviewed. Data from 515 infants were analyzed. Three hundred and four infants (n=304) were in the antenatal steroid treatment (AST) group and 211 infants were in the group that did not receive the treatment. The incidence of preeclampsia and oligohydramnios was significantly higher in the AST group. Intubation in the delivery room rates decreased in the AST group. APGAR scores at five minutes were significantly higher in the AST group. White blood counts (WBC) significantly decreased, whereas the platelet counts were higher in the AST group. Serum C-reactive protein (CRP) and Interleukin-6 (IL-6) levels did not differ between groups.
Conclusion: We did not demonstrate any relationship between inflammatory markers and antenatal steroid treatment in preterm infants.

Amaç: Baþ-boyun kanserleri, görülme ve ölümlere neden olma sýklýklarý açýsýndan diðer kanser türlerine göre daha alt sýralarda yer almasýna raðmen, yerleþim bölgesinin anatomik ve iþlevsel özellikleri nedeniyle ayrý bir öneme sahiptir. Multidisipliner tedavi rejimlerinde büyük ilerlemelere raðmen, uzun süreli saðkalýmýn iyileþtirilimesi için daha spesifik biyobelirteçleri tanýmlamaya ihtiyaç vardýr. Bu çalýþmada; baþ boyun squamöz hücreli kanserlerde tümör infiltre edici lenfosit yoðunluðunu histopatolojik parametrelerle karþýlaþtýrmayý ve prognoza olan etkisini deðerlendirmeyi amaçladýk.
Gereç ve Yöntemler: Ocak 2010 – Kasým 2013 tarihleri arasýnda Cerrahpaþa Týp Fakültesi Kulak Burun Boðaz Anabilim Dalý’na baþvuran baþ boyun kanseri teþhisi konup cerrahi müdahale yapýlan 114 hasta retrospektif tarama ile incelendi. Hastalarýn yaþ, cinsiyet, alkol-sigara kullaným alýþkanlýklarý, tümör lokalizasyonu kaydedildi. Tümörün boyutu, histolojik differansiyasyonu, tümöre karþý immün cevabý gösteren lenfosit infiltrasyon yoðunluðu, desmoplazik stromal yanýt, kan damarý, perinöral ve lenfovasküler invazyon varlýðý, lenf nodu metastazý ve perinodal yayýlým olup olmadýðý deðerlendirildi. Patolojik preparatlar Hematoksilen-Eozin boyama yapýlýp paraffin bloklar halinde kesitler alýndý, tümör dokusu içerisinde infiltre edici lenfosit yoðunluðu açýsýndan, her biri ayrý þekilde, semi-kantitatif olarak deðerlendirildi.
Bulgular: Çalýþmaya alýnan 114 hasta primer tümör lokalizasyonuna göre deðerlendirildiðinde; 97 hasta (% 85.1) ile larinks kanseri çoðunluðu oluþturmaktaydý. Diðer 17 hastanýn 10’u (% 8.8) oral kavite, 7’si (% 6.1) orofarenks kanseriydi. Lenfosit infiltrasyon yoðunluðu; tümör boyutu, lenfatik, kan damarý ve perinöral invazyon, lenf nodu metastazý, perinodal yayýlým, histolojik grade ve evre ile karþýlaþtýrýldý, aralarýnda anlamlý fark saptanmadý. Desmoplazik stromal yanýt; tümör boyutu (p: 0,014), lenfatik invazyon (p: 0,000), kan damarý invazyonu (p: 0,037), perinöral invazyon (p: 0,002) ve evre (p: 0,006) ile karþýlaþtýrýldý ve aralarýnda istatistiksel olarak anlamlý fark bulundu. Hastalarýn 5 yýllýk sað kalým oranlarýna bakýldýðýnda tümör infiltre edici lenfosit yoðunluðunun ve desmoplazik stromal yanýtýn prognoz üzerine olumlu etkisi olmasýna raðmen istatistiksel olarak anlamlý fark saptanmadý.
Sonuç: Klinik TNM evrelemesi ve histolojik parametrelerin yaný sýra kansere karþý oluþan immün hücrelerin prognoz ve yeni tedavi modelleri belirlenmesinde yol gösterici olacaðýný öngörmekteyiz. Kanser immünoterapisinde, tümör infiltre edici lenfositlerin anti-tümör etkilerinin artýrýlarak, mevcut kanser terapilerini deðiþtireceðini ve umut verici sonuçlar vereceðini düþünmekteyiz. (SETB-2018-12-167)

Objectives: The study aims to determine the ratio of the tumor-infiltrating lymphocytes (TIL) in the tumor microenvironment in squamous cell carcinoma of head and neck and its effect on prognosis using histopathological parameters.
Methods: The patients who underwent head and neck surgery with the diagnosis of squamous cell carcinoma of head and neck at Cerrahpaþa medical faculty ENT Clinic between January 2010 and November 2013 were included in this study. The age, gender, smoking status, alcohol use, radiologic images, and operation technique were analyzed for all patients. TNM pathologic staging, histologic differentiation grade, desmoplastic stromal reaction, vascular and perineural invasion, and lymph node metastasis were also evaluated. Representative hematoxylin-eosin stained slides from each block were cut and the ratio of tumor-infiltrating lymphocytes in tumor tissue was examined by an expert to confirm histology.
Results: In this study, 114 patients (105 males and 9 females) met inclusion criteria and were included. The mean age was 60.3±9.7 (ranging from 27 to 85 years). TIL and desmoplastic stromal reaction were compared statistically to the extent of primary tumor, vascular and perineural invasion, lymph node metastasis and histological grade of the tumor. While there was no statistically significant difference between TIL and these parameters, there was a statistically significant correlation between desmoplastic stromal reaction and these parameters. Considering five years of patient survival, although TIL had a positive impact on the prognosis of the tumor, there was no statistically significant difference.
Conclusion: We suggest that besides TNM pathologic staging and histologic parameters, immune cells reacting to the tumor will be a distinctive factor in determining the prognosis and new treatment methods. We believe that TIL will affect the current cancer treatments by increasing its anti-tumor effects and will give promising results in cancer immunotherapy.

Amaç
Endoskopi iþlemlerinde sedasyon ne kadar sýk yapýlýrsa, yan etki sýklýðý da o kadar artmaktadýr; iþte bu nedenle endoskopi ünitelerinde geliþmiþ monitorizasyon giderek daha önemli hale gelmiþtir.
Bu çalýþmanýn amacý, Bispektral Ýndeks (BIS) monitorizasyonunun iþlemlerde geliþebilecek solunum depresyonunu erken dönemde tespit edip etmediðini deðerlendirmek ve yaygýn olarak kullanýlan klinik sedasyon skoru ile arasýndaki uyumunu belirlemektir.
Materyal ve Metot
Çalýþmaya, etik kurul onayý alýnmasýný takiben Endoskopik RetrogradKolanjiyopankreatografi (ERKP) yapýlmasý planlanan Amerikan Anesteziyologlar Derneði (ASA) fiziksel durumu I olarak belirlenen 18 ila 50 yaþlarý arasýndaki 60 hastanýn verileri dahil edildi.
Tüm hastalara sedasyon sýrasýnda propofol kullanýldý. Sedasyon derinliðini deðerlendirmek için klinik sedasyon skoru olarak Ramsay sedasyon skoru (RSS) kullanýldý. Tüm katýlýmcýlar BIS monitörüne baðlandý. Perioperatif hemodinamik deðerler, BÝS deðerleri, ortalama propofol dozu, iþlem süresi, apne sýklýðý, desatürasyon sýklýðý ve hava yolu ile ilgili yapýlan müdahaleler, demografik parametreler kaydedildi. BIS skorlarý RSS verilerine kör tutuldu.
Bulgular
Araþtýrmayý, 18-50 yaþlarýnda (ortalama: 36.10 ± 8.02) 60 hasta (36 kadýn) oluþturmuþtur. Ortalama iþlem süresi ve Propofol dozu sýrasýyla 32.70 ± 1.79 dk ve 287.17 ± 59.66 mg idi. Solunum depresyonu sýrasýnda kaydedilen BÝS deðerlerini incelediðimizde; ölçümün 15. dakikasýnda 60 olan BÝS skorunun % 96.2 duyarlýlýða ve % 42.9 özgüllüðe; 20. dakikasýnda ölçülen 59.50'lik BÝS skorunun % 98.2 duyarlýlýða ve % 100.0 özgüllüðe ve ölçümün 25. dakikasýnda 59.00'lýk BÝS skorunun% 98.3 duyarlýlýða ve % 50.0 özgüllüðe sahip olduðu görülmüþtür. Regresyon analizi ise ortalama BÝS puanýnýn (p = 0.000,% 95 CI -0.110-0.043) RSS'de birim artýþla 0.076 oranýnda arttýðýný göstermiþtir.
Sonuçlar
BÝS Monitorizasyonunun RSS ile uyumlu olduðu ve sedasyon sýrasýnda geliþebilecek solunum depresyonunu önlemek için kullanýlabileceði kanaatindeyiz. (SETB-2020-05-085)

Objectives: The more often the endoscopy sedation is performed, the more the risk of adverse events, and therefore, advanced monitoring becomes more and more essential in endoscopy units. The present study aims to evaluate whether the Bispectral Index (BIS) monitoring is an early predictor of respiratory depression and to determine the compliance between commonly used clinical sedation score.
Methods: This study was approved by the ethics committee. The sample consisted of 60 patients aged 18 to 50 years with an American Society of Anesthesiologists (ASA) physical status of I scheduled for endoscopic retrograde cholangiopancreatography (ERCP). All patients received propofol mediated sedation. Ramsay sedation score (RSS) was used as a clinical sedation score to assess the depth of sedation. Participants were attached to a BIS monitor. Perioperative hemodynamics, BIS values, the mean dose of propofol, procedure duration, apnea, frequency of oxygen desaturation and airway-related interventions, as well as demographic parameters, were recorded. BIS scores were blinded to RSS data.
Results: The study sample consisted of 60 patients (36 females) aged 18 to 50 years (mean: 36.10±8.02). The mean procedure time and the dose of propofol were 32.70±1.79 min and 287.17±59.66 mg, respectively. The cut-off values for respiratory depression were as follows. At the 15th min of measurement, the BIS score of 60 had 96.2% sensitivity and 42.9% specificity. At the 20th min of measurement, the BIS score of 59.50 had 98.2% sensitivity and 100.0% specificity. At the 25th min of measurement, the BIS score of 59.00 had 98.3% sensitivity and 50.0% specificity. Regression analysis showed that the mean BIS score (p=0.000, 95%CI-0.110-0.043) increased by 0.076 with a unit increase in the RSS.
Conclusion: BIS was highly correlated with RSS, and therefore, can be used to avoid respiratory depression during sedation.

Kolonun divertiküler hastalýðý kas tabakasýndaki bazý zayýflýklar nedeniyle mukozanýn dýþa doðru balonlaþmasý ile oluþan bir patolojidir. Divertiküler hastalýk, semptomatik komplikasyonsuz divertiküler hastalýktan, akut divertikülit veya divertiküler kanama gibi komplikasyonlarý olan semptomatik hastalýða kadar deðiþebilir. Akut kolonik divertikülit, hastalarýn yaklaþýk %10-25’inde görülmektedir. 2016-2019 yýllarý arasýnda hastanemiz acil kliniðine karýn aðrýsý þikayeti ile baþvuran hastalar deðerlendirilerek akut divertikülit tanýsý ile yatýrýlarak tedavi uygulanan 134 hasta çalýþmaya dahil edildi. Hastalarýn cinsiyeti, yaþ, ek hastalýk varlýðý, baþvuru anýnda lökosit ve C-reaktif protein(CRP) yüksekliði, divertikül lokalizasyonu, hinchey sýnýflamasý, ortalama yatýþ süresi ve tedavi þekli deðerlendirildi. Bu parametrelerin komplikasyon ve nüks üzerindeki etkileri istatistiksel olarak incelendi. Hastanede yatýþ süresinin, hinchey sýnýflamasý ile pozitif yönde istatistiksel olarak anlamlý iliþkili saptandý(p<0,001). Medikal olarak tedavi edilen hastalarýn 18'inde daha sonra nüks geliþtiði görülürken bu oran istatistiksel olarak anlamlý bulundu(p<0,001). Hastalýðýn þiddeti ve nüks geliþmesi üzerine rol alabilecek faktörler incelendiðinde bunlardan biri olan lokalizasyonun çalýþmamýzdaki sonuçlarýný deðerlendirdiðimizde rektosigmoid yerleþimin nüks için önemli bir faktör olduðunu saptadýk. Yaptýðýmýz çalýþmada kolondaki lokalizasyonun ve hastalýðýn þiddetinin akut divertikülitin prognozu üzerinde etkili olduðunu gördük. Bu hastalarda cerrahi planlanýrken lokalizasyonun ve geçirmiþ olduklarý hastalýðýn þiddetinin göz önünde bulundurulmasý gerektiði kanaatindeyiz. (SETB-2020-08-141)

Objectives: Diverticular disease of the colon is a pathology that arises from outward ballooning of the mucosa due to some weakness in the muscle layer. Diverticular disease may range from symptomatic uncomplicated diverticular disease to symptomatic disease with complications, such as acute diverticulitis or diverticular bleeding. Acute colonic diverticulitis occurs in about 10- 25% of patients.
Methods: In this study, 134 patients who were admitted to our emergency clinic with complaints of abdominal pain between 2016-2019 and hospitalized with the diagnosis of acute diverticulitis were included. Patients' sex, age, presence of additional disease, increase in leukocyte and C-reactive protein (CRP), localization of diverticulitis, Hinchey classification, mean length of hospital stay and treatment were evaluated. The effects of these parameters on complications and recurrence were statistically analyzed.
Results: The length of hospital stay was statistically significantly associated positively with the Hinchey classification (p<0.001). While 18 patients who were medically treated developed recurrence later, and this rate was statistically significant (p<0.001). When one of the factors, localization, which may play a role in the severity of the disease and recurrence are examined, was evaluated concerning its results in our study, we found that rectosigmoid location is an important factor for recurrence. We found that the localization in the colon and the severity of the disease were effective in the prognosis of acute diverticulitis.
Conclusion: We believe that localization and the severity of the disease should be taken into consideration when planning surgery in these patients.

Amaç: Gebelikte akut apandisit ciddi maternal ve fetal komplikasyonlar ile iliþkili olabilmektedir. Gerek tanýda kullanýlan klinik, laboratuvar ve radyolojik parametreler gerekse seçilen ameliyat yöntemi ve zamanlamasýnýn sonuçlara etkisi tartýþmalýdýr. Bu çalýþmada akut apandisit þüphesi olan gebe hastalarda ayýrýcý tanýda kullanýlan klinik yaklaþýmýn ve cerrahi tedavi yöntemlerinin komplikasyonlar ile olan iliþkisinin ortaya konulmasý amaçlandý.
Yöntem: Aralýk 2007 ile Aðustos 2019 tarihleri arasýnda apendektomi yapýlan 21 gebe hasta çalýþmaya dahil edildi. Yaþ, gebelik yaþý, baþvuru esansýndaki þikayetler, lökosit sayýsý, radyolojik inceleme sonuçlarý, cerrahi yöntem (konvansiyonel veya laparoskopik), histopatoloji sonuçlarý, baþvurudan ameliyata kadar geçen süre, maternal ve fetal komplikasyonlar retrospektif olarak deðerlendirildi.
Bulgular: Komplikasyon geliþen hasta sayýsý 6 (%28,6) idi. Bu hastalarýn yarýsýnda (%14.3) erken doðum, diðer yarýsýnda (%14.3) abortus geliþti. Trimester ile komplikasyon geliþimi arasýnda istatistiksel olarak anlamlý bir iliþki bulunmadý (p=0.747). On dört hastaya (%66.7) laparoskopik cerrahi, 7 hastaya (% 33.3) konvansiyonel cerrahi uygulandý. Laparoskopik grupta komplikasyon oraný daha yüksek olmasýna raðmen istatistiksel olarak anlamlý fark saptanmadý (p=0.306). Serideki fetal kayýp oraný %14.3 olup tamamý laparoskopik gruptaydý. Ancak gruplar arasýnda istatistiksel olarak anlamlý fark yoktu (p=0.158).
Sonuç: Gebeliðe baðlý sýnýrlayýcý faktörler akut apandisit tanýsýný zorlaþtýrmaktadýr. Bu hastalar için standart klinik yaklaþýmýn ötesinde çok daha þüpheci bir tutum ve ek taný araçlarý þarttýr. Tedavide laparoskopik apendektomi güvenli bir seçenek olarak görünse de daha yüksek fetal kayýp riski ile olan iliþkisi göz önünde tutulmalýdýr. (SETB-2020-05-078)

Objectives: Acute appendicitis during pregnancy may be associated with severe maternal and fetal complications. The clinical, laboratory and radiological parameters used in diagnosis and the effects of the surgical method and timing on the results are controversial. The present study aims to reveal the relationship between clinical approach, surgical treatment methods and complications in pregnant women with suspected acute appendicitis.
Methods: Between December 2007 and August 2019, 21 pregnant women who underwent appendectomy were included in this study. Age, gestational age, complaints at admission, leukocyte count, radiological examination results, type of surgery (conventional or laparoscopic), histopathology results, time from admission to operation, maternal and fetal complications were retrospectively evaluated.
Results: The number of patients who developed complications was six (28.6%). Three (14.3%) of these patients had preterm birth and three (14.3%) had an abortion. There was no statistically significant relationship between trimester and complication (p=0.747). Fourteen patients (66.7%) underwent laparoscopic surgery and seven patients (33.3%) underwent conventional surgery. Although the complication rate was higher in the laparoscopic group, there was no statistically significant difference (p=0.306). The fetal loss rate in the series was 14.3% and all were in the laparoscopic group. However, there was no statistically significant difference between the groups (p=0.158).
Conclusion: Pregnancy-related limiting factors may complicate the diagnosis of acute appendicitis. These patients definitely need a more skeptical assessment and additional diagnostic tools beyond the standard clinical approach. Although laparoscopic appendectomy appears to be a safe option in treatment, its relationship with a higher risk of fetal loss should be kept in mind.

Objective: Laparoscopic surgery (LS) is a safe and widely used technique. During LS, carbon dioxide insufflation may produce significant hemodynamic and ventilatory consequences, such as elevated intra-abdominal pressure (IAP) and hypercarbia. Splanchnic and cardiovascular blood flow can be affected by the elevated IAP, which can result in ischemia in the splanchnic region prior to hemodynamic changes. Changes in gastric pH may be an early precursor of changes in splanchnic blood circulation. This study investigated the relationship between gastric pH measurement and IAP in patients undergoing LS.
Materials & Methods: This study included 49 patients aged 18 – 65 years with American Society of Anesthesiologists (ASA) physical status I – III who were undergoing elective laparoscopic cholecystectomy. A gastric pH tonometer probe was applied using an orogastric catheter. Simultaneously, insufflation pressure, cardiac apex beat (CAB), and mean arterial blood pressure (MAP) values were recorded. Indirect IAP was then measured through the bladder. Measurements were performed at baseline; at 15, 30, and 60 minutes after onset of insufflation (AI 15, AI 30, and AI 60, respectively); and at the end of insufflation (EI). Two pH measurements were obtained with a gastric tonometer pH probe, using an automated function of the gastric tonometer to improve measurement reliability.
Results: IAP was significantly higher than baseline at AI 15, AI 30, AI 60, and EI (p < 0.001). The pH1 and pH2 levels were significantly lower at AI 15 and AI 30, compared with baseline (p < 0.001). There were no significant differences between pH1 and pH2 measurements at AI 60 and EI. Compared with baseline, CAB was significantly lower at AI 15, AI 30, AI 60, and EI (p = 0.001, p < 0.001, p = 0.006). There were no statistically significant differences in MAP changes at any time point.
Conclusion: Elevated IAP caused by CO2 insufflation during LS led to reductions of pH1 and pH2. There was a correlation between gastric pH measurement and IAP. Measurement of gastric pH may be useful to assess blood circulation in the splenic area during LS. (SETB-2020-06-107)

Objectives: Laparoscopic surgery (LS) is a safe and widely used technique. During LS, carbon dioxide insufflation may produce significant hemodynamic and ventilatory consequences, such as elevated intra-abdominal pressure (IAP) and hypercarbia. Splanchnic and cardiovascular blood flow can be affected by the elevated IAP, which can result in ischemia in the splanchnic region prior to hemodynamic changes. Changes in gastric pH may be an early precursor of changes in splanchnic blood circulation. This study investigated the relationship between gastric pH measurement and IAP in patients undergoing LS.
Methods: This study included 49 patients aged 18–65 years with American Society of Anesthesiologists (ASA) physical status I – III who were undergoing elective laparoscopic cholecystectomy. A gastric pH tonometer probe was applied using an orogastric catheter. Simultaneously, insufflation pressure, cardiac apex beat (CAB), and mean arterial blood pressure (MAP) values were recorded. Indirect IAP was then measured through the bladder. Measurements were performed at baseline; at 15, 30, and 60 minutes after onset of insufflation (AI 15, AI 30, and AI 60, respectively); and at the end of insufflation (EI). Two pH measurements were obtained with a gastric tonometer pH probe, using an automated function of the gastric tonometer to improve measurement reliability.
Results: IAP was significantly higher than baseline at AI 15, AI 30, AI 60, and EI (p<0.001). The pH1 and pH2 levels were significantly lower at AI 15 and AI 30, compared with baseline (p<0.001). There were no significant differences between pH1 and pH2 measurements at AI 60 and EI. Compared with baseline, CAB was significantly lower at AI 15, AI 30, AI 60, and EI (p=0.001, p<0.001, p=0.006). There were no statistically significant differences in MAP changes at any time point.
Conclusion: Elevated IAP caused by CO2 insufflation during LS led to reductions of pH1 and pH2. There was a correlation between gastric pH measurement and IAP. Measurement of gastric pH may be useful to assess blood circulation in the splenic area during LS.

Objectives: In a thyroidectomy, the external branch of the superior laryngeal nerve (EBSLN) is a potential risk during the superior pole dissection due to its close anatomical relationship with the superior thyroid artery and its highly variable anatomy. In this study, we aimed to evaluate the relationship of EBSLN with the superior pole considering Cernea classification and the factors affecting this relationship.
Methods: The data of thyroidectomized 126 patients (95 female, 31 male) with 200 neck sides (mean age of 45.6±12.1 years) using intraoperative neuromonitoring (IONM) for the EBSLN exploration were evaluated retrospectively. During the superior pole dissection, the EBSLN course was classified according to Cernea classification after being confirmed with IONM. It was defined as a large goiter in the case of the thyroid lobe volume being >50 cc. The factors influencing the presence of type 2b, which has the highest risk of injury, were evaluated using logistic regression analysis.
Results: Of the 200 EBSLNs evaluated, 52 (26%) were type 1, 134 (68%) were type 2a, and 14 (7%) were type 2b. The mean volumes of the resected thyroid lobes were 22±25 cc (min-max: 2-136), 23±20 cc (3-163), and 39±24 cc (3-65) in type 1, 2a and 2b, respectively, which was significantly higher in type 2b (p=0.035). Presence of large goiter rates were 5.8% (n=3), 8.2% (n=11), 64.3% (n=9) in type 1, 2a, and 2b, respectively, and was significantly higher in type 2b (p=0.0001). There was no significant difference between EBSLN Cernea types concerning age, sex, nerve side, presence of cancer and hyperthyroidism. In logistic regression analysis, large goiter was the only independent factor associated with Cernea type 2b. In case of a lobe volume greater than 50 cc, the probability of type 2b presence was approximately 25 times higher (p<0.001, odds ratio: 25.262).
Conclusion: Type 2b course of EBSLN is more common in large goiters, and it is 25 times more likely to be seen in the presence of a lobe volume over 50 cc. Thus, it should be considered that the probability of this high-risk course is significantly higher in large goiters. (SETB-2020-09-184)

Objectives: In a thyroidectomy, the external branch of the superior laryngeal nerve (EBSLN) is a potential risk during the superior pole dissection due to its close anatomical relationship with the superior thyroid artery and its highly variable anatomy. In this study, we aimed to evaluate the relationship of EBSLN with the superior pole considering Cernea classification and the factors affecting this relationship.
Methods: The data of thyroidectomized 126 patients (95 female, 31 male) with 200 neck sides (mean age of 45.6±12.1 years) using intraoperative neuromonitoring (IONM) for the EBSLN exploration were evaluated retrospectively. During the superior pole dissection, the EBSLN course was classified according to Cernea classification after being confirmed with IONM. It was defined as a large goiter in the case of the thyroid lobe volume being >50 cc. The factors influencing the presence of type 2b, which has the highest risk of injury, were evaluated using logistic regression analysis.
Results: Of the 200 EBSLNs evaluated, 52 (26%) were type 1, 134 (68%) were type 2a, and 14 (7%) were type 2b. The mean volumes of the resected thyroid lobes were 22±25 cc (min-max: 2-136), 23±20 cc (3-163), and 39±24 cc (3-65) in type 1, 2a and 2b, respectively, which was significantly higher in type 2b (p=0.035). Presence of large goiter rates were 5.8% (n=3), 8.2% (n=11), 64.3% (n=9) in type 1, 2a, and 2b, respectively, and was significantly higher in type 2b (p=0.0001). There was no significant difference between EBSLN Cernea types concerning age, sex, nerve side, presence of cancer and hyperthyroidism. In logistic regression analysis, large goiter was the only independent factor associated with Cernea type 2b. In case of a lobe volume greater than 50 cc, the probability of type 2b presence was approximately 25 times higher (p<0.001, odds ratio: 25.262).
Conclusion: Type 2b course of EBSLN is more common in large goiters, and it is 25 times more likely to be seen in the presence of a lobe volume over 50 cc. Thus, it should be considered that the probability of this high-risk course is significantly higher in large goiters.

Giriþ: ÖÇB rekonstruksiyonunda tibial fiksasyon öncesi gerilmemiþ otogreftin siklik egzersiz yaptýrýlarak gerdirilmesi gerekliliði bilinmemektedir. Çalýþmanýn amacý; ön çapraz bað yýrtýðý sonrasýnda tek band yöntemi ile bað rekonstruksiyonu yapýlan hastalarý retrospektif olarak deðerlendirilerek, siklik egzersiz uygulanan hastalar ile uygulanmayan hastalarda anlamlý bir fark olup olmadýðýný karþýlaþtýrmaktýr.
Gerec ve Yöntem: 2016–2018 yýllarý arasýnda ön çapraz bað tamiri uygulanan en az 8 ay takibi olan 59 hasta saptandý. Bu hastalardan ameliyatý sýrasýnda tibial tespit öncesi siklik egzersiz uygulanan 30 hasta (Grup 1) ile siklik egzersiz uygulanmayan 29 hasta (Grup 2) deðerlendirildi
Sonuçlar: Grup 1’in Lysholm skoru ortalamasý 95.1 (daðýlým 83–100), Grup 2’nin 87.1 (daðýlým 78–100) saptandý. Grup 1‘in Modifiye Cincinnati skoru ortalamasý 28.7 (24–30), iken Grup 2’nin 26.2 (21-30) saptandý. IKDC subjektif diz deðerlendirme formu skoru ortalamasý Grup 1’de 91,9 (daðýlým 83–100) iken Grup 2’de 86.7 (daðýlým 75–100) saptandý. Grup 1’ de ortalama uyluk atrofi deðeri 1.5 cm, Grup 2’de 2.68 cm saptandý. Grup 1‘de tek ayaðý üzerinde ileri atlama testinde saðlam tarafa göre %85 mesafenin üzerine 23 hasta atlarken, Grup 2 ‘de 11 hastanýn baþarýyla bu mesafeyi atlayabildiði saptandý.
Bu sonuçlara göre ÖÇB rekonstruksiyonu esnasýnda siklik egzersiz yapýlan hastalarýn klinik sonucu yapýlmayanlara göre anlamlý derece de farklýdýr
Çýkarýmlar: Ameliyat sýrasýnda greftin tibial tesbiti öncesi siklik egzersiz uygulanmasýnýn fonksiyel sonuçlar üzerine olumlu etkisi olduðu saptandý. Bu nedenle siklik egzersiz uygulamasýnýn ÖÇB tamiri yapýlan hastalarda ameliyat prosedürüne eklenmesi gerektiði kanýsýndayýz. (SETB-2020-02-019)

Objectives: The necessity of cyclic exercise to pre-stretch the autograft before tibial fixation during ACL reconstruction is unknown. In this study, we evaluated whether there was a statistically significant difference between the results of patients who underwent cyclic exercise by way of physical examinations, knee joint stability tests, and functional evaluation tests, compared with the patients who underwent ACL reconstructions with or without cyclic exercise.
Methods: Between March 2016 and May 2018, 59 patients with at least eight months’ follow-up of an ACL reconstruction were identified. Thirty patients (Group 1) who underwent cyclic exercise before tibial fixation and 29 patients (Group 2) who did not undergo cyclic exercise were evaluated and compared.
Results: The mean age of the patients in Group 1 and Group 2 was 25.9 (range, 18-36) years and 25.2 (range, 18-35) years, respectively. The mean follow-up period in Group 1 was 14.6 (range, 8-22) months and 13.5 months in Group 2 (range, 8-21 months).
The mean Lysholm scores of Group 1 and 2 were 95.1 (range, 83-100) and 87.1 (range, 78-100), respectively. The modified Cincinnati scores of Groups 1 and 2 were 28.7 (range, 24-30) and 26.2 (range, 21-30). The mean IKDC subjective knee evaluation scores in Groups 1 and 2 were 91.9 (range, 83-100) and 86.7 (range, 75-100). The mean thigh atrophy was 1.5 cm in Group 1 and 2.5 cm in Group 2. In Group 1, 23 patients jumped 85% of the distance compared with the intact side in the single-legged hop test, and 12 patients in Group 2 were able to hop this distance successfully.
Group 1 had statistically significantly better results in Lysholm activity scores, modified Cincinnati scores, IKDC subjective knee assessment scores, two-time IKDC activity scale results, comparison of thigh diameters, and single-legged hop tests (p<0.05). No significant difference was found in other examinations and tests.
Conclusion: Cyclic exercise during the operation had a positive effect on functional scores. We believe that cyclic exercise should be added to the operative procedure.

Objectives: The present study aims to conduct a translation and transcultural adaptation of the International Hip Outcome Tool – 12 (IHOT-12) into Turkish and evaluate the psychometric characteristics of the Turkish version of IHOT-12 (IHOT-12-TR) for validity and reliability in Turkish patients with hip joint disorders.
Methods: Following the translation and transcultural adaptation procedures, 109 patients completed the IHOT-12-TR and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale. The retest was completed by 40 patients approximately one week after the initial assessments. The psychometric properties of the questionnaire were tested.
Results: Cronbach's alpha of 0.927 revealed the internal consistency to be highly satisfactory. The overall Interclass coefficient (ICC) between test and retest was 0.927 (p<0.001). The correlation between IHOT-12-TR and WOMAC scores was strong and statistically significant (r=0.815, p<0.001). The explanatory factor analyses revealed that IHOT-12-TR had a single factor structure, explaining 61.9% of the total variance. There was no floor or ceiling effect on the items and overall scale scores.
Conclusion: The results of the analyses in this study demonstrated that the Turkish version of the IHOT- 12 scale, the IHOT-12-TR, is a valid and reliable tool to evaluate the functionality of patients with hip pathologies. (SETB-2020-09-166)

Objectives: The present study aims to conduct a translation and transcultural adaptation of the International Hip Outcome Tool – 12 (IHOT-12) into Turkish and evaluate the psychometric characteristics of the Turkish version of IHOT-12 (IHOT-12-TR) for validity and reliability in Turkish patients with hip joint disorders.
Methods: Following the translation and transcultural adaptation procedures, 109 patients completed the IHOT-12-TR and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale. The retest was completed by 40 patients approximately one week after the initial assessments. The psychometric properties of the questionnaire were tested.
Results: Cronbach's alpha of 0.927 revealed the internal consistency to be highly satisfactory. The overall Interclass coefficient (ICC) between test and retest was 0.927 (p<0.001). The correlation between IHOT-12-TR and WOMAC scores was strong and statistically significant (r=0.815, p<0.001). The explanatory factor analyses revealed that IHOT-12-TR had a single factor structure, explaining 61.9% of the total variance. There was no floor or ceiling effect on the items and overall scale scores.
Conclusion: The results of the analyses in this study demonstrated that the Turkish version of the IHOT- 12 scale, the IHOT-12-TR, is a valid and reliable tool to evaluate the functionality of patients with hip pathologies.

Amaç: Benign ve malign kitlelerin ayrýmý hastalarýn takibinde ve prognozunda kritik öneme sahiptir. Günümüzde tek baþýna hiçbir modalite yeterli sensitiviteye sahip olmadýðýndan tüm parametrelerin kombinasyonunu içeren skorlama sistemleri kullanýlmaktadýr. Bu çalýþmada pelvik kitle skoru (PKS) ve malignite risk indeksi (RMI-3) skorlama sistemlerinin adneksiyal kitlelerin malignite potansiyelini deðerlendirmedeki rolü karþýlaþtýrýlmýþtýr.
Yöntem: Prospektif gözlemsel nitelikteki çalýþmamýza Mart-Ekim 2016 tarihleri arasýnda adneksiyal kitle tanýsý konulan 15-79 yaþýndaki 40 hasta dahil edildi. Hastalar benign(n=20) ve malign(n=20) grup olarak sýnýflandýrýldý. Yaþ, gravida, parite, pelvik muayene bulgularý, medikal ve aile öyküsü, laboratuvar deðerleri, sonografik bulgular, histopatolojik sonuçlar, PMS ve RMI-3 skorlarý kaydedildi.
Bulgular: Hastalarýn ortalama yaþý, CA-125 seviyeleri, Sassone skorlarý ve ultrasonografi skorlarý malign grupta daha yüksek iken rezistans indeksi bu grupta daha düþük saptandý. Hem RMI-3 hem de PMS skorlarý malign grupta daha yüksekti (1728.14±325.3 vs 36.27±31.01, p<0.001 ve 55.31±40.96 vs 9.91±5.29, p<0.001, sýrasýyla). PMS’nin maligniteyi öngördürme gücünü deðerlendirmek için ROC eðrisi çizildi ve cut-off deðer 14 alýnarak eðri altýndaki alan 0.955 ile sensitivite %95, spesifisite %80, pozitif ve negatif kestirim deðerleri %82.6% ve %94.1 olarak hesaplandý (p<0.001). Benzer þekilde RMI-3’ün maligniteyi ayýrt ettirici gücünü deðerlendiren ROC analizinde ise eðri altýndaki alan 0.930 ile >53.2 cut-off deðeri için sensitivite %95, spesifite %75, pozitif kestirim deðeri %79.1 ve negatif kestirim deðeri %93.7 olarak bulundu (p<0.001).
Sonuç: Yaþ, menopoz durumu, tümör belirteçleri ve sonografik parametreler malignite potansiyelini öngörmede tek baþlarýna çok deðerli veriler saðlasa da bunlarýn birlikte kullanýldýðý skorlama sistemleri maligniteyi belirlemede çok daha kuvvetli bir etkiye sahiptir. Çalýþmamýzýn sonuçlarýna göre PKS, RMI-3 sistemine göre daha hassas ve daha kolay uygulanabilir özelliklere sahiptir. (SETB-2018-11-159)

Objectives: Discrimination of benign and malignant adnexal masses is crucial for the follow-up and prognosis of the patient. Since each modality alone does not have enough sensitivity, the combination of all methods called multimodal screening is currently being used. In this study, we aimed to compare pelvic mass score (PMS) and the risk of malignancy index (RMI-3) scoring systems in determining the malignant potential of adnexal masses.
Methods: In this prospective observational study, 40 patients between the age of 15-79 who were diagnosed as an adnexal mass were included between March and October 2016. Patients were classified as benign (n=20) and malignant (n=20). The age, gravida, parity, findings of a pelvic examination, medical and family history, laboratory parameters, sonographic findings, histopathological results, PMS and RMI-3 scores of the patients were recorded.
Results: The mean age, CA-125 levels, Sassone scores and ultrasonography scores of patients were higher in malignant cases, whereas the resistance index was lower. Both RMI-3 and PMS scores were higher in the malignant group (1728.14±325.3 vs. 36.27±31.01, p<0.001 and 55.31±40.96 vs. 9.91±5.29, p<0.001, respectively). Receiver operating curve for the predictive value of PMS to diagnose malignancy was performed and a cut-off value of 14 was determined with the area under the curve (AUC) 0.955 (p<0.001). The sensitivity was 95%, specificity was 80%, positive and negative predictive values were 82.6% and 94.1%. Likewise, the discriminative value of RMI-3 to diagnose malignancy was evaluated by the ROC curve. AUC for RMI-3 was 0.930 with a sensitivity of 95%, the specificity of 75%, the positive predictive value of 79.1% and negative predictive value of 93.7% with a cut-off value of >53.2 (p<0.001).
Conclusion: Age, menopause status, tumor markers and sonographic parameters may be beneficial alone for determining malignancy, whereas the scoring systems integrating all the parameters are more powerful. According to our findings, PMS is more sensitive and more practical than the RMI-3 scoring system.

Rinosinüzit, yaygýn bir enfeksiyon olup nadiren hayatý tehdit eden orbital ve intrakranial ciddi komplikasyonlara yol açabilir. Çalýþmamýzda rinosinüzit komplikasyonu olarak preseptal sellülit ve menenjit birlikteliði geliþen iki olgu literatür verileri eþliðinde sunulmuþtur.
Olgu 1: 9 yaþ 2 aylýk kýz çocuk; ateþ, sol gözde kýzarýklýk ve þiþlik þikayetiyle getirildi. Fizik muayenede sol alt ve üst göz kapaðýnda ileri derece eritem, ödem mevcuttu, göz hareketleri her yöne aðrýsýz ve normaldi. Sistem muayeneleri normal, meningeal iritasyon bulgusu yoktu. Manyetik rezonans (MR) görüntüleme sonucunda preseptal sellülit, etmoid, frontal ve sfenoid sinüzleri içeren rinosinüzit, sol serebral hemisferde dural meningeal kontrast tutulumu saptandý. Hastaya lomber ponksiyon iþlemi sonucunda menenjit tanýsý konuldu. Hasta 14 gün uygun antibiyotik tedavisi sonrasýnda iyileþerek taburcu edildi.
Olgu 2: 8 yaþ 5 aylýk erkek çocuk; ateþ, sol gözde kýzarýklýk ve þiþlik þikayetiyle getirildi. Sol alt ve üst göz kapaðýnda eritem ve ödem mevcuttu. Sistem muayeneleri normal, meningial iritasyon bulgusu yoktu. Bilgisayarlý sinüs tomografisinde pansinüzit ve preseptal sellülit bulgularý saptandý. Tedavi altýnda ateþi devam eden, gözdeki eritem ve ödemi belirginleþen hastaya komplikasyon düþünülerek yapýlan orbital MR görüntülemede sol frontal bölgede kontrast tutulumu izlendi. Lomber ponksiyon iþlemi sonucunda hastaya menenjit tanýsý kondu. Hasta 14 gün uygun antibiyotik tedavisi sonrasýnda iyileþerek taburcu edildi.
Sonuç: Preseptal sinüzite baðlý olarak intrakranial komplikasyon nadir olarak görülmekte ancak hayatý tehdit edebilmektedir. Bu durumlarda radyolojik görütüleme yöntemi olarak MR tercih edilmesini önermekteyiz. (SETB-2019-06-092)

Rhinosinusitis is a common infection and may rarely cause severe life-threatening orbital and intracranial complications. In this study, two cases with preseptal cellulitis and meningitis as a complication of rhinosinusitis were presented in the light of the literature. A nine years and two months old girl was admitted with complaints as fever, redness and swelling in the left eye. Physical examination revealed erythema and edema in the left lower and upper eyelids, and the eye movements were painless and normal in all directions. Her systemic examination was normal and there was no sign of meningeal irritation. Magnetic resonance imaging revealed ethmoid, frontal and sphenoid sinusitis and left cerebral hemisphere dural meningeal contrast enhancement. The patient was diagnosed with meningitis after lumbar puncture. After 14 days of appropriate antibiotic treatment, the patient recovered and was discharged. An eight years and five months old boy presented with fever, redness and swelling in the left eye was admitted. There were erythema and edema in the left lower and upper eyelid; the eye movements were painless in all directions and were complete. Systemic examination was normal; there was no sign of meningeal irritation. Pansinusitis and preseptal cellulitis findings were detected on computer tomography. The patient's fever persisted under treatment and erythema and edema of the eye became more evident. Orbital MRI was performed considering the complication and contrast enhancement was observed in the left frontal region. The patient was diagnosed with meningitis after lumbar puncture. After 14 days of appropriate antibiotic treatment, the patient recovered and was discharged. Intracranial complication due to preseptal sinusitis is rare but life-threatening. In these cases, we recommend the use of MRI as the radiological imaging method.

Fetüs ve yenidoðanýn hemolitik hastalýðý, maternal alloantikorlarýn fetüse geçmesi sonucu ortaya çýkan bir hastalýktýr. Literatürde Rh (D) sensitizasyonuna baðlý yenidoðanýn hemolitik hastalýðýn sýklýðý, anti-D gammaglobulin kullanýmýnýn artmasý ile ters orantýlý olarak azalmýþtýr. Bununla beraber minör kan grubu uygunsuzluklarýnýn etyolojideki önemi artmýþtýr. Minör kan grubu uyuþmazlýðýna baðlý olgularda klinik prezentasyon; subklinik hemoliz bulgularýndan aktif hemoliz ve kan deðiþimi gerektiren hiperbilirubinemiye kadar deðiþkenlik gösterebilir. Bu yazýda anti-c antikor uyumsuzluðuna baðlý hemolitik anemi saptanan bir olgu sunulmuþtur. (SETB-2019-02-023)

Hemolytic disease of the fetus and newborn is a disease that is caused by maternal alloantibodies to the fetus. In the literature, the frequency of hemolytic disease of the newborn due to Rh (D) sensitization decreased inversely with the increase in the use of anti-D gammaglobulin. However, the importance of minor blood group incompatibilities has increased in the etiology. Clinical presentation in patients with minor blood group incompatibility may vary from subclinical hemolysis findings to active hemolysis and hyperbilirubinemia requiring blood exchange. In this case study, we present a patient with hemolytic anemia due to anti-c antibody incompatibility.

Kalçanýn geçici osteoporozu; idiopatik, genellikle kendini sýnýrlayan, orta yaþ erkek ve gebe kadýnlarda görülen, travma öyküsü olmadan kalça aðrýsýyla baþlayan bir tablodur. Bu vaka sunumunda; kalça aðrýsýyla baþvuran ve kalçanýn geçici osteoporozu saptanan bir erkek olgudan bahsedilecektir. Bu vaka sunumunun amacý; ani baþlayan kalça aðrýsýnda ayýrýcý tanýda kalçanýn geçici osteoporozunun da akla gelmesi gerektiðini vurgulamak ve bu konudaki literatürü gözden geçirmektir. (SETB-2018-10-152)

Transient osteoporosis of the hip, idiopathic, is a table, beginning with hip pain without a history of trauma, usually self-limiting and seen in middle-aged men and pregnant women. In this case report, a male patient who was admitted because of hip pain and detected transient osteoporosis go the hip was discussed. The purpose of the case presentation is to emphasize the necessity of transient osteoporosis of the hip in the differential diagnosis of sudden onset of hip pain and to review the literature on this subject.