Objective: The aim of this study was to evaluate the effect of antenatal steroid (AS) administration on the early outcome of premature infants.
Method: The data of premature infants with gestational ages ≤34 weeks who were admitted to the Neonatal Intensive Care Unit between 2008 and 2012 were analysed retrospectively. Infants with major congenital anomalies and borned out of our hospital our hospital were excluded from the study. According to the application of AS infants were divided into 3 groups: completed cure, incompleted cure and without application. The results of early period mortality and morbidity were compared between the three groups.
Results: During this time period 547 infants were borned. The study was completed with 504 infants because of 17 infants have congenital abnormalities and 26 infants referred to different hospitals. In the first 28 days of life 41 (8.1%) infants died. In our study, AS application were found as 20.8% (n=105) of completed cure, 13.3% (n=67) of the incompleted cure with the total of 34.1%. In the infants who were administered completed cure AS, the mortality ratio, the incidence of proven sepsis and ROP were found low statistically (p values: 0.001, 0.02, <0.001, respectively). The length of stay at hospital was significantly higher in infants without application (p: 0.03).
Conclusion: Preterm infants who applicated AS with completed cure had lower incidence of mortality, proven sepsis and ROP. On the other hand in infants without AS application had longer duration of hospitalization. In our country AS application rate is very low and development of appropriate health policies needed for the widespread use of AS.

Introduction and Goal: The effects of enteral alone versus combined enteral and parenteral nutritional support on biochemical parameters, morbidity and mortality were investigated in need for prolonged intensive care after cardiovascular surgery in patients with chronic heart failure.
Material and Methods: Patients were randomly divided into two groups (n=30) depending on enteral nutrition (Group 1, n=30), Group 2; combined enteral and parenteral nutrition (Group 2, n=30). On day 1, 7 and 14; glucose, cholesterol, triglyceride, albumin, alanin aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH); alkalane phospatase (ALP), total bilirubin, gamma glutamil transferase (GGT) and electrolytes were evaluated. Side effects and mortality were recorded.
Results: Demographics and all biochemical parameters revelaed no difference between groups (p>0.05). Within group comparisons revealed no change in glucose levels in Group 1 whereas, there was increase in Group 2 (p=0.01). Cholesterol and triglyceride levels in Group 1 and 2 showed a rise whereas, albumin levels decreased (p<0.001). A decrease in ALP and AST in Group 1 and a decrease
in ALP in Group 2 was observed (p<0.05), there was no difference in LDH and total bilirubin levels. In Group 1, a rise in sodium and chloride levels, a decrease in calcium levels, in Group 2, a rise in sodium and potassium levels were seen. Side effects and mortality showed no difference (p>0.05).
Conclusion: Early enteral nutritional support should be considered first in postoperative period. If the required energy amount can not be achieved, enteral and parenteral nutrition can be used together.

Objective: In our study those having tonsillar actinomyces infection together with obstructive apnea were compared with those having recurrent tonsillitis; the increase in the dimensions of tonsils, its coexistence with lymphoid hyperplasia, tonsillar asymmetry were examined.
Methods: 179 patients, for whom adenotonsiliectomy operation was performed, were investigated. Their symptoms, surgical indications, tonsil dimensions, pathologies after the operation and actinomyces growth were evaluated retrospectively.
Results: Tonsillar actinomyces infection was seen mostly in adult age patients. Actinomyces growth in patients with obstructive apnea was found to be significant in comparison to the cases with recurrent tonsillitis (p<0.05). Actinomyces growth in unilateral tonsil is also found to be important (p<0.05). When tonsils showing actinomyces growth were compared with the tonsil section undergoing hypertrophy, this data is not found meaningful.
Conclusion: Tonsillar actinomyces should be kept in mind in cases operated because of obstructive apnea. In this study, tonsil dimensions were evaluated bilaterally, and correlation of tonsil hypertrophy and actinomyces was proved. Actinomyces growth was shown in asymmetric tonsils, however this hypothesis is not approved since tonsil section undergoing hypertrophy and section with actinomyces growth showed difference.

Objective: Our study aimed to investigate the roles of ultrasonography and magnetic resonance imaging in postoperative screening of patients who have undergone reduction mammaplasty.
Material and Methods: The patients included the study were examined clinically and radiologically on the postoperative 6th months.
Results: In USG imagings, skin thicknesses were increased and locule fluid were accumulated in all patients. Also in MR imagings, parenchyma distortion, asymmetry, focal fibrosis, postoperative locule fluid accumulation and fat necrosis were the most screened findings.
Conclusion: In the literature review, there is no study which asseses the changings occur in breast tissue. With high resolution ultrasonography, the difference of benign or malignant characteristic of lesion can be made even in a very small lesions. In our study we did not find any superiority of MRI to USG. When the the cost were considered into account, USG might be more advantageous.

Objective: This study has been held descriptively with the aim of analyzing the acute intoxication cases of the ones (0-18 years) applying to Pediatric Emergency Unit.
Material and Method: Permission is obtained from the institution before starting the study. 110 children admitting to pediatric emergency unit with the problem of intoxication have been included in the study after their family signed the consent form by being informed about the aim of the study. Descriptive and parametric tests are used for the evaluation of the data gathered by a questionnaire form prepared based on the literature data.
Result: The average age for the cases is 7.7±5.7 (5 months-18 year); 44.5 % of these are in 2-6 age group, 56.4% are female, 61.% are the ones out of school. 57.3% (n=63) of the 110 intoxication cases are drug toxicity (paracetamol 26/63 %) and 65.1% of these are female children. 43.6% of the cases are taken into intensive care unit while 34.5% are hospitalized in service. The average length of hospitalization is 27.6±15.73 hours. 22.7% of the reasons of intoxication (n=5) are suicide, 20% are unconscious drug intake, 19.1% are the drugs left uncovered and 13.6% are home accidents. Gastric lavage is performed to the most of the patients (61.8%) and after giving activated charcoal they are taken into service and received supportive treatment aimed at the symptoms.
Conclusion: The fact that the intoxication is mostly seen in children and mostly results from unconsciousness shows that the education of the family about this issue has great importance. Also female children remain at the forefront of the suicidal drug intoxication. We believe that in order to prevent the childhood intoxication, there must be extensive research with the aim of reducing the mortality
and morbidity and efforts should be made to raise public awareness.

Objective: To investigate the effect of lumbar epidural steroid injection in patients with radiculopathy Materials-Methods: 37 patients with radiculopathy were recruited retrospectively in the study. Radicular, low back pain and paresthesia intensity were evaluated using visual analog scale (VAS); the evidence of nerve stretch was evaluated by straight leg rising (SRL), disability levels were evaluated using the Oswestry Disability Index (ODI) and the quality of life was evaluated by SF-36.
Results: A significant improvement was observed in VAS-radicular and lomber pain levels at the 24th hours post-injection (p<0.01), at the 1st week (p<0.01), at 1st month(p <0.01) and 3rd month (p<0.05). Recovery rate of straight leg raising test was found to be 88% (p<0.05). A statistically significant improvement was found in the ODI levels and the quality of life as assessed by the SF-36 at the1st week (p<0.01) and after 3 months of the treatment (p<0.05).
Conclusion: During the first 3 months of treatment, lumbar epidural corticosteroid injections were effective in patients with radiculopathy.

Introduction: Insulin resistance due to chronic growth hormone (GH) excess in acromegaly and inhibition of insulin and glucagon secretion by long-acting somatostatin analogues (SSA) used in the treatment are the main reasons of the impaired glucose tolerance in acromegalic patients.
Objective: We aimed to determine the effect of long-acting SSA, Octreotide-LAR and Lanreotide-Autogel treatment on glucose homeostasis regarding the insulin resistance and pancreatic β-cell function.
Method: Totally 30 patients (17 male, 13 female; mean age: 44,63±11,85 years) were enrolled in this cross sectional study. Serum IGF-1 concentrations and glucose, insulin, GH levels at 0., 30., 60. and 120. minutes during 75 gr oral glucose tolerance test (OGTT) were measured. Patients were categorized into 3 groups according to their disease activity. Patients cured after operation, patients with active disease after operation but in remission after SSA therapy and patients with active disease after operation and SSA therapy were defined as cure, remission and active group, respectively For the interpretation of glucose homeostasis, formulas for insulin resistance (HOMA-IR, QUICKI) and β-cell function (HOMA-β, Insulinogenic index) were used.
Results: There was no statistically significant difference between groups for HOMA-IR and OUICKI (p=0,78; p=0,781) and also between disease activity and insulin resistance. For the insulinogenic index, which is the marker of early phase of insulin secretion, there was a borderline difference in significance between groups (Insulinogenic index; cure group: 0,97; remission group: 0,52; active group: 0,33; p=0,076). Although no statistically significant difference between groups, HOMA-β of cure group was higher than the other two groups independent of disease activity (HOMA-β: cure group %104; active group %72; remission group %59; p=0,384). In the cure group, the insulin levels during OGTT, the peak insulin secretion during OGTT were higher and the time to reach the peak level was lower than the other groups but not significantly (p=0,420; p=0,176). When parameters determining the glucose homeostasis and disease activity were examined, only statistically significant negative correlation between insulinogenic index and nadir GH was found (r=0,367; p<0,05).
Conclusion: Treatment of long acting SSA in acromegaly leads to inhibition of insulin secretion from pancreatic β-cells, thereby may cause deterioration in glucose homeostasis.

Systemic lupus erythematosus (SLE) which is a chronic autoimmune disease can be presented with neuropsychiatric scenarios. Antibodies that react with neuronal antigens have been blamed in pathophysiology. In this article, current knowledge about the nervous system involvement of the SLE based on cases with epilepsy, polyneuropathy, plexitis, and cerebral vasculitis was reviwed.

Diffuse Idiopathic Skeletal Hyperostosis is a disease characterized by ossification of anterior longitudinal and various extraspinal ligaments with unknown aetiology. Several clinical findings appear due to cervical involvement. One of them is dysphagia and the incidence varies between 17% and 28%. Our case is a 69 year old male complaining dysphagia, cervical pain and limitation for 7 years. After the clinical and radiological examinations he was diagnosed as Diffuse Idiopathic Skeletal Hyperostosis. In this article diagnosis, clinical and radiological features of Diffuse Idiopathic Skeletal Hyperostosis is evaluated and presented by means of literature.

Bilateral thalamic infarction is a rare disorder that account a small fraction of ischemic strokes. The most common reason is the arterial occlusion. However in rare cases, it can be seen secondary to venous thrombosis. Because of the rarity and non-specific clinical symptoms diagnosis is delayed in most of the cases. Radiologic imaging methods are important in diagnosis. In this report, we describe a case in which a woman presented with headache, nausea and vomiting.

Osteonecrosis is a disease of unknown origin which degenerates the structure of the joint and causes progressive loss of function. While osteonecrosis mostly affects hip joint, it is a pathologic condition which is rarely seen in knee joint.The most frequent type of knee osteonecrosis is idiopathic osteonecrosis (spontaneous). Spontaneous osteonecrosis is more common in patients older than 60 years. In
this case report, a 39-year-old female patient diagnosed as having spontaneous osteonecrosis of the knee after a sudden pain was presented.

Backround: Metabolic acidosis is an acid-base disturbance, which is characterized by primary consumption of body buffers and causing decreased blood HCO3- level. In this article we discus a case with severe metabolic acidosis (pH=6.66) due to diarrhea that was caused by chemotherapeutic agents.
Case: The patient was a male aged 20 and had colon cancer with bone metastase. He started getting chemotherapy three months ago. When he was seen in the emergency service he was unconscious and had convulsion. He had diarrhea in his history. He was intubated and put on the mechanical ventilator after admittance to the ICU. Arteriel blood gas values were pH: 6.66, PaCO2: 102 mmHg, PaO2: 307 mmHg, HCO3: 10.7 mmol L-1, SpO2: %97, BE: -23 mmol L-1 and laktat: 28 mmol L-1. Convulsion were stopped after giving benzodiazepine and barbiturate respectively. Fluid and NaHCO3 replacement were provided. After ten hours arteriel blood gas values were measured as normal and he was extubated. He was transferred to an oncology clinic after observation for 3 days.
Result: It should be considered that risk of severe metabolic acidosis and planing early and suitable therapy when developed diarrhea in patients who are used chemotherapy.