ISSN : 1302-7123 | E-ISSN : 1308-5123
The Medical Bulletin of Sisli Etfal Hospital - Med Bull Sisli Etfal Hosp: 53 (2)
Volume: 53  Issue: 2 - 2019
INVITED REVIEW ARTICLE
1.Limitations of Continuous Neural Monitoring in Thyroid Surgery
Ettore Caruso, Antonella Pino, Alessandro Pontin, Giulia Pinto, Cristina Damiano, Antonina Catalfamo, Fausto Famà, Gianlorenzo Dionigi
PMID: 32377063  PMCID: PMC7199830  doi: 10.14744/SEMB.2019.85698  Pages 81 - 83
Continuous intraoperative neuromonitoring is currently the gold standard technique available to prevent recurrent laryngeal nerve injuries. It significantly reduces the complication rate compared with intermittent intraoperative neuromonitoring, and represents significant progress in thyroid surgery, particularly in cases of more difficult dissections.
There are, however, some technological and interpretative limits related to the lack of standardization of continuous intraoperative neuromonitoring and the prolonged length of time employed in the surgical positioning of the probe, despite various proposed approaches to the vagal nerve.
Nonetheless, this method can be considered a safe and modern approach to thyroid surgery that reduces post-surgical complications and provides useful information.
Continuous intraoperative neuromonitoring is currently the gold standard technique available to prevent recurrent laryngeal nerve injuries. It significantly reduces the complication rate compared with intermittent intraoperative neuromonitoring, and represents significant progress in thyroid surgery, particularly in cases of more difficult dissections.
There are, however, some technological and interpretative limits related to the lack of standardization of continuous intraoperative neuromonitoring and the prolonged length of time employed in the surgical positioning of the probe, despite various proposed approaches to the vagal nerve.
Nonetheless, this method can be considered a safe and modern approach to thyroid surgery that reduces post-surgical complications and provides useful information.

REVIEW ARTICLE
2.Intraoperative Adjunct Methods for Localization in Primary Hyperparathyroidism
Nurcihan Aygun, Mehmet Uludag
PMID: 32377064  PMCID: PMC7199831  doi: 10.14744/SEMB.2019.37542  Pages 84 - 95
Primary hyperparathyroidism (pHPT) is a frequently seen endocrine disease, and its main treatment is surgery. In the majority of pHPT, the disease involves only a single gland, and the majority of the pathological glands can be determined by preoperative localization methods.In addition to preoperative localization studies in parathyroidectomy, the use of adjunct methods to improve intraoperative localization in order to increase success of surgery is becoming widespread. These methods include different approaches, mainly intraoperative parathyroid hormone (PTH) measurement, followed by intraoperative gamma probe application, intraoperative ultrasonography, parathyroid imaging with methylene blue, and frozen section examination. Recently, especially promising new imaging methods have been described in the literature with various optical technologies to increase the localization of the parathyroid glands and to evaluate their viability. These methods include parathyroid imaging with autofluorescence, indocyanine green imaging with autofluorescence, autofluorescence imaging with methylene blue, autofluorescence imaging with 5-aminolevulinic acid, optical coherence tomography, laser speckle contrast imaging, dynamic optical contrast imaging, and Raman spectroscopy. Currently, minimally invasive parathyroidectomy has become the standard treatment for selected pHPT patients with the aid of preoperative imaging and intraoperative auxiliary methods. The aim of the present study was to evaluate the routinely used new promising intraoperative adjunct methods in pHPT.
Primary hyperparathyroidism (pHPT) is a frequently seen endocrine disease, and its main treatment is surgery. In the majority of pHPT, the disease involves only a single gland, and the majority of the pathological glands can be determined by preoperative localization methods.In addition to preoperative localization studies in parathyroidectomy, the use of adjunct methods to improve intraoperative localization in order to increase success of surgery is becoming widespread. These methods include different approaches, mainly intraoperative parathyroid hormone (PTH) measurement, followed by intraoperative gamma probe application, intraoperative ultrasonography, parathyroid imaging with methylene blue, and frozen section examination. Recently, especially promising new imaging methods have been described in the literature with various optical technologies to increase the localization of the parathyroid glands and to evaluate their viability. These methods include parathyroid imaging with autofluorescence, indocyanine green imaging with autofluorescence, autofluorescence imaging with methylene blue, autofluorescence imaging with 5-aminolevulinic acid, optical coherence tomography, laser speckle contrast imaging, dynamic optical contrast imaging, and Raman spectroscopy. Currently, minimally invasive parathyroidectomy has become the standard treatment for selected pHPT patients with the aid of preoperative imaging and intraoperative auxiliary methods. The aim of the present study was to evaluate the routinely used new promising intraoperative adjunct methods in pHPT.

3.Approach Toward Diabetes Treatment in the Elderly
Yüksel Altuntaş
PMID: 32377065  PMCID: PMC7199825  doi: 10.14744/SEMB.2019.00868  Pages 96 - 102
Concomitant diseases in elderly individuals with diabetes (renal failure, heart failure, ischemic heart disease, stroke, urinary incontinence, cognitive impairment, dementia, sarcopenia, and osteoporosis) make diabetes management difficult. Therefore, other comorbid conditions should be taken into account in elderly diabetics when considering a treatment approach. The use of oral antidiabetic agents in individuals older than 75 years may be limited. Although the diabetes treatment is not any different in healthy elderly patients, hypoglycemia is one of the most feared conditions, especially in the elderly. Therefore, metformin, DPP-IV inhibitors, and SGLT2 inhibitors should be considered in the first place with less risk of hypoglycemia. Low-dose sulfonylureas may also be used in selected cases. The use of new antidiabetic drugs, such as GLP-1 anologues and SGLT2 inhibitors, has strengthened our ability to cope with the risk of hypoglycemia and cardiovascular events, which are the two most important drawbacks in the treatment of elderly people with diabetes. Insulin treatment should be individualized, and the most rare injection regimens should be used. In case of failure of OAD, basal insulin should be added to the current treatment, and if necessary, a basal + plus regimen should be planned by adding bolus insulin 1/2/3 times per day to the meals. As a result, in elderly diabetics, an inadequate treatment or excessive treatment and individualizing the treatment should be the most appropriate approach.
Concomitant diseases in elderly individuals with diabetes (renal failure, heart failure, ischemic heart disease, stroke, urinary incontinence, cognitive impairment, dementia, sarcopenia, and osteoporosis) make diabetes management difficult. Therefore, other comorbid conditions should be taken into account in elderly diabetics when considering a treatment approach. The use of oral antidiabetic agents in individuals older than 75 years may be limited. Although the diabetes treatment is not any different in healthy elderly patients, hypoglycemia is one of the most feared conditions, especially in the elderly. Therefore, metformin, DPP-IV inhibitors, and SGLT2 inhibitors should be considered in the first place with less risk of hypoglycemia. Low-dose sulfonylureas may also be used in selected cases. The use of new antidiabetic drugs, such as GLP-1 anologues and SGLT2 inhibitors, has strengthened our ability to cope with the risk of hypoglycemia and cardiovascular events, which are the two most important drawbacks in the treatment of elderly people with diabetes. Insulin treatment should be individualized, and the most rare injection regimens should be used. In case of failure of OAD, basal insulin should be added to the current treatment, and if necessary, a basal + plus regimen should be planned by adding bolus insulin 1/2/3 times per day to the meals. As a result, in elderly diabetics, an inadequate treatment or excessive treatment and individualizing the treatment should be the most appropriate approach.

4.Three-dimensional Computerized Tomography and Multiplanar Imaging of Developmental Hip Dysplasia
Müjdat Bankaoğlu
PMID: 32377066  PMCID: PMC7199829  doi: 10.14744/SEMB.2019.79095  Pages 103 - 109
Gelişimsel kalça displazisi halen dünyada en önemli ortopedik sorunlardan biri olma özelliği taşır.Dünya genelinde izlenen yoksullaşma ve gelişmiş ülkelerde yaşanan sığınmacı krizi genelde gelişmekte olan ülkelerde izlenen bu durumu daha global bir sorun haline getirmektedir. Erken tanı ve etkin tedavi olmadığında kalçada artroz,ekstremite kısalığı,pelvis asimetrisi ve skolyoz gibi sorunlar kalıcı hale gelmektedir.Tanıda uzun yıllardan bu yana kullanılan direkt grafi halen kılavuz görüntüleme olarak önemli yere sahiptir.Ultrasonografi tamamen erken doğum sonrası tarama ve için kullanılır. Manyetik rezonans görüntüleme çoğu durumlarda en önemli modalite olarak kullanılsa da bilgisayarlı tomografi(BT) ve üç boyutlu bilgisayarlı tomografi geç dönem displazilerde kemik yüzey yapılardaki deformasyonu daha etkin gösterdiği için tercih edilmektedir., Bu derlemede kalça displazisi hakkında basit görüntüleme bilgileri vererek üç boyutlu BT nin geç dönem olgularda görüntüleme özelliklerinden bahsedilmektedir.
Developmental dysplasia of the hip (DDH) is still one of the biggest orthopedic problems in the world. Global poverty and refugee crises have led to it becoming a greater issue even in developed nations. Early diagnosis and effective treatment of DDH are required to prevent the possibility of arthrosis, limb shortening, pelvic asymmetry, and vertebral scoliosis. In late cases, surgery is the only choice for correction. Direct radiography has been used for many years and continues to have an important role, though ultrasonography is the primary source for early postnatal screening. Although magnetic resonance imaging (MRI) has become an important modality to provide sectional imaging in many cases, in late-period dysplasia, computed tomography (CT) and three-dimensional (3D) CT are preferred because it can more effectively demonstrate the cortical bony structures. The aim of this review was to demonstrate the effectiveness of 3D CT and multiplanar reconstruction based on previous studies.

ORIGINAL RESEARCH
5.The Effect of Technical Problems on the Operation Process in Pediatric Laparoscopy
Mehmet Özgür Kuzdan, Reyhan Alim, Birgül Karaaslan, Süleyman Çelebi, Özaydin Seyithan
PMID: 32377067  PMCID: PMC7199834  doi: 10.14744/SEMB.2018.74436  Pages 110 - 113
AMAÇ: Laparoskopi ameliyatlarındaki teknik sorunların saptanarak, sonuçlarının değerlendirilmesi amaçlandı.
GEREÇ VE YÖNTEMLER: Kliniğimizde 2012-2017 yılları arasında yapılan, 30 laparoskopik ameliyatta karşılaşılan teknik sorunlar geriye dönük incelendi.
BULGULAR: Laparoskopi ameliyatı yapılan 30 olguda yaşanan teknik sorunlar analiz edildi. Olgulara yapılan ameliyatlar; 6 splenektomi, 15 apendektomi, 1 hernioplasti, 2 over kist eksizyonu, 4 kolesistektomi, 1 karın içi testis araştırılması, 1 varikosel ameliyatı idi. On olguda enstrüman sorunu, 8 olguda insan hatası, 12 olguda cihaz sorunu, 2 olguda birden fazla sorun görüldü. Beş olguda açık ameliyata geçildi.
SONUÇ: Teknik sorunlar, ameliyat süresinin uzamasına açık ameliyata dönülmesine neden olmaktadır. Bu sorunların çözümü için kayıt altına alınması ve rapor edilerek koruyucu önlemlerin alınması gereklidir.
Objectives: The aim of this study was to determine the technical problems in pediatric laparoscopic surgery and to evaluate its results.
Methods: The technical problems encountered in 30 laparoscopic operations performed between 3 November 2012 and 31 December 2017 were retrospectively analyzed.
Results: The technical problems experienced in 30 laparoscopic surgeries were analyzed. There were 6 splenectomies, 15 appendectomies, 1 hernioplasty, 2 ovarian cyst excisions, 4 cholecystectomies, 1 intra-abdominal exploration of the testes, and 1 varicocele surgery. The technical errors included instrument failure in 10, human errors in 8, device problems in 12, and multiple problems in 2 cases. In 5 patients, we switched to open surgery.
Conclusion: Technical problems prolong the operation, and cause a conversion to open surgery. In order to solve these problems, it is necessary to register and report these problems and take the necessary preventive measures.

6.Comparison of Clinical Outcomes of Single-Incision Versus Conventional Multiport Laparoscopic Distal Pancreatectomy: A Single Institution Experience
Orhan Agcaoglu, Nihat Aksakal, İbrahim Fethi Azamat, Selim Doğan, Selçuk Mercan, Umut Barbaros
PMID: 32377068  PMCID: PMC7199824  doi: 10.14744/SEMB.2019.37880  Pages 114 - 119
Son yillarda ozellikle insizyona bagli morbiditenin daha az olmasi ve daha iyi kozmetik sonuclar sebebiyle tek kesiden yapilan laparoskopik cerrahi islemlerinin popularite artmistir. Bu calismamizda tek kesi ile coklu kesiden yapilan laparoskopik distal pankreatektomi ameliyatlarinin uygulanabilirligini ve sonuclarini karsilastirmayi amacladik. Yontem: Calismamiza Mart 2007 ile Subat 2014 tarihleri arasinda klinigimizde ardisik olarak tek kesiden ve coklu kesiden laparoskopik distal pankreatektomi ameliyati yapilmis olan hastalarimizi dahil ettik. Hastalarimizi cerrahi teknige uygun olarak tek kesiden (grup 1) ve coklu kesiden (grup 2) laparoskopik distal pankreatektomi yapilan hastalar olmak uzere iki gruba ayirdik. Karsilastirmada ameliyat suresi, ameliyat sonrasi agri, hastanede yatis suresi, komplikasyonlar, aciga gecis orani, tahmini kanama miktari ve patoloji sonuclarini degerlendirdik. Bulgular: Calismada her grupta 10 hasta olmak uzere toplam 20 hasta mevcuttu. Gruplar arasi hasta profilleri benzerdi ve her iki grupta da mortalite yoktu. En sik gorulen morbidite, iki gruptada spontan iyilesen dusuk debili pankreas fistuluydu (%30). Ameliyat suresi, 2. grupta 1. gruba gore istatistiksel olarak daha kisa olculdu (p<0.001). Grup 2'de 1 hastada peroperatif kanama sebebiyle acik teknige gecildi. Grup 1'de sadece bir vakada dalak korunabilirken, grup 2'de bes vakada korundu. Sonuc: Tek kesiden yapilan laparoskopik teknik, standart olarak coklu kesiden uyguanan laparoskopik distal pankreatektomi ile benzer sonuclar saglamaktadir ve ileri laparoskopi uygulanan merkezlerde guvenle tercih edilebilir.
Objectives: Single-incision laparoscopic procedures have been gaining popularity in recent years due to their minimal incisional morbidity and improved cosmetic outcomes. Herein, we will compare the feasibility and outcomes of single-incision and conventional multiport laparoscopic distal pancreatectomy.
Methods: This study involves consecutive patients who underwent either single-incision or conventional multiport laparoscopic distal pancreatectomy from March 2007 to February 2014. The patients were divided into two groups, based on the surgical approach: single-incision laparoscopic surgery (Group 1) and conventional multiport laparoscopic surgery (Group 2). The parameters evaluated included estimated blood loss, operative time, postoperative pain, duration of hospital stay, complications, conversion, and final pathology.
Results: There were a total of 20 patients, 10 in each study group. Baseline characteristics were similar, and there was no mortality in either of the groups. The low-flow pancreatic fistula was the most commonly seen morbidity, but it was ceased spontaneously in each group by a ratio of 30%. The operative time was significantly shorter in Group 2, with a mean of 116 minutes versus a mean of 180 minutes for Group 1 (p<0.001). One of the procedures in Group 2 was converted to open surgery due to peroperative bleeding. The median follow-up periods of the patients were 22 months and 56 months. The spleen was preserved in only 1 patient from Group 1, whereas in Group 2, the spleen preservation was achieved in 5 patients.
Conclusion: The single-incision laparoscopic technique is a safe and effective alternative to standard laparoscopic distal pancreatectomy.

7.Clinicopathologic Differences Between Micropapillary and Papillary Thyroid Carcinoma
Kinyas Kartal, Nurcihan Aygun, Mehmet Uludag
PMID: 32377069  PMCID: PMC7199821  doi: 10.14744/SEMB.2019.68790  Pages 120 - 124
Objectives: The aim of this study is observing the clinicopathologic features of thyroid papillary microcarcinomas (PTMs) and comparing these features with papillary thyroid carcinoma (PTC).
Methods: A total of 86 surgically treated patients suffering from PTC were evaluated retrospectively. Group 1 (G1) included patients with a tumor <1 cm, while Group 2 (G2) included patients with a tumor >1 cm. The two groups were compared in terms of the preoperative thyroid-stimulating hormone (TSH) level, anti-thyroid peroxidase antibody (anti-TPO) and antithyroglobulin antibody (TgAb) values, multicentricity, the lymphovascular invasion rate, the presence of extrathyroidal extension, and central and/or lateral lymph node metastasis.
Results: There was no statistically significant difference observed between the groups in terms of the preoperative TSH level, anti-TPO, and TgAb values. The rate of multicentricity of the tumor in G2 was 66%, while it was 36% in G1 (p<0.001). The lymphovascular invasion rate in G1 was 14.2%, while it was 61% in G2 (p<0.001). The extrathyroidal extension rate of the tumor cells in G1 was 21.4%, while it was 63.6% in G2 (p<0.001). The central lymph node metastasis rate in G2 was 38.6%, while it was 4.8% in G1 (p<0.001). The lateral lymph node metastasis rate in G2 was 20.5%, while it was 0% in G1 (p<0.001).
Conclusion: PTMs are generally associated with good prognostic factors with high survival rates. However, the risk factors such as multifocality, extrathyroidal extension, and lymphovascular invasion increasing the recurrence risk are not rare in PTM. Thus, the patients having these histopathological features of the tumor should be followed more carefully.
Objectives: The aim of this study is observing the clinicopathologic features of thyroid papillary microcarcinomas (PTMs) and comparing these features with papillary thyroid carcinoma (PTC).
Methods: A total of 86 surgically treated patients suffering from PTC were evaluated retrospectively. Group 1 (G1) included patients with a tumor <1 cm, while Group 2 (G2) included patients with a tumor >1 cm. The two groups were compared in terms of the preoperative thyroid-stimulating hormone (TSH) level, anti-thyroid peroxidase antibody (anti-TPO) and antithyroglobulin antibody (TgAb) values, multicentricity, the lymphovascular invasion rate, the presence of extrathyroidal extension, and central and/or lateral lymph node metastasis.
Results: There was no statistically significant difference observed between the groups in terms of the preoperative TSH level, anti-TPO, and TgAb values. The rate of multicentricity of the tumor in G2 was 66%, while it was 36% in G1 (p<0.001). The lymphovascular invasion rate in G1 was 14.2%, while it was 61% in G2 (p<0.001). The extrathyroidal extension rate of the tumor cells in G1 was 21.4%, while it was 63.6% in G2 (p<0.001). The central lymph node metastasis rate in G2 was 38.6%, while it was 4.8% in G1 (p<0.001). The lateral lymph node metastasis rate in G2 was 20.5%, while it was 0% in G1 (p<0.001).
Conclusion: PTMs are generally associated with good prognostic factors with high survival rates. However, the risk factors such as multifocality, extrathyroidal extension, and lymphovascular invasion increasing the recurrence risk are not rare in PTM. Thus, the patients having these histopathological features of the tumor should be followed more carefully.

8.Approach to Patients with Malignant Melanoma of Unknown Primary Origin
Selami Serhat Sirvan, Hikmet İhsan Eren, Sevgi Kurt Yazar, Ali Can Gunenc, Ayşin Karasoy Yeşilada, Fatih Irmak, Deniz Tuncel
PMID: 32377070  PMCID: PMC7199841  doi: 10.14744/SEMB.2019.52333  Pages 125 - 131
Amaç: Malign melanom tm cilt kanserlerin %3'ünü oluşturmasına rağmen, cilt kanserleri ölümlerinin %75'ini oluşturmaktadır. Bizim çalışmamızda, tüm olgular kliniğimizde tanı konulup tedavisi yapılmıştır ve primeri belli olmayan malign melanom olguları detaylı olarak değerlendirilip bir tedavisi yapılmıştır.
Yöntem: Ocak 1991 ve Nisan 2017 tarihleri arasında retrospektif olarak primeri belli olmayan malign melanom olguları değerlendirilmeye alınmıştır. Bu hastalar yaş, cinsiyet, tümör tipi, Breslow değerleri, metastazları ve tedavileri açısından değerlendirilmiştir. Tüm malign melanom hastlarımızdan 4 vakada primeri belli olmayan malign melanom tanısı konulmuştur.
Bulgular: Ocak 1991 ve 2017 Nisan tarihleri arasında 173 malign melanom hastasının tanısı ve tedavisi kliniğimizde yapılmıştır. Malign melanom subtipi olarak hastlarımızda, 45 nodüler tip, 43 akral lentiginöz tip, 63 yüzeyel yayılan tip,15 lentigo malign melanom tip, 7 subungual tip belirlenmiş, 10 hastamızda subtip belirlenememiştir.
Sonuç: İdeal malign melanom tedavisi multidisipliner yaklaşım gerektirmekte olup, plastik cerrahi temel rol üstlenmektedir.
Objectives: Although malignant melanoma accounts for 3% of skin cancers, it is responsible for 75% of deaths associated with skin cancer. In our study, all melanoma cases diagnosed and treated at our clinic were retrospectively reviewed, and the cases of unknown primary origin among them were examined in detail in terms of diagnosis and treatment.
Methods: The patients with malignant melanoma treated at the inpatient services of our clinic between January 1991 and April 2017 were retrospectively screened in the records. These patients were evaluated for age, sex, tumor type, Breslow depth, metastasis, and treatment. Among these patients, four cases of unknown primary origin were examined in detail.
Results: During January 1991 and April 2017, 173 patients received inpatient care for malignant melanoma at our clinic. As regards to the melanoma subtypes, nodular type in 45 patients, acral lentiginous type in 43 patients, superficial spreading type in 63 patients, lentigo maligna melanoma in 15 patients, subungual type in 7 patients, and either unidentified melanoma or other subtypes in 10 patients were identified.
Conclusion: The ideal treatment of a patient with melanoma is multidisciplinary, with plastic surgery having a central role.

9.Platelet Indices as the Predictor of Antibiotics Response in Surgical Wound Infections Following Total Abdominal Hysterectomy
Aysu Akça, Gulseren Yilmaz, Nadiye Köroğlu
PMID: 32377071  PMCID: PMC7199835  doi: 10.14744/SEMB.2019.46693  Pages 132 - 136
Amaç: Ortalama trombosit hacmi (OTH) ve OTH/Trombosit sayısı oranı inflamasyonun belirteçleri olarak bilinmektedirler. Bu çalışmada cerrahi histerektomi uygulanan ve uygun antibiyotik tedavisine rağmen yara yeri enfeksiyonu gelişen hastalarda OTH ve OTH/Trombosit oranının yara iyileşmesi için bir belirteç olup olmadığını araştırmayı amaçladık.
Yöntem: Abdominal histerektomi (TAH) sonrası yara yeri enfeksiyonu gelişen 100 hasta geriye dönük olarak çalışmaya dahil edildi. Tam kan sayımı için kan örnekleri cerrahiden önceki gün alındı. Tüm hastalar cerrahi öncesi ve sonrası antibiyotik profilaksisi ve yara yeri enfeksiyonu için uygun antibiyotik aldı. Standart bakım ve antimikrobiyal tedavi ile iyileşen hastalar standart tedavi grubu olarak adlandırıldı. Standart bakıma rağmen gelişme olmayan ve gecikmiş primer kapama planlanan hastalar gecikmiş primer kapama grubu olarak adlandırıldı.
Bulgular: Gecikmiş primer kapama grubunda standart tedavi grubuna göre trombosit sayıları daha azdı (319.5±66 103/µL’ ye karşı 392±121 103/µL; p< 0.05) ancak OTH (9.2±1.3 fL’ye karşı 8.2±1.5 fL; p< 0.05) ve OTH/Trombosit oranı (0.030 ± 0.006’ ye karşı 0.024±0.014; p< 0.05) ve anlamlı şekilde yüksekti. ROC eğrisi analizi standart tedaviye yanıtsızlığı belirlemede OTH için 8.28 fL değerini (Eğri altındaki alan: 0.647, 72% sensitivite ve 52% spesifisite), OTH/Trombosit oranı için 0.025 oranını (Eğri altındaki alan: 0.750, 75% sensitivite ve 67% spesifisite) kesim değeri olarak belirledi.
Sonuç: Yüksek preoperatif OTH ve OTH/Trombosit oranı TAH sonrası kötü yara iyileşmesi için belirteç olabilir.
Objectives: The mean platelet volume (MPV) and the MPV-to-platelet (PLT) count ratio have long been reported as inflammation markers. In this study, we aimed to investigate the predictive value of the MPV and the MPV-to-PLT ratio on surgical wound healing in patients who underwent abdominal hysterectomy and experienced infections at the surgical site following surgery, despite adequate antimicrobial treatment.
Methods: A total of 100 patients who encountered surgical wound infection (SWI) after abdominal hysterectomy were enrolled retrospectively. Samples for complete blood count were drawn the day before the operation. All patients received preoperative and postoperative antibiotic prophylaxis and proper antimicrobial treatment following the SWI development. Patients’ condition resolved after standard care and antimicrobial agents were classified as the standard care group. Others, in whom an improvement despite the standard care was not observed, underwent delayed primary closure and were classified as the delayed primary closure group.
Results: The PLT count was decreased (319.5±66 103/µL vs. 392±121 103/µL; p<0.05), MPV(9.2±1.3 fL vs. 8.2±1.5 fL; p<0.05), and the MPV-to-PLT ratio (0.030±0.006 vs. 0.024±0.014; p<0.05) was increased in the delayed primary closure group compared to the standard care group. A receiver operating characteristic curve analysis was performed to determine the predictive value of these parameters on the response to standard care measures providing 8.28fL as a cut-off value for MPV (AUC=0.647, 72% sensitivity and 52% specificity) and 0.025 as a cut-off value for the MPV-to-PLT ratio (AUC=0.750, 75% sensitivity and 67% specificity) for predicting nonresponsiveness.
Conclusion: An increased preoperative MPV and the MPV-to-PLT ratio may predict poor wound healing following total abdominal hysterectomy.

10.The Effect of Single High-Dose Preoperative Intravenous Tranexamic Acid Administration to Reduce Blood Loss in Patients with Primary Total Knee Replacement
Mehmet Ali Talmaç, Mehmet Akif Görgel, Sema Ertan Birsel, Mehmet Mesut Sönmez, Hacı Mustafa Özdemir
PMID: 32377072  PMCID: PMC7199840  doi: 10.14744/SEMB.2018.73604  Pages 137 - 142
Amaç: Bu çalışmanın amacı total diz replasmanı (TDR) yapılan hastalarda ameliyat öncesi intravenöz tek doz 20 mg/kg traneksamik asit (TA) uygulamasının etkinliğini analiz etmektir.
Yöntem: Ocak 2014 ile Aralık 2018 arasında TDR uygulanan toplam 387 hasta (82 erkek, 305 kadın) çalışmaya alındı. T + grubu, cilt insizyonundan önce intravenöz (iv) TA 20 mg / kg uygulanan hastalardan oluşuyordu. Ameliyat sonrası kan kaybını, postoperatif 24 saat sonra drenaj miktarını, postoperatif 24-48 saat arası drenaj miktarını, drenlerden gelen toplam hacmi, total kan kaybını, postoperatif hemoglobin ve hematokrit seviyelerini ve total kan transfüzyon miktarını belirledik.
Bulgular: Gruplar arasında demografik veriler açısından istatistiksel olarak anlamlı bir fark yoktu. Perioperatif kan kaybı ve total kan kaybı, T - grubunda, T + grubuna göre istatistiksel olarak daha yüksek bulundu. Postoperatif dönemde, T - grubunun ortalama hemoglobin ve hematokrit düzeyleri, T + grubundan istatistiksel olarak anlamlı derecede düşüktü.
Çıkarımlar: TDR'den önce tek bir doz 20 mg/kg iv TA uygulaması ameliyat sırasında ve postoperatif 24 saat içinde kanamayı azaltır.
Objectives: This study aimed to analyze the efficacy of single-dose tranexamic acid (TA) 20 mg/kg preoperatively to reduce blood loss in patients undergoing total knee replacement (TKR).
Methods: A total of 387 patients (82 males, 305 females) undergoing TKR between January 2014 and December 2018 were included in the study. The T + group was administrated intravenous (iv) TA 20 mg/kg 20 min before the skin incision. We determined perioperative blood loss, the amount of drainage postoperative 24 h, the amount of drainage after postoperative 24–48 h, total volume of drains, total volume of blood loss, postoperative hemoglobin and hematocrit levels, and amount of total blood transfusion.
Results: In terms of demographic data, no statistically significant difference was observed between the groups. Perioperative blood loss and total volume of blood loss was found statistically higher in T − group compared to T + group. Postoperatively, the mean hemoglobin and hematocrit levels of T − group were statistically significantly lower than T + group.
Conclusion: A single 20 mg/kg iv TA administration before TKR reduces bleeding during surgery and within 24 h postoperatively.

11.Comparison of Macintosh Laryngoscope and GlideScope® for Orotracheal Intubation in Children Older Than One Year
Leyla Kılınç, Ayşe Surhan Çınar
PMID: 32377073  PMCID: PMC7199836  doi: 10.14744/SEMB.2019.55631  Pages 143 - 147
Amaç: Bu çalışmada 1 yaş üzeri çocuklarda orotrakeal entübasyon için Glidescope videolaringoskop ile Macintosh direk laringoskopun, entübasyon koşulları, entübasyon süresi ve hemodinamik yanıt üzerine etkilerini incelemek amaçlandı.
Gereç ve Yöntem: 1-12 yaşları arasında 80 hasta, genel anestezi altında endotrakeal entübasyon ile elektif cerrahi geçirmesi planlanan prospektif, tek kör, randomize çalışmaya dahil edildi. Hariç tutma kriterleri; pulmoner aspirasyon riski, kraniyofasiyal malformasyon, zor entübasyon, acil cerrahi, kardiyovasküler hastalık, solunum hastalığı ve hemodinamik instabilite. Standart anestezi indüksiyonundan sonra hastalar iki gruba randomize edildi. Grup G hastaları (n=40) GlideScope ile, grup M hastaları (n=40) Macintosh laringoskopu ile entübe edildi. Entübasyon zamanı, deneme sayısı, Cormack-Lehane skoru, hava yolu manevraları ve görsel analog skoru kaydedildi. Hemodinamik değişkenler anestezi indüksiyonundan önce ve sonra, entübasyonda ve entübasyondan 1., 3. ve 5. dakika sonra kaydedildi. İstatistiksel analiz için Student t-testi, Mann-Whitney U testi ve test2 testi kullanıldı ve P <0.05 anlamlı kabul edildi.
Bulgular: Demografik veriler, ameliyat süresi ve hemodinamik parametreler iki grup arasında benzerdi. Entübasyon zamanı Grup G'de Grup M'ye göre daha uzundu. Cormack – Lehane skoru 1'in sıklığı Grup G'de Grup M'' ye daha yüksek bulunurken, Cormack-Lehane skoru 2 Grup M'de daha yüksek olduğu bulundu.
Sonuç: GlideScope video laringoskopun glottisin görünürlüğünü daha iyi sağladığı fakat entübasyon süresini uzattığını, entübasyona bağlı hemodinamik yanıt açısından üstünlük göstermediği sonucuna vardık.
Objectives: We aim to investigate intubation conditions, intubation times, and hemodynamic response with the GlideScope video laryngoscope or the Macintosh direct laryngoscope for orotracheal intubation in children older than one year.
Methods: Eighty patients aged 1–12 years, scheduled to undergo elective surgery under general anesthesia with endotracheal intubation were included in a prospective, single-blinded, randomized trial. Exclusion criteria were risk of pulmonary aspiration, craniofacial malformation, difficult intubation, emergency surgery, cardiovascular disease, respiratory disease, and hemodynamic instability. After standard anesthesia induction, patients were randomized into two groups. The group G patients (n=40) were intubated with the GlideScope and the group M patients (n=40) were intubated with the Macintosh laryngoscope. Intubation time, number of attempts, Cormack–Lehane score, airway maneuvers, and visual analog score were recorded. Hemodynamic variables were recorded before and after anesthesia induction, at intubation, and 1., 3., and 5. minutes after intubation. Student’s t-test, Mann–Whitney U test, and the χ2 test were used for statistical analysis, with p<0.05 considered significant.
Results: The demographic data, operation time and hemodynamic parameters were similar between the two groups. The intubation time was longer in Group G than Group M. The incidence of Cormack–Lehane score 1 was higher in Group G than Group M while Cormack–Lehane score 2 was higher in Group M.
Conclusion: We concluded that the GlideScope video laryngoscope provided better glottis visualization, but prolonged intubation time. There was no superiorty on hemodynamic effect with the video laryngoscope.

12.The Effect of Lumbar Spinal Surgery History on Intradiscal O2–O3 Treatment Results in Patients with Lumbar Disk Herniation
Mustafa Kılıç, Tülay Erçalık
PMID: 32377074  PMCID: PMC7199826  doi: 10.14744/SEMB.2018.50480  Pages 148 - 153
Amaç: Lomber disk hernisine (LDH) bağlı bel ağrısında, geçirilmiş spinal cerrahinin intradiskal O2-O3 (ozon-oksijen) tedavisi sonuçları üzerine olan etkisini araştırmak.
Materyal-Method: LDH bağlı bel ağrısı nedeni ile intradiskal O2-O3 tedavisi uygulanan hastalar, hastane kayıtlarından retrospektif olarak tarandı. Hasta homojenizasyonu sağlamak için L4-5 ve L5-S1 intervertebral disklerine uygulama yapılmış hastalardan işlem öncesi ve 1 ay verilerine ulaşılabilen ve 1. yılını doldurmuş olan hastalar çalışmaya dahil edildi. 1. yılını doldurmuş olan hastalardan verileri eksik olanlar telefon ile ulaşılarak kontrolleri yapıldı. Bu hastalardan enjeksiyon seviyesi ile önceki geçirilmiş cerrahi seviyesi aynı olan hastalar grup 1 (n: 30) olarak, hiç cerrahi geçirmemiş hastalar ise grup 2 (n: 43) olarak tanımlandı. Ağrı, vizüel analog scale (VAS) disabilite, Oswestry disabilite indeksi (ODI) ile ölçülmüştü.
Bulgular: Grupların enjeksiyon öncesi VAS ve Oswestry ortalamalarında istatistiksel olarak anlamlı fark yoktu (p=0,719 p=0,108). Grup 1’in enjeksiyon sonrası 1.ay ve 1.yıl VAS ve Oswestry ortalamaları Grup 2’ye göre istatistiksel olarak anlamlı yüksekti. İzlemde her iki gurubunda kendi içindeki değişimler istatistiksel olarak anlamlıydı (hepsi için p<0,001). Grupların 1.ay ve 1.yıl VAS değerlendirmelerinde enjeksiyon öncesine göre ağrısında (VAS) %50 ve üzeri azalma saptanma oranlarında istatistiksel olarak anlamlı fark saptanmadı (p=0,213 p=0,347).
Sonuç: Bu çalışmada spinal cerrahi geçirmiş olmanın intradiskal O2-O3 tedavisi sonuçları üzerindeki etkisi araştırılmıştır. Cerrahi geçirmemiş olan hastalardaki başarı oranları daha iyi olmakla birlikte spinal cerrahi geçirmiş hastalarda da oldukça başarılı sonuçlar elde edilmiştir.
Objectives: The aim of the present study was to investigate the effect of previous spinal surgery on intradiscal ozone–oxygen (O2–O3) treatment in low back pain associated with lumbar disc herniation (LDH).
Methods: Patients who underwent intradiscal O2–O3 therapy for LDH-induced low back pain were screened retrospectively from hospital records. To ensure homogenization of participants, patients who had received O2–O3 therapy to L4–L5 and L5–S1 intervertebral discs, those with pre-injection and post-injection month 1 data, and those who completed the first year of treatment were included in the study. Patients who completed the first year of treatment but with missing data were contacted and followed up by phone. Patients who underwent surgery at the same level as the injection level were classified as Group 1 (n=30), and those without surgery were classified as Group 2 (n=43). Pain and disability were measured by Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), respectively.
Results: There was no statistically significant difference between the pre-injection VAS and ODI scores of the groups (p=0.719 and p=0.108). Group 1 had significantly higher VAS and ODI scores on month 1 and year 1 than Group 2, and statistically significant decreases were seen in VAS and ODI scores in both groups at follow-up (p<0.001 for all). There was no statistically significant difference between month 1 and year 1 VAS evaluations of the groups with respect to ≥50% improvement in pain reduction (p=0.213 and p=0.347).
Conclusion: In the present study, the effect of the history of spinal surgery on intradiscal O2–O3 treatment results was investigated. Intradiscal injection was found to be effective for both groups, but more successful results were obtained in patients without surgical history.

13.Effects of the Folk Medicinal Plant Extract Ankaferd BloodStopper on the Healing of Colon Anastomosis: An Experimental Study in a Rat Model
Uğur Ekici, Murat Ferhat Ferhatoğlu, Bülent Çitgez, Mehmet Uludağ
PMID: 32377075  PMCID: PMC7199823  doi: 10.14744/SEMB.2019.98965  Pages 154 - 159
Amaç: Ankaferd Blood Stopper, enflamatuar yanıtı modüle eden ve yara iyileşmesini hızlandıran topikal bir hemostatik ajandır. Bu çalışmanın amacı, bir sıçan modelinde Ankaferd Blood Stopper'ın kolon anastomozunun yara iyileşmesi üzerindeki etkilerini belirlemektir.
Gereç ve Yöntem: Otuz iki Wistar albino cinsi sıçan dört gruba ayrıldı: grup A (n = 8), sol kolonik anastomoz +ABS tedavisi (üçüncü gün sakrifiye); B grubu (n = 8) (kontrol), sol kolonik anastomoz (üçüncü gün sakrifiye); grup C (n = 8), sol kolonik anastomoz + ABS tedavisi ABS (yedinci gün sakrifiye); ve grup D (n = 8) (kontrol), sol kolonik anastomoz (yedinci gün sakrifiye). Anastomoz bütünlüğünü, perianatomotik apse varlığını, peritonit ve adezyon varlığı değerlendirildi. Ek olarak, patlama basıncı, hidroksiprolin (OH-pirolin) seviyeleri ve perianatomotik dokusunun histopatolojik özellikleri değerlendirildi.
Bulgular: Genel olarak, patlama basıncı ABS ile tedavi edilen hayvanlarda kontrol hayvanlarından daha yüksekti, ancak fark istatistiksel olarak anlamlı değildi. Her iki ABS grubunun OH-pirolin seviyeleri kontrol gruplarından anlamlı derecede yüksekti. Yedinci günde ortalama OH-pirolin seviyesi, ABS uygulanmış hayvanlarda üçüncü gündekinden daha yüksekti (p = 0.038).
Sonuçlar: ABS, deneysel yara iyileşmesi modelinde kollajen oluşumunu, neovaskülarizasyonu arttırarak ve kolon anastomoz iyileşme süreci üzerinde olumlu bir etkiye sahiptir.
Objectives: Ankaferd BloodStopper (ABS) is a topical hemostatic agent that modulates the inflammatory response and accelerates wound healing. The aim of this study was to determine the effects of ABS on the colon anastomosis wound healing in a rat model.
Methods: Thirty-two Wistar albino rats were divided into four groups as follows: Group A (n=8), left colonic anastomosis plus ABS treatment (sacrificed on the 3rd day); Group B (n=8) (control), left colonic anastomosis (sacrificed on the 3rd day); Group C (n=8), left colonic anastomosis plus ABS treatment (sacrificed on the 7th day); and Group D (n=8) (control), left colonic anastomosis (sacrificed on the 7th day). All rats were sacrificed at the end of the experiment to assess the anastomosis integrity and the presence of perianastomosis abscesses, peritonitis, and adhesions. Additionally, the bursting pressure and hydroxyproline (OH-pyroline) levels were determined, and a histopathologic evaluation of the perianastomosis tissue was conducted.
Results: The mean bursting pressure on Day 7 was significantly higher than that on Day 3 in the ABS group (p=0.017). Overall, the bursting pressure was higher in animals treated with ABS than in the control animals, although the difference was not statistically significant. The OH-pyroline levels of both ABS groups were significantly higher than in the control groups. The mean OH-pyroline level on Day 7 was higher than that on Day 3 in the ABS-treated animals (p=0.038).
Conclusion: ABS increases collagen formation and neovascularization, and it has a positive impact during the colon anastomosis healing in an experimental model of wound healing.

14.Evaluation of the Knowledge of Cow’s Milk Allergy among Pediatricians
Ceren Can, Nazan Altınel, Vefa Shipar, Korhan Birgül, Lida Bülbül, Nevin Hatipoğlu, Sami Hatipoğlu
PMID: 32377076  PMCID: PMC7199828  doi: 10.14744/SEMB.2018.55381  Pages 160 - 164
Amaç
Bu çalışmada pediyatri uzmanlık öğrencileri ve uzmanlarının inek sütü alerjisiyle ilgili bilgi düzeylerinin saptanması ve meslek içi eğitimin etkisinin değerlendirilmesi amaçlandı.
Gereç ve Yöntem
Çalışmaya pediyatri uzmanlık öğrencileri ve pediyatri uzmanları dahil edildi. Katılımcılara eğitim öncesinde ve sonrasında 10 soruluk inek sütü alerjisine yönelik anket formu uygulanarak sonuçlar değerlendirildi.
Bulgular
Çalışmaya toplam 45 doktor dahil edildi. Bunların 31’i pediyatri uzmanlık öğrencisi, 14’ü pediyatri uzmanı idi. Mesleki deneyim uzmanlık öğrencisi grubunda ortalama 2.3 yıl, uzman grubunda 8.9 yıl idi. Eğitim öncesi ortalama doğru sayısı uzmanlık öğrencisi grubunda 8.32±1.37; uzman grubunda 7.5±1.69 idi ve anlamlı fark saptanmadı (p=0.09). Eğitim sonrası ortalama doğru sayısı uzmanlık öğrencisi grubunda 10; uzman grubunda 9.71± 0.6 idi ve fark anlamlı olarak saptandı (p=0.01). Grupların kendi içinde yapılan değerlendirilmesinde eğitim sonrası değerler anlamlı olarak yüksek tespit edildi( p=0.001).
Sonuç
Çalışmamızda meslek içi eğitimin inek sütü alerjisiyle ilgili bilgi düzeyini anlamlı olarak arttırdığı gösterilmiştir.
Objectives: The aim of this study was to determine the level of knowledge of pediatric residents and practicing pediatricians about cow’s milk allergy (CMA) and to evaluate the effect of occupational education.
Methods: Pediatric residents and pediatricians were included in the study. A survey about CMA was administered to the participants before and after occupational training.
Results: A total of 45 doctors were included in the study. Of the group, 31 were pediatric residents and 14 were practicing pediatricians. The pediatric resident group had a mean of 2.3 years professional experience, and the mean was 8.9 years in the pediatrician group. The mean number of correct answers of a possible score of 10 before the training was 8.32±1.37 in the resident group and 7.5±1.69 in the pediatrician group. There was no significant difference between the groups (p=0.09). The mean number of correct answers after training was 10 in the pediatric resident group, and 9.71±0.6 in the pediatrician group. The difference between the groups was statistically significant (p=0.01). Intragroup evaluation post training revealed significantly higher scores (p=0.001).
Conclusion: The results of this study indicate that occupational education significantly increased the level of knowledge about CMA in both pediatric residents and practicing pediatricians.

15.Factors Affecting Breastfeeding and Complementary Feeding Choices for Children Aged 24 to 48 Months
Neslihan Özkul Sağlam, Lida Bülbül, Selcen Yaroğlu Kazancı, Sadık Sami Hatipoğlu
PMID: 32377077  PMCID: PMC7199838  doi: 10.14744/SEMB.2018.91328  Pages 165 - 171
Amaç: Çalışmamızda 24-48 ay arası çocukların anne sütü alımı ve tamamlayıcı beslenme tercihlerine etki eden faktörler değerlendirildi.
Gereç ve yöntem: Çalışmamıza bir yıllık sürede hastanemiz çocuk polikliniğine başvuran yaşları 24-48 ay arası olan çocuklar dahil edildi. Miadından önce doğan, yenidoğan yoğun bakım ünitesinde izlenmiş olan ve kronik hastalığı olan çocuklar çalışmaya alınmadı.
Anket şeklinde düzenlenen çalışmamız dört ana başlıkta toplanan sorulardan oluşmaktaydı; bebek, anne ve ailenin sosyoekonomik durumu ile ilgili demografik özellikler ve çocuk beslenmesi uygulamaları. Veriler ankete katılmayı kabul eden ebeveynler ile bire bir görüşerek elde edildi.
Bulgular: Çalışma 100 olgu ile bir yıllık sürede tamamlandı. Olgular %49’u kız ve %51’i erkek, ortalama yaşları 36.2±7.8 ay idi. Sadece anne sütü verme süresi 4.8±2.1 ay, toplam emzirme süresi 17.7±8.4 ay, ek gıda başlama zamanı 5.7±1.2 ay bulundu. Emzirmeden kesmenin en sık nedeni annenin süreyi yeterli bulması idi. Sezaryenle doğan, emzik-biberon kullanan bebeklerde sadece ve toplam anne sütü alma süresi anlamlı düzeyde kısa saptandı. Annesi çalışmayan grupta formül mama kullanım oranı yüksek (p: 0.043) iken aynı grupta pürtüklü gıdaya başlama zamanı ile çatal-kaşık kullanmaya başlama zamanı daha geç bulundu (p: 0.001,p: 0.03). Aylık gelir düzeyi 1000 TL’nin altında olan ailelerde ek gıda başlama yaşı daha yüksek gelirli gruba göre anlamlı derecede daha erken bulundu (p: 0.04). Ek gıda seçimini etkileyen faktörler; aile büyükleri ve yakın çevre (%42), sağlık personeli (%36) şeklindeydi. Ek gıda hakkında bilgilendirmenin tek başına anne sütü verme süresini etkilemediği ancak toplam anne sütü alma süresini artırdığı (p: 0.03) tespit edildi.
Sonuç: İlk altı ay sadece anne sütü verilmesi ve emzirmenin iki yaşa kadar sürdürülmesi gerektiği, doğum şekli, emzik ve biberon kullanımının zararları konusunda aileler doğumdan önce bilgilendirilmeli ve gerekli önlemler alınmalıdır. Tamamlayıcı beslenme konusunda; besinlerin kıvamının yaşla birlikte dereceli olarak artırılması, katı gıdaların 10. aydan önce başlanması, hazır gıdalar yerine evde hazırlanmış doğal besinlerin tercih edilmesi gerektiği bilgisi anneler başta olmak üzere tüm aile bireyleri ve yakın çevresine verilmelidir. Kişiler mevcut eğitim durumları, sosyal çevreleri ve yaşam koşulları ile beraber değerlendirilmeli ve bilgilendirme
tüm bireyleri kapsamalıdır.
Objectives: The aim of this study was to evaluate factors that affected decisions regarding breastfeeding and complementary feeding practices in children aged 24 to 48 months.
Methods: Children aged 24 to 48 months who were presented at the outpatient clinic of a single hospital over a 6-month period were included in the study. Children who were born prematurely, hospitalized in the neonatal intensive care unit, and those with a chronic disease were excluded. A questionnaire was administered to parents who provided consent. Data related to demographic characteristics, socioeconomic status, and infant nutrition practices were collected and analyzed.
Results: A total of 100 cases were included. The distribution of the gender of the children was 49% female and 51% male, and the mean age was 36.2±7.8 months. The mean duration of exclusive breastfeeding was 4.83±1.23 months, the mean length of total breastfeeding was 17.65±8.44 months, and the mean initiation of complementary feeding was 5.71±1.23 months of age. The most frequent reason provided for the cessation of breastfeeding was the mother’s decision to wean. The duration of exclusive breastfeeding and the total length of breastfeeding feeding was significantly shorter among children who were born by cesarean section, and those who used a pacifier and or feeding bottle. Non-working mothers used formula for a longer period (p=0.043) and introduced solid foods and the use of utensils later than other mothers (p=0.001, p=0.03, respectively). Complementary food was provided to the infants of families whose monthly income level was less than TL 1000 earlier than in higher income level groups (p=0.04). The results of this study also showed that complementary food choices were most influenced by older members of the family and members of the mother’s immediate circle (42%) and healthcare professionals (36%). Mothers who received information about the addition of complementary food did not demonstrate a significantly different length of time devoted to exclusive breastfeeding; however, the duration of breastfeeding overall, alone and in combination with solid foods, increased (p=0.03).
Conclusion: Before the birth, families should be informed and prepared regarding the necessity of exclusive breastfeeding for the first 6 months and the continuation of breastfeeding until 2 years of age, the potential impact of relevant factors related to the type of birth, and the potentially negative effects of the use of a pacifier or bottle. All members of the family, particularly mothers and close relatives, should be advised about proper complementary feeding techniques, including the need to increase the consistency of food gradually, introducing solid foods before the 10th month, and using natural, home-cooked items instead of prepared foods. The appropriate information and guidance should be provided to all families with consideration for their education level, social environment, and life conditions.

16.Is Cardiac Troponin I Valuable to Detect Low-Level Myocardial Damage in Congestive Heart Failure?
Göktuğ Şirin, Fatih Borlu
PMID: 32377078  PMCID: PMC7199837  doi: 10.14744/SEMB.2018.45336  Pages 172 - 178
Amaç: Konjestif kalp yetersizliği artan insidans ve prevalans oranına sahip bir kalp hastalığıdır. Genellikle miyokardiyal hasarı saptamak için kullanılan CK-MB, kalp yetmezliği durumunda meydana gelen, nispeten düşük seviyedeki miyokardiyal hasarın saptanmasında duyarsızdır. Miyokardiyal hasarın tanımlanması için çok daha hassas ve spesifik olan kardiyak troponinlerin kullanımı yaygın uygulamaya girmiş ve çok düşük seviyedeki miyokard hasarının tespitine izin vermiştir. Çalışmamızda, gerçek yaşam koşullarında, konjestif kalp yetmezliğinde meydana gelen düşük seviyeli miyokardiyal hasarı tespit etmek için, kardiyak troponin I'in (cTnI) kullanılıp kullanılamayacağını kontrol etmeyi amaçladık.
Gereç ve Yöntem: Çalışma grubu (Grup I) konjestif kalp yetmezliği semptomları olan 50 hastadan oluşuyordu ve kontrol grubu (Grup II) Şişli Etfal Eğitim ve Araştırma Hastanesi tüm acil servis ve iç hastalıkları polikliniklerinde normal olarak değerlendirilen 20 hastadan oluşuyordu. Hastalar ve kontrol grubu prospektif olarak çalışmaya alındı. Konjestif kalp yetmezliği tanısında Framingham kriterleri kullanıldı. New York Kalp Derneği'ne göre hastaların fonksiyonel kapasiteleri (Grup I) belirlendi. Grup I, kalp yetersizliği derecesine göre, fonksiyonel kapasite sınıf II, grup A; Fonksiyonel kapasite sınıf III, grup B ve fonksiyonel kapasite sınıf IV, Grup C, olmak üzere sırasıyla üç alt gruba ayrıldı. Girişin ilk gününde CK-MB ve cTnI düzeyleri ölçüldü ve niceliksel olarak belirlendi. Bu üç grup arasında ve çalışma grubu ile kontrol grubu arasında cTnI düzeyleri karşılaştırıldı. Tüm olguların genel durumu stabilize olduktan sonra ekokardiyografik incelemeleri gerçekleştirildi. Ejeksiyon fraksiyonu (EF) ve cTnI arasındaki ilişkiyi araştırmak için lineer regresyon analizi yapıldı.
Bulgular: Çalışmaya yaşları 45-85 arasında değişen, 32'si erkek 18'i kadın olmak üzere toplam 50 hasta, yaşları 43-75 arasında olan, 12'si erkek, 8'i kadın olmak üzere toplam 20 kontrol vakası alındı. cTnI değeri Grup I'de 0.084 0.07 ng / mL ve Grup II'de 0.018 ± 0.012 ng / mL idi (p = 0.0001). Ortalama cTnI değerleri, sırasıyla grup A, grup B ve grup C’de, 0.047±0.016 ng/mL, 0.080±0.048 ng/mL ve 0.175±0.102 ng/mL olarak ölçüldü. Subgruplar arasındaki fark istatistiksel olarak anlamlıydı. Grup A, Grup B ve Grup C'deki EF (%) değerleri sırasıyla 38.6 ± 3.5, 30.9 ± 4.6, 22.8 ± 3.3 ve Grup I ve Grup II'de sırasıyla 32.4 ± 6.9, 60.9 ± 4.3 idi. Grup I ve II arasındaki fark ile grup A ve B ve C arasındaki farklar istatistiksel olarak anlamlıydı. Doğrusal regresyon analizi yapıldığında EF ile cTnI (r: -0.66) arasında ters bir ilişki bulunduğu görüldü (p = 0.0001).
Sonuç: Fonksiyonel kapasite kötüleştikçe, cTnI serum seviyelerinin arttığını gözledik. Bu artış, kalp yetmezliğinin tanısında kullanılabileceğini düşündürür tarzda, ejeksiyon fraksiyonu değerleri ile ters orantılıydı (%). Literatürdeki diğer çalışmalarla uyumlu olan sonuçlarımız, cTnI düzeylerinin, kalp yetmezliğinin şiddetinin değerlendirilmesinde yararlı bir belirteç olarak kullanılabileceğini göstermektedir.
Objectives: Congestive heart failure (CHF) is a heart disease with a growing incidence and prevalence. Creatine kinase-myocardial base (CK-MB) is generally used to determine myocardial damage; however, it is insufficiently sensitive to measure the relatively low level of myocardial damage that typically occurs in heart failure (HF). The use of cardiac troponins, which are far more sensitive and specific, has become common to identify myocardial damage and permits the detection of even minute amounts of damage. The aim of this study was to ascertain whether cardiac troponin I (cTnI) can be used to detect low-level myocardial damage occurring in CHF in real-life conditions.
Methods: Fifty patients with CHF symptoms (Group I) and 20 patients who were evaluated as normal (Group II) were included in this prospective study. The Framingham criteria were used to diagnose HF. Group I was divided into 3 subgroups according to the New York Heart Association classification of functional capacity: Class II, Group A; Class III, Group B, and Class IV, Group C. On the first day of admission, CK-MB and cTnI levels were measured and assessed quantitatively. The cTnI level was compared between these 3 subgroups and between Groups I and II. Linear regression analysis was performed to investigate the relationship between ejection fraction (EF) and cTnI.
Results: The mean cTnI value was 0.084±0.07 ng/mL in Group I and 0.018±0.012 ng/mL in Group II (p=0.0001). The mean cTnI value was 0.047±0.016 ng/mL, 0.080±0.048 ng/mL, and 0.175± 0.102 ng/mL in Groups A, B, and C, respectively. The difference between the subgroups of Group I was statistically significant. In addition, it was observed that there was a significant difference in the EF (%) value between Groups I and II and between Groups A, B, and C. Linear regression analysis revealed an inverse relationship between EF and cTnI (r: -0.66) (p=0.0001).
Conclusion: As the severity of HF increased, the cTnI serum level also increased. This increase was inversely related to the EF value. These results are consistent with other studies in the literature, suggesting that the cTnI level may be a useful marker in the diagnosis and evaluation of severity of HF.

17.In-hospital Outcomes of Patients with ST-segment Elevation Myocardial Infarction who were Intubated before Primary Percutaneous Intervention: Experience of a tertiary center
Süleyman Sezai Yıldız, Serhat Sığırcı, Ahmet Gürdal, Kudret Keskin, Hakan Kilci, Güneş Melike Doğan, Turgun Hamit, Kadriye Kılıçkesmez
PMID: 32377079  PMCID: PMC7199833  doi: 10.14744/SEMB.2019.00878  Pages 179 - 185
Amaç: Solunum yetmezliği ile komplike olan ST segment yükselmeli miyokard infarktüsü (STEMI) hastane içi ve hastane dışı artmış istenmeyen kardiyovasküler olaylarla (KVO) birliktedir. Çalışmamızda, üçüncü basamak merkezimizde STEMI tanısı ile kabul edilmiş ve entübe edilmiş hastaların hastane içi sonuçlarını ve etki eden faktörleri analiz etmeyi amaçladık.
Yöntem: Mayıs 2017 ile Ocak 2019 arasında acil servisde akut ST segment elevasyonlu MI tanısı alan 592 hasta retrospektif tarandı. Primer PKG öncesinde, acil servis veya ambulansda kardiyak arrest nedeniyle entübe edilen hastalar ile entübe edilmeyen hastalar biyokimyasal, kardiyovasküler risk faktörleri, anjiografik özellikleri ile karşılaştırıldı. İstenmeyen KVO, hastane içi ölüm, serebrovasküler inme ve akut stent trombozu olarak tanımlandı.
Bulgular: Entübe olan 60 hasta (%70 erkek, ortalama yaş 63.6 ±14.0) ve entübe olmayan 532 hasta (%81 erkek, ortalama yaş 60.2 ±12.1) çalışmaya dahil edildi. Gruplar arasında anjiografik özellikler benzerdi. Entübe olan hastaların %43,3’de, entübe olmayan hastaların %3.6’sında istenmeyen KVO meydana geldi. Çok değişkenli analizde, yaş (OO: 1.065, p<0.001), serum laktat düzeyi (OO: 1.308, p<0.001) ve sol ventrikül ejeksiyon fraksiyonu (SVEF) (OO: 0.946, p<0.001) entübe olan STYME hastaların hastane içi istenmeyen KVO’ların bağımsız öngördürücüsü olarak tespit edildi.
Sonuç: Tek merkezli çalışmamız, STYME’lü her 10 hastadan birinin entübe edildiğini, entübe olan 10 hastadan yaklaşık dördünün hastane içi istenmeyen olaylara sahip olduğunu gösterdi.
Objectives: ST-segment elevation myocardial infarction (STEMI) complicated by respiratory failure is associated with a greater number of in-hospital and out-of-hospital adverse cardiovascular events (CVEs). The aim of this study was to analyze in-hospital outcomes and the factors affecting the outcomes of intubated patients diagnosed with STEMI who underwent primary percutaneous coronary intervention (pPCI) at a single tertiary care center.
Methods: The data of 592 patients diagnosed with acute STEMI who were admitted to the emergency department between May 2017 and January 2019 and subsequently underwent pPCI were retrospectively reviewed. Cardiovascular risk factors as well as biochemical and angiographic characteristics of patients who were intubated in the emergency room or ambulance due to cardiac arrest and those who were not intubated were compared. Adverse CVEs were defined as in-hospital death, cerebrovascular stroke, and acute stent thrombosis.
Results: A total of 60 patients (70% male; mean age: 63.6±14.0 years) who were intubated and 532 non-intubated patients (81% male; mean age: 60.2±12.1 years) were included in the study. The angiographic features of the 2 groups were similar. An adverse CVE was experienced by 43.3% of the intubated patients and 3.6% of the non-intubated patients. Multivariate analysis indicated that age (odds ratio [OR]: 1.065; p<0.001), serum lactate level (OR: 1.308; p<0.001), and left ventricle ejection fraction (OR: 0.946; p<0.001) were independent predictors of in-hospital adverse CVE in the intubated patient group.
Conclusion: The results of this single-center study showed that 1 in 10 patients hospitalized with STEMI were intubated, and approximately 4 in 10 intubated STEMI patients had an in-hospital CVE.

18.Comparison of the Effects of Metoclopramide and Ondansetron on Emergency Service Observation Times in Acute Gastroenteritis-Related Nausea and Vomiting Cases
Mustafa Ahmet Afacan, İsmail Tayfur
PMID: 32377080  PMCID: PMC7199832  doi: 10.14744/SEMB.2019.80217  Pages 186 - 189
Amaç: Bu çalışmada akut gastroenterite bağlı bulantı ve kusmada metoklopramid ve ondansetron tedavilerinin acil servis gözlem sürelerine etkisini karşılaştırmak amaçlandı.

Gereç ve Yöntem: Bu çalışma, 6 aylık süre içerisinde, bir eğitim ve araştırma hastanesinin acil servis gözlem ünitesinde, akut gastroenterit tanısı alan 297 hasta üzerinde geriye dönük olarak gerçekleştirildi. Bulantı ve kusma şikayetleri ile gelen gastroenterit tanılı hastalar gözlem ünitesinde aldıkları tedaviye göre iki gruba ayrıldı. Ondansetron 4 miligram (mg) infüzyon tedavisi alan hastalar Grup 1 olarak ve metoklopramid 10 mg infüzyon tedavisi alan hastalar Grup 2 olarak kabul edildi.

Bulgular: Yaş ortalaması 39,57 ± 18,75 idi; Katılımcıların yüzde 56,6'sı (168) kadındı. Hastaların 51.5%'i (153) ondansetron (Grup 1) ve 48.5%'i (144) metoklopramid (Grup 2) tedavisi almıştı. Grup 1'de gözlem süresi 19 ile 75 dakika arasında, Grup 2'de 42 ile 122 dakika arasında değişmiştir. Grup 2'deki 19 hasta (13,2%) ve Grup 1'deki 5 hastanın (3,3%) devam eden şikayetler nedeniyle 24 saat içinde acil servise tekrar başvurduğu görüldü.

Sonuç: Çalışmada metoklopramid kullanımına bağlı 6.9% güçsüzlük-uyuşukluk, 4.9% akatizi tespit edildi. Ondansetron kullanımına bağlı yan etki görülmedi. Bununla birlikte ondansetron kullanımında daha kısa gözlem süresi ve acil servise daha az tekrarlayan başvuru saptandı. Bulgularımız akut gastroenterit ile ilişkili bulantı ve kusma tedavisinde ondansetronun daha etkili bir ilaç olduğunu göstermektedir.
Objectives: The aim of the present study was to compare the effect of metoclopramide and ondansetron treatments on the emergency department observation time in acute gastroenteritis-related nausea and vomiting (NV).
Methods: The study was conducted retrospectively on 297 patients diagnosed with acute gastroenteritis in a training and research hospital's emergency service observation unit within 6 months. Patients with gastroenteritis who were diagnosed with NV were divided into two groups according to the treatment they received in the observation unit. Patients who received 4 mg ondansetron slow infusion therapy were classified as Group 1, and patients who received 10 mg metoclopramide slow infusion therapy were classified as Group 2.
Results: The average age of the patients was 39.57±18.75 years. Of the 297 participants, 56.6% (168) were female. Among them, 51.5% (153) received ondansetron (Group 1), and 48.5% (144) received metoclopramide (Group 2). 6.9% weakness–numbness and 4.9% akathisia were detected due to metoclopramide use. There were no adverse effects related to ondansetron use. The duration of observation ranged from 19 to 75 min in Group 1 and from 42 to 122 min in Group 2. Nineteen (13.2%) patients in Group 2 and 5 (3.3%) patients in Group 1 revisited the emergency department within 24 h due to ongoing complaints.
Conclusion: In conclusion, side effects of weakness and akathisia due to metoclopramide use were observed. However, no side effects were observed due to ondansetron use. Additionally, the use of ondansetron showed a shorter observation time and less recurrent admission to the emergency department. Therefore, ondansetron is a more effective drug in the treatment of NV associated with acute gastroenteritis.

CASE REPORT
19.Effect of Partial Pars Plana Vitrectomy in Two Cases: Removal of Intraocular Foreign Body and Intraocular Lens Dropped Into Vitreous
Mehmet Demir, Egemen Karatas, Dogukan Aslan, Abdurahman A. Arslan
PMID: 32377081  PMCID: PMC7199827  doi: 10.14744/SEMB.2018.47123  Pages 190 - 194
Amaç: Göz içi yabancı cisim (GİYC) ve intravitreal alana düşmüş göz içi lensin (GİL) nedenleriyle parsiyel pars plana vitrektomi (PPV) iki olguyu sunmak.
Birinci olgu otuz yaşında erkek hastanın sağ gözüne GİYC nedeniyle ve ikinici olgu ise 37 yaşında bayan hasta sol gözde künt travma nedeniyle vitreus içine düşen göz içi lensin çıkarılması için parsiyel PPV yapıldı. Parsiyel PPV ile GİYC ve vitreustaki GİL etkili bir şekilde ve komplikasyonsuz çıkarıldı.
Sonuç: Parsiyel (veya minimal) PPV ile göz için çok sayıda faydası olan vitreus dokusunun büyük kısmı yerinde bırakılarak retina dekolmanı ve katarakt gelişimi gibi komplikasyonların oranında düşme sağlayabilir.
The aim of this case study was to present the effect of partial pars plana vitrectomy (PPV) in two cases that is due to the presence of an intraocular foreign body (IOFB) and intraocular lens (IOL) that has dropped into the intravitreal area. The first case was a 30-year-old man with IOFB in the right eye, and the second case was a 34-year-old woman whose IOL was dropped into vitreous after trauma. In cases, IOFB and IOL were extracted from vitreous performed by partial PPV without complication. Partial PPV was effective despite without complete vitrectomy. With minimal/partial vitrectomy approach, most of the vitreous tissues was left in place. We believe that this approach will reduce the rate of complications, such as cataract and retinal detachment.

20.Sugammadex for Cesarean in a Patient with Multiple Sclerosis
Resul Yilmaz, Sema Tuncer Uzun, Ruhiye Reisli
PMID: 32377082  PMCID: PMC7199839  doi: 10.14744/SEMB.2017.07108  Pages 195 - 198
Amaç: Olgumuzda Multiple Skleroz (MS)’lu gebe hastada anestezi yönetimini tartışmayı ve sugammadeks uygulamasının etkileri sunmayı amaçladık.
Olgu: 36 yaşındaki gebe hasta 6 yıldır ms hastalığı ile takip edilmekte idi. Steroid tedavisi almakta idi. Hasta gebelik boyunca atağı geçirmemişti. Hastaya rutin monitörizasyon uygulana ek olarak 'train of four (TOF)' monitörizasyonu kullanıldı. propofol ve roküronyum kullanarak genel anestezi verildi. Operasyon sonunda TOF değeri düşük olan hastaya sugammadeks kullanılarak kas gevşemesi geri döndürüldü. Hasta postoperatif 3.gün taburcu edildi.
Sonuç: MS hastalarında, en güvenilir yöntem tercih edilmelidir. Genel anestezi uygulanan hastalarda kas gevşetici etkisi uzayabilmektedir ve sugammadeks güvenle kullanılabilmektedir.
The aim of the present study was to discuss the management of anesthesia in our case with multiple sclerosis (MS) and to present the effects of sugammadex administration. A 36-year-old pregnant patient with MS disease was followed up for 6 years. She was on steroid treatment. The patient had not suffered the entire pregnancy. In addition to performing routine monitoring, “train of four” (TOF) monitorization was used. General anesthesia was given using propofol and rocuronium. At the end of the operation, muscle relaxation was reversed using sugammadex in the patient with a low TOF score. The patient was discharged on postoperative day 3. The most reliable method should be preferred in patients with MS. In patients under general anesthesia, the muscle relaxant effect is prolonged, and sugammadex can be safely used.

LETTER TO THE EDITOR
21.Considerations in the Measurement of Lipid Panel Tests
Hakan Ayyildiz, Mehmet Kalayci, Oğuzhan Koca
PMID: 32377083  PMCID: PMC7199822  doi: 10.14744/SEMB.2019.29566  Pages 199 - 200
Abstract | English Full Text

22.Author's Reply
Eda Kılıç Çoban
PMID: 32377084  PMCID: PMC7199842  doi: 10.14744/SEMB.2019.87513  Page 200
Abstract | English Full Text

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