The aim of this systematic review is to evaluate the efficacy of Vitamin C (VC) in preventing Complex Regional Pain Syndrome type I (CRPS-I) in fractures or surgery of the upper and lower extremities.
During December 2020, Scopus and PubMed search was performed to analyze VC supplementation in preventing CRPS-I after trauma and orthopedic care, according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline. Patient, Intervention, Comparison, Outcomes, Study Design model, and a modified version of the Coleman Methodology Score were used to analyze the included studies. The research was limited from 1990 to December 2020. Initial screening results identified 649 studies. After reviewing each study, six clinical studies were included in the study.
A total of 2026 patients of whom 632 male and 1394 female were collected in our systematic review. During the entire follow-up period, the occurrence of CRPS-I was evaluated in 1939 patients. Five of the six analyzed studies were favoring prophylactic use of the 500-1000 mg daily dose of VC for 45-50 days after orthopedic or trauma care for prevention of CRPS-I. Only one study found no benefit in VC supplementation compared with placebo to prevent CRPS-I.
Analysis of the literature suggests that a daily 500-1000 mg VC supplementation may reduce the onset of CRPS-I in trauma of upper/lower extremities and in orthopedic surgery. (SETB-2020-12-269)

The aim of this systematic review is to evaluate the efficacy of Vitamin C (VC) in preventing Complex Regional Pain Syndrome type I (CRPS-I) in fractures or surgery of the upper and lower extremities.
During December 2020, Scopus and PubMed search was performed to analyze VC supplementation in preventing CRPS-I after trauma and orthopedic care, according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline. Patient, Intervention, Comparison, Outcomes, Study Design model, and a modified version of the Coleman Methodology Score were used to analyze the included studies. The research was limited from 1990 to December 2020. Initial screening results identified 649 studies. After reviewing each study, six clinical studies were included in the study.
A total of 2026 patients of whom 632 male and 1394 female were collected in our systematic review. During the entire follow-up period, the occurrence of CRPS-I was evaluated in 1939 patients. Five of the six analyzed studies were favoring prophylactic use of the 500-1000 mg daily dose of VC for 45-50 days after orthopedic or trauma care for prevention of CRPS-I. Only one study found no benefit in VC supplementation compared with placebo to prevent CRPS-I.
Analysis of the literature suggests that a daily 500-1000 mg VC supplementation may reduce the onset of CRPS-I in trauma of upper/lower extremities and in orthopedic surgery.

Abstract | English Full Text

Tiroidektomide intraoperatif sinir monitörizasyonu (IONM) kullanýmý giderek artmaktadýr. IONM ile laringeal sinirlerin anatomisi ve sinir yaralanmalarý ile ilgili birçok veri elde edilmiþ ve bunlar tiroidektomi standartlarýnýn artýþýna önemli katký saðlamýþtýr. Bu kanýtlar: Rekürren laringeal sinirin (RLN) saptanmasýný, vizual identifikasyonunu arttýrmaktadýr. RLN’nin en sýk anatomik varyasyonu ekstralaringeal dallarýn saptanma oranýný arttýrmaktadýr. Nonreküren laringeal sinirin erken saptanmasýný ve korunmasýný saðlamaktadýr. Larinksin kompleks motor inervasyonu ile ilgili önemli veriler elde edilmiþtir. RLN veya ekstralaringeal RLN dallarý krikotiroid kasýn motor inervasyonuna katký saðlayabilir. Ekstralaringeal dallanan RLN’lerin ön dalý sürekli motor fonksiyona sahip olmakta ve hem abduktor hem de adduktor kaslara motor lifler vermektedir. Buna ek olarak %18’a kadar posterior dallarda da adduktor ve/veya abduktor motor lifler içerebilir. SLSE %70-80 oranýnda insan birleþtirici siniri yoluyla vokal kordun ana addüktörü tiroaritenoid kasýn 1/3 anterioruna motor inervasyon saðlamaktadýr. SLSE’ yaklaþýk vakalarýn 1/3’ünde ipsilateral vokal kordun ana abdüktör kasý olan posterior krikoaritenoid kas inervasyonuna da katký saðlamaktadýr. Üst özefageal sfinkterin major komponenti olan krikofaringeal kasýn motor inervasyonunu faringeal pleksusa ek olarak genellikle RLN ve/veya SLSE katký saðlamaktadýr. RLN yaralanmalarýnýn %67-93’ü oranýnda en sýk nedeni traksiyon travmasýdýr. SLSE yaralanmalarýnýn %50’sinden fazlasý sinir kesisidir. RLN yaralanmasý durumunda sinir üzerinde spesifik bir yaralanma noktasýnýn olduðu durum tip 1 (segmental) sinyal kaybý olup, yaralanma sonrasýnda elektrofizyolojik olarak saptanabilen bir hasar noktasý olmadýðýnda ipsilateral vagus-RLN aksý boyunca sinyal kaybýnýn olmasý tip 2 (global) yaralanmadýr. Sinyal kaybý geliþir ise 20 dakika beklendiðinde sinyal kaybý persiste eder veya inkomplet sinyal iyileþmesi olursa %70-80 vokal kord paralizisi (VCP) geliþir, komplet sinyal iyileþmesinde VCP geliþmez. Ýnkomplet sinyal iyileþmesi olan hastalarda VCP geçici olup, kalýcý VCP görülmemektedir. RLN yaralanmalarýnýn %15’inde vizual deðiþiklik varken, IONM RLN yaralanmalarýn %100’ünü saptayabilir. IONM bilateral VCP’yi önleyebilir. Sürekli IONM (C-IONM) vagus/RLN aksýnýn fonksiyonel bütünlüðünün gerçek zamanlý deðerlendirildiði aralýklý IONM’ye gore daha üstün bir yöntemdir. Üst pol diseksiyonu sýrasýnda IONM SLSE’nin vizual ve fonksiyonel belirlenmesine anlamlý katký saðlamaktadýr. IONM’nin rutin kullanýlmasý sinir yaralanma riskini minimalize edebilir. Krikotiroid kas amplitüdünde %50’den fazla düþme hastanýn kötü ses sonuçlarý ile iliþkilidir. (SETB-2021-05-159)

The use of intraoperative neuromonitoring (IONM) is getting more common in thyroidectomy. The data obtained by the usage of IONM regarding the laryngeal nerves’ anatomy and function have provided important contributions for improving the standards of the thyroidectomy. These evidences obtained through IONM increase the rate of detection and visual identification of recurrent laryngeal nerve (RLN) as well as the detection rate of extralaryngeal branches which are the most common anatomic variations of RLN. IONM helps early identification and preservation of the non-recurrent laryngeal nerve. Crucial knowledge has been acquired regarding the complex innervation pattern of the larynx. Extralaryngeal branches of the RLN may contribute to the motor innervation of the cricothyroid muscle (CTM). Anterior branch of the extralaryngeal branching RLN has always motor function and gives motor branches both to the abductor and adductor muscles. In addition, up to 18% of posterior branches may have adductor and/or abductor motor fibers. In 70–80% of cases, external branch of superior laryngeal nerve (EBSLN) provides motor innervation to the anterior 1/3 of the thyroarytenoid muscle which is the main adductor of the vocal cord through the human communicating nerve. Furthermore, approximately 1/3 of the cases, EBSLN may contribute to the innervation of posterior cricoarytenoid muscle which is the main abductor of ipsilateral vocal cord. RLN and/or EBSLN together with pharyngeal plexus usually contribute to the motor innervation of cricopharyngeal muscle that is the main component of upper esophageal sphincter. Traction trauma is the most common reason of RLN injuries and constitutes of 67–93% of cases. More than 50% of EBSLN injuries are caused by nerve transection. A specific point of injury on RLN can be detected in Type 1 (segmental) injury, however, Type 2 (global) injury is the loss of signal (LOS) throughout ipsilateral vagus-RLN axis and there is no electrophysiologically detectable point of injury. Vocal cord paralysis (VCP) develops in 70–80% of cases when LOS persists or incomplete recovery of signal occurs after waiting for 20 min. In case of complete recovery of signal, VCP is not expected. VCP is temporary in patients with incomplete recovery of signal and permanent VCP is not anticipated. Visual changes may be seen in only 15% of RLN injuries, on the other hand, IONM detects 100% of RLN injuries. IONM can prevent bilateral VCP. Continuous IONM (C-IONM) is a method in which functional integrity of vagus-RLN axis is evaluated in real time and C-IONM is superior to intermittent IONM (I-IONM). During upper pole dissection, IONM makes significant contributions to the visual and functional identification of EBSLN. Routine use of IONM may minimalize the risk of nerve injury. Reduction of amplitude more than 50% on CTM is related with poor voice outcome.

Abstract | English Full Text

Meme kanseri, dünya çapýnda kadýnlarda en sýk görülen kanser türüdür. Meme kanserinin tedavisinde genel olarak cerrahi tedaviye ek olarak adjuvan sistemik tedavi ve gerektiðinde radyoterapi uygulanýr. Meme kanserinin tedavisinde neoadjuvan kemoterapi, lokal ileri operabl meme kanserinde tümör boyutunun küçülmesi ile meme koruyucu cerrahi yapýlabilmesi ve aksiller diseksiyon ihtiyacýnýn azaltýlmasý için kullanýlýr. Ýnflamatuar meme kanseri ve inoperabl meme kanserinin tedavisinde adjuvan kemoterapi, genel saðkalým süresini arttýrmak ve semptomlarý giderirken hastalýðýn ilerlemesini geciktirmek için kullanýlýr. Meme kanseri için neoadjuvan kemoterapi, 20. yüzyýlýn sonlarýna doðru ortaya çýkan ve meme kanseri tedavisinde giderek daha fazla kullanýlan yeni bir stratejidir. Þu anda neoadjuvan kemoterapi, hem lokal ileri hem de operabl meme kanseri olan hastalarda sýnýrlý bir aksiller yaklaþým saðlanmasý ve büyük tümörlü hastalarýn meme koruyucu cerrahiye uygun hale gelmesi için giderek daha fazla kullanýlmaktadýr. Meme koruyucu prosedürler günümüzde cerrahlar tarafýndan daha fazla tercih edilmekte ve kemoterapi sonrasý koltuk altý diseksiyonunun yerini sentinel lenf nodu biyopsisi almaktadýr. Neoadjuvan sistemik tedavinin hedeflerinden biri, esas olarak kozmetik nedenlerle ve özellikle kol hareketliliðini korumak, aðrý ve lenfödem riskini önlemek için aksiller diseksiyondan kaçýnarak, meme koruyucu daha az agresif bir ameliyat yapmaya çalýþmaktýr. Neoadjuvan sistemik tedavinin diðer bir hedefi, tümörün kemoterapiye verdiði yanýtý görmek ve buna göre tedaviyi belirlemektir. Neoadjuvan sistemik tedavi, cerrahi tedavi öncesi meme ve koltuk altý bölgesini tümör hücrelerinden arýndýrarak tam patolojik yanýt oranýný artýrýr. Bu derlemede, meme kanserinde neoadjuvan kemoterapide önemli noktalarý, neoadjuvan kemoterapi sonrasý radyolojik görüntüleme yöntemlerini, cerrahi tedavi ve rekonstrüksiyonu irdeledik. (SETB-2020-11-235)

Breast cancer is the most common cancer in women worldwide. Breast cancer is traditionally treated with surgery, plus adjuvant systemic therapy and radiotherapy as required. Neoadjuvant chemotherapy (NACT) for the treatment of breast cancer is used for locally advanced operable breast cancer to reduce the tumor size, to perform breast conserving surgery, and to perform a limited axillary approach. Adjuvant chemotherapy for the treatment of inflammatory breast cancer and even in inoperable breast cancer is used to increase overall survival time and to delay disease progression while relieving symptoms. NACT for breast cancer is a new strategy that was introduced toward the end of the 20th century and is increasingly used in the treatment of breast cancer. At present, NACT is increasingly being used to reduce the need for axillary dissection and to convert patients with large tumors to candidates for breast conservation therapy in both locally advanced and operable breast cancers. Breast conserving procedures are currently more preferred by surgeons and axillary dissection is being replaced by sentinel lymph node biopsy after chemotherapy. One of the targets of neoadjuvant systemic therapy is to try to perform a less aggressive surgery by breast conservation, mainly for cosmetic reasons and avoiding axillary dissection mainly for arm mobility, pain, and lymphedema risk. The other target of neoadjuvant systemic therapy is to see the response of the tumor to chemotherapy and determine the treatment accordingly. Neoadjuvant systemic therapy increases the rate of complete pathological response by clearing the breast and axilla from tumor cells before surgery. In this review, we examine the key points of using the NACT in breast cancer, considering radiological imaging methods, surgical management, and reconstruction after NACT.

Abstract | English Full Text

Amaç: Laparoskopik pyeloplasti sýrasýnda üreter stenti takýlmasý, üreteropelvik bileþke darlýðýnýn cerrahi tedavisi için yaygýn olan bir uygulamadýr. Yöntemin uzun ve zor olan öðrenme eðrisi, cerrahlar arasýnda hala tartýþmalara yol açmaktadýr. Ekstrakorporeal stent yerleþtirilmesinin ameliyat süresinin kýsalmasýna katkýsý bu çalýþmada tartýþýlacaktýr.
Yöntem: Üreteropelvik bileþke obstrüksiyonu nedeniyle pyeloplasti uygulanan 36 çocuk retrospektif olarak incelendi. Pyeloplasti endikasyonlarý þunlardýr: Renal sintigrafide obstrüksiyon bulgularý, progresif renal fonksiyon kaybý, renal ultrasonografide anteroposterior pelvis çapýnda artýþ, klinik semptomlar (ateþli idrar yolu enfeksiyonu ve yan aðrýsý). Ekstrakorporeal stent yerleþtirilmesi iþlemiþu sýraya göre yapýldý: üreteropelvik alan ve üreter 3 trokar ile transperitoneal olarak diseke edildi, üreteropelvik bileþke darlýðý eksize edildi. Daha sonra, üreter pelvik trokar giriþ yerinden dýþarý alýndý ve spatüle edildi. JJ stent ekstrakorporeal olarak üretere yerleþtirildi. Takiben üreter batýn içine alýndý ve ilk üreteropelvik sütür batýn içindeatýldý.
Bulgular: Hastalarýn 13'ü kýz, 23'ü erkekti. On beþ hastaya (grup 1) açýk cerrahi, 21 hastaya laparoskopik pyeloplasti (grup 2) uygulandý. Grup 2'de JJ stent 6 hastaya (Grup 2a) intrakorporeal ve diðer 15 hastaya (Grup 2b) ekstrakorporeal olarak yerleþtirildi. Yaþ ortalamasý grup 1’de 49.2±52 ay; grup 2a’da 86±29 ay ve grup 2b’de 144±52 aydý ve anlamlý farklýlýk belirgindi (p<0.001). Ortalama hastanede kalýþ süresi açýsýndan laparoskopik ve açýk cerrahi yapýlan hastalarda anlamlý fark vardý (grup 1'de 40 saat; grup 2'de 42 saat; p=0.001). Ameliyat sonrasý JJ stent çýkarma süresi grup 1'de 58.8 gün ve grup 2'de 52.89 gündü. Grup 2’deki hastalar arasýnda stentin ekstrakorporeal olarak yerleþtirenlerde operasyon süresi belirgin kýsaydý [2a (192 dakika ± 3.76) ve 2b (135 dakika ± 2.6) (p <0.001)]. Postoperatif 2. yýlda kontrol ultrasonografik deðerlendirmede böbrek anteroposterior çaplarý açýsýndan grup 1 (9.87±5.5 mm) ve grup 2 (12.91±5.3 mm) arasýnda istatistiksel fark saptanmadý (p=0.23). Böbrek fonksiyonlarýnýn postoperative 1.yýlda sintigrafi ile deðerlendirilmesi sonucunda da iki grup arasýnda fark yoktu (grup1: %3.95±2; grup 2: %0,78±5.3).
Sonuç: Çalýþmamýza göre, laparoskopik pyeloplasti sýrasýnda ekstrakorporeal olarak üretere stent yerleþtirilmesi,ameliyat süresini belirgin kýsaltmaktadýr ve stentin yerleþtirilmesinde zorlanýldýðý durumlarda ekstrakorporeal olarak yerleþtirme yapýlmasý tercih edilebilir. (SETB-2020-06-106)

Objectives: Ureteric stent insertion during laparoscopic pyeloplasty is the common practice for the reconstruction of ureteropelvic junction obstruction (UPJO). The long and hard learning curve of the method leads still controversy among surgeons. The utility of extracorporeal stent insertion in terms of shortening the length of operation time will be discussed in this study.
Methods: A total of 36 children who underwent pyeloplasty for UPJO were evaluated retrospectively. Indications for pyeloplasty were: Obstruction findings in renal scintigraphy, progressive kidney function loss, increasing in anteroposterior pelvis diameter in renal ultrasonography, and current clinical symptoms (febrile urinary tract infection and flank pain). Extracorporeal stent insertion procedure was performed as the following order: Ureteropelvic area and ureter were visualized transperitoneal by three trochars, and UPJO was excised. Thereafter, the ureter is taken out of the skin from pelvic trochar entrance and is spatulated. JJ stent is placed into the ureter. Following this move, the ureter is taken into the intra-abdominal area and first ureteropelvic suture is performed intra-abdominally.
Results: Thirteen of patients were girls and 23 were boys. Open surgery was applied for 15 patients (Group 1) and laparoscopic pyeloplasty (Group 2) to 21 patients. In Group 2, JJ stent was placed intracorporeally for six patients (Group 2a) and extracorporeally for the other 15 patients (Group 2b). The average age in Group 1 was 49.2±52 months; it was 86±29 months in Group 2a and 144±52 months in Group 2b, and the significant difference was present (p<0.001). There was statistically significant difference between Group 1 and Group 2 regarding with mean hospital stay (40 h in Group 1 and 42 h in Group 2; p=0.001). Post-operative JJ stent removal time was 58.8 days in Group 1 and 52.89 days in Group 2. In Group 2b patients, placing the stent extracorporeally took a significantly shorter operation time and the difference between the operation times of the groups (2a [192 min±3.76] and 2b [135 min±2.6] [p<0.001]) was statistically significant. No statistical difference was found between Group 1 (9.87±5.5 mm) and Group 2 (12.91±5.3 mm) in terms of renal anteroposterior diameters in the control ultrasonographic evaluation at the post-operative 2nd year (p=0.23). There was no difference between the two groups as a result of the evaluation of renal functions by scintigraphy at the post-operative 1st year (Group 1: 3.95±2%; and Group 2: 0.78±5.3%).
Conclusion: According to the consequences in this study, extracorporeally ureteric stent insertion during laparoscopic pyeloplasty shortens the length of operation duration so that extracorporeal insertion might be preferred in cases where it is difficult to place the stent during laparoscopic pyeloplasty.

Abstract | English Full Text

Amaç: Laparoskopik parsiyel nefrektomi (LPN) ile robot yardýmlý parsiyel nefrektominin (RPN) cerrahi özelliklerinin, komplikasyon oranlarýnýn, fonksiyonel ve patolojik sonuçlarýnýn karþýlaþtýrýlmasý.
Yöntem: Ocak 2007 ve Nisan 2020 arasýnda minimal invasive yöntemlerle parsiyel nefrektomi yapýlan hastalarýn demografik, perioperative ve takip verileri retrospektif olarak incelenmiþtir. En az 3 aylýk takip süresine sahip olan hastalar çalýþmaya dahil edilmiþtir. LPN ile RPN gruplarý arasýnda perioperatif ve patolojik sonuçlar karþýlaþtýrýlmýþtýr.
Bulgular: Çalýþmaya 85 hasta (65 hasta LPN grubu ve 20 hasta RPN grubu) dahil edilmiþtir. Cerrahi esnasýnda ortalama hasta yaþý 56.31 ± 10.48 yýl olarak belirlenmiþtir. Kadýn erkek oraný 30/55’dir. RPN grubundaki hastalarýn R.E.N.A.L. ve PADUA skorlarýnýn anlamlý olarak yüksek olduðu belirlenmiþtir (p=0.039, p=0.030, sýrasýyla). Median sýcak iskemi süresi, median operasyon süresi, median intraoperative kan kaybý, ortalama postoperative hemoglobin deðiþimi ve median hospitalizasyon süresinin gruplar arasýnda benzer olduðu belirlenmiþtir (p=0.133,p=0.753, p=0.079, p=0.882, p=0.473, sýrasýyla). Sadece arteriyal klempleme oranýnýn RPN grubunda anlamlý olarak yüksek olduðu görülmüþtür (p=0.033). RPN’nin operasyon maliyetinin LPN’ye oranla belirgin olarak yüksek olduðu tespit edilmiþtir (p<0.001). Transfüzyon oranýnýn, postoperative komplikasyon oranýnýn, son takipte glomerüler filtrasyon oranýndaki deðiþim yüzdesinin ve trifecta baþarýsýnýn iki grup arasýnda benzer olduðu belirlenmiþtir (p=0.622, p=0.238, p=0.428, p=0.349, sýrasýyla).
Sonuç: Serimizde, RPN ile daha kompleks böbrek kitlelerinde LPN’ye benzer perioperatif ve fonksiyonel sonuçlar elde edilmiþtir. (SETB-2020-07-130)

Objectives: The objectives of the study were to compare the operative features, complication rates, functional, and pathological outcomes of laparoscopic partial nephrectomy (LPN) and robotic-assisted partial nephrectomy (RPN).
Methods: The demographics, perioperative, and follow-up data of patients who underwent partial nephrectomy between January 2007 and April 2020 with minimally invasive methods were retrospectively analyzed. Patients with minimum 3 months follow-up were enrolled in the present study. Perioperative and pathological outcomes were compared between the patients underwent LPN and RPN.
Results: A total of 85 patients (65 LPN and 20 RPN) were included in the present study. The mean patient age at the time of surgery was 56.31±10.48 years. Female-to-male ratio was 30/55. Patients in the RPN group had higher R.E.N.A.L. and PADUA scores (p=0.039 and p=0.030, respectively). Median warm ischemia time, median operation time, median intraoperative estimated blood loss, mean post-operative hemoglobin change, and median hospitalization time were similar between groups (p=0.133, p=0.753, p=0.079, p=0.882, and p=0.473, respectively). Artery-only clamping rate was significantly higher in RPN group (p=0.033). The cost of RPN was significantly greater than LPN (p<0.001). Transfusion rates, post-operative complication rates, percent of estimated glomerular filtration rate change at the last follow-up, and trifecta achievement were similar between the groups (p=0.622, p=0.238, p=0.428, and p=0.349, respectively).
Conclusion: In this series, similar perioperative and functional outcomes were achieved by RPN compared to LPN in more complex renal masses.

Abstract | English Full Text

Amaç: Primer hiperparatiroidi (pHPT)’nin küratif tedavisi cerrahidir. Cerrahi tedavi sonrasý persistan ve nüks hastalýk geliþebilmektedir. Bu çalýþmada kliniðimizde pHPT nedeni ile cerrahi tedavi uygulanan hastalarda cerrahi kür oranýný deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Kliniðimizde 2000-2015 yýllarý arasýnda deneyimli 2 cerrah tarafýndan pHPT nedeniyle paratiroidektomi yapýlan hastalarýn verileri retrospektif olarak deðerlendirildi. Ýlk paratiroidektomi sonrasý en az 6 ay takip edilen hastalar çalýþmaya dahil edildi. Hastalarda cerrahi kür, persistan ve nüks hastalýk oranlarý deðerlendirildi.
Bulgular: Bu dönemde kliniðimizde pHPT nedeniyle opere edilen, kriterlere uygun yaþ ortalamasý 54,9+13,1 yýl olan 357 hastaya (293K, 64E) 368 giriþim uygulandý. Ýlk ameliyatta 116 hastaya (%32,5) bilateral boyun eksplorasyonu (BBE), 251 hastaya (%67,5) unilateral boyun eksplorasyonu (UBE) veya odaklanmýþ cerrahi (OC) uygulandý. Ýlk ameliyatta 343 hastada (%96,1) hastada kür saðlandý, 14 hasta (13K, 1E) (% 3,9) persistan kaldý. Preoperatif deðerlendirme sonucunda 11 hastaya ikincil cerrahi giriþim uygulandý. 10 hastaya (%90,9) UBE veya OC uygulandý, 1 hastaya parsiyel sternotomi uygulandý. Hastalarýn 10’unda kür saðlandý. Bunlarýn 3’ünde ilk ameliyatta çýkarýlmayan soliter paratiroid adenomu, 7 hastada ikinci adenom vardý. Dört hasta persistan kaldý (%1,1). Dört hastada ise takipte nüks hastalýk geliþti (%1,1). Toplam kür oraný % 97,8’di.
Sonuç: pHPT’nin definitif tek tedavisi cerrahidir. Preoperatif deðerlendirme ve uygun cerrahi planlama yapýlarak yüksek cerrahi kür elde edilebilir. Bununla birlikte özellikle çift adenoma veya ektopik yerleþime baðlý olarak p-pHPT geliþebilir. p-pHPT’li hastalarýn tekrar görüntüleme yöntemleri ile deðerlendirilip, uygun cerrahi planlama ile ikincil cerrahide yüksek kür oraný elde edilebilir ve bu da toplam cerrahi kür oranýný arttýrabilir. Nüks oraný nadirdir. (SETB-2021-03-079)

Objectives: The curative treatment of primary hyperparathyroidism (PHPT) is surgery. Persistent and recurrent disease may develop after surgical treatment. In this study, we aimed to evaluate the surgical cure rate in patients who underwent surgery for PHPT in our clinic.
Methods: The data of patients who underwent parathyroidectomy for PHPT by two experienced surgeons between 2000 and 2015 in our clinic were retrospectively evaluated. Patients who were followed for at least 6 months after their first parathyroidectomy were included in the study. Surgical cure and persistent and recurrent disease rates were evaluated in patients.
Results: During this period, 368 interventions were performed in 357 patients (293 F and 64 M) who were operated for PHPT in our clinic, with a mean age of 54.9±13.1 years. In the first surgery, 116 patients (32.5%) had bilateral neck exploration, 251 patients (67.5%) had unilateral neck exploration (UNE) or focused parathyroid surgery (FPS). In the first operation, 343 patients (96.1%) had cure, 14 patients (13 F and 1 M) remained persistent. Secondary surgical intervention was performed in 11 patients. UNE or FPS was performed to 10 patients (90.9%); partial sternotomy was performed to one patient. Ten of the patients had cure. Three of these patients had a solitary parathyroid adenoma that was not removed in the first surgery, and seven patients had a second adenoma. Four patients remained persistent (1.1%). Recurrent disease developed in four patients during follow-up (1.1%). Total cure rate was 97.8%.
Conclusion: The only definitive treatment for PHPT is surgery. High surgical cure can be achieved by pre-operative evaluation and appropriate surgical planning. However, persistent PHPT may develop, especially due to double adenoma or ectopic location. Patients with persistent PHPT can be evaluated with repeat imaging methods and with appropriate surgical planning, a high cure rate can be obtained in secondary surgery, which can increase the total surgical cure rate. Recurrence rate is rare.

Abstract | English Full Text

Amaç: Koronavirüs hastalýðý 2019 (COVID-19), çocuklarda farklý klinik tablolarla karþýmýza çýkabilir. COVID-19 þüphesi olan çoðu semptomatik çocuðun ateþ ve solunum sistemine ait þikayetleri mevcuttur. Bu retrospektif çalýþmada, çocuk acil servisimize baþvuran doðrulanmýþ ve olasý COVID-19 hastalarýnýn demografik özelliklerini, klinik özellikleri ve sonuçlarýný tanýmlamayý amaçladýk.
Yöntem: Çocuk acil servisimize 11 Mart - 12 Mayýs 2020 tarihleri arasýnda COVID-19 þüphesi ile baþvuran 135 çocuðu (1 ay-18 yaþ) deðerlendirdik. Hastalarýn aciliyetleri Pediatrik Deðerlendirme Üçgeni (PDÜ) ve Acil Ciddiyet Skorlarýna (ESI - Emergency Severity Index) göre deðerlendirildi. Hastalar doðrulanmýþ vakalar (Grup 1) ve olasý vakalar (Grup 2) olarak ayrýldý. Hastalarýn klinik, laboratuvar, radyolojik özellikleri ve hastalýk ciddiyetleri karþýlaþtýrýldý.
Bulgular: PDÜ deðerlendirmesine göre 82 hasta (% 65,6) acil deðildi. En sýk ESI triyaj kategorisi düzey 3'tü (n=102, % 76.1). Kýrk bir (% 30,4) hasta laboratuvar olarak doðrulanmýþ vaka olarak belirlendi. Elli beþ (% 40,7) hasta 28 gün-4 yaþ arasýndaydý. COVID-19 pozitif hastalarda hastalýðýn baþlangýcýnda en sýk rastalanan þikayet, öksürük ile ateþti (n = 16, % 39). Altmýþ dört (% 47,4) hastada hafif hastalýk mevcuttu ve 40 (% 29,6) hastada ek hastalýk vardý. Grup 1'de nötropeni grup 2'den anlamlý derecede yüksekti (p=0,024). Grup 2'nin ortalama prokalsitonin ve eritrosit sedimantasyon hýzý düzeyleri Grup 1'den anlamlý olarak yüksekti (sýrasýyla p=0,012, p=0,028). Elli bir hastanýn 28'inin toraks bilgisayarlý tomografisi COVID-19 ile uyumlu idi. Hastalarýn 51’i (% 37,8) acil servisten taburcu edilirken, 81'i (% 60) servise ve üçü (% 2,2) çocuk yoðun bakým ünitesine yatýrýldý.
Sonuç: Çalýþmamýz sýrasýnda olasý 135 vakadan 45'inin tanýsýný SARS-CoV-2 polimeraz zincir reaksiyonu testi ile doðruladýk. Doðrulanmýþ COVID-19 vakalarý arasýnda, hastalarýmýzýn çoðunda hafif veya orta derecede hastalýk mevcuttu. Doðrulanmýþ vakalardan yalnýzca üç hastanýn kliniði aðýr olarak sýnýflandýrýldý ve hiç kritik hastamýz yoktu. (SETB-2020-12-237)

Objectives: Coronavirus disease 2019 (COVID-19) have different clinical presentations in children. Most symptomatic children with suspicion of COVID-19 have fever and respiratory symptoms. In this retrospective study, we aimed to describe demographic features, clinical characteristics, and outcomes of confirmed and probable COVID-19 patients admitted to our pediatric emergency department (ED).
Methods: We identified 135 children (aged 1 month-18 years) with suspicion of the COVID-19 who were admitted to our ED between March 11 and May 12, 2020. The urgency of patients was evaluated according to their Pediatric Assessment Triangle (PAT) and Emergency Severity Index (ESI) scores. Patients were divided into two groups as confirmed cases (Group 1) and probable cases (Group 2). Clinical, laboratory, radiologic features, and the disease severity of patients were analyzed.
Results: According to PAT evaluation, 82 patients (65.6%) were non-urgent. The most frequent ESI triage category level was 3 (n=102, 76.1%). Forty-one (30.4%) patients were identified as laboratory-confirmed cases. Fifty-five (40.7%) patients were between 28 days and 4 years of age. Fever with cough was the most frequent symptoms at the onset of illness in COVID-19 positive patients (n=16, 39%). Sixty-four (47.4%) patients had mild disease and 40 (29.6%) patients had comorbidities. In Group 1, neutropenia was significantly higher than Group 2 (p=0.024). Mean procalcitonin and erythrocyte sedimentation rate levels of Group 2 were significantly higher than Group 1 (p=0.012 and p=0.028, respectively). Twenty-eight of 51 patients had chest computed tomography findings which were compatible with COVID-19. Fifty-one (37.8%) patients were discharged from ED, 81 (60%) were admitted to the ward, and 3 (2.2%) were admitted to the pediatric intensive care unit.
Conclusion: During our study, we confirmed the diagnosis of 45 of 135 probable cases with the SARS-CoV-2 polymerase chain reaction test. Among confirmed COVID-19 cases, most of our patients had mild or moderate disease. The clinic of only confirmed three patients was classified as severe disease, and we had no critically ill patient.

Abstract | English Full Text

Giriþ: Primer siliyer diskinezi (PSD), özellikle solunum yollarýný etkileyen, farklý klinik ve laboratuvar özellikleri ile karakterize kronik bir genetik hastalýktýr. Tanýsý oldukça zor olup, morbiditesi yüksektir. Son yýllarda genetik bilimindeki geliþmelerle birlikte hastalara taný koyulma oraný oldukça artmýþtýr. Bu çalýþmada, PSD hastalarýnýn klinik, radyolojik ve laboratuvar özellikleri ile genetik analizleri arasýndaki iliþkinin deðerlendirilmesi amaçlanmýþtýr.
Gereç ve yöntem: Çalýþmaya 2015-2019 tarihleri arasýnda PSD tanýsý konulan ve ekzom analizi yapýlan 14 çocuk dahil edildi. Hastalarýn taný yaþlarý, vücut kitle indeksleri (VKÝ)-Z skoru, klinik ve radyolojik bulgularý, solunum fonksiyon testleri, balgam kültür üremeleri ve gen analizleri incelendi ve kýyaslamasý yapýldý.
Bulgular: Hastalarýn 6’sý (% 43) kýz, 8’i (%57) erkek olup, taný anýndaki medyan yaþ deðeri 9 (min-maks: 3-16) yýldý. Genetik analizlerinde DNAH5 (n: 4, %29), DNAH11 (n: 2, %14), RSPH4A (n: 2, %14), CCDC40 (n: 2, %14), DNAH9 (n: 1, %7), HYDIN (n: 1, %7), DNAH1 (n: 1, %7), ARMC4 (n: 1, %7) patojenik mutasyonlarý saptandý. Ýstatistiksel olarak anlamlý olmasa da CCDC40 mutasyonlarýnda taný yaþýnýn daha küçük olduðu ve VKÝ Z- skorunun daha düþük olduðu tespit edildi. DNAH5, DNAH11, RSPH4A ve ARMC4 patojenik varyantlarýnda ise büyüme ve geliþme normal bulundu. Hastalarýn genetik analizleri ile klinik özellikleri, kültür üremeleri ve solunum fonksiyon testleri arasýnda anlamlý iliþki saptanmadý.
Sonuç: PSD hastalarýnýn genetik incelemeleri sonucu elde edilen verilerle hastalýðýn olasý klinik özellikleri ve prognozu hakkýnda daha detaylý bilgiler elde edilebileceði düþünülmektedir. Fakat yine de daha yüksek hasta sayýlý klinik araþtýrmalara ihtiyaç duyulmaktadýr. (SETB-2020-05-048)

Objectives: Primary ciliary dyskinesia (PCD) is a chronic genetic disease that affects the respiratory tract, characterized by different clinical and laboratory features. It has a very difficult diagnosis, and high morbidity. In recent years, with the advances in genetics, the rate of diagnosis has increased considerably. In this study, it was aimed to evaluate the relationship between PCD patients' clinical, radiological and laboratory features and genetic analysis.
Methods: The study included 14 children who were diagnosed with PCD between 2015-2019 and underwent exome analysis. Diagnostic ages, body mass indexes (BMI)- Z score, clinical and radiological findings, pulmonary function tests, sputum culture reproduction and gene analysis were evaluated and compared.
Results: Six of the patients (43%) were girls and 8 (57%) were boys, and the median age at the time of diagnosis was 9 (min-max: 3-16) years. Genetic analysis revealed pathogenic mutations in DNAH5 (n=4, 29%), DNAH11 (n=2, 14%), RSPH4A (n=2, 14%), CCDC40 (n=2, 14%), DNAH9 (n=1, 7%), HYDIN (n=1, 7%), DNAH1 (n=1, 7%), and ARMC4 (n=1, 7%). Although not statistically significant, it was found that the diagnosis age was lower and the BMI Z-score was lower in CCDC40 mutations. Growth parametres were normal in DNAH5, DNAH11, RSPH4A and ARMC4 pathogenic variants. No significant correlation was found between genetic analysis and clinical features, culture reproduction and pulmonary function tests of the patients.
Conclusion: It is thought that more detailed information about the possible clinical features and prognosis of the disease can be obtained by genetic examinations of PCD. However, clinical trials with higher patient numbers are still needed.

Abstract | English Full Text

Amaç: Ventilatör iliþkili pnömoninin (VÝP) kritik hastalarda hastalýk ve ölüm oranlarýyla dikkate deðer bir baðlantýsý vardýr ve saðlýk bakým maliyetlerinde artýþlara neden olur. Ancak bu pnömoni önlenebilirdir ve hastaneler VÝP oranlarýný azaltabilir. Bu çalýþma, Saðlýk Bilimleri Üniversitesi Dr. Abdurrahman Yurtaslan Ankara Onkoloji Eðitim ve Araþtýrma Hastanesi yoðun bakým ünitesinde ventilatör iliþkili pnömoni oranlarýný etken organizmalardan biri olan Acinetobacter baumannii referans alýnarak geriye dönük olarak deðerlendirmeyi amaçlamýþtýr.
Yöntem: Bu çalýþmaya 2011-2015 yýllarý arasýnda ilgili hastanede yatan toplam 2277 hasta dahil edilmiþtir. Gerekli veriler hastane veri tabanlarý üzerinden hastalarýn bilgisayardaki týbbi dosyalarý incelenerek toplanmýþtýr. VÝP oraný ve ventilatör kullaným oraný, Amerika Birleþik Devletleri Hastalýk Kontrol Merkezi Ulusal Saðlýk Güvenliði Aðý metodolojisi kullanýlarak hesaplanmýþtýr.
Bulgular: Çalýþmaya dahil edilen hastalardan 302’sinde (%13,26) VÝP geliþtiði görülmüþtür. Bu hastalarýn 191’inde (%63,25), ventilatör iliþkili pnömoniye A. baumannii’nin neden olduðu mikrobiyolojik olarak teþhis edilmiþtir. Ventilatör kullaným oraný ve VÝP oranýnýn havuzlanmýþ ortalamalarý sýrasýyla 0,70 ve 22,91 olarak bulunmuþtur.
Sonuç: Bu çalýþmanýn sonuçlarý, ilgili hastanenin enfeksiyon kontrol komitesini mevcut enfeksiyon kontrol programýný ve stratejilerini gözden geçirme konusunda motive edecektir, böylece yoðun bakým ünitesindeki yüksek ventilatör iliþkili pnömoni oraný mümkün olan minimum seviyeye indirilebilir. (SETB-2021-02-045)

Objectives: Ventilator-associated pneumonia (VAP) is associated with significant morbidity and mortality in critically ill patients and leads to increases in health-care costs. However, it is preventable, and hospitals can decrease VAP rates. This study aims to retrospectively assess VAP rates in the intensive care unit of Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital of the University of Health Sciences, with reference to Acinetobacter baumannii, one of the causative organisms.
Methods: This study enrolled a total of 2277 patients hospitalized between the years of 2011 and 2015. The required data were collected by reviewing medical files of the patients through computerized hospital databases. VAP rate and ventilator utilization (VU) ratio were calculated using the United States Center for Disease Control National Healthcare Safety Network methodology.
Results: Of the study patients, 302 (13.26%) were seen to have developed VAP. Among these patients, 191 (63.25%) were microbiologically diagnosed VAP caused by A. baumannii. Pooled means of VU ratio and VAP rate were 0.70 and 22.91, respectively.
Conclusion: The results of this study will motivate the infection control committee of the study hospital to assess current infection control program and strategies so that high VAP rate in the study intensive care unit can be reduced to the minimum possible level.

Abstract | English Full Text

Amaç: Çalýþmamýzda, psoriasisli hastalar ile saðlýklý kontrol grubu arasýnda saðlýklý yaþam biçimi davranýþlarýnýn karþýlaþtýrýlmasý amaçlanmýþtýr.
Yöntem: Bu vaka kontrol çalýþmasýna 18 yaþýndan büyük 80 psoriasis hastasý ile cinsiyet ve yaþ açýsýndan eþleþtirilmiþ 80 saðlýklý kontrol dahil edildi. Katýlýmcýlara sosyodemografik veri toplama formu ve “Saðlýklý Yaþam Biçimi Davranýþlarý Ölçeði-II (SYBDÖ-II)” doldurtuldu. SYBDÖ-II 52 maddeden oluþur ve saðlýðý geliþtirici davranýþ sonuçlarýnýn altý bileþenini ölçer: beslenme, fiziksel aktivite, saðlýk sorumluluðu, manevi büyüme, kiþilerarasý iliþkiler ve stres yönetimi. Yüksek puanlar, kiþinin belirtilen saðlýk davranýþlarýný yüksek düzeyde uyguladýðýný göstermektedir.
Bulgular: SYBDÖ-II toplam puanlarý hasta grubunda 128,3 ± 21,1 ve kontrol grubunda 132,5 ± 22,3 idi. Skorlara göre, psoriasis hastalarý orta düzeyde saðlýðý geliþtiren yaþam tarzýna sahip bulunurken, kontroller iyi düzeyde saðlýðý geliþtiren yaþam tarzýna sahipti. Öte yandan, hastalarýn manevi geliþim skorlarý (ortalama ± SD = 25,6 ± 4,9) kontrollerden istatistiksel olarak daha düþüktü (ortalama ± SD = 27,3 ± 4,5) (p = 0,040). Ek olarak, hasta grubunda manevi geliþim skoru ile hastalýk süresi negatif yönde korele idi (r = -0,287, p = 0,01). Ayrýca, hasta grubunda ek komorbiditesi olanlarýn beslenme puaný, sadece psoriasisi olanlara göre anlamlý düzeyde yüksekti (p=0,002).
Sonuç: Bu çalýþma, Türk toplumunda psoriasis hastalarý ile saðlýklý gönüllülerin saðlýklý yaþam biçimi davranýþlarýný karþýlaþtýran ilk çalýþmadýr. Dermatologlarýn görevi, sadece psoriasis lezyonlarýnýn medikal tedavisi deðil; ayný zamanda hastalarýn yaþam tarzý davranýþlarýný sorgulamak ve hastalarda saðlýklý davranýþlarýn geliþimini desteklemektir. (SETB-2019-12-147)

Objectives: The purpose of our study was to compare healthy lifestyle behaviors between psoriasis patients and healthy controls.
Methods: This case–control study included 80 psoriasis patients and 80 sex- and age- matched healthy controls aged over 18. Participants completed the socio-demographic data form and the Health-Promoting Lifestyle Profile II (HPLP-II). The HPLP-II consists of 52 items and measures six components of health-promoting behavior outcomes: Nutrition, physical activity, health responsibility, spiritual growth, interpersonal relations, and stress management. Higher scores show that the individual applies the specified health behaviors at a high level.
Results: HPLP-II total scores were 128.3±21.1 in patient group and 132.5±22.3 in control group. Based on the scores, psoriasis patients showed a moderate level of health-promoting lifestyle, while controls showed a good level of health-promoting lifestyle. Spiritual growth score of patients (mean±SD = 25.6±4.9) was statistically lower than the controls (mean±SD = 27.3±4.5) (p=0.040). In addition, spiritual growth score and disease duration were negatively correlated in the patient group (r=–0.287, p=0.01). Furthermore, nutrition score of those with additional comorbidity was significantly higher than those with psoriasis alone in patient group (p=0.002).
Conclusion: This is the first study to compare healthy lifestyle behaviors of psoriasis patients and healthy volunteers in Turkish population. The task of dermatologists is not only the medical treatment of psoriasis lesions but also questioning patients’ lifestyle behaviors and supporting the development of healthy behaviors in patients.

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AMAÇ: Ýntradiskal ozon tedavisi bel aðrýsý olan ve konservatif tedaviye cevap vermeyen hastalara uygulanabilen minimal invaziv bir yöntemdir. Retrospektif olarak tasarlanan bu çalýþma; klinik etkinliði, yan etkileri ve komplikasyon oranlarýný deðerlendirmeyi amaçlamýþtýr.
GEREÇ VE YÖNTEM: Çalýþmaya Ocak 2016 - Nisan 2018 tarihleri arasýnda, lomber dejeneratif disk hastalýðý (LDDD) olan ve intradiskal O2-O3 tedavisi uygulanan hastalar dahil edildi. Aðrý ve iþ görmezlik düzeyleri enjeksiyon öncesi, enjeksiyon sonrasý, postoperatif bir aylýk ve bir yýllýk dönemlerde Görsel Analog Skala (VAS) ve Oswestry Özürlülük Ýndeksi (ODI) kullanýlarak deðerlendirildi.
BULGULAR: Yaþ ortalamasý 38.9 ± 5.7 yýl olan toplam 520 hasta (270 erkek ve 250 kadýn) çalýþmaya dahil edildi. Enjeksiyon sonrasý birinci ay ve birinci yýl VAS ve ODI skorlarý enjeksiyon öncesi skorlardan anlamlý olarak düþüktü (p <0.001). VAS skorunda azalma (% 50'den fazla) birinci ayda hastalarýn% 60.2'sinde ve ilk yýlda hastalarýn% 52.9'unda bulundu. Önemli bir yan etki kaydedilmedi.
SONUÇLAR: LDDD ile iliþkili bel aðrýsýnýn tedavisi için perkütan uygulama tekniklerinden biri olan epidural steroid tedavisi ile birlikte uygulanan intradiskal ozon tedavisinin; baþarýlý sonuçlarý, klinik etkinliði ve düþük yan etki oraný vardýr. Uygun hastalarda ameliyattan önce düþünülmesi gereken yöntemlerden biridir. (SETB-2020-05-074)

Objectives: Intradiscal ozone treatment is a minimally-invasive method that can be applied to patients who have low back pain and do not respond to conservative treatment. This retrospectively designed study aimed to evaluate its clinical efficacy, adverse effects, or complication rates.
Methods: Patients with lumbar degenerative disc disease (LDDD) who underwent intradiscal O2-O3 treatment between January 2016 and April 2018 were included in the study. Pain and disability levels were assessed at pre-injection, 1-month and 1-year post-injection periods using visual analog scale (VAS) and Oswestry Disability Index (ODI), respectively.
Results: A total of 520 patients (270 males and 250 females) with the mean age of 38.9±5.7 years included in the study. First-month and 1st-year post-injection VAS and ODI scores were significantly lower than pre-injection scores (p<0.001). Remarkable VAS score reduction (more than 50%) was found in 60.2% of patients at 1st month and in 52.9% of patients at the 1st year. No important side effects recorded.
Conclusion: Intradiscal ozone therapy applied together with the epidural steroid treatment, one of the percutaneous application techniques for the treatment of low back pain related to LDDD, has successful outcomes, clinical efficacy, and low rate of side effects, and thus, is one of the methods that should be considered before surgery when appropriate patients.

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Amaç: Çalýþmamýz kapsamýnda Kronik Obstruktif Akciðer Hastalýðý (KOAH) olan hastalarda retinal vasküler dansite ve kan akýmý deðiþikliklerinin optik koherens tomografi anjiografi (OKTA) (AngioVue Avanti, Optovue) cihazý yardýmýyla araþtýrýlmasý amaçlanmýþtýr.
Gereç ve Yöntem: KOAH’ý olan 30 hastanýn 30 gözü ile 30 kiþilik saðlýklý kontrol grubunun 30 gözü OKTA yardýmýyla deðelendirilmiþtir. Foveal ve parafoveal vasküler dansite, iç retinal ve koryokapiller kan akýmý ve foveal avasküler zon (FAZ) alaný ölçülmüþ ve gruplar arasýnda kýyaslanmýþtýr.
Bulgular: Dýþ retinal kan akýmý ve koryokapiller kan akýmý arasýnda gruplar arasýnda istatistiksel anlamlý fark saptanmamýþtýr (p=0.609, p=0.162). FAZ ve FAZ perimetre deðerlerinde gruplar arasýnda istatistiksel anlamlý fark saptanmamýþtýr (p=0.725, p=0.820). Süperfisiyal foveal ve parafoveal alanlardaki vasküler dansite ölçümlerinde gruplar arasýnda istatistiksel anlamlý fark saptanmamýþtýr (p>0.05, hepsi için). Derin parafoveal vasküler dansite deðerlerinin, superior ve inferior kadran dýþýnda, incelenen tüm alanlarda KOAH grubunda kontrol grubuna göre istatistiksel anlamlý olarak daha düþük olduðu görülmüþtür.
Sonuç: Çalýþmamýzýn sonuçlarý KOAH iliþkili hipoksi ve endotelyal disfonksiyonun parafoveal alanda vasküler dansite kaybýna sebep olduðunu ilk defa ortaya koymuþtur. (SETB-2020-07-118)

Objectives: In the current study, we aimed to investigate retinal vascular density and blood flow changes in patients with chronic obstructive pulmonary disease (COPD) using optical coherence tomography angiography (OCTA) (AngioVue Avanti, Optovue).
Methods: Thirty eyes of 30 patients with COPD and 30 eyes of 30 healthy controls were evaluated with OCTA. Foveal and parafoveal vessel density, inner retinal and choriocapillary flow area, and foveal avascular zone (FAZ) area were measured and compared between the groups.
Results: No statistically significant differences were observed in the outer retinal flow area and choriocapillary flow area measurements between the groups (p=0.609 and p=0.162, respectively). There was no statistically significant difference in FAZ and FAZ perimeter values between the groups (p=0.725 and p=0.820, respectively). Vascular density measurements in the superficial foveal and parafoveal areas were not statistically significantly different between the groups (p>0.05, for all). Deep parafoveal vascular density values of the COPD group were statistically significantly lower than the control group in all investigated areas except the superior and inferior quadrants.
Conclusion: The results of our study demonstrated for the first time that vascular density decreased in the parafoveal area due to COPD-related hypoxemia and endothelial dysfunction.

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Amaç: Çölyak Trunk abdominal aortun ilk eþleþmemiþ dalý olup, baþta karaciðer, mide ve dalak olmak üzere üst karýn yapýlarýna kan saðlar. Pankreas, dalak, safra kesesi, karaciðer ameliyatlarý ve kemoembolizasyon gibi giriþimsel radyolojik iþlemler öncesinde varyant anatomileri bilmek önemlidir. Çalýþmamýzýn amacý, yeterince çalýþýlmamýþ diyafragmatik krus ile vasküler yapýlar arasýndaki mesafelerin ölçülmesi ve vasküler varyasyonlar ile kollateral dallar arasýndaki muhtemel iliþkilerin saptanmasýdýr.
Yöntem: Haziran 2016 - Temmuz 2020 tarihleri arasýnda, merkezimizde, Çok Kesitli Bilgisayarlý Tomografi incelemesi yapýlan 200 kolorektal kanserli hastanýn (114 erkek, 86 kadýn) görüntüleme bulgularý retrospektif olarak incelendi. Çölyak Trunk, Hepatik Arter varyasyonlarý, kollateral oluþumlar, yaþ, cinsiyet arasýndaki iliþkiler Spearman’s Rho test ile deðerlendirildi.
Bulgular: Diyafram krusu ile çölyak trunk arasýndaki mesafe 4-60 mm (ortalama 24,3 mm), çölyak trunk ile superior mezenterik arter (SMA) arasýndaki mesafe 2,5-35 mm (ortalama 8,6 mm), çölyak trunk çapý 4,6-9,4 mm (ortalama 7,3 mm) ve ana hepatik arter (CHA) çapý 2,4-5,8 mm (ortalama 4,1 mm) ölçüldü. Çalýþmamýzda Çölyak Trunk, Hepatik Arter varyasyonlarý ile kollateral arterler arasýnda istatistiksel olarak anlamlý korelasyon (r -0,124 - 0.116 aralýðýnda, p> 0.05) saptanmamakla beraber Michel's tip V ve tip VIII gibi sol gastrik arterden çýkan tek aksesuar sol hepatik arter olgularýnda CHA ve SMA arasýndaki kollaterallerin nispeten daha sýk olduðu söylenebilir (p = 0,1).
Sonuç: Çalýþmamýz geçmiþte çok az çalýþýlan diyafragmatik krus-vasküler yapýlar arasýndaki mesafeleri tespit ederek literatüre katký saðlamýþtýr. Çalýþmamýzda tespit ettiðimiz Çölyak Trunk ve Hepatik Arter varyasyonlarýnýn sýklýklarý, malignitesi olmayan hasta gruplarýyla yapýlmýþ önceki çalýþmalarýn sonuçlarý ile benzerdir. (SETB-2021-03-074)

Objectives: Celiac Trunk (CT) is a vital artery and the first unmatched branch of the abdominal aorta, providing blood to upper abdominal structures, particularly the liver, stomach, and spleen. It is essential to know its anatomy in terms of pancreas, spleen, gallbladder, liver surgeries, and interventional radiological procedures such as chemoembolization. The aim of our study is to contribute to the literature with the measurements of distances between the diaphragmatic crus and vascular structures with their diameters, which have been studied insufficiently, and to detect the possible relationships between vascular variations and collateral branches.
Methods: Imaging findings of 200 patients (114 males and 86 females), who underwent Multi-Section Computed Tomography examination with various indications in our center between June 2016 and July 2020, were retrospectively analyzed. The statistical relations between CT and Hepatic Artery variations, collateral formations, age, and gender were evaluated with the Spearman’s Rho Correlation Coefficient Test.
Results: The distance between the crus of diaphragm and CT was 4–60 mm (mean 24.3 mm), the distance between CT and superior mesenteric artery (SMA) was 2.5–35 mm (mean 8.6 mm), CT diameter was 4.6–9.4 mm (mean 7.3 mm), and the main hepatic artery diameter was 2.4–5.8 mm (mean 4.1 mm). There was no correlation in our study between CT, Hepatic Artery variations, and their collaterals (r in range of −20,124–0.116, p>0.05). It can be said that in cases of the single accessory left hepatic artery originating from the left gastric artery, such as Michel’s Type V and Type VIII, collaterals between common hepatic artery and SMA were relatively more frequent (p=0.1).
Conclusion: Our study contributed to the literature by measuring the distance between diaphragmatic crus-vascular structures, which has been little studied in the past. Frequencies of CT and Hepatic Artery variations that have been detected in our study are similar to the results of the previous studies with non-malignancy patient groups.

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Amaç: Mide kanserli hastalarda aþýrý HER2 ekspresyonunun, klinikopatolojik özellikleri ve saðkalýmý etkileyen faktörleri deðerlendirmek.
Yöntemler: Çalýþma, 2005-2012 yýllarý arasýnda hastanemize baþvuran 128 mide kanseri (non-lenfoma histolojik tip) olgusu ile yapýlan retrospektif bir çalýþmadýr. Hastalarýn demografik özellikleri, performans skoru, tümör lokalizasyonu, ameliyat hakkýnda bilgiler, HER2 ölçümleri, histopatolojik özellikleri, evreleri, tedavi özellikleri, metastaz bölgeleri ve genel saðkalým süresi týbbi kayýt sisteminden elde edildi. HER2 skorlamasý için immüno-histokimyasal analiz yapýldý.
Bulgular: Çalýþma grubunda 89 (% 69,5) erkek ve 39 (% 30,5) kadýn vardý ve hastalarýn ortanca yaþý 64 idi. Medyan saðkalým süresi 24,43 aydý. Hastalarýn 5 yýllýk saðkalým oraný % 35.4 ± 5.9 olarak hesaplandý. Genel saðkalým süresinin daha yüksek HER2 seviyeleri olan grupta ve ayrýca ileri evre kanseri olanlarda daha kýsa olduðu bulunmuþtur. Perinöral invazyonlu ve ileri evre hastalarda 5 yýllýk saðkalým oraný anlamlý olarak daha düþük bulundu. Bununla birlikte, 5 yýllýk saðkalým oraný, lenfovasküler invazyon, cerrahi sýnýr tutulumu ve HER2 seviyeleri ile iliþkili deðildi. Cinsiyet, histolojik alt tip, evre ve cerrahi sýnýrýn genel saðkalým üzerindeki etkilerini deðerlendirmek için yapýlan çok deðiþkenli Cox Regresyon analizinde hastalýk evresinin saðkalým üzerinde etkili tek faktör olduðu bulundu. Cinsiyet, histolojik alt tip ve cerrahi sýnýrýn prognoz üzerine etkisi yoktu.
Sonuç: Mide kanserlerinde 5 yýllýk saðkalým oraný ileri evre hastalýðý olanlarda daha düþük bulundu. Daha yüksek HER2 seviyesi ve hastalýk evresi, daha kýsa genel hayatta kalma süresi ile iliþkilendirildi. (SETB-2020-11-241)

Objectives: The objective of the study was to evaluate the human epidermal growth factor receptor 2 (HER2) overexpression, clinicopathological features, and factors affecting survival in patients with gastric cancer.
Methods: The study is a retrospective study conducted with 128 cases of gastric cancer who were admitted to Þiþli Hamidiye Etfal Training and Research Hospital between 2005 and 2012. Patients’ demographic characteristics, performance score, tumor localization, information about surgery, HER2 measurements, histopathological characteristics, stage, treatment features, metastasis sites, and overall survival time were obtained from medical records. Immunohistochemical analysis was performed for HER2 scoring.
Results: There were 89 (69.5%) men and 39 (30.5%) women in the study group, and the median age of the patients was 64 years. The median survival time of the patients was 24.43 months. The survival rate of the patients was calculated as 35.4±5.9%. Overall survival time was found to be shorter in the group with higher HER2 levels and also those with advanced-stage cancer. The survival rate was found to be significantly lower in patients with perineural invasion and advanced stage. However, the survival rate was not associated with lymphovascular invasion, surgical margin involvement, and HER2 levels. In the multivariate Cox Regression analysis performed to assess the effects of gender, histological subtype, stage, and surgical margin on overall survival, disease stage was found to be the only factor effective on survival. Gender, histological subtype, and the surgical margin did not affect prognosis.
Conclusion: The survival rate in gastric cancers was found to be lower in those with advanced-stage disease. Higher HER2 level and the disease stage were associated with shorter overall survival time.

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Amaç: Türkiye’de Ýstanbul’da HPV (Human Papilloma Virüs) sýklýðý ve tiplerinin dokümante edilmesi yanýsýra, saptanan bu alt tipler ve sitolojik ve patolojik tanýlarýn iliþkisinin deðerlendirilmesi.
Gereçler ve Yöntem: Ýstanbul’da 2001-2019 yýllarý arasýnda moleküler patoloji departmanýmýzda 4879 olgu çalýþýlmýþtýr. 2001-2010 arasýnda 1692 olgu klasik hibridizasyon ve PCR (polimeraz zincir reaksiyonu) ile HPV 6,11,16,18, 33 için taranmýþtýr. 2011 yýlýndan itibaren chip array ile günümüzde kýrkdokuza varan HPV tiplemesi 3187 olgu için yapýlmýþtýr. Olgular sitolojik-histopatolojik deðerlendirmelerde prekanseröz deðiþiklik ve koilosit görülmesi üzerine veya tarama amacýyla ya da HPV aþýlamasý öncesi klinisyenler tarafýndan patoloji merkezine ve hastane patoloji departmanýna yönlendirilmiþtir.
Bulgular: Bu çalýþmada HPV sýklýðý %10,8 olarak saptanmýþtýr (527 HPV-pozitif olgu). Bunlar içinde 348 olgu beraberinde düþük riskli grup olsun ya da olmasýn yüksek riskli gruptur. Olgularýn yüksek riskli HPV tiplerine göre daðýlýmýna baktýðýmýzda HPV 16 (%41,7), HPV 31 (%11.7), HPV 52 (%7.9), HPV 51 (%7.1), HPV 33 (%6.9), HPV 45 (%6.5), HPV 18 (%6.3), HPV 39 (%6.1) ve HPV 58 (%5.8) olarak belirlenmiþtir. HSIL (yüksek dereceli skuamöz epiteliçi lezyon) olgularýnda çoklu enfeksiyon sýklýðý %28’dir. Sitolojik ya da histopatolojik olarak prekanseröz, LSIL (düþük dereceli skuamöz epiteliçi lezyon) ve HSIL deðiþiklik gösteren olgularda HPV sýklýðý sýrasý ile %38 ve %72’dir. Servikal kanser saptanan 10 olgunun 9’unda HPV saptanmýþtýr (%90).
Sonuç: Çalýþmada en sýk HPV 16 saptanmýþtýr. Onu sýrasý ile HPV 31, 52, 51, 33, 45, 18, 39 ve 58 takip etmektedir. Çift enfeksiyonlarda gözlenen en sýk birliktelik HPV 16 ve 58 arasýnda olmuþtur. Ýstanbul’da HPV sýklýðýnýn geliþmiþ ülkelerden çok farklý olmadýðýný görülmektedir. Tarama testleri, PCR ve chip array çalýþmalarý yaný sýra toplum koruyucu hekimlik açýsýndan bilgilendirilmeli, prezervatif kullanýmýnýn önemi vurgulanmalýdýr (SETB-2021-01-022).

Objectives: The aim of this study is the documentation of human papilloma virus (HPV) frequency and types seen in the city of Istanbul, Turkey, as well as evaluation of the relationship between these subtypes and cytological and pathological diagnoses.
Methods: 4879 cases were studied in our molecular pathology department between 2001 and 2019 in Istanbul. Between 2001 and 2010, 1692 cases were screened for HPV 6, 11, 16, 18, 31, and 33 by conventional hybridization and polymerase chain reaction (PCR). Since 2011, up to 49 HPV typing has been performed for 3187 cases with chip array. The cases were referred to the pathology center and the hospital pathology department by clinicians for screening before HPV vaccination and on the observation of precancerous changes and koilocyts in cytological-histopathological evaluations.
Results: In this study, the frequency of HPV was found to be 10.8% (527 HPV-positive cases). Among these, 348 cases were high-risk groups, whether or not they were previously associated with a low-risk group. When we look at the distribution of the cases according to the high-risk HPV types, HPV 16 is the most common type. The frequencies of occurrence of other HPV types are as following: HPV–16: 41.7%, HPV–31: 11.7%, HPV–52: 7.9%, HPV–51: 7.1%, HPV–33: 6.9%, HPV–45: 6.5%, HPV–18: 6.3%, HPV–39: 6.1%, and HPV–58: 5.8%. It was further found that multiple infections were 28% of high grade squamous intraepithelial lesion cases. HPV frequency was 38% and 72%, respectively, in cases with cytologically or histopathological precancerous, low-grade squamous intraepithelial lesion, and HSIL changes. As a final note, HPV was detected in 9 of 10 cases with cervical cancer (90%). Only 1 adenocarcinoma case detected in the series was a double infection with HPV types 18 and 45.
Conclusion: HPV 16 was the most common type found in this study. It is followed by types 31, 52, 51, 33, 45, 18, 39, and 58, respectively. The most common association observed in double infections was between HPV 16 and 58. It was also observed that the incidence of HPV in the city of Istanbul, Turkey, was similar to other developed countries. As a final note, in addition to screening tests, PCR and chip array studies should be conducted and the community should be informed about preventive medicine and the importance of condom use.

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Amaç: Folliküler neoplazm/folliküler neoplazm þüphesi (FN/FNS) Bethesda Kategori (BC)-4 grubu olgular, gri zon olarak bilinmektedir. Sitolojide bu tanýyý alan nodüller eksize edilmektedir. Ancak, bu nodüllerin çok azý maligndir. Amacýmýz, gereksiz cerrahiyi azaltmak için klinik-radyolojik-patolojik parametrelerin kullanýlabilirliðini araþtýrmaktýr. Yanýsýra, bu nodüllerde önerilmeyen, ancak klinik ya da hastaya baðlý nedenlerle yapýlmýþ FNAB tekrarýnýn yararýný sorguladýk.
Yöntem: Ocak 2014-Eylül 2020 tarihleri arasýnda kurumumuzda yapýlan tüm tiroid ÝÝAB hastalarýnýn dosyalarý veri tabanýnda tarandý. Bu hastalarýn mevcut tüm kaynaklardan elde edilen histopatolojik ve klinik sonuçlarý kaydedildi. Çalýþmamýzda bu dönemde ÝÝAB uygulanan 3624 nodül arasýnda sitoloji sonuçlarý FN / FNS olarak sýnýflandýrýlan 185 (%5,1) nodül tespit edildi. 28 hasta çalýþma grubundan çýkarýldý. Bu nodüllere sahip hastalardan, ameliyat edilen ve çalýþma kriterlerini karþýlayan 21-82 yaþ arasý 157 hastaya ait 157 nodül belirlendi. Tüm hastalarýn dosyalarý tarandý ve yaþ, cinsiyet, ultrasonografik nodül özellikleri, ÝÝAB tekrarý, ameliyat tipi ve postoperatif patoloji sonuçlarý kaydedildi. Tüm veriler nodül özellikleri ile karþýlaþtýrýlarak analiz edildi. Ýstatistiksel analiz için SPSS 15.0 for Windows programý kullanýldý.
Bulgular: Malignite sýklýðý ile erkek cinsiyet ve hipervaskülarizasyon arasýnda anlamlý iliþki bulundu (sýrasýyla p = 0,017, p = 0,002). Ýki cm'den büyük nodüllerde malignite daha azdý (p = 0,014). Diðer klinik ve radyolojik özellikler ile malignite arasýnda iliþki yoktu. FNAB tekrarý olan 29 nodülde malignite ile ileri yaþ (52.9), 2 cm'den küçük nodül varlýðý ve hipervaskülarizasyon arasýnda anlamlý iliþki bulundu (sýrasýyla p = 0.047, p = 0.047, p = 0.030).
Sonuç: Hipervasküler, hipoekojenik, mikrokalsifik BC-4 nodülleri olan (erkek cinsiyette ve yaþlý hastalar daha büyük risk altýnda) hastalarýn dikkatlice gözden geçirilmesini tavsiye ediyoruz. Ciddi malignite riski nedeniyle, bu özelliklere sahip hastalarda operasyon sýrasýnda nodüle uygulanan frozen section ile inceleme sonrasýnda total tiroidektomi ile hasta yönetimine hazýrlýklý olunmalýdýr. (SETB-2021-03-091)

Objectives: Follicular neoplasm/suspected follicular neoplasm (FN/FNS) Bethesda Category (BC)-4 group cases are known as the gray zone. Nodules diagnosed in cytology are excised. However, very few of these nodules are malignant. Our aim is to investigate the usability of clinical-radiological-pathological parameters to reduce unnecessary surgery. In addition, we questioned the benefit of repeating fine-needle aspiration biopsy (rFNAB) in these nodules, which is not recommended, but performed for clinical or patient-related reasons.
Methods: The files of all thyroid FNAB patients conducted in our institution between January 2014 and September 2020 were scanned in the database. In our study, 185 (5.1%) nodules with cytology results of which were classified as FN/FNS were identified among 3624 nodules that were applied FNAB during this period. Twenty-eight patients were excluded from the study group. 157 nodules belonging to 157 patients between the ages of 21 and 82 years who were operated and met the study criteria were identified from patients with these nodules. The files of all patients were scanned and the results of age, gender, ultrasonographic nodule characteristics, FNAB repeat, type of surgery, and postoperative pathology were recorded. All data were analyzed by comparing them with nodule features. SPSS 15.0 for Windows program was used for statistical analysis.
Results: A significant correlation was found between the incidence of malignancy and male gender and hypervascularization (p=0.017 and p=0.002, respectively). Malignancy was less in nodules larger than 2 cm (p=0.014). There was no relationship between other clinical and radiological features and malignancy. In 29 nodules with rFNAB, a significant correlation was found between malignancy and advanced age (52.9-years-old), presence of nodules smaller than 2 cm and hypervascularization (p=0.047, p=0.047, and p=0.030, respectively).
Conclusion: We recommend careful review of patients with hypervascular, hypoechogenic, and microcalcific BC-4 nodules (male gender and older patients at greater risk). Because of the serious risk of malignancy, patients with these features should be prepared for patient management with total thyroidectomy after examination with frozen section applied to the nodule during the operation.

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Giriþ ve Amaç: Miyokardiyal disfonksiyon HIV enfekte hastalarda önemli morbidite nedenidir. CD4 T hücre seviyesinde düþme ve CD4/CD8 oranýn tersine dönmesi kardiyovasküler olaylar ile iliþkilendirilmiþtir. Fragmented QRS (fQRS) miyokardiyal disfonksiyon ve kardiyovasküler olaylarý gösterebilmektedir. Bu çalýþmanýn amacý HIV enfekte hastalarda fQRS varlýðýný ve etki eden faktörleri araþtýrmaktýr.
Materyal ve Metod: Bu vaka kontrol çalýþmasýna 153 ayaktan HIV enfekte hasta (%97 male) ve 141 saðlýklý gönüllü (%96 male) alýndý. Kardiyak hastalýk öyküsü, aritmi, diyabet, kanser, tiroid disfonksiyonu çalýþma dýþý býrakýldý. Tüm katýlýmcýlara elektrokardiyografi, ekokardiyografi, biyokimya testleri yapýldý. HIV enfekte hastalara CD4 T hücre sayýsý, CD8 T hücre sayýsý ve HIV RNA düzeyi bakýldý.
Bulgular: Her iki grupta bazal karakteristik özellikler benzerdi. Ortalama nadir CD4 T hücre seviyesi 356 cell/cm3, undercontrol HIV %48 ve ART kullanýmý %64 seviyesindeydi. HIV enfekte olanlarda daha düþük sol ventrikül ejeksiyon fraksiyonu (LVEF), daha yüksek Tie index ve daha fazla sayýda fQRS saptandý. fQRS var olan HIV enfekte hastalarda daha düþük nadir CD4 T hücre seviyesi, CD4/CD8 oraný ve daha yüksek Tie index görüldü. Multivariant analizde CD4/CD8 oraný ve LVEF, HIV enfekte hastalarda fQRS göstermede baðýmsýz prediktör olarak saptandý.
Taþtýþma: HIV enfekte hastalarda miyokardiyal disfonksiyon görülebilmektedir. CD4/CD8 oraný düþük olan HIV enfekte hastalarda miyokardiyal disfonksiyon açýsýndan dikkatli olunmalýdýr. (SETB-2020-01-07)

Objectives: Myocardial dysfunction is an important cause of morbidity in human immunodeficiency virus (HIV)-infected patients. Decline in CD4 T-cell level and reversal of CD4/CD8 ratio was associated with cardiovascular events. Fragmented QRS (fQRS) can show myocardial dysfunction and cardiovascular events. The aim of this study is to investigate the presence of fQRS in HIV-infected patients and the factors affecting it.
Methods: This case-control study included 153 outpatient HIV patients (97% male) and 141 healthy subjects (96% male). Patients with cardiac disease history, arrhythmia, diabetes, cancer disease, and thyroid dysfunction were excluded from the study. Electrocardiogram, echocardiography, and biochemistry tests were performed to all participants. CD4 and CD8 T cell count, and HIV RNA level were measured in HIV-infected patients.
Results: Both groups had similar basal characteristics. Mean CD4 T-cell level was 356 cell/cm3, HIV was under control in 48%, and the rate of antiretroviral treatment use was 64%. HIV-infected patients had lower left ventricular ejection fraction (LVEF), higher Tei index, and more fQRS. HIV-infected patients with fQRS had lower nadir CD4 T-cell levels, lower CD4/CD8 ratio, and higher Tie index. In multivariate analysis, CD4/CD8 ratio and LVEF were found to be independent predictors of fQRS in HIV-infected patients.
Conclusion: Myocardial dysfunction can be seen in HIV-infected patients. Caution should be exercised in terms of myocardial dysfunction in HIV-infected patients with low CD4/CD8 ratio.

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Amaç: Akýlcý antibiyotik kullanýmýnýn yaygýnlaþtýrýlmasý için Antibiyotik Yönetim Programlarý (AYP) geliþtirilmiþtir. Hastanemiz, Türkiye'de AYP uygulamalarýnýn baþlatýldýðý ilk merkezlerden biridir. Bu çalýþmada, 2013 yýlýndan beri hastanemizde uyguladýðýmýz AYP deneyimlerimizi paylaþmayý amaçladýk.
Yöntem: Hastalýk Kontrol ve Önleme Merkezleri'nin hazýrlamýþ olduðu AYP kontrol listesi hastanemiz programýna uygulandý. Cerrahi profilaksi kýlavuzlarý ve uygulamalarýnda düzenlemeler yapýldý. Hastane enfeksiyon sürveyansýndan cerrahi profilaksiler ve nokta prevalans çalýþmalarýndan antibiyotik kullanýmý deðerlendirildi. Hastane eczane kayýtlarýndan antibiyotik tüketim indeksleri (ATÝ) hesaplandý. Influenza hýzlý antijen testi (ÝHAT) ve grup A beta hemolitik streptokok için hýzlý antijen tarama (HAT) testi kullanýlmaya baþlandý. Kümülatif antibiyotik duyarlýlýk sonuçlarý yýllýk olarak hazýrlandý.
Bulgular: Cerrahi profilaksiler insizyon öncesi 60 dakika içinde ameliyathanede uygulanmaya baþlandý. Cerrahi profilakside 3. Kuþak sefalosporinlerin kullanýmýnýn önüne geçildi, ancak sadece beyin cerrahi ve genel cerrahi kliniklerinde profilaksi süresi kýsaltýlabildi. Antibiyotik kullaným oranlarý ve uygunluðunda, 2014 ve 2018 yýllarý arasýnda istatistiksel olarak anlamlý bir fark yoktu. Yetiþkin hastalardaki J01 sýnýfý için ATÝ 2014 yýlýnda 100 hasta günü baþýna 80,5 tanýmlanmýþ günlük doz (TGD) iken, 2018 yýlýnda 100 hasta günü baþýna 64,8 TGD' ye düþürüldü. Üst solunum yoluna ait þikayetlerle baþvuran 22.445 çocuk hasta HAT testi ile deðerlendirildi ve % 75,1'i antibiyotiksiz tedavi edildi.
Sonuç: Mevcut küresel antimikrobiyal direnç döneminde, tüm hastanelerin antimikrobiyal yönetim ekipleri olmalýdýr. Her hastane kendi yönetim programýný belirlemeli ve sýklýkla revize etmelidir. Akýlcý antibiyotik kullanýmýndaki iyileþmenin multidisipliner bir çalýþma olmadan elde edilmesi güçtür. (SETB-2020-05-053)

Objectives: Antibiotic Stewardship Programs (ASP) have been developed for the spread of rational antibiotic use. Our hospital is one of the first centers where ASP applications were launched in Turkey. In this study, we aimed to share our experience with ASP which has been applied in our hospital since 2013.
Methods: We adapted ASP to our hospital program from Centers for Disease Control and Prevention’s ASP checklist. Revisions on surgical prophylaxis guidelines and practices were performed. Surgical prophylaxis was evaluated from hospital infection surveillance and antibiotic usage by point prevalence surveys. Antibiotic consumption indexes (ACI) were calculated from hospital pharmacy records. Rapid antigen detection test (RADT) for Group A beta-hemolytic streptococcus and influenza rapid antigen test were started to be used. Cumulative antibiotic susceptibility results were prepared annually.
Results: Surgical prophylaxis was started to be administered in the operating room within 60 min of incision. Third-generation cephalosporin usage for surgical prophylaxis could be restricted in all clinics but the duration could only be shortened in neurosurgery and general surgery. There was no statistically significant change in antibiotic usage rates and appropriateness between 2014 and 2018. ACI for the class J01 in adult wards was 80.5 daily defined doses (DDD) per 100 patient days in 2014 and reduced to 64.8 DDD per 100 patient days in 2018. 22.445 pediatric patients presenting with complaints of the upper respiratory tract were evaluated with RADT and 75.1% were treated without antibiotics.
Conclusion: In this global antimicrobial resistance era, all hospitals should have motivated antimicrobial stewardship teams. Each hospital should establish its own stewardship program and often revise it. Improvement in rational antibiotic use is hard to achieve without multidisciplinary involvement.

Abstract | English Full Text

AMAÇ: Sarýlýk, yenidoðan döneminde sýk görülen hiperbilirubineminin neden olduðu fizyolojik bir durumdur. Fakat takip ve tedavi edilmediðinde ciddi hiperbilirubinemi, nörolojik sorunlara yol açan ciddi bir durum olan kernikterusa neden olabilir. Biz çalýþmamýzda transkutan bilirubin (TcB) ölçümü ile standart yöntem olan total serum bilirubin (TSB) ölçüm deðerlerini karþýlaþtýrarak sarýlýk deðerlendirmesi için kan alýnmasý yerine TcB ölçümü kullanmanýn güvenli olup olmayacaðýný araþtýrmayý amaçladýk.
MATERYAL VE METOD: Çalýþmaya gestasyonel yaþlarý 37 ile 42 hafta arasý olan term ve terme yakýn 105 bebek alýndý. TcB ölçümünde MBJ20 marka transkutan bilirubin ölçüm cihazý kullanýldý. TcB ölçümü alýndan ve sternumdan yapýldý. TcB ölçümleri ile TSB ölçümleri arasýndaki iliþkiyi deðerlendirmek için pearson korelasyonu, Spearman korelasyonu, lineer regresyon analizi ve ölçümlerin ortalamalarýna karþý farklarýnýn saçýlým grafiðini deðerlendirdiðimiz Bland-Altman analizi uyguladýk.
SONUÇ: TcB alýn ve TSB ölçümleri ile TcB sternum ve TSB ölçümleri arasýnda pozitif yönde çok iyi düzeyde ve istatistiksel olarak anlamlý korelasyon mevcuttu (p<0.001). Lineer regresyon analizinde TcB alýn ve TSB ölçümleri (R2=0.85) ile TcB sternum ve TSB ölçümleri (R2=0.87) arasýnda (+) yönlü doðrusal iliþki olduðu görüldü. TSB ve TcB alýn ölçüm yöntemleri (ortalama fark: 0.39±1.46, %95 CI: (-2.47)–(3.26)) ile TSB ve TcB sternum ölçüm yöntemleri arasýndaki (ortalama fark: 0.49±1.32 %95 CI: (-2.1)–(3.07)) Bland-Altman analizinde iki yöntem arasýnda iyi bir uyum olduðunu gördük. Yaptýðýmýz çalýþma sonucunda, sarýlýk deðerlendirmesi için kan alýnmasý yerine TcB ölçümünün güvenli olarak kullanýlabileceðini gördük. (SETB-2020-01-08)

Objectives: Jaundice is a physiological condition caused by hyperbilirubinemia, which is common in neonatal period. However, severe hyperbilirubinemia can cause kernicterus, which is a serious condition that leads to neurological problems. In this study, we aimed to investigate whether it is safe to use transcutaneous bilirubin (TcB) instead of blood for the evaluation of jaundice by comparing TcB measurement with standard total serum bilirubin (TSB) measurement values.
Methods: A total of 105 term and early term infants with gestational ages between 37 and 42 weeks were included in the study. MBJ20 TcB measuring device was used for TcB measurement. TcB was measured from the forehead and sternum. To evaluate the relationship between TcB measurements and TSB measurements, we performed Pearson correlation, Spearman correlation, linear regression analysis, and Bland-Altman analysis in which we evaluated the scatter plot of the differences between the average values of the measurements.
Results: There was a positive and statistically significant correlation between TcB forehead and TSB measurements and TcB sternum and TSB measurements (p<0.001). Linear regression analysis showed a positive directional correlation between TcB forehead and TSB measurements (R²=0.85) and TcB sternum and TSB measurements (R²=0.87). Bland-Altman analysis showed a good consistency between TSB and TcB forehead measurement methods (mean difference: 0.39±1.46, 95% CI: [−2.47]–[3.26]), and between TSB and TcB sternum measurement methods (mean difference: 0.49±1.32 95% CI: [−2.1]–[3.07]).
Conclusion: As a result of our study, we found that TcB measurement can be reliable instead of taking blood for jaundice evaluation.

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Giriþ; Smith Lemli Opitz Sendromu (SLOS), kolesterol biyosentezindeki enzim eksikliði sonucunda geliþen otozomal resesif kalýtým özelliði gösteren metabolik bir hastalýktýr. Bu olgu ile þiddetli kusma yakýnmasý ile getirilen, pilor stenozu tanýsý ile izlenirken nadir bir hastalýk olan SLOS tanýsý alan olgu irdelenmiþtir.
OLGU: 34 günlük bebek postnatal dirençli kusmasý ve batýn distansiyonu geliþmesi nedeni ile çocuk cerrahisi kliniðinde hipertrofik pilor stenozu tanýsý konularak opere edildi. Olgu, ameliyat sonrasý solunum sýkýntýsý, yaygýn ödem, anemi ve hipoalbuminemi geliþmesi nedeni ile çocuk yoðun bakým kliniðine yatýrýldý. Dismorfik yüz bulgularý, parmak anomalisi, sakral dimple, ambigus genitalyasý olan olgunun kromozom incelmesi XY ile uyumlu ve tüm dizi ekzon analizinde DHCR7 geninde homozigot c.1342G>A/p Glu448Lys(rs80338864) mutasyonu saptandý.
SONUÇ: Beslenme güçlüðü, kusma yakýnmasý ile getirilen, pilor stenozu düþünülen, dismorfik yüz bulgularý ile çok sayýda anomalisi olan olgularda SLOS akýlda tutularak genetik inceleme yapýlmalý ve aileye genetik danýþma önerilmelidir. (SETB-2020-01-09)

Smith-Lemli-Opitz syndrome (SLOS) is caused by a deficiency in the enzyme 7-dehydrocholesterol reductase (DHCR7) that results in an abnormality in cholesterol metabolism. SLOS is inherited as an autosomal recessive genetic disorder. In this case, we describe a 34-day-old patient with postnatal progressive projectile vomiting, diagnosed with hypertrophic pyloric stenosis, who was suspected to have SLOS during treatment clinical and biochemical profile. A 34-day-old patient with progressively worsening vomiting and abdominal distention, diagnosed as hypertrophic pyloric stenosis, was operated by pediatric surgery department. After operation, the patient required pediatric intensive care unit admission due to respiratory distress, anemia, hypoalbuminemia, and generalized edema. Physical examination of our patient revealed dysmorphic facial features, finger anomalies, sacral dimple, and ambiguous genitalia, with chromosomal determination as XY. Molecular genetic testing was performed, and mutations in the DHCR7 gene of homozygous c.1342G>A/p.Glu448Lys (rs80338864) were detected. Infants with progressive projectile vomiting, feeding problems, and multiple anomalies with dysmorphic facial anomalies may be suspected to have SLOS and their families should be advised to have genetic testing and genetic counseling.

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