Substernal guatrlý birçok hasta için cerrahi en uygun tedavi seçeneklerinden biridir. Ancak substernal guatr (SG) cerrahisinin normal servikal tiroid cerrahisine kýyasla bazý teknik zorluklarý ve daha yüksek komplikasyon riski bulunmaktadýr. Çalýþmamýzda da bahsettiðimiz bu teknik zorluklar ve komplikasyon riskleri sebebiyle SG cerrahisi deneyimli ve yüksek hacimli endokrin cerrahlar tarafýndan, geniþ ekip ve teknik donanýma sahip merkezlerde yapýlmalýdýr.
SG'de preoperatif klinik ve radyolojik deðerlendirme ve tanýmlamalar daha önceki çalýþmamýzda detaylý olarak deðerlendirilmiþtir.
Cerrahi teknik zorluklarý ve servikal tiroid cerrahisine kýyasla artmýþ komplikasyon risklerinin ön plana çýktýðý SG cerrahisinde detaylý preoperatif deðerlendirme, preoperatif risk deðerlendirmesi, cerrahi anatomi, anestezi, uygun cerrahi planlama ve cerrahi geniþliðin tahmini son derece önemlidir. Bu çalýþmada bu preoperatif ve peroperatif hazýrlýklarý detaylý olarak deðerlendirmeyi amaçladýk. (SETB-2022-08-196)

Surgery is one of the most appropriate treatment options for many patients with substernal goiter (SG). However, SG surgery has some technical difficulties and a higher risk of complications compared to normal cervical thyroid surgery. Due to these technical difficulties and complication risks, which we also mentioned in our study, SG surgery should be performed by experienced and high-volume endocrine surgeons in centers with a large team and technical equipment. Pre-operative clinical and radiological evaluation and definitions in SG were evaluated in detail in our previous study. Detailed pre-operative evaluation, pre-operative risk assessment, surgical anatomy, anesthesia, appropriate surgical planning and estimation of surgical width are extremely important in SG surgery, where surgical technical difficulties and increased complication risks compared to cervical thyroid surgery come to the fore. In this study, we aimed to evaluate these preoperative and peroperative preparations in detail.

Amaç: Kronik sistemik hastalýklar (KSH) ve kanserler neden olduklarý immunsupresif durumlar nedeniyle COVID-19 hastalarýnda hastalýðýn klinik seyri, þiddeti ve mortalitesi ile yakýndan iliþkilidir. Bu çalýþmada kanser ve KSH’nin COVID-19 hastalarýnda klinik laboratuvar ve sað kalým üzerine etkileri arasýndaki farký incelemeyi amaçladýk.
Metod: Ondokuz Mayýs Üniversitesinde 16 Mart 2020 ile 1 Aralýk 2020 tarihleri arasýnda COVID-19 tanýsýyla yatarak tedavi gören hastalar çalýþmaya dahil edilmiþtir. Bunlar arasýnda; ek hastalýðý olmayanlar (Grup1), sadece KSH’si olanlar (Grup2), sadece kanser hastalýðý olanlar (Grup3) ve hem KSH hem de kanser hastalýðý olanlar (Grup4) olarak dört gruba ayrýlmýþtýr. Gruplar arasýnda klinik semptomlar, biyokimyasal parametreler, yoðun bakým yatýþý ve sað kalým açýsýndan istatistiksel olarak karþýlaþtýrmalý deðerlendirme yapýlmýþtýr.
Bulgular: Toplamda 750 hasta olup; Grup 1’de 242, Grup 2’de 442, Grup 3’te 27, Grup 4’te 39 hasta vardýr. Hastalarýn yaþ ortalamasý 57,1 ±9,4 (min: 18-max: 96) yýldýr ve %53,7’si erkektir. Yaþ, yoðun bakým, entübasyon, komplikasyon, sað kalým, WBC, hemoglobin, lenfosit, nötrofil/lenfosit oraný, LDH, ferritin, D-dimer, CRP açýsýndan Grup 1’in diðer gruplardan anlamlý oranda farklý olduðu belirlenmiþtir (her biri için p<0,001).
Sonuç: KSH veya kanser hastalýðý olan COVID-19 hastalarýnýn laboratuvar tetkikleri, yoðun bakým yatýþý, entübasyon ihtiyacý, komplikasyon sýklýðý ve sað kalým oranlarý açýsýndan klinik olarak anlamlý bir fark olmadýðý görülmüþtür. KSH ve kanser hastalýðý olan her 3 grubun da yoðun bakým ihtiyacý, entübasyon ve sað kalým parametreleri açýsýndan Grup 1’e göre daha olumsuz olduðu tespit edilmiþtir. (SETB-2021-10-303)

Objectives: Chronic systemic diseases (CSD) and cancer are closely related to the clinical course, severity and mortality of COVID-19 due to the immunosuppressive conditions caused by these diseases. The purpose of this study was to investigate the differences between the effects of cancer and CSD on the clinical and laboratory parameters of patients with COVID-19.
Methods: The study included patients who received inpatient treatment with the diagnosis of COVID-19 at Ondokuz Mayýs University between March 16, 2020, and December 1, 2020. The participants were divided into four groups as follows: Those without comorbidities (Group 1), those with only CSD (Group 2), those with only cancer (Group 3), and those with both CSD and cancer (Group 4). Comparative statistical evaluation was performed in terms of clinical symptoms, biochemical parameters, and admission to intensive care and survival.
Results: In total, 750 patients were included: 242 patients in Group 1, 442 in Group 2, 27 in Group 3, and 39 in Group 4. The mean age of the patients was 57.1±9.4 years and 53.7% were male. Patients of Group 1 were significantly different from those of the other groups in terms of age, requirement for intensive care and intubation, complications, survival, white blood cell and lymphocyte count, neutrophil/lymphocyte ratio and levels of hemoglobin, lactic acid dehydrogenase, ferritin, D-dimer, and C-reactive protein (for each p<0.001).
Conclusion: No difference was observed among laboratory parameters, intensive care admission, intubation need, complication frequency, and survival rates in patients with CSD or cancer. It was detected that all three groups with CSD and cancer were worse than Group 1 in terms of intensive care need, intubation, and survival.

Amaç: Bu çalýþmanýn amacý, COVID-19'lu çocuk hastalarýn iyileþme sonrasý solunum fonksiyonlarýný araþtýrmaktý.
Yöntem: Bu prospektif çalýþmaya, COVID-19 tanýsý ile hastaneye yatýrýlan ve þifa ile taburcu edilen 5-18 yaþ arasý pediatrik hastalar dahil edildi. Solunum fonksiyon testleri spirometri ile yapýldý.
Bulgular: Hasta grubu 34 çocuk ve kontrol grubu 33 kiþiden oluþuyordu. Kontrol ve hasta gruplarýnýn FVC% deðerleri 110.62 ± 11.71 ve 94.21 ± 13.68 (p <0.001), FEV1% deðerleri 104.91 ± 6.26 ve 98.67 ± 98.67 ± 14.93 (p =0.032), FEV1/FVC% deðerleri sýrasýyla 108.50 ± 8.81 ve 101.06 ± 24.89 (p =0.034), FEF %25-75 deðerleri sýrasýyla 106.71 ± 6.68 ve 101.85 ± 24.89 (p =0.286) idi. Spearman korelasyon analizi ile hastanede kalýþ süresi ile FEF %25-75 arasýnda orta düzeyde negatif korelasyon tespit edildi (r = –0.364, p=0.35).
Sonuç: Pediatrik hastalarda COVID-19'dan iyileþtikten sonra yapýlan solunum fonksiyon testleri anormal olarak tespit edildi. Sonuçlar mikst tip akciðer hastalýðý geliþimi açýsýndan anlamlýydý. Bu hastalarda prognozu daha iyi anlamak için daha kapsamlý, uzun ve kýsa süreli çalýþmalara ihtiyaç vardýr. (SETB-2021-12-360)

Objectives: The aim of this study was to investigate the pulmonary function of pediatric patients with COVID-19 after recovery.
Methods: Pediatric patients aged 5–18 years hospitalized with diagnoses of COVID-19 and discharged with recovery were included in this prospective study. Pulmonary function tests (PFTs) were performed through spirometry.
Results: The patient group consisted of 34 children and the control group of 33. The forced vital capacity (FVC%) values of the control and patient groups were 110.62±11.71 and 94.21±13.68 (p<0.001), forced expiratory volume in the first second (FEV1%) values were 104.91±6.26 and 98.67±14.93 (p=0.032), FEV1/FVC% values were 108.50±8.81 and 101.06±24.89 (p=0.034), and forced expiratory flow (FEF) 25–75% values were 106.71±6.68 and 101.85±24.89, respectively (p=0.286). However, Spearman correlation analysis revealed moderate negative correlation between length of hospital stay and FEF 25–75% (r=−0.364, p=0.35).
Conclusion: PFTs in pediatric patients after recovery from COVID-19 were abnormal in the present study. The results were significant in terms of the development of mixed-type lung disease. Further long- and short-term studies are now needed for a better understanding of the prognosis in these patients.

Amaç: Google Trendler'i (GT) kullanarak COVID-19 salgýný sýrasýnda kardiyovasküler hastalýklarla ilgili kamu ilgisini deðerlendirmek.
Yöntemler: Çalýþma 20 Kasým-1 Aralýk 2021 tarihleri arasýnda yapýldý. Kalp damar cerrahisi ile ilgili toplam 21 terim seçildi. Seçilen tüm terimlere yönelik kamuoyunun dikkati, 'web arama', 'tüm kategoriler' ve 'Türkiye' filtreleri kullanýlarak GT tarafýndan analiz edildi. Türkiye'de pandeminin baþlangýcýndan bu yana üç COVID-19 dalgasý (12 Mart 2020 ile 8 Mayýs 2020, 24 Kasým 2020 ile 20 Ocak 2021 ve 20 Mart 2021 ile 16 Mayýs 2021 arasýnda) yaþandý. COVID-19 dalgalarý sýrasýnda halkýn kardiyovasküler cerrahiye olan ilgisini analiz etmek için, COVID-19 dalgalarý sýrasýndaki sekiz haftalýk dönemler, son dört yýldaki (2016 - 2019) ayný zamanlarla karþýlaþtýrýldý.
Sonuçlar: 12 Mart - 8 Mayýs 2020 ile 2016 ve 2019 arasýndaki ayný dönem karþýlaþtýrýldýðýnda, kardiyovasküler cerrahiye toplam kamu ilgisinin önemli ölçüde azaldýðý görüldü (- %28,7, p= 0,001). Ýkinci COVID-19 dalgasýnýn karþýlaþtýrýlmasýnda (24 Kasým 2020 – 20 Ocak 2021 ile 24 Kasým – 20 Ocak 2016-2019) COVID-19 döneminde halkýn kardiyovasküler cerrahiye olan ilgisinin önemli ölçüde düþük olduðunu ortaya koydu (- %22,2, p= 0,001). Üçüncü COVID-19 dalgasý ile önceki dört yýldaki ayný dönemlerin karþýlaþtýrýlmasýnda, COVID-19 döneminde kardiyovasküler hastalýða yönelik kamu ilgisinin önemli ölçüde daha düþük olduðunu gösterdi (-%8,5, p= 0,001). Buna karþýlýk, koroner anjiyografi terimi, 2016 ve 2019 arasýndaki ayný dönemlere kýyasla COVID-19'un üçüncü dalgasý sýrasýnda önemli ölçüde daha fazla arandý (%17,9, p= 0,015).
Sonuç: Çalýþmamýz, COVID-19 pandemisinin tüm dalgalarýnda halkýn kardiyovasküler hastalýklara olan ilgisinin önemli ölçüde azaldýðýný göstermiþtir. Bununla birlikte, üçüncü pandemi dalgasýnda sadece koroner anjiyografi terimine olan ilgi önemli ölçüde artmýþtýr. (SETB-2021-12-384)

Objectives: The aim of the study was to clarify public interest about cardiovascular disease during the COVID-19 pandemic using Google Trends (GT).
Methods: The study was performed between November 20 and December 1, 2021. A total of 21 keywords related to cardiovascular surgery were selected. Public attention to all selected keywords was analyzed by GT with using the filters “web search,” “all categories,” and “Turkey.” In Turkey, three COVID-19 waves (between March 12, 2020, and May 8, 2020, November 24, 2020, and January 20, 2021, and March 20, 2021, and May 16, 2021) were experienced since the beginning of the pandemic. To analyze public attention to cardiovascular surgery during the COVID-19 waves, 8-week periods during the COVID-19 waves were compared with the same times in the past 4 years (2016–2019).
Results: Comparisons of March 12–May 8 2020 and the same period between 2016 and 2019 showed that total public interest about cardiovascular surgery was significantly decreased (−28.7%, p=0.001). The comparison of the second COVID-19 wave (November 24, 2020–January 20, 2021 versus November 24-January 20, 2016–2019) revealed that public interest about cardiovascular surgery was significantly lower in the COVID-19 era (−22.2%, p=0.001). Comparison of the third COVID-19 wave and the same periods in the previous 4 years demonstrated that public interest about cardiovascular disease was significantly lower in the COVID-19 era (−8.5%, p=0.001). In contrast, the term coronary angiography was searched significantly more during the third wave of COVID-19 in comparison to the same periods between 2016 and 2019 (17.9%, p=0.015).
Conclusion: Our study demonstrated that public interest in cardiovascular diseases was significantly decreased in all waves of the COVID-19 pandemic. However, interest in only the term coronary angiography was significantly increased in the third wave of pandemic.

Amaç: Cinsel saðlýk, yaþam kalitesinin önemli bileþenlerinden biridir. Bu çalýþmanýn amacý, Covid-19 geçirmiþ ve Covid-19 geçirmemiþ kadýnlarýn cinsel iþlev bozukluklarýný karþýlaþtýrmaktýr.
Gereç ve Yöntem: Mayýs 2020–Aralýk 2020 tarihleri arasýnda gerçekleþtirilen bu çalýþmaya Covid-19 tanýsý konan ve evde tedavi ve takibi yapýlan 50 kadýn (çalýþma grubu) ve Covid-19 öyküsü olmayan 51 kadýn (kontrol grubu) dahil edildi. Cinsel iþlev bozukluklarý Kadýn Cinsel Ýþlev Ýndeksi (FSFI) kullanýlarak deðerlendirildi.
Bulgular: Covid-19 öyküsü olan kadýnlarda cinsel iþlev bozukluðu, Covid-19 öyküsü olmayan kadýnlara göre anlamlý derecede yüksek bulundu. Covid-19 salgýný sýrasýnda Covid-19 öyküsü olan kadýnlarda cinsel iþlev bozukluðu geliþme riski 3,4 kat daha fazlaydý (p=0,008). Ýyileþme sonrasýnda, çocuk sayýsýnýn fazla olmasý ve ekonomik koþullarýn kötü olmasý cinsel iþlev bozukluðu geliþmesi açýsýndan öngörücüdür (sýrasýyla p=0,02 ve p=0,024). Covid-19 öyküsü olan kadýnlarda FSFI uyarýlma, orgazm, memnuniyet alt ölçek puanlarý ve toplam FSFI puanlarý, Covid-19 öyküsü olmayan kadýnlara göre anlamlý derecede düþüktür (sýrasýyla, p=0,011, p=0,002, p=0,028 ve p=0,008).
Sonuç: Covid-19 öyküsü olan kadýnlarda olmayanlara göre cinsel iþlev bozukluðu riski daha yüksektir. Ayrýca artan parite ve kötü ekonomik koþullar, salgýn sýrasýnda kadýnlarda cinsel iþlev bozukluðu için öngörücü görünmektedir. Covid-19 enfeksiyonunun mekanizmasýnýn kadýnýn cinsel iþlevlerine etki ettiðine iliþkin kanýtlara ihtiyaç duyulmaktadýr. (SETB-2021-11-336)

Objectives: Sexual health is an essential component of life quality. In this study, we aim to compare the sexual dysfunction of women who had a history of COVID-19 and those who did not have been infected by COVID-19.
Methods: This study was conducted in a tertiary center between May 2020 and December 2020. Our study group included 50 women treated for COVID-19 at home, and control group included 51 women with no history of COVID-19. Female Sexual Functioning Index (FSFI) was used to assess of these patients’ sexual dysfunctions.
Results: Sexual dysfunction in women with a history of COVID-19 was found to be significantly higher than those with no history of COVID-19. Sexual dysfunction development risk in women with a history of COVID-19 (study group) was 3.4 times higher compared to women with no history of COVID-19 (control group) (p=0.008). In addition, high number of children and low economic status were found to be predictive for sexual dysfunction after recovery (p=0.02 and p=0.024, respectively). Arousal, orgasm, satisfaction subscale scores, and total FSFI scores in women with a history of COVID-19 were significantly lower than those with no history of COVID-19 (p=0.011, p=0.002, p=0.028, and p=0.008, respectively).
Conclusion: Sexual dysfunction in the patients with a history of COVID-19 seems to be higher than in women with no history of COVID-19. Increased parity and low economic status are predictive for sexual dysfunction after treatment. There is a need for future studies relating to the effect of the COVID-19 infection in women’s sexual functions.

Amaç
Amacýmýz COVID-19 ile ilgili kulak burun boðaz semptomlarýnýn prevalansýný, þiddetini, süresini belirlemek ayrýca laboratuvar tarafýndan doðrulanmýþ COVID-19 hastalarý ile klinik ve bilgisayarlý tomografi ile teþhis edilmiþ COVID-19 hastalarý arasýndaki kulak burun boðaz (KBB) semptomlarýndaki farklýlýklarý ortaya koyarak; oro-nazofarenks sürüntüsü ile elde edilmiþ test sonuçlarý ile bu bölgeye ait semptomlar arasýnda ilþki kurmak.
Gereç ve Yöntem(ler)
Çalýþmaya, PCR testi pozitif olan hastalar (PCR (+)) ve tekrarlayan PCR testleri negatif olmasýna ragmen CO-RADS akciðer BT bulgularýnýn CoVID-19 ile uyumu yüksek (CO-RADS 5) veya çok yüksek (CO-RADS 6) olup kliniði COVÝD-19 ile uyumlu olan hastalar (PCR(–)/CT(+))dahil edildi. Demografik özellikler, genel semptomlar, kulak burun boðaz semptomlarý ve hastalýk þiddeti deðerlendirildi ve karþýlaþtýrýldý.
Bulgu(lar)
PCR(+) grubunda en sýk görülen KBB semptomlarý sýrasýyla tat kaybý ( n=77 %34.5), koku kaybý (%31.8) ve boðaz aðrýsýydý (%26.0); PCR(-) CT'de (+) grupta ise sýrasýyla tat kaybý (%24.6), koku kaybý (%21.1) ve boðaz aðrýsýydý ( %18.4). KBB semptomu görülme oraný PCR(+) grupta (%65,0), PCR(–)/CT(+) (%49,1) gruba göre istatistiksel olarak anlamlý farkla daha yüksekti (p=0,008). Koku kaybý oraný PCR(+) grupta PCR(–)/CT(+) gruba göre istatistiksel olarak anlamlý farkla daha yüksekti (p=0,037).
Sonuç(lar)
Koku ve tat kaybý ve boðaz aðrýsý, COVID-19 vakalarýnda sýk görülen KBB semptomlarý arasýndadýr. Ani koku veya tat kaybý ile baþvuran hastalarda covid-19 varlýðý düþünülmelidir. Üst solunum yollarýndan alýnan örnekle PCR(+) tanýsý alan hastalar ve klinik ve tomografi ile COVID-19 tanýsý konulmuþ hastalar arasýndaki üst solunum yolu semptomlarýnýn sýklýðý ve özellikle de koku kaybýnýn sýklýðý arasýndaki anlamlý fark pozitif test sonuçlarý ile semptom bölgesi arasýnda korelasyon olduðunu düþündürmektedir. Numune alma yeri kararý için semptomlarýn yeri de dikkate alýnabilinir. (SETB-2022-03-055)

Objectives: Our aim is to determine prevalence, severity, duration of otorhinolaryngologic symptoms related to coronavirus disease 2019 (COVID-19), and correlation between the test results obtained by oronasopharyngeal swab and the symptoms of these regions by evaluating differences in ear, nose, and throat (ENT) symptoms between laboratory-confirmed COVID-19 patients and clinically and computed tomography (CT)-diagnosed COVID-19 patients.
Methods: The study enrolled patients with a positive polymerase chain reaction (PCR) test diagnosed with COVID-19 that grouped as PCR (+), and those with repeated negative PCR tests but COVID-19 Reporting and Data System (CO-RADS) chest CT findings with high (CO-RADS 5) or very high (CO-RADS 6) similarity to COVID-19 that grouped as PCR(–)/CT(+). Demographic features, general symptoms, and otorhinolaryngological symptoms and severity of disease were evaluated and compared.
Results: The most common ENT symptoms in the PCR(+) group were loss of taste (n=77), loss of smell, and sore throat with respective frequencies of 34.5%, 31.8%, 26.0%, and in PCR(−) CT (+) group loss of taste, loss of smell, and sore throat with respective frequencies 24.6%, 21.1%, and 18.4%. ENT symptom rates were found higher in PCR (+) group (65.0%) according to PCR(–)/CT(+) group (49.1%) with statistically significant difference (p=0.008). Loss of smell rates were found higher in PCR (+) group according to PCR(–)/CT(+) group with statistically significant difference (p=0.037).
Conclusion: Loss of smell and taste were most common ENT symptoms in laboratory-confirmed COVID-19 cases. The presence of COVID-19 should definitely be considered in patients presenting with sudden loss of smell or taste. In addition, loss of smell and otolaryngologic symptoms were more common in laboratory-confirmed COVID-19 according to clinically and computed tomograpy diagnosed COVID-19 cases. There can be a correlation between positive sample region and symptom region. Location of symptoms must be considered for decision of sampling location.

Amaç: Anketlerin yabancý dillerden tercümelerinin validasyonu önemlidir. Anketlerin valide edilmemiþ olmasý yanlýþ uygulamaya yol açabilir.
Gereç ve Yöntemler: Bu prospektif enstrüman validasyon çalýþmasýna nazal polipli kronik rinosinüzite baðlý burun týkanýklýðý ile baþvuran 64 hasta ve 64 kontrol alýndý. RhinoQOL'un Türkçe'ye uyarlanmasý için çeviri ve geri çeviri yöntemi kullanýldý. Test-tekrar test güvenilirliði, iç tutarlýlýk, tekrarlanabilirlik, yapýsal geçerlilik ve deðiþime duyarlýlýk deðerlendirildi.
Bulgular: Kontrol grubunda ortalama±SD test ve tekrar test puanlarý benzerdi. Cronbach korelasyon katsayýlarý test için 0.872, 0.873 ve 0.959; sýklýk, rahatsýzlýk ve etki alanlarý için tekrar test puanlarý için 0.799, 0.725 ve 0.885 idi. Hasta grubundaki RhinoQOL anketinin her bir alaný için ameliyat sonrasý puanlar, ameliyat öncesi puanlardan anlamlý derecede yüksekti (p<0,001). Sýklýk, rahatsýzlýk ve etki alanlarý için ameliyat öncesi puanlar, her alan için karþýlýk gelen ortalama test-tekrar test puanlarýndan önemli ölçüde düþüktü. kontrol grubunda (p<0,001), hasta ve kontrol grubunda anlamlý olarak daha yüksek rahatsýzlýk skorlarý dýþýnda (p=0.018), postoperatif skorlar ile ortalama test-tekrar test skorlarý arasýnda anlamlý bir fark görülmedi.
Sonuçlar: Bu sonuçlar, Türkçe çevirinin iç tutarlýlýk, test-tekrar test güvenilirliði ve yapý geçerliliði açýsýndan RhinoQOL'un Ýngilizce versiyonuna eþdeðer olduðunu, deðiþime iyi yanýt verdiðini ve dolayýsýyla postoperatif sonucun deðerlendirilmesinde potansiyel fayda saðladýðýný göstermiþtir. (SETB-2022-06-160)

Objectives: Validation of the translations of questionnaires from foreign languages is important. Failure to validate surveys can lead to misapplication.
Methods: A total of 64 patients who presented with nasal obstruction due to chronic rhinosinusitis with nasal polyps and 64 control subjects were included in this prospective instrument validation study. Translation and back-translation method was used to adapt the Rhinosinusitis quality of life (RhinoQOL) into Turkish. The test and retest reliability, internal consistency, reproducibility, construct validity, and sensitivity to change were assessed.
Results: The mean±SD test and retest scores were similar in the control group. Cronbach correlation coefficients were 0.872, 0.873, and 0.959 for the test and were 0.799, 0.725, and 0.885 for the retest scores for the frequency, bothersomeness, and impact domains. Post-operative scores were significantly higher than pre-operative scores obtained for each domain of the RhinoQOL questionnaire in the patient group (p<0.001). Pre-operative scores for frequency, bothersomeness, and impact domains were significantly lower than the corresponding average test and retest scores for each domain in the control group (p<0.001), whereas other than significantly higher bothersomeness scores in patient versus controls (p=0.018), no significant difference was noted between post-operative scores and average test and retest scores.
Conclusion: These results demonstrated that the Turkish translation is equivalent to the English version of RhinoQOL in terms of internal consistency, test and retest reliability, and construct validity, with good responsiveness to change and thus potential utility in the assessment of post-operative outcome.

AMAÇ: Bu çalýşmada, işlem sýrasýnda eşlik eden bir sitopatolog olmadan alýnan tiroid ince iğne aspirasyon biyopsisi (İİAB) örneklerinde konvansiyonel yayma ve sývý bazlý sitoloji (SBS) yöntemlerinin yeterliliğini karşýlaştýrmayý amaçladýk. Ayrýca her iki teknikle elde edilen örneklerin Bethesda kategorisine göre sonuçlarý arasýnda anlamlý fark olup olmadýğýnýnýn araştýrýlmasýný amaçladýk.
YÖNTEMLER: Biyopsi için uygun bulunan 572 hastadan toplam 625 nodül bu retrospektif çalýşmaya dahil edildi. İİAB'ler işlemler sýrasýnda eşlik eden bir sitopatolog olmadan girişimsel radyologlar tarafýndan gerçekleştirildi. Numuneler ya konvansiyonel yayma ya da SBS hazýrlama yöntemleri kullanýlarak hazýrlandý. Örneklerin sitopatolojik taný yeterliliği ve sitopatolojik sonuçlarý Bethesda kategorisine göre değerlendirildi ve morfolojik bulgular arasýndaki ilişki retrospektif olarak değerlendirildi.
BULGULAR: Tüm biyopsi örneklerinden 338'i (%54,1) SBS yayma yöntemi kullanýlarak, 287'si (%45,9) konvansiyonel smear olarak hazýrlandý. Biyopsi örneklerinin malignite oranlarý hem SBS hem de konvansiyonel yayma yöntemlerinde benzer bulundu. Bethesda Kategori II, III, IV, V, VI olarak sýnýflandýrýlan nodüller göz önüne alýndýğýnda, her iki yöntemin sonuçlarý arasýnda istatistiksel bir fark yoktu. Konvansiyonel yayma yöntemi ile hazýrlanan örneklerde nondiagnostik biyopsi oraný daha yüksekti (p<0,001).
SONUÇ: Bu çalýşmada SBS yönteminde İİAB yeterlilik oraný konvansiyonel smear yöntemine göre anlamlý derecede yüksek bulundu. SBS, konvansiyonel yayma yönteminden daha pratik ve hýzlýydý. Tiroid nodüllerinin İİAB'sinde SBS yönteminin tercih edilebileceğini düşünüyoruz. (SETB-2021-11-335)

Objectives: In this study, we aimed to compare the adequacy of conventional smear (CS) and liquid-based cytology (LBC) methods in thyroid fine-needle aspiration biopsy (FNAB) samples obtained without an accompanying cytopathologist during the procedure. Furthermore, we aimed to investigate the presence of a significant difference between the rates of nodules classified as Bethesda Category III and malignancy in both techniques and the features of the nodules affecting malignancy.
Methods: A total of 625 nodules from 572 patients who were found suitable for biopsy were included in this retrospective study. FNABs were performed by interventional radiologists without an accompanying cytopathologist during the procedures. The specimens were either prepared using CS or LBC preparation methods. Cytopathological diagnostic adequacy and cytopathological results of the specimens were evaluated according to Bethesda category, and the relationship between the morphological findings was evaluated retrospectively.
Results: Of all the biopsy preparations, 338 (54.1%) of them were transferred to pathology in liquid-based solution and 287 (45.9%) were transferred as CS. Malignancy rates of the biopsy samples were found similar in both LBC and CS methods. Considering the nodules classified as Bethesda Category II, III, IV, V, and VI, there was no statistical difference between the results of both methods. Non-diagnostic biopsy rate was higher in the specimens prepared by CS method (p<0.001).
Conclusion: In this study, the adequacy rate of FNAB was found significantly higher in LBC method compared to the CS method. LBC was more practical and faster than the CS method. We think that LBC method may be preferred in FNAB of thyroid nodules.

Amaç: Kemiðin Paget hastalýðýnda, metabolik sendrom prevalansýný saptamayý ve metabolik sendrom ile kemik spesifik ALP seviyesi arasýndaki iliþkiyi belirlemeyi amaçladýk.
Materyal ve Metod: Kemiðin Paget hastalýðýna sahip 23 hasta ve 30 yaþ, cins ve vücut kitle indeksi (VKÝ) uyumlu kontrol grubu çalýþmaya dahil edildi.Tüm katýlýmcýlar Uluslararasý Diyabet Federasyonu (IDF)-2006 metabolik sendrom taný kriterleri kullanýlarak deðerlendirildi. Kemik ve mineral metabolizma parametreleri deðerlendirildi. Paget hasta grubu ve kontrol grubu metabolik sendromun metabolik komponentleri ve kemik mineral metabolizma parametreleri açýsýndan karþýlaþtýrýldý.
Bulgular: Kilo, bel çevresi, VKÝ ve sistolik kan basýncý (SKB) açýsýndan her iki grup arasýnda istatistiksel olarak anlamlý fark yoktu (sýrasýyla p=0.09, p=0.644, p=0.78, p=0.058). Paget hasta grubunda bozulmuþ açlýk glukozu (BAG) ve diyabetes mellitus (DM) sýklýðý %30 (7/23) olarak bulundu.Kontrol grubunda BAG ve DM tanýsý alan hasta yoktu.Her iki grup BAG ve DM sýklýðý açýsýndan karþýlaþtýrýldýðýnda, Paget hasta grubunda BAG ve DM sýklýðýnýn istatistiksel olarak daha fazla olduðu saptandý (p=0.002). Paget hasta grubunda metabolik sendrom sýklýðý % 73.91( 17/23) iken, kontrol grubunda metabolik sendrom sýklýðý %30 (9/30) olarak bulundu. Paget hasta grubunda metabolik sendrom sýklýðý kontrol grubuna göre istatistiksel olarak daha yüksek saptandý (p<0.01). ALP düzeyleri ile hipertansiyon tedavisi arasýnda anlamlý korelasyon gözlendi (p=0.0045, r=0.27)
Sonuç: Kemiðin Paget hastalýðýna sahip hastalarda metabolik sendrom sýk görülmektedir. Dolayýsýyla hastalarýn metabolik sendrom ve iliþkili olduðu kardiyovasküler hastalýklar açýsýndan da izlenmesi gerekmektedir. (SETB-2021-07-225)

Objective: Our aim is to verify the prevalance of metabolic syndrome (MetS) in Paget’s disease of bone (PDB) and to reveal the relationship between metabolic syndrome and bone alkaline phosphatase levels (BAP).
Material and Methods: Twenty three patients with PDB and 30 healthy subjects matched with age, sex, and body mass index (BMI) were recruited from the outpatient clinics of Endocrinology. The International Diabetes Federation (IDF)-2006 metabolic syndrome criterias were used for the evaluation of all participants. PDB group and control group were compared in terms of metabolic syndrome and metabolic components of metabolic syndrome and bone mineral metabolism parameters.
Results: When the two groups were compared in terms of weight, waist circumference, BMI and systolic blood pressure (SBP) (p=0.09, p=0.644, p=0.78, p=0.058 recpectively), no statistically significant difference was found.
The frequency of impaired fasting glucose (IFG) and Diabetes mellitus (DM) was determined as %30 (7/23) in the PDB group. There were no patients in the control group with IFG and DM diagnosis.The frequency of IFG and DM was statistically higher in the PDB group than controls (p=0.002). The frequency of MetS was statistically higher in the PDB group than the controls. (73.91%, (17/23) vs.30% (9/30);p<0.01).There was a correlation between ALP level and hypertension medication (p=0.0045, r=0.27).
Conclusion: Patients with PDB seem to have metabolic syndrome more frequently, these patients also should be monitored for metabolic syndrome.

Amaç: Deli bal zehirlenmesi (DBZ) genellikle her türlü bradiaritmi ile kendini gösterir. DBZ’nin klinik bulgulara odaklanan çok sayýda yayýn bulunmaktadýr. Bunun yanýnda çalýþmamýzda geniþ vaka serisinde DBZ’nin kötü prognostik etkilerini, iskemik elektrokardiyografik deðiþikliklerini ve ayrýntýlý elektrokardigografi bulgularýný deðerlendirmeyi amaçlýyoruz.
Yöntem: Çalýþmamýz, tek merkezli ve geriye dönük olarak acil servise DBZ ile baþvuran 117 hasta üzerinde yürütülmüþtür.
Bulgular: Çalýþmaya 26 (%22,2) kadýn (medyan 52,5 yýl), 91 (%77,8) erkek (medyan 51,0 yýl) alýndý. Ellialtý (%47.9) hastada elektrokardiyografide iskemi muhtemel deðiþiklikler izlendi. Çok deðiþkenli model analizde, beta bloker kullanýmýnýn (odds oraný (OR): 52.871; %95 güvenlik aralýðý (Cl): 3.618-772.554 (p= 0.004)), atriyoventriküler nodal ritminin (OR: 5.319; %95 CI: 1.090-25.949 (p= 0.039)) ve deli bal tüketim miktarýnýn (OR: 1.035; %95 CI: 1.008-1.063 (p= 0.011)) hastaneye yatýþýn öngörücü faktörler olduðu izlenmþtir. ROC eðrisi analizi, deli bal tüketim cut-off deðerinin 24.79 gram ve üzeri olmasý hastaneye yatýþý öngörmede %57 duyarlýlýða ve %68 özgüllüðe sahip olduðunu göstermiþtir (AUC: 0.7, %95 CI: 0.55-0.816, p= 0.027). Ayrýca hastaneye yatýrýlan olgularýn tümü erkekti.
Sonuç: Çalýþmamýz DBZ hastalarýnda erkek cinsiyeti, atriyoventriküler kavþak ritmini, deli bal tüketim miktarýný ve beta bloker kullanýmýný hastaneye yatýþ için yüksek risk kriterleri olduðunu göstermiþtir. Ayrýca, hipotansiyon veya bradikardiden baðýmsýz olarak, elektrokardiyografide iskemi benzeri deðiþiklikleri sýklýkla gözlenmiþtir. (SETB-2022-03-066)

Objectives: Mad-honey intoxication (MHI) often presents with all kinds of bradyarrhythmias. Despite numerous publications focused on clinical findings, we aim to evaluate poor prognostic implications, ischemia likely electrocardiography (ECG) changes, and detailed ECG findings of MHI in the largest series.
Methods: This is a retrospective single-center study of 117 MHI patients admitted to emergency service.
Results: The study had 26 (22.2%) females (median 52.5 years) and 91 (77.8%) males (median 51.0 years). Fifty-six (47.9%) patients had ischemia likely changes on ECG. Multivariate model demonstrated that beta-blocker usage (odds ratio (OR): 52.871; 95% confidence interval (CI): 3.618-772.554 (p=0.004)), atrioventricular junctional rhythm (AVJR) (OR: 5.319; 95%CI: 1.090-25.949 (p=0.039)), and quantity of mad-honey consumption (OR: 1.035; 95% CI: 1.008-1.063 (p=0.011)) are predictors of hospitalization. ROC curve analysis showed cutoff value of mad-honey consumption quantity 24.79 g had 57% sensitivity and 68% specificity for predicting hospitalization (AUC: 0.7, 95% CI: 0.55-0.816, p=0.027). In addition, all hospitalized cases were male.
Conclusion: Our study has shown that male gender, AVJR, the quantity of mad-honey consumption, and beta-blocker usage are high-risk criteria for hospitalization in MHI patients. Furthermore, ischemia likely ECG changes is often observed with MHI even independently from hypotension or bradycardia.

Amaç: Son yýllarda yapýlan çalýþmalar DPP4i ile BP geliþimi arasýnda bir iliþki olduðunu ortaya koymuþtur. Çalýþmamýzýn temel amacý ülkemizde DPP4i kullanýmý ile BP geliþimi arasýndaki iliþkiyi deðerlendirmektir. Ýkincil olarak DPP4i iliþkili BP vakalarýnýn klinik özellikleri ve biyokimyasal parametrelerinin non-DPP4i iliþkili BP vakalarý ile karþýlaþtýrýlmasý amaçlanmýþtýr.
Gereç ve Yöntem: 1 Kasým 2008-1 Ocak 2019 tarihleri arasýnda Ýstanbul’da üç dermatoloji bölümü büllü polikliniðinde takipli 58 tip 2 diyabetik BP hastasý retrospektif olarak deðerlendirildi. Kontrol grubuna ise endokrinoloji polikliniðinden takipli 75 tip 2 diyabetik hasta dahil edildi. Hastalara ait demografik bilgiler, hastalýða ait klinik özellikleri, kullandýklarý ilaçlar ve laboratuvar verileri hastane otomasyon sistemine kayýtlý hasta dosyalarýndan elde edildi.
Bulgular: Hasta ve kontrol grubu arasýnda yaþ ve cinsiyet açýsýndan istatistiksel bir fark yoktu.Her iki grup için de en yaygýn reçete edilen oral antidiyabetik metformindi. En yaygýn reçete edilen DPP4i ise vildagliptin idi. 58 diyabetik BP hastasýndan 14'ü (%24,1) vildagliptin,12'si (%20,7) linagliptin, 6'sý (%10,3) sitagliptin,1 'i (%1,7) saksagliptin kullanýyordu.DPP4i kullanýmý açýsýndan iki grup arasýnda anlamlý bir fark yoktu. DPP4i tedavisi alan BP hastalarý DPP4Ý tedavisi almayan BP hastalarýyla karþýlaþtýrýldýðýnda klinik özellikler,lokalizasyonlar,hastalýk þiddetleri, tedavi yanýtlarý ve laboratuvar bulgularý açýsýndan anlamlý fark saptanmadý. Sadece DPP4i tedavisi alan BP hastalarýnýn DPP4i tedavisi almayan BP hastalarýna göre istatistiksel olarak daha az mukozal tutulumu mevcuttu (p=0,044).
Sonuç: Bizim çalýþmamýzda hasta ve kontrol grubu arasýnda anlamlý fark olmamasýna raðmen diyabetik hastalarda BP geliþtiðinde DPP4i kullanýmý sorgulanmalý ve klinisyenlerle iþbirliði yapýlarak tedavi planlanmalýdýr. (SETB-2021-08-251)

Objectives: Recent studies have revealed an association between dipeptidyl peptidase 4 inhibitors (DPP4i) and development of bullous pemphigoid (BP). The main aim of our study is to evaluate the association between DPP4i treatment and BP development. The secondary endpoints were to evaluate clinical characteristics and biochemical parameters of the DPP4i associated BP cases and determine the differences of DPP4i associated BP disease than non-DPP4i associated BP cases.
Methods: We designed a retrospective case-control study, comparing type 2 diabetic 58 BP cases to 75 type 2 diabetic controls. Data were collected from three dermatological departments in Istanbul/Turkey, from November 1, 2008, to January 1, 2019. Medical records of each patient’s demographic, clinical characteristics, drugs used, and laboratory data were reviewed.
Results: There was no statistical difference in age and gender between the patient and control group. The most common prescribed oral antidiabetic for both groups was metformin. The most commonly prescribed DPP4i was vildagliptin. Fourteen (24.1%) out of 58 diabetic patients with BP were using vildagliptin, 12 (20.7%) out of 58 diabetic BP patients were using linagliptin, 6 (10.3%) out of 58 diabetic BP patients were using sitagliptin, and 1 (1.7%) out of 58 diabetic BP patients were using saxagliptin. There was no significant difference between the two groups regarding the DPP4 is use (using DPPi at the time of diagnosis and not). Both groups had similar clinical characteristics, localizations, disease severity, comorbidities, treatment responses, and biochemical parameters. BP patients using DPP4i had statistically less mucosal involvement than BP patients not using DPP4i (p=0.044).
Conclusion: Even though there was no difference between two groups, when BP develops in diabetic patients, DPP4 is should be questioned and with cooperation with clinician’s consideration of change may be planned.

Amaç: Bu çalýþmanýn amacý, altý ay boyunca 3 seans tedavi sýrasýnda ve sonrasýnda, bilateral alt konka hipertrofisi üzerinde yeni bir Erb-lazer tedavi protokolünün güvenlik ve performansýný deðerlendirmektir.
Yöntemler: Bu retrospektif çalýþma, Kýbrýs Gazimaðusa'da bir Özel Hastanenin Kulak Burun Boðaz Anabilim Dalý'nda Temmuz 2019-Aralýk 2020 tarihleri arasýnda týbbi tedaviye dirençli burun týkanýklýðý, hapþýrma, kaþýntý, akýntý ve burun týkanýklýðý þikayetleri olan 30 hasta üzerinde gerçekleþtirildi. Semptomlar Nazal Obstrüksiyon Skoru ve Görsel Analog Skala kullanýlarak subjektif olarak deðerlendirildi. Hastalar postoperatif 1.hafta, 1., 3. ve 6. aylarda deðerlendirildi. Her kontrolde semptomlar Görsel Analog Skala ve Nazal Obstrüksiyon Skoru ile yeniden deðerlendirildi.
Bulgular: Ýþlem öncesi ve sonrasý Görsel Analog Skala ve Nazal Obstrüksiyon Skorlarý arasýndaki farklar istatistiksel olarak anlamlýydý. Tüm hastalarda iþlem sonrasý birinci haftadan itibaren baþlayan ve takip süresi boyunca devam eden önemli semptomatik düzelme oldu. Aktif lazer tedavisi, iþlem sýrasýnda ve sonrasýnda burun týkanýklýðýnda yüksek oranda iyileþme gösterdi ve burun semptomlarýnýn yaþam kalitesi üzerindeki olumsuz etkisini azalttý.
Sonuç: Erbium YAG lazer tedavisi, alt konka hipertrofisinde etkili, nazal mukozada minimal hasar ile basit, güvenli ve noninvaziv bir yöntemdir. Minimal komplikasyon ile ayaktan tedavi yöntemi olarak kullanýlabilir. Bu metod gelecekte burun týkanýklýðý tedavisinde büyük avantaj saðlayacaktýr. (SETB-2021-06-183)

Objectives: Nasal obstruction (NO) is a very common complaint in the practice of otolaryngology. The cause of NO can be due to inferior turbinate hypertrophy (ITH), which may be a result of allergic rhinitis, hyperreactivity, hormonal causes, rhinitis medicamentosa or idiopathic. The most commonly used treatments today include local nasal or systemic corticosteroids, cauterization or microdebrider, or thermal ablation with radiofrequency, coblation or ablative laser (mainly carbon dioxide or diode lasers), and submucosal reduction. Erbium YAG laser in non-ablative and SMOOTH thermal mode is considered as a non-invasive treatment and could be a novel and safe alternative.
The aim of this study was to evaluate the safety and performance of a new Erb-laser treatment protocol on bilateral ITH, during and after 3 sessions of treatment throughout 6 months.
Methods: This retrospective study was carried out over 30 patients with complaints of NO, sneezing, itching, discharge, and nasal congestion refractory to medical management from July 2019 to December 2020 in the Department of Otorhinolaryngology of a private hospital in Famagusta, North Cyprus. Symptoms were evaluated subjectively by using NO Score and Visual Analog Scale (VAS). Patients were evaluated at the post-procedural 1st-week, and 1st-, 3rd-, and 6th-month postoperatively. During each follow-up visit, symptoms were reassessed by VAS and NO Score.
Results: Differences between pre-operative and post-operative VAS and NO Scores were statistically significant. All patients had significant symptomatic improvements, which started from the post-operative 1stweek and persisted throughout the follow-up period. The active laser treatment showed high improvement during and after the procedure, regarding NO, and decreased the nasal burden on quality of life.
Conclusion: Erbium YAG laser treatment is a simple, safe, effective, and non-invasive method effective on ITH, with minimal damage on the nasal mucosa. It can be done as an office procedure, with minimal complications. This method will provide a great advantage in the future treatment of NO.

Amaç: Ganglion impar blokajý, koksidini tedavisinde uzun süredir etkili bir prosedür olmasýna raðmen, impar ganglionunun pulse-radyofrekans uygulamasý koksidini tedavisi için nispeten yeni bir yaklaþýmdýr. Bu çalýþmada, koksidini nedeniyle impar ganglionunun pulse-radyofrekans uygulamasý gerçekleþtirilen hastalarý retrospektif olarak deðerlendirmeyi amaçladýk.
Metod: Bu retrospektif çalýþmaya koksidini tanýsý konan ve impar ganglionunun pulse-radyofrekans uygulamasý ile tedavi edilen yirmi altý hasta dahil edildi. Hastalarýn klinik özellikleri ve tedavi baþarýlarý deðerlendirildi. Aðrý þiddeti vizüel analog skala kullanýlarak deðerlendirildi.
Bulgular: Çalýþmaya 19 (%73.1) kadýn ve 7 (%26.9) erkek hasta dahil edildi. Hastalarýn median yaþý 45 (IQR: 24-60) idi ve deðerlendirilen 26 hastanýn 21'inde (%80.8) aðrý etiyolojisi travma idi. Ýmpar ganglionunun pulse-radyofrekans uygulamasý sonrasý VAS skorlarýnda istatistiksel olarak anlamlý bir düþüþ mevcuttu [Sýrasýyla; 6 (IQR: 6-7) ve 2 (IQR: 0-3)]. Ýmpar ganglionunun pulse-radyofrekans uygulamasý ile tedavi baþarýsý %84,6 idi. Tedavi baþarýsý nöropatik aðrýsý olan hastalarda %100, nosiseptif aðrýsý olan hastalarda ise %59,1 olarak bulundu.
Tartýþma: Sonuç olarak, impar ganglionunun pulse-radyofrekans uygulamasý ile tedavi, koksidininin giderilmesinde düþük komplikasyon oraný ile etkili ve güvenilir bir iþlemdir. (SETB-2021-11-330)

Objectives: Although ganglion impar blockade has long been an effective procedure in the treatment of coccydynia, the pulsed radiofrequency (PRF) of the ganglion impar (GI) is a relatively new approach for the management of coccydynia. In the present study, we aimed to retrospectively evaluate patients who underwent GI PRF due to coccydynia.
Methods: Twenty-six patients diagnosed with coccydynia and treated with a PRF of the GI were included in this retrospective study. Clinical characteristics of the patients and treatment success were evaluated. Pain intensity was evaluated using a visual analog scale (VAS).
Results: The study included 19 (73.1%) female and 7 (26.9%) male patients. The median age of the patients was 45 (IQR: 24–60) years, and the etiology of pain was trauma in 21 (80.8%) of the 26 patients evaluated. There was a statistically significant decrease in VAS scores after GI PRF (Respectively; 6 [IQR: 6–7] and 2 [IQR: 0–3]). The PRF of the GI treatment success was 84.6%. Treatment success was 100% in patients with neuropathic pain and 59.1% in patients with nociceptive pain.
Conclusion: GI PRF is an effective and reliable procedure with low complication rate for pain relief in coccydynia.

Amaç: Tiroid kanserleri içerisinde en sýk görülen alt tip papiller tiroid kanseri olup; lenf bezi metastazlarý sýk görülmektedir. Papiller tiroid kanserinde (PTK) santral lenf metastazý geliþimini etkileyen faktörler hastalýðýn tedavi þeklini ve prognozunu belirlemektedir. Biz de bu çalýþmada santral lenf nodu metastazý geliþimi üzerine etkili klinikopatolojik özellikleri deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Kliniðimizde Mayýs 2012-Eylül 2020 tarihleri arasýnda opere edilen, papiller tiroid kanseri tanýsý alan ve takiplerine ulaþýlabilinen toplam 346 hastanýn verileri retrospektif olarak deðerlendirildi. Tüm hastalarýn yaþý, cinsiyeti, vücut kitle oraný, preoperatif TSH düzeyleri, taný anýnda anti-TPO ve anti-Tg deðerleri, lenf nodu diseksiyonu yapýlýp yapýlmadýðý, lenf nodu metastazý varlýðý, uzak metastaz varlýðý, taný anýnda evre (TNM 8. baský), taný anýnda ATA risk grubu, tümörün multifokal ve/veya multisentrik (bilateralite) olmasý, en büyük tümör boyutu, agresif histolojik alt tipi, tümörde lenfovasküler invazyon, ekstratiroidal invazyon, lenfositik tiroidit varlýðý, cerrahi sýnýr pozitifliði özellikleri retrospektif olarak deðerlendirildi.
Bulgular: PTK santral metastaz geliþiminde; uzak metastaz varlýðý, tümör çapý, multifokalite, multisentrisite (bilateralite), lenfovasküler invazyon varlýðý, tümör subtipinin agresif olmasý, lateral metastaz varlýðý, nodüler guatr ve ekstratiroidal yayýlýmýn etkili olduðu saptandý. Bu faktörler içerisinden T evresi, lenfovasküler invazyon varlýðý ve multisentrisite santral metastaz geliþimi için baðýmsýz risk faktörleri olarak belirlendi.
Sonuç: Günümüzde PTK’da nodal metastaz geliþimi için prediktif faktörlerin araþtýrýlmasý güncelliðini yakýn zamanda kaybedecek gibi gözükmemektedir. Çalýþmamýzda PTK’de tümörün histopatolojik özelliklerinden T evresi, lenfovasküler invazyon varlýðý ve multisentrisite santral metastaz geliþimi için baðýmsýz risk faktörleri olarak belirlenmiþ olup bu faktörlerden özellikle T evresi ve multisentirisite birçok hastada preoperatif görüntüleme ile öngörülebilir ve hastalarda yapýlacak proflaktik santral lenf nodu diseksiyonu yapýlýp yapýlmamasý kararýnda kullanýlabilir. Bununla birlikte literatürde bu konuda halen yeni çalýþmalara ihtiyaç vardýr. (SETB-2022-08-186)

Objectives: The most common subtype of thyroid cancer is papillary thyroid cancer (PTC); lymph node metastases are common in this disease. Factors affecting the development of central lymph metastasis of PTC determine the treatment modality and prognosis of the disease. In this study, we aimed to evaluate the clinicopathologic features affecting the development of central lymph node metastasis.
Methods: The data of a total of 346 PTC patients who were operated between May 2012 and September 2020 in our clinic and whose follow-up could be reached were evaluated retrospectively. Demographic data, surgical treatment modalities, and histopathological data of all patients were evaluated as a result of at least 6 months of follow-up. Patients age, sex, body mass index, pre-operative TSH levels, anti-TPO, and anti-Tg values at the time of diagnosis, whether lymph node dissection is performed, presence of lymph node metastasis, presence of distant metastasis, stage at the time of diagnosis (TNM 8th edition), ATA risk group at the time of diagnosis, multifocal and/or multicentric (bilaterality), largest tumor size, aggressive histological subtype, lymphovascular invasion of the tumor, extrathyroidal invasion, presence of lymphocytic thyroiditis, and surgical margin positivity were evaluated retrospectively.
Results: In the development of PTC central metastasis, distant metastasis, tumor size, multifocality, multicentricity, presence of lymphovascular invasion, aggressive tumor subtype, presence of lateral metastasis, nodular goiter, and extrathyroidal spread were found to be effective. Among these factors, T stage, presence of lymphovascular invasion, and multicentricity were identified as independent risk factors for the development of central metastasis.
Conclusion: Today, the investigation of predictive factors for the development of nodal metastasis in PTC does not seem to be out of date anytime soon. In our study, T stage, presence of lymphovascular invasion, and multicentricity were identified as independent risk factors for the development of central metastasis from the histopathological features of the tumor in PTC and of these features, T stage and multicentricity can be predicted by pre-operative imaging in many patients and can be used to decide whether to perform prophylactic SLN dissection in patients. However, new studies are still needed on this issue, in the literature.

Soliter parmak enkondromlarýnýn cerrahi tedavisinde ilyak krestten (ÝK) ve distal radiustan (DR) elde edilen otogreftlerin klinik ve radyolojik sonuçlarýný karþýlaþtýrmak ve birbirlerine üstünlüklerini deðerlendirmek.
Metod
Parmak enkondromu nedeniyle küretaj ve otogreft uygulanan 25 hasta retrospektif olarak incelendi. Bu hastalarýn 8’inde DR otogrefti, 17’sinde ÝK otogrefti kullanýlmýþtý. Ameliyat öncesi toplam aktif eklem hareket açýklýðý (TAM), Disabilities of the arm, shoulder and hand (DASH) skoru ve etkilenen parmaðýn Visual Analogue Scale (VAS) skorlarý, ameliyat süresi, ameliyat sýrasýndaki kanama miktarý, hastanede kalýþ süresi, anesteziye baðlý komplikasyon varlýðý ve ameliyat sonrasý donör saha morbiditesine iliþkin veriler elde edildi. Ameliyat öncesi ve ameliyat sonrasý 12. ay radyografilerinde ameliyat öncesi tümör hacmi, ameliyat sonrasý lezyon kalan hacmi ve Tordai radyolojik deðerlendirmesi ölçüldü.
Bulgular
DR ve ÝK gruplarý arasýnda ameliyat sonrasý TAM (p=0,154), DASH (p=0,458), aðrý VAS skorlarý (p=0,571), kalan hacim (p=0,496), Tordai radyolojik deðerlendirme derecesi (p=0,522), ameliyat süresi (p=0,288) ve kanama miktarý (p=0,114) arasýnda istatistiksel olarak anlamlý fark saptanmadý. Ancak ortalama hastanede kalýþ süresi DR grubunda daha kýsaydý (p=0.0001). DR grubunda 1 hastada ve ÝK grubunda 3 hastada nüks gözlendi (p=0,996).
Sonuç
El parmak enkondromlarýnýn tedavisinde, DR ve ÝK'den greftlemenin klinik ve radyolojik sonuçlarý benzerdi. Bununla birlikte, DR'den greftlemede, ÝK greftlemeye göre daha kýsa hastane kalýþ süresini sahipti. (SETB-2021-12-366)

Objectives: The purpose of the study was to compare clinical and radiological outcomes of autografts obtained from the iliac crest (IC) and distal radius (DR) and to evaluate their superiority for surgical treatment of solitary finger enchondromas.
Methods: Twenty-five patients for whom curettage and autografting were carried out for finger enchondroma were retrospectively analyzed. DR autograft was used in eight patients and IC autograft was used in 17 patients. Data on pre-operative total active motion (TAM), disabilities of the arm, shoulder, and hand (DASH) score, and pain visual analog scale (VAS) scores of the involved finger, duration of surgery, amount of bleeding during the operation, length of hospital stay, presence of complications related to anesthesia, and post-operative donor site morbidity were obtained. Pre-operative and post-operative 12th month radiographies were evaluated for pre-operative tumor volume, post-operative remnant volume, and Tordai radiologic evaluation grade.
Results: No statistically significant difference could be identified between post-operative TAM (p=0.154), DASH (p=0.458), pain VAS scores (p=0.571), remnant volume (p=0.496), Tordai radiologic evaluation grade (p=0.522), duration of surgery (p=0.288), and amount of bleeding (p=0.114) between DR and IC groups. However, mean hospital stay duration was shorter for the DR group (p=0.0001). Recurrence was observed in one patient in the DR group and three patients in the IC group (p=0.996).
Conclusion: The clinical and radiological outcomes of grafting from the DR and IC were similar in the treatment of hand enchondromas. However, grafting from the DR may result in shorter hospital stay compared to IC grafting.

Amaç: Alt özofagus sfinkter basýncýnýn 24 saatlik ph metre testi ve H. pylori ile olan iliþkisini deðerlendirmeyi amaçladýk.
Gereç ve yöntemler: Özofagus manometri testi normal olan ve manometride izole hipotansif ve izole hipertansif alt özofagus sfinkteri tespit edilen hastalarýn verileri retrospektif olarak tarandý. Hastalarýn demografik özellikleri, baþvuru þikâyetleri, üst endoskopi bulgularý, 24 saatlik pH metre sonuçlarý ve mide biyopsi örneklerinde H. pylori varlýðý deðerlendirildi.
Bulgular: Çalýþmaya toplam 1226 hasta alýndý. Tüm hastalarýn %54’ü kadýndý. Ortalama hasta yaþý 45.4±13.4’tü. Hastalar en sýk pirozis (%85.4) þikayeti ile baþvurmuþtu. %61.4’ünde patolojik reflü saptandý. Hastalarýn %22.9’unda reflü özofajit vardý. Hastalarýn %40 kadarýnda H.pylori pozitif saptandý. Hipertansif LESB olan hastalarýn yaþý istatistiksel olarak anlamlý þekilde yüksekti ve Hipertansif LESB anlamlý oranda kadýnlarda daha fazlaydý. Pirozis, Hipertansif LESB olan hastalarda, anlamlý oranda daha az görülen þikayetti. BMÝ, Hipertansif LESB olanlarda istatistiksel olarak anlamlý oranda daha yüksekti. Özofajit ve LES Gevþekliði istatistiksel olarak anlamlý oranda Hipotansif LES olan hastalarda daha çok saptandý. Gruplar arasýnda reflü ve H.pylori pozitifliði açýsýndan istatistiksel olarak anlamlý fark saptanmadý. H. pylori pozitif ve negatif olan hastalar karþýlaþtýrýldýðýnda, reflü ve reflü özofajit açýsýndan anlamlý farklýlýk saptanmadý.
Sonuç: Özofagus manometrisinde LES basýncýnýn normal, hipotansif veya hipertansif olmasý ile, gastroözofageal reflü ve H. pylori arasýnda net bir iliþki saptanmadý. LES basýnçlarý arasýnda, 24 saatlik pH metrede farklýlýk görülmese de reflü özofajit geliþiminde, H. pylori’ den ziyade hipotansif LES varlýðý önemli görünmektedir. (SETB-2021-12-382)

Objectives: The aim of the study was to evaluate the relationship among lower esophageal sphincter pressure (LESP), Helicobacter pylori (Hp), and gastroesophageal reflux (GER).
Methods: The retrospective study included patients with isolated hypertensive or hypotensive lower esophageal sphincter (LES) who underwent esophageal manometry in our gastroenterology motility laboratory and had normal manometry results. Demographic characteristics, complaints on admission, upper endoscopy findings, 24-h esophageal pH monitoring results, and presence of Hp in gastric biopsy were evaluated.
Results: A total of 1226 patients were included in the study, among whom women comprised 54% of all patients. Mean age was 45.4±13.4 years. Most common presenting complaint was pyrosis (85.4%). Pathological reflux was detected in 61.4% of the patients in 24-h esophageal pH monitoring. Reflux esophagitis was detected in 22.9% and LES laxity was present in 17.4% of the patients. In gastric biopsy, Hp was positive in 40% of the patients. The age of patients with hypertensive LES was significantly higher and female gender and body mass index (BMI) were associated with hypertensive LES. Pyrosis was significantly less prevalent in patients with hypertensive LESP. Esophagitis and LES laxity were significantly more prevalent in patients with hypotensive LES. No significant difference was found among the three groups with regard to reflux and Hp positivity. No significant difference was found between Hp-positive and Hp-negative groups with regard to reflux and reflux esophagitis.
Conclusion: No clear relationship was found among LES disorders, GER, and Hp. Moreover, no significant difference was found among LES disorders with regard to GER, while the presence of hypotensive LESP, rather than Hp, was found to be an important factor in the development of reflux esophagitis.

Giriþ: Dünya çapýnda son dönem böbrek hastalýðý için diyaliz tedavilerinin prevalansýndaki artýþa ek olarak, hemodiyaliz hastalarý arasýndaki ölüm oranlarý genel popülasyondan daha yüksek olmaya devam etmektedir. Bu çalýþma, stabil hemodiyaliz hastalarýnda uzun süreli saðkalým ile iliþkili faktörleri deðerlendirmeyi amaçlamaktadýr.
Yöntem: Bu prospektif kesitsel beþ yýllýk takip çalýþmasýna Þubat 2013 tarihinden sonra hemodiyaliz baþlanan toplam 100 hasta dahil edildi. Hasta demografisi, antropometrik-beslenme parametreleri, sistolik ve diyastolik kan basýncý seviyeleri ile böbrek yetmezliði etiyolojisi, hemodiyaliz süresi, periton diyalizi öyküsü, interdiyalitik kilo alýmý ve Kt/V dahil olmak üzere hemodiyaliz parametreleri hakkýndaki veriler kaydedildi.
Bulgular: Genel beþ yýllýk sað kalým oraný %56.6 idi. Beþ yýllýk sað kalým oraný, yaþý daha genç (ortancanýn %71.4 altý ve %42.0 üzerinde, p=0.023), düþük sistolik (sýrasýyla, %63,3'e karþý %50, p=0,005) ve düþük diyastolik (sýrasýyla, 62,5'e karþý %51,0, p=0,02) kan basýncý, daha yüksek Kt/V (sýrasýyla %46,9'a karþý %66,0, p=0,044), daha düþük diyalizler arasý aðýrlýk artýþý (sýrasýyla %54,0'a karþý %32,7, p=0,026) ve daha düþük serum leptin seviyeleri (sýrasýyla %63.3'e karþý %50.0, p=0.047) olan hastalarda daha yüksekti. Cox-regresyon analizi, yalnýzca sistolik kan basýncýnýn (B=1.081, %95 GA, 0.152 ila 0.756, p=0.08) kötü sað kalým için önemli bir risk faktörü olduðunu ortaya koydu.
Sonuç: Hemodiyaliz hastalarýnda kötü uzun dönem saðkalým için tek risk faktörü diyaliz öncesi yüksek sistolik kan basýncý olduðunu saptadýk. Malnütisyon-inflamasyonun, beslenme ve inflamasyon prametreleri ile aneminin uzun süreli sað kalým üzerinde anlamlý bir etkisi saptanmadý. (SETB-2021-06-187)

Objectives: In addition to an increase in the prevalence of dialysis treatments for end-stage renal disease worldwide, the mortality rates among patients on maintenance hemodialysis remain higher than that of the general population. This study aims to evaluate factors associated with long-term survival in stable maintenance hemodialysis patients.
Methods: A total of 100 patients initiating hemodialysis by February 2013 were included in this prospective cross-sectional 5-year follow-up study. Data on patient demographics, anthropometric-nutritional parameters, systolic and diastolic blood pressure levels, and hemodialysis parameters, including etiology of kidney failure, hemodialysis duration, peritoneal dialysis history, relative interdialytic weight gain (RIDWG), and Kt/V, were recorded.
Results: Overall 5-year survival rate was 56.6%. The 5-year survival rate was higher in patients with younger age (71.4% below median vs. 42.0% above median, p=0.023), lower systolic (63.3 vs. 50%, respectively, p=0.005) and diastolic (62.5 vs. 51.0%, respectively, p=0.02) blood pressure levels, higher Kt/V (46.9 vs. 66.0%, respectively, p=0.044), lower RIDWG (54.0 vs. 32.7%, respectively, p=0.026), and lower serum leptin levels (63.3 vs. 50.0%, respectively, p=0.047). Cox-regression analysis revealed that only systolic blood pressure (B = 1.081, 95% CI, 0.152 to 0.756, p=0.08) was a significant risk factor for poor survival.
Conclusion: Our findings revealed pre-dialysis systolic blood pressure as the sole risk factor for poor long-term survival in stable maintenance hemodialysis patients. Malnutrition-inflammation, measures of nutrition, inflammation, and anemia had no significant impact on long-term survival.

Amaç: Akut lenfoblastik lösemi (ALL) çocukluk çaðýnda en sýk görülen malignitesidir. Hastalýðýn seyri sýrasýnda gerek hastalýðýn kendisi gerek iliþkili diðer klinik durumlar böbreði sýklýkla etkiler. Bu çalýþmanýn amacý yeni taný konulmuþ ALL hastasý çocuklardaki renal ultrason anomalilerini belgelemek ve renal bulgularla klinik/laboratuvar bulgularýnýn ve prognozun korrelasyonunu araþtýrmaktýr. Ýkincil amaç uzun dönem böbrek fonksiyonlarýný deðerlendirmektir.
Gereç ve Yöntem: ALL tanýsý alan toplam 163 çocuk (18 yaþ altý) çalýþmaya dahil edildi. Laboratuvar ve ultrasonografi bulgularý retrospektif olarak kaydedildi. Boyut artýþý/nefromegali (NM) veya hiperekojenite (HE) patolojik renal anomali olarak kabul edildi. NM/HE olan ve olmayan hastalar arasýnda çalýþma parametreleri karþýlaþtýrýldý.
Bulgular: Yüzaltmýþüç hastada NM±HE insidansý %12 olarak saptandý. Kreatinin yüksekliði ve dalak ve/veya karaciðer büyümesi, NM/ HE varlýðý için baðýmsýz deðiþken olarak saptandý. NM/HE indüksiyon kemoterapisi sonrasý tüm hastalarda düzeldi ve NM/ HE’nin ALL prognozu üzerine etkisi gösterilemedi. Uzun dönem takipte saðkalan hastalarda böbrek fonksiyonlarý normal sýnýrlarda saptandý.
Sonuç: Özetle, akut lenfoblastik lösemili hastalarda taný anýnda renal ultrasonografik anomaliler nadir deðildir ancak bu çalýþmada lösemi prognozu ve uzun vadeli böbrek fonksiyonlarý üzerinde olumsuz etkisi gösterilememiþtir. (SETB-2021-12-359)

Objectives: The kidney is a vulnerable organ for acute lymphoblastic leukemia (ALL), by the disease, and various associated clinical pictures. This retrospective study aims to document renal ultrasound abnormalities in children with newly diagnosed ALL as well as to investigate the correlation between renal findings and clinical/laboratory/survival data.
Methods: All children (age <18 years) with ALL were included in the study. An increase in size/nephromegaly (NM) or hyperechogenicity (HE) of the kidneys at first admission was accepted as a pathological renal abnormality. The clinical/laboratory findings, survival, and long-term renal functions were compared between patients with and without NM/HE.
Results: The incidence of NM±HE was 12% in 163 patients. Enlargement of spleen, liver, or both and, hypercreatininemia was independently correlated with the presence of NM/HE. After the induction therapy, ultrasound findings were resolved in all patients, and NM/HE did not influence ALL prognosis. All survivors had normal renal functions in long term.
Conclusion: The renal ultrasound abnormalities are not uncommon in children with leukemia at admission, without a negative impact on leukemia prognosis and on long-term renal functions.

Amaç: Kolistin, özellikle dünya çapýnda çok ilaca dirençli gram negatif enfeksiyonlarýn ortaya çýkmasýyla bir tedavi seçeneði olarak öne çýkmýþtýr. Bununla birlikte, çocuklarda kolistinin yüksek nefrotoksik etkileri göz önünde bulundurulmalýdýr. Çalýþmanýn birincil sonucu, kolistin tedavisinin klinik baþarýsýný belirlemek; ikincil sonucu ise, kolistin ile ilgili yan etkileri saptamaktýr.
Yöntemler: Çalýþmaya hastanemizde son beþ yýlda intravenöz kolistin uygulanan hastalar dahil edildi. Hastalarýn demografik ve klinik özelliklerinin yaný sýra kolistin tedavisinin klinik baþarýsý, hastalarýn 28 günlük enfeksiyona baðlý ölüm oranlarý ve kolistin yan etkileri kaydedildi.
Bulgular: 2015-2019 yýllarý arasýnda toplam 37 hasta kolistin tedavisi görmüþtü. Otuz yedi hastanýn içinde, bir yýl içerisinde iki kez kolistin tedavisi alan dört hasta mevcuttu. Bu nedenle bu hastalar iki ayrý enfeksiyon ataðýnda baðýmsýz vakalar olarak kabul edildi ve toplamda 41 vaka çalýþmaya dahil edildi. Vakalarýn ortanca yaþlarý 26 aydý (IQR: 4.50-144.50) ve 27'si (%65,9) erkekti. Hastalarýn 27’sinde (%65,9) sepsis vardý. Ortanca kolistin dozu 4.2 (IQR: 3-5) mg/kg/gün idi. Hastalardan alýnan 44 kültür arasýnda en sýk üreyen mikroorganizma %58,5 ile Acinetobacter baumannii idi. Klinik baþarý 18 hastada (%43,9) tespit edildi. 14 (%34,1) hastada nefrotoksisite geliþirken, bunlardan sadece ikisinin diyaliz ihtiyacý olmuþtu.
Sonuç: Kolistin, gram-negatif enfeksiyonlarýn tedavisinde ilk seçenek olarak düþünülmemeli, çoklu ilaca dirençli gram-negatif enfeksiyonlarda kurtarma tedavisi olarak elde tutulmalýdýr. Tedavi sürecinde nefrotoksisite geliþme riski nedeniyle böbrek fonksiyon testleri ve idrar çýkýþýnýn yakýn takibi önemlidir. (SETB-2021-08-250)

Objectives: Colistin has come to the fore as a treatment option, especially with the occurrence of multidrug-resistant Gram-negative infections across the world. However, the high nephrotoxic effects of colistin should be taken into consideration in children. The study’s primary outcome was to determine the clinical success of the colistin treatment, and the secondary outcome was to detect the side effects related to colistin.
Methods: The patients who received intravenous colistin in our hospital’s last 5 years were included in the study. In addition to the patients’ demographic and clinical characteristics, the clinical success of the colistin treatment, 28-day infection-related mortality of the patients, and side effects of colistin were recorded.
Results: A total of 37 patients received colistin therapy during 2015–2019. Four of these patients had colistin treatment twice a year, so we accepted them as separate cases in each infection attack. Therefore, 41 cases were included in the study. The median age of the cases was 26 months (IQR: 4.50–144.50) and 27 (65.9%) were male. Twenty-seven cases (65.9%) had sepsis. The median dose of colistin was 4.2 (IQR: 3–5) mg/kg/day. Among 44 cultures obtained from the patients, the most common microorganism was Acinetobacter baumannii, with 58.5%. The clinical success was detected in 18 patients (43.9%). While overall nephrotoxicity developed in 14 (34.1%) patients, only two of them needed dialysis.
Conclusion: Colistin should not be considered the first choice in treating Gram-negative infections but should be kept as salvage therapy in multidrug-resistant Gram-negative infections across the world. During the treatment process, close monitoring of renal function tests and urinary output were recommended due to the risk of developing nephrotoxicity.

Dalak torsiyonu, dalaðý stabilize eden baðlarýn gevþekliði veya yokluðuna baðlý olarak geliþebilen, akut veya karýn aðrýsýnýn nadir bir nedenidir. Torsiyone olmuþ bir dalak acil cerrahi giriþim gerektirebilmektedir. Dalak torsiyonu sonrasý akut karýn bulgularý ile kliniðimize baþvuran üç pediatrik olguyu ve tedavi yaklaþýmlarýný tartýþmayý amaçladýk.
Olgu 1: On yaþýnda kýz hasta, karýn aðrýsý, safrasýz kusma, þikâyeti ile baþvurdu. Batýn hassasiyeti, sol alt kadranda ele gelen dolgunluk mevcuttu. Görüntüleme yöntemleri dalak torsiyonu ile uyumluydu. Hastaya laparoskopik splenektomi yapýldý.
Olgu 2: Dört yaþýnda kýz hasta, karýn aðrýsý ve safrasýz kusma þikâyeti ile baþvurdu. Batýnda yaygýn hassasiyet, defans-rebound mevcuttu. Görüntüleme yöntemleri dalak torsiyonu ile uyumluydu. Laparotomi ile splenektomi yapýldý.
Olgu 3: 5 yaþýnda erkek hasta karýn aðrýsý þikayeti ile baþvurduðu baþka bir hastanede apandisit tanýsýyla açýk operasyon ile opere edilmiþ. Ameliyat sonrasý hastanýn semptomlarýnda herhangi bir iyileþme olmayýnca postoperatif beþinci günde kliniðimize konsülte edildi. Görüntüleme yöntemleri dalak torsiyonu ile uyumlu bulundu. Hastada laparoskopik splenektomi yapýldý.
Pediyatrik popülasyonda dalak torsiyonu nedeni bilinmeyen akut veya kronik karýn aðrýsýna neden olabilir. Torsiyonda dalak koruyucu yaklaþým tedavinin ilk amacý olmalýdýr ancak komplike vakalarda splenektomi tek tedavi seçeneðidir ve komplike vakalarda bile laparoskopi güvenle kullanýlabilir. (SETB-2021-05-156)

Splenic torsion is a rare cause of abdominal pain that may develop due to laxity or absence of the ligaments that stabilize the spleen. A torsioned spleen may present with an acute abdomen clinically and may require urgent surgical intervention. We aimed to discuss three pediatric cases who applied to our clinic with acute abdomen symptoms after splenic torsion and their treatment approaches. Case 1: A 10-year-old female patient presented with complaints of progressive abdominal pain and non-bilious vomiting. On examination, there was abdominal tenderness and palpable fullness in the left lower quadrant. Imaging methods were compatible with splenic torsion. Laparoscopic splenectomy was performed. Case 2: A 4-year-old girl presented with complaints of abdominal pain and non-bilious vomiting. On examination, diffuse tenderness in the abdomen and defense-rebound were positive. Imaging methods were compatible with splenic torsion. On exploration, it was observed that the spleen was torsioned in different directions around the double pedicle. Splenectomy was performed. Case 3: A 5-year-old male patient was operated in another hospital with the complaint of abdominal pain, with the diagnosis of acute appendicitis, with open surgery. However, there was no improvement in the patient’s symptoms after surgery. The patient was consulted to our clinic on the 5th post-operative day. Imaging methods were found to be compatible with splenic torsion. Laparoscopic splenectomy was performed. In the pediatric population, splenic torsion can cause acute or chronic abdominal pain of unknown cause. Splenopexy should be the first goal of treatment in torsion, but splenectomy is the only treatment option in complicated cases and laparoscopy can be used safely even in complicated cases.