Substernal guatrýn en uygun tedavisi cerrahidir. Bu hastalar preoperatif dönemde dikkatli ve multidisipliner olarak deðerlendirilmeli ve cerrahi tedavi preoperatif olarak planlanmalýdýr. Substernal guatrlarýn çoðu servikal yaklaþýmla rezeke edilebilmesine raðmen, hastalarýn küçük bir kýsmýnda ekstraservikal yaklaþým gerekebilir. Tiroidektomiye baðlý substernal guatrýn cerrahi komplikasyonlarý diðer tiroidektomilere göre daha yüksektir. Substernal guatrda tiroidektomiye baðlý komplikasyonlarýn yaný sýra cerrahi giriþimin tipine baðlý komplikasyonlar da ortaya çýkabilir. Ekstra servikal yaklaþým gerekebilecek hastalar ameliyat öncesi göðüs cerrahisi, kalp damar cerrahisi ve anestezi uzmaný ile konsülte edilmeli; cerrahi tedavi birlikte planlanmalýdýr. Bu bölümde servikal yaklaþým yöntemlerini, ekstra servikal yaklaþým yöntemlerini, teknik detaylarý ve komplikasyonlarý detaylý olarak deðerlendirmeyi amaçladýk. (SETB-2022-10-217)

The most appropriate treatment of substernal goiter (SG) is surgery. These patients should be evaluated carefully and multidisciplinary in pre-operative period and surgical management should be planned preoperatively. Although most of the SGs can be resected by the cervical approach, an extracervical approach may be required in a small proportion of patients. Surgical complications of SG related to thyroidectomy are higher than other thyroidectomies. In addition to the complications related to thyroidectomy, complications related to the type of surgical intervention may also occur in SG. The patients who may be needed extracervical approaches should be consulted with thorax surgeons, cardiovascular surgeons, and anesthesiologists preoperatively; the surgical management should be planned together. In this part, we aimed to evaluate the cervical approach methods, extracervical approach methods, technical details, and complications in detail.

Amaç: Coronavirus 2019 (COVID-19)’a baðlý olarak yaþanan kapanma süreçleri Alzheimer Hastalarýnýn nöropsikiyatrik durumu üzerinde olumsuz bir etkiye sahip olabilir. Bu çalýþmada, Alzeimer Hastalarýnýn tam ve kýsmi karantina dönemlerindeki nöropikiyatrik durumlarý deðerlendirilerek geleceðe yönelik çýkarýmlarýn bulunmasý amaçlanmýþtýr.
Gereç ve Yöntemler: Çalýþmamýz prospektif, kesitsel ve çok merkezli bir çalýþma olup; Türkiye'nin farklý bölgelerindeki polikliniklerce en az bir yýldýr takip edilen Alzheimer Hastalarýyla yapýlmýþtýr. Sosyo-demografik bilgiler, komorbidite, mobilite ile tam kapanma ve kýsmi kapanma sürecindeki sosyal etkileþim düzeyi, Klinik Demans Deðerlendirme (CDR) Ölçeði ve Nöropsikiyatrik Envanter’e (NPI) iliþkin bilgiler bakýmverenler ile dolduruldu.
Bulgular: Çalýþmaya toplam 302 Alzheimer Hastasý (ortalama yaþ: 78±8 yýl, ortalama eðitim süresi: 5,8±9 yýl) dahil edildi. En sýk eþlik eden hastalýðýn hipertansiyon olmak üzere, toplam komorbidite oraný %84 olarak bulundu. NPI skorlarýnýn ortalamasý tam kapanmada 22,9±21 ve kýsmi kapanmada 17,7±15 olup gruplar arasýndaki farkýn istatistiksel olarak anlamlý olduðu bulundu. Kapanma süreleri ve cinsiyete göre NPI puanlarýnýn toplam puanlarý ile karþýlaþtýrýldýðýnda, tam kapanmada sosyal etkileþimlerin varlýðý, mobilite ve komorbiditelerin etkisi kýsmi kapanmaya göre daha yüksek bulundu. Tam kapanmadan kýsmi sokaða çýkma yasaðýna geçildiðinde, komorbiditeler, mobilite ve CDR'ýn NPI puanlarý üzerinde anlamlý bir etkisi olduðu bulundu. Regresyon analizinde, her iki kapanma süresi için de Alzheimer Hastalarýnýn nöropsikiyatrik durumu üzerinde en etkili parametrenin CDR puaný olduðu bulundu.
Sonuç: Kapanma ile ilgili kýsýtlamalar azaltýldýðýnda, Alzheimer Hastalarýnýn nöropsikolojik durumlarý önemli ölçüde iyileþti. Kapanma kurallarý bu veriler göz önünde bulundurularak düþünülmelidir. (SETB-2021-12-375)

Objectives: Coronavirus disease 2019 (COVID-19)-related lockdown may have a negative effect on the neuropsychiatric status of Alzheimer’s disease (AD) cases. In this study, it was aimed to find future implications by evaluating the neuropsychiatric conditions of AD cases during total and partial lockdown periods.
Methods: It is a prospective, cross-sectional, and multicenter study that includes AD cases which have been followed for at least 1 year by outpatient clinics from different regions of Turkey. Sociodemographic data, comorbidities, mobility, existence of social interactions, clinical dementia rating (CDR) scale, and neuropsychiatric inventory (NPI) for total and partial lockdown were questioned by the caregivers with the help of case files of the patients.
Results: A total of 302 AD cases were enrolled to the study (mean age: 78±8 years, mean duration of education: 5.8±9 years). The total comorbidity ratio was found to be 84%, with the most frequent comorbidity being hypertension. The mean NPI score was 22.9±21 in total lockdown and 17.7±15 in partial lockdown, which is statistically significantly different. When lockdown periods were compared with the total scores of NPI scores according to gender, existence of social interactions, mobility, and comorbidities were found higher in the total lockdown than the partial lockdown. When switching from total lockdown to partial lockdown, the presence of comorbidities, mobility, and CDR were found to be factors that had a significant effect on NPI scores. In regression analysis, CDR score was found as the most effective parameter on the neuropsychiatric status of AD cases for both lockdown periods.
Conclusion: When lockdown-related restrictions were reduced, the neuropsychological conditions of AD cases were significantly improved. Lockdown rules should be considered with these data in mind.

Amaç: Kalp, çocuklarda SARS-CoV-2 enfeksiyonu ile iliþkili multisistem inflamatuar sendromdan (MIS-C) sýklýkla etkilenen organlardan biridir. Çalýþmada, MIS-C'li hastalarda kardiyak tutulum deðerlendirildi.
Metod: Bu retrospektif çalýþmada, MIS-C'li hastalarýn þikayetleri, fizik muayeneleri ve kardiyak bulgularý deðerlendirildi.
Bulgular: MÝS-C'li 16 hasta (4 erkek ve 12 kýz) çalýþmaya dahil edildi. Ortanca yaþ 6 (5-17) yýldý. Hastalarda çarpýntý (%6), göðüs aðrýsý (%12), EKG deðiþiklikleri (%50), kapak yetersizliði (%50), düþük ejeksiyon fraksiyonu (%6), koroner dilatasyon (%6), troponin (%38), ve d-dimer (%88) yüksekliði tespit edildi. Bir hasta öldü. Kapak yetersizliði 5 (%31) hastada devam etti.
Sonuç: Kardiyak erken dönem sonuçlarý çok þiddetli olan MÝS-C'nin geç dönem etkileri hakkýnda yeterli veri bulunmamaktadýr. Önümüzdeki dönemde çocukluk çaðý hastalýklarý arasýnda önemli bir saðlýk sorunu haline gelecek olan MÝS-C'nin anlaþýlmasý için çok daha fazla çalýþmaya ihtiyaç vardýr. (SETB-2021-10-309)

Objectives: The heart is one of the organs frequently affected by the multisystem inflammatory syndrome in children (MIS-C), associated with severe acute respiratory syndrome coronavirus 2 infection. Cardiac involvement in patients with MIS-C was evaluated with physical examination findings, biochemical test, and cardiological imaging tests. We reported the degree of cardiac involvement in patients with MIS-C.
Methods: In this retrospective study, the complaints, physical examination, and cardiac findings of patients with MIS-C were evaluated.
Results: Sixteen patients (four males and 12 females) with MIS-C were included in the study. The median age was 6 (5–17) years. In patients, palpitations (6%), chest pain (12%), ECG changes (50%), valve insufficiency (50%), low ejection fraction (6%), coronary dilatation (6%), troponin (38%), and d-dimer (88%) elevation were detected. One patient died. Valve insufficiency persisted in 5 (31%) patients.
Conclusion: Severe cardiac involvement can be seen in MIS-C patients. Due to its serious effects on mortality and morbidity, cardiac involvement should be evaluated with cardiac imaging tools such as echocardiography and ECG in all MIS-C patients.

Amaç: Hafif-orta ve aðýr-kritik þiddetli Covid-19 hastalarýnda koku ve tat bozukluklarýnýn prevalansýný, þiddetini ve uzun dönem seyri ve bulgularýný belirlemek.
Materyal Metod: Hastanemizde MART-Nisan 2020 tarihleri arasýnda SARS-CoV-2 pozitif olan tüm eriþkin hastalara hastalýk sýrasýnda anket uygulanmýþ ve en az 12 aylýk takipten sonra tat ve koku bozukluðu olan hastalara bu semptomlarýn seyrini ve ilerlemesini belirlemek için ikinci bir anket uygulandý. Demografik özellikler ve klinik bulgularý ile hastalýk þiddeti deðerlendirildi.
Bulgular: Koku ve/veya tat bozukluðu semptomlarý olan toplam 77 hasta çalýþmaya dahil edildi. Taný sýrasýnda 58 (% 75.3) hastada koku bozukluðu ve 75 (%97.4) hastada tat bozukluðu mevcuttu. 12-14 aylýk takip sonrasý 12 (% 15.6) hastada devam eden koku bozukluðu ve 6 (% 8) hastada tat bozukluðu bulgularý devam ediyordu. Takiplerde 3 (%3.9) hastanýn kakosmisi ve 5 ( % 6.5) hastanýn parozmisi mevcuttu. Koku ve/veya tat bozukluðu devam eden hastalarýn VAS skorlarý deðerlendirildiðinde erkek ve kadýn cinsiyeti arasýnda istatistiksel anlamlý fark saptanmadý. Semptomlarýn varlýðý ve þiddeti ile hastalýðýn þiddeti karþýlaþtýrýldýðýnda istatistiksel anlamlý fark saptanmadý.
Sonuç: Koku ve tat bozukluðu COVID-19’un mevcut semptomlarý arasýnda görünmektedir. COVID-19 hastalarýndaki koku ve tat kaybýnýn prognozu ve tedavisi halen belirsizdir. Ýyileþmeyi hýzlandýrmak ve saðlamak için patofizyoloji ve tedavi seçenekleri belirlenmelidir. (SETB-2022-09-209)

Objectives: The objective of this study was to determine prevalance, severity, course, and long-term findings of smell and taste disorders of coronavirus disease 2019 (COVID-19) patients in mild-moderate and severe-critical disease spectrum.
Methods: All adult patients conducted in our hospital with positive severe acute respiratory syndrome coronavirus 2 between March and April 2020 were surveyed during disease course and those with olfactory and taste loss were re-surveyed to determine the course and progress of these symptoms after at least 12-month follow-up. Demographic features and clinical findings were evaluated as well as disease severity.
Results: A total of 77 patients with smell and/or taste loss symptoms were included in the study. At diagnosis, 58 (75.3%) patients had loss of smell and 75 (97.4%) had loss of taste. After a follow-up period of 12–14 months, 12 (15.6%) patients had ongoing loss of smell and six (8%) patients had ongoing loss of taste. Three (3.9%) patients complained of cacosmia and 5 (6.5%) complained of parosmia at follow-up. The presence of ongoing visual analog scale scores of smell and/or taste was not statistically significant between male and female patients. When presence and severity of symptoms were compared by disease severity, no statistically significant difference was found.
Conclusion: Smell and taste loss seem to be among the presenting symptoms of COVID-19. The prognosis and the treatment of the smell loss and taste loss in COVID-19 patients remains unclear. To improve and accelerate recovery, the pathophysiology and the treatment options must be validated.

Amaç: Burun ucunun 3 ana özelliði nazal tip projeksiyonu (NTP), nazal tip rotasyonu (NTR) ve belirginliðidir. Burun estetik ameliyatý, anatomik varyasyonlar, patolojiler ve çok farklý ameliyat teknikleri nedeniyle zordur. Ýdeal teknik, sadece kýsa vadede deðil uzun vadede de iyi sonuçlar vermelidir. Rinoplastide vertikal alar rezeksiyon (VAR) tekniðinin uzun dönem sonuçlarýný analiz etmek.
Yöntemler: 2001-2017 yýllarý arasýnda kýdemli yazar tarafýndan VAR yönteminin kullanýldýðý rinoplasti ameliyatý olan 48 hasta (42 kadýn, 6 erkek) çalýþmaya dahil edildi. Hastalarýn ortalama yaþý 35.5 yýl (18-56 yýl) idi. Ameliyat sonrasý ortalama takip süresi 86.8 ay (daðýlým 25-225 ay) idi. Hastalarýn ameliyat öncesi, erken ve geç ameliyat sonrasý fotoðraflarýný inceledik. Yýllara göre NTP ve NTR deðiþiklikleri objektif olarak deðerlendirildi. Hastalar ayrýca son kontrol ziyaretlerinde Rinoplasti Sonuç Deðerlendirme anketini doldurdu
Bulgular: Ortalama NTP (Goode Metodu ile) geç postoperatif kontrolde erken dönemde 0.60'tan 0.59'a, erken postoperatif kontrolde ortalama nazofasiyal açý 29.4'ten 28.7'ye deðiþti. Erken ve geç postoperatif kontrol arasýnda ortalama nazolabial açý (NLA) 97.3'ten 94.5'e ve Tip rotasyon açýsý (TRA) 35.2'den 35.4'e deðiþti. NTP ve NLA'nýn erken ve geç postoperatif ölçümleri arasýndaki farklar anlamlýydý (tümü için p<0,001), ancak TRA anlamlý olarak deðiþmedi (p>0,001).
Sonuç: VAR, nazal tip modifikasyonu için faydalý bir yöntemdir. VAR ile NTP ve NTR'yi, lateral crus ve burnun uzunluðunu kontrol edebiliriz; Bu teknikle kýsa vadede olduðu gibi uzun vadede de tatmin edici sonuçlar elde edilir. (SETB-2022-11-239)

Objectives: Main properties of nasal tip are the nasal tip projection (NTP), the nasal tip rotation (NTR), and the definition. Its surgery is difficult due to anatomic variations, pathologies, and various surgery possibilities. The ideal technique must also provide good results in long-term. The aim of the study was to analyze long-term results of vertical alar resection (VAR) technique in rhinoplasty.
Methods: Forty-eight patients who underwent rhinoplasty operations that VAR method was used by senior author between 2001 and 2017 were included into the study (42 women and six men). The mean age of patients was 35.5 years (range 18–56 years). Mean post-operative follow-up period was 86.8 months (range 25–225 months). We analyzed pre=operative, early, and late post-operative photographs of patients. NTP and NTR changes in years were objectively evaluated. Patients also completed Rhinoplasty Outcome Evaluation questionnaire in their last control visit.
Results: Mean NTP (through Goode Method) was changed from 0.60 in early to 0.59 in late post-operative control, mean nasofacial angle from 29.4 in early to 28.7 in late post-operative control. Mean nasolabial angle (NLA) changed from 97.3 to 94.5 and Tip rotation angle (TRA) from 35.2 to 35.4 between early and late post-operative control. Differences between early and late post-operative measures of NTP and NLA were significant (p<0.001 for all), but TRA did not changed significantly (p>0.001).
Conclusion: VAR is a useful method for modifications of lateral crura and nasal tip. With VAR, we can control NTP and NTR, length of lateral crus and nose; get satisfying and long lasting results.

GÝRÝÞ: Papiller tiroid kanseri en sýk görülen tiroid kanseridir. Bazý hastalarda lobektomi yapýldýktan sonra histopatolojik incelemede saptanan papiller tiroid kanserinin histopatolojik özellikleri nedeniyle karþý loba tamamlayýcý tiroidektomi gerekebilir. Hipokalsemi tiroidektomi sonrasý en sýk görülen komplikasyon olup, etyolojisi multifaktöryeldir. Tamamlayýcý tiroidektominin hipokalsemi geliþme riskini arttýrýp arttýrmadýðý halen tartýþma konusudur. Bu çalýþmada papiller tiroid kanseri tanýsý ile tamamlayýcý tiroidektomi uygulamasýnýn total tiroidektomiye göre hipokalsemi riskini arttýrýp artýrmadýðýný deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: 2015-2018 tarihleri arasýnda opere edilen, preoperatif veya postoperatif dönemde papiller tiroid kanseri tanýsý alan hastalarýn verileri retrospektif deðerlendirilerek 2 hasta grubu oluþturuldu. Grup 1’e ilk ameliyatta lobektomi yapýldýktan sonra patolojik incelemede papiller tiroid kanseri saptanan ve karþý loba tamamlayýcý tiroidektomi uygulanan 19 hasta alýndý. Grup 2’ye ayný dönemde total tiroidektomi uygulanan preoperatif veya postoperatif papiller tiroid kanseri tanýsý koyulan hastalar arasýndan yaþ ve cinsiyet olarak 1. gruba benzer özelliklerde 53 hasta seçildi. Ýki grup arasýnda preoperatif ve postoperatif dönemde kalsiyum metabolizmasý ile ilgili biyokimyasal parametreler, paratiroid ototransplantasyonu ve istenmeden paratiroid bezi çýkarýlmasý, postoperatif hipokalsemi ve tedavi oranlarý karþýlaþtýrýldý.
Bulgular: Grup 1’de ve 2’de sýrasý ile, yaþ ortalamasý 48.3+12.1 olan 19 hasta (13K, 6E), 46.3+9 (40K, 13E) olan 53 hasta yer almakta olup; yaþ ve cinsiyet açýsýndan gruplar arasýnda anlamlý fark yoktu. Preoperatif parathormon (PTH), fosfor (P), magnezyum (Mg), D vitamin eksikliði oraný, paratiroid ototransplantasyonu ve tiroid piyesinde paratiroid bezi bulunmasý açýsýndan anlamlý fark saptanmadý. Preoperatif kalsiyum (Ca) deðeri 1. grupta 9.33+0.46 olup, 2. Gruba (9.65+0.41) göre düþüktü (p=0,012). Postoperatif 0. Gün Ca, P, Mg, PTH; 1. gün Ca, Mg, PTH; deðerleri arasýnda anlamlý fark yoktu. Postoperatif 1. Gün P düzeyi 1. grupta (2.86+0.72) 2. gruba (3.6+0.83) göre anlamlý olarak düþüktü. Postoperatif hipkalsemi oranlarý grup 1 ve 2’de sýrasý ile %21.1, %30.2 olup fark anlamlý deðildi (p=0,558). Her iki gruptada hipokalsemiler geçici olup, kalýcý hipoparatiroidi saptanmadý. Grup 1 ve 2’de sýrasý ile paratiroid ototransplantasyonu (10.5% vs 3.8%; p=0,283), piyeste aksidental çýkarýlan paratiroid oraný(0 vs 15.1; p=0,185) benzerdi.Postoperatif dönemde Ca ve bazen aktif D vitamin uygulanmasý oraný grup1’de %10.5, grup 2’de %22.6 olup, tedavi alma açýsýndan gruplar arasýnda anlamlý fark yoktu (p=0,327).
Sonuç: Postoperatif histopatolojik olarak papiller tiroid kanseri tanýsý alan bazý hastalarda tamamlayýcý tiroidektomi gerekli olabilir. Tamamlayýý tiroidektomi prosedürü, total tiroidektomiye göre hipokalsemi riskini artýrmadan uygulanabilir. (SETB-2022-10-219)

Objectives: Papillary thyroid cancer (PTC) is the most common type of thyroid cancers. In some patients, due to the histopathological features of PTC, complementary thyroidectomy (CT) may be needed to contralateral thyroid lobe after lobectomy. Hypocalcemia is the most common complication after thyroidectomy and its etiology is multifactorial. It is still controversial whether the CT increases the risk of hypocalcemia or not. In this study, we aimed to evaluate whether CT procedure increases the risk of hypocalcemia compared to total thyroidectomy (TT) in PTC patients.
Methods: The data of the patients who were operated between 2015 and 2018 and diagnosed with PTC in the pre-operative or post-operative period were evaluated retrospectively, and two patient groups were formed. Group 1 included 19 patients who were diagnosed with PTC in the pathological examination after lobectomy was performed in the first operation, and after that CT was performed to the contralateral lobe. Among the patients who were diagnosed with pre-operative or post-operative PTC in the same period, 53 patients with characteristics similar to the 1st group in terms of age and gender were selected for Group 2. Biochemical parameters related to calcium metabolism in the pre-operative and post-operative periods, parathyroid autotransplantation and unintentional parathyroid gland removal, post-operative hypocalcemia, and treatment rates were compared between the two groups.
Results: There were 19 patients (13 F and 6 M) with a mean age of 48.3±12.1 years and 53 patients with a mean age of 46.3±9 (40 F and 13 M) in Groups 1 and 2, respectively, and there was no significant difference between the groups in terms of age and gender. There was no significant difference in terms of pre-operative parathormone (PTH), phosphorus (P), magnesium (Mg), Vitamin D deficiency rate, parathyroid autotransplantation, and presence of parathyroid gland in thyroid specimen. Pre-operative calcium (Ca) value was 9.33±0.46 in Group 1 and lower than Group 2 (9.65±0.41) (p=0.012). There was no significant difference between the groups in terms of post-operative day 0 Ca, P, Mg, and PTH and post-operative day 1 Ca, Mg, and PTH. Post-operative day 1 P level was significantly lower in Group 1 (2.86±0.72) compared to Group 2 (3.6±0.83). Post-operative hypocalcemia rates were 21.1% and 30.2% in Groups 1 and 2, respectively, and the difference was not significant (p=0.558). In both groups, hypocalcemia was transient and permanent hypoparathyroidism was not detected. Parathyroid autotransplantation rates (10.5% vs. 3.8%; p=0.283) and the rate of unintentionally removed parathyroid gland (0 vs. 15.1; p=0.185) were similar in Groups 1 and 2, respectively. Ca and active Vitamin D administration rates in the post-operative period were similar in Group 1 and Group 2 (10.5% vs. 22.6%; respectively), and there was no significant difference between the groups in terms of receiving treatment (p=0.327).
Conclusion: CT can be necessary in some patients with post-operative diagnose of PTC. CT can be performed without increased risk of hypocalcemia compared to TT.

Giriþ: Son yýllarda primer hiperparatiroidinin (pHPT) cerrahi tedavisinde görüntüleme yöntemlerinin katkýsý ile seçilmiþ hastalarda minimal invaziv paratiroidektomi (MÝP) tedavisi standart hale gelmiþtir. Bununla birlikte bazý hastalarda bilateral boyun eksplorasyonu (BBE) gerekli olabilmektedir. Bu çalýþmada BNE gerekliliði ile ilgili faktörleri deðerlendirmeyi amaçladýk.
Materyal ve Metod: 2010-2019 tarihleri arasýnda tek cerrah tarafýnden opere edilen hastalarýn verileri retrospektif olarak deðerlendirildi. Hastalar MÝP ve unilateral boyun eksplorasyonu (UNE) (grup 1) ve BBE (grup 2) olarak 2 gruba ayrýldý. BNE gerekliliði ile ilgili risk faktörleri deðerlendirildi.
Bulgular: Yaþ ortalamasý 54.1±12.8 olan 344 hasta (288K, 56 E) (grup 1: 229, grup 2: 115) çalýþmaya alýndý. Grup 1’de grup 2’ye göre preoperatif parathormon (PTH) düzeyi (288 vs 190, p<0.001,) sintigrafide uyumlu, uyumsuz ve negatif görüntüleme (sýrasý ile 82.5% vs 28.7%, 9.6% vs 19.1, 7.9% vs 52.25; p<0.001), ultrasonografide uyumlu, uyumsuz ve negatif görüntüleme (sýrasý ile 72.9% vs 20%, 7% vs 19.1%, 201% vs 60.9%; p<0.001), USG ve sintigrafi kombinasyonunda iki pozitif, tek pozitif ve negatif görüntüleme (sýrasý ile 72.5% vs 11.3%, 25.8% vs 55.7%, 1.7 vs 33%; p<0.001), patolojide tek adenom, çift adenom, hiperplazi oranlarý (sýrasý ile 96.1% vs 79.1%, 3.1% vs 12.2%, 0.9% vs 8.7%; p<0.001), ek tiroidektomi uygulanmasý (sýrasý ile 11.4% vs 38.3%; p<0.001), çýkarýlan bezin çapý (2.03 vs 1.58 cm; p<0.001), çýkarýlan bezin hacmi (sýrasý ile 2.27 vs 1.22 cm3, p<0.001), anlamlý olarak farklý idi. Multinominal lojistik regresyon analizinde preoperatif PTH’nýn düþük olmasý, sintigrafinin patolojik bez için uyumlu olmasýna göre uyumsuz olmasý (odd ratio (OR): 3.690; p=0.027), negatif olmasý (OR: 9.174, p=0.000), ek tiroidektomi gerekliliði (OR: 5.067; p=0.000) BBE gerekliliðini arttýran baðýmsýz risk faktörleri olarak belirlendi. Uzun dönem kür oranlarý (sýrasý ile 98.3% vs 94.8%, p=0.079) benzerdi
Sonuçlar: Günümüzde halen pHPT’li hastalarýn önemli bir bölümünün cerrahi tedavisinde BBE gerekli olabilmektedir. Bizim sonuçlarýmýza göre preoperatif yüksek PTH deðerlerine göre düþük PTH düzeyinde, pozitif ve uyumlu sintigrafiye göre uyumsuz ve negatif sintigrafili hastalarda, ek tiroidektomi uygulanacak hastalarda BBE gerekliliði olasýlýðý daha yüksektir. BBE, MIP’nin alternatifi deðil, paratiroid cerrahisinde optimal sonucu elde edebilmek için MIP’nin tamamlayýcýsý olan etkin bir seçenek olduðu düþüncesindeyiz. (SETB-2022-11-249)

Objectives: In recent years, together with the contribution of new imaging methods, minimally invasive parathyroidectomy (MIP) has become the standard procedure in selected patients with the primary hyperparathyroidism (pHPT). However, some patients may still need bilateral neck exploration (BNE). In this study, we aimed to evaluate the factors associated with the necessity of BNE.
Methods: Data of the patients, operated by same single surgeon in between 2010 and 2019, were evaluated retrospectively. Patients were divided into two groups as MIP group (group 1) and BNE group (group 2). The risk factors associated with necessity of BNE were evaluated.
Results: Three hundred and forty-four patients (288 females and 56 males) were included in study. The mean age was 54.1±12.8. Pre-operative parathormone level (288 pg/mL vs. 190 pg/mL, p<0.001; respectively), compatible, inconsistent and negative imaging on scintigraphy (82.5% vs. 28.7%, 9.6% vs. 19.1, 7.9% vs. 52.25%, p<0.001; respectively), compatible, inconsistent and negative imaging in ultrasonography (USG) (72.9% vs. 20%, 7% vs. 19.1%, 20.1% vs 60.9%, p<0.001; respectively) in combination of USG and scintigraphy, two positive, single positive and negative imaging (72.5% vs. 11.3%, 25.8% vs. 55.7%, 1.7 vs. 33%, p<0.001; respectively), single adenoma, double adenoma, hyperplasia rates in pathology (96.1% vs. 79.1%, 3.1% vs. 12.2%, 0.9% vs. 8.7%, p<0.001; respectively), concomitant thyroidectomy (11.4% vs. 38.3%, p<0.001; respectively), diameter of the removed gland (2.03 vs. 1.58 cm, p<0.001; respectively), and volume of the removed gland (2.27 vs. 1.22 cm3, p<0.001; respectively), were significantly different in group 1 compared to group 2. Low pre-operative parathormone, discordant pathological gland localization compared to pathological gland compatible with scintigraphy images (odds ratio [OR]: 3.690; p=0.027), negative scintigraphy images (OR: 9.174, p=0.000), and need for additional thyroidectomy (OR: 5.067); p=0.000) were determined as independent risk factors increasing the need for BNE in the multinomial logistic regression analysis. Long-term cure rates were similar (98.3% vs. 94.8%, p=0.079; respectively).
Conclusion: At present, BNE may be necessary in the surgical treatment of a significant proportion of patients with pHPT. According to our results, the possibility of BNE requirement is higher in patients with low PTH level compared to pre-operative high PTH values, in patients with discordant and negative scintigraphy compared to positive and compatible scintigraphy, and in patients who will undergo additional thyroidectomy. We think that BNE is not an alternative to MIP, but an effective option that is complementary to MIP to achieve optimal results in parathyroid surgery.

Amaç: Pankreas kanserinde metastatik lenf nodlarýnýn prognostik önemi, kötü prognoz nedeniyle her zaman dikkat çekmiþtir ve bazý kantitatif faktörler, postoperatif sonuçlarý önemli ölçüde öngörmek için araþtýrýlmýþtýr. Boyut, lenf düðümünün kolay ölçülebilen morfolojik özelliklerinden birisi olup, en büyük metastatik lenf düðümü (LMLN) boyutunun saðkalým sonuçlarý üzerindeki etkisine iliþkin veriler pankreas kanseri için tanýmlanmamýþtýr.
Pankreas duktal adenokarsinomlu hastalarýn prognozu üzerine LMLN boyutunun etkisini deðerlendirmeyi amaçladýk.
Gereç ve Yöntemler: Bu retrospektif çalýþma ile Þubat 2015 ile Mayýs 2020 arasýnda pankreas duktal adenokarsinomu (PDAK) nedeni ile ameliyat edilen hastalar lenf nodu evrelerine ve LMLN boyutu için hesaplanan eþik deðerine göre gruplandýrarak LMLN boyutunun saðkalým sonuçlarý üzerindeki etkisi karþýlaþtýrýlacaktýr.
Bulgular: 131 hastadan oluþan çalýþma kohortunda yaþ ortalamasý 63.9±10.8 yýl ve 77 hasta kadýndý. Hastalarýn 99'u pN1, 32'si pN2 evresindeydi. Prognozu tahmin etmek için LMLN boyutunun optimal eþik noktasý 7.5 mm [duyarlýlýk = %81 ve özgüllük = %81] olarak hesaplandý. pN1 evreli hastalarýn 34'ünde (%34.3) ve pN2 evreli hastalarýn 7'sinde (%21.9) 7.5 mm'den küçük lenf nodu vardý. LMLN boyutu <7.5 mm olan hastalarda 3 yýllýk saðkalým anlamlý olarak daha uzundu (%56.2 - %18.2, p<0.001). LMLN boyutu <7.5 mm olan hastalar, pN1 lenf nodu evresi olan hasta alt grubunda istatistiksel olarak anlamlý daha uzun medyan saðkalým oranýna sahipken, pN2 hastalarýnýn alt gruplarý arasýnda medyan saðkalým oranlarýnda anlamlý bir fark gözlenmedi (p=0.237).
Sonuç: En büyük metastatik lenf nodu boyutu PDAK hastalarýnda saðkalýmýn potansiyel belirteçlerinden birisidir. (SETB-2022-04-108)

Objectives: Prognostic importance of metastatic lymph nodes in pancreatic cancer is always garnered attention due to dismal prognosis, with some quantitative factors drawing attention for significantly predicting outcomes. Size is one of the easy approach morphological characteristics of the lymph node, and data for effect of largest metastatic lymph node (LMLN) size on survival outcomes are lacking in pancreatic cancer. We aim to evaluate the effect of LMLN size on the prognosis of patients with pancreatic ductal adenocarcinoma (PDAC).
Methods: This retrospective study evaluates the effect of LMLN size on survival outcomes by grouping the patients who were surgically treated for PDAC, according to their lymph node stage and calculated cutoff value for LMLN size, between February 2015 and May 2020.
Results: In the study cohort of 131 patients, the mean age was 63.9±10.8 years and 77 patients were female. Ninety-nine of the patients had pN1, 32 had pN2 stage disease. The optimal cutoff point of LMLN size for predicting the prognosis was calculated as 7.5 mm (sensitivity = 81% and specificity = 81%). 34 (34.3%) of pN1 and 7 (21.9%) of pN2-staged patients had lymph node smaller than 7.5 mm. Three-year survival was significantly longer for patients whose LMLN size was <7.5 mm (56.2–18.2%, p<0.001). Whereas, the patients with LMLN size <7.5 mm had statistically significant longer median survival rate in the subgroup of patients with pN1 lymph node stage, no significant difference in median survival rates was observed between subgroups of pN2 patients (p=0.237).
Conclusion: The present study demonstrated that the LMLN size was one of the potential predictors of survival in patients with PDAC.

Amaç: Divertiküler hastalýk oldukça sýk görülen bir durumdur. Batý toplumunda dokuzuncu dekatta nüfusun %50'sini etkiler. Akut divertikülit en sýk görülen komplikasyondur. Klinik olarak stabil olup sývýyý tolere eden hastalar, sývý alým toleransý kötüleþirse, ateþ yükselirse veya aðrý artarsa hastaneye yatýrýlmalýdýr. Baðýrsak istirahati, intravenöz sývý tedavisi ve ampirik antibiyotik tedavisi, hastaneye baþvuran hastalarda geleneksel tedavilerdir. Bu retrospektif çalýþma, komplike olmayan akut divertikülit tanýsý alan hastalarýn ayaktan veya yatarak tedavisini etkileyecek parametreleri belirlemeyi amaçlamaktadýr.
Yöntemler: Ocak 2018-Aralýk 2020 tarihleri arasýnda karýn aðrýsý ile acil servise baþvuran ve intravönöz contrast madde verilmesi sonrasý çekilen bilgisayarlý tomografide(BT) komplike olmayan divertikülit (modifiye Hinchey 1a) tanýsý alan hastalar çalýþmaya dahil edildi. Hasta kayýtlarý retrospektif olarak Excel dosyasýna kaydedildi. Acil serviste görüldükten sonra yatan hasta grubu (Grup 1) ile ayaktan takip grubu (Grup 2) arasýnda karþýlaþtýrma yapýldý.
Bulgular: Çalýþma akut komplike olmayan divertiküliti (modifiye Hinchey 1a) olan 172 hastayý içermektedir. 110 (%64,0) hasta yatarak takip ve tedavi edilirken (Grup 1) 62 (%36,0) hasta ayaktan (Grup 2) takip edildi. Taburculuk sonrasý ilk 30 gün içinde (hem ayaktan takip edilen hem de yatan hasta grubunda tedavi sonrasý) hastaneye tekrar baþvuran hastalar açýsýndan iki grup arasýnda istatistiksel olarak anlamlý fark yoktu.
Sonuç: Komplike olmayan Modifiye Hinchey 1a hastalarýnda yatýþ kriterlerini deðerlendirdiðimiz bu retrospektif çalýþmada hastalarýn þiddetli fizik muayene bulgularý olmamasý durumunda güvenle ayaktan tedavi olabileði bulundu. Taburculuk sonrasý yeniden hastaneye yatýþ açýsýndan iki grup arasýnda fark olmamasýna ve Modifiye Hinchey 1a divertiküliti olan hastalarýn ayaktan oral antibiyotik tedavisi ile takibinin güvenilir olabileceði düþünülse de, daha geniþ hasta sayýsý ile prospektif çalýþmalara ihtiyaç vardýr. (SETB-2022-02-030)

Objectives: Diverticular disease is a highly frequent condition and affects 50% of the population in the 9th decade in Western society. Acute diverticulitis is the most prevalent complication. The patients who are clinically stable and tolerate fluid should be hospitalized if fluid intake tolerance worsens, fever occurs, or pain increases. Bowel rest, intravenous fluid therapy, and empiric antibiotic therapy are the traditional treatments for patients admitted to the hospital. This retrospective study aimed to determine the parameters that will affect the outpatient or inpatient treatment of patients diagnosed with uncomplicated acute diverticulitis.
Methods: Patients who presented to the emergency department with abdominal pain between January 2018 and December 2020 and were diagnosed with uncomplicated diverticulitis (modified Hinchey 1a) on computed tomography (CT) taken after intravenous contrast material shoot up were included in the study. Patient records were recorded retrospectively in the Excel file. After being seen in the emergency department, a comparison was performed between the inpatient group (Group 1) and the outpatient follow-up group (Group 2).
Results: The study comprised 172 patients with acute uncomplicated diverticulitis (modified Hinchey 1a). While 110 (64.0%) patients were followed up and treated as inpatients (Group 1), 62 (36.0%) patients were followed up as outpatients (Group 2). There was no statistically significant difference between the two groups in terms of patients readmitted to the hospital in the first 30 days after discharge (both for outpatient follow-up in the emergency department and after treatment in the inpatient group).
Conclusion: In this retrospective study, in which we evaluated the hospitalization criteria in uncomplicated Modified Hinchey 1a patients, it was found that patients can be safely treated as an outpatient if they have poor physical examination findings. Although there was no difference between the two groups in terms of hospital readmission after discharge and it was thought that follow-up of patients with Modified Hinchey 1a diverticulitis with outpatient oral antibiotic therapy might be reliable, prospective studies with larger numbers of patients are needed.

Objectives: Amputation is a devastating but preventable complication of diabetes and peripheral arterial disease. The aim of the present study was to investigate whether diabetes mellitus is an important isolated cause of toe amputation.
Methods: A cross-sectional study was conducted involving the records of 108 patients with minor lower limb amputations and 80 with major lower limb amputations. Association between diabetes/chronic arterial insufficiency and level of amputation was tested. Statistical analysis was performed using Fisher’s exact test.
Results: The prevalence of diabetes was 87.5% among patients submitted to minor amputations and 52.5% among those submitted to major amputations with or without chronic arterial disease. This difference was statistically significant (p<0.0001, Fisher’s exact test). A total of 44.44% of the patients submitted to minor amputations had diabetes alone (no chronic arterial insufficiency), whereas only 14.81% of the patients submitted to major amputations did not have chronic arterial insufficiency. Thus, diabetes was significantly associated with minor lower limb amputations (p<0.0004, Fisher’s exact test).
Conclusion: Based on the present findings, patients with diabetes are at greater risk of toe amputation compared to those with chronic arterial disease. (SETB-2022-03-072)

Objectives: Amputation is a devastating but preventable complication of diabetes and peripheral arterial disease. The aim of the present study was to investigate whether diabetes mellitus is an important isolated cause of toe amputation.
Methods: A cross-sectional study was conducted involving the records of 108 patients with minor lower limb amputations and 80 with major lower limb amputations. Association between diabetes/chronic arterial insufficiency and level of amputation was tested. Statistical analysis was performed using Fisher’s exact test.
Results: The prevalence of diabetes was 87.5% among patients submitted to minor amputations and 52.5% among those submitted to major amputations with or without chronic arterial disease. This difference was statistically significant (p<0.0001, Fisher’s exact test). A total of 44.44% of the patients submitted to minor amputations had diabetes alone (no chronic arterial insufficiency), whereas only 14.81% of the patients submitted to major amputations did not have chronic arterial insufficiency. Thus, diabetes was significantly associated with minor lower limb amputations (p<0.0004, Fisher’s exact test).
Conclusion: Based on the present findings, patients with diabetes are at greater risk of toe amputation compared to those with chronic arterial disease.

Objectives: The sustained subluxation or dislocation of the femoral head over time does not permit normal development of acetabulum and results in predictable pattern of acetabular growth disturbance that is termed hip dysplasia. The primary aim of this study is to analyze and quantify the volume mismatch between acetabulum and femoral head of affected side as compared to normal hip.
Methods: A prospective observational study was conducted by including isolated untreated unilateral idiopathic developmental dysplasia of hip (DDH). After routine clinical and radiographic examination, computed tomography (CT) of both hips was done with pre-determined radiation dosage within safe limits for the pediatric age group in 18 patients of median age 2 years (range 1–5 years).
Results: A significant difference was noted between acetabular index (p<0.001), acetabular volume (p<0.001), femoral head volume (p<0.001), and acetabular anterior sectoral angle (p=0.002) of the affected and the normal hips. As compared to the normal side, the acetabulum is 2.6 times smaller than the normal side and femoral epiphysis volume by 3.8 times. A significant negative correlation (r=−0.66, p=0.04) was noted between posterior acetabular sectoral angle and acetabular volume of affected hip.
Conclusion: CT is an important investigation in evaluation of late-presenting DDH. The absence of femoral head in its orthotopic location affects the volume of acetabulum as well as that of femoral head. The abnormality of the volume of acetabulum which is seen as related to the dysplasia should be studied and assessed in detail in a child of late-presenting DDH. This would guide us toward the coverage defect and type of osteotomy to be performed.

AMAÇ: Bu çalýþmada, ailesel Akdeniz ateþi (AAA) olan hastalarda ve saðlýklý bireylerde femoral kartilaj kalýnlýðýnýn (FKK) ölçülmesi ve FKK ile amiloidoz geliþimi ve klinik özellikler ile iliþkisinin deðerlendirilmesi amaçlanmýþtýr.
METOD: Çalýþmaya Tel-Hashomer kriterlerine göre AAA tanýsý konan hastalar ve saðlýklý kontroller dahil edildi. Her iki dizde femoral kartilaj kalýnlýðý maksimum diz fleksiyonunda 7-12 MHz lineer prob ile ölçüldü. Her iki dizden üç noktadan ölçüm alýndý: lateral femoral kondil (LFK), interkondiler alan (ICA) ve medial femoral kondil (MFK). Hastalarýn klinik özelliklerinden hastalýk süresi, ilaçlar, komorbid durumlar, amiloidoz, kronik böbrek yetmezliði (KBY), FMF gen mutasyonu, artrit, sakroiliit, PRAS skoru ve Fiziksel Aktivite Anketi Kýsa Form (IPAQ-SF) skoru kaydedildi.
BULGULAR: Çalýþmaya 46 AAA (36 kadýn) ve 20 yaþ-cinsiyet-BMI uyumlu kontrol (14 kadýn) dahil edildi. Hastalarýn ve kontrollerin yaþ ortalamalarý sýrasýyla 37 ±12.9 ve 37.5 ±8.6 yýldý. Yedi hastada (%15.2) amiloidoz, 3 hastada (%6.5) KBY ve 8 hastada (%17) diz artriti meydana geldi. Hastalýk aktivitesi %55.8'inde hafif, %20.9'unda orta ve %23.23'ünde þiddetliydi. AAA ve kontrol gruplarýnda milimetre cinsinden ortalama FKK deðerleri þu þekildeydi: saðda LFK 1,9±0,5 ve 2±0,52, ICA 2,2±0,77 ve 2,25±0,97, MFK 2±0,47 ve 2,25±0,72; sol tarafta LFK 1,9±0,4 ve 2,05±0,55, ICA 2,25±0,87 ve 2,25±0,87, MFK 1,85±0,5 ve 2,25±0,6. AAA'li hastalarda kontrollere kýyasla her iki diz LFK (p<0.05) ve sol MFK (p<0.05) kýkýrdak kalýnlýðý azalmýþtý. Artrit, amiloidoz ve KBY olan ve olmayan hastalarda FCT ölçümleri benzerdi (p>0.05). FKK skorlarý hastalýk aktivite gruplarý arasýnda farklý deðildi (p>0.05).
SONUÇ: AAA hastalarýnda kontrollere kýyasla FKK azalmýþtýr ve FKK ile amiloidoz ve hastalýk aktivitesi arasýnda anlamlý bir iliþki yoktur. (SETB-2021-12-369)

Objectives: This study aimed to determine femoral cartilage thickness (FCT) in patients with familial Mediterranean fever (FMF) and healthy individuals and to assess the relationship of FCT with the development of amyloidosis and clinical features.
Methods: Patients diagnosed with FMF according to the Tel-Hashomer criteria and healthy controls were included in the study. FCT of both knees was measured with a 7–12 MHz linear probe in maximum knee flexion. Three midpoint measurements were obtained from each knee: Lateral femoral condyle (LFC), intercondylar area (ICA), and medial femoral condyle (MFC). The patients’ clinic characteristics include disease duration, medications, comorbid conditions, amyloidosis, chronic renal failure (CRF), FMF gene mutation, arthritis, sacroiliitis, PRAS score, and Physical Activity Questionnaire Short Form score were recorded.
Results: A total of 46 patients with FMF (36 women) and 20 age-sex-body mass index-matched controls (14 women) were enrolled in this study. The patients and controls’ mean age were 37±12.9 and 37.5±8.6 years, respectively. Amyloidosis occurred in 7 patients (15.2%), CRF in 3 (6.5%), and knee arthritis in 8 (17%). Disease activity was mild in 55.8%, moderate in 20.9%, and severe in 23.23% of the patients. The mean FCT in millimeter values in the FMF and control groups was as follows: On the right side, LFC 1.9±0.5 and 2±0.52, ICA 2.2±0.77 and 2.25±0.97, and MFC 2±0.47 and 2.25±0.72; on the left side, LFC 1.9±0.4 and 2.05±0.55, ICA 2.25±0.87 and 2.25±0.87, and MFC 1.85±0.5 and 2.25±0.6. Patients with FMF had decreased cartilage thickness at the lateral condyle of both knees (p<0.05) and medial condyle of the left knee (p<0.05) compared with controls. FCT measurements were similar in patients with or without arthritis, amyloidosis, and CRF (p>0.05). FCT scores were not different among the disease activity groups (p>0.05).
Conclusion: These findings suggest that patients with FMF have decreased FCT compared with controls, and there is no significant relationship between the FCT and amyloidosis and disease activity.

Amaç: Obstetrik brakiyal pleksus paralizinde (OBPP) üst ekstremitenin fonksiyonel kýsýtlýlýðý, çocuðun günlük yaþam ve sosyal aktivitelere katýlýmýný kýsýtlar. Tedavide üst ekstremitenin rehabilitasyona katýlýmý önemlidir. Zorunlu kullaným hareket terapisi (ZKHT), nörolojik disfonksiyonu olan hastalarýn üst ekstremite fonksiyonlarýný iyileþtirmek için kullanýlan umut verici bir rehabilitasyon yaklaþýmýdýr.
Yöntem: Bu tek kör, randomize kontrollü klinik çalýþma, 2 ila 12 yaþlarý arasýnda kronik OBPP tanýsý almýþ 30 pediyatrik hastayý içermektedir. Hastalar modifiye ZKHT grubu ve kontrol grubu olmak üzere iki gruba ayrýldý. Her iki gruptaki hastalara 8 hafta boyunca haftada dört kez klasik rehabilitasyon tedavisi uygulandý. Hem kontrol hem de ZKHT grubuna hareket açýklýðý, germe, kuvvetlendirme ve proprioseptif egzersizler verildi. ZKHT grubundaki hastalar 8 hafta boyunca günde 2 saat ve haftada 4 gün kýsýtlayýcý kol askýlarý takýlmasý uygulamasý yapýldý. Hastalar, Mallet sýnýflandýrma sistemi ve Melbourne tek taraflý üst ekstremite deðerlendirmesi-2 ölçeði (MA2) kullanýlarak tedaviden önce ve sonra deðerlendirildi.
Bulgular: Her iki grupta da tedavi sürecinden sonra Mallet ve MA2 skorlarý anlamlý derecede arttý. Ancak, iyileþme yüzdesi ZKHT grubu için daha yüksekti.
Sonuç: Modifiye ZKHT, OBPP tanýlý çocuklarda eklem hareket açýklýðýný ve ekstremitenin fonksiyonel kullanýmýný iyileþtirmektedir. Bu iyileþme, kontrol grubundaki iyileþmeye kýyasla ZKHT grubunda daha fazladýr. ZKHT'nin rutin bir rehabilitasyon sürecinde uygulanmasý yardýmcý olabilir. (SETB-2021-11-333)

Objectives: Functional limitation of the upper extremity (UE) in obstetrical brachial plexus paralysis (OBPP) restricts a child’s participation in daily living and social activities. In treatment, the participation of UE in rehabilitation is important. Constraint-induced movement therapy (CIMT) is a promising rehabilitation approach that is used to improve the UE functions of patients with neurological dysfunctions.
Methods: This single-blinded randomized controlled clinical trial includes 30 pediatric patients diagnosed with chronic OBPP aged between 2 and 12 years. The patients were divided into two groups as a modified CIMT group and a control group. Patients in both groups underwent classical rehabilitation treatment 4 times a week for 8 weeks. Range of motion (ROM), stretching, strengthening, and proprioceptive exercises were given to both control and CIMT group. The patients in the CIMT group had to wear constraining arm slings 2 h per day and 4 days a week for 8 weeks. The patients were evaluated both before and after treatment using the Mallet classification system and the Melbourne unilateral upper limb assessment-2 (The MA2) scale.
Results: In both groups, the Mallet and MA2 scores significantly increased after the treatment process. However, the percentage of improvement was higher for the CIMT group.
Conclusion: Modified CIMT improves the joint ROM and the functional use of the extremity among OBPP-diagnosed children. This improvement is greater in the CIMT group compared to the improvement in the control group. Implementation of CIMT in a routine rehabilitation process may be helpful.

Amaç: Kronik Obstrüktif Akciðer Hastalýðý (KOAH), ilerleyici hava yolu kýsýtlýlýðý olan bir hastalýktýr. Asimetrik dimetil arginin (ADMA) molekülünün hava yolu inflamasyonunda ve yeniden þekillenmesinde etkili olduðu bilinmektedir. Alevlenme ile baþvuran olgularda ADMA ile KOAH arasýndaki iliþkiyi ve hastalýðýn seyrindeki rolünü araþtýrdýk.
Metod: Bu tek merkezli çalýþmaya, polikliniðimize KOAH alevlenmesi ile baþvuran ortalama yaþý 67 (41-88) olan 56 hasta (%57,1 erkek) ve cinsiyet uyumlu 26 saðlýklý kontrol dahil edildi. ADMA, Beyaz Kan Hücresi Sayýsý, eozinofil, nötrofil, lenfosit, C-Reaktif Protein, fibrinojen, Oksijen Satürasyonu %, Solunum Fonksiyon Testi deðerleri karþýlaþtýrýldý.
Bulgular: Kontrol grubuna kýyasla KOAH grubunda ADMA deðerleri anlamlý derecede yüksekti (516.93'e karþý 320.05 medyan, p<0.05). Kronik Obstrüktif Akciðer Hastalýðý için Global Giriþim' e (GOLD) göre ADMA konsantrasyonlarýnda anlamlý bir fark gösterilmedi (p>0.05). KOAH' ýn prediktif gücünü tahmin etmek için yapýlan ROC analizinde, ADMA konsantrasyonu >301 ng/ml deðeri ile tüm vakalarda KOAH hastalarýný ayýrt edebildiði bulundu.
Sonuç: KOAH' ta ADMA seviyeleri karmaþýk mekanizmalarla artmaktadýr. Hastalýðýn önemli bir göstergesi olabilir. Bununla birlikte, KOAH' ýn þiddeti ve ilerlemesinde bir biyobelirteç olarak kullanýmý için daha kapsamlý araþtýrmalara ihtiyaç vardýr. (SETB-2022-05-132)

Objectives: Chronic obstructive pulmonary disease (COPD) is a disease with progressive airway limitation. The asymmetric dimethylarginine (ADMA) molecule is known to be effective in airway inflammation and remodeling. We investigated the relationship between ADMA and COPD, and its role in the course of the disease in cases with exacerbation.
Methods: This single-center study performed in our patient clinic included 56 patients (57.1% of males) with median age 67 (41–88) presented with COPD exacerbation and 26 sex-matched healthy controls. ADMA, white blood cell count, eosinophil, neutrophil, lymphocyte, C-reactive protein, fibrinogen, oxygen saturation%, and pulmonary function test values were compared.
Results: ADMA values were significantly higher (516.93 vs. 320.05 median, p<0.05) in the COPD group compared to the control group. No significant difference was demonstrated in ADMA concentrations according to Global Initiative for Chronic Obstructive Lung Disease Stages (p>0.05). In the receiver operating characteristic analysis to estimate the predictive power of COPD, the cutoff ADMA concentration >301 ng/ml was found to be able to distinguish COPD patients in all cases.
Conclusion: ADMA levels increase with complex mechanisms in COPD. It can be a significant indicator of the disease. However, more extensive research is needed for its use as a biomarker in severity and progression of COPD.

Amaç: Antiviral tedaviye uyum tedavi baþarýsý ve direncin önlenmesi için önemlidir. Nükleoz(t)id analoglarý ile tedavi alan hastalarda tedaviye uyum oraný ve bunu etkileyen faktörlerin saptanmasý amaçlanmýþtýr.
Yöntem: En az bir yýldýr kronik hepatit B tanýsý ile oral nükleoz(t)id analogu(NA) alan 168 hasta çalýþmaya dahil edildi. Hastalarýn demografik verileri ile ilaç atlama durumlarý uygulanan geri bildirim anketinden elde edilirken, eczane kayýt sisteminden son 1 yýllýk ilaçlarýn dökümü yapýlarak Medication Possesion Ratio(MPR) hesaplandý.
Bulgular: Hastalarýn 60’ý (%35,7) kadýn, 108’i (% 64,3) erkek idi. Yaþ ortalamasý 43,61±10,35 olarak hesaplandý. MPR ye göre %29.2 hasta nonadherence- uyumsuz (MPR deðeri < 0,90) saptandý. Orta yaþlardan itibaren tedavi uyumunun arttýðý görüldü. Hepatit B dýþýndaki hastalýklar nedeni ile ilaç kullanýmý olan hastalarda tedavi uyumu daha yüksek bulundu. Cinsiyet, eðitim- çalýþma durumu, medeni hali, sigara- alkol gibi alýþkanlýklarý, kullanmakta olduðu antiviral tedavinin türü, ilaç alma zaman ve þekli, tedavi baþlangýcýndaki biopsi bulgularý arasýnda tedavi uyumu açýsýndan anlamlý fark saptanmadý. Hastalarýn en sýk ilaç atlama nedenleri unutkanlýk olarak saptandý. Sýk görülen diðer nedenler baþka iþlerle meþgul olma, günlük rutinde deðiþiklik olmasýydý.
Sonuç: Çalýþmamýzda MPR ile hesaplanan tedavi uyumu %70.8 olarak saptanmýþtýr. Bu uyum düzeyi literatürdeki KHB ile yapýlan çalýþmalara göre daha düþük düzeydedir. KHB hastalarýnda uyumun hekim tarafýndan takip edilmesi ve desteklenmesi önemlidir. (SETB-2021-09-282)

Objectives: Adherence to antiviral treatment is important for treatment success and prevention of resistance. It was aimed to determine treatment adherence to nucleoside/nucleotide analogs and factors influencing on adherence.
Methods: The study included 168 patients who received oral nucleoside/nucleotide analog with diagnosis of chronic hepatitis for at least 1 year. Data regarding demographic characteristics and missed drug were collected using a survey, while list of medication within prior year were extracted from pharmacy registry and Medication Possession Rate (MPR) was calculated.
Results: There were 60 women (35.7%) and 108 men (64.3%) in the study. Mean age was calculated as 43.61±10.35 years. It was found that 29.2% of patients were non-adherent based on MPR (MPR<0.90). It was observed that adherence was improved on middle age. Treatment adherence was found to be higher in patients receiving medication due to disorders other than hepatitis B. It was found that there was no significant difference in adherence according to age, gender, occupation status, marital status, smoking or alcohol consumption habits, type of antiviral treatment, time and mode of drug intake, and biopsy finding at time of drug prescription. The most common cause was identified as forgetfulness for missed drug. Other common causes were inoccupation and alteration in daily routine.
Conclusion: In our study, the treatment adherence determined by MPR was 70.8%. This rate was lower than those reported for chronic hepatitis B in the literature. It is important to monitor and encourage treatment adherence in patients with chronic hepatitis B by clinicians.

Amaç: Ýlaç alerji reaksiyonlarý, immünolojik mekanizma ile ortaya çýkan ve ilaca özgü antikorlarýn ve/veya T-hücrelerin oluþumu ile sonuçlanan reaksiyonlardýr ve tüm ilaç reaksiyonlarýnýn sadece %15’ten azýný oluþturmaktadýr. Ancak hem hastalar hem de ebeveynler her türlü istenmeyen ilaç etkisini altta yatan mekanizma immünolojik olsun ya da olmasýn ilaç alerjisi olarak adlandýrmaktadýr. Ýlaç alerjisi için yapýlan tanýsal testler sonrasýnda ise, klinik öykülerine dayalý olarak ilaç alerji reaksiyonlarý için pozitif rapor edilen hastalarýn sadece küçük bir yüzdesinin gerçekte ilaç alerjisi olduðu doðrulanmaktadýr. Bu çalýþma, çocuklarda ilaç alerjilerinin gerçek sýklýðýný, ilaç alerjisi þikayeti olan hastalarda en sýk alerjiye neden olan ilaçlarý belirlemeyi ve eþlik eden demografik ve klinik özelliklerini deðerlendirmeyi amaçlamaktadýr.
Yöntem: Çalýþmada, üç yýllýk bir süre içinde ilaç alerjisinden þüphelenilen toplam 266 hastanýn (0-18 yaþ) verileri deðerlendirildi. Doktor tanýlý ilaca baðlý anafilaksi tanýsý konan 24 hasta ve tanýsal testleri kabul etmeyen 85 hasta çalýþma dýþý býrakýldý ve toplam 157 hasta ile çalýþmaya devam edildi. Alerji çalýþmasý, ENDA/EAACI kýlavuzlarýnýn tavsiyelerine uygun olarak in vivo ve in vitro testlerden oluþuyordu.
Bulgular: 157 hastadan oluþan bir gruptan elde edilen veriler [E (%54.6)); K (%45.4)] geriye dönük olarak analiz edildi. Beta laktamlar (BL'ler), rapor edilen klinik öyküde en yaygýn olarak yer alan ilaçlardý ve bunu non-steroid antiinflamatuar ilaçlar (NSAID'ler) izledi. Alerjik
reaksiyonlar ilaç alýmýndan sonraki ortanca 1. günde (min: 1-maks: 8) meydana geldi ve en sýk görülen ürtiker (%55.3) olarak gözlendi. Hastalarýn %53,5'inde ani reaksiyonlar ve %46.5'inde ani olmayan reaksiyonlar gözlendi.
Sonuç: Literatürdeki verilerle uyumlu olarak, çalýþmamýzda ilaç alerji yakýnmasý ile baþvuran hastalarýn sadece %15,5’inde ilaç alerjisi doðrulandý. Ýlaç alerji þüphesi olan hastalarda tanýsal alerji testleri ile doðrulama yapýlmasý gereklidir. (SETB-2021-09-266)

Objectives: Drug hypersensitivity reactions are immunologically mediated reactions resulting in the production of drug-specific antibodies and/or T-cells and constituting only <15% of all drug reactions. Based on the clinical observations, both patients and their parents refer to any undesirable drug reactions as drug allergy, regardless of whether the underlying mechanism is immunological or not. After allergy examinations, only a small percentage of the patients who were reported positive for drug reactions based on their clinical history are actually confirmed to have hypersensitivity. This study aims to determine the actual frequency of drug allergies in children, the drugs that cause the most common allergies in patients with a complaint of drug allergy and evaluate the accompanying demographic and clinical features.
Methods: The study evaluated data from a total of 266 patients (ages of 0–18) with suspected drug allergy during a 3-year period. Twenty-four patients with doctor-diagnosed drug-related anaphylaxis and 85 patients who did not accept diagnostic tests were excluded from the study and the study continued with a total of 157 patients. The allergy work-up consisted of in vivo and in vitro tests, in accordance with the recommendations of the ENDA/EAACI guidelines.
Results: Data from a group of 157 patients (M [54.6%]; F [45.4%]) were retrospectively analyzed. Beta-lactams (BLs) were the most common drugs involved in the reported clinical history followed by non-steroidal antiinflammatory drugs (NSAIDs). Allergic reactions occurred on the median 1st day (min: 1-max: 8) after drug intake and were most frequently observed as urticaria (55.3%). Immediate reactions (IRs) were observed in 53.5% and non-IRs in 46.5% of the patients.
Conclusion: Our data demonstrated that only 15.5% of patients confirmed to be positive to allergy during testing which is in line with the data in the literature. An allergy work-up is mandatory for excluding suspected hypersensitivity.

Objectives: Increasing use of tobacco by the younger generation has resulted in an increase in oral cavity tumors. Surgical treatment is radical and results in severe functional morbidity. Using computer-aided designing technology, surgical and rehabilitative planning can be better. We present here our concept of a patient-specific biomechanical 3D model of the tongue and its clinical utility in the management of tongue tumors.
Methods: Using fused deposition modeling, the 3D model of the tongue was printed which easily differentiates the tumor and the uninvolved tongue by printing in two different colors. The 3D tongue model was used by the surgical and rehabilitation teams to frame the treatment and plan the rehabilitation taking into account the patient preferences and needs. The model was used in two patients with operable squamous cell carcinoma (SCC) of the tongue, and the utility of the model in margin planning, surgical defect assessment, and its aid in the reconstruction and rehabilitation was assessed.
Results: Two patients with Stage III SCC of the tongue underwent the surgery based on the plan evolved from the 3D model. All the surgical margins assessed by the frozen section analysis were clear. The model helped in addressing the discordance between patient expectations and surgical outcomes. We found that the model aided the reconstructive surgeon in planning the flap harvest based on the pre-operative defect assessment, which, in turn, translated into better rehabilitative outcomes.
Conclusion: 3D biomechanical tongue model is a novel concept and aids in improving the overall treatment outcomes. The realistic 3D reconstructed image model helps the oncologist in planning the resection, enables the reconstructive surgery to more precisely predict the defect volume, and lastly the rehabilitative team in developing better rehabilitation strategies.

Akut infantil hemorajik ödem ateþ, geniþ purpurik deri lezyonlarý ve ödem üçlüsü ile seyreden nadir bir lökositoklastik vaskülittir. Baþlýca özellikleri ekimotik purpura, uzuvlarda ve yüzde inflamatuar ödemdir. Dramatik baþlangýçlý benign bir durumdur, 1-3 hafta içinde kendiliðinden ve tam olarak düzelir ve 3 yaþýndan küçük çocuklarda görülür. Çocukluk çaðýnda, özellikle yenidoðan döneminde nadir görülen bir hastalýk olduðu için akut infantil hemorajik ödemli yenidoðaný detaylandýrmak istedik. (SETB-2021-09-260)

Acute infantile hemorrhagic edema is a rare leukocytoclastic vasculitis with symptom triad of fever, large purpuric skin lesions, and edema. The major features are an ecchymotic purpura, an inflammatory edema of the limbs and face. It is a benign condition with a dramatic onset, resolves spontaneously and completely within 1–3 weeks, and is seen in children younger than 3 years of age. We would like to detail a newborn with acute infantile hemorrhagic edema, as it is a rare disease in childhood, especially in the neonatal period.

Bilateral eþ zamanlý omuz çýkýklarý çok nadir görülen yaralanmalardýr. Literatürdeki olgularýn çoðu grand mal epileptik nöbetler, elektrik çarpmalarý ve elektrik çarpmalarýnda görülen yaygýn kasýlmalara baðlý posterior omuz çýkýklarýdýr. Literatür bize bilateral anterior omuz çýkýklarýnýn epileptik nöbetlerden ziyade travmaya baðlý yaralanmalardan sonra görüldüðünü göstermektedir. 39 yaþýnda erkek hasta grand mal epileptik nöbet sonrasý bilateral anterior glenohumeral çýkýk ile acil servisimize baþvurdu. Hasta kapalý redüksiyon, Velpeau bandaj, FTR ve nöroloji konsültasyonu ile konservatif olarak tedavi edildi. Hastanýn omuzlarýnýn bilateral yer deðiþtirmesi ve yaþý nedeniyle tedavisi konservatif olarak planlandý. (SETB-2021-11-324)

Bilateral simultaneous shoulder dislocations are very rare injuries. Majority of the cases in the literature are posterior shoulder dislocations due to widespread contractions seen in grand-map epileptic seizures, electrocutions, and electric shocks. The literature shows us that bilateral anterior shoulder dislocations are generally seen after trauma related injuries rather than subsequent to epileptic seizures. A 39-year-old male presented to the emergency department our clinic with bilateral anterior glenohumeral dislocation following grand mal epileptic seizure. The patient was treated conservatively with close reduction, Velpeau bandage, PT&R, and neurology consultation. Due to the bilateral displacement of patients shoulders and his age treatment was planned conservatively.

SETB-2022-02-049