Primer hiperparatiroidi (pHPT) hiperkalseminin en sýk sebebi olup, günümüzde halen tek definif tedavisi cerrahidir. Deneyimli merkezlerde paratiroidektominin baþarý oraný %95’in üzerinde olmasýna ragmen günümüzde cerrahi baþarýsýzlýk en sýk komplikasyondur. Paratirodektomi sonrasý hiperkalseminin devam etmesi veya ilk 6 ay içinde hiperkalseminin tekrar ortaya çýkmasý persistan HPT (perHPT), 6 aydan fazla bir normokalsemik dönemden sonra hiperkalseminin tekrarlamasý ise reküren HPT (recHPT) olarak tanýmlanmaktadýr. Literatürde perHPT 2-22%, reküren hiperparatiroidi (recHPT) hastalýk oraný 1-15% arasýnda bildirilmektedir. perHPT genelde gözden kaçan patoloji veya hiperfonksiyone paratiroid dokusunun yetersiz rezeksiyonu, recHPT ilk cerrahide yerinde býrakýlan potansiyel patolojik natürü olan dokudan yeni geliþen patoloji ile iliþkilidir. Preoperatif deðerlendirmede perHPT ve recHPT öntanýsý (þüphesi) ile deðerlendirilen hastalarda öncelikle ilk pHPT tanýsýnýn ve
perHPT veya rec HPT tanýsýnýn doðrulanmasý gerekir. pHPT’li hastalar cerrahi için kýlavuzlardaki önerilerden herhangi birini karþýlýyorsa ve cerrahi kontraendikasyon yok ise cerrahi önerilmektedir. Bu hastalarýn ilk ameliyat öncesi yapýlmýþ lokalizasyon çalýþmalarý, ameliyat notlarý, varsa operasyon çizimleri, intraoperatif PTH sonuçlarý, patolojik sonuçlar ve postoperatif biyokimyasal sonuçlar incelenmelidir. Tanýsý doðrulanmýþ ve cerrahi endikasyonu olan tüm PerHPT ve recHPT’li hastalarda preoperatif görüntüleme yöntemleri ile lokalizasyon çalýþmalarý uygulanmalýdýr. Ýlk aþama görüntüleme yöntemleri ultrasonografi ve Tc99m sestamibi single photon tomografi (Tc99mMIBI SPECT) veya hem SPECT hem de bilgisayarlý tomografi (SPECT/CT) ile combine edildiði hibrit görüntüleme yöntemi uygulanmaktadýr. USG ve sestamibi sintigrafi kombinasyonu patolojik bezin lokalizasyonu arttýrmaktadýr. Ikincil aþamada dört açýlý bilgisayarlý tomografi (Four-Dimensional Computed
Tomography 4D-CT) veya dinamik 4 boyutlu Magnetik Rezonans Görüntüleme (4D-MRG) uygulanabilir. Özellikle konvansiyonel yöntemlerle lezyon saptanamadýðýnda ikincil aþama görüntüleme yöntemi olarak odaklanmýþtýr. 11C-kolin veya 18F-florokolinli Positron Emisyon Tomografi(PET) ve PET/CT tetkikleri umut veren görüntüleme yöntemleridir. Noninvaziv görüntüleme yöntemlerinde þüpheli, uyumsuz veya patolojik lezyonun saptanamadýðý hastalarda nadiren invaziv incelemeler uygulanabilmektedir. Bilateral juguler ven örnekleme, selektif venöz örnekleme, paratiroid arteriografi, görüntüleme kýlavuzluðunda ince iðne aspirasyon biyopsisi ve parathormone washout uygulanan invaziv yöntemlerdir. (SETB-2023-03-037)

Primary hyperparathyroidism (pHPT) is the most common cause of hypercalcemia and currently the only definitive treatment is surgery. Although the success rate of parathyroidectomy is over 95% in experienced centers, surgical failure is the most common complication today. Persistent HPT (perHPT) is defined as persistence of hypercalcemia after parathyroidectomy or recurrence of hypercalcemia within the first 6 months, and recurrence of hypercalcemia after a normocalcemic period of more than 6 months is defined as recurrent HPT (recHPT). In the literature, perHPT is reported to be 2–22%, and the rate of recHPT is 1–15%. perHPT is often associated with misdiagnosed pathology or inadequate resection of hyperfunctioning parathyroid tissue, recHPT is associated with newly developing pathology from potentially pathologically natural tissue left in situ at the initial surgery. In the preoperative evaluation, the initial diagnosis of pHPT and the diagnosis of perHPT or rec HPT should be confirmed in patients who are evaluated with a pre-diagnosis (suspect) of perHPT and recHPT. Surgery is recommended if it meets any of the recommendations in surgical guidelines, as in patients with pHPT, and there are no surgical contraindications. The first preoperative localization studies, surgical notes, operation drawings, if any, intraoperative PTH results, pathological results, and post-operative biochemical results of these patients should be examined. Localization studies with preoperative imaging methods should be performed in all patients with perHPT and recHPT with a confirmed diagnosis and surgical indication. The first-stage imaging methods are ultrasonography and Tc99m sestamibi single photon tomography Tc99mMIBI SPECT or hybrid imaging method, which is combined with both single-photon emission computed tomography and computed tomography (SPECT/CT). The combination of USG and sestamibi scintigraphy increases the localization of the pathological gland. In the secondary stage, Four-Dimensional computer tomography
(4D-CT) or dynamic 4-dimensional Magnetic Resonance Imaging (4D-MRI) can be applied. It is focused on as a secondary stage imaging method, especially when the lesion cannot be detected by conventional methods. Positron Emission Tomography (PET) and PET/CT examinations with 11C-choline or 18F-fluorocholine are promising imaging modalities. Invasive examinations can rarely be performed in patients in whom suspicious, incompatible or pathological lesion cannot be detected in noninvasive imaging methods. Bilateral jugular vein sampling, selective venous sampling, parathyroid arteriography, imaging-guided fineneedle aspiration biopsy, and parathormone washout are invasive methods.

Bilgisayarlý tomografide (BT) split bolus yöntemi, renal dinamik güçlenme evrelerinin deðerlendirilmesinde ve patolojilerin saptanmasýnda kullanýlan yöntemdir. Bilgisayarlý tomografi (BT) ürografi tekniði tasarlanýrken tek bolus ve bölünmüþ bolus teknikleri gibi birkaç önemli seçenek vardýr. Tek bolus yöntemi üç ayrý post-kontrast fazdan oluþur: arteriyel, nefrografik ve boþaltým (ekskretuar, piyelogram), bunun sonucunda hastalara verilen toplam radyasyon dozu artar. Bölünmüþ bolus tekniðinde ise kontrast dozu birkaç ayrý uygulamaya bölünerek nefrografik ve boþaltým fazlarý ayný anda elde edilir. Split bolus tekniði ile radyasyon dozu ve hastanýn maruz kalacaðý faz sayýsý azaltýlarak, üriner sistem deðerlendirmesi ve tüm batýn patolojik deðerlendirmeleri yapýlabilmektedir. Görüntülemede kullanýlacak cihaz, en az 16 Multidetektör bilgisayarlý tomografi (MDCT) kesiti olan bir tomografi cihazý olmalýdýr. Bolus Ýzleme yöntemi, renal dinamikler ve Split-bolus tekniði için en doðru kontrast verme yöntemlerinden biridir. Otomatik doz kalibrasyonu kullanýlýr. (SETB-2022-09-204)

The split-bolus method in computed tomography (CT) is the method used in the evaluation of renal dynamic enhancement stages and in the detection of pathologies. When designing the CT urography technique, there are several important options such as single-bolus and split bolus techniques. The single-bolus method consists of three separate post-contrast phases: arterial, nephrographic, and excretory (pyelogram), as a result raising the total radiation dose imparted to patients. On the other hand, in the split-bolus technique, the contrast dose is divided into several separate administrations to obtain the nephrographic and excretory phases simultaneously. With the split-bolus technique, by reducing the radiation dose and the number of phases that the patient will be exposed to, urinary system evaluation and the whole abdomen pathological evaluations can be performed. The device to be used in imaging must be a tomography device with at least 16 Multidetector CT sections. The bolus tracking method is one of the most accurate contrast delivery methods for renal dynamics and the split-bolus technique. Automatic dose calibration is used.

Amaç: Çalýþmamýzda yoðun bakým ünitesinde (YBÜ) takip edilen koronavirüs hastalýðý (COVID-19) hastalarýnda C vitamininin kýsa dönem mortalite ve yoðun bakým ünitesinde kalýþ süresine etkisini belirlemeyi amaçladýk.
Metod: Yüksek doz intravenöz C vitamini protokolü alan ve almayan hastalar sýrasýyla tedavi ve kontrol gruplarýna ayrýldý. Her iki grupta da birincil çalýþma bulgularý YBÜ kalýþ süresi ve kýsa dönem mortalite iken, ikincil bulgular vazopresör ve invaziv mekanik ventilasyon gereksinimleri ve Sequential Organ Failure Assessment Skorunun 0'dan 96. saate deðiþimi idi.
Bulgular: Tedavi grubuna 38, kontrol grubuna 40 hasta dahil edildi. Tedavi ve kontrol gruplarýnda mortalite oranlarý sýrasýyla %44 ve %60 idi; ancak gruplar arasýndaki fark istatistiksel olarak anlamlý deðildi (p<0.05). Her iki grupta da median yoðun bakým kalýþ süresi 10 gündü (p<0.05). Gruplar arasýnda invaziv mekanik ventilasyon ve vazopresör gereksinimlerinde anlamlý fark bulunmadý (p<0.05).
Sonuç: Sonuç olarak, COVID-19 pnömonisine baðlý akut solunum yetmezliði olan hastalarda yüksek doz C vitamini tedavisi, yoðun bakýmda kalýþ süresini, mortaliteyi, invaziv mekanik ventilasyon ve vazopresör gereksinimlerini azaltmadý. (SETB-2022-11-244)

Objectives: In our study, we aimed to determine the effect of vitamin C on short-term mortality and length of intensive care unit (ICU) stay in patients with coronavirus disease (COVID-19) followed up in the ICU.
Methods: The patients who received and those who did not receive the high-dose intravenous vitamin C protocol were assigned to the treatment and control groups, respectively. The primary study findings in both groups were length of ICU stay and shortterm mortality, while the secondary findings were vasopressor and invasive mechanical ventilation requirements and change in sequential organ failure assessment score from the 0 to the 96th hour.
Results: Thirty-eight patients were included in the treatment group and 40 were included in the control group. The mortality rates were 44% and 60% in the treatment and control groups, respectively; however, the difference between the groups was not statistically significant (p>0.05). The median length of ICU stay in both groups was 10 days (p>0.05). No significant differences in the invasive mechanical ventilation and vasopressor requirements were found between the groups (p>0.05).
Conclusion: Consequently, the high-dose vitamin C therapy in the patients with acute respiratory failure due to COVID-19 pneumonia did not reduce the length of ICU stay, mortality, and invasive mechanical ventilation and vasopressor reqirements.

Amaç: Bu araþtýrmada pandemi döneminde hastane pratiðimizde sýk gördüðümüz major depresif bozukluk (MDB), yaygýn anksiyete bozukluðu (YAB) ve panik bozukluk (PB) hastalarýný koronavirüs anksiyete düzeyleri ve baþ etme tutumlarý açýsýndan saðlýklý kontroller (SK) ile karþýlaþtýrmak amaçlanmýþtýr.
Yöntem: Çalýþmamýzda katýlýmcýlara Sosyodemografik Veri Formu, Koronavirüs Anksiyete Ölçeði (CAS), Hamilton Depresyon Ölçeði (HDÖ), Hamilton Anksiyete Ölçeði (HAÖ) ve Baþa Çýkma Tutumlarýný Deðerlendirme Ölçeði (COPE) uygulanmýþtýr. 30 MDB hastasý, 32YAB hastasý, 31 PB hastasý ve 38 SK toplam 131 katýlýmcý çalýþmanýn örneklemini oluþturmuþtur.
Bulgular: Çalýþmamýzda katýlýmcýlarýn CAS puanlarý deðerlendirildiðinde; saðlýklý kontrollerin YAB hastalarýna kýyasla 3.306 (p=0.002) ve PB hastalarýna kýyasla 3.014 (p=0.005) daha düþük puan aldýklarý, saðlýklý kontroller ile majör depresyon hastalarýnýn CAS puanlarý açýsýndan istatistiksel olarak farklý olmadýklarý belirlenmiþtir (p=0.880). Baþ etme tutumlarý karþýlaþtýrýldýðýnda; ‘’aktif baþa çýkma’’ baþ etme tutumunda saðlýklý kontroller MDB hastalarýna kýyasla 3.151 (p<0.001) ve YAB hastalarýna kýyasla da 2.059 (p=0.004) daha yüksek puan almýþlardýr. ‘‘Plan yapma’’ baþ etme tutumunda saðlýklý kontroller hem MDB hastalarýna kýyasla 2.726 (p<0.001), hem YAB hastalarýna kýyasla 2.589 (p=0.001), hem de PB hastalarýna kýyasla da 2.171 (p=0.006) daha yüksek puan almýþlardýr.
Sonuç: Covid-19 pandemisi döneminde saðlýklý kontrollere kýyasla YAB ve PB hastalarýnda koronavirüs anksiyete düzeyini daha yüksek bulduðumuz ancak MDB hastalarýnda bir fark bulmadýðýmýz çalýþmamýz, MDB hastalarýnýn koronavirüs anksiyetesi ile daha iyi baþ edebildiklerine iþaret edebilir. Covid-19 pandemisi döneminde bireylerin koronavirüs anksiyetesi ile baþa çýkmak için kullandýklarý baþ etme tutumlarýnýn belirlenmesi ruh saðlýðý alanýnda çalýþan profesyonellerin hastalýkla ilgili stresörleri kontrol etmelerine yardýmcý olabilir ve tedavi sürecine katký saðlayabilir. (SETB-2022-09-213)

Objectives: This study aims to compare patients with major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD), whom we have frequently seen in our hospital practice during the pandemic, with healthy controls (HC) in terms of coronavirus anxiety levels and coping strategies.
Methods: In this study, the Sociodemographic Data Form, Coronavirus Anxiety Scale (CAS), Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Coping Orientation to Problems Experienced (COPE) scale were applied to the participants. 30 MDD patients, 32 GAD patients, 31 PD patients and 38 HCs, totaling 131 participants, constituted the sample of the study.
Results: Evaluation of the CAS scores of the participants revealed that HC scored 3.306 (p=0.002) points lower than GAD patients and 3.014 (p=0.005) points lower than PD patients, while HC and major depression patients were not statistically different in terms of CAS scores (p=0.880). In the comparison of coping strategies, HC scored 3.151 (p<0.001) points higher than MDD patients and 2.059 (p=0.004) points higher than GAD patients in terms of “active coping.” In terms of “planning,” HC scored 2.726 (p<0.001) points higher than MDD patients, 2.589 (p=0.001) points higher than GAD patients, and 2.171 (p=0.006) points higher than PD patients.
Conclusion: This study found higher coronavirus anxiety levels in GAD and PD patients but no difference in MDD patients compared to HC during the COVID-19 pandemic, which may indicate that MDD patients can COPE better with coronavirus anxiety. Determining the coping strategies that individuals use to COPE with coronavirus anxiety during the COVID-19 pandemic may help mental health professionals to control disease-related stressors and contribute to the treatment process.

Amaç: Levetirasetam (LEV) son yýllarda yaygýn olarak kullanýlan geniþ spektrumlu bir anti-nöbet ilacýdýr. Sinaptik vezikül glikoprotein 2A'ya (SV2A) baðlanarak vezikül füzyonu ve ekzositoz sonucu oluþan nörotransmitterlerin salýnýmýnda etkisi olduðu düþünülmektedir.
Yöntemler: Çalýþmaya Çocuk Nöroloji Polikliniði'nde çocukluk çaðý idiyopatik epilepsi tanýsý ile takip edilen ve nöbet önleyici ilaç monoterapisi olarak LEV alan hastalar alýndý. Tedavi öncesi (T öncesi) dönem, tedavi sonrasý 3 ila 6 aylýk kýsa dönem (TS sonrasý) ve 12 ay sonra uzun dönem (TL sonrasý) tam kan sayýmý verileri olan altmýþ dört hasta ) çalýþmaya dahil edildi. Çalýþmaya dahil edilen hastalarýn demografik verileri; nöbet sýklýðý, nöbet tipi, baþlangýç ve sonraki EEG sonuçlarý, tedaviye baþlama tarihi ve tam kan sayýmý verileri açýsýndan geriye dönük olarak incelendi.
Bulgular: 64 hastanýn 36'sý erkek, 28'i kadýndý. Hastalarýn ortalama yaþý 8,7±3,8 (2,5-16) yýldý. Tüm popülasyonda, Post-TL lenfosit sayýlarýnýn, Pre-TL lenfosit sayýlarýna göre azalmýþ olduðu bulundu. Bu azalma 6 yaþ üstü hastalarda (n=46) istatistiksel olarak anlamlýydý (p<0.075). TL sonrasý dönemde hematokrit, hemoglobin, ortalama korpüsküler hacim ve ortalama trombosit hacmi artarken beyaz küre, trombosit, nötrofil ve monosit sayýlarý azaldý (p<0.05). Vakalarýn %92,2'sinde nöbetsiz duruma ulaþýldý. Sýk nöbetler sadece 6 yaþýndan büyük 5 hastada gözlendi. Tedavi öncesi EEG bulgularý 15 (%23.4) hastada normal, 8 (%12.5) hastada jeneralize ve 41 (%64.1) hastada fokal idi. Tedavi öncesi EEG bulgularýna göre EEG'sinde düzelme olan hastalarýn tamamý bulgularý fokal olan hastalardý (p<0,001).
Sonuçlar: Ýdiyopatik epilepsili çocuklarda uzun süreli LEV monoterapisi hematolojik parametrelerde önemli deðiþikliklere neden olabilir. LEV, özellikle uzun vadede trombosit, lenfosit, monosit ve nötrofil sayýlarý ve belki de iþlevleri üzerinde etkilere sahip gibi görünmektedir. (SETB-2022-06-145)

Objectives: Levetiracetam (LEV) is a broad-spectrum anti-seizure drug (ASD) that has been widely used in recent years. It is thought to have an effect on the release of neurotransmitters that occur as a result of vesicle fusion and exocytosis by binding to synaptic vesicle glycoprotein 2A.
Methods: The study enrolled patients diagnosed in the Pediatric Neurology Outpatient Clinic who were being followed with the diagnosis of childhood idiopathic epilepsy and were receiving LEV as ASD monotherapy. Sixty-four patients with complete blood count data from the pretreatment (Pre-T) period, the short-term period of 3 to 6 months after treatment (Post-TS), and the longterm period after 12 months (Post-TL) were included in the study. The demographic data of the patients included in the study were retrospectively analyzed for seizure frequency, seizure type, initial and subsequent EEG results, starting date of the treatment, and complete blood count data.
Results: Of 64 patients, 36 were male and 28 were female. The mean age of patients was 8.7±3.8 (2.5–16) years. In the whole population, post-TL lymphocyte counts were found to be decreased compared to pre-TL lymphocyte counts. This decrease was statistically significant for patients over 6 years of age (n=46) (p<0.075). In the post-TL period, hematocrit, hemoglobin, mean corpuscular volume, and mean platelet (PLT) volume increased, while white blood cell, PLT, neutrophil, and monocyte counts decreased (p<0.05). Seizure-free status was achieved in 92.2% of cases. Frequent seizures were observed only in five patients who were older than 6 years. Pre-treatment EEG findings were normal for 15 (23.4%) patients, generalized for 8 (12.5%) patients, and focal for 41 (64.1%) patients. According to the pretreatment EEG findings, all of the patients with improvement in EEG were those whose findings were focal (p<0.001).
Conclusion: In children with idiopathic epilepsy, long-term LEV monotherapy may cause significant changes in hematological parameters. LEV seems to have effects on the counts and perhaps functions of PLTs, lymphocytes, monocytes, and neutrophils, particularly in the long-term.

Amaç: Ýdrarda 8-hidroksi-2'-deoksiguanozin (8-OHdG), 8-hidroksi-guanozin (8-OHG) ve 8-hidroksi-guanin seviyeleri ölçülerek oksidatif stresin benign paroksismal pozisyonel vertigodaki (BPPV) rolünü deðerlendirmek.
Yöntem: Bu çalýþmaya BPPV tanýsý almýþ 31 yetiþkin kadýn hasta dahil edildi. Santral ve diðer periferik vertigo nedenleri saptanan hastalar çalýþma dýþý býrakýldý. Hastalar BPPV ataðý sýrasýnda ve sonrasýnda kan örnekleri ve spot idrar testleri ile oksidatif stres açýsýndan deðerlendirildi. Duygusal stresi deðerlendirmek için Depresyon, Anksiyete ve Stres Ölçeði (DASS) anketi kullanýldý. Yaþlarý eþleþtirilmiþ 30 saðlýklý kadýndan oluþan kontrol grubu oluþturuldu.
Bulgular: Atak sýrasýndaki üriner oksidatif stres deðerleri, tedavi sonrasý gruba ve saðlýklý kontrol grubuna göre anlamlý olarak yüksekti (p<0.05). Tedavi sonrasý BPPV grubunun üriner oksidatif stres deðerleri ile saðlýklý kontrol grubu arasýnda anlamlý fark yoktu (p>0.05). DASS skorlarý atak sýrasýnda ve tedavi sonrasýnda saðlýklý kontrol grubuna göre anlamlý olarak yüksekti (p<0.05).
Sonuç: BPPV hastalarýnda spot idrar 8-OHdG, 8-OHG ve 8-hidroksi-guanin düzeylerindeki artýþ oksidatif stres için bir biyobelirteç olarak kullanýlabilir. Ayrýca emosyonel stres oksidatif stresi artýrarak BPPV ataklarýný da tetikleyebilir. (SETB-2022-12-268)

Objectives: The objectives of this study were to evaluate the role of oxidative stress in benign paroxysmal positional vertigo (BPPV) by measuring urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG), 8-hydroxy-guanosine (8-OHG), and 8-hydroxy-guanine levels.
Methods: Thirty-one adult female patients diagnosed with BPPV were included in this study. Patients with central pathologies and other peripheral causes of vertigo were excluded from the study. The patients were evaluated for oxidative stress during and after the BPPV attack with blood samples and spot urine tests. Depression, anxiety, and stress scale (DASS) questionnaire was used to evaluate emotional stress. A control group consisting of 30 age-matched healthy women was formed.
Results: Urinary oxidative stress values during the attack were significantly higher than the post-treatment group and the healthy control group (p<0.05). There was no significant difference between the urinary oxidative stress values of the BPPV group after treatment and the healthy control group (p>0.05). DASS scores were significantly higher during the attack and after the treatment compared to the healthy control group (p<0.05).
Conclusion: The increase in spot urinary 8-OHdG, 8-OHG, and 8-hydroxy-guanine levels can be used as a biomarker for oxidative stress in patients with BPPV. Furthermore, emotional stress can also trigger BPPV attacks by increasing oxidative stress.

Amaç: Aritmiler, akut koroner sendromun (AKS) yaygýn, ölümcül ve tedavi edilebilir komplikasyonudur. Ýskemik kardiyak olaylarýn aritmik bulgularý iyi bilinmektedir, ancak uzun dönem bulgularý incelenmemiþtir. Çalýþmamýzda AKS hastalarýnda eþlik eden atriyoventriküler bloklarýn (AVB) uzun dönem etkileri analiz etmeyi amaçladýk.
Yöntem: Çalýþmamýz, tek merkezli ve geriye dönük olarak acil servise AVB eþilk ettiði AKS ile baþvuran 85 hasta üzerinde yürütülmüþtür.
Bulgular: Yetmiþ altý (%89.4) hastada 3. derece AVB izlendi. Elli (%58,8) hastaya geciçi ve dört (%4,7) hastaya kalýcý kalp pili ihtiyaç oldu. Beþ yýllýk takip döneminde kardiyak ölüm olmamasýna raðmen; hastane içi ölüm oraný %30,6 (26) saptandý. Yaþý büyük ve sistolik kan basýncý (SKB) düþük olan hastalarda ölüm oranlarý daha yüksek saptandý (sýrasýyla Odds oraný (OR) 1.088, (p= 0.003), OR 0.912, (p<0.001)).
ST-segment yükselmeli miyokard enfarktüsü ve tam AVB alt grup analizlerinde bile mortalite oranlarý SKB ve yaþla iliþkiliydi [sýrasýyla, OR: 0.917, (p<0.001), OR: 1.107 (p=0.002)], [sýrasýyla OR: 0.917 (p<0.001), (OR: 1.087 p= 0.004)].
Sonuç: Çalýþmamýzýn sonuçlarý, AVB'li ACS hastalarý uzun dönem iyi prognoz ile
iliþkilendirilebilir, ancak hastane içi takipte düþük SBP ve/veya yüksek yaþ olmasý kötü prognoz ile iliþkilidir. (SETB-2022-06-143)

Objectives: Arrhythmias are the common, potentially lethal, and treatable complication of acute coronary syndrome (ACS). Arrhythmic findings of ischemic cardiac events are well-known, but long-term results have not been scrutinized. In the study, we aimed to analyze the long-term findings of the atrioventricular block (AVB) in ACS patients.
Methods: This is a single-center and retrospective study of patients admitted with ACS and AVB. The primary endpoint has combined the outcome of major adverse cardiovascular events and mortality.
Results: Seventy-six (89.4%) patients had 3rd-degree AVB. Fifty (58.8%) patients are needed for temporary ventricular pacing and 4 (4.7%) for a permanent pacemaker. Although no cardiac death occurred during the 5-year follow-up period, the in-hospital mortality ratio was 30.6%. Patients with older age and lower systolic blood pressure (SBP) levels had higher mortality rates (respectively, odds ratio [OR] 1.088, [p=0.003], OR 0.912, [p<0.001]). Even in ST-segment elevation myocardial infarction and complete AVB subgroup analyses, mortality rates were associated with SBP and age (respectively, OR: 0.917, [p<0.001], OR: 1.107 [p=0.002]), (respectively, OR: 0.917 [p<0.001], OR: 1.087 [p=0.004]).
Conclusion: The study results are associated with a better long-term overall prognosis in patients with ACS with AVB, but lower SBP and older in-hospital follow-up are associated with poor prognosis.

Amaç
Hepatik Ensefalopatinin (HE) nörotoksisitesine neden olan kesin mekanizma hala bilinmemektedir. Bu retrospektif çalýþmada hiperamonyemi sýklýðýný ve hepatik ensefalopati ile iliþkisini tanýmlamayý amaçladýk.
Material ve Method
Organ Nakli ve Hepato-Pankreato-Bilier Cerrahisi Yoðun Bakým Ünitesi'nde Aðustos 2021-Aðustos 2022 tarihleri arasýnda takip edilen 190 hastanýn kayýtlarý geriye dönük olarak incelendi. Yoðun Bakým Ünite’sindeki kaldýklarý süre boyunca amonyak düzeyi ölçülen 111 yetiþkin ve çocuk hasta çalýþmaya dahil edildi.West Haven Criteria ile deðerlendirildi. Gruplarda 0-4 arasý HE grades mevcuttu.
Bulgular
111 hastanýn yaþ medyan (aralýk) 5 (0-16) çocuk ve 60 (20-104) yetiþkin idi. Amonyak deðeri medyan(aralýk) 42,2 (16-314) idi. Tüm hastalarýn 39'unda (%35) hiperamonyemi mevcuttu. Hiperamonyemi ve evre 0 ensefalopatisi olan hastalar 16(%14), evre 1-2 hastalar 11(%10), evre 3 hastalar 12(%11) idi.
Tartýþma ve Sonuç
Bulgularýmýz ve literatür kanýtlarýmýz, HE geliþiminden sorumlu birincil faktörün amonyaðýn olduðu görüþünü güçlü bir þekilde desteklerken, amonyak dýþýndaki faktörlerin sadece HE'yi alevlendirebileceðini göstermektedir. Ek olarak ALF'li ve ACLF'li hastalarda artan amonyak deðerinin ensefalopati derecesindeki artýþla korele olduðunu düþünmekteyiz. (SETB-2022-09-215)

Objectives: The exact mechanism that causes the neurotoxicity of hepatic encephalopathy (HE) is still unknown. In this retrospective study, we aimed to define the frequency of hyperammonemia and its relationship with HE.
Methods: The records of 190 patients who were followed up in the Organ transplantation and Hepato-pancreato-biliary surgery intensive care unit (ICU) between August 2021 and August 2022 were reviewed retrospectively. 111 adults and children whose ammonia levels were examined during their stay in the ICU were included in the study He was evaluated with West Haven Criteria. HE had grades 0–4 in the groups.
Results: The median age (range) was 5 (0–16) children and 60 (20–104) adults. The median ammonia value (range) was 42,2 (16–314). Hyperammonemia was present in 39 patients (35%) of all patients. Patients with hyperammonemia and grade 0 encephalopathy were 16 (14%), grade 1–2 patients were 11(10%), and grade 3 patients were 12 (11%).
Conclusion: While our findings and literature evidence strongly support the view that ammonia is the primary factor responsible for, HE development, it shows that factors other than ammonia can only exacerbate HE. In addition, we think that the increased ammonia value in patients with acute liver failure and acute on chronic liver failure is correlated with the increase in the degree of encephalopathy.

Amaç: Çalýþmamýzda Ýnflamatuvar Baðýrsak Hastalýðý (IBH) olan çocuklarda baðýrsak dýþý bulgularýn sýklýðýný ve bunun hastalýk aktivitesi, hastalýk tipi ve hastalýk yaþý ile korelasyonunu deðerlendirmeyi amaçladýk.
Metod: Çalýþmaya 18 yaþ altý, IBH tanýsý ile takip edilen hastalar dahil edildi. Hastalarýn demografik özellikleri, yaþlarý, cinsiyetleri, hastalýk tipleri ve taný konulan yaþlarý kayýt altýna alýndý. Çalýþmaya dahil edilen hastalarýn hastalýk aktivite indeksleri enson vizitlerinde yapýlan fizik muayene ve laboratuvar bulgularý kullanýlarak Ülseratif Kolit (ÜK) hastalarýnda Pediatrik Ülseratif Kolit Aktivite Ýndeksi, Crohn Hastalarýnda (CH) ise Pediatrik Crohn Hastalýðý Aktivite Ýndeksi kullanýlarak hesaplandý.
Sonuçlar: Çalýþmaya toplam 44 hasta dahil edildi, hastalarýn 40.9% (n = 18)’u kýz ve 59.1% (n=26)’i erkek idi. Hasta yaþlarý 8-19 arasýnda deðiþirken ortalama yaþ 14.64 ± 3.19 yýl idi. Hastalýk tipine göre hastalarýn 27.3%’ü CH ve 72.7%’si ÜK idi. Hastalýk aktivitesi deðerlendirildiðinde hastalarýn 37.2% remisyonda iken 37.2%’si hafif aktivasyon, 16.3%’ü orta aktivasyon ve 9.3%’ü ise ciddi aktivasyon mevcut idi. Hastalýk ile birlikte baðýrsak dýþý bulgularýn sýklýðý kýzlarda 77.8%, erkeklerde ise 65.4% idi. CH’de baðýrsak dýþý bulgu sýklýðý % 75 iken ÜK’de % 68,8 sýklýðýnda idi. Baðýrsak dýþý bulgularda en sýk karaciðer tutulumu (%41,5) sonra sýrasýyla eklem tutulumu (%29,5), osteoporoz (%7), osteopenia (%16,3), göz tutulumu (üveit) (%2.3), cilt tutulumu (eriteme noduzum) (%2,3) görüldü.
Tartýþma: Baðýrsak dýþý bulgular çocukluk IBH’lerde sýk görülmektedir. Bilindiðinin aksine baðýrsak dýþý bulgular ÜK hastalarýnda da CH’larýnda görüldüðü kadar sýk görülmektedir. (SETB-2022-10-229)

Objectives: We aimed to evaluate the frequency of extraintestinal manifestations (EIM) in children with inflammatory bowel disease (IBD) and the correlation of EIM with disease activity index, disease type and disease age.
Methods: Records of patients who were under the 18 years of age and followed up with the diagnosis of IBD were included in the study. The demographic characteristics of the patients, the age of the patients, the sex of the patients, the type of disease and the age of the disease were recorded. When patients were enrolled in the study disease activity indexes were calculated by examining the physical examination and laboratory values of the patients in their last visits, by using the Pediatric Ulcerative Colitis Activity Index (PUCAI) in Ulcerative Colitis (UC) and the Pediatric Crohn's Disease Activity Index (PCDAI) in Crohn's Disease (CD).
Results: It was conducted with a total of 44 patients, 40.9% (n=18) females and 59.1% (n=26) males diagnosed with IBD. The ages of the patients participating in the study ranged from 8 to 19 and the mean was found to be 14.64±3.19 years. According to the type of disease; 27.3% of the patients were CD and 72.7% were UC. When the disease activity is examined; 37.2% were in remission, 37.2% were mild, 16.3% moderate and 9.3% severe. The incidence of EIM in females is 77.8% and 65.4% in males. The incidence of EIM is 75% in CD and 68.8% in UC. Hepatobiliary involvement was detected in 41.5% (n=17) of the patients, joint involvement in 29.5% (n=13), osteopenia in bone in 16.3% (n=7), osteoporosis in 7% (n=3), ocular involvement (uveitis) in 2.3% (n=1) and skin involvement (erythema nodosum) in 2.3% (n=1).
Conclusion: EIM are common in childhood IBD patients. It should be kept in mind that EIM are as common in UC as CD.

Amaç: Bu çalýþmanýn amacý, gestasyonel diabetes mellitus (GDM) tanýsý alan gebeler ile saðlýklý gebeler arasýnda adiponektin, resistin, visfatin ve irisin düzeylerini karþýlaþtýrmak ve bu parametrelerin GDM patofizyolojisinde ve erken tanýdaki rolünü deðerlendirmektir.
Gereç ve Yöntemler: Çalýþmaya 50 GDM ve 50 saðlýklý gebe dahil edildi. Gebelerin antropometrik ölçümleri yapýldý. Açlýk kan þekeri (AKÞ), hemoglobinA1c (HbA1c), 75gr OGTT, düþük yoðunluklu lipoprotein(LDL), trigliserit(TG), tam kan sayýmý sonuçlarý kaydedildi. Adiponektin, irisin, visfatin, resistin ve CRP düzeyleri bakýldý.
Bulgular: GDM'li gebelerde saðlýklý gebelere göre serum adiponektin düzeyleri anlamlý olarak daha düþük (p <0.001) ve serum resistin ve CRP düzeyleri anlamlý olarak daha yüksekti (sýrasýyla p =0.000 ve p = 0.027). Serum irisin ve visfatin düzeylerine göre gruplar arasýnda anlamlý fark yoktu (sýrasýyla p=0,942 ve p=0,332). Adiponektin düzeyi ile APG, visfatin ve resistin arasýnda negatif, irisin düzeyi arasýnda ise pozitif korelasyon saptandý. Rezistin ve CRP düzeyleri arasýnda pozitif korelasyon varken adiponektin düzeyi arasýnda negatif korelasyon vardý. Ýrisin ve adiponektin düzeyleri arasýnda pozitif korelasyon varken, aðýrlýk ile vücut kitle indeksi (VKÝ) arasýnda negatif korelasyon vardý.
Sonuç: Bu çalýþmada GDM'li hastalarda serum resistin ve CRP düzeylerinin yükselmesi ile adiponektin düzeylerinin düþmesinin glukoz metabolizmasý deðiþikliklerinde rol oynayabileceðini düþünmekteyiz. Bu konuda ileri çalýþmalara ihtiyaç vardýr. (SETB-2022-08-199)

Objectives: The aim of this study was to compare adiponectin, resistin, visfatin, and irisin levels between pregnant women diagnosed gestational diabetes mellitus (GDM) and healthy pregnant women and to evaluate the role of these parameters in GDM pathophysiology and early diagnosis.
Methods: Fifty GDM and 50 healthy pregnant women were included in the study. Anthropometric measurements of pregnant women were performed. Fasting blood glucose, hemoglobin A1c, 75 gr OGTT, low density lipoprotein, triglyceride, and complete blood count results were recorded. Adiponectin, irisin, visfatin, resistin, and C-reactive protein (CRP) levels were evaluated.
Results: Serum adiponectin levels were significantly lower (p<0.001) and serum resistin and CRP levels were significantly higher (p=0.000 and p=0.027, respectively) in pregnant women with GDM compared to healthy pregnants. There was no significant difference between groups according to serum irisin and visfatin levels (p=0.942 and p=0.332, respectively). There was a negative correlation between adiponectin level and FPG, visfatin, and resistin, while a positive correlation was found between irisin level. While there was a positive correlation between resistin and CRP levels, there was a negative correlation between adiponectin level. While there was a positive correlation between irisin and adiponectin levels, there was a negative correlation between weight and body mass index.
Conclusion: In this study, we think that elevated serum resistin and CRP levels and decreased adiponectin levels in GDM patients may play a role in glucose metabolism changes. Further studies are needed on this subject.

Amaç: Ýnvaziv meme karsinomlarýnda izlenen PASH(Psödoanjiomatöz stromal hiperplazi)-benzeri görünümün, tümör dýþý meme parankimindeki PASH odaklarý ve aksiller lenf nodu tutulumu ile iliþkisini belirlemek.
Gereç ve Yöntem: Bu çalýþmada 200 invaziv meme karsinomu olgusu yeniden incelendi. Ýnvaziv meme karsinomlarýnda PASH-benzeri alan içeren ve içermeyen olgular belirlendi. Olgular, tümör dýþý alanlarda eþlik eden PASH odaklarý (CD 34 +, CD 31-) ve diðer klinikopatolojik parametreler açýsýndan deðerlendirildi.
Bulgular: Ýnvaziv meme karsinomu içinde PASH-benzeri görünüm 200 olgunun 22’sinde (11%) mevcuttu ve 178’inde (89%) yoktu. Tümör olmayan meme parankiminde izlenen PASH odaklarýnýn, invaziv meme karsinomunda PASH-benzeri alanlar içerenlerde içermeyenlere göre daha yaygýn olduðu saptandý. Ancak bu iki grup arasýnda, diðer klinikopatolojik bulgular (yaþ, tümör boyutu, nükleer ve histolojik derece, Östrojen ve Progesteron reseptör durumu, HER2 durumu ve Ki-67 proliferasyon indeksi), lenfovasküler invazyon ve aksiller lenf nodu açýsýndan anlamlý fark yoktu. Tümöral olmayan alanlarda izlenen histopatolojik bulgular açýsýndan da iki grup arasýnda anlamlý farklýlýk saptanmadý.
Sonuç: Ýnvaziv meme karsinomu içinde izlenen PASH-benzeri görünüm, tümöral olmayan meme parankiminde izlelen PASH odaklarý ile anlamlý oranda iliþkili bulundu. Ancak bu olgularda lenfovasküler invazyon ve aksiller lenf nodu metastazý açýsýndan farklýlýk izlenmedi. (SETB-2022-02-045)

Objectives: The aim of this study were to determine the relationship of pseudoangiomatous stromal hyperplasia (PASH)-like appearance in invasive breast carcinomas (IBCs) with PASH foci in the non-tumoral breast parenchyma as well as axillary lymph node involvement.
Methods: In this study, 200 consecutive cases with IBC were re-examined. Cases with and without PASH-like appearance in IBC were determined. Each case was assessed regarding the presence of accompanying PASH foci (CD34+, CD31-) in the non-tumoral areas in addition to other clinicopathological parameters.
Results: PASH-like appearance within the IBC was present in 22 of the 200 cases (11%) and absent in 178 (89%). The presence of PASH foci in the non-tumoral breast parenchyma was significantly more common in IBC with PASH-like appearance compared to the group without such areas. However, there was no significant difference between the groups regarding other clinicopathological parameters (age, tumor size, nuclear and histological grade, Estrogen receptor/Progesterone receptor status, HER2 status, and Ki-67 proliferation index), lymphovascular invasion (LVI), and axillary lymph node involvement. There was no significant difference between the two groups regarding the istopathological findings observed in the non-tumoral areas.
Conclusion: PASH-like appearance within IBC was found to be associated with higher rate of PASH foci in the non-tumoral breast parenchyma. However, such cases do not show a difference as regards LVI and axillary lymph node metastasis.

Amaç: Etkili ve minimal invaziv bir teknik olarak üreteroskopinin bazý potansiyel intraoperatif komplikasyonlarý vardýr. Nadir de olsa üreter avulsiyonu bu komplikasyonlar arasýndadýr. Bu çalýþma literatürde ilk kez üreter avulsiyonunu medikolegal açýdan ele alarak nefrektomiyi öngören faktörleri belirlemeyi amaçlamýþtýr.
Materyal-Method: Eylül 2004-Nisan 2019 tarihleri arasýnda Türkiye'de çeþitli hastanelere baþvuran ve Adli Týp Kurumu'nda malpraktis yönünden incelemeye alýnan üreteroskopik cerrahi sýrasýnda üreter avulsiyonu geliþen toplam 33 hasta retrospektif olarak deðerlendirildi. Üreter avulsiyonu sonrasý nefrektomi yapýlan hastalar Grup 1, rekonstrüktif cerrahi uygulananlar Grup 2 olarak deðerlendirildi.
Bulgular: Hastalarýn yaþ ortalamasý 39.5±12.1 yýl idi. On yedi (%51,5) hastada kýsmi ve 16'sýnda (%48,4) tam üreter avulsiyonu vardý. Hastalarýn 14'üne (%42.4) nefrektomi, 19'una (%57.5) üreter rekonstrüksiyonu uygulandý. Grup 1'deki hastalarýn Grup 2'ye göre daha fazla proksimal taþ ve daha yüksek derecede hidronefroz olduðu belirlendi. Grup 1'deki hastalarýn %71.4'ünde, Grup 2'deki hastalarýn ise %31.6'sýnda tam avulsiyon geliþti. Grup 1'deki hastalarýn %78,6'sý bir devlet hastanesinde, Grup 2'deki hastalarýn %63.2'si üçüncü basamak bir sevk hastanesinde tedavi görmüþtür. Hidronefroz derecesindeki artýþ, tam avulsiyon varlýðý ve devlet hastanesinde müdahale nefrektomi için baðýmsýz prediktif faktörler olarak belirlendi.
Sonuç: Bu çalýþma üreter avulsiyonunu medikolegal olarak deðerlendiren ve nefrektomi için prediktif faktörleri belirleyen literatürdeki en geniþ kohorta sahip ilk çalýþmadýr. Üreter avulsiyonu varlýðýnda her hastanýn farklý yöntemlerle tedavi edilmesi gerekse de çalýþmamýz bu katastrofik komplikasyona ortak bir yaklaþým saðlamayý amaçlamýþtýr. (SETB-2022-09-207)

Objectives: As an effective and minimally invasive technique, ureteroscopy has some potential intraoperative complications. Ureteral avulsion is among these complications, although rare. This study aimed to determine factors predicting nephrectomy by considering ureteral avulsion from a medicolegal perspective for the 1st time in the literature.
Methods: A total of 33 patients with ureteral avulsion during ureteroscopic surgery, who presented to various hospitals in Turkey between September 2004 and April 2019 and whose cases were being reviewed at the Institution of Forensic Medicine with regard to malpractice, were evaluated retrospectively. The patients who underwent nephrectomy after ureteral avulsion were evaluated as Group 1, and those who underwent reconstructive surgery as Group 2.
Results: The mean age of the patients was 39.5±12.1 years. Seventeen (51.5%) patients had partial and 16 (48.4%) had complete ureteral avulsion. Nephrectomy was performed in 14 (42.4%) patients, and ureteral reconstruction in 19 (57.5%) patients. It was determined that the patients in Group 1 had more proximal stones and a higher degree of hydronephrosis compared to Group 2. Complete avulsion developed in 71.4% of the patients in Group 1 and in 31.6% of those in Group 2. After avulsion, 78.6% of the patients in Group 1 were treated in a state hospital, and 63.2% of those in Group 2 were treated in a tertiary referral hospital. The increase in the degree of hydronephrosis, presence of complete avulsion, and intervention at a state hospital were determined as independent predictive factors for nephrectomy.
Conclusion: This is the first study with the largest cohort in the literature to medicolegally evaluate ureteral avulsion and determine predictive factors for nephrectomy. Although each patient should be treated with different methods in the presence of ureteral avulsion, our study aimed to provide a common approach to this catastrophic complication.

Amaç
Fournier Gangreni (FG), acil müdahale gerektiren hýzlý ilerleyen bir enfeksiyondur. Ameliyat sonrasý yara kapama önemli bir tedavi adýmýdýr ve alternatif bir yara kapama yöntemi olarak vakum yardýmlý kapama (VAC) tercih edilebilir. Fournier Gangreni Þiddet Ýndeksi (FGSI), FG'de prognozu deðerlendirmek için geliþtirilebilen ölçeklerden bir tanesidir. Bu çalýþma FG tedavisinin tarihsel geliþim sürecinde kullanýlan ve geliþtirilen VAC tedavisini, konvansiyonel yara pansumaný (CWD) ile karþýlaþtýrmayý amaçlamaktadýr.
Yöntemler
Hastanemizde Ocak 2010 Temmuz 2021 tarihleri arasýnda FG tanýsý ile tedavi edilen 85 hastalarýn verileri retrospektif olarak deðerlendirildi. VAC grubunda vakum cihazý sýzdýrmaz þekilde uygulandý. CWD grubunda yara pansumaný uygulandý. VAC cihazý subatmosferik basýnca ayarlandý. Tüm hastalara takipleri esnasýnda geniþspektrumlu antibiyoterapi uygulandý.Takipleri esnasýnda nekrotik dokular tespit edildikçe uygun analjezi ve anestezi saðlanarak re debridmanlar uygulandý. Hastalarýn demografik verileri kayýtlar üzerinde toplandý. Klinik ve laboratuar verileri kayýtlar üzerinden elde edilerek 1.saat, 72.saat ve 1. hafta FSGI deðerleri hesaplandý. Ýstatistiksel analizde; sürekli deðiþkenler ortalama ± standart sapma, sýralý deðiþkenler medyan [IQR] ve kategorik deðiþkenler n (%) olarak ifade edildi. Gruplar arasý analizlerde veriler normal daðýlýyorsa student t testi kullanýldý. Normal daðýlým göstermiyorsa Mann-Whitney U testi uygulandý.
Bulgular
Çalýþmamýza FG tanýsý konulan 55 hasta dahil edildi. 18 hastaya CWD, 37 hastaya VAC uygulandý VAC kullanan hastalarýn ortalama 1. saat FGSI 7,05 (3,75-8), CWD uygulanan hastalarýn 5,5 (5-9) (p=0,067). Ortalama 72. saat FGSI VAC grubunda 5,35 (3,5-7), CWD grubunda 5,33 (4,75-6,25) bulundu (p=0,714). Ortalama 1. hafta FGSI VAC grubu 2,97(1-5), CWD grubunda 5(4-6) idi (p=0,0001).
Sonuç
VAC, hastanede kalýþ süresini önemli ölçüde azaltýr. Analizimizde, her iki grup da 1. hafta FGSI'leri arasýnda anlamlý bir fark gözlemledi. Bu, FG tedavisinde kullanýlan VAC tedavisinin etkisinin temel bir göstergesi olan FGSI' yi deðerlendiren ilk çalýþmadýr. FG tedavisi tarihinde, geleneksel yara pansumanýnýn yerini VAC almýþtýr. (SETB-2023-01-04)

Objectives: Fournier’s gangrene (FG) is a rapidly progressive infection that requires emergent intervention. Wound closure is an important treatment step after surgery, and vacuum-assisted closure (VAC) can be preferred as an alternative method for wound closure. FG severity index (FGSI) scales that can be developed to evaluate the prognosis in FG. This study aims to compare VAC therapy, which was used and developed in the historical development of FG therapy, with conventional wound dressing (CWD).
Methods: Data on who 85 patients treated at our hospital with a diagnosis of FG from January 2010 to July 2021. In the VAC group, the vacuum device was applied in a sealed manner. In the CWD group, mesh dressing was prepared. The VAC device was adjusted to subatmospheric pressure. Broad-spectrum antibiotics were administered to all patients during their follow-up. During the follow-up, as necrotic tissues were detected, redebridements were performed by providing appropriate analgesia and anesthesia. Demographic data of the patients were collected on the records. The clinical and laboratory data were obtained from the records at the 1st h, 72 h, and 1st week FSGI values were calculated. In statistical analysis, continuous variables were expressed as mean±standard deviation, ordinal variables were expressed as median [IQR], and categorical variables were expressed as n (%). In intergroup analyses, student’s t-test was used if the data were normally distributed. If it did not show normal distribution, the Mann–Whitney U-test was applied.
Results: Fifty-five patients who were diagnosed with FG were included in our study. CWD was applied to 18 patients, and VAC was applied to 37 patients. The mean 1st h FGSI of the patients who used VAC was 7.05 (3.75–8), and the patients who had CWD were 5.5 (5–9) (p=0.067). Mean 72nd-h FGSI was found to be 5.35 (3.5–7) in the VAC group and 5.33 (4.75–6.25) in the CWD group (p=0.714). The mean 1st-week FGSI VAC group was 2.97 (1–5), and in the CWD group, it was 5 (4–6) (p=0.0001).
Conclusion: VAC significantly reduces the length of hospital stay. In our analysis, both groups observed a significant difference between the 1st-week FGSIs. This is the first study to evaluate FGSI, which is an essential predictor of the effect of VAC therapy used in treating FG. In the history of FG treatment, CWD has been replaced by VAC.

Amaç:
Bu çalýþmada, inguinal herni tanýsý ile ameliyat edilen pediatrik hastalarýn rutin hemogram ve biyokimyasal parametrelerinin etyopatogenez ile iliþkisi araþtýrýldý.
Gereç ve Yöntem
Ocak 2019-Kasým 2022 tarihleri arasýnda inguinal herni nedeniyle opera edilen seksen olgu çalýþmaya dahil edildi. Hastane kayýtlarý kullanýlarak, bilinen herhangi bir hematolojik veya metabolik hastalýk öyküsü veya düzenli ilaç kullanýmý olmayan seksen pediatrik hasta ile de bir kontrol grubu oluþturuldu. Her iki grupta da hemoglobin (Hgb), hematokrit (Htc), ortalama korpusküler hacim (MCV), ortalama korpusküler hemoglobin (MCH), ortalama korpusküler hemoglobin konsantrasyonu (MCHC), eritrosit daðýlým geniþliði (RDW) ve trombosit (PLT)
deðerlerini karþýlaþtýrmak için istatistiksel analiz yapýldý.
Bulgular
Çocuk hastalarýn yaþ aralýðý 1-14 yýl idi. Seksen çocuðun 47'si (%58,8) erkek, 33'ü (%41,3) kadýndý ve yaþ ortalamasý 5,79 ± 3,26 saptandý. Ýn guinal herni hastalarýnda Hgb, Htc, MCH, MCHC ve MCV deðerleri kontrol grubundakilere göre istatistiksel olarak anlamlý derecede
düþük (p<0.05) ve RDW deðerleri ise anlamlý derecede yüksek bulundu (p<0.05).
Sonuç
Kontrol grubu ile karþýlaþtýrýldýðýnda, M CH, MCHC, MCV, Hgb, HTC deðerlerinde gözlenen azalma ve hasta grubunda RDW'deki artýþ, demir eksikliðinin muhtemel etkisini düþündürmektedir. Bu spesifik deðiþiklikler, demir eksikliðinin kollajen yapýsýnda yapýsal deðiþikliklere yol açarak çocukluk çaðýndaki inguinal hernilerin etyopatogenezine katkýda bulunabileceðini düþündürmektedir. (SETB-2023-01-013)

Objectives: This case control study aimed to investigate whether the routine hemogram and biochemical parameters of pediatric patients who have undergone surgery for inguinal hernia are associated with the etiopathogenesis of the disease.
Methods: Eighty cases of inguinal hernia surgery performed between January 2019 and November 2022 were included in the study. A control group was also established using hospital records, consisting of eighty pediatric patients without any known history of hematological or metabolic disease or use of regular medication. Statistical analysis was conducted to compare the total hemoglobin (Hgb), hematocrit (Htc), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), erythrocyte distribution width (RDW) and thrombocyte (PLT) values in both groups.
Results: The age range of the pediatric patients was 1-14 years. Of the eighty children, 47 (58.8%) were male and 33 (41.3%) were female, with a mean age of 5.79±3.26. The values of Hgb, Htc, MCH, MCHC, and MCV in the inguinal hernia patients were found to be statistically significantly lower than those in the control group (p<0.05). Additionally, the patient RDW values were found to be statistically significantly higher than those in the control group (p<0.05).
Conclusion: Compared to the control group, the observed decrease in MCH, MCHC, MCV, Hgb, HTC values, as well as the increase in RDW in patient group, suggests a predisposing effect of iron deficiency. These specific changes suggested that iron deficiency may lead structural changes in the collagen construction and may contribute the etiopathogenesis of childhood inguinal hernia.

Giriþ: Günümüzde halen primer hiperparatiroidi (pHPT)’li hastalarda preoperatif negatif görüntülemenin cerrahi sonuçlar üzerine etkisi tartýþmalýdýr. Bu çalýþmada preoperatif görüntülemenin cerrahi sonuçlara etkisini deðerlendirmeyi amaçladýk.
Materyal ve Metod: 2009-2018 tarihleri arasýnda opere edilen pHPT’li hastalarýn verileri retrospektif olarak deðerlendirildi. Hastalar sintigrafik ve/veya ultrason görüntüleme pozitifliðine göre 3 gruba ayrýldý: Grup 1; her iki görüntüleme pozitif, Grup 2; bir görüntüleme pozitif, Grup 3; her iki görüntüleme yönteminin de negatif olduðu hastalar. Gruplarýn preoperatif biyokimyasal özellikleri, paratiroid patolojileri, patolojik bezin çapý ve hacmi, uygulanan ameliyat oranlarý, persistan ve reküren hastalýk oranlarý karþýlaþtýrýldý.
Bulgular: Ortalama takip süresi 24,7+18 olan ve yaþ ortalamasý 54,1+12,9 olan 311 hastanýn (258K, 53E) 161’I grup 1, 111’i grup 2, 39’u grup 3’te yer almaktaydý. Grup 1’de patolojik bez çapý (Grup 1, 2, 3’te sýrasý ile 2.1±0.8, 1.6±0.9, 1.5±0.7 cm; p<0.001), patolojik bez hacmi (Grup 1, 2, 3’te sýrasý ile 2±3.2, 1.4±2.9, 1.1±2.2 cm3; p<0.001), grup 3’te çoklu bez hastalýðý oraný (Grup 1, 2, 3’te sýrasý 5.7%, 11%, 21%; p=0.024) anlamlý olarak daha yüksekti (p=0.024). Grup 1,2,3’te bilateral eksplorasyon oraný sýrasý ile 93.2%, 48.6%, 5.1% olup, odaklanmýþ cerrahi veya unilateral boyun eksplorasyonu oranlarý sýrasý ile 6.8%, 51.4%, 94.9% olup fark anlamlý idi (p<0.001). Ýlk cerrahi sonrasý grup 1,2,3’te sýrasý ile kür oraný 91.3%, 93.7%, 89.7%, persistan hasta oraný 7.5%, 3.6%, 10,3% olup anlamlý fark yoktu. Persistan ve nüks hastalarda uygulanan ikincil giriþim sonrasý takip süresi sonunda toplam kür oraný sýrasý ile 97.4%, 96.4%, 97.4%, persistans hastalýk oraný 1.3%, 1.8%, 2.6%, nüks
hastalýk oraný 1.3%, 1.8%, %0 olarak saptandý.
Sonuç: pHPT’li görüntüleme negatif olgularda cerrahi sýrasýnda çoklu bez hastalýðý olasýlýðý ve daha küçük patolojik bez olasýlýðýnýn yüksek olabileceði göz önüne alýnmalýdýr. Görüntüleme negatif hastalarda cerrahi görüntüleme pozitif hastalar benzer ve kabul edilebilir kür oraný ile uygulanabilir. (SETB-2023-01-019)

Objectives: In present, the effect of pre-operative negative imaging results on surgical outcomes of primary hyperparathyroidism (pHPT) is still controversial. In this study, we aimed to evaluate the effect of pre-operative imaging on surgical outcomes.
Methods: The data of pHPT patients who were operated between 2009 and 2018 were evaluated retrospectively. Patients were divided three groups according to scintigraphy and/or ultrasonography results: Group 1; both imaging positive, Group 2; single imaging positive, and Group 3; patients in whom both imaging modalities are negative. Pre-operative biochemical characteristics, parathyroid pathologies, diameter and volume of the pathological gland, surgery rates, persistence, and recurrent disease rates of the groups were compared.
Results: Of 311 patients (258F, 53M) with a mean follow-up period of 24.7±18 months and a mean age of 54.1±12.9 years; 161 were in Group 1, 111 were in Group 2, and 39 were in Group 3. The diameter of pathological gland (2.1±0.8, 1.6±0.9, 1.5±0.7 cm; p<0.001; in Group 1,2,3 respectively) and the volume of pathological gland (2±3.2, 1.4±2.9, 1.1±2.2 cm3; p<0.001; in Group 1,2,3, respectively) in Group 1; the rate of multi gland disease (5.7%, 11%, 21%; p=0.024; in Group 1, 2, 3, respectively) in Group 3 were significantly higher. In the 1, 2, 3 group; bilateral exploration rates were 93.2%, 48.6%, and 5.1%, and focused surgery or unilateral exploration rates were 6.8%, 51.4%, and 94.9%, respectively, with a significant difference (p<0.001). After the first surgery, the cure rate was 91.3%, 93.7%, and 89.7%, and the persistent patient rate was 7.5%, 3.6%, and 10.3% in Groups 1,2,3, respectively, and there was no significant difference. At the end of the follow-up period after secondary intervention applied in persistent and recurrent patients, the overall cure rate was 97.4%, 96.4%, and 97.4%, persistent disease rate 1.3%, 1.8%, and 2.6%, recurrent disease rate 1.3%, 1.8%, and 0%, respectively.
Conclusion: In imaging-negative patients with pHPT, the possibility of multi gland disease and smaller pathological glands should be considered at the time of surgery. Surgery in imaging-negative patients can be performed with a similar and acceptable cure rate to imaging-positive patients.

Objectives: Performing orthopedic surgery in and out of working hours may affect the success of the surgery. Timing of surgery in tibial shaft fractures is controversial. In this study, the effect of the timing of surgery on the success and complications of intramedullary nailing of tibial fractures is examined.
Methods: Archieves of patients with tibial shaft fractures treated with reamed intramedullary nails between 2010 and 2016 were retrospectively analyzed. Fifty-seven patients were included in the study. Patients were categorized by the time of the surgery. Day time (Group I) is between 7: 00 am and 5: 00 pm and after hour (Group II) is between 5: 00 pm and 07: 00 am. Group I (n: 40) and Group II (n: 17) were evaluated. Technical errors, surgery time, and length of hospital stay statistical analysis was performed between the two groups in terms of technical errors, complication rates, length of hospital stay, and duration of surgery.
Results: The mean duration of operation (p=0.419), number of distal screws (p=0.847), time to union (p=0.454), experience of the surgeon (p=0.192), and technical error rate (p=0.654) did not differ significantly between two groups. Length of hospital stay and time to surgery from emergency were significantly higher in day time group.
Conclusion: Technical errors and surgery time of intramedullary nailing of tibial shaft fractures are not higher at after hour before midnight than day time. Non-urgent tibial shaft fractures might be treated with intramedullary nailing at after hours before midnight for efficient use of hospitals.

Amaç: Sternotomi, kalp cerrahisinde halen en sýk kullanýlan insizyon yöntemidir. Sternal komplikasyonlar %0,5 ila %6,1 oranýnda görülür. Sternal detaþman, kalp cerrahisi sonrasý morbidite ve mortaliteyi arttýrýr. Detaþmaný önlemek için alternatif sternum kapatma yöntemleri arayýþlarý günümüzde de devam etmektedir. Bu amaçla üretilen titanyum plaklar, sternum detaþmaný nedeniyle reopere olan hastalarda da kullanýlabilir. Çalýþmamýzda sternum detaþmaný nedeniyle reopere edilen hastalarda titanyum plak tamir yöntemi ile robicsek tamir yönteminin postoperatif sonuçlara etkisini araþtýrdýk.
Yöntemler: Eylül 2013-Aralýk 2020 tarihleri arasýnda hastanemizde sternal detaþman nedeniyle reoperasyon uygulanan ve preoperatif dönemde enfeksiyon bulgusu olmayan 34 hasta retrospektif olarak incelendi. Hastalar uygulanan cerrahi yönteme göre üç gruba ayrýldý. Bu gruplar; Grup 1: robicsek yöntemi kullanýlan vakalar, Grup 2: titanyum plak yöntemi kullanýlan vakalar, Grup 3: robicsek + titanyum plak yöntemlerinin bir arada kullanýldýðý vakalar idi.
Bulgular: Temel demografik özellikler ve sternal detaþmana neden olan risk faktörleri açýsýndan anlamlý fark olmayan hasta gruplarýnda mortalite ve hastanede kalýþ süresi açýsýndan da anlamlý fark görülmedi. Postoperatif dönemde enfeksiyon oranlarýna bakýldýðýnda grup 1 ve grup 3'te sýrasýyla %20 ve %21.4 postoperatif enfeksiyon tespit edilirken, sadece Robicsek tekniði ile tamir edilen grup 2'de postoperatif enfeksiyon %70 olarak gözlendi (p<0.05).
Sonuç: Literatürdeki çoðu çalýþmanýn desteklediði gibi titanyum plak uygulamasý klasik tel serklaj yöntemine göre daha üstün bir sternum stabilizasyonu saðlamaktadýr. Maliyet-etkililik açýsýndan deðerlendirildiðinde sternum detaþmaný açýsýndan yüksek riskli hastalarda titanyum plak yöntemi uygulanabilir. (SETB-2022-04-087)

Objectives: Sternotomy is still the most commonly used incision in cardiac surgery. Sternal complications are seen at a rate of 0.5% to 6.1%. Sternal dehiscence increases morbidity and mortality after cardiac surgery. To prevent dehiscence, the search for alternative sternum closure methods continues today. Titanium plates produced for this purpose can also be used in patients who are re-operated due to sternal dehiscence. In our study, we investigated the effects of titanium plate repair and robicsek repair on the results in patients who were reoperated due to sternal dehiscence.
Methods: Thirty-four patients who underwent reoperation due to sternal detachment in our hospital between September 2013 and December 2020 and had no signs of infection in the pre-operative period were analyzed retrospectively. The patients were divided into three groups according to the surgical method applied. These groups are as follows: Group 1: The cases in which the robicsek method was used, Group 2: the cases in which the titanium plate method was used, and Group 3: The cases where the robicsek + titanium plate methods were used together.
Results: There was no significant difference between the groups in terms of basic demographic characteristics and risk factors, leading to sternal dehiscence. There was no significant difference between the groups in terms of mortality and length of hospital stay. Considering the infection rates in the post-operative period, 20% and 21.4% post-operative infections were detected in Group 1 and Group 3, respectively, while 70% post-operative infection was observed in Group 2, which was repaired only with the Robicsek technique (p<0.05).
Conclusion: As supported by most studies in the literature, titanium plate application provides a superior sternum stabilization compared to the classical wire cerclage method. When evaluated in terms of cost-effectiveness, titanium plate method can be applied in high-risk patients in terms of sternal dehiscence.

Amaç: YouTubeTM' daki koroner arter bypass cerrahisi (KABC) ile ilgili Ýngilizce videolarýn güvenilirliðini ve kalitesini netleþtirmek.
Gereç ve Yöntem: Çalýþma 16 Temmuz-30 Temmuz tarihleri arasýnda gerçekleþtirilmiþtir. Bir kardiyovasküler cerrah YouTubeTM'da "koroner arter hastalýðý", "koroner arter tedavisi", "koroner arter baypas" ve "koroner arter baypas ameliyatý" terimlerini içeren videolarý aradý. Tüm videolar, videoyu yükleyen kaynaða göre profesyonel videolar ve profesyonel olmayan videolar olarak iki gruba ayrýldý. YouTubeTM'daki video süresi, video uzunluðu ve her video için izlenme sayýsý gibi video özellikleri kaydedildi. Ayrýca 'yorum', 'beðeni' ve 'beðenmeme' sayýlarý da not edildi. Ayrýca videolarýn hedef kitlesi (profesyonel saðlýk çalýþanlarý ve hastalar) analiz edilmiþ ve her video için DISCERN puaný ve Global Kalite Puaný (GQS) hesaplanmýþtýr.
Bulgular: Toplamda 812 video, yükleme kaynaklarýna göre iki gruba ayrýldý; 448 video profesyonel video, 364 video ise profesyonel olmayan video olarak kategorize edildi. Ortalama izlenme sayýsý profesyonel videolar için 3220,5 ve profesyonel olmayan videolar için 2216,5 'tü (p= 0,001). Ayrýca ortalama “beðenme” sayýlarý ve ortalama yorum sayýlarý profesyonel videolar için anlamlý derecede daha yüksekti (p= 0,001 ve p= 0,001). Ortalama DISCERN puaný profesyonel videolar için 2,6 ve profesyonel olmayan videolar için 1,5 idi (p= 0,001). Benzer þekilde, ortalama GSQ profesyonel videolar için önemli ölçüde daha yüksekti (3,5 'e karþý 2,5, p= 0.001).
Sonuç: Profesyonel saðlýk çalýþanlarý tarafýndan paylaþýlan Ýngilizce YouTubeTM videolarý, önemli ölçüde daha yüksek DISCERN puaný ve GQS ile daha kaliteli ve güvenilirdir. (SETB-2022-08-181)

Objectives: The aim of the study was to clarify the reliability and quality of English videos about Coronary artery bypass grafting on YouTubeTM.
Methods: The study was performed between July 16 and July 30. A cardiovascular surgeon searched for terms including “coronary artery disease,” “coronary artery treatment,” “coronary artery bypass” and “coronary artery bypass surgery,” in YouTubeTM. All videos were classified into two groups according to the source who uploaded the video as professional videos and non-professional videos. Video characteristics including duration of video on YouTube™, length of video, and view numbers for each video were recorded. Moreover, the numbers of “comments,” “likes,” and “dislikes” were noted. Furthermore, the target audience of the videos (professional health care worker and patients) was analyzed, DISCERN score and Global quality score (GQS) were calculated for each video.
Results: Totally, 812 videos were divided into two groups according to upload sources; 448 videos were categorized as professional videos and 364 videos were categorized as non-professional videos. The mean number of views was 3220.5 for professional videos and 2216.5 for non-professional videos (p=0.001). In addition, the mean “like” numbers and mean comment numbers were significantly higher for professional videos (p=0.001 and p=0.001). The mean DISCERN score was 2.6 for professional videos and 1.5 for non-professional videos (p=0.001). Similarly, the mean GSQ was significantly higher for professional videos (3.5 vs. 2.5, p=0.001).
Conclusion: YouTube™ videos which are shared by professional healthcare workers have better quality and reliability with significantly higher DISCERN score and GQS.

Adrenal venöz varyasyonlar oldukça nadir görülür. Ýnsidental olarak saptanan sol adrenal kitle nedeniyle tarafýmýza baþvuran 66 yaþ kadýn hastanýn 3 yýldýr hipertansiyonu mevcuttu. Esansiyel trombositopeni nedeniyle yapýlan abdominal manyetik rezonans ile görüntülemede sol adrenal bölgede kitle tespit edildi. Laboratuvar analizleri bu kitlenin feokromositoma ile uyumlu olduðunu gösterdi. Preoperatif bilgisayarlý tomografi (BT) anjiyografi ile görüntülemede sol böbreðin pelviste lokalize olduðu, sol adrenal venin direkt olarak inferior vena kava’ya drene olduðu görüldü. Laparoskopik transabdominal sol adrenalektomi takiben hastanýn patoloji raporunun feokromositomayla uyumlu olduðu görüldü. Adrenal venöz varyasyonlar oldukça nadir görülür. Literatürde sol adrenal venin inferior vena kava’ya döküldüðü birkaç adet olgu sunumu mevcuttur. Kadavralarda yapýlan çalýþmalar hastalýksýz anatomiye sahip hastalarda yapýlmýþtýr. Adrenal venöz anatomi ile ilgili yapýlan klinik çalýþmalar limitlidir. Bu çalýþmalarda en sýk görülen varyasyonlar genellikle sayý ile ilgilidir, genellikle artan tümör boyutu ve eokromositima patolojisi ile korreledir. Preoperatif BT anjiyografi görüntüleme venöz anatominin belirlenmesinde önemli olabilir. Bu olgu sunumunda, oldukça nadir görülen sol ektopik böbreðe sahip bir hastada sol adrenal feokromositoma nedeniyle laparoskopik sol adrenalektomi yapýlan bir hastada sol adrenal venin direkt olarak inferior vena kava’ya drene olduðu görüþmüþtür ve literatürde ilk defa tanýmlanmýþtýr. Preoperatif BT anjiyografi ile görüntüleme, bu varyasyonun tespitinde rol oynamýþtýr. (SETB-2022-05-117)

In this report, we describe a very rare variant adrenal venous anatomy in a left-sided pheochromocytoma case with left adrenal vein draining into the inferior vena cava (IVC). A 66-year-old female with an incidentally discovered left adrenal mass was referred to our clinic for further diagnostic work up. She had hypertension for the past three years. Abdominal magnetic resonance imaging which has been performed for essential thrombocytopenia revealed a left adrenal mass. She was diagnosed as pheochromocytoma by further laboratory workup. Pre-operative imaging with computed tomography (CT) angiography showed that left kidney was ectopically localized in pelvis, and left adrenal vein was draining directly into the IVC. A laparoscopic transabdominal left adrenalectomy was performed. Final pathology result was consistent for pheochromocytoma. Variant adrenal venous anatomy is rare. There are only few case reports on patients with left adrenal vein draining into the IVC. Although there are handful of autopsy studies, these studies were performed on normal adrenal glands. The number of clinical reports on variant adrenal venous anatomy is limited. Clinical studies revealed that most commonly seen variant adrenal venous anatomy was number based and were associated with larger tumor size and pheochromocytoma. Pre-operative CT imaging could be used to improve the identification of venous anatomy. In this report, we present a very rare case of an adult patient with left ectopic kidney who had undergone
laparoscopic adrenalectomy for left adrenal pheochromocytoma and had left adrenal vein draining into the IVC. To the best of our knowledge, it is a first in the literature. Pre-operative CT imaging identified the variant adrenal venous anatomy in this patient.

Orta kulak adenomatöz nöroendokrin tümörü nadir görülen bir durumdur ve tüm orta kulak tümörlerinin yaklaþýk %2'sini oluþturur Histolojik olarak nöroendokrin ve glandüler yapýlarýn varlýðý adenom, karsinoid tümör ve nöroendokrin tümör gibi çok çeþitli terminolojilerin kullanýlmasýna yol açmýþtýr. Hastalar genellikle tek taraflý iþitme kaybý, kulakta dolgunluk, kulak çýnlamasý ve kulak aðrýsý gibi spesifik olmayan semptomlara sahiptir. Spesifik bir radyolojik bulgu yoktur. Kesin taný, tümörün tamamen çýkarýlmasý ve kombine histopatoloji ve immünohistokimyasal incelemeye dayanýr. Bu yazýda sol kulakta iþitme kaybý ve kulakta dolgunluk þikayetleri ile baþvuran hastamýzý tartýþtýk. Otomikroskopide sol dýþ kulak yolunu dolduran polipoid doku kitlesi görüldü. Saf ses odyometri testinde saf ses ortalamasý L45/5 R10/0 ve sol kulakta timpanogram tip B olarak rapor edildi. Temporal kemik bilgisayarlý tomografisinde orta kulaktaki yumuþak doku kitlesinin antrum ve dýþ kulak yoluna uzandýðý görüldü. Dýþ kulak yolundaki görünen kitleden lokal anestezi altýnda alýnan biyopsi nöroendokrin tümör olarak rapor edildi ve ameliyat sonrasý histopatoloji ve immünokimya ile taný doðrulandý. (SETB-2022-03-068)

Middle ear adenomatous neuroendocrine tumor (MEANT) is a rare entity and accounts for approximately 2% of all middle ear tumors. Histologically, the presence of neuroendocrine and glandular structures has led to the use of a wide variety of terminologies such as adenoma, carcinoid tumor, and neuroendocrine tumor. The patients usually have nonspecific symptoms such as unilateral hearing loss, auditory fullness, tinnitus, and otalgia. There is no specific radiological finding. A definitive diagnosis is based on complete removal of the tumor and combined histopathology and immunohistochemical examination. In this case-report, we describe a patient with MEANT who complained of hearing loss and auditory fullness in her left ear. Otomicroscopy revealed a mass of polypoid tissue filling the left external auditory canal. In the pure tone audiometry test, the pure-tone average was reported as L45/5 R10/0, and the tympanogram was type B on the left ear. In temporal bone computed tomography, the soft-tissue mass located in the middle ear was found to extend to the antrum and the external auditory canal. Biopsy taken under local anesthesia from the visible mass in the external auditory canal was reported as MEANT and the diagnosis was confirmed by histopathology and immunochemistry after surgery.