Günümüzde tiroidektomide yüzey elektrotlu endotrakeal tüp ile intraoperatif sinir monitorizasyonu (IONM) standart yöntem olup, aralýklý (I-IONM) veya sürekli IONM (C-IONM) þeklinde uygulanabilmektedir. I-IONM’nin tiroidektomiye olan deðerli katkýsýna raðmen kayýt elektrotlarý veya uyarý probu ile ilgili bazý sýnýrlýlýklarý bulnmaktadýr. IONM’nin sýnýrlýlýklarýný aþabilmak ve yöntemi geliþtirmek için yeni yaklaþýmlar dikkat çekmektedir. Yüzey elektrotlu endotrakeal tüp ile IONM’de teknik problemlerin büyük bölümü, tüp elektrotlarýnýn vokal kordlara uygun temas etmemesi ile ilgilidir. Günümüzde farklý kayýt elektrotlarýnýn etkinliði araþtýrýlmaktadýr. Bu kayýt elektrotlarý tiroaritenoid veya posterior krikoaritenoid kasa uygulanan iðne elektrotlar, posterior krikoaritenoid kas yüzey elektrotlarý, trakeal kartilaja uygulanan iðne veya adheziv yüzey elektrotlar ve cilde uygulanan adesiv veya iðne elektrotlar gibi farklý tipte olup, bunlar da endotrakeal tüp elektrotlarý gibi güvenli EMG kaydý yapabilmektedirler. Ýðne elektrotlarý invaziv olmasýna raðmen tüp elektrotlardan daha yüksek EMG amplitüdü kaydederler. Adheziv yüzey elektrotlarý ile amplitüd deðerleri genelde tüp elektrottan daha düþük olmakla birlikte güvenilir EMG kaydý yapýlabilmektedir. Bu farklý tip elektrotlar tüp elektrotlara göre trakeal manipülasyondan daha az etkilenmekte ve amplitüd deðiþimleri daha azdýr.
C-IONM’de vagus çepeçevre diseke edilerek vagusa ek bir uyarý probu uygulanmaktadýr. Son zamanlarda vagusa prob uygulamadan trakeabronþial aðacý yabancý cisimlerin aspirasyonundan koruyan istemsiz, primitive bir beyin sapý refleksi olan laringeal adductor reflex (LAR) arkýnýn duyu, merkezi ve motor bileþenlerini kullanan sürekli monitorizasyon yöntemi olan sürekli LAR-CIONM yöntemi klinik olarak uygulanmaya baþlanmýþtýr. LAR’ýn afferent yolu superior laringeal sinirin internal dalý ile laryngeal mukozadan beyin sapýna ulaþýp, eferent yolu RLN yoluyla larinkse ulaþmaktadýr. LAR aktivasyonunun toplam sonucu bilateral vokal kord adduksiyonu ile laringeal giriþin kapanmasýdýr. LAR-CIONM’de yüzey elektrotlu endotrakeal tüpün bir tarafýndaki elektrottan uyarý verilerek, LAR’ýn operasyon tarafýndaki vokal kordun amplitude cevabý takip edilmektedir. Son zamanlarda disektör veya enerji cihazlarýna uygulanan uyarý probu kablolarý ile I-IONM ile diseksiyon sýrasýnda gerçek zamanlý EMG cevabý saðlanabileceði bildirilmiþtir. (SETB-2021-08-236)

At present, intraoperative neuromonitorization (IONM) with surface electrode-based endotracheal tube (ETT) is a standard method in thyroidectomy and can be performed either intermittently IONM (I-IONM) or continuously IONM (C-IONM). Despite the valuable contribution of I-IONM to the thyroidectomy, it still has limitations regarding the recording electrodes and stimulation probe. New approaches for overcoming the limitations of I-IONM and developing the method are taking attention. Most of the technical issues of IONM with surface electrode-based ETT are related with inadequate contact of electrodes to the vocal cords. Nowadays, efficiency of various recording electrodes is under investigation. Recording electrodes such as needle electrodes applied to thyroarytenoid or posterior cricoarytenoid muscle (PCA), surface electrodes applied to the PCA, and needle or adhesive electrodes applied to the tracheal cartilage or skin, can make safe recordings similar to the ETT electrodes. Despite their invasiveness, needle electrodes record higher electromyography (EMG) amplitudes than tube electrodes do. Adhesive surface electrodes make safe EMG recordings, although amplitudes of these electrodes are usually lower than those of the tube electrodes. These different types of electrodes are less affected by tracheal manipulations and amplitude changes are lower compared to the tube electrodes.
During C-IONM, an additional stimulation probe is applied to the vagus nerve after dissecting the nerve circumferentially. Recently, without applying a probe, a new continuous monitorization method called laryngeal adductor reflex CIONM (LAR-CIONM) using sensorial, central, and motor components of LAR arch which is an automatic, primitive brainstem reflex protecting the tracheoesophageal tree from foreign body aspiration, has been implemented. Afferent track of LAR communicates laryngeal mucosa to the brainstem by internal branch of the superior laryngeal nerve and efferent track reaches larynx through recurrent laryngeal nerve. Total outcome of LAR activation is the closure of laryngeal entry by bilateral vocal cord adduction. In LAR-CIONM, a stimulus is given by an electrode from one side of surface electrode-based ETT and amplitude response of the LAR at the vocal cord is followed on the operation side. Recently, it has been reported that real-time EMG response can be obtained with stimulation probe cables applied to dissectors or energy devices during the dissection through I-IONM.

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Amaç: Bu çalýþmanýn amacý COVID-19 pandemisinin endokrin cerrahi hacimleri üzerindeki etkisini deðerlendirmektir.
Metod: 2020 yýlýnda pandemi nedeniyle ülkemizde periyodik olarak cerrahi kýsýtlamalar getirilmiþtir. Cerrahi kýsýtlamalarýn endokrin cerrahi hacimine etkisini araþtýrmak için Ýstanbul Týp Fakültesi Endokrin Cerrahisi Bölümünde 2019 ve 2020 yýllarýndaki endokrin cerrahi hacimleri karþýlaþtýrýldý.
Bulgular: 2020 yýlýnda 2019 yýlýna göre tiroid, paratiroid ve adrenal cerrahi hacminde sýrasýyla %20, %54,5 ve %40 azalma saptandý. 2020’de benign nodüler guatr nedeniyle tiroidektomi ve paratiroidektomi hacimleri anlamlý olarak azalýrken, adrenal cerrahi hacminde 2019'a göre anlamlý bir fark gözlenmedi. Yýllýk tiroid kanseri ve adrenokortikal kanser cerrahisi hacminde iki sene arasýnda anlamlý bir fark saptanmadý.
Tartýþma: COVID-19 salgýný esnasýndaki cerrahi kýsýtlamalar, yýllýk benign guatr nedeni ile tiroidektomi ve paratiroidektomi hacminde anlamlý bir azalmaya yol açarken, tiroid kanseri ve adrenal cerrahisi hacimleri üzerine anlamlý bir etkisi saptanmadý. (SETB-2021-06-191)

Objective: The purpose of the study was to evaluate the impact of the coronavirus disease (COVID-19) pandemic on endocrine surgical volumes.
Methods: There were periodic surgical restriction sin our country in 2020 due to the pandemic. Endocrine surgery volumes at the Division of Endocrine Surgery, Istanbul Medical Faculty were compared between 2019 and 2020.
Results: The surgical volume reduction in 2020 compared to 2019 was 20%, 54.5%, and 40% for thyroid, parathyroid, and adrenal surgery, respectively. Surgical volume for thyroidectomy for benign nodular goiter and parathyroidectomy significantly decreased, whereas adrenal surgery showed no significant difference in 2020 compared to 2019. No significant difference was found in the rates of thyroid cancer and adrenocortical cancer surgery in 2020compared to 2019.
Conclusion: The COVID-19 outbreak led to a significant reduction in the annual rates of parathyroidectomy and thyroidectomy for benign goiter, whereas the volume of thyroid cancer and adrenal surgeries were similar to the previous year.

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Giriþ: Rekürren laringeal sinirin (RLN) ekstralaringeal dallamasý sýktýr. Çalýþmalarda intraoperatif sinir monitörizasyonunun (ÝONM) ekstralaringeal sinir dallanmasýnýn saptanma oranýný arttýrdýðý bildirilmiþtir. Biz de ÝONM klavuzluðunda tiroidektomi uygulanan hastalardaki ekstralaringeal dallanma özelliklerini ve diðer anatomik varyasyonlarla iliþkisini deðerlendirmeyi amaçladýk.
Gereç-Yöntem: Ocak 2016-Aralýk 2019 tarihleri arasýnda ÝONM kýlavuzluðunda tiroidektomi uygulanan ve RLN trasesinin larinkse giriþine kadar ortaya koyulduðu risk altýndaki sinirler çalýþmaya alýndý. RLN’nin larinkse girmeden 5 mm ve öncesinde dallanmasý ekstralaringeal dallanma olarak kabul edildi. RLN’nin Berry bölgesinde vasküler bir yapý veya Berry ligamaný lifleri ile posteriorundan tuzaklanmasý ve RLN-ITA iliþkisi deðerlendirildi.
Bulgular: Yaþ ortalamasý 49,1±13,4 (18-89) olan 696 hastada (536K, 160E) 1127 boyun tarafý deðerlendirildi. Sinir dallanmasý oraný %35.3 olup, kadýnlarda erkeklerden daha yüksekti (sýrasýyla %38.2% ve %25.8, p<0.0001). Ekstralaringeal dallanan 398 sinirin 368’i (%92.5) 2 dal, 27’si (%6.8) 3 dal, 3’ü (%0.7) 4 daldý. RLN’nin ITA’yý anterior ve dallar arasýndan çaprazlama oranlarý dallanmamýþ sinirlere göre daha yüksek (sýrasý ile %47.7 ve %44.4, %12.8 ve %7.6), posteriorundan çaprazlamasý (sýrasý ile %38.5 ve %48) daha düþüktü (p=0.001). RLN’nin Berry bölgesinde tuzaklanmasý dallanmýþ sinirlerde daha yüksekti (%25.9 vs %17.5; p=0.001). Berry tuzaklamasý sað tarafta sola göre hem dallanmýþ sinirlerde (%31.5 ve %19.4, p=0.008) hem dallanmamýþ (nonbranching) sinirlerde (%20.6 ve %14.4) daha yüksekti.
Sonuç: RLN’nin ekstralaringeal dallanmasý nadir olmayýp, genellikle 2 daldýr. Kadýnlarda dallanma oraný erkeklerden daha fazladýr. Dallanmýþ sinirlerde ITA anteriorundan ve dallar arasýndan geçme oraný daha yüksek, dallanmamýþ sinirlerde ise posteriordan seyir daha sýktýr. Dallanmýþ sinirlerde Berry bölgesinde sinirin tuzaklanma olasýlýðý daha yüksektir. Hem dallanmýþ, hem de dallanmamýþ sinirlerde sað tarafta Berry bölgesinde tuzaklama daha fazladýr. Ekstralaringeal dallanma, RLN arter iliþkisi ve Berry bölgesinde tuzaklanma sýk görülen ve deðiþken olabilen anatomik varyasyonlar olup preoperatif öngörülemez. RLN’nin ITA düzeyinde bulunup larinks giriþine kadar takip edilmesi ile ekstralaringeal dallarýn büyük bölümü ve diðer anatomik varyasyonlarla iliþkisi saptanabilir. (SETB-2021-05-155)

Objective: Extralaryngeal branching of recurrent laryngeal nerve (RLN) is frequent. In various studies, detection rate of extralaryngeal nerve branching was increased by intraoperative neuromonitorization (IONM). Our aim was evaluation of the relationship between the features of extralaryngeal branching of RLN and other anatomic variations in thyroidectomy patients under the guidance of IONM.
Methods: Patients underwent thyroidectomy using IONM between January 2016 and December 2019 and whose RLNs were fully explored till the nerve’s entry point to the larynx, were enrolled to the study. Extralaryngeal branching of RLN was accepted as branching of the nerve at a ≥5 mm distance from its laryngeal entry point and having its all branches entering the larynx. Entrapment of RLN at the region of ligament of Berry (BL) by a vascular structure or posterior BL and relationship between RLN and inferior thyroid artery (ITA) was evaluated.
Results: Out of 696 patients meeting the inclusion criteria, 1127 neck sides (536F and 160M) were evaluated. Mean age was 49.1±13.4 (range; 18–89). Nerve branching ratio was 35.3% and was higher in females than males (38.2%vs.25.8%, p<0.0001, respectively). Extralaryngeal branching of RLN was detected in 398 (35.3%) out of 1127 nerves. A total of 368 (92.5%) RLNs had two, 27 (6.8%) nerves had three, and 3 (0.7%) had multiple branches. RLN crossed anterior to and between branches of ITA more frequently in branching nerves than non-branching nerves (47.7 vs. 44.4% and 12.8% vs. 7.6%, respectively) but crossed posterior to ITA less frequently in branching nerves (38.5% vs. 48%, respectively, p=0.001). Entrapment of RLN at the region of BL was higher in branched nerves (25.9% vs. 17.5%, respectively, p=0.001). Entrapment of RLN wasmore frequent at the right side than left side both in branching (31.5% vs.19.4%, respectively, p=0.008) and non-branching nerves (20.6% vs. 14.4%, respectively).
Conclusion: Extralaryngeal branching of RLN is not rare and mostly divided into two branches. Branching ratio is higher in females than males. In branching nerves, rate of crossing anterior to and between branches of ITA was higher, in non-branching nerves, rate of crossing posterior to ITA was higher. In branching nerves, possibility of entrapment of RLN at the region of BL was higher. Both in branching and non-branching nerves, entrapment of RLN at the region of BL was higher at the right side. Extralaryngeal branching, relationship between RLN and ITA, and entrapment of RLN at the region of BL are frequently seen and variable anatomic variations and cannot be foreseen preoperatively. Most of the extralaryngeal branches and their relationship with other variations can be detected by finding RLN at the level of ITA and following RLN until its entry point to the larynx.

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Amaç: Vestibüler yaklaþýmlý transoral endoskopik tiroidektomi (TOETVA), vücudun doðal açýklýklarý kullanýlarak tiroidektomi yapýlmasýný saðlayan izsiz bir yöntemdir. TOETVA yapan cerrahlar arasýnda bile yaygýn olan inanç, bu ameliyatýn tiroidektomi uygulanan hasta grubu içerisinde küçük bir yüzdeyi kapsadýðý yönündedir. Bu çalýþma ile þu anda kabul gören dýþlama kriterlerine dayanarak, endemik bir bölgede tiroidektomi uygulanmýþ olan hastalarýn aslýnda yüzde kaçýnýn TOETVA’ya uygun olduðunu belirlemeyi amaçladýk.
Yöntem: Ocak 2017-Aralýk 2019 yýllarý arasýnda, kliniðimizde tiroid patolojisi nedeni ile cerrahi uygulanan 1197 ardýþýk hasta geriye dönük olarak incelendi. Güncel dýþlanma kriterlerine göre preoperatif deðerlendirmelerinde; boyun cerrahisi geçirmemiþ, tiroid bezi uzun çapý 10 cm’den küçük, tiroid bezi hacmi 45 ml’den az, malign nodül çapý 2 cm’den küçük, benign nodül çapý 4 cm’den küçük, retrosternal uzanýmý olmayan, radyoterapi öyküsü olmayan ve lenf nodu diseksiyonu uygulanmamýþ hastalar TOETVA prosedürüne uygun görülerek çalýþmaya dahil edildi.
Bulgular: Kriterlere göre 513 hasta (%42,8) TOETVA yaklaþýmý için uygun bulundu. Hastalarýn 421 (%82)’i kadýn ve 92 (%18)’si erkek idi. Ortalama yaþ 46.2 ± 13.2 idi. Bu hastalarýn; 192 (%37) kadarý benign nedenlerle, 321 (%63)’si ise malignite veya malignite þüphesi sebebiyle ameliyat edildi. Benign hastalarda ortalama nodül boyu 1,9 cm, ortalama tiroid hacmi 23,8 ml idi. Malign hastalarda ise ortalama nodül boyu 1,7 cm, ortalama tiroid hacmi 21,8 ml idi. Hastalardan 462’sine (%90.1) total tiroidektomi, 51’ine (%9.9) ise hemitiroidektomi uygulandý. Bu tarihler arasýnda 29 hastaya TOETVA uygulanýrken 4 hastaya ise bilateral aksiller meme yaklaþýmlý (BABA) tiroidektomi ameliyatý uygulandý. Hastalarýn kesin patoloji sonuçlarý irdelendiðinde; 301 (%58,7) hastada papiller tiroid karsinomu, 192 (%37,4) hastada benign patolojiler, 20 (%3,9) hastada da diðer patolojiler saptandý (tiroidin folliküler karsinomu, Hürthle hücreli neoplazi, az diferansiye karsinom… vb.).
Sonuç: Her ne kadar ‘hasta isteði’ gibi bir faktör çalýþmaya dahil edilemese de TOETVA’ya uygun hasta havuzu sanýlanýn aksine daha geniþtir. Kozmetik kaygýlarýn giderek önem kazandýðý günümüzde, güvenilirlik bakýmýndan etkin olan TOETVA yönteminin, yaygýnlaþmaya devam edeceðini ve yakýnda rutin cerrahi asistan eðitimi içerisinde de yerini alacaðýný düþünmekteyiz. (SETB-2021-05-145)

Objective: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a scarless method that enables thyroidectomyusing natural orifice of the body. The opinion which is even common among TOETVA performing surgeons is that this surgery involves a small percentage of thyroidectomy applied patients. In this study, based on the currently accepted exclusion criteria, we aimed to determine what percentage of patients, who underwent thyroidectomy in an endemic area are actually suitable for TOETVA.
Methods: Between January 2017 and December 2019, 1197 consecutive patients who underwent surgery for thyroid pathology in our clinic were analyzed retrospectively. Pre-operative evaluations were made according to the current exclusion criteria and as a result, patients with no previous neck surgery, no history of radiotherapy, no retrosternal thyroid extension, and none lymph node dissection operation been made and whose thyroid gland diameter is <10 cm and gland volume is not more than 45 ml, malignant nodule diameter is <2 cm, and benign nodule diameter is <4 cm are involved to this study by being considered appropriate for TOETVA procedure.
Results: According to the criteria, 513 patients (42.8%) were found suitable for TOETVA. A total of 421 (82%) of these patients were female and 92 (18%) were male. The mean age was 46.2±13.2. A total of 192 (37%) of these patients were operated due to the benign reasons, and 321 (63%) of these patients operated due to the malignancy or suspicion of malignancy. Average nodule size was 1.9 cm, and the average thyroid volume was 23.8 ml among benign patients. Whereas among malignant patients, the average nodule size was 1.7 cm and the average thyroid volume was 21.8 ml. A total of 462 (90.1%) of the patients were applied to the total thyroidectomy and 51 (9.9%) of the patients were applied to the hemithyroidectomy. In the same period, 29 patients operated through TOETVA and 4 patients operated through bilateral axillary breast approach thyroidectomy. When the final pathology, results of the patients were examined, papillary thyroid carcinoma was seen in 301 (58.7%) patients, benign pathologies were seen in 192 (37.4%) patients, and 20 (3.9%) patients were diagnosed with other pathologies (follicular thyroid carcinoma, poorly differentiated carcinoma and Hürthle cell neoplasia, etc.).
Conclusion: Although “patient willingness” factor could not be included in the study, TOETVA eligible patient repository is wider contrary to popular belief. In our humble opinion, TOETVA method is going to pursue its spread and become a part of the routine surgical training session due to its effectiveness in terms of credibility in today’s world where cosmetic concerns gradually gain prominence.

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Amaç: Total tiroidektomi (TT)’ye ek olarak santral boyun diseksiyonu (SBD) uygulanmasýnýn komplikasyon riskini arttýrýp arttýrmadýðý halen tartýþmalýdýr. Bu çalýþmada diferansiye tiroid kanseri (DTK)’de TT’ye göre SBD’nin komplikasyon geliþimi üzerine etkisini deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: DTK nedeni ile opere edilen yaþ ortalamasý 48,73+14.78 (17-82) olan 186 hastanýn (136 kadýn, 50 erkek) verileri retrospektif olarak deðerlendirildi. Hastalar TT(Grup 1) ve SBD+TT/tamamlayýcý tiroidektomi+lateral boyun diseksiyonu(Grup 2) yapýlanlar olarak 2 gruba ayrýldý. Gruplarýn komplikasyon oranlarý karþýlaþtýrýldý ve komplikasyonlar üzerine etkili risk faktörleri deðerlendirildi.
Bulgular: Grup 1’de 117 (91 K, 26 E), grup 2’de 69 (45 K, 24 E) hasta vardý. Grup 2’de grup 1’den sýrasý ile paratiroid ototransplantasyonu %42, %6 (p=0.000), istenmeyen paratiroidektomi %37.7, %9.4 (p=0.000) anlamlý olarak yüksekti.
Grup 2’de grup 1’den toplam postoperatif hipoparatiroidizm (sýrasý ile %58 vs %21.4; p=0.000), geçici hipoparatiroidizm (sýrasý ile %52.2 vs %20.5; p=0.000) anlamlý olarak daha yüksek, kalýcý hipoparatiroidizm oranlarý istatistik olarak anlamlý deðildi (sýrasý ile %5.8 vs %0.9; p=0.064) (Tablo 2).
Multinominal lojistik regresyon analizinde sadece SBD hem total hem geçici hipoparatiroidizm artýþý için baðýmsýz risk faktörü olarak saptandý. SBD’nin total hipoparatirtoidizm için relatif riski (RR): 5.2 (odd ratio (OR): 0.192); p=0.007, geçici hipoparatiroidizm,çin RR 3.5 kat (OR: 0.285); p=0.036) daha yüksekti.
Risk altýndaki sinir sayýsýna göre 119 boyun tarafýna SBD, 253 boyun tarafýna sadece tiroidektomi uygulandý. SBD uygulananlarda sadece tiroidektomi uygulananlara göre total vokal kord paralizisi (VKP) oraný (sýrasý ile 9 (%7.6) vs 6 (%2.4); p=0.017), geçici VKP oraný (sýrasý ile 7 (%6) vs 4 (%1.6); p=0.021) anlamlý olarak yüksekti. Multinominal lojistik regresyon analizinde sadece SBD yapýlmasý total VCP için baðýmsýz risk faktörü olup, total VKP RR’yi yaklaþýk 5.34 kat (OR: 0.184; p=0.007) arttýrmaktadýr.
Sonuç: Sonuç olarak total tiroidektomiye göre SBD kalýcý hipoparatiroidizm ve VKP oranlarýný arttýrmadan uygulanabilmesine raðmen, total ve geçici hipoparatiroidi, total ve geçici VKP riskini arttýran bir giriþimdir. SBD yapýlan hastalar geçici hipoparatiroidi açýsýndan dikkatli takip edilmelidirler. (SETB-2021-07-202)

Objective: It is still controversial whether performing central neck dissection (CND) in addition to total thyroidectomy (TT) increases the risk of complications. In the present study, we aimed to evaluate the effect of CND on the development of complications in differentiated thyroid cancer (DTC) compared to TT.
Material and Methods: The data of 186 patients (136 females and 50 males) with a mean age of 48.73±14.78 (range, 17–82) whom were operated for DTC were evaluated retrospectively. The patients were divided into two groups; TT (Group 1) and CND±TT/Completion thyroidectomy±lateral neck dissection (Group 2).
Results: There were 117 (91 F, 26 M) patients in Group 1 and 69 (45 F, 24 M) patients in Group 2. Parathyroid auto transplantation (PA) was significantly higher in Group 2 compared to Group 1 (42% vs. 6%) (p=0.000). Total (58% vs. 21.4%, respectively; p=0.000) and transient hypoparathyroidism (52.2% vs. 20.5%, respectively; p=0.000) were significantly higher in Group 2 than in Group 1, but permanent hypoparathyroidism rates were statistically not significant (5.8% vs. 0.9%, respectively; p=0.064). In the multinomial logistic regression analysis, CND alone was determined as an independent risk factor for increased both total and transient hypoparathyroidism. The relative risk (RR) of CND for total hypoparathyroidism was 5.2 times increased (odds ratio [OR]: 0.192) (p=0.007), while the RR for transient hypoparathyroidism was 3.5 times increased (OR: 0.285) (p=0.036). According to the number of nerves at risk, CND was performed in 119 neck side and only thyroidectomy was performed in 253 neck side. Total vocal cord paralysis (VCP) rate (9 [7.6%] vs. 6 [2.4%], respectively) (p=0.017) and transient VCP rate (7 [6%] vs. 4 [1.6%], respectively) (p=0.021) in patients who underwent CND were significantly higher compared to those who underwent only thyroidectomy. In multinomial logistic regression analysis performing only CND was an independent risk factor for total VCP, and increased the total VCP RR approximately 5.34 times (OR: 0.184; p=0.007).
Conclusion: Although CND can be applied without increasing the rates of permanent hypoparathyroidism and VCP compared to TT, it increases the risk of total and transient hypoparathyroidism, total, and transient VCP. Patients undergoing CND should be followed carefully in terms of transient hypoparathyroidism.

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Amaç: Mediastinal yerleþimli tiroid ve paratiroid patolojilerinde genellikle servikal kesiler yeterli olsa da bazen mediastinal yaklaþýmlara ihtiyaç duyulmaktadýr. Son yýllarda median sternotomi yerine daha az invaziv yöntemler kullanýlmaktadýr. Bu çalýþmada, kliniðimizde retrosternal guatr (RG) ve mediastinal paratiroid patolojisi nedeniyle split sternotomi yapýlan hastalarda kesinin yeterliliði ve morbidite araþtýrýldý.
Yöntem: Ocak 2010- Ocak 2021 tarihleri arasýnda kliniðimizde retrosternal tiroid patolojisi veya mediastinal ektopik paratiroid adenomu nedeniyle servikal kesiye ek olarak ya da ayrý vertikal kesi ile sternal çentikten üçüncü interkostal aralýða uzanan split sternotomi uygulanan hastalarýn dosyalarý geriye dönük olarak incelendi. Operatif baþarý, split sternotominin saðladýðý ekspojur ve komplikasyon oranlarý incelendi.
Bulgular: Çalýþmaya split sternotomi uygulanan 12 hasta dahil edildi. Hastalarýn ortalama yaþý 57,25±12,62 (44-83) olarak hesaplandý. Hastalarýn 8’i (%66,7) kadýn, 4'ü (%33,3) ise erkekti. Ameliyat endikasyonu 3 (%25) hastada multinodüler guatr (MNG), 3 (%25) hastada nüks MNG, 3 (%25) hastada hiperparatiroidi ve 3 (%25) hastada tiroid kanseriydi. Ameliyat sonrasý 6 (%50) hastada geçici hipokalsemi ve 1 (%8,3) hastada geçici unilateral vokal kord paralizisi geliþmiþ olup, ortalama 3 haftalýk sürede tüm komplikasyonlar spontan düzeldi. Yine hiçbir hastada medyan sternotomi gerekmedi.
Sonuç: Split sternotomi servikal yaklaþýmla eksize edilemeyen RG ve mediastinal paratiroid patolojilerinde ameliyatýn baþarýsý için yeterli ve uygulanabilir bir yöntemdir. (SETB-2021-05-136)

Objectives: Although cervical incisions are usually sufficient in mediastinal located thyroid and parathyroid pathologies, sometimes mediastinal approaches are required. In recent years, less invasive methods have been used instead of median sternotomy. In this study, the adequacy of the incision and morbidity in patients who underwent split sternotomy due to retrosternal goiter (RG) and mediastinal parathyroid pathology in our clinic were investigated.
Methods: The files of patients who underwent split sternotomy in addition to cervical incision or split sternotomy extending from the sternal notch to the third intercostal space with a separate vertical incision due to retrosternal thyroid pathology or mediastinal ectopic parathyroid adenoma between January 2010 and January 2021 were retrospectively reviewed. Operative success, exposure provided by split sternotomy, and complication rates were investigated.
Results: Twelve patients who underwent split sternotomy were included in the study. The mean age of the patients was 57.25±12.62 (44–83) years. Eight (66.7%) of the patients were female and 4 (33.3%) were male. The indication for surgery was multinodular goiter (MNG) in 3 (25%) patients, recurrent MNG in 3 (25%) patients, hyperparathyroidism in 3 (25%) patients, and thyroid cancer in 3 (25%) patients. Transient hypocalcemia in 6 (50%) patients and unilateral vocal cord paralysis in 1 (8.3%) patient developed postoperatively, and all complications resolved spontaneously in an average of 3 weeks. Median sternotomy was not required for any of the patients.
Conclusion: Split sternotomy is an adequate and applicable method for the success of the surgery in RG and mediastinal parathyroid pathologies that cannot be excised with the cervical approach.

Makale Özeti | Ýngilizce Tam Metin

Amaç: Hormon aktif ve fonksiyonel olmayan adrenal kitlelerde farklý cerrahi yaklaþýmlarýn intraoperatif ve kýsa dönem sonuçlarýný karþýlaþtýrmak.
Yöntem: 2012-2020 yýllarý arasýnda kliniðimizde adrenal bez cerrahisi geçiren 206 hastanýn verileri retrospektif olarak incelendi. Hastalara ait ameliyat öncesi poliklinik kayýtlarý, görüntüleme yöntemleri, laboratuvar sonuçlarý ve ameliyat kayýtlarý, ameliyat süreleri, kanama miktarý, hastanede kalýþ süresi, komplikasyonlar deðerlendirildi. Hastalar, non-fonksiyonel kitlesi olanlar (n=80) ve hormon-aktif kitlesi olanlar (n=126) þeklinde 2 gruba ayrýldý.
Bulgular: Hastalarýn yaþ ortalamasý 56,5 (19-83) olup %77,2’si kadýndý. Ýki grup arasýnda demografik bulgular benzerdi. Kitle boyutlarý fonksiyonel kitlelerde daha büyük olup (p=0,311), feokromositoma alt grubunda fark daha belirgindi (p=0,088). Her iki grupta açýk cerrahiye geçiþ oraný benzer olup (0,959), robotik olgularda laparoskopi veya konvansiyonel açýk cerrahiye geçiþ yapýlmadý. Ýki grup arasýnda, ameliyat süresi (p=0,669), ortalama kan kaybý miktarý (p=0,834) ve ortalama hastanede kalýþ süresi de benzerdi (p=0,195). Hormon aktif grupta yer alan hastalarýn alt grup analizlerine bakýldýðýnda; Conn, Cushing ve Feokromositoma nedeniyle ameliyat edilen hastalar arasýnda ameliyat süresi ve tahmini kan kaybý açýsýndan fark saptanmazken (p=0,086 ve p=0,099; sýrasýyla), hastanede yatýþ süresi Cushing’li hastalarda daha uzun olarak bulundu (p=0,001).
Sonuç: Hormon aktif adrenal kitlelerin cerrahi sonuçlarý non-fonksiyonel kitlelerle benzer olarak bulunmuþtur. Kitlenin hormonal durumunun cerrahi prosedürün zorluk derecesini deðiþtirmediði düþünülmekle birlikte robotik yaklaþýmýn bu kitlelerde manipülasyonu kolaylaþtýrmak için tercih edilmesi düþünülmelidir. (SETB-2021-05-147)

Objective: The aim of this study is to compare the intraoperative and short-term outcomes of different surgical approaches for hormone active and non-functional adrenal masses.
Methods: The data of 206 patients who underwent adrenal gland surgery in our clinic between 2012 and 2020 were retrospectively analyzed. Pre-operative outpatient clinic records of the patients, imaging methods, laboratory results and surgery records, operation time (OT), amount of bleeding, duration of hospital stay, and complications were evaluated. Patients were divided into two groups as those with non-functional mass (n=80) and those with hormoneactive mass (n=126).
Results: The median age of the patients was 52 (range 19–83) and 77.2% of them were female. Tumor size was larger in hormone active group (p=0.311), and the difference was more pronounced in the pheochromocytoma subgroup (p=0.088). The rate of transition to open surgery was similar in both groups (0.959), and no conversion to laparoscopy or conventional open surgery was performed in robotic cases. The duration of surgery (p=0.669), mean amount of blood loss (p=0.834), and mean hospital stay (p=0.195) were also similar between the two groups. Intraoperative and post-operative complications were similar between two groups (p=0.573 and p=0.415, respectively). Considering the subgroup analysis of the patients in hormone active group; the duration of hospital stay was longer in patients with Cushing syndrome (p=0.001), while there was no difference in OT and estimated blood loss between patients who were operated for Conn, Cushing, and pheochromocytoma (p=0.086 and p=0.099; respectively).
Conclusion: Surgical results of hormone active adrenal masses were found to be similar to non-functional masses. Although the hormonal condition of the mass does not change the difficulty level of the surgical procedure, it may be recommended that the robotic approach be preferred to facilitate manipulation in these masses.

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Amaç: Bu çalýþmanýn amacý, adrenal bezlerin sað, sol, toplam hacim, þeklinin normal deðer aralýðýný belirlemek ve adrenal bez hacmi ile cinsiyet, yaþ, boy, kilo, vücut kitle indeksi (VKÝ), bel çevresi arasýndaki iliþkiyi multi dedektör bilgisayarlý tomografi (MDBT) ile deðerlendirmektir.
Yöntem: Çalýþmaya 56'sý erkek ve 59'u kadýn olmak üzere 115 MDBT taramasý dahil edildi. Adrenal bez hacmini ölçmek için adrenal bezin konturlarý yarý otomatik olarak çizildi. Daha sonra her bir kesitteki alan otomatik toplanarak hacimler ölçüldü. Tekrarlanan ölçümlerde gözlemci güvenilirliðini analiz etmek için %95 güven aralýðý ile sýnýf içi korelasyon katsayýsý testi kullanýldý. Katýlýmcýnýn yaþý, cinsiyeti, kilosu, boyu, VKÝ'si ve bel çevresi kaydedildi. P deðerinin 0.05'ten düþük olmasý istatistiksel açýdan anlamlý kabul edildi.
Bulgular: Katýlýmcýlarýn ortalama yaþý 49.5 ± 17.7 (19-81) dir. Ortalama sað adrenal bez hacmi, sol adrenal bez hacmi ve toplam adrenal bez hacmi sýrasýyla 3.47 ± 1.33, 4.77 ± 1.33 ve 8.25 ± 2.74 cm3 olarak hesaplandý. Tüm ölçümler için sýnýf içi korelasyon katsayý deðerleri > 0.80–0.90 idi ve bu mükemmel uyumu gösteriyordu. Sol adrenal bez hacmi, sað adrenal bez hacminden daha yüksek olarak ölçüldü. Adrenal bez hacimleri ile VKÝ ve bel çevresi arasýnda orta derecede pozitif korelasyonu gözlendi.
Sonuç: Obezitenin göstergesi olan VKÝ ve bel çevresindeki artýþ, adrenal bez hacimlerindeki artýþla iliþkili olup, bu bulgu obezitedeki muhtemel hipotalamik-hipofiz-adrenal aks fizyopatolojisinin aydýnlatýlmasýna katkýda bulunabilir. (SETB-2021-05-140)

Objectives: This study aims to determine the normal range of values of the right, left, and total volume and shape of the adrenal gland (AG) and to evaluate its relationship with gender, age, height, weight, body mass index (BMI), and waist circumference (WC) in multidetector computed tomography (MDCT) images.
Methods: The study included 115 MDCT scans, of which 56 were men and 59 were women. For volume measurement, the outlines of the AG were drawn semi-automatically for all patients. Then, collecting the area in each slice, the volumes were automatically measured. The intraclass correlation coefficient (ICC) test was used to analyze intraobserver reliability for repeated measurements with a 95% confidence interval. Participant’s age, gender, weight, height, BMI, and WC were obtained. p<0.05 was considered statistically significant.
Results: The mean age of participants was 49.5±17.7 (19–81). The average right AGV (RAGV), left AGV (LAGV), and total AGV were 3.47±1.33, 4.77±1.33, and 8.25±2.74, respectively. The ICC values for all measurements were >0.80–0.90, indicating good and excellent agreement. LAGV was measured as higher than the RAGV. A positive moderate correlation of the AGVs with BMI and WC was observed.
Conclusion: The increase in BMI and WC, which are indicators of obesity, correlates with the increase in AGV, we think that the findings will be valuable in evaluating the pathophysiology of the hypothalamic-pituitary-adrenal axis.

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Amaç: Bu çalýþma, tek bir merkezin sað ve sol taraf laparoskopik donör nefrektomi (LDN) sonuçlarýný karþýlaþtýrmayý amaçlamaktadýr.
Gereç ve Yöntemler: 2008-2020 yýllarý arasýnda kliniðimizde LDN uygulanan hastalarýn sonuçlarý retrospektif olarak deðerlendirildi. Verici böbreðin tarafýna göre iki grup oluþturuldu. Gruplar arasýnda cinsiyet, yaþ, vücut kitle indeksi, ameliyat süresi, kanama miktarý, sýcak iskemi süresi, dren çekilme süresi, hastanede kalýþ süresi ve komplikasyonlar karþýlaþtýrýldý.
Bulgular: Çalýþmaya toplam 314 hasta dahil edildi. Altmýþ altý hastaya sað LDN ve 248 hastaya sol LDN uygulanmýþtý. Gruplar arasýnda yaþ, operasyon süresi, kanama miktarý, sýcak iskemi süresi ve komplikasyonlar açýsýndan fark yoktu (p>0.05). Bununla birlikte dren çekilme süresi ve hastanede kalýþ süresi sol LDN grubunda daha uzun bulundu (p<0.05).
Sonuçlar: Sað LDN, sol LDN ile benzer intraoperatif sonuçlara sahiptir. Bununla birlikte sol LDN sýrasýnda lenfatik yapýlarýn disseksiyonunun titizlikle yapýlmamasý, þilöz drenaj ve uzamýþ hastanede kalýþ süresine neden olabilir. (SETB-2021-01-020)

Objective: This study aimed to compare the right and left side laparoscopic donor nephrectomy (LDN) outcomes of a single center.
Materials and Methods: The outcomes of patients who underwent LDN in our clinic between 2008 and 2020 were evaluated retrospectively. Two groups were consisted according to the side of the donor kidney. The gender, age, body mass index, duration of operation, amount of bleeding, warm ischemia time, drain removal time, and duration of hospitalization and complications were compared between groups.
Results: A total of 314 patients were included in the study. Sixty-six patients underwent right LDN and 248 underwent left LDN. There was no difference between groups in terms of age, duration of operation, amount of bleeding, warm ischemia time, and complications (p>0.05). However, drain removal time and duration of hospitalization were longer in the left LDN group (p<0.05). Conclusions: The right LDN had similar intraoperative outcomes with the left LDN. However, failure on meticulous dissection of the lymphatic structures during left LDN might cause chylous drainage and prolonged hospitalization time.

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Amaç: Hamartomlar akciðerin sýk görülen iyi huylu tümörleridir. Nadiren, teþhis sýrasýnda veya takip sýrasýnda akciðer kanseri görülebilir.
Yöntem: 2016-2019 yýllarý arasýnda ameliyat edilen ve akciðer hamartomu tanýsý alan 38 hasta klinikopatolojik özellikleri açýsýndan retrospektif olarak incelendi. Olgular yaþ, cinsiyet, radyolojik bulgular, nodüllerin lokalizasyonu, cerrahi yöntemler ve akciðer kanseri insidansýna göre analiz edildi.
Sonuçlar: Ortalama yaþ 50.2 ± 11.1 (daðýlým 28-76) idi. 23 erkek (%60.5) ve 15 kadýn (%39.5) hasta vardý. Ortalama çap 2.7 ± 1.8 (daðýlým 0.8-10 cm) idi. 28 hastada hamartom çapý <3 cm (%73,6) idi. 18 olguda (%47.4) hamartom lokalizasyonu üst lobdaydý. 6 olgu (%15.8) hamartom santral yerleþimliydi. 10 olguda (%26.3) multiple nodül tespit edildi. Taný anýnda 4 olguda (%10.5) akciðer kanseri ve hamartom birlikte görüldü. 29 olguya (%76.3) video yardýmlý torakoskopik cerrahi (VATS) uygulandý. Cerrahi yöntem olarak, 4 olguda (%10.5) enükleasyon, 28 olguda (%73.7) wedge rezeksiyonu ve 6 olguda (% 15.8) lobektomi yapýldý. Ameliyat sonrasý erken dönem takiplerde mortalite görülmedi.
Sonuç: Pulmoner hamartomlar sýklýkla benign radyolojik bulgularý olan soliter pulmoner nodüller olarak görülür. VATS wedge rezeksiyon, taný ve tedavide güvenle kullanýlabilecek bir yöntemdir. Hamartomlar taný veya takip sýrasýnda akciðer kanseri ile birliktelik gösterebilir, bu nedenle hamartom teþhisi konan hastalarda görülen farklý bir nodülün akciðer kanseri ile iliþkili olabileceði akýlda tutulmalýdýr. (SETB-2020-06-097)

Objectives: Hamartomas are common benign tumors of the lung. Rarely, lung cancer coincidence may occur at the time of diagnosis or in the follow-up period.
Methods: Between 2016 and 2019, 38 patients who underwent a surgical procedure and diagnosed with lung hamartoma were retrospectively evaluated regarding clinicopathological features. Cases were analyzed according to age, sex, radiological findings, localization of nodules, surgical methods, and the coincidence of lung cancer.
Results: The mean age was 50.2±11.1 (range 28–76 years). There were 23 male (60.5%) and 15 female (39.5%) patients. Mean size was 2.7±1.8 (range 0.8–10 cm). In 28 patients, hamartoma was <3 cm in diameter (73.6%). Eighteen hamartomas were localized in the upper lobe (47.4%). Only 6 cases (15.8%) were localized at the central part of the lung. Multiple nodules were reported in 10 cases (26.3%). In 4 cases (10.5%), lung carcinoma and hamartoma were seen together at the time of diagnosis. Video-assisted thoracoscopic surgery (VATS) has been performed in 29 cases (76.3%). As a surgical method, enucleation was performed in 4 cases (10.5%), wedge resection in 28 cases (73.7%), and lobectomy in 6 cases (15.8%). No post-operative mortality appeared in the early follow-up.
Conclusion: Pulmonary hamartomas are usually present as solitary pulmonary nodules with benign radiological findings. VATS wedge resection is a method that can be used safely in diagnosis and treatment. Hamartomas may be associated with lung cancer at the time of diagnosis or follow-up, so it should be kept in mind that a different nodule seen in patients diagnosed with hamartoma may be associated with lung cancer.

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Amaç: Travma, radyoterapi, onkolojik rezeksiyon ve tekrarlayan ameliyatlar sonrasýnda saçlý deri defektleri ortaya çýkabilir. Saçlý kafa derisinin iki rolü vardýr, bu da kalvaryumu korumak ve estetik görünüme katkýda bulunmaktýr. "Rekonstrüktif merdiven" yaklaþýmý küçük ve orta büyüklükteki kafa derisi kusurlarýný kapatmak için kullanýlabilirken, kalvaryumu içeren daha büyük olanlar veya radyasyon tedavisi geçmiþi için geçerli deðildir. Bu çalýþmanýn amacý, karmaþýk kafa derisi defektleri nedeniyle ameliyat edilen vakalarý sunmak, komplikasyonlarý analiz etmek ve rekonstrüksiyon seçimini tartýþmaktýr.
Gereç ve Yöntemler: Çalýþma, Aralýk 2017 ile Aðustos 2019 tarihleri arasýnda karmaþýk kafa derisi defekti nedeniyle opere edilen 14 hastadan oluþmaktadýr. Hastalar yaþ, cinsiyet, etiyoloji, radyasyon tedavisi öyküsü, defekt boyutu ve yeri, rekonstrüksiyon aþamalarý, kraniyoplasti ve duraplasti seçenekleri, serbest flep tipi, alýcý arter, ven greft gereksinimi ve komplikasyon açýsýndan deðerlendirilmiþtir.
Bulgular: On bir erkek ve üç kadýndan oluþan hastalarýn yaþ ortalamasý 56,7 idi. Skalp defektlerinin etiyolojisi bazoskuamöz karsinom, skuamöz hücreli karsinom, dev bazal hücreli karsinom, anjiyosarkom, atipik menenjiyom, glioblastoma multiforme ve anaplastik oligodendrogliomu içermekte idi. Defektler dokuz vakada tam kalýnlýkta kalvaryum ve beþ vakada perikranyumu içeriyordu. Kranioplastiler kaburga grefti (n = 1), kemik grefti (n = 1) ve titanyum meþ (n = 7) ile yapýldý. Rekonstrüksiyon için kullanýlan serbest flepler; muskulokutanöz latissimus dorsi (n = 4), latissimus dorsi kas (n = 3), anterolateral uyluk (n = 4), muskulokutanöz anterolateral uyluk (n = 1), vastus lateralis kas (n = 1) ve rektus abdominis kas flebi (n = 1) idi. Flep kaybý gözlenmedi. Hastalarýn dördünde komplikasyon oluþtu, bunlar kýsmi greft kaybý, yara ayrýlmasý, seroma ve tatmin edici olmayan estetik sonuç idi.
Sonuç: Kompleks skalp defektlerinin rekonstrüksiyonu için lokal flepler yerine serbest doku transferleri seçilmelidir, çünkü lokal fleplerin baþarýsýzlýðý çok daha büyük kusurlar ve daha kötü sonuçlar yaratabilir. Düzgün rekonstrüksiyon için birçok seçenek vardýr ve her vakanýn komorbid koþullarýný hesaba katarak uygun olaný seçmek önemlidir. (SETB-2020-10-199)

Objective: Scalp defects may occur following trauma, radiotherapy, oncologic resection, and recurrent surgeries. The hair-bearing scalp has a dual role, which consists of protecting the calvarium and contributing to aesthetic appearance. While the “reconstructive ladder” approach may be used to close small and medium-sized scalp defects, it is not the case for larger ones involving the calvarium or with a radiation therapy history. The aim of this study is to present cases operated due to complex scalp defects, analyze complications, and discuss the choice of reconstruction.
Material and Methods: The study consists of 14 patients who were operated between December 2017 and August 2019 due to a complex scalp defect. Patient were evaluated according to age, gender, etiology, radiation therapy history, defect size and location, reconstruction steps, cranioplasty and duraplasty options, type of free flap, recipient artery, vein graft requirement, and complications.
Results: The mean age of patients, which consists of 11 men and three women, was 56.7 years. The etiology for scalp defects included basosquamous carcinoma, squamous cell carcinoma, giant basal cell carcinoma, atypical meningioma, glioblastoma multiforme, angiosarcoma, and anaplastic oligodendroglioma. The defect involved the full thickness of calvarium in nine cases and pericranium in five cases. Cranioplasties were made with rib graft (n=1), bone graft (n=1), and titanium mesh (n=7). Free flaps used for reconstruction were musculocutaneous latissimus dorsi (LD) (n=4), LD muscle (n=3), anterolateral thigh (ALT) (n=4), musculocutaneous ALT (n=1), vastus lateralis muscle (1), and rectus abdominis muscle (n=1). Flap loss was not observed. Complications occurred in four of the patients; include a partial graft loss, a wound dehiscence, seroma, and an unsatisfactory esthetic result.
Conclusion: Free tissue transfers rather than local flaps should be opted to reconstruct complex scalp defects, as failure of the latter, could create much greater defects, and worse consequences. There are many options for proper reconstruction, and it is essential to select the appropriate one, taking into account the comorbid conditions of each case.

Makale Özeti | Ýngilizce Tam Metin

Amaç: Geçici transvenöz pacemaker (GTPM) takýlmasý, acil serviste (AS) uygulanan hayat kurtarýcý müdahalelerden biridir. Bu çalýþmanýn amacý, acil serviste hemodinamik açýdan stabil olmayan bradiaritmi nedeniyle GTPM takýlan hastalarýn demografik, klinik özelliklerini ve hastane içi sonuçlarýný belirlemekti.
Yöntem: Çalýþmamýza Ocak 2014 ve Ekim 2019 tarihleri arasýnda, ASʼde yatak baþý GTPM takýlan ardýþýk 234 hasta dahil edildi. Hastalarýn etiyolojik özellikleri, elektrokardiyografi
(EKG) bulgularý, kalýcý pacemaker (KPM) gereksinimleri ve hastane içi mortalite geriye dönük olarak incelendi.
Bulgular: Stabil olmayan bradiaritmilerin en sýk etiyolojisi ekstrinsik nedenlerdi (%57,6). Ekstrinsik etyolojilerin çoðunluðu ilaç tedavisiyle iliþkili faktörlerdi (%60,7). Bradiaritmi, ekstrinsik nedenler ortadan kaldýrýldýktan sonra hastalarýn %60'ýnda devam etti. En sýk EKG bulgusu yüksek dereceli atrioventriküler bloktu (%62). Hastalarýn %44ʼüne KPM implante edildi. Hastane içi mortalite oraný %19,7 idi. Çok deðiþkenli regresyon analizinde sol ventrikül ejeksiyon fraksiyonu (LVEF) ve baþvuru anýnda ölçülen diyastolik kan basýncý (DKB) (p<0,001; p<0,001, sýrayla) hastane içi mortalitenin baðýmsýz öngörücüleri olarak belirlendi.
Sonuç: Acil serviste ilk taný ve müdahale stabil olmayan bradiaritmili hastalar için büyük önem taþýmaktadýr. Acil serviste mümkün olan en hýzlý þekilde GTPM takýlmasý özellikle düþük LVEF’li ve düþük DBP'li hastalarda hayati organlarýn hipoperfüzyonuna maruz kalma süresini azaltarak mortaliteyi azaltabilir. Ayrýca, potansiyel olarak dýþ faktörlere baðlý olarak ortaya çýktýðý düþünülen bradiaritmilerde de altta yatan bir latent iletim sistemi hastalýðý olabileceði akýlda tutulmalýdýr. (SETB-2021-02-059)

Objectives: Insertion of a temporary transvenous pacemaker (TTPM) is one of the life-saving interventions performed in the emergency department (ED). The aim of the study was to determine demographic, clinical characteristics, and in-hospital outcomes of patients who underwent TTPM insertion due to hemodynamically unstable bradyarrhythmia in the ED.
Methods: In our study, 234 consecutive patients who underwent TTPM insertion at the bedside in the ED between January 2014 and October 2019 were included in the study. Etiological characteristics, electrocardiographic (ECG) findings, requirements for permanent pacemaker (PPM), and in-hospital mortality of the patients were analyzed retrospectively.
Results: Extrinsic causes were the most common etiology of unstable bradyarrhythmia (57.6%). Most extrinsic causes were drug therapy-related factors (60.7%). Bradyarrhythmia persisted in 60% of patients after extrinsic causes were eliminated. The most common ECG finding was a high-degree atrioventricular block (62%). PPM was implanted in 44% of patients. In-hospital mortality rate was 19.7%. In the multivariate regression analysis, the left ventricular ejection fraction (LVEF) and diastolic blood pressure (DBP) measured at admission (p<0.001 and p<0.001, respectively) were determined to be independent predictors for in-hospital mortality.
Conclusion: First diagnosis and intervention in the ED are of great importance for patients with unstable bradyarrhythmia. The fastest possible TTPM insertion in the ED can reduce mortality by reducing the exposure time to hypoperfusion of vital organs, especially in patients with reduced LVEF and low DBP. Furthermore, it should be kept in mind that an underlying latent conduction system disease can also be present in bradyarrhythmias thought to occur potentially due to extrinsic factors.

Makale Özeti | Ýngilizce Tam Metin

Amaç: Hidrops fetalis (HF) tanýsý ile yatýrýlarak tedavi edilen yenidoðan bebeklerin etiyolojik daðýlým ve prognozunun deðerlendirilmesi
Yöntem: Bu retrospektif tanýmlayýcý çalýþmaya, hastanemizde son on yýllýk süre içerisinde doðan ve HF tanýsý ile yatýrýlan tüm infantlar çalýþmaya alýndý. Bebeklerin demografik özellikleri, saptanan etiyolojik daðýlýmlar ile uygulanan tedavi giriþimleri ve prognoz bilgileri geriye yönelik olarak kaydedildi. Bebek verileri tam olmayan infantlar çalýþma dýþý býrakýldý
Bulgular: Çalýþmaya alýnan 21 HF tanýlý olgunun ortalama gestasyonel yaþý 33,6±3,1 hafta, ortalama doðum aðýrlýðý 2444±792 gram idi. HF olgularýnýn %90,5’i sezeryan ile doðmuþtu ve prenatal taný oraný %42,9 idi. Doðum salonunda, doðumda canlandýrma uygulanan bebeklerin %57.1’i entübe edilmiþti. Yenidoðan Yoðun Bakým Ünitesi’nde %81 olgu entübe edilmiþ ve %71,4’ü surfaktan tedavisi almýþtý. HF bulgularýndan en sýk asit (%81) ve cilt altý ödem (%81) saptandý. Olgulara en sýk giriþimsel iþlem olarak parasentez (%81) ve torasentez (%52,4) uygulanmýþtý. Ýmmun HF nedeni ile 2 olguya (%9,5) kan deðiþimi uygulanmýþtý. Çalýþma grubunda mortalite %52,4 idi. Çalýþma grubunda HF olgularýnýn etyolojik daðýlým deðerlendirildiðinde, 3 olguda (%14,3) immun HF ve 18 olguda (%85,7) non-immun hidrops fetalis (NIHF) saptandý. Ýmmun HF olgularýnda altta yatan neden rhesus (Rh) uyuþmazlýðý idi. NIHF saptanan olgularda, etyolojide en sýk idiyopatik (%23.8) ve kardiovasküler hastalýk (19,04%) saptandý. Doðum salonu uygulamalarý ile mortalite arasýnda anlamlý iliþki saptandý. Kaybedilen olgularda doðumhanede entübasyon gereksinimi anlamlý yüksek iken yaþayanlarda doðumhanede sadece pozitif basýnçlý ventilasyon uygulanma sýklýðý anlamlý yüksek idi ( p sýrasýyla; 0,017 ve0,013). Ýmmun HF olgularýnda saðkalým %66,7, NIHF olgularýnda saðkalým %44,4 idi.
Sonuç: Hidrops fetalis tanýlý bebeklerde perinatal mortalite riski altta yatan nedene baðlý olarak yüksektir. Çalýþmamýzda HF’in büyük bir oranda non immün nedenler ile geliþtiði, prenatal taný ve izlemin bu bebeklerde yetersiz olduðu ve doðumhanede uygulanan giriþimlerin HF’li yenidoðan bebeklerde mortaliteyi öngörmede etkili bir faktör olduðu saptandý. (SETB-2021-06-189)

Objective: The study aims to evaluate the etiological distribution and prognosis of newborn infants with hydrops fetalis (HF).
Methods: All infants born in our hospital within the past 10 years and hospitalized with the diagnosis of HF were included in this retrospective descriptive study. Demographic characteristics, etiological distributions, treatment interventions, and prognosis information of the infants were recorded retrospectively. Infants with incomplete data were excluded from the study.
Results: The mean gestational age of infants with HF was 33.6±3.1 weeks, and the mean birth weight was 2444±792 grams. Of the HF cases, 90.5% were born by cesarean section and the prenatal diagnosis rate was 42.9%. About 57.1% of the infants were intubated during resuscitation at birth in the delivery room. In the NICU, 81% of the cases were intubated and 71.4% received surfactant treatment. The most common HF findings were ascites (81%) and subcutaneous edema (81%). The most common interventional procedures were paracentesis (81%) and thoracentesis (52.4%). Exchange transfusion was performed in 2 cases (9.5%) due to immune HF. The mortality rate in the study group was 52.4%. Considering the etiological distribution of HF cases in the study group, three cases were diagnosed with immune HF (14.3%) and 18 cases with non-immune hydrops fetalis (NIHF) (85.7%). The underlying cause in immune HF cases was rhesus incompatibility. In cases with NIHF, idiopathic (23.8%) and cardiovascular diseases were the most common etiologies. A significant relationship was found between delivery room management and mortality. While the need for intubation in delivery room was significantly higher in non-survivors, the frequency of applying only positive pressure ventilation in the delivery room was significantly higher in survivors. While the rate of survival was 66.7% in immune HF cases, it was 44.4% in NIHF cases.
Conclusion: The risk of perinatal mortality in infants with HF is high depending on the underlying cause. In this study, it was determined that HF mostly developed for non-immune reasons, prenatal diagnosis and follow-up were insufficient and the interventions performed in the delivery room were an important factor in predicting mortality in the follow-up of neonates with HF.

Makale Özeti | Ýngilizce Tam Metin

Giriþ: β-laktam antibiyotik alerjisi çocuklarda en sýk görülen ilaç alerjisidir. β-laktam antibiyotiklere karþý þüpheli reaksiyonlarý olan hastalarýn çoðu aslýnda bu ilaçlarý tolere edebilir. Bu çalýþmanýn amacý β-laktam alerjisi olan çocuklarýn klinik ve laboratuvar özelliklerini deðerlendirmek ve penisilin ile sefalosporinler arasýndaki çapraz reaktiviteyi belirlemektir.
Yöntemler: β-laktam alerjisi tanýsý, deri testleri ve / veya ilaç provokasyon testlerinin sonuçlarýna göre konulmuþtur. Penisilin alerjisi deri testleri DAP penisilin® (Diater laboratories, Madrid, Ýspanya), penisilin G ve ampisilin / amoksisilin preparatlarý ile yapýldý. Sefalosporin alerjisini deðerlendirmek için penisilin cilt ve / veya provokasyon testlerine ek olarak suçlu sefalosporin ile cilt ve provokasyon testleri yapýldý.
Bulgular: β-laktam alerjisi olan hastalarýn% 87.7'sinin (71/81) suçlu ilacý tolere edebildiðini bulduk. Taný konulan 10 hastadan 2'sinde çapraz reaktivite (penisilin ve sefalosporin) ve 8'inde çeþitli β-laktam (aminopenisilin n = 6, seftriakson n = 2) alerjileri vardý. Yaþýn büyük olmasý ve erken tip klinik reaksiyonlarý, doðrulanmýþ β-laktam alerjisi için risk faktörleri olarak belirledik.
Sonuç: Deri testleri ve ilaç provokasyon testleri, β-laktam alerjisi olan hastalarda teþhis ve alternatif bir güvenli antibiyotiðin belirlenmesinde yararlý prosedürler gibi görünmektedir. Hastalarýn çoðu bu ilaçlarý tolere etti. Doðrulanmýþ alerjisi olan hastalarýn küçük bir kýsmý, çapraz reaktivite olasýlýðý nedeniyle tüm β-laktam antibiyotiklerinden kaçýnmalýdýr. (SETB-2021-02-035)

Objective: β-lactam antibiotic allergy is the most common drug allergy in children. Most of the patients with suspected reactions to β-lactam antibiotics can actually tolerate these drugs. The aim of this study is to evaluate clinical and laboratory characteristics of children with β-lactam allergy and to determine cross-reactivity between penicillin and cephalosporins.
Methods: The diagnosis of β-lactam allergy was made based on the results of skin tests and/or drug provocation tests (DPT). Penicillin allergy skin tests were performed with DAP penicillin® (Diater laboratories, Madrid, Spain), penicillin G, and ampicillin/amoxicillin preparations. Skin and provocation tests were performed with the culprit cephalosporin in addition to the penicillin skin and/or provocation tests to evaluate cephalosporin allergy.
Results: We found that 87.7% (71/81) of patients with β-lactam allergy were able to tolerate the culprit drug. Among ten patients with confirmed diagnosis, two had cross-reactivity (penicillin and cephalosporin) and 8 had a various β-lactam (aminopenicillin n=6, ceftriaxone n=2) allergies. We identified older age and early-type clinical reactions as risk factors for a confirmed β-lactam allergy.
Conclusion: Skin tests and DPT appear to be useful procedures in the diagnosis, and determination of an alternative safe antibiotic in patients with β-lactam allergy. Most of the patients tolerated the drugs. A minority of the patients with confirmed allergy should avoid all β-lactam antibiotics due to the probability of cross-reactivity.

Makale Özeti | Ýngilizce Tam Metin

Amaç: Kolay kullanýlabilen ve arteryel kan örneði alýnmasýný gerektirmeyen noninvaziv bir solunum yetmezliði deðerlendirme aracý olan respiratuvar þiddet skoru (RSS)’nun çok düþük doðum aðýrlýklý (ÇDDA) prematürelerde ekstübasyon baþarýsýzlýðýný tahmin etmedeki prediktif deðerini araþtýrmaktýr.
Yöntem: Þubat 2016 – Eylül 2020 tarihleri arasýnda ünitemize kabul edilen <30. gebelik haftasýndan önce doðan ve doðum aðýrlýklarý <1250 g olan bebeklerin demografik özellikleri, klinik seyirleri ve neonatal morbiditeleri retrospektif olarak hasta dosyalarýndan incelendi. Ekstübasyon baþarýsý, ekstübasyondan sonraki 72 saat süreyle reentübasyon ihtiyacý olmamasý olarak tanýmlandý. Hastalarýn ilk planlý ekstübasyonlarý öncesindeki RSS ve RSS/kg deðerleri hesaplandý. Baþarýlý ve baþarýsýz ekstübasyon grubundaki bebeklerin ekstübasyon öncesindeki RSS deðerleri ve ekstübasyon baþarýsýzlýðý ile iliþkilendirilen risk faktörleri karþýlaþtýrýldý.
Bulgular: Çalýþmamýz dahil edilme kriterlerini karþýlayan 142’si bebek ile gerçekleþtirildi. Ekstübasyon baþarýsýzlýðý oranýmýz %30,2 (43/142) olarak saptandý. Erken gebelik haftasý, düþük doðum aðýrlýðý, erkek cinsiyet, yüksek RSS deðerleri, grade ≥3 intraventriküler kanama, geç baþlangýçlý sepsis ile ekstübasyon zamanýndaki düþük aðýrlýk ve postmenstrüel yaþ ekstübasyon baþarýsýzlýðý için risk faktörleri olarak saptandý. Bu risk faktörlerini içeren lojistik regresyon analizinde RSS/kg, geç baþlangýçlý sepsis ile birlikte istatistiksel önemini korudu [OR 25.7 (95% CI: 5,70 - 115,76); p < 0.001]. RSS deðerleri için gerçekleþtirilen ROC analizinde 2,13 cut-off deðeri ile (AUC: %82,5) RSS/kg’ýn %77 duyarlýlýk ve %78 özgüllüðe sahip olduðu belirlendi (p<0,001). Ekstübasyon baþarýsýzlýðý yaþayan bebeklerde mekanik ventilasyon ve hastanede yatýþ süresi ile evre ≥3 prematüre retinopatisi ve evre ≥2 nekrotizan enterokolit görülme sýklýðý daha fazla saptandý.
Sonuç: Yüksek RSS ve RSS/kg deðerleri ekstübasyon baþarýsýzlýðý ile yakýndan iliþkilidir ve ekstübasyon baþarýsýzlýðýný azaltmada klinik yargýyý destekleyici noninvaziv bir deðerlendirme aracý olarak kullanýlabilir. (SETB-2021-04-119)

Objective: The objective of the study is to investigate the utility of the respiratory severity score (RSS), an easy-to-use, non-invasive respiratory failure assessment tool that does not require arterial blood sampling, for predicting extubation failure in very-low-birth-weight premature infants.
Methods: Demographic characteristics, clinical course, and neonatal morbidities were retrospectively analyzed. Data were obtained from the files of infants who were admitted to our unit between February 2016 and September 2020, were born before 30 weeks’ gestation, and had a birth weight <1250 g. Extubation success was defined as no need for reintubation for 72 h after extubation. RSS and RSS/kg values before each patient’s first planned extubation were calculated. RSS values before extubation and risk factors for extubation failure were compared between infants in the successful and failed extubation groups.
Results: Our study enrolled 142 infants who met the inclusion criteria. The extubation failure rate was 30.2% (43/142). Early gestation, low birth weight, male sex, high RSS, grade ≥3 intraventricular hemorrhage, late-onset sepsis, low weight at the time of extubation, and postmenstrual age at the time of extubation were identified as risk factors for extubation failure. In the logistic regression analysis including these risk factors, RSS/kg remained a significant risk factor, along with late-onset sepsis (OR 25.7 [95% CI: 5.70–115.76]; p<0.001). In the receiver operating characteristic analysis of RSS values, at a cutoff value of 2.13 (area under the curve: 82.5%), RSS/kg had 77% sensitivity and 78% specificity (p<0.001). The duration of mechanical ventilation and hospital stay were prolonged in infants with extubation failure. The incidence rates of stage ≥3 retinopathy of prematurity and stage ≥2 necrotizing enterocolitis were also higher.
Conclusions: High RSS and RSS/kg values were closely associated with extubation failure and can be used as a non-invasive assessment tool to support clinical decision-making, and thus reduce the rate of extubation failure.

Makale Özeti | Ýngilizce Tam Metin

Amaç: Ýnek sütü (ÝS), duyarlý bireylerde alerjik reaksiyona yol açabilen bazý proteinler içermekte olup, çocukluk çaðýnda en sýk görülen gýda alerjisi nedenlerindendir. Hastalarýn birçoðunda 3 yaþýna kadar tolerans geliþmektedir. Bu çalýþmada inek sütü alerjisinde (ÝSA), inek sütü alerjen bileþenleri (α-laktalbumin, β-Laktoglobulin, kazein) duyarlýlýðý ile birlikte keçi sütü ve koyun sütü çapraz reaksiyonlarýnýn deðerlendirilmesi ve klinik bulgular ile tolerans geliþimi üzerine etkisinin araþtýrýlmasý amaçlandý.
Metot: Bu çalýþma IgE aracýlý ÝSA tanýsý ile izlenen ortalama 38 aylýk 66 hastayý içeren retrospektif kesitsel bir çalýþma olup, hastalar iki grupta deðerlendirildi; Grup 1(n=50): besin yükleme testine (BYT) göre tolerans geliþmediði saptanan hastalar, Grup 2(n=16): eliminasyon diyeti ile izlenen ve BYT testinde tolerans geliþtiði saptanan hastalar idi. Ýki grup arasýnda Ýnek sütü(ÝS)-sIgE, α-laktalbumin(A-LA)-sIgE, β-Laktoglobulin(BLG)-sIgE, kazein(CAS)-sIgE, keçi sütü(KS)-sIgE ve koyun sütü(KoS)-sIgE, deri prik testte(DPT) ÝS ve KS ile kabarýklýk çapý, periferik kanda eosinofil yüzdesi karþýlaþtýrýldý.
Tartýþma: Yüksek CAS-sIgE, KS-sIgE, KoS-sIgE düzeyi persistan ÝSA için ÝS-sIgE düzeyi ve DPT’de ÝS kabarýklýk çapýnýn yüksekliði gibi risk faktörüdür. Ýlk reaksiyonun anafilaksi olmasý risk faktörü olarak düþünülmüþtür. Yüksek ÝS-sIgE, CAS-sIgE, KS-sIgE, KoS-sIgE düzeyi, solunum bulgularý ile iliþkilidir. (SETB-2020-09-180)
Sonuçlar: Hastalarýn %84.8’inde KS-sIgE ve KoS-sIgE duyarlýlýðý saptandý; A-LA-sIgE, bLG-sIgE, CAS-sIgE pozitifliði ise sýrasýyla %69.7, %62.7, %77.3 idi. Gruplar arasýnda, ÝSA baþlangýç ve taný yaþý, cinsiyet, ortanca eliminasyon süresi, Total IgE, ÝS-sIgE, A-LA-sIgE, bLG-sIgE, eozinofil yüzdesine göre fark yoktu (p>0.05). Grup 1’de DPT’de ÝS ve KS ile kabarýklýk çapý(p<0.001), CAS-sIgE(p<0.001), KS-sIgE(p=0.003), KoS-sIgE(p=0.001) düzeyi daha yüksekti. ÝS-sIgE ile total IgE(p=0.001), % eozinofil(p=0.04), DPT’de ÝS ile kabarýklýk çapý (p=0.001), CAS-sIgE (p<0.001), KS-sIgE (p<0.001), KoS-sIgE (p<0.001) arasýnda pozitif korelasyon saptandý. Solunum semptomlarý ve anafilaksi öyküsü olan hastalarýn ÝS-DPT, ÝS-sIgE, CAS-sIgE, KS-sIgE, KoS-sIgE düzeyi yüksekti (p<0.05); gastrointestinal bulgular veya cilt semptomlarý ile laboratuvar bulgularý arasýnda iliþki saptanmadý. Anafilaksi öyküsü olan hiçbir hastada tolerans saptanmadý.

Objective: Cow’s milk (CM) contains some proteins capable of causing an allergic reaction in a sensitized individual and one of the most common causes of food allergy in childhood. Most of the patients will develop tolerance by the age of 3. In this study, we aimed to evaluate sensitivity to CM allergen components as well as goat’s milk (GM) and sheep’s milk cross reactions in cow’s milk allergic (CMA) patients and to figure out the risk factors for tolerance non-development.
Methods: This is a retrospective cross-sectional study including 66 patients for IgE-mediated CMA with mean age of 38 months. We evaluated the patients in two groups: Group 1 (n=50): Patients who have no tolerance in oral food challenge test; Group 2 (n= 16): Patients who were found tolerant to CM after elimination diet. Cow’s milk-spesific IgE(sIgE), α-lactalbumin(ALA)-sIgE, β-Lactoglobulin(BLG)-sIgE, casein-sIgE, goat's milk-sIgE, sheep's milk-sIgE, skin prick tests(SPTs) with CM and GM, eosinophils in peripheral blood were all compared between two groups.
Results: In the whole group, goat's milk-sIgE and sheep's milk-sIgE were positive in 84.8% and ALA-sIgE, BLG-sIgE, casein-sIgE were positive in 69.7%, 62.7%, 77.3% of the patients, respectively. Two groups were similar in terms of age at onset and diagnosis, gender, median elimination period, total IgE levels, cow’s milk-sIgE and eosinophilia (p>0.05). Mean wheal diameters of CM and GM in SPT (p<0.001), goat's milk-sIgE (p=0.03), sheep's milk-sIgE (p=0.01) were significantly higher in Group 1. Cow’s milk-sIgE showed a positive correlation with total IgE (p=0.001), eosinophilia percentage (p=0.04), CM wheal diameter in SPT (p=0.001), casein-sIgE (p<0.001), goat's milk-sIgE (p<0.001), sheep's milk-sIgE (p<0.001) in Group 1. Patients with respiratory symptoms and history of anaphylaxis had higher cow’s milk-SPT, cow’s milk-sIgE, casein-sIgE, goat's milk-sIgE, sheep's milk-sIgE levels(p<0.05). Gastrointestinal and skin symptoms showed no relation with laboratory findings. Any patient with a history of anaphylaxis did not develop tolerance.
Conclusions: As with cow’s milk-sIgE levels and high induration diameters in SPT; high casein-sIgE, sheep's milk-sIgE and goat's milk-sIgE levels are also risk factors for persistence of CMA. Anaphylaxis, as a first reaction, may also be a risk factor. High cow’s milk-sIgE, casein-sIgE, sheep's milk-sIgE, goat's milk-sIgE levels are associated with respiratory symptoms.

Makale Özeti | Ýngilizce Tam Metin

Amaç: Karbapeneme dirençli Gram negatif etkenler ile geliþen bakteriyemik enfeksiyonlar artan sýklýkta karþýlaþýlmakta ve yüksek mortaliteyle sonuçlanmaktadýr. Çalýþmamýzda karbapeneme dirençli ve duyarlý Gram negatif bakteriler ile geliþen bakteriyemilerdeki risk faktörleri ve sonuçlarýn karþýlaþtýrýlmasý, mortalite ile iliþkili faktörlerin belirlenmesi amaçlanmýþtýr.
Yöntem: Çalýþma xxx Eðitim ve Araþtýrma Hastanesi’nde, Haziran 2016 – Kasým 2017 tarihleri arasýnda retrospektif gözlemsel karþýlaþtýrmalý vaka serisi olarak gerçekleþtirildi. Olgular kan kültürlerinde üreyen patojenlerin antibiyotik duyarlýlýk sonucuna göre karbapeneme duyarlý ve dirençli olmak üzere iki gruba ayrýlarak deðerlendirildi. Bu iki grup arasýnda karbapenem direnci geliþimi açýsýndan risk faktörleri, hastanede yatýþ süreleri, mortalite oranlarý, mortal seyreden olgular için mortalite ile iliþkili faktörler araþtýrýldý.
Bulgular: Çalýþmaya 211 olgu dahil edildi. Olgularýn 157 tanesi karbapeneme duyarlý, 54 tanesi karbapeneme rezistan Gram negatif bakteriyemiydi. Tüm hastalar içerisinde 60 (%28,4) hastada mortalite geliþti. Karbapenem direnci olan hastalarýn 14 ve 28 günlük mortalite oranlarý karbapenem direnci olmayanlara göre istatistiksel olarak anlamlý yüksek saptandý. Bakteriyemi geliþimi sonrasý hastane yatýþ süreleri karþýlaþtýrýldýðýnda her iki grup arasýnda istatistiksel olarak anlamlý fark saptanmadý. Pittsburgh bakteriyemi skoru, kardiyovasküler hastalýk, üriner kateterizasyon ve uygun olmayan ampirik antibiyotik tedavisi mortalite açýsýndan en anlamlý risk faktörleri olarak saptandý.
Sonuç: Karbapenem direnci artmýþ mortalite ile iliþkilidir ve uygun olmayan ampirik antibiyotik tedavisi mortaliteyi artýrmaktadýr. Bu sebeple karbapeneme dirençli Gram negatif bakteriyemileri öngörmede hastalar risk faktörleri açýsýndan deðerlendirilmeli ve uygun hastalarda dirençli patojenlere yönelik tedavi uygulanmalýdýr. (SETB-2020-05-065)

Background: Carbapenem-resistant Gram-negative bacteremia (CR-GNB) is seen with increasing frequency and result in high mortality. The aim of this study was to compare the risk factors and results of carbapenem-resistant and carbapenem-susceptible Gram-negative bacteremia and to determine the factors related to mortality.
Methods: The study was conducted as a retrospective observational comparative case series between June 2016 and November 2017 in Þiþli Hamidiye Etfal Training and Research Hospital. The patients were divided into two groups as carbapenem-susceptible and carbapenem-resistant according to antibiotic susceptibility data of blood cultures. The risk factors for the development of carbapenem resistance, length of hospital stay, mortality rates, and mortality related factors were investigated between these two groups.
Results: Two hundred and eleven cases were included in the study. Of these cases, 54 were resistant to carbapenem and 157 were susceptible to carbapenem. Mortality occurred in 60 (28.4%) patients. The 14 and 28 day mortality rates of patients with carbapenem resistance were significantly higher than those without carbapenem resistance. There was no statistically significant difference between two groups in length of stay in the hospital after bacteremia. Pittsburgh bacteremia score, cardiovascular disease, urinary catheterization, and inappropriate empirical antibiotic therapy were the most significant risk factors for mortality.
Conclusions: Carbapenem resistance is associated with increased mortality and inappropriate empirical antibiotic treatment increases mortality. Therefore, patients should be evaluated for risk factors in predicting CR-GNB and treatment for resistant pathogens should be applied in appropriate patients.

Makale Özeti | Ýngilizce Tam Metin

Amaç: Metabolik sendromlu (MS) geriatrik hastalar nötrofil / lenfosit oraný (NLO) ve C-reaktif protein (CRP) ile epikardiyal yað dokusu kalýnlýðý (EFTT) arasýndaki iliþkiyi deðerlendiren veri yoktur. Bu çalýþmada 65 yaþ üzeri metabolik sendromlu hastalarda EFTT ile CRP ve NLO arasýndaki iliþkiyi deðerlendirmeyi amaçladýk.
Yöntem: Çalýþmamýz kesitsel bir çalýþmadýr. Çalýþmaya metabolik sendromlu 50 hasta (hasta grubu) ve metabolik sendromu olmayan 25 kiþi (kontrol grubu) dahil edildi. Tüm parametreler hasta ve kontrol gruplarýnda karþýlaþtýrýldý. NLO ve CRP ile EFTT arasýndaki korelasyon deðerlendirildi.
Bulgular: WBC ve nötrofil düzeyleri metabolik sendrom grubunda daha yüksekti (sýrasýyla p = 0,020, p = 0,019). Metabolik sendromlu hastalarda hem transvers hem de longitudinal EFTT daha fazlaydý (p <0,001). Metabolik sendrom grubunda EFTT ile NLO arasýnda anlamlý bir korelasyon vardý, ancak ayný korelasyon CRP ile saptanmadý (r = 0.4, p = 0.003).
Sonuç: Çalýþmamýz, MS'li 65 yaþýn üzerindeki hastalarda hem uzunlamasýna hem de enine EFTT'nin NLO ile iliþkili olduðunu gösterdi. Geriatrik MS hastalarýnda, yüksek NLO seviyesi, miyokardýn etrafýndaki artmýþ viseral yaðýn bir göstergesi olarak kullanýlabilir. (SETB-2021-01-016)

Objective: There are no data evaluating the association of neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) with epicardial fat tissue thickness (EFTT) in elderly metabolic syndrome (MS) patients. In this study, we aimed to investigate the relationship of EFTT with CRP and NLR in patients with MS over 65 years.
Methods: A cross-sectional study was performed. Fifty patients (patient group) with MS and 25 subjects (control group) without MS were allocated in the study. All parameters were compared in patient and control groups. The correlations between NLR, CRP, and EFTT were evaluated.
Results: White blood cell and neutrophil levels were higher in MS group (p=0.020 and p=0.019, respectively). Both transverse and longitudinal EFTT were increased in MS patients (p<0.001). There was a significant correlation between the EFTT and NLR but not with CRP in the MS group (r=0.4, p=0.003).
Conclusion: Our study showed that both longitudinal and transverse EFTT are associated with NLR in patients older than 65 years with MS. In geriatric MS patients, higher NLR level may be an indicator of increased visceral fat around the myocardium.

Makale Özeti | Ýngilizce Tam Metin

Giriþ: Taný sýrasýndaki fibroz evresi ve tedavinin ilk yýlýnda ursodeoksikolik asit tedavisine yanýt, primer biliyer kolanjitte (PBK) prognostik göstergeler olarak kabul edilir. Bu göstergelerin non invaziv modeller ile belirlenebilmesi, karaciðer yetmezliði riskinin taný anýndan itibaren sürekli deðiþkenler ile monitorize edilmesini saðlayabilir. Bu çalýþmanýn amacý, PBK'li hastalarda basit non-invaziv modellerin prognostik göstergeleri belirleyebilme açýsýndan tanýsal performanslarýný deðerlendirmektir.
Gereç ve Yöntemler: PBK'li hastalara ait veriler retrospektif olarak tarandý. Hastalar erken (≤2) ve ileri (≥3) fibroz gruplarýna ayrýldý. Ek olarak, hastalarýn Paris-II kriterlerine göre tedavi yanýt durumu ve UK-PBC skoruna göre karaciðer yetmezliði riskleri (KYR) belirlendi. Non-invaziv indikatörlerin fibroz evresi, tedaviye yanýt ve düþük KYR’ni saptayabilme açýsýndan tanýsal performanslarý analiz edildi.
Bulgular: Çalýþmaya 53 hasta dahil edildi. Hastalarýn ortalama taný yaþý 49.6 ± 13.6/yýl ve % 86.8'i (n: 46) kadýndý. S-Index fibroz evresini, tedavi yanýtlý ve düþük KYR sahip hastalarý belirleyebildi (Sýrasý ile AUC: 0.747, 0.823, 0.752; p: 0.006, <0.001, 0.0007). Ayrýca, S-Index’in PBK'nin prognostik göstergelerin teþhisi bakýmýndan diðer non-invaziv göstergelerden (APRI, Fib-4 ve RDW/ Trombosit oraný) üstün olduðu saptandý.
Sonuç: S-index, PBK'de karaciðer fibrosisi ve tedavi yanýtlý hastalarý belirleyebilen, pratik ve ucuz non invaziv bir modeldir. PBK’te sürekli deðiþken prognostik bir model olarak kullanýlabilir. (SETB-2020-09-172)

Objective: The fibrosis stage during diagnosis and the response to ursodeoxycholic acid in the 1st year of treatment are considered to be prognostic indicators in primary biliary cholangitis (PBC). Determining these indicators with non-invasive models can enable the risk of liver failure to be monitored with continuous variables from the moment of diagnosis. The aim of this study was to evaluate the diagnostic performance of non-invasive models for determining the prognostic indicators in patients with PBC.
Materials and Methods: Data from patients with PBC were screened retrospectively. Patients were divided into early (≤2) and advanced (≥3) fibrosis groups. In addition, treatment response status according to the Paris-II criteria and liver failure risk (LFR) according to the UK-PBC score were determined. The S-Index consisting of gamma-glutamyltransferase (GGT), platelets (PLT), and albumin, (S-index: 1000×GGT÷[PLT×Albumýn2]), other non-invasive models were calculated. The diagnostic effectiveness of non-invasive indicators to determine the fibrosis stage, response to treatment, and low LFR was analyzed.
Results: Fifty-three patients were included in the study. The overall mean age at diagnosis was 49.6±13.6 years and 86.8% of the patients (n=46) were female. The S-Index was able to determine fibrosis stage, treatment responded, and patients with low LFR (AUC: 0.747, 0.823, and 0.752; p=0.006, <0.001, and 0.0007, respectively). Furthermore, S-Index found to superior to other non-invasive indicators in terms diagnosis of prognostic indicators of PBC.
Conclusion: S-index is a practical and inexpensive non-invasive model that can identify liver fibrosis and treatment response in patients with PBC. It can be used as a continuous variable prognostic model in PBC.

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Amaç: Bu çalýþmada tiroid otoantikoru pozitif olan invitro fertilizasyon hastalarýnda prednizolon tedavisinin gebelik hýzýna etkisinin incelenmesi amaçlanmýþtýr.
Gereç ve Yöntemler: Bu çalýþma, Gazi Üniversitesi Týp Fakültesi Kadýn Hastalýklarý ve Doðum Bölümü Tüp Bebek Ünitesi Bölümünden, Ekim 2010 ile Eylül 2011 arasýnda tiroid otoantikoru pozitif olan gonadotropin salgýlatýcý hormon (GnRH) agonisti uzun protokolü kullanýlarak gerçekleþtirilen intrasitoplazmik sperm enjeksiyonu (ICSI) yapýlmýþ 158 hastayý içeren retrospektif bir çalýþmadýr. Anti-TPO ve anti-TG antikorlarýnýn pozitiflik ölçütü olarak her tetkikin kendi referans deðeri kullanýldý. 158 hastanýn 44’üne oositin alýndýðý gün prednol baþlandý ve diðer 114 hasta ilaçsýz takip edildi.
Bulgular: Araþtýrmaya katýlan kontrol grubunun %67,5’inin gebe kalmadýðý, %21,1’inin gebe kaldýðý, %5,3’ünün biyokimyasal gebelik, %4,4’ünün ikiz gebelik, %0,9’unun üçüz gebelik, %0,9’unun ise ektopik gebelik yaþadýðý belirlenmiþtir. Prednol verilip uzatýlan grupta ise, %56,8’inde gebelik gerçekleþmediði, %36,4’ününde gebelik gerçekleþtiði, %4,5’inde ikiz gebelik gerçekleþtiði, %2,3’ünde biyokimyasal gebelik gerçekleþtiði belirlenmiþtir. Prednol verilerek uzatýlan grupta gebelik oranýnda artýþ olduðu gözlenmiþtir.
Çalýþma grubunun gebelik durumuna göre prednol ortalama deðerleri arasýnda istatistiksel anlamlý bir farklýlýk olduðu belirlenmiþtir (p<0,05). Kontrol grubuna göre prednol verilmesi uzatýlan grupta gebe kalma oranýnýn yükseldiði belirlenmiþtir.
Sonuç: Tiroid otoantikorlarýnýn varlýðý ile zayýf IVF sonucu arasýnda güçlü bir iliþki vardýr. Prednisolon birlikte tedavisi, tiroid otoimmünitesinden etkilenen kadýnlarda, klinik gebelik oranýný iyileþtirebilir. (SETB-2020-05-079)

Objective: This study aims to investigate the effect of prednisolone treatment on the pregnancy rates of in vitro fertilization (IVF) patients with positive thyroid autoantibodies.
Methods: This study was conducted in the IVF unit of Gazi University Faculty of Medicine. It included 158 patients who underwent intracytoplasmic sperm injection using the long-term protocol of a gonadotropin-releasing hormone (GnRH) agonist that was positive for thyroid autoantibodies. Each test’s reference value was used as a positive measure of anti-thyroid peroxidase and anti-TG antibodies. On the day of oocyte intake, 44 of 158 patients were started on prednisolone, and the other 114 patients were followed up without medication.
Results: In the control group, pregnancy did not occur in 67.5% of the patients; it was determined that 21.1% were pregnant, 5.3% had biochemical pregnancies, 4.4% had twin pregnancies, 0.9% had triplet pregnancies, and 0.9% had ectopic pregnancies. In the extended prednisolone group, pregnancy did not occur in 56.8% of the patients; it was determined that 36.4% of them were pregnant, 4.5% had twin pregnancies, and 2.3% had biochemical pregnancies. An increase in pregnancy rate was observed in the extended prednisolone group, while a statistically significant difference was found between the groups in terms of the mean values of prednisolone according to pregnancy status (p<0.05). It was thus determined that the rate of conception increased in the extended prednisolone group compared to the controls.
Conclusion: There is a strong relationship between the presence of thyroid autoantibodies and poor IVF results. The coadministration of prednisolone can improve the clinical pregnancy rate in women affected by thyroid autoimmunity.

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Amaç: Bu çalýþmada hastanemizde doðum yapmýþ preeklamptik gebelerin fetal ve maternal sonuçlarýný deðerlendirdik ayrýca bu hastalarda preeklampsi rekürrens oranlarýný ve takip eden gebelikteki fetal ve maternal sonuçlarý deðerlendirdik.
Yöntemler: Bu retrospektif kohort çalýþmada medikal kayýtlarýna eksiksiz ulaþýlabilen, tekrar gebe kalýp hastanemizde gebeliði sonuçlanan 126 hasta analiz edildi. Birincil amaç preeklampsinin rekürrens oranýný ortaya koymak ikincil amaç ise preeklampsi geliþen ilk gebelik ve bunu takip eden gebeliðin maternal ve fetal sonuçlarýný deðerlendirmekti.
Bulgular: Kliniðimizde preeklampsi görülme oraný %2.1 olarak tespit edildi. Preeklampsi geliþen ilk gebelikte 111 (%80.2) gebelik canlý doðum ile sonuçlanýrken, 7 (%5.6) gebelik terminasyon, 8 (%6.3) gebelik de ölü doðum ile sonuçlanmýþtýr. Neonatal ölüm 10 (%7.9) gebelikte izlendi. Takip eden gebeliklerin 105 tanesi canlý doðum ile sonuçlanýrken, 10 (%7.9) tanesi abortus, 9 (%7.1) tanesi ölü doðum ve 2 (%1.6) tanesi preeklampsi nedeniyle terminasyon ile sonuçlandý. Neonatal ölüm 3 (%2.6) gebelikte izlendi. Takip eden gebelikte hastalardan 70 (%55.5)'inde preeklampsi geliþti ve bunlardan 39 (%55.7) tanesi þiddetli preeklampsi kriterlerine sahipti.
Sonuç: Bu çalýþma preeklampsi ile ilgili risk faktörleri ve fetomaternal advers sonuçlarýn oranlarý konusunda bize yol gösterici olup geçirilmiþ preeklampsi öyküsü olan hastalarýn takip eden gebeliklerinde de antenatal takibin sýký ve düzenli olarak yürütülmesi konusuna dikkat çekmektedir. Bu þekilde maternal ve fetal morbidite ve mortalitenin iyileþtirilmesi en büyük hedeftir. (SETB-2020-07-135)

Objectives: We evaluated the fetal and maternal outcomes of pregnant women with preeclampsia who gave birth in our hospital; we also evaluated preeclampsia recurrence rates in these patients and their fetal and maternal outcomes in their subsequent pregnancy.
Methods: In this retrospective cohort study, 126 patients whose medical records were accessed completely and who got pregnant again and gave birth in our hospital were analyzed. The primary aim was to show the recurrence rate of preeclampsia, while the secondary aim was to evaluate the maternal and fetal results of the first pregnancy in which preeclampsia developed and the subsequent pregnancy.
Results: The incidence of preeclampsia was found to be 2.1% in our clinic. The first pregnancy in which preeclampsia developed; 111 (80.2%) pregnancies resulted in a live birth, 7 (5.6%) resulted in termination, and 8 (6.3%) resulted in stillbirth. Neonatal death occurred in 10 (7.9%) pregnancies. While 105 of the subsequent pregnancies resulted in a live birth, 10 (7.9%) resulted in abortion, 9 (7.1%) resulted in stillbirth, and 2 (1.6%) resulted in termination due to preeclampsia. Neonatal death developed in 3 (2.6%) pregnancies. In the subsequent pregnancy, preeclampsia developed in 70 (55.5%) patients and 39 (55.7%) of these had preeclampsia with severe features.
Conclusion: The present study guides us on the risk factors related to preeclampsia and the rate of fetomaternal adverse outcomes and emphasizes the need for strict and regular antenatal follow-up in the subsequent pregnancies of women who have a history preeclampsia. Improvement of maternal and fetal morbidity and mortality in this way is the utmost goal.

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SETB-2021-09-289

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