Ýskemik Serebrovasküler Olaylarda endokan seviyesinin prognostik önemi
Amaç: Endotel disfonksiyonu ve endokan düzeyi trombotik aterosklerotik komplikasyonlarýn geliþmesi ile iliþkili olabilir. Ýskemik serebrovasküler hastalýkta (ICD) ile serum endokan düzeyi ve prognoz arasýndaki iliþkiyi araþtýrmayý amaçladýk.
Gereç ve Yöntem: 80 hastanýn endokan serum düzeyi ve 60 saðlýklý kontrol karþýlaþtýrýldý. Hasta grubundan ilk 24 saat içinde, ilk hafta sonuna kadar ve üçüncü ayýn sonuna kadar kan örnekleri alýndý. Ýnme prognozu, Ulusal Saðlýk Ýnme Ölçeði (NIHSS) ve deðiþtirilmiþ Rankin Ölçeði (mRS) skorlarý ile ayný aralýklarla yorumlanmýþtýr.
Bulgular: Hasta ve kontrol grubu arasýnda serum endokan düzeyleri açýsýndan anlamlý fark bulunmadý. Ayrýca, ilk 24 saat, birinci hafta ve 3. ayda iki grup arasýnda endokan serum seviyeleri açýsýndan istatistiksel olarak anlamlý bir fark yoktu. 1. hafta endokan düzeyleri ile total kolesterol ve LDL düzeyleri arasýnda pozitif korelasyon saptandý (sýrasýyla r = 0.329, p = 0.021; r = 0.317, p = 0.032).
Sonuç: ICD ve endokan düzeyleri ile prognozu arasýnda iliþki bulunamadý. Endokan düzeylerinin vasküler risk faktörleri ve ilaçlardan etkilenebileceði gösterilmiþtir.
Anahtar Kelimeler: inme, endokan, atherosklerosis, iskemik serebreovasküler olay
Short Title in Turkish: Ýskemik Serebrovasküler Olaylarda endokanýn prognostik önemi

Objective: Endothelial dysfunction and the level of endocan may be related to the development of thrombotic atherosclerotic complications. We aimed to investigate the relationship between ischemic cerebrovascular disease (ICD) and serum level of endocan and prognosis in ICD.
Material and Method: We compared the serum level of endocan of 80 patients and 60 healthy controls. Blood samples were obtained from the patient group within the first 24 hours, by the end of the first week and by the end of the third month. The stroke prognosis was interpreted with the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) scores at the same intervals.
Results: No significant difference was found in regard to serum levels of endocan between the patient and the control groups. Also, there was not any statistically significant difference seen between the two groups for serum levels of endocan within the first 24 hours, first week, and 3rd month. A positive correlation was observed between the 1st week endocan levels and total cholesterol and LDL levels (r=0.329, p=0.021; r=0.317, p=0.032 respectively).
Conclusion: We found no relationship between levels of endocan and ICD and its prognosis. It was demonstrated that levels of endocan may be influenced by vascular risk factors and medications.

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Amaç: Lenfödem kronik ve genelde kalýcý olan bir hastalýk olduðundan, bu durum için farklý tedavilerin karþýlaþtýrmalý yararlarýný belirlemeye halen ihtiyaç duyulmaktadýr.
Bu çalýþmada, farklý tedavi protokollerinin meme kanseri ile iliþkili lenfödem (MKÝL) hastalarýnda ekstremite volümü üzerine olan etkilerini retrospektif olarak karþýlaþtýrmayý amaçladýk.
Yöntemler: Çalýþmaya MKÝL'si olan toplam 117 hasta dahil edildi. Hastalar 4 grupta sýnýflandýrýldý. Grup 1'deki hastalara (n: 25) kompleks dekonjestif tedavi (KDT), Grup 2'deki hastalara (n: 25) KDT + pnömotik kompresyon tedavisi (PCT), Grup 3'deki hastalara (n: 45) KDT + PCT+ düþük güçlü lazer tedavisi (LLT) ve Grup 4'deki hastalara (n: 22) PCT+ LLT tedavisi verildi.
Bulgular: Gruplar arasýndaki analizimiz, grup 4 dýþýndaki hemen hemen tüm gruplarda (grup 1, 2, 3) (p: 0.001) üst ekstremitelerin ortalama volümünde istatistiksel olarak anlamlý azalmayý gösterdi (p: 0.592). Ayrýca, gruplar arasýndaki post-hoc analiz sonuçlarý, delta ekstremite volümü (p = 0.000) ile anlamlý bir farklýlýðý ortaya koymuþtur. PCT + LLT grubunun istatistiksel farka neden olduðunu belirledik. Bu grupta delta deðerleri diðer gruplara göre anlamlý olarak düþüktü.
Sonuç: En etkili tedavi protokolünü belirlemeyi amaçladýðýmýz bu çalýþmada; KDT tek baþýna ve KDT ile birlikte PCT ve LLT'nin lenfödem tedavisinde etkili olduðunu gözlemledik. Bununla birlikte, PCT ve LLT, KDT ile kombinasyon halinde kullanýldýklarýnda önemli miktarda volüm azalmasý ile sonuçlandýðýndan tek baþýna kullanýldýklarýnda etkili tedaviler olduklarý sonucuna varýlamaz.

Objective: Since lymphedema is a disorder which is both chronic and generally persistive, there is still need to determine the comparative benefits of the different therapies for this condition. In this study we aimed to retrospectively compare the responses of different therapy protocols on extremity volume in patients with breast cancer related lymphedema (BCRL).
Methods: A total number of 117 patients with BCRL were selected for the study. The patients were treated with complex decongestive therapy (CDT) (n: 25) in- Group 1, with CDT + pneumatic compression therapy (PCT) (n: 25) in- Group 2, with CDT + PCT+ low intensity laser therapy (LLT) (n: 45) in-Group 3, and with PCT+ LLT (n: 22) in-Group 4.
Results: Our analysis within groups suggested statistically significant reduction in the average volume of the upper limbs in nearly all the groups (group 1, 2, 3) (p: 0.001) except group 4 (p: 0.592). Besides, the results of post-hoc analysis between groups demonstrated a significant difference by means of delta limb volume (p=0.000). We noted that PCT+LLT group caused the statistical difference. The delta values in this group were significantly lower compared to other groups.
Conclusion: The rationale behind conducting this study was to determine the most effective therapy protocol, and we observed that CDT alone and the PCT and LLT in combination with CDT were effective in lymphedema treatment. However, since the PCT and LLT result in significant volume reduction only when they are used in combination with CDT, we cannot conclude that they are effective treatments when used alone.

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Giriþ: Pek çok obez tip 2 diyabetli hastada, arttýrýlan insülin dozlarýna raðmen glisemik kontrol baþarýlý deðildir. Çalýþmamýzýn amacý, obez, kötü glisemik kontrollü tip 2 diyabetik hastalarda insülin doz arttýrma ve azaltma yaklaþýmlarýnýn etkisini karþýlaþtýrmaktýr.
Materyel ve metod: Ýnsülin tedavisi altýnda, kötü kontrollü ve son bir sene içerisinde en az beþ kilo almýþ olan 60 tip 2 diyabetli hasta konvansiyonel (insülin dozu arttýrma) ve azaltma gruplarýna randomize edildi. Tüm hastalara, her vizitte saðlýklý beslenme ve egzersiz eðitimi verildi. Altýncý ayýn sonunda hastalara ait obezite parametreleri (bel çevresi ve kilo) ve glisemik kontrolleri deðerlendirildi.
Sonuçlar: Bel çevresi ve kilo insülin dozu azaltýlan grupta azalýrken (sýrasýyla 113 cm den 109,4 cm ‘e ve 88,2 kg dan 86,8 kg’a), insülin dozu arttýrýlan grupta ( sýrasýyla 110.7 cm den to 115.6 cm’e ve 83.2 kg dan to 84.6 kg ya) arttý. Her 2 grupta da HbA1C gruplarýnda anlamlý azalma vardý. (% 9.64 den 9.12’ ya, % 10.05 den 8.86’a; p=0.024, p=0.003) Gruplarýn HbA1C seviyelerindeki deðiþiklikler benzerdi (p=0.12)
Yoðunlaþtýrýlmýþ yaþam tarzý deðiþiklikleri eþliðinde insülin dozu azaltma stratejisi ile kilo kaybý ve bel çevresinde azalma ve ayný zamanda konvansiyonel tedaviye benzer düzeyde HbA1C deðiþikliði saðlanmýþtýr.

Background: Despite increasing insulin doses, glycemic regulation fails in many obese patients with type 2 diabetes, The purpose of the present study was to compare the effects of downward insulin therapy with conventional insulin dose adjustments in obese dysregulated patients with type 2 diabetes
Material and methods: Sixty type 2 diabetic poorly regulated patients under insulin treatment and had gained at least five kilograms in the last year were randomized into either conventional insulin dose adjustment group or downward insulin dose adjustment group. All patients had education on healty eating and exercise in all visits. Patients’ obesity parameters (as waist circumference and weight) and glycemic controls evaluated at the end of sixth months.
Results: Waist circumference and weight decreased (from 113 to 109.4 cm and 88.2 to 86.8 kg from respectively) in downward dose adjustment group and increased (from 110.7 to 115.6 cm and 83.2 to 84.6 kg from respectively) in conventional insulin dose adjustments. Both groups had significant reduction in HbA1C levels (9.64 to 9.12, 10.05 to 8.86; p=0.024, p=0.003; respectively). Changes in HbA1C levels were similar in the groups (p=0.12).
Conclusion: Downward insulin dose adjustment with intensified life style modifications may provide weight loss and reduction in waist circumference also similar glycemic control with conventional insulin dose adjustments

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Amaç: Bu çalýþmada saðlýklý kadýnlarda Anti-Müllerian Hormon ile androjenlerin iliþkisi belirlemeyi amaçladýk.
Yöntem: Çalýþmamýza 16-43 aralýðýndaki, üç yýllýk zaman dilimi içerisinde üniversite hastanemizde anti-müllerian hormon ve androjen profili tetkiki yapýlmýþ 1300 hasta alýndý. Hastalarýn dosyalarýndan hastalarýn demografik verileri, klinik ve sonografik bulgularý, serum prolaktin, luteinizan hormon, total ve serbest testosteron, östradiol, tiroid stimulan hormon, folikül stimulan hormon, 17-hidroksi progesteron, dihidroepiandrosteron ve Anti-Müllerian hormon seviyeleri kaydedildi. Dahil edilme ve dýþlanma kriterleri sonucunda yapýlan seçimle çalýþmaya 337 hasta ile devam edildi.
Bulgular: Çalýþmaya alýnan hastalarýn yaþ ortalamasý 28.82±5.24 yýl ve vücut kitle indekslerinin ortalamasý 25.49±4.37 kg/m2 idi. Serum folikül stimulan hormon ortalamasý 6.82±4.71mIU/mL, serum luteinizan hormon ortalamasý 5.59±3.78mIU/mL, serum östradiol ortalamasý 40.77±36.28 pg/mL olarak bulundu. Hastalarýn androjen profiline bakýldýðýnda total testosteron deðerlerinin ortalamasý 47.36±33.09 pg/mL, serbest testosteronun ortalamasý 2.61±2.54 pg/mL, 17-hidroksi progesteronun ortalamasý 0.65±0.20ng/mL, androstenedionun ortalamasý 2.43±1.25ng/mL ve dihidroepiandrosteronun ortalamasý 244.45±115.87 mcg/dL olarak hesaplandý. Anti-Müllerian Hormon deðeri ortalamasý 4.43±4.70 ng/mL olarak bulundu. Yapýlan istatistiksel analiz sonucunda luteinizan hormon (p=0.009), folikül stimulan hormon (p=0.001), androstenedion (p=0.050), dihidroepiandrosteron (p=0.034) ve vücut kitle indeksinin (p=0.021) Anti-Müllerian Hormon ile anlamlý iliþki gösterdiði saptandý. Bunlardan folikül stimulan hormon ve vücut kitle indeksinin Anti-Müllerian Hormon üzerine azaltýcý; luteinizan hormon, androstenedion ve dihidroepiandrosteronun ise arttýrýcý etkisi olduðu görüldü.
Sonuç: Bizim çalýþmamýzda hiperandrojenemi, polikistik over sendromu ve geç baþlangýçlý konjenital adrenal hiperplazisi olmayan hasta grubunda bile androstenedionun (testosteron öncülü) ve dihidroepiandrosteronun Anti-Müllerian Hormonu arttýrýcý etkisi saptanmýþtýr.

Aim: To determine the relationship between androgens and Anti-Mullerian Hormone in healthy women without hyperandrogenemia.
Methods: A total of 1300 patients aged 16-43 who had Anti-Mullerian Hormone and androgen profile in three years period in a university hospital were included. Sociodemographic features, clinical and sonographic findings, serum prolactin, luteinizing hormone, total and free testosterone, estradiol, thyroid stimulating hormone, follicle stimulating hormone, 17-hydroxy progesterone, dehydroepiandrosterone and Anti-Mullerian Hormone levels were recorded. Patients were selected according to inclusion and exclusion criteria and the study was completed with 337 patients.
Results: The mean age of the patients was 28.82±5.24 and body mass index was 25.49±4.37 kg/m². Mean levels of follicle stimulating hormone, luteinizing hormone and estradiol were 6.82±4.71 mIU/mL, 5.59±3.78 mIU/mL and 40.77±36.28 pg/mL, respectively. When the androgen profiles were evaluated, the mean total testosterone, free testosterone, 17-hydroxy progesterone, androstenedione and dehydroepiandrosterone levels were detected as 47.36±33.09 pg/mL, 2.61±2.54 pg/mL, 0.65±0.20 ng/mL, 2.43±1.25 ng/mL and 244.45±115.87 mcg/dL,respectively. The mean Anti-Mullerian hormone levels were 4.43±4.70 ng/mL. A significant independent relationship was found between Anti-Mullerian hormone and luteinizing hormone (p=0.009), follicle stimulating hormone (p= 0.001), androstenedione (p= 0.050), dehydroepiandrosterone (p= 0.034) and body mass index (p= 0.021). Anti-Mullerian hormone levels were affected by follicle stimulating hormone and body mass index negatively; while luteinizing hormone, androstenedione and dehydroepiandrosterone affect it positively.
Conclusion: In our study even in patients who have not hyperandrogenemia or not diagnosed as late-onset congenital adrenal hyperplasia or polycystic ovary syndrome, androstenedione (a precursor of testosterone) and dehydroepiandrosterone were found to increase Anti-Mullerian hormone levels.

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Giriþ: Kardiyak sendrom X’li (KSX) hastalarda kardiyovasküler istenmeyen olaylarýn sýklýðýnýn fazla olduðu iyi bilinmesine ragmen atriyal fibrilasyon (AF) ve ventriküler aritmik olay riskinin artýp artmadýðý net olarak bilinmemektedir. Bu çalýþmanýn amacý bu riskleri deðerlendirmektir. Bu amaçla AF geliþme riskini gösteren P dalga dispersiyonu (PDD) ve ventriküler aritmik olaylarýn geliþme riskini gösteren düzeltilmiþ QT interval dispersiyonu (DQTD), Tp-e interval ve Tp-e interval/düzeltilmiþ QT oraný KSX’li hastalarda ölçülerek deðerlendirilmiþtir.
Yöntem: Çalýþma geriyedönük olarak gerçekleþtirildi. Toplam 298 birey (155 KSX’li hasta, 143 kontrol) çalýþmaya dahil edildi. PDD, DQTD, Tp-e interval ve Tp-e/düzeltilmiþ QT interval oraný her iki gruptada hesaplandý ve karþýlaþtýrýldý.
Bulgular: PDD, DQTD, Tp-e interval ve Tp-e interval/düzeltilmiþ QT interval oraný deðerlerinin KSX’li hastalarda saðlýklý gruba göre istatistiksel olarak daha yüksek olduðu görüldü (p=0.003, p<0.001, p<0.001 and p<0.001 sýrasýyla).
Sonuç: Bu sonuçlara göre atriyal ve ventriküler repolarizasyon anormallikleri KSX’li hastalarda normal populasyondan daha yüksek olabilir. Bu sonuçlar bize indirekt olarak AF ve ventriküler aritmik olay sýklýðýnýn KSX’li hastalarda daha fazla olacaðýný düþündürebilir

Objective: Even though it is well known that major adverse cardiac event rates elevate in cardiac syndrome x (CSX) patients, it is not clear whether the risk of atrial fibrillation (AF) and ventricular arrhythmia (VA) is elevated or not. The purpose of this study was to evaluate AF and VA risks in these patients. Therefore, P wave dispersion (PWD), a indicator of AF; and corrected QT interval dispersion (CQTD), Tp-e interval, Tp-e interval/ corrected QT proportion, which are indicators of VA, were assessed in CSX patients.
Methods: The study was performed as retrospectively. A total of 298 subjects (155 CSX patients, 143 control) were examined. PWD, CQTD, Tp-e interval, Tp-e interval/corrected QT proportion were calculated and compared between both groups.
Results: PWD, CQTD, Tp-e interval, Tp-e interval/ corrected QT ratio values were elevated in CSX patients compared to the healty subjects (p=0.003, p<0.001, p<0.001 and p<0.001 respectively).
Conclusion: We suggest that CSX patients have increased atrial and ventricular repolarization abnormalities compare to normal population. Furthermore, our results may indirectly indicate that patients with CSX have increased risk of AF and VA.

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AMAÇ: Bu çalýþmada, fokal baþlangýçlý nöbetleri olan dirençli epilepsi hastalarýnda lakozamid ek tedavisinin etkinliði ve güvenilirliðinin incelenmesi amaçlandý.
GEREÇ VE YÖNTEM: Dirençli fokal baþlangýçlý nöbetleri olan ve en az altý ay süresince lakozamid ek tedavisi kullanan hastalarýn dosya kayýtlarý gözden geçirildi. Hastalarýn demografik verileri, lakozamid dozlarý ve birlikte kullanýldýðý antiepileptik ilaçlar (AEÝ) ve gözlenen yan etkiler deðerlendirildi. Hastalarýn lakozamid tedavisi öncesindeki nöbet sýklýklarý ile tedavi baþlanmasýndan sonraki birinci ve altýncý aylardaki nöbet sýklýklarý karþýlaþtýrýldý.
BULGULAR: Çalýþmaya 68 hasta (32 kadýn, 36 erkek) alýndý. Hastalarýn yaþ ortalamasý 34.6±11.01, ortalama hastalýk süresi 20.3±12.25 yýl idi. Elli dokuz hasta (%86.8) lakozamid ile birlikte sodyum kanalý üzerinden etki eden baþka bir AEÝ kullanýyordu. Lakozamid tedavisine yanýt oraný birinci ayda %48.5 iken, altýncý ayda bu oranýn %64.7’ye yükseldiði saptandý. Altýncý ay sonunda 14 hastada (% 20.6) tam nöbet kontrolü saðlandýðý izlendi. Yedi hastada tedavinin birinci ayýnda nöbetlerde azalma veya sonlanma olduðu, ancak altýncý ay kontrollerinde bu hastalarda nöbetlerin tekrar arttýðý belirlendi. Yirmi bir hastada (%30.9) lakozamid tedavisi ile iliþkili yan etki geliþtiði, bir hastada ise yan etkinin tolere edilememesi nedeniyle ilacýn kesildiði saptandý.
SONUÇ: Çalýþmanýn sonuçlarý dirençli fokal baþlangýçlý nöbetleri olan hastalarda lakozamidin etkin bir ek tedavi seçeneði olabileceðine iþaret etmiþtir.

OBJECTIVE: In this study, we aimed to evaluate the efficacy and safety of lacozamide add-on therapy in patients with uncontrolled focal onset seizures.
MATERIALS AND METHODS: Medical records of patients with uncontrolled focal onset seizures using lacozamide add-on therapy for at least six months were evaluated. Demographic data of patients, lacozamide doses, concomitant antiepileptic drugs (AEDs) and side effects were evaluated. Patients' seizure frequency before lacozamide treatment and seizure frequency in the first and sixth months after treatment initiation were compared.
RESULTS: Sixty-eight patients (32 females, 36 males) were included in the study. The mean age of the patients was 34.6±11.01 and mean duration of illness was 20.29±12.25 years. Fifty-nine (86.8%) were using another sodium channel blocking AED in the treatment as well as lacozamide. The response rates to lacozamide add-on treatment were 48.5% at 1th month and 64.7% at 6th month. At the end of the 6th, 14 (20.58%) of the patients had complete seizure control. Seven patients showed a decrease or termination in seizure frequency in the 1th month of treatment, but during the 6th month of treatment the seizures increased again in these patients.. Twenty-one patients (30.9%) were found to have side effects associated with lacozamide treatment, while in one patient the drug was discontinued due to the inability to tolerate side effects.
CONCLUSION: The results of the study indicated that lacozamide may be an effective adjunctive treatment option in patients with refractory focal onset seizures.

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Giriþ: Ýnfektif endokardit (ÝE), yüksek mortalite ve morbiditeye sahip ciddi bir kalp hastalýðýdýr. ÝE riski taþýyan hastalara dental giriþim öncesinde antibiyotik profilaksisi önerilmektedir. Online uygulanan tanýmlayýcý nitelikteki bu anket çalýþmasýnýn amacý ÝE geliþme riski bulunan hastalara diþ hekimlerin ve diþ hekimliði öðrencilerinin antibiyotik profilaksisi uygulama konusundaki bilgi ve farkýndalýk düzeylerini deðerlendirmektir.
Yöntem: Profilaksi gerektiren dental giriþimler ve kalp hastalýklarý, profilakside uygulanan antibiyotiklerin dozu, süresi ve uygulama zamaný ile ilgili sorulara verilen yanýtlar ile birlikte katýlýmcýlarýn demografik bilgilerini içeren anket verileri 1 Þubat ve 30 Haziran 2016 tarihleri arasýnda toplanmýþtýr. Her doðru cevaba bir puan verilmiþtir. Dört puan üstü baþarýlý olarak kabul edilmiþtir.
Bulgular: Toplamda 584 diþ hekimi ve 199 diþ hekimliði öðrencisi ankete katýlmýþtýr. ÝE profilaksisi uygulama oraný % 92.6’ saptanmýþtýr. Profilaksi gerektiren dental prosedürler ve kalp hastalýklarý ile iliþkili sorularda genel baþarý oraný sýrasýyla % 90.3 ve % 72.6 bulunmuþtur. Kadýnlarýn, beþ ve beþ yýldan daha az deneyimi olan diþ hekimlerin ve diþ hekimliði fakültelerinde çalýþanlarýn profilaksi gerektiren kalp hastalýklarý, antibiyotik dozu ve uygulama süresi ile ilgili bilgi düzeyleri daha yüksek saptanmýþtýr. (p <0.05). Beþ ve beþ yýldan daha az deneyimli diþ hekimlerinin profilaksi gerektiren dental prosedür konusundaki farkýndalýk düzeyi beþ yýldan fazla deneyim sahibi olanlara göre daha fazladýr (p<0.001).
Sonuç: Diþ hekimlerinin ÝE profilaksisi uygulama konusunda bilgi düzeylerinin düþük saptanmasý, diþ hekimlerinin güncel geliþmeleri takip etmeleri için hizmet içi eðitimlerin gerekliliði birkez daha ortaya konulmuþtur.

Introduction: Infective endocarditis is a serious heart disease with high mortality and morbidity. Antibiotic prophylaxis is recommended for patients at risk of infective endocarditis before dental procedures. This Turkish online descriptive survey aimed to evaluate the knowledge and awareness levels of dentists and dental students regarding antibiotic prophylaxis for patients at risk of infective endocarditis.
Method: Data on participants’ demographics and responses regarding dental treatments and heart diseases requiring prophylaxis as well as appropriate antibiotic dosage, duration, and administration time were collected between February 1 and June 30, 2016 in Turkey. For each correct answer one point was given. A score of >4 was considered successful.
Findings: In total, 584 dentists and 199 dental students responded to the questionnaire. The rate of administration of antibiotic prophylaxis against infective endocarditis was 92.59%. Overall success rates of dental procedures requiring prophylaxis and knowledge regarding heart diseases were 90.3% and 72.6%, respectively. Knowledge levels regarding the use of antibiotic prophylaxis for heart diseases and antibiotic dosage and duration were greater in women, those with ≤5 years of professional experience, dentists, and those working at dental faculties (p < 0.05). Dentists with ≤5 years of professional experience had greater awareness levels about dental procedures of prophylaxis requirement than those with >5 years of experience (p< 0.001).
Conclusion: Given their poor knowledge of antibiotic prophylaxis against infective endocarditis, dentists should receive in-service training to keep up with current practices.

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Amaç: Patofizyolojisi ve risk faktörleri hala net olmayan kronik aðrý önemli bir halk saðlýðý sorunudur. Her türlü yaralanma, travma ve ameliyat kronik aðrýya yol açabilir. Vaka kontrol çalýþmamýzda, kronik aðrý þikayeti ile baþvuran hastalarda ameliyat sonrasý oluþan skar dokusu ile kronik aðrý arasýndaki iliþkiyi deðerlendirmeyi amaçladýk.
Hastalar ve Yöntem: Cerrahi ve kronik aðrý arasýndaki iliþkiyi deðerlendirmek için, iki yaygýn kronik aðrý hastalýk incelendi. En sýk non-mekanik kronik aðrý nedeni olan fibromiyalji (FMS) ve en sýk mekanik kronik aðrý nedeni olan kronik bel aðrýsý (CLBP) ile baþvuran hastalar çalýþmaya alýndý. Çalýþmaya 75 FMS, 57 CLBP ve 47 saðlýklý kontrol dahil edildi. Tüm katýlýmcýlarýn demografik özellikleri, semptomlarý, cerrahi öyküsü ve komorbid hastalýklarý incelendi.
Bulgular: Her iki aðrýlý hasta grupta da cerrahi iþlemlerin oraný benzerdi (p> 0.05), bu oranlar her iki grupta da kontrol grubundan yüksekti (p <0.001). VAS skor ortalamalarý her iki hasta grubunda da benzerdi (p = 0.825). Bu skorlar, çoklu cerrahi iþlem öyküsü olan hastalarda, tek cerrahi iþlem öyküsü olan hastalara göre daha yüksekti (p = 0.043), fakat bu yükseklik uygulanan cerrahi iþleme baðlý deðildi (p> 0.05).
Sonuç: Cerrahi sonrasý skar dokusu lokal veya uzak bir kronik aðrýya neden olabilir. Kronik aðrý, çok sayýda operasyon geçiren hastalarda daha sýktý.

Background: Chronic persistent pain (CPP) is an important public health problem and its pathophysiology and the risk factors are still not clear. Scar tissues emerging after any type of injury, trauma, and surgery may lead to CPP. In this case-control study, we investigated whether surgical scar tissues can be related to CPP in our patient population.
Patients and Methods: To assess the relation between surgery and CPP, two common chronic pain diseases were examined; fibromyalgia (FMS) as the most common non-mechanical CPP, and chronic low back pain (CLBP) as the most common mechanical CPP. For this purpose, 75 FMS, 57 CLBP patients and 47 healthy controls were recruited. All of the participant were examined, their demographic characteristics, symptoms, medical history of surgeries, and comorbid diseases were reported.
Results: The frequency of surgical procedures was similar in both of the patient’s group (p>0.05), but were higher than the controls in both of the patients’ group (p<0.001). The mean pain VAS score was similar in both patient’s groups (p=0.825). These scores were higher in the patients with history of the multiple surgical procedures than the patients with history of single surgical procedure (p=0.043), but this was not related to the type of surgery procedure (p>0.05).
Conclusion: Scar tissues after surgery may cause a local or distant chronic pain. Chronic pain was more common in patients with more operations.

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Giriþ
Bu çalýþmanýn amacý humerus þaft kýrýðý tanýsý ile triceps sparing veya triceps splitting yaklaþým ile opere edilen hastalarýn sonuçlarýný karþýlaþtýrmaktýr.

Materyal ve metod
2014-2017 yýllarý arasýnda humerus þaft kýrýðý tanýsý ile opere edilen 39 hasta (18 erkek, 21 kadýn) çalýþmaya dahil edildi. Hastalar tercih edilen cerrahi yaklaþýma göre ticeps-split veya triceps-sparing þeklinde iki gruba ayrýldý. Son kontrolde dirsek ROM, izometrik dirsek ekstansiyon gücü, kaynama zamaný ve kas gücü ölçüldü. Fonksiyonel deðerlendirme Disabilities of the Arm, Shoulder and Hand (DASH) skoru kullanýlarak yapýldý.
Sonuçlar
Hastalarýn ortalama takip süresi 18 aydý (13-56 ay). Her iki grup arasýnda dirsek fleksiyonu, dirsek ekstansiyon kontraktürü, DASH skoru açýsýndan istatiksel açýdan anlamlý fark bulunmazken, triceps gücü açýsýndan anlamlý fark elde edildi. Klinik olarak hastalarda ortalama 13,2 (12-26) haftada kaynama gerçekleþtiði görüldü.

Tartýþma
Sonuç olarak humerus þaft kýrýklarýnda gerek triceps sparing gerekse triceps splitting yaklaþým operasyonu gerçekleþtiren cerrahýn tecrübesine göre güvenle kullanýlabilir. Operasyonu gerçekleþtirecek cerrahýn tecrübesi ve kýrýk tipi seçilecek insizyonu belirlemede önemlidir. Triceps sparing yaklaþýmýn triceps bütünlüðünün korunmasý ve operasyon sonrasý triceps gücü açýsýndan üstünlüðü mevcuttur.

Objective: The aim of the current study was to compare patients with a diagnosis of humerus shaft fracture operated on with a triceps-sparing or triceps-splitting approach.
Methods and Material: Between 2014-2017, 39 patients (18 males, 21 females) were operated for humerus shaft fractures. The patients were separated into two groups, triceps-split or triceps-sparing, according to the surgical approach. At the final follow-up examination, ROM, isometric elbow extension, time to union, and muscle strength were measured. Functional evaluation was made using the Disabilities of the Arm, Shoulder and Hand (DASH) Score.
Results: The mean follow-up period was 18 months (range, 13-56 months). No statistically significant difference was determined between the groups in terms of elbow flexion, elbow extension contracture, or DASH score. The difference in triceps strength between the groups was statistically significant. Union was seen to occur clinically at mean 13.2 weeks (range, 12-26 weeks).
Conclusion: Both the triceps-sparing and triceps-splitting approaches can be used safely in humerus shaft fractures, and the experience of the surgeon can help determine which is best suited to the circumstances. The triceps-sparing approach offers the advantages of protecting the integrity of the triceps and providing better postoperative triceps strength.

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Background: Diabetic autonomic neuropathy (DAN) is one of the serious, microvascular complications of diabetes mellitus. Clinically the most important form of DAN is cardiovascular autonomic neuropathy (CAN). Determination of the presence of CAN is usually done by a battery of cardiovascular reflex tests. This study was aimed to compare the standard cardiovascular reflex tests between adolescents with diagnosed type 1 diabetes mellitus (T1 DM) and Healthy Controls.
Methods: A total of 64 subjects were recruited for this study. Mean age of case group was 16.15 ± 2.66 years and the mean age of control group was 17.13 ± 1.34 years. Mean duration of diabetes in them was 54.81± 33.57 months. Standard cardiovascular tests such as deep breathing test (DBT), Valsalva ratio (VR), Lying to standing test (LST or 30: 15 ratio) and cold pressor test (CPT) were performed.
Results: We found a significantly reduced LST (30: 15 ratio) in diabetic group. We also found a significantly reduced change in diastolic blood pressure (∆DBP) at 1 minute of CPT in diabetic group. Furthermore, greater the duration of disease lesser was the DBT.
Conclusions: A significantly reduced LST (30: 15 ratio) in diabetic group signifies reduced parasympathetic activity. Significantly a reduced value of ∆ DBP at the end of 1 minute of CPT implies a reduced sympathetic activity in this group of patients. It can be said that in these patients autonomic activity is compromised. Furthermore, the impairment in parasympathetic activity (DBT) is directly related to the duration of diabetes

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Giriþ: Pycnogenol® (PYC) çeþitli týbbi amaçlar için kullanýlmaktadýr. Bu çalýþmanýn amacý, farelerde PYC yüklü in situ jelin yara iyileþme aktivitesini deðerlendirmek ve antibakteriyel aktivitesini araþtýrmaktýr.
Yöntem: %5 PYC içeren sýcaklýða duyarlý in situ jel, Poloksamer 188, Poloxamer 407 kullanýlarak soðuk yöntemle formüle edilmiþtir. Boþ ve etkin madde yüklü in situ jel formülasyonlarý, berraklýk, pH, viskozite, jelasyon sýcaklýðý, jelleþme kapasitesi açýsýndan deðerlendirilmiþtir. PYC in situ jelin yara iyileþtirici etkisi in vivo yara modeli ile test edildi. PYC in situ jel 10 gün boyunca topikal olarak %5'lik bir konsantrasyonda uygulandý. Yara kapanmasý 10 gün boyunca ölçüldü ve 10. günde yara iyileþmesi anjiyogenez, granülasyon dokusu kalýnlýðý, epidermal ve dermal rejenerasyon seviyeleri ile deðerlendirildi. Antimikrobiyal özellik Agar well difüzyon testi ile deðerlendirildi.
Bulgular: In situ jellerin berraklýk, pH, viskozite, jelleþme kapasitesi uygun özellikte bulunmuþtur. PYC in situ jelin, yara modelinde kontrol grubuna kýyasla 10. günde yara alanýnda %86.91 küçülme ile belirgin yara iyileþme aktivitesine sahip olduðunu görüldü. Ayrýca PYC in situ jel, kontrol grubuna göre anjiyogenez, granülasyon dokusu kalýnlýðý, epidermal ve dermal rejenerasyon üzerinde anlamlý bir etki göstermiþtir. Buna ek olarak, PYC antibakteriyel ve antifungal aktivite göstermiþtir. En hassas suþlar B. cereus (23.66 mm), C. albicans (22.66 mm), S. aueus (23 mm) olarak belirlendi.
Sonuç: PYC içeren in situ jelin etkili bir þekilde yara iyileþmesini arttýrdýðý görülmüþ ve yapýlacak ileri çalýþmalarla yara iyileþmesinde etkili bir ajan olarak geliþtirilebileceði düþünülmektedir.

Introduction: Pycnogenol® (PYC) are used for various medicinal purposes. The aims of the present study were to evaluate wound healing activity of PYC loaded in situ gel in mice and to investigate its antibacterial activity.
Method: Temperature-sensitive in situ gel containing 5% PYC was formulated by cold method using Poloxamer 188, Poloxamer 407. Blank and drug loaded in situ gel formulations were evaluated for clarity, pH, viscosity, gelation temperature, gellation capacity. The wound healing effect was tested by excisional wound model. PYC in situ gel was administrated topically at a concentration of 5% for the 10 consecutive days after skin injury. Wound closure was measured for 10 days and at 10th day wound healing was assessed by levels of angiogenesis, granulation tissue thickness, epidermal and dermal regeneration. Antimicrobial ability was evaluated by Agar well diffusion test.
Findings: The clarity, pH, viscosity, gellation capacity of in situ gels was found to be satisfactory.Results showed that PYC in situ gel exhibited remarkable wound healing activity with the 86.91% reduction of the wound area at the day 10 on the circular excision wound model compared to control group. Moreover PYC showed significant effect on angiogenesis, granulation tissue thickness, epidermal and dermal regeneration compared to control group. In addition to this, PYC demonstrated antibacterial and antifungal activity. The most sensitive strains were B. cereus (23.66mm), C. albicans (22.66 mm), S. aueus (23mm).
Conclusion: Results indicated that PYC in situ gel enhanced wound healing effectively, and so may be developed as a cover to promote wound healing.

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Amaç: Hipergliseminin, glukoz oto-oksidasyonu sonucu serbest radikallerde bir artýþa ve bu radikallerin antioksidan savunma sistemini baskýlamasý sonucu lipit peroksidasyonuna neden olduðu bilinmektedir. Diyabetes mellitus ve komplikasyonlarýnýn önlenmesi ve tedavisinde antioksidan ajanlarýn kullanýmý geliþmekte olan bir trenddir. Stobadin pridoindol yapýda bir bileþiktir ve biyolojik sistemlerde etkili bir antioksidan olduðu bilinmektedir. Bu çalýþmada streptozotosin ile diyabet oluþturulmuþ sýçanlarýn karaciðer dokularýnda, stobadinin lipid peroksidasyonu ve Paraoksonaz-1 enzim aktiviteleri üzerindeki etkilerini araþtýrmayý amaçladýk.
Materyal ve Metod: Her biri 250 gr aðýrlýðýndaki toplam 60 adet Wistar erkek sýçan rastgele; Kontrol (K), Stobadin (STB), Diyabet (D) ve STB ile tedavi edilmiþ Diyabet (D+STB) gruplarýný oluþturmak üzere dört eþit gruba ayrýldý. Diyabet; periton içi streptozotosin (55 mg/kg) enjeksiyonu ile, Stobadin tedavisi ise 4 ay süre ile 25 mg/kg/gün oral Stobadin verilerek yapýldý. Sýçanlar anestezi sonrasý sakrifiye edildi. Porsiyonlandýktan sonra homojenize edilen sýçan karaciðer dokularýnda; Malondialdehid düzeyleri ve Paraoksonaz-1 enzim aktiviteleri manuel spektrofotometrik yöntemle ölçüldü.
Bulgular: K ve STB grubu ile karþýlaþtýrýldýðýnda, D grubunda, Malondialdehid düzeyleri anlamlý artmýþ, Paraoksonaz-1 aktiviteleri anlamlý azalmýþ bulundu (p<0.001). Stobadin ile tedavi edilen diyabetik ratlarýn ise D grubuna göre Malondialdehid düzeyleri azalýrken, Paraoksonaz-1 aktiviteleri anlamlý artmýþ bulundu (p<0.001). Malondialdehid düzeyleri ve Paraoksonaz-1 aktiviteleri açýsýndan K ve STB gruplarý arasýnda anlamlý fark bulunamadý (p>0.05). Malondialdehid düzeyleri ile Paraoksonaz-1 enzim aktivitesi arasýnda negatif orta derecede korelasyon saptandý (r = - 0.435, p < 0.001).
Sonuç: Stobadin verilmesinin, streptozotosin ile diyabet oluþturulmuþ ratlarýn karaciðer dokularýnda lipid peroksidasyonunu azalttýðý ve Paraoksonaz-1 enzim aktivitelerini arttýrdýðý bulunmuþtur. Diyabetes mellitus ve komplikasyonlarýnýn önlenmesi ve tedaviye destek için, Stobadin ve pridoindol türevlerinin kullanýldýðý yapýlacak daha ileri araþtýrmalarla, bu bileþiklerin potansiyel ajanlar olarak kullanýlmasý mümkün olabilir.

Aim: Diabetes is known to cause lipid peroxidation due to an increase in free radicals due to glucose auto-oxidation and by suppressing the antioxidant defense system of these radicals. Antioxidant therapy to manage diabetes mellitus and its complications is an emerging trend. Stobadine is a pyridoindole compound and is known to be an effective antioxidant in biological systems. In this study, we aimed to investigate the effects of stobadine on lipid peroxidation and paraoxonase-1 enzyme activities in liver tissues of streptozotocin-induced diabetic rats.
Materials and Methods: A total of 60 Wistar male rats, each weighing 250 g were randomly distributed into four groups; Control (C), Stobadine (STB), diabetic (D), treated with STB diabetic rat (D+STB). Diabetes was induced by a single intraperitoneal injection of streptozotocin (55 mg/kg) to animals fasted overnight. Stobadine was administrated to rats as 25 mg/kg/day orally for 4 months. Rats were sacrificed after anesthesia. Homogenized rat liver tissue after portioning; Malondialdehyde levels and PON-1 enzyme activities were measured by manual spectrophotometric method.
Results: Malondialdehyde levels were significantly increased and paraoxonase-1 activities were significantly decreased in group D compared to group C and STB (p <0.001). Malondialdehyde levels of diabetic rats treated with Stobadine decreased while paraoxonase-1 activities were significantly increased (p <0.001). No significant difference was found between C and STB groups in terms of MDA levels and paraoxonase-1 activities (p> 0.05). There was a negative correlation between MDA levels and paraoxonase-1 enzyme activity (r = - 0.435, p <0.001).
Conclusion: Stobadine administration was found to decrease lipid peroxidation and increase paraoxonase-1 enzyme activity in liver tissues of streptozotocin-induced diabetic rats. Further research using Stobadine and pridoindole derivatives may be possible to use these compounds as potential agents for the prevention of diabetes mellitus and its complications.

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Psychopharmacology especially behavioral study is a field of pharmacology that is getting broader attention in Nigeria due to the low quality of life and high prevalence of mental disorders such as anxiety. Various experimental models have been used successfully to demonstrate the anxiolytic property of medicinal plants using laboratory animals. Techniques such as open field test, elevated plus maze, staircase test method, light and dark box test, hole-board test, and beam walking assay are available and functioning effectively in various pharmaceutical research centers and higher institutions of learning in Nigeria. Consequently, this has led to the advancement made in the field of behavioral studies. Furthermore, these experimental models are easy to operate and, in many instances, yield promising and reproducible results. However, the accuracy and the validity of the outcome defend on the experience of the researcher, familiarization with laboratory animals and in-depth knowledge of animal psychology. It is recommended that experimental models for anxiolytic testing can be improved by making an automated apparatus connected to digital watches, video cameras and computers available in Nigeria. The primary goal of this paper is to discuss the most commonly available experimental models in the evaluation of the anxiolytic activity of medicinal plants in Nigeria and to give a recommendation for further improvement and drug development.

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Objective: Cochlear implantation (CI) is a safe procedure. Complications are rare but it can be fetal such as meningitis. Hematoma following CI is uncommon with prevalence of 0.9%. To best of our knowledge only few cases reported in English journal pertaining to hematoma following CI.

Case Presentation: We present an 18 years old lady with bilateral congenital profound sensorineural hearing loss. She had unilateral CI at age of three. She presented with acute onset recurrent painful swelling at receiver site fifteen years post CI. There is no significant otological finding on examination. Ultrasonography showed anechoic collection superficial to cochlear implant. She was treated with intravenous antibiotic and compression mastoid bandage. She had clinical improvement and was discharged. However swelling recurred. She was immediately admitted and had needle aspiration under ultrasound guidance with application of compression mastoid bandage subsequently.

Conclusion: Hematoma post CI has varying time frame in its development, as early as days up to years due to multiple etiologies such as trauma, coagulopathy, and idiopathic cause. A prompt recognition and treatment must be instituted to prevent further complications. We recommend longer use of mastoid compression bandage for 48-72 hours in adjunct with needle aspiration under ultrasound guided.

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Kollisyon tümör ayný lezyonda 2 ya da daha fazla tümörün birlikte görülmesidir. Bu tümörlerin rastlantýsal ya da tümörlerden birinde geliþen epitelyal ve stromal deðiþikliklere cevap olarak ortaya çýktýðý düþünülmektedir. Derinin kollisyon tümörleri nadir görülür. Bu olguda 48 yaþýnda kadýn hastanýn burun üzerinde yerleþimli nodüler lezyonu sunulmuþtur. Histopatolojik incelemede ayný lezyonda geliþen keratoakantoma benzeri skuamöz hücreli karsinom ve bazal hücreli karsinomun kollisyon tümörü gösterilmiþtir. Ýlk tümör derine uzaným gösteren keratinize skuamöz hücre adalarýndan oluþmaktaydý. Keratoakantoma benzeri alanlarýn zemininde dermise invaze atipik skuamöz hücre adalarý izlendi. Bu alanlara bitiþik periferal palizatlama gösteren bazofilik hücre adalarý izlendi. Bu nedenle kollisyon tümör olarak deðerlendirildi.

Collision tumor refers to 2 or more different neoplasms within the same lesion. This tumor was considered coincidental, or the presence of one tumor may cause epithelial and stromal changes responsible for the development of the other tumor. It is very rarely in the skin. We report here a 48-year-old woman with a nodule on the nose for a very long time. The histological examination showed the presence of a collision tumor with keratoacanthoma-like squamous cell carcinoma and basal cell carcinoma in the same lesion. The first tumor was composed of deeply elongated solid islands of squamous cells with keratinization. At the bottom of the keratoacanthoma-like areas, there were malign tumor islands with atypical squamous cells with invasion to the dermis. Near this area, there was basal cell carcinoma, which demonstrated aggregates of basophilic staining neoplastic cells with well-defined contours palisading the peripheral row of cells. So, we evaluated it as a collision tumor.

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Metastatic skull base tumors occur in 4% of patients with systemic malignancy1, most commonly prostate (38%), breast cancer (20.5%), lung (6%) and they usually present with cranial neuropathies.2 We discuss a case that presented with otological and jugular fossa syndrome symptoms as the initial presentation for non-small cell lung carcinoma. So far, only one similar case had been reported. 3
A 57-year-old male presented with left reduced hearing, tinnitus and features of jugular fossa syndrome for five months. Examination revealed left IX, X, XI, XII cranial nerve palsy with no abnormality on lung examination and chest X-ray. Computed tomography of brain, skull base and neck showed ill-defined heterogenous enhancing mass occupying the jugular fossa with surrounding erosion suggestive of glomus jugulare. Two weeks later, he showed clinical evidence of primary lung malignancy and bronchial biopsy returned as non-small cell carcinoma of the lung. The jugular fossa tumor was later confirmed by magnetic resonance imaging to be a metastatic skull base tumor.
In conclusion, high index of suspicion must be applied when investigating any jugular foramen tumor as it may be a metastatic lesion from an asymptomatic primary.

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Pyogenic granuloma of the oral cavity is rare, more so over the tongue in a young child. It is a soft tissue lesion thought to be due to reactive exuberant tissue reaction to local irritation or trauma. We report a case of a recalcitrant huge pyogenic granuloma in a 3 years old girl who had the lesion ever since she was 1 year old in which there was a recurrence after surgical excision. Radiological imaging suggested the lesion as a lingual hemangioma arising from the lingual arteries. Trial of propranolol was in vain and subsequent re-excision and avoidance of irritative factors turned out to be successful in treating her condition.

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