Amaç: Glenoid kemik morfolojisi ile Bankart lezyonlarý arasýndaki iliþki iyi aydýnlatýlmamýþtýr. Bu çalýþmada ilk kez travmatik çýkýklarý olan hastalarda glenoid boyutlarý ile labral yýrtýk oluþumu arasýndaki iliþki incelenmiþtir.
Hastalar ve Yöntem: Bu retrospektif kohort çalýþmasýnda, ilk kez glenohumeral dislokasyonu olan ve kriterleri karþýlayan 226 hasta deðerlendirildi. Hastalar iki gruba ayrýldý: Bankart lezyonu olanlar (Grup 1, n=113) ve olmayanlar (Grup 2, n=113). Tüm hastalar için standart omuz MRG sekanslarý alýndý. Buna göre iki boyutlu glenoid ölçümleri yapýldý: en uzun superior-inferior (SI) uzunluk, ön-arka geniþlik (AP), glenoid uzunluðunun 2/3 seviyesindeki en uzun ön-arka geniþlik (DD) ölçüldü. Ayrýca uzunluk ve geniþlik oranlarý (SI/AP, SI/DD, AP/DD) hesaplandý. Gruplar, glenoid boyutlarý ve boyut oranlarý açýsýndan karþýlaþtýrýldý.
Bulgular: Gruplar arasýnda yaþ (p=0.109), cinsiyet (p=0.086), AP (p=0.086) ve DD geniþlikleri (p=0.881), AP / DD oraný (p=0.764) açýsýndan fark yoktu. Grup 1'deki hastalarýn SI ortalama deðeri Grup 2'den anlamlý olarak yüksekti (p=0.024). Grup 1'deki hastalarýn ortalama SI/AP ve SI/DD oranlarý Grup 2'den anlamlý olarak yüksekti (sýrasýyla, p <0.001 ve p = 0.039).
Sonuç: Bu çalýþmanýn bulgularý, glenoid boyutlarý ile Bankart lezyonlarýnýn ortaya çýkýþý arasýnda bir iliþki olduðunu göstermektedir. SI uzunluðunda, SI / AP ve SI / DD oranlarýndaki artýþ, Bankart lezyonlarýnýn oluþumu ile iliþkilidir.

Purpose: The relationship between glenoid bony morphology and Bankart lesions has not been well elucidated. There could be an association between the dimensions of glenoid and occurrence of labral tears in patients with first time traumatic dislocations.
Methods: This retrospective cohort study of first time dislocators identified 226 patients who met criteria. Patients were divided into two groups: those with a Bankart lesion (Group 1, n=113) and those without (Group 2, n=113). Standard shoulder MRI sequences were obtained for all patients. Two-dimensional glenoid measurements were made accordingly: the most superior to inferior (SI) length, the greatest anterior and posterior width (AP), and the most anterior and posterior width at a point 2/3 of the glenoid length (DD). Also, ratios of length and width (SI/AP, SI/DD, AP/DD) were calculated. The groups were compared in terms of the glenoid dimensions and dimension ratios.
Results: There was no difference between groups in terms of age (p=0.109), gender (p=0.086), AP (p=0.086) and DD widths (p=0.881), AP/DD ratio (p=0.764). The SI mean value of the patients in Group 1 was significantly higher than Group 2 (p=0.024). The mean SI/AP and SI/DD ratios of patients in Group 1 was significantly higher than Group 2 (p<0.001 and p=0.039, respectively).
Conclusions: The results of this study show a relationship between glenoid dimensions and occurrence of Bankart lesions. An increase in the SI length, SI/AP, and SI/DD ratios shows an increase incidence in the occurrence of Bankart lesions.

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Amaç: Amiyotrofik Lateral Skleroz (ALS) spinal ve kortikal motor nöronlarý etkileyen nörodejeneratif bir hastalýktýr. Motor nöron dejenerasyonu ise kaslarda ilerleyici atrofiye sebep olur. ALS’ye neden olan genlerden biri Als2 (alsin) genidir ve UXT geni de Als2 ile etkileþimde olan genleden biridir. UXT proteininin NF-κB kompleksinde kofaktör olarak rol aldýðý da bilinmektedir. Bu çalýþmadaki amacýmýz Als2’nin susturulmasýnýn NF-κB aktivitesindeki olasý etkilerini N2a ve C2C12 hücre hatlarýnda karþýlaþtýrmaktýr.

Yöntem: Bu çalýþmada fare nöroblastoma hücreleri (N2a) ile fare miyoblast hücreleri (C2C12) kullanýldý. Söz konusu hücrelerde Als2 geni RNAi ile susturuldu ve UXT, IL8 ve A20 genlerinin ekspresyonlarý qRT-PCR ile ölçüldü. Veriler Student t-tes kullanýlarak istatistiksel olarak deðerlendirildi.

Bulgular: N2a hücrelerinde Als2 ekspresyonundaki azalýþ %73,4 olurken C2C12 hücrelerinde %73,7’lik bir düþüþ gözlendi. Als2 geni susturulmuþ N2a hücrelerinde UXT seviyesi %40 azalýrken, C2C12 hücrelerinde 9 katlýk bir UXT artýþý saptandý. IL8 ekspresyonu N2a hücrelerinde %84’lük bir düþüþ gösterdi, ancak C2C12 hücrelerinde IL8 ekspresyonu 50 katlýk bir yükseliþ kaydetti. Öte yandan A20 ekspresyonu N2a hücre hattýnda %65 artarken, bu artýþ C2C12 hücre hattýnda 10 misli olarak gerçekleþti.

Sonuç: Als2 geninin susturulmasýnýn UXT üzerinden NF-κB yolaðýna olan etkilerinin farklý olduðu sonucuna ulaþýlmýþtýr. Bu sonuca IL8 ve A20 genlerinin ekspresyonlarýndaki deðiþimlerin her iki hücre hattýnda da farklýlýk göstermesi üzerinden varýlmýþtýr. Ayrýca Als2 ve UXT arasýndaki baðlantý her iki hücre hattýnda da tekrar gösterilmiþ ve Als2’nin susturulmasýnýn nöronal hücreler ile kas hücreleri açýsýndan farklý sonuçlar doðurabileceði de anlaþýlmýþtýr.

Aim: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disorder affecting spinal and cortical motor neurons. Motor neuron degeneration leads to progressive muscular atrophy. Als2 (alsin) is one of the causative genes of ALS and UXT gene is an interacting partner of Als2. Since UXT is a known cofactor in NF-κB enhancesome, we aimed here to compare the effects of Als2 silencing on NF-κB activity by using N2a and C2C12 cell lines.

Methods: Mouse neuroblastoma and myoblast cell lines (N2a and C2C12) were used. Als2 was silenced by RNAi and UXT, A20 and IL8 expressions were measured by qRT-PCR. Data were statistically evaluated by Student t-test.

Results: In N2a cells, 73.4% Als2 transcript decrease was observed, whereas in the C2C12 cells 73.7% decrease was found. UXT expression in Als2-silenced N2a cells was found to be decreased by 40%, while in Als2-silenced C2C12 it increased 9-fold. IL8 expression was found to be decreased by 84% in N2a cells, on the other hand, in C2C12 cells it increased approximately by 50-folds. A20 expression was found to be upregulated by only 65% in N2a cells, whereas it was drastically increased (10-folds) in C2C12 cells.

Conclusion: In these cell lines, responses to Als2 knock-down in terms of UXT gene expression were different. These responses were followed by investigating the expression levels of IL8, and A20. Our findings show that not only the Als2 protein interacts with UXT, but the Als2 gene expression affects the UXT gene expression both in N2a cells and C2C12 myoblasts.

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Amaç: Dermoskopik muayene sýrasýnda izlenen vasküler paternler, önemli tanýsal ipuçlarý olarak kabul edilir ve birçok deri lezyonu karakteristik bir vasküler paterne sahiptir. Polimorf vasküler patern (PVP) sýklýkla, malign lezyonlarýn vasküler paterni olarak deðerlendirilmektedir. Bu çalýþmada, sýk görülen benign deri tümörlerinde dermoskopik PVP sýklýðýnýn araþtýrýlmasý amaçlanmýþtýr.
Materyal Metod: Bu çalýþmaya iki farklý merkezden toplanan, histopatolojik olarak doðrulanmýþ olan sýk görülen benign deri tümörleri dahil edilmiþtir. Tüm lezyonlarýn dermoskopik görüntüleri, retrospektif olarak incelenmiþ ve polimorf vasküler patern gösteren lezyonlar tespit edilmiþtir.
Bulgular: Histopatolojik olarak tanýnýn doðrulandýðý toplamda 350 benign deri tümörü PVP varlýðý açýsýndan deðerlendirilmiþtir. Dermal/konjenital nevüslerin yüzde 9’u, seboreik keratozlarýn yüzde 13’ü, viral siðillerin yüzde 5’i PVP göstermiþtir. Dermatofibroma olgularýnda PVP izlenmemiþtir.
Sonuç: Çalýþmamýz, PVP’nin benign tümörlerde çok nadir rastlanýlan bir vasküler patern olmadýðýný göstermiþtir. Biz, dermoskopik PVP’nin tek baþýna bir malignite bulgusu olarak görülmemesi ve diðer yapýsal dermoskopik bulgular baðlamýnda deðerlendirilmesi gerektiðini düþünüyoruz.

Aim: The vascular patterns observed in dermoscopic examination are considered to be important diagnostic clues and many skin lesions show a characteristic vasculature. Polymorphous vascular pattern (PVP) is usually thought to indicate malignant cutaneous tumors. In this study, we aimed to investigate the frequency of PVP in common benign cutaneous tumors.
Material and Methods: Dermoscopic images of histopathologically proven common benign cutaneous tumors collected from two centers were examined retrospectively and the lesions showing a combination of two vessel patterns were detected.
Results: A total of 350 histopathologically confirmed benign cutaneous tumors were evaluated regarding the presence of PVP. Nine percent of dermal/congenital nevi (n=9), 13 percent (n=13) of seborrheic keratoses and 5 percent of viral warts (n=5) showed PVP. None of the dermatofibromas exhibited PVP.
Conclusion: To the best of our knowledge, this is the only study primarily focusing on the PVP in benign skin growths. Our study showed that PVP is not a very rare dermoscopic vascular pattern in benign skin tumors. We suggest that PVP alone should not be accepted as a dermoscopic sign indicating malignancy and should be evaluated in context of the other present structural dermoscopic findings.

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Amaç: Hekimler çalýþma ortamlarýnda çeþitli duygusal ve fiziksel streslere maruz kalýrlar. Acil servisler özellikle stresli çalýþma ortamlarýdýr. Bu çalýþmada acil týp uzmanlarýnda (ATU) ve diðer klinik uzmanlarýnda anksiyete sýklýðýnýn belirlenmesi amaçlanmýþtýr.
Metot: Türkiye'deki hastanelerde çalýþan ve bu kesitsel anket çalýþmasýna gönüllü olarak katýlmayý kabul eden uzman hekimler çalýþmaya dahil edilmiþtir. Doktorlar, Beck anksiyete puanlarýna göre gruplandýrýlmýþ ve özellikleri karþýlaþtýrýlmýþtýr. Hekimlerin anksiyete sýklýðý ve diðer özellikleri incelenmiþtir.
Bulgular: Analize dahil edilen 508 uzman doktorun (erkek: %71.9; ortalama yaþ: 37.5 ± 7.2) 97'si (%19,1) ATU, 411'i (%80,9) diðer klinik dallarda uzmandý. Beck anksiyete skorlarý ortalama 9.6 ± 7.7 olarak saptandý. Orta ve þiddetli anksiyete düzeyinde olan uzman doktorlarýn yüzdeleri sýrasýyla %13.8 ve %2.8 idi. Orta-þiddetli anksiyetesi olanlarýn sýklýðý %16.5; bu oran ATU’larda diðer klinik uzmanlarýnkinden daha yüksekti (sýrasýyla %33 ve %12,7). ATU ve diðer klinik uzman doktorlarýnýn ortalama Beck anksiyete düzeyleri sýrasýyla 13±9.3 ve 8.7±7.0 olarak saptandý (p<0.001). Anksiyete skoru yaþ ve uzman olarak çalýþma süresi ile negatif korelasyon gösterdi. Acil hekimlerinde sigara içme (p=0.008) ve alkol tüketimi (p=0.003) ile anksiyete skorlarý daha yüksek iken uzman olarak çalýþma süreleri daha kýsaydý (p<0.001).
Sonuç: Uzman doktorlarda anksiyete sýklýðý yüksektir. Branþlar dikkate alýndýðýnda, acil týp uzmanlarýnda saptanan yüksek anksiyete düzeyi, bu alandaki çalýþma koþullarýnýn araþtýrýlmasý ve koruyucu ve önleyici politikalarýn geliþtirilmesi için bir rehber olabilir.

Background: Physicians are exposed to various emotional and physical stressors in their working environment. Emergency departments are particularly stressful working environments. This study aimed to determine the frequency of anxiety in emergency physicians (EP) and other medical specialists.
Methods: This cross-sectional survey included voluntarily participated physicians working in hospitals in Turkey. Physicians were grouped based on their Beck anxiety scores (BAS) and their characteristics were compared. The frequency of anxiety and other characteristics of the physicians were investigated.
Results: 508 medical specialists (male 71.9%; mean age 37.5±7.2 years) included in the analysis; 97 (19,1%) were EP and 411 (80,9%) were from other medical specialties. The mean BAS was 9.6±7.7. The percentages of medical specialists with moderate and severe anxiety were 13.8%, and 2.8%, respectively. The frequency of those with moderate-severe anxiety was 16.5%; it was found higher in emergency physicians than in other physicians (33% and 12.7%, respectively). The mean BAS of EP and other medical specialists were found as 13±9.3 and 8.7±7.0, respectively (p<0.001). Anxiety score showed a negative correlation with age and duration of working as a specialist. In the emergency physicians, the rates of smoking (p=0.008) and alcohol consumption (p=0.003) and anxiety scores were higher and the duration of working as a specialist was shorter (p<0.001).
Conclusions: Frequency of anxiety is high among physicians. Considering medical specialties, higher level of anxiety determined in the EP might be a guide for investigation of working conditions in this field and for development of protective and preventive policies.

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Giriþ: Lösemi, hematopoetik sistemin kanseridir ve kan öncül hücrelerinin anormal proliferasyonu ile karakterizedir. Diðer kanser hücreleri gibi lösemi hücreleri de hýzla çoðalýr ve artmýþ besin gereksinimleri vardýr. Kanser hücreleri tarafýndan en yaygýn olarak kullanýlan besin maddesi glukozdur ve bu nedenle kanser hücrelerinin çevresinde düþük seviyede glikozun bulunduðu varsayýlmaktadýr. Lösemi hücrelerine besin eksikliði meydana gelen metabolik deðiþiklikler nedeniyle ekstra sorumluluk katar. Son zamanlarda yapýlan çalýþmalarda, farklý tümörlerde artmýþ glikoliz ve yeniden programlanmýþ glikoz metabolizmasý gösterilmiþtir. Heksokinaz, fosfodruktokinaz, piruvat dehidrojenaz kinaz ve laktat dehidrojenaz enzimlerini içeren glikoliz ara adýmlarý reaksiyonda hýz sýnýrlayýcý adýmlardýr ve artan ekspresyonlarý löseminin zayýf prognozu ile iliþkilendirilmiþtir.Bu çalýþmanýn amacý düþük glukoz konsantrasyonlarýnda glikolizde rol alan genlerin ekspresyonlarýný araþtýrmaktýr.
Yöntem: Bu çalýþmada, normal (10 mM) ortama kýyasla düþük glikozlu (1 mM) ortamda, K562, NB-4 ve HL-60 hücre hatlarýnda hýz sýnýrlayýcý glikolitik enzimlerin mRNA ifadelerini qRT-PCR ile kontrol ettik.
Bulgular: PKM2 ve LDHA mRNA ifadelerinin düþük glukoz koþullarýnda önemli ölçüde azaldýðýný bulduk. Öte yandan, HK1 ve HK2 mRNA’larý ise K562 hücrelerinde artmýþtýr (p <0.001). K562 hücrelerinde PFKL ekspresyonunun azaldýðýný da bulduk.
Sonuç: Sonuçlarýmýz, glikoz metabolizmasýnýn hedeflenmesinin glikolitik genlerin ekspresyonunu azaltabileceðini ve dolayýsýyla glukoz metabolizmasýnýn lösemi tedavisinde bir hedef olabileceðini göstermektedir.

Aims: Leukemia is the cancer of hematopoietic system and is characterized by abnormal proliferation of blood precursor cells. Leukemia cells as other cancer cells multiply rapidly and they have increased nutrient needs. The most commonly used nutrient by cancer cells is glucose and therefore it is hypothesized that glucose is present at a low level in the microenvironment of cancer cells. Metabolic changes in leukemia cells due to nutrient deficiency add liabilities to the cells. In recent studies, increased glycolysis and reprogrammed glucose metabolism have been shown in different tumors. Glycolysis intermediate steps involving hexokinase, phosphofructokinase, pyruvate dehydrogenase kinase and lactate dehydrogenase enzymes are rate-limiting steps in the reaction and increased expressions were correlated with poor prognosis of leukemia.The aim of this study is to investigate the expression of glycolytic genes in low glucose conditions.
Methods: In this study, we control expression of rate-limiting glycolytic enzymes’ mRNA expressions in K562, NB-4 and HL-60 cell lines in low glucose (1mM) medium compare to normal (10mM) medium with qRT-PCR assay.
Results: We found that PKM2 and LDHA mRNA expressions were significantly decreased in low glucose conditions. On the other hand, HK1 and HK2 expressions were increased in K562 cells (p<0.001). We also found that PFKL expression was decreased in K562 cells.
Conclusion: Our results show that targeting glucose metabolism can reduce expression of glycolytic genes and therefore suggest in compliance with the literature that glucose metabolism may be a target in the treatment of leukemia.

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Giriþ ve Amaç

Alarngeal konuþmanýn akustiðinde en temel iki parametre; ünlülerin formant frekanslarý ve durasyon özellikleridir. Ancak; vokal yolun iletim özellikleri ve ünlülerin zamansal özellikleri alryngeal konuþma türüne göre farklýlýk göstermektedir.
Bu çalýþmanýn temel amacý Türkçe ünlülerin formant frekans ve durasyon özelliklerinin özefageal, trakeoözefageal ve laryngeal konuþmacýlar arasýnda karþýlaþtýrýlmasýdýr.

Gereç ve Yöntem 
Bu çalýþmada Türkçe’de yer alan 8 ünlünün formant frekans ve durasyon deðerleri tespit edilmiþ ve bu deðerler özefageal, trakeoözefageal ve laryngeal konuþmacýlar arasýnda karþýlaþtýrýlmýþtýr. Formant Frekansýn tespiti, Linear Productive Coding ve Fast Fourier Transform yöntemiyle yapýlmýþtýr. 
Bulgular 
Alaryngeal konuþmacýlarýn /y/ ve /i/ ünlüleri hariç diðer ünlülerde 1. Formant Frekans (F1) ve 2. Formant Frekans (F2) deðerleri, sözcük baþý ve sözcük sonunda laryngeal konuþmacýlardan daha yüksek bulunmuþtur. Alaryngeal konuþmacý gruplarýnýn ünlü alanlarý daralmýþtýr. Tüm konuþmacýlarda sözcük sonundaki ünlülerin sözcük baþýndakine göre durasyonlarý daha uzun tespit edilmiþtir.
Tartýþma ve Sonuç 
Bu çalýþmanýn sonuçlarý, genel olarak, alaryngeal konuþmacýlarda vokal traktýn daha kýsa ve dilin yüksek-önde pozisyonlandýðýný desteklemektedir. Literatürdeki diðer çalýþmalar arasýndaki küçük farklýlýklarýn, kullanýlan ünsüzler ve koartikülasyon farklýlýklarýndan kaynaklanabileceði düþünülmektedir.
Ayrýca elde edilen bulgular tarakeözefageal konuþmanýn, özefageal konuþmaya kýyasla laryngeal konuþmaya daha benzer olduðunu iþaret etmektedir. Ancak, bu çalýþmanýn bulgularýný doðrulamak için daha fazla sayýda katýlýmcý içeren daha fazla çalýþmaya ihtiyaç vardýr.

Objective 
In the alaryngeal speech acoustics, formant frequencies and durations of vowels are two main parameters searched. However, it is not clear if the vocal tract transmission properties and temporal characteristics of vowels vary related to alaryngeal speech type.
The main purpose of this study is to compare the formant frequeny and duration characteristics of Turkish vowels between the esophageal, tracheoesophageal, and laryngeal speakers. 
Methods 
Formant frequency and duration values of 8 Turkish vowels have been defined and these values are compared between the esophageal, tracheoesophageal, laryngeal speakers. Detection of a formant was based on Linear Predictive Coding and Fast Fourier Transform. 
Results 
Except the vowels /y/ and /i/; F1 and F2 values of alaryngeal speakers were higher than laryngeal speakers both in the initial and final position. Alaryngeal groups’ vowel space areas have been diminished. The vowels in the final position had longer durations comparing to initial position in all groups. 
Conclusion 
The results of this study generally supported the shorter vocal tract and fronted-higher tongue position in Turkish alaryngeal speakers. The minor differences between other studies thought to be arised from the consonantal context and possible coarticulatory effects. Acoustic findings obtained in the present study, indicated that TES was more like laryngeal speakers as compared to ES. However, further studies including higher number of participants are needed to verify the findings of this study.

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Amaç: Epikardiyal yað dokusu, dolaþýmdaki biyobelirteçlerin plazma konsantrasyonundan ve hastanýn geleneksel risk faktörlerinden baðýmsýz olarak meydana gelen kardiyovasküler olaylarýn önemli bir prediktif faktörüdür. Çalýþmamýzda, obezite, yüksek serum lipid ve konvansiyonel C-reaktif protein seviyeleri gibi geleneksel risk faktörlerinden baðýmsýz olarak, migren ile kardiyovasküler risk arasýndaki baðlantý riskini saptamak için hem epikardiyal yað dokusu kalýnlýðýný hem de karotis intima media kalýnlýðýný deðerlendirmeyi amaçladýk.
Yöntem: Kýrkbeþ adet migren hastasý, kýrk yedi yaþ ve cinsiyet olarak uyumlu saðlýklý çocuk deðerlendirildi. Ekokardiyografi ile ölçülen karotis intima media ve epikardiyal yað dokusu kalýnlýðý parametreleri iki grup arasýnda karþýlaþtýrýldý.
Bulgular: Migren ve kontrol grubundaki çocuklar arasýnda koroner vasküler deðiþikliklerle iliþkili olduðu bilinen serum lipid düzeyleri, C-reaktif protein düzeyleri açýsýndan anlamlý fark saptanmadý. Çalýþma grubu ile kontrol grubu karþýlaþtýrýldýðýnda karotis intima media ve epikardiyal yað dokusu kalýnlýðý deðerlerinde istatistiksel olarak anlamlý fark bulundu (p <0.001). Migren grubunda karotis intima media ile epikardiyal yað dokusu kalýnlýðý deðerleri arasýnda istatistiksel olarak anlamlý bir iliþki bulundu.
Sonuç: Karotid arterdeki erken vasküler deðiþiklikler, migrenli çocuklarda epikardiyal yað dokusu kalýnlýðýnýn proinflamatuar ve enflamatuar özellikleriyle iliþkili olabilir. Bu nedenle, migren ataklarý olan çocuklarda, geleneksel risk faktörlerinden baðýmsýz olarak, kardiyovasküler olay riskinin arttýðýný tespit edebileceðimizi düþünebiliriz.

Background: Epicardial adipose tissue is an important predictive factor of incident cardiovascular events independent from the plasma concentration of circulating biomarkers as well as patient’s traditional risk factors. In our study, we aimed to evaluate both epicardial adipose tisssue thickness and carotid intima media thickness to detect the link between migraine and the increased risk of cardivascular events in children with migraine, independent from traditional risk factors like obesity, high serum lipid and conventional C- reactive protein levels.
Methods: Forty-five patients with migraine and forty-seven age and gender matched healthy children were assesed. carotid intima media and epicardial adipose tissue thickness parameters measured by echocardiography were compared between two groups.
Results: No significant difference was detected in children with migraine and control group in terms of serum lipid levels, C- reactive protein levels that are known to be related with coronary vascular changes between two groups. The statistically significant difference was found in carotid intima media and epicardial adipose tissue thickness values between the study and control group (p< 0.001). We found a significantly positive correlation between carotid intima media and epicardial adipose tissue thickness values in migraine group.
Conclusion: Early vascular changes in carotid artery can be related to the proinflammatory and inflammatory properties of epicardial adipose tissue thickness in children with migraine. So, we can consider that independent from the traditional risk factors we can detect the increased risk of cardiovascular events in children with migraine attacks.

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Amaç
Bu çalýþmanýn amacý, üreterolitiazisli hastalarda bilgisayarlý tomografi üzerindeki kirli mezenter bulgusunu deðerlendirmektir.
Yöntem
Bu retrospektif çalýþmaya 3 yýllýk zaman aralýðýnda abdominal bilgisayarlý tomografi ile üreter taþý tanýsý konulan tüm hastalar dahil edildi. Bilgisayarlý tomografi görüntüleri, kirli mezenterin varlýðý ve iliþkilerini, üreter çapý, taþlarýn hacmini ve yerini, periüreteral ve perinefrik yaðlý planlarda çizgilenmenin varlýðýný, perirenal fasya kalýnlaþmasýný, nefromegali ve hidronefroz derecesini deðerlendirmek için gözden geçirildi.
Bulgular
Çalýþmaya 434 hasta dahil edildi. Hastalarýn 62’sinde(% 14.2) kirli mezenter saptandý. Kirli mezenteri olan hastalarýn yaþý (yaþ ortalamasý = 37,3 ± 10,9), olmayanlara kýyasla anlamlý olarak daha büyük bulundu (yaþ ortalamasý = 45,2 ± 12,2) (p = 0,022). Perirenal fasyal kalýnlaþma 101 (% 23.2) hastada tespit edildi ve kirli mezenter ile anlamlý bir þekilde iliþkili bulundu (ꭓ2 = 7.74, p = 0.005). Ýki yüz hastanýn (% 46) kirli mezenter ile anlamlý olarak iliþkili olduðu belirtilen periüreteral yaðlý planlarda çizgilenme sergilediði kaydedildi (ꭓ2 = 13.6, p = 0.000). Kirli mezenter ile pelvikaliksiyel ektazi, perinefrik yaðlý planda çizgilenme, taþýn üretral yerleþim yeri ve nefromegali arasýndaki iliþki istatistiksel olarak anlamlý bulunmadý.
Sonuç
Bilgisayarlý tomografi incelemede üreterolitiazis ve kirli mezenter birlikte izlenebilir. Üreterolitiazis ve kirli mezenter arasýnda potansiyel bir iliþki olabilir.

Purpose
The purpose of this study is to evaluate the misty mesentery sign on computed tomography in patients with ureterolithiasis.
Methods
This retrospective study enrolled all consecutive patients with ureteral stone diagnosed in abdominal computed tomography in the 3-year study period. Computed tomography scans were reviewed to assess the presence and interrelations of misty mesentery, ureteral diameter, volume and location of stones, presence of periureteral and perinephric stranding, thickening of the perirenal fascia, nephromegaly, and grade of hydronephrosis.
Results
Four hundred thirty-four patients were included in the analysis. Misty mesentery was identified in 62 (14.2%) patients. Patients with misty mesentery were significantly older (mean age=45.2±12.2) than those without (mean age=37.3±10.9) (p=0.022). Perirenal fascial thickening was identified in 101 (23.2%) patients and found to be significantly associated with misty mesentery (ꭓ2=7.74, p=0.005). Two hundred patients (46%) were noted to exhibit periureteral stranding which was noted to be significantly related with misty mesentery (ꭓ2=13.6, p=0.000).The relationship between misty mesentery and pelvicalyceal ectasia, perinephric stranding, ureteral location of the stone, and nephromegaly were not found statistically significant.
Conclusions
Ureterolithiasis can be accompanied by misty mesentery at computed tomography examination. There may be a potential association between ureterolithiasis and misty mesentery.

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Amaç: Somatostatin, endokrin sistem üzerinde etkii ve majör görevi inhibisyon olan asidik bir peptittir. Somatostatin analoglarý ile tedavi edilen gastrointestinal nöroendokrin tümörlü (NET) hastalarda prostatta boyutsal bir deðiþimin olup olmadýðýný deðerlendirmeyi amaçladýk.
Metod: Hastalarýn çoðuna noröenokrin tümör nedenyle, intramusküler olarak 4 hafta arayla 30 mg uzun etkili oktreotid asetat verildi. Sadece 1 hasta, her 4 haftada bir subkutan 120 mg baþka uzun etkili somatostatin diðer bir analog olan lanreotid aldý. Somatostatin analog tedavisi altýnda bazal ve yanýt deðerlendirme sürecinde çekilen bilgisayarlý tomografi görüntüleri ile prostat volüm deðerlendirilmesi yapýldý.

Bulgular: Somatostatin analoðu alan toplam 15 NET hastasý analiz edildi. On üç (% 86.6) hastada somatostatin analog kullanýmýndan sonra prostat hacmi azalmýþ olarak saptandý. Somatostatin analog kullanýmý ile ortanca azalmýþ hacim 5.66 (1.97-9.60) cc idi (ortanca tedavi süresi 3.2, 2.8-8.6 aydý). Tüm hastalarda medyan OS 34.8 ay (% 95 CI 13.8-55.9) idi. Prostat hacmi azalmýþ hastalarda 36.1 ay (% 95 CI 9.5-62.7) ve prostat hacimleri deðiþmeden kalanlarda 21.7 (% 95 CI 6.9-36.5) idi (p = 0.14).

Sonuç: NET hastalarýnda somatostatin analog tedavisi, prostat hacimlerinin düþmesine neden oldu. Prostat hacmi artmýþ hastalarýnýn tedavisinde somatostatin analoðunun potansiyel terapötik rolü prospektif çalýþmalarda deðerlendirilebilir.

Aim: Somatostatin is a acidic peptide that has major inhibitory function on endocrine system. We aimed to assess whether a dimensional change on the prostate is possible in patients with gastrointestinal neuroendocrine tumors, who treated with somatostatin analogs.

Methods: Majority of the patients were intramuscularly given 30  mg long-acting octreotide acetate into the gluteal muscle with 4-week intervals. Only 1 patient received 120 mg of another long-acting somatostatin analog subcutaneously every 4 weeks. Baseline and follow-up CT studies of the patients who under treatment of somatostatin analogs were performed.

Results: A total of 15 NET patients who received somatostatin analog were analyzed. Thirteen (86.6%) patients had reduced prostate volume after somatostatin analog use. Median reduced volume was 5.66 (1.97-9.60) cc with somatostatin analog use (median treatment time was 3.2, 2.8-8.6 months). Median OS was 34.8 months (95%CI 13.8-55.9) in all patients. It was 36.1 months (95%CI 9.5-62.7) in patients with reduced prostate volume and 21.7 (95%CI 6.9-36.5) in those whose prostate volumes remained unchanged (p=0.14).

Conclusions: Intriguingly, somatostatin analog treatment in NET patients has remarkably resulted in decreased prostate volumes. Potential therapeutic role of somatostatin analog in the treatment of BPH patients might be evaluated in prospective studies.

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Giriþ: Serebral palsili hastalarda gözlenen artmýþ hamstring kas gerginliði diz fleksiyon kontraktürünün en sýk rastlanan sebebidir ve hamstring uzatma cerrahisi bu problem için uygulanan yararlý bir yöntemdir. Bu çalýþmada açýk ya da perkütan yöntemle uygulanan hamstring uzatma cerrahisi sonuçlarýnýn klinik sonuçlarýnýn deðerlendirilmesi amaçlanmýþtýr.
Hastalar ve Yöntem: Geriye dönük hasta kayýtlarý üzerinden yapýlan bu çalýþmada 2014-2018 yýllarý arasýnda diz fleksiyon kontraktürü nedeniyle açýk ya da kapalý yöntemle hamstring uzatma cerrahisi uygulanan srebral palsili hastalar incelenmiþtir. Tüm cerrahi müdahaleler genel anestezi altýnda yapýlmýþ ve hastalarýn preoperatif ve postoperatif popliteal açýlarý (PA) kaydedilmiþtir. Açýk teknikte medial ve lateral hamstring kaslarýný uzatmak için tek bir orta hat insizyonu kullanýlmýþtýr. Perkütan teknikte ise medial ve lateral hamstring kaslarý 15 numara bistüri yardýmýyla perkütan olarak uzatýlmýþtýr.
Bulgular: Çalýþmaya 17 hastanýn 26 dizi dahil edildi. Hastalarýn ortalama yaþý 10.6 (6-17) idi. Açýk cerrahi uygulanan grupta 9 hasta (14 diz), perkütan cerrahi uygulanan grupta ise 8 hasta (12 diz) mevcut idi. Açýk cerrahi sonucunda preoperatif ortalama 45° (± 6,03) olan popliteal açý postoperatif 24° (± 4,37)’ye geriledi (p=0.0001). Perkütan teknik uygulanan grupta ise ortalama popliteal açý 49,75° (± 6,7)’ten 26° (± 7,12)’ye geriledi (p=0.0001). Gruplar arasýnda preoperatif ve postoperatif popliteal açý deðiþimleri açýsýndan anlamlý farklýlýk saptanmadý (p=0.215).
Sonuç: Bu çalýþmanýn bulgularý, nispeten basit ve minimal invazif bir teknik olan perkütan hamstring uzatma cerrahisinin seçilmiþ hasta gruplarýnda uygun bir seçenek olarak kabul edilebileceðini göstermiþtir.

Background: Knee flexion contracture due to increased hamstring muscle spasticity is the most commonly seen knee deformity in cerebral palsy (CP) and hamstring lengthening is a useful technique for this problem. The purpose of this study is to evaluate the clinical reflections of open vs. percutaneous hamstring lengthening (OHL vs. PHL) surgery results.
Patients and methods: This was a retrospective study of all spastic CP patients having knee flexion deformity who underwent OHL or PHL between 2014 and 2018. The procedures were carried out under general anesthesia and the patients’ preoperative and postoperative popliteal angles (PA) were recorded. In OHL, one midline incision was used to lengthen the medial and lateral hamstrings. In PHL, both the medial and lateral hamstrings were lengthened percutaneously by a no. 15 blade.
Results: Twenty-six knees of 17 patients were included. Mean age of the patients were 10.6 (6-17). Nine patients with 14 knees were present in OHL group and eight patients with 12 knees were present in PHL group. Mean preoperative PA was 45° (± 6,03) and decreased to 24° (± 4,37) after the OHL procedure (p=0.0001). Mean preoperative PA was 49,75° (± 6,7) and decreased to 26° (± 7,12) after the PHL procedure (p=0.0001). There was no statistically significant difference in terms of the mean differences between the preoperative and postoperative PA of OHL and PHL groups (p=0.215).
Conclusion: The findings of this study have shown that the relatively simple and minimal invasive PHL technique can be considered a viable option in selected patient groups for hamstring lengthening.

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Amaç: Bu çalýþmada, yeni kurulan kalp ve damar cerrahisi kliniðimizde koroner arter hastalýðý nedeniyle, izole elektif koroner arter by-pass ameliyatý olan ilk 100 vakanýn erken dönem sonuçlarýnýn deðerlendirilmesini amaçladýk.
Yöntem: Ekim 2016 ile Ocak 2018 tarihleri arasýnda izole elektif koroner arter by-pass ameliyatý olan ilk 100 hasta çalýþmaya dahil edildi. Preoperatif dönemde tüm hastalara; rutin kan tetkikleri, ekokardiyografi, elektrokardiyografi, akciðer grafisi, karotis-vertebral arter doppler ultrasonografi, solunum fonksiyon testi yapýldý ve burun kültürleri alýndý. Mortalite riskinin hesaplanmasý için Euroscore II skorlama sistemi kullanýldý. Operasyon intratorasik genel anestezi altýnda, median sternotomi insizyon tekniði ile asendan aorta arteriel kanülasyon, unikaval venöz kanülasyon eþliðinde, aralýklý antegrad soðuk kan kardiyoplejisi ve hafif hipotermiyle kardiyopulmoner bypass altýnda yapýldý. Taburculuk sonrasý 2.-4. hafta ve 2. ay poliklinik kontrol muayeneleri yapýldý. Hastalarýn verileri retrospektif olarak tarandý.
Bulgular: Ortalama yaþý 58 yýl olup, hastalarýn %35 (n=35)’i kadýn cinsiyet idi. Ensýk görülen risk faktörleri; %50(n=50)’sinde hipertansiyon (HT), %42(n=42)’sinde sigara içme öyküsü idi. Operasyonda ortalama CPB süresi 70±13dk, ortalama kross klemp zamaný 40±16dk, ortalama bypass yapýlan damar sayýsý 3.4±1.0 idi. Postoperatif dönemde %22(n=22) hastada atriyal fibrilasyon geliþti ve tüm hastalarda medikal tedavi ile sinüs ritmi saðlandý. Hastane içi mortalite %2(n=2) hastada görüldü.
Sonuç: Ýzole koroner arter hastalýðýnýn cerrahi tedavisi, özellikle düþük riskli hasta grubunda, düþük mortalite ve morbidite oranlarý olan güncel tedavideki yerini korumaktadir.

Aim: In this study, we aimed to investigate the early results of first 100 patients who underwent isolated elective coronary artery by-pass surgery because of coronary arter disease in our clinic.
Methods: First 100 patients who underwent isolated elective coronary artery by-pass surgery between October 2016-January 2018 were included. Routine blood tests, echocardiography, electrocardiography, chest X-ray, carotid-vertebral artery doppler ultrasound, pulmonary function test were performed and nasal culture was obtained preoperatively. Euroscore II was used for calculating the mortality risk. All operations were performed under intrathoracic general anesthesia, with median sternotomy, ascending aortic cannulation, unicaval venous cannulation, intermittant antegrade cold blood cardioplegia and under mild hypothermic cardiopulmonary by-pass.
Results: Mean age was 58 years and %35 (n=35) were female. Most common preoperative risk factors were hypertension (HT) %50(n=50) and smoking %42(n=42). Mean cardiopulmonary by-pass time was 70±13 minutes, mean cross clamp time was 40±16 minutes, mean number of revascularized coronary artery was 3.4±1.0. Postoperative atrial fibrillation was detected as %22(n=22) and all patients were converted to sinüs ritm with medical treatments. In hospital mortality was %2(n=2).
Conclusion: Surgical treatment of isolated coronary artery disease, especially in low risk patient group, remains in the current treatment with low mortality and morbidity rates.

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Giriþ
Ailevi Akdeniz Ateþi (AAA) baþta periton ve plevral dokular olmak üzere birçok doku ve organý etkileyen ataklar halinde giden kronik inflamatuvar otozomal resesif bir hastalýktýr. AAA gibi subklinik inflamasyonla giden hastalýklarda klasik kardiovasküler risk faktörlerinin yaný sýra oksidatif stres, inflamasyon ve endotelyal hasar da kardiyovasküler hastalýk oluþumuna sebep olabilmektedir. Monosit/yüksek dansiteli lipoprotein oraný inflamasyon ve oksidatif stresi monositlerin proenflamatuar etkileri üzerinden gösterebilmektedir. Bu çalýþmamýzda AAA hastalarýnda ateroskleroz ve monosit/HDL oranýný arasýndaki olasý bir iliþkiyi araþtýrdýk.
Metod
Çalýþmaya Haziran 2006 ile Aðustos 2018 tarihleri arasýnda -körlük açýsýndan belirtilmemiþtir- ne baþvurmuþ, çalýþmaya dahil edilme kriterlerini taþýyan Tel-Hashomer kriterleri ile taný konmuþ 40 AAA hastasý [21 kadýn, medyan yaþ: 37 (27-47)] alýndý. Kontrol grubu olarak yaþ ve cinsiyet yönünden benzer 35 saðlýklý gönüllü [21 kadýn, medyan yaþ: 38 (35-40)] alýndý. Monosit/HDL oraný yaný sýra koroner akým rezervleri de deðerlendirildi.
Bulgular
Gruplar arasýnda demografik özellikler açýsýndan fark yoktu. Monosit sayýsý ve monosit/HDL oraný hastalarda kontrollerden daha yüksekti [(0.55 ± 0.15 vs. 0.46 ± 0.14; p: 0.013) ve (0.014 (0.010-0.017) vs. 0.010 (0.008-0.013); p: 0.003, sýrasýyla]. Yüksek sensitiviteli C reaktif protein düzeyi de hastalarda daha yüksek olarak bulundu [6.70 (2.7-15.4) vs. 1.75 (1.0-2.73), p<0.001]
Sonuç: Monosit/HDL oraný AAA olan hastalarda aterosklerozu erken tanýyabilmek için yeni bir belirteç olabilir ve günlük kullanýma uygundur.

Objective: Familial Mediterranean Fever (FMF) is an autosomal recessive disease characterized by febrile episodes caused by increased inflammatory protein levels. In diseases with subclinical inflammation such as FMF along with conventional cardiovascular risk factors oxidative stress, inflammation and endothelial damage can cause cardiovascular diseases. The monocyte/high-density lipoprotein ratio (MHR) indicates inflammation and oxidative stress due to the proinflammatory effect of the monocytes. We aimed to investigate the relationship between atherosclerosis and monocyte/HDL ratio in patient with FMF.
Material and Methods: FMF was diagnosed with Tel-Hashomer criteria. After all inclusion and exclusion criteria were applied 40 patients with FMF [21 female, median age: 37 (27-47)] and 35 controls [21 female, median age: 38 (35-40)] were recruited from -blinded for peer review. Along with MHR, coronary flow velocity reserve of the subjects was evaluated.
Results: Both groups were similar regarding age, sex, BMI, systolic and diastolic blood pressure and lipid parameters. Monocyte count (0.55 ± 0.15 vs. 0.46 ± 0.14; p value: 0.013) and monocyte/HDL ratio (0.014 (0.010-0.017) vs. 0.010 (0.008-0.013); p value: 0.003) were significantly higher in patients than controls. High sensitive-CRP was also significantly higher in patients with FMF as compared with controls.
Conclusion: As an easy method to evaluate atherosclerosis monocyte/HDL ratio may gain a role in prediction of coronary microvascular dysfunction in patient with FMF during daily clinical practice.

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Mikrobiyota hakkýndaki araþtýrmalar bir çok sistemdeki hastalýk geliþiminde baðýrsak mikrobiyomunun etkisi olduðunu iddia ediyor. Bunlardan birkaçý; yað doku, kalp, dolaþým sistemi, sindirim sistemi ve hatta santral sinir sistemidir. Bu konudaki araþtýrmalarýn sayýsýnýn ve kalitesinin artmasýyla birlikte üzerinde araþtýrýlan konular; baðýrsak mikrobiyomunun saf oluþumundan, bu floranýn kana geçiþ yapan metabolitleri ve vucüdun buna verdiði tepkiye kadar çeþitlilik göstermeye baþladý. Baðýrsak florasýnýn salgýladýðý metabolitler, vücutta kronik enflamasyonu tetikleyerek metabolik sendrom, kronik böbrek hastalýðý ya da kardiyovasküler hastalýklar gibi hastalýklara yol açabilmektedir. Bunlar gibi geniþ kapsamlý ve multi-sistemik hastalýklarýn baðýrsak mikrobiyomuyla baðlantýlarý kurulmasý üzerine, baðýrsak mikrobiyomunun bozulmasýnýn flora aktarýmý gibi yöntemlerle tedavi edilmeye çalýþýlmasý þaþýrtýcý olmayan bir geliþme olmuþtur. Bu yazý bazý hastalýklarýn flora disbiyozundan nasýl etkilendikleri üzerine yoðunlaþacaktýr. Indoxil sülfat, p-krezil sülfat ya da trimetilamin N-oksit gibi baðýrsak disbiyozu sýrasýnda artan metabolitlerin kronik böbrek hastalýðý ve ateroskleroz gibi hastalýklarda ne gibi roller oynadýðý tartýþýlacaktýr. Baðýrsak bariyerlerinin permeabilitesinin kronik böbrek hastalýðý sonucunda geliþen üremi sebebiyle artmasý ve bunun sonucunda geliþen disbiyoz gibi bu hastalýklarýn da disbiyoz üzerindeki etkilerine de deðinilecektir.

Research related to micobiome claims to find associations to disease processes of many organ systems. Fat tissue, kidneys, heart and vasculature, intestines and even brain tissue is affected by dysbiosis of gut flora. With the advance of studies and their qualities on topic, research evolved from being focused solely on microbiome itself to encompassing metabolites penetrating into serum and immune response demonstrated by host. Effect of such a molecular invasion of body results in a low grade inflammation and chronic diseases such as metabolic syndrome, diabetes mellitus, chronic kidney disease and cardiovascular disease ensues. With such a vast gamut of diseases and pathologic conditions related to microbiome, it should come as no surprise that there have been attempts at treatment of dysbiosis with methods including flora transfer from healthy individuals. This review will focus on these disease states and how they are affected by dysbiosis. Specific metabolites such as indoxyl sulfate, p-cresyl sulfate or trimethylamine N-oxide are increased in a dysbiotic state and affect the pathological course of chronic kidney disease and atherosclerosis. The disease state host is in has effect on permeability of gut barriers and will create dysbiosis such as in uremia related epithelial barrier degradation due to chronic kidney disease.

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Eþ zamanlý olarak saptanan çoklu kanserler senkron tümör olarak adlandýrýlmaktadýr. Böbrek hücreli karsinomlarýn senkron tümörlerle birlikte görülmesi nadir bir durumdur. 79 yaþýnda kadýn hasta aralýklý ateþ, anemi, kilo kaybý ve iþtah kaybý þikayetleri ile tarafýmýza baþvurdu. Yapýlan görüntüleme yöntemleri ile koledok kanalý proksimalinde dilatasyonun eþlik ettiði pankreatik lezyon ve sol böbrek alt polde kitle tespit edildi. Hastaya sol açýk parsiyel nefrektomi ve kolesistektomi ile birlikte pankreoduodenektomi yapýlarak baþarýlý þekilde tedavi uygulandý. Bu olgu sunumunda böbrek hücreli karsinom ile birlikte senkron ampulla vateri karsinomu tespit edilen bir vaka sunulacaktýr.

Multiple tumors that occur at the same time are defined as synchronized tumors. Occurrence of renal cell carcinomas with synchronous tumors is a rare condition. 79-year-old female presented with complaints of intermittent fever, anemia, losing appetite and weight. Imaging studies revealed the presence of pancreatic lesion with proximal choledocal dilatation and a lesion of lower zone of the left kidney. The patient was treated successfully by open left partial nephrectomy for the renal cancer and pancreaticoduodenectomy with cholecystectomy for the pancreatic lesion. In this case report, a patient who has synchronous adenocarcinoma of ampulla of vater and renal cell carcinoma will be presented.

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Plastik bronþit; hava yolunu týkayan fibrinöz mukus plaklarý sonucunda oluþan, çocukluk çaðýnda nadir görülen bir hastalýktýr. Birçok pulmoner ve sistemik hastalýða sekonder olabileceði gibi idiyopatik de olabilir. Hasta, balgamsýz öksürük, dispne ve hýþýltý ile yabancý cisim aspirasyonunu taklit edecek þekilde akut solunum yetmezliði bulgularý ile baþvurabileceði için önemli bir hastalýktýr. Burada, bronkoskopi ile plastik bronþit tanýsý alan dört yaþýndaki hastamýzý sunuyoruz.
Dört yaþýnda erkek hasta öksürük ve nefes almakta güçlük þikayetiyle getirildi. Fizik muayenede ronküsler ve dispne mevcuttu, oksijen saturasyonu %92 idi. Klinik ve laboratuvar olarak baþka herhangi bir enfeksiyon bulgusu yoktu. Göðüs grafisinde ve bilgisayarlý tomografide yabancý cisim aspirasyonuna ait özellikler görüldü ve hastaya bu ön taný ile bronkoskopi yapýldý. Bronkoskopide mukus plaklarýn görülmesi ile plastik bronþit tanýsý alan hastada plaklarýn aspirasyonu sonrasýnda tam iyileþme izlendi.
Plastik bronþit çocukluk çaðýnda nadir görülen bir durumdur. Medikal tedaviye dirençli solunum yetmezliði bulgularý olan hastalar; özellikle radyolojik olarak atalektazi veya intraluminal týkanýklýk bulgularý da varsa yabancý cisim aspirasyonu yanýnda plastik bronþit de akýlda tutularak bronkoskopi ile deðerlendirilmelidir.

Plastic bronchitis is a rare disease of pediatric age resulting from the fibrinous mucus plugs obstructing the airway. Plastic bronchitis can be secondary to many pulmonary and systemic diseases; but also idiopathic. It is an important entity because it can present with acute respiratory system failure symptoms like non-productive cough, dyspnea and wheezing mimicking foreign body aspiration. Here, we report a four year old boy diagnosed as plastic bronchitis by bronchoscopy.
4-year-old boy applied with cough and difficulty in breathing. He had wheezing and dyspnea in pyhsical examination and oxygen saturation was 92% without any other clinical and laboratory signs of infection. Chest X-ray and Computerized Tomography showed characteristics of foreign body aspiration. He was diagnosed as plastic bronchitis by flexible bronchoscopy and had full recovery after extraction of the plugs by aspiration in bronchoscopy session.
Plastic bronchitis is a rare entity of pediatric age which can be idiopathic. Patients who have respiratory failure resistant to conventional medical therapy; especially if they have radiologic signs of atelectasia of intraluminal blockage, should be evaluated with bronchoscopy.

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Background: Glomus jugulare tumor arises within the jugular foramen with close proximity to lower cranial nerves and major vessels. The aim of treatment is complete resection of tumor with preservation of cranial nerves. However, surgery carries high morbidities and challenging especially in large tumors.
Case presentation: A 47-year old lady experienced a hearing loss followed by pulsatile tinnitus for 2 years. Upon a thorough examination and investigations, she was later diagnosed with glomus jugulare. Transmastoid approach excision of tumour was performed with residual tumour left at surgery to prevent potential morbidities. She underwent adjuvant stereotactic radiotherapy post operatively.
Conclusion: Due to insidious onset, high index of suspicion for glomus tumor is needed to initiate early treatment and reduce morbidity. Thus, tinnitus should not be taken lightly. Combined modalities of partial resection of tumor with post-operative radiotherapy are the most suited and effective treatment in large tumors with preserved cranial nerves function. Routine post-operative MRI is beneficial to monitor residual and recurrence.

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Nasal Chondromesenchymal Hamartoma (NCMH) is a rare, benign tumour of sinonasal tract usually presents in infants. Even though it is benign in origin, its aggressive clinical behaviour and florid radiological finding always mislead the initial diagnosis, mimicking a malignant sinonasal tumour.
We report a case of NCMH in a 2-year-old boy who was referred to by an ophthalmologist for progressive facial distortion, left eye proptosis, persistent left rhinorrhoea and epiphora. Biopsy from the nasal cavity which appeared to be lobulated mass on endoscopy examination confirmed it was Nasal Chondromesenchymal Hamartoma (NCMH). Surgical excision of the tumour was performed. The symptoms of NCMH depend on the tumour location, thus the clinical presentation can be varied. The only way to establish the diagnosis of NCMH is by histopathology and immunohistochemistry of the tumour. Complete surgical treatment is advocated once the diagnosis is confirmed. This benign tumour has an established relation with the DICER1 mutations, hence other DICER1 tumours need to be ruled out at the time of diagnosis.

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Multiple laryngeal cyst in adult are rare entity. Laryngeal cysts are usually benign lesion. They rarely cause symptoms unless they progressively increase in dimension or enlarge in due of course of time. Here we described a case of asymptomatic patient with multiple laryngeal cyst in elderly which was successfully treated with endoscopic surgery without complication.

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