Adölesan idiopatik skolyoz (AIS) cerrahisinde güvenli enstrümantasyon ve düzeltme yapýlabilmesi için, deforme omurlarýn morfolojisinin ayrýntýlý olarak bilinmesi önemlidir. Bu çalýþmada, kord uzunluðu (KU), transvers pedikül geniþliði (TPG) ve transvers pedikül açýsý (TPA) baz alýnarak, AIS hastalarýnýn her bir omur morfolojisinin deðerlendirilmesi amaçlanmýþtýr.
AIS tanýlý 81 hastanýn ameliyat öncesi bilgisayarlý tomografi (BT) görüntüleri retrospektif olarak incelendi. Ortalama yaþý 15.1 olan hastalarýn 64’ü kadýn, 17’si erkekti. Torasik ve lomber bölgedeki tüm omurlarýn konkav ve konveks pediküllerine KU, TPG ve TPA ölçümleri dijital olarak uygulandý. Konkav ve konveks taraflardaki deðerler karþýlaþtýrýldý.
KU T1’de en kýsa, L5’te en uzun olarak ölçüldü. Konkav taraftaki KU deðerleri konveks tarafa göre daha fazla bulunurken, T9 ve L3 seviyelerinde bu fark anlamlýydý (p<0.05). TPG deðerleri ise konkav tarafta daha düþük olarak ölçüldü, anlamlý fark T8 ve T9 seviyelerinde saptandý (p<0.05). En dar pediküller T5 seviyesinde bulundu. TPA ölçümlerinin en yüksek ve en düþük deðerleri sýrasýyla T1 ve T12 seviyelerindeydi. Konkav taraftaki deðerler daha yüksek bulunurken, anlamlý fark T7, T8 ve L3 seviyelerinde saptandý (p<0.05).
Konkav taraftaki pediküller genel olarak daha uzun ve daha dar olup bunlarýn transvers plandaki medial inklinasyonlarý da daha fazladýr. Bu bulgular apikal bölgede daha belirgin olmakla beraber hastadan hastaya farlýlýklar gösterebilir. Ameliyat öncesi rutin BT taramasý hastaya özgü kemik yapýsý hakkýnda önemli bilgiler verebilir.

In adolescent idiopathic scoliosis surgery (AIS) thorough knowledge of the morphometry of scoliotic vertebrae is important for safe pedicle screw instrumentation and deformity correction. This study aimed to evaluate the morphometry of each vertebrae in AIS patients based on chord length (CL), transverse pedicle width (TPW) and transverse pedicle angle (TPA).
Preoperative thoracolumbar computerized tomography (CT) images of 81 AIS patients that were retrospectively evaluated. Mean age of the patients was 15.1 years, 64 of them were female and 17 were male. CL, TPW and TPA measurements were performed for concave and convex pedicles at all thoracic and lumbar levels. Values of concave and convex sides were compared.
CL was shortest at T1 and longest at L5. CL values on the concave side were higher than those on the convex side with significant difference at T9 and L3 levels (p<0.05). Consistently smaller TPW values were observed on the concave side, however significant difference was only found at T8 and T9 levels (p<0.05). Narrowest pedicles were observed at T5. Highest and lowest values of TPA were observed at T1 and T12 levels respectively. Values were higher on the concave side with significant difference at T7, T8 and L3 levels (p<0.05).
Concave pedicles are generally longer, thinner and more medially inclined in transverse plane. These findigs are distinct in the apical region but may show variability among patients. Routine preoperative CT examination can give important information about the individual bone structure of each patient.

Abstract | Full Text PDF

Çalýþmamýzýn amacý, Türk Ortopedi ve Travmatolojisinin uluslararasý bilimsel literatüre olan etkisindeki deðiþimi Acta Orthopaedica et Traumatologica Turcica (AOTT) dergisinin baþarýsýný inceleyerek araþtýrmaktýr. 2006-2015 yýllarý arasýnda AOTT’de yayýmlanmýþ tüm klinik araþtýrma makaleleri çalýþmaya dahil edildi. Atýf sayýsý ve atýf sayýsýný etkileyebilecek faktörler (çalýþmaya katýlan merkezlerin sayýsý, çalýþmanýn orjini (yurt içi-yurt dýþý), dizayný, kanýt seviyesi, çalýþmalarýn tipi ve alt tipi) deðerlendirildi. 517 klinik araþtýrma makalesi deðerlendirildi. Atýf alma hýzýnda son beþ yýlda artýþ görüldü (p=0.046). Makalalerin çoðunluðu çok merkezli (%54.9) ve yurt içi orjinli (%85.1) idi. Son beþ yýlda yurt dýþý orjinli makale sayýsýnda artýþ görüldü. Makalelerin çoðunluðu Level 4 (%76.2) ve retrospektif dizaynlýydý (%95.9). Son beþ yýlda makalelerin kanýt seviyelerinde ve prospektif dizaynlý çalýþma sayýsýnda artýþ görüldü (sýrasýyla; p=0,07; p=0.157). Makalelerin çoðunluðu terapötik tipteydi (%74). Son beþ yýlda ekonomik ve karar analizi çalýþma tipinde artýþ görüldü (p=0,055). Makaleler, en sýk travma ile iliþkiliydi (%26.5). Son beþ yýlda artroplasti ile iliþkili makale oranýndaki artýþ, ayak-ayak bileði ve pediatrik ortopedi ile iliþkili makale oranýnda azalma görüldü (sýrasýyla; p=0.022; p=0.036; p=0.007). Sonuç olarak; Türk Ortopedi ve Travmatolojisinin 2011-2015 yýllarý arasýnda uluslararasý bilimsel literatür üzerindeki etkisini artýrdýðý görüldü.

The aim of our study is to investigate change in the impact of Turkish Orthopedics and Traumatology on the international scientific literature by examining the success of the Acta Orthopaedica et Traumatologica Turcica (AOTT) journal. All clinical research articles published in the AOTT between 2006 and 2015 were included in the study. The number of citations and the factors (number of centers participating in the study, the origin of study (domestic-foreign), design, level of evidence, type and subtype of studies) that may affect the number of citations were evaluated. 517 clinical research articles were evaluated. There has been an increase in the citation rate over the last five years (p=0.046). The majority of the articles were multi-center (54.9%) and domestic-origin (85.1%). In the last five years, there has been an increase foreign-origin articles (p=0.01). The majority of the articles was level 4 (76.2%) and designed retrospectively (95.9%). In the last five years, there has been an increase in the evidence levels of the articles and prospective design studies (p=0.07,p=0.157,respectively). The majority of the articles were therapeutic type (74%). In the last five years, there has been an increase economic and decision analysis studies (p=0.055). Articles were mostly related to trauma (26.5%). In the last five years, there has been an increase articles related to arthroplasty, and a decrease articles associated with foot-ankle and pediatric orthopedics (p=0.022,p=0.036,p=0.007,respectively). As a result; it was seen that Turkish Orthopedics and Traumatology increased its influence on the international scientific literature between the years 2011-2015.

Abstract | Full Text PDF

Amaç: Subakut lomber disk hernisi tanýlý hastalarda fizik tedavi yöntemlerinden biri olan traksiyonun iki farklý aðýrlýkla; klinik, fonksiyonel durum ve yaþam kalitesi üzerine olan etkilerini araþtýrmak.
Gereç ve Yöntem: Çalýþmaya 70 hasta alýndý. 9 hasta çalýþmaya katýlmak istemedi. 61 hasta randomize olarak iki gruba ayrýldý. Birinci gruba (n=30) vücut aðýrlýðýnýn %35-50 kuvvetinde, ikinci gruba (n=31) vücut aðýrlýðýnýn %10-20’si olacak kuvvette “intermittant traksiyon” uygulandý. Tüm hastalara egzersiz programý ve bel aðrýsýndan korunmak için önlemler konusunda eðitim verildi. Tedavi etkinliði visüel analog skala, short-form 36, Oswestry Bel Aðrýsý Özürlülük ve Roland-Morris Fonksiyonel Deðerlendirme formlarý ile tedavi öncesi, tedavi sonrasý (10. gün) ve tedaviden bir ay sonra (40. gün) deðerlendirildi.

Bulgular: Çalýþmada sonuç deðerlendirme ölçekleri ile her iki grupta iyileþme görülürken bu deðiþimler açýsýndan gruplar arasýnda istatistiksel olarak fark bulunmadý. Gruplarýn kendi içlerinde yapýlan karþýlaþtýrma sonuçlarýnda ise; istirahatteki ve hareket sýrasýndaki VAS deðerleri, Oswestry Bel Aðrýsý Özürlülük, Roland-Morris Fonksiyonel Deðerlendirme skorlarý ve SF-36 sorgulamasýnda tedavi öncesi-birinci kontrol ve tedavi öncesi-ikinci kontrol arasýnda istatistiksel olarak anlamlý fark bulundu (p<0,05 ).
Sonuç: Ýki gruptaki iyileþmenin; disk hernilerinin yaklaþýk %50’sinin yapýlan tedaviye baðlý olmaksýzýn, birkaç haftada doðal seyri sonucu iyileþmesine, traksiyon dýþýnda diðer konservatif tedaviler ve egzersiz programýna da baðlý olabileceði kanaatindeyiz.

Objective: Investigate the effects of traction with two different loads, as a physical treatment, for the patients with subacute lumbar disc herniation on clinic status, functional status and quality of life.
Material and Method: Seventy patients were enrolled. Nine of them did not agree to participate in the study. Sixty-one patients were divided into the two groups, randomly. The first group (n=30) was gone through intermittent traction with a force of their body weight’s 35-50%, and the second group (n=31) was gone through intermittent traction with a force of their body weight’s 10-20%. An exercise program was given to all patients and all patients were informed about precautions to protect themselves from lumbar pain. Treatment efficacy was evaluated before the treatment, after the treatment (tenth day) and a month later after trteatment (fortieth day) with the short form 36, Oswestry Lumbar Pain Disability and Roland-Morris Functional Evaluation forms.
Results: We observed improvement in outcome evaluation forms in both groups. However, there was no statistically significant difference between the groups.
In the comparison results made within the groups themselves; there was a statistically significant difference between VAS values at rest and during movement, Oswestry Lumbar Disability, Roland-Morris Functional Assessment scores, and pre-treatment-first control and pre-treatment-second control in SF-36 interrogation (p<0,05 ).
Conclusion: In natural process, 50% of the disc herniations can be improvement within a few weeks. We think that the improvement in both groups could be due to this condition and also be related to conservative treatments and exercise program except for the traction.

Abstract | Full Text PDF

Giriþ: Kardiyovasküler hastalýklar, kandaki eritrositlerin hacimlerindeki deðiþkenliðin göstergesi olan eritrosit daðýlým geniþliðinin (EDG) artýþý ile iliþkilendirilmektedir. Enflamasyona baðlý olarak akut koroner sendrom (AKS) ve atriyal fibrilasyon (AF) gibi durumlar EDG’de artýþa sebep olabilir. Çalýþmamýzda, AKS ile hastaneye baþvuran hastalardaki eþlik eden AF’nin EDG ile iliþkisini araþtýrdýk.
Hastalar ve Yöntem: Ocak 2016-Aralýk 2017 tarihleri arasýndaki AKS ile baþvuran AF mevcut olan 50 hasta ve, yaþ ve cinsiyet yönünden eþleþtirilmiþ 62 kontrol hastasý retrospektif olarak deðerlendirildi. Tüm hastalara ayrýntýlý fizik muayene ve ekokardiyografik görüntüleme uygulandý. Ayrýca, tam kan sayýmýný içeren rutin kan örnekleri alýndý.
Bulgular: Her iki grup arasýnda temel klinik özellikler benzerdi. Sol atriyal (SA) çap (47±13 ve 38±12 mm, p<0.05) ve ortalama EDG (%14.5±2 ve %12.6±1, p<0.001) AF olan hastalarda kontrol grubuna göre anlamlý olarak daha yüksekti. Regresyon analizinde, SA çap (Odds oraný-OO=1.10, %95 Güven aralýðý-GA: 1.07-1.18, p<0.05), EDG (OO: 1.53, %95 GA: 1.12-1.98, p<0.005) ve troponin T (OO=1.13, 95% GA: 1.1-1.15, p<0.05) AF’nin baðýmsýz öngördürücüleri olarak bulundu. Serum EDG düzeyinin >%11.7 olmasý AF varlýðýný %56 duyarlýlýk ve %64 özgüllük ile öngördü (EAA= 0.637, p<0.001).
Sonuç: EDG ucuz ve kolay ulaþýlabilir bir biyobelirteçtir. Yüksek EDG, AKS ile baþvuran hastalarda AF varlýðýný öngörebilir.

Background: Cardiovascular disease is associated with red cell distribution width (RDW), an indicator of variability in circulating erythrocyte volume. The inflammatory process in acute coronary syndrome (ACS) and atrial fibrillation (AF) may cause an increase in RDW. In this study, we purposed to investigate whether admission RDW is associated with AF in patients with ACS.
Methods: This retrospective study included 50 patients with AF and 62 age- and sex- matched controls, who had presented with ACS between January 2016 to December 2017. All subjects had routine blood tests including common blood cell counts and also underwent physical examination and echocardiographic examination.
Results: Baseline characteristics were similar in the two groups. Left atrial (LA) diameter (47±13 vs 38±12 mm, p<0.05) and RDW (14.5±2% vs. 12.6±1%, p<0.001) were significantly higher in the patients with AF than the control group. In multivariate analysis, LA diameter (Odds ratio- OR= 1.10, 95% Confidence interval-CI: 1.07-1.18, p<0.05), RDW (OR=1.53, 95% CI: 1.12-1.98, p<0.005) and troponin T (OR=1.13, 95% CI: 1.1-1.15, p<0.05) were found to be significant independent predictors of AF in patients with ACS. A serum RDW level of >11.7% predicted the presence of AF with a sensitivity of 56% and a specificity of 64% (AUC= 0.637, p<0.001).
Conclusions: RDW is an inexpensive and readily available biomarker that may predict AF in patients with ACS.

Abstract | Full Text PDF

Amaç: Monosit sayýsýnýn HDL-Kolesterole oraný (MHO)’nýn yeni bir kardiyovasküler belirteç olduðu gösterilmiþtir. Çoðu çalýþmada hafif primer hiperparatiroidi (PHPT)’nin bile kardiyovasküler hastalýk riskini arttýrdýðý bildirilmiþtir. Bu çalýþmada, MHO’nun PHPT hastalarýnda yüksek olup olmadýðýný ve kardiyo-metabolik risk faktörleri ile iliþkisini deðerlendirmeyi amaçladýk.

Hastalar ve Yöntemler: Çalýþmaya primer hiperparatiroidisi olan 75 hasta ve 96 kontrol olgusu alýndý. Demografik, antropometrik ve biyokimyasal veriler kaydedildi. Gruplar, monosit sayýlarý, HDL-Kolesterol (HDL-K) ve MHO’na göre karþýlaþtýrýldý. MHO ile labaratuvar ve kardiyo-metabolik risk faktörleri arasýndaki iliþki korrelasyon analizi ile deðerlendirildi.

Sonuçlar: Ortalama yaþ her iki grupta benzerdi (52.69 ± 10.91 to 53.33 ± 7.70, p: 0.667). Cinsiyet daðýlýmý, vücut kitle indeksi (VKÝ) gruplar arasý benzerdi (p>0.05). Monosit sayýsý ve HDL-K düzeyleri gruplar arasý benzerdi (479.73±136.97 to 500.13 ± 144.06 and 51.54 ± 11.99 to 51.95 ± 11.66, p>0.05). MHO gruplar arasý benzerdi (9.71 ± 3.65 to 10.11 ± 3.86, p>0.05). MHO sistolik kan basýncý ve insulin direnci (HOMA-IR) ile pozitif korrele idi (r2: 0.276, p: 0.019 and r2: 0.271, p: 0.020). MHO ile diðer kardiyovasküler risk faktörleri olan diastolik kan basýncý, karotis intima media kalýnlýðý (KIMK) ve c-reaktif protein (CRP) arasýnda korrelasyon saptanmadý (p>0.05).

Tartýþma: Monosit sayýsýnýn HDL-Kolesterole oraný primer hiperparatiroidili hastalarda yüksek deðildi. Monosit sayýsýnýn HDL-Kolesterole oraný sistolik kan basýncý ve insulin direnci ile korrele iken, diðer kardiyovasküler risk faktörleri olan diastolik kan basýncý, KIMK ve CRP ile korrele deðildi.

Objectives: The monocyte count to HDL-Cholesterol ratio (MHR) has been shown as a novel prognostic indicator of cardiovascular diseases. Several studies demonstrated that even mild primary hyperparathyroidism (PHPT) has an increased risk for cardiovascular disease. We aimed to evaluate MHR and its relation with cardio-metabolic risk factors in patients with PHPT.

Methods: Seventy-five patients with PHPT and 96 control subjects were included in the study. Demographic, anthropometric, and biochemistry results were recorded. The groups were compared in terms of monocyte counts, HDL-cholesterol (HDL-C), and MHR values. Correlation analysis was used to determine the relation between MHR and cardio-metabolic parameters.

Results: The mean age was similar in each group (52.69 ± 10.91 to 53.33 ± 7.70 years, p=0.667). Sex distribution and body mass index were similar in each group (p>0.05). Monocyte counts and HDL-C levels were similar in each group (479.73±136.97 to 500.13 ± 144.06 and 51.54 ± 11.99 to 51.95 ± 11.66 mg/dL, p>0.05). MHR was similar between groups (9.71 ± 3.65 to 10.11 ± 3.86, p>0.05). MHR was positively correlated with systolic blood pressure (SBP) and homeostasis model assessment of insulin resistance (HOMA-IR) (r2=0.276, p=0.019 and r2=0.271, p=0.020, respectively). There was no association between MHR and other cardio-metabolic risk factors including diastolic blood pressure (DBP), carotis intima media thickness (CIMT), and c-reactive protein (CRP) (p>0.05).

Conclusions: The MHR did not increase in patients with PHPT. The MHR was correlated with SBP and HOMA-IR; however, it was not associated with other cardio-metabolic risk factors including DBP, CIMT, and CRP.

Abstract | Full Text PDF

ÝNSAN KÝTÝNAZ - 3 PROTEÝN: TEKRARLAYAN ÝMPLANTASYON BAÞARISIZLIÐINDA PATOJENÝK ROLÜ VAR MI?

Ýnsan kitinaz - 3 protein 1 (CHI3L1) (ayný zamanda serum insan kýkýrdak 39 glikoprotein olarak bilinir, YKL - 40), kanser ve inflamatuar hastalýklar ile ilgili yeni bir belirteçtir. Ýnflamasyonun hassas belirteçleri arasýnda ortalama trombosit volüm (MPV) ve sistemsel inflamatuar tepki (SIR) belirteçleri [nötrofil lenfosit oraný (NLR), trombosit - lenfosit oraný (PLR)] sayýlabilir. Bu çalýþmada, tekrarlayan implantasyon baþarýsýzlýðý (RIF) olan hastalarda CHI3L1, MPV, NLR ve PLR düzeylerini incelemek ve bu deðerlerin doðurgan saðlýklý kadýnlarla karþýlaþtýrýlmasý amaçlanmýþtýr. Bu çalýþma bir kesitsel çalýþma olup tekrarlayan implantasyon baþarýsýzlýðý olan 28 infertil kadýn çalýþmaya alýndý. RIF arka arkaya üç siklus IVF veya ICSI tedavisi sonucunda klinik gebelik elde edilememesi olarak tanýmlandý. Bölünme aþamasý embriyolar için en az dört ve blastokistler için en az iki kaliteli ve uygun geliþim düzeyinde embriyonun verilmesi þartý arandý. Kontrol grubuna spontan gebe kalmýþ ve abort yapmamýþ 28 saðlýklý kadýn dahil edildi. Hematolojik parametreler otomatik olarak hesaplandý. Ýnsan serumu kitinaz -3- protein 1 düzeyleri, üreticinin talimatlarýna göre bir ticari kolorimetrik kiti (Elabscience Biyoteknoloji Ltd, Pekin) kullanýlarak hesaplandý. Yaþ ve vücut kitle indeksi için gruplar arasýnda anlamlý fark bulunmadý. Ýnsan kitinaz-3 - protein 1 düzeyleri RIF (59.6 (38,6-421,2 ng / ml)) ve kontrol grubunda (68.5 (20,6-486,4 ng / ml) benzerdi. (p=0.222). MPV, NLR ve PLR açýsýndan anlamlý farklýlýk bulunamadý. Tekrarlayan implantasyon baþarýsýzlýðýnda CHI3L1, MPV, NLR ve PLR kan düzeyleri ile iliþki saptanmadý.
Anahtar kelimeler: Ýnsan Kitinaz - 3 - benzeri protein 1 (YKL - 40 / CHI3L1), tekrarlayan implantasyon baþarýsýzlýðý, nötrofil lenfosit oraný, trombosit - lenfosit oraný.

HUMAN CHITINASE-3-LIKE PROTEIN: A PATHOGENIC ROLE IN RECURRENT IMPLANTATION FAILURE?

Human Chitinase-3-like Protein 1 (CHI3L1) alias serum human cartilage glycoprotein 39 (YKL- 40) is a new biomarker frequently associated with cancer and inflammatory diseases. Hematological parameters also can be called as sensitive markers of inflammation including mean platelet volume (MPV) and systemic inflammatory response (SIR) markers [neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR)]. In this paper, it was aimed to examine the levels of CHI3L1, MPV, NLR and PLR in patients with recurrent implantation failure (RIF) and compare them with healthy women with proven fertility. The study group consisted of 28 infertile women with RIF charectirized as a failing to attain a clinical pregnancy after three consecutive cycles of IVF or ICSI. In these processes, first, all embryos must be valuable and sufficient experimental phase – second, the total number of transferred ones was at least four cleavages –stage embryos and minimum two for blastocysts as well. The control group included 28 healthy women with proven fertility that had conceived spontaneously and not lost a pregnancy. Hematological parameters were automatically calculated. Irrevelant differences were revealed among the groups with regard to age and body mass index. Whereas Human Chitinase-3-like Protein 1 levels were similar in RIF (59.6 (38.6-421.2 ng/ml)) and control subjects (68.5 (20.6-486.4 ng/ml)) (p=0.222). insignificant differences were resulted in MPV, NLR and PLR. Recurrent implantation failure was not associated with altered CHI3L1, MPV, NLR and PLR levels.
Key words: Human Chitinase-3-like Protein 1, recurrent implantation failure, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio

Abstract | Full Text PDF

Bu çalýþmada amacýmýz Crohn hastalýðý (CH)’ nda ürogenital sistem tutulumu (ÜGT) sýklýðýný, tutulum yerlerini, multidetektör bilgisayarlý tomografi (BT) ve manyetik rezonans görüntüleme (MRG) bulgularýný sunmak ve takip süresi ile ÜGT arasýndaki iliþkiyi deðerlendirmektir. Kasým 2008-Kasým 2017 tarihleri arasýnda CH tanýlý 59 hastanýn (25K, 34E) BT ve MRG incelemeleri ÜGT açýsýndan deðerlendirildi. ÜGT sýklýðý, tutulum yerleri, görüntüleme bulgularý ve takip süresi ile ÜGT arasýndaki iliþki incelendi. CH tanýlý olgularýmýzda ÜGT sýklýðý %33,9 (n: 20)’ dur. En sýk böbrek taþý (n: 9, %15,3) ve mesane tutulumu (n: 7, %11,9) saptandý. Diðer bulgular adneksiyal tutulum (n: 3, %5,1), üreter tutulumu (n: 2, %3,4), anovaginal fistül (n: 2, %3,4), vulva-perine tutulumu (n: 2, %3,4), penis kökü ve skrotal tutulum (n: 2, %3,4) ve prostat tutulumuydu (n: 1, %1,7). Erkeklerle kadýnlar arasýnda ÜGT sýklýðý açýsýndan fark saptanmadý. MRG’ de yüksek uzaysal rezolüsyonlu yað baskýlý T2 ve yað baskýlý kontrastlý T1 sekanslarýnda ÜGT daha iyi gösterildi. Takip süresi ile ÜGT arasýnda istatistiksel olarak anlamlý iliþki saptanmadý (p=0,58). CH olgularýnda ÜGT nadir deðildir. CH’ nýn ürogenital komplikasyon ve görüntüleme bulgularýnýn bilinmesi hastalýðýn taný ve yönetiminde faydalý olacaktýr.

Our aim in this study is to present the frequency of urogenital system involvement (UGT) in Crohn's disease (CH), involvement sites, CT and MR findings and relationship between follow up time and UGT. Multidetector computed tomography (CT) and magnetic resonance imaging (MRI) of 59 patients with CH (25K, 34E) between November 2008 and November 2017 were evaluated in terms of UGT. Frequency and location of UGT involvement, imaging findings and relationship between duration of illness and UGT was examined. The prevalence of UGT in our CH cases is 33.9% (n: 20). The most common findings were kidney stones (n: 9, 15.3%) and bladder involvement (n: 7, 11.9%). Other findings include adnexal involvement (n: 3, 5,1%), ureter involvement (n: 2, 3,4%), anovaginal fistula (n: 2, 3,4%), vulva-perine involvement (n: 2, 3.4%), penile root and scrotal involvement (n: 2, 3.4%) and prostate involvement (n: 1, 1.7%). There was no difference in the frequency of UGT between males and females. Kidney stones were better seen on unenhanced CT. High-spatial-resolution fat-suppressed T2 and fat-suppressed contrast-enhanced T1 sequences on MRI were better for visualization of UGT. There was no statistically
significant relationship between disease duration and UGT (p=0,58). UGT is not uncommon in CH. Being familiar with urogenital complications and imaging findings of CH will be useful in the diagnosis and management of the disease.

Abstract | Full Text PDF

Meningiomlar, biyolojik davranýþ paterni önceden bilinmesi her zaman mümkün olmayan, genelde benign karakterdeki ekstraaksiyel tümörlerdir. Bu araþtýrmada, meningiom tanýlý olgularýnýn biyopatogenezi literatür eþliðinde araþtýrýlmasý amaçlandý. Nöroþirurji kliniðinde, 2005 ile 2010 yýllarý arasýnda meningiom nedeniyle opere edilmiþ olan olgular (n=79) geriye dönük olarak incelendi. Dosya arþiv taramasý sonrasýnda elde edilen demografik veriler ile kan grubu, sigara kullanýmý, meningiom lokalizasyonu, peritümöral ödem, Simpson ve Kobayashi rezeksiyon derecesi, histotolojik alt tip, grade, nüks bilgilerine ait klinik veriler, kayýt altýna alýndý. Raporlanan bu veriler içerisinde kaydedilen tümörlere ait biyolojik davranýþ ve prognozuna etki edebilecek bulgular deðerlendirildi. Araþtýrma kriterlerini karþýlayan toplam 79 olgu çalýþmaya dâhil edildi. Olgularýn histopatolojik grade incelendiðinde; 59 (%74,7) olgunun grade I; 20 (%25,3) olgunun grade II olduðu görüldü. Olgularýn lokalizasyonu ve histolojik grade iliþkisine bakýldýðýnda, meningiomlarýn en sýk konveksitede yerleþtiði ve grade II olgularýn çoðunun bu lokalizasyonda olduðu saptandý. Preoperatif peritümöral ödemin, özellikle sfenoid kanat ve konveksite meningiomlarýnda daha fazla olduðu saptandý. Olgularýn takipleri esnasýnda toplam 9 (%11,4) olguda nüks görüldü. Cerrahi rezeksiyon derecesi ile nüks olgular arasýnda yapýlan deðerlendirmede Simpson grade IV ve Kobayashi grade IVA ve IVB rezeksiyon yapýlan olgularýn tümünde nüks saptandý. Nüks olgular ile histopatolojik alt tip arasýndaki iliþki incelendiðinde nüks eden 7 (%77,7) olgunun grade II, 2 (%33,3) olgunun ise grade I meningiom olduðu saptandý. Nüks olgularýn lokalizasyonu incelendiðinde 4 (%44,4) olgu sfenoid kanat, 2’si (%22,2) parasagittal, 1’i(%11,1) tuberkulum sella, 1’i (%11,1) ise intraventriküler yerleþimliydi. Çalýþmamýzda, meningiomlarda histopatalojik alt tip ve cerrahi rezeksiyon derecesinin prognozda önemli rol oynadýðý saptandý. Ayrýca tümör lokalizasyonunun ve peritümöral ödem varlýðýnýn meningioma prognozunda ve biyolojik davranýþa etki edebileceði düþünüldü. Elde edilen bulgularýn, ileriye yönelik, farklý ýrklarýn yer alacaðý, çok merkezli ve daha fazla serileri içeren olgularýn yer alacaðý çalýþmalarla desteklenmesi gerekmektedir.

In this study, it was aimed to investigate the bio pathogenesis of the cases diagnosed with meningioma in the light of the literature. The patients (n=79) operated due to the meningioma in neurosurgery department between 2005 and 2010 were retrospectively examined. Findings that may affect the biological behavior and prognosis of the tumours recorded in these reported data were evaluated. A total of 79 cases meeting the research criteria were included in the study. When the histopathological grade of the cases was examined, it was seen that 59 cases (74.7%) were grade I and 20 cases(25.3%) were grade II. When the relation between the localization and histological grade of the cases was examined, it was determined that the meningiomas were most frequently located in convexity and that most of grade II cases were localized at this site. Preoperative peritumoral oedema was found to be more prevalent, especially in the sphenoid wing and convexity meningiomas. A total of 9 cases of recurrence(11.4%) occurred during follow-up period. When carrying out evaluation between surgical resection grade and recurrent cases, it was detected that all cases where it was performed Simpson grade IV and Kobayashi grade IVA and IVB resection had a recurrence.. When the localization of recurrent cases was examined, it was seen that 4 cases (%44,4) were sphenoid wing meningioma, 2 cases (%22,2) were parasagittal meningioma, 1 case (%11,1) was tuberculosis sellae meningioma and 1 case (%11,1) was intraventricular meningioma. In our study, histopathologic subtype and surgical resection grade were found to play a significant role in prognosis in meningiomas. It was also thought that the presence of peritumoral oedema and tumour localization could affect the biological behavior and prognosis of the meningioma. Findings obtained should be supported by multi-center studies that will include the cases of different races with more series.

Abstract | Full Text PDF

Amaç: Stereotaktik mikrocerrahi teknik beynin derin ya da korteksin kritik bölgelerindeki lezyonlarýn doðru lokalizasyonu ve rezeksiyonuna olanak tanýmakla kalmayýp, çevre dokularýn cerrahiden minimal düzeyde etkilenmesini de saðlar. Bu çalýþma Leksell çerçeve kullanarak gerçekleþtirdiðimiz serebral lezyonlarýn BT rehberliðinde stereotaktik mikrocerrahi rezeksiyonu konusundaki deneyimlerimizi sunmayý amaçlamaktadýr.
Yöntem ve Gereç: Temmuz 2000 ve Eylül 2017 arasýnda bilgisayarlý tomografi rehberliðinde serebral lezyonlarýn stereotaktik rezeksiyonu yapýlan toplam 42 hasta dahil edilmiþtir. Klinik, radyolojik, histolojik veriler ve takip verileri retrospektif olarak incelenmiþtir. Hastalarýn pre- ve postoperatif durumlarý Karnofsky Performans Skalasý (KPS) kullanýlarak deðerlendirilmiþtir.
Bulgular: Yüksek dereceli glioma hastalarý hariç, tüm hastalarda tam rezeksiyon yapýlabilmiþtir. Epilepsisi olan 24 hastanýn 20’sinde bunlar tamamen kontrol altýna alýnmýþ, 4 hastada ise epileptik ataklarýn sayýsý azalmýþtýr. Genel olarak, hastalarýn 20’sinde KPS skorunda deðiþiklik olmamýþ, 28 hastada bu skorda artýþ, 2’sinde ise azalma olmuþtur. Hiç postoperatif mortalite saptanmamýþtýr.
Sonuç: . BT rehberliðinde yapýlan stereotaktik mikrocerrahi rezeksiyon güvenli ve etkili bir yöntemdir. Bu yöntem özellikle küçük ve benign kraniyal lezyonlarla serebral metastazlarýn rezeksiyonunda yararlýdýr.

Objective: Stereotactic microsurgical techniques not only allow for the precise localization and resection of lesions in critical areas of cortex or deep within the brain, they also minimize operative exposure to the surrounding tissues as well. This study presents our experience with CT-guided stereotactic microsurgical resection of cerebral lesions using the Leksell frame.
Material and Methods: A total of 42 patients undergoing stereotactic microsurgical resection of cerebral lesions guided by computerized tomography between June 2000 and September 2017 were included. Clinical, radiological, histological and follow-up data were retrospectively evaluated. Pre- and post-operative general status of the patient was assessed by Karnofsky Performance Scale (KPS).
Results: Except for the subjects with high-grade gliomas, complete resection could be accomplished in all cases. Of the 24 cases with convulsions, a complete cessation was attained in 20 and a decrease in the number and frequency of epileptic attacks was noted in 4 cases. Overall, 20 patients had no change in the KPS score, while 28 patients had increased and two had decreased KPS scores. No postoperative mortality occurred.
Conclusions: CT-guided stereotactic microsurgical craniotomy is a safe, reliable and effective technique, which is particularly useful for the surgical treatment of small, benign cranial lesions and cerebral metastases

Abstract | Full Text PDF

Akustik Ýmmitansmetri dýþ kulak kanalýndan verilen saf sesin kulak zarýndan yansýdýktan sonra kaydedilmesiyle oluþur, böylece orta kulaðýn durumu hakkýnda objektif bilgiler elde edilmektedir. Kliniklerde genellikle geleneksel immitansmetri olarak adlandýrýlan 226 Hz ve 1000 Hz immitansmetri kullanýlmaktadýr fakat bu yöntem orta kulaðýn durumu ile ilgili bilgi saðlamada yeterli olmamaktadýr. Geniþ Bant Timpanometride (GBT), dýþ kulak kanalýndan geniþ bir frekans aralýðýný (226-8000Hz) kapsayan klik uyaran verilerek ölçüm yapýlmaktadýr. Bu sýrada orta kulaktan yansýyan ve absorbe edilen ses ölçülmektedir. Orta kulaktan yansýyan ses Reflektans, orta kulak tarafýndan soðurulan ses Absorbans olarak tanýmlanýr. Bu çalýþmanýn amacý geniþ bant timpanometrinin geleneksel timpanometriye göre üstün yönleri ve farklýlýklarýný açýklamaktýr.

Acoustic Immitancemetry consists of recording the reflected pure tone sound from the eardrum sent which was delivered from the probe at the outer ear canal, it provides objective information about the condition of the middle ear. Traditional 226 Hz and 1000 Hz
tympanometries are usually used in clinics but it’s not enough to identify middle ear disorders. Wideband Tympanometry (WBT) uses a click stimulus that contains a wide frequency range (226-8000 Hz). WBT measures sounds that are reflected back from the middle ear and absorbed by the middle ear. The sound that is reflected back from the middle ear is called reflectance, the sound that is absorbed by the middle ear is called absorbance. It is the purpose of this study to explain the superiority of WBT and its differences from traditional tympanometry

Abstract | Full Text PDF

Adenotonsillectomy is one of the most frequently performed surgeries by otorhinolaryngologists worldwide. Coblation and PEAK surgery system are new technique of surgery that revolutionizes the way surgery is performed today. We report our experience of two patients being treated with the combined techniques of adenotonsillectomy using both coblation and PEAK plasma blade technology.

Abstract | Full Text PDF

Renal arter týkanýklýðýna, çoðunlukla uzak bölgelerdeki vasküler sistemden renal artere gelen tromboemboli neden olur. Hiperhomosisteinemi, kalýtýmsal hiperkoagülopati nedenlerinden birisidir. Arteriyel tromboz vakalarýnda, etyolojiyi ortaya çýkarmak için hiperkoagülopati tarama testlerinin gerekliliði hala tartýþmalýdýr. Ameliyat sonrasý anüri geliþen hastalarda renal arteriyel tromboemboli akla gelmeli ve renovasküler görüntüleme sonrasý anjiografik trombolitik tedavi acilen uygulanmalýdýr. Sol açýk radikal nefrektomi sonrasý karþý böbrekte hiperhomosisteinemiye baðlý renal arter embolisi geliþen 54 yaþýnda bayan hasta sunmaktayýz.

Renal artery occlusion results commonly from thromboembolism to renal artery from distant vascular system. Hyperhomocysteinemia is one of the hereditary hypercoagulability reasons. In order to elicit ethiology in the cases of arterial thrombosis, necessity of hypercoagulopathy screening tests is still controversial. Diagnosis of renal artery thromboembolism should be remembered in the patients who develop postoperative anuria and renal angiographic intervention must be performed immediately for thrombolytic therapy after renovascular imaging. We report a case of a 54-year-old woman with renal artery embolism on the contralateral kidney due to hyperhomocysteinemia after an open left radical nephrectomy.

Abstract | Full Text PDF

This paper reports an unusual case of successful neurosurgical and medical management of subdural empyema combined with cerebral abscess verified by clinical and neuroradiological criteria. It proves that if there is improvement in clinical-neurological condition patient can be discharged after intensive and continuous parenteral antibiotic therapy (1,5-2 months) followed with peroral antibiotic therapy (approx. 1 months) even if the CT abnormalities still persist i.e. CT improvement may lag behind clinical improvement.

Abstract | Full Text PDF

Üç yýldýr sentetik kannabinoid içeren bonzai adlý maddeyi kötüye kullanan 17 yaþýnda erkek ergen, hastaneye maddeyi buhar ile içine çekme sonrasý geliþen akut piramidal, ekstrapiramidal, serebellar sistem ve nörodavranýþsal bozuklukla baþlayýp hýzlýca akinetik mutizme ilerleyen durum nedeniyle ambulans ile baþvurdu. Yapýlan kraniyal manyetik rezonans görüntülemede toksik lökoensefalopati ile benzer bulgular saptandý. Bonzai kullanýmý inanýlmaz düþük fiyat ve kolay ulaþýlabilirlik nedeniyle geliþmekte olan bizim gibi ülkelerde özellikle çocuklarda ve genç eriþkinlerde çok sýklaþmaktadýr.

A 17-year-old male, who had abused bonsai consisting of synthetic cannabinoids for three years, admitted to the hospital by ambulance after vapor inhalation -“chasing the dragon”- of bonsai on the day of symptom onset and presented with acute pyramidal, extrapyramidal, cerebellar system signs and neurobehavioral changes, which rapidly progressed to akinetic mutism. His cranial magnetic resonance imaging findings were similar to those of toxic leukoencephalopathy. We emphasize that the use of bonsai is becoming increasingly common in developing countries, mainly among children and young adults, as a result of incredibly low price and availability.

Abstract | Full Text PDF