INTRODUCTION: The aim of this study was to investigate the appropriate time for surgery and surgical criteria in patients followed up with Chiari type II malformation (CM-II).
METHODS: CM-II patients who were admitted to Kanuni Sultan Süleyman Training and Research Hospital between June 1, 2015 and June 01, 2019 were screened retrospectively. Newborns with CM-II detected in screening MMC were included, who were operated in our hospital or in an external center. Demographic characteristics, birth weights, symptoms, myelomeningocele diameter, surgical technique, preoperative and postoperative findings were evaluated.

RESULTS: Fifty infants were included in the study, 32 of them were boy and 18 were girl. All babies had myelomeningocel at birth. Nine babies (18%) were operated on for symptomatic CM-II, and 41 asymptomatic babies were observed for CM-II after MMC repair. After V-P shunt surgery, decompression was performed in patients who did not regress symptoms. Apnea was the most common symptom in the postoperative period. The diameter of the myelomeningocele defect of the patients was also evaluated and it was found that myelomeningocele had a larger diameter in patients operated for symptomatic CM-II.
DISCUSSION AND CONCLUSION: It was observed that rapid surgical decompression of the posterior brain, which was judged by accurate physical and clinical evaluation, was more valuable in preventing morbidity and mortality in patients under 1 year of age.

INTRODUCTION: The aim of this study is to investigate the demographic characteristics of patients undergoing robotic rehabilitation, according to age groups, in a public rehabilitation hospital.
METHODS: For one year (January 1 - December 31, 2018), data were collected by retrospectively scanning the files of patients undergoing inpatient and outpatient robotic rehabilitation treatment in our hospital. Patients (0-20 years /21-40 years /41-60 years and over 61 years old ) were divided into 4 age groups and the data were compiled.
RESULTS: In one year, 363 patients benefited from robotic rehabilitation treatment for a total of 8409 sessions. In geriartic patients over 61 years of age, hemiplegia (66.9%) is the most frequent diagnosis. When we look at the session numbers according to patiens age; patiens who recieved 1-5, 6-10, 11-20, 21-30, 31-50, sessions robotic rehabilitaion are who are above 61 years old. Patients who mostly recieved 51-100 and 101-300 sessions are between 41-60 years old.
DISCUSSION AND CONCLUSION: Cerebral palsy was the most common diagnosis in adolescents and children (0-20 years), while paraplegia was the most frequent diagnosis in young adults and adults (21-60 years).The most common diagnosis in the geriatric patient group (≥61 years) is hemiplegia. The group with the highest number of patients who is going under robotic rehabilitation was found to be hemiplgic patients who are over 61 years.
Although hemiplegic patients are the most commonly group of patients who used robotic rehabilitation, according the sesssion numbers the patients who are between 41-60years old and with the diagnosis of paraplegia have themost ofthe sessions.

INTRODUCTION: The aim of the current retrospective study was comparing the effects of ozone injections and Extracorporeal Shockwave Therapy in the alleviation of pain associated with chronic lateral epicondylitis.
METHODS: A Retrospective Cohort Study was performed, and data was collected from the medical records of 89 patients with unilateral chronic lateral epicondylitis. Local injections of ozone (n=49) and Extracorporeal Shockwave Therapy (n=40) were performed. Pain assessment was made by means of Verhaar scores before and after the first injection and the on 1st, 3rd, 6th, and 9th month after treatment. The two groups were compared with respect to baseline demographics including age, gender, dominant and affected sides and Verhaar scores.
RESULTS: Evaluation of pain scores after the treatment showed significant differences between the two groups. Analysis of pain on the 3rd and 9th month after treatment demonstrated that the ozone group had significantly better scores at rest (p<0.001), on compression (p<0.001) and during activity (p<0.001).
DISCUSSION AND CONCLUSION: Our results demonstrated that ozone injection as well as Extracorporeal Shockwave Therapy can be an effective therapeutic option for chronic lateral epicondylitis patients who are refractory to conservative treatment with Ozone treatment being superior in long term pain relief.

INTRODUCTION: Type 2 diabetes mellitus(T2DM) is associated with structural brain anomalies. TD2M, may cause cognitive impairment and dementia by causing white matter and gray matter microstructural disorders. In our study, we investigated the structural changes in white matter and gray matter in the brain and the relation with diabetes duration in T2DM patients.
METHODS: Followed up patients with T2DM in our outpatient clinic and patients with cranial MRI for routine control and without any history of chronic disease were included in the study. White matter, gray matter, cerebellum, caudat nucleus, thalamus, putamen, hippocampus, globus pallidum and the lateral ventricular volumes were analyzed in images of T-sequence of cranial MRI with Using the 'volBrain volumentry report, version 1.0' program. Variations in this parameters and relation between duration of diabetes, severity of diabetes and routine biochemical parameters were examined.
RESULTS: The laboratory datas between T2DM patients and control group were similar. Fasting blood glucose and HbA1c were high in T2DM patients as expected Table 1). The brain volumes that measured by cranial MR; total brain volume, White matter volume, cerebrum volume, caudat and thalamus nucleus volumes were found lower in T2DM group. White matter / gray matter ratio were significantly lower in the T2DM group (p=0,004).
DISCUSSION AND CONCLUSION: There is a strong association between type 2 diabetes mellitus and structural changes in brain. The most affected parts from diabetes were total brain volume, white matter, grey matter, lateral ventricles and nucleuses.

Objective: In this study we aimed to present the midterm clinical and radiological outcomes of low contact dynamic compression plate fixation of adult forearm fractures Materials and Method: The study included 104 patients with adult forearm fractures who were compatible with the inclusion criteria and have attended the last follow up.. Results The mean time to union was 10,82 weeks. Mean Disabilities of the Arm, Shoulder and Hand (DASH) score was 12.75. There were no cases with implant failure, mechanical irritation, refractures and radioulnar synostoses. 36 patieents were evaluated as perfect, 34 patients as good, 34 patients as acceptable outcomes. No unacceptable outcomes have been obtained. Concliuson. Adult forearm diaphyseal fractures are challenging cases in terms of treatment rehabilitation and complications. In order to prevent medicolegal consequences soft tissues and periosteum must be handled gently and anatomic, rigid, and stable reduction must be obtained in primary surgery. Open reduction and internal fixation with LC DCP’ is the golden standart treatmen option for forearm diaphyseal fracture management and perfec radiologic and functional outcomes can be obtained with this method.

INTRODUCTION: To reveal the etiology in adult patients those are admitted to our hospital with complaints of lymphadenopathy.
METHODS: Patients who were admitted to our hospital with the complaint of lymphadenopathy between 1 January 2017 and 1 October 2018 were screened retrospectively. Patients who had previously had any specific diagnosis in terms of diseases that could cause lymphadenopathy were not included in the study.The main characteristics and epidemiological findings of these patients were revealed.
RESULTS: A total of 90 adult patients were included in the study.The age of the patients ranged from 18 to 89 years.The duration of lymphadenopathy ranged from 1 day to 6 years, and the length of the long axis of the lymph node ranged from 8 to 77 mm.Only 33(36.7%) of the patients were diagnosed with a specific diagnosis.Of these, 24(26.6%) had infection, 6(6.7%) had malignancy, and 3 (3.3%) had other etiologies.The most common infections were TB lymphadenitis (n: 8, 8.9%), cytomegalovirus disease (n: 6, 6.6%) and cat scratch disease (n: 5, 5.5%).Lymph node biopsy was performed in 23 patients.Five of the histopathology specimens resulted as malignant, 4 cases with caseating granulomatous lymphadenitis, 2 with necrotizing granulomatous lymphadenitis, 5 with granulomatous lymphadenitis, 6 with reactive/non-specific changes and one with insufficient material.
DISCUSSION AND CONCLUSION: In addition to TB and CMV, cat scratch disease that we have limited data on the prevalence in Turkey, stands out as one of the major cause of LAP.As there is lack of epidemiological data on LAP etiology in Turkey, more comprehensive and multicenter studies are needed to reveal the epidemiology.

INTRODUCTION: As a part of modern medicine, blood and blood product transfusion has been in clinical use for more than 50 years. Blood transfusions are frequently performed in emergency departments(ED) and this brings extra workload. The aim of this study is to investigate the transfusion rates in the ED and demographic characteristics and the effects on the functioning of the ED.
METHODS: In this study, the patients who were given blood and blood products in the first three months of 2017 were examined retrospectively. Demographic characteristics, which department requested the blood product, which blood product was given, hospital service cost were recorded. SPSS for Windows 22.0 program was used for statistical analysis.
RESULTS: Of the 356 patients, 54.2% were female and 45.8% were male. The mean age was 60,60±19,77. The most common anemia (49.2%) was diagnosed with transfusion. The most common erythrocyte suspension (84.8%) was used. The rate of discharge of patients with anemia was high(p=0.001) and this rate was lower in patients with GIS bleeding and trauma(p=0.001). The cost of service was high in patients who were requested by general surgery(p=0.001) and internal medicine(p=0.031) and the mean was 289,36±36,65 Turkish lira.
DISCUSSION AND CONCLUSION: Appropriate blood and blood product transfusion; it is thought that it will decrease the intensity of emergency service, length of stay, hospital service costs, and incompatibility between transfusion numbers and demand. Transfusion should be taken into consideration in ED. Transfusion procedures should be carried out for patients considering the balance of profit and loss.

INTRODUCTION: Our aim was to investigate whether there is a relation beetween extreme carbon dioxide levels and neurodevelopment in premature infants.
METHODS: Preterm infants less than 1200 grams and smaller than 32 weeks of gestational age included and reviewed. Infants with a neurodeveleopmental assessment (MDI, mental development index, PDI, psychomotor development index) completed 24 months of corrected age and with an available laboratory data retrospectively evaluated. The differences between these first three pCO2 values were calculated and analysed. pCO2 level was found to be high if it was higher than 65 mmHg and low if was lower than 35 mmHg.
RESULTS: Mean birth weight was 924 ± 149 g, and mean gestational age was 27 ± 2.1 weeks.
In a multinomial logistic regression analysis (corrected for gestational age and birthweight), having a difference of 20 or more between pCO2 values of two different blood gas values, this has a risk for having a PDI or MDI less than 75, OR: 4.64 (1.58-13.6% 95 CI), (p = 0.005).


DISCUSSION AND CONCLUSION: We can say that low or too high partial carbon dioxide values in the blood gas and the difference between two different measurements is 20 or more is associated with neurodevelopmental impairment. Clinicans should be aware of very low and very high values of partial carbon dioxide pressures in blood gases, and avoid sudden fluctuations.

INTRODUCTION: The amyloidosis is a potentially life-threatening disease characterized by protein-misfolding. Amyloid-associated (AA) amyloidosis is the most prevalent form of systemic amyloidosis. Cardiovascular involvement is known to be a significant manifestation of amyloidosis. Common carotid artery intima-media thickness (CIMT) assessment is one of the well-recognized tools for identification of subclinical atherosclerotic vascular diseases. It was reported that high FGF-23 concentration may be a significantIs serum fgf 23 associated with subclinic ateroscicosis in patients with AA amyloidosis independent risk factor for an increased CIMT. In this study, we aimed to investigate whether elevated FGF-23 levels might be associated with CIMT levels in AA amyloidosis patients.
METHODS: We studied 63 patients with AA amyloidosis and 29 aged-matched healthy controls.
RESULTS: CIMT levels were significantly higher in AA amyloidosis patients compared to the control group (p < 0.001). However, serum FGF-23 levels were not different between the groups (p =0.110). CIMT was correlated with ages of the patients (r=0.471, p<0.001), but serum FGF23 was not associated with CIMT in patients with amyloidosis (r=0.031, p=0.807).
DISCUSSION AND CONCLUSION: FGF-23 may not be a mediator of atherosclerosis in patients with AA amyloidosis.

INTRODUCTION: Stress incontinence is seen in 20-30% of women over 20 years of age. Transobturator tape (TOT) operation is the most commonly used surgical method in the treatment of stress incontinence.The purpose of our study is evaluation of quality of lifen in patients who underwent Transobturator Tape(TOT) surgery for stress incontinence.
METHODS: This study is included 40 patients who underwent TOT surgery for stress incontinence at Kanuni Sultan Suleyman Training and Research Hospital Beylikduzu Campus.The short-form health survey (SF36) was performed to the patients before surgery and at six month after surgery. Eight parameters of the SF-36 and mental (MCS) and physical (PCS) component summary scores were calculated. The Student’s t-test and Wilcoxon test were used in the statistical analysis(1).
RESULTS: Eight parameters of SF-36 questionnaire form evaluated separately. the findings showed that patients’ quality of life increased significantly regarding physical functioning, social functioning, role limitations because of emotional problems and general health perceptions domains in six months after surgery (p<0.001).But in parameters of bodily pain, vitality and mental health weren't determined significantly difference between preop and postop. The physical component scores (PCS) and mental component scores (MCS) significantly increased after surgery (p<0.001)(1).
DISCUSSION AND CONCLUSION: The SF-36 questionnaire results showed that a significant improvement in the patients’ quality of life was observed in patients who underwent TOT surgery for stress incontinence. Our findings suggest that SF-36 could be considered a reliable evaluation test to be used in the patients who performed TOT surgery for stress incontinence after surgery(1).

INTRODUCTION: Depending on hygiene and general health conditions, parasitic infections are still frequently seen in human populations.The aim of this study was to determine the prevalence of intestinal parasitosis and to evaluate its association with demographic factors in our hospital in the last five years.
METHODS: A total of 24.786 patients from inpatient and outpatient departments who had gastrointestinal symptoms were included in this study between 1 January 2014 and 31 August 2018 in XXX Hospital in X. Stool samples of 24.651 were examined by the saline-iodine method. The sellotape method was also performed on 135 patients.
RESULTS: A total of 11.836 (48%) and 12.815 (52%) samples belonged to female and male patients, respectively. In this sudy, 61.8% of the stool samples were given by patients of 0-15 years of age.In 1234 (4.9%) stool samples, various parasites were detected by the saline-iodine method for helminth eggs and protozoon cysts. The most common parasite was Entamoeba histolytica (12.9%), followed by Giardia intestinalis (11.4%), Ascaris lumbricoides 3.9%, Enterobius vermicularis 2.4%, Taenia saginata 0.4%, Trichuris trichiura 0.1% and (nonpathogen) Entamoeba dispar 68.9%. Enterobius vermicularis eggs were detected by the sellotape method in 30 (2.4%) out of 135 patients.The positive cases were evaluated according to the age and sex, 51% of them were found in 0-15 years-of-age group and 44% of them were female.
DISCUSSION AND CONCLUSION: In addition to developing effective treatment protocols to prevent infectious diseases caused by parasites, it is also important to take protective measures.Intestinal parasites are still important a health issue and must be struggled.

INTRODUCTION: We aimed to determine sleep quality of medical faculty assistants and evaluate this with socio-demographic characteristics.
METHODS: This cross-sectional study was conducted from June to October 2012, after receiving permission from local Ethics Committee. The data for the research were collected using the Pittsburgh Sleep Quality Index (PSQI) and a socio-demographic questionnaire completed with face-to-face interviews after providing necessary explanation and receiving oral consent.
RESULTS: 133 assistants were included in the study. There were significant differences found in bedtimes, duration to fall asleep, sleep duration and waking time with PSQI mean points for assistants included in the study according to department (p<0,05). According to departments, the highest PSQI points and worst sleep quality were observed among surgical sciences and Anesthesiology assistants (24,7±7,8; p<0,05).
DISCUSSION AND CONCLUSION: As highest PSQI points and worst sleep quality were obtained by Anesthesiology assistants, we conclude precautions must be taken for the safety of patients and health workers in surgeries and intensive care units.

INTRODUCTION: Phyllodes tumors (PTs) are rare neoplasms of the breast with a rapid growth potential. PTs have an increased risk of metastases to lung and bone and also the chest wall invasion. Therefore, early diagnosis and treatment is very crucial. Ultrasound (US) elastography is a US based modality providing information about tissue stiffness and elasticity. US elastography has been reported to help differentiation of benign and malignant breast lesions. In clinical practice, there are two different modalities; Strain Elastography (SE) and Shear Wave Elastography (SWE). The aim of this study was to define the US and elastography findings of PTs.
METHODS: 21 patients diagnosed with PT at our breast center from January 2014 to January 2018 were included retrospectively.
RESULTS: SWE of 13 patients and SE of 8 patients were evaluated. The lesions were categorized according to BI-RADS US classification as follows; soft (n =10, 47,6%), intermediate (n =8, 38%) and high (n =3, 14,4%). Median Strain Ratio was 7,72 (range; 0,95-19,14). Mean Shear Wave Velocity (SWV) was 3,3 ±1,18m/s and 2,85 m/s ±1,16 by VTIQ and VTQ methods respectively.
DISCUSSION AND CONCLUSION: In this study, we showed that most of the PTs showed soft or intermediate features in favor of benign lesions by elastography. Radiologists should be aware of the radiologic- pathologic correlation of core biopsy results for planning surgical approach.

INTRODUCTION: Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder caused by a defect in any of the enzymatic steps of adrenal steroidogenesis. The most common cause is the 21-hydroxylase deficiency. In this study, we aimed to reveal frequency of enzyme deficiencies and clinical features of CAH patients.
METHODS: A total of 145 patients, admitted between January 1998 and 2018 with a diagnosis of CAH were evaluated. Clinical features of patients were recorded.
RESULTS: The study included 82 female, 63 male patients. All patients were raised in accordance with their genetic sex. 87.6% of the patients were diagnosed with 21-hydroxylase deficiency, while 80.9% were classical (76.3% salt-wasting, 23.7% simple virilizing) and 19.1% non-classical type. 9.0% of the patients had 11β-hydroxylase, 2.8% had 3β-hydroxysteroid dehydrogenase and 0.7% had POR deficiency. Consanguinity rate was 73.8%. 70.7% of the female patients were diagnosed with ambiguous genitalia and 73.0% of the male patients were diagnosed with salt loss. 15 patients were treated with GnRH analogues due to central precocious puberty. Testicular adrenal rest tumor was present in 14.3% of male cases and polycystic ovary syndrome was found in 9.8% of female cases. Hypertension was present in half of 11β-hydroxylase deficiency cases. The only patient with POR deficiency was diagnosed with Antley-Bixler Syndrome due to her syndromic features.
DISCUSSION AND CONCLUSION: The frequency of enzyme deficiencies in our center was consistent with the literature. Patients with clinical and hormonal features incompatible with 21-hydroxylase deficiency, like hypertension and syndromic features, should be reevaluated for the rare forms of CAH.

INTRODUCTION: Breast cancer is the leading type of cancer in women worldwide and the number of cases is increasing in developing countries. Besides the other imaging diagnostic tools ultrasound guided breast biopsies are being performed for accurate diagnosis. This procedure requires hand-eye coordination skills with two dimensional ultrasound imaging and tracking biopsy needle.
METHODS: Ultrasound biopsy simulator incorporates a cohesive platform between virtual reality, physical objects, location sensors, haptic feedback data and scenarios. A game scoring system was also incorporated into software interface of the simulator. Silicone based breast and thorax model inserted in a torso were used as physical models. Ultrasound probe and biopsy needle were integrated with location sensors and haptic feedback device. A software interface with different training scenarios was developed.
RESULTS: Compared with the existing breast biopsy simulation modalities, the main advantages of this simulation system were that the breast lesions of different types could be generated at any quadrant of the breast tissue and the lack of needle tracks originating from the previous procedures.
DISCUSSION AND CONCLUSION: A novel ultrasound based biopsy simulation system was created for breast lesions that may help to improve technical skills of trainees during the learning period of biopsy procedure. By adding other virtual anatomic and physical models, new modules for liver and renal biopsies can be added to the existing platform.