INTRODUCTION: Hypermobility (HM) is a condition of connective tissue in which the synovial joints move beyond the normal limits and its effects on disc degeneration (DD), and low back pain (LBP) is not fully known. We aimed to reveal the relationship between HM and DD and also LBP.
METHODS: The cases between 20-50 years old with low back and leg pain were included in the study. Their lumbar MRIs were evaluated using Pfirrmann grading system. For the cases meeting the study criteria, the Beighton score was used for evaluating the generalized joint laxity, and the 1998 Brighton criteria were used to assess the benign joint HM syndrome. The cases were also evaluated prospectively for pain by using the visual analog scale (VAS) and for disability using the Oswestry disability index (ODİ).
RESULTS: Of the 172 cases that met the inclusion and the exclusion criteria, 65.1% were female, 34.9% were male, and the mean age of the cases was 36.82 ± 7.62. While 14 % of cases have joint HM, HM was not detected in 86 %. There was no statistically significant difference in the values of Pfirrmann grade parameters in all lumbar disc levels between the groups (p> 0.05). Likewise, there was no statistically significant difference between the groups concerning the VAS and the ODİ values (p> 0.05).
DISCUSSION AND CONCLUSION: These findings suggest that HM may not yield to an increase lumbar DD grades and also VAS and ODİ values between the cases 20-50 years old.

INTRODUCTION: Langerhans cell histiocytosis is seen primarily in pediatric population. It is characterized by langerhans cell proliferation with organ infiltration. Eosinophilic granuloma (EG) is usually located in the thoracic spine and it rarely cause local destructive lesion in cervical spine in children. The aim of this study was to review the treatment approaches and clinical course of 5 pediatric patients with eosinophilic granuloma.
METHODS: In this study, five pediatric patients who were followed up in our clinic between 2015-2019 with the diagnosis of cervical spine eosinophilic granuloma were retrospectively analyzed. Each patient underwent a detailed neurological history and examination. All patients had isolated cervical spine involvement and histological diagnosis of eosinophilic granuloma was confirmed.
RESULTS: There were 3 boys and 2 girls (mean age: 8 years; range 4 –10 years). We followed-up patients for 19 mounths (range 8 –29). Symptoms vary according to localization of the lesion in the cervical spine. Four children who had no symptoms other than neck pain were diagnosed by biopsy and methylprednisolone injection was performed, and one child with neurological deficit underwent decompression and fusion surgery.
DISCUSSION AND CONCLUSION: The management of pediatric patients with EG of the cervical spine is difficult, especially in the case with neurological involvement. Observation alone, long-term immobilization, systemic chemotherapy, curettage, corticosteroid injection and low-dose radiation therapy have been recommended for the treatment of EG patients, but surgical treatment is evident when neurological involvement is present.

INTRODUCTION: The aim of this study was to determine the effects of socio-demographic and disease-related features of female patients with infertility on quality of life.
METHODS: The study was carried out with 100 infertile female patients who came to 4 private hospitals located in İstanbul province after receiving the permission of ethics committee. Data were collected applying "Information Form" and "FertiQol Scale". Data were analyzed statistically.
RESULTS: The average age of the patients was found as 36± 5 It was seen that 70% of the patients had undergraduate degrees, 40% were housewives, 49% of them were married for 1-5 years, 52% were infertile for 3-5 years, 81% of them were primary infertile, 51% previously had 2-4 times infertility treatment and 56% were partially informed about infertility treatment. The quality of life was observed to be low in those who had high school education and lower education level; who had infertility treatment many times before; who have been infertile for 6 years and more; who were housewives; and who have been married for 6-10 years,
who had endometriosis and ovarian cyst-induced infertility. The average score of female patients diagnosed with infertility took from scale was determined as 67 ± 18 (p <0.05).

DISCUSSION AND CONCLUSION: It was observed that those who were younger, those with high school or lower education level, housewives, low income level, infertility duration and number of treatments were lower, the quality of life of primary infertile patients and who had endometriosis and ovarian cyst-induced infertility was lower.

INTRODUCTION: Ischemic stroke is one of the most common causes of disability and death worldwide. The aim of the study was to investigate the diagnostic value of DW-MRI in patients with ischemic stroke, and to emphasize the necessity and importance of imaging modalities in such patients with symptoms of speech disorder, impaired consciousness, numbness and/or weakness in one half of the body admitted to the emergency department.
METHODS: The study was performed retrospectively between 01.05.2018 and 31.06.2018 in Adult Emergency Department of our hospital. A total of 1303 patients who underwent diffuse magnetic resonance imaging in the emergency department were included. Age, sex, complaints on admission of the patients, whether computerized tomography revealed hypodensity, and whether DW-MRI showed signs of ischemic stroke were recorded.
RESULTS: A total of 1303 patients were enrolled in our study, of which 745 were female (57.2%) and 558 (42.8%) were male. The mean age of the patients (range;11-95) was 54.29±18.73 years. In 5.4% (n=70) of the cases, there were hypodense areas on CCT and in 11.1% (n=145), DW-MRI revealed signs of ischemic stroke. 82.9% of patients with hypodense area on CCT showed ischemic stroke on DW-MRI. (p=0.001)
DISCUSSION AND CONCLUSION: Especially in patients with a speech disorder, impaired consciousness, numbness and weakness in one half of the body, having a DW-MRI at the first appropriate time and initiation of diagnosis and treatment faster and more accurately are thought to be important steps in reducing and even preventing mortality and morbid outcomes in emergency departments.

INTRODUCTION: The aim of this study is to determine the Vitamin D levels of patients diagnosed with unexplained recurrent pregnancy loss (RPL).
METHODS: Sixty five patients with RPL were investigated regarding the possible etiology of RPL. All patients underwent an operation called dilatation curretage (D&C) and the material went to genetic examination whether fetus had a cromosomal abnormality. Patients were investigated in terms of inherited and acquired trombophlia. 45 pregnant patients who had a healthy fetus were choosen as a control group. All participants gave blood sample to determine the levels of 25(OH)D, glucose, prolactine, TSH and insuline.
RESULTS: Fourteen of RPL patients had a karyotype abnormality, Twelve patients were diagnosed with trombophilia, 2 patients had a uterin intracavitary abnormalities, 2 patients diagnosed with hypothyroidism and 1 patient diagnosed with Diabetes mellitus. Last of all 34 patients diagnosed with unexplained RPL. The mean 25(OH)D level of unexplained RPL patients was significantly lower than controls (p=0.022). According to ROC curve analysis the cut-off level for 25(OH)D was determined 11 ng/mL. The specifity of the test was%97.8 and the sensitivity of the test was %29.4.
DISCUSSION AND CONCLUSION: Unexplained RPL patients had lower Vitamin D levels. These results may show the possible role of Vitamin D regarding RPL. Further study is needed to show whether supplemental vitamin D administration can prevent the onset of pregnancy loss.

INTRODUCTION: To evaluate the clinical features, prognostic factors and perinatal outcomes of fetuses with the diagnosis of congenital pulmonary airway malformation and bronchopulmonary sequestration.
METHODS: The medical records of 59 fetuses with the diagnosis of congenital pulmonary airway malformation and bronchopulmonary sequestration were retrospectively analyzed. The characteristics and natural history of the thoracic mass, and the perinatal outcomes of cases were evaluated.
RESULTS: While 37 cases (%71.2) were diagnosed as congenital pulmonary airway malformation, 15 cases (% 28.8) were diagnosed as bronchopulmonary sequestration. Associated structural anomalies were detected in 17.3 percent of cases and chromosomal anomalies were present in 7.7 percent of cases with associated anomalies. Live birth occured in 75 percent of cases. The presence of bronchopulmonary malformation was shown in 59 percent of cases in postnatal period, and 78.3 percent of these cases were operated in the first year of life.
DISCUSSION AND CONCLUSION: We observed that fetuses with the diagnosis of bronchopulmonary malformation had a good prognosis in the absence of associated anomaly and fetal hydrops. It is also observed that the cases with spontaneous regression of the thoracic mass did not need an operation. Thoracic transverse sections should be evaluated during basic fetal anatomic screening in order to increase the frequency of prenatal diagnosis of fetal thoracic anomalies.

INTRODUCTION: Our aim was to evaluate the imaging findings and treatment outcomes of patients diagnosed with Coats’ disease in our clinic.
METHODS: Records of patients diagnosed with Coats’ disease in our clinic between 2010 and 2016 were evaluated retrospectively. Stage of the disease, imaging findings and clinical characteristics at the time of diagnosis and at the final visit, and the received treatment were noted. Records of fundus photograhy, fundus florescein angiography and optic coherence tomography (OCT) imagings were reviewed. The relationship between visual acuity (VA) and central macular thickness (CMT) was analyzed.
RESULTS: Thirteen eyes of 13 patients were included in this study. Four patients were over 18 years old. Ten patients received combined treatment of bevacizumab and laser photocoagulation, whereas 4 patients required surgery. Intravitreal dexamethasone implant was applied to 2 patients. Eleven patients’ OCT images were available, and 9 patients showed regression, 1 patient showed progression and 1 patient remained stable in terms of OCT findings. There was no correlation found between initial and final CMT and VA (p=0,89, r=0,47).
DISCUSSION AND CONCLUSION: Coats’ disease require regular follow-up and OCT is a useful tool for evaluating the course of disease. Different treatment modalities might be effective for anatomic success and result in globe salvage, even though functional success is harder to achieve.

INTRODUCTION: The aim of this study was to present the results of surgical treatment along with demographic and clinical features in tethered spinal cord syndrome cases seen in adulthood.
METHODS: We retrospectively evaluated 73 cases who underwent tethered cord release operations between 2004 and 2015 in our clinic. The mean follow-up period was 21.7 (3 - 63) months. Adult cases were 5 female and 4 male patients with ages between 18 - 55. Clinical and radiological characteristics of the patients and follow-up data on the surgical treatment were obtained. Pain and neurological findings were graded using the scoring system proposed by Klekamp et al.
RESULTS: Nine patients had complaints of back and/or leg pain, two patients had gait ataxia and three patients had bladder dysfunction. Only one patient had a loss of muscle strength. There were cutaneous stigmata in a total of three patients: Two dermal sinus tracts, one thoracic dermatomal hypertrichosis. Four patients had scoliosis, 4 had syringomyelia and 3 had split cord malformation. The level of conus medullaris was L3 in one patient, L4 in 3 patients, L5 in 2 patients, and S1 in one patient. All patients underwent surgical de-tethering. Most of the patients reported a decrease in their pain levels. However, sensory dysfunction and sphincter problems remained unresolved.
DISCUSSION AND CONCLUSION: The main difference between adult cases compared to paediatric cases was symptomatology. The pain was the cardinal symptom in almost all cases. While the surgery was effective to diminish pain, resolution of neurological deficits was disappointing in this series.

INTRODUCTION: Tularemia is a zoonosis caused by Francisella tularensis;a small Gram negative aerobic coccobacillus.It is endemic in northern hemisphere and often occurs in hunters,farmers,animal breeders,forest workers nature lovers,veterinarians and laboratory staff.After the first epidemic in 1936,there have been many outbreaks in Turkey The number of cases has increased each year and reached 4986 by 2015.We aimed to determine the seroprevalence of tularemia in rura land urban regionsof Diyarbakır.
METHODS: Serum samples of 1503 healthy blood donors regardless of age and genderfrom Diyarbakir and neighboring provinces were included in the study.Sera samples were investigated for the presence of IgG antibodies against F.tularensis by microagglutination methods.Serum samples with positive titration of 1/20 were studied by Rose Bengal test in terms of cross reactivity with Brucella antibodies.Rose-Bengal test negative samples were retested in low titers.
RESULTS: Ovearall 1410 of the donors were male,93 were female.The mean age of donors was 33,2±9,8 Sera of 22 donors were determined as positive in 1/20 titration.Three of them which were reactive with Brucella slide agglutination were considered positive for Brucella antibodies.The remaining 19 sera(1.3%) were accepted as tularemia seropositivity.Sixteen (84,2%) of seropositive donors were male, while three (15,8%) of them were female.The mean age of seropositive donors was 29,5±10,3 There was no significant difference in gender(p=0.108 ) and age groups(p=0,053) of tularemia seropositive donors.
DISCUSSION AND CONCLUSION: Seropositivity rate of 1,3% indicates the presence of tularemia agent in the region.To inform the local people and population inhabiting especially in rural area risk groups about the disease may reduce the transmission of the agent

INTRODUCTION: We aimed to differentiate oncocytoma from renal cell carcinoma (RCC) and to define subtypes of RCC by using density level of tumors from pre-operative contrast-enhanced dynamic CT.
METHODS: The records of patients who underwent nephrectomy due to tumor in our hospital between 2014-2018 were examined retrospectively. CT scans were performed in non-contrast, arterial, venous and late venous phases with the 4-phase Dynamic Abdominal CT protocol. One general radiologist evaluated the images blinded to pathology. Tumor size (cm), heterogeneous-homogenous composition, border, collecting system involvement, calcification, necrosis, accompanying LAP or thrombosis and mass attenuation values were noted.
RESULTS: Of the 38 patients, 22 were clear cell carcinoma, 6 were papillary cell carcinoma, 5 were chromophobe cell carcinoma and 5 were oncocytoma. The mean tumor size was 6 cm in clear cell RCC, 10.9 cm in chromophobe cell RCC, 3.7 cm in papillary cell RCC and 4.4 cm in oncocytoma. Bleeding in a clear cell RCC, septation in 2 clear cell RCC, local invasion in one clear cell RCC, calsification in one clear cell RCC were noted. No metastasis, LAP and venous thrombosis were found. HU values of papillary cell carcinoma in arterial and venous phases were lower than clear cell RCC(p=0,001, p=0,016). Also HU values of oncocytoma in late phase were higher than clear cell carcinoma (p=0,019).
DISCUSSION AND CONCLUSION: Differential diagnoses can be narrowed by the attenuation values obtained by using Dynamic CT in kidney masses. Oncocytoma with high HU levels and papillary cell carcinoma with low HU levels should be considered in the priority order.

INTRODUCTION: The aim of this retrospective study was to enlighten which types of polypoid lesions are encountered during the endoscopy of upper gastrointestinal (GIS) and how to manage with these polypoid lesions.
METHODS: Upper gastrointestinal system endoscopies carried out in a total of 301 patients between the dates of January 2015- January 2018 in our endoscopy unit of the department of general surgery were evaluated.Detecting the polypoid lesions,data of all patients who undergone polypectomy or biopsy during the endoscopy procedure were examined in terms of the location,size and number of lesions,the histopathological characteristics and Helicobacter pylori (Hp) positivity.
RESULTS: A single polypoid lesion in 234 patients and multipolypoid lesions in 77 patients were detected,and polypectomy was applied to these patients.Histopathologically, 40.19(%) of 301 polypoid lesions were defined as true polyps,and 251 of them were detected in stomach.Lesions smaller than 1 cm were generally highly reactive polypoids while the reactive polypoids were mostly observed in Hp positive cases.Considering the locations of lesions, non-neoplastic polypoids were mostly found in the cardia and antrum.Comparing the number of fundic and hyperplastic polyps,the only difference was found in the chronic active and inactive gastritis.
DISCUSSION AND CONCLUSION: To define true or reactive polps histopathologically in examination of the polypoids during upper GIS endoscopies gains importance in follow up patients in terms of neoplastic transformation.In fact,neoplastic potential these lesions are important to be evaluated according to the location in upper GIS in addition to their sizes,however,further studies with larger samples are needed to clear the issue.

INTRODUCTION: We aimed the age and sex-related changes in the frequency of lumbar discopathy by lumbar MR imaging in patients admitted to the polyclinic presenting with low back pain
METHODS: 147 patients who underwent lumbar MRI in our hospital between January 2017 and June 2017 were evaluated retrospectively. Age and sex-related changes of lumbar discopathy findings and presence of high density zone were examined.
RESULTS: The mean age of the patients was 45.8 ± 12.6 years for females and 46.9 ± 16.2 years for males (p = 0.646). The number of cases with hernia was 84 (57.1%). There was no difference between men and women in terms of hernia frequency (p = 0.219). In 94 (63.9%) of the cases, there were hernia in two or more segments. There was a significant difference in the frequency of hernias in between decades (p = 0.029). LDH was found most frequently in L4-L5 levels in all decades.The number of herniated disk levels was positively correlated with age (r = 0.54, p = 0.0001). The frequency of high density zones was significantly higher at herniated disks (p = 0.001).
DISCUSSION AND CONCLUSION: In our study, when we retrospectively evaluated lumbar MRI of the patients presented with low back pain, we found lumbar discopathy findings in more than 50% of these patients. Especially compared to the literature, there is an increased ratio of multi-level discopathy findings.

INTRODUCTION: Isolation of the causative agent is the gold standard for the diagnosis of tuberculosis. Most commonly used culture media for isolation are Lowenstein-Jensen(L-J) and automatic liquid medium(ALM). However, the cost and growth time are still an important concern. In this study, performance of 5% sheep blood agar(SBA) was investigated.
METHODS: Samples from lower respiratory tract(n=617) which were collected at laboratories of Marmara University Hospital and Sureyyapaşa Chest Diseases Hospital were inoculated on ALM, L-J and SBA.
RESULTS: Growth was observed in 38 samples. Thirty six strain were grown on ALM(%5.8),31 on L-J(%5) and only 5 on SBA(%0.8); isolation days of 14.53, 29.09 and 19.2 respectively. In the study period, we also inoculated 108 lower respiratory tract samples which were positive for acid fast bacteria, on ALM, L-J and SBA. For SBA inoculation, samples were seeded after enrichment by incubation in Middlebrook-7H9 broth for 48 hours. Totally, 75 of the samples(%69,4) exhibited growth in ALM, 73(%67,6) on L-J and,72(%66,7) on M-7H9+SBA, requiring isolation time of 14.57 days for ALM, 26.10 days for L-J and, 18.74 days for M-7H9+SBA. Where as difference of isolation time between these media were determined to be statistically meaningful (p<0.001).
DISCUSSION AND CONCLUSION: SBA showed comparable growth rates with that of ALM and L-J media and was superior than L-J in respect to isolation time while their costs were similar. According to the results of our study, M-7H9+SBA method might be an alternative for laboratories where automated systems are not available.

Acute ischemic stroke is a common cause of mortality and morbidity worldwide. Motor deficits are often the main problem in these patients. However, sensory losses related to touch, hearing and sight also occur in many patients. Impaired color vision, visual hallucinations, and visual field defects often develop as regards vision. Visual field damage is often seen in occipital and temporal lobe lesions and middle and posterior cerebral artery infarcts.
Patients who have stroke often present to the emergency outpatient departments with weakness in the extremities, speech impairment, and unconsciousness. It is rare in daily practice for a stroke diagnosis to be made after the patient presents to an ophthalmology outpatient department only complaining of visual loss or blurred vision. We present clinical findings of two patients who presented to our clinic with visual symptoms, were found to have no ophthalmic pathology, and were diagnosed with stroke after the visual field test revealed defects.

Adrenal myelolipoma is rare benign tumor, and contrary to most of the adrenal tumors it is an endocrinologically inactive tumor. Mature adipose tissue, and active bone marrow components detected during histopathological examination are diagnostic clues. They are generally small in size, and detected incidentally. Its exact etiology has not been determined yet. However multiple number of etiopathogenetic factors have been defined. Hematopoietic stem cell embolization in the adrenal gland is one of the most probable theories.
In this case report we present a 31-year-old patient whose pregnancy is terminated 10 months previously and developed rapidly progressive giant adrenal myelolipoma during the course of her pregnancy. According to literature findings, our case presented in the study is the first case who presented with abdominal pain during postpartum period. We think that this progressively increasing mass during nearly 10 months might be related to pregnancy.