INTRODUCTION: The aim of this study was to compare the success rates of anterior and anterior-posterior flap anastomosis techniques in external dacryocystorhinostomy (DCR) operations.
METHODS: In our clinic, 82 eyes of 82 patients who underwent external DCR due to epiphora and chronic dacryocystitis were analyzed retrospectively. All of these patients' lacrimal canals were intubated with silicone tube. External DCR surgery was performed with single flap anastomosis in 42 eyes of 42 patients and double flap anastomosis in 40 eyes of 40 patients and control examinations were performed at 1, 3, 6, and 12 months. Surgical success was defined by open punctum lavage and by absence of epiphora after follow-up of 12 months.
RESULTS: A total of 82 cases, 62 females and 20 males, were included in the study. Anterior flap surgery was performed in 42 cases and anterior-posterior flap surgery was performed in 40 cases. Of the 40 patients who underwent anterior-posterior flap surgery, 11 were male and 29 were female, and the mean age was 46.53±15.15 years. Of the 42 patients who underwent anterior flap surgery, 9 were male, 33 were female, and the mean age was 48.19±14.15 years. While the mean follow-up period of the anterior-posterior flap group was 15.7±3.4 months, the follow-up period of the anterior flap group was 16.5±4.2 months. The success rate was 92.5 % in the anterior-posterior flap group and 90.5 % in the anterior flap group. There was no statistically significant difference between the groups in terms of surgical success (p>0.05).
DISCUSSION AND CONCLUSION: The success rates of the DCR techniques with anterior and anterior-posterior flap anastomosis were similar. Since there is no significant difference in terms of surgical success, the anterior flap anastomosis may be preferred because of the easy technique.

INTRODUCTION: This retrospective study aims to assess the clinical and radiological outcomes of cheilectomy in patients diagnosed with Grade 3-4 Hallux Rigidus.
METHODS: Nineteen patients (21 feet) who underwent cheilectomy between January 2016 and September 2018 were retrospectively analyzed. Clinical evaluation included a range of motion (ROM), Visual Analog Scale (VAS), and American Orthopedic Foot and Ankle Society (AOFAS) scoring. Radiological assessment involved examining osteophyte recurrence and arthrosis progression through both anteroposterior (AP) and lateral X-ray images.
RESULTS: The average patient age was 52 years, with a mean follow-up of 26.2 months. Following cheilectomy, significant improvements in dorsiflexion and total joint ROM were observed compared to preoperative levels (p=0.001). VAS scores significantly decreased at the last follow-up compared to preoperative values (p=0.018). Based on AOFAS scoring, 19 out of 21 feet achieved good to excellent results, while 2 patients showed poor outcomes. Radiologically, no osteophyte recurrence was noted. One patient required arthroplasty revision.
DISCUSSION AND CONCLUSION: Cheilectomy may offer favorable outcomes in well-selected patients with high-grade Hallux Rigidus, particularly when joint mobility preservation is desired over arthrodesis.

INTRODUCTION: Atrial fibrillation (AF) is a prevalent arrhythmia, often managed with pulmonary vein isolation (PVI) using cryoballoon ablation, particularly in symptomatic patients. This retrospective single-center study aimed to evaluate the long-term outcomes and influencing factors of cryoballoon-based PVIs.
METHODS: Seventy-four patients diagnosed with paroxysmal AF, symptomatic despite medical therapy, underwent successful cryoballoon PVI between January 2012 and August 2022. Patients were monitored for AF recurrence via ECG and Holter follow-ups. Recurrence rates were compared between groups based on various demographic, echocardiographic, biochemical, and procedural parameters.
RESULTS: A median follow-up of 27 (14.5) months revealed AF recurrence in 50% of patients. Recurrence rates at 1, 3, and 5 years were 23%, 44%, and 51.4%, respectively. Factors significantly associated with recurrence included low hemoglobin and potassium levels, enlarged left atrial diameter, mitral valve abnormalities, and elevated estimated pulmonary artery pressure. Multivariate Cox regression analysis identified left atrial diameter as an independent predictor of recurrence (HR=1.130, 95% CI: 1.010-1.285, p=0.034). A receiver operating characteristic curve was drawn and a cut-off value of 39.5 mm was determined for the left atrium using the Youden index (AUC: 0.747, 95% CI: 0.636-0.859, p<0.001). This cut-off value predicted AF recurrence with 64.9% sensitivity, 70.3% specification.
DISCUSSION AND CONCLUSION: This study confirms existing literature on cryoballoon PVI outcomes. Left atrial diameter emerges as a significant independent predictor of AF recurrence, highlighting its importance in assessing patient and procedural parameters.

INTRODUCTION: Subcutaneous Venous Access Devices (SVADs), commonly known as port catheters, play a crucial role in the monitoring of pediatric patients with chronic diseases requiring long-term treatment. They have become indispensable for children with conditions such as malnutrition, renal insufficiency, and chronic intestinal problems, in addition to oncology patients undergoing chemotherapy. The aim of this study is to present the port catheter procedures performed by the radiological method in our Pediatric Cardiology Department and the methods of dealing with complications.
METHODS: The data of 254 pediatric patients who underwent port placement procedures between October 2020 and October 2022 were analyzed retrospectively. The complications and the management strategies were explained.
RESULTS: Our clinic conducted the port placement procedure for 254 patients, and the port was successfully placed in 253 patients, resulting in a procedural success rate of 99.6%. The median procedure duration was 30 minutes (IQR 20-40 minutes). The fluoroscopy time was 30 seconds (IQR 18-45 seconds). 15 complications (5.9%) were observed. Except for one complication, none required the removal of the port.
DISCUSSION AND CONCLUSION: Port catheters are indispensable in pediatric patients with chronic diseases requiring long-term treatment. Performing port insertion procedures with the support of ultrasound (USG) and fluoroscopy in angiography suites may provide the opportunity to achieve high success rates and low complication rates.

INTRODUCTION: Gallstone disease is among the most common known causes of acute pancreatitis. In our study, we examined the role of the length-diameter of the choledochus, the Wirsung diameter and the angle of the choledochal-Wirsung junction, which may cause obstruction in the etiology of acute pancreatitis. We aimed to recommend prophylactic cholecystectomy for asymptomatic patients whose anatomical features may affect acute attacks and to prevent attacks.
METHODS: Patients who were diagnosed with uncomplicated cholelithiasis and patients who were diagnosed with acute biliary pancreatitis and admitted to our clinic between January 2019 and August 2022 were retrospectively examined. Conservative follow-up of patients with uncomplicated cholelithiasis continued. Patients with acute biliary pancreatitis were treated with treatments recommended by current guidelines. In the MRCP imaging performed in our hospital, the length-diameter, Wirsung diameter and junction angle with the common bile duct were measured and compared by a single radiologist.
RESULTS: A total of 149 patients were included in the study. Among the groups, the age of the control group was found to be significantly lower (p<0.001). There was no significant difference between the groups in terms of common bile duct diameter or Wirsung diameter. Although the common bile duct length parameter was found to be high in patients with acute pancreatitis (p=0.013), the common bile duct-Wirsung junction angle was significantly lower (p=0.036).
DISCUSSION AND CONCLUSION: In our study, a high Choledoc length increased the risk of acute biliary pancreatitis, and a low angle between the Choledoc and Wirsung increased the risk of acute biliary pancreatitis.

INTRODUCTION: The aim of this study is to evaluate the awareness and comprehension of breast cancer, the screening program, and mammography among female academic staff members who work in an academic study center, as well as female patients who applied to the general surgery outpatient clinic with complaints unrelated to breast.
METHODS: A breast cancer awareness survey consisting of 13 questions was administered to a total of 209 respondents, of which 100 were outpatient clinic group (OG) and 109 were academic group (AG). The SPSS 27.0 program was utilized in the statistical analyses.
RESULTS: There was no statistically significant difference between the groups other than the level of education. Regarding the breast cancer awareness rates both groups have a similar rate of awareness above average, however, annual breast examination rates and mammography and/or ultrasonography screening rates were similarly around or below average.
DISCUSSION AND CONCLUSION: "Lack of information", "neglect", "do not have problem" and "not believing it is necessary" were the main reasons for women who do not participate in breast cancer screening programs. Therefore more efforts should be made to increase breast cancer awareness and importance of early diagnosis to prevent breast cancer-related deaths.

INTRODUCTION: Cardiovascular diseases (CVD) are the number one cause of death globally. Emergency cases related to CVDs have an important place among all emergency applications. This study was conducted to determine the competencies of intern physicians studying at the Faculty of Medicine in the Republic of Türkiye regarding their perspective on cardiology education and expertise, their ability to diagnose and treat cardiovascular emergencies and their ability to manage these emergency cases.
METHODS: The study included 286 intern physicians, 149 of whom were women (52.1%) and 137 of whom were men (47.9%), who completed the survey sent to social messaging programs. Physicians were asked about the adequacy of the education at the medical schools they attended and case questions regarding cardiovascular emergencies, including basic biochemical and radiological imaging methods, and their answers were recorded.
RESULTS: The average age of the intern physicians participating in the study was found to be 24.1±1.3 years. In questions regarding medical and specialty education, only 57% of intern physicians stated that they received adequate medical education, and 76.6% stated that the Covid-19 pandemic affected their medical education. The part that physicians are most hesitant about making the correct diagnosis and applying treatment in cardiovascular emergencies is medication administration.
DISCUSSION AND CONCLUSION: Intern physicians should be given basic training on the correct approach to cardiovascular emergencies, both during their medical education and in workshops after graduation.

INTRODUCTION: Identifying the factors associated with the development of multiple sclerosis (MS) in isolated optic neuritis (ION) is vital for early treatment decisions.
METHODS: In this study, we investigated definite MS conversion properties in patients with ION based on neurological, laboratory, magnetic resonance imaging (MRI), visual evoked potential (VEP), cerebrospinal fluid (CSF) examinations according to McDonald criteria 2005 and 2017.
RESULTS: Twenty-six of 41 patients (63.4%) with ION developed definite MS according to McDonald criteria 2005, and 32 patients (78%) developed it according to McDonald criteria 2017. We found that the risk of MS development after ION increased in the first 2 years (34.1%) according to McDonald Criteria 2005. VEP examinations revealed that prolonged latency in the P100 response supported the MS diagnosis. In the cranial MRI, the presence and excessiveness of white mat- ter lesions were critical factors in predicting conversion from ON to MS. In addition, oligoclonal band (OCB) detection in the CSF helps predict MS conversion.
DISCUSSION AND CONCLUSION: Identifying the prognostic factors to understand MS development in ION and other clinically isolated syndromes (CIS) is essential when selecting patients for early treatment and considering early treatment options. The 2017 McDonald criteria provide a more rapid diagnosis of MS, but atypical clinical manifestations and misleading MRI findings must be carefully considered.

INTRODUCTION: Uterine fibroids have two common symptoms: pelvic pain and irregular uterine bleeding. Surgical treatment should be applied in cases where medical treatment fails or cannot be applied. Myomectomy can be performed hysteroscopically, laparoscopically, robotically, or laparotomically. This retrospective study aims to compare the results of laparoscopic and laparotomic myomectomy cases performed in our clinic.
METHODS: A total of 168 patients who underwent 84 laparoscopic and 84 open myomectomies were included in the study. Demographic characteristics (mean age, parity, BMI), indications for myomectomy, duration of operation, complications, pain VAS score, estimated blood loss hospital stay, and the number and diameter of myomas were compared. Before surgery, each patient gave their signed informed consent. SPSS for Windows 24 (SPSS Inc. Chicago, IL) was utilized. The significance threshold of 0.05 was accepted.
RESULTS: The mean operative time in the LM group was significantly longer than in the OM group (p=0.002). The hemoglobin drop was significantly lower in the LM group than in the OM group (p=0.005). The length of hospital stay was significantly different in the laparoscopic myomectomy group (p=0.012). Postoperative VAS scores were significantly different in the LM group (p=0.00).
DISCUSSION AND CONCLUSION: In selected cases, compared to open myomectomy, laparoscopic myomectomy resulted in less loss of blood, a brief stay in the hospital, and less pelvic pain.

INTRODUCTION: This study aimed to clinically compare patients with culture-negative (CN) adult knee septic arthritis and culture-positive (CP) adult knee septic arthritis patients.
METHODS: 51 patients who were operated on with the diagnosis of adult knee septic arthritis between June 2016 and May 2023 were retrospectively examined. While 23 patients with CN were called Group 1, 28 patients with CP were called Group 2. Age, gender, side, C-reactive protein (Crp) value at admission, culture results, hospital stay and follow-up periods were evaluated. In clinical evaluation, knee ROM (range of motion) and visual analog score (VAS) were evaluated.
RESULTS: Both groups had similar distributions in terms of age, gender, side and follow-up periods. Group 1's Crp level at admission and total hospital stay were lower than Group 2. (p=0.018/p=0.0001) ROM and VAS scores of both groups were similar. No patient developed deep infection.
DISCUSSION AND CONCLUSION: In CN adult knee septic arthritis patients, the average Crp values at the time of admission are lower and the hospital stay is shorter. Clinically, they have similar results to CP patients in terms of ROM and VAS.

Transurethral resection of the prostate (TURP) syndrome is a systemic complication caused by excessive absorption of electrolyte-free irrigation fluids during transurethral resection of prostate or bladder tumors. TURP syndrome can begin as early as 15 minutes after resection begins and can last up to 24 hours after surgery. The factors affecting the development of TURP syndrome are divided into two categories: patient-related factors (age, comorbid diseases, and prostate size) and surgery-related factors (type of irrigation fluid, duration, height of the fluid bag, absorption rate of irrigation fluid, and surgeon's experience). Signs and symptoms are due to hypervolemia, hyponatremia, and toxicity of substances in the irrigation fluid. Diagnosis is difficult because many signs and symptoms are variable and nonspecific. The clinical spectrum can range from asymptomatic hyponatremia and headache to nausea, vomiting, convulsions, visual disturbances, pulmonary edema, coma, cardiovascular collapse, and death. Since it may occur in the early perioperative period and causes central nervous system symptoms and signs, spinal anesthesia may be helpful for early diagnosis. When the diagnosis is made, informing the surgical team and ending the surgery is critical. Control of seizures, ensuring airway safety with endotracheal intubation, and treating hypervolemia, hyponatremia, and other electrolyte irregularities should be implemented immediately.

Diastematomyelia, a congenital spinal anomaly characterized by a longitudinal split of the spinal cord into two hemicords, poses significant clinical and surgical challenges. This condition, often associated with scoliosis and other neural tube defects, necessitates careful diagnostic and therapeutic approaches to prevent neurological deterioration and improve patient outcomes. Understanding the embryological development and manifestations of diastematomyelia is crucial for timely diagnosis and management. We report on an 11-month-old female patient with no history of systemic diseases, presenting with significant scoliosis but no neurological deficits. Diagnostic imaging, including computerized tomography, revealed no thoracic involvement but confirmed the presence of Type 1 diastematomyelia, characterized by two dural sacs separated by a bony septum. Anesthetic management was tailored to address the complexities of the condition, involving inhalation anesthesia with sevoflurane, followed by remifentanil and propofol for neuromonitoring. Surgical intervention focused on the unification of the separated dural sacs, with careful intraoperative monitoring to avoid neurological complications. The patient's postoperative course was uneventful, and she was transferred to the pediatric intensive care unit for recovery. The management of dias- tematomyelia, particularly in pediatric patients, requires a multidisciplinary approach, encompassing accurate diagnostic imaging, specialized anesthetic management, and surgical precision. The case further illustrates the necessity of a detailed examination and a comprehensive management strategy, advocating for early intervention and tailored care to optimize patient outcomes in the context of this complex congenital condition.