INTRODUCTION: To define if Chlamydia Trachomatis-IgG seropositivity can discriminate ectopic pregnancy cases and women with normal reproductive histories; and whether Chlamydia Trachomatis-IgG seropositivity could predict therapeutical success when medical management is preferred.
METHODS: In a prospective design, 3 patient groups were formed, (Group 1): patients diagnosed as ectopic pregnancy and succesfully treated with methotrexate; (Group 2): failed with methotrexate and surgically treated; (Group 3): the control group being healthy with no history of ectopic pregnancies. Serum isolated from all blood samples and analysed with the double sandwich ELISA technique to semiquantitatively measure IgG-Chlamydia Trachomatis-IgG concentrations.
RESULTS: Cases were included in the study: (Group 1: 30; Group2: 29; Group3: 30). The mean age in Group 2 was significantly older than Group 3 (31.5±1.3 and 27.4±1) and similar to group 1. The mean number of abortions in Group 1 was higher than Group 3 (0.6±0.2 and 0.03±0.03). Free peritoneal fluid was observed in a higher proportion in Group 2 than Group 3. Adnexial masses were observed in a similar proporton of cases in Groups 1 and 2; but in both, significantly higher than Group 3. The β-hCG concentrations were higher in Group 2 than in Group 1 (1493.3±359.5 mIU/ml and 5917.3±945.5 mIU/ml). The Chlamydia Trachomatis IgG positivity were similar in all Groups 1,2 and 3 (46.7%, 44.8% and 33.3); and the Groups (1 and 2) compared with Group 3 (45.8% and 33.3).
DISCUSSION AND CONCLUSION: Chlamydia serology (Chlamydia Trachomatis-IgG) can not be used to discriminate ectopic pregnancies from healthy cases; and can not predict successful treatment with methotrexate.

INTRODUCTION: Spinal anesthesia is often preferred for lower extremity surgery. There are various complications related to spinal anesthesia such as post-spinal headache which causes patient discomfort. In this study, we aimed to investigate the effect of fentanyl added to heavy marcaine over the incidence of post-spinal headache.
METHODS: The patients scheduled for varicose vein surgery were randomized into two groups. 15 mg hyperbaric bupivacaine was given to the patients in the control group, where 15 mg hyperbaric bupivacaine and 20 mcg fentanyl were given to the patients in the study group.
RESULTS: Data of 206 patients (116 male, 90 female) were analyzed. The incidences of post-spinal headache were similar in both groups. With multivariate regression analysis of variables related to post-spinal headache, height, alcohol usage, the number of trials for injection, the value of partial oxygen saturation before intervention and the heart rate of the patient measured on the 10th minute following the intervention were found as independent risk factors for post-spinal headache.
DISCUSSION AND CONCLUSION: We think that 20 mcg fentanyl added to heavy marcaine during spinal anesthesia had no effect over post-spinal headache. However, alcohol usage, the number of lumbar punctures, basal partial oxygen saturation value and the heart rate of the patient measured on the 10th minute following the intervention were found as independent risk factors for post-spinal headache. We believe that there is need for new studies on these variables.

INTRODUCTION: To reduce soft tissue damage in tibia distal fractures, various fixation and treatment methods have been described. We aimed to evaluate the functional results of patients applied with minimally invasive anatomic plate or external fixator for fractures in the distal third of the tibia not extending to the joint.
METHODS: The study included 30 patients who presented at the Emergency Department with a distal tibia fracture type AO 42A2 between 2010 and 2013. Group 1 comprised 15 patients with Gustilo-Andersen Grade 1-2 open fracture who were applied with minimally invasive plate. The 15 patients in Group 2 with closed fractures and Grade 1-2 open fractures were applied with a Limb Reconstruction System (LRS) fixator to the distal tibia. The functional results were evaluated according to the Johner Wrusch criteria.
RESULTS: The mean age of the patients was 36 years. The mean follow-up period was 16 months. The duration of the external fixator application was mean 4 months. The hospital stay was mean 2.5 days for the patients in Group 1 and mean 1.5 days for Group 2 patients Partial weight-bearing was achieved at 6 weeks and full weight-bearing at 10 weeks in Group 1. Partial weight-bearing was applied on the 3rd day in Group 2 with external fixator application and full weight-bearing was generally permitted after Day 10 (8-14) depending on the severity of pain. Full union was obtained in all the patients.
DISCUSSION AND CONCLUSION: Both methods applied to extra-articular tibia distal fractures in selected patients provided very good early stage functiional results.

INTRODUCTION: In this retrospective study, it is aimed to share the clinical, laboratory and surgical results of the patients whom were underwent emergency operation due to ovarian and adnexal torsion in the last 3 years.
METHODS: All data of the patients were retrospectively analyzed. Patients were included who have applied to the emergency service between April 2013 and April 2016, underwent to a surgery with a prediagnosis of ovarian and adnexal torsion and whom diagnosis of torsion have confirmed during the surgery. Demographic features (age, marital status, gravidity, parity, abortus), physical examination findings, laboratory findings, ultrasonographic signs, operation notes and duration of hospitalization were noted.
RESULTS: 19 eligible patients with accessible records were included. Mean age was 29,94± 11,415 years. 42.1% of the patients were virgin and 57.8% of patients were married or sexually active (n: 11). Abdominal and pelvic pain were observed in all patients as clinical symptom. Ultrasonographically mean cysts size was 77,47± 42 mm. 84.2% of torsions (n: 16) were located at right ovary and adnexa. Out of all surgical procedures, laparotomy was performed in 63.1% of all cases (n: 12).
DISCUSSION AND CONCLUSION: Early diagnosis and rapid surgery are substantial in particularly women at reproductive age and children. Although clinical symptoms are mostly nonspecific, clinical suspicious is substantial in early diagnosis. Organ preserving surgery should be the first line option in surgical management.

INTRODUCTION: To present the uterus preserving surgical procedures for the cases of morbidly adherent placenta (MAP).
METHODS: Surgeries for the placental adhesive disorders done between July 1st, 2015 and December 31st, 2016 at the Obstetrics and Gynecology Departments of Sağlık Bilimleri University İstanbul Kanuni Sultan Suleyman Education and Research Hospital were evaluated by reviewing the patient documents and operation records. MAP was diagnosed with transabdominal, transvaginal and color Doppler ultrasonography. In cases of cervical shortening, lacunae in the cervix, or increased vasculature in the cervix were evaluated with speculum as well. Uterus-bladder distance was evaluated both when the bladder was empty and full. Ultrasonographic signs of adhesive placenta such as disruption of the uterine–vesical interface, bulging of the uterine serosa–bladder interface, bridging vessels into the bladder, uterine-bladder interface hypervascularity with aberrant vessels extending into bladder, loss of the retroplacental hypoechogenic area, retroplacental increased blood flow and placental lacunes were recorded as ultrasonographic pictures.
RESULTS: : Plasenta previa was the cause of 268 operations in the last 18 months, these cases of 129 was found to be placenta accreta, 57 of which required hysterectomy and Bakri balloon was used in 43 patients and segmental resection was performed in 13 cases. In the second half of 2016, temporary aortic clamping was used in 6 MAP cases and bilateral common iliac artery clamping was used in 3 MAP cases. The uterus was preserved in the 8 of the cases of clamping while a planned hysterectomy was performed in one case after temporary aortic clamping to reduce hemorrhage due to presence of severe invasion to the servix, parametrium and vagina. In 3 cases, placentas were left inside the uterus (in situ placenta) by a two-step surgery, and after 3 days, the placenta was removed by reoperation, Bakri balloon were placed at the same time and uterus were preserved.
DISCUSSION AND CONCLUSION: Recently, uterus preserving surgeries such as placement of Bakri balloon upon manual removal of placenta, short-term (3 days) retainment of placenta, and aorta or bilateral common iliac artery clamping procedures started to be practiced in our clinic in cases of placental adhesive disorders in addition to segmental uterine resection. The initial results are promising for utrerus-preserving surgeries and reduced need for transfusion

Introduction: Alkaptonuria is a rare autosomal recessive disorder of inborn errors of metabolism. Disease caused by deficiency of homogentisate 1-2 dioxygenase, which is associated with thyrosine metabolism. Deficiency of this enzyme is caused by mutation in homogentisic acid oxidase gene which described in 1996. The result is accumulation of homogentisic acid in collagenous structures throughout the body, especially in fibrous and cartilaginous tissue. Ochronosis consists of excessive deposition of homogentisic acid the connective tissue and present as brown or black pigmentation. The disease often manifests itself in childhood by darkening of urine on standing. Nitisinone efficiently reduces homogentisic acid production alkaptonuria although no experience is available regarding long-term efficacy.
Case Report: We reported a fifteen-year-old male patient diagnosed as alkaptonuria who had darkening urine.
Conclusion: Alkaptonuria is a progressive systemic disease and may cause serious complications in the future. By this case we wanted to emphasize the necessity of considering alcaptonuria in the differential diagnosis of disease children presenting with dark urine, especially when there is no apparent cause.

Lithium is one of the most effective drugs in treatment of bipolar personality disorders. There is 10-15% risk of lithium intoxication in patients treated with lithium. There are several risk factors for lithium intoxication including older age, female gender, presence of neurological disorders andrenalin sufficiency. Better determination of these risk factors and taking measures may lower the rate of lithium intoxication.
The first step in treatment of lithium intoxication is discontinuation of lithium treatment, regulation of fluid and electrolyte imbalances and adequate hydration. In this case report, we emphasized the importance of hemodiafiltration for treatment of lithium intoxication in patients with low cardiac ejection fraction.

Congenital laryngeal cysts are observed at a frequency of 1.82 per 100.000 live births. They arise from the glottic area (58.2 %), vallecula (10.5 %), epiglottis (10.1 %) or aryepiglottic fold. Congenital supraglottic cysts usually become symptomatic immediately after birth, with severe cyanosis and stridor. Without urgent intervention, it can cause pneumomediastinum, pneumothorax, neonatal asphyxia and even mortality. Polyhydroamnios in antenatal history and anechoic mass in the fetal cervical ultrasound or magnetic resonance imaging may support the diagnosis but the definitive diagnosis is made only by flexible fiberoptic laryngoscopy. The best treatment is to remove the cyst using endoscopic or cervical approach. In this paper; a case of congenital supraglottic cyst; who has developed pneumothorax and pneumomediastinum, has been diagnosed through indirect laryngoscopy, and treated with laryngoscopic marsupialization in the 3rd day of birth is presented.

Key words: Congenital supraglottic cyst, newborn

Nephronophthisis is a disease characterised with autosomal recessive hereditary chronic tubulointerstitial nephrite end-stage renal failure. Nephronophthisis may generally be affiliated with non-kidney organ involvements. The situation where retinitis pigmentosa and nephronophthisis are seen together is called the Senior Loken Syndrome. This case is rarely observed, however it is presented for drawing attention to the importance of researching renal pathologies in patients consulting with retinal degeneration and due to the presence of applications with eye symptoms as opposed to renal symptoms.