GÝRÝÞ ve AMAÇ: Prostat biyopsisi prostat kanseri tanýsýnda kullanýlan altýn standart yöntemdir. Bu iþlem sýrasýnda, lokal anestezik maddelerin periprostatik enjeksiyonunun prostat biyopsisi sýrasýndaki aðrýnýn azaltýlmasýnda en etkili yöntem olduðu bilinmekle birlikte rektuma lokal anestetik madde uygulanmasýnýn da etkili bir yöntem olduðunu belirten çalýþmalar mevcuttur. Bu çalýþma ile prostat biyopsi endikasyonu olan hastalarýmýzda TRUS eþliðinde prostat biyopsisi almadan önce intrarektal lidokainli jel (Konix Catheter Gel®), intrarektal ultrasonik jel (Konix Ultrasonic Gel®) ve periprostatik bölgeye verilen lidokainin aðrýyý azaltmadaki etkinliðini karþýlaþtýrýldý.
YÖNTEM ve GEREÇLER: Trakya Üniversitesi Týp Fakültesi Bilimsel Araþtýrmalar Etik Kurulu’nun TUTF-BAEK2019/203 onay numarasý ile çalýþmamýza Trakya Üniversitesi Týp Fakültesi Üroloji Kliniði’ne baþvuran ve prostat biyopsi endikasyonu olan 100 gönüllü hasta dahil edildi. Ýþlem öncesi hastalarýn anksiyete durumunu ölçmek için STAI-I anket formu dolduruldu. Hastalar randomize olarak 25’er kiþiden oluþan A, B, C ve D olmak üzere dört gruba ayrýldý. Tüm hastalara 12 parça prostat biyopsisi alýnmasý iþlemi uygulandý. Ýþlem sonrasýnda hastanýn aðrý toleransý vizüel analog skorlamasý yapýldý.
BULGULAR: Gruplar arasýnda her üç aþamadaki vizual aðrý skorlarý arasýnda da istatistiksel olarak anlamlý fark bulunmuþtur. Hastalarýn iþlem öncesi anksiyetelerinin iþlem sýrasýnda ve sonrasýndaki aðrý arasýnda çalýþmamýzda anlamlý iliþki bulunmamýþtýr. Probun rektuma yerleþtirilmesi sýrasýnda duyulan aðrýnýn sadece intrarektal lidokain jel kullanýmý ile intrarektal ultrasonik jel ve lidokainli periprostatik blokajýn birlikte kullanýldýðýnda duyulan aðrýnýn VAS deðerleri arasýnda anlamlý fark olmadýðý görüldü. Prob yerleþtirilirken üzerine lubrikan jel sürülmesine raðmen yalnýzca periprostatik blokaj yapýlan hastalarýn daha fazla aðrý duyduklarý ancak biyopsi alýmý ve biyopsi sonrasý VAS deðerlerinin intrarektal ultrasonik jel ve lidokainli periprostatik blokajýn birlikte kullanýldýðý hastalar ile anlamlý olarak fark taþýmadýðý saptandý.
TARTIÞMA ve SONUÇ: Prostat biyopsileri sýrasýnda yalnýzca lidokain ile periprostatik blokajýn probun giriþ anýnda yeterli olmayýp hastalarýn aðrý duymasýna neden olduðu, bu nedenle periprostatik blokajla beraber intrarektal lidakain jel ile kombine kullanýlmasýnýn hasta konforunu arttýrdýðý ve bu kombinasyonun biyopsinin her üç aþamasýnda da en düþük VAS skorlarýna sahip olduðu gösterilmiþtir.

INTRODUCTION: Prostate biopsy is the gold standard method used in the diagnosis of prostate cancer. While periprostatic injection of local anesthetic agents during this procedure is the most effective method for reducing pain during the prostate biopsy, there are studies indicating that application of a local anesthetic agent to the rectum is also an effective method. In this study, we compared the effectiveness of intrarectal lidocaine gel (Konix Catheter Gel®), intrarectal ultrasonic gel (Konix Ultrasonic Gel®) and lidocaine administered to the periprostatic region in pain reduction before taking prostate biopsy in our patients with prostate biopsy indication.
METHODS: In our study, 100 volunteer patients with prostate biopsy indication were included with TUTF_BAEK2019/203 approval number of Trakya University Faculty of Medicine Ethics Committee. These patients were randomly divided into four groups of 25. Groups were named A, B, C and D. A standard 12-piece prostate biopsy was performed with a tru-cut biopsy needle from all patients. After the procedure, the patient's pain tolerance was evaluated by a different individual. The VAS scale was used to assess pain tolerance.
RESULTS: A statistically significant difference was also found between the groups regarding the visual pain scores in all three stages. When STAI-I of the patients participating in this study was compared, there was no significant difference among the four groups. In our study, no significant relationship was found between pre-procedure anxiety and pain during and after the procedure.
DISCUSSION AND CONCLUSION: During prostate biopsies, only periprostatic blockade with lidocaine was not sufficient at the time of introduction of the probe, causing patients to feel pain, therefore, combined with periprostatic blockage with intrarectal lidocaine gel, it has been shown that it increases patient comfort and has the lowest VAS scores in all three stages of biopsy.

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GÝRÝÞ ve AMAÇ: Hastanemizde COVID-19 pandemisinden önceki ve sonraki 2 ay içindeki vakalarý karþýlaþtýrarak artan COVID-19 tanýlarý ile ortopedik kýrýða multidisipliner yaklaþýmýmýzý bildirmek.
YÖNTEM ve GEREÇLER: Pandemi öncesi (Grup 1) 2 ay ve sonrasý ilk (Grup 2) 2 ay içinde acil servisimize baþvuran ve ortopedi kiniðine konsülte edilen kýrýk vakalarý çalýþmaya dahil edildi. Vaka sayýlarý, kýrýk tipleri, yatýþ süreleri, ameliyat bekleme süreleri ve ameliyat sonrasý taburcu süreleri her iki grup arasýnda karþýlaþtýrýldý. Pandemi sonrasý kýrýk hastalarýna yaklaþým, ameliyathane kullanýmý ve ekipman seçimi derlendi. PCR sonucu ile Covid-19 pozitif infeksiyonu tespit edilen vaka sayýlarý kaydedilerek, bu hastalara yaklaþým açýsýndan bilgiler derlendi.
BULGULAR: Çalýþmamýza dahil edilen hasta sayýsý 388'dir. Pandemi öncesi 1 ay Grup 1, sonrasý 1 ay Grup 2 olarak ayrýldý. 292 (%75,3) hasta Grup 1, 96 (%24.7) hasta ise Grup 2’ye dahil edildi. Opere edilen hastalarýn 102 (%75)’i grup 1, 34 (%25)’si Grup 2 idi. Yatýþ süresi Grup 1’de 9.55±4.28, Grup 2’de 7.82±3,64 gün idi. Ameliyat bekleme süresi Grup 1’de 7.28±3.79, Grup 2’de ise 7.24±4.37 gün idi. Taburculuk süreleri ise Grup 1’de 3.02±1,75 gün, Grup 2’de ise 2.63±1.54gün idi. Tüm deðerlendirilen paremetrelerdegruplar arasýnda istatiksel olarak anlamlý fark saptanmadý (p=0.14), (p=0.97) (p=0.42).
TARTIÞMA ve SONUÇ: Kýrýk vakalarýna yaklaþýmýmýz ortopedi prensipleri içerisindedaha akýlcý, optimal ve hýzlý bir þekilde uygulanmalý; Covid-19 enfeksiyonundan korunmak için önlemleri titizlikle uygulamalýyýz.

INTRODUCTION: To report our multidisciplinary approach to the orthopedic fracture with increasing COVID-19 diagnoses by comparing the cases within two months before and after COVID -19 pandemic in our hospital.
METHODS: Fracture cases admitted to our emergency department and consulted to the orthopedic clinic were included in this study two months before pandemic (Group 1) and after the first (Group 2) two months. The number of cases, types of fractures, duration of hospitalization, waiting times for surgery and post-surgery discharge times were compared between the two groups. Approach to fracture, operating room usage and equipment selection were compiled after the pandemic. The number of cases with COVID-19 positive infection detected by PCR was recorded. Data were compared.
RESULTS: The number of patients included in our study was 388. Patients were divided as Group 1 for two months before Pandemic and Group 2 for two months after. 292 (75.3%) patients were included in Group 1 and 96 (24.7%) patients were included in Group 2. Of the patients being operated, 102 (75%) were Group 1, 34 (25%) were Group 2. The duration of hospitalization was 9.54±4.28 days in Group 1 and 7.82±3.64 days in Group 2. The waiting time for surgery was 7.28±3.79 days in Group 1 and 7.23±4.37 days in Group 2. The discharge times were 3.02±1.75 days in Group 1 and 2.62±1.54 days in Group 2. There was no statistically significant difference between the groups in all evaluated parameters (p=0.14), (p=0.97) (p=0.42).
DISCUSSION AND CONCLUSION: Our approach to fracture cases should be applied more rationally, optimally and rapidly within the principles of orthopedics. We must strictly follow the precautions to protect against COVID-19 infection.

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GÝRÝÞ ve AMAÇ: Benign tiroid nodüllerinde tedavi; basý bulgularý, kozmetik sorunlar, malign transformasyon riski ve/veya kaygýsý nedeniyle yapýlabilmektedir. Son yýllarda cerrahi tedavi yerine minimal invaziv perkütan ablasyon yöntemleri giderek daha sýk kullanýlmaktadýr. Mikrodalga ablasyon (MWA) bu yöntemlerin en yenisi olup, özellikle soðutmasýz tipine ait veriler oldukça sýnýrlýdýr. Bu çalýþmanýn amacý; benign tiroid nodüllerinin tedavisinde perkütan soðutmasýz MWA yönteminin güvenilirliðini ve kýsa dönem etkinliðini araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Çalýþmaya Ocak-Mart 2020 tarihleri arasýnda biyopsi ile benign tanýsý almýþ 9 nodul dahil edilmiþtir. Nodüllerin iþlem öncesinde ve 3.ay kontrollerinde; en uzun çap, volüm ve kompozisyonlarý ultrasonografik olarak görüntülenmiþtir. Ýþlemde soðutmasýz tip 18G proba sahip MWA sistemi (TATO, Terumo) kullanýlmýþtýr. Olgularýn iþlem öncesi ve üçüncü ay tiroid fonksiyon monitorizasyonu (TSH, sT4, sT3), antikor testleri (anti-TG, anti TPO) yapýlmýþ, klinik basý semptomlarý, kozmetik skorlarý ayrýca üçüncü ay kontrollerindeki yüzdesel hacim deðiþimleri kaydedilmiþtir.
BULGULAR: Çalýþmada, 5’i solid, kalan 4’ü ise aðýrlýkla solid yapýda 9 nodül tedavi edilmiþtir. Majör komplikasyon izlenmemiþtir. Nodüllerin iþlem öncesi en uzun çaplarý ortalama 41.64±11.41 mm ve ortalama hacimleri 20.93±14.82 cm3 olup, üçüncü ay kontrollerindeki en uzun çaplarý ortalama 28.6±5.97 mm ve hacimleri ortalama 8.19±3.30 cm3 olarak ölçülmüþtür. Ýþlem öncesi ve sonrasý çap (p=0.011) ve hacimler (p=0.015) arasýnda istatistiksel olarak anlamlý farklýlýk bulunmaktadýr. Üçüncü ay yüzdesel hacim deðiþimi 50.20±39.58%’dir. Ýþlem öncesi kozmetik skor ortanca deðeri 4, semptom skoru 6, üçüncü ayda ise sýrasýyla 2 ve 1’dir.Kontrol tiroid fonksiyon testlerinde ve antikor deðerlerinde anlamlý deðiþiklik izlenmemiþtir (p=1.000-0.286).
TARTIÞMA ve SONUÇ: Tiroid nodüllerinin standart tedavi yöntemi total tiroidektomidir. Ancak cerrahi komplikasyonlar, hastanýn cerrahi tedaviyi reddetmesi ve tiroid fonksiyonlarý üzerine etkileri minimal invaziv ablasyon tekniklerinin son yýllarda artan kullanýmý ile sonuçlanmýþtýr. Sonuç olarak soðutmasýz sistem ile tiroide dedike 18G prob kullanýlarak yapýlan MWA yönteminin benign tiroid nodüllerinin tedavisinde güvenilir ve etkili olduðu bulunmuþtur. Klinik semptomatoloji ve kozmetik yakýnmalarda izlenen hýzlý düzelme ve yatýþ gerektirmeme gibi özellikleriyle, hastalarca cerrahiye tercih edilme potansiyeline sahiptir.

INTRODUCTION: Treatment of benign thyroid nodules may be performed due to compressive symptoms, cosmetic problems, malignant transformation risk, and/or anxiety. In recent years, minimally invasive percutaneous ablation methods have been increasingly used instead of surgical treatment. Microwave ablation (MWA) is the new approach for thermal ablation of thyroid nodules, although data on uncooled MWA are rather limited. This study aims to investigate the safety and short-term effectiveness of percutaneous uncooled MWA in the treatment of benign thyroid nodules.
METHODS: This study included nine benign thyroid nodules diagnosed with biopsy between January-March 2020. The largest diameter, volume, and composition of the nodules were evaluated before the procedure and at a 3-month follow-up. Uncooled MWA system (TATO, Terumo) with an 18G probe was used for the procedure. Thyroid function monitorization (TSH, sT4, sT3) and antibody tests (anti-TG, anti-TPO), clinical compressive symptoms and cosmetic scores were evaluated before the procedure and at 3-month follow up. Volume reduction rates were also evaluated at 3-month follow-up.
RESULTS: Five solid and four mostly solid nodules were treated. The mean largest diameter was 41.64±11.41 mm and mean volume was 20.93±14.82 cm3 before the procedure, while the mean largest diameter was 28.6±5.97 mm (p=0.011) and mean volume was 8.19±3.30 cm3 (p=0.015) at 3-month follow-up. The volume reduction rate at three months was 50.20%±39.58%. Before the procedure, the median cosmetic score was 4 and the symptom score was 6; at 3-month follow-up, these scores were 2 and 1, respectively. There was no significant change in thyroid function tests and antibody levels at follow-up. Major complications were not observed.
DISCUSSION AND CONCLUSION: Uncooled MWA system using 18G probe was found to be a safe and effective method in the treatment of benign thyroid nodules. With its advantages of rapidly improving clinical symptomatology and cosmetic complaints without requiring hospitalization, it has the potential to be more preferred than surgery by patients.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada amacýmýz, sert gaz geçirgen kontakt lenslerin keratokonus ve miyopi hastalarýnda görsel kalite ve kornea aberasyonlarý üzerindeki etkisini araþtýrmaktý.
YÖNTEM ve GEREÇLER: Bu çalýþmaya miyopi nedeniyle sert gaz geçiren kontakt lens kullanan 17 hastanýn 30 gözü (A Grubu) ve keratokonuslu (B grubu) 47 hastanýn 72 gözü dahil edildi. Keratokonus hastalarý Amsler-Krumeich sýnýflamasýna göre dört alt gruba ayrýldý. Tüm hastalara görme keskinliði, kontrast duyarlýlýk ve simüle edilmiþ keratometrik deðer (sim K), yüzey asimetrik indeksi (SAI), yüzey düzenlilik indeksi (SRI), kornea topografisi ile ölçülen öngörülen keskinlik (PVA) deðerleri dahil olmak üzere inceleme prosedürleri uygulandý; sert gaz geçirgen kontakt lens uygulamasýndan önce ve sonra, aberrometri ile ölçülen sferik aberasyon, koma, trefoil ve toplam yüksek dereceli aberasyonlarýn (THOA) ortalama RMS deðerlerine bakýldý.
BULGULAR: Lens kullanýmýndan önce düzeltilmiþ en iyi görme keskinliði deðerleri Grup A'da 0,68 (±0,33) ve Grup B’de ise 0,37 (±0,21), kullanýmdan sonra ise 0,86 (±0,20), ve 0,83 (±0,17)idi. Düþük kontrast duyarlýlýk ölçümünde Grup A'da kontakt lens taktýktan sonra 9 harf, Grup B'de 18,7 harf kazanýmý elde edildi. Kontakt lens kullanýmýndan sonraki topografik deðerlerde her iki grupta da anlamlý farklýlýklar tespit edildi. Deðiþim miktarý Grup B'de Grup A'ya göre daha anlamlýydý (p<0,05). PVA deðerlerinde Grup B1 ile Grup B4 arasýnda anlamlý fark vardý (p<0,01). Kontakt lens kullanýmýndan sonra, her iki grupta da sferik, koma, trefoil ve toplam yüksek dereceli aberasyon deðerlerindeki deðiþiklikler istatistiksel olarak anlamlý bulundu. Aberasyon deðerlerindeki ortalama azalma, Grup B'de, Grup A'ya göre anlamlý derecede yüksekti (p<0,05). THOA dýþýndaki aberasyon deðerlerinde alt gruplar arasýnda anlamlý farklýlýk yoktu. Kontrast duyarlýlýðý, görme keskinliði ve yüksek dereceli aberasyonlar arasýnda negatif bir korelasyon vardý.
TARTIÞMA ve SONUÇ: Topografik ve aberrometrik deðerler, RGP kontakt lenslerden sonra tüm gözlerde önemli ölçüde azalmýþtýr. Keratokonus hastalarýnda azalma miktarý anlamlý derecede yüksek bulundu. Görme keskinliði ve kontrast duyarlýlýðýndaki artma, aralarýndaki yakýn iliþkiyi iþaret eden yüksek aberasyonlardaki azalma ile baðlantýlý olarak tespit edilmiþtir.

INTRODUCTION: Aim was to investigate the effects of rigid gas permeable contact lenses (RGPCL) on visual quality and corneal aberrations in the patients with keratoconus and myopia.
METHODS: Thirty-one eyes of 17 patients wearing RGPCL because of myopia (Group A) and 72 eyes of 47 patients who had keratoconus (Group B) were included in this study. Keratoconus patients were divided into four subgroups according to the Amsler-Krumeich classification. All patients underwent examination procedures, including visual acuity, contrast sensitivity and simulated keratometric value (sim K), surface asymmetric index (SAI), surface regularity index (SRI), predicted visual acuity (PVA) values measured with corneal topography; mean RMS values of spherical aberration, coma, trefoil, and total high order aberrations (THOA) measured with aberrometry, before and after RGPCL application.
RESULTS: Mean best-corrected visual acuity values before lens use was 0.68 (±0.33) and afterwards 0.86 (±0.20) in Group A, 0.37 (±0.21) and 0.83 (±0.17) in Group B, respectively. During low contrast sensitivity measurement, nine letters were gained after wearing contact lenses in Group A, 18.7 letters in Group B. The change of topographic values after contact lens use was significant in both groups. The amount of change was more significant in Group B when compared to Group A (p<0.05). There was a significant difference in PVA values between Group B1 and Group B4 (p<0.01). After contact lens use, the change in spherical, coma, trefoil and THOA values were statistically significant in both groups. The mean decrease in aberration values was significantly higher in Group B comparing to Group A (p<0.05). The aberration values except THOA did not differ significantly among subgroups.
DISCUSSION AND CONCLUSION: The topographic and aberrometry values decreased significantly in all eyes after RGPCL. The amount of decrease was significantly higher in keratoconus patients. Increase in visual acuity and contrast sensitivity was correlated with the decrease in higher aberrations, which points to the close relationship between them.

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GÝRÝÞ ve AMAÇ: Diyabetik makula ödemi (DMÖ) hastalarýnda aflibercept tedavisinin anatomik ve görsel sonuçlarýný ve elipsoid zon defekti (EZD) ve seröz retina dekolmanýnýn (SRD) tedavi sonuçlarýný nasýl etkilediðini deðerlendirmek.
YÖNTEM ve GEREÇLER: Bu çalýþmada, ocak 2016-ocak 2017 yýllarý arasýnda tedavi naif, baþlangýç tedavisi olarak aflibercept baþlayýp 3 yükleme dozunu tamamladýðýmýz DMÖ hastalarýn týbbi kayýtlarýný geriye dönük olarak analiz ettik. Fundus floresein angiografide (FFA) makula ve periferik retina iskemisi olan, spektral optik koherens tomografide (S-OKT) vitreoretinal arayüz hastalýðý olan, tedaviye baþlamadan önce retinal neovaskülarizasyonu olan ve 12 aydan daha az takip süresine sahip olan hastalar çalýþmaya dahil edilmedi. Hastalarýn yaþý, cinsiyeti, baþlangýç, 3, 6, 9 ve 12. aylardaki en iyi düzeltilmiþ görme keskinliði (EÝDGK) ve santral makula kalýnlýðý (SMK), EZD ve SRD olup olmadýðý kaydedildi.
BULGULAR: Çalýþmaya 20’si kadýn 27’si erkek toplam 47 hastanýn 72 gözü dahil edildi. Hastalarýn yaþ ortalamasý 59.7±8.0 idi. Ortalama takip süreleri 14±2 aydý. Tüm hasta grubunda intravitreal aflibercebt (ÝVA) enjeksiyonu sonrasý 3, 6, 9 ve 12. ayda EÝDGK’de baþlangýç deðerlerine göre anlamlý derecede artýþ gözlendi. (sýrasýyla p<0.009, p<0.001, p<0.001 ve p<0.001). EÝDGK, ÝVA öncesi EZD olmayan grupta EZD olan gruba göre anlamlý derecede daha iyiydi. Bunun yaný sýra tedavi sonrasý 12. ayda da EÝDGK, EZD olmayan grupta daha iyiydi. SRD+ ve SRD- gruplarýndaki EÝDGK’deki deðiþime baktýðýmýzda 3. aydaki EÝDGK deðiþimi benzerdi; ancak 6, 9 ve 12. aydaki EÝDGK’i deðiþimi SRD+ olan grupta daha yüksekti. Tüm hasta grubunda ortalama santral retina kalýnlýðýnda (SMK) ÝVA sonrasý 3, 6, 9 ve 12. ayda baþlangýç deðerlerine göre anlamlý olarak daha düþük saptandý. Hastalarda SRD ve EZD olmasý ile baþlangýç EÝDGK arasýnda negatif bir korelasyon (p<0.001), ayrýca baþlangýçta SRD’nin olmasý ile EÝDGK ve SMK’deki deðiþim arasýnda pozitif bir korelasyon (p<0.001) saptandý.
TARTIÞMA ve SONUÇ: Aflibercept, DMÖ hastalarýnda hem EÝDGK’nin iyileþtirilmesi hem de SMK’nin azaltýlmasýnda etkili ve güvenli bir tedavi ajanýdýr. SRD’nin eþlik ettiði ya da etmediði DMÖ’de etkilidir. EZD tedavinin görsel sonuçlarý açýsýndan prediktif deðere sahiptir.

INTRODUCTION: To evaluate the anatomical and visual results of aflibercept treatment in patients with diabetic macular edema and how ellipsoid zone defect (EZD) and serous retinal detachment (SRD) affect the treatment outcomes.
METHODS: We analyzed the medical enrollments of treatment naïve DME patients who were initially treated with aflibercept and who were completed 3 loading doses between January 2016 and January 2017 in this retrospective study. Patients having macular ischemia, peripheral retinal ischemia in fluorescein angiography, patients with vitreoretinal interface disease on spectral domain optical coherence tomography (SD-OCT), patients with DME who had received any previous treatment, or with neovascularization of retinal at beginning treatment, or patients with a follow-up of less than 12 months were excluded from the study. The patients' age, gender, best corrected visual acuity (BCVA) and central macular thickness (CMT) at baseline, 3, 6, 9 and 12 months, EZD and SRD were recorded.
RESULTS: Seventy-two eyes of 47 patients including 20 women and 27 men were included in the study. The mean age of the patients was 59.7±8.0. The mean follow-up period was 14±2 months. The mean BCVA at 3, 6, 9 and 12 months was statistically better than baseline in all patient group (p<0.009, p<0.001, p<0.001 and p<0.001, respectively). Before intravitreal aflibercept, the mean BCVA was significantly better in the group without EZD than in the group with EZD. In addition, the mean BCVA was better in the group without EZD at 12 months. When we looked at the change in the mean BCVA in SRD+ and SRD- groups, the change in the mean BCVA at 3 months was similar between two groups; however, the change in the mean BCVA at 6, 9 and 12 months was higher in the group with SRD+. In all patient groups, mean central retinal thickness (CMT) was found to be significantly lower than baseline values at 3, 6, 9 and 12 months after IVA. There was a negative correlation (p<0.001) between the presence of SRD and EZD and the initial BCVA, and a positive correlation (p<0.001) between the presence of SRD at the beginning and the change in BCVA and CMT.
DISCUSSION AND CONCLUSION: Aflibercept treatment is an effective and safe treatment agent for both improving BCVA and decreasing CMT in DME patients. It is effective in DME with or without SRD. EZD has a predictive value in terms of visual results of treatment.

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GÝRÝÞ ve AMAÇ: Preperimetrik glokomda (PPG) Heidelberg Retinal Tomografi(HRT) ile elde edilen optik sinir baþý topografik parametrelerini ve Optik Koherens Tomografi (OKT) ile ölçülen retina sinir lifi tabakasý(RSLT) kalýnlýðýný deðerlendirmek.
YÖNTEM ve GEREÇLER: Çalýþmaya 17 PPG'li olgunun 30 gözü ile ayný yaþ ve cinsiyet grubuna uygun 18 saðlýklý bireyin 30 gözü dahil edildi. Tüm olgulara OKT ile RSLT kalýnlýk ölçümleri, HRT ile OSB analizleri ve GA testleri yapýldý. PPG kriterleri: iki yada daha fazla ölçümde göz içi basýncý (GÝB) >21 mmHg, 30-2 görme alaný testi normal, klinik olarak anormal OSB görünümü (rim çentiklenmesi, lokalize veya diffüz RSLT kaybý, vertikal geniþleme, OSB hemoraji) olarak tanýmlandý.
BULGULAR: PPG ve kontrol grubu yaþ ortalamasý sýrasýyla 50.57±11.50 ve 45.60±12.87 yýl idi. PPG ile kontrol grubu HRT ölçümlerinden çukurluk/disk oraný (C/D), rim alaný (RA), maksimum çukurluk derinliði (MCD) ve çukurluk þekil ölçümü (CSM) parametreleri anlamlý farklý bulunmuþ diðerleri fark göstermemiþtir (p<0.05). OKT ile ölçülen RSLT kalýnlýklarýnda alt, üst, nazal, temporal kadran ve ortalama kalýnlýk ölçüm deðerleri PPG’li olgularda kontrol grubuna göre daha inceydi ve aradaki fark istatistiksel olarak anlamlýydý (p<0.05).
TARTIÞMA ve SONUÇ: Bu çalýþma PPG'li ve normal gözler arasýnda RSLT ve OSB parametrelerinde anlamlý farklar olduðunu ortaya koymaktadýr. PPG'li olgularda HRT ile OSB analizi ve OKT ile RSLT kalýnlýk ölçümlerinin erken tanýda yardýmcý olacaðý kanaatindeyiz.

INTRODUCTION: To evaluate the optic nerve head topographic (ONH) parameters obtained by Heidelberg Retinal Tomography (HRT) and retinal nerve fiber layer (RNFL) thickness measured by Optical Coherence Tomography (OCT) in preperimetric glaucoma (PPG).
METHODS: Thirty eyes of 17 patients with PPG and 30 eyes of 18 healthy individuals of the same age and gender were included in this study. RNFL thickness measurements with OCT, ONH analysis with HRT and VF tests were performed in all cases. PPG inclusion criteria were defined as: intraocular pressure (IOP)> 21 mmHg in two or more measurements, 30-2 VF test normal, clinically abnormal ONH appearance (neuroretinal rim appearance with rim notching, localized or diffuse RNFL, vertical enlargement, ONH hemorrhage).
RESULTS: The mean age in the PPG and the control group was 50.57±11.50 and 45.60±12.87 years, respectively. Among the PPG and control group HRT measurements, cup/disc rate (C/D), rim area (RA), maximum cup depth (MCD) and cup shape measure (CSM) parameters were significantly different; others did not show any difference (p<0.05). The inferior, superior, nasal, temporal quadrant and average thickness measurement values of RNFL thickness measured by OCT were thinner in cases with PPG than in the control group, and the difference was statistically significant (p<0.05).
DISCUSSION AND CONCLUSION: This study shows that there are significant differences between PPG and normal eyes. We consider that evaluation of the ONH by HRT and measurements of the RNFL thickness by OCT may be helpful for early diagnosis in cases with PPG.

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GÝRÝÞ ve AMAÇ: Endoskopik submukozal rezeksiyon (ESD) veya endoskopik tam kat rezeksiyon (ETR) materyallerinin doðru histopatolojik deðerlendirilmesi hastalýk takibi açýsýndan oldukça önemlidir. Literatürde formalin solüsyonunun histopatolojik deðerlendirme üzerine etkisini araþtýran birçok makale bulunmaktadýr. Bidiðimiz kadarýyla, bu makalede ise ilk kez, bu solüsyonun mide dokusundaki makroskopik ölçümlerine etkisi araþtýrýlmýþtýr.
YÖNTEM ve GEREÇLER: Morbid obezite nedeniyle sleeve gastrektomi yapýlan hastalardan çýkarýlan mide rezeksiyon materyallerinin farklý lokalizasyonlarýndan ESD/ETR spesmenleri elde edildi. Çalýþmayý yürüten cerrah ve patolog tarafýndan formalin solüsyonu öncesi ve sonrasý makroskopik ölçümler yapýldý ve birbiri ile karþýlaþtýrýldý.
BULGULAR: Bu çalýþmada, ortalama yaþý 36.04 ve vücut kitle indeksi 46.06 olan 50 hastadan alýnan mide spesmenleri deðerlendirildi. Formalin fiksasyonu sonrasý yapýlan deðerlerdirmede sýrasýyla antrum, korpus ve fundus tam kat duvar kalýnlýklarýnda 4.4, 5.6 ve 7.2 kat kalýnlaþma meydana geldiði izlendi. Benzer þekilde mukoza/submukoza kalýnlýklarýnda ise 1.8, 2.5 ve 4.6 kat artýþ olduðu saptandý. Ayrýca, formalin solüsyonunun meydana getirdiði büzülme etkisi ile mukoza/submukoza ve tam kat mide dokusunda sýrasýyla ortalama %31.0 ve %23.3 boyut küçülmesi saptandý.
TARTIÞMA ve SONUÇ: Formalin solüsyonunun dokularda büzülme etkisi olabileceði daha önce literatürde bahsedilmiþ olsa da, kanýt düzeyinde makroskopik ölçümlere olan etkisi bildirilmemiþtir. Bu çalýþma, formalin solüsyonunun mide dokusunda makroskopik boyut deðiþikliðini bildiren ilk çalýþma olmasý bakýmýndan önemlidir.

INTRODUCTION: Histopathological evaluation of endoscopic submucosal dissection (ESD)/endoscopic full-thickness resection (EFTR) resection materials is important for disease follow-up. There are many studies on the effects of formalin solution on histopathological examination. To our knowledge, in this study, the effects of this solution on the macroscopic dimensions of gastric tissue were investigated for the first time.
METHODS: ESD/EFTR specimens were obtained from different localizations of the stomach resection materials removed from patients who underwent laparoscopic sleeve gastrectomy surgery due to morbid obesity. Pre- and post-formalin fixation, macroscopic measurements were made by the surgeon and pathologist conducting the study and compared with each other.
RESULTS: In this study, stomach specimens taken from 50 patients with a mean age of 36.04, and a body mass index of 46.06 were evaluated. After formalin fixation, it was observed that 4.4, 5.6 and 7.2 times thickening occurred in full-layer wall thicknesses of the antrum, corpus and fundus, respectively. Similarly, 1.8, 2.5 and 4.6 times increase was found in mucosa/submucosa thickness. In addition, due to the shrinkage effect of the formalin solution, an average size reduction of 31.0% and 23.3% in the mucosa/submucosa and full-thickness stomach tissue, respectively, were detected.
DISCUSSION AND CONCLUSION: The shrinkage effect of formalin solution on tissues has been reported before, but it has not provided any evidence of how this effect affects macroscopic measurements. This study is important in that, to our knowledge, it is the first study of formalin fixation to investigate macroscopic size changes on stomach tissue.

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Anti-N-metil-D-aspartat reseptör ensefaliti otoimmün ensefalitler arasýnda en sýk karþýlaþýlan tür olmasýna raðmen, diðer nöropsikiyatrik hastalýklarla karþýlaþtýrýldýðýnda nadir görülen bir hastalýktýr. Semptomatolojisi depresif belirtilerden dirençli nöbetlere kadar uzanan geniþ bir yelpazeyi kapsadýðýndan ayýrýcý taný yapýlýrken mutlaka akla getirilmelidir. Çoðunlukla genç kadýnlarda görüldüðü ve malignite, özellikle de over malignitele-riyle iliþkili olabileceði unutulmamalýdýr. Katatoni ve psikozla ortaya çýkan bu ensefalit olgusu hem demogra-fik özellikleri açýsýndan atipik olmasý yönüyle hem de tam iyileþme saðlanmýþ olmasý nedeni ile sunulmuþtur.

Anti N-methyl-D-aspartate (NMDA) receptor antibody encephalitis is the most common autoimmune encephalitis. However, when compared to the prevalences of other neuropsychiatric diseases, it is a rare condition. Since it may present with a wide range of symptoms from depression to drug-resistant seizures, it must be considered in a differential diagnosis. It should be kept in mind that anti NMDA encephalitis usually affects young women with malignant tumors, especially over tumors. We want to present this encephalitis case which presented with psychosis and catatonia, both in terms of the patient’s demographical aspects and accomplishment of a full recovery.

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Chopart ve Lisfranc eklemleri dahil, orta ayak eklemlerinde kýrýklý çýkýklarýn teþhis edilemeyerek kaçýrýlmasý çok kolay olabilir. Ayrýca, bu bölgede nadiren görülen yaralanma türleri olarak; kunei-navikular ve kalkaneokuboid eklemlerde orta ayaðýn dorsal çýkýðý, tarsal navikulanýn izole dorsal çýkýðý, tarsal navikulanýn dorsal kýrýklý-çýkýðý ve medial küneiform kemiðin tam medial çýkýðý bildirilmiþtir. Bu tür yaralanmalarýn %33'e varan kýsmýnda bariz radyografik bulgular bulunmayabilir ve bu tür yaralanmalarý tedavi eden birçok hekim bu yaralanmalara aþina olmayabilir. BT taramalarý statik görüntüleme yöntemleridir ve aðýrlýk taþýmadan elde edilir. Bununla birlikte, 3D BT taramasý, karmaþýk kýrýk modellerini daha iyi deðerlendirmede yardýmcý olabilir. Bu yazýda, 3 boyutlu BT çekildikten sonra küboid kýrýðý ile beraber kunei-naviküler eklemde orta ayaðýn tam dorsal çýkýðý olan bir olgu paylaþtýk.

Midfoot fracture-dislocations including those involving the Chopart and Lisfranc joints can be very easy to misdiagnosed. Moreover, some rarely seen types of injuris of these region including; dorsal dislocation of the midfoot at the cunei-navicular and calcaneocuboid joints, isolated dorsal dislocation of the tarsal navicular, dorsal fracture-dislocation of the tarsal navicular and complete medial dislocation of the first cuneiform have been reported. There is a lack of obvious radiographic findings in up to 33% of such injuries and there may not be familiarity with such injuries by many treating physicians. CT scans are static imaging modalities and obtained without weight bearing. However, 3D CT scan may aid to better visualize complex fracture patterns. In this paper we report a case with a total dorsal dislocation of midfoot at the cunei-navicular joint associated with cuboid fracture diagnosed after performing a 3D CT.

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L-karnitin, uzun zincirli yað asitlerinin mitokondri matriksine transportunda yer alan, lipid metabolizmasýnda önemli görevlere sahip bir moleküldür. Ayný zamanda antioksidan özelliktedir. Propiyonik asit gibi toksik bileþenlerin açil-l-karnitin esterleri olarak atýmýný saðlayarak mitokondride birikmesini önlerler. L-karnitinin %75’i besinlerle karþýlanýrken, %25’i endojen biyosentez ile saðlanmaktadýr. Vücutta sentez edildiðinden dolayý eriþkinler için essansiyel deðildir. Dallý zincirli non-esansiyel bir amino asit olan L-karnitin, esansiyel olan lizin ve metiyonin aminoasitlerinden genellikle karaciðerde sentezlenir. Eksojen olarak diyet ile alýnan L-karnitinin en zengin kaynaklarý kýrmýzý et, balýk, tavuk ve süt ürünleridir. Bu derlemede L-karnitin metabolizmasýnýn beslenme ve hastalýklarla iliþkisi ile yapýlan çalýþmalara yer verilmiþtir.

L-carnitine is a molecule involved in transporting long-chain fatty acids to the mitochondrial matrix and has important roles in lipid metabolism. It also has antioxidant properties. They prevent the excretion of compound components, such as propionic acid, as acyl-l-carnitine esters from accumulating in the mitochondria. While 75% of the L-carnitine is supplied by food, 25% can be renewed by endogenous biosynthesis. It is not essential for adults as it is synthesized in the body. L-carnitine, a branched-chain non-essential amino acid, is synthesized in others from the essential amino acids lysine and methionine. The richest sources of L-carnitine administered exogenously through the diet are red meat, fish, chicken and dairy products. In this review, studies on the relationship of L-carnitine metabolism with nutrition and diseases are included.

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