GÝRÝÞ ve AMAÇ: Romatizmal kalp hastalýðý (RKH), streptokokal boðaz enfeksiyonunun neden olduðu romatizmal ateþten (RA) kaynaklanýr. RA geçiren hastalarýn %3-6’sý RKH’ye dönüþmektedir. Son çalýþmalar yakýn zamanda tanýmlanmýþ yeni bir efektör T hücre hattý olan Th17 hücrelerinin RKH patogenezinde rol oynadýðýný göstermiþtir. Hücresel ve humoral immün tepkilerin aracýlýk ettiði konakçý oto-reaktivitesinin RKH geliþiminde rol oynadýðý bilinmektedir ve bu süreçteki baþrol oyuncularý interlökin (IL)-17 gibi gözükmektedir. RKH patogenezindeki bu merkezi role karþýn IL-17 varyantlarý ile iliþkili çalýþma sayýsý oldukça sýnýrlýdýr. Dahasý Türk toplumunda bu konu ile iliþkili hiç veri bulunmamaktadýr. Bu nedenle, bu çalýþmada RKH patogenezinde IL-17A rs2275913, IL-17F rs763780 polimorfizmlerinin iliþkisini araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Bu vaka-kontrol çalýþmasýnda 390 kadýn bireyden oluþan çalýþma grubu (170RKH/220kontrol) IL-17A rs2275913, IL-17F rs763780 gen varyantlarý TaqMan 5’ Allelik Ayrým Testi yöntemi kullanýlarak incelenmiþtir.

BULGULAR: Çalýþma gruplarý arasýnda IL-17A rs2275913 genotip daðýlýmlarý istatistiksel olarak anlamlýydý (p=0.010).Ek olarak, IL-17A rs2275913 AA genotipi hem tek kapak lezyonlarýnda (p=0.021) hem de kombine kapak lezyonlarýnda(p=0.038), kontrol gurubu ile karþýlaþtýrýldýðýnda istatistiksel olarak daha fazlaydý. IL-17F rs763780 varyanrý RKH patogenezi ile hiçbir iliþki göstermedi.
TARTIÞMA ve SONUÇ: Bulgularýmýza dayanarak, IL-17A rs2275913 varyantýnýn hem RKH patogenezinde hem de þiddetinde etkili olduðunu ve yüksek duyarlýlýðý tanýmlamada ciddi bir iliþki tespit ettiðimizi bildirmek isteriz. Türk toplumunda IL-17A rs2275913 varyantlarýnýn duyarlý bireylerin belirlenmesi açýsýndan uygun bir biobelirteç olarak önerilebileceðini düþünmekteyiz.

INTRODUCTION: Rheumatic heart disease (RHD) results from rheumatic fever (RA) caused by streptococcal throat infection. 3-6% of patients with rheumatic fever turn into RHD. Recent studies have shown that Th17 cells, a newly identified new effector T cell line, play a role in the pathogenesis of RHD. Host auto-reactivity mediated by cellular and humoral immune responses is known to play a role in RHD development, and interleukin (IL)-17 appears to be the leading actors in this process. Despite this central role in RHD pathogenesis, the number of studies on IL-17 variants is very limited. Moreover, there is no data related to this issue in Turkish society. Therefore, in this study, we aimed to investigate the relationship between IL-17A rs2275913 and IL-17F rs763780 polymorphisms in the pathogenesis of RHD.
METHODS: In this case-control study, the study group consisting of 390 women (170RHD/220 control) IL-17A rs2275913, IL-17F rs763780 gene variants were examined using the TaqMan 5 'Allelic Discrimination Test method.
RESULTS: The IL-17A rs2275913 genotype distributions among study groups were statistically significant (p=0.010). In addition, the IL-17A rs2275913 AA genotype was found in both single valve lesions (p=0.021) and combined valve lesions (p=0.038). It was statistically higher compared to the group. IL-17F rs763780 variants showed no association with RHD pathogenesis.
DISCUSSION AND CONCLUSION: Based on our findings, we would like to report that the IL-17A rs2275913 variant is effective in both the pathogenesis and severity of RHD, and that we found a serious correlation in defining high sensitivity. We think that IL-17A rs2275913 variants can be recommended as a suitable biomarker for the identification of susceptible individuals in the Turkish population.

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GÝRÝÞ ve AMAÇ: Kellgren-Lawrence sistemine göre evre 2 ve 3 diz osteoartrit olan olgular için intraartiküler hyaluronik asit enjeksiyonu ve artroskopik debridman uygulanmasýnýn güvenilirliði ve etkinliðini göstermek amaçlandý.
YÖNTEM ve GEREÇLER: Diz aðrýsý ile baþvuran osteoartritli 113 olgu, rastgele üç gruba ayrýldý. Ýlk gruba intraartiküler hyaluronik asit enjeksiyonu, ikinci gruba artroskopik debridman ve üçüncü gruba her ikisi birden uygulandý. Olgular tedaviden hemen önce ve tedavi sonrasý ilk üç ay aylýk, daha sonra üç ayda bir Lysholm Diz Skorlama Skalasý ve Vizüel Analog Skala ile deðerlendirildiler.

BULGULAR: Olgularýn %82,3’ü (n=93) kadýndý. Gruplar arasýnda BMÝ ve yaþ açýsýndan istatistiksel olarak anlamlý fark bulunmadý. Tüm tedavi gruplarýnda baþlangýç deðerlerine göre takipler boyunca VAS ve Lysholm skalasý puanlarýnda anlamlý düzelme saptandý. Bu durum ilk üç ayda daha hýzlý gerçekleþmekte, 3. ve 6. aylar arasýnda geliþme durarak bir plato çizmekte ve sonrasýnda baþlangýca göre deðerler pozitif olmasýna raðmen azalma eðilimi göstermektedir. Cinsiyete göre Lysholm skalasý puanlarýna bakýldýðýnda tedavi sonrasý 3, 6, 9, 12. aylarda erkeklerde Lysholm skalasý puanlarý istatistiksel olarak anlamlý þekilde daha fazla bulundu. Olgularýmýzda tedavi süreleri boyunca herhangi bir komplikasyon gözlenmedi. Menisküs yýrtýðý durumu, plika varlýðý ve ACL’nin saðlam veya yýrtýk olmasý ile VAS ve Lysholm skala puanlarý arasýnda bir iliþki saptanmadý. Tek anlamlý bulgu synoviyal hipertrofisi olanlarda saptandý.
TARTIÞMA ve SONUÇ: Artroskopik debridmanýn tek veya intraartiküler hyaluronik asit enjeksiyonu ile birlikte uygulanmasýnýn etkili bir tedavi olduðu sonucuna vardýk. Bu olgu grubu için intraartiküler hyaluronik asit eklem içi enjeksiyonunun tercih edilmesi gerektiðini, sonraki takiplerinde 3-6. aya kadar anlamlý düzelme görülmez ise artroskopik debridman uygulamasýnýn planlanmasý gerektiði kanaatindeyiz. Yine ayný olgu grubu için artroskopik debridman uygulamasý tercih edilebilecek bir diðer tedavi seçeneðidir. Artroskopik giriþim sýrasýnda eklem kýkýrdaði hasarý saptanýr ise, postoperatif dönemde hyaluronik asit enjeksiyonu yapýlmasýnýn fonksiyonel skorlarý daha da iyiye götüreceðini düþünmekteyiz.

INTRODUCTION: The aim of this study is to analyze the effectiveness of intraarticular hyaluronic acid injection and arthroscopic debridement for stage 2 and 3 osteoarthritides of the knee based on the Kellgren-Lawrence system.
METHODS: One hundred and thirteen patients with knee pain complaints diagnosed as osteoarthritis were divided randomly into three groups. The first group was treated with intraarticular hyaluronic acid injection the second group was treated with arthroscopic debridement operation and for the last group, both procedures were performed. The patients were evaluated with Lysholm Knee Score and Visual Analogue Scale just before and 3 months after the treatment. The evaluation has continued every 3 months for the rest of the year.
RESULTS: About 82.3% (n=93) of the patients were female. There was no significant statistical difference between the groups according to age and Body Mass Index. All the three groups had significant improvement in the Visual Analog Scale (VAS) and Lysholm Scale compared with the starting values. This improvement especially occurred in the first 3 months, then stopped and entered a plateau phase between the 3 and 6 months. After the 6 month a decline phase starts although the values are still positive compared to starting ones. According to sex, the Lysholm scale values of male patients were statistically significantly higher at the 3, 6, 9, and 12 month. During the treatment period, no complications were observed among the patients. The existence of torn meniscus, plica, or injured or intact ACL did not influence the VAS and Lysholm values. The only significant score change was observed in patients with synovial hypertrophy.
DISCUSSION AND CONCLUSION: We observed that arthroscopy alone or with additional hyaluronic acid injection after the operation is an effective treatment for knee osteoarthritis. For our selected patient group the first treatment option is intraarticular hyaluronic acid injection. If there is no significant improvement at the 3 and 6 months follow-up period an arthroscopic debridement procedure should be performed. If any cartilage injury is obtained during arthroscopic intervention we think that postoperative intraarticular hyaluronic acid improves functional scores.

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GÝRÝÞ ve AMAÇ: Ameliyat öncesi bulgulara göre yapýlan ameliyat öncesi planlama ile ameliyat sýrasýnda yapýlan giriþimler arasýndaki iliþkiyi kurmayý ve araþtýrmayý hedefliyoruz.

YÖNTEM ve GEREÇLER: Çalýþmaya dört Ortopedi ve Travmatoloji uzmaný tarafýndan ameliyat edilmesine karar verilen dejeneratif lomber omurga bozukluðu olan 16 hasta dahil edildi. Hastalar için dahil edilme kriterleri iki yönlüydü: lomber bölgede dejeneratif temelde ameliyat gerektiren omurga bozukluðunun geliþimi ve en azýndan cerrahlar tarafýndan posterior spinal enstrümantasyonun dikkate alýnmasý. Doðuþtan, travmatik, patolojik ve enfektif etiyolojilere sekonder geliþen omurga bozukluklarý çalýþma dýþý býrakýldý. Tüm hastalarýn ameliyatlarýnda Titanyum Alaþýmlý (Ti-6A1-4V) spinal enstrümantasyon setleri kullanýldý. Çalýþma için standart istatistiksel analiz saðlamak amacýyla hasta þikayetleri, klinik bulgular, radyografik inceleme sonuçlarý ve planlanan ameliyatla ilgili 162 sorudan oluþan deðerlendirme formu hazýrlandý.
BULGULAR: Diskektomi, laminektomi, flavum eksizyonu ve posterior spinal enstrümantasyon müdahaleleri için güçlü bir kappa tutarlýlýðý bulundu. Foraminotomi ve foraminektomi için orta düzeyde kappa tutarlýlýðý bulundu. Topallama ve radikülopati bulgularýnýn preoperatif planlamada tamamen yetersiz olduðu; manyetik rezonans görüntüleme ile yorumlanan spinal kanal daralmasý bulgularý ise ameliyat öncesi planlamada oldukça etkili oldu. Son olarak lomber omurga bölgesinin L5-S1 seviyesi için yapýlan ameliyat öncesi planlamanýn lomber omurga bölgesinin diðer seviyelerine göre çok daha tutarsýz olduðu belirlendi.
TARTIÞMA ve SONUÇ: Kladikasyo ve radikülopati bulgularýnýn planlamaya katkýsý yoktu, ancak manyetik rezonans görüntüleme bulgularý deðerliydi. Herhangi bir cerrahi seviyede foraminotomi ve foraminektomi yapýlmasýnýn veya ameliyat öncesi planlama ile L5-S1 seviyesinde uygulanacak herhangi bir cerrahi prosedürün belirlenmesinin potansiyel olarak hata içerdiði bulundu.

INTRODUCTION: We aim to establish and investigate the correlation between the pre-operative planning performed based on the pre-operative findings and the interventions performed during the surgery.

METHODS: Sixteen patients with degenerative lumbar spine disorder who decided to be operated on by four orthopedics and traumatology specialists were included in the study. The inclusion criteria for patients were 2-fold: Development of spine disorder requiring surgery in the lumbar region on a degenerative basis and consideration of posterior spinal instrumentation at least in a level by the surgeons. Spine disorders developing secondary to congenital, traumatic, pathological, and infective etiologies were excluded from the study. Titanium alloy (Ti-6A1-4V) spinal instrumentation sets were used in the surgeries of all patients. To provide standard statistical analysis for the study, an assessment form consisting of 162 questions related to the patient complaints, clinical findings, results of radiographic examination, and the surgery planned was prepared.
RESULTS: A strong kappa consistency was also found for interventions of discectomy, laminectomy, flavum excision, and posterior spinal instrumentation. An intermediate kappa consistency was found for foraminotomy and foraminectomy. It was found that findings of claudication and radiculopathy were completely inefficient in pre-operative planning; on the other hand, findings of the narrowing of the spinal canal interpreted with magnetic resonance imaging were highly efficient in pre-operative planning. Finally, it was determined that pre-operative planning performed for the level of L5-S1 of the lumbar spine region was much more inconsistent compared to the other levels of the lumbar spine region.
DISCUSSION AND CONCLUSION: Findings of claudication and radiculopathy had no contribution to the planning, but the magnetic resonance imaging findings were valuable. Performing foraminotomy and foraminectomy at any surgical level or determining any surgical procedure that would be performed at the L5-S1 level with a pre-operative planning were found to potentially contain error.

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GÝRÝÞ ve AMAÇ: Diabetes mellitus, artan serum glukozu ile çok çeþitli hücre tiplerine zarar veren endokrin bir hastalýktýr. Hastalýðýn komplikasyonlarýndan biri olan diyabetik ayak ülserleri en bilinenleridir. Önemli morbidite ve mortalite ile sonuçlanan bu ülserler, diyabetli hastalarýn %25'ini yaþamlarý boyunca etkilemektedir. Diyabetik ayak ülserleri, iyileþmeye karþý dirençleri nedeniyle bir saðlýk sorunudur. Bu nedenle bu hastalýk için geliþtirilecek yeni ve iyi bir ilaç büyük önem taþýmaktadýr.
YÖNTEM ve GEREÇLER: Bu çalýþmada diyabetik ayak hastalarýna (n=25) gümüþ ve çinko içeren krem uygulandý.
BULGULAR: Bu çalýþmanýn bulgularý, diyabetik ayakta gümüþ ve çinkodan zengin uygulamanýn antimikrobiyal özelliklerini ortaya koydu. Yara iyileþmesi üzerinde önemli etkiler 1 hafta, 2 hafta, 1 ay, 3 ay ve 6 ayda yapýlan takiplerle gösterilmiþtir. Bu süreçte yan doku ve yara derinliði gibi özelliklere göre yara özellikleri deðerlendirildi.
TARTIÞMA ve SONUÇ: Veriler, kremin klinikte kullanýlabilecek bir tedavi edici tedavi aracý olduðunu belirtti.

INTRODUCTION: Diabetes mellitus is an endocrine disease that damages a wide variety of cell types with increased serum glucose. Diabetic foot ulcers, one of the complications of the disease, are the most well-known. These ulcers, which result in significant morbidity and mortality, affect 25% of patients with diabetes during the lifetime. Diabetic foot ulcers are a health problem due to their resistance to healing. Therefore, a new and good drug to be developed for this disease is of great importance.
METHODS: In this study, a cream containing silver and zinc was applied to diabetic foot patients (n=25).
RESULTS: The findings of this study revealed the antimicrobial properties of the application rich in silver and zinc in the diabetic foot. Significant effects on wound healing were demonstrated by follow-up at 1 week, 2 weeks, 1 month, 3 months, and 6 months. In this process, wound characteristics were evaluated based on features such as side tissue and wound depth.
DISCUSSION AND CONCLUSION: Data stated that the cream is a therapeutic treatment tool that can be used in the clinic.

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GÝRÝÞ ve AMAÇ: Nötrofil ve lenfosit sayýlarýnýn inflamatuar yanýtta ve aterosklerotik süreçte rol oynadýðý bilinmektedir. Nötrofil/lenfosit oraný (NLO) seviyesinin yüksekliði kardiyovasküler hastalýklarda ve aterosklerozda prognoz, hastalýk þiddeti ve mortalite ile iliþkilidir. Bu çalýþmada, NLO’nun akut iskemik inme (AÝÝ) hastalarýnda yükselip yükselmediðinin, yaþ ve cinsiyete göre deðiþiminin, lezyon boyutu ve tutulum tipi ile iliþkisinin ve kýsa dönem prognoz üzerindeki etkisinin araþtýrýlmasý amaçlandý.

YÖNTEM ve GEREÇLER: AÝÝ tanýsý alan 174 hasta çalýþmaya alýndý. Hastalarýn mevcut dosyalarý taranarak, anamnez bilgileri, fizik ve nörolojik muayeneleri, kronik hastalýk öyküleri, antiagregan ve antikoagülan kullanýp kullanmadýklarý, hemogram kolesterol paneli, rutin biyokimya tetkikleri, kraniyal BT ve MRG bulgularý incelendi. Hastalar Bamford ve TOAST sýnýflandýrmasýna göre olarak gruplandýrýldý.
BULGULAR: Çalýþmaya alýnanlarýn 88’i (%50.9) kadýn, 86’sý (%49.1) erkek ve yaþ ortalamalarý 73.8 ± 10.5 yýl idi. AÝÝ hastalarýnda NLO referans deðerlere göre anlamlý düzeyde yüksek saptandý. Hastalar kendi içinde deðerlendirildiðinde yaþ arttýkça NLO artýyordu. Erkeklerde 50-59 ve 60-69 yaþ gruplarýnda NLO daha yüksek bulundu.Yetmiþ yaþ ve üzerinde cinsiyet farký bulunmadý. TACI grubunun NLO deðerleri diðer gruplara göre anlamlý oranda yüksek saptandý. Eksitus olan hastalarýn NLO deðerleri diðer hastalardan anlamlý oranda yüksek bulundu.
TARTIÞMA ve SONUÇ: AÝÝ olgularýnda NLO deðeri yükselmektedir ve yaþ artýþý, erkek cinsiyet ve geniþ infarkt alaný olmasý bu yükselme ile korelasyon göstermektedir. NLO’nun kýsa dönem mortalite ile olan iliþkisi, prognoz için prediktif bir deðer taþýdýðýný ortaya koymaktadýr.

INTRODUCTION: Neutrophil and lymphocyte numbers are known to play a role in the inflammatory response and in the atherosclerotic process. The elevated level of neutrophil/lymphocyte ratio (NLR) is associated with prognosis, disease severity and mortality in cardiovascular diseases and atherosclerosis. In this study, we aimed to investigate whether NLR changed in acute ischemic stroke (AIS) patients, whether there was a relationship between NLR and lesion size, type of involvement, age, sex, and whether NLR had effect on short term prognosis.

METHODS: One hundred and seventy-four patients admitted with AIS diagnosis were included in the study. Patients’ existing files were screened for anamnesis, physical and neurological examinations, chronic illness history, antiplatelet and anticoagulant use, complete blood count, cholesterol panel, routine biochemical examinations, cranial Computed Tomography and Magnetic Resonance Imaging findings. Patients were grouped according to Bamford classification and TOAST classification.
RESULTS: Of the participants, 88 (50.9%) were female, 86 (49.1%) were male and the mean age was 73.8 ± 10.5 years. NLR was significantly higher in patients with AIS in terms of normal reference values. When patients were assessed within themselves, NLR increased as age increased. In the 50-59 and 60-69 age groups, NLR was higher in males. No gender difference was found over 70 years old patients. The NLR values of the total anterior circulation infarct group were significantly higher than the other groups (p=0.011; p=0.038; p=0.001). The NLR values of the patients with exitus were meaningfully higher than the surviving patients (p=0.006).
DISCUSSION AND CONCLUSION: The NLR value is elevated in patients with AIS and correlates with increased age, male gender and wide infarct area. Higher NLR seems to predict short-term mortality and may be used as a prognostic tool.

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GÝRÝÞ ve AMAÇ: Ýntravitreal olarak, bevasizumab, aflibersept ve ranibizumab kullanýma hazýr enjektör sistemi ile yapýlan enjeksiyon sonrasý erken dönemde saptanan göz içi basýncý (GÝB) deðiþikliklerini deðerlendirmek.
YÖNTEM ve GEREÇLER: Yaþa baðlý makula dejenerasyonu (YBMD), diyabetik maküler ödem (DMÖ) ve retinal ven oklüzyonu (RVO) tanýsý ile antivegf tedavisi uygulanan 39 hastanýn 39 gözü çalýþmaya dahil edildi. GÝB deðerleri, enjeksiyondan hemen önce, enjeksiyondan bir dakika, 30 dakika ve 60 dakika sonra Tono-pen (AVIA, Reichert, USA) ile ölçüldü.
BULGULAR: Hastalarýn ortalama yaþý 66.08±10.18 idi. YBMD tanýlý 19, DMÖ tanýlý 16 ve RVO tanýlý 4 hasta çalýþmaya dahil edildi. Olgularýn %25.6’sýna (n=10) aflibersept, %35.9’una (n=14) bevasizumab ve %38.5’ine (n=15) ranibizumab kullanýma hazýr enjektör sistemi ile intravitreal tedavi uygulanmýþtýr. Hastalarýn enjeksiyondan önce ölçülen ortalama GÝB deðeri aflibersept, bevasizumab ve ranibizumab için sýrasýyla 17.36±3.99, 19.94±2.83 ve 17.33±4.04 mmHg idi. Enjeksiyon öncesine göre 60.dk GÝB ölçümlerindeki deðiþim anlamlý deðilken, 1.dk ve 30.dk GÝB ölçümlerindeki artýþ istatistiksel anlamlý bulunmuþtur (p<0.01). Uygulanan antivegf ajana göre 1.dk ve 30.dk GÝB ölçümleri istatistiksel olarak anlamlý farklýlýk göstermemektedir (p>0.05). Bevasizumab kullananlarýn 60.dk GÝB ölçümleri, ranibizumab kullananlardan daha yüksek bulunmuþtur.
TARTIÞMA ve SONUÇ: Ýntravitreal olarak uygulanan antivegf ajanlar, erken dönemde ani ve geçici GÝB yükselmesine yol açabilir. Özellikle glokom hastalarýnda mükerrer uygulamalar hastalarýn glokom hasarýný derinleþtirebilir. Tek kullanýmlýk hazýr enjeksiyon sistemleri ile ilacýn kullanýlacak hacmi daha kontrollü olarak verilebilir. Bu sayede enjeksiyon esnasýnda oluþan ani GÝB yüksekliðinin, hatalý fazla hacim kullanýlmasýnýn önüne geçilerek sýnýrlandýrýlabileceði pratikte düþünülse de çalýþmamýz da fark saptanmamýþtýr.

INTRODUCTION: This study aims to evaluate the intraocular pressure (IOP) changes detected in the early period after intravitreal injection with bevacizumab, aflibercept and ranibizumab pre-filled syringe system.
METHODS: 39 eyes of 39 patients with age-related macular degeneration (AMD), diabetic macular edema (DME) and retinal vein occlusion (RVO) who were treated with intravitreal antivegf agents were included in this study. IOP values were measured with Tono-pen (AVIA, Reichert, USA) just before injection, 1 minute, 30 minutes and 60 minutes after injection.
RESULTS: The mean age of the patients was 66.08±10.18. 19 patients with AMD, 16 patients with DME and 4 patients with RVO were included in this study. 25.6% (n=10) of the cases were treated with intravitreal aflibercept, 35.9% (n=14) with bevacizumab and 38.5% (n=15) with ranibizumab pre-filled syringe system. The mean IOP value of the patients measured before injection was 17.36±3.99, 19.94±2.83 and 17.33±4.04 mmHg for aflibercept, bevacizumab, and ranibizumab, respectively. While the change in IOP values measured at 60 minutes after the injection compared to the pre-injection values was not significant, the increase in IOP measurements at 1 minute and 30 minutes after the injection was statistically significant. IOP values measured at 1st and 30th minute were not significant according to the antivegf agent types.
DISCUSSION AND CONCLUSION: Antivegf agents administered intravitreally may cause sudden and temporary IOP elevation in the early period. Repeated applications, especially in glaucoma patients, may increase the glaucomatous damage of the patients. The amount of the intravitreal agent can be given in a more controlled way with disposable prefilled syringe systems. Although it is thought in practice that the sudden IOP elevation that occurs during an injection can be prevented by avoiding the use of excessive amounts, there was no significant difference in our study.

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Levetirasetam (LEV) merkezi sinir sistemi ve endokrin dokularda bulunan sinaptik vezikül 2A proteinine baðlanarak etki gösteren, fokal ve jeneralize epilepsilerde tercih edilebilen yeni kuþak anti-nöbet ilacýdýr. Bulantý, baþ aðrýsý, sersemlik, yorgunluk, somnolans, davranýþ deðiþikliði, psikiyatrik bozukluk gibi yan etkileri mevcuttur. Ayný zamanda az sayýda çalýþmada levetirasetamýn testesteron ve östrojen sekresyonunu arttýrarak endokrin fonksiyonlarý etkilediði tespit edilmiþtir. Yirmi altý yaþýnda, daha önce epilepsi tanýsý olan erkek hasta bayýlmalar ve kasýlmalar nedeniyle kliniðimize baþvurdu. Ayný zamanda reaktif hipoglisemi tanýsý da olan hastanýn LEV tedavisi altýnda hipoglisemiye baðlý olarak geliþen bayýlmalarýnýn arttýðý dikkat çekiciydi. Bu nedenle hastanýn LEV tedavisi kesilerek 2000 mg/gün valproik asit baþlandý. Bu tedavi altýnda dört yýldan uzun bir süre izlenen hastanýn hipoglisemiye baðlý olarak geliþen bayýlmalarýnýn tekrarlamadýðý ve ayný zamanda jeneralize konvülsiyonlarýnýn da olmadýðý görüldü. Hipoglisemi, LEV kullanýmýna baðlý olarak görülebilen nadir yan etkilerinden birisidir. Olgumuzda LEV’in hastanýn mevcut hipoglisemisinde artýþa yol açtýðý ve özellikle hastanýn nöbetlerini tetiklediði izlenmiþtir. LEV kullanýmýný takiben hastanýn nöbetlerinde veya yakýnmalarýnda artýþ görüldüðü durumlarda, hastanýn LEV kullanýmýna baðlý olarak hipoglisemisinin tetiklenebileceði ve epileptik nöbetlerinde artýþ olabileceði akla getirilmelidir.

Levetiracetam (LEV) is a new generation anti-seizure drug that acts by binding to the synaptic vesicle 2A protein found in the central nervous system and endocrine tissues, and can be preferred in focal and generalized epilepsies. It has side effects such as nausea, headache, dizziness, fatigue, somnolence, behavioral change, psychiatric disorder. Also, few studies have found that levetiracetam affects endocrine functions by increasing testosterone and estrogen secretion. Twenty-six-year-old male patient with a previous diagnosis of epilepsy was admitted to our clinic with fainting and convulsions. It was noteworthy that the patient, who was also diagnosed with reactive hypoglycemia, increased fainting due to hypoglycemia under levetiracetam treatment. Therefore, the patient's levetiracetam treatment was discontinued and 2000 mg/day valproic acid was started. It was observed that fainting due to hypoglycemia did not recur and also did not have generalized convulsions. Hypoglycemia is one of the rare side effects that can be seen due to LEV use. In our case, it was observed that LEV caused an increase in the patient's existing hypoglycemia and especially triggered the patient's seizures. In cases where the patient's seizures or complaints increase following LEV use, it should be kept in mind that hypoglycemia may be triggered and an increase in epileptic seizures may occur due to the use of LEV.

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Son dönem kalp yetmezliðinin tedavisinde, kardiyak cihaz implantasyonu uygulamalarý, son derece hýz kazanarak devam etmektedir. Uygulamalar arttýkça, komplikasyon oranlarý da artmýþtýr. Gerek çocuk hastalar için ebat olarak büyük olmasý ve basýya baðlý çevre dokularý etkilemesi, gerekse enfeksiyon, kanama gibi sistemik komplikasyonlar bunlar arasýnda yeralmaktadýr.
Bu olgumuz, sol ventriküler destek cihaz (LVAD) takýlmasý sonrasýnda sol torakolateral doku defekti ve cihaz açýklýðý oluþmuþ 11 yaþýnda erkektir. Tedavisinde, kýsmi latissimus dorsi (LD) miyokutaneus flebi yapýlmýþ, postoperatif komplikasyon yaþanmamýþtýr. Tüm dünyada kalp nakli için uygun donörler, genelde eriþkin olduðu için, hastanýn nakile yönelik zaman kazanmasý saðlanmýþtýr. Bu flebin, bu tip doku defektlerinde kolay ve güvenilir olduðu kanýsýndayýz. Cihaz deðiþimi de mortal bir durum olabildiði için defekt ivedi bir þekilde uygun, yeterli kalýnlýkta ve vaskularitede bir doku ile örtülmesi saðlanmýþtýr.

In the treatment of end-stage heart failure, cardiac device implantation applications continue at an extremely rapid pace. As the applications increased, the complication rates also increased. These include its large size for pediatric patients and its impact on surrounding tissues due to compression, as well as systemic complications such as infection and bleeding.
This case is an 11-year-old male with a left thoracolateral tissue defect and device opening after left ventricular assist device implantation. In the treatment, a partial latissimus dorsi myocutaneous flap was performed and no postoperative complications were experienced. As the donors suitable for heart transplantation are generally adults all over the world, the patient has gained time for the transplant. We believe that this flap is easy and safe for this type of tissue defects. As device replacement can also be a mortal condition, the defect was immediately covered with a suitable tissue of sufficient thickness and vascularity.

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Susac sendromu (SS), ensefalopati, retinopati ve iþitme kaybý ile karakterize nadir bir hastalýktýr. Tanýda akla gelmeli ve vaskülopati ayýrýcý tanýsýnda dikkate alýnmalýdýr. Hastalýðýn ilerlemesini durduracaðýndan ve kalýcý sakatlýðý önleyebileceðinden erken taný önemlidir. Bu vaka sunumunda, SS tanýsý alan 32 yaþýnda erkek bir hastada erken tanýnýn önemi, taný kriterleri ve tedavide kullanýlan steroid ve diðer sitotoksik ilaçlarýn kombinasyonu da dahil olmak üzere agresif bir terapötik yaklaþýmýn önemi vurgulandý.

Susac syndrome (SS) is a rare disease characterized by encephalopathy, retinopathy and hearing loss. It should be considered in diagnosis and should be taken into consideration in the differential diagnosis of vasculopathy. An early diagnosis which can stop the progression of the disease and prevent permanent disability is important. Herein, we reported a case of Susac syndrome in a 32-year-old man. We emphasized the importance of early diagnosis, the criteria for diagnosis, and the importance of an aggressive therapeutic approach, including a combination of steroids and other cytotoxic drugs.

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Mor idrar torbasý sendromu (MÝTS), idrar sondasýnda mevcut olan bakteriyel kolonizasyon nedeniyle triptofan metabolizmasýyla açýða çýkan indigo (mavi) ve indirubin (kýrmýzý) pigmentlerin polivinil klorür (PVC) içeren materyal ile etkileþimi ile karakterize nadir görülen bir klinik durumdur. Bu sendromun klinisyenler tarafýndan çok iyi tanýnamamasý izlenecek tedavi yöntemleri konusunda çeliþkilere neden olmaktadýr. Bu sunumda MÝTS geliþen kritik bir hastanýn sunulmasý ve konu ile iliþkili literatürün gözden geçirilmesi amaçlamaktadýr.

Purple urine bag syndrome (PUBS) is a rare clinical condition characterized by the interaction of indigo (blue) and indirubin (red) pigments with polyvinyl chloride (PVC) containing material, which is released by tryptophan metabolism due to bacterial colonization in the urinary catheter. This syndrome is not well recognized by clinicians, so the management of these patients is a challenge. We aimed to represent a critically ill patient developing PUBS and review the existing literature.

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Statin iliþkili otoimmün nekrotizan miyopati nadir görülen bir yan etki olup immünsupresif tedavi gerektirir. Statin tedavisinin kesilmesiyle düzelmeyen proksimal kas güçsüzlüðü ve kreatin kinaz yüksekliði, kas nekrozu ve yüksek anti-HMGCR (3-hidroksi 3-metilglutaril koenzim-A redüktaz) otoantikorunun bulunmasý statine baðlý diðer kas iskelet yan etkilerinden ayýrt edici özellikleridir. Burada, statin kullanan ve otoimmün nekrotizan miyopati tespit edilen bir olgu sunulmuþtur.

Statin induced necrotizing autoimmune myopathy is a rare side effect and requires immunosuppressive therapy. Persistence of proximal muscle weakness and elevated creatine kinase level despite statin discontinuation, muscle necrosis and elevated anti-HMGCR (3-hydroxy 3-methyl glutaryl coenzyme A reductase) autoantibodies are distinguishing features from other statin related musculoskeletal side effects. In this report, a case using statin and diagnosed with autoimmune necrotizing myopathy is presented.

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Serebral Palsi’de (SP) fizik tedavi ve rehabilitasyon uygulamalarý, fiziksel yetersizliðin çocuðun geliþimindeki olumsuz etkilerini en aza indirgeyip çocuk ve ailenin yaþam kalitesini yükselterek çocuðun baðýmsýz ve sosyal bir birey olarak topluma kazandýrýlmasýný amaçlamaktýr. Saðlýðý korumak için her alanda olduðu gibi SP’de de yaratýcý ve destekleyici yaklaþýmlar gereklidir. Tamamlayýcý týp uygulamalarý dünyada ve ülkemizde daha çok da kronik hastalýklarda kullanýlmaktadýr. Bununla birlikte, yüksek kalitede bilimsel kanýtlarýn sýnýrlý olmasý, birçok tamamlayýcý týp yönteminin uygulanmasýný imkansýz hale getirmekte ve daha ileri araþtýrmalarýn gerekliliðini artýrmaktadýr. Bu yazýda son literatürler incelenip, bilimsel kanýtlar eþliðinde SP’de uygulanan tamamlayýcý tedaviler özetlenmiþtir.

Physical therapy and rehabilitation practices in Cerebral Palsy (CP) aim to minimize the effects of physical disability on the development of the child and increase the quality of life of the child and family, and reintegrating the child into society as an independent and social individual. As in every field to protect health, creative and supportive approaches are required in SP. Complementary medicine applications are used mostly in chronic diseases in the world and in our country. However, limited high quality scientific evidence makes it impossible to apply many complementary medicine methods and increases the necessity of further research. In this article, the latest literature has been reviewed and complementary therapies applied in CP are summarized with scientific evidence.

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