GÝRÝÞ ve AMAÇ: Excessive generation of the reactive oxygen species triggers oxidative stress. Bilirubin suppresses oxidation more vigorously than many other antioxidants. Since it has received significant attention on Parkinson’s disease (PD) pathophysiology, researchers have started investigating its impact on the disease. The correlation between PD and antioxidant status has not entirely been researched. Therefore, our aim in this study is to assess serum bilirubin levels in association with demographic and clinical features of patients with PD.
YÖNTEM ve GEREÇLER: A total of 289 individuals were involved in this study. Their serum total bilirubin (TB), direct bilirubin (DB), and indirect bilirubin (IB) concentrations were compared with demographic and clinical characteristics. We determined the severity of the disease by the modified Hoehn and Yahr Staging Scale (mHYRS), and the clinical features by the Unified Parkinson's Disease Rating Scale (UPDRS). We separated the patients into three motor subgroups according to their clinical features as tremor dominant (TD), postural instability and gait difficult, and the mixed type and based on mHYRS stages as early (≤2) and advanced (>2).
BULGULAR: There were 189 patients with PD and 100 healthy controls in the study. IB levels were significantly higher in the patients with PD after adjusting age (p=0.024). Male patients had higher levels of bilirubin levels (DB, IB, and TB) than the females (p<0.05). Bilirubin levels were also similar between the different motor subtypes of PD patients and in the early and advanced stages of PD (p>0.05).
TARTIÞMA ve SONUÇ: Bilirubin is an essential antioxidant marker indicating a dopaminergic deficiency in PD. Increased bilirubin levels may be an improved response to oxidative stress that occurs during the progression of PD.

INTRODUCTION: Reaktif oksijen radikallerinin aþýrý üretimi oksidatif stresi tetikler. Bilirubin oksidasyonu diðer birçok antioksidandan daha güçlü bir þekilde bastýrýr. Araþtýrmacýlar, Parkinson hastalýðý patofizyolojisine büyük önem verdiklerinden, hastalýk üzerindeki etkisini incelemiþlerdir. Parkinson hastalýðý ile antioksidan durum arasýndaki iliþki tam olarak araþtýrýlmamýþtýr. Bu çalýþmanýn amacý, Parkinson hastalarýnýn serum bilirubin düzeyleri ile demografik ve klinik özellikleri arasýndaki iliþkiyi deðerlendirmektir.
METHODS: Çalýþmaya toplam 289 kiþi dahil edildi. Serum total, direkt ve indirekt bilirubin düzeyleri demografik ve klinik özelliklerle karþýlaþtýrýldý. Hastalýðýn þiddeti modifiye Hoehn&Yahr Evreleme Ölçeði ile, klinik özellikleri ise Birleþik Parkinson Hastalýðý Derecelendirme Ölçeði ile belirlendi. Hastalar, klinik özelliklerine göre tremor dominant tip, postüral instabilite ve yürüme zorluðu tipi, karýþýk tip olarak üç motor alt gruba ayrýldý. Modifiye Hoehn&Yahr Evreleme Ölçeði evrelerine göre ise erken (≤2) ve ileri (>2) evre olarak ayrýldý.
RESULTS: Çalýþma, 189 hasta ve 100 saðlýklý kontrolden oluþtu. Yaþ ayarlandýktan sonra Parkinson hastalarýnda indirekt bilirubin düzeyleri anlamlý olarak daha yüksek saptandý (p=0,024). Erkek hastalarda kadýn hastalardan daha yüksek bilirubin düzeyleri (direkt, indirekt ve total bilirubin) vardý (p<0,05). Parkinson hastalarýnýn motor alt tipleri arasýnda ve Parkinson hastalýðý evrelerinde bilirubin düzeyleri benzerdi (p>0,05).
DISCUSSION AND CONCLUSION: Bilirubin, Parkinson hastalýðýnda dopaminerjik eksikliði gösteren önemli bir antioksidan belirteçtir. Artan bilirubin seviyeleri, Parkinson hastalýðýnýn ilerlemesi sýrasýnda ortaya çýkan oksidatif strese karþý geliþtirilmiþ bir yanýt olabilir.

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GÝRÝÞ ve AMAÇ: Kronik baþ aðrýsý sendromlarýnýn demans riskinin artmasýyla iliþkili olduðu makul olarak öne sürülebilir. Bununla birlikte, baþ aðrýsýný demansa baðlayan çalýþmalardan elde edilen mevcut kanýtlar azdýr ve çalýþma popülasyonlarý genellikle klinik olarak ilgili iliþkileri tespit etmek için çok küçüktür. Bu çalýþmada, demans popülasyonun-daki kronik baþ aðrýsý öyküsü insidansý, ayný yaþtaki demansý olmayan kontrol grubuyla karþýlaþtýrmalý olarak araþtýrýlmýþtýr.
YÖNTEM ve GEREÇLER: Ocak 2022-Haziran 2022 tarihleri arasýnda baþ aðrýsý dýþýnda herhangi bir þikayetle polikliniðe baþvuran toplam 122 demans hastasý ve benzer yaþ grubundaki demansý olmayan 114 kiþi çalýþmaya dahil edildi. Demans hastalarý Alzheimer hastalýðý, vasküler demans, mikst demans, frontotemporal demans ve Parkinson ile iliþkili de-mans olarak sýnýflandýrýlanlar arasýndan seçildi. Biliþsel bozulmanýn þiddetini deðerlendirmek için mini mental test skoru kullanýldý. Uluslararasý baþ aðrýsý sýnýflamasýna göre baþ aðrýsý alt tipleri migren tipi baþ aðrýsý, epizodik gerilim tipi baþ aðrýsý ve kronik gerilim tipi baþ aðrýsý olarak sýnýflandýrýldý. Bu iki grup arasýnda kronik baþ aðrýsý bozukluklarýnýn sýklýðý karþýlaþtýrýldý. Ayrýca, demansý olan hastalarda baþ aðrýsý tipleri ve genel popülasyondan farký araþtýrýldý.
BULGULAR: Kronik baþ aðrýsý sýklýðý açýsýndan hasta ve kontrol grubu arasýnda istatistiksel bir farklýlýk tespit edilmedi (p=0,568). Baþ aðrýsý alt tipleri mini mental test skorlarý arasýnda da istatistiksel olarak anlamlý iliþki yoktu (p=0,669). Ayrýca demans türü ve baþ aðrýsý alt tipleri arasýnda da herhangi bir anlamlý iliþki tespit edilmedi (p=0,070).
TARTIÞMA ve SONUÇ: Bu küçük gruplu retrospektif çalýþmada, kronik baþ aðrýsý öyküsü açýsýndan demansý olan ve olmayan gruplar arasýnda anlamlý bir farklýlýk ve dolayýsýyla kronik baþ aðrýsý sendromlarý ile demans arasýnda anlamlý bir iliþki tespit edilmedi.

INTRODUCTION: Headache disorders can be reasonably speculated to be associated with the increased risk of dementia. However, the current evidence from longitudinal studies linking headache disorders to dementia is scarce, and study populations are often too small to detect clinically relevant associations. In this study, we investigated the incidence of chronic headache history in the dementia population in comparison with the age-matched non-demented control group.
METHODS: A total of 122 dementia patients and 114 age-matched non-demented people admitted to outpatient clinic for any complaints other than headache in dates between January 2022 and June 2022 included in this study. Dementia patients who were classified as Alzheimer disease, vascular dementia, mixed dementia, frontotemporal dementia, and Parkinson-related dementia were selected. Mini-mental test score (MMSE) was used to assess the severity of the cognitive impairment. Headache subtypes were classified as migraine headache, episodic tension type headache, and chronic tension-type headache according to International Headache Classification. We investigated and compare the frequency of chronic headache disorders in between two groups. We also aimed to investigate the types of the headaches in demented people and to search the difference from the general population.
RESULTS: We could not find any difference statistically between the patient and control groups for the frequency of chronic headache disorder (p=0.568) and between headache subtypes and MMSE (p=0.669). We also examine the relationship between dementia type and subtypes of chronic headache in patient group and we could not find any relationship between this (p=0.070).
DISCUSSION AND CONCLUSION: In our small population retrospective study, we could not detect increased chronic headache history in demented people other than non-demented and could not find any relation between chronic headache disorders and dementia.

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GÝRÝÞ ve AMAÇ: Fibromiyalji, kronik yaygýn kas-iskelet sistemi aðrýsýnýn en sýk nedenidir. Etyoloji ve patofizyoloji henüz netlik kazanmamýþtýr. Ancak fibromiyalji ile tiroid hastalýklarý arasýndaki iliþkiyi aydýnlatan bazý çalýþmalar mevcuttur. Bu nedenle bu çalýþmada, hipotiroidili hastalarda fibromiyalji sýklýðýnýn belirlenmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Bu çalýþma, tek merkezli kesitsel, prospektif bir çalýþmadýr. Çalýþmaya dahiliye polikliniðine baþvuran hipotiroidi tanýlý 180 hasta dahil edildi. Aðrýlý hastalar fiziksel týp ve rehabilitasyon polikliniðinde deðerlendirildi, taný konulan fibromiyalji hastalarýnýn demografik verileri, laboratuvar bulgularý kaydedildi. Hastalar, Beck Depresyon Anketi (BDA) ve Fibromiyalji Etki Anketi (FEA) ile deðerlendirildi.
BULGULAR: Hipotiroidili hastalarýn %39,4'ünde (n=71) fibromiyalji saptanýrken, %60,6'sýnda (n=109) fibromiyalji mevcut deðildi. FEA skoru ile taný yaþý ve hastalýk süresi arasýnda pozitif bir korelasyon vardý. Taný yaþý ve hastalýk süresi arttýkça FEA skoru sýrasýyla %37,3 ve %25,7 oranýnda artýþ gösterdi. Ayrýca BDA skoru arttýkça FEA skoru %44,8 oranýnda artýþ gösterdi.
TARTIÞMA ve SONUÇ: Hipotiroidizmin belirti ve semptomlarý fibromiyalji belirti ve semptomlarýna benzer ve hipotiroidili hastalarýn yaklaþýk %40'ýnda eþ zamanlý fibromiyalji tanýsý mevcut olabilir. Dolayýsýyla hipotiroidi tanýsýnýn varlýðý bu hastalarda fibromiyalji tanýsýnýn gözden kaçmasýna neden olmamalýdýr. Bu nedenle hipotiroidili tüm hastalar fibromiyalji açýsýndan da deðerlendirilmelidir.

INTRODUCTION: Fibromyalgia (FM) is the most common cause of chronic generalized musculoskeletal pain. The etiology and the pathophysiology are still not clear but there are some studies that elucidate relationship between FM and thyroid diseases. The aim of this study was to determine the frequency of FM in patients with hypothyroidism.
METHODS: This is a cross-sectional, single-center, and prospective study from Bakýrkoy Dr Sadi Konuk Training and Research Hospital. A total of 180 patients – who were applied to internal medicine outpatient clinics – included in the study and the patients who described the generalized musculoskeletal pain were consulted to the physical medicine and rehabilitation outpatient clinics. Demographic data, laboratory findings, presence of thyroid disease, and FM were noted. Patients were evaluated with Beck Depression Questionnaire (BDQ) and FM Impact Questionnaire (FIQ) for FM patients.
RESULTS: About 39.4% (n=71) of the patients had FM and 60.6% (n=109) of them did not have FM. There was a positive correlation between FIQ score and age at diagnosis and disease duration. As the age at diagnosis and duration of disease increased, the FIQ score increased by 37.3% and 25.7%, respectively. In addition, as BDQ increased, the FIQ score increased by 44.8%.
DISCUSSION AND CONCLUSION: Signs and symptoms of hypothyroidism are similar to signs and symptoms of FM, and approximately 40% of patients with hypothyroidism could have FM concomitantly. Hence, the presence of a diagnosis of hypothyroidism should not cause us to miss the diagnosis of FM in these patients. Therefore, all patients with hypothyroidism should also be examined for FM.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada, karpal tünel sendromu nedeni ile açýk cerrahi ve mini açýk cerrahi uygulanan olgularýn tedavi sonuçlarý karþýlaþtýrýldý
YÖNTEM ve GEREÇLER: Açýk cerrahi uygulananlar Grup 1, mini açýk cerrahi uygulananlar Grup 2 olarak adlandýrýldý. Klinik sonuçlar, hasta memnuniyeti anketi, günlük yaþam aktiviteleri skoru ve el kavrama güçleri ile deðerlendirildi.
BULGULAR: Grup 1’de 13 (%31) erkek ve 29 (%69) kadýn ile toplam 42 (%46,2) olgu, Grup 2’de 15 (%30,6) erkek ve 34 (%69,4) kadýn ile toplam 49 (%53,8) olgu mevcuttu. Olgularýn günlük yaþam aktiviteleri skoru Grup 1’de 13,86±1,00, Grup 2’de 13,61±0,98 idi. El kavrama gücü Grup 1’de 0,27±0,07 (0,22-0,54), Grup 2’de 0,31±0,09 (0,21-0,55) bar idi. Buna göre Grup 1 ile Grup 2 arasýnda yaþ, cinsiyet, taraf, günlük yaþam aktiviteleri skorlarý ve el kavrama gücü açýsýndan istatistiksel olarak anlamlý fark bulunamadý. Cerrahi süre Grup 1’de 18,05±1,78, Grup 2’de 13,18±1,52 dakika olarak bulundu. Günlük aktivitelere dönüþ süresi Grup 1’de 16,17±2,07, Grup 2’de 12,53±1,80 gündü. Grup 1’de cerrahi süre ortalamasý ve günlük aktivitelere dönüþ zamaný istatistiksel olarak anlamlý yüksek saptandý. Olgularýn hasta memnuniyet anketi sonuçlarý Grup 1’de 87,60±2,63, Grup 2’de 89,49±2,55 idi. Grup 2’de hasta memnuniyet anketi Grup 1’den istatistiksel olarak anlamlý düzeyde yüksek saptandý.
TARTIÞMA ve SONUÇ: Fonksiyonel sonuçlar benzer olmakla birlikte özellikle nasýrlý el durumunda cerrahinin mini invaziv olarak seçilmesi, daha önceden geçirilen cerrahi ve ileri tenaratrofi gibi aðýr derece median sinir kompresyonundan þüphelenilen olgularda ise tercihin açýk cerrahiden yana kullanýlmasý daha güvenilir olarak görülmektedir.

INTRODUCTION: We evaluated the functional results of open and mini open surgical approaches in carpal tunnel syndrome patients.
METHODS: Group 1 was undergone open surgery while Group 2 patients were operated by mini open technique. Clinical results were evaluated with patient satisfaction questionnaire, daily activities and grip strength.
RESULTS: Twenty-eight patients were male and 63 were female. There were 13 male and 29 female with a total of 42 patients in Group 1, whereas 15 male and 34 female with a total of 49 patients were present in Group 2. Daily activity score was 13.86±1.00 for open group and 13.61±0.98 for Group 2. Grip strength was 0.27±0.07 bar in Group 1 and 0.31±0.09 bar in Group 2. There was no significant difference between two groups regarding to age, sex, operation site, daily activity scores, and grip strength. Surgical time was 18.05±1.78 minutes in Group 1 and 13.18±1.52 min in Group 2. Return to daily activity was 16.17±2.07 day in Group 1 and 12.53±1.80 day in Group 2. Surgery time and time to activity return is statistically significantly higher in open surgery group compared to mini-open group. Patient satisfaction score was 87.60±2.63 in Group 1 and 87.60±2.63 in Group 2. Patient satisfaction questionnaire result was statistically higher for mini-open group compared to Group 1.
DISCUSSION AND CONCLUSION: In tandem with similar functional results, mini-open surgery can be preferred in callous hand, while open surgery is more suitable to patients with serious thenar atrophy along with suspicion of median nerve compression.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, hastanelerde görülen iþ kazalarýnýn nedenlerinin, görülme sýklýðýnýn ve sonuçlarýnýn incelenmesidir.
YÖNTEM ve GEREÇLER: Tanýmlayýcý nitelikte ve tek merkezde yapýlan çalýþmada, bir hastanede 2019 yýlýnda görülen tüm iþ kazalarý incelendi. Ýþ kazalarýnýn nedenleri, meydana gelme saati, kaza sonucunda geliþen yaralanma durumu ve iþ gücü kaybý yaþanma durumuna dair veriler frekans tablolar ile gösterildi. Kazalardaki iþ gücü kaybýnda, cinsiyet ve eðitim seviyesine göre farklýlýk olup olmadýðý Yates Ki-Kare ve Kruskal Wallis analizleri ile yapýldý. Verilerin analizinde SPSS v.22 istatistik programý kullanýldý.
BULGULAR: Hastanede toplam 131 iþ kazasý oldu ve yýllýk iþ kazasý görülme sýklýðý %9 olarak tespit edildi. Kazaya maruz kalan personelin yaþ ortalamasý 33,3±9,41 yýl, çoðunluðu (%58) kadýn ve hemþire/ebe/laborant (%29,8) olup 1-5 yýl arasý çalýþanlardý (%42,7). Eðitim düzeyi açýsýndan en fazla kaza lisans eðitiminde (%24,4) görüldü. Kazalarýn çoðunlukla (%71) mesai saatleri içinde yataklý kliniklerde (%27,5) geliþtiði ve en sýk kesici delici alet yaralanmalarý (%35,9) olduðu görüldü. Kaza sonrasý iþ gücü kaybý %19,8 oranýnda ve toplam 98 gün olarak tespit edildi. Erkeklerde kadýnlara göre ve ön lisans düzeyinde eðitimi olan çalýþanlarda diðerlerine göre iþ gücü kaybý yaþanma oraný daha yüksek saptandý.

TARTIÞMA ve SONUÇ: Ýþ kazalarý, iþ gücü kaybý oluþturmasýnýn yaný sýra personelin saðlýðýný da olumsuz yönde etkilemektedir. Yüksek riskli personelin tespit edilmesi, kazalarýn önlenmesine yönelik koruyucu yaklaþýmlarýn daha etkili olmasýna yarar saðlayacaktýr.

INTRODUCTION: It is the examination of the causes, frequency, and consequences of occupational accidents in hospitals.
METHODS: In this descriptive study, conducted in a single center, all occupational accidents in a hospital in 2019 were examined. Data on the causes of occupational accidents, occurrence time, the injury caused by the accident, and the labor loss were shown in frequency tables. The differences between the groups according to gender and education level for labor loss due to the accidents were analyzed with Yates Chi-square and Kruskal–Wallis Analysis. SPSS v.22 statistics program was used in the analysis of the data.
RESULTS: A total of 131 occupational accidents occurred in the hospital and the annual occupational accident rate was 9%. The mean age of the employees exposed to the accident was 33.3±9.41 years, the majority was women (58%) and nurses/midwives/laboratory workers (29.8%), and their working experience was between 1 and 5 years (42.7%). In terms of education level, most accidents were seen in undergraduate education (24.4%). Most of the accidents occurred during day shifts (71%), in inpatient clinics (27.5%), and the most common was with sharp-piercing injuries (35.9%). The labor loss after the accidents was 19.8% and 98 days in total. The labor loss was higher for males than females and for employees with associate degree education compared to others.
DISCUSSION AND CONCLUSION: Occupational accidents not only cause loss of workforce, but also negatively affect the health of employees. Identification of high-risk personnel will ensure that the protective approaches to prevent accidents will be more effective.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada, tip 2 diyabet hastalarýnda, diyabetik retinopati ile monosit/yüksek dansiteli lipoprotein oranýnýn (MHR) iliþkisi incelenmiþtir.
YÖNTEM ve GEREÇLER: Diyabetik retinopatisi bulunan 45 diyabet hastasý çalýþma grubunu oluþtururken, diyabetik retinopatisi bulunmayan 45 diyabet hastasý ile 45 diyabeti bulunmayan saðlýklý katýlýmcý kontrol grubunu oluþturdu. Hastalarýn retrospektif olarak medikal ve laboratuvar kayýtlarý tarandý.
BULGULAR: Ortalama MHR, diyabetik retinopatisi bulunan hastalarda, diyabetik retinopatisi bulunmayan diyabet hastalarýna ve diyabeti bulunmayan gruba göre istatistiksel olarak anlamlý yüksekti. Ayrýca MHR, diyabetik retinopatisi bulunmayan diyabet hastalarýnda, diyabeti bulunmayan kontrol grubuna göre anlamlý olarak daha yüksekti.
TARTIÞMA ve SONUÇ: Ýnflamasyonun göstergesi olarak potansiyel bir biyobelirteç olarak kabul edilen MHR, diyabetik retinopatisi bulunan diyabet hastalarýnda, diyabetik retinopatisi bulunmayan diyabet hastalarýna ve diyabeti bulunmayan gruba göre anlamlý olarak daha yüksek bulundu.

INTRODUCTION: The purpose of the study was to evaluate the association of monocyte to high-density lipoprotein cholesterol ratio (MHR) with diabetic retinopathy (DR) in patients with type II diabetes mellitus (DM).
METHODS: Forty-five DM patients with DR included in the study. Similarly, 45 DM patients without DR and 45 healthy subjects were determined as control groups. The data were composed based on a retrospective scan of the medical records and laboratory archives of patients.
RESULTS: The mean MHR was significantly higher in DR patients compared to DM patients without DR and healthy subjects. There was also a statistical difference between DM patients without DR and healthy subjects. The optimal cutoff value of MHR for DR was 9.17 with 82.9% sensitivity and 59.8% specificity and an area under the receiver operating characteristics curve was 0.755.
DISCUSSION AND CONCLUSION: The MHR recognized as a potential biomarker of inflammation was significantly higher in patients with DR compared to the DM patients without DR and healthy subjects. Our results demonstrated that the MHR has high sensitivity and low specificity for DR.

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GÝRÝÞ ve AMAÇ: Sindesmozun malredüksiyonu kötü prognozla iliþkilidir; son çalýþmalar bu fenomeni önlemek için intraoperatif radyolojik parametreleri belirlemeye odaklanmýþtýr. Çalýþmada, ideal trans-sindesmotik açý (TSA) ve sindesmotik fiksasyon ekseninin (SFE) belirlenmesinde manyetik rezonans görüntüleme (MRG) tabanlý kesitsel görüntü analizinden kolay uygulanabilir ve tekrarlanabilir radyolojik parametrelerin belirlemesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Osseöz/ligamentöz yaralanmasý olmayan 120 ayak bileði MRG taramasý, bir ortopedist ve bir radyolog tarafýndan kör olarak yapýldý. Kesitsel ölçümlerle, talus anterior teðeti (TAT) ve talar eksen çizgisi (TEÇ) belirlendi. Sindesmotik eklem anterior ve posterior teðetleri kesiþiminin açýortayý SFE, SFE ile TEÇ kesiþimi ile de TSA belirlendi.
BULGULAR: Ortalama TSA 16°-17° idi. SFE lateralde tibianýn ön-arka mesafesinin ve medialde fibula apeksinin önünde %28±%6,6 ve %30±%5,7 arasýndaydý. Gözlemci 1 tarafýndan elde edilen ölçümler için sýnýf içi korelasyon katsayýsý aralýðý 0,600-0,882 iken, gözlemci 2 tarafýndan elde edilenler için 0,565-0,904 idi. Gözlemciler arasý anlaþma 0,589 ile 0,901 arasýndaydý; güvenilirlik bu yeni ölçüm seti için kabul edilebilirdi.
TARTIÞMA ve SONUÇ: Ölçümlerimiz ideal TSA’nýn 16° ile 17° arasýnda olduðunu ve SFE’nin lateralde fibular apeks ile medialde tibianýn anterior 1/3’ü arasýnda yer aldýðýný gösterdi. Rotasyon TSA’yý ve SFE’nin iki boyutlu görüntüdeki görünümünü etkileyeceðinden, uygulanacak tüm parametreler gerçek bir ayak bileði lateral grafisinde deðerlendirilmelidir.

INTRODUCTION: Malreduction of the syndesmosis is associated with a poor prognosis; recent studies have focused on identifying intraoperative radiological parameters to prevent this phenomenon. Our study aimed to determine easily applicable and reproducible radiological parameters from magnetic resonance image (MRI)-based cross-sectional image analysis in determining the ideal trans-syndesmotic angle (TSA) and syndesmotic fixation axis (SFA).
METHODS: A total of 120 ankle MRI scans without osseous/ligamentous injury were performed blindly by an orthopedist and a radiologist. Talar anterior tangent and talar axis line (TAL) were determined by cross-sectional measurements. The bisector of the anterior and posterior tangents of the syndesmotic joint was determined by the SFA, and the TSA was determined by the intersection of SFA and TAL.
RESULTS: The average TSA was 16–17°. The SFA was between 28%±6.6% and 30%±5.7% anterior to the anteroposterior distance of the tibia laterally and the fibular apex medially. The intraclass correlation coefficient (ICC) range for measurements obtained by observer 1 was 0.600–0.882, while that for those obtained by observer 2 was 0.565-0.904. Interobserver agreement was between 0.589 and 0.901; reliability was acceptable for this new set of measurements.
DISCUSSION AND CONCLUSION: Our measurements showed that the ideal TSA was between 16° and 17°, and SFA was located between the fibular apex laterally and the anterior third of the tibia medially. All parameters to be applied should be evaluated on a true lateral radiograph of the ankle because rotation will affect the TSA and the appearance of the SFA in a two-dimensional image.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, kalça ve diz periprostetik eklem enfeksiyonlarýnýn mikrobiyolojik profillerini ve antimikrobiyal direncini araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Eylül 2018-Ocak 2022 tarihleri arasýnda kalça veya diz primer artoplastisi geçiren 18 yaþ üzeri hastalar hastanenin veri tabanýndan tarandý ve çalýþmaya dahil edildi. Hastalarýn demografik verileri, periprostetik doku kültürü ve eklem sývýlarýnýn antimikrobiyal dirençleri deðerlendirildi.
BULGULAR: Çalýþmaya %66,7’si kadýn olmak üzere toplam 51 hasta dahil edildi. Hastalarýn %62,7’sinde kalça ekleminin enfekte olduðu görüldü. En yaygýn patojen koagülaz-negatif stafilokok (%41,2) olarak saptanmýþ olup, bunu Staphylococcus aureus (%23,5) ve Acinetobacter baumannii (%23,5) izledi. A.baumannii’nin oraný kalça periprostetik eklem enfeksiyonlarýnda diz periprostetik eklem enfeksiyonlarýndan daha yüksek saptandý (p=0,02). Saptanan Acinetobacter türlerinin %25’i karbapenemlere karþý dirençlidir. Diz ve kalça periprostetik eklem enfeksiyonlarý gruplarý arasýnda gram-pozitif veya gram-negatif mikroorganizmalarýn daðýlýmý istatistiksel olarak anlamlý deðildir (p>0,05). Hastalarýn %56,9’unda enfeksiyon monobakteriyeldir. Patojenlerin polimikrobiyal olma olasýlýðý kalça protezlerinde diz protezlerine göre daha fazla olmasýna raðmen iki grup arasýndaki fark istatistiksel olarak anlamlý deðildir (p>0,05).
TARTIÞMA ve SONUÇ: Dominant bakteri genellikle farklý coðrafi bölgelere ve protez lokasyonuna göre deðiþmektedir. Enfeksiyona neden olan ajanýn izole edilmesi ve antimikrobiyal direncin bilinmesi, enfeksiyon yönetiminde temel stratejidir. Literatürde periprostetik eklem enfeksiyonlarý konusunda bulgularýn sýnýrlý olduðu göz önüne alýndýðýnda bilgi birikimi ve periprostetik eklem enfeksiyonlarýnýn mikrobiyolojik profillerinin daha iyi analiz edilmesi için daha fazla çalýþma gereklidir.

INTRODUCTION: The aim of this study was to investigate microbiological profiles and antimicrobial resistance of hip and knee periprosthetic joint infection (PJI).
METHODS: Patients over 18 years of age who underwent hip or knee primary arthroplasty between September 2018 and January 2022 were screened from the hospital database and retrospectively included in the study. Patients’ demographic data, periprosthetic tissue culture, and joint fluids’ antimicrobial resistances were evaluated.
RESULTS: A total of 51 patients with 66.7% being female were enrolled. The hip joint was infected in 62.7% of the patients. The most common causative pathogen identified was Coagulase-negative staphylococci (CoNS) (41.2%), followed by Staphylococcus aureus (23.5%) and Acinetobacter baumanii (23.5%). The proportion of A. baumanii in hip PJI was higher than that in knee PJI (p=0.02). Twenty-five of the detected Acinetobacter strains were resistant to carbapenems. The distribution of Gram-positive or Gram-negative microorganisms between the knee and hip PJI groups was not statistically significant (p>0.05). The infection was monobacterial in 56.9% of the patients. Polymicrobial pathogens were more likely to occur in the hip prosthetic joint than in the knee prosthetic joint, but no statistical difference was observed between the two groups (p>0.05).
DISCUSSION AND CONCLUSION: The predominant bacteria usually differ among different geographic area and location of the prosthesis. Knowing the causative agents and antimicrobial resistance is the basic strategy in infection management. Considering that there are limited evidence in literature about PJI’s, further studies are needed to accumulate knowledge and to analyze better microbiological profiles of PJIs.

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Ekstrakraniyal karotis arter anevrizmalarý tüm arteriyel anevrizmalarýn %1’den azýný, periferik arter anevrizmalarýnýn da %4’ünü oluþturmaktadýr. Etyolojide ateroskleroz (%46-70) en sýk nedendir. Bu anevrizmalar tedavi edilmediðinde rüptür riski, tromboemboliye baðlý inme, ölüm gibi komplikasyonlar bildirilmiþtir. Bu olguda, akut infarkt nedeni olarak tespit edilen bilateral ve dev ekstrakraniyal karotis arter anevrizmasýnýn sunulmasý amaçlanmýþtýr.

The extracranial carotid artery aneurysm (ECAA) constitutes <1% of all arterial aneurysms and 4% of peripheral arterial aneurysms. Atherosclerosis (46–70%) is the most common cause of etiology. When these aneurysms are not treated, complications such as risk of rupture, stroke and death due to thromboembolism have been reported. In this case, we aimed to present a case of bilateral and giant ECAA as the cause of acute infarction.

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Görme yollarý üzerinde kitle veya iskemik lezyonu bulunan hastalar, lezyonun lokalizasyonuyla uyumlu olarak etkilenen taraftaki engellerden kaçýnamazlar, yaklaþan insanlara ve engellere çarpabilirler. Bu olgu sunumunda, baþ aðrýsý ve tekrarlayan travma öykülerinden yola çýkýlarak yapýlan görme alaný muayenesinde homonim hemianopsisi olan ve glioblastoma tanýsý alan olguya dikkat çekilmek istendi. Elli iki yaþýnda erkek hasta, son bir haftadýr sol tarafýndaki nesnelere çarpma ve arabasýnýn sol yanýný iki kez vurma þikayetiyle acil servise baþvurdu. Hastanýn görme alaný muayenesinde sol homonim hemianopsi tespit edildi. Bilgisayarlý tomografi görüntülemesinde sað oksipitopariyetalde yaygýn periferik ödemin eþlik ettiði kitle izlendi. Hastanýn beyin cerrahisi bölümüne yatýþý yapýldý. Yatýþýndan bir gün sonra opere edilen hastanýn patoloji sonucu glioblastoma ile uyumlu bulundu. Görme alanlarý, özellikle diðer semptomlarla iliþkilendirildiðinde, beyin lezyonlarýnýn yeri hakkýnda deðerli bilgiler saðlar. Bu þikayetler ile gelen hastalarýn anamnezi derinleþtirilmelidir. Bu hastalar görme kusurlarýnýn farkýnda olmayabilir, bu nedenle hastalara nörolojik deðerlendirmede rutin görme alaný muayenesi mutlaka yapýlmalýdýr.

Patients with a mass or ischemic lesion on the visual pathways cannot avoid obstacles on the affected side in accordance with the localization of the lesion and may collide with approaching people and obstacles. In this case, we wanted to draw attention to the case with homonim hemianopsy and diagnosed with glioblastoma in the visual field examination based on the history of headaches and recurrent trauma. A 52-year-old male patient applied to the emergency department with the complaints of hitting objects on his left side and hitting the left side of his car twice in the past week. Left homonymous hemianopsia was detected in the visual field examination of the patient. On CT imaging, a mass with diffuse peripheral edema were observed in the right occipitoparietal. The patient was admitted to the neurosurgery department. The patient was operated 1 day after hospitalization and his pathology result of the lesion was compatible with glioblastoma. Visual fields provide valuable information about the location of brain lesions, especially when associated with other symptoms. The anamnesis of patients with these complaints should be examined in detail. These patients may not be aware of their visual impairment. Therefore, routine visual field examination should be performed in the neurological evaluation of the patients.

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Tüberküloz lenfadenit, akciðer dýþý tüberkülozun en yaygýn þeklidir. Servikal bölge lenf düðümlerinde sýklýkla karþýlaþýlýr. Tanýda, tutulan lenf nodundan eksizyonel biyopsi, biyopsi materyalinin aside dirençli basil tespitinde kullanýlan boyalarla boyanmasý ve mikobakteriyel kültür kullanýlýr. Bu olgu sunumunda, bir haftadýr boyun sað tarafýnda þiþlik ve solunumla birlikte olan göðüs aðrýsý þikayetiyle dahiliye polikliniðine baþvuran 22 yaþýndaki erkek hasta sunuldu. Hastanýn fizik muayenesinde boynun sað tarafýnda yaklaþýk 3 cm büyüklüðünde hassas olmayan bir þiþlik saptandý. Yapýlan ince iðne aspirasyon biyopsisinde ön planda tüberküloz düþündüren nekrotizan granülomatöz enfeksiyon olarak deðerlendirildi. Hastaya antitüberküloz tedavi baþlandý. Altý ay sonra hastanýn þikayetleri geriledi ve saðlýðý yerindeydi.

Tuberculous lymphadenitis is the most common form of extrapulmonary tuberculosis. It is frequently encountered in the cervical region lymph nodes. Excisional biopsy of the involved lymph node, staining of the biopsy material with stains used for the detection of acid-fast bacilli, and mycobacterial culture are used for the diagnosis. We report here on a 22-year-old male patient who was admitted to the internal medicine outpatient clinic with a 1 week history of swelling on the right side of his neck and accompanying chest pain with breathing. The patient’s physical examination documented a non-tender swelling of approximately 3 cm size on the right side of his neck. Fine-needle aspiration biopsy of the node evaluated for causes of necrotizing granulomatous infections with tuberculosis at the forefront. A right-sided pleural effusion (7 cm deep) was detected in the thorax computed tomography examination. The patient was started antituberculous treatment. Following 6 months, the patient’s complaints regressed, he was in good health.

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Birinci servikal vertebranýn (atlas) varyasyonlarýndan olan arkuat foramen (AF) vertebral arter sulkusu üzerinde lokalizedir ve tanýsýnda bilgisayarlý tomografi altýn standarttýr. Komplet ve inkomplet tipleri olan arkuat foramenin rastlanma sýklýðý toplumlara, etnik gruplara ve inceleme yöntemine göre deðiþmekte olup %1-68 arasýnda deðiþen oranlar bildirilmektedir. Ýçinden, vertebral arterin üçüncü segmenti, suboksipital sinir, perivasküler sempatik pleksus ve vertebral venöz pleksus geçmektedir. Arkuat foramen içinden geçen yapýlara yaptýðý basýnýn derecesine göre bulgu vermekte olup komplet tipte olanýnýn klinik bulgu verme olasýlýðý daha yüksektir. Boynu aþýrý zorlayan travmalar ve üst servikal bölgeye uygulanan cerrahi giriþimler esnasýnda vertebral arter diseksiyonuna neden olma potansiyelinin yüksek olmasý nedeniyle arkuat foramen ayrýca önem taþýmaktadýr. Bu çalýþmada son literatürler de incelenip bilimsel kanýtlar eþliðinde arkuat foramenin klinik önemi özetlenmiþtir.

The arcuate foramen (AF), one of the variations of the first cervical vertebra (atlas), is localized on the vertebral artery (VA) sulcus, and computed tomography is the gold standard in its diagnosis. AF has complete and incomplete types, and its incidence varies according to societies, ethnic groups, and examination methods, ranging from 1% to 68%. The third segment of the VA, the suboccipital nerve, the perivascular sympathetic plexus, and the vertebral venous plexus pass through it. It gives symptoms according to the degree of pressure on the structures passing through it, and the complete type is more likely to give clinical findings. AF is also important because of its potential to cause VA dissection during neck traumas and surgical procedures applied to the upper cervical region. In this study, the latest literature was reviewed, and the clinical importance of AF was summarized in the light of scientific evidence.

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