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SETB: 52 (3)

Volume: 52  Issue: 3 - 2018

REVIEW ARTICLE
1.Standards and Definitions in Neck Dissections of Differentiated Thyroid Cancer
Mehmet Uludağ, Mert Tanal, Adnan Işgör
doi: 10.14744/SEMB.2018.14227  Pages 149 - 163
Papillary and follicular thyroid carcinomas arising from the follicular epithelial cells and forming differentiated thyroid cancer (DTC) consist of >95% of thyroid cancers. Lymph node metastasis to the neck is common in DTC, especially in papillary thyroid cancer. The removal of only the metastatic lymph nodes (berry picking) does not help to achieve a potential positive contribution to the survival and recurrence of lymph node dissection in the DTC. Thus, systematic dissection of the cervical lymph nodes is needed. Today, according to the widely accepted and commonly used definitions and lymph node staging, the deep lymph nodes of the lateral side of the neck are divided into five regions. Based on the fact that some groups have biologically independent regions, Groups I, II, and V are divided into the A and B subgroups. The central region lymph nodes contain VI and VII region lymph nodes, which consist of the prelaryngeal, pretracheal, and right and left paratracheal lymph node groups.
Radical neck dissection (RND) is accepted as the standard basic procedure in defining neck dissections. In this method, in addition to all the regions of the Groups I–V lymph nodes at one side, the ipsilateral spinal accessory nerve, internal jugular vein, and sternocleidomastoid muscle are removed. Sparing of one or more of the routinely removed non-lymphatic structures in the RND is called modified RND (MRND), whereas the preservation of one or more of the routinely removed lymph node groups in the RND is termed as selective neck dissection (SND). In difference, the procedure with an addition of a lymph node and/or non-lymphatic structures to routinely removed neck structures in RND is called extended RND. Generally, involving one or more regions of SND are applied for DTC.
The removal of the paratracheal, prelaryngeal, and pretracheal lymph node groups at one side is termed as ipsilateral central dissection, whereas the removal of the bilateral paratracheal lymph node groups, in other words, the excision of four lymph node groups in the central region (Groups VI and VII), is defined as bilateral central dissection. In conclusion, bilateral central neck dissection (CND) is the SND in which the regions of VI and VII are removed.
In the DTC, CND is prophylactically and therapeutically applied, whereas lateral neck dissection is performed only therapeutically in the presence of clinical metastasis (N1b) in the lateral neck region. Debates on the extent of SNDs to be made in the central and lateral neck regions are still ongoing. Central dissection should be made at least unilaterally. In the lateral side of the neck, SNDs can be applied in different combinations in which at least one region from Groups I to V is removed. The main variables that determine the extent of SND in the central and lateral regions in DTC are the complication rates, the effect of the procedure, and its effect on prognosis and recurrence.
Papillary and follicular thyroid carcinomas arising from the follicular epithelial cells and forming differentiated thyroid cancer (DTC) consist of >95% of thyroid cancers. Lymph node metastasis to the neck is common in DTC, especially in papillary thyroid cancer. The removal of only the metastatic lymph nodes (berry picking) does not help to achieve a potential positive contribution to the survival and recurrence of lymph node dissection in the DTC. Thus, systematic dissection of the cervical lymph nodes is needed. Today, according to the widely accepted and commonly used definitions and lymph node staging, the deep lymph nodes of the lateral side of the neck are divided into five regions. Based on the fact that some groups have biologically independent regions, Groups I, II, and V are divided into the A and B subgroups. The central region lymph nodes contain VI and VII region lymph nodes, which consist of the prelaryngeal, pretracheal, and right and left paratracheal lymph node groups.
Radical neck dissection (RND) is accepted as the standard basic procedure in defining neck dissections. In this method, in addition to all the regions of the Groups I–V lymph nodes at one side, the ipsilateral spinal accessory nerve, internal jugular vein, and sternocleidomastoid muscle are removed. Sparing of one or more of the routinely removed non-lymphatic structures in the RND is called modified RND (MRND), whereas the preservation of one or more of the routinely removed lymph node groups in the RND is termed as selective neck dissection (SND). In difference, the procedure with an addition of a lymph node and/or non-lymphatic structures to routinely removed neck structures in RND is called extended RND. Generally, involving one or more regions of SND are applied for DTC.
The removal of the paratracheal, prelaryngeal, and pretracheal lymph node groups at one side is termed as ipsilateral central dissection, whereas the removal of the bilateral paratracheal lymph node groups, in other words, the excision of four lymph node groups in the central region (Groups VI and VII), is defined as bilateral central dissection. In conclusion, bilateral central neck dissection (CND) is the SND in which the regions of VI and VII are removed.
In the DTC, CND is prophylactically and therapeutically applied, whereas lateral neck dissection is performed only therapeutically in the presence of clinical metastasis (N1b) in the lateral neck region. Debates on the extent of SNDs to be made in the central and lateral neck regions are still ongoing. Central dissection should be made at least unilaterally. In the lateral side of the neck, SNDs can be applied in different combinations in which at least one region from Groups I to V is removed. The main variables that determine the extent of SND in the central and lateral regions in DTC are the complication rates, the effect of the procedure, and its effect on prognosis and recurrence.

ORIGINAL RESEARCH
2.Role of Laparoscopic Appendectomy Radix Ligation Techniques on the Formation of Inner Abdomen Abscess
Omer Avlanmis, Gurhan Riza Isil, Adnan Nadir Hacim, Hakan Teoman Yanar
doi: 10.14744/SEMB.2017.92905  Pages 164 - 168
Amaç
Laparoskopik appendektomide güdük bağlanma tekniklerinin batın içi abse gelişiminde etkili olup olmadığını araştırmak.
Gereç ve Yöntem
Eylül 2009-Nisan 2017 tarihleri arasında acil cerrahi polikliniğimize başvurmuş olan tüm olguların verileri geriye dönük incelendi ve laparoskopik apendektomi ameliyatı geçiren tüm hastaların verileri toplandı. Epikrizlerdeki ameliyat notlarında apendiks güdüğünün nasıl bağlandığı incelendi ve kaydedildi. Ameliyat sonrası kontroller de incelendi ve abse gelişen olgular kaydedildi.
Bulgular
Toplam 350 hasta çalışmaya dahil edildi. Olguların 207’si erkek, 143’ü kadın idi. Yaş ortalaması 26.89±4.9 yıl idi. 189 olguya iki endo-loop üst üste konulup, 161 olguya ise iki endo-loop’un arasında ikişer milimetre mesafe bırakılarak bağlandığı görüldü. Endo-loop üst üste konulup ameliyat edilen 189 olgunun hiç birinde batın içi abse saptanmadı, endo-loop’ ların arasında ikişer milimetre mesafe bırakılarak bağlanıp ameliyat edilen 161 olgunun 8’inde batın içi abse saptandı. Bu 8 olgudan 7’sinin tedavisi girişimsel radyoloji tarafından perkütan abse drenajı ile, birinin ise laparoskopi ile yapıldığı saptandı.

Sonuç
Bu çalışmada, endo-loop üst üste konulup ameliyat edilen hastalarda hiç abse formasyonu gözlemlenmezken, literatürde altın standart olarak tarif edilen endo-loop’un arasında ikişer milimetre mesafe bırakılarak bağlanıp ameliyat edilen hastaların 8(%4.9)’ inde batın içi abse geliştiği görüldü. İki loop’ un arasında ölü mesafe bırakılarak ameliyat edilen hastalarda bu ölü mesafenin batın içi abse gelişimine katkıda bulunduğuna inanmaktayız.
Objectives: Our aim was to study whether laparoscopic appendectomy radix ligation techniques were eutrophic in the development of intra-abdominal abscess.
Methods: Between September 2009 and April 2017, all emergency cases admitted to our surgery polyclinic were reviewed, and the results of the patients who underwent laparoscopic appendectomy were collected. Appendectomy radix ligation techniques were reviewed from surgical notes on discharge reports. Postoperative controls were also reviewed, and any cases with abscess formation were reported.
Results: A total of 350 patients were included in the study. Of these cases, 207 were males, and 143 were females. The mean age of the patients was 26.89±4.9 years. One hundred eighty-nine cases were found to have two endoloops placed on top of each other, whereas 161 cases had a 2 mm distance left in between the two endoloops and tied. None of the 189 cases who had endoloops placed on top of each other developed abscess formation. However, of the 161 cases who had endoloops with a 2 mm distance in between, 8 reported with abscess formation in the inner abdomen. Of these eight cases, seven had percutaneous abscess drainage by an interventional radiologist, whereas one was treated with relaparoscopy.
Conclusion: In the present study, patients who had endoloops placed on top of each other developed no abscess formation, whereas in the literature’s gold standard procedure, those with a 2 mm distance left between two endoloops developed an inner abdominal abscess formation in 8 (4.9%) of the patients. We believe that this 2 mm dead space distance left between the two endoloops contributes to the formation of the abscess.

3.Laparoscopic Gastrostomy in Children: 10 Years of Experience
Ufuk Ates, Anar Gurbanov, Gulnur Gollu Bahadir, Nil Yasam Tastekin, Sumeyye Sozduyar, Ergun Ergun, Aydin Yagmurlu, Murat Cakmak, Tanju Aktug, Huseyin Dindar, Meltem Bingol Kologlu
doi: 10.14744/SEMB.2017.15870  Pages 169 - 172
Giriş: Laparoskopik gastrostomi, beslenme bozuklukları, nörolojik hastalığı veya büyüme gelişme geriliği olan çocuklarda yaygın olarak kullanılan bir prosedürdür. Gastrostomi tüpü takılması uygulama tekniğine göre farklı yöntemlerle gerçekleştirilebilir. Laparoskopik trokar yerinden yapılan primer gastrostomi, özel enstrümantasyon ve kit gerektirmeyen basit ve kolay bir tekniktir. Bu çalışmada, 10 yıllık gastrostomi deneyimlerinin sunulması amaçlanmıştır.
Yöntem ve Gereçler: 2006-2016 yılları arasında laparoskopik gastrostomi uygulanan 128 çocuğun verileri geriye dönük olarak incelendi. Demografik bilgiler, operatif işlemler ve komplikasyonlar da dahil olmak üzere veriler kaydedildi. Tüm çocuklara preoperatif kontrastlı görüntüleme ve 24 saatlik Ph monitörizasyonu uygulandı. Tüm hastalara trokar giriş yerinden primer gastrostomi yapıldı. Mide laparoskopik olarak trokar yerinden çekildi, mideden pursestring bir dikiş geçilerek mide rektus kasının anterioruna ekstrakorporeal olarak sabitlendi ve gastrostomi tüpü veya butonu yerleştiridi.
Bulgular: 49 kız (% 38,3) ve 79 erkek (% 61,7) çocuk vardı. Cerrahi öncesi süre (1 gün-18 yıl) ortalama yaş 50 aydı ve ortalama vücut ağırlığı 13 kg (2300 gr-65 kg) idi. 116 (% 90,6) çocuğa hem laparoskopik Nissen fundoplikasyonu hem gastrostomi; 12 hastada (% 9,4) sadece laparoskopik gastrostomi uygulandı. En sık görülen komplikasyon antibiyotik ile tedavi edilen gastrostomi alanı enfeksiyonuydu (n=14). 9 (% 7) hastada 30 gün içinde periton kaçağı görüldü. 5 çocukta gastrostomi tüpünün çıkması nedeni ile ameliyat gerekti. 4 çocukta gastrostomi çevresinde granülom gelişti, gümüş nitrat ile yakılarak tedavi edildi.
Sonuç: Trokar giriş yerinden yapılan primer laparoskopik gastrostomi, komplikasyon oranlarının diğer laparoskopik gastrostomi yöntemleriyle karşılaştırılabilir olduğu, güvenli ve kolay bir yöntemdir.
Objectives: Laparoscopic gastrostomy is a widely used procedure in children with failure to thrive, feeding disorders, or neurologic impairment. Various methods of laparoscopic gastrostomy and fixing stomach to abdominal wall have been described. Trocar site primary gastrostomy under laparoscopic control is a simple and easy technique that does not require special instruments and a kit. The aim of this study was to present 10 years of experience in laparoscopic gastrostomy.
Methods: The charts of 128 children who underwent laparoscopic gastrostomy between 2006 and 2016 were retrospectively reviewed. The data, including demographics, operative procedures, and complications, were recorded. All children underwent preoperative contrast imaging and 24-hour Ph monitorization. In all patients, the trocar site primary gastrostomy was done. A gastrostomy tube or a button was inserted into the stomach in the center of a purse–string suture loop, and the stomach was fixed to the anterior rectus sheath extracorporeally.
Results: There were 49 girls (38.3%) and 79 boys (61.7%). The mean age was 50 months at surgery (1 day–18 years), and the average body weight was 13 kg (2300 gr–65 kg). Both laparoscopic Nissen fundoplication and gastrostomy were done in 116 (90.6%) patients, and 12 (9.4%) patients had only laparoscopic gastrostomy. Infection at the site of gastrostomy, which was treated by antibiotics, was the most common complication, observed in 14 (11%) patients. Peritoneal leakage within 30 days was seen in 9 (7%) patients. Severe dislodgement of gastrostomy resulting in operative intervention occurred in 5 (3.9%) patients. Granuloma developed in 4 (3.1%) patients and was treated with silver nitrate.
Conclusion: The trocar site primary laparoscopic gastrostomy is a safe and easy technique with complication rates comparable to other gastrostomy methods.

4.The Treatment Method and Results of Percutaneous Pinning and Dynamic External Fixator Application for Unstable Distal Radius Fractures
Adnan Kara, Erden Ertürer, Faik Seçkin, Şenol Akman, Irfan Öztürk
doi: 10.14744/SEMB.2018.07078  Pages 173 - 178
Amaç: Çalışmamızda instabil radius distal uç kırığı nedeniyle kapalı redüksiyon ve K teli ile tespit sonrası erken el bileği hareketine izin veren Pennig tipi dinamik eksternal fiksatör (Orthofix, Srl, Italya) uygulanan hastaların sonuçlarının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: Kapalı redüksiyon ve perkütan K teli ile tespiti takiben dinamik el bileği eksternal fiksatörü uygulanan instabil radius distal uç kırıklı 25 olgu (15 erkek [%60], 10 kadın [%40], yaş ortalaması 47.32 [20-76yaş]) değerlendirildi. Travma sonrası ortalama 8.52 (1-23) günde ameliyat edilen hastalara, ilk gün aktif omuz, dirsek ve parmak egzersizleri başlanarak normal günlük aktivitelerine geri dönmeleri sağlandı.
Bulgular: Radyolojik-anatomik sonuçlar Lidström’ün geliştirdiği Sarmiento tarafından modifiye edilen radyolojik kriterlerlere göre yapıldı. Oniki olguda (%46.15) mükemmel, onbir olguda (%42.30) iyi, üç olguda (%11.55) ise orta sonuç elde edildi. Kötü sonuç alınan hasta bulunmamaktaydı. Fonksiyonel sonuçlar Sarmiento tarafından modifiye edilen Gartland-Werley’in geliştirdiği skorlama sistemi ile değerlendirildi. Hastaların ondördünde (%56) mükemmel, sekizinde (%32) iyi, üçünde de (%12) orta sonuç alındığı saptandı.
Sonuç: Stabil olmayan radius distal uç kırıklarının tedavisinde Pennig tipi dinamik el bileği eksternal fiksatörü; kolay uygulanması, minimal cerrahi travma yaratması, erken dönemde rehabilitasyona izin vererek hastaların normal günlük aktivitelerine kısa sürede geri dönmelerini sağlaması ile birlikte başarılı anatomik ve fonksiyonel sonuçlara ulaşılması açılarından tercih edilebilir bir tedavi yöntemidir.
Objective: The aim of the present study was to present the results of patients with unstable distal radius fracture treated with closed reduction and percutaneous fixation followed by application of the Pennig dynamic wrist fixator to allow early wrist motion.
Methods: Twenty-five patients diagnosed with distal radius fracture and treated with closed reduction and percutaneous fixation followed by application of a dynamic wrist fixator were included in the study. There were 15 (60%) male and 10 (40%) female patients. The mean age of the patients was 47.32 (20–76) years. The mean period between initial trauma and operation was 8.52 (1–23) days. All patients were allowed active shoulder, elbow, and finger exercises immediately after surgery.
Results: Radiological evaluation was performed according to the criteria described by Sarmiento and modified by Lidström. Results were excellent in 12 (46.15%), good in 11 (42.30%), and fair in 3 (11.55%) patients. No patient had poor result. Functional scores were assessed according to the Gartland–Werley classification and modified by Sarmiento. Results were excellent in 14 (56%), good in 8 (32%), and moderate in 3 (12%) patients.
Conclusion: Use of the Pennig dynamic wrist fixator in the treatment of unstable distal radius fractures has advantages, such as ease of use, minimal surgical trauma, allowing early rehabilitation, and early return to daily activities as well as increased anatomical and functional results.

5.Contralateral Ear Findings in Chronic Otitis Media
Özlem Ünsal, Bilge Türk, Nurullah Seyhun, Suat Turgut
doi: 10.5350/SEMB.20171129090822  Pages 179 - 183
Amaç: Kronik otitis media (KOM) bulgular spektrumu gösteren ve her iki kulağı etkilebilen bir hastalıktır. KOM tespit edilen kulaklarda kontralateral kulak bulgularının değerlendirimesi hastalığın bu kulaktaki öncü belirtilerinin belirlenmesi, takip ve erken tedavi olasılığı tanıması açısından önemlidir. Bu çalışmada KOM nedeniyle opere edilen hastaların kontralateral kulak bulgularını (otoskopik ve odyolojik) araştırmayı amaçladık.
Gereç ve Yöntemler: 2014-2017 yılları arasında kliniğimzde KOM nedeniyle opere edilen hastaların dataları retrospektif olarak incelendi. Süpüratif, tedaviye yanıtsız, kolesteatomlu kötü kulaklar ve kuru, tedaviye yanıt veren otoreli, kolesteatomsuz kulaklar iki grupta toplandı. Her iki gruptaki kontralateral kulaklar perforasyon, retraksiyon, miringoskleroz ve atrofi açısından değerlendirildi ve gruplar karşılaştırıldı.
Bulgular: Her iki grupta, kontralateral kulakların yaklaşık yarısında patolojik otoskopik bulgulara rastlandı. Timpanik membran retraksiyonu, özellikle kötü kulak grubunda kuru kulak grubuna kıyasla anlamlı yüksekti (p<0.05). Hava ve kemik yolu eşikleri de benzer şekilde kötü kulak grubunda anlamlı olarak yüksekti (p<0.05).
Sonuç: KOM, aynı predispozan faktörlerden etkilenmeleri sebebiyle bilateral görülebilen bir hastalıktır. Bu nedenle KOM tespit edilen hastalarda kontralateral patolojik kulak bulgularının bilinmesi, takibi ve erken tedavisi, bu kulaklarda olası KOM gelişiminin önüne geçmede ya da süreci geciktirmede klinik öneme sahiptir.
Objectives: Chronic otitis media (COM) reveals a spectrum of otoscopic findings, and both ears may be affected to a different degree. The analysis of contralateral ear in patients with COM is important to detect the early signs of the disease. This may enable the follow-up and treatment of abnormalities in contralateral ear without delay. Therefore, in this study, we aimed to investigate the otoscopic and audiologic findings of contralateral ears of patients with COM.
Methods: The institutional data of patients who underwent surgical treatment between 2014 and 2017 due to COM were reviewed. Suppurative ears with cholesteatoma, polyps, and otorrhea refractory to medical treatment and ears with dry middle ear mucosa, with otorrhea responsive to medical treatment, and without cholesteatoma were divided into two groups (Group 1 and Group 2, respectively). All patients were examined with regard to the presence of perforation, retraction, myringosclerosis, atrophy, and audiological results before the groups were compared.
Results: Approximately 50% of contralateral ears of patients with COM showed abnormalities at an otoscopic examination in both groups. Tympanic membrane retraction in Group 1 was greater than in Group 2, and the difference was statistically significant (p<0.05). Both the mean air and bone conduction thresholds of the contralateral ears in Group 1 were also found to be elevated when compared with Group 2, and the differences were statistically significant (p<0.05).
Conclusion: COM may be seen bilaterally due to the same predisposing factors affecting the ears. Therefore, detection, follow-up, and early treatment of abnormalities of contralateral ear associated with otitis media have clinical importance in the prevention or delaying progression of these abnormalities to COM.

6.Does Residual Renal Function Have a Beneficial Effect on Patient and Technique Survival in Peritoneal Dialysis Patients?
Elbis Ahbap, Mustafa Sevinc
doi: 10.14744/SEMB.2018.59219  Pages 184 - 189
Amaç: Periton diyalizi (PD) başlangıcındaki rezidüel renal fonksiyon (RRF) hastaların sağkalımının öngörülmesini sağlayabilir. Çalışmanın amacı başlangıçtaki RRF’nin PD hasta ve teknik sağkalımına olan etkisinin incelenmesidir.
Metot: Toplam 202 PD hastasının verileri geriye dönük olarak başlangıçtaki idrar miktarlarına göre incelendi. Hastalar anürik (idrar miktarı <100ml/gün) ve anürik olmayan (idrar miktarı >100ml/gün) olmak üzere iki gruba ayrıldı.
Bulgular: PD başlangıcında 58 hasta (38 kadın, ort. yaş 42.8±14.9 yıl, ort. takip süresi 44.2±35 ay) anürik idi. Bunların 28’i daha önce hemodiyaliz tedavisi görmüştü.
Anürik olmayan hasta sayısı 144 (68 kadın, ort. yaş 43.7±14.5 yıl, ort. takip süresi 39.6±26.1 ay, ort. idrar miktarı 592±442 ml/gün) idi. Daha önce 23 hasta hemodiyaliz tedavisi almıştı. Ortalama 22.5±19.6 ay sonra 65 hasta anürik hale geldi.
Tedavinin başlangıcında, anürik hastalarda, anürik olmayanlara göre, sistolik ve diastolik kan basıncı daha düşük (p<0.001), CRP (p=0.004) ve ferritin (p<0.001) düzeyi daha yüksek idi. İki grup arasında yaş, takip süresi, diyabet varlığı, ultrafiltrasyon volümleri, albümin, hemoglobin, parathormon düzeyleri, kalsiyum fosfor çarpımı, Kt/V değerleri benzer idi(p>0.05).
Kaplan-Meier sağkalım eğrisine gore, anürik olmayan hastalarda 1 ve 3. yıllardaki sağkalım sırası ile %97 ve %86.6; anürik hastalarda ise sırası ile %94 ve %85.3 idi. Beş yılılk teknik sağkalım iki grup arasında benzer saptandı (p>0.05).
Hasta sağkalımı anürik olmayan hastalarda 1, 3, 5. yıllarda sırası ile %96.9, %89.6 ve %86.5 iken anürik hastalarda sırası ile 87.3%, 77.3% and 53.7% saptandı. Beş yıllık hasta sağkalımı iki grup arasında anlamlı olarak farklı bulundu (p<0.05).
Sonuç: Periton diyaliz başlangıcında rezidüel renal fonksiyonun varlığı hasta sağkalımına pozitif etkide bulunmaktadır. Teknik sağkalım ve peritonit oranları anürik ve anürik olmayan hastalar arazında benzerlik göstermektedir.
Objectives: Residual renal function (RRF) at the initiation of peritoneal dialysis (PD) therapy can be a predictor of survival in stable PD patients. The aim of the present study was to investigate PD patients regarding the effect of baseline RRF on patient and technique survival.
Methods: Urine output at the beginning of PD therapy was evaluated retrospectively in 202 PD patients. Patients were divided into two groups: patients with anuria (urine output ≤100 ml/day) and patients without anuria (urine output >100 ml/day).
Results: The number of patients with anuria was 58 in which 38 patients were females. The mean age of the patients was 42.8±14.9 years. The mean follow-up period was 44.2±35 months. Twelve percent of patients with anuria had history of hemodialysis (HD).
One hundred forty-four had no anuria (68 females, mean age 43.7±14.5 years, mean follow-up period 39.6 ± 26.1 months, mean urine volume 592±442 ml). Twenty-three patients had received HD therapy before. Sixty-five had anuria in the following 22.5±19.6 months.
At the beginning of therapy, systolic and diastolic blood pressures were lower in patients with oliguria than in patients without oliguria (p<0.001), but C-reactive protein (p=0.004) and ferritin (p<0.001) levels were higher. There was no difference between two groups regarding the other parameters (age, follow-up periods, presence of diabetes, ultrafiltration volumes, albumin, hemoglobin, calcium phosphorus product, parathormone, and Kt/V levels) (p>0.05).
The peritonitis rate was one episode per 28.2 versus 30 patient-months for the anuric and non-anuric groups, respectively (p>0.05).
For Kaplan–Meier survival analysis, the mean technique survival rates at 1 and 3 years were 97% and 86.6% in patients without anuria and 94% and 85.3% in patients with anuria, respectively. The 5-year technique survival rates according to residual volume states were not statistically significant with log-rank test (p>0.05).
The 1-, 3-, and 5-year survival rates were 96.9%, 89.6%, and 86.5% in patients without anuria, respectively, whereas they were 87.3%, 77.3%, and 53.7% in patients with anuria, respectively. The 5-year survival rates according to residual volume states were statistically significant (p<0.05).
Conclusion: RRF at the beginning of PD has an important and positive impact on patient survival in PD patients. Peritonitis rates and technique survival were not different for patients with anuria and without anuria.

7.The Impact of Red Cell Distribution Width on the Development of Contrast-Induced Nephropathy in Patients with Stable Coronary Artery Disease who Underwent Coronary Angiography
Serhat Sığırcı, Irfan Şahin, Kudret Keskin, Süleyman Sezai Yıldız, Gökhan Çetinkal, Gökhan Aksan, Şükrü Çetin, Ertuğrul Okuyan
doi: 10.14744/SEMB.2018.75537  Pages 190 - 195
Amaç: Kontrast madde nefropatisi (KMN), hastanede gelişen böbrek yetersizliklerin % 10’nunu oluşturur. KMN gelişimindeki hücresel patofizyolojik mekanizma net olmayıp çok faktörlü görünmektedir. KMN gelişiminde kırmızı hücre dağılım genişliğinin (RDW) rolü stabil koroner arter hastalarında yeterince araştırılmamıştır. Bu çalışmayla stabil koroner arter hastalarında koroner anjiogarfi sonrasında KMN gelişiminde RDW rolünü sorgulamayı amaçladık.
Gereç ve Yöntem: Ekim 2009-Ekim 2011 tarihleri arasında stabil koroner arter hastalığı olan ve non-invazif tanı testleri ile iskemi saptanan, koroner anjiografi ve girişim uygulanan toplam 211 hasta ileriye dönük olarak incelendi. Hastalar KMN gelişimine göre iki gruba ayrıldı ve iki grup klinik, demografik ve RDW’yi de içeren laboratuar bulgularına göre istatistiksel olarak karşılaştırıldı.
Bulgular: Hastaların %18.8‘inde KMN gelişimi izlendi. Ortalama yaş 64±10.5, %59’u erkekti. İleri yaş, erkek cinsiyet, hipertansiyon, high density lipoprotein (HDL) düzeyi, serum albumin ve total protein miktarları KMN gelişimi ile ilişkili bulundu. Ortalama kırmızı hücre dağılım genişliği %13,7±1.4 olup, ortalama kreatinin değeri 1.0±0.2 mg/dL olarak gözlenmiştir. KMN varlığı ile kırmızı hücre dağılım genişliği arasında ilişki gözlenmemiş olup (sırasıyla 13.8±1.5, 13.6±1.0, p>0.05), çok değişkenli regresyon analizi de bu durumu desteklemiştir. (Odd oranı (OR): 0.92, % 95 CI: 0.62 – 1.34; p: 0.67) Çok değişkenli regresyon analizinde yalnızca cinsiyet ve hipertansiyon varlığı KMN gelişiminde bağımsız öngördürücü olarak belirlenmiştir. (sırasıyla, OR: 5.74, %95 CI: 1.96-16.79 p<0.01 ve OR: 5.34, %95 CI: 1.22-23.3 p: 0.02 )
Sonuç: Bulgularımız, stabil koronoer arter hastalarında kırmızı hücre dağılım genişliğinin KMN gelişiminde öngördürücü olarak kullanımının kısıtlı yeri olduğunu göstermiştir.
Objectives: Contrast-induced nephropathy (CIN) accounts for 10% of all causes of hospital-acquired renal failure. The pathophysiological cellular mechanism of the CIN development remains unclear and seems to be multifactorial. Herein, we aimed to determine the role of red cell distribution width (RDW) in the development of CIN after elective percutaneous intervention in patients with stable coronary artery disease, which in our opinion has not been researched enough.
Methods: Between October 2009 and October 2011, a total of 211 patients with stable coronary artery disease who had undergone a coronary intervention procedure were evaluated prospectively. The patients were classified according to the development of CIN, and both groups were compared statistically according to clinical, laboratory, and demographic features, including the serum RDW level.
Results: In 18.8% of the patients, CIN was observed. The mean age was 64±10.5, and 59% of the study group was male. An advanced age, male gender, hypertension, the serum total protein level, high density lipoprotein, and albumin levels were correlated with the development of CIN. The mean RDW level was 13.7±1.4%, and the mean creatinine level was 1.0±0.2 mg/dL. There was not any correlation between RDW and the presence of CIN (CIN[−]=13.8±1.5, CIN[+]=13.6±1.0, p>0.05), and also a multivariate regression analysis proved this non-correlation (OR: 0.92, 95% confidence interval [CI]=0.62–1.34; p: 0.67 ). There was only a correlation between hypertension and male gender with CIN that was proved with a multivariate regression analysis (OR=5.74, 95% CI: 1.96–16.79, p<0.01 vs OR=5.34, 95% CI=1.22–23.3, p: 0.02, respectively).
Conclusion: Our outcomes indicate that the RDW has a limited use as a CIN predictor in patients with stable coronary artery disease.

8.Evaluation of Toll-Like Receptor Expression with Clinicopathologic Variables in Endometrium Cancer
Berat Berrin Gençoğlu Bakbak, Tolgay Tuyan Ilhan, Aybike Pekin, Özlem Seçilmiş Kerimoğlu, Setenay Arzu Yılmaz, Ayşegül Kebapçılar, Nasuh Utku Doğan, Pınar Karabağlı, Çetin Çelik
doi: 10.14744/SEMB.2018.63325  Pages 196 - 200
Amaç: Toll-like reseptör (TLR) ile anormal hücre çoğalması ve kanser oluşumu arasında bir ilişki gösterilmiştir. Bu çalışmamızda TLR 2, 4, 5 ve 6’nın sağlıklı ve kanserli endometrium dokusundaki ekspresyonunu ve karsinogenezis ile olan ilişkisini incelemeyi amaçladık.
Gereç ve Yöntemler: Bu çalışmaya endometrium kanseri (grup 1, 66 hasta,) ve endometrial hiperplazi (grup 2, 14 hasta) nedeniyle histerektomi uygulanan ve endometrium kanseri dışı nedenler ile histerektomi yapılan hastalar (Grup 3, 20 hasta) dahil edildi. Birinci gruptaki olgular; histolojik özellikler, kanser evresi, grade ve tümör çapı açısından sınıflandırıldı. Tüm endometrium doku örneklerinde TLR 2, 4, 5 ve 6 ekspresyonu değerlendirildi ve bu belirteçlerin klinikopatolojik bulgular ile arasındaki ilişki araştırıldı. İmmünohistokimyasal boyanma için nükleer ve/veya sitoplazmik boyanma pozitif reaksiyon olarak kabul edildi. Gruplar arası değerlendirmede ki-kare testi kullanıldı. p < 0.05 anlamlı kabul edildi.
Bulgular: Grup 1’deki hastaların yaş ortalaması 59.8 yıl (33-83 yaş), Grup 2 hastaların yaş ortalaması 48.3 yıl (40-59 yaş) ve 3’deki hastaların yaş ortalaması 53.4 yıl (38-84 yaş) idi. Tüm TLR türleri, endometrium kanserinden alınan doku örneklerinde yüksek oranda açığa çıkmaktadır (Grup 1 ve 2). Ancak TLR2, grup 1’de % 87.9 açığa çıkarken, grup 2’de %100, grup 3’te % 35 oranında açığa çıkmaktadır. Bu üç grubun TLR 2 ekspresyonu açısından istatiksel karşılaştırmalarında anlamlı bir fark saptandı (p=0.000). Endometrium kanseri ve endometrial hiperplazili olgularda TLR6 ekspresyonu, kontrol grubuna göre istatiksel olarak yüksek saptandı (sırasıyla, p=0.000, p=0.000). Ayrıca ileri evre endometrium kanserinde TLR6 ekspresyonunun anlamlı olarak fazla olduğu görüldü (p=0.033). Hem TLR2 ve hem de TLR6 ile histolojik grade ve tümör boyutu arasında anlamlı bir ilişki saptanmadı.
Sonuç: TLR 2 ve TLR 6 reseptörleri, endometrium kanserli ve hiperplazili olgularda kontrol grubuna göre anlamlı düzeyde yüksek oranda açığa çıkmaktadır. Ayrıca TLR 6 ekspresyonun mevcudiyeti, kanserin ileri evresini işaret edebilir.
Objectives: Clinical evidence supports the association of toll-like receptor (TLR) with abnormal cell proliferation and cancer. In this study, we investigated the expression of TLRs 2, 4, 5, and 6 in healthy endometrium and endometrium cancer to study the relationship of these receptors’ expression with carcinogenesis.
Methods: Patients who had undergone a hysterectomy owing to endometrium cancer (group 1, 66 patients), endometrial hyperplasia (group 2, 14 patients), and other reasons besides endometrium cancer (group 3, 20 patients as controls) were included. The cases in the first group were classified by histological type of the cancer, stage, grade, and size of the tumor. In all the cases, expressions of TLRs 2, 4, 5, and 6 were assessed, and the relationship of these receptors with clinicopathologic signs was analyzed. For immunohistochemical staining, nuclear and cytoplasmic stainings were considered positive. A Chi-squared test was used to assess the correlation of the groups. A p<0.05 was considered significant.
Results: The mean ages of patients in groups 1, 2, and 3 were 59.8 (range 33–83), 48.3 (range 40–59), and 53.4 (range 38–84) years, respectively. All types of TLRs were highly expressed in both types of endometrium cancer (groups 1 and 2). TLR expression was observed with a ratio of 87.9% in group 1, 100% in group 2, and 35% in group 3. There was a statistically significant association of TLR 2 among the three groups (p=0.000). TLR 6 expression in both group 1 and group 2 was significantly higher than that in the control group (p=0.000, p=0.000, respectively). In addition, TLR 6 was higher in cases with late-stage cancer (p=0.033). Regarding tumor grade and the size of the tumor, no association was found between TLR 2 and TLR 6.
Conclusion: TLR 2 and TLR 6 were significantly more expressed in cases with endometrium cancer and endometrial hyperplasia. In addition, the presence of TLR 6 may indicate the presence of late-stage endometrial cancer.

9.Can TG/HDL Ratio be an Accurate Predictor in the Determination of the Risk of Cerebrovascular Events in Youngsters?
Eda Kılıç Çoban
doi: 10.14744/SEMB.2018.83097  Pages 201 - 205
AMAÇ; İnmede değiştirilebilir risk faktörlerinin düzeltilmesi ile inmenin engellenmesi kanıtlanmıştır. Hiperlipidemi. bu risk faktörlerinden biridir. Son çalışmalar göstermektedir ki; geleneksel olmayan lipidler olarak adlandırılan total kolesterol (TK)/ Yüksek molekül ağırlıklı kolesterol (HDL), Düşük molekül ağırlıklı kolesterol (LDL)/HDL, Trigliserid (TG)/HDL oranları vasküler riskin belirlenmesinde daha iyi öngörücüler olabilmektedir Çalışmamız; genç iskemik inme hastalarında aynı yaş grubunda sağlıklı populasyonla ve yaşlı iskemik inme hastalarıyla kıyaslandığında geleneksel ve geleneksel olmayan kolesterol ölçümleri arasında ilişki olup olmadığını ortaya koymak amacıyla planlanmıştır.
GEREÇ VE YÖNTEM; Çalışmamıza 16-45 yaş arası 112 hasta, kontrol grubu olarak aynı yaş grubunda inme öyküsü olmayan 113 hasta ve 45 yaş üstü 110 hasta dahil edildi. Hastaların serum lipid düzeylerine ( total kolesterol, LDL, HDL, TG) standart laboratuar yöntemi ile bakıldı, TK/HDL, LDL/HDL, TG/HDL oranları hesaplandı. Çalışmada SPSS 16,0 versiyonu, istatistiki yöntem olarak ki-kare ve student t-test kullanıldı. p≤ 0.05 istatistiksel olarak anlamlı kabul edildi.
BULGULAR; 112 genç inme hastasının 63’ü erkek 49’u kadın, yaş ortalaması 38,46±5,96 idi. Hastaların ortalama kolesterol düzeyleri; LDL 121,42±36,56, HDL 38,84±12,47, TG 186,10±176,14, TK 194,76±45,35, LDL/HDL oranı 3,39±1,46, TG/HDL oranı 5,44±6,36, TK/HDL oranı 5,40±6,36 olarak hesaplandı. Genç inme hastalarında tüm kolesterol değerleri inme geçirmemiş genç populasyona göre anlamlı olarak yüksek bulundu.
45 yaş üstü 110 iskemik inme hastasının 63’ü erkek, 47’si kadın olup yaş ortalaması 69,53±12,34 idi. Hastaların ortalama kolesterol düzeyleri; LDL 125,18±35,97, HDL 41,47±14,16, TG 117,53±59,03, TK 190,16±42,96, LDL/HDL 3,32±1,55, TG/HDL 3,46±3,43, TK/HDL 5,01±2,08 olarak hesaplandı.
Genç ve yaşlı inme hastaları kolesterol değerleri açısından kıyaslandığında, genç inme hastalarında TG ve TG/HDL düzeyleri yaşlı hastalara göre anlamlı olarak yüksek bulundu.
SONUÇ; Genç iskemik inme hastalarında altta yatan etyolojiye bakılmaksızın genç sağlıklı popülasyona göre tüm kolesterol değerlerinde anlamlı yükseklik mevcuttur. Özellikle TG ve TG/HDL oranı aynı yaş grubundaki sağlıklı populasyona ve yaşlı iskemik inme hastalarına kıyasla daha yüksektir. Yapılan çalışmalar TG/HDL oran yüksekliğinin tekrarlayan inme açısından prognostik değer taşıdığını gösterdiğinden, genç inme hastalarında saptanan etyolojiden bağımsız olarak TG/HDL oranı belirlenmelidir.
Objectives: There is good evidence that shows that modification of modifiable risk factor will reduce the risk of stroke. Hyperlipidemia is one of these risk factors. Studies have shown that nontraditional serum lipid variables may be better predictors of vascular risk rather than others.
The objective of the present study was to assess the relationships of traditional and nontraditional serum lipid measurements between young and elder patients with stroke and healthy young adults.
Methods: One hundred twelve young patients with ischemic stroke, 113 healthy adults, and 110 patients with ischemic stroke aged >45 years were included in the study. Laboratory tests for total cholesterol (TC), its fractions, and triglycerides (TGs) were performed using standard techniques, and we computed four nontraditional lipid variables.
Statistical analyses were performed using chi-square test, Student's t-test, and SPSS version 16.0 software. A p value of <0.05 was considered statistically significant.
Results: The mean age of 112 young patients with stroke was 38.46±5.96 years. There were 63 male and 49 female patients. Measurements of lipid parameters were as follows: low-density lipoprotein (LDL) 121.42±36.56 mg/dl, high-density lipoprotein (HDL) 38.84±12.47 mg/dl, TG 186.10±176.14 mg/dl, TC 194.76±45.35 mg/dl, LDL/HDL 3.39±1.46, TG/HDL 5.44±6.36, and TC/HDL 5.40±6.36. All lipid measurements were significantly higher in young patients with stroke than in healthy adults.
The mean age of 110 patients with stroke aged >45 years was 69.53±12.34 years. There were 63 male and 47 female patients. Measurements of lipid parameters were as follows: LDL 125.18±35.97 mg/dl, HDL 41.47±14.16 mg/dl, TG 117.53±59.03 mg/dl, TC 190.16±42.96 mg/dl, LDL/HDL 3.32±1.55, TG/HDL 3.46±3.43, and TC/HDL 5.01±2.08. TG level and TG/HDL ratio were significantly higher in young patients with stroke than in older cases.
Conclusion: All lipid measurements were significantly higher in young patients with ischemic stroke than in young healthy adults. TG level and TG/HDL ratio were significantly higher in male than in female patients. In addition, TG level and TG/HDL ratio were significantly higher in young patients with stroke than in older cases. As the TG/HDL ratio has proven to be a highly significant independent prognostic predictor of stroke, it should be calculated in young patients with ischemic stroke.

10.Discriminating Performance of Early Uterine and Cervical Artery Pulsatility and Resistivity In Pre-Invasive Cervical Lesions
Ozan Doğan, Çiğdem Pulatoğlu, Alper Başbuğ, Aşkı Ellibeş Kaya, Murat Yassa
doi: 10.14744/SEMB.2018.07769  Pages 206 - 211
Objective: It was aimed to investigate the diagnostic effectiveness of the uterine and cervical vascularity alone or by combining with Human Papillomavirus (HPV) DNA testing and with cytology.
Materials and Methods: Data were prospectively collected from 129 patients in an outpatient clinic of a secondary setting. Routine liquid-based cervical cytology and HPV-DNA testing were obtained. An abnormal result of any of these high‑risk types was viewed as positive. Pulsatiliy (PI) and resistance (RI) indexes of uterine (UA) and cervical (CA) arteries were assessed by Doppler sonography. Pathological diagnosis was taken as the golden standard for assessment. Diagnostic efficiency of alone and joint screening of the three indexes for discriminating CIN-I or above from below was assessed.
Results: UA-RI and also CA-RI was significantly lower in HPV(+) group when compared to controls (p=0.02, p=0.03, respectively). In subsequent sub-analysis among patients with positive HPV-DNA, UA-PI was significantly higher in HPV-16(+) group when compared to HPV-18(+) (p=0.04). Hr-HPV testing had the highest sensitivity compared to Doppler and cytology (76.5%, 64.7% and 58.5%, respectively). Combining CA-RI with cytology or HR-HPV significantly reduced the sensitivity (23.5% and 29.4, respectively) but improved the specificity from 54.4% to 69.8% and 40.9% to 70.7%, respectively. Combining the UA-PI with Hr-HPV slightly increased the positive predictivity when compared to testing Hr-HPV alone (36.1% vs. 33.3%).
Conclusions: Potential of the Doppler indices of uterine and cervical arteries was doubtful in discriminating CIN-I or above lesions in early period. Besides, RI of uterine and cervical arteries differed regarding to the presence of HPV infection while cervical artery RI differed in also high-risk HPV cases.
Objectives: The aim of the present study was to investigate the diagnostic effectiveness of uterine and cervical vascularity alone or in combination with human papillomavirus (HPV) DNA testing and with cytology.
Methods: Data were prospectively collected from 129 patients in an outpatient clinic of a secondary setting. Routine liquid-based cervical cytology and HPV-DNA testing were obtained. An abnormal result of any of these high-risk types was viewed as positive. Pulsatility (PI) and resistance (RI) indices of uterine (UA) and cervical (CA) arteries were assessed by Doppler sonography. Pathological diagnosis was considered as the gold standard for assessment. Diagnostic efficiency of alone and joint screening of the three indices for discriminating cervical intraepithelial neoplasia (CIN-I) or above from below was assessed.
Results: UA-RI and CA-RI were significantly lower in the HPV (+) group than in the controls (p=0.02 and p=0.03, respectively). In subsequent sub-analysis among patients with positive HPV-DNA, UA-PI was significantly higher in the HPV-16 (+) group than in the HPV-18 (+) group (p=0.04). High-risk HPV (Hr-HPV) testing had the highest sensitivity compared with Doppler and cytology (76.5%, 64.7%, and 58.5%, respectively). Combining CA-RI with cytology or Hr-HPV significantly reduced the sensitivity (23.5% and 29.4, respectively) but improved the specificity from 54.4% to 69.8% and 40.9% to 70.7%, respectively. Combining UA-PI with Hr-HPV slightly increased the positive predictivity when compared with testing Hr-HPV alone (36.1% vs. 33.3%).
Conclusion: The potential of the Doppler indices of UA and CA was doubtful in discriminating CIN-I or above lesions in the early period. In addition, RI of UA and CA differed with regard to the presence of HPV infection, whereas CA-RI differed in high-risk HPV cases.

11.Examination of the Effects of Celecoxib on Postmastectomy Seroma and Wound Healing
Evren Besler, Ömer Harmancıoğlu
doi: 10.14744/SEMB.2018.66933  Pages 212 - 219
Amaç:
Seroma meme kanser cerrahisi sonrasında ortaya çıkan ölü boşlukta seröz sıvı birikimidir. Seromanın patofizyolojisi net olarak aydınlatılamamıştır. Seroma gelişimi hastanede kalış süresinin uzaması, maliyet artışı, fleplerde iskemi, sıvı birikimine bağlı infeksiyon ve adjuvan tedavide gecikmeye yol açmaktadır. Seroma günümüzde halen güncel bir sorundur ve bu sorun için en çok uygulanan yöntem ameliyat sonrası beş - yedi gün süre ile drenaj ve tekrarlanan aspirasyonlardan ibarettir.
Gereç ve Yöntemler:
Bu çalışmada antiinflamatuar, antianjiyogenik ve antioksidan etkinliği gösterilmiş olan celecoxib’in dişi Wistar ratlar üzerinde uygulanan mastektomi modelinde seroma’ya etkinliği incelendi. Kontrol grubunda 10, celecoxib grubunda 10 olmak üzere toplam 20 rat incelemeye alındı. Mastektomi sonrasında celecoxib grubuna intraperitoneal 0,25 cc/250gr (20 mg/kg/gün) celecoxib beş gün süre ile, kontrol grubuna ise aynı volümde serum fizyolojik beş gün süre ile verildi. Ratlar ameliyat sonrasında 10 gün izlendi. Bu süreç içinde ratların canlılıkları, kol hareketleri, yara yeri iyileşme durumları, yara infeksiyonu, flep nekrozu ve seroma oluşumları kaydedildi. Bu süre sonunda seromalar aspire edildi ve doku örnekleri alınarak ratlar sakrifiye edildi. Doku örneklerinde fibrin, kanama, ödem, damarlanma, konjesyon, polimorf nüveli lökositler, fibröz doku artışı, fibroblast, lenfosit ve makrofajlar değerlendirildi. Seroma sıvılarında ise inflamasyon parametrelerinden akut faz reaktanı olan interlökin 1 beta ve damar proliferasyonu ve anjiyogenezin temel parametresi olan vasküler endotelyal büyüme faktörü incelemesi yapıldı.
Bulgular:
Deneyler sonunda biyokimyasal incelemede celecoxib uygulanan grupta seroma hacimlerinin belirgin olarak azaldığı (p≤0,001), seroma sıvısında interlökin 1 beta düzeyinin belirgin olarak azaldığı (p=0,014), histopatolojik incelemede ise celecoxib grubunda konjesyonun arttığı (p=0,044) tesbit edildi.

Sonuçlar:
Bu çalışmanın sonucunda, celecoxib’in mastektomi sonrası seroma hacimlerini belirgin olarak azalttığı, bir akut faz reaktanı olan interlökin 1 betayı baskıladığı; bu etkisinin antiinflamatuar etkisi ile olduğu sonucuna varıldı. Celecoxib’in etkilerinin farklı doz uygulamalarıyla ve daha geniş sayıda denek üzerinde araştırılması gerektiği düşünüldü.
Objectives: To examine the effect of celecoxib on wound healing and development of seroma after mastectomy.
Seroma is an accumulation of serous fluid in dead space emerging after breast cancer surgery. The pathophysiology of seroma has not been clearly elucidated. Development of seroma leads to prolongation of hospital stay, increase in costs, ischemia of the flaps, infections due to fluid accumulation, and delayed adjuvant treatment.
Seroma is still a current problem, and the most common treatment method for this problem is drainage and repeated aspirations for 5–7 days after surgery.
Methods: The effect of celecoxib whose anti-inflammatory, antiangiogenic, and antioxidant effectiveness has been demonstrated in a mastectomy model applied on female Wistar rats has been investigated in the present study. A total of 20 rats including 10 rats in the control and 10 in the celecoxib group were studied.
Intraperitoneal 0.25 cc/250 g (20 mg/kg/day) celecoxib was administered to the celecoxib group for 5 days after mastectomy, and the same volume of physiological saline solution was given to the control group for 5 days. Rats were followed up for 10 days after surgery. During this process, vitality of the rats, movements of the extremities, wound healing conditions, wound infections, flap necrosis, and occurrence of seroma were recorded. At the end of this period, seromas were aspirated, tissue samples were retrieved, and the rats were sacrificed. Fibrin, hemorrhage, edema, vascularization, congestion, polymorphonuclear leukocytes, and increase in fibrotic tissue fibroblasts, lymphocytes, and macrophages were evaluated in tissue samples.
In seroma fluids, interleukin-1 beta (IL-1β), an acute phase reactant, and vascular endothelial growth factor, a vital parameter of vascular proliferation and angiogenesis, were examined.
Results: At the end of the experiments, the seroma volume decreased significantly in the celecoxib group (p=0.804; 0.001), the IL-1β level decreased significantly as detected in the biochemical examination (p=0.014), and in the histopathological examination, an increase in congestion in the celecoxib group was determined.
Conclusion: In conclusion, celecoxib markedly decreased interleukin and the volume of seroma after mastectomy; suppressed the level of an acute phase reactant, IL-1β; and demonstrated this effect through its anti-inflammatory activity. We believe that the effects of celecoxib should be investigated using different dose applications and larger number of subjects.

CASE REPORT
12.Acute Hemorrhagic Edema of Infancy: A Two-Case Report
Lida Bülbül, Nevin Hatipoğlu, Neslihan Özkul Sağlam, Canan Hasbal Akkuş, Sami Hatipoğlu
doi: 10.5350/SEMB.20170419063548  Pages 220 - 223
Akut infantil hemorajik ödem, süt çocuklarında, deride sınırlı, küçük damarları tutan lökositoklastik vaskülit olup, genellikle iyi seyirlidir, sistemik tutulum gelişmez ve sıklıkla tedavi gerekmemektedir. Hastalık ateş, ödem ve alt ekstremitelerde ciltte geniş purpurik raş döküntüsü ile karekterizedir. Tipik olarak yakın dönemde solunum yolu enfeksiyonu öyküsü olan 6-24 aylık bebeklerde görülür. Bu yazıda, aynı zamanda alt solunum yolu enfeksiyonu geçirmekte olan, 57 ve 11 aylık, iki akut infantil hemorajik ödem olgusu sunulmuştur.
Acute hemorrhagic edema of infancy is a leukocytoclastic small vessel vasculitis of young children that is limited to the skin, generally has a benign course without systemic involvement, and does not require treatment. It is characterized by fever, edema of the lower extremities, and wide purpuric rash of the skin. It typically affects infants aged 6–24 months with a history of recent respiratory system illness. An 11-month-old and a 57-month-old cases with acute hemorrhagic edema of infancy who concurrently have a lower respiratory system infection are presented in this case report.

13.A Rare Tumor in Childhood Desmoplastic Infantile Astrocytoma: Two Case Reports
Canan Tanık, Elif Gökçe Devecioğlu, Seyhan Hasçiçek, Songül Meltem Can, Ahmet Mesrur Halefoğlu, Fevziye Kabukçuoğlu
doi: 10.14744/SEMB.2018.29292  Pages 224 - 228
Amaç: Desmoplastik Infantil Astrositomlar(DIA), sıklıkla hayatın ilk 24 ayında görülen, sık rastlanılmayan supratentoriyal tümörlerdir. Agresif görünümlerine rağmen iyi prognozludurlar. Total veya totale yakın rezeksiyon genellikle yeterli tedavidir. Desmoplastik Infantil Ganglioglioma (DIG) ve DIA benzer klinik ve morfolojik bulgular gösteren WHO Grade 1 tümörlerdir. DIA’nın nöral komponent içermemesi DIG ile ayırıcı tanısında tek kriterdir. İnfantil olmayan vakalar bildirilmiş olmasına rağmen, genellikle erken çocukluk döneminde görülürler. Bu olguların stromaları yoğun fibroblastik olup immunohistokimyasal olarak GFAP ve CD34 pozitiflikleri gösterirler.
Olgu: Olgu1; 1 yaşındaki hastada sağ tarafta parsiyel motor nöbetle presente olan, nadir görülen desmoplastik infantil astrositom olgusu sunuldu. Olgu 2; 1 yaşındaki hastada fokal başlangıçlı generalize motor nöbetle ortaya çıkan DIA olgusu sunuldu.
Sonuç: Bu olgular radyolojik ve histolojik özelliklerine rağmen iyi gidişli benign seyirli tümörlerdir. Birinci olgumuzun 3 yıllık takiplerinde nüks izlenmedi.
Desmoplastic infantile astrocytomas (DIAs), are rare supratentorial tumors, usually observed in the first 24 months of life. Despite their aggressive appearance, they tend to follow a favorable clinical course. Total or near total resection of tumor is usually the treatment option. Desmoplastic Infantile Ganglioglioma (DIG) and DIA are WHO grade I tumors that have similar clinical and morphological findings. The only criterion in differential diagnosis is the neural component of DIG. These tumors both have dense fibroblastic stroma and positive staining with glial fibrillar acidic protein (GFAP) and CD34.
A rare case of desmoplastic infantile astrocytoma presenting with right side partial seizures presented in a 1-year-old child.
A rare case of desmoplastic infantile astrocytoma presenting with focal onset generalized seizures presented in a 1-year-old child.
Despite their radiological and histological properties, these tumors have a benign course. After 3-year follow-up for the first case and 1-year follow-up for the second case, there was no recurrence.

14.Extranasopharyngeal Angiofibroma Localized in the Nasal Dorsum: A Rare Location for This Tumor
Bilge Türk, Özlem Ünsal, Meltem Akpınar, Şermin Tülay Başak, Berna Uslu Coşkun
doi: 10.5350/SEMB.20170508042536  Pages 229 - 231
Amaç: Nadir görülmesine rağmen burun kitlelerinin ayırıcı tanısında ekstranazofarengeal anjiofibrom tanısı da akılda tutulmalıdır. Nazal tip ve lateral nazal bölgede yerleşimli nadir görülen bir ekstranazofarengeal anjiofibrom olgusu sunduk.
Olgu: Nazal tip sol tarafında kitlesi olan 43 yaşında erkek hasta sunulmuştur. Burun tıkanıklığı ve burun ucunda şişlik şikayeti olan hastanın kitlesi cerrahi olarak eksize edildi. Histopatoloiik inceleme sonucu ekstranazofarengeal anjiofibrom olarak raporlandı. Olgu hastalıksız olarak takip edilmektedir.
Sonuç: Ekstranazofarengeal anjiofibromlar (ENA) nadirdirler ve klinik ve radyolojik özellikler açılardan nazofarengeal anjiofibromlardan farklıdırlar. Dolayısıyla nadir görülmesine rağmen tek taraflı nazal kitlelerde ve dirençli epistaksis vakalarında hastanın yaşı ve cinsiyetinden bağımsız olarak ayırıcı tanıda akılda tutulmalıdır.
Although extranasopharyngeal angiofibroma (ENA) is a rare condition, its diagnosis should be considered during differential diagnosis of nasal masses. We report a rare case of ENA originating from the left lateral side of nasal tip.
A 43-year-old man with an ENA mass located on the left lateral side of the nasal tip presented to our hospital. The nasal mass caused nasal obstruction and swelling at the nasal tip and was surgically removed. Histopathological examination revealed ENA. The patient is being followed up and remains free of disease.
ENAs are rare and differ from nasopharyngeal angiofibromas regarding clinical and radiological features. Although it is rare, the diagnosis should be considered during differential diagnosis of a patient with one sided nasal mass and/or with refractory epistaxis, regardless of the patient’s age or sex.

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