ISSN : 1302-7123 | E-ISSN : 1308-5123
The Medical Bulletin of Sisli Etfal Hospital - SETB: 54 (2)
Volume: 54  Issue: 2 - 2020
REVIEW ARTICLE
1.Endocrine Surgery during the COVID-19 Pandemic: Recommendations from the Turkish Association of Endocrine Surgery
Nurcihan Aygun, Yalin Iscan, Murat Ozdemir, Selen Soylu, Oguz Ugur Aydin, Ismail Cem Sormaz, Ahmet Cem Dural, Nuri Alper Sahbaz, Serkan Teksoz, Ozer Makay, Ali Ugur Emre, Mehmet Haciyanli, Recep Gokhan Icoz, Yasemin Giles, Adnan Isgor, Mehmet Uludag, Fatih Tunca
PMID: 32617048  PMCID: PMC7326680  doi: 10.14744/SEMB.2020.65902  Pages 117 - 131
The 2019 novel coronavirus disease (COVID-19) was initially seen in Wuhan, China, in December 2019. World Health Organization classified COVID-19 as a pandemic after its rapid spread worldwide in a few months. With the pandemic, all elective surgeries and non-emergency procedures have been postponed in our country, as in others. Most of the endocrine operations can be postponed for a certain period. However, it must be kept in mind that these patients also need surgical treatment, and the delay time should not cause a negative effect on the surgical outcome or disease process. It has recently been suggested that elective surgical interventions can be described as medically necessary, time-sensitive (MeNTS) procedures.
Some guidelines have been published on proper and safe surgery for both the healthcare providers and the patients after the immediate onset of the COVID-19 pandemic. We should know that these guidelines and recommendations are not meant to constitute a position statement, the standard of care, or evidence-based/best practice. However, these are mostly the opinions of a selected group of surgeons. Generally, only life-threatening emergency operations should be performed in the stage where the epidemic exceeds the capacity of the hospitals (first stage), cancer and transplantation surgery should be initiated when the outbreak begins to be controlled (second stage), and surgery for elective cases should be performed in a controlled manner with suppression of the outbreak (third stage).
In this rapidly developing pandemic period, the plans and recommendations to be made on this subject are based on expert opinions by considering factors, such as the course and biology of the disease, rather than being evidence-based. In the recent reports of many endocrine surgery associations and in various reviews, it has been stated that most of the cases can be postponed to the third stage of the epidemic.
We aimed to evaluate the risk reduction strategies and recommendations that can help plan the surgery, prepare for surgery, protect both patients and healthcare workers during the operation and care for the patients in the postoperative period in endocrine surgery. (SETB-2020-05-084)
The 2019 novel coronavirus disease (COVID-19) was initially seen in Wuhan, China, in December 2019. World Health Organization classified COVID-19 as a pandemic after its rapid spread worldwide in a few months. With the pandemic, all elective surgeries and non-emergency procedures have been postponed in our country, as in others. Most of the endocrine operations can be postponed for a certain period. However, it must be kept in mind that these patients also need surgical treatment, and the delay time should not cause a negative effect on the surgical outcome or disease process. It has recently been suggested that elective surgical interventions can be described as medically necessary, time-sensitive (MeNTS) procedures.
Some guidelines have been published on proper and safe surgery for both the healthcare providers and the patients after the immediate onset of the COVID-19 pandemic. We should know that these guidelines and recommendations are not meant to constitute a position statement, the standard of care, or evidence-based/best practice. However, these are mostly the opinions of a selected group of surgeons. Generally, only life-threatening emergency operations should be performed in the stage where the epidemic exceeds the capacity of the hospitals (first stage), cancer and transplantation surgery should be initiated when the outbreak begins to be controlled (second stage), and surgery for elective cases should be performed in a controlled manner with suppression of the outbreak (third stage).
In this rapidly developing pandemic period, the plans and recommendations to be made on this subject are based on expert opinions by considering factors, such as the course and biology of the disease, rather than being evidence-based. In the recent reports of many endocrine surgery associations and in various reviews, it has been stated that most of the cases can be postponed to the third stage of the epidemic.
We aimed to evaluate the risk reduction strategies and recommendations that can help plan the surgery, prepare for surgery, protect both patients and healthcare workers during the operation and care for the patients in the postoperative period in endocrine surgery.

2.Management of Breast Cancer during the COVID-19 Pandemic
Bulent Citgez, Banu Yigit, Emir Capkinoglu, Gurkan Yetkin
PMID: 32617049  PMCID: PMC7326681  doi: 10.14744/SEMB.2020.23326  Pages 132 - 135
Yeni koronavirüs hastalığına (COVID-19) orijinal SARS virüsüne benzeyen SARS-CoV-2 virüsü neden olur. COVID-19 enfeksiyonunun en yaygın semptomları ateş, öksürük ve nefes darlığıdır. Mevcut verilere göre, COVID-19 virüsü için birincil bulaşma yolu solunum damlacıkları ve temas yoluyla insanlar arasındadır. Virüs, özellikle yaşlı hastalarda ve kanser gibi önceden mevcut hastalıkları olanlarda pnömoni de dahil olmak üzere ciddi respiratuar komplikasyonlara yol açabilir. Kanser hastalarının COVID-19 ile enfekte olma riski önemli ölçüde yüksektir çünkü bağışıklık sistemleri zayıftır ve bu durum hem kanser olmaları hem de kanser tedavisi almalarından kaynaklanır. COVID 19 krizi, poliklinik, elektif bakım, servisler, acil bakım, konferanslar, öğretim ve araştırma dahil olmak üzere pek çok uygulamayı her yönüyle etkilemiştir. Aktif kanser tedavisi gören hastaların uygun şekilde tedavi edildiğinden emin olmalıyız. Bu derlemede, COVID-19 pandemisinin meme kanseri hastalarının tanı ve tedavisi üzerindeki olumsuz etkilerinin nasıl önlenebileceğini açıklamaya çalıştık. (SETB-2020-05-073)
The novel coronavirus disease (COVID-19) arises from the virus SARS-CoV-2 which is similar to the original SARS virus. The most common symptoms of the COVID-19 infection are fever, coughing and shortness of breath. According to the current data, the primary mode of transmission for the COVID-19 virus is between people through respiratory droplets and contact routes. The virus may lead to worse respiratory complications, including pneumonia, especially in older patients and patients with pre-existing illnesses, such as cancer. Cancer patients are at a significantly higher risk of getting infected with COVID-19 since their immune system can be compromised and that reality has to do with both that they have cancer and that they are on therapy for their cancer. COVID-19 crisis has impacted every aspect of the practice, including outpatient, elective, wards, emergency care, conferences, teaching and research. We should make sure cancer patients on active treatment are treated appropriately. In this review, we tried to explain how to prevent the negative effects of the COVID-19 pandemic on the diagnosis and treatment of breast cancer patients.

3.How should be the Surgical Treatment Approach during the COVID-19 Pandemic in Patients with Gastrointestinal Cancer?
Mustafa Fevzi Celayir, Nurcihan Aygun, Mert Tanal, Hakan Mustafa Koksal, Evren Besler, Mehmet Uludag
PMID: 32617050  PMCID: PMC7326676  doi: 10.14744/SEMB.2020.93709  Pages 136 - 141
COVID-19 ilk olarak Aralık 2019'un sonunda Çin’de görülmüştür. COVID-19, akciğerlerde hafif veya şiddetli olabilen ve akut solunum yolu enfeksiyonuna yol açan SARS-CoV-2 olarak tanımlanmış yeni bir koronavirüs türüdür. Hastalık literatürde ilk kez Şubat 2020 ' de Coronavirus Hastalığı 2019 (COVID-19) olarak bildirilmiştir. Hastalık hızla yayılmış ve 11 Mart 2020'de Dünya Sağlık Örgütü (WHO) tarafından bir salgın olarak ilan edilmiştir. Bugüne kadar yaklaşık 7734185 vaka ve 412369 kadar da ölüm bildirmiştir (09 / Haziran / 2020).
COVID-19 dünyaya ve ülkemize yayıldıkça, bu hastalıkla mücadele eden hastaneler de hastalığın bulaşması için riskli alanlar haline gelmiştir. Sağlık çalışanlarının damlacıklar ve yüzeylerden doğrudan temas yolu ile viral kontaminasyon riski yüksektir. Maskeler, tulumlar, eldivenler, yüz siperleri ve / veya gözlükler gibi kişisel koruyucu ekipmanlar (KKEE) zorunludur. Amaç, hastaneye yatmayı gerektiren vakaların akışını zamanla yaymak, böylece hastanelerde olası birikimi önlemektir.
Elektif ameliyatlar ve tanısal müdahaleler gibi acil olmayan tüm prosedürler önemli ölçüde etkilenmiştir. Hastaneye yatış prosedürleri çoğunlukla COVID-19 enfeksiyonu olan hastalara tahsis edildiğinden ve cerrahi operasyonlar ertelendi. Bu pandemi sürecinde ise sadece acil cerrahi olgular ve ertelenemeyen onkolojik ameliyatlar yapıldı.
Onkoloji hastalarının, hem hastalığın kendisi, hem de alınan kemoterapi ve / veya radyoterapinin yan etkileri nedeniyle bağışıklığı baskılanmıştır. Bu durum, hastaları enfeksiyonlara karşı daha hassas hale getirir ve bu hastalardaki enfeksiyonların prognozu daha kötü ve yıkıcıdır. Kanser hastalarının genel popülasyona kıyasla COVID-19'a yakalanma olasılıkları neredeyse iki kat daha fazladır.
COVID-19 pandemisinde malignitesi olan hastaların cerrahi prosedürlerinin seçimi ve perioperatif yönetimi daha da önemli hale gelmiştir. Çalışmamızda, bu pandemi sırasında malignitesi olan ve cerrahi onkolojik girişim yapılan hastalarımızın tedavi süreçlerini analiz ettik. (SETB-2020-06-089)
COVID-19 was first seen in China at the end of December 2019. COVID-19 is a novel type of coronavirus that is defined as SARS-CoV-2, which can be mild or severe in the lungs, causing acute respiratory infection. The disease was first presented in the literature as Coronavirus Disease 2019 (COVID-19) in February 2020. The disease spread rapidly and was declared as a pandemic by the World Health Organization (WHO) on March 11, 2020. There have been approximately 7734185 reported cases, and 412369 reported deaths to date (09/June/2020).
As COVID-19 spread in the world and our country, hospitals struggling with this disease have also become risky areas for transmitting the disease. Health workers also have a high risk of viral contamination from direct contact of droplets and surfaces. Personal protective equipment (PPE), such as masks, coveralls, gloves, face shields and/or goggles, are mandatory. The aim is to spread the flow of cases requiring hospitalization over time, thereby preventing possible accumulation in hospitals.
All non-urgent procedures, such as elective surgeries and diagnostic interventions, were significantly affected. The hospitalization procedures were mostly allocated to patients with COVID-19 infection, and surgical operations were postponed. Only urgent surgical cases and oncological surgeries that cannot be postponed were performed during this pandemic process.
Patients followed by oncology are immunosuppressed both because of the disease itself and the side effects of chemotherapy and/or radiotherapy taken. This makes patients more susceptible to infections, and the prognosis of infections in these patients is worse and more destructive. Cancer patients are almost twice as likely to catch COVID-19 compared to the general population.
The choice of surgical procedures and perioperative management of the patients with malignancy has become even more important in the COVID-19 pandemic. In this study, we analyzed the treatment processes of our patients with malignancy that underwent a surgical oncological procedure during this pandemic.

4.Neonatal Sepsis
Ilkay Ozmeral Odabasi, Ali Bulbul
PMID: 32617051  PMCID: PMC7326682  doi: 10.14744/SEMB.2020.00236  Pages 142 - 158
Neonatal sepsis yenidoğan döneminde ciddi morbidite ve mortalite ile ilişkilidir. Klinik bulgular subklinik enfeksiyondan, lokal veya sistemik ciddi enfeksiyona kadar geniş bir prezentasyona sahiptir. Bulguların ortaya çıkış zamanına göre erken başlangıçlı neonatal sepsis, geç başlangıçlı neonatal sepsis ve çok geç başlangıçlı neonatal sepsis olarak üç gruba ayrılır. İntrapartum antibiyotik tedavisi ile erken başlangıçlı neonatal sepsis sıklığında azalma olduğu görülmüştür. Bununla birlikte preterm ve çok düşük ağırlıklı bebeklerin yaşam oranının artması ile geç başlangıçlı neonatal sepsis insidansında artış ortaya çıkmıştır. Neonatal sepsiste etken patojen intrauterin kaynaklı olabileceği gibi, maternal flora, hastane veya toplum kaynaklı olabilir. Prematürite, düşük doğum ağırlığı, koryoamnionit, erken uzamış membran rüptürü, resüstasyon öyküsü, düşük APGAR skoru, anne sütü ile beslenememe, hastanede yatış süresinin uzun olması, invaziv girişimler, neonatal sepsis risk faktörleri arasında sayılmaktadır. Bu makalede neonatal sepsisin tanımı, sınıflaması, epidemiyolojisi, risk faktörleri, patogenezi, klinik bulguları, tanı yöntemleri ve tedavisindeki güncel bilgiler paylaşılmıştır. (SETB-2019-12-144)
Neonatal sepsis is associated with severe morbidity and mortality in the neonatal period. Clinical manifestations range from subclinical infection to severe local or systemic infection. Neonatal sepsis is divided into three groups as early-onset neonatal sepsis, late-onset neonatal sepsis and very late-onset neonatal sepsis according to the time of the onset. It was observed that the incidence of early-onset neonatal sepsis decreased with intrapartum antibiotic treatment. However, the incidence of late-onset neonatal sepsis has increased with the increase in the survival rate of preterm and very low weight babies. The source of the causative pathogen may be acquisition from the intrauterine origin but may also acquisition from maternal flora, hospital or community. Prematurity, low birth weight, chorioamnionitis, premature prolonged rupture of membranes, resuscitation, low APGAR score, inability to breastfeed, prolonged hospital stay and invasive procedures are among the risk factors. This article reviews current information on the definition, classification, epidemiology, risk factors, pathogenesis, clinical symptoms, diagnostic methods and treatment of neonatal sepsis.

5.Pheochromocytoma and Paraganglioma: From Epidemiology to Clinical Findings
Nurcihan Aygun, Mehmet Uludag
PMID: 32617052  PMCID: PMC7326683  doi: 10.14744/SEMB.2020.18794  Pages 159 - 168
Pheochromocytomas (PCC) and paragangliomas (PGL) are rare neuroendocrine tumors. Pheochromocytomas arise from chromaffin cells in the adrenal medulla, and PGLs arise from chromaffin cells in the ganglia of the autonomic nervous system. Paragangliomas originate from sympathetic or parasympathetic ganglia in the abdomen, thorax, and pelvis. The majority of PCC and sympathetic PGL are endocrine active tumors causing clinical symptoms by secreting excess catecholamines (norepinephrine, epinephrine, dopamine) and their metabolites. The incidence of PCC and PGL ranges between 2 and 8 per million, with a prevalence between 1: 2500 and 1: 6500. It peaks between the 3rd and 5th decades of life, and approximately 20% of cases are pediatric patients. The prevalence among patients with hypertension in outpatient clinic ranges between 0.1-0.6% in adults and between 2-4.5% in the pediatric age group. 10-49% of these tumors are detected incidentally in imaging techniques performed for other reasons. However, 4-8% of adrenal incidentalomas are PCCs. Of these neuroendocrine tumors, 80-85% are PCCs and 15-20% are PGLs.
Up to 40% of patients with PCC and PGL have disease-specific germline mutations and the situation is hereditary. Of 60% of the remaining sporadic patients, at least 1/3 have somatic mutation in predisposing genes. 8% of the sporadic cases, 20-75% of the hereditary ones, 5% of the bilateral, adrenal cases, and 33% of the extradrenal ones at first presentation are metastatic.Although PCCs and PGLs have scoring systems for histological evaluation of the primary tumor, it is not possible to diagnose whether the tumor is malignant, since there is no histological system approved for the biological aggressiveness of this tumor group. Metastasis is defined as the presence of chromaffin tissue in non-chromaffin organs such as lymph nodes, liver, lungs and bone. Although most of the PCC and PGL are benign, metastatic disease can develop in 15-17%. Metastatic disease is reported between 2-25% in PCCs and 2.4-60% in PGLs. The TNM staging system of the American Joint Committee on Cancer (AJCC) was developed to predict the prognosis, based on the specific anatomical features of the primary tumor and the occurrence of metastasis. (SETB-2020-05-068)
Pheochromocytomas (PCC) and paragangliomas (PGL) are rare neuroendocrine tumors. Pheochromocytomas arise from chromaffin cells in the adrenal medulla, and PGLs arise from chromaffin cells in the ganglia of the autonomic nervous system. Paragangliomas originate from sympathetic or parasympathetic ganglia in the abdomen, thorax, and pelvis. The majority of PCC and sympathetic PGL are endocrine active tumors causing clinical symptoms by secreting excess catecholamines (norepinephrine, epinephrine, dopamine) and their metabolites. The incidence of PCC and PGL ranges between 2 and 8 per million, with a prevalence between 1: 2500 and 1: 6500. It peaks between the 3rd and 5th decades of life, and approximately 20% of cases are pediatric patients. The prevalence among patients with hypertension in outpatient clinic ranges between 0.1-0.6% in adults and between 2-4.5% in the pediatric age group. 10-49% of these tumors is detected incidentally in imaging techniques performed for other reasons. However, 4-8% of adrenal incidentalomas are PCCs. Of these neuroendocrine tumors, 80-85% are PCCs and 15-20% are PGLs.
Up to 40% of patients with PCC and PGL has disease-specific germline mutations and the situation is hereditary. Of 60% of the remaining sporadic patients, at least 1/3 has a somatic mutation in predisposing genes. 8% of the sporadic cases, 20-75% of the hereditary cases, 5% of the bilateral, adrenal cases, and 33% of the extra-adrenal cases at first presentation are metastatic. Although PCCs and PGLs have scoring systems for histological evaluation of the primary tumor, it is not possible to diagnose whether the tumor is malignant since there is no histological system approved for the biological aggressiveness of this tumor group. Metastasis is defined as the presence of chromaffin tissue in non-chromaffin organs, such as lymph nodes, liver, lungs and bone. Although most of the PCC and PGL are benign, the metastatic disease may develop in 15-17%. Metastatic disease is reported between 2-25% in PCCs and 2.4-60% in PGLs. The TNM staging system of the American Joint Committee on Cancer (AJCC) was developed to predict the prognosis, based on the specific anatomical features of the primary tumor and the occurrence of metastasis.

ORIGINAL RESEARCH
6.Neutrophil Elastase Inhibitor Increases Flap Survival in Experimental Degloving Injuries
Erkan Yuce, Kamuran Zeynep Sevim, Medeni Volkan Kiyak, Kemalettin Yildiz, Daghan Dagdelen, Fatih Irmak, Semra Karsidag, Ulkan Kilic
PMID: 32617053  PMCID: PMC7326670  doi: 10.14744/SEMB.2018.45077  Pages 169 - 175
Objectives: Degloving hand injuries have generally been viewed as among the most difficult of injuries to manage due to the extensive nature of associated damage. The traditional approach to the circumferentially degloved segment of problematic flap viability has been to resuture the flap and to wait and see. However, the waiting period or the specific hemorheological protocol remains uncertain. The purpose of this study is to acknowledge if Sivelestat, known to ameliorate ischemia reperfusion injury, enhances the survival of avulsed flaps in a hind limb degloving model of rats and to compare Sivelestat’s effects to Pentoxifylline.
Methods: Total flap area (cm2), area of necrosis in the flap (cm2), and the ratio between the necrotic and total areas (percentage) were determined. Angiogenesis among the groups were documented with CD31, anti-PECAM stainings. TUNEL assay was performed to allow the visualization of cell nuclei containing fragmented DNA, a typical feature of apoptosis.
Results: This study demonstrated that, Sivelestat administered at 10 mg/kg/hour dosage will inhibit the ischemia reperfusion injury more pertinently than Pentoxifylline which exerts only hemorheological effects.
Conclusion: The anti-inflammatory effects of Sivelestat, will be beneficial for decreasing the early complications of degloving injury, such as inflammation, sepsis, and edema, better than Pentoxifylline which exerts only hemorheological effects.
Objectives: Degloving hand injuries have generally been viewed as among the most difficult of injuries to manage due to the extensive nature of associated damage. The traditional approach to the circumferentially degloved segment of problematic flap viability has been to resuture the flap and to wait and see. However, the waiting period or the specific hemorheological protocol remains uncertain. This study aims to acknowledge if Sivelestat, known to ameliorate ischemia-reperfusion injury, enhances the survival of avulsed flaps in a hind limb degloving model of rats and to compare Sivelestat’s effects to Pentoxifylline.
Methods: In this study, total flap area (cm2), area of necrosis in the flap (cm2), and the ratio between the necrotic and total areas (percentage) were determined. Angiogenesis among the groups was documented with CD31, anti-PECAM staining. TUNEL assay was performed to allow the visualization of cell nuclei containing fragmented DNA, a typical feature of apoptosis.
Results: The findings obtained in this study showed that Sivelestat administered at 10 mg/kg/hour dosage will inhibit the ischemia-reperfusion injury more pertinently than Pentoxifylline, which exerts only hemorheological effects.
Conclusion: The anti-inflammatory effects of Sivelestat will be beneficial for decreasing the early complications of degloving injury, such as inflammation, sepsis, and edema, better than Pentoxifylline, which exerts only hemorheological effects.

7.Late Intraluminal Stent Application in Strictures due to Corrosive Esophagitis: Our Preliminary Experiences
Meltem Kaba, Cetin Ali Karadag, Mesut Demir, Nihat Sever, Melih Akin, Ali Ihsan Dokucu
PMID: 32617054  PMCID: PMC7326674  doi: 10.14744/SEMB.2018.09634  Pages 176 - 180
Amaç: Gelişmekte olan ülkelerde sık görülen korozif madde alımlarının özofagus darlığı ile sonuçlanması yaygın rastlanılan bir durumdur ve darlıklara yönelik standart bir tedavi yöntemi henüz bulunamamıştır. Çalışmamızda özofagus darlıklarının tedavisinde
stent uygulanmasına ilişkin ilk deneyimlerimiz sunulmuştur.
Yöntem: Kliniğimizde korozif özofajit nedeniyle darlık gelişen ve stent tedavisi uygulanmış olan hastaların dosyaları geriye dönük olarak değerlendirildi. Özofagus darlığının boyu 30 ile 130 mm arasında değişiyordu. Kullanılan stentler, silindirik nitinol alaşım yapı üzerine silikon kaplanmış, üst ucu huni şeklinde, yerleştirildiğinde kendiliğinden genişleyen ve çıkarılabilir özellikteydiler. Stent çapları 10–20 mm, boyları 60–170 mm arasındaydı.
Bulgular: Toplam yedi hasta (4 kız, 7 erkek) çalışmaya katıldı. Stentler genel anestezi altında yerleştirildiler. Stent sonrası hastaların tümünde değişik sürelerde ağrı, kusma, yutma güçlüğü ve bir hastada kanama oldu. Bir hasta stentli iken akciğer enfeksiyonuna bağlı olduğu düşünülen komplikasyonla kaybedildi. Stentler tolerans sorunları (Granulasyon dokusu oluşması, stentin gömülmeye başlaması) gibi nedenlerden dolayı ortlama 38 günde çıkartılmak zorunda kalındılar. Hastaların özofagus mukozasında granülasyon oluştuğu, kesin iyileşme sağlamadığı ancak dar bir lümenin ortaya çıktığı gözlendi.
Tartışma: Klinik uygulamamızda stenent tedavisi kalıcı fayda sağlamamıştır. Hangi tip, uzunluk ve çaptaki stentin, yanıktan ne kadar süre sonra uygulanacağı, ne kadar süreyle kalacağı, hangi uzunluktaki ve yerleşimdeki darlıkların stent tedavisine uygun
olduğu, birlikte uygulandığında yarar sağlayacak tıbbi tedavilerin neler olacağı konusunda yeni çalışmalara ihtiyaç vardır. (SETB-2018-07-094)
Objectives: Household chemicals result in corrosive esophageal burns in the developing third world countries, and most of them cause esophageal strictures. There is no standard treatment for esophageal strictures. Here, we present our preliminary experience with intraluminal esophageal stents for stricture treatment.
Methods: The files of the patients who had stenosis due to corrosive esophagitis in our clinic were evaluated retrospectively. Stricture lengths were between 30 and 130 mm. Stents were self-expandable, made of nitinol alloy that was covered with silicone, and they were cylindrical in shape with a conical tip. The lengths varied between 60 and 170 mm and the diameters were between 10-20 mm. The stent application was made under general anaesthesia.
Results: There were seven patients (four girls and three boys). After stent application, all patients experienced constant or temporary pain, vomiting, and difficulty in swallowing. Bleeding occurred in one patient. Sudden death occurred in one patient, probably as a complication of chest infection. All stents had to be removed in mean 38 days because of embedding of the stent, development of granulation tissue and intolerance.
Conclusion: More research is needed to determine the type, length and diameter of the stent, the timing and the duration of the application, the length and level of the stricture suitable for stent application and medications during treatment.

8.Sleep Quality in Psoriasis Patients and its Relations with Possible Affecting Factors
Betul Tas, Vasfiye Kabeloglu, Aysun Soysal, Dilek Atakli
PMID: 32617055  PMCID: PMC7326668  doi: 10.14744/SEMB.2018.53189  Pages 181 - 187
Amaç: Psoriazis (PS) kronik, immüniteyle ilişkili bir inflamatuar deri hastalığıdır. Yaşam kalitesi ve diğer sistemler üzerine önemli etkilere yol açar. Burada, psoriaziste uyku kalitesi (UK) ve onu etkileyebilecek olası faktörlerle ilişkisinin araştırılması amaçlanmıştır.
Yöntem: Her 2 cinsten toplam 74 denek çalışmaya dahil edidi. Hastalar demografik özellikleri, vücut kitle indeksi (VKİ), Psoriazis Alan Şiddet İndeksi (PAŞİ), Pittsburg Uyku Kalite İndeksi (PUKİ), Psoriazis Yaşam Kalite İndeksi (PYKİ), Benlik Algısı Skalası (BAS), ile değerlendirildi. Ayrıca eşlik eden kronik hastalıklar, hastalık süresi, ve kaşıntının şiddeti kaydedildi. Elde edilen PUKİ değerleri, sözü edilen diğer faktörlerle UK ilişkisinin önemi açısından karşılaştırıldı. Sonuçların analizi SPSS, version 24, 2016 ile yapıldı ve anlamlılık <0.05, 0.01, ve 0.001 p değerleri, ve < 0.2, =0.2-0.4, =0.4-0.6, =0.6-0.8 and > 0.8 rho (r) değerlerine göre değerlendirildi.
Bulgular: Otuz yedi kadın ve 37 erkek değerlendirmeye alındı. Ortalama yaş 47.21±13.91 idi. Ortalama VKİ ve ortalama hastalık süresi 30.09±4.68 kg/m2 ve 10.58±9.1 aydı. Çalışma grubunun PAŞİ, PUKİ, BAS ve PYKİ değerleri sırasıyla 19.79±16.99, 9.14±5.09, 142.12±23.83, ve 21.94±16.31 idi. Deneklerin yaklaşık yüzde otuzunda en az bir kronik hastalık vardı. Alkol ve sigara kullanımı %17.56, %50 idi. PAŞİ, PUKİ ile kuvvetli pozitif korelasyon gösterirken, BAS ile negative ve zayıf korelasyon gösterdi. PUKİ değerleriyle, yaş, cinsiyet ve VKİ arasında korelasyon saptanmazken, PYKİ, diyabet (DM) ve kaşıntı şiddetiyle orta kuvvette pozitif, ve hipertansiyon (HT), troid hastalıkları, PAŞİ, ve hastalık süresiyle zayıf pozitif korelasyon saptandı. PAŞİ ve DM’un UK üzerine belirgin öngörücü etkileri saptandı.
Sonuçlar: Psoriaziste, uyku kalitesi, yaşam kalitesi, hastalık şiddeti ve süresi, kaşıntı şiddeti, eşlik eden DM, HT ve troid hastalıkları gibi faktörlerden etkilenmektedir ve bunlardan hastalık şiddeti ve DM’un UK üzerine belirgin negatif öngörücü etkileri vardır.
Hastalık aktivasyonunun control altında tutulması ve DM gelişiminin önlenmesi PS hastalarında UK’nin korunmasını sağlayabilir. (SETB-2018-07-098)
Objectives: Psoriasis (PS) is a chronic, immune-mediated inflammatory skin disease. PS may lead to significant effects on health-related quality of life (HRQoL) and other outcomes. In the present study, an investigation into sleep quality (SQ), and its possible relations with factors which may affect SQ were aimed.
Methods: A total of 74 subjects from both sexes were enrolled in this study, between January and July 2017. Patients were evaluated with their demographics, body mass index (BMI), Psoriasis Area Severity Index (PASI), Pittsburgh Sleep Quality Index (PSQI), Psoriasis Quality of Life Index (PQLI), Self Perception Scale (SPS). Additionally, accompanying chronic diseases, disease duration and severity of pruritus were recorded. Obtained PSQI values were compared with the mentioned parameters concerning the significance of their relations with it. SPSS version 24, 2016 was used to analyse the data, and significance was evaluated with p-values of <0.05, 0.01, and 0.001, and rho (r) values of <0.2, =0.2-0.4, =0.4-0.6, =0.6-0.8 and >0.8.
Results: Thirty-seven female and 37 male were studied. The mean age of total of the study population was 47.21±13.91. Mean BMI and mean duration were 30.09± 4.68 kg/m2, and 10.58±9.1 months. Mean values of PASI, PSQI, SPS, and PQLI of the study group were 19.79±16.99, 9.14±5.09, 142.12±23.83, and 21.94±16.31, respectively. Approximately thirty-one percent of them had at least one chronic disease. Alcohol and smoking rates were 17.56%, 50%. PASI was positive/strongly correlated with PQLI and negative/weakly correlated with SPS. No correlation was detected between PSQI values and age, gender, BMI, and SPS values. PSQI was moderately correlated with PQLI, diabetes mellitus (DM), and pruritus severity, whereas it was weak correlated with PASI, hypertension (HT), thyroid diseases and disease duration. PASI and DM showed a predictive effect on SQ.
Conclusion: SQ is affected by certain factors, such as QoL, disease severity, disease duration, pruritus severity, accompanying disorders, such as HT, DM and thyroid diseases, in which disease severity and DM have predictive effects on SQ in PS patients. Controls of disease activation and prevention of progression in DM may provide to keep SQ in PS.

9.Effects of Ankylosing Spondylitis on Erectile Function
Ibrahim Halil Erdem, Mazhar Ortac, Emre Salabas
PMID: 32617056  PMCID: PMC7326678  doi: 10.14744/SEMB.2018.49358  Pages 188 - 192
Objectives: Ankylosing spondylitis (AS), which is a chronic rheumatologic disorder, may be associated with erectile dysfunction (ED). This study aims to investigate the incidence of erectile dysfunction in patients with AS with a control group and to investigate the risk factors for ED.
Methods: All demographic data were recorded. Participants in both groups filled in the IIEF-5 (International Index of Erectile Function), Beck Depression Index (BDI) and Beck Anxiety Index (BAI) questionnaires, whereas patients with AS additionally filled in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrological Index (BASMI) and Ankylosing Spondylitis Quality of Life (ASQoL) questionnaires. Patients were compared concerning erectile function and predictive factors. Fifty patients with the AS diagnosis and fifty healthy males were included in this study.
Results: ED of all degrees was present in 38% and 30% of males in the AS group and control group, respectively, with no statistical difference. However, the mean IIEF-EF domain score of the AS group (22.3±7.0) was significantly lower than the control group (25.7±4.3) (p=0.004). In addition, BDI and BAI scores were significantly higher in the AS group. When we have divided patients in the AS group into two, according to the presence or absence of the ED, the mean IIEF-EF domain score of patients with ED was lower than AS patients without ED. No difference was detected in both groups concerning age and the duration of the disease. Patients who had ED in the AS group had significantly higher scores in BASDAI, BASFI, depression and anxiety; however, no significant difference was detected among groups regarding BASMI scores.
Mean IIEF score was lower in patients with AS, and this had a negative correlation with BASDAI, BASFI, ASQoL, BDI and BAI scores.
Conclusion: Erectile function scores were slightly lower in the AS group than the control group in our study. ED risk factors were shown as disease activity and psychological status. (SETB-2018-07-102)
Objectives: Ankylosing spondylitis (AS), which is a chronic rheumatologic disorder, may be associated with erectile dysfunction (ED). This study aims to investigate the incidence of erectile dysfunction in patients with AS with a control group and to investigate the risk factors for ED.
Methods: All demographic data were recorded. Participants in both groups filled in the IIEF-5 (International Index of Erectile Function), Beck Depression Index (BDI) and Beck Anxiety Index (BAI) questionnaires, whereas patients with AS additionally filled in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrological Index (BASMI) and Ankylosing Spondylitis Quality of Life (ASQoL) questionnaires. Patients were compared concerning erectile function and predictive factors. Fifty patients with the AS diagnosis and fifty healthy males were included in this study.
Results: ED of all degrees was present in 38% and 30% of males in the AS group and control group, respectively, with no statistical difference. However, the mean IIEF-EF domain score of the AS group (22.3±7.0) was significantly lower than the control group (25.7±4.3) (p=0.004). In addition, BDI and BAI scores were significantly higher in the AS group. When we have divided patients in the AS group into two, according to the presence or absence of the ED, the mean IIEF-EF domain score of patients with ED was lower than AS patients without ED. No difference was detected in both groups concerning age and the duration of the disease. Patients who had ED in the AS group had significantly higher scores in BASDAI, BASFI, depression and anxiety; however, no significant difference was detected among groups regarding BASMI scores.
Mean IIEF score was lower in patients with AS, and this had a negative correlation with BASDAI, BASFI, ASQoL, BDI and BAI scores.
Conclusion: Erectile function scores were slightly lower in the AS group than the control group in our study. ED risk factors were shown as disease activity and psychological status.

10.A Retrospective Analysis of Er: YAG Laser Treatment in Solar Lentigines: Our Clinical Observations
Ezgi Aktas Karabay, Neslihan Fisek Izci
PMID: 32617057  PMCID: PMC7326671  doi: 10.14744/SEMB.2018.46548  Pages 193 - 196
Amaç: Bu çalışmanın amacı Erbium-doped yttrium aluminium garnet (Er: YAG) lazerin solar lentigo tedavisinde etkinliğini araştırmaktır.
Gereç ve Yöntemler: Er: YAG lazer ile tedavi edilen hastalar ile retrospektif çalışma düzenlendi. Tedavi öncesinde çok sayıda solar lentigosu olan 14 hasta çalışmaya dahil edildi. Tedavi parametreleri ve izlenen yan etkiler kaydedildi. Bağımsız bir dermatolog tarafından klinik iyileşme değerlendirildi, hastalar da tedavi sonuçları ile ilgili memnuniyetlerini derecelendirdi.
Bulgular: Hastaların ortalama yaşı 41.07±7.16 (yıl) idi. Her hastaya uygulanan tedavi seasn sayısı ortalaması 1.79±1.05 idi. Son değerlendirmede 8 hastada (% 57.1) mükemmel iyileşme t (%76–100 gerileme) izlenirken, 5 hastada (%35.7) iyi derecede iyileşme (%51-75 gerileme) izlendi. On hasta (% 71.4) tedavi sonuçlarından çok memnun, 4 hasta (%28.5) memnun idi. Tedaviye bağlı hiçbir yan etki izlenmedi.
Sonuç: Solar lentigolarda Er: YAG lazer tedavisi etkili ve güvenli bir yöntem olabilir. (SETB-2018-07-101)
Objectives: To investigate the efficacy of erbium-doped yttrium aluminium garnet (Er: YAG) laser in the treatment of solar lentigines.
Methods: A retrospective study was conducted on patients treated with the only Er: YAG laser. In this study, 14 patients with multiple solar lentigines before treatment were included. Treatment parameters and all side effects were recorded. One independent, blinded dermatologist evaluated the clinical improvement and the patients also scored their satisfaction degree with the treatment.
Results: The mean age of the patients was 41.07±7.16 years. The number of mean treatment session for each patient was 1.79±1.05. At the final visit, excellent improvement (76–100% clearance) was reached in eight (57.1%) patients, while good improvement (51-75% clearance) was achieved in five (35.7%) patients. Ten patients (71.4%) were very satisfied and four (28.5%) patients were satisfied with the results of the treatment. No side effects occurred.
Conclusion: Er: YAG laser treatment may be an effective and safe optional modality for solar lentigines.

11.Evaluation of Dermatology Consultations in a Tertiary Care Centre Emergency Service
Ezgi Ozkur, Ilknur Kivanc Altunay, Gul Sekerlisoy, Yasemin Erdem
PMID: 32617058  PMCID: PMC7326684  doi: 10.14744/SEMB.2018.72473  Pages 197 - 200
Amaç: Çalışmamızın amacı acil servise başvuran ve dermatolojiye konsülte edilen hastaların özelliklerini değerlendirmektir.
Gereç ve Yöntem(ler): 01.05.2017 ve 01.05.2018 tarihleri arasında 12 ay boyunca acil servisten yapılan dermatoloji konsültasyonlarının elektronik medikal kayıtları incelendi. Hastaların yaş, cinsiyet, şikayetleri, tanı ve tedavi bilgileri kaydedildi.
Bulgular: Toplamda 444 hasta değerlendirmeye alındı. En sık görülen dermatolojik hastalık enfeksiyonlar (86,9%) (en sık viral), 2. sırada inflamatauar dermatozlar(5.4%) ve 3. sırada ürtiker ve anjiyoödem (5.1%) olarak saptandı. En yüksek başvuru oranı Nisan ayında saptandı (%14).
Sonuç(lar): Acil serviste karşılaşılan en sık dermatolojik hastalıklar, en sık enfeksiyöz hastalıklar olmak üzere, bu çalışmada saptanmıştır. Dermatolojik acillerin epidemiyolojisinin ve deri bulgularının bilinmesi daha iyi bir sağlık hizmeti için yararlı olacaktır. (SETB-2018-07-091)
Objectives: The primary objective of our study was to investigate the profile of patients visiting our hospital’s emergency department and underwent dermatology consultation.
Methods: In this study, we reviewed electronic medical records of 444 consultations from the emergency department over a period from 01.05.2017 to 01.05.2018. We recorded patients’ age, gender, complaint, diagnosis and treatment from the database.
Results: Overall, 444 patients were studied. The most common conditions seen were infection (86.9%) (mainly viral), followed by inflammatory dermatoses (5.4%) and urticaria and angioedema (5.1%). The highest rate of cases peaked in April (14%).
Conclusion: Commonly encountered dermatological disorders in the emergency department identified in this study, mostly infectious diseases. Knowing the epidemiology of dermatological emergencies and the alarming skin signs and symptoms can be useful for better health care.

12.Are Symptoms Sufficient in the Decision to Start Antibiotics in Tonsillopharyngitis?
Elif Serap Esen, Memet Taskin Egici, Guzin Zeren Ozturk
PMID: 32617059  PMCID: PMC7326667  doi: 10.14744/SEMB.2018.01336  Pages 201 - 205
Amaç: Gereksiz antibiyotik kullanımı antibiyotik direnci sebeplerindendir.Hızlı antijen testi (HAT), tonsillofarenjit düşünülen hastalarda bakteri/ virüs ayrımını sağlayarak gereksiz antibiyotik kullanımını önlemek için önerilmektedir. Fakat tipik semptomlara sahip hastalarda yalancı negatif test sonuçları hekimleri kararsız bırakmaktadır. Çalışmamızda HAT sonucuyla hastaların semptomları arasındaki ilişkiyi değerlendirmeyi amaçladık.
Yöntem: Çalışmamıza Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi Aile Hakimliği polikliniğine başvuran tonsillofarenjit tanısı almış ve HAT istenmiş hastalar alınmıştır.Çalışma retrospektif dosya tarama yöntemi ile yapılmış; hastaların yaşı, cinsiyeti, semptomları, HAT sonuçları ile birlikte varsa boğaz kültürleri incelenmiştir. İstatistiksel analiz için SPSS 15.0 for Windows programı kullanıldı. İstatistiksel anlamlılık seviyesi p<0,05 olarak kabul edildi.
Bulgular: 265 hastanın HAT’ ı ve 141 hastanın boğaz kültürü incelenmiştir. HAT pozitifliği %28,7, boğaz kültüründe A grubu Beta Hemolitik Streptokok (AGBHS) saptanma oranı %22,5 iken antibiyotik reçeteleme oranı %37’ dir. AGBHS kültürü pozitif olan 32 kişinin 27 (%84,4)’sinde HAT da pozitifti. Semptomlarla HAT pozitifliği ilişkisi irdelendiğinde; 380C üstü ateş varlığı ile HAT pozitifliği arasında anlamlı ilişki saptanmazken; HAT pozitif olan hastalara 380C üstü ateş daha fazla eşlik etmekteydi. Bunun dışında tonsiller eksuda varlığı ile HAT pozitifliği arasında istatistiki olarak anlamlı ilişki mevcuttu (p=0,000). Yaş gruplarına göre semptomlar ile HAT arası ilişki incelendiğinde; 18 yaş altı grupta LAP varlığı ve tonsiller eksuda varlığı ile HAT pozitifliği anlamlı ilişki bulundu (p=0,000; p=0,001). 18 yaş ve üstü grupta ise tonsiller eksuda varlığı ile HAT pozitifliği anlamlı ilişki saptandı (p=0,001).
Sonuç: Çalışmamızda tonsiller eksuda hem 18 yaş altı hem de 18 yaş ve üstü yaş grubunda da ortak semptom olup HAT ile istatistiki olarak anlamlı ilişkilidir. Ancak tonsiller eksuda sadece bakteriyel enfeksiyonlarda değil virütik enfeksiyonlarda da oluşmaktadır. Bu nedenle yalnızca semptomlarla karar verilerek antibiyotik başlanılmaması ve HAT’ın daha etkin kullanılması gerektiğini düşünmekteyiz. (SETB-2018-09-121)
Objectives: Unnecessary use of antibiotics is one of the causes of antibiotic resistance. Rapid Antigen Test (RAT) is recommended to prevent unnecessary use of antibiotics by providing bacteria/virus isolation in patients with tonsillopharyngitis. However, in patients with typical symptoms, false-negative test results may lead to doubt in doctors. In this study, we aimed to evaluate the relationship between patients’ symptoms and RAT results.
Methods: In this study, we chose the patients that referred to the University of Health Sciences (SBÜ) Şişli Hamidiye Etfal Training and Research Hospital Family Medicine Polyclinics and got a diagnosis of tonsillopharyngitis with RAT. This study was conducted by a retrospective file scanning method. We examined the age, sex, symptoms, RAT results and throat culture results of the patients. SPSS 15.0 for Windows program was used for the statistical analysis. The level of statistical significance was accepted as p<0.05.
Results: In this study, the RAT of 265 patients and the throat culture of 141 patients were examined. We found RAT positivity as 28.7%, Group A Beta Hemolytic Streptococcus (AGBHS) detection rate in throat culture was 22.5%, and the antibiotic prescription rate was 37%. There were 32 patients with AGBHS positivity in throat culture. Twenty-seven of them got RAT positivity, too. When symptoms and RAT positivity were examined, there was no significant relationship between RAT positivity and fever higher than 38 oC, but RAT was more often positive in patients with a fever higher than 38 oC. On the other hand, there is a statistically significant relationship between RAT positivity and the presence of tonsillar exudate (p=0.000). When the relationship between symptoms and RAT according to age groups was examined, the presence of LAP and tonsillitis were significant (p=0.000; p=0.001). In the age group of 18 years and over, the presence of tonsillar exudates was significant (p=0.001).
Conclusion: In our study, tonsillar exudate was a common symptom in both age groups of <18, and ≥18 years of age; at the same time, there is a statistically significant relation with RAT. Tonsillar exudates are not seen only in bacterial infections but also in viral infections. Thus, we think that antibiotics should not be started based on symptoms, and RAT should be used effectively.

13.European Standard Series Patch Test Results in Contact Dermatitis Patients in a Tertiary Care Hospital
Ersoy Acer, Hilal Kaya Erdogan, Tayfun Batan, Zeynep Nurhan Saracoglu
PMID: 32617060  PMCID: PMC7326666  doi: 10.14744/SEMB.2020.02703  Pages 206 - 210
Amaç: Alerjenlere duyarlanma toplumlar arasında farklılık gösterir, ayrıca yaş ve cinsiyet gibi çeşitli faktörlerden etkilenir, yıllar içinde bile değişebilir. Bu çalışmada merkezimizde, kontakt dermatitli (KD) hastalarda yapılan yama testi sonuçlarını değerlendirmeyi amaçladık.
Yöntem: İki bin on yedi-2018 yılları arasında KD’li hastaların Avrupa standart seri yama testi sonuçları retrospektif olarak değerlendirildi.
Bulgular: Yüz otuz beş hastanın 65'i (%48,1) erkek, 70'i (%51,9) kadındı. Hastaların yaş ortalaması 41,43 ± 14,26 (11-78) idi. 78'inde (%57,8) en az bir alerjene karşı pozitif reaksiyon tespit edildi. En sık alerjenler nikel sülfat (%27,4), potasyum dikromat (%14,8), kobalt klorür (%11,9), tekstil boya karışımı (%8,1), koku karışımı Ⅰ, Ⅱ (%6,7) ve peru balsamı (%4,4) idi. Kadınlarda nikel sülfat, erkeklerde kobalt klorür ve potasyum dikromat duyarlılığı daha yüksekti (sırasıyla, p = 0.03, 0.05, 0.03). Çok değişkenli lojistik regresyon analizinde; yaş, en az bir alerjene karşı pozitif reaksiyon ile bağımsız olarak ilişkiliydi.
Sonuç: Nikel sülfat, potasyum dikromat, kobalt klorür ve tekstil boya karışımı en sık saptanan alerjenlerdi. Bu alerjenlere maruziyeti azaltmak için yasal düzenlemeler yapılmalıdır. (SETB-2019-08-114)
Objectives: Sensitization of allergens varies among societies and also it is influenced by various factors, such as age and gender. It may even change over the years. In this study, we aimed to evaluate the patch test results in patients with contact dermatitis (CD) in our center.
Methods: European standard series patch test results of patients with CD between 2017 and 2018 were evaluated retrospectively.
Results: Of the 135 patients, 65 (48.1%) were males, 70 (51.9%) were females. The mean age of patients was 41.43±14.26 (11-78) years. In 78 (57.8%) patients, a positive reaction against at least one allergen was detected. The most common allergens were nickel sulfate (27.4%), potassium dichromate (14.8%), cobalt chloride (11.9%), textile dye mix (8.1%), fragrance mix i, ii (6.7%) and balsam of Peru (4.4%). The sensitization of nickel sulfate was higher in females and sensitization of cobalt chloride and potassium dichromate in males (p=0.03, 0.05, 0.03, respectively). In the multivariate logistic regression analysis, age was independently related to a positive reaction against at least one allergen.
Conclusion: Nickel sulfate, potassium dichromate, cobalt chloride and textile dye mix were the most common allergens. Legal regulations should be made to decrease exposure to allergens.

14.Comparison of the Oral Steroids, Macrolides and Combination Therapy in Nasal Polyposis Patients
Fatih Tetik, Arzu Yasemin Korkut, Kerem Sami Kaya, Irmak Ucak, Irfan Celebi, Berna Uslu Coskun
PMID: 32617061  PMCID: PMC7326679  doi: 10.14744/SEMB.2018.40316  Pages 211 - 217
Objectives: In this study, our aim was to compare oral steroid therapy with macrolide therapy and with oral steroid + macrolide (combine) therapy in patients with nasal polyposis (NP).
Methods: All patients were treated with nasal steroid therapy for eight weeks and divided randomly into three groups as follows: Oral steroid group, oral macrolide group and combine group. All patients underwent endoscopic staging, radiological grading, odour testing and completed the sino-nasal outcome test-22 (SNOT-22) questionnaire before and after treatment.
Results: Significant improvement was observed in all parameters after treatment in all three groups. All parameters were significantly better in the combined group than in the macrolide group. Comparison of the oral steroid group and macrolide group revealed significantly better radiological grading and odour test changes for the oral steroid group, but no statistically significant differences existed according to endoscopic staging and SNOT-22. The post-treatment SNOT-22 score was significantly better in the combined group than in the steroid group. A comparison of the combined and steroid groups showed better results for the combined group for all parameters, but the differences were not significant.
Conclusion: All treatment protocols were effective and the successful use of macrolide indicates its potential as an alternative in patients with contraindications to oral steroid treatment. The combined treatment may demonstrate significantly better results than steroid treatment alone if larger studies with more patients are performed. (SETB-2018-07-095)
Objectives: In this study, our aim was to compare oral steroid therapy with macrolide therapy and with oral steroid + macrolide (combine) therapy in patients with nasal polyposis (NP).
Methods: All patients were treated with nasal steroid therapy for eight weeks and divided randomly into three groups as follows: Oral steroid group, oral macrolide group and combine group. All patients underwent endoscopic staging, radiological grading, odour testing and completed the sino-nasal outcome test-22 (SNOT-22) questionnaire before and after treatment.
Results: Significant improvement was observed in all parameters after treatment in all three groups. All parameters were significantly better in the combined group than in the macrolide group. Comparison of the oral steroid group and macrolide group revealed significantly better radiological grading and odour test changes for the oral steroid group, but no statistically significant differences existed according to endoscopic staging and SNOT-22. The post-treatment SNOT-22 score was significantly better in the combined group than in the steroid group. A comparison of the combined and steroid groups showed better results for the combined group for all parameters, but the differences were not significant.
Conclusion: All treatment protocols were effective and the successful use of macrolide indicates its potential as an alternative in patients with contraindications to oral steroid treatment. The combined treatment may demonstrate significantly better results than steroid treatment alone if larger studies with more patients are performed.

15.Assessment of Patients with Hirschsprung Disease and the Use of Laparoscopy
Mesut Demir, Melih Akin, Meltem Kaba, Nimetullah Mete Genc, Nihat Sever, Cetin Ali Karadag, Ali Ihsan Dokucu
PMID: 32617062  PMCID: PMC7326675  doi: 10.14744/SEMB.2018.84565  Pages 218 - 221
Amaç: Çalışmamızın amacı kliniğimizde Hirschsprung’s Hastalığı ( HH) nedeni ile tanı konulup, tedavi edilen hastalarımızın sonuçlarının değerlendirilmesi.
Gereç ve Yöntem: Ocak 2010-Aralık 2015 tarihleri arasında HH nedeniyle operatif tedavisi yapılan hastalarımızın demografik ve klinik bulguları dosyası üzerinden geriye dönük olarak değerlendirildi.
Bulgular: 28 (19 E, 9K) hastamız kliniğimizde HH tanısı ile operasyonları yapıldı. Ortalama yaş 16.8 (1-168) aydı. 20’sine “Transanal Endorektal Pull –through (TERPT)”, 5’ine Duhamell operasyonu, 3’üne Soave prosedürü uygulandı. 20 TERPT hastasını 4’ü laparoskopi yardımlı yapıldı, diğer 16’sının birine ve 5 Duhamel yapılan hastanında 1’ine perop laparoskopi yapıldı ve biyopsiler alındı. Üç hastaya Soave prosedürü uygulandı. Bu hastalardan birine de laparoskopi yapılıp preop biyopsiler alındı, birisi TERPT sonrası enterokolit ve darlık gelişen patolojik analizinde nöronal intestinal displazi olan hastaydı, diğeride total kolonik HH olan kolonik patch yapılan hastaydı. Hastalarımızın hiçbirinde postop yoğun bakım ihityacı ve eksitus olmadı. Hastanede kalış süresi ortalama 8.75 (2-14) gündü. Patoloji raporlarından alınan sonuçlara göre çıkarılan barsak segmenti ortalama uzunluğu 23.6 (5-38 ) cmdi. Enterokolit sıklığı %25 di. Enterokolit gelişen 7 hastamızın 5 (% 25)’ine TERPT, 2 (%40)’sine Duhamel yapılmıştı. Bu hastalarda sadece biri total kolonik HH’dı. Total kolonik hastalarının 2’sine Duhamell-Martin, 1’ine Kimura yöntemi ile hazırlanan kolonik yama ile Soave prosedürü uygulandı. Enterokolit sıklığı iki hastada 3 kere, iki hastada 2 kere, üç hastada 1 kere gelişti. Bu hastaların tedavileri rektal yıkama ve geniş spektrumlu antibiyotik ile yapıldı. Anal darlık TERPT yapılan 2 hastamızda gelişti dilatasyonlara cevap verdi. Gayta inkontinans oranı %3 (1/28)’dü, laksatifler ve tuvalet eğitimi ile tedavi edildi. Hastaların ortalama takip süresi 35.5 (2-56) aydı.
Sonuç: Hirschsprung Hastalığının tedavisinde TERPT yöntemi öncelik kazanmış olup diğer prosedürler de önemini korumaktadır. Laporoskopi yardımlı TERPT’de biyopsi almadaki kolaylığı, geçiş zonunun görülmesindeki faydası, mezo hazırlamadaki avantajı ve gergin olmayan anastomoz yapmayı sağladığı için kliniğimizde tedavide yerini almıştır. (SETB-2018-07-096)
Objectives: This study aims to evaluate patients who were diagnosed and treated due to Hirschsprung disease (HD) in our clinic.
Methods: We retrospectively evaluated the demographic and clinical findings of the patients with HD, who were operated in our clinic between January 2010 and December 2015.
Results: During study period, 28 patients (19 male 9 female) were found to be operated due to HD in our clinic. Mean age was 16.8 months (1-168). “Transanal Endorectal Pull–through (TERPT)” was performed to 20 of them, Duhamell procedure to five and Soave procedure to three of them. TERPT was applied as laparoscopy assisted in four of them and biopsies were taken laparoscopically preoperatively from one of the patients from each group. Soave procedure was performed in three patients; one had anal stenosis and history of recurrent enterocolitis after TERPT procedure and pathologic analysis revealed neuronal intestinal dysplasia and the other one had total colonic HD and performed Soave procedure with colonic patch. Seven (25%) patients had enterocolitis. Frequencies of enterocolitis were three in two patients, two in two patients and one in three patients. Broad spectrum anibiotics and rectal washouts were supplied to these patients. Five of the seven patients with enterocolitis were operated with TERPT; two patients were operated with Duhamell procedure. Only one of them had total colonic HD. Three patients had total colonic HD diagnosis. Two of them were operated with Duhamell-Martin procedure and one was with Soave procedure with colonic patch according to Kimura technique. Anal stenosis developed in two patients after TERPT and treated with dilatations. Soiling rate was 3% (1/28) and this single patient was treated with laxatives and toilet training. Mean duration of hospitalization was 8.75 (2-14) days. Mean length of the removed intestinal segment was 23.6 (5-38) cm. Mean follow-up was for 35.5 (2-56) months. Neither of the patients was followed in the intensive care unit postoperatively nor died.
Conclusion: TERPT procedure win priority in HD, but other procedures keep importance. Recently, laparoscopy-assisted TERPT is preferred in our clinic in HD therapy due to easy biopsy, full exposure to the transitional zone, the advantage of meso preparation of colon and prevention of strained anastomosis.

16.Clinical Characteristics of and Cancer Incidence in Children Evaluated for Lymphadenoapthy Referred to Pediatric Oncology Clinics
Sema Vural, Dildar Bahar Genç, Ezgi Çelikboya
PMID: 32617063  PMCID: PMC7326673  doi: 10.14744/SEMB.2018.34603  Pages 222 - 226
Amaç: Lenfadenopati (LAP) çocukluk çağında sık karşılaşılan bir klinik bulgudur. Çoğunlukla reaktif ve iyi seyirli olup etyolojisinde çocukluk çağı kanserleri nadiren yer alır. LAP nedeniyle izlenen hastalar arasındaki kanser sıklığı merkezlere göre farklılık gösterir. Birinci basamakta hastaların çok az bir bölümü kanser tanısı alırken onkoloji polikliniği gibi referans merkezlerinde sıklık artar. Hastaların kanser riski açısından yeterince değerlendirilmeden sevk edilmesi, referans merkezlerindeki kanser oranını azaltır. Çalışmamızda, LAP nedeniyle çocuk onkoloji polikliniğine gönderilen hastaların klinik, laboratuvar özelliklerinin ve kanser sıklığının araştırılması amaçlandı.
Hastalar ve Yöntem: Çocuk onkoloji polikliniklerimize Ocak 2014-Aralık 2016 arasında başvuran LAP’lı hastaların kayıtları geriye dönük olarak inceledi. Yaş, cinsiyet, yakınma süresi, uygulanan tedavi, sistemik belirti ve bulgular, lenf nodunun özellikleri, laboratuvar sonuçları kaydedildi; kanser sıklığı hesaplandı.
Bulgular: Yaşları 4 ay-17 yaş arasında (ortanca 6 yaş) değişen, 34 kız, 100 erkek 134 hasta çalışma grubunu oluşturdu. Lenf nodlarının %98’i bölgesel, bunların % 87’si baş-boyun bölgesinde olup, fizik muayenede boyutları 0.5-5 cm arasında değişiyordu (ortanca 2 cm). Olguların 21’ine (% 15.6 ) biyopsi yapıldı. Patolojik incelemede dört hastada LAP dışı nedenler (perfore epidermal kist, lenfanjiom, pilomatrikoma, ektopik timus) saptandı. Diğer biyopsilerin dokuzu reaktif LAP, dördü lenfadenit, dördü Hodgkin lenfoma tanısı aldı. Kanser tanısı alan tüm hastalarda LAP boyutu 2,5 cm’den büyük ve LAP saptandıktan sonra geçen süre dört haftadan uzundu. Bu olguların üçünde LAP’a sistemik bulgular eşlik ediyordu.
Sonuç: Kanser şüphesi ile çocuk onkolojisi polikliniğine gönderilen LAP’lı hastaların yalnızca % 3’ü kanser tanısı aldı. Bu oran diğer pediatik onkolojiBir referans merkezi için çok düşük olan bu oran, birinci basamak sağlık merkezlerinde izlenebilecek hastaların yeterince değerlendirilmeden ve risk faktörleri gözetilmeden onkoloji polikliniğine yönlendirildiğini düşündürdü. (SETB-2018-05-075)
Objectives: In our study, we aimed to investigate the clinical characteristics and cancer frequency in patients referred to our pediatric oncology outpatient clinic for lymphadenopathy.
Methods: The charts of patients admitted to our pediatric oncology outpatient clinics for lymphadenopathy between January 2014, and December 2016 were retrospectively reviewed in this study. Age, gender, duration of complaints, previous therapies, systemic signs and symptoms, lymph node characteristics and laboratory findings were recorded. The frequency of malignancy was calculated.
Results: One hundred thirty-four patients (34 girls) with a median age of six years (range four months-17 years) were included in our study. The majority of the patients (98%) had localized lymphadenopathy and the head and neck region was the most common site of involvement (87%). The median long-axis diameter of lymph nodes ranged between 0.5 cm and 5 cm (median 2 cm) by physical examination. Twenty-one patients (15.6%) had lymph node biopsy. Four patients had ruptured epidermal cyst, lymphangioma, pilomatricoma and ectopic thymus. Of the other biopsies, nine patients were diagnosed with reactive LAP, four with lymphadenitis, and four with Hodgkin’s disease. The lymphoma patients had lymph node size greater than 2.5 cm and the duration of lymphadenopathy was longer than four weeks. Three out of four patients had systemic clinical findings accompanying lymph node enlargement.
Conclusion: Three percent of the patients with lymphadenopathy who were referred for suspected malignancy received a cancer diagnosis. This rate, which is too low for a reference center, suggested that the patients might be referred to the pediatric oncology outpatient clinic without a thorough evaluation in primary health care.

17.The Importance of Neurological Examination for the Indication of Computed Tomography of the Brain in Pediatric Emergency Room
Nezir Ozgun, Hepsen Mine Serin, Aysegul Cansu, Ali Cansu
PMID: 32617064  PMCID: PMC7326665  doi: 10.14744/SEMB.2018.80457  Pages 227 - 230
Amaç: Bu çalışmanın amacı, çocuk hekimlerinin hastayı radyasyondan koruma farkındalığını artırmak, Bilgisayarlı Beyin Tomografisi (BBT)’nin doğru endikasyonda kullanılıp kullanılmadığı ve nörolojik muayenenin belirleyici faktör olup olmadığını değerlendirmektir.
Gereç ve Yöntemler: Ocak 2005-Aralık 2010 tarihleri arasında Çocuk Acil Polikliniği’mize başvuran travma dışı, kronik hastalığı olmayan ve BBT çekilen 342 olgunun retrospektif olarak, başvuru şikayeti, nörolojik muayene bulguları ve BBT sonuçları değerlendirildi. Nörolojik muayenede saptanan patoloji ile uyumlu anormal BBT bulgu varlığının sensivite ve spesifitesi hesaplandı.
Bulgular: BBT çekilen 342 olgunun 319’unda sonuçlar normal, 23 olguda anormal olarak değerlendirilmişti. Nörolojik muayenesi normal olan 301 hastanın sadece 3’ ünde (%0.99) BBT sonucu anormal olarak rapor edilmişti. Nörolojik muayenesi anormal olan 41 hastanın ise 20’sinde (%48.8) BBT anormal olarak saptanmıştı. İki grup arasındaki fark istatistiksel olarak anlamlıydı (p=0.001). Nörolojik muayenede saptanan patoloji ile uyumlu anormal BBT bulgu varlığının sensivitesi %87 ve spesifitesi %94 olarak hesaplandı.
Sonuç: Çocuk acil servis hastalarında ayrıntılı nörolojik muayene BBT çekim endikasyonunu belirlemede anahtar role sahiptir. Nörolojik muayenesi normal olan çocuklarda nöroradyolojik görüntülemenin hemen yapılmayıp, klinik takip sonucuna göre karar verilmesi daha uygun bir yaklaşım olabilir. (SETB-2018-05-079)
Objectives: In this study, records of the children who underwent Computed Tomography of the Brain (CTB) were reviewed to increase the awareness of pediatricians to protect patients from radiation, whether CTB was used with right indications or if it was determinative for diagnosis.
Methods: In total, in this study, 342 cases applied to our Pediatric Emergency Polyclinic between January 2005-December 2010 were retrospectively evaluated regarding complaints at admission, neurological examination and CTB results. The sensitivity and specificity of the neurological examination in detecting the CTB pathology was determined.
Results: The results were normal in 319 of the 342 cases with CBT and abnormal in 23, out of which abnormal CTB results were only in three (0.99%) of the 301 patients with normal neurological examination results and in 20 (48.8%) of 41 patients with abnormal neurological examination results. The difference between the two groups was statistically significant (p=0.001). The sensitivity and specificity of the neurological examination in detecting CTB pathology were 87% and 94%, respectively.
Conclusion: Detailed neurological examination of the patients in the pediatric emergency department has a key role in determining the indications for CTB. Clinical follow-up should guide neuroradiological imaging in children with normal results of the neurological examination.

18.Our Ultrasound Guided Brachial Plexus Block Experiences for Upper Extremity Surgeries in Pediatric Patients
Mustafa Aliınay, Hacer Sebnem Turk, Naim Ediz, Mehmet Ali Talmac, Sibel Oba
PMID: 32617065  PMCID: PMC7326672  doi: 10.14744/SEMB.2018.98958  Pages 231 - 235
Amaç: Brakial pleksus blokları çocuk hastalarda üst ekstremite ameliyatlarında en etkin analjezi ve anestezi yöntemidir. Son yıllarda brakial pleksus bloklarının ultrason eşliğinde yapılması pnömotoraks, intravasküler enjeksiyon, sinir hasarı gibi büyük komplikasyonları ve işlem başarısızlığı oranını azaltmıştır. Ancak özellikle çocuk hastalarda brakial pleksus bloklarıyla ilgili çalışmalar yetersiz sayıdadır. Biz çalışmamızda, kliniğimizde ultrason eşliğinde brakial pleksus bloğu uygulanan çocuk hastaların verilerini geriye dönük inceleyerek, bu hasta grubunda brakial pleksus bloğunun etkinliğini ve güvenliğini tartışmayı amaçladık.
Gereç ve Yöntem: Ocak 2015- Ocak 2017 tarihleri arasında kliniğimizde ultrason eşliğinde brakial pleksus bloğu uygulanan çocuk hastaların verileri geriye dönük incelendi. Demografik verileri, tanıları, işlem ve ameliyat süreleri, kullanılan ilaçlar, motor ve sensoriyel blok süreleri kaydedildi.
Bulgular: Ocak 2015- Ocak 2017 tarihleri arasında kliniğimizde ultrason eşliğinde üst ekstremite periferik sinir bloğu uygulanan çocuk hasta sayısı 24’tü. Bu hastaların 15’inde supraklavikular, 9’unda infraklavikular blok uygulanmış. Hastaların yaş ortalaması 9,6±3,12 idi. E/K oranı 14/10’du. İşlem süresi ortalaması supraklavikular blok uygulanan hastalarda 9,54±2,14 dakika, infraklavikular blok uygulanan grupta 12,9±2,8 dakikaydı. Operasyon süreleri ortalama 64±13,6 dakikaydı. Lokal anestezik olarak 21 hastada bupivakain+lidokain, 3 hastada bupivakain kullanılmış, 8 hastada adjuvan eklenmiş. İşlem 12 hastada genel anestezi altında, 12 hastada sedasyon altında uygulanmış. Ortalama motor blok süresi supraklavikular blok uygulanan hastalarda 7,5±2 saat, infraklavikular blok uygulanan hastalarda 7,4±1,5 saat idi. Ortalama sensoriyel blok süresi supraklavikular blok uygulanan hastalarda 10,5±1,7 saat, infraklavikular blok uygulanan hastalarda 10,45±1,15 saat idi. Adjuvan eklenen hastaların ortalama motor blok süresi 7,7 ±0,5 saat, sensoriyel blok süresi 11,12±1,1 saatti. Hastaların hiçbirinde işlem esnasında, intraoperatif ve postoperatif takipte komplikasyon görülmemiş.
Sonuç: Çocuk hastalarda ultrason eşliğinde yapılan brakial pleksus blokları uzun analjezi süresi sağlamaları ve düşük komplikasyon oranları ile etkin ve güvenlidir. Bu konuda daha geniş hasta sayısı olan prospektif çalışmalara ihtiyaç vardır. (SETB-2018-04-051)
Objectives: Brachial plexus block is the most effective analgesia and anesthesia procedure for the upper extremity surgeries in pediatric patients. In recent years, ultrasound guidance for this procedure has reduced the fail and complications like pneumothorax, intravascular injection and nerve damage. However, the number of studies about brachial plexus block is not enough, particularly in pediatric patients, which remained under-researched. In our study, we aimed to discuss the efficacy and safety of the ultrasound-guided brachial plexus block in pediatric patients by retrospectively examining their data.
Methods: We retrospectively reviewed the data of pediatric patients who underwent ultrasound-guided brachial block in our clinic between January 2015-January 2017. Demographic data, diagnosis, procedure and operation times, medications, motor and sensorial block times were recorded.
Results: Between January 2015 and January 2017, the number of pediatric patients who underwent ultrasound-guided peripheral nerve block in our clinic was 24. In 15 of these patients, the supraclavicular block was applied in 15, and the infraclavicular block was applied in nine patients. The mean age of the patients was 9.6±3.12, with a male/female ratio 14/10. The mean duration of the procedure was 9.54±2.14 minutes in patients for the supraclavicular block and 12.9 ± 2.8 minutes for the infraclavicular block. The mean surgery time was 64±13.6 minutes. As a local anesthetic, bupivacaine was used in three patients; bupivacaine+lidocaine combination was used in 21 patients and adjuvants were added in eight patients. The block procedure was performed under general anesthesia in 12 patients and under sedation in 12 patients. The mean motor block time was 7.5±2 hours in patients who received supraclavicular block, and 7.4±1.5 hours in patients who received infraclavicular block. The mean sensorial block time was 10.5±1.7 hours in the supraclavicular block, and 10.45±1.15 hours in the infraclavicular block. The mean motor block period with added adjuvants was 7.7±0.5 hours, and the sensorial block period was 11.12±1.1 hours. No complications were seen during the procedure, intraoperative and postoperative follow-up.
Conclusion: Ultrasound-guided brachial plexus block in pediatric patients is effective and safe, with longer analgesia duration and lower complication rates. Prospective studies with a larger number of patients are needed in this regard.

19.Efficacy and Side Effect Profile of Clobazam in Children with Different Etiologies of Epilepsy from a Single Center
Tugce Aksu Uzunhan, Zeynep Gor
PMID: 2617066  PMCID: PMC7326669  doi: 10.14744/SEMB.2020.60252  Pages 236 - 244
Amaç: Klobazam çocukluk çağı epilepsilerinin tedavisinde politerapide kullanılan uzun etkili bir benzodiazepin grubu antiepileptiktir. Amacımız çoğu ilaca dirençli epilepsi olan farklı etiyolojili çocuklarda klobazamın etkinliği ve yan etki profilini retrospektif olarak değerlendirmektir.
Gereç ve Yöntemler: Okmeydanı Eğitim ve Araştırma Hastanesi çocuk nöroloji polikliniği’ne Ocak 2017- Ocak 2019 arasında başvuran epilepsi nedeniyle klobazam reçete edilmiş 0-18 yaş arası 40 hasta çalışmaya alındı. Aydınlatılmış onam alınan hastaların verileri çocuk nöroloji poliklinik notlarından retrospektif olarak tarandı. Nöbetsiz ve nöbetlerde >%50 azalma olan gruplara klobazam yanıtlı, nöbetlerde <%50 azalma, yanıtsız, ilaç yan etkisi nedeniyle ilacı kesilen hastalar klobazam yanıtsız gruba dahil edildi.
Bulgular: Hastaların 23’ü (%57,5) erkek, 17’si (%42,5) kız idi. Epilepsi başlama yaşı ortalaması 31,8 ± 37,2 ay, klobazam başlama yaşı ise 70,6 ± 48,9 ay idi. Nöbet tipleri 23 (%57,5) hastada fokal, 17 (%42,5) hastada generalize başlangıçlı idi. Otuz üç (%82.5) hasta klobazam tedaviye eklendiğinde sekiz farklı antiepileptik ilacın ikili veya üçlü kombinasyonlarını kullanıyordu ve ilaca dirençli epilepsi olarak kabul edildiler. Yirmi (%52,5) bir hastanın etiyolojisi bilinmiyordu, geri kalan 19 (%47,5) hastada ise en sık yapısal etiyolojiler olmak üzere genetik, enfeksiyöz ve metabolik sebepler saptandı. Hastaların 31’i (%77,5) klobazam yanıtlı olarak kabul edildi. Bunlardan on beş (%37,5) hasta nöbetsiz, 16’sının (%40) nöbetlerinde >%50 azalma mevcuttu. Dokuz (%22,5) hasta klobazama yanıtsız değerlendirildi. Ortalama doz 0,7 ± 0,3 mg/kg/gün, mediyanı 0,63 mg/kg/gün idi. Klobazam yan etkileri toplam 18 (%45) hastada görüldü, yan etkiler sadece altı (%15) hastada ilaç kesimi ile sonuçlandı. İlaç kesimine neden olan yan etkiler sedasyon, tada bağlı ilacı içmek istememek, irritabilite, salya artışı, halsizlik idi. Dört (%10) hastada doz azaltıldı, klobazam yanıtlı yedi (%17,5) hastada yan etkilere rağmen ilaca aynı dozda devam edildi. Tüm hastalarda en sık rastlanan yan etkiler sırasıyla hiperaktivite ve sedasyon idi.
Sonuçlar: Klobazam çoğunluğu ilaca dirençli epilepsi olan çocuk hastalarda nöbetsizliği sağlamada etkili bir tedavidir. Yan etkiler ilaca yanıtlı hastalarda tolere edilebilir düzeydedir.
Objectives: Clobazam is a long-acting antiepileptic drug that belongs to benzodiazepines used in the polytherapy of childhood epilepsy. In this study, our aim is to retrospectively evaluate the effectiveness and side effect profile of clobazam in children with different etiologies of epilepsy, mostly drug resistant.
Methods: Forty patients aged 0-18 years that were admitted to Okmeydanı Training and Research Hospital pediatric neurology outpatient clinic between January 2017–January 2019 and prescribed clobazam were included in this study. The data of the patients who gave informed consent were extracted retrospectively from the outpatient clinic files. The patients with no seizures over 50% reduction in seizures were classified as clobazam-responsive, whereas the patients with less than 50% reductions in seizures, patients who had no response, and who manifested side effects and stopped using the drug were classified as clobazam-unresponsive.
Results: Twenty-three of the patients (57.5%) were male, 17 were (42.5%) were female. The average onset age of epilepsy was 31.8±37.2 months, while the average age for the prescription of clobazam was 70.6±48.9 months. The types of seizures were focal in 23 patients (57.5%) and generalized in 17 (42.5%) patients. Thirty-three (82.5%) patients had been using double or triple combinations of eight different antiepileptic drugs when clobazam was added to their treatment and accepted as drug-resistant epilepsy. The etiology of twenty one patients (52.5%) was unknown. In the remaining 19 patients (47.5%), the most common cause was structural and others were genetic, infectious and metabolic. Thirty one of the patients (77.5%) were responsive to clobazam. Of them, fifteen (37.5%) had no seizures, and 16 had a reduction in seizures (>50%). Nine (22.5%) patients were accepted as unresponsive to clobazam. The mean dose per kg was 0.7±0.3 mg/kg/day with a median of 0.63 mg/kg/day. Side effects of clobazam were encountered in 18 patients (45%); these resulted in the cessation of administration in only six (15%) patients. The side effects that cause the cessation of clobazam were sedation, refusal to take the drug due to the taste, irritability, hypersalivation, and malaise. Four patients (10%) had their doses reduced, seven patients (17.5%) responsive to clobazam although with side effects continued taking the drug as prescribed. The most common side effects of all were hyperactivity and sedation consecutively.
Conclusion: Clobazam is an effective treatment for ensuring seizure freedom in pediatric epilepsy, mostly drug-resistant. The side effects are at tolerable levels in patients who are responsive to the drug.

20.Intraoperative Imprint-squash Methods in Central Nervous System Tumors
Canan Tanik, Fevziye Kabukcuoglu
PMID: 32617067  PMCID: PMC7326685  doi: 10.14744/SEMB.2020.08466  Pages 245 - 251
Santral sinir sistemi (SSS) tümörleri, erişkinlerde tüm kanserlerin %1.3'ünü oluşturmakta ve gelişmiş ülkelerde yedinci önde gelen ölüm nedenidir.SSS tümörleri makroskopik olarak çok yumuşak kıvamda ve jelatinöz görünümdedir. İntraoperatif squash smear tekniği, beyin tümörlerinin tanısında pek çok çalışmada kullanılmakla birlikte çok basit ve hızlı bir yöntemdir. Çalışmamızda SBÜ Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi Beyin ve Sinir Cerrahisi Kliniği’nde opere edilerek Patoloji Kliniği’ne 2 yıl içinde gönderilen 100 olguya ait imprint lam¬ları intraoperatif konsültasyon ile yorumlandı.Daha sonra standart doku takip işlemleri ile hazırlanan parafin bloklara ait kesitler histopatolojik olarak değerlendirildi, birlikte sonuçlandırıldı. İncelediğimiz 100 olguluk seride ana hedefimiz olan ma¬lign - benign tümör ayırımında olguların % 94 inde başarılı olundu. Malign –benign ayırımında % 94,tümör tiplendirmesinde ve gradelendirmesinde % 90 oranında olup çok küçük doku parçaları ile ça-lışılmıştır.. Tanı yanılgısı genellikle solid sert tümörler, epitelyal orjinli kistik yapılar ve çocukluk çağı posterior fossada lokalize medulloblastom, ependimom olgularının ayrımında oldu. Ancak bu yöntem teknik olarak kolay oluşu, ucuzluğu, ekipmanda tasarruf nedeniyle uygulamada oldukça elverişli bulundu. (SETB-2019-06-093)
Objectives: Central nervous system (CNS) tumors constitute 1.3% of all cancers in adults and are the seventh leading cause of death in developed countries. CNS tumors are very soft and have a gelatin-like texture. Smear technique is a very simple and fast method for the diagnosis of brain tumors.
Methods: In this study, we evaluated the imprint and squash cytology of 100 cases sent to the pathology clinic. The sections of the paraffin blocks were prepared after the operation in the neurosurgery clinic of the SBU Hamidiye Şişli Efal Training and Research Hospital. The accuracy rate was 90% in the differential diagnosis of malignant tumors from the benign ones.
Conclusion: Cytological samples were taken from 100 cases of intracranial tumors that were operated in the neurosurgery clinic of Şişli Etfal Hospital, and the paraffin sections prepared from the biopsy materials were examined. The cases with misdiagnosis were usually differentiated from solid-hard tumors, epithelial-grade cystic structures, and medulloblastoma localized in the posterior fossa, medulloblastoma and ependymoma. However, this method has been found to be very convenient in practice due to its ease technically, low cost and equipment savings.

CASE REPORT
21.Metformin-Associated Lactic Acidosis Developed as a Result of a Suicidal Attempt
Habibe Zehra Vural, Omer Faruk Koseoglu, Serhat Soylu, Ulku Aygen Turkmen
PMID: 32617068  PMCID: PMC7326677  doi: 10.14744/SEMB.2018.35582  Pages 252 - 256
AMAÇ: Metformin Tip2 DM tedavisinde sık kullanılan biguanid grubu bir ilaçtır. Metformin ilişkili laktik asidoz (MİLA) görülme sıklığı düşük olmakla beraber yüksek mortalite oranları ile birliktedir.Bu olgu MİLA tedavisinde hemodiyaliz ve CVVHDF tedavi etkinliğine dikkat çekmek amacıyla sunulmuştur.
OLGU: 25 yaşında kadın hasta karın ağrısı,şuur bulanıklığı ile acil servise getirilmiştir. Detaylı anamnezinde 100 adet 1000 mg metformin tablet aldığı öğrenilmiştir. Laboratuar tetkiklerinde derin metabolik asidoz,üre kreatinin yüksekliği ve hiperkalemi görülen hastaya acilen hemodiyaliz uygulanmıştır. Sonrasında Glasgow Koma Skalası düşen hasta (GKS: 3) entübe edilmiş ve hipotansif olması nedeniyle vazopressor ajan başlanmıştır. Yoğun bakım ünitesinde kş: 44 mg dl-1 olarak görülmesi üzerine %10 dextrozlu mayi uygulanmıştır. Anüri ve metaboli kasidoz nedeniyle CVVHDF tedavisi başlanmıştır.Yatış süresi boyunca 12 gün CVVHDF tedavisi uygulanan hasta ybü yatışının 23.gününde şuur açık vitalleri stabil olarak nefroloji servisine ekterne edilmiştir.
SONUÇLAR: Sonuç olarak metformin ilişkili laktik asidoz tanısı konulan hastalarda ilk olarak düşünülmesi gereken tedavi yöntemi hemodiyaliz ve CVVHDF olmalıdır. Hızlı başlanılan ve yeterli süre devam edilen renal replasman tedavileri mortalite oranı yüksek olan bu tabloda umut vericidir. (SETB-2018-05-069)
Metformin is a biguanide group drug commonly used in the treatment of Type 2 DM. Even though Metformin- Associated Lactic Acidosis (MALA) is not seen very frequently, MALA has a high mortality rate. This case is presented to draw attention to efficiency of hemodialysis and CVVHDF tin the treatment of MALA.
A 25-year-old female patient was brought to the emergency service with abdominal pain and confusion. In her detailed history, it was learned that she took 100 tablets of metformin (1000 mg per tablet). Hemodialysis initiated because of severe metabolic acidosis, elevation of blood urea and hyperkalemia were seen in laboratory results. After that, patient was intubated because of low Glasgow Coma Scale (GCS: 3) and vasopressor agent were started due to hypotension. In the intensive care unit, blood glucose was seen 44 mg dl-1 and treated with 10% dextrose solution. CVVHDF treatment was started because of anuria and metabolic acidosis. Patient who underwent CVVHDF treatment for 12-days transferred to nephrology service on the 23rd day of the ICU admission with full consciousness and stabilized vitals.
In conclusion, hemodialysis and CVVHDF should be the first treatment methods to be considered in patients with metformin-associated lactic acidosis. Renal replacement therapies, initiated rapidly and maintained for an adequate time period are promising in this high mortality rate cases.

22.Giant Fibroepithelial Polyps: Why do they Grow Excessively?
Bilgen Can, Arzu Yıldırım Özlük
PMID: 32617069  PMCID: PMC7326686  doi: 10.14744/SEMB.2018.33603  Pages 257 - 260
Fibroepitelyal polip, akrokordon ya da skin tag, genellikle aksilla, genital bölge ya da boyun gibi cilt katlantılarında oluşan iyi huylu tümörlerdir. Soliter ya da multiple olabilirler. Boyutları genellikle 1-2 milimetreyi geçmez. Bazen aşırı büyüme göstererek dev boyutlara ulaşabilirler. Literatürde boyutları 42 santimetreye ulaşmış dev fibroepitelyal polip olgusu mevcuttur.
Etyolojisi ve aşırı büyümeye neden olan faktörler aydınlatılamamış olmakla birlikte, obezite ve insulin rezistansının büyümeye neden olabileceği belirtilmektedir. Ayrıca son yıllarda tanımlanmış olan lenfödematoz fibroepitelyal polip olguları göstermektedir ki uzun süreli lenf stazı ve kronik enflamasyon fibroepitelyal polipte büyümeye neden olabilmektedir.
Biz 21 yaşında, göğüs ön duvarında orta hatta yerleşmiş boyutları 14x6 santimetre olan dev fibroepitelyal polip olgusunu sunduk. Literatürde sunulmuş, bu lokalizasyondaki tek olgudur. Bu nedenle özellik arzetmektedir. Olgumuzu tanı, tedavi ve büyümeye neden olan faktörler açısından literatür taraması ile birlikte sunduk. (SETB-2018-06-086)
Fibroepithelial polyps (acrochordon or skin tag) are benign tumors that usually occur in skin folds, such as the axilla, genital area or neck. They can be solitary or multiple. Their dimensions usually do not exceed 1-2 millimeters. Sometimes, they can reach huge dimensions. In the literature, a giant fibroepithelial polyp with a size of 42 centimeters has been reported. Although the etiology and the factors that cause excessive growth have not been elucidated, it is stated that obesity and insulin resistance might trigger growth. Lymphedematous fibroepithelial polyps described in recent years show that prolonged lymphatic stasis and chronic inflammation may lead to the growth of fibroepithelial polyps. We present a 21-year-old patient with a giant fibroepithelial polyp with a size of 14x6 centimeter, located in the midline on the anterior chest wall. To our knowledge, this is the first case in the literature, in this location, which makes our case unique. Herein, we presented our patient along with the review of current literature pertaining to the diagnosis and the treatment of fibroepithelial polyps (FEPs) and the factors leading to excessive growth.

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