Endokrin patolojide frozen kesit (FS) inceleme en sýk tiroid ve paratiroid tümörleri ve servikal lenf nodlarýnýn intraoperatif deðerlendirilmesinde kullanýlmaktadýr. Geçmiþte tiroid cerrahisinde frozen inceleme temel araç olarak deðerlendirilmekteydi. Preoperatif utrasonografi ve ince iðne aspirasyon biyopsisi (FNAB)’ndeki geliþmelere baðlý olarak preoperatif tanýnýn artmasý ile son zamanlarda rutin kullanýmý ile ilgili sorgulamalar artmaktadýr. Günümüzde tiroidektomi sýrasýnda FS kullanýmý azal-makla birlikte halen farklý amaçlarla intraoperatif ek yöntem olarak kullanýlmaktadýr. FS her zaman kesin sonuç vermeyebilir. FS operasyon planýný ve geniþliðini deðiþtirecekse uygulanmalýdýr. Tiroid nodüllerinin deðerlendirilmesinde rutin FS önerilmemektedir. Eðer FNAB ek olarak FS sonuçlarý operasyon planýný veya operasyon geniþliðini deðiþtirecekse kullanýlabilir. FS 1 cm’den küçük tiroid lezyonlarýnda uygulanmamalýdýr ve bir lezyonun tümü FS için dondurulmamalýdýr. Tiroid nodülle-rinde FNAB Bethesda kategorilerine göre FS kullanýmýna karar verilebilir. FS Bethesda I kategori nodüllerin malign benign ayrýmýna ve cerrahi tedavisinde katký saðlayabilir. Bethesda II nodüllerde mlignite oraný düþük olup FNAB ile FS performansý karþýlatýrýlabilir olup, cerrahi startejiye anlamlý katkýsý olmadýðýndan önerilmemektedir. Bethesda III ve IV nodüllerde FS’nin sensitivitesi düþük, tanýya katkýsý sýnýrlý olup, tedaviye anlamlý katký saðlamadýðý için önerilmemektedir. Bethesda V no-düllerde FS nodüllerin malignite tanýsýný doðrulamada etkili olup, cerrahi stratejiye anlamlý katký sað-layarak tamamlayýcý tiroidektomi olasýlýðýný azaltabilir ve kullanýlmasý önerilmektedir. Bethesda V nodüllerde FS benign rapor edilen nodüllerde malignite oraný yüksek olup, maligniteyi dýþlamada kullanýlmamalýdýr. Bethesda VI nodüllerde FS’nin performansý FNAB’den düþük veya karþýlaþtýrýla-bilir ve tedavi stratejisine anlamlý katký saðlamayacaðý için kullanýlmasý önerilmemektedir. Özellikle papiller tiroid kanserli hastalarda intraoperatif FS’ýn ekstratiroidal yayýlýmý saptamada etkili olup, ti-roid cerrahisinin geniþliði ve santral diseksiyon geniþliði konusunda cerraha yardýmcý olabilir. FS santral bölgenin lenfatik durumunun intraoperatif olarak deðerlendirilmesinde yüksek duyarlýlýk ve özgüllüðe sahip yararlý bir araç olup, santral bölge nod diseksiyonu geniþliðini belirlemede kullaný-labilir. Tiroidektomi sýrasýnda FS inceleme paratiroid dokusunun tanýnmasýnda ve yað dokusu, timüs, tiroid, lenf nodu özellikle de metastatik lenf nodundan ayrýmýnda kullanýlabilir. (SETB-2023-12-239)

In endocrine pathology, frozen section (FS) examination is most commonly used for the intraoperative evaluation of thyroid and parathyroid tumors, as well as cervical lymph nodes. In the past, frozen section was considered a fundamental tool in thyroid surgery. However, with advancements in preoperative ultrasound and fine-needle aspiration biopsy (FNAB), there have been increasing queries about its routine use due to the improved preoperative diagnosis. Nowadays, while the use of FS during thyroidectomy has decreased, it is still used as an additional method for different purposes intraoperatively. FS may not always provide definitive results. If FS will alter the surgical plan or extent, it should be applied. Routine FS is not recommended for evaluating thyroid nodules. But in addition to FNAB, if FS results may change the operation plan or extent, they can be utilized. FS should not be applied for thyroid lesions smaller than 1 cm, and the entire lesion should not be frozen for FS. For the assessment of thyroid nodules, the use of FS is recommended based on the Bethesda categories of FNAB. In Bethesda I category nodules, FS may contribute to distinguishing between malignant and benign lesions and guide surgical treatment. In Bethesda II nodules, where the malignancy rate is low, the performance of FNAB and FS can be compared, but it's not recommended due to the lack of a significant contribution to the surgical strategy. The sensitivity of FS in Bethesda III and IV nodules is low; its contribution to the diagnosis is limited, and it does not provide an apparent benefit to treatment; therefore, it is not recommended. In Bethesda V nodules, FS can effectively confirm the malignancy diagnosis, contribute to the surgical strategy, and reduce the possibility of completion thyroidectomy, and accordingly, it is recommended for use. Nonetheless, in Bethesda V nodules with a benign FS report, the malignancy rate remains high, so it should not be used to rule out malignancy. In Bethesda VI nodules, the performance of FS is lower or comparable to FNAB and does not significantly contribute to the treatment strategy; hence, it is not recommended. Particularly in patients with papillary thyroid cancer, intraoperative FS can be effective in detecting extrathyroidal extension and can assist the surgeon in determining the extent of thyroid surgery and central neck dissection. FS has high sensitivity and specificity in evaluating the lymphatic status of the central region intraoperatively and can be used to determine the extent of central compartment node dissection. During thyroidectomy, FS examination can be used in recognizing parathyroid tissue and distinguishing it from fatty tissue, thymus, thyroid, lymph nodes, especially in differentiating metastatic lymph nodes.

Amaç: Diferansiye tiroid karsinomunda (DTC) radyoaktif iyot (RAI) genellikle remnant ablasyonu veya adjuvan tedavi amacýyla kullanýlmaktadýr. Orta risk (InR) grubu hastalar için RAI kararý halen tartýþma konusudur. Bu çalýþmanýn amacý, düþük riskli (LoR) veya InR olarak sýnýflandýrýlan papiller tiroid kanseri (PTC) hastalarýnda erken postoperatif risk deðerlendirmesinin RAI kullanýmýna etkisini analiz etmektir.
Gereçler ve Yöntemler: Bu, tek merkezli, prospektif bir kayýt çalýþmasýdýr. Ocak 2012 ile Aðustos 2021 tarihleri arasýnda ameliyat edilen ve LoR veya InR olarak sýnýflandýrýlan 186 hasta bu çalýþmaya dahil edildi. Tüm hastalara ayný endokrin cerrah tarafýndan total tiroidektomi (TT) ve santral lenf nodu diseksiyonu (CLND) uygulandý. Her hastaya ameliyattan sonra altýncý haftada boyun ultrasonografisi (US), serum tiroglobulin (Tg) ve anti-tiroglobulin (Anti-Tg) düzeylerinden oluþan bir erken dinamik risk deðerlendirmesi (EDRA) yapýldý. Hastalarýn çoðu ya RAI uygulanmadan izlendi ya da önceden belirlenmiþ kriterlere göre ablatif düþük aktivite (30-50 mCi) RAI aldý.
Sonuçlar: Medyan takip süresi 63 ay idi. LoR grubundaki altmýþ altý (%61) hasta ve InR grubundaki 43 (%56) hasta RAI tedavisi almadý. LoR ve InR gruplarýndaki sýrasýyla otuz sekiz (%35) ve 22 (%29) hasta ablatif (30-50 mCi) RAI tedavisi aldýlar. LoR grubunda 5 (%4.6) hasta ve InR grubunda 12 (%16) hasta 100 mCi veya daha fazla RAI aktivitesi ile tedavi edildiler. InR grubundan sadece bir hastada takip sýrasýnda nüks geliþti. LoR (p=0,152) ve InR (p=0,272) gruplarýnda RAI almayan veya RAI ile tedavi edilen hastalar arasýnda lokal nüks açýsýndan istatistiksel olarak anlamlý bir fark bulunmadý.
Çýkarýmlar: LoR hastalarýnda ameliyattan sonra RAI tedavisinin verilmemesi konusunda uzlaþma vardýr. InR DTC’de RAI tedavisi endikasyonlarý halen tartýþýlmaktadýr. EDRA'ya dayalý RAI kullanýmý, yalnýzca histopatolojik risk faktörlerine göre verilen kararlardan daha iyi bir seçenek gibi görünmektedir ve nüks riskini artýrmadan adjuvan yüksek aktivite RAI kullanýmýný azaltmaktadýr. (SETB-2023-06-105)

Objectives: In differentiated thyroid cancer (DTC), radioiodine (RAI) therapy is most frequently employed for remnant ablation or as adjuvant therapy for the remaining disease. The application of RAI to patients classified as intermediate risk (InR) is still a matter of debate. The aim of this study is to analyze the effect of early postoperative risk assessment on RAI use on papillary thyroid cancer patients who are classified as low risk (LoR) or InR.
Methods: This is a single-center, prospective registry study. One-hundred-eighty-six patients operated between January 2012 and August 2021 and categorized as LoR or InR were included in this study. All patients had total thyroidectomy and central lymph node dissection by the same endocrine surgeon. An early dynamic risk assessment (EDRA) consisting of neck ultrasonography, serum thyroglobulin (Tg) and anti-Tg levels was performed 6 weeks after surgery. Most of the patients were either followed up without RAI or received ablative low activity (30–50 mCi) RAI based on predetermined criteria.
Results: Median follow-up was 63 months. Sixty-six (61%) patients in the LoR group and 43 (56%) patients in the InR group did not receive RAI treatment. Thirty-eight (35%) and 22 (29%) patients in LoR and InR groups received ablative (30–50 mCi) RAI therapy, respectively. In LoR group 5 (4.6%) patients and in InR group 12 (16%) patients received 100 mCi or more RAI activity. Only one patient in the InR group recurred during follow-up. No statistically significant difference regarding local recurrence was found between patients who didn’t receive RAI or were treated with RAI within both LoR (p=0.152) and InR (p=0.272) groups.
Conclusion: There is consensus for LoR patients about omitting RAI therapy after surgery. Indications for RAI treatment in InR DTC are still under debate. RAI use based on EDRA seems to be a better option than decisions solely made on histopathological risk factors and decreases adjuvant high-activity RAI use without increasing recurrence risk.

AMAÇ: Lateral metastazlý papiller tiroit kanserinde (PTK) santral diseksiyonun tek taraflý veya bilateral yapýlmasý halen tartýþmalýdýr. Bu çalýþmada lateral metastazlý hastalarda sntral diseksiyon geniþliðini ve karþý paratrakeal lenf bezi metastazý için risk faktörlerini deðerlendirmeyi amaçladýk.
YÖNTEM: Ocak 2012- Kasým 2019 yýllarý arasýnda lateral metastazlý PTK nedeni ile tiroidektomi ile birlikte bilateral santral boyun diseksiyonu (BSBD) ve lateral boyun diseksiyonu uygulanan hastalarýn verileri retrospektif olarak deðerlendirildi. Hastalar karþý paratrakeal bölgede metastaz olmasý (Grup 1) ve olmamasýna (Grup 2) göre 2 gruba ayrýldý.
BULGULAR: Yaþ ortalamasý 46+15.7 olan 42 hasta opere edilmiþ olup (18 E, 24 K); karþý paratrakeal bölgede 15 hastada (%35.7) (grup 1) metastaz saptandý, 27 hastada (%64.3) (grup 2) metastaz görülmedi. Gruplar arasýnda yaþ, cinsiyet, PTK histolojik tipi, tümör çapý ve T evresi, tiroid kapsül invazyonu, ekstratiroidal yayýlým, multifokalite, bilateralite, lenfovasküler invaztonu açýsýndan fark saptanmadý. Grup 1 ve 2’de sýrasý ile metastaz oranlarý ipsilateral paratrakeal %100 vs %77.8 (p=0.073), prelaringeal metastaz %46.7 vs %18.5 (p=0.078), pretrakeal %80 vs %40.7 (p=0.023) idi.
Santral bölgede metastatik lenf nodu sayýsý Grup 1 ve 2’de sýrasýyla unilateral santral 8.3+7.4 vs 2.9+2.7, (p=0.001), ipsilateral paratrakeal 3.8+3.4 vs 1.9 vs 1.9 (p=0.023), pretrakeal 3.7+4.6 vs 0.6+0.9 (p=0.001) anlamlý olarak yüksek, prelaringeal 0.9+1.8 vs 0.2+0.4 (p=0.71) ise benzerdi.
ROC Curve analizde ve Youden index (J)’te optimal cutt off deðerleri tek taraflý santral diseksiyon materyalinde metastatik santral lenf nodu sayýsýnýn ikiden fazla olmasý olarak saptanmýþtýr.(AUC: 0.814, p<0.001, J: 0.563) Bu veri %93 sensitivite, %63 spesifite ile elde edilmiþtir. Pretrakeal metastazýn ikiden fazla olmasý ise (AUC: 0.795, p<0.001, J: 0.563) 60% sensitivite, 96.3% spesifite ile karþý paratrakeal metastazý öngörebilir.
SONUÇ: Sonuç olarak lateral metastazlý hastalarda ipsilateral paratrakeal metastaz oraný 85%, karþý paratrakeal metastaz oraný 35.7%’dir. Özellikle ipsilateral santral bölge veya pretrakeal lenf bezi metastaz sayýsý, karþý paratrakeal lenf bezi metastazýný öngörmede yardýmcý olabilir. Özellikle ipsilateral santral bölgede 2 ve 2’nin altýnda metastaz varlýðýnda tek taraflý santral boyu diseksiyonu uygulanabilir. (SETB-2023-12-232)

Objectives: Unilateral or bilateral prophylactic central neck dissection (CND) in papillary thyroid cancer (PTC) is still controversial. We aimed to evaluate the risk factors for contralateral paratracheal lymph node metastasis and whether CND might be performed unilaterally.
Methods: Prospectively collected data of patients who underwent bilateral CND and lateral neck dissection (LND) with thyroidectomy due to PTC with lateral metastases, between January 2012 and November 2019, were evaluated retrospectively. The patients were divided into two groups according to the presence (Group 1) and absence (Group 2) of metastasis in the contralateral paratracheal region.
A total of 42 patients (46 ±15.7 years) were operated. In the contralateral paratracheal region, Group 1 (35.7%) had metastases, while Group 2 (64.3%) had no metastases. In groups 1 and 2, metastasis rates were 100% vs 77.8% (p=0.073), 46.7% vs 18.5% (p=0.078), and 80% vs 40.7% (p=0.023) for the ipsilateral paratracheal, prelaryngeal and pretracheal lymph nodes, respectively. The number of metastatic lymph nodes in the central region was significantly higher in Group 1 compared to Group 2 as; 10.7±8.4 vs. 2.6±2.4 (p=0.001) in bilateral central region material; 8.3±7.4 vs. 2.9±2.7 (p=0.001) in lateral metastasis with ipsilateral unilateral central region; 3.8±3.4 vs. 1.9±1.9 (p=0.023) in ipsilateral paratracheal area; and 3.7±4.6 vs. 0.6±0.9 (p=0.001) in pretracheal region, respectively. However, no significant difference was found regarding the prelaryngeal region material (0.9±1.8 vs. 0.2±0.4 (p=0.71)). Results: >2 metastatic central lymph nodes in unilateral CND material (AUC: 0.814, p<0.001, J=0.563) can estimate contralateral paratracheal metastasis with 93% sensitivity, 63% specificity, while >2 pretracheal metastatic lymph nodes (AUC: 0.795, p<0.001, J: 0.563) can estimate contralateral paratracheal metastasis with 60% sensitivity and 96.3% specificity.
Conclusion: In patients with lateral metastases, the rate of ipsilateral paratracheal metastasis is 85%, while the rate of contralateral paratracheal metastasis is 35.7%. The number of ipsilateral central region or pretracheal lymph node metastases may be helpful in predicting contralateral paratracheal lymph node metastases. Notably, unilateral CND may be performed in the presence of ≤ 2 metastases in the ipsilateral central region.

Amaç: Postoperatif hipoparatiroidizm tiroidektomi sonrasý sýk görülen bir komplikasyondur ve önemli morbidite ve maliyet potansiyeline sahiptir. Ameliyat sýrasýnda paratiroid bezinin (PB) tanýmlanmasý ve korunmasý için önerilen çeþitli tekniklerden indosiyanin yeþili (ICG) anjiyografisi umut verici bir yöntem olarak ortaya çýkmýþtýr. Bu retrospektif çalýþmada, santral boyun diseksiyonu olsun ya da olmasýn total tiroidektomi yapýlan hastalar, ICG anjiyografisinin PB'leri belirlemedeki faydasý ve ICG skorlarýnýn postoperatif paratiroid fonksiyonu ile korelasyonu açýsýndan deðerlendirildi.
Yöntem: ICG anjiyografisi standart bir protokol kullanýlarak yapýldý ve PB vaskülarizasyon derecesi görsel olarak deðerlendirildi. Literatürde tanýmlanan PB'nin ICG alým yoðunluðuna dayalý bir puanlama sistemi kullanýldý. Pearson korelasyon testi kullanýlarak, toplam ICG skoru ile paratiroid hormon (PTH) gradyaný yüzdesi, ameliyat sonrasý kalsiyum ve PTH seviyeleri arasýndaki iliþki incelendi. Ayrýca en az bir iyi vaskülarize PB'si olan hastalar da deðerlendirildi.
Bulgular: Yirmi iki hasta çalýþmaya dahil edildi. Toplam ICG skoru ile ameliyat sonrasý PTH düzeyleri arasýnda anlamlý pozitif korelasyon (r=0.549, p=0.008), PTH gradyan yüzdesi ile negatif korelasyon (r=- r=-0.504, p=0.01) bulundu. Ancak ICG anjiyografisinde PB'leri iyi vaskülarize olan altý hastada postoperatif hipoparatiroidizm geliþtiþtiði görüldü.
Sonuç: ICG anjiyografisi, tiroidektomi sýrasýnda PB vaskülarizasyonunu deðerlendirmek ve postoperatif hipoparatiroidizm riskini tahmin etmek için potansiyel olarak kullanýlabilecek bir tekniktir. Ancak uygulama akýllýca kullanýlmalý ve teknik PB’lerini korumak için geliþtirilmelidir. Tekniðin tiroid cerrahisindeki faydalarýný ve sýnýrlamalarýný belirlemek için yeni çalýþmalara ihtiyaç duyulmaktadýr. (SETB-2023-09-185)

Objectives: Postoperative hypoparathyroidism is a common complication following thyroidectomy, with the potential for significant morbidity and cost. While various techniques have been proposed for intraoperative parathyroid gland (PG) identification and preservation, indocyanine green (ICG) angiography has emerged as a promising method. In this retrospective study, patients who underwent total thyroidectomy with or without central neck dissection were evaluated for the utility of ICG angiography in identifying PGs and the correlation of ICG scores with postoperative parathyroid function.
Methods: ICG angiography was performed using a standardized protocol, and the degree of PG vascularization was assessed visually. A scoring system was employed based on ICG uptake intensity in PGs, as described in the literature. Pearson's correlation test examined the relationship between the total ICG score and percentage parathyroid hormone (PTH) gradient, postoperative calcium, and PTH levels. In addition, patients with at least one well-vascularized PG were also evaluated.
Results: Twenty-two patients were included in the study. Significant positive correlations were found between the total ICG score and postoperative PTH levels (r=0.549, p=0.008), and a negative correlation with the percentage of PTH gradient (r=-0.504, p=0.01). However, six patients with well-vascularized PGs on ICG angiography still developed postoperative hypoparathyroidism. Conclusion: ICG angiography offers a potential tool for evaluating PG vascularization during thyroidectomy and predicting the risk of postoperative hypoparathyroidism. However, its application should be used judiciously, and the technique should be improved for PG preservation. Further studies are warranted to better understand its benefits and limitations in thyroid surgery.

Amaç: Fetuin-A, adiposit disfonksiyonu ve artmýþ insülin direnci ile birlikte proaterojenik, proinflamatuar ve antiinflamatuar etkiler sergileyen bir proteindir. Nükleer faktör eritroid 2 ile iliþkili faktör (Nrf2), hücrelerin oksidatif hasara karþý korunmasýnda önemli roller oynayan bir transkripsiyon faktörüdür. Sitokeratin18 (CK18) düzeyleri, hücre yýkýmýnýn bir indirekt göstergesi olarak, hem normal hem de tümör hücrelerinin nekrozu ve/veya apoptozu sýrasýnda artmaktadýr. Hashimoto tiroiditinde etkili olan bazý patofizyolojik yolaklar ile iliþkili olabilecekleri hipotezine dayanarak, bu üç biyo-belirtecin plazma düzeylerini analiz ettik.
Yöntemler: Hashimoto tiroiditine baðlý aþikar hipotiroidisi olan 34 kadýn hasta (Grup 1) ile benzer yaþtaki 34 saðlýklý kadýn hastayý (Grup 2) karþýlaþtýrdýk. Karþýlaþtýrma için tüm katýlýmcýlarýn plazma örneðinden tiroid uyarýcý hormon (TSH), fetuin-A, Nrf2 ve CK18 düzeyleri ölçüldü.
Bulgular: Grup 1'de ortalama TSH düzeyleri (31,4±15,3) grup 2'ye göre (2,6±1,0) anlamlý olarak yüksekti (p<.001). Ortalama Fetuin-A (606.7±34.2) ve Nrf2 (1.3±0.6) düzeyleri grup 1'de grup 2'ye göre anlamlý olarak yüksek bulundu (440.0±34.2'ye karþý 0.7±0.2) (her ikisi için p<.001). CK18 düzeyleri de grup 1'de (0,36±0,13) grup 2'den (0,26±0,16) anlamlý olarak yüksekti (p=0,020). TSH düzeyleri ile Fetuin A arasýnda anlamlý bir pozitif korelasyon gözlendi (r=0,401, p=0,001).
Sonuç: Hashimoto tiroiditinde artan fetuin-A, Nrf2 ve CK18 seviyeleri, bu hastalýkta etkili olan patofizyolojik yolaklarýn bir sebebi veya sonucu olabilir. Bu biyobelirteçlerin artan düzeylerinin klinik öneminin daha iyi anlaþýlmasý için daha fazla çalýþmaya ihtiyaç vardýr. (SETB-2023-05-093)

Objectives: Fetuin-A is a protein that exhibits proatherogenic, pro-inflammatory, and anti-inflammatory effects with increased insulin resistance and adipocyte dysfunction. The nuclear factor erythroid 2-related factor (Nrf2) is a transcription factor that is crucial for protecting cells against oxidative damage. As a cell death product, cytokeratin 18 (CK18) levels increase during necrosis and apoptosis of both normal and tumor cells. We analyzed the plasma levels of three biomarkers based on the hypothesis that they might be related to some pathophysiological pathways in Hashimoto’s disease.
Methods: We compared 34 female patients with overt hypothyroidism due to Hashimoto’s disease (Group 1) with 34 age-matched healthy females (Group 2). For comparison, plasma levels of thyroid-stimulating hormone (TSH), fetuin-A, Nrf2, and CK18 were measured in all participants.
Results: In group 1, the mean TSH levels (31.4±15.3) were significantly higher than those in group 2 (2.6±1.0) (p<0.001). The levels of mean fetuin-A (606.7±34.2) and Nrf2 (1.3±0.6) were found to be significantly higher in group 1 than in group 2 (440.0±34.2 vs. 0.7±0.2) (p<0.001 for both). CK18 levels in group 1 (0.36±0.13) were also significantly higher than in group 2 (0.26±0.16) (p=0.020). A significant correlation was observed between TSH levels and fetuin-A (r=0.401, p=0.001).
Conclusion: Increased levels of fetuin-A, Nrf2, and CK18 may be a consequence or cause of the pathophysiological pathways of Hashimoto’s disease. The clinical significance of increased levels of these biomarkers requires further investigation.

Giriþ: Kadýnlarda en sýk ölüm nedeni olan metastatik meme kanseri(MMK), son dekatta tedavisi olmayan cerrahi bir sorun olarak görülmekte iken; meme kanserinin heterojen doðasý, artan moleküler çalýþmalar ve onkolojik protokollerdeki geliþmelerle netleþtikçe, beklenen yaþam süresi de artmaktadýr. Biz bu çalýþmada MMK ile takip ettiðimiz hastalarýn klinikopatolojik özelliklerini incelemeyi amaçladýk.
Metod: Hastanemizde 2018-2023 yýllarý arasýnda meme kanseri tanýsý ile opere edilen ve sonrasýnda metastaz saptanan hastalar veri tabanýndan retrospektif olarak incelendi. Hastalarýn yaþý, tümörün histolojik ve moleküler tipi, evresi, derecesi, tanýdan metastaza kadar geçen süre, metastaz yeri, tedavi ve takip süreleri araþtýrýldý. Baþka merkezlerde opere edilen ve/ve ya takipten çýkan hastalar çalýþmaya alýnmadý. Bulgularýn istatistiksel analizi için 0,05 anlamlýlýk düzeyinde NCSS (NumberCruncher Statistical System) 2020 Statistical Software (NCSS LLC, Kaysville, Utah, ABD) kullanýldý.
Bulgular: Toplam 48 kadýn hastanýn %77.1’inde(n=37) metastaz, %22.9’unda(n=11) rekürrens saptandý. Hastalarýn yaþ ortalamasý 57 idi. Demografik açýdan hastalar arasýnda istatiksel anlamlý fark yoktu. TNM evresine göre deðerlendirildiðinde hastalarýn %24,3'ü (n=9) erken evrede, %75,7'si (n=28) lokal ileri evredeydi; lokal ileri hasta sayýsý erken evreye göre daha yüksek olduðu görüldü. Histoloji incelemede; hastalarýn %27.1’i(n=13) lüminal A, %31.3’ü(n=15) lüminal B, %16.7’si(n=8)HER2 pozitif,%25’i(N=12) Triple negatif idi. Ki67 %64.6 hastada(n=31) %14’den yüksek idi.Hastalarýn %41.6’sýna(n=20) meme koruyucu cerrahi(MKC), %58.3’ü(n=28) mastektomi uygulandý. Olgularýn %34,2'sinde (n=13) 1-2 yýl içinde, %42,1'inde (n=16) 2-5 yýl içinde ve %23,7'sinde (n=9) 5 yýl sonra metastaz gerçekleþti. Metastaz bölgeleri kemik (%37,7, n=28), karaciðer (%28,9, n=11), beyin (%10,5, n=4) ve akciðerdi (%7,9, n=3). Metastazý olan hastalarýn %21,05'inde (n=8) birden fazla metastaz yeri gözlendi. Lüminal A, Lüminal B, HER 2+ gruplarý ile TNBC arasýnda metastaz zamaný ve yeri açýsýndan istatistiksel olarak anlamlý fark yoktu (p>0,05). Lümen A grubunda adjuvan hormon tedavisi daha sýk görülürken, HER2+ grubunda neoadjuvan tedavi daha yaygýndý.Toplamda 48 hastada (%41,7) 20 ölüm gözlendi. Ortalama hastalýksýz saðkalým 64 aydý.
Sonuç: Metastatik meme kanserinde tüm geliþmelere raðmen 5 yýllýk saðkalým oraný %27 olarak görülmektedir. Hedefe yönelik kiþiselleþtirilmiþ tedaviler, meme kanserinde metastaz mekanizmasý ve özel yolaklar ortaya çýktýðýnda umut verici olabilir. (SETB-2023-05-084)

Objectives: While metastatic breast cancer (MBC), which is the most common cause of death in women, has been seen as an incurable surgical problem in the past decade, as the heterogeneous nature of breast cancer becomes clear with increasing molecular studies and advances in oncological protocols, life expectancy is increasing. In this study, we aimed to examine the clinicopathological features of the patients we followed up with MBC.
Methods: Patients who were operated on with the diagnosis of breast cancer in our hospital between 2018 and 2023 and who were later found to have metastases were retrospectively analyzed from the database. The age of the patients, the histological and molecular type, stage and grade of the tumor, the time from diagnosis to metastasis, the location of metastasis, the duration of treatment and follow-up were investigated. Patients who were operated on in other centers and/or were out of follow-up were excluded from the study. For the statistical analysis of the findings, number cruncher statistical system (NCSS) 2020 statistical soft- ware (NCSS LLC, Kaysville, Utah, USA) was used at a significance level of 0.05.
Results: Metastasis was detected in 77.1% (n=37) of a total of 48 female patients, and recurrence was found in 22.9% (n=11). The mean age of the patients was 57 years. There was no statistically significant difference between the patients in terms of demographics. When evaluated according to the TNM stage, 24.3% (n=9) of the patients were in the early stage and 75.7% (n=28) were in the locally advanced stage; the number of locally advanced patients was found to be higher than the early stage. In histology examination, 27.1% (n=13) of the patients were luminal A, 31.3% (n=15) luminal B, 16.7% (n=8) HER2 positive, and 25% (n=12) triple negative. Ki67 was higher than 14% in 64.6% (n=31) patients. Breast conserving surgery was performed in 41.6% (n=20) of the patients, and mastectomy was performed in 58.3% (n=28) patients. Metastasis in 34.2% (n=13) of the cases within 1–2 years, in 42.1% (n=16) within 2–5 years, and in 23.7% (n=9) after 5 years took place. Sites of metastasis were bone (37.7%, n=28), liver (28.9%, n=11), brain (10.5%, n=4), and lung (7.9%, n=3). More than one metastasis site was observed in 21.05% (n=8) of patients with metastases. There was no statistically significant difference between luminal A, luminal B, HER 2 groups and triple-negative breast cancer in terms of metastasis time and location (p>0.05). Adjuvant hormone therapy was more common in the luminal A group, whereas neoadjuvant therapy was more common in the HER2+ group. A total of 20 deaths were observed in 48 patients (41.7%). The median disease-free survival was 64 months.
Conclusion: Despite all the developments in metastatic breast cancer, the 5-year survival rate is 27%. Targeted personalized therapies may be promising when the mechanism of metastasis and specific pathways in breast cancer emerge.

Amaç: Mastalji, öncelikle tüm yaþ gruplarýndaki kadýnlarý etkileyen týbbi bir durumdur. Etkilenen bireyler, meme dokusunda dayanýlmaz bir aðrý, gerginlik veya yanma hissi yaþarlar. Bu çalýþmanýn amacý mastaljili kadýnlarýn klinikopatolojik özelliklerini incelemek ve bu özellikleri asemptomatik olgularla karþýlaþtýrmaktýr.
Yöntemler: Genel cerrahi polikliniðine baþvuran toplam 524 kadýn hasta prospektif olarak deðerlendirildi. Hastalar iki gruba ayrýldý. Grup 1'e (G1) mastaljisi olan hastalar, Grup 2'ye (G2) asemptomatik olan hastalar alýndý. Ýki grup klinik, radyolojik ve patolojik özellikler açýsýndan karþýlaþtýrýldý.
Bulgular: Bu araþtýrma mastalji prevalansýnýn %61.45 olduðu 524 kadýn üzerinde yapýlmýþtýr. G1'de 322 hasta, G2'de 202 hasta vardý. Ortalama yaþ G2'de G1'e göre anlamlý olarak daha yüksekti (sýrasýyla 46.33±10.33, 43.58±10.33; p=0.001). Premenopozal kadýn oranlarý G1 ve G2 için sýrasýyla %73.91 ve %59.4 idi (p=0.001). Düzenli egzersiz yapma oraný G1'de %18.01 iken G2'de %25.74 idi (p=0.034). Geçmiþ meme kanseri öyküsü G2'de G1'e göre anlamlý olarak yüksekti (p=0.015). Analjezik tüketimi G2'de G1'e göre anlamlý olarak düþüktü (p=0.05). Non-steroidal antiinflamatuar ilaçlar her iki grupta da gruplar arasý anlamlý farkla en sýk kullanýlan analjezik ilaç sýnýfýydý (G1: %27.63, G2: %19.8, p=0.043). Ultrason görüntülemesiyle birlikte olan veya olmayan tarama mamografisi G2'de G1'e göre anlamlý olarak daha sýk uygulandý (sýrasýyla %66.33'e karþý %55.27 ve %82.17'ye karþý %72.98, p=0.012 ve p=0.016). Gruplar arasýnda benign veya malign patolojilerin sýklýðý açýsýndan anlamlý bir fark bulunmadý.
Sonuç: Meme aðrýsý yaygýndýr ve diðer meme semptomlarý olmadan ve meme dýþý sebepler dýþlandýktan sonra fizyolojik olarak kabul edilmelidir. Meme aðrýsý olan ancak daha fazla týbbi inceleme gerektiren altta yatan olasý ciddi bir duruma iþaret eden belirti veya semptomlarý olmayan hastalara semptom kontrolü tavsiyesi ve güvence saðlamak güvenlidir. (SETB-2023-07-120)

Objectives: Mastalgia is a medical condition that primarily affects women of all age groups. Affected individuals experience excruciating pain, tightness, or a burning sensation in the breast tissue. The aim of this study is to observe the clinicopathologic features of women with mastalgia and compare these features with asymptomatic cases.
Methods: A total of 524 female patients who applied to the general surgery outpatient clinic were prospectively evaluated. The patients were divided into two groups. Group 1 (G1) included patients with mastalgia, while Group 2 (G2) included asymptomatic patients. The two groups were compared in terms of clinical, radiological, and pathological features.
Results: This study was conducted on 524 women, among whom the prevalence of mastalgia was found to be 61.45%. There were 322 patients in G1 and 202 patients in G2. The mean age was significantly higher in G2 compared to G1 (46.33±10.33 vs. 43.58±10.33, respectively; p=0.001). Premenopausal women rates for G1 and G2 were 73.91% and 59.4%, respectively (p=0.001). The regular exercise rate in G1 was 18.01%, while it was 25.74% in G2 (p=0.034). The past history of breast cancer rate was significantly higher in G2 than in G1 (p=0.015). The consumption of analgesics was significantly lower in G2 compared to G1 (p=0.05). Non-steroidal anti-inflammatory drugs were the most commonly used analgesic drug class in both groups, with significant intergroup differences (G1: 27.63%, G2: 19.8%, p=0.043). Screening mammography with or without ultrasound examination was performed significantly more often in G2 compared to G1 (66.33% vs. 55.27% and 82.17% vs. 72.98%, p=0.012 and p=0.016, respectively). No significant difference was found concerning the frequency of benign or malignant pathologies between the groups. Conclusion: Breast pain is common and should be considered physiological without other breast symptoms and after excluding non-breast causes. It is safe to provide symptom control advice and reassurance to patients who have breast pain but do not have signs or symptoms indicating a possible serious underlying condition requiring further medical intervention.

Amaç: Bu çalýþmanýn amacý, suprakondiler humerus kýrýklarýnda üç farklý pinleme tekniðini lateral baþlangýçlý çapraz pinleme tekniði ile biyomekanik açýdan karþýlaþtýrmaktýr.
Materyal ve Yöntem: Biyomekanik testler, 52 sentetik humerus üzerinde gerçekleþtirildi. Dört farklý pin konfigürasyonu test edildi: çapraz pin, 2 lateral pin, 3 lateral pin ve lateral baþlangýçlý çapraz pin tekniði. Biyomekanik testler Shimadzu Autograph ölçüm cihazýnda gerçekleþtirildi. Her pin konfigürasyonu toplamda 13 humerus üzerinde test edildi: 4'ü varus bükülme, 4'ü valgus bükülme ve 5'i fleksiyon bükülme durumunda. Her test sýrasýnda deplasman (mm) ve yük (N) verileri 10 Hz'de örneklendi. Sertlik verileri (N/mm), her testin son 2 döngüsünün yüklenme fazýndan hesaplandý ve karþýlaþtýrýldý.
Sonuçlar: 2 lateral pin grubunda varus deðerleri, çapraz pin, 3 lateral pin ve lateral baþlangýçlý çapraz pin gruplarýyla karþýlaþtýrýldýðýnda istatistiksel olarak daha düþüktü (sýrasýyla p=0.01, p=0.02, p=0.012). Fleksiyon yük deðerleri, 2 lateral pin grubunda, çapraz pin, 3 lateral pin ve lateral baþlangýçlý çapraz pin gruplarýyla karþýlaþtýrýldýðýnda istatistiksel olarak daha düþüktü (sýrasýyla p=0.03, p=0.001, p=0.031). Valgus deðerleri açýsýndan gruplar arasýnda fark yoktu (p>0.05).
Sonuç: Lateral baþlangýçlý çapraz pin, geleneksel çapraz pin tekniðiyle biyomekanik açýdan benzerdir. Ortopedik cerrahlarýn medial taraf defektleri olan distal humerus kýrýklarýnda olduðu gibi, lateral pinlere ek mediyal pinlemeyi de eklemeyi tercih ettiði durumlarda kullanýlabilecek bir tekniktir. (SETB-2023-05-089)

Objectives: It is aimed to compare biomechanically the 3 different pin techniques and the lateral onset cross-pinning (LXP) technique in supracondylar humeral fractures.
Methods: Biomechanical testing was performed on 52 synthetic humeri Four pin configurations techniques were tested: crossed pins (XP), 2 lateral pins (2LP), 3 lateral pins (3LP), and LXP technique. Biomechanical testing was performed on Shimadzu Autograph measuring machine. Each pin configuration was tested in a total of 13 humeri: 4 in varus bending, 4 in valgus bending, and 5 in flexion bending. Displacement (mm), and load (N) data were sampled at 10 Hz during each test.
Results: Varus values were statistically lower in 2 LP group comparing to XP, 3 LP, LXP groups (p=0.01, p=0.02, p=0.012, consequently). Flexion load values statistically lower in 2 LP group comparing to XP, 3 LP, LXP groups (p=0.03, p=0.001, p=0,031, consequently). There was no difference between the groups in terms of valgus values (p>0.05).
Conclusion: LXP technique is biomechanically similar to the traditional XP technique. In situations where orthopedic surgeons choose to use medial pins in addition to lateral pins such as distal humerus fractures with medial-sided defects.

Amaç: Bu çalýþma, stres üriner inkontinans (SÜÝ) nedeniyle mid-üretral aský ameliyatý geçiren bireylerde pelvik tabanýn ultrason bulgularýný kullanarak tedaviye yanýt eksikliðini deðerlendirmeyi amaçlamaktadýr.
Metot: Çalýþmaya Ocak 2016-Ocak 2021 tarihleri arasýnda stres tipte inkontinans nedeniyle Tension-free Vaginal Tape (TVT) iþlemi uygulanan hastalar dahil edildi ve tedavi baþarýsýzlýðý, mesane hacmi 200-400 ml dolu haldeyken; Valsalva manevrasý sýrasýnda stres üriner inkontinansýn varlýðý ile belirlendi.
Bulgular: Çalýþmaya toplam 214 hasta dahil edildi. Mid-üretral aský ameliyatý sonrasý 32 hastada (%25.8) stress testi pozitifliði ile baþarýsýz sonuç alýndýðý gözlemlenmiþtir. Baþarýsýz grupta mesh ile posterior üretra arasýndaki mesafe anlamlý olarak daha kýsaydý (4,09±0,39'a karþý 4,91±0,51; p<0,001), posterior üretrovezikal açý istirahatte daha düþüktü, ancak Valsalva manevrasý sýrasýnda açý daha arttý ve mesane boynu açýsý daha dardý (p<0.001).
Sonuç: Baþarýsýz hastalarda mesh-posteriour üretral mesafe ortalama deðerleri iyileþen hasta grubunda bulunanlara göre daha düþük elde ettik. Pelvik taban ultrasonu, TVT ameliyatlarýnýn baþarýsýný tahmin edebilir, ancak henüz çok az veri vardýr ve yakýn gelecekte idrar kaçýrma tanýsý için daha standart ve objektif parametreler bulmaya ihtiyaç vardýr. (SETB-2023-06-106)

Objectives: This study aims to assess the lack of response to treatment in individuals undergoing mid-urethral sling surgery for stress urinary incontinence (SUI) using ultrasound findings of the pelvic floor.
Methods: The study included patients who underwent the tension-free vaginal tape (TVT) procedure for stress urinary incontinence within the period spanning from January 2016 to January 2021. The physical examination involved maintaining bladder filling at an average volume of 200–400 mL, and treatment failure was determined by the presence of SUI during the Valsalva maneuver.
Results: The study comprised a total of 214 patients, where it was observed during the stress test that 32 patients (25.8%) had an unsuccessful outcome following mid-urethral sling surgery. In the unsuccessful group, the distance of the mesh-posterior urethra was lower (4.09±0.39 vs. 4.91±0.51; p<0.001), the posterior urethrovesical angle was lower when at rest, but the angle increased more significantly during the Valsalva maneuver, and the bladder neck angle was narrower (p<0.001).
Conclusion: We obtained lower mean values of mesh-posterior urethral distance in unsuccessful patients compared to those found in the group of cured patients. Pelvic floor ultrasound can predict the success of TVT surgeries but there is as yet little data and there is a need to find in the near future more standard and objective parameters for the diagnosis of urinary incontinence.

Amaç: Geçmiþ yýllarda aðýr amfizemin medikal olmayan tedavisi için cerrahiden faydalanýlýrdý. Ancak son yýllarda bronkoskopik hacim azaltma tedavisi daha az invaziv olmasý nedeniyle daha sýk tercih edilir olmuþtur. Bronkoskopik sarmal tedavi de bu yöntemlerden en sýk uygulanan tekniktir. Araþtýrmanýn amacý, aðýr amfizemli hastalarda bronkoskopik hacim azaltýcý sarmal tedavisinin etkinliðini ve güvenliðini incelemektir.
Metod: 2015-2017 yýllarý arasýnda bronþiyal volüm azaltýcý sarmal tedavisi uygulanan hastalar retrospektif olarak incelendi. Ýþlemden sonra hastalar üç aylýk aralýklarla bir yýl boyunca takip edildi. Modifiye Medical Research Council (mMRC) dispne skoru, St George'un Solunum Anketi (SGRQ) yaþam kalitesi ölçeði, 6 dakikalýk yürüme mesafesi (6-DYT), solunum fonksiyon testleri ve görülen komplikasyon kayýtlarý ile hastalar güvenlik ve etkinlik açýsýndan deðerlendirildi.
Bulgular: Onüçü (%81) erkek, üçü (%19) kadýn 16 hastanýn yaþ ortalamasý 62±6.9 idi. Hastalarýn preoperatif mMRC klinik dispne skoru ortalama 3,38, üçüncü ay mMRC skoru ortalama 2,62 (p=0,007), 12. ay mMRC ortalamasý 2,37 (p=0,003) idi. Preoperatif SGRQ yaþam kalitesi parametresi 71,95±15,7, üçüncü ay 66,7±16,2 (p=0,007), 12. ay 62,9±16,4 (p=0,003) idi. Preoperatif ortalama 6-DYT sýrasýyla 247,25±112,36 m, üçüncü ay 264,25±95 m (p=0,148), 12. ay 317±122,9 m (p=0,034) idi. Hastalarýn ameliyat öncesi rezidüel volüm 5,28±1,96 L, üçüncü ay 4,52±1,35 L (p=0,023), 12. ay 4,545±1,83 L (p=0,163) olarak hesaplandý. Hastalarýn preoperatif birinci saniye zorlu ekspiratuar volüm deðerleri sýrasýyla 0,79±0,29 L, üçüncü ay 0,79±0,3 L (p=0,917), 12. ay 0,86±0,3 L (p=0,756) idi.
Sonuç: Solunum fonksiyon testi parametrelerindeki düzelmeden ziyade nefes darlýðýný azaltan, günlük yaþam kalitesini arttýran, etkin ve güvenilir bir iþlem olan bronkoskopik hacim azaltýcý sarmal tedavisi daha da yaygýnlaþacak gibi görünmektedir. (SETB-2023-02-030)

Objectives: In the past years, surgery has been used for the non-medical treatment of severe emphysema. However, in recent years, bronchoscopic lung volume reduction (LVR) treatment has become more preferred because it is less invasive. Bronchoscopic coil treatment is the most frequently applied technique among these methods. The aim of the investigation was to determine the efficacy and safety of bronchoscopic volume reduction coil treatment for patients with severe emphysema.
Methods: The patients who were performed bronchial volume reduction coil treatment between 2015 and 2017 and were followed in our outpatient clinic were retrospectively examined. They were followed for 1 year at quarterly intervals after the procedure. All the safety and efficacy of the patient’s records, including the modified Medical Research Council (MRC) dyspnea score, the St. George’s Respiratory Questionnaire (SGRQ) quality of life scale, the 6 min walk distance (6-MWT), pulmonary function tests, and adverse events, were evaluated.
Results: Sixteen patients were included in the study. The mean of the preoperative mMRC clinic dyspnea score was 3.38, the mean of the 3rd month’s mMRC score was 2.62 (p=0.007), and the mean of the 12th month’s mMRC was 2.37 (p=0.003). The preoperative SGRQ quality of life parameter was 71.95±15.7, the 3rd month was 66.7±16.2 (p=0.007), and the 12th month was 62.9±16.4 (p=0.003). Preoperative mean of 6-MWT was 247.25±112.36 m, 3rd month 264.25±95 m (p=0.148), and 12th month 317±122.9 m (p=0.034). Patients’ preoperative residual volume was 5.28±1.96 L, 3rd month 4.52±1.35 L (p=0.023), and 12th month 4.545±1.83 L (p=0.163). Patients’ preoperative forced expiratory volume in one second, respectively, was 0.79±0.29 L, 3rd month 0.79±0.3 L (p=0.917), and 12th month 0.86±0.3 L (p=0.756).
Conclusion: It seems that bronchoscopic LVR coil treatment, which is an effective and reliable procedure that reduces shortness of breath rather than respiratory function test parameters and improves the quality of daily life, will become even more widespread.

Amaç: Parkinson hastalýðýnda non-invaziv vagus sinir stimülasyonunun tremor üzerindeki etkilerini araþtýrmak.
Yöntemler: Bu tek merkezli, prospektif, önce-sonra tasarýmlý uygulama çalýþmasýna Parkinson Hastalýðý tanýsý konmuþ 5 katýlýmcý dahil edildi. Auriküler vagus sinir stimülasyonu her katýlýmcýya farklý günlerde 3 kez uygulandý. Vagus sinir stimülasyonu katýlýmcýlara sað kulak, sol kulak ve bilateral kulak olarak uygulanmýþtýr. Katýlýmcýlarýn kardiyovasküler parametreleri Kubios HRV Standardý ile, tremor ise UPDRS tremor alt ölçeði ve akýllý telefon uygulamasý ile müdahale öncesi ve sonrasýnda deðerlendirilmiþtir.
Bulgular: Bilateral auriküler vagus sinir stimülasyonu uygulanan katýlýmcýlarda diyastolik kan basýncýnda anlamlý bir düþüþ (p=0.043) tespit edildi. UPDRS tremor alt ölçeðinde anlamlý bir deðiþiklik olmamasýna raðmen, akýllý telefon uygulamasý ile yapýlan ölçümlerde x (p=0.043) ve y (0.014) düzlemlerinde maksimum tremor genliðinde azalmalar tespit edildi.
Sonuç: Bu çalýþmada Parkinson Hastalýðý olan hastalarda auriküler vagus sinir stimülasyonu ile 3 boyutlu düzlemde ölçülen tremor amplitüdünde azalma saptanmýþtýr. (SETB-2023-03-035)

Objectives: The aim of this study is to investigate the effects of non-invasive vagus nerve stimulation (VNS) on tremor in Parkinson’s disease (PD).
Methods: This single-center, prospective, and implementation study with before-after design included five participants diagnosed with PD. Auricular VNS was applied to each participant 3 times on different days. VNS was applied to the participants as the right ear, left ear, and bilateral ear. The cardiovascular parameters of the participants were evaluated with Kubios HRV Standard and tremor with UPDRS tremor subscale and smartphone application before and after the intervention.
Results: Significant decrease in diastolic blood pressure (p=0.043) was found in participants who underwent bilateral auricular VNS. Although there was no significant change in the UPDRS tremor subscale, decreases in the maximum tremor amplitude in the x (p=0.043) and y (0.014) planes were detected in the measurements made with the smartphone application.
Conclusion: In this study, a decrease in the tremor amplitude measured in the 3D plane with auricular VNS was found in patients with PD.

Amaç: Bu çalýþmada Yoðun Bakým Ünitemizde (YBÜ) sigara içme prevalansýnýn, sigara kullanýmýna baðlý kalýþ süresinin ve COVID-19 mortalitesi üzerine etkilerini görmeyi amaçladýk.
Gereç ve Yöntem: 16 Mart-16 Mayýs 2020 tarihleri arasýnda COVID-19 hastalarý üzerinde yoðun bakým ünitesinde yapýlan retrospektif tek merkezli bir çalýþmadýr. Demografik veriler, komorbidite durumlarý, kabul edildikleri birimler, klinik semptomlar, solunum desteði, hastalarýn sigara içme sýklýðý/prevalansý, yoðun bakýmda kalýþ süreleri ve mortaliteleri kaydedildi. Hastalar sigara içen ve içmeyen olarak iki gruba ayrýldý. 1100 COVID-19 hastasý vardý ve bunlardan 150'si yoðun bakým ünitesinde tedavi gördü. 95 hastanýn verilerine ulaþýldý. Ýstatistiksel analizler Sosyal Bilimler için Bilimsel Paket ile yapýldý.
Bulgular: Hiç sigara içmemiþ hastalar %64.2'di. Bu hastalarýn %5.3'ü daha önce sigara içen, %30,5'i ise aktif içici idi. Sigara içen gruptaki hastalarýn yaþ ortalamasýnýn içmeyenlere göre daha az olduðu görüldü. Sigara içenlerde kronik obstrüktif akciðer hastalýðý insidansý daha yüksek bulundu. Sigara içme durumu, yoðun bakýmda kalýþ süresi ve saðkalým arasýnda iliþki bulunamadý. Sigara kullanýmý, COVID-19 hastalýðýnda solunum yetmezliðine kadar ilerleyebilen ve ölümle sonuçlanabilen agresif sürece neden olan faktörler arasýnda yer almaktadýr.
Sonuç: Bazý araþtýrmalar da sigaranýn koruyucu olabileceðini iddia etmektedir. Bu konu hakkýnda henüz bir netlik yoktur. COVID-19 pnömonisine baðlý solunum yetmezliði olan YBÜ'de tedavi edilen hastalarda sigara içmenin yoðun bakýmda kalýþ süresi ve mortalite üzerinde etkisi olmadýðýný ortaya koydu. (SETB-2023-01-012)

Objectives: In this study, we aimed to see the effects of smoking prevalence, the length of stay regarding the usage of cigarettes, and the effects on the mortality of COVID-19 in our Intensive Care Unit (ICU).
Methods: This is a retrospective single-centered study that was done in the ICU on patients with COVID-19 between 16th of March and 16th of May in 2020. The demographic data, comorbidity status, the units they were accepted from, clinical symptoms, respiratory support, prevalence of smoking, length of stay in the ICU, and mortalities of the patients were recorded. There were two groups: Smoker and non-smoker. There were 1100 COVID-19 patients and 150 of these were treated in ICU unit. 95 patient’s data were accessed. Statistical analyses were performed with the Scientific Package for the Social Science (version 21.0; SPSS Inc.). Results: There were 69.4% non-smoker and 35.8% smoker, and 5.3% of the smoker did smoke before (Table 1). The average age of the patients in smoker group was less than nonsmoker. The incidence of chronic obstructive pulmonary disease was higher in smokers (Table 2). The most common symptom was cough and it was 82% in nonsmoker group and 76.5% in smoker group (Table 3). In both groups, respiratory support was provided by ÝMV (Table 4). There was no relationship between two groups according to age (p=0.044) and gender of patients (p: 0.062) (Table 2). The length of ICU stay was 7.6 days for smoking patients in the ICU and 9.3 days for non-users. While the mortality was 52.9% for smokers, it was 39.3% for non-smokers. No statistical correlation was found between smoking status, length of stay in ICU, and survival (Fig. 1). Smoking is blamed among the factors that cause this aggressive process, which can progress to respiratory failure and result in mortality in COVID-19 disease.
Conclusion: Some studies also claim that smoking can be protective. There is still no clarity on this issue. It was concluded that smoking has no effect on the duration of ICU stay and mortality in patients treated in the ICU with respiratory failure due to COVID-19 pneumonia.

Amaç: Çalýþmamýzda hastanemizde son 15 yýlda beyin ölümü tanýsý almýþ olgularýn retrospektif incelenmesi.
Gereç ve Yöntem: Hastanemizin yoðun bakým ünitelerinde Ocak 2008 ile Ocak 2023 tarihleri arasýnda beyin ölümü tanýsý alan vakalarýn dosya ve bilgisayar kayýtlarý retrospektif olarak deðerlendi. Olgularýn demografik verileri, beyin ölümüne yol açan primer hastalýk, beyin ölümü tanýsýnda kullanýlan tamamlayýcý testler, yoðun bakýmda kaçýncý günde beyin ölümü tanýsý aldýðý ve donör durumlarý incelendi.
Bulgular: Beyin ölümü tanýsý alan toplam 228 vaka tespit edildi. Verileri eksik 7 hasta çalýþma dýþý býrakýldý. Vakalarýn %61.99’u erkek, %38.01’i kadýn, %14,02’si 18 yaþýn altýnda, %68.34’ü 18-65 yaþ arasýnda, %17,64’ü 65 yaþ üstü bulundu. Yoðun bakýma yatan vakalarýn %69,69 ‘u ilk 7 günde, %22,17’si 7-14 günde, %8,14’ü ise 14 günden sonra beyin ölümü tanýsý aldý. Beyin ölümüne neden olan primer hastalýk; %47 vaka hemorajik serebral hasar, %21 vaka travmatik hemorajik hasar, %18 vaka iskemik serebral hasar ve %14 vaka hipoksik serebral hasar olarak bulundu. Vakalarýn %38’inde yardýmcý test kullanmamýþtýr.%36’sýnda karotis doppler ultrason, %22’sinda BT anjiografi ve %4’ünde transkranial doppler kullanýldýðý saptandý. Vakalarýn %28,95’i organ nakli donörü olmasýný aileleri kabul etti. %71,05 aile yakýný organ nakli donörü olmasýný reddetti
Sonuç: Organ baðýþý sayýsý ve beyin ölümü tanýsý covid-19 pandemisiyle hýzlý bir düþüþ yaþamýþtýr. Organ baðýþýný arttýrmak için organ baðýþ bilincini ve toplumsal bilincin artmasý için gerekli eðitimlerin erken yaþlarda yapýlmasý gerektiðini düþünüyoruz. (SETB-2023-05-092)

Objectives: Retrospective analysis of cases diagnosed with brain death in our hospital in the last 15 years.
Methods: The files and computer records of the cases diagnosed with brain death in the intensive care units of our hospital between January 2008 and January 2023 were evaluated retrospectively. The demographic data of the cases, the primary disease leading to brain death, the complementary tests used in the diagnosis of brain death, the day on which brain death was diagnosed in the intensive care unit, and the donor status were examined.
Results: A total of 228 cases diagnosed as brain death were detected. Seven patients with missing data were excluded from the study. 61.99% of the cases were male, 38.01% were female, 14.02% were under 18 years old, 68.34% were between 18 and 65 years old, 17.64% were over 65 years old. Brain death was diagnosed in 69.69% of the patients admitted to the intensive care unit in the first 7 days, 22.17% in 7–14 days, and 8.14% after 14 days. The primary disease causing brain death was found to be 47% hemorrhagic cerebral injury, 21% traumatic hemorrhagic injury, 18% ischemic cerebral injury, and 14% hypoxic cerebral injury. No ancillary testing was used in 38% of the cases. Carotid doppler ultrasound was used in 36%, computed tomography angiography was used in 22%, and transcranial doppler was used in 4%. Families agreed to be organ transplant donors in 28.95% of the cases. 71.05% family members refused to be organ transplant donors.
Conclusion: The number of organ donations and the diagnosis of brain death has decreased rapidly with the covid-19 pandemic. In order to increase organ donation, we think that the necessary education should be given at an early age to increase organ donation awareness and social awareness.

Amaç: Herediter sferositoz tanýlý hastalarýmýzýn demografik özelliklerini, klinik ve laboratuvar bulgularýný ve sonuçlarýný sunmak.
Yöntemler: Demografik özellikler, hastalarýn klinik ve laboratuvar verileri, hastalýða baðlý komplikasyonlar ve tedavide yapýlan splenektomi sonrasý sonuçlar retrospektif olarak incelendi. Hastalýðýn þiddeti Eber kriterlerine göre derecelendirildi.
Bulgular: Altmýþ dokuz hasta (42 erkek, 27 kýz, medyan yaþ: 3) çalýþmaya alýndý. Hastalarýn %68'inde yenidoðan sarýlýðý öyküsü vardý. Baþvuru yakýnmalarý sarýlýk (%71), halsizlik (%27,5), bayýlma (%4,3) ve solgunluk (%4,3) idi.
Medyan takip süresi 8,5 yýldýr. Eber kriterlerine göre 3 (%4,3), 57 (%82,6) ve 9 (%13,1) hastada sýrasýyla hafif, orta ve ciddi hastalýk vardý. Otuz altý hastaya (%52,1) splenektomi yapýldý. Splenektomiyi takiben hemoglobin seviyelerinde belirgin bir artýþ ve indirekt bilirubin seviyelerinde bir düþüþ gözlemledik. Postoperatif trombositoz yaygýn olarak izlendi, zaman ilerledikçe düþme eðilimindeydi ve bir ay sonra stabilize oldu. Tromboembolik komplikasyon görülmedi.
Sonuç: Çalýþma grubumuzdaki yüksek akraba evliliði oranýna raðmen, ailede HS öyküsü ve yenidoðan sarýlýðý, HS hastalarýnýn büyük çoðunluðuna göre görece geç, yaklaþýk üç yýl içinde saptanmaktadýr. Bu bulgu, HS'nin birinci basamakta yeterince tanýnmadýðýný göstermektedir. Seçilmiþ vakalarda splenektomi transfüzyon ihtiyacýný azaltabilir. Splenektomi sonrasý geçici trombositoz sýk görülür ve iyi huylu bir seyir gösterir. (SETB-2023-04-058)

Objectives: The objective of the study is to present the demographic characteristics, clinical and laboratory features and outcome of our patients with hereditary spherocytosis (HS).
Methods: Demographic, clinical, and laboratory data; complications; and splenectomy results were analyzed retrospectively. The severity of the disease was scaled according to Eber’s criteria.
Results: Sixty-nine patients (42 boys, 27 girls, median age: 3 years) were eligible. Sixty-eight percent of the patients had a history of neonatal jaundice. The complaints at admission were jaundice (71%), fatigue (27.5%), fainting (4.3%), and pallor (4.3%). The median follow-up duration was 8.5 years. According to Eber’s criteria, three (4.3%), 57 (82.6%), and nine (13.1%) patients had mild, moderate, and severe diseases, respectively. Thirty-six patients (52.1%) had a splenectomy. Following splenectomy, we observed a significant rise in hemoglobin levels and a decline in indirect bilirubin levels. Post-operative thrombocytosis was common, with a tendency to fall and stabilize after 1 month. There were no thromboembolic complications.
Conclusion: In spite of the high rate of consanguinity, familial history of HS, and neonatal jaundice in our study group, the majority of the HS patients were identified relatively late, about 3 years. This finding shows that HS might be insufficiently acknowledged by primary care. Splenectomy, in selected cases, may reduce the need for transfusions. Post-splenectomy transient thrombocytosis is common and has a benign course.

Amaç: Kapsamlý araþtýrmalara raðmen, henüz psoriasis tedavi yanýtýnýn etkili bir þekilde izlenmesi için evrensel olarak kabul edilen bir laboratuvar belirteç bulunmamaktadýr. Psoriasisli hastalarda birer sistemik inflamasyon belirteci olan nötrofil-lenfosit oraný (NLO), platelet-lenfosit oraný (PLO), monosit-lenfosit oraný (MLO), sistemik immün-inflamasyon indeksi (SÝÝ) ve sistemik immün yanýt indeksi (SÝYÝ)’nin deðerlendirildiði çeþitli çalýþmalar mevcut olmakla birlikte biyolojik tedavi ile bu belirteçlerdeki deðiþimin araþtýrýldýðý az sayýda yayýn mevcuttur. Bu çalýþmada psoriasisli hastalarda biyolojik tedavinin NLO, PLO, MLO, SÝÝ ve SÝYÝ üzerine olan etkisini incelemek amaçlanmýþtýr.
Yöntem: Bu kohort çalýþmasýnda, en az 12 hafta boyunca interlökin (IL)17, IL12/23 ve IL23 inhibitörlerinden birini kullanan 108 psoriasis hastasý retrospektif olarak deðerlendirildi. Tedavi öncesi ve tedaviden 12 hafta sonraki Psoriasis Alan Þiddet Ýndeksi (PAÞÝ) skorlarý, tam kan sayýmý parametreleri ve C-reaktif protein (CRP) seviyeleri analiz edildi ve karþýlaþtýrýldý.
Bulgular: Oniki haftalýk tedavi sonrasý kullanýlan biyolojik ajanýn türünden baðýmsýz olarak NLO, PLO, MLO, SÝÝ, SÝYÝ ve CRP deðerlerinde anlamlý azalma olduðu saptandý (sýrayla p=0.001, 0.007, 0.011, <0.001, <0.001 ve <0.001). Ayrýca PAÞÝ skorlarýndaki düþüþ ile PLO, SÝÝ ve SÝYÝ deðerlerindeki düþüþ arasýnda düþük derecede ancak istatistiksel olarak anlamlý korelasyon olduðu tespit edildi (sýrayla p=0.036, r=0.202; p=0.042, r=0.196; p=0.023, r=0.219).
Sonuç: NLO, MLO, özellikle PLO, SÝÝ ve SÝYÝ, biyolojik tedavi sonrasý inflamasyonun derecesini ve tedaviye yanýtý izlemek için günlük pratikte basit, pratik ve ekonomik laboratuvar belirteçleri olarak kullanýlabilir. (SETB-2023-11-203)

Objectives: Despite extensive research, there is currently no specific biomarker that reliably and universally indicates treatment response in psoriasis. Multiple studies have evaluated systemic inflammation markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic immune response index (SIRI) in psoriasis patients. However, there are limited studies investigating changes in these markers with biologic therapy. The goal of this study was to investigate the impact of biologic therapy on parameters including NLR, PLR, MLR, SII, and SIRI in patients with psoriasis.
Methods: In this cohort study, we retrospectively evaluated 108 psoriasis patients who were on biological treatment, including interleukin (IL)17, IL23, and IL12/23 inhibitors, for a minimum of 12 weeks. We analyzed Psoriasis Area Severity Index (PASI) scores, complete blood count parameters, and C-reactive protein (CRP) levels both before and after 12 weeks of treatment.
Results: The NLR, PLR, MLR, SII, SIRI, and CRP values all demonstrated a significant decrease, regardless of the specific type of biologic agent (p=0.001, 0.007, 0.011, <0.001, <0.001 and <0.001, respectively). Furthermore, we observed a statistically significant but low correlation between the reduction in PASI scores and PLR, SII, and SIRI values (p=0.036, r=0.202; p=0.042, r=0.196; p=0.023, r=0.219, respectively).
Conclusion: The NLR, MLR, especially PLR, SII, and SIRI might be used as simple, convenient, and inexpensive laboratory markers to monitor the degree of inflammation and response to treatment after biologic therapy in daily practice.

Amaç: Çalýþmada amacýmýz, Týp Fakültesi öðrencilerinin refleksiyon becerilerini ve bu becerileri etkileyen faktörleri deðerlendirmek yanýnda öðrencilerin refleksiyon becerilerinin klinik karar vermeleri üzerindeki etkilerini de ölçmektir.
Gereç ve Yöntem: Bu araþtýrma Vakýf Üniversitesi Týp Fakültesi 5. sýnýf Kulak Burun Boðaz (KBB) stajý yapan öðrenciler üzerinde gerçekleþtirilen bir eðitim uygulama araþtýrmasýdýr. Çalýþmaya alýnan 125 öðrencinin refleksiyon becerileri ve kilinik karar verme yetenekleri geçerli ve güvenilir ölçekler olan “Yansýtýcý Düþünme Düzeyi Belirleme Ölçeði” ve “Klinik Karar Verme Ölçeði” kullanýlarak deðerlendirilmiþtir.
Bulgular: Yaptýðýmýz çalýþmada anketi uyguladýðýmýz 5. Sýnýf öðrenci popülasyonunda Groningen Refleksiyon Becerisi Ölçeði alt boyutlarýndan aldýklarý ortalama puan 77,04±5,14’dýr. Katýlýmcýlarýn Groningen Refleksiyon Becerisi Ölçeðinin “Kendini Yansýtma” ve “Reflektif Ýletiþim” alt boyutlarý ile ölçekten aldýklarý toplam puanlar, cinsiyetlerine, yaz stajýna katýlým durumlarýna, burs almalarýna, sosyal bilimler kulüp üyelik varlýðýna, yaþadýklarý yerlere, okuduklarý okullara, günlük tutmalarýna, ders çalýþma tarzlarýna ve yaþadýklarý þehirlere göre farklýlýklar göstermesine raðmen bu farklýlar istatistiksel olarak anlamlý bulunmamýþtýr. Öðrencilerin Klinik Karar Verme Ölçeði alt boyutlarýndan aldýklarý toplam puanlar 98 ile 169 arasýnda deðiþmekte olup; ortalama puan 146,18±10,97’dir. Katýlýmcýlarýn Groningen Refleksiyon Becerisi Ölçeðinden aldýklarý toplam puanlar ile Klinik Karar Verme Ölçeðinden aldýklarý toplam puanlar arasýnda istatistiksel olarak pozitif yönlü anlamlý orta düzeyde iliþki saptanmýþtýr (r=0,403; p=0,001).
Sonuç: Sonuç olarak, katýlýmcýlarýn refleksiyon becerileri arttýkça klinik karar verme basamaklarý puanlarý da artmaktadýr. Refleksiyon, öðrencileri acemi olmaktan uzman olmaya yönlendirmenin tek yolunu temsil ederek hem derinlemesine öðrenmeyi hem de öðrenme deneyimlerini geliþtirir. Bu nedenle, her týp fakültesi, öðrencilerin müfredata yansýtýlabilecek deneyimlere aktif olarak katýlmalarýna izin veren öðrenci refleksiyonu için bir eðitim programý ve bir geri bildirim ve deðerlendirme sistemi geliþtirmelidir. (SETB-2023-09-184)

Objectives: The aim of this study is to evaluate the reflection skills of students at the Faculty of Medicine and the factors influencing these skills, as well as to measure the impact of students' reflection skills on their clinical decision-making.
Methods: This study is an educational research project conducted on fifth-year Ear Nose Throat (ENT) interns at Vakif University's Faculty of Medicine. The "Reflective Thinking Level Determination Scale" and the "Clinical Decision-Making Scale," which are valid and reliable, were used to assess the reflection skills and clinical decision-making abilities of the 125 students participating in the study.
Results: In our study, the mean score of the sub-dimensions of the Groningen Reflection Skills Scale was 77.04±5.14 for the fifth-year student population surveyed. Scores from the "Self-Reflection" and "Reflective Communication" sub-dimensions of the Gron- ingen Reflection Skills Scale were compared based on gender, participation in summer internships, receipt of scholarships, membership in social sciences clubs, place of residence, school attended, diary-keeping habits, study styles, and cities of residence. Although there were some differences between the groups, these differences were not statistically significant. The total scores of the students on the Clinical Decision-Making Scale sub-dimensions ranged from 98 to 169, with a mean score of 146.18±10.97. A statistically positive and moderate correlation was found between the total scores of the participants on the Groningen Reflection Skills Scale and the total scores they obtained on the Clinical Decision-Making Scale (r=0.403; p=0.001).
Conclusion: Consequently, an increase in the reflection skills of participants is associated with higher clinical decision-making scores. Reflection is the primary means of transitioning students from novices to experts, enhancing both comprehensive learning and learning experiences. Therefore, every medical school should develop a training program for student reflection, along with a feedback and assessment system integrated into the curriculum.

Aquafilling® jel son yýllarda meme büyütme ameliyatýna alternatif bir yöntem olarak kullanýlmaktadýr. Bu olgu sunumunda Aquafilling® jel enjeksiyonunun radyolojik görüntüleme bulgularýný ve komplikasyonlarýný tartýþmayý amaçladýk. 34 yaþýnda emziren kadýn hasta sol memede þiþlik ve aðrý þikayeti ile baþvurdu. Ultrasonografide her iki memede ve pektoral kas lifleri arasýnda septalý, yoðun içerikli, masif sývý koleksiyonlarý görüldü. Mamografide her iki memede yoðun parankim içerisinde yüksek dansiteli opasiteler izlendi. Manyetik rezonans görüntülemede sývý sinyalinde yaygýn kistik alanlar gözlendi. Kontrastlý serilerde sol memedeki kistik alanlarýn çevresinde periferik kontrastlanma mevcuttu. 5 yýl önce her iki memeye de Aquafilling® uygulandýðýný anamnezinden öðrenmiþtik. Sol memedeki kistik alanlardan ultrasonografi eþliðinde
örnekleme yapýldý ve sitolojik incelemede diffüz inflamatuar infiltratlarla çevrili bazofilik Aquafilling® materyali saptandý. Aquafilling® jel enjeksiyonu ve komplikasyonlarý çok çeþitli semptomlarla ortaya çýkabileceðinden ve kanser, apse, granülomatöz mastit ve parazit enfeksiyonlarý gibi radyolojik görüntülemedeki diðer çeþitli durumlarý taklit edebileceðinden þüpheli durumlarda meme büyütme öyküsü sorgulanmalýdýr. (SETB-2022-10-228)

Aquafilling® gel has been used in recent years as an alternative method to breast augmentation surgery. In this case report, we aimed to discuss radiological imaging findings and complications of Aquafilling® gel injection. Case: A 34-year-old lactating female patient presented with swelling and pain in the left breast. Ultrasonography showed massive septate fluid collections with dense content in both breasts and between the pectoral muscle fibers. On mammography, both breasts appeared dense with large mass opacities. On magnetic resonance imaging, extensive fluid-signal cystic areas were observed. Peripheral enhancement around the fluid in the left breast was present in the contrast-enhanced series. We learned from her anamnesis that Aquafilling® was applied to both breasts 5 years ago. Ultrasonography-guided sampling was performed from the cystic areas in the left breast and cytological examination revealed basophilic Aquafilling® material surrounded by diffuse inflammatory infiltrates. Breast augmentation history should be questioned in suspicious cases because Aquafilling® gel injection and its complications can present with a wide variety of symptoms and may mimic various other conditions on radiological imaging, such as cancer, abscess, granulomatous mastitis, and parasite infections.

Ön Çapraz Bað (ÖÇB) yaralanmasý olan bazý durumlarda, fizik muayene ve manyetik rezolüsyon görüntüleme (MRI) ÖÇB'nin saðlam mý yoksa kýsmen/tamamen yýrtýlmýþ mý olduðunu net olarak belirleyemez. 40 yaþýnda bayan hasta diz aðrýsý þikayeti ile kliniðimize baþvurdu. Ýstenen incelemelerden sonra ÖÇB'nin saðlam mý yoksa kýsmen/tamamen yýrtýlmýþ mý olduðunu net olarak belirleyemedik. Hastaya artroskopik diz cerrahisi planlandý. Diagnostik artroskopide de þekil 4 pozisyonunda sinovyum ile çevrili olmayan ve gergin çok demetli ÖÇB olduðu belirlendi. Menisküs yýrtýðý onarýlarak ameliyat tamamlandý. Bu olgu sunumunda ÖÇB'nin etrafýndaki sinovyumu örtmeyen çok demetli bir yapý olduðu görüldü. Bu gibi durumlarda ÖÇB'nin deðerlendirilmesi zordur ve ÖÇB'nin varyasyonlarýnýn da olabileceði akýlda tutulmalýdýr. (SETB-2022-09-210)

In some cases with anterior cruciate ligament (ACL) injury, physical examination and magnetic resolution imaging cannot clearly identify whether the ACL is intact or partially or completely ruptured. A 40-year-old female patient was admitted to our clinic with complaints of knee pain. After the requested examinations, we could not clearly identify whether the ACL was intact or partially or completely ruptured. Arthroscopic knee surgery was planned for the patient. In diagnostic arthroscopy, it was also determined that there was a multibundle ACL that was not surrounded by the synovium and was tight in the figure 4 position. The surgery was completed by repairing the meniscal tear. It was seen in the current case report that the ACL was a multibundle structure without overlying synovium around. In such cases, it is difficult to evaluate the ACL, and it should be kept in mind that there may also be variations of the ACL.

Holt-Oram sendromu üst ekstremite defektleri ve konjenital kalp malformasyonu ile karakterizedir ve prevalansý çok nadirdir. Matür kistik teratom yenidoðanlarda en sýk görülen tümördür ve en sýk yerleþim yeri sakrokoksigeal bölgedir. Sakrokoksigeal teratom tanýsý patoloji ile doðrulanmalýdýr. Cerrahi rezeksiyon bu tümörün temel tedavi
yaklaþýmýdýr. Bu tümörle iliþkili genitoüriner sistem, kas-iskelet sistemi anomalileri, nöral defektler, kardiyovasküler anomaliler, pulmoner bozukluklar gibi bazý malformasyonlar bildirilmiþtir. Biz burada sakrokoksigeal teratom ile iliþkili Holt-Oram sendromu tanýsý almýþ erkek bir yenidoðaný bildirdik. Bildiðimiz kadarýyla þu zamana kadar sakrokoksigeal 2 teratom ile iliþkili Holt-Oram sendromlu bir olgu bildirilmemiþtir. Sakrokoksigeal teratomlu hastalarda birden fazla doðumsal anormali olabilir, bu nedenle; hastalar klinik, laboratuvar ve radyolojik olarak dikkatle deðerlendirilmeli ve Holt Oram sendromunun da eþlik edebileceði düþünülmelidir. (SETB-2022-08-198)

Holt-Oram syndrome (HOS) is characterized by upper-limb defects and congenital heart malformation, and its prevalence is very rarely. Mature cystic teratoma is the most common tumor seen in neonates and its most common location is sacrococcygeal region. Diagnosis of a sacrococcygeal teratoma should be confirmed by pathology. Surgical resection is the mainstay therapeutic approach of this tumor. Some malformations such as genitourinary system, musculoskeletal anomalies, neural defects, cardiovascular anomalies, and pulmonary disorders associated with this tumor have been reported. Herein, we reported a male neonate diagnosed with HOS associated with sacrococcygeal teratoma. To our knowledge, it has been not reported a case with HOS associated with sacrococcygeal teratoma. Patients with sacrococcygeal teratomas (SCTs) may have multiple and extreme congenital abnormalities; therefore, patients with SCTs should be carefully evaluated clinically, laboratory, and radiologically and it should be also considered that HOS may accompany them.

Covid-19 pandemisini takiben, özellikle psöriazis hastalarýnda olmak üzere maske kullanýmýna baðlý Köbner fenomeni bildirilmiþtir. Pemfigus hastalarýnda Köbner fenomeni ile ilgili raporlar literatürde bulunmasýna raðmen, yüz maskelerinin tetiklediði pemfigus lezyonlarý daha önce tanýmlanmamýþtýr. Burada, uzun süre yüz maskesi kullanýmý sonrasýnda burunda yeni ve inatçý lezyonlar olan bir pemfigus vulgaris ve bir pemfigus vegetans vakasý sunuyoruz. Her iki vakada da yüz maskelerinin en çok irritasyona neden olduðu burunlarýnda inatçý pemfigus lezyonlarý mevcuttu. Her iki olguda da maske kullanýmý sonrasý lezyon geliþmesi ve tedavi ile diðer cilt lezyonlarýnda düzelme olmasýna karþýn burun üzerindeki lezyonlarýnýn devam etmesi, maske kullanýmýna baðlý minör travmalarýn pemfigus lezyonlarýnýn oluþumunda rol oynadýðýný düþündürmektedir. (SETB-2022-12-261)

Koebner phenomenon of skin diseases due to face masks have been reported since COVID-19 pandemic, especially in psoriasis patients. Although there are reports on Koebner phenomenon in pemphigus patients in the literature, pemphigus lesions triggered by face masks have not been described previously. Herein, we report one case of pemphigus vulgaris and one case of pemphigus vegetans with new and persistent lesions on the nose following prolonged use of face masks. Both cases had persistent pemphigus lesions on their noses where face masks irritated the most. The development of lesions after the use of masks and the persistence of nasal lesions despite the improvement of other skin lesions with the treatment in both cases, suggested that minor traumas due to the use of masks played a role in the formation of lesions.