Amaç: Coronavirüs hastalýðý 2019 (COVID-19), aralýk 2019’da Çin’in Hubei eyaletinde baþladýktan sonra yerel ve uluslararasý olarak hýzlý bir þekilde yayýlma göstermiþtir. Bu enfeksiyöz hastalýðýn dünyada yayýlýmý esnasýnda saðlýk çalýþanlarý hastalýðýn taranmasý ve tedavisinde baþlýca kiþiler olarak yer almýþtýr. Bu çalýþmanýn amacý hastanemizde COVID-19 pandemisi sürecinde saðlýk çalýþanlarýnda algýlanan stres ve stresle baþa çýkma yöntemleri ile anksiyete ve depresyon düzeyleri arasýndaki iliþkinin deðerlendirilmesidir.
Metod: Ýki yüz gönüllü çalýþmaya dahil edilmiþtir. Beck Anksiyete Ölçeði (BAÖ), Beck Depresyon Ölçeði (BDÖ), Algýlanan Stress Ölçeði-10 (ASÖ) ve Baþa Çýkma Tutumlarýný Deðerlendirme Ölçeði (COPE) uygulanmýþtýr.
Bulgular: BDÖ ve BAÖ ölçeklerinin ortalama skorlarý sýrasýyla 9.2±8.9 ve 8.2±9.2 idi. 200 katýlýmcýnýn 33’ünün (%16.5) BDÖ skorlarý 17 ve üzerindeydi. BDÖ skorlarýna gore katýlýmcýlarýn %62’sinde minimal depresyon, %21.5’inde hafif depresyon, %13.5’ inde orta depresyon ve %3’ünde þiddetli depresyon mevcuttu. BAÖ skorlarýna gore katýlýmcýlarýn %60.5’inde minimal anksiyete, %25.5’inde hafif anksiyete, %8.5’inde orta anksiyete ve %5.5’inde þiddetli anksiyete mevcuttu. Kadýn katýlýmcýlarýn BAÖ ve BDÖ skorlarý erkek katýlýmcýlardan istatistiksel olarak daha yüksek olarak bulundu. BAÖ ve BDÖ skorlarý ile ASÖ-10 arasýnda iyi derecede pozitif yönde istatistiksel olarak anlamlý iliþki saptandý. Meslek gruplarýnda, BAÖ ve BDÖ, ASÖ-10 COPE 3 (Soruna odaklanma ve duygularý açýða vurma), 7 (Dini olarak baþa çýkma) ve 13 (Kabullenme) düzeyi ortalamalarýnda istatistiksel olarak anlamlý fark saptandý. Pandemi süresince klinik birim gruplarýnda, BDÖ düzeylerinde istatistiksel olarak anlamlý fark saptandý.
Sonuçlar: Bu çalýþma, COVID-19 pandemisi sürecinde saðlýk çalýþanlarýnda anksiyete, depresyon ve stres düzeyleri ile iliþkili olarak farklý baþa çýkma tutumlarý kullanýlabileceðini göstermiþtir. Problem çözme ve emosyon odaklý, adaptif baþa çýkma yöntemleri belirtilerin azaltýlmasýna yardýmcý olurken, maladaptif ve negatif baþa çýkma yöntemleri belirtilerin daha da alevlenmesine sebep olabilmektedir. Bu nedenle saðlýk çalýþanlarýnýn stresle baþa çýkma tutumlarýný geliþtirmelerine yönelik eðitimler verilmelidir. (SETB-2020-10-205)

Objectives: Coronavirus disease (COVID-19) has spread rapidly, locally and internationally after it started in Hubei province of China in December 2019. During the spread of this infectious disease in the world, health care workers are taking place as the main people in the screening and treatment of the disease. The present study aims to evaluate the relationship between anxiety and depression levels with perceived stress and coping strategies in health care workers during the COVID-19 pandemic.
Methods: In this study, 200 participants were included. Beck Anxiety Inventory (BDI), Beck Depression Inventory (BDI), Perceived Stress Scale-10 (PSS-10) and COPE (Coping Orientation to Problems Experienced) were applied.
Results: Mean scores for BDI and BAI were 9.2±8.9 and 8.2±9.2, respectively. BDI scores of 33 (16.5%) of 200 participants were ≥17. 62% of the participants had minimal depression, 21.5% of the participants had mild depression, 13.5 % of the participants had moderate depression, and 3% of the participants had severe depression according to BDI scores. 60.5% of the participants had minimal anxiety, 25.5% of the participants had mild anxiety, 8.5% of the participants had moderate anxiety and 5.5% of the participants had severe anxiety according to BAI scores. BAI and BDI scores of the female participants were statistically higher than the male participants. A statistically significant positive correlation was found between BAI and BDI scores and PSS-10 scores. A statistically significant difference was found in the averages of BAI and BDI, PSS-10 COPE 3 (Focus on and venting of emotions), 7 (Religious coping) and 13 (Acceptance) subscales levels in occupational groups. A statistically significant difference was found in BDI levels in the clinical units during the pandemic.
Conclusion: This study indicated that different coping strategies can be used in health care workers regarding anxiety, depression and stress levels during the COVID-19 pandemic. While problem-solving and emotion-focused adaptive coping mechanisms help reduce symptoms, maladaptive and negative coping mechanisms can cause symptoms to exacerbate. Thus, training should be given to developing attitudes of health care workers to cope with stress.

Amaç: Gastrointestinal sistem (GÝS) ve pankreatiko-bilyer (PB) sistem kaynaklý karaciðer metastazlarýnýn tespitinde 18F-fluorodeoxyglucose pozitron emisyon tomografi (18F-FDG PET/BT) ve manyetik rezonans görüntüleme (MRG)’nin etkinliðinin karþýlaþtýrýlmasýdýr.
Gereç ve Yöntemler: Bu retrospektif çalýþmaya primer GÝS (mide veya kolorektal) veya PB sistem malignitesi olup karaciðere metastaz yapmýþ, histopatolojik olarak tanýsý doðrulanmýþ, MRG ve 18F-FDG PET/BT’si bulunan 42 hasta dahil edildi. MRG ve 18F-FDG PET/BT görüntüleri prospektif olarak analiz edildi. Metastaz sayýlarýnýn tespitinde iki modaliteyi karþýlaþtýrmak için Student's t-testi ve modaliteler arasý uyumu belirlemek için Cohen’s kappa testi kullanýldý.
Bulgular: Çalýþmaya dahil edilen hastalarýn 28 (%66.7)’i erkek olup, yaþ ortalamasý 60.67±9.4 yýl idi. Kolon (n=25; %59.5) ve pankreas (n=7; %16.6) adenokarsinomu metastaz yapan en sýk primer tümörlerdi. MRG ile 12 (%28.5) hastada daha fazla sayýda, 7 (%16.6) hastada daha az sayýda ve 23 (%54.7) hastada ise eþit sayýda metastaz tespit edildi. MRG ve 18F-FDG PET/BT ile tespit edilen metastaz sayýsý arasýnda istatistiksel olarak anlamlý fark yoktu (sýrasýyla; 7.55 ± 7.96 ve 6.36 ± 7.28; p = 0.11). Ýki modalite arasýnda orta derece uyum mevcuttu (kappa deðeri = 0.423). MRG’de tespit edilip 18F-FDG PET/BT’de görülmeyen metastazlarýn büyük kýsmý (n=10, %23,8) 10 mm’den küçük lezyonlardý. Lenf nodu metastazý olan 8 (%19) hastada MRG ve 18F-FDG PET/BT’nin lenf nodu saptama sayýlarý benzerdi (sýrasýyla, 12’ye 14 adet, p> 0.05).
Sonuç: MRG’nin lezyonlarý küçük boyutlarda erken aþamada tespit etmesi ve 18F-FDG PET/BT’nin lezyonlarýn metabolik aktivitesini göstermesi nedeniyle her iki modalitenin kombine kullanýlmasý hastalara daha fazla fayda saðlayacaktýr. (SETB-2020-11-234)

Objectives: To compare the efficacy of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) and magnetic resonance imaging (MRI) in the detection of liver metastases originating from the gastrointestinal system (GIS) and the pancreaticobiliary (PB) system.
Methods: This retrospective study included 42 patients with primary GIS (stomach or colorectal) or PB system malignancies that metastasized to the liver, histopathologically confirmed diagnoses, and MRI and 18F-FDG PET/CT images. The MRI and 18F-FDG PET/CT images were analyzed. Student's t-test was used to compare the two modalities in terms of determining the number of metastases, and Cohen's kappa test was conducted to determine the agreement between the modalities.
Results: Twenty-eight (66.7%) of the patients included in this study were male, and the mean age was 60.67±9.4 years. Colon (n=25; 59.5%) and pancreatic (n=7; 16.6%) adenocarcinomas were the most common primary tumors that had metastasized to the liver. MRI detected more metastases in 12 (28.5%) patients, less in seven (16.6%), and an equal number of metastases in 23 (54.7%). No statistically significant difference was observed between the number of metastases detected by MRI and 18F-FDG PET/CT (7.55±7.96 and 6.36±7.28, respectively; p=0.11). There was a moderate agreement between the two modalities (kappa value=0.423). Most of the metastases detected on MRI but not seen on 18F-FDG PET/CT (n=10, 23.8%) were lesions smaller than 10 mm. For the eight (19%) patients with lymph node metastases, the number of metastatic lymph nodes detected by MRI and 18F-FDG PET/CT was similar (12 and 14, respectively, p>0.05).
Conclusion: MRI can detect small lesions at an early stage, and 18F-FDG PET/CT shows the metabolic activity of lesions; therefore, the combined use of the two modalities can potentially offer a beneficial outcome for patients.

Amaç: Çalýþmamýzýn amacý; akut apandisitli hastalarda VKÝ (vücut kitle indeksi) de göz önünde bulundurularak yapýlan ölçümlerde, ileokolik arter ve ven kalibrasyonlarýndaki artýþýn yardýmcý bir taný kriteri olarak kullanýlabileceðinin gösterilmesidir.
Materyal ve Method: Çalýþmamýzda; Ocak 2016- Nisan 2019 tarihleri arasýnda, akut appandisit klinik ön tanýsýyla ÝV (intravenöz) kontrastlý abdominal ÇKBT (çok kesitli bilgisayarlý tomografi)’leri çekilmiþ, opere edilmiþ ve sonucunda patolojik olarak akut apandisit tanýsý konmuþ 76 hasta ile klinik ve radyolojik olarak akut apandisit lehine bulgusu olmayan veya ÇKBT’de ÝLK(ileokolik) arter ve ven çapýný etkileyebilecek baþka bir abdominal patolojisi tespit edilmeyen 81 kontrol grubu hasta retrospektif olarak deðerlendirildi. Her iki grupta aksiyel planlarda ÝLK arter ve ven çaplarý ölçüldü ve VKÝ’leri (vücut kitle indeksi,Kg/m²) hesaplandý.Gruplar VKÝ lerine göre 3 alt gruba (VKÝ si;20-24,9 arasý olanlar,25-29,9 arasý olanlar ve 30 ve üstü olanlar þeklinde) ayrýldý. Her iki grup hem total hasta sayýsý bazýnda hem de VKÝ ye göre ayrýlmýþ alt grup düzeylerinde ayrý ayrý karþýlaþtýrýldý. Ýstatistiksel alfa anlamlýlýk seviyesi p<0,05 olarak kabul edildi.
Bulgular: ÝLK arter ve ven çaplarý akut apandisitli hastalarda kontrol grubuna göre istatistiksel olarak anlamlý oranda artmaktadýr (P < 0.001). Ayrýca VKÝ ile ÝLK arter ve ven çaplarý arasýnda pozitif bir korelasyon mevcuttur (P < 0.001).
Sonuç: Akut apandisit þüphesi bulunan hastalarda ÝLK arter ve ven çaplarý VKÝ’leri de göz önünde bulundurularak ölçüldüðünde akut apandisit tanýsýnda yardýmcý bir kriter olarak kullanýlabilir. (SETB-2020-03-031)

Objectives: We aimed to investigate the diagnostic value of the increasement in the ileocolic artery and vein diameters considering the body mass index (BMIs) of the patients with acute appendicitis.
Methods: Between January 2016 and April 2019, 76 patients who were diagnosed with acute appendicitis by contrast-enhanced abdominal multislice computerized tomography (MSCT) and had histopathologically confirmed appendicitis after an appendectomy were included in this study. To evaluate the value of MSCT, we created a control group, which consisted of 81 patients who had contrast-enhanced MSCT for other reasons and had no clinical and radiological findings suspicious for acute appendicitis and also had no other abdominal pathology that might interfere with ileocolic artery and vein diameter. In both groups, ileocolic artery and vein diameters were measured in axial MSCT scan. The body mass index was calculated for each patient (kg/m2). Both groups were divided into three subgroups according to the BMI of patients (20-24.9; 25-29.9 and more than 30). Both groups and subgroups were compared individually. Statistical significance level was accepted as p <0.05.
Results: Ileocolic artery and vein diameters were higher in the patient group than control group, which was statistically significant (p<0.001), and a positive correlation was found between BMI and ileocolic artery and vein diameters (p < 0.001).
Conclusion: Ileocolic artery and vein diameters with taking BMI into consideration can be used as alternative criteria in the suspicion of acute appendicitis in adults.

Amaç: Mide kanseri, dünyada en yaygýn beþinci kanser ve kansere baðlý ölümlerin üçüncü en yaygýn nedenidir. Bu çalýþmada, mide adenokarsinomuna baðlý olarak küratif amaçlý gastrektomi uygulanan hastalarda klinikopatolojik faktörlerin genel saðkalýma etkisini deðerlendirmeyi amaçladýk.
Yöntem: Ocak 2007 - Ocak 2017 tarihleri arasýnda kliniðimizde gastrektomi yapýlan 644 hastanýn týbbi kayýtlarý retrospektif olarak incelendi. Bu hastalardan 359 hasta çalýþmaya dahil edildi. Çeþitli prognostik faktörlerin saðkalýma etkisi araþtýrýldý.
Bulgular: Ortalama yaþ 59,2 ± 11,6 (29-83) idi. Erkek / kadýn oraný 2,12 olarak bulundu. Medyan takip süresi 19 ay (CI = 10,1-31,1) idi. Medyan genel saðkalým 23 ± 2.3 aydý (CI = 18,3-27,6). Splenektomi, R1 (mikroskobik inkomplet) rezeksiyon ve ileri evre tümör kötü prognoz için baðýmsýz risk faktörleri olarak bulundu.
Sonuç: Mide kanserinde R1 rezeksiyon, splenektomi ve ileri TNM evresi kötü prognoz ile iliþkili bulundu. Tümör invazyonu veya dalak hilusunda lenf nodu metastazý olmadýðý durumda postoperatif enfeksiyöz komplikasyonlara baðlý mortalite riski nedeniyle splenektomiden kaçýnýlmalýdýr. (SETB-2020-09-183)

Objectives: Gastric cancer is the fifth most common cancer and the third most common cause of cancer-related deaths in the world. In this study, we aimed to evaluate the impact of clinicopathological factors on overall survival in the patients who underwent curative-intent gastrectomy due to gastric adenocarcinoma.
Methods: The medical records of 644 patients who underwent gastrectomy between January 2007 and January 2017 in our clinic were retrospectively reviewed. Among these patients, 359 patients were included in this study. The impact of several prognostic factors on survival was investigated.
Results: The mean age was 59.2±11.6 (29-83). Male/female ratio was 2.12. The median follow-up time was 19 months (CI=10.1-31.1). Median overall survival was 23±2.3 months (CI=18.3-27.6). Splenectomy, R1 (microscopically incomplete) resection, and advanced stage were independent risk factors for poor prognosis.
Conclusion: R1 resection, splenectomy, and advanced TNM stage were associated with poor prognosis in gastric cancer. Splenectomy should be avoided in the absence of direct invasion of the tumour or metastasis of lymph nodes on splenic hilum to prevent postoperative infectious complication-related mortality.

Objectives: Hypocalcemia is the most common complication and acute parathyroid gland insufficiency is the main cause of it after thyroidectomy. In this study, we aimed to evaluate the relationship between the recovery time of parathyroid gland function and patient characteristics, preoperative and postoperative electrolyte changes, and intraoperative parathyroid findings in patients with postoperative hypoparathyroidism.
Methods: Patients who underwent total thyroidectomy (TT) with or without central neck dissection ± lateral neck dissection with a parathyroid hormone (PTH) value of <15 pg/mL within the postoperative 4th hour were included in this study. Postoperative calcium level of <8mg/dL was defined as biochemical hypocalcemia and a PTH value of <15 pg/mL was defined as hypoparathyroidism. The patients were divided into three groups according to the time of PTH recovery (>15 pg/mL); within the first 24 hours, between one day and 30 days, after 30 days, respectively.
Results: One hundred eleven patients (mean age, 49.3±14.4 years) consisted of Groups 1, 2 and 3, including 19 (16F, 3M), 67 (54F, 13M) and 25 (19F, 6M), respectively. Vitamin D deficiency rates for Groups 1, 2, 3 were 41.7%, 53.1% and 88.2%, respectively (p=0.018). Postoperative day 0 PTH values were 11.69±2.79pg/mL, 6.92±3.45 pg/mL, 4.99±2.36 pg/mL, (p<0.001). Biochemical hypocalcemia rates of Groups 1, 2, 3 on postoperative day 1 were 15.8%, 53.7%, 64%, (p=004) respectively, and calcium values were 8.68±0.67 mg/dL, 8.15±0.66 mg/dL, 7.75±1 mg/dL, (p=0.014), respectively. Magnesium values on postoperative day 1 and 7 for Groups 1, 2, 3 were 1.85±0.1 mg/dL, 1.77±0.17 mg/dL, 1.64±0.17 mg/dL, (p=0.005), and 1.86±0.16mg/dL, 1.82±0.21mg/dL, 1.59±0.15mg/dL (p=0.001), respectively. PTH values on postoperative day 1 and 7 in Groups 1, 2, 3 were 20.5±6.4 pg/mL, 7.06±4.35 pg/mL, 4.66±3.26 pg/mL (p<0.001), and 31.04±10.54pg/mL, 18.72±13.84pg/mL, 4.55±4.9pg/mL (p<0.0001), respectively. Parathyroid function improved in 106 patients, and permanent hypoparathyroidism developed in five patients (4.5%).
Conclusion: Hypoparathyroidism can recover rapidly in the first 24 hours in patients with a PTH value of around 10 pg/mL at postoperative 4th hour. As the number of preserved parathyroids increased, recovery time decreased. In patients with postoperative hypoparathyroidism, postoperative low magnesium levels may be associated with delayed recovery of parathyroid function. (SETB-2020-12-275)

Objectives: Hypocalcemia is the most common complication and acute parathyroid gland insufficiency is the main cause of it after thyroidectomy. In this study, we aimed to evaluate the relationship between the recovery time of parathyroid gland function and patient characteristics, preoperative and postoperative electrolyte changes, and intraoperative parathyroid findings in patients with postoperative hypoparathyroidism.
Methods: Patients who underwent total thyroidectomy (TT) with or without central neck dissection ± lateral neck dissection with a parathyroid hormone (PTH) value of <15 pg/mL within the postoperative 4th hour were included in this study. Postoperative calcium level of <8mg/dL was defined as biochemical hypocalcemia and a PTH value of <15 pg/mL was defined as hypoparathyroidism. The patients were divided into three groups according to the time of PTH recovery (>15 pg/mL); within the first 24 hours, between one day and 30 days, after 30 days, respectively.
Results: One hundred eleven patients (mean age, 49.3±14.4 years) consisted of Groups 1, 2 and 3, including 19 (16F, 3M), 67 (54F, 13M) and 25 (19F, 6M), respectively. Vitamin D deficiency rates for Groups 1, 2, 3 were 41.7%, 53.1% and 88.2%, respectively (p=0.018). Postoperative day 0 PTH values were 11.69±2.79pg/mL, 6.92±3.45 pg/mL, 4.99±2.36 pg/mL, (p<0.001). Biochemical hypocalcemia rates of Groups 1, 2, 3 on postoperative day 1 were 15.8%, 53.7%, 64%, (p=004) respectively, and calcium values were 8.68±0.67 mg/dL, 8.15±0.66 mg/dL, 7.75±1 mg/dL, (p=0.014), respectively. Magnesium values on postoperative day 1 and 7 for Groups 1, 2, 3 were 1.85±0.1 mg/dL, 1.77±0.17 mg/dL, 1.64±0.17 mg/dL, (p=0.005), and 1.86±0.16mg/dL, 1.82±0.21mg/dL, 1.59±0.15mg/dL (p=0.001), respectively. PTH values on postoperative day 1 and 7 in Groups 1, 2, 3 were 20.5±6.4 pg/mL, 7.06±4.35 pg/mL, 4.66±3.26 pg/mL (p<0.001), and 31.04±10.54pg/mL, 18.72±13.84pg/mL, 4.55±4.9pg/mL (p<0.0001), respectively. Parathyroid function improved in 106 patients, and permanent hypoparathyroidism developed in five patients (4.5%).
Conclusion: Hypoparathyroidism can recover rapidly in the first 24 hours in patients with a PTH value of around 10 pg/mL at postoperative 4th hour. As the number of preserved parathyroids increased, recovery time decreased. In patients with postoperative hypoparathyroidism, postoperative low magnesium levels may be associated with delayed recovery of parathyroid function.

Amaç: Meme küçültme, hastalar tarafýndan sýk baþvurulan bir prosedürdür ve plastik cerrahlar tarafýndan sýk yapýlan ameliyatlardan biridir. Redüksiyon mamoplasti sonrasý histopatolojik sonuçlarýn takibi çok önemlidir. Bu çalýþma, bilateral redüksiyon mamoplastisi uygulanan hastalarýn histopatolojik sonuçlarýný deðerlendirmeyi, meme lezyonlarýnýn insidansýný ve yüksek riskli meme lezyonlarýnýn risk faktörlerini belirlemeyi amaçlamýþtýr.
Gereç ve Yöntemler: Ekim 2013 - Ocak 2020 arasýnda plastik cerrahi bölümünde redüksiyon mamoplastisi uygulanan 477 hasta çalýþmaya dahil edildi. Hastalar yaþ, vücut kitle indeksi, komorbidite faktörleri, sigara kullanýmý, aile hikayesi ve histopatolojik bulgulara göre deðerlendirildi.
Bulgular: Hastalarýn yaþý ortalama 42.43 ± 12.05’idi. Vücut kitle indeksi 23-34.6 arasýnda deðiþmekte idi. Eþlik eden faktörler, 12 hastada hipertansiyon, 5 hastada astým ve 6 hastada diyabetes mellitus vardý. 17 hastada (% 3.6) sigara ve 25 (% 5.2) hastada meme kanseri öyküsü mevcuttu. Hastalarýn% 2.3'ü 20 yaþ ve altý, % 17.1'i 21 ila 30 yaþlarý arasýnda, % 21.5'i 31 ila 40 yaþlarý arasýnda,% 33.1'i 41 ila 50 yaþlarý arasýnda,% 18.2'si 51 ila 60 yaþlarý arasýndaydý. 7.5'i 60 yaþ ve üstünde idi. Histopatolojik bulgularýn% 85.4'ü normal meme dokusu ve nonproliferatif meme lezyonlarýndan oluþuyordu. Proliferatif meme lezyonlarý, atipik hiperplazi ve in situ lezyonlarýn insidansý sýrasýyla % 5.7, % 2 ve % 0.4 olarak hesaplandý. Ortalama takip süresi 3.8 ± 1.6 yýl idi.
Sonuç: Preoperatif meme kanseri tarama yöntemleri redüksiyon mamoplastisinden önce kullanýlsa da, yüksek riskli lezyonlarla karþýlaþýlabilir. Psikofizyolojik iyileþmeye ek olarak redüksiyon mamoplastisinin en büyük avantajlarýndan biri de meme kanseri riskinin azaltýlmasýdýr. (SETB-2020-04-041)

Objectives: Breast reduction is a frequently sought procedure by patients and one of the most commonly performed operations by plastic surgeons. Follow-up of histopathological results after reduction mammoplasty is very important. This study aimed to evaluate the histopathological results of patients undergoing bilateral reduction mammoplasty to determine the incidence of breast lesions and risk factors of high-risk breast lesions.
Methods: 477 patients who underwent reduction mammoplasty in the plastic surgery department between October 2013 and January 2020 were included in this study. Patients were evaluated according to age, body mass index (BMI), comorbidity factors, tobacco use, family history and histopathological findings.
Results: The mean age of patients was 42.43±12.05 years. Body mass index ranged from 23 to 34.6. As for comorbidity factors, 12 patients had hypertension, five patients had asthma and six patients had diabetes mellitus. Seventeen patients (3.6%) were smokers, and 25 (5.2%) patients had a family history of breast cancer. Among the patients, 2.3% were 20 years and under, 17.1% were between 21 and 30 years old, 21.5% were between 31 and 40 years old, 33.1% were between 41 and 50 years old, 18.2% were between 51 and 60 years old, and 7.5% were 60 years and above. 85.4% of histopathological findings consisted of normal breast tissue and nonproliferative breast lesion breast lesions. The incidences of proliferative breast lesions, atypical hyperplasia and in situ lesions were calculated as 5.7%, 2% and 0.4%, respectively. The mean follow-up period was 3.8±1.6 years.
Conclusion: Although preoperative breast cancer screening methods are used before the reduction mammoplasty, high-risk lesions may be encountered afterwards. One of the biggest advantages of reduction mammoplasty in addition to psychophysiological recovery is breast cancer risk reduction.

Amaç: Mediyastinum içerisinde serbest hava bulunmasý pnömomediyastinum olarak tanýmlanýr. Görülme sýklýðý 1/7000-1/32000 arasýndadýr. Bu çalýþmada amacýmýz görülme sýklýðý az olan spontan pnömomediyastinum (SPM) olgularýmýzý literatür bilgileri ýþýðýnda tartýþmaktýr.
Gereç ve Yöntem: Göðüs hastalýklarý ve göðüs cerrahisi bölümlerinde 2012-2018 SPM tanýsý konulup, göðüs cerrahisi kliniðinde takip ve tedavisi yapýlmýþ olan 11 olgunun dosyalarý retrospektif olarak incelendi. Hastalar; yaþ, cinsiyet, etyolojik faktörler, taný ve tedavi yöntemleri ile hastanede yatýþ süreleri açýsýndan deðerlendirildi.
Bulgular: Ýkibinoniki-2018 yýllarý arasýnda travmaya baðlý olmayan 11 SPM’ li olgu tespit edildi. Hastalarýn dokuz (% 81.8)’u erkek olup; yaþ ortancasý 38.5 idi. Spontan pnömomediyastinum oluþumunda rol oynayan predispozan faktörler arasýnda ilk sýrayý solunum yolu enfeksiyonuna sekonder geliþen öksürük nöbetleri alýrken en sýk görülen semptom ise dispne olarak tespit edildi. Olgularýn hastanede yatýþ süreleri ortancasý 3,8 gün olarak belirlenirken,mortalite gözlenmedi.
Sonuç: Spontan pnömomediyastinum özellikle genç erkeklerde görülen nadir bir klinik durumdur. Spontan pnömomediyastinum tedavisi konservatif ya da cerrahi olabilir. (SETB-2019-04-075)

Objectives: The presence of free air in mediastinum is defined as pneumomediastinum. The incidence is between 1/7000-1/32000. In this study, our aim is to discuss our cases with spontaneous pneumomediastinum (SPM), which has low incidence, in the light of the literature.
Methods: The files of 11 cases who were diagnosed with SPM in pulmonary diseases and thoracic surgery department and followed up and treated in thoracic surgery clinic between 2012-2018 were retrospectively analyzed. Patients’ age, sex, etiological factors, diagnosis and treatment methods and hospital stay were evaluated.
Results: Between the years of 2012-2018, 11 cases with SPM who were not related to trauma were detected. Nine (81.8%) of the patients were male; the median age was 38.5 years. Among the predisposing factors that played a role in the formation of SPM, the most common symptom was dyspnea, while the second most common symptom was coughing seizures. The median duration of hospitalization was 3.8 days, and no mortality was observed.
Conclusion: Spontaneous pneumomediastinum is a rare clinical condition, especially in young men. SPM treatment can be conservative or surgical.

Amaç: Küçük (≤4 cm) solid renal kitlelerin preoperatif deðerlendirmesinde, benign-malign ayrýmýný yapmada kullanýlabilecek ek klinik parametrelerin öngörü deðerini araþtýrarak, gereksiz yere nefron kaybýyla sonuçlanacak cerrahilerden kaçýnýlmasý gerekilen hastalarý belirlemeyi amaçladýk.
Yöntemler: Eylül 2009 - Aralýk 2017 tarihleri arasýnda, lokalize renal hücreli karsinom ön tanýsýyla parsiyel veya radikal nefrektomi yapýlan boyutu ≤4 cm olan 56 hastanýn verisi retrospektif olarak incelendi. Hastalara ait demografik veriler, histopatolojik tümör tipleri, nötrofil/lenfosit oraný (NLO), monosit/lenfosit oraný (MLO), platelet/lenfosit oraný (PLO), ortalama platelet hacmi (MPV), eritrosit daðýlým geniþliði (RDW), 10 yýllýk kardiyovasküler hastalýk geliþimi ve mortalite riskini öngören Framingham risk skoru ve bileþenlerinin varlýðý, postoperatif takip verileri kaydedildi. Tümör histopatolojisine göre hastalar benign ve malign olarak iki gruba ayrýlarak karþýlaþtýrýldý.
Bulgular: Ortanca taný yaþý 60 (min: 35-max: 74) olan 56 hastanýn 13’ü benign, 43’ü malign patolojiye sahipti. MLO (p=0.011), NLO (p=0.032), PLO (p=0.006), MPV (p=0.025) ve eGFR (p=0.019) malign grupta anlamlý olarak yüksek bulunurken; RDW (p=0.396) açýsýndan gruplar arasýnda farklýlýk izlenmedi. Malign olgularda Framingham skoru daha yüksekken (p=0.008); bu risk skorunu oluþturan bileþenler içerisinde sadece sigara kullanýmý (p=0.032), hipertansiyon varlýðý (p=0.041), total kolesterol (p=0.021) düzeyi anlamlý olarak daha yüksekti. ROC analizine göre kestirim deðerleri hesaplandýktan sonra, çok deðiþkenli analizde, NLO>2.02 (OR: 7.184, p=0.037), PLO>109.65 (OR: 12.692, p=0.002), MPV>3.44 (OR: 10.543, p=0.046) ve Framingham skoru>10.5 (OR: 12.287, p=0.007) küçük solid renal kitlelerde benign-malign ayrýmýný yapmada prediktif faktörler olarak belirlendi.
Sonuç: Malignite ayrýmýnýn net olarak yapýlamadýðý küçük solid renal kitlelerin klinik deðerlendirilmesinde, özellikle de NLO, PLO, MPV ve Framingham skorunu kullanmanýn öngörü gücünü artýrarak, benign kitlelerde gereksiz yere nefron kaybý yaþanmasýný engelleyebileceðini düþünmekteyiz. (SETB-2019-04-063)

Objectives: We aimed to investigate the predictive value of additional parameters for distinguishing benign-malign tumors and to prevent the loss of nephrons in small (≤4 cm) solid renal masses.
Methods: The data of 56 patients underwent partial or radical nephrectomy between September 2009 and December 2017 due to diagnosis of localized renal cell carcinoma were retrospectively analyzed. Demographic datas, histopathological tumor types, neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), red blood cell distribution width (RDW), mean platelet volume (MPV), the Framingham risk score and its components, postoperative follow-up results were recorded. Patients were divided into two groups as benign and malign.
Results: Among 56 patients with a median age of 60 (min: 35-max: 74) years, 13 patients had benign and 43 patients had malign pathologies. MLR (p=0.011), NLR (p=0.032), PLR (p=0.006), MPV (p=0.025), eGFR (p=0.019) and the Framingham score (p=0.008) were significantly higher in malign group. Among the components constituting the Framingham score, only presence of smoking (p=0.032), presence of hypertension (p=0.041) and total cholesterol values (p=0.021) were significantly higher. In multivariate analysis, NLR>2.02 (OR: 7.184, p=0.037), PLR>109.65 (OR: 12.692, p=0.002), MPV>3.44 (OR: 10.543, p=0.046) and Framingham score >10.5 (OR: 12.287, p=0.007) were found as predictive factors for distinguishing small solid renal masses concerning malignancy.
Conclusion: We think that NLR, PLR, MPV and the Framingham scores may be used in the clinical evaluation of small solid renal masses. In this way, we may prevent the unnecessary loss of nephrons in benign masses with suspicion of malignancy.

Amaç: Günde bir doz ve günde iki doz takrolimusun formülasyonunun, de novo böbrek nakli hastalarýnda, greft fonksiyonu üzerindeki etkinliðini karþýlaþtýrmayý amaçladýk.
Yöntem: Kurumumuzdaki immünsüpresyon protokolüne göre (0.2 mg / kg takrolimus+1000 miligram steroid þemsiyesi+ 720 mg mikofenolat ve 2,5 mg / kg anti-timosit globülin); yirmi günde tek doz (TAC-OD), yirmi günde iki doz takrolimus uygulanan (TAC-BID) de novo böbrek alýcýlarý demografik özellikleri, ilaç dozlarý ve ilaç kan konsantrasyonu ve greft fonksiyonu açýsýndan deðerlendirildi.
Bulgular: Ortalama takrolimus kan konsantrasyonu ölçümleri, transplantasyondan sonraki ilk altmýþ günde TAC-OD grubunda daha yüksekti, ayrýca TAC-OD grubu, tedavinin ilk 30 gününde daha fazla kan konsantrasyonu aþýmý/dalgalanma gösterdi. Baþlangýç ilaç dozu, TAC-OD grubunda TAC-BID grubuna kýyasla önemli ölçüde daha yüksekti (p = 0.04). Greft fonksiyonu açýsýndan (kreatinin ölçümleri) gruplar arasýnda anlamlý fark yoktu (p> 0.05).
Sonuç: De novo böbrek alýcýlarý arasýnda, yeni TAC-OD formülasyonu TAC-BID ile benzer bir kýsa vadeli etkinlik profili sunmaktadýr. Bununla birlikte, erken postoperatif dönemde benzer kan konsantrasyonlarýna ulaþmak için daha yüksek günlük TAC-OD dozajýna ihtiyaç vardýr. (SETB-2020-11-240)

Objectives: We aimed to compare the once-daily and twice-daily formulation of tacrolimus concerning the efficiency and effects on graft function in de novo kidney transplant patients.
Methods: Twenty once-daily (TAC-OD) and twenty twice-daily (TAC-BID) tacrolimus administrated de novo kidney recipients who had received initial immunosuppressive therapy according to protocols at our institution (0.2 mg/kg of tacrolimus combined with 1000 milligrams of steroid taper plus 720 mg of mycophenolate and with 2.5mg/kg anti-thymocyte globulin) assessed concerning demographics, drug doses and blood concentration, and graft function.
Results: The mean tacrolimus blood concentration measurements were higher in the TAC-OD group in the first sixty days after transplantation, and the TAC-OD group showed more blood concentration overshoots/fluctuations in the first 30 days of the treatment. The initial drug dose was significantly higher in the TAC-OD group than the TAC-BID group (p=0.04). There was no meaningful difference among groups according to graft function (creatinine measurements) (p>0.05).
Conclusion: Between de novo kidney recipients, the new TAC-OD formulation presents a similar short-term efficacy profile as TAC-BID. However, a higher daily dosage of TAC-OD is needed to achieve similar blood concentrations in the early postoperative period.

Amaç: Allojenik kemik iliði transplantasyonu ile hematopoetik kök hücre aktarýmý, çeþitli genetik, immünolojik bozuklukta, hematolojik ve solid organ malignitelerinin tedavisinde kullanýlan bir yöntemdir. Graft versus host hastalýðý allojenik kemik iliði transplantasyonunun temel ve ölümcül komplikasyonlarýndan biridir. Deri, gastrointestinal trakt, karaciðer, akciðer ve hematopoetik sistem olmak üzere beþ ana bölgeyi etkileyen sistemik bir hastalýktýr. Kutanöz Graft Versus Host Hastalýðýnýn tanýsý hastanýn klinik bulgularý ile histopatolojik bulgularýnýn korelasyonu ile konulur. Çalýþmamýzýn amacý, merkezimizde allojenik kemik iliði transplantasyonu yapýlmýþ hastalarda kutanöz graft versus host hastalýðýnýn görülme oranýný belirlemek, hastalýðýn histopatolojik özelliklerini ve ayýrýcý tanýsýný literatür eþliðinde tartýþmaktýr.
Gereç ve yöntemler: Kurumumuzda Ocak 2015 - Ocak 2019 tarihleri arasýnda allojenik kemik iliði transplantasyonu yapýlmýþ ve patoloji anabilim dalýmýzda graft versus host hastalýðý tanýsýný almýþ olan Hastalara ait deri biyopsi preparatlarý yeniden deðerlendirilip epidermal ve dermal histomorfolojik bulgular sýnýflandýrýldý. Hastalarýn klinik ve demografik bilgilerine dosyalarýndan ulaþýldý. Kutanöz Graft Versus Host hastalýðý görülme oraný belirlendi.
Bulgular: Merkezimizde Ocak 2015- Ocak 2019 tarihleri arasýnda pediatrik 173, eriþkin 100 olmak üzere toplam 273 hastaya allojenik, 181 hastaya ise otolog kemik iliði transplantasyonu yapýldý. Allojenik kemik iliði transplantasyonu yapýlan hastalarýn 23’inde kutanöz, 21’inde ise gastrointestinal Graft Versus Host hastalýðý görüldü. Kutanöz ve gastrointestinal Graft Versus Host hastalýðý görülme oraný %16,1; yalnýzca kutanöz Graft Versus Host hastalýðý görülme oraný ise %8,42 idi. Kutanöz Graft Versus Host hastalýðý’nýn klinik ön tanýlarý arasýnda en sýk ilaç reaksiyonu yer almakta idi (%74). Preparatlarda en sýk görülen epidermal histomorfolojik bulgu keratinosit nekrozu idi (%87). Bunu sýrasý ile bazal keratinositlerde vakuoler dejenerasyon (%63) ve Achanthosis ve spongiyoz (%61) izlemekte idi. Dermiste en sýk görülen bulgu ise Pigment incontinence idi (%59). Graft Versus Host hastalýðý saptanan hastalarýn %56’sýna akraba olmayan, %44’üne ise akraba olan donörlerden transplantasyon yapýlmýþtý.
Sonuç: Kutanöz Graft Versus Host Hastalýðý allojenik hematopoietik kök hücre transplantasyonunun sýk görülen bir komplikasyonudur. Yüksek mortalite oranlarý ile iliþkilidir ve hastanýn yaþam kalitesi üzerine belirgin negatif etkisi olan bir hastalýktýr. Dermatolojik olarak hastalýðýn erken tanýnmasý; ayýrýcý tanýlarý ile birlikte histopatolojik olarak deðerlendirilmesi ve verifikasyonu hasta morbidite ve mortalitesinin önlenmesinde kilit rol oynar. (SETB-2019-09-118)

Objectives: Hematopoietic stem cell transplantation by allogeneic bone marrow transplantation is a method used in the treatment of various genetic, immunological disorders, hematologic and solid organ malignancies. Graft versus Host Disease is one of the major and fatal complications of allogeneic bone marrow transplantation. It is a systemic disease affecting five main areas: skin, gastrointestinal tract, liver, lung and hematopoietic system. Diagnosis of cutaneous Graft versus Host Disease is made by the correlation between clinical and histopathological findings of the patient. The present study aims to investigate the incidence of cutaneous graft versus Host Disease in allogeneic bone marrow transplantation patients in our center, to discuss the histopathological features and differential diagnosis of cutaneous graft versus Host Disease in the light of the literature.
Methods: The pathology slides of allogeneic bone marrow transplantation patients who were diagnosed as graft versus Host Disease in our pathology department between January 2015 and January 2019 were re-evaluated. Epidermal and dermal histomorphological findings of the disease were classified; the patients’ clinical and demographic information was obtained from the files. The incidence of cutaneous Graft versusHost Disease was calculated.
Results: In our center, between January 2015 and January 2019, 273 pediatric and 100 adult patients underwent allogeneic and 181 autologous bone marrow transplantation. Twenty-three patients who underwent allogeneic bone marrow transplantation had cutaneous Graft versus Host Disease whereas and 21 patients had gastrointestinal Graft versus Host Disease. The incidence of cutaneous and gastrointestinal Graft versus Host Disease was 16.1% whereas the incidence of cutaneous Graft versus Host Disease was 8.42%. The most common clinical differential diagnosis of cutaneous Graft versus Host Disease was drug reaction (74%). The most common epidermal histomorphologic finding in our cases was keratinocyte necrosis (87%). In our cases, the most common epidermal histomorphologic finding was keratinocyte necrosis (87%). This was followed by vacuolar degeneration in basal keratinocytes (63%), acanthosis and spongiosis (61%), respectively. The most common finding in the dermis was pigment incontinence (59%). Of the patients with Graft versus Host Disease, 56% had transplantation from unrelated donors, whereas 44% of them had transplantation from their relatives.
Conclusion: Cutaneous Graft versus Host Disease is a common complication of allogeneic hematopoietic stem cell transplantation. It is associated with high mortality rates and has a significant negative impact on the patient's quality of life. Dermatological early recognition of the disease; histopathological evaluation and verification with differential diagnosis plays a key role in preventing patient morbidity and mortality.

Giriþ ve amaç; Saðlýk hizmetlerine eriþimin artmasý ile birlikte gereksiz koroner anjiyo sýklýðýnda artýþ olmuþtur. Red cell distribution width (RDW) eritrositlerin daðýlým hacmini gösterip koroner arter hastalýðý ile iliþki bulunmuþtur. Bu çalýþmadaki amaç miyokard perfüzyon sintigrafisi ile koroner iskemi araþtýrmasý yapýlýp koroner anjiyo planlanan hastalarda RDW deðerinin ciddi koroner lezyon saptanmasý arasýndaki iliþkiyi araþtýrmaktýr.
Materyal ve metod; Çalýþma retrospektif olarak yapýldý. Araþtýrmaya MPS ile koroner iskemi araþtýrmasý yapýldýktan sonra koroner anjiyo yapýlan 452 stabil anjina hastasý alýndý. Hastalara ayný gün hemogram bakýldý. Hastalar MPS’de iskemisi olan ve olmayan diye ve MPS’de iskemisi olanlar RDW düzeyi 13.5 ve üzeri ve 13.5 altý olmak üzere ikiþer gruba ayrýldý. MPS’de sabit perfüzyon defekti, kronik böbrek yetersizliði, tiroid disfonksiyonu, hematolojik hastalýk varlýðý, demir ilacý kullanýmý, aktif enfeksiyon çalýþma dýþý býrakýldý..
Bulgular; Her iki grupta temel karakteristik özellikler benzerdi. Ciddi damar hastalýðý, tek damar, iki damar ve üç damar MPS’de iskemisi olup RDW 13.5 ve üzerinde olan grupta daha yüksek saptandý. (p deðeri sýrasýyla <0.001, 0.036, 0.029, 0.005). Multivariant analizde ciddi koroner arter hastalýðýný göstermede RDW 13.5 ve üzeri olmasý baðýmsýz prediktör olarak saptandý (p<0.001 OR: 3.55).
Tartýþma ve sonuç; MPS ile iskemi araþtýrmasý yapýlýp RDW deðeri 13.5 üzerinde olan hastalarda daha fazla ciddi koroner arter hastalýðý saptanmýþtýr. MPS ile iskemi araþtýrmasý yapýlýp koroner anjiyo yapýlmasý planlanan hastalarda gereksiz anjiyolarýn önüne geçebilmek için ucuz ve kolay ulaþýlabilir bir parametre olan RDW göz önünde bulundurmalýdýr. (SETB-2018-12-165)

Objectives: As the feasibility of obtaining health care has improved in the last decade, there is an increase in the number of performing unnecessary coronary angiogram. Red Cell Distribution Width (RDW), which shows erythrocyte dispersion volume, is associated with coronary artery disease. The present study aims to evaluate the relationship between RDW value and the severity of coronary artery disease in patients who undergo myocardial perfusion scintigraphy (MPS) as an evaluation for coronary ischemia and after which patients had a coronary angiography.
Methods: This retrospective study included 452 patients diagnosed as stabile angina that had MPS to evaluate coronary ischemia and after which coronary angiography was performed. Complete blood count was obtained on the same day. Patients were first divided into two groups: patients with and without ischemia on MPS. Then, the group who had ischemia on the MPS where divided into another two groups: patients who had RDW values ≥13.5 and the others who had RDW value <13.5. Patients who had fixed perfusion defect, chronic kidney disease, thyroid dysfunction, hematological disease, those who use iron supplements, and those who had active infectious disease were excluded from this study.
Results: The basic characteristics were the same between study groups. We found that severe coronary vessel disease, single vessel, two vessels and three vessels diseases were higher in patients who had ischemia on the MPS and RDW values ≥13.5 (p-value were 0.032, 0.004, 0.042 respectively). RDW values ≥13.5 was found to be an independent predictor for the presence of severe coronary artery disease (p<0.001 OR: 3.55).
Conclusion: Patients who have MPS for ischemic evaluation and RDW values of ≥ 13.5 were more severe coronary heart diseases. As a result, the findings suggest that using of RDW value is a cheap and feasible parameter that may prevent performing unnecessary coronary angiography for patients after MPS.

Amaç: Meme radyoterapisi sýrasýnda Boost hacmini belirlemek bazen zor olabilir, bu nedenle cerrahi klipsler günümüzde yaygýn olarak kullanýlmaktadýr.Bazen cerrahi klipsler Boost hacmini belirlemekte yetersiz kalabilir, baþka görüntüleme yöntemi gerekeli olur.Biz bu çalýþmamýzda, cerrahi öncesinde çekilen 18-FDG /PET-BT’nin Boost hacminin belirlenmesideki etkinliðini agöstermeyi amaçladýk.
Yöntemler: Meme koruyucu cerrahi sýrasýnda cerrahi klips yerleþtirilen ve cerrahi öncesinde 18-FDG /PET-CT’si bulunan otuz hasta incelendi.Boost hacmi planlama tomograsinde ve cerrahi öncesinde 18-FDG /PET-BT’sinde ayný radyasyon onkoloðu tarafýndan belirlendi.Her iki hacim birbiri üstüne füzyon yapýldý.Her iki hacminde orta noktasý belirlenip hacimlerin ortalama farklarý ölçüldü ve planlama tomograsindeki Boost hacmi (PTV-BV), PET-BT’deki tümör hacmi( PET-CT TV)’nin yüzde kaçýný içerdiði hesaplandý.
Bulgular: Hastalarýn yaþ ortalamasý 52 (25-72 yaþ)’dur.Cerrahi öncesi PET-BT TV ortalama 8.89 cm3 ( 1.00-64.30 cm3). PTV-BV’nin ortalama hacmi 6.92 cm3 (12.57-123.07 cm3).Her iki hacmin orta noktalarýndan, X (Coronal) düzlemde ortalama 1.76 cm (0.90-3.50), Y(aksiyel) düzleminde ortalama 1.73 cm (0.60-3.60), Z (sagittal) düzleminde ortalama1.20 cm(0.40-2.80) fark tespit edildi.Üç düzlemdeki fark istatiksel olarak anlamlý bulundu (p<0.001).PTV BV ortalama %54±29.53 (%35-%100) oranýnda PET-BT TV’ni içerir ve 30 hastanýn 2 tanesinde
PET-BT TV’ü PTV BV’nin tamanen dýþýndadýr.
Sonuç: Meme koruyucu cerrahi sonrasýnda cerrahi klips yerleþtirilen hastalarda boost hacminin belirlenmesinde cerrahi öncesi çekilen PET-BT kullanýlmamalýdýr.Daha doðru bir boost hacmi tanýmlanmasý için cerrahi klipsler 4 düzleme yerleþtirilmeli ve tedavi planlanmasýnda daha fazla PTV marjlarý verilmesi gerekir. (SETB-2019-12-156)

Objectives: Determining boost volume (BV) during breast radiotherapy can be challenging at times. Therefore, surgical clips are now being widely used. At times, when surgical clips are inadequate in determining the BV, other additional imaging methods are required. In the present study, we aimed to demonstrate that pre-operative positron emission tomography/computed tomography (PET-CT) can be used to determine the BV after a breast-conversing surgery.
Methods: We selected thirty patients who underwent breast-conserving surgery with surgical clips and had preoperative Fluorine-18-Fluorodeoxyglucose PET (18 FDG PET/CT). The BV in planning tomography (CT) and primary tumor volume (TV) in pre-operative F-18 FDG PET/CT was contoured by a radiation oncologist. These two volumes were superposed using rigid image fusion. In every patient, two BVs were measured. The mean shift between the two volumes by the calculation of the center of mass and percentage of the PET-CT TV (PET-CT TV) in planning the BV (planning target volume [PTV]-BV) was calculated.
Results: The median age was 52 years (range 25–72 years). The pre-operative PET-CT TV median was 8.89 cm3 (range 1.00–64.30 cm3). The median PTV-BV was 62.92 cm3 (12.57–123.07 cm3). The median shifts between the center of volumes were 1.76 cm (range 0.90–3.50) in X(coronal), 1.73 cm (range 0.60–3.60) in the Y(axial), and 1.20 cm (0.40–2.80) in the Z(sagittal) directions, respectively. The shifts in these three planes were determined to be statistically significant (p<0.001). The percent volume of PET-CT TV included PTV TV, ranging from 35% to 100% (mean 54%, standard deviation 29.53) and 100% in two out of 31 patients.
Conclusion: Our study has shown that pre-operative PET-CT cannot be used to determine the BV in patients who replaced surgical clips and had undergone breast-conserving surgery. To define a more accurate BV, surgical clips should be placed in four planes, and more PTV margins should be given in treatment planning.

Giriþ ve Amaç: Hepatit C virusu (HCV), dünya üzerinde yaygýn olarak bulunan, koruyucu bir aþýsý olmayan, ciddi bir halk saðlýðý tehdidi oluþturan kronik hepatit etkenidir. HCV genomunun deðiþik bölgelerinde nükleotid ve aminoasit dizileri bakýmýndan farklýlýklar bulunmaktadýr. Bu farklýlýklar neticesinde HCV'nin en az yedi majör genotip ve birçok alt tipinin bulunduðu gösterilmiþtir. Türkiye'de de, genotip 1'in prevalansý % 51,7 - % 97,1 arasýnda olup, tüm genotipler içinde en yüksek orana sahiptir ve çoðunluðunu alt tip1b oluþturur. Mikst genotip enfeksiyonlarýn tedavi baþarýsýzlýðýna neden olmasý açýsýndan güvenilir bir þekilde saptanmasý önemlidir. Bu çalýþmada amaç, Ýstanbul bölgesindeki hastanemizde HCV genotiplerinin, yýllar içindeki daðýlýmlarýný ortaya koymak ve elde edilecek epidemiyolojik verilerle Türkiye verilerine katkýda bulunmaktýr.
Materyal ve Metod: Bu amaçla Ocak 2016 ve Haziran 2019 arasýnda Sisli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi Klinik Mikrobiyoloji Laboratuvarýna anti-HCV (+) hastalarda genotip belirlenmesi için gönderilmiþ 385 adet hasta numunesi retrospektif olarak deðerlendirilmiþtir. Anti-HCV enzim immunoassay, doðrulama Line immunoassay ile yapýlmýþtýr. Genotip tayini için çalýþýlan testler, iyi korunmuþ bölge 5′UTR ve çok deðiþken bölge NS5B hedeflenerek yapýlmýþtýr.
Bulgular: En sýk görülen genotip 313 vaka ile genotip 1 (%81.3) olup genotip 1a %10.9, genotip 1b %67.8 oranýnda bulunmuþtur. Bunun dýþýnda genotip 3, 2, 4, 5 sýrasýyla %8.8, %3.4, %2.9, %0.8 oranýnda tespit edilmiþ ve %2.9 vakada mikst genotip saptanmýþtýr. Genotip 5 Güney Afrika’da görülmesine karþýn, düþük oranda da olsa Orta Doðu bölgesinde saptanmaktadýr. Araþtýrmamýzda farklý yýllarda tespit edilen genotip 5 vakalarýnýn Suriye kökenli hastalar olduðu görülmüþtür.
Tartýþma: Çalýþmamýzda, literatürle uyumlu olarak genotip 1 %81.3 oranýnda en yaygýn genotip olarak saptanmýþ olup alt tip 1b’nin %67.8 oranýnda olduðu görülmüþtür. Bununla birlikte genotip 3,2,4,5 düþük oranlarda da olsa mevcuttur. Çevre ülkelerde bu genotiplerin bazýlarýnýn baskýn olmasýndan dolayý takip edilmesi önemlidir. Ayrýca %2.9 oranýnda HCV mikst genotip tespit edilmiþ olmasý HCV enfeksiyonunun yönetimi açýsýndan dikkat edilmesi gereken bir durumdur. (SETB-2020-05-056)

Objectives: Hepatitis C virus (HCV), which has no protective vaccine, is a common cause of chronic hepatitis, which is a severe public health threat. There are differences in nucleotide and amino acid sequences in different regions of the HCV genome. As a result of these differences, HCV has been shown to have at least seven major genotypes and many subtypes. In Turkey, the prevalence of genotype 1 is between 51.7% and 97.1%, the highest rate among all genotypes, while subtype 1b is the genotype with the highest rate. It is important to detect mixed genotype infection reliably as it causes treatment failure. This study aims to reveal the distribution of the HCV genotypes in our hospital in Istanbul over the years and to contribute to the epidemiological data of Turkey.
Methods: For this purpose, 385 patient samples sent to Sisli Hamidiye Etfal Training and Research Hospital, Clinical Microbiology Laboratory for HCV genotype determination between January 2016 and June 2019 were evaluated retrospectively. Anti-HCV was screened by enzyme immunoassay and confirmation was performed by Line immunoassay. HCV genotyping assays targeting highly conserved 5’UTR and most variable region NS5B regions were used.
Results: The most common genotype was genotype 1 (81.3%) with 313 cases and subtypes 1a and 1b were detected at the rates of 10.9% and 67.8%, respectively. In addition, genotype 3, 2, 4, 5 were detected at the rates of 8.8%, 3.4%, 2.9%, 0.8%, respectively and mixed genotype was found in 2.9% of cases. Although genotype 5 is seen in South Africa, it is found in the Middle East region, albeit at a low rate. In our study, it was observed that genotype 5 was detected in different years from patients of Syrian origin.
Conclusion: In this study, genotype 1 was the most common genotype with a rate of 81.3% and subtype 1b was 67.8%, in accordance with the literature. However, genotypes 3, 2, 4 and 5 were also present at low rates. It is important to monitor these rare genotypes since some of them are dominant in surrounding countries. In addition, 2.9% of HCV mixed genotype was detected and this should be considered concerning management of HCV infection.

Amaç: Bethesda kategorisine göre deðerlendirilen, tiroid nodüllerinin aspirasyon sonuçlarýný, ameliyat materyallerinden sonraki kesin doku tanýlarý yaný sýra, sitolojide kullanýlan yöntemlere göre de karþýlaþtýrmak, duyarlýlýk, özgüllük ve doðruluk oranlarýný belirlemektir.
Yöntem: 2010-2017 yýllarý arasýnda opere olmuþ, histopatolojik olarak doku tanýsý teyit edilen 879 olgunun tiroid nodüllerinden alýnan ince iðne aspirasyon biyopsisi (ÝÝAB) sonuçlarý karþýlaþtýrýldý. Bethesda sistemine göre belirlenen ÝÝAB sonuçlarý, doku tanýlarý ile eþleþtirildi, sitoloji yöntemlerine göre duyarlýlýk, özgüllük, doðruluk oranlarý belirlenip karþýlaþtýrýldý.
Bulgular: Tüm ÝÝAB sonuçlarýnda, duyarlýlýk, özgüllük, Pozitif öngörü deðeri (PPV), Negatif öngörü deðeri (NPV) ve doðruluk oranlarý bulundu (%’lik birimde; Duyarlýlýk; 84.7, Özgüllük; 81.1, PPV; 74.1, NPV; 89.2, Doðruluk; 82.5). Tiroid ÝÝAB’lerinin sitolojik deðerlendirme yöntemlerinin hepsi güvenilir ve etkili oranlarda bulundu (Genel olarak sonuçlar %80 ve üzerindedir). Özgüllük ve doðruluk oranlarý, bütün yöntemlerde, genel ortalamaya (%82.5) yakýn idi. Ancak sývý bazlý sitoloji(SBS) yöntemiyle deðerlendirilen olgularda ve SBS veya Konvansiyonel yayma(KY)’ya ek olarak, hücre bloðu(HB)’nun birlikte deðerlendirildiði olgulardaki duyarlýlýk oranlarý, SBS ve KY’nýn tek baþýna kullanýldýðý olgulara göre daha yüksekti (% 92.6 ve% 91.0). Ýstatiksel olarak bakýldýðýnda ise, sitolojik yöntemlerin duyarlýlýk, özgüllük ve doðruluk oranlarý açýsýndan anlamlý fark yoktu (p>0.05, sýrasýyla, p=0.576, 0.065, 0.643).
Sonuç: Sitopatolojide, tiroid aspirasyonlarýný deðerlendirirken, KY yerine SBS yönteminin kullanýmýnýn yerleþtiði görülmektedir. Biz de, çalýþmamýzda, KY yerine, duyarlýlýðýn en yüksek olduðu görülen (teknik avantajlarýný da gözönüne alarak), SBS yönteminin kullanýmýný öneriyoruz. Ancak gerek KY, gerek SBS yönteminin, ek olarak hücre bloðu kesitleriyle birlikte desteklenerek deðerlendirilmesinin gerekli olduðunu düþünüyoruz. (SETB-2020-10-208)

Objectives: In this study, we aim to compare the results of aspiration of thyroid nodules evaluated according to the Bethesda category (BC) with tissue diagnoses in the operation materials and to compare the sensitivity, specificity and accuracy rates according to cytology methods.
Methods: The previous fine-needle aspiration biopsy (FNAB) of thyroid nodules of 879 cases diagnosed histopathologically between 2010 and 2017 was examined. The FNAB results determined according to the Bethesda system were matched with tissue diagnoses, sensitivity, specificity, and accuracy rates were investigated according to cytology methods.
Results: Sensitivity, specificity, Positive predictive value (PPV), Negative predictive value (NPV) and accuracy rates were found in all FNAB results (in units of %; Sensitivity; 84.7, Specificity; 81.1, PPV; 74.1, NPV; 89.2, Accuracy; 82.5). All of the cytological evaluation methods of thyroid FNABs were found to be reliable and effective (Generally, the results are 80% and above). Specificity and accuracy rates were close to the general average (82.5%) in all methods. However, in cases evaluated with liquid base cytology (LBC) method and in addition to LBC or conventional smear (CS), the sensitivity rates in cases where cell block (CB) were evaluated together were higher than cases in which LBC and CS were used alone (92.6% and 91.0%). When examined statistically, there was no significant difference concerning sensitivity, specificity and accuracy rates of cytological methods (p>0.05, respectively, p=0.576, 0.065, 0.643).
Conclusion: In cytopathology, when evaluating thyroid aspirations, it is seen that the LBC method is used instead of CS. In our study, we recommend the use of the LBC method, which seems to have the highest sensitivity (taking into account its technical advantages), instead of CS. However, we think that both CS and LBC methods should be evaluated by supporting them with cell block sections.

Amaç: Adenotonsillektomi çocukluk çaðýnda en sýk yapýlan ameliyatlardan biridir. Birçok doktor için tonsillektomi sonrasý aðrý hala bir problemdir. Cerrahi tekniklerdeki yeniliklere, analjezikler ve antienflamatuar ilaçlardaki ilerlemelere raðmen, tonsillektomi sonrasý aðrý yönetimi için halen standart bir strateji belirlenmemiþtir. Bu çalýþmanýn amacý tonsil lojlarýna tonsillektomi sonrasý uygulanan steroid içeren nazal spreyin analjezik etkisini araþtýrmaktýr.
Materyal Method: Çalýþmaya dahil edilen seksen iki hasta çalýþma ve kontrol grubu olarak iki gruba ayrýldý. Çalýþma grubuna, her iki tonsil lojuna ameliyattan sonra 5 gün boyunca steroid içeren nazal sprey uygulandý. Postoperatif tüm hastalarýn aðrýlarý görsel analog skala ile deðerlendirildi ve sonuçlar karþýlaþtýrýldý.
Bulgular: Hem çalýþma grubunda hem de kontrol grubunda aðrý zamanla giderek azaldý. Ameliyat sonrasý 4 saatten- postoperatif 5. güne kadar olan aðrý skorlarý, steroid içeren nazal sprey kullanan çocuklarda kontrol grubuna göre anlamlý olarak azalmamýþ olsa da, bu hastalarda postoperatif 5. günde istatistiksel olarak anlamlý derecede daha az aðrý geliþti (p <0.05).
Sonuç: Yayýnlarda tonsillektomi sonrasý aðrýnýn, yara inflamasyonunun en fazla olduðu postoperatif 5. gün civarýnda arttýðý bildirilmiþtir. Bu nedenle, bu sorunun üstesinden gelmek için steroid içeren burun spreyi uygulanan çocuklarda gözlenen postoperatif 5. günde belirgin aðrý azalmasý, klinik öneme sahip olabilir. (SETB-2020-01-012)

Objectives: Adenotonsillectomy is one of most common surgeries performed in childhood. Post-operative pain associated particularly with tonsillectomy is still a problem for many physicians. Despite advances in surgical techniques, analgesics, or anti-inflammatory drugs, no unique strategy for post-tonsillectomy pain management has been suggested. The aim of this study is to investigate the analgesic effect of steroid containing nasal spray applied to tonsillar region after tonsillectomy.
Methods: Eighty-two patients were assigned into two groups as study and control. In study group, nasal spray containing steroid was applied to each tonsillar region after surgery for 5 days. Post-operative pain of all patients was assessed using a visual analog scale and results were compared.
Results: Pain decreased gradually over time in both the study and control groups. Although the pain scores from 4 h post-surgery to post-operative day 5 were not found to significantly decrease in children that used nasal spray containing steroid, these patients developed less pain on post-operative day 5,with statistical significance (p<0.05).
Conclusion: Post-tonsillectomy pain was reported to increase around post-operative day 5, which coincides with the time of intense wound inflammation. Therefore, significant pain reduction on post-operative day 5 observed in children that used nasal spray with steroid may have clinical importance for overcoming this problem.

Amaç: Bu çalýþmada laparoskopik inguinal herni onarýmý sýrasýnda pediatride entübasyon ve laringeal maske kullanýmýnýn etkilerini kan gazý analizi, End Tidal CO2 ölçümleri ve hava yolu deðiþiklikleriyle araþtýrmayý amaçladýk.
Gereç ve Yöntem: Bu çalýþma, laparoskopik inguinal herni onarýmý planlanan 1-8 yaþ arasý, ASA I 150 hastada prospektif randomize bir çalýþma olarak tasarlanmýþtýr. Grup1 (n = 75) fentanil, propofol ve rokuronyum ile genel anestezi aldý ve orotrakeal olarak entübe edildi. Grup2 (n = 75) fentanil ve propofol ile genel anestezi aldý ve bir laringeal maske yerleþtirildi. Hastalarýn demografik verileri, operasyon baþlangýcýndaki, CO2 insüflasyonundan sonra 10.dakikadaki, CO2 insuflasyonu sonlandýrýldýktan sonra 10. dakikadaki arter kan gazý deðerleri kaydedildi. End Tidal CO2, Kalp Atým Hýzý, SPO2, inspiratuar basýnç, plato basýncý, tidal volüm ve sýklýk kaydedildi. Anestezi süresi, operasyon süresi, insüflasyon süresi ve komplikasyonlarý kaydedildi.
Bulgular: Anestezi ve derlenme süreleri Grup1'de Grup2'ye göre daha uzundu. Hemodinamik parametreler, EndTidalCO2 deðerleri, tidal volüm ve hava yolu basýnçlarý, solunum frekanslarý arasýnda istatistiksel olarak farklýlýk yoktu. Kan gazý örneklerinde analiz edilen pH, pCO2 ve pO2 deðerlerine göre gruplar arasýnda istatistiksel olarak anlamlý bir fark yoktu.
Sonuç: Çocuklarda laparoskopik inguinal herni operasyonlarýnda laringeal maske uygulamasý orotrakeal entübasyon ile karþýlaþtýrýldýðýnda, kan gazý analizlerinde, havayolu basýnçlarýnda farklýlýk tespit edilmezken, derlenmenin daha hýzlý olduðu görüldü. Bu nedenle, laringeal maske, kýsa süreli pediatrik laparoskopik cerrahide güvenli bir havayolu aracý olarak kullanýlabilir. (SETB-2019-09-119)

Objectives: We aimed to investigate the effects of intubation and laryngeal mask airway (LMA) use by evaluating the results of blood gas tests, end-tidal CO2 measurements, and airway changes during laparoscopic inguinal hernia repair in children.
Methods: This study was designed to be a prospective randomized study enrolling 150 ASA-I patients, aged 1–8 years; who were scheduled for laparoscopic inguinal hernia repair. Group 1 (n=75) received general anesthesia with fentanyl, propofol, and rocuronium and they were orotracheally intubated. Group 2 (n=75) received general anesthesia with fentanyl and propofol and were inserted an LMA. Demographical data were recorded. Arterial blood gas test results at baseline, in the 10th min after the insufflation, and in the 10th min after the end of the insufflation were noted. The end-tidal CO2, HR, SPO2, inspiratory pressure, plateau pressure, tidal volume (TV), and respiratory frequencies were recorded. The duration of anesthesia, operation, and insufflations was noted. Emergent complications were recorded.
Results: The duration of both anesthesia and recovery was longer in Group 1 compared to Group 2. Hemodynamical parameters, end-tidal CO2 values, TVs, airway pressures, and respiratory frequencies were not statistically significantly different between the groups. There were no statistically meaningful differences in the levels of pH, PCO2, and PO2 between the groups.
Conclusion: Compared to orotracheal intubation during laparoscopic inguinal surgery; LMA did not cause any statistically significant differences in the blood gas test results or airway pressures and recovery was faster with LMA. Therefore, LMA can be used in pediatric laparoscopic surgery as a safe tool for maintaining the airway.

Amaç: Çalýþmamýz çok düþük doðum aðýrlýklý bebeklerde aralýklý bolus beslenme ile devamlý beslenme modellerinin erken dönem büyüme ve taburculuk süresi üzerine etkisini belirlemek.
Metod: Çalýþma prospektif, randomize ve kontrollü olarak planlandý. Hastanemizde bir yýllýk süre içerisinde doðan ve doðum aðýrlýðý 1500 gram altýndaki bebekler çalýþmaya alýndý. Örneklem sayýsý, güç analizi ile belirlendi. Bebekler doðum aðýrlýðýna göre randomize edilerek aralýklý bolus beslenme ve devamlý besleme modelleri ile beslenmeleri saðlandý. Bebeklerin demografik özellikleri, klinik bulgularý, tanýlarý ve beslenme durumlarý ile hastanede kalýþ süreleri karþýlaþtýrýldý.
Bulgular: Çalýþma, devamlý beslenme (n=41) ve aralýklý beslenme (n=39) grubu olmak üzere toplam 80 preterm bebek ile yapýldý. Her iki gruptaki bebeklerin cinsiyet, gestasyon haftasý, doðum kilosu, boy ve baþ çevresi daðýlýmlarýnda anlamlý bir fark yoktu. Bebeklerin doðum kilosuna ulaþma zamaný ve maksimum tartý kaybý oranlarý, parenteral beslenme süreleri, tam enteral beslenmeye geçiþ süresi, oral beslenmeye geçiþ süresi, beslenme intoleransý geliþimi, mekanik ventilasyon süresi ile yoðun bakýmda yatýþ süreleri ortalamalarý arasýndaki fark istatistiksel olarak anlamsýzdý. Devamlý beslenme modeli ile beslenen bebeklerin %34,1’inde aralýklý beslenen bebeklerin %28,2’sinde nekrotizan enterokolit (NEK) Evre I ve II geliþtiði, NEK’in devamlý beslenen grupta ortalama 4,5±2,8 gün, aralýklý beslenen grupta ise 2,8±5,2 gün saptandýðý gruplar arasýnda bu farklýlýklarýn anlamsýz olduðu belirlendi (sýrasýyla p: 0,634 ve p: 0,266).
Sonuç: Devamlý ve aralýklý bolus beslenme modeli uygulanan preterm bebeklerin büyüme parametreleri ve taburculuk süreleri arasýnda fark olmadýðý saptandý. NEK geliþimi üzerinde istatistiksel anlamlý saptanmasa bile aralýklý beslenme modelinde daha erken zamanda NEK geliþtiði belirlendi. (SETB-2019-12-143)

Objectives: The aim of this study was to determine the effect of intermittent bolus feeding and continuous feeding models on early growth and discharge time in very low birth weight infants.
Methods: The study was designed as a prospective, randomized, and controlled study. Infants born in our hospital with birth weight below 1500 g within a 1 year period were included in the study. The number of samples was determined by power analysis. Babies were randomized according to birth weight and fed with intermittent bolus feeding and continuous feeding models. Demographic characteristics, clinical findings, diagnosis, nutritional status, and length of hospital stay were compared.
Results: The study was conducted with 80 preterm infants, which consisted of continuous feeding (n=41) and intermittent bolus feeding (n=39). There was no significant difference in gender, gestational week, birth weight, height, and head circumference distribution of the babies between groups. The difference between the reach time to birth weight and maximum weight loss rates, parenteral feeding time, transition time to full enteral feeding, transition time to oral feeding, development of feeding intolerance, mechanical ventilation time, and hospitalization time in intensive care unit were not statistically significant. Necrotizing enterocolitis (NEC) Stage I and II developed in 34.1% of babies fed with continuous feeding model and 28.2% of babies fed intermittently; NEC was detected to start in 4.5±2.8 days in the continuous feeding group and in 2.8±5.2 days in the intermittent group. These differences were found to be insignificant between the two groups (p=0.634 and p=0.266, respectively).
Conclusion: There was no difference between growth parameters and discharge time of preterm babies who were applied continuous and intermittent bolus feeding model. Although there was no statistically significant difference on the development of NEC, it was determined that NEC developed earlier in the intermittent bolus feeding model.

Giriþ: Trafik kazalarý, düþmeler, darp olgularý, iþ kazalarý, intoksikasyonlar, yanýklar, elektrik ve yýldýrým çarpmalarý, her türlü asifiksi olgularý, delici kesici ve ateþli silah yaralanmalarý, istismar olgularý veya þüphesi ve intihar giriþimleri adli olgu olarak deðerlendirilmelidir. Bu çalýþmamýzda adli olgularda çocuk yoðun bakým deneyimimizi sunmayý amaçladýk.
Yöntemler: Çocuk Yoðun Bakým Ünitemize 1 Þubat 2017 – 1 Eylül 2018 tarihleri arasýnda kabul edilen adli olgular geriye dönük olarak deðerlendirildi.
Bulgular: Çalýþmamýza 65’i (%42.5) erkek ve 88’i (%57.5) kýz olmak üzere toplam 153 çocuk dahil edildi. Yoðun bakým yatýþlarýnýn %54,9’unun adli nedenini ilaç intoksikasyonu oluþtururken, %24.2’sini özkýyým giriþimleri, %5.2’sini yüksekten düþme, %5.2’sini çocuk istismarý, %2.6’sýný araç dýþý trafik kazasý, %2.6’sýný suda boðulma, %2’sini araç içi trafik kazasý, %2’sini elektrik çarpmasý ve %1.3’ünü CO (karbonmonoksit) zehirlenmesi oluþturdu. Ýlaç intoksikasyonlarýna neden olan ilaçlarýn %40.6’sýnýn çocuðun annesine ait olduðu, %27.1’inin ise çocuðun kendisine ait olduðu saptandý. Ýntoksikasyon olgularýnýn %33.1’i analjezik–antiinflamatuar ilaçlarla, %22.3’ü antidepresan ilaçlarla meydana geldiði, bu olgularda saptanan en sýk ilacýn parasetamol olup tüm intoksikasyon olgularýndaki oraný %21.9, analjezik grubunda ise %72.5 olarak saptandý. Antidepresan ilaçlar grubunda ise en sýk etken amitriptilin (%59.2) olarak bulundu. Özkýyým giriþimlerinin yoðun bakýma kabul saatinin 08: 00-14: 00 arasýnda olma oraný (%35.1), özkýyým giriþimi olmayanlardan (%16.4) istatistiksel olarak anlamlý düzeyde yüksek bulundu (p: 0.025; p<0.05).
Sonuç: Çocuk yoðun bakým ünitemizde izlenen adli olgularda en sýk hasta grubunu ilaç zehirlenmeleri oluþturdu. Bu zehirlenmelerin büyük çoðunluðu (%69.4) kaza ile alým sonucu gerçekleþti. Bu nedenle çocuklarýn ilaçlara eriþiminin engellenmesinin, ilaç zehirlenmelerine baðlý çocuk yoðun bakým adli olgu yatýþlarýný önemli ölçüde azaltacaðýný düþünmekteyiz. (SETB-2019-04-069)

Objectives: Traffic accidents, falls, assaults, occupational accidents, intoxications, burns, electric shock, lightning strike, all cases of asphyxia, penetrating and firearm injuries, suspected or definite cases of sexual abuse, and suicide attempts should be evaluated in the forensic category. In this study, we aimed to present our intensive care experiences in forensic cases.
Methods: We retrospectively evaluated forensic cases admitted to our Pediatric Intensive Care Unit between 1 February 2017 and 1 September 2018.
Results: This study included 153 children, 65 (42.5%) boys and 88 (57.5%) girls. The forensic causes of hospitalizations in the intensive care unit included drug intoxication with a rate of 54.9%, followed by suicide attempts with 24.2%, falling from a high place with 5.2%, child abuse with 5.2%, pedestrian (out-of-vehicle) traffic accidents with 2.6%, drowning in water with 2.6%, road (in-vehicle) traffic accidents with 2%, electric shocks with 2%, and CO (carbon monoxide) poisoning with 1.3%. The drug intoxication was caused by drugs prescribed to the mother and the child with a rate of 40.6% and 27.1%, respectively. Analgesic anti-inflammatory drugs (33.1%) and antidepressant drugs (22.3%) were identified as major causes of intoxication. In addition, paracetamol was the most common cause of intoxication, with a rate of 21.9% among all intoxication cases and 72.5% in the analgesic group. Amitriptyline was the most common agent in the antidepressant group (59.2%). The admission rate to the intensive care unit between 08: 00 and 14: 00 was 35.1% for suicide attempts and 16.4% for non-suicide attempts, with a statistically significant difference (p=0.025; p<0.05, respectively).
Conclusion: Drug intoxications had the highest rate of forensic cases followed in our pediatric intensive care unit. The majority of these intoxications (69.4%) arose from accidental drug ingestion. Therefore, we believe that there may be a significant decrease in the number of hospitalizations of forensic cases associated with drug intoxications in pediatric intensive care units by preventing children’s access to drugs.

Amaç: Baþ aðrýsý, çocukluk çaðýnda çok sýktýr ve poliklinik baþvurularýnýn önemli bir kýsmýný oluþturur. Bu çalýþmanýn amacý, baþ aðrýsý yakýnmasýyla baþvuran hasta¬larda etiyoloji, klinik özellikler, tetkik sonuçlarý, proflaktik tedavi ve izlem sonuçlarýný deðerlendirmektir.
Yöntem: Ocak 2017 ile Aralýk 2018 tarihleri arasýnda baþ aðrýsý yakýnmasýyla baþvuran hastalarýn dosyalarý retrospektif olarak incelendi. Baþ aðrýlarý, Uluslararasý Baþ Aðrýsý Derneði kriterlerine göre sýnýflandýrýldý.
Bulgular: Yaþlarý 3-17 arasýnda, yaþ ortalamalarý 11,2±2,7 yýl olan 212 kýz (%60,6), 138 erkek (%39,4) toplam 350 baþ aðrýsý olan hasta dahil edildi. Kýz cinsiyette birincil baþ aðrýsý oraný erkek cinsiyete göre daha yüksek oranda bulundu (p=0,004). Baþ aðrýsý nedenleri %51,1 hastada migren, %32,3’ünde gerilim tipi baþ aðrýsý, %13,4 hastada ikincil, %3,1’isinde ise sýnýflandýrýlamayandý. Birincil baþ aðrýsý olanlarýn yaþ ortalamasý, ikincil baþ aðrýsý olanlara göre istatistiksel olarak yüksekti (p<0,001). En sýk tetikleyici faktör uykusuzluktu (%52.7). Hastalarýn 17 (%9,49)‘sinde anormal fizik/nörolojik bulgu saptandý. Kranial manyetik rezonans görüntüleme incelemesi 121 (%34,5) hastaya yapýlmýþtý. Bunlarýn 35 (%28,9)’inde anormal bulgular saptandý. Toplamda 33 hastaya elektroensefalogtrafi çekildi, hiçbirinde epileptiform anormallik saptanmadý. Proflaktik tedavi olarak en çok flunarizin (%23,2) ve siproheptadin (%7,5) verildi. Proflaksi baþlanan ve kontrole gelen tüm hastalarýn baþ aðrýlarýnda belirgin azalma olduðu gözlendi.
Sonuç: Çocukluk çaðý baþ aðrýlarýnýn nedeni çoðunlukla migren ve gerilim tipi baþ aðrýsýdýr. Anamnez ve nörolojik muayenede anormallik olmadýðý sürece baþ aðrýlý hastalarýn rutin deðerlendirmesinde nörogörüntüleme çalýþmalarýna gerek yoktur. Seçilmiþ vakalarda verilen proflaktik tedavi hayat kalitesini arttýr. (SETB-2018-12-183)

Objectives: A headache is prevalent in childhood and constitutes a significant part of outpatient applications. This study aimed to evaluate the results of etiology, clinical features, examination results, prophylactic treatment and follow-up in patients with a headache.
Methods: Between January 2017 and December 2018, the files of the patients with the complaint of headache were reviewed retrospectively in this study. A headache was classified according to the International Headache Society (IHS) criteria.
Results: In this study, 350 patients aged between 3-17 years old and the mean age of 11.2±2.7 with a headache were included; 212 (60.6%) of them was female and 138 (39.4%) of them was male. The rate of a primary headache was higher in females than in males (p=0.004). The headache causes were a migraine in 51.1%, tension-type headache in 32.3%, secondary in 13.4%, and not classified in 3.1%. The mean age of the patients with a primary headache was significantly higher than patients with a secondary headache (p<0.001). The most common trigger factor was insomnia (52.7%). Abnormal physical/neurological signs and symptoms were detected in 17 (9.49%) patients. Cranial magnetic resonance imaging (MRI) examination was performed in 121 (34.5%) patients. Abnormal findings were found in 35 (28.9%) of these. In this study, 33 patients underwent electroencephalography (EEG); none of the had an epileptiform abnormality. Flunarizine (23.2%) and cyproheptadine (7.5%) were the most administered prophylactic treatments. It was observed that all patients who had prophylaxis and who had come to control had a significant decrease in headaches.
Conclusion: The cause of childhood headaches is mostly migraine and tension-type headache. As long as there is no abnormality in the history and neurological examination, neuroimaging studies are not required in the routine evaluation of patients with a headache. Prophylactic treatment increases the quality of life in selected cases.

Önceleri Dev Hücreli Anjiyofibrom olarak da bilinen, yeni sýnýflamayla Dev Hücreden Zengin Soliter Fibröz Tümör olarak adlandýrýlan nadir görülen tümörün daha önce hiç bildirilmemiþ sublingual bölgede saptandýðý ve cerrahi tedavi edildiði bir vaka sunulmuþtur. Sublingual bölgede aðrýsýz yavaþ büyüyen kitleyle baþvuran 49 yaþýnda kadýn hasta cerrahi sonrasý yapýlan patolojik incelemede Dev Hücreli Anjiyofibrom tanýsý almýþtýr. Yapýlan literatür taramasýnda bu bölgede bu tümörün bildirimine rastlanmamýþtýr. WHO tarafýndan yapýlan yeni sýnýflamada önceleri Dev Hücreli Anjiyofibrom olarak isimlendirilen tümörün hem sýnýflamasý hem de isimlendirilmesi deðiþimiþtir. Bu vaka sunumunda da yeni sýnýflama ýþýðýnda literatür taramasý yapýlarak bu nadir tümörün baþ-boyun bölgesindeki yerleþiminin ve klinik seyrinin gözden geçirilmesi amaçlanmýþtýr. (SETB-2019-08-110)

We present a case of Giant Cell-Rich Solitary Fibrous Tumor also known as Giant cell angiofibroma, occuring in sublingual region, to our knowledge, which has never been reported before. Forty-nine years old female who presented with painless, slowly growing mass in the sublingual region underwent excisional surgery and was diagnosed with giant cell-rich solitary fibrous tumor previously referred to as giant cell angiofibroma. In our report, we aimed to report the unusual localization of this rare tumor, examine the new nomenclature and classification of giant cell-rich solitary sibrous tumor or giant cell angiofibroma and review the literature regarding head and neck localization of this tumor.