Objective: Infection with Brucella Agglutinatis is a common problem in Eastern region of Turkey. For this reason nearly all patients admitting to our hospital with complaint of fever are searched for Brucella infection. We moved from this point and investigated monthly distribution of Brucella Wright agglutination test positivity in our hospital. Methods: For this purpose we restrospectively searched Wright agglutination test results of the patients admitted to different clinics of our hospital during period of 2006 and 2009. Results greater than 1/160 were considered as positive. Z test was used to investigate the statistical difference between Brucella sero positivity and gender and age groups of patients and monthly distribution. Results: We found 1102 (5%) positive results in 21887 tests. Of the 1102 patients 776 (70%) were adults and 326 (30%) were children. Positivity in adult population and children population were similar and there was no differance for gender of the patients. When we looked at the relation with test positivity and monthly distribution, positive results were gradually increasing from March and making a peak at August and then gradually decreasing from October. A statistically significant relation was found between positive results and the months August and Semptember. Conclusion: Brucella infection is still a public health problem in our region. The increase in positive results during summer period should be associated with consumption of dairy products made from uncooked milk. This relation can be used as an additive factor to prevent Brucella infections.

Aim: There are three methods for the diagnosis of cerebral aneurysms, including magnetic resonance angiography (MRA), digital substracting angiography (DSA), and three-dimensional computed tomographic angiography (CTA). We tried to understand advantages and disadvantages of CTA in a comparison with DSA in the present study. Material and methods: The study was performed in the Neurosurgery Department of the Mustafa Kemal University on cases with subarachnoid hemorrhage during 2011 and 2012. Computed tomography examinations were performed without administration of any contrast agent. Results: Fourty cases were included into the study. CTA at first and then DSA were performed in all cases in the first three days. Aneurysm could be detected in 30 cases (75.0%) with ranges of 3x2 and 7x11 mm in sizes. Discussion: DSA is accepted as the gold standard method for the diagnosis and evaluation of intracranial aneurysms. However, it is an expensive and time-consuming method, and it has a low risk of complications. Conclusion: According to our results, although CTA has some disadvantages, it is as effective as DSA for the diagnosis of intracranial aneurysms.

Objectives: Treatment results of 23 femoral neck fractures treated with minimal incision and proximal femoral nail (PFN) between 2009-2012 in our clinic were evaluated. Materials and Methods: The data of the patients with the diagnosis of femoral neck fracture and treated using PFN in our hospital were analyzed retrospectively between March 2009-September 2012 on the basis of avascular necrosis, pseudoarthrosis and displacement rates by age. Results: Our patients, 13 male and 10 female and the mean age was 35.6. A large part of the fracture occurred as a result of high-energy trauma (69%). According to classification of Garden, 6 patients were classified as type II, 8 patients type III and 9 patients type IV. Patients were operated within an average of 2 days, all of them were treated using blade lag screw proximal femoral nail. Mean follow-up time was 14 months with a range of 8-22 months. During follow-up, avascular necrosis developed in 3 patients (13%), nonunion developed in 4 patients (17%), and 16 patients recovered uneventfully. Conclusion: Owing to these results, we believe that proximal femoral nail lag screw technique is confidential in carefully selected group of patients with femoral neck fractures.

Aim: In current study, we assessed 52 foot of 32 congenital talipes equinovarus (TEV) patients whom we treated with Ponseti method at Orthopaedics and Traumatology department of Yüzüncü Yil University Medical Faculty between 2005-2008. Before treatment and at the last examination, evaluation has been executed with classification of Dimeglio. Material and Method: Eight casts have been used for patient’s foot on avarage (between 6-10). On 42 foot, achilles tenotomy with mini open technique has been applied under operation conditions with local anaesthesia. After removing the cast, Steenback orthosis was used for each foot. The average follow-up time was 36 months (between 6-59 months). Results: The most observed complication diagnosed at congenital TEV patients was metatarsus adductus (44%). There was metatarsus adductus in 3 of 17 patients who had compliance with orthesis (17%) and 9 of 10 patients who had non-compliance with orthesis (90%). Although all patients had complex TEV, the compliance to orthesis was perfect, recurrence was viewed in all of them, so we needed more treating procedures for these patients. Conclusion: In our study, we achieved 78% success rate with cast treatment and manipulation applied by Ponseti technique in the treatment of congenital TEV patients. Compliance of orthesis possibly affects on the result of the treatment. The rate of correction by Ponseti method at complex TEV patients was 100%, but nevertheless recurrence was viewed during long-lasting follow-up period for all patients.

Aim: Infections of intensive care units are the most important cause of mortality in intensive care. In our study; we investigated causes of mortality in intensive care patients who died between January and June 2013. Material and Methods: We reviewed the records of intensive care patients retrospectively between 1 January 2013 and 30 June2013. Age, gender, reasons of the first acceptance to the intensive care unit, staying days in intensive care, mortality reasons, the bacteries isolated from who died of ventilator associated pneumonia (VAP), and chest X-rays were evaluated. Results: We investigated 38 patients who died in intensive care unit between January 2013- June 2013. Of these patients, 14 patients (37%) were ventilator-associated pneumonia, 9 patients (24%) cerebrovascular accident, 6 patients (16%) heart failure, 2 patients (5%) massive pulmonary embolism, 2 patients (5%) malignancy, 1 patients (2.5%) gastric cancer and pneumonia, 1 patient (2.5%) died due to hepatic encephalopathy. 2 patients (5%) the exact cause of mortality could not be determined. One patient (2.5%) was transferred to organ transplantation due to diagnosis of brain death. All of the patients who died due to VAP were hospitalized for more than 7 days (mean 16.5 days). The number of hospitalized patients for more than 7 days was 24. Mortality rate was 58% in these patients by VAP. Patients numbers were 16 who stayed more than 10 days. Mortality rate by VAP was 75% who sated for more than 10 days. Conclusion: Nowadays, infections of intensive care units are still the most important cause of mortality in intensive care. To prevent infections in intensive care is far more important than cure.

Aim: To examine the differences in patients with different levels of pain during transrectal ultrasound guided biopsy (TRUS-bx) of prostate, and to evaluate the effectiveness of digital rectal examination (DRE) staging. Methods: Between April 2012 and 2013, patients who underwent DRE staging and TRUS-bx due to suspicion of prostate cancer were retrospectively evaluated. All patients were categorized into two groups according to visual analog scale (VAS) (median = 4) (Group 1: < 4; Group 2: ?4). Parameters regarding the relationship between groups were compared and investigated for the correlations. Results: The mean age of 65.74 ± 7.5 (47-84) total 77 TRUS-bx patients were studied. 31 and 46 patients were included in Group 1 and 2, respectively. A correlation was found between VAS and prostate volume and DRE staging (p=0.019, p=0.002, respectively), but when the VAS groups were compared, there was only significant difference in DRE staging (p=0.038). Accoding to DRE staging, in group 2, patients were 58.3%, 62% and 88.9% in stage I, stage II and in stage III, respectively. Conclusion: There was a relation between VAS and DRE staging. Independent of the size of the prostate, patients with increased DRE stage may experience more pain during TRUS-bx.

We aimed to share our difficult airway management experience in a 70 year-old female patient who was operated three times for revision surgery. She was agnatic due to old operations and her ASA score was III and Mallampati score was 4.

Nausea and vomiting in the first half of pregnancy is very common and often need supportive treatment. In this case report we aimed to present candida esophagitis in an immunocompetent pregnant woman. Because of refractory nausea and vomiting not responding to supportive treatment, upper gastrointestinal endoscopy was performed and was diagnosed with candida esophagitis. Investigations of underlying immunodeficiency was performed. Human immundefiency virus (HIV) antibody were negative. T-cell subset were within normal range. Oral nystatin treatment was started. The esophagitis resolved completely when reassessed on fifth day of nystatin treatment. At the end of the treatment her symptoms disappeared. In conclusion, pregnant patients who don’t respond to symptomatic treatment for refractory nausea, vomiting and weight loss should be evaluated by endoscopy for candida esophagitis. It can be treated easily with nystatin.

Vasospasm following aneurysmal subarachnoid hemorrhage is the cause of morbidity and mortality in approximately 30% of patients. We try to describe delayed ischemic neurological deficit (DIND) and the role of diffusion-weighted magnetic resonance imaging (MRI) study in detection of early ischemia caused by vasospasm. There are many techniques which offer some data regarding cerebral blood flow in the setting of DIND. Diffusion-weighted MRI is one of the major tools to identify early ischemia. We present a 73 year old patient who suffered from aneurysmal subarachnoid hemorrhage (SAH) who had a therapy of endovascular aneurysm repair due to anterior communicating artery (ACA) aneurysm. Seven days after endovascular therapy neurological level of the patient depressed. Diffusion-weighted MRI showed multiple focal ischemia in both middle cerebral artery (MCA) feeding areas. The patient was followed with computed tomography (CT). Seven days after MRI, CT showed infarction in the feeding area of ACA. Cerebral infarction occured in a different area from expected. In this report possible causes of the unexpected infarction was discussed. Although a few cases of reversible diffusion-weighted MRI-identified lesions have been described in the literature, the occurrence of changing lesions in the middle cerebral artery to anterior cominicating artery is exceedingly rare.

Complete atrio-ventricular block can be seen in the course of ST elevation myocardial infarction (STEMI). Although some drugs given in the treatment of STEMI can cause bradyarrhtymia, there is no information about meperidine causing complete atrio-ventricular block. In this report, we present a patient with non- ST elevation myocardial infarction (NSTEMI) in whom complete atrio-ventricular block developed after administration of meperidine.

On the transthoracic echocardiography of patient, who admitted to our emergency clinic with chest pain and was established non-ST elavation myocardial infarction, had critical lesion at the circumflex artery after obtuse marginal branch and was performed sucsessfull percutaneous transluminal balloon angioplasty and stenting, was detected a hyper-echoic mass on the left ventricula. At first glance, it appeared to be a tumor or thrombus but it was concluded that the mass which appeared just above the chordate structures and continued on the hypertrophied papillary muscles was compatible with calcification when carefully looked at. This was reported since although it is primarily associated with several diseases, foremost hypertrophic cardiomyopathy, in this case it was seen as isolated, and therefore, was considered a different entity.

Gastric diverticula are extremely rare conditions and are usually detected incidentally during upper endoscopic examination. These can sometimes be diagnosed on barium study of upper gastrointestinal tract. Gastric diverticula are almost always located on the posteromedial wall of the fundus and are commonly asymptomatic. Rarely, abdominal dyscomfort and pain may be presented. Gastric corpus and antrum are unexpected localizations for gastric diverticula. Herein we report two different cases with gastric diverticula of gastric corpus and antrum.

Motor neuron disorder (MND) is a progressive motor neuron degenerative disorder that can be fatal. We report a 41 year-old male initially presenting with left upper limb weakness and thenar-hypothenar atrophy. The neurological examination revealed weakness of distal and proximal upper limb muscles (4/5 and +4/5, respectively). The electromyography detected an axonal degeneration and spontaneous activity findings. The cervical magnetic resonance imaging was within normal limits. In case of asymmetric and progressive involvement of one limb in young patients group, MND should be considered in the differential diagnosis as well as cervical discopathy.

It is reported that parapneumonic pleural effusion may occur as a complication in approximately half of patients with community-acquired pneumoniae and about 20% of the cases can change into empyema. Studies have shown that culture-positive pleural empyema is most commonly due to aerobic microorganisms but 15% of the cases are caused by anaerobic factors. In this study, a case report of 11-year-old male patient with parapneumonic pleural empyema caused by Peptostreptococcus magnus is discussed.

Upper urinary tract urothelial tumors can rarely develop during the long term follow up after radical cystectomy in bladder cancer patients. Early cystectomy should be considered as one of the treatment options on T1G3 tumors because of their aggressive nature. In this study, we present a case who underwent early cystectomy because of T1G3 urothelial cancer and developed a pelvis renalis tumor 10 years after radical cystectomy.

Congenital hypothyroidism is an endocrine disorder that causes large changes in the normal physiology. Preoperative recognition is important for the safety of anesthesia. In the present study, the management of anesthesia has been discussed in a 17 years old female patient with congenital hypothyroidism and developmental retardation who was operated due to neck mass and respiratory distress.

Brucellosis is an important infectious disease seen as endemic in our country. It is transmitted from animals to humans and concerning multisystem with the symptoms such as fever, weakness, fatigue, flu¬like finding, joint, muscle and back pain, and headache. In this case, a 15 years old a girl, being followed-up with epilepsy, was referred with headache that was turned out to be brucellosis at the end of investigation while antiepileptic drugs were gradually discontinued. We present this case to accentuate that Brucellosis should be taken into consideration in case of an epileptic patient comes across with headache.

A 22-year-old, gravida 2, parity 2 woman being married for 2 years delivered her both babies in our clinic by cesarean section. In her first pregnancy, a 2000 gr., vertex presentation female baby with Pierre Robin Syndrome was delivered by cesarean section at the 32nd week of gestation with the indications of ablatio placenta and preterm labor. Her Apgar scores were 5 and 9 at first and fifth minutes. She died 24 hours after delivery while being followed at the neonatal intensive care unit. The patient delivered a 1700 gr. female baby in her second cesarean section performed with the indications of preterm labor, breech presentation and fetal distress. The baby was diagnosed as Pierre Robin Syndrome and lived only 9 hours at the neonatal intensive care unit conditions. This case is reported since recurrent Pierre Robin Syndrome is very rare in the literature.

Although basic principals of some physiological and anatomical differences associated with childhood are same as adults, children with traumatic injury should be evaluated separately than adults. In this study our purpose was to evaluate childhood traumas and determine the differences between management with the knowledge of the literature.

Coronary artery bypass grafting surgery is the preferred treatment for unprotected left main coronary artery stenosis. With the advent of drug-eluting stents, percutaneous approach have been reported to be associated with low rates of complications, in low-risk patient population. Moreover, percutaneous intervention in a patient population necessitating revascularisation but not suitable for surgery have been supported by American College of Cardiology/American Heart Association 2009 guidelines. As the mortality rate is similar to surgery in high-risk patients, we postulate that this approach can be an alternative treatment for such patients.

Asthma is a chronic inflammatory disease characterized by increased airway sensitivity to different stimuli, and reversible airway obstruction. Physical examination of children thought to be asthma; cyanosis, tachycardia, increased air trapping in the lungs, the use of accessory respiratory muscles, intercostal / suprasternal / subcostal retractions, slurred speech in terms of such findings must be reviewed carefully. Asthma is one of the most common childhood diseases and has a significant impact on the daily lives of children. In these patients exercise, on the one hand by provoking increased airway resistance may be caused by bronchospasm, on the other hand participation in regular physical activity and sports activities, aerobic capacity, body composition, flexibility, muscle strength and makes a positive impact on the general health status with psychological status. In this review, exercise is emphasized in children with asthma.

Echinococcosis is a common parasitic disease manifesting as a cyst formation in humans and animals, caused by the platyhelmint Echinococcus and it is an important health problem in our country and our region. Echinococcosis remains an endemic surgical problem in countries where sheep and cattle raising is carried out. This disease has been known since the time of Galen and Hippocrates. Although the cysts can be observed in any localization, the most common affected organs are liver and lungs. Clinical findings are associated with localization and size of the cysts. Radiological findings in pulmonary disease are determined mainly by the presence or absence of complications, particularly rupture and super-infection. Surgical excision of pulmonary hydatidosis with maximum preservation of lung parenchyma is the main stay of treatment.

Fertilization, a complex sequence of interactions between the spermatozoon and the egg, is a highly complicated process. These events start with the release of a mature egg from the follicle, continue with the appearance of the two pronuclei after sperm entry, and are completed with the first mitotic divisions. This process, required for permanence of speciation in humans and all animals, has always attracted the attention of scientists. In our study we aimed to compile which signaling networks took place in each stage of fertilization and the mechanism of the actions happened at molecular level during the fertilizations in the light of literature information.

Hair is one of the characteristic features of people that is defined as a collection of hair in the scalp. Hair is not a vital function for the people but is important for sexual and social communication. Management of genetic baldness in men is tolerated but reduces the quality of life in women. There are many causes of diffuse hair loss. Telogen effluvium is one of the most common causes of diffuse hair loss. A number of methods are developed in the diagnosis of hair loss. In this review, the most common causes of hair loss in women with diffuse hair loss, and the methods used in the diagnosis are described.